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Sample records for improvement project hip

  1. Hypertension Improvement Project (HIP: study protocol and implementation challenges

    Directory of Open Access Journals (Sweden)

    Pollak Kathryn I

    2009-02-01

    providers and the challenges faced during study implementation are presented. The HIP interventions may improve blood pressure control and lower cardiovascular disease risk in a primary care practice setting by addressing key components of the chronic care model. The study design allows an assessment of the effectiveness and cost of physician and patient interventions separately, so that health care organizations can make informed decisions about implementation of 1 or both interventions in the context of local resources. Trial registration ClinicalTrials.gov identifier NCT00201136

  2. Improving hip surgery patients’ outcomes:

    DEFF Research Database (Denmark)

    Bagger, Bettan; Poulsen, Dorthe Varning; Taylor Kelly, Hélène

    2013-01-01

    This presentation focuses upon the improvement of hip surgery patients’ outcomes with respect to health promotion and rehabilitation. The overall aims of the EU financed orthopedic nursing project will be introduced. Speakers highlight the project’s contribution to: -the development of nurse...

  3. Improving older frail hip fracture patients’ experience and recovery:

    DEFF Research Database (Denmark)

    Bagger, Bettan; Taylor Kelly, Hélène; Kjøller varmarken, Tine

    2013-01-01

    Background: An Interregional Project named Pro-hip aims at improving hip surgery patients’ outcomes based on best evidence in relation to rehabilitation; nutrition; urine retention; delirium and pressure ulcers. This presentation is an introduction to a new evidence based standard developed...... review identifying best evidence with respect to intermittent versus permanent catheterization - Developing the new standard - Implementation - Audit and evaluation Presentation and sharing: - Target groups - Decisions makers Conclusion: Reduction of incidence of retention and urinary tract infection...

  4. Hypertension Improvement Project (HIP) Latino: results of a pilot study of lifestyle intervention for lowering blood pressure in Latino adults

    Science.gov (United States)

    del Pilar Rocha-Goldberg, María; Corsino, Leonor; Batch, Bryan; Voils, Corrine I.; Thorpe, Carolyn T.; Bosworth, Hayden B.; Svetkey, Laura P.

    2010-01-01

    Objectives To assess the feasibility of a culturally tailored behavioral intervention for improving hypertension-related health behaviors in Hispanic/Latino adults. Design Feasibility pilot study in a community health center and a Latino organization in Durham, North Carolina (NC). Intervention The culturally adapted behavioral intervention consisted of 6 weekly group sessions incorporating motivational interviewing techniques. Goals included weight loss if overweight, adoption of the Dietary Approaches to Stop Hypertension (DASH) dietary pattern, and increased physical activity. Participants were also encouraged to monitor their daily intake of fruits, vegetables, dairy and fat, and to record physical activity. Cultural adaptations included conducting the study in familiar places, using Spanish-speaking interventionist, culturally-appropriate food choices, and physical activity. Main outcomes Systolic blood pressure, weight, body mass index (BMI), exercise, and dietary pattern were measured at baseline and at 6 weeks follow-up. Qualitative evaluations of the recruitment process and the intervention were also conducted. Results There were 64 potential participants identified via health care provider referrals (33%), printed media (23%), and direct contact (44%). Seventeen participants completed the intervention and had main outcome data available. Participants “strongly agreed/ agreed” that the group sessions provided them with the tools they needed to achieve weight loss, blood pressure control, and the possibility of sustaining the lifestyle changes after completing the intervention. At the end of the intervention, all physiological, diet, and exercise outcomes were more favorable, with the exception of fat. After 6 weeks, systolic blood pressure decreased an average of −10.4 ± 10.6 mmHg, weight decreased 1.5 ± 3.2 lbs, BMI decreased 0.3 ± 0.5, and physical activity increased 40 minutes per week. Conclusion Our findings suggest that lifestyle

  5. The Hip Impact Protection Project: design and methods.

    Science.gov (United States)

    Barton, Bruce A; Birge, Stanley J; Magaziner, Jay; Zimmerman, Sheryl; Ball, Linda; Brown, Kathleen M; Kiel, Douglas P

    2008-01-01

    Nearly 340,000 hip fractures occur each year in the U.S. With current demographic trends, the number of hip fractures is expected to double at least in the next 40 years. The Hip Impact Protection Project (HIP PRO) was designed to investigate the efficacy and safety of hip protectors in an elderly nursing home population. This paper describes the innovative clustered matched-pair research design used in HIP PRO to overcome the inherent limitations of clustered randomization. Three clinical centers recruited 37 nursing homes to participate in HIP PRO. They were randomized so that the participating residents in that home received hip protectors for either the right or left hip. Informed consent was obtained from either the resident or the resident's responsible party. The target sample size was 580 residents with replacement if they dropped out, had a hip fracture, or died. One of the advantages of the HIP PRO study design was that each resident was his/her own case and control, eliminating imbalances, and there was no confusion over which residents wore pads (or on which hip). Generalizability of the findings may be limited. Adherence was higher in this study than in other studies because of: (1) the use of a run-in period, (2) staff incentives, and (3) the frequency of adherence assessments. The use of a single pad is not analogous to pad use in the real world and may have caused unanticipated changes in behavior. Fall assessment was not feasible, limiting the ability to analyze fractures as a function of falls. Finally, hip protector designs continue to evolve so that the results generated using this pad may not be applicable to other pad designs. However, information about factors related to adherence will be useful for future studies. The clustered matched-pair study design avoided the major problem with previous cluster-randomized investigations of this question - unbalanced risk factors between the experimental group and the control group. Because each

  6. Canine Hip Dysplasia Screening Within the United States: Pennsylvania Hip Improvement Program and Orthopedic Foundation for Animals Hip/Elbow Database.

    Science.gov (United States)

    Reagan, Jennifer K

    2017-07-01

    Canine hip dysplasia (CHD) is a complex, polygenic disease radiographically associated with hip subluxation and development of osteoarthritis. Screening programs have been established with the goal of hip improvement, with the most common in the United States being OFA hip scoring and the PennHIP method. When evaluating the single hip-extended view used by OFA versus the 3 radiographic views and associated distraction index (DI) used by PennHIP for CHD screening, the scientific evidence supports the use of the DI and PennHIP method. OFA scoring can be used to effect hip improvement, especially when incorporated into estimated breeding values. Copyright © 2017 Elsevier Inc. All rights reserved.

  7. Improved Mass Spectrometer Project

    Data.gov (United States)

    National Aeronautics and Space Administration — The Improved Mass Spectrometer project will develop system requirements and analyze the path to space qualification.   The results of this project...

  8. Meaningful improvement in gait speed in hip fracture recovery.

    Science.gov (United States)

    Alley, Dawn E; Hicks, Gregory E; Shardell, Michelle; Hawkes, William; Miller, Ram; Craik, Rebecca L; Mangione, Kathleen K; Orwig, Denise; Hochberg, Marc; Resnick, Barbara; Magaziner, Jay

    2011-09-01

    To estimate meaningful improvements in gait speed observed during recovery from hip fracture and to evaluate the sensitivity and specificity of gait speed changes in detecting change in self-reported mobility. Secondary longitudinal data analysis from two randomized controlled trials Twelve hospitals in the Baltimore, Maryland, area. Two hundred seventeen women admitted with hip fracture. Usual gait speed and self-reported mobility (ability to walk 1 block and climb 1 flight of stairs) measured 2 and 12 months after fracture. Effect size-based estimates of meaningful differences were 0.03 for small differences and 0.09 for substantial differences. Depending on the anchor (stairs vs walking) and method (mean difference vs regression), anchor-based estimates ranged from 0.10 to 0.17 m/s for small meaningful improvements and 0.17 to 0.26 m/s for substantial meaningful improvement. Optimal gait speed cutpoints yielded low sensitivity (0.39-0.62) and specificity (0.57-0.76) for improvements in self-reported mobility. Results from this sample of women recovering from hip fracture provide only limited support for the 0.10-m/s cut point for substantial meaningful change previously identified in community-dwelling older adults experiencing declines in walking abilities. Anchor-based estimates and cut points derived from receiver operating characteristic curve analysis suggest that greater improvements in gait speed may be required for substantial perceived mobility improvement in female hip fracture patients. Furthermore, gait speed change performed poorly in discriminating change in self-reported mobility. Estimates of meaningful change in gait speed may differ based on the direction of change (improvement vs decline) or between patient populations. © 2011, Copyright the Authors. Journal compilation © 2011, The American Geriatrics Society.

  9. Machine Learning Principles Can Improve Hip Fracture Prediction

    DEFF Research Database (Denmark)

    Kruse, Christian; Eiken, Pia; Vestergaard, Peter

    2017-01-01

    Apply machine learning principles to predict hip fractures and estimate predictor importance in Dual-energy X-ray absorptiometry (DXA)-scanned men and women. Dual-energy X-ray absorptiometry data from two Danish regions between 1996 and 2006 were combined with national Danish patient data.......89 [0.82; 0.95], but with poor calibration in higher probabilities. A ten predictor subset (BMD, biochemical cholesterol and liver function tests, penicillin use and osteoarthritis diagnoses) achieved a test AUC of 0.86 [0.78; 0.94] using an "xgbTree" model. Machine learning can improve hip fracture...... prediction beyond logistic regression using ensemble models. Compiling data from international cohorts of longer follow-up and performing similar machine learning procedures has the potential to further improve discrimination and calibration....

  10. Current practice in primary total hip replacement: results from the National Hip Replacement Outcome Project

    OpenAIRE

    Best, A. J.; Fender, D.; Harper, W. M.; McCaskie, A. W.; Oliver, K; Gregg, P J

    1999-01-01

    As part of the National Study of Primary Hip Replacement Outcome, 402 consultant orthopaedic surgeons from three regions were contacted by postal questionnaire which covered all aspects of total hip replacement (THR). There was a 70% response rate of which 71 did not perform hip surgery, a further 33 refused to take part, leaving 181 valid responses. Preoperative assessment clinics were used by 89% of surgeons, but anaesthetists and rehabilitation services were rarely involved at this stage. ...

  11. Improving Project Manufacturing Coordination

    Directory of Open Access Journals (Sweden)

    Korpivaara Ville

    2014-09-01

    Full Text Available The objective of this research is to develop firms’ project manufacturing coordination. The development will be made by centralizing the manufacturing information flows in one system. To be able to centralize information, a deep user need assessment is required. After user needs have been identified, the existing system will be developed to match these needs. The theoretical background is achieved through exploring the literature of project manufacturing, development project success factors and different frameworks and tools for development project execution. The focus of this research is rather in customer need assessment than in system’s technical expertise. To ensure the deep understanding of customer needs this study is executed by action research method. As a result of this research the information system for project manufacturing coordination was developed to respond revealed needs of the stakeholders. The new system improves the quality of the manufacturing information, eliminates waste in manufacturing coordination processes and offers a better visibility to the project manufacturing. Hence it provides a solid base for the further development of project manufacturing.

  12. Identifying the procedural gap and improved methods for maintaining accuracy during total hip arthroplasty.

    Science.gov (United States)

    Gross, Allan; Muir, Jeffrey M

    2016-09-01

    Osteoarthritis is a ubiquitous condition, affecting 26 million Americans each year, with up to 17% of adults over age 75 suffering from one variation of arthritis. The hip is one of the most commonly affected joints and while there are conservative options for treatment, as symptoms progress, many patients eventually turn to surgery to manage their pain and dysfunction. Early surgical options such as osteotomy or arthroscopy are reserved for younger, more active patients with less severe disease and symptoms. Total hip arthroplasty offers a viable solution for patients with severe degenerative changes; however, post-surgical discrepancies in leg length, offset and component malposition are common and cause significant complications. Such discrepancies are associated with consequences such as low back pain, neurological deficits, instability and overall patient dissatisfaction. Current methods for managing leg length and offset during hip arthroplasty are either inaccurate and susceptible to error or are cumbersome, expensive and lengthen surgical time. There is currently no viable option that provides accurate, real-time data to surgeons regarding leg length, offset and cup position in a cost-effective manner. As such, we hypothesize that a procedural gap exists in hip arthroplasty, a gap into which fall a large majority of arthroplasty patients who are at increased risk of complications following surgery. These complications and associated treatments place significant stress on the healthcare system. The costs associated with addressing leg length and offset discrepancies can be minor, requiring only heel lifts and short-term rehabilitation, but can also be substantial, with revision hip arthroplasty costs of up to $54,000 per procedure. The need for a cost-effective, simple to use and unobtrusive technology to address this procedural gap in hip arthroplasty and improve patient outcomes is of increasing importance. Given the aging of the population, the projected

  13. Delirium detection and improved delirium management in older patients hospitalized for hip fracture.

    Science.gov (United States)

    Todd, Kristine S; Barry, Jean; Hoppough, Susan; McConnell, Eleanor

    2015-11-01

    Delirium is a common and potentially devastating problem for older patients following hip fracture. Although early detection is recommended, description and evaluation of standardized approaches are scarce. The aims of this quality improvement project were to: (1) implement a clinical algorithm for improving delirium detection and management and (2) assess the impact of the clinical algorithm on length of stay, discharge disposition and patient satisfaction. The pilot study was implemented on an orthopedic unit to evaluate the effectiveness of a clinical protocol for delirium detection and management to improve outcomes. Outcomes of 33 elderly post-operative hip fracture patients were compared to historical controls from the same unit. Delirium was detected in 18% of patients. Length of stay was reduced by 22% (P patient satisfaction scores showed a 15% (P = .15) improvement post-intervention. Implementation of a clinical algorithm to promote early detection and treatment of delirium in post-operative hip fracture patients is feasible and associated with improved outcomes.

  14. Interstate Electrification Improvement Project

    Energy Technology Data Exchange (ETDEWEB)

    Puckette, Margaret [Shorepower Technologies, Hillsboro, OR (United States); Kim, Jeff [Shorepower Technologies, Hillsboro, OR (United States)

    2015-07-01

    The Interstate Electrification Improvement Project, publicly known as the Shorepower Truck Electrification Project (STEP), started in May 2011 and ended in March 2015. The project grant was awarded by the Department of Energy’s Vehicles Technology Office in the amount of $22.2 million. It had three overarching missions: 1. Reduce the idling of Class 8 tractors when parked at truck stops, to reduce diesel fuel consumption and thus U.S. dependence on foreign petroleum; 2. Stimulate job creation and economic activity as part of the American Reinvestment and Recovery Act of 2009; 3. Reduce greenhouse gas emissions (GHG) from diesel combustion and the carbon footprint of the truck transportation industry. The project design was straightforward. First, build fifty Truck Stop Electrification (TSE) facilities in truck stop parking lots across the country so trucks could plug-in to 110V, 220V, or 480VAC, and shut down the engine instead of idling. These facilities were strategically located at fifty truck stops along major U.S. Interstates with heavy truck traffic. Approximately 1,350 connection points were installed, including 150 high-voltage electric standby Transport Refrigeration Unit (eTRU) plugs--eTRUs are capable of plugging in to shore power1 to cool the refrigerated trailer for loads such as produce, meats and ice cream. Second, the project provided financial incentives on idle reduction equipment to 5,000 trucks in the form of rebates, to install equipment compatible with shore power. This equipment enables drivers to shut down the main engine when parked, to heat or cool their cab, charge batteries, or use other household appliances without idling—a common practice that uses approximately 1 gallon of diesel per hour. The rebate recipients were intended to be the first fleets to plug into Shorepower to save diesel fuel and ensure there is significant population of shore power capable trucks. This two part project was designed to complement each other by

  15. MDSplus quality improvement project

    Energy Technology Data Exchange (ETDEWEB)

    Fredian, Thomas W., E-mail: twf@psfc.mit.edu [Massachusetts Institute of Technology, 175 Albany Street, Cambridge, MA 02139 (United States); Stillerman, Joshua [Massachusetts Institute of Technology, 175 Albany Street, Cambridge, MA 02139 (United States); Manduchi, Gabriele; Rigoni, Andrea [Consorzio RFX, Euratom-ENEA Association, Corso Stati Uniti 4, Padova 35127 (Italy); Erickson, Keith [Princeton Plasma Physics Laboratory, Princeton, NJ 08543 (United States)

    2016-11-15

    Highlights: • Project to improve the quality of the MDSplus software package. • Use of modern software technology, compiler options, automake. • Refactoring of older code. • Use of testing tools. - Abstract: MDSplus is a data acquisition and analysis system used worldwide predominantly in the fusion research community. Development began 29 years ago on the OpenVMS operating system. Since that time there have been many new features added and the code has been ported to many different operating systems. There have been contributions to the MDSplus development from the fusion community in the way of feature suggestions, feature implementations, documentation and porting to different operating systems. The bulk of the development and support of MDSplus, however, has been provided by a relatively small core developer group of three or four members. Given the size of the development team and the large number of users much more effort was focused on providing new features for the community than on keeping the underlying code and documentation up to date with the evolving software development standards. To ensure that MDSplus will continue to provide the needs of the community in the future, the MDSplus development team along with other members of the MDSplus user community has commenced on a major quality improvement project. The planned improvements include changes to software build scripts to better use GNU Autoconf and Automake tools, refactoring many of the source code modules using new language features available in modern compilers, using GNU MinGW-w64 to create MS Windows distributions, migrating to a more modern source code management system, improvement of source documentation as well as improvements to the (www.mdsplus.org) web site documentation and layout, and the addition of more comprehensive test suites to apply to MDSplus code builds prior to releasing installation kits to the community. This work should lead to a much more robust product and

  16. Photovoltaic solar power in building engineering. Experience feedback in France of the European Hip Hip project. Advances and realizations; L'electricite solaire photovoltaique dans le batiment. Retour d'experience en France du Projet Europeen Hip Hip. Avancees et realisations

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2003-07-01

    The European demonstration project Hip Hip (house integrated photovoltaic high-tech in public) led the French photovoltaic market to reach a level comparable to those of the other European countries in terms of relevance of implemented solutions and costs. This document presents the best realizations and the experience gained through the Hip Hip project. Its aim is to convince the designers and managers of building projects of the advantages of photovoltaic installations integrated to the structure and connected to the power distribution grid: 1 - presentation of the technology; 2 - status of the Hip Hip demonstration project (goals, results: main innovations and impact on the French market); 3 - different possibilities of integration to the building structure; 4 - examples of projects realized in France in the framework of the Hip Hip project: integration in glass roof, frontage, added elements, fitting on roofs. (J.S.)

  17. Machine Learning Principles Can Improve Hip Fracture Prediction.

    Science.gov (United States)

    Kruse, Christian; Eiken, Pia; Vestergaard, Peter

    2017-04-01

    Apply machine learning principles to predict hip fractures and estimate predictor importance in Dual-energy X-ray absorptiometry (DXA)-scanned men and women. Dual-energy X-ray absorptiometry data from two Danish regions between 1996 and 2006 were combined with national Danish patient data to comprise 4722 women and 717 men with 5 years of follow-up time (original cohort n = 6606 men and women). Twenty-four statistical models were built on 75% of data points through k-5, 5-repeat cross-validation, and then validated on the remaining 25% of data points to calculate area under the curve (AUC) and calibrate probability estimates. The best models were retrained with restricted predictor subsets to estimate the best subsets. For women, bootstrap aggregated flexible discriminant analysis ("bagFDA") performed best with a test AUC of 0.92 [0.89; 0.94] and well-calibrated probabilities following Naïve Bayes adjustments. A "bagFDA" model limited to 11 predictors (among them bone mineral densities (BMD), biochemical glucose measurements, general practitioner and dentist use) achieved a test AUC of 0.91 [0.88; 0.93]. For men, eXtreme Gradient Boosting ("xgbTree") performed best with a test AUC of 0.89 [0.82; 0.95], but with poor calibration in higher probabilities. A ten predictor subset (BMD, biochemical cholesterol and liver function tests, penicillin use and osteoarthritis diagnoses) achieved a test AUC of 0.86 [0.78; 0.94] using an "xgbTree" model. Machine learning can improve hip fracture prediction beyond logistic regression using ensemble models. Compiling data from international cohorts of longer follow-up and performing similar machine learning procedures has the potential to further improve discrimination and calibration.

  18. Projections of total hip replacement in Sweden from 2013 to 2030.

    Science.gov (United States)

    Nemes, Szilárd; Gordon, Max; Rogmark, Cecilia; Rolfson, Ola

    2014-06-01

    The continuously increasing demand for joint replacement surgery in the past decades imposes higher constraints on the budgets of hospitals and healthcare providers. We undertook an analysis of historical trends in total hip replacement performed in Sweden between 1968 and 2012 in order to provide projections of future demand. We obtained data on total hip replacements registered every year and on the evolution of the Swedish population between 1968 and 2012. We assumed the existence of a maximum incidence. So we adopted a regression framework that assumes the existence of an upper limit of total hip replacement incidence. We found that the incidence of total hip replacement will continue to increase until a projected upper incidence level of about 400 total hip replacements per 10(5) Swedish residents aged 40 years and older will be reached around the year 2107. In 2020, the estimated incidence of total hip replacement will be 341 (95% prediction interval (PI): 302-375) and in 2030 it will be 358 (PI: 317-396). Using official forecasted population growth data, about 18,000 operations would be expected to be performed in 2020 and 20,000 would be expected to be performed in 2030. Growing incidence, population growth, and increasing life expectancy will probably result in increased demand for hip replacement surgery. Our findings could serve as a basis for decision making.

  19. Does achieving the best practice tariff improve outcomes in hip fracture patients? An observational cohort study

    National Research Council Canada - National Science Library

    Oakley, B; Nightingale, J; Moran, CG; Moppett, IK

    2017-01-01

      Objectives To determine if the introduction of the best practice tariff (BPT) has improved survival of the elderly hip fracture population, or if achieving BPT results in improved survival for an individual...

  20. Alternative materials to improve total hip replacement tribology.

    Science.gov (United States)

    Santavirta, Seppo; Böhler, Max; Harris, William H; Konttinen, Yrjö T; Lappalainen, Reijo; Muratoglu, Orhun; Rieker, Claude; Salzer, Martin

    2003-08-01

    An improvement in tribology of bearing surfaces is an effective means of increasing the longevity of total hip replacement (THR). Currently, 3 approaches are available to achieve this aim: first, use of highly cross-linked UHMWPE; second, aluminum oxide ceramic bearings, and third, metal-on-metal bearings. Cross-linking reduces the wear resistance of UHMWPE markedly without impairment of other significant properties of the material. Simulator studies and some clinical long-term (10-22 years) follow-up surveys suggest an almost immeasurable wear of the highly cross-linked UHMWPE-based acetabular components during an expected clinical life span. Bioinert alumina ceramic (aluminum oxide) was introduced 3 decades ago for THR-bearing surfaces to improve performance and longevity. Alumina ceramic is entirely biostable and bioinert and has good mechanical properties. For correctly positioned alumina-on-alumina bearings, the annual linear wear rate has been reported to be 3.9 microm. Alumina heads have been successfully used in combination with polyethylene sockets, but as regards wear, the best results have been obtained with alumina-on-alumina bearings. In ceramic THR bearings, precise manufacture and contact surface geometry, including optimal clearance, are most important. For the currently available products, the component fracture risk is almost nonexistent (less than 1 per 1000). Metal-on-metal bearings were used in the early stage of THR surgery, although not all old designs were successful. More recent analyses of the early series have shown the advantages of metal-on-metal to be better and have led to a renaissance of this articulation. Initially, stainless steel was used because it was easy to manufacture and polish. Current metal-on-metal bearings are based on cobalt-chromium-molybdenum alloys with varying carbon contents. Such bearings are self-polishing. Linear wear rates remain at the level of a few microm a year. An improvement in technology has increased

  1. QUALITY OF LIFE PARAMETERS IMPROVEMENT FOLLOWING TOTAL HIP REPLACEMENT

    OpenAIRE

    Grierosu, Carmen

    2012-01-01

    Large joint replacement regarding lower limbs include hip and knee arthroplasty surgical procedures, meant toimprove Quality Of Life (QOL) parameters, an optimal representation for patient recovery toward an independent lifestyle. The present study is a consequence of an imperative requirement from the nursing staff, which, in closecooperation with the surgeon, the physical therapist and the psychologist intend a better understanding regardingpatient perception of the so-called post-discharge...

  2. Patients report improvement in quality of life and satisfaction after hip resurfacing arthroplasty.

    Science.gov (United States)

    Rahman, Wael A; Greidanus, Nelson V; Siegmeth, Alexander; Masri, Bassam A; Duncan, Clive P; Garbuz, Donald S

    2013-02-01

    A number of reconstructive procedures are available for the management of hip osteoarthritis. Hip resurfacing arthroplasty is now an accepted procedure, with implant survivorship comparable to THA at up to 10 years' followup in certain series. Most reports focus on implant survivorship, surgeon-derived results, or complications. Fewer data pertain to patient-reported results, including validated measures of quality of life (QoL) and satisfaction and baseline measures from which to determine magnitude of improvement. Validated patient-reported results are essential to guide patients and surgeons in the current era of informed and shared decision making. We determined whether patients reported improvement in disease-specific, joint-specific, and generic QoL after hip resurfacing arthroplasty; whether patients were satisfied with the results of the procedure; and latest activity level and return to sport. We retrospectively reviewed 127 patients (100 men, 27 women) who underwent 143 hip resurfacing procedures between 2002 and 2006. Mean patient age was 52 years. Patients completed the WOMAC, Oxford Hip Score, and SF-12 at baseline and again at minimum 2-year followup (mean, 2.5 years; range, 2-6 years). At latest followup, patients completed a validated satisfaction questionnaire and UCLA activity score. All QoL scores improved (normalized to a 0-100 scale, where 100 = best health state). WOMAC improved from 46 to 95, Oxford Hip Score from 42 to 95, SF-12 (physical) from 34 to 54, and SF-12 (mental) from 46 to 56. Patient satisfaction score was 96. UCLA activity score was 8. The majority of patients reported improvement in QoL, were very satisfied with their outcome, and returned to a high level of activity after hip resurfacing arthroplasty. Level IV, therapeutic study. See the Instructions for Authors for a complete description of levels of evidence.

  3. Distributed Wind Competitiveness Improvement Project

    Energy Technology Data Exchange (ETDEWEB)

    2016-05-01

    The Competitiveness Improvement Project (CIP) is a periodic solicitation through the U.S. Department of Energy and its National Renewable Energy Laboratory. Manufacturers of small and medium wind turbines are awarded cost-shared grants via a competitive process to optimize their designs, develop advanced manufacturing processes, and perform turbine testing. The goals of the CIP are to make wind energy cost competitive with other distributed generation technology and increase the number of wind turbine designs certified to national testing standards. This fact sheet describes the CIP and funding awarded as part of the project.

  4. Improving time to surgery for hip fracture patients. Impact of the introduction of an emergency theatre

    LENUS (Irish Health Repository)

    French-O’Carroll, F

    2017-01-01

    Hip fractures are a major cause of morbidity and mortality1. Surgery performed on the day of or after admission is associated with improved outcome2,3. An audit cycle was performed examining time to surgery for hip fracture patients. Our initial audit identified lack of theatre space as one factor delaying surgery. A dedicated daytime emergency theatre was subsequently opened and a re-audit was performed to assess its impact on time to surgery. Following the opening of the theatre, the proportion of patients with a delay to hip fracture surgery greater than 36 hours was reduced from 49% to 26% with lack of theatre space accounting for 23% (3 of 13) of delayed cases versus 28.6% (9 of 32) previously. 44% of hip fracture surgeries were performed in the emergency theatre during daytime hours, whilst in-hospital mortality rose from 4.6% to 6%. We conclude that access to an emergency theatre during daytime hours reduced inappropriate delays to hip fracture surgery.

  5. A Procedural Model for Process Improvement Projects

    OpenAIRE

    Kreimeyer, Matthias;Daniilidis, Charampos;Lindemann, Udo

    2017-01-01

    Process improvement projects are of a complex nature. It is therefore necessary to use experience and knowledge gained in previous projects when executing a new project. Yet, there are few pragmatic planning aids, and transferring the institutional knowledge from one project to the next is difficult. This paper proposes a procedural model that extends common models for project planning to enable staff on a process improvement project to adequately plan their projects, enabling them to documen...

  6. Computer navigation experience in hip resurfacing improves femoral component alignment using a conventional jig

    Directory of Open Access Journals (Sweden)

    Zachary Morison

    2013-01-01

    Full Text Available Background:The use of computer navigation has been shown to improve the accuracy of femoral component placement compared to conventional instrumentation in hip resurfacing. Whether exposure to computer navigation improves accuracy when the procedure is subsequently performed with conventional instrumentation without navigation has not been explored. We examined whether femoral component alignment utilizing a conventional jig improves following experience with the use of imageless computer navigation for hip resurfacing. Materials and Methods:Between December 2004 and December 2008, 213 consecutive hip resurfacings were performed by a single surgeon. The first 17 (Cohort 1 and the last 9 (Cohort 2 hip resurfacings were performed using a conventional guidewire alignment jig. In 187 cases, the femoral component was implanted using the imageless computer navigation. Cohorts 1 and 2 were compared for femoral component alignment accuracy. Results:All components in Cohort 2 achieved the position determined by the preoperative plan. The mean deviation of the stem-shaft angle (SSA from the preoperatively planned target position was 2.2° in Cohort 2 and 5.6° in Cohort 1 ( P = 0.01. Four implants in Cohort 1 were positioned at least 10° varus compared to the target SSA position and another four were retroverted. Conclusions: Femoral component placement utilizing conventional instrumentation may be more accurate following experience using imageless computer navigation.

  7. Does surgical hip dislocation and periacetabular osteotomy improve pain in patients with Perthes-like deformities and acetabular dysplasia?

    Science.gov (United States)

    Clohisy, John C; Nepple, Jeffrey J; Ross, James R; Pashos, Gail; Schoenecker, Perry L

    2015-04-01

    modified Harris hip score (mHHS) as well as by prospectively recorded data on patient complications and followup. Acetabular labrochondral abnormalities included labral hypertrophy in all hips and labral and/or articular cartilage lesions requiring treatment in 13 hips. Radiographic analysis demonstrated consistent radiographic correction. The median preoperative mHHS improved from 64 to 92 at a median followup of 40 months (p hips) had a good or excellent clinical result. Two patients (two hips) were classified as failures based on mHHS less than 70 (n = 1) or conversion to total hip arthroplasty (n = 1). Combined surgical hip dislocation and PAO provides major deformity correction in Perthes-like hip deformities with associated acetabular dysplasia. Early clinical results suggest this technique is safe and effective. Long-term studies are needed to determine if improved long-term outcomes are associated with comprehensive deformity correction.

  8. Total hip arthroplasty in young females with congenital dislocation of the hip, radically improves their long-term quality of life.

    Science.gov (United States)

    Roidis, Nikolaos T; Pollalis, Athanasios P; Hartofilakidis, George C

    2013-08-01

    Eighty-two female patients with low dislocation (67 hips) or high dislocation (48 hips) were assessed using clinical scores and EQ-5D quality of life (QoL) questionnaire. Assessment was performed at the first to secondyear postoperatively and at the final follow-up, after a minimum of 12 years (12-37). Patients reported with a high EQ-5D health state VAS scale, VAS index and TTO index at 1 to 2 years follow-up (94,21/0,907/0,931) that remained considerably high despite the long-term follow-up (73,8/0,721/0,746). The scores for pain and range of motion presented with a statistically significant improvement at 1 to 2 years postoperatively and at the time of final follow-up. Function scores have declined with age. Total hip arthroplasty in CHD patients radically improves QoL for a long period of time.

  9. Improved Hip-Based Individual Recognition Using Wearable Motion Recording Sensor

    Science.gov (United States)

    Gafurov, Davrondzhon; Bours, Patrick

    In todays society the demand for reliable verification of a user identity is increasing. Although biometric technologies based on fingerprint or iris can provide accurate and reliable recognition performance, they are inconvenient for periodic or frequent re-verification. In this paper we propose a hip-based user recognition method which can be suitable for implicit and periodic re-verification of the identity. In our approach we use a wearable accelerometer sensor attached to the hip of the person, and then the measured hip motion signal is analysed for identity verification purposes. The main analyses steps consists of detecting gait cycles in the signal and matching two sets of detected gait cycles. Evaluating the approach on a hip data set consisting of 400 gait sequences (samples) from 100 subjects, we obtained equal error rate (EER) of 7.5% and identification rate at rank 1 was 81.4%. These numbers are improvements by 37.5% and 11.2% respectively of the previous study using the same data set.

  10. Perioperative Interdisciplinary Intervention Contributes to Improved Outcomes of Adolescents Treated With Hip Preservation Surgery.

    Science.gov (United States)

    Richard, Heather M; Nguyen, Dylan C; Podeszwa, David A; De La Rocha, Adriana; Sucato, Daniel J

    2016-06-18

    Adolescent hip preservation surgery (HPS) candidates typically present with chronic pain, which can negatively affect psychological function and surgical outcomes. A previous study demonstrated high rates of psychological symptoms and maladaptive behaviors in this population. This study quantified psychological and functional improvements in these patients from preoperative presentation to postoperative follow-up. An integrated interdisciplinary approach is also described. A total of 67 patients undergoing HPS were evaluated preoperatively and postoperatively at 1 year by staff psychologists. Perioperative psychological intervention consisted of education, counseling, and administration of self-report measures. Self-report measure scores were compared preoperatively and postoperatively, grouped by orthopaedic diagnoses. Frequency analysis, correlational analysis, and analysis of variance were conducted. Psychological function improved significantly at follow-up: decreased emotional symptomatology (46.1 to 43.6, P=0.013), anxiety (49.6 to 45.8, Pactivity also significantly improved (University of California-Los Angeles: 7.1 to 8.7, P=0.017; modified Harris Hip Score: 67.3 to 83.8, Pactivity positively correlated with optimism and self-efficacy (P=0.041). Femoroacetabular impingement and hip dysplasia patients consistently reported feeling less depressed (P=0.036), having fewer somatic complaints (P=0.023), fewer internalized problems (P=0.037), and exhibiting fewer atypical behaviors (P=0.036) at follow-up. Slipped capital femoral epiphysis patients did not demonstrate improvements in psychological functioning postoperatively. Perioperative psychological education and counseling, in combination with HPS, improved postoperative psychological and physical function. Patients reported reduced anxiety, school problems, and social stress, with marked increase in resilience. Increased mobility and return to activity significantly correlated with improved optimism and self

  11. Soft tissue release of the spastic hip by psoas-rectus transfer and adductor tenotomy for long-term functional improvement and prevention of hip dislocation.

    Science.gov (United States)

    Heimkes, Bernhard; Martignoni, Kathrin; Utzschneider, Sandra; Stotz, Siegfried

    2011-07-01

    The purpose of this study was to assess the long-term development of children with cerebral palsy treated with soft tissue releases of the hip and, if necessary, also of the hamstrings and the Achilles tendon. The follow-up had to consider the functional status and the hip centration. Seventy-one patients (46 with tetrapareses, 24 with dipareses, and one with triparesis) who underwent soft tissue releases of the hip by the so-called psoas-rectus transfer at an average age of 7 years were assessed preoperatively, after 1 year and at an average age of 19 years. Functional status and the radiological lapse were assigned. The functional status of the patients significantly improved (P<0.001) after surgery. The number of patients who were able to walk increased from 49.3 to 80.3%. The migration percentage decreased from 26.6 to 17.3%. For medium-to-severe functional deficits, a clear gain of function and a safe prevention of spastic hip luxation were achieved.

  12. Total hip prosthesis CT with single-energy projection-based metallic artifact reduction: impact on the visualization of specific periprosthetic soft tissue structures

    Energy Technology Data Exchange (ETDEWEB)

    Gondim Teixeira, Pedro Augusto [CHU-Nancy, Service D' Imagerie Guilloz, Nancy (France); UMR, S 947, Universite de Lorraine, IADI, Nancy (France); Meyer, Jean-Baptiste; Raymond, Ariane; Blum, Alain [CHU-Nancy, Service D' Imagerie Guilloz, Nancy (France); Baumann, Cedric [CHU-Nancy, Service d' Epidemiologie et Evaluation Cliniques, Nancy (France); Sirveaux, Francois [Service de Chirurgie Traumatologique et Orthopedique, Nancy (France); Coudane, Henry [CHU-Nancy, Service de Chirurgie Traumatologique et Arthroscopique de l' Appareil Locomoteur (ATOL), Nancy (France)

    2014-09-15

    To compare the image quality of CT with iterative reconstruction alone and in association with projection-based single-energy metal artifact reduction (SEMAR) for the visualization of specific periarticular soft tissue structures in patients with hip prostheses. CT studies from 48 consecutive patients with a hip prosthesis (24 unilateral and 24 bilateral) were retrospectively reconstructed using two different methods: iterative reconstruction (IR) alone and IR associated with SEMAR. The influence of metallic artifacts on the identification of various periarticular structures was evaluated subjectively by two readers. The image quality was compared in patients with unilateral and bilateral prostheses. Visualization of periprosthetic soft tissue was significantly improved by the SEMAR algorithm (p < 0.0001). When SEMAR was associated with IR, the gluteus minimus and medius tendons, obturator internus muscle, prostate/uterus and bladder could be seen with medium or high confidence. There were no significant differences in image quality between patients with unilateral or bilateral prosthesis when SEMAR was used (p > 0.2). This algorithm increased the detection of periarticular masses by 30 %. SEMAR significantly improves the image quality of periarticular soft-tissue structures in patients with hip prostheses. (orig.)

  13. Hydroxyapatite coating does not improve uncemented stem survival after total hip arthroplasty!

    DEFF Research Database (Denmark)

    Hailer, Nils P; Lazarinis, Stergios; Mäkelä, Keijo T

    2015-01-01

    Background and purpose - It is still being debated whether HA coating of uncemented stems used in total hip arthroplasty (THA) improves implant survival. We therefore investigated different uncemented stem brands, with and without HA coating, regarding early and long-term survival. Patients...... and methods - We identified 152,410 THA procedures using uncemented stems that were performed between 1995 and 2011 and registered in the Nordic Arthroplasty Register Association (NARA) database. We excluded 19,446 procedures that used stem brands less than 500 times in each country, procedures performed due...

  14. Improved 1-year mortality in elderly patients with a hip fracture following integrated orthogeriatric treatment.

    Science.gov (United States)

    Folbert, E C; Hegeman, J H; Vermeer, M; Regtuijt, E M; van der Velde, D; Ten Duis, H J; Slaets, J P

    2017-01-01

    To improve the quality of care and reduce the healthcare costs of elderly patients with a hip fracture, surgeons and geriatricians collaborated intensively due to the special needs of these patients. After treatment at the Centre for Geriatric Traumatology (CvGT), we found a significant decrease in the 1-year mortality rate in frail elderly patients compared to the historical control patients who were treated with standard care. The study aimed to evaluate the effect of an orthogeriatric treatment model on elderly patients with a hip fracture on the 1-year mortality rate and identify associated risk factors. This study included patients, aged 70 years and older, who were admitted with a hip fracture and treated in accordance with the integrated orthogeriatric treatment model of the CvGT at the Hospital Group Twente (ZGT) between April 2008 and October 2013. Data registration was carried out by several disciplines using the clinical pathways of the CvGT database. A multivariate logistic regression analysis was used to identify independent risk factors for 1-year mortality. The outcome measures for the 850 patients were compared with those of 535 historical control patients who were managed under standard care between October 2002 and March 2008. The analysis demonstrated that the 1-year mortality rate was 23.2 % (n = 197) in the CvGT group compared to 35.1 % (n = 188) in the historical control group (p year mortality were male gender (odds ratio (OR) 1.68), increasing age (OR 1.06), higher American Society of Anesthesiologists (ASA) score (ASA 3 OR 2.43, ASA 4-5 OR 7.05), higher Charlson Comorbidity Index (CCI) (CCI 1-2 OR 1.46, CCI 3-4 OR 1.59, CCI 5 OR 2.71), malnutrition (OR 2.01), physical limitations in activities of daily living (OR 2.35), and decreasing Barthel Index (BI) (OR 0.96). After integrated orthogeriatric treatment, a significant decrease was seen in the 1-year mortality rate in the frail elderly patients with a hip fracture compared to

  15. Improvement of Construction Project Management Processes

    OpenAIRE

    Nazarko, J.

    2017-01-01

    The common denominator of the five papers published in the current edition of the Journal of Engineering, Project, and Production Management is the improvement of construction project management processes for effective use of resources. Execution of proper project management processes is widely recognized as a key success factor influencing likelihood of project success (Alleman, 2014). It is noticeable that four out of five papers in this issue of the Journal are authored or co-authored by I...

  16. Improved hyperspectral imaging technologies Project

    Data.gov (United States)

    National Aeronautics and Space Administration — Improved hyperspectral imaging technologies could enable lower-cost analysis for planetary science including atmospheric studies, mineralogical investigations, and...

  17. Periacetabular Osteotomy Redirects the Acetabulum and Improves Pain in Charcot-Marie-Tooth Hip Dysplasia With Higher Complications Compared With Developmental Dysplasia of the Hip.

    Science.gov (United States)

    Novais, Eduardo N; Kim, Young-Jo; Carry, Patrick M; Millis, Michael B

    2016-12-01

    The Bernese periacetabular osteotomy (PAO) is a well-accepted reorientation pelvic osteotomy used to treat symptomatic acetabular dysplasia secondary to developmental dysplasia of the hip (DDH). However, there are limited data regarding PAO in patients with symptomatic hip dysplasia secondary to Charcot-Marie-Tooth disease. We compared patients who underwent PAO for the treatment of Charcot-Marie-Tooth disease hip dysplasia (CMTHD group) with patients who underwent PAO for treatment of hip dysplasia secondary to DDH in terms of (1) modified Harris Hip scores; (2) radiographic correction of acetabular dysplasia; and (3) the rate of complications. Twenty-seven subjects with Charcot-Marie-Tooth disease who underwent a PAO between January 1991 and December 2010 were matched to 54 subjects with DDH on the basis of sex, age, date of surgery, and body mass index. Preoperative and postoperative hip functional scores and radiographic data were collected with a minimum 2-year follow-up. The modified Harris Hip Scores (mHHS) assessed functional hip outcomes. Radiographic variables included lateral (LCEA) and anterior (ACEA) center-edge angles, Tönnis angle and Tönnis grade of arthritis. Postoperative complications were classified according to a modified Dindo-Clavien system. At latest follow-up mHHS improved in the CMTHD group (preoperative median 63; (interquartile range [IQR]=54-70 to postoperative median 88; IQR=74-91); P=0.004) and in the DDH groups (preoperative median 71; IQR=58-83 to postoperative median 86; IQR=73-96; P=0.002) with no difference between the 2 groups (P=0.631). Radiographic improvement (LCEA: mean difference, 36 degrees, 95% confidence interval [CI], 30-41 degrees, P<0.001; ACEA: mean difference, 27 degrees, 95% CI, 20-33 degrees, P<0.001; Tönnis angles: mean difference, 21 degrees, 95% CI, 15-26 degrees, P<0.001) was achieved in the CMTHD group. Similarly, radiographic improvements in LCEA (mean difference, 33 degrees, 95% CI, 29-37 degrees, P<0

  18. Intellijoint HIP®: a 3D mini-optical navigation tool for improving intraoperative accuracy during total hip arthroplasty

    Directory of Open Access Journals (Sweden)

    Paprosky WG

    2016-11-01

    Full Text Available Wayne G Paprosky,1,2 Jeffrey M Muir3 1Department of Orthopedics, Section of Adult Joint Reconstruction, Department of Orthopedics, Rush University Medical Center, Rush–Presbyterian–St Luke’s Medical Center, Chicago, 2Central DuPage Hospital, Winfield, IL, USA; 3Intellijoint Surgical, Inc, Waterloo, ON, Canada Abstract: Total hip arthroplasty is an increasingly common procedure used to address degenerative changes in the hip joint due to osteoarthritis. Although generally associated with good results, among the challenges associated with hip arthroplasty are accurate measurement of biomechanical parameters such as leg length, offset, and cup position, discrepancies of which can lead to significant long-term consequences such as pain, instability, neurological deficits, dislocation, and revision surgery, as well as patient dissatisfaction and, increasingly, litigation. Current methods of managing these parameters are limited, with manual methods such as outriggers or calipers being used to monitor leg length; however, these are susceptible to small intraoperative changes in patient position and are therefore inaccurate. Computer-assisted navigation, while offering improved accuracy, is expensive and cumbersome, in addition to adding significantly to procedural time. To address the technological gap in hip arthroplasty, a new intraoperative navigation tool (Intellijoint HIP® has been developed. This innovative, 3D mini-optical navigation tool provides real-time, intraoperative data on leg length, offset, and cup position and allows for improved accuracy and precision in component selection and alignment. Benchtop and simulated clinical use testing have demonstrated excellent accuracy, with the navigation tool able to measure leg length and offset to within <1 mm and cup position to within <1° in both anteversion and inclination. This study describes the indications, procedural technique, and early accuracy results of the Intellijoint HIP

  19. Education, marital status, and risk of hip fractures in older men and women: the CHANCES project.

    Science.gov (United States)

    Benetou, V; Orfanos, P; Feskanich, D; Michaëlsson, K; Pettersson-Kymmer, U; Ahmed, L A; Peasey, A; Wolk, A; Brenner, H; Bobak, M; Wilsgaard, T; Schöttker, B; Saum, K-U; Bellavia, A; Grodstein, F; Klinaki, E; Valanou, E; Papatesta, E-M; Boffetta, P; Trichopoulou, A

    2015-06-01

    The role of socioeconomic status in hip fracture incidence is unclear. In a diverse population of elderly, higher education was found to be associated with lower, whereas living alone, compared to being married/cohabiting, with higher hip fracture risk. Educational level and marital status may contribute to hip fracture risk. The evidence on the association between socioeconomic status and hip fracture incidence is limited and inconsistent. We investigated the potential association of education and marital status with hip fracture incidence in older individuals from Europe and USA. A total of 155,940 participants (79 % women) aged 60 years and older from seven cohorts were followed up accumulating 6456 incident hip fractures. Information on education and marital status was harmonized across cohorts. Hip fractures were ascertained through telephone interviews/questionnaires or through record linkage with registries. Associations were assessed through Cox proportional hazard regression adjusting for several factors. Summary estimates were derived using random effects models. Individuals with higher education, compared to those with low education, had lower hip fracture risk [hazard ratio (HR) = 0.84, 95 % confidence interval (CI) 0.72-0.95]. Respective HRs were 0.97 (95 % CI 0.82-1.13) for men and 0.75 (95 % CI 0.65-0.85) for women. Overall, individuals living alone, especially those aged 60-69 years, compared to those being married/cohabiting, tended to have a higher hip fracture risk (HR = 1.12, 95 % CI 1.02-1.22). There was no suggestion for heterogeneity across cohorts (P heterogeneity > 0.05). The combined data from >150,000 individuals 60 years and older suggest that higher education may contribute to lower hip fracture risk. Furthermore, this risk may be higher among individuals living alone, especially among the age group 60-69 years, when compared to those being married/cohabiting.

  20. The TARGET project in Tuscany: the first disease management model of a regional project for the prevention of hip re-fractures in the elderly.

    Science.gov (United States)

    Piscitelli, Prisco; Brandi, Maria Luisa; Nuti, Ranuccio; Rizzuti, Carla; Giorni, Loredano; Giovannini, Valtere; Metozzi, Alessia; Merlotti, Daniela

    2010-09-01

    The official inquiry on osteoporosis in Italy, promoted by the Italian Senate in 2002 concluded that proper preventive strategies should be adopted at regional level in order to prevent osteoporotic fractures. Tuscany is the first Italian region who has promoted an official program (the TARGET project) aimed to reduce osteoporotic fractures by ensuring adequate treatment to all people aged ≥65 years old who experience a hip fragility fracture. this paper provides information concerning the implementation of TARGET project in Tuscany, assuming that it may represent an useful model for similar experiences to be promoted in other Italian Regions and across Europe. we have examined the model proposed for the regional program, and we have particularly analyzed the in-hospital and post-hospitalization path of hip fractured patients aged >65 years old in Tuscany after the adoption of TARGET project by Tuscany healthcare system and during its ongoing start-up phase. orthopaedic surgeons have been gradually involved in the project and are increasingly fulfilling all the clinical prescriptions and recommendations provided in the project protocol. Different forms of cooperation between orthopaedic surgeons and other clinical specialists have been adopted at each hospital for the treatment of hip fractured elderly patients. GPs involvement needs to be fostered both at regional and local level. The effort of Tuscany region to cope with hip fractures suffered from elderly people must be acknowledged as an interesting way of addressing this critical health problem. Specific preventive strategies modelled on the Tuscany TARGET project should be implemented in other Italian regions.

  1. Reduced fasting time improves comfort and satisfaction of elderly patients undergoing anesthesia for hip fracture

    Directory of Open Access Journals (Sweden)

    Luiz Eduardo Imbelloni

    2015-04-01

    Full Text Available BACKGROUND AND OBJECTIVES: Patient's satisfaction is a standard indicator of care quality. The aim of this study was to evaluate whether a preoperative oral ingestion of 200 mL of a carbohydrate drink can improve comfort and satisfaction with anesthesia in elderly patients with hip fracture. METHOD: Prospective randomized clinical trial conducted in a Brazilian public hospital, with patients ASA I-III undergoing surgery for hip fracture. The control group (NPO received nothing by mouth after 9:00 p.m. the night before, while patients in the experimental group (CHO received 200 mL of a carbohydrate drink 2-4 h before the operation. Patients' characteristics, subjective perceptions, thirst and hunger and satisfaction were determined in four steps. Mann-Whitney U-test and Fisher exact test were used for comparison of control and experimental groups. A p-value <0.05 was considered significant. RESULTS: A total of 100 patients were included in one of the two regimens of preoperative fasting. Fasting time decreased significantly in the study group. Patients drank 200 mL 2:59 h before surgery and showed no hunger (p < 0.00 and thirst on arrival to OR (p < 0.00, resulting in increased satisfaction with the perioperative anesthesia care (p < 0.00. CONCLUSIONS: The satisfaction questionnaire for surgical patient could become a useful tool in assessing the quality of care. In conclusion, CHO significantly reduces preoperative discomfort and increases satisfaction with anesthesia care.

  2. OPTIMAL IMPROVEMENT IN FUNCTION AFTER TOTAL HIP AND KNEE REPLACEMENT: HOW DEEP DO YOU KNOW YOUR PATIENT’S MIND?

    Science.gov (United States)

    De Caro, M F; Vicenti, G; Abate, A; Picca, G; Leoncini, V; Lomuscio, M; Casalino, A; Solarino, G; Moretti, B

    2015-01-01

    Osteoarthritis (OA) of the hip and knee causes pain and loss of joint mobility, leading to limitations in physical function. When conservative treatment fails total hip and knee replacement is a cost-effective surgical option. Patients have high expectations regarding functional outcome after these procedures. If such expectations are not met, they may still be dissatisfied with the outcome of a technically successful procedure. Recently, numerous studies reported that psychological factors can influence the outcome of total knee replacement (tkr) and total hip artrhoplasty with total hip replacement (thr). We conducted a prospective study on a consecutive sample of 280 patients affected by hip or knee OA who underwent total joint replacement. At patients’ admission, Harris Hip Score (HHS) and Knee Society Score (KSS) were used to assess pain and function. Furthermore, SF-36, Mini-Mental Status Examination (MMSE), Symptom Checklist-90-R (SCL-90-R), Coping Orientation to Problems Experienced (BRIEF-COPE) and the Amsterdam Preoperative Anxiety and Information Scale (APAIS) were administered. Patients had clinical and radio graphical follow up at 1, 3 and 6 months post-operatively. The HHS and KSS values before surgery showed a linear correlation with both SCL-90-R and MMSE. None of the investigated variables influenced post-operative HHS and KSS scores; however, the improvement of functional scores resulted conditioned by SCL-90-R values, VAS score, schooling and MMSE. Psychological factors and mental status in primary total hip and knee replacement can affect outcome and patient satisfaction. Strategies focused on identification and facing of these conditions must be considered to improve outcome of total replacement.

  3. Improvement of Construction Project Management Processes

    Directory of Open Access Journals (Sweden)

    Nazarko, J.

    2017-07-01

    Full Text Available The common denominator of the five papers published in the current edition of the Journal of Engineering, Project, and Production Management is the improvement of construction project management processes for effective use of resources. Execution of proper project management processes is widely recognized as a key success factor influencing likelihood of project success (Alleman, 2014. It is noticeable that four out of five papers in this issue of the Journal are authored or co-authored by Iranian researchers from the same Institute but their conclusions bear importance that cannot be limited to the authors’ region.

  4. Groin and hip quandaries

    African Journals Online (AJOL)

    specialist opinions and four different surgical procedures. One needs sound ... of pain. The two joints in the pelvis should be emphasised – the hip joint and the pubic .... intervention aimed at improving hip kinematics would be effective in.

  5. How to Begin a Quality Improvement Project.

    Science.gov (United States)

    Silver, Samuel A; Harel, Ziv; McQuillan, Rory; Weizman, Adam V; Thomas, Alison; Chertow, Glenn M; Nesrallah, Gihad; Bell, Chaim M; Chan, Christopher T

    2016-05-01

    Quality improvement involves a combined effort among health care staff and stakeholders to diagnose and treat problems in the health care system. However, health care professionals often lack training in quality improvement methods, which makes it challenging to participate in improvement efforts. This article familiarizes health care professionals with how to begin a quality improvement project. The initial steps involve forming an improvement team that possesses expertise in the quality of care problem, leadership, and change management. Stakeholder mapping and analysis are useful tools at this stage, and these are reviewed to help identify individuals who might have a vested interest in the project. Physician engagement is a particularly important component of project success, and the knowledge that patients/caregivers can offer as members of a quality improvement team should not be overlooked. After a team is formed, an improvement framework helps to organize the scientific process of system change. Common quality improvement frameworks include Six Sigma, Lean, and the Model for Improvement. These models are contrasted, with a focus on the Model for Improvement, because it is widely used and applicable to a variety of quality of care problems without advanced training. It involves three steps: setting aims to focus improvement, choosing a balanced set of measures to determine if improvement occurs, and testing new ideas to change the current process. These new ideas are evaluated using Plan-Do-Study-Act cycles, where knowledge is gained by testing changes and reflecting on their effect. To show the real world utility of the quality improvement methods discussed, they are applied to a hypothetical quality improvement initiative that aims to promote home dialysis (home hemodialysis and peritoneal dialysis). This provides an example that kidney health care professionals can use to begin their own quality improvement projects.

  6. Use of iPhone technology in improving acetabular component position in total hip arthroplasty

    Directory of Open Access Journals (Sweden)

    Xiau Wei Tay, MBBS

    2017-09-01

    Full Text Available Improper acetabular cup positioning is associated with high risk of complications after total hip arthroplasty. The aim of our study is to objectively compare 3 methods, namely (1 free hand, (2 alignment jig (Sputnik, and (3 iPhone application to identify an easy, reproducible, and accurate method in improving acetabular cup placement. We designed a simple setup and carried out a simple experiment (see Method section. Using statistical analysis, the difference in inclination angles using iPhone application compared with the freehand method was found to be statistically significant (F[2,51] = 4.17, P = .02 in the “untrained group”. There is no statistical significance detected for the other groups. This suggests a potential role for iPhone applications in junior surgeons in overcoming the steep learning curve.

  7. SNF project engineering process improvement plan

    Energy Technology Data Exchange (ETDEWEB)

    KELMENSON, R.L.

    1999-05-24

    This Engineering Process Improvement Plan documents the activities and plans to be taken by the SNF Project (the Project) to support its engineering process and to produce a consolidated set of engineering procedures that are fully compliant with the requirements of HNF-PRO-1819 (1819). These requirements are imposed on all engineering activities performed for the Project and apply to all life-cycle stages of the Project's systems, structures and components (SSCs). This Plan describes the steps that will be taken by the Project during the transition period to ensure that new procedures are effectively integrated into the Project's work process as these procedures are issued. The consolidated procedures will be issued and implemented by September 30, 1999.

  8. Retrospective analysis for genetic improvement of hip joints of cohort labrador retrievers in the United States: 1970-2007.

    Directory of Open Access Journals (Sweden)

    Yali Hou

    Full Text Available BACKGROUND: Canine Hip Dysplasia (CHD is a common inherited disease that affects dog wellbeing and causes a heavy financial and emotional burden to dog owners and breeders due to secondary hip osteoarthritis. The Orthopedic Foundation for Animals (OFA initiated a program in the 1960's to radiograph hip and elbow joints and release the OFA scores to the public for breeding dogs against CHD. Over last four decades, more than one million radiographic scores have been released. METHODOLOGY/PRINCIPAL FINDINGS: The pedigrees in the OFA database consisted of 258,851 Labrador retrievers, the major breed scored by the OFA (25% of total records. Of these, 154,352 dogs had an OFA hip score reported between 1970 and 2007. The rest of the dogs (104,499 were the ancestors of the 154,352 dogs to link the pedigree relationships. The OFA hip score is based on a 7-point scale with the best ranked as 1 (excellent and the worst hip dysplasia as 7. A mixed linear model was used to estimate the effects of age, sex, and test year period and to predict the breeding value for each dog. Additive genetic and residual variances were estimated using the average information restricted maximum likelihood procedure. The analysis also provided an inbreeding coefficient for each dog. The hip scores averaged 1.93 (+/-SD = 0.59 and the heritability was 0.21. A steady genetic improvement has accrued over the four decades. The breeding values decreased (improved linearly. By the end of 2005, the total genetic improvement was 0.1 units, which is equivalent to 17% of the total phenotypic standard deviation. CONCLUSION/SIGNIFICANCE: A steady genetic improvement has been achieved through the selection based on the raw phenotype released by the OFA. As the heritability of the hip score was on the low end (0.21 of reported ranges, we propose that selection based on breeding values will result in more rapid genetic improvement than breeding based on phenotypic selection alone.

  9. Room for improvement in the treatment of hip fractures in Denmark

    DEFF Research Database (Denmark)

    Egerod, Ingrid; Rud, Kirsten; Specht, Kirsten;

    2010-01-01

    INTRODUCTION: Treatment of hip fractures has evolved since the introduction of fast-track surgical programs in the late 1990s. The aim of our study was to describe the quality of treatment and care related to fast-track hip fracture surgery in Denmark by external audit of patient records. MATERIAL...... AND METHODS: This was a national multicenter audit of hospital charts from each hospital treating ≥ 50 hip fracture patients per year (n = 594). RESULTS: The study demonstrated significant variability in treatment and care of patients with hip fractures among the regions of Denmark. Pain management...

  10. Improved design of cementless hip stems using two-dimensional functionally graded materials.

    Science.gov (United States)

    Hedia, H S; Shabara, M A N; El-Midany, T T; Fouda, N

    2006-10-01

    Increasingly, it is acknowledged that bone resorption around cementless hip implants may cause future problems. The solution is frequently sought in reducing implant stiffness. However, this confronts the designer with a true design conflict: how to reduce the stiffness without excessively loading the proximal bone/prosthesis interface? The aim of this work is to improve the design of cementless hip stem material, using two-dimensional (2D) functionally graded material (FGM) concept in order to solve the above problems. Two models were used in this analysis, using three materials with different elastic moduli, E(1), E(2), and E(3). In model I, the elastic moduli E(1) and E(2) gradually change along the upper stem surface, while E(3) is maintained constant along all the lower surface of the stem. However, in model II, the elastic moduli E(1) and E(2) gradually change along the lower stem surface, while E(3) is maintained constant all along the upper stem surface. It is found that the recommended model is model I, which has three distinct materials of hydroxyapatite, Bioglass, and collagen. The recommended design of 2D FGM is expected to reduce the stress shielding by 91% and 12%, respectively, compared with titanium stem and model II of FGM. It is found that this new design reduces the maximum interface shear stress at the lateral and medial sides of the femur by about 50%, compared with titanium stem. Furthermore, the maximum interface shear stress is reduced by about 17% and 11% at the lateral and medial sides of the femur, respectively, compared with that of model II of FGM.

  11. Intellijoint HIP®: a 3D mini-optical navigation tool for improving intraoperative accuracy during total hip arthroplasty

    Science.gov (United States)

    Paprosky, Wayne G; Muir, Jeffrey M

    2016-01-01

    Total hip arthroplasty is an increasingly common procedure used to address degenerative changes in the hip joint due to osteoarthritis. Although generally associated with good results, among the challenges associated with hip arthroplasty are accurate measurement of biomechanical parameters such as leg length, offset, and cup position, discrepancies of which can lead to significant long-term consequences such as pain, instability, neurological deficits, dislocation, and revision surgery, as well as patient dissatisfaction and, increasingly, litigation. Current methods of managing these parameters are limited, with manual methods such as outriggers or calipers being used to monitor leg length; however, these are susceptible to small intraoperative changes in patient position and are therefore inaccurate. Computer-assisted navigation, while offering improved accuracy, is expensive and cumbersome, in addition to adding significantly to procedural time. To address the technological gap in hip arthroplasty, a new intraoperative navigation tool (Intellijoint HIP®) has been developed. This innovative, 3D mini-optical navigation tool provides real-time, intraoperative data on leg length, offset, and cup position and allows for improved accuracy and precision in component selection and alignment. Benchtop and simulated clinical use testing have demonstrated excellent accuracy, with the navigation tool able to measure leg length and offset to within <1 mm and cup position to within <1° in both anteversion and inclination. This study describes the indications, procedural technique, and early accuracy results of the Intellijoint HIP surgical tool, which offers an accurate and easy-to-use option for hip surgeons to manage leg length, offset, and cup position intraoperatively. PMID:27920583

  12. Monitoring Hip and Elbow Dysplasia achieved modest genetic improvement of 74 dog breeds over 40 years in USA.

    Directory of Open Access Journals (Sweden)

    Yali Hou

    Full Text Available Hip (HD and Elbow Dysplasia (ED are two common complex developmental disorders of dogs. In order to decrease their prevalence and severity, the Orthopedic Foundation for Animals (OFA has a voluntary registry of canine hip and elbow conformation certified by boarded radiologists. However, the voluntarily reports have been severely biased against exposing dogs with problems, especially at beginning period. Fluctuated by additional influential factors such as age, the published raw scores barely showed trends of improvement. In this study, we used multiple-trait mixed model to simultaneously adjust these factors and incorporate pedigree to derive Estimated Breeding Values (EBV. A total of 1,264,422 dogs from 74 breeds were evaluated for EBVs from 760,455 hip scores and 135,409 elbow scores. These EBVs have substantially recovered the reporting bias and the other influences. Clear and steady trends of genetic improvement were observed over the 40 years since 1970. The total genetic improvements were 16.4% and 1.1% of the phenotypic standard deviation for HD and ED, respectively. The incidences of dysplasia were 0.83% and 2.08%, and the heritabilities were estimated as 0.22 and 0.17 for hip and elbow scores, respectively. The genetic correlation between them was 0.12. We conclude that EBV is more effective than reporting raw phenotype. The weak genetic correlation suggested that selection based on hip scores would also slightly improve elbow scores but it is necessary to allocate effort toward improvement of elbow scores alone.

  13. Monitoring Hip and Elbow Dysplasia Achieved Modest Genetic Improvement of 74 Dog Breeds over 40 Years in USA

    Science.gov (United States)

    Zhang, Xu; Zhao, Qian; Todhunter, Rory J.; Zhang, Zhiwu

    2013-01-01

    Hip (HD) and Elbow Dysplasia (ED) are two common complex developmental disorders of dogs. In order to decrease their prevalence and severity, the Orthopedic Foundation for Animals (OFA) has a voluntary registry of canine hip and elbow conformation certified by boarded radiologists. However, the voluntarily reports have been severely biased against exposing dogs with problems, especially at beginning period. Fluctuated by additional influential factors such as age, the published raw scores barely showed trends of improvement. In this study, we used multiple-trait mixed model to simultaneously adjust these factors and incorporate pedigree to derive Estimated Breeding Values (EBV). A total of 1,264,422 dogs from 74 breeds were evaluated for EBVs from 760,455 hip scores and 135,409 elbow scores. These EBVs have substantially recovered the reporting bias and the other influences. Clear and steady trends of genetic improvement were observed over the 40 years since 1970. The total genetic improvements were 16.4% and 1.1% of the phenotypic standard deviation for HD and ED, respectively. The incidences of dysplasia were 0.83% and 2.08%, and the heritabilities were estimated as 0.22 and 0.17 for hip and elbow scores, respectively. The genetic correlation between them was 0.12. We conclude that EBV is more effective than reporting raw phenotype. The weak genetic correlation suggested that selection based on hip scores would also slightly improve elbow scores but it is necessary to allocate effort toward improvement of elbow scores alone. PMID:24124555

  14. Evaluation of a simplified hip structure analysis method for the prediction of incident hip fracture events.

    Science.gov (United States)

    Khoo, B C C; Lewis, J R; Brown, K; Prince, R L

    2016-01-01

    Many attempts have been made to improve the predictive ability of areal bone mineral density (aBMD) which integrates bone mass and area. The addition of an extra variable derived from the hip dual-energy X-ray (DXA) image TR_σ, which describes distribution of mass within the scanned area of the trochanter, improved prediction of 15-year hip fracture probability in elderly women. Two-dimensional DXA imaging of the proximal femur to produce an aBMD is a clinically useful predictor of future fracture risk. Further analysis of the DXA image to produce an eight-variable hip structure analysis (Beck HSA) has been developed to improve understanding of structural factors determining hip bone strength at each of three proximal femur sites, the narrow femoral neck (NN), intertrochanter (TR) and shaft (S). Recently, data on four measurements derived from the currently used eight Beck HSA variables were used to capture population variation in bone structure at each site. These include two previously used variables, the localised aBMD and the sub-periosteal width (W) applying to 5-mm sections (at each sites), and two new variables, standard deviation of normalised mineral-mass projection profile distribution (σ), and displacement between centre-of-mineral mass and geometric centre-of-mineral mass of projection profile (δ). Using a cohort of 1159 women, mean baseline age 75, who sustained 139 hip fractures over 15 years, we determined whether these measures significantly improved 15-year hip fracture prediction compared to current approach utilising age and total hip aBMD. To describe the most parsimonious model for hip fracture risk prediction, the 12 base measures (4 from each site), total hip aBMD and age were evaluated in stepwise logistic regression models. The final model included TR_σ, total hip aBMD and age and provided improved utility for hip fracture prediction compared to total hip aBMD and age alone (C-statistic 0.73 vs. 0.69, P = 0.009 and net

  15. Improved Functional Outcomes with Robotic Compared with Manual Total Hip Arthroplasty.

    Science.gov (United States)

    Bukowski, Brandon R; Anderson, Paul; Khlopas, Anton; Chughtai, Morad; Mont, Michael A; Illgen, Richard L

    2016-10-26

    Functional outcome following total hip arthroplasty (THA) is affected by accurate component positioning and restoration of hip biomechanics. Robotic-assisted THA (rTHA) has been shown to improve accuracy of component positioning, but its impact on functional outcomes has not been demonstrated. The purpose of this study was to compare: 1) operative time; 2) estimated blood loss; 3) postoperative complications; and 4) patient-reported outcome measures (PROMs) between patients who either underwent rTHA or manual THA (mTHA). In this retrospective cohort study, a single-center database was used to identify all patients who underwent primary THA since introduction of rTHA at a large academic medical center. Surgical factors including operative time and estimated blood loss as well as postoperative complications were recorded. Validated PROMs following rTHA (n = 100) were compared with consecutive mTHA cases (n = 100) performed by the same fellowship-trained surgeon at a minimum one-year follow-up (24 ± 6 months). PROMs included the Short-Form 12 Health Survey (SF-12), UCLA activity score (UCLA), Western Ontario and McMaster (WOMAC) Osteoarthritis Index, and modified Harris Hip Score (mHHS). A categorical analysis was performed to determine differences in proportions of patients with mHHS scores of 90 to 100, 80 to 89, 70 to 79, and < 70 points between the two groups. Chi-square and two-tailed t-tests were used to compare categorical and continuous data between cohorts. Mean operative time was nine minutes longer for the rTHA group compared with the mTHA group (131 ± 23 min vs. 122 ± 29 min, respectively, p = 0.012). Estimated intraoperative blood loss was significantly reduced for the rTHA group when compared to the mTHA group (374 ± 133 mL vs. 423 ± 186 mL, p = 0.035), and there was no difference in overall complication rates between the two groups (p = 0.101). Robotic-assisted THA demonstrated significantly higher mean postoperative mHHS (92.1 ± 10.5 vs. 86.1

  16. Hip Ultrasound

    Science.gov (United States)

    ... Physician Resources Professions Site Index A-Z Hip Ultrasound Hip ultrasound uses sound waves to produce pictures ... of Ultrasound Imaging of the Hip? What is Ultrasound Imaging of the Hip? Ultrasound images of the ...

  17. Leveraging gait dynamics to improve efficiency and performance of powered hip exoskeletons.

    Science.gov (United States)

    Ryder, Matthew C; Sup, Frank

    2013-06-01

    This paper presents a new mechanical design for efficient exoskeleton actuation to power the sagittal plane motion in the human hip. The device uses a DC motor to drive a Scotch-Yoke mechanism and series elasticity to take advantage of the cyclic nature of human gait and to reduce power and control requirements of the exoskeleton. The mechanism creates a transmission that varies between 4:1 and infinity and does not require the motor to reverse direction when the hip joint reverses direction. This paper provides a detailed analysis of how the dynamic nature of human walking can be leveraged with this hip exoskeleton design.

  18. Echosonogrametric diagnosis of developmental dysplasia of the hip.

    Science.gov (United States)

    Vrdoljak, J; Bojić, D

    1998-12-01

    In view of adding to ultrasonographic scanning of the neonatal hip through various projections and in order to improve the measurement and quantification base of the normal and dysplastic neonatal hip, the research was conducted on anatomic hip preparation of full-term still-born baby. The research on a clinical sample covered 600 ultrasonically examined normal and dysplastic hips. Ultrasonographic serial scanning was performed on various planes using linear transducer with 5 and 7.5 MHz and with or without a water pillow. On the clinical sample of the particular group various projections were applied and results compared with projections obtained on anatomic preparation. Concluded was that with several projections frontal sonographic projections tomographic examination of the hip joint could be performed. Better insight of the position of the femoral head at rest in neutral and flexed positions, the relative stability of the hip with motion and stress and the depth and configuration of the bony and cartilaginous portions of the acetabulum could be obtained if, besides frontal sections, cross sections of the hip were used. Sufficient measurement data echosonogrametric parameters were indispensable for an adequate definition of all hip joint structures.

  19. Jumping improves hip and lumbar spine bone mass in prepubescent children: a randomized controlled trial.

    Science.gov (United States)

    Fuchs, R K; Bauer, J J; Snow, C M

    2001-01-01

    .9%) but were not different at the spine. Our data indicate that jumping at ground reaction forces of eight times body weight is a safe, effective, and simple method of improving bone mass at the hip and spine in children. This program could be easily incorporated into physical education classes.

  20. Novel carbon fiber composite for hip replacement with improved in vitro and in vivo osseointegration.

    Science.gov (United States)

    Dimitrievska, S; Whitfield, J; Hacking, S A; Bureau, M N

    2009-10-01

    A novel composite femoral stem has been developed to match cortical stiffness and achieve fixation by osseointegration with the primary goal to reduce cortical bone loss associated with stress shielding. The femoral stem consists of three distinct material layers: the first is a long carbon fiber (CF) in a polyamide 12 (PA12) polymer matrix (PA12/CF); the second is a PA12/HA (hydroxyapatite) interface; and the third is a plasma-sprayed coating of HA. In vitro studies with MG63 cells indicated that the HA surface supported improved proliferation and differentiation of osteoblast-like cells as determined by alkaline phosphatase activity and osteocalcin production when compared with Ti-6Al-4V (Ti64). In vivo studies comparing the composite and Ti64 rods in the rabbit femur demonstrated significantly higher bone apposition to the composite than Ti64 rods. The results of this study indicate that the invasion of surrounding bone cells and thus osteointegration together with its bone-matching mechanical properties make the PA12/CF/HA stem a promising hip replacement candidate.

  1. Does anterior knee pain severity and function relate to the frontal plane projection angle and trunk and hip strength in women with patellofemoral pain?

    Science.gov (United States)

    Almeida, Gabriel Peixoto Leão; Carvalho E Silva, Ana Paula de Moura Campos; França, Fábio Jorge Renovato; Magalhães, Maurício Oliveira; Burke, Thomaz Nogueira; Marques, Amélia Pasqual

    2015-07-01

    The aim of the present study was to determine the relationship between knee pain severity and function with the frontal plane projection angle (FPPA) and trunk and hip peak torque (PT) in women with patellofemoral pain (PFPS). Twenty-two women with PFPS were assessed. Knee pain severity (KPS) was assessed with an 11-point visual analog scale and function with an Anterior Knee Pain Scale. The FPPA was recorded with a digital camera. PT of extensors, abductors, and the lateral rotators of hip and lateral core stability were measured with a handheld dynamometer. FPPA was the only predictor for the KPS. Regarding predictors of function, PT of lateral core stability and the extensor and abductor of the hip explained 41.4% of the function. Increase in FPPA was associated with greater KPS, and the lowest PT of lateral core stability, hip abductors, and extensors was associated with lower function in women with PFPS.

  2. Using Q Methodology in Quality Improvement Projects.

    Science.gov (United States)

    Tiernon, Paige; Hensel, Desiree; Roy-Ehri, Leah

    Q methodology consists of a philosophical framework and procedures to identify subjective viewpoints that may not be well understood, but its use in nursing is still quite limited. We describe how Q methodology can be used in quality improvement projects to better understand local viewpoints that act as facilitators or barriers to the implementation of evidence-based practice. We describe the use of Q methodology to identify nurses' attitudes about the provision of skin-to-skin care after cesarean birth. Copyright © 2017 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses. Published by Elsevier Inc. All rights reserved.

  3. Improvements in hip- and pelvic motion for patients with osseointegrated trans-femoral prostheses.

    Science.gov (United States)

    Tranberg, R; Zügner, R; Kärrholm, J

    2011-02-01

    This study describes the changes in hip and pelvic kinematics in 19 trans-femoral amputees, who were treated with an osseointegrated trans-femoral prosthesis. Patients were studied with 3-dimensional gait analysis, walking with socket prosthesis within two days before the osseointergration procedure. The post-operative gait analysis was carried out at the 2 year follow-up visit. Fifty-seven; age-, side- and gender-matched healthy subjects served as controls. Post-operative data showed that patients who had an osseointegrated transfemoral prosthesis increased their hip extension by 7.3° (p=0.007), changing from -2.6° (range -13.4° to 10.7°) to -9.9° (range -29.4° to 5°). Moreover, the pre-operative anterior pelvic tilt was reduced by 4.0° (p=0.016), changing from 21.7° (range 11.9-34.8°) to 17.7° (range 5.5-25.7°). Values for hip extension and pelvic tilt changed toward those of controls. These results confirm that patients treated with osseointegrated trans-femoral prosthesis encounter significant changes of their kinematic pattern in terms of hip extension and anterior pelvic tilt. Even though the changes were moderate they may, in the long-term have a positive influence on low-back biomechanics and could contribute to reducing the risk of further problems with low back pain.

  4. Hip Ultrasound

    Science.gov (United States)

    ... be used in infants to check for developmental dysplasia of the hip. Ultrasound is safe, noninvasive, and does not use ... be used to check the hips for developmental dysplasia of the hip (DDH), which in infants can range from a ...

  5. Hip Fracture

    Science.gov (United States)

    Diseases and Conditions Hip fracture By Mayo Clinic Staff A hip fracture is a serious injury, with complications that can be life-threatening. The risk of hip fracture rises with age. Older people are at a ...

  6. Improving Public Reporting and Data Validation for Complex Surgical Site Infections After Coronary Artery Bypass Graft Surgery and Hip Arthroplasty

    Science.gov (United States)

    Calderwood, Michael S.; Kleinman, Ken; Murphy, Michael V.; Platt, Richard; Huang, Susan S.

    2014-01-01

    Background  Deep and organ/space surgical site infections (D/OS SSI) cause significant morbidity, mortality, and costs. Rates are publicly reported and increasingly used as quality metrics affecting hospital payment. Lack of standardized surveillance methods threaten the accuracy of reported data and decrease confidence in comparisons based upon these data. Methods  We analyzed data from national validation studies that used Medicare claims to trigger chart review for SSI confirmation after coronary artery bypass graft surgery (CABG) and hip arthroplasty. We evaluated code performance (sensitivity and positive predictive value) to select diagnosis codes that best identified D/OS SSI. Codes were analyzed individually and in combination. Results  Analysis included 143 patients with D/OS SSI after CABG and 175 patients with D/OS SSI after hip arthroplasty. For CABG, 9 International Classification of Diseases, 9th Revision (ICD-9) diagnosis codes identified 92% of D/OS SSI, with 1 D/OS SSI identified for every 4 cases with a diagnosis code. For hip arthroplasty, 6 ICD-9 diagnosis codes identified 99% of D/OS SSI, with 1 D/OS SSI identified for every 2 cases with a diagnosis code. Conclusions  This standardized and efficient approach for identifying D/OS SSI can be used by hospitals to improve case detection and public reporting. This method can also be used to identify potential D/OS SSI cases for review during hospital audits for data validation. PMID:25734174

  7. Improving Culture, One Quality Improvement Project at a Time.

    Science.gov (United States)

    Vander Schaaf, Emily B; Cornett, Amanda C; Randolph, Greg D

    2017-04-04

    A culture of quality improvement (QI) values collaboration, transparency, and staff empowerment. Organizations exhibiting a culture of QI are more likely to engage in QI. We examined whether local health departments' (LHDs') participation in a longitudinal, experiential QI training program changes QI culture. Prior to and following participation in a QI training program, all employees of participating LHDs were asked to complete an 8-item survey assessing components of QI culture on a 5-point scale. From 2010 to 2015, multidisciplinary teams from North Carolina LHDs participated in sequential cohorts of a 6-month QI training program, during which the teams completed a QI project. We dichotomized culture survey responses, with 4 or 5 being "Supportive." We compared adjusted proportions, using linear regression, clustering at LHD, and controlling for cohort. Data from 42 LHDs were included. At baseline, 7.8% responded that their LHD had a supportive culture for all 8 components, compared with 12% at follow-up (P cultures increased for all components of culture including communication by 4.1% (95% CI: 2.0%-6.2%), problem solving by 2.9% (95% CI: 1.6%-5.5%), team work by 5.2% (95% CI: 2.5%-7.8%), vision by 4.3% (95% CI: 1.1%-7.5%), performance measures by 5.6% (95% CI: 1.6%-9.6%), recognition by 4.7% (95% CI: 1.4%-8.0%), for conflict by 5.5% (95% CI: 1.7%-9.4%), and alignment by 5.8% (95% CI: 2.3%-9.2%). Engagement with structured QI training programs-and perhaps simply completing QI projects-can cause small, but important changes in organizations' cultures, thus increasing engagement in future QI and improving overall care and services. The article demonstrates that when LHDs participate in a longitudinal, experiential QI training program, their cultures of QI improve. Local health departments participating in similar training programs might experience similar improvements in culture, increasing subsequent participation in QI projects and improving related health

  8. HYPERTENSION IMPROVEMENT PROJECT (HIP): RANDOMIZED TRIAL OF QUALITY IMPROVEMENT FOR PHYSICIANS AND LIFESTYLE MODIFICATION FOR PATIENTS

    Science.gov (United States)

    Svetkey, Laura P.; Pollak, Kathryn I.; Yancy, William S.; Dolor, Rowena J.; Batch, Bryan C.; Samsa, Greg; Matchar, David B.; Lin, Pao-Hwa

    2009-01-01

    Despite widely publicized hypertension treatment guidelines for physicians and lifestyle recommendations for patients, blood pressure control rates remain low. In community-based primary care clinics, we performed a nested, 2×2 randomized, controlled trial of physician intervention vs. control and/or patient intervention vs. control. Physician Intervention included internet-based training, self-monitoring, and quarterly feedback reports. Patient Intervention included 20 weekly group sessions followed by 12 monthly phone counseling contacts, and focused on weight loss, DASH dietary pattern, exercise, and reduced sodium intake. The primary outcome was change in systolic blood pressure at 6 months. Eight primary care practices (32 physicians) were randomized to Physician Intervention or Control. Within those practices, 574 patients were randomized to Patient Intervention or Control. Patients’ mean age was 60 years, 61% female, 37% African American. BP data were available for 91% of patients at 6 months. The main effect of Physician Intervention on systolic blood pressure at 6 months, adjusted for baseline pressure, was 0.3 mmHg (95% CI −1.5 to 2.2; p = 0.72). The main effect of the Patient Intervention was −2.6 mmHg (95% CI −4.4, −0.7; p = 0.01). The interaction of the 2 interventions was significant (p = 0.03); the largest impact was observed with the combination of Physician and Patient Intervention (−9.7 ± 12.7 mmHg). Differences between treatment groups did not persist at 18 months. Combined physician and patient intervention lowers blood pressure; future research should focus on enhancing effectiveness and sustainability of these interventions. PMID:19920081

  9. Hip arthroscopy in the setting of hip dysplasia

    Science.gov (United States)

    Yeung, M.; Kowalczuk, M.; Simunovic, N.

    2016-01-01

    Objective Hip arthroscopy in the setting of hip dysplasia is controversial in the orthopaedic community, as the outcome literature has been variable and inconclusive. We hypothesise that outcomes of hip arthroscopy may be diminished in the setting of hip dysplasia, but outcomes may be acceptable in milder or borderline cases of hip dysplasia. Methods A systematic search was performed in duplicate for studies investigating the outcome of hip arthroscopy in the setting of hip dysplasia up to July 2015. Study parameters including sample size, definition of dysplasia, outcomes measures, and re-operation rates were obtained. Furthermore, the levels of evidence of studies were collected and quality assessment was performed. Results The systematic review identified 18 studies investigating hip arthroscopy in the setting of hip dysplasia, with 889 included patients. Criteria used by the studies to diagnose hip dysplasia and borderline hip dysplasia included centre edge angle in 72% of studies but the range of angles were quite variable. Although 89% of studies reported improved post-operative outcome scores in the setting of hip dysplasia, revision rates were considerable (14.1%), with 9.6% requiring conversion to total hip arthroplasty. Conclusion The available orthopaedic literature suggests that although improved outcomes are seen in hip arthroscopy in the setting of hip dysplasia, there is a high rate of re-operation and conversion to total hip arthroplasty. Furthermore, the criteria used to define hip dysplasia vary considerably among published studies. Cite this article: M. Yeung, M. Kowalczuk, N. Simunovic, O. R. Ayeni. Hip arthroscopy in the setting of hip dysplasia: A systematic review. Bone Joint Res 2016;5:225–231. DOI: 10.1302/2046-3758.56.2000533. PMID:27313136

  10. STUDY REGARDING THE EFFICIENCY OF A PHYSIOTHERAPY PROGRAM IN PAIN REDUCTION, PHYSICAL FUNCTION AND QUALITY OF LIFE IMPROVEMENT IN PATIENTS WITH HIP OSTHEOARTHRITIS

    Directory of Open Access Journals (Sweden)

    Doriana Ioana CIOBANU

    2016-12-01

    Full Text Available Hip osteoarthritis is mainly characterized by articular cartilage lesisons (distrophy, erosions, lack of articular surfaces shape and contour due to femoral head distruction.Aim. This paperwork aims to emphasize the efficiency of a comprehensive rehabilitation program in functional and quality of life improvement and pain reduction, in patients with hip osteoarthritis.Subjects. This study was conducted in Clinical Rehabilitation Hospital from Baile Felix, on a group of 10 patiants with hip arthrosis, aged between 50 and 80 years old, 50% man, 50% woman, average weight &2 kg, IMC 25.6, duration of affection average 17 years, 50% retired from activity, 50% workers.Metods. As assessment tools were used: goniometry, 0-5 scale for muscular force and Womac index for pain and quality of life assessment. The exercise program aimed to increase hip muscle tonus and the increasing of hip jount mobility and stability due to a better crossing of femorla head in the acetabular cavity.Results. After following rehabilitation program, we found the reduction of pain (11±8.18 baseline versus 9±8.18 final, the improvement of hip joint moiblity (4.60±3.28 pretest versus 3.7±3.27 posttest, of physical functioning (43.20±26.75 pretest versus 40.30±26.42 posttest and of quality of life (59.8±38.12 pretest versus 53±37.70 posttest. Conclusions: A rehabilitation program followed 5 times/ week, for two weeks, can lead to the improvement of hip joint mobility, to an increased muscular force of pelvic girdle and to the impovement of quality of life in patients with hip osteoarthritis

  11. Revision of failed hip resurfacing to total hip arthroplasty rapidly relieves pain and improves function in the early post operative period

    Directory of Open Access Journals (Sweden)

    Muirhead-Allwood Sarah K

    2010-11-01

    Full Text Available Abstract We reviewed the results of 25 consecutive patients who underwent revision of a hip resurfacing prosthesis to a total hip replacement. Revisions were performed for recurrent pain and effusion, infection and proximal femoral fractures. Both components were revised in 20 cases. There were 12 male and 13 female patients with average time to revision of 34.4 and 26.4 months respectively. The mean follow up period was 12.7 months (3 to 31. All patients reported relief of pain and excellent satisfaction scores. Two patients experienced stiffness up to three months post operatively. Pre operative Oxford, Harris and WOMAC hip scores were 39.1, 36.4 and 52.2 respectively. Mean post operative scores at last follow up were 17.4, 89.8 and 6.1 respectively (p

  12. Improving Planning and Post-Operative Assessment for Total Hip Arthroplasty

    Science.gov (United States)

    Pétursson, Þröstur; Edmunds, Kyle; Magnúsdóttir, Gígja; Halldórsson, Grétar; jr., Halldór Jónsson; Gargiulo, Paolo

    2015-01-01

    Total Hip Arthroplasty (THA) remains the gold standard of treatment for patients who suffer with a variety of hip-related pathological degeneration or trauma. These patients often exhibit significantly less post-operative pain and an increase in the range of motion of the joint, but there are still relatively common instances of debilitating periprosthetic complications that call into question the method for pre-surgical implant choice. Currently, there are two principal options for THA prostheses: cemented or non cemented. Utilizing the cemented procedure ensures a faster acquisition of adequate implant stability than with the non cemented procedure, but can eventually lead to an increased periprosthetic fracture risk. Non cemented prosthetic stems are more frequently revised within the first few years following THA due to periprosthetic fracture, but non cemented revision surgeries generally result in fewer complications than those of cemented implants. Surgeons typically rely on experience or simple patient metrics such as age and sex to prescribe which implant procedure is optimal, and while this may work for most patients, there is a clear need to analyze more rigoriously patient conditions that correlate to optimal post-THA outcomes. The results from the investigation reported herein indicate that an understanding of how the percent composition and quality of a patient's quadriceps muscle in both healthy and operated legs may be a better indicator for prosthetic choice. Additionally, these data emphasize that the traditional metrics of age and sex inadequately predict changes in quadriceps composition and quality and thereby have comparatively minor utility in determining the patient-appropriate prosthetic type. Key Words: Total Hip Arthroplasty, Prosthetic selection, Muscle size and quality, Anatomical modeling, Surgical planning. PMID:26913152

  13. SNF Project Engineering Process Improvement Plan

    Energy Technology Data Exchange (ETDEWEB)

    DESAI, S.P.

    2000-02-09

    This plan documents the SNF Project activities and plans to support its engineering process. It describes five SNF Project Engineering initiatives: new engineering procedures, qualification cards process; configuration management, engineering self assessments, and integrated schedule for engineering activities.

  14. Improving community ambulation after hip fracture: protocol for a randomised, controlled trial

    Science.gov (United States)

    Orwig, D; Mangione, KK; Baumgarten, M; Terrin, M; Fortinsky, R; Kenny, AM; Gruber-Baldini, AL; Beamer, B; Tosteson, ANA; Shardell, M; Magder, L; Binder, E; Koval, K; Resnick, B; Craik, RL; Magaziner, J

    2017-01-01

    Introduction After a hip fracture in older persons, significant disability often remains; dependency in functional activities commonly persists beyond 3 months after surgery. Endurance, dynamic balance, quadriceps strength, and function are compromised, and contribute to an inability to walk independently in the community. In the United States, people aged 65 years and older are eligible to receive Medicare funding for physiotherapy for a limited time after a hip fracture. A goal of outpatient physiotherapy is independent and safe household ambulation 2 to 3 months after surgery. Current Medicare-reimbursed post-hip-fracture rehabilitation fails to return many patients to pre-fracture levels of function. Interventions delivered in the home after usual hip fracture physiotherapy has ended could promote higher levels of functional independence in these frail and older adult patients. Primary objective To evaluate the effect of a specific multicomponent physiotherapy intervention (PUSH), compared with a non-specific multi-component control physiotherapy intervention (PULSE), on the ability to ambulate independently in the community 16 weeks after randomisation. Design Parallel, two-group randomised multicentre trial of 210 older adults with a hip fracture assessed at baseline and 16 weeks after randomisation, and at 40 weeks after randomisation for a subset of approximately 150 participants. Participants and setting A total of 210 hip fracture patients are being enrolled at three clinical sites and randomised up to 26 weeks after admission. Study inclusion criteria are: closed, non-pathologic, minimal trauma hip fracture with surgical fixation; aged ≥ 60 years at the time of randomisation; community residing at the time of fracture and randomisation; ambulating without human assistance 2 months prior to fracture; and being unable to walk at least 300 m in 6 minutes at baseline. Participants are ineligible if the interventions are deemed to be unsafe or unfeasible

  15. Improve the performance of coated cemented hip stem through the advanced composite materials.

    Science.gov (United States)

    Hedia, H S; Fouda, N

    2015-01-01

    Design of hip joint implant using functionally graded material (FGM) (advanced composite material) has been used before through few researches. It gives great results regarding the stress distribution along the implant and bone interfaces. However, coating of orthopaedic implants has been widely investigated through many researches. The effect of using advanced composite stem material, which mean by functionally graded stem material, in the total hip replacement coated with the most common coated materials has not been studied yet. Therefore, this study investigates the effect of utilizing these two concepts together; FGM and coating, in designing new stem material. It is concluded that the optimal FGM cemented stem is consisting from titanium at the upper stem layers graded to collagen at a lower stem layers. This optimal graded stem coated with hydroxyapatite found to reduce stress shielding by 57% compared to homogenous titanium stem coated with hydroxyapatite. However, the optimal functionally graded stem coated with collagen reduced the stress shielding by 51% compared to homogenous titanium stem coated with collagen.

  16. In hip osteoarthritis, Nordic Walking is superior to strength training and home-based exercise for improving function.

    Science.gov (United States)

    Bieler, T; Siersma, V; Magnusson, S P; Kjaer, M; Christensen, H E; Beyer, N

    2017-08-01

    This observer-blinded, randomized controlled trial compared the short- and long-term effects of 4 months of supervised strength training (ST) in a local fitness center, supervised Nordic Walking (NW) in a local park, and unsupervised home-based exercise (HBE, control) on functional performance in 60+-year-old persons (n = 152) with hip osteoarthritis (OA) not awaiting hip replacement. Functional performance [i.e., 30-s chair stand test (primary outcome), timed stair climbing, and 6-min walk test] and self-reported outcomes (i.e., physical function, pain, physical activity level, self-efficacy, and health-related quality of life) were measured at baseline and at 2, 4, and 12 months. Based on intention-to-treat-analyses improvements [mean (95% CI)] after intervention in number of chair stands were equal in all three groups at 4 months [ST: 0.9 (0.2-1.6), NW: 1.9 (0.8-3.0), HBE: 1.1 (0.1-2.0)] but greater in the NW group [1.4 (0.02-2.8)] than in the ST group at 12 months. Generally, improvements in functional performance were greater (P superior (P < 0.01) to HBE for improving vigorous physical activity and to both ST and HBE for improving (P < 0.01) mental health. These data suggest that NW is the recommended exercise modality compared with ST and HBE. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  17. Designing a Safety Reporting Smartphone Application to Improve Patient Safety After Total Hip Arthroplasty.

    Science.gov (United States)

    Krumsvik, Ole Andreas; Babic, Ankica

    2017-01-01

    This paper presents a safety reporting smartphone application which is expected to reduce the occurrence of postoperative adverse events after total hip arthroplasty (THA). A user-centered design approach was utilized to facilitate optimal user experience. Two main implemented functionalities capture patient pain levels and well-being, the two dimensions of patient status that are intuitive and commonly checked. For these and other functionalities, mobile technology could enable timely safety reporting and collection of patient data out of a hospital setting. The HCI expert, and healthcare professionals from the Haukeland University Hospital in Bergen have assessed the design with respect to the interaction flow, information content, and self-reporting functionalities. They have found it to be practical, intuitive, sufficient and simple for users. Patient self-reporting could help recognizing safety issues and adverse events.

  18. Neuromuscular exercise improves functional performance in patients with severe hip osteoarthritis

    DEFF Research Database (Denmark)

    Villadsen, Allan; Overgaard, Søren; Larsen, Anders Holsgaard

    Purpose. Exercise is regarded a cornerstone in the treatment of mild to moderate osteoarthritis (OA). However, little is known of the effects in patients with advanced and end-stage OA. The purpose was to evaluate the effect of neuromuscular exercise in patients with severe hip OA. Methods. Design...... to an eight-week neuromuscular exercise (NEMEX-TJR) intervention or care-as-usual (verbal and written preoperative information). Intervention was supervised and offered twice a week with each session lasting one hour. The program is considered feasible and safe in this patient group and previously described...... in detail. Assessments were carried out at baseline and within one week after the intervention. Outcomes. Functional performance: 20-m walk at maximal pace and 5 repeated chair stands timed. Muscle power: Unilateral multi-joint leg extension power and unilateral single-joint knee extension power evaluated...

  19. TREATMENT OF HIP DYSPLASIA

    Directory of Open Access Journals (Sweden)

    Iulian ICLEANU

    2015-11-01

    Full Text Available In this thesis, our purpose is to show that using physiotherapy on patients with hip dysplasia from the very beginning, in the first months of life, helps treating them faster. Common literature proposes to use physiotherapy on patients with hip dysplasia either after their recovery or in the terminal phase of recovery, claiming that any earlier intervention will prolong the hip recovery. The effects of hip dysplasia reflect over the whole musculoskeletal system, while it hinders the knees (genu valgum, the ankles (ankle valgus, calcaneal valgus and the spine (scoliosis especially at the lumbar level. The most spectacular are at the hip level, that is why we made an analytical evaluation only for this joint. To show the importance of physiotherapy for children with hip dysplasia we started from the hypothesis: untimely treatment for children with hip dysplasia has improved results in functional recovery and in obtaining a better stability, without the necessity of orthopedics or surgical interventions. The research methods used in this study are: the observation method, the bibliographic study method, the experimental method, the graphics method and the statistical mathematical method to process the data and to represent the results graphically. In the end, the results obtained are significantly different from the initial evaluations and we came to the conclusion that starting an untimely analytical kinetic treatment and globally personalizing it to every patient improves stability and biomechanical parameters for the hip.

  20. Newland A Watershed Water Quality Improvement Project

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — This project was an effort to address the drainage problems associated with Newland. As a result of significant flooding, urban development, and the concern for the...

  1. Achieving best practice tariff may not reflect improved survival after hip fracture treatment

    Directory of Open Access Journals (Sweden)

    Khan SK

    2014-12-01

    Full Text Available Sameer K Khan,1 Mark DF Shirley,2 Clare Glennie,1 Paul V Fearon,1 David J Deehan1 1The Newcastle upon Tyne Hospitals NHS Foundation Trust, 2School of Biology, Newcastle University, Newcastle upon Tyne, UK Objective: The best practice tariff (BPT incentivizes hospitals in the England and Wales National Health Service to provide multiprofessional care to patients with hip fractures. The initial six targets included: 1 admission under consultant-led joint orthopedic–geriatric care, 2 multidisciplinary assessment protocol on admission, 3 surgery within 36 hours, 4 geriatrician review within 72 hours, 5 multiprofessional rehabilitation, and 6 assessment for falls and bone protection. We aimed to examine the relationship between BPT achievement and important patient outcomes and whether the BPT could predict these independently of other validated predictors.Materials and methods: A retrospective review was conducted on 516 patient episodes. Four outcomes were defined: 1 30-day mortality, 2 365-day mortality, 3 postoperative length of stay on trauma ward (LOS-T, and 4 total post-operative hospital LOS (LOS-H. Patient episodes were grouped as follows: 1 group 1, pre-BPT, 2 group 2, BPT achievers, 3 group 3, BPT fails. These were compared for mortality (χ2 test and for LOS (Kruskal–Wallis test. Event analysis was done for groups 2 and 3 using generalized linear modeling, with age, sex, American Society of Anesthesiologists grade, hemoglobin, albumin, creatinine, and BPT achievement evaluated as predictors.Results: The three groups did not differ significantly in baseline characteristics or outcomes. In the event analysis, the risk of 30-day mortality was related only to abnormal creatinine (P=0.025; mortality at 365 days was related significantly to low albumin (P=0.023 and weakly to abnormal creatinine (P=0.089. The risks of both increased LOS-T and LOS-H were related to age only (P=0.052, P<0.001, respectively.Conclusion: Achieving BPT does not

  2. Advanced Acoustic Blankets for Improved Aircraft Interior Noise Reduction Project

    Data.gov (United States)

    National Aeronautics and Space Administration — In this project advanced acoustic blankets for improved low frequency interior noise control in aircraft will be developed and demonstrated. The improved performance...

  3. SF Bay Water Quality Improvement Fund: Projects and Accomplishments

    Science.gov (United States)

    San Francisco Bay Water Quality Improvement Fund (SFBWQIF) projects listed here are part of an EPA competitive grant program to improve SF Bay water quality focused on restoring impaired waters and enhancing aquatic resources.

  4. Rebuilding Habitat and Shoreline Resilience through Improved Flood Control Project

    Science.gov (United States)

    Information about the SFBWQP Rebuilding Habitat and Shoreline Resilience through Improved Flood Control Project, part of an EPA competitive grant program to improve SF Bay water quality focused on restoring impaired waters and enhancing aquatic resources.

  5. Hip Arthropathy in Haemophilia

    Directory of Open Access Journals (Sweden)

    Christian Carulli

    2017-04-01

    Full Text Available Hip arthropathy in haemophilic patients is disabling for hip and other common target joints. Even if bleedings in the hip are not frequent, femoroacetabular alterations may affect the functional ability of patients at a very young age. A haematologic prophylaxis combined with an adequate lifestyle and regular and low-traumatic physical activity are the keys to preventing such arthropathy. In the early stages of arthropathy, anti-inflammatory drugs and physical therapy may be sufficient to limit its progression. In cases of recurrent symptoms, viscosupplementation with hyaluronic acid, and chemical synoviorthesis are useful options. In more advanced stages, hip arthroscopy may be treated by synovectomy or loose body removal. For late stages, total hip arthroplasty (THA is mandatory. Until a few decades ago, the clinical outcomes after hip arthroplasty were variable, due to the different management of patients and the use of old generation implants and couplings. In the last decade, the introduction of the multidisciplinary management and the use of modern cementless implants with high performing materials and less invasive surgical techniques have dramatically improved the functional results. Nowadays, as is the case for other target joints, the purpose of the management in haemophilia centers is the early detection of any hip alterations—by clinical and ultrasound (US evaluations of patients in childhood—to reveal any early articular damage and to provide adequate treatment in case of symptoms. The present paper represents an updated review of the several approaches to hip arthropathy in haemophilia.

  6. Preoperative home-based physical therapy versus usual care to improve functional health of frail older adults scheduled for elective total hip arthroplasty: A pilot randomized controlled trial

    NARCIS (Netherlands)

    Oosting, E.; Jans, M.P.; Dronkers, J.J.; Naber, R.H.; Dronkers-Landman, C.M.; Appelman-De Vries, S.M.; Meeteren, N.L. van

    2012-01-01

    Preoperative home-based physical therapy versus usual care to improve functional health of frail older adults scheduled for elective total hip arthroplasty: a pilot randomized controlled trial. Objective: To investigate the feasibility and preliminary effectiveness of a home-based intensive exercise

  7. Improving Software Engineering on NASA Projects

    Science.gov (United States)

    Crumbley, Tim; Kelly, John C.

    2010-01-01

    Software Engineering Initiative: Reduces risk of software failure -Increases mission safety. More predictable software cost estimates and delivery schedules. Smarter buyer of contracted out software. More defects found and removed earlier. Reduces duplication of efforts between projects. Increases ability to meet the challenges of evolving software technology.

  8. Investment Planning of Interdependent Waterway Improvement Projects

    Science.gov (United States)

    1993-03-01

    effects that cut across many, if not all subsets of the project set. Several authors including [Schoeman 68, Aaker 78, Baker 75, Gear 80, Fox 84...solution or at least a good suboptimal solution. 118 RZFIRUNCEB Aaker , D. A. and Tyebjee, T. T., "A Model for the Selection of Interdependent R and D

  9. Improved optical planar waveguides for lasers Project

    Data.gov (United States)

    National Aeronautics and Space Administration — Demonstrate efficacy of a novel growth technique for planar waveguides (PWG) Enable PWG laser technology with improved performance, efficiency and manufacturability....

  10. Improving IT Project Portfolio Management: Lessons Learned

    DEFF Research Database (Denmark)

    Pedersen, Keld

    2013-01-01

    The IT PPM improvement process is not well understood, and our knowledge about what makes IT PPM improvement succeed or fail is not well developed. This article presents lessons learned from organizations trying to improve their IT PPM practice. Based on this research IT PPM practitioners are adv...... are advised to respect the limitations for fundamentally changing the way that organizational actors and teams make portfolio decisions, invest in understanding IT PPM decision-making, focus on decision-risks, and balance formalization and professionalization during improvement efforts....

  11. Improving IT Project Portfolio Management: Lessons Learned

    DEFF Research Database (Denmark)

    Pedersen, Keld

    2013-01-01

    The IT PPM improvement process is not well understood, and our knowledge about what makes IT PPM improvement succeed or fail is not well developed. This article presents lessons learned from organizations trying to improve their IT PPM practice. Based on this research IT PPM practitioners are adv...... are advised to respect the limitations for fundamentally changing the way that organizational actors and teams make portfolio decisions, invest in understanding IT PPM decision-making, focus on decision-risks, and balance formalization and professionalization during improvement efforts....

  12. Total hip arthroplasty

    Directory of Open Access Journals (Sweden)

    Slavković Nemanja

    2012-01-01

    Full Text Available Total hip arthroplasty is most common reconstructive hip procedure in adults. In this surgery we replace some parts of the upper femur and acetabulum with biocompatible materials. The main goal of this surgery is to eliminate pain and regain full extent of joint motion, maintaining hip stability. Surgical technique, biomaterials, design of the prosthesis and fixation techniques have evolved with time adjusting to each other. After total hip arthroplasty patients’ quality of life should be improved. There are many various postoperative complications. Some of them are fatal, and some are minor, which may become manifested years after surgery. Each next surgical procedure following previous hip surgery is associated with considerably lower chances to be successful. Therefore, in primary total hip arthroplasty, preoperative evaluation and preparation of patients are essential. Every orthopaedic surgeon needs to improve already adopted surgical skills applying them with precision and without compromise, with the main goal to achieve long-term durability of the selected implant. The number of total hip arthroplasties will also increase in future, and newer and higher quality materials will be used.

  13. In hip osteoarthritis Nordic Walking is superior to strength training and home based exercise for improving function

    DEFF Research Database (Denmark)

    Bieler, T; Siersma, Volkert Dirk; Magnusson, P

    2017-01-01

    in 60+-year-old persons (n = 152) with hip osteoarthritis (OA) not awaiting hip replacement. Functional performance [i.e., 30-s chair stand test (primary outcome), timed stair climbing, and 6-min walk test] and self-reported outcomes (i.e., physical function, pain, physical activity level, self...

  14. Improving Project Management with Simulation and Completion Distribution Functions

    Science.gov (United States)

    Cates, Grant R.

    2004-01-01

    million per month is being spent on this project, which is scheduled to complete by 2010. NASA project stakeholders participated in determining and managing completion distribution functions produced from PAST. The first result was that project stakeholders improved project completion risk awareness. Secondly, using PAST, mitigation options were analyzed to improve project completion performance and reduce total project cost.

  15. Improvement in Space Food Packaging Methods Project

    Data.gov (United States)

    National Aeronautics and Space Administration — The Space Food Systems Laboratory's (SFSL) current Bulk Overwrap Bag (BOB) package, while simple and effective, leaves room for improvement. Currently, BOBs are...

  16. Surgical hip dislocation for treatment of cam femoroacetabular impingement

    Directory of Open Access Journals (Sweden)

    Milind M Chaudhary

    2015-01-01

    Conclusion: Cam femoroacetabular Impingement causing pain and limitation of hip movements was treated by open osteochondroplasty after surgical hip dislocation. This reduced pain, improved hip motion and gave good to excellent results in the short term.

  17. Improving Sustainability Performance for Public-Private-Partnership (PPP Projects

    Directory of Open Access Journals (Sweden)

    Liyin Shen

    2016-03-01

    Full Text Available Improving sustainability performance in developing infrastructure projects is an important strategy for pursuing the mission of sustainable development. In recent years, the business model of public-private-partnership (PPP is promoted as an effective approach in developing infrastructure projects. It is considered that the distribution of the contribution on project investment between private and public sectors is one of the key variables affecting sustainability performance of PPP-type projects. This paper examines the impacts of the contribution distribution between public and private sectors on project sustainability performance. A model named the sustainability performance-based evaluation model (SPbEM is developed for assisting the assessment of the level of sustainability performance of PPP projects. The study examines the possibility of achieving better sustainability through proper arrangement of the investment distribution between the two primary sectors in developing PPP-type infrastructure projects.

  18. Hypothesis Generation in Quality Improvement Projects: Approaches for Exploratory Studies

    NARCIS (Netherlands)

    de Mast, J.; Bergman, M.

    2006-01-01

    In quality improvement projects - such as Six Sigma projects - an exploratory phase can be discerned, during which possible causes, influence factors or variation sources are identified. In a subsequent confirmatory phase the effects of these possible causes are experimentally verified. Whereas the

  19. Improving Project Management Using Formal Models and Architectures

    Science.gov (United States)

    Kahn, Theodore; Sturken, Ian

    2011-01-01

    This talk discusses the advantages formal modeling and architecture brings to project management. These emerging technologies have both great potential and challenges for improving information available for decision-making. The presentation covers standards, tools and cultural issues needing consideration, and includes lessons learned from projects the presenters have worked on.

  20. A portfolio evaluation framework for air transportation improvement projects

    Science.gov (United States)

    Baik, Hyeoncheol

    This thesis explores the application of portfolio theory to the Air Transportation System (ATS) improvement. The ATS relies on complexly related resources and different stakeholder groups. Moreover, demand for air travel is significantly increasing relative to capacity of air transportation. In this environment, improving the ATS is challenging. Many projects, which are defined as technologies or initiatives, for improvement have been proposed and some have been demonstrated in practice. However, there is no clear understanding of how well these projects work in different conditions nor of how they interact with each other or with existing systems. These limitations make it difficult to develop good project combinations, or portfolios that maximize improvement. To help address this gap, a framework for identifying good portfolios is proposed. The framework can be applied to individual projects or portfolios of projects. Projects or portfolios are evaluated using four different groups of factors (effectiveness, time-to-implement, scope of applicability, and stakeholder impacts). Portfolios are also evaluated in terms of interaction-determining factors (prerequisites, co-requisites, limiting factors, and amplifying factors) because, while a given project might work well in isolation, interdependencies between projects or with existing systems could result in lower overall performance in combination. Ways to communicate a portfolio to decision makers are also introduced. The framework is unique because (1) it allows using a variety of available data, and (2) it covers diverse benefit metrics. For demonstrating the framework, an application to ground delay management projects serves as a case study. The portfolio evaluation approach introduced in this thesis can aid decision makers and researchers at universities and aviation agencies such as Federal Aviation Administration (FAA), National Aeronautics and Space Administration (NASA), and Department of Defense (DoD), in

  1. Improving peri-prosthetic bone adaptation around cementless hip stems: A clinical and finite element study

    NARCIS (Netherlands)

    Broeke, ten R.H.M.; Tarala, M.; Arts, J.J.; Janssen, D.W.; Verdonschot, N.J.J.; Geesink, R.G.T.

    2014-01-01

    This study assessed whether the Symax™ implant, a modification of the Omnifit® stem (in terms of shape, proximal coating and distal surface treatment), would yield improved bone remodelling in a clinical DEXA study, and if these results could be predicted in a finite element (FE) simulation study.

  2. Improving peri-prosthetic bone adaptation around cementless hip stems: A clinical and finite element study

    NARCIS (Netherlands)

    Broeke, R.H. Ten; Tarala, M.; Arts, J.J.C.; Janssen, D.W.; Verdonschot, N.J.J.; Geesink, R.G.T.

    2014-01-01

    This study assessed whether the Symax implant, a modification of the Omnifit((R)) stem (in terms of shape, proximal coating and distal surface treatment), would yield improved bone remodelling in a clinical DEXA study, and if these results could be predicted in a finite element (FE) simulation study

  3. Health improvement and prevention study (HIPS - evaluation of an intervention to prevent vascular disease in general practice

    Directory of Open Access Journals (Sweden)

    Davies Gawaine

    2010-08-01

    Full Text Available Abstract Background The Health Improvement and Prevention Study (HIPS study aims to evaluate the capacity of general practice to identify patients at high risk for developing vascular disease and to reduce their risk of vascular disease and diabetes through behavioural interventions delivered in general practice and by the local primary care organization. Methods/Design HIPS is a stratified randomized controlled trial involving 30 general practices in NSW, Australia. Practices are randomly allocated to an 'intervention' or 'control' group. General practitioners (GPs and practice nurses (PNs are offered training in lifestyle counselling and motivational interviewing as well as practice visits and patient educational resources. Patients enrolled in the trial present for a health check in which the GP and PN provide brief lifestyle counselling based on the 5As model (ask, assess, advise, assist, and arrange and refer high risk patients to a diet education and physical activity program. The program consists of two individual visits with a dietician or exercise physiologist and four group sessions, after which patients are followed up by the GP or PN. In each practice 160 eligible patients aged between 40 and 64 years are invited to participate in the study, with the expectation that 40 will be eligible and willing to participate. Evaluation data collection consists of (1 a practice questionnaire, (2 GP and PN questionnaires to assess preventive care attitudes and practices, (3 patient questionnaire to assess self-reported lifestyle behaviours and readiness to change, (4 physical assessment including weight, height, body mass index (BMI, waist circumference and blood pressure, (5 a fasting blood test for glucose and lipids, (6 a clinical record audit, and (7 qualitative data collection. All measures are collected at baseline and 12 months except the patient questionnaire which is also collected at 6 months. Study outcomes before and after the

  4. Improving care for people with osteoarthritis of the hip and knee: how has national policy for osteoarthritis been translated into service models in Australia?

    Science.gov (United States)

    Brand, Caroline; Hunter, David; Hinman, Rana; March, Lyn; Osborne, Richard; Bennell, Kim

    2011-05-01

    There is strong rationale for improving care for people with chronic conditions, including osteoarthritis (OA). Successful implementation of healthcare reform requires new concepts and directions that are strongly supported by policy, new models of care (service redesign) and changes in day-to-day practice (healthcare provider and patient practice). In this paper we discuss the extent to which policy about management of OA of the hip and knee has been translated into new service models in Australia. A structured search of government and other key health websites in Australia was performed to identify policy, funding initiatives and new services models for managing OA of the hip and knee. This search was supported by a literature review. Musculoskeletal conditions were designated a National Health Priority in Australia in 2002. Under the Better Arthritis and Osteoporosis Care initiative, Australia has developed a national policy for OA care and national evidence-based clinical practice guidelines for management of OA of the hip and knee. Only two well-described examples of new chronic disease management service models, the Osteoarthritis Clinical Pathway (OACP) model and the Osteoarthritis Hip and Knee Service (OAHKS) were identified. Primarily focused within acute care public hospital settings, these have been shown to be feasible and acceptable but have limited data on clinical impact and cost-effectiveness. While policy is extant, implementation has not been systematic and comprehensive. Clinicians have evidence-based recommendations for OA management but are poorly supported by service models to deliver these effectively and efficiently.

  5. Evaluation of 60 continuous quality improvement projects in French hospitals.

    Science.gov (United States)

    Maguerez, G; Erbault, M; Terra, J L; Maisonneuve, H; Matillon, Y

    2001-04-01

    To evaluate the feasibility of implementing continuous quality improvement (CQI) projects in French health care organizations. The French Ministry of Health issued two calls for CQI projects (in 1995 and 1996). ANAES was commissioned to monitor and evaluate the projects, and to provide advice. ANAES in collaboration with French public hospitals. A jury selected 64 projects from 483 submissions. The first series of projects related to safety issues (e.g. blood transfusions), the second related chiefly to patient management. ANAES instructed project leaders in process analysis (modified four-step FOCUS-PDCA model), convened regular meetings between leaders and performed on-site visits. Objective outcomes: goal achievement, extension of projects to other topics and departments, allocation of resources. Subjective outcomes: changes in attitudes. Statistics were obtained from two questionnaires completed by project leaders. Four projects were discontinued; 82% (49 out of 60) met more than half their objectives. The CQI method was adopted by other departments in 65% and 50% (1st and 2nd series respectively) of cases. Hospital management often chose to provide continued support (81%/88%), offer training (59%/80%), create a CQI unit (62%/73%), and allocate a budget (61%/65%). A positive impact on staff attitudes was noted in over 75% of projects. ANAES' co-ordinated initiative to acquaint a hard core of French public hospitals with CQI proved successful. Identification of the factors for success and of potential hurdles helped pave the way for the national hospital accreditation procedure currently underway.

  6. Improving Student Teamwork in a Collaborative Project-Based Course

    Science.gov (United States)

    Kapp, Edward

    2009-01-01

    While collaborative student projects can be effective in improving student learning, the failure of students to work together effectively remains a widely reported problem in collaborative learning. This article describes a team-building intervention designed to improve the students' abilities to work together in teams successfully. The…

  7. ELECTRICAL SAFETY IMPROVEMENT PROJECT A COMPLEX WIDE TEAMING INITIATIVE

    Energy Technology Data Exchange (ETDEWEB)

    GRAY BJ

    2007-11-26

    This paper describes the results of a year-long project, sponsored by the Energy Facility Contractors Group (EFCOG) and designed to improve overall electrical safety performance throughout Department of Energy (DOE)-owned sites and laboratories. As evidenced by focused metrics, the Project was successful primarily due to the joint commitment of contractor and DOE electrical safety experts, as well as significant support from DOE and contractor senior management. The effort was managed by an assigned project manager, using classical project-management principles that included execution of key deliverables and regular status reports to the Project sponsor. At the conclusion of the Project, the DOE not only realized measurable improvement in the safety of their workers, but also had access to valuable resources that will enable them to do the following: evaluate and improve electrical safety programs; analyze and trend electrical safety events; increase electrical safety awareness for both electrical and non-electrical workers; and participate in ongoing processes dedicated to continued improvement.

  8. EFFECTIVENESS OF DRY NEEDLING, STRETCHING, AND STRENGTHENING TO REDUCE PAIN AND IMPROVE FUNCTION IN SUBJECTS WITH CHRONIC LATERAL HIP AND THIGH PAIN: A RETROSPECTIVE CASE SERIES.

    Science.gov (United States)

    Pavkovich, Ron

    2015-08-01

    Chronic lateral hip and thigh pain is regularly treated by the physical therapist. Many issues can cause pain in this region, and trigger points may contribute to pain. Dry Needling (DN) is an intervention used by physical therapists where a monofilament needle is inserted into soft tissue to reduce pain thereby facilitating return to prior level of function. The purpose of this case series is to report the outcomes of DN and conventional physical therapy as a treatment intervention for subjects with chronic lateral hip and thigh pain. Four subjects with chronic lateral hip and thigh pain attended between four and eight sixty-minute sessions of dry needling and stretching/ strengthening activities over a four to eight week intervention course. Outcomes were tested at baseline and upon completion of therapy. A long-term follow up averaging 12.25 months (range 3 to 20 months) was also performed. The outcome measures included the Visual Analog Scale (VAS) and the Lower Extremity Functional Scale (LEFS). The LEFS and VAS indicated clinically meaningful improvements in disability and pain in the short term and upon long term follow up for each subject. The LEFS(mean) for the four subjects improved from 50.75 at baseline to 66.75 at the completion of treatment. At long-term follow-up, the LEFS(mean) was 65.50. Each subject met the minimal clinically important difference (MCID) and minimal detectable change (MDC) for the LEFS and the VAS. The VAS was broken down into best (VAS(B)), current (VAS(C)), and worst (VAS(W)) rated pain levels and averaged between the four subjects. The VAS(B) improved from 20 mm at the initial assessment to 0 mm upon completion of the intervention duration. The VAS(C) improved from 25.75 mm to 11.75 mm, and the VAS(W) improved from 85 mm to 32.5 mm. At the long-term follow up (average 12.25 months), the VAS(B), VAS(C), and VAS(W) scores were 0 mm, 14.58 mm, and 43.75 mm respectively. Clinically meaningful improvements in pain and disability were

  9. Lessons learnt from a primary care asthma improvement project.

    Science.gov (United States)

    Lenney, Warren; Clayton, Sadie; Gilchrist, Francis J; Price, David; Small, Iain; Smith, Judy; Sutton, Emma J

    2016-01-07

    Asthma is a very common disease that can occur at any age. In the UK and in many other countries it is mainly managed in primary care. The published evidence suggests that the key to improving diagnosis and management lies in better training and education rather than in the discovery of new medications. An asthma improvement project managed through the British Lung Foundation is attempting to do this. The project has three pilot sites: two in England supported by the Department of Health and one in Scotland supported by the Scottish Government. If the project is successful it will be rolled out to other health areas within the UK. The results of this project are not yet available. This article highlights the challenges encountered in setting up the project and may well be applicable to other areas in the UK and to other countries where similar healthcare systems exist. The encountered challenges reflect the complex nature of healthcare systems and electronic data capture in primary care. We discuss the differences between general practices in their ability and willingness to support the project, the training and education of their staff on asthma management, governance issues in relation to information technology systems, and the quality of data capture. Virtually all the challenges have now been overcome, but discussing them should ensure that others become aware of them at an early stage should they wish to undertake similar projects in the future.

  10. Hip arthroscopy

    Directory of Open Access Journals (Sweden)

    Henrique Antônio Berwanger de Amorim Cabrita

    2015-06-01

    Full Text Available Hip arthroscopy is a safe method for treating a variety of pathological conditions that were unknown until a decade ago. Femoroacetabular impingement is the commonest of these pathological conditions and the one with the best results when treated early on. The instruments and surgical technique for hip arthroscopy continue to evolve. New indications for hip arthroscopy has been studied as the ligamentum teres injuries, capsular repair in instabilities, dissection of the sciatic nerve and repair of gluteal muscles tears (injuries to the hip rotator cuff, although still with debatable reproducibility. The complication rate is low, and ever-better results with fewer complications should be expected with the progression of the learning curve.

  11. Rose Hip

    Science.gov (United States)

    ... dropsy or edema), gout, back and leg pain (sciatica), diabetes, high cholesterol, weight loss, high blood pressure, ... Painful menstruation. Some evidence suggests that applying an aromatherapy formula containing lavender, clary sage, and rose hip ...

  12. Hip ultrasound

    Energy Technology Data Exchange (ETDEWEB)

    Martinoli, Carlo, E-mail: carlo.martinoli@libero.it [Radiologia, DISC, Università di Genova, Largo Rosanna Benzi 8, I-16132 Genoa (Italy); Garello, Isabella; Marchetti, Alessandra; Palmieri, Federigo; Altafini, Luisa [Radiologia, DISC, Università di Genova, Largo Rosanna Benzi 8, I-16132 Genoa (Italy); Valle, Maura [Radiologia, Gaslini Children Hospital, Genova (Italy); Tagliafico, Alberto [Radiologia, National Institute for Cancer Research, Genoa (Italy)

    2012-12-15

    In newborns, US has an established role in the detection and management of developmental dysplasia of the hip. Later in childhood, when the limping child is a major diagnostic dilemma, US is extremely helpful in the identification of the varied disease processes underlying this condition, as transient synovitis, septic arthritis, Perthes disease and slipped femoral capital epiphysis. In adolescent practicing sporting activities, US is an excellent means to identify apophyseal injures about the pelvic ring, especially when avulsions are undisplaced and difficult-to-see radiographically. Later on, in the adulthood, US is an effective modality to diagnose tendon and muscle injuries about the hip and pelvis, identify effusion or synovitis within the hip joint or its adjacent bursae and guide the treatment of these findings. The aim of this article is to provide a comprehensive review of the most common pathologic conditions about the hip, in which the contribution of US is relevant for the diagnostic work-up.

  13. Canine Hip Dysplasia: Diagnostic Imaging.

    Science.gov (United States)

    Butler, J Ryan; Gambino, Jennifer

    2017-07-01

    Diagnostic imaging is the principal method used to screen for and diagnose hip dysplasia in the canine patient. Multiple techniques are available, each having advantages, disadvantages, and limitations. Hip-extended radiography is the most used method and is best used as a screening tool and for assessment for osteoarthritis. Distraction radiographic methods such as the PennHip method allow for improved detection of laxity and improved ability to predict future osteoarthritis development. More advanced techniques such as MRI, although expensive and not widely available, may improve patient screening and allow for improved assessment of cartilage health. Copyright © 2017 Elsevier Inc. All rights reserved.

  14. Guide for prioritizing power plant productivity improvement projects: handbook of availability improvement methodology

    Energy Technology Data Exchange (ETDEWEB)

    1981-09-15

    As part of its program to help improve electrical power plant productivity, the Department of Energy (DOE) has developed a methodology for evaluating productivity improvement projects. This handbook presents a simplified version of this methodology called the Availability Improvement Methodology (AIM), which provides a systematic approach for prioritizing plant improvement projects. Also included in this handbook is a description of data taking requirements necessary to support the AIM methodology, benefit/cost analysis, and root cause analysis for tracing persistent power plant problems. In applying the AIM methodology, utility engineers should be mindful that replacement power costs are frequently greater for forced outages than for planned outages. Equivalent availability includes both. A cost-effective ranking of alternative plant improvement projects must discern between those projects which will reduce forced outages and those which might reduce planned outages. As is the case with any analytical procedure, engineering judgement must be exercised with respect to results of purely mathematical calculations.

  15. Declining incidence trends for hip fractures have not been accompanied by improvements in lifetime risk or post-fracture survival--A nationwide study of the Swedish population 60 years and older.

    Science.gov (United States)

    Karampampa, Korinna; Ahlbom, Anders; Michaëlsson, Karl; Andersson, Tomas; Drefahl, Sven; Modig, Karin

    2015-09-01

    Hip fracture is a common cause of disability and mortality among the elderly. Declining incidence trends have been observed in Sweden. Still, this condition remains a significant public health problem since Sweden has one of the highest incidences worldwide. Yet, no Swedish lifetime risk or survival trends have been presented. By examining how hip fracture incidence, post-fracture survival, as well as lifetime risk have developed between 1995 and 2010 in Sweden, this study aims to establish how the burden hip fractures pose on the elderly changed over time, in order to inform initiatives for improvements of their health. The entire Swedish population 60 years-old and above was followed between 1987 and 2010 in the National Patient Register and the Cause of Death Register. Annual age-specific hip fracture cumulative incidence was estimated using hospital admissions for hip fractures. Three-month and one-year survival after the first hip fracture were also estimated. Period life table was used to assess lifetime risk of hip fractures occurring from age 60 and above, and the expected mean age of the first hip fracture. The age-specific hip fracture incidence decreased between 1995 and 2010 in all ages up to 94 years, on average by 1% per year. The lifetime risk remained almost stable, between 9% and 11% for men, and between 18% and 20% for women. The expected mean age of a first hip fracture increased by 2.5 years for men and by 2.2 years for women. No improvements over time were observed for the 3-month survival for men, while for women a 1% decrease per year was observed. The 1-year survival slightly increased over time for men (0.4% per year) while no improvement was observed for women. The age-specific hip fracture incidence has decreased over time. Yet the lifetime risk of a hip fracture has not decreased because life expectancy in the population has increased in parallel. Overall, survival after hip fracture has not improved. Copyright © 2015. Published by

  16. Exercise adherence improving long-term patient outcome in patients with osteoarthritis of the hip and/or knee.

    NARCIS (Netherlands)

    Pisters, M.F.; Veenhof, C.; Schellevis, F.G.; Twisk, J.W.; Dekker, J.; Bakker, D.H. de

    2010-01-01

    OBJECTIVE: To determine the effect of patient exercise adherence within the prescribed physical therapy treatment period and after physical therapy discharge on patients' outcome on pain, physical function and patient self-perceived effect in individuals with osteoarthritis (OA) of the hip and/or kn

  17. Exercise adherence improves long-term patient outcome in patients with osteoarthritis of the hip and/or knee.

    NARCIS (Netherlands)

    Pisters, M.; Veenhof, C.; Schellevis, F.; Twisk, J.; Dekker, J.; Bakker, D. de

    2011-01-01

    Purpose: To determine the effect of patient exercise adherence, within the prescribed physiotherapy treatment period and after discharge, on patients’ outcome on pain, physical function and patient self-perceived effect in individuals with osteoarthritis (OA) of the hip and/or knee. Relevance: The p

  18. Exercise adherence improves long-term patient outcome in patients with osteoarthritis of the hip and/or knee.

    NARCIS (Netherlands)

    Pisters, M.; Veenhof, C.; Schellevis, F.; Twisk, J.; Dekker, J.; Bakker, D. de

    2011-01-01

    Purpose: To determine the effect of patient exercise adherence, within the prescribed physiotherapy treatment period and after discharge, on patients’ outcome on pain, physical function and patient self-perceived effect in individuals with osteoarthritis (OA) of the hip and/or knee. Relevance: The

  19. Risk of hip fractures associated with benzodiazepines: Applying common protocol to a multi-database nested case-control study. The protect project

    NARCIS (Netherlands)

    Requena, Gema; Logie, John; González-González, Rocío; Gardarsdottir, Helga; Afonso, Ana; Souverein, Patrick C.; Merino, Elisa Martin; Boudiaf, Nada; Huerta, Consuelo; Bate, Andrew; Alvarez, Yolanda; García-Rodríguez, Luis A.; Reynolds, Robert; Schlienger, Raymond G.; De Groot, Mark C.H.; Klungel, Olaf H.; De Abajo, Francisco J.

    2014-01-01

    Background: The association between benzodiazepines (BZD) and hip fractures has been estimated in several observational studies although diverse methodologies and definitions have hampered comparability. Objectives: To evaluate the discrepancies in the risk estimates of hip/femur fractures associate

  20. What drives continuous improvement project success in healthcare?

    Science.gov (United States)

    Stelson, Paul; Hille, Joshua; Eseonu, Chinweike; Doolen, Toni

    2017-02-13

    Purpose The purpose of this paper is to present findings from a study of factors that affect continuous improvement (CI) project success in hospitals. Design/methodology/approach Quantitative regression analysis was performed on Likert scale survey responses. Qualitative thematic analysis was performed on open-ended survey responses and written reports on CI projects. Findings The paper identifies managerial and employee factors that affect project success. These factors include managerial support, communication, and affective commitment. Affective commitment is the extent to which employees perceive the change as being needed or necessary. Practical implications The results highlight how managerial decisions, approaches to communication - including communication before, during and after CI projects affect project success. The results also show that success depends on the way employees perceive proposed changes. This suggests the need for a more individualized approach to CI, lean, and broader change initiatives. Originality/value This research is the first to fuse project success and sustainability theory to CI projects, beyond Kaizen events, in healthcare environments. The research is particularly important at a time when healthcare organizations are required to make rapid changes with limited resources as they work toward outcome-based assessment and reimbursement rules.

  1. Columbia River Channel Improvement Project Rock Removal Blasting: Monitoring Plan

    Energy Technology Data Exchange (ETDEWEB)

    Carlson, Thomas J.; Johnson, Gary E.

    2010-01-29

    This document provides a monitoring plan to evaluate take as outlined in the National Marine Fisheries Service 2002 Biological Opinion for underwater blasting to remove rock from the navigation channel for the Columbia River Channel Improvement Project. The plan was prepared by the Pacific Northwest National Laboratory (PNNL) for the U.S. Army Corps of Engineers (USACE), Portland District.

  2. IMPROVING PROJECT SCHEDULE ESTIMATES USING HISTORICAL DATA AND SIMULATION

    Directory of Open Access Journals (Sweden)

    P.H. Meyer

    2012-01-01

    Full Text Available

    ENGLISH ABSTRACT: Many projects are not completed on time or within the original budget. This is caused by uncertainty in project variables as well as the occurrence of risk events. A study was done to determine ways of measuring the risk in development projects executed by a mining company in South Africa. The main objective of the study was to determine whether historical project data would provide a more accurate means of estimating the total project duration. Original estimates and actual completion times for tasks of a number of projects were analysed and compared. The results of the study indicated that a more accurate total duration for a project could be obtained by making use of historical project data. The accuracy of estimates could be improved further by building a comprehensive project schedule database within a specific industry.

    AFRIKAANSE OPSOMMING: Verskeie projekte word nie binne die oorspronklike skedule of begroting voltooi nie. Dit word dikwels veroorsaak deur onsekerheid oor projekveranderlikes en die voorkoms van risiko’s. 'n Studie is gedoen om 'n metode te ontwikkel om risiko te meet vir ontwikkelingsprojekte van 'n mynmaatskappy in Suid Afrika. Die hoofdoel van die studie was om te bepaal of historiese projekdata gebruik kon word om 'n akkurater tydsduur vir 'n projek te beraam. Die geraamde tydsduur van take vir 'n aantal projekte is ontleed en vergelyk met die werklike tydsduur. Die resultate van die studie het getoon dat 'n akkurater totale tydsduur vir die projek verkry kon word deur gebruik te maak van historiese projekdata. Die akkuraatheid kan verder verbeter word deur 'n databasis van projekskedules vir 'n bepaalde industrie te ontwikkel en by datum te hou.

  3. Hip Microfracture

    Science.gov (United States)

    McGill, Kevin C.; Bush-Joseph, Charles A.; Nho, Shane J.

    2010-01-01

    Microfracture is a marrow-stimulating technique used in the hip to treat cartilage defects associated with femoro-acetabular impingement, instability, or traumatic hip injury. These defects have a low probability of healing spontaneously and therefore often require surgical intervention. Originally adapted from the knee, microfracture is part of a spectrum of cartilage repair options that include palliative procedures such as debridement and lavage, reparative procedures such as marrow-stimulating techniques (abrasion arthroplasty and microfracture), and restorative procedures such as autologous chondrocyte implantation and osteochondral allograft/autografts. The basic indications for microfracture of the hip include focal and contained lesions typically less than 4 cm in diameter, full-thickness (Outerbridge grade IV) defects in weightbearing areas, unstable lesions with intact subchondral bone, and focal lesions without evidence of surrounding chondromalacia. Although not extensively studied in the hip, there are some small clinical series with promising early outcomes. Although the widespread use of microfracture in the hip is hindered by difficulties in identifying lesions on preoperative imaging and instrumentation to circumvent the femoral head, this technique continues to gain acceptance as an initial treatment for small, focal cartilage defects. PMID:26069544

  4. Hip arthroscopy in the setting of hip dysplasia: A systematic review.

    Science.gov (United States)

    Yeung, M; Kowalczuk, M; Simunovic, N; Ayeni, O R

    2016-06-01

    Hip arthroscopy in the setting of hip dysplasia is controversial in the orthopaedic community, as the outcome literature has been variable and inconclusive. We hypothesise that outcomes of hip arthroscopy may be diminished in the setting of hip dysplasia, but outcomes may be acceptable in milder or borderline cases of hip dysplasia. A systematic search was performed in duplicate for studies investigating the outcome of hip arthroscopy in the setting of hip dysplasia up to July 2015. Study parameters including sample size, definition of dysplasia, outcomes measures, and re-operation rates were obtained. Furthermore, the levels of evidence of studies were collected and quality assessment was performed. The systematic review identified 18 studies investigating hip arthroscopy in the setting of hip dysplasia, with 889 included patients. Criteria used by the studies to diagnose hip dysplasia and borderline hip dysplasia included centre edge angle in 72% of studies but the range of angles were quite variable. Although 89% of studies reported improved post-operative outcome scores in the setting of hip dysplasia, revision rates were considerable (14.1%), with 9.6% requiring conversion to total hip arthroplasty. The available orthopaedic literature suggests that although improved outcomes are seen in hip arthroscopy in the setting of hip dysplasia, there is a high rate of re-operation and conversion to total hip arthroplasty. Furthermore, the criteria used to define hip dysplasia vary considerably among published studies.Cite this article: M. Yeung, M. Kowalczuk, N. Simunovic, O. R. Ayeni. Hip arthroscopy in the setting of hip dysplasia: A systematic review. Bone Joint Res 2016;5:225-231. DOI: 10.1302/2046-3758.56.2000533. © 2016 Ayeni et al.

  5. Similar range of motion and function after resurfacing large-head or standard total hip arthroplasty

    DEFF Research Database (Denmark)

    Penny, Jeannette Østergaard; Ovesen, Ole; Varmarken, Jens-Erik

    2013-01-01

    BACKGROUND AND PURPOSE: Large-size hip articulations may improve range of motion (ROM) and function compared to a 28-mm THA, and the low risk of dislocation allows the patients more activity postoperatively. On the other hand, the greater extent of surgery for resurfacing hip arthroplasty (RHA) c...... for large articulations did not improve the clinical and patient-perceived outcomes. The more extensive surgical procedure of RHA did not impair the rehabilitation. This project is registered at ClinicalTrials.gov under # NCT01113762.......BACKGROUND AND PURPOSE: Large-size hip articulations may improve range of motion (ROM) and function compared to a 28-mm THA, and the low risk of dislocation allows the patients more activity postoperatively. On the other hand, the greater extent of surgery for resurfacing hip arthroplasty (RHA...

  6. Improvements in hip fracture incidence counterbalanced by the rise of other fracture types: data from Spain 2000-2010.

    Science.gov (United States)

    Cirera, Eva; Pérez, Katherine; Santamariña-Rubio, Elena; Novoa, Ana M; Olabarria, Marta

    2014-12-01

    In recent years, the incidence of injury in older people has increased. The aim of this study is to address the hypothesis that this increase is due to an increase in the incidence of some injuries that, while less common than hip fractures, are sufficient jointly to counteract the decrease or stabilisation in hip fracture rates observed in most countries. We performed a descriptive study of trends using data from the National Hospital Discharge Register. We included individuals 65 years and older who were discharged from a Spanish hospital during the period 2000-2010 with at least one injury diagnosis in the primary diagnosis field on the discharge form. The dependent variables were the following injury groups, classified using the Barell Matrix: hip fracture, shoulder and upper arm fractures, forearm and elbow fractures, thoracic fractures, lower leg and ankle fractures, and TBI type 1 internal injury. Incidence rates were calculated per 100,000 inhabitants (data from National Statistics Institute) and stratified by sex and age group. Trends, in terms of Annual Percent Change (APC), were assessed using Poisson Regression with discharge year as the independent variable. Hip fracture continues to be the most important injury type in older people. Thoracic fractures and TBI internal injuries are more common in men, while fractures in the upper extremities are more common in women. All injuries increased in frequency with age, except lower leg and ankle fractures, which decreased. While a secular decreasing trend in hip fracture was noted, the incidences of fractures of the shoulder and upper arm, forearm and elbow, and lower leg and ankle, as well as of TBI type 1 internal injuries have increased steadily. Although hip fracture continue to be the most common type of injury in older people, this study has allowed identifying other types of injury that are becoming increasingly common. These trends are driving paradigm changes in the burden of injuries requiring

  7. Assessing local resources and culture before instituting quality improvement projects.

    Science.gov (United States)

    Hawkins, C Matthew

    2014-12-01

    The planning phases of quality improvement projects are commonly overlooked. Disorganized planning and implementation can escalate chaos, intensify resistance to change, and increase the likelihood of failure. Two important steps in the planning phase are (1) assessing local resources available to aid in the quality improvement project and (2) evaluating the culture in which the desired change is to be implemented. Assessing local resources includes identifying and engaging key stakeholders and evaluating if appropriate expertise is available for the scope of the project. This process also involves engaging informaticists and gathering available IT tools to plan and automate (to the extent possible) the data-gathering, analysis, and feedback steps. Culture in a department is influenced by the ability and willingness to manage resistance to change, build consensus, span boundaries between stakeholders, and become a learning organization. Allotting appropriate time to perform these preparatory steps will increase the odds of successfully performing a quality improvement project and implementing change. Copyright © 2014 American College of Radiology. Published by Elsevier Inc. All rights reserved.

  8. Improving the quality of nursing documentation: An action research project

    Directory of Open Access Journals (Sweden)

    Elisha M. Okaisu

    2014-10-01

    Full Text Available Background: Documentation is an important function of professional nursing practise. In spite of numerous improvement efforts globally, inadequate documentation continues to be reported as nurse authors investigate barriers and challenges. Objectives: The project aimed to improve nurses’ documentation of their patient assessments at the CURE Children’s Hospital of Uganda in order to enhance the quality of nursing practise. Method: An action research methodology, using repeated cycles of planning, intervention, reflection and modification, was used to establish best practise approaches in this context for improving nurses’ efficacy in documenting assessments in the patient record. The researchers gathered data from chart audits, literature reviews and key informant interviews. Through analysis and critical reflection, these data informed three cycles of systems and practise modifications to improve the quality of documentation. Results: The initial cycle revealed that staff training alone was insufficient to achievethe project goal. To achieve improved documentation, broader changes were necessary, including building a critical mass of competent staff, redesigned orientation and continuing education, documentation form redesign, changes in nurse skill mix, and continuous leadership support. Conclusion: Improving nursing documentation involved complex challenges in this setting and demanded multiple approaches. Evidence-based practise was the foundation of changes in systems required to produce visible improvement in practise. The involved role of leadership in these efforts was very important.

  9. Risk Management Improvement of Engineering Projects in Woodworking Industry

    Directory of Open Access Journals (Sweden)

    Simona Bartkutė

    2014-02-01

    Full Text Available Risk is a complex phenomenon that has physical, monetary, cultural and social dimensions. Every company wants tosave money, time, increase quality, optimise manufacturing, but each factor may involve different risks with different influenceto company, its reputation. The aim of the research is to find better risk management improvement decisions, using techniquesthat could help to reduce risk impact in wood-based nonstandard production with shorter project time, smoother design process,lower costs, better project coordination, increased ability to manage problems, technical solutions.

  10. Trochanteric osteotomy in total hip replacement for congenital hip disease.

    Science.gov (United States)

    Hartofilakidis, G; Babis, G C; Georgiades, G; Kourlaba, G

    2011-05-01

    We studied the effect of trochanteric osteotomy in 192 total hip replacements in 140 patients with congenital hip disease. There was bony union in 158 hips (82%), fibrous union in 29 (15%) and nonunion in five (3%). The rate of union had a statistically significant relationship with the position of reattachment of the trochanter, which depended greatly on the pre-operative diagnosis. The pre-operative Trendelenburg gait substantially improved in all three disease types (dysplasia, low and high dislocation) and all four categories of reattachment position. A persistent Trendelenburg gait post-operatively was noticed mostly in patients with defective union (fibrous or nonunion). Acetabular and femoral loosening had a statistically significant relationship with defective union and the position of reattachment of the trochanter. These results suggest that the complications of trochanteric osteotomy in total hip replacement for patients with congenital hip disease are less important than the benefits of this surgical approach.

  11. Effectiveness of an innovative hip energy storage walking orthosis for improving paraplegic walking: A pilot randomized controlled study.

    Science.gov (United States)

    Yang, Mingliang; Li, Jianjun; Guan, Xinyu; Gao, Lianjun; Gao, Feng; Du, Liangjie; Zhao, Hongmei; Yang, Degang; Yu, Yan; Wang, Qimin; Wang, Rencheng; Ji, Linhong

    2017-09-01

    The high energy cost of paraplegic walking using a reciprocating gait orthosis (RGO) is attributed to limited hip motion and excessive upper limb loading for support. To address the limitation, we designed the hip energy storage walking orthosis (HESWO) which uses a spring assembly on the pelvic shell to store energy from the movements of the healthy upper limbs and flexion-extension of the lumbar spine and hip and returns this energy to lift the pelvis and lower limb to assist with the swing and stance components of a stride. Our aim was to evaluate gait and energy cost indices for the HESWO compared to the RGO in patients with paraplegia. The cross-over design was used in the pilot study. Twelve patients with a complete T4-L5 chronic spinal cord injury underwent gait training using the HESWO and RGO. Gait performance (continuous walking distance, as well as the maximum and comfortable walking speeds) and energy expenditure (at a walking speed of 3.3m/min on a treadmill) were measured at the end of the 4-week training session. Compared to the RGO, the HESWO increased continuous walking distance by 24.7% (Penergy expenditure by 13.9% (P<0.05). Our preliminary results provide support for the use of the HESWO as an alternative support for paraplegic walking. Copyright © 2017. Published by Elsevier B.V.

  12. Improving 6061-Al Grain Growth and Penetration across HIP-Bonded Clad Interfaces in Monolithic Fuel Plates: Initial Studies

    Energy Technology Data Exchange (ETDEWEB)

    Hackenberg, Robert E. [Los Alamos National Lab. (LANL), Los Alamos, NM (United States); McCabe, Rodney J. [Los Alamos National Lab. (LANL), Los Alamos, NM (United States); Montalvo, Joel D. [Los Alamos National Lab. (LANL), Los Alamos, NM (United States); Clarke, Kester D. [Los Alamos National Lab. (LANL), Los Alamos, NM (United States); Dvornak, Matthew J. [Los Alamos National Lab. (LANL), Los Alamos, NM (United States); Edwards, Randall L. [Los Alamos National Lab. (LANL), Los Alamos, NM (United States); Crapps, Justin M. [Los Alamos National Lab. (LANL), Los Alamos, NM (United States); Trujillo, R. Ralph [Los Alamos National Lab. (LANL), Los Alamos, NM (United States); Aikin, Beverly [Los Alamos National Lab. (LANL), Los Alamos, NM (United States); Vargas, Victor D. [Los Alamos National Lab. (LANL), Los Alamos, NM (United States); Hollis, Kendall J. [Los Alamos National Lab. (LANL), Los Alamos, NM (United States); Lienert, Thomas J. [Los Alamos National Lab. (LANL), Los Alamos, NM (United States); Forsyth, Robert T. [Los Alamos National Lab. (LANL), Los Alamos, NM (United States); Harada, Kiichi L. [Los Alamos National Lab. (LANL), Los Alamos, NM (United States)

    2013-05-06

    Grain penetration across aluminum-aluminum cladding interfaces in research reactor fuel plates is desirable and was obtained by a legacy roll-bonding process, which attained 20-80% grain penetration. Significant grain penetration in monolithic fuel plates produced by Hot Isostatic Press (HIP) fabrication processing is equally desirable but has yet to be attained. The goal of this study was to modify the 6061-Al in such a way as to promote a much greater extent of crossinterface grain penetration in monolithic fuel plates fabricated by the HIP process. This study documents the outcomes of several strategies attempted to attain this goal. The grain response was characterized using light optical microscopy (LOM) electron backscatter diffraction (EBSD) as a function of these prospective process modifications done to the aluminum prior to the HIP cycle. The strategies included (1) adding macroscopic gaps in the sandwiches to enhance Al flow, (2) adding engineering asperities to enhance Al flow, (3) adding stored energy (cold work), and (4) alternative cleaning and coating. Additionally, two aqueous cleaning methods were compared as baseline control conditions. The results of the preliminary scoping studies in all the categories are presented. In general, none of these approaches were able to obtain >10% grain penetration. Recommended future work includes further development of macroscopic grooving, transferred-arc cleaning, and combinations of these with one another and with other processes.

  13. Nursing intervention by telephone interviews of patients aged over 65 years after total hip replacement improves health status: a randomised clinical trial Nursing intervention by telephone interviews of patients aged over 65 years after total hip replacement improves health status: a randomised

    DEFF Research Database (Denmark)

    Hørdam, Britta

    2010-01-01

    Nursing intervention by telephone interviews of patients aged over 65 years after total hip replacement improves health status: a randomised clinical trial Objective: We hypothesised that all areas of health status after total hip replacement could be improved in patients aged over 65 years...... and over by using telephone support and counselling 2 and 10 weeks after surgery compared with a control group receiving conventional care and treatment. Design: A randomised clinical trial focusing on patients' health status by using short-form 36 at 4 weeks preoperatively and 3 and 9 months...... postoperatively was carried out. Sample: 180 patients aged 65 years and over were randomised 4 weeks preoperatively to either control or intervention groups. Measurements: both groups received conventional surgical treatment, but the intervention group was interviewed by telephone 2 and 10 weeks after surgery...

  14. Hip Replacement

    Science.gov (United States)

    ... The most common cause of damage is osteoarthritis. Osteoarthritis causes pain, swelling, and reduced motion in your joints. It can interfere with your daily activities. If other treatments such as physical therapy, pain medicines, and exercise haven't helped, hip ...

  15. Recommendations for improvements to program and project management

    Energy Technology Data Exchange (ETDEWEB)

    1994-01-01

    Oak Ridge National Laboratory (ORNL) has operated with a balanced matrix organization for over sixteen years. Much of the work at the Laboratory is accomplished with good customer satisfaction through programs, projects, and matrix management. During the past several years concerns about program and project management at ORNL have been expressed by both the Department of Energy and ORNL staff. In May 1993 the ORNL Division/Program/Office Directors Caucus chartered a ``fox team`` to identity and to recommend improvements to matrix management that would lead to resolution of these concerns. Nine experienced ORNL staff members served on this Matrix Management Upgrade Solutions Team (MMUST). The MMUST adopted a four-phase approach in which they first gathered information and then developed and proposed recommended actions. In the fourth phase the team was available to support implementation of the recommendations. They began work in June 1993, gathering and evaluating information in biweekly meetings for six months. Recommendations developed in October and November 1993 were presented to ORNL management in December. The MMUST issued three principal recommendations based on their evaluation of the information gathered. They are: Renew and enhance the ORNL management commitment to matrix management, program managers, and project managers; Implement actions to ensure career path parity between the program/project manager family of positions and the technical line manager family of positions across all directorates and divisions; and Clarify and document program/project manager roles, responsibilities, and authorities.

  16. Housing improvement projects in Indonesia: responding to local demand.

    Science.gov (United States)

    Josodipoero, R I

    2003-06-01

    For more than three decades, environmental health programmes in Indonesia have emphasized prevention and treatment of the high incidence of disease among villagers. One of the main causes of disease is the unhygienic conditions of typical rural houses - two-room constructions with dirt floors and walls of lightly fired bricks or woven bamboo skins. While most houses have few or no windows, the occupants frequently cook, eat, sleep and even keep animals in a single room. The main objective of the housing improvement programme was to improve air circulation and introduce more sunlight to kill bacteria, avoid dampness and eliminate smoke from cooking. The programme encourages villagers to construct a permanent floor, enlarge existing windows or insert new windows for good ventilation. This presentation will share the 'success stories' of housing improvement projects in Indonesia that adopted demand-responsive approaches instead of the conventional 'supply approach'. Through exercises like Wealth Classification and Social Mapping, a demand-responsive approach lets the community decide who is eligible for assistance, resulting in higher participation and accurate information on community demand and on materials needed. In addition to the successes, the failures will be discussed at field level. This presentation will discuss the lessons learned from: the World Bank-funded Kalisemut Case Study; government's Family Welfare Movement; Plan International's project in Yogyakarta, and AusAID-funded Sustainable Development through Community Participation Project in Lombok.

  17. Rare variant associations with waist-to-hip ratio in European-American and African-American women from the NHLBI-Exome Sequencing Project.

    Science.gov (United States)

    Kan, Mengyuan; Auer, Paul L; Wang, Gao T; Bucasas, Kristine L; Hooker, Stanley; Rodriguez, Alejandra; Li, Biao; Ellis, Jaclyn; Adrienne Cupples, L; Ida Chen, Yii-Der; Dupuis, Josée; Fox, Caroline S; Gross, Myron D; Smith, Joshua D; Heard-Costa, Nancy; Meigs, James B; Pankow, James S; Rotter, Jerome I; Siscovick, David; Wilson, James G; Shendure, Jay; Jackson, Rebecca; Peters, Ulrike; Zhong, Hua; Lin, Danyu; Hsu, Li; Franceschini, Nora; Carlson, Chris; Abecasis, Goncalo; Gabriel, Stacey; Bamshad, Michael J; Altshuler, David; Nickerson, Deborah A; North, Kari E; Lange, Leslie A; Reiner, Alexander P; Leal, Suzanne M

    2016-08-01

    Waist-to-hip ratio (WHR), a relative comparison of waist and hip circumferences, is an easily accessible measurement of body fat distribution, in particular central abdominal fat. A high WHR indicates more intra-abdominal fat deposition and is an established risk factor for cardiovascular disease and type 2 diabetes. Recent genome-wide association studies have identified numerous common genetic loci influencing WHR, but the contributions of rare variants have not been previously reported. We investigated rare variant associations with WHR in 1510 European-American and 1186 African-American women from the National Heart, Lung, and Blood Institute-Exome Sequencing Project. Association analysis was performed on the gene level using several rare variant association methods. The strongest association was observed for rare variants in IKBKB (P=4.0 × 10(-8)) in European-Americans, where rare variants in this gene are predicted to decrease WHRs. The activation of the IKBKB gene is involved in inflammatory processes and insulin resistance, which may affect normal food intake and body weight and shape. Meanwhile, aggregation of rare variants in COBLL1, previously found to harbor common variants associated with WHR and fasting insulin, were nominally associated (P=2.23 × 10(-4)) with higher WHR in European-Americans. However, these significant results are not shared between African-Americans and European-Americans that may be due to differences in the allelic architecture of the two populations and the small sample sizes. Our study indicates that the combined effect of rare variants contribute to the inter-individual variation in fat distribution through the regulation of insulin response.

  18. 75 FR 47348 - Open Meeting of Taxpayer Advocacy Panel Notice Improvement Project Committee

    Science.gov (United States)

    2010-08-05

    ... Internal Revenue Service Open Meeting of Taxpayer Advocacy Panel Notice Improvement Project Committee... the Taxpayer Advocacy Panel Notice Improvement Project Committee will be conducted. The Taxpayer Advocacy Panel is soliciting public comments, ideas and suggestions on improving customer service at...

  19. 76 FR 6190 - Open Meeting of Taxpayer Advocacy Panel Notice Improvement Project Committee

    Science.gov (United States)

    2011-02-03

    ... Internal Revenue Service Open Meeting of Taxpayer Advocacy Panel Notice Improvement Project Committee... the Taxpayer Advocacy Panel Notice Improvement Project Committee will be conducted. The Taxpayer Advocacy Panel is soliciting public comments, ideas and suggestions on improving customer service at...

  20. 76 FR 56879 - Open Meeting of Taxpayer Advocacy Panel Notice Improvement Project Committee

    Science.gov (United States)

    2011-09-14

    ... Internal Revenue Service Open Meeting of Taxpayer Advocacy Panel Notice Improvement Project Committee... the Taxpayer Advocacy Panel Notice Improvement Project Committee will be conducted. The Taxpayer Advocacy Panel is soliciting public comments, ideas and suggestions on improving customer service at...

  1. 76 FR 10941 - Open Meeting of Taxpayer Advocacy Panel Notice Improvement Project Committee

    Science.gov (United States)

    2011-02-28

    ... Internal Revenue Service Open Meeting of Taxpayer Advocacy Panel Notice Improvement Project Committee... the Taxpayer Advocacy Panel Notice Improvement Project Committee will be conducted. The Taxpayer Advocacy Panel is soliciting public comments, ideas and suggestions on improving customer service at...

  2. 75 FR 10864 - Open meeting of Taxpayer Advocacy Panel Notice Improvement Project Committee

    Science.gov (United States)

    2010-03-09

    ... Internal Revenue Service Open meeting of Taxpayer Advocacy Panel Notice Improvement Project Committee... the Taxpayer Advocacy Panel Notice Improvement Project Committee will be conducted. The Taxpayer Advocacy Panel is soliciting public comments, ideas and suggestions on improving customer service at...

  3. 75 FR 4140 - Open Meeting of Taxpayer Advocacy Panel Notice Improvement Project Committee

    Science.gov (United States)

    2010-01-26

    ... Internal Revenue Service Open Meeting of Taxpayer Advocacy Panel Notice Improvement Project Committee... the Taxpayer Advocacy Panel Notice Improvement Project Committee will be conducted. The Taxpayer Advocacy Panel is soliciting public comments, ideas and suggestions on improving customer service at...

  4. 76 FR 32021 - Open Meeting of Taxpayer Advocacy Panel Notice Improvement Project Committee

    Science.gov (United States)

    2011-06-02

    ... Internal Revenue Service Open Meeting of Taxpayer Advocacy Panel Notice Improvement Project Committee... the Taxpayer Advocacy Panel Notice Improvement Project Committee will be conducted. The Taxpayer Advocacy Panel is soliciting public comments, ideas and suggestions on improving customer service at...

  5. 75 FR 55404 - Open Meeting of Taxpayer Advocacy Panel Notice Improvement Project Committee

    Science.gov (United States)

    2010-09-10

    ... Internal Revenue Service Open Meeting of Taxpayer Advocacy Panel Notice Improvement Project Committee... the Taxpayer Advocacy Panel Notice Improvement Project Committee will be conducted. The Taxpayer Advocacy Panel is soliciting public comments, ideas and suggestions on improving customer service at...

  6. 75 FR 7540 - Open Meeting of Taxpayer Advocacy Panel Notice Improvement Project Committee

    Science.gov (United States)

    2010-02-19

    ... Internal Revenue Service Open Meeting of Taxpayer Advocacy Panel Notice Improvement Project Committee... the Taxpayer Advocacy Panel Notice Improvement Project Committee will be conducted. The Taxpayer Advocacy Panel is soliciting public comments, ideas and suggestions on improving customer service at...

  7. 75 FR 39333 - Open Meeting of Taxpayer Advocacy Panel Notice Improvement Project Committee

    Science.gov (United States)

    2010-07-08

    ... Internal Revenue Service Open Meeting of Taxpayer Advocacy Panel Notice Improvement Project Committee... the Taxpayer Advocacy Panel Notice Improvement Project Committee will be conducted. The Taxpayer Advocacy Panel is soliciting public comments, ideas and suggestions on improving customer service at...

  8. 76 FR 17993 - Open Meeting of Taxpayer Advocacy Panel Notice Improvement Project Committee

    Science.gov (United States)

    2011-03-31

    ... Internal Revenue Service Open Meeting of Taxpayer Advocacy Panel Notice Improvement Project Committee... the Taxpayer Advocacy Panel Notice Improvement Project Committee will be conducted. The Taxpayer Advocacy Panel is soliciting public comments, ideas and suggestions on improving customer service at...

  9. 75 FR 33893 - Open Meeting of Taxpayer Advocacy Panel Notice Improvement Project Committee

    Science.gov (United States)

    2010-06-15

    ... Internal Revenue Service Open Meeting of Taxpayer Advocacy Panel Notice Improvement Project Committee... the Taxpayer Advocacy Panel Notice Improvement Project Committee will be conducted. The Taxpayer Advocacy Panel is soliciting public comments, ideas and suggestions on improving customer service at...

  10. 76 FR 63717 - Open Meeting of Taxpayer Advocacy Panel Notice Improvement Project Committee

    Science.gov (United States)

    2011-10-13

    ... Internal Revenue Service Open Meeting of Taxpayer Advocacy Panel Notice Improvement Project Committee... the Taxpayer Advocacy Panel Notice Improvement Project Committee will be conducted. The Taxpayer Advocacy Panel is soliciting public comments, ideas and suggestions on improving customer service at...

  11. 76 FR 37196 - Open Meeting of Taxpayer Advocacy Panel Notice Improvement Project Committee

    Science.gov (United States)

    2011-06-24

    ... Internal Revenue Service Open Meeting of Taxpayer Advocacy Panel Notice Improvement Project Committee... the Taxpayer Advocacy Panel Notice Improvement Project Committee will be conducted. The Taxpayer Advocacy Panel is soliciting public comments, ideas and suggestions on improving customer service at...

  12. 75 FR 62629 - Open Meeting of Taxpayer Advocacy Panel Notice Improvement Project Committee

    Science.gov (United States)

    2010-10-12

    ... Internal Revenue Service Open Meeting of Taxpayer Advocacy Panel Notice Improvement Project Committee... the Taxpayer Advocacy Panel Notice Improvement Project Committee will be conducted. The Taxpayer Advocacy Panel is soliciting public comments, ideas and suggestions on improving customer service at...

  13. 76 FR 45005 - Open Meeting of Taxpayer Advocacy Panel Notice Improvement Project Committee

    Science.gov (United States)

    2011-07-27

    ... Internal Revenue Service Open Meeting of Taxpayer Advocacy Panel Notice Improvement Project Committee... the Taxpayer Advocacy Panel Notice Improvement Project Committee will be conducted. The Taxpayer Advocacy Panel is soliciting public comments, ideas and suggestions on improving customer service at...

  14. 76 FR 2194 - Open Meeting of Taxpayer Advocacy Panel Notice Improvement Project Committee

    Science.gov (United States)

    2011-01-12

    ... Internal Revenue Service Open Meeting of Taxpayer Advocacy Panel Notice Improvement Project Committee... the Taxpayer Advocacy Panel Notice Improvement Project Committee will be conducted. The Taxpayer Advocacy Panel is soliciting public comments, ideas and suggestions on improving customer service at...

  15. Has the Reform of the Japanese Healthcare Provision System Improved the Value in Healthcare? A Cost-Consequence Analysis of Organized Care for Hip Fracture Patients.

    Science.gov (United States)

    Fukuda, Haruhisa; Shimizu, Sayuri; Ishizaki, Tatsuro

    2015-01-01

    To assess the value of organized care by comparing the clinical outcomes and healthcare expenditure between the conventional Japanese "integrated care across specialties within one hospital" mode of providing healthcare and the prospective approach of "organized care across separate facilities within a community". Retrospective cohort study. Two groups of hospitals were categorized according to healthcare delivery approach: the first group included 3 hospitals autonomously providing integrated care across specialties, and the second group included 4 acute care hospitals and 7 rehabilitative care hospitals providing organized care across separate facilities. Patients aged 65 years and above who had undergone hip fracture surgery. Regression models adjusting for patient characteristics and clinical variables were used to investigate the impact of organized care on the improvements to the mobility capability of patients before and after hospitalization and the differences in healthcare resource utilization. The sample for analysis included 837 hip fracture surgery cases. The proportion of patients with either unchanged or improved mobility capability was not statistically associated with the healthcare delivery approaches. Total adjusted mean healthcare expenditure for integrated care and organized care were US$28,360 (95% confidence interval: 27,787-28,972) and US$21,951 (21,511-22,420), respectively, indicating an average increase of US$6,409 in organized care. Our cost-consequence analysis underscores the need to further investigate the actual contribution of organized care to the provision of efficient and high-quality healthcare.

  16. In the queue for total joint replacement: patients' perspectives on waiting times. Ontario Hip and Knee Replacement Project Team.

    Science.gov (United States)

    Llewellyn-Thomas, H A; Arshinoff, R; Bell, M; Williams, J I; Naylor, C D

    1998-02-01

    We assessed patients on the waiting lists of a purposive sample of orthopaedic surgeons in Ontario, Canada, to determine patients' attitudes towards time waiting for hip or knee replacement. We focused on 148 patients who did not have a definite operative date, obtaining complete information on 124 (84%). Symptom severity was assessed with the Western Ontario/McMaster Osteoarthritis Index and a disease-specific standard gamble was used to elicit patients' overall utility for their arthritic state. Next, in a trade-off task, patients considered a hypothetical choice between a 1-month wait for a surgeon who could provide a 2% risk of post-operative mortality, or a 6-month wait for joint replacement with a 1% risk of post-operative mortality. Waiting times were then shifted systematically until the patient abandoned his/her initial choice, generating a conditional maximal acceptable wait time. Patients were divided in their attitudes, with 57% initially choosing a 6-month wait with a 1% mortality risk. The overall distribution of conditional maximum acceptable wait time scores ranged from 1 to 26 months, with a median of 7 months. Utility values were independently but weakly associated with patients' tolerance of waiting times (adjusted R-square = 0.059, P = 0.004). After splitting the sample along the median into subgroups with a relatively 'low' and 'high' tolerance for waiting, the subgroup with the apparently lower tolerance for waiting reported lower utility scores (z = 2.951; P = 0.004) and shorter times since their surgeon first advised them of the need for surgery (z = 3.014; P = 0.003). These results suggest that, in the establishment and monitoring of a queue management system for quality-of-life-enhancing surgery, patients' own perceptions of their overall symptomatic burden and ability to tolerate delayed relief should be considered along with information derived from clinical judgements and pre-weighted health status instruments.

  17. Heritage plaza parking lots improvement project- Solar PV installation

    Energy Technology Data Exchange (ETDEWEB)

    Hooks, Todd [Agua Caliente Indian Reservation, Palm Springs, CA (United States)

    2017-03-31

    The Agua Caliente Band of Cahuilla Indians (ACBCI or the “Tribe”) installed a 79.95 kW solar photovoltaic (PV) system to offset the energy usage costs of the Tribal Education and Family Services offices located at the Tribe's Heritage Plaza office building, 90I Tahquitz Way, Palm Springs, CA, 92262 (the "Project"). The installation of the Solar PV system was part of the larger Heritage Plaza Parking Lot Improvements Project and mounted on the two southern carport shade structures. The solar PV system will offset 99% of the approximately 115,000 kWh in electricity delivered annually by Southern California Edison (SCE) to the Tribal Education and Family Services offices at Heritage Plaza, reducing their annual energy costs from approximately $22,000 annually to approximately $200. The total cost of the proposed solar PV system is $240,000.

  18. Improving Climate Projections by Understanding How Cloud Phase affects Radiation

    Science.gov (United States)

    Cesana, Gregory; Storelvmo, Trude

    2017-01-01

    Whether a cloud is predominantly water or ice strongly influences interactions between clouds and radiation coming down from the Sun or up from the Earth. Being able to simulate cloud phase transitions accurately in climate models based on observational data sets is critical in order to improve confidence in climate projections, because this uncertainty contributes greatly to the overall uncertainty associated with cloud-climate feedbacks. Ultimately, it translates into uncertainties in Earth's sensitivity to higher CO2 levels. While a lot of effort has recently been made toward constraining cloud phase in climate models, more remains to be done to document the radiative properties of clouds according to their phase. Here we discuss the added value of a new satellite data set that advances the field by providing estimates of the cloud radiative effect as a function of cloud phase and the implications for climate projections.

  19. Establishing a portfolio of quality-improvement projects in pediatric surgery through advanced improvement leadership systems.

    Science.gov (United States)

    Gerrein, Betsy T; Williams, Christina E; Von Allmen, Daniel

    2013-01-01

    Formal quality-improvement (QI) projects require that participants are educated in QI methods to provide them with the capability to carry out successful, meaningful work. However, orchestrating a portfolio of projects that addresses the strategic mission of the institution requires an extension of basic QI training to provide the division or business unit with the capacity to successfully develop and manage the portfolio. Advanced Improvement Leadership Systems is a program to help units create a meaningful portfolio. This program, used by the Division of Pediatric General and Thoracic Surgery at Cincinnati Children's Hospital Medical Center, helped establish a portfolio of targeted QI projects designed to achieve outstanding outcomes at competitive costs in multiple clinical areas aligned with the institution's strategic goals (improve disease-based outcomes, patient safety, flow, and patient and family experience). These objectives are addressed in an institutional strategic plan built around 5 core areas: Safety, Productivity, Care Coordination and Outcomes, Patient and Family Experience, and Value. By combining the portfolio of QI projects with improvements in the divisional infrastructure, effective improvement efforts were realized throughout the division. In the 9 months following the program, divisional capability resulted in a 16.5% increase (5.7% to 22.2%) of formally trained staff working on 10 QI teams. Concurrently, a leadership team, designed to coordinate projects, remove barriers, and provide technical support, provided the capacity to pursue this ongoing effort. The Advanced Improvement Leadership Systems program increased the Division's efficiency and effectiveness in pursing the QI mission that is integral at our hospital.

  20. Port Isabel (GIWW) Channel Improvements at the Queen Isabella Causeway. Laguna Madre, Texas, Navigation Improvement Project

    Science.gov (United States)

    2009-09-01

    ER D C/ CH L TR -0 9 -1 3 Port Isabel (GIWW) Channel Improvements at the Queen Isabella Causeway Laguna Madre , Texas, Navigation...Causeway Laguna Madre , Texas, Navigation Improvement Project Timothy W. Shelton, P.E. and Dennis Webb, P.E. Coastal and Hydraulics Laboratory U.S...distribution is unlimited. Prepared for U.S. Army Corps of Engineer District, Galveston Galveston, TX 77550 ERDC/CHL TR-09-13 ii Abstract: Laguna Madre is

  1. Quality improvement project to determine outpatient chemotherapy capacity and improve utilization.

    Science.gov (United States)

    Gruber, Marcia; Smith, Debra; O'Neal, Charnese; Hennessy, Kelli; Therrien, Melissa

    2008-01-01

    Nurses in chemotherapy administration settings are constantly challenged to increase utilization while maintaining patient safety. A performance improvement project was carried out to identify barriers to patient throughput and opportunities to improve utilization while not compromising patient safety. We found ways to safely increase the number of patients from 92 to 108 per day; however, patient tardiness and staff vacancies had a negative impact on patient wait times and nursing staff overtime.

  2. Quality Improvement Project to Improve Patient Satisfaction With Pain Management: Using Human-Centered Design.

    Science.gov (United States)

    Trail-Mahan, Tracy; Heisler, Scott; Katica, Mary

    2016-01-01

    In this quality improvement project, our health system developed a comprehensive, patient-centered approach to improving inpatient pain management and assessed its impact on patient satisfaction across 21 medical centers. Using human-centered design principles, a bundle of 6 individual and team nursing practices was developed. Patient satisfaction with pain management, as measured by the Hospital Consumer Assessment of Healthcare Providers and Systems pain composite score, increased from the 25th to just under the 75th national percentile.

  3. Quality Improvement Project to Reduce Delayed Vaccinations in Preterm Infants.

    Science.gov (United States)

    Cuna, Alain; Winter, Lindy

    2017-08-01

    Preterm infants are especially vulnerable to infectious diseases. Although vaccinations are a safe and effective measure to protect preterm infants from vaccine-preventable diseases, delays in vaccinations are not uncommon. The goal of this quality improvement project was to improve on time vaccinations of preterm infants hospitalized in the neonatal intensive care unit. The Plan-Do-Study-Act model of quality improvement was adopted to develop, test, and implement interventions aimed at improving timely vaccination of preterm infants. The primary outcome measure of interest was the rate of on time vaccination, which was defined as the proportion of medically eligible preterm infants who received vaccinations within 2 weeks of the recommended schedule. Baseline on time vaccination rate was only 36%. Following several Plan-Do-Study-Act cycles, a steady increase in on time vaccinations of eligible infants was observed, and a new baseline on time vaccination rate of 82% was achieved. Simple interventions implemented within the context of Plan-Do-Study-Act cycles are effective in improving timely vaccinations among preterm infants. Future research that focuses on vaccinations in preterm infants is needed to further reinforce the safety and efficacy of vaccines. Effective methods on how to disseminate and apply this knowledge to practice should also be studied.Video Abstract available at http://links.lww.com/ANC/A27.

  4. Total hip arthroplasty following failed fixation of proximal hip fractures

    Directory of Open Access Journals (Sweden)

    Srivastav Shekhar

    2008-01-01

    Full Text Available Background: Most proximal femoral fractures are successfully treated with internal fixation but a failed surgery can be very distressing for the patient due to pain and disability. For the treating surgeon it can be a challenge to perform salvage operations. The purpose of this study was to evaluate the short-term functional outcome and complications of total hip arthroplasty (THA following failed fixation of proximal hip fracture. Materials and Methods: In a retrospective study, 21 hips in 20 patients (13 females and seven males with complications of operated hip fractures as indicated by either established nonunion or fracture collapse with hardware failure were analysed. Mean age of the patients was 62 years (range 38 years to 85 years. Nine patients were treated for femoral neck fracture, 10 for intertrochanteric (I/T fracture and two for subtrochanteric (S/T fracture of the hip. Uncemented THA was done in 11 cases, cemented THA in eight hip joints and hybrid THA in two patients. Results: The average duration of follow-up was four years (2-13 years. The mean duration of surgery was 125 min and blood loss was 1300 ml. There were three dislocations postoperatively. Two were managed conservatively and one was operated. There was one superficial infection and one deep infection. Only one patient required a walker while four required walking stick for ambulation. The mean Harris Hip score increased from 32 preoperatively to 79 postoperatively at one year interval. Conclusion: Total hip arthroplasty is an effective salvage procedure after failed osteosynthesis of hip fractures. Most patients have good pain relief and functional improvements inspite of technical difficulties and high complication rates than primary arthroplasty.

  5. Quality improvement primer part 1: Preparing for a quality improvement project in the emergency department.

    Science.gov (United States)

    Chartier, Lucas B; Cheng, Amy H Y; Stang, Antonia S; Vaillancourt, Samuel

    2017-07-31

    Emergency medicine (EM) providers work in a fast-paced and often hectic environment that has a high risk for patient safety incidents and gaps in the quality of care. These challenges have resulted in opportunities for frontline EM providers to play a role in quality improvement (QI) projects. QI has developed into a mature field with methodologies that can dramatically improve the odds of having a successful project with a sustainable impact. However, this expertise is not yet commonly taught during professional training. In this first of three articles meant as a QI primer for EM clinicians, we will introduce QI methodology and strategic planning using a fictional case study as an example. We will review how to identify a QI problem, define components of an effective problem statement, and identify stakeholders and core change team members. We will also describe three techniques used to perform root cause analyses-Ishikawa diagrams, Pareto charts and process mapping-and how they relate to preparing for a QI project. The next two papers in this series will focus on the execution of the QI project itself using rapid-cycle testing and on the evaluation and sustainability of QI projects.

  6. Can fire atlas data improve species distribution model projections?

    Science.gov (United States)

    Crimmins, Shawn M; Dobrowski, Solomon Z; Mynsberge, Alison R; Safford, Hugh D

    2014-07-01

    Correlative species distribution models (SDMs) are widely used in studies of climate change impacts, yet are often criticized for failing to incorporate disturbance processes that can influence species distributions. Here we use two temporally independent data sets of vascular plant distributions, climate data, and fire atlas data to examine the influence of disturbance history on SDM projection accuracy through time in the mountain ranges of California, USA. We used hierarchical partitioning to examine the influence of fire occurrence on the distribution of 144 vascular plant species and built a suite of SDMs to examine how the inclusion of fire-related predictors (fire occurrence and departure from historical fire return intervals) affects SDM projection accuracy. Fire occurrence provided the least explanatory power among predictor variables for predicting species' distributions, but provided improved explanatory power for species whose regeneration is tied closely to fire. A measure of the departure from historic fire return interval had greater explanatory power for calibrating modern SDMs than fire occurrence. This variable did not improve internal model accuracy for most species, although it did provide marginal improvement to models for species adapted to high-frequency fire regimes. Fire occurrence and fire return interval departure were strongly related to the climatic covariates used in SDM development, suggesting that improvements in model accuracy may not be expected due to limited additional explanatory power. Our results suggest that the inclusion of coarse-scale measures of disturbance in SDMs may not be necessary to predict species distributions under climate change, particularly for disturbance processes that are largely mediated by climate.

  7. Improving Rural Geriatric Care Through Education: A Scalable, Collaborative Project.

    Science.gov (United States)

    Buck, Harleah G; Kolanowski, Ann; Fick, Donna; Baronner, Lawrence

    2016-07-01

    HOW TO OBTAIN CONTACT HOURS BY READING THIS ISSUE Instructions: 1.2 contact hours will be awarded by Villanova University College of Nursing upon successful completion of this activity. A contact hour is a unit of measurement that denotes 60 minutes of an organized learning activity. This is a learner-based activity. Villanova University College of Nursing does not require submission of your answers to the quiz. A contact hour certificate will be awarded after you register, pay the registration fee, and complete the evaluation form online at http://goo.gl/gMfXaf. In order to obtain contact hours you must: 1. Read the article, "Improving Rural Geriatric Care Through Education: A Scalable, Collaborative Project," found on pages 306-313, carefully noting any tables and other illustrative materials that are included to enhance your knowledge and understanding of the content. Be sure to keep track of the amount of time (number of minutes) you spend reading the article and completing the quiz. 2. Read and answer each question on the quiz. After completing all of the questions, compare your answers to those provided within this issue. If you have incorrect answers, return to the article for further study. 3. Go to the Villanova website to register for contact hour credit. You will be asked to provide your name, contact information, and a VISA, MasterCard, or Discover card number for payment of the $20.00 fee. Once you complete the online evaluation, a certificate will be automatically generated. This activity is valid for continuing education credit until June 30, 2019. CONTACT HOURS This activity is co-provided by Villanova University College of Nursing and SLACK Incorporated. Villanova University College of Nursing is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation. OBJECTIVES Describe the unique nursing challenges that occur in caring for older adults in rural areas. Discuss the

  8. Improving Environmental Literacy through GO3 Citizen Science Project

    Science.gov (United States)

    Wilkening, B.

    2011-12-01

    In the Global Ozone (GO3) Project students measure ground-level ozone on a continuous basis and upload their results to a global network used by atmospheric scientists and schools. Students learn important concepts such as chemical measurement methods; instrumentation; calibration; data acquisition using computers; data quality; statistics; data analysis and graphing; posting of data to the web; the chemistry of air pollution; stratospheric ozone depletion and global climate change. Students collaborate with researchers and other students globally in the GO3 network. Wilson K-8 School is located in a suburban area in Pima County, Arizona. Throughout the year we receive high ozone alert days. Prior to joining the GO3 project, my students were unaware of air pollution alerts, risks and causes. In the past when Pima County issued alerts to the school, they were posted on signs around the school. No explanation was provided to the students and the signs were often left up for days. This discounted the potential health effects of the situation, resulting in the alerts effectively being ignored. The GO3 project is transforming both my students and our school community. Now my students are: Performing science research Utilizing technology and increasing their skills Collaborating in a responsible manner on the global GO3 social network Communicating their work to the community Issuing their own ozone alerts to their school Advocating for actions that will improve air quality My students participation in this citizen science project is creating a more cognizant and active community in regards to air pollution.

  9. Improving patient care through student leadership in team quality improvement projects.

    Science.gov (United States)

    Tschannen, Dana; Aebersold, Michelle; Kocan, Mary Jo; Lundy, Francene; Potempa, Kathleen

    2015-01-01

    In partnership with a major medical center, senior-level nursing students completed a root cause analysis and implementation plan to address a unit-specific quality issue. To evaluate the project, unit leaders were asked their perceptions of the value of the projects and impact on patient care, as well as to provide exemplars depicting how the student root cause analysis work resulted in improved patient outcome and/or unit processes. Liaisons noted benefits of having an RCA team, with positive impact on patient outcomes and care processes.

  10. [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.

  11. Can a disease-specific education program augment self-management skills and improve Health-Related Quality of Life in people with hip or knee osteoarthritis?

    Directory of Open Access Journals (Sweden)

    Buchbinder Rachelle

    2006-11-01

    using the Assessment of Quality of Life instrument. Secondary outcome measures include the Health Education Impact Questionnaire, Western Ontario and McMaster Universities Osteoarthritis Index (pain subscale and total scores, Kessler Psychological Distress Scale and the Hip and Knee Multi-Attribute Priority Tool. Cost-utility analyses will be undertaken using administrative records and self-report data. A subgroup of 100 participants will undergo qualitative interviews to explore the broader potential impacts of the ASMP. Discussion Using an innovative design combining both quantitative and qualitative components, this project will provide high quality data to facilitate evidence-based recommendations regarding the ASMP.

  12. Conversion of hip arthrodesis to total hip arthroplasty.

    Science.gov (United States)

    Panagiotopoulos, K P; Robbins, G M; Masri, B A; Duncan, C P

    2001-01-01

    With the predictably good outcome now found with THA, hip arthrodesis has limited indications today. The procedure still has a role in the case of the young, heavy demand male with an isolated arthritic hip condition, and developments such as the Cobra head plate have considerably improved success rates. However, a long-term hip arthrodesis can have profound effects on a patient's daily function and activities of daily living. In addition, gait pattern is considerably affected as well as other joints such as the lower back, ipsilateral knee, and contralateral hip. Many patients with a hip arthrodesis will eventually require a takedown of the fused hip and conversion to a THA. The primary indications include fusion in malposition, pseudarthrosis, or severe pain in other joints. The surgeon undertaking such a task must be familiar with the arthrodesis techniques that have been used in the past as well as the equipment that may be required to extract the fixation hardware. Clinical assessment with particular attention to leg-length discrepancy, position of the arthrodesis, and function of the abductors is of paramount importance. The surgeon must carefully review preoperative radiographs to plan the procedure. The surgeon must also be aware of the presence of pathology in other joints. After takedown of a hip arthrodesis and conversion to a THA, patients cannot expect the result to equal the success rates of primary THA. Patients generally can expect an improvement in function and mobility. Back pain and ipsilateral knee pain are usually improved postoperatively, but the effect on contralateral hip pain is less predictable. Many patients will continue to show a positive Trendelenburg sign, but further improvement in strength of the hip abductors can be expected with time. Leg-length discrepancy is generally improved substantially after THA. However, a substantial number of patients will require a walking aid postoperatively. Overall, the risk of complications and the

  13. Quality improvement primer part 2: executing a quality improvement project in the emergency department.

    Science.gov (United States)

    Chartier, Lucas B; Stang, Antonia S; Vaillancourt, Samuel; Cheng, Amy H Y

    2017-09-22

    The topics of quality improvement (QI) and patient safety have become important themes in health care in recent years, particularly in the emergency department setting, which is a frequent point of contact with the health care system for patients. In the first of three articles in this series meant as a QI primer for emergency medicine clinicians, we introduced the strategic planning required to develop an effective QI project using a fictional case study as an example. In this second article we continue with our example of improving time to antibiotics for patients with sepsis, and introduce the Model for Improvement. We will review what makes a good aim statement, the various categories of measures that can be tracked during a QI project, and the relative merits and challenges of potential change concepts and ideas. We will also present the Model for Improvement's rapid-cycle change methodology, the Plan-Do-Study-Act (PDSA) cycle. The final article in this series will focus on the evaluation and sustainability of QI projects.

  14. Recovery Act--Class 8 Truck Freight Efficiency Improvement Project

    Energy Technology Data Exchange (ETDEWEB)

    Trucks, Daimler [Daimler Trucks North America Llc, Portland, OR (United States)

    2015-07-26

    Daimler Trucks North America completed a five year, $79.6M project to develop and demonstrate a concept vehicle with at least 50% freight efficiency improvement over a weighted average of several drive cycles relative to a 2009 best-in-class baseline vehicle. DTNA chose a very fuel efficient baseline vehicle, the 2009 Freightliner Cascadia with a DD15 engine, yet successfully demonstrated a 115% freight efficiency improvement. DTNA learned a great deal about the various technologies that were incorporated into Super Truck and those that, through down-selection, were discarded. Some of the technologies competed with each other for efficiency, and notably some of the technologies complemented each other. For example, we found that Super Truck’s improved aerodynamic drag resulted in improved fuel savings from eCoast, relative to a similar vehicle with worse aerodynamic drag. However, some technologies were in direct competition with each other, namely the predictive technologies which use GPS and 3D digital maps to efficiently manage the vehicles kinetic energy through controls and software, versus hybrid which is a much costlier technology that essentially targets the same inefficiency. Furthermore, the benefits of a comprehensive, integrated powertrain/vehicle approach was proven, in which vast improvements in vehicle efficiency (e.g. lower aero drag and driveline losses) enabled engine strategies such as downrating and downspeeding. The joint engine and vehicle developments proved to be a multiplier-effect which resulted in large freight efficiency improvements. Although a large number of technologies made the selection process and were used on the Super Truck demonstrator vehicle, some of the technologies proved not feasible for series production.

  15. Hip flexor strain - aftercare

    Science.gov (United States)

    ... flexor - aftercare; Hip flexor injury - aftercare; Hip flexor tear - aftercare; Iliopsoas strain - aftercare; Strained iliopsoas muscle - aftercare; Torn iliopsoas muscle - aftercare; Psoas strain - aftercare

  16. Improving diabetic foot screening at a primary care clinic: A quality improvement project

    Science.gov (United States)

    Allen, Michelle L.; Gunst, Colette

    2016-01-01

    Background Foot screening is an important part of diabetic care as it prevents significant morbidity, loss of function and mortality from diabetic foot complications. However, foot screening is often neglected. Aim This project was aimed at educating health care workers (HCWs) in a primary health care clinic to increase diabetic foot screening practices. Setting A primary health care clinic in the Western Cape province of South Africa Methods A quality improvement project was conducted. HCWs’ needs were assessed using a questionnaire. This was followed by focus group discussions with the HCWs, which were recorded, transcribed and assessed using a general inductive approach. An intervention was designed based on common themes. Staff members were trained on foot screening and patient information pamphlets and screening tools were made available to all clinic staff. Thirty-two consecutive diabetic patient folders were audited to compare screening in 2013 with that in 2014 after initiation of the quality improvement cycle. Results HCWs’ confidence in conducting foot screening using the diabetic foot assessment questionnaire improved markedly after training. Diabetic foot screening practices increased from 9% in 2013 to 69% in 2014 after the first quality improvement cycle. A strengths, opportunities, aspirations and results (SOAR) analysis showed promise for continuing quality improvement cycles. Conclusion The findings showed a significant improvement in the number of diabetic patients screened. Using strategic planning with appreciative intent based on SOAR, proved to be motivational and can be used in the planning of the next cycle. PMID:27608673

  17. Rehabilitation of patients aged 65 and over after total hip replacement

    DEFF Research Database (Denmark)

    Hørdam, Britta

    The overall aim of this thesis was to investigate improvement in health status of patients aged 65 and over after total hip replacement (THR) as a result of nursing rehabilitation. The projects conssits of three studies, first a description of patients´health status after THR, followed...

  18. Autonomous, Cryogenic Leak Detector for Improving Launch Site Operations Project

    Data.gov (United States)

    National Aeronautics and Space Administration — Spaceports, spacecrafts for planetary missions, future projects on the moon and mars ? they all need to monitor mission critical propellants. This project...

  19. Yakima Habitat Improvement Project Master Plan, Technical Report 2003.

    Energy Technology Data Exchange (ETDEWEB)

    Golder Associates, Inc.

    2003-04-22

    The Yakima Urban Growth Area (UGA) is a developing and growing urban area in south-central Washington. Despite increased development, the Yakima River and its tributaries within the UGA continue to support threatened populations of summer steelhead and bull trout as well as a variety of non-listed salmonid species. In order to provide for the maintenance and recovery of these species, while successfully planning for the continued growth and development within the UGA, the City of Yakima has undertaken the Yakima Habitat Improvement Project. The overall goal of the project is to maintain, preserve, and restore functioning fish and wildlife habitat within and immediately surrounding the Yakima UGA over the long term. Acquisition and protection of the fish and wildlife habitat associated with key properties in the UGA will prevent future subdivision along riparian corridors, reduce further degradation or removal of riparian habitat, and maintain or enhance the long term condition of aquatic habitat. By placing these properties in long-term protection, the threat of development from continued growth in the urban area will be removed. To most effectively implement the multi-year habitat acquisition and protection effort, the City has developed this Master Plan. The Master Plan provides the structure and guidance for future habitat acquisition and restoration activities to be performed within the Yakima Urban Area. The development of this Master Plan also supports several Reasonable and Prudent Alternatives (RPAs) of the NOAA Fisheries 2000 Biological Opinion (BiOp), as well as the Water Investment Action Agenda for the Yakima Basin, local planning efforts, and the Columbia Basin Fish and Wildlife Authority's 2000 Fish and Wildlife Program. This Master Plan also provides the framework for coordination of the Yakima Habitat Improvement Project with other fish and wildlife habitat acquisition and protection activities currently being implemented in the area. As a

  20. Selecting clinical quality improvement projects: getting a bigger return for your investment.

    Science.gov (United States)

    Leininger, C J; Seaman, L H

    2000-02-01

    An urban medical center developed and implemented a process for selecting clinical quality-improvement projects. The process was designed to select projects that would deliver greater returns than had previous projects. The four-step process involved: (1) establishing project selection criteria, (2) identifying potential projects, (3) assigning points and ranking projects, and (4) selecting projects based on rank and available resources. This process won physician commitment and secured administrative support. It identified projects that had unprecedented success in improving clinical outcomes, increasing patient satisfaction, and reducing cost.

  1. Project EDDIE: Improving Big Data skills in the classroom

    Science.gov (United States)

    Soule, D. C.; Bader, N.; Carey, C.; Castendyk, D.; Fuller, R.; Gibson, C.; Gougis, R.; Klug, J.; Meixner, T.; Nave, L. E.; O'Reilly, C.; Richardson, D.; Stomberg, J.

    2015-12-01

    High-frequency sensor-based datasets are driving a paradigm shift in the study of environmental processes. The online availability of high-frequency data creates an opportunity to engage undergraduate students in primary research by using large, long-term, and sensor-based, datasets for science courses. Project EDDIE (Environmental Data-Driven Inquiry & Exploration) is developing flexible classroom activity modules designed to (1) improve quantitative and reasoning skills; (2) develop the ability to engage in scientific discourse and argument; and (3) increase students' engagement in science. A team of interdisciplinary faculty from private and public research universities and undergraduate institutions have developed these modules to meet a series of pedagogical goals that include (1) developing skills required to manipulate large datasets at different scales to conduct inquiry-based investigations; (2) developing students' reasoning about statistical variation; and (3) fostering accurate student conceptions about the nature of environmental science. The modules cover a wide range of topics, including lake physics and metabolism, stream discharge, water quality, soil respiration, seismology, and climate change. Assessment data from questionnaire and recordings collected during the 2014-2015 academic year show that our modules are effective at making students more comfortable analyzing data. Continued development is focused on improving student learning outcomes with statistical concepts like variation, randomness and sampling, and fostering scientific discourse during module engagement. In the coming year, increased sample size will expand our assessment opportunities to comparison groups in upper division courses and allow for evaluation of module-specific conceptual knowledge learned. This project is funded by an NSF TUES grant (NSF DEB 1245707).

  2. THE ARTHRITIS AND MUSCULOSKELETAL QUALITY IMPROVEMENT PROGRAM (AMQUIP: A BREAKTHROUGH SERIES METHODOLOGY PROJECT

    Directory of Open Access Journals (Sweden)

    MASTURA I

    2008-01-01

    Full Text Available The Australian government had funded the National Primary Care Collaborative (NPCC program with funding of $14.6 million over three years. One of the pilots project was the Arthritis and Musculoskeletal Quality Improvement Program (AMQuIP.The study aims to optimize general practitioners (GPs management of patients with osteoarthritis (OA of the hip and knee by identifying gaps between their current practice and best practice. The Breakthrough Series Collaborative methodology with several Plan-Do-Study-Act (PDSA cycles was employed. Participants comprises of 12 GPs/practices from two Victorian Divisions of general Practice (one rural, one metropolitan with 10 patients per GP/practice. GPs/practices attended an orientation and three learning workshops and a videoconference. GPs/practices completed PDSA cycles between workshop and reported results at workshops. GPs/practices reported use of guidelines, change in patient management and change in practice management/systems. All recruited patients completed the SF-12v2 Health Survey and WOMAC OA Index Questionnaire twice. Follow up activities including focus groups and face-to-face interviews were held six months after the final workshop. All GPs/practices used the guidelines/key messages, introduced “new” management strategies to patients, and made positive changes to their practice management/systems. Patient reported positive changes and outcomes. By using a structured methodology and evidence-based guidelines/key messages; GPs can introduce new patient management strategies, and by identifying gaps in practice management systems, positive changes can be achieved.

  3. Improvement treatments and criteria assessing banks the energy efficiency projects

    Directory of Open Access Journals (Sweden)

    Ryzhkova Anna Vladimirovna

    2013-05-01

    Full Text Available Stimulate bank lending to businesses for energy efficiency projects is possible by increasing the accuracy of the valuation the project and the effect of its implementation. The paper presents a sequence of procedures and appropriate assessment criteria for energy efficiency projects, which will increase the chances of success of the investment project and to ensure the financial stability of the bank.

  4. Improving critical care discharge summaries: a collaborative quality improvement project using PDSA.

    Science.gov (United States)

    Goulding, Lucy; Parke, Hannah; Maharaj, Ritesh; Loveridge, Robert; McLoone, Anne; Hadfield, Sophie; Helme, Eloise; Hopkins, Philip; Sandall, Jane

    2015-01-01

    Around 110,000 people spend time in critical care units in England and Wales each year. The transition of care from the intensive care unit to the general ward exposes patients to potential harms from changes in healthcare providers and environment. Nurses working on general wards report anxiety and uncertainty when receiving patients from critical care. An innovative form of enhanced capability critical care outreach called 'iMobile' is being provided at King's College Hospital (KCH). Part of the remit of iMobile is to review patients who have been transferred from critical care to general wards. The iMobile team wished to improve the quality of critical care discharge summaries. A collaborative evidence-based quality improvement project was therefore undertaken by the iMobile team at KCH in conjunction with researchers from King's Improvement Science (KIS). Plan, Do, Study, Act (PDSA) methodology was used. Three PDSA cycles were undertaken. Methods adopted comprised: a scoping literature review to identify relevant guidelines and research evidence to inform all aspects of the quality improvement project; a process mapping exercise; informal focus groups / interviews with staff; patient story-telling work with people who had experienced critical care and subsequent discharge to a general ward; and regular audits of the quality of both medical and nursing critical care discharge summaries. The following behaviour change interventions were adopted, taking into account evidence of effectiveness from published systematic reviews and considering the local context: regular audit and feedback of the quality of discharge summaries, feedback of patient experience, and championing and education delivered by local opinion leaders. The audit results were mixed across the trajectory of the project, demonstrating the difficulty of sustaining positive change. This was particularly important as critical care bed occupancy and through-put fluctuates which then impacts on work

  5. COMPLEX FUNCTIONAL ASSESSMENT OF THE HIP JOINT.

    Directory of Open Access Journals (Sweden)

    Maya S. Krastanova

    2015-09-01

    Full Text Available Introduction: In relation to the study reporting the effects of applying phased complex rehabilitation in patients with total hip arthroplasty, it has been concluded that the everyday clinical practice in Bulgaria does not apply complex examination, giving an objective picture about the extent of functional status of patients with trauma and diseases of the hip. Aim: The main goal of this report is to present a test which incorporates all known and routine research and in which the total number of points determines the functional status of patients with trauma and diseases of the hip. Material and Methods: Based on the Hip dysfunction and Osteoarthritis Outcome Score, the Harris Hip Score modified test, scale D’Aubigne and Postel and Iowa’s test for complex functional evaluation of the hip joint, we have developed a test including information about the degree of pain; goniometry and manual muscle testing of the hip; locomotor test – type of gait and adjuvants; test for Daily Activities of Life. The test has been developed on the basis of expert assessment by doctors and physiotherapists of the proposed indicators for evaluation and determination of the weighting factors’ contribution to the general condition of the patient. Conclusion: The developed and tested method of complex functional assessment of the hip joint enables our colleagues, dealing with trauma and diseases of the hip, to use it in various research and scientific projects, as well as in general medical practice.

  6. Optimizing insulin pump therapy: a quality improvement project.

    Science.gov (United States)

    Meade, Lisa T; Rushton, Wanda E

    2013-01-01

    The purpose of the study was to assess insulin pump use and provide ongoing education. A quality improvement project using a pump assessment questionnaire was implemented at an endocrinology office in the southeastern United States. The questionnaire was designed to evaluate all aspects of insulin pump therapy, including pump operations, infusion set failure, management of acute complications, and usage of advanced device features. Eighty-nine patients (80% with type 1 diabetes and 20% with type 2 diabetes) completed the questionnaire at the endocrinology practice. A certified diabetes educator reviewed the questions with each patient, identifying deficiencies and training opportunities. The most common areas of deficiency identified after implementation of the assessment form included the following: expired or no basal insulin prescription in the event of pump failure or removal, no mupirocin (Bactroban®, GlaxoSmithKline, Research Triangle Park, North Carolina) prescription for suspected site infections, lack of insulin syringe if pump stopped working, failure to check urine ketones, no antiemetic prescription for sick day intervention, using manual bolus instead of bolus calculator, and lack of in-date glucagon kit. Use of a pump assessment questionnaire allows for focused discussion concerning patient behaviors related to pump operations, troubleshooting, and self-management. Incorporating use of a pump assessment questionnaire into routine practice may result in improved patient education and avoidance of adverse events specific to insulin pump therapy.

  7. Ultrasound: Infant Hip

    Science.gov (United States)

    ... ultrasound when they suspect a problem called developmental dysplasia of the hip (DDH) . DDH is a hip deformity that can ... THIS TOPIC X-Ray Exam: Leg Length Developmental Dysplasia of the Hip X-Ray Exam: Hip Contact Us Print Resources ...

  8. Does a micro-grooved trunnion stem surface finish improve fixation and reduce fretting wear at the taper junction of total hip replacements? A finite element evaluation.

    Science.gov (United States)

    Ashkanfar, Ariyan; Langton, David J; Joyce, Thomas J

    2017-08-10

    The generation of particulate debris at the taper junction of total hip replacements (THRs), can cause failure of the artificial hip. The taper surfaces of femoral heads and trunnions of femoral stems are generally machined to a certain roughness to enhance fixation. However, the effect of the surface roughness of these surfaces on the fixation, wear and consequently clinical outcomes of the design is largely unknown. In this study, we asked whether a micro-grooved trunnion surface finish (1) improves the fixation and (2) reduces the wear rate at the taper junction of THRs. We used 3D finite element (FE) models of THRs to, firstly, investigate the effect of initial fixation of a Cobalt-Chromium femoral head with a smooth taper surface mated with a Titanium (1) micro-grooved and (2) smooth, trunnion surface finishes. Secondly, we used a computational FE wear model to compare the wear evolution between the models, which was then validated against wear measurements of the taper surface of explanted femoral heads. The fixation at the taper junction was found to be better for the smooth couplings. Over a 7 million load cycle analysis in-silico, the linear wear depth and the total material loss was around 3.2 and 1.4 times higher for the femoral heads mated with micro-grooved trunnions. It was therefore concluded that smooth taper and trunnion surfaces will provide better fixation at the taper junction and reduce the volumetric wear rates. Copyright © 2017 Elsevier Ltd. All rights reserved.

  9. Conus hip prosthesis.

    Science.gov (United States)

    Wagner, H; Wagner, M

    2001-01-01

    50 years ago, prosthetic replacement of the hip joint ushered in a new epoch in orthopaedics. Total hip replacement made it possible to remove a severely diseased, painful hip and restore normal function and a normal quality of life to the afflicted patient. The early results of total hip replacement are almost all spectacular and hip replacement has become the most successful type of orthopaedic surgery. These good results using an approach that was technically relatively simple resulted in a temptation to implant prosthetic hip joints with ever increasing frequency in ever younger patients. This led to the emergence of new problems, which were not so clearly recognised at the outset: it emerged that the stability of prosthetic hip joints was of limited duration. This had the following consequence: If a total hip prosthesis is implanted in an elderly person whose remaining life-expectancy is shorter than the longevity of the prosthesis, hip replacement is a life-long solution. We can therefore say that, for a patient who has only 10 to 15 years left to live, their hip problem is solved by total hip replacement. For young people, who still have a long life expectancy in front of them, it is different. They will experience failure of the artificial joint and require further surgery. The commonest and most important type of failure in total hip prostheses is aseptic loosening, which is associated with resorption of bone at the site of the prosthesis. The cause of this phenomenon has only gradually been recognised in the course of the years. Initially, the unanimous opinion was that the methacrylate cement, used to fix the components of the prosthesis in the bone, was the definitive cause of aseptic loosening because fissures and fractures of the cement were almost always found during surgical revision of loosened joints. There was talk of "cement disease" and great efforts were made to improve the quality of the cement and the cementing technique. Moreover, even

  10. Conversion of fused hip to total hip arthroplasty with presurgical and postsurgical gait studies.

    Science.gov (United States)

    Bonin, Stephanie J; Eltoukhy, Moataz A; Hodge, W Andrew; Asfour, Shihab S

    2012-03-01

    This case study presents a subject with a fused hip converted to total hip arthroplasty. Kinematic gait analysis was conducted on 3 occasions, presurgery, 4 months postsurgery, and 2.5 years postsurgery. Presurgery data showed decreased cadence and shorter step length; sound limb possessed increased hip, knee range of motion (ROM), and increased knee flexion during stance; the affected limb had minimal hip motion and normal knee ROM with abnormal pattern. At 4 months postsurgery, the sound limb showed decreased step length, whereas the affected limb showed increased knee extension during stance and increased hip ROM. Data obtained at 2.5 years postsurgery indicated decreased cadence and speed and increased ROM in both limbs. The total hip arthroplasty had provided relief of chronic back and affected hip pain and improved mobility. Gait-specific training is recommended. Copyright © 2012 Elsevier Inc. All rights reserved.

  11. Improvement in Herpes Zoster Vaccination in Patients with Rheumatoid Arthritis: A Quality Improvement Project.

    Science.gov (United States)

    Sheth, Heena; Moreland, Larry; Peterson, Hilary; Aggarwal, Rohit

    2017-01-01

    To improve herpes zoster (HZ) vaccination rates in high-risk patients with rheumatoid arthritis (RA) being treated with immunosuppressive therapy. This quality improvement project was based on the pre- and post-intervention design. The project targeted all patients with RA over the age of 60 years while being treated with immunosuppressive therapy (not with biologics) seen in 13 rheumatology outpatient clinics. The study period was from July 2012 to June 2013 for the pre-intervention and February 2014 to January 2015 for the post-intervention phase. The electronic best practice alert (BPA) for HZ vaccination was developed; it appeared on electronic medical records during registration and medication reconciliation of the eligible patient by the medical assistant. The BPA was designed to electronically identify patient eligibility and to enable the physician to order the vaccine or to document refusal or deferral reason. Education regarding vaccine guidelines, BPA, vaccination process, and feedback were crucial components of the project interventions. The vaccination rates were compared using the chi-square test. We evaluated 1823 and 1554 eligible patients with RA during the pre-intervention and post-intervention phases, respectively. The HZ vaccination rates, reported as patients vaccinated among all eligible patients, improved significantly from the pre-intervention period of 10.1% (184/1823) to 51.7% (804/1554) during the intervention phase (p Electronic identification of vaccine eligibility and BPA significantly improved HZ vaccination rates. The process required minimal modification of clinic work flow and did not burden the physician's time, and has the potential for self-sustainability and generalizability.

  12. Economic viability of geriatric hip fracture centers.

    Science.gov (United States)

    Clement, R Carter; Ahn, Jaimo; Mehta, Samir; Bernstein, Joseph

    2013-12-01

    Management of geriatric hip fractures in a protocol-driven center can improve outcomes and reduce costs. Nonetheless, this approach has not spread as broadly as the effectiveness data would imply. One possible explanation is that operating such a center is not perceived as financially worthwhile. To assess the economic viability of dedicated hip fracture centers, the authors built a financial model to estimate profit as a function of costs, reimbursement, and patient volume in 3 settings: an average US hip fracture program, a highly efficient center, and an academic hospital without a specific hip fracture program. Results were tested with sensitivity analysis. A local market analysis was conducted to assess the feasibility of supporting profitable hip fracture centers. The results demonstrate that hip fracture treatment only becomes profitable when the annual caseload exceeds approximately 72, assuming costs characteristic of a typical US hip fracture program. The threshold of profitability is 49 cases per year for high-efficiency hip fracture centers and 151 for the urban academic hospital under review. The largest determinant of profit is reimbursement, followed by costs and volume. In the authors’ home market, 168 hospitals offer hip fracture care, yet 85% fall below the 72-case threshold. Hip fracture centers can be highly profitable through low costs and, especially, high revenues. However, most hospitals likely lose money by offering hip fracture care due to inadequate volume. Thus, both large and small facilities would benefit financially from the consolidation of hip fracture care at dedicated hip fracture centers. Typical US cities have adequate volume to support several such centers.

  13. Correlations between the Harris Hip Score and the Visual Analogue Scale in the assessment of total hip replacement in hip dysplasia

    OpenAIRE

    S.G Zuh; Ö. Nagy; Ancuța Zazgyva; O.M. Russu; Gergely, I; T.S. Pop

    2014-01-01

    Total hip replacement is one of the most frequently performed orthopaedic interventions that can significantly improve the functional status and the quality of life of patients suffering from hip arthrosis. Recently patient satisfaction and patient-reported results of total hip arthroplasty are increasingly emphasised as important tools for the assessments of these interventions. For patients with arthrosis secondary to hip dysplasia, these evaluations can be more difficult, due to younger ag...

  14. Traditional Project Management and the Visual Workplace Environment to Improve Project Success

    Science.gov (United States)

    Fichera, Christopher E.

    2016-01-01

    A majority of large IT projects fail to meet scheduled deadlines, are over budget and do not satisfy the end user. Many projects fail in spite of utilizing traditional project management techniques. Research of project management has not identified the use of a visual workspace as a feature affecting or influencing the success of a project during…

  15. Traditional Project Management and the Visual Workplace Environment to Improve Project Success

    Science.gov (United States)

    Fichera, Christopher E.

    2016-01-01

    A majority of large IT projects fail to meet scheduled deadlines, are over budget and do not satisfy the end user. Many projects fail in spite of utilizing traditional project management techniques. Research of project management has not identified the use of a visual workspace as a feature affecting or influencing the success of a project during…

  16. Annual Progress Report Fish Research Project Oregon : Project title, Evaluation of Habitat Improvements -- John Day River.

    Energy Technology Data Exchange (ETDEWEB)

    Olsen, Erik A.

    1984-01-01

    This report summarizes data collected in 1983 to evaluate habitat improvements in Deer, Camp, and Clear creeks, tributaries of the John Day River. The studies are designed to evaluate changes in abundance of spring chinook and summer steelhead due to habitat improvement projects and to contrast fishery benefits with costs of construction and maintenance of each project. Structure types being evaluated are: (1) log weirs, rock weirs, log deflectors, and in stream boulders in Deer Creek; (2) log weirs in Camp Creek; and (3) log weir-boulder combinations and introduced spawning gravel in Clear Creek. Abundance of juvenile steelhead ranged from 16% to 119% higher in the improved (treatment) area than in the unimproved (control) area of Deer Creek. However, abundance of steelhead in Camp Creek was not significantly different between treatment and control areas. Chinook and steelhead abundance in Clear Creek was 50% and 25% lower, respectively in 1983, than the mean abundance estimated in three previous years. The age structure of steelhead was similar between treatment and control areas in Deer and Clear creeks. The treatment area in Camp Creek, however, had a higher percentage of age 2 and older steelhead than the control. Steelhead redd counts in Camp Creek were 36% lower in 1983 than the previous five year average. Steelhead redd counts in Deer Creek were not made in 1983 because of high streamflows. Chinook redds counted in Clear Creek were 64% lower than the five year average. Surface area, volume, cover, and spawning gravel were the same or higher than the corresponding control in each stream except in Deer Creek where there was less available cover and spawning gravel in sections with rock weirs and in those with log deflectors, respectively. Pool:riffle ratios ranged from 57:43 in sections in upper Clear Creek with log weirs to 9:91 in sections in Deer Creek with rock weirs. Smolt production following habitat improvements is estimated for each stream

  17. Colocación de implantes glúteos y de cadera: una alternativa para mejorar el contorno en hipoplasia glúteo-trocantérea Placement of buttock and hip implants: an alternative for contour improvement in buttock and hips hypoplasia

    Directory of Open Access Journals (Sweden)

    L. Cárdenas-Camarena

    2012-03-01

    Full Text Available La mejoría del contorno glúteo y de caderas en un paciente varón que desea un contorno femenino es difícil de conseguir cuando no es posible disponer de una cantidad de grasa suficiente para inyectar y lograr una mejoría integral. Presentamos la técnica quirúrgica utilizada en un paciente transexual masculino que había tenido dos intentos fallidos de feminizar su contorno de glúteos y caderas. Utilizamos implantes ovales de silicona cohesiva, tanto para la región glútea como para las caderas, inyectando grasa en las áreas de transición entre los dos implantes. Con esta combinación obtuvimos un contorno femenino integral, eliminando por completo el aspecto masculino de la región glúteo-trocantérea. En conclusión, pensamos que la combinación empleada supone una opción novedosa y no descrita hasta el momento para el tratamiento de pacientes transexuales que buscan un contorno glúteo más femenino de forma integral, con resultados predecibles y muy gratificantes, que mejora las deficiencias que los pacientes masculinos tienen en esta zona en comparación con el contorno de los glúteos femeninos.Improvement of the gluteal and hip contour in patients seeking a more feminine shape is difficult to achieve, specially for those who don't have enough fat to transfer from other areas of the body. We describe the surgical technique used to improve hips and buttocks contour in a genetic male transsexual. This patient previously underrwent two unsuccessful surgeries to feminize his hip and buttock contour. Our successful approach involved the use of an oval-shaped cohesive silicone gel implants placed in both, the hip and buttock areas, along with fat injection in the areas between the two implants. A natural, feminine contour was achieved using the combination of buttock and hip implants with lipofilling using patient's own fat. These procedures completely eliminated the male contour previously noted in the gluteal trochanteric region

  18. Improving Project Outcomes and Growing the Anaerobic Digestion Industy Report

    Science.gov (United States)

    Anaerobic digestion ombudsmen assist with project development, ensure the long-term sustainability of projects, and help advance the industry. This report explores the benefits of anaerobic digestion ombudsmen and provides guidance for implementing them.

  19. Hip Resurfacing. Case presentation.

    Directory of Open Access Journals (Sweden)

    Pedro Gonzalo González González

    2008-12-01

    Full Text Available Hip resurfacing in youngest patients is an excellent surgical technique for Avascular Necrosis compare with a traditional Total Hip Replacement. Report about a 21 years old female patient involved in a car accident in February 2004 with Fracture of the neck of femur treated with compression hip screw Richard’s type. Two years later the patient was diagnose with avascular necrosis of the contra lateral hip. Hip resurfacing Metal-Metal was carry out in the above mentioned patient.

  20. Improving project delivery; Programmes as the silver bullet?

    NARCIS (Netherlands)

    Busscher, Tim; Tillema, Taede; Arts, Eric

    2015-01-01

    Transport and land use planning are in a state of flux. Projects face increased technical, social, financial, political and legal complexities while the conventional project planning approach is struggling to deal with these complexities. As a result, many projects fail to be completed in time and

  1. Projects to improve mathematics performance at a university of technology

    Directory of Open Access Journals (Sweden)

    Ina Louw

    2009-09-01

    Full Text Available Lecturers at tertiary institutions have been expressing concern about the quality of students in mathematics for a long time now. Blame is usually placed at the door of secondary schools, but through put figures are still determining state subsidies and as such necessitate institutions to constantly revisit their efforts in terms of improving performance in mathematics. In this article, the results of two studies to improve the mathematics performance at a technical university are reported. The first study took place at the former Technikon Northern Gauteng and was an action research project with an experimental design. The study entailed the implementation of tutorial sessions and it revealed certain traits of tertiary mathematics education. Data were collected through structured observation, questionnaires and focus group interviews. A standardized questionnaire, Study Orientation Questionnaire in Maths (SOM, was introduced and “study habits” was the field in the test that featured most significantly in both the experimental and the control groups. The results revealed, inter alia, that timely assessment is needed to detect and correct misconceptions as soon as possible. It also pointed out that attendance of lectures (and tutorials impacted strongly on performance. Lastly, it was found that students preferred communicating mathematics through the medium of English and not by using their mother tongue. The second project was conducted at the Tshwane University of Technology (TUT and consisted of an investigation into assessment practices in first year mathematics. The study was executed with action research as strategy and data were collected through interviews, questionnaires and focus group interviews. Qualitative and quantitative data were collected and respondents were exposed to contemporary assessment strategies as suggested by OBE. The aim of the study was to enhance the respondents’ insight into contemporary assessment

  2. Revision of Failed Hip Resurfacing and Large Metal-on-Metal Total Hip Arthroplasty Using Dual-Mobility Components.

    Science.gov (United States)

    Snir, Nimrod; Park, Brian K; Garofolo, Garret; Marwin, Scott E

    2015-06-01

    Revision of metal-on-metal (MoM) total hip arthroplasty (THA) or hip resurfacing is associated with high complication rates. The authors propose dual-mobility components as a surgical option and present short- to mid-term results of MoM hips revised with dual-mobility components. Eighteen consecutive hips that underwent revision of MoM THA or hip resurfacing using dual-mobility components were identified. At final follow-up (mean, 17.5 months), the visual analog scale, modified Harris Hip Score, and SF-12 scores had all improved (Phip resurfacing using a dual-mobility device is an effective strategy.

  3. SOFT TISSUE BALANCING IN TOTAL HIP ARTHROPLASTY.

    Directory of Open Access Journals (Sweden)

    Pencho Kosev

    2015-03-01

    Full Text Available We present our experience with the soft tissue balancing in total hip arthroplasty. Detailed indications, planning and surgical technique are presented. The described procedures are performed on 278 hips for a period of 6 years (2008-2014. We conclude that the outcome of a THA can be improved by balancing the stability, ROM, muscle strength and limb length equality.

  4. Bilaterally Primary Cementless Total Hip Arthroplasty for Severe Hip Ankylosis with Ankylosing Spondylitis.

    Science.gov (United States)

    Feng, Dong-Xu; Zhang, Kun; Zhang, Yu-Min; Nian, Yue-Wen; Zhang, Jun; Kang, Xiao-Min; Wu, Shu-Fang; Zhu, Yang-Jun

    2016-08-01

    Total hip arthroplasty is a reliable therapeutic intervention in patients with ankylosing spondylitis, in whom the aims of surgery are to reduce pain, restore hip function and improve quality of life. The current study is a retrospective analysis of the clinical and radiographic findings in a consecutive series of patients with hip ankylosis associated with severe ankylosing spondylitis who underwent bilateral primary total hip arthroplasty using non-cemented components. From June 2008 to May 2012, total hip arthroplasty was performed on 34 hips in 17 patients with bilateral ankylosis caused by ankylosing spondylitis. The study patients included 13 men and 4 women with a mean age of 24.2 years. The mean duration of disease was 8.3 years and the average duration of hip involvement was 7.6 years. All patients had severe hip pain and dysfunction with bilateral bony ankylosis and no range of motion preoperatively and all underwent bilateral cementless total hip arthroplasty performed by a single surgeon. Joint pain, range of motion (ROM), and Harris hip scores were assessed to evaluate the postoperative results. At a mean follow-up of 31.7 months, all patients had experienced significant clinical improvement in function, ROM, posture and ambulation. At the final follow-up, the mean postoperative flexion ROM was 134.4° compared with 0° preoperatively. Similar improvements were seen in hip abduction, adduction, internal rotation and external rotation. Postoperatively, 23 hips were completely pain-free, six had only occasional discomfort, three mild to moderate pain and two severe pain. The average Harris Hip Score improved from 23.7 preoperatively to 65.8 postoperatively. No stems had loosened at the final follow-up in any patient, nor had any revision surgery been required. Bilateral severe hip ankylosis in patients with ankylosing spondylitis can be treated with cementless bilateral synchronous total hip arthroplasty, which can greatly improve hip joint function and

  5. Complications after Hip Arthroscopy

    Science.gov (United States)

    Larson, Christopher M.; Clohisy, John C.; Beaule, Paul; Kelly, Bryan T.; Giveans, Russell; Stone, Rebecca M.; Samuelson, Kathryn M.

    2013-01-01

    Objectives: There is very little published literature looking at comprehensive complication rates after hip arthroscopy with current techniques and indications. Methods: Between 01/2011 and 11/2012, 1,026 consecutive hips (507 males, 519 females) with a mean age of 31.2 years (range 12 - 73) underwent hip arthroscopy at three institutions. The diagnosis, demographic information, and procedures were recorded, and a validated complications grading classification for hip joint surgery (Clavian classification) was utilized for all patients prospectively. Results: There were 951 primary hip arthroscopies and 75 revision hip arthroscopies. Arthroscopy was performed for FAI in 936 hips (91.2%), and 760 hips (74.1%) had a labral repair and 229 hips (22.3%) had a labral debridement. The most common event (18.7% of hips) noted was post-operative sensory disturbance adjacent to the portals or involving the distal anterolateral thigh consistent with LFC nerve disturbance. This was typically not noticed by patients and found on physical examination and only persisted beyond 6 months in 7 hips (0.7%). Iatrogenic chondral injury was noted for 20 hips (1.9%), iatrogenic labral puncture in 11 hips (1.1%), superficial portal infection in 6 hips (0.6%), sensory deficit about the foot in 9 hips (0.9%), deep venous thrombosis in 3 hips (0.3%), pulminary embolism in 1 hip (0.1%), pulmonary edema in 1 hip (0.1%), wound hematoma in 2 hips (0.2%), perineal numbness (pudendal nerve) in 9 hips (0.9%), heterotopic ossification in 4 hips (0.4%), reflex sympathetic dystrophy in 1 hip (0.1%) and wound/skin (traction) dehiscence in 1 hips (0.1%). There were no femoral neck fractures, iatrogenic instability, AVN, or extra-abdominal fluid extravasation in this cohort. The overall complication rate not including temporary periportal and thigh numbness (sequalae) was 6.9% (71 hips). Overall 88.7% had a grade 1, 5.6% Grade 2, 4.2% grade 3, and 1.4% grade 4 complication. There was no difference in the

  6. Cryogenic Propellant Storage and Handling Efficiency Improvement Project

    Data.gov (United States)

    National Aeronautics and Space Administration — The project determined specific performance metrics and discrete technology development goals with which to gage proposed investments in ground propellant systems...

  7. New and Improved Lithium-Ion Battery Project

    Data.gov (United States)

    National Aeronautics and Space Administration — This project is a partnership effort between American Energy Technologies Company (Illinois), Yardney Technical Products (Connecticut) and A.J. Drexel Nanotechnology...

  8. An improved affine projection algorithm for active noise cancellation

    Science.gov (United States)

    Zhang, Congyan; Wang, Mingjiang; Han, Yufei; Sun, Yunzhuo

    2017-08-01

    Affine projection algorithm is a signal reuse algorithm, and it has a good convergence rate compared to other traditional adaptive filtering algorithm. There are two factors that affect the performance of the algorithm, which are step factor and the projection length. In the paper, we propose a new variable step size affine projection algorithm (VSS-APA). It dynamically changes the step size according to certain rules, so that it can get smaller steady-state error and faster convergence speed. Simulation results can prove that its performance is superior to the traditional affine projection algorithm and in the active noise control (ANC) applications, the new algorithm can get very good results.

  9. 76 FR 22170 - Open Meeting of Taxpayer Advocacy Panel Notice Improvement Project Committee

    Science.gov (United States)

    2011-04-20

    ... Internal Revenue Service Open Meeting of Taxpayer Advocacy Panel Notice Improvement Project Committee... of the Taxpayer Advocacy Panel Notice Improvement Project Committee will be conducted. The Taxpayer Advocacy Panel is soliciting public comments, ideas and suggestions on improving customer service at...

  10. 75 FR 25316 - Open Meeting of Taxpayer Advocacy Panel Notice Improvement Project Committee

    Science.gov (United States)

    2010-05-07

    ... Internal Revenue Service Open Meeting of Taxpayer Advocacy Panel Notice Improvement Project Committee... of the Taxpayer Advocacy Panel Notice Improvement Project Committee will be conducted. The Taxpayer Advocacy Panel is soliciting public comments, ideas and suggestions on improving customer service at...

  11. Interdisciplinary Project-Based Learning: Technology for Improving Student Cognition

    Science.gov (United States)

    Stozhko, Natalia; Bortnik, Boris; Mironova, Ludmila; Tchernysheva, Albina; Podshivalova, Ekaterina

    2015-01-01

    The article studies a way of enhancing student cognition by using interdisciplinary project-based learning (IPBL) in a higher education institution. IPBL is a creative pedagogic approach allowing students of one area of specialisation to develop projects for students with different academic profiles. The application of this approach in the Ural…

  12. Discovering Strategies to Improve Business Value in Outsourcing Projects

    NARCIS (Netherlands)

    Ponisio, M.L.; Eck, van P.A.T.; Vruggink, P.

    2008-01-01

    This paper deals with the problem of leveraging client business value in a software development outsourcing relationship. We have observed software development projects from two different Dutch IT outsourcing companies and studied the approach they apply in their (successful) projects. The results s

  13. Discovering Strategies to Improve Business Value in Outsourcing Projects

    NARCIS (Netherlands)

    Ponisio, Laura; van Eck, Pascal; Vruggink, P.

    2008-01-01

    This paper deals with the problem of leveraging client business value in a software development outsourcing relationship. We have observed software development projects from two different Dutch IT outsourcing companies and studied the approach they apply in their (successful) projects. The results

  14. Emerging topics on the hip: Ligamentum teres and hip microinstability

    Energy Technology Data Exchange (ETDEWEB)

    Cerezal, Luis, E-mail: lcerezal@gmail.com [Diagnóstico Médico Cantabria, C/Castilla 6, 39002 Santander (Spain); Arnaiz, Javier; Canga, Ana; Piedra, Tatiana [Valdecilla University Hospital, 39011 Santander (Spain); Altónaga, José R. [Leon University, 24071 Leon (Spain); Munafo, Ricardo [CETEA, Buenos Aires (Argentina); Pérez-Carro, Luis [Valdecilla University Hospital, 39011 Santander (Spain)

    2012-12-15

    Microinstability and ligament teres lesions are emergent topics on the hip pathology. These entities are an increasingly recognized cause of persistent hip pain and should be considered in the differential diagnosis of the patient with hip pain. Conventional (non-arthrographic) CT and MR have a very limited role in the evaluation of these entities. CTa and MRa have emerged as the modalities of choice for pre-operative imaging of ligamentum teres injuries and microinstability. To date, pre-operative imaging detection of these pathologies is not widespread but with appropriate imaging and a high index of suspicion, preoperative detection should improve. This article discusses current concepts regarding anatomy, biomechanics, clinical findings, diagnosis and treatment of ligament teres lesions and microinstability.

  15. Pre-operative ambulatory measurement of asymmetric leg loading during sit to stand in hip arthroplasty patients

    NARCIS (Netherlands)

    Martínez-Ramírez, Alicia; Weenk, Dirk; Lecumberri, Pablo; Verdonschot, Nico; Pakvis, Dean; Veltink, Peter H.

    2013-01-01

    Total hip arthroplasty is a successful surgical procedure to treat patients with hip osteoarthritis. Clinicians use different questionnaires to evaluate these patients. Gait velocity and these questionnaires; usually show significant improvement after total hip arthroplasty. This clinical evaluation

  16. [Real-time sonography of the infant hip joint in the early diagnosis of congenital hip dysplasia].

    Science.gov (United States)

    Casser, H R; Forst, R

    1985-01-01

    The ultrasonic examination of infant hip joint means a great advantage in early diagnosis of congenital hip dysplasia. The sonographic type classification by Graf enables the experienced examiner to make up a differentiated diagnostic-therapeutic concept as early as possible. Therapeutic omissions just as well as exaggerated therapeutic measures can be avoided. Consequently the prognosis of hip joint dysplasia is considerably improved by ultrasonic examination of new-born hip joints.

  17. Socio-economic position has no effect on improvement in health-related quality of life and patient satisfaction in total hip and knee replacement: a cohort study.

    Directory of Open Access Journals (Sweden)

    J Christiaan Keurentjes

    Full Text Available INTRODUCTION: Considerable evidence suggests that patients with more advantaged Socio-Economic Positions undergo Total Hip and Knee Replacement (THR/TKR more often, despite having a lower need. We questioned whether more disadvantaged Socio-Economic Position is associated with an lower improvement in Health-Related Quality of Life (HRQoL and a lower patient satisfaction after THR/TKR. METHODS: Patients who underwent primary THR/TKR in one academic and three community hospitals between 2005 and 2009, were eligible for inclusion. The highest completed levels of schooling were aggregated to index social class. We compared the improvement in HRQoL and postoperative satisfaction with surgery (measured using the Short-Form 36 (SF36 and an 11-point numeric rating scale of satisfaction between the aggregated groups of highest completed levels of schooling, using linear mixed model analysis, with center as a random effect and potential confounders (i.e. age, gender, Body Mass Index and Charnley's comorbidity classification as fixed effects. RESULTS: 586 THR patients and 400 TKR patients (40% of all eligible patients agreed to participate and completed all questionnaires sufficiently. We found no differences in HRQoL improvement in any dimension of the SF36 in THR patients. Patients with a higher completed level of schooling had a larger improvement in role-physical (9.38 points, 95%-CI:0.34-18.4, a larger improvement in general health (3.67 points, 95%-CI:0.56-6.79 and a smaller improvement in mental health (3.60 points, 95%-CI:0.82-6.38 after TKR. Postoperative patient satisfaction did not differ between different highest completed level of schooling groups. DISCUSSION: Completed level of schooling has no effect on the improvement in HRQoL and patient satisfaction in a Dutch THR population and a small effect in a similar TKR population. Undertreatment of patients with more disadvantaged Socio-Economic Position cannot be justified, given the similar

  18. Topography improvements in MEMS DMs for high-contrast, high-resolution imaging Project

    Data.gov (United States)

    National Aeronautics and Space Administration — This project will develop and demonstrate an innovative microfabrication process to substantially improve the surface quality achievable in high-resolution...

  19. Novel Solar Cell Nanotechnology for Improved Efficiency and Radiation Hardness Project

    Data.gov (United States)

    National Aeronautics and Space Administration — Significant improvements in photovoltaic materials and systems are required to enable NASA future exploration missions. In this project, CFD Research Corporation...

  20. Novel Solar Cell Nanotechnology for Improved Efficiency and Radiation Hardness Project

    Data.gov (United States)

    National Aeronautics and Space Administration — Significant improvements in photovoltaic materials and systems are required to enable future exploration missions. This SBIR project, involving two innovative...

  1. Generic project definitions for improvement of health care delivery: a case-based approach.

    Science.gov (United States)

    Niemeijer, Gerard C; Does, Ronald J M M; de Mast, Jeroen; Trip, Albert; van den Heuvel, Jaap

    2011-01-01

    The purpose of this article is to create actionable knowledge, making the definition of process improvement projects in health care delivery more effective. This study is a retrospective analysis of process improvement projects in hospitals, facilitating a case-based reasoning approach to project definition. Data sources were project documentation and hospital-performance statistics of 271 Lean Six Sigma health care projects from 2002 to 2009 of general, teaching, and academic hospitals in the Netherlands and Belgium. Objectives and operational definitions of improvement projects in the sample, analyzed and structured in a uniform format and terminology. Extraction of reusable elements of earlier project definitions, presented in the form of 9 templates called generic project definitions. These templates function as exemplars for future process improvement projects, making the selection, definition, and operationalization of similar projects more efficient. Each template includes an explicated rationale, an operationalization in the form of metrics, and a prototypical example. Thus, a process of incremental and sustained learning based on case-based reasoning is facilitated. The quality of project definitions is a crucial success factor in pursuits to improve health care delivery. We offer 9 tried and tested improvement themes related to patient safety, patient satisfaction, and business-economic performance of hospitals.

  2. Reconstruction of the Acetabulum in Developmental Dysplasia of the Hip in total hip replacement.

    Science.gov (United States)

    Sakellariou, Vasileios I; Christodoulou, Michael; Sasalos, Gregory; Babis, George C

    2014-09-01

    Developmental dysplasia of the hip (DDH) or congenital hip dysplasia (CDH) is the most prevalent developmental childhood hip disorder. It includes a wide spectrum of hip abnormalities ranging from dysplasia to subluxation and complete dislocation of the hip joint. The natural history of neglected DDH in adults is highly variable. The mean age of onset of symptoms is 34.5 years for dysplastic DDH, 32.5 years for low dislocation, 31.2 years for high dislocation with a false acetabulum, and 46.4 years for high dislocation without a false acetabulum. Thorough understanding of the bony and soft tissue deformities induced by dysplasia is crucial for the success of total hip arthroplasty. It is important to evaluate the existing acetabular deformity three-dimensionally, and customize the correction in accordance with the quantity and location of ace tabular deficiencies. Acetabular reconstruction in patients with DDH is challenging. Interpretation of published data is difficult and should be done with caution because most series include patients with different types of hip disease. In general, the complication rate associated with THA is higher in patients with hip dysplasia than it is in patients with osteoarthritis. Overall, clinical and functional outcomes following THA in patients hip dysplasia (DDH) differ from those treated for primary hip osteoarthritis, possibly due to the lower age and level of activity. Although function scores decline with age, the scores for pain and range of motion presented with a statistically significant improvement in the long-term.

  3. Reconstruction of the Acetabulum in Developmental Dysplasia of the Hip in Total Hip Replacement

    Directory of Open Access Journals (Sweden)

    Vasileios Sakellariou

    2014-09-01

    Full Text Available Developmental dysplasia of the hip (DDH or congenital hip dysplasia (CDH is the most prevalent developmental childhood hip disorder. It includes a wide spectrum of hip abnormalities ranging from dysplasia to subluxation and complete dislocation of the hip joint. The natural history of neglected DDH in adults is highly variable. The mean age of onset of symptoms is 34.5 years for dysplastic DDH, 32.5 years for low dislocation, 31.2 years for high dislocation with a false acetabulum, and 46.4 years for high dislocation without a false acetabulum. Thorough understanding of the bony and soft tissue deformities induced by dysplasia is crucial for the success of total hip arthroplasty. It is important to evaluate the existing acetabular deformity three-dimensionally, and customize the correction in accordance with the quantity and location of ace tabular deficiencies. Acetabular reconstruction in patients with DDH is hallenging. Interpretation of published data is difficult and should be done with caution because most series include patients with different types of hip disease. In general, the complication rate associated with THA is higher in patients with hip dysplasia than it is in patients with osteoarthritis. Overall, clinical and functional outcomes following THA in patients hip dysplasia (DDH differ from those treated for primary hip osteoarthritis, possibly due to the lower age and level of activity. Although function scores decline with age, the scores for pain and range of motion presented with a statistically significant improvement in the long-term.

  4. Renewable Energy Project Financing: Improved Guidance and Information Sharing Needed for DOD Project-Level Officials

    Science.gov (United States)

    2012-04-01

    include a biogenic methane gas project at Fort Knox, financed through a Utility Energy Service Contract, and a 500-megawatt solar project currently in...and approval process, leading organizations develop decision packages , such as business case analyses, to justify capital project requests.26 We

  5. Creating a Project-Based Learning Environment to Improve Project Management Skills of Graduate Students

    Science.gov (United States)

    Arantes do Amaral, Joao Alberto; Gonçalves, Paulo; Hess, Aurélio

    2015-01-01

    This article describes the project-based learning environment created to support project management graduate courses. The paper will focus on the learning context and procedures followed for 13 years, in 47 project-based learning MBA courses, involving approximately 1,400 students and 34 community partners.

  6. Developmental hip dysplasia in adolescence

    Directory of Open Access Journals (Sweden)

    Vukašinović Zoran

    2009-01-01

    Full Text Available The authors define adolescence and developmental dysplasia of the hip (DDH. Special attention is paid to pathological findings characteristic of DDH in adolescence (unrecognized and untreated DDH; treated DDH, but non-terminated treatment; DDH diagnosed with delay, inadequately treated, with complications. The authors emphasise that DDH treatment has to be successfully terminated well before the adolescence; possibilities are explained on management modes at the time of adolescence, and possible persons guilty for the persistence of later hip problems are indicated. Based on the authors' experience and having in mind all surgical possibilities for the treatment (pelvic osteotomies, femoral osteotomies, trochanteroplasties, leg length equalization procedures the authors propose treatment protocols. The intention is to provide better treatment results and to prevent secondary hip arthrosis. Furthermore, how to improve the struggle against DDH is suggested.

  7. Hip fracture - discharge

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/patientinstructions/000168.htm Hip fracture - discharge To use the sharing features on this page, please enable JavaScript. Hip fracture surgery is done to repair a break in ...

  8. Hip fracture surgery

    Science.gov (United States)

    ... neck fracture repair; Trochanteric fracture repair; Hip pinning surgery; Osteoarthritis - hip ... You may receive general anesthesia for this surgery. This means you ... spinal anesthesia . With this kind of anesthesia, medicine is ...

  9. Autonomous, Cryogenic Leak Detector for Improving Launch Site Operations Project

    Data.gov (United States)

    National Aeronautics and Space Administration — For detecting leakage of cryogenic fluids in spaceport facilities and in spacebound vehicles, this project proposes to demonstrate the feasibility of an all-optical...

  10. Improved Lunar and Martian Regolith Simulant Production Project

    Data.gov (United States)

    National Aeronautics and Space Administration — The technical objective of the Phase II project is to provide a more complete investigation of the long-term needs of the simulant community based on the updated...

  11. Using Heliospheric Imager Data to Improve Space Weather Forecasting Project

    Data.gov (United States)

    National Aeronautics and Space Administration — The objective of this project is to test a new approach for selecting the optimal solar wind model from an ensemble of model runs.Because of the paucity of...

  12. Physical Improvements in Exciter/Igniter Units Project

    Data.gov (United States)

    National Aeronautics and Space Administration — The proposed project consists of developing a prototype exciter/igniter unit that can operate to a subset of expected flight performance requirements. The main focus...

  13. Physical Improvements in Exciter/Igniter Units Project

    Data.gov (United States)

    National Aeronautics and Space Administration — The proposed Phase 2 project consists of the physical integration of our Phase 1 small, compact exciter with a "flight like" igniter or spark plug capable of...

  14. The Environmental Management Project Manager`s Handbook for improved project definition

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1995-02-01

    The United States Department of Energy (DOE) is committed to providing high quality products that satisfy customer needs and are the associated with this goal, DOE personnel must possess the knowledge, skills, and abilities to ensure successful job performance. In addition, there must be recognition that the greatest obstacle to proper project performance is inadequate project definition. Without strong project definition, DOE environmental management efforts are vulnerable to fragmented solutions, duplication of effort, and wastes resources. The primary means of ensuring environmental management projects meet cost and schedule milestones is through a structured and graded approach to project definition, which is the focus of this handbook.

  15. The Environmental Management Project Manager`s Handbook for improved project definition

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1995-02-01

    The United States Department of Energy (DOE) is committed to providing high quality products that satisfy customer needs and are the associated with this goal, DOE personnel must possess the knowledge, skills, and abilities to ensure successful job performance. In addition, there must be recognition that the greatest obstacle to proper project performance is inadequate project definition. Without strong project definition, DOE environmental management efforts are vulnerable to fragmented solutions, duplication of effort, and wastes resources. The primary means of ensuring environmental management projects meet cost and schedule milestones is through a structured and graded approach to project definition, which is the focus of this handbook.

  16. The Hip Restoration Algorithm

    Science.gov (United States)

    Stubbs, Allston Julius; Atilla, Halis Atil

    2016-01-01

    Summary Background Despite the rapid advancement of imaging and arthroscopic techniques about the hip joint, missed diagnoses are still common. As a deep joint and compared to the shoulder and knee joints, localization of hip symptoms is difficult. Hip pathology is not easily isolated and is often related to intra and extra-articular abnormalities. In light of these diagnostic challenges, we recommend an algorithmic approach to effectively diagnoses and treat hip pain. Methods In this review, hip pain is evaluated from diagnosis to treatment in a clear decision model. First we discuss emergency hip situations followed by the differentiation of intra and extra-articular causes of the hip pain. We differentiate the intra-articular hip as arthritic and non-arthritic and extra-articular pain as surrounding or remote tissue generated. Further, extra-articular hip pain is evaluated according to pain location. Finally we summarize the surgical treatment approach with an algorithmic diagram. Conclusion Diagnosis of hip pathology is difficult because the etiologies of pain may be various. An algorithmic approach to hip restoration from diagnosis to rehabilitation is crucial to successfully identify and manage hip pathologies. Level of evidence: V. PMID:28066734

  17. Hip Injuries and Disorders

    Science.gov (United States)

    ... problems. Osteoarthritis can cause pain and limited motion. Osteoporosis of the hip causes weak bones that break easily. Both of these are common in older people. Treatment for hip disorders may include rest, medicines, physical therapy, or surgery, including hip replacement.

  18. Ultrasound: Infant Hip

    Science.gov (United States)

    ... Old Feeding Your 1- to 2-Year-Old Ultrasound: Infant Hip KidsHealth > For Parents > Ultrasound: Infant Hip A A A What's in this ... en los lactantes What It Is A hip ultrasound is a safe and painless test that uses ...

  19. Hip Problems in Infants

    Science.gov (United States)

    ... hip problems later in life? ResourcesScreening for Developmental Dysplasia of the Hip by LM French, M.D., and FR Dietz, ... 2014 Categories: Family Health, Infants and ToddlersTags: dislocation, dysplasia, external, femoral, hip, infants, internal, problems, socket, torsion Family Health, Infants ...

  20. [Bernese periacetabular osteotomy for the treatment of severe hip dysplasia].

    Science.gov (United States)

    Huang, Ye; Zhang, Hong; Liu, Qing; Jiang, Zeng-hui; Dou, Yong

    2010-02-15

    To analyze the mid-term clinical and radiographic results obtained with the Bernese periacetabular osteotomy for the treatment of severe hip dysplasia. From October 1997 to December 2002 20 hips of 18 patients were classified as having severe acetabular dysplasia (Severin classification Grade IVb). Preoperatively, all patients had hip pain, and sufficient hip joint congruency on functional radiographs. All 20 hips underwent Bernese periacetabular osteotomy. Postoperatively, the hips were assessed radiographically on center edge angle (CE), acetabular roof obliquity and the progression of osteoarthritis. Clinical results and hip function were measured with the Harris hip score at an average of 6.2 years follow-up. Comparison of preoperative and follow-up radiographs demonstrated significant improvements in the lateral CE angle, the anterior CE angle, and roof obliquity. The average Harris hip score improved from 78.5 points preoperatively to 91.1 points at the time of the latest follow-up. Fourteen of 18 patients were satisfied with the result of the surgery, and 16 of 20 hips had a good or excellent clinical result. Under-correction occurred in 5 hips. The Bernese periacetabular osteotomy is an effective procedure for surgical correction of the severe dysplastic hip. This osteotomy can predictably obtain major reorientation of the acetabulum in all planes. The clinical results in the mid-term follow-up are encouraging.

  1. A CONCEPTUAL MODEL FOR IMPROVED PROJECT SELECTION AND PRIORITISATION

    Directory of Open Access Journals (Sweden)

    P. J. Viljoen

    2012-01-01

    Full Text Available

    ENGLISH ABSTRACT: Project portfolio management processes are often designed and operated as a series of stages (or project phases and gates. However, the flow of such a process is often slow, characterised by queues waiting for a gate decision and by repeated work from previous stages waiting for additional information or for re-processing. In this paper the authors propose a conceptual model that applies supply chain and constraint management principles to the project portfolio management process. An advantage of the proposed model is that it provides the ability to select and prioritise projects without undue changes to project schedules. This should result in faster flow through the system.

    AFRIKAANSE OPSOMMING: Prosesse om portefeuljes van projekte te bestuur word normaalweg ontwerp en bedryf as ’n reeks fases en hekke. Die vloei deur so ’n proses is dikwels stadig en word gekenmerk deur toue wat wag vir besluite by die hekke en ook deur herwerk van vorige fases wat wag vir verdere inligting of vir herprosessering. In hierdie artikel word ‘n konseptuele model voorgestel. Die model berus op die beginsels van voorsieningskettings sowel as van beperkingsbestuur, en bied die voordeel dat projekte geselekteer en geprioritiseer kan word sonder onnodige veranderinge aan projekskedules. Dit behoort te lei tot versnelde vloei deur die stelsel.

  2. Improving decision making in the early phases of configuration projects

    DEFF Research Database (Denmark)

    Mortensen, Niels Henrik; Harlou, Ulf; Haug, Anders

    2008-01-01

    During the early phases of configuration projects very important decisions are made which will heavily influence the performance of the company, benefits in different functional areas (production, sales, purchase, product development, service etc), maintenance of the configuration system and qual......During the early phases of configuration projects very important decisions are made which will heavily influence the performance of the company, benefits in different functional areas (production, sales, purchase, product development, service etc), maintenance of the configuration system......¬eling in configuration projects. Each of the five phases is sup¬ported by a set of tools. The main idea of the pro¬cedure is utili¬zation of a so-called Product Family Master Plan, which is a formal description of the product assortment and its variation. The procedure has been tested at one of Baan's cus¬tomers...

  3. Improving decision making in the early phases of configuration projects

    DEFF Research Database (Denmark)

    Mortensen, Niels Henrik; Harlou, Ulf; Haug, Anders

    2008-01-01

    During the early phases of configuration projects very important decisions are made which will heavily influence the performance of the company, benefits in different functional areas (production, sales, purchase, product development, service etc), maintenance of the configuration system and qual......During the early phases of configuration projects very important decisions are made which will heavily influence the performance of the company, benefits in different functional areas (production, sales, purchase, product development, service etc), maintenance of the configuration system......¬eling in configuration projects. Each of the five phases is sup¬ported by a set of tools. The main idea of the pro¬cedure is utili¬zation of a so-called Product Family Master Plan, which is a formal description of the product assortment and its variation. The procedure has been tested at one of Baan's cus...

  4. Improving decision making in the early phases of configuration projects

    DEFF Research Database (Denmark)

    Mortensen, Niels Henrik; Hvam, Lars; Harlou, Ulf

    2011-01-01

    During the early phases of configuration projects very important decisions are made which will heavily influence the performance of the company, benefits in different functional areas (production, sales, purchase, product development, service etc), maintenance of the configuration system and qual......During the early phases of configuration projects very important decisions are made which will heavily influence the performance of the company, benefits in different functional areas (production, sales, purchase, product development, service etc), maintenance of the configuration system...... in configuration projects. Each of the five phases is supported by a set of tools. The main idea of the procedure is utilization of a so-called Product Family Master Plan, which is a formal description of the product assortment and its variation. The procedure has been tested at one of Baan's (SSA Global...

  5. AN APPROACH TO THE QUALITY IMPROVEMENT OF A MASSIVE INVESTMENT PROJECT BY INTEGRATING ICT AND QMS

    Directory of Open Access Journals (Sweden)

    Tamara Gvozdenovic

    2007-12-01

    Full Text Available This work has presented an approach to the quality improvement of an investment project by the change in the concept of project management. Building time of the investment project is a complex factor which needs a special attention. It is well known that the PERT method has been applied with long-lasting investment projects, where a big time distance brings about significant uncertainty of future situations. Microsoft Project 2002 and Matlab: Neural Network Toolbox are the software tools used for solving the problem of investment project management.

  6. A decision support system framework to improve design-construction integration and project performance on public sector underground utility projects

    Science.gov (United States)

    Gehrig, Gary Bruce

    One of the noted difficulties with the traditional public works project development process is the lack of integration and sharing of information between engineering and construction entities that results in a decrease in project performance. To improve project performance on public sector underground utility projects, the research develops a decision support system framework that enhances the exchange and integration of relevant information and knowledge between entities on such projects by incorporating a lessons-learned database to document, organize and disseminate lessons-learned on a project. To identify the critical activities within the project development process that could be linked to the decision support system, the Integration Definition for Functioning Modeling (IDEFO) technique was used to create a representative model of the public works project development process. The resultant model demonstrated the repeatable nature of the process both across project phases and from project-to-project and identified the decision-making activities of generating and evaluating alternatives as key opportunities for construction-related input that could be linked to a decision support system. An inspection of current industry practices was conducted through interviews with knowledgeable industry sources to determine the scope of the decision support system framework. Results revealed the type of critical decisions on underground utility projects that could benefit from construction-related input and identified the documentation of lessons-learned as a major industry weakness. A prototype decision support system incorporating a lessons-learned database was developed and the framework integrated into common project management reporting mechanisms found in the industry. The actual decision-maker can retrieve lessons-learned according to predetermined categories of critical decisions, compare and evaluated retrieved alternatives, and document the rationale behind the

  7. Improving decision making in the early phases of configuration projects

    DEFF Research Database (Denmark)

    Mortensen, Niels Henrik; Hvam, Lars; Harlou, Ulf

    2011-01-01

    During the early phases of configuration projects very important decisions are made which will heavily influence the performance of the company, benefits in different functional areas (production, sales, purchase, product development, service etc), maintenance of the configuration system and qual......During the early phases of configuration projects very important decisions are made which will heavily influence the performance of the company, benefits in different functional areas (production, sales, purchase, product development, service etc), maintenance of the configuration system......) customers with very convincing results. © International Journal of Industrial Engineering....

  8. Revision Total Hip Replacement: A Case Report

    Directory of Open Access Journals (Sweden)

    Md Hafizur Rahman

    2013-07-01

    Full Text Available Total hip replacement is a reconstructive procedure that has improved the management of those diseases of the hip joint that have responded poorly to conventional medical therapy. Conventional, primary total hip replacement is a durable operation in the majority of patients. A hip replacement is a mechanical device with parts that are assembled before and during the operation. But the possible complications of total hip arthroplasty, and its clinical performance over time, is a challenging occasion to the surgeons, and such a challenge we faced with our presenting patient. A 68 year old lady with history of cemented bipolar hemiarthroplasty done in a tertiary care hospital, due to fracture neck of the left femur having the history of diabetes, chronic kidney disease, heart disease, anaemia, and mental disorders presented with loosened prosthesis, thinning of medial proximal cortex of the femur which had broken within few months after surgery. She complained of painful walking at left hip joint. There was also evidence of chronic infective and degenerative arthritis of acetabular component of the affected hip joint. Cemented revision total hip replacement surgery was performed with expert multidisciplinary involvement. On 2nd postoperative day the patient was allowed to walk on operated limb with the aid of walker. On 12th postoperative day all the stitches were removed and wound was found healthy.

  9. Generic project definitions for improvement of health care delivery: A case-base approach

    NARCIS (Netherlands)

    Niemeijer, G.C.; Does, R.J.M.M.; de Mast, J.; Trip, A.; van den Heuvel, J.

    2011-01-01

    Background: The purpose of this article is to create actionable knowledge, making the definition of process improvement projects in health care delivery more effective. Methods: This study is a retrospective analysis of process improvement projects in hospitals, facilitating a case-based reasoning a

  10. Generic project definitions for improvement of health care delivery: A case-base approach

    NARCIS (Netherlands)

    Niemeijer, G.C.; Does, R.J.M.M.; de Mast, J.; Trip, A.; van den Heuvel, J.

    2011-01-01

    Background: The purpose of this article is to create actionable knowledge, making the definition of process improvement projects in health care delivery more effective. Methods: This study is a retrospective analysis of process improvement projects in hospitals, facilitating a case-based reasoning a

  11. HIP-HOP教室

    Institute of Scientific and Technical Information of China (English)

    2006-01-01

    从现在开始我们要为了Hip-hop而奋斗,使身边的人改变对Hip-hop文化的看法,让他们知道什么是真正的Hip-hop,更要让大家学会怎样用肢体去表达,Yo,在这里,永远不会出现半吊子的Hip-hop,因为我们都是来真的,Yo,来真的,因为我要将Hip-hop发扬到底,Yeah!

  12. Hip arthroscopy in the setting of hip dysplasia

    OpenAIRE

    Yeung, M; Kowalczuk, M.; Simunovic, N.; Ayeni, O. R.

    2016-01-01

    Objective Hip arthroscopy in the setting of hip dysplasia is controversial in the orthopaedic community, as the outcome literature has been variable and inconclusive. We hypothesise that outcomes of hip arthroscopy may be diminished in the setting of hip dysplasia, but outcomes may be acceptable in milder or borderline cases of hip dysplasia. Methods A systematic search was performed in duplicate for studies investigating the outcome of hip arthroscopy in the setting of hip dysplasia up to Ju...

  13. Critical Factors for Improving Social Sustainability of Urban Renewal Projects

    Science.gov (United States)

    Chan, Edwin; Lee, Grace K. L.

    2008-01-01

    This study reviews the sustainable urban design concept and identifies critical factors for enhancing social sustainability of urban renewal projects. Through a questionnaire survey carried out in Hong Kong, the opinions of architects, planners, property development managers, and local citizens were sought and evaluated. The results derived from…

  14. Doppler Lidar in the Wind Forecast Improvement Projects

    Directory of Open Access Journals (Sweden)

    Pichugina Yelena

    2016-01-01

    Full Text Available This paper will provide an overview of some projects in support of Wind Energy development involving Doppler lidar measurement of wind flow profiles. The high temporal and vertical resolution of these profiles allows the uncertainty of Numerical Weather Prediction models to be evaluated in forecasting dynamic processes and wind flow phenomena in the layer of rotor-blade operation.

  15. Doppler Lidar in the Wind Forecast Improvement Projects

    Science.gov (United States)

    Pichugina, Yelena; Banta, Robert; Brewer, Alan; Choukulkar, Aditya; Marquis, Melinda; Olson, Joe; Hardesty, Mike

    2016-06-01

    This paper will provide an overview of some projects in support of Wind Energy development involving Doppler lidar measurement of wind flow profiles. The high temporal and vertical resolution of these profiles allows the uncertainty of Numerical Weather Prediction models to be evaluated in forecasting dynamic processes and wind flow phenomena in the layer of rotor-blade operation.

  16. Metrics to improve control in outsourcing software development projects

    NARCIS (Netherlands)

    Ponisio, Laura; van Eck, Pascal; Messnarz, R.; Ekert, D.; Christiansen, M.; Johansen, J.; Koinig, S.

    2011-01-01

    Measurements serve as vital instruments to control projects involving software development outsourcing. However, managers have found it difficult to develop and implement effective measurement programs, in part because guidelines for choosing among concrete measure-ments are scarce. We address this

  17. Utilisation and Improvement of the Initialisation of Project Communication Processes During the Management of Projects in Industrial Enterprises in Slovakia

    Science.gov (United States)

    Samáková, Jana; Šujanová, Jana; Špirková, Marta

    2016-06-01

    Nowadays, project communication is slowed due to the need for compliance with strict rules. Therefore the aim of this paper is to analyse the use of the communication environment as a basic part of the initialisation of project communication in industrial enterprises in Slovakia, and to propose measures to improve the process of initialisation of project communication in these enterprises. In this paper, theoretical and empirical research (quantitative and qualitative) approaches were chosen. On the basis of the research we can conclude, that communication as a basic part of the "Initialisation of project communication" is not adequately elaborated in international methodologies and standards of project management and in industrial enterprises. Industrial enterprises do not deal with processes of the communication environment and this results in negative consequences.

  18. Functionalized Graphitic Supports for Improved Fuel Cell Catalyst Stability Project

    Data.gov (United States)

    National Aeronautics and Space Administration — Physical Sciences Inc. (PSI) together with the University of Connecticut (UCONN) proposes to demonstrate the improved fuel cell catalyst support durability offered...

  19. Developing and executing quality improvement projects (concept, methods, and evaluation).

    Science.gov (United States)

    Likosky, Donald S

    2014-03-01

    Continuous quality improvement, quality assurance, cycles of change--these words of often used to express the process of using data to inform and improve clinical care. Although many of us have been exposed to theories and practice of experimental work (e.g., randomized trial), few of us have been similarly exposed to the science underlying quality improvement. Through the lens of a single-center quality improvement study, this article exposes the reader to methodology for conducting such studies. The reader will gain an understanding of these methods required to embark on such a study.

  20. [Geometry of the hip joint: methodology and guidelines].

    Science.gov (United States)

    Gaspar, Drago; Crnković, Tomislav

    2013-03-01

    An hip fracture is an significant personal, family and health issue of people older than 65 years. In the first year of the fracture up to 30% of the injured die and about 50% of them never regain their formal degree of independence in fulfilling day-to-day activities. Estimations are that throughout 30 years in the world there will be around 6 million hip fractures per year which is about four times the todays amount. Todays predictions of hip fractures based on the hip geometry have shown us that the hip geometry is an independent variable of the bone mineral density. The hip geometry is more resistant to the effect of various factors than the bone mineral density and the changes throu life are a lot slower. The uniqueness and the sensitivity of the hip geometry in predicting a fracture is high and acceptable in research results of most authors. In this review we present the previous relevant knowledge about the measures and factors which determines the hip geometry and the accepted amount of pictorial methods of hip display. We have compared the methodology and the patients of eleven randomly picked writings on predicting hip fracture based on the hip geometry. We highlight the need of further refinement of the methodology and the more balanced selection of patients for a greater conformity in future writings. The hip geometry has shown it self as an useful diagnostical instrument but there is still more room for its improvement.

  1. UNCEMENTED PRIMARY TOTAL HIP ARTHROPLASTY FOR OSTEONECROSIS OF HIP WITH SECONDARY OSTEOARTHRITIS IN YOUNG ADULTS

    Directory of Open Access Journals (Sweden)

    Chatla

    2016-03-01

    Full Text Available BACKGROUND Osteonecrosis of the femoral head is a progressive disease that generally affects patients in the third through fifth decade of life, if left untreated. Currently, 18% of all Total Hip Arthroplasty performed in USA are done for Osteonecrosis.(1 The aetiology for the Osteonecrosis varies from idiopathic, alcohol intoxication, steroid abuse or due to childhood hip disorders and hip trauma. We have selected 40 patients suffering from advanced femoral head osteonecrosis with subchondral collapse leading to Osteoarthritis of hip in young adults, treated by uncemented primary total hip replacement. This study is aimed to suggest that uncemented total hip arthroplasty can be applied predictably to this younger, potentially more active patient population. MATERIAL AND METHODS We have done 54 uncemented primary hips in 40 cases with mean follow-up of 5.5 years. The average age of the patient at the time of surgery was 43 years. All the hips are clinically and radiologically examined both pre- and post-operatively. All the cases are operated through postero-lateral approach and have used the fully Hydroxyapatite coated femoral straight stem designed for press fit insertion and hemispherical HA-coated cup inserted with press fit and in few cases we used an HA-coated screw. The patients are under regular follow-up. RESULTS All the patients are reviewed at 6 weeks, 3 months, 6 months and yearly thereafter. The clinical and functional status was recorded using the Harris Hip Score and WOMAC Hip Score. The mean Harris score has improved from an average of 44 points to an average of 93 points postoperatively; 94% showed good-to-excellent results, 2% of cases had shortening, one case developed hip dislocation after two weeks due to unguarded physiotherapy. CONCLUSION The short-term results of cementless total hip arthroplasty in patients with Osteonecrosis of the femoral head were encouraging. We await further follow-up to see if these promising

  2. Metal on metal hip resurfacing versus uncemented custom total hip replacement - early results

    Directory of Open Access Journals (Sweden)

    Muirhead-Allwood Sarah K

    2010-02-01

    Full Text Available Abstract Introduction There is no current consensus on the most appropriate prosthesis for treating symptomatic osteoarthritis (OA of the hip in young, active patients. Modern metal on metal hip resurfacing arthroplasty (HR has gained popularity as it is theoretically more stable, bone conserving and easier to revise than total hip arthroplasty. Early results of metal on metal resurfacing have been encouraging. We have compared two well matched cohorts of patients with regard to function, pain relief and patient satisfaction. Methods This prospective study compares 2 cohorts of young, active patients treated with hip resurfacing (137 patients, 141 hips and custom uncemented (CADCAM stems (134 patients, 141 hips. All procedures were performed by a single surgeon. Outcome measures included Oxford, WOMAC and Harris hip scores as well as an activity score. Statistical analysis was performed using the unpaired student's t-test. Results One hundred and thirty four and 137 patients were included in the hip replacement and resurfacing groups respectively. The mean age of these patients was 54.6 years. The mean duration of follow up for the hip resurfacing group was 19.2 months compared to 13.4 months for the total hip replacement group. Pre operative oxford, Harris and WOMAC scores in the THA group were 41.1, 46.4 and 50.9 respectively while the post operative scores were 14.8, 95.8 and 5.0. In the HR group, pre- operative scores were 37.0, 54.1 and 45.9 respectively compared to 15.0, 96.8 and 6.1 post operatively. The degree of improvement was similar in both groups. Conclusion There was no significant clinical difference between the patients treated with hip resurfacing and total hip arthroplasty in the short term.

  3. Project 8 Phase II: Improved beta decay electrons reconstruction

    Science.gov (United States)

    Guigue, Mathieu; Project 8 Collaboration

    2017-01-01

    The Project 8 collaboration aims to measure the absolute neutrino mass scale using a cyclotron radiation emission spectroscopy technique on the beta decays of tritium. The second phase of the project will measure a differential spectrum of tritium beta decays and extract the tritium endpoint value with an eV or sub-eV scale precision. Monoenergetic electrons emitted by gaseous 83mKr atoms can be used to determine the coefficient between the cyclotron frequency and the electron energy and to optimize the instrument configuration for the tritium measurement. We present the progress on the processing of the electron cyclotron radiation signal to reconstruct the beta decay spectrum of krypton and tritium.

  4. Hip arthroscopy in patients with recurrent pain following Bernese periacetabular osteotomy for acetabular dysplasia: operative findings and clinical outcomes.

    Science.gov (United States)

    Cvetanovich, Gregory L; Heyworth, Benton E; Murray, Kerri; Yen, Yi-Meng; Kocher, Mininder S; Millis, Michael B

    2015-10-01

    To report the operative findings and outcomes of hip arthroscopy for recurrent pain following periacetabular osteotomy (PAO) for acetabular dysplasia. A departmental database was used to identify patients who underwent hip arthroscopy following PAO between 2000 and 2009. Demographic data, arthroscopic findings, functional outcome scores and patient satisfaction were analysed. Of 556 PAO patients, 17 hips in 16 patients (3.1%) underwent post-PAO hip arthroscopy. Mean age at PAO was 23.8 years, and mean age at arthroscopy was 27.0 years. Common hip arthroscopy findings included labral tears (13 hips, 81.3%), significant (≥grade 2) chondral changes (12 hips, 75%), cam impingement (7 hips, 43.8%) and pincer impingement (6 hips, 37.5%). At mean follow-up 2.8 years after arthroscopy, additional procedures had been performed in six hips (37.5%), including total hip arthroplasty in one hip. Post-PAO arthroscopy questionnaire revealed 85.7% of patients with improved hip pain, 57.1% improved hip stiffness and 57.1% improved hip function. There was no significant difference in functional outcome measures. Common post-PAO hip arthroscopy findings include labral tears, chondral changes and femoroacetabular impingement. Many patients reported subjective hip improvement from post-PAO arthroscopy, but hip outcome scores were unchanged and one-third of patients had further surgery.

  5. Hip arthroscopy in patients with recurrent pain following Bernese periacetabular osteotomy for acetabular dysplasia: operative findings and clinical outcomes

    Science.gov (United States)

    Cvetanovich, Gregory L.; Heyworth, Benton E.; Murray, Kerri; Yen, Yi-Meng; Kocher, Mininder S.; Millis, Michael B.

    2015-01-01

    To report the operative findings and outcomes of hip arthroscopy for recurrent pain following periacetabular osteotomy (PAO) for acetabular dysplasia. A departmental database was used to identify patients who underwent hip arthroscopy following PAO between 2000 and 2009. Demographic data, arthroscopic findings, functional outcome scores and patient satisfaction were analysed. Of 556 PAO patients, 17 hips in 16 patients (3.1%) underwent post-PAO hip arthroscopy. Mean age at PAO was 23.8 years, and mean age at arthroscopy was 27.0 years. Common hip arthroscopy findings included labral tears (13 hips, 81.3%), significant (≥grade 2) chondral changes (12 hips, 75%), cam impingement (7 hips, 43.8%) and pincer impingement (6 hips, 37.5%). At mean follow-up 2.8 years after arthroscopy, additional procedures had been performed in six hips (37.5%), including total hip arthroplasty in one hip. Post-PAO arthroscopy questionnaire revealed 85.7% of patients with improved hip pain, 57.1% improved hip stiffness and 57.1% improved hip function. There was no significant difference in functional outcome measures. Common post-PAO hip arthroscopy findings include labral tears, chondral changes and femoroacetabular impingement. Many patients reported subjective hip improvement from post-PAO arthroscopy, but hip outcome scores were unchanged and one-third of patients had further surgery. PMID:27011852

  6. WAYS TO IMPROVE RISK MANAGEMENT IN COMPLEX PROJECTS

    Directory of Open Access Journals (Sweden)

    Emilia IORDACHE

    2012-01-01

    Full Text Available Risk is present in all human activities; it can be associated with health, security, economy or environment. The goal of risk management is to control, prevent or decrease potential damages. Technically speaking, risk management means all the activities coordinated so as to orient and monitor an organization from the risk perspective. Risk management helps formulate the most adequate decisions by taking account of uncertainties and their effects upon the accomplishment of proposed goals, and argues the need to lay down and implement coercive, preventive actions typical of the management of a company. The benefits of good risk management and also the consequences of bad management shall undoubtedly be felt by an organization’s board, employees, shareholders, customers as well as by all other entities concerned with organizational performance. Projects generally include a number of risks in common with those in business as well as certain typical ones. In complex projects, it is this very feature – complexity – which generates the need to implement risk management for the purpose to diminish, remove, and monitor the risks which can influence the development of a project.

  7. Revision hip arthroplasty in patients with a previous total hip replacement for osteonecrosis of the femoral head.

    Science.gov (United States)

    Park, Youn-Soo; Moon, Young-Wan; Lee, Keun-Ho; Lim, Seung-Jae

    2014-12-01

    Patients with osteonecrosis of the femoral head are typically relatively young and active and often require high rates of revision after primary total hip arthroplasty. However, outcomes of revision hip arthroplasty in this patient population have rarely been reported in the literature. The authors conducted a retrospective review of 72 patients (75 hips) who underwent revision hip arthroplasty with a primary diagnosis of osteonecrosis of the femoral head. Mean age at index revision was 53.3 years (range, 34-76). Components of acetabular revision included a cementless porous-coated cup in 58 hips and an acetabular cage in 3 hips. Components of femoral revision included a fully grit-blasted tapered stem in 30 hips and a proximally porous-coated modular stem in 9 hips. Mean duration of follow-up was 7 years (range, 3-17). Mean Harris Hip Score improved from 49 points preoperatively to 90 points postoperatively. At final follow-up, 11 hips (14.7%) required reoperation because of aseptic loosening (6 hips), infection (2 hips), recurrent dislocation (1 hip), periprosthetic fracture (1 hip), and ceramic fracture (1 hip). Kaplan-Meier survivor-ship with an endpoint of re-revision for any reason was 81% and for mechanical failure was 87.5% for the cup and 100% for the stem at 10 years. Unlike the previous report, the authors' study showed a lower failure rate of the femoral stem after revision hip arthroplasty using modern cementless femoral components in patients with osteonecrosis of the femoral head. Aseptic cup loosening or osteolysis is the most common mechanism of failure at medium-term follow-up. Copyright 2014, SLACK Incorporated.

  8. Imaging of the hip: a systematic approach to the young adult hip

    Science.gov (United States)

    Chiamil, Sara Muñoz; Abarca, Claudia Astudillo

    2016-01-01

    Summary Background Great advances in knowledge and understanding of the biomechanics of the hip, both in arthroscopic procedures and imaging techniques, have expanded and improved the diagnosis of pathologies of the young adult hip. The anatomy of the hip joint is complex due to its morphology and orientation. The inter-pretation of the images requires deep knowledge of the osseous and soft tissue anatomy: muscles, tendons, ligaments, vessels and nerves. There are multiple imaging tools. Diagnostic techniques have different utilities and often are complementary. Methods In this article the various diagnostic imaging techniques for evaluation of hip pathologies are discussed, their indications and usefulness, with emphasis on those resolved arthroscopically. Conclusion Young adult hip disorders are increasingly diagnosed and treated as arthroscopic procedures improved. Radiology is a fundamental contribution in the diagnostic process. Plain radiography (X-ray) is always the initial examination. Level of evidence V. PMID:28066731

  9. The improvement paradox in project contexts: A clue to the way forward?

    OpenAIRE

    Brady, Tim; Maylor, Harvey

    2010-01-01

    This paper emerged as the authors struggled to make sense of a phenomenon observed during fieldwork. We had entered the field knowing a project-based organisation to be performing poorly and to be in need of improvement in its management of projects. We expected that the organisation would be actively trying to achieve the necessary improvement. We found that the organisation as a matter of course was not pursuing any improvement activities. It was only following a crisis wi...

  10. Compensation in Swedish infrastructure projects and suggestions on policy improvements

    Directory of Open Access Journals (Sweden)

    Jesper Persson

    2015-07-01

    Full Text Available Environmental compensation includes a range of activities intended to counterbalance such negative impacts of development projects that remain in the environment after all preventive and corrective measures have been fully implemented. Sweden, being a member state of the European Union (EU, must implement environmental compensation under EU directives such as the Habitat Directive. However, like in other countries, implementation is not yet widespread in Sweden, and new practices and guidelines remain to be developed both nationally and at European level. This need is all the more urgent considering that the European Commission estimates that, within the EU, about 100,000 hectares of land is converted from its natural state each year. The aim of this paper is to describe current environmental-compensation practices in Swedish road and railway projects and to discuss issues of vital importance to the development of compensation policy, such as what to compensate for, how much, and how. A national inventory was performed, for the first time in Sweden, to identify compensation measures in road and railway projects. Data were collected from a national mailing list including 141 officials at county administrative boards (CABs, internal e-mail correspondence within the Swedish Transport Administration and databases of court decisions. The inventory focused on compensation measures ordered by virtue of the Swedish Environmental Code. In addition, two case studies were carried out to investigate the planning of compensation measures. The results showed that CABs and courts rarely order compensation in infrastructure projects, even though this is possible under Swedish law. Between 1999 and 2012, 37 cases (i.e. permits issued were found for which compensation was ordered. Of these cases, 76% concerned compensation for encroachments on minor habitats such as small ponds and cairns. No CAB ordered compensation for non-protected areas. Compensation ratios

  11. A Framework for Improving Project Performance of Standard Design Models in Saudi Arabia

    Directory of Open Access Journals (Sweden)

    Shabbab Al-Otaib

    2013-07-01

    Full Text Available Improving project performance in the construction industry poses several challenges for stakeholders. Recently, there have been frequent calls for the importance of adopting standardisation in improving construction design as well as the process and a focus on learning mapping from other industries. The Saudi Ministry of Interior (SMoI has adopted a new Standard Design Model (SDM approach for the development of its construction programme to effectively manage its complex project portfolio and improve project performance. A review of existing literature indicates that despite the adoption of SDM repetitive projects, which enable learning from past mistakes and improving the performance of future projects, it has been realised that there is a lack of learning instruments to capture, store and disseminate Lessons Learnt (LL. This research proposes a framework for improving the project performance of SDMs in the Saudi construction industry. Eight case studies related to a typical standard design project were performed that included interviews with of 24 key stakeholders who are involved in the planning and implementation of SDM projects within the SMoI. The research identified 14 critical success factors CSFs have a direct impact on the SDM project performance. These are classified into three main CSF-related clusters: adaptability to the context; contract management; and construction management. A framework, which comprises the identified 14 CSFs, was developed, refined and validated through a workshop with 12 key stakeholders in the SMoI construction programme. Additionally, a framework implementation process map was developed. Web-based tools and KM were identified as core factors in the framework implementation strategy. Although many past CSF-related studies were conducted to develop a range of construction project performance improvement frameworks, the paper provides the first initiative to develop a framework to improve the performance of

  12. Improvement of projection-type associative memories by using a two-phase recalling procedure.

    Science.gov (United States)

    Lee, D L; Wang, W J

    1996-05-01

    In this letter, we propose a Two-Phase Recalling Procedure (TPRP) to improve the recall capability of the projection-type associative memory. It is known that the conventional projection dynamic sometimes produces spurious states that do not belong to the space spanned by the prototype vectors (memory space). The proposed TPRP provides a trapped spurious state another chance to project onto the memory space such that the recall capability of the projection-type associative memories can be greatly improved. Finally a simulation result demonstrates the effectiveness of the TPRP.

  13. Advanced Acoustic Blankets for Improved Aircraft Interior Noise Reduction Project

    Data.gov (United States)

    National Aeronautics and Space Administration — The objective of the proposed Phase II research effort is to develop heterogeneous (HG) blankets for improved sound reduction in aircraft structures. Phase I...

  14. Improved Stability of Mercuric Iodide Detectors for Anticoincidence Shields Project

    Data.gov (United States)

    National Aeronautics and Space Administration — We propose to utilize guard ring electrode structures and a new film growth technique to create improved polycrystalline mercuric iodide detectors for background...

  15. A Maximum Power Tracker for Improved Thermophotovoltaic Power Generation Project

    Data.gov (United States)

    National Aeronautics and Space Administration — Radioisotope Power Systems (RPS) are critical for future flagship exploration missions in space and on planetary surfaces. Small improvements in the RPS performance,...

  16. The ligamentum teres of the adult hip.

    Science.gov (United States)

    Bardakos, N V; Villar, R N

    2009-01-01

    Advances in hip arthroscopy have renewed interest in the ligamentum teres. Considered by many to be a developmental vestige, it is now recognised as a significant potential source of pain and mechanical symptoms arising from the hip joint. Despite improvements in imaging, arthroscopy remains the optimum method of diagnosing lesions of the ligamentum teres. Several biological or mechanical roles have been proposed for the ligament. Unless these are disproved, the use of surgical procedures that sacrifice the ligamentum teres, as in surgical dislocation of the hip, should be carefully considered. This paper provides an update on the development, structure and function of the ligamentum teres, and discusses associated clinical implications.

  17. Improved Projections of 21st Century Trans-Arctic Shipping

    Science.gov (United States)

    Melia, N.; Haines, K.; Hawkins, E.

    2015-12-01

    Climate models unanimously project a decline in the extent and thickness of Arctic sea ice as the climate warms, but at differing rates. Projecting the timing of an ice-free Arctic is a topic that has received considerable scientific and public attention. An ice-free Arctic opens up the potential for shorter global trade routes through the Arctic Ocean and there has already been a sharp increase in the number of transits along Russia's Northern Sea Route with escorts from nuclear powered icebreakers.Here we present results on the future of trans-Arctic shipping using bias corrected sea ice thickness projections, utilising the CMIP5 multi-model ensemble and considering multiple emission scenarios. We find that for 'Open Water' vessels (normal ocean going vessels that possess no specific ice strengthening), unaided trans-Arctic shipping is likely to become feasible in the next couple of decades. We find that the North West Passage will open approximately a decade later than the Northern Sea Route. Initially however, both routes exhibit marked inter-annual variability in accessibility which we quantify. The hypothesised trans-polar sea route through international waters via the North Pole will start to become navigable by 2050. Towards the latter period of the 21st century, normal ocean going vessels will be able to transit their choice of any of these routes for at least six months of any given year under the RCP 8.5 high future emissions scenario and four months for the lower RCP 4.5 emissions scenario. These findings suggest that further increases in global temperature could transform the Arctic into a global transport hub.

  18. A Traffic Light Grading System of Hip Dysplasia to Predict the Success of Arthroscopic Hip Surgery.

    Science.gov (United States)

    Grammatopoulos, George; Davies, Owain L I; El-Bakoury, Ahmed; Gill, Harinderjit S; Pollard, Tom C B; Andrade, Antonio J

    2017-06-01

    The role of hip arthroscopic surgery in dysplasia is controversial. To determine the 7-year joint preservation rate after hip arthroscopic surgery in hip dysplasia and identify anatomic and intraoperative features that predict the success of hip preservation with arthroscopic surgery, allowing the formulation of an evidence-based classification system. Case-control study; Level of evidence, 3. Between 2008 and 2013, 111 hips with dysplastic features (acetabular index [AI] >10° and/or lateral center-edge angle [LCEA] hip (AI, LCEA, extrusion index) were performed. Outcome measures included whether the hip was preserved (ie, did not require arthroplasty) at follow-up and the preoperative and postoperative Non-Arthritic Hip Score (NAHS) and Hip disability and Osteoarthritis Outcome Score (HOOS). The AI and LCEA were calculated, factored by a measure of articular wear (AIf and LCEAf, respectively), according to the University College Hospital, London (UCL) grading system as follows: AIf = AI × (number of UCL wear zones + 1), and LCEAf = LCEA / (number of UCL wear zones + 1). A contour plot of the resulting probability value of failure for every combination of AIf and LCEAf allowed for the determination of the zones with the lowest and highest incidences of failure to preserve the hip. The mean AI and LCEA were 9.8° and 18.0°, respectively. At a mean follow-up of 4.5 years (range, 0.4-8.3 years), 33 hips had failed, requiring hip arthroplasty. The 7-year joint survival rate was 68%. The mean improvements in the NAHS and HOOS were 11 ( P = .001) and 22.8 ( P hip survival rate in hip dysplasia appears inferior compared with that reported in femoroacetabular impingement (78%). Hip arthroscopic surgery is associated with an excellent chance of hip preservation in mild dysplasia (green zone: AI = 0°-15°, LCEA = 15°-25°) and no articular wear. The authors advise that the greatest caution should be used when considering arthroscopic options in cases of severe dysplasia

  19. Hip Reconstruction Osteotomy by Ilizarov Method as a Salvage Option for Abnormal Hip Joints

    Directory of Open Access Journals (Sweden)

    Masood Umer

    2014-01-01

    Full Text Available Hip joint instability can be secondary to congenital hip pathologies like developmental dysplasia (DDH or acquired such as sequel of infective or neoplastic process. An unstable hip is usually associated with loss of bone from the proximal femur, proximal migration of the femur, lower-extremity length discrepancy, abnormal gait, and pain. In this case series of 37 patients coming to our institution between May 2005 and December 2011, we report our results in treatment of unstable hip joint by hip reconstruction osteotomy using the Ilizarov method and apparatus. This includes an acute valgus and extension osteotomy of the proximal femur combined with gradual varus and distraction (if required for realignment and lengthening at a second, more distal, femoral osteotomy. 18 males and 19 females participated in the study. There were 17 patients with DDH, 12 with sequelae of septic arthritis, 2 with tuberculous arthritis, 4 with posttraumatic arthritis, and 2 with focal proximal femoral deficiency. Outcomes were evaluated by using Harris Hip Scoring system. At the mean follow-up of 37 months, Harris Hip Score had significantly improved in all patients. To conclude, illizarov hip reconstruction can successfully improve Trendelenburg’s gait. It supports the pelvis and simultaneously restores knee alignment and corrects lower-extremity length discrepancy (LLD.

  20. The trauma report nurse: a trauma triage process improvement project.

    Science.gov (United States)

    Jelinek, Lisa; Fahje, Carol; Immermann, Carol; Elsbernd, Terri

    2014-09-01

    Accurate trauma triage is imperative to facilitate appropriate resource mobilization for severely injured trauma patients. A critical window of opportunity exists to prevent secondary injury or death. Timely assessment with a multidisciplinary trauma team is essential to facilitate rapid diagnosis and treatment. However, consistent and accurate trauma triage proved daunting at our institution, resulting in instances of undertriage. A process improvement strategy aimed at improving trauma triage accuracy was implemented. An innovative role, the trauma report nurse (TRN), was created and became the trauma nurse expert. The TRN was responsible for assigning a trauma triage level to all incoming adult and pediatric trauma patients. In parallel, improvements were made to the prehospital report format, increasing standardization and clarifying hand-off verbiage. Undertriage rates dropped from 14% to 4.8%. Qualitative data demonstrated acceptance and support of the TRN role among physicians, nurses and nursing and ancillary staff. Designating trauma triage to an ED registered nurse proved to reduce undertriage rates. By providing staff education, infrastructure improvements, and leadership support, the role continues to thrive, resulting in improved care for severely injured trauma patients. Copyright © 2014 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved.

  1. The Effect of the Hayward Corridor Improvement Project on Carbon Monoxide Emission

    Science.gov (United States)

    Muhlfelder, M.; Martinez, E.; Maestas, A.; Peek, A.

    2013-12-01

    In August of 2010, construction began on a stretch of road in Downtown Hayward to address a problem with traffic flow. Known as the Hayward Corridor, the project reshaped the flow of traffic, replacing the two way streets of Foothill, Mission, and A Street with a loop between them. This project began with the initiative of reducing congestion in this area and improving access to businesses for pedestrians. The project was expected to have little environmental impact in most common assessments of degree of effect, including particulate matter, ozone and carbon monoxide levels. This report will discuss the effect of the Hayward Corridor Improvement Project on carbon monoxide emission. Data available to the public in the project's Environmental Impact Report shows that carbon monoxide levels before construction began were at an acceptable level according to federal and state standards. Projections for future concentrations both with and without the project show a decrease in carbon monoxide levels due to technological improvements and the gradual replacement of older, less efficient vehicles. The Environmental Impact Report projected that there would be little difference in carbon monoxide levels whether the project took place or not, at an average of 1.67x102 fewer parts per million per 1 hour period of measurement emitted in the case of the project not taking place. While it is not possible to draw a conclusion on what the current carbon monoxide levels would be if the project had not taken place due to the changes in traffic flow and other surrounding roads as a result of the project, the data gathered in June of 2013 suggested that carbon monoxide levels are higher than the values projected in 2007. This report summarizes both the accuracy of these carbon monoxide level projections and the effect of construction on carbon monoxide levels in the Hayward Corridor and the surrounding area.

  2. Improvements Needed in Managing Scope Changes and Oversight of Construction Projects at Camp Lemonnier, Djibouti

    Science.gov (United States)

    2016-09-30

    Improvements Needed in Managing Scope Changes and Oversight of Construction Projects at Camp Lemonnier, Djibouti S E P T E M B E R 3 0 , 2 0 1 6 Report...Improvements Needed in Managing Scope Changes and Oversight of Construction Projects at Camp Lemonnier, Djibouti Visit us at www.dodig.mil Objective We...Findings (cont’d) ii │ DODIG-2016-141 (Project No. D2014-D000RE-0157.000) Results in Brief Improvements Needed in Managing Scope Changes and Oversight

  3. Conducting a Successful Practice Quality Improvement Project for American Board of Radiology Certification.

    Science.gov (United States)

    Lee, Cindy S; Wadhwa, Vibhor; Kruskal, Jonathan B; Larson, David B

    2015-10-01

    Practice quality improvement (PQI) is a required component of the American Board of Radiology (ABR) Maintenance of Certification (MOC) cycle, with the goal to "improve the quality of health care through diplomate-initiated learning and quality improvement." The essential requirements of PQI projects include relevance to one's practice, achievability in one's clinical setting, results suited for repeat measurements during an ABR MOC cycle, and reasonable expectation to result in quality improvement (QI). PQI projects can be performed by a group or an individual or as part of a participating institution. Given the interdisciplinary nature of radiology, teamwork is critical to ensure patient safety and the success of PQI projects. Additionally, successful QI requires considerable investment of time and resources, coordination, organizational support, and individual engagement. Group PQI projects offer many advantages, especially in larger practices and for processes that cross organizational boundaries, whereas individual projects may be preferred in small practices or for focused projects. In addition to the three-phase "plan, do, study, act" model advocated by the ABR, there are several other improvement models, which are based on continuous data collection and rapid simultaneous testing of multiple interventions. When properly planned, supported, and executed, group PQI projects can improve the value and viability of a radiology practice.

  4. Improvement in RUP Project Management via Service Monitoring: Best Practice of SOA

    CERN Document Server

    Saqib, Sheikh Muhammad; Hussain, Shahid; Ahmad, Bashir; Bano, Arjamand

    2010-01-01

    Management of project planning, monitoring, scheduling, estimation and risk management are critical issues faced by a project manager during development life cycle of software. In RUP, project management is considered as core discipline whose activities are carried in all phases during development of software products. On other side service monitoring is considered as best practice of SOA which leads to availability, auditing, debugging and tracing process. In this paper, authors define a strategy to incorporate the service monitoring of SOA into RUP to improve the artifacts of project management activities. Moreover, the authors define the rules to implement the features of service monitoring, which help the project manager to carry on activities in well define manner. Proposed frame work is implemented on RB (Resuming Bank) application and obtained improved results on PM (Project Management) work.

  5. Improving Sanitation Project Management for Unsewered Rural Communities in Morocco

    Directory of Open Access Journals (Sweden)

    M MAHI

    2015-06-01

    Full Text Available The hydraulic potential in Morocco is limited, droughts are more frequent, resulting of climate change, and increasing water demand relating to the population growth and socio-economic development. Morocco has invested in the urban sanitation sector through the establishment of the National Liquid Sanitation Program. In rural Area, the intervention in this sector remains limited due to various constraints. In order to support the efforts of establishment of the National Rural Assainissment Program (PNAR, we conducted a case study that recommended the treatment of wastewater by an innovative process used for the first time in Morocco. We realized, first, a pilot experiment at the douar (Unstructured Village Talat Marghen within the rural Municipality of Aghouatim a few km from Marrakech. The innovative aspect of the project is managerial proposes covering the different technical aspects, management and institutional innovation, to meet the various constraints that characterize the rural areas.

  6. Improving Instruction: The Napa County Follow Through Research Project.

    Science.gov (United States)

    Robbins, Pam

    1985-01-01

    Developing a model to improve student academic learning time and achievement and to develop local resources to continue the program after the funding period required a staff development program that enabled teachers to use specific direct instruction teaching behaviors. The staff development program is described and recommendations are made. (MT)

  7. Imaging of hip arthroplasty

    Energy Technology Data Exchange (ETDEWEB)

    Miller, Theodore T., E-mail: millertt@hss.edu [Department of Radiology and Imaging, Hospital for Special Surgery, 535 E. 70th Street, New York, NY 10021 (United States)

    2012-12-15

    The imaging evaluation of the prosthetic hip begins with radiography, but arthrography, aspiration, scintigraphy, sonography, CT and MR imaging all have roles in the evaluation of the painful prosthesis. This article will review the appearance of normal hip arthroplasty including hemiarthroplasty, total arthroplasty, and hip resurfacing, as well as the appearances of potential complications such as aseptic loosening and osteolysis, dislocation, infection, periprosthetic fracture, hardware failure, and soft tissue abnormalities.

  8. Hip resurfacing arthroplasty

    OpenAIRE

    2010-01-01

    Background and purpose Hip resurfacing arthroplasty is claimed to allow higher activity levels and to give better quality of life than total hip arthroplasty. In this literature review, we assessed the therapeutic value of hip resurfacing arthroplasty as measured by functional outcome. Methods An extensive literature search was performed using the PubMed, Embase, and Cochrane databases. Results 9 patient series, 1 case-control study, and 1 randomized controlled trial (RCT) were included. Clin...

  9. The strength and function of hip abductors following anterolateral minimally invasive total hip arthroplasty

    Directory of Open Access Journals (Sweden)

    Tan Jixiang

    2014-04-01

    Full Text Available Objective: To analyze the extent of postoperative hip abductor insufficiency in primary total hip arthroplasty (THA patients undergoing anterolateral minimally invasive (ALMI approach, and to investigate whether the clinical outcomes are more favorable in femoral neck fracture (FNF patients than in non-femoral neck fracture (nFNF patients. Methods:A total of 48 patients were enrolled in this study. Each patient underwent a clinical examination preoperatively and 6, 12, 24 and 48 weeks postoperatively. The abductor torque, Trendelenburg's sign, gait velocity, Harris hip score, Oxford hip score, Westren Ontario and McMaster Universities (WOMAC score and visual analog scale pain score were recorded. Statistical evaluation was performed with SPSS software version 18.0. The significance level was set at P<0.05. Results:The abductor torque of the operated hip and the recovery ratio showed a gradual improving tendency from 6 weeks postoperatively until the last follow-up. Gait velocity, Harris hip score, Oxford hip score and WOMAC score improved significantly after the operation until 24 weeks postoperatively. In the FNF group, the abductor torque of the operated side and the recovery ratio were significantly higher than in nFNF group at 6 weeks postoperatively, however, as time passed, this trend tended to disappear. Conclusion:This study demonstrates that patients can obtain good abductor strength and function in the early postoperative period and the hip abductor function of patients who suffer from hip osteoarthritis, rheumatoid arthritis, avascular necrosis of the femoral head could be significantly improved following ALMI THA. Key words: Arthroplasty, replacement, hip; Surgical procedures, minimally invasive; Recovery of function

  10. Novel and Improved Nanomaterials, Chemistries and Apparatus for Nanobiotechnology: the NACBO project.

    Science.gov (United States)

    Bruce, Ian James

    2011-02-01

    This article outlines the nature and activities of the recently completed EU Framework Programme 6 Integrated Project, Novel and Improved Nanomaterials, Chemistries and Apparatus for Nanobiotechnology (NACBO). This project was designed to yield new nanomaterials, surface activation and synthetic nucleic acid chemistries, procedures and hardware for applications in forensics and diagnostics. It provides details on the project's structure and partnership along with its principal objectives and successes in terms of publications and commercial exploitation.

  11. Potential Improvement of Building Information Modeling (BIM) Implementation in Malaysian Construction Projects

    OpenAIRE

    Latiffi, Aryani,; Mohd, Suzila; Rakiman, Umol,

    2015-01-01

    Part 4: Building Information Modeling (BIM); International audience; Application of building information modeling (BIM), such as preview design clashes and visualize project’s model increase effectiveness in managing construction projects. However, its implementation in Malaysian construction projects is slow in order to see and gain the benefits. Therefore, this paper aims to explore on potential improvement that could increase BIM implementation in construction projects. A literature review...

  12. Differential diagnosis of pain around the hip joint.

    Science.gov (United States)

    Tibor, Lisa M; Sekiya, Jon K

    2008-12-01

    The differential diagnosis of hip pain is broad and includes intra-articular pathology, extra-articular pathology, and mimickers, including the joints of the pelvic ring. With the current advancements in hip arthroscopy, more patients are being evaluated for hip pain. In recent years, our understanding of the functional anatomy around the hip has improved. In addition, because of advancements in magnetic resonance imaging, the diagnosis of soft tissue causes of hip pain has improved. All of these advances have broadened the differential diagnosis of pain around the hip joint and improved the treatment of these problems. In this review, we discuss the causes of intra-articular hip pain that can be addressed arthroscopically: labral tears, loose bodies, femoroacetabular impingement, capsular laxity, tears of the ligamentum teres, and chondral damage. Extra-articular diagnoses that can be managed arthroscopically are also discussed, including: iliopsoas tendonitis, "internal" snapping hip, "external" snapping hip, iliotibial band and greater trochanteric bursitis, and gluteal tendon injury. Finally, we discuss extra-articular causes of hip pain that are often managed nonoperatively or in an open fashion: femoral neck stress fracture, adductor strain, piriformis syndrome, sacroiliac joint pain, athletic pubalgia, "sports hernia," "Gilmore's groin," and osteitis pubis.

  13. Senior Project: Analysis and Improvement of Existing Apparel Technology

    Science.gov (United States)

    1991-09-10

    and improve the quality of the seam , the major cost centers - work in process, operator handlinq, and production control were left far behind. Was it...skilled operation when performed manually; the curve must be stitched without puckering or irregular stitches and the line must remain parallel to the...equipped with side seam expanders. In this plant the Ajax Presses had been modified with a spring I steel clamp on the back of the buck to secure the box

  14. Improvement of the Biogas Production Process : Explorative project (EP1)

    OpenAIRE

    Karlsson, Anna; Björn, Annika; Sepehr, Shakeri Yekta; Svensson, Bo

    2014-01-01

    There are several ways to improve biogas production in anaerobic digestion processes and a number of strategies may be chosen. Increased organic loading in existing plants will in most cases demand the introduction of new substrate types. However, to substantially increase the Swedish biogas production new, large-scale biogas plants digesting new substrate types need to be established. Better utilization of existing digester volumes can be linked to:  Increase of organic loading rates and/or ...

  15. Project B: Improved Liquid Steel Feed For Slab Casters

    Energy Technology Data Exchange (ETDEWEB)

    Brent S. Isaacson; Mike Slepian; Thomas Richter

    1998-10-01

    This report describes the completion of the development of an electromagnetic valve to control liquid steel flow for improved liquid steel feeding for slab casters. Achievements result from a joint research effort between Westinghouse Science and Technology Center, North American Refractories and U.S. Steel. This effort is part of the American Iron and Steel Institute's (AISI) Advanced Process Control Program, a collaboration between the U.S. Department of Energy (DOE) and fifteen North American steel makers.

  16. Resistance Factors in the Implementation of Software Process Improvement Project in Malaysia

    Directory of Open Access Journals (Sweden)

    Mohd H.N.M. Nasir

    2008-01-01

    Full Text Available For the past two decades, improving the quality of software has become an important agenda in the software industries as they have been assessed according to standards such as the CMM, CMM-I, ISO 9000 SIX-SIGMA and etc. As the result, software process improvement project implementations have been the main targets by most software companies. However, many initiatives are facing variety of problems and difficulties due to lack of guidance and experience. Hence, this research attempted to identify and analyze main resistance factors which influenced the implementation of the software process improvement project specifically companies operated in Malaysia including local and multi-national companies. The findings helped other software companies to manage future projects through the use of preventive actions or proper planning which intended to lessen anticipated problems during software process improvement projects implementation. This research used a survey instrument to gather data from 29 companies operated across Malaysia with the total of 174 business and software professionals responded. Average of 4 to 8 questionnaires were distributed to each company with the objective of getting wider views on each SPI project. The questionnaires were mainly distributed to professionals who are directly involved in SPI projects. The results showed that the most critical resistance factor is lack of adhesion and participation of the entire individual involved in SPI projects. This result is similar with the result gained by Brietzke and Rabello which they have conducted it in Brazil and corroborated the research findings experience in SPI project.

  17. Investing in Educator Data Literacy Improves Student Achievement. Evidence of Impact: The Oregon Data Project

    Science.gov (United States)

    Data Quality Campaign, 2012

    2012-01-01

    Since 2007 the Oregon DATA Project has been investing resources to provide educators on-the-job training around effective data use to improve student achievement. New evidence shows that their efforts are paying off. A 2011 Oregon DATA Project report detailed the impact of their investment in the state's educators, finding the following: (1)…

  18. The Critical Care Communication project: improving fellows' communication skills.

    Science.gov (United States)

    Arnold, Robert M; Back, Anthony L; Barnato, Amber E; Prendergast, Thomas J; Emlet, Lillian L; Karpov, Irina; White, Patrick H; Nelson, Judith E

    2015-04-01

    The aim of this study was to develop an evidence-based communication skills training workshop to improve the communication skills of critical care fellows. Pulmonary and critical care fellows (N = 38) participated in a 3-day communication skills workshop between 2008 and 2010 involving brief didactic talks, faculty demonstration of skills, and faculty-supervised small group skills practice sessions with simulated families. Skills included the following: giving bad news, achieving consensus on goals of therapy, and discussing the limitations of life-sustaining treatment. Participants rated their skill levels in a pre-post survey in 11 core communication tasks using a 5-point Likert scale. Of 38 fellows, 36 (95%) completed all 3 days of the workshop. We compared pre and post scores using the Wilcoxon signed rank test. Overall, self-rated skills increased for all 11 tasks. In analyses by participant, 95% reported improvement in at least 1 skill; with improvement in a median of 10 of 11 skills. Ninety-two percent rated the course as either very good/excellent, and 80% recommended that it be mandatory for future fellows. This 3-day communication skills training program increased critical care fellows' self-reported family meeting communication skills. Copyright © 2014 Elsevier Inc. All rights reserved.

  19. An Assessment of Stream Health in Urban Creeks with Community Led Improvement Projects

    Science.gov (United States)

    Sanchez, L.; Mercado, M.

    2016-12-01

    Small-scale restoration and improvement projects along urban creeks have become increasingly common and the need to assess their impact on stream health is necessary. Courtland and Peralta Creek have been subject to a variety of community, non-profit and city sponsored improvement projects. Assessment of nutrient contamination in the form of ammonia and nitrate indicate that these urban creeks have been impacted by human activity (Water Quality of Peralta and Courtland Creeks Oakland, CA, A. Ahumada). Continued assessment of the stream health through nitrate, ammonia and phosphate concentrations, benthic invertebrate derived biotic index and E. coli concentrations were used to assess site improvements. Youth and community site improvement project at Courtland Creek has resulted in the decline of nitrate contamination and an overall increase in benthic invertebrates species. Peralta Creek has a group of dedicated community volunteers that participate in clean up events but is just now implementing a planned restoration project increasing native plant diversity at the site.

  20. 75 FR 38538 - Central Valley Project Improvement Act, Water Management Plans

    Science.gov (United States)

    2010-07-02

    ... Bureau of Reclamation Central Valley Project Improvement Act, Water Management Plans AGENCY: Bureau of Reclamation, Interior. ACTION: Notice of availability. SUMMARY: The following Water Management Plans are... 1982, the Bureau of Reclamation developed and published the Criteria for Evaluating Water...

  1. 75 FR 70020 - Central Valley Project Improvement Act, Water Management Plans

    Science.gov (United States)

    2010-11-16

    ... Bureau of Reclamation Central Valley Project Improvement Act, Water Management Plans AGENCY: Bureau of Reclamation, Interior ACTION: Notice of Availability. SUMMARY: The following Water Management Plans are... Bureau of Reclamation developed and published the Criteria for Evaluating Water Management...

  2. 77 FR 33240 - Central Valley Project Improvement Act, Water Management Plans

    Science.gov (United States)

    2012-06-05

    ... Bureau of Reclamation Central Valley Project Improvement Act, Water Management Plans AGENCY: Bureau of Reclamation, Interior. ACTION: Notice of availability. SUMMARY: The following Water Management Plans are... Bureau of Reclamation developed and published the Criteria for Evaluating Water Management...

  3. 76 FR 54251 - Central Valley Project Improvement Act, Water Management Plans

    Science.gov (United States)

    2011-08-31

    ... Bureau of Reclamation Central Valley Project Improvement Act, Water Management Plans AGENCY: Bureau of Reclamation, Interior. ACTION: Notice of availability. SUMMARY: The following Water Management Plans are... Management Plans (Criteria). For the purpose of this announcement, Water Management Plans (Plans)...

  4. 76 FR 12756 - Central Valley Project Improvement Act, Water Management Plans

    Science.gov (United States)

    2011-03-08

    ... Bureau of Reclamation Central Valley Project Improvement Act, Water Management Plans AGENCY: Bureau of Reclamation, Interior. ACTION: Notice of availability. SUMMARY: The following Water Management Plans are... published the Criteria for Evaluating Water Management Plans (Criteria). For the purpose of...

  5. 78 FR 21414 - Central Valley Project Improvement Act, Water Management Plans

    Science.gov (United States)

    2013-04-10

    ... Bureau of Reclamation Central Valley Project Improvement Act, Water Management Plans AGENCY: Bureau of Reclamation, Interior. ACTION: Notice of availability. SUMMARY: The following Water Management Plans are... Water Management Plans (Criteria). For the purpose of this announcement, Water Management Plans...

  6. 78 FR 22947 - Open Meeting of the Taxpayer Advocacy Panel Taxpayer Assistance Center Improvements Project...

    Science.gov (United States)

    2013-04-17

    ... Internal Revenue Service Open Meeting of the Taxpayer Advocacy Panel Taxpayer Assistance Center.... SUMMARY: An open meeting of the Taxpayer Advocacy Panel Taxpayer Assistance Center Improvements Project Committee will be conducted. The Taxpayer Advocacy Panel is soliciting public comments, ideas,...

  7. 78 FR 41194 - Open Meeting of the Taxpayer Advocacy Panel Taxpayer Assistance Center Improvements Project...

    Science.gov (United States)

    2013-07-09

    ... Internal Revenue Service Open Meeting of the Taxpayer Advocacy Panel Taxpayer Assistance Center.... SUMMARY: An open meeting of the Taxpayer Advocacy Panel Taxpayer Assistance Center Improvements Project Committee will be conducted. The Taxpayer Advocacy Panel is soliciting public comments, ideas,...

  8. 78 FR 64064 - Open Meeting of the Taxpayer Advocacy Panel Taxpayer Assistance Center Improvements Project...

    Science.gov (United States)

    2013-10-25

    ... Internal Revenue Service Open Meeting of the Taxpayer Advocacy Panel Taxpayer Assistance Center.... SUMMARY: An open meeting of the Taxpayer Advocacy Panel Taxpayer Assistance Center Improvements Project Committee will be conducted. The Taxpayer Advocacy Panel is soliciting public comments, ideas,...

  9. 78 FR 78516 - Open Meeting of the Taxpayer Advocacy Panel Taxpayer Assistance Center Improvements Project...

    Science.gov (United States)

    2013-12-26

    ... Internal Revenue Service Open Meeting of the Taxpayer Advocacy Panel Taxpayer Assistance Center.... SUMMARY: An open meeting of the Taxpayer Advocacy Panel Taxpayer Assistance Center Improvements Project Committee will be conducted. The Taxpayer Advocacy Panel is soliciting public comments, ideas,...

  10. Fracture After Total Hip Replacement

    Science.gov (United States)

    ... osteolysis. Symptoms The most common symptoms of periprosthetic hip fracture include: • Pain around the hip or thigh • Swelling ... o en very painful, someone with a periprosthetic hip fracture will most likely go directly to the emergency ...

  11. Hip Fractures among Older Adults

    Science.gov (United States)

    ... online training for health care providers. Learn More Hip Fractures Among Older Adults Recommend on Facebook Tweet Share ... get older. What You Can Do to Prevent Hip Fractures You can prevent hip fractures by taking steps ...

  12. Collaborative Project: Improving the Representation of Coastal and Estuarine Processes in Earth System Models

    Energy Technology Data Exchange (ETDEWEB)

    Bryan, Frank [Univ. of Washington, Seattle, WA (United States); Dennis, John [Univ. of Washington, Seattle, WA (United States); MacCready, Parker [Univ. of Washington, Seattle, WA (United States); Whitney, Michael [Univ. of Washington, Seattle, WA (United States)

    2016-10-20

    This project aimed to improve long term global climate simulations by resolving and enhancing the representation of the processes involved in the cycling of freshwater through estuaries and coastal regions. This was a collaborative multi-institution project consisting of physical oceanographers, climate model developers, and computational scientists. It specifically targeted the DOE objectives of advancing simulation and predictive capability of climate models through improvements in resolution and physical process representation.

  13. Final Report Collaborative Project: Improving the Representation of Coastal and Estuarine Processes in Earth System Models

    Energy Technology Data Exchange (ETDEWEB)

    Bryan, Frank [Univ. of Connecticut, Storrs, CT (United States); Dennis, John [Univ. of Connecticut, Storrs, CT (United States); MacCready, Parker [Univ. of Connecticut, Storrs, CT (United States); Whitney, Michael M. [Univ. of Connecticut, Storrs, CT (United States)

    2016-09-30

    This project aimed to improve long term global climate simulations by resolving and enhancing the representation of the processes involved in the cycling of freshwater through estuaries and coastal regions. This was a collaborative multi-institution project consisting of physical oceanographers, climate model developers, and computational scientists. It specifically targeted the DOE objectives of advancing simulation and predictive capability of climate models through improvements in resolution and physical process representation.

  14. Cementless Total Hip Arthroplasty With a High Hip Center for Hartofilakidis Type B Developmental Dysplasia of the Hip: Results of Midterm Follow-Up.

    Science.gov (United States)

    Chen, Min; Luo, Zheng-Liang; Wu, Ke-Rong; Zhang, Xiao-Qi; Ling, Xiao-Dong; Shang, Xi-Fu

    2016-05-01

    Acetabular reconstruction in adults with Hartofilakidis type B developmental dysplasia of the hip is a major technical challenge. The purpose of this retrospective study was to evaluate hip function and radiographic outcomes regarding high hip center at midterm follow-up. From January 1, 2007 to December 31, 2009, 37 patients who had Hartofilakidis type B developmental dysplasia of the hip underwent a primary total hip arthroplasty using a high hip center technique. Functional, radiographic, and survivorship outcomes were evaluated. Of the 37 patients, 31 patients (83.8%) were available for the mean follow-up of 6.1 years (range, 1.5-7.6 years). Thirty-one cementless cups were located at an average vertical distance of 38.1 ± 3.3 mm and at a mean horizontal distance of 35.5 ± 3.4 mm. The mean ratio of the height of the hip center was 2.4% (range, 2.0%-2.9%). The Harris Hip Scores were improved from 50.3 points (range, 38-63 points) preoperatively to 92.3 points (range, 85-100 points) at the final follow-up (P hip center technique in conjunction with a cementless acetabular component seems to be a valuable alternative to achieve satisfactory midterm outcomes for Hartofilakidis type B developmental dysplasia of the hip. Copyright © 2016 Elsevier Inc. All rights reserved.

  15. CONSERVATIVE TREATMENT OF HIP DYSPLASIA

    OpenAIRE

    Михаил Михайлович Камоско; Махмуд Станиславович Познович

    2014-01-01

    Hip dysplasia in children is the subject of careful study by specialists both in our country and abroad. There are three basic variants of hip dysplasia: congenital acetabular dysplasia, congenital subluxation of the hip and congenital dislocation of the hip. However, treatment of congenital dislocation of the hip, which is the most severe form of hip dysplasia in children, currently remains one of the topical problems of children’s orthopedics, despite the significant achievements of modern ...

  16. Institutionalizing pain management: the Post-Operative Pain Management Quality Improvement Project.

    Science.gov (United States)

    Dahl, June L; Gordon, Deb; Ward, Sandra; Skemp, Marty; Wochos, Sarah; Schurr, Michael

    2003-09-01

    Clinical practice and quality improvement (QI) guidelines for acute postoperative pain management have been developed to address the well-documented problem of undertreatment of postoperative pain. The Post-Operative Pain Management Quality Improvement Project (the POP Project) was initiated to determine whether an intervention designed to support hospitals in the development of QI efforts would lead to improvements in structures, processes, and outcomes consistent with recommended guidelines. A nationwide sample of 233 hospitals joined the project. The intervention consisted of written resource materials accompanied by support services that included an e-mail list server, a resource Web page, and assistance from POP Project staff via telephone. Data regarding critical structures, processes (practice patterns), and patient outcomes were collected at baseline before the intervention began and at follow-up 12 to 18 months later. Results showed a statistically significant increase from baseline (45%) to follow-up (72%) in the presence of structural elements that are critical to improving pain management. There were statistically significant improvements in practices including documented use of pain rating scales, decreased use of intramuscular opioids, and increased use of nonpharmacologic strategies. Patient survey data showed no change in pain outcomes. Evaluation data showed that 70% of hospitals were very or extremely satisfied with their participation in the POP Project and 90% of them planned to continue efforts to improve pain management after the POP Project ended. Further research is needed to determine how to translate the excellent results obtained for structure and process into meaningful outcomes for patients.

  17. Communication in high technology product development projects:project personnel’s viewpoint for improvement

    OpenAIRE

    Väänänen, M. (Mirja)

    2010-01-01

    Abstract Product development plays a crucial role in the survival of high technology companies. High technology product development projects typically are multi-technical, multicultural, geographically dispersed, inter-connected and organized in a network of companies. These settings pose extra challenges for communication. In this qualitative multiple-case study, communication challenges and possible solutions for developing communication were studied. The empirical data were collect...

  18. Bernese periacetabular osteotomy for hip dysplasia: Surgical technique and indications.

    Science.gov (United States)

    Kamath, Atul F

    2016-05-18

    For young, active patients with healthy hip cartilage, pelvic osteotomy is a surgical option in to address hip pain and to improve mechanical loading conditions related to dysplasia. Hip dysplasia may lead to arthrosis at an early age due to poor coverage of the femoral head and abnormal loading of the joint articulation. In patients with symptomatic dysplasia and closed triradiate cartilage (generally over age 10), including adolescents and young adults (generally up to around age 40), the Bernese periacetabular osteotomy (PAO) is a durable technique for addressing underlying structural deformity. The PAO involves a modified Smith-Petersen approach. Advantages of the Bernese osteotomy include preservation of the weight-bearing posterior column of the hemi-pelvis, preservation of the acetabular blood supply, maintenance of the hip abductor musculature, and the ability to effect powerful deformity correction about an ideal center of rotation. There is an increasing body of evidence that preservation of the native hip can be improved through pelvic osteotomy. In contrast to hip osteotomy and joint preservation, the role of total hip arthroplasty in young, active patients with correctable hip deformity remains controversial. Moreover, the durability of hip replacement in young patients is inherently limited. Pelvic osteotomy should be considered the preferred method to address correctable structural deformity of the hip in the young, active patient with developmental dysplasia. The Bernese PAO is technically demanding, yet offers reproducible results with good long-term survivorship in carefully selected patients with preserved cartilage and the ability to meet the demands of rehabilitation.

  19. The programme benefits of improving project team communication through a contact centre

    Directory of Open Access Journals (Sweden)

    Bond-Barnard, T. J.

    2013-08-01

    Full Text Available A South African national programme to repair government infrastructure uses a contact centre (or call centre to facilitate and manage communication. An important question is: How does the contact centre benefit the programme and its projects? This study discusses the findings of a survey that quantified the benefits of the programme when the communication between team members in the programme was improved by using a contact centre. The results show that, by using a contact centre to improve the communication between project team members, their perception of communication effectiveness, quality of project deliverables, service delivery, and customer satisfaction of the programme dramatically increases.

  20. The Bristol Hip View: Its Role in the Diagnosis and Surgical Planning and Occult Fracture Diagnosis for Proximal Femoral Fractures

    Directory of Open Access Journals (Sweden)

    J. Harding

    2013-01-01

    Full Text Available Aim. To evaluate whether a modified radiographic view of the femoral neck improves the diagnosis of occult proximal femoral. Materials and Methods. Prospective study of patients presenting with clinically suspected proximal femoral fractures or who underwent traditional plain radiographic views and the Bristol hip view (a 30-degree angled projection. Six blinded independent observers assessed the images for presence of a fracture, anatomical level, and displacement. Results. 166 consecutive patients presenting with the clinical diagnosis of a proximal femoral fracture, of which 61 sustained a fracture. Six of these were deemed occult due to negative plain and had proven fractures on subsequent cross-sectional imaging. The Bristol hip view demonstrated five of these six fractures. It performed better than the traditional lateral hip view to identify the injury. The Bristol hip view predicted correctly the fracture type and displacement in all cases and missed only one of the occult fractures. Conclusion. The Bristol hip view is more sensitive and clearer than a lateral projection for patients. It adds useful diagnostic information and performs better than the traditional views in occult fractures. Its use may prevent the need for further cross sectional imaging and subsequent surgical delay.

  1. Maintaining Perioperative Normothermia: Sustaining an Evidence-Based Practice Improvement Project.

    Science.gov (United States)

    Levin, Rona F; Wright, Fay; Pecoraro, Kathleen; Kopec, Wendy

    2016-02-01

    Unintentional perioperative hypothermia has been shown to cause serious patient complications and, thus, to increase health care costs. In 2009, an evidence-based practice improvement project produced a significant decrease in unintentional perioperative hypothermia in colorectal surgical patients through monitoring of OR ambient room temperature. Project leaders engaged all interdisciplinary stakeholders in the original project, which facilitated the sustainability of the intervention method. An important aspect of sustainability is ongoing monitoring and evaluation of a new intervention method. Therefore, continued evaluation of outcomes of the protocol developed in 2009 was scheduled at specific time points after the initial small test of change with colorectal patients. This article focuses on how attention to sustainability factors during implementation of an improvement project led to the sustainability of a protocol for monitoring OR ambient room temperature with all types of surgical patients five years after the initial project.

  2. Hip joint pathology

    DEFF Research Database (Denmark)

    Tijssen, M; van Cingel, R E H; de Visser, E

    2016-01-01

    The purpose of this retrospective cohort study was to (a) describe the clinical presentation of femoroacetabular impingement (FAI) and hip labral pathology; (b) describe the accuracy of patient history and physical tests for FAI and labral pathology as confirmed by hip arthroscopy. Patients (18-6...

  3. Hip Resurfacing Implants.

    Science.gov (United States)

    Cadossi, Matteo; Tedesco, Giuseppe; Sambri, Andrea; Mazzotti, Antonio; Giannini, Sandro

    2015-08-01

    EDUCATIONAL OBJECTIVES As a result of reading this article, physicians should be able to: 1. Describe the advantages of hip resurfacing. 2. Describe the disadvantages of hip resurfacing. 3. Identify the population in which hip resurfacing is most often indicated. 4. Demonstrate how to properly postoperatively manage patients with metal-on-metal prostheses. Hip resurfacing offers a suitable solution for young patients affected by hip disease who have high function demands and good bone quality. Bone stock preservation, restoration of the normal proximal femur anatomy, the lack of stress shielding, and the possibility of resuming sporting activity are proven advantages of hip resurfacing. However, there are some disadvantages, such as fracture of the femoral neck, onset of neck narrowing, and possible complications due to the metal-on-metal bearings, including pseudotumors, peri-implant osteolysis, and chronic elevation of metal ions in serum levels. Recent data suggest that the ideal candidate for hip resurfacing is an active male, younger than 65 years, with primary or posttraumatic osteoarthritis, and with a femoral head diameter larger than 50 to 54 mm. Based on these selection criteria, the literature reports implant survival to be similar to that of total hip arthroplasty. The current authors' experience confirms a low failure rate and excellent functional outcomes, with metal ion serum levels becoming stable over time in well-functioning implants. Proper surgical technique, correct patient selection, and the right choice of a well-established prosthetic model are essential elements for the long-term success of these implants.

  4. Improvement of skeleton conversion in ICRP reference phantom conversion project

    Energy Technology Data Exchange (ETDEWEB)

    Wang, Zhao Jun; Yeom, Yeon Soo; Thang, Nguyen Tat; Kim, Han Sung; Han, Min Cheol; Kim, Chan Hyeong [Dept. of Nuclear Engineering, Hanyang University, Seoul (Korea, Republic of); Kim, Seong Hoon [Dept. of Radiation Oncology, College of Medicine, Hanyang University, Seoul (Korea, Republic of)

    2014-11-15

    In the previous skeleton conversion, most bones were directly converted from the ICRP voxel phantoms by using the 3D rendering method whereas several complex-shape bones (cranium, ribs, spines, feet, and hands) were not able to be directly converted. We alternatively employed the corresponding well-defined polygonal models and attempted to adjust them to match the voxel models. However, this approach was unsatisfactory. The shapes of the alternative models were significantly different from those of the voxel models, making it virtually impossible to exactly match the voxel models as shown in Fig. 3 (left). In order to overcome the difficulty in the complex bone conversion, the present study developed a new conversion method and converted these complex bones voxel models of the ICRP male phantom to polygonal models. The present study developed the new conversion method and successfully improved polygonal models for cranium, ribs, and spines for the ICRP male phantom. The new conversion method will be also applied to the complex bone conversion for the ICRP female phantom as well as other complex organ conversion in the future.

  5. Formed HIP Can Processing

    Energy Technology Data Exchange (ETDEWEB)

    Clarke, Kester Diederik [Los Alamos National Lab. (LANL), Los Alamos, NM (United States)

    2015-07-27

    The intent of this report is to document a procedure used at LANL for HIP bonding aluminum cladding to U-10Mo fuel foils using a formed HIP can for the Domestic Reactor Conversion program in the NNSA Office of Material, Management and Minimization, and provide some details that may not have been published elsewhere. The HIP process is based on the procedures that have been used to develop the formed HIP can process, including the baseline process developed at Idaho National Laboratory (INL). The HIP bonding cladding process development is summarized in the listed references. Further iterations with Babcock & Wilcox (B&W) to refine the process to meet production and facility requirements is expected.

  6. Safety Issue of Hip Resurfacing

    Directory of Open Access Journals (Sweden)

    Timothy McTighe

    2015-10-01

    Full Text Available Hip Resurfacing (HR development of the 1970s was an attempt to address the failures of conventional cemented stems. Those early HR designs failed because problems with maintaining bone under the resurfaced femoral head, and loosening of the socket with substantial acetabular bone loss. However technology, knowledge and surgical techniques have evolved over the past 45 years. The more recent designs like the Birmingham Hip Resurfacing (BHR focused on metal to metal bearing surfaces. These devices are under attack and maybe they should be. However, lets not ignore the significant amount of information and potential improvements in both design technology and surgical techniques that have come about over the past few years.

  7. Preoperative ambulatory measurement of asymmetric leg loading during sit-to-stand in hip arthroplasty patients

    NARCIS (Netherlands)

    Martinez-Ramirez, A.; Weenk, D.; Lecumberri, P.; Verdonschot, N.J.; Pakvis, D.; Veltink, P.H.

    2014-01-01

    Total hip arthroplasty (TGA) is a successful surgical procedure to treat patients with hip osteoarthritis. Clinicians use different questionnaires to evaluate these patients. Gait velocity and these questionnaires; usually show significant improvement after TGA . This clinical evaluation does, howev

  8. The strength and function of hip abductors following anterolateral minimally invasive total hip arthroplasty

    Institute of Scientific and Technical Information of China (English)

    Tan Jixiang; Chen Hong; Chen Cheng; Liang Xi; Huang Wei

    2014-01-01

    Objective:To analyze the extent of postoperative hip abductor insufficiency in primary total hip arthroplasty (THA) patients undergoing anterolateral minimally invasive (ALMI) approach,and to investigate whether the clinical outcomes are more favorable in femoral neck fracture (FNF) patients than in non-femoral neck fracture (nFNF) patients.Methods:A total of 48 patients were enrolled in this study.Each patient underwent a clinical examination preoperatively and 6,12,24 and 48 weeks postoperatively.The abductor torque,Trendelenburg's sign,gait velocity,Harris hip score,Oxford hip score,Westren Ontario and McMaster Universities (WOMAC) score and visual analog scale pain score were recorded.Statistical evaluation was performed with SPSS software version 18.0.The significance level was set at P<0.05.Results:The abductor torque of the operated hip and the recovery ratio showed a gradual improving tendency from 6 weeks postoperatively until the last follow-up.Gait velocity,Harris hip score,Oxford hip score and WOMAC score improved significantly after the operation until 24 weeks postoperatively.In the FNF group,the abductor torque of the operated side and the recovery ratio were significantly higher than in nFNF group at 6 weeks postoperatively,however,as time passed,this trend tended to disappear.Conclusion:This study demonstrates that patients can obtain good abductor strength and function in the early postoperative period and the hip abductor function of patients who suffer from hip osteoarthritis,rheumatoid arthritis,avascular necrosis of the femoral head could be significantly improved following ALMI THA.

  9. The effect of a resident-led quality improvement project on improving communication between hospital-based and outpatient physicians.

    Science.gov (United States)

    Kalanithi, Lucy; Coffey, Charles E; Mourad, Michelle; Vidyarthi, Arpana R; Hollander, Harry; Ranji, Sumant R

    2013-01-01

    This article reports on a resident-led quality improvement program to improve communication between inpatient internal medicine residents and their patients' primary care physicians (PCPs). The program included education on care transitions, standardization of documentation, audit and feedback of documented PCP communication rates with public reporting of performance, rapid-cycle data analysis and improvement projects, and a financial incentive. At baseline, PCP communication was documented in 55% of patients; after implementation of the intervention, communication was documented in 89.3% (2477 of 2772) of discharges during the program period. The program was associated with a significant increase in referring PCP satisfaction with communication at hospital admission (baseline, 27.7% "satisfied" or "very satisfied"; postintervention, 58.2%; P importance of PCP communication for patient care and audit and feedback of their performance as the principal drivers of their engagement in the project.

  10. Improving Initiation and Tracking of Research Projects at an Academic Health Center: A Case Study.

    Science.gov (United States)

    Schmidt, Susanne; Goros, Martin; Parsons, Helen M; Saygin, Can; Wan, Hung-Da; Shireman, Paula K; Gelfond, Jonathan A L

    2016-09-20

    Research service cores at academic health centers are important in driving translational advancements. Specifically, biostatistics and research design units provide services and training in data analytics, biostatistics, and study design. However, the increasing demand and complexity of assigning appropriate personnel to time-sensitive projects strains existing resources, potentially decreasing productivity and increasing costs. Improving processes for project initiation, assigning appropriate personnel, and tracking time-sensitive projects can eliminate bottlenecks and utilize resources more efficiently. In this case study, we describe our application of lean six sigma principles to our biostatistics unit to establish a systematic continual process improvement cycle for intake, allocation, and tracking of research design and data analysis projects. The define, measure, analyze, improve, and control methodology was used to guide the process improvement. Our goal was to assess and improve the efficiency and effectiveness of operations by objectively measuring outcomes, automating processes, and reducing bottlenecks. As a result, we developed a web-based dashboard application to capture, track, categorize, streamline, and automate project flow. Our workflow system resulted in improved transparency, efficiency, and workload allocation. Using the dashboard application, we reduced the average study intake time from 18 to 6 days, a 66.7% reduction over 12 months (January to December 2015).

  11. The Agricultural Model Intercomparison and Improvement Project (AgMIP): Protocols and pilot studies

    NARCIS (Netherlands)

    Rosenzweig, C.; Jones, W.; Hatfield, J.L.; Ruane, A.C.; Boote, K.J.; Thorburn, P.; Antle, J.M.; Nelson, G.C.; Porter, C.; Janssen, S.J.C.; Asseng, S.; Basso, B.; Ewert, F.; Wallach, D.; Baigorria, G.; Winter, J.M.

    2013-01-01

    The Agricultural Model Intercomparison and Improvement Project (AgMIP) is a major international effort linking the climate, crop, and economic modeling communities with cutting-edge information technology to produce improved crop and economic models and the next generation of climate impact

  12. Evaluation of School Improvement through an Educational Effectiveness Model: The Case of Indonesia's PEQIP Project.

    Science.gov (United States)

    van der Werf, Greetje; Creemers, Bert; De Jong, Rob; Klaver, Elizabeth

    2000-01-01

    In 1992, the government of Indonesia initiated the Primary Education Quality Improvement Project (PEQIP) to improve educational quality at the elementary level. A World Bank-sponsored assessment of school effectiveness in two provinces found very large differences in student achievement among schools, with implementation of PEQIP components…

  13. The Agricultural Model Intercomparison and Improvement Project (AgMIP): Protocols and pilot studies

    NARCIS (Netherlands)

    Rosenzweig, C.; Jones, W.; Hatfield, J.L.; Ruane, A.C.; Boote, K.J.; Thorburn, P.; Antle, J.M.; Nelson, G.C.; Porter, C.; Janssen, S.J.C.; Asseng, S.; Basso, B.; Ewert, F.; Wallach, D.; Baigorria, G.; Winter, J.M.

    2013-01-01

    The Agricultural Model Intercomparison and Improvement Project (AgMIP) is a major international effort linking the climate, crop, and economic modeling communities with cutting-edge information technology to produce improved crop and economic models and the next generation of climate impact projecti

  14. The Coronary Health Improvement Projects Impact on Lowering Eating, Sleep, Stress, and Depressive Disorders

    Science.gov (United States)

    Merrill, Ray M.; Aldana, Stephen G.; Greenlaw, Roger L.; Diehl, Hans A.

    2008-01-01

    Background: The Coronary Health Improvement Project (CHIP) is designed to lower cardiovascular risk factors among a group of generally healthy individuals through health education. Purpose: This study will evaluate the efficacy of the CHIP intervention at improving eating, sleep, stress, and depressive disorders. Methods: A health education…

  15. From "They" Science to "Our" Science: Hip Hop Epistemology in STEAM Education

    Science.gov (United States)

    Dolberry, Maurice E.

    Hip hop has moved from being considered a type of music into being understood as a culture in which a prominent type of music originates. Hip hop culture has a philosophy and epistemological constructs as well. This study analyzed those constructs to determine how conceptions of science factor in hip hop worldviews. Pedagogical models in culturally responsive teaching and Science, Technology, Engineering, Arts, and Mathematics (STEAM) education were also examined to discern their philosophical connections with hip hop culture. These connections were used to create two theoretical models. The first one, Hip Hop Science, described how scientific thought functions in hip hop culture. The second model, Hip Hop STEAM Pedagogy, proposes how hip hop culture can inform STEAM teaching practices. The study began by using Critical Race Theory to create a theoretical framework proposing how the two theoretical models could be derived from the philosophical and pedagogical concepts. Content analysis and narrative inquiry were used to analyze data collected from scholarly texts, hip hop songs, and interviews with hip hop-responsive educators. The data from these sources were used initially to assess the adequacy of the proposed theoretical framework, and subsequently to improve its viability. Four overlapping themes emerged from the data analyses, including hip hop-resistance to formal education; how hip hop culture informs pedagogical practice in hip hop-responsive classrooms; conceptions of knowledge and reality that shape how hip hoppers conduct scientific inquiry; and hip hop-based philosophies of effective teaching for hip hoppers as a marginalized cultural group. The findings indicate that there are unique connections between hip hop epistemology, sciencemindedness, and pedagogical practices in STEAM education. The revised theoretical framework clarified the nature of these connections, and supported claims from prior research that hip hop culture provides viable sites of

  16. Hip cortical thickness assessment in postmenopausal women with osteoporosis and strontium ranelate effect on hip geometry.

    Science.gov (United States)

    Briot, Karine; Benhamou, Claude Laurent; Roux, Christian

    2012-01-01

    The aims of this study were to assess the relationship between hip geometry and the 5-yr risk of hip fractures in postmenopausal osteoporotic women and the effects of strontium ranelate on these parameters. Using the 5-yr data of a randomized placebo-controlled trial of strontium ranelate (Treatment of Peripheral Osteoporosis Study [TROPOS]), we reanalyzed the hip dual-energy X-ray absorptiometry scans to determine the role of hip geometry in the risk of hip fractures (placebo group, n=636) and to analyze the effects of strontium ranelate (n=483). The outcomes included the hip structure analysis (HSA) parameters: cross-sectional area (CSA), section modulus, cortical thickness, and buckling ratio, measured at femoral neck, intertrochanteric (IT) region, and proximal shaft. The geometric parameters associated with an increased risk of hip fracture over 5yr were IT CSA and femoral shaft cortical thickness independent of age and total-hip bone mineral density (BMD). Using Bonferroni adjustment, IT cortical thickness was associated with the risk of hip fracture. Over 5yr, significant decreases in some femoral dimensions of the placebo group contrast with significant increases in strontium ranelate group after adjustment for age and BMD. Using Bonferroni adjustment, differences between placebo and strontium ranelate groups were no longer significant after adjustment on 5-yr BMD changes. Some HSA parameters have predictive value for hip fracture risk in postmenopausal osteoporotic women. Strontium ranelate improves some HSA parameters, through the BMD increase. Copyright © 2012 The International Society for Clinical Densitometry. Published by Elsevier Inc. All rights reserved.

  17. Improving patient and project outcomes using interorganisational innovation, collaboration and co-design.

    Science.gov (United States)

    Evans, Liz; Green, Stuart; Howe, Cathy; Sharma, Kiran; Marinho, Fatima; Bell, Derek; Thomas, Paul

    2014-01-01

    Background Common mental disorders (CMDs) are a leading cause of disability. The Department of Health has launched a large-scale initiative to improve access to evidence-based psychological treatments, such as cognitive behavioural therapy (CBT), through the Improving Access to Psychological Therapy (IAPT) programme. Access to IAPT services by black and minority ethnic (BME) communities is lower than for other groups. Setting The London Borough of Ealing in west London; a diverse borough with areas of high BME population and relatively high deprivation. Aim To compare the outcomes of two linked quality improvement (QI) projects undertaken by Ealing Mental Health and Wellbeing Service (MHWBS), both with the same aim of increasing access to talking therapies for BME communities. Methods Application of QI methodologies supported by the NIHR CLAHRC for northwest London in two different settings in Ealing. One, the 'Southall project', was set within a wider initiative for collaborative improvements and shared learning (the Southall Initiative for Integrated Care) in an ethnically diverse area of Ealing; it was undertaken between April 2010 and September 2011. The second, 'the Ealing project', operated in the two other Ealing localities that did not have the advantage of a broader initiative for collaborative improvements; it was undertaken between April 2011 and September 2012. Results Comparison of the monthly referral rates of BME patients (standardised per 10 000 general practitioner (GP)-registered patients) show that the Southall project was more effective in increasing referrals from BME communities than the Ealing project. Conclusion Broad local participation and ownership in the project design of the Southall project may explain why it was more effective in achieving its aims than the Ealing project which lacked these ownership-creating mechanisms.

  18. The other hip in unilateral hip dysplasia

    DEFF Research Database (Denmark)

    Jacobsen, Steffen; Rømer, Lone; Søballe, Kjeld

    2006-01-01

    We reviewed transverse pelvic computed tomography scans of 197 consecutively referred adult patients with hip pain thought to be secondary to developmental dysplasia. A center-edge angle of 20 degrees or less was considered the upper normal value. Four groups were identified: 69 patients with app...

  19. Microinstability of the hip: a previously unrecognized pathology

    Science.gov (United States)

    Bolia, Ioanna; Chahla, Jorge; Locks, Renato; Briggs, Karen; Philippon, Marc J.

    2016-01-01

    Summary Background Hip microinstability is an established diagnosis; however, its occurrence is still debated by many physicians. Diagnosis of hip microinstability is often challenging, due to a lack of specific signs or symptoms, and patients may remain undiagnosed for long periods. This may lead to early manifestation of degenerative joint disease. Consequently, careful patient and family history must be obtained and diagnostic imaging should follow. After a thorough clinical evaluation of the patient with suspected hip microinstability, the physician should focus on how to improve symptoms and functionality in daily and sports activities. Purpose The purpose of this review article was to give a current update regarding this diagnosis and to provide a complete diagnostic approach in order to effectively treat hip microinstability. Methods We reviewed the literature on the diagnosis, the non-operative and operative indications for the treatment of this complex and often misdiagnosed pathology. Conclusion Conservative treatment is considered the best initial approach, though, surgical intervention should be considered if symptoms persist or other hip pathology exists. Successful surgical intervention, such as hip arthroscopy, should focus on restoring the normal anatomy of the hip joint in order to regain its functionality. The role of the hip joint capsule has gained particular research interest during the last years, and its repair or reconstruction during hip arthroscopy is considered necessary in order to avoid iatrogenic hip microinstability. Various capsular closure/plication techniques have been developed towards this direction with encouraging results. Level of evidence V. PMID:28066740

  20. Prevention of hip fractures.

    Science.gov (United States)

    Meunier, P J

    1993-11-30

    For a 50-year old Caucasian woman today, the risk of a hip fracture over her remaining life-time is about 17%. Tomorrow the situation will clearly be worse because the continuous increase in life expectancy will cause a three-fold increase in worldwide fracture incidence over the next 60 years. Through diagnostic bone mass measurements at the hip and assessment of biochemical parameters, a great deal has been learned in recent years about reduction of hip fracture risk. Preventive strategies are based on prevention of falls, use of hip protectors, and prevention of bone fragility. The latter includes the optimization of peak bone mass during childhood, postmenopausal estrogen replacement therapy, and also late prevention consisting in reversing senile secondary hyperparathyroidism, which plays an important role in the decrease of skeletal strength. This secondary hyperparathyroidism, which results from both vitamin D insufficiency and low calcium intake, is preventable with vitamin D3 and calcium supplements. They have recently been shown capable of providing effective prevention of hip fractures in elderly women living in nursing homes, with a reduction of about 25% in the number of hip fractures noted in a 3-year controlled study in 3,270 women (intention-to-treat analysis). In conclusion, it is never too early to reduce the risk of osteoporosis and never too late to prevent hip fractures.

  1. Involving patients in care decisions improves satisfaction: an outcomes-based quality improvement project.

    Science.gov (United States)

    Leff, Ellen W

    2004-05-01

    A home care agency used quality improvement processes to improve patient satisfaction survey ratings. The focus was on involving patients in decisions about their care. A multidisciplinary team developed creative strategies to increase staff awareness and enhance customer service skills, which had dramatic results.

  2. Improved efficient proportionate affine projection algorithm based on l(0-norm for sparse system identification

    Directory of Open Access Journals (Sweden)

    Haiquan Zhao

    2014-01-01

    Full Text Available A new improved memorised improved proportionate affine projection algorithm (IMIPAPA is proposed to improve the convergence performance of sparse system identification, which incorporates l(0-norm as a measure of sparseness into a recently proposed MIPAPA algorithm. In addition, a simplified implementation of the IMIPAPA (SIMIPAPA with low-computational burden is presented while maintaining the consistent convergence performance. The simulation results demonstrate that the IMIPAPA and SIMIPAPA algorithms outperform the MIPAPA algorithm for sparse system identification.

  3. Performance improvement of the software development project using the Value Management approach

    CERN Document Server

    Salem-Mhamdia, Amel Ben Hadj

    2011-01-01

    Improving performance and delivering value for customers have become a central theme in business. The software industry has become an increasingly important sector for the economy growth in Tunisia. This study aims to show how using Value Management in the Tunisian software industry for project analysis gives new insight about true project value and performance. This new approach is considered as an appropriate tool for guiding the process of making decisions. It offers tools in order to analyze the service value from the customer and organization perspectives. The results showed that the VM allows to have better performance in the software development project by linking customer satisfaction and cost analysis. The present case shows to service managers how they can benchmark project function to reduce their costs and improve resource allocation taking into consideration what customers consider important during their overall service experience. It can identify best professional practices, orient decisions to ...

  4. The Dorset Seedcorn Project: interprofessional learning and continuous quality improvement in primary care.

    Science.gov (United States)

    Wilcock, Peter M; Campion-Smith, Charles; Head, Michael

    2002-10-01

    There is a need to develop models of practice-based learning that are effective in bringing about improvement in the quality of care that patients receive. This paper describes a facilitated practice-based project where five general practices in Dorset formed interprofessional teams that worked over a six-month period using a continuous quality improvement (CQI) approach to make a change in areas of importance to them. All the teams completed the project and planned and implemented demonstrable changes. Qualitative enquiry showed changes in relationships and teamworking that extended beyond the specific topic of the project with teams reporting an enhanced sense of competence and achievement. The project facilitators were able to develop a model of learning that acknowledges and utilises the depth of experience and understanding within interprofessional practice teams. Protected time and an environment and processes that encourage full partcipation of a wide range of team members is essential.

  5. Doctor Who? A Quality Improvement Project to Assess and Improve Patients' Knowledge of Their Inpatient Physicians.

    Science.gov (United States)

    Broderick-Forsgren, Kathleen; Hunter, Wynn G; Schulteis, Ryan D; Liu, Wen-Wei; Boggan, Joel C; Sharma, Poonam; Thomas, Steven; Zaas, Aimee; Bae, Jonathan

    2016-05-01

    Background Patient-physician communication is an integral part of high-quality patient care and an expectation of the Clinical Learning Environment Review program. Objective This quality improvement initiative evaluated the impact of an educational audit and feedback intervention on the frequency of use of 2 tools-business cards and white boards-to improve provider identification. Methods This before-after study utilized patient surveys to determine the ability of those patients to name and recognize their physicians. The before phase began in July 2013. From September 2013 to May 2014, physicians received education on business card and white board use. Results We surveyed 378 patients. Our intervention improved white board utilization (72.2% postintervention versus 54.5% preintervention, P < .01) and slightly improved business card use (44.4% versus 33.7%, P = .07), but did not improve physician recognition. Only 20.3% (14 of 69) of patients could name their physician without use of the business card or white board. Data from all study phases showed the use of both tools improved patients' ability to name physicians (OR = 1.72 and OR = 2.12, respectively; OR = 3.68 for both; P < .05 for all), but had no effect on photograph recognition. Conclusions Our educational intervention improved white board use, but did not result in improved patient ability to recognize physicians. Pooled data of business cards and white boards, alone or combined, improved name recognition, suggesting better use of these tools may increase identification. Future initiatives should target other barriers to usage of these types of tools.

  6. Hip arthroscopy in children and adolescents.

    Science.gov (United States)

    Kocher, Mininder S; Kim, Young-Jo; Millis, Michael B; Mandiga, Rahul; Siparsky, Patrick; Micheli, Lyle J; Kasser, James R

    2005-01-01

    Hip arthroscopy has become an established procedure for certain indications in adults, but experience in children and adolescents has been more limited. The purpose of this study is to report the early-term results of hip arthroscopy in children and adolescents. A consecutive case series of 54 hip arthroscopies in 42 patients 18 years old and younger over a 3-year period at a tertiary-care children's hospital with a minimum of 1 year of follow-up was reviewed. Patients were assessed with the modified Harris hip score (HHS) before and after surgery. Overall results and results by common diagnoses were analyzed. Indications for surgery included isolated labral tear (n = 30), Perthes disease (n = 8), hip dysplasia with labral tear after prior periacetabular osteotomy (n = 8), inflammatory arthritis (n = 3), spondyloepiphyseal dysplasia (n = 2), avascular necrosis (n = 1), slipped capital femoral epiphysis (n = 1), and osteochondral fracture (n = 1). Overall, there was a significant improvement in HHS from 53.1 to 82.9 (P < 0.001), with 83% of patients improved. By diagnosis, significant improvement in HHS was seen for patients with isolated labral tears undergoing labral debridement (before surgery 57.6; after surgery 89.2; P < 0.001), for patients with Perthes disease undergoing chondroplasty and loose body excision (before surgery 49.5; after surgery 80.1; P < 0.001), and for patients with hip dysplasia after prior periacetabular osteotomy undergoing labral debridement (before surgery 51.8; after surgery 79.8; P < 0.001). Complications included transient pudendal nerve palsy (n = 3), instrument breakage (n = 1), and recurrent labral tear (n = 3). Hip arthroscopy in children and adolescents appears to be safe and efficacious for certain indications in the short term.

  7. Improvement of Project Portfolio Management in an Information Technology Consulting Company

    Science.gov (United States)

    Kaewta, S.; Chutima, P.

    2014-06-01

    The scope of this research is to improve the efficiency of multiple project management in an information technology consulting company through the adaptation of the project portfolio management technique. The project management information system (PMIS) is implemented to establish effective communication channels so that internal and external teams as well as all relevant stakeholders can be employed to negotiate their work schedules. In addition, all activities created by multiple teams can be systematically reviewed and combined into a single checklist to be used as an agreed working plan for all team members. A general guideline for project portfolio management in information technology consulting companies is also proposed, which could results in a higher level of project on-time delivery.

  8. National health expenditure projections, 2012-22: slow growth until coverage expands and economy improves.

    Science.gov (United States)

    Cuckler, Gigi A; Sisko, Andrea M; Keehan, Sean P; Smith, Sheila D; Madison, Andrew J; Poisal, John A; Wolfe, Christian J; Lizonitz, Joseph M; Stone, Devin A

    2013-10-01

    Health spending growth through 2013 is expected to remain slow because of the sluggish economic recovery, continued increases in cost-sharing requirements for the privately insured, and slow growth for public programs. These factors lead to projected growth rates of near 4 percent through 2013. However, improving economic conditions, combined with the coverage expansions in the Affordable Care Act and the aging of the population, drive faster projected growth in health spending in 2014 and beyond. Expected growth for 2014 is 6.1 percent, with an average projected growth of 6.2 percent per year thereafter. Over the 2012-22 period, national health spending is projected to grow at an average annual rate of 5.8 percent. By 2022 health spending financed by federal, state, and local governments is projected to account for 49 percent of national health spending and to reach a total of $2.4 trillion.

  9. Fat content of hip muscles: an anteroposterior gradient.

    Science.gov (United States)

    Daguet, Edouard; Jolivet, Erwan; Bousson, Valérie; Boutron, Carole; Dahmen, Natacha; Bergot, Catherine; Vicaut, Eric; Laredo, Jean-Denis

    2011-10-19

    Despite the importance of the hip muscles in protecting against hip fracture and in the outcome of hip arthroplasty, the variability in their fat content has not been previously studied. Our objectives were to evaluate the variability in the fat content of the hip muscles in a population without myopathy or a need for hip surgery with the use of computed tomography (CT), to study the relationship between hip muscle fat content and physical performance, and to identify medical conditions and lifestyle habits associated with an increase in hip muscle fat content. Ten normal subjects without a relevant medical history and ninety-nine consecutive nonsurgical patients without myopathy (age, twenty-one to ninety-four years) underwent a nonenhanced CT scan of the pelvis. Patients were asked to perform physical tests (six-meter walk, repeated chair stands, and Trendelenburg test), and their level of physical activity and medical history were recorded. Evaluation of the fat content of the hip muscles was based on the analysis of four reproducible and representative CT slices with use of custom software. The fat content varied among the muscles, with an anteroposterior gradient from the hip flexors (mean, 2%) to the hip extensors (mean, 10%). This gradient increased after fifty years of age. Fat content also varied considerably among patients. Higher fat content was associated with poorer performance on physical tests, even after adjustment for the cross-sectional area of the muscle (p fat content was also associated with greater age, higher body-mass index, and lower physical activity (p fat content of individuals without myopathy or a need for hip surgery should be useful for comparison with future studies of specific populations of patients, such as those with muscle weakness secondary to hip fracture or hip surgery. Simple lifestyle changes such as dietary restriction, increased physical activity, and vitamin D supplementation may decrease muscle fat content and improve

  10. Recommendations for improved acceptance of wind farm projects in France with regard to acoustic noise

    Energy Technology Data Exchange (ETDEWEB)

    Dutilleux, P.; Gabriel, J. [Deutsches Windenergie-Institut GmbH (DEWI), Wilhelmshaven (Germany)

    2008-03-15

    From the consideration of the various acoustic issues that are raised by wind farm projects, the similarities and differences of approaches and methods used in France and in Germany are reviewed. Recommendations to the acousticians, to the wind turbine manufacturers, to the developers and to the operators are derived with the objective of improving the acoustic quality of wind farm projects and their acceptance by the population. (orig.)

  11. CHAOS Chronicles, Focusing on Failures and Possible Improvements in IT Projects

    Directory of Open Access Journals (Sweden)

    Jim Johnson

    2016-10-01

    Full Text Available The Standish Group started in 1985 in the business of IT markets forecasts and predictions using Artificial Intelligence and cased-based reasoning technology. In 1994 we turned to predicting project outcomes, improving software development, and building a world-class database. Standish's cumulative research encompasses 22 years of data on why projects succeed or fail, representing more than 50,000 active completed IT projects. In this paper we clarify how we got here, where we are, and how academia next to practitioners can be part of the next stage of the CHAOS journey. The vehicle which drives our journey is the CHAOS University System.

  12. Improving IT project governance: A reflective analysis based on critical systems heuristics

    Directory of Open Access Journals (Sweden)

    David Johnstone

    2017-05-01

    Full Text Available IT project governance involves establishing authority structures, policies and mechanisms for IT projects. However, the way governance arrangements are implemented can sometimes exclude or marginalise important stakeholders. In this paper, we use critical systems thinking, and the notions of boundary critique and entrenched structural conflict, to inform a critical re-analysis of a case study where the governance proved relatively ineffective. We use the ‘twelve questions’ from the critical systems heuristics (CSH approach to diagnose problems with governance arrangements and suggest solutions. Based on this, we suggest the CSH approach has theoretical and practical efficacy for improving IT project governance in general.

  13. Prospective study comparing functional outcomes and revision rates between hip resurfacing and total hip arthroplasty: preliminary results for 2 years.

    Science.gov (United States)

    Pailhé, Régis; Reina, Nicolas; Cavaignac, Etienne; Sharma, Akash; Lafontan, Valérie; Laffosse, Jean-Michel; Chiron, Philippe

    2013-01-01

    There is a need of independent prospective studies about modern generation of hip resurfacing implants. The aim of this propective observational study was to compare the functional outcomes and revision rates with hip resurfacing arthroplasty and total hip arthroplasty and to present the preliminary results at 2 years. Patients included were recruited prospectively in the Partial Pelvic Replacement Hip Project by a single surgeon between January 2007 and January 2010. Patients were assessed with the Harris Hip Score (HHS) and Postel-Merle d'Aubigné (MDA) score and Devane Score. The end point of the study was reoperation for any cause related to the prosthesis. At a mean follow up of 38.6 months there were a total of 142 patients with hip resurfacing (group 1) [100 Durom(®) (Zimmer Inc., Warsaw, IN, USA) and 42 Birmingham Hip Resurfacing(®) (Smith & Nephew, Memphis, TN, USA)] and 278 patients with total hip arthroplasty (group 2). The results showed significantly greater gain of HHS, MDA and Devane score with hip resurfacing procedures. However, considering all the complications, the rate was significantly higher in group 16.4% vs 1.79% in group 2 (P<0.0001). In group 1 we observed 6 complications only concerned males with Durom(®) implants. The follow up of this cohort is still on going and may deliver more information on the evolution of these results in time.

  14. Prospective study comparing functional outcomes and revision rates between hip resurfacing and total hip arthroplasty: preliminary results for 2 years

    Directory of Open Access Journals (Sweden)

    Régis Pailhé

    2013-07-01

    Full Text Available There is a need of independent prospective studies about modern generation of hip resurfacing implants. The aim of this propective observational study was to compare the functional outcomes and revision rates with hip resurfacing arthroplasty and total hip arthroplasty and to present the preliminary results at 2 years. Patients included were recruited prospectively in the Partial Pelvic Replacement Hip Project by a single surgeon between January 2007 and January 2010. Patients were assessed with the Harris Hip Score (HHS and Postel-Merle d’Aubigné (MDA score and Devane Score. The end point of the study was reoperation for any cause related to the prosthesis. At a mean follow up of 38.6 months there were a total of 142 patients with hip resurfacing (group 1 [100 Durom® (Zimmer Inc., Warsaw, IN, USA and 42 Birmingham Hip Resurfacing® (Smith & Nephew, Memphis, TN, USA] and 278 patients with total hip arthroplasty (group 2. The results showed significantly greater gain of HHS, MDA and Devane score with hip resurfacing procedures. However, considering all the complications, the rate was significantly higher in group 16.4% vs 1.79% in group 2 (P<0.0001. In group 1 we observed 6 complications only concerned males with Durom® implants. The follow up of this cohort is still on going and may deliver more information on the evolution of these results in time.

  15. Quality initiatives: planning, setting up, and carrying out radiology process improvement projects.

    Science.gov (United States)

    Tamm, Eric P; Szklaruk, Janio; Puthooran, Leejo; Stone, Danna; Stevens, Brian L; Modaro, Cathy

    2012-01-01

    In the coming decades, those who provide radiologic imaging services will be increasingly challenged by the economic, demographic, and political forces affecting healthcare to improve their efficiency, enhance the value of their services, and achieve greater customer satisfaction. It is essential that radiologists master and consistently apply basic process improvement skills that have allowed professionals in many other fields to thrive in a competitive environment. The authors provide a step-by-step overview of process improvement from the perspective of a radiologic imaging practice by describing their experience in conducting a process improvement project: to increase the daily volume of body magnetic resonance imaging examinations performed at their institution. The first step in any process improvement project is to identify and prioritize opportunities for improvement in the work process. Next, an effective project team must be formed that includes representatives of all participants in the process. An achievable aim must be formulated, appropriate measures selected, and baseline data collected to determine the effects of subsequent efforts to achieve the aim. Each aspect of the process in question is then analyzed by using appropriate tools (eg, flowcharts, fishbone diagrams, Pareto diagrams) to identify opportunities for beneficial change. Plans for change are then established and implemented with regular measurements and review followed by necessary adjustments in course. These so-called PDSA (planning, doing, studying, and acting) cycles are repeated until the aim is achieved or modified and the project closed.

  16. Five Year Follow-up of One Stage Bilateral Total Hip Arthroplasty

    Directory of Open Access Journals (Sweden)

    CC Tai

    2007-04-01

    Full Text Available We report on the medium term outcome of five patients (ten hips who underwent one stage bilateral total hip arthroplasty. Both Harris Hip Scores and Oxford Hip Scores improved postoperatively as did range of motion. There was no radiographic evidence of loosening in any hip arthroplasty involved in this study, however one revision surgery was needed due to periprosthetic fracture. There were no increased medical complications. Based on our limited experience, we believe that one stage bilateral total hip arthroplasty is safe in selected patients.

  17. [Clinical pathway for hip fracture patients].

    Science.gov (United States)

    Sáez López, Pilar; Sánchez Hernández, Natalia; Paniagua Tejo, Sonsoles; Valverde García, José Antonio; Montero Díaz, Margarita; Alonso García, Noelia; Freites Esteve, Alfonso

    2015-01-01

    Hip fracture in the elderly often occurs in patients with high co-morbidity. Effective management requires a comprehensive and multidisciplinary approach. To evaluate the effect of a quality improvement intervention in the detection and treatment of complications in elderly patients admitted for hip fracture. A comparative study was conducted between two groups of patients admitted for hip fracture prior to 2010, and after a quality improvement intervention in 2013. The intervention consisted of implementing improved multidisciplinary measures in accordance with recent scientific evidence. The degree of compliance of the implemented measures was quantified. Patients admitted due to hip fracture in 2010 (216 patients) and 2013 (196 patients) were similar in age, sex, Barthel Index, and a reduced Charlson Index, although there were more comorbidities in 2013. After implementation of the protocols, the detection of delirium, malnutrition, anemia, and electrolyte disturbances increased. A larger number of patients in 2013 were precribed intravenous iron (24% more) and osteoporosis treatment (61.3% more). The average stay was reduced by 45.3% and surgical delay by 29.4%, achieving better functional efficiency. The implementation of a clinical pathway in geriatric patients with hip fracture is useful to detect and treat complications at an early stage, and to reduce pre-operative and overall stay, all without a negative clinical or functional impact. Copyright © 2014 SEGG. Published by Elsevier Espana. All rights reserved.

  18. The Surgical Care Improvement Project Antibiotic Guidelines: Should We Expect More Than Good Intentions?

    Science.gov (United States)

    Schonberger, Robert B; Barash, Paul G; Lagasse, Robert S

    2015-08-01

    Since 2006, the Surgical Care Improvement Project (SCIP) has promoted 3 perioperative antibiotic recommendations designed to reduce the incidence of surgical site infections. Despite good evidence for the efficacy of these recommendations, the efforts of SCIP have not measurably improved the rates of surgical site infections. We offer 3 arguments as to why SCIP has fallen short of expectations. We then suggest a reorientation of quality improvement efforts to focus less on reporting, and incentivizing adherence to imperfect metrics, and more on creating local and regional quality collaboratives to educate clinicians about how to improve practice. Ultimately, successful quality improvement projects are behavioral interventions that will only succeed to the degree that they motivate individual clinicians, practicing within a particular context, to do the difficult work of identifying failures and iteratively working toward excellence.

  19. Results of hip arthroplasty using Paavilainen technique in patients with congenitally dislocated hip

    Directory of Open Access Journals (Sweden)

    R. M. Tikhilov

    2014-01-01

    Full Text Available The purpose of the study was to analyze the medium- and long-term results of hip arthroplasty using Paavilainen technique in patients with the congenitally dislocated hip. Methods: From 2001 to 2012 180 operations were carried out were using the Paavilainen technique in 140 patients with high dislocation of the hip (Crowe IV. All patients were clinically evaluated using the Harris Hip Score (HHS, VAS and radiography. Statistical analysis was performed using the Pearson correlation coefficients, multiple regression analysis and classification trees analysis. Results: The average Harris score improved from preoperative 41.6 (40,3-43,5 to 79.3 (77,9-82,7 at final follow-up, and the difference was significant. Early complications were 9% (the most frequent were fractures of the proximal femur, later - 16.7% (pseudoarthrosis of the greater trochanter, 13.9%; disclocations-1,1%, aseptic loosening of the components - 1.7%, reoperation performed in 8.3% of cases. Such factors as age and limb length has statistically significant effect on functional outcomes. Established predictive model allows to get the best possible functional outcome in such patients with severe dysplasia. Conclusions: Total Hip arthroplasty using the Paavilainen technique is an effective method of surgical treatment in patients with the congenitally dislocated hip, but it is technically difficult operation with a high incidence of complications in comparison with standard primary total hip replacement.

  20. Human hip joint center analysis for biomechanical design of a hip joint exoskeleton

    Institute of Scientific and Technical Information of China (English)

    Wei YANG; Can-jun YANG‡; Ting XU

    2016-01-01

    We propose a new method for the customized design of hip exoskeletons based on the optimization of the human- machine physical interface to improve user comfort. The approach is based on mechanisms designed to follow the natural tra-jectories of the human hip as the flexion angle varies during motion. The motions of the hip joint center with variation of the flexion angle were measured and the resulting trajectory was modeled. An exoskeleton mechanism capable to follow the hip center’s movement was designed to cover the full motion ranges of flexion and abduction angles, and was adopted in a lower extremity assistive exoskeleton. The resulting design can reduce human-machine interaction forces by 24.1% and 76.0% during hip flexion and abduction, respectively, leading to a more ergonomic and comfortable-to-wear exoskeleton system. The human- exoskeleton model was analyzed to further validate the decrease of the hip joint internal force during hip joint flexion or abduction by applying the resulting design.

  1. Hip Implant Systems

    Science.gov (United States)

    ... made of metal or ceramic, and the socket (acetabulum) is removed and replaced with a prosthetic cup. ... its socket in the hip bone (pelvis) Bone fracture Joint infection Local nerve damage with numbness/weakness ...

  2. HIP osteoarthritis and work.

    Science.gov (United States)

    Harris, E Clare; Coggon, David

    2015-06-01

    Epidemiological evidence points strongly to a hazard of hip osteoarthritis from heavy manual work. Harmful exposures may be reduced by the elimination or redesign of processes and the use of mechanical aids. Reducing obesity might help to protect workers whose need to perform heavy lifting cannot be eliminated. Particularly high relative risks have been reported in farmers, and hip osteoarthritis is a prescribed occupational disease in the UK for long-term employees in agriculture. Even where it is not attributable to employment, hip osteoarthritis impacts importantly on the capacity to work. Factors that may influence work participation include the severity of disease, the physical demands of the job, age and the size of the employer. Published research does not provide a strong guide to the timing of return to work following hip arthroplasty for osteoarthritis, and it is unclear whether patients should avoid heavy manual tasks in their future employment.

  3. Hip-Hop

    Institute of Scientific and Technical Information of China (English)

    张敬伟

    2008-01-01

    Hip-Hop是一种美国街头黑人文化,可分成五个要素:音乐、舞蹈、涂鸦、刺青和衣著。源自80年代美国纽约的黑人社区BRONX,他们将生活上的娱乐发展成为现今多样的HIP-HOP文化,发挥黑

  4. Distinct Cognitive Trajectories in the First Year After Hip Fracture

    NARCIS (Netherlands)

    Beishuizen, Sara J. E.; van Munster, Barbara C.; de Jonghe, Annemarieke; Abu-Hanna, Ameen; Buurman, Bianca M.; de Rooij, Sophia E.

    ObjectivesChange in cognitive functioning is often observed after hip fracture. Different patterns, with both improvement and decline, are expected, depending on premorbid cognitive functioning and events that occur during hospitalization. These patterns are unknown and important for older hip

  5. Arthroscopic intervention in early hip disease.

    Science.gov (United States)

    McCarthy, Joseph C; Lee, Jo-Ann

    2004-12-01

    Advancement in diagnostic and therapeutic applications for hip arthroscopy have dispelled previous myths about early hip disease. Arthroscopic findings have established the following facts: Acetabular labral tears do occur; acetabular chondral lesions do exist; tears are most frequently anterior and often associated with sudden twisting or pivoting motions; and labral tears often occur in association with articular cartilage lesions of the adjacent acetabulum or femoral head, and if present for years, contribute to the progression of delamination process of the chondral cartilage. Magnetic resonance arthrography represents an improvement over conventional magnetic resonance imaging, it does have limitations when compared with direct observation. Although indications for hip arthroscopy are constantly expanding, the most common indications include: labral tears, loose bodies, chondral flap lesions of the acetabular or femoral head, synovial chondromatosis, foreign body removal, and crystalline hip arthropathy (gout, pseudogout, and others). Contraindications include conditions that limit the potential for hip distraction such as joint ankylosis, dense heterotopic bone formation, considerable protrusio, or morbid obesity. Complication rates have been reported between 0.5 and 5%, most often related to distraction and include sciatic or femoral nerve palsy, avascular necrosis, and compartment syndrome. Transient peroneal or pudendal nerve effects and chondral scuffing have been associated with difficult or prolonged distraction. Meticulous consideration to patient positioning, distraction time and portal placement are essential. Judicious patient selection and diagnostic expertise are critical to successful outcomes. Candidates for hip arthroscopy should include only those patients with mechanical symptoms (catching, locking, or buckling) that have failed to respond to conservative therapy. The extent of articular cartilage involvement has the most direct relationship

  6. Using BIM to Improve the Design and Construction of Bridge Projects: A Case Study of a Long-span Steel-box Arch Bridge Project

    OpenAIRE

    Wenping Liu; Hongling Guo; Heng Li; Yan Li

    2014-01-01

    More and more mega-complex bridge projects are being or will be built worldwide. At the same time, the design and construction of such projects involve more and more challenges, e.g., complex structural designs, complicated construction environments, etc. This research study aims to apply BIM (Building Information Modelling) to bridge projects to improve the efficiency and effectiveness of design and construction. Through the analysis of the characteristics of bridge projects and relevant, as...

  7. Nourishing a partnership to improve middle school lunch options: a community-based participatory research project.

    Science.gov (United States)

    Reich, Stephanie M; Kay, Joseph S; Lin, Grace C

    2015-01-01

    Community-based participatory research is predicated on building partnerships that tackle important issues to the community and effectively improve these issues. Community-based participatory research can also be an empowering experience, especially for children. This article describes a university-community partnership in which students at a low-income middle school worked to improve the quality of the cafeteria food provided to the 986 students eligible for free and reduced price lunches. The project led to menu changes, improved communication between youth, school administrators, and district staff, and enabled youth to enact school improvements that were beneficial for their health.

  8. Our Experience with Short Stem Hip Replacement Surgery

    Directory of Open Access Journals (Sweden)

    Sumeet Rastogi

    2016-07-01

    Full Text Available Context- A short anatomical metaphyseal femoral stem is a desirable hip implant for bone and soft tissue preserving hip replacing surgery in young arthritic patients. Physiological loading of the proximal femur prevents stress shielding and preserves bone stock of the femur in the long run. Thus it is an ideal hip implant suited for conservative hip surgeries in active young adults with arthritic hips. Materials and methods- 50 Proxima hip replacements were performed on 41 patients with a mean age of 45 over a 3-year period (between July 2006 and September 2009. Diagnosis of hip pathologies varied from osteoarthritis secondary to avascular necrosis, rheumatoid arthritis, post-tubercular arthritis to dysplastic hips. 9 of these patients had symptomatic bilateral hip involvement and underwent bilateral hip replacement in a single sitting. All patient had a Proxima metaphyseal stem implantation( DePuy, Warsaw with either a large diameter metal on metal or pinnacle articulation. Clinical and radiological evaluation was done at 3 months, 6 months, 1 year and then yearly thereafter. Statiscal analysis used- VAS and Harris hip score formed the basis of evaluation Results- These patients were followed up for a mean period of 49 months (Range 36-72 months. The average incision size was 14.38 cm (10-18 cm and blood loss was 269 ml (175-450 ml. There was no peri-operative mortality or serious morbidity in any patients. One patient had an intraoperative lateral cortex crack that required only delayed rehabilitation. Five of the 41 patients (12.1 % had complications with three recovering completely and one requiring revision of femoral stem for aseptic loosening. One patient was lost in follow-up. Harris hip score improved from 52 to 89.3 at last follow-up. Overall 95.1% (39/41 patients had an excellent outcome at last follow-up. Conclusion- We conclude that Proxima metaphyseal stem provided clinically and radiologically stable fixation through snug fit

  9. A Quality Improvement Project to Improve Family Recognition of Medical Team Member Roles.

    Science.gov (United States)

    Hayes, Rebecca M; Wickline, Afton; Hensley, Christina; Cowen, Kelsey; Jessie, Ashley; Akers, Melanie; Dolan, Jenna; Pritt, Audra; Goodrich, Shea; O'Neill, Kelly; Flesher, Susan L

    2015-09-01

    Previous studies have shown that inpatients and families in academic settings have a limited ability to recall either their medical team members or the roles of those members. This is an important issue for patient and family satisfaction as well as patient safety. The objective of this study was to increase families' recognition of medical team members' roles. We established a multidisciplinary quality improvement leadership team, measured family recognition of medical team members and their roles, and conducted 2 PDSA (Plan-Do-Study-Act) cycles. The first intervention was standardization of the content and delivery of our verbal team introductions to ensure inclusion of essential elements and family engagement. The second intervention was addition of an informational white board in each patient room. The prospective study included 105 families in the preintervention phase, 103 post-PDSA cycle 1, and 92 post-PDSA cycle 2. After conduction of 2 PDSA cycles, the recognition of the attending role increased from 49% to 87% (P = .000), the resident role from 39% to 73% (P = .000), and the medical student from 75% to 89% (P = .038). The multidisciplinary quality improvement model was effective in improving family recognition of the roles of attending physicians, resident physicians, and medical students. Consistent attention to engaging the families and explaining our roles as well as providing informational white boards are effective interventions to facilitate this process. Copyright © 2015 by the American Academy of Pediatrics.

  10. Integrating Safe Sleep Practices into a Pediatric Hospital: Outcomes of a Quality Improvement Project.

    Science.gov (United States)

    Rowe, Angela D; Sisterhen, Laura L; Mallard, Ellen; Borecky, Betsy; Schmid, Barbara; Rettiganti, Mallikarjuna; Luo, Chunqiao

    2016-01-01

    A quality improvement project for implementing safe sleep practices (SSP) was conducted at a large, U.S children's hospital. The intervention involved education of staff and standardization of infant sleep practices utilizing a multifaceted approach. Staff surveys and environmental audits were conducted pre- and post-intervention. Safe Sleep Environment (SSE) audits showed an improvement from 23% to 34% (psafe sleep practices have the potential to reduce infant mortality.

  11. Improving Intrinsic Motivation among Sophomore Electrical Engineering Students by an Introductory Project

    Directory of Open Access Journals (Sweden)

    Aharon Gero

    2012-10-01

    Full Text Available In 2011, the Technion – Israel Institute of Technology decided to open a new elective course designed for sophomore electrical engineering students. The course was devised to expose students to the discipline of electrical engineering and improve their motivation. The core of the course was a team-based design project of a window cleaning robot. The present mixed-method study indicates a significant improvement in intrinsic motivation of the students who took the course.

  12. Immediate effects of hip mobilization with movement in patients with hip osteoarthritis: A randomised controlled trial.

    Science.gov (United States)

    Beselga, Carlos; Neto, Francisco; Alburquerque-Sendín, Francisco; Hall, Toby; Oliveira-Campelo, Natália

    2016-04-01

    Mobilization with movement (MWM) has been shown to reduce pain, increase range of motion (ROM) and physical function in a range of different musculoskeletal disorders. Despite this evidence, there is a lack of studies evaluating the effects of MWM for hip osteoarthritis (OA). To determine the immediate effects of MWM on pain, ROM and functional performance in patients with hip OA. Randomized controlled trial with immediate follow-up. Forty consenting patients (mean age 78 ± 6 years; 54% female) satisfied the eligibility criteria. All participants completed the study. Two forms of MWM techniques (n = 20) or a simulated MWM (sham) (n = 20) were applied. pain recorded by numerical rating scale (NRS). hip flexion and internal rotation ROM, and physical performance (timed up and go, sit to stand, and 40 m self placed walk test) were assessed before and after the intervention. For the MWM group, pain decreased by 2 points on the NRS, hip flexion increased by 12.2°, internal rotation by 4.4°, and functional tests were also improved with clinically relevant effects following the MWM. There were no significant changes in the sham group for any outcome variable. Pain, hip flexion ROM and physical performance immediately improved after the application of MWM in elderly patients suffering hip OA. The observed immediate changes were of clinical relevance. Future studies are required to determine the long-term effects of this intervention. Copyright © 2015 Elsevier Ltd. All rights reserved.

  13. Persistently High Hip Circumference after Bariatric Surgery Is a Major Hurdle to Successful Hip Replacement

    Directory of Open Access Journals (Sweden)

    Menachem M. Meller

    2014-01-01

    Full Text Available The prevalence of class III obesity (BMI≥40 kg/m2 in black women is 18%. As class III obesity leads to hip joint deterioration, black women frequently present for orthopedic care. Weight loss associated with bariatric surgery should lead to enhanced success of hip replacements. However, we present a case of a black woman who underwent Roux-en-Y gastric bypass with the expectation that weight loss would make her a better surgical candidate for hip replacement. Her gastric bypass was successful as her BMI declined from 52.0 kg/m2 to 33.7 kg/m2. However, her hip circumference after weight loss remained persistently high. Therefore, at surgery the soft tissue tunnel geometry presented major challenges. Tunnel depth and immobility of the soft tissue interfered with retractor placement, tissue reflection, and surgical access to the acetabulum. Therefore a traditional cup placement could not be achieved. Instead, a hemiarthroplasty was performed. After surgery her pain and reliance on external support decreased. But her functional independence never improved. This case demonstrates that a lower BMI after bariatric surgery may improve the metabolic profile and decrease anesthesia risk, but the success of total hip arthroplasties remains problematic if fat mass in the operative field (i.e., high hip circumference remains high.

  14. IMPROVING THE PROVISION OF STATE GUARANTEES UNDER CREDITS OR BONDED LOANS RAISED FOR INVESTMENT PROJECTS IMPLEMENTATION

    Directory of Open Access Journals (Sweden)

    Lola D. Sanginova

    2015-01-01

    Full Text Available Importance: Under current conditions, the Russian economy needs investment resources to ensure sustainable social and economic development. One of instruments of state-financing backing that can be used to support capital intensive, economically viable, financially and socially efficient investment projects that create "growing points" are state guarantees of theRussian Federation.Objective: The objective of this study is to identify possible ways to improve the requirements and procedures of providing state guarantees of theRussian Federationwhich contribute to the increase in the quantity and quality of investment projects of high social importance. Methods: Through the use of general scientific methods, analysis and synthesis, induction and deduction the possibility of creating a more attractive environment for principals is analyzed, measures to reduce the risk for public legal entities in providing state guarantees of theRussian Federationunder credits or bonded loans raised for investment projects implementation.Results: Principles of state guarantee support that ensure the interests of both the principals and the guarantor are defined. The basic directions for improving the mechanism how state guarantees of theRussian Federationsupport investment projects are justified. These directions include increasing availability of obtaining state guarantee support by lowering the cost of investment projects for which the state guarantees may be provided; reducing time of decision making on granting a state guarantee; increasing the creditors’ responsibility for a qualitative assessment of the creditworthiness of principals and investment projects; changing the methodology for assessing the social efficiency of investment projects; increasing the information transparency of provided state guarantees of the Russian Federation.Conclusions: The main result of this study is that under current conditions of economic turbulence state guarantees of the

  15. Homeless Veterans: Management Improvements Could Help VA Better Identify Supportive Housing Projects

    Science.gov (United States)

    2016-12-01

    end to homelessness does not mean that no one will ever experience a housing crisis again, but that every community will have a systematic response...focuses on short-term, crisis intervention when providing homeless prevention and rapid rehousing; both of these programs also provide supportive... HOMELESS VETERANS Management Improvements Could Help VA Better Identify Supportive-Housing Projects Report to

  16. Implementing an organization-wide quality improvement initiative: insights from project leads, managers, and frontline nurses.

    Science.gov (United States)

    Jeffs, Lianne P; Lo, Joyce; Beswick, Susan; Campbell, Heather

    2013-01-01

    With the movement to advance quality care and improve health care outcomes, organizations have increasingly implemented quality improvement (QI) initiatives to meet these requirements. Key to implementation success is the multilevel involvement of frontline clinicians and leadership. To explore the perceptions and experiences of frontline nurses, project leads, and managers associated with an organization-wide initiative aimed at engaging nurses in quality improvement work. To address the aims of this study, a qualitative research approach was used. Two focus groups were conducted with a total of 13 nurse participants, and individual interviews were done with 10 managers and 6 project leads. Emergent themes from the interview data included the following: improving care in a networked approach; driving QI and having a sense of pride; and overcoming challenges. Specifically, our findings elucidate the value of communities of practice and ongoing mentorship for nurses as key strategies to acquire and apply QI knowledge to a QI project on their respective units. Key challenges emerged including workload and time constraints, as well as resistance to change from staff. Our study findings suggest that leaders need to provide learning opportunities and protected time for frontline nurses to participate in QI projects.

  17. The Project «schools: space for Peace» as part of improving school life

    Directory of Open Access Journals (Sweden)

    M.ª Ángeles DÍAZ LINARES

    2010-11-01

    Full Text Available In the doctoral dissertation is a study conducted in public and private schools from non-university educational levels of the autonomous community of Andalusia, in order to determine whether the projects «schools: space for Peace» (PEEP are instruments to prevent violence and improve relationships in the framework of the education schools.

  18. Research and Implementation for License Plate Recognition Based on Improved Projection Algorithm

    Institute of Scientific and Technical Information of China (English)

    LI Xiu-juan; Yimamu’aishan.Abudoulikemu

    2013-01-01

    This paper analyzes and dissertates the discrete wavelet transform and improved projection algorithm in four kernel stages (image preprocessing, license plate localization, character segmentation, license plate recognition, i.e.) of license plate recognition system in detail. At last, it gives some conclusions and suggestions on future research.

  19. 77 FR 64544 - Central Valley Project Improvement Act, Water Management Plans

    Science.gov (United States)

    2012-10-22

    ... Bureau of Reclamation Central Valley Project Improvement Act, Water Management Plans AGENCY: Bureau of Reclamation, Interior. ACTION: Notice of availability. SUMMARY: The following Water Management Plans are... and published the Criteria for Evaluating Water Management Plans (Criteria). For the purpose of...

  20. 78 FR 63491 - Central Valley Project Improvement Act, Water Management Plans

    Science.gov (United States)

    2013-10-24

    ... Bureau of Reclamation Central Valley Project Improvement Act, Water Management Plans AGENCY: Bureau of Reclamation, Interior. ACTION: Notice of availability. SUMMARY: The following Water Management Plans are... developed and published the Criteria for Evaluating Water Management Plans (Criteria). For the purpose...

  1. 76 FR 58840 - Central Valley Project Improvement Act; Refuge Water Management Plans

    Science.gov (United States)

    2011-09-22

    ... Bureau of Reclamation Central Valley Project Improvement Act; Refuge Water Management Plans AGENCY... Refuge Water Management Plans (Refuge Criteria). Several entities have each developed a Refuge Water...) 978-5281 (TDD 978-5608). SUPPLEMENTARY INFORMATION: The following Refuge Water Management Plans...

  2. Improving Teachers' Practices through Supervision and Observations by School Principals: An Action Research Project

    Science.gov (United States)

    Taylor, Latasha M.

    2013-01-01

    This study focused on the impact of a new observation tool for principals to utilize and the effects it has on improving teachers' instruction and influencing best practices. The action research project explored the impact and influence that a well-developed observation tool could possess to help address areas of need; essentially, focusing on how…

  3. Evaluation of CSRA CESA Project for Incremental Improvement in Career Education, 1976-1979.

    Science.gov (United States)

    Bartos, Robert B.; Smith, Lyle R.

    Central Savannah River Area Cooperative Educational Services Agency (CSRA CESA) implemented a career education project for grades K-12 in the Columbia County School System to develop a replicable model for incremental improvements. The major emphasis was the infusion of career education activities into the teaching of basic skills. Program…

  4. The Multi-Purpose Center for Curriculum Improvement. End of Project Report.

    Science.gov (United States)

    Puzzuoli, David A.; Wholley, Peter J.

    The report for the 8-county West Virginia Multi-Purpose Center for Curriculum Improvement, funded under Title III of the Elementary and Secondary Education Act, represents a comprehensive evaluation of the numerous activities with which the center was involved. The first section of the document presents general characteristics of the project area,…

  5. Improving patient participation in a challenging context: a 2-year evaluation study of an implementation project.

    Science.gov (United States)

    Jangland, Eva; Gunningberg, Lena

    2017-05-01

    To evaluate an implementation project on patient participation. Patient participation is one of the cornerstones of person-centred care. A previous intervention study resulted in improved patient participation in a surgical department in a large university hospital in Sweden. A subsequent implementation project was guided by the PARiSH framework and included several strategies over 2 years. Patients (n = 198) in five units completed a questionnaire and nurse managers (n = 5) were interviewed. Although the long-term implementation project did not improve patient participation in the units, the nurse managers described a changing culture in which staff grew to accept patients' involvement in their own care. Several barriers to change and sustainability were acknowledged. Improving patient participation in a busy environment is challenging. The framework was useful in the different steps of the project. In the future, the interrelationship of the core elements needs to be analysed in an ongoing and deeper way to allow both prediction and prevention of barriers to improvement. A dedicated leadership together with skilled facilitators should encourage and support staff to reflect on their attitudes and ways of working to increase person-centred care. © 2017 John Wiley & Sons Ltd.

  6. A Project Reviewing the Intersection of School Culture, Leadership, Professional Development, and Environment in School Improvement

    Science.gov (United States)

    Jones, Sharon; Lawyer, James Douglas; Loewe, Jon

    2010-01-01

    This document reports the procedure and outcomes associated with a project focusing on educational research and development (R&D) based resources in the essential components of school improvement systems. Yet, the dissemination of and access to these R&D resources can be a complicated process. Access to educational resources and information…

  7. Total hip arthroplasty with femoral subtrochanteric osteotomy after Schanz osteotomy.

    Science.gov (United States)

    Sonohata, Motoki; Kitajima, Masaru; Kawano, Shunsuke; Tanaka, Riki; Mawatari, Masaaki

    2016-07-01

    Schanz osteotomy is one of the options for the management of hip instability caused by congenital or septic arthritis. Following Schanz osteotomy, there is risk of hip pain secondary to hip arthritis. It may be necessary to perform subtrochanteric femoral osteotomy in conjunction with total hip arthroplasty (THA). This study evaluates the outcomes and complications associated with THA. We performed 36 THA after Schanz osteotomy. Patients were divided into three groups: (1) successful Schanz osteotomy, (2) highly dislocated hip with contact between the femoral head and pelvis, and (3) completely dislocated hip without contact between the femur and pelvis. Clinical and radiological evaluations were completed for each group. In all three groups, hip function improved significantly (p osteotomy after Schanz osteotomy. However, this procedure is a technically demanding treatment option, and there were characteristic complications intra and after surgery. Therefore, surgeons should treat hip osteoarthritis after Schanz operation with utmost care, especially completely dislocated hip. Copyright © 2016 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.

  8. Quality Improvement Project to Improve Timeliness Between Bronchodilator Treatments from Emergency Department to Medical Wards.

    Science.gov (United States)

    Cockerham, Jennifer R; Lowe, Gary R; Willis, Randy; Stecks, Ryan M; Berlinski, Ariel

    2016-12-01

    Quality improvement methodology was applied to study sporadic reports that patients with asthma were not given bronchodilator treatments or assessed within an appropriate time frame when they were admitted from the emergency department to the medical ward. The goal was to increase the number of patients who had an interval between emergency department assessment/bronchodilator treatment and medical ward assessment/treatment of flow chart diagram, a fishbone diagram, data collection, intervention implementation, and data monitoring and analysis were used in this study. Data were collected on a pre-test of change cohort of 227 subjects with asthma from January 2013 to March 2014. A test of change adding a Q2H respiratory therapist assessment and as needed bronchodilator treatment order while the subject was in the emergency department was implemented during May of 2014. These data were compared with a post-test of change cohort of 278 subjects with asthma from May 2014 to July 2015. Data collection for both cohorts included the time from the last assessment/bronchodilator treatment in the emergency department to emergency department discharge, the time from emergency department discharge to assessment/treatment in the medical ward, and the sum of these 2 time periods. Mean times (minutes) were noted, and comparisons were made using 2-tailed independent t tests with significance set at P process control charts. There was a 124% increase noted in the percentage of subjects who received bronchodilator treatment within 120 min, a 53% increase within 180 min, and a 19% increase within 240 min. The interval time between treatments decreased 21%. Through quality improvement methodology, the group was able to significantly decrease the time between the last assessment/bronchodilator treatment in the emergency department and the first assessment/treatment in the medical ward for subjects with asthma. Moreover, improvement was seen in all studied parameters despite similar

  9. Exercise Training in Treatment and Rehabilitation of Hip Osteoarthritis: A 12-Week Pilot Trial

    OpenAIRE

    Kirsti Uusi-Rasi; Radhika Patil; Saija Karinkanta; Kari Tokola; Pekka Kannus; Harri Sievänen

    2017-01-01

    Introduction. Osteoarthritis (OA) of the hip is one of the major causes of pain and disability in the older population. Although exercise is an effective treatment for knee OA, there is lack of evidence regarding hip OA. The aim of this trial was to test the safety and feasibility of a specifically designed exercise program in relieving hip pain and improving function in hip OA participants and to evaluate various methods to measure changes in their physical functioning. Materials and Methods...

  10. USING TRABECULAR METAL AUGMENTS FOR TOTAL HIP REPLACEMENT IN PATIENTS AFTER ACETABULAR FRACTURES

    Directory of Open Access Journals (Sweden)

    R. M. Tikhilov

    2011-01-01

    Full Text Available The authors presented the experience of treatment of two patients with hip arthritis after acetabular fracture. Both patients were treated with total hip replacement. During the operation, to manage posterior-superior bone defects of the acetabulum, augments of trabecular metal were used. Pain and limitation of motions in hip were indications for operative treatment. After a year of follow up there was no pain in hip; also recovery of motion and improved quality of life were observed.

  11. Orthogeriatric Service Reduces Mortality in Patients With Hip Fracture

    DEFF Research Database (Denmark)

    Stenqvist, Charlotte; Madsen, Christian Medom; Riis, Troels

    2016-01-01

    INTRODUCTION: Orthogeriatric service has been shown to improve outcomes in patients with hip fracture. The purpose of this study is to evaluate the effect of orthogeriatrics at Bispebjerg University Hospital, Denmark. The primary outcome is mortality inhospital and after 1, 3, and 12 months for p......, and ASA score. Future trials should include frail patients with other fracture types who can benefit from orthogeriatrics.......INTRODUCTION: Orthogeriatric service has been shown to improve outcomes in patients with hip fracture. The purpose of this study is to evaluate the effect of orthogeriatrics at Bispebjerg University Hospital, Denmark. The primary outcome is mortality inhospital and after 1, 3, and 12 months...... for patients with hip fracture. The secondary outcome is mortality for home dwellers and nursing home inhabitants. MATERIALS AND METHODS: This is a retrospective clinical cohort study with an historic control group including all patients with hip fracture admitted from 2007 to 2011. Patients with hip fracture...

  12. Steam Pressure-Reducing Station Safety and Energy Efficiency Improvement Project

    Energy Technology Data Exchange (ETDEWEB)

    Lower, Mark D [ORNL; Christopher, Timothy W [ORNL; Oland, C Barry [ORNL

    2011-06-01

    The Facilities and Operations (F&O) Directorate is sponsoring a continuous process improvement (CPI) program. Its purpose is to stimulate, promote, and sustain a culture of improvement throughout all levels of the organization. The CPI program ensures that a scientific and repeatable process exists for improving the delivery of F&O products and services in support of Oak Ridge National Laboratory (ORNL) Management Systems. Strategic objectives of the CPI program include achieving excellence in laboratory operations in the areas of safety, health, and the environment. Identifying and promoting opportunities for achieving the following critical outcomes are important business goals of the CPI program: improved safety performance; process focused on consumer needs; modern and secure campus; flexibility to respond to changing laboratory needs; bench strength for the future; and elimination of legacy issues. The Steam Pressure-Reducing Station (SPRS) Safety and Energy Efficiency Improvement Project, which is under the CPI program, focuses on maintaining and upgrading SPRSs that are part of the ORNL steam distribution network. This steam pipe network transports steam produced at the ORNL steam plant to many buildings in the main campus site. The SPRS Safety and Energy Efficiency Improvement Project promotes excellence in laboratory operations by (1) improving personnel safety, (2) decreasing fuel consumption through improved steam system energy efficiency, and (3) achieving compliance with applicable worker health and safety requirements. The SPRS Safety and Energy Efficiency Improvement Project being performed by F&O is helping ORNL improve both energy efficiency and worker safety by modifying, maintaining, and repairing SPRSs. Since work began in 2006, numerous energy-wasting steam leaks have been eliminated, heat losses from uninsulated steam pipe surfaces have been reduced, and deficient pressure retaining components have been replaced. These improvements helped ORNL

  13. Designing and implementing an outcomes-based performance improvement project: behavioral health care.

    Science.gov (United States)

    1998-08-01

    1. All performance measurement and improvement initiatives should be planned. Planning should reveal the origins of the project, define and validate the project purpose, specify the desired effect of the project, develop project success measures, specify necessary resources, describe any constraints, anticipate problems, and specify milestones and deadlines. 2. An interdisciplinary team is usually created to implement the improvement project. This team is generally composed of staff from different disciplines, organizational entities, and levels throughout the facility. 3. Am improvement team typically consists of an executive coach, a team leader, a facilitator, and multiple team members. Sometimes a measurement specialist is included in the team. Additional subject matter experts serve as ad hoc team members as needed. 4. Data management is a process comprising the following discrete activities: determination of data needs, specification of indicators, definition of data elements, specification of data sources, creation of data collection instruments, determination of data analysis strategies, completion of a data collection plan, pilot testing of data collection and analysis, and modification of data management tactics based on the results of the pilot test. 5. There are two fundamental kinds of studies: quantitative and qualitative. Quantitative studies present numeric performance data, such as averages, correlations,and variation. Qualitative studies provide narrative data, such as content and theme analyses, and individual quotes. 6. Effective data collection requires valid and reliable data collection instruments and trained data collectors. 7. Analysis of performance data may be quantitative or qualitative and may compare an organization's performance to itself over time, as well as to external benchmarks. 8. Root cause analysis is based on tools such as the process flow diagram, cause-effect diagram, scatter diagram, Pareto analysis, and repetitive why to

  14. Improving Hydro-Climatic Projections with Bias-Correction in Sahelian Niger Basin, West Africa

    Directory of Open Access Journals (Sweden)

    Ganiyu Titilope Oyerinde

    2017-02-01

    Full Text Available Climate simulations in West Africa have been attributed with large uncertainties. Global climate projections are not consistent with changes in observations at the regional or local level of the Niger basin, making management of hydrological projects in the basin uncertain. This study evaluates the potential of using the quantile mapping bias correction to improve the Coupled Model Intercomparison Project (CMIP5 outputs for use in hydrological impact studies. Rainfall and temperature projections from 8 CMIP5 Global Climate Models (GCM were bias corrected using the quantile mapping approach. Impacts of climate change was evaluated with bias corrected rainfall, temperature and potential evapotranspiration (PET. The IHACRES hydrological model was adapted to the Niger basin and used to simulate impacts of climate change on discharge under present and future conditions. Bias correction with quantile mapping significantly improved the accuracy of rainfall and temperature simulations compared to observations. The mean of six efficiency coefficients used for monthly rainfall comparisons of 8 GCMs to the observed ranged from 0.69 to 0.91 and 0.84 to 0.96 before and after bias correction, respectively. The range of the standard deviations of the efficiency coefficients among the 8 GCMs rainfall data were significantly reduced from 0.05–0.14 (before bias correction to 0.01–0.03 (after bias correction. Increasing annual rainfall, temperature, PET and river discharge were projected for most of the GCMs used in this study under the RCP4.5 and RCP8.5 scenarios. These results will help improving projections and contribute to the development of sustainable climate change adaptation strategies.

  15. Projecting future expansion of invasive species: comparing and improving methodologies for species distribution modeling.

    Science.gov (United States)

    Mainali, Kumar P; Warren, Dan L; Dhileepan, Kunjithapatham; McConnachie, Andrew; Strathie, Lorraine; Hassan, Gul; Karki, Debendra; Shrestha, Bharat B; Parmesan, Camille

    2015-12-01

    Modeling the distributions of species, especially of invasive species in non-native ranges, involves multiple challenges. Here, we developed some novel approaches to species distribution modeling aimed at reducing the influences of such challenges and improving the realism of projections. We estimated species-environment relationships for Parthenium hysterophorus L. (Asteraceae) with four modeling methods run with multiple scenarios of (i) sources of occurrences and geographically isolated background ranges for absences, (ii) approaches to drawing background (absence) points, and (iii) alternate sets of predictor variables. We further tested various quantitative metrics of model evaluation against biological insight. Model projections were very sensitive to the choice of training dataset. Model accuracy was much improved using a global dataset for model training, rather than restricting data input to the species' native range. AUC score was a poor metric for model evaluation and, if used alone, was not a useful criterion for assessing model performance. Projections away from the sampled space (i.e., into areas of potential future invasion) were very different depending on the modeling methods used, raising questions about the reliability of ensemble projections. Generalized linear models gave very unrealistic projections far away from the training region. Models that efficiently fit the dominant pattern, but exclude highly local patterns in the dataset and capture interactions as they appear in data (e.g., boosted regression trees), improved generalization of the models. Biological knowledge of the species and its distribution was important in refining choices about the best set of projections. A post hoc test conducted on a new Parthenium dataset from Nepal validated excellent predictive performance of our 'best' model. We showed that vast stretches of currently uninvaded geographic areas on multiple continents harbor highly suitable habitats for parthenium

  16. Estimated Entrainment of Dungeness Crab During Dredging For The Columbia River Channel Improvement Project

    Energy Technology Data Exchange (ETDEWEB)

    Pearson, Walter H.; Williams, Greg D.; Skalski, John R.

    2002-12-01

    The studies reported here focus on issues regarding the entrainment of Dungeness crab related to the proposed Columbia River Channel Improvement Project and provided direct measurements of crab entrainment rates at three locations (Desdomona Shoals, Upper Sands, and Miller Sands) from RM4 to RM24 during summer 2002. Entrainment rates for all age classes of crabs ranged from zero at Miller Sands to 0.224 crabs per cy at Desdemona Shoals in June 2002. The overall entrainment rate at Desdomona Shoals in September was 0.120 crabs per cy. A modified Dredge Impact Model (DIM) used the summer 2002 entrainment rates to project crab entrainment and adult equivalent loss and loss to the fishery for the Channel Improvement Project. To improve the projections, entrainment data from Flavel Bar is needed. The literature, analyses of salinity intrusion scenarios, and the summer 2002 site-specific data on entrainment and salinity all indicate that bottom salinity influences crab distribution and entrainment, especially at lower salinities. It is now clear from field measurements of entrainment rates and salinity during a period of low river flow (90-150 Kcfs) and high salinity intrusion that entrainment rates are zero where bottom salinity is less than 16 o/oo most of the time. Further, entrainment rates of 2+ and older crab fall with decreasing salinity in a clear and consistent manner. More elaboration of the crab distribution- salinity model, especially concerning salinity and the movements of 1+ crab, is needed.

  17. Improving intercultural competency in global IT projects through recognition of culture-based behaviors

    Directory of Open Access Journals (Sweden)

    Richard Amster

    2016-01-01

    Full Text Available The success of global IT projects is highly influenced by culture-based behaviors. Issues between individuals arise when behaviors are (mis-perceived, (mis-interpreted, and (mis-judged by using the perceiver’s expectations, beliefs, and values. Misperception results when the behavior is not anticipated because it would not occur in ones own culture. As a result, behavior should be the starting point for cross-cultural research. But, studies have primarily focused on belief and value systems which are more abstract and less specific than behaviors. This paper presents a study that analyzed cultural behavioral differences between Indian project managers and their counterparts in other countries. The conducted qualitative, semi-structured interviews revealed insights into cross-cultural challenges and shed light on the complex ways that culture-based behaviors impact IT projects. The study identified 127 behaviors that significantly affected project success and cross-cultural cooperation between Indian managers and managers from all over the world. These behaviors were grouped into 19 behavior clusters. Understanding these behavior clusters, and correlating these behaviors to values and beliefs, will improve project collaboration, and inform cross-cultural training strategies. In addition, existing cultural dimensions were reduced in scope, additional dimensions were defined for clarity, and new business-related dimensions were identified. Finally, based on the study’s results, the paper suggests four important components that should be added to cross-cultural training programs for international project managers.

  18. Georgia Pacific: Crossett Mill Identifies Heat Recovery Projects and Operational Improvements

    Energy Technology Data Exchange (ETDEWEB)

    None

    2003-10-01

    An assessment team conducted a mill-wide energy survey at Georgia-Pacific's Crossett, Arkansas mill to update a previous pinch analysis. Three heat recovery projects were identified that could reduce annual costs by $4.8 million and reduce natural gas use by 1,845,000 x 106 Btu. The overall payback period for the heat recovery projects would be less than 1 year. Furthermore, by implementing operational improvements, the mill could save $4.8 million more annually and 1,500,000 x 106 Btu in natural gas.

  19. 3D printing technology used in severe hip deformity.

    Science.gov (United States)

    Wang, Shanshan; Wang, Li; Liu, Yan; Ren, Yongfang; Jiang, Li; Li, Yan; Zhou, Hao; Chen, Jie; Jia, Wenxiao; Li, Hui

    2017-09-01

    This study was designed to assess the use of a 3D printing technique in total hip arthroplasty (THA) for severe hip deformities, where new and improved approaches are needed. THAs were performed from January 2015 to December 2016. Bioprosthesis artificial hip joints were used in both conventional and 3D printing hip arthroplasties. A total of 74 patients (57 cases undergoing conventional hip replacements and 17 undergoing 3D printing hip replacements) were followed-up for an average of 24 months. The average age of the patients was 62.7 years. Clinical data between the patients treated with different approaches were compared. Results showed that the time to postoperative weight bearing and the Harris scores of the patients in the 3D printing group were better than those for patients in the conventional hip replacement group. Unfortunately, the postoperative infection and loosening rates were higher in the 3D printing group. However, there were no significant differences in femoral neck anteversion, neck shaft, acetabular or sharp angles between ipsilateral and contralateral sides in the 3D printing group (P>0.05). The femoral neck anteversion angle was significantly different between the two sides in the conventional hip replacement group (P3D printing approach provides a better short-term curative effect that is more consistent with the physiological structure and anatomical characteristics of the patient, and we anticipate that its use will help improve the lives of many patients.

  20. Providing a framework to improve the performance of business process management projects based on BPMN

    Directory of Open Access Journals (Sweden)

    Mojtaba Ahmadi

    2016-01-01

    Full Text Available Modeling of business processes, based on Business Process Modeling Notation (BPMN, helps analysts and managers to understand business processes, and, identify their shortages. These models provide a context to make rational decision of organizing business processes activities in an understandable manner. The purpose of this paper is to provide a framework for better understanding of business processes and their problems by reducing the cognitive load of displayed information for their audience at different managerial levels while keeping the essential information which are needed by them. For this reason, we integrate business process diagrams across the different managerial levels to develop a framework to improve the performance of business process management (BPM projects. This framework, which is referred to as “Business Process Improvement Framework Based on Managerial Levels (BPIML” in this paper, considers three levels of management (Organizational level managers, Process /Departmental level managers and Activity level managers for manager of an organization. Then, defines certain types of models based on BPMN, for each management level, by taking into the account the objectives and tasks of various managerial levels in organizations and their role in Business Process Management (BPM projects. This framework will make us able to provide the necessary support for making decisions about business processes. The framework is evaluated with a case study in a real business process improvement project, to demonstrate its superiority over the conventional method. A questionnaire consisted of 10 questions using Likert scale was designed and given to the participants (three managerial levels. The results of this questionnaire suggested that, managers and senior experts of the organization considered utilization of the proposed framework improving for implementation of BPM projects and provide support for correct and timely decisions by

  1. EFFECT OF HIP MOBILIZATION WITH EXERCISES FOR SUBJECTS WITH CHRONIC NON SPECIFIC LOW BACK PAIN ASSOCIATED WITH HIP IMPAIRMENT

    Directory of Open Access Journals (Sweden)

    Chintan Patel

    2015-02-01

    Full Text Available Background:There is a basic assumption from the studies on hip–LBP relationship that suboptimal function of the hip might result in an alteration of the mechanics of the lumbopelvic region. Evidence is mounting to support the possibility that low back pain may be result of hip rotation deficits. The excessive or limited hip rotation range of motion could be a predisposing factor for low back dysfunction. Exercises and hip joint mobilization, individually found to be effective in chronic nonspecific low back pain with hip impairment. Hence, the purpose is to find the effect of hip joint mobilization with stretching exercises on intensity of pain and functional disability for subjects with chronic nonspecific low back pain associated with hip impairment. Method: An experimental study design selected 30 subjects with chronic low back pain associated with Hip impairment randomized 15 subjects each into Study and Control group. Control group received stretching exercises while Study group received hip joint mobilization with stretching exercises thrice a week for 3 weeks. Pain intensity was measured using Visual Analogue Scale and Functional disability was measured by Modified Oswestry Disability Index for LBP before and after 2 weeks of treatment. Results: There is statistically significant difference in improvement in means of VAS and Modified ODI when analyzed within the group. When the post-intervention means were compared between Study and Control group there is a statistically significant difference in means after 2 weeks of treatment. Conclusion: The present study concluded that the two weeks duration of combined hip joint mobilization with stretching exercises significantly effective on improving pain and functional disability than only stretching exercise regimen for chronic non-specific low back pain associated with Hip impairment.

  2. Sonography for hip joint effusion in adults with hip pain

    NARCIS (Netherlands)

    S.M. Bierma-Zeinstra (Sita); A.M. Bohnen (Arthur); J.A.N. Verhaar (Jan); A. Prins (Ad); J.S. Lameris; A.Z. Ginai (Abida)

    2000-01-01

    textabstractOBJECTIVE: To study the prevalence of ultrasonic hip joint effusion and its relation with clinical, radiological and laboratory (ESR) findings in adults with hip pain. METHODS: Patients (n = 224) aged 50 years or older with hip pain, referred by the general

  3. sign hip construct: achieving hip fracture fixation without using an ...

    African Journals Online (AJOL)

    Objective: The aim of this study was to assess outcomes of using the SIGN Hip Construct (SHC) to achieve ... The majority (76%) of patients were ambulatory within. 3 days after the surgery. ... Conclusion: Using the SIGN Hip Construct, hip fracture fixation can be ... elderly has made stable reduction and internal fixation.

  4. [Rotator cuff tear of the hip].

    Science.gov (United States)

    Jeanneret, Luc; Kurmann, Patric T; van Linthoudt, Daniel

    2008-05-14

    We report the observations of two women with a recurrent periarthritis of the hip complicated by a spontaneous rupture of the tendons of the gluteus medius and minimus. These patients usually complain from an acute lateral hip pain and show a Trendelenburg gait. When the rupture is complete, clinical evaluation reveals a drop of the pelvis on the non-stance side and resisted rotation starting from the extreme external rotation position is weak. MRI plays a key role in the diagnosis and the evaluation of a possible surgical repair. Hip rotator-cuff rupture is probably insufficiently diagnosed by ignorance. Nonetheless, optimized handling could relieve the pain of most these patients and improve the disability of some of them.

  5. Hip Pain: Dry Needling Versus Cortisone Injections.

    Science.gov (United States)

    2017-04-01

    Greater trochanteric pain syndrome (GTPS) is chronic, intermittent pain and tenderness on the outside of the hip. The medical community once thought that a swollen hip bursa was the source of such pain, which led to the use of corticosteroid injections to the bursa to help decrease swelling and pain. However, researchers now believe that injuries to the muscles and tendons around the hip are the actual cause of this pain, and that inflammation is often not involved. A study published in the April 2017 issue of JOSPT explores dry needling as an alternative to cortisone injections to reduce pain and improve function in patients with GTPS. J Orthop Sports Phys Ther 2017;47(4):240. doi:10.2519/jospt.2017.0504.

  6. HIP-HOP

    Institute of Scientific and Technical Information of China (English)

    QunyKing; 人在羽中; 钱李明

    2005-01-01

    自从一群摇滚青年开始跟风 Elvis 的《Blue SuedeShoes》风格,hip-hop 似乎就成为了全球最具影响力的音乐风格。它最初起源于美国的黑人和拉丁美洲人,之后迅速在全世界流行,成为80年代、90年代和新千年的主流音乐。无论是在广告界还是在电影业,从各类排行榜到各种酒吧,hip-hop 的影响逐年增加。在1997年,英国的 hip-hop 还只是一种地下音

  7. Developmental Dysplasia of the Hip

    Science.gov (United States)

    ... in the motion of the hip and obvious shortening of the affected leg in older kids, an ... socket. During the procedure, doctors loosen the tight muscles and tissues around the hip joint and then ...

  8. Implementation of quality improvement techniques for management and technical processes in the ACRV project

    Science.gov (United States)

    Raiman, Laura B.

    1992-12-01

    Total Quality Management (TQM) is a cooperative form of doing business that relies on the talents of everyone in an organization to continually improve quality and productivity, using teams and an assortment of statistical and measurement tools. The objective of the activities described in this paper was to implement effective improvement tools and techniques in order to build work processes which support good management and technical decisions and actions which are crucial to the success of the ACRV project. The objectives were met by applications in both the technical and management areas. The management applications involved initiating focused continuous improvement projects with widespread team membership. The technical applications involved applying proven statistical tools and techniques to the technical issues associated with the ACRV Project. Specific activities related to the objective included working with a support contractor team to improve support processes, examining processes involved in international activities, a series of tutorials presented to the New Initiatives Office and support contractors, a briefing to NIO managers, and work with the NIO Q+ Team. On the technical side, work included analyzing data from the large-scale W.A.T.E.R. test, landing mode trade analyses, and targeting probability calculations. The results of these efforts will help to develop a disciplined, ongoing process for producing fundamental decisions and actions that shape and guide the ACRV organization .

  9. Implementation of quality improvement techniques for management and technical processes in the ACRV project

    Science.gov (United States)

    Raiman, Laura B.

    1992-01-01

    Total Quality Management (TQM) is a cooperative form of doing business that relies on the talents of everyone in an organization to continually improve quality and productivity, using teams and an assortment of statistical and measurement tools. The objective of the activities described in this paper was to implement effective improvement tools and techniques in order to build work processes which support good management and technical decisions and actions which are crucial to the success of the ACRV project. The objectives were met by applications in both the technical and management areas. The management applications involved initiating focused continuous improvement projects with widespread team membership. The technical applications involved applying proven statistical tools and techniques to the technical issues associated with the ACRV Project. Specific activities related to the objective included working with a support contractor team to improve support processes, examining processes involved in international activities, a series of tutorials presented to the New Initiatives Office and support contractors, a briefing to NIO managers, and work with the NIO Q+ Team. On the technical side, work included analyzing data from the large-scale W.A.T.E.R. test, landing mode trade analyses, and targeting probability calculations. The results of these efforts will help to develop a disciplined, ongoing process for producing fundamental decisions and actions that shape and guide the ACRV organization .

  10. SAFETY IMPROVES DRAMATICALLY IN FLUOR HANFORD SOIL AND GROUNDWATER REMEDIATION PROJECT

    Energy Technology Data Exchange (ETDEWEB)

    GERBER MS

    2007-12-05

    This paper describes dramatic improvements in the safety record of the Soil and Groundwater Remediation Project (SGRP) at the Hanford Site in southeast Washington state over the past four years. During a period of enormous growth in project work and scope, contractor Fluor Hanford reduced injuries, accidents, and other safety-related incidents and enhanced a safety culture that earned the SGRP Star Status in the Department of Energy's (DOE's) Voluntary Protection Program (VPP) in 2007. This paper outlines the complex and multi-faceted work of Fluor Hanford's SGRP and details the steps taken by the project's Field Operations and Safety organizations to improve safety. Holding field safety meetings and walkdowns, broadening safety inspections, organizing employee safety councils, intensively flowing down safety requirements to subcontractors, and adopting other methods to achieve remarkable improvement in safety are discussed. The roles of management, labor and subcontractors are detailed. Finally, SGRP's safety improvements are discussed within the context of overall safety enhancements made by Fluor Hanford in the company's 11 years of managing nuclear waste cleanup at the Hanford Site.

  11. Hip resurfacing: a technology reborn

    OpenAIRE

    2006-01-01

    In recent years there has been a resurgence of interest in the concept of hip resurfacing. Much of this interest has stemmed from the work of McMinn in the West Midlands. Hip resurfacing is now emerging as a viable alternative to conventional hip replacement. In this article, we discuss the conceptual advantages offered by hip resurfacing and review the early clinical results and the ongoing clinical concerns regarding this technology.

  12. Improving building life-cycle information management through documentation and communication of project objectives

    Energy Technology Data Exchange (ETDEWEB)

    Hitchcock, R.J.

    1995-08-01

    Most currently available computer tools for the building industry proffer little more than productivity improvement in the transmission of graphical drawings and textual specifications, without addressing more fundamental changes in building life-cycle information management. This paper describes preliminary research into the development of a framework for the documentation and communication of the project objectives of a building project. When implemented in an interactive networked environment, this framework is intended to promote multiple participant involvement in the establishment and use of a common set of explicit goals, from the earliest phase of a project throughout its life cycle. A number of potential applications for this framework are identified. The requirements for integrating this life-cycle information with a product model of the physical design of a building, in an attempt to document and communicate design intent, are also discussed.

  13. X-Ray Exam: Hip

    Science.gov (United States)

    ... Old Feeding Your 1- to 2-Year-Old X-Ray Exam: Hip KidsHealth > For Parents > X-Ray Exam: Hip A A A What's in ... español Radiografía: cadera What It Is A hip X-ray is a safe and painless test that ...

  14. Development of an Improved Process for Installation Projects of High Technology Manufacturing Equipment

    Energy Technology Data Exchange (ETDEWEB)

    Quintana, Sarah V. [Los Alamos National Lab. (LANL), Los Alamos, NM (United States)

    2014-04-30

    High technology manufacturing equipment is utilized at Los Alamos National Laboratory (LANL) to support nuclear missions. This is undertaken from concept initiation where equipment is designed and then taken through several review phases, working closely with system engineers (SEs) responsible for each of the affected systems or involved disciplines (from gasses to HVAC to structural, etc.). After the design is finalized it moves to procurement and custom fabrication of the equipment and equipment installation, including all of the paperwork involved. Not only are the engineering and manufacturing aspects important, but also the scheduling, financial forecasting, and planning portions that take place initially and are sometimes modified as the project progresses should requirements, changes or additions become necessary. The process required to complete a project of this type, including equipment installation, is unique and involves numerous steps to complete. These processes can be improved and recent work on the Direct Current Arc (DC Arc) Glovebox Design, Fabrication and Installation Project provides an opportunity to identify some important lessons learned (LL) that can be implemented in the future for continued project improvement and success.

  15. Proposed IMS infrastructure improvement project, Seward, Alaska. Final environmental impact statement

    Energy Technology Data Exchange (ETDEWEB)

    1994-09-01

    This Environmental Impact Statement (EIS) examines a proposal for improvements at the existing University of Alaska, Fairbanks, Institute of Marine Science (IMS), Seward Marine Center. The Exxon Valdez Oil Spill (EVOS) Trustee Council is proposing to improve the existing research infrastructure to enhance the EVOS Trustee Council`s capabilities to study and rehabilitate marine mammals, marine birds, and the ecosystem injured by the Exxon Valdez oil spill. The analysis in this document focuses on the effects associated with construction and operation of the proposed project and its proposed alternatives. The EIS gives a detailed description of all major elements of the proposed project and its alternatives; identifies resources of major concern that were raised during the scoping process; describes the environmental background conditions of those resources; defines and analyzes the potential effects of the proposed project and its alternatives on these conditions; and identifies mitigating measures that are part of the project design as well as those proposed to minimize or reduce the adverse effects. Included in the EIS are written and oral comments received during the public comment period.

  16. EMPRESS: A European Project to Enhance Process Control Through Improved Temperature Measurement

    Science.gov (United States)

    Pearce, J. V.; Edler, F.; Elliott, C. J.; Rosso, L.; Sutton, G.; Andreu, A.; Machin, G.

    2017-08-01

    A new European project called EMPRESS, funded by the EURAMET program `European Metrology Program for Innovation and Research,' is described. The 3 year project, which started in the summer of 2015, is intended to substantially augment the efficiency of high-value manufacturing processes by improving temperature measurement techniques at the point of use. The project consortium has 18 partners and 5 external collaborators, from the metrology sector, high-value manufacturing, sensor manufacturing, and academia. Accurate control of temperature is key to ensuring process efficiency and product consistency and is often not achieved to the level required for modern processes. Enhanced efficiency of processes may take several forms including reduced product rejection/waste; improved energy efficiency; increased intervals between sensor recalibration/maintenance; and increased sensor reliability, i.e., reduced amount of operator intervention. Traceability of temperature measurements to the International Temperature Scale of 1990 (ITS-90) is a critical factor in establishing low measurement uncertainty and reproducible, consistent process control. Introducing such traceability in situ (i.e., within the industrial process) is a theme running through this project.

  17. The Improvement Project in Postponement of Bankruptcy Process: An Evaluation from the Business Point of View

    Directory of Open Access Journals (Sweden)

    Mahmut Ozdevecioglu

    2010-07-01

    Full Text Available It is inevitable for the capital companies and cooperatives in Turkey to go bankrupt in case the assets of the company are insufficient to meet the obligations. However, the law enacted in 2004 has enabled the bankruptcy to be postponed. The company requesting the adjournment of bankruptcy should not only fulfill the legal requirements but also present the court a convincing and serious improvement project. The main objective of this study is to discuss how to prepare such a plan from the point of view of business manager. The improvement project is a financial project based on objective and solid data which contains precautionary measures envisaged to rescue the company. In general the project should incorporate financial and administrative measures. Financial measures include direct and indirect cash inflows from sources like finding new partners, selling personal assets of existing partners and focusing on high profit margin products to ensure that the assets can cover the liabilities. The administrative measures in the field of accounting, finance and human resources contribute to the healing process indirectly. This paper explains the financial and administrative measures in detail.

  18. Fuel Fabrication Capability WBS 01.02.01.05 - HIP Bonding Experiments Final Report

    Energy Technology Data Exchange (ETDEWEB)

    Dickerson, Patricia O' Donnell [Los Alamos National Lab. (LANL), Los Alamos, NM (United States); Summa, Deborah Ann [Los Alamos National Lab. (LANL), Los Alamos, NM (United States); Liu, Cheng [Los Alamos National Lab. (LANL), Los Alamos, NM (United States); Tucker, Laura Arias [Los Alamos National Lab. (LANL), Los Alamos, NM (United States); Chen, Ching-Fong [Los Alamos National Lab. (LANL), Los Alamos, NM (United States); Aikin, Beverly [Los Alamos National Lab. (LANL), Los Alamos, NM (United States); Aragon, Daniel Adrian [Los Alamos National Lab. (LANL), Los Alamos, NM (United States); Beard, Timothy Vance [Los Alamos National Lab. (LANL), Los Alamos, NM (United States); Montalvo, Joel Dwayne [Los Alamos National Lab. (LANL), Los Alamos, NM (United States); Pena, Maria Isela [Los Alamos National Lab. (LANL), Los Alamos, NM (United States); Dombrowski, David E. [Los Alamos National Lab. (LANL), Los Alamos, NM (United States)

    2015-06-10

    The goals of this project were to demonstrate reliable, reproducible solid state bonding of aluminum 6061 alloy plates together to encapsulate DU-10 wt% Mo surrogate fuel foils. This was done as part of the CONVERT Fuel Fabrication Capability effort in Process Baseline Development . Bonding was done using Hot Isotatic Pressing (HIP) of evacuated stainless steel cans (a.k.a HIP cans) containing fuel plate components and strongbacks. Gross macroscopic measurements of HIP cans prior to HIP and after HIP were used as part of this demonstration, and were used to determine the accuracy of a finitie element model of the HIP bonding process. The quality of the bonding was measured by controlled miniature bulge testing for Al-Al, Al-Zr, and Zr-DU bonds. A special objective was to determine if the HIP process consistently produces good quality bonding and to determine the best characterization techniques for technology transfer.

  19. The uncertainty of crop yield projections is reduced by improved temperature response functions

    DEFF Research Database (Denmark)

    Wang, Enli; Martre, Pierre; Zhao, Zhigan

    2017-01-01

    Increasing the accuracy of crop productivity estimates is a key element in planning adaptation strategies to ensure global food security under climate change. Process-based crop models are effective means to project climate impact on crop yield, but have large uncertainty in yield simulations. Here...... response functions that when substituted in four wheat models reduced the error in grain yield simulations across seven global sites with different temperature regimes by 19% to 50% (42% average). We anticipate the improved temperature responses to be a key step to improve modelling of crops under rising...... temperature and climate change, leading to higher skill of crop yield projections. Process-based modelling of crop growth is an effective way of representing how crop genotype, environment and management interactions affect crop production to aid tactical and strategic decision making1. Process-based crop...

  20. Arthroscopic bursectomy for recalcitrant trochanteric bursitis after hip arthroplasty.

    Science.gov (United States)

    Van Hofwegen, Christopher; Baker, Champ L; Savory, Carlton G; Baker, Champ L

    2013-01-01

    This study evaluated the use of arthroscopic bursectomy for pain relief in patients with trochanteric bursitis after hip arthroplasty. In this retrospective case series of 12 patients undergoing arthroscopic treatment of recalcitrant trochanteric bursitis after hip arthroplasty, outcomes were assessed via phone interview with a numeric pain rating scale from 1 to 10 and were compared with preoperative pain ratings. Patients were asked the percentage of time they had painless hip function and whether they would have the surgery again. At an average 36-month follow-up (range, 4-85 months), the average numeric pain scale rating improved from 9.3 to 3.3. At an average of 62% of the time, patients had painless use of the hip. Ten of 12 patients in the study felt the pain relief gained was substantial enough to warrant having procedure again. In these patients, arthroscopic bursectomy was a viable option for patients with recalcitrant bursitis after hip arthroplasty.

  1. EUROPEAN PROJECTS AS A TOOL FOR IMPROVING FARMERS SKILLS VIA MODERN INFORMATION TECHNOLOGIES

    Directory of Open Access Journals (Sweden)

    Zuzana PALKOVA

    2013-01-01

    Full Text Available This article presents European projects with the main focus on the improving the skills and competitiveness of farmers by modern information and communication technologies and e-learning methods. Two projects – AVARES - Enhance attractiveness of renewable energy training by virtual reality and NewCAP - New European Standards in the Context of Reformed EU Common Agricultural Policy are projects under the Leonardo da Vinci Transfer ofInnovation grant scheme. They try to present new way of vocational education and training in the agrosector. The main aim of the AVARES project is to develop the multimedia learning materials for vocational education and training in the field of agricultural and rural development and application of modern information and communication technologies into vocational education and training. The emphasis is put on the application of modern ICT equipment and technologies, with the main focus on the Virtual reality, 3D visual display and e - learning 2.0 methods. New programming period 2014 – 2020 will bring significant changes within the Common Agricultural Policy (CAP which will have a serious impact on economy especially of larger beneficiaries. The „NewCAP“ project aiming at preparation of actors in rural areas to take the proposed changes in the policy through interactive educational programme.

  2. Software for improving the quality of project management, a case study: international manufacture of electrical equipment

    Science.gov (United States)

    Preradović, D. M.; Mićić, Lj S.; Barz, C.

    2017-05-01

    Production conditions in today’s world require software support at every stage of production and development of new products, for quality assurance and compliance with ISO standards. In addition to ISO standards such as usual metrics of quality, companies today are focused on other optional standards, such as CMMI (Capability Maturity Model Integrated) or prescribing they own standards. However, while there is intensive progress being made in the PM (project management), there is still a significant number of projects, at the global level, that are failures. These have failed to achieve their goals, within budget or timeframe. This paper focuses on checking the role of software tools through the rate of success in projects implemented in the case of internationally manufactured electrical equipment. The results of this research show the level of contribution of the project management software used to manage and develop new products to improve PM processes and PM functions, and how selection of the software tools affects the quality of PM processes and successfully completed projects.

  3. Environmental Assessment of the Prather Water Line Improvement Project Otero County, New Mexico

    Science.gov (United States)

    2009-04-01

    remaining two sites has not been determined (LA II244I, LA I55866). From June II to June 13, 2008, archeologists from Ecological Communications...the pipeline on wildlife, vegetation, sensitive ecological features, and sensitive species. 4.4.2 Potential Impacts 4.4.2.1 Alternative A: U.S...Assessment - Prather Water Line Improvement Project April 2009 5-1 6.0 LIST OF PREP ARERS Victor Palma , EComm Quality Assurance Officer B.S. in Biology

  4. Projected techno-economic improvements for advanced solar thermal power plants

    Science.gov (United States)

    Fujita, T.; Manvi, R.; Roschke, E. J.

    1979-01-01

    The projected characteristics of solar thermal power plants (with outputs up to 10 MWe) employing promising advanced technology subsystems/components are compared to current (or pre-1985) steam-Rankine systems. Improvements accruing to advanced technology development options are delineated. The improvements derived from advanced systems result primarily from achieving high efficiencies via solar collector systems which (1) capture a large portion of the available insolation and (2) concentrate this captured solar flux to attain high temperatures required for high heat engine/energy conversion performance. The most efficient solar collector systems employ two-axis tracking. Attractive systems include the central receiver/heliostat and the parabolic dish.

  5. Hip-Hop(e): The Cultural Practice and Critical Pedagogy of International Hip-Hop. Adolescent Cultures, School, and Society. Volume 56

    Science.gov (United States)

    Porfilio, Brad J., Ed.; Viola, Michael J., Ed.

    2012-01-01

    Illuminating hip-hop as an important cultural practice and a global social movement, this collaborative project highlights the emancipatory messages and cultural work generated by the organic intellectuals of global hip-hop. Contributors describe the social realities--globalization, migration, poverty, criminalization, and racism--youth are…

  6. Decreasing IV Infiltrates in the Pediatric Patient--System-Based Improvement Project.

    Science.gov (United States)

    Major, Tracie Wilt; Huey, Tricia K

    2016-01-01

    Intravenous infiltrates pose tremendous risk for the hospitalized pediatric patient. Infiltrate events increase hospital-acquired harm, the number of painful procedures, use of supplies, length of stay, and nursing time; it threatens relationships essential in patient- and family-centered care. The goal of this quality improvement project was to achieve a 10% decrease in the baseline infiltrate rate on two inpatient units and in the overall infiltrate rate across all of the pediatric units. A Lean Six Sigma methodology was used to guide project activities. Improvement strategies focused on evidence-based education, intravenous (IV) catheter securement, and family engagement. A comparative purposive sample was used to evaluate the pre- and post-implementation period to determine if desired project success measures were achieved. Data analysis revealed positive results across all units, with the number of events (n = 51 pre; n = 19 post) and the infiltration rates (13.5 pre; 7.1 post) decreasing over a three-month period. A decrease was also noted in the overall percent of IVs that infiltrated in the first 24 hours (45% pre; 42% post). A statistically significant increase (t = 15.16; p < 0.001) was noted in nurses' education pre- and post-assessment survey scores. The family engagement strategy revealed overall parental responses to be 88% positive. By decreasing infiltrates, quality of care improved, resulting in the delivery of safe, effective, and patient-centered IV therapy.

  7. Improved speckle projection profilometry for out-of-plane shape measurement.

    Science.gov (United States)

    Pan, Bing; Xie, Huimin; Gao, Jianxin; Asundi, Anand

    2008-10-10

    An improved speckle projection profilometry that combines the projection of computer generated random speckle patterns using an ordinary LCD projector and the two-dimensional digital image correlation technique for in-plane displacements measurement is proposed for accurate out-of-plane shape and displacement measurements. The improved technique employs a simple yet effective calibration technique to determine the linear relationship between the out-of-plane height and the measured in-plane displacements. In addition, the iterative spatial domain cross-correlation algorithm, i.e., the improved Newton-Raphson algorithm using the zero-normalized sum of squared differences correlation criterion and the second-order shape function was employed in image correlation analysis for in-plane displacement determination of the projected speckle patterns, which provides more reliable and accurate matching with a higher correlation coefficient. Experimental results of both a regular cylinder and a human hand demonstrate that the proposed technique is easy to implement and can be applied to a practical out-of-plane shape and displacement measurement with high accuracy.

  8. Treatment of hip instability.

    Science.gov (United States)

    Robbins, G M; Masri, B A; Garbuz, D S; Greidanus, N; Duncan, C P

    2001-10-01

    Instability after total hip arthroplasty is a major source of patient morbidity, second only to aseptic loosening. Certain patient groups have been identified as having a greater risk of instability, including patients undergoing revision arthroplasty as early or late treatment for proximal femoral fractures.

  9. INL HIP Plate Fabrication

    Energy Technology Data Exchange (ETDEWEB)

    B. H. Park; C. R. Clark; J. F. Jue

    2010-02-01

    This document outlines the process used to bond monolithic fuel plates by Hot Isostatic Pressing (HIP). This method was developed at Idaho National Laboratory (INL) for the Reduced Enrichment for Research and Test Reactors (RERTR) program. These foils have been used in a number of irradiation experiments in support of the United States Global Threat Reduction Initiative (GTRI) program.

  10. Hip Arthroscopy: A Brief History.

    Science.gov (United States)

    Kandil, Abdurrahman; Safran, Marc R

    2016-07-01

    Hip arthroscopy is a fast-growing and evolving field. Like knee and shoulder arthroscopy, hip arthroscopy began as a diagnostic procedure and then progressed to biopsy and resection of abnormalities. Subsequently, it has evolved to repair of various tissues and treatment of underlying causes. As the understanding of the hip joint and its associated pathophysiology grows, indications will continue to expand for this diagnostic and therapeutic modality. This article outlines the historic developments of hip arthroscopy, including advancements in instrumentation and techniques from the days of the first hip arthroscopies to the present day.

  11. Lesion of the hip abductor mechanism

    Directory of Open Access Journals (Sweden)

    Caviglia Horacio

    2016-01-01

    Full Text Available Introduction: The disruption of the abductor muscles of the hip after hip revision surgery often causes limping, pain, and instability of the implant. The purpose of our paper is to describe a mesh technique to repair hip abductor mechanism injuries after hip revision. Patients and methods: Forty-six patients with hip abductor damage after prosthetic revision were treated. Inclusion criteria were: patients presenting with prosthetic loosening, complaint of pain, and with a positive Trendelenburg sign due to deficient abductor muscle mechanisms. Thirty-one were women (67.39% with an average age of 64 years (34–82 years. The number of previous revision surgeries was three (two to seven. The Merle d’Aubigné score and variants before and after treatment were also reported. Results: In the postoperative follow-up after hip revision with the mesh technique, the Merle d’Aubigné score improved and the Trendelenburg sign was negative in 78.3% of the patients (p < 0.001. Also, the Trendelenburg test with the knee flexed was negative in 60.9% (p < 0.001 and the stair-climbing test was negative in 60.9% of cases (p < 0.001. The gluteus medius test in the lateral position was negative in 52.2% of patients, and in the lateral position with the knee flexed it was negative in 47.8% of patients (p < 0.001. Discussion: Repair of the abductor mechanism with the mesh technique has proven effective for both partial and total lesions.

  12. Proximal femoral canal shape is more accurately assessed on AP hip radiographs than AP pelvis radiographs in primary hip osteoarthritis.

    Science.gov (United States)

    Merle, Christian; Waldstein, Wenzel; Gregory, Jennifer S; Goodyear, Simon R; Aspden, Richard M; Aldinger, Peter R; Murray, David W; Gill, Harinderjit S

    2013-01-01

    The objectives of the present study were to determine whether differences in the radiographic appearance of the of the proximal femoral canal exist on corresponding AP pelvis and AP hip radiographs, and whether radiographic assessment of canal shape is accurate with reference to computed tomography (CT). In a retrospective study, corresponding radiographs and CT scans of 100 consecutive patients with primary hip OA were evaluated. Active shape modelling (ASM) was performed to assess the variation in proximal femoral canal shape and to identify differences between AP hip and AP pelvis views. Differences in the medial cortical flare between radiographs and CT were quantified using least squares curve fitting. ASM identified significant differences in the assessment of canal shape on corresponding AP hip and AP pelvis views. Curve fitting demonstrated a good agreement between AP hip radiographs and CT. Agreement between AP pelvis radiographs and CT was less good. In contrast to AP pelvis radiographs, AP hip radiographs allow a more accurate and reliable assessment of proximal femoral canal shape in the frontal plane in primary hip OA. Our findings may improve stem fit in total hip arthroplasty without the routine use of CT.

  13. Hinged distraction of the adolescent arthritic hip.

    Science.gov (United States)

    Thacker, Mihir M; Feldman, David S; Madan, Sanjeev S; Straight, Joseph J; Scher, David M

    2005-01-01

    From 1996 to 2000, 11 adolescents with hip joint arthritis secondary to osteonecrosis or idiopathic chondrolysis were treated with articulated hinged distraction arthroplasty. Indications for surgery were severe pain and limited ambulation. Charts and radiographs were reviewed. Clinical status was assessed preoperatively and at latest follow-up (mean 4.8 years after surgery) using criteria of pain, range of motion, and ambulation level. Ten patients showed improved clinical status, with seven having an excellent outcome and three a good outcome. One patient failed distraction. Mean joint space was 2.6 mm before surgery and 4.8 mm at latest follow-up. Average duration of fixator use was 4.4 months. Four patients (36.4%) had complications. Articulated hip distraction was effective in eliminating pain, improving function, and preventing progressive degenerative changes in young patients' hips. It should be considered a salvage procedure for arthritic hips and an alternative to arthrodesis in this difficult-to-treat group of patients.

  14. Process Evaluation of a Quality Improvement Project to Decrease Hospital Readmissions From Skilled Nursing Facilities.

    Science.gov (United States)

    Meehan, Thomas P; Qazi, Daniel J; Van Hoof, Thomas J; Ho, Shih-Yieh; Eckenrode, Sheila; Spenard, Ann; Pandolfi, Michelle; Johnson, Florence; Quetti, Deborah

    2015-08-01

    To describe and evaluate the impact of quality improvement (QI) support provided to skilled nursing facilities (SNFs) by a Quality Improvement Organization (QIO). Retrospective, mixed-method, process evaluation of a QI project intended to decrease preventable hospital readmissions from SNFs. Five SNFs in Connecticut. SNF Administrators, Directors of Nursing, Assistant Directors of Nursing, Admissions Coordinators, Registered Nurses, Certified Nursing Assistants, Receptionists, QIO Quality Improvement Consultant. QIO staff provided training and technical assistance to SNF administrative and clinical staff to establish or enhance QI infrastructure and implement an established set of QI tools [Interventions to Reduce Acute Care Transfers (INTERACT) tools]. Baseline SNF demographic, staffing, and hospital readmission data; baseline and follow-up SNF QI structure (QI Committee), processes (general and use of INTERACT tools), and outcome (30-day all-cause hospital readmission rates); details of QIO-provided training and technical assistance; QIO-perceived barriers to quality improvement; SNF leadership-perceived barriers, accomplishments, and suggestions for improvement of QIO support. Success occurred in establishing QI Committees and targeting preventable hospital readmissions, as well as implementing INTERACT tools in all SNFs; however, hospital readmission rates decreased in only 2 facilities. QIO staff and SNF leaders noted the ongoing challenge of engaging already busy SNF staff and leadership in QI activities. SNF leaders reported that they appreciated the training and technical assistance that their institutions received, although most noted that additional support was needed to bring about improvement in readmission rates. This process evaluation documented mixed clinical results but successfully identified opportunities to improve recruitment of and provision of technical support to participating SNFs. Recommendations are offered for others who wish to conduct

  15. Functional activity in patients after total hip replacement.

    Science.gov (United States)

    Pogorzała, Adam M; Stryła, Wanda; Nowakowski, Andrzej

    2012-11-08

    Osteoarthritis of hip joints is one of the most common diseases limiting social functioning of patients. Pain and mobility disorders are major problems associated with the disease. The goal of the study was to compare the efficacy of surgical treatment in a selected group of patients using a modified Harris Hip Score questionnaire including questions regarding the pain, the type of gait disorders and the functional activity. Surgical treatment helped to reduce the pain and improve the gait quality and parameters as well as functional activities associated with putting on socks and shoes, climbing stairs, sitting and using public transportation. Following conclusions were drawn after the study: Surgical treatment leads to significant reduction in hip pain. Mobility improvement was observed in most analyzed patients in early post-operative period as a consequence of hip contracture and pain being eliminated. The walking speed and distance improved significantly during the first 3 months after the surgery. All patients were satisfied with the treatment.

  16. New Unesco Project To Improve Primary School Performance through Improved Nutrition and Health. First Technical Report. Nutrition Education Series, Issue 18.

    Science.gov (United States)

    United Nations Educational, Scientific, and Cultural Organization, Paris (France). Div. of Science, Technical and Environmental Education.

    A new Unesco project seeks to increase the capacity of developing countries to strengthen primary school academic performance by improving children's nutrition and health status. The first technical meeting of the new project took place in Stockholm, Sweden, in April 1989. Three working groups were formed which focused on assessment, intervention,…

  17. Lake Roosevelt Rainbow Trout Habitat/Passage Improvement Project, Annual Report 2001-2002.

    Energy Technology Data Exchange (ETDEWEB)

    Sears, Sheryl

    2003-01-01

    The construction of Chief Joseph and Grand Coulee Dams completely and irrevocably blocked anadromous fish migrations to the Upper Columbia River. Historically this area hosted vast numbers of salmon returning to their natal waters to reproduce and die. For the native peoples of the region, salmon and steelhead were a principle food source, providing physical nourishment and spiritual sustenance, and contributing to the religious practices and the cultural basis of tribal communities. The decaying remains of spawned-out salmon carcasses contributed untold amounts of nutrients into the aquatic, aerial, and terrestrial ecosystems of tributary habitats in the upper basin. Near the present site of Kettle Falls, Washington, the second largest Indian fishery in the state existed for thousands of years. Returning salmon were caught in nets and baskets or speared on their migration to the headwater of the Columbia River in British Columbia. Catch estimates at Kettle Falls range from 600,000 in 1940 to two (2) million around the turn of the century (UCUT, Report No.2). The loss of anadromous fish limited the opportunities for fisheries management and enhancement exclusively to those actions addressed to resident fish. The Lake Roosevelt Rainbow Trout Habitat/Passage Improvement Project is a mitigation project intended to enhance resident fish populations and to partially mitigate for anadromous fish losses caused by hydropower system impacts. This substitution of resident fish for anadromous fish losses is considered in-place and out-of-kind mitigation. Upstream migration and passage barriers limit the amount of spawning and rearing habitat that might otherwise be utilized by rainbow trout. The results of even limited stream surveys and habitat inventories indicated that a potential for increased natural production exists. However, the lack of any comprehensive enhancement measures prompted the Upper Columbia United Tribes Fisheries Center (UCUT), Colville Confederated

  18. Lake Roosevelt Rainbow Trout Habitat/Passage Improvement Project, Annual Report 2002-2003.

    Energy Technology Data Exchange (ETDEWEB)

    Sears, Sheryl

    2004-01-01

    The construction of Chief Joseph and Grand Coulee Dams completely and irrevocably blocked anadromous fish migrations to the Upper Columbia River. Historically this area hosted vast numbers of salmon returning to their natal waters to reproduce and die. For the native peoples of the region, salmon and steelhead were a principle food source, providing physical nourishment and spiritual sustenance, and contributing to the religious practices and the cultural basis of tribal communities. The decaying remains of spawned-out salmon carcasses contributed untold amounts of nutrients into the aquatic, aerial, and terrestrial ecosystems of tributary habitats in the upper basin. Near the present site of Kettle Falls, Washington, the second largest Indian fishery in the state existed for thousands of years. Returning salmon were caught in nets and baskets or speared on their migration to the headwater of the Columbia River in British Columbia. Catch estimates at Kettle Falls range from 600,000 in 1940 to two (2) million around the turn of the century (UCUT, Report No.2). The loss of anadromous fish limited the opportunities for fisheries management and enhancement exclusively to those actions addressed to resident fish. The Lake Roosevelt Rainbow Trout Habitat/Passage Improvement Project is a mitigation project intended to enhance resident fish populations and to partially mitigate for anadromous fish losses caused by hydropower system impacts. This substitution of resident fish for anadromous fish losses is considered in-place and out-of-kind mitigation. Upstream migration and passage barriers limit the amount of spawning and rearing habitat that might otherwise be utilized by rainbow trout. The results of even limited stream surveys and habitat inventories indicated that a potential for increased natural production exists. However, the lack of any comprehensive enhancement measures prompted the Upper Columbia United Tribes Fisheries Center (UCUT), Colville Confederated

  19. The Agricultural Model Intercomparison and Improvement Project (AgMIP): Protocols and Pilot Studies

    Science.gov (United States)

    Rosenzweig, C.; Jones, J. W.; Hatfield, J. L.; Ruane, A. C.; Boote, K. J.; Thorburn, P.; Antle, J. M.; Nelson, G. C.; Porter, C.; Janssen, S.; Asseng, S.; Basso, B.; Ewert, F.; Wallach, D.; Baigorria, G.; Winter, J. M.

    2012-01-01

    The Agricultural Model Intercomparison and Improvement Project (AgMIP) is a major international effort linking the climate, crop, and economic modeling communities with cutting-edge information technology to produce improved crop and economic models and the next generation of climate impact projections for the agricultural sector. The goals of AgMIP are to improve substantially the characterization of world food security due to climate change and to enhance adaptation capacity in both developing and developed countries. Analyses of the agricultural impacts of climate variability and change require a transdisciplinary effort to consistently link state-of-the-art climate scenarios to crop and economic models. Crop model outputs are aggregated as inputs to regional and global economic models to determine regional vulnerabilities, changes in comparative advantage, price effects, and potential adaptation strategies in the agricultural sector. Climate, Crop Modeling, Economics, and Information Technology Team Protocols are presented to guide coordinated climate, crop modeling, economics, and information technology research activities around the world, along with AgMIP Cross-Cutting Themes that address uncertainty, aggregation and scaling, and the development of Representative Agricultural Pathways (RAPs) to enable testing of climate change adaptations in the context of other regional and global trends. The organization of research activities by geographic region and specific crops is described, along with project milestones. Pilot results demonstrate AgMIP's role in assessing climate impacts with explicit representation of uncertainties in climate scenarios and simulations using crop and economic models. An intercomparison of wheat model simulations near Obregón, Mexico reveals inter-model differences in yield sensitivity to [CO2] with model uncertainty holding approximately steady as concentrations rise, while uncertainty related to choice of crop model increases with

  20. Improving safety culture on adult medical units through multidisciplinary teamwork and communication interventions: the TOPS Project.

    Science.gov (United States)

    Blegen, M A; Sehgal, N L; Alldredge, B K; Gearhart, S; Auerbach, A A; Wachter, R M

    2010-08-01

    The goal of this project was to improve unit-based safety culture through implementation of a multidisciplinary (pharmacy, nursing, medicine) teamwork and communication intervention. The Agency for Healthcare Research and Quality Hospital Survey on Patient Safety Culture was used to determine the impact of the training with a before-after design. Surveys were returned from 454 healthcare staff before the training and 368 staff 1 year later. Five of eleven safety culture subscales showed significant improvement. Nurses perceived a stronger safety culture than physicians or pharmacists. While it is difficult to isolate the effects of the team training intervention from other events occurring during the year between training and postevaluation, overall the intervention seems to have improved the safety culture on these medical units.

  1. Improved recovery in highwall mining using backfill. ACARP Project C3052

    Energy Technology Data Exchange (ETDEWEB)

    Hume, R.G.; Searle, G.K. [BFP, Richmond, Vic. (Australia)

    1998-07-01

    In Australia, coal mines have generally not adopted filling to increase mining recovery. The aim of this project, entitled 'Improved recovery in highwall mining using backfill', was to examine the feasibility of using fill to improve recovery in highwall mining. Current fill practice was reviewed for metalliferous as well as coal mining, both here in Australia and overseas, for its applicability to highwall mining. Studies were then made at a conceptual level to determine whether fill could be economically used, to determine appropriate sources for fill and to trial key aspects of fill behaviour. A review of filling methods led to conceptual studies being undertaken on seven filling methods and these studies demonstrated that fill could be used to improve recovery. These studies were then further refined. Selected filling materials have been reviewed and laboratory tests have been made on these to assess their suitability. 40 refs., 5 figs., 2 tabs.

  2. Improving safety behaviour and accident rates of professional drivers: the Dead Sea project.

    Science.gov (United States)

    Calé, Michael H

    2012-01-01

    It was the aim of the Dead Sea project to change and improve traffic safety behaviour and lower the accident rates of professional drivers by applying principles and techniques known from social and traffic psychology. All interventions were based on a sample of 48 workers from one company. Extensive changes in attitudes were obtained by manipulating the workers' behaviour and causing them to publicly represent positive safety attitudes and values. The results show significant improvements in safety behaviour and reductions of accident rates. In spite of the fact that only a small minority of the workers in this plant directly participated in the programme, many others were influenced and improved their safety behaviour on the road. Therefore, the employed method seems to be not only effective but also very cost efficient.

  3. Improving the Management of Cost and Scope in Software Projects Using Agile Practices

    Directory of Open Access Journals (Sweden)

    Adriano Olimpio Tonelli

    2013-03-01

    Full Text Available While organizations want to develop software products with reduced cost and flexible scope, stories aboutthe applicability of agile practices to improve project development and performance in the softwareindustry are scarce and focused on specific methodologies such as Scrum and XP. Given these facts, thispaper aims to investigate, through practitioners' perceptions of value, which agile practices are being usedto improve two performance criteriafor software projects—cost and scope. Using a multivariate statisticaltechnique known as Exploratory Factor Analysis (EFA,the results suggest that the use of agile practicescan be represented infactors which describedifferent applicationsin software development processtoimprove cost and scope.Also, we conclude that some agile practices should be used together in order to getbetter efficiency on cost and scope in fourdevelopmentaspects: improving (a team abilities, (bmanagement of requirements, (c quality of the code developed, and (d delivery of software on-budget andon-time

  4. Canine hip and elbow dysplasia in UK Labrador retrievers.

    Science.gov (United States)

    Woolliams, J A; Lewis, T W; Blott, S C

    2011-08-01

    This paper examines the outcomes from recent genetic analyses of hip and elbow scores from British Veterinary Association (BVA)/UK Kennel Club (KC) screening programmes targeted at reducing the prevalence of hip dysplasia (HD) and elbow dysplasia in UK Labrador retrievers. The analyses made use of 25,243 hip scores and 3613 elbow scores. Heritabilities (± standard error) for hip score, analysed on a log scale, and for elbow score were 0.35±0.02 and 0.19±0.04, respectively, with a genetic correlation of 0.41±0.09. For both hip and elbow scores, there was a near perfect genetic correlation between the left and right joint; analysis of hip score showed a predictive benefit of using the total of left and right scores rather than worst score and the benefit of using all component scores rather than their aggregate score. Downward genetic trends were observed in both hip and elbow scores, although the latter was consistent with it being correlated to response to genetic change in hip score. Estimated breeding values (EBVs) offered substantial benefits in accuracy and hence genetic progress when compared to the use of phenotypes for both hip and elbow scores. There are major opportunities for improving selection against elbow dysplasia through the use of bivariate evaluations, although progress against dysplasia would be improved by more widespread elbow scoring. The studies highlighted a number of ways in which data recording for addressing complex traits may be improved in the future. Ongoing advances in genomic technology may be utilised for increasing the rate of genetic progress in selection against HD and for complex diseases in general, through the use of genomic evaluations. Copyright © 2011. Published by Elsevier Ltd.

  5. Combining Quality Improvement and Geriatrics Training: The Nursing Home Polypharmacy Outcomes Project

    Science.gov (United States)

    Kojima, Gotaro; Bell, Christina L.; Tamura, Bruce; Davis, James; Inaba, Michiko; Lorenzo, Pia; Blanchette, Patricia Lanoie; Iwasaki, Wendy; Masaki, Kamal

    2014-01-01

    To examine sustained effects of an educational intervention, we repeated a successful quality improvement (QI) project on medication safety and cost-effectiveness. In October 2007 and August 2008, facility leadership and geriatrics faculty identified all patients receiving ≥9 medications (polypharmacy cohort) in a 170-bed teaching nursing home and taught Geriatric Medicine fellows (n=12 in 2007, 11 in 2008) to: 1) systematically collect medication data; 2) generate medication recommendations (stop, taper, or continue) based on expert criteria (Beers Criteria) or drug-drug interaction programs; 3) discuss recommendations with patients’ attending physicians; and 4) implement approved recommendations. Over the two projects, the polypharmacy cohorts demonstrated decreased potentially inappropriate medications (odds ratio (OR) 0.78, 95% confidence interval (95%CI)0.69–0.88, pclinical and educational benefits. PMID:24829040

  6. A Project-Based Language Learning Model for Improving the Willingness to Communicate of EFL Students

    Directory of Open Access Journals (Sweden)

    Ibrahim Farouck

    2016-04-01

    Full Text Available Anxiety and inadequate motivation due to misapplication of some language teaching methodologies and learning materials have been shown to affect the Willingness to Communicate of students in EFL programs. This study used a Project-Based Language Learning to improve learning motivation and content relevance. Students were grouped into pairs to conduct fieldwork activities on their chosen topics and learned the English language that was suitable for describing their activities and outcomes. They interacted with content and peers through Web 2.0 environments. In the classroom, they engaged in communicative tasks in a jigsaw format and presented their projects where their peers used an online rubric and forum to give feedback. They also participated in a speech contest with peers outside their class or from another university in order to broaden their confidence. Findings from this study show that students were able to develop the language and evaluation skills for presentation. Additionally, they indicated a reduction in communication anxiety.

  7. Improving student critical thinking skills through a root cause analysis pilot project.

    Science.gov (United States)

    Tschannen, Dana; Aebersold, Michelle

    2010-08-01

    The Essentials of Baccalaureate Education for Professional Nursing Practice provides a framework for building the baccalaureate education for the twenty-first century. One of the exemplars included in the essentials toolkit includes student participation in an actual root cause analysis (RCA) or failure mode effects analysis. To align with this exemplar, faculty at the University of Michigan School of Nursing developed a pilot RCA project for the senior-level Leadership and Management course. While working collaboratively with faculty and unit liaisons at the University Health System, students completed an RCA on a nursing sensitive indicator (pain assessment or plan of care compliance). An overview of the pilot project, including the implementation process, is described. Each team of students identified root causes and recommendations for improvement on clinical and documentation practice within the context of the unit. Feedback from both the unit liaisons and the students confirmed the pilot's success.

  8. Lens distortion elimination for improving measurement accuracy of fringe projection profilometry

    Science.gov (United States)

    Li, Kai; Bu, Jingjie; Zhang, Dongsheng

    2016-10-01

    Fringe projection profilometry (FPP) is a powerful method for three-dimensional (3D) shape measurement. However, the measurement accuracy of the existing FPP is often hindered by the distortion of the lens used in FPP. In this paper, a simple and efficient method is presented to overcome this problem. First, the FPP system is calibrated as a stereovision system. Then, the camera lens distortion is eliminated by correcting the captured images. For the projector lens distortion, distorted fringe patterns are generated according to the lens distortion model. With these distorted fringe patterns, the projector can project undistorted fringe patterns, which means that the projector lens distortion is eliminated. Experimental results show that the proposed method can successfully eliminate the lens distortions of FPP and therefore improves its measurement accuracy.

  9. Revision of hip resurfacing arthroplasty.

    Science.gov (United States)

    Wera, Glenn D; Gillespie, Robert J; Petty, Carter; Petersilge, William J; Kraay, Matthew J; Goldberg, Victor M

    2010-08-01

    Metal-on-metal (MOM) hip resurfacing has become an increasingly popular treatment for young, active patients with degenerative disease of the hip, as bearing surfaces with better wear properties are now available. One proposed advantage of resurfacing is its ability to be successfully revised to total hip arthroplasty (THA). In addition, radiographic parameters that may predict failure in hip resurfacing have yet to be clearly defined. Seven MOM resurfacing arthroplasties were converted to conventional THAs because of aseptic failure. Using Harris Hip Scores (HHS) and Short Form 12 (SF-12) questionnaire scores, we compared the clinical outcomes of these patients with those of patients who underwent uncomplicated MOM hip resurfacing. In addition, all revisions were radiographically evaluated. Mean follow-up periods were 51 months (revision group) and 43 months (control group). There was no significant difference between the 2 groups' HHS or SF-12 scores. There was no dislocation or aseptic loosening after conversion of any resurfacing arthroplasty. Valgus neck-shaft angle (P hip resurfacing. Conversion of aseptic failure of hip resurfacing to conventional THA leads to clinical outcomes similar to those of patients who undergo uncomplicated hip resurfacing. The orientation of the femur and the components placed play a large role in implant survival in hip resurfacing. More work needs to be done to further elucidate these radiographic parameters.

  10. [Juvenile hip pain. 2. Femur head epiphysiolysis, hip dysplasia, tumors].

    Science.gov (United States)

    Hackenbruch, W; von Gumppenberg, S; Karpf, P M

    1978-11-09

    The early symptom in hip joint diseases in children is pain. Pain is localized in the groin and thight, but mostly in the knee. Other important signs are limping and reduced internal rotation. If a hip disease is suspected it is necessary to take X-rays in two planes. If diagnosis is early and special therapy started immediately, the results are usually excellent without deformation of the hip. Otherwise early osteoarthritis can develop. This is important because osteoarthritis in the hip joint is in 75% of the cases due to hip joint diseases in childhood. The problems of diagnosis and treatment of the most common hip joint diseases in children (transient synovitis, rheumatoid arthritis, osteomyelitis, Legg-Perthes disease, slipped capital femoral epiphysis, dysplasia, tumors) are discussed.

  11. Surface evaluation of orthopedic hip implants marketed in Brazil

    Science.gov (United States)

    Souza, M. M.; Trommer, R. M.; Maru, M. M.; Roesler, C. R. M.; Barros, W. S.; Dutra, M. S.

    2016-07-01

    One of the factors that contribute to the quality of total hip prostheses is the degree of accuracy in the manufacturing of the joint surfaces. The dimensional control of joint components is important because of its direct influence on the durability and, consequently, in the patients’ life quality. This work presents studies on the form and roughness of orthopedic hip prostheses marketed in Brazil. The results provide data for quality control of the surfaces of the femoral heads and acetabular components of hip prostheses and indicate the need of improvement in the procedures used to this control.

  12. Using BIM to Improve the Design and Construction of Bridge Projects: A Case Study of a Long-span Steel-box Arch Bridge Project

    Directory of Open Access Journals (Sweden)

    Wenping Liu

    2014-08-01

    Full Text Available More and more mega-complex bridge projects are being or will be built worldwide. At the same time, the design and construction of such projects involve more and more challenges, e.g., complex structural designs, complicated construction environments, etc. This research study aims to apply BIM (Building Information Modelling to bridge projects to improve the efficiency and effectiveness of design and construction. Through the analysis of the characteristics of bridge projects and relevant, associated problems, a BIM-based solution to improving design and construction is developed, including conceptual design optimization, detailed design optimization, the optimization of construction sequences, construction scheduling, construction management, and construction process monitoring. Furthermore, a real-life bridge project is presented to demonstrate the feasibility and validity of the BIM-aided approach to design and construction. It is shown that BIM has the potential to improve the design and construction of bridge projects. It is expected that this research could contribute to the extensive application of BIM in mega-complex bridge projects to aid in design and construction in the future.

  13. Investments on Pro-poor Development Projects on Goats: Ensuring Success for Improved Livelihoods

    Directory of Open Access Journals (Sweden)

    C. Devendra

    2013-01-01

    Full Text Available The elements that determine the success of development projects on goats and the prerequisites for ensuring this are discussed in the context of the bewildering diversity of goat genetic resources, production systems, multifunctionality, and opportunities for responding to constraints for productivity enhancement. Key determinants for the success of pro-poor projects are the imperatives of realistic project design, resolution of priorities and positive impacts to increase investments and spur agricultural growth, and appropriate policy. Throughout the developing world, there exist 97% of the total world population of 921 million goats across all agro-ecological zones (AEZs, including 570 breeds and 64% share of the breeds. They occupy a very important biological and socio-economic niche in farming systems making significant multifunctional contributions especially to food, nutrition and financial security, stability of farm households, and survival of the poor in the rural areas. Definitions are given of successful and failed projects. The analyses highlighted in successful projects the value of strong participatory efforts with farmers and climate change. Climate change effects on goats are inevitable and are mediated through heat stress, type of AEZ, water availability, quantity and quality of the available feed resources and type of production system. Within the prevailing production systems, improved integrated tree crops - ruminant systems are underestimated and are an important pathway to enhance C sequestration. Key development strategies and opportunities for research and development (R and D are enormous, and include inter alia defining a policy framework, resolution of priority constraints using systems perspectives and community-based participatory activities, application of yield-enhancing technologies, intensification, scaling up, and impacts. The priority for development concerns the rainfed areas with large concentrations of

  14. Investments on Pro-poor Development Projects on Goats: Ensuring Success for Improved Livelihoods.

    Science.gov (United States)

    Devendra, C

    2013-01-01

    The elements that determine the success of development projects on goats and the prerequisites for ensuring this are discussed in the context of the bewildering diversity of goat genetic resources, production systems, multifunctionality, and opportunities for responding to constraints for productivity enhancement. Key determinants for the success of pro-poor projects are the imperatives of realistic project design, resolution of priorities and positive impacts to increase investments and spur agricultural growth, and appropriate policy. Throughout the developing world, there exist 97% of the total world population of 921 million goats across all agro-ecological zones (AEZs), including 570 breeds and 64% share of the breeds. They occupy a very important biological and socio-economic niche in farming systems making significant multifunctional contributions especially to food, nutrition and financial security, stability of farm households, and survival of the poor in the rural areas. Definitions are given of successful and failed projects. The analyses highlighted in successful projects the value of strong participatory efforts with farmers and climate change. Climate change effects on goats are inevitable and are mediated through heat stress, type of AEZ, water availability, quantity and quality of the available feed resources and type of production system. Within the prevailing production systems, improved integrated tree crops - ruminant systems are underestimated and are an important pathway to enhance C sequestration. Key development strategies and opportunities for research and development (R and D) are enormous, and include inter alia defining a policy framework, resolution of priority constraints using systems perspectives and community-based participatory activities, application of yield-enhancing technologies, intensification, scaling up, and impacts. The priority for development concerns the rainfed areas with large concentrations of ruminants in which

  15. Investments on Pro-poor Development Projects on Goats: Ensuring Success for Improved Livelihoods*

    Science.gov (United States)

    Devendra, C.

    2013-01-01

    The elements that determine the success of development projects on goats and the prerequisites for ensuring this are discussed in the context of the bewildering diversity of goat genetic resources, production systems, multifunctionality, and opportunities for responding to constraints for productivity enhancement. Key determinants for the success of pro-poor projects are the imperatives of realistic project design, resolution of priorities and positive impacts to increase investments and spur agricultural growth, and appropriate policy. Throughout the developing world, there exist 97% of the total world population of 921 million goats across all agro-ecological zones (AEZs), including 570 breeds and 64% share of the breeds. They occupy a very important biological and socio-economic niche in farming systems making significant multifunctional contributions especially to food, nutrition and financial security, stability of farm households, and survival of the poor in the rural areas. Definitions are given of successful and failed projects. The analyses highlighted in successful projects the value of strong participatory efforts with farmers and climate change. Climate change effects on goats are inevitable and are mediated through heat stress, type of AEZ, water availability, quantity and quality of the available feed resources and type of production system. Within the prevailing production systems, improved integrated tree crops - ruminant systems are underestimated and are an important pathway to enhance C sequestration. Key development strategies and opportunities for research and development (R and D) are enormous, and include inter alia defining a policy framework, resolution of priority constraints using systems perspectives and community-based participatory activities, application of yield-enhancing technologies, intensification, scaling up, and impacts. The priority for development concerns the rainfed areas with large concentrations of ruminants in which

  16. Application of uncemented Zweymüller hip prosthesis in adult patients with hip osteoarthritis secondary to developmental dysplasia

    Institute of Scientific and Technical Information of China (English)

    XU Yong-sheng; WANG Yan; LU Long; WEI Bao-gang

    2012-01-01

    Background Developmental dysplasia encompasses a wide spectrum of hip pathology ranging from a shallow acetabulum to a completely dislocated ‘high-riding' hip.It is a common cause of secondary osteoarthritis in young adults and is the underlying diagnosis in up to 48% of patients requiring total hip arthroplasty (THA) for coxarthrosis.The aim of this study was to evaluate efficiency and safety of THA using Zweymüller hip implant in the treatment of severe osteoarthritis secondary to developmental dysplasia of the hip (DDH) in adults.Methods From January 2000 to February 2008,35 patients (40 hips) with developmental dysplasia of the hip were included.Five were male and 30 were female,with ages ranging from 26 to 65 years and an average age of 45 years.According to Hartofilakidis classification,there were type Ⅰ in 5 hips,type Ⅱ in 20 hips,type Ⅲ in 15 hips.All the patients were performed the THA using the Zweymüller hip implant.The preoperative average Harris score was 44.The bilateral arthroplasty was performed in 5 patients and the unilateral arthroplasty in 30 patients.The patients mainly suffered from pain and claudication.Clinical and radiological results were analyzed.The Harris score was used for outcome measurement.Results Thirty five patients (40 hips) were followed and the mean follow-up period was 46 months (ranged from 24 months to 96 months).The latest follow-up average Harris score was 88.9 (97.1% of good rate).All the patients were pain-free and there was no sign of infection,aseptic loosening and subsidence.Conclusions In summary,THA using Zweymüller hip implant is a good treatment method for severe osteoarthritis secondary to DDH in adults.The key techniques for the total hip replacement are as follows:good preoperative plan,firmly placing the acetabular component in the true acetabulum,proper preparation of proximal femur,suitable femoral component choosing and improving the techniques of the bone graft.

  17. Integrating community outreach into a quality improvement project to promote maternal and child health in Ghana.

    Science.gov (United States)

    Cofie, Leslie E; Barrington, Clare; Akaligaung, Akalpa; Reid, Amy; Fried, Bruce; Singh, Kavita; Sodzi-Tettey, Sodzi; Barker, Pierre M

    2014-01-01

    Quality improvement (QI) is used to promote and strengthen maternal and child health services in middle- and low-income countries. Very little research has examined community-level factors beyond the confines of health facilities that create demand for health services and influence health outcomes. We examined the role of community outreach in the context of Project Fives Alive!, a QI project aimed at improving maternal and under-5 outcomes in Ghana. Qualitative case studies of QI teams across six regions of Ghana were conducted. We analysed the data using narrative and thematic techniques. QI team members used two distinct outreach approaches: community-level outreach, including health promotion and education efforts through group activities and mass media communication; and direct outreach, including one-on-one interpersonal activities between health workers, pregnant women and mothers of children under-5. Specific barriers to community outreach included structural, cultural, and QI team-level factors. QI efforts in both rural and urban settings should consider including context-specific community outreach activities to develop ties with communities and address barriers to health services. Sustaining community outreach as part of QI efforts will require improving infrastructure, strengthening QI teams, and ongoing collaboration with community members.

  18. Project-based teaching in health informatics: a course on health care quality improvement.

    Science.gov (United States)

    Moehr, J R; Berenji, G R; Green, C J; Kagolovsky, Y

    2001-01-01

    Teaching the skills and knowledge required in health informatics [1] is a challenge because the skill of applying knowledge in real life requires practice. We relate the experience with introducing a practice component to a course in "Health Care Quality Improvement". Working health care professionals were invited to bring an actual quality problem from their place of work and to work alongside students in running the problem through a quality improvement project lifecycle. Multiple technological and process oriented teaching innovations were employed including project sessions in observation rooms, video recording of these sessions, generation of demonstration examples and distance education components. Both students and their collaborators from the work place developed proficiency in applying quality improvement methods as well as in experiencing the realities of group processes, information gaps and organizational constraints. The principles used to achieve high involvement of the whole class, the employed resources and technical support are described. The resulting academic and practical achievements are discussed in relation to the alternative instructional modalities, and with respect to didactic implications for similar endeavors and beyond to other fields such as systems engineering.

  19. Nonarthritic hip joint pain.

    Science.gov (United States)

    Enseki, Keelan; Harris-Hayes, Marcie; White, Douglas M; Cibulka, Michael T; Woehrle, Judith; Fagerson, Timothy L; Clohisy, John C

    2014-06-01

    The Orthopaedic Section of the American Physical Therapy Association (APTA) has an ongoing effort to create evidence-based practice guidelines for orthopaedic physical therapy management of patients with musculoskeletal impairments described in the World Health Organization's International Classification of Functioning, Disability, and Health (ICF). The purpose of these clinical practice guidelines is to describe the peer-reviewed literature and make recommendations related to nonarthritic hip joint pain.

  20. Resurfacing hip replacement and cemented total hip replacement have equivalent outcome at one year in a disease matched population: a case-control study of patient reported outcome measures.

    Science.gov (United States)

    Ray, Robbie; Goudie, Ewan B; Jenkins, Paul; Gaston, Paul

    2013-01-01

    Resurfacing hip replacement has demonstrated good survival and outcomes for cohorts of younger male patients, but few controlled studies exist. In this study we compared patient reported outcome measures and satisfaction scores at one year following resurfacing hip replacement in 69 male patients with two control groups of equal numbers undergoing cemented total hip replacement: aged-matched patients and disease matched patients. At one year we found no difference in improvement in patient reported outcome measures between patients undergoing resurfacing hip replacement and disease matched patients, whereas patients undergoing resurfacing hip replacement had a statistically significant improvement in Oxford Hip Score compared to the age-matched controls (pResurfacing hip replacement and total 
hip replacement both confer increase in patient reported outcome scores and high patient satisfaction at one year. The results of this study will allow better counselling of patients and help inform 
treatment decisions.

  1. Decreasing the Use of Damage Control Laparotomy in Trauma: A Quality Improvement Project.

    Science.gov (United States)

    Harvin, John A; Kao, Lillian S; Liang, Mike K; Adams, Sasha D; McNutt, Michelle K; Love, Joseph D; Moore, Laura J; Wade, Charles E; Cotton, Bryan A; Holcomb, John B

    2017-08-01

    Our institution has published damage control laparotomy (DCL) rates of 30% and documented the substantial morbidity associated with the open abdomen. The purpose of this quality improvement (QI) project was to decrease the rate of DCL at a busy, Level I trauma center in the US. A prospective cohort of all emergent trauma laparotomies from November 2013 to October 2015 (QI group) was followed. The QI intervention was multifaceted and included audit and feedback for every DCL case. Morbidity and mortality of the QI patients were compared with those from a published control (control group: emergent laparotomy from January 2011 to October 2013). A significant decrease was observed immediately on beginning the QI project, from a 39% DCL rate in the control period to 23% in the QI group (p control 16% vs QI 12%; p = 0.15), fascial dehiscence (6% vs 8%; p = 0.20), unplanned relaparotomy (11% vs 10%; p = 0.58), or mortality (9% vs 10%; p = 0.69) were observed. The reduction in use resulted in a decrease of 68 DCLs over the 2-year period. There was a further reduction in the rate of DCL to 17% after completion of the QI project. A QI initiative rapidly changed the use of DCL and improved quality of care by decreasing resource use without an increase morbidity or mortality. This decrease was sustained during the QI period and further improved upon after its completion. Copyright © 2017 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

  2. Hip disability and osteoarthritis outcome score (HOOS)--validity and responsiveness in total hip replacement

    DEFF Research Database (Denmark)

    Nilsdotter, Anna K; Lohmander, L Stefan; Klässbo, Maria

    2003-01-01

    The aim of the study was to evaluate if physical functions usually associated with a younger population were of importance for an older population, and to construct an outcome measure for hip osteoarthritis with improved responsiveness compared to the Western Ontario McMaster osteoarthritis score...

  3. Extended porous femoral stems in hip revisions.

    Directory of Open Access Journals (Sweden)

    Pablo Bruno

    2016-08-01

    Full Text Available Introduction: The porous coated cylindrical  stem are one of the most popular option in the set of hip revison surgery. The poupose of this study is present the clinical and radiographic results of a group of patients treated with this stem. Material and Methods: Between 1997 and 2010, we retrospectively evaluated 150 stem in 148 patients. The indication for revisión was aseptic loosening in 88 cases (58.6%, septic loosening in 41 cases (27.3%, periprosthetic fracture in 14 cases (9.3%, failed hip ostesynthesis in 4 cases (2.6% and stem fracture in 3 cases (2%. We followed the patient on average for 7.7 years. Results: We achived bone-ingrowth fixation in 135 patients (90 %,,  fibrous tissue fixation in 12 (8% and unstable fixation in 3 (2 %. The mean Harris hip score improved to 92 points at last follow-up. Three stem were revised (2%. One patient had revisión becouse of stem loosening. The other two becouse of deep infection required a 2 staged revision.  Three patient (2% had dislocation and was treated succesfully with closed reduction. Conclusion:  The porous coated cylindrical stem is a predictable technique with excellent survival rates  in  the set of  revisión hip surgery.

  4. Current status of noncemented hip implants.

    Science.gov (United States)

    Harris, W H

    1987-01-01

    Recently the operative techniques, instrumentation, design, and material properties of bony ingrowth total hip replacement have been greatly improved. I prefer a hemispherical acetabular component fixed with screws going through the metal shell. The titanium mesh allows microinterlock with new bone, and macrointerlock is obtained by adding bone graft into the unused screw holes. The femoral component, made of Tivanium with titanium mesh attached to it by a new process called diffusion bonding, retains superalloy fatigue strength characteristics. An intimate press fit is assured by the specific operative technique, and both the fiber mesh and the collar provide proximal stress transfer. The design affords a nondestructive method for removal if necessary. The short-term clinical results are promising; most patients function as well as with cemented total hip replacement. The incidence of thigh pain has been significantly reduced since prior reports of cementless total hip replacement; however, a few patients still have thigh pain. The results in revision surgery are also promising, but as in cemented total hip replacement, the functional capacity of revision cases is usually lower than primary cases. There is an increased capacity to correct complex and difficult acetabular problems with this acetabular component. Obviously, long-term data are needed to establish the behavior of these implants over the immediate and long term.

  5. Madrid 2012 project evaluation under a market perspective: An exploration of possibilities and opportunities for improvement

    Directory of Open Access Journals (Sweden)

    RICARDO GIMENO NOGUÉS

    2004-12-01

    Full Text Available Madrid has never been so close to the organization of the Olympic Games since April 24, 1966 when Madrid lose against Munich to organize the Olympic Games of 1972. When organizing the Olympic Games, it is necessary to bear in mind not only infrastructures and sport venues, but also the opportunity for improving the quality of life and the community image abroad. In the present work, the Madrid Olympic Project presented to the Olympic International Committee in order to be elected to host the 2012 Summer Olympic Games is evaluated using a market orientation that takes into account the citizens” long term social welfare.

  6. Confronting hip resurfacing and big femoral head replacement gait analysis

    Directory of Open Access Journals (Sweden)

    Panagiotis K. Karampinas

    2014-03-01

    Full Text Available Improved hip kinematics and bone preservation have been reported after resurfacing total hip replacement (THRS. On the other hand, hip kinematics with standard total hip replacement (THR is optimized with large diameter femoral heads (BFH-THR. The purpose of this study is to evaluate the functional outcomes of THRS and BFH-THR and correlate these results to bone preservation or the large femoral heads. Thirty-one patients were included in the study. Gait speed, postural balance, proprioception and overall performance. Our results demonstrated a non-statistically significant improvement in gait, postural balance and proprioception in the THRS confronting to BFH-THR group. THRS provide identical outcomes to traditional BFH-THR. The THRS choice as bone preserving procedure in younger patients is still to be evaluated.

  7. The rehabilitation management after hip arthroplasty: a case report

    Directory of Open Access Journals (Sweden)

    Adina BURCHICI

    2017-03-01

    Full Text Available Aim: In this paper we describe the physical therapy management of a 64-year-old female following a bilateral hip arthroplasty. Method: The patient featured in this study, after the surgical intervention had undergone specific recovery treatment consisting of: posture techniques, static (isometric contractions and dynamic kinetic techniques (passive motion, passive-actives, actives, actives with resistance, massage, respiratory gymnastics and reeducation of walking. Results: At the end of the rehabilitation program, hip muscular strength and joint range of motion were improved significantly. The Harris hip score was significantly improved, in comparison to the preoperative one. Conclusion: This case illustrates the importance of the rehabilitation management after bilateral hip replacement.

  8. The Wind Forecast Improvement Project (WFIP). A Public-Private Partnership Addressing Wind Energy Forecast Needs

    Energy Technology Data Exchange (ETDEWEB)

    Wilczak, James M. [NOAA, Boulder, CO (United States); Finley, Cathy [WindLogics, Inc., St. Paul, MN (United States); Freedman, Jeff [AWS Truepower, Albany, NY (United States); Cline, Joel [USDOE Office of Energy Efficiency and Renewable Energy, Washington, DC (United States); Bianco, L. [Univ. of Colorado, Boulder, CO (United States); Olson, J. [Univ. of Colorado, Boulder, CO (United States); Djalaova, I. [Univ. of Colorado, Boulder, CO (United States); Sheridan, L. [WindLogics, Inc., St. Paul, MN (United States); Ahlstrom, M. [WindLogics, Inc., St. Paul, MN (United States); Manobianco, J. [Meso, Inc., Troy, NY (United States); Zack, J. [Meso, Inc., Troy, NY (United States); Carley, J. [National Oceanic and Atmospheric Administration (NOAA), College Park, MD (United States); Benjamin, S. [NOAA, Boulder, CO (United States); Coulter, R. L. [Argonne National Lab. (ANL), Lemont, IL (United States); Berg, Larry K. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Mirocha, Jeff D. [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); Clawson, K. [National Oceanic and Atmospheric Administration (NOAA), Idaho Falls, ID (United States); Natenberg, E. [Meso, Inc., Troy, NY (United States); Marquis, M. [NOAA, Boulder, CO (United States)

    2015-10-30

    The Wind Forecast Improvement Project (WFIP) is a public-private research program, the goals of which are to improve the accuracy of short-term (0-6 hr) wind power forecasts for the wind energy industry and then to quantify the economic savings that accrue from more efficient integration of wind energy into the electrical grid. WFIP was sponsored by the U.S. Department of Energy (DOE), with partners that include the National Oceanic and Atmospheric Administration (NOAA), private forecasting companies (WindLogics and AWS Truepower), DOE national laboratories, grid operators, and universities. WFIP employed two avenues for improving wind power forecasts: first, through the collection of special observations to be assimilated into forecast models to improve model initial conditions; and second, by upgrading NWP forecast models and ensembles. The new observations were collected during concurrent year-long field campaigns in two high wind energy resource areas of the U.S. (the upper Great Plains, and Texas), and included 12 wind profiling radars, 12 sodars, 184 instrumented tall towers and over 400 nacelle anemometers (provided by private industry), lidar, and several surface flux stations. Results demonstrate that a substantial improvement of up to 14% relative reduction in power root mean square error (RMSE) was achieved from the combination of improved NOAA numerical weather prediction (NWP) models and assimilation of the new observations. Data denial experiments run over select periods of time demonstrate that up to a 6% relative improvement came from the new observations. The use of ensemble forecasts produced even larger forecast improvements. Based on the success of WFIP, DOE is planning follow-on field programs.

  9. Evaluation of Two Total Hip Bearing Materials for Resistance to Wear Using a Hip Simulator

    Directory of Open Access Journals (Sweden)

    Kenneth R. St. John

    2015-06-01

    Full Text Available Electron beam crosslinked ultra high molecular weight polyethylene (UHMWPE 32 mm cups with cobalt alloy femoral heads were compared with gamma-irradiation sterilized 26 mm cups and zirconia ceramic heads in a hip wear simulator. The testing was performed for a total of ten million cycles with frequent stops for cleaning and measurement of mass losses due to wear. The results showed that the ceramic on UHMWPE bearing design exhibited higher early wear than the metal on highly crosslinked samples. Once a steady state wear rate was reached, the wear rates of the two types of hip bearing systems were similar with the ceramic on UHMPWE samples continuing to show a slightly higher rate of wear than the highly crosslinked samples. The wear rates of each of the tested systems appear to be consistent with the expectations for low rates of wear in improved hip replacement systems.

  10. An asthma and diabetes quality improvement project: enhancing care in clinics and community health centers.

    Science.gov (United States)

    Silver, Alan; Figge, James; Haskin, Donna L; Pryor, Veronica; Fuller, Karen; Lemme, Thomas; Li, Nancy; O'Brien, Mary Jane

    2011-04-01

    Asthma and diabetes are major chronic conditions in the United States, particularly in the Medicaid population. The majority of care for these diseases occurs at ambulatory practice sites. The New York State Department of Health Office of Health Insurance Programs (OHIP) worked with IPRO, the New York State Medicare quality improvement organization, to develop and implement a quality improvement project (QIP) for these conditions. The approach was based upon the Chronic Care Model and used an iterative academic-detailing methodology. Clinics and community health centers volunteered to participate and used IPRO-collected data with audit and feedback to improve their practices. Several metrics significantly improved for asthma (e.g., use of anti-inflammatory long term controller agents, assessment of asthma severity, use of asthma action plans) and for diabetes (e.g., lipid testing and control, A1c testing). Key organizational elements of success included senior medical leadership commitment and practice site quality improvement team meetings. OHIP has used the QIP experience to begin patient-centered medical home implementation in New York State.

  11. Affiliation and Alienation: Hip-Hop, Rap, and Urban Science Education

    Science.gov (United States)

    Emdin, Christopher

    2010-01-01

    The critiques of rap artists and other participants in hip-hop culture provide data for teachers and researchers to investigate the attitudes of US urban youth towards schooling. This study explores the complex relationships between hip-hop and science education by examining how rap lyrics project beliefs about schooling, the relevance of existing…

  12. Application of improved Hardinge approach for total hip replacement in limb length control system%改良Hardinge入路全髋置换在双下肢等长控制中的应用

    Institute of Scientific and Technical Information of China (English)

    季卫平; 王波; 李浩; 黄自强; 吴博

    2014-01-01

    目的:评价改良Hardinge入路全髋置换在双下肢等长控制中的应用效果。方法对行改良Hardinge入路全髋置换及术中用自创等长测量方法进行双下肢等长控制并获1年以上随访的100例患者进行总结,采用Harris标准对髋关节功能进行评定。结果100例患者均获随访,时间12~60(26±2.1)个月。 Harris评分:优92例,良7例,可1例,优良率99%。下肢等长95例,下肢不等长在0.3~0.5 cm之间3例,相差0.6cm 1例,相差0.8 cm 1例。结论该入路暴露好,假体安装定位好,因术中下肢基本处于标准侧卧位,易于控制下肢长度,特别适用自创的术中精确测量调控双下肢等长的手术方法,可减少因体位原因导致的误差,术后外展肌恢复快,总体恢复良好。%Objective To evaluate the application of improved Hardinge approach in total hip arthroplasty in limb length control system. Methods The improved Hardinge approach and length measurement methods were used for total hip arthroplasty. 100 cases were followed up for more than 1 year. The Harris standard was used to evaluate the hip joint function. Results All 100 cases were followed up for 12~60 (26 ± 2. 1) months. The results were excel-lent in 92 cases, good in 7, and fair in 1, the excellent-good rate was 99%. 95 cases got equalized legs, leg length discrepancy was between 0. 3~0. 5 cm in 3 cases, 0. 6 cm in 1 case and 0. 8 cm in 1. Conclusions This approach provides good exposure and good positioning of prosthesis. Lower limb length can be controlled in standard lateral po-sition, especially with our own long intraoperative surgical method to accurately measure the regulation of both lower extremities. Abductor can get faster recovery after surgery, which facilitate good recovery.

  13. Medical librarians supporting information systems project lifecycles toward improved patient safety. Medical librarians possess expertise to navigate various search resources and can investigate inquiries during IS project lifecycles.

    Science.gov (United States)

    Saimbert, Marie K; Zhang, Yingting; Pierce, Jenny; Moncrief, Erica S; O'Hagan, Keydi Boss; Cole, Peter

    2010-01-01

    Health information systems (HIS) have progressed from being used to manage billing to impacting patient safety and health professionals' job satisfaction. Many decisions are made during project management and the information system lifecycle of a HIS. Medical librarians are underutilized in HIS lifecycles; it may not be clear to stakeholders what they can provide and where their services fit. Medical librarians possess expertise to navigate various search resources and can investigate inquiries during information systems project lifecycles. Librarians can market specific skills to project lifecycle teams such as those involved in computerized provider order entry (CPOE), electronic medication administration record (eMAR) and root cause analysis (RCA). HIS project personnel, including patient safety team members, should make use of medical librarians in phases of health information systems project management. This will help them meet institutional and global objectives for evidence-based use of technology towards improved patient safety.

  14. Fish Habitat Improvement Projects in the Fifteenmile Creek and Trout Creek Basins of Central Oregon: Field Review and Management Recommendations.

    Energy Technology Data Exchange (ETDEWEB)

    Kauffman, J. Boone

    1993-07-01

    A field review of stream habitat improvement project sites in the lower Deschutes River Basin was conducted by riparian ecology, fisheries, and hydrology specialists. Habitat management objectives, limiting factors, project implementation, land use history, and other factors were discussed at each site. This information, in conjunction with the reviewer`s field inspections of portions of a particular habitat project, provided the basis for this report.

  15. Model for improving the accuracy of relevant project selection in analogy using differential evolution algorithm

    Indian Academy of Sciences (India)

    I THAMARAI; S MURUGAVALLI

    2017-01-01

    Software effort estimation is the process of calculating the effort required to develop a software product based on the input parameters that are usually partial in nature. It is an important task but the most difficult and complicated step in the software product development. Estimation requires detailed information about project scope, process requirements and resources available. Inaccurate estimation leads to financial lossand delay in the projects. Due to the intangible nature of software, most of the software estimation process unreliable. But there is a strong relationship between effort estimation and project management activities.Various methodologies have been employed to improve the procedure of software estimation. This paper reviews journal articles on software development to get the direction in the future estimation research. Several methods for software effort estimation are discussed in this paper, including the data sets widely used and metrics used for evaluation. The use of evolutionary computational tools in the estimation is dealt with in detail.A new model for estimation using differential evolution algorithm called DEAPS is proposed and its advantagesare discussed.

  16. Cooling vest for improving surgeons' thermal comfort: a multidisciplinary design project.

    Science.gov (United States)

    Langø, Thomas; Nesbakken, Ragnhild; Faerevik, Hilde; Holbø, Kristine; Reitan, Jarl; Yavuz, Yunus; Mårvik, Ronald

    2009-01-01

    A laparoscopic surgeon sometimes experiences heat-related discomfort even though the temperature situation is moderate. The aim of this project was to design a cooling vest using a phase change material to increase thermal comfort for the surgeon. The project focused on the design process to reveal the most important parameters for the design of a cooling vest that could be demonstrated in a clinical setting. We performed an entire design process, from problem analysis, situation observations, concept for a prototype, temperature measurements, and a final design based on clinical testing. The project was conducted by a multidisciplinary team consisting of product designers, engineers, physiologists, and surgeons. We carried out four physiological demonstrations of one surgeon's skin temperatures and heart rate during different laparoscopic procedures. A commercially available cooling vest for firemen and two proof-of-concept prototypes were tested alongside a reference operation without cooling. To aid the final design, one person went through a climate chamber test with two different set-ups of cooling elements. The final design was found to improve the conditions of our test subject. It was found that whole trunk cooling was more effective than only upper trunk cooling. A final design was proposed based on the design process and the findings in the operating room and in the laboratory. Although the experiences using the vest seemed positive, further studies on several operators and more surgical procedures are needed to determine the true benefits for the operator.

  17. Innovative ICT solutions to improve treatment outcomes for depression: the ICT4Depression project.

    Science.gov (United States)

    Warmerdam, Lisanne; Riper, Heleen; Klein, Michel; van den Ven, Pepijn; Rocha, Artur; Ricardo Henriques, Mario; Tousset, Eric; Silva, Hugo; Andersson, Gerhard; Cuijpers, Pim

    2012-01-01

    Depression is expected to be the disorder with the highest disease burden in high-income countries by the year 2030. ICT4Depression (ICT4D) is a European FP7 project, which aims to contribute to the alleviation of this burden by making use of depression treatment and ICT innovations. In this project we developed an ICT-based system for use in primary care that aims to improve access as well as actual care delivery for depressed adults. Innovative technologies within the ICT4D system include 1) flexible self-help treatments for depression, 2) automatic assessment of the patient using mobile phone and web-based communication 3) wearable biomedical sensor devices for monitoring activities and electrophysiological indicators, 4) computational methods for reasoning about the state of a patient and the risk of relapse (reasoning engine) and 5) a flexible system architecture for monitoring and supporting people using continuous observations and feedback via mobile phone and the web. The general objective of the ICT4D project is to test the feasibility and acceptability of the ICT4D system within a pilot study in the Netherlands and in Sweden during 2012 and 2013.

  18. CURBSIDE CONSULTATION IN HIP ARTHROPLASTY

    OpenAIRE

    Sporer, Scott M.; Bernard R. Bach, Jr

    2009-01-01

    DESCRIPTION A user friendly reference for decision making in hip arthroplasty designed in a question formed clinical problem scenarios and answers format .The articles composed of the answers, containing current concepts and preferences of experts in primary and revision hip surgery are enhanced by several images, diagrams and references and written in the form of a curbside consultation by Scott M. Sporer, MD. and his collaborators. PURPOSE By this practical reference of hip arthroplasty, Sc...

  19. Advanced practice quality improvement project: how to influence physician radiologic imaging ordering behavior.

    Science.gov (United States)

    Durand, Daniel J; Kohli, Marc D

    2014-12-01

    With growing pressure on the health care sector to improve quality and reduce costs, the stakes associated with imaging appropriateness have never been higher. Although radiologists historically functioned as imaging gatekeepers, this role has been deprioritized in the recent past. This article discusses several potential practice quality improvement projects that can help radiologists regain their role as valued consultants and integral members of the care team. By applying the PDSA framework, radiologists can incrementally optimize their practice's consultation service. While it can be expected that different strategies will gain traction in different environments, it is our hope that the methodology described here will prove useful to most or all practices as a starting point. In addition, we discuss several other influencing techniques that extend beyond traditional consultation services.

  20. A Practice Improvement Project to Reduce Cesarean Surgical Site Infection Rates.

    Science.gov (United States)

    Holland, Cindra; Foster, Peggy; Ulrich, Deborah; Adkins, Kathryn

    We implemented an evidence-based practice improvement project at a health care facility in the Midwestern United States to address the increasing rate of cesarean surgical site infections. Women who experienced cesarean birth were cared for using a standardized evidence-based protocol including preoperative and postoperative care and education. In addition, a team-created educational video was used by both women and their families during the postoperative period and at home after discharge. This new protocol resulted in a decrease in the rate of cesarean surgical site infections from 1.35% in 2013 to 0.7% in 2014 and 0.36% in 2015. Our interdisciplinary approach to integrate best-practice strategies resulted in decreased infection rates and improved patient satisfaction scores. © 2016 AWHONN, the Association of Women’s Health, Obstetric and Neonatal Nurses.

  1. A practical guide to applying lean tools and management principles to health care improvement projects.

    Science.gov (United States)

    Simon, Ross W; Canacari, Elena G

    2012-01-01

    Manufacturing organizations have used Lean management principles for years to help eliminate waste, streamline processes, and cut costs. This pragmatic approach to structured problem solving can be applied to health care process improvement projects. Health care leaders can use a step-by-step approach to document processes and then identify problems and opportunities for improvement using a value stream process map. Leaders can help a team identify problems and root causes and consider additional problems associated with methods, materials, manpower, machinery, and the environment by using a cause-and-effect diagram. The team then can organize the problems identified into logical groups and prioritize the groups by impact and difficulty. Leaders must manage action items carefully to instill a sense of accountability in those tasked to complete the work. Finally, the team leaders must ensure that a plan is in place to hold the gains.

  2. Surgical repair of chronic tears of the hip abductor mechanism.

    Science.gov (United States)

    Davies, Hywel; Zhaeentan, Sohelia; Tavakkolizadeh, Adel; Janes, Gregory

    2009-01-01

    Lateral sided hip pain frequently presents to the orthopaedic clinic. The most common cause of this pain is trochanteric bursitis. This usually improves with conservative treatment. In a few cases it doesn't settle and warrants further investigation and treatment. We present a series of 28 patients who underwent MRI scanning for such pain, 16 were found to have a tear of their abductors. All 16 underwent surgical repair using multiple soft tissue anchors inserted into the greater trochanter of the hip to reattach the abductors. There were 15 females and 1 male. All patients completed a self-administered questionnaire pre-operatively and 1 year post-operatively. Data collected included: A visual analogue score for hip pain, Charnley modification of the Merle D'Aubigne and Postel hip score, Oxford hip score, Kuhfuss score of Trendelenburg and SF36 scores.Of the 16 patients who underwent surgery 5 had a failure of surgical treatment. There were 4 re ruptures, 3 of which were revised and 1 deep infection which required debridement. In the remaining 11 patients there were statistically significant improvements in hip symptoms. The mean change in visual analogue score was 5 out of 10 (p=0.0024) The mean change of Oxford hip score was 20.5 (p=0.00085). The mean improvement in SF-36 PCS was 8.5 (P=0.0020) and MCS 13.7 (P=0.134). 6 patients who had a Trendelenburg gait pre-surgery had normal gait 1 year following surgery.We conclude that hip abductor mechanism tear is a frequent cause of recalcitrant trochanteric pain that should be further investigated with MRI scanning. Surgical repair is a successful operation for reduction of pain and improvement of function. However there is a relatively high failure rate.

  3. The influence of heterotopic ossification on functional status of hip joint following total hip arthroplasty

    Energy Technology Data Exchange (ETDEWEB)

    Pohl, F.; Seufert, J.; Flentje, M.; Koelbl, O. [Wuerzburg Univ. (Germany). Dept. of Radiotherapy; Tauscher, A.; Springorum, H.W. [Caritas Krankenhaus Bad Mergentheim (Germany). Orthopedic Clinic; Lehmann, H. [Caritas Krankenhaus Bad Mergentheim (Germany). Inst. of Radiology

    2005-08-01

    Purpose: The functional failure induced by heterotopic ossification (HO) following total hip arthroplasty (THA) was analyzed and correlated to the radiologic failure. Patients and methods: From July 1997 to July 2001, 315 patients (345 hips) received THA indicated by a hypertrophic osteoarthritis of higher degree (Kellgren grade III, IV). All patients were irradiated prophylactically for prevention of HO on the evening before surgery with a 7-Gy single fraction. The patients' median age was 66.3 years. Radiologic failure was assessed by comparison of pre- and postoperative hip X-rays (immediately and 6 months after surgery). Analysis of radiographs was performed according to the Brooker Score. Clinical failure was appraised by measurement of passive range of motion (ROM) of the hip joint with a standard goniometer. The t-test was used for statistical analysis. Results: 281 patients (81.5%) did not develop HO. HO of Brooker grade I or II was found in 58 patients (16.8%). Six patients (1.7%) developed HO Brooker grade III or IV. There was a significant negative correlation between the degree of radiologic and clinical failure. ROM differed significantly between patients with HO Brooker grade 0, I, II and patients with HO Brooker grade III, IV. Comparing the pre- and postoperative ROM, all patients with Brooker grade 0, I and II showed a significant improvement of flexion, internal and external rotation, abduction and adduction movement. Patients with HO Brooker grade III and IV showed no improvement of ROM in the postoperative follow-up. Conclusion: The development of HO following THA influences the physical function of the hip joint dependent on the degree of ossification. HO of lower degree (Brooker I, II) does not influence the clinical outcome, whereas HO of higher degree (Brooker III, IV) reduces the function of hip arthroplasty. Therefore, the purpose of a prophylactic therapy must be to reduce HO of higher degree. (orig.)

  4. Recovery Act: Hydroelectric Facility Improvement Project - Replacement of Current Mechanical Seal System with Rope Packing System

    Energy Technology Data Exchange (ETDEWEB)

    Stephens, Jessica D.

    2013-05-29

    On January 27, 2010 the City of North Little Rock, Arkansas received notification of the awarding of a Department of Energy (DOE) grant totaling $450,000 in funding from the American Recovery and Reinvestment Act (ARRA) under the Project Title: Recovery Act: Hydroelectric Facility Improvement Project – Automated Intake Clearing Equipment and Materials Management. The purpose of the grant was for improvements to be made at the City’s hydroelectric generating facility located on the Arkansas River. Improvements were to be made through the installation of an intake maintenance device (IMD) and the purchase of a large capacity wood grinder. The wood grinder was purchased in order to receive the tree limbs, tree trunks, and other organic debris that collects at the intake of the plant during high flow. The wood grinder eliminates the periodic burning of the waste material that is cleared from the intake and reduces any additional air pollution to the area. The resulting organic mulch has been made available to the public at no charge. Design discussion and planning began immediately and the wood grinder was purchased in July of 2010 and immediately put to work mulching debris that was gathered regularly from the intake of the facility. The mulch is currently available to the public for free. A large majority of the design process was spent in discussion with the Corps of Engineers to obtain approval for drawings, documents, and permits that were required in order to make changes to the structure of the powerhouse. In April of 2011, the City’s Project Engineer, who had overseen the application, resigned and left the City’s employ. A new Systems Mechanical Engineer was hired and tasked with overseeing the project. The transfer of responsibility led to a re-examination of the original assumptions and research upon which the grant proposal was based. At that point, the project went under review and a trip was booked for July 2011 to visit facilities that currently

  5. Results of hip resurfacing for developmental dysplasia of the hip of Crowe type Ⅰ and Ⅱ

    Institute of Scientific and Technical Information of China (English)

    XU Wei-dong; LI Jia; ZHOU Zhen-hua; WU Yue-song; LI Ming

    2008-01-01

    Background Recently, the new generation of metal-on-metal total hip resurfacing arthroplasty is well known for preserving the proximal femoral bone stock, minimizing the risk of postoperative dislocation using large femoral heads, and expecting low wear of metal-on-metal articulation for longer prosthesis survival. It also has the advantage in biomechanical loading in the proximal femur. The osteoarthritis secondary to developmental dysplasia of the hip (DDH) has been the most common reason for total hip arthroplasty. Most of the patients are young and active, who require improved range of motion of the hip besides relief of the pain, even expect to resume the ability to run and jump after the joint arthroplasty, thus to be allowed an active lifestyle. The objective of the current study was to evaluate the early outcome of resurfacing arthroplasty for the mild DDH cases (Crowe type Ⅰ and Ⅱ).Methods Between September 2005 and May 2007, twenty-one consecutive patients (twenty-six hips) with the diagnosis of osteoarthritis secondary to DDH underwent metal-on-metal resurfacing arthroplasty. The average age at the time of surgery was 46.5 years (range, 37-59 years). Six patients (28.6%) were male and fifteen (71.4%) were female. Clinical and radiographic results were observed. The follow-up was performed at 6 weeks, 3, 6, 9 months and then yearly.Results All patients were followed for a mean of 18 months (9-29 months). During the follow-up period no complications, such as dislocation of hip joints, infection or femoral neck fracture occurred. The clinical outcomes, as rated with the Harris hip score, improved significantly compared with the preoperative ratings. The mean postoperative Harris hip score was 90.7, compared to 35.5 preoperatively. The radiographic analysis showed that all prostheses were fixed with no radiolucencies. All of the patients who had equal limb lengths preoperatively had equal lengths postoperatively. Of the nine patients with preoperative

  6. Investigating organizational quality improvement systems, patient empowerment, organizational culture, professional involvement and the quality of care in European hospitals: the 'Deepening our Understanding of Quality Improvement in Europe (DUQuE' project

    Directory of Open Access Journals (Sweden)

    Thompson Andrew

    2010-09-01

    Full Text Available Abstract Background Hospitals in European countries apply a wide range of quality improvement strategies. Knowledge of the effectiveness of these strategies, implemented as part of an overall hospital quality improvement system, is limited. Methods/Design We propose to study the relationships among organisational quality improvement systems, patient empowerment, organisational culture, professionals' involvement with the quality of hospital care, including clinical effectiveness, patient safety and patient involvement. We will employ a cross-sectional, multi-level study design in which patient-level measurements are nested in hospital departments, which are in turn nested in hospitals in different EU countries. Mixed methods will be used for data collection, measurement and analysis. Hospital/care pathway level constructs that will be assessed include external pressure, hospital governance, quality improvement system, patient empowerment in quality improvement, organisational culture and professional involvement. These constructs will be assessed using questionnaires. Patient-level constructs include clinical effectiveness, patient safety and patient involvement, and will be assessed using audit of patient records, routine data and patient surveys. For the assessment of hospital and pathway level constructs we will collect data from randomly selected hospitals in eight countries. For a sample of hospitals in each country we will carry out additional data collection at patient-level related to four conditions (stroke, acute myocardial infarction, hip fracture and delivery. In addition, structural components of quality improvement systems will be assessed using visits by experienced external assessors. Data analysis will include descriptive statistics and graphical representations and methods for data reduction, classification techniques and psychometric analysis, before moving to bi-variate and multivariate analysis. The latter will be conducted

  7. Assessment of hip dysplasia and osteoarthritis: Variability of different methods

    Energy Technology Data Exchange (ETDEWEB)

    Troelsen, Anders; Elmengaard, Brian; Soeballe, Kjeld (Orthopedic Research Unit, Univ. Hospital of Aarhus, Aarhus (Denmark)), e-mail: a_troelsen@hotmail.com; Roemer, Lone (Dept. of Radiology, Univ. Hospital of Aarhus, Aarhus (Denmark)); Kring, Soeren (Dept. of Orthopedic Surgery, Aabenraa Hospital, Aabenraa (Denmark))

    2010-03-15

    Background: Reliable assessment of hip dysplasia and osteoarthritis is crucial in young adults who may benefit from joint-preserving surgery. Purpose: To investigate the variability of different methods for diagnostic assessment of hip dysplasia and osteoarthritis. Material and Methods: By each of four observers, two assessments were done by vision and two by angle construction. For both methods, the intra- and interobserver variability of center-edge and acetabular index angle assessment were analyzed. The observers' ability to diagnose hip dysplasia and osteoarthritis were assessed. All measures were compared to those made on computed tomography scan. Results: Intra- and interobserver variability of angle assessment was less when angles were drawn compared with assessment by vision, and the observers' ability to diagnose hip dysplasia improved when angles were drawn. Assessment of osteoarthritis in general showed poor agreement with findings on computed tomography scan. Conclusion: We recommend that angles always should be drawn for assessment of hip dysplasia on pelvic radiographs. Given the inherent variability of diagnostic assessment of hip dysplasia, a computed tomography scan could be considered in patients with relevant hip symptoms and a center-edge angle between 20 deg and 30 deg. Osteoarthritis should be assessed by measuring the joint space width or by classifying the Toennis grade as either 0-1 or 2-3

  8. Clinical and Functional Outcomes of the Birmingham Hip Resurfacing System.

    Science.gov (United States)

    Pascual-Garrido, Cecilia; Morris, Brandon L; Dayton, Michael R

    2016-01-01

    This study reported the outcomes of patients treated with the Birmingham Hip Resurfacing System (Smith & Nephew, Memphis, Tennessee) to identify the prevalence of complications and failures. A retrospective review of 202 patients (206 hips) was performed. Outcomes were assessed clinically with Harris Hip Score at 6 and 12 months and then yearly. Subanalysis was performed, with the hips divided according to patient sex and size of the femoral component. Mean patient age was 51±8 years, and mean follow-up was 4±1.6 years. Of the patients, 163 were men (83%) and 35 were women (17%). Postoperative improvement was significant, with preoperative Harris Hip Score of 62.9±10.6 and postoperative Harris Hip Score of 98.6±6.7 (Phips (2.4%) underwent revision. At 3 years, mean survival was better for men than for women (99% vs 92%, respectively). Survival was lowest in patients with femoral component diameter of less than 46 mm. According to the authors' results, the Birmingham Hip Resurfacing System resulted in good clinical outcomes at 4 years. Survival and outcomes in women, particularly those with modest bone size, are inferior.

  9. Multi-factor Analysis Model for Improving Profit Management Using Excel in Shellfish Farming Projects

    Institute of Scientific and Technical Information of China (English)

    Zhuming; ZHAO; Changlin; LIU; Xiujuan; SHAN; Jin; YU

    2013-01-01

    By using a farm’s data in Yantai City and the theory of Cost-Volume-Profit analysis and the financial management methods,this paper construct a multi-factor analysis model for improving profit management using Excel 2007 in Shellfish farming projects and describes the procedures to construct a multi-factor analysis model.The model can quickly calculate the profit,improve the level of profit management,find out the breakeven point and enhance the decision-making efficiency of businesses etc.It is also a thought of the application to offer suggestions for government decisions and economic decisions for corporations as a simple analysis tool.While effort has been exerted to construct a four-variable model,some equally important variables may not be discussed sufficiently due to limitation of the paper’s space and the authors’knowledge.All variables can be listed in EXCEL 2007 and can be associated in a logical way to manage the profit of shellfish farming projects more efficiently and more practically.

  10. Residency Training: Quality improvement projects in neurology residency and fellowship: applying DMAIC methodology.

    Science.gov (United States)

    Kassardjian, Charles D; Williamson, Michelle L; van Buskirk, Dorothy J; Ernste, Floranne C; Hunderfund, Andrea N Leep

    2015-07-14

    Teaching quality improvement (QI) is a priority for residency and fellowship training programs. However, many medical trainees have had little exposure to QI methods. The purpose of this study is to review a rigorous and simple QI methodology (define, measure, analyze, improve, and control [DMAIC]) and demonstrate its use in a fellow-driven QI project aimed at reducing the number of delayed and canceled muscle biopsies at our institution. DMAIC was utilized. The project aim was to reduce the number of delayed muscle biopsies to 10% or less within 24 months. Baseline data were collected for 12 months. These data were analyzed to identify root causes for muscle biopsy delays and cancellations. Interventions were developed to address the most common root causes. Performance was then remeasured for 9 months. Baseline data were collected on 97 of 120 muscle biopsies during 2013. Twenty biopsies (20.6%) were delayed. The most common causes were scheduling too many tests on the same day and lack of fasting. Interventions aimed at patient education and biopsy scheduling were implemented. The effect was to reduce the number of delayed biopsies to 6.6% (6/91) over the next 9 months. Familiarity with QI methodologies such as DMAIC is helpful to ensure valid results and conclusions. Utilizing DMAIC, we were able to implement simple changes and significantly reduce the number of delayed muscle biopsies at our institution. © 2015 American Academy of Neurology.

  11. Outlier analysis in orthopaedics: use of CUSUM: the Scottish Arthroplasty Project: shouldering the burden of improvement.

    Science.gov (United States)

    Macpherson, Gavin J; Brenkel, Ivan J; Smith, Rik; Howie, Colin R

    2011-12-21

    National joint registries have become well established across the world. Most registries track implant survival so that poorly performing implants can be removed from the market. The Scottish Arthroplasty Project was established in 1999 with the aim of encouraging continual improvement in the quality of care provided to joint replacement patients in Scotland. This aim has been achieved by using statistics to engage surgeons in the process of audit. We monitor easily identifiable end points of public concern and inform surgeons if they breach our statistical limits and become "outliers." Outlier status is often associated with poor implants, and our methods are therefore applicable for indirect implant surveillance. The present report describes the evolution of our statistical methodology, the processes that we use to promote positive changes in practice, and the improvements in patient outcomes that we have achieved. Failure need not be fatal, but failure to change almost always is. We describe the journey of both the Scottish Arthroplasty Project and the orthopaedic surgeons of Scotland to this realization.

  12. "The moving body": a sustainable project to improve children's physical activity at kindergarten.

    Science.gov (United States)

    Serpentino, Carmela

    2011-10-01

    Physical activity promotes children's awareness of the body. Children, to experience and to learn, need to be physically active and their innate physical activity is playing. Playing together means building relationships with peers, means learning how to use tools and space, means addressing egocentric behaviour toward rules' respect; in summary, it means learning "social conviviality and respect". The aim of the project "The moving body" was to favour children's physical and cognitive development and their social relationships. Gross motor physical abilities were assessed in 270 children attending the kindergarten. The children were grouped according their level of motor abilities to promote learning through older children's imitation. Structured games and playing were alternated to free time, and words such as physical activity, movement, and so on, were never used. Every month the children were asked to draw their own body to assess their body shape perception and their ability in representing it. All the children improved their physical abilities as compared to the beginning of the project; they strengthened their creativity and fantasy, inventing new and imaginative games, became more confident in their own capacities, and they learned how to deal and overcome, with a greater autonomy, difficult tasks. The body shape perception, and its representation as drawing, showed, especially among children 3 years old, remarkable progress. The importance of physical activity and play in kindergarten activities was evidenced through the significant improvement of children's several specific motor and psychosocial competences.

  13. Marmoset: A programming project assignment framework to improve the feedback cycle for students, faculty and researchers

    Science.gov (United States)

    Spacco, Jaime W.

    We developed Marmoset, a system that improves the feedback cycle on programming assignments for students, faculty and researchers alike. Using automation, Marmoset substantially lowers the burden on faculty for grading programming assignments, allowing faculty to give students more rapid feedback on their assignments. To further improve the feedback cycle, Marmoset provides students with limited access to the results of the instructor's private test cases before the submission deadline using a novel token-based incentive system. This both encourages students to start their work early and to think critically about their work. Because students submit early, instructors can monitor all students' progress on test cases and identify where in projects students are having problems in order to update the project requirements in a timely fashion and make the best use of time in lectures, discussion sections, and office hours. To study in more detail the development process of students, Marmoset can be configured to transparently capture snapshots to a central repository every-time students save their files. These detailed development histories offer a unique, detailed perspective of each student's progress on a programming assignment, from the first line of code written and saved all the way through the final edit before the final submission. This type of data has proved extremely valuable for many uses, such as mining new bug patterns and evaluating existing bug-finding tools.

  14. Final Report Collaborative Project. Improving the Representation of Coastal and Estuarine Processes in Earth System Models

    Energy Technology Data Exchange (ETDEWEB)

    Bryan, Frank [National Center for Atmospheric Research, Boulder, CO (United States); Dennis, John [National Center for Atmospheric Research, Boulder, CO (United States); MacCready, Parker [Univ. of Washington, Seattle, WA (United States); Whitney, Michael [Univ. of Connecticut

    2015-11-20

    This project aimed to improve long term global climate simulations by resolving and enhancing the representation of the processes involved in the cycling of freshwater through estuaries and coastal regions. This was a collaborative multi-institution project consisting of physical oceanographers, climate model developers, and computational scientists. It specifically targeted the DOE objectives of advancing simulation and predictive capability of climate models through improvements in resolution and physical process representation. The main computational objectives were: 1. To develop computationally efficient, but physically based, parameterizations of estuary and continental shelf mixing processes for use in an Earth System Model (CESM). 2. To develop a two-way nested regional modeling framework in order to dynamically downscale the climate response of particular coastal ocean regions and to upscale the impact of the regional coastal processes to the global climate in an Earth System Model (CESM). 3. To develop computational infrastructure to enhance the efficiency of data transfer between specific sources and destinations, i.e., a point-to-point communication capability, (used in objective 1) within POP, the ocean component of CESM.

  15. An innovative artificial fog production device improved in the European project “FOG”

    Science.gov (United States)

    Colomb, M.; Hirech, K.; André, P.; Boreux, J. J.; Lacôte, P.; Dufour, J.

    2008-03-01

    Transport safety is a major goal in the European Union. Low visibility conditions, especially due to fog, increase the risk of major accidents (chain collision). Innovative products have been developed by the automotive industry, including equipment manufacturers, to increase the level of safety of car passengers and drivers. Testing of these products requires the simulation or artificial reproduction of low visibility (fog) conditions with good stability and reproducibility characteristics. We report on the results of the European Union funded "FOG" project to improve road transport safety through fog production in an experimental test chamber located at the Clermont-Ferrand laboratory for research on road safety and visibility. The project developed a prototype of a small-scale climatic chamber, an improved fog production spraying device, a laser-based visibility measurement device, a reduced scale transmissometer, and a combined indoor climate-fog production simulation software. The ability of the fog chamber to test for driver reaction was also investigated. Recent developments include a device able to produce stable visibility levels and homogeneous fog, representative of various types of natural water droplet distribution. The fog characteristics were determined and compared to natural fog. Results are presented for a selection of conditions including stabilized visibility levels for dense fog and two kinds of droplet distributions.

  16. Exercise therapy, manual therapy, or both, for osteoarthritis of the hip or knee: a factorial randomised controlled trial protocol

    Directory of Open Access Journals (Sweden)

    Baxter G David

    2009-02-01

    Full Text Available Abstract Background Non-pharmacological, non-surgical interventions are recommended as the first line of treatment for osteoarthritis (OA of the hip and knee. There is evidence that exercise therapy is effective for reducing pain and improving function in patients with knee OA, some evidence that exercise therapy is effective for hip OA, and early indications that manual therapy may be efficacious for hip and knee OA. There is little evidence as to which approach is more effective, if benefits endure, or if providing these therapies is cost-effective for the management of this disorder. The MOA Trial (Management of OsteoArthritis aims to test the effectiveness of two physiotherapy interventions for improving disability and pain in adults with hip or knee OA in New Zealand. Specifically, our primary objectives are to investigate whether: 1. Exercise therapy versus no exercise therapy improves disability at 12 months; 2. Manual physiotherapy versus no manual therapy improves disability at 12 months; 3. Providing physiotherapy programmes in addition to usual care is more cost-effective than usual care alone in the management of osteoarthritis at 24 months. Methods This is a 2 × 2 factorial randomised controlled trial. We plan to recruit 224 participants with hip or knee OA. Eligible participants will be randomly allocated to receive either: (a a supervised multi-modal exercise therapy programme; (b an individualised manual therapy programme; (c both exercise therapy and manual therapy; or, (d no trial physiotherapy. All participants will continue to receive usual medical care. The outcome assessors, orthopaedic surgeons, general medical practitioners, and statistician will be blind to group allocation until the statistical analysis is completed. The trial is funded by Health Research Council of New Zealand Project Grants (Project numbers 07/199, 07/200. Discussion The MOA Trial will be the first to investigate the effectiveness and cost

  17. Conservation and restoration of indigenous plants to improve community livelihoods: the Useful Plants Project

    Science.gov (United States)

    Ulian, Tiziana; Sacandé, Moctar; Mattana, Efisio

    2014-05-01

    Kew's Millennium Seed Bank partnership (MSBP) is one of the largest ex situ plant conservation initiatives, which is focused on saving plants in and from regions most at risk, particularly in drylands. Seeds are collected and stored in seed banks in the country of origin and duplicated in the Millennium Seed Bank in the UK. The MSBP also strengthens the capacity of local communities to successfully conserve and sustainably use indigenous plants, which are important for their wellbeing. Since 2007, high quality seed collections and research information have been gathered on ca. 700 useful indigenous plant species that were selected by communities in Botswana, Kenya, Mali, Mexico and South Africa through Project MGU - The Useful Plants Project. These communities range from various farmer's groups and organisations to traditional healers, organic cotton/crop producers and primary schools. The information on seed conservation and plant propagation was used to train communities and to propagate ca. 200 species that were then planted in local gardens, and as species reintroduced for reforestation programmes and enriching village forests. Experimental plots have also been established to further investigate the field performance (plant survival and growth rate) of indigenous species, using low cost procedures. In addition, the activities support revenue generation for local communities directly through the sustainable use of plant products or indirectly through wider environmental and cultural services. This project has confirmed the potential of biodiversity conservation to improve food security and human health, enhance community livelihoods and strengthen the resilience of land and people to the changing climate. This approach of using indigenous species and having local communities play a central role from the selection of species to their planting and establishment, supported by complementary research, may represent a model for other regions of the world, where

  18. Prioritizing Improvement Projects of EFQM by Fuzzy Group AHP and Try-Success Matrix- The Case of a Manufacturing Industry

    Directory of Open Access Journals (Sweden)

    Seyed javad Mosa kassamy

    2012-06-01

    Full Text Available The aim of this paper is to prioritize projects by a new approach . For prioritizing EFQM projects , self-assessment is conducted by industry experts and then , improve ment projects are determined . For these projects, “prioritizing” is the main problem in organizations. Because of resource constraints, those projects should be selected and implemented that provide most benefits. Selecting the appropriate indicators, such as " quantity of required resources", " impact on stakeholders" and " p robability of project success" can significantly influence selection of projects. These indicators have been considered in the Try-Success matrix. Also, since each project is depend ed on the EFQM’s criteria, the weights of the criteria have been localized . In the designed software of this study, the scoring mechanism is based on Try-Success matrix, and the local weights are determined by Fuzzy-group AHP. In this paper , the application of software in prioritization of projects has been also addressed. T he output of this approach together with software and investigation, are the determined projects that have higher priorities and provide considerable improvement to the industry .

  19. PRIMARY CEMENTLESS TOTAL HIP ARTHROPLASTY IN ANKYLOSING SPONDYLITIS

    Directory of Open Access Journals (Sweden)

    Nageshwara Rao

    2015-12-01

    Full Text Available INTRODUCTION Ankylosing Spondylitis (AS, family of Spondyloarthritides (SpAs, is a chronic inflammatory disease affecting the axial skeleton, the entheses and occasionally the peripheral joints. The shoulders and hips are considered axial joints and involvement occurs in up to 50% of patients and is more common than involvement of the more distal joints. Aim of our study is to evaluate outcome of Cementless Total Hip Arthroplasty (THA in ankylosing spondylitis. MATERIALS AND METHODS We prospectively and retrospectively reviewed 27 hips in 20 patients who underwent cementless THA between 2007-2013. Mean age of patient was 31.5 years. We analysed demographic data, preoperative deformity, Harris Hip Score, ambulatory status, need for walking aids. RESULTS All patients experienced significant improvement in function, range of motion, posture and ambulation. Postoperative Harris Hip Score improved from 18.95 to 89.35; 90% are completely pain free, 5% have occasional discomfort and 5% have mild-to-moderate pain. CONCLUSION Cementless THA for deformed hips in young patients with AS is worthwhile surgical intervention, as it increases the mobility of the patient, improves the ability to sit comfortably, decrases the morbidity of the disease. However, the technically demanding nature of the procedure should not be underestimated.

  20. Minimal clinically important improvement (MCII) and patient-acceptable symptom state (PASS) in total hip arthroplasty (THA) patients 1 year postoperatively

    DEFF Research Database (Denmark)

    Paulsen, Aksel; Roos, Ewa M.; Pedersen, Alma B;

    2013-01-01

    Background and purpose - The increased use of patient-reported outcomes (PROs) in orthopedics requires data on estimated minimal clinically important improvements (MCIIs) and patient-acceptable symptom states (PASSs). We wanted to find cut-points corresponding to minimal clinically important PRO ...