WorldWideScience

Sample records for greatly improved results

  1. With Great Measurements Come Great Results

    Science.gov (United States)

    Williams, Carl

    Measurements are the foundation for science and modern life. Technologies we take for granted every day depend on them-cell phones, CAT scans, pharmaceuticals, even sports equipment. Metrology, or measurement science, determines what industry can make reliably and what they cannot. At the National Institute of Standards and Technology (NIST) we specialize in making world class measurements that an incredibly wide range of industries use to continually improve their products - computer chips with nanoscale components, atomic clocks that you can hold in your hand, lasers for both super-strong welds and delicate eye surgeries. Think of all the key technologies developed over the last 100 years and better measurements, standards, or analysis techniques played a role in making them possible. NIST works collaboratively with industry researchers on the advanced metrology for tomorrow's technologies. A new kilogram based on electromagnetic force, cars that weigh half as much but are just as strong, quantum computers, personalized medicine, single atom devices - it's all happening in our labs now. This talk will focus on how metrology creates the future.

  2. 100 ways to make good photos great tips & techniques for improving your digital photography

    CERN Document Server

    Cope, Peter

    2013-01-01

    A practical, accessible guide to turning your good photographs into great ones whether you are shooting on the latest digital SLR or a camera phone! Discover 100 simple and fun ways to improve your photographs both in-camera and through post-processing image manipulation. Every key photographic genre is covered, from perfect portraits and the great outdoors, to travel photos and shooting at night. Filled with inspirational examples of great photographs compared against the more average images, with easy to follow techniques for how you can achieve the same results.

  3. New and Improved Results from Daya Bay

    CERN Multimedia

    CERN. Geneva

    2017-01-01

    Despite the great progress achieved in the last decades, neutrinos remain among the least understood fundamental particles to have been experimentally observed. The Daya Bay Reactor Neutrino Experiment consists of eight identically designed detectors placed underground at different baselines from three groups of nuclear reactors in China, a configuration that is ideally suited for studying the properties of these elusive particles. In this talk I will review the improved results released last summer by the Daya Bay collaboration. These results include (i) a precision measurement of the θ13 mixing angle and the effective mass splitting in the electron antineutrino disappearance channel with a dataset comprising more than 2.5 million antineutrino interactions, (ii) a high-statistics measurement of the absolute flux and spectrum of reactor-produced electron antineutrinos, and (iii) a search for light sterile neutrino mixing performed with more than three times the statistics of the previous result. I w...

  4. Modeling detection probability to improve marsh bird surveys in southern Canada and the Great Lakes states

    Directory of Open Access Journals (Sweden)

    Douglas C. Tozer

    2016-12-01

    Full Text Available Marsh birds are notoriously elusive, with variation in detection probability across species, regions, seasons, and different times of day and weather. Therefore, it is important to develop regional field survey protocols that maximize detections, but that also produce data for estimating and analytically adjusting for remaining differences in detections. We aimed to improve regional field survey protocols by estimating detection probability of eight elusive marsh bird species throughout two regions that have ongoing marsh bird monitoring programs: the southern Canadian Prairies (Prairie region and the southern portion of the Great Lakes basin and parts of southern Québec (Great Lakes-St. Lawrence region. We accomplished our goal using generalized binomial N-mixture models and data from ~22,300 marsh bird surveys conducted between 2008 and 2014 by Bird Studies Canada's Prairie, Great Lakes, and Québec Marsh Monitoring Programs. Across all species, on average, detection probability was highest in the Great Lakes-St. Lawrence region from the beginning of May until mid-June, and then fell throughout the remainder of the season until the end of June; was lowest in the Prairie region in mid-May and then increased throughout the remainder of the season until the end of June; was highest during darkness compared with light; and did not vary significantly according to temperature (range: 0-30°C, cloud cover (0%-100%, or wind (0-20 kph, or during morning versus evening. We used our results to formulate improved marsh bird survey protocols for each region. Our analysis and recommendations are useful and contribute to conservation of wetland birds at various scales from local single-species studies to the continental North American Marsh Bird Monitoring Program.

  5. Optimizing hyaluronidase dose and plasmid DNA delivery greatly improves gene electrotransfer efficiency in rat skeletal muscle

    DEFF Research Database (Denmark)

    Åkerström, Thorbjörn; Vedel, Kenneth; Needham Andersen, Josefine

    2015-01-01

    Transfection of rat skeletal muscle in vivo is a widely used research model. However, gene electrotransfer protocols have been developed for mice and yield variable results in rats. We investigated whether changes in hyaluronidase pre-treatment and plasmid DNA delivery can improve transfection...... with a homogenous distribution. We also show that transfection was stable over five weeks of regular exercise or inactivity. Our findings show that species-specific plasmid DNA delivery and hyaluronidase pre-treatment greatly improves transfection efficiency in rat skeletal muscle....... efficiency in rat skeletal muscle. We found that pre-treating the muscle with a hyaluronidase dose suitable for rats (0.56. U/g b.w.) prior to plasmid DNA injection increased transfection efficiency by >200% whereas timing of the pre-treatment did not affect efficiency. Uniformly distributing plasmid DNA...

  6. Factors Associated With Worsened or Improved Mental Health in the Great East Japan Earthquake Survivors.

    Science.gov (United States)

    Yamanouchi, Tomoko; Hiroshima, Mayo; Takeuchi, Yumiko; Sawada, Yumiko; Takahashi, Makiko; Amagai, Manami

    2018-02-01

    The aim of this study was to identify factors contributing to the worsening or improved mental health of long-term evacuees over three years following the Great East Japan Earthquake. The Japanese version of the K6 questionnaire was used as a measure of mental health. The first- and third-year survey results were compared and differences in mental health status calculated. Respondents were then divided into two groups according to worsening or improved mental health status. Differences in stress factors, stress relief methods, and demographics were compared between the two groups. Factors associated with exacerbation of poor mental health were the stress factors "Uncertainty about future" (p=0.048) and "Loss of purpose in life" (p=0.023). Multivariable analysis identified two factors associated with improved mental health, the stress relief methods "Accepting myself" (odds ratio (OR): 2.15, 95% confidence interval (CI): 1.02-4.51) and "Interactions with others" (OR: 3.34, 95% CI: 1.43-7.79). While motivation and hope of livelihood reconstruction have gradually risen in the three years since the disaster, anxieties about an uncertain future, loss of purpose in life, and disruption of social networks continue adversely to affect the mental health of survivors. Copyright © 2017 Elsevier Inc. All rights reserved.

  7. Clinical results of a new strategy (modified CHIVA) for surgical treatment of anterior accessory great saphenous varicose veins.

    Science.gov (United States)

    Maldonado-Fernández, Nicolás; Linares-Palomino, Jose Patricio; López-Espada, Cristina; Martínez-Gámez, Francisco Javier; Ros-Díe, Eduardo

    2016-03-01

    Traditionally, anterior accessory great saphenous vein insufficiency was managed by crossectomy and resection of varicose veins. The aim of this paper is to show the safety and efficacy of a new therapeutic strategy for anterior accessory great saphenous varicose veins. This non-randomised prospective study included 65 patients with varicose veins from the anterior accessory great saphenous vein. The novelty of the technique is to avoid the great saphenous vein crossectomy and perform just flebectomy of the visible veins. Venous duplex studies were performed preoperatively, a month and a year postoperatively. The clinical assessment was done by the Fligelstone scale. The baseline CEAP clinical classification was: 58% C2, 26% C3 and 15% C4-6. The new strategy was applied to all cases. 3 haematomas, 7 cases of asymptomatic partial anterior saphenous thrombosis. Reduction of the initial average diameter was from 6.4 mm anterior saphenous to 3.4 mm by one year (p <0.001). At twelve months a forward flow is maintained in 82% of cases. Recurrence of varicose veins was 8%. All patients improved their clinical status based on the Fligelstone scale. Cases with saphenous diameter bigger than 7.5 mm and obesity were identified as predictors of worse clinical and hemodynamic outcome. This modified surgical strategy for anterior saphenous varicose veins results in better clinical outcomes at one year postoperatively. Copyright © 2015 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.

  8. GREAT3 results - I. Systematic errors in shear estimation and the impact of real galaxy morphology

    Energy Technology Data Exchange (ETDEWEB)

    Mandelbaum, R.; Rowe, B.; Armstrong, R.; Bard, D.; Bertin, E.; Bosch, J.; Boutigny, D.; Courbin, F.; Dawson, W. A.; Donnarumma, A.; Fenech Conti, I.; Gavazzi, R.; Gentile, M.; Gill, M. S. S.; Hogg, D. W.; Huff, E. M.; Jee, M. J.; Kacprzak, T.; Kilbinger, M.; Kuntzer, T.; Lang, D.; Luo, W.; March, M. C.; Marshall, P. J.; Meyers, J. E.; Miller, L.; Miyatake, H.; Nakajima, R.; Ngole Mboula, F. M.; Nurbaeva, G.; Okura, Y.; Paulin-Henriksson, S.; Rhodes, J.; Schneider, M. D.; Shan, H.; Sheldon, E. S.; Simet, M.; Starck, J. -L.; Sureau, F.; Tewes, M.; Zarb Adami, K.; Zhang, J.; Zuntz, J.

    2015-05-01

    We present first results from the third GRavitational lEnsing Accuracy Testing (GREAT3) challenge, the third in a sequence of challenges for testing methods of inferring weak gravitational lensing shear distortions from simulated galaxy images. GREAT3 was divided into experiments to test three specific questions, and included simulated space- and ground-based data with constant or cosmologically varying shear fields. The simplest (control) experiment included parametric galaxies with a realistic distribution of signal-to-noise, size, and ellipticity, and a complex point spread function (PSF). The other experiments tested the additional impact of realistic galaxy morphology, multiple exposure imaging, and the uncertainty about a spatially varying PSF; the last two questions will be explored in Paper II. The 24 participating teams competed to estimate lensing shears to within systematic error tolerances for upcoming Stage-IV dark energy surveys, making 1525 submissions overall. GREAT3 saw considerable variety and innovation in the types of methods applied. Several teams now meet or exceed the targets in many of the tests conducted (to within the statistical errors). We conclude that the presence of realistic galaxy morphology in simulations changes shear calibration biases by ~1 per cent for a wide range of methods. Other effects such as truncation biases due to finite galaxy postage stamps, and the impact of galaxy type as measured by the Sérsic index, are quantified for the first time. Our results generalize previous studies regarding sensitivities to galaxy size and signal-to-noise, and to PSF properties such as seeing and defocus. Almost all methods’ results support the simple model in which additive shear biases depend linearly on PSF ellipticity.

  9. Contrasting results from GWAS and QTL mapping on wing length in great reed warblers.

    Science.gov (United States)

    Hansson, Bengt; Sigeman, Hanna; Stervander, Martin; Tarka, Maja; Ponnikas, Suvi; Strandh, Maria; Westerdahl, Helena; Hasselquist, Dennis

    2018-04-15

    A major goal in evolutionary biology is to understand the genetic basis of adaptive traits. In migratory birds, wing morphology is such a trait. Our previous work on the great reed warbler (Acrocephalus arundinaceus) shows that wing length is highly heritable and under sexually antagonistic selection. Moreover, a quantitative trait locus (QTL) mapping analysis detected a pronounced QTL for wing length on chromosome 2, suggesting that wing morphology is partly controlled by genes with large effects. Here, we re-evaluate the genetic basis of wing length in great reed warblers using a genomewide association study (GWAS) approach based on restriction site-associated DNA sequencing (RADseq) data. We use GWAS models that account for relatedness between individuals and include covariates (sex, age and tarsus length). The resulting association landscape was flat with no peaks on chromosome 2 or elsewhere, which is in line with expectations for polygenic traits. Analysis of the distribution of p-values did not reveal biases, and the inflation factor was low. Effect sizes were however not uniformly distributed on some chromosomes, and the Z chromosome had weaker associations than autosomes. The level of linkage disequilibrium (LD) in the population decayed to background levels within c. 1 kbp. There could be several reasons to why our QTL study and GWAS gave contrasting results including differences in how associations are modelled (cosegregation in pedigree vs. LD associations), how covariates are accounted for in the models, type of marker used (multi- vs. biallelic), difference in power or a combination of these. Our study highlights that the genetic architecture even of highly heritable traits is difficult to characterize in wild populations. © 2018 John Wiley & Sons Ltd.

  10. Prenatal Diagnosis of Transposition of the Great Arteries over a 20-Year Period: Improved but Imperfect

    Science.gov (United States)

    Escobar-Diaz, Maria C; Freud, Lindsay R; Bueno, Alejandra; Brown, David W; Friedman, Kevin; Schidlow, David; Emani, Sitaram; del Nido, Pedro; Tworetzky, Wayne

    2015-01-01

    Objective To evaluate temporal trends in prenatal diagnosis of transposition of the great arteries with intact ventricular septum (TGA/IVS) and its impact on neonatal morbidity and mortality. Methods Newborns with TGA/IVS referred for surgical management to our center over a 20-year period (1992 – 2011) were included. The study time was divided into 5 four-year periods, and the primary outcome was rate of prenatal diagnosis. Secondary outcomes included neonatal pre-operative status and perioperative survival. Results Of the 340 patients, 81 (24%) had a prenatal diagnosis. Prenatal diagnosis increased over the study period from 6% to 41% (p<0.001). Prenatally diagnosed patients underwent a balloon atrial septostomy (BAS) earlier than postnatally diagnosed patients (0 vs. 1 day, p<0.001) and fewer required mechanical ventilation (56% vs. 69%, p=0.03). There were no statistically significant differences in pre-operative acidosis (16% vs. 26%, p=0.1) and need for preoperative ECMO (2% vs. 3%, p=1.0). There was also no significant mortality difference (1 pre-operative and no post-operative deaths among prenatally diagnosed patients, as compared to 4 pre-operative and 6 post-operative deaths among postnatally diagnosed patients). Conclusion The prenatal detection rate of TGA/IVS has improved but still remains below 50%, suggesting the need for strategies to increase detection rates. The mortality rate was not statistically different between pre- and postnatally diagnosed patients; however, there were significant pre-operative differences with regard to earlier BAS and less mechanical ventilation. Ongoing study is required to elucidate whether prenatal diagnosis confers long-term benefit. PMID:25484180

  11. 10 ways to improve NSS results

    OpenAIRE

    Byrd, Hugh

    2014-01-01

    This presentation is a series of suggestions and ideas for improving NSS results in an architectural course, though much of it is applicable to other design-based courses. The slides are not intended to be in any order of priority. 50 practical suggestions around 10 themes that correspond to NSS questions

  12. Long-term results of external valvuloplasty in adult patients with isolated great saphenous vein insufficiency

    Directory of Open Access Journals (Sweden)

    Sarac A

    2014-04-01

    Full Text Available Atilla Sarac,1 Artan Jahollari,1 Sureyya Talay,1 Sevket Ozkaya,2 Ertugrul Ozal1 1Department of Cardiovascular Medicine, Samsun Medical Park Hospital, Samsun, Turkey; 2Department of Pulmonary Medicine, Faculty of Medicine, Bahcesehir University, Istanbul, Turkey Objective: The aim of this study is to present our 7-year results of external valvuloplasty for isolated great saphenous vein (GSV insufficiency. Methods: External valvuloplasty was applied in 83 patients with isolated GSV insufficiency. Follow-up consisted of venous color duplex scanning performed on the first postoperative day, the first postoperative month, and then annually. Valvular insufficiency, venous reflux, and venous thrombosis formation in the saphenofemoral junction were the main outcomes. Results: A complete clinical and radiological healing was observed in 50 patients (60%. In 13 cases (15.6%, a secondary surgical treatment was performed consisting of vena saphena magna high ligation/stripping and varicose vein excisions, mainly due to severe and progressive vena saphena magna valvular insufficiency and clinical persistence of symptoms. Eight patients (9.6% developed superficial vein thrombosis, and only one patient (1.2% developed deep vein thrombosis. Contact was lost from 32 patients (38.5% for different reasons. Conclusion: External valvuloplasty is an effective surgical technique for selected cases of isolated GSV insufficiency without extensive varicose dilatations. This alternative method can be safely administered as an alternative to high ligation and conventional GSV stripping. Keyword: vein, saphenous, insufficiency, external valv, valvuloplasty, varicosis

  13. 50th Anniversary of Bilyar Archaeological Expedition: results and issues of Great Town investigation

    Directory of Open Access Journals (Sweden)

    Khuzin Fayaz Sh.

    2017-07-01

    Full Text Available The article outlines the main results of the investigation of Bilyar fortified settlement – a unique monument of medieval East-European archaeology located in Alexeyevsky District of the Tatarstan Republic. A small amount of information on Bilyar has remained in Ancient Russian chronicles (in which it is referred to as Great Town and the works by 10th – 14th century Arabic and Persian authors. The monument has been known to historians since 18th century, but its archaeological excavations only started in 1967. For 20 years researchers studied its fortifications, five urban burial grounds (including a necropolis of nobility in the centre of the town, discovered the ruined remains of three brick buildings and a white-stone Cathedral Mosque with a free-standing minaret, craft workshops (pottery, glass-making, blacksmithing and metallurgical, as well as tens and hundreds of common dwellings, utility structures and wells. The discoveries made by Bilyar expedition received a positive reaction from the archaeological community of the country. Since late 1980s the activity of the expedition gradually decreased due to the absence of adequate financing. Minor protective excavations were generally performed in the neighbouring villages. Investigation of the settlement it self continued in 2015. The necessity of continuing systematic excavations in Bilyar and the surrounding monuments is evident from both the scientific and practical viewpoints – application of investigation results for the purposes of tourism.

  14. IMAGE ANALYSIS FOR COSMOLOGY: RESULTS FROM THE GREAT10 STAR CHALLENGE

    Energy Technology Data Exchange (ETDEWEB)

    Kitching, T. D.; Heymans, C. [Mullard Space Science Laboratory, University College London, Holmbury St. Mary, Dorking, Surrey RH5 6NT (United Kingdom); Rowe, B.; Witherick, D. [Department of Physics and Astronomy, University College London, Gower Street, London WC1E 6BT (United Kingdom); Gill, M. [Center for Cosmology and AstroParticle Physics, Physics Department, The Ohio State University, Columbus, OH (United States); Massey, R. [Institute for Computational Cosmology, Durham University, South Road, Durham DH1 3LE (United Kingdom); Courbin, F.; Gentile, M.; Meylan, G. [Laboratoire d' Astrophysique, Ecole Polytechnique Federale de Lausanne (EPFL) (Switzerland); Georgatzis, K. [Department of Information and Computer Science, Aalto University, P.O. Box 15400, FI-00076 Aalto (Finland); Gruen, D. [Department of Physics and Astronomy, 209 South 33rd Street, University of Pennsylvania, Philadelphia, PA 19104 (United States); Kilbinger, M. [Excellence Cluster Universe, Boltzmannstr. 2, D-85748 Garching (Germany); Li, G. L. [Purple Mountain Observatory, 2 West Beijing Road, Nanjing 210008 (China); Mariglis, A. P.; Storkey, A. [School of Informatics, University of Edinburgh, 10 Crichton Street, Edinburgh EH8 9AB (United Kingdom); Xin, B., E-mail: t.kitching@ucl.ac.uk [Department of Physics, Purdue University, 525 Northwestern Avenue, West Lafayette, IN 47907 (United States)

    2013-04-01

    We present the results from the first public blind point-spread function (PSF) reconstruction challenge, the GRavitational lEnsing Accuracy Testing 2010 (GREAT10) Star Challenge. Reconstruction of a spatially varying PSF, sparsely sampled by stars, at non-star positions is a critical part in the image analysis for weak lensing where inaccuracies in the modeled ellipticity e and size R {sup 2} can impact the ability to measure the shapes of galaxies. This is of importance because weak lensing is a particularly sensitive probe of dark energy and can be used to map the mass distribution of large scale structure. Participants in the challenge were presented with 27,500 stars over 1300 images subdivided into 26 sets, where in each set a category change was made in the type or spatial variation of the PSF. Thirty submissions were made by nine teams. The best methods reconstructed the PSF with an accuracy of {sigma}(e) Almost-Equal-To 2.5 Multiplication-Sign 10{sup -4} and {sigma}(R {sup 2})/R {sup 2} Almost-Equal-To 7.4 Multiplication-Sign 10{sup -4}. For a fixed pixel scale, narrower PSFs were found to be more difficult to model than larger PSFs, and the PSF reconstruction was severely degraded with the inclusion of an atmospheric turbulence model (although this result is likely to be a strong function of the amplitude of the turbulence power spectrum).

  15. IMAGE ANALYSIS FOR COSMOLOGY: RESULTS FROM THE GREAT10 STAR CHALLENGE

    International Nuclear Information System (INIS)

    Kitching, T. D.; Heymans, C.; Rowe, B.; Witherick, D.; Gill, M.; Massey, R.; Courbin, F.; Gentile, M.; Meylan, G.; Georgatzis, K.; Gruen, D.; Kilbinger, M.; Li, G. L.; Mariglis, A. P.; Storkey, A.; Xin, B.

    2013-01-01

    We present the results from the first public blind point-spread function (PSF) reconstruction challenge, the GRavitational lEnsing Accuracy Testing 2010 (GREAT10) Star Challenge. Reconstruction of a spatially varying PSF, sparsely sampled by stars, at non-star positions is a critical part in the image analysis for weak lensing where inaccuracies in the modeled ellipticity e and size R 2 can impact the ability to measure the shapes of galaxies. This is of importance because weak lensing is a particularly sensitive probe of dark energy and can be used to map the mass distribution of large scale structure. Participants in the challenge were presented with 27,500 stars over 1300 images subdivided into 26 sets, where in each set a category change was made in the type or spatial variation of the PSF. Thirty submissions were made by nine teams. The best methods reconstructed the PSF with an accuracy of σ(e) ≈ 2.5 × 10 –4 and σ(R 2 )/R 2 ≈ 7.4 × 10 –4 . For a fixed pixel scale, narrower PSFs were found to be more difficult to model than larger PSFs, and the PSF reconstruction was severely degraded with the inclusion of an atmospheric turbulence model (although this result is likely to be a strong function of the amplitude of the turbulence power spectrum).

  16. Assessment of compliance costs resulting from implementation of the proposed Great Lakes water quality guidance

    International Nuclear Information System (INIS)

    Fenner, K.; Podar, M.; Snyder, B.

    1993-01-01

    The primary purpose of the study was to develop an estimate of the incremental cost to direct dischargers resulting from the implementation of the proposed Great Lakes Water Quality Guidance (GLWQG). This estimate reflects the incremental cost of complying with permit requirements developed using the Implementation Procedures and water quality criteria proposed in the GLWQG versus permit requirements based on existing State water quality standards. Two secondary analyses were also performed, one to develop a preliminary estimate of the costs that would be incurred by indirect dischargers to publicly owned treatment works (POTWs), and another to evaluate the cost-effectiveness of the GLWQG. Finally, several sensitivity analyses were performed to evaluate the impact of several major assumptions on the estimated compliance costs. To estimate compliance costs, permit limitations and conditions based on existing State water quality standards were compared to water quality-based limitations and conditions based on the proposed GLWQG criteria and Implementation Procedures for a sample of plants. The control measures needed to comply with the proposed GLWQG-based effluent limitations were evaluated. Individual plant compliance costs were estimated for these control measures based on information on treatment technology and cost analyses available in the literature. An overall compliance cost was projected from the sample based on statistical methods

  17. Long-term results after atrial correction of complete transposition of the great arteries.

    Science.gov (United States)

    Merlo, M; de Tommasi, S M; Brunelli, F; Abbruzzese, P A; Crupi, G; Ghidoni, I; Casari, A; Pitì, A; Mamprin, F; Parenzan, L

    1991-02-01

    This study presents the late results for the first 104 consecutive patients surviving and atrial repair for transposition of the great arteries (TGA) between January 1971 and December 1978 (group 1). Mean follow-up was 12 years (range, 0.1 to 17.7 years). The actuarial survival rate at 18 years was 84.2% (70% confidence limits, 79% to 88%) for simple TGA and 93.7% (70% confidence limits, 84% to 97%) for complex TGA. Nine of the 11 deaths were sudden. Two (2.6%) of the 78 late survivors operated on for simple TGA are in New York Heart Association functional class III or IV versus 4 (26.7%) of the 15 survivors with complex TGA; the other patients are doing very well. To better assess long-term results, we report the findings for randomly obtained electrocardiograms, Holter monitor recordings, radionuclide angiographic studies, and cardiac catheterizations performed in 1987 in a larger group of 159 long-term survivors of atrial repair operated on at Ospedale Riuniti di Bergamo from January 1971 to December 1984 (group 2), which includes all of group 1. The findings confirm that the arterial switch repair is the procedure of choice for complex TGA and that there is a major incidence (approximately 10%) of systemic right ventricular dysfunction and rhythm disturbances after the atrial repair. On the other hand, our late survival rate at 18 years of 84% for simple TGA with 97.5% of the patients in functional class I is a result that should be kept in mind, especially in institutions where the arterial switch is a relatively new approach and presumably is a higher risk to cause early death.

  18. Assessing community values for reducing agricultural emissions to improve water quality and protect coral health in the Great Barrier Reef

    Science.gov (United States)

    Rolfe, John; Windle, Jill

    2011-12-01

    Policymakers wanting to increase protection of the Great Barrier Reef from pollutants generated by agriculture need to identify when measures to improve water quality generate benefits to society that outweigh the costs involved. The research reported in this paper makes a contribution in several ways. First, it uses the improved science understanding about the links between management changes and reef health to bring together the analysis of costs and benefits of marginal changes, helping to demonstrate the appropriate way of addressing policy questions relating to reef protection. Second, it uses the scientific relationships to frame a choice experiment to value the benefits of improved reef health, with the results of mixed logit (random parameter) models linking improvements explicitly to changes in "water quality units." Third, the research demonstrates how protection values are consistent across a broader population, with some limited evidence of distance effects. Fourth, the information on marginal costs and benefits that are reported provide policymakers with information to help improve management decisions. The results indicate that while there is potential for water quality improvements to generate net benefits, high cost water quality improvements are generally uneconomic. A major policy implication is that cost thresholds for key pollutants should be set to avoid more expensive water quality proposals being selected.

  19. Guiding principles for the improved governance of port and shipping impacts in the Great Barrier Reef.

    Science.gov (United States)

    Grech, A; Bos, M; Brodie, J; Coles, R; Dale, A; Gilbert, R; Hamann, M; Marsh, H; Neil, K; Pressey, R L; Rasheed, M A; Sheaves, M; Smith, A

    2013-10-15

    The Great Barrier Reef (GBR) region of Queensland, Australia, encompasses a complex and diverse array of tropical marine ecosystems of global significance. The region is also a World Heritage Area and largely within one of the world's best managed marine protected areas. However, a recent World Heritage Committee report drew attention to serious governance problems associated with the management of ports and shipping. We review the impacts of ports and shipping on biodiversity in the GBR, and propose a series of guiding principles to improve the current governance arrangements. Implementing these principles will increase the capacity of decision makers to minimize the impacts of ports and shipping on biodiversity, and will provide certainty and clarity to port operators and developers. A 'business as usual' approach could lead to the GBR's inclusion on the List of World Heritage in Danger in 2014. Copyright © 2013 Elsevier Ltd. All rights reserved.

  20. Seismogenic Tectonic Environment of 1976 Great Tangshan Earthquake: Results from Dense Seismic Array Observations

    Science.gov (United States)

    LIU, Qiyuan; WANG, Jun; CHEN, Jiuhui; LI, Shuncheng; GUO, Biao

    On July 28, 1976, the great Tangshan earthquake that shook the whole world took place in the Tangshan area of the Hebei Province, China. A big incomprehensible question is why such a tremendous earthquake took place in the Paleo-craton area in North China? It would be worth considering whether a similar event will reoccur in the Tangshan region. In this study, using the receiver function inversion technique and teleseismic P waveform data recorded at the Capital Circle Seismic network and our movable seismic array, we investigated the 3-D S-wave velocity structure of the crust and upper mantle down to 60 km beneath Tangshan area. Our results manifest that (1) the media beneath the Tangshan block cut by active faults are very different from the adjacent area, and all of the active faults surrounding the Tangshan block was through the whole crust; (2) in the upper and middle crust, there exist obvious heterogeneous low-velocity media beneath the Tangshan earthquake region; the crust-mantle boundary has an obvious block uplift and, in comparison with both sides, the top anomalous uplift of the upper mantle beneath the Tangshan block reaches to 10 km, and the upper mantle beneath has an anomalous heterogeneous structure; (4) beneath the Tangshan earthquake region, there are probably massive intrusions derived from the upper mantle, which form the low-velocity body in the upper and middle crust. Because of our results having much higher resolution than previous results, some new features of the crust and upper mantle velocity structure could be shown in this study; (5) the locations of destructive earthquakes are not random and are related closely to their deep structure of the crust and upper mantle. This provides a possibility of correctly estimating the location of destructive earthquakes. On the basis of our results, we discuss the dynamic genesis of the Tangshan earthquake. We consider that the main dynamic source for the Tangshan earthquake is the vertical

  1. SLAC modulator system improvements and reliability results

    International Nuclear Information System (INIS)

    Donaldson, A.R.

    1998-06-01

    In 1995, an improvement project was completed on the 244 klystron modulators in the linear accelerator. The modulator system has been previously described. This article offers project details and their resulting effect on modulator and component reliability. Prior to the project, the authors had collected four operating cycles (1991 through 1995) of MTTF data. In this discussion, the '91 data will be excluded since the modulators operated at 60 Hz. The five periods following the '91 run were reviewed due to the common repetition rate at 120 Hz

  2. Ecosystem Services in the Great Lakes – Results of a Summit

    Science.gov (United States)

    A comprehensive inventory of ecosystem services across the entire Great Lakes basin is currently lacking and is needed to make informed management decisions. A greater appreciation and understanding of ecosystem services, including both use and non-use services, may have avoided ...

  3. Great improvement in pseudocapacitor properties of nickel hydroxide via simple gold deposition

    Science.gov (United States)

    Kim, Sun-I.; Thiyagarajan, Pradheep; Jang, Ji-Hyun

    2014-09-01

    In this letter, we report a facile approach to improve the capacitor properties of nickel hydroxide (Ni(OH)2) by simply coating gold nanoparticles (Au NPs) on the surface of Ni(OH)2. Au NP-deposited Ni(OH)2 (Au/Ni(OH)2) has been prepared by application of a conventional colloidal coating of Au NPs on the surface of 3D-Ni(OH)2 synthesized via a hydrothermal method. Compared with pristine Ni(OH)2, Au/Ni(OH)2 shows a 41% enhanced capacitance value, excellent rate capacitance behavior at high current density conditions, and greatly improved cycling stability for supercapacitor applications. The specific capacitance of Au/Ni(OH)2 reached 1927 F g-1 at 1 A g-1, which is close to the theoretical capacitance and retained 66% and 80% of the maximum value at a high current density of 20 A g-1 and 5000 cycles while that of pristine Ni(OH)2 was 1363 F g-1 and significantly decreased to 48% and 30%, respectively, under the same conditions. The outstanding performance of Au/Ni(OH)2 as a supercapacitor is attributed to the presence of metal Au NPs on the surface of semiconductor Ni(OH)2; this permits the creation of virtual 3D conducting networks via metal/semiconductor contact, which induces fast electron and ion transport by acting as a bridge between Ni(OH)2 nanostructures, thus eventually leading to significantly improved electrochemical capacitive behaviors, as confirmed by the EIS and I-V characteristic data.In this letter, we report a facile approach to improve the capacitor properties of nickel hydroxide (Ni(OH)2) by simply coating gold nanoparticles (Au NPs) on the surface of Ni(OH)2. Au NP-deposited Ni(OH)2 (Au/Ni(OH)2) has been prepared by application of a conventional colloidal coating of Au NPs on the surface of 3D-Ni(OH)2 synthesized via a hydrothermal method. Compared with pristine Ni(OH)2, Au/Ni(OH)2 shows a 41% enhanced capacitance value, excellent rate capacitance behavior at high current density conditions, and greatly improved cycling stability for

  4. Interim Results on Improvement of Melia volkensii

    International Nuclear Information System (INIS)

    Kariuki, J.G.; Kimondo, J.M; Muchri, D.K

    2007-01-01

    Melia volkensii is important in some dry lands of Kenya as a high quality timber, for fodder, shade and construction. It is both drought resistant and fast growing and is termite resistant. Demand for the species has led to dysgenic selection, resulting in the selection of superior trees, progressively leading to a pool of poor parent trees remaining in most populations. A genetic improvement strategy and implementation plan was initiated in the year 2005. The main objective was genetic improvement of melia volkensii through selection, breeding and propagation. Specific objectives was to develop new plantations that are superior to their predecessors in one or several key economic traits and to maximize value of logs produced by farmers. The basic material for selection of plus trees were the natural and on farm populations across most of the species' natural range. Selection was carried out in nine transects located in various areas from Isiolo to Voi, through assessment of candidate trees and subsequent comparison with nearest 5 check trees. Site characterization and passport data collection was also carried out. Various selection criteria were used including diameter at breast height (dbh), height, form (straightness and branching habit), resistance to diseases, pests and spiral grain tendency. For establishment of hedges , stressing of root through severing part of the root to produce scions was done, followed by scion selection and grafting. Initial results showed the existence of two main forms in M. volkensii i.e crop and tree ideotypes. Crop ideotypes are shorter, have shorter clear boles with deep large and spreading crowns, mainly found in Mwingi, Nuu, Tseikuru and some parts of Kitui. Tree ideotypes are taller with long clear boles, light branching and sparce crowns mainly found in Voi, Mbeere,Mutha and Embu. Intermediate forms also exist. Because the breeding objective was timber production, the tree ideotypes were favoured in selection. In all nine

  5. Improved results for vestibular schwannoma radiosurgery

    Energy Technology Data Exchange (ETDEWEB)

    Flickinger, J C; Kondziolka, D; Pollock, B; Lunsford, L D

    1995-07-01

    PURPOSE/OBJECTIVE: Treatment techniques in radiosurgery have changed since 1987. We reviewed patients who received radiosurgery for vestibular schwannoma to identify these changes and to investigate any differences in tumor control and complications. MATERIALS and METHODS: One hundred thirty-eight unilateral vestibular schwannoma patients with a minimum follow-up of two years after treatment with gamma knife radiosurgery between 1987 and 1992 were analyzed. The early treatment group consisted of 55 patients treated between 1987-1989 (median: tumor volume 3.63 cc, Dmin 18.1 Gy, Dmax 35.4 Gy, isocenters 2.3, follow-up 50.4 mos.). The later treatment group consisted of 83 patients treated between 1990-1992 (median: tumor volume 3.81 cc, Dmin 16.0 Gy, Dmax 31.6 Gy, isocenters 4.7, follow-up 35.8 mos.) RESULTS: Clinical tumor recurrence requiring surgical intervention occurred in one patient in each group. The overall actuarial clinical tumor control rate was 98%. Slight increases in tumor size (1 to 2 mm) were identified in five other patients not requiring intervention, because of no further tumor growth (n=4) or shrinkage (n=1). This led to an overall radiologic tumor control rate of 92% (not significantly different in either group). Compared to the early treatment group, the incidence of facial neuropathy (temporary or permanent) decreased in the later group (49% vs. 11%, p < 0.0001), as did trigeminal neuropathy (40% vs. 8%, p < 0.0001). Serviceable hearing preservation improved only slightly in the later group (27% vs. 40%, p = 0.70). CONCLUSION: We document a significant decrease in the morbidity of vestibular schwannoma radiosurgery over this time period with no decrease in the high rate of tumor control. This improvement is attributed to a) better conformal dose-planning with stereotactic MRI rather than CT, b) an increase in the number of isocenters used, and c) a reduction in the average dose administered by 2 Gy.

  6. Improved self-exclusion program: preliminary results.

    Science.gov (United States)

    Tremblay, Nicole; Boutin, Claude; Ladouceur, Robert

    2008-12-01

    The gambling industry has offered self-exclusion programs for quite a long time. Such measures are designed to limit access to gaming opportunities and provide problem gamblers with the help they need to cease or limit their gambling behaviour. However, few studies have empirically evaluated these programs. This study has three objectives: (1) to observe the participation in an improved self-exclusion program that includes an initial voluntary evaluation, phone support, and a mandatory meeting, (2) to evaluate satisfaction and usefulness of this service as perceived by self-excluders, (3) to measure the preliminary impact of this improved program. One hundred sixteen self-excluders completed a questionnaire about their satisfaction and their perception of the usefulness during the mandatory meeting. Among those participants, 39 attended an initial meeting. Comparisons between data collected at the initial meeting and data taken at the final meeting were made for those 39 participants. Data showed that gamblers chose the improved self-exclusion program 75% of the time; 25% preferred to sign a regular self-exclusion contract. Among those who chose the improved service, 40% wanted an initial voluntary evaluation and 37% of these individuals actually attended that meeting. Seventy percent of gamblers came to the mandatory meeting, which was a required condition to end their self-exclusion. The majority of participants were satisfied with the improved self-exclusion service and perceived it as useful. Major improvements were observed between the final and the initial evaluation on time and money spent, consequences of gambling, DSM-IV score, and psychological distress. The applicability of an improved self-exclusion program is discussed and, as shown in our study, the inclusion of a final mandatory meeting might not be so repulsive for self-excluders. Future research directives are also proposed.

  7. Leveraging Big Data to Improve Health Awareness Campaigns: A Novel Evaluation of the Great American Smokeout.

    Science.gov (United States)

    Ayers, John W; Westmaas, J Lee; Leas, Eric C; Benton, Adrian; Chen, Yunqi; Dredze, Mark; Althouse, Benjamin M

    2016-01-01

    Awareness campaigns are ubiquitous, but little is known about their potential effectiveness because traditional evaluations are often unfeasible. For 40 years, the "Great American Smokeout" (GASO) has encouraged media coverage and popular engagement with smoking cessation on the third Thursday of November as the nation's longest running awareness campaign. We proposed a novel evaluation framework for assessing awareness campaigns using the GASO as a case study by observing cessation-related news reports and Twitter postings, and cessation-related help seeking via Google, Wikipedia, and government-sponsored quitlines. Time trends (2009-2014) were analyzed using a quasi-experimental design to isolate spikes during the GASO by comparing observed outcomes on the GASO day with the simulated counterfactual had the GASO not occurred. Cessation-related news typically increased by 61% (95% CI 35-87) and tweets by 13% (95% CI -21 to 48) during the GASO compared with what was expected had the GASO not occurred. Cessation-related Google searches increased by 25% (95% CI 10-40), Wikipedia page visits by 22% (95% CI -26 to 67), and quitline calls by 42% (95% CI 19-64). Cessation-related news media positively coincided with cessation tweets, Internet searches, and Wikipedia visits; for example, a 50% increase in news for any year predicted a 28% (95% CI -2 to 59) increase in tweets for the same year. Increases on the day of the GASO rivaled about two-thirds of a typical New Year's Day-the day that is assumed to see the greatest increases in cessation-related activity. In practical terms, there were about 61,000 more instances of help seeking on Google, Wikipedia, or quitlines on GASO each year than would normally be expected. These findings provide actionable intelligence to improve the GASO and model how to rapidly, cost-effectively, and efficiently evaluate hundreds of awareness campaigns, nearly all for the first time.

  8. Summary of Great East Japan Earthquake response at Onagawa Nuclear Power Station and further safety improvement measures

    International Nuclear Information System (INIS)

    Sato, Toru

    2013-01-01

    A large earthquake occurred on March 11, 2011 and tsunami was generated following it. The East Japan suffered serious damage by the earthquake and tsunami. This is called the Great East Japan Earthquake. Onagawa Nuclear Power Station (NPS) is located closest to the epicenter of Great East Japan Earthquake. We experienced intense shake by the earthquake and some flooding from the tsunami, however, we have succeeded safely cold shutdown of the reactors. In this paper, we introduce summary of Great East Japan Earthquake response a Onagawa NPS and safety improvement measures which are based on both experience of Onagawa NPS and lesson from Fukushima Daiichi NPS accident. (author)

  9. Kinds of damage that could result from a great earthquake in the central United States

    Science.gov (United States)

    Hooper, M.G.; Algermissen, S.T.

    1985-01-01

    In the winter of 1811-12 a series of three great earthquakes occurred in the New Madrid, Missouri seismic zone in the central United States. In addition to the three principal shocks, at least 15 other earthquakes of intensity VIII or more occurred within a year of the first large earthquake on December 16, 1811. The three main shocks were felt over the entire eastern United States. They were strong enough to cause minor damage cause minor damage as far away as Indiana and Ohio on the north, the Carolinas on the east, and southern Mississippi to the south. They were strong enough to cause severe or structural damage in parts of Missouri, Illinois, Indiana, Kentucky, Tennessee, Mississippi, and Arkansas. A later section in this article describes what happened in the epicentral region. Fortunately, few people lived in the severely shaken area in 1811; that is not the case today. What would happen if a series of earthquakes as large and numerous as the "New Madrid" earthquakes were to occur in the New Madrid seismic zone today?

  10. Great Expectations, Mixed Results: Standards and Performance in Denver's New Public Schools, 2007-2011

    Science.gov (United States)

    Ooms, Alexander

    2012-01-01

    In conjunction with the Denver Plan instituted in 2005, Denver Public Schools (DPS) has embarked upon a consistent strategy of opening new schools in an effort to improve overall academic performance. DPS has pursued this strategy under several different paths: an annual request for proposals from charter school applicants; allowing current…

  11. 3 Steps to Great Coaching: A Simple but Powerful Instructional Coaching Cycle Nets Results

    Science.gov (United States)

    Knight, Jim; Elford, Marti; Hock, Michael; Dunekack, Devona; Bradley, Barbara; Deshler, Donald D.; Knight, David

    2015-01-01

    In this article the authors describe a three-step instructional coaching cycle that can helps coaches become more effective. The article provides the steps and related components to: (1) Identify; (2) Learn; and (3) Improve. While the instructional coaching cycle is only one effective coaching program, coaches also need professional learning that…

  12. Intensive precipitation observation greatly improves hydrological modelling of the poorly gauged high mountain Mabengnong catchment in the Tibetan Plateau

    Science.gov (United States)

    Wang, Li; Zhang, Fan; Zhang, Hongbo; Scott, Christopher A.; Zeng, Chen; Shi, Xiaonan

    2018-01-01

    Precipitation is one of the most critical inputs for models used to improve understanding of hydrological processes. In high mountain areas, it is challenging to generate a reliable precipitation data set capturing the spatial and temporal heterogeneity due to the harsh climate, extreme terrain and the lack of observations. This study conducts intensive observation of precipitation in the Mabengnong catchment in the southeast of the Tibetan Plateau during July to August 2013. Because precipitation is greatly influenced by altitude, the observed data are used to characterize the precipitation gradient (PG) and hourly distribution (HD), showing that the average PG is 0.10, 0.28 and 0.26 mm/d/100 m and the average duration is around 0.1, 0.8 and 5.2 h for trace, light and moderate rain, respectively. A distributed biosphere hydrological model based on water and energy budgets with improved physical process for snow (WEB-DHM-S) is applied to simulate the hydrological processes with gridded precipitation data derived from a lower altitude meteorological station and the PG and HD characterized for the study area. The observed runoff, MODIS/Terra snow cover area (SCA) data, and MODIS/Terra land surface temperature (LST) data are used for model calibration and validation. Runoff, SCA and LST simulations all show reasonable results. Sensitivity analyses illustrate that runoff is largely underestimated without considering PG, indicating that short-term intensive precipitation observation has the potential to greatly improve hydrological modelling of poorly gauged high mountain catchments.

  13. An evaluation of The Great Escape: can an interactive computer game improve young children's fire safety knowledge and behaviors?

    Science.gov (United States)

    Morrongiello, Barbara A; Schwebel, David C; Bell, Melissa; Stewart, Julia; Davis, Aaron L

    2012-07-01

    Fire is a leading cause of unintentional injury and, although young children are at particularly increased risk, there are very few evidence-based resources available to teach them fire safety knowledge and behaviors. Using a pre-post randomized design, the current study evaluated the effectiveness of a computer game (The Great Escape) for teaching fire safety information to young children (3.5-6 years). Using behavioral enactment procedures, children's knowledge and behaviors related to fire safety were compared to a control group of children before and after receiving the intervention. The results indicated significant improvements in knowledge and fire safety behaviors in the intervention group but not the control. Using computer games can be an effective way to promote young children's understanding of safety and how to react in different hazardous situations.

  14. CLEO results, CLEO II and CESR improvements

    International Nuclear Information System (INIS)

    Hartill, D.L.

    1990-01-01

    Recent results from the analysis of CLEO data are presented along with a status report of the installation progress for the new CLEO II detector. The physics results include new results on B semileptonic decays, B to charm, and B to u decays. In addition, new results on D** and D s decays are presented along with Y(1S)→Ψ and other Upsilon decays. The installation of CLEO II is more than 80% complete with first operation with CESR expected by late summer 1989. CESR luminosity upgrade plans are given along with a schedule for that upgrade, called CESR Plus, to become operational. Recently, a modest effort has started at Cornell to design a B-factory with a peak luminosity in region of 10 34 cm -2 sec -1 . Initial parameters for a symmetric energy storage ring design are given. (author)

  15. The development of a sub-daily gridded rainfall product to improve hydrological predictions in Great Britain

    Science.gov (United States)

    Quinn, Niall; Freer, Jim; Coxon, Gemma; O'Loughlin, Fiachra; Woods, Ross; Liguori, Sara

    2015-04-01

    In Great Britain and many other regions of the world, flooding resulting from short duration, high intensity rainfall events can lead to significant economic losses and fatalities. At present, such extreme events are often poorly evaluated using hydrological models due, in part, to their rarity and relatively short duration and a lack of appropriate data. Such storm characteristics are not well represented by daily rainfall records currently available using volumetric gauges and/or derived gridded products. This research aims to address this important data gap by developing a sub-daily gridded precipitation product for Great Britain. Our focus is to better understand these storm events and some of the challenges and uncertainties in quantifying such data across catchment scales. Our goal is to both improve such rainfall characterisation and derive an input to drive hydrological model simulations. Our methodology involves the collation, error checking, and spatial interpolation of approximately 2000 rain gauges located across Great Britain, provided by the Scottish Environment Protection Agency (SEPA) and the Environment Agency (EA). Error checking was conducted over the entirety of the TBR data available, utilising a two stage approach. First, rain gauge data at each site were examined independently, with data exceeding reasonable thresholds marked as suspect. Second, potentially erroneous data were marked using a neighbourhood analysis approach whereby measurements at a given gauge were deemed suspect if they did not fall within defined bounds of measurements at neighbouring gauges. A total of eight error checks were conducted. To provide the user with the greatest flexibility possible, the error markers associated with each check have been recorded at every site. This approach aims to enable the user to choose which checks they deem most suitable for a particular application. The quality assured TBR dataset was then spatially interpolated to produce a national

  16. History of the Great Patriotic War of the Soviet Union, 1941-1945. Volume 6. Results of the Great Patriotic War,

    Science.gov (United States)

    1982-10-06

    Iraq, Iceland, Canada, Costa Rica, Cuba, Lebanon, Mexico , Netherlands, Nicaragua, New Zealand, Syria, Uruguay, Chile, Ecuador, Ethiopia 4. The number...Great Patriotic War), a collection of docu- ments. Yaroslavl’ Book Publishers, 1960. ALBANIA Banca Nazionale d’Albania. Ufficio studi. Economia albanese

  17. Complete exon sequencing of all known Usher syndrome genes greatly improves molecular diagnosis.

    Science.gov (United States)

    Bonnet, Crystel; Grati, M'hamed; Marlin, Sandrine; Levilliers, Jacqueline; Hardelin, Jean-Pierre; Parodi, Marine; Niasme-Grare, Magali; Zelenika, Diana; Délépine, Marc; Feldmann, Delphine; Jonard, Laurence; El-Amraoui, Aziz; Weil, Dominique; Delobel, Bruno; Vincent, Christophe; Dollfus, Hélène; Eliot, Marie-Madeleine; David, Albert; Calais, Catherine; Vigneron, Jacqueline; Montaut-Verient, Bettina; Bonneau, Dominique; Dubin, Jacques; Thauvin, Christel; Duvillard, Alain; Francannet, Christine; Mom, Thierry; Lacombe, Didier; Duriez, Françoise; Drouin-Garraud, Valérie; Thuillier-Obstoy, Marie-Françoise; Sigaudy, Sabine; Frances, Anne-Marie; Collignon, Patrick; Challe, Georges; Couderc, Rémy; Lathrop, Mark; Sahel, José-Alain; Weissenbach, Jean; Petit, Christine; Denoyelle, Françoise

    2011-05-11

    Usher syndrome (USH) combines sensorineural deafness with blindness. It is inherited in an autosomal recessive mode. Early diagnosis is critical for adapted educational and patient management choices, and for genetic counseling. To date, nine causative genes have been identified for the three clinical subtypes (USH1, USH2 and USH3). Current diagnostic strategies make use of a genotyping microarray that is based on the previously reported mutations. The purpose of this study was to design a more accurate molecular diagnosis tool. We sequenced the 366 coding exons and flanking regions of the nine known USH genes, in 54 USH patients (27 USH1, 21 USH2 and 6 USH3). Biallelic mutations were detected in 39 patients (72%) and monoallelic mutations in an additional 10 patients (18.5%). In addition to biallelic mutations in one of the USH genes, presumably pathogenic mutations in another USH gene were detected in seven patients (13%), and another patient carried monoallelic mutations in three different USH genes. Notably, none of the USH3 patients carried detectable mutations in the only known USH3 gene, whereas they all carried mutations in USH2 genes. Most importantly, the currently used microarray would have detected only 30 of the 81 different mutations that we found, of which 39 (48%) were novel. Based on these results, complete exon sequencing of the currently known USH genes stands as a definite improvement for molecular diagnosis of this disease, which is of utmost importance in the perspective of gene therapy.

  18. Complete exon sequencing of all known Usher syndrome genes greatly improves molecular diagnosis

    Directory of Open Access Journals (Sweden)

    Lacombe Didier

    2011-05-01

    Full Text Available Abstract Background Usher syndrome (USH combines sensorineural deafness with blindness. It is inherited in an autosomal recessive mode. Early diagnosis is critical for adapted educational and patient management choices, and for genetic counseling. To date, nine causative genes have been identified for the three clinical subtypes (USH1, USH2 and USH3. Current diagnostic strategies make use of a genotyping microarray that is based on the previously reported mutations. The purpose of this study was to design a more accurate molecular diagnosis tool. Methods We sequenced the 366 coding exons and flanking regions of the nine known USH genes, in 54 USH patients (27 USH1, 21 USH2 and 6 USH3. Results Biallelic mutations were detected in 39 patients (72% and monoallelic mutations in an additional 10 patients (18.5%. In addition to biallelic mutations in one of the USH genes, presumably pathogenic mutations in another USH gene were detected in seven patients (13%, and another patient carried monoallelic mutations in three different USH genes. Notably, none of the USH3 patients carried detectable mutations in the only known USH3 gene, whereas they all carried mutations in USH2 genes. Most importantly, the currently used microarray would have detected only 30 of the 81 different mutations that we found, of which 39 (48% were novel. Conclusions Based on these results, complete exon sequencing of the currently known USH genes stands as a definite improvement for molecular diagnosis of this disease, which is of utmost importance in the perspective of gene therapy.

  19. Chasing the Great American 2017 Total Solar Eclipse: Coronal Results from NASA's WB-57F High-Altitude Research Aircraft

    Science.gov (United States)

    Caspi, A.; Tsang, C.; DeForest, C. E.; Seaton, D. B.; Bryans, P.; Burkepile, J.; Casey, T. A.; Collier, J.; Darrow, D.; DeLuca, E.; Durda, D. D.; Gallagher, P.; Golub, L.; Judge, P. G.; Laurent, G. T.; Lewis, J.; Mallini, C.; Parent, T.; Propp, T.; Steffl, A.; Tomczyk, S.; Warner, J.; West, M. J.; Wiseman, J.; Zhukov, A.

    2017-12-01

    Total solar eclipses present rare opportunities to study the complex solar corona, down to altitudes of just a few percent of a solar radius above the surface, using ground-based and airborne observatories that would otherwise be dominated by the intense solar disk and high sky brightness. Studying the corona is critical to gaining a better understanding of physical processes that occur on other stars and astrophysical objects, as well as understanding the dominant driver of space weather that affects human assets at Earth and elsewhere. For example, it is still poorly understood how the corona is heated to temperatures of 1-2 MK globally and up to 5-10 MK above active regions, while the underlying chromosphere is 100 times cooler; numerous theories abound, but are difficult to constrain due to the limited sensitivities and cadences of prior measurements. The origins and stability of coronal fans, and the extent of their reach to the middle and outer corona, are also not well known, limited in large part by sensitivities and fields of view of existing observations. Airborne observations during the eclipse provide unique advantages; by flying in the stratosphere at altitudes of 50 kft or higher, they avoid all weather, the seeing quality is enormously improved, and additional wavelengths such as near- IR also become available due to significantly reduced water absorption. For an eclipse, an airborne observatory can also follow the shadow, increasing the total observing time by 50% or more. We present results of solar coronal measurements from airborne observations of the 2017 Great American Total Solar Eclipse using two of NASA's WB-57 high-altitude research aircraft, each equipped with two 8.7" telescopes feeding high-sensitivity visible (green-line) and medium-wave IR (3-5 μm) cameras operating at high cadence (30 Hz) with 3 arcsec/pixel platescale and ±3 R_sun fields of view. The aircraft flew along the eclipse path, separated by 110 km, to observe a summed 7

  20. PROPOSAL FOR IMPROVEMENT OF BUINESS CONTINUITY PLAN (BCP) BASED ON THE LESSONS OF THE GREAT EAST JAPAN EARTHQUAKE

    Science.gov (United States)

    Maruya, Hiroaki

    For most Japanese companies and organizations, the enormous damage of the Great East Japan Earthquake was more than expected. In addition to great tsunami and earthquake motion, the lack of electricity and fuel disturbed to business activities seriously, and they should be considered important constraint factors in future earthquakes. Furthermore, disruption of supply chains also led considerable decline of production in many industries across Japan and foreign countries. Therefore it becomes urgent need for Japanese government and industries to utilize the lessons of the Great Earthquake and execute effective countermeasures, considering great earthquakes such as Tonankai & Nankai earthquakes and Tokyo Inland Earthquakes. Obviously most basic step is improving earthquake-resistant ability of buildings and facilities. In addition the spread of BCP and BCM to enterprises and organizations is indispensable. Based on the lessons, the BCM should include the point of view of the supply chain management more clearly, and emphasize "substitute strategy" more explicitly because a company should survive even if it completely loses its present production base. The central and local governments are requested, in addition to develop their own BCP, to improve related systematic conditions for BCM of the private sectors.

  1. Public opinion on environmental and energy issues. Result of the census after 3 years of the Great East Japan Earthquake

    International Nuclear Information System (INIS)

    Kosugi, Motoko

    2014-01-01

    The public opinion on the energy and environmental issues has changed greatly in Japan through experiences in and along the Great East Japan Earthquake. We conducted a social survey in order to grasp public opinions for environment and energy issues in March, 2014, which obtained 2313 valid responses (response rate was 64.3%). For the energy and environmental issues, while respondents show high interests in matters related to the Fukushima accident and nuclear power generation as well as electricity prices, they show relatively low interest in every other aspect. With regard to Japan's energy policy in the future, as expectations for renewable and natural sources of energy are large, about 60% of respondents have negative attitude in restart of nuclear power. For nuclear power, as compared to the previous survey conducted in August 2008, evaluation of 'control-ability of environmental impacts' and 'the power companies' risk management ability' was greatly reduced in particular. These results suggest the importance of provoke interest in the energy issues in general, as a premise to seek an understanding of the activities of the government and power companies. Furthermore, in order for the power companies to restore trust from the public, it is important to sympathize to public's anticipations of impacts on the health and environment through uses of nuclear power in the future. (author)

  2. Improving cattle nutrition on the Great Plains with shrubs and fecal seeding of fourwing saltbush

    Science.gov (United States)

    Two in vitro trials were conducted for estimates of dietary percentage of fourwing saltbush (Atriplex canescens; FS) or winterfat (Krascheninnikovia lanata; WF) to improve diet digestibility when cattle graze mature cool-season grass. Three in vitro trials were conducted to estimate the percentage ...

  3. ECMO: Improving our Results by Chasing the Rabbits

    Directory of Open Access Journals (Sweden)

    Luiz Fernando Canêo

    2015-12-01

    Full Text Available ABSTRACT As Marcelo Giugale published in the Financial Times, Latin America, on the whole, has not excelled at innovation - doing the same things in a new and better way or at doing new things. It has been slow to acquire, adopt and adapt technologies by this time available in other places[1]. Although extracorporeal membrane oxygenation (ECMO is not a new technology, its use in Latin America is not widespread as needed. Furthermore, we still have a number centers doing ECMO, not reporting their cases, lacking a structured training program and not registered with the extracorporeal life support organization (ELSO. With this scenario, and accepting that ECMO is the first step in any circulatory support program, it is difficult to anticipate the incorporation of new and more complex devices as the technologically advanced world is currently doing. However, the good news is that with the support of experts from USA, Europe and Canada the results in Latin America ELSO'S centers are improving by following its guidelines for training, and using a standard educational process. There is no doubt that we can learn a great deal from the high velocity organizations - the rabbits - whom everyone chases but never catches, that manage to stay ahead because of their endurance, responsiveness, and their velocity in self-correction[2].

  4. Good to great: using 360-degree feedback to improve physician emotional intelligence.

    Science.gov (United States)

    Hammerly, Milton E; Harmon, Larry; Schwaitzberg, Steven D

    2014-01-01

    The past decade has seen intense interest and dramatic change in how hospitals and physician organizations review physician behaviors. The characteristics of successful physicians extend past their technical and cognitive skills. Two of the six core clinical competencies (professionalism and interpersonal/communication skills) endorsed by the Accreditation Council for Graduate Medical Education, the American Board of Medical Specialties, and The Joint Commission require physicians to succeed in measures associated with emotional intelligence (EI). Using 360-degree anonymous feedback surveys to screen for improvement opportunities in these two core competencies enables organizations to selectively offer education to further develop physician EI. Incorporating routine use of these tools and interventions into ongoing professional practice evaluation and focused professional practice evaluation processes may be a cost-effective strategy for preventing disruptive behaviors and increasing the likelihood of success when transitioning to an employed practice model. On the basis of a literature review, we determined that physician EI plays a key role in leadership; teamwork; and clinical, financial, and organizational outcomes. This finding has significant implications for healthcare executives seeking to enhance physician alignment and transition to a team-based delivery model.

  5. Performance Results of CMMI-Based Process Improvement

    National Research Council Canada - National Science Library

    Gibson, Diane L; Goldenson, Dennis R; Kost, Keith

    2006-01-01

    .... There now is evidence that process improvement using the CMMI Product Suite can result in improvements in schedule and cost performance, product quality, return on investment and other measures of performance outcome...

  6. Great Apes

    Science.gov (United States)

    Sleeman, Jonathan M.; Cerveny, Shannon

    2014-01-01

    Anesthesia of great apes is often necessary to conduct diagnostic analysis, provide therapeutics, facilitate surgical procedures, and enable transport and translocation for conservation purposes. Due to the stress of remote delivery injection of anesthetic agents, recent studies have focused on oral delivery and/or transmucosal absorption of preanesthetic and anesthetic agents. Maintenance of the airway and provision of oxygen is an important aspect of anesthesia in great ape species. The provision of analgesia is an important aspect of the anesthesia protocol for any procedure involving painful stimuli. Opioids and nonsteroidal anti-inflammatory drugs (NSAIDs) are often administered alone, or in combination to provide multi-modal analgesia. There is increasing conservation management of in situ great ape populations, which has resulted in the development of field anesthesia techniques for free-living great apes for the purposes of translocation, reintroduction into the wild, and clinical interventions.

  7. Big Ship Data: Using vessel measurements to improve estimates of temperature and wind speed on the Great Lakes

    Science.gov (United States)

    Fries, Kevin; Kerkez, Branko

    2017-05-01

    The sheer size of many water systems challenges the ability of in situ sensor networks to resolve spatiotemporal variability of hydrologic processes. New sources of vastly distributed and mobile measurements are, however, emerging to potentially fill these observational gaps. This paper poses the question: How can nontraditional measurements, such as those made by volunteer ship captains, be used to improve hydrometeorological estimates across large surface water systems? We answer this question through the analysis of one of the largest such data sets: an unprecedented collection of one million unique measurements made by ships on the North American Great Lakes from 2006 to 2014. We introduce a flexible probabilistic framework, which can be used to integrate ship measurements, or other sets of irregular point measurements, into contiguous data sets. The performance of this framework is validated through the development of a new ship-based spatial data product of water temperature, air temperature, and wind speed across the Great Lakes. An analysis of the final data product suggests that the availability of measurements across the Great Lakes will continue to play a large role in the confidence with which these large surface water systems can be studied and modeled. We discuss how this general and flexible approach can be applied to similar data sets, and how it will be of use to those seeking to merge large collections of measurements with other sources of data, such as physical models or remotely sensed products.

  8. Greatly improved cache update times for conditions data with Frontier/Squid

    Energy Technology Data Exchange (ETDEWEB)

    Dykstra, Dave; Lueking, Lee, E-mail: dwd@fnal.go [Computing Division, Fermilab, Batavia, IL (United States)

    2010-04-01

    The CMS detector project loads copies of conditions data to over 100,000 computer cores worldwide by using a software subsystem called Frontier. This subsystem translates database queries into HTTP, looks up the results in a central database at CERN, and caches the results in an industry-standard HTTP proxy/caching server called Squid. One of the most challenging aspects of any cache system is coherency, that is, ensuring that changes made to the underlying data get propagated out to all clients in a timely manner. Recently, the Frontier system was enhanced to drastically reduce the time for changes to be propagated everywhere without heavily loading servers. The propagation time is now as low as 15 minutes for some kinds of data and no more than 60 minutes for the rest of the data. This was accomplished by taking advantage of an HTTP and Squid feature called If-Modified-Since. In order to use this feature, the Frontier server sends a Last-Modified timestamp, but since modification times are not normally tracked by Oracle databases, a PL/SQL program was developed to track the modification times of database tables. We discuss the details of this caching scheme and the obstacles overcome including database and Squid bugs.

  9. Greatly improved cache update times for conditions data with Frontier/Squid

    International Nuclear Information System (INIS)

    Dykstra, Dave; Lueking, Lee

    2009-01-01

    The CMS detector project loads copies of conditions data to over 100,000 computer cores worldwide by using a software subsystem called Frontier. This subsystem translates database queries into HTTP, looks up the results in a central database at CERN, and caches the results in an industry-standard HTTP proxy/caching server called Squid. One of the most challenging aspects of any cache system is coherency, that is, ensuring that changes made to the underlying data get propagated out to all clients in a timely manner. Recently, the Frontier system was enhanced to drastically reduce the time for changes to be propagated everywhere without heavily loading servers. The propagation time is now as low as 15 minutes for some kinds of data and no more than 60 minutes for the rest of the data. This was accomplished by taking advantage of an HTTP and Squid feature called If-Modified-Since. In order to use this feature, the Frontier server sends a Last-Modified timestamp, but since modification times are not normally tracked by Oracle databases, a PL/SQL program was developed to track the modification times of database tables. We discuss the details of this caching scheme and the obstacles overcome including database and Squid bugs.

  10. The use of process models to inform and improve statistical models of nitrate occurrence, Great Miami River Basin, southwestern Ohio

    Science.gov (United States)

    Walter, Donald A.; Starn, J. Jeffrey

    2013-01-01

    Statistical models of nitrate occurrence in the glacial aquifer system of the northern United States, developed by the U.S. Geological Survey, use observed relations between nitrate concentrations and sets of explanatory variables—representing well-construction, environmental, and source characteristics— to predict the probability that nitrate, as nitrogen, will exceed a threshold concentration. However, the models do not explicitly account for the processes that control the transport of nitrogen from surface sources to a pumped well and use area-weighted mean spatial variables computed from within a circular buffer around the well as a simplified source-area conceptualization. The use of models that explicitly represent physical-transport processes can inform and, potentially, improve these statistical models. Specifically, groundwater-flow models simulate advective transport—predominant in many surficial aquifers— and can contribute to the refinement of the statistical models by (1) providing for improved, physically based representations of a source area to a well, and (2) allowing for more detailed estimates of environmental variables. A source area to a well, known as a contributing recharge area, represents the area at the water table that contributes recharge to a pumped well; a well pumped at a volumetric rate equal to the amount of recharge through a circular buffer will result in a contributing recharge area that is the same size as the buffer but has a shape that is a function of the hydrologic setting. These volume-equivalent contributing recharge areas will approximate circular buffers in areas of relatively flat hydraulic gradients, such as near groundwater divides, but in areas with steep hydraulic gradients will be elongated in the upgradient direction and agree less with the corresponding circular buffers. The degree to which process-model-estimated contributing recharge areas, which simulate advective transport and therefore account for

  11. CONTINUOUS IMPROVEMENT PRACTICE IN LARGE ENTERPRISES: STUDY RESULTS

    Directory of Open Access Journals (Sweden)

    Dorota Stadnicka

    2015-03-01

    Full Text Available Continuous improvement is indispensable for ensuring the company's development and its survival on the constantly changing global market. Continuous improvement is particularly important in the quality and production management systems. A company should deliver a product compliant with a client's requirements in a specified time and at an appropriate price. That is why, continuous improvement refers to different areas of an organization's functioning and it is an integral part of Lean Manufacturing. This article presents the results of the study conducted in production enterprises on a limited area. The aim of the study was the assessment of the implementation of continuous improvement in Lean Manufacturing, and, in particular, employees' involvement in the problem identification and in reporting improvements as well as the way of motivating employees to involve themselves. The authors also tried to identify the factors influencing the elements of a continuous improvement system.

  12. Do clinical safety charts improve paramedic key performance indicator results? (A clinical improvement programme evaluation).

    Science.gov (United States)

    Ebbs, Phillip; Middleton, Paul M; Bonner, Ann; Loudfoot, Allan; Elliott, Peter

    2012-07-01

    Is the Clinical Safety Chart clinical improvement programme (CIP) effective at improving paramedic key performance indicator (KPI) results within the Ambulance Service of New South Wales? The CIP intervention area was compared with the non-intervention area in order to determine whether there was a statistically significant improvement in KPI results. The CIP was associated with a statistically significant improvement in paramedic KPI results within the intervention area. The strategies used within this CIP are recommended for further consideration.

  13. Results of bald eagle, osprey and great blue heron nest site surveys near Fort MacKay, Alberta

    International Nuclear Information System (INIS)

    Strom, K.; Balagus, P.

    1996-01-01

    As part of the environmental impact assessment process, a study was conducted to assess the occurrence of bald eagle, osprey and great blue heron on Syncrude's proposed oil sand leases near Fort MacKay. The objective of the study was to determine the relative abundance, habitat preferences and nesting occurrences of these different birds. Aerial count surveys were conducted to include coverage of the shorelines of four rivers and 22 lakes. Breeding activities of the osprey, bald eagle and great blue heron were observed in the regional study area, but not in the local study area. 14 refs., 1 tab., 4 figs

  14. Mercury Sources and Cycling in the Great Lakes: Dramatic Changes Resulting from Altered Atmospheric Loads and the Near-Shore Shunt

    Science.gov (United States)

    Krabbenhoft, D. P.; DeWild, J. F.; Maglio, M. M.; Tate, M. T.; Ogorek, J. M.; Hurley, J. P.; Lepak, R.

    2013-12-01

    Mercury (Hg) contamination of the aquatic food webs across the Great Lakes remains a significant environmental issue. However, our ability to prescribe corrective actions has been significantly hampered by a scarcity of data, particularly for methylmercury (MeHg) the most toxic and bioaccumulative form of mercury in freshwater ecosystems. As part of the Great Lakes Restoration Initiative initiated in 2010, a joint effort was undertaken by the U.S. Geological Survey (USGS) and U.S. Environmental Protection Agency (USEPA) to improve our understanding of total Hg and MeHg concentrations and distributions in the Great Lakes. Since 2010, sampling surveys have been conducted at about 15-20 stations twice annually (April and August) at 15-20 stations per lake to collect data from both cold and warm water conditions. All sampling was conducted using trace-metal free protocols using a sampling rosette equipped with 12 Teflon-lined Niskin. Water samples were collected at predetermined depths: mid-epilimnion, mid-thermocline, deep chlorophyll layer, mid-hypolimnion, and about 2 meters above the bottom. Seston samples were collected from the top 20 meters using plankton nets, while bottom sediments and benthos samples were acquired using a ponar sampler. Water, biota, and sediment samples were all analyzed for Hg and MeHg concentration at the USGS Mercury Research Laboratory in Middleton, Wisconsin. Several important trends are apparent from the water column samples. First, most stations reveal a strong top-to-bottom declining trend total Hg concentration, underscoring the importance of atmospheric deposition to the Great Lakes. Methylmercury profiles, show maximal concentrations at the thermocline or deep chlorophyll layer, suggesting in situ water-column MeHg production. Calculations suggest this in-lake MeHg source is similar in magnitude to tributary loading of MeHg, which heretofore was thought to be the dominant MeHg source. Aqueous total Hg results also suggest that

  15. Managing for Results in America's Great City Schools. A Report of the Performance Measurement and Benchmarking Project, Spring 2008

    Science.gov (United States)

    Council of the Great City Schools, 2008

    2008-01-01

    This report describes statistical indicators developed by the Council of the Great City Schools and its member districts to measure big-city school performance on a range of operational functions in business, finance, human resources and technology. The report also presents data city-by-city on those indicators. This is the second time that…

  16. Managing for Results in America's Great City Schools. A Report of the Performance Measurement and Benchmarking Project

    Science.gov (United States)

    Council of the Great City Schools, 2008

    2008-01-01

    This report describes statistical indicators developed by the Council of the Great City Schools and its member districts to measure big-city school performance on a range of operational functions in business, finance, human resources and technology. The report also presents data city-by-city on those indicators. This is the second time that…

  17. Spatial distribution and trends of total mercury in waters of the Great Lakes and connecting channels using an improved sampling technique

    International Nuclear Information System (INIS)

    Dove, A.; Hill, B.; Klawunn, P.; Waltho, J.; Backus, S.; McCrea, R.C.

    2012-01-01

    Environment Canada recently developed a clean method suitable for sampling trace levels of metals in surface waters. The results of sampling for total mercury in the Laurentian Great Lakes between 2003 and 2009 give a unique basin-wide perspective of concentrations of this important contaminant and represent improved knowledge of mercury in the region. Results indicate that concentrations of total mercury in the offshore regions of the lakes were within a relatively narrow range from about 0.3 to 0.8 ng/L. The highest concentrations were observed in the western basin of Lake Erie and concentrations then declined towards the east. Compared to the offshore, higher levels were observed at some nearshore locations, particularly in lakes Erie and Ontario. The longer-term temporal record of mercury in Niagara River suspended sediments indicates an approximate 30% decrease in equivalent water concentrations since 1986. - Highlights: ► Basin-wide concentrations of total mercury in Great Lakes surface waters are provided for the first time. ► A clean sampling method is described, stressing isolation of the sample from extraneous sources of contamination. ► Sub-ng/L concentrations of total mercury are observed in most Great Lakes offshore areas. ► Concentrations in the western basin of Lake Erie are consistently the highest observed in the basin. ► The longer-term record of mercury in Niagara River suspended sediments indicates an approximate 30% decrease since 1986. - A new, clean sampling method for metals is described and basin-wide measurements of total mercury are provided for Great Lakes surface waters for the first time.

  18. Improvement results of rice (Oryza glaberima) by induced mutation

    International Nuclear Information System (INIS)

    Cisse, F.

    1994-01-01

    In Mali, rice (Orzya glaberima) is still largely cultivated under conditions of natural semi-controlled submersion. To improve productivity the local varieties have been gradually replaced by new varieties, but the yields of these became lower because of the irregularity of the rain and the comparative weakness of the strain. For this reason a programme to improve the local varieties by means of gamma radiation has been undertaken. This document presents the results obtained to date

  19. Baryon axial charges from chirally improved fermions - first results

    Science.gov (United States)

    Engel, G.; Gattringer, C.; Glozman, L. Y.; Lang, C. B.; Limmer, M.; Mohler, D.; Schäfer, A.

    We present first results from dynamical Chirally Improved (CI) fermion simulations for the axial charge $G_A$ of various hadrons. We work with 16^3x32 lattices of spatial extent 2.4 fm and use the variational method with a suitable basis of Jacobi-smeared interpolators to suppress contaminations from excited states.

  20. Alterations in physique among young children after the Great East Japan Earthquake: Results from a nationwide survey.

    Science.gov (United States)

    Kikuya, Masahiro; Matsubara, Hiroko; Ishikuro, Mami; Sato, Yuki; Obara, Taku; Metoki, Hirohito; Isojima, Tsuyoshi; Yokoya, Susumu; Kato, Noriko; Tanaka, Toshiaki; Chida, Shoichi; Ono, Atsushi; Hosoya, Mitsuaki; Yokomichi, Hiroshi; Yamagata, Zentaro; Tanaka, Soichiro; Kure, Shigeo; Kuriyama, Shinichi

    2017-10-01

    Data for earthquake-related alterations in physique among young children in developed countries is lacking. The Great East Japan Earthquake caused severe damage in Iwate, Miyagi, and Fukushima Prefectures in northeastern Japan. We retrospectively obtained anthropometric measurements in nursery school from 40,046 (cohort 1, historical control) and 53,492 (cohort 2) children aged 3.5-4.5 years without overweight in October 2008, and in October 2010, respectively. At the time of the earthquake in March, 2011, children in cohort 1 had already graduated from nursery school; however, children in cohort 2 were still enrolled in nursery school at this time. We compared the onset of overweight at 1 year after the baseline between children enrolled in their school located in one of the three target prefectures versus those in other prefectures using a logistic regression model, with adjustment for sex, age, history of disease, and obesity index at baseline. Overweight was defined as an obesity index of >+15%, which was calculated as (weight minus sex- and height-specific standard weight)/sex- and height-specific standard weight. The odds ratio (OR) for the onset of overweight in the three target prefectures was significant in cohort 2 (OR 1.25; 95% confidence interval [CI], 1.01-1.55) but not in cohort 1. When the two cohort were pooled (n = 93,538), the OR of the interaction term for school location × cohort was significant (OR 1.56; 95% CI, 1.09-2.23). Incident overweight in young children was significantly more common in the three prefectures affected by the Great East Japan Earthquake than in other prefectures after the disaster. Copyright © 2017 The Authors. Production and hosting by Elsevier B.V. All rights reserved.

  1. Improved nuclear emergency management system reflecting lessons learned from the emergency response at Fukushima Daini Nuclear Power Station after the Great East Japan Earthquake

    International Nuclear Information System (INIS)

    Kawamura, Shinichi; Narabayashi, Tadashi

    2016-01-01

    Three nuclear reactors at Fukushima Daini Nuclear Power Station lost all their ultimate heat sinks owing to damage from the tsunami caused by the Great East Japan Earthquake on March 11, 2011. Water was injected into the reactors by alternate measures, damaged cooling systems were restored with promptly supplied substitute materials, and all the reactors were brought to a cold shutdown state within four days. Lessons learned from this experience were identified to improve emergency management, especially in the areas of strategic response planning, logistics, and functions supporting response activities continuing over a long period. It was found that continuous planning activities reflecting information from plant parameters and response action results were important, and that relevant functions in emergency response organizations should be integrated. Logistics were handled successfully but many difficulties were experienced. Therefore, their functions should be clearly established and improved by emergency response organizations. Supporting emergency responders in the aspects of their physical and mental conditions was important for sustaining continuous response. As a platform for improvement, the concept of the Incident Command System was applied for the first time to a nuclear emergency management system, with specific improvement ideas such as a phased approach in response planning and common operation pictures. (author)

  2. Multilevel Empirical Bayes Modeling for Improved Estimation of Toxicant Formulations to Suppress Parasitic Sea Lamprey in the Upper Great Lakes

    Science.gov (United States)

    Hatfield, L.A.; Gutreuter, S.; Boogaard, M.A.; Carlin, B.P.

    2011-01-01

    Estimation of extreme quantal-response statistics, such as the concentration required to kill 99.9% of test subjects (LC99.9), remains a challenge in the presence of multiple covariates and complex study designs. Accurate and precise estimates of the LC99.9 for mixtures of toxicants are critical to ongoing control of a parasitic invasive species, the sea lamprey, in the Laurentian Great Lakes of North America. The toxicity of those chemicals is affected by local and temporal variations in water chemistry, which must be incorporated into the modeling. We develop multilevel empirical Bayes models for data from multiple laboratory studies. Our approach yields more accurate and precise estimation of the LC99.9 compared to alternative models considered. This study demonstrates that properly incorporating hierarchical structure in laboratory data yields better estimates of LC99.9 stream treatment values that are critical to larvae control in the field. In addition, out-of-sample prediction of the results of in situ tests reveals the presence of a latent seasonal effect not manifest in the laboratory studies, suggesting avenues for future study and illustrating the importance of dual consideration of both experimental and observational data. ?? 2011, The International Biometric Society.

  3. Types of damage that could result from a great earthquake in the New Madrid, Missouri, seismic zone

    Science.gov (United States)

    Hopper, M.G.; Algermissen, S.T.

    1984-01-01

    In the winter of 1811–1812 a series of three great earthquakes occurred in the New Madrid seismic zone. In addition to the three principal shocks, at least 15 other earthquakes, Io ≥ VIII, occurred within a year of the first large earthquake on December 16, 1811. The three main shocks were felt over the entire eastern United States. They were strong enough to cause minor damage as far away as Indiana and Ohio on the north, the Carolinas on the east, and southern Mississippi on the south. They were strong enough to cause severe or structural damage in parts of Missouri, Illinois, Indiana, Kentucky, Tennessee, Mississippi, and Arkansas. The section of this poster titled "Seismic history of the New Madrid region" describes what happened in the epicentral region. Fortunately, few people lived in the severely shaken area in 1811; that is not the case today. What would happen if a series of earthquakes as large and numerous as the "New Madrid" earthquakes were to occur in the New Madrid seismic zone today?

  4. Social support improves mental health among the victims relocated to temporary housing following the Great East Japan Earthquake and Tsunami.

    Science.gov (United States)

    Koyama, Shihoko; Aida, Jun; Kawachi, Ichiro; Kondo, Naoki; Subramanian, S V; Ito, Kanade; Kobashi, Gen; Masuno, Kanako; Kondo, Katsunori; Osaka, Ken

    2014-11-01

    The victims of the Great East Japan Earthquake and Tsunami have been forced to live in temporary housing, mainly by two different methods of resettlement: group allocation that preserved pre-existing local social ties and lottery allocation. We examined the effects of various factors, including the resettlement methods and social support, on mental health. From February to March 2012, we completed a cross-sectional survey of 281 refugees aged 40 years or older, who had lost their homes in the tsunami and were living in temporary housing in Iwanuma city. Psychological distress of the victims was assessed using the Kessler Psychological Distress Scale (K6) that consists of six self-reported items. Participants were also asked whether they had provided or received social support during this time. Participants were categorized as "providing social support" if they listened to someone else's concerns and complaints, or "receiving social support" if they have someone who listened to their concerns and complaints. After adjusting for age and sex, multiple log-binomial regression analysis showed that participants without social support had a higher risk of psychological distress. Group allocation victims were more likely to receive social support than those who underwent lottery allocation. However, the resettlement approach did not significantly correlate with distress. Other factors associated with a higher risk of psychological distress were a younger age (55 or younger), living with either 3 people or 6 or more people, and having a lower income. The present results suggest that social support promotes the mental health of disaster victims.

  5. Ear surgery techniques results on hearing threshold improvement

    Directory of Open Access Journals (Sweden)

    Farhad Mokhtarinejad

    2013-01-01

    Full Text Available Background: Bone conduction (BC threshold depression is not always by means of sensory neural hearing loss and sometimes it is an artifact caused by middle ear pathologies and ossicular chain problems. In this research, the influences of ear surgeries on bone conduction were evaluated. Materials and Methods: This study was conducted as a clinical trial study. The ear surgery performed on 83 patients classified in four categories: Stapedectomy, tympanomastoid surgery and ossicular reconstruction partially or totally; Partial Ossicular Replacement Prosthesis (PORP and Total Ossicular Replacement Prosthesis (TORP. Bone conduction thresholds assessed in frequencies of 250, 500, 1000, 2000 and 4000 Hz pre and post the surgery. Results: In stapedectomy group, the average of BC threshold in all frequencies improved approximately 6 dB in frequency of 2000 Hz. In tympanomastoid group, BC threshold in the frequency of 500, 1000 and 2000 Hz changed 4 dB (P-value < 0.05. Moreover, In the PORP group, 5 dB enhancement was seen in 1000 and 2000 Hz. In TORP group, the results confirmed that BC threshold improved in all frequencies especially at 4000 Hz about 6.5 dB. Conclusion: In according to results of this study, BC threshold shift was seen after several ear surgeries such as stapedectomy, tympanoplasty, PORP and TORP. The average of BC improvement was approximately 5 dB. It must be considered that BC depression might happen because of ossicular chain problems. Therefore; by resolving middle ear pathologies, the better BC threshold was obtained, the less hearing problems would be faced.

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

    Science.gov (United States)

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

    2016-01-01

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

  7. [Great discoveries: from the painstaking efforts of researchers to the contribution of accidental findings and the dissemination of study results].

    Science.gov (United States)

    Garattini, Silvio

    2015-06-01

    This article takes its cue from the original work of sir Alexander Fleming on penicillin, published in the first issue of Recenti Progressi in Medicina in 1946 and reproduced here on the occasion of the approaching 70-year anniversary of the journal. The path that brought Fleming to the discovery of penicillin, one of the major milestones in the history of clinical pharmacology, provides insight for a range of considerations: the painstaking efforts of researchers, the contribution from accidental findings, and the dissemination of study results. Although the discovery of penicillin has changed the course of medicine, the benefits deriving from such an important advance are most likely to be offset by the overprescription of antibiotics, which is the leading cause of antimicrobial resistance and one of the most serious public health problems of our time.

  8. Improving sexually transmitted infection results notification via mobile phone technology.

    Science.gov (United States)

    Reed, Jennifer L; Huppert, Jill S; Taylor, Regina G; Gillespie, Gordon L; Byczkowski, Terri L; Kahn, Jessica A; Alessandrini, Evaline A

    2014-11-01

    To improve adolescent notification of positive sexually transmitted infection (STI) tests using mobile phone technology and STI information cards. A randomized intervention among 14- to 21-year olds in a pediatric emergency department (PED). A 2 × 3 factorial design with replication was used to evaluate the effectiveness of six combinations of two factors on the proportion of STI-positive adolescents notified within 7 days of testing. Independent factors included method of notification (call, text message, or call + text message) and provision of an STI information card with or without a phone number to obtain results. Covariates for logistic regression included age, empiric STI treatment, days until first attempted notification, and documentation of confidential phone number. Approximately half of the 383 females and 201 males enrolled were ≥18 years of age. Texting only or type of card was not significantly associated with patient notification rates, and there was no significant interaction between card and notification method. For females, successful notification was significantly greater for call + text message (odds ratio, 3.2; 95% confidence interval, 1.4-6.9), and documenting a confidential phone number was independently associated with successful notification (odds ratio, 3.6; 95% confidence interval, 1.7-7.5). We found no significant predictors of successful notification for males. Of patients with a documented confidential phone number who received a call + text message, 94% of females and 83% of males were successfully notified. Obtaining a confidential phone number and using call + text message improved STI notification rates among female but not male adolescents in a pediatric emergency department. Copyright © 2014 Society for Adolescent Health and Medicine. All rights reserved.

  9. Nationwide quality improvement of cholecystectomy: results from a national database

    DEFF Research Database (Denmark)

    Harboe, Kirstine M; Bardram, Linda

    2011-01-01

    To evaluate whether quality improvements in the performance of cholecystectomy have been achieved in Denmark since 2006, after revision of the Danish National Guidelines for treatment of gallstones.......To evaluate whether quality improvements in the performance of cholecystectomy have been achieved in Denmark since 2006, after revision of the Danish National Guidelines for treatment of gallstones....

  10. LWR surveillance dosimetry improvement program: PSF metallurgical blind test results

    International Nuclear Information System (INIS)

    Kam, F.B.K.; Maerker, R.E.; Stallmann, F.W.

    1984-01-01

    The metallurgical irradiation experiment at the Oak Ridge Research Reactor Poolside Facility (ORR-PSF) was designed as a benchmark to test the accuracy of radiation embrittlement predictions in the pressure vessel wall of light water reactors on the basis of results from surveillance capsules. The PSF metallurgical Blind Test is concerned with the simulated surveillance capsule (SSC) and the simulated pressure vessel capsule (SPVC). The data from the ORR-PSF benchmark experiment are the basis for comparison with the predictions made by participants of the metallurgical ''Blind Test''. The Blind Test required the participants to predict the embrittlement of the irradiated specimen based only on dosimetry and metallurgical data from the SSC1 capsule. This exercise included both the prediction of damage fluence and the prediction of embrittlement based on the predicted fluence. A variety of prediction methodologies was used by the participants. No glaring biases or other deficiencies were found, but neither were any of the methods clearly superior to the others. Closer analysis shows a rather complex and poorly understood relation between fluence and material damage. Many prediction formulas can give an adequate approximation, but further improvement of the prediction methodology is unlikely at this time given the many unknown factors. Instead, attention should be focused on determining realistic uncertainties for the predicted material changes. The Blind Test comparisons provide some clues for the size of these uncertainties. In particular, higher uncertainties must be assigned to materials whose chemical composition lies outside the data set for which the prediction formula was obtained. 16 references, 14 figures, 5 tables

  11. Fuel improvement and WWER-1000 FA main operational results

    International Nuclear Information System (INIS)

    Rozhkov, V.; Enin, A.; Bezborodov, Y.; Petrov, V.

    2003-01-01

    The JSC NCCP experience of WWER-1000 Fuel Assemblies (FAs) fabrication and operation confirms the adequate feasibility and efficiency of fuel operation in 3-4-x fuel cycles, high operating reliability and competitive capacity as compared with foreign analogues. The work on fuel improvement is aimed at an improvement of the operating reliability and an enhancement of the fuel use efficiency in WWER-1000 advanced FAs

  12. Improving open access to the results of USGS research (Invited)

    Science.gov (United States)

    Bristol, S.

    2013-12-01

    Since its establishment under the Organic Act of March 3, 1879, the U.S. Geological Survey (USGS) has been committed to classifying and characterizing 'the geological structure, mineral resources, and products of the national domain.' Over time, the pursuit of this mission and understanding the products of the national domain has involved a broad scientific pursuit to understand complex Earth system processes and includes topographic, geologic, biogeographic, and other types of mapping; chemical, physical, hydrological, and biological research; and the application of computer and data science. As science and technology have evolved, classification and characterization of the Nation's natural resources has come to be embodied in digital data of various structure and form. Fundamentally, scientific publications and data produced through research and monitoring form the core of the USGS mission. They are an organizational and national treasure held and provided in trust for the American people and for the global scientific community. The recent memo from the Office of Science and Technology Policy (OSTP) on 'Increasing Access to the Results of Federally Funded Scientific Research' is part of an overall initiative toward open digital government that dovetails well with the USGS mission. The objectives outlined in the memo correspond directly to goals and objectives of the 2007 USGS Science Strategy ('Facing Tomorrow's Challenges--U.S. Geological Survey Science in the Decade 2007-2017') and the recently released Science Strategy Plans across all USGS Mission Areas. The USGS response to the OSTP memo involves reinforcing aspects of the USGS commitment to open and free access to scholarly publications and data along with improvements to some of the underlying technological systems that facilitate search and discovery. These actions also align with the USGS response to the Executive Order on May 9, 2013, entitled 'Making Open and Machine Readable the New Default for

  13. Improved extraction of ePTFE and medical adhesive modified defibrillation leads from the coronary sinus and great cardiac vein.

    Science.gov (United States)

    Wilkoff, Bruce L; Belott, Peter H; Love, Charles J; Scheiner, Avram; Westlund, Randy; Rippy, Marian; Krishnan, Mohan; Norlander, Barry E; Steinhaus, Bruce; Emmanuel, Janson; Zeller, Peter J

    2005-03-01

    Permanent leads with shocking coils for defibrillation therapy are sometimes implanted in the coronary sinus (CS) and great cardiac vein (GCV). These shocking coils, as documented by pathologic examination of animal investigations, often become tightly encapsulated by fibrosis and can be very difficult to remove. One of three configurations of the Guidant model 7109 Perimeter coronary sinus shocking lead was implanted into the distal portion of the GCV of 24 sheep for up to 14 months. Group 1 had unmodified coils (control), group 2 had coils backfilled with medical adhesive (MA), and Group 3 had coils coated with expanded polytetrafluoroethylene (ePTFE). Eighteen leads, three from each group at 6 and 14 months were transvenously extracted from the left jugular vein. The remaining six animals were not subject to extraction. All animals were euthanized for pathological and microscopic examination. All six of the control, three of the MA, and one of the ePTFE leads required the use of an electrosurgical dissection sheath (EDS) for extraction. Five control, two MA, and none of the ePTFE leads had significant fibrotic attachments to the shocking coils. Significant trauma was observed at necropsy for those leads requiring the use of the EDS for extraction. Tissue ingrowth is a major impediment to the removal of defibrillation leads implanted in the CS and GCV of sheep. Reduction of tissue ingrowth by coating the shocking coils with ePTFE or by backfilling with MA facilitates transvenous lead removal with reduced tissue trauma.

  14. Great Expectations

    NARCIS (Netherlands)

    Dickens, Charles

    2005-01-01

    One of Dickens's most renowned and enjoyable novels, Great Expectations tells the story of Pip, an orphan boy who wishes to transcend his humble origins and finds himself unexpectedly given the opportunity to live a life of wealth and respectability. Over the course of the tale, in which Pip

  15. Sustainable production. The ultimate result of a continuous improvement

    NARCIS (Netherlands)

    Ron, de A.J.

    1998-01-01

    To fulfil market requirements, companies have introduced cost awareness, quality programs and techniques to become flexible. These items should be handled as a continuous process of improvement. The cost awareness implies that e.g. material waste is avoided during production, the quality programs

  16. Results-driven approach to improving quality and productivity

    Science.gov (United States)

    John Dramm

    2000-01-01

    Quality control (QC) programs do not often realize their full potential. Elaborate and expensive QC programs can easily get side tracked by the process of building a program with promises of “Someday, this will all pay off.” Training employees in QC methods is no guarantee that quality will improve. Several documented cases show that such activity-centered efforts...

  17. Tungsten ion implantation of aluminum for improved resistance to pitting corrosion -- electrochemical testing results

    International Nuclear Information System (INIS)

    Smith, P.P.; Buchanan, R.A.; Williams, J.M.

    1995-01-01

    The greatly accelerated localized corrosion of aluminum in salt solutions has been observed and combated for many years. The susceptibility to pitting attack has been linked to the presence of chloride ions in the solution. Alloying additions to aluminum for improved corrosion resistance are restricted due to its limited solubility for passivating species such as chromium and molybdenum. However, many recent attempts to produce non-equilibrium alloys with these and other species, both through sputtering techniques and by rapid solidification, have met with very promising pitting resistance enhancements. The most dramatic increase in passivity is demonstrated by a thin co-sputtered film of Al and 9 atomic percent W, in which the pitting potential is increased by 2600 m V relative to pure Al. Recent efforts to extrapolate the promising W-Al thin film results to a bulk aluminum alloy using tungsten ion implantation are discussed here

  18. Improving the distinguishable cluster results: spin-component scaling

    Science.gov (United States)

    Kats, Daniel

    2018-06-01

    The spin-component scaling is employed in the energy evaluation to improve the distinguishable cluster approach. SCS-DCSD reaction energies reproduce reference values with a root-mean-squared deviation well below 1 kcal/mol, the interaction energies are three to five times more accurate than DCSD, and molecular systems with a large amount of static electron correlation are still described reasonably well. SCS-DCSD represents a pragmatic approach to achieve chemical accuracy with a simple method without triples, which can also be applied to multi-configurational molecular systems.

  19. Improve Business Results by Learning from Experience in Proactive Reviews

    DEFF Research Database (Denmark)

    Kolbæk, Ditte

    2018-01-01

    This article aims to provide a theoretically based and proven educational design for lessons learned. Called a Proactive Review, this educational design is exemplified in a case study of a global information technology company classified as big business, where Proactive Reviews were developed...... and implemented in over 40 countries. This article explores how employees who solve a task together can learn from the experience and share this learning with relevant colleagues to improve work practices, services, and/or products. This article describes the format of Proactive Reviews, suggestions for starting...

  20. PIAAC results: need for new approaches in improving adult literacy

    NARCIS (Netherlands)

    Gouw, Paula; De Greef, Maurice; Brand-Gruwel, Saskia; Jarodzka, Halszka

    2018-01-01

    According to the results of the PIAAC study, too many adults are not able to acquire basic reading skills. This influences their individual lives, besides their economic and social well-being, negatively (OECD, 2013). In accordance with current research results and trends, adult literacy seems to

  1. Preliminary results on adhesion improvement using Ion Beam Sputtering Deposition

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Yonggi; Kim, Bomsok; Lee, Jaesang [Korea Atomic Energy Research Institute, Daejeon (Korea, Republic of)

    2013-05-15

    Sputtering is an established technique for depositing films with smooth surfaces and interfaces and good thick control. Ejection of articles from a condensed matter due to impingement of high energy particles, termed as sputtering was observed as early as in 1852, however, it is only recently that the complex process of sputtering system. Coating adhesion and environmental stability of the ion beam sputtering deposition coatings performed very well. High-energy high-current ion beam thin film synthesis of adhesion problems can be solved by using. Enhancement of adhesion in thin film synthesis, using high energy and high current ion beam, of mobile phones, car parts and other possible applications in the related industry Alternative technology of wet chrome plating, considering environment and unit cost, for car parts and esthetic improvement on surface of domestic appliances.

  2. Preliminary results on adhesion improvement using Ion Beam Sputtering Deposition

    International Nuclear Information System (INIS)

    Kim, Yonggi; Kim, Bomsok; Lee, Jaesang

    2013-01-01

    Sputtering is an established technique for depositing films with smooth surfaces and interfaces and good thick control. Ejection of articles from a condensed matter due to impingement of high energy particles, termed as sputtering was observed as early as in 1852, however, it is only recently that the complex process of sputtering system. Coating adhesion and environmental stability of the ion beam sputtering deposition coatings performed very well. High-energy high-current ion beam thin film synthesis of adhesion problems can be solved by using. Enhancement of adhesion in thin film synthesis, using high energy and high current ion beam, of mobile phones, car parts and other possible applications in the related industry Alternative technology of wet chrome plating, considering environment and unit cost, for car parts and esthetic improvement on surface of domestic appliances

  3. Great Lakes

    Science.gov (United States)

    Edsall, Thomas A.; Mac, Michael J.; Opler, Paul A.; Puckett Haecker, Catherine E.; Doran, Peter D.

    1998-01-01

    The Great Lakes region, as defined here, includes the Great Lakes and their drainage basins in Minnesota, Wisconsin, Illinois, Indiana, Ohio, Pennsylvania, and New York. The region also includes the portions of Minnesota, Wisconsin, and the 21 northernmost counties of Illinois that lie in the Mississippi River drainage basin, outside the floodplain of the river. The region spans about 9º of latitude and 20º of longitude and lies roughly halfway between the equator and the North Pole in a lowland corridor that extends from the Gulf of Mexico to the Arctic Ocean.The Great Lakes are the most prominent natural feature of the region (Fig. 1). They have a combined surface area of about 245,000 square kilometers and are among the largest, deepest lakes in the world. They are the largest single aggregation of fresh water on the planet (excluding the polar ice caps) and are the only glacial feature on Earth visible from the surface of the moon (The Nature Conservancy 1994a).The Great Lakes moderate the region’s climate, which presently ranges from subarctic in the north to humid continental warm in the south (Fig. 2), reflecting the movement of major weather masses from the north and south (U.S. Department of the Interior 1970; Eichenlaub 1979). The lakes act as heat sinks in summer and heat sources in winter and are major reservoirs that help humidify much of the region. They also create local precipitation belts in areas where air masses are pushed across the lakes by prevailing winds, pick up moisture from the lake surface, and then drop that moisture over land on the other side of the lake. The mean annual frost-free period—a general measure of the growing-season length for plants and some cold-blooded animals—varies from 60 days at higher elevations in the north to 160 days in lakeshore areas in the south. The climate influences the general distribution of wild plants and animals in the region and also influences the activities and distribution of the human

  4. EpCAM-based flow cytometry in cerebrospinal fluid greatly improves diagnostic accuracy of leptomeningeal metastases from epithelial tumors

    NARCIS (Netherlands)

    Milojkovic Kerklaan, B.; Pluim, Dick; Bol, Mijke; Hofland, Ingrid; Westerga, Johan; van Tinteren, Harm; Beijnen, Jos H; Boogerd, Willem; Schellens, Jan H M; Brandsma, Dieta

    BACKGROUND: Moderate diagnostic accuracy of MRI and initial cerebrospinal fluid (CSF) cytology analysis results in at least 10%-15% false negative diagnoses of leptomeningeal metastases (LM) of solid tumors, thus postponing start of therapy. The aim of this prospective clinical study was to

  5. Stress-inducible expression of AtDREB1A transcription factor greatly improves drought stress tolerance in transgenic indica rice.

    Science.gov (United States)

    Ravikumar, G; Manimaran, P; Voleti, S R; Subrahmanyam, D; Sundaram, R M; Bansal, K C; Viraktamath, B C; Balachandran, S M

    2014-06-01

    The cultivation of rice (Oryza sativa L.), a major food crop, requires ample water (30 % of the fresh water available worldwide), and its productivity is greatly affected by drought, the most significant environmental factor. Much research has focussed on identifying quantitative trait loci, stress-regulated genes and transcription factors that will contribute towards the development of climate-resilient/tolerant crop plants in general and rice in particular. The transcription factor DREB1A, identified from the model plant Arabidopsis thaliana, has been reported to enhance stress tolerance against drought stress. We developed transgenic rice plants with AtDREB1A in the background of indica rice cultivar Samba Mahsuri through Agrobacterium-mediated transformation. The AtDREB1A gene was stably inherited and expressed in T1 and T2 plants and in subsequent generations, as indicated by the results of PCR, Southern blot and RT-PCR analyses. Expression of AtDREB1A was induced by drought stress in transgenic rice lines, which were highly tolerant to severe water deficit stress in both the vegetative and reproductive stages without affecting their morphological or agronomic traits. The physiological studies revealed that the expression of AtDREB1A was associated with an increased accumulation of the osmotic substance proline, maintenance of chlorophyll, increased relative water content and decreased ion leakage under drought stress. Most of the homozygous lines were highly tolerant to drought stress and showed significantly a higher grain yield and spikelet fertility relative to the nontransgenic control plants under both stressed and unstressed conditions. The improvement in drought stress tolerance in combination with agronomic traits is very essential in high premium indica rice cultivars, such as Samba Mahsuri, so that farmers can benefit in times of seasonal droughts and water scarcity.

  6. Machine learning improves the accuracy of myocardial perfusion scintigraphy results

    International Nuclear Information System (INIS)

    Groselj, C.; Kukar, M.

    2002-01-01

    Objective: Machine learning (ML) an artificial intelligence method has in last decade proved to be an useful tool in many fields of decision making, also in some fields of medicine. By reports, its decision accuracy usually exceeds the human one. Aim: To assess applicability of ML in interpretation of the stress myocardial perfusion scintigraphy results in coronary artery disease diagnostic process. Patients and methods: The 327 patient's data of planar stress myocardial perfusion scintigraphy were reevaluated in usual way. Comparing them with the results of coronary angiography the sensitivity, specificity and accuracy of the investigation were computed. The data were digitized and the decision procedure repeated by ML program 'Naive Bayesian classifier'. As the ML is able to simultaneously manipulate with whatever number of data, all reachable disease connected data (regarding history, habitus, risk factors, stress results) were added. The sensitivity, specificity and accuracy of scintigraphy were expressed in this way. The results of both decision procedures were compared. Conclusion: Using ML method, 19 more patients out of 327 (5.8%) were correctly diagnosed by stress myocardial perfusion scintigraphy. In this way ML could be an important tool for myocardial perfusion scintigraphy decision making

  7. Results on improved environmental monitoring at the Ignalina NPP site

    International Nuclear Information System (INIS)

    Gudelis, A.; Remeikis, V.; Gubachev, I.; Batalin, J.

    2002-01-01

    Within the IAEA TC Project 'Radioecology in the vicinity of the Ignalina NPP' (LIT/9/003) a high efficiency HPGe well-type detector was obtained in 1998 for the investigations in environmental radioactivity in Lithuania. Efficiency calibration for this detector was done in the energy range 122-1461 keV by using reference standard solution with single-photon emitting radionuclides. At the same time, the coincidence-summing correction factor was experimentally determined for 60 Co. Earlier investigations carried out in moss samples in 1996 have shown that the site-specific radionuclide 60 Co was distributed on the ground mainly in the area of radius of 5-7 km from the source, and the maximum activity concentration on the earth surface was found to be 22 Bq/m 2 . However, only natural 7 Be and globally distributed 137 Cs were permanently measured in aerosol filter samples taken at 7 Ignalina NPP (INPP) monitoring stations, before the introduction of efficient HPGe well-type detector. Normally, the aerosol filters have been pressed into tablets and counted on the end cap of the Ge(Li)-detector that had relatively high MDA value (of the order of 0.5 Bq per sample for 137 Cs). It was, therefore, expected that the use of 4π geometry attainable inside a well would considerably improve the detection probability for 60 Co and other artificial radionuclides of the INPP origin. In order to prepare the aerosol filter samples for counting in new geometry they had to be ashed at 450 deg C. The final volume of ash samples was close to 2 cm 3 , and this amount could be easily fit into well that could accommodate samples of up to 4 cm 3 . For this geometry, the MDA values for 60 Co and 137 Cs were determined as 20 mBq and 12 mBq, respectively, when counting time was set to 100,000 s. After the remeasuring the aerosol filter samples in high-efficiency geometry a number of samples revealed the content of activation products 54 Mn and 60 Co that were not detected when Ge

  8. Improved PFB operations - 400-hour turbine test results

    Science.gov (United States)

    Rollbuhler, R. J.; Benford, S. M.; Zellars, G. R.

    1980-04-01

    The paper deals with a 400-hr small turbine test in the effluent of a pressurized fluidized bed (PFB) at an average temperature of 770 C, an average relative gas velocity of 300 m/sec, and average solid loadings of 200 ppm. Consideration is given to combustion parameters and operating procedure as well as to the turbine system and turbine test operating procedures. Emphasis is placed on erosion/corrosion results.

  9. LWR surveillance dosimetry improvement program: PSF metallurgical blind test results

    International Nuclear Information System (INIS)

    Kam, F.B.K.; Stallmann, F.W.; Guthrie, G.; McElroy, W.N.

    1985-01-01

    The ORR-PSF benchmark experiment was designed to simulate the surveillance capsule-pressure vessel configuration in power reactors and to test the validity of procedures which determine the radiation damage in the vessel from test results in the surveillance capsule. The PSF metallurgical blind test was initiated to give participants an opportunity to test their current embrittlement prediction methodologies. Experimental results were withheld from the participants except for the type of information which is normally contained in surveillance reports. Preliminary analysis of the PSF metallurgical blind test results shows that: (1) current prediction methodologies, as used by the PSF Blind Test participants, are adequate, falling within +- 20 0 C of the measured values for Δ NDT. None of the different methods is clearly superior; (2) the proposed revision of Reg. Guide 1.99 (Rev. 2) gives a better representation of the fluence and chemistry dependency of Δ NDT than the current version (Rev. 1); and (3) fluence rate effects can be seen but not quantified. Fluence spectral effects are too small to be detectable in this experiment. (orig.)

  10. Using robust statistics to improve neutron activation analysis results

    International Nuclear Information System (INIS)

    Zahn, Guilherme S.; Genezini, Frederico A.; Ticianelli, Regina B.; Figueiredo, Ana Maria G.

    2011-01-01

    Neutron activation analysis (NAA) is an analytical technique where an unknown sample is submitted to a neutron flux in a nuclear reactor, and its elemental composition is calculated by measuring the induced activity produced. By using the relative NAA method, one or more well-characterized samples (usually certified reference materials - CRMs) are irradiated together with the unknown ones, and the concentration of each element is then calculated by comparing the areas of the gamma ray peaks related to that element. When two or more CRMs are used as reference, the concentration of each element can be determined by several different ways, either using more than one gamma ray peak for that element (when available), or using the results obtained in the comparison with each CRM. Therefore, determining the best estimate for the concentration of each element in the sample can be a delicate issue. In this work, samples from three CRMs were irradiated together and the elemental concentration in one of them was calculated using the other two as reference. Two sets of peaks were analyzed for each element: a smaller set containing only the literature-recommended gamma-ray peaks and a larger one containing all peaks related to that element that could be quantified in the gamma-ray spectra; the most recommended transition was also used as a benchmark. The resulting data for each element was then reduced using up to five different statistical approaches: the usual (and not robust) unweighted and weighted means, together with three robust means: the Limitation of Relative Statistical Weight, Normalized Residuals and Rajeval. The resulting concentration values were then compared to the certified value for each element, allowing for discussion on both the performance of each statistical tool and on the best choice of peaks for each element. (author)

  11. Study of physical properties of UO2 quality improvement result

    International Nuclear Information System (INIS)

    Rachmat-Pratomo; Hidayati; Didiek Herhady, R; Busron-Masduki

    1996-01-01

    Activation of uranium dioxide (UO 2 ) by reoxidation to U 3 O 8 and reduction to uranium dioxide (UO 2 ) by temperature reduction variation of 850 o C and 900 o C for 3 hours has been studied. The physical properties before and after treatment are compared. It proved that the oxidation-reduction cycle increased the physical properties. It can be concluded that the reoxidation of UO 2 to U 3 O 8 on fourth cycle and reduction at 900 o C for 3 hours result in a density of 1.32 gram/ml a tap density of 1.60 gram/ml, true density of 9.08 gram/ml and O/U ratio : 2.04. Reduction at 850 o C, for 3 hours result in the bulk density of 1.30 gram/ml, tap density of 1.58 gram/ml, true density of 9.04 gram/ml and O/U ratio 2.09

  12. Improvement of natural image search engines results by emotional filtering

    Directory of Open Access Journals (Sweden)

    Patrice Denis

    2016-04-01

    Full Text Available With the Internet 2.0 era, managing user emotions is a problem that more and more actors are interested in. Historically, the first notions of emotion sharing were expressed and defined with emoticons. They allowed users to show their emotional status to others in an impersonal and emotionless digital world. Now, in the Internet of social media, every day users share lots of content with each other on Facebook, Twitter, Google+ and so on. Several new popular web sites like FlickR, Picassa, Pinterest, Instagram or DeviantArt are now specifically based on sharing image content as well as personal emotional status. This kind of information is economically very valuable as it can for instance help commercial companies sell more efficiently. In fact, with this king of emotional information, business can made where companies will better target their customers needs, and/or even sell them more products. Research has been and is still interested in the mining of emotional information from user data since then. In this paper, we focus on the impact of emotions from images that have been collected from search image engines. More specifically our proposition is the creation of a filtering layer applied on the results of such image search engines. Our peculiarity relies in the fact that it is the first attempt from our knowledge to filter image search engines results with an emotional filtering approach.

  13. Human resource leadership: the key to improved results in health

    Directory of Open Access Journals (Sweden)

    O'Neil Mary L

    2008-06-01

    Full Text Available Abstract This article is the lead article in the Human Resources for Health journal's first quarterly feature. The series of seven articles has been contributed by Management Sciences for Health (MSH under the theme of leadership and management in public health and will be published article by article over the next few weeks. The journal has invited Dr Manuel M. Dayrit, Director of the WHO Department of Human Resources for Health and former Minister of Health for the Philippines to launch the feature with an opening editorial to be found in the journal's blog. This opening article describes the human resource challenges that managers around the world report and analyses why solutions often fail to be implemented. Despite rising attention to the acute shortage of health care workers, solutions to the human resource (HR crisis are difficult to achieve, especially in the poorest countries. Although we are aware of the issues and have developed HR strategies, the problem is that some old systems of leading and managing human resources for health do not work in today's context. The Leadership Development Program (LDP is grounded on the belief that good leadership and management can be learned and practiced at all levels. The case studies in this issue were chosen to illustrate results from using the LDP at different levels of the health sector. The LDP makes a profound difference in health managers' attitudes towards their work. Rather than feeling defeated by a workplace climate that lacks motivation, hope, and commitment to change, people report that they are mobilized to take action to change the status quo. The lesson is that without this capacity at all levels, global policy and national HR strategies will fail to make a difference.

  14. Improved Process Used to Treat Aqueous Mixed Waste Results in Cost Savings and Improved Worker Safety

    International Nuclear Information System (INIS)

    Hodge, D.S.; Preuss, D.E.; Belcher, K.J.; Rock, C.M.; Bray, W.S.; Herman, J.P.

    2006-01-01

    This paper describes an improved process implemented at Argonne National Laboratory (ANL) to treat aqueous mixed waste. This waste is comprised of radioactively-contaminated corrosive liquids with heavy metals. The Aqueous Mixed Waste Treatment System (AMWTS) system components include a reaction tank and a post-treatment holding tank with ancillary piping and pumps; and a control panel with pumping/mixing controls; tank level, temperature and pH/Oxidation Reduction Potential (ORP) indicators. The process includes a neutralization step to remove the corrosive characteristic, a chromium reduction step to reduce hexavalent chromium to trivalent chromium, and a precipitation step to convert the toxic metals into an insoluble form. Once the toxic metals have precipitated, the resultant sludge is amenable to stabilization and can be reclassified as a low-level waste if the quantity of leachable toxic metals, as determined by the TCLP, is below Universal Treatment Standards (UTS). To date, six batches in eight have passed the UTS. The AMWTS is RCRA permitted and allows for the compliant treatment of mixed waste prior to final disposal at a Department of Energy (DOE) or commercial radioactive waste disposal facility. Mixed wastes eligible for treatment include corrosive liquids (pH 12.5) containing EPA-regulated toxic metals (As, Ba, Pb, Cd, Cr, Ag, Se, Hg) at concentrations greater than the RCRA Toxicity Characteristic Leaching Procedure (TCLP) limit. The system has also been used to treat corrosive wastes with small quantities of fissionable materials. The AMWTS is a significant engineered solution with many improvements over the more labor intensive on-site treatment method being performed within a ventilation hood used previously. The previously used treatment system allowed for batch sizes of only 15-20 gallons whereas the new AMWTS allows for the treatment of batches up to 75 gallons; thereby reducing batch labor and supply costs by 40-60% and reducing analytical

  15. Using an energy management strategy to drive improved business results and improve manufacturing operations

    Energy Technology Data Exchange (ETDEWEB)

    Leroux, Marc

    2010-09-15

    Energy typically represents the single largest controllable cost in manufacturing, and is under constant scrutiny by all levels of management. In this paper we will examine the role and components of an energy management strategy, and focus on the benefits of looking at the strategy from a business perspective. We will then examine the role that an effective program, either existing or new, can play in a collaborative manufacturing environment, and how these improvements can reduce energy requirements while maintaining, or improving productivity.

  16. 30-day mortality after coronary artery bypass grafting and valve surgery has greatly improved over the last decade, but the 1-year mortality remains constant

    Directory of Open Access Journals (Sweden)

    Laura Sommer Hansen

    2015-01-01

    Full Text Available Introduction: European system for cardiac operative risk evaluation (EuroSCORE is a valuable tool in control of the quality of cardiac surgery. However, the validity of the risk score for the individual patient may be questioned. The present study was carried out to investigate whether the continued fall in short-term mortality reflects an actual improvement in late mortality, and subsequently, to investigate EuroSCORE as predictor of 1-year mortality. Methods: A population-based cohort study of 25,602 patients from a 12-year period from three public university hospitals undergoing coronary artery bypass grafting (CABG or valve surgery. Analysis was carried out based on EuroSCORE, age and co-morbidity factors (residual EuroSCORE. Results: During the period the average age increased from 65.1 ± 10.0 years to 68.9 ± 10.7 years (P < 0.001, one-way ANOVA, and the number of females increased from 26.0% to 28.2% (P = 0.0012, Chi-square test. The total EuroSCORE increased from 4.67 to 5.68 while the residual EuroSCORE decreased from 2.64 to 1.83. Thirty-day mortality decreased from 4.07% in 1999-2000 to 2.44% in 2011-2012 (P = 0.0056; Chi-square test, while 1-year mortality was unchanged (6.50% in 1999-2000 vs. 6.25% in 2011-2012 [P = 0.8086; Chi-square test]. Discussion: The study demonstrates that both co-morbidity and age has a great impact on 30-day mortality. However, with time the impact of co-morbidity seems less. Thus, age is more important than co-morbidity in late mortality. The various developments in short and long-term mortality are not readily explained. Conclusion: Although 30-day mortality of CABG and valve surgery patients has decreased during the 12-year period, the 1-year mortality remains the same.

  17. 226Ra, 232Th and 40K analysis in sand samples from some beaches of Great Vitoria, Espirito Santo, Brazil: preliminary results

    International Nuclear Information System (INIS)

    Aquino, Reginaldo R.; Pecequilo, Brigitte R.S.

    2009-01-01

    The natural radioactivity in superficial beach sand samples of 7 beaches of Great Vitoria, metropolitan region of the State of Espirito Santo, southeast Brazil, was determined from the 226 Ra, 232 Th and 4 0 K contents. The assessed beaches were Manguinhos, Camburi, Praia do Canto, Curva da Jurema, Itapua, Setibao and Areia Preta. Three samples of each beach were sealed in standard 100 mL polyethylene flasks and stored in order to obtain secular equilibrium in the 238 U and 232 Th series. All samples were measured by high resolution gamma spectrometry and the spectra were analyzed with the WinnerGamma software. The 232 Th concentration was determined from the average concentrations of 228 Ac, 212 Pb and 212 Bi and the 226 Ra concentration was determined from the average concentrations of 214 Pb and 214 Bi. Preliminary results show concentrations varying from 9 Bq.kg -1 to 6035 Bq.kg -1 for 232 Th, from 4 Bq.kg -1 to 575 Bq.kg -1 for 226 Ra and from 13 Bq.kg -1 to 142 Bq.kg -1 for 40 K. Areia Preta beach shows the highest values for 232 Th, while the highest value for 226 Ra was observed for Camburi beach. High values of 40 K were observed for Curva da Jurema beach. (author)

  18. Impact of the Great East Japan Earthquake on feeding methods and newborn growth at 1 month postpartum: results from the Fukushima Health Management Survey

    International Nuclear Information System (INIS)

    Kyozuka, Hyo; Yasuda, Shun; Kawamura, Makoto; Nomura, Yasuhisa; Fujimori, Keiya; Goto, Aya; Yasumura, Seiji; Abe, Masafumi

    2016-01-01

    This study examined the effects of three disasters (the Great East Japan Earthquake of March 11, 2011, followed by a tsunami and the Fukushima Daiichi Nuclear Power Plant accident) on feeding methods and growth in infants born after the disasters. Using results from the Fukushima Health Management Survey, Soso District (the affected area where the damaged nuclear power plant is located) and Aizu District (a less-affected area located farthest from the plant) were compared. In this study, newborn and maternal background characteristics were examined, as well as feeding methods, and other factors for newborn growth at the first postpartum examination for 1706 newborns born after the disaster in the affected (n = 836) and less-affected (n = 870) areas. Postpartum examinations took place 1 month after birth. Feeding method trends were examined, and multivariate regression analyses were used to investigate effects on newborn mass gain. There were no significant differences in background characteristics among newborns in these areas. When birth dates were divided into four periods to assess trends, no significant change in the exclusive breastfeeding rate was found, while the exclusive formula-feeding rate was significantly different across time periods in the affected area (p = 0.02). Multivariate analyses revealed no significant independent associations of maternal depression and change in medical facilities (possible disaster effects) with other newborn growth factors in either area. No area differences in newborn growth at the first postpartum examination or in exclusive breastfeeding rates were found during any period. Exclusive formula-feeding rates varied across time periods in the affected, but not in the less-affected area. It is concluded that effective guidance to promote breast-feeding and prevent exclusive use of formula is important for women in post-disaster circumstances. (orig.)

  19. Impact of the Great East Japan Earthquake on feeding methods and newborn growth at 1 month postpartum: results from the Fukushima Health Management Survey

    Energy Technology Data Exchange (ETDEWEB)

    Kyozuka, Hyo; Yasuda, Shun; Kawamura, Makoto; Nomura, Yasuhisa; Fujimori, Keiya [Fukushima Medical University, Department of Obstetrics and Gynecology, School of Medicine, Fukushima (Japan); Goto, Aya; Yasumura, Seiji [Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima (Japan); Fukushima Medical University, Department of Public Health, School of Medicine, Fukushima (Japan); Abe, Masafumi [Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima (Japan)

    2016-05-15

    This study examined the effects of three disasters (the Great East Japan Earthquake of March 11, 2011, followed by a tsunami and the Fukushima Daiichi Nuclear Power Plant accident) on feeding methods and growth in infants born after the disasters. Using results from the Fukushima Health Management Survey, Soso District (the affected area where the damaged nuclear power plant is located) and Aizu District (a less-affected area located farthest from the plant) were compared. In this study, newborn and maternal background characteristics were examined, as well as feeding methods, and other factors for newborn growth at the first postpartum examination for 1706 newborns born after the disaster in the affected (n = 836) and less-affected (n = 870) areas. Postpartum examinations took place 1 month after birth. Feeding method trends were examined, and multivariate regression analyses were used to investigate effects on newborn mass gain. There were no significant differences in background characteristics among newborns in these areas. When birth dates were divided into four periods to assess trends, no significant change in the exclusive breastfeeding rate was found, while the exclusive formula-feeding rate was significantly different across time periods in the affected area (p = 0.02). Multivariate analyses revealed no significant independent associations of maternal depression and change in medical facilities (possible disaster effects) with other newborn growth factors in either area. No area differences in newborn growth at the first postpartum examination or in exclusive breastfeeding rates were found during any period. Exclusive formula-feeding rates varied across time periods in the affected, but not in the less-affected area. It is concluded that effective guidance to promote breast-feeding and prevent exclusive use of formula is important for women in post-disaster circumstances. (orig.)

  20. Spatial variation in pollen and charcoal records in relation to the 665 yr BP Kaharoa tephra at Harataonga Bay, Great Barrier Island, northern New Zealand : preliminary results

    International Nuclear Information System (INIS)

    Horrocks, M.; Nichol, S.L.; Jones, M.D.; Shane, P.A.; Sutton, D.G.

    2001-01-01

    We present preliminary results of a pollen study examining spatial variability using the 665 14 C yr BP Kaharoa tephra as the key stratigraphic marker. Our aim is to highlight potential differences in pollen and charcoal profiles from adjacent sites, and to point out the implications of these differences for the interpretation of pollen records. Three sediment cores were taken from swampy ground behind foredunes at Harataonga Bay, a small catchment on Great Barrier Island. Core 1 provides a c. 5000 14 C yr record of the swamp and is typical of northern New Zealand pollen profiles in that the deforestation signal appears immediately after Kaharoa tephra. Cores 2 and 3, however, show this signal at least 1 m below the tephra layer. Also, artefact pollen of gourd Lagenaria, an introduced Polynesian cultigen, was found 80 cm below the tephra layer in Core 2. This apparent difference in the timing of the human signal may be explained by the occurrence of small-scale, highly localised fires that are not recorded at adjacent sites. This has implications for inferring date of human presence in extensive areas, such as regions or large catchments, from a small number of pollen cores taken from within those areas. An alternative explanation is that sediments in cores 2 and 3 have been reworked to a much greater extent than those in Core 1. This has implications for the use of tephra as critical data for events, particularly when using recent tephra such as Kaharoa for dating human presence when the necessary resolution is to decades or centuries rather than millenia. (author). 18 refs., 6 figs., 2 tabs

  1. Spinal Cord Stimulation Provides Pain Relief with Improved Psychosocial Function: Results from EMP3OWER.

    Science.gov (United States)

    Rosenberg, Jason; Fabi, Alain; Candido, Kenneth; Knezevic, Nick; Creamer, Michael; Carayannopoulos, Alexios; Ghodsi, Abdi; Nelson, Christopher; Bennett, Matthew

    2016-12-01

    The EMP 3 OWER™ study evaluated spinal cord stimulation (SCS) safety and efficacy and the associated changes in psychosocial and functional outcomes. Upon informed consent and IRB approval, 620 eligible subjects were enrolled prior to SCS trial evaluation and were assessed at baseline, 3, 6 and 12 months post-implant. Patient-reported pain relief (PRP), numerical rating scale (NRS), satisfaction, quality of life (QOL), and pain disability index (PDI) were assessed at all follow-up visits while the pain catastrophizing scale (PCS), short form-36 (SF-36), short form-McGill pain questionnaire version 2 (SF-MPQ-2), and the state-trait anxiety inventory (STAI) were assessed at the 6- and 12-month follow-up visits. Device and/or procedure-related adverse events were also recorded and reported. Subjects reporting a PRP ≥ 50% were considered responders. Repeated measures analysis of variance (RMANOVA) examined the changes across time for all continuous measures. A total of 401 (71%) subjects received a permanent implant. Mean (±SD) patient-reported pain relief was 59.3% (±26.2), 59.2% (±28.9), and 58.2% (±32.0) at 3, 6, and 12 months, respectively. A majority of enrolled subjects were responders at 3 (75.5%), 6 (74.7%), and 12 months (69.7%). RMANOVA revealed a statistically significant change for NRS, PCS, PDI, SF-36, SF-MPQ-2, and STAI scores. At 3 months, the majority of subjects (85.7%) were either very satisfied or satisfied with their device, with similar results at 6 and 12 months. At 3 months, the majority of subjects (73.3%) reported greatly improved or improved QOL with similar results at 6 and 12 months. Spinal cord stimulation provided pain relief and significant improvement of patient psychological and functional outcome measures. © 2016 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  2. The first US National Coastal Condition Assessment survey in the Great Lakes: Development of the GIS frame and exploration of spatial variation in nearshore water quality results

    Science.gov (United States)

    A comprehensive approach to assess conditions in the Great Lakes nearshore zone has been lacking for decades. We had the opportunity to conduct a pilot survey in Lake Erie (45 sites) in summer 2009 and to develop a full survey across the 5 lakes (~400 sites) as part of the US N...

  3. Multilevel eEmpirical Bayes modeling for improved estimation of toxicant formulations tosuppress parasitic sea lamprey in the Upper Great Lakes

    Science.gov (United States)

    Hatfield, Laura A.; Gutreuter, Steve; Boogaard, Michael A.; Carlin, Bradley P.

    2011-01-01

    Estimation of extreme quantal-response statistics, such as the concentration required to kill 99.9% of test subjects (LC99.9), remains a challenge in the presence of multiple covariates and complex study designs. Accurate and precise estimates of the LC99.9 for mixtures of toxicants are critical to ongoing control of a parasitic invasive species, the sea lamprey, in the Laurentian Great Lakes of North America. The toxicity of those chemicals is affected by local and temporal variations in water chemistry, which must be incorporated into the modeling. We develop multilevel empirical Bayes models for data from multiple laboratory studies. Our approach yields more accurate and precise estimation of the LC99.9 compared to alternative models considered. This study demonstrates that properly incorporating hierarchical structure in laboratory data yields better estimates of LC99.9 stream treatment values that are critical to larvae control in the field. In addition, out-of-sample prediction of the results of in situ tests reveals the presence of a latent seasonal effect not manifest in the laboratory studies, suggesting avenues for future study and illustrating the importance of dual consideration of both experimental and observational data.

  4. The Great Recession was not so Great

    NARCIS (Netherlands)

    van Ours, J.C.

    2015-01-01

    The Great Recession is characterized by a GDP-decline that was unprecedented in the past decades. This paper discusses the implications of the Great Recession analyzing labor market data from 20 OECD countries. Comparing the Great Recession with the 1980s recession it is concluded that there is a

  5. I Love My Librarian Award: An Award That Recognizes Great Librarians Also Highlights the Central Role of Libraries in Communities across America. Carnegie Results

    Science.gov (United States)

    Deutsch, Abigail

    2013-01-01

    The Carnegie Corporation of New York/"New York Times" I Love My Librar­ian Award publicizes librarians' abilities to improve their communities, and by highlighting the achievements of the winners, inspire other librarians to boost their own performance. Since the award's creation in 2008, it has helped the public to better understand…

  6. Formal quality improvement curriculum and DMAIC method results in interdisciplinary collaboration and process improvement in renal transplant patients.

    Science.gov (United States)

    Leaphart, Cynthia L; Gonwa, Thomas A; Mai, Martin L; Prendergast, Mary B; Wadei, Hani M; Tepas, Joseph J; Taner, C Burcin

    2012-09-01

    Broad-based formal quality improvement curriculum emphasizing Six Sigma and the DMAIC approach developed by our institution is required for physicians in training. DMAIC methods evaluated the common outcome of postoperative hyponatremia, thus resulting in collaboration to prevent hyponatremia in the renal transplant population. To define postoperative hyponatremia in renal transplant recipients, a project charter outlined project aims. To measure postoperative hyponatremia, serum sodium at admission and immediately postoperative were recorded by retrospective review of renal transplant recipient charts from June 29, 2010 to December 31, 2011. An Ishikawa diagram was generated to analyze potential causative factors. Interdisciplinary collaboration and hospital policy assessment determined necessary improvements to prevent hyponatremia. Continuous monitoring in control phase was performed by establishing the goal of DMAIC approach and formal quality curriculum for trainees addresses core competencies by providing a framework for problem solving, interdisciplinary collaboration, and process improvement. Copyright © 2012 Elsevier Inc. All rights reserved.

  7. Great software debates

    CERN Document Server

    Davis, A

    2004-01-01

    The industry’s most outspoken and insightful critic explains how the software industry REALLY works. In Great Software Debates, Al Davis, shares what he has learned about the difference between the theory and the realities of business and encourages you to question and think about software engineering in ways that will help you succeed where others fail. In short, provocative essays, Davis fearlessly reveals the truth about process improvement, productivity, software quality, metrics, agile development, requirements documentation, modeling, software marketing and sales, empiricism, start-up financing, software research, requirements triage, software estimation, and entrepreneurship.

  8. Leukocyte depletion results in improved lung function and reduced inflammatory response after cardiac surgery

    NARCIS (Netherlands)

    Gu, YJ; Boonstra, PW; vanOeveren, W

    Leukocyte depletion during cardiopulmonary bypass has been demonstrated in animal experiments to improve pulmonary function, Conflicting results have been reported, however, with clinical depletion by arterial line filter of leukocytes at the beginning of cardiopulmonary bypass. In this study, we

  9. 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.

  10. Combined platelet-rich plasma and lipofilling treatment provides great improvement in facial skin-induced lesion regeneration for scleroderma patients

    Directory of Open Access Journals (Sweden)

    Francesco Virzì

    2017-10-01

    Full Text Available Abstract Background The use of stem cells, including mesenchymal stem cells (MSCs, for regenerative medicine is gaining interest for the clinical benefits so far obtained in patients. This study investigates the use of adipose autologous tissue in combination with platelet-rich plasma (PRP to improve the clinical outcome of patients affected by systemic sclerosis (SSc. Methods Adipose-derived mesenchymal stem cells (AD-MSCs and PRPs were purified from healthy donors and SSc patients. The multilineage differentiation potential of AD-MSCs and their genotypic–phenotypic features were investigated. A cytokine production profile was evaluated on AD-MSCs and PRPs from both healthy subjects and SSc patients. The adipose tissue-derived cell fraction, the so-called stromal vascular fraction (SVF, was coinjected with PRP in the perioral area of SSc patients. Results Histopathological and phenotypical analysis of adipose tissue from SSc patients revealed a disorganization of its distinct architecture coupled with an altered cell composition. Although AD-MSCs derived from SSc patients showed high multipotency, they failed to sustain a terminally differentiated progeny. Furthermore, SVFs derived from SSc patients differed from healthy donors in their MSC-like traits coupled with an aberrant cytokine production profile. Finally, the administration of PRP in combination with autologous SVF improved buccal’s rhyme, skin elasticity and vascularization for all of the SSc patients enrolled in this study. Conclusions This innovative regenerative therapy could be exploited for the treatment of chronic connective tissue diseases, including SSc.

  11. Great Lakes Science Center

    Data.gov (United States)

    Federal Laboratory Consortium — Since 1927, Great Lakes Science Center (GLSC) research has provided critical information for the sound management of Great Lakes fish populations and other important...

  12. Waste Minimization Improvements Achieved Through Six Sigma Analysis Result In Significant Cost Savings

    International Nuclear Information System (INIS)

    Mousseau, Jeffrey D.; Jansen, John R.; Janke, David H.; Plowman, Catherine M.

    2003-01-01

    Improved waste minimization practices at the Department of Energy's (DOE) Idaho National Engineering and Environmental Laboratory (INEEL) are leading to a 15% reduction in the generation of hazardous and radioactive waste. Bechtel, BWXT Idaho, LLC (BBWI), the prime management and operations contractor at the INEEL, applied the Six Sigma improvement process to the INEEL Waste Minimization Program to review existing processes and define opportunities for improvement. Our Six Sigma analysis team: composed of an executive champion, process owner, a black belt and yellow belt, and technical and business team members used this statistical based process approach to analyze work processes and produced ten recommendations for improvement. Recommendations ranged from waste generator financial accountability for newly generated waste to enhanced employee recognition programs for waste minimization efforts. These improvements have now been implemented to reduce waste generation rates and are producing positive results

  13. Exploring the Great Schism in the Social Sciences: Confirmation Bias and the Interpretation of Results Relating to Biological Influences on Human Behavior and Psychology.

    Science.gov (United States)

    Winking, Jeffrey

    2018-01-01

    The nature-nurture debate is one that biologists often dismiss as a false dichotomy, as all phenotypic traits are the results of complex processes of gene and environment interactions. However, such dismissiveness belies the ongoing debate that is unmistakable throughout the biological and social sciences concerning the role of biological influences in the development of psychological and behavioral traits in humans. Many have proposed that this debate is due to ideologically driven biases in the interpretation of results. Those favoring biological approaches have been accused of a greater willingness to accept biological explanations so as to rationalize or justify the status quo of inequality. Those rejecting biological approaches have been accused of an unwillingness to accept biological explanations so as to attribute inequalities solely to social and institutional factors, ultimately allowing for the possibility of social equality. While it is important to continue to investigate this topic through further research and debate, another approach is to examine the degree to which the allegations of bias are indeed valid. To accomplish this, a convenience sample of individuals with relevant postgraduate degrees was recruited from Mechanical Turk and social media. Participants were asked to rate the inferential power of different research designs and of mock results that varied in the degree to which they supported different ideologies. Results were suggestive that researchers harbor sincere differences of opinion concerning the inferential value of relevant research. There was no suggestion that ideological confirmation biases drive these differences. However, challenges associated with recruiting a large enough sample of experts as well as identifying believable mock scenarios limit the study's inferential scope.

  14. Explaining variation in perceived team effectiveness: results from eleven quality improvement collaboratives.

    Science.gov (United States)

    Strating, Mathilde M H; Nieboer, Anna P

    2013-06-01

    Explore effectiveness of 11 collaboratives focusing on 11 different topics, as perceived by local improvement teams and to explore associations with collaborative-, organisational- and team-level factors. Evidence underlying the effectiveness of quality improvement collaboratives is inconclusive and few studies investigated determinants of implementation success. Moreover, most evaluation studies on quality improvement collaboratives are based on one specific topic or quality problem, making it hard to compare across collaboratives addressing different topics. A multiple-case cross-sectional study. Quality improvement teams in 11 quality improvement collaboratives focusing on 11 different topics. Team members received a postal questionnaire at the end of each collaborative. Of the 283 improvement teams, 151 project leaders and 362 team members returned the questionnaire. Analysis of variance revealed that teams varied widely on perceived effectiveness. Especially, members in the Prevention of Malnutrition and Prevention of Medication Errors collaboratives perceived a higher effectiveness than other groups. Multilevel regression analyses showed that educational level of professionals, innovation attributes, organisational support, innovative culture and commitment to change were all significant predictors of perceived effectiveness. In total, 27·9% of the individual-level variance, 57·6% of the team-level variance and 80% of the collaborative-level variance could be explained. The innovation's attributes, organisational support, an innovative team culture and professionals' commitment to change are instrumental to perceived effectiveness. The results support the notion that a layered approach is necessary to achieve improvements in quality of care and provides further insight in the determinants of success of quality improvement collaboratives. Understanding which factors enhance the impact of quality improvement initiatives can help professionals to achieve

  15. Wide Angle Imaging Lidar (WAIL): Theory of Operation and Results from Cross-Platform Validation at the ARM Southern Great Plains Site

    Science.gov (United States)

    Polonsky, I. N.; Davis, A. B.; Love, S. P.

    2004-05-01

    WAIL was designed to determine physical and geometrical characteristics of optically thick clouds using the off-beam component of the lidar return that can be accurately modeled within the 3D photon diffusion approximation. The theory shows that the WAIL signal depends not only on the cloud optical characteristics (phase function, extinction and scattering coefficients) but also on the outer thickness of the cloud layer. This makes it possible to estimate the mean optical and geometrical thicknesses of the cloud. The comparison with Monte Carlo simulation demonstrates the high accuracy of the diffusion approximation for moderately to very dense clouds. During operation WAIL is able to collect a complete data set from a cloud every few minutes, with averaging over horizontal scale of a kilometer or so. In order to validate WAIL's ability to deliver cloud properties, the LANL instrument was deployed as a part of the THickness from Off-beam Returns (THOR) validation IOP. The goal was to probe clouds above the SGP CART site at night in March 2002 from below (WAIL and ARM instruments) and from NASA's P3 aircraft (carrying THOR, the GSFC counterpart of WAIL) flying above the clouds. The permanent cloud instruments we used to compare with the results obtained from WAIL were ARM's laser ceilometer, micro-pulse lidar (MPL), millimeter-wavelength cloud radar (MMCR), and micro-wave radiometer (MWR). The comparison shows that, in spite of an unusually low cloud ceiling, an unfavorable observation condition for WAIL's present configuration, cloud properties obtained from the new instrument are in good agreement with their counterparts obtained by other instruments. So WAIL can duplicate, at least for single-layer clouds, the cloud products of the MWR and MMCR together. But WAIL does this with green laser light, which is far more representative than microwaves of photon transport processes at work in the climate system.

  16. Preventing falls in assisted living: Results of a quality improvement pilot study.

    Science.gov (United States)

    Zimmerman, Sheryl; Greene, Angela; Sloane, Philip D; Mitchell, Madeline; Giuliani, Carol; Nyrop, Kirsten; Walsh, Edith

    Residents of assisted living (AL) communities are at high risk for falls, which result in negative outcomes and high health care costs. Adapting effective falls prevention programs for AL quality improvement (QI) has the potential to reduce falls, improve resident quality of life, and reduce costs. This project tested the feasibility and outcomes of an evidence-based multi-component QI program, the Assisted Living Falls Prevention and Monitoring Program (AL-FPMP). Resident posture and gait improved, likely due to exercise and/or physical therapy. Effective falls prevention QI programs can be implemented in AL, and are advised to (1) establish and maintain a falls team to create a culture focused on the reduction of falls risk; (2) teach staff to assess residents using the Morse Falls Scale to increase their awareness of residents' falls risk and improvement; and (3) modify existing exercise programs to address balance and lower body strength. Copyright © 2016 Elsevier Inc. All rights reserved.

  17. Urban rural differences in diet, physical activity and obesity in India: are we witnessing the great Indian equalisation? Results from a cross-sectional STEPS survey

    Directory of Open Access Journals (Sweden)

    Jaya Prasad Tripathy

    2016-08-01

    Full Text Available Abstract Background The rising morbidity and mortality due to non-communicable diseases can be partly attributed to the urbanized lifestyle leading to unhealthy dietary practices and increasing physical levels of inactivity. The demographic and nutrition transition in India has also contributed to the emerging epidemic of non-communicable diseases in this country. In this context, there is limited information in India on dietary patterns, levels of physical activity and obesity. The aim of the present study was thus to assess the urban rural differences in dietary habits, physical activity and obesity in India. Methods A household survey was done in the state of Punjab, India in a multistage stratified sample of 5127 individuals using the WHO STEPS questionnaire. Results No rural urban difference was found in dietary practices and prevalence of overweight and obesity except the fact that a significantly higher proportion of respondents belonging to rural area (15.6 % always/often add salt before/when eating as compared to urban area (9.1 %. Overall 95.8 % (94.6–97.0 of participants took less than 5 servings of fruits and/or vegetables on average per day. No significant urban rural difference was noted in both sexes in all three domains of physical activity such as work, transport and recreation. However, rural females (19.1 % were found to be engaged in vigorous activity more than the urban females (6.3 %. Males reported high levels of physical activity in both the settings. Absence of recreational activity was reported by more than 95 % of the subjects. Higher prevalence of obesity (asian cut offs used was seen among urban females (34.3 % as compared to their rural counterparts (23.2 %. Abdominal obesity was found to be significantly higher among females in both the settings compared to males (p < 0.001. Conclusions Poor dietary practices and physical inactivity seems to fuel the non-communicable disease epidemic in India. Non

  18. The wind forecasting improvement project. Description and results from the Southern study region

    Energy Technology Data Exchange (ETDEWEB)

    Freedman, Jeffrey [AWS Truepower LLC, Albany, NY (United States); Benjamin, Stan; Wilczak, James [National Oceanic and Atmospheric Administration, Washington, DC and Boulder, CO (United States)] [and others

    2012-07-01

    The Wind Forecasting Improvement Project (WFIP) is a multi-year U.S. Department of Energy (DOE)/National Oceanographic and Atmospheric Administration (NOAA) sponsored study whose main purpose is to demonstrate the scientific and economic benefits of additional atmospheric observations and model enhancements on wind energy production forecasts. WFIP covers two geographical regions of the U.S.: (1) the upper Great Plains, or Northern Study Area, and (2) most of Texas-the Southern Study Area. The Southern campaign is being led by AWS Truepower LLC, and includes a team of private, government, and academic partners with collective experience and expertise in all facets required to ensure a successful completion of the project. In addition presenting a summary of the state-of-the-art forecasting techniques used and phenomena-based analysis mentioned above, a brief synopsis of how ''lessons learned'' from the WFIP Southern Study Area can be articulated and applied to other wind resource regions will be described. (orig.)

  19. Safety improvement and results of commissioning of Mochovce NPP WWER 440/213

    International Nuclear Information System (INIS)

    Lipar, M.

    1998-01-01

    Mochovce NPP is the last one of this kind and compared to its predecessors, it is characterized by several modifications which contribute to the improvement of the safety level. In addition based on Nuclear Regulatory Authority requirements and based on documents: - IAEA - Safety Issues and their ranking for NPP WWER 440/213, - IAEA - Safety Improvement of Mochovce NPP Project Review Mission, - Riskaudit - Evaluation of the Mochovce NPP Safety Improvements. Additional safety measures have been implemented before commissioning. The consortium EUCOM (FRAMATOME - SIEMENS), SKODA Praha, ENERGOPROJEKT Praha, Russian organizations and VUJE Trnava Nuclear Power Plants research institute were selected for design and implementation of the safety measures. The papers summarized, safety requirements, safety measures implemented, results of commissioning and results of safety analysis report evaluation. (author)

  20. Why greatness cannot be planned the myth of the objective

    CERN Document Server

    Stanley, Kenneth O

    2015-01-01

    Why does modern life revolve around objectives? From how science is funded, to improving how children are educated -- and nearly everything in-between -- our society has become obsessed with a seductive illusion: that greatness results from doggedly measuring improvement in the relentless pursuit of an ambitious goal. In Why Greatness Cannot Be Planned, Stanley and Lehman begin with a surprising scientific discovery in artificial intelligence that leads ultimately to the conclusion that the objective obsession has gone too far. They make the case that great achievement can't be bottled up int

  1. Result

    African Journals Online (AJOL)

    Tsinuel

    BACKGROUND: Neonatal deaths in general, early neonatal deaths in particular now represent two- third of infant deaths and one-third of under-five deaths worldwide. Therefore, improving newborn survival is a major priority in child health today. Negotiation of improved neonatal health care practice into the community ...

  2. Online Student Evaluation Improves Course Experience Questionnaire Results in a Physiotherapy Program

    Science.gov (United States)

    Tucker, Beatrice; Jones, Sue; Straker, Leon

    2008-01-01

    This paper reports the use of an online student evaluation system, Course Experience on the Web (CEW), in a physiotherapy program to improve their Course Experience Questionnaire (CEQ) results. CEW comprises a course survey instrument modeled on the CEQ and a tailored unit survey instrument. Closure of the feedback loop is integral in the CEW…

  3. Effectiveness of an Intervention Program for Improving School Atmosphere: Some Results

    Science.gov (United States)

    Sanchez, A. M.; Rivas, M. T.; Trianes, M. V.

    2006-01-01

    This work describes the results of the "Programa de Desarrollo Social y Afectivo" [Social and Affective Development Program] (Trianes & Munoz, 1994; Trianes, 1996), under way during four years at a public school in a disadvantaged area Malaga, earmarked for special educational resources. The intervention is meant to improve classroom…

  4. Incorrect results in software engineering experiments: How to improve research practices

    OpenAIRE

    Jørgensen, Magne; Dybå, Tore; Liestøl, Knut; Sjøberg, Dag

    2016-01-01

    Context The trustworthiness of research results is a growing concern in many empirical disciplines. Aim The goals of this paper are to assess how much the trustworthiness of results reported in software engineering experiments is affected by researcher and publication bias, given typical statistical power and significance levels, and to suggest improved research practices. Method First, we conducted a small-scale survey to document the presence of researcher and publication biases in software...

  5. The superomedial thigh flap in scrotal reconstruction: Technical steps to improve cosmetic results

    Directory of Open Access Journals (Sweden)

    Ayat Allah Oufkir

    2013-01-01

    Full Text Available The superomedial thigh flap is a reliable and easy method for scrotal reconstruction described in 1980 and infrequently reported in the literature since its description. We used it for four patients presenting scrotal defects after Fournier′s gangrene with some technical modifications to improve the esthetic results and to facilitate the closure of the donor area. We describe the technical steps and the results.

  6. Improving the Simplified Acquisition of Base Engineering Requirements (SABER) Delivery Order Award Process: Results of a Process Improvement Plan

    Science.gov (United States)

    1991-09-01

    putting all tasks directed towsrds achieving an outcome in aequence. The tasks can be viewed as steps in the process (39:2.3). Using this...improvement opportunity is investigated. A plan is developed, root causes are identified, and solutions are tested and implemented. The process is... solutions , check for actual improvement, and integrate the successful improvements into the process. ?UP 7. Check Improvement Performance. Finally, the

  7. Does improved access to diagnostic imaging results reduce hospital length of stay? A retrospective study

    Directory of Open Access Journals (Sweden)

    Hurlen Petter

    2010-09-01

    Full Text Available Abstract Background One year after the introduction of Information and Communication Technology (ICT to support diagnostic imaging at our hospital, clinicians had faster and better access to radiology reports and images; direct access to Computed Tomography (CT reports in the Electronic Medical Record (EMR was particularly popular. The objective of this study was to determine whether improvements in radiology reporting and clinical access to diagnostic imaging information one year after the ICT introduction were associated with a reduction in the length of patients' hospital stays (LOS. Methods Data describing hospital stays and diagnostic imaging were collected retrospectively from the EMR during periods of equal duration before and one year after the introduction of ICT. The post-ICT period was chosen because of the documented improvement in clinical access to radiology results during that period. The data set was randomly split into an exploratory part used to establish the hypotheses, and a confirmatory part. The data was used to compare the pre-ICT and post-ICT status, but also to compare differences between groups. Results There was no general reduction in LOS one year after ICT introduction. However, there was a 25% reduction for one group - patients with CT scans. This group was heterogeneous, covering 445 different primary discharge diagnoses. Analyses of subgroups were performed to reduce the impact of this divergence. Conclusion Our results did not indicate that improved access to radiology results reduced the patients' LOS. There was, however, a significant reduction in LOS for patients undergoing CT scans. Given the clinicians' interest in CT reports and the results of the subgroup analyses, it is likely that improved access to CT reports contributed to this reduction.

  8. A Pragmatic Smoothing Method for Improving the Quality of the Results in Atomic Spectroscopy

    Science.gov (United States)

    Bennun, Leonardo

    2017-07-01

    A new smoothing method for the improvement on the identification and quantification of spectral functions based on the previous knowledge of the signals that are expected to be quantified, is presented. These signals are used as weighted coefficients in the smoothing algorithm. This smoothing method was conceived to be applied in atomic and nuclear spectroscopies preferably to these techniques where net counts are proportional to acquisition time, such as particle induced X-ray emission (PIXE) and other X-ray fluorescence spectroscopic methods, etc. This algorithm, when properly applied, does not distort the form nor the intensity of the signal, so it is well suited for all kind of spectroscopic techniques. This method is extremely effective at reducing high-frequency noise in the signal much more efficient than a single rectangular smooth of the same width. As all of smoothing techniques, the proposed method improves the precision of the results, but in this case we found also a systematic improvement on the accuracy of the results. We still have to evaluate the improvement on the quality of the results when this method is applied over real experimental results. We expect better characterization of the net area quantification of the peaks, and smaller Detection and Quantification Limits. We have applied this method to signals that obey Poisson statistics, but with the same ideas and criteria, it could be applied to time series. In a general case, when this algorithm is applied over experimental results, also it would be required that the sought characteristic functions, required for this weighted smoothing method, should be obtained from a system with strong stability. If the sought signals are not perfectly clean, this method should be carefully applied

  9. Capabilities of gravitational surgery for improvement of treatment results in patients with diabetic foot syndrome

    Directory of Open Access Journals (Sweden)

    M B Akhmedov

    2018-06-01

    Full Text Available Aim. Improvement of complex treatment results in patients with diabetic foot syndrome by introducing methods of gravitational surgery and α-lipoic acid. Methods. The results of treatment were analyzed for 558 patients with diabetic foot syndrome treated in Scientific Centre of Surgery named after M.A. Topchubashov (Baku, Azerbaijan from 1988 to 2015. The age varied from 28 to 83 years. The patients included 416 men and 142 women. The control group included 90 patients who at the perioperative period underwent basic therapy including antibiotics, anticoagulants, antiaggregants, dextrans, angioprotectors, spasmolytics, corticosteroids, narcotic and non-narcotic analgesics. The study group included 468 patients, along with traditional therapy receiving efferent methods (plasmapheresis, ultraviolet blood irradiation, ozone therapy and α-lipoic acid. 282 patients of the study group received outpatient treatment and 186 - complex inpatient surgical treatment. A comparative evaluation of the results was performed separately in three groups: angiopathy, neuropathy, angioneuropathy. The results were evaluated by clinical and instrumental examinations before and after treatment (6, 12, 60 months and more. Results. In the study group a satisfactory result of treatment was registered in 85.5% of patients, in the control group - in 62.2%, unsatisfactory in 14.5 and 37.8% of patients, respectively (p=0.046. Conclusion. The use of efferent methods and α-lipoic acid provided prompt elimination of numerous pathogenetic disorders observed in diabetes mellitus, decrease of amputation frequency and improvement of complex surgical treatment results in patients with diabetic foot syndrome.

  10. Combined platelet-rich plasma and lipofilling treatment provides great improvement in facial skin-induced lesion regeneration for scleroderma patients

    OpenAIRE

    Virzì, Francesco; Bianca, Paola; Giammona, Alessandro; Apuzzo, Tiziana; Di Franco, Simone; Mangiapane, Laura Rosa; Colorito, Maria Luisa; Catalano, Dario; Scavo, Emanuela; Nicotra, Annalisa; Benfante, Antonina; Pistone, Giuseppe; Caputo, Valentina; Dieli, Francesco; Pirrello, Roberto

    2017-01-01

    Background The use of stem cells, including mesenchymal stem cells (MSCs), for regenerative medicine is gaining interest for the clinical benefits so far obtained in patients. This study investigates the use of adipose autologous tissue in combination with platelet-rich plasma (PRP) to improve the clinical outcome of patients affected by systemic sclerosis (SSc). Methods Adipose-derived mesenchymal stem cells (AD-MSCs) and PRPs were purified from healthy donors and SSc patients. The multiline...

  11. Improved measurement results for the Avogadro constant using a 28Si-enriched crystal

    Science.gov (United States)

    Azuma, Y.; Barat, P.; Bartl, G.; Bettin, H.; Borys, M.; Busch, I.; Cibik, L.; D'Agostino, G.; Fujii, K.; Fujimoto, H.; Hioki, A.; Krumrey, M.; Kuetgens, U.; Kuramoto, N.; Mana, G.; Massa, E.; Meeß, R.; Mizushima, S.; Narukawa, T.; Nicolaus, A.; Pramann, A.; Rabb, S. A.; Rienitz, O.; Sasso, C.; Stock, M.; Vocke, R. D., Jr.; Waseda, A.; Wundrack, S.; Zakel, S.

    2015-04-01

    New results are reported from an ongoing international research effort to accurately determine the Avogadro constant by counting the atoms in an isotopically enriched silicon crystal. The surfaces of two 28Si-enriched spheres were decontaminated and reworked in order to produce an outer surface without metal contamination and improved sphericity. New measurements were then made on these two reconditioned spheres using improved methods and apparatuses. When combined with other recently refined parameter measurements, the Avogadro constant derived from these new results has a value of NA = 6.022 140 76(12) × 1023 mol-1. The x-ray crystal density method has thus achieved the target relative standard uncertainty of 2.0  ×  10-8 necessary for the realization of the definition of the new kilogram.

  12. EXERCISE IMPROVES SEXUAL FUNCTION IN WOMEN TAKING ANTIDEPRESSANTS: RESULTS FROM A RANDOMIZED CROSSOVER TRIAL

    Science.gov (United States)

    Lorenz, Tierney Ahrold; Meston, Cindy May

    2014-01-01

    Background In laboratory studies, exercise immediately before sexual stimuli improved sexual arousal of women taking antidepressants [1]. We evaluated if exercise improves sexual desire, orgasm, and global sexual functioning in women experiencing antidepressant-induced sexual side effects. Methods Fifty-two women who were reporting antidepressant sexual side effects were followed for 3 weeks of sexual activity only. They were randomized to complete either three weeks of exercise immediately before sexual activity (3×/week) or 3 weeks of exercise separate from sexual activity (3×/week). At the end of the first exercise arm, participants crossed to the other. We measured sexual functioning, sexual satisfaction, depression, and physical health. Results Exercise immediately prior to sexual activity significantly improved sexual desire and, for women with sexual dysfunction at baseline, global sexual function. Scheduling regular sexual activity significantly improved orgasm function; exercise did not increase this benefit. Neither regular sexual activity nor exercise significantly changed sexual satisfaction. Conclusions Scheduling regular sexual activity and exercise may be an effective tool for the behavioral management of sexual side effects of antidepressants. PMID:24754044

  13. Combined platelet-rich plasma and lipofilling treatment provides great improvement in facial skin-induced lesion regeneration for scleroderma patients.

    Science.gov (United States)

    Virzì, Francesco; Bianca, Paola; Giammona, Alessandro; Apuzzo, Tiziana; Di Franco, Simone; Mangiapane, Laura Rosa; Colorito, Maria Luisa; Catalano, Dario; Scavo, Emanuela; Nicotra, Annalisa; Benfante, Antonina; Pistone, Giuseppe; Caputo, Valentina; Dieli, Francesco; Pirrello, Roberto; Stassi, Giorgio

    2017-10-23

    The use of stem cells, including mesenchymal stem cells (MSCs), for regenerative medicine is gaining interest for the clinical benefits so far obtained in patients. This study investigates the use of adipose autologous tissue in combination with platelet-rich plasma (PRP) to improve the clinical outcome of patients affected by systemic sclerosis (SSc). Adipose-derived mesenchymal stem cells (AD-MSCs) and PRPs were purified from healthy donors and SSc patients. The multilineage differentiation potential of AD-MSCs and their genotypic-phenotypic features were investigated. A cytokine production profile was evaluated on AD-MSCs and PRPs from both healthy subjects and SSc patients. The adipose tissue-derived cell fraction, the so-called stromal vascular fraction (SVF), was coinjected with PRP in the perioral area of SSc patients. Histopathological and phenotypical analysis of adipose tissue from SSc patients revealed a disorganization of its distinct architecture coupled with an altered cell composition. Although AD-MSCs derived from SSc patients showed high multipotency, they failed to sustain a terminally differentiated progeny. Furthermore, SVFs derived from SSc patients differed from healthy donors in their MSC-like traits coupled with an aberrant cytokine production profile. Finally, the administration of PRP in combination with autologous SVF improved buccal's rhyme, skin elasticity and vascularization for all of the SSc patients enrolled in this study. This innovative regenerative therapy could be exploited for the treatment of chronic connective tissue diseases, including SSc.

  14. Improved Method of Detection Falsification Results the Digital Image in Conditions of Attacks

    Directory of Open Access Journals (Sweden)

    Kobozeva A.A.

    2016-08-01

    Full Text Available The modern level of information technologies development has led to unheard ease embodiments hitherto unauthorized modifications of digital content. At the moment, very important question is the effective expert examination of authenticity of digital images, video, audio, development of the methods for identification and localization of violations of their integrity using these contents for purposes other than entertainment. Present paper deals with the improvement of the detection method of the cloning results in digital images - one of the most frequently used in the software tools falsification realized in all modern graphics editors. The method is intended for clone detection areas and pre-image in terms of additional disturbing influences in the image after the cloning operation for "masking" of the results, which complicates the search process. The improvement is aimed at reducing the number of "false alarms", when the area of the clone / pre-image detected in the original image or the localization of the identified areas do not correspond to the real clone and pre-image. The proposed improvement, based on analysis of different sizes per-pixel image blocks with the least difference from each other, has made it possible efficient functioning of the method, regardless of the specificity of the analyzed digital image.

  15. Revolutionary impact of PET and PET-CT on the day-to-day practice of medicine and its great potential for improving future health care

    International Nuclear Information System (INIS)

    Basu, S.; Alavi, A.

    2009-01-01

    In this communication, we present an overview of the impact and advantages of PET and PET-CT fusion imaging in the practice of medicine. We also discuss the evolution of this promising molecular imaging technique since its inception and the future prospects of the combined structure-function approach. Superior contrast resolution, accurate quantification and above all optimal image quality aid in improved diagnosis of many serious disorders including cancer. We speculate that this powerful imaging approach will almost completely replace most other conventional methods in the future. Currently, 18[F]-fluorodeoxyglucose (FDG) is the main radiopharmaceutical employed for PET studies around the globe. With the availability of high quality PET images on a routine basis in most centres around the world and the likelihood that several other useful PET tracers will be approved in the near future for routine clinical applications, this technique will likely become essential in almost any medical disorder. (authors)

  16. Experimental results on performance improvement of doped carbon-base materials

    International Nuclear Information System (INIS)

    Xu Zengyu

    2002-01-01

    Carbon-base materials is one of candidate plasma facing materials and have been widely used in current tokamak facilities in the world. But some defect properties are presented on high yield of chemical sputtering , high yield of radiation enhancement sublimate (RES), cracking after heat flux and so on. It can be improved by doped some little other elements into the carbon-base materials, such as boron, silicon, titanium and so on. Experimental results indicate that it is feasible and successful to improve thermo-physics and chemical properties of carbon-base materials by multi-element doped. Doped 12 % silicon can strained RES and chemical sputtering yield do not changed. It is the same level of chemical sputtering yield for B 4 C from 3 % to 10 % , but their resistance thermal shock properties ability increases with B 4 C increases

  17. Leveraging finances for public health system improvement: results from the Turning Point initiative.

    Science.gov (United States)

    Bekemeier, Betty; Riley, Catharine M; Berkowitz, Bobbie

    2007-01-01

    Reforming the public health infrastructure requires substantial system changes at the state level; state health agencies, however, often lack the resources and support for strategic planning and systemwide improvement. The Turning Point Initiative provided support for states to focus on large-scale system changes that resulted in increased funding for public health capacity and infrastructure development. Turning Point provides a test case for obtaining financial and institutional resources focused on systems change and infrastructure development-areas for which it has been historically difficult to obtain long-term support. The purpose of this exploratory, descriptive survey research was to enumerate the actual resources leveraged toward public health system improvement through the partnerships, planning, and implementation activities funded by the Robert Wood Johnson Foundation as a part of the Turning Point Initiative.

  18. Recent improvements in the calculation of prompt fission neutron spectra: Preliminary results

    International Nuclear Information System (INIS)

    Madland, D.G.; LaBauve, R.J.; Nix, J.R.

    1989-01-01

    We consider three topics in the refinement and improvement of our original calculations of prompt fission neutron spectra. These are an improved calculation of the prompt fission neutron spectrum N(E) from the spontaneous fission of 252 Cf, a complete calculation of the prompt fission neutron spectrum matrix N(E,E n ) from the neutron-induced fission of 235 U, at incident neutron energies ranging from 0 to 15 MeV, and an assessment of the scission neutron component of the prompt fission neutron spectrum. Preliminary results will be presented and compared with experimental measurements and an evaluation. A suggestion is made for new integral cross section measurements. (author). 45 refs, 12 figs, 1 tab

  19. Phase 1, Background study results under the Council of Great Lake Governors program to perform stack sampling and analysis of emissions from densified refuse derived fuels (d-RDF)

    Energy Technology Data Exchange (ETDEWEB)

    1989-04-07

    This report covers the results of the first part of the study. Chapter 2 contains a summary of the d-RDF literature which was surveyed. Chapter 3 contains a compilation of existing and proposed regulation information from the seven participating Great Lakes States. Chapter 4 includes identification of pellet producers in the region. Chapter 5 contains a description of the pellet producers and test burn facilities selected for the experimental work to be undertaken in the second part of the program study. Chapter 6 contains a list of references. 27 refs., 7 figs., 6 tabs.

  20. Standardization of reflectance measurements in dispersed organic matter: results of an exercise to improve interlaboratory agreement

    Science.gov (United States)

    Hackley, Paul C.; Araujo, Carla Viviane; Borrego, Angeles G.; Bouzinos, Antonis; Cardott, Brian; Cook, Alan C.; Eble, Cortland; Flores, Deolinda; Gentzis, Thomas; Gonçalves, Paula Alexandra; Filho, João Graciano Mendonça; Hámor-Vidó, Mária; Jelonek, Iwona; Kommeren, Kees; Knowles, Wayne; Kus, Jolanta; Mastalerz, Maria; Menezes, Taíssa Rêgo; Newman, Jane; Pawlewicz, Mark; Pickel, Walter; Potter, Judith; Ranasinghe, Paddy; Read, Harold; Reyes, Julito; Rodriguez, Genaro De La Rosa; de Souza, Igor Viegas Alves Fernandes; Suarez-Ruiz, Isabel; Sýkorová, Ivana; Valentine, Brett J.

    2015-01-01

    Vitrinite reflectance generally is considered the most robust thermal maturity parameter available for application to hydrocarbon exploration and petroleum system evaluation. However, until 2011 there was no standardized methodology available to provide guidelines for vitrinite reflectance measurements in shale. Efforts to correct this deficiency resulted in publication of ASTM D7708: Standard test method for microscopical determination of the reflectance of vitrinite dispersed in sedimentary rocks. In 2012-2013, an interlaboratory exercise was conducted to establish precision limits for the D7708 measurement technique. Six samples, representing a wide variety of shale, were tested in duplicate by 28 analysts in 22 laboratories from 14 countries. Samples ranged from immature to overmature (0.31-1.53% Ro), from organic-lean to organic-rich (1-22 wt.% total organic carbon), and contained Type I (lacustrine), Type II (marine), and Type III (terrestrial) kerogens. Repeatability limits (maximum difference between valid repetitive results from same operator, same conditions) ranged from 0.03-0.11% absolute reflectance, whereas reproducibility limits (maximum difference between valid results obtained on same test material by different operators, different laboratories) ranged from 0.12-0.54% absolute reflectance. Repeatability and reproducibility limits degraded consistently with increasing maturity and decreasing organic content. However, samples with terrestrial kerogens (Type III) fell off this trend, showing improved levels of reproducibility due to higher vitrinite content and improved ease of identification. Operators did not consistently meet the reporting requirements of the test method, indicating that a common reporting template is required to improve data quality. The most difficult problem encountered was the petrographic distinction of solid bitumens and low-reflecting inert macerals from vitrinite when vitrinite occurred with reflectance ranges overlapping

  1. Possibilities for using plant extracts added to ruminant feed aimed at improving production results

    Directory of Open Access Journals (Sweden)

    Grdović Svetlana

    2010-01-01

    Full Text Available The use of plant extracts with the objective of improving production results and the quality of food articles of animal origin is an area which is acquiring increasing scientific importance. Numerous investigations carried out so far on ruminants and other species of domestic animals have been aimed at examining specific bioactive matter of plants. The results of these investigations have demonstrated a positive influence on the production results. A large number of data indicate that plant extracts added to animal feed contribute to increasing overall productivity. Furthermore, plant extracts as additives in animal feed have a positive effect also on the health condition of the animals. A large number of plants have characteristics which potentially improve consumption, digestibility and conversion of food, and also growth. Examinations have been performed of the effects of different plant extracts on food consumption, wool growth, growth and composition of the trunk, milk production, reproductive parameters, agents for wool shearing, preventing bloat, methane production, as well as the influence of plants on curbing nematode infestations of ruminants. This work presents a review of scientific investigations of different plant species and their effects on the production characteristics of ruminants. .

  2. An improved machine learning protocol for the identification of correct Sequest search results

    Directory of Open Access Journals (Sweden)

    Lu Hui

    2010-12-01

    Full Text Available Abstract Background Mass spectrometry has become a standard method by which the proteomic profile of cell or tissue samples is characterized. To fully take advantage of tandem mass spectrometry (MS/MS techniques in large scale protein characterization studies robust and consistent data analysis procedures are crucial. In this work we present a machine learning based protocol for the identification of correct peptide-spectrum matches from Sequest database search results, improving on previously published protocols. Results The developed model improves on published machine learning classification procedures by 6% as measured by the area under the ROC curve. Further, we show how the developed model can be presented as an interpretable tree of additive rules, thereby effectively removing the 'black-box' notion often associated with machine learning classifiers, allowing for comparison with expert rule-of-thumb. Finally, a method for extending the developed peptide identification protocol to give probabilistic estimates of the presence of a given protein is proposed and tested. Conclusions We demonstrate the construction of a high accuracy classification model for Sequest search results from MS/MS spectra obtained by using the MALDI ionization. The developed model performs well in identifying correct peptide-spectrum matches and is easily extendable to the protein identification problem. The relative ease with which additional experimental parameters can be incorporated into the classification framework, to give additional discriminatory power, allows for future tailoring of the model to take advantage of information from specific instrument set-ups.

  3. An Epigenetic Modifier Results in Improved In Vitro Blastocyst production after Somatic Cell Nuclear Transfer

    DEFF Research Database (Denmark)

    Zhang, Yunhai; Li, Juan; Villemoes, Klaus

    2007-01-01

    The present study was designed to examine the effect of trichostatin A (TSA), an inhibitor of histone deacetylase, on development of porcine cloned embryos. Our results showed that treatment of cloned embryos derived from sow oocytes with 50 nM TSA for up to 24 h after the onset of activation cou...... were tested, and for all cell lines an enhancement in blastocyst development compared to their corresponding control was observed. Our data demonstrate that TSA treatment after somatic cell nuclear transfer in the pig can significantly improve the in vitro blastocyst production...

  4. Methods for improving mechanical properties of partially stabilized zirconia and the resulting product

    International Nuclear Information System (INIS)

    Aronov, V.A.

    1987-01-01

    A method for improving mechanical surface properties of a rigid body comprising partially stabilized zirconia as a constituent is described comprising the following steps: (i) providing a rigid body having an exposed surface and an interior volume; (ii) subjecting the exposed surface region of partially stabilized zirconia to external heating to heat the exposed surface region to 1100 0 C-1600 0 C without heating the interior volume above 500 0 C-800 0 C; and (iii) cooling the rigid body to a temperature of less than 500 0 C to cause a portion of the exposed surface region to transform from the tetragonal lattice modification to the monoclinic lattice modification, thereby creating a compressive stress field in the exposed surface region and improving the mechanical surface properties of the exposed surface region. In a ceramic body comprising a first exposed region of a partially stabilized zirconia, and a second region of a partially stabilized zirconia at an interior portion of the ceramic body, the improvement is described comprising the ceramic body having in the first, exposed region a greater percentage of the monoclinic lattice modification than in the second region; having in the first, exposed region 5 percent to 100 percent in the monoclinic lattice modification; and having a molded surface finish in the first, exposed region; the first, exposed region being subjected to a compressive field resulting from the greater percentage of the monoclinic lattice modification

  5. Using kaizen to improve employee well-being: Results from two organizational intervention studies.

    Science.gov (United States)

    von Thiele Schwarz, Ulrica; Nielsen, Karina M; Stenfors-Hayes, Terese; Hasson, Henna

    2017-08-01

    Participatory intervention approaches that are embedded in existing organizational structures may improve the efficiency and effectiveness of organizational interventions, but concrete tools are lacking. In the present article, we use a realist evaluation approach to explore the role of kaizen, a lean tool for participatory continuous improvement, in improving employee well-being in two cluster-randomized, controlled participatory intervention studies. Case 1 is from the Danish Postal Service, where kaizen boards were used to implement action plans. The results of multi-group structural equation modeling showed that kaizen served as a mechanism that increased the level of awareness of and capacity to manage psychosocial issues, which, in turn, predicted increased job satisfaction and mental health. Case 2 is from a regional hospital in Sweden that integrated occupational health processes with a pre-existing kaizen system. Multi-group structural equation modeling revealed that, in the intervention group, kaizen work predicted better integration of organizational and employee objectives after 12 months, which, in turn, predicted increased job satisfaction and decreased discomfort at 24 months. The findings suggest that participatory and structured problem-solving approaches that are familiar and visual to employees can facilitate organizational interventions.

  6. Recent TCV results. Innovative plasma shaping to improve plasma properties and insight

    International Nuclear Information System (INIS)

    Pochelon, Antoine; Angelino, Paolo; Behn, Roland

    2012-01-01

    The TCV tokamak facility is used to study the effect of innovative plasma shapes on core and edge confinement properties. In low collisionality L-mode plasmas with electron cyclotron heating (ECH) confinement increases with increasing negative triangularity δ. The confinement improvement correlates with a decrease of the inner core electron heat transport, even though triangularity vanishes to the core, pointing to the effect of nonlocal transport properties. TCV has recently started the study of the effects of negative triangularity in H-mode plasmas. H-mode confinement is known to improve towards positive triangularity, due to the increase of pedestal height, though plagued by increasingly large edge localised modes (ELMs). An optimum triangularity could thus be sought between steep edge barriers (δ > 0) with large ELMs, and improved core confinement (δ < 0) with small ELMs. This opens the possibility for a reactor of having H-mode-level confinement within an L-mode edge, or at least with mitigated ELMs. In TCV, ELMy H-modes with upper triangularity δ top < 0 are explored, showing a reduction of ELM peak energy losses compared to δ top > 0. Alternative shapes are proposed on the basis of ideal MHD stability calculations. Shaping has the potential to bring at the same time key solutions to confinement, stability and wall loading issues and, from the comparison of experimental and simulation results, to give deeper insight in transport and stability. (author)

  7. Energy efficiency improvement procedures and audit results of electrical, thermal and solar applications in Palestine

    International Nuclear Information System (INIS)

    Ibrik, I.H.; Mahmoud, M.M.

    2005-01-01

    Energy conservation in utilities has played a vital role in improving energy efficiency in the industrial, commercial and residential sectors. The electrical energy consumption in Palestine has increased sharply in the past few years and achieved by the end of 2001 to 10% per year. It is expected that this percentage will increase to about 12% if the current political situation will end hopefully with peace. Modern energy efficient technologies are needed for the national energy policy. Such technologies are investigated in this paper. Implementing of a national 3 years project aiming at energy efficiency improvement in residential and industrial sectors as well as in public utilities, which include wide range of diversified audits and power measurements, had led to creating this paper. Measurement and audit results had shown that the total conservation potential in these sectors is around 15% of the total energy consumption. The associated costs of the investment in this field are relatively low and correspond to a pay back period varying in the range from 6 to 36 months. Consequently, the energy conservation policy will be seriously improved in the forthcoming years. It is estimated that 10% of the new energy purchasing capacity will be reduced accordingly

  8. Using kaizen to improve employee well-being: Results from two organizational intervention studies

    Science.gov (United States)

    von Thiele Schwarz, Ulrica; Nielsen, Karina M; Stenfors-Hayes, Terese; Hasson, Henna

    2016-01-01

    Participatory intervention approaches that are embedded in existing organizational structures may improve the efficiency and effectiveness of organizational interventions, but concrete tools are lacking. In the present article, we use a realist evaluation approach to explore the role of kaizen, a lean tool for participatory continuous improvement, in improving employee well-being in two cluster-randomized, controlled participatory intervention studies. Case 1 is from the Danish Postal Service, where kaizen boards were used to implement action plans. The results of multi-group structural equation modeling showed that kaizen served as a mechanism that increased the level of awareness of and capacity to manage psychosocial issues, which, in turn, predicted increased job satisfaction and mental health. Case 2 is from a regional hospital in Sweden that integrated occupational health processes with a pre-existing kaizen system. Multi-group structural equation modeling revealed that, in the intervention group, kaizen work predicted better integration of organizational and employee objectives after 12 months, which, in turn, predicted increased job satisfaction and decreased discomfort at 24 months. The findings suggest that participatory and structured problem-solving approaches that are familiar and visual to employees can facilitate organizational interventions. PMID:28736455

  9. Aerobic Exercise Improves Mood, Cognition, and Language Function in Parkinson's Disease: Results of a Controlled Study.

    Science.gov (United States)

    Altmann, Lori J P; Stegemöller, Elizabeth; Hazamy, Audrey A; Wilson, Jonathan P; Bowers, Dawn; Okun, Michael S; Hass, Chris J

    2016-10-01

    Parkinson's disease (PD) results in a range of non-motor deficits that can affect mood, cognition, and language, and many of these issues are unresponsive to pharmacological intervention. Aerobic exercise can improve mood and cognition in healthy older adults, although only a few studies have examined exercise effects on these domains in PD. The current study assesses the effects of aerobic exercise on aspects of cognition, mood, and language production in people with PD. This study compares the effects of aerobic exercise to stretch-balance training and a no-contact control group in participants with idiopathic PD. The aerobic and stretch-balance groups trained three times a week for 16 weeks, while controls continued normal activities. Outcome measures included disease severity, mood, cognition (speed of processing, memory, and executive function), and language production (picture descriptions). Cognition and language were assessed in single and dual task conditions. Depressive symptoms increased only in the control group (pimproved in the aerobic exercise group only in the single task (p=.007) and declined in controls in the dual task. Completeness of picture descriptions improved significantly more in the aerobic group than in the stretch-balance group (pexercise is a viable intervention for PD that can be protective against increased depressive symptoms, and can improve several non-motor domains, including executive dysfunction and related aspects of language production. (JINS, 2016, 22, 878-889).

  10. Improved results in paediatric diabetes care using a quality registry in an improvement collaborative: a case study in Sweden.

    Directory of Open Access Journals (Sweden)

    Anette Peterson

    Full Text Available Several studies show that good metabolic control is important for children and adolescents with type 1 diabetes. In Sweden, there are large differences in mean haemoglobin A1c (HbA1c in different hospitals and difficulties implementing national guidelines in everyday practice. This study shows how the participation in an improvement collaborative could facilitate improvements in the quality of care by paediatric diabetes teams. The Swedish paediatric diabetes quality registry, SWEDIABKIDS was used as a tool and resource for feedback and outcome measures.Twelve teams at paediatric diabetes centres, caring for 30% (2302/7660 of patients in Sweden, participated in an 18-month quality improvement program. Each team defined treatment targets, areas needing improvement, and action plans. The main outcome was the centre patients' mean HbA1c levels, but other clinical variables and change concepts were also studied. Data from the previous six months were compared with the first six months after starting the program, and the long-term follow up after another eleven months.All centres reduced mean HbA1c during the second and third periods compared with the first. The mean reduction for all was 3·7 mmol/mol (p<0.001, compared with non-participating centres who improved their mean HbA1c with 1·7 mmol/mol during the same period. Many of the participating centres reduced the frequency of severe hypoglycaemia and/or ketoacidosis, and five centres reached their goal of ensuring that all patients had some sort of physical activity at least once weekly. Change concepts were, for example, improved guidelines, appointment planning, informing the patients, improving teamwork and active use of the registry, and health promotion activities.By involving paediatric diabetes teams in a quality improvement collaborative together with access to a quality register, the quality of paediatric diabetes care can improve, thereby contributing to a reduced risk of late

  11. GREAT: a web portal for Genome Regulatory Architecture Tools.

    Science.gov (United States)

    Bouyioukos, Costas; Bucchini, François; Elati, Mohamed; Képès, François

    2016-07-08

    GREAT (Genome REgulatory Architecture Tools) is a novel web portal for tools designed to generate user-friendly and biologically useful analysis of genome architecture and regulation. The online tools of GREAT are freely accessible and compatible with essentially any operating system which runs a modern browser. GREAT is based on the analysis of genome layout -defined as the respective positioning of co-functional genes- and its relation with chromosome architecture and gene expression. GREAT tools allow users to systematically detect regular patterns along co-functional genomic features in an automatic way consisting of three individual steps and respective interactive visualizations. In addition to the complete analysis of regularities, GREAT tools enable the use of periodicity and position information for improving the prediction of transcription factor binding sites using a multi-view machine learning approach. The outcome of this integrative approach features a multivariate analysis of the interplay between the location of a gene and its regulatory sequence. GREAT results are plotted in web interactive graphs and are available for download either as individual plots, self-contained interactive pages or as machine readable tables for downstream analysis. The GREAT portal can be reached at the following URL https://absynth.issb.genopole.fr/GREAT and each individual GREAT tool is available for downloading. © The Author(s) 2016. Published by Oxford University Press on behalf of Nucleic Acids Research.

  12. Great Lakes Literacy Principles

    Science.gov (United States)

    Fortner, Rosanne W.; Manzo, Lyndsey

    2011-03-01

    Lakes Superior, Huron, Michigan, Ontario, and Erie together form North America's Great Lakes, a region that contains 20% of the world's fresh surface water and is home to roughly one quarter of the U.S. population (Figure 1). Supporting a $4 billion sport fishing industry, plus $16 billion annually in boating, 1.5 million U.S. jobs, and $62 billion in annual wages directly, the Great Lakes form the backbone of a regional economy that is vital to the United States as a whole (see http://www.miseagrant.umich.edu/downloads/economy/11-708-Great-Lakes-Jobs.pdf). Yet the grandeur and importance of this freshwater resource are little understood, not only by people in the rest of the country but also by many in the region itself. To help address this lack of knowledge, the Centers for Ocean Sciences Education Excellence (COSEE) Great Lakes, supported by the U.S. National Science Foundation and the National Oceanic and Atmospheric Administration, developed literacy principles for the Great Lakes to serve as a guide for education of students and the public. These “Great Lakes Literacy Principles” represent an understanding of the Great Lakes' influences on society and society's influences on the Great Lakes.

  13. The Next Great Generation?

    Science.gov (United States)

    Brownstein, Andrew

    2000-01-01

    Discusses ideas from a new book, "Millennials Rising: The Next Great Generation," (by Neil Howe and William Strauss) suggesting that youth culture is on the cusp of a radical shift with the generation beginning with this year's college freshmen who are typically team oriented, optimistic, and poised for greatness on a global scale. Includes a…

  14. Improve the Efficiency of the Service Process as a Result of the Muda Ideology

    Science.gov (United States)

    Lorenc, Augustyn; Przyłuski, Krzysztof

    2018-06-01

    The aim of the paper was to improve service processes carried out by Knorr-Bremse Systemy Kolejowe Polska sp. z o.o. Particularly, emphasise unnecessary movements and physical efforts of employees. The indirect goal was to find a solution in the simplest possible way using the Muda ideology. In order to improve the service process at the beginning was executed the process mapping for the devices to be repaired, ie. brake callipers, electro-hydraulic units and auxiliary release units. The processes were assessed and shown as Pareto-Lorenz analysis. In order to determine the most time consuming process. Based on the obtained results use of a column crane with articulated arm was proposed to facilitate the transfer of heavy components between areas. The final step was to assess the effectiveness of the proposed solution in terms of time saving. From the company perspective results of the analysis are important. The proposed solution not only reduces total service time but also contributes to crew's work comfort.

  15. Psychological distress after the Great East Japan Earthquake and Fukushima Daiichi Nuclear Power Plant accident: results of a mental health and lifestyle survey through the Fukushima Health Management Survey in FY2011 and FY2012.

    Science.gov (United States)

    Yabe, Hirooki; Suzuki, Yuriko; Mashiko, Hirobumi; Nakayama, Yoko; Hisata, Mitsuru; Niwa, Shin-Ichi; Yasumura, Seiji; Yamashita, Shunichi; Kamiya, Kenji; Abe, Masafumi

    2014-01-01

    On 11 March 2011, the Great East Japan Earthquake followed by a gigantic tsunami hit the Pacific coast of Northeast Japan (Tohoku) and damaged Tokyo Electric Power Company's Fukushima Daiichi Nuclear Power Plant, causing a radiation hazard in the entire Fukushima Prefecture. The radiation dose exposed either externally and internally in Fukushima residents have been evaluated to be low so far and it is hardly believed that they may have any direct radiation risk on physical condition. The purpose of this report is, therefore, to describe results of a mental health and lifestyle survey intended to facilitate adequate care for residents who are at a higher risk of developing mental health problems after the complicated accident. The target population of this survey is the residents of evacuation zones including Hirono Town, Naraha Town, Tomioka Town, Kawauchi Village, Okuma Town, Futaba Town, Namie Town, Katsurao Village, Minamisoma City, Tamura City, Yamakiya district of Kawamata Town, and Iitate Village. The targeted population was 210,189 in fiscal year 2011 (FY2011) and 211,615 in fiscal year 2012 (FY2012). Questionnaires have been mailed since January 2012, and subsequently, January 2013, 10 and 22 months after the disaster. Among of them, children 63.4%, adults 40.7% for FY2011, and children 41.0%, adults 29.7% for FY2012 responded to the questionnaires mailed. Sociodemographic data showed that many evacuee households were separated after the disaster and had to move several times. K6 was used in this survey to estimate general mental health. The proportion (14.6% in FY2011 and 11.9% inFY2012) of adults who scored above the K6 cut-off (≥13) for general mental health was higher than usual, indicating severe mental health problems among evacuees. The proportion (21.6% in FY2011 and 18.3% inFY2012) of adults who scored above the cut-off (≥44) of PTSD checklist (PCL), reflecting traumatic symptoms, was almost equal to that of the workers after the 9.11 World

  16. Great improvement on tetracycline removal using ZnO rod-activated carbon fiber composite prepared with a facile microwave method

    Energy Technology Data Exchange (ETDEWEB)

    Tran Thi, Viet Ha; Lee, Byeong-Kyu, E-mail: bklee@ulsan.ac.kr

    2017-02-15

    Highlights: • ZnO rod-ACF was prepared by a method involving a microwave within only 3 min. • ZnO rods (average diameter of 0.3–0.5 μm, length of 1.0–1.5 μm) were grown on ACF. • 99% of tetracycline was degraded and 90.7% TOC was removed within 1 h under UV light. • ZnO rod-ACF achieved high performances even after three cycles of uses. - Abstract: New composite materials of activated carbon fiber (ACF) coated with zinc oxide (ZnO) were obtained by applying a green, cost-effective and rapid synthetic route using a commercial microwave oven. ZnO rods with a uniform and stable structure and an average diameter of 0.3–0.5 μm and length of 1.0–1.5 μm were achieved after only 3-min microwave treatment. The properties of ZnO were efficiently transferred to ACF, such that the resulting material, termed ZnO rod-ACF, demonstrated a promising potential as an efficient photocatalyst and simultaneously as an adsorbent. Pharmaceutical tetracycline at a concentration of 40 mg/L was used to evaluate the organic pollutant removal capacity of the synthesized materials. At pH 8, ZnO rod-ACF exhibited excellent removal capacity (over 99%) and mineralization (90.7%) of tetracycline in aqueous solution within 1 h under UV irradiation. The stability of ZnO rod-ACF was maintained and the mineralization of tetracycline was also maintained at 81.35% after multiple usage cycles. The photodegradation pathways of tetracycline were proposed based on the identified reaction intermediates.

  17. results

    Directory of Open Access Journals (Sweden)

    Salabura Piotr

    2017-01-01

    Full Text Available HADES experiment at GSI is the only high precision experiment probing nuclear matter in the beam energy range of a few AGeV. Pion, proton and ion beams are used to study rare dielectron and strangeness probes to diagnose properties of strongly interacting matter in this energy regime. Selected results from p + A and A + A collisions are presented and discussed.

  18. Modern Russian Demographic Policy in the Field of Fertility: Results and Areas for Improvement

    Directory of Open Access Journals (Sweden)

    Larisa Alekseevna Popova

    2016-05-01

    Full Text Available During last years in Russia the active state demographic policy, directed on the support of second and subsequent births, is leading. The article describes its evolution, evaluates efficiency and recommends directions of its improvement. It was detected, that increment of measures of demographic policy by introduction in 2011 the regional maternity capitals to a third child in addition to the federal capital to a second child gave a perceptible positive results. It allowed continuing the positive trend of fertility already in the condition of the beginning deterioration the age structure of the women in the childbearing age; maximally realize the births, which were postponed by the older generations; to increase number of children on account of additional births; to enhance the family component of fertility. Despite of concerns, the growth of reproductive attitudes happened not only in the older cohorts of the population. Conducted in 2013 sociological research gives grounds to expect, that minorities generations 1990 years of birth, which will be determine prospects of fertility, will reach the level of slightly expanded reproduction of population. In the conditions of deterioration the age structure of fertile contingents the demographic policy must be elongated and improved. All components of economic demographic measures must be saved, including child allowances to needy families, but with increasing the horizon of its assignment to adulthood of child. The directions of maternity capitals realizations must be expanded. During the develop of new measures of demographic policy need to focus on psychological measures of formation the value orientations of the population in area of number of children, on improvement of qualitative structure of fertility and strengthening of the family institute. The economic measures need to redirect on the second births, which are more family. The general line of family demographic policy is the increasing of

  19. Implementation of a quality improvement initiative in Belgian diabetic foot clinics: feasibility and initial results.

    Science.gov (United States)

    Doggen, Kris; Van Acker, Kristien; Beele, Hilde; Dumont, Isabelle; Félix, Patricia; Lauwers, Patrick; Lavens, Astrid; Matricali, Giovanni A; Randon, Caren; Weber, Eric; Van Casteren, Viviane; Nobels, Frank

    2014-07-01

    This article aims to describe the implementation and initial results of an audit-feedback quality improvement initiative in Belgian diabetic foot clinics. Using self-developed software and questionnaires, diabetic foot clinics collected data in 2005, 2008 and 2011, covering characteristics, history and ulcer severity, management and outcome of the first 52 patients presenting with a Wagner grade ≥ 2 diabetic foot ulcer or acute neuropathic osteoarthropathy that year. Quality improvement was encouraged by meetings and by anonymous benchmarking of diabetic foot clinics. The first audit-feedback cycle was a pilot study. Subsequent audits, with a modified methodology, had increasing rates of participation and data completeness. Over 85% of diabetic foot clinics participated and 3372 unique patients were sampled between 2005 and 2011 (3312 with a diabetic foot ulcer and 111 with acute neuropathic osteoarthropathy). Median age was 70 years, median diabetes duration was 14 years and 64% were men. Of all diabetic foot ulcers, 51% were plantar and 29% were both ischaemic and deeply infected. Ulcer healing rate at 6 months significantly increased from 49% to 54% between 2008 and 2011. Management of diabetic foot ulcers varied between diabetic foot clinics: 88% of plantar mid-foot ulcers were off-loaded (P10-P90: 64-100%), and 42% of ischaemic limbs were revascularized (P10-P90: 22-69%) in 2011. A unique, nationwide quality improvement initiative was established among diabetic foot clinics, covering ulcer healing, lower limb amputation and many other aspects of diabetic foot care. Data completeness increased, thanks in part to questionnaire revision. Benchmarking remains challenging, given the many possible indicators and limited sample size. The optimized questionnaire allows future quality of care monitoring in diabetic foot clinics. Copyright © 2014 John Wiley & Sons, Ltd.

  20. Cognitive dysfunction improves in systemic lupus erythematosus: Results of a 10 years prospective study.

    Directory of Open Access Journals (Sweden)

    Fulvia Ceccarelli

    Full Text Available Cognitive impairment (CI has been described in 3-80% of Systemic lupus erythematosus (SLE patients but only short-term studies evaluated its over-time changes, suggesting that CI is usually a stable finding. We aimed at evaluating the changes of SLE-related CI in a 10-years prospective single center cohort study.We evaluated 43 patients (M/F 5/38; mean age = 45.7±10.1 years; mean disease duration = 230.8±74.3 months at baseline (T0 and after 10 years (T1. A test battery designed to detect fronto-subcortical dysfunction across five domains (memory, attention, abstract reasoning, executive and visuospatial function was administered. A global cognitive dysfunction score (GCD was obtained and associated with clinical and laboratory features.Prevalence of CI was 20.9% at T0 and 13.9% at T1 (P = NS. This impairment was prevalently mild at T0 (55.5% and mild or moderate at T1 (36.3% for both degrees. After 10 years, CI improved in 50% of patients, while 10% worsened. Impaired memory (P = 0.02, executive functions (P = 0.02 and abstract reasoning (P = 0.03 were associated with dyslipidemia at T0. Worsening of visuospatial functions was significantly associated with dyslipidemia and Lupus Anticoagulant (P = 0.04 for both parameters. Finally, GCD significantly correlated with chronic damage measured by SLICC/damage index at T0 (r = 0.3; P = 0.04 and T1 (r = 0.3; P = 0.03.For the first time, we assessed CI changes over 10-years in SLE. CI improved in the majority of the patients. Furthermore, we observed an improvement of the overall cognitive functions. These results could suggest that an appropriate management of the disease during the follow-up could be able to control SLE-related CI.

  1. Resveratrol supplementation did not improves cognition in patients with schizophrenia: results from a randomized clinical trial

    Directory of Open Access Journals (Sweden)

    KARINE ZORTEA

    2016-09-01

    Full Text Available Background: Schizophrenia is associated with psychotic experiences and cognitive deficits. Therefore, cognitive function is one of the most critical determinants of quality of life in this pathology. Resveratrol has been related with neuroprotective action but there are no studies evaluating resveratrol in schizophrenia. The objective of this study was to determine the efficacy of resveratrol supplementation on cognition in individuals with schizophrenia. Methods: This is a 1-month randomized, double-blind controlled trial (NCT 02062190, in which 19 men with diagnosis of schizophrenia, aged 18 to 65 years, were assigned to a resveratrol supplement group (200mg or placebo group (200mg, with a 1-month follow-up. Applying a series of cognitive tests assessed neuropsychology performance (Hopkins Verbal Learning Test, Stroop Color and Word Test, Weschler Adult Intelligence Scale and Brief Psychiatric Rating Scale assessed psychopathology severity. Results: There were no significant improvement in neuropsychology performance (episodic memory, working memory, attention and concentration capacity, inhibitory control, interference measures, selective attention and mental flexibility and psychopathology severity after 1-month of resveratrol supplementation (p>0.05. Conclusion: In conclusion, we have shown that 1-month of a resveratrol supplementation (200 mg/day did not improve episodic memory, working memory, attention and concentration capacity, inhibitory control, interference measures, selective attention and mental flexibility as compared with placebo in patients with schizophrenia.

  2. State landscape in public health planning and quality improvement: results of the ASTHO survey.

    Science.gov (United States)

    Madamala, Kusuma; Sellers, Katie; Pearsol, Jim; Dickey, Michael; Jarris, Paul E

    2010-01-01

    Limited data exist on state public health agencies and their use of planning and quality improvement (QI) initiatives. Using the 2007 Association of State and Territorial Health Officials (ASTHO) State Public Health Survey, this article describes how state public health agencies perform tasks related to planning, performance management (PM), and QI. While 82 percent of respondents report having a QI process in place, only 9.8 percent have it fully implemented departmentwide. Seventy-six percent reported having a PM process in place, with 16 percent (n = 8) having it fully implemented departmentwide. A state health improvement plan was used by 80.4 percent of respondents, with 56.9 percent of respondents completing the plan more than 3 years ago. More than two-thirds (68.2%) of the respondents developed the plan by using results of their state health assessment. Analysis of state health department level planning, PM, and QI initiatives can inform states' efforts to ready themselves to meet the proposed national voluntary accreditation standards of the Public Health Accreditation Board.

  3. Improving perceptions of healthy food affordability: results from a pilot intervention.

    Science.gov (United States)

    Williams, Lauren K; Abbott, Gavin; Thornton, Lukar E; Worsley, Anthony; Ball, Kylie; Crawford, David

    2014-03-10

    Despite strong empirical support for the association between perceived food affordability and dietary intake amongst families with a lower socioeconomic position (SEP), there is limited evidence of the most effective strategies for promoting more positive perceptions of healthy food affordability among this group. This paper reports findings from a pilot intervention that aimed to improve perceptions of healthy food affordability amongst mothers. Participants were 66 mothers who were the parents of children recruited from primary schools located in socioeconomically disadvantaged suburbs. Intervention group participants viewed a slideshow focussed on healthy snack food affordability that illustrated cheaper healthier alternatives to common snack foods as well as food budgeting tips and price comparison education. A mixed between-within ANCOVA was conducted to examine group differences in perceived affordability of healthy food across three time points. Results revealed no difference in perceived affordability of healthy food between the two groups at baseline whereas at post-intervention and follow-up, mothers in the intervention group perceived healthy food as more affordable than the control group. Focussing on education-based interventions to improve perceptions of healthy food affordability may be a promising approach that complements existing nutrition promotion strategies.

  4. Interventions to Improve Follow-Up of Laboratory Test Results Pending at Discharge: A Systematic Review.

    Science.gov (United States)

    Whitehead, Nedra S; Williams, Laurina; Meleth, Sreelatha; Kennedy, Sara; Epner, Paul; Singh, Hardeep; Wooldridge, Kathleene; Dalal, Anuj K; Walz, Stacy E; Lorey, Tom; Graber, Mark L

    2018-02-28

    Failure to follow up test results pending at discharge (TPAD) from hospitals or emergency departments is a major patient safety concern. The purpose of this review is to systematically evaluate the effectiveness of interventions to improve follow-up of laboratory TPAD. We conducted literature searches in PubMed, CINAHL, Cochrane, and EMBASE using search terms for relevant health care settings, transition of patient care, laboratory tests, communication, and pending or missed tests. We solicited unpublished studies from the clinical laboratory community and excluded articles that did not address transitions between settings, did not include an intervention, or were not related to laboratory TPAD. We also excluded letters, editorials, commentaries, abstracts, case reports, and case series. Of the 9,592 abstracts retrieved, 8 met the inclusion criteria and reported the successful communication of TPAD. A team member abstracted predetermined data elements from each study, and a senior scientist reviewed the abstraction. Two experienced reviewers independently appraised the quality of each study using published LMBP™ A-6 scoring criteria. We assessed the body of evidence using the A-6 methodology, and the evidence suggested that electronic tools or one-on-one education increased documentation of pending tests in discharge summaries. We also found that automated notifications improved awareness of TPAD. The interventions were supported by suggestive evidence; this type of evidence is below the level of evidence required for LMBP™ recommendations. We encourage additional research into the impact of these interventions on key processes and health outcomes. © 2018 Society of Hospital Medicine.

  5. Myosin7a deficiency results in reduced retinal activity which is improved by gene therapy.

    Directory of Open Access Journals (Sweden)

    Pasqualina Colella

    Full Text Available Mutations in MYO7A cause autosomal recessive Usher syndrome type IB (USH1B, one of the most frequent conditions that combine severe congenital hearing impairment and retinitis pigmentosa. A promising therapeutic strategy for retinitis pigmentosa is gene therapy, however its pre-clinical development is limited by the mild retinal phenotype of the shaker1 (sh1(-/- murine model of USH1B which lacks both retinal functional abnormalities and degeneration. Here we report a significant, early-onset delay of sh1(-/- photoreceptor ability to recover from light desensitization as well as a progressive reduction of both b-wave electroretinogram amplitude and light sensitivity, in the absence of significant loss of photoreceptors up to 12 months of age. We additionally show that subretinal delivery to the sh1(-/- retina of AAV vectors encoding the large MYO7A protein results in significant improvement of sh1(-/- photoreceptor and retinal pigment epithelium ultrastructural anomalies which is associated with improvement of recovery from light desensitization. These findings provide new tools to evaluate the efficacy of experimental therapies for USH1B. In addition, although AAV vectors expressing large genes might have limited clinical applications due to their genome heterogeneity, our data show that AAV-mediated MYO7A gene transfer to the sh1(-/- retina is effective.

  6. ACTIVITIES RESULTS AIMED AT IMPROVED MEDICAL ASSISTANCE TO THE VASCULAR PATIENTS IN TOMSK REGION

    Directory of Open Access Journals (Sweden)

    D. M. Plotnikov

    2013-01-01

    Full Text Available Acute disorders of cerebral circulation remain serious medical and social problem associated with high disability and mortality rates. Since 2011 Tomsk oblast is a participating member of the medical campaign aimed at improved medical services to the vascular patients. The preliminary implementation data analysis for 2012 revealed improvement of most of the indices of medical support to patients suffering from acute cerebral circulation; increased number of the in-patient cases (Regional Vascular Center and primary vascular department, decreased lethality rates from strokes, specifically hemorrhagic cases. Strict observance of the Regulations on Medical Assistance for stroke patients and the using of modern methods of therapy allowed to decrease hospital mortality in the Primary Vascular Departments and early mortality in the Regional Vascular Center. The active implementation of neurorehabilitation approaches resulted in the increased number of patients who do not require third parties’ assistance. Analysis of the work of the departments helped to identifying current problems and perspectives of further development of special medical care for stroke patients.

  7. EDF: Solid 2009 results despite a difficult year in France. Improvement in operating performance expected in 2010. 2009 results

    International Nuclear Information System (INIS)

    2010-01-01

    As the world's biggest electricity generator, the EDF Group covers every sector of expertise, from generation to trading and transmission grids. EDF builds on the expertise of its people, its R and D and engineering skills, its experience as a leading industry operator and the attentive support of its customers to deliver competitive solutions that successfully reconcile economic growth with climate protection. This document presents the 2009 annual results and Consolidated financial statements of the Group at 31 December 2009: Consolidated Income Statements; Consolidated Balance Sheets; Consolidated Cash Flow Statements; Changes in Consolidated Equity; Notes to the Consolidated Financial Statements: Group accounting standards; Summary of the principal accounting and valuation methods; Regulatory events in France in 2009; Major external growth operations; Other major events and transactions; Changes in the scope of consolidation; Segment reporting; Sales; Fuel and energy purchases; Other external expenses; Contractual obligations and commitments; Personnel expenses; Other operating income and expenses; Prolongation of the transition tariff system (TaRTAM) - Law of August 4, 2008; Impairments / reversals; Other income and expenses; Financial result; Income taxes; Goodwill; Other intangible assets; Property, plant and equipment operated under French public electricity distribution concessions; Property, plant and equipment operated under concessions for other activities; Property, plant and equipment used in generation and other tangible assets owned by the Group; Investments in companies accounted for under the equity method; Current and non-current financial assets; Inventories, including work-in-process; Trade receivables; Other receivables; Cash and cash equivalents; Held-for-sale assets and liabilities; Equity; Provisions; Specific French public electricity distribution concession liabilities for existing assets and assets to be replaced; Current and non

  8. IMPROVEMENT AND RESULT TRACKING OF THE SPECIAL RESISTENCE OF THE WRESTLERS AS AN ALTITUDE RESPONSE

    Directory of Open Access Journals (Sweden)

    Mališa Radović

    2008-08-01

    Full Text Available In the system of preparations for top-level sportsmen for grand competitions, impor tant place has training in the conditions of middle altitude mountains. In that condi tions it develops complex of adaptation reactions /fi rst of all the lack of oxygen/,that brings to improvement of functional possibilities of organism for competitions in lowland con ditions. In order to achieve high results, during the training in the mountains, it is important to fi nd the most effi cient way for use of environment conditions. It was deducted that adapta tion to the mountains conditions and development of the effi ciency of high quality wrest ling sportsmen it defers from less successful wrestlers. Repetition of staying in moun ted areas enables faster adaptation and offers possibility for use of high physical uti li zation.

  9. Sodium oxybate therapy provides multidimensional improvement in fibromyalgia: results of an international phase 3 trial

    Science.gov (United States)

    Spaeth, Michael; Bennett, Robert M; Benson, Beverly A; Wang, Y Grace; Lai, Chinglin; Choy, Ernest H

    2012-01-01

    Background Fibromyalgia is characterised by chronic musculoskeletal pain and multiple symptoms including fatigue, multidimensional function impairment, sleep disturbance and tenderness. Along with pain and fatigue, non-restorative sleep is a core symptom of fibromyalgia. Sodium oxybate (SXB) is thought to reduce non-restorative sleep abnormalities. This study evaluated effects of SXB on fibromyalgia-related pain and other symptoms. Methods 573 patients with fibromyalgia according to 1990 American College of Rheumatology criteria were enrolled at 108 centres in eight countries. Subjects were randomly assigned to placebo, SXB 4.5 g/night or SXB 6 g/night. The primary efficacy endpoint was the proportion of subjects with ≥30% reduction in pain visual analogue scale from baseline to treatment end. Other efficacy assessments included function, sleep quality, effect of sleep on function, fatigue, tenderness, health-related quality of life and subject's impression of change in overall wellbeing. Results Significant improvements in pain, sleep and other symptoms associated with fibromyalgia were seen in SXB treated subjects compared with placebo. The proportion of subjects with ≥30% pain reduction was 42.0% for SXB4.5 g/night (p=0.002) and 51.4% for SXB6 g/night (pQuality of sleep (Jenkins sleep scale) improved by 20% for SXB4.5 g/night (p≤0.001) and 25% for SXB6 g/night (p≤0.001) versus 0.5% for placebo. Adverse events with an incidence ≥5% and twice placebo were nausea, dizziness, vomiting, insomnia, anxiety, somnolence, fatigue, muscle spasms and peripheral oedema. Conclusion These results, combined with findings from previous phase 2 and 3 studies, provide supportive evidence that SXB therapy affordsimportant benefits across multiple symptoms in subjects with fibromyalgia. PMID:22294641

  10. The Agricultural Model Intercomparison and Improvement Project (AgMIP): Progress and Preliminary Results

    Science.gov (United States)

    Rosenzweig, C.

    2011-12-01

    The Agricultural Model Intercomparison and Improvement Project (AgMIP) is a distributed climate-scenario simulation exercise for historical model intercomparison and future climate change conditions with participation of multiple crop and agricultural trade modeling groups around the world. The goals of AgMIP are to improve substantially the characterization of risk of hunger and world food security due to climate change and to enhance adaptation capacity in both developing and developed countries. Recent progress and the current status of AgMIP will be presented, highlighting three areas of activity: preliminary results from crop pilot studies, outcomes from regional workshops, and emerging scientific challenges. AgMIP crop modeling efforts are being led by pilot studies, which have been established for wheat, maize, rice, and sugarcane. These crop-specific initiatives have proven instrumental in testing and contributing to AgMIP protocols, as well as creating preliminary results for aggregation and input to agricultural trade models. Regional workshops are being held to encourage collaborations and set research activities in motion for key agricultural areas. The first of these workshops was hosted by Embrapa and UNICAMP and held in Campinas, Brazil. Outcomes from this meeting have informed crop modeling research activities within South America, AgMIP protocols, and future regional workshops. Several scientific challenges have emerged and are currently being addressed by AgMIP researchers. Areas of particular interest include geospatial weather generation, ensemble methods for climate scenarios and crop models, spatial aggregation of field-scale yields to regional and global production, and characterization of future changes in climate variability.

  11. Energetic optimization as a result of improvement for social comfort: international example

    Energy Technology Data Exchange (ETDEWEB)

    Melandri, D.

    2007-07-01

    Comfort of human beings is related to the availability of energetic sources. In these terms, connection between comfort and energy becomes synonymous of connection between comfort and productivity. Thus Energy Management can be considered as a tool to optimize different parameters, with clear results on global efficiency of all processes. A clear energetic analysis, besides standard evaluation, can bring to optimization of following parameters: Lay out, Human resources, Internal logistic processes, Business productivity. Through energetic cost, for example, it is possible to have reference indicators useful for the lay out and number of employees optimization in offices. An International study has been conducted in this sense, with important and surprising results. A design for a building in Australia shows that an excellent energetic efficiency brings to an annual saving of 10 ml dollars, as a result of the improved efficiency of the working area. Similar examples can be found in several parts of the world. For these reasons, in civil and tertiary sector, some important pollution causes must be considered during the design of energy efficiency systems: atmospheric pollution due to chemical agents and radiations, acoustic pollution, vibration pollution, microclimate states, lighting. All these elements are part of the study. (auth)

  12. LAST MINUTE SOLUTIONS FOR IMPROVING ROMANIA’S FINAL RESULTS IN RELATION TO EUROPE 2020 STRATEGY

    Directory of Open Access Journals (Sweden)

    ANA MARIA TALMACIU (BANU

    2016-10-01

    Full Text Available The aim of this study is to upgrade the competitive position of Romania in relation to the Europe 2020 Strategy, and to offer some last-minute solutions to improve the final results. Romania's interim results revealed a very slow pace for meeting the national proposed targets. The context in which Romania joined this competitive program was not a favorable one, if we consider her state of new state in the EU and the economic crisis. In the first part of the study we analyze the main macroeconomic indicators for the period before adopting the Europe 2020 Strategy. We believe that this initial analysis is relevant to a better understanding of the initially context of the country, and for a better assessment of actual outcomes. The second part of the study updates interim results of proposed national targets in the Europe 2020 strategy. The personal contribution in this study consists in the comments on the analyzed indicators and in the proposed solutions for the next 3 years of implementation of the strategic program.

  13. Stenting is improving and stabilizing anatomical results of coiled intracranial aneurysms

    International Nuclear Information System (INIS)

    Lubicz, Boris; Bandeira, Alexandra; Baleriaux, Danielle; Bruneau, Michael; Witte, Olivier de; Dewindt, Aloys

    2009-01-01

    Stent-assisted coiling (SAC) is an alternative to surgical clipping for the treatment of wide-necked intracranial aneurysms (IA). However, little information is available concerning the long-term results of this treatment. The aim of this study was to report the long-term clinical and anatomical findings in 32 patients with 34 wide-necked IA treated by SAC. A retrospective review of our prospectively maintained database identified all patients followed up for wide-necked IA treated by SAC. The clinical charts, procedural data, and angiographic results were reviewed. Thirty-two patients with 34 IA were identified including 25 asymptomatic patients, four with cranial nerve palsies, two with a subarachnoid hemorrhage, and one with transient ischemic attacks. Mean aneurysm size was 10.2 mm (range 3.5 to 26 mm). Embolization was successful in all patients and no procedure-related neurological morbidity or mortality was observed. Immediate anatomical results included nine complete occlusions (26.5%), two neck remnants (6%), and 23 incomplete occlusions (67.5%). Mean imaging follow-up of 20 months showed 18 further thrombosis (53%) and 16 stable results (47%). Finally, 27 aneurysms were completely occluded (79%), three had a neck remnant (9%), and four were incompletely occluded (12%). Asymptomatic and nonsignificant in-stent stenosis occurred in seven patients (22%). SAC is safe and effective for the treatment of wide-necked IA. Despite unsatisfying immediate aneurysm occlusion, the adjunctive effect of the stent is stabilizing or significantly improving long-term anatomical results. (orig.)

  14. Results of the Software Process Improvement Efforts of the Early Adopters in NAVAIR 4.0

    National Research Council Canada - National Science Library

    Saint-Amand, David C; Hodgins, Bradley

    2007-01-01

    .... The process improvement efforts described in this paper began in the 1990s and early 2000s. Their process improvement tool sets included the Capability Maturity Model, the Capability Maturity Model (CMM...

  15. Great Indoors Awards 2007

    Index Scriptorium Estoniae

    2007-01-01

    Hollandis Maastrichtis jagati 17. XI esimest korda rahvusvahelist auhinda The Great Indoors Award. Aasta sisekujundusfirmaks valiti Masamichi Katayama asutatud Wonderwall. Auhinna said veel Zaha Hadid, Heatherwick Studio, Ryui Nakamura Architects ja Item Idem

  16. Great Lakes Bathymetry

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — Bathymetry of Lakes Michigan, Erie, Saint Clair, Ontario and Huron has been compiled as a component of a NOAA project to rescue Great Lakes lake floor geological and...

  17. Small cause - big effect: improvement in interface design results in improved data quality - a multicenter crossover study.

    Science.gov (United States)

    Ahlbrandt, Janko; Henrich, Michael; Hartmann, Bernd A; Bundschuh, Bettina B; Schwarz, Julia; Klasen, Joachim; Röhrig, Rainer

    2012-01-01

    In Germany the core data set for anesthesia version 3.0 was recently introduced for external quality assurance, which includes five surgical tracer procedures. We found a low rate of correctly documented tracers when compared to procedure data (OPS-Codes) documented separately. Examination revealed that the graphical user interface (GUI) contravened the dialogue principles as defined in EN ISO 9241-110. We worked with the manufacturer to implement small improvements and roll out the software. A crossover study was conducted at a university hospital and a municipal hospital chain with five hospitals. All study sites and surgical tracer procedures combined, we found an improvement from 42% to 65% (pbig effect small changes to the GUI can have on data quality. They also raise the question, if highly flexible and parameterized clinical documentation systems are suited to achieve high usability. Finding the right balance between GUIs designed by usability experts and the flexibility of parameterization by administrators will be a difficult task for the future and subject to further research.

  18. Improved Limits On The Existence Of Dark Matter. The Final Results From The PICASSO Experiment

    Science.gov (United States)

    Kamaha, Alvine Christelle

    The final results of the PICASSO experiment, with 409 kg days of exposure collected from November 2012 to January 2014, have yielded new limits for Spin-Dependent and Spin-Independent Dark Matter interactions. The data collected and the various backgrounds were assiduously studied using Monte Carlo simulations and a new set of sophisticated analysis techniques including the wavelet analysis presented in this thesis. In general, a good suppression of most backgrounds was attained. The neutron background event rate was reduced to about a factor of 10 compared to the previous phase of the experiment. Electronic and acoustic noise events were thoroughly suppressed. A new class of "mystery events" were removed as well. All that remained was the irreducible alpha background. No signal consistent with a WIMP Dark Matter hypothesis was observed. Consequently, an exclusion curve was obtained with a minimum limit at 90% C.L. of sigmaSDchip = 0.0228 pb at a WIMP mass of 20 GeV/c2 in the Spin-Dependent sector. By combining results from 2012 and the current results, an improved constraint of sigmaSDchip (90% C.L.) = 0.0188 pb at 20 GeV/c2 was placed on the Dark Matter interaction with protons in the Fluorine nuclei used in the detectors. In addition, the new limits on WIMP-proton interactions in the Spin Independent sector exclude the DAMA/LIBRA results (at 90% C.L.) for low masses below 12 GeV/c2 and further constrain the published CRESST and CDMS Si discovery regions at low WIMP masses.

  19. Precipitation Dynamical Downscaling Over the Great Plains

    Science.gov (United States)

    Hu, Xiao-Ming; Xue, Ming; McPherson, Renee A.; Martin, Elinor; Rosendahl, Derek H.; Qiao, Lei

    2018-02-01

    Detailed, regional climate projections, particularly for precipitation, are critical for many applications. Accurate precipitation downscaling in the United States Great Plains remains a great challenge for most Regional Climate Models, particularly for warm months. Most previous dynamic downscaling simulations significantly underestimate warm-season precipitation in the region. This study aims to achieve a better precipitation downscaling in the Great Plains with the Weather Research and Forecast (WRF) model. To this end, WRF simulations with different physics schemes and nudging strategies are first conducted for a representative warm season. Results show that different cumulus schemes lead to more pronounced difference in simulated precipitation than other tested physics schemes. Simply choosing different physics schemes is not enough to alleviate the dry bias over the southern Great Plains, which is related to an anticyclonic circulation anomaly over the central and western parts of continental U.S. in the simulations. Spectral nudging emerges as an effective solution for alleviating the precipitation bias. Spectral nudging ensures that large and synoptic-scale circulations are faithfully reproduced while still allowing WRF to develop small-scale dynamics, thus effectively suppressing the large-scale circulation anomaly in the downscaling. As a result, a better precipitation downscaling is achieved. With the carefully validated configurations, WRF downscaling is conducted for 1980-2015. The downscaling captures well the spatial distribution of monthly climatology precipitation and the monthly/yearly variability, showing improvement over at least two previously published precipitation downscaling studies. With the improved precipitation downscaling, a better hydrological simulation over the trans-state Oologah watershed is also achieved.

  20. Does an individual estimation of halflife improve the results of radioiodine therapy of Graves' disease?

    International Nuclear Information System (INIS)

    Schneider, P.; Koerber, C.; Koerber-Hafner, N.; Haenscheid, H.; Reiners, Chr.

    2002-01-01

    Aim: The impact of our dosimetry concept on radioiodine therapy success in Graves' disease (GD) was analysed. Three questions arised: Did individual estimation of pretherapeutic halflife improve therapeutic success? Did individual dosimetry result in accurate dose calculation? Did antithyroid medication have a measurable influence on therapeutic success under the prevailing conditions? Methods: 126 consecutive patients were treated with 200 Gy I-131 in our therapy ward for GD and followed-up six to nine months after therapy. Success quote was assessed using a standardized protocol and treatment was classified as successful when the patients was eu- or hypothyroid, or unsuccessful when he or she presented with a suppressed TSH-level or in hyperthyroid condition after antithyroid medication withdrawal. Antithyroid medication, activity I-131, dose, concentration of fT 3 and fT 4 , specific delivered dose and halflife were put into a multiple regression model to assess their influence on therapeutic success. In order to assess possible factors disturbing the therapeutic outcome, relevant parameters were analyzed using Logit transformation. Results: Out of 126 patients 84 were classified as successfully treated and 42 (33,3%) as failures. A significant influence on the outcome only was found for thyroid mass. However, therapeutic success appeared to be more distinctly determined by the specific delivered dose using an estimated halflife of 5.5 days (Odds: 10.0, p [de

  1. Fulfilling the law of a single independent variable and improving the result of mathematical educational research

    Science.gov (United States)

    Pardimin, H.; Arcana, N.

    2018-01-01

    Many types of research in the field of mathematics education apply the Quasi-Experimental method and statistical analysis use t-test. Quasi-experiment has a weakness that is difficult to fulfil “the law of a single independent variable”. T-test also has a weakness that is a generalization of the conclusions obtained is less powerful. This research aimed to find ways to reduce the weaknesses of the Quasi-experimental method and improved the generalization of the research results. The method applied in the research was a non-interactive qualitative method, and the type was concept analysis. Concepts analysed are the concept of statistics, research methods of education, and research reports. The result represented a way to overcome the weaknesses of quasi-Experiments and T-test. In addition, the way was to apply a combination of Factorial Design and Balanced Design, which the authors refer to as Factorial-Balanced Design. The advantages of this design are: (1) almost fulfilling “the low of single independent variable” so no need to test the similarity of the academic ability, (2) the sample size of the experimental group and the control group became larger and equal; so it becomes robust to deal with violations of the assumptions of the ANOVA test.

  2. Improving Environmental Health Literacy and Justice through Environmental Exposure Results Communication

    Directory of Open Access Journals (Sweden)

    Monica D. Ramirez-Andreotta

    2016-07-01

    Full Text Available Understanding the short- and long-term impacts of a biomonitoring and exposure project and reporting personal results back to study participants is critical for guiding future efforts, especially in the context of environmental justice. The purpose of this study was to evaluate learning outcomes from environmental communication efforts and whether environmental health literacy goals were met in an environmental justice community. We conducted 14 interviews with parents who had participated in the University of Arizona’s Metals Exposure Study in Homes and analyzed their responses using NVivo, a qualitative data management and analysis program. Key findings were that participants used the data to cope with their challenging circumstances, the majority of participants described changing their families’ household behaviors, and participants reported specific interventions to reduce family exposures. The strength of this study is that it provides insight into what people learn and gain from such results communication efforts, what participants want to know, and what type of additional information participants need to advance their environmental health literacy. This information can help improve future report back efforts and advance environmental health and justice.

  3. Improving the results of transarterial embolization of type 2 endoleaks with the embolic polymer Onyx.

    Science.gov (United States)

    Wojtaszek, Mikolaj; Wnuk, Emilia; Maciag, Rafal; Solonynko, Bohdan; Korzeniowski, Krzysztof; Lamparski, Krzysztof; Rowinski, Olgierd

    2016-01-01

    Type 2 endoleaks (T2E) occur in 10 to 20% of patients after endovascular abdominal aortic aneurysm repair (EVAR) and remain a significant clinical issue. To evaluate the efficacy and clinical outcomes of transarterial treatment of persistent type II endoleaks after EVAR using the liquid embolic Onyx. From February 2012 to August 2015 transarterial T2E embolization was attempted in 22 patients (21 men, median age: 73, range: 62-88 years). Indications for treatment included an increase in the diameter of the aneurysm sac above 5 mm and a persistent endoleak observed for more than 6 months. Mean time from EVAR to endoleak treatment was 43 months (range: 2-125 months). Primary technical success was achieved in 17 (77.3%) patients and secondary technical success in 81.8%, with 0% in-hospital mortality. The mean procedure time was 95 ±48 min, with an average fluoroscopy time of 54 ±25 min. The mean amount of Onyx used was 7.5 ±6.6 ml. Clinical success was seen in 17/21 patients with follow-up imaging (80.9%). Mean follow-up time was 17 months (range: 3-38 months). Onyx has been shown to effectively stabilize previous aneurysm growth as a result of the T2E in the majority of our patients. Transarterial embolization of T2E can be significantly improved as compared to previously reported results by using liquid embolic polymers such as Onyx.

  4. Fractional flow reserve guided percutaneous coronary intervention results in reduced ischemic myocardium and improved outcomes.

    Science.gov (United States)

    Sawant, Abhishek C; Bhardwaj, Aishwarya; Banerjee, Kinjal; Jobanputra, Yash; Kumar, Arnav; Parikh, Parth; Kandregula, Krishna C; Poddar, Kanhaiya; Ellis, Stephen G; Nair, Ravi; Corbelli, John; Kapadia, Samir

    2018-02-06

    To determine if fractional flow reserve guided percutaneous coronary intervention (FFR-guided PCI) is associated with reduced ischemic myocardium compared with angiography-guided PCI. Although FFR-guided PCI has been shown to improve outcomes, it remains unclear if it reduces the extent of ischemic myocardium at risk compared with angiography-guided PCI. We evaluated 380 patients (190 FFR-guided PCI cases and 190 propensity-matched controls) who underwent PCI from 2009 to 2014. Clinical, laboratory, angiographic, stress testing, and major adverse cardiac events [MACE] (all-cause mortality, recurrence of MI requiring PCI, stroke) data were collected. Mean age was 63 ± 11 years; the majority of patients were males (76%) and Caucasian (77%). Median duration of follow up was 3.4 [Range: 1.9, 5.0] years. Procedural complications including coronary dissection (2% vs. 0%, P = .12) and perforation (0% vs. 0%, P = 1.00) were similar between FFR-guided and angiography-guided PCI patients. FFR-guided PCI patients had lower unadjusted (14.7% vs. 23.2%, P = .04) and adjusted [OR = 0.58 (95% CI: 0.34-0.98)] risk of repeat revascularization at one year. FFR-guided PCI patients were less likely (23% vs. 32%, P = .02) to have ischemia and had lower (5.9% vs. 21.1%, P guided PCI, FFR-guided PCI results in less repeat revascularization and a lower incidence of post PCI ischemia translating into improved survival, without an increase in complications. © 2018 Wiley Periodicals, Inc.

  5. Current discharge management of acute coronary syndromes: baseline results from a national quality improvement initiative.

    Science.gov (United States)

    Wai, A; Pulver, L K; Oliver, K; Thompson, A

    2012-05-01

    Evidence-practice gaps exist in the continuum of care for patients with acute coronary syndromes (ACS), particularly at hospital discharge. We aimed to describe the methodology and baseline results of the Discharge Management of Acute Coronary Syndromes (DMACS) project, focusing on the prescription of guideline-recommended medications, referral to cardiac rehabilitation and communication between the hospital, patient and their primary healthcare professionals. DMACS employed Drug Use Evaluation methodology involving data collection, evaluation and feedback, and targeted educational interventions. Adult patients with ACS discharged during a 4-month period were eligible to participate. Data were collected (maximum 50 patients) at each site through an inpatient medical record review, a general practitioner (GP) postal/fax survey conducted 14 days post discharge and a patient telephone survey 3 months post discharge. Forty-nine hospitals participated in the audit recruiting 1545 patients. At discharge, 57% of patients were prescribed a combination of antiplatelet agent(s), beta-blocker, statin and angiotensin-converting enzyme inhibitor and/or angiotensin II-antagonist. At 3 months post discharge, 48% of patients reported using the same combination. Some 67% of patients recalled being referred to cardiac rehabilitation; of these, 33% had completed the programme. In total, 83% of patients had a documented ACS management plan at discharge. Of these, 90% included a medication list, 56% a chest pain action plan and 54% risk factor modification advice. Overall, 65% of GPs rated the quality of information received in the discharge summary as 'very good' to 'excellent'. The findings of our baseline audit showed that despite the robust evidence base and availability of national guidelines, the management of patients with ACS can be improved. These findings will inform a multifaceted intervention strategy to improve adherence to guidelines for the discharge management of

  6. Improvements to TAO Ocean Observations as a Result of Refresh Technology

    Science.gov (United States)

    Grissom, K.; Petraitis, D. C.; Pounder, D.

    2016-02-01

    The Tropical Atmosphere Ocean (TAO) array has been a major observational component of El Nino Southern Oscillation (ENSO) and climate prediction research since its completion in 1994 by NOAA's Pacific Marine Environmental Laboratory (PMEL). In 2005 operational responsibility and control of the TAO array was transitioned from PMEL to the National Data Buoy Center (NDBC). As part of the transition, a project for TAO Technology Refresh was developed to address equipment obsolescence and the need for higher data throughput in real-time. Completed in 2014, the "TAO Refresh" array has met the requirements of the NOAA transition plan and added new capabilities and value. These new capabilities include a reduced latency of data and increased real-time resolution from one observation per sensor each day to 144+ observations per sensor each day. Also, improvements in NDBC data management practices resulted in the development of a new TAO Automated Statistical Quality-control (TASQ) system that provides a real-time automated quality-control method based upon 20 years of historical data. In addition, an active method for gathering actionable evidence and combating vandalism was achieved through the installation of cameras on TAO buoys. With these enhanced capabilities, the TAO Refresh array is better positioned to support timely analyses of the diurnal cycle and high frequency weather phenomena that affect climate. An added benefit of the Refresh technology is the reduced sampling error due to the temporal averaging. For example, during a recent week long vandalism event at a Refresh buoy we have found an average error of 0.24°C (±0.17) in the subsurface temperature daily average, with the maximum error of 0.67°C. Historically, due to the limitations of real-time communications, these errors were masked within the daily average. However, with today's satellite system we can retrieve the full-resolution time series in real-time and improve the quality of our data.

  7. Experimental results on improved JARE deep ice core drill-Experiments in Rikubetsu, Hokkaido in 2002 -

    Directory of Open Access Journals (Sweden)

    Takao Kameda

    2002-07-01

    Full Text Available Deep ice coring to bedrock (3028m in depth at Dome Fuji Station is planned during three successive summer seasons starting from 2003/2004. An improved JARE deep ice core drill (12.2m in length and 3.8m in maximum core length was developed in December 2001 for the ice coring at Dome Fuji. In January/February of 2002,we performed experiments on drill performance using artificial ice blocks in Rikubetsu, Hokkaido. In this paper, we outline the experiment and report the results. It was found through the experiment that an ice core of 3.8m length was smoothly obtained by the improved drill with three screws in the chip chamber and cutting pitch of 5mm/cycle. About 45000 small holes 1.2mm in diameter were made on the surface of the chip chamber. These small holes enabled liquid to circulate between cutters and outside of the drill through the chip chamber in the drill. The dry density of the chips was 440 to 500kg/m^3 and the chip recovery rate during ice coring was 65 to 91%. A check valve installed at the bottom of the chip chamber to prevent outflow of chips from the drill was not tested enough, but more durability is needed for the valve. The newly developed motor system and core catchers of the drill worked perfectly. The average coring speed was 24.5cm/min with cutting pitch of 5mm/cycle. The average power consumption during ice coring was 171W.

  8. Improving results of surgery for fecal peritonitis due to perforated colorectal disease: A single center experience.

    Science.gov (United States)

    Mineccia, Michela; Zimmitti, Giuseppe; Ribero, Dario; Giraldi, Francesco; Bertolino, Franco; Brambilla, Romeo; Ferrero, Alessandro

    2016-01-01

    fecal peritonitis due to colorectal perforation is a dramatic event characterized by high mortality. Our study aims at determining how results of sigmoid resection (eventually extended to upper rectum) for colorectal perforation with fecal peritonitis changed in recent years and which factors affected eventual changes. Seventy-four patients were operated on at our institution (2005-2014) for colorectal perforation with fecal peritonitis and were divided into two numerically equal groups (operated on before (ERA1-group) and after (ERA2-group) May 2010). Mannheim Peritonitis Index (MPI) was calculated for each patient. Characteristics of two groups were compared. Predictors of postoperative outcomes were identified. Postoperative overall complications, major complications, and mortality occurred in 59%, 28%, and 18% of cases, respectively, and were less frequent in ERA2-group (51%, 16%, and 8%, respectively), compared to ERA1-group (68%, 41%, and 27%, respectively; p = .155, .02, and .032, respectively). Such results paralleled lower MPI values in ERA2-group, compared to ERA1-group (23(16-39) vs. 28(21-43), p = .006). Using receiver operating characteristic analysis, the best cut-off value for MPI for predicting postoperative complications and mortality was 28.5. MPI>28 was the only independent predictor of postoperative overall (p = .009, OR = 4.491) and major complications (p peritonitis longer than 24 h (p = .045, OR = 17.099). results of surgery for colorectal perforation with fecal peritonitis have improved over time, matching a concurrent decrease of MPI values and a better preoperative patient management. MPI value may help in selecting patients benefitting from surgical treatment. Copyright © 2015 IJS Publishing Group Limited. Published by Elsevier Ltd. All rights reserved.

  9. 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.

  10. Translational Environmental Research: Improving the Usefulness and Usability of Research Results

    Science.gov (United States)

    Garfin, G.

    2008-12-01

    In recent years, requests for proposals more frequently emphasize outreach to stakeholder communities, decision support, and science that serves societal needs. Reports from the National Academy of Sciences and Western States Water Council emphasize the need for science translation and outreach, in order to address societal concerns with climate extremes, such as drought, the use of climate predictions, and the growing challenges of climate change. In the 1990s, the NOAA Climate Program Office developed its Regional Integrated Sciences and Asssessments program to help bridge the gap between climate science (notably, seasonal predictions) and society, to improve the flow of information to stakeholders, and to increase the relevance of climate science to inform decisions. During the same time period, the National Science Foundation initiated multi-year Science and Technology Centers and Decision Making Under Uncertainty Centers, with similar goals, but different metrics of success. Moreover, the combination of population growth, climate change, and environmental degradation has prompted numerous research initiatives on linking knowledge and action for sustainable development. This presentation reviews various models and methodologies for translating science results from field, lab, or modeling work to use by society. Lessons and approaches from cooperative extension, boundary organizations, co-production of science and policy, and medical translational research are examined. In particular, multi-step translation as practiced within the health care community is examined. For example, so- called "T1" (translation 1) research moves insights from basic science to clinical research; T2 research evaluates the effectiveness of clinical practice, who benefits from promising care regimens, and develops tools for clinicians, patients, and policy makers. T3 activities test the implementation, delivery, and spread of research results and clinical practices in order to foster

  11. Strategy for 90% autoverification of clinical chemistry and immunoassay test results using six sigma process improvement.

    Science.gov (United States)

    Randell, Edward W; Short, Garry; Lee, Natasha; Beresford, Allison; Spencer, Margaret; Kennell, Marina; Moores, Zoë; Parry, David

    2018-06-01

    Six Sigma involves a structured process improvement strategy that places processes on a pathway to continued improvement. The data presented here summarizes a project that took three clinical laboratories from autoverification processes that allowed between about 40% to 60% of tests being auto-verified to more than 90% of tests and samples auto-verified. The project schedule, metrics and targets, a description of the previous system and detailed information on the changes made to achieve greater than 90% auto-verification is presented for this Six Sigma DMAIC (Design, Measure, Analyze, Improve, Control) process improvement project.

  12. A Continuous Quality Improvement Airway Program Results in Sustained Increases in Intubation Success.

    Science.gov (United States)

    Olvera, David J; Stuhlmiller, David F E; Wolfe, Allen; Swearingen, Charles F; Pennington, Troy; Davis, Daniel P

    2018-02-21

    Airway management is a critical skill for air medical providers, including the use of rapid sequence intubation (RSI) medications. Mediocre success rates and a high incidence of complications has challenged air medical providers to improve training and performance improvement efforts to improve clinical performance. The aim of this research was to describe the experience with a novel, integrated advanced airway management program across a large air medical company and explore the impact of the program on improvement in RSI success. The Helicopter Advanced Resuscitation Training (HeART) program was implemented across 160 bases in 2015. The HeART program includes a novel conceptual framework based on thorough understanding of physiology, critical thinking using a novel algorithm, difficult airway predictive tools, training in the optimal use of specific airway techniques and devices, and integrated performance improvement efforts to address opportunities for improvement. The C-MAC video/direct laryngoscope and high-fidelity human patient simulation laboratories were implemented during the study period. Chi-square test for trend was used to evaluate for improvements in airway management and RSI success (overall intubation success, first-attempt success, first-attempt success without desaturation) over the 25-month study period following HeART implementation. A total of 5,132 patients underwent RSI during the study period. Improvements in first-attempt intubation success (85% to 95%, p improving RSI intubation performance in a large air medical company.

  13. Test results for triple-modulation radar electronics with improved range disambiguation

    Energy Technology Data Exchange (ETDEWEB)

    Pollastrone, Fabio, E-mail: fabio.pollastrone@enea.it; Neri, Carlo

    2015-10-15

    Highlights: • A new digital radar electronic system based on triple-modulation has been developed. • The triple-modulation system uses an improved algorithm for the range-disambiguation. • The new radar electronics has been applied in the IVVS optical radar prototype for ITER. • The performances obtained with IVVS double and triple-modulation were compared. - Abstract: The In Vessel Viewing System (IVVS) is an optical radar with sub milimetrical resolution that will be used for imaging and metrology pourposes in ITER. The electronics of the system is based on a Digital Radar Electronics developed in ENEA Frascati laboratories during the past years. Until the present study, the system was based on amplitude modulation technique having double-modulation frequency. The power of the laser is sinusoidally modulated and the distance of the points scanned by the laser beam is obtained measuring the phase difference between outgoing and echo signals. Recently a triple-modulation radar electronics version and an algorithm able to solve the range disambiguation were developed. The aim of the upgrade was the increase of the robustness in the range disambiguation. The paper briefly describes the updates carried out on the Digital Radar Electronics and extensively the test results obtained by comparing the performance of the triple modulation versus the double modulation techniques.

  14. Reducing Stigma in Media Professionals: Is there Room for Improvement? Results from a Systematic Review.

    Science.gov (United States)

    Maiorano, Alessandra; Lasalvia, Antonio; Sampogna, Gaia; Pocai, Benedetta; Ruggeri, Mirella; Henderson, Claire

    2017-10-01

    The mass media may increase stigma against people with mental health problems by reinforcing common stereotypes. Media professionals thus represent a target group for antistigma interventions. This paper aims to review available literature on antistigma interventions for mass media professionals, seeking to clarify what kind of interventions have been found to be effective in reducing mental health stigma among mass media professionals. Six electronic databases (MEDLINE, PsycINFO, Embase, Cochrane Reviews Library and Cochrane Central Register of Controlled Trials, Web of Science, and Applied Social Sciences Index & Abstracts) were systematically searched through March 2017 for studies addressing antistigma interventions on mass media professionals.  Results: A total of 27 studies on antistigma interventions targeted to media professionals were found. Reviewed articles were classified into 3 categories: media-monitoring projects/reporting guidelines ( n = 23), interventions for educating journalists ( n = 2), and interventions for educating journalism students ( n = 2). Overall, antistigma interventions for media professionals seem to have some effect in improving reporting style, thus providing a more balanced portrayal of people with mental health problems: the most promising interventions are contact-based educational approaches and the provision of guidelines by authoritative institutions. It should be useful to promote and disseminate contact-based educational interventions targeted to journalists and to include specific modules on mental health topics in the training curricula of journalism students. However, as research in the field suffers from several limitations, high-quality studies exploring the long-term effect of antistigma interventions for media professionals are needed.

  15. Applying national survey results for strategic planning and program improvement: the National Diabetes Education Program.

    Science.gov (United States)

    Griffey, Susan; Piccinino, Linda; Gallivan, Joanne; Lotenberg, Lynne Doner; Tuncer, Diane

    2015-02-01

    Since the 1970s, the federal government has spearheaded major national education programs to reduce the burden of chronic diseases in the United States. These prevention and disease management programs communicate critical information to the public, those affected by the disease, and health care providers. The National Diabetes Education Program (NDEP), the leading federal program on diabetes sponsored by the National Institutes of Health (NIH) and the Centers for Disease Control and Prevention (CDC), uses primary and secondary quantitative data and qualitative audience research to guide program planning and evaluation. Since 2006, the NDEP has filled the gaps in existing quantitative data sources by conducting its own population-based survey, the NDEP National Diabetes Survey (NNDS). The NNDS is conducted every 2–3 years and tracks changes in knowledge, attitudes and practice indicators in key target audiences. This article describes how the NDEP has used the NNDS as a key component of its evaluation framework and how it applies the survey results for strategic planning and program improvement. The NDEP's use of the NNDS illustrates how a program evaluation framework that includes periodic population-based surveys can serve as an evaluation model for similar national health education programs.

  16. Improved diabetes management in Swedish schools: results from two national surveys.

    Science.gov (United States)

    Särnblad, Stefan; Åkesson, Karin; Fernström, Lillemor; Ilvered, Rosita; Forsander, Gun

    2017-09-01

    Support in diabetes self-care in school is essential to achieve optimal school performance and metabolic control. Swedish legislation regulating support to children with chronic diseases was strengthened 2009. To compare the results of a national survey conducted 2008 and 2015 measuring parents' and diabetes specialist teams' perceptions of support in school. All pediatric diabetes centers in Sweden were invited to participate in the 2015 study. In each center, families with a child being treated for T1DM and attending preschool class or compulsory school were eligible. The parents' and the diabetes teams' opinions were collected in two separate questionnaires. Forty-one out of 42 eligible diabetes centers participated and 568 parents answered the parental questionnaire in 2015. Metabolic control had improved since the 2008 survey (55.2 ± 10.6 mmol/mol, 7.2% ± 1.0%, in 2015 compared with 61.8 ± 12.4 mmol/mol, 7.8% ± 1.1% in 2008). The proportion of children with a designated staff member responsible for supporting the child's self-care increased from 43% to 59%, (P self-care in school in 2015 compared with 2008. More efforts are needed to implement the national legislation to achieve equal support in all Swedish schools. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  17. CHESS Improves Cancer Caregivers’ Burden and Mood: Results of an eHealth RCT

    Science.gov (United States)

    DuBenske, Lori L.; Gustafson, David H.; Namkoong, Kang; Hawkins, Robert P.; Atwood, Amy K.; Brown, Roger L.; Chih, Ming-Yuan; McTavish, Fiona; Carmack, Cindy L.; Buss, Mary K.; Govindan, Ramaswamy; Cleary, James F.

    2014-01-01

    Objective Informal caregivers (family and friends) of people with cancer are often unprepared for their caregiving role, leading to increased burden or distress. CHESS (Comprehensive Health Enhancement Support System) is a web-based lung cancer information, communication and coaching system for caregivers. This randomized trial reports the impact on caregiver burden, disruptiveness and mood of providing caregivers access to CHESS versus the Internet with a list of recommended lung cancer websites. Methods 285 informal caregivers of patients with advanced non-small cell lung cancer were randomly assigned to a comparison group that received Internet or a treatment group that received Internet and CHESS. Caregivers were provided a computer and Internet service if needed. Written surveys were completed at pretest and during the intervention period bimonthly for up to 24 months. ANCOVA analyses compared the intervention’s effect on caregivers’ disruptiveness and burden (CQOLI-C), and negative mood (combined Anxiety, Depression, and Anger scales of the POMS) at six months, controlling for blocking variables (site, caregiver’s race, and relationship to patient) and the given outcome at pretest. Results Caregivers randomized to CHESS reported lower burden [t (84) = 2.36, p = .021, d= .39] and negative mood [t (86) = 2.82, p = .006, d= .44] than those in the Internet group. The effect on disruptiveness was not significant. Conclusions Although caring for someone with a terminal illness will always exact a toll on caregivers, eHealth interventions like CHESS may improve caregivers’ understanding and coping skills and, as a result, ease their burden and mood. PMID:24245838

  18. Introduction of e-learning in dental radiology reveals significantly improved results in final examination.

    Science.gov (United States)

    Meckfessel, Sandra; Stühmer, Constantin; Bormann, Kai-Hendrik; Kupka, Thomas; Behrends, Marianne; Matthies, Herbert; Vaske, Bernhard; Stiesch, Meike; Gellrich, Nils-Claudius; Rücker, Martin

    2011-01-01

    Because a traditionally instructed dental radiology lecture course is very time-consuming and labour-intensive, online courseware, including an interactive-learning module, was implemented to support the lectures. The purpose of this study was to evaluate the perceptions of students who have worked with web-based courseware as well as the effect on their results in final examinations. Users (n(3+4)=138) had access to the e-program from any networked computer at any time. Two groups (n(3)=71, n(4)=67) had to pass a final exam after using the e-course. Results were compared with two groups (n(1)=42, n(2)=48) who had studied the same content by attending traditional lectures. In addition a survey of the students was statistically evaluated. Most of the respondents reported a positive attitude towards e-learning and would have appreciated more access to computer-assisted instruction. Two years after initiating the e-course the failure rate in the final examination dropped significantly, from 40% to less than 2%. The very positive response to the e-program and improved test scores demonstrated the effectiveness of our e-course as a learning aid. Interactive modules in step with clinical practice provided learning that is not achieved by traditional teaching methods alone. To what extent staff savings are possible is part of a further study. Copyright © 2010 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

  19. Physics-Based Scientific Learning Module to Improve Students Motivation and Results

    Directory of Open Access Journals (Sweden)

    Soni Nugroho Yuliono

    2018-02-01

    Full Text Available Teaching materials that available in the school to learn physics especially scientific-based is limited and become one of the obstacles to achieving the learning objectives on electromagnetic waves maerial. The research aims is to gain scientific Physics-based learning modules for high school grade XII students who have met the eligibility criteria, determine the effectiveness of using scientific-based learning modules Physics to improve motivation and learning outcomes from students of grade XII High School. The development of this research on Physics module using 4D development procedure which consist of the steps of define, design, development, and dissemination. Definition phase consists of the teacher and student’s needs analysis process, material analysis, as well as the formulation of the learning module. The design phase of physics learning modules according to the stage of scientific learning are integrated into the module. The development phase consists of the development process of the modules from the design results, validating the feasibility, module revision, limited testing, and the use of scientifically-based learning modules Physics in grade XII IPA 1 Batik 2 Surakarta senior high school. The deployment phase is the deployment process module to another Senior High School in Surakarta. Data Analysis for the study is quantitative descriptive analysis based on the score criteria and analysis of increasing student motivation through N-gain. Conclusion obtained are ; 1 Physics-based scientific learning modules that developed meet the eligibility criteria on aspects of content and presentation, language, the chart, and aspects of learning. The module is declared worthy of the ideals validation results with the percentage of 85.16%, 83.66% by students and teachers in the response phase of the deployment of 85.93%, which is included in the category of "very good"; 2 Physics-based scietific learning modules with material scientific

  20. The GREAT3 challenge

    International Nuclear Information System (INIS)

    Miyatake, H; Mandelbaum, R; Rowe, B

    2014-01-01

    The GRavitational lEnsing Accuracy Testing 3 (GREAT3) challenge is an image analysis competition that aims to test algorithms to measure weak gravitational lensing from astronomical images. The challenge started in October 2013 and ends 30 April 2014. The challenge focuses on testing the impact on weak lensing measurements of realistically complex galaxy morphologies, realistic point spread function, and combination of multiple different exposures. It includes simulated ground- and space-based data. The details of the challenge are described in [1], and the challenge website and its leader board can be found at http://great3challenge.info and http://great3.projects.phys.ucl.ac.uk/leaderboard/, respectively

  1. Factors to Consider in Selecting an Organisational Improvement Initiative: Survey Results

    Directory of Open Access Journals (Sweden)

    Mohammad Musli

    2017-01-01

    Full Text Available Organisations should select the appropriate improvement initiative that will fit with the context of organisation and provide value to the organisation. This paper presents 18 factors to be considered when selecting an organisational improvement initiative. Organisational improvement initiatives are approaches, management systems, tools and/or techniques that can be used for managing and improving organisations, such as Lean, ISO9001, Six Sigma and Improvement Team. A survey was conducted to identify the level of importance of these 18 factors as criteria for selecting an improvement initiative. Purposive sampling was used for this survey involving practitioners, managers, engineers, executives, consultants and/or academicians, who have been involved in the selection and/or implementation of organisational improvement initiatives in Malaysia. Two factors were rated as ‘very high importance’, which involve: (1 The ability to gain top management commitment and support to introduce and implement the initiative successfully, and (2 The initiative is aligned to the vision, mission and/or purpose of the organisation. All these factors can be adopted by the organisations as decision criteria to assist in the selection of the most appropriate improvement initiative based on rational decision making.

  2. Targets, drivers and metrics in software process improvement: results of a survey in a multinational organization

    NARCIS (Netherlands)

    Trienekens, J.J.M.; Kusters, R.J.; Genuchten, van M.J.I.M.; Aerts, H.

    2007-01-01

    This paper reports on a survey amongst software groups in a multinational organization. The survey was initiated by the Software Process Improvement (SPI) Steering Committee of Philips, a committee that monitors the status and quality of software process improvement in the global organization. The

  3. Results from three years on the prairie - improving management through volunteer-collected data

    Science.gov (United States)

    Hadley, N.; Force, A.; Holsinger, K.

    2017-12-01

    Citizen science is a nascent and diversifying field with the ability to support wide-ranging outcomes from volunteer education and empowerment to data-driven decisions. Adventure Scientists is a nonprofit organization that focuses on the latter. We approach citizen science through a solutions-oriented lens, in which quality data can influence decisions leading to improved policy, land management and business practices. All our work is interdisciplinary, as we collaborate with partners in government, academia, industry and nonprofits to help fill their data collection needs. In addressing our partners' data needs, it is critical that we align any newfound knowledge with tangible outcomes. Therefore, our projects and partnerships incorporate concrete theories of change and involve the collaborations and relationships necessary to support decision-making. In this presentation, we will highlight Landmark, a landscape-scale project spanning 30,000 acres of North American prairie in Montana, to illustrate one example of a partnership that resulted in improved management from our volunteer-collected data. This was a multi-year citizen science project, where we assisted the American Prairie Reserve's effort to create the largest grasslands and wildlife protected area in the continental U.S. Our partners identified a need to better understand the extent and diversity of wildlife inhabiting and migrating through the space. To provide this enhanced understanding, we helped design and implement a program to collect key wildlife data on the prairie. We recruited, trained and managed specialized volunteers from the outdoor adventure community. Volunteers were responsible for collecting data year-round on animals moving through the landscape to support their management and protection. After three years of data collection and over 19,000 wildlife observations made while monitoring 29 species, the grasslands preserve is now moving forward with an expansive wildlife dataset to

  4. Improved operating scenarios of the DIII-D tokamak as a result of the addition of UNIX computer systems

    International Nuclear Information System (INIS)

    Henline, P.A.

    1995-10-01

    The increased use of UNIX based computer systems for machine control, data handling and analysis has greatly enhanced the operating scenarios and operating efficiency of the DRI-D tokamak. This paper will describe some of these UNIX systems and their specific uses. These include the plasma control system, the electron cyclotron heating control system, the analysis of electron temperature and density measurements and the general data acquisition system (which is collecting over 130 Mbytes of data). The speed and total capability of these systems has dramatically affected the ability to operate DIII-D. The improved operating scenarios include better plasma shape control due to the more thorough MHD calculations done between shots and the new ability to see the time dependence of profile data as it relates across different spatial locations in the tokamak. Other analysis which engenders improved operating abilities will be described

  5. Nothing Great Is Easy

    OpenAIRE

    Stansbie, Lisa

    2014-01-01

    A solo exhibition of 13 pieces of art work.\\ud \\ud Nothing Great is Easy is an exhibition of sculpture, film, drawing and photography that proposes reconstructed narratives using the sport of swimming and in particular the collective interaction and identity of the channel swimmer. The work utilises the processes, rituals/rules, language and the apparatus of sport.\\ud \\ud “Nothing great is easy” are the words on the memorial to Captain Matthew Webb who was the first man to swim the English ch...

  6. Great Books. What Works Clearinghouse Intervention Report

    Science.gov (United States)

    What Works Clearinghouse, 2011

    2011-01-01

    "Great Books" is a program that aims to improve the reading, writing, and critical thinking skills of students in kindergarten through high school. The program is implemented as a core or complementary curriculum and is based on the Shared Inquiry[TM] method of learning. The purpose of "Great Books" is to engage students in…

  7. Adjuvant Hormone Therapy May Improve Survival in Epithelial Ovarian Cancer: Results of the AHT Randomized Trial.

    Science.gov (United States)

    Eeles, Rosalind A; Morden, James P; Gore, Martin; Mansi, Janine; Glees, John; Wenczl, Miklos; Williams, Christopher; Kitchener, Henry; Osborne, Richard; Guthrie, David; Harper, Peter; Bliss, Judith M

    2015-12-10

    To assess the effects of adjuvant hormone therapy (AHT) on survival and disease outcome in women with epithelial ovarian cancer. Participants were premenopausal and postmenopausal women who had been diagnosed with epithelial ovarian cancer (any International Federation of Gynecology and Obstetrics stage) 9 or fewer months previously. Ineligible patients included those with deliberately preserved ovarian function, with a history of a hormone-dependent malignancy, or with any contraindications to hormone-replacement therapy. Patients were centrally randomly assigned in a 1:1 ratio to either AHT for 5 years after random assignment or no AHT (control). Main outcome measures were overall survival (OS), defined as time from random assignment to death (any cause), and relapse-free survival, defined as time from random assignment to relapse or death (any cause). Patients who continued, alive and relapse free, were censored at their last known follow-up. A total of 150 patients (n = 75, AHT; n = 75, control) were randomly assigned from 1990 to 1995 from 19 centers in the United Kingdom, Spain, and Hungary; all patients were included in intention-to-treat analyses. The median follow-up in alive patients is currently 19.1 years. Of the 75 patients with AHT, 53 (71%) have died compared with 68 (91%) of 75 patients in the control group. OS was significantly improved in patients who were receiving AHT (hazard ratio, 0.63; 95% CI, 0.44 to 0.90; P = .011). A similar effect was seen for relapse-free survival (hazard ratio, 0.67; 95% CI, 0.47 to 0.97; P = .032). Effects remained after adjustment for known prognostic factors. These results show that women who have severe menopausal symptoms after ovarian cancer treatment can safely take hormone-replacement therapy, and this may, in fact, infer benefits in terms of OS in addition to known advantages in terms of quality of life. © 2015 by American Society of Clinical Oncology.

  8. CHESS improves cancer caregivers' burden and mood: results of an eHealth RCT.

    Science.gov (United States)

    DuBenske, Lori L; Gustafson, David H; Namkoong, Kang; Hawkins, Robert P; Atwood, Amy K; Brown, Roger L; Chih, Ming-Yuan; McTavish, Fiona; Carmack, Cindy L; Buss, Mary K; Govindan, Ramaswamy; Cleary, James F

    2014-10-01

    Informal caregivers (family and friends) of people with cancer are often unprepared for their caregiving role, leading to increased burden or distress. Comprehensive Health Enhancement Support System (CHESS) is a Web-based lung cancer information, communication, and coaching system for caregivers. This randomized trial reports the impact on caregiver burden, disruptiveness, and mood of providing caregivers access to CHESS versus the Internet with a list of recommended lung cancer websites. A total of 285 informal caregivers of patients with advanced nonsmall cell lung cancer were randomly assigned to a comparison group that received Internet or a treatment group that received Internet and CHESS. Caregivers were provided a computer and Internet service if needed. Written surveys were completed at pretest and during the intervention period bimonthly for up to 24 months. Analyses of covariance (ANCOVAs) compared the intervention's effect on caregivers' disruptiveness and burden (CQOLI-C), and negative mood (combined Anxiety, Depression, and Anger scales of the POMS) at 6 months, controlling for blocking variables (site, caregiver's race, and relationship to patient) and the given outcome at pretest. Caregivers randomized to CHESS reported lower burden, t(84) = 2.36, p = .021, d = .39, and negative mood, t(86) = 2.82, p = .006, d = .44, than those in the Internet group. The effect on disruptiveness was not significant. Although caring for someone with a terminal illness will always exact a toll on caregivers, eHealth interventions like CHESS may improve caregivers' understanding and coping skills and, as a result, ease their burden and mood.

  9. Recent results on steady state and confinement improvement research on JT-60U

    International Nuclear Information System (INIS)

    Ide, Shunsuke

    2000-01-01

    On the JT-60U tokamak, fusion plasma research for realization of a steady state tokamak reactor has been pursued. Towards that goal, confinement improved plasmas such as H-mode, high β p , reversed magnetic shear (RS) and latter two combined with H-mode edge pedestal have been developed and investigated intensively. A key issue to achieve non-inductive current drive relevant to a steady state fusion reactor is to increase the fraction of the bootstrap current and match the spatial profile to the optimum. In 1999, as the result of the optimization, the equivalent deuterium-tritium (D-T) fusion gain (Q DT eq ) of 0.5 was sustained for 0.8 s, which is roughly equal to the energy confinement time, in a RS plasma. In order to achieve a RS plasma in steady state two approach have been explored. One is to use external current driver such as lower hybrid current drive (LHCD), and by optimizing LHCD a quasi-steady RS discharge was obtained. The other approach is to utilize bootstrap current as much as possible, and with highly increased fraction of the bootstrap current, a confinement enhancement factor of 3.6 was maintained for 2.7 s in a RS plasma with H-mode edge. A heating and current drive system in the electron cyclotron range of frequency for localized heating and current drive has been installed on JT-60U, and in initial experiments a clear increase of the central electron temperature in a RS high density central region was confirmed only with injected power of 0.75 MW. (author)

  10. Outcomes of Concurrent Operations: Results From the American College of Surgeons' National Surgical Quality Improvement Program.

    Science.gov (United States)

    Liu, Jason B; Berian, Julia R; Ban, Kristen A; Liu, Yaoming; Cohen, Mark E; Angelos, Peter; Matthews, Jeffrey B; Hoyt, David B; Hall, Bruce L; Ko, Clifford Y

    2017-09-01

    To determine whether concurrently performed operations are associated with an increased risk for adverse events. Concurrent operations occur when a surgeon is simultaneously responsible for critical portions of 2 or more operations. How this practice affects patient outcomes is unknown. Using American College of Surgeons' National Surgical Quality Improvement Program data from 2014 to 2015, operations were considered concurrent if they overlapped by ≥60 minutes or in their entirety. Propensity-score-matched cohorts were constructed to compare death or serious morbidity (DSM), unplanned reoperation, and unplanned readmission in concurrent versus non-concurrent operations. Multilevel hierarchical regression was used to account for the clustered nature of the data while controlling for procedure and case mix. There were 1430 (32.3%) surgeons from 390 (77.7%) hospitals who performed 12,010 (2.3%) concurrent operations. Plastic surgery (n = 393 [13.7%]), otolaryngology (n = 470 [11.2%]), and neurosurgery (n = 2067 [8.4%]) were specialties with the highest proportion of concurrent operations. Spine procedures were the most frequent concurrent procedures overall (n = 2059/12,010 [17.1%]). Unadjusted rates of DSM (9.0% vs 7.1%; P < 0.001), reoperation (3.6% vs 2.7%; P < 0.001), and readmission (6.9% vs 5.1%; P < 0.001) were greater in the concurrent operation cohort versus the non-concurrent. After propensity score matching and risk-adjustment, there was no significant association of concurrence with DSM (odds ratio [OR] 1.08; 95% confidence interval [CI] 0.96-1.21), reoperation (OR 1.16; 95% CI 0.96-1.40), or readmission (OR 1.14; 95% CI 0.99-1.29). In these analyses, concurrent operations were not detected to increase the risk for adverse outcomes. These results do not lessen the need for further studies, continuous self-regulation and proactive disclosure to patients.

  11. Explaining variation in perceived team effectiveness: Results from eleven quality improvement collaboratives

    NARCIS (Netherlands)

    M.M.H. Strating (Mathilde); A.P. Nieboer (Anna)

    2013-01-01

    textabstractAims and objectives. Explore effectiveness of 11 collaboratives focusing on 11 different topics, as perceived by local improvement teams and to explore associations with collaborative-, organisational- and team-level factors. Background. Evidence underlying the effectiveness of quality

  12. A major advance in the quality of the training aimed at improving results

    International Nuclear Information System (INIS)

    Delgado, J. L.; Gonzalez Anez, F.

    2013-01-01

    Tecnatom has made in the last years several initiatives focused on improving quality and standards of training services with respect to processes,methodology and instructor qualification. Main areas of actuation are described in this article. (Author)

  13. Logistics analysis to Improve Deployability (LOG-AID): Field Experiment/Results

    National Research Council Canada - National Science Library

    Evers, Kenneth

    2000-01-01

    .... Under sponsorship of the Air Force Research Laboratory Logistics Readiness Branch (AFRL/HESR), the Synergy team analyzed the current wing-level deployment process as part of the Logistics Analysis to Improve Deployability (LOG-AID) program...

  14. The Great Mathematician Project

    Science.gov (United States)

    Goldberg, Sabrina R.

    2013-01-01

    The Great Mathematician Project (GMP) introduces both mathematically sophisticated and struggling students to the history of mathematics. The rationale for the GMP is twofold: first, mathematics is a uniquely people-centered discipline that is used to make sense of the world; and second, students often express curiosity about the history of…

  15. Nationwide Inpatient Sample and National Surgical Quality Improvement Program give different results in hip fracture studies.

    Science.gov (United States)

    Bohl, Daniel D; Basques, Bryce A; Golinvaux, Nicholas S; Baumgaertner, Michael R; Grauer, Jonathan N

    2014-06-01

    National databases are being used with increasing frequency to conduct orthopaedic research. However, there are important differences in these databases, which could result in different answers to similar questions; this important potential limitation pertaining to database research in orthopaedic surgery has not been adequately explored. The purpose of this study was to explore the interdatabase reliability of two commonly used national databases, the Nationwide Inpatient Sample (NIS) and the National Surgical Quality Improvement Program (NSQIP), in terms of (1) demographics; (2) comorbidities; and (3) adverse events. In addition, using the NSQIP database, we identified (4) adverse events that had a higher prevalence after rather than before discharge, which has important implications for interpretation of studies conducted in the NIS. A retrospective cohort study of patients undergoing operative stabilization of transcervical and intertrochanteric hip fractures during 2009 to 2011 was performed in the NIS and NSQIP. Totals of 122,712 and 5021 patients were included from the NIS and NSQIP, respectively. Age, sex, fracture type, and lengths of stay were compared. Comorbidities common to both databases were compared in terms of more or less than twofold difference between the two databases. Similar comparisons were made for adverse events. Finally, adverse events that had a greater postdischarge prevalence were identified from the NSQIP database. Tests for statistical difference were thought to be of little value given the large sample size and the resulting fact that statistical differences would have been identified even for small, clinically inconsequential differences resulting from the associated high power. Because it is of greater clinical importance to focus on the magnitude of differences, the databases were compared by absolute differences. Demographics and hospital lengths of stay were not different between the two databases. In terms of comorbidities

  16. What great managers do.

    Science.gov (United States)

    Buckingham, Marcus

    2005-03-01

    Much has been written about the qualities that make a great manager, but most of the literature overlooks a fundamental question: What does a great manager actually do? While there are countless management styles, one thing underpins the behavior of all great managers. Above all, an exceptional manager comes to know and value the particular quirks and abilities of her employees. She figures out how to capitalize on her staffers' strengths and tweaks her environment to meet her larger goals. Such a specialized approach may seem like a lot of work. But in fact, capitalizing on each person's uniqueness can save time. Rather than encourage employees to conform to strict job descriptions that may include tasks they don't enjoy and aren't good at, a manager who develops positions for his staff members based on their unique abilities will be rewarded with behaviors that are far more efficient and effective than they would be otherwise. This focus on individuals also makes employees more accountable. Because staffers are evaluated on their particular strengths and weaknesses, they are challenged to take responsibility for their abilities and to hone them. Capitalizing on a person's uniqueness also builds a stronger sense of team. By taking the time to understand what makes each employee tick, a great manager shows that he sees his people for who they are. This personal investment not only motivates individuals but also galvanizes the entire team. Finally, this approach shakes up existing hierarchies, which leads to more creative thinking. To take great managing from theory to practice, the author says, you must know three things about a person: her strengths, the triggers that activate those strengths, and how she learns. By asking the right questions, squeezing the right triggers, and becoming aware of your employees' learning styles, you will discover what motivates each person to excel.

  17. Increasing Throughput: Results from a 42-Hospital Collaborative to Improve Emergency Department Flow.

    Science.gov (United States)

    Zocchi, Mark S; McClelland, Mark S; Pines, Jesse M

    2015-12-01

    An 18-month collaborative in 42 hospitals across 16 communities in the United States to improve emergency department (ED) flow was conducted from October 2010 through March 2012. Hospitals were invited to participate through the Aligning Forces for Quality (AF4Q) program. Each participating hospital identified one or more interventions to improve ED flow and submitted data on four measures of ED flow: discharged length of stay (LOS), admitted LOS, boarding time, and left without being seen (LWBS) rates. Participating hospitals also provided quarterly progress reports on challenges encountered and lessons learned. Univariate linear regression was used to assess the effectiveness of interventions at the hospital level, where an improvement was defined as a negative slope in one or more of the throughput indicators. Challenges and lessons learned were tabulated and described. A total of 172 interventions were implemented across the 42 hospitals. Two thirds (n = 28) demonstrated improvement on at least one measure of ED flow. Among hospitals demonstrating improvement, the average reduction in discharged LOS was 26 minutes (95% confidence interval [CI] 11 to 41); admitted LOS, 36.5 minutes (95% CI 20 to 53), boarding time, 20.9 minutes (95% CI 12 to 30), and LWBS seen rates decreased by 1.4 absolute percentage points (95% CI 0.2 to 2.7). Teams were frequently challenged by issues related to leadership, staff buy-in, and resource constraints. The majority of hospitals in this collaborative improved on one or more ED flow measures. Many challenges were shared across hospitals, demonstrating that successful approaches to ED flow improvement require certain fundamental elements, including engaged leadership and staff, and sufficient resources.

  18. Cognition improvement in Taekwondo novices over forty. Results from the SEKWONDO Study.

    Directory of Open Access Journals (Sweden)

    Gaby ePons Van Dijk

    2013-11-01

    Full Text Available AbstractAge-related cognitive decline is associated with increased risk of disability, dementia and death. Recent studies suggest improvement in cognitive speed, attention and executive functioning with physical activity. However, whether such improvements are activity specific is unclear.Therefore, we aimed to study the effect of one year age-adapted Taekwondo training on several cognitive functions, including reaction/ motor time, information processing speed, and working and executive memory, in 24 healthy volunteers over forty.Reaction and motor time decreased with 41.2 seconds and 18.4 seconds (p=0.004, p=0.015, respectively. Digit symbol coding task improved with a mean of 3.7 digits (p=0.017. Digit span, letter fluency, and trail making test task-completion-time all improved, but not statistically significant. The questionnaire reported better reaction time in 10 and unchanged in 9 of the nineteen study compliers. In conclusion, our data suggest that age-adapted Taekwondo training improves various aspects of cognitive function in people over 40, which may, therefore, offer a cheap, safe and enjoyable way to mitigate age-related cognitive decline.

  19. Great magnetic storms

    International Nuclear Information System (INIS)

    Tsurutani, B.T.; Yen Te Lee; Tang, F.; Gonzalez, W.D.

    1992-01-01

    The five largest magnetic storms that occurred between 1971 and 1986 are studied to determine their solar and interplanetary causes. All of the events are found to be associated with high speed solar wind streams led by collisionless shocks. The high speed streams are clearly related to identifiable solar flares. It is found that (1) it is the extreme values of the southward interplanetary magnetic fields rather than solar wind speeds that are the primary causes of great magnetic storms, (2) shocked and draped sheath fields preceding the driver gas (magnetic cloud) are at least as effective in causing the onset of great magnetic storms (3 of 5 events ) as the strong fields within the driver gas itself, and (3) precursor southward fields ahead of the high speed streams allow the shock compression mechanism (item 2) to be particularly geoeffective

  20. Improve Your Marketing Results by Asking Peter F. Drucker's "Five Most Important Questions."

    Science.gov (United States)

    Rossum, Constance; Baum, Geoffrey

    2001-01-01

    This case study demonstrates how the Office of Marketing & Public Relations at Claremont McKenna College used five "Drucker Tool" questions to improve marketing's image on campus and awareness of the college among key constituencies. It concludes with a reevaluation of the initial marketing strategy based on the growing importance of…

  1. Improvements of adolescent psychopathology after insomnia treatment: results from a randomized controlled trial over 1 year

    NARCIS (Netherlands)

    de Bruin, Eduard J.; Bögels, Susan M.; Oort, Frans J.; Meijer, Anne Marie

    2017-01-01

    Adolescent insomnia can be treated effectively with cognitive behavioural therapy for insomnia (CBTI). However, little is known about effects of CBTI on psychopathology in adolescents. This study aimed to investigate whether (a) CBTI improves psychopathology in Internet- (IT) and face-to-face group

  2. Improvements of adolescent psychopathology after insomnia treatment : Results from a randomized controlled trial over 1 year

    NARCIS (Netherlands)

    de Bruin, E.J.; Bögels, S.M.; Oort, F.J.; Meijer, A.M.

    Adolescent insomnia can be treated effectively with cognitive behavioural therapy for insomnia (CBTI). However, little is known about effects of CBTI on psychopathology in adolescents. This study aimed to investigate whether (a) CBTI improves psychopathology in Internet- (IT) and face-to-face group

  3. Improving self-esteem in women diagnosed with Turner syndrome: results of a pilot intervention.

    Science.gov (United States)

    Chadwick, Paul M; Smyth, Arlene; Liao, Lih-Mei

    2014-06-01

    To evaluate a brief intervention to improve the self esteem of women diagnosed with Turner syndrome (TS). Prospective observational study. Turner Syndrome Support Society, UK. 30 women aged 18-60 years. A 1-day psychology workshop targeting problems of self-esteem in women diagnosed with TS. The workshop drew on cognitive-behavioral therapy and narrative therapy skills and emphasized increased self-awareness of interpersonal difficulties and improved capacity for self-management. Rosenberg Self-esteem Scale (RSS); Hospital Anxiety and Depression Scale (HADS); bespoke user experiences questionnaire. All 30 women provided baseline data, 27/30 provided immediate post-intervention data and 22/30 provided follow-up data at 3 months. The intervention improved RSS and HADS scores at 3 months. Generic skills-based psychological interventions have the potential to be adapted to provide brief and low-cost interventions to improve self-esteem and reduce psychological distress in women diagnosed with TS. Copyright © 2014 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

  4. Improving Accuracy and Relevance of Race/Ethnicity Data: Results of a Statewide Collaboration in Hawaii.

    Science.gov (United States)

    Pellegrin, Karen L; Miyamura, Jill B; Ma, Carolyn; Taniguchi, Ronald

    2016-01-01

    Current race/ethnicity categories established by the U.S. Office of Management and Budget are neither reliable nor valid for understanding health disparities or for tracking improvements in this area. In Hawaii, statewide hospitals have collaborated to collect race/ethnicity data using a standardized method consistent with recommended practices that overcome the problems with the federal categories. The purpose of this observational study was to determine the impact of this collaboration on key measures of race/ethnicity documentation. After this collaborative effort, the number of standardized categories available across hospitals increased from 6 to 34, and the percent of inpatients with documented race/ethnicity increased from 88 to 96%. This improved standardized methodology is now the foundation for tracking population health indicators statewide and focusing quality improvement efforts. The approach used in Hawaii can serve as a model for other states and regions. Ultimately, the ability to standardize data collection methodology across states and regions will be needed to track improvements nationally.

  5. The great intimidators.

    Science.gov (United States)

    Kramer, Roderick M

    2006-02-01

    After Disney's Michael Eisner, Miramax's Harvey Weinstein, and Hewlett-Packard's Carly Fiorina fell from their heights of power, the business media quickly proclaimed thatthe reign of abrasive, intimidating leaders was over. However, it's premature to proclaim their extinction. Many great intimidators have done fine for a long time and continue to thrive. Their modus operandi runs counter to a lot of preconceptions about what it takes to be a good leader. They're rough, loud, and in your face. Their tactics include invading others' personal space, staging tantrums, keeping people guessing, and possessing an indisputable command of facts. But make no mistake--great intimidators are not your typical bullies. They're driven by vision, not by sheer ego or malice. Beneath their tough exteriors and sharp edges are some genuine, deep insights into human motivation and organizational behavior. Indeed, these leaders possess political intelligence, which can make the difference between paralysis and successful--if sometimes wrenching--organizational change. Like socially intelligent leaders, politically intelligent leaders are adept at sizing up others, but they notice different things. Those with social intelligence assess people's strengths and figure out how to leverage them; those with political intelligence exploit people's weaknesses and insecurities. Despite all the obvious drawbacks of working under them, great intimidators often attract the best and brightest. And their appeal goes beyond their ability to inspire high performance. Many accomplished professionals who gravitate toward these leaders want to cultivate a little "inner intimidator" of their own. In the author's research, quite a few individuals reported having positive relationships with intimidating leaders. In fact, some described these relationships as profoundly educational and even transformational. So before we throw out all the great intimidators, the author argues, we should stop to consider what

  6. Great Lakes Energy Institute

    Energy Technology Data Exchange (ETDEWEB)

    Alexander, J. Iwan [Case Western Reserve Univ., Cleveland, OH (United States)

    2012-11-18

    The vision of the Great Lakes Energy Institute is to enable the transition to advanced, sustainable energy generation, storage, distribution and utilization through coordinated research, development, and education. The Institute will place emphasis on translating leading edge research into next generation energy technology. The Institute’s research thrusts focus on coordinated research in decentralized power generation devices (e.g. fuel cells, wind turbines, solar photovoltaic devices), management of electrical power transmission and distribution, energy storage, and energy efficiency.

  7. Predicting Great Lakes fish yields: tools and constraints

    Science.gov (United States)

    Lewis, C.A.; Schupp, D.H.; Taylor, W.W.; Collins, J.J.; Hatch, Richard W.

    1987-01-01

    Prediction of yield is a critical component of fisheries management. The development of sound yield prediction methodology and the application of the results of yield prediction are central to the evolution of strategies to achieve stated goals for Great Lakes fisheries and to the measurement of progress toward those goals. Despite general availability of species yield models, yield prediction for many Great Lakes fisheries has been poor due to the instability of the fish communities and the inadequacy of available data. A host of biological, institutional, and societal factors constrain both the development of sound predictions and their application to management. Improved predictive capability requires increased stability of Great Lakes fisheries through rehabilitation of well-integrated communities, improvement of data collection, data standardization and information-sharing mechanisms, and further development of the methodology for yield prediction. Most important is the creation of a better-informed public that will in turn establish the political will to do what is required.

  8. Public say food regulatory policies to improve health in Western Australia are important: population survey results

    OpenAIRE

    Pollard, Christina M; Daly, Alison; Moore, Michael; Binns, Colin W

    2013-01-01

    Objective To investigate the level of support among Western Australian adults for food control policies to improve diet, reduce obesity and protect the environment. Methods Attitudes towards government food control policies on food labelling, food advertising, and the supply of environmentally friendly food data were pooled from two Nutrition Monitoring Survey Series telephone surveys of 2,147 adults aged 18?64 years collected in 2009 and 2012. Descriptive and logistic regression analyses wer...

  9. Improved result on stability analysis of discrete stochastic neural networks with time delay

    International Nuclear Information System (INIS)

    Wu Zhengguang; Su Hongye; Chu Jian; Zhou Wuneng

    2009-01-01

    This Letter investigates the problem of exponential stability for discrete stochastic time-delay neural networks. By defining a novel Lyapunov functional, an improved delay-dependent exponential stability criterion is established in terms of linear matrix inequality (LMI) approach. Meanwhile, the computational complexity of the newly established stability condition is reduced because less variables are involved. Numerical example is given to illustrate the effectiveness and the benefits of the proposed method.

  10. A novel telemonitoring device for improving diabetes control: protocol and results from a randomized clinical trial.

    Science.gov (United States)

    Pressman, Alice R; Kinoshita, Linda; Kirk, Susan; Barbosa, Gina Monraz; Chou, Cathy; Minkoff, Jerome

    2014-02-01

    Telemedicine is one approach to managing patients with chronic illness. Several telephone-based monitoring studies of diabetes patients have shown improved glycosylated hemoglobin (HbA1c), blood pressure (BP), and low-density lipoprotein (LDL) levels. The purpose of this study was to evaluate an investigational in-home telemetry device for improving glucose and BP control over 6 months for patients with type 2 diabetes. The device was used to transmit weekly blood glucose, weight, and BP readings to a diabetes care manager. We conducted a two-arm, parallel-comparison, single-blind, randomized controlled trial among Kaiser Permanente Northern California members 18-75 years old with type 2 diabetes mellitus and entry HbA1c levels between 7.5% and 10.0%. Participants were randomly assigned to either the telemonitoring arm or the usual care arm. We observed very small, nonsignificant changes in fructosamine (telemonitoring, -54.9 μmol; usual care, -59.4 μmol) and systolic BP (telemonitoring, -6.3 mm Hg; usual care, -3.2 mm Hg) from baseline to 6 weeks in both groups. At 6 months, we observed no significant intergroup differences in change from baseline for HbA1c, fructosamine, or self-efficacy. However, LDL cholesterol in the telemonitoring arm decreased more than in the usual care arm (-17.1 mg/dL versus -5.4 mg/dL; P=0.045). Although HbA1c improved significantly over 6 months in both groups, the difference in improvement between the groups was not significant. This lack of significance may be due to the relatively healthy status of the volunteers in our study and to the high level of care provided by the care managers in the Santa Rosa, CA clinic. Further study in subgroups of less healthy diabetes patients is recommended.

  11. Network Interactions in the Great Altai Region

    Directory of Open Access Journals (Sweden)

    Lev Aleksandrovich Korshunov

    2017-12-01

    Full Text Available To improve the efficiency and competitiveness of the regional economy, an effective interaction between educational institutions in the Great Altai region is needed. The innovation growth can enhancing this interaction. The article explores the state of network structures in the economy and higher education in the border territories of the countries of Great Altai. The authors propose an updated approach to the three-level classification of network interaction. We analyze growing influence of the countries with emerging economies. We define the factors that impede the more stable and multifaceted regional development of these countries. Further, the authors determine indicators of the higher education systems and cooperation systems at the university level between the Shanghai Cooperation Organization countries (SCO and BRICS countries, showing the international rankings of the universities in these countries. The teaching language is important to overcome the obstacles in the interregional cooperation. The authors specify the problems of the development of the universities of the SCO and BRICS countries as global educational networks. The research applies basic scientific logical methods of analysis and synthesis, induction and deduction, as well as the SWOT analysis method. We have indentified and analyzed the existing economic and educational relations. To promote the economic innovation development of the border territories of the Great Altai, we propose a model of regional network university. Modern universities function in a new economic environment. Thus, in a great extent, they form the technological and social aspects of this environment. Innovative network structures contribute to the formation of a new network institutional environment of the regional economy, which impacts the macro- and microeconomic performance of the region as a whole. The results of the research can help to optimize the regional economies of the border

  12. Visual Input Enhancement via Essay Coding Results in Deaf Learners' Long-Term Retention of Improved English Grammatical Knowledge

    Science.gov (United States)

    Berent, Gerald P.; Kelly, Ronald R.; Schmitz, Kathryn L.; Kenney, Patricia

    2009-01-01

    This study explored the efficacy of visual input enhancement, specifically "essay enhancement", for facilitating deaf college students' improvement in English grammatical knowledge. Results documented students' significant improvement immediately after a 10-week instructional intervention, a replication of recent research. Additionally, the…

  13. Exercise Therapy Augments the Ischemia-Induced Proangiogenic State and Results in Sustained Improvement after Stroke

    Directory of Open Access Journals (Sweden)

    Man He

    2013-04-01

    Full Text Available The induction of angiogenesis will stimulate endogenous recovery mechanisms, which are involved in the long-term repair and restoration process of the brain after an ischemic event. Here, we tested whether exercise influences the pro-angiogenic factors and outcomes after cerebral infarction in rats. Wistar rats were exposed to two hours of middle-cerebral artery occlusion and reperfusion. Different durations of treadmill training were performed on the rats. The expression of matrix metalloproteinase 2 (MMP2 and vascular endothelial growth factor (VEGF-related genes and proteins were higher over time post-ischemia, and exercise enhanced their expression. Sixteen days post-ischemia, the regional cerebral blood flow in the ischemic striatum was significantly increased in the running group over the sedentary. Although no difference was seen in infarct size between the running and sedentary groups, running evidently improved the neurobehavioral score. The effects of running on MMP2 expression, regional cerebral blood flow and outcome were abolished when animals were treated with bevacizumab (BEV, a VEGF-targeting antibody. Exercise therapy improves long-term stroke outcome by MMP2-VEGF-dependent mechanisms related to improved cerebral blood flow.

  14. Evidence-Based Scar Management: How to Improve Results with Technique and Technology.

    Science.gov (United States)

    Khansa, Ibrahim; Harrison, Bridget; Janis, Jeffrey E

    2016-09-01

    Scars represent the visible sequelae of trauma, injury, burn, or surgery. They may induce distress in the patient because of their aesthetically unpleasant appearance, especially if they are excessively raised, depressed, wide, or erythematous. They may also cause the patient symptoms of pain, tightness, and pruritus. Numerous products are marketed for scar prevention or improvement, but their efficacy is unclear. A literature review of high-level studies analyzing methods to prevent or improve hypertrophic scars, keloids, and striae distensae was performed. The evidence from these articles was analyzed to generate recommendations. Each intervention's effectiveness at preventing or reducing scars was rated as none, low, or high, depending on the strength of the evidence for that intervention. For the prevention of hypertrophic scars, silicone, tension reduction, and wound edge eversion seem to have high efficacy, whereas onion extract, pulsed-dye laser, pressure garments, and scar massage have low efficacy. For the treatment of existing hypertrophic scars, silicone, pulsed-dye laser, CO2 laser, corticosteroids, 5-fluorouracil, bleomycin, and scar massage have high efficacy, whereas onion extract and fat grafting seem to have low efficacy. For keloid scars, effective adjuncts to excision include corticosteroids, mitomycin C, bleomycin, and radiation therapy. No intervention seems to have significant efficacy in the prevention or treatment of striae distensae. Although scars can never be completely eliminated in an adult, this article presents the most commonly used, evidence-based methods to improve the quality and symptoms of hypertrophic scars, as well as keloid scars and striae distensae.

  15. Turning great strategy into great performance.

    Science.gov (United States)

    Mankins, Michael C; Steele, Richard

    2005-01-01

    Despite the enormous time and energy that goes into strategy development, many companies have little to show for their efforts. Indeed, research by the consultancy Marakon Associates suggests that companies on average deliver only 63% of the financial performance their strategies promise. In this article, Michael Mankins and Richard Steele of Marakon present the findings of this research. They draw on their experience with high-performing companies like Barclays, Cisco, Dow Chemical, 3M, and Roche to establish some basic rules for setting and delivering strategy: Keep it simple, make it concrete. Avoid long, drawn-out descriptions of lofty goals and instead stick to clear language describing what your company will and won't do. Debate assumptions, not forecasts. Create cross-functional teams drawn from strategy, marketing, and finance to ensure the assumptions underlying your long-term plans reflect both the real economics of your company's markets and its actual performance relative to competitors. Use a rigorous analytic framework. Ensure that the dialogue between the corporate center and the business units about market trends and assumptions is conducted within a rigorous framework, such as that of "profit pools". Discuss resource deployments early. Create more realistic forecasts and more executable plans by discussing up front the level and timing of critical deployments. Clearly identify priorities. Prioritize tactics so that employees have a clear sense of where to direct their efforts. Continuously monitor performance. Track resource deployment and results against plan, using continuous feedback to reset assumptions and reallocate resources. Reward and develop execution capabilities. Motivate and develop staff. Following these rules strictly can help narrow the strategy-to-performance gap.

  16. Postgraduate Education in Quality Improvement Methods: Initial Results of the Fellows' Applied Quality Training (FAQT) Curriculum.

    Science.gov (United States)

    Winchester, David E; Burkart, Thomas A; Choi, Calvin Y; McKillop, Matthew S; Beyth, Rebecca J; Dahm, Phillipp

    2016-06-01

    Training in quality improvement (QI) is a pillar of the next accreditation system of the Accreditation Committee on Graduate Medical Education and a growing expectation of physicians for maintenance of certification. Despite this, many postgraduate medical trainees are not receiving training in QI methods. We created the Fellows Applied Quality Training (FAQT) curriculum for cardiology fellows using both didactic and applied components with the goal of increasing confidence to participate in future QI projects. Fellows completed didactic training from the Institute for Healthcare Improvement's Open School and then designed and completed a project to improve quality of care or patient safety. Self-assessments were completed by the fellows before, during, and after the first year of the curriculum. The primary outcome for our curriculum was the median score reported by the fellows regarding their self-confidence to complete QI activities. Self-assessments were completed by 23 fellows. The majority of fellows (15 of 23, 65.2%) reported no prior formal QI training. Median score on baseline self-assessment was 3.0 (range, 1.85-4), which was significantly increased to 3.27 (range, 2.23-4; P = 0.004) on the final assessment. The distribution of scores reported by the fellows indicates that 30% were slightly confident at conducting QI activities on their own, which was reduced to 5% after completing the FAQT curriculum. An interim assessment was conducted after the fellows completed didactic training only; median scores were not different from the baseline (mean, 3.0; P = 0.51). After completion of the FAQT, cardiology fellows reported higher self-confidence to complete QI activities. The increase in self-confidence seemed to be limited to the applied component of the curriculum, with no significant change after the didactic component.

  17. Does levodopa improve vision in albinism? Results of a randomized, controlled clinical trial.

    Science.gov (United States)

    Summers, C Gail; Connett, John E; Holleschau, Ann M; Anderson, Jennifer L; De Becker, Inge; McKay, Brian S; Brilliant, Murray H

    2014-11-01

    Dopamine is an intermediate product in the biosynthesis of melanin pigment, which is absent or reduced in albinism. Animal research has shown that supplying a precursor to dopamine, levodopa, may improve visual acuity in albinism by enhancing neural networks. This study examines the safety and effectiveness of levodopa on best-corrected visual acuity in human subjects with albinism. Prospective, randomized, placebo-controlled, double-masked clinical trial conducted at the University of Minnesota. Forty-five subjects with albinism. Subjects with albinism were randomly assigned to one of three treatment arms: levodopa 0.76 mg/kg with 25% carbidopa, levodopa 0.51 mg/kg with 25% carbidopa, or placebo and followed for 20 weeks, with best-corrected visual acuity measured at enrollment, and at weeks 5, 10, 15, and 20 after enrollment. Side-effects were recorded with a symptom survey. Blood was drawn for genotyping. Side-effects and best-corrected visual acuity 20 weeks after enrolment. All subjects had at least one mutation found in a gene known to cause albinism. Mean age was 14.5 years (range: 3.5 to 57.8 years). Follow up was 100% and compliance was good. Minor side-effects were reported; there were no serious adverse events. There was no statistically significant improvement in best-corrected visual acuity after 20 weeks with either dose of levodopa. Levodopa, in the doses used in this trial and for the time course of administration, did not improve visual acuity in subjects with albinism. © 2014 Royal Australian and New Zealand College of Ophthalmologists.

  18. Formulation, computation and improvement of steady state security margins in power systems. Part II: Results

    International Nuclear Information System (INIS)

    Echavarren, F.M.; Lobato, E.; Rouco, L.; Gomez, T.

    2011-01-01

    A steady state security margin for a particular operating point can be defined as the distance from this initial point to the secure operating limits of the system. Four of the most used steady state security margins are the power flow feasibility margin, the contingency feasibility margin, the load margin to voltage collapse, and the total transfer capability between system areas. This is the second part of a two part paper. Part I has proposed a novel framework of a general model able to formulate, compute and improve any steady state security margin. In Part II the performance of the general model is validated by solving a variety of practical situations in modern real power systems. Actual examples of the Spanish power system will be used for this purpose. The same computation and improvement algorithms outlined in Part I have been applied for the four security margins considered in the study, outlining the convenience of defining a general framework valid for the four of them. The general model is used here in Part II to compute and improve: (a) the power flow feasibility margin (assessing the influence of the reactive power generation limits in the Spanish power system), (b) the contingency feasibility margin (assessing the influence of transmission and generation capacity in maintaining a correct voltage profile), (c) the load margin to voltage collapse (assessing the location and quantity of loads that must be shed in order to be far away from voltage collapse) and (d) the total transfer capability (assessing the export import pattern of electric power between different areas of the Spanish system). (author)

  19. Metabolic Correction in the Management of Diabetic Peripheral Neuropathy: Improving Clinical Results Beyond Symptom Control

    Science.gov (United States)

    Miranda-Massari, Jorge R.; Gonzalez, Michael J.; Jimenez, Francisco J.; Allende-Vigo, Myriam Z.; Duconge, Jorge

    2013-01-01

    Current Clinical Management Guidelines of Diabetic Peripheral Neuropathy (DPN) are based on adequate glucose control and symptomatic pain relief. However, meticulous glycemic control could delay the onset or slow the progression of diabetic neuropathy in patients with DM type 2, but it does not completely prevent the progression of the disease. Complications of DPN as it continues its natural course, produce increasing pain and discomfort, loss of sensation, ulcers, infections, amputations and even death. In addition to the increased suffering, disability and loss of productivity, there is a very significant economic impact related to the treatment of DPN and its complications. In USA alone, it has been estimated that there are more than 5,000,000 patients suffering from DPN and the total annual cost of treating the disease and its complications is over $10,000 million dollars. In order to be able to reduce complications of DPN, it is crucial to improve or correct the metabolic conditions that lead to the pathology present in this condition. Pathophysiologic mechanisms implicated in diabetic neuropathy include: increased polyol pathway with accumulation of sorbitol and reduced Na+/K+-ATPase activity, microvascular damage and hypoxia due to nitric oxide deficit and increased oxygen free radical activity. Moreover, there is a decrease in glutathione and increase in homocysteine. Clinical trials in the last two decades have demonstrated that the use of specific nutrients can correct some of these metabolic derangements, improving symptom control and providing further benefits such as improved sensorium, blood flow and nerve regeneration. We will discuss the evidence on lipoic acid, acetyi-L-carnitine, benfotiamine and the combination of active B vitamins L-methylfolate, methylcobalamin and piridoxal-6-phosphate. In addition, we discuss the role of metforrnin, an important drug in the management of diabetes, and the presence of specific polymorphic genes, in the risk

  20. Formulation, computation and improvement of steady state security margins in power systems. Part II: Results

    Energy Technology Data Exchange (ETDEWEB)

    Echavarren, F.M.; Lobato, E.; Rouco, L.; Gomez, T. [School of Engineering of Universidad Pontificia Comillas, C/Alberto Aguilera, 23, 28015 Madrid (Spain)

    2011-02-15

    A steady state security margin for a particular operating point can be defined as the distance from this initial point to the secure operating limits of the system. Four of the most used steady state security margins are the power flow feasibility margin, the contingency feasibility margin, the load margin to voltage collapse, and the total transfer capability between system areas. This is the second part of a two part paper. Part I has proposed a novel framework of a general model able to formulate, compute and improve any steady state security margin. In Part II the performance of the general model is validated by solving a variety of practical situations in modern real power systems. Actual examples of the Spanish power system will be used for this purpose. The same computation and improvement algorithms outlined in Part I have been applied for the four security margins considered in the study, outlining the convenience of defining a general framework valid for the four of them. The general model is used here in Part II to compute and improve: (a) the power flow feasibility margin (assessing the influence of the reactive power generation limits in the Spanish power system), (b) the contingency feasibility margin (assessing the influence of transmission and generation capacity in maintaining a correct voltage profile), (c) the load margin to voltage collapse (assessing the location and quantity of loads that must be shed in order to be far away from voltage collapse) and (d) the total transfer capability (assessing the export import pattern of electric power between different areas of the Spanish system). (author)

  1. QGSJET-II: physics, recent improvements, and results for air showers

    Directory of Open Access Journals (Sweden)

    Ostapchenko S.

    2013-06-01

    Full Text Available Modeling of high energy hadronic and nuclear interactions by the QGSJET-II generator is discussed. Recent updates related to the treatment of nonlinear effects inthe interaction dynamics and to the model calibration with new LHC data are described. A special attention is devoted to the predictions of the new model version forcharacteristics of extensive air showers initiated by high energy cosmic rays. In particular, an improved description of charge exchange processes in pion collisionsis discussed and the respective enhancement of the shower muon content is analyzed.

  2. Results of the European research project 'Improving the effectiveness of cancer treatment with 3D Brachytherapy'

    International Nuclear Information System (INIS)

    Solc, J.; Sochor, V.; Selbach, H.-J.; Aubineau-Laniec, I.; Lourenco, V.; Gabris, F.; Grindborg, J.-E.; Kosunen, A.; Jarvinen, H.; Sipila, P.; Gouldstone, C.; Sander, T.; Sharpe, P.; Zeman, J.; Portugal, L.; Rodrigues, M.; Carlsson Tedgren, A.; Pooter de, M

    2011-01-01

    The project iMERA + T2.J06 'Improving the effectiveness of cancer treatment using 3D brachytherapy' was solved in the period 2008-2011 in collaboration of metrology institutes from 10 European Union countries, including participation of the Czech Republic. Its main objective was to create a means to ensure metrological quantity absorbed dose in water from brachyterapeutical (BT) sources enabling more accurate assessment of therapeutic benefit than using existing dosimetry protocols that are based on the quantity kerma in the air. This project is discussed on the poster.

  3. Improving the Interpretability of Classification Rules Discovered by an Ant Colony Algorithm: Extended Results

    OpenAIRE

    Otero, Fernando E.B.; Freitas, Alex A.

    2016-01-01

    The vast majority of Ant Colony Optimization (ACO) algorithms for inducing classification rules use an ACO-based procedure to create a rule in an one-at-a-time fashion. An improved search strategy has been proposed in the cAnt-MinerPB algorithm, where an ACO-based procedure is used to create a complete list of rules (ordered rules)-i.e., the ACO search is guided by the quality of a list of rules, instead of an individual rule. In this paper we propose an extension of the cAnt-MinerPB algorith...

  4. The ways of improvement of combination therapy results in patients with local cervical cancer

    International Nuclear Information System (INIS)

    Shumilo, A.O.

    2010-01-01

    A new solutions of a scientific task of modern oncogynecology, improvement of the efficacy of treatment for local cervical cancer on the account of expansion of the indications to operative treatment is presented on the clinical material (275 patients with stage II-III CC). The use of the developed technique of multimodality therapy based on the split course of combination radiation therapy against a background of neoadjuvant chemotherapy allowed to convert in 49.6% of cases of immobile tumor process to an operable stage followed by uterus and adnexae removal while at the traditional combination radiotherapy the resectability index was 6.9%.

  5. [Close teamwork between pathologist and surgeon can improve results in colorectal cancer treatment].

    Science.gov (United States)

    West, Nicholas P; Quirke, Philip; Hagemann-Madsen, Rikke Hjarnø

    2011-04-04

    Colorectal cancer is common in the Western world and is a leading cause of cancer related mortality. The introduction of multidisciplinary teams and focus on quality control has led to improved outcomes in which pathologists play a central role through feedback to surgeons, radiologists, and oncologists. This review focuses on the importance of pathological examination of the resection specimen and subsequent feedback to the surgical team regarding quality. Specific markers of oncological quality including grading the plane of surgery, tissue morphometry and lymph node yields are discussed.

  6. Rational gas consumption resulting from technological innovations and improved gas appliances

    Energy Technology Data Exchange (ETDEWEB)

    Doering, H

    1980-07-01

    Ruhrgas AG has developed several new or improved appliances with a view toward conserving energy. Its household heat center (see also Gas Abstr. 36, 80-1144f) uses a single core unit to supply heat for all the major heat requirements in the house, from cooking and dishwashing to water heating, space heating, and laundry washing/drying. A new burner that can function at both full and partial load with an air ratio of about 1.35 offers economical, yet quiet operation. Ruhrgas is also continuing its laboratory and field research into the application of gas-fired compression-type heat pumps.

  7. Idiopathic great saphenous phlebosclerosis.

    Directory of Open Access Journals (Sweden)

    Ahmadreza Jodati

    2013-06-01

    Full Text Available Arterial sclerosis has been extensively described but reports on venous sclerosis are very sparse. Phlebosclerosis refers to the thickening and hardening of the venous wall. Despite its morphological similarities with arteriosclerosis and potential morbid consequences, phlebosclerosis has gained only little attention. We report a 72 year old male with paralysis and atrophy of the right leg due to childhood poliomyelitis who was referred for coronary artery bypass surgery. The great saphenous vein, harvested from the left leg, showed a hardened cord-like obliterated vein. Surprisingly, harvested veins from the atrophic limb were normal and successfully used for grafting.

  8. Making Psychotherapy Great Again?

    Science.gov (United States)

    Plakun, Eric M

    2017-05-01

    Psychotherapy never stopped being as "great" as other treatments. This column explores the evidence base for both psychotherapy and medications, using depression as a specific example. The limitations are comparable for psychotherapy and medication, with much of the evidence based on small degrees of "statistically significant" rather than "clinically meaningful" change. Our field's biomedical emphasis leads to a false assumption that most patients present with single disorders, when comorbidity is the rule rather than the exception. This false assumption contributes to limitations in the evidence base and in our ability to treat patients optimally.

  9. Improving the Interpretability of Classification Rules Discovered by an Ant Colony Algorithm: Extended Results.

    Science.gov (United States)

    Otero, Fernando E B; Freitas, Alex A

    2016-01-01

    Most ant colony optimization (ACO) algorithms for inducing classification rules use a ACO-based procedure to create a rule in a one-at-a-time fashion. An improved search strategy has been proposed in the cAnt-Miner[Formula: see text] algorithm, where an ACO-based procedure is used to create a complete list of rules (ordered rules), i.e., the ACO search is guided by the quality of a list of rules instead of an individual rule. In this paper we propose an extension of the cAnt-Miner[Formula: see text] algorithm to discover a set of rules (unordered rules). The main motivations for this work are to improve the interpretation of individual rules by discovering a set of rules and to evaluate the impact on the predictive accuracy of the algorithm. We also propose a new measure to evaluate the interpretability of the discovered rules to mitigate the fact that the commonly used model size measure ignores how the rules are used to make a class prediction. Comparisons with state-of-the-art rule induction algorithms, support vector machines, and the cAnt-Miner[Formula: see text] producing ordered rules are also presented.

  10. Public say food regulatory policies to improve health in Western Australia are important: population survey results.

    Science.gov (United States)

    Pollard, Christina M; Daly, Alison; Moore, Michael; Binns, Colin W

    2013-10-01

    To investigate the level of support among Western Australian adults for food control policies to improve diet, reduce obesity and protect the environment. Attitudes towards government food control policies on food labelling, food advertising, and the supply of environmentally friendly food data were pooled from two Nutrition Monitoring Survey Series telephone surveys of 2,147 adults aged 18-64 years collected in 2009 and 2012. Descriptive and logistic regression analyses were conducted using survey module of STATA 12. The majority of adults believe it is important that government regulates food policy options under consideration: nutrition information on food labels (97% versus 2% who think it is not important); health rating on food labels (95% versus 3%); food advertising (83% versus 11%); and the supply of environmentally friendly food (86% versus 9%). Community perception is that government control or regulation of food labelling, food advertising and the supply of environmentally friendly food is important. Curbing excess weight gain and related disease burden is a public health priority. Australian governments are considering food regulatory interventions to assist the public to improve their dietary intake. These findings should provide reassurance to government officials considering these regulatory measures. © 2013 The Authors. ANZJPH © 2013 Public Health Association of Australia.

  11. Resveratrol Supplementation Did Not Improve Cognition in Patients with Schizophrenia: Results from a Randomized Clinical Trial.

    Science.gov (United States)

    Zortea, Karine; Franco, Viviane C; Guimarães, Paula; Belmonte-de-Abreu, Paulo S

    2016-01-01

    Schizophrenia (SZ) is associated with psychotic experiences and cognitive deficits. Therefore, cognitive function is one of the most critical determinants of quality of life in this pathology. Resveratrol has been related to neuroprotective action, but there are no studies evaluating resveratrol in SZ. The objective of this study was to determine the efficacy of resveratrol supplementation on cognition in individuals with SZ. This is a 1-month randomized, double-blind, and controlled trial (NCT 02062190), in which 19 men with diagnosis of SZ, aged 18-65 years, were assigned to a resveratrol supplementation group (200 mg) or placebo group (200 mg), with a 1-month follow-up. Applying a series of cognitive tests assessed neuropsychology performance (Hopkins Verbal Learning Test, Stroop Color and Word Test, and Weschler Adult Intelligence Scale) and Brief Psychiatric Rating Scale assessed psychopathology severity. There were no significant improvement in neuropsychology performance (episodic memory, working memory, attention and concentration capacity, inhibitory control, interference measures, selective attention, and mental flexibility) and psychopathology severity after 1 month of resveratrol supplementation ( P  > 0.05). In conclusion, we have shown that 1 month of a resveratrol supplementation (200 mg/day) did not improve episodic memory, working memory, attention and concentration capacity, inhibitory control, interference measures, selective attention, and mental flexibility as compared with placebo in patients with SZ.

  12. Supply and Demand for Improved Sanitation: Results from Randomized Pricing Experiments in Rural Tanzania.

    Science.gov (United States)

    Peletz, Rachel; Cock-Esteb, Alicea; Ysenburg, Dorothea; Haji, Salim; Khush, Ranjiv; Dupas, Pascaline

    2017-06-20

    Improving access to sanitation is a global public health priority. Sufficient consumer demand is required for sanitation coverage to expand through private provision. To measure consumer demand for hygienic latrine platform products in rural Tanzania, we conducted a randomized, voucher-based real-money sales trial with 1638 households with unimproved latrines. We also evaluated multiple supply chain options to determine the costs of supplying latrine platform products to rural households. For concrete latrine SanPlats, 60% of households were willing to pay US$0.48 and 10% of households were willing to pay US$4.05, yet the average cost of supplying the SanPlat to households was US$7.51. Similarly, for plastic sanitary platforms, willingness-to-pay (WTP) dropped from almost 60% at a price of US$1.43 to 5% at a price of US$12.29, compared to an average supply cost of US$23.28. WTP was not significantly different between villages that had participated in the National Sanitation Campaign and those that had not. Randomized informational interventions, including hygiene data-sharing and peer-based exposure to latrine platform products, had minimal effects on WTP. In conclusion, current household demand for latrine platform products is too low to achieve national goals for improved sanitation coverage through fully commercial distribution.

  13. Disease management of early childhood caries: results of a pilot quality improvement project.

    Science.gov (United States)

    Ng, Man Wai; Torresyap, Gay; White, Alex; Melvin, Patrice; Graham, Dionne; Kane, Daniel; Scoville, Richard; Ohiomoba, Henry

    2012-08-01

    The purpose is to report findings of a quality improvement (QI) project implemented at two hospital-based dental clinics that care for children with early childhood caries (ECC). We tested a disease management (DM) approach in children younger than age 60 months with ECC. After 30 months, for the 403 and 234 DM patients at Children's Hospital Boston (CHB) and Saint Joseph Hospital (SJH) who returned for at least two visits, rates of new cavitation, pain, and referrals to the OR were 26.1, 13.4 and 10.9% for CHB and 41.0, 7.3 and 14.9% for SJH. Rates of new cavitation, pain, and referrals to the OR for historical controls were 75.2, 21.7, and 20.9% for CHB and 71.3, 31.3, and 25.0% for SJH. A risk-based DM approach utilizing QI strategies to address ECC can be implemented into practice and has the potential to improve care and health outcomes.

  14. Interpreting clinical trial results by deductive reasoning: In search of improved trial design.

    Science.gov (United States)

    Kurbel, Sven; Mihaljević, Slobodan

    2017-10-01

    Clinical trial results are often interpreted by inductive reasoning, in a trial design-limited manner, directed toward modifications of the current clinical practice. Deductive reasoning is an alternative in which results of relevant trials are combined in indisputable premises that lead to a conclusion easily testable in future trials. © 2017 WILEY Periodicals, Inc.

  15. Flux gain for a next-generation neutron reflectometer resulting from improved supermirror performance

    CERN Document Server

    Rehm, C

    2002-01-01

    Next-generation spallation neutron source facilities will offer instruments with unprecedented capabilities through simultaneous enhancement of source power and usage of advanced optical components. The Spallation Neutron Source (SNS), already under construction at Oak Ridge National Laboratory and scheduled to be completed by 2006, will provide greater than an order of magnitude more effective source flux than current state-of-the-art facilities, including the most advanced research reactors. An additional order of magnitude gain is expected through the use of new optical devices and instrumentation concepts. Many instrument designs require supermirror neutron guides with very high critical angles for total reflection. In this contribution, we will discuss how the performance of a modern neutron-scattering instrument depends on the efficiency of these supermirrors. We summarize current limitations of supermirror coatings and outline ideas for enhancing their performance, particularly for improving the reflec...

  16. First results on the development of improved doped carbon materials for fusion applications

    International Nuclear Information System (INIS)

    Garcia-Rosales, C.; Paz, P.; Echeberria, J.; Balden, M.; Behrisch, R.

    2001-01-01

    Improved carbon-based plasma facing materials are developed by doping graphite with different carbides and optimizing the microstructure in order to refine their thermomechanical properties and to reduce both processes of chemical erosion. As starting material a mixture of mesophase carbon powder with mean particle size of 0.6 μm, and carbide powders (TiC, V 8 C 7 , WC, ZrC, SiC and B 4 C) with particle sizes around 1 μm have been used. The carbides were added to the carbon powder up to a metal concentration of about 5 at.%. Most dopants showed a catalytic effect on graphitization, V 8 C 7 being the most effective one. The materials obtained exhibit a high density, a low open porosity and good mechanical properties. Chemical erosion was reduced with doping, typically by a factor of the order of two. (orig.)

  17. Weight management in obese pets: the tailoring concept and how it can improve results.

    Science.gov (United States)

    German, Alexander J

    2016-10-20

    Obesity is now recognised as the most important medical disease in pets worldwide. All current strategies for weight management involve dietary energy restriction with a purpose-formulated diet. Whilst current weight management regimes can be successful, outcomes are often disappointing with the rate of weight loss progressively slowing down as time goes on. Success is most challenging for the most obese dogs and cats that are more likely to discontinue the programme before reaching target weight. To improve outcomes, clinicians must focus carefully on better tailoring programmes, paying particular to setting an appropriate target weight so as to maximise the benefits for the individual. In this opinionated review, the author will discuss findings from recent clinical research studies examining weight management in obese dogs and cats. A strategy for tailoring weight management targets will then be discussed, illustrated with case examples.

  18. Techniques for improving shuffler assay results for 55-gallon waste drums

    International Nuclear Information System (INIS)

    Rinard, P.M.; Prettyman, T.H.; Stuenkel, D.

    1994-01-01

    Accurate assays of the fissile contents in waste drums are needed to ensure the most proper and economical handling and disposal of the waste. An improvement of accuracy will mean fewer drums disposed as transuranic waste when they really contain low-level waste, saving both money and burial sites. Shufflers are used for assaying waste drums and are very accurate with nonmoderating matrices (such as iron). In the active mode they count delayed neutrons released after fissions are induced by irradiation neutrons from a 252 Cf source. However, as the hydrogen density from matrices such as paper or gloves increases, the accuracy can suffer without proper attention. The neutron transport and fission probabilities change with the hydrogen density, causing the neutron count rate to vary with the position of the fissile material within the drum. The magnitude of this variation grows with the hydrogen density

  19. Licensee Event Report System. Evaluation of first year results, and recommendations for improvements. Supplement No. 2

    International Nuclear Information System (INIS)

    1985-09-01

    This report describes an evaluation of an industry-wide sample of Licensee Event Reports (LERs) that was conducted to determine whether or not these LERs were prepared in accordance with the requirements set forth in 10 CFR 50.73. The study was performed at the Idaho National Engineering Laboratory (INEL), by EG and G, Inc. This evaluation (NUREG/CR-4178) indicated that although the overall quality of the LERs was good, many LERs failed to meet all of the requirements. This report presents the methodology that was used to evaluate the LERs, the conclusions reached concerning problem areas in the reports, and suggestions as to how the overall quality and completeness of reports can be improved

  20. Initial results from the Auto/Oil Air Quality Improvement Research Program

    International Nuclear Information System (INIS)

    McCabe, L.J.

    1993-01-01

    The Auto/Air Quality Improvement Research Program (AQIRP), a cooperative effort by the three major US auto companies and fourteen oil companies, is the most comprehensive research effort ever undertaken to develop data on the air quality effects of the use of various motor fuels in various automotive systems and the relative cost-effectiveness of various fuel/vehicle combinations. Phase 1 of the Program, at a cost of about $15 million, is examining emissions and air quality impacts from current and older vehicles using reformulated gasolines with widely different values of aromatics content, olefin content, oxygenate content and type, sulfur content, vapor pressure (RVP) and 90% distillation temperature. Emissions from Flexible and Variable Fuel vehicles using methanol/gasoline mixtures are also being examined. A second phase with a $25 million budget over three years has also been approved. Initial findings for the Phase 1 study and Phase 2 plans are presented

  1. Cognitive function in multiple sclerosis improves with telerehabilitation: Results from a randomized controlled trial.

    Directory of Open Access Journals (Sweden)

    Leigh E Charvet

    Full Text Available Cognitive impairment affects more than half of all individuals living with multiple sclerosis (MS. We hypothesized that training at home with an adaptive online cognitive training program would have greater cognitive benefit than ordinary computer games in cognitively-impaired adults with MS. This was a double-blind, randomized, active-placebo-controlled trial. Participants with MS were recruited through Stony Brook Medicine and randomly assigned to either the adaptive cognitive remediation (ACR program or active control of ordinary computer games for 60 hours over 12 weeks. Training was remotely-supervised and delivered through a study-provided laptop computer. A computer generated, blocked stratification table prepared by statistician provided the randomization schedule and condition was assigned by a study technician. The primary outcome, administered by study psychometrician, was measured by change in a neuropsychological composite measure from baseline to study end. An intent-to-treat analysis was employed and missing primary outcome values were imputed via Markov Chain Monte Carlo method. Participants in the ACR (n = 74 vs. active control (n = 61 training program had significantly greater improvement in the primary outcome of cognitive functioning (mean change in composite z score±SD: 0·25±0·45 vs. 0·09±0·37, p = 0·03, estimated difference = 0·16 with 95% CI: 0·02-0·30, despite greater training time in the active control condition (mean±SD:56·9 ± 34·6 vs. 37·7 ±23 ·8 hours played, p = 0·006. This study provides Class I evidence that adaptive, computer-based cognitive remediation accessed from home can improve cognitive functioning in MS. This telerehabilitation approach allowed for rapid recruitment and high compliance, and can be readily applied to other neurological conditions associated with cognitive dysfunction.Clinicaltrials.gov NCT02141386.

  2. Empowering primary care workers to improve health services: results from Mozambique's leadership and management development program.

    Science.gov (United States)

    Perry, Cary

    2008-07-23

    This article is the third article in the Human Resources for Health journal's feature on the theme of leadership and management in public health. The series of six articles has been contributed by Management Sciences for Health (MSH) and will be published article-by-article over the next few weeks. The third article presents a successful application in Mozambique of a leadership development program created by Management Sciences for Health (MSH). Through this program, managers from 40 countries have learned to work in teams to identify their priority challenges and act to implement effective responses. From 2003 to 2004, 11 health units in Nampula Province, participated in a leadership and management development program called the Challenges Program. This was following an assessment which found that the quality of health services was poor, and senior officials determined that the underlying cause was the lack of human resource capacity in leadership and management in a rapidly decentralizing health care system. The program was funded by the US Agency for International Development (USAID) and implemented in partnership between the Mozambican Ministry of Health (MOH) Provincial Directorate in Nampula and Management Sciences for Health (MSH). The Challenges Program used simple management and leadership tools to assist the health units and their communities to address health service challenges. An evaluation of the program in 2005 showed that 10 of 11 health centers improved health services over the year of the program. The Challenges Program used several strategies that contributed to successful outcomes. It integrated leadership strengthening into the day-to-day challenges that staff were facing in the health units. The second success factor in the Challenges Program was the creation of participatory teams. After the program, people no longer waited passively to be trained but instead proactively requested training in needed areas. MOH workers in Nampula reported

  3. 77 FR 36510 - Applications for New Awards: Personnel Development To Improve Services and Results for Children...

    Science.gov (United States)

    2012-06-19

    ...., academic, social, emotional, behavioral) for all children, including children with disabilities (birth...). By using existing and emerging technologies such as application software, social media, and mobile... Results for Children With Disabilities; National Center for Development of Coursework and Training Modules...

  4. An improved method for interpreting API filter press hydraulic conductivity test results

    International Nuclear Information System (INIS)

    Heslin, G.M.; Baxter, D.Y.; Filz, G.M.; Davidson, R.R.

    1997-01-01

    The American Petroleum Institute (API) filter press is frequently used to measure the hydraulic conductivity of soil-bentonite backfill during the mix design process and as part of construction quality controls. However, interpretation of the test results is complicated by the fact that the seepage-induced consolidation pressure varies from zero at the top of the specimen to a maximum value at the bottom of the specimen. An analytical solution is available which relates the stress, compressibility, and hydraulic conductivity in soil consolidated by seepage forces. This paper presents the results of a laboratory investigation undertaken to support application of this theory to API hydraulic conductivity tests. When the API test results are interpreted using seepage consolidation theory, they are in good agreement with the results of consolidometer permeameter tests. Limitations of the API test are also discussed

  5. Health and management improvements of family poultry production in Africa - Survey results from Kenya

    International Nuclear Information System (INIS)

    Njue, S.W.; Kasiiti, J.L.; Macharia, M.J.; Gacheru, S.G.; Mbugua, H.C.W.

    2002-01-01

    In Kenya the poultry population is about 25 million, 80% of which comprises local chicken and the rest, improved breeds. With the ever-increasing prices of red meat, local chicken has become the main source of animal protein in the form of meat and eggs for the rural population. Both egg production and egg size varies with season as the quantity and availability of feed varies. This paper describes work done during the wet season to identify constraints of family chicken production in the study area. The study was repeated on the same farms that were identified in work done earlier during the dry season. Data were gathered from 24 family poultry farms located in Kangundo and Kikuyu divisions. Through the Veterinary Officers and the Animal Health Assistants who assisted in the dry season fieldwork the farmers were contacted a week before the intended f m visits. Baseline and disease survey forms were administered again. The baseline survey achieved 100% response rate. During the farm visits, serum samples, blood and faecal samples were collected. Post mortem examination was also done on sick birds. The flock size in the two ecological zones decreased during the wet season, most probably due to the Christmas festivities. The percentage deaths in Ecological Zone III (ECZIII) were high because most farmers in this zone set their chicken free thus predisposing them to predators, disease and harsh weather conditions. Disease control information was scanty as most farmers were not keen about it. Worm infestation was not as prevalent in the wet season as compared to the dry season. Except for three farms, all the other twenty-one farms had been exposed to Salmonellosis at one time or another. Women were involved in aspects of poultry management, while the men were significantly involved in shelter construction. The local birds were free-range feeding on green grass, leafy vegetables and insects. Occasionally, the birds were supplemented with crushed maize grains or

  6. Results of a Medicare Bundled Payments for Care Improvement Initiative for Chronic Obstructive Pulmonary Disease Readmissions.

    Science.gov (United States)

    Bhatt, Surya P; Wells, J Michael; Iyer, Anand S; Kirkpatrick, deNay P; Parekh, Trisha M; Leach, Lauren T; Anderson, Erica M; Sanders, J Greg; Nichols, Jessica K; Blackburn, Cindy C; Dransfield, Mark T

    2017-05-01

    Approximately 20% of Medicare beneficiaries hospitalized for acute exacerbations of chronic obstructive pulmonary disease (COPD) are readmitted within 30 days of discharge. In addition to implementing penalties for excess readmissions, the U.S. Centers for Medicare and Medicaid Services has developed Bundled Payments for Care Improvement (BPCI) initiatives to improve outcomes and control costs. To evaluate whether a comprehensive COPD multidisciplinary intervention focusing on inpatient, transitional, and outpatient care as part of our institution's BPCI participation would reduce 30-day all-cause readmission rates for COPD exacerbations and reduce overall costs. We performed a pre-postintervention study comparing all-cause readmissions and costs after index hospitalization for Medicare-only patients with acute exacerbation of COPD. The primary outcome was the difference in 30-day all-cause readmission rate compared with historical control subjects; secondary outcomes included the 90-day all-cause readmission rate and also health care costs compared with BPCI target prices. Seventy-eight consecutive Medicare patients were prospectively enrolled in the BPCI intervention in 2014 and compared with 109 patients in the historical group from 2012. Patients in BPCI were more likely to receive regular follow-up phone calls, pneumococcal and influenza vaccines, home health care, durable medical equipment, and pulmonary rehabilitation, and to attend pulmonary clinic. There was no difference in all-cause readmission rates at 30 days (BPCI, 12 events [15.4%] vs. non-BPCI, 19 events [17.4%]; P = 0.711), and 90 days (21 [26.9%] vs. 37 [33.9%]; P = 0.306). Compared with BPCI target prices, we incurred 4.3% lower 90-day costs before accounting for significant investment from the health system. A Medicare BPCI intervention did not reduce 30-day all-cause readmission rates or overall costs after hospitalization for acute exacerbation of COPD. Although additional studies

  7. Vaginal Repair of Cesarean Section Scar Diverticula that Resulted in Improved Postoperative Menstruation.

    Science.gov (United States)

    Zhou, Jieru; Yao, Min; Wang, Husheng; Tan, Weilin; Chen, Pin; Wang, Xipeng

    2016-01-01

    Owing to the increase in cesarean sections (C-sections) worldwide, long-term complications such as postmenstrual spotting, chronic pelvic pain, and C-section scar ectopic pregnancies have created a new medical era of gynecologic disease. A new type of vaginal repair is evaluated to repair C-section diverticulum (CSD) and rebuild the muscular layer to improve symptoms of abnormal uterine bleeding and decrease the risk of uterine rupture. Retrospective cohort study (Canadian Task Force classification II-2). University hospital. A total of 121 patients with CSD diagnoses by transvaginal ultrasound (TVU) presented with postmenstrual spotting between June 2012 and March 2015. All patients had undergone at least 1 C-section delivery and had no history of postmenstrual spotting before undergoing C-section. Vaginal excision and suture of CSD. The mean duration of menstruation was 14.87 ± 3.46 days preoperatively and decreased to 8.22 ± 2.73 days at 1 month after surgery, 8.89 ± 2.67 days at 3 months after surgery, and 9.02 ± 2.47 days at 6 months after surgery (p menstruation and imaging data did not differ markedly between 3 months and 6 months, suggesting that follow-up at 3 months represents an adequate endpoint for evaluating the effectiveness of surgery. At 6 months, 80.3% of patients (94 of 117) reached ≤10 days of menstruation. Further study revealed that a TRM at 6 months of ≥8.5 mm measured by TVU (relative risk [RR], 6.418; 95% confidence interval [CI], 1.478-28.443) and an interval between CS and vaginal repair of ≤2.5 years (RR, 12.0; 95% CI, 1.541- 93.454) were good prognostic factors associated with surgery. Vaginal repair of CSD improved the symptoms of postmenstrual spotting and anatomically corrected the scars. An interval between C-section and a surgery of ≤2.5 years was optimal for vaginal repair, and a TRM at 6 months of ≥8.5 mm represented the standard healing of CSD. Copyright © 2016 AAGL. Published by

  8. Empowering primary care workers to improve health services: results from Mozambique's leadership and management development program

    Directory of Open Access Journals (Sweden)

    Perry Cary

    2008-07-01

    Full Text Available Abstract This article is the third article in the Human Resources for Health journal's feature on the theme of leadership and management in public health. The series of six articles has been contributed by Management Sciences for Health (MSH and will be published article-by-article over the next few weeks. The third article presents a successful application in Mozambique of a leadership development program created by Management Sciences for Health (MSH. Through this program, managers from 40 countries have learned to work in teams to identify their priority challenges and act to implement effective responses. From 2003 to 2004, 11 health units in Nampula Province, participated in a leadership and management development program called the Challenges Program. This was following an assessment which found that the quality of health services was poor, and senior officials determined that the underlying cause was the lack of human resource capacity in leadership and management in a rapidly decentralizing health care system. The program was funded by the US Agency for International Development (USAID and implemented in partnership between the Mozambican Ministry of Health (MOH Provincial Directorate in Nampula and Management Sciences for Health (MSH. The Challenges Program used simple management and leadership tools to assist the health units and their communities to address health service challenges. An evaluation of the program in 2005 showed that 10 of 11 health centers improved health services over the year of the program. The Challenges Program used several strategies that contributed to successful outcomes. It integrated leadership strengthening into the day-to-day challenges that staff were facing in the health units. The second success factor in the Challenges Program was the creation of participatory teams. After the program, people no longer waited passively to be trained but instead proactively requested training in needed areas. MOH workers

  9. Improvement in operating characteristics resulting from the addition of FLIP fuel to a standard TRIGA core

    International Nuclear Information System (INIS)

    Randall, J.D.; Feltz, D.E.; Godsey, T.A.; Schumacher, R.F.

    1974-01-01

    To overcome problems associated with fuel burnup the Nuclear Science Center of Texas A and M University decided to convert from standard TRIGA fuel to FLIP-TRIGA fuel. FLIP fuel, which incorporates erbium as a burnable poison and is enriched to 70 percent in U-235, has a calculated lifetime of 9/MW-years. Due to limited funds a core was designed with a central region of 35 FLIP elements surrounded by 63 standard elements. Calculations indicated that the core excess and neutron fluxes were satisfactory, but no prediction was made of the improvements in core lifetime. The reactivity loss due to burnup for a standard core was measured to be 1.54 cents/MW-day. The addition of 35 FLIP fuel elements has reduced this value to approximately 0.5 cents/MW-day. The incorporation of FLIP fuel has, therefore, increased the lifetime of the core by a factor of three using fuel that is only 20 percent more expensive. The mixed core has other advantages as well. The power coefficient is less, the effect of xenon is less, and the fluxes in experimental facilities are higher. Thus, the mixed core has significant advantages over standard TRIGA fuel. (U.S.)

  10. Improving BPH symptoms and sexual dysfunctions with a saw palmetto preparation? Results from a pilot trial.

    Science.gov (United States)

    Suter, Andreas; Saller, Reinhard; Riedi, Eugen; Heinrich, Michael

    2013-02-01

    In elderly men, benign prostatic hyperplasia (BPH) is a major risk factor for sexual dysfunctions (SDys). Additionally, the standard treatments for BPH symptoms, alpha blockers and 5-alpha-reductase inhibitors, cause SDys themselves. Preparations from saw palmetto berries are an efficacious and well-tolerated symptomatic treatment for mild to moderate BPH and have traditionally been used to treat SDys. We conducted an open multicentric clinical pilot trial to investigate whether the saw palmetto berry preparation Prostasan® influenced BPH symptoms and SDys. Eighty-two patients participated in the 8-week trial, taking one capsule of 320 mg saw palmetto extract daily. At the end of the treatment, the International Prostate Symptom Score was reduced from 14.4 ± 4.7 to 6.9 ± 5.2 (p saw palmetto to show improvement in BPH symptoms and SDys as well. [Corrections made here after initial online publication.] Copyright © 2012 John Wiley & Sons, Ltd.

  11. Flux Gain for Next-Generation Neutron-Scattering Instruments Resulting From Improved Supermirror Performance

    International Nuclear Information System (INIS)

    Rehm, C.

    2001-01-01

    Next-generation spallation neutron source facilities will offer instruments with unprecedented capabilities through simultaneous enhancement of source power and usage of advanced optical components. The Spallation Neutron Source (SNS), already under construction at Oak Ridge National Laboratory and scheduled to be completed by 2006, will provide greater than an order of magnitude more effective source flux than current state-of-the-art facilities, including the most advanced research reactors. An additional order of magnitude gain is expected through the use of new optical devices and instrumentation concepts. Many instrument designs require supermirror (SM) neutron guides with very high critical angles for total reflection. In this contribution, they discuss how the performance of modern neutron scattering instruments depends on the efficiency of these supermirrors. They outline ideas for enhancing the performance of the SM coatings, particularly for improving the reflectivity at the position of the critical wave vector transfer. A simulation program has been developed which allows different approaches for SM designs to be studied. Possible instrument performance gains are calculated for the example of the SNS reflectometer

  12. Multiple Behavior Change Intervention to Improve Detection of Unmet Social Needs and Resulting Resource Referrals.

    Science.gov (United States)

    Colvin, Jeffrey D; Bettenhausen, Jessica L; Anderson-Carpenter, Kaston D; Collie-Akers, Vicki; Plencner, Laura; Krager, Molly; Nelson, Brooke; Donnelly, Sara; Simmons, Julia; Higinio, Valeria; Chung, Paul J

    2016-03-01

    It is critical that pediatric residents learn to effectively screen families for active and addressable social needs (ie, negative social determinants of health). We sought to determine 1) whether a brief intervention teaching residents about IHELP, a social needs screening tool, could improve resident screening, and 2) how accurately IHELP could detect needs in the inpatient setting. During an 18-month period, interns rotating on 1 of 2 otherwise identical inpatient general pediatrics teams were trained in IHELP. Interns on the other team served as the comparison group. Every admission history and physical examination (H&P) was reviewed for IHELP screening. Social work evaluations were used to establish the sensitivity and specificity of IHELP and document resources provided to families with active needs. During a 21-month postintervention period, every third H&P was reviewed to determine median duration of continued IHELP use. A total of 619 admissions met inclusion criteria. Over 80% of intervention team H&Ps documented use of IHELP. The percentage of social work consults was nearly 3 times greater on the intervention team than on the comparison team (P Social work provided resources for 78% of positively screened families. The median duration of screening use by residents after the intervention was 8.1 months (interquartile range 1-10 months). A brief intervention increased resident screening and detection of social needs, leading to important referrals to address those needs. Copyright © 2016 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

  13. Relative efficiency within a tax administration: The effects of result improvement

    Directory of Open Access Journals (Sweden)

    Elena Villar Rubio

    2017-03-01

    Full Text Available This paper analyses the Spanish tax administration, evaluating the relative efficiency of each of the regional offices that are its constituent parts via output-oriented two-stage data envelopment analysis. In the study, a total of 47 regional offices were analysed, considering three inputs: 1 current expenditure in goods and services; 2 number of tax returns processed in terms of the two main direct taxes; and, 3 personnel numbers. Revenue resulting from tax assessments was considered as output. The analysis shows that the efficient action of regional offices might have increased by 21.6% the results of the management of this administration.

  14. Great Britain at CERN

    CERN Multimedia

    2006-01-01

    From 14 to 16 November 2006 Administration Building, Bldg. 60/61 - ground and 1st floor 09.30 - 17.30 Fifteen companies will present their latest technologies at the 'Great Britain at CERN' exhibition. British industry will exhibit products and technologies related to the field of particle physics. The main fields represented will be computing technologies, electrical engineering, electronics, mechanical engineering, vacuum & low temperature technologies and particle detectors. The exhibition is organised by BEAMA Exhibitions (the British Electrotechnical and Allied Manufacturers Association). Below you will find: a list of the exhibitors. A detailed programme will be available in due course: from your Departmental secretariat, from the Reception information desk, Building 33, at the exhibition itself. A detailed list of the companies is available at the following FI link: http://fi-dep.web.cern.ch/fi-dep/structure/memberstates/exhibitions_visits.htm LIST OF EXHIBITORS 3D Metrics Almat...

  15. Great Britain at CERN

    CERN Multimedia

    2006-01-01

    From 14 to 16 November 2006 Administration Building, Bldg. 60/61 - ground and 1st floor 09.30 - 17.30 Fifteen companies will present their latest technologies at the 'Great Britain at CERN' exhibition. British industry will exhibit products and technologies related to the field of particle physics. The main fields represented will be computing technologies, electrical engineering, electronics, mechanical engineering, vacuum & low temperature technologies and particle detectors. The exhibition is organised by BEAMA Exhibitions (the British Electrotechnical and Allied Manufacturers Association). Below you will find: a list of the exhibitors. A detailed programme will be available in due course: from your Departmental secretariat, from the Reception information desk, Building 33, at the exhibition itself. A detailed list of the companies is available at the following FI link: http://fi-dep.web.cern.ch/fi-dep/structure/memberstates/exhibitions_visits.htm LIST OF EXHIBITORS 3D Metrics Alma...

  16. Improving the Management Style of School Principals: Results from a Randomized Trial

    Science.gov (United States)

    Lassibille, Gérard

    2016-01-01

    Using information from a randomized experiment carried out over the course of two school years in Madagascar, this paper evaluates the impact of specific actions designed to streamline and tighten the work processes of public primary school directors. The results show that interventions at the school level, reinforced by interventions at the…

  17. Improving the accuracy of myocardial perfusion scintigraphy results by machine learning method

    International Nuclear Information System (INIS)

    Groselj, C.; Kukar, M.

    2002-01-01

    Full text: Machine learning (ML) as rapidly growing artificial intelligence subfield has already proven in last decade to be a useful tool in many fields of decision making, also in some fields of medicine. Its decision accuracy usually exceeds the human one. To assess applicability of ML in interpretation the results of stress myocardial perfusion scintigraphy for CAD diagnosis. The 327 patient's data of planar stress myocardial perfusion scintigraphy were reevaluated in usual way. Comparing them with the results of coronary angiography the sensitivity, specificity and accuracy for the investigation was computed. The data were digitized and the decision procedure repeated by ML program 'Naive Bayesian classifier'. As the ML is able to simultaneously manipulate of whatever number of data, all reachable disease connected data (regarding history, habitus, risk factors, stress results) were added. The sensitivity, specificity and accuracy for scintigraphy were expressed in this way. The results of both decision procedures were compared. With ML method 19 patients more out of 327 (5.8 %) were correctly diagnosed by stress myocardial perfusion scintigraphy. ML could be an important tool for decision making in myocardial perfusion scintigraphy. (author)

  18. 77 FR 46077 - Applications for New Awards: Personnel Development To Improve Services and Results for Children...

    Science.gov (United States)

    2012-08-02

    ... Results for Children With Disabilities; Center To Support the Development of Effective Educators To Serve... Children With Disabilities--Center To Support the Development of Effective Educators To Serve Students With... prepare, license, support, and evaluate today's teachers. Traditionally, SEAs have exerted influence over...

  19. Results of improvement of simultaneous and sequential x-ray fluorescence equipment for quantitative routine analysis

    International Nuclear Information System (INIS)

    Zsamboky, Jozsef

    1985-01-01

    Two main types of x-ray fluorescence analyzers measuring sequentially and simultaneously, respectively, the intensities at given wave lengths are described. The main parts of an up to date x-ray fluorescence analyzer are surveyed in detail. The advantages and disadvantages of both methods are discussed. Some results on calibration and optimization are given. (D.Gy.)

  20. A blood-result turn-around time survey to improve congenital ...

    African Journals Online (AJOL)

    The results of a turn-around time study of blood specimens for syphilis serology in antenatal clinic attenders between 19 rural clinics and their base hospital, including a follow-up survey to assess the impact of interventions, are described. The objective of the study was to detennine how long blood samples took to get.

  1. Interuniversity Telecollaboration to Improve Academic Results and Identify Preferred Communication Tools

    Science.gov (United States)

    Jaime, Arturo; Dominguez, Cesar; Sanchez, Ana; Blanco, Jose Miguel

    2013-01-01

    Telecollaboration is defined as a collaborative activity that involves people from distant geographic locations working together through Internet tools and other resources. This technique has not been frequently used in learning experiences and has produced diverse academic results, as well as degrees of satisfaction. This paper describes a…

  2. Improving the trust in results of numerical simulations and scientific data analytics

    Energy Technology Data Exchange (ETDEWEB)

    Cappello, Franck [Argonne National Lab. (ANL), Argonne, IL (United States); Constantinescu, Emil [Argonne National Lab. (ANL), Argonne, IL (United States); Hovland, Paul [Argonne National Lab. (ANL), Argonne, IL (United States); Peterka, Tom [Argonne National Lab. (ANL), Argonne, IL (United States); Phillips, Carolyn [Argonne National Lab. (ANL), Argonne, IL (United States); Snir, Marc [Argonne National Lab. (ANL), Argonne, IL (United States); Wild, Stefan [Argonne National Lab. (ANL), Argonne, IL (United States)

    2015-04-30

    This white paper investigates several key aspects of the trust that a user can give to the results of numerical simulations and scientific data analytics. In this document, the notion of trust is related to the integrity of numerical simulations and data analytics applications. This white paper complements the DOE ASCR report on Cybersecurity for Scientific Computing Integrity by (1) exploring the sources of trust loss; (2) reviewing the definitions of trust in several areas; (3) providing numerous cases of result alteration, some of them leading to catastrophic failures; (4) examining the current notion of trust in numerical simulation and scientific data analytics; (5) providing a gap analysis; and (6) suggesting two important research directions and their respective research topics. To simplify the presentation without loss of generality, we consider that trust in results can be lost (or the results’ integrity impaired) because of any form of corruption happening during the execution of the numerical simulation or the data analytics application. In general, the sources of such corruption are threefold: errors, bugs, and attacks. Current applications are already using techniques to deal with different types of corruption. However, not all potential corruptions are covered by these techniques. We firmly believe that the current level of trust that a user has in the results is at least partially founded on ignorance of this issue or the hope that no undetected corruptions will occur during the execution. This white paper explores the notion of trust and suggests recommendations for developing a more scientifically grounded notion of trust in numerical simulation and scientific data analytics. We first formulate the problem and show that it goes beyond previous questions regarding the quality of results such as V&V, uncertainly quantification, and data assimilation. We then explore the complexity of this difficult problem, and we sketch complementary general

  3. Effects of Secondary Hyperparathyroidism Treatment on Improvement in Anemia: Results from the MBD-5D Study.

    Directory of Open Access Journals (Sweden)

    Motoko Tanaka

    Full Text Available Anemia is an important prognostic factor in hemodialysis patients. It has been reported that parathyroidectomy ameliorates anemia and reduces the requirement of postoperative erythropoiesis-stimulating agents. The objective of this study was to assess the effect of cinacalcet, which is considered as a pharmacological parathyroidectomy, on anemia in hemodialysis patients.We used data from a prospective cohort of Japanese hemodialysis patients with secondary hyperparathyroidism; the criteria were: intact parathyroid hormone concentrations ≥ 180 pg/mL or use of an intravenous or oral vitamin D receptor activator. All patients were cinacalcet-naïve at study enrollment. The main outcome measure was achievement of the target hemoglobin level (≥10.0 g/dL, which was measured repeatedly every 6 months. Cinacalcet exposure was defined as cumulative time since initiation. Both conventional longitudinal models and marginal structural models were adjusted for confounding factors.Among 3,201 cinacalcet-naïve individuals at baseline, cinacalcet was initiated in 1,337 individuals during the follow up. Cinacalcet users were slightly younger; included more patients with chronic glomerulonephritis and fewer with diabetes; were more likely to have a history of parathyroidectomy; and were more often on activated vitamin D agents, phosphate binders, and iron supplements. After adjusting for both time-invariant and time-varying potential confounders, including demographics, comorbidities, comedications, and laboratory values, each additional 6-month duration on cinacalcet was associated with a 1.1-fold increase in the odds of achieving the target hemoglobin level.Cinacalcet may improve anemia in chronic hemodialysis patients with secondary hyperparathyroidism, possibly through pathways both within and outside the parathyroid hormone pathways. Further investigations are warranted to delineate the roles of cinacalcet not only in the management of chronic kidney

  4. Diabetic retinopathy screening in New Zealand requires improvement: results from a multi-centre audit.

    Science.gov (United States)

    Hutchins, Edward; Coppell, Kirsten J; Morris, Ainsley; Sanderson, Gordon

    2012-06-01

    To determine whether diabetic retinal screening services and retinopathy referral centres in New Zealand meet the national guidelines for referral and assessment of screen detected moderate retinal and mild macular diabetic eye disease. Diabetic retinal screening pathways and the data collected at four main centre retinal screening services were described and compared with recommendations in the national diabetes retinal screening guidelines. A retrospective audit of photoscreen detected moderate retinopathy (grade R3), and mild maculopathy (grades M2B and M3) during May to August 2008 was undertaken. Data collected by retinopathy referral centres were used to examine the follow-up of screen detected cases and to make comparisons with the national recommendations. All four screening services used the guidelines for grading, but the recommended dataset was incomplete. Not all recorded data were readily accessible. The retinal photos of 157 (2.4%) patients were graded as R3, M2B, M3 or a combination. The proportion of those screened with these grades varied across the four centres from 1.2% to 3.4%. Follow-up of the 157 screen positive patients did not always comply with guideline recommendations. Seventy five (48%) were referred for review by an ophthalmologist as recommended, 45 (60% of referred) were seen within the recommended six months. Nine patients (15% of the 60 with a documented assessment) were referred for or received laser treatment at 12-months follow-up. Quality diabetic retinal screening data systems and quality assurance programs are required to improve the monitoring and quality of retinal screening in New Zealand. © 2012 The Authors. ANZJPH © 2012 Public Health Association of Australia.

  5. High-dose estradiol improves cognition for women with AD: results of a randomized study.

    Science.gov (United States)

    Asthana, S; Baker, L D; Craft, S; Stanczyk, F Z; Veith, R C; Raskind, M A; Plymate, S R

    2001-08-28

    To characterize the cognitive and neuroendocrine response to treatment with a high dose of estrogen for postmenopausal women with AD. Twenty postmenopausal women with AD were randomized to receive either 0.10 mg/day of 17 beta-estradiol by skin patch or a placebo patch for 8 weeks. Subjects were evaluated at baseline, at weeks 3, 5, and 8 during treatment, and again 8 weeks after treatment termination. During each visit, cognition was assessed with a battery of neuropsychological tests, and blood samples were collected to measure plasma estradiol as well as several other neuroendocrine markers of interest. Significant effects of estrogen treatment were observed on attention (Stroop Color Word Interference Test), verbal memory (Buschke Selective Reminding Test), and visual memory (Figure Copy/Memory). In addition, women treated with estrogen demonstrated improved performance on a test of semantic memory (Boston Naming Test) compared with subjects who received a placebo. Estrogen appeared to have a suppressive effect on the insulin-like growth factor (IGF) system such that plasma concentration of IGF binding protein-3 was significantly reduced and plasma levels of estradiol and IGF-I were negatively correlated during estrogen treatment. Administration of a higher dose of estrogen may enhance attention and memory for postmenopausal women with AD. Although these findings provide further clinical evidence to support a cognitive benefit of estrogen for women with AD, studies evaluating the effect of estradiol administration, in particular, using larger sample sizes and for longer treatment durations are warranted before the therapeutic potential of estrogen replacement for women with AD can be firmly established.

  6. Dissection of malonyl-coenzyme A reductase of Chloroflexus aurantiacus results in enzyme activity improvement.

    Directory of Open Access Journals (Sweden)

    Changshui Liu

    Full Text Available The formation of fusion protein in biosynthetic pathways usually improves metabolic efficiency either channeling intermediates and/or colocalizing enzymes. In the metabolic engineering of biochemical pathways, generating unnatural protein fusions between sequential biosynthetic enzymes is a useful method to increase system efficiency and product yield. Here, we reported a special case. The malonyl-CoA reductase (MCR of Chloroflexus aurantiacus catalyzes the conversion of malonyl-CoA to 3-hydroxypropionate (3HP, and is a key enzyme in microbial production of 3HP, an important platform chemical. Functional domain analysis revealed that the N-terminal region of MCR (MCR-N; amino acids 1-549 and the C-terminal region of MCR (MCR-C; amino acids 550-1219 were functionally distinct. The malonyl-CoA was reduced into free intermediate malonate semialdehyde with NADPH by MCR-C fragment, and further reduced to 3HP by MCR-N fragment. In this process, the initial reduction of malonyl-CoA was rate limiting. Site-directed mutagenesis demonstrated that the TGXXXG(AX(1-2G and YXXXK motifs were important for enzyme activities of both MCR-N and MCR-C fragments. Moreover, the enzyme activity increased when MCR was separated into two individual fragments. Kinetic analysis showed that MCR-C fragment had higher affinity for malonyl-CoA and 4-time higher K cat/K m value than MCR. Dissecting MCR into MCR-N and MCR-C fragments also had a positive effect on the 3HP production in a recombinant Escherichia coli strain. Our study showed the feasibility of protein dissection as a new strategy in biosynthetic systems.

  7. Improved PFB operations - 400-hour turbine test results. [Pressurized Fluidized Bed

    Science.gov (United States)

    Rollbuhler, R. J.; Benford, S. M.; Zellars, G. R.

    1980-01-01

    The paper deals with a 400-hr small turbine test in the effluent of a pressurized fluidized bed (PFB) at an average temperature of 770 C, an average relative gas velocity of 300 m/sec, and average solid loadings of 200 ppm. Consideration is given to combustion parameters and operating procedure as well as to the turbine system and turbine test operating procedures. Emphasis is placed on erosion/corrosion results.

  8. Improving the natural gas transporting based on the steady state simulation results

    International Nuclear Information System (INIS)

    Szoplik, Jolanta

    2016-01-01

    The work presents an example of practical application of gas flow modeling results in the network, that was obtained for the existing gas network and for real data about network load depending on the time of day and air temperature. The gas network load in network connections was estimated based on real data concerning gas consumption by customers and weather data in 2010, based on two-parametric model based on the number of degree-days of heating. The aim of this study was to elaborate a relationship between pressure and gas stream introduced into the gas network. It was demonstrated that practical application of elaborated relationship in gas reduction station allows for the automatic adjustment of gas pressure in the network to the volume of network load and maintenance of gas pressure in the whole network at possibly the lowest level. It was concluded based on the results obtained that such an approach allows to reduce the amount of gas supplied to the network by 0.4% of the annual network load. - Highlights: • Determination of the hourly nodal demand for gas by the consumers. • Analysis of the results of gas flow simulation in pipeline network. • Elaboration of the relationship between gas pressure and gas stream feeding the network. • Automatic gas pressure steering in the network depending on the network load. • Comparison of input gas pressure in the system without and with pressure steering.

  9. Flue gas conditioning for improved particle collection in electrostatic precipitators. First topical report, Results of laboratory screening of additives

    Energy Technology Data Exchange (ETDEWEB)

    Durham, M.D.

    1993-04-16

    Several tasks have been completed in a program to evaluate additives to improve fine particle collection in electrostatic precipitators. Screening tests and laboratory evaluations of additives are summarized in this report. Over 20 additives were evaluated; four were found to improve flyash precipitation rates. The Insitec particle analyzer was also evaluated; test results show that the analyzer will provide accurate sizing and counting information for particles in the size range of {le} 10 {mu}m dia.

  10. Water balance and fertigation for crop improvement in West Asia. Results of a technical co-operation project

    International Nuclear Information System (INIS)

    2002-01-01

    Mediterranean countries have a severe shortage of water resources for agricultural, municipal and industrial purposes. This situation is aggravated daily due to the rapidly increasing population in the area. Agriculture is the biggest consumer of water with about 80% of the renewable resource used for irrigation. Traditional irrigation methods are highly inefficient: only about one-third of the applied water is actually transpired by the crops. Clearly, there is great scope for improved irrigation management. Intensification of agricultural production to meet growing market demand requires the simultaneous application of irrigation water and fertilizers. Application of fertilizer in drip irrigation (fertigation) is an effective way to promote efficient use of these scarce and expensive resources. There is widespread interest in Mediterranean countries in fertigation. Nevertheless, information on the form and concentration of the nutrients required for different crops is presently inadequate. Moreover, the low fertilizer recoveries due to extensive fertilization practiced during the last few decades have created serious agricultural and environmental problems. High nitrate concentrations in groundwater and deterioration of some important quality parameters of agricultural products are the main concerns. Recognizing the potential role of nuclear techniques in identifying improved water and fertilizer management practices, the IAEA implemented two regional technical co-operation projects during the period 1995-2000 with eight participating countries from the West Asia region: The Islamic Republic of Iran, Jordan, Lebanon, Saudi Arabia, the Syria Arab Republic, Turkey, United Arab Emirates and Yemen. The main objective was to establish water balance and fertigation practices using nuclear techniques, with a view to improving crop production in arid and semi-arid zones. The projects aimed to compare the following parameters under conventional fertilizer and water

  11. Results of the use and ways to improve transcolumn packers at fields of the Tatar ASSR

    Energy Technology Data Exchange (ETDEWEB)

    Golyshkina, L A; Kateyev, I S; Pleshko, O F

    1979-01-01

    A classification is made of wells according to the complexity of separation of the beds. Five categories are isolated. The criterion for comparing the categories was the presence or absence in the productive part of the section of water-bearing levels and screening beds. In a number of cases, as a result of unsatisfactory sedimentation stability of the cementing fluid, channels can be formed in it which may be the reason for transcolumn overflows and interruption in the removal of pure (not containing water) oil. In order to control transcolumn overflows in wells of the II-III-IV category, packer-filters (PFM) are used whose action is based on the forced recovery from the cement fluid of part of the liquid phase. The use of PFM is recommended only after conducting of a set of special (laboratory, geophysical, geological-technical, ect.) studies. The possibility is shown of positive use of PFM not only in the well shafts of nominal diameter, but also in wells prone to cavern formation. In the example of well No 13993 of the Abdrakhmanovskiy field, the possibility is shown of sectioning the PFM. Based on the PFM, and PFU was created with elongated filtering part. The results of introducing the PFU and the PFM are positive, and the economic effect from using the PFU is 1.5-fold greater than from PFM. In addition to PFU and PFM, the wells of the association ''Tatneft''' have used packers of the type PPG designed by the All-Union Scientific Research of Drilling Equipment. The results of introducing the packers PPG are positive.

  12. Bioprosthetic Valve Fracture Improves the Hemodynamic Results of Valve-in-Valve Transcatheter Aortic Valve Replacement.

    Science.gov (United States)

    Chhatriwalla, Adnan K; Allen, Keith B; Saxon, John T; Cohen, David J; Aggarwal, Sanjeev; Hart, Anthony J; Baron, Suzanne J; Dvir, Danny; Borkon, A Michael

    2017-07-01

    Valve-in-valve (VIV) transcatheter aortic valve replacement (TAVR) may be less effective in small surgical valves because of patient/prosthesis mismatch. Bioprosthetic valve fracture (BVF) using a high-pressure balloon can be performed to facilitate VIV TAVR. We report data from 20 consecutive clinical cases in which BVF was successfully performed before or after VIV TAVR by inflation of a high-pressure balloon positioned across the valve ring during rapid ventricular pacing. Hemodynamic measurements and calculation of the valve effective orifice area were performed at baseline, immediately after VIV TAVR, and after BVF. BVF was successfully performed in 20 patients undergoing VIV TAVR with balloon-expandable (n=8) or self-expanding (n=12) transcatheter valves in Mitroflow, Carpentier-Edwards Perimount, Magna and Magna Ease, Biocor Epic and Biocor Epic Supra, and Mosaic surgical valves. Successful fracture was noted fluoroscopically when the waist of the balloon released and by a sudden drop in inflation pressure, often accompanied by an audible snap. BVF resulted in a reduction in the mean transvalvular gradient (from 20.5±7.4 to 6.7±3.7 mm Hg, P valve effective orifice area (from 1.0±0.4 to 1.8±0.6 cm 2 , P valves to facilitate VIV TAVR with either balloon-expandable or self-expanding transcatheter valves and results in reduced residual transvalvular gradients and increased valve effective orifice area. © 2017 American Heart Association, Inc.

  13. Improving Spectral Results Using Row-by-Row Fourier Transform of Spatial Heterodyne Raman Spectrometer Interferogram.

    Science.gov (United States)

    Barnett, Patrick D; Strange, K Alicia; Angel, S Michael

    2017-06-01

    This work describes a method of applying the Fourier transform to the two-dimensional Fizeau fringe patterns generated by the spatial heterodyne Raman spectrometer (SHRS), a dispersive interferometer, to correct the effects of certain types of optical alignment errors. In the SHRS, certain types of optical misalignments result in wavelength-dependent and wavelength-independent rotations of the fringe pattern on the detector. We describe here a simple correction technique that can be used in post-processing, by applying the Fourier transform in a row-by-row manner. This allows the user to be more forgiving of fringe alignment and allows for a reduction in the mechanical complexity of the SHRS.

  14. Study on environmental results improvement plan through flexible industrial environmental regulation system

    Energy Technology Data Exchange (ETDEWEB)

    Moon, Hyun Joo; Chang, Kee Bok; Lee, Young Soon [Korea Environment Institute, Seoul (Korea)

    1999-12-01

    As the economic environment has been changed to the direction of decentralization and diversification, there shows various changes in the area and method of market intervention by the government. In the environmental sector, it has been discussed to extend its use of economic incentive coming out of an existing direct regulation policy. Recently the importance on the new forms of government role such as voluntary agreements and information opening have been emphasized. Although the existing direct regulation policy has an advantage of visible and direct effect, it blocked the chance to explore technological and economical alternatives toward environmental problems by business sector. Therefore it is recognized that there is a fundamental limit on inducing the efficient pollution resisting activities from the business sector. Therefore this study analyzed and recommended theoretical characteristics on mechanism that a voluntary approach can bring appropriate results on policy objectives. 98 refs. 7 figs., 47 tabs.

  15. AREVA: Operating performance shows distinct improvement; Results heavily impacted by the cost of remedial measures

    International Nuclear Information System (INIS)

    2016-01-01

    The 2015 results illustrate the progress AREVA made in 2015 and open up favorable prospects for 2016 and the following years in view of its fundamentals. The group's competitiveness plan had a very positive impact on its costs and cash, despite the heavy net loss situation which continues and in a market environment that remained difficult in 2015. Half of this loss of 2 billion Euro is due to additional provisions for OL3 and half to provisions for restructuring and impairment related to market conditions. Concerning the group's liquidity, 2016 is funded and the capital increase which will be launched in the coming months will enable AREVA to gradually regain the group's positive profile. A new phase awaits the Group in 2016 with clarity and confidence in the implementation of the restructuring announced in 2015 and in particular the autonomy of AREVA NP and the creation of New AREVA

  16. Desensitizing bioactive agents improves bond strength of indirect resin-cemented restorations: preliminary results

    Directory of Open Access Journals (Sweden)

    Fernanda de Carvalho Panzeri Pires-de-Souza

    2007-04-01

    Full Text Available OBJECTIVE: The aim of this study was to assess the bond strength of indirect composite restorations cemented with a resin-based cement associated with etch-and-rinse and self-etching primer adhesive systems to dentin treated or not with a bioactive material. MATERIALS AND METHOD: Twenty bovine incisor crowns had the buccal enamel removed and the dentin ground flat. The teeth were assigned to 4 groups (n=5: Group I: acid etching + Prime & Bond NT (Dentsply; Group II: application of a bioactive glass (Biosilicato®+ acid etching + Prime & Bond NT; Group III: One-up Bond F (J Morita; Group IV: Biosilicato® + One-up Bond F. Indirect composite resin (Artglass, Kulzer cylinders (6x10mm were fabricated and cemented to the teeth with a dual-cure resin-based cement (Enforce, Dentsply. After cementation, the specimens were stored in artificial saliva at 37ºC for 30 days and thereafter tested in tensile strength in a universal testing machine (EMIC with 50 kgf load cell at a crosshead speed of 1 mm/min. Failure modes were assessed under scanning electron microscopy. Data were analyzed statistically by ANOVA and Tukey's test (95% level of confidence. RESULTS: Groups I, II and III had statistically similar results (p>0.05. Group IV had statistically significant higher bond strength means (p<0.05 than the other groups. The analysis of the debonded surfaces showed a predominance of adhesive failure mode for Group III and mixed failure mode for the other groups. CONCLUSION: The use of desensitizing agent did not affect negatively the bonding of the indirect composite restorations to dentin, independently of the tested adhesive systems.

  17. Restrictive annuloplasty to treat functional mitral regurgitation: optimize the restriction to improve the results?

    Science.gov (United States)

    Totaro, Pasquale; Adragna, Nicola; Argano, Vincenzo

    2008-03-01

    Today, the 'gold standard' treatment of functional mitral regurgitation (MR) is the subject of much discussion. Although restrictive annuloplasty is currently considered the most reproducible technique, the means by which the degree of annular restriction is optimized remains problematic. The study was designed in order to identify whether the degree of restriction of the mitral annulus could influence early and midterm results following the treatment of functional MR using restrictive annuloplasty. A total of 32 consecutive patients with functional MR grade > or = 3+ was enrolled, among whom the mean anterior-posterior (AP) mitral annulus diameter was 39 +/- 3 mm. Restrictive mitral annuloplasty (combined with coronary artery bypass grafting) was performed in all patients using a Carpentier-Edwards Classic or Physio ring (size 26 or 28). The degree of AP annular restriction was calculated for each patient, and correlated with early and mid-term residual MR and left ventricular (LV) reverse remodeling (in terms of LV end-diastolic diameter (LVEDD) and LV end-diastolic volume (LVEDV) reduction). All surviving patients were examined at a one-year follow up. The mean AP mitral annulus restriction achieved was 48 +/- 4%. Intraoperatively, transesophageal echocardiography showed no residual MR in any patient. Before discharge from hospital, transthoracic echocardiography confirmed an absence of residual MR and showed significant LV reverse remodeling (LVEDV from 121 +/- 25 ml to 97 +/- 26 ml; LVEDD from 55 +/- 6 mm to 47 +/- 8 mm). A significant correlation (r = 0.57, p 40% of preoperative) appears to have a favorable influence on early postoperative LV reverse remodeling, and also allows for complete resolution of functional MR. In addition, 'no tolerance' of early residual MR seems to have a favorable influence on mid-term results, leading to a reduction in the one-year recurrence of significant MR.

  18. Prospective study of probiotic supplementation results in immune stimulation and improvement of upper respiratory infection rate

    Directory of Open Access Journals (Sweden)

    Hong Zhang

    2018-06-01

    Full Text Available The human gut microbiota is an important environmental factor for human health with evolutionarily conserved roles in immunity, metabolism, development, and behavior of the host. Probiotic organisms are claimed to offer several functional properties including stimulation of immune system. The purpose of this study is to investigate the effects of a probiotic supplementation on adult volunteers who have contracted the common cold four or more times in the past year. This study is a single center, double-blind, randomized, controlled, prospective trial. Subjects received a probiotic drink containing Lactobacillus paracasei (at least 3 × 107 colony forming units (CFU ml−1, Lactobacillus casei 431® (at least 3 × 107 CFU ml−1 and Lactobacillus fermentium PCC® (at least 3 × 106 CFU ml−1 or an identical placebo without probiotics for a 12-week study period. The consumption of probiotics significantly reduced the incidence of upper respiratory infection (p < 0.023 and flu-like symptoms with an oral temperature higher than 38 °C (p < 0.034 as compared to the placebo group. Subjects that consumed probiotics demonstrated a significantly higher level of IFN-γ in the serum (p < 0.001 and sIgA in the gut (p < 0.010 as compared to the placebo group and a significant higher level of serum IFN-γ (p < 0.001 and gut sIgA (p < 0.001 as compared to their baseline test results. In contrast, there were no significant differences in the serum IL-4, IL-10, IgA, IgG or IgM between the probiotics and the placebo groups. Results of this study demonstrated that probiotics were safe and effective for fighting the common cold and influenza-like respiratory infections by boosting the immune system. Keywords: Probiotics, Upper respiratory infections, Human microbiota, IFN-γ, sIgA

  19. IMPROVING THE RESULTS OF TREATMENT OF PATIENTS WITH URETERAL CONCREMENTS AFTER CONTACT URETEROLITHOTRIPSY

    Directory of Open Access Journals (Sweden)

    R. M. Solh

    2017-01-01

    Full Text Available Purpose. Im proving the results of treatment of patients with ureteral stones and reducing the dam aging effects of contact lithotripsy.Materials and methods. In this study, 48 patients were examined aged 20 to 63 years. All patients admitted to the urology department with diagnoses: urolithiasis, calculus of the ureter. In all cases contact ureterolithotripsy with stenting of the upper urinary tract were performed. The patients were divided into two groups: main and control. 25 patients (52 .1% were included into the main group, which in the postoperative period, we used low-level laser therapy (L-therapy. 23 patients were included in a control group (47.9% who did not receive low-laser therapy. Laboratory tests and ultrasound with Doppler renal blood vessels scan were performed on admission, on the first day after the operation and on the 5-th day of hospitalization. Low-intensity laser therapy was performed within 5 days after contact ureterolithotripsy on projection of placement of stone and kidney projection by series for 5 minutes.Results. All patients admitted to the hospital, were spared from ureteral stones. In the main group during the treatment with L-therapy a decrease in the level of beta-2 microglobulin to normal was observed. (4.8 ± 0.1 mg/l on the first day. On the 5th day 2 .3 + 0.1 mg/l. In the control group during the treatment without the use of L-therapy, the average level of beta-2 microglobulin decreased but did not reach normal levels. (5.5 ± 0.1 mg/l on the first day. On the 5th day 3,2 ±0, l mg/l.Resistance index in the study group decreased compared to the control. In the control group, cases of acute pyelonephritis were observed. The average hospital stay for patients of the main group (6 days was less than in the control group (6 .5 + days.Conclusion. The use of laser therapy in the treatment of patients who did undergo ureterolithotripsy can reduce the length of stay of the patient in the hospital and reduce the

  20. Finding electronic information for health policy advocacy: a guide to improving search results.

    Science.gov (United States)

    Olsan, Tobie H; Bianchi, Carolanne; White, Pamela; Glessner, Theresa; Mapstone, Pamela L

    2011-12-01

    The success of advanced practice registered nurses' (APRNs') health policy advocacy depends on staying well informed about key issues. Searching for high-quality health policy information, however, can be frustrating and time consuming. Busy clinicians need strategies and tips to reduce information overload and to access synthesized research for evidence-based health policy. This article therefore offers APRNs practical guidelines and resources for searching electronic health policy information. Scholarly databases and Internet sites. Electronic health policy information is generated by a wide variety of public and private organizations and disseminated in hundreds of journals and Web pages. Specialty search tools are needed to retrieve the unindexed gray literature, which includes government documents, agency reports, fact sheets, standards, and statistics not produced by commercial publishers. Further, Internet users need to examine search results with a critical eye for information quality. Expertise in searching electronic health policy information is a prerequisite for developing APRNs' leadership in political arenas to influence health policy and the delivery of healthcare services. ©2011 The Author(s) Journal compilation ©2011 American Academy of Nurse Practitioners.

  1. Grooming Great Urban Teachers

    Science.gov (United States)

    Foster, Michele; Lewis, Jeffrey; Onafowora, Laura

    2005-01-01

    Master teachers working in real urban classrooms have shared their exemplary teaching practices in an After-School Pedagogical Laboratory (L-TAPL), a program for elementary students that aims to improve the achievement of urban students and the competence of their teachers. The L-TAPL enrichment program curriculum includes language arts, math,…

  2. Still making progress to improve the hospital workplace environment? Results from the 2008 National Survey of Registered Nurses.

    Science.gov (United States)

    Buerhaus, Peter I; DesRoches, Catherine; Donelan, Karen; Hess, Robert

    2009-01-01

    Despite the majority of RNs perceiving a shortage of nurses, findings from the 2008 National Survey of RNs indicate the hospital workplace improved in several areas compared to a 2006 survey. Improvements included the time RNs spend with patients, quality of nursing care, and a decreasing impact of the shortage on delaying nurses' responses to pages or calls, staff communication, patients' wait time for surgery, and timeliness and efficiency of care. Areas the environment was perceived to have worsened included overtime hours, sexual harassment/hostile, and physical violence. RNs hold mixed views about the consequences of reporting errors and mistakes with a majority agreeing that reporting them had led to positive changes to prevent future errors, but that mistakes were held against them. Overall, results suggest that hospital managers can be reassured that their efforts to improve the workplace environment are having their intended effect but, at the same time, important areas for improvement remain.

  3. Improved immediate breast reconstruction as a result of oncoplastic multidisciplinary meeting

    Directory of Open Access Journals (Sweden)

    El Gammal MM

    2017-04-01

    Full Text Available Mohsen M El Gammal,1 Maria Lim,1 Rajan Uppal,2 Richard Sainsbury1 1Department of Breast Surgery, Parapet Breast Centre, Frimley Health Foundation Trust, Windsor, 2Department of Plastic and Reconstructive Surgery, Wexham and Heatherwood Hospital, Frimley Health Foundation Trust, Slough, UK Introduction: The National Institute for Health and Clinical Excellence guidelines recommend that breast reconstruction should be available to all women undergoing mastectomy and discussed at the initial surgical consultation (2002, and updated 2009. The National Mastectomy and Breast Reconstruction Audit (2009 showed that 21% of mastectomy patients underwent immediate breast reconstruction (IBR and 11% had delayed breast reconstruction (DBR. Breast reconstruction has been shown to have a positive effect on quality of life postmastectomy. This retrospective study investigated the impact of the introduction of a dedicated oncoplastic multidisciplinary meeting (OP MDM on our unit’s breast reconstruction rate.Patients and methods: A retrospective analysis of 229 women who underwent mastectomy, of whom 81 (35% underwent breast reconstruction between April 2014 and March 2016. Data were analyzed before and after introduction of OP MDM in April 2015. Data on patient age, type of surgery (mastectomy only, mastectomy and reconstruction, timing of reconstruction (IBR, DBR, and type of reconstruction (implant, autologous were collected.Results: Between April 2015 and March 2016, following establishment of OP multidisciplinary team in April 2015, of the 120 patients who had mastectomy, 50 (42% underwent breast reconstruction with 78% (39/50 choosing IBR (56% implant reconstruction and 22% autologous. Compared to the period between April 2014 and March 2015 preceding the OP MDM, of 109 patients who underwent mastectomy, only 31 (28% had breast reconstruction with 64% (20/31 choosing IBR (45% implant reconstruction and 19% autologous. The rate of DBR was lower, 22% (11

  4. What killed Alexander the Great?

    Science.gov (United States)

    Battersby, Cameron

    2007-01-01

    The cause of the death of the Macedonian King, Alexander the Great, at Babylon in 323 BC has excited interest and conjecture throughout the ages. The information available in the surviving ancient sources, none of which is contemporaneous, has been reviewed and compared with modern knowledge as set out in several well-known recent surgical texts. The ancient sources record epic drinking by the Macedonian nobility since at least the time of Phillip II, Alexander's father. Alexander's sudden illness and death is likely to have resulted from a surgical complication of acute alcoholic excess.

  5. Current regimen of pulse therapy for pemphigus: Minor modifications, improved results

    Directory of Open Access Journals (Sweden)

    Pasricha J

    2008-01-01

    Full Text Available Background: If administered properly, dexamethasone cyclophosphamide pulse (DCP therapy has the potential to effect lifelong recovery from pemphigus. Aims: The objective of this paper is to highlight various parameters of DCP therapy and also, to report the effects of a few modifications in the regimen. Methods: An analysis of 123 patients treated with the DCP/DP regimen over a period of five years (1998 to 2002 is presented here. Seventeen patients who did not start/continue the treatment and three patients who died during the treatment have been excluded from the analysis. Twenty patients who had not yet started families were given only dexamethasone pulses (DPs while 103 patients received DCPs. Low dose (50 mg/day cyclophosphamide was used as in the standard regimen. The three modifications introduced into the regimen were: (1 an additional daily dose of oral betamethasone sufficient to control the disease activity during phase I, which was progressively tapered off completely as the patient recovered, (2 use of systemic antibiotics if the patient had skin lesions, and oral anti-candida drugs if the patient had oral ulcers until complete healing, and (3 insistence on thorough cleaning of the skin and scalp with a normal soap and shampoo, and proper maintenance of oral hygiene in spite of skin/mucosal lesions. The regimen consisted of DCP/DP repeated in exactly 28-day cycles, along with 50 mg cyclophosphamide per day, insistence on completing the treatment and avoiding irregular pulses in all patients. The number of DCPs/DPs during phase I varied in different patients depending upon the dose of betamethasone used and the rate of recovery, but phase II (nine DCPs/DPs in exactly 28-day cycles along with 50 mg cyclophosphamide per day and phase III (only 50 mg cyclophosphamide per day was fixed at nine months each. This was followed by posttreatment follow-up (phase IV. Results: At present, all the patients are in complete remission. The

  6. Review: The Great Gatsby

    Directory of Open Access Journals (Sweden)

    Antonia de Jesus Sales

    2016-08-01

    Full Text Available A presente resenha busca discutir a tradução de The Great Gatsby para o contexto brasileiro. Diversas traduções foram feitas, em diversas épocas e com repercussão positiva no contexto brasileiro. Para o presente estudo, foi observada a tradução de Vanessa Bárbara, de 2011. Nesse sentido, o aspecto biográficos do autor e a forma como se apresentam os personagens na obra são fatores de cotejamento na obra original e na tradução brasileira. Francis Scott Key Fitzgerald (1896 – 1940 é famoso por ter em suas obras traços biográficos, algo que certamente influencia o leitor que adentra a sua obra. Quanto à recepção de O Grande Gatsby no contexto brasileiro, há que se considerar que O Grande Gatsby teve diversas traduções no Brasil. Depois dessa tradução de Vanessa Bárbara, em 2011, outras três vieram em 2013, juntamente com o filme. Há que considerar os aspectos comerciais embutidos nessas traduções e que muito corroboram para o resultado final. Prova disso são as capas, que são sempre diferenciadas em cada edição lançada. O tradutor nem sempre pode opinar sobre questões como estas. A tradução, a meu ver, é uma obra de qualidade, visto que a tradutora buscou ser fiel, sem dificultar a interpretação da obra para o leitor.

  7. Review: The Great Gatsby

    Directory of Open Access Journals (Sweden)

    Antonia de Jesus Sales

    2016-05-01

    Full Text Available A presente resenha busca discutir a tradução de The Great Gatsby para o contexto brasileiro. Diversas traduções foram feitas, em diversas épocas e com repercussão positiva no contexto brasileiro. Para o presente estudo, foi observada a tradução de Vanessa Bárbara, de 2011. Nesse sentido, o aspecto biográficos do autor e a forma como se apresentam os personagens na obra são fatores de cotejamento na obra original e na tradução brasileira. Francis Scott Key Fitzgerald (1896 – 1940 é famoso por ter em suas obras traços biográficos, algo que certamente influencia o leitor que adentra a sua obra. Quanto à recepção de O Grande Gatsby no contexto brasileiro, há que se considerar que O Grande Gatsby teve diversas traduções no Brasil. Depois dessa tradução de Vanessa Bárbara, em 2011, outras três vieram em 2013, juntamente com o filme. Há que considerar os aspectos comerciais embutidos nessas traduções e que muito corroboram para o resultado final. Prova disso são as capas, que são sempre diferenciadas em cada edição lançada. O tradutor nem sempre pode opinar sobre questões como estas. A tradução, a meu ver, é uma obra de qualidade, visto que a tradutora buscou ser fiel, sem dificultar a interpretação da obra para o leitor.

  8. Great Ellipse Route Planning Based on Space Vector

    Directory of Open Access Journals (Sweden)

    LIU Wenchao

    2015-07-01

    Full Text Available Aiming at the problem of navigation error caused by unified earth model in great circle route planning using sphere model and modern navigation equipment using ellipsoid mode, a method of great ellipse route planning based on space vector is studied. By using space vector algebra method, the vertex of great ellipse is solved directly, and description of great ellipse based on major-axis vector and minor-axis vector is presented. Then calculation formulas of great ellipse azimuth and distance are deduced using two basic vectors. Finally, algorithms of great ellipse route planning are studied, especially equal distance route planning algorithm based on Newton-Raphson(N-R method. Comparative examples show that the difference of route planning between great circle and great ellipse is significant, using algorithms of great ellipse route planning can eliminate the navigation error caused by the great circle route planning, and effectively improve the accuracy of navigation calculation.

  9. Improvements in reading accuracy as a result of increased interletter spacing are not specific to children with dyslexia

    NARCIS (Netherlands)

    Hakvoort, Britt; van den Boer, Madelon; Leenaars, Tineke; Bos, Petra; Tijms, Jurgen

    2017-01-01

    Recently, increased interletter spacing (LS) has been studied as a way to enhance reading fluency. It is suggested that increased LS improves reading performance, especially in poor readers. Theoretically, these findings are well substantiated as a result of diminished crowding effects. Empirically,

  10. Great Lakes Environmental Database (GLENDA)

    Data.gov (United States)

    U.S. Environmental Protection Agency — The Great Lakes Environmental Database (GLENDA) houses environmental data on a wide variety of constituents in water, biota, sediment, and air in the Great Lakes area.

  11. Great apes prefer cooked food.

    Science.gov (United States)

    Wobber, Victoria; Hare, Brian; Wrangham, Richard

    2008-08-01

    The cooking hypothesis proposes that a diet of cooked food was responsible for diverse morphological and behavioral changes in human evolution. However, it does not predict whether a preference for cooked food evolved before or after the control of fire. This question is important because the greater the preference shown by a raw-food-eating hominid for the properties present in cooked food, the more easily cooking should have been adopted following the control of fire. Here we use great apes to model food preferences by Paleolithic hominids. We conducted preference tests with various plant and animal foods to determine whether great apes prefer food items raw or cooked. We found that several populations of captive apes tended to prefer their food cooked, though with important exceptions. These results suggest that Paleolithic hominids would likewise have spontaneously preferred cooked food to raw, exapting a pre-existing preference for high-quality, easily chewed foods onto these cooked items. The results, therefore, challenge the hypothesis that the control of fire preceded cooking by a significant period.

  12. Quality initiatives: improving patient flow for a bone densitometry practice: results from a Mayo Clinic radiology quality initiative.

    Science.gov (United States)

    Aakre, Kenneth T; Valley, Timothy B; O'Connor, Michael K

    2010-03-01

    Lean Six Sigma process improvement methodologies have been used in manufacturing for some time. However, Lean Six Sigma process improvement methodologies also are applicable to radiology as a way to identify opportunities for improvement in patient care delivery settings. A multidisciplinary team of physicians and staff conducted a 100-day quality improvement project with the guidance of a quality advisor. By using the framework of DMAIC (define, measure, analyze, improve, and control), time studies were performed for all aspects of patient and technologist involvement. From these studies, value stream maps for the current state and for the future were developed, and tests of change were implemented. Comprehensive value stream maps showed that before implementation of process changes, an average time of 20.95 minutes was required for completion of a bone densitometry study. Two process changes (ie, tests of change) were undertaken. First, the location for completion of a patient assessment form was moved from inside the imaging room to the waiting area, enabling patients to complete the form while waiting for the technologist. Second, the patient was instructed to sit in a waiting area immediately outside the imaging rooms, rather than in the main reception area, which is far removed from the imaging area. Realignment of these process steps, with reduced technologist travel distances, resulted in a 3-minute average decrease in the patient cycle time. This represented a 15% reduction in the initial patient cycle time with no change in staff or costs. Radiology process improvement projects can yield positive results despite small incremental changes.

  13. An initiative to improve the management of clinically significant test results in a large health care network.

    Science.gov (United States)

    Roy, Christopher L; Rothschild, Jeffrey M; Dighe, Anand S; Schiff, Gordon D; Graydon-Baker, Erin; Lenoci-Edwards, Jennifer; Dwyer, Cheryl; Khorasani, Ramin; Gandhi, Tejal K

    2013-11-01

    The failure of providers to communicate and follow up clinically significant test results (CSTR) is an important threat to patient safety. The Massachusetts Coalition for the Prevention of Medical Errors has endorsed the creation of systems to ensure that results can be received and acknowledged. In 2008 a task force was convened that represented clinicians, laboratories, radiology, patient safety, risk management, and information systems in a large health care network with the goals of providing recommendations and a road map for improvement in the management of CSTR and of implementing this improvement plan during the sub-force sequent five years. In drafting its charter, the task broadened the scope from "critical" results to "clinically significant" ones; clinically significant was defined as any result that requires further clinical action to avoid morbidity or mortality, regardless of the urgency of that action. The task force recommended four key areas for improvement--(1) standardization of policies and definitions, (2) robust identification of the patient's care team, (3) enhanced results management/tracking systems, and (4) centralized quality reporting and metrics. The task force faced many challenges in implementing these recommendations, including disagreements on definitions of CSTR and on who should have responsibility for CSTR, changes to established work flows, limitations of resources and of existing information systems, and definition of metrics. This large-scale effort to improve the communication and follow-up of CSTR in a health care network continues with ongoing work to address implementation challenges, refine policies, prepare for a new clinical information system platform, and identify new ways to measure the extent of this important safety problem.

  14. Studying The Great Russian Revolution

    Directory of Open Access Journals (Sweden)

    A. V. Torkunov

    2017-01-01

    Full Text Available The article revises an established view of Russian Revolution as two separate events - February Revolution and October Revolution. The author supports the concept of the «Great Russian Revolution», which unites these two events in a single process of revolutionary development. The author draws attention to the following advantages of the concept under consideration. First, it conceptualizes the revolution as a process contingent of a local and global historical context. In this sense, the revolution is presented as the transition of society to the modern stage of development, meaning the transition to modernity. Second, revolutionary events in Russia are considered from the point of view of the evolution of the spatial and socioeconomic distribution and rearrangement of key social groups: peasantry, elites, national and ethnic minorities. Third, it takes into account the personal factor in the revolutionary events, the influence of individual personalities on escalation or the reduction of socio-political tensions. Fourth, it draws attention to the fact that revolutions imply the use of various forms of political violence. Each revolution is characterized by a unique correlation of forms and intensity of political violence. Finally, it gives a normative assessment of the Revolution, encouraging a national discussion on the results and consequences of this great event.

  15. The great crusade

    International Nuclear Information System (INIS)

    Tovar Aguirre, Leyla

    2004-01-01

    The paper is about the exploratory campaign of Ecopetrol, to check the presence of hydrocarbons in Colombia, mainly in the Department of Santander. The company has dear a cost of ten million dollars and it is expected that for the 2005 results be had

  16. Integrated system of Supervision of Centrals (SISC): results, anticipated self-evaluation and improvements, cross-sectional subjects

    International Nuclear Information System (INIS)

    Zarzuela, J.

    2008-01-01

    The integrated System for Plan Oversight was already implemented in 2007 in full scope i.e., including public information of its results. At the moment, the first self-assessment if the system is being implemented and, consequently, it is expected to trigger changes for improvement. Specifically, the management of cross cutting issues will be reviewed in depth, so that the causes of inspection findings will be analysed deeper and closer attention devoted to their correction. (Author)

  17. The great transition.

    Science.gov (United States)

    Lieberthal, Kenneth; Lieberthal, Geoffrey

    2003-10-01

    As China's economy grows and opens further, the opportunity it presents to multinationals is changing. Foreign companies are moving to country development and new strategic choices. Now, foreign firms can actually go after the Chinese domestic market, and it's worth going after. Improvements in China's infrastructure, workforce, and regulatory environment are making it possible for companies to lower their costs to reap new competitive advantages. Multifaceted and often-shifting risks accompany this shifting opportunity. The reforms required for admission into the WTO will be politically difficult for China to implement, and its progress will be slowed by the scarcity of resources for the country's shaky banking system, the inadequacy of the social safety net, environmental problems, and local governments' cash shortage. China's breathtaking 9% average annual GDP growth rests on an unsteady foundation of overcapitalized state-owned enterprises, which have oversupplied many markets, and fiercely protectionist regional government officials pursuing growth-at-almost-all-costs policies. Frequent changes in regulations, bureaucracies, and reporting relationships will continue to make planning difficult, and, as the SARS epidemic demonstrated, there is always the potential for serious disruptions. But for at least the next ten years, multinationals should be the biggest winners in China. To reap the benefits, a multinational must properly nest its effort into its overall organization, show "one face to China" at the national level but also tailor local strategies, be wary of joint ventures, and mitigate risk, in particular the theft of intellectual property. China is a major opportunity for companies that forthrightly face its complexities. It will remain largely inscrutable--and unprofitable--for the rest.

  18. Progress of Design Improvements for APR1400 Computerized Procedure System from HFE V and V results and Design Experience

    International Nuclear Information System (INIS)

    Lee, Sungjin; Seong, Nokyu

    2015-01-01

    This study shows major already improved design features from the above three processes and a design proposal for to-be-improving items. APR1400 CPS has been verified and validated by the HFE process, internal design review and site acceptance tests. APR1400 Computerized Procedure System (CPS) has been applied to Shin-Kori Nuclear Power Plant (SKN) 3 and 4 units, Shin-Hanul Nuclear Power Plant (SHN) 1 and 2 units and Baraka Nuclear Power Plant (BNPP) 1, 2, 3 and 4 units. Since APR1400 CPS is a first-of-a-kind (FOAK) human machine interface (HMI) for executing a computerized procedure in the nuclear power plant's main control room in South Korea, it has been continuously improved through a) the human factor engineering (HFE) verification and validation (V and V), b) the internal design review and c) prototype tests. Human engineering discrepancies (HEDs) can be identified by the HFE V and V activity. Some HEDs of APR1400 CPS for SKN 3 and 4 and SHN 1 and 2 have been adopted as a role of design improvement in the CPS system while others were regarded as an operator training requirement or part of task contents. Various requests for improving the CPS have been collected from those results. A HMI system should be improved continuously for removing potential defects. Some of introduced design features in this paper has been adopted for APR1400 nuclear power plants. Some of them are under the review in the CPS design team of KHNP

  19. Improving Dairy Organizational Communication from the Veterinarian's Perspective: Results of a Continuing Veterinary Medical Education Pilot Program.

    Science.gov (United States)

    Moore, Dale A; Sischo, William M; Kurtz, Suzanne; Siler, Julie D; Pereira, Richard V; Warnick, Lorin D; Davis, Margaret A

    2016-01-01

    The increasing size and complexity of US dairy farms could make it more difficult for a veterinary practitioner to effectively communicate protocol recommendations for prevention or treatment on the farm. A continuing education workshop was set up based on the results of research on dairy organizational communication on dairy farms, which resulted in a tool to assess dairy communication structure and flow. The workshop specifically focused on communication structure and whom to talk to when implementing health care changes in calf rearing. In addition, modern methods of veterinary-client communication knowledge and skills were provided. Primary outcomes of the workshops were to obtain feedback from participants about research findings and the communication model, to improve awareness about the complexity of communication structures on dairy farms, and to change participants' knowledge and skills associated with on-farm communication by providing communication theory and skills and an approach to evaluate and improve dairy organizational communication. Of the 37 participants completing the pre-program assessment, most recognized a need for themselves or their practice to improve communication with clients and farm employees. After the program, most participants were confident in their new communication skills and would consider using them. They highlighted specific new ideas they could apply in practice, such as conducting a "communication audit." The results from the assessment of this communication workshop, focused on dairy veterinarians, highlighted the need for communication training in this sector of the profession and practitioners' desire to engage in this type of training.

  20. Climate variability and Great Plains agriculture

    International Nuclear Information System (INIS)

    Rosenberg, N.J.; Katz, L.A.

    1991-01-01

    The ways in which inhabitants of the Great Plains, including Indians, early settlers, and 20th century farmers, have adapted to climate changes on the Great Plains are explored. The climate of the Great Plains, because of its variability and extremes, can be very stressful to plants, animals and people. It is suggested that agriculture and society on the Great Plains have, during the last century, become less vulnerable to the stresses imposed by climate. Opinions as to the sustainability of agriculture on the Great Plains vary substantially. Lockeretz (1981) suggests that large scale, high cost technologies have stressed farmers by creating surpluses and by requiring large investments. Opie (1989) sees irrigation as a climate substitute, however he stresses that the Ogallala aquifer must inevitably become depleted. Deborah and Frank Popper (1987) believe that farming on the Plains is unsustainable, and destruction of shelterbelts, out-migration of the rural population and environmental problems will lead to total collapse. With global warming, water in the Great Plains is expected to become scarcer, and although improvements in irrigation efficiency may slow depletion of the Ogallala aquifer, ultimately the acreage under irrigation must decrease to levels that can be sustained by natural recharge and reliable surface flows. 23 refs., 2 figs

  1. Improving the sweeping efficiency of permanganate into low permeable zones to treat TCE: experimental results and model development.

    Science.gov (United States)

    Chokejaroenrat, Chanat; Kananizadeh, Negin; Sakulthaew, Chainarong; Comfort, Steve; Li, Yusong

    2013-11-19

    The residual buildup and treatment of dissolved contaminants in low permeable zones (LPZs) is a particularly challenging issue for injection-based remedial treatments. Our objective was to improve the sweeping efficiency of permanganate into LPZs to treat dissolved-phase TCE. This was accomplished by conducting transport experiments that quantified the ability of xanthan-MnO4(-) solutions to penetrate and cover (i.e., sweep) an LPZ that was surrounded by transmissive sands. By incorporating the non-Newtonian fluid xanthan with MnO4(-), penetration of MnO4(-) into the LPZ improved dramatically and sweeping efficiency reached 100% in fewer pore volumes. To quantify how xanthan improved TCE removal, we spiked the LPZ and surrounding sands with (14)C-lableled TCE and used a multistep flooding procedure that quantified the mass of (14)C-TCE oxidized and bypassed during treatment. Results showed that TCE mass removal was 1.4 times greater in experiments where xanthan was employed. Combining xanthan with MnO4(-) also reduced the mass of TCE in the LPZ that was potentially available for rebound. By coupling a multiple species reactive transport model with the Brinkman equation for non-Newtonian flow, the simulated amount of (14)C-TCE oxidized during transport matched experimental results. These observations support the use of xanthan as a means of enhancing MnO4(-) delivery into LPZs for the treatment of dissolved-phase TCE.

  2. Quality of life is modestly improved in older patients with mild primary hyperparathyroidism postoperatively: results of a prospective multicenter study.

    Science.gov (United States)

    Blanchard, Claire; Mathonnet, Muriel; Sebag, Frédéric; Caillard, Cécile; Kubis, Caroline; Drui, Delphine; van Nuvel, Elise; Ansquer, Catherine; Henry, Jean-François; Masson, Damien; Kraeber-Bodéré, Françoise; Hardouin, Jean-Benoît; Zarnegar, Rasa; Hamy, Antoine; Mirallié, Eric

    2014-10-01

    The objectives of this study were to evaluate, in mild primary hyperparathyroidism (pHPT) patients, the quality of life (QoL) using the SF-36 questionnaire before and after parathyroidectomy and to detect preoperatively patients who benefit the most from surgery. Most pHPT patients present a mild pHPT defined by calcemia ≤11.4 mg/dL. For these patients, there is debate about whether they should be managed with surveillance, medical therapy, or surgery. A prospective multicenter study investigated QoL (SF-36) in patients with mild pHPT before and after parathyroidectomy in four university hospitals. Laboratory results and SF-36 scores were obtained preoperatively and postoperatively (3, 6, and 12 months). One hundred sixteen patients were included. After surgery, the biochemical cure rate was 98%. Preoperatively, the mental component summary and the physical component summary (PCS) were 38.69 of 100 and 39.53 of 100, respectively. At 1 year, the MCS and the PCS were 41.29 of 100 and 42.03 of 100. The subgroup analysis showed a more significant improvement in patients < 70 years and with calcemia ≥10.4 mg/dL. Postoperative PCS was correlated with age and preoperative PCS: variation = 32.11 - 0.21 × age - 0.4 × preoperative PCS. Men did not improve their MCS postoperatively. Only women with a preoperative MCS <43.6 of 100 showed postoperative improvement. This study showed, in patients with mild pHPT, an improvement of QoL 1 year after parathyroidectomy. Patients <70 years and with calcemia ≥10.4 mg/dL had a more significant improvement.

  3. The diverse impacts of the great recession

    OpenAIRE

    Makoto Nakajima

    2013-01-01

    The Great Recession had a large negative impact on the U.S. economy. Asset prices, most notably stock and house prices, declined substantially, resulting in a loss in wealth for many American households. In this article, Makoto Nakajima documents how diverse households were affected in a variety of dimensions during the Great Recession, in particular between 2007 and 2009, using newly available data from the 2007-2009 Survey of Consumer Finances. He discusses why it is important to look at th...

  4. Endovascular Stroke Therapy Results Improve over Time: The ‘Learning Curve' at a New Comprehensive Stoke Center

    Directory of Open Access Journals (Sweden)

    Ethan A. Benardete

    2015-01-01

    Full Text Available Background: The requirements for a comprehensive stroke center (CSC include the capability to perform endovascular stroke therapy (EST. EST is a complex process requiring early identification of appropriate patients and effective delivery of intervention. In order to provide prompt intervention for stroke, CSCs have been established away from large academic centers in community-based hospitals. We hypothesized that quantifiable improvements would occur during the first 2 years of a community-based CSC as the processes and personnel evolved. We report the results over time of EST at a new community-based CSC. Methods: We have retrospectively analyzed demographic data and outcome metrics of EST from the initiation phase of a new community-based CSC. Data was divided into year 1 and year 2. Statistical analysis (Student's t test and Fisher's exact test was performed to compare the patient population and outcomes across the two time periods. Outcome variables included the thrombolysis in cerebral infarction (TICI score, a change in the NIH stroke scale score and the modified Rankin Scale (mRS score. Analysis of variance (ANOVA was used to statistically analyze the relationship between population variables and outcome. Computed tomography (CT angiography and CT perfusion analysis were used to select patients for EST. Approximately half of the patients undergoing EST were excluded from receiving intravenous recombinant tissue plasminogen activator (IV rt-PA by standard criteria, while the other half showed no sign of improvement following 1 h of IV rt-PA treatment. Mechanical thrombolysis with a stentriever was performed in the majority of cases with or without intra-arterial medication. The majority of treated occlusions were in the middle cerebral artery. Results: A total of 18 patients underwent EST during year 1 and year 2. A statistically significant increase in good outcomes (mRS score ≤2 at discharge was seen from year 1 to year 2 (p = 0

  5. Does weight loss improve semen quality and reproductive hormones? results from a cohort of severely obese men

    Directory of Open Access Journals (Sweden)

    Ernst Emil

    2011-08-01

    Full Text Available Abstract Background A high body mass index (BMI has been associated with reduced semen quality and male subfecundity, but no studies following obese men losing weight have yet been published. We examined semen quality and reproductive hormones among morbidly obese men and studied if weight loss improved the reproductive indicators. Methods In this pilot cohort study, 43 men with BMI > 33 kg/m2 were followed through a 14 week residential weight loss program. The participants provided semen samples and had blood samples drawn, filled in questionnaires, and had clinical examinations before and after the intervention. Conventional semen characteristics as well as sperm DNA integrity, analysed by the sperm chromatin structure assay (SCSA were obtained. Serum levels of testosterone, estradiol, sex hormone-binding globulin (SHBG, luteinizing hormone (LH, follicle-stimulating hormone (FSH, anti-Müllerian hormone (AMH and inhibin B (Inh-B were measured. Results Participants were from 20 to 59 years of age (median = 32 with BMI ranging from 33 to 61 kg/m2. At baseline, after adjustment for potential confounders, BMI was inversely associated with sperm concentration (p = 0.02, total sperm count (p = 0.02, sperm morphology (p = 0.04, and motile sperm (p = 0.005 as well as testosterone (p = 0.04 and Inh-B (p = 0.04 and positively associated to estradiol (p Conclusion This study found obesity to be associated with poor semen quality and altered reproductive hormonal profile. Weight loss may potentially lead to improvement in semen quality. Whether the improvement is a result of the reduction in body weight per se or improved lifestyles remains unknown.

  6. [The great virus comeback].

    Science.gov (United States)

    Forterre, Patrick

    2013-01-01

    Viruses have been considered for a long time as by-products of biological evolution. This view is changing now as a result of several recent discoveries. Viral ecologists have shown that viral particles are the most abundant biological entities on our planet, whereas metagenomic analyses have revealed an unexpected abundance and diversity of viral genes in the biosphere. Comparative genomics have highlighted the uniqueness of viral sequences, in contradiction with the traditional view of viruses as pickpockets of cellular genes. On the contrary, cellular genomes, especially eukaryotic ones, turned out to be full of genes derived from viruses or related elements (plasmids, transposons, retroelements and so on). The discovery of unusual viruses infecting archaea has shown that the viral world is much more diverse than previously thought, ruining the traditional dichotomy between bacteriophages and viruses. Finally, the discovery of giant viruses has blurred the traditional image of viruses as small entities. Furthermore, essential clues on virus history have been obtained in the last ten years. In particular, structural analyses of capsid proteins have uncovered deeply rooted homologies between viruses infecting different cellular domains, suggesting that viruses originated before the last universal common ancestor (LUCA). These studies have shown that several lineages of viruses originated independently, i.e., viruses are polyphyletic. From the time of LUCA, viruses have coevolved with their hosts, and viral lineages can be viewed as lianas wrapping around the trunk, branches and leaves of the tree of life. Although viruses are very diverse, with genomes encoding from one to more than one thousand proteins, they can all be simply defined as organisms producing virions. Virions themselves can be defined as infectious particles made of at least one protein associated with the viral nucleic acid, endowed with the capability to protect the viral genome and ensure its

  7. The Normal Position of Umbilicus in the Newborn: An Aid to Improve Cosmetic Result in Exomphalos Major

    Directory of Open Access Journals (Sweden)

    H Davari

    2004-02-01

    Full Text Available Background: Position of umbilicus is an important esthetic landmark and its absence or deformity may be associated with poor self-image. In abdominoplasty, the creation of a normal-looking, well shaped and sufficiently deep umbilicus on a normal position seems essential. The aim of this study was to determine the normal position of umbilicus and hence to improve the cosmetic result of exomphalos major repair. Methods: In a cross-sectional study the position of umbilicus was determined in a random sample of 200 healthy and normal neonates (107 boys and 93 girls who were born in Isfahan University hospitals from Oct. 2002 till Mar. 2003, with respect to the xiphisternum and pubis. Results: The normal umbilical position was 59.3 ± 5.2 percent of the way from the inferior border of xiphisternum to the superior border of the pubis in the midline and it was independent of gender and neonatal Conclusions: Recent years have witnessed major improvements in the survival of newborns with exomphalocele. The primary repair of the abdominal wall with umbilicoplasty is generally considered the treatment of choice, and the cosmetic appearance of the navel becomes increasingly important as children grow older. In repair of exomphalos major, the most esthetically pleasing result is obtained if the umbilicus is placed 59.3% of the way from the xiphisternum to the pubis. Keywords: Umbilicus, Exomphalos, Neonate, Umbilicoplasty, Isfahan

  8. Great Lakes Regional Biomass Energy Program

    International Nuclear Information System (INIS)

    Kuzel, F.

    1993-01-01

    The Great Lakes Regional Biomass Energy Program (GLRBEP) was initiated September, 1983, with a grant from the Office of Energy Efficiency and Renewable Energy of the US Department of Energy (DOE). The program provides resources to public and private organizations in the Great Lakes region to increase the utilization and production of biomass fuels. The objectives of the GLRBEP are to: (1) improve the capabilities and effectiveness of biomass energy programs in the state energy offices; (2) assess the availability of biomass resources for energy in light of other competing needs and uses; (3) encourage private sector investments in biomass energy technologies; (4) transfer the results of government-sponsored biomass research and development to the private sector; (5) eliminate or reduce barriers to private sector use of biomass fuels and technology; (6) prevent or substantially mitigate adverse environmental impacts of biomass energy use. The Program Director is responsible for the day-to-day activities of the GLRBEP and for implementing program mandates. A 40 member Technical Advisory Committee (TAC) sets priorities and recommends projects. The governor of each state in the region appoints a member to the Steering Council, which acts on recommendations of the TAC and sets basic program guidelines. The GLRBEP is divided into three separate operational elements. The State Grants component provides funds and direction to the seven state energy offices in the region to increase their capabilities in biomass energy. State-specific activities and interagency programs are emphasized. The Subcontractor component involves the issuance of solicitations to undertake projects that address regional needs, identified by the Technical Advisory Committee. The Technology Transfer component includes the development of nontechnical biomass energy publications and reports by Council staff and contractors, and the dissemination of information at conferences, workshops and other events

  9. Sesame improvement by induced mutations: Results of the co-ordinated research project and recommendation for future studies

    International Nuclear Information System (INIS)

    Zanten, L. van

    2001-01-01

    The FAO/IAEA Co-ordinated Research Project has brought together sesame breeders from 11 countries. They, together with pathologists, agronomists and physiologists, have made considerable effort to advance the genetic improvement in sesame. The results and conclusions from this project cover the mutation techniques used for the genetic improvement of various aspects of sesame. These recommendations do not only deal with the application of mutation induction, but also with the wider plant breeding related objectives and methods to be considered for this semi-domesticated crop. It is clear that more advanced techniques can and should be incorporated in the process which would enhance the genetic improvement. Although five years is a relatively limited time in a plant breeding programme, the participants have been able to produce and make available a considerable pool of agronomically interesting mutant sesame germplasm. The participants in the CRP considered that, together with other specialists, plant breeders can gain fuller benefit from the mutations induced by radiation or chemicals. Work on these mutants must continue in co-operation/consultation with plant physiologists and pathologists, and with biotechnologists who may in the future be able to provide in the future methods for introducing beneficial traits from other crops into sesame. The sesame programme should include scientists from the Member States where sesame grows and scientists from developed countries who may have greater access to physiological and molecular research facilities. (author)

  10. Botulinum toxin to improve results in cleft lip repair: a double-blinded, randomized, vehicle-controlled clinical trial.

    Directory of Open Access Journals (Sweden)

    Chun-Shin Chang

    Full Text Available Most patients with facial scarring would value even a slight improvement in scar quality. Botulinum toxin A is widely used to alleviate facial dynamic rhytides but is also believed to improve scar quality by reducing wound tension during healing. The main objective was to assess the effect of Botulinum toxin on scars resultant from standardized upper lip wounds.In this double-blinded, randomized, vehicle-controlled, prospective clinical trial, 60 consecutive consenting adults undergoing cleft lip scar revision (CLSR surgery between July 2010 and March 2012 were randomized to receive botulinum toxin A (n = 30 or vehicle (normal saline; n = 30 injections into the subjacent orbicularis oris muscle immediately after wound closure. Scars were independently assessed at 6-months follow-up in blinded fashion using: Vancouver Scar Scale (VSS, Visual Analogue Scale (VAS and photographic plus ultrasound measurements of scar widths.58 patients completed the trial. All scar assessment modalities revealed statistically significantly better scars in the experimental than the vehicle-control group.Quality of surgical upper lip scars, which are oriented perpendicular to the direction of pull of the underlying orbicularis oris muscle, is significantly improved by its temporary paralysis during wound healing.ClinicalTrials.gov NCT01429402.

  11. Patient complaints as a means to improve quality of hospital care. Results of a qualitative content analysis

    Science.gov (United States)

    Hoffmann, Susanne; Dreher-Hummel, Thomas; Dollinger, Claudia; Frei, Irena Anna

    2018-04-01

    Background: Many hospitals have defined procedures for a complaint management. A systematic analysis of patient complaints helps to identify similar complaints and patterns so that targeted improvement measures can be derived (Gallagher & Mazor, 2015). Aim: Our three-month, nurse-led practice development project aimed 1) to identify complaints regarding communication issues, 2) to systemise and prioritise complaints regarding communication issues, and 3) to derive clinic-specific recommendations for improvement. Method: We analysed 273 complaints of patients documented by the quality management (secondary data analysis). Using content analysis and applying the coding taxonomy for inpatient complaints by Reader, Gillespie and Roberts (2014), we distinguished communication-related complaints. By further inductive differentiation of these complaints, we identified patterns and prioritised fields of action. Results: We identified 186 communication-related complaints divided into 16 subcategories. For each subcategory, improvement interventions were derived, discussed and prioritised. Conclusions: Thus, patient complaints provided an excellent opportunity for reflection and workplace learning for nurses. The analysis gave impulse to exemplify the subject “person-centered care” for nurses.

  12. What Caused the Great Depression?

    Science.gov (United States)

    Caldwell, Jean; O'Driscoll, Timothy G.

    2007-01-01

    Economists and historians have struggled for almost 80 years to account for the American Great Depression, which began in 1929 and lasted until the early years of World War II. In this article, the authors discuss three major schools of thought on the causes of the Great Depression and the long failure of the American economy to return to full…

  13. Quantifying and improving the efficiency of Gamma Knife treatment plans for brain metastases: results of a 1-year audit.

    Science.gov (United States)

    Wright, Gavin; Hatfield, Paul; Loughrey, Carmel; Reiner, Beatrice; Bownes, Peter

    2014-12-01

    A method for quantifying the efficiency of Gamma Knife treatment plans for metastases was previously implemented by the authors to retrospectively identify the least efficient plans and has provided insights into improved planning strategies. The aim of the current work was to ascertain whether those insights led to improved treatment plans. Following completion of the initial study, a 1-year audit of metastasis plans created at St. James's Institute of Oncology was carried out. Audited recent plans were compared with the earlier plans of the initial study, in terms of their efficiency and dosimetric quality. The statistical significance of any differences between relevant plan parameters was quantified by Mann-Whitney U-tests. Comparisons were made between all plans and repeated for a reduced set of plans from which the smallest lesions treated with a single 4-mm shot were excluded. The plan parameters compared were a plan efficiency index (PEI), the number of shots, Paddick conformity index (PCI), gradient index (GI), and percent coverage (of the lesion by the prescription isodose). A total of 157 metastatic lesions were included in the audit and were compared with 241 in the initial study. In a comparison of all cases, the audited plans achieved a higher median PEI score than did the earlier plans from the initial study (1.08 vs 1.02), indicating improved efficiency of the audited plans. When the smallest lesions (for which there was little scope for varying plan strategy) were discounted, the improvement in median PEI score was greater (1.23 vs 1.03, p planning strategy yielding these efficiency improvements did not rely on the use of significantly fewer shots (median 11 vs 11 shots, p = 0.924), nor did it result in significant detriment to dosimetric quality (median coverage 99% vs 99%, median PCI 0.84 vs 0.83, p = 0.449, and median GI 2.72 vs 2.67, p = 0.701, audited plans vs initial plans, respectively). Choice of planning strategy can substantially affect

  14. Successful lumbar surgery results in improved psychological well-being: a longitudinal assessment of depressive and anxiety symptoms.

    Science.gov (United States)

    Mancuso, Carol A; Duculan, Roland; Cammisa, Frank P; Sama, Andrew A; Hughes, Alexander P; Lebl, Darren R; Girardi, Federico P

    2018-04-01

    Preoperative psychological symptoms predict surgical outcomes. The impact of surgical outcomes on psychological well-being, however, has not been delineated. This study aimed to compare pre- with postoperative depressive and anxiety symptoms based on success of surgery, defined as fulfilled expectations and improvement in disability and pain. A prospective 2-year longitudinal study in a tertiary care center was carried out. The sample consisted of 276 patients who underwent lumbar surgery. The Geriatric Depression Scale (GDS) and the Spielberger State-Trait Anxiety Inventory (STAI) were the outcome measures. Patients completed the following validated surveys several days before and again 2 years after surgery: the GDS with a set threshold for a positive screen for depression; the STAI with population norms used as threshold values; the Oswestry Disability Index (ODI); a numerical pain rating; and the Expectations Survey measuring amount of improvement expected. Dependent variables were pre- to postoperative within-patient change in GDS and STAI scores. Independent variables were three outcomes of surgery: proportion of expectations fulfilled, and changes in ODI scores and pain ratings. Analyses were conducted with GDS and STAI scores as continuous variables and according to threshold values, and for expectations, ODI and pain according to minimum clinically important differences (MCIDs). Mean age was 55, 56% were men, and 78% had degenerative diagnoses. For depressive symptoms, 41% screened positive preoperatively and 16% screened positive postoperatively; 72% had some improvement. In multivariable analysis adjusted for age, gender, comorbidity, diagnosis, and surgical invasiveness, depressive symptoms improved more for more expectations fulfilled (ppsychological well-being resulted after surgery among patients with favorable spine-specific outcomes. Copyright © 2017 Elsevier Inc. All rights reserved.

  15. Picture archiving and communication systems lead to sustained improvements in reporting times and productivity: results of a 5-year audit

    Energy Technology Data Exchange (ETDEWEB)

    Mackinnon, A.D.; Billington, R.A.; Adam, E.J.; Dundas, D.D. [Department of Radiology, St Georges Hospital NHS Trust, London (United Kingdom); Patel, U. [Department of Radiology, St Georges Hospital NHS Trust, London (United Kingdom)], E-mail: Uday.Patel@stgeorges.nhs.uk

    2008-07-15

    Aim: To evaluate the impact of picture archiving and communications systems (PACS) on reporting times and productivity in a large teaching hospital. Materials and methods: Reporting time, defined as the time taken from patient registration to report availability, and productivity, defined as the number of reports issued per whole time equivalent (WTE) radiologist per month, were studied for 2 years pre- and 3 years post-PACS installation. Mean reporting time was calculated for plain radiographs and specialist radiology techniques [computed tomography (CT), magnetic resonance imaging (MRI), ultrasound, and nuclear medicine]. Productivity, total department workload, and unreported film rates were also assessed. Pre- and post-PACS findings were compared. Results: Between 2002-2006 the number of radiological patient episodes increased by 30% from 11,531/month to 15,057/month. This was accompanied by a smaller increase in WTE reporting radiologists, from 32 to 37 (15%). Mean reporting times have improved substantially post-PACS, plain radiograph reporting time decreased by 26% (from 6.8 to 5 days; p = 0.002) and specialty modalities by 24% (4.1 to 3.1 days; p < 0.001). Radiologist productivity has increased by 18% (337 films to 407 films/WTE radiologist/month). Unreported films have decreased from 5 to 4% for plain radiographs and are steady for specialty modalities (< 1%). In most areas improvements have been sustained over a 3-year period. Conclusion: Since the introduction of PACS, reporting times have decreased by 25% and the productivity improved by 18%. Sustained improvements are felt to reflect the efficiencies and cultural change that accompanied the introduction of PACS and digital dictation.

  16. Improving esthetic results in benign parotid surgery: statistical evaluation of facelift approach, sternocleidomastoid flap, and superficial musculoaponeurotic system flap application.

    Science.gov (United States)

    Bianchi, Bernardo; Ferri, Andrea; Ferrari, Silvano; Copelli, Chiara; Sesenna, Enrico

    2011-04-01

    The purpose of this article was to analyze the efficacy of facelift incision, sternocleidomastoid muscle flap, and superficial musculoaponeurotic system flap for improving the esthetic results in patients undergoing partial parotidectomy for benign parotid tumor resection. The usefulness of partial parotidectomy is discussed, and a statistical evaluation of the esthetic results was performed. From January 1, 1996, to January 1, 2007, 274 patients treated for benign parotid tumors were studied. Of these, 172 underwent partial parotidectomy. The 172 patients were divided into 4 groups: partial parotidectomy with classic or modified Blair incision without reconstruction (group 1), partial parotidectomy with facelift incision and without reconstruction (group 2), partial parotidectomy with facelift incision associated with sternocleidomastoid muscle flap (group 3), and partial parotidectomy with facelift incision associated with superficial musculoaponeurotic system flap (group 4). Patients were considered, after a follow-up of at least 18 months, for functional and esthetic evaluation. The functional outcome was assessed considering the facial nerve function, Frey syndrome, and recurrence. The esthetic evaluation was performed by inviting the patients and a blind panel of 1 surgeon and 2 secretaries of the department to give a score of 1 to 10 to assess the final cosmetic outcome. The statistical analysis was finally performed using the Mann-Whitney U test for nonparametric data to compare the different group results. P less than .05 was considered significant. No recurrence developed in any of the 4 groups or in any of the 274 patients during the follow-up period. The statistical analysis, comparing group 1 and the other groups, revealed a highly significant statistical difference (P esthetic results in benign parotid surgery. The evaluation of functional complications and the recurrence rate in this series of patients has confirmed that this technique can be safely

  17. Adult emergency department patients with sickle cell pain crisis: results from a quality improvement learning collaborative model to improve analgesic management.

    Science.gov (United States)

    Tanabe, Paula; Hafner, John W; Martinovich, Zoran; Artz, Nicole

    2012-04-01

    The aims of this study were to 1) estimate differences in pain management process and patient-reported outcomes, pre- and postimplementation of analgesic protocols for adults with sickle cell disease (SCD), and 2) examine the effects of site and visit frequency on changes in pain scores and time to analgesic. A multicenter, prospective, longitudinal study enrolled patients from three academic medical centers between October 2007 and September 2009. All ED patients 18 years or older with a chief complaint of a sickle cell pain episode were enrolled. Sites formed a SCD quality improvement (QI) team and implemented standard nurse-initiated emergency department (ED) analgesic protocols; outcomes were compared between study periods defined as pre- and postimplementation of protocols. Medical record review was conducted to measure time to administration of initial analgesic, opioids used, route of opioid administration, the change in pain scores from arrival to discharge (negative numbers reflect a decrease in pain scores), and the number of ED visits per individual patient during the study period at each site. On day 7 after the ED visit, a follow-up phone interview was conducted. Patients were queried about their ED pain management using a scale from 1 to 10 (1 = outstanding, 10 = worst). Descriptive statistics are used to report the results. Ordinary least-squares regression models were constructed to measure the effect of time period, site, and number of visits per patient on change in pain score. During the study period, 342 unique patients (57% female, mean ± SD age = 32 ± 11 years) were enrolled and had a total of 2,934 visits. There was no difference in time to administration of the initial analgesic between study periods. Overall, there was a significant decrease in pain scores from arrival to discharge between the pre- and postintervention study periods: the average difference in arrival to discharge pain scores (cm) was greater during the postimplementation

  18. Pyramiding of transgenic Pm3 alleles in wheat results in improved powdery mildew resistance in the field.

    Science.gov (United States)

    Koller, Teresa; Brunner, Susanne; Herren, Gerhard; Hurni, Severine; Keller, Beat

    2018-04-01

    The combined effects of enhanced total transgene expression level and allele-specificity combination in transgenic allele-pyramided Pm3 wheat lines result in improved powdery mildew field resistance without negative pleiotropic effects. Allelic Pm3 resistance genes of wheat confer race-specific resistance to powdery mildew (Blumeria graminis f. sp. tritici, Bgt) and encode nucleotide-binding domain, leucine-rich repeat (NLR) receptors. Transgenic wheat lines overexpressing alleles Pm3a, b, c, d, f, and g have previously been generated by transformation of cultivar Bobwhite and tested in field trials, revealing varying degrees of powdery mildew resistance conferred by the transgenes. Here, we tested four transgenic lines each carrying two pyramided Pm3 alleles, which were generated by crossbreeding of lines transformed with single Pm3 alleles. All four allele-pyramided lines showed strongly improved powdery mildew resistance in the field compared to their parental lines. The improved resistance results from the two effects of enhanced total transgene expression levels and allele-specificity combinations. In contrast to leaf segment tests on greenhouse-grown seedlings, no allelic suppression was observed in the field. Plant development and yield scores of the pyramided lines were similar to the mean scores of the corresponding parental lines, and thus, the allele pyramiding did not cause any negative effects. On the contrary, in pyramided line, Pm3b × Pm3f normal plant development was restored compared to the delayed development and reduced seed set of parental line Pm3f. Allele-specific RT qPCR revealed additive transgene expression levels of the two Pm3 alleles in the pyramided lines. A positive correlation between total transgene expression level and powdery mildew field resistance was observed. In summary, allele pyramiding of Pm3 transgenes proved to be successful in enhancing powdery mildew field resistance.

  19. A memory and organizational aid improves Alzheimer disease research consent capacity: results of a randomized, controlled trial.

    Science.gov (United States)

    Rubright, Jonathan; Sankar, Pamela; Casarett, David J; Gur, Ruben; Xie, Sharon X; Karlawish, Jason

    2010-12-01

    Early and progressive cognitive impairments of patients with Alzheimer disease (AD) hinder their capacity to provide informed consent. Unfortunately, the limited research on techniques to improve capacity has shown mixed results. Therefore, the authors tested whether a memory and organizational aid improves the performance of patients with AD on measures of capacity and competency to give informed consent. Patients with AD randomly assigned to standard consent or standard plus a memory and organizational aid. Memory and organizational aid summarized the content of information mandated under the informed consent disclosure requirements of the Common Rule at a sixth grade reading level. Three psychiatrists without access to patient data independently reviewed MacArthur Competence Assessment Tool for Clinical Research (MacCAT-CR) interview transcripts to judge whether the patient was capable of providing informed consent. The agreement of at least two of the three experts defined a participant as capable of providing informed consent. Secondary outcomes are MacCAT-CR measures of understanding, appreciation and reasoning, and comparison with cognitively normal older adult norms. AD intervention and control groups were similar in terms of age, education, and cognitive status. The intervention group was more likely to be judged competent than control group and had higher scores on MacCAT-CR measure of understanding. The intervention had no effect on the measures of appreciation or reasoning. A consent process that addresses the deficits in memory and attention of a patient with AD can improve capacity to give informed consent for early phase AD research. The results also validate the MacCAT-CR as an instrument to measure capacity, especially the understanding subscale. ClinicalTrials.Gov#NCT00105612, http://clinicaltrials.gov/show/NCT00105612.

  20. RESEARCH ON CUSTOMER SATISFACTION DEGREE AT THE STORE MOBEXPERT PITEŞTI, IN ORDER TO IMPROVE THE SALES RESULTS

    Directory of Open Access Journals (Sweden)

    BRUTU MĂDĂLINA

    2015-07-01

    Full Text Available This paper presents a detailed research of customer satisfaction at the store Mobexpert Pitesti, in order to identify the main causes that led to their possible dissatisfaction. Starting from these results, the paper also aims at identifying a range of solutions designed to improve sales activity. Therefore we defined the research purpose and objectives, designed the questionnaire, defined the variables and established the research hypotheses. The sample of research consisted of the customers of the store Mobexpert Pitesti, men and women aged between 18 and over 55, with middle, high and very high incomes. A single operator collected the data inside Mobexpert Piteşti for two days, using a 3 minute questionnaire. Analyzing the research results, we conclude that there is a high degree of customer satisfaction for the store Mobexpert Piteşti, that it can be further increased by applying the following improvement directions: increasing service quality, better customer understanding, training the sales force through e-learning, motivating the sales force more effectively through a satisfactory system of salaries and bonuses and, not least, increasing the impact of marketing actions.

  1. Desmopressin (melt) therapy in children with monosymptomatic nocturnal enuresis and nocturnal polyuria results in improved neuropsychological functioning and sleep.

    Science.gov (United States)

    Van Herzeele, Charlotte; Dhondt, Karlien; Roels, Sanne P; Raes, Ann; Hoebeke, Piet; Groen, Luitzen-Albert; Vande Walle, Johan

    2016-09-01

    There is a high comorbidity between nocturnal enuresis, sleep disorders and psychological problems. The aim of this study was to investigate whether a decrease in nocturnal diuresis volume not only improves enuresis but also ameliorates disrupted sleep and (neuro)psychological dysfunction, the major comorbidities of this disorder. In this open-label, prospective phase IV study, 30 children with monosymptomatic nocturnal enuresis (MNE) underwent standardized video-polysomnographic testing and multi-informant (neuro)psychological testing at baseline and 6 months after the start of desmopressin treatment in the University Hospital Ghent, Belgium. Primary endpoints were the effect on sleep and (neuro)psychological functioning. The secondary endpoint was the change in the first undisturbed sleep period or the time to the first void. Thirty children aged between 6 and 16 (mean 10.43, standard deviation 3.08) years completed the study. The results demonstrated a significant decrease in periodic limb movements during sleep (PLMS) and a prolonged first undisturbed sleep period. Additionally, (neuro)psychological functioning was improved on several domains. The study demonstrates that the degree of comorbidity symptoms is at least aggravated by enuresis (and/or high nocturnal diuresis rate) since sleep and (neuro)psychological functioning were significantly ameliorated by treatment of enuresis. These results indicate that enuresis is not such a benign condition as has previously been assumed.

  2. Use of a surgical rehearsal platform and improvement in aneurysm clipping measures: results of a prospective, randomized trial.

    Science.gov (United States)

    Chugh, A Jessey; Pace, Jonathan R; Singer, Justin; Tatsuoka, Curtis; Hoffer, Alan; Selman, Warren R; Bambakidis, Nicholas C

    2017-03-01

    OBJECTIVE The field of neurosurgery is constantly undergoing improvements and advances, both in technique and technology. Cerebrovascular neurosurgery is no exception, with endovascular treatments changing the treatment paradigm. Clipping of aneurysms is still necessary, however, and advances are still being made to improve patient outcomes within the microsurgical treatment of aneurysms. Surgical rehearsal platforms are surgical simulators that offer the opportunity to rehearse a procedure prior to entering the operative suite. This study is designed to determine whether use of a surgical rehearsal platform in aneurysm surgery is helpful in decreasing aneurysm dissection time and clip manipulation of the aneurysm. METHODS The authors conducted a blinded, prospective, randomized study comparing key effort and time variables in aneurysm clip ligation surgery with and without preoperative use of the SuRgical Planner (SRP) surgical rehearsal platform. Initially, 40 patients were randomly assigned to either of two groups: one in which surgery was performed after use of the SRP (SRP group) and one in which surgery was performed without use of the SRP (control group). All operations were videotaped. After exclusion of 6 patients from the SRP group and 9 from the control group, a total of 25 surgical cases were analyzed by a reviewer blinded to group assignment. The videos were analyzed for total microsurgical time, number of clips used, and number of clip placement attempts. Means and standard deviations (SDs) were calculated and compared between groups. RESULTS The mean (± SD) amount of operative time per clip used was 920 ± 770 seconds in the SRP group and 1294 ± 678 seconds in the control group (p = 0.05). In addition, the mean values for the number of clip attempts, total operative time, ratio of clip attempts to clips used, and time per clip attempt were all lower in the SRP group, although the between-group differences were not statistically significant

  3. Too little but not too late: results of a literature review to improve routine immunization programs in developing countries.

    Science.gov (United States)

    Ryman, Tove K; Dietz, Vance; Cairns, K Lisa

    2008-06-21

    Globally, immunization services have been the center of renewed interest with increased funding to improve services, acceleration of the introduction of new vaccines, and the development of a health systems approach to improve vaccine delivery. Much of the credit for the increased attention is due to the work of the GAVI Alliance and to new funding streams. If routine immunization programs are to take full advantage of the newly available resources, managers need to understand the range of proven strategies and approaches to deliver vaccines to reduce the incidence of diseases. In this paper, we present strategies that may be used at the sub-national level to improve routine immunization programs. We conducted a systematic review of studies and projects reported in the published and gray literature. Each paper that met our inclusion criteria was rated based on methodological rigor and data were systematically abstracted. Routine-immunization - specific papers with a methodological rigor rating of greater than 60% and with conclusive results were reported. Greater than 11,000 papers were identified, of which 60 met our inclusion criteria and 25 papers were reported. Papers were grouped into four strategy approaches: bringing immunizations closer to communities (n = 11), using information dissemination to increase demand for vaccination (n = 3), changing practices in fixed sites (n = 4), and using innovative management practices (n = 7). Immunization programs are at a historical crossroads in terms of developing new funding streams, introducing new vaccines, and responding to the global interest in the health systems approach to improving immunization delivery. However, to complement this, actual service delivery needs to be strengthened and program managers must be aware of proven strategies. Much was learned from the 25 papers, such as the use of non-health workers to provide numerous services at the community level. However it was startling to see how few papers

  4. Physical activity within a CBT intervention improves coping with pain in traumatized refugees: results of a randomized controlled design.

    Science.gov (United States)

    Liedl, Alexandra; Müller, Julia; Morina, Naser; Karl, Anke; Denke, Claudia; Knaevelsrud, Christine

    2011-02-01

    Many traumatized refugees experience both posttraumatic stress disorder and chronic pain. Based on Mutual Maintenance Theory and the Perpetual Avoidance Model, this study examined the additional effect of physical activity within a biofeedback-based cognitive behavioral therapy (CBT-BF) for traumatized refugees. In a controlled design, 36 patients were randomized into one of three conditions (CBT-BF, CBT-BF with physical activity [CBT-BF+active], and a waiting list control group [WL]). Thirty patients (n=10 in each group) completed the treatment and a follow-up assessment 3 months later. Participants' coping strategies, pain and mental health status, and physiological reactivity were assessed before and after the intervention and at 3-month follow-up. Treatment effects were analyzed using analyses of variance with baseline scores as covariates (ANCOVAs) and the Reliable Change Index. The CBT-BF and CBT-BF+active groups showed improvements in all outcome measures relative to the WL group. The effect sizes for the main outcome measures were higher in the CBT-BF+active group than in the CBT-BF group. Repeated measures analyses of covariance showed significant group effects for coping strategies--in particular, for the "cognitive restructuring" and "counter-activities" subscales as well as a marginally significant group effect for "perceived self-competence"--with the CBT-BF+active group showing more favorable outcomes than the CBT-BF group. Moreover, 60% of participants in the CBT-BF+active group showed clinically reliable intraindividual change in at least one subscale of the pain coping strategies questionnaire, compared with just 30% of participants in the CBT-BF group. Findings of improved coping strategies, larger effect sizes, and higher rates of clinical improvement in the CBT-BF+active group suggest that physical activity adds value to pain management interventions for traumatized refugees. Given the small sample size, however, these preliminary results need

  5. USING A MULTIFACETED APPROACH TO IMPROVE THE FOLLOW-UP OF POSITIVE FECAL OCCULT BLOOD TEST RESULTS

    Science.gov (United States)

    Singh, Hardeep; Kadiyala, Himabindu; Bhagwath, Gayathri; Shethia, Anila; El-Serag, Hashem; Walder, Annette; Velez, Maria; Petersen, Laura A.

    2010-01-01

    Background Inadequate follow-up of abnormal fecal occult blood test (FOBT) results occurs in several types of practice settings. Our institution implemented multifaceted quality improvement (QI) activities in 2004–2005 to improve follow-up of FOBT positive results. Activities addressed pre-colonoscopy referral processes and system-level factors such as electronic communication and provider education and feedback. We evaluated their effects on timeliness and appropriateness of positive FOBT follow-up and identified factors that affect colonoscopy performance. Methods Retrospective electronic medical record (EMR) review was used to determine outcomes pre- and post-QI activities in a multi-specialty ambulatory clinic of a tertiary care Veterans Affairs facility and its affiliated satellite clinics. From 1869 FOBT positive cases, 800 were randomly selected from time periods before and after QI activities. Two reviewers used a pretested standardized data collection form to determine whether colonoscopy was appropriate or indicated based on pre-determined criteria and if so, the timeliness of colonoscopy referral and performance pre- and post-QI activities. Results In cases where a colonoscopy was indicated, the proportion of patients who received a timely colonoscopy referral and performance were significantly higher post implementation (60.5% vs. 31.7%, pperformance (6 vs. 19 days pperformance of an indicated colonoscopy included performance of a non-colonoscopy procedure such as barium enema or flexible sigmoidoscopy (OR=16.9; 95% CI 1.9–145.1), patient non-adherence (OR=33.9; 95% CI 17.3–66.6), not providing an appropriate provisional diagnosis on the consultation (OR= 17.9; 95% CI 11.3–28.1) and gastroenterology service not rescheduling colonoscopies after an initial cancellation (OR= 11.0; 95% CI 5.1–23.7) Conclusions Multifaceted QI activities improved rates of timely colonoscopy referral and performance in an EMR system. However, colonoscopy was not

  6. Transposition of the great arteries

    Directory of Open Access Journals (Sweden)

    Castela Eduardo

    2008-10-01

    Full Text Available Abstract Transposition of the great arteries (TGA, also referred to as complete transposition, is a congenital cardiac malformation characterised by atrioventricular concordance and ventriculoarterial (VA discordance. The incidence is estimated at 1 in 3,500–5,000 live births, with a male-to-female ratio 1.5 to 3.2:1. In 50% of cases, the VA discordance is an isolated finding. In 10% of cases, TGA is associated with noncardiac malformations. The association with other cardiac malformations such as ventricular septal defect (VSD and left ventricular outflow tract obstruction is frequent and dictates timing and clinical presentation, which consists of cyanosis with or without congestive heart failure. The onset and severity depend on anatomical and functional variants that influence the degree of mixing between the two circulations. If no obstructive lesions are present and there is a large VSD, cyanosis may go undetected and only be perceived during episodes of crying or agitation. In these cases, signs of congestive heart failure prevail. The exact aetiology remains unknown. Some associated risk factors (gestational diabetes mellitus, maternal exposure to rodenticides and herbicides, maternal use of antiepileptic drugs have been postulated. Mutations in growth differentiation factor-1 gene, the thyroid hormone receptor-associated protein-2 gene and the gene encoding the cryptic protein have been shown implicated in discordant VA connections, but they explain only a small minority of TGA cases. The diagnosis is confirmed by echocardiography, which also provides the morphological details required for future surgical management. Prenatal diagnosis by foetal echocardiography is possible and desirable, as it may improve the early neonatal management and reduce morbidity and mortality. Differential diagnosis includes other causes of central neonatal cyanosis. Palliative treatment with prostaglandin E1 and balloon atrial septostomy are usually

  7. A 20-week program of resistance or concurrent exercise improves symptoms of schizophrenia: results of a blind, randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Bruna Andrade e Silva

    2015-01-01

    Full Text Available Objective:To evaluate the effects of 20 weeks of resistance and concurrent training on psychotic and depressive symptoms, quality of life outcomes, and serum IGF-1, IGFBP-3, and brain-derived neurotrophic factor (BDNF concentrations in patients with schizophrenia.Methods:In this blind, randomized controlled clinical trial, 34 patients with schizophrenia were assigned to one of three groups: control (CTRL, n=13, resistance exercise (RESEX, n=12, or concurrent exercise (CONCEX, n=9. Symptoms, quality of life, strength, and other variables were assessed.Results:A significant time-by-group interaction was found for the RESEX and CONCEX groups on the Positive and Negative Syndrome Scale (PANSS total score for disease symptoms (p = 0.007, positive symptoms (p = 0.003, and on the arm extension one-repetition maximum (1RM test (p = 0.016. In addition, significant improvements on negative symptoms (p = 0.027, on the role-physical domain of the Short Form-36 Health Survey (p = 0.019, and on the chest press 1RM test (p = 0.040 were observed in the RESEX group. No changes were observed for the other variables investigated.Conclusions:In this sample of patients with schizophrenia, 20 weeks of resistance or concurrent exercise program improved disease symptoms, strength, and quality of life. ClinicalTrials.gov: NCT01674543.

  8. Improving follow-up of abnormal cancer screens using electronic health records: trust but verify test result communication

    Directory of Open Access Journals (Sweden)

    Reis Brian

    2009-12-01

    Full Text Available Abstract Background Early detection of colorectal cancer through timely follow-up of positive Fecal Occult Blood Tests (FOBTs remains a challenge. In our previous work, we found 40% of positive FOBT results eligible for colonoscopy had no documented response by a treating clinician at two weeks despite procedures for electronic result notification. We determined if technical and/or workflow-related aspects of automated communication in the electronic health record could lead to the lack of response. Methods Using both qualitative and quantitative methods, we evaluated positive FOBT communication in the electronic health record of a large, urban facility between May 2008 and March 2009. We identified the source of test result communication breakdown, and developed an intervention to fix the problem. Explicit medical record reviews measured timely follow-up (defined as response within 30 days of positive FOBT pre- and post-intervention. Results Data from 11 interviews and tracking information from 490 FOBT alerts revealed that the software intended to alert primary care practitioners (PCPs of positive FOBT results was not configured correctly and over a third of positive FOBTs were not transmitted to PCPs. Upon correction of the technical problem, lack of timely follow-up decreased immediately from 29.9% to 5.4% (p Conclusion Electronic communication of positive FOBT results should be monitored to avoid limiting colorectal cancer screening benefits. Robust quality assurance and oversight systems are needed to achieve this. Our methods may be useful for others seeking to improve follow-up of FOBTs in their systems.

  9. Great Lakes Environmental Research Laboratory

    Data.gov (United States)

    Federal Laboratory Consortium — NOAA-GLERL and its partners conduct innovative research on the dynamic environments and ecosystems of the Great Lakes and coastal regions to provide information for...

  10. What Caused the Great Recession?

    OpenAIRE

    Homburg, Stefan

    2014-01-01

    This paper examines five possible explanations for the Great Recession of 2008 and 2009, using data for the United States and the eurozone. Of these five hypotheses, four are not supported by the data, while the fifth appears reasonable.

  11. Arthroscopy of the great toe

    NARCIS (Netherlands)

    Frey, C.; van Dijk, C. N.

    1999-01-01

    The few available reports of arthroscopic treatment of the first MTP joint in the literature indicate favorable outcome. However, arthroscopy of the great toe is an advanced technique and should only be undertaken by experienced surgeons

  12. Conversion of radwaste-loaded zeolites into a borosilicate glass to improve their properties for final disposal (preliminary results)

    International Nuclear Information System (INIS)

    Kazemian, H.; Ghannadi Maraghe, M.; Mallah, M.H.; Firooz Zare, M.; Kooshkestani, R.; Naghavi, S.Sh.

    2002-01-01

    Research was undertaken to fix radioisotopes from simulated nuclear waste streams into durable and stable borosilicate glass matrices based on the conversion of different type of zeolites. It was found that the selectivity of Iranian clinoptilolite and the relevant synthetic zeolite toward cesium and strontium were quite good whereas the leach resistance of the loaded zeolite was relatively poor. To improve the leach resistance of the used zeolites, conversion of the spent exchangers into borosilicate glass was investigated. Results obtained in the non active bench scale tests phase were promising. It is concluded that spent zeolites loaded with radioactive materials can be converted into a durable, high leach resistant borosilicate glass, a proper matrix for final disposal of nuclear waste. (author)

  13. The Sixth Great Mass Extinction

    Science.gov (United States)

    Wagler, Ron

    2012-01-01

    Five past great mass extinctions have occurred during Earth's history. Humanity is currently in the midst of a sixth, human-induced great mass extinction of plant and animal life (e.g., Alroy 2008; Jackson 2008; Lewis 2006; McDaniel and Borton 2002; Rockstrom et al. 2009; Rohr et al. 2008; Steffen, Crutzen, and McNeill 2007; Thomas et al. 2004;…

  14. Results of speech improvement following simultaneous push-back together with velopharyngeal flap surgery in cleft palate patients.

    Science.gov (United States)

    Wermker, Kai; Lünenbürger, Henning; Joos, Ulrich; Kleinheinz, Johannes; Jung, Susanne

    2014-07-01

    Velopharyngeal insufficiency (VPI) can be caused by a variety of disorders. The most common cause of VPI is the association with cleft palate. The aim of this study was to evaluate the effectiveness of different surgical techniques for cleft palate patients with VPI: (1) velopharyngoplasty with an inferiorly based posterior pharyngeal flap (VPP posterior, Schönborn-Rosenthal), and (2) combination of VPP posterior and push-back operation (Dorrance). 41 subjects (26 females, 15 males) with VPI were analysed. Hypernasality was judged subjectively and nasalance data were assessed objectively using the NasalView system preoperative and 6 months postoperative. Subjective analysis showed improved speech results regarding hypernasality for all OP-techniques with good results for VPP posterior and VPP posterior combined with push-back with success rates of 94.4% and 87.7%, respectively. Objective analysis showed a statistically significant reduction of nasalance for both VPP posterior and VPP posterior combined with push-back (p push-back. Based on our findings, both VPP posterior and VPP posterior combined with push-back showed good results in correction of hypernasality in cleft patients with velopharyngeal insufficiency. Copyright © 2013 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

  15. Improving work-up of the abnormal mammogram through organized assessment: results from the ontario breast screening program.

    Science.gov (United States)

    Quan, May Lynn; Shumak, Rene S; Majpruz, Vicky; Holloway, Claire M D; O'Malley, Frances P; Chiarelli, Anna M

    2012-03-01

    Women with an abnormal screening mammogram should ideally undergo an organized assessment to attain a timely diagnosis. This study evaluated outcomes of women undergoing work-up after abnormal mammogram through a formal breast assessment affiliate (BAA) program with explicit care pathways compared with usual care (UC) using developed quality indicators for screening mammography programs. Between January 1 and December 31, 2007, a total of 320,635 women underwent a screening mammogram through the Ontario Breast Screening Program (OBSP), of whom 25,543 had an abnormal result requiring further assessment. Established indicators assessing timeliness, appropriateness of follow-up, and biopsy rates were compared between women who were assessed through either a BAA or UC using χ(2) analysis. Work-up of the abnormal mammogram for patients screened through a BAA resulted in a greater proportion of women attaining a definitive diagnosis within the recommended time interval when a histologic diagnosis was required. In addition, use of other quality measures including specimen radiography for both core biopsies and surgical specimens and preoperative core needle biopsy was greater in BAA facilities. These findings support future efforts to increase the number of BAAs within the OBSP, because the pathways and reporting methods associated with them result in improvements in our ability to provide timely and appropriate care for women requiring work-up of an abnormal mammogram.

  16. Coverage of Large-Scale Food Fortification of Edible Oil, Wheat Flour, and Maize Flour Varies Greatly by Vehicle and Country but Is Consistently Lower among the Most Vulnerable: Results from Coverage Surveys in 8 Countries.

    Science.gov (United States)

    Aaron, Grant J; Friesen, Valerie M; Jungjohann, Svenja; Garrett, Greg S; Neufeld, Lynnette M; Myatt, Mark

    2017-05-01

    Background: Large-scale food fortification (LSFF) of commonly consumed food vehicles is widely implemented in low- and middle-income countries. Many programs have monitoring information gaps and most countries fail to assess program coverage. Objective: The aim of this work was to present LSFF coverage survey findings (overall and in vulnerable populations) from 18 programs (7 wheat flour, 4 maize flour, and 7 edible oil programs) conducted in 8 countries between 2013 and 2015. Methods: A Fortification Assessment Coverage Toolkit (FACT) was developed to standardize the assessments. Three indicators were used to assess the relations between coverage and vulnerability: 1 ) poverty, 2 ) poor dietary diversity, and 3 ) rural residence. Three measures of coverage were assessed: 1 ) consumption of the vehicle, 2 ) consumption of a fortifiable vehicle, and 3 ) consumption of a fortified vehicle. Individual program performance was assessed based on the following: 1 ) achieving overall coverage ≥50%, 2) achieving coverage of ≥75% in ≥1 vulnerable group, and 3 ) achieving equity in coverage for ≥1 vulnerable group. Results: Coverage varied widely by food vehicle and country. Only 2 of the 18 LSFF programs assessed met all 3 program performance criteria. The 2 main program bottlenecks were a poor choice of vehicle and failure to fortify a fortifiable vehicle (i.e., absence of fortification). Conclusions: The results highlight the importance of sound program design and routine monitoring and evaluation. There is strong evidence of the impact and cost-effectiveness of LSFF; however, impact can only be achieved when the necessary activities and processes during program design and implementation are followed. The FACT approach fills an important gap in the availability of standardized tools. The LSFF programs assessed here need to be re-evaluated to determine whether to further invest in the programs, whether other vehicles are appropriate, and whether other approaches

  17. Coverage of Large-Scale Food Fortification of Edible Oil, Wheat Flour, and Maize Flour Varies Greatly by Vehicle and Country but Is Consistently Lower among the Most Vulnerable: Results from Coverage Surveys in 8 Countries123

    Science.gov (United States)

    Aaron, Grant J; Friesen, Valerie M; Jungjohann, Svenja; Garrett, Greg S; Myatt, Mark

    2017-01-01

    Background: Large-scale food fortification (LSFF) of commonly consumed food vehicles is widely implemented in low- and middle-income countries. Many programs have monitoring information gaps and most countries fail to assess program coverage. Objective: The aim of this work was to present LSFF coverage survey findings (overall and in vulnerable populations) from 18 programs (7 wheat flour, 4 maize flour, and 7 edible oil programs) conducted in 8 countries between 2013 and 2015. Methods: A Fortification Assessment Coverage Toolkit (FACT) was developed to standardize the assessments. Three indicators were used to assess the relations between coverage and vulnerability: 1) poverty, 2) poor dietary diversity, and 3) rural residence. Three measures of coverage were assessed: 1) consumption of the vehicle, 2) consumption of a fortifiable vehicle, and 3) consumption of a fortified vehicle. Individual program performance was assessed based on the following: 1) achieving overall coverage ≥50%, 2) achieving coverage of ≥75% in ≥1 vulnerable group, and 3) achieving equity in coverage for ≥1 vulnerable group. Results: Coverage varied widely by food vehicle and country. Only 2 of the 18 LSFF programs assessed met all 3 program performance criteria. The 2 main program bottlenecks were a poor choice of vehicle and failure to fortify a fortifiable vehicle (i.e., absence of fortification). Conclusions: The results highlight the importance of sound program design and routine monitoring and evaluation. There is strong evidence of the impact and cost-effectiveness of LSFF; however, impact can only be achieved when the necessary activities and processes during program design and implementation are followed. The FACT approach fills an important gap in the availability of standardized tools. The LSFF programs assessed here need to be re-evaluated to determine whether to further invest in the programs, whether other vehicles are appropriate, and whether other approaches are needed

  18. How genetic data improve the interpretation of results of faecal glucocorticoid metabolite measurements in a free-living population.

    Directory of Open Access Journals (Sweden)

    Maik Rehnus

    Full Text Available Measurement of glucocorticoid metabolites (GCM in faeces has become a widely used and effective tool for evaluating the amount of stress experienced by animals. However, the potential sampling bias resulting from an oversampling of individuals when collecting "anonymous" (unknown sex or individual faeces has rarely been investigated. We used non-invasive genetic sampling (NIGS to investigate potential interpretation errors of GCM measurements in a free-living population of mountain hares during the mating and post-reproductive periods. Genetic data improved the interpretation of results of faecal GCM measurements. In general GCM concentrations were influenced by season. However, genetic information revealed that it was sex-dependent. Within the mating period, females had higher GCM levels than males, but individual differences were more expressed in males. In the post-reproductive period, GCM concentrations were neither influenced by sex nor individual. We also identified potential pitfalls in the interpretation of anonymous faecal samples by individual differences in GCM concentrations and resampling rates. Our study showed that sex- and individual-dependent GCM levels led to a misinterpretation of GCM values when collecting "anonymous" faeces. To accurately evaluate the amount of stress experienced by free-living animals using faecal GCM measurements, we recommend documenting individuals and their sex of the sampled population. In stress-sensitive and elusive species, such documentation can be achieved by using NIGS and for diurnal animals with sexual and individual variation in appearance or marked individuals, it can be provided by a detailed field protocol.

  19. Does teaching of documentation of shoulder dystocia delivery through simulation result in improved documentation in real life?

    Science.gov (United States)

    Comeau, Robyn; Craig, Catherine

    2014-03-01

    Documentation of deliveries complicated by shoulder dystocia is a valuable communication skill necessary for residents to attain during residency training. Our objective was to determine whether the teaching of documentation of shoulder dystocia in a simulation environment would translate to improved documentation of the event in an actual clinical situation. We conducted a cohort study involving obstetrics and gynaecology residents in years 2 to 5 between November 2010 and December 2012. Each resident participated in a shoulder dystocia simulation teaching session and was asked to write a delivery note immediately afterwards. They were given feedback regarding their performance of the delivery and their documentation of the events. Following this, dictated records of shoulder dystocia deliveries immediately before and after the simulation session were identified through the Meditech system. An itemized checklist was used to assess the quality of residents' dictated documentation before and after the simulation session. All eligible residents (18) enrolled in the study, and 17 met the inclusion criteria. For 10 residents (59%) documentation of a delivery with shoulder dystocia was present before and after the simulation session, for five residents (29%) it was only present before the session, and for two residents (18%) it was only present after the session. When residents were assessed as a group, there were no differences in the proportion of residents recording items on the checklist before and after the simulation session (P > 0.05 for all). Similarly, analysis of the performance of the10 residents who had dictated documentation both before and after the session showed no differences in the number of elements recorded on dictations done before and after the simulation session (P > 0.05 for all). The teaching of shoulder dystocia documentation through simulation did not result in a measurable improvement in the quality of documentation of shoulder dystocia in

  20. Effectiveness of psycho-educational intervention in improving outcome of unipolar depression: results from a randomised clinical trial.

    Science.gov (United States)

    Kumar, K; Gupta, M

    2015-03-01

    Depressive disorders are one of the leading components of the global burden of disease with a prevalence of up to 14% in the general population. Numerous studies have demonstrated that pharmacotherapy combined with non-pharmacological measures offer the best treatment approach. Psycho-education as an intervention has been studied mostly in disorders such as schizophrenia and dementia, less so in depressive disorders. The present study aimed to assess the impact of psycho-education of patients and their caregivers on the outcome of depression. A total of 80 eligible depressed subjects were recruited and randomised into 2 groups. The study group involved an eligible family member and all were offered individual structured psycho-educational modules. Another group (controls) received routine counselling. The subjects in both groups also received routine pharmacotherapy and counselling from the treating clinician and were assessed at baseline, 2, 4, 8, and 12 weeks using the Hamilton Depression Rating Scale (HDRS), Global Assessment of Functioning (GAF), and Psychological General Well-Being Index (PGWBI). Results from both groups were compared using statistical methods including Chi-square test, Fisher's exact test, Student's t test, Pearson's correlation coefficient, as well as univariate and multiple regression analyses. Baseline socio-demographic and assessment measures were similar in both groups. The study group had consistent improvement in terms of outcome measures with HDRS, GAF, and PGWBI scores showing respective mean change of -15.08, 22, and 60 over 12 weeks. The comparable respective changes in the controls were -8.77, 18.1, and 43.25. Structured psycho-education combined with pharmacotherapy is an effective intervention for people with depressive disorders. Psycho-education optimises the pharmacological treatment of depression in terms of faster recovery, reduction in severity of depression, and improvement in subjective wellbeing and social functioning.

  1. Results from a national survey of Crown prosecutors and defense counsel on impaired driving in Canada: a "System Improvements" perspective.

    Science.gov (United States)

    Robertson, Robyn; Vanlaar, Ward; Simpson, Herb; Boase, Paul

    2009-01-01

    This article summarizes the main findings from a study designed to examine the legal process in Canada as it applies to alcohol-impaired driving from the point of view of Crown prosecutors and defense counsel, and to identify evidentiary or procedural factors that may impact the legal process, the rights of the accused, and interactions of all parts in the legal process. The data in this study were collected by means of a survey that was mailed out to the population of Crown prosecutors and defense counsel in Canada. In total, 765 prosecutors and 270 defense lawyers or an estimated 33% of all Canadian prosecutors and 15% of defense lawyers completed and returned the questionnaire. The "systems improvement" paradigm was used to interpret the findings and draw conclusions. Such an approach acknowledges the importance of the context in which countermeasures are implemented and delivered and the structures or entities used to deliver countermeasures to a designated target group. Results on type of charges and breath alcohol concentration, caseload, case outcomes, case preparation time, conviction rate at trial and overall conviction rate, reasons for acquittals and time to resolve cases are described. The findings from this national survey suggest that there are important challenges within the criminal justice system that impede the effective and efficient processing of impaired driving cases. Some of these challenges occur as a function of practices and policies, while others occur as a function of legislation. This study illustrates that a "system improvements" approach that acknowledges the importance of all elements of the criminal justice system and the interaction between those elements, can be beneficial in overcoming the alcohol-impaired driving problem.

  2. State Government Revenue Recovery from the Great Recession

    OpenAIRE

    James Alm; David L. Sjoquist

    2014-01-01

    The "Great Recession" lasted from December 2007 to June 2009, and it wreaked havoc on the revenues of state (and local) governments. While the U.S. economy has improved since the end of the Great Recession, state government revenues have in most cases still not completely recovered. We use various indicators to measure how different states have -- or have not -- recovered in the aftermath of the Great Recession, and we also attempt to explain why these different patterns of recovery have emer...

  3. Great Basin Factsheet Series 2016 - Information and tools to restore and conserve Great Basin ecosystems

    Science.gov (United States)

    Jeanne C. Chambers

    2016-01-01

    Land managers are responsible for developing effective strategies for conserving and restoring Great Basin ecosystems in the face of invasive species, conifer expansion, and altered fire regimes. A warming climate is magnifying the effects of these threats and adding urgency to implementation of management practices that will maintain or improve ecosystem...

  4. Improvement of production layout based on optimum production balancing scale results by using Moodie Young and Comsoal method

    Science.gov (United States)

    Ikhsan, Siregar; Ulina Anastasia Sipangkar, Tri; Prasetio, Aji

    2017-09-01

    This research was conducted at a make to order production system company which is engaged in the car body of the vehicle. One of the products produced is dump truck which is one kind of transportation for the transport of goods equipped with hydraulics to facilitate goods’ loading and unloading process. The company has 7 work stations with different cycle times. Companies often experience delays in order delivery. The production process on the production floor has not been done optimally where there is a build up of work in process in some work centres. The build up of work in process (WIP) products is seen in the welding and painting stations. Stacking that occurs on the production line may cause the company to be liable for damages due to delays in product completion. The WIP occurs due to unbalanced paths can be seen from the variance of cycle time of each station is very diverse. The time difference of each work element is due to the allocation of work elements to each work centre unevenly. On the basis of the allocation of uneven work elements, the dump truck assembly line is made. The analysis is done by using Moodie Young and Comsoal method to do the balancing of production line. The result of layout improvement by using systematic layout planning (SLP) method is change the composition of the work centre from 7 into 4 work centre which enables the movement of material to be more effective and efficient so that it can get an efficient and effective production trajectory and can solve existing problems. The result of the track balancing is then used as a guide in constructing a new layout based on the balancing result with the most optimum method.

  5. Absence of fks1p in lager brewing yeast results in aberrant cell wall composition and improved beer flavor stability.

    Science.gov (United States)

    Wang, Jin-jing; Xu, Wei-na; Li, Xin'er; Li, Jia; Li, Qi

    2014-06-01

    The flavor stability during storage is very important to the freshness and shelf life of beer. However, beer fermented with a yeast strain which is prone to autolyze will significantly affect the flavor of product. In this study, the gene encoding β-1,3-glucan synthetase catalytic subunit (fks1) of the lager yeast was destroyed via self-clone strategy. β-1,3-glucan is the principle cell wall component, so fks1 disruption caused a decrease in β-1,3-glucan level and increase in chitin level in cell wall, resulting in the increased cell wall thickness. Comparing with wild-type strain, the mutant strain had 39.9 and 63.41 % less leakage of octanoic acid and decanoic acid which would significantly affect the flavor of beer during storage. Moreover, the results of European Brewery Convention tube fermentation test showed that the genetic manipulation to the industrial brewing yeast helped with the anti-staling ability, rather than affecting the fermentation ability. The thiobarbituric acid value reduced by 65.59 %, and the resistant staling value increased by 26.56 %. Moreover, the anti-staling index of the beer fermented with mutant strain increased by 2.64-fold than that from wild-type strain respectively. China has the most production and consumption of beer around the world, so the quality of beer has a significant impact on Chinese beer industry. The result of this study could help with the improvement of the quality of beer in China as well as around the world.

  6. Integrated care for patients with a stroke in the Netherlands: results and experiences from a national Breakthrough Collaborative Improvement project

    Directory of Open Access Journals (Sweden)

    M.M.N. Minkman

    2005-03-01

    Full Text Available Purpose: This article considers the question if measurable improvements are achieved in the quality of care in stroke services by using a Breakthrough collaborative quality improvement model. Context of case: Despite the availability of explicit criteria, evidence based guidelines, national protocols and examples of best practices; stroke care in the Netherlands did not improve substantially yet. For that reason a national collaborative started in 2002 to improve integrated stroke care in 23 self selected stroke services. Data sources: Characteristics of sites, teams, aims and changes were assessed by using a questionnaire and monthly self-reports of teams. Progress in achieving significant quality improvement has been assessed on a five point Likert scale (IHI score. Case description: The stroke services (n=23 formed multidisciplinary teams, which worked together in a collaborative based on the IHI Breakthrough Series Model. Teams received instruction in quality improvement, reviewed self reported performance data, identified bottlenecks and improvement goals, and implemented “potentially better practices” based on criteria from the Edisse study, evidence based guidelines, own ideas and expert opinion. Conclusion and discussion: Quality of care has been improved in most participating stroke services. Eighty-seven percent of the teams have improved their care significantly on at least one topic. About 34% of the teams have achieved significant improvement on all aims within the time frame of the project. The project has contributed to the further development and spread of integrated stroke care in the Netherlands.

  7. A physician-led initiative to improve clinical documentation results in improved health care documentation, case mix index, and increased contribution margin.

    Science.gov (United States)

    Aiello, Francesco A; Judelson, Dejah R; Durgin, Jonathan M; Doucet, Danielle R; Simons, Jessica P; Durocher, Dawn M; Flahive, Julie M; Schanzer, Andres

    2018-05-04

    Clinical documentation is the key determinant of inpatient acuity of illness and payer reimbursement. Every inpatient hospitalization is placed into a diagnosis related group with a relative value based on documented procedures, conditions, comorbidities and complications. The Case Mix Index (CMI) is an average of these diagnosis related groups and directly impacts physician profiling, medical center profiling, reimbursement, and quality reporting. We hypothesize that a focused, physician-led initiative to improve clinical documentation of vascular surgery inpatients results in increased CMI and contribution margin. A physician-led coding initiative to educate physicians on the documentation of comorbidities and conditions was initiated with concurrent chart review sessions with coding specialists for 3 months, and then as needed, after the creation of a vascular surgery documentation guide. Clinical documentation and billing for all carotid endarterectomy (CEA) and open infrainguinal procedures (OIPs) performed between January 2013 and July 2016 were stratified into precoding and postcoding initiative groups. Age, duration of stay, direct costs, actual reimbursements, contribution margin (CM), CMI, rate of complication or comorbidity, major complication or comorbidity, severity of illness, and risk of mortality assigned to each discharge were abstracted. Data were compared over time by standardizing Centers for Medicare and Medicaid Services (CMS) values for each diagnosis related group and using a CMS base rate reimbursement. Among 458 CEA admissions, postcoding initiative CEA patients (n = 253) had a significantly higher CMI (1.36 vs 1.25; P = .03), CM ($7859 vs $6650; P = .048), and CMS base rate reimbursement ($8955 vs $8258; P = .03) than precoding initiative CEA patients (n = 205). The proportion of admissions with a documented major complication or comorbidity and complication or comorbidity was significantly higher after the coding initiative (43% vs

  8. Closing the gap-cardiovascular risk and primary prevention: results from the American College of Physicians quality improvement program.

    Science.gov (United States)

    Snow, Vincenza; Reynolds, Cara Egan; Bennett, Lia; Weiss, Kevin B; Snooks, Qianna; Qaseem, Amir

    2010-01-01

    The objective was to study the impact of a practice-based quality improvement program on practice teams' care for patients who have increased risk of cardiovascular disease. A total of 54 team members from 18 internal medicine practices participated in an educational program that used a pre-post intervention study design and focused on measures related to cardiovascular risk factors. The program involved live instruction, faculty-led conference calls, practice data collection, and progress reports detailing practices' improvement strategies. Data on 817 patients were reported. Practices showed significant improvement in counseling for diet (70% to 78%), exercise (67% to 74%), and weight loss (64% to 72%). Use of aspirin (53% to 64%) and statins (83% to 89%) also showed significant improvement. Administration of flu vaccine increased significantly from 51% to 54%. Improvements in patient counseling and medication management, if sustained, should lead to fewer cardiovascular events. However, program duration did not allow the capture of outcomes measures improvement.

  9. ["Great jobs"-also in psychiatry?].

    Science.gov (United States)

    Spiessl, H; Hübner-Liebermann, B

    2003-09-01

    Against the background of a beginning shortage of psychiatrists, results from interviews with 112 employees of an automotive company with the topic "Great Job" are presented to discuss their relevance to psychiatry. The interviews were analysed by means of a qualitative content analysis. Most employees assigned importance to great pay, constructive collaboration with colleagues, and work appealing to personal interests. Further statements particularly relevant to psychiatry were: successful career, flexible working hours, manageable job, work-life balance, well-founded training, no bureaucracy within the company, and personal status in society. The well-known economic restrictions in health care and the still negative attitude towards psychiatry currently reduce the attraction of psychiatry as a profession. From the viewpoint of personnel management, the attractors of a great job revealed in this study are proposed as important clues for the recruitment of medical students for psychiatry and the development of psychiatric staff.

  10. Famous puzzles of great mathematicians

    CERN Document Server

    Petković, Miodrag S

    2009-01-01

    This entertaining book presents a collection of 180 famous mathematical puzzles and intriguing elementary problems that great mathematicians have posed, discussed, and/or solved. The selected problems do not require advanced mathematics, making this book accessible to a variety of readers. Mathematical recreations offer a rich playground for both amateur and professional mathematicians. Believing that creative stimuli and aesthetic considerations are closely related, great mathematicians from ancient times to the present have always taken an interest in puzzles and diversions. The goal of this

  11. The Joint Action on Health Workforce Planning and Forecasting: Results of a European programme to improve health workforce policies.

    Science.gov (United States)

    Kroezen, Marieke; Van Hoegaerden, Michel; Batenburg, Ronald

    2018-02-01

    Health workforce (HWF) planning and forecasting is faced with a number of challenges, most notably a lack of consistent terminology, a lack of data, limited model-, demand-based- and future-based planning, and limited inter-country collaboration. The Joint Action on Health Workforce Planning and Forecasting (JAHWF, 2013-2016) aimed to move forward on the HWF planning process and support countries in tackling the key challenges facing the HWF and HWF planning. This paper synthesizes and discusses the results of the JAHWF. It is shown that the JAHWF has provided important steps towards improved HWF planning and forecasting across Europe, among others through the creation of a minimum data set for HWF planning and the 'Handbook on Health Workforce Planning Methodologies across EU countries'. At the same time, the context-sensitivity of HWF planning was repeatedly noticeable in the application of the tools through pilot- and feasibility studies. Further investments should be made by all actors involved to support and stimulate countries in their HWF efforts, among others by implementing the tools developed by the JAHWF in diverse national and regional contexts. Simultaneously, investments should be made in evaluation to build a more robust evidence base for HWF planning methods. Copyright © 2017 Elsevier B.V. All rights reserved.

  12. Can Multiple Lifestyle Behaviours Be Improved in People with Familial Hypercholesterolemia? Results of a Parallel Randomised Controlled Trial

    Science.gov (United States)

    Broekhuizen, Karen; van Poppel, Mireille N. M.; Koppes, Lando L.; Kindt, Iris; Brug, Johannes; van Mechelen, Willem

    2012-01-01

    Objective To evaluate the efficacy of an individualised tailored lifestyle intervention on physical activity, dietary intake, smoking and compliance to statin therapy in people with Familial Hypercholesterolemia (FH). Methods Adults with FH (n = 340) were randomly assigned to a usual care control group or an intervention group. The intervention consisted of web-based tailored lifestyle advice and face-to-face counselling. Physical activity, fat, fruit and vegetable intake, smoking and compliance to statin therapy were self-reported at baseline and after 12 months. Regression analyses were conducted to examine between-group differences. Intervention reach, dose and fidelity were assessed. Results In both groups, non-significant improvements in all lifestyle behaviours were found. Post-hoc analyses showed a significant decrease in saturated fat intake among women in the intervention group (β = −1.03; CI −1.98/−0.03). In the intervention group, 95% received a log on account, of which 49% logged on and completed one module. Nearly all participants received face-to-face counselling and on average, 4.2 telephone booster calls. Intervention fidelity was low. Conclusions Individually tailored feedback is not superior to no intervention regarding changes in multiple lifestyle behaviours in people with FH. A higher received dose of computer-tailored interventions should be achieved by uplifting the website and reducing the burden of screening questionnaires. Counsellor training should be more extensive. Trial Registration Dutch Trial Register NTR1899 PMID:23251355

  13. Electrocoagulation improving bone cement use in middle-ear surgery: short-term and middle-term results.

    Science.gov (United States)

    Galy-Bernadoy, C; Akkari, M; Mondain, M; Uziel, A; Venail, F

    2016-12-01

    Bone cement is used for ossicular chain repair and revision stapes surgery. Its efficient use requires cautious removal of mucosa from the ossicles. This paper reports a technique for easy, fast and safe removal of this mucosa prior to cement application. It consists of the application of monopolar electrocoagulation on the ossicles prior to bone cement application. The outcomes of six cases of revision stapes surgery and seven cases of partial ossiculoplasty, conducted between 2007 and 2012 using this new technique, were evaluated. Intra-operative reports and audiometric data were collected. During the last assessment, reconstruction using bone cement resulted in mean post-operative air-bone gaps of 4.1 ± 6.5 dB in revision stapes surgery cases and 5.7 ± 5.5 dB in partial ossiculoplasty cases, reflecting a significant hearing improvement (p = 0.03). No complications were observed. Electrocoagulation allows the removal of mucosa from the ossicles in an easy, fast and safe manner, enabling the use of bone cement for ossicular chain reconstruction.

  14. Improved Outcome Prediction Using CT Angiography in Addition to Standard Ischemic Stroke Assessment: Results from the STOPStroke Study

    Science.gov (United States)

    González, R. Gilberto; Lev, Michael H.; Goldmacher, Gregory V.; Smith, Wade S.; Payabvash, Seyedmehdi; Harris, Gordon J.; Halpern, Elkan F.; Koroshetz, Walter J.; Camargo, Erica C. S.; Dillon, William P.; Furie, Karen L.

    2012-01-01

    Purpose To improve ischemic stroke outcome prediction using imaging information from a prospective cohort who received admission CT angiography (CTA). Methods In a prospectively designed study, 649 stroke patients diagnosed with acute ischemic stroke had admission NIH stroke scale scores, noncontrast CT (NCCT), CTA, and 6-month outcome assessed using the modified Rankin scale (mRS) scores. Poor outcome was defined as mRS>2. Strokes were classified as “major” by the (1) Alberta Stroke Program Early CT Score (ASPECTS+) if NCCT ASPECTS was≤7; (2) Boston Acute Stroke Imaging Scale (BASIS+) if they were ASPECTS+ or CTA showed occlusion of the distal internal carotid, proximal middle cerebral, or basilar arteries; and (3) NIHSS for scores>10. Results Of 649 patients, 253 (39.0%) had poor outcomes. NIHSS, BASIS, and age, but not ASPECTS, were independent predictors of outcome. BASIS and NIHSS had similar sensitivities, both superior to ASPECTS (p10/BASIS+ had poor outcomes, versus 21.5% (77/358) with NIHSS≤10/BASIS− (p10/BASIS+ compared to patients who are NIHSS≤10/BASIS−; the odds ratio is 5.4 (95% CI: 3.5 to 8.5) when compared to patients who are only NIHSS>10 or BASIS+. Conclusions BASIS and NIHSS are independent outcome predictors. Their combination is stronger than either instrument alone in predicting outcomes. The findings suggest that CTA is a significant clinical tool in routine acute stroke assessment. PMID:22276182

  15. ["What you will": Results of an Empirical Analysis of the Need to Improve Work-life Balance for Physicians].

    Science.gov (United States)

    Jerg-Bretzke, L; Krüsmann, P; Traue, H C; Limbrecht-Ecklundt, K

    2018-01-01

    This study assessed the perceived need for clinics to improve work-life balance of physicians. Hospitals are increasingly facing demands to offer physicians working conditions that allow greater balance between family life and pursuit of career. Simultaneously, hospitals could consider this an opportunity to stand out as attractive employers. N=120 doctors of the medical faculty and N=679 medical students in their premedical and clinical training participated online. The results of the Work-Family/Family-Work Conflict Scale (WFC/FWC) showed physicians to have a decreased work/life balance when starting to work professionally, especially with a child. Ninety percent of the respondents considered the following arrangements to be especially helpful: temporary work interruptions in an emergency, part-time positions or emergency childcare. The doctors also expressed their wish to be actively supported by their supervisors on the topic of work/life balance. This analysis on work-family balance shows the need for change in the studied samples. Based on the measures that were determined to be helpful, hospitals can make conclusions about what concrete steps of action can be taken. Additionally, WFC/FWC could be used as a standardized analysis measure to assess the load imposed on physicians by family on work place and vice versa. © Georg Thieme Verlag KG Stuttgart · New York.

  16. Further effort is needed to improve management of chronic pain in primary care. Results from the Arkys project

    Directory of Open Access Journals (Sweden)

    Gaetano Piccinocchi

    2016-06-01

    Full Text Available Treatment of chronic pain is challenging. The Arkys project was initiated in Italy to assist general practitioners (GPs in the management of chronic pain. The main objective of this study was to determine the usefulness of Arkys for selecting new therapeutic strategies. An online interactive questionnaire for assessing pain and guiding therapeutic decisions was made available to GPs participating to Arkys. The GPs were invited to complete the questionnaire for each patient who presented moderate-severe chronic pain, and to decide on a new analgesic treatment based on the information provided by the questionnaire. Two hundred and forty four GPs participated with a total of 3035 patients. Patients (mean age 68.9 years had mostly chronic non-cancer pain (87.7%. In 42.3%, pain had neuropathic components. Only 53.6% of patients were in treatment with analgesics (strong opioids, 38.9%; NSAIDs, 32.6%; weak opioids, 25.6%; anti-epileptics, 17.3%; paracetamol, 14.9%. Use of the questionnaire resulted in the prescription of analgesics to all patients and in increased prescription of strong opioids (69.7%. NSAID prescription decreased (12.8%, while anti-epileptics use remained stable. These findings show that current management of chronic pain in primary care is far from optimal and that efforts are needed to educate GPs and improve guideline implementation.

  17. Replication Improves Sorting-Task Results Analyzed by DISTATIS in a Consumer Study of American Bourbon and Rye Whiskeys.

    Science.gov (United States)

    Lahne, Jacob; Collins, Thomas S; Heymann, Hildegarde

    2016-05-01

    In consumer food-sensory studies, sorting and closely related methods (for example, projective mapping) have often been applied to large product sets which are complex and fatiguing for panelists. Analysis of sorting by Multi-Dimensional Scaling (MDS) is common, but this method discards relevant individual decisions; analysis by DISTATIS, which accounts for individual differences, is gaining acceptance. This research posits that replication can improve DISTATIS analysis by stabilizing consumer sensory maps, which are often extremely unstable. As a case study a fatiguing product set was sorted: 10 American whiskeys-5 bourbons and 5 ryes-were sorted into groups by 21 consumers over 2 replications. These products were chosen because American whiskeys are some of the most important distilled beverages in today's market; in particular, "bourbon" (mashbill more than 50% corn) and "rye" (more than 50% rye) whiskeys are important and assumed to be products with distinct sensory attributes. However, there is almost no scientific information about their sensory properties. Data were analyzed using standard and aggregated DISTATIS and MDS. No significant relationship between mashbill and consumer categorization in whiskeys was found; instead, there was evidence of producer and aging effects. aggregated DISTATIS was found to provide more stable results than without replication, and DISTATIS results provided a number of benefits over MDS, including bootstrapped confidence intervals for product separation. In addition, this is the first published evidence that mashbill does not determine sensory properties of American whiskey: bourbons and ryes, while legally distinct, were not separated by consumers. © 2016 Institute of Food Technologists®

  18. Global proteomics profiling improves drug sensitivity prediction: results from a multi-omics, pan-cancer modeling approach.

    Science.gov (United States)

    Ali, Mehreen; Khan, Suleiman A; Wennerberg, Krister; Aittokallio, Tero

    2018-04-15

    Proteomics profiling is increasingly being used for molecular stratification of cancer patients and cell-line panels. However, systematic assessment of the predictive power of large-scale proteomic technologies across various drug classes and cancer types is currently lacking. To that end, we carried out the first pan-cancer, multi-omics comparative analysis of the relative performance of two proteomic technologies, targeted reverse phase protein array (RPPA) and global mass spectrometry (MS), in terms of their accuracy for predicting the sensitivity of cancer cells to both cytotoxic chemotherapeutics and molecularly targeted anticancer compounds. Our results in two cell-line panels demonstrate how MS profiling improves drug response predictions beyond that of the RPPA or the other omics profiles when used alone. However, frequent missing MS data values complicate its use in predictive modeling and required additional filtering, such as focusing on completely measured or known oncoproteins, to obtain maximal predictive performance. Rather strikingly, the two proteomics profiles provided complementary predictive signal both for the cytotoxic and targeted compounds. Further, information about the cellular-abundance of primary target proteins was found critical for predicting the response of targeted compounds, although the non-target features also contributed significantly to the predictive power. The clinical relevance of the selected protein markers was confirmed in cancer patient data. These results provide novel insights into the relative performance and optimal use of the widely applied proteomic technologies, MS and RPPA, which should prove useful in translational applications, such as defining the best combination of omics technologies and marker panels for understanding and predicting drug sensitivities in cancer patients. Processed datasets, R as well as Matlab implementations of the methods are available at https://github.com/mehr-een/bemkl-rbps. mehreen

  19. Improving immunization in Afghanistan: results from a cross-sectional community-based survey to assess routine immunization coverage

    Directory of Open Access Journals (Sweden)

    Raveesha R. Mugali

    2017-04-01

    Full Text Available Abstract Background Despite progress in recent years, Afghanistan is lagging behind in realizing the full potential of immunization. The country is still endemic for polio transmission and measles outbreaks continue to occur. In spite of significant reductions over the past decade, the mortality rate of children under 5 years of age continues to remain high at 91 per 1000 live births. Methods The study was a descriptive community-based cross sectional household survey. The survey aimed to estimate the levels of immunization coverage at national and province levels. Specific objectives are to: establish valid baseline information to monitor progress of the immunization program; identify reasons why children are not immunized; and make recommendations to enhance access and quality of immunization services in Afghanistan. The survey was carried out in all 34 provinces of the country, with a sample of 6125 mothers of children aged 12–23 months. Results Nationally, 51% of children participating in the survey received all doses of each antigen irrespective of the recommended date of immunization or recommended interval between doses. About 31% of children were found to be partially vaccinated. Reasons for partial vaccination included: place to vaccinate child too far (23%, not aware of the need of vaccination (17%, no faith in vaccination (16%, mother was too busy (15%, and fear of side effects (11%. Conclusion The innovative mechanism of contracting out delivery of primary health care services in Afghanistan, including immunization, to non-governmental organizations is showing some positive results in quickly increasing coverage of essential interventions, including routine immunization. Much ground still needs to be covered with proper planning and management of resources in order to improve the immunization coverage in Afghanistan and increase survival and health status of its children.

  20. Improving quantitative gas chromatography-electron ionization mass spectrometry results using a modified ion source: demonstration for a pharmaceutical application.

    Science.gov (United States)

    D'Autry, Ward; Wolfs, Kris; Hoogmartens, Jos; Adams, Erwin; Van Schepdael, Ann

    2011-07-01

    Gas chromatography-mass spectrometry is a well established analytical technique. However, mass spectrometers with electron ionization sources may suffer from signal drifts, hereby negatively influencing quantitative performance. To demonstrate this phenomenon for a real application, a static headspace-gas chromatography method in combination with electron ionization-quadrupole mass spectrometry was optimized for the determination of residual dichloromethane in coronary stent coatings. Validating the method, the quantitative performance of an original stainless steel ion source was compared to that of a modified ion source. Ion source modification included the application of a gold coating on the repeller and exit plate. Several validation aspects such as limit of detection, limit of quantification, linearity and precision were evaluated using both ion sources. It was found that, as expected, the stainless steel ion source suffered from signal drift. As a consequence, non-linearity and high RSD values for repeated analyses were obtained. An additional experiment was performed to check whether an internal standard compound would lead to better results. It was found that the signal drift patterns of the analyte and internal standard were different, consequently leading to high RSD values for the response factor. With the modified ion source however, a more stable signal was observed resulting in acceptable linearity and precision. Moreover, it was also found that sensitivity improved compared to the stainless steel ion source. Finally, the optimized method with the modified ion source was applied to determine residual dichloromethane in the coating of coronary stents. The solvent was detected but found to be below the limit of quantification. Copyright © 2011 Elsevier B.V. All rights reserved.

  1. Making a Great First Impression

    Science.gov (United States)

    Evenson, Renee

    2007-01-01

    Managers and business owners often base hiring decisions on first impressions. That is why it is so important to teach students to make a great first impression--before they go on that first job interview. Managers do not have unrealistic expectations, they just want to hire people who they believe can develop into valuable employees. A nice…

  2. Great Basin paleoenvironmental studies project

    International Nuclear Information System (INIS)

    1993-01-01

    Project goals, project tasks, progress on tasks, and problems encountered are described and discussed for each of the studies that make up the Great Basin Paleoenvironmental Studies Project for Yucca Mountain. These studies are: Paleobotany, Paleofauna, Geomorphology, and Transportation. Budget summaries are also given for each of the studies and for the overall project

  3. The Great Books and Economics.

    Science.gov (United States)

    Hartley, James E.

    2001-01-01

    Describes an introductory economics course in which all of the reading material is drawn from the Great Books of Western Civilization. Explains the rationale and mechanics of the course. Includes an annotated course syllabus that details how the reading material relates to the lecture material. (RLH)

  4. Great tit hatchling sex ratios

    NARCIS (Netherlands)

    Lessells, C.M.; Mateman, A.C.; Visser, J.

    1996-01-01

    The sex of Great Tit Parus major nestlings was determined using PCR RAPDs. Because this technique requires minute amounts of DNA, chicks could be sampled soon (0-2d) after hatching, before any nestling mortality occurred. The proportion of males among 752 chicks hatching in 102 broods (98.9% of

  5. The Great Gatsby. [Lesson Plan].

    Science.gov (United States)

    Zelasko, Ken

    Based on F. Scott Fitzgerald's novel "The Great Gatsby," this lesson plan presents activities designed to help students understand that adapting part of a novel into a dramatic reading makes students more intimate with the author's intentions and craft; and that a part of a novel may lend itself to various oral interpretations. The main activity…

  6. Great Basin wildlife disease concerns

    Science.gov (United States)

    Russ Mason

    2008-01-01

    In the Great Basin, wildlife diseases have always represented a significant challenge to wildlife managers, agricultural production, and human health and safety. One of the first priorities of the U.S. Department of Agriculture, Division of Fish and Wildlife Services was Congressionally directed action to eradicate vectors for zoonotic disease, particularly rabies, in...

  7. Improving predictions for collider observables by consistently combining fixed order calculations with resummed results in perturbation theory

    International Nuclear Information System (INIS)

    Schoenherr, Marek

    2011-01-01

    With the constantly increasing precision of experimental data acquired at the current collider experiments Tevatron and LHC the theoretical uncertainty on the prediction of multiparticle final states has to decrease accordingly in order to have meaningful tests of the underlying theories such as the Standard Model. A pure leading order calculation, defined in the perturbative expansion of said theory in the interaction constant, represents the classical limit to such a quantum field theory and was already found to be insufficient at past collider experiments, e.g. LEP or HERA. Such a leading order calculation can be systematically improved in various limits. If the typical scales of a process are large and the respective coupling constants are small, the inclusion of fixed-order higher-order corrections then yields quickly converging predictions with much reduced uncertainties. In certain regions of the phase space, still well within the perturbative regime of the underlying theory, a clear hierarchy of the inherent scales, however, leads to large logarithms occurring at every order in perturbation theory. In many cases these logarithms are universal and can be resummed to all orders leading to precise predictions in these limits. Multiparticle final states now exhibit both small and large scales, necessitating a description using both resummed and fixed-order results. This thesis presents the consistent combination of two such resummation schemes with fixed-order results. The main objective therefor is to identify and properly treat terms that are present in both formulations in a process and observable independent manner. In the first part the resummation scheme introduced by Yennie, Frautschi and Suura (YFS), resumming large logarithms associated with the emission of soft photons in massive QED, is combined with fixed-order next-to-leading matrix elements. The implementation of a universal algorithm is detailed and results are studied for various precision

  8. A standards-based approach to quality improvement for HIV services at Zambia Defence Force facilities: results and lessons learned.

    Science.gov (United States)

    Kols, Adrienne; Kim, Young-Mi; Bazant, Eva; Necochea, Edgar; Banda, Joseph; Stender, Stacie

    2015-07-01

    The Zambia Defence Force adopted the Standards-Based Management and Recognition approach to improve the quality of the HIV-related services at its health facilities. This quality improvement intervention relies on comprehensive, detailed assessment tools to communicate and verify adherence to national standards of care, and to test and implement changes to improve performance. A quasi-experimental evaluation of the intervention was conducted at eight Zambia Defence Force primary health facilities (four facilities implemented the intervention and four did not). Data from three previous analyses are combined to assess the effect of Standards-Based Management and Recognition on three domains: facility readiness to provide services; observed provider performance during antiretroviral therapy (ART) and antenatal care consultations; and provider perceptions of the work environment. Facility readiness scores for ART improved on four of the eight standards at intervention sites, and one standard at comparison sites. Facility readiness scores for prevention of mother-to-child transmission (PMTCT) of HIV increased by 15 percentage points at intervention sites and 7 percentage points at comparison sites. Provider performance improved significantly at intervention sites for both ART services (from 58 to 84%; P improved at intervention sites and declined at comparison sites; differences in trends between study groups were significant for eight items. A standards-based approach to quality improvement proved effective in supporting healthcare managers and providers to deliver ART and PMTCT services in accordance with evidence-based standards in a health system suffering from staff shortages.

  9. Predicting phosphorus concentrations in British rivers resulting from the introduction of improved phosphorus removal from sewage effluent

    International Nuclear Information System (INIS)

    Bowes, Michael J.; Neal, Colin; Jarvie, Helen P.; Smith, Jim T.; Davies, Helen N.

    2010-01-01

    Phosphorus (P) concentration and flow data gathered during the 1990s for a range of British rivers were used to determine the relative contributions of point and diffuse inputs to the total P load, using the Load Apportionment Model (LAM). Heavily urbanised catchments were dominated by sewage inputs, but the majority of the study catchments received most of their annual phosphorus load from diffuse sources. Despite this, almost 80% of the study sites were dominated by point source inputs for the majority of the year, particularly during summer periods when eutrophication risk is greatest. This highlights the need to reduce sewage P inputs to improve the ecological status of British rivers. These modelled source apportionment estimates were validated against land-use data and boron load (a chemical marker for sewage). The LAM was applied to river flow data in subsequent years, to give predicted P concentrations (assuming no change in P source inputs), and these estimates were compared with observed concentration data. This showed that there had been significant reductions in P concentration in the River Thames, Aire and Ouse in the period 1999 to 2002, which were attributable to the introduction of P stripping at sewage treatment works (STW). The model was then used to forecast P concentrations resulting from the introduction of P removal at STW to a 2 or 1 mg l -1 consent limit. For the urbanised rivers in this study, the introduction of phosphorus stripping to a 1 mg l -1 consent level at all STW in the catchment would not reduce P concentrations in the rivers to potentially limiting concentrations. Therefore, further sewage P stripping will be required to comply with the Water Framework Directive. Diffuse P inputs may also need to be reduced before some of the highly nutrient-enriched rivers achieve good ecological status.

  10. Home grocery delivery improves the household food environments of behavioral weight loss participants: Results of an 8-week pilot study

    Directory of Open Access Journals (Sweden)

    Niemeier Heather M

    2007-11-01

    Full Text Available Abstract Background Household food availability is consistently linked to dietary intake; yet behavioral weight control treatment includes only minimal instruction on how to change the home environment to support dietary goals. This pilot study examined whether it is feasible to change the household food environments of behavioral weight loss participants through the use of a commercially available grocery home delivery service. Methods Overweight participants (N = 28; BMI = 31.7 ± 3.6 kg/m2; 89.3% women, 47.9 ± 9.5 years were randomly assigned to 8-weeks of standard behavioral weight loss (SBT or to SBT plus home food delivery (SBT+Home. SBT+Home participants were instructed to do their household grocery shopping via an online service affiliated with a regional supermarket chain and were reimbursed for delivery charges. Results Compared to SBT, SBT+Home produced significantly greater reductions in the total number of foods in the home (p = .01 and number of foods that were high in fat (p = .002. While the groups did not differ in 8-week weight losses, within SBT+Home there was a trend for the number of home deliveries to be associated with weight loss (p = .08. Participants reported that the home delivery service was easy to use and that it helped decrease impulse purchases and lead to healthier choices; however, few planned to continue using the service after the study. Conclusion Encouraging weight loss participants to use a commercially available online grocery ordering and home delivery service reduces the overall number of food items in the home and decreases access to high-fat food choices. More research is needed to determine whether this is a viable strategy to strengthen stimulus control and improve weight loss outcomes.

  11. Great Basin geologic framework and uranium favorability

    International Nuclear Information System (INIS)

    Larson, L.T.; Beal, L.H.

    1978-01-01

    Work on this report has been done by a team of seven investigators assisted over the project span by twenty-three undergraduate and graduate students from May 18, 1976 to August 19, 1977. The report is presented in one volume of text, one volume or Folio of Maps, and two volumes of bibliography. The bibliography contains approximately 5300 references on geologic subjects pertinent to the search for uranium in the Great Basin. Volume I of the bibliography lists articles by author alphabetically and Volume II cross-indexes these articles by location and key word. Chapters I through IV of the Text volume and accompanying Folio Map Sets 1, 2, 3, 4, and 5, discuss the relationship of uranium to rock and structural environments which dominate the Great Basin. Chapter 5 and Map Sets 6 and 7 provide a geochemical association/metallogenic grouping of mineral occurrences in the Great Basin along with information on rock types hosting uranium. Chapter VI summarizes the results of a court house claim record search for 'new' claiming areas for uranium, and Chapter VII along with Folio Map Set 8 gives all published geochronological data available through April 1, 1977 on rocks of the Great Basin. Chapter VIII provides an introduction to a computer analysis of characteristics of certain major uranium deposits in crystalline rocks (worldwide) and is offered as a suggestion of what might be done with uranium in all geologic environments. We believe such analysis will assist materially in constructing exploration models. Chapter IX summarizes criteria used and conclusions reached as to the favorability of uranium environments which we believe to exist in the Great Basin and concludes with recommendations for both exploration and future research. A general summary conclusion is that there are several geologic environments within the Great Basin which have considerable potential and that few, if any, have been sufficiently tested

  12. Historical return on investment and improved quality resulting from development and mining of a hospital laboratory relational database.

    Science.gov (United States)

    Brimhall, Bradley B; Hall, Timothy E; Walczak, Steven

    2006-01-01

    A hospital laboratory relational database, developed over eight years, has demonstrated significant cost savings and a substantial financial return on investment (ROI). In addition, the database has been used to measurably improve laboratory operations and the quality of patient care.

  13. Omega-3 fatty acid supplementation improves dry eye symptoms in patients with glaucoma: results of a prospective multicenter study

    Directory of Open Access Journals (Sweden)

    Tellez-Vazquez J

    2016-04-01

    Full Text Available Jesús Tellez-Vazquez On behalf of the Dry Eye In Glaucoma Study Group (DEIGSG Glaucoma Section, Ophthalmology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain Purpose: The purpose of this study is to assess the effectiveness and tolerability of a dietary supplement with a combination of omega-3 fatty acids and antioxidants on dry eye symptoms caused by chronic instillation of antihypertensive eye drops in patients with glaucoma. Patients and methods: A total of 1,255 patients with glaucoma and dry eye symptoms related to antiglaucoma topical medication participated in an open-label, uncontrolled, prospective, and multicenter study and were instructed to take three capsules a day of the nutraceutical formulation (Brudypio® 1.5 g for 12 weeks. Dry eye symptoms (graded as 0–3 [none to severe, respectively], conjunctival hyperemia, tear breakup time, Schirmer I test, Oxford grading scheme, and intraocular pressure were assessed. Results: After 12 weeks of administration of the dietary supplement, all dry eye symptoms improved significantly (P<0.001 (mean 1.3 vs 0.6 for scratching, 1.4 vs 0.7 for stinging sensation, 1.6 vs 0.7 for grittiness, 1.0 vs 0.4 for tired eyes, 1.1 vs 0.5 for grating sensation, and 0.8 vs 0.3 for blurry vision. The Schirmer test scores and the tear breakup time also increased significantly. There was an increase in the percentage of patients grading 0–I in the Oxford scale and a decrease in those grading IV–V. Compliance was recorded in 62.5% of patients. In compliant patients, the mean differences at 12 weeks vs baseline of dry eye symptoms were statistically significant as compared to noncompliant patients. Conclusion: Dietary supplementation with Brudypio® may be a clinically valuable additional option for the treatment of dry eye syndrome in patients with glaucoma using antiglaucoma eye drops. These results require confirmation with an appropriately designed randomized controlled study

  14. Shifting management of a community volunteer system for improved child health outcomes: results from an operations research study in Burundi.

    Science.gov (United States)

    Weiss, Jennifer; Makonnen, Raphael; Sula, Delphin

    2015-01-01

    Community-based strategies that foster frequent contact between caregivers of children under five and provide credible sources of health information are essential to improve child survival. Care Groups are a community-based implementation strategy for the delivery of social and behavior change interventions. This study assessed if supervision of Care Group activities by Ministry of Health (MOH) personnel could achieve the same child health outcomes as supervision provided by specialized non-governmental organization (NGO) staff. The study was a pretest-posttest quasi-experimental design implemented in Burundi. A total of 45 MOH-led Care Groups with 478 Care Group Volunteers (CGVs) were established in the intervention area; and 50 NGO-led Care Groups with 509 CGVs were formed in the comparison area. Data were collected from 593 and 700 mothers of children 0-23 months at baseline and endline, respectively. Pearson's chi-squared test and difference-in-difference analysis assessed changes in 40 child health and nutrition outcomes. A qualitative process evaluation was also conducted midway through the study. The MOH-led Care Group model performed at least as well as the NGO-led model in achieving specific child health and nutrition outcomes. Mothers of children 0-23 months in the intervention and comparison sites reported similar levels of knowledge and practices for 38 of 40 dependent variables measured in the study, and these results remained unchanged after accounting for differences in the indicator values at baseline. Process monitoring data confirmed that the MOH-led Care Group model and the NGO-led Care Group model were implemented with similar intervention strength. The study demonstrated that behavior change interventions traditionally led by NGOs can be implemented through the existing MOH systems and achieve similar results, thereby increasing the potential for sustainable child health outcomes. Future research on the MOH-led Care Group model is required to

  15. Field Test Results of Using a Nacelle-Mounted Lidar for Improving Wind Energy Capture by Reducing Yaw Misalignment (Presentation)

    Energy Technology Data Exchange (ETDEWEB)

    Fleming, P.; Scholbrock, A.; Wright, A.

    2014-11-01

    Presented at the Nordic Wind Power Conference on November 5, 2014. This presentation describes field-test campaigns performed at the National Wind Technology Center in which lidar technology was used to improve the yaw alignment of the Controls Advanced Research Turbine (CART) 2 and CART3 wind turbines. The campaigns demonstrated that whether by learning a correction function to the nacelle vane, or by controlling yaw directly with the lidar signal, a significant improvement in power capture was demonstrated.

  16. Many faces of rationality: Implications of the great rationality debate for clinical decision-making

    OpenAIRE

    Djulbegovic, B.; Elqayam, Shira

    2017-01-01

    open access article Given that more than 30% of healthcare costs are wasted on inappropriate care, suboptimal care is increasingly connected to the quality of medical decisions. It has been argued that personal decisions are the leading cause of death, and 80% of healthcare expenditures result from physicians' decisions. Therefore, improving healthcare necessitates improving medical decisions, ie, making decisions (more) rational. Drawing on writings fromThe Great Rationality Debate from t...

  17. Cosmic Reason of Great Glaciation

    Science.gov (United States)

    Bagrov, Alexander; Murtazov, Andrey

    The origin of long-time and global glaciations in the past of our planet, which have been named «great», is still not clear. Both the advance of glaciers and their subsequent melting must be connected with some energy consuming processes. There is a powerful energy source permanently functioning throughout the Earth’s history - the solar radiation. The equality of the incoming shortwave solar energy and the transformed long-wave energy emitted by the Earth provides for the whole ecosphere’s sustainable evolution. Great glaciations might be caused by space body falls into the world oceans. If the body is large enough, it can stir waters down to the bottom. The world waters are part of the global heat transfer from the planet’s equator to its poles (nowadays, mostly to the North Pole). The mixing of the bottom and surface waters breaks the circulation of flows and they stop. The termination of heat transfer to the poles will result in an icecap at high latitudes which in its turn will decrease the total solar heat inflow to the planet and shift the pole ice boarder to the equator. This positive feedback may last long and result in long-time glaciations. The oceanic currents will remain only near the equator. The factor obstructing the global cooling is the greenhouse effect. Volcanic eruptions supply a lot of carbon dioxide into the atmosphere. When due to the increased albedo the planet receives less solar heat, plants bind less carbon oxide into biomass and more of it retains in the atmosphere. Therefore, the outflow of heat from the planet decreases and glaciations does not involve the whole planet. The balance established between the heat inflow and heat losses is unstable. Any imbalance acts as a positive feed-back factor. If the volcanic activity grows, the inflow of the carbon dioxide into the atmosphere will cause its heating-up (plants will fail to reproduce themselves quickly enough to utilize the carbonic acid). The temperature growth will lead to

  18. Cost-effectiveness analysis of a voucher scheme combined with obstetrical quality improvements: quasi experimental results from Uganda.

    Science.gov (United States)

    Alfonso, Y Natalia; Bishai, David; Bua, John; Mutebi, Aloysius; Mayora, Crispus; Ekirapa-Kiracho, Elizabeth

    2015-02-01

    The maternal mortality ratio (MMR) in Uganda has declined significantly during the last 20 years, but Uganda is not on track to reach the millennium development goal of reducing MMR by 75% by 2015. More evidence on the cost-effectiveness of supply- and demand-side financing programs to reduce maternal mortality could inform future strategies. This study analyses the cost-effectiveness of a voucher scheme (VS) combined with health system strengthening in rural Uganda against the status quo. The VS, implemented in 2010, provided vouchers for delivery services at public and private health facilities (HF), as well as round-trip transportation provided by private sector workers (bicycles or motorcycles generally). The VS was part of a quasi-experimental non-randomized control trial. Improvements in institutional delivery coverage (IDC) rates can be estimated using a difference-in-difference impact evaluation method and the number of maternal lives saved is modelled using the evidence-based Lives Saved Tool. Costs were estimated from primary and secondary data. Results show that the demand for births at HFs enrolled in the VS increased by 52.3 percentage points. Out of this value, conservative estimates indicate that at least 9.4 percentage points are new HF users. This 9.4% bump in IDC implies 20 deaths averted, which is equivalent to 1356 disability-adjusted-life years (DALYs) averted. Cost-effectiveness analysis comparing the status quo and VS's most conservative effectiveness estimates shows that the VS had an incremental cost-effectiveness ratio per DALY averted of US$302 and per death averted of US$20 756. Although there are limitations in the data measures, a favourable cost-effectiveness ratio persists even under extreme assumptions. Demand-side vouchers combined with supply-side financing programs can increase attended deliveries and reduce maternal mortality at a cost that is acceptable. Published by Oxford University Press in association with The London School

  19. Atmospheric measurements of hydroperoxides and aldehydes during field campaigns : new results due to improvement of measurements techniques

    Science.gov (United States)

    François, S.; Sowka, I.; Poulain, L.; Monod, A.; Wortham, H.

    2003-04-01

    Hydroperoxides and aldehydes are considered as atmospheric reservoirs of OH, HO_2 and RO_2 radicals and can reflect the oxidizing levels of the atmosphere. They are considered as important gas phase photo-oxidants present in the atmosphere. However, the atmospheric role of these compounds can vary from one species to another, therefore it is essential to investigate their measurement and speciation in the atmosphere. Atmospheric measurements were realized during two different field campaigns in the Marseilles area (France). Hydroperoxides were trapped in aqueous phase, with a glass coil and analyzed by HPLC/fluorescence detector with post column derivatization. Aldehydes were trapped in a liquid phase containing 2-4 DNPH, with a mist chamber and analyzed by HPLC/UV. The analytical techniques provided individual separation and quantification of seven hydroperoxides (hydrogen peroxide, hydroxymethyl hydroperoxide, bis(hydroxymethyl) peroxide, 1-hydroxyethyl hydroperoxide, methyl hydroperoxide, ethyl hydroperoxide and peroxyacetic acid) and eleven volatile aldehydes (formaldehyde, acetaldehyde, acrolein, acetone, propionaldehyde, crotonaldehyde, butyraldehyde, benzaldehyde, glyoxal, valeraldehyde and methylglyoxal). The first field campaign was part of the ESCOMPTE project (June 4th to July 16th 2001). During this campaign five different sampling sites, at low altitudes (<= 285 m), were investigated (maritime, urban, sub-industrial, biogenic and rural sites) and atmospheric measurements were realized during photochemical air pollution events. The second field campaign was part of the BOND project (July 2nd to July 14th 2002). Atmospheric measurements of hydroperoxides were carried out on one biogenic site, at altitude 690 m. The measurement system was improved allowing online sampling and analysis. During these field campaigns collection efficiencies were better than 96% for hydroperoxides, and from 78% to 96% for aldehydes. Detection limits were between 7,3× 10-3

  20. Southern Great Plains Safety Orientation

    Energy Technology Data Exchange (ETDEWEB)

    Schatz, John

    2014-05-01

    Welcome to the Atmospheric Radiation Measurement (ARM) Climate Research Facility (ARM) Southern Great Plains (SGP) site. This U.S. Department of Energy (DOE) site is managed by Argonne National Laboratory (ANL). It is very important that all visitors comply with all DOE and ANL safety requirements, as well as those of the Occupational Safety and Health Administration (OSHA), the National Fire Protection Association, and the U.S. Environmental Protection Agency, and with other requirements as applicable.

  1. Sustained reductions in time to antibiotic delivery in febrile immunocompromised children: results of a quality improvement collaborative.

    Science.gov (United States)

    Dandoy, Christopher E; Hariharan, Selena; Weiss, Brian; Demmel, Kathy; Timm, Nathan; Chiarenzelli, Janis; Dewald, Mary Katherine; Kennebeck, Stephanie; Langworthy, Shawna; Pomales, Jennifer; Rineair, Sylvia; Sandfoss, Erin; Volz-Noe, Pamela; Nagarajan, Rajaram; Alessandrini, Evaline

    2016-02-01

    Timely delivery of antibiotics to febrile immunocompromised (F&I) paediatric patients in the emergency department (ED) and outpatient clinic reduces morbidity and mortality. The aim of this quality improvement initiative was to increase the percentage of F&I patients who received antibiotics within goal in the clinic and ED from 25% to 90%. Using the Model of Improvement, we performed Plan-Do-Study-Act cycles to design, test and implement high-reliability interventions to decrease time to antibiotics. Pre-arrival interventions were tested and implemented, followed by post-arrival interventions in the ED. Many processes were spread successfully to the outpatient clinic. The Chronic Care Model was used, in addition to active family engagement, to inform and improve processes. The study period was from January 2010 to January 2015. Pre-arrival planning improved our F&I time to antibiotics in the ED from 137 to 88 min. This was sustained until October 2012, when further interventions including a pre-arrival huddle decreased the median time to antibiotics within 60 min to >90%. In September 2014, we implemented a rapid response team to improve reliable venous access in the ED, which increased our mean percentage of patients receiving timely antibiotics to its highest rate (95%). This stepwise approach with pre-arrival planning using the Chronic Care Model, followed by standardisation of processes, created a sustainable improvement of timely antibiotic delivery in F&I patients. 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/

  2. Results Of The Extraction-Scrub-Strip Testing Using An Improved Solvent Formulation And Salt Waste Processing Facility Simulated Waste

    International Nuclear Information System (INIS)

    Peters, T.; Washington, A.; Fink, S.

    2012-01-01

    The Office of Waste Processing, within the Office of Technology Innovation and Development, is funding the development of an enhanced solvent - also known as the next generation solvent (NGS) - for deployment at the Savannah River Site to remove cesium from High Level Waste. The technical effort is a collaborative effort between Oak Ridge National Laboratory (ORNL) and Savannah River National Laboratory (SRNL). As part of the program, the Savannah River National Laboratory (SRNL) has performed a number of Extraction-Scrub-Strip (ESS) tests. These batch contact tests serve as first indicators of the cesium mass transfer solvent performance with actual or simulated waste. The test detailed in this report used simulated Tank 49H material, with the addition of extra potassium. The potassium was added at 1677 mg/L, the maximum projected (i.e., a worst case feed scenario) value for the Salt Waste Processing Facility (SWPF). The results of the test gave favorable results given that the potassium concentration was elevated (1677 mg/L compared to the current 513 mg/L). The cesium distribution value, DCs, for extraction was 57.1. As a comparison, a typical D Cs in an ESS test, using the baseline solvent formulation and the typical waste feed, is ∼15. The Modular Caustic Side Solvent Extraction Unit (MCU) uses the Caustic-Side Solvent Extraction (CSSX) process to remove cesium (Cs) from alkaline waste. This process involves the use of an organic extractant, BoBCalixC6, in an organic matrix to selectively remove cesium from the caustic waste. The organic solvent mixture flows counter-current to the caustic aqueous waste stream within centrifugal contactors. After extracting the cesium, the loaded solvent is stripped of cesium by contact with dilute nitric acid and the cesium concentrate is transferred to the Defense Waste Processing Facility (DWPF), while the organic solvent is cleaned and recycled for further use. The Salt Waste Processing Facility (SWPF), under

  3. Building unique surface structure on aramid fibers through a green layer-by-layer self-assembly technique to develop new high performance fibers with greatly improved surface activity, thermal resistance, mechanical properties and UV resistance

    Energy Technology Data Exchange (ETDEWEB)

    Zhou, Lifang; Yuan, Li; Guan, Qingbao; Gu, Aijuan, E-mail: ajgu@suda.edu.cn; Liang, Guozheng, E-mail: lgzheng@suda.edu.cn

    2017-07-31

    Highlights: • A green technology is setup to build unique surface structure on aramid fiber (AF). • The method is layer-by-layer self-assembling SiO{sub 2} and layered double hydroxide. • The surface of AF is adjustable by controlling the self-assembly cycle number. • New AF has excellent surface activity, anti-UV, thermal and mechanical properties. • The origin behind attractive performances of new AFs was intensively studied. - Abstract: Combining green preparation and high performance is becoming the direction of sustainable development of materials. How to simultaneously overcome the two bottlenecks (poor surface activity and UV resistance) of aramid fibers (AFs) while improving thermal and mechanical properties through a green process is still an interesting issue with big challenge. Herein, new AFs (BL-AFs) were prepared by alternately self-assembling SiO{sub 2} and MgAlFe layered double hydroxide (LDH) on surfaces of AFs, successively, through a green layer-by-layer (LBL) self-assembly technique without using high temperature and organic solvent. The structures and properties of BL-AFs were systematically studied, which are controllable by adjusting the number of self-assembly cycle. The new fibers with three or more self-assembly cycles have remarkably improved surface activity, thermal resistance, mechanical properties and UV resistance compared with AFs. Typically, with three self-assembly cycles, the initial degradation temperature and char yield of the new fiber (3BL-AF) are as high as 552.9 °C and 81.2%, about 92 °C and 25.2% higher than those of AF, respectively; after 168 h-UV irradiation, the retention of tensile performances of 3BL-AF fiber is as high as 91–95%, about 29–14% higher than that of AF, showing the best overall performances among all modified AFs prepared using a green technique reported so far. The origin behind the attractive performances of BL-AFs is revealed through correlating with structures of original and

  4. Introducing the Improved Heaviside Approach to Partial Fraction Decomposition to Undergraduate Students: Results and Implications from a Pilot Study

    Science.gov (United States)

    Man, Yiu-Kwong

    2012-01-01

    Partial fraction decomposition is a useful technique often taught at senior secondary or undergraduate levels to handle integrations, inverse Laplace transforms or linear ordinary differential equations, etc. In recent years, an improved Heaviside's approach to partial fraction decomposition was introduced and developed by the author. An important…

  5. Does weight loss improve semen quality and reproductive hormones? Results from a cohort of severely obese men

    DEFF Research Database (Denmark)

    Håkonsen, Linn Berger; Thulstrup, Ane Marie; Aggerholm, Anette Skærbech

    2011-01-01

    A high body mass index (BMI) has been associated with reduced semen quality and male subfecundity, but no studies following obese men losing weight have yet been published. We examined semen quality and reproductive hormones among morbidly obese men and studied if weight loss improved...

  6. Dutch healthcare reform: did it result in performance improvement of health plans? A comparison of consumer experiences over time.

    NARCIS (Netherlands)

    Hendriks, M.; Spreeuwenberg, P.; Rademakers, J.; Delnoij, D.M.J.

    2009-01-01

    BACKGROUND: Many countries have introduced elements of managed competition in their healthcare system with the aim to accomplish more efficient and demand-driven health care. Simultaneously, generating and reporting of comparative healthcare information has become an important quality-improvement

  7. Clinical improvement in patients with borderline personality disorder after treatment with repetitive transcranial magnetic stimulation: preliminary results.

    Science.gov (United States)

    Reyes-López, Julian; Ricardo-Garcell, Josefina; Armas-Castañeda, Gabriela; García-Anaya, María; Arango-De Montis, Iván; González-Olvera, Jorge J; Pellicer, Francisco

    2018-01-01

    Current treatment of borderline personality disorder (BPD) consists of psychotherapy and pharmacological interventions. However, the use of repetitive transcranial magnetic stimulation (rTMS) could be beneficial to improve some BPD symptoms. The objective of this study was to evaluate clinical improvement in patients with BPD after application of rTMS over the right or left dorsolateral prefrontal cortex (DLPFC). Twenty-nine patients with BPD from the National Institute of Psychiatry, Mexico, were randomized in two groups to receive 15 sessions of rTMS applied over the right (1 Hz, n=15) or left (5 Hz, n=14) DLPFC. Improvement was measured by the Clinical Global Impression Scale for BPD (CGI-BPD), Borderline Evaluation of Severity Over Time (BEST), Beck Depression Inventory (BDI), Hamilton Anxiety Rating Scale (HAM-A), and Barratt Impulsiveness Scale (BIS). Intragroup comparison showed significant (p < 0.05) reductions in every psychopathologic domain of the CGI-BPD and in the total scores of all scales in both groups. Both protocols produced global improvement in severity and symptoms of BPD, particularly in impulsiveness, affective instability, and anger. Further studies are warranted to explore the therapeutic effect of rTMS in BPD. NCT02273674

  8. A Legacy of Leadership and Lessons Learned: Results from the Rural Systemic Initiatives for Improving Mathematics and Science Education

    Science.gov (United States)

    Harmon, Hobart L.; Smith, Keith

    2007-01-01

    This report pays tribute to the National Science Foundation's (NSF) Rural Systemic Initiatives (RSIs), an investment of more than $140 million to improve mathematics and science education in some of rural America's most impoverished communities. The report illustrates the impact of NSF's RSI program on a national scale. Each RSI planned a project…

  9. Reproductive behavior of the great hornbill (Buceros bicornis).

    Science.gov (United States)

    Kozlowski, Corinne P; Bauman, Karen L; Asa, Cheryl S

    2015-01-01

    Great hornbills (Buceros bicornis) are a long-lived, monogamous species that forms strong pair-bonds, and mate compatibility is thought to be important for successful reproduction. Within AZA, great hornbills are listed as a red SSP. The population consists of a limited number of individuals that do not breed reliably, and improving reproduction is a top priority for the Coraciiformes TAG. To better understand mating behavior and evaluate mate compatibility, this study documented the behavior of pairs of great hornbills during and immediately after courtship. Using live observations, the study followed one female, an experienced and successful breeder, as she was paired with four successive males over 11 breeding seasons. Initially, males frequently vocalized, investigated the nest, and approached the female. As the female spent more time in the nest, these behaviors were replaced by regurgitation and food offering. The female was most often observed plastering and vocalizing. Behavioral differences between successful and unsuccessful pairs, possibly indicative of pair compatibility, included rates of approaching, billing, and biting. Numerous behaviors occurred more frequently during years that a chick hatched, including pseudoregurgitation, regurgitation, offering food items, and nest investigation. Males also spent more time in proximity to both the female and the nest during years that a chick hatched. Together, these results suggest that the amount of time pairs spend in proximity, the amount of time a male spends near the nest, and the frequency of certain behaviors may help evaluate compatibility and the likelihood of successful reproduction for pairs of great hornbills. © 2015 Wiley Periodicals, Inc.

  10. Enriching Great Britain's National Landslide Database by searching newspaper archives

    Science.gov (United States)

    Taylor, Faith E.; Malamud, Bruce D.; Freeborough, Katy; Demeritt, David

    2015-11-01

    Our understanding of where landslide hazard and impact will be greatest is largely based on our knowledge of past events. Here, we present a method to supplement existing records of landslides in Great Britain by searching an electronic archive of regional newspapers. In Great Britain, the British Geological Survey (BGS) is responsible for updating and maintaining records of landslide events and their impacts in the National Landslide Database (NLD). The NLD contains records of more than 16,500 landslide events in Great Britain. Data sources for the NLD include field surveys, academic articles, grey literature, news, public reports and, since 2012, social media. We aim to supplement the richness of the NLD by (i) identifying additional landslide events, (ii) acting as an additional source of confirmation of events existing in the NLD and (iii) adding more detail to existing database entries. This is done by systematically searching the Nexis UK digital archive of 568 regional newspapers published in the UK. In this paper, we construct a robust Boolean search criterion by experimenting with landslide terminology for four training periods. We then apply this search to all articles published in 2006 and 2012. This resulted in the addition of 111 records of landslide events to the NLD over the 2 years investigated (2006 and 2012). We also find that we were able to obtain information about landslide impact for 60-90% of landslide events identified from newspaper articles. Spatial and temporal patterns of additional landslides identified from newspaper articles are broadly in line with those existing in the NLD, confirming that the NLD is a representative sample of landsliding in Great Britain. This method could now be applied to more time periods and/or other hazards to add richness to databases and thus improve our ability to forecast future events based on records of past events.

  11. Improvement of Tidal Analysis Results by a Priori Rain Fall Modelling at the Vienna and Membach stations

    Science.gov (United States)

    Meurers, B.; van Camp, M.; Petermans, T.

    2005-12-01

    We investigate how far tidal analysis results can be improved when a rain fall admittance model is applied on the superconducting gravity (SG) data. For that purpose both Vienna and Membach data have been analysed with and without a priori rain fall correction. In Membach the residual drop for most events (80%) can be explained by the rain water load, while in Vienna only 50% of all events fit the model in detail. In the other cases the Newtonian effect of vertical air mass redistribution (vertical density variation without air pressure change), predominantly connected with high vertical convection activity, e.g. thunderstorms, plays an essential role: short-term atmospheric signals show up steep gravity residual decreases of a few nms-2 within 10 - 60 min, well correlated with outdoor air temperature in most cases. However, even in those cases the water load model is able to explain the dominating part of the residual drop especially during heavy rain fall. In Vienna more than 110 events have been detected over 10 years. 84% of them are associated with heavy rain starting at or up to 10 min later than the residual drop while the rest (16%) shows no or only little rainfall. The magnitude of the gravity drop depends on the total amount of rainfall accumulated during the meteorological event. Step like signals deteriorate the frequency spectrum estimates. This even holds for tidal analysis. As the drops are of physical origin, they should not be eliminated blindly but corrected using water load modeling constrained by high temporal resolution (1 min) rain data. 3D modeling of the water mass load due to a rain event is based on the following assumptions: (1) Rain water intrudes into the uppermost soil layer (close to the topography surface) and remains there at least until rain has stopped. This is justified for a period of some hours after the rainfall as evapotranspiration is not yet effective. (2) No run-off except of sealed areas or building roofs, where water can

  12. Evaluating strategies to improve glucosinolate concentration and root yield of field-grown horseradish in a Mediterranean environment: preliminary results

    Directory of Open Access Journals (Sweden)

    Anna Rita Rivelli

    2016-03-01

    Full Text Available Horseradish is grown for its enlarged taproot that is widely used as a dish condiment and as a source of horseradish peroxidase. Nowadays, the species is gaining great interest due to the richness in bioactive compounds that besides providing a high nutritional value are tested for innovative applications in different fields. Nevertheless, the effect of crop management on root yield and glucosinolates (GLS biosynthesis is poorly documented. Aim of this study was to evaluate the root yield and GLS concentration of two field-grown horseradish accessions (Cor and Mon grown with nitrogen (N alone and both N and sulphur (S (-N-S, +N-S and +N+S treatments and harvested at different times [late autumn (LA, 2011 and 2012, early spring (ES, 2012]. Yield increased throughout the harvests up to 48% on average of the fertilised treatments and 25% in the unfertilised control. Conversely, root GLS concentration significantly declined in the unfertilised control throughout the harvests [from 7.6 in LA_2011 to 1.43 μmol/g dry matter (DM in LA_2012] while it highly increased in plants grown with N alone and with both N and S by 46 and 98%, respectively, from LA_2011 to ES_2012 (up to 11.9 and 21.1 μmol/g DM, respectively; then it drastically decreased by 80% on average, in the next harvest. Among individual GLS, the concentration of sinigrin and nasturtin similarly varied as effect of the analysed factors, showing the highest values in Cor accession. The data show that although the level of GLS is highly dependent on genotype, fertilisation and harvesting date may play a primary role in determining the yield and GLS concentration in horseradish root.

  13. Determining Wind Erosion in the Great Plains

    OpenAIRE

    Elwin G. Smith; Burton C. English

    1982-01-01

    Wind erosion is defined as the movement of soil particles resulting from strong turbulent winds. The movement of soil particles can be categorized as suspension, saltation, or surface creep. Fine soil particles can be suspended in the atmosphere and carried for great distances. Particles too large to be suspended move in a jumping action along the soil surface, known as saltation. Heavier particles have a rolling movement along the surface and this type of erosion is surface creep.

  14. A karate program for improving self-concept and quality of life in childhood epilepsy: results of a pilot study.

    Science.gov (United States)

    Conant, Kerry D; Morgan, Amy K; Muzykewicz, David; Clark, Derrick C; Thiele, Elizabeth A

    2008-01-01

    The potential cognitive and psychosocial effects of childhood epilepsy have significant implications for a child's self-image and academic achievement. This study focuses on a 10-week karate program for children and adolescents with epilepsy aimed at increasing social confidence, self-concept, and quality of life, as well as reducing parental anxiety. Eleven children (8-16 years old) and their parents participated in this questionnaire study, and complete data were available for nine of these families. Measures consisted of the Piers-Harris Children's Self-Concept Scale, the Quality of Life in Childhood Epilepsy (QOLCE) questionnaire, and the Parental Stress Index. By parental report, significant improvement in memory function and largely positive trends in quality of life on multiple subscales were observed. By child report, intellectual self-esteem and social confidence also improved. Parental stress decreased, although not significantly, suggesting a potential benefit and indicating a role for future interventions targeting family anxiety.

  15. Does Bacopa monnieri improve memory performance in older persons? Results of a randomized, placebo-controlled, double-blind trial.

    Science.gov (United States)

    Morgan, Annette; Stevens, John

    2010-07-01

    The objective of this study was to investigate the effectiveness of Bacopa monnieri Linn. for improvement of memory performance in healthy older persons. This was a randomized, double-blind, placebo-controlled trial. The trial took place in Lismore, NSW, Australia between February and July 2005. Ninety-eight (98) healthy participants over 55 years of age were recruited from the general population. Participants were randomized to receive an extract of Bacopa monnieri called BacoMind(TM) (Natural Remedies Pvt. Ltd.), 300 mg/day, or an identical placebo. Following screening, neuropsychologic and subjective memory assessments were performed at baseline and at 12 weeks. Audioverbal and visual memory performance were measured by the Rey Auditory Verbal Learning Test (AVLT), the Rey-Osterrieth Complex Figure Test (CFT), and the Reitan Trail Making Test (TMT). Subjective memory performance was measured by the Memory Complaint Questionnaire (MAC-Q). One hundred and thirty-six (136) subjects volunteered; 103 met entry criteria, 98 commenced, and 81 completed the trial. Bacopa significantly improved verbal learning, memory acquisition, and delayed recall as measured by the AVLT: trial a4 (p = 0.000), trial a5 (p = 0.016); trial a6 (p = 0.000); trial a7 (delayed recall) (p = 0.001); total learning (p = 0.011); and retroactive interference (p = 0.048). CFT, MAC-Q, and TMT scores improved but group differences were not significant. Bacopa versus placebo caused gastrointestinal tract (GIT) side-effects. Bacopa significantly improved memory acquisition and retention in healthy older Australians. This concurs with previous findings and traditional use. Bacopa caused GIT side-effects of increased stool frequency, abdominal cramps, and nausea.

  16. Learning and the Great Moderation

    OpenAIRE

    Bullard, James B.; Singh, Aarti

    2009-01-01

    We study a stylized theory of the volatility reduction in the U.S. after 1984 - the Great Moderation - which attributes part of the stabilization to less volatile shocks and another part to more difficult inference on the part of Bayesian households attempting to learn the latent state of the economy. We use a standard equilibrium business cycle model with technology following an unobserved regime-switching process. After 1984, according to Kim and Nelson (1999a), the variance of U.S. macroec...

  17. Pricing regulations in Great Britain

    International Nuclear Information System (INIS)

    Cicoletti, G.

    1993-01-01

    This paper briefly describes the structure and functions of Great Britain's essential electric power regulatory authority institutionalized by the 1989 British Electricity Act, i.e., the Office of Electricity Regulation, OFFER, and the responsibilities and tasks of the head of OFFER -the Director General of Electricity Supply (DGES). In particular, with regard to the latter, the paper describes how the DGES works together with regional electricity commissions to ensure the respect, by the various utilities, of consumer price caps and compliance with overall quality of service standards, as well as, to oversee 'pooling' activities by producers and distributors

  18. Pricing regulations in Great Britain

    International Nuclear Information System (INIS)

    Cicoletti, G.

    1993-01-01

    This paper briefly describes the structure and functions of Great Britain's essential electric power regulatory authority institutionalized by the 1989 British Electricity Act, i.e., the Office of Electricity Regulation, OFFER, and the responsibilities and tasks of the head of OFFER - the Director General of Electricity Supply (DGES). In particular, with regard to the latter, the paper describes how the DGES works together with regional electricity commissions to ensure the respect, by the various utilities, of consumer price caps and compliance with overall quality of service standards, as well as, to oversee 'pooling' activities by producers and distributors

  19. Commanders of the Great Victory

    Directory of Open Access Journals (Sweden)

    Anatoly Dmitriyevich Borshchov

    2015-01-01

    Full Text Available The honorary title of «commander» as well as the «admiral» is granted to a military or naval figure on the basis of public recognition of his personal contribution to the success of actions. Generals are usually individuals with creative thinking, the ability to foresee the development of military events. Generals usually have such personality traits as a strong will and determination, rich combat experience, credibility and high organizational skills. In an article dedicated to the 70th anniversary of the Soviet victory in the Great War examines the experience of formation and practice of the most talent-ed Soviet military leaders.

  20. Improving Timely Resident Follow-Up and Communication of Results in Ambulatory Clinics Utilizing a Web-Based Audit and Feedback Module.

    Science.gov (United States)

    Boggan, Joel C; Swaminathan, Aparna; Thomas, Samantha; Simel, David L; Zaas, Aimee K; Bae, Jonathan G

    2017-04-01

    Failure to follow up and communicate test results to patients in outpatient settings may lead to diagnostic and therapeutic delays. Residents are less likely than attending physicians to report results to patients, and may face additional barriers to reporting, given competing clinical responsibilities. This study aimed to improve the rates of communicating test results to patients in resident ambulatory clinics. We performed an internal medicine, residency-wide, pre- and postintervention, quality improvement project using audit and feedback. Residents performed audits of ambulatory patients requiring laboratory or radiologic testing by means of a shared online interface. The intervention consisted of an educational module viewed with initial audits, development of a personalized improvement plan after Phase 1, and repeated real-time feedback of individual relative performance compared at clinic and program levels. Outcomes included results communicated within 14 days and prespecified "significant" results communicated within 72 hours. A total of 76 of 86 eligible residents (88%) reviewed 1713 individual ambulatory patients' charts in Phase 1, and 73 residents (85%) reviewed 1509 charts in Phase 2. Follow-up rates were higher in Phase 2 than Phase 1 for communicating results within 14 days and significant results within 72 hours (85% versus 78%, P  Communication of "significant" results was more likely to occur via telephone, compared with communication of nonsignificant results. Participation in a shared audit and feedback quality improvement project can improve rates of resident follow-up and communication of results, although communication gaps remained.

  1. Five-year results from a prospective multicentre study of percutaneous pulmonary valve implantation demonstrate sustained removal of significant pulmonary regurgitation, improved right ventricular outflow tract obstruction and improved quality of life

    DEFF Research Database (Denmark)

    Hager, Alfred; Schubert, Stephan; Ewert, Peter

    2017-01-01

    . The EQ-5D quality of life utility index and visual analogue scale scores were both significantly improved six months post PPVI and remained so at five years. CONCLUSIONS: Five-year results following PPVI demonstrate resolved moderate or severe pulmonary regurgitation, improved right ventricular outflow...

  2. Improving the management of diabetes in hospitalized patients: the results of a computer-based house staff training program.

    Science.gov (United States)

    Vaidya, Anand; Hurwitz, Shelley; Yialamas, Maria; Min, Le; Garg, Rajesh

    2012-07-01

    Poorly controlled diabetes in hospitalized patients is associated with poor clinical outcomes. We hypothesized that computer-based diabetes training could improve house staff knowledge and comfort for the management of diabetes in a large tertiary-care hospital. We implemented a computer-based training program on inpatient diabetes for internal medicine house staff at the Brigham and Women's Hospital (Boston, MA) in September 2009. House staff were required to complete the program and answer a set of questions, before and after the program, to evaluate their level of comfort and knowledge of inpatient diabetes. Chart reviews of all non-critically ill patients with diabetes managed by house staff in August 2009 (before the program) and December 2009 (after the program) were performed. Chart reviews were also performed for August 2008 and December 2008 to compare house staff management practices when the computer-based educational program was not available. A significant increase in comfort levels and knowledge in the management of inpatient diabetes was seen among house staff at all levels of training (Pstaff compared with junior house staff. Nonsignificant trends suggesting increased use of basal-bolus insulin (P=0.06) and decreased use of sliding-scale insulin (P=0.10) were seen following the educational intervention in 2009, whereas no such change was seen in 2008 (P>0.90). Overall, house staff evaluated the training program as "very relevant" and the technology interface as "good." A computer-based diabetes training program can improve the comfort and knowledge of house staff and potentially improve their insulin administration practices at large academic centers.

  3. The economic value of an improved malaria treatment programme in Zambia: results from a contingent valuation survey

    Directory of Open Access Journals (Sweden)

    Rehnberg Clas

    2005-12-01

    Full Text Available Abstract Background Zambia is facing a double crisis of increasing malaria burden and dwindling capacity to deal with the endemic malaria burden. The pursuit of sustainable but equity mechanisms for financing malaria programmes is a subject of crucial policy discussion. This requires that comprehensive accounting of the economic impact of the various malaria programmes. Information on the economic value of programmes is essential in soliciting appropriate funding allocations for malaria control. Aims and objectives This paper specifically seeks to elicit a measure of the economic benefits of an improved malaria treatment programme in Zambia. The paper also studies the equity implications in malaria treatment given that demand or malaria treatment is determined by household socio-economic status. Methods A contingent valuation survey of about 300 Zambian households was conducted in four districts. Willingness-to-pay (WTP was elicited for an improved treatment programme for malaria in order to generate a measure of the economic benefits of the programme. The payment card method was used in eliciting WTP bids. Findings The study reports that malaria treatment has significant economic benefits to society. The total economic benefits of an improved treatment programme were estimated at an equivalent of US$ 77 million per annum, representing about 1.8% of Zambia's GDP. The study also reports the theoretically anticipated association between WTP and several socio-economic factors. Our income elasticity of demand is positive and similar in magnitude to estimates reported in similar studies. Finally, from an equity standpoint, the constraints imposed by income and socio-economic status are discussed.

  4. Can fire safety in hotels be improved? Results from the survey of a panel of experts in Spain.

    Science.gov (United States)

    Rubio-Romero, Juan Carlos; Márquez-Sierra, Francisco; Suárez-Cebador, Manuel

    2016-06-08

    The hotel industry is an important driver of the European labour market with over 250,000 hotels employing some 2 million people. In Spain, 240 workers were injured by fires in hotels from 2004 to 2008. Fire is considered to be the most important risk in the hotel industry, but the lack of an EU-wide data recording system for hotels makes it difficult to give exact figures for fire events. We analysed the state of fire prevention systems in hotels in Spain with the aim of proposing strategies to improve fire safety. A 10-item questionnaire was administered from 2007 to 2009 to 15 Spanish experts in fire safety. The questions were measured using a Likert scale and classified into 4 sections: current state of installations, influence of establishment characteristics, application of regulations and priority ranking of actions. Descriptive statistics summarized the data and t-tests evaluated the agreement foreach statement in the questionnaire. The statistical analysis showed homogeneity in the responses by the experts in all four categories: current state of fire safety installations, influence of establishment characteristics, application of regulations, and priority of actions. There was consensus among the experts over the necessity to improve the enforcement of regulations and also regarding the existence of an association between the hotel category (in Spain they are ranked using a 1 to 5 "star" rating system) and the level of fire safety; hotels with a higher category had higher levels of safety. There is a need to identify ways to apply fire safety standards to older hotels so that they comply with new regulations, to standardize regulations for different regions and countries, to improve the maintenance of installations and equipment, to increase the effectiveness of inspections conducted by government bodies, and to raise the general awareness of stakeholders involved in hotel fire prevention.

  5. Measuring the Willingness to Pay for Tap Water Quality Improvements: Results of a Contingent Valuation Survey in Pusan

    Directory of Open Access Journals (Sweden)

    Chang-Seob Kim

    2013-10-01

    Full Text Available With increasing concern regarding health, people have developed an interest in the safety of drinking water. In this study, we attempt to measure the economic benefits of tap water quality improvement through a case study on Pusan, the second largest city in Korea. To this end, we use a scenario that the government plans to implement a new project of improving water quality and apply the contingent valuation (CV method. A one-and-one-half bounded dichotomous choice question (OOHBDC format is employed to reduce the potential for response bias in multiple-bound formats such as the double-bound model, while maintaining much of the efficiency. Moreover, we employ the spike model to deal with zero willingness to pay (WTP responses from the OOHBDC CV survey. The CV survey of 400 randomly selected households was rigorously designed to comply with the guidelines for best-practice CV studies using person-to-person interviews. From the spike OOHBDC CV model, the mean WTP for the improvement was estimated to be KRW 2,124 (USD 2.2, on average, per household, per month. The value amounts to 36.6% of monthly water bill and 20.2% of production costs of water. The conventional OOHBDC model produces statistically insignificant mean WTP estimate and even negative value, but the OOHBDC spike model gives us statistically significant mean WTP estimate and fitted our data well. The WTP value to Pusan residents can be computed to be KRW 31.2 billion (USD 32.1 million per year.

  6. Barriers to and facilitators for implementing quality improvements in palliative care - results from a qualitative interview study in Norway.

    Science.gov (United States)

    Sommerbakk, Ragni; Haugen, Dagny Faksvåg; Tjora, Aksel; Kaasa, Stein; Hjermstad, Marianne Jensen

    2016-07-15

    Implementation of quality improvements in palliative care (PC) is challenging, and detailed knowledge about factors that may facilitate or hinder implementation is essential for success. One part of the EU-funded IMPACT project (IMplementation of quality indicators in PAlliative Care sTudy) aiming to increase the knowledge base, was to conduct national studies in PC services. This study aims to identify factors perceived as barriers or facilitators for improving PC in cancer and dementia settings in Norway. Individual, dual-participant and focus group interviews were conducted with 20 employees working in different health care services in Norway: two hospitals, one nursing home, and two local medical centers. Thematic analysis with a combined inductive and theoretical approach was applied. Barriers and facilitators were connected to (1) the innovation (e.g. credibility, advantage, accessibility, attractiveness); (2) the individual professional (e.g. motivation, PC expertise, confidence); (3) the patient (e.g. compliance); (4) the social context (e.g. leadership, culture of change, face-to-face contact); (5) the organizational context (e.g. resources, structures/facilities, expertise); (6) the political and economic context (e.g. policy, legislation, financial arrangements) and (7) the implementation strategy (e.g. educational, meetings, reminders). Four barriers that were particular to PC were identified: the poor general condition of patients in need of PC, symptom assessment tools that were not validated in all patient groups, lack of PC expertise and changes perceived to be at odds with staff's philosophy of care. When planning an improvement project in PC, services should pay particular attention to factors associated with their chosen implementation strategy. Leaders should also involve staff early in the improvement process, ensure that they have the necessary training in PC and that the change is consistent with the staff's philosophy of care. An important

  7. Reducing glucocorticoid dosage improves serum osteocalcin in patients with rheumatoid arthritis-results from the TOMORROW study.

    Science.gov (United States)

    Tada, M; Inui, K; Sugioka, Y; Mamoto, K; Okano, T; Koike, T; Nakamura, H

    2016-02-01

    Decreasing the daily dose of glucocorticoids improved bone metabolic marker levels in patients with rheumatoid arthritis. However, changes in disease activity did not influence bone metabolism. Bone metabolism might thus remain uncontrolled even if disease activity is under good control. Decreasing glucocorticoid dosage appears important for improving bone metabolism. Patients with rheumatoid arthritis (RA) develop osteoporosis more frequently than healthy individuals. Bone resorption is increased and bone formation is inhibited in patients with RA, and glucocorticoid negatively affects bone metabolism. We aimed to investigate factors influencing bone metabolic markers in patients with RA. We started the 10-year prospective cohort Total Management of Risk Factors in Rheumatoid Arthritis Patients to Lower Morbidity and Mortality (TOMORROW) study in 2010. We compared changes in urinary cross-linked N-telopeptide of type I collagen (uNTx) and serum osteocalcin (OC), as markers of bone resorption and formation, respectively, in 202 RA patients and age- and sex-matched volunteers between 2010 and 2011. We also investigated factors influencing ΔuNTx and ΔOC in the RA group using multivariate analysis. Values of ΔuNTx were significantly lower in patients with RA than in healthy controls (-0.51 vs. 7.41 nmol bone collagen equivalents (BCE)/mmol creatinine (Cr); p = 0.0013), whereas ΔOC values were significantly higher in RA patients (0.94 vs. 0.37 ng/ml; p = 0.0065). Changes in prednisolone dosage correlated negatively with ΔOC (β = -0.229, p = 0.001), whereas changes in disease activity score, bisphosphonate therapy, and period of biologics therapy did not correlate significantly with ΔOC. No significant correlation was seen between ΔuNTx and change in prednisolone dosage. Decreased glucocorticoid dosage improved bone metabolic markers in RA, but disease activity, bisphosphonate therapy, and period of biologics therapy did not influence

  8. Determinants of residential space heating expenditures in Great Britain

    Energy Technology Data Exchange (ETDEWEB)

    Meier, Helena [Department of Economics, University of Hamburg, Von Melle Park 5, 20146 Hamburg (Germany); Rehdanz, Katrin [Department of Economics, University of Kiel, Olshausenstrasse 40, 24118 Kiel (Germany)

    2010-09-15

    In Great Britain, several policy measures have been implemented in order to increase energy efficiency and reduce carbon emissions. In the domestic sector, this could, for example, be achieved by improving space heating efficiency and thus decreasing heating expenditure. However, in order to efficiently design and implement such policy measures, a better understanding of the determinants affecting heating expenditure is needed. In this paper we examine the following determinants: socio-economic factors, building characteristics, heating technologies and weather conditions. In contrast to most other studies we use panel data to investigate household demand for heating in Great Britain. Our data sample is the result of an annual set of interviews with more than 5000 households, starting in 1991 and ending in 2005. The sample represents a total of 64,000 observations over the fifteen-year period. Our aim is to derive price and income elasticities both for Britain as a whole and for different types of household. Our results suggest that differences exist between owner-occupied and renter households. These households react differently to changes in income and prices. Our results also imply that a number of socio-economic criteria have a significant influence on heating expenditure, independently of the fuel used for heating. Understanding the impacts of different factors on heating expenditure and impact differences between types of household is helpful in designing target-oriented policy measures. (author)

  9. Quality in-training initiative--a solution to the need for education in quality improvement: results from a survey of program directors.

    Science.gov (United States)

    Kelz, Rachel R; Sellers, Morgan M; Reinke, Caroline E; Medbery, Rachel L; Morris, Jon; Ko, Clifford

    2013-12-01

    The Next Accreditation System and the Clinical Learning Environment Review Program will emphasize practice-based learning and improvement and systems-based practice. We present the results of a survey of general surgery program directors to characterize the current state of quality improvement in graduate surgical education and introduce the Quality In-Training Initiative (QITI). In 2012, a 20-item survey was distributed to 118 surgical residency program directors from ACS NSQIP-affiliated hospitals. The survey content was developed in collaboration with the QITI to identify program director opinions regarding education in practice-based learning and improvement and systems-based practice, to investigate the status of quality improvement education in their respective programs, and to quantify the extent of resident participation in quality improvement. There was a 57% response rate. Eighty-five percent of program directors (n = 57) reported that education in quality improvement is essential to future professional work in the field of surgery. Only 28% (n = 18) of programs reported that at least 50% of their residents track and analyze their patient outcomes, compare them with norms/benchmarks/published standards, and identify opportunities to make practice improvements. Program directors recognize the importance of quality improvement efforts in surgical practice. Subpar participation in basic practice-based learning and improvement activities at the resident level reflects the need for support of these educational goals. The QITI will facilitate programmatic compliance with goals for quality improvement education. Copyright © 2013 American College of Surgeons. All rights reserved.

  10. Cost-utility of medication withdrawal in older fallers: results from the improving medication prescribing to reduce risk of FALLs (IMPROveFALL trial

    Directory of Open Access Journals (Sweden)

    Suzanne Polinder

    2016-11-01

    Full Text Available Abstract Background The use of Fall-Risk-Increasing-Drugs (FRIDs has been associated with increased risk of falls and associated injuries. This study investigates the effect of withdrawal of FRIDs versus ‘care as usual’ on health-related quality of life (HRQoL, costs, and cost-utility in community-dwelling older fallers. Methods In a prospective multicenter randomized controlled trial FRIDs assessment combined with FRIDs-withdrawal or modification was compared with ‘care as usual’ in older persons, who visited the emergency department after experiencing a fall. For the calculation of costs the direct medical costs (intramural and extramural and indirect costs (travel costs were collected for a 12 month period. HRQoL was measured at baseline and at 12 months follow-up using the EuroQol-5D and Short Form-12 version 2. The change in EuroQol-5D and Short Form-12 scores over 12 months follow-up within the control and intervention groups was compared using the Wilcoxon Signed Rank test for continuous variables and the McNemar test for dichotomous variables. The change in scores between the control and intervention groups were compared using a two-way analysis of variance. Results We included 612 older persons who visited an emergency department because of a fall. The mean cost of the FRIDs intervention was €120 per patient. The total fall-related healthcare costs (without the intervention costs did not differ significantly between the intervention group and the control group (€2204 versus €2285. However, the withdrawal of FRIDs reduced medication costs with a mean of €38 per participant. Furthermore, the control group had a greater decline in EuroQol-5D utility score during the 12-months follow-up than the intervention group (p = 0.02. The change in the Short Form-12 Physical Component Summary and Mental Component Summary scores did not differ significantly between the two groups. Conclusions Withdrawal of FRID’s in older

  11. A structured self-directed basic skills curriculum results in improved technical performance in the absence of expert faculty teaching.

    Science.gov (United States)

    Wright, Andrew S; McKenzie, Jill; Tsigonis, Abraham; Jensen, Aaron R; Figueredo, Edgar J; Kim, Sara; Horvath, Karen

    2012-06-01

    We developed a novel curriculum teaching 20 open surgical skills in 5 general domains (instrument handling, knot tying, simple wound closure, advanced wound closure, and hemostasis). The curriculum includes online didactics, skills practice, and defined performance metrics, but is entirely self-guided with no expert oversight or teaching. Subjects included first- and second-year medical students (n = 9). Subjects first viewed a demonstration video depicting proper technique. The pretest was video-recorded performance of each skill. Subjects then completed the self-guided skills curriculum at their own pace, returning for posttesting once they met defined self-assessment criteria. Performance was evaluated through both self-assessment and blinded video review by 2 expert reviewers using previously validated scales. After completion of the curriculum, performance improved significantly by both self-assessment (3,754 ± 1,742 to 6,496 ± 1,337; P performance was significantly better for all domains by self-assessment (P instrument handling). Completion of a self-guided basic surgical skills curriculum allows novice learners to significantly improve performance in basic open surgical skills, without traditional expert teaching. This curriculum is useful for medical students and incoming junior residents. Copyright © 2012 Mosby, Inc. All rights reserved.

  12. Individualized Physical 3-dimensional Kidney Tumor Models Constructed From 3-dimensional Printers Result in Improved Trainee Anatomic Understanding.

    Science.gov (United States)

    Knoedler, Margaret; Feibus, Allison H; Lange, Andrew; Maddox, Michael M; Ledet, Elisa; Thomas, Raju; Silberstein, Jonathan L

    2015-06-01

    To evaluate the effect of 3-dimensionally (3D) printed physical renal models with enhancing masses on medical trainee characterization, localization, and understanding of renal malignancy. Proprietary software was used to import standard computed tomography (CT) cross-sectional imaging into 3D printers to create physical models of renal units with enhancing renal lesions in situ. Six different models were printed from a transparent plastic resin; the normal parenchyma was printed in a clear, translucent plastic, with a red hue delineating the suspicious renal lesion. Medical students, who had completed their first year of training, were given an overview and tasked with completion of RENAL nephrometry scores, separately using CT imaging and 3D models. Trainees were also asked to complete a questionnaire about their experience. Variability between trainees was assessed by intraclass correlation coefficients (ICCs), and kappa statistics were used to compare the trainee to experts. Overall trainee nephrometry score accuracy was significantly improved with the 3D model vs CT scan (P renal mass. Physical 3D models using readily available printing techniques improve trainees' understanding and characterization of individual patients' enhancing renal lesions. Published by Elsevier Inc.

  13. Balance improvement after physical therapy training using specially developed serious games for cerebral palsy children: preliminary results.

    Science.gov (United States)

    Bonnechère, Bruno; Omelina, Lubos; Jansen, Bart; Van Sint Jan, Serge

    2017-02-01

    Cerebral palsy (CP) leads to various clinical signs mainly induced by muscle spasticity and muscle weakness. Among these ones impaired balance and posture are very common. Traditional physical therapy exercise programs are focusing on this aspect, but it is difficult to motivate patients to regularly perform these exercises, especially at home without therapist supervision. Specially developed serious games (SG) could therefore be an interesting option to motivate children to perform specific exercise for balance improvement. Ten CP children participated in this study. Patients received four sessions of SG included into conventional therapy (1 session of 30 min a week during 4 weeks). Trunk control and balance were assessed using Trunk Control Motor Scale (TCMS) before and after interventions. Children presented a significant improvement in TCMS global score after interventions [37.6 (8.7) and 39.6 (9.5) before and after interventions, respectively, p = 0.04]. SG could therefore be an interesting option to integrate in the conventional treatment of CP children. Implication for Rehabilitation Cerebral palsy (CP) leads to balance issues. Rehabilitation exercises are not performed (enough) at home. Serious games (SG) could increase patients' motivation. SG increase balance control of CP children.

  14. Single-Staged Improved Tubularized Preputial/Penile Skin Flap Urethroplasty for Obliterated Anterior Urethral Stricture: Long-Term Results.

    Science.gov (United States)

    Xue, Jing-Dong; Xie, Hong; Fu, Qiang; Feng, Chao; Guo, Hui; Xu, Yue-Min

    2016-01-01

    To present an improved tubularized flap (ITF) technique and report the outcome of single-stage urethroplasty using preputial/penile skin flaps (PSFs) for the treatment of obliterative anterior urethral strictures (AUSs). From January 2000 to June 2012, 42 cases of obliterative AUS (3-14 cm, mean 6.38 cm) with urethral plate unsalvageable were treated using PSF-ITF urethroplasty including longitudinal skin flap, circular island flap, L-flap, Q-flap. Patients were divided into 3 groups: pendulous urethral stricture (Group A), bulbar urethral stricture (Group B) and panurethral strictures (Group C). Patients were followed up by uroflowmetry, urethrography and ureteroscope when necessary. The mean follow-up in these patients was 65 months (range 36 months-15 years). The primary success rates at 3-year follow-up were 75, 75 and 60% for Groups A, B and C, respectively. The overall success rates were 85, 83 and 70% with the remedial measure of a single visual internal urethrotomy at 3-year follow-up. A total 60% of the patients in the study completed more than 5 years of follow-up with no additional recurrence. Improved tubularized preputial/PSF urethroplasty with relatively high overall satisfaction is a novel technique for treatment of AUS when there is inadequate urethral plate or obliterative defects. © 2016 S. Karger AG, Basel.

  15. An intervention to improve sibling relationship quality among youth in foster care: Results of a randomized clinical trial.

    Science.gov (United States)

    Kothari, Brianne H; McBeath, Bowen; Sorenson, Paul; Bank, Lew; Waid, Jeff; Webb, Sara Jade; Steele, Joel

    2017-01-01

    Sibling programming is an important part of a prevention framework, particularly for youth in foster care. After children are removed from their families and placed into foster care in the aftermath of maltreatment, the sibling relationship is often the most viable ongoing relationship available to the child, and may be critical to a youth's sense of connection, emotional support, and continuity. The promise of dyadic sibling programming in particular rests on the ability of interventions to enhance the quality of sibling relationships; yet little research exists that suggests that sibling interventions can improve relationship quality among foster youth. The primary aim of the current study was to examine the effects of a specific dyadic sibling-focused intervention for older and younger siblings on sibling relationship quality. One hundred sixty four dyads (328 youth) participated in the study, with each dyad consisting of an older sibling between 11 and 15 years of age at baseline and a younger sibling separated in age by less than 4 years. Hierarchical linear models were applied to self-reported, observer-reported and observational data over the 18-month study period. Findings suggest that the sibling intervention holds promise for improving sibling relationship quality among youth in foster care. Implications and future directions for research are discussed. Copyright © 2016 Elsevier Ltd. All rights reserved.

  16. Feasibility and results of a case study of yoga to improve physical functioning in people with chronic traumatic brain injury.

    Science.gov (United States)

    Schmid, Arlene A; Miller, Kristine K; Van Puymbroeck, Marieke; Schalk, Nancy

    2016-01-01

    The purpose of this mixed-methods case study was to investigate whether an 8-week 1:1 yoga program was feasible and beneficial to people with traumatic brain injury (TBI). This was a mixed-methods case study of one-to-one yoga for people with TBI included three people. We completed assessments before and after the 8-week yoga intervention and included measures of balance, balance confidence, pain, range of motion, strength and mobility. Qualitative interviews were included at the post-assessment. We include a percent change calculation and salient quotes that represent the perceived impact of the yoga intervention. All participants completed the yoga intervention and all demonstrated improvements in physical outcome measures. For the group, balance increased by 36%, balance confidence by 39%, lower extremity strength by 100% and endurance by 105%. Qualitative data support the use of yoga to improve multiple aspects of physical functioning, one participant stated: "I mean it's rocked my world. It's changed my life. I mean all the different aspects. I mean physically, emotionally, mentally, it's given me you know my life back…". Yoga, delivered in a one-to-one setting, appears to be feasible and beneficial to people with chronic TBI. Chronic traumatic brain injury (TBI) leads to many aspects of physical functioning impairment. Yoga delivered in a one-to-one setting may be feasible and beneficial for people with chronic TBI.

  17. Rates of Delirium Diagnosis Do Not Improve with Emergency Risk Screening: Results of the Emergency Department Delirium Initiative Trial.

    Science.gov (United States)

    Arendts, Glenn; Love, Jennefer; Nagree, Yusuf; Bruce, David; Hare, Malcolm; Dey, Ian

    2017-08-01

    To determine whether a bundled risk screening and warning or action card system improves formal delirium diagnosis and person-centered outcomes in hospitalized older adults. Prospective trial with sequential introduction of screening and interventional processes. Two tertiary referral hospitals in Australia. Individuals aged 65 and older presenting to the emergency department (ED) and not requiring immediate resuscitation (N = 3,905). Formal ED delirium screening algorithm and use of a risk warning card with a recommended series of actions for the prevention and management of delirium during the subsequent admission MEASUREMENTS: Delirium diagnosis at hospital discharge, proportion discharged to new assisted living arrangements, in-hospital complications (use of sedation, falls, aspiration pneumonia, death), hospital length of stay. Participants with a positive risk screen were significantly more likely (relative risk = 6.0, 95% confidence interval = 4.9-7.3) to develop delirium, and the proportion of at-risk participants with a positive screen was constant across three study phases. Delirium detection rate in participants undergoing the final intervention (Phase 3) was 12.1% (a 2% absolute and 17% relative increase from the baseline rate) but this was not statistically significant (P = .29), and a similar relative increase was seen over time in participants not receiving the intervention CONCLUSION: A risk screening and warning or action card intervention in the ED did not significantly improve rates of delirium detection or other important outcomes. © 2017, Copyright the Authors Journal compilation © 2017, The American Geriatrics Society.

  18. How to constrain multi-objective calibrations using water balance components for an improved realism of model results

    Science.gov (United States)

    Accurate discharge simulation is one of the most common objectives of hydrological modeling studies. However, a good simulation of discharge is not necessarily the result of a realistic simulation of hydrological processes within the catchment. To enhance the realism of model results, we propose an ...

  19. Cost-utility of medication withdrawal in older fallers: results from the improving medication prescribing to reduce risk of FALLs (IMPROveFALL) trial.

    Science.gov (United States)

    Polinder, Suzanne; Boyé, Nicole D A; Mattace-Raso, Francesco U S; Van der Velde, Nathalie; Hartholt, Klaas A; De Vries, Oscar J; Lips, Paul; Van der Cammen, Tischa J M; Patka, Peter; Van Beeck, Ed F; Van Lieshout, Esther M M

    2016-11-04

    reduction of total health-care costs. However, the withdrawal of FRIDs reduced medication costs with a mean of €38 per participant in combination with less decline in HRQoL is an important result. The trial is registered in the Netherlands Trial Register ( NTR1593 - October 1 st 2008).

  20. Lifestyle Intervention Improves Heart Rate Recovery from Exercise in Adults with Type 2 Diabetes: Results from the Look AHEAD Study

    Directory of Open Access Journals (Sweden)

    Paul M. Ribisl

    2012-01-01

    Full Text Available The primary aims of this paper were (1 to evaluate the influence of intensive lifestyle weight loss and exercise intervention (ILI compared with diabetes support and education (DSE upon Heart Rate Recovery (HRR from graded exercise testing (GXT and (2 to determine the independent and combined effects of weight loss and fitness changes upon HRR. In 4503 participants (45–76 years who completed 1 year of intervention, HRR was measured after a submaximal GXT to compare the influence of (ILI with (DSE upon HRR. Participants assigned to ILI lost an average 8.6% of their initial weight versus 0.7% in DSE group (P<0.001 while mean fitness increased in ILI by 20.9% versus 5.8% in DSE (P<0.001. At Year 1, all exercise and HRR variables in ILI improved (P<0.0001 versus DSE: heart rate (HR at rest was lower (72.8±11.4 versus 77.7±11.7 b/min, HR range was greater (57.7±12.1 versus 53.1±12.4 b/min, HR at 2 minutes was lower (89.3±21.8 versus 93.0±12.1 b/min, and HRR was greater (41.25±22.0 versus 37.8±12.5 b/min. Weight loss and fitness gain produced significant separate and independent improvements in HRR.

  1. INR targets and site-level anticoagulation control: results from the Veterans AffaiRs Study to Improve Anticoagulation (VARIA).

    Science.gov (United States)

    Rose, A J; Berlowitz, D R; Miller, D R; Hylek, E M; Ozonoff, A; Zhao, S; Reisman, J I; Ash, A S

    2012-04-01

    Not all clinicians target the same International Normalized Ratio (INR) for patients with a guideline-recommended target range of 2-3. A patient's mean INR value suggests the INR that was actually targeted. We hypothesized that sites would vary by mean INR, and that sites of care with mean values nearest to 2.5 would achieve better anticoagulation control, as measured by per cent time in therapeutic range (TTR). To examine variations among sites in mean INR and the relationship with anticoagulation control in an integrated system of care. We studied 103,897 patients receiving oral anticoagulation with an expected INR target between 2 and 3 at 100 Veterans Health Administration (VA) sites from 1 October 2006 to 30 September 2008. Key site-level variables were: proportion near 2.5 (that is, percentage of patients with mean INR between 2.3 and 2.7) and mean risk-adjusted TTR. Site mean INR ranged from 2.22 to 2.89; proportion near 2.5, from 30 to 64%. Sites' proportions of patients near 2.5, below 2.3 and above 2.7 were consistent from year to year. A 10 percentage point increase in the proportion near 2.5 predicted a 3.8 percentage point increase in risk-adjusted TTR (P < 0.001). Proportion of patients with mean INR near 2.5 is a site-level 'signature' of care and an implicit measure of targeted INR. This proportion varies by site and is strongly associated with site-level TTR. Our study suggests that sites wishing to improve TTR, and thereby improve patient outcomes, should avoid the explicit or implicit pursuit of non-standard INR targets. © 2012 International Society on Thrombosis and Haemostasis.

  2. A Simple, Visually Oriented Communication System to Improve Postoperative Care Following Microvascular Free Tissue Transfer: Development, Results, and Implications.

    Science.gov (United States)

    Henderson, Peter W; Landford, Wilmina; Gardenier, Jason; Otterburn, David M; Rohde, Christine H; Spector, Jason A

    2016-07-01

    Background Communication, particularly transmission of information between the surgical and nursing teams, has been identified as one of the most crucial determinants of patient outcomes. Nonetheless, transfer of information among and between the physician and nursing teams in the immediate postoperative period is often informal, verbal, and inconsistent. Methods An iterative process of multidisciplinary information gathering was undertaken to create a novel postoperative communication system (the "Pop-form"). Once developed, nurses were surveyed on multiple measures regarding the perceived likelihood that it would improve their ability to provide directed patient care. Data were quantified using a Likert scale (0-10), and statistically analyzed. Results The Pop-form records and transfers operative details, specific anatomic monitoring parameters, and senior physician contact information. Sixty-eight nurses completed surveys. The perceived usefulness of different components of the Pop-form system was as follows: 8.9 for the description of the procedure; 9.3 for the operative diagram; 9.4 for the monitoring details and parameters; and 9.4 for the direct contact information for the appropriate surgical team member. All respondents were in favor of widespread adoption of the Pop-form. Conclusion This uniform, visual communication system requires less than 1 minute to compose, yet formalizes and standardizes inter-team communication, and therefore shows promise for improving outcomes following microvascular free tissue transfer. We believe that this simple, innovative communication tool has the potential to be more broadly applied to many other health care settings. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  3. Improving Work Outcome in Supported Employment for Serious Mental Illness: Results From 2 Independent Studies of Errorless Learning.

    Science.gov (United States)

    Kern, Robert S; Zarate, Roberto; Glynn, Shirley M; Turner, Luana R; Smith, Kellie M; Mitchell, Sharon S; Sugar, Catherine A; Bell, Morris D; Liberman, Robert P; Kopelowicz, Alex; Green, Michael F

    2018-01-13

    Heterogeneity in work outcomes is common among individuals with serious mental illness (SMI). In 2 studies, we sought to examine the efficacy of adding errorless learning, a behavioral training intervention, to evidence-based supported employment to improve SMI work outcomes. Work behavior problems were targeted for intervention. We also explored associations between early work behavior and job tenure. For both studies (VA: n = 71; community mental health center: n = 91), randomization occurred at the time of job obtainment with participants randomized (1:1) to either errorless learning plus ongoing supported employment or ongoing supported employment alone and then followed for 12 months. Dependent variables included job tenure, work behavior, and hours worked and wages earned per week. For the primary intent-to-treat analyses, data were combined across studies. Findings revealed that participants in the errorless learning plus supported employment group stayed on their jobs significantly longer than those in the supported employment alone group (32.8 vs 25.6 wk). In addition, differential treatment effects favoring errorless learning were found on targeted work behavior problems (50.5% vs 27.4% improvement from baseline to follow-up assessment). There were no other differential treatment effects. For the prediction analyses involving work behavior, social skills explained an additional 18.3% of the variance in job tenure beyond levels of cognition, symptom severity, and past work history. These data support errorless learning as an adjunctive intervention to enhance supported employment outcomes and implicate the relevance of workplace social difficulties as a key impediment to prolonged job tenure. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center 2017.

  4. The Great Hedge of India

    International Nuclear Information System (INIS)

    Moxham, Roy

    2015-01-01

    The 'Great Hedge of India', a 3 700 kilometre-long hedge installed by the British customs to safeguard the colonial salt tax system and avoid salt smuggling totally faded from both memory and records (e.g. maps) in less than a century. Roy Moxham found traces of the hedge in a book footnote and searched it for several years until he found its meagre remains. The speaker wrote a book about this quest. He said that this story reveals how things disappear when they are no longer useful and, especially, when they are linked to parts of history that are not deemed particularly positive (the hedge was a means of colonial power)

  5. Gypsum karst in Great Britain

    Directory of Open Access Journals (Sweden)

    Cooper A.H.

    1996-01-01

    Full Text Available In Great Britain the most spectacular gypsum karst development is in the Zechstein gypsum (late Permian mainly in north-eastern England. The Midlands of England also has some karst developed in the Triassic gypsum in the vicinity of Nottingham. Along the north-east coast, south of Sunderland, well-developed palaeokarst, with magnificent breccia pipes, was produced by dissolution of Permian gypsum. In north-west England a small gypsum cave system of phreatic origin has been surveyed and recorded. A large actively evolving phreatic gypsum cave system has been postulated beneath the Ripon area on the basis of studies of subsidence and boreholes. The rate of gypsum dissolution here, and the associated collapse lead to difficult civil engineering and construction conditions, which can also be aggravated by water abstraction.

  6. Great-Britain at CERN

    CERN Multimedia

    C. Laignel

    2004-01-01

    From 23 to 25 November 2004 Administration Building Bldg 60/61 - ground and 1st floor 09.30 - 17.30 Twenty five companies will present their latest technology at the "Great-Britain at CERN" exhibition. British industry will exhibit products and technologies which are related to the field of particle physics. The main subjects are: electrical engineering, electronics, mechanical engineering, vacuum & low temperatures technologies, particles detectors and telecommunications. The exhibition is organised by BEAMA Exhibitions, The British Electrotechnical and Allied Manufacturer's Association There follows : the list of exhibitors. A detailed programme will be available in due course at : your Departemental secretariat, the reception information desk, Building 33, the exhibition. A detailed list of firms is available under the following FI link: http://fi-dep.web.cern.ch/fi-dep/structure/memberstates/exhibitions_visits.htm 1 Accles & Pollock 2 A S Scientific Products Ltd 3 C...

  7. Great Basin Experimental Range: Annotated bibliography

    Science.gov (United States)

    E. Durant McArthur; Bryce A. Richardson; Stanley G. Kitchen

    2013-01-01

    This annotated bibliography documents the research that has been conducted on the Great Basin Experimental Range (GBER, also known as the Utah Experiment Station, Great Basin Station, the Great Basin Branch Experiment Station, Great Basin Experimental Center, and other similar name variants) over the 102 years of its existence. Entries were drawn from the original...

  8. The origin of 'Great Walls'

    International Nuclear Information System (INIS)

    Shandarin, Sergei F.

    2009-01-01

    A new semi-analytical model that explains the formation and sizes of the 'great walls' - the largest structures observed in the universe is suggested. Although the basis of the model is the Zel'dovich approximation it has been used in a new way very different from the previous studies. Instead of traditional approach that evaluates the nonlinear density field it has been utilized for identification of the regions in Lagrangian space that after the mapping to real or redshift space (depending on the kind of structure is studied) end up in the regions where shell-crossing occurs. The set of these regions in Lagrangian space form the progenitor of the structure and after the mapping it determines the pattern of the structure in real or redshift space. The particle trajectories have crossed in such regions and the mapping is no longer unique there. The progenitor after mapping makes only one stream in the multi-stream flow regions therefore it does not comprise all the mass. Nevertheless, it approximately retains the shape of the structure. The progenitor of the structure in real space is determined by the linear density field along with two non-Gaussian fields derived from the initial potential. Its shape in Eulerian space is also affected by the displacement field. The progenitor of the structure in redshift space also depends on these fields but in addition it is strongly affected by two anisotropic fields that determine the pattern of great walls as well as their huge sizes. All the fields used in the mappings are derived from the linear potential smoothed at the current scale of nonlinearity which is R nl = 2.7 h −1 Mpc for the adopted parameters of the ΛCDM universe normalized to σ 8 = 0.8. The model predicts the existence of walls with sizes significantly greater than 500 h −1 Mpc that may be found in sufficiently large redshift surveys

  9. The Great Warming Brian Fagan

    Science.gov (United States)

    Fagan, B. M.

    2010-12-01

    The Great Warming is a journey back to the world of a thousand years ago, to the Medieval Warm Period. Five centuries of irregular warming from 800 to 1250 had beneficial effects in Europe and the North Atlantic, but brought prolonged droughts to much of the Americas and lands affected by the South Asian monsoon. The book describes these impacts of warming on medieval European societies, as well as the Norse and the Inuit of the far north, then analyzes the impact of harsh, lengthy droughts on hunting societies in western North America and the Ancestral Pueblo farmers of Chaco Canyon, New Mexico. These peoples reacted to drought by relocating entire communities. The Maya civilization was much more vulnerable that small-scale hunter-gatherer societies and subsistence farmers in North America. Maya rulers created huge water storage facilities, but their civilization partially collapsed under the stress of repeated multiyear droughts, while the Chimu lords of coastal Peru adapted with sophisticated irrigation works. The climatic villain was prolonged, cool La Niñalike conditions in the Pacific, which caused droughts from Venezuela to East Asia, and as far west as East Africa. The Great Warming argues that the warm centuries brought savage drought to much of humanity, from China to Peru. It also argues that drought is one of the most dangerous elements in today’s humanly created global warming, often ignored by preoccupied commentators, but with the potential to cause over a billion people to starve. Finally, I use the book to discuss the issues and problems of communicating multidisciplinary science to the general public.

  10. Evaluating the improvements of the BOLAM meteorological model operational at ISPRA: A case study approach - preliminary results

    Science.gov (United States)

    Mariani, S.; Casaioli, M.; Lastoria, B.; Accadia, C.; Flavoni, S.

    2009-04-01

    Fritsch. A fully updated serial version of the BOLAM code has been recently acquired. Code improvements include a more precise advection scheme (Weighted Average Flux); explicit advection of five hydrometeors, and state-of-the-art parameterization schemes for radiation, convection, boundary layer turbulence and soil processes (also with possible choice among different available schemes). The operational implementation of the new code into the SIMM model chain, which requires the development of a parallel version, will be achieved during 2009. In view of this goal, the comparative verification of the different model versions' skill represents a fundamental task. On this purpose, it has been decided to evaluate the performance improvement of the new BOLAM code (in the available serial version, hereinafter BOLAM 2007) with respect to the version with the Kain-Fritsch scheme (hereinafter KF version) and to the older one employing the Kuo scheme (hereinafter Kuo version). In the present work, verification of precipitation forecasts from the three BOLAM versions is carried on in a case study approach. The intense rainfall episode occurred on 10th - 17th December 2008 over Italy has been considered. This event produced indeed severe damages in Rome and its surrounding areas. Objective and subjective verification methods have been employed in order to evaluate model performance against an observational dataset including rain gauge observations and satellite imagery. Subjective comparison of observed and forecast precipitation fields is suitable to give an overall description of the forecast quality. Spatial errors (e.g., shifting and pattern errors) and rainfall volume error can be assessed quantitatively by means of object-oriented methods. By comparing satellite images with model forecast fields, it is possible to investigate the differences between the evolution of the observed weather system and the predicted ones, and its sensitivity to the improvements in the model code

  11. Air pollution and environmental justice in the Great Lakes region

    Science.gov (United States)

    Comer, Bryan

    While it is true that air quality has steadily improved in the Great Lakes region, air pollution remains at unhealthy concentrations in many areas. Research suggests that vulnerable and susceptible groups in society -- e.g., minorities, the poor, children, and poorly educated -- are often disproportionately impacted by exposure to environmental hazards, including air pollution. This dissertation explores the relationship between exposure to ambient air pollution (interpolated concentrations of fine particulate matter, PM2.5) and sociodemographic factors (race, housing value, housing status, education, age, and population density) at the Census block-group level in the Great Lakes region of the United States. A relatively novel approach to quantitative environmental justice analysis, geographically weighted regression (GWR), is compared with a simplified approach: ordinary least squares (OLS) regression. While OLS creates one global model to describe the relationship between air pollution exposure and sociodemographic factors, GWR creates many local models (one at each Census block group) that account for local variations in this relationship by allowing the value of regression coefficients to vary over space, overcoming OLS's assumption of homogeneity and spatial independence. Results suggest that GWR can elucidate patterns of potential environmental injustices that OLS models may miss. In fact, GWR results show that the relationship between exposure to ambient air pollution and sociodemographic characteristics is non-stationary and can vary geographically and temporally throughout the Great Lakes region. This suggests that regulators may need to address environmental justice issues at the neighborhood level, while understanding that the severity of environmental injustices can change throughout the year.

  12. Adults with idiopathic scoliosis improve disability after motor and cognitive rehabilitation: results of a randomised controlled trial.

    Science.gov (United States)

    Monticone, Marco; Ambrosini, Emilia; Cazzaniga, Daniele; Rocca, Barbara; Motta, Lorenzo; Cerri, Cesare; Brayda-Bruno, Marco; Lovi, Alessio

    2016-10-01

    To evaluate the effects of motor and cognitive rehabilitation on disability in adults with idiopathic scoliosis at lower risk of progression. 130 adults with idiopathic scoliosis (main curve rehabilitation programme consisting of active self-correction, task-oriented exercises and cognitive-behavioural therapy (experimental group, 65 subjects, mean age of 51.6, females 48) or general physiotherapy consisting of active and passive mobilizations, stretching, and strengthening exercises of the spinal muscles (control group, 65 subjects, mean age of 51.7, females 46). Before, at the end, and 12 months after treatment, each participant completed the Oswestry disability index (ODI) (primary outcome), the Tampa scale for kinesiophobia, the pain catastrophizing scale, a pain numerical rating scale, and the Scoliosis Research Society-22 Patient Questionnaire. Radiological (Cobb angle) and clinical deformity (angle of trunk rotation) changes were also investigated. A linear mixed model for repeated measures was used for each outcome. Significant effects of time, group, and time by group interaction were found for all outcome measures (P cognitive rehabilitation also led to improvements in dysfunctional thoughts, pain, and quality of life. Changes were maintained for at least 1 year.

  13. A facility specialist model for improving retention of nursing home staff: results from a randomized, controlled study.

    Science.gov (United States)

    Pillemer, Karl; Meador, Rhoda; Henderson, Charles; Robison, Julie; Hegeman, Carol; Graham, Edwin; Schultz, Leslie

    2008-07-01

    This article reports on a randomized, controlled intervention study designed to reduce employee turnover by creating a retention specialist position in nursing homes. We collected data three times over a 1-year period in 30 nursing homes, sampled in stratified random manner from facilities in New York State and Connecticut and randomly assigned to treatment and control conditions. Staff outcomes were measured through certified nursing assistant interviews, and turnover rates were measured over the course of the year. In the intervention condition, a staff member was selected to be the facility retention specialist, who would advocate for and implement programs to improve staff retention and commitment throughout the facility. Retention specialists received an intensive 3-day training in retention leadership and in a number of evidence-based retention programs. Ongoing support was provided throughout the project. Treatment facilities experienced significant declines in turnover rates compared to control facilities. As predicted, we found positive effects on certified nursing assistant assessments of the quality of retention efforts and of care provided in the facility; we did not find effects for job satisfaction or stress. The study provides evidence for the effectiveness of the retention specialist model. Findings from a detailed process evaluation suggest modifications of the program that may increase program effects.

  14. Follow-up of Antihypertensive Therapy Improves Blood Pressure Control: Results of HYT (HYperTension survey) Follow-up.

    Science.gov (United States)

    Fici, F; Seravalle, G; Koylan, N; Nalbantgil, I; Cagla, N; Korkut, Y; Quarti-Trevano, F; Makel, W; Grassi, G

    2017-09-01

    Although improved during the past few years, blood pressure control remains sub optimal. The impact of follow-up assessment on blood pressure control was evaluated in a group of patients of the HYT (HYperTension survey), treated with a combination of different dihydropyridine calcium-channel blockers (CCBs regimen) and inhibitors of renin-angiotensin-aldosterone system (RAAS) and with uncontrolled blood pressure. This was obtained assessing (a) the rate of blood pressure control at 3 and 6 months of follow-up in the whole group of patients, (b) the rate of blood pressure control and the average blood pressure values in subjects treated with different DHP-CCBs regimen. From the 4993 patients with uncontrolled blood pressure, (BP ≥ 140/90 or ≥140/85 in patients with diabetes), 3729 (mean age 61.2 ± 11.5 years), maintained CCBs regimen combined wih RAAS blockers and were evaluated at 3 and 6 months follow-up. At each visit BP (semiautomatic device, Omron-M6, 3 measurements), heart rate, adverse events and treatment persistence were collected. At 1st and 2nd follow-up the rate of controlled BP was 63.5 and 72.8% respectively (p blood pressure control; (b) there is no significant difference in the antihypertensive effect between different CCBs regimen; (c) lipophilic CCBs induce less ankle edema.

  15. Surviving "Payment by Results": a simple method of improving clinical coding in burn specialised services in the United Kingdom.

    Science.gov (United States)

    Wallis, Katy L; Malic, Claudia C; Littlewood, Sonia L; Judkins, Keith; Phipps, Alan R

    2009-03-01

    Coding inpatient episodes plays an important role in determining the financial remuneration of a clinical service. Insufficient or incomplete data may have very significant consequences on its viability. We created a document that improves the coding process in our Burns Centre. At Yorkshire Regional Burns Centre an inpatient summary sheet was designed to prospectively record and present essential information on a daily basis, for use in the coding process. The level of care was also recorded. A 3-month audit was conducted to assess the efficacy of the new forms. Forty-nine patients were admitted to the Burns Centre with a mean age of 27.6 years and TBSA ranging from 0.5% to 65%. The total stay in the Burns Centre was 758 days, of which 22% were at level B3-B5 and 39% at level B2. The use of the new discharge document identified potential income of about 500,000 GB pound sterling at our local daily tariffs for high dependency and intensive care. The new form is able to ensure a high quality of coding with a possible direct impact on the financial resources accrued for burn care.

  16. Post eLetter Solutions: Healthy Results for Improving Patient Communication Processes at the Royal Hobart Hospital.

    Science.gov (United States)

    Boulter, Rhonda

    2009-06-01

    The primary objective of the Australia Post eLetter project 1 was to determine the feasibility of using the eLetter service with the Patient Administration System Appointment Scheduling Module to provide a fully automated mailing function that would eliminate the need for manual processing of mail delivery. Issues with timely delivery of letters throughout all outpatient sites at the Royal Hobart Hospital (RHH) have been identified as being mainly due to limited human resources being available to perform mailing duties and the like. This new desktop service enables staff to transmit data electronically in conjunction with the appointment software for large quantity mail postings to Australia Post via a secure line. Australia Post then validates the address, appends a barcode, prints the letter, envelopes it and inserts it into the mail distribution network in the state of the recipient. This article depicts the process that has eliminated the manual processing of a letter via the traditional Microsoft application, Wordmate, a system at RHH that was always difficult to use. With the introduction of eLetter, the RHH's Specialist Clinics have significantly improved the timeliness and quality of communication with patients as well as reducing administration tasks for staff.

  17. A pilot study of simple interventions to improve informed consent in clinical research: feasibility, approach, and results.

    Science.gov (United States)

    Kass, Nancy E; Taylor, Holly A; Ali, Joseph; Hallez, Kristina; Chaisson, Lelia

    2015-02-01

    Research suggests that participants do not always adequately understand studies. While some consent interventions increase understanding, methodologic challenges have been raised in studying consent outside of actual trial settings. This study examined the feasibility of testing two consent interventions in actual studies and measured effectiveness of interventions in improving understanding. Participants enrolling in any of eight ongoing clinical trials were sequentially assigned to one of three different informed consent strategies for enrollment in their clinical trial. Control participants received standard consent procedures for their trial. Participants in the first intervention arm received a bulleted fact sheet summarizing key study information. Participants in the second intervention arm received the bulleted fact sheet and also engaged in a feedback Q&A session. Later, patients answered closed- and open-ended questions to assess patient understanding and literacy. Descriptive statistics, Wilcoxon -Mann -Whitney and Kruskal-Wallis tests were generated to assess correlations; regression analysis determined predictors of understanding. 144 participants enrolled. Using regression analysis, participants receiving the second intervention scored 7.6 percentage points higher (p = .02) on open-ended questions about understanding than participants in the control, although unadjusted comparisons did not reach statistical significance. Our study supports the hypothesis that patients receiving both bulleted fact sheets and a Q&A session had higher understanding compared to standard consent. Fact sheets and short structured dialog are quick to administer and easy to replicate across studies and should be tested in larger samples. © The Author(s) 2014.

  18. Improving temporal bone dissection using self-directed virtual reality simulation: results of a randomized blinded control trial.

    Science.gov (United States)

    Zhao, Yi Chen; Kennedy, Gregor; Yukawa, Kumiko; Pyman, Brian; O'Leary, Stephen

    2011-03-01

    A significant benefit of virtual reality (VR) simulation is the ability to provide self-direct learning for trainees. This study aims to determine whether there are any differences in performance of cadaver temporal bone dissections between novices who received traditional teaching methods and those who received unsupervised self-directed learning in a VR temporal bone simulator. Randomized blinded control trial. Royal Victorian Eye and Ear Hospital. Twenty novice trainees. After receiving an hour lecture, participants were randomized into 2 groups to receive an additional 2 hours of training via traditional teaching methods or self-directed learning using a VR simulator with automated guidance. The simulation environment presented participants with structured training tasks, which were accompanied by real-time computer-generated feedback as well as real operative videos and photos. After the training, trainees were asked to perform a cortical mastoidectomy on a cadaveric temporal bone. The dissection was videotaped and assessed by 3 otologists blinded to participants' teaching group. The overall performance scores of the simulator-based training group were significantly higher than those of the traditional training group (67% vs 29%; P < .001), with an intraclass correlation coefficient of 0.93, indicating excellent interrater reliability. Using other assessments of performance, such as injury size, the VR simulator-based training group also performed better than the traditional group. This study indicates that self-directed learning on VR simulators can be used to improve performance on cadaver dissection in novice trainees compared with traditional teaching methods alone.

  19. Stroke acute management with urgent risk-factor assessment and improvement (SAMURAI) rt-PA registry. General results and subanalyses

    International Nuclear Information System (INIS)

    Toyoda, Kazunori; Koga, Masatoshi; Shiokawa, Yoshiaki

    2010-01-01

    Stroke Acute Management with Urgent Risk-factor Assessment and Improvement [SAMURAI] rt-PA Registry is a multicenter retrospective observational study from 10 Japanese stroke centers. A total of 600 patients (223 women, 72±12 years old) treated with intravenous alteplase (0.6 mg/kg) were studied. Symptomatic intracerebral hemorrhage within 36 hours with ≥4 point-increase from the baseline National Institutes of Health (NIH) Stroke Scale score developed in 8 patients (1.3%, 95% confidence interval (CI) 0.7-2.6%). At 3 months, 199 patients (33.2%, 29.5-37.0%) had a modified Rankin Scale (mRS) score ≤1. Analysis of 399 patients with a premorbid mRS score ≤1 who met the criteria of the European license (≤80 years old, an initial NIHSS score ≤24, etc.) showed that 40.6% (35.9-45.5%) had a 3-month mRS ≤1. In the subanalyses from this registry, early ischemic change on diffusion-weighted imaging assessed by the Alberta Stroke Programme Early CT Score, as well as reduced estimated glomerular filtration rate, was associated with early intracerebral hemorrhage and 3-month outcomes of patients. (author)

  20. Stroke acute management with urgent risk-factor assessment and improvement (SAMURAI) rt-PA registry. General results and subanalyses

    Energy Technology Data Exchange (ETDEWEB)

    Toyoda, Kazunori; Koga, Masatoshi [National Cerebral and Cardiovascular Center, Suita, Osaka (Japan); Shiokawa, Yoshiaki [Kyorin Univ., School of Medicine, Mitaka, Tokyo (Japan)

    2010-11-15

    Stroke Acute Management with Urgent Risk-factor Assessment and Improvement [SAMURAI] rt-PA Registry is a multicenter retrospective observational study from 10 Japanese stroke centers. A total of 600 patients (223 women, 72{+-}12 years old) treated with intravenous alteplase (0.6 mg/kg) were studied. Symptomatic intracerebral hemorrhage within 36 hours with {>=}4 point-increase from the baseline National Institutes of Health (NIH) Stroke Scale score developed in 8 patients (1.3%, 95% confidence interval (CI) 0.7-2.6%). At 3 months, 199 patients (33.2%, 29.5-37.0%) had a modified Rankin Scale (mRS) score {<=}1. Analysis of 399 patients with a premorbid mRS score {<=}1 who met the criteria of the European license ({<=}80 years old, an initial NIHSS score {<=}24, etc.) showed that 40.6% (35.9-45.5%) had a 3-month mRS {<=}1. In the subanalyses from this registry, early ischemic change on diffusion-weighted imaging assessed by the Alberta Stroke Programme Early CT Score, as well as reduced estimated glomerular filtration rate, was associated with early intracerebral hemorrhage and 3-month outcomes of patients. (author)

  1. Weight loss and improved gross motor coordination in children as a result of multidisciplinary residential obesity treatment.

    Science.gov (United States)

    D'Hondt, Eva; Gentier, Ilse; Deforche, Benedicte; Tanghe, Ann; De Bourdeaudhuij, Ilse; Lenoir, Matthieu

    2011-10-01

    This study evaluated the short-term effectiveness of a multidisciplinary residential obesity treatment program by describing changes in body weight, related measures, and gross motor co-ordination. Secondarily, it was examined to what extent the amount of relative weight loss achieved by overweight and obese (OW/OB) participants explained the projected improvement in gross motor co-ordination. Thirty-six OW/OB children (aged 10.5 ± 1.4 years, 12 girls and 24 boys) were recruited at the Zeepreventorium VZW (De Haan, Belgium), where they followed a specific program consisting of moderate dietary restriction, psychological support, and physical activity. For reference purposes, an additional group of 36 age- and gender-matched healthy-weight (HW) children was included in the study. Anthropometric measures were recorded and gross motor co-ordination was assessed using the Körperkoordinationstest für Kinder (KTK) on two occasions with an interval of 4 months. Regardless of the test moment, OW/OB participants displayed significantly poorer KTK performances (P motor co-ordination performance, with a greater increase in KTK score(s) from baseline to re-test as compared to HW peers (P motor co-ordination, which in turn may promote physical activity participation.

  2. Improved survival of baby boomer women with early-stage uterine cancer: A Surveillance, Epidemiology and End Results (SEER) Study.

    Science.gov (United States)

    Elshaikh, Mohamed A; Ruterbusch, Julie; Cote, Michele L; Cattaneo, Richard; Munkarah, Adnan R

    2013-11-01

    To study the prognostic impact of baby boomer (BB) generation on survival end-points of patients with early-stage endometrial carcinoma (EC). Data were obtained from the SEER registry between 1988-2009. Inclusion criteria included women who underwent hysterectomy for stage I-II EC. Patients were divided into two birth cohorts: BB (women born between 1946 and 1964) and pre-boomers (PB) (born between 1926 and 1945). A total of 30,956 patients were analyzed. Considering that women in the PB group were older than those of the BB generation, the statistical analysis was limited to women 50-59 years of age at the time of diagnosis (n=11,473). Baby boomers had a significantly higher percentage of endometrioid histology (pgeneration compared to the PB generation (p=0.0003) with a trend for improved uterine cancer-specific survival (p=0.0752). On multivariate analysis, birth cohort (BB vs. PB) was not a significant predictor of survival end-points. Factors predictive of survival included: tumor grade, FIGO stage, African-American race, and increased number of dissected LN. Our study suggests that the survival of BB women between 50-60 years of age is better compared to women in the PB generation. As more BB patients are diagnosed with EC, further research is warranted.

  3. Corrected transposition of the great arteries

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Young Hi; Park, Jae Hyung; Han, Man Chung [Seoul National University College of Medicine, Seoul (Korea, Republic of)

    1981-12-15

    The corrected transposition of the great arteries is an usual congenital cardiac malformation, which consists of transposition of great arteries and ventricular inversion, and which is caused by abnormal development of conotruncus and ventricular looping. High frequency of associated cardiac malformations makes it difficult to get accurate morphologic diagnosis. A total of 18 cases of corrected transposition of the great arteries is presented, in which cardiac catheterization and angiocardiography were done at the Department of Radiology, Seoul National University Hospital between September 1976 and June 1981. The clinical, radiographic, and operative findings with the emphasis on the angiocardiographic findings were analyzed. The results are as follows: 1. Among 18 cases, 13 cases have normal cardiac position, 2 cases have dextrocardia with situs solitus, 2 cases have dextrocardia with situs inversus and 1 case has levocardia with situs inversus. 2. Segmental sets are (S, L, L) in 15 cases, and (I, D,D) in 3 cases and there is no exception to loop rule. 3. Side by side interrelationships of both ventricles and both semilunar valves are noticed in 10 and 12 cases respectively. 4. Subaortic type conus is noted in all 18 cases. 5. Associated cardic malformations are VSD in 14 cases, PS in 11, PDA in 3, PFO in 3, ASD in 2, right aortic arch in 2, tricuspid insufficiency, mitral prolapse, persistent left SVC and persistent right SVC in 1 case respectively. 6. For accurate diagnosis of corrected TGA, selective biventriculography using biplane cineradiography is an essential procedure.

  4. Corrected transposition of the great arteries

    International Nuclear Information System (INIS)

    Choi, Young Hi; Park, Jae Hyung; Han, Man Chung

    1981-01-01

    The corrected transposition of the great arteries is an usual congenital cardiac malformation, which consists of transposition of great arteries and ventricular inversion, and which is caused by abnormal development of conotruncus and ventricular looping. High frequency of associated cardiac malformations makes it difficult to get accurate morphologic diagnosis. A total of 18 cases of corrected transposition of the great arteries is presented, in which cardiac catheterization and angiocardiography were done at the Department of Radiology, Seoul National University Hospital between September 1976 and June 1981. The clinical, radiographic, and operative findings with the emphasis on the angiocardiographic findings were analyzed. The results are as follows: 1. Among 18 cases, 13 cases have normal cardiac position, 2 cases have dextrocardia with situs solitus, 2 cases have dextrocardia with situs inversus and 1 case has levocardia with situs inversus. 2. Segmental sets are (S, L, L) in 15 cases, and (I, D,D) in 3 cases and there is no exception to loop rule. 3. Side by side interrelationships of both ventricles and both semilunar valves are noticed in 10 and 12 cases respectively. 4. Subaortic type conus is noted in all 18 cases. 5. Associated cardic malformations are VSD in 14 cases, PS in 11, PDA in 3, PFO in 3, ASD in 2, right aortic arch in 2, tricuspid insufficiency, mitral prolapse, persistent left SVC and persistent right SVC in 1 case respectively. 6. For accurate diagnosis of corrected TGA, selective biventriculography using biplane cineradiography is an essential procedure

  5. OF THE GREAT TEMPLE OF BEL

    Directory of Open Access Journals (Sweden)

    A. Denker

    2017-02-01

    Full Text Available The Great Temple of Bel in Palmyra was a unique edifice which had blended the well established lines of Greco-Roman architecture with the art and taste of the Orient. With the gilded bronze capitals of its 41 Corinthian columns it was the product of enormous effort and budget. It was the gem of a remarkable epoch of wealthy Palmyra and mighty Roma. With its splendidly decorated adyta ceilings it became a source of inspiration and imagination for Western architecture and decorative arts. While continuing to captivate the World, it was leveled and vanished as a grim result of conflict based vandalism. The aim of this work is to piece together this, the most eloquent and stupendous monument of the Roman East, from its ruins and reconstruct it as it was once extant. Its loss is irreplacable, but its photo-realistic reconstruction can offer some solace by waking the memories of the great temple as in the past. The lost reality of the Great Temple of Bel is revived here by digitally constructing its “ghost images".

  6. Moral reasoning about great apes in research

    Science.gov (United States)

    Okamoto, Carol Midori

    2006-04-01

    This study explored how individuals (biomedical scientists, Great Ape Project activists, lay adults, undergraduate biology and environmental studies students, and Grade 12 and 9 biology students) morally judge and reason about using great apes in biomedical and language research. How these groups perceived great apes' mental capacities (e.g., pain, logical thinking) and how these perceptions related to their judgments were investigated through two scenarios. In addition, the kinds of informational statements (e.g., biology, economics) that may affect individuals' scenario judgments were investigated. A negative correlation was found between mental attributions and scenario judgments while no clear pattern occurred for the informational statements. For the biomedical scenario, all groups significantly differed in mean judgment ratings except for the biomedical scientists, GAP activists and Grade 9 students. For the language scenario, all groups differed except for the GAP activists, and undergraduate environmental studies and Grade 9 students. An in-depth qualitative analysis showed that although the biomedical scientists, GAP activists and Grade 9 students had similar judgments, they produced different mean percentages of justifications under four moral frameworks (virtue, utilitarianism, deontology, and welfare). The GAP activists used more virtue reasoning while the biomedical scientists and Grade 9 students used more utilitarian and welfare reasoning, respectively. The results are discussed in terms of developing environmental/humane education curricula.

  7. Early morning fledging improves recruitment in great tits Parus major

    NARCIS (Netherlands)

    Radersma, Reinder; Komdeur, Jan; Tinbergen, Joost M.

    A potential key event linking the nestling phase to first-year survival is fledging (nest leaving) because this process is characterized by a major change of environments and therefore a sudden shift in selective forces. Here we assessed whether different facets of fledging predicted subsequent

  8. Does transfusion improve the outcome for HNSCC patients treated with radiotherapy? - Results from the randomized DAHANCA 5 and 7 trials

    DEFF Research Database (Denmark)

    Hoff, Camilla Molich; Lassen, Pernille; Eriksen, Jesper Grau

    2011-01-01

    of transfusion by the results from the randomized DAHANCA 5 trial, including 414 patients in the analysis. Aim of the current analysis was to gain additional power by adding patients from the continued subrandomization in the DAHANCA 7 trial, now including a total of almost 1200 patients. Material and methods...

  9. Health locus of control as a psychological factor in improving treatment results in adolescents with primary hypertension and diabetes

    Directory of Open Access Journals (Sweden)

    Marta Anna Biernacka

    2016-10-01

    Full Text Available Background The belief that an individual can influence and control the course of events is a factor which enables a person to overcome difficulties. Some studies, however, have questioned the universality of this statement. This study aims to investigate and explore the relationship between the self-health locus of control and the effectiveness of cooperation in the treatment process in adolescents with chronic diseases. Participants and procedure One hundred and sixty-four adolescent patients suffering from chronic diseases (61 girls and 103 boys ranging from 11 to 17 years old participated in the study. Eighty-seven had primary hypertension and 77 had type 1 diabetes. To investigate their sense of health control we used the Health Locus of Control Scale (HLC. Cooperation in the treatment process was assessed using a 4-item scale completed by a doctor. Results Better results in the treatment were positively correlated with a better internal health locus of control. A negative correlation between the chance health locus of control and results in the treatment was found. Differences in the health locus of control proved to be dependent on gender, age and different clinical groups. Conclusions Health locus of control in patients with chronic diseases seems to be a crucial factor in determining the results of the treatment process in such patients.

  10. Improving Library Service Quality to Graduate Students: LibQual+[TM] Survey Results in a Practical Setting

    Science.gov (United States)

    Jankowska, Maria Anna; Hertel, Karen; Young, Nancy J.

    2006-01-01

    The LibQUAL+[TM] survey was conducted to determine user satisfaction and expectations concerning library service quality. The results of the "22 items and a box" constituted a rich source of information for the University of Idaho (UI) Library's strategic planning process. Focusing on graduate students, this study used three…

  11. An online community improves adherence in an internet-mediated walking program. Part 1: results of a randomized controlled trial.

    Science.gov (United States)

    Richardson, Caroline R; Buis, Lorraine R; Janney, Adrienne W; Goodrich, David E; Sen, Ananda; Hess, Michael L; Mehari, Kathleen S; Fortlage, Laurie A; Resnick, Paul J; Zikmund-Fisher, Brian J; Strecher, Victor J; Piette, John D

    2010-12-17

    Approximately half of American adults do not meet recommended physical activity guidelines. Face-to-face lifestyle interventions improve health outcomes but are unlikely to yield population-level improvements because they can be difficult to disseminate, expensive to maintain, and inconvenient for the recipient. In contrast, Internet-based behavior change interventions can be disseminated widely at a lower cost. However, the impact of some Internet-mediated programs is limited by high attrition rates. Online communities that allow participants to communicate with each other by posting and reading messages may decrease participant attrition. Our objective was to measure the impact of adding online community features to an Internet-mediated walking program on participant attrition and average daily step counts. This randomized controlled trial included sedentary, ambulatory adults who used email regularly and had at least 1 of the following: overweight (body mass index [BMI] ≥ 25), type 2 diabetes, or coronary artery disease. All participants (n = 324) wore enhanced pedometers throughout the 16-week intervention and uploaded step-count data to the study server. Participants could log in to the study website to view graphs of their walking progress, individually-tailored motivational messages, and weekly calculated goals. Participants were randomized to 1 of 2 versions of a Web-based walking program. Those randomized to the "online community" arm could post and read messages with other participants while those randomized to the "no online community" arm could not read or post messages. The main outcome measures were participant attrition and average daily step counts over 16 weeks. Multiple regression analyses assessed the effect of the online community access controlling for age, sex, disease status, BMI, and baseline step counts. Both arms significantly increased their average daily steps between baseline and the end of the intervention period, but there were no

  12. Validation of a new bedside echoscopic heart examination resulting in an improvement in echo-lab workflow.

    Science.gov (United States)

    Réant, Patricia; Dijos, Marina; Arsac, Florence; Mignot, Aude; Cadenaule, Fabienne; Aumiaux, Annette; Jimenez, Christine; Dufau, Marilyne; Prévost, Alain; Pillois, Xavier; Fort, Patrick; Roudaut, Raymond; Lafitte, Stéphane

    2011-03-01

    In daily cardiology practice, porters are usually required to transfer inpatients who need an echocardiogram to the echocardiographic department (echo-lab). To assess echo-lab personnel workflow and patient transfer delay by comparing the use of a new, ultraportable, echoscopic, pocket-sized device at the bedside with patient transfer to the echo-lab for conventional transthoracic echocardiography, in patients needing pericardial control after cardiac invasive procedures. After validation of echoscopic capabilities for pericardial effusion, left ventricular function and mitral regurgitation grade compared with conventional echocardiography, we evaluated echo-lab personnel workflow and time to perform bedside echoscopy for pericardial control evaluation after invasive cardiac procedures. This strategy was compared with conventional evaluation at the echo-lab, in terms of personnel workflow, and patients' transfer, waiting and examination times. Concordance between echoscopy and conventional echocardiography for evaluation of pericardial effusion was good (0.97; kappa value 0.86). For left ventricular systolic function and mitral regurgitation evaluations, concordances were 0.96 (kappa value 0.90) and 0.96 (kappa value 0.86), respectively. In the second part of the study, the mean total time required in the bedside echoscopy group was 20.3±5.4 mins vs. 66.0±16.4 mins in the conventional echo-lab group (pporters in 100% of cases; 69% of patients needed a wheelchair. The use of miniaturized echoscopic tools for pericardial control after invasive cardiac procedures was feasible and accurate, allowing improvement in echo-lab workflow and avoiding patient waiting time and transfer. Copyright © 2011 Elsevier Masson SAS. All rights reserved.

  13. Improving the Quality of Outpatient Diabetes Care Using an Information Management System: Results From the Observational VISION Study.

    Science.gov (United States)

    Weissmann, Joerg; Mueller, Angelika; Messinger, Diethelm; Parkin, Christopher G; Amann-Zalan, Ildiko

    2015-07-29

    This study aimed to evaluate the effects of information management system (IMS) use with individuals with type 1 and type 2 diabetes who were treated in outpatient settings. In this 7-month, prospective, observational study, 965 adults with diabetes, mean (SD) baseline HbA1c 8.61(1.2)% (70.6[13.1] mmol/mol), were recruited from 132 outpatient care centers in Germany and Denmark. HbA1c was measured at baseline, month 4, and month 7. IMS reports were generated from uploaded self-monitored blood glucose data and therapy adjustments were documented at months 1 and 4. Hypoglycemic events were documented. Mean (SD) HbA1c decreased from baseline in type 1 and type 2 diabetes patients at month 4 (-0.61[1.03]% (-6.7[11.3] mmol/mol), n = 213; -0.88[1.22]% (-9.6[13.3] mmol/mol), n = 589, respectively) and month 7 (-0.64[1.02]% (-7.0[11.1] mmol/mol), n = 219; -0.93[1.27]% (-10.2[13.9] mmol/mol), n = 594, respectively), all P < .0001, with no increase in hypoglycemic events. Therapy was adjusted in 106(42.7)% type 1 and 349(52.4)% type 2 diabetes patients at months 1 and 105(42.3)% type 1 and 282(42.3)% type 2 diabetes patients at month 4. Physicians used IMS reports to make therapy adjustments in 90% of patients at month 1 and 86% of patients at month 4. Integration of the IMS into outpatient care facilitates significant improvements in glycemic control. © 2015 Diabetes Technology Society.

  14. Home grocery delivery improves the household food environments of behavioral weight loss participants: results of an 8-week pilot study.

    Science.gov (United States)

    Gorin, Amy A; Raynor, Hollie A; Niemeier, Heather M; Wing, Rena R

    2007-11-14

    Household food availability is consistently linked to dietary intake; yet behavioral weight control treatment includes only minimal instruction on how to change the home environment to support dietary goals. This pilot study examined whether it is feasible to change the household food environments of behavioral weight loss participants through the use of a commercially available grocery home delivery service. Overweight participants (N = 28; BMI = 31.7 +/- 3.6 kg/m2; 89.3% women, 47.9 +/- 9.5 years) were randomly assigned to 8-weeks of standard behavioral weight loss (SBT) or to SBT plus home food delivery (SBT+Home). SBT+Home participants were instructed to do their household grocery shopping via an online service affiliated with a regional supermarket chain and were reimbursed for delivery charges. Compared to SBT, SBT+Home produced significantly greater reductions in the total number of foods in the home (p = .01) and number of foods that were high in fat (p = .002). While the groups did not differ in 8-week weight losses, within SBT+Home there was a trend for the number of home deliveries to be associated with weight loss (p = .08). Participants reported that the home delivery service was easy to use and that it helped decrease impulse purchases and lead to healthier choices; however, few planned to continue using the service after the study. Encouraging weight loss participants to use a commercially available online grocery ordering and home delivery service reduces the overall number of food items in the home and decreases access to high-fat food choices. More research is needed to determine whether this is a viable strategy to strengthen stimulus control and improve weight loss outcomes.

  15. The use of a pocket-sized ultrasound device improves physical examination: results of an in- and outpatient cohort study.

    Directory of Open Access Journals (Sweden)

    Agostino Colli

    Full Text Available The performance of pocket mobile ultrasound devices (PUDs is comparable with that of standard ultrasonography, whereas the accuracy of a physical examination is often poor requiring further tests to assess diagnostic hypotheses. Adding the use of PUD to physical examination could lead to an incremental benefit.We assessed whether the use of PUD in the context of physical examination can reduce the prescription of additional tests when used by physicians in different clinical settings.We conducted a cohort impact study in four hospital medical wards, one gastroenterological outpatient clinic, and 90 general practices in the same geographical area. The study involved 135 physicians who used PUD, after a short predefined training course, to examine 1962 consecutive patients with one of 10 diagnostic hypotheses: ascites, pleural effusion, pericardial effusion, urinary retention, urinary stones, gallstones, biliary-duct dilation, splenomegaly, abdominal mass, abdominal aortic aneurysm. According to the physicians' judgment, PUD examination could rule out or in the diagnostic hypothesis or require further testing; the concordance with the final diagnosis was assessed. The main outcome was the proportion of cases in which additional tests were required after PUD. The PUD diagnostic accuracy was assessed in patients submitted to further testing.The 1962 patients included 37% in-patients, 26% gastroenterology outpatients, 37% from general practices. Further testing after PUD examination was deemed unnecessary in 63%. Only 5% of patients with negative PUD not referred for further testing were classified false negatives with respect to the final diagnosis. In patients undergoing further tests, the sensitivity was 91%, and the specificity 83%.After a simple and short training course, a PUD examination can be used in addition to a physical examination to improve the answer to ten common clinical questions concerning in- and outpatients, and can reduce the

  16. Electroacupuncture Improves Bladder and Bowel Function in Patients with Traumatic Spinal Cord Injury: Results from a Prospective Observational Study

    Directory of Open Access Journals (Sweden)

    Zhishun Liu

    2013-01-01

    Full Text Available In order to explore the effect of electroacupuncture (EA for chronic bowel and bladder dysfunction after traumatic spinal cord injury, 14 patients were treated with electroacupuncture once a day, five times a week for the first four weeks, and once every other day, three times a week for the following four weeks. The patients were then followed up for six months. After treatment, four (4/14, 28.57% patients resumed normal voiding; six (6/14, 42.86% resumed normal voiding for no less than half of all micturition behaviors; four (4/14, 28.57% required supplementary urination methods for higher than half of all micturition behaviors. These effects persisted during followup. Mean postvoid RUV decreased by 190.29±101.87 mL (P<0.01 after treatment and by 198.86±112.18 mL (P<0.01 during followup. Patients’ weekly urinary incontinence frequency decreased 7.14±46.34 times/week (P=0.036 after treatment and decreased 49.86±44.38 times/week during followup. After treatment, four (4/14, 28.57% patients resumed normal bowel movements (P=0.025; five (5/14, 35.71% reduced the dependence on supplementary defecation methods; five (5/14, 35.71% had no changes. In patients with chronic bowel and bladder dysfunction after traumatic SCI, EA may provide a valuable alternative tool in improving patients’ self-controlled bowel and bladder functions with minimal side effects.

  17. Improved results of the vacuum assisted closure and Nitinol clips sternal closure after postoperative deep sternal wound infection.

    Science.gov (United States)

    Tocco, Maria Pia; Costantino, Alberto; Ballardini, Milva; D'Andrea, Claudio; Masala, Marcello; Merico, Eusebio; Mosillo, Luigi; Sordini, Paolo

    2009-05-01

    Postoperative deep sternal wound infection is a severe complication of cardiac surgery, with a high mortality rate and a high morbidity rate. The objective of this prospective study is to report our experience with the vacuum assisted closure (VAC) system for the management of deep wound infection. We also devised an innovative closure technique post VAC therapy using thermo reactive clips. The advantage of this technique is that the posterior face of the sternum does not have to be separated from the mediastinal structures thus minimising the risk of damage. From October 2006 to October 2008, we prospectively evaluated 21 patients affected by mediastinitis after sternotomy. Nineteen patients had sternotomy for coronary artery bypass grafting (CABG), one patient for aortic valve replacement (AVR) and another one for ascending aortic replacement (AAR). All patients were treated with the VAC system at the time of infection diagnosis. When the wound tissue appeared viable and the microbiological cultures were negative, the chest was closed using the most suitable procedure for the patient in question; nine patients were closed using pectoralis flaps, nine patients using Nitinol clips, one patient with a combined technique (use of Nitinol clips and muscle flap), one patient with a direct wound closure and another patient, who needed AAR with a homograft performed in another institution, was closed using sternal wires. We had no mortality; wound healing was successfully achieved in all patients. In more than 50% of the patients, the VAC therapy allowed direct sternal resynthesis. The average duration of the vacuum therapy was 26 days (range 14-37 days). VAC is a safe and effective option in the treatment of post-sternotomy mediastinitis, with excellent survival and immediate improvement of local wound conditions; furthermore, the use of Nitinol clips after VAC therapy demonstrated to be a safe and non-invasive option for sternal resynthesis. After VAC therapy, a

  18. Integration of Web 2.0 Tools in a VLE to Improve the EFL Spanish University Entrance Examination Results: A Quasiexperimental Study

    Science.gov (United States)

    Martin-Monje, Elena

    2014-01-01

    The article shows the results of a research project designed to improve the results in the English section of the Spanish University Admission Examination, or PAU, Prueba de Acceso a la Universidad (EFL-PAU henceforth). Using a quasi-experimental methodology relevant data was collected from both groups during a whole academic year just before…

  19. Improvement of the prediction of fluid pressure from the results of techno-geophysical studies under complex geological conditions

    Energy Technology Data Exchange (ETDEWEB)

    Aleksandrov, B.L.; Esipko, O.A.; Dakhkilgov, T.D.

    1981-12-01

    Results of statistical processing of the data of prediction of pore pressures in the course of well sinking, according to the material of oil field and geophysical investigations in different areas, are presented. Likewise, the errors of pressure prediction, their causes, geological models of series with anomalously high formation pressure, and methods for prediction of pore and formation pressures under different geological conditions are considered. 12 refs.

  20. FURTHER IMPROVEMENT OF THE INVESTMENT CLIMATE IN RUSSIA AS A RESULT OF MODERNIZATION OF THE RUSSIAN CIVIL CODE

    Directory of Open Access Journals (Sweden)

    V. Musin

    2014-01-01

    Full Text Available This article traces the history, and discusses some of the recent changes in the Russian Federation Civil Code, which result in a more favorable business climate inRussia. In particular, it discusses the development of changes related to the documentation of contracts, expansion in the durations and uses of powers of attorney, and the modernization of the statute of limitations period for bringing an action.">Russia >

  1. Results of special security inspection on improvement of security management setup in Head Office and Tsuruga Nuclear Power Station of the Japan Atomic Power Company and improvement of facilities in Tsuruga Nuclear Power Station

    International Nuclear Information System (INIS)

    1982-01-01

    In connection with the series of accidents in the Tsuruga Nuclear Power Station, the Agency of Natural Resources and Energy had instructed JAPC to make comprehensive inspection on the security management setup and to take improvement measures in the nuclear power station. The results of the subsequent inspection by ANRE confirmed that the improvements made by JAPC are adequate, and the following items are described: improvement of security management setup - communication and reporting in emergency, the management of inspection and maintenance records, work control and supervision in repair, improvement, etc., functional authority and responsibility in maintenance management, operation management, radiation control, personnel education; improvement of facilities - feed water heaters, laundry waste-water filter room, radioactive waste treatment facility, general drainage, concentrated waste liquid storage tanks in newly-built waste treatment building, etc. (J.P.N.)

  2. The third flight of the Colorado high-resolution echelle stellar spectrograph (CHESS): improvements, calibrations, and preliminary results

    Science.gov (United States)

    Kruczek, Nicholas; Nell, Nicholas; France, Kevin; Hoadley, Keri; Fleming, Brian; Kane, Robert; Ulrich, Stefan; Egan, Arika; Beatty, Dawson

    2017-08-01

    In this proceeding, we describe the scientific motivation and technical development of the Colorado HighResolution Echelle Stellar Spectrograph (CHESS), focusing on the hardware advancements and testing of components for the third launch of the payload (CHESS-3). CHESS is a far ultraviolet rocket-borne instrument designed to study the atomic-to-molecular transitions within translucent cloud regions in the interstellar medium. CHESS is an objective echelle spectrograph, which uses a mechanically-ruled echelle and a powered (f/12.4) crossdispersing grating, and is designed to achieve a resolving power R > 100,000 over the bandpass λλ 1000-1600 Å. Results from final efficiency and reflectivity measurements for the optical components of CHESS-3 are presented. An important role of sounding rocket experiments is the testing and verification of the space flight capabilities of experimental technologies. CHESS-3 utilizes a 40mm-diameter cross-strip anode microchannel plate detector fabricated by Sensor Sciences LLC, capable of achieving high spatial resolution and a high global count rate (˜1 MHz). We present pre-flight laboratory spectra and calibration results, including wavelength solution and resolving power of the instrument. The fourth launch of CHESS (CHESS-4) will demonstrate a δ-doped CCD, assembled in collaboration with the Microdevices Laboratory at JPL and Arizona State University. In support of CHESS-4, the CHESS-3 payload included a photomultiplier tube, used as a secondary confirmation of the optical alignment of the payload during flight. CHESS-3 launched on 26 June 2017 aboard NASA/CU sounding rocket mission 36.323 UG. We present initial flight results for the CHESS-3 observation of the β1 Scorpii sightline.

  3. Portal Vein Embolization before Right Hepatectomy: Improved Results Using n-Butyl-Cyanoacrylate Compared to Microparticles Plus Coils

    Energy Technology Data Exchange (ETDEWEB)

    Guiu, Boris, E-mail: boris.guiu@chu-dijon.fr; Bize, Pierre; Gunthern, Daniel [Centre Hospitalo-Univeristaire Vaudois, Digestive and Oncologic Imaging and Interventional Radiology Unit, Department of Radiology and Interventional Radiology (Switzerland); Demartines, Nicolas; Halkic, Nermin [Centre Hospitalo-Univeristaire Vaudois, Department of Visceral Surgery (Switzerland); Denys, Alban [Centre Hospitalo-Univeristaire Vaudois, Digestive and Oncologic Imaging and Interventional Radiology Unit, Department of Radiology and Interventional Radiology (Switzerland)

    2013-10-15

    Background: There is currently no consensus in the literature on which embolic agent induces the greatest degree of liver hypertrophy after portal vein embolization (PVE). Only experimental results in a pig model have demonstrated an advantage of n-butyl-cyanoacrylate (NBCA) over 3 other embolic materials (hydrophilic gel, small and large polyvinyl alcohol particles) for PVE. Therefore, the aim of this human study was to retrospectively compare the results of PVE using NBCA with those using spherical microparticles plus coils. Methods: A total of 34 patients underwent PVE using either NBCA (n = 20), or spherical microparticles plus coils (n = 14). PVE was decided according to preoperative volumetry on the basis of contrast-enhanced CT. Groups were compared for age, sex, volume of the left lobe before PVE and future remnant liver ratio (FRL) (volume of the left lobe/total liver volume - tumor volume). The primary end point was the increase in left lobe volume 1 month after PVE. Secondary end points were procedure complications and biological tolerance. Results: Both groups were similar in terms of age, sex ratio, left lobe volume, and FRL before PVE. NBCA induced a greater increase in volume after PVE than did microparticles plus coils (respectively, +74 {+-} 69 % and +23 {+-} 14 %, p < 0.05). The amount of contrast medium used for the procedure was significantly larger when microparticles and coils rather than NBCA were used (respectively, 264 {+-} 43 ml and 162 {+-} 34 ml, p < 0.01). The rate of PVE complications as well as the biological tolerance was similar in both groups. Conclusion: NBCA seems more effective than spherical microparticles plus coils to induce left-lobe hypertrophy.

  4. Does transfusion improve the outcome for HNSCC patients treated with radiotherapy? - results from the randomized DAHANCA 5 and 7 trials

    DEFF Research Database (Denmark)

    Hoff, Camilla; Lassen, Pernille; Eriksen, Jesper Grau

    2011-01-01

    Patients with head and neck squamous cell carcinoma (HNSCC) and a low level of hemoglobin often have a poor response to radiation that may be related to hypoxia-induced radioresistance. We have previously published the importance of hemoglobin level and the effect of transfusion by the results fr...... the randomized DAHANCA 5 trial, including 414 patients in the analysis. Aim of the current analysis was to gain additional power by adding patients from the continued subrandomization in the DAHANCA 7 trial, now including a total of almost 1200 patients....

  5. Silicone rubbers for dielectric elastomers with improved dielectric and mechanical properties as a result of substituting silica with titanium dioxide

    DEFF Research Database (Denmark)

    Yu, Liyun; Skov, Anne Ladegaard

    2016-01-01

    One prominent method of modifying the properties of dielectric elastomers (DEs) is by adding suitable metal oxide fillers. However, almost all commercially available silicone elastomers are already heavily filled with silica to reinforce the otherwise rather weak silicone network and the resulting...... and dynamic viscosity. Filled silicone elastomers with high loadings of nano-sized titanium dioxide (TiO2) particles were also studied. The best overall performing formulation had 35 wt.% TiO2 nanoparticles in the POWERSIL® XLR LSR, where the excellent ensemble of relative dielectric permittivity of 4.9 at 0...

  6. The heart and great vessels

    International Nuclear Information System (INIS)

    Condon, V.

    1985-01-01

    Heart disease is the fifth most common cause of death in infants and children (preceded by anoxic and hypoxic conditions, gross congenital malformations, accidental death, and immaturity). Of all the cardiac lesions, congenital heart disease (CHD) makes up the gross majority, accounting for approximately 90% of all cardiac deaths. Approximately two-thirds of all infants who die from CHD do so within the first year of life; of these, approximately one-third die within the first month. The most common cause of death in the first month is hypoplastic left heart syndrome and lesions associated with it, i.e., aortic atresia/critical aortic stenosis and mitral atresia/critical mitral stenosis. Severe coarctation of the aorta (coarctation syndrome) and transposition of the great arteries are the other most important causes of death in this age group. CHD occurs as a familial condition in approximately 1-4% of cases; ventricular septal defects, patent ductus arteriosus, and atrial septal defect are particularly common forms. Parental age plays an important role, with a significantly increased risk of CHD in infants of mothers over 39 years of age. Patent ductus arteriosus is more prevalent in firstborn children, particularly those born prematurely to young mothers. Environmental factors, such as exposure to teratogenic agents, have also been shown to increase the incidence of CHD. Children with various syndromes also have increased incidence of CHD. Down syndrome is a classic example, as are other trisomies

  7. Tipping Points, Great and Small

    Science.gov (United States)

    Morrison, Foster

    2010-12-01

    The Forum by Jordan et al. [2010] addressed environmental problems of various scales in great detail, but getting the critical message through to the formulators of public policies requires going back to basics, namely, that exponential growth (of a population, an economy, or most anything else) is not sustainable. When have you heard any politician or economist from anywhere across the ideological spectrum say anything other than that more growth is essential? There is no need for computer models to demonstrate “limits to growth,” as was done in the 1960s. Of course, as one seeks more details, the complexity of modeling will rapidly outstrip the capabilities of both observation and computing. This is common with nonlinear systems, even simple ones. Thus, identifying all possible “tipping points,” as suggested by Jordan et al. [2010], and then stopping just short of them, is impractical if not impossible. The main thing needed to avoid environmental disasters is a bit of common sense.