WorldWideScience

Sample records for general improvement district

  1. ARSENIC REMOVAL FROM DRINKING WATER BY ADSORPTIVE MEDIA. U.S. EPA DEMONSTRATION PROJECT AT SOUTH TRUCKEE MEADOWS GENERAL IMPROVEMENT DISTRICT (STMIG), NV. INTERIM EVALUATION REPORT

    Science.gov (United States)

    This report documents the activities performed during and the results obtained from the first 32 weeks of operation of an arsenic and antimony removal technology currently being demonstrated at the South Truckee Meadows General Improvement District (STMGID) in Washoe County, NV. ...

  2. Improving district heating in Kiev

    International Nuclear Information System (INIS)

    Salminen, P.

    2000-01-01

    The district heating modernisation project currently under way in Kiev, the capital of the Ukraine, is the largest project of its type financed by the World Bank. The budget for the five-year project is some USD 250 million of which USD 200 million is financed by the World Bank loan. The target of the project is to improve the city's district heating system, which is owned and operated by Kyivenergo. Consultancy services for the Project Implementation Unit are being provided by Electrowatt-Ekono and financed by the Finnish government

  3. Arsenic and Antimony Removal from Drinking Water by Adsorptive Media - U.S. EPA Demonstration Project at South Truckee Meadows General Improvement District (STMGID), NV, Final Performance Evaluation Report

    Science.gov (United States)

    This report documents the activities performed during and the results obtained from the operation of an arsenic and antimony removal technology demonstrated at the South Truckee Meadows General Improvement District (STMGID) in Washoe County, NV. The objectives of the project wer...

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

    International Nuclear Information System (INIS)

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

    2010-01-01

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

  5. Manganese Exposure in the General Population in a Mining District ...

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

    Manganese Exposure in the General Population in a Mining District (Mexico) ... in a population living close to a mine and mineral processing plant in Mexico ... Call for proposals: Innovations for the economic inclusion of marginalized youth.

  6. A Longitudinal Study of School Districts' Sustained Improvement

    Science.gov (United States)

    Sampson, Pauline M.

    2011-01-01

    In this longitudinal study of one region in the state of Texas, there was an examination of district leadership and the sustaining of high student achievement for their districts. The results of this study suggest that sustained improvement of student achievement is very difficult. The districts that had sustained improvement had stable district…

  7. Carotid Surgery in a District General Hospital

    Science.gov (United States)

    Fairgrieve, John

    1981-01-01

    The carotid surgical experience of Cheltenham General Hospital over a 13 year period (1968-81) is presented. This includes 42 operations for stenosis, and 12 further operations for carotid body tumour, carotid aneurysm, subclavian steal syndrome and trauma to the internal carotid artery. The operative techniques and complications are briefly discussed and reasons advanced for a more agressive approach to the problems of extra-cerebral carotid disease in this country. PMID:7185417

  8. General oilfield driver improvement

    International Nuclear Information System (INIS)

    Johnson, G.

    1997-01-01

    The general oilfield driver improvement (GODI) course was discussed. The course is offered to truckers in the oil and gas industry to help reduce accidents and injuries. Oilfield trucking is one of the most accident and injury prone sectors in the Alberta economy. This paper presented Heck's Trucking company's experience in sending its employees on the course. Drivers were taught (1) the National safety code requirements, (2) Commercial Vehicle Safety Alliance requirements, (3) occupational health and safety concerns, (4) vehicle dimension and GVW restrictions, (5) hours of service regulations, (6) log book and pre-trip inspection requirements, (7) workplace hazardous material information, and (8) transportation of dangerous goods. Overall, the course was judged to provide excellent training before sending drivers into the field. The employee, the customer, and the company, all stand to benefit from having rigorous and uniform standards for all drivers in the oil and gas industry

  9. District-Wide Involvement: The Key to Successful School Improvement.

    Science.gov (United States)

    Mundell, Scott; Babich, George

    1989-01-01

    Describes the self-study process used by the Marana Unified School District to meet accreditation requirements with minimal expense, to emphasize curriculum development, and to improve the school. Considers the key feature of the cyclical review model to be the personal involvement of nearly every faculty member in the 10-school district. (DMM)

  10. Achieving Competitive Advantage in Human Resource Management in General School District of Riyadh in Saudi Arabia

    Science.gov (United States)

    Al dakeel, Taghreed M.; Almannie, Mohamed A.

    2015-01-01

    The general school district of Riyadh is one of largest in the country of (45) school districts in Saudi Arabia. The school districts play an important roles in the development of education, therefore the objective of the study is to examine the roles of the management in the school districts to see if it is achieving competitive advantage. After…

  11. Iowa House of Representatives District Boundaries for 2013 - 2022_85th - 89th General Assemblies

    Data.gov (United States)

    Iowa State University GIS Support and Research Facility — Iowa Legislative House district boundaries, enacted April 19, 2011, effective beginning with the elections in 2012 for the 85th General Assembly. The districts will...

  12. Continuous Improvement in Schools and Districts: Policy Considerations

    Science.gov (United States)

    Best, Jane; Dunlap, Allison

    2014-01-01

    Discussions about improving public education often focus on outcomes without considering how schools and districts can accomplish those outcomes. Research shows that using a continuous improvement process has proven successful in healthcare, manufacturing, and technology, and may hold potential for use in education as well. This brief defines and…

  13. DRUG MANAGEMENT REVIEWS IN DISTRICT DRUG MANAGEMENT UNIT AND GENERAL HOSPITAL

    Directory of Open Access Journals (Sweden)

    Max Joseph Herman

    2009-12-01

    Full Text Available Drug is one of the essential elements in healthcare that should be effectively and efficiently managed. Following thedecentralization in 2001 in Indonesia, drug management has changed in district drug management units and also in District General Hospitals. Certainly this condition influences the sustainability of drug access in primary health care such as in Community Health Center and District General Hospital, especially in drug financing policy. A cross sectional descriptive study to obtain information on drug management in public healthcare in district had been carried out between July and December 2006 in 10 District Public Drug Management Units from 10 district health offices and 9 district general hospitals as samples. Data were collected by interviewing heads of Drug Section in District Health Offices and heads of Hospital Pharmacies using structured questionnaires and observing drug storage in District Drug Management Units, Community Health Centers, and Hospital Pharmacies. Results of the study show that drug planning in District Health Offices and General Hospitals did not meet the basic real need in some districts nor District Hospitals. The minimum health service standards had no been achieved yet. Furthermore, drug procurement, storage and recording as well as reporting was not good enough either, such as shown by the existence of expired drugs. Lead time for drug delivery to community health centers in some districts was longer than the average of lead time in the past 3 years.

  14. Istra district heating system. General technical report. Appendix 1 to the master plan

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2001-09-01

    The objective of the master plan project is to improve the heat supply in Istra. The considerable system losses from the fuel supplied to the end-users are one issue for improvement. At the same time, the current system operation results in poor quality heat for the consumers. Due to the inflexibility of the system the dwellings/premises of the consumers are either overheated or insufficiently heated. The financial situation in Istra, the legal ownership of the district heating system and consumers' lacking ability to pay limit the possibilities for system improvements. The Master Plan and Feasibility Study evaluates four different development scenarios. Each of the scenarios is compared to the current situation in Istra, where nothing is done to change the system, but only to operate the present system in a sustainable way. The sustainable operation of the district heating system includes all necessary renovations and component replacements necessary. The project does not take into account the present financial situation in Istra, which has resulted in less maintenance than necessary. This situation is not a comparable parameter, as it is not sustainable and will lead to a breakdown of the heat supply within a short time horizon. The General Technical Report evaluates the technical situation and describes system improvements at a general level. The intention with this report is to provide important information useful to other district heating companies in Russia. (au)

  15. Management of perforated peptic ulcer in a district general hospital.

    Science.gov (United States)

    Critchley, A C; Phillips, A W; Bawa, S M; Gallagher, P V

    2011-11-01

    Laparoscopic surgery has become increasingly popular for elective surgery but it has gained slow transference to emergency surgery. The management of perforated peptic ulcers (PPU) laparoscopically is an accepted strategy yet it still remains infrequently used. The purpose of this study was to analyse the utility and outcomes of laparoscopy versus open repair for PPU in a district general hospital. In addition, we evaluated whether the subspecialty of the on-call consultant affected the method of repair performed and the training opportunities for trainee surgeons. Between 2003 and 2009, 53 patients underwent laparoscopic repair, 89 patients underwent open repair and a further 20 patients had laparoscopic repair that was converted to open repair for PPU. The results from a prospectively compiled database were analysed with primary outcome measures including operative time, length of hospital stay and mortality. The median operating time in the laparoscopic group was 60.0 minutes compared with 50.5 minutes in the open group. Hospital stay in surviving patients was significantly shorter in patients treated completely laparoscopically (5 days) when compared with the open group (6 days) ( p management of PPU. Our findings support the view that this procedure can be successfully used as a training operation.

  16. Challenges Encountered by Connecticut Partner School Districts when Implementing Legislatively Required District Improvement Plans: An Exploratory Study

    Science.gov (United States)

    Martins, Meghan G.

    2010-01-01

    This research developed a survey that measures the degree to which challenges are experienced by school and district leaders, and teachers, when attempting to implement legislatively required District Improvement Plans (DIPs). The data indicate that there are certainly challenges when implementing DIPs and that teachers report experiencing a…

  17. Collaborative School Improvement: Eight Practices for District-School Partnerships to Transform Teaching and Learning

    Science.gov (United States)

    Kaufman, Trent E.; Grimm, Emily Dolci; Miller, Allison E.

    2012-01-01

    How can districts bring instructional improvement to scale within and across schools? The authors of "Collaborative School Improvement" argue that districts can play a powerful part in helping schools build the capacity to engage in inquiry-based reform--but that this effort requires a shift in districts' traditional role as a professional…

  18. Can sonographers offer an accurate upper abdominal ultrasound service in a district general hospital?

    International Nuclear Information System (INIS)

    Dongola, N.A.; Guy, R.L.; Giles, J.A.; Ward, S.

    2003-01-01

    Purpose: This study was performed to evaluate the accuracy of upper abdominal ultrasound (US) scanning performed by sonographers in a district general hospital, to identify potential areas of weakness and to make recommendations to improve the service. Materials and methods: Upper abdominal US examinations performed and reported by sonographers over a 4-week period were retrospectively reviewed. The accuracy of the imaging findings and reports were assessed against other imaging, surgical, histological or laboratory findings and against clinical outcome. Results: A heterogenous group of 104 patients were included in the study, 62 of whom had an US abnormality. Errors of scanning or interpretation were identified in 10 patients (9.6%) of whom five (4.8%) were felt to be potentially significant. Conclusions: The sonographers' accuracy in reporting upper abdominal US scans was 90%. However, on the basis of this study we have implemented specific recommendations to improve the quality of the service

  19. School Climate Improvement Action Guide for District Leaders. 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 key action steps that district leaders--including superintendents, assistant superintendents, directors of student support services, or others--can take to support school climate improvements. Key action steps are provided for…

  20. District Finds the Right Equation to Improve Math Instruction

    Science.gov (United States)

    Holmstrom, Annette

    2010-01-01

    The math problem is common to most U.S. school districts, and education leaders are well aware that U.S. math achievement lags far behind many other countries in the world. University Place (Washington) School District Superintendent Patti Banks found the conspicuous income gap for math scores even more disturbing. In her school district, only 23%…

  1. General practitioners' and district nurses' conceptions of the encounter with obese patients in primary health care

    Directory of Open Access Journals (Sweden)

    Rasmussen Finn

    2011-02-01

    Full Text Available Abstract Background Primary health care specialists have a key role in the management of obesity. Through understanding how they conceive the encounter with patients with obesity, treatment may be improved. The aim of this study was thus to explore general practitioners' and district nurses' conceptions of encountering patients with obesity in primary health care. Method Data were collected through semi-structured interviews, and analysed using a phenomenographic approach. The participants were 10 general practitioners (6 women, 4 men and 10 district nurses (7 women, 3 men from 19 primary health care centres within a well-defined area of Sweden. Results Five descriptive categories were identified: Adequate primary health care, Promoting lifestyle change, Need for competency, Adherence to new habits and Understanding patient attitudes. All participants, independent of gender and profession, were represented in the descriptive categories. Some profession and gender differences were, however, found in the underlying conceptions. The general staff view was that obesity had to be prioritised. However, there was also the contradictory view that obesity is not a disease and therefore not the responsibility of primary health care. Despite this, staff conceived it as important that patients were met with respect and that individual solutions were provided which could be adhered to step-by-step by the patient. Patient attitudes, such as motivation to change, evasive behaviour, too much trust in care and lack of self-confidence, were, however, conceived as major barriers to a fruitful encounter. Conclusions Findings from this study indicate that there is a need for development and organisation of weight management in primary health care. Raising awareness of staff's negative views of patient attitudes is important since it is likely that it affects the patient-staff relationship and staff's treatment efforts. More research is also needed on gender and

  2. Improving the Small Rural or Remote School: The Role of the District

    Science.gov (United States)

    Clarke, Simon; Wildy, Helen

    2011-01-01

    There is a robust body of work highlighting distinctive challenges encountered by leaders of small schools in pursuit of school improvement but this work has focused on the school as the unit of change and neglects the role of the district. As the district potentially influences what principals know and how they use their knowledge, this article…

  3. Improving paediatric and neonatal care in rural district hospitals in the highlands of Papua New Guinea: a quality improvement approach.

    Science.gov (United States)

    Sa'avu, Martin; Duke, Trevor; Matai, Sens

    2014-05-01

    In developing countries such as Papua New Guinea (PNG), district hospitals play a vital role in clinical care, training health-care workers, implementing immunization and other public health programmes and providing necessary data on disease burdens and outcomes. Pneumonia and neonatal conditions are a major cause of child admission and death in hospitals throughout PNG. Oxygen therapy is an essential component of the management of pneumonia and neonatal conditions, but facilities for oxygen and care of the sick newborn are often inadequate, especially in district hospitals. Improving this area may be a vehicle for improving overall quality of care. A qualitative study of five rural district hospitals in the highlands provinces of Papua New Guinea was undertaken. A structured survey instrument was used by a paediatrician and a biomedical technician to assess the quality of paediatric care, the case-mix and outcomes, resources for delivery of good-quality care for children with pneumonia and neonatal illnesses, existing oxygen systems and equipment, drugs and consumables, infection-control facilities and the reliability of the electricity supply to each hospital. A floor plan was drawn up for the installation of the oxygen concentrators and a plan for improving care of sick neonates, and a process of addressing other priorities was begun. In remote parts of PNG, many district hospitals are run by under-resourced non-government organizations. Most hospitals had general wards in which both adults and children were managed together. Paediatric case-loads ranged between 232 and 840 patients per year with overall case-fatality rates (CFR) of 3-6% and up to 15% among sick neonates. Pneumonia accounts for 28-37% of admissions with a CFR of up to 8%. There were no supervisory visits by paediatricians, and little or no continuing professional development of staff. Essential drugs were mostly available, but basic equipment for the care of sick neonates was often absent or

  4. Bully Proofing: What One District Learned about Improving School Climate.

    Science.gov (United States)

    Berkey, Leonard G.; Keyes, Barbara J.; Longhurst, James E.

    2001-01-01

    Collaborating with school officials, a group of concerned parents implemented a bully-proofing program throughout their school district. After two years, the results are encouraging; it was received with enthusiasm at the elementary level. Further study will be needed to determine how these principles might be applied at the secondary level. (MKA)

  5. STUDIES OF ADVERSE DRUG REACTION PROFILE OF ANTISNAKE VENOM AT DISTRICT GENERAL HOSPITAL

    OpenAIRE

    Mulchand Shende *, Sneha Gawali , Kanchan Bhongade , Vivek Bhuskade , Abhijit Nandgaonkar

    2017-01-01

    Snake bite is a common predominant problem of the rural and periurban areas, neglected and frequently devastating environmental and occupational disease, especially in rural areas of tropical developing countries. This study aimed to investigate of the adverse drug reaction profile of anti-snake venom (ASV) in a district general hospital. An observational study was conducted in hospital for six months. A total number of 142 indoor case papers of snake bite from October 2016 to April 2017 were...

  6. Trees of Electoral District in Indonesian Legislative Election: Empirical Case of Assortments in 2004 General Election

    OpenAIRE

    Situngkir, Hokky; Mauludy, Rolan

    2007-01-01

    The short paper presents interesting discussions related to specific Indonesian legislative election system. We build algorithmic steps in computational geometry that employ the basic patterns that emerged from the legal decisions of Indonesian General Election Commission about the election district. Some interesting facts are observed and tried to be analyzed and concerning them to the democratization processes in the country. The further implementation of the model can be utilized as a tool...

  7. Improving child survival through a district management strengthening and community empowerment intervention: early implementation experiences from Uganda.

    Science.gov (United States)

    Katahoire, Anne Ruhweza; Henriksson, Dorcus Kiwanuka; Ssegujja, Eric; Waiswa, Peter; Ayebare, Florence; Bagenda, Danstan; Mbonye, Anthony K; Peterson, Stefan Swartling

    2015-08-19

    The Community and District Empowerment for Scale-up (CODES) project pioneered the implementation of a comprehensive district management and community empowerment intervention in five districts in Uganda. In order to improve effective coverage and quality of child survival interventions CODES combines UNICEF tools designed to systematize priority setting, allocation of resources and problem solving with Community dialogues based on Citizen Report Cards and U-Reports used to engage and empower communities in monitoring health service provision and to demand for quality services. This paper presents early implementation experiences in five pilot districts and lessons learnt during the first 2 years of implementation. This qualitative study was comprised of 38 in-depth interviews with members of the District Health Teams (DHTs) and two implementing partners. These were supplemented by observations during implementation and documents review. Thematic analysis was used to distill early implementation experiences and lessons learnt from the process. All five districts health teams with support from the implementing partners were able to adopt the UNICEF tools and to develop district health operational work plans that were evidence-based. Members of the DHTs described the approach introduced by the CODES project as a more systematic planning process and very much appreciated it. Districts were also able to implement some of the priority activities included in their work plans but limited financial resources and fiscal decision space constrained the implementation of some activities that were prioritized. Community dialogues based on Citizen Report Cards (CRC) increased community awareness of available health care services, their utilization and led to discussions on service delivery, barriers to service utilization and processes for improvement. Community dialogues were also instrumental in bringing together service users, providers and leaders to discuss problems and

  8. 75 FR 15453 - Central Valley Project Improvement Act, Westlands Water District Drainage Repayment Contract

    Science.gov (United States)

    2010-03-29

    ... DEPARTMENT OF THE INTERIOR Bureau of Reclamation Central Valley Project Improvement Act, Westlands Water District Drainage Repayment Contract AGENCY: Bureau of Reclamation, Interior. ACTION: Notice of Proposed Repayment Contract. SUMMARY: The Bureau of Reclamation will be initiating negotiations with the...

  9. The Business Improvement District Movement: Contributions to Public Administration and Management by Seth A. Grossman

    Directory of Open Access Journals (Sweden)

    Stephen Kleinschmit

    2016-11-01

    Full Text Available Grossman, S. (2016. The Business Improvement District Movement: Contributions to Public Administration and Management. New York, NY: Routledge. $49.95 (paperback, ISBN: 978-1-1386-6889-8.

  10. Webinar: Healthy Schools, Healthy Students: Taking Action to Improve IAQ in Your School District

    Science.gov (United States)

    A page to register to view the first webinar in the IAQ Knowledge-to-Action Professional Training Webinar Series: Healthy Schools, Healthy Students: Taking Action to Improve IAQ in Your School District

  11. Present Situation and Problems of Land Improvement District as an Operation and Maintenance Organization of Land Improvement Facilities

    OpenAIRE

    長堀, 金造; 赤江, 剛夫; 大田, 征六

    1994-01-01

    Land improvement districts originally started as organizations after World War II: They are in charge of construction and operation of irrigation and drainage facilities, Development of agricultural land, reclamation from sea water, reclamation by filling, Recovery from disaster, exchange and consolidation of agricultural land and so on. As the Main construction projects were completed, the purpose of land improvement districts Has shifted from facilities construction to operation and mainten...

  12. Are area-based initiatives able to improve area safety in deprived areas? A quasi-experimental evaluation of the Dutch District Approach.

    Science.gov (United States)

    Kramer, Daniëlle; Jongeneel-Grimen, Birthe; Stronks, Karien; Droomers, Mariël; Kunst, Anton E

    2015-07-28

    Numerous area-based initiatives have been implemented in deprived areas across Western-Europe with the aim to improve the socio-economic and environmental conditions in these areas. Only few of these initiatives have been scientifically evaluated for their impact on key social determinants of health, like perceived area safety. Therefore, this study aimed to assess the impact of a Dutch area-based initiative called the District Approach on trends in perceived area safety and underlying problems in deprived target districts. A quasi-experimental design was used. Repeated cross-sectional data on perceived area safety and underlying problems were obtained from the National Safety Monitor (2005-2008) and its successor the Integrated Safety Monitor (2008-2011). Study population consisted of 133,522 Dutch adults, including 3,595 adults from target districts. Multilevel logistic regression analyses were performed to assess trends in self-reported general safety, physical order, social order, and non-victimization before and after the start of the District Approach mid-2008. Trends in target districts were compared with trends in various control groups. Residents of target districts felt less safe, perceived less physical and social order, and were victimized more often than adults elsewhere in the Netherlands. For non-victimization, target districts showed a somewhat more positive change in trend after the start of the District Approach than the rest of the Netherlands or other deprived districts. Differences were only statistically significant in women, older adults, and lower educated adults. For general safety, physical order, and social order, there were no differences in trend change between target districts and control groups. Results suggest that the District Approach has been unable to improve perceptions of area safety and disorder in deprived areas, but that it did result in declining victimization rates.

  13. Lessons Learned: A Strategic Alliance to Improve Elementary Physical Education in an Urban School District.

    Science.gov (United States)

    Thompson, Hannah R; Haguewood, Robin; Tantoco, Nicole; Madsen, Kristine A

    2015-01-01

    Physical education (PE) can help to achieve important public health goals, but is often under-prioritized and lacking in schools. To detail the actions, impact, and successes of a strategic alliance formed by three collaborating organizations to improve PE in a large California school district. Semistructured interviews with alliance members, principals, and teachers in 20 elementary schools, 3 years after the alliance formation. Interviewees reported district-level increases in priority and funding for PE and attributed improvements to the alliance's collection and dissemination of local data on the status of PE. Common goals, trust, and open communication within the alliance were seen as critical to the alliance's success. However, changes in district- or school-level accountability measures for PE were not reported. This strategic alliance succeeded in promoting district-level priority and funding for PE. Ongoing alliance work will focus on increasing accountability measures for PE, which may take longer to implement.

  14. A Systems Theory Approach to the District Central Office's Role in School-Level Improvement

    Science.gov (United States)

    Mania-Singer, Jackie

    2017-01-01

    This qualitative case study used General Systems Theory and social network analysis to explore the relationships between the members of a district central office and principals of elementary schools within an urban school district in the Midwest. Findings revealed sparse relationships between members of the district central office and principals,…

  15. Prioritizing quality improvement in general surgery.

    Science.gov (United States)

    Schilling, Peter L; Dimick, Justin B; Birkmeyer, John D

    2008-11-01

    Despite growing interest in quality improvement, uncertainty remains about which procedures offer the most room for improvement in general surgery. In this context, we sought to describe the relative contribution of different procedures to overall morbidity, mortality, and excess length of stay in general surgery. Using data from the American College of Surgeons' National Surgery Quality Improvement Program (ACS-NSQIP), we identified all patients undergoing a general surgery procedure in 2005 and 2006 (n=129,233). Patients were placed in 36 distinct procedure groups based on Current Procedural Terminology codes. We first examined procedure groups according to their relative contribution to overall morbidity and mortality. We then assessed procedure groups according to their contribution to overall excess length of stay. Ten procedure groups alone accounted for 62% of complications and 54% of excess hospital days. Colectomy accounted for the greatest share of adverse events, followed by small intestine resection, inpatient cholecystectomy, and ventral hernia repair. In contrast, several common procedures contributed little to overall morbidity and mortality. For example, outpatient cholecystectomy, breast procedures, thyroidectomy, parathyroidectomy, and outpatient inguinal hernia repair together accounted for 34% of procedures, but only 6% of complications (and only 4% of major complications). These same procedures accounted for surgery. Focusing quality improvement efforts on these procedures may be an effective strategy for improving patient care and reducing cost.

  16. Improving urban district heating systems and assessing the efficiency of the energy usage therein

    Science.gov (United States)

    Orlov, M. E.; Sharapov, V. I.

    2017-11-01

    The report describes issues in connection with improving urban district heating systems from combined heat power plants (CHPs), to propose the ways for improving the reliability and the efficiency of the energy usage (often referred to as “energy efficiency”) in such systems. The main direction of such urban district heating systems improvement suggests transition to combined heating systems that include structural elements of both centralized and decentralized systems. Such systems provide the basic part of thermal power via highly efficient methods for extracting thermal power plants turbines steam, while peak loads are covered by decentralized peak thermal power sources to be mounted at consumers’ locations, with the peak sources being also reserve thermal power sources. The methodology was developed for assessing energy efficiency of the combined district heating systems, implemented as a computer software product capable of comparatively calculating saving on reference fuel for the system.

  17. Decimated Input Ensembles for Improved Generalization

    Science.gov (United States)

    Tumer, Kagan; Oza, Nikunj C.; Norvig, Peter (Technical Monitor)

    1999-01-01

    Recently, many researchers have demonstrated that using classifier ensembles (e.g., averaging the outputs of multiple classifiers before reaching a classification decision) leads to improved performance for many difficult generalization problems. However, in many domains there are serious impediments to such "turnkey" classification accuracy improvements. Most notable among these is the deleterious effect of highly correlated classifiers on the ensemble performance. One particular solution to this problem is generating "new" training sets by sampling the original one. However, with finite number of patterns, this causes a reduction in the training patterns each classifier sees, often resulting in considerably worsened generalization performance (particularly for high dimensional data domains) for each individual classifier. Generally, this drop in the accuracy of the individual classifier performance more than offsets any potential gains due to combining, unless diversity among classifiers is actively promoted. In this work, we introduce a method that: (1) reduces the correlation among the classifiers; (2) reduces the dimensionality of the data, thus lessening the impact of the 'curse of dimensionality'; and (3) improves the classification performance of the ensemble.

  18. Improving generalized inverted index lock wait times

    Science.gov (United States)

    Borodin, A.; Mirvoda, S.; Porshnev, S.; Ponomareva, O.

    2018-01-01

    Concurrent operations on tree like data structures is a cornerstone of any database system. Concurrent operations intended for improving read\\write performance and usually implemented via some way of locking. Deadlock-free methods of concurrency control are known as tree locking protocols. These protocols provide basic operations(verbs) and algorithm (ways of operation invocations) for applying it to any tree-like data structure. These algorithms operate on data, managed by storage engine which are very different among RDBMS implementations. In this paper, we discuss tree locking protocol implementation for General inverted index (Gin) applied to multiversion concurrency control (MVCC) storage engine inside PostgreSQL RDBMS. After that we introduce improvements to locking protocol and provide usage statistics about evaluation of our improvement in very high load environment in one of the world’s largest IT company.

  19. Emergency general surgery in Rwandan district hospitals: a cross-sectional study of spectrum, management, and patient outcomes.

    Science.gov (United States)

    Mpirimbanyi, Christophe; Nyirimodoka, Alexandre; Lin, Yihan; Hedt-Gauthier, Bethany L; Odhiambo, Jackline; Nkurunziza, Theoneste; Havens, Joaquim M; Omondi, Jack; Rwamasirabo, Emile; Ntirenganya, Faustin; Toma, Gabriel; Mubiligi, Joel; Bayitondere, Scheilla; Riviello, Robert

    2017-12-01

    Management of emergency general surgical conditions remains a challenge in rural sub-Saharan Africa due to issues such as insufficient human capacity and infrastructure. This study describes the burden of emergency general surgical conditions and the ability to provide care for these conditions at three rural district hospitals in Rwanda. This retrospective cross-sectional study included all patients presenting to Butaro, Kirehe and Rwinkwavu District Hospitals between January 1st 2015 and December 31st 2015 with emergency general surgical conditions, defined as non-traumatic, non-obstetric acute care surgical conditions. We describe patient demographics, clinical characteristics, management and outcomes. In 2015, 356 patients presented with emergency general surgical conditions. The majority were male (57.2%) and adults aged 15-60 years (54.5%). The most common diagnostic group was soft tissue infections (71.6%), followed by acute abdominal conditions (14.3%). The median length of symptoms prior to diagnosis differed significantly by diagnosis type (p operated on at the district hospital, either by a general surgeon or general practitioner. Patients were more likely to receive surgery if they presented to a hospital with a general surgeon compared to a hospital with only general practitioners (75% vs 43%, p operation in a hospital with a general surgeon as opposed to a general practitioner. This provides evidence to support increasing the surgical workforce in district hospitals in order to increase surgical availability for patients.

  20. District heating development, air quality improvement, and cogeneration in Krakow, Poland

    International Nuclear Information System (INIS)

    Manczyk, H.; Leach, M.D.

    1992-01-01

    Krakow, Poland, is served by a district heating system that includes coal-fired electrical and heating plants and distribution networks and by approximately 200,000 residential coal furnaces. Cogeneration facilities were added in the mid-1970s to supply up to 40% of the regional peak electrical demand and to optimize energy extraction from the low-heating-value coal mined in the region. Several difficulties prevent the district from realizing the potential efficiencies of its technology: the poor condition of the distribution network, the lack of consumption control and metering devices, inadequate plant maintenance, and the lack of economic incentives for operator productivity and energy conservation by users. Environmental concerns have caused the local government and international agencies to plan major improvements to the system. This paper discusses the development of the district heating system, coal use in Poland, cogeneration facilities, environmental concerns and pollution control plans, and improvement strategies

  1. Improving quality of reproductive health care in Senegal through formative supervision: results from four districts.

    Science.gov (United States)

    Suh, Siri; Moreira, Philippe; Ly, Moussa

    2007-11-29

    In Senegal, traditional supervision often focuses more on collection of service statistics than on evaluation of service quality. This approach yields limited information on quality of care and does little to improve providers' competence. In response to this challenge, Management Sciences for Health (MSH) has implemented a program of formative supervision. This multifaceted, problem-solving approach collects data on quality of care, improves technical competence, and engages the community in improving reproductive health care. This study evaluated changes in service quality and community involvement after two rounds of supervision in 45 health facilities in four districts of Senegal. We used checklists to assess quality in four areas of service delivery: infrastructure, staff and services management, record-keeping, and technical competence. We also measured community involvement in improving service quality using the completion rates of action plans. The most notable improvement across regions was in infection prevention.Management of staff, services, and logistics also consistently improved across the four districts. Record-keeping skills showed variable but lower improvement by region. The completion rates of action plans suggest that communities are engaged in improving service quality in all four districts. Formative supervision can improve the quality of reproductive health services, especially in areas where there is on-site skill building and refresher training. This approach can also mobilize communities to participate in improving service quality.

  2. Improving quality of reproductive health care in Senegal through formative supervision: results from four districts

    Directory of Open Access Journals (Sweden)

    Moreira Philippe

    2007-11-01

    Full Text Available Abstract Background In Senegal, traditional supervision often focuses more on collection of service statistics than on evaluation of service quality. This approach yields limited information on quality of care and does little to improve providers' competence. In response to this challenge, Management Sciences for Health (MSH has implemented a program of formative supervision. This multifaceted, problem-solving approach collects data on quality of care, improves technical competence, and engages the community in improving reproductive health care. Methods This study evaluated changes in service quality and community involvement after two rounds of supervision in 45 health facilities in four districts of Senegal. We used checklists to assess quality in four areas of service delivery: infrastructure, staff and services management, record-keeping, and technical competence. We also measured community involvement in improving service quality using the completion rates of action plans. Results The most notable improvement across regions was in infection prevention. Management of staff, services, and logistics also consistently improved across the four districts. Record-keeping skills showed variable but lower improvement by region. The completion rates of action plans suggest that communities are engaged in improving service quality in all four districts. Conclusion Formative supervision can improve the quality of reproductive health services, especially in areas where there is on-site skill building and refresher training. This approach can also mobilize communities to participate in improving service quality.

  3. Quality Improvement: Appropriate episiotomies in a district hospital ...

    African Journals Online (AJOL)

    A multidisciplinary team did a quality improvement project to reduce the number of episiotomies. The results of the project were positive: the episiotomy rate decreased from 66,2% to 25,3% and the episiotomy dehiscence rate dropped from 2.28% to 0.7%. This had a positive impact also on patient satisfaction and staff ...

  4. Piracetam improves children's memory after general anaesthesia.

    Science.gov (United States)

    Fesenko, Ułbołgan A

    2009-01-01

    Surgery and anaesthesia may account for postoperative complications including cognitive impairment. The purpose of the study was to assess the influence of general anaesthetics on children's memory and effectiveness of piracetam for prevention of postoperative cognitive dysfunction. The study included patients receiving different kinds of anaesthesia for various surgical procedures, randomly allocated to two groups. According to immediate postoperative treatment, the study group received intravenous piracetam 30 mg kg(-1) and the control group--placebo. The cognitive functions were examined preoperatively and within 10 consecutive postoperative days using the ten-word memory test. The study group consisted of 123 children, the control one--of 127. Declines in memory indexes were observed in all anaesthetized patients. The most injured function was long-term memory. The intravenous administration of piracetam improved this cognitive function. The study results confirm that general anaesthesia affects the memory function in children. Piracetam is effective for prevention of postoperative cognitive dysfunction after anaesthesia.

  5. Can action research strengthen district health management and improve health workforce performance? A research protocol.

    Science.gov (United States)

    Mshelia, C; Huss, R; Mirzoev, T; Elsey, H; Baine, S O; Aikins, M; Kamuzora, P; Bosch-Capblanch, X; Raven, J; Wyss, K; Green, A; Martineau, T

    2013-08-30

    The single biggest barrier for countries in sub-Saharan Africa (SSA) to scale up the necessary health services for addressing the three health-related Millennium Development Goals and achieving Universal Health Coverage is the lack of an adequate and well-performing health workforce. This deficit needs to be addressed both by training more new health personnel and by improving the performance of the existing and future health workforce. However, efforts have mostly been focused on training new staff and less on improving the performance of the existing health workforce. The purpose of this paper is to disseminate the protocol for the PERFORM project and reflect on the key challenges encountered during the development of this methodology and how they are being overcome. The overall aim of the PERFORM project is to identify ways of strengthening district management in order to address health workforce inadequacies by improving health workforce performance in SSA. The study will take place in three districts each in Ghana, Tanzania and Uganda using an action research approach. With the support of the country research teams, the district health management teams (DHMTs) will lead on planning, implementation, observation, reflection and redefinition of the activities in the study. Taking into account the national and local human resource (HR) and health systems (HS) policies and practices already in place, 'bundles' of HR/HS strategies that are feasible within the context and affordable within the districts' budget will be developed by the DHMTs to strengthen priority areas of health workforce performance. A comparative analysis of the findings from the three districts in each country will add new knowledge on the effects of these HR/HS bundles on DHMT management and workforce performance and the impact of an action research approach on improving the effectiveness of the DHMTs in implementing these interventions. Different challenges were faced during the development of

  6. Improving district level health planning and priority setting in Tanzania through implementing accountability for reasonableness framework

    DEFF Research Database (Denmark)

    Maluka, Stephen; Kamuzora, Peter; Sebastián, Miguel San

    2010-01-01

    In 2006, researchers and decision-makers launched a five-year project - Response to Accountable Priority Setting for Trust in Health Systems (REACT) - to improve planning and priority-setting through implementing the Accountability for Reasonableness framework in Mbarali District, Tanzania...

  7. Review of paediatric cardiology services in district general hospitals in the United Kingdom.

    Science.gov (United States)

    Andrews, Hannah; Singh, Yogen

    2016-03-01

    Following the Safe and Sustainable review of Paediatric Services in 2012/2013, National Health Service England recommended that local paediatric cardiology services should be provided by specially trained paediatricians with expertise in cardiology in all non-specialist hospitals. To understand the variation in local paediatric cardiology services provided across district general hospitals in the United Kingdom. An internet-based questionnaire was sent out via the Paediatrician with Expertise in Cardiology Special Interest Group and the Neonatologists with Interest in Cardiology and Haemodynamics contact databases and the National Health Service directory. Non-responders were followed-up via telephone. The response rate was 80% (141 of 177 hospitals), and paediatricians with expertise in cardiology were available in 68% of those. Local cardiology clinics led by paediatricians with expertise in cardiology were provided in 96 hospitals (68%), whereas specialist outreach clinics were held in 123 centres (87%). A total of 11 hospitals provided neither specialist outreach clinics nor any local cardiology clinics led by paediatricians with expertise in cardiology. Paediatric echocardiography services were provided in 83% of the hospitals, 12-lead electrocardiogram in 96%, Holter electrocardiogram in 91%, and exercise testing in only 47% of the responding hospitals. Telemedicine facilities were established in only 52% of the centres, where sharing echocardiogram images via picture archiving and communication system was used most commonly. There has been a substantial increase in the availability of paediatricians with expertise in cardiology since 2008. Most of the hospitals are well-supported by specialist cardiology centres via outreach clinics; however, there remains significant variation in the local paediatric cardiology services provided across district general hospitals in the United Kingdom.

  8. Measuring and improving productivity in general radiology.

    Science.gov (United States)

    Wilt, Michelle A; Miranda, Rafael; Johnson, C Daniel; Love, Peggy Sue

    2010-10-01

    The aim of this study was to determine a method of measuring productivity among general radiographers in a moderate-sized hospital and to improve and sustain productivity within that work area. The average times needed to perform the 13 most common examinations were measured. Performance of the various examinations was tracked and multiplied by the time allocated per procedure; this measure was divided by the length of the work shift to determine productivity. Productivity measures were shared among the work group, and decisions to improve productivity (eg, whether to fill open positions) were made by group members. Average time spent per examination type was calculated (range, 10 minutes to 1 hour 16 minutes). At baseline (February 2008), group productivity was 50%. Productivity increased during the first year of monitoring and was sustained through November 2009 (productivity range, 57%-63%). Yearly savings from not filling open positions were estimated to be $174,000. Productivity in a general radiology work area can be measured. Consensus among the work group helped increase productivity and assess progress. This methodology, if widely adopted, could be standardized and used to compare productivity across departments and institutions. Copyright © 2010 American College of Radiology. Published by Elsevier Inc. All rights reserved.

  9. Integration of leprosy services into the General Health Service in Sri Lanka: overcoming challenges to implementation in a remote district.

    Science.gov (United States)

    Wijesinghe, Thushanthi S; Wijesinghe, Pushpa Ranjan

    2013-01-01

    Sri Lanka took a policy decision to integrate leprosy services into the general health services (GHS) in 1999. This paper aims to summarize the emergence of new, specific challenges and how they were overcome during the integration of leprosy services to the GHS in a remote, leprosy endemic district in Sri Lanka. In this article, the regional epidemiologist as the team leader describes the principles used for transition to an effective integrated model of leprosy services from a centralized leprosy control model in the district. In addition, rationale for integration is viewed from the epidemiological and operational perspectives. National and district leprosy epidemiological data from secondary sources are also reviewed for corroborating the effectiveness of integration. Challenges surfaced were mainly related to the transfer of ownership of the programme, selection of appropriate service providing institutions easily accessible to clients, sustainability of leprosy services at the GHS, ensuring participation of all stakeholders in capacity building programmes and co-ordination of patient care in the absence of a dermatologist in the district. An empowered district team leader with specified roles and responsibilities, his sound technical and managerial know how and ability to translate 'team work' concept to practice were found to be essential for successful implementation of integration. Decision-making powers at the district level and flexibility to introduce new, area-specific changes to the centrally prepared core activities of integration were also vital to overcome locally surfaced challenges.

  10. Dysphagia referrals to a district general hospital gastroenterology unit: hard to swallow.

    Science.gov (United States)

    Melleney, Elizabeth Mary-Ann; Subhani, Javaid Mohammed; Willoughby, Charles Peter

    2004-01-01

    The aim of our study was to audit dysphagia referrals received by a specialist gastroenterology unit during an entire year. We used a prospective audit carried out over a 12-month period at the District General Hospital gastroenterology unit. The audit included 396 consecutive patients who were referred with swallowing difficulties. We found that 60 referrals (15.2%) were inaccurate and the patients had no swallowing problem. Of the 336 patients with genuine dysphagia, only 29 (8.6%) were new cancer cases. The large majority of subjects had benign disease mostly related to acid reflux. Weight loss was significantly associated with malignancy but also occurred in one third of patients with reflux alone. The temporal pattern of dysphagia was not significantly predictive of cancer. All the cancer patients were above the age of 50 years. Although patients were in general assessed rapidly after hospital referral, the productivity, in terms of early tumor diagnosis, was extremely low. We conclude that there is a substantial rate of inaccurate referrals of dysphagia patients. Most true cases of swallowing difficulty relate to benign disease. Even the devotion of considerable resources to the early diagnosis of esophago gastric malignancy in an attempt to conform with best practice guidelines results in a very low success rate in terms of the detection of potentially curable tumors.

  11. Upper gastrointestinal endoscopy in patients aged 85 years or more. Results of a feasibility study in a district general hospital.

    NARCIS (Netherlands)

    Kouwen, M.C.A. van; Drenth, J.P.H.; Verhoeven, H.M.; Bos, L.P.; Engels, L.G.

    2003-01-01

    We performed a cross sectional analysis of the feasibility and yield of upper gastrointestinal endoscopy (UGE) in a cohort of patients aged 85 years or more. The study involved 218 patients who underwent diagnostic upper gastrointestinal endoscopy in a district general hospital between 1994 and

  12. VOLUNTEERING TO BE TAXED: BUSINESS IMPROVEMENT DISTRICTS AND THE EXTRA-GOVERNMENTAL PROVISION OF PUBLIC SAFETY

    OpenAIRE

    Leah Brooks

    2006-01-01

    When the median voter's preference sets the level of local public goods, some voters are left unsatisfied. Is there an institution by which subsets of voters can resolve the collective action problem and increase the local provision of public goods? If so, what are the consequences? In response to problems such as crime and vandalism, neighborhood property owners have established Business Improvement Districts (BIDs) to provide local public goods. When a BID is approved by a majority of prope...

  13. Deficiencies in provision of integrated multidisciplinary podiatry care for patients with inflammatory arthritis: a UK district general hospital experience.

    Science.gov (United States)

    Juarez, M; Price, E; Collins, D; Williamson, L

    2010-01-01

    Foot problems are highly prevalent in inflammatory arthritis (IA), especially rheumatoid arthritis (RA). Chronic inflammation can lead to permanent structural changes, deformity and disability. Early podiatry intervention in RA improves long term outcomes. National guidelines recommend that patients should be treated by a multidisciplinary team with dedicated podiatry services. In clinical practice funding constraints limit availability of these services. To assess prevalence of foot problems and quality and availability of foot care services at a UK district general hospital. 1200 IA patients in Swindon (Wiltshire, UK) were invited to complete an anonymised questionnaire regarding access to foot care services and education/information on foot problems. 448 patients. Prevalence of foot problems: 68%. Only 31% of patients had access to appropriate foot specialist. 24% had received foot assessment within 3 months of diagnosis of IA and 17% yearly review thereafter. Despite high prevalence of foot problems in our population we identified significant deficiencies in provision of integrated multidisciplinary podiatry care. The data we present could be used by others to support business cases to obtain funding to improve the links between rheumatology and podiatry services. Copyright 2010 Elsevier Ltd. All rights reserved.

  14. Management of spontaneous pneumothorax compared to British Thoracic Society (BTS) 2003 guidelines: a district general hospital audit.

    Science.gov (United States)

    Medford, Andrew Rl; Pepperell, Justin Ct

    2007-10-01

    In 1993, the British Thoracic Society (BTS) issued guidelines for the management of spontaneous pneumothorax (SP). These were refined in 2003. To determine adherence to the 2003 BTS SP guidelines in a district general hospital. An initial retrospective audit of 52 episodes of acute SP was performed. Subsequent intervention involved a junior doctor educational update on both the 2003 BTS guidelines and the initial audit results, and the setting up of an online guideline hyperlink. After the educational intervention a further prospective re-audit of 28 SP episodes was performed. Management of SP deviated considerably from the 2003 BTS guidelines in the initial audit - deviation rate 26.9%. After the intervention, a number of clinical management deviations persisted (32.1% deviation rate); these included failure to insert a chest drain despite unsuccessful aspiration, and attempting aspiration of symptomatic secondary SPs. Specific tools to improve standards might include a pneumothorax proforma to improve record keeping and a pneumothorax care pathway to reduce management deviations compared to BTS guidelines. Successful change also requires identification of the total target audience for any educational intervention.

  15. Can a District-Level Teacher Salary Incentive Policy Improve Teacher Recruitment and Retention? Policy Brief 13-4

    Science.gov (United States)

    Hough, Heather J.; Loeb, Susanna

    2013-01-01

    In this policy brief, Heather Hough and Susanna Loeb examine the effect of the Quality Teacher and Education Act of 2008 (QTEA) on teacher recruitment, retention, and overall teacher quality in the San Francisco Unified School District (SFUSD). They provide evidence that a salary increase can improve a school district's attractiveness within their…

  16. School District Leadership Styles and School Improvement: Evidence from Selected School Principals in the Eastern Cape Province

    Science.gov (United States)

    Moorosi, Pontso; Bantwini, Bongani D.

    2016-01-01

    The purpose of this study was to investigate how leadership styles in the Eastern Cape school districts support school improvement. Mixed methods research was employed and data was collected through the use of questionnaires and semi-structured interviews with school principals in various districts. The study was guided by the following questions:…

  17. Air source absorption heat pump in district heating: Applicability analysis and improvement options

    International Nuclear Information System (INIS)

    Wu, Wei; Shi, Wenxing; Li, Xianting; Wang, Baolong

    2015-01-01

    Highlights: • Applicability of air source absorption heat pump (ASAHP) district heating is studied. • Return temperature and energy saving rate (ESR) in various conditions are optimized. • ASAHP is more suitable for shorter distance or lower temperature district heating. • Two options can reduce the primary return temperature and improve the applicability. • The maximum ESR is improved from 13.6% to 20.4–25.6% by compression-assisted ASAHP. - Abstract: The low-temperature district heating system based on the air source absorption heat pump (ASAHP) was assessed to have great energy saving potential. However, this system may require smaller temperature drop leading to higher pump consumption for long-distance distribution. Therefore, the applicability of ASAHP-based district heating system is analyzed for different primary return temperatures, pipeline distances, pipeline resistances, supplied water temperatures, application regions, and working fluids. The energy saving rate (ESR) under different conditions are calculated, considering both the ASAHP efficiency and the distribution consumption. Results show that ASAHP system is more suitable for short-distance district heating, while for longer-distance heating, lower supplied hot water temperature is preferred. In addition, the advantages of NH 3 /H 2 O are inferior to those of NH 3 /LiNO 3 , and the advantages for warmer regions and lower pipeline resistance are more obvious. The primary return temperatures are optimized to obtain maximum ESRs, after which the suitable distances under different acceptable ESRs are summarized. To improve the applicability of ASAHP, the integration of cascaded heat exchanger (CHX) and compression-assisted ASAHP (CASAHP) are proposed, which can reduce the primary return temperature. The integration of CHX can effectively improve the applicability of ASAHP under higher supplied water temperatures. As for the utilization of CASAHP, higher compression ratio (CR) is better in

  18. Generalized network improvement and packing problems

    CERN Document Server

    Holzhauser, Michael

    2016-01-01

    Michael Holzhauser discusses generalizations of well-known network flow and packing problems by additional or modified side constraints. By exploiting the inherent connection between the two problem classes, the author investigates the complexity and approximability of several novel network flow and packing problems and presents combinatorial solution and approximation algorithms. Contents Fractional Packing and Parametric Search Frameworks Budget-Constrained Minimum Cost Flows: The Continuous Case Budget-Constrained Minimum Cost Flows: The Discrete Case Generalized Processing Networks Convex Generalized Flows Target Groups Researchers and students in the fields of mathematics, computer science, and economics Practitioners in operations research and logistics The Author Dr. Michael Holzhauser studied computer science at the University of Kaiserslautern and is now a research fellow in the Optimization Research Group at the Department of Mathematics of the University of Kaiserslautern.

  19. Pregnancy outcomes of women with HIV in a district general hospital in the UK.

    Science.gov (United States)

    Carey, L; Desouza, C; Moorcroft, A; Elgalib, A

    2018-03-12

    The aim of this study was to describe the obstetrical and virological outcomes in HIV-infected pregnant women who delivered at a district general hospital in south London in the period from 2008 to 2014. Our review identified 137 pregnancies; most (60%, 63/105) of them were unplanned. The commonest mode of delivery was spontaneous vaginal delivery (SVD) (42%, 48/114) followed by emergency Caesarean section (32%, 36/114). Gestational age at delivery was ≥37 weeks in most (84%, 91/106) of the cases. Maternal HIV VL at or closest to delivery was undetectable (1000 copies/mL in 73% (94/129), 90% (116/129) and 6% (8/129) of the pregnancies, respectively. None of the infants were infected with HIV making the rate of MTCT of HIV 0% (zero). Our study shows that favourable virological and obstetrical outcomes of HIV-infected pregnant women are achievable in non-tertiary HIV treatment centres. Impact Statement What is already known on this subject: Prevention of mother-to-child transmission (MTCT) of HIV has been one of the major public health successes in the last decades. This success was evident by the reduction of MTCT of HIV in the UK from 25.6% in the 1993 to only 0.46% in 2011. Furthermore, many reports from individual providers, mainly from tertiary centres, of HIV care in the UK also showed very low rates MTCT of HIV. What the results of this study add: Our study shows that favourable virological and obstetrical outcomes of HIV-infected pregnant women are achievable in non-tertiary HIV treatment centres. The MTCT of HIV rate in our hospital was zero in the period from 2008 to 2014. What the implications are of these findings for clinical practice and/or further research: Staff caring for pregnant HIV positive women in general hospitals and small-to-medium HIV clinics should liaise closely with each other and utilise the skill-mix within their hospital in order to provide a quality care that is similar to what is achieved in large teaching centres; however, a

  20. General Equilibrium Models: Improving the Microeconomics Classroom

    Science.gov (United States)

    Nicholson, Walter; Westhoff, Frank

    2009-01-01

    General equilibrium models now play important roles in many fields of economics including tax policy, environmental regulation, international trade, and economic development. The intermediate microeconomics classroom has not kept pace with these trends, however. Microeconomics textbooks primarily focus on the insights that can be drawn from the…

  1. What do District Health Planners in Tanzania think about improving priority setting using 'Accountability for Reasonableness'?

    Directory of Open Access Journals (Sweden)

    Olsen Oystein

    2007-11-01

    Full Text Available Abstract Background Priority setting in every health system is complex and difficult. In less wealthy countries the dominant approach to priority setting has been Burden of Disease (BOD and cost-effectiveness analysis (CEA, which is helpful, but insufficient because it focuses on a narrow range of values – need and efficiency – and not the full range of relevant values, including legitimacy and fairness. 'Accountability for reasonableness' is a conceptual framework for legitimate and fair priority setting and is empirically based and ethically justified. It connects priority setting to broader, more fundamental, democratic deliberative processes that have an impact on social justice and equity. Can 'accountability for reasonableness' be helpful for improving priority setting in less wealthy countries? Methods In 2005, Tanzanian scholars from the Primary Health Care Institute (PHCI conducted 6 capacity building workshops with senior health staff, district planners and managers, and representatives of the Tanzanian Ministry of Health to discussion improving priority setting in Tanzania using 'accountability for reasonableness'. The purpose of this paper is to describe this initiative and the participants' views about the approach. Results The approach to improving priority setting using 'accountability for reasonableness' was viewed by district decision makers with enthusiastic favour because it was the first framework that directly addressed their priority setting concerns. High level Ministry of Health participants were also very supportive of the approach. Conclusion Both Tanzanian district and governmental health planners viewed the 'accountability for reasonableness' approach with enthusiastic favour because it was the first framework that directly addressed their concerns.

  2. Summary of hydrologic conditions in the Reedy Creek Improvement District, central Florida

    Science.gov (United States)

    German, Edward R.

    1986-01-01

    The Reedy Creek Improvement is an area of about 43 square miles in southwestern Orange and northwestern Osceola Counties, Florida. A systematic program of hydrologic data collection in the Reedy Creek Improvement District and vicinity provided data for assessing the impact of development, mostly the Walt Disney World Theme Park and related development on the hydrology. Data collected include stream discharge, water quality, groundwater levels, lakes levels, and climatological. Rainfall has been less than the long-term average in the Reedy Creek Improvement District since development began in 1968. The deficient rainfall has reduced stream discharge, lowered groundwater and lake levels, and possibly affected water quality in the area. Groundwater levels and lake levels have declined since 1970. However, the coincidence of below-average rainfall with the period of development makes it impossible to assess the effect of pumping on declines. Occurrence of toxic metals does not relate to development, but distribution of insecticides and herbicides does appear to relate to development. Specific conductance, phosphorous, and nitrate concentrations have increased in Reedy Creek since 1970, probably due to disposal of treated wastes. (USGS)

  3. Improving drug treatment in general practice

    NARCIS (Netherlands)

    Veninga, CCM; Denig, P; Zwaagstra, R; Haaijer-Ruskamp, FM

    In the international Drug Education Project, an educational program involving auditing and feedback in peer groups to improve the treatment of asthma and urinary tract infections (UTI) was developed and tested in primary care. Individualized feedback was provided and discussed in 24 Dutch peer

  4. Building district-level capacity for continuous improvement in maternal and newborn health.

    Science.gov (United States)

    Stover, Kim Ethier; Tesfaye, Solomon; Frew, Aynalem Hailemichael; Mohammed, Hajira; Barry, Danika; Alamineh, Lamesgin; Teshome, Abebe; Hepburn, Kenneth; Sibley, Lynn M

    2014-01-01

    The Maternal and Newborn Health in Ethiopia Partnership (MaNHEP) adapted a collaborative improvement strategy to develop woreda (district) leadership capacity to support and facilitate continuous improvement of community maternal and neonatal health (CMNH) and to provide a model for other woredas, dubbed "lead" woredas. Community-level quality improvement (QI) teams tested solutions to improve CMNH care supported by monthly coaching and regular meetings to share experiences. This study examines the extent of the capacity built to support continuous improvement in CMNH care. Surveys and in-depth interviews assessed the extent to which MaNHEP developed improvement capacity. A survey questionnaire evaluated woreda culture, leadership support, motivation, and capacity for improvement activities. Interviews focused on respondents' understanding and perceived value of the MaNHEP improvement approach. Bivariate analyses and multivariate linear regression models were used to analyze the survey data. Interview transcripts were organized by region, cadre, and key themes. Respondents reported significant positive changes in many areas of woreda culture and leadership, including involving a cross-section of community stakeholders (increased from 3.0 to 4.6 on 5-point Likert scale), using improvement data for decision making (2.8-4.4), using locally developed and tested solutions to improve CMNH care (2.5-4.3), demonstrating a commitment to improve the health of women and newborns (2.6-4.2), and creating a supportive environment for coaches and QI teams to improve CMNH (2.6-4.0). The mean scores for capacity were 3.7 and higher, reflecting respondents' agreement that they had gained capacity in improvement skills. Interview respondents universally recognized the capacity built in the woredas. The themes of community empowerment and focused improvement emerged strongly from the interviews. MaNHEP was able to build capacity for continuous improvement and develop lead woredas. The

  5. Evidence from district level inputs to improve quality of care for maternal and newborn health: interventions and findings.

    Science.gov (United States)

    Salam, Rehana A; Lassi, Zohra S; Das, Jai K; Bhutta, Zulfiqar A

    2014-09-04

    District level healthcare serves as a nexus between community and district level facilities. Inputs at the district level can be broadly divided into governance and accountability mechanisms; leadership and supervision; financial platforms; and information systems. This paper aims to evaluate the effectivness of district level inputs for imporving maternal and newborn health. We considered all available systematic reviews published before May 2013 on the pre-defined district level interventions and included 47 systematic reviews. Evidence suggests that supervision positively influenced provider's practice, knowledge and client/provider satisfaction. Involving local opinion leaders to promote evidence-based practice improved compliance to the desired practice. Audit and feedback mechanisms and tele-medicine were found to be associated with improved immunization rates and mammogram uptake. User-directed financial schemes including maternal vouchers, user fee exemption and community based health insurance showed significant impact on maternal health service utilization with voucher schemes showing the most significant positive impact across all range of outcomes including antenatal care, skilled birth attendant, institutional delivery, complicated delivery and postnatal care. We found insufficient evidence to support or refute the use of electronic health record systems and telemedicine technology to improve maternal and newborn health specific outcomes. There is dearth of evidence on the effectiveness of district level inputs to improve maternal newborn health outcomes. Future studies should evaluate the impact of supervision and monitoring; electronic health record and tele-communication interventions in low-middle-income countries.

  6. Empowering districts to target priorities for improving child health service in Uganda using change management and rapid assessment methods

    Science.gov (United States)

    Odaga, John; Henriksson, Dorcus K.; Nkolo, Charles; Tibeihaho, Hector; Musabe, Richard; Katusiime, Margaret; Sinabulya, Zaccheus; Mucunguzi, Stephen; Mbonye, Anthony K.; Valadez, Joseph J.

    2016-01-01

    Background Local health system managers in low- and middle-income countries have the responsibility to set health priorities and allocate resources accordingly. Although tools exist to aid this process, they are not widely applied for various reasons including non-availability, poor knowledge of the tools, and poor adaptability into the local context. In Uganda, delivery of basic services is devolved to the District Local Governments through the District Health Teams (DHTs). The Community and District Empowerment for Scale-up (CODES) project aims to provide a set of management tools that aid contextualised priority setting, fund allocation, and problem-solving in a systematic way to improve effective coverage and quality of child survival interventions. Design Although the various tools have previously been used at the national level, the project aims to combine them in an integral way for implementation at the district level. These tools include Lot Quality Assurance Sampling (LQAS) surveys to generate local evidence, Bottleneck analysis and Causal analysis as analytical tools, Continuous Quality Improvement, and Community Dialogues based on Citizen Report Cards and U reports. The tools enable identification of gaps, prioritisation of possible solutions, and allocation of resources accordingly. This paper presents some of the tools used by the project in five districts in Uganda during the proof-of-concept phase of the project. Results All five districts were trained and participated in LQAS surveys and readily adopted the tools for priority setting and resource allocation. All districts developed health operational work plans, which were based on the evidence and each of the districts implemented more than three of the priority activities which were included in their work plans. Conclusions In the five districts, the CODES project demonstrated that DHTs can adopt and integrate these tools in the planning process by systematically identifying gaps and setting

  7. Empowering districts to target priorities for improving child health service in Uganda using change management and rapid assessment methods

    Directory of Open Access Journals (Sweden)

    John Odaga

    2016-05-01

    Full Text Available Background: Local health system managers in low- and middle-income countries have the responsibility to set health priorities and allocate resources accordingly. Although tools exist to aid this process, they are not widely applied for various reasons including non-availability, poor knowledge of the tools, and poor adaptability into the local context. In Uganda, delivery of basic services is devolved to the District Local Governments through the District Health Teams (DHTs. The Community and District Empowerment for Scale-up (CODES project aims to provide a set of management tools that aid contextualised priority setting, fund allocation, and problem-solving in a systematic way to improve effective coverage and quality of child survival interventions. Design: Although the various tools have previously been used at the national level, the project aims to combine them in an integral way for implementation at the district level. These tools include Lot Quality Assurance Sampling (LQAS surveys to generate local evidence, Bottleneck analysis and Causal analysis as analytical tools, Continuous Quality Improvement, and Community Dialogues based on Citizen Report Cards and U reports. The tools enable identification of gaps, prioritisation of possible solutions, and allocation of resources accordingly. This paper presents some of the tools used by the project in five districts in Uganda during the proof-of-concept phase of the project. Results: All five districts were trained and participated in LQAS surveys and readily adopted the tools for priority setting and resource allocation. All districts developed health operational work plans, which were based on the evidence and each of the districts implemented more than three of the priority activities which were included in their work plans. Conclusions: In the five districts, the CODES project demonstrated that DHTs can adopt and integrate these tools in the planning process by systematically identifying

  8. Empowering districts to target priorities for improving child health service in Uganda using change management and rapid assessment methods.

    Science.gov (United States)

    Odaga, John; Henriksson, Dorcus K; Nkolo, Charles; Tibeihaho, Hector; Musabe, Richard; Katusiime, Margaret; Sinabulya, Zaccheus; Mucunguzi, Stephen; Mbonye, Anthony K; Valadez, Joseph J

    2016-01-01

    Local health system managers in low- and middle-income countries have the responsibility to set health priorities and allocate resources accordingly. Although tools exist to aid this process, they are not widely applied for various reasons including non-availability, poor knowledge of the tools, and poor adaptability into the local context. In Uganda, delivery of basic services is devolved to the District Local Governments through the District Health Teams (DHTs). The Community and District Empowerment for Scale-up (CODES) project aims to provide a set of management tools that aid contextualised priority setting, fund allocation, and problem-solving in a systematic way to improve effective coverage and quality of child survival interventions. Although the various tools have previously been used at the national level, the project aims to combine them in an integral way for implementation at the district level. These tools include Lot Quality Assurance Sampling (LQAS) surveys to generate local evidence, Bottleneck analysis and Causal analysis as analytical tools, Continuous Quality Improvement, and Community Dialogues based on Citizen Report Cards and U reports. The tools enable identification of gaps, prioritisation of possible solutions, and allocation of resources accordingly. This paper presents some of the tools used by the project in five districts in Uganda during the proof-of-concept phase of the project. All five districts were trained and participated in LQAS surveys and readily adopted the tools for priority setting and resource allocation. All districts developed health operational work plans, which were based on the evidence and each of the districts implemented more than three of the priority activities which were included in their work plans. In the five districts, the CODES project demonstrated that DHTs can adopt and integrate these tools in the planning process by systematically identifying gaps and setting priority interventions for child survival.

  9. An application of data mining in district heating substations for improving energy performance

    Science.gov (United States)

    Xue, Puning; Zhou, Zhigang; Chen, Xin; Liu, Jing

    2017-11-01

    Automatic meter reading system is capable of collecting and storing a huge number of district heating (DH) data. However, the data obtained are rarely fully utilized. Data mining is a promising technology to discover potential interesting knowledge from vast data. This paper applies data mining methods to analyse the massive data for improving energy performance of DH substation. The technical approach contains three steps: data selection, cluster analysis and association rule mining (ARM). Two-heating-season data of a substation are used for case study. Cluster analysis identifies six distinct heating patterns based on the primary heat of the substation. ARM reveals that secondary pressure difference and secondary flow rate have a strong correlation. Using the discovered rules, a fault occurring in remote flow meter installed at secondary network is detected accurately. The application demonstrates that data mining techniques can effectively extrapolate potential useful knowledge to better understand substation operation strategies and improve substation energy performance.

  10. Analysis of Survival Rates Following Primary Surgery of 178 Consecutive Patients with Oral Cancer in a Large District General Hospital.

    Science.gov (United States)

    Stathopoulos, Panagiotis; Smith, William P

    2017-06-01

    The aim of this study is to present the survival rates in patients treated for oral cancer with primary surgery in a large district general hospital. We discuss the influence of the most significant prognostic factors on survival and compare our results with larger centres specializing in the management of oral cancer. All patients diagnosed with oral cancer from 1995 to 2006 and were treated in the Department had their details entered prospectively onto a computerized database. Demographic details of patients, type of treatment, pathological stage of tumor (TNM), local and regional recurrence rate, overall survival, disease specific survival and incidence of involved margins were recorded and calculated. Of the 178 patients, 96 (54 %) were alive and free of oral cancer 5 years after surgery. Forty-four patients died of oral cancer (24.7 %) but 38 (21.3 %) died of other causes. The overall survival rate after primary surgery in relation to stage was: I 84 %, II 71 %, III 36 % and IV 28 %. As almost half of our patients presented with advanced cancer and had discouraging survival rates, we emphasize the need for early recognition of the disease. Advanced disease signifies difficulty in obtaining clear margins which actually indicates a higher recurrence rate. 25 % of our patients died of oral cancer within 5 years of surgery which highlights the poor prognosis that recurrence carries after treatment. Effective educational campaign with purpose to raise oral cancer awareness and earlier referral may result in improvement of survival.

  11. No One Way: Differentiating School District Leadership and Support for School Improvement

    Science.gov (United States)

    Anderson, Stephen E.; Mascall, Blair; Stiegelbauer, Suzanne; Park, Jaddon

    2012-01-01

    This article examines findings from a qualitative investigation of how school district administrators in four mid to large sized urban school districts (10,000-50,000) identify and address differences in school performance. The analysis explores the interaction between district policies and actions that centralize and standardize expectations for…

  12. Energy efficiency improvements utilising mass flow control and a ring topology in a district heating network

    International Nuclear Information System (INIS)

    Laajalehto, Tatu; Kuosa, Maunu; Mäkilä, Tapio; Lampinen, Markku; Lahdelma, Risto

    2014-01-01

    Heating and cooling have a major role in the energy sector, covering 46% of total final energy use worldwide. District heating (DH) is a significant technology for improving the energy efficiency of heating systems in communities, because it enables waste heat sources to be utilised economically and therefore significantly reduces the environmental impacts of power generation. As a result of new and more stringent construction regulations for buildings, the heat demands of individual buildings are decreasing and more energy-efficient heating systems have to be developed. In this study, the energy efficiency of a new DH system which includes both a new control system called mass flow control and a new network design called a ring network is examined. A topology in the Helsinki region is studied by using a commercial DH network modelling tool, Grades Heating. The district heating network is attached to a wood-burning heat station which has a heat recovery system in use. Examination is performed by means of both technical and economic analysis. The new non-linear temperature programme that is required is adopted for supply and return temperatures, which allows greater temperature cooling and smaller flow rates. Lower district heating water temperatures are essential when reducing the heat losses in the network and heat production. Mass flow control allows smaller pressure drops in the network and thus reduces the pumping power. The aim of this study was to determine the most energy-efficient DH water supply temperatures in the case network. If the ring network design is utilised, the district heating system is easier to control. As a result the total heat consumption within the heating season is reduced compared to traditional DH systems. On the basis of the results, the new DH system is significantly more energy-efficient in the case network that was examined than the traditional design. For example, average energy losses within the constraints (which consist of heat

  13. Improving the quality of care for patients with hypertension in Moshupa District, Botswana: Quality improvement cycle

    Directory of Open Access Journals (Sweden)

    Cathy Kande

    2014-01-01

    Full Text Available Background: Although there are no prevalence studies on hypertension in Botswana, this condition is thought to be common and the quality of care to be poor.Aim: The aim of this project was to assess and improve the quality of primary care forhypertension.Setting: Moshupa clinic and catchment area, Botswana.Methods: Quality improvement cycle.Results: Two hundred participants were included in the audit. Sixty-eight per cent were women with a mean age of 55 years. In the baseline audit none of the target standards were met. During the re-audit six months later, six out of nine structural target standards, five out of 11 process target standards and one out of two outcome target standards were achieved. Statistically-significant improvement in performance (p < 0.05 was shown in 10 criteria although the target standard was not always met. In the re-audit, the target of achieving blood pressure control (< 140/90 in 70% of patients was achieved.Conclusion: The quality of care for hypertension was suboptimal in our setting. Simple interventions were designed and implemented to improve the quality of care. These interventions led to significant improvement in structural and process criteria. A corresponding significant improvement in the control of blood pressure was also seen.

  14. Characteristics of patients who are admitted with or acquire Pressure Ulcers in a District General Hospital; a 3 year retrospective analysis

    NARCIS (Netherlands)

    Worsley, P.R.; Smith, G.; Schoonhoven, L.; Bader, D.L.

    2016-01-01

    AIM: The study aimed to characterize demographic and clinical practice factors associated with community (CAPU) and hospital acquired pressure ulcers (HAPU). DESIGN: A comparative retrospective evaluation of pressure ulcer data, collected from a district general hospital. METHODS: Demographic and

  15. Ten thousand steps: a pedometer study of junior dentists in a major British teaching hospital and a district general hospital.

    Science.gov (United States)

    Keat, R M; Thomas, M; McKechnie, A

    2017-05-01

    Sedentary behaviour is widely associated with deleterious health outcomes that in modern medicine have similar connotations to smoking tobacco and alcohol misuse. The integration of e-portfolio, e-logbook, British National Formulary (BNF) and encrypted emails has made smartphones a necessity for trainees. Smartphones also have the ability to record the amount of exercise taken, which allows activity at work to be monitored. The aim of this study to compare the activity of the same group of dental core trainees when they worked within a large multisite teaching hospital and a smaller district general hospital, to find out if supplementary activity was needed outside work. Data were collected from smartphones. To ensure continuity, data were collected only from those who had calibrated iPhones (n=10). At the teaching hospital six of the trainees walked over 10 000 steps a day while working (mean (SD) 10 004 (639)). At the district hospital none of the trainees walked 10 000 steps. The mean (SD) number of steps completed by all trainees was 6265 (119). Walking at work provides the full quota of recommended daily exercise most of the time for those working in the teaching hospital, but additional exercise is occasionally required. While working at the district hospital they walk less, meaning that they should try to increase their activity outside work. Trainees working in the teaching hospital walk significantly more steps than in the district hospital. Copyright © 2016 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

  16. Improving thermal performance of an existing UK district heat network: a case for temperature optimization

    DEFF Research Database (Denmark)

    Tunzi, Michele; Boukhanouf, Rabah; Li, Hongwei

    2018-01-01

    This paper presents results of a research study into improving energy performance of small-scale district heat network through water supply and return temperature optimization technique. The case study involves establishing the baseline heat demand of the estate’s buildings, benchmarking...... the existing heat network operating parameters, and defining the optimum supply and return temperature. A stepwise temperature optimization technique of plate radiators heat emitters was applied to control the buildings indoor thermal comfort using night set back temperature strategy of 21/18 °C....... It was established that the heat network return temperature could be lowered from the current measured average of 55 °C to 35.6 °C, resulting in overall reduction of heat distribution losses and fuel consumption of 10% and 9% respectively. Hence, the study demonstrates the potential of operating existing heat...

  17. Organizing for Improvement in an Urban School District: Shifting From a Culture of Compliance to a Culture of Collective Responsibility

    OpenAIRE

    Kovacic, Kelly Anne

    2015-01-01

    There is high demand for understanding the ways in which a central office can best support school improvement and student growth. This Capstone examines how a cross-functional senior leadership team collaborated to design a district-wide school improvement planning process with the goal of improving the quality of teaching and learning for all students. In particular, the analysis focuses on the functions of teaming and strategic improvement planning as drivers to help an organization achieve...

  18. Structuring diabetes care in general practices: many improvements, remaining challenges.

    LENUS (Irish Health Repository)

    Jennings, S

    2009-08-07

    BACKGROUND: For people with type 2 diabetes to enjoy improved longevity and quality of life, care needs to be organised in a systematic way. AIM: To test if processes and intermediate outcomes for patients with type 2 diabetes changed with the move to structured care in general practice shared with secondary care. METHODS: An audit of process and intermediate outcomes for patients with type 2 diabetes before and after the change to structured care in 10 Dublin general practices shared with secondary care four years on. RESULTS: Structured diabetes care in general practice has led to more dedicated clinics improved processes of care and increased access to multidisciplinary expertise. Improvement in blood pressure control, the use of aspirin and the use of lipid lowering agents indicate a significant decrease in absolute risk of vascular events for this population. CONCLUSIONS: Structured care in general practice improves intermediate outcomes for people with type 2 diabetes. Further improvements need to be made to reach international targets.

  19. Empowerment Of Farmer Group In Improving Chilli Farming Income In Kerinci District, Indonesia

    Directory of Open Access Journals (Sweden)

    Indra Karim

    2013-08-01

    Full Text Available Purpose of the agricultural development is to raise the quality of human resources and the livelihood of farmers and their families. The role of farmer groups are very important in supporting the agricultural intensification program, but their ability to adopt new technologies are still very limited. Base on these facts then problems of this research is role of the chilli farmers group empowerment in improving the farming revenues.The research was carried out in the Air Hangat Timur Subdistrict, Kerinci District, many farmers who insist the chili farming traditionally, they have not implemented the recommended agrotechnologies package. The number of samples as much as two groups of farmers, including 28 farmers from the Pinang-Jaya farmers group and 17 farmers from Usaha-Sepakat farmer groups. To find out the improvement level of farmers ability in improving farmer income, it is conducted the Coefficient Spearman test.The results showed that the ability of chilli agrotechnology implementation is included in the category of “intermediate”. There is a strong relationship between farmer age, educational level, experience farming and the number of family member with the farmer capability in implementing chilli agrotechnologies. Keywords: farmer group, chili farming, farming income

  20. Strengthening health district management competencies in Ghana, Tanzania and Uganda: lessons from using action research to improve health workforce performance.

    Science.gov (United States)

    Martineau, Tim; Raven, Joanna; Aikins, Moses; Alonso-Garbayo, Alvaro; Baine, Sebastian; Huss, Reinhard; Maluka, Stephen; Wyss, Kaspar

    2018-01-01

    To achieve Universal Health Coverage (UHC), more health workers are needed; also critical is supporting optimal performance of existing staff. Integrated human resource management (HRM) strategies, complemented by other health systems strategies, are needed to improve health workforce performance, which is possible at district level in decentralised contexts. To strengthen the capacity of district management teams to develop and implement workplans containing integrated strategies for workforce performance improvement, we introduced an action-research-based management strengthening intervention (MSI). This consisted of two workshops, follow-up by facilitators and meetings between participating districts. Although often used in the health sector, there is little evaluation of this approach in middle-income and low-income country contexts. The MSI was tested in three districts in Ghana, Tanzania and Uganda. This paper reports on the appropriateness of the MSI to the contexts and its effects. Documentary evidence (workshop reports, workplans, diaries, follow-up visit reports) was collected throughout the implementation of the MSI in each district and interviews (50) and focus-group discussions (6) were conducted with managers at the end of the MSI. The findings were analysed using Kirkpatrick's evaluation framework to identify effects at different levels. The MSI was appropriate to the needs and work patterns of District Health Management Teams (DHMTs) in all contexts. DHMT members improved management competencies for problem analysis, prioritisation and integrated HRM and health systems strategy development. They learnt how to refine plans as more information became available and the importance of monitoring implementation. The MSI produced changes in team behaviours and confidence. There were positive results regarding workforce performance or service delivery; these would increase with repetition of the MSI. The MSI is appropriate to the contexts where tested and

  1. Care of "new" long-stay patients in a district general hospital psychiatric unit. The first two years of a hospital-hostel.

    Science.gov (United States)

    Gibbons, J S

    1986-05-01

    The paper describes the need for long-term inpatient care in an English health district whose psychiatric services were based on a unit in a District General Hospital. Patients who became long-stay were placed in a new hospital-hostel in a city centre. Three quarters of those eligible could be managed in the hostel, with those rejected posing more control problems. Patients in the hostel became less withdrawn and increased their activity and use of community facilities.

  2. How primary care reforms influenced health indicators in Manisa district in Turkey: Lessons for general practitioners.

    Science.gov (United States)

    Cevik, Celalettin; Sozmen, Kaan; Kilic, Bulent

    2018-12-01

    Turkish health reforms began in 2003 and brought some significant changes in primary care services. Few studies in Turkey compare the shift from health centres (HC) to family physicians (FP) approach, which was initiated by reforms. This study compares health status indicators during the HC period before reforms (2003-2007) and the FP period after reforms (2008-2012) in Turkey. This study encompasses time series data consisting of the results of a 10-year assessment (2003-2012) in Manisa district. All the data were obtained electronically and by month. The intersection points of the regression curves of these two periods and the beta coefficients were compared using segmented linear regression analysis. The mean number of follow-up per person/year during the HC period in infants (10.5), pregnant women (6.6) and women (1.8) was significantly higher than the mean number of follow-up during the FP period in infants (6.7), pregnant women (5.6) and women (0.9). Rates of BCG and measles vaccinations were significantly higher during the FP period; however, rates of HBV and DPT were same. The mean number of outpatient services per person/year during the FP period (3.3) was significantly higher than HC period (2.8). Within non-communicable diseases, no difference was detected for hypertension prevalence. Within communicable diseases, there was no difference for rabies suspected bites but acute haemorrhagic gastroenteritis significantly decreased. The infant mortality rate and under five-year child mortality rate significantly increased during the FP period. Primary care services should be reorganized and integrated with public health services.

  3. Incidence of trampoline related pediatric fractures in a large district general hospital in the United Kingdom: lessons to be learnt.

    Science.gov (United States)

    Bhangal, K K; Neen, D; Dodds, R

    2006-04-01

    To test the observation that the incidence of trampoline related pediatric fractures is increasing-both nationally and in a large district general hospital. A retrospective analysis was undertaken of patient records establishing mechanism of injury of pediatric fractures over three consecutive summers from 2000-03. Theatre records of fractures treated operatively were used as the initial data source. A statistically significant increase in trampoline related injuries was discovered. This reflects the rising incidence of injuries from national data and furthermore corresponds to the growing popularity of domestic use trampolines in the UK. The incidence of injuries is increasing. There are lessons to be learnt from existing work from countries where trampoline prevalence has been greater for longer. The authors recommend various safety measures that may reduce children's injuries.

  4. Improving disaster risk reduction capacity of District Civil Protection Units in managing veld fires: A case of Mangwe District in Matabeleland South Province, Zimbabwe

    Directory of Open Access Journals (Sweden)

    Ernest Dube

    2015-05-01

    Full Text Available This article analysed disaster risk reduction capacity of District Civil Protection Units (DCPUs in managing veld fires in Mangwe District of Matabeleland South Province, Zimbabwe. Veld fires have resulted in unnecessary material, environmental and economic losses. Communities’ livelihoods and property have been destroyed, and the natural environment depleted. The research sought to improve disaster risk reduction capacity of DCPUs in managing veld fires, through new intervention strategies and a new model. The objectives of the study were to investigate the main causes of veld fires; to analyse their impacts; to examine the effectiveness of the current intervention strategies; and to identify challenges in implementing these interventions. Furthermore, the study sought to recommend new possible intervention strategies. This mainly qualitative study employed self-administered questionnaires, interviews and focus-group discussions. Questionnaires were used to investigate members of the DCPU’s ideas, views and experiences, interviews solicited perceptions of community leaders and their subjects, whilst focus-group discussions assisted with information from members of the District Civil Protection Planning Committee. Veld fires in the district are mainly caused by human activities, and they are prevalent during the months of September and October. They affect livelihoods and the natural environment the most. This study found that DCPUs are not prepared to manage veld fires and therefore recommended new strategies and adoption of the community-based disaster risk reduction model. The new strategies include involving community leaders and members of the communities in DCPUs; regular training and workshops to members of DCPUs on veld fire management; creation of fire protection associations; regular campaigns and rehearsal of emergency drills by the DCPU personnel; the introduction of competitions and incentives in veld fire management; vigorous

  5. Improving Former Shifted Cultivation Land Using Wetland Cultivation in Kapuas District, Central Kalimantan

    Directory of Open Access Journals (Sweden)

    Wahyudi Wahyudi

    2016-06-01

    Full Text Available Degraded forest area in Kalimantan could be caused by shifted cultivation activity that be conducted by local peoples in the surrounding forest areas. Efforts to improve the former shifted cultivation area (non productive land is developing the settled cultivation by use of irrigation system, better paddy seed, land processing, fertilizing, spraying pesticide, weeding, and better acces to the market.  Local peoples, especially in Kalimantan, has been depended their food on the shifted cultivation pattern since the long time ago.  This tradition could cause forest damage, forest fire, forest degradation, deforestation, and lose out of children education because they were following shifted cultivation activity although itsspace is very far from their home.  This research was aimed to improve former shifted cultivation lands using wetland cultivation in order to improve land productivity and to support food securityin the local community. This research was administratively located in Tanjung Rendan Village, Kapuas Hulu Sub-Ddistrict, Kapuas District, Central Kalimantan Province, Indonesia.  Data of rice yield from settled cultivation and shifted cultivation were got from 15 households that was taking by random at 2010 to 2011. Homogeneity test, analysis of variants, and least significant different (LSD test using SPSS 15.0 for Windows. Result of this research showed that     paddy yield at settled cultivation was significantly differentand better than shifted cultivation at 0.05 level. LSD test also indicated that all paddy yields from settled cultivation were significantly different compare to shifted cultivation at the 0.05 level.  The community in Tanjung Rendan Villages preferred settled cultivation than shifted cultivation, especially due to higher paddy production. Profit for settled cultivation was IDR10.95 million ha-1, meanwhile profit for shifted cultivation was just IDR 2.81 million ha-1 only.  Settled cultivation pattern could

  6. Molar apicectomy with amalgam root-end filling: results of a prospective study in two district general hospitals.

    Science.gov (United States)

    Wesson, C M; Gale, T M

    2003-12-20

    To determine the five-year success rates, site or sites of failure, prognostic indicators and lower lip morbidity associated with molar apicectomy using amalgam root-end filling. Multicentre, prospective study. The departments of oral and maxillo-facial surgery in two district general hospitals. One thousand and seven molar apicectomy procedures, combined with amalgam root-end filling were expedited during the period 1974-1995. A five-year review of each operated tooth was carried out or attempted between 1979-2000. Of the 790 (78%) operated molars successfully reviewed at 5 years or later 451 (57%) exhibited 'complete healing' and 39 (5%) 'uncertain healing'. Three hundred (38%) were classified as 'unsatisfactory healing' (failures), and these included 12 which were assumed to be of periodontal origin. Whilst longitudinal root fracture, perforation and/or infection in the furcation, periodontal disease or a non-restorable crown accounted for treatment failure and often the need to remove teeth subsequently, the study probably pointed to the apical ends of the roots rather than the furcation as being the major sites at which 'unsatisfactory healing' occurred. Mandibular first molars attracted the highest 'complete healing' rate (60%) and mandibular second molars the lowest (46%). 'Good' root canal treatment (RCT) at the outset improved the prognosis of a root-end filling (REF) whilst the absence of RCT compromised it. Cystic change pointed to a better prognosis than apical granulomatous change as did a deep compared with a shallow 'bone cuff'. Disease at the furcation suggested a worse prognosis. Teeth which showed 'complete healing' at 1 year had a 75% probability of maintaining this outcome at 5 years. Sensory disturbance of variable duration occurred in the lower lip following 20-21% of mandibular molar procedures. In the majority of cases (79-80%) this had remitted within 3 months. A permanent deficit occurred in 8 patients (1%) where the apicectomy could

  7. North Plant co-generation project for South Davis County Sewer Improvement District

    Energy Technology Data Exchange (ETDEWEB)

    Rogers, L.S. [Aqua Environmental Services, Inc., Bountiful, UT (United States)

    1993-12-31

    In the summer of 1988, the South Davis County Sewer Improvement District (SDCSID) learned of a grant/loan program being administered by the Utah State Department of Energy(DOE) for projects that demonstrate new and innovative ways of conserving energy or utilizing renewable energy sources. The SDCSID applied for and received from the DOE both a grant and a no-interest loan to finance half of the cost of a co-generation project at the North Wastewater Treatment Plant. This co-generation project utilizes methane gas, a by-product of the anaerobic digestion process, to generate both electricity and heat that is used at the plant. The SDCSID calculated that at the current anaerobic gas production rate, a 140 KW engine generator could be run almost 24 hours a day. Approximately 75% of the current electrical needs at the North Plant are supplied by the 140 KW engine generator. Also, all of the heat necessary to raise the temperature of the incoming sludge to 95{degrees}F, and to heat four large buildings is supplied from the heat recovery system of the engine. The system utilizes an induction type generator to supply electricity, which is somewhat simpler to design and less expensive to install than a synchronous type system. An induction system utilizes the Electrical Utility`s incoming power to excite the generator to correct the phase so that is can be used by the loads in the plant. In addition, the SDCSID installed a second identical engine generator as a back-up and to peak shave. Plant effluent is used to cool the engines instead of air-cooling through radiators.

  8. The Experience of a District General Hospital with a Large Outdoor Music Festival in England.

    Science.gov (United States)

    Kamour, A; Yardley, R; Longshaw, M; Stuart, J

    2017-01-01

    To assess the impact of the Parklife annual music festival on the local hospital, North Manchester General. Data was obtained retrospectively by analysis of emergency department records during the weekend of Parklife 2015. 32 patients were identified, 56% reported taking drugs. 34% were admitted for overnight observation. 4 patients presented with methaemoglobinaemia following oral ingestion of amyl nitrate. One patient had a methaemoglobin fraction of 90.6%, which is amongst the most extreme recorded in literature. Music festivals can impose a burden on local health services. Organisers should operate an efficient surveillance system in order to prevent the sale and use of recreational drugs, providing adequate on-site health services and working in collaboration with local emergency services.

  9. Hip resurfacing in a district general hospital: 6-year clinical results using the ReCap hip resurfacing system

    Directory of Open Access Journals (Sweden)

    van der Weegen Walter

    2012-12-01

    Full Text Available Abstract Background The purpose of our study was to prospectively report the clinical results of 280 consecutive hips (240 patients who received a ReCap Hip Resurfacing System implant (Biomet Inc., Warsaw, USA in a single district general hospital. Literature reports a large variation in clinical results between different resurfacing designs and published results using this particular design are scarce. Methods Mean follow up was 3.3 years (1.0 to 6.3 and four patients were lost to follow-up. All patients were diagnosed with end-stage hip osteoarthritis, their mean age was 54 years and 76.4% of all patients were male. Results There were 16 revisions and four patients reported a Harris Hip Score Conclusions This independent series confirms that hip resurfacing is a demanding procedure, and that implant survival of the ReCap hip resurfacing system is on a critical level in our series. In non-revised patients, reported outcomes are generally excellent. Trial registration ClinicalTrials.gov Identifier: NCT00603395

  10. Improving the performance of district heating systems by utilization of local heat boosters

    DEFF Research Database (Denmark)

    Falcone, A.; Dominkovic, D. F.; Pedersen, A. S.

    was to evaluate the possibilities to lower the forward temperature of the heat supply in order to reduce the heat losses of the system. Booster heat pumps are introduced to increase the water temperature close to the final users. A Matlab model was developed to simulate the state of the case study DH network...... was set to minimize the system heat losses. * Corresponding author 0303-1 1 This goal was achieved by lowering the forward temperature to 40°C and relying on the installed heat pumps to boost the water temperature to the admissible value needed for the domestic hot water preparation. Depending......District Heating (DH) plays an important role into the Danish energy green transition towards the future sustainable energy systems. The new, 4 th generation district heating network, the so called Low Temperature District Heating (LTDH), tends to lower the supply temperature of the heat down to 40...

  11. Improved dynamic equations for the generally configured Stewart platform manipulator

    International Nuclear Information System (INIS)

    Pedrammehr, Siamak; Mahboubkhah, Mehran; Khani, Navid

    2012-01-01

    In this paper, a Newton-Euler approach is utilized to generate the improved dynamic equations of the generally configured Stewart platform. Using the kinematic model of the universal joint, the rotational degree of freedom of the pods around the axial direction is taken into account in the formulation. The justifiable direction of the reaction moment on each pod is specified and considered in deriving the dynamic equations. Considering the theorem of parallel axes, the inertia tensors for different elements of the manipulator are obtained in this study. From a theoretical point, the improved formulation is more accurate in comparison with previous ones, and the necessity of the improvement is clear evident from significant differences in the simulation results for the improved model and the model without improvement. In addition to more feasibility of the structure and higher accuracy, the model is highly compatible with computer arithmetic and suitable for online applications for loop control problems in hardware

  12. Possibility of introducing Smallholder Beef Cattle Farmer’s Association as a starting point to develop the beef cattle chain and improve their income in Arua district, Uganda

    NARCIS (Netherlands)

    Candia, A.

    2008-01-01

    The theme of the research is “Possibility of introducing smallholder Beef Cattle Farmers Association as a starting point to develop the beef chain and improve their income in Arua district, Uganda”. The study was carried out in two Sub Counties of Arua district, Uganda. The objective was to

  13. An implementation evaluation of a policy aiming to improve financial access to maternal health care in Djibo district, Burkina Faso

    Directory of Open Access Journals (Sweden)

    Belaid Loubna

    2012-12-01

    Full Text Available Abstract Background To bring down its high maternal mortality ratio, Burkina Faso adopted a national health policy in 2007 that designed to boost the assisted delivery rate and improving quality of emergency obstetrical and neonatal care. The cost of transportation from health centres to district hospitals is paid by the policy. The worst-off are exempted from all fees. Methods The objectives of this paper are to analyze perceptions of this policy by health workers, assess how this health policy was implemented at the district level, identify difficulties faced during implementation, and highlight interactional factors that have an influence on the implementation process. A multiple site case study was conducted at 6 health centres in the district of Djibo in Burkina Faso. The following sources of data were used: 1 district documents (n = 23; 2 key interviews with district health managers (n = 10, health workers (n = 16, traditional birth attendants (n = 7, and community management committees (n = 11; 3 non-participant observations in health centres; 4 focus groups in communities (n = 62; 5 a feedback session on the findings with 20 health staff members. Results All the activities were implemented as planned except for completely subsidizing the worst-off, and some activities such as surveys for patients and the quality assurance service team aiming to improve quality of care. District health managers and health workers perceived difficulties in implementing this policy because of the lack of clarity on some topics in the guidelines. Entering the data into an electronic database and the long delay in reimbursing transportation costs were the principal challenges perceived by implementers. Interactional factors such as relations between providers and patients and between health workers and communities were raised. These factors have an influence on the implementation process. Strained relations between the groups involved

  14. An implementation evaluation of a policy aiming to improve financial access to maternal health care in Djibo district, Burkina Faso.

    Science.gov (United States)

    Belaid, Loubna; Ridde, Valéry

    2012-12-08

    To bring down its high maternal mortality ratio, Burkina Faso adopted a national health policy in 2007 that designed to boost the assisted delivery rate and improving quality of emergency obstetrical and neonatal care. The cost of transportation from health centres to district hospitals is paid by the policy. The worst-off are exempted from all fees. The objectives of this paper are to analyze perceptions of this policy by health workers, assess how this health policy was implemented at the district level, identify difficulties faced during implementation, and highlight interactional factors that have an influence on the implementation process. A multiple site case study was conducted at 6 health centres in the district of Djibo in Burkina Faso. The following sources of data were used: 1) district documents (n = 23); 2) key interviews with district health managers (n = 10), health workers (n = 16), traditional birth attendants (n = 7), and community management committees (n = 11); 3) non-participant observations in health centres; 4) focus groups in communities (n = 62); 5) a feedback session on the findings with 20 health staff members. All the activities were implemented as planned except for completely subsidizing the worst-off, and some activities such as surveys for patients and the quality assurance service team aiming to improve quality of care. District health managers and health workers perceived difficulties in implementing this policy because of the lack of clarity on some topics in the guidelines. Entering the data into an electronic database and the long delay in reimbursing transportation costs were the principal challenges perceived by implementers. Interactional factors such as relations between providers and patients and between health workers and communities were raised. These factors have an influence on the implementation process. Strained relations between the groups involved may reduce the effectiveness of the policy

  15. CT scanning in stroke patients: meeting the challenge in the remote and rural district general hospital.

    Science.gov (United States)

    Todd, A W; Anderson, E M

    2009-05-01

    National audit data allow crude comparison between centres and indicate that most Scottish hospitals fail to meet current guidelines for CT scanning of the brain in stroke patients. This study identifies some of the reasons for delay in performing CT scans in a largely rural population. This audit study assesses the delays from onset of symptoms, time of admission and request received to CT scan in stroke patients for three different in-patient groups as well as those managed in the community. The reasons for delay in CT scanning varied between different patient groups but for one group of in-patients, changes in booking procedure and introduction of a second CT scanner increased the proportion scanned within 48 hours of request from 65% to 96%. Further developments including the introduction of Saturday and Sunday routine CT scanning, radiologist reporting from home and additional CT scanners placed in remote hospitals may be expected to improve these figures further. Target times of three hours from onset of symptoms to scan to allow thrombolysis may however be impossible to meet for all stroke patients in rural areas.

  16. Accuracy of clinical coding from 1210 appendicectomies in a British district general hospital.

    Science.gov (United States)

    Bhangu, Aneel; Nepogodiev, Dmitri; Taylor, Caroline; Durkin, Natalie; Patel, Rajan

    2012-01-01

    The primary aim of this study was to assess the accuracy of clinical coding in identifying negative appendicectomies. The secondary aim was to analyse trends over time in rates of simple, complex (gangrenous or perforated) and negative appendicectomies. Retrospective review of 1210 patients undergoing emergency appendicectomy during a five year period (2006-2010). Histopathology reports were taken as gold standard for diagnosis and compared to clinical coding lists. Clinical coding is the process by which non-medical administrators apply standardised diagnostic codes to patients, based upon clinical notes at discharge. These codes then contribute to national databases. Statistical analysis included correlation studies and regression analyses. Clinical coding had only moderate correlation with histopathology, with an overall kappa of 0.421. Annual kappa values varied between 0.378 and 0.500. Overall 14% of patients were incorrectly coded as having had appendicitis when in fact they had a histopathologically normal appendix (153/1107), whereas 4% were falsely coded as having received a negative appendicectomy when they had appendicitis (48/1107). There was an overall significant fall and then rise in the rate of simple appendicitis (B coefficient -0.239 (95% confidence interval -0.426, -0.051), p = 0.014) but no change in the rate of complex appendicitis (B coefficient 0.008 (-0.015, 0.031), p = 0.476). Clinical coding for negative appendicectomy was unreliable. Negative rates may be higher than suspected. This has implications for the validity of national database analyses. Using this form of data as a quality indictor for appendicitis should be reconsidered until its quality is improved. Copyright © 2012 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.

  17. Consultant-led, multidisciplinary balance clinic: process evaluation of a specialist model of care in a district general hospital.

    Science.gov (United States)

    Trinidade, A; Yung, M W

    2014-04-01

    A specialist balance clinic to effectively deal with dizzy patients is recommended by ENT-UK. We audit the patient pathway before and following the introduction of a consultant-led dedicated balance clinic. Process evaluation and audit. ENT outpatients department of a district general hospital. The journey of dizzy patients seen in the general ENT clinic was mapped from case notes and recorded retrospectively. A consultant-led, multidisciplinary balance clinic involving an otologist, a senior audiologist and a neurophysiotherapist was then set up, and the journey was prospectively recorded and compared with that before the change. Of the 44 dizzy patients seen in the general clinic, 41% had further follow-up consultations; 64% were given definitive or provisional diagnoses; 75% were discharged without a management plan. Oculomotor examination was not systematically performed. The mean interval between Visits 1 and 2 was 8.4 weeks and the mean number of visits was 3. In the consultant-led dedicated balance clinic, following Visit 1, only 8% of patients required follow-up; 97% received definitive diagnoses, which guided management; all patients left with definitive management plans in place. In all patients, oculomotor assessment was systematically performed and all patients received consultant and, where necessary, allied healthcare professional input. By standardising the management experience for dizzy patients, appropriate and timely treatment can be achieved, allowing for a more seamless and efficient patient journey from referral to treatment. A multidisciplinary balance clinic led by a consultant otologist is the ideal way to achieve this. © 2014 John Wiley & Sons Ltd.

  18. Improving Immunization Coverage in a Rural School District in Pierce County, Washington

    Science.gov (United States)

    Peterson, Robin M.; Cook, Carolyn; Yerxa, Mary E.; Marshall, James H.; Pulos, Elizabeth; Rollosson, Matthew P.

    2012-01-01

    Washington State has some of the highest percentages of school immunization exemptions in the country. We compared school immunization records in a rural school district in Pierce County, Washington, to immunization records in the state immunization information system (IIS) and parent-held records. Correcting school immunization records resulted…

  19. Legislative Districts, Rhode Island Senate Districts; risen07; State legislature district boundaries for the RI State Senate as determined in 2002 and revised in 2004 as designated in Rhode Island General Law 17-11. Corrected for renumbering of districts 9,12,24,and 32 in 2007, Published in 2007, 1:100000 (1in=8333ft) scale, Rhode Island and Providence Plantations.

    Data.gov (United States)

    NSGIC State | GIS Inventory — Legislative Districts dataset current as of 2007. Rhode Island Senate Districts; risen07; State legislature district boundaries for the RI State Senate as determined...

  20. Impact of extension interventions in improving livelihood of dairy farmers of Nadia district of West Bengal, India.

    Science.gov (United States)

    Garai, Suman; Garai, Sanchita; Maiti, Sanjit; Meena, B S; Ghosh, M K; Bhakat, Champak; Dutta, T K

    2017-03-01

    Livestock is a one of the major sources of livelihood for most of the small and marginal farmers in India, particularly for rural households who live in below poverty line. Extension interventions have long been seen as a key element for enabling farmers to obtain information and technologies that can improve their livelihoods. It is also recognized that extension is an important factor in promoting dairy development. Ex-post-facto cause to effect research design was applied in this study to trace out the impact of extension interventions in improving knowledge, attitude, adoption towards scientific dairy farming practices and improvement in milk production of dairy animal and income from dairying which will be resulted into improved livelihood of rural poor in Nadia district of West Bengal, India. Therefore, 60 dairy farmers of experimental villages who were considered as beneficiaries and 60 dairy farmers of control villages who were considered as non-beneficiaries were selected as sample for the study. It was found that beneficiaries had significantly higher score in all the five components of livelihood improvement with its all sub components, i.e., knowledge, attitude, adoption of scientific dairy farming practices, milk production per household per day and monthly income from dairying except disease control, and marketing component of adoption. Hence, it may be concluded that extension interventions had a significant impact on improving livelihood of rural dairy farmers in Nadia district of West Bengal, India.

  1. Operations research to add postpartum family planning to maternal and neonatal health to improve birth spacing in Sylhet District, Bangladesh.

    Science.gov (United States)

    Ahmed, Salahuddin; Norton, Maureen; Williams, Emma; Ahmed, Saifuddin; Shah, Rasheduzzaman; Begum, Nazma; Mungia, Jaime; Lefevre, Amnesty; Al-Kabir, Ahmed; Winch, Peter J; McKaig, Catharine; Baqui, Abdullah H

    2013-08-01

    Short birth intervals are associated with increased risk of adverse maternal and neonatal health (MNH) outcomes. Improving postpartum contraceptive use is an important programmatic strategy to improve the health and well-being of women, newborns, and children. This article documents the intervention package and evaluation design of a study conducted in a rural district of Bangladesh to evaluate the effects of an integrated, community-based MNH and postpartum family planning program on contraceptive use and birth-interval lengths. The study integrated family planning counseling within 5 community health worker (CHW)-household visits to pregnant and postpartum women, while a community mobilizer (CM) led community meetings on the importance of postpartum family planning and pregnancy spacing for maternal and child health. The CM and the CHWs emphasized 3 messages: (1) Use of the Lactational Amenorrhea Method (LAM) during the first 6 months postpartum and transition to another modern contraceptive method; (2) Exclusive, rather than fully or nearly fully, breastfeeding to support LAM effectiveness and good infant breastfeeding practices; (3) Use of a modern contraceptive method after a live birth for at least 24 months before attempting another pregnancy (a birth-to-birth interval of about 3 years) to support improved infant health and nutrition. CHWs provided only family planning counseling in the original study design, but we later added community-based distribution of methods, and referrals for clinical methods, to meet women's demand. Using a quasi-experimental design, and relying primarily on pre/post-household surveys, we selected pregnant women from 4 unions to receive the intervention (n = 2,280) and pregnant women from 4 other unions (n = 2,290) to serve as the comparison group. Enrollment occurred between 2007 and 2009, and data collection ended in January 2013. Formative research showed that women and their family members generally did not perceive

  2. District nurse training

    OpenAIRE

    Elliott, Arnold; Freeling, Paul; Owen, John

    1980-01-01

    Training for district nursing is being reviewed. By 1981 district nurses will have a new administrative structure, a new curriculum, and a new examination. Training for nursing, like that for general practice, is to become mandatory. The history of the development of district nurse training is briefly described.

  3. Stochastic abstract policies: generalizing knowledge to improve reinforcement learning.

    Science.gov (United States)

    Koga, Marcelo L; Freire, Valdinei; Costa, Anna H R

    2015-01-01

    Reinforcement learning (RL) enables an agent to learn behavior by acquiring experience through trial-and-error interactions with a dynamic environment. However, knowledge is usually built from scratch and learning to behave may take a long time. Here, we improve the learning performance by leveraging prior knowledge; that is, the learner shows proper behavior from the beginning of a target task, using the knowledge from a set of known, previously solved, source tasks. In this paper, we argue that building stochastic abstract policies that generalize over past experiences is an effective way to provide such improvement and this generalization outperforms the current practice of using a library of policies. We achieve that contributing with a new algorithm, AbsProb-PI-multiple and a framework for transferring knowledge represented as a stochastic abstract policy in new RL tasks. Stochastic abstract policies offer an effective way to encode knowledge because the abstraction they provide not only generalizes solutions but also facilitates extracting the similarities among tasks. We perform experiments in a robotic navigation environment and analyze the agent's behavior throughout the learning process and also assess the transfer ratio for different amounts of source tasks. We compare our method with the transfer of a library of policies, and experiments show that the use of a generalized policy produces better results by more effectively guiding the agent when learning a target task.

  4. The perceived meaning of a (wholistic view among general practitioners and district nurses in Swedish primary care: a qualitative study

    Directory of Open Access Journals (Sweden)

    Borgquist Lars

    2007-03-01

    Full Text Available Abstract Background The definition of primary care varies between countries. Swedish primary care has developed from a philosophic viewpoint based on quality, accessibility, continuity, co-operation and a holistic view. The meaning of holism in international literature differs between medicine and nursing. The question is, if the difference is due to different educational traditions. Due to the uncertainties in defining holism and a holistic view we wished to study, in depth, how holism is perceived by doctors and nurses in their clinical work. Thus, the aim was to explore the perceived meaning of a holistic view among general practitioners (GPs and district nurses (DNs. Methods Seven focus group interviews with a purposive sample of 22 GPs and 20 nurses working in primary care in two Swedish county councils were conducted. The interviews were transcribed verbatim and analysed using qualitative content analysis. Results The analysis resulted in three categories, attitude, knowledge, and circumstances, with two, two and four subcategories respectively. A professional attitude involves recognising the whole person; not only fragments of a person with a disease. Factual knowledge is acquired through special training and long professional experience. Tacit knowledge is about feelings and social competence. Circumstances can either be barriers or facilitators. A holistic view is a strong motivator and as such it is a facilitator. The way primary care is organised can be either a barrier or a facilitator and could influence the use of a holistic approach. Defined geographical districts and care teams facilitate a holistic view with house calls being essential, particularly for nurses. In preventive work and palliative care, a holistic view was stated to be specifically important. Consultations and communication with the patient were seen as important tools. Conclusion 'Holistic view' is multidimensional, well implemented and very much alive among both

  5. A study of the improvement of the district heat price cap system

    Energy Technology Data Exchange (ETDEWEB)

    Yoo, S.J. [Korea Energy Economics Institute, Euiwang (Korea)

    2001-11-01

    This study proposes revision of the price cap mechanism applied to the district heating company, which was introduced in 1999. The revision aims at the provision of the incentives to lower the production cost to the heat producers and preventing the monopoly price from being charged to the consumer. It is proposed to extend the application period of the price cap to 3 or 5 years. 3 year application period is recommended because of lack of the experiences of the price cap mechanism and information of its performance in the public utility industries in Korea. The calculation of the price cap is better to be set based upon the minimum of the full cost of heat production in the last year of the previous application periods or the prices actually charged to the consumer during the previous application period. As the opportunity cost of the equity capital, the interest rate of the 5 year government bond or the actual interest cost of the debt financed capital is recommended to increase the share of the equity capital and to reflect the investment risk of the district heating industry. Production efficiency index applicable to the district heating company is estimated with 3 different methods. Among three different results, 3% is the first choice from a conservative perspective. It is also recommended to adjust production efficiency index as the data are accumulated and to be implemented with a profit sharing mechanism between the consumer and the monopoly supplier. In application of the price index, producer price index is applicable if the price cap is calculated from the full production cost. consumer price index is applicable if the price cap is set from the previous year's actual district heat prices (tariffs). Transfer of the ownership either by transferring stocks or by asset selling could affect the price cap determined by the full cost of the district heat production. In order to keep the consumer's welfare from being decreased, it is necessary to set

  6. Is the Current Management of Patients Presenting With Spinal Trauma to District General Hospitals Fit for Purpose? Our Experience of Delivering a Spinal Service Using an Electronic Referral Platform in a Large District General Teaching Hospital Without Onsite Spinal Services.

    Science.gov (United States)

    Hill, Daniel S; Marynissen, Hans

    2018-04-12

    A retrospective cross-sectional analysis. To describe the provision of a spinal service using an electronic platform to direct management from an external spinal unit, and quantify time taken to obtain definitive management plans whilst under prescribed spinal immobilization. Most attending district general hospitals following spinal trauma will have stable injuries and normal neurology, with only a small proportion requiring urgent transfer to a specialist centre. A retrospective review of 104 patients admitted following vertebral during a 12-month period. The British Orthopaedic Association Standards for Trauma consensus that "spinal immobilisation is not recommended for more than 48 hours" was the standard of care measured against. 100 patients occupied a total of 975 hospital inpatient bed days. 117 radiological investigations were requested after the point of external referral (47 CT-scans, 37 MRI-scans, and 33 weight bearing radiographs). The period between initial referral to the regional spinal service and then receiving a definitive final management had a median value of 72 hours and a range of 0 - 33 days. Patients will have been under some form of prescribed spinal immobilisation until the definitive management plan was communicated. 34 patients (34% of the overall cohort) had a definitive management plan in place within 48 hours. 80 patients had vertebral injuries (73 stable, 6 unstable), 3 patients had prolapsed intervertebral disks, 1 had metastatic disease, and 17 had not evidence of an acute injury following evaluation. Patients are being placed under prescribed immobilisation for longer than is recommended. Delays in obtaining radiological imaging were an important factor, together with the time taken to receive a definitive management plan. Limitations in social care provision and delays in arranging this were additional barriers to hospital discharge following the final management plan. 4.

  7. Nurses caring for ENT patients in a district general hospital without a dedicated ENT ward score significantly less in a test of knowledge than nurses caring for ENT patients in a dedicated ENT ward in a comparable district general hospital.

    Science.gov (United States)

    Foxton, C R; Black, D; Muhlschlegel, J; Jardine, A

    2014-12-01

    To assess whether there is a difference in ENT knowledge amongst nurses caring for patients on a dedicated ENT ward and nurses caring for ENT patients in a similar hospital without a dedicated ENT ward. A test of theoretical knowledge of ENT nursing care was devised and administered to nurses working on a dedicated ENT ward and then to nurses working on generic non-subspecialist wards regularly caring for ENT patients in a hospital without a dedicated ENT ward. The test scores were then compared. A single specialist ENT/Maxillo-Facial/Opthalmology ward in hospital A and 3 generic surgical wards in hospital B. Both hospitals are comparable district general hospitals in the south west of England. Nursing staff working in hospital A and hospital B on the relevant wards were approached during the working day. 11 nurses on ward 1, 10 nurses on ward 2, 11 nurses on ward 3 and 10 nurses on ward 4 (the dedicated ENT ward). Each individual test score was used to generate an average score per ward and these scores compared to see if there was a significant difference. The average score out of 10 on ward 1 was 6.8 (+/-1.6). The average score on ward two was 4.8 (+/-1.6). The average score on ward three was 5.5 (+/-2.1). The average score on ward 4, which is the dedicated ENT ward, was 9.7 (+/-0.5). The differences in average test score between the dedicated ENT ward and all of the other wards are statistically significant. Nurses working on a dedicated ENT ward have an average higher score in a test of knowledge than nurses working on generic surgical wards. This difference is statistically significant and persists despite banding or training. © 2014 John Wiley & Sons Ltd.

  8. Venous thromboprophylaxis in general surgery ward admissions: strategies for improvement.

    Science.gov (United States)

    Galante, Mariana; Languasco, Agustín; Gotta, Daniel; Bell, Soledad; Lancelotti, Tomás; Knaze, Viktoria; Saubidet, Cristián Lopez; Grand, Beatriz; Milberg, Matías

    2012-12-01

    To estimate the adherence to institutional venous thromboprophylaxis clinical practice guidelines (CPGs) in general surgery patients and to assess the effectiveness of a multi-strategy improvement intervention. A prospective before-after study. Two teaching hospitals located in the city of Buenos Aires, Argentina. Prescriptions belonging to patients admitted to the general surgery wards were evaluated. A multi-strategy intervention that included (i) simplification of institutional CPGs for venous thromboprophylaxis using a single drug at a single dose, based on the American College of Chest Physicians recommendations, (ii) distribution of pocket cards with an algorithm for the implementation of new recommendations to both, physicians and nurses, working in the general surgery units, (iii) educational talks, (iv) paper-based reminders and (v) audit and feedback. The adherence of the venous thromboprophylaxis prescription to the institutional recommendations. The prescriptions of 100 admitted patients before and 90 after the intervention were included in the analysis. The initial rate of adherence was 31%. After the intervention this rate rose to 71.1% (P< 0.001). The major improvement observed was the reduction in omitted prophylaxis in patients at risk of venous thromboembolism from 45 to 13.3% (P< 0.001). In the adjusted model, prescribing compliance with CPGs was five times more likely during the second stage than during the first stage (OR = 5.60, 95% CI = 2.92-10.74). Simple and economical interventions such as those described in this study can improve general surgeons compliance with the institutional and international guidelines, thus assuring patient safety and quality of health care.

  9. Generalization in the XCSF classifier system: analysis, improvement, and extension.

    Science.gov (United States)

    Lanzi, Pier Luca; Loiacono, Daniele; Wilson, Stewart W; Goldberg, David E

    2007-01-01

    We analyze generalization in XCSF and introduce three improvements. We begin by showing that the types of generalizations evolved by XCSF can be influenced by the input range. To explain these results we present a theoretical analysis of the convergence of classifier weights in XCSF which highlights a broader issue. In XCSF, because of the mathematical properties of the Widrow-Hoff update, the convergence of classifier weights in a given subspace can be slow when the spread of the eigenvalues of the autocorrelation matrix associated with each classifier is large. As a major consequence, the system's accuracy pressure may act before classifier weights are adequately updated, so that XCSF may evolve piecewise constant approximations, instead of the intended, and more efficient, piecewise linear ones. We propose three different ways to update classifier weights in XCSF so as to increase the generalization capabilities of XCSF: one based on a condition-based normalization of the inputs, one based on linear least squares, and one based on the recursive version of linear least squares. Through a series of experiments we show that while all three approaches significantly improve XCSF, least squares approaches appear to be best performing and most robust. Finally we show how XCSF can be extended to include polynomial approximations.

  10. Assessment of existing local houses condition as analysis tools for shore housing improvement program in Weriagar district, Bintuni Bay

    Science.gov (United States)

    Firmansyah, F.; Fernando, A.; Allo, I. P. R.

    2018-01-01

    The housing assessment is a part of the pre-feasibility study inThe Shore Housing Improvement Program in Weriagar District, West Papua. The housing assessment was conducted to identify the physical condition of existing houses. The parameters of assessment formulated from local references, practices and also national building regulation that covers each building system components, such as building structure/frame, building floor, building cover, and building roof. This study aims to explains lessons from local practices and references, used as the formula to generate assessment parameter, elaborate with Indonesia building regulation. The result of housing assessment were used as a basis to develop the house improvement strategy, the design alternative for housing improvement and further planning recommendations. The local knowledges involved in housing improvement program expected that the local-based approach could respect to the local build culture, respect the local environment, and the most important can offer best suitable solutions for functional utility and livability.

  11. IMPROVEMENT OF MANGOSTEEN FARMING AND POSTHARVEST HANDLING STRATEGIES BASED ON GLOBAL GAP STANDARD AT KIARA PEDES, PURWAKARTA DISTRICT

    Directory of Open Access Journals (Sweden)

    Nanda Erlangga

    2012-09-01

    Full Text Available The objectives of this research were (1 to determine the value chain of mangosteen at Kiara Pedes Sub district, Purwakarta District, (2 to identify the gap between actual condition at Kiara Pedes and Global GAP standard, (3 to identify internal and external factors that can affect the implementation strategy of Global GAP standards, and (4 to develop alternative strategies that can be applied to improve the system of mangosteen cultivation and post harvest handling based on Global GAP standards. The analytical tools being used in this study were value chain analysis, gap analysis, internal and external factor evaluation (IFE, EFE, IE matrix, SWOT analysis, and quantitative strategic planning matrix (QSPM. Identified primary actors in mangosteen value chain were farmers, middlemen, suppliers, exporters, and local and overseas retailers. Based on IE Matrix and SWOT analysis, the strategies to implement Global GAP standards were (a to increase mangosteen productivity and improve its quality by using developed cultivation and postharvest technology, (b to increase productivity, and improve quality and transportation network in accordance with Global GAP standard, (c to improve clean water and post-harvest infrastructure through cooperation with exporters and financial institutions, and (d to improve warehouse and supporting facilities such as packaging and sanitation according to the Global GAP standard for minimizing the environmental constraints. The most priority strategies from the QSPM analysis were improving clean water and post-harvest infrastructure through cooperation with exporters and financial institutions, followed by using the developed cultivation and postharvest technology to increase mangosteen productivity and improve its quality.Keywords: Mangosteen, Global GAP Standard, Value Chain, Improvement Strategies, Farming and Postharvest Handling Practices

  12. VT Data - Overlay District 20170419, Colchester

    Data.gov (United States)

    Vermont Center for Geographic Information — The following Overlay Districts are included in the data:General Development Four Commercial DistrictGeneral Development Four Openspace DistrictShoreland...

  13. Multitask Classification Hypothesis Space With Improved Generalization Bounds.

    Science.gov (United States)

    Li, Cong; Georgiopoulos, Michael; Anagnostopoulos, Georgios C

    2015-07-01

    This paper presents a pair of hypothesis spaces (HSs) of vector-valued functions intended to be used in the context of multitask classification. While both are parameterized on the elements of reproducing kernel Hilbert spaces and impose a feature mapping that is common to all tasks, one of them assumes this mapping as fixed, while the more general one learns the mapping via multiple kernel learning. For these new HSs, empirical Rademacher complexity-based generalization bounds are derived, and are shown to be tighter than the bound of a particular HS, which has appeared recently in the literature, leading to improved performance. As a matter of fact, the latter HS is shown to be a special case of ours. Based on an equivalence to Group-Lasso type HSs, the proposed HSs are utilized toward corresponding support vector machine-based formulations. Finally, experimental results on multitask learning problems underline the quality of the derived bounds and validate this paper's analysis.

  14. Screening of hepatitis B and C among people visiting general practice clinics in rural district of Sindh, Pakistan

    International Nuclear Information System (INIS)

    Kumar, A.; Lalani, S.; Afridi, A.A.K.; Khuwaja, A.K.

    2010-01-01

    Background: Hepatitis B (HB), Hepatitis C (HC) and their risk factors are amongst the major health problems in developing countries including Pakistan. This study aimed to screen for HB and HC among people who visited General Practice clinics and also to identify the differences of screening positive cases by age and sex. Methods: This was a retrospective study conducted in Tando Muhammad Khan city, one of the rural districts of Sindh. All together we reviewed 5989 laboratory reports of people for hepatitis B and C on consecutive basis from two laboratories. A pre-designed and structured perform was used to collect the required information. Chi-squared test and univariate analysis was calculated to assess the difference in HB and HC proportion by age groups and sex. Results: One-fourth of reports were positive for at least one entity whereas 8% and 17% of reviewed reports of adults (>18 years and above) were screened positive for HB and HC respectively. Positive screened tests were higher among older age group compared to young age group (HB: older age group=56.6% vs. younger age group=43.4%; OR=1.07) and (HC: older age group=58.3% vs. younger age group=41.7%; OR=1.08). In the same way, positive screened tests were higher among men compared to women (HB: men=67.0% vs. women=33.0%; OR=1.2) and (HC: men=62.0% vs. women=38.0%; OR=1.3). Conclusion: A large proportion of people were screened positive for HB and HC in this study. Prevention and screening are suggested at larger scale for urgent planning and implementation of intervention strategies in this regard. Further research is also recommended to explore this important health issue at large scale. (author)

  15. PROPOSALS FOR OPTIMISATION THE GENETIC IMPROVEMENT ACTIVITIES IN THE PHASIANUS COLCHICUS COLCHICUS POPULATION FROM PISCHIA PHEASANT PRESERVE, FORESTRY DISTRICT TIMISOARA

    Directory of Open Access Journals (Sweden)

    D. DRONCA

    2008-10-01

    Full Text Available Romania adhesion and integration into the European Union offers opportunities for production and export of a significant number of pheasants for game. Pheasant meat is very tender and succulent with a pleasant flavor. The aim the paper was to try to makwe efficient the genetic improvement actions of the Phasianus Colchicus Colchicus stock from the Pischia pheasant preserve, Timis County. The study was carried out on a total of 11550 common game pheasants belonging to the Forestry District Timisoara. Based on analysis carried out, this paper is finalizing with a number of conclusions and recommendations.

  16. Feasibility study on rehabilitation and improvement of thermal power plants, district heating and heat supply system in Botosani City

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2001-03-01

    Discussions have been given on the improvement and modification project intended of saving energies and reducing greenhouse gas emission in the Botosani district heating and heat supplying facilities in Romania. Thirty years have elapsed since the building of the Botosani district heating and heat supplying facilities, whereas noticeable energy loss has occurred due to aged deterioration, such as thermal efficiency decrease, performance decrease, and hot water leakage due to piping corrosion. The present project is intended to improve the heat production and power generation facility efficiencies, and reduce the heat loss in heat transportation and distribution to less than 5%. The improvements will be implemented by replacing and rehabilitating the existing boilers, replacing the turbine generators, and replacing the transportation and distribution pipelines and heat exchangers. As a result of the discussions, the present project is estimated to result in annual fuel conservation of 35,820 tons of crude oil equivalent, and annual reduction of the greenhouse gas emission of 110,835 t-CO2. The total amount of the initial investment for the project would be 11.369 billion yen, and the payback period would be 12 years. The project will produce profit of 31.358 billion yen in 20 years, thus the project is financially feasible. (NEDO)

  17. Impact of different improvement measures on the thermal performance of a solar collector field for district heating

    DEFF Research Database (Denmark)

    Bava, Federico; Furbo, Simon

    2018-01-01

    The paper describes the impact of different measures to improve the thermal performance of a solar heating plant for district heating applications. The impact of the different measures was evaluated through a validated TRNSYS-Matlab model. The model included details such as effect of the flow...... temperature of the collector field, control strategy based on weather forecast and use of different heat transfer fluids. The results showed that accurate input to the control strategy improved the yearly energy output of the plant by about 3%. If accurate input is not technically or economically feasible...... regime in the absorber pipes on the collector efficiency, flow distribution in the collector field, thermal capacity of the pipes and shadows from row to row. The improvement measures included variation of the operating temperatures, accurate input to the control strategy, feedback control on the outlet...

  18. General surgery training and robotics: Are residents improving their skills?

    Science.gov (United States)

    Finnerty, Brendan M; Afaneh, Cheguevara; Aronova, Anna; Fahey, Thomas J; Zarnegar, Rasa

    2016-02-01

    While robotic-assisted operations have become more prevalent, many general surgery residencies do not have a formal robotic training curriculum. We sought to ascertain how well current general surgery training permits acquisition of robotic skills by comparing robotic simulation performance across various training levels. Thirty-six participants were categorized by level of surgical training: eight medical students (MS), ten junior residents (JR), ten mid-level residents (MLR), and eight senior residents (SR). Participants performed three simulation tasks on the da Vinci (®) Skills Simulator (MatchBoard, EnergyDissection, SutureSponge). Each task's scores (0-100) and cumulative scores (0-300) were compared between groups. There were no differences in sex, hand dominance, video gaming history, or prior robotic experience between groups; however, SR was the oldest (p Robotic skillsets acquired during general surgery residency show minimal improvement during the course of training, although laparoscopic experience is correlated with advanced robotic task performance. Changes in residency curricula or pursuit of fellowship training may be warranted for surgeons seeking proficiency.

  19. Vendor-to-vendor education to improve malaria treatment by private drug outlets in Bungoma District, Kenya

    Directory of Open Access Journals (Sweden)

    Makama Sammy

    2003-05-01

    Full Text Available Abstract Background Private outlets are the main suppliers of uncomplicated malaria treatment in Africa. However, they are so numerous that they are difficult for governments to influence and regulate. This study's objective was to evaluate a low-cost outreach education (vendor-to-vendor programme to improve the private sector's compliance with malaria guidelines in Bungoma district, Kenya. The cornerstone of the programme was the district's training of 73 wholesalers who were equipped with customized job aids for distribution to small retailers. Methods Six months after training the wholesalers, the programme was evaluated using mystery shoppers. The shoppers posed as caretakers of sick children needing medication at 252 drug outlets. Afterwards, supervisors assessed the outlets' knowledge, drug stocks, and prices. Results The intervention seems to have had a significant impact on stocking patterns, malaria knowledge and prescribing practices of shops/kiosks, but not consistently on other types of outlets. About 32% of shops receiving job aids prescribed to mystery shoppers the approved first-line drug, sulfadoxine-pyremethamine, as compared to only 3% of the control shops. In the first six months, it is estimated that 500 outlets were reached, at a cost of about $8000. Conclusions Changing private sector knowledge and practices is widely acknowledged to be slow and difficult. The vendor-to-vendor programme seems a feasible district-level strategy for achieving significant improvements in knowledge and practices of shops/kiosks. However, alternate strategies will be needed to influence pharmacies and clinics. Overall, the impact will be only moderate unless national policies and programmes are also introduced.

  20. Room for improvement? Leadership, innovation culture and uptake of quality improvement methods in general practice.

    Science.gov (United States)

    Apekey, Tanefa A; McSorley, Gerry; Tilling, Michelle; Siriwardena, A Niroshan

    2011-04-01

    Leadership and innovation are currently seen as essential elements for the development and maintenance of high-quality care. Little is known about the relationship between leadership and culture of innovation and the extent to which quality improvement methods are used in general practice. This study aimed to assess the relationship between leadership behaviour, culture of innovation and adoption of quality improvement methods in general practice. Self-administered postal questionnaires were sent to general practitioner quality improvement leads in one county in the UK between June and December 2007. The questionnaire consisted of background information, a 12-item scale to assess leadership behaviour, a seven-dimension self-rating scale for culture of innovation and questions on current use of quality improvement tools and techniques. Sixty-three completed questionnaires (62%) were returned. Leadership behaviours were not commonly reported. Most practices reported a positive culture of innovation, featuring relationship most strongly, followed by targets and information but rated lower on other dimensions of rewards, risk and resources. There was a significant positive correlation between leadership behaviour and the culture of innovation (r = 0.57; P improvement methods were not adopted by most participating practices. Leadership behaviours were infrequently reported and this was associated with a limited culture of innovation in participating general practices. There was little use of quality improvement methods beyond clinical and significant event audit. Practices need support to enhance leadership skills, encourage innovation and develop quality improvement skills if improvements in health care are to accelerate. © 2010 Blackwell Publishing Ltd.

  1. In the way of clean and safe drinking water : exploring limitations to improvement of the water supply in Bagamoyo District, Tanzania

    OpenAIRE

    Bemspång, Josefina; Segerström, Rebecka

    2009-01-01

    Bagamoyo District, in the Pwani region in Tanzania, supplies a large part of Tanzania'sbiggest city, Dar es Salaam, with water. At the same time many people in rural villages in thedistrict do not have access to clean and safe water. This thesis aims to explore what limitationsthere are to improvement of the rural water supply in Bagamoyo District. Specific attention ispaid to the organizational structure of the water sector and how roles and responsibilities aredivided, defined and communica...

  2. The evolution and outcome of surveillance of Barrett's oesophagus over four decades in a UK District General Hospital.

    Science.gov (United States)

    Royston, Christine; Caygill, Christine; Charlett, Andre; Bardhan, Karna Dev

    2016-12-01

    We present the long-term outcome of Barrett's oesophagus (BO) at a District General Hospital set against the increasing numbers of patients with gastro-oesophageal reflux disease (GORD). Data were collected prospectively over 37 years. Comparison of GORD without Barrett's (NoBO) versus BO was performed from 1/1/1977 to 31/12/2001 when the NoBO database closed and outcomes of all cases of BO diagnosed until 31/12/2011 and followed up until 31/12/2013 have been reported. During the period 1977-2001 the number of GORD NoBO cases was 11 610, and that of BO cases was 764 (6.2% of all GORD); total number of BO cases in 1977-2011 was 1468. NoBO patients were younger than BO patients: 52.2 versus 61.6 years. There was a male predominance in both groups: NoBO 55% and BO 62% (P<0.0001). The prevalence of oesophageal adenocarcinoma (OAC) was 87/1468 (5.9%) BO cases. Its incidence was 54/1381 (3.9%); the mean interval between the diagnosis of BO and incident OAC was 9 years (range 13 months-25.4 years); there was one OAC per 192 patient-years of follow-up (0.52% per year). Mortality was significantly lower in 37 patients under endoscopic surveillance at the time OAC was diagnosed (51 vs. 88% P=0.0141) partly because of older age and comorbidity of the other 17, in whom serial endoscopy was contraindicated. A proportional hazards model to allow for age estimated that the hazard rate ratio was lower in the surveillance group; however, this difference did not reach statistical significance (0.64, 95% confidence interval 0.30-1.48, P=0.08). Excluding prevalent cancers from both groups, mortality in BO was double that in NoBO (47 vs. 24%). These 37 years of observation suggest, but do not confirm, that endoscopic surveillance may reduce the risk of death from OAC. Modern technology is likely to yield better results, but larger prospective studies are needed to confirm the benefits.

  3. The effect of sporting events on emergency department attendance rates in a district general hospital in Northern Ireland.

    Science.gov (United States)

    McGreevy, A; Millar, L; Murphy, B; Davison, G W; Brown, R; O'Donnell, M E

    2010-10-01

    Previous studies have reported a conflicting relationship between the effect of live and televised sporting events on attendance rates to emergency departments (ED). The objectives of this study were to investigate the relationship of major sporting events on emergency department attendance rates and to determine the potential effects of such events on service provision. A retrospective analysis of ED attendances to a district general hospital (DGH) and subsequent admissions over a 24-h period following live and televised sporting activities was performed over a 5-year period. Data were compiled from the hospital's emergency record books including the number of attendances, patient demographics, clinical complaint and outcome. Review patients were excluded. Analysis of sporting events was compiled for live local, regional and national events as well as world-wide televised sporting broadcasts. A total of 137,668 (80,445 men) patients attended from April 2002 to July 2007. Mean attendance rate per day was 80 patients (men = 47). Mean admission rate was 13.6 patients per day. Major sporting events during the study period included; Soccer: 4 FA Cup and 1 World Cup (WC) finals; Rugby: 47 Six Nations, 25 Six nations games involving Ireland, 1 WC final, 2 WC semi-finals, 2 WC quarter-finals and 4 WC games involving Ireland; and Gaelic Football [Gaelic Athletic Association (GAA)]: 5 All-Ireland finals, 11 semi-finals, 11 quarter-finals and 5 provincial finals. There was a significantly higher patient admission rate during the soccer FA Cup final, Rugby Six Nations and games involving Ireland and for GAA semi- and quarter-final games (p = 0.001-0.01). There was no difference identified in total attendance or non-admission rates for sporting events throughout the study period. Although there was no correlation identified between any of these sporting events and total emergency department attendances (r 0.07), multinomial logistic regression demonstrated that FA Cup final (p

  4. An intervention to improve paediatric and newborn care in Kenyan district hospitals: Understanding the context

    Directory of Open Access Journals (Sweden)

    Opondo Charles

    2009-07-01

    Full Text Available Abstract Background It is increasingly appreciated that the interpretation of health systems research studies is greatly facilitated by detailed descriptions of study context and the process of intervention. We have undertaken an 18-month hospital-based intervention study in Kenya aiming to improve care for admitted children and newborn infants. Here we describe the baseline characteristics of the eight hospitals as environments receiving the intervention, as well as the general and local health system context and its evolution over the 18 months. Methods Hospital characteristics were assessed using previously developed tools assessing the broad structure, process, and outcome of health service provision for children and newborns. Major health system or policy developments over the period of the intervention at a national level were documented prospectively by monitoring government policy announcements, the media, and through informal contacts with policy makers. At the hospital level, a structured, open questionnaire was used in face-to-face meetings with senior hospital staff every six months to identify major local developments that might influence implementation. These data provide an essential background for those seeking to understand the generalisability of reports describing the intervention's effects, and whether the intervention plausibly resulted in these effects. Results Hospitals had only modest capacity, in terms of infrastructure, equipment, supplies, and human resources available to provide high-quality care at baseline. For example, hospitals were lacking between 30 to 56% of items considered necessary for the provision of care to the seriously ill child or newborn. An increase in spending on hospital renovations, attempts to introduce performance contracts for health workers, and post-election violence were recorded as examples of national level factors that might influence implementation success generally. Examples of factors

  5. An intervention to improve paediatric and newborn care in Kenyan district hospitals: understanding the context.

    Science.gov (United States)

    English, Mike; Ntoburi, Stephen; Wagai, John; Mbindyo, Patrick; Opiyo, Newton; Ayieko, Philip; Opondo, Charles; Migiro, Santau; Wamae, Annah; Irimu, Grace

    2009-07-23

    It is increasingly appreciated that the interpretation of health systems research studies is greatly facilitated by detailed descriptions of study context and the process of intervention. We have undertaken an 18-month hospital-based intervention study in Kenya aiming to improve care for admitted children and newborn infants. Here we describe the baseline characteristics of the eight hospitals as environments receiving the intervention, as well as the general and local health system context and its evolution over the 18 months. Hospital characteristics were assessed using previously developed tools assessing the broad structure, process, and outcome of health service provision for children and newborns. Major health system or policy developments over the period of the intervention at a national level were documented prospectively by monitoring government policy announcements, the media, and through informal contacts with policy makers. At the hospital level, a structured, open questionnaire was used in face-to-face meetings with senior hospital staff every six months to identify major local developments that might influence implementation. These data provide an essential background for those seeking to understand the generalisability of reports describing the intervention's effects, and whether the intervention plausibly resulted in these effects. Hospitals had only modest capacity, in terms of infrastructure, equipment, supplies, and human resources available to provide high-quality care at baseline. For example, hospitals were lacking between 30 to 56% of items considered necessary for the provision of care to the seriously ill child or newborn. An increase in spending on hospital renovations, attempts to introduce performance contracts for health workers, and post-election violence were recorded as examples of national level factors that might influence implementation success generally. Examples of factors that might influence success locally included frequent

  6. A Survey of Former Business Students (General Business, Management, Marketing, Real Estate). Summary Findings of Respondents District-Wide.

    Science.gov (United States)

    Glyer-Culver, Betty

    In fall 2002 staff of the Los Rios Community College District (LRCCD) Office of Institutional Research collaborated with occupational deans, academic deans, and faculty to develop and administer a survey of former business students. The survey was designed to determine how well courses had met the needs of former business students in the areas of…

  7. Generalized Anxiety Disorder and Hypoglycemia Symptoms Improved with Diet Modification

    Directory of Open Access Journals (Sweden)

    Monique Aucoin

    2016-01-01

    Full Text Available Observational evidence suggests that a relationship may exist between high glycemic index diets and the development of anxiety and depression symptoms; however, as no interventional studies assessing this relationship in a psychiatric population have been completed, the possibility of a causal link is unclear. AB is a 15-year-old female who presented with concerns of generalized anxiety disorder and hypoglycemia symptoms. Her diet consisted primarily of refined carbohydrates. The addition of protein, fat, and fiber to her diet resulted in a substantial decrease in anxiety symptoms as well as a decrease in the frequency and severity of hypoglycemia symptoms. A brief return to her previous diet caused a return of her anxiety symptoms, followed by improvement when she restarted the prescribed diet. This case strengthens the hypothesis that dietary glycemic index may play a role in the pathogenesis or progression of mental illnesses such as generalized anxiety disorder and subsequently that dietary modification as a therapeutic intervention in the treatment of mental illness warrants further study.

  8. Generalized Anxiety Disorder and Hypoglycemia Symptoms Improved with Diet Modification.

    Science.gov (United States)

    Aucoin, Monique; Bhardwaj, Sukriti

    2016-01-01

    Observational evidence suggests that a relationship may exist between high glycemic index diets and the development of anxiety and depression symptoms; however, as no interventional studies assessing this relationship in a psychiatric population have been completed, the possibility of a causal link is unclear. AB is a 15-year-old female who presented with concerns of generalized anxiety disorder and hypoglycemia symptoms. Her diet consisted primarily of refined carbohydrates. The addition of protein, fat, and fiber to her diet resulted in a substantial decrease in anxiety symptoms as well as a decrease in the frequency and severity of hypoglycemia symptoms. A brief return to her previous diet caused a return of her anxiety symptoms, followed by improvement when she restarted the prescribed diet. This case strengthens the hypothesis that dietary glycemic index may play a role in the pathogenesis or progression of mental illnesses such as generalized anxiety disorder and subsequently that dietary modification as a therapeutic intervention in the treatment of mental illness warrants further study.

  9. Extension and improvement of Central Station District heating budget period 1 and 2, Krakow Clean Fossil Fuels and Energy Efficiency Program. Final report

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1997-07-01

    Project aim was to reduce pollution levels in the City of Krakow through the retirement of coal-fired (hand and mechanically-stoked) boiler houses. This was achieved by identifying attractive candidates and connecting them to the Krakow district heating system, thus permitting them to eliminate boiler operations. Because coal is less costly than district hot water, the district heating company Miejskie Przedsiebiorstwo Energetyki Cieplnej S.A., henceforth identified as MPEC, needed to provide potential customers with incentives for purchasing district heat. These incentives consisted of offerings which MPEC made to the prospective client. The offerings presented the economic and environmental benefits to district heating tie-in and also could include conservation studies of the facilities, so that consumption of energy could be reduced and the cost impact on operations mitigated. Because some of the targeted boiler houses were large, the capacity of the district heating network required enhancement at strategic locations. Consequently, project construction work included both enhancement to the district piping network as well as facility tie-ins. The process of securing new customers necessitated the strengthening of MPEC`s competitive position in Krakow`s energy marketplace, which in turn required improvements in marketing, customer service, strategic planning, and project management. Learning how US utilities address these challenges became an integral segment of the project`s scope.

  10. Phenotypical and genotypical expression of Wolfram syndrome in 12 patients from a Sicilian district where this syndrome might not be so infrequent as generally expected.

    Science.gov (United States)

    Lombardo, F; Salzano, G; Di Bella, C; Aversa, T; Pugliatti, F; Cara, S; Valenzise, M; De Luca, F; Rigoli, L

    2014-02-01

    Since the original description, there have been only few epidemiological studies of Wolfram syndrome (WS). Aims of the present paper are to ascertain WS prevalence and expression in a district of North-eastern Sicily, i.e. a geographic area where consanguineous unions are not very unusual. Prevalence rates of WS in the Messina district were calculated by taking into consideration both the total population (653,737) and the populations included within the 0-30 year age range (202,681). We estimated the relative prevalence of WS among patients with youth-onset insulin-dependent diabetes mellitus (DM) who are currently aged under 30 years (256). Global WS prevalence in our district is 1:54,478, whereas prevalence among individuals under 30 is 1:16,890 and relative prevalence among patients with juvenile-onset insulin-dependent DM is 1:22.3. When compared with the patients with insulin-dependent DM of Messina district, WS patients did not exhibit significant differences in terms of biochemical features at DM onset, whereas age at DM diagnosis was significantly earlier in WS group. (a) WS prevalence is not so infrequent as generally expected; (b) in our series, DM presented before 10 years in 11/12 patients and ten cases have already developed all the four peculiar manifestations of WS by 26 years; (c) 9/12 patients exhibited a homozygous frameshift/truncation mutation (Y454_L459del_fsX454), which is the one most frequently found also in patients from other Italian regions; (d) age at DM diagnosis was significantly earlier in WS group than in the patients with insulin-dependent DM of Messina district.

  11. 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.

  12. Public sector scale-up of zinc and ORS improves coverage in selected districts in Bihar, India.

    Science.gov (United States)

    Walker, Christa L Fischer; Taneja, Sunita; Lamberti, Laura M; Black, Robert E; Mazumder, Sarmila

    2015-12-01

    In Bihar, India, a new initiative to enhance diarrhea treatment with zinc and ORS in the public sector was rolled out in selected districts. We conducted an external evaluation to measure changes in diarrhea careseeking and treatment in intervention districts. We conducted baseline and endline household surveys among caregivers of children 2-59 months of age. We calculated summary statistics for household characteristics, knowledge, careseeking and treatments given to children with a diarrhea episode in the last 14 days and built logistic regression models to compare baseline and endline values. Caregivers named a public health center as an appropriate source of care for childhood diarrhea more often at endline (71.3%) compared to baseline (38.4%) but did not report increased careseeking to public sector providers for the current diarrhea episode. In logistic regression analyses, the odds of receiving zinc, with or without oral rehydration salts (ORS), increased at endline by more than 2.7 as compared to baseline. Children who were taken to the public sector for care were more likely to receive zinc (odds ratio, OR = 3.93) and zinc in addition to ORS (OR = 6.10) compared to children who were not taken to the public sector. Coverage of zinc and ORS can improve with public sector programs targeted at training and increasing product availability, but demand creation may be needed to increase public sector careseeking in areas where the private sector has historically provided much of the care.

  13. Public sector scale–up of zinc and ORS improves coverage in selected districts in Bihar, India

    Directory of Open Access Journals (Sweden)

    Christa L. Fischer Walker

    2015-02-01

    Full Text Available In Bihar, India, a new initiative to enhance diarrhea treatment with zinc and ORS in the public sector was rolled out in selected districts. We conducted an external evaluation to measure changes in diarrhea careseeking and treatment in intervention districts. We conducted baseline and endline household surveys among caregivers of children 2–59 months of age. We calculated summary statistics for household characteristics, knowledge, careseeking and treatments given to children with a diarrhea episode in the last 14 days and built logistic regression models to compare baseline and endline values. Caregivers named a public health center as an appropriate source of care for childhood diarrhea more often at endline (71.3% compared to baseline (38.4% but did not report increased careseeking to public sector providers for the current diarrhea episode. In logistic regression analyses, the odds of receiving zinc, with or without oral rehydration salts (ORS, increased at endline by more than 2.7 as compared to baseline. Children who were taken to the public sector for care were more likely to receive zinc (odds ratio, OR = 3.93 and zinc in addition to ORS (OR = 6.10 compared to children who were not taken to the public sector. Coverage of zinc and ORS can improve with public sector programs targeted at training and increasing product availability, but demand creation may be needed to increase public sector careseeking in areas where the private sector has historically provided much of the care.

  14. Tell me where you live, and I will know why you are there. Territorial mobility and settlement of minor cities in General Pueyrredon District (Buenos Aires Province

    Directory of Open Access Journals (Sweden)

    Sofía Estela Ares

    2010-09-01

    Full Text Available Recognizing the space transformations related to the residential behaviors and the mobility of the population requires taking into consideration all the mobility habits, whatever the distance and duration. The purpose of this work is to put into evidence the prevailing motivations in the processes of observed mobility of the population in a set of minor cities next to provincial routes 11th south and 226th of General Pueyrredon District (Buenos Aires Province. Primary data were collected through ninety eight semi-structured surveys carried out in the space units that comprise the study area. The selection of the sampling units was accomplished through a non probabilistic method. The results show a set of non similarities among distinctive settlement lines, and even within them, and point to processes of consolidation of the social-territorial fragmentation beyond the main district urban area.

  15. Improving district level health planning and priority setting in Tanzania through implementing accountability for reasonableness framework: Perceptions of stakeholders.

    Science.gov (United States)

    Maluka, Stephen; Kamuzora, Peter; San Sebastián, Miguel; Byskov, Jens; Ndawi, Benedict; Hurtig, Anna-Karin

    2010-12-01

    In 2006, researchers and decision-makers launched a five-year project - Response to Accountable Priority Setting for Trust in Health Systems (REACT) - to improve planning and priority-setting through implementing the Accountability for Reasonableness framework in Mbarali District, Tanzania. The objective of this paper is to explore the acceptability of Accountability for Reasonableness from the perspectives of the Council Health Management Team, local government officials, health workforce and members of user boards and committees. Individual interviews were carried out with different categories of actors and stakeholders in the district. The interview guide consisted of a series of questions, asking respondents to describe their perceptions regarding each condition of the Accountability for Reasonableness framework in terms of priority setting. Interviews were analysed using thematic framework analysis. Documentary data were used to support, verify and highlight the key issues that emerged. Almost all stakeholders viewed Accountability for Reasonableness as an important and feasible approach for improving priority-setting and health service delivery in their context. However, a few aspects of Accountability for Reasonableness were seen as too difficult to implement given the socio-political conditions and traditions in Tanzania. Respondents mentioned: budget ceilings and guidelines, low level of public awareness, unreliable and untimely funding, as well as the limited capacity of the district to generate local resources as the major contextual factors that hampered the full implementation of the framework in their context. This study was one of the first assessments of the applicability of Accountability for Reasonableness in health care priority-setting in Tanzania. The analysis, overall, suggests that the Accountability for Reasonableness framework could be an important tool for improving priority-setting processes in the contexts of resource-poor settings

  16. Coastal women empowerment in improving enterprise of fish product processing in Sanga-Sanga Districts

    Science.gov (United States)

    Haqiqiansyah, G.; Sugiharto, E.

    2018-04-01

    This research was conducted to identify and scrutinize women empowerment of fish product processing group in the District of Sanga-Sanga on 2017. The method used was survey method, which is direct observation and interview to respondent. Data were collected in the form of primary and secondary data. Collected data then processed, tabulated, and displayed in the table and graph. The measurement of women empowerment degree was measured by Likert Scale on 3 level, that are score 1 = low, score 2 = less, and score 3 = high. The result of research demonstrated that the rate of empowerment women group of fish product processor was high (score 42,75). Partially, awareness level or willingness to change of processing enterprise group which indicate empowerment indicator categorized as high (91,67%). The level of capability to increase the chance of acquiring access was high (66,67%), the level of capability to overcome an obstacle tend to categorized as less (50%) and the level of capability to collaborate was high (66,67%). It means that the level of coastal women empowerment could be reliable to do a reformation.

  17. Generalized structural equations improve sexual-selection analyses.

    Directory of Open Access Journals (Sweden)

    Sonia Lombardi

    Full Text Available Sexual selection is an intense evolutionary force, which operates through competition for the access to breeding resources. There are many cases where male copulatory success is highly asymmetric, and few males are able to sire most females. Two main hypotheses were proposed to explain this asymmetry: "female choice" and "male dominance". The literature reports contrasting results. This variability may reflect actual differences among studied populations, but it may also be generated by methodological differences and statistical shortcomings in data analysis. A review of the statistical methods used so far in lek studies, shows a prevalence of Linear Models (LM and Generalized Linear Models (GLM which may be affected by problems in inferring cause-effect relationships; multi-collinearity among explanatory variables and erroneous handling of non-normal and non-continuous distributions of the response variable. In lek breeding, selective pressure is maximal, because large numbers of males and females congregate in small arenas. We used a dataset on lekking fallow deer (Dama dama, to contrast the methods and procedures employed so far, and we propose a novel approach based on Generalized Structural Equations Models (GSEMs. GSEMs combine the power and flexibility of both SEM and GLM in a unified modeling framework. We showed that LMs fail to identify several important predictors of male copulatory success and yields very imprecise parameter estimates. Minor variations in data transformation yield wide changes in results and the method appears unreliable. GLMs improved the analysis, but GSEMs provided better results, because the use of latent variables decreases the impact of measurement errors. Using GSEMs, we were able to test contrasting hypotheses and calculate both direct and indirect effects, and we reached a high precision of the estimates, which implies a high predictive ability. In synthesis, we recommend the use of GSEMs in studies on

  18. Council Districts

    Data.gov (United States)

    Town of Cary, North Carolina — View the location of the Town of Cary’s four Town Council districts.Please note that one district, District A, is split into two geo-spatial areas. One area is in...

  19. Improvements mineral dressing and extraction processes of gold-silver ores from San Pedro Frio Mining District, Colombia

    International Nuclear Information System (INIS)

    Yanez Traslavina, J. J.; Vargas Avila, M. A.; Garcia Paez, I. H.; Pedraza Rosas, J. E.

    2005-01-01

    The San Pedro Frio district mining, Colombia, is a rich region production gold-silver ores. Nowadays, the extraction processes used are amalgamation, percolation cyanidation and precipitation with zinc wood. Due to the ignorance of the ore characteristics, gold and silver treatment processes are inadequate and not efficient. In addition the inappropriate use of mercury and cyanide cause environmental contamination. In this research the ore characterization was carried out obtained fundamental parameters for the technical selection of more efficient gold and silver extraction processes. Experimental work was addressed to the study of both processes the agitation cyanidation and the adsorption on activated carbon in pulp. As a final result proposed a flowsheet to improve the precious metals recovery and reduce the environment contamination. (Author)

  20. A School Based Cluster Randomised Health Education Intervention Trial for Improving Knowledge and Attitudes Related to Taenia solium Cysticercosis and Taeniasis in Mbulu District, Northern Tanzania

    Science.gov (United States)

    Mwidunda, Sylvester A.; Carabin, Hélène; Matuja, William B. M.; Winkler, Andrea S.; Ngowi, Helena A.

    2015-01-01

    Taenia solium causes significant economic and public health impacts in endemic countries. This study determined effectiveness of a health education intervention at improving school children’s knowledge and attitudes related to T. solium cysticercosis and taeniasis in Tanzania. A cluster randomised controlled health education intervention trial was conducted in 60 schools (30 primary, 30 secondary) in Mbulu district. Baseline data were collected using a structured questionnaire in the 60 schools and group discussions in three other schools. The 60 schools stratified by baseline knowledge were randomised to receive the intervention or serve as control. The health education consisted of an address by a trained teacher, a video show and a leaflet given to each pupil. Two post-intervention re-assessments (immediately and 6 months post-intervention) were conducted in all schools and the third (12 months post-intervention) was conducted in 28 secondary schools. Data were analysed using Bayesian hierarchical log-binomial models for individual knowledge and attitude questions and Bayesian hierarchical linear regression models for scores. The overall score (percentage of correct answers) improved by about 10% in all schools after 6 months, but was slightly lower among secondary schools. Monitoring alone was associated with improvement in scores by about 6%. The intervention was linked to improvements in knowledge regarding taeniasis, porcine cysticercosis, human cysticercosis, epilepsy, the attitude of condemning infected meat but it reduced the attitude of contacting a veterinarian if a pig was found to be infected with cysticercosis. Monitoring alone was linked to an improvement in how best to raise pigs. This study demonstrates the potential value of school children as targets for health messages to control T. solium cysticercosis and taeniasis in endemic areas. Studies are needed to assess effectiveness of message transmission from children to parents and the general

  1. A school based cluster randomised health education intervention trial for improving knowledge and attitudes related to Taenia solium cysticercosis and taeniasis in Mbulu district, northern Tanzania.

    Science.gov (United States)

    Mwidunda, Sylvester A; Carabin, Hélène; Matuja, William B M; Winkler, Andrea S; Ngowi, Helena A

    2015-01-01

    Taenia solium causes significant economic and public health impacts in endemic countries. This study determined effectiveness of a health education intervention at improving school children's knowledge and attitudes related to T. solium cysticercosis and taeniasis in Tanzania. A cluster randomised controlled health education intervention trial was conducted in 60 schools (30 primary, 30 secondary) in Mbulu district. Baseline data were collected using a structured questionnaire in the 60 schools and group discussions in three other schools. The 60 schools stratified by baseline knowledge were randomised to receive the intervention or serve as control. The health education consisted of an address by a trained teacher, a video show and a leaflet given to each pupil. Two post-intervention re-assessments (immediately and 6 months post-intervention) were conducted in all schools and the third (12 months post-intervention) was conducted in 28 secondary schools. Data were analysed using Bayesian hierarchical log-binomial models for individual knowledge and attitude questions and Bayesian hierarchical linear regression models for scores. The overall score (percentage of correct answers) improved by about 10% in all schools after 6 months, but was slightly lower among secondary schools. Monitoring alone was associated with improvement in scores by about 6%. The intervention was linked to improvements in knowledge regarding taeniasis, porcine cysticercosis, human cysticercosis, epilepsy, the attitude of condemning infected meat but it reduced the attitude of contacting a veterinarian if a pig was found to be infected with cysticercosis. Monitoring alone was linked to an improvement in how best to raise pigs. This study demonstrates the potential value of school children as targets for health messages to control T. solium cysticercosis and taeniasis in endemic areas. Studies are needed to assess effectiveness of message transmission from children to parents and the general

  2. A school based cluster randomised health education intervention trial for improving knowledge and attitudes related to Taenia solium cysticercosis and taeniasis in Mbulu district, northern Tanzania.

    Directory of Open Access Journals (Sweden)

    Sylvester A Mwidunda

    Full Text Available Taenia solium causes significant economic and public health impacts in endemic countries. This study determined effectiveness of a health education intervention at improving school children's knowledge and attitudes related to T. solium cysticercosis and taeniasis in Tanzania. A cluster randomised controlled health education intervention trial was conducted in 60 schools (30 primary, 30 secondary in Mbulu district. Baseline data were collected using a structured questionnaire in the 60 schools and group discussions in three other schools. The 60 schools stratified by baseline knowledge were randomised to receive the intervention or serve as control. The health education consisted of an address by a trained teacher, a video show and a leaflet given to each pupil. Two post-intervention re-assessments (immediately and 6 months post-intervention were conducted in all schools and the third (12 months post-intervention was conducted in 28 secondary schools. Data were analysed using Bayesian hierarchical log-binomial models for individual knowledge and attitude questions and Bayesian hierarchical linear regression models for scores. The overall score (percentage of correct answers improved by about 10% in all schools after 6 months, but was slightly lower among secondary schools. Monitoring alone was associated with improvement in scores by about 6%. The intervention was linked to improvements in knowledge regarding taeniasis, porcine cysticercosis, human cysticercosis, epilepsy, the attitude of condemning infected meat but it reduced the attitude of contacting a veterinarian if a pig was found to be infected with cysticercosis. Monitoring alone was linked to an improvement in how best to raise pigs. This study demonstrates the potential value of school children as targets for health messages to control T. solium cysticercosis and taeniasis in endemic areas. Studies are needed to assess effectiveness of message transmission from children to parents and

  3. Improved measurements of RNA structure conservation with generalized centroid estimators

    Directory of Open Access Journals (Sweden)

    Yohei eOkada

    2011-08-01

    Full Text Available Identification of non-protein-coding RNAs (ncRNAs in genomes is acrucial task for not only molecular cell biology but alsobioinformatics. Secondary structures of ncRNAs are employed as a keyfeature of ncRNA analysis since biological functions of ncRNAs aredeeply related to their secondary structures. Although the minimumfree energy (MFE structure of an RNA sequence is regarded as the moststable structure, MFE alone could not be an appropriate measure foridentifying ncRNAs since the free energy is heavily biased by thenucleotide composition. Therefore, instead of MFE itself, severalalternative measures for identifying ncRNAs have been proposed such asthe structure conservation index (SCI and the base pair distance(BPD, both of which employ MFE structures. However, thesemeasurements are unfortunately not suitable for identifying ncRNAs insome cases including the genome-wide search and incur high falsediscovery rate. In this study, we propose improved measurements basedon SCI and BPD, applying generalized centroid estimators toincorporate the robustness against low quality multiple alignments.Our experiments show that our proposed methods achieve higher accuracythan the original SCI and BPD for not only human-curated structuralalignments but also low quality alignments produced by CLUSTALW. Furthermore, the centroid-based SCI on CLUSTAL W alignments is moreaccurate than or comparable with that of the original SCI onstructural alignments generated with RAF, a high quality structuralaligner, for which two-fold expensive computational time is requiredon average. We conclude that our methods are more suitable forgenome-wide alignments which are of low quality from the point of viewon secondary structures than the original SCI and BPD.

  4. Promotional study for joint implementation program. Energy conservation and efficiency improvement for district heating system in Tashkent, Uzbekistan

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2000-03-01

    For the purpose of reducing greenhouse effect gas emissions, a study was carried out for repair/improvement of the district heating system in Tashkent City, the Republic of Uzbekistan. In the project, the following were studied: heightening of electrical insulation of the total pipeline, improvement in efficient utilization of heat energy in the thermal plant. As to the existing pipeline, heat loss is improved by 0-5% by changing it to electrical insulation pipe. In relation to the thermal plant, studied were cogeneration facility A using three 4MW gas turbines and combined cycle cogeneration facility B using two 40MW gas turbines. As a result, the amount of energy saving was 11,370 toe/y in pipeline, 12,750 toe/y in facility A and 69,000 toe/y in facility B. Further, the reduction amount of greenhouse effect gas emissions was 27,200t-CO2/y in pipeline, 30,500t-CO2/y in facility A and 164,900t-CO2/y in facility B. (NEDO)

  5. Systems for Instructional Improvement: Creating Coherence from the Classroom to the District Office

    Science.gov (United States)

    Cobb, Paul; Jackson, Kara; Henrick, Erin; Smith, Thomas M.

    2018-01-01

    In "Systems for Instructional Improvement," Paul Cobb and his colleagues draw on their extensive research to propose a series of specific, empirically grounded recommendations that together constitute a theory of action for advancing instruction at scale. The authors outline the elements of a coherent instructional system; describe…

  6. Good Housekeeping Implementation for Improving Efficiency in Cassava Starch Industry (Case Study : Margoyoso District, Pati Regency)

    Science.gov (United States)

    Aji, Wijayanto Setyo; Purwanto; Suherman, S.

    2018-02-01

    Cassava starch industry is one of the leading small-medium enterprises (SMEs) in Pati Regency. Cassava starch industry released waste that reduces the quantity of final product and potentially contamined the environment. This study was conducted to observe the feasibility of good housekeeping implementation to reduce waste and at the same time improve efficiency of production process. Good housekeeping opportunities are consideration by three aspect, technical, economy and environmental. Good housekeeping opportunities involved water conservation and waste reduction. These included reuse of water in washing process, improving workers awareness in drying section and packaging section. Implementation of these opportunities can reduce water consumption, reduce wastewater and solid waste generation also increased quantity of final product.

  7. Association of oral health related quality of life with dental anxiety and depression along with general health among people of Bhopal district, Madhya Pradesh

    Science.gov (United States)

    Shet, RGK; Jain, Gaurvi; Maroli, Sohani; Srivastava, Kirti Jajoo; Kasina, Sitaram Prasad; Shwetha, GS

    2013-01-01

    Background: To associate oral health related quality of life with dental anxiety and depression along with general health among people of Bhopal district, Madhya Pradesh. Materials & Methods: A cross sectional questionnaires based survey was conducted among the subjects of Bhopal district, Madhya Pradesh. The survey was carried among 101 subjects aging from 20-40 years. Subjects under investigation were belonging to various occupations. They were assigned a questionnaire. Questionnaire consisted of four parts, first part consists of socio-demographic data along with dental visiting habits, second part has OHqOL-questionnaire, third part has general health (sf-12) and fourth part has hospital anxiety and depression questionnaire. Questionnaire was used for assessment of OHqOL. It consists of 16 questions which takes into account both effect and impact of oral health on quality of life. Dental anxiety and depression was measured by Hospital Anxiety and Depression Scale. Each question was provided with four options and numbering ranging from 0-3. For general health consideration sf-12 v2 was being used, which calculates two values PCS and MCS giving result in percentage. Results: A large proportion of respondent perceived oral health as having an enhanced effect on their quality of life in all three aspects that is general health, social and psychological. This is in stark contrast to other studies, where only physical aspects of oral health were more frequently considered to have the greatest overall impact of life quality compared with items relating to social, psychological and general health aspects. Conclusion: Gender variations were not apparent in the study. Both genders were likely to perceive oral health as it is impacting strongly on their quality of life. No significant gender variations are seen. But both have specific oral health needs and are most likely to utilize dental services which may be the key in understanding oral health behavior, including

  8. Economic geology of the Bingham mining district, Utah, with a section on areal geology, and an introduction on general geology

    Science.gov (United States)

    Boutwell, J.M.; Keith, Arthur; Emmons, S.F.

    1905-01-01

    The field work of which this report represents the final results was first undertaken in the summer of the year 1900. This district had long been selected by the writer as worthy of special economic investigation, as well on account of the importance of its products as because of its geological structure and the peculiar relations of its ore deposits. It was not, however, until the summer mentioned above that the means at the disposal of the Survey, both pecuniary and scientific, justified its undertaking. As originally planned, the areal or surface geology was to have been worked out by Mr. Keith, who had already spent many years in unraveling the complicated geological structure of the Appalachian province, while Mr. Boutwell, who had more recently become attached to the Survey, was to have charge of the underground geology, or a study of the ore deposits, under the immediate supervision of the writer. When the time came for actually taking the field, it was found that the pressure of other work would not permit Mr. Keith to carry out fully the part allotted to him, and in consequence a part of his field work has fallen to Mr. Boutwell. Field work was commenced by the writer and Mr. Boutwell early in July, 1900. Mr. Keith joined the party on August 10, but was obliged to leave for other duties early in September. Mr. Boutwell carried on his field work continuously from July until December, taking up underground work after the snowfall had rendered work on the surface geology impracticable. The geological structure had proved to be unexpectedly intricate and complicated, so that, on the opening of the field season of 1901, it was found necessary to make further study in the light of results already worked out, and Mr. Boutwell spent some weeks in the district in the early summer of 1901. His field work that year, partly in California and partly in Arizona, as assistant to Mr. Waldemar Lindgren, lasted through the summer and winter and well into the spring of 1902

  9. Role of courtyard counselling meeting in improving household food safety knowledge and practices in Munshiganj district of Bangladesh.

    Science.gov (United States)

    Riaz, Baizid Khoorshid; Alim, Md Abdul; Islam, Anm Shamsul; Amin, Km Bayzid; Sarker, Mohammad Abul Bashar; Hasan, Khaled; Ashad-Uz-Zaman, Md Noor; Selim, Shahjada; Quaiyum, Salman; Haque, Emdadul; Monir Hossain, Shah; Ryder, John; Khanam, Rokeya

    2016-12-01

    Unsafe food is linked to the deaths of an estimated two million people annually. Food containing harmful agents is responsible for more than 200 diseases ranging from diarrhoea to cancers. A one-sample pilot intervention study was conducted to evaluate the role of courtyard counselling meetings as the means of intervention for improving food safety knowledge and practices among household food handlers in a district of Bangladesh. The study was conducted in three phases: a baseline survey, the intervention and an end-line survey between April and November 2015 where 194 food handlers took part. Data were collected through observations and face-to-face interviews. The mean age of the respondents was 38.8 (±12.4) years, all of whom were females. Hand washing before eating, and washing utensils with soap were significantly improved at the end-line in comparison to the baseline (57% vs. 40% and 83% vs. 69%, respectively). Hand washing with soap was increased by 4%. The mean score of food handling practices was significantly increased after the intervention (20.5 vs. 22.1; Pfood and the necessity of thorough cooking were significantly increased after the intervention (88% from 64% and 34% from 21%, respectively). Mean scores of knowledge and practice on food safety were significantly increased by 1.9 and 1.6, respectively after the one month intervention. Thus this food safety education in rural communities should be scaled up and, indeed, strengthened using the courtyard counselling meetings in Bangladesh.

  10. Improving Pilot/ATC Voice Communication in General Aviation

    National Research Council Canada - National Science Library

    Morrow, Daniel

    1999-01-01

    ...) Basic General Aviation Research Simulator (BGARS). Prior to flying the simulator each pilot was provided with familiarization training, listened to and read back ATC messages spoken in either grouped or sequential format...

  11. Improving Racial and Ethnic Distribution and Intergroup Relations; An Advisory Report to the Board of Education, Vallejo Unified School District.

    Science.gov (United States)

    Gunsky, Frederic R.; And Others

    As the result of field observation and a review of school data, this report presents the findings of a study of minority-group education and intergroup relations in the Vallejo Unified School District in California. It analyzes the racial and ethnic distribution o f students in the school district and describes the amount of equal educational…

  12. 76 FR 1592 - National Poultry Improvement Plan; General Conference Committee Meeting

    Science.gov (United States)

    2011-01-11

    ...] National Poultry Improvement Plan; General Conference Committee Meeting AGENCY: Animal and Plant Health... General Conference Committee of the National Poultry Improvement Plan. DATES: The General Conference... Improvement Plan, VS, APHIS, 1498 Klondike Road, Suite 101, Conyers, GA 30094-5104; (770) 922-3496...

  13. Feasibility improvement project of a district heat supply system in Dalian, China

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2001-03-01

    Investigations and discussions have been given on energy saving possibilities at two medium-sized heat and power supplying plants in the city of Dalian in China. The project will improve the operation methods of the heat and power plants so that the energy cost can be minimized, and attempt to improve the boiler heat efficiency and save the energy by means of heat recovery and utilization. The draft modification plan for energy conservation has planned operation optimization for energy conservation, control of boiler operation under variable pressure, modification of the external boiler heat converter, use of inverters for the large capacity motors for boilers, and recovery of heat from the boiler blow-down water. In the analysis, models were structured from the operation data, and the effects of applying the energy saving measures were derived from simulation. As a result, the energy saving effect was found to be about 13,000 tons at the Chunhai plant and about 7,000 tons at the Pulandian plant annually (converted to oil). The reduction in greenhouse gas emission was found to be about 40,000 tons at the Chunhai plant and about 20,000 tons at the Pulandian plant annually. The number of years for investment payback is about 4.1 years at the Chunhai plant, and about 4.9 years at the Pulandian plant, wherein good profitability can be estimated. (NEDO)

  14. Improving neonatal care in district and community health facilities in South Africa.

    Science.gov (United States)

    Woods, David Lawrance

    2015-08-01

    A high standard of newborn care, especially at a primary level, is needed to address the neonatal mortality rate in South Africa. The current approach to continuing training of health-care workers uses traditional methods of centralised teaching by formal tutors away from the place of work. This is no longer affordable, achievable or desirable, particularly in rural areas. An innovative system of self-directed learning by groups of nurses caring for mothers and their newborn infants uses specially prepared course books without the need for trainers. Using self-study supported by peer discussion groups, nurses can take responsibility for their own professional growth. This builds competence, confidence and a sense of pride. Since 1993, the Perinatal Education Programme has provided continuing learning opportunities for thousands of nurses in Southern Africa. A number of prospective trials have demonstrated that study groups can significantly improve knowledge and understanding, attitudes, clinical skills and quality of care provided to mothers and infants. A recent review of 10,000 successful participants across a wide range of provinces, ages and home languages documented the success of the project. Using a question-and-answer format to promote problem-solving, case studies, simple skills workshops and multiple choice tests, each module addresses common conditions with appropriate care practices such as thorough drying at birth, delayed cord-clamping, skin-to-skin care, breast feeding, basic resuscitation, correct use of oxygen therapy, hand-washing, blood glucose monitoring and promotion of parental bonding. The training material is now also available free of charge on an on-line website as well as being presented as e-books which can be downloaded onto personal computers, tablet readers and smart phones. This is supplemented by regular SMS text messages providing nurses with relevant 'knowledge bites'. All nurses caring for newborn infants now have easy

  15. Improving homework compliance in the treatment of generalized anxiety disorder.

    Science.gov (United States)

    Leahy, Robert L

    2002-05-01

    Generalized anxiety disorder is a chronic condition characterized by beliefs that worry prepares and protects, but that excessive worry is out of control. In this article, I review the cognitive-behavioral model of generalized anxiety, focusing specifically on problems related to excessive worrying. Noncompliance in self-help homework is reflected in the patient's excessive focus on negative feelings, difficulty identifying automatic thoughts, demand for immediate results, and the belief that worries are realistic. Interventions for these problems are illustrated in the case of the treatment of a patient characterized by persistent worries, low self-confidence, procrastination, and avoidance. Copyright 2002 Wiley Periodicals, Inc.

  16. Performance Improvement Strategic Home Based Manufacturer Tahu And Tempe Groups Based In The District Of Jember

    Directory of Open Access Journals (Sweden)

    Istatuk Budi Yuswanto

    2017-04-01

    Full Text Available Tahu dan tempe is a product of the soybean meal that has been known since long in Indonesia. Tahu is a Chinese food products in contrast to tempe an authentic Indonesian food . As tempe tahu also favored by the people of Indonesia because it has a taste that delicious nutritious and affordable price.Industries that produce tahu dan tempe are generally small-scale home-based businesses with the number of workers a little less than 2-6 people and investments that are not too large. The use of technology in small business home-based producer of tahu dan tempe quite simple and easy to learn so it can be run by anyone. The success of small business home-based manufacturers to survive and evolve toward more advanced by knowing their strengths weaknesses opportunities that can be taken by small business home-based and threat or better known as the SWOT Strength Weakness Opportunity Threath that can be retrieved strategies that affect the success and development of small business home-based manufacturer of tahu dan tempe.Constraints faced by small businesses and home-based manufacturers know that the soybean Tepe that include budget constraints limited access to banking limited human resources marketing only the scope of Jember and lack of good management. No group or cooperative does not have a good recording making it difficult to make financial reports manufacturing planning and operational supervision and finances into this industry employers group lemah.Pembentukan help solve problems and maximize its potential.

  17. Regional Social Infrastructure Management as the Instrument for Improving the Quality of Life in the Ural Federal District

    Directory of Open Access Journals (Sweden)

    Valentina Sergeyevna Antonyuk

    2015-09-01

    Full Text Available The article analyzes the processes of the social sphere and the effective operation of social infrastructure in order to improve the quality of life of the population in the Russian regions. Particular attention is paid to the role of the organizational and managerial component affecting usage performance of infrastructure objects and including regulation of the institutions of social infrastructure, planning and software. The purpose of the study is to evaluate the effectiveness of management of social infrastructure through the conjugation of immediate results (the dynamics of indicators of social services and outcomes (parameters of the quality of life of the population. The hypothesis of the study was the violation of the principle of infra-systematicity in the infrastructural support of the improvement of the quality of life in the Russian regions, due to the lack of effectiveness of public administration. In the study, the following methodological approaches are used: structural, factoral, systematic and evolutionary approaches to justify the conception, develop methodology and determine the impact of changes in the parameters of social infrastructure availability for the provided services, shifts in indexes of quality of life. The paper proposes the quantitative evaluation of the effectiveness of organizational management based on the diagnosis of the adequacy of the implementation of the principle of infra-systematicity in the functioning of social infrastructure on the basis of the elasticity coefficient. The proposed approach and the received analytical data on health, education, commerce, housing, culture and sport fields have allowed to range the regions of the Ural Federal District and highlight the areas of insufficient effectiveness of the organizational and management tool for improvement of life quality. The findings of the research may serve as a core for practical recommendations for executive bodies of administrative units of

  18. Lifestyle intervention according to general recommendations improves glucose tolerance

    NARCIS (Netherlands)

    Mensink, M.R.; Blaak, E.E.; Corpeleijn, E.; Saris, W.H.M.; Bruin, T.W.; Feskens, E.J.M.

    2003-01-01

    Objective: Changing dietary and physical activity habits has the potential to postpone or prevent the development of type 2 diabetes. However, it needs to be assessed whether moderate interventions, in agreement with current guidelines for the general population, are effective. We evaluated the

  19. Segmenting a general practitioner market to improve recruitment outcomes.

    Science.gov (United States)

    Hemphill, Elizabeth; Kulik, Carol T

    2011-05-01

    Recruitment is an ongoing challenge in the health industry with general practitioner (GP) shortages in many areas beyond rural and Indigenous communities. This paper suggests a marketing solution that identifies different segments of the GP market for recruitment strategy development. In February 2008, 96 GPs in Australia responded to a mail questionnaire (of which 85 questionnaires were useable). A total of 350 GPs were sent the questionnaire. Respondents considered small sets of attributes in the decision to accept a new job at a general practice and selected the most and least important attribute from each set. We identified latent class clusters (cohorts) of GPs from the most-least important data. Three cohorts were found in the GP market, distinguishing practitioners who emphasised job, family or practice attributes in their decision to join a practice. Few significant demographic differences exist between the cohorts. A segmented GP market suggests two alternative recruitment strategies. One option is for general practices to target members of a single cohort (family-, job-, or practice-focussed GPs). The other option is for general practices to diversify their recruitment strategies to target all three cohorts (family-, job- and practice-focussed GPs). A single brand (practice) can have multiple advertising strategies with each strategy involving advertising activities targeting a particular consumer segment.

  20. Generalized Anxiety Disorder and Hypoglycemia Symptoms Improved with Diet Modification

    OpenAIRE

    Aucoin, Monique; Bhardwaj, Sukriti

    2016-01-01

    Observational evidence suggests that a relationship may exist between high glycemic index diets and the development of anxiety and depression symptoms; however, as no interventional studies assessing this relationship in a psychiatric population have been completed, the possibility of a causal link is unclear. AB is a 15-year-old female who presented with concerns of generalized anxiety disorder and hypoglycemia symptoms. Her diet consisted primarily of refined carbohydrates. The addition of ...

  1. Improving General Intelligence with a Nutrient-Based Pharmacological Intervention

    Science.gov (United States)

    Stough, Con; Camfield, David; Kure, Christina; Tarasuik, Joanne; Downey, Luke; Lloyd, Jenny; Zangara, Andrea; Scholey, Andrew; Reynolds, Josh

    2011-01-01

    Cognitive enhancing substances such as amphetamine and modafinil have become popular in recent years to improve acute cognitive performance particularly in environments in which enhanced cognition or intelligence is required. Nutraceutical nootropics, which are natural substances that have the ability to bring about acute or chronic changes in…

  2. Improving the smoking patterns in a general hospital psychiatric unit

    Directory of Open Access Journals (Sweden)

    Celso Iglesias García

    2009-01-01

    Full Text Available Objectives: The purpose of the present paper is to evaluate the effects of a smoking ban in a general hospital psychiatric unit. Methods: We study the effects of smoking ban in 40 consecutive psychiatric inpatients. The staff registered socio-demographic and tobacco-related variables. We also registered any kind of behavioral effects of smoking ban.Results: The patients were willing to stop smoking during their hospital stay (with or without nicotine replacement with two mild behavioural incidences registered throughout the study. Conclusions: The benefits of non-smoking policy in a psychiatric unit can be significant. The introduction of smoking bans in psychiatric inpatients settings is possible and safe.

  3. 75 FR 23222 - National Poultry Improvement Plan; General Conference Committee Meeting and 40th Biennial Conference

    Science.gov (United States)

    2010-05-03

    ...] National Poultry Improvement Plan; General Conference Committee Meeting and 40th Biennial Conference AGENCY... notice of a meeting of the General Conference Committee of the National Poultry Improvement Plan (NPIP... Coordinator, National Poultry Improvement Plan, VS, APHIS, 1498 Klondike Road, Suite 101, Conyers, GA 30094...

  4. 77 FR 46374 - National Poultry Improvement Plan; General Conference Committee Meeting and 41st Biennial Conference

    Science.gov (United States)

    2012-08-03

    ...] National Poultry Improvement Plan; General Conference Committee Meeting and 41st Biennial Conference AGENCY... notice of a meeting of the General Conference Committee of the National Poultry Improvement Plan (NPIP... CONTACT: Dr. C. Stephen Roney, Senior Coordinator, National Poultry Improvement Plan, VS, APHIS, 1506...

  5. 77 FR 1051 - General Conference Committee of the National Poultry Improvement Plan; Meeting

    Science.gov (United States)

    2012-01-09

    ...] General Conference Committee of the National Poultry Improvement Plan; Meeting AGENCY: Animal and Plant... the General Conference Committee of the National Poultry Improvement Plan. DATES: The meeting will be... INFORMATION CONTACT: Dr. C. Stephen Roney, Senior Coordinator, National Poultry Improvement Plan, VS, APHIS...

  6. 77 FR 42257 - General Conference Committee of the National Poultry Improvement Plan; Solicitation for Membership

    Science.gov (United States)

    2012-07-18

    ...] General Conference Committee of the National Poultry Improvement Plan; Solicitation for Membership AGENCY... regional membership for the General Conference Committee of the National Poultry Improvement Plan. DATES... INFORMATION CONTACT: Dr. C. Stephen Roney, Senior Coordinator, National Poultry Improvement Plan, VS, APHIS...

  7. Improvements in cross-infection control in general dental practice.

    Science.gov (United States)

    Bentley, E M; Sarll, D W

    1995-07-08

    A questionnaire about cross-infection control was sent to all GDPs in five FHSAs in the North Western Region. Replies came from 312 dentists, a response rate of 74%. They worked in 185 practices, a response rate of 85%. Gloves were worn routinely by 86% of dentists and 80% of DSAs. Handpieces were autoclaved between patients in 77% of practices. Much however, remains to be improved. DSAs could be better protected if more ultrasonic cleaners were used, eye protection encouraged and heavy duty gloves were available for cleaning instruments. BDA guidelines were reported as being the most influential factor, though it would appear that the media did persuade many practitioners to use autoclavable handpieces and sterilise them after each use.

  8. Surface energy and radiation balance systems - General description and improvements

    Science.gov (United States)

    Fritschen, Leo J.; Simpson, James R.

    1989-01-01

    Surface evaluation of sensible and latent heat flux densities and the components of the radiation balance were desired for various vegetative surfaces during the ASCOT84 experiment to compare with modeled results and to relate these values to drainage winds. Five battery operated data systems equipped with sensors to determine the above values were operated for 105 station days during the ASCOT84 experiment. The Bowen ratio energy balance technique was used to partition the available energy into the sensible and latent heat flux densities. A description of the sensors and battery operated equipment used to collect and process the data is presented. In addition, improvements and modifications made since the 1984 experiment are given. Details of calculations of soil heat flow at the surface and an alternate method to calculate sensible and latent heat flux densities are provided.

  9. Korean district heating. Part 1: A general report on Korean district heating 1994/1995; Fjaerrvaerme i Korea. Del 1: En allmaen redovisning av koreansk fjaerrvaerme aarsskiftet 1994/95

    Energy Technology Data Exchange (ETDEWEB)

    Joensson, Mats; Olsson, Nils

    1996-02-01

    This thesis describes the conditions for district heating in the Republic of Korea at the turn of the year 1994-95. It is based on a study made in Seoul at Korea District Heating Corporation, which is the largest district heating utility in Korea. The substations were particularly studied. District heating was introduced in Korea in the 80s because of the environmental advantages. KHDC was established in 1985 and in 1994 they provided 340 000 households with district heating. By the year of 2001 KDHC plans to supply 45% of the heating in Seoul with its 12 million inhabitants. KDHC receives most of its thermal energy from combined heat and power plants that use natural gas as fuel. In 1991 KDHC initiated a collaboration with Ekono of Finland to develop more advanced technology in Korea. Therefore the Finnish standard, which is similar to Swedish standard, has left it`s mark on the Korean district heating technology. Typical for the Korean substation is that the heat exchangers are connected in parallel in only one step. KDHC:s expansion will, within a couple of years, help to make Korea one of the leading countries in modern district heating. 9 refs, 3 figs, 2 tabs

  10. Participative leadership practice in junior high schools and actions to improve the practice : a case study of Sekyere south district, Ghana

    OpenAIRE

    Gyasi, Kwame

    2015-01-01

    Gyasi, Kwame. 2015. Participative leadership practice in junior high schools and actions to improve the practice: a case study of Sekyere south district, Ghana Master's Thesis in Education. University of Jyväskylä. Department of Education Participative leadership practice is seen as the kind of school leadership which recognizes parents’ contribution and teachers’ ability and talents in leadership by sharing with them roles and responsibilities in the school administrative process. Th...

  11. District heating

    International Nuclear Information System (INIS)

    Hansen, L.

    1993-01-01

    The environmental risks and uncertainties of a high-energy future are disturbing and give rise to several reservations concerning the use of fossil fuels. A number of technologies will help to reduce atmospheric pollution. In Denmark special importance is attached to the following: Energy conservation. Efficient energy conversion. Renewable energy sources. District heating, combined production of heat and power. Many agree that district heating (DH), produced by the traditional heat-only plant, and combined heat and power (CHP) have enormous potential when considering thermal efficiency and lowered environmental impacts: The basic technology of each is proven, it would be relatively simple to satisfy a substantial part of the energy demand, and their high efficiencies mean reduced pollution including greenhouse gas emissions. This is especially important in high population density areas - the obviously preferred sites for such energy generation. Compared with individual heating DH can provide a community with an operationally efficient and most often also an economically competitive heat supply. This is particularly true under the circumstances where the DH system is supplied from CHP plants. Their use results in very substantial improvements in overall efficiency. Further environmental improvements arise from the reduced air pollution obtainable in reasonably large CHP plants equipped with flue gas cleaning to remove particles, sulphur dioxide, and nitrogen acids. As a consequence of these considerations, DH plays an important role in fulfilling the space and water heating demand in many countries. This is especially the case in Denmark where this technology is utilised to a very great extent. Indeed, DH is one of the reasons why Denmark has relatively good air quality in the cities. (au)

  12. Knowledge and practices of general practitioners at district hospitals towards cervical cancer prevention in Burundi, 2015: a cross-sectional study.

    Science.gov (United States)

    Ndizeye, Zacharie; Vanden Broeck, Davy; Vermandere, Heleen; Bogers, John Paul; Van Geertruyden, Jean-Pierre

    2018-01-16

    Well-organized screening and treatment programmes are effective to prevent Invasive Cervical Cancer (ICC) in LMICs. To achieve this, the World Health Organization (WHO) recommends the involvement of existing health personnel in casu doctors, nurses, midwives in ICC prevention. A necessary precondition is that health personnel have appropriate knowledge about ICC. Therefore, to inform policy makers and training institutions in Burundi, we documented the knowledge and practices of general practitioners (GPs) at district hospital level towards ICC control. A descriptive cross-sectional survey was conducted from February to April, 2015 among all GPs working in government district hospitals. A structured questionnaire and a scoring system were used to assess knowledge and practices of GPs. The participation rate was 58.2%. Majority of GPs (76.3%) had appropriate knowledge (score > 70%) on cervical cancer disease; but some risk factors were less well known as smoking and the 2 most important oncogenic HPV. Only 8.4% of the participants had appropriate knowledge on ICC prevention: 55% of the participants were aware that HPV vaccination exists and 48.1% knew cryotherapy as a treatment method for CIN. Further, 15.3% was aware of VIA as a screening method. The majority of the participants (87%) never or rarely propose screening tests to their clients. Only 2 participants (1.5%) have already performed VIA/VILI. Wrong thoughts were also reported: 39.7% thought that CIN could be treated with radiotherapy; 3.1% thought that X-ray is a screening method. In this comprehensive assessment, we observed that Burundian GPs have a very low knowledge level about ICC prevention, screening and treatment. Suboptimal practices and wrong thoughts related to ICC screening and treatments have also been documented. We therefore recommend an adequate pre- and in-service training of GPs and most probably nurses on ICC control before setting up any public health intervention on ICC control.

  13. Investigating the Role of Instructional Rounds in the Development of Social Networks and District-Wide Improvement

    Science.gov (United States)

    Hatch, Thomas; Hill, Kathryn; Roegman, Rachel

    2016-01-01

    In this article, we explore how organizational routines involving instructional rounds--collective, structured observations and reflections on classroom practice--might contribute to the development of social networks among administrators and support a common, district-wide focus on instruction. Building on work on communities of practice, we…

  14. Innovations in Agriculture in Oregon: Farmers Irrigation District Improves Water Quality, Maximizes Water Conservation, and Generates Clean, Renewable Energy

    Science.gov (United States)

    The Hood River Farmers Irrigation District used $36.2 million in CWSRF loans for a multiple-year endeavor to convert the open canal system to a piped, pressurized irrigation system to maximize water conservation and restore reliable water delivery to crops

  15. Method for reducing excess heat supply experienced in typical Chinese district heating systems by achieving hydraulic balance and improving indoor air temperature control at the building level

    International Nuclear Information System (INIS)

    Zhang, Lipeng; Gudmundsson, Oddgeir; Thorsen, Jan Eric; Li, Hongwei; Li, Xiaopeng; Svendsen, Svend

    2016-01-01

    A common problem with Chinese district heating systems is that they supply more heat than the actual heat demand. The reason for this excess heat supply is the general failure to use control devices to adjust the indoor temperature and flow in the building heating systems in accordance with the actual heat demand. This results in 15–30% of the total supplied heat being lost. This paper proposes an integrated approach that aims to reduce the excess heat loss by introducing pre-set thermostatic radiator valves combined with automatic balancing valves. Those devices establish hydraulic balance, and stabilize indoor temperatures. The feasibility and the energy consumption reduction of this approach were verified by means of simulation and a field test. By moving the system from centrally planned heat delivery to demand-driven heat delivery, excess heat loss can be significantly reduced. Results show that once the hydraulic balance is achieved and indoor temperatures are controlled with this integrated approach, 17% heat savings and 42.8% pump electricity savings can be achieved. The energy savings will also have a positive environmental effect with seasonal reductions of 11 kg CO_2, 0.1 kg SO_2, and 0.03 kg NO_x per heating square meter for a typical case in Harbin. - Highlights: • Two real cases reflect the temperature and flow control situation of heating systems in China. • Pre-set radiator valves with automatic balancing valves create dynamic hydraulic balance. • IDA-ICE simulation shows 17% heat saving and 48% pump electricity saving. • This approach can improve the comfort level of multi-storey/high-rise residential buildings. • This approach can reduce excess heat supply and bring out positive environmental impacts.

  16. Is Knowledge Regarding Tuberculosis Associated with Stigmatising and Discriminating Attitudes of General Population towards Tuberculosis Patients? Findings from a Community Based Survey in 30 Districts of India.

    Science.gov (United States)

    Sagili, Karuna D; Satyanarayana, Srinath; Chadha, Sarabjit S

    2016-01-01

    Stigmatising and discriminating attitudes may discourage tuberculosis (TB) patients from actively seeking medical care, hide their disease status, and discontinue treatment. It is expected that appropriate knowledge regarding TB should remove stigmatising and discriminating attitudes. In this study we assessed the prevalence of stigmatising and discriminating attitudes towards TB patients among general population and their association with knowledge regarding TB. A cross-sectional knowledge, attitude and practice survey was conducted in 30 districts of India in January-March 2011. A total of 4562 respondents from general population were interviewed using semi-structured questionnaires which contained items to measure stigma, discrimination and knowledge on TB. Of the 4562 interviewed, 3823 were eligible for the current analysis. Of these, 73% (95% CI 71.4-74.2) had stigmatising and 98% (95% CI 97.4-98.3) had discriminating attitude towards TB patients. Only 17% (95% CI 15.6-18.0) of the respondents had appropriate knowledge regarding TB with even lower levels observed amongst females, rural areas and respondents from low income groups. Surprisingly stigmatising (adjusted OR 1.31 (0.78-2.18) and discriminating (adjusted OR 0.79 (0.43-1.44) attitudes were independent of knowledge regarding TB. Stigmatising and discriminating attitudes towards TB patients remain high among the general population in India. Since these attitudes were independent of the knowledge regarding TB, it is possible that the current disseminated knowledge regarding TB which is mainly from a medical perspective may not be adequately addressing the factors that lead to stigma and discrimination towards TB patients. Therefore, there is an urgent need to review the messages and strategies currently used for disseminating knowledge regarding TB among general population and revise them appropriately. The disseminated knowledge should include medical, psycho-social and economic aspects of TB that not

  17. Is Education Associated with Improvements in General Cognitive Ability, or in Specific Skills?

    Science.gov (United States)

    Ritchie, Stuart J.; Bates, Timothy C.; Deary, Ian J.

    2015-01-01

    Previous research has indicated that education influences cognitive development, but it is unclear what, precisely, is being improved. Here, we tested whether education is associated with cognitive test score improvements via domain-general effects on general cognitive ability ("g"), or via domain-specific effects on particular cognitive…

  18. An improved model for provision of rural community-based health rehabilitation services in Vhembe District, Limpopo Province of South Africa

    Directory of Open Access Journals (Sweden)

    Rudzani E. Luruli

    2016-03-01

    Full Text Available Background: In 1991, Riakona Community Rehabilitation Programme initiated community-based rehabilitation (CBR in the Vhembe District of Limpopo Province. Subsequently, the South African government adopted the programme. Aim: The aim of the study was to suggest an improvement in the model of providing CBR services. Setting: The study was conducted in six rehabilitation centres located in hospitals in the Vhembe District in Limpopo Province of South Africa. Method: A mixed-mode research design with qualitative and quantitative elements was used to conduct the study. Content analysis, the chi-square test for Goodness of Fit and the Kruskal–Wallis and Mann–Whitney non-parametric tests were conducted. Results: The key determinants of client satisfaction with the services that the community rehabilitation workers rendered included provision of assistive devices and the adoption of a holistic approach to their work. Overall, satisfaction per domain for each one of the five domains of satisfaction scored less than 90%. More than 80% of clients were satisfied with empathy (83% and assurance (80% domains. Tangibles, reliability and responsiveness domains had scores of 78%, 72% and 67%, respectively. These results, together with the reasoning map of conceptual framework description, were used as the building blocks of the CBR model. Conclusion: The improved CBR model is useful for putting the programme into practice. This is particularly so for the CBR managers in the districts of the Limpopo Province. Keywords: client satisfaction, disability, community-based rehabilitation, community rehabilitation worker

  19. District-level hospital trauma care audit filters: Delphi technique for defining context-appropriate indicators for quality improvement initiative evaluation in developing countries.

    Science.gov (United States)

    Stewart, Barclay T; Gyedu, Adam; Quansah, Robert; Addo, Wilfred Larbi; Afoko, Akis; Agbenorku, Pius; Amponsah-Manu, Forster; Ankomah, James; Appiah-Denkyira, Ebenezer; Baffoe, Peter; Debrah, Sam; Donkor, Peter; Dorvlo, Theodor; Japiong, Kennedy; Kushner, Adam L; Morna, Martin; Ofosu, Anthony; Oppong-Nketia, Victor; Tabiri, Stephen; Mock, Charles

    2016-01-01

    Prospective clinical audit of trauma care improves outcomes for the injured in high-income countries (HICs). However, equivalent, context-appropriate audit filters for use in low- and middle-income country (LMIC) district-level hospitals have not been well established. We aimed to develop context-appropriate trauma care audit filters for district-level hospitals in Ghana, was well as other LMICs more broadly. Consensus on trauma care audit filters was built between twenty panellists using a Delphi technique with four anonymous, iterative surveys designed to elicit: (i) trauma care processes to be measured; (ii) important features of audit filters for the district-level hospital setting; and (iii) potentially useful filters. Filters were ranked on a scale from 0 to 10 (10 being very useful). Consensus was measured with average percent majority opinion (APMO) cut-off rate. Target consensus was defined a priori as: a median rank of ≥9 for each filter and an APMO cut-off rate of ≥0.8. Panellists agreed on trauma care processes to target (e.g. triage, phases of trauma assessment, early referral if needed) and specific features of filters for district-level hospital use (e.g. simplicity, unassuming of resource capacity). APMO cut-off rate increased successively: Round 1--0.58; Round 2--0.66; Round 3--0.76; and Round 4--0.82. After Round 4, target consensus on 22 trauma care and referral-specific filters was reached. Example filters include: triage--vital signs are recorded within 15 min of arrival (must include breathing assessment, heart rate, blood pressure, oxygen saturation if available); circulation--a large bore IV was placed within 15 min of patient arrival; referral--if referral is activated, the referring clinician and receiving facility communicate by phone or radio prior to transfer. This study proposes trauma care audit filters appropriate for LMIC district-level hospitals. Given the successes of similar filters in HICs and obstetric care filters in LMICs

  20. Improving malaria treatment and prevention in India by aiding district managers to manage their programmes with local information: a trial assessing the impact of Lot Quality Assurance Sampling on programme outcomes.

    Science.gov (United States)

    Valadez, Joseph J; Devkota, Baburam; Pradhan, Madan Mohan; Meherda, Pramod; Sonal, G S; Dhariwal, Akshay; Davis, Rosemary

    2014-10-01

    This paper reports the first trial of Lot Quality Assurance Sampling (LQAS) assessing associations between access to LQAS data and subsequent improvements in district programming. This trial concerns India's approach to addressing an increase in malaria-attributable deaths by training community health workers to diagnose, treat and prevent malaria, while using LQAS to monitor sub-district performance and make programme improvements. The Ministry of Health introduced LQAS into four matched high malaria burden districts (Annual Parasite Incidence >5) (N > 5 million). In each sub-district, we sampled four populations in three 6-monthly surveys: households, children LQAS results appeared to support district managers to increase coverage in underperforming areas, especially for vertical strategies in the presence of diligent managers. © 2014 The Authors. Tropical Medicine & International Health published by John Wiley & Sons Ltd.

  1. LOCAL POLITICAL DYNAMICS IN THE GENERAL ELECTION DIRECTLY CONDUCTED TO VOTE FOR DISTRICT HEADS (PILKADA IN BADUNG REGENCY IN 2005

    Directory of Open Access Journals (Sweden)

    Anak Agung Gede Oka Wisnumurti

    2012-11-01

    Full Text Available The general election directly conducted to vote for the regent and vice regent(Pemilihan Kepala Daerah, abbreviated to Pilkada by the people in Badung Regency in2005 was the first one. The people’s direct involvement in the local political life movedhighly dynamically. The struggle for power by various strengths affected variousdimensions of the people’s lives; therefore, it is interesting to investigate the localpolitical dynamics in the Pilkada directly conducted in Badung Regency in 2005 in theperspective of cultural studies. There are three problems formulated in this study. Theyare (1 what was the dynamics of the Pilkada directly conducted in Badung Regency in2005 like?; (2 how the relation of strengths affected the local political dynamics in thePilkada directly conducted in Badung Regency in 2005?; (3 what were the implicationsand meanings of the local political dynamics of the Pilkada directly conducted in BadungRegency in 2005?The results of the study show that fluctuative changes took place continuouslywith regard to the form and functions of societal structure. Culturally, the people’sideology changed from being mono centric into being multi centric. The relation ofstrengths became segmented into three main strengths forming a new formation ofstrength referred to as trisula. This led to an institutional configuration, differentiation ofpower and locality sedimentation, and provided meanings to competition and tolerance,emancipatory, political comodification, adaptive leadership and local democratic culturalstrengthening.

  2. 75 FR 70712 - General Conference Committee of the National Poultry Improvement Plan; Reestablishment

    Science.gov (United States)

    2010-11-18

    ...] General Conference Committee of the National Poultry Improvement Plan; Reestablishment AGENCY: Animal and... Poultry Improvement Plan (Committee) for a 2-year period. The Secretary of Agriculture has determined that.... Rhorer, Senior Coordinator, National Poultry Improvement Plan, VS, APHIS, USDA, Suite 101, 1498 Klondike...

  3. 77 FR 59888 - General Conference Committee of the National Poultry Improvement Plan

    Science.gov (United States)

    2012-10-01

    ... Improvement Plan AGENCY: Animal and Plant Health Inspection Service, USDA. ACTION: Notice of intent to renew... the General Conference Committee of the National Poultry Improvement Plan (Committee) for a 2year... Improvement Plan, VS, APHIS, USDA, 1506 Klondike Road, Suite 300, Conyers, GA 30094; (770) 922-3496...

  4. Oral sildenafil (Viagra™ in male erectile dysfunction: use, efficacy and safety profile in an unselected cohort presenting to a British district general hospital.

    Directory of Open Access Journals (Sweden)

    Boustead Gregory

    2002-04-01

    Full Text Available Abstract Introduction Sildenafil (Viagra® is one of the drugs used in the first line therapy of male erectile dysfunction (MED. We have recorded outcomes, adverse events and acceptability of Sildenafil (Viagra therapy in an unselected group of men presenting with ED to a British district general hospital. Methods In this prospective observational study, 147 men with ED were seen since Oct 1999. Study patients were reviewed at 4, 12 and 52 weeks. All the patients filled the International Index of Erectile Function (IIEF questionnaire and were asked about their willingness to pay (WTP for treatment. Results All suitable men accepted Viagra as first line therapy. 91% of our patients found sildenafil treatment successful. 80% of these patients were willing to continue with sildenafil therapy. Side effect profile of sildenafil was different in this study with much higher incidence of headache, dyspepsia, flushing and abnormal vision. 92% of men with ED expect to be treated by the NHS. Of those men eligible for treatment in the NHS, 30% qualify under the clinical categories and 18% under the 'distress' category. Only 55% of those with cardiovascular risk factors qualify for NHS treatment. Conclusions Sildenafil is widely accepted as first line therapy among British men with ED and has a success rate of 91%. Nearly half of men with ED qualify for NHS treatment. Nearly half of those with vascular risk factors do not qualify for NHS treatment. Most men with ED could possibly be managed in primary care.

  5. Using targeted vouchers and health equity funds to improve access to skilled birth attendants for poor women: a case study in three rural health districts in Cambodia.

    Science.gov (United States)

    Ir, Por; Horemans, Dirk; Souk, Narin; Van Damme, Wim

    2010-01-07

    In many developing countries, the maternal mortality ratio remains high with huge poor-rich inequalities. Programmes aimed at improving maternal health and preventing maternal mortality often fail to reach poor women. Vouchers in health and Health Equity Funds (HEFs) constitute a financial mechanism to improve access to priority health services for the poor. We assess their effectiveness in improving access to skilled birth attendants for poor women in three rural health districts in Cambodia and draw lessons for further improvement and scaling-up. Data on utilisation of voucher and HEF schemes and on deliveries in public health facilities between 2006 and 2008 were extracted from the available database, reports and the routine health information system. Qualitative data were collected through focus group discussions and key informant interviews. We examined the trend of facility deliveries between 2006 and 2008 in the three health districts and compared this with the situation in other rural districts without voucher and HEF schemes. An operational analysis of the voucher scheme was carried out to assess its effectiveness at different stages of operation. Facility deliveries increased sharply from 16.3% of the expected number of births in 2006 to 44.9% in 2008 after the introduction of voucher and HEF schemes, not only for voucher and HEF beneficiaries, but also for self-paid deliveries. The increase was much more substantial than in comparable districts lacking voucher and HEF schemes. In 2008, voucher and HEF beneficiaries accounted for 40.6% of the expected number of births among the poor. We also outline several limitations of the voucher scheme. Vouchers plus HEFs, if carefully designed and implemented, have a strong potential for reducing financial barriers and hence improving access to skilled birth attendants for poor women. To achieve their full potential, vouchers and HEFs require other interventions to ensure the supply of sufficient quality maternity

  6. Using targeted vouchers and health equity funds to improve access to skilled birth attendants for poor women: a case study in three rural health districts in Cambodia

    Directory of Open Access Journals (Sweden)

    Souk Narin

    2010-01-01

    Full Text Available Abstract Background In many developing countries, the maternal mortality ratio remains high with huge poor-rich inequalities. Programmes aimed at improving maternal health and preventing maternal mortality often fail to reach poor women. Vouchers in health and Health Equity Funds (HEFs constitute a financial mechanism to improve access to priority health services for the poor. We assess their effectiveness in improving access to skilled birth attendants for poor women in three rural health districts in Cambodia and draw lessons for further improvement and scaling-up. Methods Data on utilisation of voucher and HEF schemes and on deliveries in public health facilities between 2006 and 2008 were extracted from the available database, reports and the routine health information system. Qualitative data were collected through focus group discussions and key informant interviews. We examined the trend of facility deliveries between 2006 and 2008 in the three health districts and compared this with the situation in other rural districts without voucher and HEF schemes. An operational analysis of the voucher scheme was carried out to assess its effectiveness at different stages of operation. Results Facility deliveries increased sharply from 16.3% of the expected number of births in 2006 to 44.9% in 2008 after the introduction of voucher and HEF schemes, not only for voucher and HEF beneficiaries, but also for self-paid deliveries. The increase was much more substantial than in comparable districts lacking voucher and HEF schemes. In 2008, voucher and HEF beneficiaries accounted for 40.6% of the expected number of births among the poor. We also outline several limitations of the voucher scheme. Conclusions Vouchers plus HEFs, if carefully designed and implemented, have a strong potential for reducing financial barriers and hence improving access to skilled birth attendants for poor women. To achieve their full potential, vouchers and HEFs require other

  7. The perceived meaning of a (w)holistic view among general practitioners and district nurses in Swedish primary care: a qualitative study

    Science.gov (United States)

    Strandberg, Eva Lena; Ovhed, Ingvar; Borgquist, Lars; Wilhelmsson, Susan

    2007-01-01

    Background The definition of primary care varies between countries. Swedish primary care has developed from a philosophic viewpoint based on quality, accessibility, continuity, co-operation and a holistic view. The meaning of holism in international literature differs between medicine and nursing. The question is, if the difference is due to different educational traditions. Due to the uncertainties in defining holism and a holistic view we wished to study, in depth, how holism is perceived by doctors and nurses in their clinical work. Thus, the aim was to explore the perceived meaning of a holistic view among general practitioners (GPs) and district nurses (DNs). Methods Seven focus group interviews with a purposive sample of 22 GPs and 20 nurses working in primary care in two Swedish county councils were conducted. The interviews were transcribed verbatim and analysed using qualitative content analysis. Results The analysis resulted in three categories, attitude, knowledge, and circumstances, with two, two and four subcategories respectively. A professional attitude involves recognising the whole person; not only fragments of a person with a disease. Factual knowledge is acquired through special training and long professional experience. Tacit knowledge is about feelings and social competence. Circumstances can either be barriers or facilitators. A holistic view is a strong motivator and as such it is a facilitator. The way primary care is organised can be either a barrier or a facilitator and could influence the use of a holistic approach. Defined geographical districts and care teams facilitate a holistic view with house calls being essential, particularly for nurses. In preventive work and palliative care, a holistic view was stated to be specifically important. Consultations and communication with the patient were seen as important tools. Conclusion 'Holistic view' is multidimensional, well implemented and very much alive among both GPs and DNs. The word

  8. Healthy life styles and perceived health status in the general population of a Northern Italian health district: a cross-sectional study

    Directory of Open Access Journals (Sweden)

    Edoardo Colzani

    2010-09-01

    Full Text Available

    Background: Evidence should drive public health initiatives to better address the most important health issues. Chronic diseases represent the main burden of healthcare expenditure in Western countries and are determined by risk factors related to behaviour. Population-based surveys should lead to well informed decision making in this field.

    Methods: A cross-sectional survey was carried out among the general population aged between 18 and 69 in the district of Monza-Brianza in Northern Italy through phone interviews. A validated questionnaire investigating health-related lifestyles and behaviours was used. The questionnaire was divided into the following parts: general health status, physical activity, smoking habit, nutrition, alcohol consumption, driving safety, cardiovascular risk, cancer screening, mental health, domestic safety and socio-economic status.

    Results: In total, 308 interviews were carried out (response rate=76%. Almost 40% reported a body mass index >25, 64.9% had high school or university degrees, 60.4% worked full-time, 26.2% were assessed as physically inactive, and 13.3% were on a weight –loss diet. In addition, 19.7% had an “at risk” alcohol consumption , especially among younger age groups. Symptoms of depression were identified in 4.9% of the study subjects, particularly in women.

    Conclusions: Age, body mass index, education, and occupation were significantly associated with the likelihood of reporting poor health status. Young subjects were more likely to be smokers and drinkers at risk. Psychological health and appropriate prescription of anti-cholesterol and anti-hypertensive drugs areì areas deserving further investigations. Nutrition, physical activity, driving safety and youth health, especially concerning drinking

  9. Knowledge, attitude and practice related to diabetes mellitus among the general public in Galle district in Southern Sri Lanka: a pilot study

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    H. M. M Herath

    2017-06-01

    Full Text Available Abstract Background Type 2 diabetes mellitus (DM has become a global epidemic with significant disability and premature death. Identification of the level of knowledge, attitude and practice (KAP related to diabetes among the general public is important in strategies for prevention of diabetes mellitus. Methods This study was conducted as a community based cross sectional study in three Medical Officers of Health (MOH areas in Galle district. Previously healthy literate individuals who have not attended any diabetes education program in the last two years were selected for this study. Results A total of 277 participants were included in the study. The majority (77% had either moderate (39% or above moderate knowledge (38% on diabetes mellitus. Even though, level of education was significantly and positively associated with knowledge (p = 0.001, the association of gender and age with knowledge was not significant. Unlike knowledge, the attitude towards diabetes was poor in majority (90% and level of education had no significant effect on attitude. With regards to practices, more than half of study subjects never had their blood sugar checked and, about 65% used to take refined sugar liberally and a large majority (80% had no regular exercise activity. Conclusions Even though the majority (77% had moderate or above moderate knowledge on diabetes, their attitudes towards diabetes was poor (88%. It appears that the higher knowledge on diabetes did not translate into good practices as over 50% of study subjects did not involve with any preventive measures. Therefore, more emphasis should be given to address the issue of poor attitude and practices towards diabetes mellitus among general public in Sri Lanka.

  10. IMPROVEMENT OF ECONOMIC COMPETENCE OF HEADS OF SECONDARY EDUCATION FOR EFFECTIVE ACTIVITY OF GENERAL SCHOOLS

    Directory of Open Access Journals (Sweden)

    Volodymyr V. Dyvak

    2010-08-01

    Full Text Available In the article the actual problem of improvement of economic competence of professional work of directors of schools for more efficient control of activity of general schools is considered.

  11. Improving financial access to health care in the Kisantu district in the Democratic Republic of Congo: acting upon complexity

    Directory of Open Access Journals (Sweden)

    Stéphanie Stasse

    2015-01-01

    Full Text Available Background: Comzmercialization of health care has contributed to widen inequities between the rich and the poor, especially in settings with suboptimal regulatory frameworks of the health sector. Poorly regulated fee-for-service payment systems generate inequity and initiate a vicious circle in which access to quality health care gradually deteriorates. Although the abolition of user fees is high on the international health policy agenda, the sudden removal of user fees may have disrupting effects on the health system and may not be affordable or sustainable in resource-constrained countries, such as the Democratic Republic of Congo. Methods and Results: Between 2008 and 2011, the Belgian development aid agency (BTC launched a set of reforms in the Kisantu district, in the province of Bas Congo, through an action-research process deemed appropriate for the implementation of change within open complex systems such as the Kisantu local health system. Moreover, the entire process contributed to strengthen the stewardship capacity of the Kisantu district management team. The reforms mainly comprised the rationalization of resources and the regulation of health services financing. Flat fees per episode of disease were introduced as an alternative to fee-for-service payments by patients. A financial subsidy from BTC allowed to reduce the height of the flat fees. The provision of the subsidy was made conditional upon a range of measures to rationalize the use of resources. Conclusions: The results in terms of enhancing people access to quality health care were immediate and substantial. The Kisantu experience demonstrates that a systems approach is essential in addressing complex problems. It provides useful lessons for other districts in the country.

  12. Method for reducing excess heat supply experienced in typical Chinese district heating systems by achieving hydraulic balance and improving indoor air temperature control at the building level

    DEFF Research Database (Denmark)

    Zhang, Lipeng; Gudmundsson, Oddgeir; Thorsen, Jan Eric

    2016-01-01

    A common problem with Chinese district heating systems is that they supply more heat than the actual heat demand. The reason for this excess heat supply is the general failure to use control devices to adjust the indoor temperature and flow in the building heating systems in accordance with the a......A common problem with Chinese district heating systems is that they supply more heat than the actual heat demand. The reason for this excess heat supply is the general failure to use control devices to adjust the indoor temperature and flow in the building heating systems in accordance...... with the actual heat demand. This results in 15-30% of the total supplied heat being lost. This paper proposes an integrated approach that aims to reduce the excess heat loss by introducing pre-set thermostatic radiator valves combined with automatic balancing valves. Those devices establish hydraulic balance...... that once the hydraulic balance is achieved and indoor temperatures are controlled with this integrated approach, 17% heat savings and 42.8% pump electricity savings can be achieved. The energy savings will also have a positive environmental effect with seasonal reductions of 11 kg CO2, 0.1 kg SO2, and 0...

  13. Evaluating the implementation of a quality improvement process in General Practice using a realist evaluation framework.

    Science.gov (United States)

    Moule, Pam; Clompus, Susan; Fieldhouse, Jon; Ellis-Jones, Julie; Barker, Jacqueline

    2018-05-25

    Underuse of anticoagulants in atrial fibrillation is known to increase the risk of stroke and is an international problem. The National Institute for Health Care and Excellence guidance CG180 seeks to reduce atrial fibrillation related strokes through prescriptions of Non-vitamin K antagonist Oral Anticoagulants. A quality improvement programme was established by the West of England Academic Health Science Network (West of England AHSN) to implement this guidance into General Practice. A realist evaluation identified whether the quality improvement programme worked, determining how and in what circumstances. Six General Practices in 1 region, became the case study sites. Quality improvement team, doctor, and pharmacist meetings within each of the General Practices were recorded at 3 stages: initial planning, review, and final. Additionally, 15 interviews conducted with the practice leads explored experiences of the quality improvement process. Observation and interview data were analysed and compared against the initial programme theory. The quality improvement resources available were used variably, with the training being valued by all. The initial programme theories were refined. In particular, local workload pressures and individual General Practitioner experiences and pre-conceived ideas were acknowledged. Where key motivators were in place, such as prior experience, the programme achieved optimal outcomes and secured a lasting quality improvement legacy. The employment of a quality improvement programme can deliver practice change and improvement legacy outcomes when particular mechanisms are employed and in contexts where there is a commitment to improve service. © 2018 John Wiley & Sons, Ltd.

  14. Fisheries Districts

    Data.gov (United States)

    Vermont Center for Geographic Information — The Fisheries districts data layer is part of a larger dataset that contains administrative boundaries for Vermont's Agency of Natural Resources. The dataset...

  15. Warden Districts

    Data.gov (United States)

    Vermont Center for Geographic Information — This dataset is a representation overlay of warden (areas of responsibility). The Vermont Warden Districts layer is part of a dataset that contains administrative...

  16. Forestry Districts

    Data.gov (United States)

    Vermont Center for Geographic Information — The Forestry Districts layer is part of a dataset that contains administrative boundaries for Vermont's Agency of Natural Resources. This is a layer file which...

  17. Wastewater Districts

    Data.gov (United States)

    Vermont Center for Geographic Information — The Wastewater districts layer is part of a larger dataset that contains administrative boundaries for Vermont's Agency of Natural Resources. The dataset includes...

  18. Wildlife Districts

    Data.gov (United States)

    Vermont Center for Geographic Information — The Wildlife Districts layer is part of a larger dataset contains administrative boundaries for Vermont's Agency of Natural Resources. The dataset includes feature...

  19. Park Districts

    Data.gov (United States)

    Vermont Center for Geographic Information — The Parks Districts layer is part of a dataset contains administrative boundaries for Vermont's Agency of Natural Resources. The dataset includes feature classes for...

  20. Improving mapping for Ebola response through mobilising a local community with self-owned smartphones: Tonkolili District, Sierra Leone, January 2015.

    Directory of Open Access Journals (Sweden)

    Laura M Nic Lochlainn

    Full Text Available During the 2014-16 Ebola virus disease (EVD outbreak, the Magburaka Ebola Management Centre (EMC operated by Médecins Sans Frontières (MSF in Tonkolili District, Sierra Leone, identified that available district maps lacked up-to-date village information to facilitate timely implementation of EVD control strategies. In January 2015, we undertook a survey in chiefdoms within the MSF EMC catchment area to collect mapping and village data. We explore the feasibility and cost to mobilise a local community for this survey, describe validation against existing mapping sources and use of the data to prioritise areas for interventions, and lessons learned.We recruited local people with self-owned Android smartphones installed with open-source survey software (OpenDataKit (ODK and open-source navigation software (OpenStreetMap Automated Navigation Directions (OsmAnd. Surveyors were paired with local motorbike drivers to travel to eligible villages. The collected mapping data were validated by checking for duplication and comparing the village names against a pre-existing village name and location list using a geographic distance and text string-matching algorithm.The survey teams gained sufficient familiarity with the ODK and OsmAnd software within 1-2 hours. Nine chiefdoms in Tonkolili District and three in Bombali District were surveyed within two weeks. Following de-duplication, the surveyors collected data from 891 villages with an estimated 127,021 households. The overall survey cost was €3,395; €3.80 per village surveyed. The MSF GIS team (MSF-OCG created improved maps for the MSF Magburaka EMC team which were used to support surveillance, investigation of suspect EVD cases, hygiene-kit distribution and EVD survivor support. We shared the mapping data with OpenStreetMap, the local Ministry of Health and Sanitation and Sierra Leone District and National Ebola Response Centres.Involving local community and using accessible technology allowed

  1. Improving mapping for Ebola response through mobilising a local community with self-owned smartphones: Tonkolili District, Sierra Leone, January 2015.

    Science.gov (United States)

    Nic Lochlainn, Laura M; Gayton, Ivan; Theocharopoulos, Georgios; Edwards, Robin; Danis, Kostas; Kremer, Ronald; Kleijer, Karline; Tejan, Sumaila M; Sankoh, Mohamed; Jimissa, Augustin; Greig, Jane; Caleo, Grazia

    2018-01-01

    During the 2014-16 Ebola virus disease (EVD) outbreak, the Magburaka Ebola Management Centre (EMC) operated by Médecins Sans Frontières (MSF) in Tonkolili District, Sierra Leone, identified that available district maps lacked up-to-date village information to facilitate timely implementation of EVD control strategies. In January 2015, we undertook a survey in chiefdoms within the MSF EMC catchment area to collect mapping and village data. We explore the feasibility and cost to mobilise a local community for this survey, describe validation against existing mapping sources and use of the data to prioritise areas for interventions, and lessons learned. We recruited local people with self-owned Android smartphones installed with open-source survey software (OpenDataKit (ODK)) and open-source navigation software (OpenStreetMap Automated Navigation Directions (OsmAnd)). Surveyors were paired with local motorbike drivers to travel to eligible villages. The collected mapping data were validated by checking for duplication and comparing the village names against a pre-existing village name and location list using a geographic distance and text string-matching algorithm. The survey teams gained sufficient familiarity with the ODK and OsmAnd software within 1-2 hours. Nine chiefdoms in Tonkolili District and three in Bombali District were surveyed within two weeks. Following de-duplication, the surveyors collected data from 891 villages with an estimated 127,021 households. The overall survey cost was €3,395; €3.80 per village surveyed. The MSF GIS team (MSF-OCG) created improved maps for the MSF Magburaka EMC team which were used to support surveillance, investigation of suspect EVD cases, hygiene-kit distribution and EVD survivor support. We shared the mapping data with OpenStreetMap, the local Ministry of Health and Sanitation and Sierra Leone District and National Ebola Response Centres. Involving local community and using accessible technology allowed rapid

  2. Redesigning the District Operating System

    Science.gov (United States)

    Hodas, Steven

    2015-01-01

    In this paper, we look at the inner workings of a school district through the lens of the "district operating system (DOS)," a set of interlocking mutually-reinforcing modules that includes functions like procurement, contracting, data and IT policy, the general counsel's office, human resources, and the systems for employee and family…

  3. Peer Mentor Program for the General Chemistry Laboratory Designed to Improve Undergraduate STEM Retention

    Science.gov (United States)

    Damkaci, Fehmi; Braun, Timothy F.; Gublo, Kristin

    2017-01-01

    We describe the design and implementation of an undergraduate peer mentor program that can overlay an existing general chemistry laboratory and is designed to improve STEM student retention. For the first four freshman cohorts going through the program, year-to-year retention improved by a four-year average of 20% for students in peer-mentored…

  4. The Role of Magnetic Resonance Imaging in the Investigation and Management of Invasive Lobular Carcinoma-A 3-Year Retrospective Study in Two District General Hospitals.

    Science.gov (United States)

    Derias, Mina; Subramanian, Ashok; Allan, Simon; Shah, Elizabeth; Teraifi, Hassan El; Howlett, David

    2016-07-01

    Invasive lobular carcinoma (ILC) accounts for 5-15% of breast cancers. In comparison to other types of breast cancer, ILC is more likely to be associated with multifocal and contralateral breast involvement as well as a tendency to a diffuse infiltrative growth pattern which can represent a diagnostic challenge. The National Institute of Clinical Excellence guidelines in 2009 recommended the use of magnetic resonance imaging (MRI) in the preoperative assessment of ILC. This study aims to assess compliance with the guidelines in two District General Hospitals and the utility of MRI in the investigation of ILC. All cases of ILC between 2011 and 2013 were retrospectively identified from the pathology database and their breast imaging findings, pathology report, and operative intervention were reviewed. A total of 126 patients were identified with ILC, of these 46 had MRI preoperatively (36.5%). MRI upgraded mammography/ultrasound diagnoses in 10 patients (21.7%). MRI showed multicentric unilateral disease in 17 patients (37.0%) occult on ultrasound/mammogram, with these patients undergoing mastectomy and 16/17 (94.1%) confirmed multifocality on pathology. MRI showed a contralateral lesion in 9 patients (19.6%), four (8.7%) of which were malignant and had bilateral surgery, and five (10.9%) were benign on further imaging/biopsy. MRI also downgraded three patients (6.5%) to unifocal disease with reported multifocal appearances on mammography/ultrasound, and these patients underwent breast-conserving surgery. MRI adds significant additional information to mammograms/ultrasound in ILC and should be undertaken in all such cases preoperatively assuming no contraindication. © 2016 Wiley Periodicals, Inc.

  5. An Example of an Improvable Rao-Blackwell Improvement, Inefficient Maximum Likelihood Estimator, and Unbiased Generalized Bayes Estimator.

    Science.gov (United States)

    Galili, Tal; Meilijson, Isaac

    2016-01-02

    The Rao-Blackwell theorem offers a procedure for converting a crude unbiased estimator of a parameter θ into a "better" one, in fact unique and optimal if the improvement is based on a minimal sufficient statistic that is complete. In contrast, behind every minimal sufficient statistic that is not complete, there is an improvable Rao-Blackwell improvement. This is illustrated via a simple example based on the uniform distribution, in which a rather natural Rao-Blackwell improvement is uniformly improvable. Furthermore, in this example the maximum likelihood estimator is inefficient, and an unbiased generalized Bayes estimator performs exceptionally well. Counterexamples of this sort can be useful didactic tools for explaining the true nature of a methodology and possible consequences when some of the assumptions are violated. [Received December 2014. Revised September 2015.].

  6. On the Use of Generalized Volume Scattering Models for the Improvement of General Polarimetric Model-Based Decomposition

    Directory of Open Access Journals (Sweden)

    Qinghua Xie

    2017-01-01

    Full Text Available Recently, a general polarimetric model-based decomposition framework was proposed by Chen et al., which addresses several well-known limitations in previous decomposition methods and implements a simultaneous full-parameter inversion by using complete polarimetric information. However, it only employs four typical models to characterize the volume scattering component, which limits the parameter inversion performance. To overcome this issue, this paper presents two general polarimetric model-based decomposition methods by incorporating the generalized volume scattering model (GVSM or simplified adaptive volume scattering model, (SAVSM proposed by Antropov et al. and Huang et al., respectively, into the general decomposition framework proposed by Chen et al. By doing so, the final volume coherency matrix structure is selected from a wide range of volume scattering models within a continuous interval according to the data itself without adding unknowns. Moreover, the new approaches rely on one nonlinear optimization stage instead of four as in the previous method proposed by Chen et al. In addition, the parameter inversion procedure adopts the modified algorithm proposed by Xie et al. which leads to higher accuracy and more physically reliable output parameters. A number of Monte Carlo simulations of polarimetric synthetic aperture radar (PolSAR data are carried out and show that the proposed method with GVSM yields an overall improvement in the final accuracy of estimated parameters and outperforms both the version using SAVSM and the original approach. In addition, C-band Radarsat-2 and L-band AIRSAR fully polarimetric images over the San Francisco region are also used for testing purposes. A detailed comparison and analysis of decomposition results over different land-cover types are conducted. According to this study, the use of general decomposition models leads to a more accurate quantitative retrieval of target parameters. However, there

  7. Water supply network district metering theory and case study

    CERN Document Server

    Di Nardo, Armando; Di Mauro, Anna

    2013-01-01

    The management of a water supply network can be substantially improved defining permanent sectors or districts that enhances simpler water loss detection and pressure management. However, the water network partitioning may compromise water system performance, since some pipes are usually closed to delimit districts in order not to have too many metering stations, to decrease costs and simplify water balance. This may reduce the reliability of the whole system and not guarantee the delivery of water at the different network nodes. In practical applications, the design of districts or sectors is generally based on empirical approaches or on limited field experiences. The book proposes a design support methodology, based on graph theory principles and tested on real case study. The described methodology can help water utilities, professionals and researchers to define the optimal districts or sectors of a water supply network.

  8. Improving the training process of highly skilled bodybuilders in the preparatory period, general preparatory phase

    Directory of Open Access Journals (Sweden)

    Olexandr Tyhorskyy

    2015-08-01

    Full Text Available Purpose: to improve the method of training highly skilled bodybuilders during the general preparatory phase. Material and Methods: the study involved eight highly skilled athletes, members of the team of Ukraine on bodybuilding. Results: comparative characteristics of the most commonly used methods of training process in bodybuilding. Developed and substantiated the optimal method of training highly skilled bodybuilders during the general preparatory phase of the preparatory period, which can increase body weight through muscle athletes component. Conclusions: based on studies, recommended the optimum method of training highly skilled bodybuilders depending on mezotsykles and microcycles general preparatory phase

  9. Hospital discharge summary scorecard: a quality improvement tool used in a tertiary hospital general medicine service.

    Science.gov (United States)

    Singh, G; Harvey, R; Dyne, A; Said, A; Scott, I

    2015-12-01

    We assessed the impact of completion and feedback of discharge summary scorecards on the quality of discharge summaries written by interns in a general medicine service of a tertiary hospital. The scorecards significantly improved summary quality in the first three rotations of the intern year and could be readily adopted by other units as a quality improvement intervention for optimizing clinical handover to primary care providers. © 2015 Royal Australasian College of Physicians.

  10. Process mapping as a framework for performance improvement in emergency general surgery.

    Science.gov (United States)

    DeGirolamo, Kristin; D'Souza, Karan; Hall, William; Joos, Emilie; Garraway, Naisan; Sing, Chad Kim; McLaughlin, Patrick; Hameed, Morad

    2018-02-01

    Emergency general surgery conditions are often thought of as being too acute for the development of standardized approaches to quality improvement. However, process mapping, a concept that has been applied extensively in manufacturing quality improvement, is now being used in health care. The objective of this study was to create process maps for small bowel obstruction in an effort to identify potential areas for quality improvement. We used the American College of Surgeons Emergency General Surgery Quality Improvement Program pilot database to identify patients who received nonoperative or operative management of small bowel obstruction between March 2015 and March 2016. This database, patient charts and electronic health records were used to create process maps from the time of presentation to discharge. Eighty-eight patients with small bowel obstruction (33 operative; 55 nonoperative) were identified. Patients who received surgery had a complication rate of 32%. The processes of care from the time of presentation to the time of follow-up were highly elaborate and variable in terms of duration; however, the sequences of care were found to be consistent. We used data visualization strategies to identify bottlenecks in care, and they showed substantial variability in terms of operating room access. Variability in the operative care of small bowel obstruction is high and represents an important improvement opportunity in general surgery. Process mapping can identify common themes, even in acute care, and suggest specific performance improvement measures.

  11. District Energy Windsor

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2002-07-01

    This paper presents a summary of how District Energy Windsor operates. It includes a system site map and reasons why it is advantageous to get connected to a district heating system. District Energy Windsor is a division of the Windsor Utilities Commission. It was developed in 1996 and was the first in North America to supply both heating and cooling requirements. It supplies nearly 2 million square feet of heating and cooling for Windsor's city centre. The district energy system produces hot water or chilled water at a central plant. Energy is then piped out to buildings in the area, including the Art Gallery of Windsor, the Royal Bank Business Centre, the Windsor Justice Facility, the Windsor Casino, and Northwind Windsor. The energy, which is transferred through heat exchangers, is used for space heating, domestic hot water heating, and air conditioning. The 8 reasons for getting connected are: (1) less management costs, (2) lower energy costs, (3) lower level of risk management, (4) stable energy rates, (5) better use of building space, (6) reliable service, (7) reduced expansion costs, and (8) a cleaner environment. District heating improves air quality through reduced carbon dioxide and nitrogen oxide emissions. In addition, fuel delivery and storage are eliminated. figs.

  12. 78 FR 33799 - National Poultry Improvement Plan; General Conference Committee Meeting

    Science.gov (United States)

    2013-06-05

    ... Washington, DC, this 3rd day of June 2013. Kevin Shea, Acting Administrator, Animal and Plant Health... DEPARTMENT OF AGRICULTURE Animal and Plant Health Inspection Service [Docket No. APHIS-2013-0032] National Poultry Improvement Plan; General Conference Committee Meeting AGENCY: Animal and Plant Health...

  13. Audit and feedback by medical students to improve the preventive care practices of general practice supervisors.

    Science.gov (United States)

    Gilkes, Lucy A; Liira, Helena; Emery, Jon

    Medical students benefit from their contact with clinicians and patients in the clinical setting. However, little is known about whether patients and clinicians also benefit from medical students. We developed an audit and feedback intervention activity to be delivered by medical students to their general practice supervisors. We tested whether the repeated cycle of audit had an effect on the preventive care practices of general practitioners (GPs). The students performed an audit on topics of preventive medicine and gave feedback to their supervisors. Each supervisor in the study had more than one student performing the audit over the academic year. After repetitive cycles of audit and feedback, the recording of social history items by GPs improved. For example, recording alcohol history increased from 24% to 36%. This study shows that medical students can be effective auditors, and their repeated audits may improve their general practice supervisors' recording of some aspects of social history.

  14. Critical differences between elective and emergency surgery: identifying domains for quality improvement in emergency general surgery.

    Science.gov (United States)

    Columbus, Alexandra B; Morris, Megan A; Lilley, Elizabeth J; Harlow, Alyssa F; Haider, Adil H; Salim, Ali; Havens, Joaquim M

    2018-04-01

    The objective of our study was to characterize providers' impressions of factors contributing to disproportionate rates of morbidity and mortality in emergency general surgery to identify targets for care quality improvement. Emergency general surgery is characterized by a high-cost burden and disproportionate morbidity and mortality. Factors contributing to these observed disparities are not comprehensively understood and targets for quality improvement have not been formally developed. Using a grounded theory approach, emergency general surgery providers were recruited through purposive-criterion-based sampling to participate in semi-structured interviews and focus groups. Participants were asked to identify contributors to emergency general surgery outcomes, to define effective care for EGS patients, and to describe operating room team structure. Interviews were performed to thematic saturation. Transcripts were iteratively coded and analyzed within and across cases to identify emergent themes. Member checking was performed to establish credibility of the findings. A total of 40 participants from 5 academic hospitals participated in either individual interviews (n = 25 [9 anesthesia, 12 surgery, 4 nursing]) or focus groups (n = 2 [15 nursing]). Emergency general surgery was characterized by an exceptionally high level of variability, which can be subcategorized as patient-variability (acute physiology and comorbidities) and system-variability (operating room resources and workforce). Multidisciplinary communication is identified as a modifier to variability in emergency general surgery; however, nursing is often left out of early communication exchanges. Critical variability in emergency general surgery may impact outcomes. Patient-variability and system-variability, with focus on multidisciplinary communication, represent potential domains for quality improvement in this field. Copyright © 2017 Elsevier Inc. All rights reserved.

  15. Sekhukhune District Municipality workshop proceedings: Wastewater treatment: Towards improved water quality to promote social and economic development

    CSIR Research Space (South Africa)

    Ntombela, C

    2013-09-01

    Full Text Available The aim of the workshop was to reinforce, at the strategic decision-making level within the municipality, the significance of properly managed wastewater treatment facilities towards improved water quality....

  16. Community and District Empowerment for Scale-up (CODES): a complex district-level management intervention to improve child survival in Uganda: study protocol for a randomized controlled trial.

    Science.gov (United States)

    Waiswa, Peter; O'Connell, Thomas; Bagenda, Danstan; Mullachery, Pricila; Mpanga, Flavia; Henriksson, Dorcus Kiwanuka; Katahoire, Anne Ruhweza; Ssegujja, Eric; Mbonye, Anthony K; Peterson, Stefan Swartling

    2016-03-11

    Innovative and sustainable strategies to strengthen districts and other sub-national health systems and management are urgently required to reduce child mortality. Although highly effective evidence-based and affordable child survival interventions are well-known, at the district level, lack of data, motivation, analytic and planning capacity often impedes prioritization and management weaknesses impede implementation. The Community and District Empowerment for Scale-up (CODES) project is a complex management intervention designed to test whether districts when empowered with data and management tools can prioritize and implement evidence-based child survival interventions equitably. The CODES strategy combines management, diagnostic, and evaluation tools to identify and analyze the causes of bottlenecks to implementation, build capacity of district management teams to implement context-specific solutions, and to foster community monitoring and social accountability to increase demand for services. CODES combines UNICEF tools designed to systematize priority setting, allocation of resources and problem solving with Community dialogues based on Citizen Report Cards and U-Reports used to engage and empower communities in monitoring health service provision and to demand for quality services. Implementation and all data collection will be by the districts teams or local Community-based Organizations who will be supported by two local implementing partners. The study will be evaluated as a cluster randomized trial with eight intervention and eight comparison districts over a period of 3 years. Evaluation will focus on differences in uptake of child survival interventions and will follow an intention-to-treat analysis. We will also document and analyze experiences in implementation including changes in management practices. By increasing the District Health Management Teams' capacity to prioritize and implement context-specific solutions, and empowering communities to

  17. Improved probabilistic inference as a general learning mechanism with action video games.

    Science.gov (United States)

    Green, C Shawn; Pouget, Alexandre; Bavelier, Daphne

    2010-09-14

    Action video game play benefits performance in an array of sensory, perceptual, and attentional tasks that go well beyond the specifics of game play [1-9]. That a training regimen may induce improvements in so many different skills is notable because the majority of studies on training-induced learning report improvements on the trained task but limited transfer to other, even closely related, tasks ([10], but see also [11-13]). Here we ask whether improved probabilistic inference may explain such broad transfer. By using a visual perceptual decision making task [14, 15], the present study shows for the first time that action video game experience does indeed improve probabilistic inference. A neural model of this task [16] establishes how changing a single parameter, namely the strength of the connections between the neural layer providing the momentary evidence and the layer integrating the evidence over time, captures improvements in action-gamers behavior. These results were established in a visual, but also in a novel auditory, task, indicating generalization across modalities. Thus, improved probabilistic inference provides a general mechanism for why action video game playing enhances performance in a wide variety of tasks. In addition, this mechanism may serve as a signature of training regimens that are likely to produce transfer of learning. Copyright © 2010 Elsevier Ltd. All rights reserved.

  18. Improvement of the future energy situation by enforced district heating supply of city core areas on the basis of coal

    Energy Technology Data Exchange (ETDEWEB)

    Jacobi, E

    1980-01-01

    The statement made by the author in the contribution (published in HLH 30 (1979) is based on a number of tables that could not be published together with the article for reasons of the layout. The supplementary imprint is made from the viewpoint of additional information and also of general interest.

  19. Systematic review protocol of interventions to improve the psychological well-being of general practitioners.

    Science.gov (United States)

    Murray, Marylou; Murray, Lois; Donnelly, Michael

    2015-09-22

    The challenges and complexities faced by general practitioners are increasing, and there are concerns about their well-being. Consequently, attention has been directed towards developing and evaluating interventions and strategies to improve general practitioner well-being and their capacity to cope with workplace challenges. This systematic review aims to evaluate research evidence regarding the effectiveness of interventions designed to improve general practitioner well-being. Eligible studies will include programmes developed to improve psychological well-being that have assessed outcomes using validated tools pertaining to well-being and related outcomes. Only programmes that have been evaluated using controlled study designs will be reviewed. An appropriately developed search strategy will be applied to six electronic databases: the Cochrane Database of Systematic Reviews, MEDLINE, Embase, CINAHL, PsycINFO and Web of Science. Studies will be screened in two stages by two independent reviewers. A third reviewer will arbitrate when required. Pre-specified inclusion and exclusion criteria will be assessed during a pilot phase early on in the review process. The Cochrane data extraction form will be adapted and applied to each eligible study by two independent reviewers, and each study will be appraised critically using standardised checklists from the Cochrane Handbook. Methodological quality will be taken into account in the analysis of the data and the synthesis of results. A narrative synthesis will be undertaken if data is unsuited to a meta-analysis. The systematic review will be reported according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidance. This will be the first systematic review on this topic, and the evidence synthesis will aid decision-making by general practitioners, policy makers and planners regarding ways in which to improve GP well-being. Findings will be disseminated at general practitioner meetings

  20. Supply chain solutions to improve the distribution of antiretroviral drugs (ARVs to clinics in rural areas: A case study of the QwaQwa district

    Directory of Open Access Journals (Sweden)

    Mamolise Mokheseng

    2017-10-01

    Full Text Available This article serves as a case study based on research that was performed in the QwaQwa district in the Free State Province where the distribution of ARVs to the regional Manapo hospital, as well as between the hospital and its peripheral clinics, was interrupted and inconsistent due to problems in the supply chain. An unreliable and interrupted ARV supply chain creates the risk of virus reactivation and eventual patient mortality. The objectives of the study were to explore the problems experienced with the ARV distribution practices at the Manapo hospital, and to recommend ways in which the distribution of ARVs can be improved so that patients can receive an uninterrupted supply. The nature of the topic researched dictated the use of mainly the quantitative research method. The main problems identified include: Wrong and no uniform practice of ordering stock by the hospital and the clinics; lack of reliable, structured transportation from the depot to the hospital; as well as poor inventory management and poor overall communication. Recommendations to address the problems include: Implementing a supply chain planning and design process; improving inventory management and warehousing practices; implementing more effective and reliable distribution and transportation processes; as well as improving supply chain coordination and overall communication.

  1. New generalized and improved (G′/G-expansion method for nonlinear evolution equations in mathematical physics

    Directory of Open Access Journals (Sweden)

    Hasibun Naher

    2014-10-01

    Full Text Available In this article, new extension of the generalized and improved (G′/G-expansion method is proposed for constructing more general and a rich class of new exact traveling wave solutions of nonlinear evolution equations. To demonstrate the novelty and motivation of the proposed method, we implement it to the Korteweg-de Vries (KdV equation. The new method is oriented toward the ease of utilize and capability of computer algebraic system and provides a more systematic, convenient handling of the solution process of nonlinear equations. Further, obtained solutions disclose a wider range of applicability for handling a large variety of nonlinear partial differential equations.

  2. What Principals Do to Improve Teaching and Learning: Comparing the Use of Informal Classroom Observations in Two School Districts

    Science.gov (United States)

    Ing, Marsha

    2013-01-01

    Informally observing classrooms is one way that principals can help improve teaching and learning. This study describes the variability of principals' classroom observations across schools and identifies the conditions under which observations relate to the instructional climate in some schools and not others. Data for this study come from…

  3. EMB history to increase health technology literacy in the general public for improved health worldwide.

    Science.gov (United States)

    Leder, Ron S

    2009-01-01

    History provides common access to technology for both technical and non technical persons and for youngsters. Placed in an historical context complex health technology and health care can be more understandable and therefore more accessible to the general public; technical persons can understand past health technology advances to help propel the field. History is a reference for experts disguised as a story that anyone can understand and enjoy. This can be useful and effective at improving self advocate based health care.

  4. A rapid assessment of a community health worker pilot programme to improve the management of hypertension and diabetes in Emfuleni sub-district of Gauteng Province, South Africa.

    Science.gov (United States)

    Ndou, Tshipfuralo; van Zyl, Greer; Hlahane, Salamina; Goudge, Jane

    2013-01-24

    Non-communicable diseases (NCD) and infectious chronic illnesses are recognised as significant contributing factors to the burden of disease globally, specifically in South Africa, yet clinical management is often poor. The involvement of community health workers (CHWs) in TB and HIV care in South Africa, and other low- and middle-income settings, suggests that they could make an important contribution in the management of NCDs. Using a rapid assessment, this study examines the outcomes of a pilot CHW programme to improve the management of hypertension and diabetes in Gauteng province, South Africa. A record review compared outcomes of patients receiving home visits (n56) with a control group (n168) attending the clinic, matched, as far as possible, on age, gender, and condition. Focus group discussions and semi-structured interviews with CHWs, patients, district, clinic, and NGO staff were used to obtain descriptions of the functioning of the programme and patient experiences. Despite the greater age and co-morbidity among those in the pilot programme, the findings suggest that control of hypertension was improved by CHW home visits in comparison to usual clinic care. However, too few doctor visits, insufficient monitoring of patient outcomes by clinic staff, and a poor procurement process for supplies required by the CHWs hampered the programme's activities. The role of CHWs in the management of hypertension should be given greater consideration, with larger studies being conducted to provide more robust evidence. Adequate training, supervision, and operational support will be required to ensure success of any CHW programme.

  5. District of Columbia Public Education: Agencies Have Enhanced Internal Controls over Federal Payments for School Improvement, but More Consistent Monitoring Needed. Report to Congressional Requesters. GAO-11-16

    Science.gov (United States)

    Ashby, Cornelia M.

    2010-01-01

    Between fiscal years 2004 and 2009, Congress appropriated nearly $190 million in federal payments for school improvement to the District of Columbia (D.C.). This includes $85 million to the state education office--currently the Office of the State Superintendent of Education (OSSE)--to expand public charter schools and $105 million to D.C. Public…

  6. Improving mapping for Ebola response through mobilising a local community with self-owned smartphones: Tonkolili District, Sierra Leone, January 2015.

    NARCIS (Netherlands)

    Nic Lochlainn, Laura M; Gayton, Ivan; Theocharopoulos, Georgios; Edwards, Robin; Danis, Kostas; Kremer, Ronald; Kleijer, Karline; Tejan, Sumaila M; Sankoh, Mohamed; Jimissa, Augustin; Greig, Jane; Caleo, Grazia

    2018-01-01

    During the 2014-16 Ebola virus disease (EVD) outbreak, the Magburaka Ebola Management Centre (EMC) operated by Médecins Sans Frontières (MSF) in Tonkolili District, Sierra Leone, identified that available district maps lacked up-to-date village information to facilitate timely implementation of EVD

  7. Report card on school snack food policies among the United States' largest school districts in 2004–2005: Room for improvement

    Directory of Open Access Journals (Sweden)

    Rivara Frederick P

    2006-01-01

    Full Text Available Abstract Background Federal nutritional guidelines apply to school foods provided through the national school lunch and breakfast programs, but few federal regulations apply to other foods and drinks sold in schools (labeled "competitive foods", which are often high in calories, fat and sugar. Competitive food policies among school districts are increasingly viewed as an important modifiable factor in the school nutrition environment, particularly to address rising rates of childhood overweight. Congress passed legislation in 2004 requiring all school districts to develop a Wellness Policy that includes nutrition guidelines for competitive foods starting in 2006–2007. In addition, the Institute of Medicine (IOM recently published recommendations for schools to address childhood obesity. Methods Representatives of school districts with the largest student enrollment in each state and D.C. (N = 51 were interviewed in October-November 2004 about each school district's nutrition policies on "competitive foods." District policies were examined and compared to the Institute of Medicine's recommendations for schools to address childhood obesity. Information about state competitive food policies was accessed via the Internet, and through state and district contacts. Results The 51 districts accounted for 5.9 million students, representing 11% of US students. Nineteen of the 51 districts (39% had competitive food policies beyond state or federal requirements. The majority of these district policies (79% were adopted since 2002. School district policies varied in scope and requirements. Ten districts (53% set different standards by grade level. Most district policies had criteria for food and beverage content (74% and prohibited the sale of soda in all schools (63%; fewer policies restricted portion size of foods (53% or beverages (47%. Restrictions more often applied to vending machines (95%, cafeteria à la carte (79%, and student stores (79% than

  8. Improving Generalization Based on l1-Norm Regularization for EEG-Based Motor Imagery Classification

    Directory of Open Access Journals (Sweden)

    Yuwei Zhao

    2018-05-01

    Full Text Available Multichannel electroencephalography (EEG is widely used in typical brain-computer interface (BCI systems. In general, a number of parameters are essential for a EEG classification algorithm due to redundant features involved in EEG signals. However, the generalization of the EEG method is often adversely affected by the model complexity, considerably coherent with its number of undetermined parameters, further leading to heavy overfitting. To decrease the complexity and improve the generalization of EEG method, we present a novel l1-norm-based approach to combine the decision value obtained from each EEG channel directly. By extracting the information from different channels on independent frequency bands (FB with l1-norm regularization, the method proposed fits the training data with much less parameters compared to common spatial pattern (CSP methods in order to reduce overfitting. Moreover, an effective and efficient solution to minimize the optimization object is proposed. The experimental results on dataset IVa of BCI competition III and dataset I of BCI competition IV show that, the proposed method contributes to high classification accuracy and increases generalization performance for the classification of MI EEG. As the training set ratio decreases from 80 to 20%, the average classification accuracy on the two datasets changes from 85.86 and 86.13% to 84.81 and 76.59%, respectively. The classification performance and generalization of the proposed method contribute to the practical application of MI based BCI systems.

  9. Applications of Information and Communication Technology for Improvements of Water and Soil Monitoring and Assessments in Agricultural Areas—A Case Study in the Taoyuan Irrigation District

    Directory of Open Access Journals (Sweden)

    Yu-Pin Lin

    2017-01-01

    Full Text Available In order to guarantee high-quality agricultural products and food safety, efforts must be made to manage and maintain healthy agricultural environments under the myriad of risks that they face. Three central system components of sustainable agricultural management schemes are real-time monitoring, decision-making, and remote access. Information and Communications Technology (ICT systems are a convenient means of providing both these and other functions, such as wireless sensor networking, mobile phone applications, etc., to agricultural management schemes. ICT systems have significantly improved in recent years and have been widely used in many fields, including environmental monitoring and management. Moreover, ICT could benefit agricultural environment management by providing a platform for collaboration between researchers and stakeholders, thereby improving agricultural practices and environments. This article reviews and discusses the way in which ICT can efficiently improve monitoring systems and risk assessments of agricultural environment monitoring, as well as the technological and methodological improvements of ICT systems. Finally, we develop and apply an ICT system, referred to as the agricultural environment protection system—comprised of a cloud, six E-platforms, three mobile devices, automatic monitoring devices, indigenous wireless sensor nodes, and gateways in agricultural networks—to a case study in the Taoyuan irrigation district, which acts as a pilot area in Taiwan. Through the system, we use all available information from the interdisciplinary structured cloud database to classify the focal area into different agricultural environmental risk zones. We also conducted further analysis based on a hierarchical approach in order to classify the agricultural environments in the study area, to allocate additional sampling with resin packages and mobile devices, as well as to assist decision makers and stakeholders. The main

  10. Roles of the combined irrigation, drainage, and storage of the canal network in improving water reuse in the irrigation districts along the lower Yellow River, China

    Science.gov (United States)

    Liu, Lei; Luo, Yi; He, Chansheng; Lai, Jianbin; Li, Xiubin

    2010-09-01

    SummaryThe commonly used irrigation system in the irrigation districts (with a combined irrigation area of 3.334 × 10 6 ha) along the lower Yellow River of China is canal network. It delivers water from the Yellow River to the fields, collects surface runoff and drainage from cropland, and stores both of them for subsequent irrigation uses. This paper developed a new combined irrigation, drainage, and storage (CIDS) module for the SWAT2000 model, simulated the multiple roles of the CIDS canal system, and estimated its performance in improving water reuse in the irrigation districts under different irrigation and water diversion scenarios. The simulation results show that the annual evapotranspiration (ET) of the double-cropping winter wheat and summer maize was the highest under the full irrigation scenario (automatic irrigation), and the lowest under the no irrigation scenario. It varied between these two values when different irrigation schedules were adopted. Precipitation could only meet the water requirement of the double-cropping system by 62-96% on an annual basis; that of the winter wheat by 32-36%, summer maize by 92-123%, and cotton by 87-98% on a seasonal basis. Hence, effective irrigation management for winter wheat is critical to ensure high wheat yield in the study area. Runoff generation was closely related to precipitation and influenced by irrigation. The highest and lowest annual runoff accounted for 19% and 11% of the annual precipitation under the full irrigation and no irrigation scenarios, respectively. Nearly 70% of the annual runoff occurred during months of July and August due to the concentrated precipitation in these 2 months. The CIDS canals play an important role in delivering the diversion water from the Yellow River, intercepting the surface runoff and drainage from cropland (inflow of the CIDS canal) and recharging the shallow aquifer for later use. Roughly 14-26% of the simulated total flow in the CIDS canal system recharged

  11. A social autopsy of neonatal mortality suggests needed improvements in maternal and neonatal interventions in Balaka and Salima districts of Malawi

    Directory of Open Access Journals (Sweden)

    Alain K. Koffi

    2015-06-01

    Full Text Available Background The Every Newborn Action Plan calls for reducing the neonatal mortality rates to fewer than 10 deaths per 1000 live births in all countries by 2035. The current study aims to increase our understanding of the social and modifiable factors that can be addressed or reinforced to improve and accelerate the decline in neonatal mortality in Malawi. Methods The data come from the 2013 Verbal and Social Autopsy (VASA study that collected data in order to describe the biological causes and the social determinants of deaths of children under 5 years of age in Balaka and Salima districts of Malawi. This paper analyses the social autopsy data of the neonatal deaths and presents results of a review of the coverage of key interventions along the continuum of normal maternal and newborn care and the description of breakdowns in the care provided for neonatal illnesses within the Pathway to Survival framework. Results A total of 320 neonatal deaths were confirmed from the VASA survey. While one antenatal care (ANC visit was high at 94%, the recommended four ANC visits was much lower at 41% and just 17% of the mothers had their urines tested during the pregnancy. 173 (54% mothers of the deceased newborns had at least one labor/delivery complication that began at home. The caregivers of 65% (n = 75 of the 180 newborns that were born at home or born and left a health facility alive perceived them to be severely ill at the onset of their illness, yet only 44% (n = 80 attempted and 36% (n = 65could reach the first health provider after an average of 91 minutes travel time. Distance, lack of transport and cost emerged as the most important constraints to formal care–seeking during delivery and during the newborn fatal illness. Conclusions This study suggests that maternal and neonatal health organizations and the local government of Malawi should increase the demand for key maternal and child health interventions, including the recommended 4

  12. Sepsis in general surgery: the 2005-2007 national surgical quality improvement program perspective.

    Science.gov (United States)

    Moore, Laura J; Moore, Frederick A; Todd, S Rob; Jones, Stephen L; Turner, Krista L; Bass, Barbara L

    2010-07-01

    To document the incidence, mortality rate, and risk factors for sepsis and septic shock compared with pulmonary embolism and myocardial infarction in the general-surgery population. Retrospective review. American College of Surgeons National Surgical Quality Improvement Program institutions. General-surgery patients in the 2005-2007 National Surgical Quality Improvement Program data set. Incidence, mortality rate, and risk factors for sepsis and septic shock. Of 363 897 general-surgery patients, sepsis occurred in 8350 (2.3%), septic shock in 5977 (1.6%), pulmonary embolism in 1078 (0.3%), and myocardial infarction in 615 (0.2%). Thirty-day mortality rates for each of the groups were as follows: 5.4% for sepsis, 33.7% for septic shock, 9.1% for pulmonary embolism, and 32.0% for myocardial infarction. The septic-shock group had a greater percentage of patients older than 60 years (no sepsis, 40.2%; sepsis, 51.7%; and septic shock, 70.3%; P surgery resulted in more cases of sepsis (4.5%) and septic shock (4.9%) than did elective surgery (sepsis, 2.0%; septic shock, 1.2%) (P surgery, and the presence of any comorbidity. This study emphasizes the need for early recognition of patients at risk via aggressive screening and the rapid implementation of evidence-based guidelines.

  13. Rebound effect of improved energy efficiency for different energy types: A general equilibrium analysis for China

    International Nuclear Information System (INIS)

    Lu, Yingying; Liu, Yu; Zhou, Meifang

    2017-01-01

    This paper explores the rebound effect of different energy types in China based on a static computable general equilibrium model. A one-off 5% energy efficiency improvement is imposed on five different types of energy, respectively, in all the 135 production sectors in China. The rebound effect is measured both on the production level and on the economy-wide level for each type of energy. The results show that improving energy efficiency of using electricity has the largest positive impact on GDP among the five energy types. Inter-fuel substitutability does not affect the macroeconomic results significantly, but long-run impact is usually greater than the short-run impact. For the exports-oriented sectors, those that are capital-intensive get big negative shock in the short run while those that are labour-intensive get hurt in the long run. There is no “backfire” effect; however, improving efficiency of using electricity can cause negative rebound, which implies that improving the energy efficiency of using electricity might be a good policy choice under China's current energy structure. In general, macro-level rebound is larger than production-level rebound. Primary energy goods show larger rebound effect than secondary energy goods. In addition, the paper points out that the policy makers in China should look at the rebound effect in the long term rather than in the short term. The energy efficiency policy would be a good and effective policy choice for energy conservation in China when it still has small inter-fuel substitution. - Highlights: • Primary energy goods show larger rebound effect than secondary energy goods. • Improving efficiency of using electricity can cause negative rebound. • The energy efficiency policy would be an effective policy choice for China. • Policy-makers should consider the rebound effect in the longer term.

  14. Improved QRD-M Detection Algorithm for Generalized Spatial Modulation Scheme

    Directory of Open Access Journals (Sweden)

    Xiaorong Jing

    2017-01-01

    Full Text Available Generalized spatial modulation (GSM is a spectral and energy efficient multiple-input multiple-output (MIMO transmission scheme. It will lead to imperfect detection performance with relatively high computational complexity by directly applying the original QR-decomposition with M algorithm (QRD-M to the GSM scheme. In this paper an improved QRD-M algorithm is proposed for GSM signal detection, which achieves near-optimal performance but with relatively low complexity. Based on the QRD, the improved algorithm firstly transforms the maximum likelihood (ML detection of the GSM signals into searching an inverted tree structure. Then, in the searching process of the M branches, the branches corresponding to the illegitimate transmit antenna combinations (TACs and related to invalid number of active antennas are cut in order to improve the validity of the resultant branches at each level by taking advantage of characteristics of GSM signals. Simulation results show that the improved QRD-M detection algorithm provides similar performance to maximum likelihood (ML with the reduced computational complexity compared to the original QRD-M algorithm, and the optimal value of parameter M of the improved QRD-M algorithm for detection of the GSM scheme is equal to modulation order plus one.

  15. What makes British general practitioners take part in a quality improvement scheme?

    Science.gov (United States)

    Spooner, A; Chapple, A; Roland, M

    2001-07-01

    To understand the reasons for the apparent success of a quality improvement scheme designed to produce widespread changes in chronic disease management in primary care. Purposeful sample of 36 primary care staff, managers and specialists. Qualitative analysis of 27 interviews in East Kent Health Authority area, where, over a three-year period, more than three-quarters of general practitioners (GPs) and enrolled in a quality improvement programme which required them to meet challenging chronic disease management targets (PRImary Care Clinical Effectiveness--PRICCE). Major changes in clinical practice appeared to have taken place as a result of participation in PRICCE. The scheme was significantly dependent on leadership from the health authority and on local professional support. Factors that motivated GPs to take part in the project included: a desire to improve patient care; financial incentives; maintenance of professional autonomy in how to reach the targets; maintenance of professional pride; and peer pressure. Good teamworking was essential to successful completion of the project and often improved as a result of taking part. The scheme included a combination of interventions known to be effective in producing professional behavioural change. When managerial vision is aligned to professional values, and combined with a range of interventions known to influence professional behaviour including financial incentives, substantial changes in clinical practice can result. Lessons are drawn for future quality improvement programmes in the National Health Service.

  16. Learning to improve: using writing to increase critical thinking performance in general education biology.

    Science.gov (United States)

    Quitadamo, Ian J; Kurtz, Martha J

    2007-01-01

    Increasingly, national stakeholders express concern that U.S. college graduates cannot adequately solve problems and think critically. As a set of cognitive abilities, critical thinking skills provide students with tangible academic, personal, and professional benefits that may ultimately address these concerns. As an instructional method, writing has long been perceived as a way to improve critical thinking. In the current study, the researchers compared critical thinking performance of students who experienced a laboratory writing treatment with those who experienced traditional quiz-based laboratory in a general education biology course. The effects of writing were determined within the context of multiple covariables. Results indicated that the writing group significantly improved critical thinking skills whereas the non-writing group did not. Specifically, analysis and inference skills increased significantly in the writing group but not the non-writing group. Writing students also showed greater gains in evaluation skills; however, these were not significant. In addition to writing, prior critical thinking skill and instructor significantly affected critical thinking performance, whereas other covariables such as gender, ethnicity, and age were not significant. With improved critical thinking skill, general education biology students will be better prepared to solve problems as engaged and productive citizens.

  17. Improving Modeling of Extreme Events using Generalized Extreme Value Distribution or Generalized Pareto Distribution with Mixing Unconditional Disturbances

    OpenAIRE

    Suarez, R

    2001-01-01

    In this paper an alternative non-parametric historical simulation approach, the Mixing Unconditional Disturbances model with constant volatility, where price paths are generated by reshuffling disturbances for S&P 500 Index returns over the period 1950 - 1998, is used to estimate a Generalized Extreme Value Distribution and a Generalized Pareto Distribution. An ordinary back-testing for period 1999 - 2008 was made to verify this technique, providing higher accuracy returns level under upper ...

  18. Effectiveness of community based Safe Motherhood promoters in improving the utilization of obstetric care. The case of Mtwara Rural District in Tanzania.

    Science.gov (United States)

    Mushi, Declare; Mpembeni, Rose; Jahn, Albrecht

    2010-04-01

    In Tanzania, maternal mortality ratio remains unacceptably high at 578/100,000 live births. Despite a high coverage of antenatal care (96%), only 44% of deliveries take place within the formal health services. Still, "Ensure skilled attendant at birth" is acknowledged as one of the most effective interventions to reduce maternal deaths. Exploring the potential of community-based interventions in increasing the utilization of obstetric care, the study aimed at developing, testing and assessing a community-based safe motherhood intervention in Mtwara rural District of Tanzania. This community-based intervention was designed as a pre-post comparison study, covering 4 villages with a total population of 8300. Intervention activities were implemented by 50 trained safe motherhood promoters (SMPs). Their tasks focused on promoting early and complete antenatal care visits and delivery with a skilled attendant. Data on all 512 deliveries taking place from October 2004 to November 2006 were collected by the SMPs and cross-checked with health service records. In addition 242 respondents were interviewed with respect to knowledge on safe motherhood issues and their perception of the SMP's performance. Skilled delivery attendance was our primary outcome; secondary outcomes included antenatal care attendance and knowledge on Safe Motherhood issues. Deliveries with skilled attendant significantly increased from 34.1% to 51.4% (rho utilization of obstetric care and a skilled attendant at delivery. This improvement is attributed to the SMPs' home visits and the close collaboration with existing community structures as well as health services.

  19. Implementation experience during an eighteen month intervention to improve paediatric and newborn care in Kenyan district hospitals

    Directory of Open Access Journals (Sweden)

    Wamae Annah

    2009-07-01

    Full Text Available Abstract Background We have conducted an intervention study aiming to improve hospital care for children and newborns in Kenya. In judging whether an intervention achieves its aims, an understanding of how it is delivered is essential. Here, we describe how the implementation team delivered the intervention over 18 months and provide some insight into how health workers, the primary targets of the intervention, received it. Methods We used two approaches. First, a description of the intervention is based on an analysis of records of training, supervisory and feedback visits to hospitals, and brief logs of key topics discussed during telephone calls with local hospital facilitators. Record keeping was established at the start of the study for this purpose with analyses conducted at the end of the intervention period. Second, we planned a qualitative study nested within the intervention project and used in-depth interviews and small group discussions to explore health worker and facilitators' perceptions of implementation. After thematic analysis of all interview data, findings were presented, discussed, and revised with the help of hospital facilitators. Results Four hospitals received the full intervention including guidelines, training and two to three monthly support supervision and six monthly performance feedback visits. Supervisor visits, as well as providing an opportunity for interaction with administrators, health workers, and facilitators, were often used for impromptu, limited refresher training or orientation of new staff. The personal links that evolved with senior staff seemed to encourage local commitment to the aims of the intervention. Feedback seemed best provided as open meetings and discussions with administrators and staff. Supervision, although sometimes perceived as fault finding, helped local facilitators become the focal point of much activity including key roles in liaison, local monitoring and feedback, problem solving

  20. Effectiveness of community based intervention on improvement of pregnancy and delivery process in district 4 of Tehran

    Directory of Open Access Journals (Sweden)

    Mamak Shariat

    2015-10-01

    seen between two groups' gestational age (P= 0.007. Conclusion: After intervention, in spite of no decline in cesarean section rate, NVD tendency and morbidity rate were raised and improved respectively. It seems that cesarean section rate was influenced by other important factors.

  1. Improving the training process of highly skilled bodybuilders in the preparatory period, general preparatory phase

    Directory of Open Access Journals (Sweden)

    Olexandr Tyhorskyy

    2015-10-01

    Full Text Available Purpose: to improve the method of training highly skilled bodybuilders. Material and Methods: the study involved eight highly skilled athletes, members of the team of Ukraine on bodybuilding. Results: comparative characteristics of the most commonly used methods of training process in bodybuilding. Developed and substantiated the optimal method of training highly skilled bodybuilders during the general preparatory phase of the preparatory period, which can increase body weight through muscle athletes component. Conclusions: dynamic load factor to raise the intensity of training loads allows orientation help to increase volumes shoulder muscles

  2. Improved decay rates for solutions for a multidimensional generalized Benjamin-Bona-Mahony equation

    KAUST Repository

    Said-Houari, Belkacem

    2014-01-01

    In this paper, we study the decay rates of solutions for the generalized Benjamin-Bona-Mahony equation in multi-dimensional space. For initial data in some L1-weighted spaces, we prove faster decay rates of the solutions. More precisely, using the Fourier transform and the energy method, we show the global existence and the convergence rates of the solutions under the smallness assumption on the initial data and we give better decay rates of the solutions. This result improves early works in J. Differential Equations 158(2) (1999), 314-340 and Nonlinear Anal. 75(7) (2012), 3385-3392. © 2014-IOS Press.

  3. Boise geothermal district heating system

    Energy Technology Data Exchange (ETDEWEB)

    Hanson, P.J.

    1985-10-01

    This document describes the Boise geothermal district heating project from preliminary feasibility studies completed in 1979 to a fully operational system by 1983. The report includes information about the two local governments that participated in the project - the City of Boise, Idaho and the Boise Warm Springs Water District. It also discusses the federal funding sources; the financial studies; the feasibility studies conducted; the general system planning and design; design of detailed system components; the legal issues involved in production; geological analysis of the resource area; distribution and disposal; the program to market system services; and the methods of retrofitting buildings to use geothermal hot water for space heating. Technically this report describes the Boise City district heating system based on 170/sup 0/F water, a 4000 gpm production system, a 41,000 foot pipeline system, and system economies. Comparable data are also provided for the Boise Warm Springs Water District. 62 figs., 31 tabs.

  4. Improving the Quality of the Deteriorated Regions of Multicrystalline Silicon Ingots during General Solar Cell Processes

    International Nuclear Information System (INIS)

    Wu Shan-Shan; Wang Lei; Yang De-Ren

    2011-01-01

    The behavior of wafers and solar cells from the border of a multicrystalline silicon (mc-Si) ingot, which contain deteriorated regions, is investigated. It is found that the diffusion length distribution of minority carriers in the cells is uniform, and high efficiency of the solar cells (about 16%) is achieved. It is considered that the quality of the deteriorated regions could be improved to be similar to that of adjacent regions. Moreover, it is indicated that during general solar cell fabrication, phosphorus gettering and hydrogen passivation could significantly improve the quality of deteriorated regions, while aluminum gettering by RTP could not. Therefore, it is suggested that the border of a mc-Si ingot could be used to fabricate high efficiency solar cells, which will increase mc-Si utilization effectively. (condensed matter: structure, mechanical and thermal properties)

  5. Improvement of the safety level of installations with the generalization of procedures

    International Nuclear Information System (INIS)

    Cornille, Y.; Dupraz, B.; Schektman, N.

    1986-06-01

    The generalization of control procedures to the largest possible spectra of accidental situations which is being developed on pressurized water reactor units will allow to increase the safety level of these installations. This improvement has been quantified for some situations pointing out an appreciable mitigation of meltdown risk which could result. A new improvement is aimed with the definition and the utilization of new procedures ''by states'' which will allow an optimized treatment of situations resulting from multiple failures, now treated in the procedures SPI - SPU - U1. The needs related to these procedures and their development led to joint research and development programs between Electricite de France and the Institute of Protection and Nuclear Safety [fr

  6. An Improved Generalized Predictive Control in a Robust Dynamic Partial Least Square Framework

    Directory of Open Access Journals (Sweden)

    Jin Xin

    2015-01-01

    Full Text Available To tackle the sensitivity to outliers in system identification, a new robust dynamic partial least squares (PLS model based on an outliers detection method is proposed in this paper. An improved radial basis function network (RBFN is adopted to construct the predictive model from inputs and outputs dataset, and a hidden Markov model (HMM is applied to detect the outliers. After outliers are removed away, a more robust dynamic PLS model is obtained. In addition, an improved generalized predictive control (GPC with the tuning weights under dynamic PLS framework is proposed to deal with the interaction which is caused by the model mismatch. The results of two simulations demonstrate the effectiveness of proposed method.

  7. Technical improvements for the dynamic measurement of general scour and landslides

    Science.gov (United States)

    Chung Yang, Han; Su, Chih Chiang

    2017-04-01

    Disasters occurring near riverbeds, such as landslides, earth slides, debris flow, and general scour, are easily caused by flooding from typhoons. The occurrence of each type of disaster involves a process, so if a disaster event can be monitored in real time, hazards can be predicted, thereby enabling early warnings that could reduce the degree of loss engendered by the disaster. The study of technical improvements for the dynamic measurement of general scour and landslides could help to release these early warnings. In this study, improved wireless tracers were set up on site to ensure the feasibility of the improved measurement technology. A wireless tracer signal transmission system was simultaneously set up to avoid danger to surveyors caused by them having to be on site to take measurements. In order to understand the real-time dynamic riverbed scouring situation, after the flow path of the river was confirmed, the sites for riverbed scouring observation were established at the P30 pier of the Dajia River Bridge of National Highway No. 3, and approximately 100 m both upstream and downstream (for a total of three sites). A rainy event that caused riverbed erosion occurred in May 2015, and subsequently, Typhoons Soudelor, Goni, and Dujuan caused further erosion in the observed area. The results of the observations of several flood events revealed that wireless tracers can reflect the change in riverbed scour depth caused by typhoons and flooding in real time. The wireless tracer technique can be applied to real-time dynamic scouring observation of rivers, and these improvements in measurement technology could be helpful in preventing landslides in the future.

  8. A multifaceted intervention to improve the quality of care of children in district hospitals in Kenya: a cost-effectiveness analysis.

    Science.gov (United States)

    Barasa, Edwine W; Ayieko, Philip; Cleary, Susan; English, Mike

    2012-01-01

    To improve care for children in district hospitals in Kenya, a multifaceted approach employing guidelines, training, supervision, feedback, and facilitation was developed, for brevity called the Emergency Triage and Treatment Plus (ETAT+) strategy. We assessed the cost effectiveness of the ETAT+ strategy, in Kenyan hospitals. Further, we estimate the costs of scaling up the intervention to Kenya nationally and potential cost effectiveness at scale. Our cost-effectiveness analysis from the provider's perspective used data from a previously reported cluster randomized trial comparing the full ETAT+ strategy (n = 4 hospitals) with a partial intervention (n = 4 hospitals). Effectiveness was measured using 14 process measures that capture improvements in quality of care; their average was used as a summary measure of quality. Economic costs of the development and implementation of the intervention were determined (2009 US$). Incremental cost-effectiveness ratios were defined as the incremental cost per percentage improvement in (average) quality of care. Probabilistic sensitivity analysis was used to assess uncertainty. The cost per child admission was US$50.74 (95% CI 49.26-67.06) in intervention hospitals compared to US$31.1 (95% CI 30.67-47.18) in control hospitals. Each percentage improvement in average quality of care cost an additional US$0.79 (95% CI 0.19-2.31) per admitted child. The estimated annual cost of nationally scaling up the full intervention was US$3.6 million, approximately 0.6% of the annual child health budget in Kenya. A "what-if" analysis assuming conservative reductions in mortality suggests the incremental cost per disability adjusted life year (DALY) averted by scaling up would vary between US$39.8 and US$398.3. Improving quality of care at scale nationally with the full ETAT+ strategy may be affordable for low income countries such as Kenya. Resultant plausible reductions in hospital mortality suggest the intervention could be cost

  9. A multifaceted intervention to improve the quality of care of children in district hospitals in Kenya: a cost-effectiveness analysis.

    Directory of Open Access Journals (Sweden)

    Edwine W Barasa

    Full Text Available To improve care for children in district hospitals in Kenya, a multifaceted approach employing guidelines, training, supervision, feedback, and facilitation was developed, for brevity called the Emergency Triage and Treatment Plus (ETAT+ strategy. We assessed the cost effectiveness of the ETAT+ strategy, in Kenyan hospitals. Further, we estimate the costs of scaling up the intervention to Kenya nationally and potential cost effectiveness at scale.Our cost-effectiveness analysis from the provider's perspective used data from a previously reported cluster randomized trial comparing the full ETAT+ strategy (n = 4 hospitals with a partial intervention (n = 4 hospitals. Effectiveness was measured using 14 process measures that capture improvements in quality of care; their average was used as a summary measure of quality. Economic costs of the development and implementation of the intervention were determined (2009 US$. Incremental cost-effectiveness ratios were defined as the incremental cost per percentage improvement in (average quality of care. Probabilistic sensitivity analysis was used to assess uncertainty. The cost per child admission was US$50.74 (95% CI 49.26-67.06 in intervention hospitals compared to US$31.1 (95% CI 30.67-47.18 in control hospitals. Each percentage improvement in average quality of care cost an additional US$0.79 (95% CI 0.19-2.31 per admitted child. The estimated annual cost of nationally scaling up the full intervention was US$3.6 million, approximately 0.6% of the annual child health budget in Kenya. A "what-if" analysis assuming conservative reductions in mortality suggests the incremental cost per disability adjusted life year (DALY averted by scaling up would vary between US$39.8 and US$398.3.Improving quality of care at scale nationally with the full ETAT+ strategy may be affordable for low income countries such as Kenya. Resultant plausible reductions in hospital mortality suggest the intervention could be

  10. THE EFFECT OF INTRODUCED FORAGE LEGUMES ON IMPROVEMENT OF SOIL FERTILITY IN NATURAL PASTURES OF SEMI-ARID RANGELANDS OF KAJIADO DISTRICT, KENYA

    Directory of Open Access Journals (Sweden)

    Peter N Macharia

    2010-11-01

    Full Text Available A two phase study was carried out from 2002 to 2005 in the semi-arid rangelands of Kajiado District, Kenya to determine the effect of introduced forage legumes on soil fertility improvement of natural pastures. During legume evaluation phase, Neonotonia wightii (Glycine, Macroptilium atropurpureum (Siratro, Lablab purpureus cv. Rongai (Dolichos, Mucuna pruriens (Velvet bean and Stylosanthes scabra var. Seca (Stylo were screened for adaptability and growth performance under the semi-arid conditions for two years. Results of soil analysis showed there were significant increases in soil pH (4.92 to 5.36, organic carbon (1.17 to 2.57% , nitrogen (0.17 to 0.22% and potassium (1.23 to 1.68 me% probably due to the large amounts of organic residues produced by the legumes (particularly Glycine, Siratro and Stylo which are perennials. The calcium content decreased significantly from 7.97 to 4.50 me% (which was attributed to plant uptake while the decrease of phosphorus was not significant. During the second phase of study for 1½ years Glycine, Siratro and Stylo were integrated into natural pastures. The results showed that only the soil pH significantly increased from 5.23 to 5.31 while all the other nutrients decreased results, which were attributed to production of less organic residues by the legumes compared to the residues produced during the legume evaluation phase. The study concluded that Glycine, Siratro and Stylo were capable of improving the soil fertility of semi-arid natural pastures only if the respective dry matter production was 10.31, 7.81 and 3.52 tha-1, amounts which were able to produce large amounts of organic residues. Â

  11. Improving mapping for Ebola response through mobilising a local community with self-owned smartphones: Tonkolili District, Sierra Leone, January 2015

    OpenAIRE

    Nic Lochlainn, Laura M.; Gayton, Ivan; Theocharopoulos, Georgios; Edwards, Robin; Danis, Kostas; Kremer, Ronald; Kleijer, Karline; Tejan, Sumaila M.; Sankoh, Mohamed; Jimissa, Augustin; Greig, Jane; Caleo, Grazia

    2018-01-01

    Background During the 2014–16 Ebola virus disease (EVD) outbreak, the Magburaka Ebola Management Centre (EMC) operated by Médecins Sans Frontières (MSF) in Tonkolili District, Sierra Leone, identified that available district maps lacked up-to-date village information to facilitate timely implementation of EVD control strategies. In January 2015, we undertook a survey in chiefdoms within the MSF EMC catchment area to collect mapping and village data. We explore the feasibility and cost to mobi...

  12. Fast digital envelope detector based on generalized harmonic wavelet transform for BOTDR performance improvement

    International Nuclear Information System (INIS)

    Yang, Wei; Yang, Yuanhong; Yang, Mingwei

    2014-01-01

    We propose a fast digital envelope detector (DED) based on the generalized harmonic wavelet transform to improve the performance of coherent heterodyne Brillouin optical time domain reflectometry. The proposed DED can obtain undistorted envelopes due to the zero phase-shift ideal bandpass filter (BPF) characteristics of the generalized harmonic wavelet (GHW). Its envelope average ability benefits from the passband designing flexibility of the GHW, and its demodulation speed can be accelerated by using a fast algorithm that only analyses signals of interest within the passband of the GHW with reduced computational complexity. The feasibility and advantage of the proposed DED are verified by simulations and experiments. With an optimized bandwidth, Brillouin frequency shift accuracy improvements of 19.4% and 11.14%, as well as envelope demodulation speed increases of 39.1% and 24.9%, are experimentally attained by the proposed DED over Hilbert transform (HT) and Morlet wavelet transform (MWT) based DEDs, respectively. Spatial resolution by the proposed DED is undegraded, which is identical to the undegraded value by HT-DED with an allpass filter characteristic and better than the degraded value by MWT-DED with a Gaussian BPF characteristic. (paper)

  13. How to improve mental health competency in general practice training?--a SWOT analysis.

    Science.gov (United States)

    van Marwijk, Harm

    2004-06-01

    It is quite evident there is room for improvement in the primary care management of common mental health problems. Patients respond positively when GPs adopt a more proactive role in this respect. The Dutch general practice curriculum is currently being renewed. The topics discussed here include the Strengths, Weaknesses, Opportunities and Threats (SWOT) of present primary mental healthcare teaching. What works well and what needs improving? Integrated teaching packages are needed to help general practice trainees manage various presentations of psychological distress. Such packages comprise training videotapes, in which models such as problem-solving treatment (PST) are demonstrated, as well as roleplaying material for new skills, self-report questionnaires for patients, and small-group video feedback of consultations. While GP trainees can effectively master such skills, it is important to query the level of proficiency required by registrars. Are these skills of use only to connoisseur GPs, or to all? More room for specialisation and differentiation among trainees may be the way forward. We have just developed a new curriculum for the obligatory three-month psychiatry housemanship. It is competency oriented, self-directed and assignment driven. This new curriculum will be evaluated in due course.

  14. Modeling of chemical exergy of agricultural biomass using improved general regression neural network

    International Nuclear Information System (INIS)

    Huang, Y.W.; Chen, M.Q.; Li, Y.; Guo, J.

    2016-01-01

    A comprehensive evaluation for energy potential contained in agricultural biomass was a vital step for energy utilization of agricultural biomass. The chemical exergy of typical agricultural biomass was evaluated based on the second law of thermodynamics. The chemical exergy was significantly influenced by C and O elements rather than H element. The standard entropy of the samples also was examined based on their element compositions. Two predicted models of the chemical exergy were developed, which referred to a general regression neural network model based upon the element composition, and a linear model based upon the high heat value. An auto-refinement algorithm was firstly developed to improve the performance of regression neural network model. The developed general regression neural network model with K-fold cross-validation had a better ability for predicting the chemical exergy than the linear model, which had lower predicted errors (±1.5%). - Highlights: • Chemical exergies of agricultural biomass were evaluated based upon fifty samples. • Values for the standard entropy of agricultural biomass samples were calculated. • A linear relationship between chemical exergy and HHV of samples was detected. • An improved GRNN prediction model for the chemical exergy of biomass was developed.

  15. Impact of an improved shortwave radiation scheme in the MAECHAM5 General Circulation Model

    Directory of Open Access Journals (Sweden)

    J. J. Morcrette

    2007-05-01

    Full Text Available In order to improve the representation of ozone absorption in the stratosphere of the MAECHAM5 general circulation model, the spectral resolution of the shortwave radiation parameterization used in the model has been increased from 4 to 6 bands. Two 20-years simulations with the general circulation model have been performed, one with the standard and the other with the newly introduced parameterization respectively, to evaluate the temperature and dynamical changes arising from the two different representations of the shortwave radiative transfer. In the simulation with the increased spectral resolution in the radiation parameterization, a significant warming of almost the entire model domain is reported. At the summer stratopause the temperature increase is about 6 K and alleviates the cold bias present in the model when the standard radiation scheme is used. These general circulation model results are consistent both with previous validation of the radiation scheme and with the offline clear-sky comparison performed in the current work with a discrete ordinate 4 stream scattering line by line radiative transfer model. The offline validation shows a substantial reduction of the daily averaged shortwave heating rate bias (1–2 K/day cooling that occurs for the standard radiation parameterization in the upper stratosphere, present under a range of atmospheric conditions. Therefore, the 6 band shortwave radiation parameterization is considered to be better suited for the representation of the ozone absorption in the stratosphere than the 4 band parameterization. Concerning the dynamical response in the general circulation model, it is found that the reported warming at the summer stratopause induces stronger zonal mean zonal winds in the middle atmosphere. These stronger zonal mean zonal winds thereafter appear to produce a dynamical feedback that results in a dynamical warming (cooling of the polar winter (summer mesosphere, caused by an

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

    Science.gov (United States)

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

    2003-07-01

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

  17. Early tracking would improve the operative experience of general surgery residents.

    Science.gov (United States)

    Stain, Steven C; Biester, Thomas W; Hanks, John B; Ashley, Stanley W; Valentine, R James; Bass, Barbara L; Buyske, Jo

    2010-09-01

    High surgical complexity and individual career goals has led most general surgery (GS) residents to pursue fellowship training, resulting in a shortage of surgeons who practice broad-based general surgery. We hypothesize that early tracking of residents would improve operative experience of residents planning to be general surgeons, and could foster greater interest and confidence in this career path. Surgical Operative Log data from GS and fellowship bound residents (FB) applying for the 2008 American Board of Surgery Qualifying Examination (QE) were used to construct a hypothetical training model with 6 months of early specialization (ESP) for FB residents in 4 specialties (cardiac, vascular, colorectal, pediatric); and presumed these cases would be available to GS residents within the same program. A total of 142 training programs had both FB residents (n = 237) and GS residents (n = 402), and represented 70% of all 2008 QE applicants. The mean numbers of operations by FB and GS residents were 1131 and 1091, respectively. There were a mean of 252 cases by FB residents in the chief year, theoretically making 126 cases available for each GS resident. In 9 defined categories, the hypothetical model would result in an increase in the 5-year operative experience of GS residents (mastectomy 6.5%; colectomy 22.8%; gastrectomy 23.4%; antireflux procedures 23.4%; pancreatic resection 37.4%; liver resection 29.3%; endocrine procedures 19.6%; trauma operations 13.3%; GI endoscopy 6.5%). The ESP model improves operative experience of GS residents, particularly for complex gastrointestinal procedures. The expansion of subspecialty ESP should be considered.

  18. Furfural and its biochar improve the general properties of a saline soil

    Science.gov (United States)

    Wu, Y.; Xu, G.; Shao, H. B.

    2014-07-01

    Organic materials (e.g., furfural residue) are generally believed to improve the physical and chemical properties of saline soils with low fertility. Recently, biochar has been received more attention as a possible measure to improve the carbon balance and improve soil quality in some degraded soils. However, little is known about their different amelioration of a sandy saline soil. In this study, 56 d incubation experiment was conducted to evaluate the influence of furfural and its biochar on the properties of saline soil. The results showed that both furfural and biochar greatly reduced pH, increased soil organic carbon (SOC) content and cation exchange capacity (CEC), and enhanced the available phosphorus (P) in the soil. Furfural is more efficient than biochar in reducing pH: 5% furfural lowered the soil pH by 0.5-0.8 (soil pH: 8.3-8.6), while 5% biochar decreased by 0.25-0.4 due to the loss of acidity in pyrolysis process. With respect to available P, furfural addition at a rate of 5% increased available P content by 4-6 times in comparison to 2-5 times with biochar application. In reducing soil exchangeable sodium percentage (ESP), biochar is slightly superior to furfural because soil ESP reduced by 51% and 43% with 5% furfural and 5% biochar at the end of incubation. In addition, no significant differences were observed between furfural and biochar about their capacity to retain N, P in leaching solution and to increase CEC in soil. These facts may be caused by the relatively short incubation time. In general, furfural and biochar exhibited a different effect depending on the property: furfural was more effective in decreasing pH and increasing available P, whereas biochar played a more important role in increasing SOC and reducing ESP of saline soil.

  19. Domain-Specific and Domain-General Training to Improve Kindergarten Children’s Mathematics

    Directory of Open Access Journals (Sweden)

    Geetha B. Ramani

    2017-12-01

    Full Text Available Ensuring that kindergarten children have a solid foundation in early numerical knowledge is of critical importance for later mathematical achievement. In this study, we targeted improving the numerical knowledge of kindergarteners (n = 81 from primarily low-income backgrounds using two approaches: one targeting their conceptual knowledge, specifically, their understanding of numerical magnitudes; and the other targeting their underlying cognitive system, specifically, their working memory. Both interventions involved playing game-like activities on tablet computers over the course of several sessions. As predicted, both interventions improved children’s numerical magnitude knowledge as compared to a no-contact control group, suggesting that both domain-specific and domain-general interventions facilitate mathematical learning. Individual differences in effort during the working memory game, but not the number knowledge training game predicted children’s improvements in number line estimation. The results demonstrate the potential of using a rapidly growing technology in early childhood classrooms to promote young children’s numerical knowledge.

  20. Mobile task management tool that improves workflow of an acute general surgical service.

    Science.gov (United States)

    Foo, Elizabeth; McDonald, Rod; Savage, Earle; Floyd, Richard; Butler, Anthony; Rumball-Smith, Alistair; Connor, Saxon

    2015-10-01

    Understanding and being able to measure constraints within a health system is crucial if outcomes are to be improved. Current systems lack the ability to capture decision making with regard to tasks performed within a patient journey. The aim of this study was to assess the impact of a mobile task management tool on clinical workflow within an acute general surgical service by analysing data capture and usability of the application tool. The Cortex iOS application was developed to digitize patient flow and provide real-time visibility over clinical decision making and task performance. Study outcomes measured were workflow data capture for patient and staff events. Usability was assessed using an electronic survey. There were 449 unique patient journeys tracked with a total of 3072 patient events recorded. The results repository was accessed 7792 times. The participants reported that the application sped up decision making, reduced redundancy of work and improved team communication. The mode of the estimated time the application saved participants was 5-9 min/h of work. Of the 14 respondents, nine discarded their analogue methods of tracking tasks by the end of the study period. The introduction of a mobile task management system improved the working efficiency of junior clinical staff. The application allowed capture of data not previously available to hospital systems. In the future, such data will contribute to the accurate mapping of patient journeys through the health system. © 2015 Royal Australasian College of Surgeons.

  1. The IPR-R1 TRIGA Mark I Reactor in 39 years: Operations and general improvements

    International Nuclear Information System (INIS)

    Maretti Junior, Fausto; Prado Fernandes, Marcio; Oliveira, Paulo Fernando; Alves de Amorim, Valter

    1999-01-01

    The nuclear IPR-R1 TRIGA Mark I Reactor operating in the Nuclear Technology Development Center, originally Institute for Radioactive Research in Minas Gerais, Brazil, was dedicated in November 11, 1960. Initially operating for the production of radioisotopes for different uses, it started later to be used in large scale for neutron activation analysis and training of operators for nuclear power plants. Many improvements have been made throughout these years to provide a better performance in its operation and safety conditions. A new cooling system to operate until 300 kW, a new control rod mechanism, an aluminum tank for the reactor pool, an optimization in the pneumatic system, a new reactor control console and a general remodeling of the reactor laboratory were some of the improvements added. To prevent and mitigate the ageing effects, the reactor operation personnel is starting a program to minimize future operation problems. This paper describes the improvements made, the results obtained during the past 39 years, and the precautions taken to ensure future safe operation of the reactor to give operators better conditions of safe work. (author)

  2. Effectiveness of Tarling Cirebonan Cultural Arts as a Media to Improve Pregnant Women’s Knowledge in Cirebon District of West Java

    Directory of Open Access Journals (Sweden)

    Herti Maryani

    2016-02-01

    Full Text Available Background: Antenatal class is a program from the Ministry of Health of the Republic of Indonesia for increasing pregnant women’s knowledge. Until recently, the media used in has not varied yet; thus, innovation on instructional media based on culture to complement the existing media is needed. One of the typical cultural arts of Cirebon is Tarling Cirebonan. The objective is to analyze the effectiveness of media Tarling Cirebonan to improve pregnant women’s knowledges. Methods: This was an analytic study with a quasi experimental design and a non-randomized pre-test and post-test with control group design, by making use of qualitative data. The study was conducted in Cirebon District from March to September 2014. The study sample was 80 pregnant women in Kalibuntu Health Center (40 with Cirebonan Tarling media and 40 with fl ipchart media. Research instruments included music box containing ringtone and lyrics of Tarling Cirebonan consisting of antenatal class materials, fl ipchart, questionnaires, in-depth interview and focus group discussion’s guide. Data analysis with a paired t-test and independent t-test. Result: There were signifi cant differences in score changes on pregnant women’s knowledge at pre-test and fi rst post-test and second post test with a mean difference of 1.35 and 1.70. There was a positive response from pregnant women, the husband, village midwives and society against Cirebonan Tarling media. Conclusions: There were signifi cant differences in score changes on pregnant women’s knowledge at pre-test and fi rst post-test and second post test with a mean difference of 1.35 and 1.70. There was a positive response from pregnant women, the husband, village midwives and society against Cirebonan Tarling media. Recommendation: Tarling Cirebonan Media is more effective to improve pregnant women’s knowledge than fl ipchart media, so that it can be used as an innovative media in improving pregnant women’s knowledge.

  3. Survey report of year 2000 version. Feasibility study on energy efficiency/conservation, and environmental improvement of district heat and electricity supply station Radom City

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2000-03-01

    In order to promote the COP3 joint implementation, discussions were given on the district heat and electricity supply station in Radom City in Poland. Power capacity utilized above a certain level will be generated by cogeneration power plants according to the annual heat supply load patterns, and insufficient capacity will be supplied from the existing hot water boilers during winter when thermal load is high. Daily load variation will be handled by installing auxiliary combustion facilities of 20% of the full capacity. The power plants will be of natural gas burning gas-turbine cogeneration plants, and hot water will be supplied from the modified waste heat boilers. The cogeneration power plants will be capable of taking care of 80% of the annual supply quantity of heat. The heat supply capacity will be 72 MWt including the auxiliary combustion, and the electric power generation capacity will be 35 MWe. Improvement in thermal efficiency to 80% or higher will reduce coal consumption, resulting in saving of 28,117 toe/year after subtracting the increase in natural gas consumption. Reduction in CO2 emission will also be as large as 206,000 tons/year, causing air pollutants to be also reduced. Assuming the facility cost of 4,336 billion yen to be taken care by the Japanese environmental yen loan, the Polish National Fund loan, and the independent fund of the city of Radom, the IRRON investment over the operation period of 30 years is considerably good at 10%. The investment can be recovered in nine years, and the cash flow will have no problems. (NEDO)

  4. Effectiveness of community based safe motherhood promoters in improving the utilization of obstetric care. The case of Mtwara Rural District in Tanzania

    Directory of Open Access Journals (Sweden)

    Jahn Albrecht

    2010-04-01

    Full Text Available Abstract Background In Tanzania, maternal mortality ratio remains unacceptably high at 578/100,000 live births. Despite a high coverage of antenatal care (96%, only 44% of deliveries take place within the formal health services. Still, "Ensure skilled attendant at birth" is acknowledged as one of the most effective interventions to reduce maternal deaths. Exploring the potential of community-based interventions in increasing the utilization of obstetric care, the study aimed at developing, testing and assessing a community-based safe motherhood intervention in Mtwara rural District of Tanzania. Method This community-based intervention was designed as a pre-post comparison study, covering 4 villages with a total population of 8300. Intervention activities were implemented by 50 trained safe motherhood promoters (SMPs. Their tasks focused on promoting early and complete antenatal care visits and delivery with a skilled attendant. Data on all 512 deliveries taking place from October 2004 to November 2006 were collected by the SMPs and cross-checked with health service records. In addition 242 respondents were interviewed with respect to knowledge on safe motherhood issues and their perception of the SMP's performance. Skilled delivery attendance was our primary outcome; secondary outcomes included antenatal care attendance and knowledge on Safe Motherhood issues. Results Deliveries with skilled attendant significantly increased from 34.1% to 51.4% (ρ Conclusion The study has demonstrated the effectiveness of community-based safe motherhood intervention in promoting the utilization of obstetric care and a skilled attendant at delivery. This improvement is attributed to the SMPs' home visits and the close collaboration with existing community structures as well as health services.

  5. Implementation of a new 'community' laboratory CD4 service in a rural health district in South Africa extends laboratory services and substantially improves local reporting turnaround time.

    Science.gov (United States)

    Coetzee, L M; Cassim, N; Glencross, D K

    2015-12-16

    The CD4 integrated service delivery model (ITSDM) provides for reasonable access to pathology services across South Africa (SA) by offering three new service tiers that extend services into remote, under-serviced areas. ITSDM identified Pixley ka Seme as such an under-serviced district. To address the poor service delivery in this area, a new ITSDM community (tier 3) laboratory was established in De Aar, SA. Laboratory performance and turnaround time (TAT) were monitored post implementation to assess the impact on local service delivery. Using the National Health Laboratory Service Corporate Data Warehouse, CD4 data were extracted for the period April 2012-July 2013 (n=11,964). Total mean TAT (in hours) was calculated and pre-analytical and analytical components assessed. Ongoing testing volumes, as well as external quality assessment performance across ten trials, were used to indicate post-implementation success. Data were analysed using Stata 12. Prior to the implementation of CD4 testing at De Aar, the total mean TAT was 20.5 hours. This fell to 8.2 hours post implementation, predominantly as a result of a lower pre-analytical mean TAT reducing from a mean of 18.9 to 1.8 hours. The analytical testing TAT remained unchanged after implementation and monthly test volumes increased by up to 20%. External quality assessment indicated adequate performance. Although subjective, questionnaires sent to facilities reported improved service delivery. Establishing CD4 testing in a remote community laboratory substantially reduces overall TAT. Additional community CD4 laboratories should be established in under-serviced areas, especially where laboratory infrastructure is already in place.

  6. Superintendents' Perceptions of the School Improvement Planning Process in the Southeastern USA

    Science.gov (United States)

    Dunaway, David M.; Bird, James J.; Wang, Chuang; Hancock, Dawson

    2014-01-01

    The purpose of this study of school improvement planning in the southeastern USA was to establish the current view of the process through the eyes of the district superintendents. The answers to the questions were consistently mixed. Generally, the presence of school improvement planning is prevalent in the large majority of districts. However,…

  7. Do longer consultations improve the management of psychological problems in general practice? A systematic literature review

    Directory of Open Access Journals (Sweden)

    Hutton Catherine

    2007-05-01

    Full Text Available Abstract Background Psychological problems present a huge burden of illness in our community and GPs are the main providers of care. There is evidence that longer consultations in general practice are associated with improved quality of care; but this needs to be balanced against the fact that doctor time is a limited resource and longer consultations may lead to reduced access to health care. The aim of this research was to conduct a systematic literature review to determine whether management of psychological problems in general practice is associated with an increased consultation length and to explore whether longer consultations are associated with better health outcomes for patients with psychological problems. Methods A search was conducted on Medline (Ovid databases up to7 June 2006. The following search terms, were used: general practice or primary health care (free text or family practice (MeSH AND consultation length or duration (free text or time factors (MeSH AND depression or psychological problems or depressed (free text. A similar search was done in Web of Science, Pubmed, Google Scholar, and Cochrane Library and no other papers were found. Studies were included if they contained data comparing consultation length and management or detection of psychological problems in a general practice or primary health care setting. The studies were read and categories developed to enable systematic data extraction and synthesis. Results 29 papers met the inclusion criteria. Consultations with a recorded diagnosis of a psychological problem were reported to be longer than those with no recorded psychological diagnosis. It is not clear if this is related to the extra time or the consultation style. GPs reported that time pressure is a major barrier to treating depression. There was some evidence that increased consultation length is associated with more accurate diagnosis of psychological problems. Conclusion Further research is needed to

  8. Improved anomaly detection using multi-scale PLS and generalized likelihood ratio test

    KAUST Repository

    Madakyaru, Muddu

    2017-02-16

    Process monitoring has a central role in the process industry to enhance productivity, efficiency, and safety, and to avoid expensive maintenance. In this paper, a statistical approach that exploit the advantages of multiscale PLS models (MSPLS) and those of a generalized likelihood ratio (GLR) test to better detect anomalies is proposed. Specifically, to consider the multivariate and multi-scale nature of process dynamics, a MSPLS algorithm combining PLS and wavelet analysis is used as modeling framework. Then, GLR hypothesis testing is applied using the uncorrelated residuals obtained from MSPLS model to improve the anomaly detection abilities of these latent variable based fault detection methods even further. Applications to a simulated distillation column data are used to evaluate the proposed MSPLS-GLR algorithm.

  9. Reorganizing the General Clinical Research Center to improve the clinical and translational research enterprise.

    Science.gov (United States)

    Allen, David; Ripley, Elizabeth; Coe, Antoinette; Clore, John

    2013-12-01

    In 2010, Virginia Commonwealth University (VCU) was granted a Clinical and Translational Science Award which prompted reorganization and expansion of their clinical research infrastructure. A case study approach is used to describe the implementation of a business and cost recovery model for clinical and translational research and the transformation of VCU's General Clinical Research Center and Clinical Trials Office to a combined Clinical Research Services entity. We outline the use of a Plan, Do, Study, Act cycle that facilitated a thoughtful transition process, which included the identification of required changes and cost recovery processes for implementation. Through this process, the VCU Center for Clinical and Translational Research improved efficiency, increased revenue recovered, reduced costs, and brought a high level of fiscal responsibility through financial reporting.

  10. Improved anomaly detection using multi-scale PLS and generalized likelihood ratio test

    KAUST Repository

    Madakyaru, Muddu; Harrou, Fouzi; Sun, Ying

    2017-01-01

    Process monitoring has a central role in the process industry to enhance productivity, efficiency, and safety, and to avoid expensive maintenance. In this paper, a statistical approach that exploit the advantages of multiscale PLS models (MSPLS) and those of a generalized likelihood ratio (GLR) test to better detect anomalies is proposed. Specifically, to consider the multivariate and multi-scale nature of process dynamics, a MSPLS algorithm combining PLS and wavelet analysis is used as modeling framework. Then, GLR hypothesis testing is applied using the uncorrelated residuals obtained from MSPLS model to improve the anomaly detection abilities of these latent variable based fault detection methods even further. Applications to a simulated distillation column data are used to evaluate the proposed MSPLS-GLR algorithm.

  11. Improvement of the Model of Enterprise Management Process on the Basis of General Management Functions

    Directory of Open Access Journals (Sweden)

    Ruslan Skrynkovskyy

    2017-12-01

    Full Text Available The purpose of the article is to improve the model of the enterprise (institution, organization management process on the basis of general management functions. The graphic model of the process of management according to the process-structured management is presented. It has been established that in today's business environment, the model of the management process should include such general management functions as: 1 controlling the achievement of results; 2 planning based on the main goal; 3 coordination and corrective actions (in the system of organization of work and production; 4 action as a form of act (conscious, volitional, directed; 5 accounting system (accounting, statistical, operational-technical and managerial; 6 diagnosis (economic, legal with such subfunctions as: identification of the state and capabilities; analysis (economic, legal, systemic with argumentation; assessment of the state, trends and prospects of development. The prospect of further research in this direction is: 1 the formation of a system of interrelation of functions and management methods, taking into account the presented research results; 2 development of the model of effective and efficient communication business process of the enterprise.

  12. An Improved Method for Sizing Standalone Photovoltaic Systems Using Generalized Regression Neural Network

    Directory of Open Access Journals (Sweden)

    Tamer Khatib

    2014-01-01

    Full Text Available In this research an improved approach for sizing standalone PV system (SAPV is presented. This work is an improved work developed previously by the authors. The previous work is based on the analytical method which faced some concerns regarding the difficulty of finding the model’s coefficients. Therefore, the proposed approach in this research is based on a combination of an analytical method and a machine learning approach for a generalized artificial neural network (GRNN. The GRNN assists to predict the optimal size of a PV system using the geographical coordinates of the targeted site instead of using mathematical formulas. Employing the GRNN facilitates the use of a previously developed method by the authors and avoids some of its drawbacks. The approach has been tested using data from five Malaysian sites. According to the results, the proposed method can be efficiently used for SAPV sizing whereas the proposed GRNN based model predicts the sizing curves of the PV system accurately with a prediction error of 0.6%. Moreover, hourly meteorological and load demand data are used in this research in order to consider the uncertainty of the solar energy and the load demand.

  13. An Improved Minimum Error Interpolator of CNC for General Curves Based on FPGA

    Directory of Open Access Journals (Sweden)

    Jiye HUANG

    2014-05-01

    Full Text Available This paper presents an improved minimum error interpolation algorithm for general curves generation in computer numerical control (CNC. Compared with the conventional interpolation algorithms such as the By-Point Comparison method, the Minimum- Error method and the Digital Differential Analyzer (DDA method, the proposed improved Minimum-Error interpolation algorithm can find a balance between accuracy and efficiency. The new algorithm is applicable for the curves of linear, circular, elliptical and parabolic. The proposed algorithm is realized on a field programmable gate array (FPGA with Verilog HDL language, and simulated by the ModelSim software, and finally verified on a two-axis CNC lathe. The algorithm has the following advantages: firstly, the maximum interpolation error is only half of the minimum step-size; and secondly the computing time is only two clock cycles of the FPGA. Simulations and actual tests have proved that the high accuracy and efficiency of the algorithm, which shows that it is highly suited for real-time applications.

  14. Preliminary statement on general policy for rulemaking to improve nuclear power plant licensing

    International Nuclear Information System (INIS)

    1978-11-01

    In June 1977 an NRC study group seeking to identify ways to improve the effectiveness of NRC nuclear power plant licensing procedures, recommended (among other measures) that rulemaking should be considered for the generic resolution of certain major issues that are presently litigated in individual licensing proceedings (NUREG--0292). In response to a Commission directive, the staff prepared an interim statement of general policy and plans for rulemaking, which the Commission approved for publication n the Federal Register at Affirmation Session 78-7 held on October 26, 1978. This interim policy statement fully supports Executive Order 12044 of March 23, 1978, requesting improvement of existing and future government regulations so as to be as simple and clear as possible and avoid imposing unnecessary burdens on the economy, on individuals, on public and private organizations, or on State and local governments. This NUREG publication includes the full text of the Federal Register notice published concurrently. Also provided are Enclosures A and B which contain more complete information than is presented in the FR notice regarding the selection and discussion of issues proposed by the staff for generic rulemaking. However, the discussion of issues avoids being overly specific about the likely outcome of rulemaking in order to stimulate creative public and industry comments as desirable inputs to shaping the ultimate form of generic rules

  15. Potential use of mobile phones in improving animal health service delivery in underserved rural areas: experience from Kilosa and Gairo districts in Tanzania.

    Science.gov (United States)

    Karimuribo, Esron D; Batamuzi, Emmanuel K; Massawe, Lucas B; Silayo, Richard S; Mgongo, Frederick O K; Kimbita, Elikira; Wambura, Raphael M

    2016-10-07

    Sub-optimal performance of the animal health delivery system in rural areas is common in developing countries including Tanzania. However, penetration of mobile phones and availability of good road network and public transport systems offer opportunities for improving the access of rural communities to diagnostic and advisory services from facilities and expertise located in urban areas. A questionnaire survey on possession and use of mobile phones by pastoral and agro-pastoral communities in Kilosa and Gairo districts was carried out between November and December 2015. A total number of 138 livestock keepers from three villages of Chakwale (54), Mvumi (41) and Parakuyo (43) participated in the study. An e-based system was designed and tested to link rural communities with urban diagnostic facilities. It was observed that the average number of phones possessed by individuals interviewed and household families was 1.1 ± 0.26 (1-2) and 3.5 ± 2.23 (1-10), respectively. It was further observed that out of 138 livestock keepers interviewed, 133 (96.4 %) had feature phones while 10 (7.2 %) of them possessed smartphones. Mobile phone is currently used to support livestock production by communicating on animal health in Parakuyo (18, 41.9 %), Mvumi (18, 43.9 %) and Chakwale (14, 25.9 %). Other contributions of mobile phones in livestock and crop agriculture observed in the study area include: exchange of livestock price information, crop price information, communicating on plant health/diseases, livestock extension and advisory services as well as crop farming extension and advisory services. We also designed and tested an e-based SUAVetDiag® system to support timely diagnosis of infectious disease conditions and prompt advice on case management in veterinary underserved areas. Availability of mobile phones in rural areas, in combination with supporting infrastructure and facilities in urban areas, has potential to stimulate local development and improving

  16. Enlightenment of Qilou Street Space Intelligence to Pedestrian System Design in Commercial District

    Directory of Open Access Journals (Sweden)

    Chen Jing

    2016-01-01

    Full Text Available Aiming at those generally existing problems in urban commercial pedestrian districts, through the design methods of extracting separation of man from vehicle in traditional Qilou pedestrian street space, continuous pedestrian space with shelter, and the behavior paths with combination of commercial activities, this thesis sets about from the behaviors of pedestrians in walking state, and finds that the traditional Qilou pedestrian street space can satisfy pedestrians’ physiological and psychological demands in shopping better. At the same time, combining current urban commercial districts developing demands, and the successful experience from traditional Qilou, this thesis also proposes relevant improvement measures. The improvements in design means are expected to improve pedestrian environment for, and achieve the commercial values of these districts, as well as the win-win of environment improvement and commercial activity development.

  17. Career satisfaction among general surgeons in Canada: a qualitative study of enablers and barriers to improve recruitment and retention in general surgery.

    Science.gov (United States)

    Ahmed, Najma; Conn, Lesley Gotlib; Chiu, Mary; Korabi, Bochra; Qureshi, Adnan; Nathens, Avery B; Kitto, Simon

    2012-11-01

    To understand what influences career satisfaction among general surgeons in urban and rural areas in Canada in order to improve recruitment and retention in general surgery. Semistructured interviews were conducted with 32 general surgeons in 2010 who were members of the Canadian Association of General Surgeons and who currently practice in either an urban or rural area. Interviews explored factors contributing to career satisfaction, as well as suggestions for preventive, screening, or management strategies to support general surgery practice. Findings revealed that both urban and rural general surgeons experienced the most satisfaction from their ability to resolve patient problems quickly and effectively, enhancing their sense of the meaningfulness of their clinical practice. The supportive relationships with colleagues, trainees, and patients was also cited as a key source of career satisfaction. Conversely, insufficient access to resources and a perceived disconnect between hospital administration and clinical practice priorities were raised as key "systems-level" problems. As a result, many participants felt alienated from their work by these systems-level barriers that were perceived to hinder the provision of high-quality patient care. Career satisfaction among both urban and rural general surgeons was influenced positively by the social aspects of their work, such as patient and colleague relationships, as well as a perception of an increasing amount of control and autonomy over their professional commitments. The modern general surgeon values a balance between professional obligations and personal time that may be difficult to achieve given the current system constraints.

  18. To what extent do site-based training, mentoring, and operational research improve district health system management and leadership in low- and middle-income countries: a systematic review protocol.

    Science.gov (United States)

    Belrhiti, Zakaria; Booth, Andrew; Marchal, Bruno; Verstraeten, Roosmarijn

    2016-04-27

    District health managers play a key role in the effectiveness of decentralized health systems in low- and middle-income countries. Inadequate management and leadership skills often hamper their ability to improve quality of care and effectiveness of health service delivery. Nevertheless, significant investments have been made in capacity-building programmes based on site-based training, mentoring, and operational research. This systematic review aims to review the effectiveness of site-based training, mentoring, and operational research (or action research) on the improvement of district health system management and leadership. Our secondary objectives are to assess whether variations in composition or intensity of the intervention influence its effectiveness and to identify enabling and constraining contexts and underlying mechanisms. We will search the following databases: MEDLINE, PsycInfo, Cochrane Library, CRD database (DARE), Cochrane Effective Practice and Organisation of Care (EPOC) group, ISI Web of Science, Health Evidence.org, PDQ-Evidence, ERIC, EMBASE, and TRIP. Complementary search will be performed (hand-searching journals and citation and reference tracking). Studies that meet the following PICO (Population, Intervention, Comparison, Outcome) criteria will be included: P: professionals working at district health management level; I: site-based training with or without mentoring, or operational research; C: normal institutional arrangements; and O: district health management functions. We will include cluster randomized controlled trials, controlled before-and-after studies, interrupted time series analysis, quasi-experimental designs, and cohort and longitudinal studies. Qualitative research will be included to contextualize findings and identify barriers and facilitators. Primary outcomes that will be reported are district health management and leadership functions. We will assess risk of bias with the Cochrane Collaboration's tools for randomized

  19. The use of Collagenase Clostridium Histolyticum in the management of Dupuytren's contracture-outcomes of a pilot study in a District General Hospital setting.

    Science.gov (United States)

    Murphy, Lynn E; Murphy, Karen M; Kilpatrick, Shauneen M; Thompson, Neville W

    2017-05-01

    Collagenase Clostridium Histolyticum (CCH) is a recognised treatment option for adult patients presenting with Dupuytren's contracture (DC). Twenty male patients with established DC were treated using CCH. The average metacarpophalangeal (MCP) joint and proximal interphalangeal joint (PIP) contractures pre-treatment were 52 0 (range, 0 - 75 0 ) and 35 0 (range, 0 - 84 0 ) respectively. The average DASH score pre-treatment was 24.2 points (range, 0 - 68.2 points). Patients were reviewed at lmonth, 3months and at an average of 23 months (17 to 27 months). MCP joint contractures significantly improved compared to pre-treatment and the improvement was maintained at latest follow up. PIP joint contractures did significantly improve but to a lesser degree and there was no significant improvement compared to pre-treatment beyond 3months. A trend for MCP and PIP joint contracture recurrence was observed at latest follow up but did not reach statistical significance. DASH scores significantly improved from pre-treatment and the improvement was maintained at latest follow up. At 3months, the average patient satisfaction score was 9.5 (range, 6 - 10), which decreased to 8.6 (range, 6 - 10) at latest follow up. We estimated a potential cost saving of approximately £70,000 by treating 20 patients using CCH compared to inpatient operative fasciectomy. CCH is a useful option in the management of DC in appropriately selected patients. Cost-effectiveness in the treatment of DC should be carefully considered.

  20. Fiscal 1999 basic research on promotion of joint implementation. Comprehensive feasibility study on efficiency improvement project for heat generation facilities and heat supply networks for district heating at districts in Moscow region, the Russian Federation (2 model districts within the region)

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2000-03-01

    For the purpose of conserving energy and reducing greenhouse gas, a survey is conducted for district heating facilities of the Khimki district and Voskresensk district in Moscow and for their heat supply networks. Four boilers existing at the Khimki district are all to be replaced by natural gas turbine centralized cogeneration plants, and four boilers existing at the Voskresensk district are all to be replaced by natural gas turbine cogeneration facilities. These projects are designated as Case 1 and Case 2, different from each other in terms of power generation capability and heat supply scale. As for investment, a total of 267-million dollars will be necessary for Case 1, and 208-million dollars for Case 2. As for energy conservation, energy will be saved by approximately 2.8-million tons in total in terms of oil in Case 1, and approximately 2-million tons in terms of oil in Case 2. As for greenhouse gas reduction, there will be a reduction of approximately 6.8-million tons in terms of CO2 in Case 1, and a reduction of approximately 4.9-million tons in terms of CO2 in Case 2. (NEDO)

  1. Influence of Head Teachers' General and Instructional Supervisory Practices on Teachers' Work Performance in Secondary Schools in Entebbe Municipality, Wakiso District, Uganda

    Science.gov (United States)

    Jared, Nzabonimpa Buregeya

    2011-01-01

    The study examined the Influence of Secondary School Head Teachers' General and Instructional Supervisory Practices on Teachers' Work Performance. Qualitative and qualitative methods with a descriptive-correlational research approach were used in the study. Purposive sampling technique alongside random sampling technique was used to select the…

  2. Strategic laparoscopic surgery for improved cosmesis in general and bariatric surgery: analysis of initial 127 cases.

    Science.gov (United States)

    Nguyen, Ninh T; Smith, Brian R; Reavis, Kevin M; Nguyen, Xuan-Mai T; Nguyen, Brian; Stamos, Michael J

    2012-05-01

    Strategic laparoscopic surgery for improved cosmesis (SLIC) is a less invasive surgical approach than conventional laparoscopic surgery. The aim of this study was to examine the feasibility and safety of SLIC for general and bariatric surgical operations. Additionally, we compared the outcomes of laparoscopic sleeve gastrectomy with those performed by the SLIC technique. In an academic medical center, from April 2008 to December 2010, 127 patients underwent SLIC procedures: 38 SLIC cholecystectomy, 56 SLIC gastric banding, 26 SLIC sleeve gastrectomy, 1 SLIC gastrojejunostomy, and 6 SLIC appendectomy. SLIC sleeve gastrectomy was initially performed through a single 4.0-cm supraumbilical incision with extraction of the gastric specimen through the same incision. The technique evolved to laparoscopic incisions that were all placed within the umbilicus and suprapubic region. There were no 30-day or in-hospital mortalities or 30-day re-admissions or re-operations. For SLIC cholecystectomy, gastric banding, appendectomy, and gastrojejunostomy, conversion to conventional laparoscopy occurred in 5.3%, 5.4%, 0%, and 0%, respectively; there were no major or minor postoperative complications. For SLIC sleeve gastrectomy, there were no significant differences in mean operative time and length of hospital stay compared with laparoscopic sleeve gastrectomy; 1 (3.8%) of 26 SLIC patients required conversion to five-port laparoscopy. There were no major complications. Minor complications occurred in 7.7% in the SLIC sleeve group versus 8.3% in the laparoscopic sleeve group. SLIC in general and bariatric operations is technically feasible, safe, and associated with a low rate of conversion to conventional laparoscopy. Compared with laparoscopic sleeve gastrectomy, SLIC sleeve gastrectomy can be performed without a prolonged operative time with comparable perioperative outcomes.

  3. Seeking to improve spatial justice - the case of rationalising the district court areas in South Africa - utilising several spatial analysis methods.

    CSIR Research Space (South Africa)

    Maritz, J

    2015-08-01

    Full Text Available for the Department of Justice and Constitutional Development during 2014 to assist the process to rationalise magisterial districts. In order to determine access to courts, some form of impact assessment is required – this paper outlines the accessibility analysis...

  4. Cooperating with a palliative home-care team: expectations and evaluations of GPs and district nurses

    DEFF Research Database (Denmark)

    Goldschmidt, Dorthe; Groenvold, Mogens; Johnsen, Anna Thit

    2005-01-01

    BACKGROUND: Palliative home-care teams often cooperate with general practitioners (GPs) and district nurses. Our aim was to evaluate a palliative home-care team from the viewpoint of GPs and district nurses. METHODS: GPs and district nurses received questionnaires at the start of home-care and one...... month later. Questions focussed on benefits to patients, training issues for professionals and cooperation between the home-care team and the GP/ district nurse. A combination of closed- and open-ended questions was used. RESULTS: Response rate was 84% (467/553). Benefits to patients were experienced...... by 91 %, mainly due to improvement in symptom management, 'security', and accessibility of specialists in palliative care. After one month, 57% of the participants reported to have learnt aspects of palliative care, primarily symptom control, and 89% of them found cooperation satisfactory...

  5. 78 FR 58049 - Proposed Establishment of the Adelaida District, Creston District, El Pomar District, Paso Robles...

    Science.gov (United States)

    2013-09-20

    ... Shallow, well- Deep alluvial Deep to moderate Mostly shallow drained, residual soils, with clay, depth... neither an approval nor an endorsement by TTB of the wine produced in that area. Requirements Section 4.25... Adelaida District viticultural area are hillside residual soils, which generally have shallow rooting...

  6. Atmospheric radiation measurement: A program for improving radiative forcing and feedback in general circulation models

    International Nuclear Information System (INIS)

    Patrinos, A.A.; Renne, D.S.; Stokes, G.M.; Ellingson, R.G.

    1991-01-01

    The Atmospheric Radiation Measurement (ARM) Program is a key element of the Department of Energy's (DOE's) global change research strategy. ARM represents a long-term commitment to conduct comprehensive studies of the spectral atmospheric radiative energy balance profile for a wide range of cloud conditions and surface types, and to develop the knowledge necessary to improve parameterizations of radiative processes under various cloud regimes for use in general circulation models (GCMs) and related models. The importance of the ARM program is a apparent from the results of model assessments of the impact on global climate change. Recent studies suggest that radiatively active trace gas emissions caused by human activity can lead to a global warming of 1.5 to 4.5 degrees Celsius and to important changes in water availability during the next century (Cess, et al. 1989). These broad-scale changes can be even more significant at regional levels, where large shifts in temperature and precipitation patterns are shown to occur. However, these analyses also indicate that considerable uncertainty exists in these estimates, with the manner in which cloud radiative processes are parameterized among the most significant uncertainty. Thus, although the findings have significant policy implications in assessment of global and regional climate change, their uncertainties greatly influence the policy debate. ARM's highly focused observational and analytical research is intended to accelerate improvements and reduce key uncertainties associated with the way in which GCMs treat cloud cover and cloud characteristics and the resulting radiative forcing. This paper summarizes the scientific context for ARM, ARM's experimental approach, and recent activities within the ARM program

  7. Do district health systems perform differently because of their managers? Preliminary insights from Indonesia

    Directory of Open Access Journals (Sweden)

    Augustine Asante

    2015-07-01

    Full Text Available District health systems (DHS are central to the global efforts to improve health outcomes but many remain ineffective. In many lowresource settings, despite the generally weak DHS there is evidence that some districts consistently perform well against the odds, and this is often attributed to the calibre of managers leading such districts and their management and leadership (M&L skills. This paper examines the M&L practices of district health managers in high and low performing districts in Indonesia in an attempt to understand whether the differences in the performance of DHS can be explained, at least in part, by the differences in the performance of their health managers. We employed a mixed methods case study design focusing on two purposefully selected districts. Data were collected in 2011 using questionnaires and in-depth interviews. The preliminary results suggest that M&L practices of managers in the high and low performing districts are similar and provide little explanation for the differences in the performance of the two DHS. Contextual and health system factors offered a much better explanation for the variations in DHS performance.

  8. Characterizing and improving generalized belief propagation algorithms on the 2D Edwards–Anderson model

    International Nuclear Information System (INIS)

    Domínguez, Eduardo; Lage-Castellanos, Alejandro; Mulet, Roberto; Ricci-Tersenghi, Federico; Rizzo, Tommaso

    2011-01-01

    We study the performance of different message passing algorithms in the two-dimensional Edwards–Anderson model. We show that the standard belief propagation (BP) algorithm converges only at high temperature to a paramagnetic solution. Then, we test a generalized belief propagation (GBP) algorithm, derived from a cluster variational method (CVM) at the plaquette level. We compare its performance with BP and with other algorithms derived under the same approximation: double loop (DL) and a two-way message passing algorithm (HAK). The plaquette-CVM approximation improves BP in at least three ways: the quality of the paramagnetic solution at high temperatures, a better estimate (lower) for the critical temperature, and the fact that the GBP message passing algorithm converges also to nonparamagnetic solutions. The lack of convergence of the standard GBP message passing algorithm at low temperatures seems to be related to the implementation details and not to the appearance of long range order. In fact, we prove that a gauge invariance of the constrained CVM free energy can be exploited to derive a new message passing algorithm which converges at even lower temperatures. In all its region of convergence this new algorithm is faster than HAK and DL by some orders of magnitude

  9. Improved variational description of the Wick-Cutkosky model with the most general quadratic trial action

    International Nuclear Information System (INIS)

    Rosenfelder, R.; Schreiber, A.W.

    2002-01-01

    We generalize the worldline variational approach to field theory by introducing a trial action which allows for anisotropic terms to be induced by external 4-momenta of Green's functions. By solving the ensuing variational equations numerically we demonstrate that within the (quenched) scalar Wick-Cutkosky model considerable improvement can be achieved over results obtained previously with isotropic actions. In particular, the critical coupling associated with the instability of the model is lowered, in accordance with expectations from Baym's proof of the instability in the unquenched theory. The physical picture associated with a different quantum mechanical motion of the dressed particle along and perpendicular to its classical momentum is discussed. Indeed, we find that for large couplings the dressed particle is strongly distorted in the direction of its four-momentum. In addition, we obtain an exact relation between the renormalized coupling of the theory and the propagator. Along the way we introduce new and efficient methods to evaluate the averages needed in the variational approach and apply them to the calculation of the 2-point function. (orig.)

  10. The role of physician counseling in improving adherence to physical activity among the general population

    Directory of Open Access Journals (Sweden)

    Marcos Ausenka Ribeiro

    2007-03-01

    Full Text Available The regular practice of physical activity at appropriate levels ensures various benefits for the individual over the short, medium and long terms. It is therefore important in health promotion. On the other hand, sedentary behavior has reached alarming levels among the general population, which qualifies it as a serious health problem of endemic proportions. The present review describes public health problems consequent to sedentary behavior and the importance of physician counseling for change their patients’ beha-vior and making them more physically active on a regular basis. Models and behavioral theories are presented to facilitate physicians’ understan-ding of how to approach patients during clinical practice. We also describe programs conducted in many countries based on physician counseling for reducing sedentary behavior, and we present many tools used to quantify and qualify patients’ attitudes towards becoming more physically active. Through understanding the barriers faced by patients, we suggest methodologies that will enable physicians to use physical activity promotion appropriately. We hope that this will provide support for physicians in conducting physical activity counseling, as a means for improving the health of the population.

  11. Mortality after hemorrhagic stroke: data from general practice (The Health Improvement Network).

    Science.gov (United States)

    González-Pérez, Antonio; Gaist, David; Wallander, Mari-Ann; McFeat, Gillian; García-Rodríguez, Luis A

    2013-08-06

    To investigate short-term case fatality and long-term mortality after intracerebral hemorrhage (ICH) and subarachnoid hemorrhage (SAH) using data from The Health Improvement Network database. Thirty-day case fatality was stratified by age, sex, and calendar year after ICH and SAH using logistic regression. Cox proportional hazards regression analyses were used to estimate the risk of death during the first year of follow-up and survivors at 1 year. Case fatality after ICH was 42.0%, compared with 28.7% after SAH. It increased with age (ICH: 29.7% for 20-49 years, 54.6% for 80-89 years; SAH: 20.3% for 20-49 years, 56.7% for 80-89 years; both p-trend stroke patients during the first year of follow-up compared with controls (ICH: hazard ratio [HR] 2.60, 95% confidence interval [CI] 2.09-3.24, p hemorrhagic stroke, and patients younger than 50 years are more likely to die after ICH than SAH. Short-term case fatality has decreased over time. Patients who survive hemorrhagic stroke have a continuing elevated risk of death compared with matched individuals from the general population.

  12. Quality improvement training for core medical and general practice trainees: a pilot study of project participation, completion and journal publication.

    Science.gov (United States)

    McNab, Duncan; McKay, John; Bowie, Paul

    2015-11-01

    Small-scale quality improvement projects are expected to make a significant contribution towards improving the quality of healthcare. Enabling doctors-in-training to design and lead quality improvement projects is important preparation for independent practice. Participation is mandatory in speciality training curricula. However, provision of training and ongoing support in quality improvement methods and practice is variable. We aimed to design and deliver a quality improvement training package to core medical and general practice specialty trainees and evaluate impact in terms of project participation, completion and publication in a healthcare journal. A quality improvement training package was developed and delivered to core medical trainees and general practice specialty trainees in the west of Scotland encompassing a 1-day workshop and mentoring during completion of a quality improvement project over 3 months. A mixed methods evaluation was undertaken and data collected via questionnaire surveys, knowledge assessment, and formative assessment of project proposals, completed quality improvement projects and publication success. Twenty-three participants attended the training day with 20 submitting a project proposal (87%). Ten completed quality improvement projects (43%), eight were judged as satisfactory (35%), and four were submitted and accepted for journal publication (17%). Knowledge and confidence in aspects of quality improvement improved during the pilot, while early feedback on project proposals was valued (85.7%). This small study reports modest success in training core medical trainees and general practice specialty trainees in quality improvement. Many gained knowledge of, confidence in and experience of quality improvement, while journal publication was shown to be possible. The development of educational resources to aid quality improvement project completion and mentoring support is necessary if expectations for quality improvement are to be

  13. Marketing Techniques for School Districts.

    Science.gov (United States)

    Lane, John J., Ed.

    Development of marketing plans can assist not only public school districts in meeting recent competition but will also improve educational processes, increase revenue, and restore confidence in schools. This collection of articles describes a new role for school administrators--particulary for business managers: administrators as "entrepreneurs."…

  14. General anaesthesia does not improve outcome in opioid antagonist detoxification treatment: a randomised controlled trial

    NARCIS (Netherlands)

    Jong, C.A.J. de; Laheij, R.J.F.; Krabbe, P.F.M.

    2005-01-01

    Aim  Opioid detoxification by administering opioid-antagonists under general anaesthesia has caused considerable controversy. This study is conducted to determine whether rapid detoxification under general anaesthesia results in higher levels of opioid abstinence than rapid detoxification without

  15. General anaesthesia does not improve outcome in opioid antagonist detoxification treatment : a randomized controlled trial

    NARCIS (Netherlands)

    De Jong, Cor A J; Laheij, Robert J F; Krabbe, Paul F M

    AIM: Opioid detoxification by administering opioid-antagonists under general anaesthesia has caused considerable controversy. This study is conducted to determine whether rapid detoxification under general anaesthesia results in higher levels of opioid abstinence than rapid detoxification without

  16. General anaesthesia does not improve outcome in opioid antagonist detoxification treatment: a randomized controlled trial.

    NARCIS (Netherlands)

    Jong, C.A.J. de; Laheij, R.J.F.; Krabbe, P.F.M.

    2005-01-01

    AIM: Opioid detoxification by administering opioid-antagonists under general anaesthesia has caused considerable controversy. This study is conducted to determine whether rapid detoxification under general anaesthesia results in higher levels of opioid abstinence than rapid detoxification without

  17. Training general practitioners in behavior change counseling to improve asthma medication adherence

    NARCIS (Netherlands)

    Broers, Sandra; Smets, Ellen; Bindels, Patrick; Bennebroek Evertsz', Floor; Calff, Mart; de Haes, Hanneke

    2005-01-01

    Objective: Adherence to asthma medication regimens is problematic in general practice. We developed and evaluated a communication training for general practitioners (GPs) to help them address medication adherence during routine consultations. This paper describes the development of the training and

  18. A randomised controlled trial to improve the role of the general practitioner in cancer rehabilitation: effect on patients’ satisfaction with their general practitioners

    DEFF Research Database (Denmark)

    Bergholdt, Stinne Holm; Gilså Hansen, Dorte; Larsen, Pia Veldt

    2013-01-01

    ' rehabilitation course. OUTCOME MEASURES: 6 months after inclusion of the patient, patient satisfaction with their GP during the last 12 months in five different dimensions of GP care was assessed using the Danish version of the EuroPEP (European Patients Evaluate General Practice Care) questionnaire (DanPEP). 14....... Subgroup analysis of the patients with breast cancer showed statistically significant improvement of satisfaction with the GP in two of the five DanPEP dimensions. CONCLUSIONS: This complex intervention aiming at improving GPs' services in cancer rehabilitation had no impact on patient satisfaction. TRIAL...

  19. Free distribution of insecticidal bed nets improves possession and preferential use by households and is equitable: findings from two cross-sectional surveys in thirteen malaria endemic districts of Bangladesh

    Directory of Open Access Journals (Sweden)

    Ahmed Syed M

    2011-12-01

    to self-rated poverty status of the households. Conclusions There has been a substantial improvement in possession and usage of insecticidal bed nets especially for the two most vulnerable groups (under-five children and pregnant women, including a reduction of gaps between the high and low endemic districts, and the deficit and non-deficit households during the study period.

  20. Private Water Districts

    Data.gov (United States)

    California Natural Resource Agency — Private Water District boundaries are areas where private contracts provide water to the district in California. This database is designed as a regions polygon...

  1. Lieutenant Chief Warden Districts

    Data.gov (United States)

    Vermont Center for Geographic Information — This dataset is a representation overlay of Lieutenant Chief Warden Districts (areas of responsibility). The Vermont Lieutenant Chief Warden Districts layer is part...

  2. District heating in Switzerland

    International Nuclear Information System (INIS)

    Herzog, F.

    1991-01-01

    District heating has been used in Switzerland for more than 50 years. Its share of the heat market is less than 3% today. An analysis of the use of district heating in various European countries shows that a high share of district heating in the heat market is always dependent on ideal conditions for its use. Market prospects and possible future developments in the use of district heating in Switzerland are described in this paper. The main Swiss producers and distributors of district heating are members of the Association of District Heating Producers and Distributors. This association supports the installation of district heating facilities where ecological, energetical and economic aspects indicate that district heating would be a good solution. (author) 2 tabs., 6 refs

  3. California Political Districts

    Data.gov (United States)

    California Natural Resource Agency — This is a series of district layers pertaining to California'spolitical districts, that are derived from the California State Senateand State Assembly information....

  4. State Water Districts

    Data.gov (United States)

    California Natural Resource Agency — State Water Project District boundaries are areas where state contracts provide water to the district in California. This database is designed as a regions polygon...

  5. National Register Historic Districts

    Data.gov (United States)

    Iowa State University GIS Support and Research Facility — The National Register Historic District layer is a shape file showing the boundaries of Historic Districts that are listed on the National Register of Historic Places.

  6. Zero Energy Districts

    Energy Technology Data Exchange (ETDEWEB)

    Polly, Benjamin J [National Renewable Energy Laboratory (NREL), Golden, CO (United States)

    2018-05-04

    This presentation shows how NREL is approaching Zero Energy Districts, including key opportunities, design strategies, and master planning concepts. The presentation also covers URBANopt, an advanced analytical platform for district that is being developed by NREL.

  7. Utilizing General Purpose Graphics Processing Units to Improve Performance of Computer Modelling and Visualization

    Science.gov (United States)

    Monk, J.; Zhu, Y.; Koons, P. O.; Segee, B. E.

    2009-12-01

    With the introduction of the G8X series of cards by nVidia an architecture called CUDA was released, virtually all subsequent video cards have had CUDA support. With this new architecture nVidia provided extensions for C/C++ that create an Application Programming Interface (API) allowing code to be executed on the GPU. Since then the concept of GPGPU (general purpose graphics processing unit) has been growing, this is the concept that the GPU is very good a algebra and running things in parallel so we should take use of that power for other applications. This is highly appealing in the area of geodynamic modeling, as multiple parallel solutions of the same differential equations at different points in space leads to a large speedup in simulation speed. Another benefit of CUDA is a programmatic method of transferring large amounts of data between the computer's main memory and the dedicated GPU memory located on the video card. In addition to being able to compute and render on the video card, the CUDA framework allows for a large speedup in the situation, such as with a tiled display wall, where the rendered pixels are to be displayed in a different location than where they are rendered. A CUDA extension for VirtualGL was developed allowing for faster read back at high resolutions. This paper examines several aspects of rendering OpenGL graphics on large displays using VirtualGL and VNC. It demonstrates how performance can be significantly improved in rendering on a tiled monitor wall. We present a CUDA enhanced version of VirtualGL as well as the advantages to having multiple VNC servers. It will discuss restrictions caused by read back and blitting rates and how they are affected by different sizes of virtual displays being rendered.

  8. Supply chain solutions to improve the distribution of antiretroviral drugs (ARVs) to clinics in rural areas: A case study of the QwaQwa district

    OpenAIRE

    Mokheseng, Mamolise; Horn, Gideon S.; Klopper, Aileen G.

    2017-01-01

    This article serves as a case study based on research that was performed in the QwaQwa district in the Free State Province where the distribution of ARVs to the regional Manapo hospital, as well as between the hospital and its peripheral clinics, was interrupted and inconsistent due to problems in the supply chain. An unreliable and interrupted ARV supply chain creates the risk of virus reactivation and eventual patient mortality. The objectives of the study were to explore the problems e...

  9. Implementation of a decentralized community-based treatment program to improve the management of Buruli ulcer in the Ouinhi district of Benin, West Africa.

    Directory of Open Access Journals (Sweden)

    Arnaud Setondji Amoussouhoui

    2018-03-01

    Full Text Available Mycobacterium ulcerans infection, commonly known as Buruli ulcer (BU, is a debilitating neglected tropical disease. Its management remains complex and has three main components: antibiotic treatment combining rifampicin and streptomycin for 56 days, wound dressings and skin grafts for large ulcerations, and physical therapy to prevent functional limitations after care. In Benin, BU patient care is being integrated into the government health system. In this paper, we report on an innovative pilot program designed to introduce BU decentralization in Ouinhi district, one of Benin's most endemic districts previously served by centralized hospital-based care.We conducted intervention-oriented research implemented in four steps: baseline study, training of health district clinical staff, outreach education, outcome and impact assessments. Study results demonstrated that early BU lesions (71% of all detected cases could be treated in the community following outreach education, and that most of the afflicted were willing to accept decentralized treatment. Ninety-three percent were successfully treated with antibiotics alone. The impact evaluation found that community confidence in decentralized BU care was greatly enhanced by clinic staff who came to be seen as having expertise in the care of most chronic wounds.This study documents a successful BU outreach and decentralized care program reaching early BU cases not previously treated by a proactive centralized BU program. The pilot program further demonstrates the added value of integrated wound management for NTD control.

  10. District Fiscal Policy and Student Achievement

    Directory of Open Access Journals (Sweden)

    Gary G. Huang

    2002-09-01

    Full Text Available School restructuring raises questions about the role of school districts in improving student learning. Centralization by state governments and decentralization to individual schools as proposed in systemic reform leave districts' role unsettled. Empirical research on the district role in the context of ongoing reform is inadequate. This analysis of combined data from the NAEP and the Common Core of Data (CCD was intended to address the issue. We analyzed 1990, 1992, and 1996 NAEP 8th grade mathematics national assessment data in combination with CCD data of corresponding years to examine the extent to which student achievement was related to districts' control over instructional expenditure, adjusting for relevant key factors at both district and student levels. Upon sample modification, we used hierarchical linear modeling (HLM to estimate the relationships of student achievement to two district fiscal policy indictors, current expenditure per pupil (CEPP and districts' discretionary rates for instructional expenditure (DDR. Net of relevant district factors, DDR was found unrelated to districts' average 8th grade math performance. The null effect was consistent in the analysis of the combined NAEP-CCD data for 1990, 1992, and 1996. In contrast, CEPP was found related to higher math performance in a modest yet fairly consistent way. Future research may be productive to separately study individual states and integrate the findings onto the national level.

  11. Improving outcomes for patients with type 2 diabetes using general practice networks: a quality improvement project in east London.

    Science.gov (United States)

    Hull, Sally; Chowdhury, Tahseen A; Mathur, Rohini; Robson, John

    2014-02-01

    Structured diabetes care can improve outcomes and reduce risk of complications, but improving care in a deprived, ethnically diverse area can prove challenging. This report evaluates a system change to enhance diabetes care delivery in a primary care setting. All 35 practices in one inner London Primary Care Trust were geographically grouped into eight networks of four to five practices, each supported by a network manager, clerical staff and an educational budget. A multidisciplinary team developed a 'care package' for type 2 diabetes management, with financial incentives based on network achievement of targets. Monthly electronic performance dashboards enabled networks to track and improve performance. Network multidisciplinary team meetings including the diabetic specialist team supported case management and education. Key measures for improvement included the number of diabetes care plans completed, proportion of patients attending for digital retinal screen and proportions of patients achieving a number of biomedical indices (blood pressure, cholesterol, glycated haemoglobin). Between 2009 and 2012, completed care plans rose from 10% to 88%. The proportion of patients attending for digital retinal screen rose from 72% to 82.8%. The proportion of patients achieving a combination of blood pressure ≤ 140/80 mm Hg and cholesterol ≤ 4 mmol/L rose from 35.3% to 46.1%. Mean glycated haemoglobin dropped from 7.80% to 7.66% (62-60 mmol/mol). Investment of financial, organisational and education resources into primary care practice networks can achieve clinically important improvements in diabetes care in deprived, ethnically diverse communities. This success is predicated on collaborative working between practices, purposively designed high-quality information on network performance and engagement between primary and secondary care clinicians.

  12. District nursing in Dominica

    NARCIS (Netherlands)

    Kolkman, PME; Luteijn, AJ; Nasiiro, RS; Bruney, [No Value; Smith, RJA; Meyboom-de Jong, B

    1998-01-01

    District nurses constitute the basis of the primary health care services in Dominica. All encounters of three district nurses were registered using the international classification of primary care. Information on other aspects of district nursing was collected by participating observation and the

  13. The theory, practice, and future of process improvement in general thoracic surgery.

    Science.gov (United States)

    Freeman, Richard K

    2014-01-01

    Process improvement, in its broadest sense, is the analysis of a given set of actions with the aim of elevating quality and reducing costs. The tenets of process improvement have been applied to medicine in increasing frequency for at least the last quarter century including thoracic surgery. This review outlines the theory underlying process improvement, the currently available data sources for process improvement and possible future directions of research. Copyright © 2015 Elsevier Inc. All rights reserved.

  14. Protecting and improving health through the radiological sciences. A report to the Surgeon General

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1966-04-01

    , the Committee in this report makes a number of recommendations to the Surgeon General and urges that he take appropriate steps for their early implementation. For convenience, these recommendations are summarized as follows: 1. The Public Health Service should take immediate steps to strengthen its programs in the radiological sciences by unifying their administrative direction. Such action is needed to assure an orderly development of the broad spectrum of radiological activities for which the Service is responsible and to give continuous attention to the balance of benefit and risk in all matters pertaining to the human application of ionizing radiation. 2. The Service should undertake the following training and research and development programs to upgrade the quality of the radiological services which have become such a critical part of medical and dental care and to improve radiation protection practices in the health professions: (a) a series of training programs: (i) to strengthen radiological instruction of medical students; (ii) to increase the number of academic radiologists in American medical schools; and (iii) to increase the number of practicing radiologists in the United States. (b) a series of training programs to provide increasing numbers of radiochemists, radiological engineers, radiobiologists, radiological physicists and radiological health specialists. (c) a series of training programs to provide increasing numbers of technologists in the several disciplines of the radiological sciences. (d) a series of applied research and development programs to increase the effectiveness and safety with which radiological procedures are employed in the health professions.

  15. Protecting and improving health through the radiological sciences. A report to the Surgeon General

    International Nuclear Information System (INIS)

    1966-04-01

    , the Committee in this report makes a number of recommendations to the Surgeon General and urges that he take appropriate steps for their early implementation. For convenience, these recommendations are summarized as follows: 1. The Public Health Service should take immediate steps to strengthen its programs in the radiological sciences by unifying their administrative direction. Such action is needed to assure an orderly development of the broad spectrum of radiological activities for which the Service is responsible and to give continuous attention to the balance of benefit and risk in all matters pertaining to the human application of ionizing radiation. 2. The Service should undertake the following training and research and development programs to upgrade the quality of the radiological services which have become such a critical part of medical and dental care and to improve radiation protection practices in the health professions: (a) a series of training programs: (i) to strengthen radiological instruction of medical students; (ii) to increase the number of academic radiologists in American medical schools; and (iii) to increase the number of practicing radiologists in the United States. (b) a series of training programs to provide increasing numbers of radiochemists, radiological engineers, radiobiologists, radiological physicists and radiological health specialists. (c) a series of training programs to provide increasing numbers of technologists in the several disciplines of the radiological sciences. (d) a series of applied research and development programs to increase the effectiveness and safety with which radiological procedures are employed in the health professions

  16. GENERAL SURGERY

    African Journals Online (AJOL)

    Department of Surgery, University of Cape Town Health Sciences Faculty, Groote Schuur Hospital, Observatory, Cape Town,. South Africa ... included all district, regional and tertiary hospitals in the nine provinces. Clinics and so-called ..... large contingency of senior general surgeons from countries such as Cuba, who have ...

  17. Improving general flexibility with a mind-body approach: a randomized, controlled trial using neuro emotional Technique®.

    Science.gov (United States)

    Jensen, Anne M; Ramasamy, Adaikalavan; Hall, Michael W

    2012-08-01

    General flexibility is a key component of health, well-being, and general physical conditioning. Reduced flexibility has both physical and mental/emotional etiologies and can lead to musculoskeletal injuries and athletic underperformance. Few studies have tested the effectiveness of a mind-body therapy on general flexibility. The aim of this study was to investigate if Neuro Emotional Technique® (NET), a mind-body technique shown to be effective in reducing stress, can also improve general flexibility. The sit-and-reach test (SR) score was used as a measure of general flexibility. Forty-five healthy participants were recruited from the general population and assessed for their initial SR score before being randomly allocated to receive (a) two 20-minute sessions of NET (experimental group); (b) two 20-minute sessions of stretching instruction (active control group); or (c) no intervention or instruction (passive control group). After intervention, the participants were reassessed in a similar manner by the same blind assessor. The participants also answered questions about demographics, usual water and caffeine consumption, and activity level, and they completed an anxiety/mood psychometric preintervention and postintervention. The mean (SD) change in the SR score was +3.1 cm (2.5) in the NET group, +1.2 cm (2.3) in the active control group and +1.0 cm (2.6) in the passive control group. Although all the 3 groups showed some improvement, the improvement in the NET group was statistically significant when compared with that of either the passive controls (p = 0.015) or the active controls (p = 0.021). This study suggests that NET could provide an effective treatment in improving general flexibility. A larger study is required to confirm these findings and also to assess longer term effectiveness of this therapy on general flexibility.

  18. Forging Multidisciplinary Collaboration to Improve Mental/Behavioral Health.

    Science.gov (United States)

    Vaughn, Wanda M; Bunde, Paula K; Remick-Erickson, Kara; Rebeck, Shelby; Denny, Darla

    2017-09-01

    Five Johnson and Johnson fellows validated the lack of communication regarding students with mental/behavioral health issues and took a leadership position within their school district to address the problem. An open-ended survey revealed inconsistent and fragmented support given to students with mental/behavioral health concerns. A multidisciplinary task force was formed consisting of stakeholders including district and nondistrict community members. The procedure for district staff to address students' behavioral/mental health concerns was adapted by representatives from all stakeholders and was distributed district wide and uploaded to the district's staff website for general access. Training of district employees in Youth Mental Health First Aid has provided the foundation for communicating and implementing a standardized approach for identifying, responding, and referring students with mental/behavioral health concerns. Open dialog, better communication and understanding of disciplines, and more initiatives aimed at improving the mental health of all students has resulted from the collaboration started with this initiative.

  19. Financing Energy Upgrades for K-12 School Districts: A Guide to Tapping into Funding for Energy Efficiency and Renewable Energy Improvements

    Energy Technology Data Exchange (ETDEWEB)

    Goggio Borgeson, Merrian [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States). Environmental Energy Technologies Division; Zimring, Mark [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States). Environmental Energy Technologies Division

    2013-04-01

    This guide focuses on clean energy financing options for school administrators, facility managers, and other K-12 school decision makers who are considering investments in high performance school projects. This guide explicitly focuses on comprehensive energy upgrades, those that involve multiple measures and are targeted toward achieving significant energy savings. Successful implementation of clean energy upgrades in schools is a matter of understanding the opportunity, making the commitment, and creatively tapping into available financing. This guide attempts to provide the foundation needed for successful projects in U.S. schools. It walks through the financing options available to K-12 schools and provides case studies of six school districts from around the country.

  20. DoD Needs to Improve Screening and Access Controls for General Public Tenants Leasing Housing on Military Installations (REDACTED)

    Science.gov (United States)

    2016-04-01

    helps enhance service members’ quality of life by improving the condition of military-owned housing faster and more economically than traditional...DEPARTMENT OF THE ARMY SUBJECT: DoD Needs to Improve Screening and Access Controls for General Public Tenants Leasing Housing on Military...public tenants who leased DoD privatized housing before granting those tenants unescorted access to military installations. In addition, DoD officials

  1. Improving Students' Inquiry Skills and Self-Efficacy through Research-Inspired Modules in the General Chemistry Laboratory

    Science.gov (United States)

    Winkelmann, Kurt; Baloga, Monica; Marcinkowski, Tom; Giannoulis, Christos; Anquandah, George; Cohen, Peter

    2015-01-01

    Research projects conducted by faculty in STEM departments served as the inspiration for a new curriculum of inquiry-based, multiweek laboratory modules in the general chemistry 1 course. The purpose of this curriculum redesign was to improve students' attitudes about chemistry as well as their self-efficacy and skills in performing inquiry…

  2. Future Services for District Heating Solutions in Residential Districts

    Directory of Open Access Journals (Sweden)

    Hannele Ahvenniemi

    2014-06-01

    Full Text Available The underlying assumption of this study is that in order to retain the competitiveness while reaching for the EU targets regarding low-energy construction, district heating companies need to develop new business and service models. How district heating companies could broaden their perspective and switch to a more service-oriented way of thinking is a key interest of our research. The used methods in our study are house builder interviews and a questionnaire. With the help of these methods we discussed the potential interest in heating related services acquiring a comprehensive understanding of the customer needs. The results indicate the importance of certain criteria when choosing the heating system in households: easiness, comfort and affordability seem to dominate the house builders’ preferences. Also environmental awareness seems to be for many an important factor when making a decision about the heating of the house. Altogether, based on the results of this study, we suggest that the prospects of district heating could benefit from highlighting certain aspects and strengths in the future. District heating companies need to increase flexibility, readiness to adopt new services, to invest in new marketing strategies and improving the communication skills.

  3. An Improved Second-Order Generalized Integrator Based Quadrature Signal Generator

    DEFF Research Database (Denmark)

    Xin, Zhen; Wang, Xiongfei; Qin, Zian

    2016-01-01

    The second-order generalized integrator based quadrature signal generator (SOGI-QSG) is able to produce in-quadrature signals for many applications, such as frequency estimation, grid synchronization, and harmonic extraction. However, the SOGI-QSG is sensitive to input dc and harmonic components...

  4. Improved design of a high lift system for general aviation aircraft

    NARCIS (Netherlands)

    Florjancic, D.; Steenhuizen, D.; Veldhuis, L.L.M.

    2016-01-01

    Optimization of a single slotted flap with dropped hinge is performed with the objective of increasing the payload of a propeller driven 4-seater general aviation aircraft. Within the optimization loop, two-dimensional aerodynamic characteristics are evaluated using the MSES code, while

  5. Development and feasibility of a patient feedback programme to improve consultation skills in general practice training

    NARCIS (Netherlands)

    Reinders, M.E.; Blankenstein, A.H.; van Marwijk, H.W.J.; Schleypen, H.; Schoonheim, P.L.; Stalman, W.A.B.

    2008-01-01

    Objective: To develop an attractive and effective patient feedback training programme for general practice trainees (GPTs). Methods: First, an exploratory study was conducted in which patients and GPTs were interviewed after they had worked with patient feedback. This contributed to the development

  6. Improving the Success of First Term General Chemistry Students at a Liberal Arts Institution

    Science.gov (United States)

    Stone, Kari L.; Shaner, Sarah E.; Fendrick, Carol M.

    2018-01-01

    General Chemistry is a high impact course at Benedictine University where a large enrollment of ~250 students each year, coupled with low pass rates of a particularly vulnerable student population from a retention point of view (i.e., first-year college students), make it a strategic course on which to focus innovative pedagogical development.…

  7. Improving General Chemistry Course Performance through Online Homework-Based Metacognitive Training

    Science.gov (United States)

    Casselman, Brock L.; Atwood, Charles H.

    2017-01-01

    In a first-semester general chemistry course, metacognitive training was implemented as part of an online homework system. Students completed weekly quizzes and multiple practice tests to regularly assess their abilities on the chemistry principles. Before taking these assessments, students predicted their score, receiving feedback after…

  8. District heating in Italy

    International Nuclear Information System (INIS)

    Sacchi, E.

    1998-01-01

    The legislative act establishing the electric monopoly virtually shut out the district heating associated with electricity cogeneration, while other laws, issued to counteract the effects of oil shocks, allowed municipal utilities to do so. Thus, district heating has experienced some development, though well below its possibilities. The article analyses the reasons for this lagging, reports district heating data and projects its forecasts against the Kyoto Protocol objectives [it

  9. Improvement of the management of residual waste in areas without thermal treatment facilities: A life cycle analysis of an Italian management district

    Energy Technology Data Exchange (ETDEWEB)

    Di Maria, Francesco, E-mail: francesco.dimaria@unipg.it [LAR Laboratory, Dipartimento di Ingegneria, Via G. Duranti 93, Perugia (Italy); Micale, Caterina; Morettini, Emanuela [LAR Laboratory, Dipartimento di Ingegneria, Via G. Duranti 93, Perugia (Italy); Sisani, Luciano [TSA spa, Via Case Sparse 107, Magione (Italy); Damiano, Roberto [GESENU spa, Via della Molinella 7, Perugia (Italy)

    2015-10-15

    Highlights: • LCA analysis of two option for residual waste management. • Exploitation of mechanical physical sorting facility for extracting recyclable from RMSW. • Processing the mechanically sorted organic fraction in bioreactor landfill. • Sensitivity analysis demonstrate high influence for impact assessment of substitution ratio for recycle materials. - Abstract: Starting from an existing waste management district without thermal treatment facilities, two different management scenarios for residual waste were compared by life cycle assessment (LCA). The adoption of a bioreactor landfill for managing the mechanically sorted organic fraction instead of bio-stabilization led to reduction of global warming and fresh water eutrophication by 50% and 10%, respectively. Extraction of recyclables from residual waste led to avoided emissions for particulate matter, acidification and resource depletion impact categories. Marginal energy and the amount of energy recovered from landfill gas marginally affected the LCA results. On the contrary the quality of the recyclables extracted can significantly modify the eco profile of the management schemes.

  10. A strategic approach to quality improvement and patient safety education and resident integration in a general surgery residency.

    Science.gov (United States)

    O'Heron, Colette T; Jarman, Benjamin T

    2014-01-01

    To outline a structured approach for general surgery resident integration into institutional quality improvement and patient safety education and development. A strategic plan to address Accreditation Council for Graduate Medical Education (ACGME) Clinical Learning Environment Review assessments for resident integration into Quality Improvement and Patient Safety initiatives is described. Gundersen Lutheran Medical Foundation is an independent academic medical center graduating three categorical residents per year within an integrated multi-specialty health system serving 19 counties over 3 states. The quality improvement and patient safety education program includes a formal lecture series, online didactic sessions, mandatory quality improvement or patient safety projects, institutional committee membership, an opportunity to serve as a designated American College of Surgeons National Surgical Quality Improvement Project and Quality in Training representative, mandatory morbidity and mortality conference attendance and clinical electives in rural surgery and international settings. Structured education regarding and participation in quality improvement and patient safety programs are able to be accomplished during general surgery residency. The long-term outcomes and benefits of these strategies are unknown at this time and will be difficult to measure with objective data. © 2013 Published by Association of Program Directors in Surgery on behalf of Association of Program Directors in Surgery.

  11. Domain Adaptation Methods for Improving Lab-to-field Generalization of Cocaine Detection using Wearable ECG

    Science.gov (United States)

    Natarajan, Annamalai; Angarita, Gustavo; Gaiser, Edward; Malison, Robert; Ganesan, Deepak; Marlin, Benjamin M.

    2016-01-01

    Mobile health research on illicit drug use detection typically involves a two-stage study design where data to learn detectors is first collected in lab-based trials, followed by a deployment to subjects in a free-living environment to assess detector performance. While recent work has demonstrated the feasibility of wearable sensors for illicit drug use detection in the lab setting, several key problems can limit lab-to-field generalization performance. For example, lab-based data collection often has low ecological validity, the ground-truth event labels collected in the lab may not be available at the same level of temporal granularity in the field, and there can be significant variability between subjects. In this paper, we present domain adaptation methods for assessing and mitigating potential sources of performance loss in lab-to-field generalization and apply them to the problem of cocaine use detection from wearable electrocardiogram sensor data. PMID:28090605

  12. Domain Adaptation Methods for Improving Lab-to-field Generalization of Cocaine Detection using Wearable ECG

    OpenAIRE

    Natarajan, Annamalai; Angarita, Gustavo; Gaiser, Edward; Malison, Robert; Ganesan, Deepak; Marlin, Benjamin M.

    2016-01-01

    Mobile health research on illicit drug use detection typically involves a two-stage study design where data to learn detectors is first collected in lab-based trials, followed by a deployment to subjects in a free-living environment to assess detector performance. While recent work has demonstrated the feasibility of wearable sensors for illicit drug use detection in the lab setting, several key problems can limit lab-to-field generalization performance. For example, lab-based data collection...

  13. Improvements Could Be Made in Reconciling Other Defense Organizations Civilian Pay to the General Ledger

    Science.gov (United States)

    2016-03-25

    could not record a journal entry to this account. DFAS Indianapolis provided us with a System Change Proposal dated April 17, 2014, which proposed a...system change to DAI to permit journal entries to USSGL 2213 that was implemented in October 2015. However, DFAS Indianapolis should not have allowed...properly accrued civilian pay for the 12 ODOs that used the Defense Agencies Initiative or the Defense Business Management System general ledgers

  14. Definition and general properties of the transfer matrix in continuum limit improved lattice gauge theories

    International Nuclear Information System (INIS)

    Luescher, M.; Weisz, P.

    1984-02-01

    When operators of dimension 6 are added to the standard Wilson action in lattice gauge theories, physical positivity is lost in general. We show that a transfer matrix can nevertheless be defined. Its properties are, however, unusual: complex eigenvalues may occur (leading to damped oscillatory behaviour of correlation functions), and there are always contributions in the spectral decomposition of two-point functions that come with a negative weight. (orig.)

  15. Computer-Based Instruction for Improving Student Nurses' General Numeracy: Is It Effective? Two Randomised Trials

    Science.gov (United States)

    Ainsworth, Hannah; Gilchrist, Mollie; Grant, Celia; Hewitt, Catherine; Ford, Sue; Petrie, Moira; Torgerson, Carole J.; Torgerson, David J.

    2012-01-01

    In response to concern over the numeracy skills deficit displayed by student nurses, an online computer programme, "Authentic World[R]", which aims to simulate a real-life clinical environment and improve the medication dosage calculation skills of users, was developed (Founded in 2004 Authentic World Ltd is a spin out company of…

  16. Improved decay rates for solutions for a multidimensional generalized Benjamin-Bona-Mahony equation

    KAUST Repository

    Said-Houari, Belkacem

    2014-01-01

    the Fourier transform and the energy method, we show the global existence and the convergence rates of the solutions under the smallness assumption on the initial data and we give better decay rates of the solutions. This result improves early works in J

  17. Improved stratospheric atmosphere forecasts in the general circulation model through a methane oxidation parametrization

    Science.gov (United States)

    Wang, S.; Jun, Z.

    2017-12-01

    Climatic characteristics of tropical stratospheric methane have been well researched using various satellite data, and numerical simulations have furtherly conducted using chemical climatic models, while the impact of stratospheric methane oxidation on distribution of water vapor is not paid enough attention in general circulation models. Simulated values of water vapour in the tropical upper stratosphere, and throughout much of the extratropical stratosphere, were too low. Something must be done to remedy this deficiency in order to producing realistic stratospheric water vapor using a general circulation model including the whole stratosphere. Introduction of a simple parametrization of the upper-stratospheric moisture source due to methane oxidation and a sink due to photolysis in the mesosphere was conducted. Numerical simulations and analysis of the influence of stratospheric methane on the prediction of tropical stratospheric moisture and temperature fields were carried out. This study presents the advantages of methane oxidation parametrization in producing a realistic distribution of water vapour in the tropical stratosphere and analyzes the impact of methane chemical process on the general circulation model using two storm cases including a heavy rain in South China and a typhoon caused tropical storm.It is obvious that general circulation model with methane oxidation parametrization succeeds in simulating the water vapor and temperature in stratosphere. The simulating rain center value of contrast experiment is increased up to 10% than that of the control experiment. Introduction of methane oxidation parametrization has modified the distribution of water vapour and then producing a broadly realistic distribution of temperature. Objective weather forecast verifications have been performed using simulating results of one month, which demonstrate somewhat positive effects on the model skill. There is a certain extent impact of methane oxidation

  18. Optimising corrosion monitoring in district heating systems

    DEFF Research Database (Denmark)

    Hilbert, Lisbeth Rischel; Thorarinsdottir, R.I.; Andersen, A.

    2002-01-01

    A three-year project - financially supported by the Nordic Industrial Fund - on monitoring of corrosion in district heating systems has been initiated with participation of researchers and industrial partners in Denmark, Finland, Iceland, Norway and Sweden. The primary objective of the project...... is to improve the quality control in district heating systems by corrosion monitoring. In Danish systems electrochemical impedance spectroscopy (EIS), linear polarisation resistance (LPR), high-sensitive electrical resistance (ER) technology, crevice corrosion probes, as well as weight loss coupons...

  19. Cauda equina syndrome: is the current management of patients presenting to district general hospitals fit for purpose? A personal view based on a review of the literature and a medicolegal experience.

    Science.gov (United States)

    Todd, N V

    2015-10-01

    There is no universally agreed definition of cauda equina syndrome (CES). Clinical signs of CES including direct rectal examination (DRE) do not reliably correlate with cauda equina (CE) compression on MRI. Clinical assessment only becomes reliable if there are symptoms/signs of late, often irreversible, CES. The only reliable way of including or excluding CES is to perform MRI on all patients with suspected CES. If the diagnosis is being considered, MRI should ideally be performed locally in the District General Hospitals within one hour of the question being raised irrespective of the hour or the day. Patients with symptoms and signs of CES and MRI confirmed CE compression should be referred to the local spinal service for emergency surgery. CES can be subdivided by the degree of neurological deficit (bilateral radiculopathy, incomplete CES or CES with retention of urine) and also by time to surgical treatment (12, 24, 48 or 72 hour). There is increasing understanding that damage to the cauda equina nerve roots occurs in a continuous and progressive fashion which implies that there are no safe time or deficit thresholds. Neurological deterioration can occur rapidly and is often associated with longterm poor outcomes. It is not possible to predict which patients with a large central disc prolapse compressing the CE nerve roots are going to deteriorate neurologically nor how rapidly. Consensus guidelines from the Society of British Neurological Surgeons and British Association of Spinal Surgeons recommend decompressive surgery as soon as practically possible which for many patients will be urgent/emergency surgery at any hour of the day or night. ©2015 The British Editorial Society of Bone & Joint Surgery.

  20. A frequency-domain approach to improve ANNs generalization quality via proper initialization.

    Science.gov (United States)

    Chaari, Majdi; Fekih, Afef; Seibi, Abdennour C; Hmida, Jalel Ben

    2018-08-01

    The ability to train a network without memorizing the input/output data, thereby allowing a good predictive performance when applied to unseen data, is paramount in ANN applications. In this paper, we propose a frequency-domain approach to evaluate the network initialization in terms of quality of training, i.e., generalization capabilities. As an alternative to the conventional time-domain methods, the proposed approach eliminates the approximate nature of network validation using an excess of unseen data. The benefits of the proposed approach are demonstrated using two numerical examples, where two trained networks performed similarly on the training and the validation data sets, yet they revealed a significant difference in prediction accuracy when tested using a different data set. This observation is of utmost importance in modeling applications requiring a high degree of accuracy. The efficiency of the proposed approach is further demonstrated on a real-world problem, where unlike other initialization methods, a more conclusive assessment of generalization is achieved. On the practical front, subtle methodological and implementational facets are addressed to ensure reproducibility and pinpoint the limitations of the proposed approach. Copyright © 2018 Elsevier Ltd. All rights reserved.

  1. Effects of demand-side incentives in improving the utilisation of delivery services in Oyam District in northern Uganda: a quasi-experimental study.

    Science.gov (United States)

    Massavon, William; Wilunda, Calistus; Nannini, Maria; Majwala, Robert Kaos; Agaro, Caroline; De Vivo, Emanuela; Lochoro, Peter; Putoto, Giovanni; Criel, Bart

    2017-12-19

    We evaluated the effects and financial costs of two interventions with respect to utilisation of institutional deliveries and other maternal health services in Oyam District in Uganda. We conducted a quasi-experimental study involving intervention and comparable/control sub-counties in Oyam District for 12 months (January-December 2014). Participants were women receiving antenatal care, delivery and postnatal care services. We evaluated two interventions: the provision of (1) transport vouchers to women receiving antenatal care and delivering at two health centres (level II) in Acaba sub-county, and (2) baby kits to women who delivered at Ngai Health Centre (level III) in Ngai sub-county. The study outcomes included service coverage of institutional deliveries, four antenatal care visits, postnatal care, and the percentage of women 'bypassing' maternal health services inside their resident sub-counties. We calculated the effect of each intervention on study outcomes using the difference in differences analysis. We calculated the cost per institutional delivery and the cost per unit increment in institutional deliveries for each intervention. Overall, transport vouchers had greater effects on all four outcomes, whereas baby kits mainly influenced institutional deliveries. The absolute increase in institutional deliveries attributable to vouchers was 42.9%; the equivalent for baby kits was 30.0%. Additionally, transport vouchers increased the coverage of four antenatal care visits and postnatal care service coverage by 60.0% and 49.2%, respectively. 'Bypassing' was mainly related to transport vouchers and ranged from 7.2% for postnatal care to 11.9% for deliveries. The financial cost of institutional delivery was US$9.4 per transport voucher provided, and US$10.5 per baby kit. The incremental cost per unit increment in institutional deliveries in the transport-voucher system was US$15.9; the equivalent for the baby kit was US$30.6. The transport voucher scheme

  2. Impact assessment of biomass-based district heating systems in densely populated communities. Part II: Would the replacement of fossil fuels improve ambient air quality and human health?

    Science.gov (United States)

    Petrov, Olga; Bi, Xiaotao; Lau, Anthony

    2017-07-01

    To determine if replacing fossil fuel combustion with biomass gasification would impact air quality, we evaluated the impact of a small-scale biomass gasification plant (BRDF) at a university campus over 5 scenarios. The overall incremental contribution of fine particles (PM2.5) is found to be at least one order of magnitude lower than the provincial air quality objectives. The maximum PM2.5 emission from the natural gas fueled power house (PH) could adversely add to the already high background concentration levels. Nitrogen dioxide (NO2) emissions from the BRDF with no engineered pollution controls for NOx in place exceeded the provincial objective in all seasons except during summer. The impact score, IS, was the highest for NO2 (677 Disability Adjusted Life Years, DALY) when biomass entirely replaced fossil fuels, and the highest for PM2.5 (64 DALY) and CO (3 DALY) if all energy was produced by natural gas at PH. Complete replacement of fossil fuels by one biomass plant can result in almost 28% higher health impacts (708 DALY) compared to 513 DALY when both the current BRDF and the PH are operational mostly due to uncontrolled NO2 emissions. Observations from this study inform academic community, city planners, policy makers and technology developers on the impacts of community district heating systems and possible mitigation strategies: a) community energy demand could be met either by splitting emissions into more than one source at different locations and different fuel types or by a single source with the least-impact-based location selection criteria with biomass as a fuel; b) advanced high-efficiency pollution control devices are essential to lower emissions for emission sources located in a densely populated community; c) a spatial and temporal impact assessment should be performed in developing bioenergy-based district heating systems, in which the capital and operational costs should be balanced with not only the benefit to greenhouse gas emission

  3. Preventing infection in general surgery: improvements through education of surgeons by surgeons.

    LENUS (Irish Health Repository)

    McHugh, S M

    2011-08-01

    Surgical patients are at particular risk of healthcare-associated infection (HCAI) due to the presence of a surgical site leading to surgical site infection (SSI), and because of the need for intravascular access resulting in catheter-related bloodstream infection (CRBSI). A two-year initiative commenced with an initial audit of surgical practice; this was used to inform the development of a targeted educational initiative by surgeons specifically for surgical trainees. Parameters assessed during the initial audit and a further audit after the educational initiative were related to intra- and postoperative aspects of the prevention of SSIs, as well as care of peripheral venous catheters (PVCs) in surgical patients. The proportion of prophylactic antibiotics administered prior to incision across 360 operations increased from 30.0% to 59.1% (P<0.001). Surgical site dressings were observed in 234 patients, and a significant decrease was found in the percentage of dressings that were tampered with during the initial 48h after surgery (16.5% vs 6.2%, P=0.030). In total, 574 PVCs were assessed over the two-year period. Improvements were found in the proportion of unnecessary PVCs in situ (37.9% vs 24.4%, P<0.001), PVCs in situ for >72h (10.6% vs 3.1%, P<0.001) and PVCs covered with clean and intact dressings (87.3% vs 97.6%, P<0.001). Significant improvements in surgical practice were established for the prevention of SSI and CRBSI through a focused educational programme developed by and for surgeons. Potentially, other specific measures may also be warranted to achieve further improvements in infection prevention in surgical practice.

  4. General formula for on-axis sun-tracking system and its application in improving tracking accuracy of solar collector

    Energy Technology Data Exchange (ETDEWEB)

    Chong, K.K.; Wong, C.W. [Faculty of Engineering and Science, Universiti Tunku Abdul Rahman, Off Jalan Genting Kelang, Setapak, 53300 Kuala Lumpur (Malaysia)

    2009-03-15

    Azimuth-elevation and tilt-roll tracking mechanism are among the most commonly used sun-tracking methods for aiming the solar collector towards the sun at all times. It has been many decades that each of these two sun-tracking methods has its own specific sun-tracking formula and they are not interrelated. In this paper, the most general form of sun-tracking formula that embraces all the possible on-axis tracking methods is presented. The general sun-tracking formula not only can provide a general mathematical solution, but more significantly it can improve the sun-tracking accuracy by tackling the installation error of the solar collector. (author)

  5. Differences in Food and Beverage Marketing Policies and Practices in US School Districts, by Demographic Characteristics of School Districts, 2012

    Science.gov (United States)

    Michael, Shannon; Brener, Nancy D.; Coffield, Edward; Kingsley, Beverly S.; Zytnick, Deena; Blanck, Heidi

    2016-01-01

    Introduction Foods and beverages marketed in schools are typically of poor nutritional value. School districts may adopt policies and practices to restrict marketing of unhealthful foods and to promote healthful choices. Students’ exposure to marketing practices differ by school demographics, but these differences have not yet been examined by district characteristics. Methods We analyzed data from the 2012 School Health Policies and Practices Study to examine how food and beverage marketing and promotion policies and practices varied by district characteristics such as metropolitan status, size, and percentage of non-Hispanic white students. Results Most practices varied significantly by district size: a higher percentage of large districts than small or medium-sized districts restricted marketing of unhealthful foods and promoted healthful options. Compared with districts whose student populations were majority (>50%) non-Hispanic white, a higher percentage of districts whose student populations were minority non-Hispanic white (≤50% non-Hispanic white) prohibited advertising of soft drinks in school buildings and on school grounds, made school meal menus available to students, and provided families with information on school nutrition programs. Compared with suburban and rural districts, a higher percentage of urban districts prohibited the sale of soft drinks on school grounds and used several practices to promote healthful options. Conclusion Preliminary findings showing significant associations between district demographics and marketing policies and practices can be used to help states direct resources, training, and technical assistance to address food and beverage marketing and promotion to districts most in need of improvement. PMID:27978408

  6. Differences in Food and Beverage Marketing Policies and Practices in US School Districts, by Demographic Characteristics of School Districts, 2012.

    Science.gov (United States)

    Merlo, Caitlin L; Michael, Shannon; Brener, Nancy D; Coffield, Edward; Kingsley, Beverly S; Zytnick, Deena; Blanck, Heidi

    2016-12-15

    Foods and beverages marketed in schools are typically of poor nutritional value. School districts may adopt policies and practices to restrict marketing of unhealthful foods and to promote healthful choices. Students' exposure to marketing practices differ by school demographics, but these differences have not yet been examined by district characteristics. We analyzed data from the 2012 School Health Policies and Practices Study to examine how food and beverage marketing and promotion policies and practices varied by district characteristics such as metropolitan status, size, and percentage of non-Hispanic white students. Most practices varied significantly by district size: a higher percentage of large districts than small or medium-sized districts restricted marketing of unhealthful foods and promoted healthful options. Compared with districts whose student populations were majority (>50%) non-Hispanic white, a higher percentage of districts whose student populations were minority non-Hispanic white (≤50% non-Hispanic white) prohibited advertising of soft drinks in school buildings and on school grounds, made school meal menus available to students, and provided families with information on school nutrition programs. Compared with suburban and rural districts, a higher percentage of urban districts prohibited the sale of soft drinks on school grounds and used several practices to promote healthful options. Preliminary findings showing significant associations between district demographics and marketing policies and practices can be used to help states direct resources, training, and technical assistance to address food and beverage marketing and promotion to districts most in need of improvement.

  7. Clinical audit, a valuable tool to improve quality of care: General methodology and applications in nephrology

    Science.gov (United States)

    Esposito, Pasquale; Dal Canton, Antonio

    2014-01-01

    Evaluation and improvement of quality of care provided to the patients are of crucial importance in the daily clinical practice and in the health policy planning and financing. Different tools have been developed, including incident analysis, health technology assessment and clinical audit. The clinical audit consist of measuring a clinical outcome or a process, against well-defined standards set on the principles of evidence-based medicine in order to identify the changes needed to improve the quality of care. In particular, patients suffering from chronic renal diseases, present many problems that have been set as topics for clinical audit projects, such as hypertension, anaemia and mineral metabolism management. Although the results of these studies have been encouraging, demonstrating the effectiveness of audit, overall the present evidence is not clearly in favour of clinical audit. These findings call attention to the need to further studies to validate this methodology in different operating scenarios. This review examines the principle of clinical audit, focusing on experiences performed in nephrology settings. PMID:25374819

  8. A virtual reality endoscopic simulator augments general surgery resident cancer education as measured by performance improvement.

    Science.gov (United States)

    White, Ian; Buchberg, Brian; Tsikitis, V Liana; Herzig, Daniel O; Vetto, John T; Lu, Kim C

    2014-06-01

    Colorectal cancer is the second most common cause of death in the USA. The need for screening colonoscopies, and thus adequately trained endoscopists, particularly in rural areas, is on the rise. Recent increases in required endoscopic cases for surgical resident graduation by the Surgery Residency Review Committee (RRC) further emphasize the need for more effective endoscopic training during residency to determine if a virtual reality colonoscopy simulator enhances surgical resident endoscopic education by detecting improvement in colonoscopy skills before and after 6 weeks of formal clinical endoscopic training. We conducted a retrospective review of prospectively collected surgery resident data on an endoscopy simulator. Residents performed four different clinical scenarios on the endoscopic simulator before and after a 6-week endoscopic training course. Data were collected over a 5-year period from 94 different residents performing a total of 795 colonoscopic simulation scenarios. Main outcome measures included time to cecal intubation, "red out" time, and severity of simulated patient discomfort (mild, moderate, severe, extreme) during colonoscopy scenarios. Average time to intubation of the cecum was 6.8 min for those residents who had not undergone endoscopic training versus 4.4 min for those who had undergone endoscopic training (p Virtual reality endoscopic simulation is an effective tool for both augmenting surgical resident endoscopy cancer education and measuring improvement in resident performance after formal clinical endoscopic training.

  9. Nankana West District of Ghana

    African Journals Online (AJOL)

    Agribotix GCS 077

    Local governments in Ghana play very important roles with actors in the ... Metropolitan, Municipal and District Chief Executives (MMDCEs), the .... District Budget Officer, District Finance Officer, Presiding Member, members of the Works Sub-.

  10. Food and nutrition surveillance and planning in Kilifi District, Kenya : a model for district based multi-sectoral policy formulation and planning

    NARCIS (Netherlands)

    Owuor, J.O.; Okello, W.O.

    1995-01-01

    Chronic malnutrition has been consistently high in Kilifi District, Kenya, despite efforts to improve nutrition. This report presents an alternative approach to nutrition planning in Kilifi District, taking into account the multidimensional and multidisciplinary nature of nutrition. This approach

  11. Community-based inquiry improves critical thinking in general education biology.

    Science.gov (United States)

    Quitadamo, Ian J; Faiola, Celia L; Johnson, James E; Kurtz, Martha J

    2008-01-01

    National stakeholders are becoming increasingly concerned about the inability of college graduates to think critically. Research shows that, while both faculty and students deem critical thinking essential, only a small fraction of graduates can demonstrate the thinking skills necessary for academic and professional success. Many faculty are considering nontraditional teaching methods that incorporate undergraduate research because they more closely align with the process of doing investigative science. This study compared a research-focused teaching method called community-based inquiry (CBI) with traditional lecture/laboratory in general education biology to discover which method would elicit greater gains in critical thinking. Results showed significant critical-thinking gains in the CBI group but decreases in a traditional group and a mixed CBI/traditional group. Prior critical-thinking skill, instructor, and ethnicity also significantly influenced critical-thinking gains, with nearly all ethnicities in the CBI group outperforming peers in both the mixed and traditional groups. Females, who showed decreased critical thinking in traditional courses relative to males, outperformed their male counterparts in CBI courses. Through the results of this study, it is hoped that faculty who value both research and critical thinking will consider using the CBI method.

  12. Praises & Nudges: A Case of District-Wide Change.

    Science.gov (United States)

    Doyle, Richard; And Others

    This paper describes the processes and outcomes experienced by the Marshalltown Community School District (Iowa) as it implemented a shared decision-making, school-improvement program. A district Shared Decision Making (SDM) Team and School Improvement Program (SIP) teams were trained to facilitate greater staff participation in the…

  13. Making Good Choices: Districts Take the Lead. Comprehensive School Reform.

    Science.gov (United States)

    North Central Regional Educational Lab., Oak Brook, IL.

    Public schools across the country are aiming to improve student performance by engaging in comprehensive school reform (CSR). This guide was created to help school districts make CSR an integral part of their strategies for improving student achievement. Five components for CSR are described: (1) Strategizing, whereby the district supports CSR by…

  14. A general improved methodology to forecasting future oil production: Application to the UK and Norway

    International Nuclear Information System (INIS)

    Fiévet, L.; Forró, Z.; Cauwels, P.; Sornette, D.

    2015-01-01

    We present a new Monte-Carlo methodology to forecast the crude oil production of Norway and the U.K. based on a two-step process, (i) the nonlinear extrapolation of the current/past performances of individual oil fields and (ii) a stochastic model of the frequency of future oil field discoveries. Compared with the standard methodology that tends to underestimate remaining oil reserves, our method gives a better description of future oil production, as validated by our back-tests starting in 2008. Specifically, we predict remaining reserves extractable until 2030 to be 5.7 ± 0.3 billion barrels for Norway and 3.0 ± 0.3 billion barrels for the UK, which are respectively 45% and 66% above the predictions using an extrapolation of aggregate production. - Highlights: • Two step methodology to forecast a countries oil production. • Nonlinear extrapolation of the performance of individual fields. • Stochastic model of the frequency of future discoveries. • Backtest starting in 2008 of the methodology. • Improvement upon standard extrapolation of aggregate production

  15. Improvements mineral dressing and extraction processes of gold-silver ores from San Pedro Frio Mining District, Colombia; Mejora de los procesos de beneficio y extraccion de minerales auroargentiferos del asentamiento minero de San Pedro Frio, Colombia

    Energy Technology Data Exchange (ETDEWEB)

    Yanez Traslavina, J. J.; Vargas Avila, M. A.; Garcia Paez, I. H.; Pedraza Rosas, J. E.

    2005-07-01

    The San Pedro Frio district mining, Colombia, is a rich region production gold-silver ores. Nowadays, the extraction processes used are amalgamation, percolation cyanidation and precipitation with zinc wood. Due to the ignorance of the ore characteristics, gold and silver treatment processes are inadequate and not efficient. In addition the inappropriate use of mercury and cyanide cause environmental contamination. In this research the ore characterization was carried out obtained fundamental parameters for the technical selection of more efficient gold and silver extraction processes. Experimental work was addressed to the study of both processes the agitation cyanidation and the adsorption on activated carbon in pulp. As a final result proposed a flowsheet to improve the precious metals recovery and reduce the environment contamination. (Author)

  16. Assessing physical activity and sedentary lifestyle behaviours for children and adolescents living in a district of Poland. What are the key determinants for improving health?

    Directory of Open Access Journals (Sweden)

    Paulina Wojtyła-Buciora

    2014-09-01

    Full Text Available [b]Introduction.[/b] Adequate levels of physical activity throughout an individual’s life ensure an optimal state of health. Only 30% of adolescents and 10% of adults perform sufficient physical activity to facilitate proper physical, psychological/mental and emotional development. [b]Objective[/b]. Determining physical activity behaviour in children and adolescents through surveying the opinions of school pupils and parents, in order to lend support for optimised educational programmes designed to promote healthy lifestyle behaviour, as well as establishing consistent answers. [b]Materials and Methods[/b]. A randomised survey was conducted on two groups of n=1100 pupil subjects, each attending elementary or secondary school, with the former in Classes 5 and 6, whereas the latter were aged between 16–19 years old; in both instances parents were also included in the survey. All subjects came from the Kalisz District in western-central Poland, and were divided into those living in the city of Kalisz and those in the surrounding rural areas. [b]Results[/b]. It was found that 87%, 96% and 89% of elementary, middle and secondary school pupils, respectively, participated in Physical Education (PE lessons. The numbers of pupils who daily, or almost daily, spent time on a computer, were 52%, 60% and 70%, respectively, for elementary, middle and secondary schools, and likewise 70%, 62% and 48% for watching TV. [b]Conclusions[/b]. It is vital that education programmes with a focus on a healthy lifestyle are introduced and targeted at teenagers in order to promote physical activity during the crucial time of the body’s development. The period of maturing into adulthood is particularly crucial for acquiring the right knowledge, convictions, skills and attitudes that help shape a pro-healthy lifestyle in later years.

  17. Assessing physical activity and sedentary lifestyle behaviours for children and adolescents living in a district of Poland. What are the key determinants for improving health?

    Science.gov (United States)

    Wojtyła-Buciora, Paulina; Stawińska-Witoszyńska, Barbara; Wojtyła, Krzysztof; Klimberg, Aneta; Wojtyła, Cezary; Wojtyła, Andrzej; Samolczyk-Wanyura, Danuta; Marcinkowski, Jerzy T

    2014-01-01

    Adequate levels of physical activity throughout an individual's life ensure an optimal state of health. Only 30% of adolescents and 10% of adults perform sufficient physical activity to facilitate proper physical, psychological/mental and emotional development. Determining physical activity behaviour in children and adolescents through surveying the opinions of school pupils and parents, in order to lend support for optimised educational programmes designed to promote healthy lifestyle behaviour, as well as establishing consistent answers. A randomised survey was conducted on two groups of n=1100 pupil subjects, each attending elementary or secondary school, with the former in Classes 5 and 6, whereas the latter were aged between 16-19 years old; in both instances parents were also included in the survey. All subjects came from the Kalisz District in western-central Poland, and were divided into those living in the city of Kalisz and those in the surrounding rural areas. It was found that 87%, 96% and 89% of elementary, middle and secondary school pupils, respectively, participated in Physical Education (PE) lessons. The numbers of pupils who daily, or almost daily, spent time on a computer, were 52%, 60% and 70%, respectively, for elementary, middle and secondary schools, and likewise 70%, 62% and 48% for watching TV. It is vital that education programmes with a focus on a healthy lifestyle are introduced and targeted at teenagers in order to promote physical activity during the crucial time of the body's development. The period of maturing into adulthood is particularly crucial for acquiring the right knowledge, convictions, skills and attitudes that help shape a pro-healthy lifestyle in later years.

  18. Protective mechanical ventilation during general anesthesia for open abdominal surgery improves postoperative pulmonary function.

    Science.gov (United States)

    Severgnini, Paolo; Selmo, Gabriele; Lanza, Christian; Chiesa, Alessandro; Frigerio, Alice; Bacuzzi, Alessandro; Dionigi, Gianlorenzo; Novario, Raffaele; Gregoretti, Cesare; de Abreu, Marcelo Gama; Schultz, Marcus J; Jaber, Samir; Futier, Emmanuel; Chiaranda, Maurizio; Pelosi, Paolo

    2013-06-01

    The impact of intraoperative ventilation on postoperative pulmonary complications is not defined. The authors aimed at determining the effectiveness of protective mechanical ventilation during open abdominal surgery on a modified Clinical Pulmonary Infection Score as primary outcome and postoperative pulmonary function. Prospective randomized, open-label, clinical trial performed in 56 patients scheduled to undergo elective open abdominal surgery lasting more than 2 h. Patients were assigned by envelopes to mechanical ventilation with tidal volume of 9 ml/kg ideal body weight and zero-positive end-expiratory pressure (standard ventilation strategy) or tidal volumes of 7 ml/kg ideal body weight, 10 cm H2O positive end-expiratory pressure, and recruitment maneuvers (protective ventilation strategy). Modified Clinical Pulmonary Infection Score, gas exchange, and pulmonary functional tests were measured preoperatively, as well as at days 1, 3, and 5 after surgery. Patients ventilated protectively showed better pulmonary functional tests up to day 5, fewer alterations on chest x-ray up to day 3 and higher arterial oxygenation in air at days 1, 3, and 5 (mmHg; mean ± SD): 77.1 ± 13.0 versus 64.9 ± 11.3 (P = 0.0006), 80.5 ± 10.1 versus 69.7 ± 9.3 (P = 0.0002), and 82.1 ± 10.7 versus 78.5 ± 21.7 (P = 0.44) respectively. The modified Clinical Pulmonary Infection Score was lower in the protective ventilation strategy at days 1 and 3. The percentage of patients in hospital at day 28 after surgery was not different between groups (7 vs. 15% respectively, P = 0.42). A protective ventilation strategy during abdominal surgery lasting more than 2 h improved respiratory function and reduced the modified Clinical Pulmonary Infection Score without affecting length of hospital stay.

  19. General consumer communication tools for improved image management and communication in medicine

    Science.gov (United States)

    Ratib, Osman M.; Rosset, Antoine; McCoy, J. Michael

    2005-04-01

    We elected to explore emerging consumer technologies that can be adopted to improve and facilitate image and data communication in medical and clinical environment. The wide adoption of new communication paradigm such as instant messaging, chatting and direct emailing can be integrated in specific applications. The increasing capacity of portable and hand held devices such as iPod music players offer an attractive alternative for data storage that exceeds the capabilities of traditional offline storage media such as CD or even DVD. We adapted medical image display and manipulation software called OSIRIX to integrate different innovative technologies facilitating the communication and data transfer between remote users. We integrated email and instant messaging features to the program allowing users to instantaneously email an image or a set of images that are displayed on the screen. Using iChat instant messaging application from Apple a user can share the content of his screen with a remote correspondent and communicate in real time using voice and video. To provide convenient mechanism for exchange of large data sets the program can store the data in DICOM format on CD or DVD, but was also extended to use the large storage capacity of iPod hard disks as well as Apple"s online storage service "dot Mac" that users can subscribe to benefit from scalable secure storage that accessible from anywhere on the internet. The adoption of these innovative technologies is likely to change the architecture of traditional picture archiving and communication systems and provide more flexible and efficient means of communication.

  20. [Patient-centered care. Improvement of communication between university medical centers and general practitioners for patients in neuro-oncology].

    Science.gov (United States)

    Renovanz, M; Keric, N; Richter, C; Gutenberg, A; Giese, A

    2015-12-01

    Communication between university medical centers and general practitioners (GP) is becoming increasingly more important in supportive patient care. A survey among GPs was performed with the primary objective to assess their opinion on current workflow and communication between GPs and the university medical center. The GPs were asked to score (grades 1-6) their opinion on the current interdisciplinary workflow in the care of patients with brain tumors, thereby rating communication between a university medical center in general and the neuro-oncology outpatient center in particular. Questionnaires were sent to1000 GPs and the response rate was 15 %. The mean scored evaluation of the university medical center in general was 2.62 and of the neuro-oncological outpatient clinic 2.28 (range 1-6). The most often mentioned issues to be improved were easier/early telephone information (44 %) and a constantly available contact person (49 %). Interestingly, > 60 % of the GPs indicated they would support web-based tumor boards for interdisciplinary and palliative neuro-oncological care. As interdisciplinary care for neuro-oncology patients is an essential part of therapy, improvement of communication between GPs and university medical centers is indispensable. Integrating currently available electronic platforms under data protection aspects into neuro-oncological palliative care could be an interesting tool in order to establish healthcare networks and could find acceptance with GPs.

  1. Can general practitioner commissioning deliver equity and excellence? Evidence from two studies of service improvement in the English NHS.

    Science.gov (United States)

    Gridley, Kate; Spiers, Gemma; Aspinal, Fiona; Bernard, Sylvia; Atkin, Karl; Parker, Gillian

    2012-04-01

    To explore some of the key assumptions underpinning the continued development of general practitioner-led commissioning in health services. Qualitative data from two studies of service improvement in the English NHS were considered against England's plans for GP-led commissioning. These data were collected through in-depth interviews with a total of 187 professionals and 99 people affected by services in 10 different primary care trust areas across England between 2008 and 2009. Internationally, GPs are seen to have a central position in health systems. In keeping with this, the English policy places emphasis on the 'pivotal role' of general practitioners, considered to be ideally placed to commission in the best interests of their patients. However, our evidence suggests that general practitioners do not always have a pivotal role for all patients. Moreover, it is planned that the new commissioning groups in England will not be subject to top-down performance management and this raises the question of how agreed quality standards will be met under the proposed new system. This paper questions the assumption that GPs are best placed to commission health services in a way that meets quality standards and leads to equitable outcomes. There is little evidence to suggest that GPs will succeed where others have failed and a risk that, without top-down performance management, service improvement will be patchy, leading to greater, not reduced, inequity.

  2. Generalization of improved step length symmetry from treadmill to overground walking in persons with stroke and hemiparesis†

    Science.gov (United States)

    Savin, Douglas N.; Morton, Susanne M.; Whitall, Jill

    2013-01-01

    Objectives Determine whether adaptation to a swing phase perturbation during gait transferred from treadmill to overground walking, the rate of overground deadaptation, and whether overground aftereffects improved step length asymmetry in persons with hemiparetic stroke and gait asymmetry. Methods Ten participants with stroke and hemiparesis and 10 controls walked overground on an instrumented gait mat, adapted gait to a swing phase perturbation on a treadmill, then walked overground on the gait mat again. Outcome measures, primary: overground step length symmetry, rates of treadmill step length symmetry adaptation and overground step length symmetry deadaptation; secondary: overground gait velocity, stride length, and stride cycle duration. Results Step length symmetry aftereffects generalized to overground walking and adapted at a similar rate on the treadmill in both groups. Aftereffects decayed at a slower rate overground in participants with stroke and temporarily improved overground step length asymmetry. Both groups’ overground gait velocity increased post adaptation due to increased stride length and decreased stride duration. Conclusions Stroke and hemiparesis do not impair generalization of step length symmetry changes from adapted treadmill to overground walking, but prolong overground aftereffects. Significance Motor adaptation during treadmill walking may be an effective treatment for improving overground gait asymmetries post-stroke. PMID:24286858

  3. [General practice has to contribute to the continuous improvement of quality of care and integrate health promotion].

    Science.gov (United States)

    Vanmeerbeek, Marc

    2009-09-01

    Quality of care in general practice is mainly based on effectiveness of clinical and inter-personal care, and access to care. Assessment has to focus on structures and processes, more than on outcomes. The sets of clinical indicators used in some european countries, though good starting points are still incomplete to encompass the complexity of activity. Assessment of care quality by the public authorities must be acceptable to the doctors who are the object of this assessment; otherwise its conclusions will be rejected. Continuous quality improvement can maintain quality of care at a high level and maintain costs under control. Health has to be managed, and doctors have a collective responsibility towards their patients. The procedures of the quality cycle are applicable in general practice for the development of community-based projects of health promotion, within the network of care. The discipline can find in it a new lease of life and perhaps curb the loss of interest among young doctors.

  4. Improved general physical fitness of young swimmers by applying in the training process of endogenous hypoxic breathing techniques

    Directory of Open Access Journals (Sweden)

    Y.M. Furman

    2014-10-01

    Full Text Available Purpose : to examine the effect of general physical preparedness of young swimmers in the body artificially created state hypercapnic normobaric hypoxia. Material : the study involved 21 swimmer aged 13-14 years with sports qualifications at third and second sports categories. Results : the original method of working with young swimmers. Studies were conducted for 16 weeks a year preparatory period macrocycle. The average value of the index on the results of general endurance races 800m improved by 2.80 %. 8.24 % increased speed- strength endurance and 18.77 % increased dynamic strength endurance. During the period of formative experiment performance speed, agility, static endurance, flexibility and explosive strength athletes first experimental group was not significantly changed. Conclusions : it was found that the use of the proposed technique provides statistically significant increase in overall endurance, speed strength endurance and dynamic strength endurance.

  5. PROCEDIMIENTO GENERAL DE REDISEÑO ORGANIZACIONAL PARA MEJORAR EL ENFOQUE A PROCESOS / GENERAL PROCEDURE OF ORGANIZATIONAL REDESIGN TO IMPROVE THE PROCESS APPROACH

    Directory of Open Access Journals (Sweden)

    Daniel Alfonso-Robaina

    2011-09-01

    Full Text Available

    Para mejorar el enfoque a procesos en el rediseño de la organización de la empresa, es necesaria la adecuación de 6 fases. En la propuesta se presentan las actividades de cada fase del Procedimiento de rediseño organizacional para mejorar el enfoque a procesos, así como sus entradas y salidas. El procedimiento propuesto en esta investigación es el resultado de la fusión de varios de los estudiados, teniendo como base el procedimiento de Rummler y Brache (1995 [1]. En la investigación fue útil la utilización de técnicas, entre las que se destacan: las entrevistas, la tormenta de ideas y la búsqueda bibliográfica; además del empleo de herramientas como: el Mapa de Procesos y el Modelo General de Organización. Con el uso de estas técnicas y herramientas se identificó como asunto crítico de negocio en la empresa Explomat, la insuficiente gestión integrada de los procesos, lo que debilita las posibilidades de la entidad para aprovechar las oportunidades que le brinda el entorno, poniendo en peligro el cumplimiento de su misión. Teniendo en cuenta el análisis del nivel de integración del sistema de dirección, a partir de las matrices de relaciones, se contribuyó a proyectar mejoras, confeccionando el debe “ser”.

    Abstract

    In order to improve the process approach relative to the organizational redesign, it is necessary the adaptation of 6 phases. In the proposal, the activities of each phase of the Procedure of organizational redesign to improve the process approach, as well as its inputs and outputs, are presented. The proposed procedure in this investigation is the result of the merger of several of those studied, taking as a starting point the procedure of Rummler and Brache (1995 [1]. In this investigation it was useful the use of techniques, such as the interviews, the brainstorm and bibliographical search; besides the employment of tools like the Processes Map and the General Model of

  6. Elementary Assessment Handbook; a self-assessment handbook for compliance with the laws relating to elementary school boards of trustees and the state board of education policies for the general operation of a school district.

    Science.gov (United States)

    Arizona State Dept. of Education, Phoenix.

    As an alternative to assessments conducted by the State Department of Education, Arizona school districts can use this handbook for self evaluation of their compliance with school law, which is basically controlled by Arizona Revised Statute (ARS) Title 15 and State Board of Education policy. This handbook is divided into seven parts which…

  7. Solid Waste Management Districts

    Data.gov (United States)

    Vermont Center for Geographic Information — The Solid waste management districts layer is part of a dataset that contains administrative boundaries for Vermont's Agency of Natural Resources. This dataset...

  8. District nursing is vital.

    Science.gov (United States)

    Bliss, Julie

    2016-08-03

    Queen's Nursing Institute chief executive Crystal Oldman has welcomed the RCN congress resolution urging RCN council to lobby for all district nurses to have a specialist practice qualification. This provides the ideal route for future talent and must be supported.

  9. Floodplain District Permit

    Data.gov (United States)

    Montgomery County of Maryland — The purpose of a Floodplain District Permit (FPDP) is to control floodplain development in order to protect persons and property from danger and destruction and to...

  10. 115th Congressional Districts

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — This layer depicts the 115th Congressional Districts for the United States, with attributes listing the elected officials for the 115th Congress. Elected to a...

  11. Allegheny County Council Districts

    Data.gov (United States)

    Allegheny County / City of Pittsburgh / Western PA Regional Data Center — This dataset portrays the boundaries of the County Council Districts in Allegheny County. The dataset is based on municipal boundaries and City of Pittsburgh ward...

  12. ACT250 Districts

    Data.gov (United States)

    Vermont Center for Geographic Information — The ACT 250 Districts layer is part of a larger dataset that contains administrative boundaries for Vermont's Agency of Natural Resources. The dataset includes...

  13. NM Property Tax Districts

    Data.gov (United States)

    Earth Data Analysis Center, University of New Mexico — This layer represents boundaries for New Mexico tax district "OUT" categories and incorporated/municipal "IN" categories as identified on the "Certificate of Tax...

  14. NM School District Boundaries

    Data.gov (United States)

    Earth Data Analysis Center, University of New Mexico — The dataset represents the boundaries of all public school districts in the state of New Mexico. The source for the data layer is the New Mexico Public Education...

  15. Groundwater Managment Districts

    Data.gov (United States)

    Kansas Data Access and Support Center — This dataset outlines the location of the five Groundwater Management Districts in Kansas. GMDs are locally formed and elected boards for regional groundwater...

  16. District heating in sequential energy supply

    International Nuclear Information System (INIS)

    Persson, Urban; Werner, Sven

    2012-01-01

    Highlights: ► European excess heat recovery and utilisation by district heat distribution. ► Heat recovery in district heating systems – a structural energy efficiency measure. ► Introduction of new theoretical concepts to express excess heat recovery. ► Fourfold potential for excess heat utilisation in EU27 compared to current levels. ► Large scale excess heat recovery – a collaborative challenge for future Europe. -- Abstract: Increased recovery of excess heat from thermal power generation and industrial processes has great potential to reduce primary energy demands in EU27. In this study, current excess heat utilisation levels by means of district heat distribution are assessed and expressed by concepts such as recovery efficiency, heat recovery rate, and heat utilisation rate. For two chosen excess heat activities, current average EU27 heat recovery levels are compared to currently best Member State practices, whereby future potentials of European excess heat recovery and utilisation are estimated. The principle of sequential energy supply is elaborated to capture the conceptual idea of excess heat recovery in district heating systems as a structural and organisational energy efficiency measure. The general conditions discussed concerning expansion of heat recovery into district heating systems include infrastructure investments in district heating networks, collaboration agreements, maintained value chains, policy support, world market energy prices, allocation of synergy benefits, and local initiatives. The main conclusion from this study is that a future fourfold increase of current EU27 excess heat utilisation by means of district heat distribution to residential and service sectors is conceived as plausible if applying best Member State practice. This estimation is higher than the threefold increase with respect to direct feasible distribution costs estimated by the same authors in a previous study. Hence, no direct barriers appear with

  17. Rural district hospitals - essential cogs in the district health system - and primary healthcare re-engineering.

    Science.gov (United States)

    le Roux, K W D P; Couper, I

    2015-06-01

    The re-engineering of primary healthcare (PHC) is regarded as an essential precursor to the implementation of National Health Insurance in South Africa, but improvements in the provision of PHC services have been patchy. The authors contend that the role of well- functioning rural district hospitals as a hub from which PHC services can be most efficiently managed has been underestimated, and that the management of district hospitals and PHC clinics need to be co-located at the level of the rural district hospital, to allow for proper integration of care and effective healthcare provision.

  18. Training on the DSM-5 Cultural Formulation Interview improves cultural competence in general psychiatry residents: A pilot study.

    Science.gov (United States)

    Mills, Stacia; Xiao, Anna Q; Wolitzky-Taylor, Kate; Lim, Russell; Lu, Francis G

    2017-04-01

    The objective of this study was to assess whether a 1-hour didactic session on the DSM-5 Cultural Formulation Interview (CFI) improves the cultural competence of general psychiatry residents. The main hypothesis was that teaching adult psychiatry residents a 1-hour session on the CFI would improve cultural competence. The exploratory hypothesis was that trainees with more experience in cultural diversity would have a greater increase in cultural competency scores. Psychiatry residents at a metropolitan, county hospital completed demographics and preintervention questionnaires, were exposed to a 1-hour session on the CFI, and were given a postintervention questionnaire. The questionnaire was an adapted version of the validated Cultural Competence Assessment Tool . Paired samples t tests compared pre- to posttest change. Hierarchical linear regression assessed whether pretraining characteristics predicted posttest scores. The mean change of total pre- and posttest scores was significant ( p = .002), as was the mean change in subscales Nonverbal Communications ( p < .001) and Cultural Knowledge ( p = .002). Demographic characteristics did not predict higher posttest scores (when covarying for pretest scores). Psychiatry residents' cultural competence scores improved irrespective of previous experience in cultural diversity. More research is needed to further explore the implications of the improved scores in clinical practice.

  19. 75 FR 61367 - Revisions to the California State Implementation Plan, South Coast Air Quality Management District

    Science.gov (United States)

    2010-10-05

    ... the California State Implementation Plan, South Coast Air Quality Management District AGENCY... the South Coast Air Quality Management District (SCAQMD) portion of the California State... Measure for Architectural Coatings,'' CARB, October 2007. 4. ``Improving Air Quality with Economic...

  20. 77 FR 66780 - Revisions to the California State Implementation Plan, South Coast Air Quality Management District

    Science.gov (United States)

    2012-11-07

    ... the California State Implementation Plan, South Coast Air Quality Management District AGENCY... the South Coast Air Quality Management District (SCAQMD) portion of the California State... Control Measure for Architectural Coatings,'' CARB, October 2007. 4. ``Improving Air Quality with Economic...

  1. Creating a Statewide Educational Data System for Accountability and Improvement: A Comprehensive Information and Assessment System for Making Evidence-Based Change at School, District, and Policy Levels

    Science.gov (United States)

    Felner, Robert D.; Bolton, Natalie; Seitsinger, Anne M.; Brand, Stephen; Burns, Amy

    2008-01-01

    This article reports on one ongoing statewide effort to create a high-quality data reporting and utilization system (i.e., High-Performance Learning Community [HiPlaces] Assessment) to inform educational accountability and improvement efforts system. This effort has undergoing refinement for more than a decade. The article describes the features…

  2. Are area-based initiatives able to improve area safety in deprived areas? A quasi-experimental evaluation of the Dutch District Approach

    NARCIS (Netherlands)

    Kramer, Daniëlle; Jongeneel-Grimen, Birthe; Stronks, Karien; Droomers, Mariël; Kunst, Anton E.

    2015-01-01

    Numerous area-based initiatives have been implemented in deprived areas across Western-Europe with the aim to improve the socio-economic and environmental conditions in these areas. Only few of these initiatives have been scientifically evaluated for their impact on key social determinants of

  3. Effectiveness of social work intervention with a systematic approach to improve general health in opioid addicts in addiction treatment centers.

    Science.gov (United States)

    Raheb, Ghoncheh; Khaleghi, Esmat; Moghanibashi-Mansourieh, Amir; Farhoudian, Ali; Teymouri, Robab

    2016-01-01

    This study takes a systematic approach to investigate the effect of social work intervention aimed at increasing general health among opioid addicts in addiction treatment centers. This is an experimental plan (pretest to posttest with a control group); the study sample included 60 patients with drug dependencies undergoing treatment in addiction treatment centers. These patients were randomly assigned as case (30) and control (30) groups. The case group was subjected to intervention over ten sessions, whereas the control group received no intervention. Both groups then passed through a posttest, while a follow-up was conducted after 4 months. Data were obtained via a General Health Questionnaire. A covariance analysis test and independent and dependent t -test results indicated that a social work intervention adopting systematic approach was effective in increasing the general health of drug-addicted patients under treatment. Thus, the nature of the presence of social workers in addiction treatment centers has been effective and can have a significant influence by reducing anxiety and insomnia and somatic symptoms, improving patients' self-understanding and self-recognition, and enhancing social functioning.

  4. General chemistry courses that can affect achievement: An action research study in developing a plan to improve undergraduate chemistry courses

    Science.gov (United States)

    Shweikeh, Eman

    Over the past 50 years, considerable research has been dedicated to chemistry education. In evaluating principal chemistry courses in higher education, educators have noted the learning process for first-year general chemistry courses may be challenging. The current study investigated perceptions of faculty, students and administrators on chemistry education at three institutions in Southern California. Via action research, the study sought to develop a plan to improve student engagement in general chemistry courses. A mixed method was utilized to analyze different perceptions on key factors determining the level of commitment and engagement in general chemistry education. The approach to chemistry learning from both a faculty and student perspective was examined including good practices, experiences and extent of active participation. The research study considered well-known measures of effective education with an emphasis on two key components: educational practices and student behavior. Institutional culture was inclusively assessed where cognitive expectations of chemistry teaching and learning were communicated. First, the extent in which faculty members are utilizing the "Seven Principles for Good Practice in Undergraduate Education" in their instruction was explored. Second, student attitudes and approaches toward chemistry learning were examined. The focus was on investigating student understanding of the learning process and the structure of chemistry knowledge. The seven categories used to measure students' expectations for learning chemistry were: effort, concepts, math link, reality link, outcome, laboratory, and visualization. This analysis represents the views of 16 faculty and 140 students. The results validated the assertion that students need some competencies and skills to tackle the challenges of the chemistry learning process to deeply engage in learning. A mismatch exists between the expectations of students and those of the faculty

  5. Improvement of Adolescent Reproductive Health Understanding by Implementation of Educative, Collaborative, Participative, and Problem Based (ECPPB Learning Strategy in Buleleng District, Bali-Indonesia

    Directory of Open Access Journals (Sweden)

    Desak Made Citrawathi

    2016-10-01

    Full Text Available Introduction: One of potential public health issues in Indonesia is the problem of Adolescent Reproduction Health (ARH, particulary the behavior of having sex premaritaly and promiscuity, which is at risk of having unwanted pregnancy and sexually transmitted deseases such as HIV/AIDS. Increase in student’s knowledge, attitude, and skill by application of education of adolescent reproduction health (EARHis hopefully  will reduce the ARH problem.Method: This was experimental research with randomized pretest-posttest control group design. This research was conducted in Grade VIII of Junior High School with 72 research samples. Data were analysed by using Multivariate Analysis of Variances (Manova. Result: Data analysis showed that ECPPB learning strategy was better to improve students’ knowledge ARH, students’ attitude toward reproduction health, and students’ skill in ARH problem solving than students who were treated by using conventional teaching strategy in which the p = 0.0001(p < 0,05. The Partial Ata Squared (PTA was 87.4 %, which means the learning strategy was able to improve learning achievement as much as 87.4 %. The highest improvement of learning achievement by using ECPPBlearning strategy was on students’ skill in ARH problem solving (PES=80.9%. Improvement of health reproduction attitude was 63.2 %, and improvement of students’ knowledge about reproduction health was 25.1%. Conclusion: Based on the result of this study was suggested in order to students be given EARH was integrated on the subject of science in junior high school by using ECPPB strategy.

  6. EyeFrame: Real-time memory aid improves human multitasking via domain-general eye tracking procedures

    Directory of Open Access Journals (Sweden)

    P. eTaylor

    2015-09-01

    Full Text Available OBJECTIVE: We developed an extensively general closed-loop system to improve human interaction in various multitasking scenarios, with semi-autonomous agents, processes, and robots. BACKGROUND: Much technology is converging toward semi-independent processes with intermittent human supervision distributed over multiple computerized agents. Human operators multitask notoriously poorly, in part due to cognitive load and limited working memory. To multitask optimally, users must remember task order, e.g., the most neglected task, since longer times not monitoring an element indicates greater probability of need for user input. The secondary task of monitoring attention history over multiple spatial tasks requires similar cognitive resources as primary tasks themselves. Humans can not reliably make more than ~2 decisions/s. METHODS: Participants managed a range of 4-10 semi-autonomous agents performing rescue tasks. To optimize monitoring and controlling multiple agents, we created an automated short term memory aid, providing visual cues from users' gaze history. Cues indicated when and where to look next, and were derived from an inverse of eye fixation recency. RESULTS: Contingent eye tracking algorithms drastically improved operator performance, increasing multitasking capacity. The gaze aid reduced biases, and reduced cognitive load, measured by smaller pupil dilation. CONCLUSIONS: Our eye aid likely helped by delegating short-term memory to the computer, and by reducing decision making load. Past studies used eye position for gaze-aware control and interactive updating of displays in application-specific scenarios, but ours is the first to successfully implement domain-general algorithms. Procedures should generalize well to: process control, factory operations, robot control, surveillance, aviation, air traffic control, driving, military, mobile search and rescue, and many tasks where probability of utility is predicted by duration since last

  7. Guidelines for District Heating Substations

    Energy Technology Data Exchange (ETDEWEB)

    2009-07-15

    The present guidelines contain a set of recommendations focusing on planning, installation, use and maintenance of district heating (DH) substations within district heating systems throughout Europe. The recommendations were developed in order to enable readers to develop well-functioning substations and an effective heat and domestic warm water delivery. These guidelines are intended to give the most effective overall solutions for various parts of the customer installation. The guidelines are not meant to specify the different components of the substation such as meters or heat exchangers. The guidelines deal with a wide variety of issues concerning both present systems of today and district heating systems of the future. Specific handling and maintenance recommendations are mainly focused on present modern systems but are also intended to cover the future situation as much as is feasible. For this reason, certain existing systems are not dealt with in these guidelines. For instance, these guidelines do not cover steam systems, systems with temperatures exceeding 110 deg C and pressure levels above 1.6 MPa. The guidelines include a chapter on the heat meter, as the meter and especially the meter installation is always installed simultaneously with the rest of the substation. These guidelines aim to provide best-practice and easy-to-handle recommendations for: - those who are responsible for relations between district heating utilities and customers; - those who own or maintain a building connected to the district heating network; - those who manufacture, plan, purchase, test and install substations. These guidelines do not deal with investment or cost aspects, but in general, Euroheat and Power recommends looking at the lifetime cost of all components of the substation, instead of investment costs alone. An example of this is provided in Chapter 7.8. The Guidelines were developed based on the most optimal operating principles of substations and meters

  8. Army Needs to Improve Controls and Audit Trails for the General Fund Enterprise Business System Acquire-to-Retire Business Process

    Science.gov (United States)

    2013-09-13

    Event 1.4.4,” August 7, 2012 AAA Attestation Report A-2010-0187- FFM , “General Fund Enterprise Business System - Federal Financial Management...Improvement Act Compliance. Examination of Requirements Through Test Event 1.4.0,” September 14, 2010 AAA Audit Report A-2009-0232- FFM , “General Fund...September 30, 2009 AAA Audit Report A-2009-0231- FFM , “General Fund Enterprise Business System - Federal Financial Management Improvement Act

  9. A concept paper: using the outcomes of common surgical conditions as quality metrics to benchmark district surgical services in South Africa as part of a systematic quality improvement programme.

    Science.gov (United States)

    Clarke, Damian L; Kong, Victor Y; Handley, Jonathan; Aldous, Colleen

    2013-07-31

    The fourth, fifth and sixth Millennium Development Goals relate directly to improving global healthcare and health outcomes. The focus is to improve global health outcomes by reducing maternal and childhood mortality and the burden of infectious diseases such as HIV/AIDS, tuberculosis and malaria. Specific targets and time frames have been set for these diseases. There is, however, no specific mention of surgically treated diseases in these goals, reflecting a bias that is slowly changing with emerging consensus that surgical care is an integral part of primary healthcare systems in the developing world. The disparities between the developed and developing world in terms of wealth and social indicators are reflected in disparities in access to surgical care. Health administrators must develop plans and strategies to reduce these disparities. However, any strategic plan that addresses deficits in healthcare must have a system of metrics, which benchmark the current quality of care so that specific improvement targets may be set.This concept paper outlines the role of surgical services in a primary healthcare system, highlights the ongoing disparities in access to surgical care and outcomes of surgical care, discusses the importance of a systems-based approach to healthcare and quality improvement, and reviews the current state of surgical care at district hospitals in South Africa. Finally, it proposes that the results from a recently published study on acute appendicitis, as well as data from a number of other common surgical conditions, can provide measurable outcomes across a healthcare system and so act as an indicator for judging improvements in surgical care. This would provide a framework for the introduction of collection of these outcomes as a routine epidemiological health policy tool.

  10. Time-frequency analysis of time-varying modulated signals based on improved energy separation by iterative generalized demodulation

    Science.gov (United States)

    Feng, Zhipeng; Chu, Fulei; Zuo, Ming J.

    2011-03-01

    Energy separation algorithm is good at tracking instantaneous changes in frequency and amplitude of modulated signals, but it is subject to the constraints of mono-component and narrow band. In most cases, time-varying modulated vibration signals of machinery consist of multiple components, and have so complicated instantaneous frequency trajectories on time-frequency plane that they overlap in frequency domain. For such signals, conventional filters fail to obtain mono-components of narrow band, and their rectangular decomposition of time-frequency plane may split instantaneous frequency trajectories thus resulting in information loss. Regarding the advantage of generalized demodulation method in decomposing multi-component signals into mono-components, an iterative generalized demodulation method is used as a preprocessing tool to separate signals into mono-components, so as to satisfy the requirements by energy separation algorithm. By this improvement, energy separation algorithm can be generalized to a broad range of signals, as long as the instantaneous frequency trajectories of signal components do not intersect on time-frequency plane. Due to the good adaptability of energy separation algorithm to instantaneous changes in signals and the mono-component decomposition nature of generalized demodulation, the derived time-frequency energy distribution has fine resolution and is free from cross term interferences. The good performance of the proposed time-frequency analysis is illustrated by analyses of a simulated signal and the on-site recorded nonstationary vibration signal of a hydroturbine rotor during a shut-down transient process, showing that it has potential to analyze time-varying modulated signals of multi-components.

  11. Effectiveness of social work intervention with a systematic approach to improve general health in opioid addicts in addiction treatment centers

    Directory of Open Access Journals (Sweden)

    Raheb G

    2016-11-01

    Full Text Available Ghoncheh Raheb,1,2 Esmat Khaleghi,1 Amir Moghanibashi-Mansourieh,1 Ali Farhoudian,2 Robab Teymouri3 1Department of Social Work, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran; 2Substance Abuse and Dependence Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran; 3Pediatric Neurorehabilitation Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran Purpose: This study takes a systematic approach to investigate the effect of social work intervention aimed at increasing general health among opioid addicts in addiction treatment centers. Patients and methods: This is an experimental plan (pretest to posttest with a control group; the study sample included 60 patients with drug dependencies undergoing treatment in addiction treatment centers. These patients were randomly assigned as case (30 and control (30 groups. The case group was subjected to intervention over ten sessions, whereas the control group received no intervention. Both groups then passed through a posttest, while a follow-up was conducted after 4 months. Data were obtained via a General Health Questionnaire. Results: A covariance analysis test and independent and dependent t-test results indicated that a social work intervention adopting systematic approach was effective in increasing the general health of drug-addicted patients under treatment. Conclusion: Thus, the nature of the presence of social workers in addiction treatment centers has been effective and can have a significant influence by reducing anxiety and insomnia and somatic symptoms, improving patients’ self-understanding and self-recognition, and enhancing social functioning. Keywords: social work, intervention, systematic approach, general health, opioid addicts

  12. Analysis of development achievement of overseas resources and study of plans of system improvement (bituminous coal, general mineral resources)

    Energy Technology Data Exchange (ETDEWEB)

    Hwang, J N [Korea Energy Economics Institute, Euiwang (Korea, Republic of)

    1998-05-01

    Development policy of overseas resources of Korea should be carried out as a part of long-term resources security policy that can prepare for the stable supply and demand of needed resources under the proper economic size and industrial structure. This study tried to search for the ways to promote overseas development of bituminous coal and, general mineral resources, and support them more effectively per field. For this, development achievements so far, domestic and foreign pending issues, and operation status of the support system are studied, analyzed, and the improvement plans are drafted per field. Financial support for overseas resources development should be more expanded than the present in the future. For this, the current collateral system centered on real right should be improved and financial support centered on the credit of enterprise should be reinforced. Besides, in the related tax support system, related tax laws and systems should be improved in order to alleviate the tax burden of business operators so that they can carry out the overseas resources development business with more advantageous conditions through the additive introduction of current deduction system of indirect payment tax. Since payback period of overseas resources development business tends to become long-term, it should be continuously carried out based on future-oriented development investment plan and will of more than twenty (20) years rather than on temporary development support plan based on short-term market trend. 25 refs., 73 tabs.

  13. An analytical study of the improved nonlinear tolerance of DFT-spread OFDM and its unitary-spread OFDM generalization.

    Science.gov (United States)

    Shulkind, Gal; Nazarathy, Moshe

    2012-11-05

    DFT-spread (DFT-S) coherent optical OFDM was numerically and experimentally shown to provide improved nonlinear tolerance over an optically amplified dispersion uncompensated fiber link, relative to both conventional coherent OFDM and single-carrier transmission. Here we provide an analytic model rigorously accounting for this numerical result and precisely predicting the optimal bandwidth per DFT-S sub-band (or equivalently the optimal number of sub-bands per optical channel) required in order to maximize the link non-linear tolerance (NLT). The NLT advantage of DFT-S OFDM is traced to the particular statistical dependency introduced among the OFDM sub-carriers by means of the DFT spreading operation. We further extend DFT-S to a unitary-spread generalized modulation format which includes as special cases the DFT-S scheme as well as a new format which we refer to as wavelet-spread (WAV-S) OFDM, replacing the spreading DFTs by Hadamard matrices which have elements +/-1 hence are multiplier-free. The extra complexity incurred in the spreading operation is almost negligible, however the performance improvement with WAV-S relative to plain OFDM is more modest than that achieved by DFT-S, which remains the preferred format for nonlinear tolerance improvement, outperforming both plain OFDM and single-carrier schemes.

  14. Effect of autogenic training on general improvement in patients with irritable bowel syndrome: a randomized controlled trial.

    Science.gov (United States)

    Shinozaki, Masae; Kanazawa, Motoyori; Kano, Michiko; Endo, Yuka; Nakaya, Naoki; Hongo, Michio; Fukudo, Shin

    2010-09-01

    Autogenic training (AT) is a useful and comprehensive relaxation technique. However, no studies have investigated the effects of AT on irritable bowel syndrome (IBS). In this study we tested the hypothesis that AT improves symptoms of IBS. Twenty-one patients with IBS were randomly assigned to AT (n = 11, 5 male, 6 female) or control therapy (n = 10, 5 male, 5 female). AT patients were trained intensively, while the control therapy consisted of discussions about patients' meal habits and life styles. All patients answered a question related to adequate relief (AR) of IBS symptoms and four questionnaires: Self-induced IBS Questionnaire (SIBSQ), Self-reported Depression Scale (SDS), State-Trait Anxiety Inventory (STAI), and Medical Outcome Short Form 36 Health Survey (SF-36). The proportion of AR in the last AT session in the AT group (9/11, 81.8%) was significantly higher than that in the controls (3/10, 30.0%, Chi-square test, p = 0.048). Two subscales of the SF-36, i.e., social functioning and bodily pain, were significantly improved in the AT group (p < 0.05) as compared to the control group. Role emotional (p = 0.051) and general health (p = 0.068) showed a tendency for improvement in the AT group. AT may be useful in the treatment of IBS by enhancing self-control.

  15. Intensive educational efforts combined with external quality assessment improve the preanalytical phase in general practitioner offices and nursing homes.

    Science.gov (United States)

    Sølvik, Una Ørvim; Bjelkarøy, Wenche Iren; Berg, Kari van den; Saga, Anne Lise; Hager, Helle Borgstrøm; Sandberg, Sverre

    2017-10-26

    Errors in the preanalytical phase in clinical laboratories affect patient safety. The aim of this study was to evaluate the effect of intensive educational efforts together with external quality assessment (EQA) of the preanalytical phase from 2013 to 2015 to improve patient identification in primary health care in Norway. In addition, routines for venous and capillary blood sampling were investigated. A preanalytical EQA was circulated in 2013 by the Norwegian Quality Improvement of Laboratory Examinations (Noklus) to general practitioner offices and nursing homes (n=2000) to obtain information about important issues to focus on before launching an intensive educational program with courses, posters and visits in 2013-2015. Preanalytical EQA surveys were further circulated in 2014 and 2015. The response rate varied between 42% and 55%. The percentages of participants asking for the patients' name and the Norwegian identification number increased from about 8% in 2013 to about 35% in 2015. The increase was similar for those participating in only one EQA survey and for those who participated in EQA surveys both in 2013 and 2015. Guidelines for venous and capillary blood sampling were not always followed. Educational efforts more than the preanalytical EQA influenced the actions and resulted in an increase in the percentages of participants that followed the guidelines for patient identification. Some aspects of blood sampling routines need improvement.

  16. Evaluation of the Implementation of the Reaching Every District ...

    African Journals Online (AJOL)

    46987.2

    ABSTRACT. Background: In 2003, the Government of Zambia in collaboration with implementing partners in immunisation introduced the Reaching Every District. (RED) strategy to improve immunization coverage. The aim of this study is to evaluate the implementation of the. RED strategy in Lusaka district. Methods: A ...

  17. Health improvement and prevention study (HIPS - evaluation of an intervention to prevent vascular disease in general practice

    Directory of Open Access Journals (Sweden)

    Davies Gawaine

    2010-08-01

    Full Text Available Abstract Background The Health Improvement and Prevention Study (HIPS study aims to evaluate the capacity of general practice to identify patients at high risk for developing vascular disease and to reduce their risk of vascular disease and diabetes through behavioural interventions delivered in general practice and by the local primary care organization. Methods/Design HIPS is a stratified randomized controlled trial involving 30 general practices in NSW, Australia. Practices are randomly allocated to an 'intervention' or 'control' group. General practitioners (GPs and practice nurses (PNs are offered training in lifestyle counselling and motivational interviewing as well as practice visits and patient educational resources. Patients enrolled in the trial present for a health check in which the GP and PN provide brief lifestyle counselling based on the 5As model (ask, assess, advise, assist, and arrange and refer high risk patients to a diet education and physical activity program. The program consists of two individual visits with a dietician or exercise physiologist and four group sessions, after which patients are followed up by the GP or PN. In each practice 160 eligible patients aged between 40 and 64 years are invited to participate in the study, with the expectation that 40 will be eligible and willing to participate. Evaluation data collection consists of (1 a practice questionnaire, (2 GP and PN questionnaires to assess preventive care attitudes and practices, (3 patient questionnaire to assess self-reported lifestyle behaviours and readiness to change, (4 physical assessment including weight, height, body mass index (BMI, waist circumference and blood pressure, (5 a fasting blood test for glucose and lipids, (6 a clinical record audit, and (7 qualitative data collection. All measures are collected at baseline and 12 months except the patient questionnaire which is also collected at 6 months. Study outcomes before and after the

  18. Improvement in mortality and retention among adult HIV-infected patients in the first 12 months of antiretroviral therapy in Dodoma urban district, Tanzania.

    Science.gov (United States)

    Tweve, Escor N; Kayabu, David; Nassari, Nahum O; Todd, Jim

    2015-06-01

    To determine mortality and retention in ART programmes in Tanzania, between 2010 and 2013. Retrospective routinely collected data were analysed from people starting ART in the period 2010-2013. Mortality and retention over the first 12 months on ART were compared across the 4 years, and adjustment was made for individual level potential confounders. Data from 3844 people (70.6% female) starting ART were analysed. Mortality in the first year declined from 11.4% in 2010 to 4.9% in 2013, and retention after 12 months increased from 77.8% in 2010 to 98.1% in 2013. Mortality was inversely associated with CD4 count, lowest among those with CD4 350+ cells/μl [adjusted odds ratio (AOR) = 0.03, 95% CI 0.01-0.03], associated with male sex (AOR = 1.79, 95% CI 1.39-2.31), but not age. Lost to follow-up (LTFU) was lowest among those with CD4 = 350+ cells/μl AOR = 0.20, 95% CI 0.10-0.30), but not associated with age or sex, and higher in urban health facilities (AOR = 1.88, 95% CI 1.15-3.09). After adjustment for individual level characteristics, there was a statistically significant yearly improvement in mortality (AOR = 0.31, 95% CI (0.21-0.44) and LTFU (AOR = 0.06, 95% CI 0.04-0.10). Mortality and retention in the first 12 months on ART have significantly improved over the 4 years from 2010 to 2013. These improvements may indicate better services, earlier initiation on ART, and strengthened systems to provide ART in Tanzania. These results refute the worries that earlier initiation on ART might lead to lower retention in the ART programme. © 2015 John Wiley & Sons Ltd.

  19. District heating in Flensburg

    Energy Technology Data Exchange (ETDEWEB)

    Prinz, W.

    1981-01-01

    The majority of our population, but also of our authorities, are still skeptical or even disapproving towards district heating. The reasons of this negative attitude are partly psychological - e.g. the individualism of the Swiss and their dislike for too centralised structures and ''forced connections'' - but also the existence of finished gas supply networks and the fear of considerable pre-investments and torn streets over years. The following article - held as a speech on the information meeting ''District heating and the possible contribution of nuclear energy'' organised by the Swiss Association for Atomic Energy in Bern shows a practical problem solving at the example of the district heating in Flensburg and deals with these questions.

  20. Improvement in 5-year mortality in incident rheumatoid arthritis compared with the general population-closing the mortality gap.

    Science.gov (United States)

    Lacaille, Diane; Avina-Zubieta, J Antonio; Sayre, Eric C; Abrahamowicz, Michal

    2017-06-01

    Excess mortality in rheumatoid arthritis (RA) is expected to have improved over time, due to improved treatment. Our objective was to evaluate secular 5-year mortality trends in RA relative to general population controls in incident RA cohorts diagnosed in 1996-2000 vs 2001-2006. We conducted a population-based cohort study, using administrative health data, of all incident RA cases in British Columbia who first met RA criteria between January 1996 and December 2006, with general population controls matched 1:1 on gender, birth and index years. Cohorts were divided into earlier (RA onset 1996-2000) and later (2001-2006) cohorts. Physician visits and vital statistics data were obtained until December 2010. Follow-up was censored at 5 years to ensure equal follow-up in both cohorts. Mortality rates, mortality rate ratios and HRs for mortality (RA vs controls) using proportional hazard models adjusting for age, were calculated. Differences in mortality in RA versus controls between earlier and later incident cohorts were tested via interaction between RA status (case/control) and cohort (earlier/later). 24 914 RA cases and controls experienced 2747 and 2332 deaths, respectively. Mortality risk in RA versus controls differed across incident cohorts for all-cause, cardiovascular diseases (CVD) and cancer mortality (interactions pyears was observed in people with RA onset before, but not after, 2000. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  1. Identification of influencing factors and strategies to improve communication between general practitioners and community nurses: a qualitative focus group study.

    Science.gov (United States)

    Nieuwboer, Minke S; Perry, Marieke; van der Sande, Rob; Maassen, Irma T H M; Olde Rikkert, Marcel G M; van der Marck, Marjolein A

    2018-02-26

    As the number of patients with complex healthcare needs grows, inter-professional collaboration between primary care professionals must be constantly optimized. General practitioners (GPs) and community nurses (CNs) are key professions in primary care; however, poor GP-CN communication is common, and research into the factors influencing its quality is limited. To explore patient-related GP-CN communication and facilitating and hindering factors, and to identify strategies to enhance this communication. A qualitative focus group design was used to identify the facilitating and hindering factors and strategies for improvement. In a Dutch primary care setting, 6 mono-professional focus group interviews (3 meetings of 13 GPs; 3 meetings of 18 CNs) were organized between June 2015 and April 2016, recorded and transcribed verbatim. Two independent researchers performed the coding of these interviews, identifying their categories and themes. Results show that, despite the regular contact between GPs and CNs, communication was generally perceived as poor in effectiveness and efficiency by both professions. Mutual trust was considered the most important facilitating factor for effective communication. Profession-specific factors (e.g. differences in responsibility and profession-specific language) and organizational factors (e.g. lack of shared care plans, no in-person communication, lack of time) may be of influence on communication. Participants' suggestions for improvement included organizing well-structured and reimbursed team meetings and facilitating face-to-face contact. GP-CN patient-related communication benefits most from trusting inter-personal relationships. Inter-professional training programmes should address both professional and organizational factors and should be evaluated for their effect on quality of care.

  2. Promoting mobility and reducing length of stay in hospitalized general medicine patients: A quality-improvement project.

    Science.gov (United States)

    Hoyer, Erik H; Friedman, Michael; Lavezza, Annette; Wagner-Kosmakos, Kathleen; Lewis-Cherry, Robin; Skolnik, Judy L; Byers, Sherrie P; Atanelov, Levan; Colantuoni, Elizabeth; Brotman, Daniel J; Needham, Dale M

    2016-05-01

    To determine whether a multidisciplinary mobility promotion quality-improvement (QI) project would increase patient mobility and reduce hospital length of stay (LOS). Implemented using a structured QI model, the project took place between March 1, 2013 and March 1, 2014 on 2 general medicine units in a large academic medical center. There were 3352 patients admitted during the QI project period. The Johns Hopkins Highest Level of Mobility (JH-HLM) scale, an 8-point ordinal scale ranging from bed rest (score = 1) to ambulating ≥250 feet (score = 8), was used to quantify mobility. Changes in JH-HLM scores were compared for the first 4 months of the project (ramp-up phase) versus 4 months after project completion (post-QI phase) using generalized estimating equations. We compared the relative change in median LOS for the project months versus 12 months prior among the QI units, using multivariable linear regression analysis adjusting for 7 demographic and clinically relevant variables. Comparing the ramp-up versus post-QI phases, patients reaching JH-HLM's ambulation status increased from 43% to 70% (P mobility scores between admission and discharge increased from 32% to 45% (P 7 days), were associated with a significantly greater adjusted median reduction in LOS of 1.11 (95% CI: -1.53 to -0.65, P mobility was not associated with an increase in injurious falls compared to 12 months prior on the QI units (P = 0.73). Active prevention of a decline in physical function that commonly occurs during hospitalization may be achieved with a structured QI approach. In an adult medicine population, our QI project was associated with improved mobility, and this may have contributed to a reduction in LOS, particularly for more complex patients with longer expected hospital stay. Journal of Hospital Medicine 2016. © 2016 Society of Hospital Medicine. © 2016 Society of Hospital Medicine.

  3. Energy-efficient and cost-effective use of district heating bypass for improving the thermal comfort in bathrooms in low-energy buildings

    DEFF Research Database (Denmark)

    Dalla Rosa, Alessandro; Brand, Marek; Svendsen, Svend

    2012-01-01

    , in the example considered 10-35% lower than in the traditional “intermittent bypass” case; secondly, it can be used to increase the thermal comfort outside the heating-season in bathrooms through floor heating, without causing overheating. It is important that the building design foresees the use of shading......, the utilization of the bypass in bathroom floor heating is a cost-effective solution, both for the DH utilities (reduced heat loss from the DH network and higher revenues), the end-users (improved thermal comfort) and the society (reduction of greenhouse gas emissions)....... floor heating to increase the users’ comfort; its techno-economic analysis, including the modelling of the in-house space heating system; the effect of the bypass to the DH network. Some conclusions were derived. First, the “continuous bypass” guarantees low heat losses in the service pipe...

  4. Improving incidence estimation in practice-based sentinel surveillance networks using spatial variation in general practitioner density

    Directory of Open Access Journals (Sweden)

    Cécile Souty

    2016-11-01

    Full Text Available Abstract Background In surveillance networks based on voluntary participation of health-care professionals, there is little choice regarding the selection of participants’ characteristics. External information about participants, for example local physician density, can help reduce bias in incidence estimates reported by the surveillance network. Methods There is an inverse association between the number of reported influenza-like illness (ILI cases and local general practitioners (GP density. We formulated and compared estimates of ILI incidence using this relationship. To compare estimates, we simulated epidemics using a spatially explicit disease model and their observation by surveillance networks with different characteristics: random, maximum coverage, largest cities, etc. Results In the French practice-based surveillance network – the “Sentinelles” network – GPs reported 3.6% (95% CI [3;4] less ILI cases as local GP density increased by 1 GP per 10,000 inhabitants. Incidence estimates varied markedly depending on scenarios for participant selection in surveillance. Yet accounting for change in GP density for participants allowed reducing bias. Applied on data from the Sentinelles network, changes in overall incidence ranged between 1.6 and 9.9%. Conclusions Local GP density is a simple measure that provides a way to reduce bias in estimating disease incidence in general practice. It can contribute to improving disease monitoring when it is not possible to choose the characteristics of participants.

  5. The Nation's Report Card Reading 2013 Trial Urban District Snapshot Report. Austin Independent School District. Grade 4, Public Schools

    Science.gov (United States)

    National Center for Education Statistics, 2013

    2013-01-01

    The National Assessment of Educational Progress (NAEP), in partnership with the National Assessment Governing Board and the Council of the Great City Schools (CGCS), created the Trial Urban District Assessment (TUDA) in 2002 to support the improvement of student achievement in the nation's large urban districts. NAEP TUDA results in mathematics…

  6. The Nation's Report Card Mathematics 2013 Trial Urban District Snapshot Report. Austin Independent School District. Grade 4, Public Schools

    Science.gov (United States)

    National Center for Education Statistics, 2013

    2013-01-01

    The National Assessment of Educational Progress (NAEP), in partnership with the National Assessment Governing Board and the Council of the Great City Schools (CGCS), created the Trial Urban District Assessment (TUDA) in 2002 to support the improvement of student achievement in the nation's large urban districts. NAEP TUDA results in mathematics…

  7. The Nation's Report Card Mathematics 2013 Trial Urban District Snapshot Report. Austin Independent School District. Grade 8, Public Schools

    Science.gov (United States)

    National Center for Education Statistics, 2013

    2013-01-01

    The National Assessment of Educational Progress (NAEP), in partnership with the National Assessment Governing Board and the Council of the Great City Schools (CGCS), created the Trial Urban District Assessment (TUDA) in 2002 to support the improvement of student achievement in the nation's large urban districts. NAEP TUDA results in mathematics…

  8. The Nation's Report Card Reading 2013 Trial Urban District Snapshot Report. Austin Independent School District. Grade 8, Public Schools

    Science.gov (United States)

    National Center for Education Statistics, 2013

    2013-01-01

    The National Assessment of Educational Progress (NAEP), in partnership with the National Assessment Governing Board and the Council of the Great City Schools (CGCS), created the Trial Urban District Assessment (TUDA) in 2002 to support the improvement of student achievement in the nation's large urban districts. NAEP TUDA results in mathematics…

  9. Understanding Standards and Assessment Policy in Science Education: Relating and Exploring Variations in Policy Implementation by Districts and Teachers in Wisconsin

    Science.gov (United States)

    Anderson, Kevin John Boyett

    Current literature shows that many science teachers view policies of standards-based and test-based accountability as conflicting with research-based instruction in science education. With societal goals of improving scientific literacy and using science to spur economic growth, improving science education policy becomes especially important. To understand perceived influences of science education policy, this study looked at three questions: 1) How do teachers perceive state science standards and assessment and their influence on curriculum and instruction? 2) How do these policy perspectives vary by district and teacher level demographic and contextual differences? 3) How do district leaders' interpretations of and efforts within these policy realms relate to teachers' perceptions of the policies? To answer these questions, this study used a stratified sample of 53 districts across Wisconsin, with 343 middle school science teachers responding to an online survey; science instructional leaders from each district were also interviewed. Survey results were analyzed using multiple regression modeling, with models generally predicting 8-14% of variance in teacher perceptions. Open-ended survey and interview responses were analyzed using a constant comparative approach. Results suggested that many teachers saw state testing as limiting use of hands-on pedagogy, while standards were seen more positively. Teachers generally held similar views of the degree of influence of standards and testing regardless of their experience, background in science, credentials, or grade level taught. District SES, size and past WKCE scores had some limited correlations to teachers' views of policy, but teachers' perceptions of district policies and leadership consistently had the largest correlation to their views. District leadership views of these state policies correlated with teachers' views. Implications and future research directions are provided. Keywords: science education, policy

  10. Sustainability Profile for Urban Districts in Copenhagen

    DEFF Research Database (Denmark)

    Jensen, Jesper Ole

    urban designers to creatively improve the sustainable performance of a district" (Kortman et al, 2001). Compared to other tools for assessing urban sustainability, DPL represents a simple and flexible approach. The idea is to use a limited number of indicators based on already collected data. Once...

  11. Districts Begin Looking Harder at Absenteeism

    Science.gov (United States)

    Sparks, Sarah D.

    2010-01-01

    As policymakers debate the merits of new tests and intervention strategies to improve student achievement, some districts are exploring a more basic warning sign: Are students even showing up? A growing consensus of research points to chronic absence--defined by the national policy group Attendance Counts as missing 10 percent of school or…

  12. A bias correction for covariance estimators to improve inference with generalized estimating equations that use an unstructured correlation matrix.

    Science.gov (United States)

    Westgate, Philip M

    2013-07-20

    Generalized estimating equations (GEEs) are routinely used for the marginal analysis of correlated data. The efficiency of GEE depends on how closely the working covariance structure resembles the true structure, and therefore accurate modeling of the working correlation of the data is important. A popular approach is the use of an unstructured working correlation matrix, as it is not as restrictive as simpler structures such as exchangeable and AR-1 and thus can theoretically improve efficiency. However, because of the potential for having to estimate a large number of correlation parameters, variances of regression parameter estimates can be larger than theoretically expected when utilizing the unstructured working correlation matrix. Therefore, standard error estimates can be negatively biased. To account for this additional finite-sample variability, we derive a bias correction that can be applied to typical estimators of the covariance matrix of parameter estimates. Via simulation and in application to a longitudinal study, we show that our proposed correction improves standard error estimation and statistical inference. Copyright © 2012 John Wiley & Sons, Ltd.

  13. [A proposal to improve nursing fee differentiation policy for general hospitals using profitability-analysis in the national health insurance].

    Science.gov (United States)

    Kim, Sungjae; Kim, Jinhyun

    2012-06-01

    The purpose of this study was to propose optimal hospitalization fees for nurse staffing levels and to improve the current nursing fee policy. A break-even analysis was used to evaluate the impact of a nursing fee policy on hospital's financial performance. Variables considered included the number of beds, bed occupancy rate, annual total patient days, hospitalization fees for nurse staffing levels, the initial annual nurses' salary, and the ratio of overhead costs to nursing labor costs. Data were collected as secondary data from annual reports of the Hospital Nursing Association and national health insurance. The hospitalization fees according to nurse staffing levels in general hospitals are required to sustain or decrease in grades 1, 2, 3, 4, and 7, and increase in grades 5 and 6. It is suggested that the range between grade 2 and 3 be sustained at the current level, the range between grade 4 and 5 be widen or merged into one, and the range between grade 6 and 7 be divided into several grades. Readjusting hospitalization fees for nurse staffing level will improve nurse-patient ratio and enhance the quality of nursing care in hospitals. Follow-up studies including tertiary hospitals and small hospitals are recommended.

  14. Improving ability measurement in surveys by following the principles of IRT: The Wordsum vocabulary test in the General Social Survey.

    Science.gov (United States)

    Cor, M Ken; Haertel, Edward; Krosnick, Jon A; Malhotra, Neil

    2012-09-01

    Survey researchers often administer batteries of questions to measure respondents' abilities, but these batteries are not always designed in keeping with the principles of optimal test construction. This paper illustrates one instance in which following these principles can improve a measurement tool used widely in the social and behavioral sciences: the GSS's vocabulary test called "Wordsum". This ten-item test is composed of very difficult items and very easy items, and item response theory (IRT) suggests that the omission of moderately difficult items is likely to have handicapped Wordsum's effectiveness. Analyses of data from national samples of thousands of American adults show that after adding four moderately difficult items to create a 14-item battery, "Wordsumplus" (1) outperformed the original battery in terms of quality indicators suggested by classical test theory; (2) reduced the standard error of IRT ability estimates in the middle of the latent ability dimension; and (3) exhibited higher concurrent validity. These findings show how to improve Wordsum and suggest that analysts should use a score based on all 14 items instead of using the summary score provided by the GSS, which is based on only the original 10 items. These results also show more generally how surveys measuring abilities (and other constructs) can benefit from careful application of insights from the contemporary educational testing literature. Copyright © 2012 Elsevier Inc. All rights reserved.

  15. Improved Minimum Entropy Filtering for Continuous Nonlinear Non-Gaussian Systems Using a Generalized Density Evolution Equation

    Directory of Open Access Journals (Sweden)

    Jinliang Xu

    2013-06-01

    Full Text Available This paper investigates the filtering problem for multivariate continuous nonlinear non-Gaussian systems based on an improved minimum error entropy (MEE criterion. The system is described by a set of nonlinear continuous equations with non-Gaussian system noises and measurement noises. The recently developed generalized density evolution equation is utilized to formulate the joint probability density function (PDF of the estimation errors. Combining the entropy of the estimation error with the mean squared error, a novel performance index is constructed to ensure the estimation error not only has small uncertainty but also approaches to zero. According to the conjugate gradient method, the optimal filter gain matrix is then obtained by minimizing the improved minimum error entropy criterion. In addition, the condition is proposed to guarantee that the estimation error dynamics is exponentially bounded in the mean square sense. Finally, the comparative simulation results are presented to show that the proposed MEE filter is superior to nonlinear unscented Kalman filter (UKF.

  16. Empowerment Zones and Enterprise Districts - MDC_CommunityDevelopmentDistrict

    Data.gov (United States)

    NSGIC Local Govt | GIS Inventory — Community Development Districts (CDDs) are special taxing districts or local units of special-purpose government. A CDD may charge separate non-ad valorem special...

  17. Effective analysis of a community-based intervention during heat waves to improve knowledge, attitude and practice in a population in Licheng District, Jinan City, China.

    Science.gov (United States)

    Xu, Xin; Li, Jing; Gao, Jinghong; Liu, Keke; Liu, Qiyong

    2017-09-18

    Intervention strategies that focus on coping with continuous heat wave threats have been implemented in many countries. Despite these efforts, we still lack evidence concerning intervention efficacy. A Heat Wave Intervention Program (HWIP) that impacts knowledge, attitude and practice (KAP) was designed, and its effectiveness during heat waves was evaluated. A stratified two-stage probability proportion to size sampling method was employed to analyze an intervention group and a control group. Two cross-sectional surveys, which included questions about heat waves in 2014 and 2015, were analyzed using difference-in-difference (DID) analysis. Mean KAP scores among participants with different demographic characteristics in the intervention group were higher in 2015 than those in 2014. Further analysis by DID found that implementing interventions was positively associated with knowledge (ß = 0.387, P < 0.001) and attitude (ß = 0.166, P < 0.01). Intervention measures can significantly promote levels of knowledge and attitude. However, as the practice level, most of the sub-groups showed no significant differences for net values between in the intervention group and control group. A cost-benefit analysis was suggested as future work to check the effectiveness of the program. Therefore, further improvement measures should be targeted towards the populations to enable them to effectively cope with the heat waves. © The Author 2017. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

  18. Improvement of decision-making criteria for the care of elderly cancer patients by general practitioners (Lorraine, France

    Directory of Open Access Journals (Sweden)

    Niemier JY

    2018-05-01

    Full Text Available Jean-Yves Niemier,1,2 Frédérique Claudot,3,4 Phi Linh Nguyen-Thi,4 Jean-Marie Hubert,5 Hubert Rousselot,2,6 Athanase Benetos,1 Christine Perret-Guillaume1,3 1Department of Geriatric Medicine, CHRU de Nancy, Nancy, France; 2UCOG Lorraine, Nancy, France; 3EA 4360 APEMAC, Faculté de Médecine, Université de Lorraine, Nancy, France; 4PARC, CHRU de Nancy, Nancy, France; 5Spincourt Multidisciplinary MSP, Spincourt, France; 6SISSPO Department, Institut de Cancérologie de Lorraine, Vandœuvre-lès-Nancy, France Objective: The objective of this study was to identify changes in the decision-making criteria of general practitioners (GPs concerning the care of elderly cancer patients after 1 year of corrective measures for care practices in the Lorraine region, France. Materials and methods: In 2014, a postal mail questionnaire was sent to all GPs in the Lorraine region. This questionnaire was designed to identify GPs’ decision-making criteria. It was based on the results of a literature review and on existing guidelines. During 1 year, corrective measures were implemented to improve practices, especially training sessions for physicians and production of specific tools, including a guide to the accepted ideas in geriatric oncology. In 2015, the same questionnaire was resent to all GPs to compare the answers. Results: In 2014, 430 questionnaires were returned out of 2,048 sent, and in 2015, 378 questionnaires were returned out of 2,066 sent. Our results show for the first time that there exists a significant difference in the overall decision criteria between the two survey periods. This difference mainly concerns criteria related to the cancerous diseases. Physicians tend to consider the principal decision criteria to be less important after the training period. GPs express the importance of accessibility to specialists for additional advice in both 2014 and 2015; the distance between the patient’s home and an adapted care facility and the

  19. Effect of a multi-faceted quality improvement intervention on inappropriate antibiotic use in children with non-bloody diarrhoea admitted to district hospitals in Kenya

    Directory of Open Access Journals (Sweden)

    Opondo Charles

    2011-11-01

    Full Text Available Abstract Background There are few reports of interventions to reduce the common but irrational use of antibiotics for acute non-bloody diarrhoea amongst hospitalised children in low-income settings. We undertook a secondary analysis of data from an intervention comprising training of health workers, facilitation, supervision and face-to-face feedback, to assess whether it reduced inappropriate use of antibiotics in children with non-bloody diarrhoea and no co-morbidities requiring antibiotics, compared to a partial intervention comprising didactic training and written feedback only. This outcome was not a pre-specified end-point of the main trial. Methods Repeated cross-sectional survey data from a cluster-randomised controlled trial of an intervention to improve management of common childhood illnesses in Kenya were used to describe the prevalence of inappropriate antibiotic use in a 7-day period in children aged 2-59 months with acute non-bloody diarrhoea. Logistic regression models with random effects for hospital were then used to identify patient and clinician level factors associated with inappropriate antibiotic use and to assess the effect of the intervention. Results 9, 459 admission records of children were reviewed for this outcome. Of these, 4, 232 (44.7% were diagnosed with diarrhoea, with 130 of these being bloody (dysentery therefore requiring antibiotics. 1, 160 children had non-bloody diarrhoea and no co-morbidities requiring antibiotics-these were the focus of the analysis. 750 (64.7% of them received antibiotics inappropriately, 313 of these being in the intervention hospitals vs. 437 in the controls. The adjusted logistic regression model showed the baseline-adjusted odds of inappropriate antibiotic prescription to children admitted to the intervention hospitals was 0.30 times that in the control hospitals (95%CI 0.09-1.02. Conclusion We found some evidence that the multi-faceted, sustained intervention described in this

  20. Factors influencing mother's participation in Posyandu for improving nutritional status of children under-five in Aceh Utara district, Aceh province, Indonesia.

    Science.gov (United States)

    Nazri, Cut; Yamazaki, Chiho; Kameo, Satomi; Herawati, Dewi M D; Sekarwana, Nanan; Raksanagara, Ardini; Koyama, Hiroshi

    2016-01-22

    associated with participation. The logistic regression showed that monitoring the nutritional status of children under five was the main reason that mothers participated in Posyandu. Mothers who were satisfied with the Posyandu services were more likely to attend than those who were dissatisfied. Respondents with intention to participate in Posyandu every month were more likely to attend than those who did not intend to attend every month. Households with low income were more likely to participate in Posyandu than households with high income. Household income, mothers' satisfaction with Posyandu services, attitude towards Posyandu benefits and intention to attend Posyandu affect the participation frequency of the mother. In addition, monitoring the nutritional status of children under five was the main reason respondents attend Posyandu. Improving the quality of Posyandu services and providing qualified resources are needed to promote mothers' participation.

  1. Interim district energy implementation

    Energy Technology Data Exchange (ETDEWEB)

    Fearnley, R.; Susak, W. [City of Vancouver, BC (Canada); Johnstone, I. [BCG Services Inc., Vancouver, BC (Canada)

    2001-07-01

    The concept of district energy was introduced in the City of North Vancouver, a city of 45,000, in 1997. A preliminary study was completed in 1997, followed by a tour of some district energy facilities in Finland in the same year. In 1999 a large district energy study was completed by a consultant. The study indicated the need for an investment of $15 million to implement district heating in the City. Lack of sufficient financial resources and immediately connectable heat load, the project was considered a non-starter. Some of the other factors leading to shelving the project included no current significant pricing advantages over competing energy sources and no current opportunity for cogeneration, given the low price that BC Hydro is willing to pay for independently produced power. The project, although shelved for the moment, has not been discarded. Planning and exploration are continuing, aided by the City's commitment to energy efficiency and conservation, its long term planning horizon and its significant influence over the development of some prime real estate.

  2. Jordan Lake Watershed Protection District

    Data.gov (United States)

    Town of Chapel Hill, North Carolina — Polygon representing the area of the Jordan Lake Watershed Protection District. The Watershed Protection District (PDF) is a sensitive area of land that drains to...

  3. New Mexico State Forestry Districts

    Data.gov (United States)

    Earth Data Analysis Center, University of New Mexico — This dataset contains boundaries of the New Mexico Forestry Districts, plus the names of the district offices. It is in a vector digital structure digitized from a...

  4. A randomised controlled trial to improve general practitioners' services in cancer rehabilitation: Effects on general practitioners' proactivity and on patients' participation in rehabilitation activities

    DEFF Research Database (Denmark)

    Bergholdt, SH; Søndergaard, J; Larsen, PV

    2013-01-01

    by their GP reported by the patients and GPs, respectively, and patients' participation in rehabilitation activities. Methods. Cluster randomised controlled trial. All general practices in Denmark were randomised to an intervention group or to a control group (usual procedures). Patients were subsequently...

  5. The Big Money Question: Action Research Projects Give District a Clear Picture of Professional Learning's Impact

    Science.gov (United States)

    Dill-Varga, Barbara

    2015-01-01

    How do districts know if the resources they have allocated to support professional learning in their school district are actually improving the quality of teaching and impacting student performance? In an increasingly challenging financial environment, this is important to know. In this article, a Chicago-area district facing a budget deficit…

  6. District Consolidation: Rivals Coming Together

    Science.gov (United States)

    Mart, Dan

    2011-01-01

    District consolidation is a highly emotional process. One key to success is sticking to the facts. In Iowa, school districts facing financial difficulties or enrollment concerns do not have to move directly to consolidation. In many cases, districts begin by developing sharing agreements. These sharing agreements may start with simple sharing of…

  7. Long-term mortality rates (>8-year) improve as compared to the general and obese population following bariatric surgery.

    Science.gov (United States)

    Telem, Dana A; Talamini, Mark; Shroyer, A Laurie; Yang, Jie; Altieri, Maria; Zhang, Qiao; Gracia, Gerald; Pryor, Aurora D

    2015-03-01

    Sparse data are available on long-term patient mortality following bariatric surgery as compared to the general population. The purpose of this study was to assess long-term mortality rates and identify risk factors for all-cause mortality following bariatric surgery. New York State (NYS) Planning and Research Cooperative System (SPARCS) longitudinal administrative data were used to identify 7,862 adult patients who underwent a primary laparoscopic bariatric surgery from 1999 to 2005. The Social Security Death Index database identified >30-day mortalities. Risk factors for mortality were screened using a univariate Cox proportional hazard (PH) model and analyzed using a multiple PH model. Based on age, gender, and race/ethnicity, actuarial projections for NYS mortality rates obtained from Centers of Disease Control were compared to the actual post-bariatric surgery mortality rates observed. The mean bariatric mortality rate was 2.5 % with 8-14 years of follow-up. Mean time to death ranged from 4 to 6 year and did not differ by operation (p = 0.073). From 1999 to 2010, the actuarial mortality rate predicted for the general NYS population was 2.1 % versus the observed 1.5 % for the bariatric surgery population (p = 0.005). Extrapolating to 2013, demonstrated the actuarial mortality predictions at 3.1 % versus the bariatric surgery patients' observed morality rate of 2.5 % (p = 0.01). Risk factors associated with an earlier time to death included: age, male gender, Medicare/Medicaid insurance, congestive heart failure, rheumatoid arthritis, pulmonary circulation disorders, and diabetes. No procedure-specific or perioperative complication impact for time-to-death was found. Long-term mortality rate of patients undergoing bariatric surgery significantly improves as compared to the general population regardless of bariatric operation performed. Additionally, perioperative complications do not increase long-term mortality risk. This study did identify specific patient

  8. Effects of quality improvement in health facilities and community mobilization through women's groups on maternal, neonatal and perinatal mortality in three districts of Malawi: MaiKhanda, a cluster randomized controlled effectiveness trial.

    Science.gov (United States)

    Colbourn, Tim; Nambiar, Bejoy; Bondo, Austin; Makwenda, Charles; Tsetekani, Eric; Makonda-Ridley, Agnes; Msukwa, Martin; Barker, Pierre; Kotagal, Uma; Williams, Cassie; Davies, Ros; Webb, Dale; Flatman, Dorothy; Lewycka, Sonia; Rosato, Mikey; Kachale, Fannie; Mwansambo, Charles; Costello, Anthony

    2013-09-01

    Maternal, perinatal and neonatal mortality remains high in low-income countries. We evaluated community and facility-based interventions to reduce deaths in three districts of Malawi. We evaluated a rural participatory women's group community intervention (CI) and a quality improvement intervention at health centres (FI) via a two-by-two factorial cluster randomized controlled trial. Consenting pregnant women were followed-up to 2 months after birth using key informants. Primary outcomes were maternal, perinatal and neonatal mortality. Clusters were health centre catchment areas assigned using stratified computer-generated randomization. Following exclusions, including non-birthing facilities, 61 clusters were analysed: control (17 clusters, 4912 births), FI (15, 5335), CI (15, 5080) and FI + CI (14, 5249). This trial was registered as International Standard Randomised Controlled Trial [ISRCTN18073903]. Outcomes for 14,576 and 20,576 births were recorded during baseline (June 2007-September 2008) and intervention (October 2008-December 2010) periods. For control, FI, CI and FI + CI clusters neonatal mortality rates were 34.0, 28.3, 29.9 and 27.0 neonatal deaths per 1000 live births and perinatal mortality rates were 56.2, 55.1, 48.0 and 48.4 per 1000 births, during the intervention period. Adjusting for clustering and stratification, the neonatal mortality rate was 22% lower in FI + CI than control clusters (OR = 0.78, 95% CI 0.60-1.01), and the perinatal mortality rate was 16% lower in CI clusters (OR = 0.84, 95% CI 0.72-0.97). We did not observe any intervention effects on maternal mortality. Despite implementation problems, a combined community and facility approach using participatory women's groups and quality improvement at health centres reduced newborn mortality in rural Malawi.

  9. Effects of quality improvement in health facilities and community mobilization through women’s groups on maternal, neonatal and perinatal mortality in three districts of Malawi: MaiKhanda, a cluster randomized controlled effectiveness trial

    Science.gov (United States)

    Colbourn, Tim; Nambiar, Bejoy; Bondo, Austin; Makwenda, Charles; Tsetekani, Eric; Makonda-Ridley, Agnes; Msukwa, Martin; Barker, Pierre; Kotagal, Uma; Williams, Cassie; Davies, Ros; Webb, Dale; Flatman, Dorothy; Lewycka, Sonia; Rosato, Mikey; Kachale, Fannie; Mwansambo, Charles; Costello, Anthony

    2016-01-01

    Background Maternal, perinatal and neonatal mortality remains high in low-income countries. We evaluated community and facility-based interventions to reduce deaths in three districts of Malawi. Methods We evaluated a rural participatory women’s group community intervention (CI) and a quality improvement intervention at health centres (FI) via a two-by-two factorial cluster randomized controlled trial. Consenting pregnant women were followed-up to 2 months after birth using key informants. Primary outcomes were maternal, perinatal and neonatal mortality. Clusters were health centre catchment areas assigned using stratified computer-generated randomization. Following exclusions, including non-birthing facilities, 61 clusters were analysed: control (17 clusters, 4912 births), FI (15, 5335), CI (15, 5080) and FI + CI (14, 5249). This trial was registered as International Standard Randomised Controlled Trial [ISRCTN18073903]. Outcomes for 14 576 and 20 576 births were recorded during baseline (June 2007–September 2008) and intervention (October 2008–December 2010) periods. Results For control, FI, CI and FI + CI clusters neonatal mortality rates were 34.0, 28.3, 29.9 and 27.0 neonatal deaths per 1000 live births and perinatal mortality rates were 56.2, 55.1, 48.0 and 48.4 per 1000 births, during the intervention period. Adjusting for clustering and stratification, the neonatal mortality rate was 22% lower in FI + CI than control clusters (OR = 0.78, 95% CI 0.60–1.01), and the perinatal mortality rate was 16% lower in CI clusters (OR = 0.84, 95% CI 0.72–0.97). We did not observe any intervention effects on maternal mortality. Conclusions Despite implementation problems, a combined community and facility approach using participatory women’s groups and quality improvement at health centres reduced newborn mortality in rural Malawi. PMID:24030269

  10. 7 CFR 917.14 - District.

    Science.gov (United States)

    2010-01-01

    ... District. (g) Contra Costa District includes and consists of Contra Costa County. (h) Santa Clara District... Ventura County. (l) Stockton District includes and consists of San Joaquin County, Amador County...

  11. Ways of Improving the Training of Interns Pediatricians and General Practitioners — Family Physicians in «Pediatrics» Discipline

    Directory of Open Access Journals (Sweden)

    S.A. Mokiia-Serbina

    2015-09-01

    Full Text Available Graduates of medical schools having sufficient theoretical and practical skills often have difficulty in communicating with patients — children and their parents, as well as with colleagues. Objective: improving the efficiency of the educational process in the training of interns pediatricians and general practitioners — family physicians in «Pediatrics» course. Methods of the study: theoretical analysis of gathered experience. Results and discussion. During internship at the department, there are used seminars-discussions, seminars — training conferences, seminars — round tables that allows you to work out the tactics of speech, methods of discussion, reasoning of judgments, review, assessment, analysis. Interns most of the time must participate in the examination of a sick child, discussions of the results, conversations with parents. Clinical analysis of patients should be carried out using the method of structured group discussion when each intern can express his views. Interns are involved in scientific work, speak at scientific conferences. The department created a series of ambulatory pediatrics, -during which the intern talks to a child, his parents and he must to conciliate them, to inspire confidence and to prove himself as a specialist. During this course, special attention is paid to the psychological component of medical trai-ning. Clas-ses are conducted by assistant pediatrician, a graduate majoring in «Practical Psychology». Conclusions. The use of interactive teaching methods at different stages of the educational process contributes not only to improvement of theoretical activity, but also the formation in interns of professional qualities of clinical and scientific thinking, competence in the construction and development of interpersonal relations, humanism.

  12. Load Management in District Heating Operation

    OpenAIRE

    Li, Hongwei; Wang, Stephen Jia

    2015-01-01

    Smooth operation of district heating system will avoid installation of expensive peak heat boilers, improve plant partial load performance, increase the system redundancy for further network expansion and improve its resilience to ensuresecurity of supply during severe heating seasons. The peak heating load can be reduced through building demand side management. The building thermal mass can be used to shift the heating supply under the circumstance withoutjeopardizing the consumer thermal co...

  13. Improvement of the reliability graph with general gates to analyze the reliability of dynamic systems that have various operation modes

    Energy Technology Data Exchange (ETDEWEB)

    Shin, Seung Ki [Div. of Research Reactor System Design, Korea Atomic Energy Research Institute, Daejeon (Korea, Republic of); No, Young Gyu; Seong, Poong Hyun [Dept. of Nuclear and Quantum Engineering, Korea Advanced Institute of Science and Technology, Daejeon (Korea, Republic of)

    2016-04-15

    The safety of nuclear power plants is analyzed by a probabilistic risk assessment, and the fault tree analysis is the most widely used method for a risk assessment with the event tree analysis. One of the well-known disadvantages of the fault tree is that drawing a fault tree for a complex system is a very cumbersome task. Thus, several graphical modeling methods have been proposed for the convenient and intuitive modeling of complex systems. In this paper, the reliability graph with general gates (RGGG) method, one of the intuitive graphical modeling methods based on Bayesian networks, is improved for the reliability analyses of dynamic systems that have various operation modes with time. A reliability matrix is proposed and it is explained how to utilize the reliability matrix in the RGGG for various cases of operation mode changes. The proposed RGGG with a reliability matrix provides a convenient and intuitive modeling of various operation modes of complex systems, and can also be utilized with dynamic nodes that analyze the failure sequences of subcomponents. The combinatorial use of a reliability matrix with dynamic nodes is illustrated through an application to a shutdown cooling system in a nuclear power plant.

  14. Is identification of smoking, risky alcohol consumption and overweight and obesity by General Practitioners improving? A comparison over time.

    Science.gov (United States)

    Bryant, Jamie; Yoong, Sze Lin; Sanson-Fisher, Rob; Mazza, Danielle; Carey, Mariko; Walsh, Justin; Bisquera, Alessandra

    2015-12-01

    Detection of lifestyle risk factors by GPs is the first step required for intervention. Despite significant investment in preventive health care in general practice, little is known about whether GP detection of lifestyle risk factors have improved over time. To examine whether sensitivity and specificity of GP detection of smoking, risky alcohol consumption and overweight and obesity has increased in patients presenting to see their GP, by comparing results from four Australian studies conducted between 1982 and 2011. Demographic characteristics of patient and GP samples and the prevalence, sensitivity and specificity of detection of each risk factor were extracted from published studies. Differences between GP and patient sample characteristics were examined. To identify trends over time in prevalence of risk factors, sensitivity and specificity of detection across studies and the Cochran-Armitage test for trend were calculated for each risk factor for the overall sample and by male and female subgroups. There were no statistically significant changes in the sensitivity of GP detection of smoking or overweight or obesity over time. Specificity of detection of smoking increased from 64.7% to 98% (P investment to increase GP detection and intervention for lifestyle risk factors, accurate detection of smoking, risky alcohol consumption and overweight and obesity occurs for less than two-thirds of all patients. © The Author 2015. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  15. Classical neurotransmitters and neuropeptides involved in generalized epilepsy in a multi-neurotransmitter system: How to improve the antiepileptic effect?

    Science.gov (United States)

    Werner, Felix-Martin; Coveñas, Rafael

    2017-06-01

    Here, we describe in generalized epilepsies the alterations of classical neurotransmitters and neuropeptides acting at specific subreceptors. In order to consider a network context rather than one based on focal substrates and in order to make the interaction between neurotransmitters and neuropeptides and their specific subreceptors comprehensible, neural networks in the hippocampus, thalamus, and cerebral cortex are described. In this disease, a neurotransmitter imbalance between dopaminergic and serotonergic neurons and between presynaptic GABAergic neurons (hypoactivity) and glutaminergic neurons (hyperactivity) occurs. Consequently, combined GABA A agonists and NMDA antagonists could furthermore stabilize the neural networks in a multimodal pharmacotherapy. The antiepileptic effect and the mechanisms of action of conventional and recently developed antiepileptic drugs are reviewed. The GASH:Sal animal model can contribute to examine the efficacy of antiepileptic drugs. The issues of whether the interaction of classical neurotransmitters with other subreceptors (5-HT 7 , metabotropic 5 glutaminergic, A 2A adenosine, and alpha nicotinic 7 cholinergic receptors) or whether the administration of agonists/antagonists of neuropeptides might improve the therapeutic effect of antiepileptic drugs should be addressed. This article is part of a Special Issue entitled "Genetic and Reflex Epilepsies, Audiogenic Seizures and Strains: From Experimental Models to the Clinic". Copyright © 2015 Elsevier Inc. All rights reserved.

  16. Improvement of the reliability graph with general gates to analyze the reliability of dynamic systems that have various operation modes

    International Nuclear Information System (INIS)

    Shin, Seung Ki; No, Young Gyu; Seong, Poong Hyun

    2016-01-01

    The safety of nuclear power plants is analyzed by a probabilistic risk assessment, and the fault tree analysis is the most widely used method for a risk assessment with the event tree analysis. One of the well-known disadvantages of the fault tree is that drawing a fault tree for a complex system is a very cumbersome task. Thus, several graphical modeling methods have been proposed for the convenient and intuitive modeling of complex systems. In this paper, the reliability graph with general gates (RGGG) method, one of the intuitive graphical modeling methods based on Bayesian networks, is improved for the reliability analyses of dynamic systems that have various operation modes with time. A reliability matrix is proposed and it is explained how to utilize the reliability matrix in the RGGG for various cases of operation mode changes. The proposed RGGG with a reliability matrix provides a convenient and intuitive modeling of various operation modes of complex systems, and can also be utilized with dynamic nodes that analyze the failure sequences of subcomponents. The combinatorial use of a reliability matrix with dynamic nodes is illustrated through an application to a shutdown cooling system in a nuclear power plant

  17. Army Engineers in Memphis District: A Documentary Chronicle

    Science.gov (United States)

    1982-05-01

    of levees in the St. Francis Levee District, stretching from just above Point Pleasant, Missouri, to Pecan Point, Arkansas. Meanwhile, the...troops in Trieste, Italy , 1948-1951 Commanding General, 9th Corps, Korea, 1951 Commanding General, 4th U.S. Army, 1952-1953 Commanding General

  18. VII international district heating conference

    International Nuclear Information System (INIS)

    1988-01-01

    The proceedings of the 7th International District Heating Conference contain the full texts of the 89 presented papers of which 11 fall under the INIS Subject Scope. The conference met in seven sessions and dealt with the following problem areas: design and optimization of systems of district heating, integration of the power system and the district heating systems, cooperation of nuclear and fossil burning sources in district heating systems, the use of specific nuclear power plants for heating purposes, questions of the control of systems of district heating, the development of components of heating networks, the reliability and design of heat supply pipes. (Z.M.)

  19. Strategies for Improving Maintenance and Generalization of Academic Skills--So Students "Don't Leave Class without It."

    Science.gov (United States)

    Gable, Robert A.; And Others

    1992-01-01

    An instructional process for facilitating maintenance and generalization of academic skills is presented, using the ABCD'S (Antecedent Events, Behavior, Consequent Events, Data, and Setting Events) Generalization Intervention Model. (JDD)

  20. Decentralization in Zambia: resource allocation and district performance.

    Science.gov (United States)

    Bossert, Thomas; Chitah, Mukosha Bona; Bowser, Diana

    2003-12-01

    Zambia implemented an ambitious process of health sector decentralization in the mid 1990s. This article presents an assessment of the degree of decentralization, called 'decision space', that was allowed to districts in Zambia, and an analysis of data on districts available at the national level to assess allocation choices made by local authorities and some indicators of the performance of the health systems under decentralization. The Zambian officials in health districts had a moderate range of choice over expenditures, user fees, contracting, targeting and governance. Their choices were quite limited over salaries and allowances and they did not have control over additional major sources of revenue, like local taxes. The study found that the formula for allocation of government funding which was based on population size and hospital beds resulted in relatively equal per capita expenditures among districts. Decentralization allowed the districts to make decisions on internal allocation of resources and on user fee levels and expenditures. General guidelines for the allocation of resources established a maximum and minimum percentage to be allocated to district offices, hospitals, health centres and communities. Districts tended to exceed the maximum for district offices, but the large urban districts and those without public district hospitals were not even reaching the minimum for hospital allocations. Wealthier and urban districts were more successful in raising revenue through user fees, although the proportion of total expenditures that came from user fees was low. An analysis of available indicators of performance, such as the utilization of health services, immunization coverage and family planning activities, found little variation during the period 1995-98 except for a decline in immunization coverage, which may have also been affected by changes in donor funding. These findings suggest that decentralization may not have had either a positive or

  1. Contribution of community-based newborn health promotion to reducing inequities in healthy newborn care practices and knowledge: evidence of improvement from a three-district pilot program in Malawi.

    Science.gov (United States)

    Callaghan-Koru, Jennifer A; Nonyane, Bareng A S; Guenther, Tanya; Sitrin, Deborah; Ligowe, Reuben; Chimbalanga, Emmanuel; Zimba, Evelyn; Kachale, Fannie; Shah, Rashed; Baqui, Abdullah H

    2013-11-07

    Inequities in both health status and coverage of health services are considered important barriers to achieving Millennium Development Goal 4. Community-based health promotion is a strategy that is believed to reduce inequities in rural low-income settings. This paper examines the contributions of community-based programming to improving the equity of newborn health in three districts in Malawi. This study is a before-and-after evaluation of Malawi's Community-Based Maternal and Newborn Care (CBMNC) program, a package of facility and community-based interventions to improve newborn health. Health Surveillance Assistants (HSAs) within the catchment area of 14 health facilities were trained to make pregnancy and postnatal home visits to promote healthy behaviors and assess women and newborns for danger signs requiring referral to a facility. "Core groups" of community volunteers were also trained to raise awareness about recommended newborn care practices. Baseline and endline household surveys measured the coverage of the intervention and targeted health behaviors for this before-and-after evaluation. Wealth indices were constructed using household asset data and concentration indices were compared between baseline and endline for each indicator. The HSAs trained in the intervention reached 36.7% of women with a pregnancy home visit and 10.9% of women with a postnatal home visit within three days of delivery. Coverage of the intervention was slightly inequitable, with richer households more likely to receive one or two pregnancy home visits (concentration indices (CI) of 0.0786 and 0.0960), but not significantly more likely to receive a postnatal visit or know of a core group. Despite modest coverage levels for the intervention, health equity improved significantly over the study period for several indicators. Greater improvements in inequities were observed for knowledge indicators than for coverage of routine health services. At endline, a greater proportion of

  2. Improved vocabulary production after naming therapy in aphasia: can gains in picture naming generalize to connected speech?

    Science.gov (United States)

    Conroy, Paul; Sage, Karen; Ralph, Matt Lambon

    2009-01-01

    Naming accuracy for nouns and verbs in aphasia can vary across different elicitation contexts, for example, simple picture naming, composite picture description, narratives, and conversation. For some people with aphasia, naming may be more accurate to simple pictures as opposed to naming in spontaneous, connected speech; for others, the opposite pattern may be evident. These differences have, in some instances, been related to word class (for example, noun or verb) as well as aphasia subtype. Given that the aim of picture-naming therapies is to improve word-finding in general, these differences in naming accuracy across contexts may have important implications for the potential functional benefits of picture-naming therapies. This study aimed to explore single-word therapy for both nouns and verbs, and to answer the following questions. (1) To what extent does an increase in naming accuracy after picture-naming therapy (for both nouns and verbs) predict accurate naming of the same items in less constrained spontaneous connected speech tasks such as composite picture description and retelling of a narrative? (2) Does the word class targeted in therapy (verb or noun) dictate whether there is 'carry-over' of the therapy item to connected speech tasks? (3) Does the speed at which the picture is named after therapy predict whether it will also be used appropriately in connected speech tasks? Seven participants with aphasia of varying degrees of severity and subtype took part in ten therapy sessions over five weeks. A set of potentially useful items was collected from control participant accounts of the Cookie Theft Picture Description and the Cinderella Story from the Quantitative Production Analysis. Twenty-four of these words (twelve verbs and twelve nouns) were collated for each participant, on the basis that they had failed to name them in either simple picture naming or connected speech tasks (picture-supported narrative and unsupported retelling of a narrative

  3. Construction Manager or General Contractor?

    Science.gov (United States)

    McKinley, John

    1991-01-01

    Unlike the general contractor approach, the construction management firm acts on behalf of the school district in school construction. Examines the development and nature of construction management, and cites its advantages and disadvantages. (MLF)

  4. Improving 200 MW NDHR reactor protection system with GAL devices

    International Nuclear Information System (INIS)

    Shi Mingde; Li Duo; Xie Zhengguo

    1999-01-01

    The emergence of General Array Logic (GAL), a fairly new type of logic devices with the characteristics of user-definable logic functions, have led to a revolutionary change in the design of logical circuits. The improvements of the reactor protection system for the 200 MW nuclear district heating reactor (NDHR) using GAL are covered

  5. Influencing Swedish homeowners to adopt district heating system

    Energy Technology Data Exchange (ETDEWEB)

    Mahapatra, Krushna; Gustavsson, Leif [Ecotechnology, Mid Sweden University, Akademigatan 1, 831 25 Oestersund (Sweden)

    2009-02-15

    Improved energy efficiency and greenhouse gas mitigation could be achieved by replacing resistance heaters with district heating system. In 2005, only about 8% of the Swedish detached houses had district heating system. The expansion of such systems largely depends on homeowners' adoption decisions. And, to motivate homeowners to adopt district heating, it is essential to understand their decision-making process. In this context, in June 2005 we carried out a questionnaire survey of about 700 homeowners who lived in the city of Oestersund in houses with resistance heaters (baseline survey). About 84% of the respondents did not intend to install a new heating system. Since then these homeowners were influenced by (a) an investment subsidy by the Swedish government to replace resistance heaters with district heating, a brine/water-based heat pump, or a biomass-based heating system and (b) a marketing campaign by the municipality-owned district heating company. This paper analyses how these two measures influenced about 78% of the homeowners to adopt the district heating system. For this purpose we carried out a follow-up survey of the same homeowners in December 2006 (resurvey). Results showed that the investment subsidy and the marketing campaign created a need among the homeowners to adopt a new heating system. The marketing campaign was successful in motivating them to adopt the district heating system. The marketing strategy by the district heating company corresponds to the results obtained in the baseline survey. (author)

  6. Influencing Swedish homeowners to adopt district heating system

    Energy Technology Data Exchange (ETDEWEB)

    Mahapatra, Krushna; Gustavsson, Leif [Ecotechnology, Mid Sweden University, Akademigatan 1, 831 25 Oestersund (Sweden)

    2009-02-15

    Improved energy efficiency and greenhouse gas mitigation could be achieved by replacing resistance heaters with district heating system. In 2005, only about 8% of the Swedish detached houses had district heating system. The expansion of such systems largely depends on homeowners' adoption decisions. And, to motivate homeowners to adopt district heating, it is essential to understand their decision-making process. In this context, in June 2005 we carried out a questionnaire survey of about 700 homeowners who lived in the city of Oestersund in houses with resistance heaters (baseline survey). About 84% of the respondents did not intend to install a new heating system. Since then these homeowners were influenced by (a) an investment subsidy by the Swedish government to replace resistance heaters with district heating, a brine/water-based heat pump, or a biomass-based heating system and (b) a marketing campaign by the municipality-owned district heating company. This paper analyses how these two measures influenced about 78% of the homeowners to adopt the district heating system. For this purpose we carried out a follow-up survey of the same homeowners in December 2006 (resurvey). Results showed that the investment subsidy and the marketing campaign created a need among the homeowners to adopt a new heating system. The marketing campaign was successful in motivating them to adopt the district heating system. The marketing strategy by the district heating company corresponds to the results obtained in the baseline survey. (author)

  7. Influencing Swedish homeowners to adopt district heating system

    International Nuclear Information System (INIS)

    Mahapatra, Krushna; Gustavsson, Leif

    2009-01-01

    Improved energy efficiency and greenhouse gas mitigation could be achieved by replacing resistance heaters with district heating system. In 2005, only about 8% of the Swedish detached houses had district heating system. The expansion of such systems largely depends on homeowners' adoption decisions. And, to motivate homeowners to adopt district heating, it is essential to understand their decision-making process. In this context, in June 2005 we carried out a questionnaire survey of about 700 homeowners who lived in the city of Ostersund in houses with resistance heaters (baseline survey). About 84% of the respondents did not intend to install a new heating system. Since then these homeowners were influenced by (a) an investment subsidy by the Swedish government to replace resistance heaters with district heating, a brine/water-based heat pump, or a biomass-based heating system and (b) a marketing campaign by the municipality-owned district heating company. This paper analyses how these two measures influenced about 78% of the homeowners to adopt the district heating system. For this purpose we carried out a follow-up survey of the same homeowners in December 2006 (resurvey). Results showed that the investment subsidy and the marketing campaign created a need among the homeowners to adopt a new heating system. The marketing campaign was successful in motivating them to adopt the district heating system. The marketing strategy by the district heating company corresponds to the results obtained in the baseline survey

  8. Implementing Geothermal Plants in the Copenhagen District Heating System

    DEFF Research Database (Denmark)

    Jensen, Louise Overvad; Hallgreen, Christine Erikstrup; Larsen, Esben

    2003-01-01

    of geothermal energy in Denmark as well as the Danish potential, which, in former investigations, has been found to be around 100.000 PJ annually, and the economical potential is less, about 15 PJ/year. Since a considerable amount of the Danish power supply is tied to weather and the demand for heating......The possibility of implementing geothermal heating in the Copenhagen district-heating system is assessed. This is done by building up general knowledge on the geological factors that influence the development of useable geothermal resources, factors concerning the exploration and utilization......, an increasing demand for flexibility has been raised. Implementing geothermal heating would improve the flexibility in the Eastern Danish power system. Based on this information, as well as, on the hourly values of the expected production and consumption in 2010 and 2020, a model of the Copenhagen power...

  9. Procedures for selecting and buying district heating equipment. Sofia district heating. Final report

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1997-11-01

    The aim of this Final Report, prepared for the project `Procedures for Selecting and Buying DistRict Heating Equipment - Sofia District Heating Company`, is to establish an overview of the activities accomplished, the outputs delivered and the general experience gained as a result of the project. The main objective of the project is to enable Sofia District Heating Company to prepare specifications and tender documents, identify possible suppliers, evaluate offers, etc. in connection with purchase of district heating equipment. This objective has been reached by using rehabilitation of sub-stations as an example requested by Sofia DH. The project was originally planned to be finalized end of 1995, but due to the extensions of the scope of work, the project has been prolonged until end 1997. The following main activities were accomplished: Preparation of a detailed work plan; Collection of background information; Discussion and advice about technical specifications and tender documents for sub-station rehabilitation; Input to terms of reference for a master plan study; Input to technical specification for heat meters; Collection of ideas for topics and examples related to dissemination of information to consumers about matters related to district heating consumption. (EG)

  10. Factors Associated with Awareness, Attitudes and Practices Regarding Common Eye Diseases in the General Population in a Rural District in Bangladesh: The Bangladesh Population-based Diabetes and Eye Study (BPDES).

    Science.gov (United States)

    Islam, Fakir M Amirul; Chakrabarti, Rahul; Islam, Silvia Z; Finger, Robert P; Critchley, Christine

    2015-01-01

    To assess the awareness, attitudes, and practices associated with common eye diseases and eye care utilization in a rural district of Bangladesh. Data were collected using a multilevel cluster random sampling technique from 3104 adults aged ≥30 years from the Banshgram union with a questionnaire assessing the awareness, attitudes and practice about diabetes and common eye diseases, educational attainment, socio-economic status, and medical history. Participants were aged between 30 and 89 years with a mean (SD) age of 51 (12) years and 65% were female. The majority of participants had heard of cataracts (90%), trachoma (86%) and Pterygium (84%), yet only 4% had heard of diabetic retinopathy (DR), 7% of glaucoma and 8% of Age-related macular degeneration (AMD). However, 58% of participants did not know vision loss could be prevented. Factors associated with lower awareness regarding common eye diseases were increasing age, lack of formal schooling, and lower socio-economic status. A lower proportion (57%) of people with no schooling compared to those who had attained at least secondary school certificate education (72%) reported that they knew that vision loss could be prevented (pBangladesh awareness of cataract, trachoma and pterygium was good but limited in relation to the potentially blinding conditions of glaucoma, DR, and AMD. The results show a large gap between public awareness and treatment practices about common eye diseases. Public health promotion should be designed to address these knowledge gaps.

  11. Factors Associated with Awareness, Attitudes and Practices Regarding Common Eye Diseases in the General Population in a Rural District in Bangladesh: The Bangladesh Population-based Diabetes and Eye Study (BPDES)

    Science.gov (United States)

    Islam, Fakir M. Amirul; Chakrabarti, Rahul; Islam, Silvia Z.; Finger, Robert P.; Critchley, Christine

    2015-01-01

    Background To assess the awareness, attitudes, and practices associated with common eye diseases and eye care utilization in a rural district of Bangladesh. Methods Data were collected using a multilevel cluster random sampling technique from 3104 adults aged ≥30 years from the Banshgram union with a questionnaire assessing the awareness, attitudes and practice about diabetes and common eye diseases, educational attainment, socio-economic status, and medical history. Results Participants were aged between 30 and 89 years with a mean (SD) age of 51 (12) years and 65% were female. The majority of participants had heard of cataracts (90%), trachoma (86%) and Pterygium (84%), yet only 4% had heard of diabetic retinopathy (DR), 7% of glaucoma and 8% of Age-related macular degeneration (AMD). However, 58% of participants did not know vision loss could be prevented. Factors associated with lower awareness regarding common eye diseases were increasing age, lack of formal schooling, and lower socio-economic status. A lower proportion (57%) of people with no schooling compared to those who had attained at least secondary school certificate education (72%) reported that they knew that vision loss could be prevented (pBangladesh awareness of cataract, trachoma and pterygium was good but limited in relation to the potentially blinding conditions of glaucoma, DR, and AMD. The results show a large gap between public awareness and treatment practices about common eye diseases. Public health promotion should be designed to address these knowledge gaps. PMID:26200458

  12. No improvement in the reporting of clinical trial subgroup effects in high-impact general medical journals.

    Science.gov (United States)

    Gabler, Nicole B; Duan, Naihua; Raneses, Eli; Suttner, Leah; Ciarametaro, Michael; Cooney, Elizabeth; Dubois, Robert W; Halpern, Scott D; Kravitz, Richard L

    2016-07-16

    When subgroup analyses are not correctly analyzed and reported, incorrect conclusions may be drawn, and inappropriate treatments provided. Despite the increased recognition of the importance of subgroup analysis, little information exists regarding the prevalence, appropriateness, and study characteristics that influence subgroup analysis. The objective of this study is to determine (1) if the use of subgroup analyses and multivariable risk indices has increased, (2) whether statistical methodology has improved over time, and (3) which study characteristics predict subgroup analysis. We randomly selected randomized controlled trials (RCTs) from five high-impact general medical journals during three time periods. Data from these articles were abstracted in duplicate using standard forms and a standard protocol. Subgroup analysis was defined as reporting any subgroup effect. Appropriate methods for subgroup analysis included a formal test for heterogeneity or interaction across treatment-by-covariate groups. We used logistic regression to determine the variables significantly associated with any subgroup analysis or, among RCTs reporting subgroup analyses, using appropriate methodology. The final sample of 416 articles reported 437 RCTs, of which 270 (62 %) reported subgroup analysis. Among these, 185 (69 %) used appropriate methods to conduct such analyses. Subgroup analysis was reported in 62, 55, and 67 % of the articles from 2007, 2010, and 2013, respectively. The percentage using appropriate methods decreased over the three time points from 77 % in 2007 to 63 % in 2013 (p < 0.05). Significant predictors of reporting subgroup analysis included industry funding (OR 1.94 (95 % CI 1.17, 3.21)), sample size (OR 1.98 per quintile (1.64, 2.40), and a significant primary outcome (OR 0.55 (0.33, 0.92)). The use of appropriate methods to conduct subgroup analysis decreased by year (OR 0.88 (0.76, 1.00)) and was less common with industry funding (OR 0.35 (0.18, 0

  13. Determinants of modern family planning use among women of reproductive age in the Nkwanta district of Ghana: a case–control study

    Science.gov (United States)

    2014-01-01

    Background Average contraceptive prevalence rate in the Nkwanta district of Ghana was estimated to be 6.2% relative to the national average at the time, of 19%. While several efforts had been made to improve family planning in the country, the district still had very low use of modern family planning methods. This study sought to determine the factors that influenced modern family planning use in general and specifically, the factors that determined the consistently low use of modern family planning methods in the district. Methods A case–control study was conducted in the Nkwanta district of Ghana to determine socio-economic, socio-cultural and service delivery factors influencing family planning usage. One hundred and thirty cases and 260 controls made up of women aged 15–49 years were interviewed using structured questionnaires. A logistic regression was fitted. Results Awareness and knowledge of modern family planning methods were high among cases and controls (over 90%). Lack of formal education among women, socio-cultural beliefs and spousal communication were found to influence modern family planning use. Furthermore, favourable opening hours of the facilities and distance to health facilities influenced the use of modern contraceptives. Conclusion While modern family planning seemed to be common knowledge among these women, actual use of such contraceptives was limited. There is need to improve use of modern family planning methods in the district. In addition to providing health facilities and consolidating close-to-client service initiatives in the district, policies directed towards improving modern family planning method use need to consider the influence of formal education. Promoting basic education, especially among females, will be a crucial step as the district is faced with high levels of school dropout and illiteracy rates. PMID:25117887

  14. Managing Neonatal and Early Childhood Syndromic Sepsis in Sub-District Hospitals in Resource Poor Settings: Improvement in Quality of Care through Introduction of a Package of Interventions in Rural Bangladesh

    Science.gov (United States)

    Iqbal, Afrin; Hoque, D. M. Emdadul; Moinuddin, Md.; Zaman, Sojib Bin; Rahman, Qazi Sadeq-ur; Begum, Tahmina; Chowdhury, Atique Iqbal; Haider, Rafiqul; Arifeen, Shams El; Kissoon, Niranjan; Larson, Charles P.

    2017-01-01

    Introduction Sepsis is dysregulated systemic inflammatory response which can lead to tissue damage, organ failure, and death. With an estimated 30 million cases per year, it is a global public health concern. Severe infections leading to sepsis account for more than half of all under five deaths and around one quarter of all neonatal deaths annually. Most of these deaths occur in low and middle income countries and could be averted by rapid assessment and appropriate treatment. Evidence suggests that service provision and quality of care pertaining to sepsis management in resource poor settings can be improved significantly with minimum resource allocation and investments. Cognizant of the stark realities, a project titled ‘Interrupting Pathways to Sepsis Initiative’ (IPSI) introduced a package of interventions for improving quality of care pertaining to sepsis management at 2 sub-district level public hospitals in rural Bangladesh. We present here the quality improvement process and achievements regarding some fundamental steps of sepsis management which include rapid identification and admission, followed by assessment for hypoxemia, hypoglycaemia and hypothermia, immediate resuscitation when required and early administration of parenteral broad spectrum antibiotics. Materials and Method Key components of the intervention package include identification of structural and functional gaps through a baseline environmental scan, capacity development on protocolized management through training and supportive supervision by onsite ‘Program Coaches’, facilitating triage and rapid transfer of patients through ‘Welcoming Persons’ and enabling rapid treatment through ‘Task Shifting’ from on-call physicians to on-duty paramedics in the emergency department and on-call physicians to on-duty nurses in the inpatient department. Results From August, 2013 to March, 2015, 1,262 under-5 children were identified as syndromic sepsis in the emergency departments; of

  15. Managing Neonatal and Early Childhood Syndromic Sepsis in Sub-District Hospitals in Resource Poor Settings: Improvement in Quality of Care through Introduction of a Package of Interventions in Rural Bangladesh.

    Directory of Open Access Journals (Sweden)

    Ahmed Ehsanur Rahman

    Full Text Available Sepsis is dysregulated systemic inflammatory response which can lead to tissue damage, organ failure, and death. With an estimated 30 million cases per year, it is a global public health concern. Severe infections leading to sepsis account for more than half of all under five deaths and around one quarter of all neonatal deaths annually. Most of these deaths occur in low and middle income countries and could be averted by rapid assessment and appropriate treatment. Evidence suggests that service provision and quality of care pertaining to sepsis management in resource poor settings can be improved significantly with minimum resource allocation and investments. Cognizant of the stark realities, a project titled 'Interrupting Pathways to Sepsis Initiative' (IPSI introduced a package of interventions for improving quality of care pertaining to sepsis management at 2 sub-district level public hospitals in rural Bangladesh. We present here the quality improvement process and achievements regarding some fundamental steps of sepsis management which include rapid identification and admission, followed by assessment for hypoxemia, hypoglycaemia and hypothermia, immediate resuscitation when required and early administration of parenteral broad spectrum antibiotics.Key components of the intervention package include identification of structural and functional gaps through a baseline environmental scan, capacity development on protocolized management through training and supportive supervision by onsite 'Program Coaches', facilitating triage and rapid transfer of patients through 'Welcoming Persons' and enabling rapid treatment through 'Task Shifting' from on-call physicians to on-duty paramedics in the emergency department and on-call physicians to on-duty nurses in the inpatient department.From August, 2013 to March, 2015, 1,262 under-5 children were identified as syndromic sepsis in the emergency departments; of which 82% were admitted. More neonates (30

  16. Woodfuel procurement strategies of district heating plants

    International Nuclear Information System (INIS)

    Roos, A.; Bohlin, F.; Hektor, B.; Hillring, B.

    2003-01-01

    Woodfuel use in the Swedish district heating sector increased significantly from 1985 to 1999. This study analysed strategies and considerations concerning woodfuel procurement in district heating plants. Priorities and concerns in the industry involved an increased woodfuel share, ambitions to create an environmental image, cost minimisation, awareness about the role of energy policies for fuel choice, improvement of woodfuel quality and the ambition to maintain a competitive woodfuel market with several suppliers. Factor analysis yielded five dimensions in the woodfuel procurement strategies among the district heating companies: (1) increased woodfuel use; (2) import; (3) spot market woodfuel purchases; (4) focus on refined woodfuels; and (5) using price only when deciding whether to use woodfuels or other fuels. Five clusters were defined along the three strategy dimensions (1)-(3). The clusters differed concerning size, experiences from the introduction of woodfuels, perceptions about woodfuels and strategies employed to date. This paper describes different strategies that the district heating companies apply on the woodfuel market. The conclusion is that policies should consider this diversity in procurement strategies, mitigate their negative side-effects and assist to make them cost-effective. (author)

  17. District heating from Forsmark

    International Nuclear Information System (INIS)

    1980-11-01

    The district heating system of Greater Stockholm must be based on other energy sources than oil. Two alternatives are assessed, namely heat from Forsmark or a coal fueled plant in the region of Stockholm. Forsmark 3 can produce both electricity and heat from the year 1988 on. The capacity can be increased by coal fueled blocks. For low electricity use, 115 TWh in the year 1990, the Forsmark alternative will be profitable. The alternative will be profitable. The alternative with a fossile fuelled plant will be profitable when planning for high consumption of electricity, 125 TWh. The Forsmark alternative means high investments and the introduction of new techniques. (G.B.)

  18. 46 CFR 1.01-15 - Organization; Districts; National Maritime Center.

    Science.gov (United States)

    2010-10-01

    ... 46 Shipping 1 2010-10-01 2010-10-01 false Organization; Districts; National Maritime Center. 1.01... General Flow of Functions § 1.01-15 Organization; Districts; National Maritime Center. (a) To assist the... navigation, vessel inspection and seaman laws in general. (c) The Commanding Officer of the National Maritime...

  19. Fortification of staple foods with zinc for improving zinc status and other health outcomes in the general population.

    Science.gov (United States)

    Shah, Dheeraj; Sachdev, Harshpal S; Gera, Tarun; De-Regil, Luz Maria; Peña-Rosas, Juan Pablo

    2016-06-09

    Zinc deficiency is a global nutritional problem, particularly in children and women residing in settings where diets are cereal based and monotonous. It has several negative health consequences. Fortification of staple foods with zinc may be an effective strategy for preventing zinc deficiency and improving zinc-related health outcomes. To evaluate the beneficial and adverse effects of fortification of staple foods with zinc on health-related outcomes and biomarkers of zinc status in the general population. We searched the following databases in April 2015: Cochrane Central Register of Controlled Trials (CENTRAL, Issue 3 of 12, 2015, the Cochrane Library), MEDLINE & MEDLINE In Process (OVID) (1950 to 8 April 2015), EMBASE (OVID) (1974 to 8 April 2015), CINAHL (1982 to April 2015), Web of Science (1900 to 9 April 2015), BIOSIS (1969 to 9 April 2015), POPLINE (1970 to April 2015), AGRICOLA, OpenGrey, BiblioMap, and Trials Register of Promoting Health Interventions (TRoPHI), besides regional databases (April 2015) and theses. We also searched clinical trial registries (17 March 2015) and contacted relevant organisations (May 2014) in order to identify ongoing and unpublished studies. We included randomised controlled trials, randomised either at the level of the individual or cluster. We also included non-randomised trials at the level of the individual if there was a concurrent comparison group. We included non-randomised cluster trials and controlled before-after studies only if there were at least two intervention sites and two control sites. Interventions included fortification (central/industrial) of staple foods (cereal flours, edible fats, sugar, condiments, seasonings, milk and beverages) with zinc for a minimum period of two weeks. Participants were members of the general population who were over two years of age (including pregnant and lactating women) from any country. Two review authors independently assessed the eligibility of studies for inclusion

  20. Prescribing Optimization Method for Improving Prescribing in Elderly Patients Receiving Polypharmacy Results of Application to Case Histories by General Practitioners

    NARCIS (Netherlands)

    Drenth-van Maanen, A. Clara; van Marum, Rob J.; Knol, Wilma; van der Linden, Carolien M. J.; Jansen, Paul A. F.

    2009-01-01

    Background: Optimizing polypharmacy is often difficult, and critical appraisal of medication use often leads to one or more changes. We developed the Prescribing Optimization Method (POM) to assist physicians, especially general practitioners (GPs), in their attempts to optimize polypharmacy in

  1. Ben Taub General Hospital & LifeGift: Strengthening a Partnership to Save Lives and Improve Healthcare Delivery

    National Research Council Canada - National Science Library

    Philpot, Douglas G

    2007-01-01

    Ben Taub General Hospital, working closely with LifeGift, consistently ranks at or near the top of the list of hospitals in the United States that receive informed consent for organ donation from patients' families...

  2. The Streltsovskoye uranium district

    International Nuclear Information System (INIS)

    Ischukova, L.P.

    1997-01-01

    This paper describes the geology of the Streltsovskoye uranium district located in south-eastern Zabaikalie region, Chita Province, Siberia, Russia. This district hosts Russia's only currently active uranium production centre. The uranium ore was discovered from 1963 to 1967 by drilling below fluorite veins which had minor associated uranium mineralization and radioactive anomalies. The uranium occurs as large scale vein stockwork deposits of hydrothermal origin within a volcano-tectonic caldera formed by continental volcanism of Late Mesozoic age. Rocks occurring in the caldera include basalt and trachydacite, overlain by rhyolite, and with associated interbedded sediments. The ore bodies occur in steeply dipping faults, with the greatest concentrations located where faults along the margins of the caldera intersect steeply dipping, cross cutting, northeasterly and northwesterly striking faults. The Streltsovskoye caldera extends over an area of 150 km 2 and is underlain by a large batholith. The 19 identified uranium deposits occurred in structural features that cut through the caldera sequence and extend into the basement rocks. The caldera has a maximum thickness of 1400 metres. Details of several deposits are given, including descriptions of mineralization and associated alteration. (author). 10 figs

  3. Reforming health service delivery at district level in Ghana: the perspective of a district medical officer.

    Science.gov (United States)

    Agyepong, I A

    1999-03-01

    Many countries in sub-Saharan Africa face the problem of organizing health service delivery in a manner that provides adequate quality and coverage of health care to their populations against a background of economic recession and limited resources. In response to these challenges, different governments, including that of Ghana, have been considering or are in the process of implementing varying degrees of reform in the health sector. This paper examines aspects of health services delivery, and trends in utilization and coverage, using routine data over time in the Dangme West district of the Greater Accra region of Ghana, from the perspective of a district health manager. Specific interventions through which health services delivery and utilization at district level could be improved are suggested. Suggestions include raising awareness among care providers and health managers that increased resource availability is only a success in so far as it leads to improvements in coverage, utilization and quality; and developing indicators of performance which assess and reward use of resources at the local level to improve coverage, utilization and quality. Also needed are more flexibility in Central Government regulations for resource allocation and use; integration of service delivery at district level with more decentralized planning to make services better responsive to local needs; changes in basic and inservice training strategies; and exploration of how the public and private sectors can effectively collaborate to achieve maximum coverage and quality of care within available resources.

  4. Factors Associated with Awareness, Attitudes and Practices Regarding Common Eye Diseases in the General Population in a Rural District in Bangladesh: The Bangladesh Population-based Diabetes and Eye Study (BPDES.

    Directory of Open Access Journals (Sweden)

    Fakir M Amirul Islam

    Full Text Available To assess the awareness, attitudes, and practices associated with common eye diseases and eye care utilization in a rural district of Bangladesh.Data were collected using a multilevel cluster random sampling technique from 3104 adults aged ≥30 years from the Banshgram union with a questionnaire assessing the awareness, attitudes and practice about diabetes and common eye diseases, educational attainment, socio-economic status, and medical history.Participants were aged between 30 and 89 years with a mean (SD age of 51 (12 years and 65% were female. The majority of participants had heard of cataracts (90%, trachoma (86% and Pterygium (84%, yet only 4% had heard of diabetic retinopathy (DR, 7% of glaucoma and 8% of Age-related macular degeneration (AMD. However, 58% of participants did not know vision loss could be prevented. Factors associated with lower awareness regarding common eye diseases were increasing age, lack of formal schooling, and lower socio-economic status. A lower proportion (57% of people with no schooling compared to those who had attained at least secondary school certificate education (72% reported that they knew that vision loss could be prevented (p<0.001. Overall 51% of people had heard of at least six (67% out of nine items relating to awareness of common eye diseases. This included 41% of participants aged 65 years or older compared to 61% of those aged 30-35 years (p<0.001. Only 4% had an eye check at least once a year and higher education and better SES were associated with higher frequency of eye checks.In rural Bangladesh awareness of cataract, trachoma and pterygium was good but limited in relation to the potentially blinding conditions of glaucoma, DR, and AMD. The results show a large gap between public awareness and treatment practices about common eye diseases. Public health promotion should be designed to address these knowledge gaps.

  5. Improvement of Organizational Performance and Instructional Design: An Analogy Based on General Principles of Natural Information Processing Systems

    Science.gov (United States)

    Darabi, Aubteen; Kalyuga, Slava

    2012-01-01

    The process of improving organizational performance through designing systemic interventions has remarkable similarities to designing instruction for improving learners' performance. Both processes deal with subjects (learners and organizations correspondingly) with certain capabilities that are exposed to novel information designed for producing…

  6. On-line corrosion monitoring in geothermal district heating systems

    DEFF Research Database (Denmark)

    Richter, S.; Hilbert, Lisbeth Rischel; Thorarinsdottir, R.I.

    2006-01-01

    General corrosion rates in the geothermal district heating systems in Iceland are generally low, of the magnitude 1 lm/y. The reason is high pH (9.5), low-conductivity (200 lm/y) and negligible dissolved oxygen. The geothermal hot water is either used directly from source or to heat up cold ground...

  7. The power of the National Surgical Quality Improvement Program--achieving a zero pneumonia rate in general surgery patients.

    Science.gov (United States)

    Fuchshuber, Pascal R; Greif, William; Tidwell, Chantal R; Klemm, Michael S; Frydel, Cheryl; Wali, Abdul; Rosas, Efren; Clopp, Molly P

    2012-01-01

    The National Surgical Quality Improvement Program (NSQIP) of the American College of Surgeons provides risk-adjusted surgical outcome measures for participating hospitals that can be used for performance improvement of surgical mortality and morbidity. A surgical clinical nurse reviewer collects 135 clinical variables including preoperative risk factors, intraoperative variables, and 30-day postoperative mortality and morbidity outcomes for patients undergoing major surgical procedures. A report on mortality and complications is prepared twice a year. This article summarizes briefly the history of NSQIP and how its report on surgical outcomes can be used for performance improvement within a hospital system. In particular, it describes how to drive performance improvement with NSQIP data using the example of postoperative respiratory complications--a major factor of postoperative mortality. In addition, this article explains the benefit of a collaborative of several participating NSQIP hospitals and describes how to develop a "playbook" on the basis of an outcome improvement project.

  8. District heating in energetic and environmental politics

    Energy Technology Data Exchange (ETDEWEB)

    di Riscaldamento Urbano, Associazione Italiana

    1989-05-01

    A review is made of what was said at the Third Bi-annual Convention (Reggio Emilia, 24-25/11/88) of AIRU (the Italian Association for District Heating). In general, the seven papers presented dealt with the following points: the technology of primary energy supply, thermal energy production, energy distribution to users, environmental engineering and socio-economic factors. Emphasis was given to the themes: district heating in Italy within the framework of the 1988 National Energy Plan and the impact on energy marketing due to the future free trade system planned for the E.E.C. in 1992. A critical analysis is made of: forecasts of primary energy demand for the year 2000, plans for the reduction of dependency on foreign supplied petroleum, the promotion of the increased use of natural gas and methane and overall energy conservation measures as called for by the National Energy Plan.

  9. General practitioner views on the determinants of test ordering: a theory-based qualitative approach to the development of an intervention to improve immunoglobulin requests in primary care.

    LENUS (Irish Health Repository)

    Cadogan, S L

    2016-07-19

    Research suggests that variation in laboratory requesting patterns may indicate unnecessary test use. Requesting patterns for serum immunoglobulins vary significantly between general practitioners (GPs). This study aims to explore GP\\'s views on testing to identify the determinants of behaviour and recommend feasible intervention strategies for improving immunoglobulin test use in primary care.

  10. [Results from a general training hospital for the implementation of a diagnostic workup for pulmonary embolism according to the Dutch Institute for Health Care Improvement

    NARCIS (Netherlands)

    Kamphuisen, P.W.; Jacobs, E.M.G.; Mol, J.J.; Rijnders, A.J.; Ullmann, E.F.

    2002-01-01

    OBJECTIVE: To evaluate the active implementation of the Dutch Institute for Healthcare Improvement's guideline for the diagnostic work-up for pulmonary embolism in a general training hospital, and to analyse reasons for not following the guideline strategy. DESIGN: Partly retrospective and partly

  11. Inquiry and Blended Learning Based Learning Material Development for Improving Student Achievement on General Physics I of Mathematics and Natural Science of State University of Medan

    Science.gov (United States)

    Motlan; Sinulinggga, Karya; Siagian, Henok

    2016-01-01

    The aim of this research is to determine if inquiry and blended learning based materials can improve student's achievement. The learning materials are: book, worksheet, and test, website, etc. The type of this research is quasi experiment using two-group pretest posttest design. The population is all students of first year who take general physics…

  12. Promoting Children's and Adolescents' Social and Emotional Development: District Adaptations of a Theory of Action.

    Science.gov (United States)

    Kendziora, Kimberly; Osher, David

    2016-01-01

    This article contributes to the broader discussion of promotion, prevention, and intervention in child and adolescent mental health by describing implementation and early outcomes of an 8-school district demonstration project aimed at making the promotion of social and emotional learning a systemic part of school districts' practice. Eight districts are 2-3 years in to their participation in the 6-year project. The districts are large, are predominantly urban, and serve many students who are at disadvantage. The evaluation involved collection of qualitative data to measure the degree to which the districts realized the goals established in the initiative's theory of action, as well as school climate data, extant student records, and surveys of students' social and emotional competence. To date, results show that districts have followed highly individual pathways toward integrating social and emotional learning systemically, and all have made progress over time. Although school-level implementation remains at moderate levels, 2 districts in which we could examine school climate showed gains from preinitiative years. Four of 6 measured districts showed improvement in social and emotional competence for students in Grade 3, and achievement and discipline showed overall improvements across all districts. Overall findings show that implementation of the initiative's theory of action by school districts is feasible, even in times of budgetary stress and leadership turnover. This establishes the potential for school districts to serve as a lever of change in the promotion of students' social and emotional development and mental wellness.

  13. Routinely-collected general practice data are complex, but with systematic processing can be used for quality improvement and research

    Directory of Open Access Journals (Sweden)

    Simon de Lusignan

    2006-03-01

    Conclusions Routinely collected primary care data could contribute more to the process of health improvement; however, those working with these data need to understand fully the complexity of the context within which data entry takes place.

  14. A Tale of Two Districts

    Science.gov (United States)

    Simon, Mark

    2012-01-01

    These days, everyone seems to be wringing their hands about how to construct new evaluation systems that will make teachers better. This unnecessary angst has led to crazy experiments in reform that have embraced churn for the sake of churn, put school districts at risk, and demoralized many of the most talented teachers. A few school districts,…

  15. Suburban District Leadership Does Matter

    Science.gov (United States)

    Thompson, Eustace; France, Roxanne Garcia

    2015-01-01

    The increased demand for educational reform and accountability has resulted in a renewed focus on the relationship between building leaders and district leaders, particularly on how district leaders can support principals to ensure the academic success of students. The No Child Left Behind Act of 2001 (NCLB) and Race to the Top (RttT) legislations…

  16. Nuclear district heating

    International Nuclear Information System (INIS)

    Ricateau, P.

    1976-01-01

    An economic study of nuclear district heating is concerned with: heat production, its transmission towards the area to be served and the distribution management towards the consumers. Foreign and French assessments show that the high cost of now existing techniques of hot water transport defines the competing limit distance between the site and township to be below some fifty kilometers for the most important townships (provided that the fuel price remain stationary). All studies converge towards the choice of a high transport temperature as soon as the distance is of some twenty kilometers. As for fossile energy saving, some new possibilities appear with process heat reactors; either PWR of about 1000MWth for large townships, or pool-type reactors of about 100MWth when a combination with an industrial steam supply occurs [fr

  17. IM-Chem: The Use of Instant Messaging to Improve Student Performance and Personalize Large Lecture General Chemistry Courses

    Science.gov (United States)

    Behmke, Derek A.; Atwood, Charles H.

    2012-01-01

    Previous research has linked poor student performance with the depersonalized feeling of large lecture courses. Various forms of enhanced communication have been tried that appear to enhance personalization in large courses. For general chemistry classes taught in a 365-seat lecture hall at the University of Georgia, we have attempted to enhance…

  18. General Chemistry Courses That Can Affect Achievement: An Action Research Study in Developing a Plan to Improve Undergraduate Chemistry Courses

    Science.gov (United States)

    Shweikeh, Eman

    2014-01-01

    Over the past 50 years, considerable research has been dedicated to chemistry education. In evaluating principal chemistry courses in higher education, educators have noted the learning process for first-year general chemistry courses may be challenging. The current study investigated perceptions of faculty, students and administrators on…

  19. CREATION OF PUBLIC DIGITAL EDUCATIONAL RESOURCES FOR SECONDARY SCHOOLS AS AN IMPORTANT FACTOR FOR IMPROVING OF GENERAL EDUCATION QUALITY

    Directory of Open Access Journals (Sweden)

    Anatolii Yu. Pylypchuk

    2010-08-01

    Full Text Available The article deals with the problems that must be addressed for digital educational resources to meet current requirements and to ensure their general education, analyzed ways to solve these problems abroad, particularly in the Russian Federation, and suggested possible ways to address them in Ukraine.

  20. VT Data - Overlay District 20170710, South Burlington

    Data.gov (United States)

    Vermont Center for Geographic Information — Overlay data for the City of South Burlington included in this data:Flood Plain Overlay DistrictTraffic Overlay DistrictInterstate Highway Overlay DistrictScenic...

  1. Corrosion Rate Monitoring in District Heating Systems

    DEFF Research Database (Denmark)

    Hilbert, Lisbeth Rischel; Nielsen, Lars Vendelbo; Andersen, A.

    2005-01-01

    be applicable, and if on-line monitoring could improve the quality control. Water quality monitoring was applied as well as corrosion rate monitoring with linear polarization resistance (LPR), electrochemical impedance spectroscopy (EIS), electrical resistance (ER) technique, mass loss and a crevice corrosion......Quality control in district heating systems to keep uniform corrosion rates low and localized corrosion minimal is based on water quality control. Side-stream units equipped with carbon steel probes for online monitoring were mounted in district heating plants to investigate which techniques would...... cell for localized corrosion risk estimation. Important variations in corrosion rate due to changes in make-up water quality were detected with the continuous monitoring provided by ER and crevice cell, while LPR gave unreliable corrosion rates. The acquisition time of two-three days for EIS...

  2. Load Management in District Heating Operation

    DEFF Research Database (Denmark)

    Li, Hongwei; Wang, Stephen Jia

    2015-01-01

    Smooth operation of district heating system will avoid installation of expensive peak heat boilers, improve plant partial load performance, increase the system redundancy for further network expansion and improve its resilience to ensure security of supply during severe heating seasons. The peak...... heating load can be reduced through building demand side management. The building thermal mass can be used to shift the heating supply under the circumstance without jeopardizing the consumer thermal comfort. In this paper, the multi-agent framework is applied to a simplified building dynamic model...

  3. Important improvement of utilization the available geological reserves of the South mining district deposit in Majdanpek in the new defined optimum contour of the open pit using the Whittle and Gemcom softwares

    OpenAIRE

    Kržanović, Daniel; Žikić, Miodrag; Pantović, Radoje

    2012-01-01

    A significant increase in copper prices on the World Metal Exchange, whose lower limit in the long term will not be under $ 6,000 per ton of cathode copper, and reduction the operating costs of ore mining by introduction the high capacity mining equipment in the production process, requires a new consideration of the open pit South Mining District Majdanpek and defining the new final (optimum) limit of mining for the given techno economic parameters. Using the modern software tools for strate...

  4. Factors influencing the work efficiency of district health managers in low-resource settings: a qualitative study in Ghana.

    Science.gov (United States)

    Bonenberger, Marc; Aikins, Moses; Akweongo, Patricia; Wyss, Kaspar

    2016-01-14

    There is increasing evidence that good district management practices can improve health system performance and conversely, that poor and inefficient management practices have detrimental effects. The aim of the present study was to identify factors contributing to inefficient management practices of district health managers and ways to improve their overall efficiency. Nineteen semi-structured interviews were conducted with district health managers in three districts of the Eastern Region in Ghana. The 19 interviews conducted comprised 90% of the managerial workforce in these districts in 2013. A thematic analysis was carried out using the WHO's leadership and management strengthening framework to structure the results. Key factors for inefficient district health management practices were identified to be: human resource shortages, inadequate planning and communication skills, financial constraints, and a narrow decision space that constrains the authority of district health managers and their ability to influence decision-making. Strategies that may improve managerial efficiency at both an individual and organizational level included improvements to planning, communication, and time management skills, and ensuring the timely release of district funds. Filling District Health Management Team vacancies, developing leadership and management skills of district health managers, ensuring a better flow of district funds, and delegating more authority to the districts seems to be a promising intervention package, which may result in better and more efficient management practices and stronger health system performance.

  5. VT Data - Overlay District 20070306, Marlboro

    Data.gov (United States)

    Vermont Center for Geographic Information — Cartographic version of overlay district (surface water buffer), Marlboro, Vermont. Base zoning districts are in a separate shapefile. Data were originally created...

  6. Long-term effectiveness of a quality improvement program for patients with type 2 diabetes in general practice.

    NARCIS (Netherlands)

    Renders, C.M.; Valk, G.D.; Franse, L.V.; Schellevis, F.; Eijk, J.T.M. van; Wal, G. van der

    2001-01-01

    OBJECTIVE— To assess the long-term effectiveness of a quality improvement program on care provided and patient outcomes in patients with diabetes. RESEARCH DESIGN AND METHODS— A nonrandomized trial was performed with 312 patients with type 2 diabetes in the intervention group and 77 patients with

  7. Improving Student Perceptions of Science through the Use of State-of-the-Art Instrumentation in General Chemistry Laboratory

    Science.gov (United States)

    Aurentz, David J.; Kerns, Stefanie L.; Shibley, Lisa R.

    2011-01-01

    Access to state-of-the-art instrumentation, namely nuclear magnetic resonance (NMR) spectroscopy, early in the college curriculum was provided to undergraduate students in an effort to improve student perceptions of science. Proton NMR spectroscopy was introduced as part of an aspirin synthesis in a guided-inquiry approach to spectral…

  8. Federally Sponsored Research at Educational Institutions: A Need for Improved Accountability. Report by the U.S. General Accounting Office.

    Science.gov (United States)

    General Accounting Office, Washington, DC.

    This report discusses federally sponsored research at educational institutions and suggests ways to improve accountability for these funds. The following suggestions are made for minimizing problems presented in this report: (1) development of more definitive cost principles for both the institutions and the Federal auditors to follow; (2) more…

  9. Short term (14 days) consumption of insoluble wheat bran fibre-containing breakfast cereals improves subjective digestive feelings, general wellbeing and bowel function in a dose dependent manner.

    Science.gov (United States)

    Lawton, Clare L; Walton, Jenny; Hoyland, Alexa; Howarth, Elaine; Allan, Peter; Chesters, David; Dye, Louise

    2013-04-22

    This study investigated whether increasing insoluble (predominantly wheat bran) fibre over 14 days improves subjective digestive feelings, general wellbeing and bowel function. A single centre, multi-site, open, within subjects design with a 14 day non-intervention (baseline) monitoring period followed by a 14 day fibre consumption (intervention) period was performed. 153 low fibre consumers (breakfast cereal containing at least 5.4 g fibre (3.5 g from wheat bran) for 14 days and completed a daily symptom diary. Significant improvements were demonstrated in subjective perception of bowel function (e.g., ease of defecation) and digestive feelings (bloating, constipation, feeling sluggish and digestive discomfort). Significant improvements were also found in subjective perception of general wellbeing (feeling less fat, more mentally alert, slim, happy and energetic whilst experiencing less stress, mental and physical tiredness, difficulty concentrating and fewer headaches). In general, improvements in study outcomes increased with increasing cereal/fibre consumption. However, consuming an additional minimum 5.4 g of fibre (3.5 g wheat bran) per day was shown to deliver measurable and significant benefits for digestive health, comfort and wellbeing. Encouraging consumption of relatively small amounts of wheat bran could also provide an effective method of increasing overall fibre consumption.

  10. Short Term (14 Days Consumption of Insoluble Wheat Bran Fibre-Containing Breakfast Cereals Improves Subjective Digestive Feelings, General Wellbeing and Bowel Function in a Dose Dependent Manner

    Directory of Open Access Journals (Sweden)

    Louise Dye

    2013-04-01

    Full Text Available This study investigated whether increasing insoluble (predominantly wheat bran fibre over 14 days improves subjective digestive feelings, general wellbeing and bowel function. A single centre, multi-site, open, within subjects design with a 14 day non-intervention (baseline monitoring period followed by a 14 day fibre consumption (intervention period was performed. 153 low fibre consumers (<15 g/day AOAC 985.29 completed a daily symptom diary for 14 days after which they consumed one bowl of ready-to-eat breakfast cereal containing at least 5.4 g fibre (3.5 g from wheat bran for 14 days and completed a daily symptom diary. Significant improvements were demonstrated in subjective perception of bowel function (e.g., ease of defecation and digestive feelings (bloating, constipation, feeling sluggish and digestive discomfort. Significant improvements were also found in subjective perception of general wellbeing (feeling less fat, more mentally alert, slim, happy and energetic whilst experiencing less stress, mental and physical tiredness, difficulty concentrating and fewer headaches. In general, improvements in study outcomes increased with increasing cereal/fibre consumption. However, consuming an additional minimum 5.4 g of fibre (3.5 g wheat bran per day was shown to deliver measurable and significant benefits for digestive health, comfort and wellbeing. Encouraging consumption of relatively small amounts of wheat bran could also provide an effective method of increasing overall fibre consumption.

  11. Short Term (14 Days) Consumption of Insoluble Wheat Bran Fibre-Containing Breakfast Cereals Improves Subjective Digestive Feelings, General Wellbeing and Bowel Function in a Dose Dependent Manner

    Science.gov (United States)

    Lawton, Clare L.; Walton, Jenny; Hoyland, Alexa; Howarth, Elaine; Allan, Peter; Chesters, David; Dye, Louise

    2013-01-01

    This study investigated whether increasing insoluble (predominantly wheat bran) fibre over 14 days improves subjective digestive feelings, general wellbeing and bowel function. A single centre, multi-site, open, within subjects design with a 14 day non-intervention (baseline) monitoring period followed by a 14 day fibre consumption (intervention) period was performed. 153 low fibre consumers (<15 g/day AOAC 985.29) completed a daily symptom diary for 14 days after which they consumed one bowl of ready-to-eat breakfast cereal containing at least 5.4 g fibre (3.5 g from wheat bran) for 14 days and completed a daily symptom diary. Significant improvements were demonstrated in subjective perception of bowel function (e.g., ease of defecation) and digestive feelings (bloating, constipation, feeling sluggish and digestive discomfort). Significant improvements were also found in subjective perception of general wellbeing (feeling less fat, more mentally alert, slim, happy and energetic whilst experiencing less stress, mental and physical tiredness, difficulty concentrating and fewer headaches). In general, improvements in study outcomes increased with increasing cereal/fibre consumption. However, consuming an additional minimum 5.4 g of fibre (3.5 g wheat bran) per day was shown to deliver measurable and significant benefits for digestive health, comfort and wellbeing. Encouraging consumption of relatively small amounts of wheat bran could also provide an effective method of increasing overall fibre consumption. PMID:23609776

  12. A study of a small nuclear power plant system for district heating

    International Nuclear Information System (INIS)

    Imamura, Mitsuru; Sato, Kotaro; Narabayashi, Tadashi; Shimazu, Yoichiro; Tsuji, Masashi

    2009-01-01

    We have studied nuclear power plant for district heating. Already some towns and villages in Hokkaido have requested small reactor for district heating. Using existing technology allows us to shorten development period and to keep a lid on development cost. We decided to develop new reactor based on 'MUTSU' reactor technology because 'MUTSU' had already proved its safety. And this reactor was boron free reactor. It allows plant system to reduce the chemical control system. And moderator temperature coefficient is deeply negative. It means to improve its operability and leads to dependability enhancement. We calculated burn-up calculation of erbium addition fuel. In the result, the core life became about 10 years. And we adapt the cassette type refueling during outagein in order to maintain nonproliferation. In the district heating system, a double heat exchanger system enables to response to load change in season. To obtain the acceptance of public, this system has a leak prevention system of radioactive materials to public. And road heating system of low grade heat utilization from turbine condenser leads to improve the heat utilization efficiency. We carried out performance evaluation test of district heating pipeline. Then the heat loss of pipeline is estimated at about 0.440degC/km. This result meets general condition, which is about 1degC/km. This small plant has passive safety system. It is natural cooling of containment vessel. In case of loss of coolant accident, decay heat can remove by natural convection air cooling after 6 hours. Decay heat within 6 hours can remove by evaporative heat transfer of pool on containment vessel. (author)

  13. New Zealand evidence for the impact of primary healthcare investment in Capital and Coast District Health Board.

    Science.gov (United States)

    Tan, Lee; Carr, Julia; Reidy, Johanna

    2012-03-30

    This paper provides New Zealand evidence on the effectiveness of primary care investment, measured through the Capital and Coast District Health Board's (DHB) Primary Health Care Framework. The Framework was developed in 2002/2003 to guide funding decisions at a DHB level, and to provide a transparent basis for evaluation of the implementation of the Primary Health Care Strategy in this district. The Framework used a mixed method approach; analysis was based on quantitative and qualitative data. This article demonstrates the link between investment in primary health care, increased access to primary care for high-need populations, workforce redistribution, and improved health outcomes. Over the study period, ambulatory sensitive hospitalisations and emergency department use reduced for enrolled populations and the District's immunisation coverage improved markedly. Funding and contracting which enhanced both 'mainstream' and 'niche' providers combined with community-based health initiatives resulted in a measurable impact on a range of health indicators and inequalities. Maori primary care providers improved access for Maori but also for their enrolled populations of Pacific and Other ethnicity. Growth and redistribution of primary care workforce was observed, improving the availability of general practitioners, nurses, and community workers in poorer communities.

  14. 2006 Southwest Florida Water Management District (SWFWMD) Lidar: North District

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — This data set is one component of a digital terrain model (DTM) for the Southwest Florida Water Management District's FY2006 Digital Orthophoto (B089) and LiDAR...

  15. Reducing indoor air pollution by air conditioning is associated with improvements in cardiovascular health among the general population.

    Science.gov (United States)

    Lin, Lian-Yu; Chuang, Hsiao-Chi; Liu, I-Jung; Chen, Hua-Wei; Chuang, Kai-Jen

    2013-10-01

    Indoor air pollution is associated with cardiovascular effects, however, little is known about the effects of improving indoor air quality on cardiovascular health. The aim of this study was to explore whether improving indoor air quality through air conditioning can improve cardiovascular health in human subjects. We recruited a panel of 300 healthy subjects from Taipei, aged 20 and over, to participate in six home visits each, to measure a variety of cardiovascular endpoints, including high sensitivity-C-reactive protein (hs-CRP), 8-hydroxy-2'-deoxyguanosine (8-OHdG), fibrinogen in plasma and heart rate variability (HRV). Indoor particles and total volatile organic compounds (VOCs) were measured simultaneously at the participant's home during each visit. Three exposure conditions were investigated in this study: participants were requested to keep their windows open during the first two visits, close their windows during the next two visits, and close the windows and turn on their air conditioners during the last two visits. We used linear mixed-effects models to associate the cardiovascular endpoints with individual indoor air pollutants. The results showed that increases in hs-CRP, 8-OHdG and fibrinogen, and decreases in HRV indices were associated with increased levels of indoor particles and total VOCs in single-pollutant and two-pollutant models. The effects of indoor particles and total VOCs on cardiovascular endpoints were greatest during visits with the windows open. During visits with the air conditioners turned on, no significant changes in cardiovascular endpoints were observed. In conclusion, indoor air pollution is associated with inflammation, oxidative stress, blood coagulation and autonomic dysfunction. Reductions in indoor air pollution and subsequent improvements in cardiovascular health can be achieved by closing windows and turning on air conditioners at home. Copyright © 2013 Elsevier B.V. All rights reserved.

  16. Generalization of some ways of improvement of depreciation policy and restoration of depreciation of fixed assets of the enterprises

    Directory of Open Access Journals (Sweden)

    Sergeev Leonid Ivanovich

    2016-07-01

    Full Text Available Discusses approaches to consider different factors in constructing the amortization policy and recording of different forms of wear of fixed assets of enterprises. Analyzed proposals of domestic and foreign researchers on the improvement of recovery processes and the acquisition of fixed assets under different conditions of their exploitation. It is proposed on the basis of management accounting and financial performance to build rational depreciation system recovery value of fixed assets of enterprises.

  17. Barriers and facilitators to evidence based care of type 2 diabetes patients: experiences of general practitioners participating to a quality improvement program

    Directory of Open Access Journals (Sweden)

    Hannes Karen

    2009-07-01

    Full Text Available Abstract Objective To evaluate the barriers and facilitators to high-quality diabetes care as experienced by general practitioners (GPs who participated in an 18-month quality improvement program (QIP. This QIP was implemented to promote compliance with international guidelines. Methods Twenty out of the 120 participating GPs in the QIP underwent semi-structured interviews that focused on three questions: 'Which changes did you implement or did you observe in the quality of diabetes care during your participation in the QIP?' 'According to your experience, what induced these changes?' and 'What difficulties did you experience in making the changes?' Results Most GPs reported that enhanced knowledge, improved motivation, and a greater sense of responsibility were the key factors that led to greater compliance with diabetes care guidelines and consequent improvements in diabetes care. Other factors were improved communication with patients and consulting specialists and reliance on diabetes nurse educators. Some GPs were reluctant to collaborate with specialists, and especially with diabetes educators and dieticians. Others blamed poor compliance with the guidelines on lack of time. Most interviewees reported that a considerable minority of patients were unwilling to change their lifestyles. Conclusion Qualitative research nested in an experimental trial may clarify the improvements that a QIP may bring about in a general practice, provide insight into GPs' approach to diabetes care and reveal the program's limits. Implementation of a QIP encounters an array of cognitive, motivational, and relational obstacles that are embedded in a patient-healthcare provider relationship.

  18. Improving communication in general practice when mental health issues appear: piloting a set of six evidence-based skills.

    Science.gov (United States)

    Stensrud, Tonje Lauritzen; Gulbrandsen, Pål; Mjaaland, Trond Arne; Skretting, Sidsel; Finset, Arnstein

    2014-04-01

    To test a communication skills training program teaching general practitioners (GPs) a set of six evidence-based mental health related skills. A training program was developed and tested in a pilot test-retest study with 21 GPs. Consultations were videotaped and actors used as patients. A coding scheme was created to assess the effect of training on GP behavior. Relevant utterances were categorized as examples of each of the six specified skills. The GPs' self-perceived learning needs and self-efficacy were measured with questionnaires. The mean number of GP utterances related to the six skills increased from 13.3 (SD 6.2) utterances before to 23.6 (SD 7.2) utterances after training; an increase of 77.4% (PSkills exploring emotions, cognitions and resources, and the skill Promote coping, increased significantly. Self-perceived learning needs and self-efficacy did not change significantly. The results from this pilot test are encouraging. GPs enhanced their use on four out of six mental health related communication skills significantly, and the effects were medium to large. This training approach appears to be an efficacious approach to mental health related communication skills training in general practice. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  19. Analysis of district heating pricing in Finland from the customers' and energy companies perspectives. Final report; Kaukolaemmoen hinnoittelun nykytila ja tulevaisuuden mahdollisuudet. Loppuraportti

    Energy Technology Data Exchange (ETDEWEB)

    Sarvaranta, A.; Jaaskelainen, J.; Puolakka, J.; Kouri, P. [AF-Consult, Vantaa (Finland)

    2012-12-15

    The heating market in Finland is changing. Until now, district heating demand has been constantly increasing. However, forecasts predict the demand to drop slightly in the future due to the increasing energy efficiency demands and development of competing heating technologies. Maintaining existing customer base may rise as one of the major challenges of a district heating company in the future. This report covers the topic 'Analysis of district heating pricing in Finland from the customers' and energy companies perspectives'. The report provides a general description of the current challenges and future opportunities of district heating pricing in Finland. Cost and pricing structures are discussed from both the companies and customers' perspectives. The overall objective is to provide an overview of the current state of district heating pricing in Finland and provide information on new pricing opportunities. The conclusions of the report provide information that district heating companies can use in developing their pricing system. Based on the literature and material analysed in this study, district heating pricing currently lacks adequate transparency and therefore should be developed to reflect the cost structure more closely. New metering technologies allow more accurate information on heat consumption and can hence be used to improve the transparency of pricing. Average marginal costs generally vary between seasons. If the goal is to reflect the cost structure taking into account the average variable costs, season dependent pricing becomes desirable. More variability in pricing between seasons may also keep customers from switching completely or partially into other heating systems, as the pricing becomes more cost-effective and easier to understand. Different types of customers wish for different properties in pricing: transparency, freedom of choice, convenience, more dynamic pricing, etc.. While expanding and tailoring the pricing

  20. Local or district heating by natural gas: Which is better from energetic, environmental and economic point of views?

    International Nuclear Information System (INIS)

    Lazzarin, R.; Noro, M.

    2006-01-01

    Generally, a CHP plant coupled with district heating is considered more efficient than traditional local heating systems from an economic and environmental point of view. This is certainly true for municipal waste CHP plants, but for plants fuelled by natural gas the important developments of the last years regarding both boilers (premixed and modulating burners, condensing boilers, etc.) and mechanical vapour compression and absorption heat pumps can change the traditional view. At the same time also district heating plants improved. Therefore it is worth to analyse the whole matter comparing advantages and disadvantages of the different alternatives, with a wide difference between them. The paper reports on the analysis of major district heating natural gas based technologies (vapour and gas turbines, internal combustion engine, combined cycles); the cost of heat and power produced in these plants is compared to the cost of producing the same quantity of electrical energy by a reference GTCC-Gas Turbine Combined Cycle (actually the most efficient technology for pure electrical production) and the cost of heat production by modern local heating technologies using natural gas as fuel (condensing boilers, electrical, gas engine and absorption heat pumps). Regarding energy efficiency and emissions, modern local heating turns out to be more efficient than district heating for most CHP technologies. However, the same does not happen from an economic point of view, because in Italy natural gas used by cogeneration plants is subjected to a much lower taxation than local heating technologies