Ovarian cancer clinical trial endpoints: Society of Gynecologic Oncology white paper

Science.gov (United States)

Herzog, Thomas J.; Armstrong, Deborah K.; Brady, Mark F.; Coleman, Robert L.; Einstein, Mark H.; Monk, Bradley J.; Mannel, Robert S.; Thigpen, J. Tate; Umpierre, Sharee A.; Villella, Jeannine A.; Alvarez, Ronald D.

2015-01-01

from active post-progression therapies. A large magnitude of effect in PFS improvement should establish benefit, and further communication with regulatory authorities to clarify acceptable endpoints should be undertaken. PMID:24239753

Ovarian cancer clinical trial endpoints: Society of Gynecologic Oncology white paper.

Science.gov (United States)

Herzog, Thomas J; Armstrong, Deborah K; Brady, Mark F; Coleman, Robert L; Einstein, Mark H; Monk, Bradley J; Mannel, Robert S; Thigpen, J Tate; Umpierre, Sharee A; Villella, Jeannine A; Alvarez, Ronald D

2014-01-01

. A large magnitude of effect in PFS improvement should establish benefit, and further communication with regulatory authorities to clarify acceptable endpoints should be undertaken. Copyright © 2013. Published by Elsevier Inc.

Establishing a group of endpoints to support collective operations without specifying unique identifiers for any endpoints

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Archer, Charles J.; Blocksom, Michael A.; Ratterman, Joseph D.; Smith, Brian E.; Xue, Hanghon

2016-02-02

A parallel computer executes a number of tasks, each task includes a number of endpoints and the endpoints are configured to support collective operations. In such a parallel computer, establishing a group of endpoints receiving a user specification of a set of endpoints included in a global collection of endpoints, where the user specification defines the set in accordance with a predefined virtual representation of the endpoints, the predefined virtual representation is a data structure setting forth an organization of tasks and endpoints included in the global collection of endpoints and the user specification defines the set of endpoints without a user specification of a particular endpoint; and defining a group of endpoints in dependence upon the predefined virtual representation of the endpoints and the user specification.

Role of TIPS in Improving Survival of Patients with Decompensated Liver Disease

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Sundeep J. Punamiya

2011-01-01

Full Text Available Liver cirrhosis is associated with higher morbidity and reduced survival with appearance of portal hypertension and resultant decompensation. Portal decompression plays a key role in improving survival in these patients. Transjugular intrahepatic portosystemic shunts are known to be efficacious in reducing portal venous pressure and control of complications such as variceal bleeding and ascites. However, they have been associated with significant problems such as poor shunt durability, increased encephalopathy, and unchanged survival when compared with conservative treatment options. The last decade has seen a significant improvement in these complications, with introduction of covered stents, better selection of patients, and clearer understanding of procedural end-points. Use of TIPS early in the period of decompensation also appears promising in further improvement of survival of cirrhotic patients.

Two-temperature LATE-PCR endpoint genotyping

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Reis Arthur H

2006-12-01

2:1 and 1:2 ratios of the same alleles. Conclusion SNP genotyping via Two-Temperature LATE-PCR takes place in a homogeneous closed-tube format and uses a single hybridization probe per SNP site. These assays are convenient, rely on endpoint analysis, improve the options for construction of multiplex assays, and are suitable for SNP genotyping, mutation scanning, and detection of DNA duplication or deletions.

Patients’ preferences for selection of endpoints in cardiovascular clinical trials

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Robert D. Chow

2014-02-01

Full Text Available Background: To reduce the duration and overall costs of cardiovascular trials, use of the combined endpoints in trial design has become commonplace. Though this methodology may serve the needs of investigators and trial sponsors, the preferences of patients or potential trial subjects in the trial design process has not been studied. Objective: To determine the preferences of patients in the design of cardiovascular trials. Design: Participants were surveyed in a pilot study regarding preferences among various single endpoints commonly used in cardiovascular trials, preference for single vs. composite endpoints, and the likelihood of compliance with a heart medication if patients similar to them participated in the trial design process. Participants: One hundred adult English-speaking patients, 38% male, from a primary care ambulatory practice located in an urban setting. Key results: Among single endpoints, participants rated heart attack as significantly more important than death from other causes (4.53 vs. 3.69, p=0.004 on a scale of 1–6. Death from heart disease was rated as significantly more important than chest pain (4.73 vs. 2.47, p<0.001, angioplasty/PCI/CABG (4.73 vs. 2.43, p<0.001, and stroke (4.73 vs. 2.43, p<0.001. Participants also expressed a slight preference for combined endpoints over single endpoint (43% vs. 57%, incorporation of the opinions of the study patient population into the design of trials (48% vs. 41% for researchers, and a greater likelihood of medication compliance if patient preferences were considered during trial design (67% indicated a significant to major effect. Conclusions: Patients are able to make judgments and express preferences regarding trial design. They prefer that the opinions of the study population rather than the general population be incorporated into the design of the study. This novel approach to study design would not only incorporate patient preferences into medical decision making, but

Shared Contract-Obedient Endpoints

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Étienne Lozes

2012-12-01

Full Text Available Most of the existing verification techniques for message-passing programs suppose either that channel endpoints are used in a linear fashion, where at most one thread may send or receive from an endpoint at any given time, or that endpoints may be used arbitrarily by any number of threads. The former approach usually forbids the sharing of channels while the latter limits what is provable about programs. In this paper we propose a midpoint between these techniques by extending a proof system based on separation logic to allow sharing of endpoints. We identify two independent mechanisms for supporting sharing: an extension of fractional shares to endpoints, and a new technique based on what we call reflexive ownership transfer. We demonstrate on a number of examples that a linear treatment of sharing is possible.

Empowering Post-Surgical Patients to Improve Opioid Disposal: A Before and After Quality Improvement Study.

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Hasak, Jessica M; Roth Bettlach, Carrie L; Santosa, Katherine B; Larson, Ellen L; Stroud, Jean; Mackinnon, Susan E

2018-03-01

Our country is in the midst of an opioid epidemic. Although the problem is multifactorial, one issue is the presence of excess prescription opioid medications circulating in our communities. Our objective was to determine whether dissemination of an educational brochure would improve the disposal of unused opioids after surgery. Eligible surgery patients from an upper extremity/peripheral nerve clinic were enrolled into this prospective before and after study between February 2017 and September 2017. Patients who reported opioid use preoperatively were excluded from this study. The same survey was administered to the group of patients who did not receive the intervention and to those who did receive the intervention. Our primary endpoint was the proportion of patients who disposed of unused opioid medications. A total of 334 patients were studied: 164 who did not receive the brochure and 170 who received the brochure. Seventy-six patients were excluded for preoperative opioid use. After dissemination of the brochure, there was a significant increase in the proportion of patients who disposed of their unused opioids (11% vs 22%, p = 0.02). Of those who disposed of their opioids, there was no significant difference in the proportion of patients from each group who disposed in a manner that was recommended by the brochure (43% vs 64%, p = 0.19). Dissemination of the educational brochure improved disposal of unused opioids after surgery. This low-cost, easily implemented intervention can improve disposal of unused opioids and ultimately, decrease the amount of excess opioids circulating in our communities. Copyright © 2017 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

Improving prehospital trauma care in Rwanda through continuous quality improvement: an interrupted time series analysis.

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Scott, John W; Nyinawankusi, Jeanne D'Arc; Enumah, Samuel; Maine, Rebecca; Uwitonze, Eric; Hu, Yihan; Kabagema, Ignace; Byiringiro, Jean Claude; Riviello, Robert; Jayaraman, Sudha

2017-07-01

Injury is a major cause of premature death and disability in East Africa, and high-quality pre-hospital care is essential for optimal trauma outcomes. The Rwandan pre-hospital emergency care service (SAMU) uses an electronic database to evaluate and optimize pre-hospital care through a continuous quality improvement programme (CQIP), beginning March 2014. The SAMU database was used to assess pre-hospital quality metrics including supplementary oxygen for hypoxia (O2), intravenous fluids for hypotension (IVF), cervical collar placement for head injuries (c-collar), and either splinting (splint) or administration of pain medications (pain) for long bone fractures. Targets of >90% were set for each metric and daily team meetings and monthly feedback sessions were implemented to address opportunities for improvement. These five pre-hospital quality metrics were assessed monthly before and after implementation of the CQIP. Met and unmet needs for O2, IVF, and c-collar were combined into a summative monthly SAMU Trauma Quality Scores (STQ score). An interrupted time series linear regression model compared the STQ score during 14 months before the CQIP implementation to the first 14 months after. During the 29-month study period 3,822 patients met study criteria. 1,028 patients needed one or more of the five studied interventions during the study period. All five endpoints had a significant increase between the pre-CQI and post-CQI periods (pRwanda. This programme may be used as an example for additional efforts engaging frontline staff with real-time data feedback in order to rapidly translate data collection efforts into improved care for the injured in a resource-limited setting. Copyright © 2017 Elsevier Ltd. All rights reserved.

 Alkaline phosphatase normalization is a biomarker of improved survival in primary sclerosing cholangitis.

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Hilscher, Moira; Enders, Felicity B; Carey, Elizabeth J; Lindor, Keith D; Tabibian, James H

2016-01-01

 Introduction. Recent studies suggest that serum alkaline phosphatase may represent a prognostic biomarker in patients with primary sclerosing cholangitis. However, this association remains poorly understood. Therefore, the aim of this study was to investigate the prognostic significance and clinical correlates of alkaline phosphatase normalization in primary sclerosing cholangitis. This was a retrospective cohort study of patients with a new diagnosis of primary sclerosing cholangitis made at an academic medical center. The primary endpoint was time to hepatobiliaryneoplasia, liver transplantation, or liver-related death. Secondary endpoints included occurrence of and time to alkaline phosphatase normalization. Patients who did and did not achieve normalization were compared with respect to clinical characteristics and endpoint-free survival, and the association between normalization and the primary endpoint was assessed with univariate and multivariate Cox proportional-hazards analyses. Eighty six patients were included in the study, with a total of 755 patient-years of follow-up. Thirty-eight patients (44%) experienced alkaline phosphatase normalization within 12 months of diagnosis. Alkaline phosphatase normalization was associated with longer primary endpoint-free survival (p = 0.0032) and decreased risk of requiring liver transplantation (p = 0.033). Persistent normalization was associated with even fewer adverse endpoints as well as longer survival. In multivariate analyses, alkaline phosphatase normalization (adjusted hazard ratio 0.21, p = 0.012) and baseline bilirubin (adjusted hazard ratio 4.87, p = 0.029) were the only significant predictors of primary endpoint-free survival. Alkaline phosphatase normalization, particularly if persistent, represents a robust biomarker of improved long-term survival and decreased risk of requiring liver transplantation in patients with primary sclerosing cholangitis.

Endurance training improves insulin sensitivity and body composition in prostate cancer patients treated with androgen deprivation therapy.

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Hvid, Thine; Winding, Kamilla; Rinnov, Anders; Dejgaard, Thomas; Thomsen, Carsten; Iversen, Peter; Brasso, Klaus; Mikines, Kari J; van Hall, Gerrit; Lindegaard, Birgitte; Solomon, Thomas P J; Pedersen, Bente K

2013-10-01

Insulin resistance and changes in body composition are side effects of androgen deprivation therapy (ADT) given to prostate cancer patients. The present study investigated whether endurance training improves insulin sensitivity and body composition in ADT-treated prostate cancer patients. Nine men undergoing ADT for prostate cancer and ten healthy men with normal testosterone levels underwent 12 weeks of endurance training. Primary endpoints were insulin sensitivity (euglycemic-hyperinsulinemic clamps with concomitant glucose-tracer infusion) and body composition (dual-energy X-ray absorptiometry and magnetic resonance imaging). The secondary endpoint was systemic inflammation. Statistical analysis was carried out using two-way ANOVA. Endurance training increased VO2max (ml(O2)/min per kg) by 11 and 13% in the patients and controls respectively (PBody weight (Pbody fat mass (FM) (Pbody mass (P=0.99) was unchanged. Additionally, reductions were observed in abdominal (Pcancer patients exhibited improved insulin sensitivity and body composition to a similar degree as eugonadal men.

The Impact of Chemoembolization Endpoints on Survival in Hepatocellular Carcinoma Patients

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Jin, Brian; Wang, Dingxin; Lewandowski, Robert J.; Riaz, Ahsun; Ryu, Robert K.; Sato, Kent T.; Larson, Andrew C.; Salem, Riad; Omary, Reed A.

2010-01-01

OBJECTIVE To investigate the relationship between angiographic embolic endpoints of transarterial chemoembolization (TACE) and survival in patients with hepatocellular carcinoma (HCC). MATERIALS AND METHODS This study retrospectively assessed 105 patients with surgically unresectable HCC who underwent TACE. Patients were classified according to a previously established subjective angiographic chemoembolization endpoint (SACE) scale. Only one patient was classified as SACE level 1 and thus excluded from all subsequent analysis. Survival was evaluated with Kaplan-Meier analysis. Multivariate analysis with Cox’s proportional hazard regression model was used to determine independent prognostic risk factors of survival. RESULTS Overall median survival was 21.1 months (95% confidence interval [CI], 15.9–26.4). Patients embolized to SACE levels 2 and 3 were aggregated and had a significantly higher median survival (25.6 months; 95% CI, 16.2–35.0) than patients embolized to SACE level 4 (17.1 months; 95% CI, 13.3–20.9) (p = 0.035). Multivariate analysis indicated that SACE level 4 (Hazard ratio [HR], 2.49; 95% CI, 1.41–4.42; p = 0.002), European Cooperative Oncology Group performance status > 0 (HR, 1.97; 95% CI, 1.15–3.37; p = 0.013), American Joint Committee on Cancer stage 3 or 4 (HR, 2.42; 95% CI, 1.27–4.60; p = 0.007), and Child-Pugh class B (HR, 1.94; 95% CI, 1.09–3.46; p = 0.025) were all independent negative prognostic indicators of survival. CONCLUSION Embolization to an intermediate, sub-stasis endpoint (SACE levels 2 and 3) during TACE improves survival compared to embolization to a higher, stasis endpoint (SACE level 4). Interventional oncologists should consider targeting these intermediate, sub-stasis angiographic endpoints during TACE. PMID:21427346

Etoricoxib improves osteoarthritis pain relief, joint function, and quality of life in the extreme elderly

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Wen-Nan Huang

2018-02-01

Full Text Available Etoricoxib is a selective cyclooxygenase-2 inhibitor, with a lower risk of gastrointestinal toxicity compared to traditional nonsteroidal anti-inflammatory drugs (NSAIDs. We evaluated the effectiveness and tolerability of etoricoxib in extremely elderly patients with chronic pain due to osteoarthritis (OA. A prospective, single-center, single-arm study was conducted, enrolling 19 extremely elderly men with OA (mean age 85.9, range 79-96 years, who responded inadequately to NSAIDs or other analgesics. Patients were switched to etoricoxib, 60 mg once daily for 4 weeks, without prior medication washout. Data were recorded before and after etoricoxib treatment. The primary endpoint was improvement in pain, assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC after the 4-week treatment. Other endpoints included the Brief Pain Inventory Short Form (BPI-SF, Treatment Satisfaction Questionnaire for Medication (TSQM, Short Form 36 (SF36, and European Quality of Life-5 Dimensions (EQ-5D. Safety and tolerability were assessed by collecting adverse events data. Pain and disability scores measured by WOMAC index were lower after treatment (pain, p ≤ 0.001; disability, p = 0.020. BPI-SF showed a significant improvement in joint function when walking and performing normal work (walking, p = 0.021; normal work, p = 0.030. SF36 scores improved for 7 out of 11 items after etoricoxib treatment (#1, p = 0.032; #4, p = 0.026; #5, p = 0.017; #6, p = 0.008; #7, p = 0.009; #8, p = 0.013; and #10, p = 0.038. EQ-5D showed a significant improvement in visual analogue scale scores (p = 0.036. TSQM results demonstrated a higher patient perception of overall satisfaction. No adverse events were reported. Pain relief, joint function, quality of life, and treatment satisfaction improved significantly in elderly patients with OA after etoricoxib administration.

Improving adherence to the Epic Beacon ambulatory workflow.

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Chackunkal, Ellen; Dhanapal Vogel, Vishnuprabha; Grycki, Meredith; Kostoff, Diana

2017-06-01

Computerized physician order entry has been shown to significantly improve chemotherapy safety by reducing the number of prescribing errors. Epic's Beacon Oncology Information System of computerized physician order entry and electronic medication administration was implemented in Henry Ford Health System's ambulatory oncology infusion centers on 9 November 2013. Since that time, compliance to the infusion workflow had not been assessed. The objective of this study was to optimize the current workflow and improve the compliance to this workflow in the ambulatory oncology setting. This study was a retrospective, quasi-experimental study which analyzed the composite workflow compliance rate of patient encounters from 9 to 23 November 2014. Based on this analysis, an intervention was identified and implemented in February 2015 to improve workflow compliance. The primary endpoint was to compare the composite compliance rate to the Beacon workflow before and after a pharmacy-initiated intervention. The intervention, which was education of infusion center staff, was initiated by ambulatory-based, oncology pharmacists and implemented by a multi-disciplinary team of pharmacists and nurses. The composite compliance rate was then reassessed for patient encounters from 2 to 13 March 2015 in order to analyze the effects of the determined intervention on compliance. The initial analysis in November 2014 revealed a composite compliance rate of 38%, and data analysis after the intervention revealed a statistically significant increase in the composite compliance rate to 83% ( p < 0.001). This study supports a pharmacist-initiated educational intervention can improve compliance to an ambulatory, oncology infusion workflow.

Observations on Three Endpoint Properties and Their Relationship to Regulatory Outcomes of European Oncology Marketing Applications.

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Liberti, Lawrence; Stolk, Pieter; McAuslane, James Neil; Schellens, Jan; Breckenridge, Alasdair M; Leufkens, Hubert

2015-06-01

Guidance and exploratory evidence indicate that the type of endpoints and the magnitude of their outcome can define a therapy's clinical activity; however, little empirical evidence relates specific endpoint properties with regulatory outcomes. We explored the relationship of 3 endpoint properties to regulatory outcomes by assessing 50 oncology marketing authorization applications (MAAs; reviewed from 2009 to 2013). Overall, 16 (32%) had a negative outcome. The most commonly used hard endpoints were overall survival (OS) and the duration of response or stable disease. OS was a component of 91% approved and 63% failed MAAs. The most commonly used surrogate endpoints were progression-free survival (PFS), response rate, and health-related quality of life assessments. There was no difference (p = .3801) between the approved and failed MAA cohorts in the proportion of hard endpoints used. A mean of slightly more than four surrogate endpoints were used per approved MAA compared with slightly more than two for failed MAAs. Longer OS and PFS duration outcomes were generally associated with approvals, often when not statistically significant. The approved cohort was associated with a preponderance of statistically significant (p < .05) improvements in primary endpoints (p < .0001 difference between the approved and failed groups). Three key endpoint properties (type of endpoint [hard/surrogate], magnitude of an endpoint outcome, and its statistical significance) are consistent with the European Medicines Agency guidance and, notwithstanding the contribution of unique disease-specific circumstances, are associated with a predictable positive outcome for oncology MAAs. Regulatory decisions made by the European Medicines Agency determine which new medicines will be available to European prescribers and for which therapeutic indications. Regulatory success or failure can be influenced by many factors. This study assessed three key properties of endpoints used in

A Portable Automatic Endpoint Detection System for Amplicons of Loop Mediated Isothermal Amplification on Microfluidic Compact Disk Platform

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Shah Mukim Uddin

2015-03-01

Full Text Available In recent years, many improvements have been made in foodborne pathogen detection methods to reduce the impact of food contamination. Several rapid methods have been developed with biosensor devices to improve the way of performing pathogen detection. This paper presents an automated endpoint detection system for amplicons generated by loop mediated isothermal amplification (LAMP on a microfluidic compact disk platform. The developed detection system utilizes a monochromatic ultraviolet (UV emitter for excitation of fluorescent labeled LAMP amplicons and a color sensor to detect the emitted florescence from target. Then it processes the sensor output and displays the detection results on liquid crystal display (LCD. The sensitivity test has been performed with detection limit up to 2.5 × 10−3 ng/µL with different DNA concentrations of Salmonella bacteria. This system allows a rapid and automatic endpoint detection which could lead to the development of a point-of-care diagnosis device for foodborne pathogens detection in a resource-limited environment.

A New Test Unit for Disintegration End-Point Determination of Orodispersible Films.

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Low, Ariana; Kok, Si Ling; Khong, Yuet Mei; Chan, Sui Yung; Gokhale, Rajeev

2015-11-01

No standard time or pharmacopoeia disintegration test method for orodispersible films (ODFs) exists. The USP disintegration test for tablets and capsules poses significant challenges for end-point determination when used for ODFs. We tested a newly developed disintegration test unit (DTU) against the USP disintegration test. The DTU is an accessory to the USP disintegration apparatus. It holds the ODF in a horizontal position, allowing top-view of the ODF during testing. A Gauge R&R study was conducted to assign relative contributions of the total variability from the operator, sample or the experimental set-up. Precision was compared using commercial ODF products in different media. Agreement between the two measurement methods was analysed. The DTU showed improved repeatability and reproducibility compared to the USP disintegration system with tighter standard deviations regardless of operator or medium. There is good agreement between the two methods, with the USP disintegration test giving generally longer disintegration times possibly due to difficulty in end-point determination. The DTU provided clear end-point determination and is suitable for quality control of ODFs during product developmental stage or manufacturing. This may facilitate the development of a standardized methodology for disintegration time determination of ODFs. © 2015 Wiley Periodicals, Inc. and the American Pharmacists Association.

The ADAS-Cog revisited: novel composite scales based on ADAS-Cog to improve efficiency in MCI and early AD trials.

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Raghavan, Nandini; Samtani, Mahesh N; Farnum, Michael; Yang, Eric; Novak, Gerald; Grundman, Michael; Narayan, Vaibhav; DiBernardo, Allitia

2013-02-01

The Alzheimer's Disease Assessment Scale-Cognitive (ADAS-Cog) has been used widely as a cognitive end point in Alzheimer's Disease (AD) clinical trials. Efforts to treat AD pathology at earlier stages have also used ADAS-Cog, but failure in these trials can be difficult to interpret because the scale has well-known ceiling effects that limit its use in mild cognitive impairment (MCI) and early AD. A wealth of data exists in ADAS-Cog from both historical trials and contemporary longitudinal natural history studies that can provide insights about parts of the scale that may be better suited for MCI and early AD trials. Using Alzheimer's Disease Neuroimaging Initiative study data, we identified the most informative cognitive measures from the ADAS-Cog and other available scales. We used cross-sectional analyses to characterize trajectories of ADAS-Cog and its individual subscales, as well as other cognitive, functional, or global measures across disease stages. Informative measures were identified based on standardized mean of 2-year change from baseline and were combined into novel composite endpoints. We assessed performance of the novel endpoints based on sample size requirements for a 2-year clinical trial. A bootstrap validation procedure was also undertaken to assess the reproducibility of the standardized mean changes of the selected measures and the corresponding composites. All proposed novel endpoints have improved standardized mean changes and thus improved statistical power compared with the ADAS-Cog 11. Further improvements were achieved by using cognitive-functional composites. Combining the novel composites with an enrichment strategy based on cerebral spinal fluid beta-amyloid (Aβ(1-42)) in a 2-year trial yielded gains in power of 20% to 40% over ADAS-Cog 11, regardless of the novel measure considered. An empirical, data-driven approach with existing instruments was used to derive novel composite scales based on ADAS-Cog 11 with improved performance

Vorinostat and hydroxychloroquine improve immunity and inhibit autophagy in metastatic colorectal cancer.

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Patel, Sukeshi; Hurez, Vincent; Nawrocki, Steffan T; Goros, Martin; Michalek, Joel; Sarantopoulos, John; Curiel, Tyler; Mahalingam, Devalingam

2016-09-13

Hydroxychloroquine (HCQ) enhances the anti-cancer activity of the histone deacetylase inhibitor, vorinostat (VOR), in pre-clinical models and early phase clinical studies of metastatic colorectal cancer (mCRC). Mechanisms could include autophagy inhibition, accumulation of ubiquitinated proteins, and subsequent tumor cell apoptosis. There is growing evidence that autophagy inhibition could lead to improved anti-cancer immunity. To date, effects of autophagy on immunity have not been reported in cancer patients. To address this, we expanded an ongoing clinical study to include patients with advanced, refractory mCRC to evaluate further the clinical efficacy and immune effects of VOR plus HCQ. Refractory mCRC patients received VOR 400 milligrams orally with HCQ 600 milligrams orally daily, in a 3-week cycle. The primary endpoint was median progression-free survival (mPFS). Secondary endpoints include median overall survival (mOS), adverse events (AE), pharmacodynamic of inhibition of autophagy in primary tumors, immune cell analyses, and cytokine levels. Twenty patients were enrolled (19 evaluable for survival) with a mPFS of 2.8 months and mOS of 6.7 months. Treatment-related grade 3-4 AEs occurred in 8 patients (40%), with fatigue, nausea/vomiting, and anemia being the most common. Treatment significantly reduced CD4+CD25hiFoxp3+ regulatory and PD-1+ (exhausted) CD4+ and CD8+ T cells and decreased CD45RO-CD62L+ (naive) T cells, consistent with improved anti-tumor immunity. On-study tumor biopsies showed increases in lysosomal protease cathepsin D and p62 accumulation, consistent with autophagy inhibition. Taken together, VOR plus HCQ is active, safe and well tolerated in refractory CRC patients, resulting in potentially improved anti-tumor immunity and inhibition of autophagy.

Multiple-endpoint assay provides a detailed mechanistic view of responses to herbicide exposure in Chlamydomonas reinhardtii

International Nuclear Information System (INIS)

Nestler, Holger; Groh, Ksenia J.; Schönenberger, René; Behra, Renata; Schirmer, Kristin; Eggen, Rik I.L.; Suter, Marc J.-F.

2012-01-01

The release of herbicides into the aquatic environment raises concerns about potential detrimental effects on ecologically important non-target species, such as unicellular algae, necessitating ecotoxicological risk assessment. Algal toxicity tests based on growth, a commonly assessed endpoint, are integrative, and hence do not provide information about underlying toxic mechanisms and effects. This limitation may be overcome by measuring more specific biochemical and physiological endpoints. In the present work, we developed and applied a novel multiple-endpoint assay, and analyzed the effects of the herbicides paraquat, diuron and norflurazon, each representing a specific mechanism of toxic action, on the single celled green alga Chlamydomonas reinhardtii. The endpoints added to assessment of growth were pigment content, maximum and effective photosystem II quantum yield, ATP content, esterase and oxidative activity. All parameters were measured at 2, 6 and 24 h of exposure, except for growth and pigment content, which were determined after 6 and 24 h only. Effective concentrations causing 50% of response (EC50s) and lowest observable effect concentrations (LOECs) were determined for all endpoints and exposure durations where possible. The assay provided a detailed picture of the concentration- and time-dependent development of effects elicited by the analyzed herbicides, thus improving the understanding of the underlying toxic mechanisms. Furthermore, the response patterns were unique to the respective herbicide and reflected the different mechanisms of toxicity. The comparison of the endpoint responses and sensitivities revealed that several physiological and biochemical parameters reacted earlier or stronger to disturbances than growth. Overall, the presented multiple-endpoint assay constitutes a promising basis for investigating stressor and toxicant effects in green algae.

Multiple-endpoint assay provides a detailed mechanistic view of responses to herbicide exposure in Chlamydomonas reinhardtii

Energy Technology Data Exchange (ETDEWEB)

Nestler, Holger [Eawag, Swiss Federal Institute of Aquatic Science and Technology, Ueberlandstrasse 133, 8600 Duebendorf (Switzerland); ETH Zurich, Swiss Federal Institute of Technology, Institute of Biogeochemistry and Pollutant Dynamics, Universitaetstrasse 16, 8092 Zurich (Switzerland); Groh, Ksenia J.; Schoenenberger, Rene; Behra, Renata [Eawag, Swiss Federal Institute of Aquatic Science and Technology, Ueberlandstrasse 133, 8600 Duebendorf (Switzerland); Schirmer, Kristin [Eawag, Swiss Federal Institute of Aquatic Science and Technology, Ueberlandstrasse 133, 8600 Duebendorf (Switzerland); ETH Zurich, Swiss Federal Institute of Technology, Institute of Biogeochemistry and Pollutant Dynamics, Universitaetstrasse 16, 8092 Zurich (Switzerland); EPF Lausanne, School of Architecture, Civil and Environmental Engineering, 1015 Lausanne (Switzerland); Eggen, Rik I.L. [Eawag, Swiss Federal Institute of Aquatic Science and Technology, Ueberlandstrasse 133, 8600 Duebendorf (Switzerland); ETH Zurich, Swiss Federal Institute of Technology, Institute of Biogeochemistry and Pollutant Dynamics, Universitaetstrasse 16, 8092 Zurich (Switzerland); Suter, Marc J.-F., E-mail: suter@eawag.ch [Eawag, Swiss Federal Institute of Aquatic Science and Technology, Ueberlandstrasse 133, 8600 Duebendorf (Switzerland); ETH Zurich, Swiss Federal Institute of Technology, Institute of Biogeochemistry and Pollutant Dynamics, Universitaetstrasse 16, 8092 Zurich (Switzerland)

2012-04-15

The release of herbicides into the aquatic environment raises concerns about potential detrimental effects on ecologically important non-target species, such as unicellular algae, necessitating ecotoxicological risk assessment. Algal toxicity tests based on growth, a commonly assessed endpoint, are integrative, and hence do not provide information about underlying toxic mechanisms and effects. This limitation may be overcome by measuring more specific biochemical and physiological endpoints. In the present work, we developed and applied a novel multiple-endpoint assay, and analyzed the effects of the herbicides paraquat, diuron and norflurazon, each representing a specific mechanism of toxic action, on the single celled green alga Chlamydomonas reinhardtii. The endpoints added to assessment of growth were pigment content, maximum and effective photosystem II quantum yield, ATP content, esterase and oxidative activity. All parameters were measured at 2, 6 and 24 h of exposure, except for growth and pigment content, which were determined after 6 and 24 h only. Effective concentrations causing 50% of response (EC50s) and lowest observable effect concentrations (LOECs) were determined for all endpoints and exposure durations where possible. The assay provided a detailed picture of the concentration- and time-dependent development of effects elicited by the analyzed herbicides, thus improving the understanding of the underlying toxic mechanisms. Furthermore, the response patterns were unique to the respective herbicide and reflected the different mechanisms of toxicity. The comparison of the endpoint responses and sensitivities revealed that several physiological and biochemical parameters reacted earlier or stronger to disturbances than growth. Overall, the presented multiple-endpoint assay constitutes a promising basis for investigating stressor and toxicant effects in green algae.

Calorimetry end-point predictions

International Nuclear Information System (INIS)

Fox, M.A.

1981-01-01

This paper describes a portion of the work presently in progress at Rocky Flats in the field of calorimetry. In particular, calorimetry end-point predictions are outlined. The problems associated with end-point predictions and the progress made in overcoming these obstacles are discussed. The two major problems, noise and an accurate description of the heat function, are dealt with to obtain the most accurate results. Data are taken from an actual calorimeter and are processed by means of three different noise reduction techniques. The processed data are then utilized by one to four algorithms, depending on the accuracy desired to determined the end-point

Does quality improvement work in neonatology improve clinical outcomes?

Science.gov (United States)

Ellsbury, Dan L; Clark, Reese H

2017-04-01

Quality improvement initiatives in neonatology have been promoted as an important way of improving outcomes of newborns. The purpose of this review is to examine the effectiveness of recent quality improvement work in improving the outcomes of infants requiring neonatal intensive care. Quality improvement collaboratives and single-center projects demonstrate improvement of clinical processes and outcomes in neonatology that impact both preterm and term infants. Declines in morbidities, resource use, and length of stay have been associated with reductions in healthcare costs. Recent quality improvement work has shown evidence of improvement in clinical outcomes in neonatal intensive care patients. These improvements have important implications for the reduction of healthcare costs in this population.

Improved nutrition in adolescents and young adults after childhood cancer - INAYA study.

Science.gov (United States)

Quidde, J; von Grundherr, J; Koch, B; Bokemeyer, C; Escherich, G; Valentini, L; Buchholz, D; Schilling, G; Stein, A

2016-11-08

Multimodality treatment improves the chance of survival but increases the risk for long-term side effects in young cancer survivors, so-called" Adolescents and Young Adults"(AYAs). Compared to the general population AYAs have a 5 to 15-fold increased risk of cardiovascular morbidity. Thus, improving modifiable lifestyle risk factors is of particular importance. The INAYA trial included AYAs between 18 and 39 years receiving an intensified individual nutrition counseling at four time points in a 3-month period based on a 3-day dietary record. At week 0 and 12 AYAs got a face-to-face counseling, at week 2 and 6 by telephone. Primary endpoint was change in nutritional behavior measured by Healthy Eating Index - European Prospective Investigation into Cancer and Nutrition (HEI-EPIC). Twenty-three AYAs (11 female, 12 male, median age 20 years (range 19-23 years), median BMI: 21.4 kg/m 2 (range: 19.7-23.9 kg/m 2 ) after completion of cancer treatment for sarcoma (n = 2), carcinoma (n = 2), blastoma (n = 1), hodgkin lymphoma (n = 12), or leukemia (n = 6) were included (median time between diagnosis and study inclusion was 44 month). The primary endpoint was met, with an improvement of 20 points in HEI-EPIC score in 52.2 % (n = 12) of AYAs. At baseline, median HEI-EPIC score was 47.0 points (range from 40.0 to 55.0 points) and a good, moderate and bad nutritional intake was seen in 4.3, 73.9 and 21.7 % of AYAs. At week 12, median HEI-EPIC improved significantly to 65.0 points (range from 55.0 to 76.0 points) (p ≤ 0.001) and a good, moderate and bad nutritional intake was seen in 47.8, 52.2 and 0 % of AYAs. No change was seen in quality of life, waist-hip ratio and blood pressure. Intensified nutrition counseling is feasible and seem to improve nutritional behavior of AYAs. Further studies will be required to demonstrate long-term sustainability and confirm the results in a randomized design in larger cohorts. Clinical trial identifier

Improving patient satisfaction in glaucoma care

Directory of Open Access Journals (Sweden)

Islam S

2017-12-01

Full Text Available Samsul Islam, Ahmad Salha, Saeed Azizi Faculty of Medicine, St George’s Hospital Medical School, London, UKWe read the article by Foo et al1 with great interest. We were intrigued by the factors influencing satisfaction rates among glaucoma patients. It made us question what changes could be made in the future attempting to improve patient satisfaction.\tSimilar to Foo et al,1 we were also surprised to find a lower end-point intraocular pressure was linked with increased patient dissatisfaction. As stated by Foo et al,1 other studies exploring clinical outcomes and patient satisfaction found that a positive clinical state was linked to higher patient satisfaction. Prakash2 proposes a three-way association between patient satisfaction, increased compliance, and better clinical outcomes. Hence, in attempting to investigate patient satisfaction, it would be appropriate to assess patient compliance and clinical outcomes.View the original paper by Foo and colleagues.

Creative Dance Practice Improves Postural Control in a Child With Cerebral Palsy.

Science.gov (United States)

Stribling, Kate; Christy, Jennifer

2017-10-01

To investigate the effect of creative dance instruction on postural control and balance in an 11-year-old with spastic triplegic cerebral palsy, Gross Motor Function Classification Scale level II. We conducted 1-hour dance interventions twice weekly for 8 weeks, with a focus on somatosensory awareness and movement in all planes of motion. Computerized dynamic posturography using the SMART Balance Master/EquiTest (NeuroCom) was used to assess postural control and balance reactions before the first class and following the final class. Gains in standing stability, balance recovery, directional control, and endpoint excursion of movement were found. Participation in creative dance lessons appears to improve somatosensory effectiveness and postural control in a child with cerebral palsy. Dance is a fun way to improve balance and coordination. These interventions could be easily implemented into programs for children with cerebral palsy.

Continuous Improvement and Collaborative Improvement: Similarities and Differences

DEFF Research Database (Denmark)

Middel, Rick; Boer, Harry; Fisscher, Olaf

2006-01-01

the similarities and differences between key components of continuous and collaborative improvement by assessing what is specific for continuous improvement, what for collaborative improvement, and where the two areas of application meet and overlap. The main conclusions are that there are many more similarities...... between continuous and collaborative improvement. The main differences relate to the role of hierarchy/market, trust, power and commitment to collaboration, all of which are related to differences between the settings in which continuous and collaborative improvement unfold....

Epicardial shock-wave therapy improves ventricular function in a porcine model of ischaemic heart disease.

Science.gov (United States)

Holfeld, Johannes; Zimpfer, Daniel; Albrecht-Schgoer, Karin; Stojadinovic, Alexander; Paulus, Patrick; Dumfarth, Julia; Thomas, Anita; Lobenwein, Daniela; Tepeköylü, Can; Rosenhek, Raphael; Schaden, Wolfgang; Kirchmair, Rudolf; Aharinejad, Seyedhossein; Grimm, Michael

2016-12-01

Previously we have shown that epicardial shock-wave therapy improves left ventricular ejection fraction (LVEF) in a rat model of myocardial infarction. In the present experiments we aimed to address the safety and efficacy of epicardial shock-wave therapy in a preclinical large animal model and to further evaluate mechanisms of action of this novel therapy. Four weeks after left anterior descending (LAD) artery ligation in pigs, the animals underwent re-thoracotomy with (shock-wave group, n = 6) or without (control group, n = 5) epicardial shock waves (300 impulses at 0.38 mJ/mm 2 ) applied to the infarcted anterior wall. Efficacy endpoints were improvement of LVEF and induction of angiogenesis 6 weeks after shock-wave therapy. Safety endpoints were haemodynamic stability during treatment and myocardial damage. Four weeks after LAD ligation, LVEF decreased in both the shock-wave (43 ± 3%, p wave animals 6 weeks after treatment (62 ± 9%, p = 0.006); no improvement was observed in controls (41 ± 4%, p = 0.36), yielding a significant difference. Quantitative histology revealed significant angiogenesis 6 weeks after treatment (controls 2 ± 0.4 arterioles/high-power field vs treatment group 9 ± 3; p = 0.004). No acute or chronic adverse effects were observed. As a potential mechanism of action in vitro experiments showed stimulation of VEGF receptors after shock-wave treatment in human coronary artery endothelial cells. Epicardial shock-wave treatment in a large animal model of ischaemic heart failure exerted a positive effect on LVEF improvement and did not show any adverse effects. Angiogenesis was induced by stimulation of VEGF receptors. Copyright © 2014 John Wiley & Sons, Ltd. Copyright © 2014 John Wiley & Sons, Ltd.

Use of automated reminder letters to improve diabetes management in primary care: outcomes of a quality improvement initiative.

Science.gov (United States)

Berryman, Sally H; Sick, Brian T; Wang, Qi; Swan, Paul J; Weber-Main, Anne Marie

2013-01-01

Effective management of patients with diabetes mellitus (DM) can be time-consuming and costly. One patient-centred quality improvement strategy is to generate reminder letters to prompt patient action(s), but this strategy's effect on DM outcomes is uncertain. To determine whether using the electronic medical record to automatically generate reminder letters for patients not meeting recommended DM targets is associated with improvement in practice level quality metrics for DM management. Over 15 months, letters were sent monthly to all patients with DM in a large, urban, primary care teaching practice whose records for haemoglobin A1c (HbA1c), low-density lipoprotein (LDL) or blood pressure (BP) indicated non-compliance with recommended levels and testing intervals. Logistic regression was used to analyse cross-sectional, practice-level differences in the proportion of patients meeting DM quality metrics (HbA1c < 7%, LDL < 100 mg/dl and BP < 130/80 mmHg; rates of checking each value within the last 12 months; and a composite of these five measures) across four time points: six months before the intervention, start of the intervention, end of the 15-month intervention period and six months after the intervention. The number of letters sent per month ranged from 284 to 392, representing 28-38% of all patients with DM. At the end of the intervention, patients' odds of being at goal were higher than before the intervention began for LDL < 100 mg/dl, and for HbA1c and LDL tested once within the last 12 months (or 1.24, P = 0.005; or 1.35, P = 0.03; or 1.48, P < 0.001, respectively). Post intervention, declines were seen in LDL checked within the last 12 months (or 0.76, P = 0.003) and in the composite endpoint (or 0.78, P = 0.005). The automated patient-reminder letter intervention was associated with modest improvements in several, but not all DM measures. This approach may be an effective tool for improving quality of care for patients with DM.

Improving B-cell depletion in systemic lupus erythematosus and rheumatoid arthritis.

Science.gov (United States)

Mota, Pedro; Reddy, Venkat; Isenberg, David

2017-07-01

Rituximab-based B-cell depletion (BCD) therapy is effective in refractory rheumatoid arthritis (RA) and although used to treat patients with refractory systemic lupus erythematosus (SLE) in routine clinical practice, rituximab failed to meet the primary endpoints in two large randomised controlled trials (RCTs) of non-renal (EXPLORER) and renal (LUNAR) SLE. Areas covered: We review how BCD could be improved to achieve better clinical responses in RA and SLE. Insights into the variability in clinical response to BCD in RA and SLE may help develop new therapeutic strategies. To this end, a literature search was performed using the following terms: rheumatoid arthritis, systemic erythematosus lupus, rituximab and B-cell depletion. Expert commentary: Poor trial design may have, at least partly, contributed to the apparent lack of response to BCD in the two RCTs of patients with SLE. Enhanced B-cell depletion and/or sequential therapy with belimumab may improve clinical response at least in some patients with SLE.

Improving Patient Safety: Improving Communication.

Science.gov (United States)

Bittner-Fagan, Heather; Davis, Joshua; Savoy, Margot

2017-12-01

Communication among physicians, staff, and patients is a critical element in patient safety. Effective communication skills can be taught and improved through training and awareness. The practice of family medicine allows for long-term relationships with patients, which affords opportunities for ongoing, high-quality communication. There are many barriers to effective communication, including patient factors, clinician factors, and system factors, but tools and strategies exist to address these barriers, improve communication, and engage patients in their care. Use of universal precautions for health literacy, appropriate medical interpreters, and shared decision-making are evidence-based tools that improve communication and increase patient safety. Written permission from the American Academy of Family Physicians is required for reproduction of this material in whole or in part in any form or medium.

Improving Earth/Prediction Models to Improve Network Processing

Science.gov (United States)

Wagner, G. S.

2017-12-01

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

Establishing a group of endpoints in a parallel computer

Science.gov (United States)

Archer, Charles J.; Blocksome, Michael A.; Ratterman, Joseph D.; Smith, Brian E.; Xue, Hanhong

2016-02-02

A parallel computer executes a number of tasks, each task includes a number of endpoints and the endpoints are configured to support collective operations. In such a parallel computer, establishing a group of endpoints receiving a user specification of a set of endpoints included in a global collection of endpoints, where the user specification defines the set in accordance with a predefined virtual representation of the endpoints, the predefined virtual representation is a data structure setting forth an organization of tasks and endpoints included in the global collection of endpoints and the user specification defines the set of endpoints without a user specification of a particular endpoint; and defining a group of endpoints in dependence upon the predefined virtual representation of the endpoints and the user specification.

Continuous Improvement and Collaborative Improvement: Similarities and Differences

NARCIS (Netherlands)

Middel, H.G.A.; Boer, Harm; Fisscher, O.A.M.

2006-01-01

A substantial body of theoretical and practical knowledge has been developed on continuous improvement. However, there is still a considerable lack of empirically grounded contributions and theories on collaborative improvement, that is, continuous improvement in an inter-organizational setting. The

"Rheum to Improve": Quality Improvement in Outpatient Rheumatology.

Science.gov (United States)

Chow, Shirley L; Shojania, Kaveh G

2017-09-01

The commitment to improve care processes and patient outcomes is a professional mandate for clinicians and is also seen as an operational priority for institutions. Quality improvement now figures in the accreditation of training programs, specialty examinations, and hospital scorecards. Rheumatologists have traditionally focused primarily on quality problems such as guideline adherence; however, improvement goals should also include other aspects of care that are helpful to patients and are professionally rewarding for practitioners. This review makes use of improvement projects in outlining tangible tools rheumatologists can use to resolve quality concerns in their practices.

Improving the health and well-being of cancer survivors: past as prologue.

Science.gov (United States)

Bloom, Joan R

2008-06-01

During the past two decades, there have been a number of unsuccessful replication attempts of our finding that group psychotherapy improves cancer survival. One explanation for this failure is that the wrong phenomenon has been studied. Rather than focusing on the effects of the psychotherapeutic relationship, perhaps, the focus should have been on the social support provided and networks developed by these groups. Since the late 1970s, a growing body of research indicates the importance of social networks and social support on reductions in not only all cause mortality, but also disease specific mortality including cancer. We have learned about how the health, well-being, and ultimate survival of cancer patients is improved by social support and social networks. The social milieu within which we live can provide resources that facilitate reintegration into society. These resources at the individual level, such as one's perception of social and emotional support, at the level of one's social ties with family and friends, and at the community level appear to improve survival across disease conditions including cancer. Even though, the mechanisms by which these endpoints are achieved remain elusive, there is much that can be done. The challenge of our time is to translate what we already know into programs to improve quality of life and to focus research toward increasing our understanding the mechanisms.

A randomized controlled trial of 8-form Tai chi improves symptoms and functional mobility in fibromyalgia patients.

Science.gov (United States)

Jones, Kim D; Sherman, Christy A; Mist, Scott D; Carson, James W; Bennett, Robert M; Li, Fuzhong

2012-08-01

Previous researchers have found that 10-form Tai chi yields symptomatic benefit in patients with fibromyalgia (FM). The purpose of this study was to further investigate earlier findings and add a focus on functional mobility. We conducted a parallel-group randomized controlled trial FM-modified 8-form Yang-style Tai chi program compared to an education control. Participants met in small groups twice weekly for 90 min over 12 weeks. The primary endpoint was symptom reduction and improvement in self-report physical function, as measured by the Fibromyalgia Impact Questionnaire (FIQ), from baseline to 12 weeks. Secondary endpoints included pain severity and interference (Brief Pain Inventory (BPI), sleep (Pittsburg sleep Inventory), self-efficacy, and functional mobility. Of the 101 randomly assigned subjects (mean age 54 years, 93 % female), those in the Tai chi condition compared with the education condition demonstrated clinically and statistically significant improvements in FIQ scores (16.5 vs. 3.1, p = 0.0002), BPI pain severity (1.2 vs. 0.4, p = 0.0008), BPI pain interference (2.1 vs. 0.6, p = 0.0000), sleep (2.0 vs. -0.03, p = 0.0003), and self-efficacy for pain control (9.2 vs. -1.5, p = 0.0001). Functional mobility variables including timed get up and go (-.9 vs. -.3, p = 0.0001), static balance (7.5 vs. -0.3, p    0.0001), and dynamic balance (1.6 vs. 0.3, p = 0.0001) were significantly improved with Tai chi compared with education control. No adverse events were noted. Twelve weeks of Tai chi, practice twice weekly, provided worthwhile improvement in common FM symptoms including pain and physical function including mobility. Tai chi appears to be a safe and an acceptable exercise modality that may be useful as adjunctive therapy in the management of FM patients. (ClinicalTrials.gov Identifier, NCT01311427).

Changes in Hypertension Treatment in the Yaroslavl Region of Russia: Improvements Observed Between 2 Cross-Sectional Surveys

OpenAIRE

Mozheyko, Maria; Eregin, Sergey; Vigdorchik, Alexey; Tobe, Sheldon; Campbell, Norman; Riahi, Farhad; Hughes, David

2013-01-01

This prospective before-and-after survey of hypertensive patients visiting government-run outpatient health facilities in the Yaroslavl Region of Russia assessed blood pressure (BP)–related endpoints following initiation of a comprehensive health system improvement program for hypertension. Two cross-sectional surveys, one at baseline and the other approximately 1 year after program initiation, evaluated the primary measure of BP control rate. Secondary measures included mean BP levels and di...

Improving employee productivity through improved health.

Science.gov (United States)

Mitchell, Rebecca J; Ozminkowski, Ronald J; Serxner, Seth

2013-10-01

The objective of this study was to estimate productivity-related savings associated with employee participation in health promotion programs. Propensity score weighting and multiple regression techniques were used to estimate savings. These techniques were adjusted for demographic and health status differences between participants who engaged in one or more telephonic health management programs and nonparticipants who were eligible for but did not engage in these programs. Employees who participated in a program and successfully improved their health care or lifestyle showed significant improvements in lost work time. These employees saved an average of $353 per person per year. This reflects about 10.3 hours in additional productive time annually, compared with similar, but nonparticipating employees. Participating in health promotion programs can help improve productivity levels among employees and save money for their employers.

Improving care at cystic fibrosis centers through quality improvement.

Science.gov (United States)

Kraynack, Nathan C; McBride, John T

2009-10-01

Quality improvement (QI) using a clinical microsystems approach provides cystic fibrosis (CF) centers the opportunity to make a significant positive impact on the health of their patients. The availability of center-specific outcomes data and the support of the Cystic Fibrosis Foundation are important advantages for these quality improvement efforts. This article illustrates how the clinical microsystems methodology can improve care delivery and outcomes by describing the gradual application of quality improvement principles over the past 5 years by the CF team at the Lewis Walker Cystic Fibrosis Center at Akron Children's Hospital in Akron, Ohio. Using the example of a project to improve the pulmonary function of the pediatric patients at our center as a framework, we describe the QI process from the initial team-building phase, through the assessment of care processes, standardization of care, and developing a culture of continuous improvement. We outline how enthusiastic commitment from physician leadership, clinical managers and central administration, the availability of coaches, and an appreciation of the importance of measurement, patient involvement, communication, and standardization are critical components for successful process improvement. Copyright Thieme Medical Publishers.

Improved limit on the electron anti neutrino rest mass from tritium β decay

International Nuclear Information System (INIS)

Weinheimer, C.; Przyrembel, M.; Backe, H.; Barth, H.; Bonn, J.; Degen, B.; Edling, T.; Fischer, H.; Fleischmann, L.; Grooss, J.U.; Haid, R.; Hermanni, A.; Kube, G.; Loeken, T.; Molz, A.; Osipowicz, A.; Otten, E.W.; Picard, A.; Schrader, M.; Steininger, M.

1993-01-01

This paper presents the results of a re-measurement of the endpoint region of the beta-spectrum of tritium by an electrostatic spectrometer with magnetic guiding field. It enables the search for a rest mass of the electron anti neutrino with improved precision. The result is: m ν 2 =(-39±34 stat ±15 syst ) (eV/c 2 ) 2 , from which an upper limit of: m ν 2 may be derived. The experiment yields the atomic mass difference: m(T)-m( 3 He)=(18591±3) eV/c 2 . (TEC). 31 refs., 4 figs., 3 tabs

Collaborative quality improvement.

Science.gov (United States)

Luckenbaugh, Amy N; Miller, David C; Ghani, Khurshid R

2017-07-01

Quality improvement collaboratives were developed in many medical and surgical disciplines with the goal of measuring and improving the quality of care provided to patients. The aim of this review is to provide an overview of surgical quality improvement collaboratives, and in particular those aimed at improving urological care. Quality improvement collaboratives collect high-quality data using standardized methodologies, and use the data to provide feedback to physicians and practices, and then implement processes to improve patient outcomes. The largest regional collaborative in urology is the Michigan Urological Surgery Improvement Collaborative (MUSIC). Recent efforts by this group have been focused at understanding variation in care, improving patient selection for treatment, reducing treatment morbidity and measuring and optimizing technical skill. The American Urological Association has also recently launched a national quality registry (AQUA), with an initial focus on prostate cancer care. By understanding factors that result in exemplary performance, quality improvement collaboratives are able to develop best practices around areas of care with high variation that have the potential to improve outcomes and reduce costs. These developments have been made possible by the unique model offered by the collaborative structure with the goal of improving patient care at a population level.

Dosimetric improvements following 3D planning of tangential breast irradiation

International Nuclear Information System (INIS)

Aref, Amr; Thornton, Dale; Youssef, Emad; He, Tony; Tekyi-Mensah, Samuel; Denton, Lori; Ezzell, Gary

2000-01-01

Purpose: To evaluate the dosimetric difference between a simple radiation therapy plan utilizing a single contour and a more complex three-dimensional (3D) plan utilizing multiple contours, lung inhomogeneity correction, and dose-based compensators. Methods and Materials: This is a study of the radiation therapy (RT) plans of 85 patients with early breast cancer. All patients were considered for breast-conserving management and treated by conventional tangential fields technique. Two plans were generated for each patient. The first RT plan was based on a single contour taken at the central axis and utilized two wedges. The second RT plan was generated by using the 3D planning system to design dose-based compensators after lung inhomogeneity correction had been made. The endpoints of the study were the comparison between the volumes receiving greater than 105% and greater than 110% of the reference dose, as well as the magnitude of the treated volume maximum dose. Dosimetric improvement was defined to be of significant value if the volume receiving > 105% of one plan was reduced by at least 50% with the absolute difference between the volumes being 5% or greater. The dosimetric improvements in 49 3D plans (58%) were considered of significant value. Patients' field separation and breast size did not predict the magnitude of improvement in dosimetry. Conclusion: Dose-based compensator plans significantly reduced the volumes receiving > 105%, >110%, and volume maximum dose.

Improved core monitoring for improved plant operations

International Nuclear Information System (INIS)

Mueller, N.P.

1987-01-01

Westinghouse has recently installed a core on-line surveillance, monitoring and operations systems (COSMOS), which uses only currently available core and plant data to accurately reconstruct the core average axial and radial power distributions. This information is provided to the operator in an immediately usable, human-engineered format and is accumulated for use in application programs that provide improved core performance predictive tools and a data base for improved fuel management. Dynamic on-line real-time axial and radial core monitoring supports a variety of plant operations to provide a favorable cost/benefit ratio for such a system. Benefits include: (1) relaxation or elimination of certain technical specifications to reduce surveillance and reporting requirements and allow higher availability factors, (2) improved information displays, predictive tools, and control strategies to support more efficient core control and reduce effluent production, and (3) expanded burnup data base for improved fuel management. Such systems can be backfit into operating plants without changing the existing instrumentation and control system and can frequently be implemented on existing plant computer capacity

Collaborative Improvement

DEFF Research Database (Denmark)

Kaltoft, Rasmus

The thesis data have been collected in the EU-sponsored project: Collaborative Improvement Tool for the Extended Manufacturing Enterprise, CO-IMPROVE. In this project four universities (Denmark, Ireland, Italy, and The Netherlands), two software vendors (Greece and Sweden) and three companies...... (Denmark, Italy and The Netherlands) each with three to five suppliers were involved. The CO-IMPROVE project and the thesis is based on “action research” and “action learning”. The main aim of the whole project is through actual involvement and actions make the researchers, companies and selected suppliers...... learn how to improve operations in (hopefully) a win-win like manner through collaboration....

Improving Project Portfolio Management (PPM) for Improvement Projects

DEFF Research Database (Denmark)

Pries-Heje, Jan; Jakobsen, Peter M.; Korsaa, Morten

2017-01-01

Project Portfolio Management (PPM) focus on the integration and alignment of projects with the business operation in order to achieve most value and cost-efficiency for the investment in projects. PPM is often a challenge and especially so for improvement projects where PPM is considerably...... of evaluating a portfolio of improvement projects and combine this evaluation with the effect they have on the CMMI maturity level. Further, the paper demonstrates how the combination of a strong senior management requirement for improved maturity and the focus on getting the most value out of PPM made...

The interpolation method based on endpoint coordinate for CT three-dimensional image

International Nuclear Information System (INIS)

Suto, Yasuzo; Ueno, Shigeru.

1997-01-01

Image interpolation is frequently used to improve slice resolution to reach spatial resolution. Improved quality of reconstructed three-dimensional images can be attained with this technique as a result. Linear interpolation is a well-known and widely used method. The distance-image method, which is a non-linear interpolation technique, is also used to convert CT value images to distance images. This paper describes a newly developed method that makes use of end-point coordinates: CT-value images are initially converted to binary images by thresholding them and then sequences of pixels with 1-value are arranged in vertical or horizontal directions. A sequence of pixels with 1-value is defined as a line segment which has starting and end points. For each pair of adjacent line segments, another line segment was composed by spatial interpolation of the start and end points. Binary slice images are constructed from the composed line segments. Three-dimensional images were reconstructed from clinical X-ray CT images, using three different interpolation methods and their quality and processing speed were evaluated and compared. (author)

The intermediate endpoint effect in logistic and probit regression

Science.gov (United States)

MacKinnon, DP; Lockwood, CM; Brown, CH; Wang, W; Hoffman, JM

2010-01-01

Background An intermediate endpoint is hypothesized to be in the middle of the causal sequence relating an independent variable to a dependent variable. The intermediate variable is also called a surrogate or mediating variable and the corresponding effect is called the mediated, surrogate endpoint, or intermediate endpoint effect. Clinical studies are often designed to change an intermediate or surrogate endpoint and through this intermediate change influence the ultimate endpoint. In many intermediate endpoint clinical studies the dependent variable is binary, and logistic or probit regression is used. Purpose The purpose of this study is to describe a limitation of a widely used approach to assessing intermediate endpoint effects and to propose an alternative method, based on products of coefficients, that yields more accurate results. Methods The intermediate endpoint model for a binary outcome is described for a true binary outcome and for a dichotomization of a latent continuous outcome. Plots of true values and a simulation study are used to evaluate the different methods. Results Distorted estimates of the intermediate endpoint effect and incorrect conclusions can result from the application of widely used methods to assess the intermediate endpoint effect. The same problem occurs for the proportion of an effect explained by an intermediate endpoint, which has been suggested as a useful measure for identifying intermediate endpoints. A solution to this problem is given based on the relationship between latent variable modeling and logistic or probit regression. Limitations More complicated intermediate variable models are not addressed in the study, although the methods described in the article can be extended to these more complicated models. Conclusions Researchers are encouraged to use an intermediate endpoint method based on the product of regression coefficients. A common method based on difference in coefficient methods can lead to distorted

A randomized controlled trial of 8-form Tai chi improves symptoms and functional mobility in fibromyalgia patients

OpenAIRE

Jones, Kim D.; Sherman, Christy A.; Mist, Scott D.; Carson, James W.; Bennett, Robert M.; Li, Fuzhong

2012-01-01

Previous researchers have found that 10-form Tai chi yields symptomatic benefit in patients with fibromyalgia (FM). The purpose of this study was to further investigate earlier findings and add a focus on functional mobility. We conducted a parallel-group randomized controlled trial FM-modified 8-form Yang-style Tai chi program compared to an education control. Participants met in small groups twice weekly for 90 min over 12 weeks. The primary endpoint was symptom reduction and improvement in...

Sample size determination for equivalence assessment with multiple endpoints.

Science.gov (United States)

Sun, Anna; Dong, Xiaoyu; Tsong, Yi

2014-01-01

Equivalence assessment between a reference and test treatment is often conducted by two one-sided tests (TOST). The corresponding power function and sample size determination can be derived from a joint distribution of the sample mean and sample variance. When an equivalence trial is designed with multiple endpoints, it often involves several sets of two one-sided tests. A naive approach for sample size determination in this case would select the largest sample size required for each endpoint. However, such a method ignores the correlation among endpoints. With the objective to reject all endpoints and when the endpoints are uncorrelated, the power function is the production of all power functions for individual endpoints. With correlated endpoints, the sample size and power should be adjusted for such a correlation. In this article, we propose the exact power function for the equivalence test with multiple endpoints adjusted for correlation under both crossover and parallel designs. We further discuss the differences in sample size for the naive method without and with correlation adjusted methods and illustrate with an in vivo bioequivalence crossover study with area under the curve (AUC) and maximum concentration (Cmax) as the two endpoints.

End-point impedance measurements across dominant and nondominant hands and robotic assistance with directional damping.

Science.gov (United States)

Erden, Mustafa Suphi; Billard, Aude

2015-06-01

The goal of this paper is to perform end-point impedance measurements across dominant and nondominant hands while doing airbrush painting and to use the results for developing a robotic assistance scheme. We study airbrush painting because it resembles in many ways manual welding, a standard industrial task. The experiments are performed with the 7 degrees of freedom KUKA lightweight robot arm. The robot is controlled in admittance using a force sensor attached at the end-point, so as to act as a free-mass and be passively guided by the human. For impedance measurements, a set of nine subjects perform 12 repetitions of airbrush painting, drawing a straight-line on a cartoon horizontally placed on a table, while passively moving the airbrush mounted on the robot's end-point. We measure hand impedance during the painting task by generating sudden and brief external forces with the robot. The results show that on average the dominant hand displays larger impedance than the nondominant in the directions perpendicular to the painting line. We find the most significant difference in the damping values in these directions. Based on this observation, we develop a "directional damping" scheme for robotic assistance and conduct a pilot study with 12 subjects to contrast airbrush painting with and without robotic assistance. Results show significant improvement in precision with both dominant and nondominant hands when using robotic assistance.

From continuous improvement to collaborative improvement: scope, scale, skill and social networking in collaborative improvement

NARCIS (Netherlands)

Middel, H.G.A.; Groen, Arend J.; Fisscher, O.A.M.

2004-01-01

More than ever, companies are challenged to improve their performance and respond quickly and accurately to changes within the market. As competitive battlefield is moving towards the level of networks of organisations, the individual firm is an inadequate entity for identifying improvements.

Pilot Study for Managing Complex Chronic Care Medicaid Patients With Diabetes Using a Mobile Health Application Achieves "Triple Aim" Improvement in a Primary Care Setting.

Science.gov (United States)

Bovbjerg, Marit L; Lee, Jenney; Wolff, Rosa; Bangs, Bobby; May, Michael A

2017-10-01

IN BRIEF Cost-effective innovations to improve health and health care in patients with complex chronic diseases are urgently needed. Mobile health (mHealth) remote monitoring applications (apps) are a promising technology to meet this need. This article reports on a study evaluating patients' use of a tablet device with an mHealth app and a cellular-enabled glucose meter that automatically uploaded blood glucose values to the app. Improvements were observed across all three components of the Patient Protection and Affordable Care Act's "triple aim." Self-rated wellness and numerous quality-of-care metrics improved, billed charges and paid claims decreased, but no changes in clinical endpoints were observed.

Integrating empowerment evaluation and quality improvement to achieve healthcare improvement outcomes

Science.gov (United States)

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

2015-01-01

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

Improve strategic supplier performance using DMAIC to develop a Quality Improvement Plan

Science.gov (United States)

Jardim, Kevin P.

Supplier performance that meets the requirements of the customer has long plagued quality professionals. Despite the vast efforts by organizations to improve supplier performance, little has been done to standardize the plan to improve performance. This project presents a guideline and problem-solving strategy using a Define, Measure, Analyze, Improve, and Control (DMAIC) structured tool that will assist in the management and improvement of supplier performance. An analysis of benchmarked Quality Improvement Plans indicated that this topic needs more focus on how to accomplish improved supplier performance. This project is part of a growing body of supplier continuous improvement efforts. With the input of Zodiac Aerospace quality professionals this project's results provide a solution to Quality Improvement Plans and show objective evidence of its benefits. This project contributes to the future research on similar topics.

A randomized controlled trial of 8-form Tai chi improves symptoms and functional mobility in fibromyalgia patients

Science.gov (United States)

Sherman, Christy A.; Mist, Scott D.; Carson, James W.; Bennett, Robert M.; Li, Fuzhong

2017-01-01

Previous researchers have found that 10-form Tai chi yields symptomatic benefit in patients with fibromyalgia (FM). The purpose of this study was to further investigate earlier findings and add a focus on functional mobility. We conducted a parallel-group randomized controlled trial FM-modified 8-form Yang-style Tai chi program compared to an education control. Participants met in small groups twice weekly for 90 min over 12 weeks. The primary endpoint was symptom reduction and improvement in self-report physical function, as measured by the Fibromyalgia Impact Questionnaire (FIQ), from baseline to 12 weeks. Secondary endpoints included pain severity and interference (Brief Pain Inventory (BPI), sleep (Pittsburg sleep Inventory), self-efficacy, and functional mobility. Of the 101 randomly assigned subjects (mean age 54 years, 93 % female), those in the Tai chi condition compared with the education condition demonstrated clinically and statistically significant improvements in FIQ scores (16.5 vs. 3.1, p=0.0002), BPI pain severity (1.2 vs. 0.4, p=0.0008), BPI pain interference (2.1 vs. 0.6, p=0.0000), sleep (2.0 vs. −0.03, p=0.0003), and self-efficacy for pain control (9.2 vs. −1.5, p=0.0001). Functional mobility variables including timed get up and go (−.9 vs. −.3, p=0.0001), static balance (7.5 vs. −0.3, p= 0.0001), and dynamic balance (1.6 vs. 0.3, p=0.0001) were significantly improved with Tai chi compared with education control. No adverse events were noted. Twelve weeks of Tai chi, practice twice weekly, provided worthwhile improvement in common FM symptoms including pain and physical function including mobility. Tai chi appears to be a safe and an acceptable exercise modality that may be useful as adjunctive therapy in the management of FM patients. (ClinicalTrials.gov Identifier, NCT01311427) PMID:22581278

Continuous improvement in teams : The (mis)fit between improvement and operational activities of improvement teams

NARCIS (Netherlands)

Ros, D.J.

1999-01-01

Since the 1970s and 1980s, increasing attention has been paid to the Japanese ways of organising production. One of the subjects often discussed is the importance of continuous incremental improvements. Nowadays, for many organisations, continuous improvement has become an important topic; many

Collaborative Improvement

DEFF Research Database (Denmark)

Kaltoft, Rasmus

-organisational continuous improvement of their performance, relative to that of other EMEs. Developing a collaborative improvement relationship between companies is a protracted and complex process and, according to some surveys, the failure rate is as low as one to three. This failure rate is affected by a whole range...... of factors. The research presented in this thesis was aimed at identifying these factors and investigating their interplay and influence on the progress and success of the development of the collaborative improvement. This thesis presents our findings regarding the factors found, their interplay...

Endurance training improves insulin sensitivity and body composition in prostate cancer patients treated with androgen deprivation therapy

DEFF Research Database (Denmark)

Hvid, Thine; Winding, Kamilla; Rinnov, Anders

2013-01-01

Insulin resistance and changes in body composition are side effects of androgen deprivation therapy (ADT) given to prostate cancer patients. The present study investigated whether endurance training improves insulin sensitivity and body composition in ADT-treated prostate cancer patients. Nine me...... and magnetic resonance imaging). The secondary endpoint was systemic inflammation. Statistical analysis was carried out using two-way ANOVA. Endurance training increased VO2max (ml(O2)/min per kg) by 11 and 13% in the patients and controls respectively (P...

A summation free β+-endpoint spectrometer

International Nuclear Information System (INIS)

Keller, H.; Kirchner, R.; Klepper, O.; Roeckl, E.; Schardt, D.; Simon, R.S.; Kleinheinz, P.; Liang, C.F.; Paris, P.

1990-08-01

A β + -endpoint spectrometer is described, where positrons are observed in an 11-mm thick silicon detector in coincidence with subsequent γ-rays meausred in a germanium detector, and where the summing of the positron energy with the annihilation radiation is prevented by detecting both 511-keV quanta in opposite segments of a BGO ring surrounding the silicon detector. The procedure of measuring and analyzing the data is outlined for the decay of the 11/2 - -isomer of 149 Tb; its endpoint energy is determined to be 1853(10) keV, in agreement with the literature. The accuracy and reliability of β + -endpoint measurements is discussed in comparison to the EC/β + -ratio method. (orig.)

End-point sharpness in thermometric titrimetry.

Science.gov (United States)

Tyrrell, H J

1967-07-01

It is shown that the sharpness of an end-point in a thermometric titration where the simple reaction A + B right harpoon over left harpoon AB takes place, depends on Kc(A') where K is the equilibrium constant for the reaction, and c(A') is the total concentration of the titrand (A) in the reaction mixture. The end-point is sharp if, (i) the enthalpy change in the reaction is not negligible, and (ii) Kc(A') > 10(3). This shows that it should, for example, be possible to titrate 0.1 M acid, pK(A) = 10, using a thennometric end-point. Some aspects of thermometric titrimetry when Kc(A') < 10(3) are also considered.

A novel protocol for dispatcher assisted CPR improves CPR quality and motivation among rescuers-A randomized controlled simulation study.

Science.gov (United States)

Rasmussen, Stinne Eika; Nebsbjerg, Mette Amalie; Krogh, Lise Qvirin; Bjørnshave, Katrine; Krogh, Kristian; Povlsen, Jonas Agerlund; Riddervold, Ingunn Skogstad; Grøfte, Thorbjørn; Kirkegaard, Hans; Løfgren, Bo

2017-01-01

Emergency dispatchers use protocols to instruct bystanders in cardiopulmonary resuscitation (CPR). Studies changing one element in the dispatcher's protocol report improved CPR quality. Whether several changes interact is unknown and the effect of combining multiple changes previously reported to improve CPR quality into one protocol remains to be investigated. We hypothesize that a novel dispatch protocol, combining multiple beneficial elements improves CPR quality compared with a standard protocol. A novel dispatch protocol was designed including wording on chest compressions, using a metronome, regular encouragements and a 10-s rest each minute. In a simulated cardiac arrest scenario, laypersons were randomized to perform single-rescuer CPR guided with the novel or the standard protocol. a composite endpoint of time to first compression, hand position, compression depth and rate and hands-off time (maximum score: 22 points). Afterwards participants answered a questionnaire evaluating the dispatcher assistance. The novel protocol (n=61) improved CPR quality score compared with the standard protocol (n=64) (mean (SD): 18.6 (1.4)) points vs. 17.5 (1.7) points, pCPR. A novel bundle of care protocol improved CPR quality score and motivation among rescuers. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Improvement Science Meets Improvement Scholarship: Reframing Research for Better Healthcare.

Science.gov (United States)

Cribb, Alan

2018-06-01

In this editorial essay I explore the possibilities of 'improvement scholarship' in order to set the scene for the theme of, and the other papers in, this issue. I contrast a narrow conception of quality improvement (QI) research with a much broader and more inclusive conception, arguing that we should greatly extend the existing dialogue between 'problem-solving' and 'critical' currents in improvement research. I have in mind the potential for building a much larger conversation between those people in 'improvement science' who are expressly concerned with tackling the problems facing healthcare and the wider group of colleagues who are engaged in health-related scholarship but who do not see themselves as particularly interested in quality improvement, indeed who may be critical of the language or concerns of QI. As one contribution to that conversation I suggest that that the increasing emphasis on theory and rigour in improvement research should include more focus on normative theory and rigour. The remaining papers in the issue are introduced including the various ways in which they handle the 'implicit normativity' of QI research and practice, and the linked theme of combining relatively 'tidy' and potentially 'unruly' forms of knowledge.

A disease-specific enteral nutrition formula improves nutritional status and functional performance in patients with head and neck and esophageal cancer undergoing chemoradiotherapy: results of a randomized, controlled, multicenter trial.

Science.gov (United States)

Fietkau, Rainer; Lewitzki, Victor; Kuhnt, Thomas; Hölscher, Tobias; Hess, Clemens-F; Berger, Bernhard; Wiegel, Thomas; Rödel, Claus; Niewald, Marcus; Hermann, Robert M; Lubgan, Dorota

2013-09-15

In patients with head and neck and esophageal tumors, nutritional status may deteriorate during concurrent chemoradiotherapy (CRT). The aim of this study was to investigate the influence of enteral nutrition enriched with eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) on body composition and nutritional and functional status. In a controlled, randomized, prospective, double-blind, multicenter study, 111 patients with head and neck and esophageal cancer undergoing concurrent CRT received either an enteral standard nutrition (control group) or disease-specific enteral nutrition Supportan®-containing EPA+DHA (experimental group) via percutaneous endoscopic gastrostomy. The primary endpoint was the change of body cell mass (BCM) following CRT at weeks 7 and 14 compared with the baseline value. Secondary endpoints were additional parameters of body composition, anthropometric parameters, and nutritional and functional status. The primary endpoint of the study, improvement in BCM, reached borderline statistical significance. Following CRT, patients with experimental nutrition lost only 0.82 ± 0.64 kg of BCM compared with 2.82 ± 0.77 kg in the control group (P = .055). The objectively measured nutritional parameters, such as body weight and fat-free mass, showed a tendency toward improvement, but the differences were not significant. The subjective parameters, in particular the Kondrup score (P = .0165) and the subjective global assessment score (P = .0065) after follow-up improved significantly in the experimental group, compared with the control group. Both enteral regimens were safe and well tolerated. Enteral nutrition with EPA and DHA may be advantageous in patients with head and neck or esophageal cancer by improving parameters of nutritional and functional status during CRT. © 2013 American Cancer Society.

Sensitivity of submersed freshwater macrophytes and endpoints in laboratory toxicity tests

International Nuclear Information System (INIS)

Arts, Gertie H.P.; Belgers, J. Dick M.; Hoekzema, Conny H.; Thissen, Jac T.N.M.

2008-01-01

The toxicological sensitivity and variability of a range of macrophyte endpoints were statistically tested with data from chronic, non-axenic, macrophyte toxicity tests. Five submersed freshwater macrophytes, four pesticides/biocides and 13 endpoints were included in the statistical analyses. Root endpoints, reflecting root growth, were most sensitive in the toxicity tests, while endpoints relating to biomass, growth and shoot length were less sensitive. The endpoints with the lowest coefficients of variation were not necessarily the endpoints, which were toxicologically most sensitive. Differences in sensitivity were in the range of 10-1000 for different macrophyte-specific endpoints. No macrophyte species was consistently the most sensitive. Criteria to select endpoints in macrophyte toxicity tests should include toxicological sensitivity, variance and ecological relevance. Hence, macrophyte toxicity tests should comprise an array of endpoints, including very sensitive endpoints like those relating to root growth. - A range of endpoints is more representative of macrophyte fitness than biomass and growth only

Can Physiological Endpoints Improve the Sensitivity of Assays with Plants in the Risk Assessment of Contaminated Soils?

Science.gov (United States)

Gavina, Ana; Antunes, Sara C.; Pinto, Glória; Claro, Maria Teresa; Santos, Conceição; Gonçalves, Fernando; Pereira, Ruth

2013-01-01

Site-specific risk assessment of contaminated areas indicates prior areas for intervention, and provides helpful information for risk managers. This study was conducted in the Ervedosa mine area (Bragança, Portugal), where both underground and open pit exploration of tin and arsenic minerals were performed for about one century (1857 – 1969). We aimed at obtaining ecotoxicological information with terrestrial and aquatic plant species to integrate in the risk assessment of this mine area. Further we also intended to evaluate if the assessment of other parameters, in standard assays with terrestrial plants, can improve the identification of phytotoxic soils. For this purpose, soil samples were collected on 16 sampling sites distributed along four transects, defined within the mine area, and in one reference site. General soil physical and chemical parameters, total and extractable metal contents were analyzed. Assays were performed for soil elutriates and for the whole soil matrix following standard guidelines for growth inhibition assay with Lemna minor and emergence and seedling growth assay with Zea mays. At the end of the Z. mays assay, relative water content, membrane permeability, leaf area, content of photosynthetic pigments (chlorophylls and carotenoids), malondialdehyde levels, proline content, and chlorophyll fluorescence (Fv/Fm and ΦPSII) parameters were evaluated. In general, the soils near the exploration area revealed high levels of Al, Mn, Fe and Cu. Almost all the soils from transepts C, D and F presented total concentrations of arsenic well above soils screening benchmark values available. Elutriates of several soils from sampling sites near the exploration and ore treatment areas were toxic to L. minor, suggesting that the retention function of these soils was seriously compromised. In Z. mays assay, plant performance parameters (other than those recommended by standard protocols), allowed the identification of more phytotoxic soils. The

Can physiological endpoints improve the sensitivity of assays with plants in the risk assessment of contaminated soils?

Directory of Open Access Journals (Sweden)

Ana Gavina

Full Text Available Site-specific risk assessment of contaminated areas indicates prior areas for intervention, and provides helpful information for risk managers. This study was conducted in the Ervedosa mine area (Bragança, Portugal, where both underground and open pit exploration of tin and arsenic minerals were performed for about one century (1857-1969. We aimed at obtaining ecotoxicological information with terrestrial and aquatic plant species to integrate in the risk assessment of this mine area. Further we also intended to evaluate if the assessment of other parameters, in standard assays with terrestrial plants, can improve the identification of phytotoxic soils. For this purpose, soil samples were collected on 16 sampling sites distributed along four transects, defined within the mine area, and in one reference site. General soil physical and chemical parameters, total and extractable metal contents were analyzed. Assays were performed for soil elutriates and for the whole soil matrix following standard guidelines for growth inhibition assay with Lemna minor and emergence and seedling growth assay with Zea mays. At the end of the Z. mays assay, relative water content, membrane permeability, leaf area, content of photosynthetic pigments (chlorophylls and carotenoids, malondialdehyde levels, proline content, and chlorophyll fluorescence (Fv/Fm and ΦPSII parameters were evaluated. In general, the soils near the exploration area revealed high levels of Al, Mn, Fe and Cu. Almost all the soils from transepts C, D and F presented total concentrations of arsenic well above soils screening benchmark values available. Elutriates of several soils from sampling sites near the exploration and ore treatment areas were toxic to L. minor, suggesting that the retention function of these soils was seriously compromised. In Z. mays assay, plant performance parameters (other than those recommended by standard protocols, allowed the identification of more phytotoxic soils

Continual improvement plan

Science.gov (United States)

1994-01-01

NASA's approach to continual improvement (CI) is a systems-oriented, agency-wide approach that builds on the past accomplishments of NASA Headquarters and its field installations and helps achieve NASA's vision, mission, and values. The NASA of the future will fully use the principles of continual improvement in every aspect of its operations. This NASA CI plan defines a systematic approach and a model for continual improvement throughout NASA, stressing systems integration and optimization. It demonstrates NASA's constancy of purpose for improvement - a consistent vision of NASA as a worldwide leader in top-quality science, technology, and management practices. The CI plan provides the rationale, structures, methods, and steps, and it defines NASA's short term (1-year) objectives for improvement. The CI plan presents the deployment strategies necessary for cascading the goals and objectives throughout the agency. It also provides guidance on implementing continual improvement with participation from top leadership and all levels of employees.

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

Science.gov (United States)

Tamm, Eric Peter

2016-03-01

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

Ordered kinematic endpoints for 5-body cascade decays

Energy Technology Data Exchange (ETDEWEB)

Klimek, Matthew D. [Theory Group, Department of Physics and Texas Cosmology Center,University of Texas at Austin, 2515 Speedway, Stop C1608, Austin, TX, 78712 (United States)

2016-12-23

We present expressions for the kinematic endpoints of 5-body cascade decay chains proceeding through all possible combinations of 2-body and 3-body decays, with one stable invisible particle in the final decay stage. When an invariant mass can be formed in multiple ways by choosing different final state particles from a common vertex, we introduce techniques for finding the sub-leading endpoints for all indistinguishable versions of the invariant mass. In contrast to short decay chains, where sub-leading endpoints are linearly related to the leading endpoints, we find that in 5-body decays, they provide additional independent constraints on the mass spectrum.

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

Science.gov (United States)

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

2015-10-01

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

Outside the box: will information technology be a viable intervention to improve the quality of cancer care?

Science.gov (United States)

Hesse, Bradford W; Hanna, Christopher; Massett, Holly A; Hesse, Nicola K

2010-01-01

The use of health information technology (IT) to resolve the crisis in communication inherent within the fragmented service environment of medical care in the United States is a strategic priority for the Department of Health and Human Services. Yet the deployment of health IT alone is not sufficient to improve quality in health service delivery; what is needed is a human factors approach designed to optimize the balance between health-care users, health-care providers, policies, procedures, and technologies. An evaluation of interface issues between primary and specialist care related to cancer reveals opportunities for human factors improvement along the cancer care continuum. Applications that emphasize cognitive support for prevention recommendations and that encourage patient engagement can help create a coordinated health-care environment conducive to cancer prevention and early detection. An emphasis on reliability, transparency, and accountability can help improve the coordination of activities among multiple service providers during diagnosis and treatment. A switch in emphasis from a transaction-based approach to one emphasizing long-term support for healing relationships should help improve patient outcomes during cancer survivorship and end-of-life care. Across the entire continuum of care, an emphasis on "meaningful use" of health IT-rather than on IT as an endpoint-should help put cancer on a path toward substantive continuous quality improvement. The accompanying research questions will focus on reducing the variance between the social and technical subsystems as IT is used to improve patient outcomes across the interfaces of care.

A Cutting Pattern Recognition Method for Shearers Based on Improved Ensemble Empirical Mode Decomposition and a Probabilistic Neural Network

Directory of Open Access Journals (Sweden)

Jing Xu

2015-10-01

Full Text Available In order to guarantee the stable operation of shearers and promote construction of an automatic coal mining working face, an online cutting pattern recognition method with high accuracy and speed based on Improved Ensemble Empirical Mode Decomposition (IEEMD and Probabilistic Neural Network (PNN is proposed. An industrial microphone is installed on the shearer and the cutting sound is collected as the recognition criterion to overcome the disadvantages of giant size, contact measurement and low identification rate of traditional detectors. To avoid end-point effects and get rid of undesirable intrinsic mode function (IMF components in the initial signal, IEEMD is conducted on the sound. The end-point continuation based on the practical storage data is performed first to overcome the end-point effect. Next the average correlation coefficient, which is calculated by the correlation of the first IMF with others, is introduced to select essential IMFs. Then the energy and standard deviation of the reminder IMFs are extracted as features and PNN is applied to classify the cutting patterns. Finally, a simulation example, with an accuracy of 92.67%, and an industrial application prove the efficiency and correctness of the proposed method.

Teaching quality improvement.

Science.gov (United States)

Murray, Marry Ellen; Douglas, Stephen; Girdley, Diana; Jarzemsky, Paula

2010-08-01

Practicing nurses are required to engage in quality improvement work as a part of their clinical practice, but few undergraduate nursing education programs offer course work and applied experience in this area. This article presents a description of class content and teaching strategies, assignments, and evaluation strategies designed to achieve the Quality and Safety Education in Nursing competencies related to quality improvement and interdisciplinary teams. Students demonstrate their application of the quality improvement process by designing and implementing a small-scale quality improvement project that they report in storyboard format on a virtual conference Web site.

Prostate Health Index improves multivariable risk prediction of aggressive prostate cancer.

Science.gov (United States)

Loeb, Stacy; Shin, Sanghyuk S; Broyles, Dennis L; Wei, John T; Sanda, Martin; Klee, George; Partin, Alan W; Sokoll, Lori; Chan, Daniel W; Bangma, Chris H; van Schaik, Ron H N; Slawin, Kevin M; Marks, Leonard S; Catalona, William J

2017-07-01

To examine the use of the Prostate Health Index (PHI) as a continuous variable in multivariable risk assessment for aggressive prostate cancer in a large multicentre US study. The study population included 728 men, with prostate-specific antigen (PSA) levels of 2-10 ng/mL and a negative digital rectal examination, enrolled in a prospective, multi-site early detection trial. The primary endpoint was aggressive prostate cancer, defined as biopsy Gleason score ≥7. First, we evaluated whether the addition of PHI improves the performance of currently available risk calculators (the Prostate Cancer Prevention Trial [PCPT] and European Randomised Study of Screening for Prostate Cancer [ERSPC] risk calculators). We also designed and internally validated a new PHI-based multivariable predictive model, and created a nomogram. Of 728 men undergoing biopsy, 118 (16.2%) had aggressive prostate cancer. The PHI predicted the risk of aggressive prostate cancer across the spectrum of values. Adding PHI significantly improved the predictive accuracy of the PCPT and ERSPC risk calculators for aggressive disease. A new model was created using age, previous biopsy, prostate volume, PSA and PHI, with an area under the curve of 0.746. The bootstrap-corrected model showed good calibration with observed risk for aggressive prostate cancer and had net benefit on decision-curve analysis. Using PHI as part of multivariable risk assessment leads to a significant improvement in the detection of aggressive prostate cancer, potentially reducing harms from unnecessary prostate biopsy and overdiagnosis. © 2016 The Authors BJU International © 2016 BJU International Published by John Wiley & Sons Ltd.

Radiobiological research for improving tumor radiotherapy - an Indian perspective

International Nuclear Information System (INIS)

Jain, Viney

1990-01-01

Radiation-induced damage to normal tissues within the non-target volume is a major limitation of tumor radiotherapy. Physical methods to obtain superior spatial dose distributions use sophisticated technology and are expensive. Large scale applications of these technologies in a developing country like India, with a large number of cancer patients, poor instrumental facilities and inadequate infrastructure face several problems. Radiobiological research aiming at developing simple, inexpensive and effective methods to increase the differential response between tumor and normal tissues should be, therefore, strengthened. Biological end-points are determined not only by the molecular lesions produced due to the absorption of the radiation energy but also by the cellular repair processes, which become operative in response to lesions in the living system. Therefore, enhancement of repair processes in the normal tissues and inhibition of the same in tumors should considerably improve the therapeutic index of radiation treatment. A combination of agents which can suitably alter the spectrum of important molecular lesions with modifiers of cellular repair could be an effective strategy. Initial experiments using halopyrimidines to increase repairable DNA lesions produced by sparsely ionizing radiations in combination with 2-deoxy-D-glucose to modulate differentially the repair and fixation processes in the tumor and normal tissues have provided promising results. Further research work is warranted since this strategy appears to have great potential for improving tumor radiotherapy. (author). 46 refs., 4 figs., 1 tab

Addition of 2-(ethylamino)acetonitrile group to nitroxoline results in significantly improved anti-tumor activity in vitro and in vivo.

Science.gov (United States)

Mitrović, Ana; Sosič, Izidor; Kos, Špela; Tratar, Urša Lampreht; Breznik, Barbara; Kranjc, Simona; Mirković, Bojana; Gobec, Stanislav; Lah, Tamara; Serša, Gregor; Kos, Janko

2017-08-29

Lysosomal cysteine peptidase cathepsin B, involved in multiple processes associated with tumor progression, is validated as a target for anti-cancer therapy. Nitroxoline, a known antimicrobial agent, is a potent and selective inhibitor of cathepsin B, hence reducing tumor progression in vitro and in vivo . In order to further improve its anti-cancer properties we developed a number of derivatives using structure-based chemical synthesis. Of these, the 7-aminomethylated derivative (compound 17 ) exhibited significantly improved kinetic properties over nitroxoline, inhibiting cathepsin B endopeptidase activity selectively. In the present study, we have evaluated its anti-cancer properties. It was more effective than nitroxoline in reducing tumor cell invasion and migration, as determined in vitro on two-dimensional cell models and tumor spheroids, under either endpoint or real time conditions. Moreover, it exhibited improved action over nitroxoline in impairing tumor growth in vivo in LPB mouse fibrosarcoma tumors in C57Bl/6 mice. Taken together, the addition of a 2-(ethylamino)acetonitrile group to nitroxoline at position 7 significantly improves its pharmacological characteristics and its potential for use as an anti-cancer drug.

Improving a Dental School's Clinic Operations Using Lean Process Improvement.

Science.gov (United States)

Robinson, Fonda G; Cunningham, Larry L; Turner, Sharon P; Lindroth, John; Ray, Deborah; Khan, Talib; Yates, Audrey

2016-10-01

The term "lean production," also known as "Lean," describes a process of operations management pioneered at the Toyota Motor Company that contributed significantly to the success of the company. Although developed by Toyota, the Lean process has been implemented at many other organizations, including those in health care, and should be considered by dental schools in evaluating their clinical operations. Lean combines engineering principles with operations management and improvement tools to optimize business and operating processes. One of the core concepts is relentless elimination of waste (non-value-added components of a process). Another key concept is utilization of individuals closest to the actual work to analyze and improve the process. When the medical center of the University of Kentucky adopted the Lean process for improving clinical operations, members of the College of Dentistry trained in the process applied the techniques to improve inefficient operations at the Walk-In Dental Clinic. The purpose of this project was to reduce patients' average in-the-door-to-out-the-door time from over four hours to three hours within 90 days. Achievement of this goal was realized by streamlining patient flow and strategically relocating key phases of the process. This initiative resulted in patient benefits such as shortening average in-the-door-to-out-the-door time by over an hour, improving satisfaction by 21%, and reducing negative comments by 24%, as well as providing opportunity to implement the electronic health record, improving teamwork, and enhancing educational experiences for students. These benefits were achieved while maintaining high-quality patient care with zero adverse outcomes during and two years following the process improvement project.

A Simulation-Based Quality Improvement Initiative Improves Pediatric Readiness in Community Hospitals.

Science.gov (United States)

Whitfill, Travis; Gawel, Marcie; Auerbach, Marc

2017-07-17

The National Pediatric Readiness Project Pediatric Readiness Survey (PRS) measured pediatric readiness in 4149 US emergency departments (EDs) and noted an average score of 69 on a 100-point scale. This readiness score consists of 6 domains: coordination of pediatric patient care (19/100), physician/nurse staffing and training (10/100), quality improvement activities (7/100), patient safety initiatives (14/100), policies and procedures (17/100), and availability of pediatric equipment (33/100). We aimed to assess and improve pediatric emergency readiness scores across Connecticut's hospitals. The aim of this study was to compare the National Pediatric Readiness Project readiness score before and after an in situ simulation-based assessment and quality improvement program in Connecticut hospitals. We leveraged in situ simulations to measure the quality of resuscitative care provided by interprofessional teams to 3 simulated patients (infant septic shock, infant seizure, and child cardiac arrest) presenting to their ED resuscitation bay. Assessments of EDs were made based on a composite quality score that was measured as the sum of 4 distinct domains: (1) adherence to sepsis guidelines, (2) adherence to cardiac arrest guidelines, (3) performance on seizure resuscitation, and (4) teamwork. After the simulation, a detailed report with scores, comparisons to other EDs, and a gap analysis were provided to sites. Based on this report, a regional children's hospital team worked collaboratively with each ED to develop action items and a timeline for improvements. The National Pediatric Readiness Project PRS scores, the primary outcome of this study, were measured before and after participation. Twelve community EDs in Connecticut participated in this project. The PRS scores were assessed before and after the intervention (simulation-based assessment and gap analysis/report-out). The average time between PRS assessments was 21 months. The PRS scores significantly improved 12

76 FR 41246 - Pesticide Program Dialogue Committee, Pesticide Registration Improvement Act Process Improvement...

Science.gov (United States)

2011-07-13

... Committee, Pesticide Registration Improvement Act Process Improvement Workgroup; Notice of Public Meeting...) Process Improvement Work Group. EPA plans to meet its ESA consultation obligations through the pesticide... a pesticide during the registration review process. This meeting of the PRIA Process Improvement...

Non-oblivious Strategy Improvement

Science.gov (United States)

Fearnley, John

We study strategy improvement algorithms for mean-payoff and parity games. We describe a structural property of these games, and we show that these structures can affect the behaviour of strategy improvement. We show how awareness of these structures can be used to accelerate strategy improvement algorithms. We call our algorithms non-oblivious because they remember properties of the game that they have discovered in previous iterations. We show that non-oblivious strategy improvement algorithms perform well on examples that are known to be hard for oblivious strategy improvement. Hence, we argue that previous strategy improvement algorithms fail because they ignore the structural properties of the game that they are solving.

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

Science.gov (United States)

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

2016-09-01

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

Making process improvement 'stick'.

Science.gov (United States)

Studer, Quint

2014-06-01

To sustain gains from a process improvement initiative, healthcare organizations should: Explain to staff why a process improvement initiative is needed. Encourage leaders within the organization to champion the process improvement, and tie their evaluations to its outcomes. Ensure that both leaders and employees have the skills to help sustain the sought-after process improvements.

Experimental Study on Durability Improvement of Fly Ash Concrete with Durability Improving Admixture

OpenAIRE

Quan, Hong-zhu; Kasami, Hideo

2014-01-01

In order to improve the durability of fly ash concrete, a series of experimental studies are carried out, where durability improving admixture is used to reduce drying shrinkage and improve freezing-thawing resistance. The effects of durability improving admixture, air content, water-binder ratio, and fly ash replacement ratio on the performance of fly ash concrete are discussed in this paper. The results show that by using durability improving admixture in nonair-entraining fly ash concrete,...

TBI Endpoints Development

Science.gov (United States)

2015-10-01

therapy , and early mild physical activity, which result in fewer symptoms, lower mean severity of symptoms, less social disability, and fewer days off work...developing more precise TBI diagnostic tools, clinical endpoints, and effective therapies . We designed and executed an interactive program that combined...surgery, neuropsychology, neuroradiology, psychiatry, neurology, sports medicine, pediatrics, geriatrics , health economics, biostatistics, and informatics

CDBG Public Improvements Activity

Data.gov (United States)

Department of Housing and Urban Development — CDBG activity related to public improvements, including senior centers, youth centers, parks, street improvements, water/sewer improvements, child care centers, fire...

Changes in natriuretic peptides after acute hospital presentation for heart failure with preserved ejection fraction: A feasible surrogate trial endpoint? A report from the prospective Karen study.

Science.gov (United States)

Savarese, Gianluigi; Donal, Erwan; Hage, Camilla; Oger, Emmanuel; Persson, Hans; Daubert, Jean-Claude; Linde, Cecilia; Lund, Lars H

2017-01-01

In acute decompensated heart failure (ADHF) with preserved ejection fraction (HFpEF) there are no surrogate endpoints for early phase trials. The aim of the current study was to evaluate whether a reduction in natriuretic peptides (NP) between acute hospital presentation to stable follow-up is associated with improved mortality and morbidity. Patients presenting acutely to the hospital for ADHF with HFpEF enrolled in the Karolinska Rennes (KaRen) study and reporting N-terminal pro-B-type NP or B-type NP assessment at baseline hospital presentation and at 4-8weeks follow-up were prospectively studied. Logistic regression analyses were performed to detect the predictors of baseline and changes in NPs. Cox regression models were performed to assess the impact of NP reductions on mortality and the composite of mortality and HF hospitalization. Of 361 patients (median follow-up 585days), 267 (74%) reported an improvement in NPs, while 94 (26%) reported worsening. At baseline, the independent predictors of lower NPs were higher glomerular filtration rate (Odds Ratio [OR] per unit: 1.013; 95% Confidence Interval [CI]: 1.005-1.021) and younger age (OR per year: 0.972; CI: 0.947-0.998). Improvement in NPs at follow-up was predicted by higher heart rate at baseline (OR per bpm: 1.014; CI: 1.003-1.025). After adjustments, the hazard ratio for all-cause death was 0.730 (CI: 0.456-1.169) and for the composite outcome 0.814 (CI: 0.582-1.139) for patients who improved vs. worsened in NP levels. In patients presenting acutely to the hospital with HFPEF, an improvement in NP levels did not independently and significantly predict improved mortality and/or morbidity. NPs as surrogate endpoints in acute HFpEF require further study. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Process Improvement Essentials

CERN Document Server

Persse, James R

2006-01-01

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

Improving fleet performance

International Nuclear Information System (INIS)

Ramjist, S.

2015-01-01

Use Fleet Initiatives to Improve Overall Fleet Performance . Tightly Integrated with Business Planning (Cause & Effect) . Leverage Strength of Broader Organization - Converge on Standard Business Practices . Ancillary Benefit of Improved Agility.

Improving fleet performance

Energy Technology Data Exchange (ETDEWEB)

Ramjist, S. [Ontario Power Generation, Toronto, ON (Canada)

2015-07-01

Use Fleet Initiatives to Improve Overall Fleet Performance . Tightly Integrated with Business Planning (Cause & Effect) . Leverage Strength of Broader Organization - Converge on Standard Business Practices . Ancillary Benefit of Improved Agility.

A cluster-randomised quality improvement study to improve two inpatient stroke quality indicators.

Science.gov (United States)

Williams, Linda; Daggett, Virginia; Slaven, James E; Yu, Zhangsheng; Sager, Danielle; Myers, Jennifer; Plue, Laurie; Woodward-Hagg, Heather; Damush, Teresa M

2016-04-01

Quality indicator collection and feedback improves stroke care. We sought to determine whether quality improvement training plus indicator feedback was more effective than indicator feedback alone in improving inpatient stroke indicators. We conducted a cluster-randomised quality improvement trial, randomising hospitals to quality improvement training plus indicator feedback versus indicator feedback alone to improve deep vein thrombosis (DVT) prophylaxis and dysphagia screening. Intervention sites received collaborative-based quality improvement training, external facilitation and indicator feedback. Control sites received only indicator feedback. We compared indicators pre-implementation (pre-I) to active implementation (active-I) and post-implementation (post-I) periods. We constructed mixed-effect logistic models of the two indicators with a random intercept for hospital effect, adjusting for patient, time, intervention and hospital variables. Patients at intervention sites (1147 admissions), had similar race, gender and National Institutes of Health Stroke Scale scores to control sites (1017 admissions). DVT prophylaxis improved more in intervention sites during active-I period (ratio of ORs 4.90, pimproved similarly in both groups during active-I, but control sites improved more in post-I period (ratio of ORs 0.67, p=0.04). In logistic models, the intervention was independently positively associated with DVT performance during active-I period, and negatively associated with dysphagia performance post-I period. Quality improvement training was associated with early DVT improvement, but the effect was not sustained over time and was not seen with dysphagia screening. External quality improvement programmes may quickly boost performance but their effect may vary by indicator and may not sustain over time. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Experimental study on durability improvement of fly ash concrete with durability improving admixture.

Science.gov (United States)

Quan, Hong-zhu; Kasami, Hideo

2014-01-01

In order to improve the durability of fly ash concrete, a series of experimental studies are carried out, where durability improving admixture is used to reduce drying shrinkage and improve freezing-thawing resistance. The effects of durability improving admixture, air content, water-binder ratio, and fly ash replacement ratio on the performance of fly ash concrete are discussed in this paper. The results show that by using durability improving admixture in nonair-entraining fly ash concrete, the compressive strength of fly ash concrete can be improved by 10%-20%, and the drying shrinkage is reduced by 60%. Carbonation resistance of concrete is roughly proportional to water-cement ratio regardless of water-binder ratio and fly ash replacement ratio. For the specimens cured in air for 2 weeks, the freezing-thawing resistance is improved. In addition, by making use of durability improving admixture, it is easier to control the air content and make fly ash concrete into nonair-entraining one. The quality of fly ash concrete is thereby optimized.

The Work Compatibility Improvement Framework: theory and application of improvement action and intervention strategies.

Science.gov (United States)

Genaidy, Ash M; Rinder, Magda M; Sequeira, Reynold; A-Rehim, Amal D

2009-05-01

Challenges facing management of manufacturing firms can be transformed into asset gains by giving careful consideration to the worker-work environment interface. The benefits of a 'healthy' interface may lead to sizable reductions in rising health care costs and retention of highly qualified workers. This paper presents a novel approach for the 'improve' phase of the Work Compatibility Improvement Framework. The work tasks of this research consisted of: (a) fundamentals of cognitive-based improvement action and intervention; (b) design concepts and process of improvement action/intervention generation; (c) assessment model of estimated gains in company's assets; (d) application demonstration in the manufacturing sector. The process of improvement action/intervention generation is described, preceded by a description of the fundamentals of cognitive-based improvement action and intervention and system architecture. This is followed by a documentation of estimated asset gains as a result of the improvement plan. The results showed that expert workers were, on average, 78% in agreement with the algorithm-identified improvement actions. Their knowledge was used to update the recommended actions as well as to detail the multiple strategies required to address the improvement actions. As a result, an integrated improvement plan was developed resulting in estimated asset gains of $1.6 million, which was validated by the general manager. The research reported herein documented the theory and application of the 'improve' phase of the Work Compatibility Improvement Framework. The economic assessment of the suggested improvement is also reported and this has proved to be an important driver to secure the firm collaboration of manufacturing enterprise management. An integrated improvement solution plan backed by a detailed economic assessment of suggested improvements is essential to demonstrate the full potential of workplace micro- and macro-ergonomic interventions.

Improving Family Meetings in Intensive Care Units: A Quality Improvement Curriculum.

Science.gov (United States)

Gruenewald, David A; Gabriel, Michelle; Rizzo, Dorothy; Luhrs, Carol A

2017-07-01

Family meetings in the intensive care unit are associated with beneficial outcomes for patients, their families, and health care systems, yet these meetings often do not occur in a timely, effective, reliable way. The Department of Veterans Affairs Comprehensive End-of-Life Care Implementation Center sponsored a national initiative to improve family meetings in Veterans Affairs intensive care units across the United States. Process measures of success for the initiative were identified, including development of a curriculum to support facility-based quality improvement projects to implement high-quality family meetings. Identified curriculum requirements included suitability for distance learning and applicability to many clinical intensive care units. Curriculum modules were cross-mapped to the "Plan-Do-Study-Act" model to aid in planning quality improvement projects. A questionnaire was e-mailed to users to evaluate the curriculum's effectiveness. Users rated the curriculum's effectiveness in supporting and achieving aims of the initiative as 3.6 on a scale of 0 (not effective) to 4 (very effective). Users adapted the curriculum to meet local needs. The number of users increased from 6 to 17 quality improvement teams in 2 years. All but 3 teams progressed to implementation of an action plan. Users were satisfied with the effectiveness and adaptability of a family-meeting quality improvement curriculum to support implementation of a quality improvement project in Veterans Affairs intensive care units. This tool may be useful in facilitating projects to improve the quality of family meetings in other intensive care units. ©2017 American Association of Critical-Care Nurses.

Latiglutenase Improves Symptoms in Seropositive Celiac Disease Patients While on a Gluten-Free Diet.

Science.gov (United States)

Syage, Jack A; Murray, Joseph A; Green, Peter H R; Khosla, Chaitan

2017-09-01

Celiac disease (CD) is a widespread condition triggered by dietary gluten and treated with a lifelong gluten-free diet (GFD); however, inadvertent exposure to gluten can result in episodic symptoms. A previous trial of latiglutenase (clinicaltrials.gov; NCT01917630), an orally administered mixture of two recombinant gluten-specific proteases, was undertaken in symptomatic subjects with persistent injury. The primary endpoint for histologic improvement was not met, presumably due to a trial effect. In this post hoc analysis, we investigated the efficacy of latiglutenase for reducing symptoms in subgroups of the study participants based on their seropositivity. The study involved symptomatic CD patients following a GFD for at least one year prior to randomization. Patients were treated for 12 weeks with latiglutenase or placebo. Of 398 completed patients, 173 (43%) were seropositive at baseline. Symptoms were recorded daily, and weekly symptom scores were compiled. p values were calculated by analysis of covariance. A statistically significant, dose-dependent reduction was detected in the severity and frequency of symptoms in seropositive but not seronegative patients. The severity of abdominal pain and bloating was reduced by 58 and 44%, respectively, in the cohort receiving the highest latiglutenase dose (900 mg, n = 14) relative to placebo (n = 54). Symptom improvement increased from week 6 to week 12. There was also a trend toward greater symptom improvement with greater baseline symptom severity. Seropositive CD patients show symptomatic improvement from latiglutenase taken with meals and would benefit from the availability of this treatment.

Endpoint behavior of high-energy scattering cross sections

International Nuclear Information System (INIS)

Chay, Junegone; Kim, Chul

2010-01-01

In high-energy processes near the endpoint, there emerge new contributions associated with spectator interactions. Away from the endpoint region, these new contributions are suppressed compared to the leading contribution, but the leading contribution becomes suppressed as we approach the endpoint and the new contributions become comparable. We present how the new contributions scale as we reach the endpoint and show that they are comparable to the suppressed leading contributions in deep inelastic scattering by employing a power-counting analysis. The hadronic tensor in deep inelastic scattering is shown to factorize including the spectator interactions, and it can be expressed in terms of the light cone distribution amplitudes of initial hadrons. We also consider the contribution of the spectator contributions in Drell-Yan processes. Here the spectator interactions are suppressed compared to double parton annihilation according to the power counting.

Continuous Improvement in Education. Advancing Teaching--Improving Learning. White Paper

Science.gov (United States)

Park, Sandra; Hironaka, Stephanie; Carver, Penny; Nordstrum, Lee

2013-01-01

In recent years, "continuous improvement" has become a popular catchphrase in the field of education. However, while continuous improvement has become commonplace and well-documented in other industries, such as healthcare and manufacturing, little is known about how this work has manifested itself in education. This white paper attempts…

Implementing a customer focused continual business improvement program to improve the maintenance process

International Nuclear Information System (INIS)

Kharshafdjian, G.; Fisher, C.; Beres, T.; Brooks, S.; Forbes, S.; Krause, M.; McAuley, K.; Wendorf, M.

2006-01-01

Global market pressures and increasing competition demands that successful companies establish a continual business improvement program as part of implementing its business strategy. Such programs must be driven by the definition of quality from the customer's perspective. This customer quality focus often requires a change in all aspects of the business including products, services, processes and culture. This paper will describe how Atomic Energy of Canada Limited implemented a Continual Business Improvement Program in their Nuclear Laboratories Business Unit. In particular, to review how the techniques were applied to improve the maintenance process and the status of the project. Customer (internal users of the processes at CRL) feedback has shown repeatedly there is dissatisfaction of the maintenance process. Customers complain about jobs not getting done to schedule or being deferred. A project has been launched with the following goals: to improve the maintenance process customer satisfaction and increase trades wrench time by 30 minutes / trade / day. DMAIC (Define-Measure-Analyze-Improve-Control) methodology was applied to find out the Root Cause(s) of the problem, provide solutions, and implement improvements. The expected Operational Benefits include: Executing work efficiently to quality standards and business performance of the site, improve maintenance efficiencies, reduce cycle time for maintenance process and improve process yield, and improve customer and employee satisfaction. (author)

Implementing a customer focused continual business improvement program to improve the maintenance process

Energy Technology Data Exchange (ETDEWEB)

Kharshafdjian, G.; Fisher, C.; Beres, T.; Brooks, S.; Forbes, S.; Krause, M.; McAuley, K.; Wendorf, M. [Atomic Energy of Canada Limited, Chalk River, Ontario (Canada)

2006-07-01

Global market pressures and increasing competition demands that successful companies establish a continual business improvement program as part of implementing its business strategy. Such programs must be driven by the definition of quality from the customer's perspective. This customer quality focus often requires a change in all aspects of the business including products, services, processes and culture. This paper will describe how Atomic Energy of Canada Limited implemented a Continual Business Improvement Program in their Nuclear Laboratories Business Unit. In particular, to review how the techniques were applied to improve the maintenance process and the status of the project. Customer (internal users of the processes at CRL) feedback has shown repeatedly there is dissatisfaction of the maintenance process. Customers complain about jobs not getting done to schedule or being deferred. A project has been launched with the following goals: to improve the maintenance process customer satisfaction and increase trades wrench time by 30 minutes / trade / day. DMAIC (Define-Measure-Analyze-Improve-Control) methodology was applied to find out the Root Cause(s) of the problem, provide solutions, and implement improvements. The expected Operational Benefits include: Executing work efficiently to quality standards and business performance of the site, improve maintenance efficiencies, reduce cycle time for maintenance process and improve process yield, and improve customer and employee satisfaction. (author)

Non-oblivious Strategy Improvement

OpenAIRE

Fearnley, John

2010-01-01

We study strategy improvement algorithms for mean-payoff and parity games. We describe a structural property of these games, and we show that these structures can affect the behaviour of strategy improvement. We show how awareness of these structures can be used to accelerate strategy improvement algorithms. We call our algorithms non-oblivious because they remember properties of the game that they have discovered in previous iterations. We show that non-oblivious strategy improvement algorit...

Chirally improving Wilson fermions I. O(a) improvement

International Nuclear Information System (INIS)

Frezzotti, R.; Rossi, G.C.

2004-01-01

We show that it is possible to improve the chiral behaviour and the approach to the continuum limit of correlation functions in lattice QCD with Wilson fermions by taking arithmetic averages of correlators computed in theories regularized with Wilson terms of opposite sign. Improved hadronic masses and matrix elements can be obtained by similarly averaging the corresponding physical quantities separately computed within the two regularizations. To deal with the problems related to the spectrum of the Wilson-Dirac operator, which are particularly worrisome when Wilson and mass terms are such as to give contributions of opposite sign to the real part of the eigenvalues, we propose to use twisted-mass lattice QCD for the actual computation of the quantities taking part to the averages. The choice ±π/2 for the twisting angle is particularly interesting, as O(a) improved estimates of physical quantities can be obtained even without averaging data from lattice formulations with opposite Wilson terms. In all cases little or no extra computing power is necessary, compared to simulations with standard Wilson fermions or twisted-mass lattice QCD. (author)

Maintenance improvement program

International Nuclear Information System (INIS)

Derbonne, D.R.; Plunkett, T.F.; Simpson, J.R.

1989-01-01

During fuel cycle 1 at River Bend station, considerable effort was expended to reduce corrective maintenance work orders (MWOs) to <1,000. This was done by complementing the plant staff with costly contract personnel. Coming out of the first refueling outage, most contract personnel were released. The change in MWO backlog started a steady rise. It became readily apparent that to avoid costly contract staff time, a maintenance improvement program (MIP) was necessary. The MIP Was primarily directed at two areas: crew efficiency improvements and improved preplanned MWO packages. The overall effect of the MIP was to achieve significant productivity improvements with reduced operation and maintenance cost by providing frequent accountability to all levels of maintenance supervision. The MIP also produced a feeling of pride among the maintenance department employees that had not really existed before. This was the best benefit of all

Improving Healthcare Logistics Processes

DEFF Research Database (Denmark)

Feibert, Diana Cordes

logistics processes in hospitals and aims to provide theoretically and empirically based evidence for improving these processes to both expand the knowledge base of healthcare logistics and provide a decision tool for hospital logistics managers to improve their processes. Case studies were conducted...... processes. Furthermore, a method for benchmarking healthcare logistics processes was developed. Finally, a theoretically and empirically founded framework was developed to support managers in making an informed decision on how to improve healthcare logistics processes. This study contributes to the limited...... literature concerned with the improvement of logistics processes in hospitals. Furthermore, the developed framework provides guidance for logistics managers in hospitals on how to improve their processes given the circumstances in which they operate....

Hippeastrum hybridum anthocyanins as indicators of endpoint in ...

African Journals Online (AJOL)

Anthocyanins from Hippeastrum hybridum (Amaryllis) were investigated as indicators of endpoint in acid- base titrations. Extraction of the anthocyanins was done using distilled water, methanol and methanol containing 0.5% acetic acid. The extracts were used in determination of endpoint in titrations between strong ...

Process benchmarking for improvement of environmental restoration activities

International Nuclear Information System (INIS)

Celorie, J.A.; Selman, J.R.; Larson, N.B.

1995-01-01

A process benchmarking study was initiated by the Office of Environmental Management (EM) of the US Department of Energy (DOE) to analyze and improve the department's environmental assessment and environmental restoration (ER) processes. The purpose of this study was to identify specific differences in the processes and implementation procedures used at comparable remediation sites to determine best practices which had the greatest potential to minimize the cost and time required to conduct remedial investigation/ feasibility study (RI/FS) activities. Technical criteria were identified and used to select four DOE, two Department of Defense (DOD), and two Environmental Protection Agency (EPA) restoration sites that exhibited comparable characteristics and regulatory environments. By comparing the process elements and activities executed at the different sites for similar endpoints, best practices were identified for streamlining process elements and minimizing non-value-added activities. Critical measures that influenced process performance were identified and characterized for the sites. This benchmarking study focused on two processes and the internal/external review of documents and the development of the initial evaluation and data collection plan (IEDCP)--since these had a great potential for savings, a high impact on other processes, and a high probability for implementation

Pharmaceutics, Drug Delivery and Pharmaceutical Technology: A New Test Unit for Disintegration End-Point Determination of Orodispersible Films.

Science.gov (United States)

Low, Ariana; Kok, Si Ling; Khong, Yuetmei; Chan, Sui Yung; Gokhale, Rajeev

2015-11-01

No standard time or pharmacopoeia disintegration test method for orodispersible films (ODFs) exists. The USP disintegration test for tablets and capsules poses significant challenges for end-point determination when used for ODFs. We tested a newly developed disintegration test unit (DTU) against the USP disintegration test. The DTU is an accessory to the USP disintegration apparatus. It holds the ODF in a horizontal position, allowing top-view of the ODF during testing. A Gauge R&R study was conducted to assign relative contributions of the total variability from the operator, sample or the experimental set-up. Precision was compared using commercial ODF products in different media. Agreement between the two measurement methods was analysed. The DTU showed improved repeatability and reproducibility compared to the USP disintegration system with tighter standard deviations regardless of operator or medium. There is good agreement between the two methods, with the USP disintegration test giving generally longer disintegration times possibly due to difficulty in end-point determination. The DTU provided clear end-point determination and is suitable for quality control of ODFs during product developmental stage or manufacturing. This may facilitate the development of a standardized methodology for disintegration time determination of ODFs. © 2015 Wiley Periodicals, Inc. and the American Pharmacists Association J Pharm Sci 104:3893-3903, 2015. Copyright © 2015 Wiley Periodicals, Inc. and the American Pharmacists Association.

Does teaching non-technical skills to medical students improve those skills and simulated patient outcome?

Science.gov (United States)

Hagemann, Vera; Herbstreit, Frank; Kehren, Clemens; Chittamadathil, Jilson; Wolfertz, Sandra; Dirkmann, Daniel; Kluge, Annette; Peters, Jürgen

2017-03-29

The purpose of this study is to evaluate the effects of a tailor-made, non-technical skills seminar on medical student's behaviour, attitudes, and performance during simulated patient treatment. Seventy-seven students were randomized to either a non-technical skills seminar (NTS group, n=43) or a medical seminar (control group, n=34). The human patient simulation was used as an evaluation tool. Before the seminars, all students performed the same simulated emergency scenario to provide baseline measurements. After the seminars, all students were exposed to a second scenario, and behavioural markers for evaluating their non-technical skills were rated. Furthermore, teamwork-relevant attitudes were measured before and after the scenarios, and perceived stress was measured following each simulation. All simulations were also evaluated for various medical endpoints. Non-technical skills concerning situation awareness (ptechnical skills to improve student's non-technical skills. In a next step, to improve student's handling of emergencies and patient outcomes, non-technical skills seminars should be accompanied by exercises and more broadly embedded in the medical school curriculum.

Using Quality Improvement to Improve Internal and External Coordination and Referrals.

Science.gov (United States)

Cain, Katherine L; Collins, Ragan P

As part of accreditation, Public Health Accreditation Board site visitors recommended that the New Orleans Health Department strengthen its quality improvement program. With support from the Public Health Accreditation Board, the New Orleans Health Department subsequently embarked on a data-driven planning process through which it prioritized quality improvement projects for 2016. One of these projects aimed to improve referrals to New Orleans Health Department's direct services programs from local clinics and hospitals to better provide our most vulnerable residents with a continuum of care. After completing a cause-and-effect analysis, we implemented a solution involving increased outreach to health care institutions and saw annual participation increase in 3 out of 4 of our programs. We leveraged this work to successfully apply for funding to create a centralized referral system, which will facilitate partnerships among local health and human service agencies and improve access to services. This is one example of how accreditation has benefited our health department and our community. We have found that the accreditation process promotes a culture of quality and helps health departments identify and address areas for improvement.

SpEnD: Linked Data SPARQL Endpoints Discovery Using Search Engines

Science.gov (United States)

Yumusak, Semih; Dogdu, Erdogan; Kodaz, Halife; Kamilaris, Andreas; Vandenbussche, Pierre-Yves

In this study, a novel metacrawling method is proposed for discovering and monitoring linked data sources on the Web. We implemented the method in a prototype system, named SPARQL Endpoints Discovery (SpEnD). SpEnD starts with a "search keyword" discovery process for finding relevant keywords for the linked data domain and specifically SPARQL endpoints. Then, these search keywords are utilized to find linked data sources via popular search engines (Google, Bing, Yahoo, Yandex). By using this method, most of the currently listed SPARQL endpoints in existing endpoint repositories, as well as a significant number of new SPARQL endpoints, have been discovered. Finally, we have developed a new SPARQL endpoint crawler (SpEC) for crawling and link analysis.

Planning and analyzing clinical trials with composite endpoints

CERN Document Server

Rauch, Geraldine; Kieser, Meinhard

2017-01-01

This book addresses the most important aspects of how to plan and evaluate clinical trials with a composite primary endpoint to guarantee a clinically meaningful and valid interpretation of the results. Composite endpoints are often used as primary efficacy variables for clinical trials, particularly in the fields of oncology and cardiology. These endpoints combine several variables of interest within a single composite measure, and as a result, all variables that are of major clinical relevance can be considered in the primary analysis without the need to adjust for multiplicity. Moreover, composite endpoints are intended to increase the size of the expected effects thus making clinical trials more powerful. The book offers practical advice for statisticians and medical experts involved in the planning and analysis of clinical trials. For readers who are mainly interested in the application of the methods, all the approaches are illustrated with real-world clinical trial examples, and the software codes requ...

Improving palliative care.

LENUS (Irish Health Repository)

Moran, Sue

2009-05-01

Any service improvement project requires planning, action and evaluation. Using a recognised quality improvement framework can offer a structured approach to implementing and assessing changes to patient care. This article describes how use of the Deming Cycle has helped to identify nurses\\' learning needs.

Room for improvement

DEFF Research Database (Denmark)

Sandal, Louise F; Thorlund, Jonas B; Moore, Andrew J

2018-01-01

-reported outcomes and qualitative findings supported the primary finding, while improvements in muscle strength and aerobic capacity did not differ between exercise groups. CONCLUSION: Results suggest that the physical environment contributes to treatment response. Matching patients' preferences to treatment rooms...... significance (p=0.07). Waitlist group reported no improvement (-0.05 95% CI -0.5 to 0.4). In interviews, participants from the standard environment expressed greater social cohesion and feeling at home. Qualitative themes identified; reflection, sense of fellowship and transition. Secondary patient...... may improve patient-reported outcomes. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov identifier: NCT02043613....

Improvement in pain severity category in clinical trials of pregabalin

Directory of Open Access Journals (Sweden)

Parsons B

2016-10-01

Full Text Available Bruce Parsons,1 Charles E Argoff,2 Andrew Clair,1 Birol Emir1 1Pfizer, New York, NY, USA; 2Albany Medical Center, Albany, NY, USA Background: Pregabalin is approved by the US Food and Drug Administration for the treatment of fibromyalgia (FM, diabetic peripheral neuropathy (DPN, postherpetic neuralgia (PHN, and neuropathic pain due to spinal cord injury (SCI. Approval was based on clinical trial data demonstrating statistically significant differences in pain scores versus placebo. However, statistically significant pain relief may not always equate to clinically meaningful pain relief. To further characterize the clinical benefit of pregabalin, this analysis examined shifts in pain severity categories in patients with FM, DPN/PHN (pooled in this analysis, and SCI treated with pregabalin.Methods: Data were pooled from 23 placebo-controlled trials in patients with FM (1,623 treated with pregabalin, 937 placebo, DPN/PHN (2,867 pregabalin, 1,532 placebo, or SCI (181 pregabalin, 175 placebo. Pain scores were assessed on an 11-point numeric rating scale and categorized as mild (0 to <4, moderate (4 to <7, or severe (7 to 10. Only patients with mean score ≥4 at baseline were randomized to treatment. The percentage of patients shifting pain category from baseline to endpoint for pregabalin and placebo was analyzed using a modified ridit transformation with the Cochran–Mantel–Haenszel procedure.Results: A higher proportion of patients shifted to a less severe pain category at endpoint with pregabalin compared with placebo. With flexible-dose pregabalin, the percentage of patients improving from: severe to mild (pregabalin versus placebo was 15.8 versus 13.4 in FM patients, 36.0 versus 16.6 in DPN/PHN patients, 14.3 versus 7.7 in SCI patients; severe to moderate was 28.7 versus 28.2 in FM patients, 32.5 versus 28.2 in DPN/PHN patients, 35.7 versus 28.2 in SCI patients; and moderate to mild was 38.3 versus 26.4 in FM patients, 59.5 versus 41.4 in

Framing quality improvement tools and techniques in healthcare the case of improvement leaders' guides.

Science.gov (United States)

Millar, Ross

2013-01-01

The purpose of this paper is to present a study of how quality improvement tools and techniques are framed within healthcare settings. The paper employs an interpretive approach to understand how quality improvement tools and techniques are mobilised and legitimated. It does so using a case study of the NHS Modernisation Agency Improvement Leaders' Guides in England. Improvement Leaders' Guides were framed within a service improvement approach encouraging the use of quality improvement tools and techniques within healthcare settings. Their use formed part of enacting tools and techniques across different contexts. Whilst this enactment was believed to support the mobilisation of tools and techniques, the experience also illustrated the challenges in distributing such approaches. The paper provides an important contribution in furthering our understanding of framing the "social act" of quality improvement. Given the ongoing emphasis on quality improvement in health systems and the persistent challenges involved, it also provides important information for healthcare leaders globally in seeking to develop, implement or modify similar tools and distribute leadership within health and social care settings.

Genetic improvement of vegetables

International Nuclear Information System (INIS)

Jaramillo Vasquez, J.G.

2001-01-01

Some genetic bases of the improvement of vegetables are given. The objectives of the genetic improvement and the fundamental stages of this process are done. The sources of genetic variation are indicated and they are related the reproduction systems of the main horticultural species. It is analyzed the concept of genetic inheritance like base to determine the procedures more appropriate of improvement. The approaches are discussed, has more than enough phenotypic value, genetic action and genotypic variance; Equally the heredability concepts and value of improvement. The conventional methods of improvement are described, like they are: the introduction of species or varieties, the selection, the pure line, the pedigree method, the selection for families, the recurrent selection, the selection for unique seed, the haploids method, the selection for heterosis and the synthetic varieties

Reference Manual on Making School Climate Improvements. School Climate Improvement Resource Package, 2017

Science.gov (United States)

Yoder, N.; Darling-Churchill, K.; Colombi, G. D.; Ruddy, S.; Neiman, S.; Chagnon, E.; Mayo, R.

2017-01-01

This reference manual identifies five overarching sets of activities for improving school climate, with the goal of improving student outcomes (e.g., achievement, attendance, behaviors, and skills). These sets of activities help to initiate, implement, and sustain school climate improvements. For each activity set, the manual presents a clear…

Stroke rehabilitation at home before and after discharge reduced disability and improved quality of life

DEFF Research Database (Denmark)

Rasmussen, Rune Skovgaard; Østergaard, Ann; Kjær, Pia

2016-01-01

part of usual treatment and rehabilitation services. Thirty-three control patients received treatment and rehabilitation following usual guidelines for the treatment of stroke patients. MAIN MEASURES: Ninety days post-stroke the modified Rankin Scale score was the primary endpoint. Other outcome...... score (Intervention median = 2, IQR = 2-3; Control median = 3, IQR = 2-4; P=0.04). EuroQol-5D™ quality of life median scores were improved in intervention patients (Intervention median = 0.77, IQR = 0.66-0.79; Control median = 0.66, IQR = 0.56 - 0.72; P=0.03). The total amount of home-based training...... and increased quality of life. Compared to standard care, home-based stroke rehabilitation was more cost-effective....

Improving inter-observer variability in the evaluation of ultrasonographic features of polycystic ovaries

Directory of Open Access Journals (Sweden)

Leswick David A

2008-07-01

Full Text Available Abstract Background We recently reported poor inter-observer agreement in identifying and quantifying individual ultrasonographic features of polycystic ovaries. Our objective was to determine the effect of a training workshop on reducing inter-observer variation in the ultrasonographic evaluation of polycystic ovaries. Methods Transvaginal ultrasound recordings from thirty women with polycystic ovary syndrome (PCOS were evaluated by three radiologists and three reproductive endocrinologists both before and after an ultrasound workshop. The following endpoints were assessed: 1 follicle number per ovary (FNPO, 2 follicle number per single cross-section (FNPS, 3 largest follicle diameter, 4 ovarian volume, 5 follicle distribution pattern and 6 presence of a corpus luteum (CL. Lin's concordance correlation coefficients (rho and kappa statistics for multiple raters (kappa were used to assess level of inter-observer agreement (>0.80 good, 0.60 – 0.80 moderate/fair, Results Following the workshop, inter-observer agreement improved for the evaluation of FNPS (rho = 0.70, delta rho = +0.11, largest follicle diameter (rho = 0.77, delta rho = +0.10, ovarian volume (rho = 0.84, delta rho = +0.12, follicle distribution pattern (kappa = 0.80, delta kappa = +0.21 and presence of a CL (kappa = 0.87, delta kappa = +0.05. No improvement was evident for FNPO (rho = 0.54, delta rho = -0.01. Both radiologists and reproductive endocrinologists demonstrated improvement in scores (p Conclusion Reliability in evaluating ultrasonographic features of polycystic ovaries can be significantly improved following participation in a training workshop. If ultrasonographic evidence of polycystic ovaries is to be used as an objective measure in the diagnosis of PCOS, then standardized training modules should be implemented to unify the approach to evaluating polycystic ovarian morphology.

Continuous Personal Improvement.

Science.gov (United States)

Emiliani, M. L.

1998-01-01

Suggests that continuous improvement tools used in the workplace can be applied to self-improvement. Explains the use of such techniques as one-piece flow, kanban, visual controls, and total productive maintenance. Points out misapplications of these tools and describes the use of fishbone diagrams to diagnose problems. (SK)

Parametric Study of Beta-Endpoint Energy in Direct Energy Converters

Science.gov (United States)

2007-01-01

value to the endpoint energy of nickel-63 ( Ni63 ), whose endpoint energy is 66 keV. Only an approximation is sought. Nickel-63 is an easily...is known to vary from Sr90’s spectrum, where instead of peaking at approximately one third of the endpoint energy, the peak of Ni63 ’s output spectrum

Improved Dosimetric and Clinical Outcomes With Intensity-Modulated Radiotherapy for Head-and-Neck Cancer of Unknown Primary Origin

International Nuclear Information System (INIS)

Chen, Allen M.; Li Baoqing; Farwell, D. Gregory; Marsano, Joseph; Vijayakumar, Srinivasan; Purdy, James A.

2011-01-01

Purpose: To compare differences in dosimetric, clinical, and quality-of-life endpoints among a cohort of patients treated by intensity-modulated radiotherapy (IMRT) and conventional radiotherapy (CRT) for head-and-neck cancer of unknown primary origin. Methods and Materials: The medical records of 51 patients treated by radiation therapy for squamous cell carcinoma of the head and neck presenting as cervical lymph node metastasis of occult primary origin were reviewed. Twenty-four patients (47%) were treated using CRT, and 27 (53%) were treated using IMRT. The proportions of patients receiving concurrent chemotherapy were 54% and 63%, respectively. Results: The 2-year estimates of overall survival, local-regional control, and disease-specific survival for the entire patient population were 86%, 89%, and84%, respectively. There were no significant differences in any of these endpoints with respect to radiation therapy technique (p > 0.05 for all). Dosimetric analysis revealed that the use of IMRT resulted in significant improvements with respect to mean dose and V30 to the contralateral (spared) parotid gland. In addition, mean doses to the ipsilateral inner and middle ear structures were significantly reduced with IMRT (p < 0.05 for all). The incidence of severe xerostomia in the late setting was 58% and 11% among patients treated by CRT and IMRT, respectively (p < 0.001). The percentages of patients who were G-tube dependent at 6 months after treatment were 42% and 11%, respectively (p < 0.001). Conclusions: IMRT results in significant improvements in the therapeutic ratio among patients treated by radiation therapy for head-and-neck cancer of unknown primary origin.

Continuous quality improvement

NARCIS (Netherlands)

Rohlin, Madeleine; Schaub, Rob M.H.; Holbrook, Peter; Leibur, Edvitar; Lévy, Gérard; Roubalikova, Lenka; Nilner, Maria; Roger-Leroi, Valerie; Danner, Gunter; Iseri, Haluk; Feldman, Cecile

2002-01-01

Versch. in: Eur J Dent Educ; 6 (Suppl. 3): 67–77 Continuous quality improvement (CQI) can be envisaged as a circular process of goal-setting, followed by external and internal evaluations resulting in improvements that can serve as goals for a next cycle. The need for CQI is apparent, because of

Correlation of improved erectile function and rate of successful intercourse with improved emotional well-being assessed with the Self-Esteem And Relationship questionnaire in men treated with sildenafil for erectile dysfunction and stratified by age.

Science.gov (United States)

Steidle, Christopher P; Stecher, Vera J; Pace, Cindy; Tseng, Li-Jung

2006-05-01

The quality of life consequences of erectile dysfunction (ED) include depression, anxiety, and loss of self-esteem. The Self-Esteem And Relationship (SEAR) questionnaire is a validated, patient-administered, psychometric instrument specific to ED. To determine correlations between erectile function (EF), intercourse success, and emotional well-being measured with the SEAR questionnaire in men treated with sildenafil citrate for ED and stratified by age ( 65 years). This was an open-label, flexible-dose trial of sildenafil (25, 50 and 100 mg) administered for 10 weeks to 382 men with ED (mean +/- SD age, 55 +/- 13 years; mean ED duration, 4 years), which was conducted at 62 centers in the United States. Analysis (by intent-to-treat, n = 368) of the change from baseline to the week-10 endpoint in the SEAR questionnaire Self-Esteem subscale, the intercourse success rate (percent of occasions at which an erection that lasted long enough for successful intercourse was achieved), and their correlation. For the overall population, there was mean +/- SD improvement (p Erectile Function; event log frequency of erection hard enough for sexual intercourse and of ejaculation/orgasm) also improved (p 65 years, and six were positive in men aged erectile function and an increased intercourse success rate, which correlated positively with improvement in SEAR measures of self-esteem and sexual relationship.

Identification and content validation of wound therapy clinical endpoints relevant to clinical practice and patient values for FDA approval. Part 1. Survey of the wound care community.

Science.gov (United States)

Driver, Vickie R; Gould, Lisa J; Dotson, Peggy; Gibbons, Gary W; Li, William W; Ennis, William J; Kirsner, Robert S; Eaglstein, William H; Bolton, Laura L; Carter, Marissa J

2017-05-01

Wounds that exhibit delayed healing add extraordinary clinical, economic, and personal burdens to patients, as well as to increasing financial costs to health systems. New interventions designed to ease such burdens for patients with cancer, renal, or ophthalmologic conditions are often cleared for approval by the U.S. Food and Drug Administration (FDA) using multiple endpoints but the requirement of complete healing as a primary endpoint for wound products impedes FDA clearance of interventions that can provide other clinical or patient-centered benefits for persons with wounds. A multidisciplinary group of wound experts undertook an initiative, in collaboration with the FDA, to identify and content validate supporting FDA criteria for qualifying wound endpoints relevant to clinical practice (CP) and patient-centered outcomes (PCO) as primary outcomes in clinical trials. As part of the initiative, a research study was conducted involving 628 multidisciplinary expert wound clinicians and researchers from 4 different groups: the interdisciplinary core advisory team; attendees of the Spring 2015 Symposium on Advanced Wound Care (SAWC); clinicians employed by a national network of specialty clinics focused on comprehensive wound care; and Association for the Advancement of Wound Care (AAWC) and Wound Healing Society (WHS) members who had not previously completed the survey. The online survey assessed 28 literature-based wound care endpoints for their relevance and importance to clinical practice and clinical research. Fifteen of the endpoints were evaluated for their relevance to improving quality of life. Twenty-two endpoints had content validity indexes (CVI) ≥ 0.75, and 15 were selected as meriting potential inclusion as additional endpoints for FDA approval of future wound care interventions. This study represents an important first step in identifying and validating new measurable wound care endpoints for clinical research and practice and for regulatory

Can Quality Improvement System Improve Childcare Site Performance in School Readiness?

Science.gov (United States)

Ma, Xin; Shen, Jianping; Lu, Xuejin; Brandi, Karen; Goodman, Jeff; Watson, Grace

2013-01-01

The authors evaluated the effectiveness of the Quality Improvement System (QIS) developed and implemented by Children's Services Council of Palm Beach County (Florida) as a voluntary initiative to improve the quality of childcare and education. They adopted a growth model approach to investigate whether childcare sites that participated in QIS…

Improving School Improvement: Development and Validation of the CSIS-360, a 360-Degree Feedback Assessment for School Improvement Specialists

Science.gov (United States)

McDougall, Christie M.

2013-01-01

The purpose of the mixed methods study was to develop and validate the CSIS-360, a 360-degree feedback assessment to measure competencies of school improvement specialists from multiple perspectives. The study consisted of eight practicing school improvement specialists from a variety of settings. The specialists nominated 23 constituents to…

Evaluation of early efficacy endpoints for proof-of-concept trials.

Science.gov (United States)

Chen, Cong; Sun, Linda; Li, Chih-Lin

2013-03-11

A Phase II proof-of-concept (POC) trial usually uses an early efficacy endpoint other than a clinical endpoint as the primary endpoint. Because of the advancement in bioscience and technology, which has yielded a number of new surrogate biomarkers, drug developers often have more candidate endpoints to choose from than they can handle. As a result, selection of endpoint and its effect size as well as choice of type I/II error rates are often at the center of heated debates in design of POC trials. While optimization of the trade-off between benefit and cost is the implicit objective in such a decision-making process, it is seldom explicitly accounted for in practice. In this research note, motivated by real examples from the oncology field, we provide practical measures for evaluation of early efficacy endpoints (E4) for POC trials. We further provide optimal design strategies for POC trials that include optimal Go-No Go decision criteria for initiation of Phase III and optimal resource allocation strategies for conducting multiple POC trials in a portfolio under fixed resources. Although oncology is used for illustration purpose, the same idea developed in this research note also applies to similar situations in other therapeutic areas or in early-stage drug development in that a Go-No Go decision has to rely on limited data from an early efficacy endpoint and cost-effectiveness is the main concern.

Improved participants' understanding of research information in real settings using the SIDCER informed consent form: a randomized-controlled informed consent study nested with eight clinical trials.

Science.gov (United States)

Koonrungsesomboon, Nut; Tharavanij, Thipaporn; Phiphatpatthamaamphan, Kittichet; Vilaichone, Ratha-Korn; Manuwong, Sudsayam; Curry, Parichat; Siramolpiwat, Sith; Punchaipornpon, Thanachai; Kanitnate, Supakit; Tammachote, Nattapol; Yamprasert, Rodsarin; Chanvimalueng, Waipoj; Kaewkumpai, Ruchirat; Netanong, Soiphet; Kitipawong, Peerapong; Sritipsukho, Paskorn; Karbwang, Juntra

2017-02-01

This study aimed to test the applicability and effectiveness of the principles and informed consent form (ICF) template proposed by the Strategic Initiative for Developing Capacity in Ethical Review (SIDCER) across multiple clinical trials involving Thai research participants with various conditions. A single-center, randomized-controlled study nested with eight clinical trials was conducted at Thammasat University Hospital, Thailand. A total of 258 participants from any of the eight clinical trials were enrolled and randomly assigned to read either the SIDCER ICF (n = 130) or the conventional ICF (n = 128) of the respective trial. Their understanding of necessary information was assessed using the post-test questionnaire; they were allowed to consult a given ICF while completing the questionnaire. The primary endpoint was the proportion of the participants who had the post-test score of ≥80%, and the secondary endpoint was the total score of the post-test. The proportion of the participants in the SIDCER ICF group who achieved the primary endpoint was significantly higher than that of the conventional ICF group (60.8 vs. 41.4%, p = 0.002). The total score of the post-test was also significantly higher among the participants who read the SIDCER ICF than those who read the conventional ICF (83.3 vs. 76.0%, p study demonstrated that the SIDCER ICF was applicable and effective to improve Thai research participants' understanding of research information in diverse clinical trials. Using the SIDCER ICF methodology, clinical researchers can improve the quality of ICFs for their trials.

Establishment of Early Endpoints in Mouse Total-Body Irradiation Model.

Directory of Open Access Journals (Sweden)

Amory Koch

Full Text Available Acute radiation sickness (ARS following exposure to ionizing irradiation is characterized by radiation-induced multiorgan dysfunction/failure that refers to progressive dysfunction of two or more organ systems, the etiological agent being radiation damage to cells and tissues over time. Radiation sensitivity data on humans and animals has made it possible to describe the signs associated with ARS. A mouse model of total-body irradiation (TBI has previously been developed that represents the likely scenario of exposure in the human population. Herein, we present the Mouse Intervention Scoring System (MISS developed at the Veterinary Sciences Department (VSD of the Armed Forces Radiobiology Research Institute (AFRRI to identify moribund mice and decrease the numbers of mice found dead, which is therefore a more humane refinement to death as the endpoint. Survival rates were compared to changes in body weights and temperatures in the mouse (CD2F1 male TBI model (6-14 Gy, 60Co γ-rays at 0.6 Gy min-1, which informed improvements to the Scoring System. Individual tracking of animals via implanted microchips allowed for assessment of criteria based on individuals rather than by group averages. From a total of 132 mice (92 irradiated, 51 mice were euthanized versus only four mice that were found dead (7% of non-survivors. In this case, all four mice were found dead after overnight periods between observations. Weight loss alone was indicative of imminent succumbing to radiation injury, however mice did not always become moribund within 24 hours while having weight loss >30%. Only one survivor had a weight loss of greater than 30%. Temperature significantly dropped only 2-4 days before death/euthanasia in 10 and 14 Gy animals. The score system demonstrates a significant refinement as compared to using subjective assessment of morbidity or death as the endpoint for these survival studies.

Continuous quality improvement

International Nuclear Information System (INIS)

Bourne, P.B.

1985-01-01

This paper describes the various statistical tools used at the Hanford Engineering Development Laboratory to achieve continuous quality improvement in the development of Breeder Reactor Technology and in reactor operations. The role of the quality assurance professionals in this process, including quantifiable measurements using actual examples, is provided. The commitment to quality improvement through top management involvement is dramatically illustrated

The Relationship of Engagement in Improvement Practices to Outcome Measures in Large-Scale Quality Improvement Initiatives.

Science.gov (United States)

Foster, Gregory L; Kenward, Kevin; Hines, Stephen; Joshi, Maulik S

Hospital engagement networks (HENs) are part of the largest health care improvement initiative ever undertaken. This article explores whether engagement in improvement activities within a HEN affected quality measures. Data were drawn from 1174 acute care hospitals. A composite quality score was created from 10 targeted topic area measures multiplied by the number of qualifying topics. Scores improved from 5.4 (SD = 6.8) at baseline to 4.6 (5.9) at remeasurement; P improvement ( P improvement, whereas hospitals in the West ( P = .0009) did not improve as much as hospitals in other regions. After adjusting for hospital characteristics, hospitals with improvement champions ( P = .008), a higher level of engagement with their state association ( P = .001), and more leadership involvement ( P = .005) in HEN demonstrated greater improvement.

Quality improvement - the future begins

International Nuclear Information System (INIS)

Boissy, G.J.

1987-01-01

The comprehensive quality improvement program of the Florida Power and Light Co. is described: management commitment, quality improvement process, quality improvement teams, policy development, and quality in daily work are discussed

Ergonomic Improvements for Foundries

Energy Technology Data Exchange (ETDEWEB)

Frank Peters; Patrick Patterson

2002-06-18

The goal of this project was to make improvements to the production systems of the steel casting industry through ergonomic improvements. Because of the wide variety of products, the wide range of product sizes, and the relatively small quantities of any particular product, manual operations remain a vital part of the production systems of the steel casting companies. Ergonomic improvements will assist the operators to more efficiently and consistently produce quality products.

Measure to succeed: How to improve employee participation in continuous improvement

Energy Technology Data Exchange (ETDEWEB)

Jurburg, M.; Viles, E.; Tanco, M.; Mateo, R.; Lleó, A.

2016-07-01

Purpose: Achieving employee participation in continuous improvement (CI) systems is considered as one of the success factors for the sustainability of those systems. Yet, it is also very difficult to obtain because of the interaction of many critical factors that affect employee participation. Therefore, finding ways of measuring all these critical factors can help practitioners manage the employee participation process accordingly. Design/methodology/approach: Based upon the existing literature, this paper presents a 4-Phase (9 steps) diagnostic tool to measure the main determinants associated with the implementation of CI systems affecting employee participation in improvement activities. Findings: The tool showed its usefulness to detect the main weaknesses and improvement opportunities for improving employee participation in CI through the application in two different cases. Practical implications: This diagnostic tool could be particularly interesting for companies adopting CI and other excellence frameworks, which usually include a pillar related to people development inside the organization, but do not include tools to diagnose the state of this pillar. Originality/value: This diagnostic tool presents a user’s perspective approach, ensuring that the weaknesses and improvement opportunities detected during the diagnose come directly from the users of the CI system, which in this case are the employees themselves. Given that the final objective is to identify reasons and problems hindering employee participation, adopting this user’s perspective approach seem more relevant than adopting other more traditional approaches, based on gathering information from the CI system itself or from the CI managers.

Measure to succeed: How to improve employee participation in continuous improvement

International Nuclear Information System (INIS)

Jurburg, M.; Viles, E.; Tanco, M.; Mateo, R.; Lleó, A.

2016-01-01

Purpose: Achieving employee participation in continuous improvement (CI) systems is considered as one of the success factors for the sustainability of those systems. Yet, it is also very difficult to obtain because of the interaction of many critical factors that affect employee participation. Therefore, finding ways of measuring all these critical factors can help practitioners manage the employee participation process accordingly. Design/methodology/approach: Based upon the existing literature, this paper presents a 4-Phase (9 steps) diagnostic tool to measure the main determinants associated with the implementation of CI systems affecting employee participation in improvement activities. Findings: The tool showed its usefulness to detect the main weaknesses and improvement opportunities for improving employee participation in CI through the application in two different cases. Practical implications: This diagnostic tool could be particularly interesting for companies adopting CI and other excellence frameworks, which usually include a pillar related to people development inside the organization, but do not include tools to diagnose the state of this pillar. Originality/value: This diagnostic tool presents a user’s perspective approach, ensuring that the weaknesses and improvement opportunities detected during the diagnose come directly from the users of the CI system, which in this case are the employees themselves. Given that the final objective is to identify reasons and problems hindering employee participation, adopting this user’s perspective approach seem more relevant than adopting other more traditional approaches, based on gathering information from the CI system itself or from the CI managers.

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

International Nuclear Information System (INIS)

1981-01-01

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

Infrastructure for large-scale quality-improvement projects: early lessons from North Carolina Improving Performance in Practice.

Science.gov (United States)

Newton, Warren P; Lefebvre, Ann; Donahue, Katrina E; Bacon, Thomas; Dobson, Allen

2010-01-01

Little is known regarding how to accomplish large-scale health care improvement. Our goal is to improve the quality of chronic disease care in all primary care practices throughout North Carolina. Methods for improvement include (1) common quality measures and shared data system; (2) rapid cycle improvement principles; (3) quality-improvement consultants (QICs), or practice facilitators; (4) learning networks; and (5) alignment of incentives. We emphasized a community-based strategy and developing a statewide infrastructure. Results are reported from the first 2 years of the North Carolina Improving Performance in Practice (IPIP) project. A coalition was formed to include professional societies, North Carolina AHEC, Community Care of North Carolina, insurers, and other organizations. Wave One started with 18 practices in 2 of 9 regions of the state. Quality-improvement consultants recruited practices. Over 80 percent of practices attended all quarterly regional meetings. In 9 months, almost all diabetes measures improved, and a bundled asthma measure improved from 33 to 58 percent. Overall, the magnitude of improvement was clinically and statistically significant (P = .001). Quality improvements were maintained on review 1 year later. Wave Two has spread to 103 practices in all 9 regions of the state, with 42 additional practices beginning the enrollment process. Large-scale health care quality improvement is feasible, when broadly supported by statewide leadership and community infrastructure. Practice-collected data and lack of a control group are limitations of the study design. Future priorities include maintaining improved sustainability for practices and communities. Our long-term goal is to transform all 2000 primary-care practices in our state.

Hippeastrum hybridum anthocyanins as indicators of endpoint in acid

African Journals Online (AJOL)

Anthocyanins from Hippeastrum hybridum (Amaryllis) were investigated as indicators of endpoint in acid- base titrations. Extraction of the anthocyanins was done using distilled water, methanol and methanol containing 0.5% acetic acid. The extracts were used in determination of endpoint in titrations between strong.

Software Process Improvement Defined

DEFF Research Database (Denmark)

Aaen, Ivan

2002-01-01

This paper argues in favor of the development of explanatory theory on software process improvement. The last one or two decades commitment to prescriptive approaches in software process improvement theory may contribute to the emergence of a gulf dividing theorists and practitioners....... It is proposed that this divide be met by the development of theory evaluating prescriptive approaches and informing practice with a focus on the software process policymaking and process control aspects of improvement efforts...

An Improved Model of Nonuniform Coleochaete Cell Division.

Science.gov (United States)

Wang, Yuandi; Cong, Jinyu

2016-08-01

Cell division is a key biological process in which cells divide forming new daughter cells. In the present study, we investigate continuously how a Coleochaete cell divides by introducing a modified differential equation model in parametric equation form. We discuss both the influence of "dead" cells and the effects of various end-points on the formation of the new cells' boundaries. We find that the boundary condition on the free end-point is different from that on the fixed end-point; the former has a direction perpendicular to the surface. It is also shown that the outer boundaries of new cells are arc-shaped. The numerical experiments and theoretical analyses for this model to construct the outer boundary are given.

School Climate Improvement Action Guide for Working with Families. School Climate Improvement Resource Package

Science.gov (United States)

National Center on Safe Supportive Learning Environments, 2017

2017-01-01

Improving school climate takes time and commitment from a variety of people in a variety of roles. This document outlines how family members--including guardians of students--can support school climate improvements. Key action steps are provided for the following strategies: (1) Participate in planning for school climate improvements; (2) Engage…

School Climate Improvement Action Guide for Working with Students. School Climate Improvement Resource Package

Science.gov (United States)

National Center on Safe Supportive Learning Environments, 2017

2017-01-01

Improving school climate takes time and commitment from a variety of people in a variety of roles. This document outlines key action steps to engage students in the school climate improvement process. Key action steps are provided for the following strategies: (1) Participate in planning for school climate improvements; (2) Engage stakeholders in…

Two-step bacterial broad-range polymerase chain reaction analysis of heart valve tissue improves bacteriological diagnosis of infective endocarditis.

Science.gov (United States)

Boussier, Rémi; Rogez, Sylvie; François, Bruno; Denes, Eric; Ploy, Marie-Cécile; Garnier, Fabien

2013-03-01

Positive heart valve (HV) culture is a major Duke's criterion for the diagnosis of infective endocarditis but is poorly sensitive. Two broad-range 16S rDNA polymerase chain reaction (PCR) methods were applied to 31 HV samples: first, a real-time method, then conventional end-point PCR was applied to HV samples on which the first PCR was negative. Five specific real-time PCR procedures were also used in order to identify Bartonella spp., Tropheryma whipplei, Chlamydophila pneumoniae, Mycoplasma pneumonia, and Coxiella burnetii. A strategy combining the 2-step broad-range PCR methods improved the sensitivity of the molecular method from 38.7% to 58%. Specific PCR identified 1 T. whipplei, which was also identified by conventional end-point PCR. These results confirm that blood culture is the gold standard for the diagnosis of infective endocarditis, shows that molecular methods applied to HV can be useful when blood culture is negative, and that 2-step broad-range PCR approach seems to be more sensitive. Copyright © 2013 Elsevier Inc. All rights reserved.

Improv(ing) the Academy: Applied Improvisation as a Strategy for Educational Development

Science.gov (United States)

Rossing, Jonathan P.; Hoffmann-Longtin, Krista

2016-01-01

Improvisational theater training (or "improv") is a strategy employed by many business leaders and educators to cultivate creativity and collaboration amid change. Drawing on improv principles such as "Yes, And…" and "Make your scene partners look good," we explore the ways in which educational developers might apply…

Documentation of Improvement Competences

DEFF Research Database (Denmark)

Johansen, Jørn; Back, Karsten Kristensen; Korsaa, Morten

2017-01-01

This paper demonstrates how a report used in a Master in Project management and Process improvement training at Roskilde University Denmark can be used to evaluate if a student can pass the ECQA SPI Manager exam. It also demonstrates how the structure of the report addresses all necessary...... Manager job role, which is based on the SPI Manifesto and the ImprovAbilityTM model (part of ISO/IEC 33014 Guideline for Process Improvement) among other types of knowledge and research....... competences, which should or could be brought into play during the project – and therefor also in one way or another addresses the quality of the activated competences in the improvement project – a kind of qualification. The clue is that the structure of the report follows the units and element in the SPI...

Researchers' Roles in Patient Safety Improvement.

Science.gov (United States)

Pietikäinen, Elina; Reiman, Teemu; Heikkilä, Jouko; Macchi, Luigi

2016-03-01

In this article, we explore how researchers can contribute to patient safety improvement. We aim to expand the instrumental role researchers have often occupied in relation to patient safety improvement. We reflect on our own improvement model and experiences as patient safety researchers in an ongoing Finnish multi-actor innovation project through self-reflective narration. Our own patient safety improvement model can be described as systemic. Based on the purpose of the innovation project, our improvement model, and the improvement models of the other actors in the project, we have carried out a wide range of activities. Our activities can be summarized in 8 overlapping patient safety improvement roles: modeler, influencer, supplier, producer, ideator, reflector, facilitator, and negotiator. When working side by side with "practice," researchers are offered and engage in several different activities. The way researchers contribute to patient safety improvement and balance between different roles depends on the purpose of the study, as well as on the underlying patient safety improvement models. Different patient safety research paradigms seem to emphasize different improvement roles, and thus, they also face different challenges. Open reflection on the underlying improvement models and roles can help researchers with different backgrounds-as well as other actors involved in patient safety improvement-in structuring their work and collaborating productively.

Quality improvement: the nurse's role.

Science.gov (United States)

Moran, M J; Johnson, J E

1992-06-01

Continuous quality improvement is a concept which includes: Quality assurance--the provision of services that meet an appropriate standard. Problem resolution--including all departments involved in the issue at hand. Quality improvement--a continuous process involving all levels of the organization working together across departmental lines to produce better services for health care clients. Deming (1982b) and others have espoused total system reform to achieve quality improvement--not merely altering the current system, but radically changing it. It must be assumed that those who provide services at the staff level are acting in good faith and are not willfully failing to do what is correct (Berwick, 1991). Those who perform direct services are in an excellent position to identify the need for change in service delivery processes. Based on this premise, the staff nurse--who is at the heart of the system--is the best person to assess the status of health care services and to work toward improving the processes by which these services are provided to clients in the health care setting. The nurse manager must structure the work setting to facilitate the staff nurse's ability to undertake constructive action for improving care. The use of quality circles, quality councils, or quality improvement forums to facilitate the coordination of quality improvement efforts is an effective way to achieve success. The QA coordinator assists departments in documenting that the quality improvement efforts are effective across all departments of the organization, and aggregates data to demonstrate that they meet the requirements of external regulatory agencies, insurers, and professional standards. The nurse executive provides the vision and secures the necessary resources to ensure that the organization's quality improvement efforts are successful. By inspiring and empowering the staff in their efforts to improve the process by which health care is provided, nurse managers

Improving Reference Service: The Case for Using a Continuous Quality Improvement Method.

Science.gov (United States)

Aluri, Rao

1993-01-01

Discusses the evaluation of library reference service; examines problems with past evaluations, including the lack of long-term planning and a systems perspective; and suggests a method for continuously monitoring and improving reference service using quality improvement tools such as checklists, cause and effect diagrams, Pareto charts, and…

35/30 outage improvement project

International Nuclear Information System (INIS)

Clewett, L.

2011-01-01

Outage performance is a significant contributor to the business plan at Bruce Power. A process improvement initiative commenced in 2010-11 to improve outage efficiency and predictability. 12 teams (over 200 people) participated in improvement identification in four areas: Organizational Engagement; Outage Scope; Resources; and, Critical Outage Execution. Out of over 550 initiatives identified, 200 are being incorporated into the Outage Improvement Initiative. Key deliverables include: Development of a long-range 'fleet-level' business strategy to integrate outage duration, outage improvements and unit refurbishments; Development of a 35 day outage schedule template; Determining optimal outage organization to perform outages on an 8-unit site; Improved schedule adherence and productivity; Process to integrate scope needs to support life-cycle and long-range outage needs improvement while meeting near term and regulatory requirements; Consistent methodology in planning of outages to front-end load the high risk work into the outage schedule; Consistent baseline by senior leaders for the expectations of milestone ownership and completion; Consistent framework for milestone compliance and preparation; Communication strategy to educate personnel on the importance of the outage program and nuclear safety, business goals, and budget; and, Suite of metrics based upon industry benchmarks. The Outage Improvement Initiative has a goal of 35 day outages every 30 months. This potentially represents considerable savings to the Bruce Power business plan, both direct revenue savings attributed to reduced outage duration, as well as incremental outage cost savings. Other improvements from the initiative will include personnel radiation exposure and equipment reliability due to decreased outage duration and adherence to scoping, assessing and long lead part milestones. This presentation will describe the outage improvement initiatives to achieve a goal of consistent 35 day outages

35/30 outage improvement project

Energy Technology Data Exchange (ETDEWEB)

Clewett, L. [Bruce Power, Tiverton, Ontario (Canada)

2011-07-01

Outage performance is a significant contributor to the business plan at Bruce Power. A process improvement initiative commenced in 2010-11 to improve outage efficiency and predictability. 12 teams (over 200 people) participated in improvement identification in four areas: Organizational Engagement; Outage Scope; Resources; and, Critical Outage Execution. Out of over 550 initiatives identified, 200 are being incorporated into the Outage Improvement Initiative. Key deliverables include: Development of a long-range 'fleet-level' business strategy to integrate outage duration, outage improvements and unit refurbishments; Development of a 35 day outage schedule template; Determining optimal outage organization to perform outages on an 8-unit site; Improved schedule adherence and productivity; Process to integrate scope needs to support life-cycle and long-range outage needs improvement while meeting near term and regulatory requirements; Consistent methodology in planning of outages to front-end load the high risk work into the outage schedule; Consistent baseline by senior leaders for the expectations of milestone ownership and completion; Consistent framework for milestone compliance and preparation; Communication strategy to educate personnel on the importance of the outage program and nuclear safety, business goals, and budget; and, Suite of metrics based upon industry benchmarks. The Outage Improvement Initiative has a goal of 35 day outages every 30 months. This potentially represents considerable savings to the Bruce Power business plan, both direct revenue savings attributed to reduced outage duration, as well as incremental outage cost savings. Other improvements from the initiative will include personnel radiation exposure and equipment reliability due to decreased outage duration and adherence to scoping, assessing and long lead part milestones. This presentation will describe the outage improvement initiatives to achieve a goal of consistent 35 day

Cholinergic Potentiation and Audiovisual Repetition-Imitation Therapy Improve Speech Production and Communication Deficits in a Person with Crossed Aphasia by Inducing Structural Plasticity in White Matter Tracts.

Science.gov (United States)

Berthier, Marcelo L; De-Torres, Irene; Paredes-Pacheco, José; Roé-Vellvé, Núria; Thurnhofer-Hemsi, Karl; Torres-Prioris, María J; Alfaro, Francisco; Moreno-Torres, Ignacio; López-Barroso, Diana; Dávila, Guadalupe

2017-01-01

Donepezil (DP), a cognitive-enhancing drug targeting the cholinergic system, combined with massed sentence repetition training augmented and speeded up recovery of speech production deficits in patients with chronic conduction aphasia and extensive left hemisphere infarctions (Berthier et al., 2014). Nevertheless, a still unsettled question is whether such improvements correlate with restorative structural changes in gray matter and white matter pathways mediating speech production. In the present study, we used pharmacological magnetic resonance imaging to study treatment-induced brain changes in gray matter and white matter tracts in a right-handed male with chronic conduction aphasia and a right subcortical lesion (crossed aphasia). A single-patient, open-label multiple-baseline design incorporating two different treatments and two post-treatment evaluations was used. The patient received an initial dose of DP (5 mg/day) which was maintained during 4 weeks and then titrated up to 10 mg/day and administered alone (without aphasia therapy) during 8 weeks (Endpoint 1). Thereafter, the drug was combined with an audiovisual repetition-imitation therapy (Look-Listen-Repeat, LLR) during 3 months (Endpoint 2). Language evaluations, diffusion weighted imaging (DWI), and voxel-based morphometry (VBM) were performed at baseline and at both endpoints in JAM and once in 21 healthy control males. Treatment with DP alone and combined with LLR therapy induced marked improvement in aphasia and communication deficits as well as in selected measures of connected speech production, and phrase repetition. The obtained gains in speech production remained well-above baseline scores even 4 months after ending combined therapy. Longitudinal DWI showed structural plasticity in the right frontal aslant tract and direct segment of the arcuate fasciculus with both interventions. VBM revealed no structural changes in other white matter tracts nor in cortical areas linked by these tracts. In

Cholinergic Potentiation and Audiovisual Repetition-Imitation Therapy Improve Speech Production and Communication Deficits in a Person with Crossed Aphasia by Inducing Structural Plasticity in White Matter Tracts

Directory of Open Access Journals (Sweden)

Marcelo L. Berthier

2017-06-01

Full Text Available Donepezil (DP, a cognitive-enhancing drug targeting the cholinergic system, combined with massed sentence repetition training augmented and speeded up recovery of speech production deficits in patients with chronic conduction aphasia and extensive left hemisphere infarctions (Berthier et al., 2014. Nevertheless, a still unsettled question is whether such improvements correlate with restorative structural changes in gray matter and white matter pathways mediating speech production. In the present study, we used pharmacological magnetic resonance imaging to study treatment-induced brain changes in gray matter and white matter tracts in a right-handed male with chronic conduction aphasia and a right subcortical lesion (crossed aphasia. A single-patient, open-label multiple-baseline design incorporating two different treatments and two post-treatment evaluations was used. The patient received an initial dose of DP (5 mg/day which was maintained during 4 weeks and then titrated up to 10 mg/day and administered alone (without aphasia therapy during 8 weeks (Endpoint 1. Thereafter, the drug was combined with an audiovisual repetition-imitation therapy (Look-Listen-Repeat, LLR during 3 months (Endpoint 2. Language evaluations, diffusion weighted imaging (DWI, and voxel-based morphometry (VBM were performed at baseline and at both endpoints in JAM and once in 21 healthy control males. Treatment with DP alone and combined with LLR therapy induced marked improvement in aphasia and communication deficits as well as in selected measures of connected speech production, and phrase repetition. The obtained gains in speech production remained well-above baseline scores even 4 months after ending combined therapy. Longitudinal DWI showed structural plasticity in the right frontal aslant tract and direct segment of the arcuate fasciculus with both interventions. VBM revealed no structural changes in other white matter tracts nor in cortical areas linked by these

Accelerate Water Quality Improvement

Science.gov (United States)

EPA is committed to accelerating water quality improvement and minimizing negative impacts to aquatic life from contaminants and other stressors in the Bay Delta Estuary by working with California Water Boards to strengthen water quality improvement plans.

Entropy based software processes improvement

NARCIS (Netherlands)

Trienekens, J.J.M.; Kusters, R.J.; Kriek, D.; Siemons, P.

2009-01-01

Actual results of software process improvement projects show different levels of success. Although many software development organisations have adopted improvement models such as CMMI, it appears to be difficult to improve software development processes in the right way, e.g. tuned to the actual

Endpoints in pediatric pain studies

NARCIS (Netherlands)

M. van Dijk (Monique); I. Ceelie (Ilse); D. Tibboel (Dick)

2011-01-01

textabstractAssessing pain intensity in (preverbal) children is more difficult than in adults. Tools to measure pain are being used as primary endpoints [e.g., pain intensity, time to first (rescue) analgesia, total analgesic consumption, adverse effects, and long-term effects] in studies on the

Biomarkers of Host Response Predict Primary End-Point Radiological Pneumonia in Tanzanian Children with Clinical Pneumonia: A Prospective Cohort Study.

Directory of Open Access Journals (Sweden)

Laura K Erdman

Full Text Available Diagnosing pediatric pneumonia is challenging in low-resource settings. The World Health Organization (WHO has defined primary end-point radiological pneumonia for use in epidemiological and vaccine studies. However, radiography requires expertise and is often inaccessible. We hypothesized that plasma biomarkers of inflammation and endothelial activation may be useful surrogates for end-point pneumonia, and may provide insight into its biological significance.We studied children with WHO-defined clinical pneumonia (n = 155 within a prospective cohort of 1,005 consecutive febrile children presenting to Tanzanian outpatient clinics. Based on x-ray findings, participants were categorized as primary end-point pneumonia (n = 30, other infiltrates (n = 31, or normal chest x-ray (n = 94. Plasma levels of 7 host response biomarkers at presentation were measured by ELISA. Associations between biomarker levels and radiological findings were assessed by Kruskal-Wallis test and multivariable logistic regression. Biomarker ability to predict radiological findings was evaluated using receiver operating characteristic curve analysis and Classification and Regression Tree analysis.Compared to children with normal x-ray, children with end-point pneumonia had significantly higher C-reactive protein, procalcitonin and Chitinase 3-like-1, while those with other infiltrates had elevated procalcitonin and von Willebrand Factor and decreased soluble Tie-2 and endoglin. Clinical variables were not predictive of radiological findings. Classification and Regression Tree analysis generated multi-marker models with improved performance over single markers for discriminating between groups. A model based on C-reactive protein and Chitinase 3-like-1 discriminated between end-point pneumonia and non-end-point pneumonia with 93.3% sensitivity (95% confidence interval 76.5-98.8, 80.8% specificity (72.6-87.1, positive likelihood ratio 4.9 (3.4-7.1, negative likelihood ratio 0

Biomarkers of Host Response Predict Primary End-Point Radiological Pneumonia in Tanzanian Children with Clinical Pneumonia: A Prospective Cohort Study

Science.gov (United States)

Erdman, Laura K.; D’Acremont, Valérie; Hayford, Kyla; Kilowoko, Mary; Kyungu, Esther; Hongoa, Philipina; Alamo, Leonor; Streiner, David L.; Genton, Blaise; Kain, Kevin C.

2015-01-01

Background Diagnosing pediatric pneumonia is challenging in low-resource settings. The World Health Organization (WHO) has defined primary end-point radiological pneumonia for use in epidemiological and vaccine studies. However, radiography requires expertise and is often inaccessible. We hypothesized that plasma biomarkers of inflammation and endothelial activation may be useful surrogates for end-point pneumonia, and may provide insight into its biological significance. Methods We studied children with WHO-defined clinical pneumonia (n = 155) within a prospective cohort of 1,005 consecutive febrile children presenting to Tanzanian outpatient clinics. Based on x-ray findings, participants were categorized as primary end-point pneumonia (n = 30), other infiltrates (n = 31), or normal chest x-ray (n = 94). Plasma levels of 7 host response biomarkers at presentation were measured by ELISA. Associations between biomarker levels and radiological findings were assessed by Kruskal-Wallis test and multivariable logistic regression. Biomarker ability to predict radiological findings was evaluated using receiver operating characteristic curve analysis and Classification and Regression Tree analysis. Results Compared to children with normal x-ray, children with end-point pneumonia had significantly higher C-reactive protein, procalcitonin and Chitinase 3-like-1, while those with other infiltrates had elevated procalcitonin and von Willebrand Factor and decreased soluble Tie-2 and endoglin. Clinical variables were not predictive of radiological findings. Classification and Regression Tree analysis generated multi-marker models with improved performance over single markers for discriminating between groups. A model based on C-reactive protein and Chitinase 3-like-1 discriminated between end-point pneumonia and non-end-point pneumonia with 93.3% sensitivity (95% confidence interval 76.5–98.8), 80.8% specificity (72.6–87.1), positive likelihood ratio 4.9 (3.4–7

Biomarkers and correlative endpoints for immunotherapy trials.

Science.gov (United States)

Morse, Michael A; Osada, Takuya; Hobeika, Amy; Patel, Sandip; Lyerly, H Kim

2013-01-01

Immunotherapies for lung cancer are reaching phase III clinical trial, but the ultimate success likely will depend on developing biomarkers to guide development and choosing patient populations most likely to benefit. Because the immune response to cancer involves multiple cell types and cytokines, some spatially and temporally separated, it is likely that multiple biomarkers will be required to fully characterize efficacy of the vaccine and predict eventual benefit. Peripheral blood markers of response, such as the ELISPOT assay and cytokine flow cytometry analyses of peripheral blood mononuclear cells following immunotherapy, remain the standard approach, but it is increasingly important to obtain tissue to study the immune response at the site of the tumor. Earlier clinical endpoints such as response rate and progression-free survival do not correlate with overall survival demonstrated for some immunotherapies, suggesting the need to develop other intermediary clinical endpoints. Insofar as all these biomarkers and surrogate endpoints are relevant in multiple malignancies, it may be possible to extrapolate findings to immunotherapy of lung cancer.

Infrastructure for Large-Scale Quality-Improvement Projects: Early Lessons from North Carolina Improving Performance in Practice

Science.gov (United States)

Newton, Warren P.; Lefebvre, Ann; Donahue, Katrina E.; Bacon, Thomas; Dobson, Allen

2010-01-01

Introduction: Little is known regarding how to accomplish large-scale health care improvement. Our goal is to improve the quality of chronic disease care in all primary care practices throughout North Carolina. Methods: Methods for improvement include (1) common quality measures and shared data system; (2) rapid cycle improvement principles; (3)…

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

Science.gov (United States)

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

2012-07-01

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

An overview of techniques for linking high-dimensional molecular data to time-to-event endpoints by risk prediction models.

Science.gov (United States)

Binder, Harald; Porzelius, Christine; Schumacher, Martin

2011-03-01

Analysis of molecular data promises identification of biomarkers for improving prognostic models, thus potentially enabling better patient management. For identifying such biomarkers, risk prediction models can be employed that link high-dimensional molecular covariate data to a clinical endpoint. In low-dimensional settings, a multitude of statistical techniques already exists for building such models, e.g. allowing for variable selection or for quantifying the added value of a new biomarker. We provide an overview of techniques for regularized estimation that transfer this toward high-dimensional settings, with a focus on models for time-to-event endpoints. Techniques for incorporating specific covariate structure are discussed, as well as techniques for dealing with more complex endpoints. Employing gene expression data from patients with diffuse large B-cell lymphoma, some typical modeling issues from low-dimensional settings are illustrated in a high-dimensional application. First, the performance of classical stepwise regression is compared to stage-wise regression, as implemented by a component-wise likelihood-based boosting approach. A second issues arises, when artificially transforming the response into a binary variable. The effects of the resulting loss of efficiency and potential bias in a high-dimensional setting are illustrated, and a link to competing risks models is provided. Finally, we discuss conditions for adequately quantifying the added value of high-dimensional gene expression measurements, both at the stage of model fitting and when performing evaluation. Copyright © 2011 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Evaluation of non-radioactive endpoints of ex vivo local lymph node assay-BrdU to investigate select contact sensitizers.

Science.gov (United States)

Ulker, Ozge Cemiloglu; Ates, Ilker; Atak, Aysegul; Karakaya, Asuman

2013-01-01

The present study sought to verify the utility of the non-radioactive endpoints LLNA BrdU (5-bromo-2'-deoxyuridine) ex vivo incorporation and cytokine release using auricular lymph node cells isolated from BALB/c mice topically treated with a strong (formaldehyde or p-phenylene-diamine [PPD]), moderate sensitizer (cinnamal), or weak sensitizer (eugenol). Stimulation index (SI) and EC₃ values were calculated for each agent. Based on the results of ex vivo LLNA-BrdU assays, EC₃ values were calculated to be 0.29, 0.09, 1.91, and 16.60% for formaldehyde, PPD, cinnamal, and eugenol, respectively. These results were in good agreement with data from previous standard radioactive LLNA. Cytokine analyses indicated T(H)1 and T(H)2 cytokine involvement in the regulation of murine contact allergy and these could be utilized as endpoints in assessments of contact allergy in mice. In conclusion, the current study provided evidence that the non-radioactive endpoint LLNA BrdU ex vivo incorporation could be of use as a viable alternative approach to assess the skin sensitization potential of test compound with respect to improving animal welfare. This is of particular importance in the case of any laboratory where it might be difficult to handle and/or readily employ radioisotopes. Further studies will be required to confirm--across test agents--the reproducibility as well as the limits of utility of this new ex vivo BrdU method.

Improving Banking Supervision

OpenAIRE

Mayes, David G.

1998-01-01

This paper explains how banking supervision within the EU, and in Finland in particular, can be improved by the implementation of greater market discipline and related changes. Although existing EU law, institutions, market structures and practices of corporate governance restrict the scope for change, substantial improvements can be introduced now while there is a window of opportunity for change. The economy is growing H5ly and the consequences of the banking crises of the early 1990s have ...

Using Lean to Advance Quality Improvement Research.

Science.gov (United States)

Blackmore, Christopher Craig; Williams, Barbara L; Ching, Joan M; Chafetz, Lynne A; Kaplan, Gary S

2016-01-01

Quality improvement research skills are not commonplace among quality improvement practitioners, and research on the effectiveness of quality improvement has not always kept pace with improvement innovation. However, the Lean tools applied to quality improvement should be equally relevant to the advancement of quality improvement research. We applied the Lean methods to develop a simplified quality improvement publication pathway enabling a small research methodology group to increase quality improvement research throughout the institution. The key innovations of the pathway are horizontal integration of the quality improvement research methods group across the institution, implementation of a Lean quality improvement research pathway, and application of a just-in-time quality improvement research toolkit. This work provides a road map and tools for the acceleration of quality improvement research. At our institution, the Lean quality improvement research approach was associated with statistically significant increases in the number (annual mean increase from 3.0 to 8.5, p = .03) and breadth of published quality improvement research articles, and in the number of quality improvement research projects currently in process. Application of Lean methods to the quality improvement research process can aid in increasing publication of quality improvement articles from across the institution.

Improving Agile Software Practice

DEFF Research Database (Denmark)

Tjørnehøj, Gitte

2006-01-01

Software process improvement in small and agile organizations is often problematic, but achieving good SPI-assessments can still be necessary to stay in the marked or to meet demands of multinational owners. The traditional norm driven, centralized and control centered improvement approaches has...

Why Process Improvement Training Fails

Science.gov (United States)

Lu, Dawei; Betts, Alan

2011-01-01

Purpose: The purpose of this paper is to explore the underlying reasons why providing process improvement training, by itself, may not be sufficient to achieve the desired outcome of improved processes; and to attempt a conceptual framework of management training for more effective improvement. Design/methodology/approach: Two similar units within…

Modulation of the Gastrointestinal Microbiome with Nondigestible Fermentable Carbohydrates To Improve Human Health.

Science.gov (United States)

Deehan, Edward C; Duar, Rebbeca M; Armet, Anissa M; Perez-Muñoz, Maria Elisa; Jin, Mingliang; Walter, Jens

2017-09-01

There is a clear association between the gastrointestinal (GI) microbiome and the development of chronic noncommunicable diseases, providing a rationale for the development of strategies that target the GI microbiota to improve human health. In this article, we discuss the potential of supplementing the human diet with nondigestible fermentable carbohydrates (NDFCs) to modulate the composition, structure, diversity, and metabolic potential of the GI microbiome in an attempt to prevent or treat human disease. The current concepts by which NDFCs can be administered to humans, including prebiotics, fermentable dietary fibers, and microbiota-accessible carbohydrates, as well as the mechanisms by which these carbohydrates exert their health benefits, are discussed. Epidemiological research presents compelling evidence for the health effects of NDFCs, with clinical studies providing further support for some of these benefits. However, rigorously designed human intervention studies with well-established clinical markers and microbial endpoints are still essential to establish (i) the clinical efficiency of specific NDFCs, (ii) the causal role of the GI microbiota in these effects, (iii) the underlying mechanisms involved, and (iv) the degree by which inter-individual differences between GI microbiomes influence these effects. Such studies would provide the mechanistic understanding needed for a systematic application of NDFCs to improve human health via GI microbiota modulation while also allowing the personalization of these dietary strategies.

Increased physical activity improves sleep and mood outcomes in inactive people with insomnia: a randomized controlled trial.

Science.gov (United States)

Hartescu, Iuliana; Morgan, Kevin; Stevinson, Clare D

2015-10-01

While high levels of activity and exercise training have been associated with improvements in sleep quality, minimum levels of activity likely to improve sleep outcomes have not been explored. A two-armed parallel randomized controlled trial (N=41; 30 females) was designed to assess whether increasing physical activity to the level recommended in public health guidelines can improve sleep quality among inactive adults meeting research diagnostic criteria for insomnia. The intervention consisted of a monitored program of ≥150 min of moderate- to vigorous-intensity physical activity per week, for 6 months. The principal end-point was the Insomnia Severity Index at 6 months post-baseline. Secondary outcomes included measures of mood, fatigue and daytime sleepiness. Activity and light exposure were monitored throughout the trial using accelerometry and actigraphy. At 6 months post-baseline, the physical activity group showed significantly reduced insomnia symptom severity (F(8,26) = 5.16, P = 0.03), with an average reduction of four points on the Insomnia Severity Index; and significantly reduced depression and anxiety scores (F(6,28) = 5.61, P = 0.02; and F(6,28) = 4.41, P = 0.05, respectively). All of the changes were independent of daily light exposure. Daytime fatigue showed no significant effect of the intervention (F(8,26) = 1.84, P = 0.18). Adherence and retention were high. Internationally recommended minimum levels of physical activity improve daytime and night-time symptoms of chronic insomnia independent of daily light exposure levels. © 2015 European Sleep Research Society.

Quantitative research versus quality assurance, quality improvement, total quality management, and continuous quality improvement.

Science.gov (United States)

Vogelsang, J

1999-04-01

The purpose of this report is to provide a review of the scientific method used in the quantitative research studies for consumers, evaluators, and applied nurse researchers. The fundamental characteristics of the problem-solving/ performance-improvement processes of quality assurance, quality improvement, total quality management, and continuous quality improvement are described. Research is compared with these processes, and is followed by a discussion about the publication of quantitative research findings.

Improving with Kaizen

OpenAIRE

Dahl, Helene

2016-01-01

Master's thesis in Executive MBA Kaizen is a Japanese word translated to Good Change, but the meaning behind the word is continuous improvement. Kaizen events are a part of the Lean philosophy and developed by Toyota. The event typically takes place during 4-5 days and aims to make significant change by identifying possibilities for improvement. This thesis is a study of one Kaizen event that took place in an American oil-service company in Sandnes, Norway. A case study has been u...

KAIZEN CONTINUOUS IMPROVEMENT

OpenAIRE

Yenque D., Julio; García P., Manuel; Raez G., Luis

2014-01-01

Many times we ask the question why Japanese companies are competitive?, Surely many of the answers to this mystery have support in the Kaizen. And the Kaizen is not a simple concept, it is a whole way of life that involves both managers and workers in the pursuit of progressive improvement of enterprises. In his book Kaizen, The Key to Japanese Competitive Advantage, Masaaki Imai explains in simple terms what is the essence of this philosophy: Kaizen means improvement means further progressiv...

Historical Improvement in Speed Skating Economy

NARCIS (Netherlands)

Noordhof, Dionne A; Tok, Elmy van; Joosten, Florentine S J G M; Hettinga, Florentina J; Hoozemans, Marco J M; Foster Jr., Carl; Koning, Jos J de

Half the improvement in 1500-m speed-skating world records can be explained by technological innovations and the other half by athletic improvement. It is hypothesized that improved skating economy is accountable for much of the athletic improvement. PURPOSE: To determine skating economy in

Improving patient safety culture in Saudi Arabia (2012-2015): trending, improvement and benchmarking.

Science.gov (United States)

Alswat, Khalid; Abdalla, Rawia Ahmad Mustafa; Titi, Maher Abdelraheim; Bakash, Maram; Mehmood, Faiza; Zubairi, Beena; Jamal, Diana; El-Jardali, Fadi

2017-08-02

Measuring patient safety culture can provide insight into areas for improvement and help monitor changes over time. This study details the findings of a re-assessment of patient safety culture in a multi-site Medical City in Riyadh, Kingdom of Saudi Arabia (KSA). Results were compared to an earlier assessment conducted in 2012 and benchmarked with regional and international studies. Such assessments can provide hospital leadership with insight on how their hospital is performing on patient safety culture composites as a result of quality improvement plans. This paper also explored the association between patient safety culture predictors and patient safety grade, perception of patient safety, frequency of events reported and number of events reported. We utilized a customized version of the patient safety culture survey developed by the Agency for Healthcare Research and Quality. The Medical City is a tertiary care teaching facility composed of two sites (total capacity of 904 beds). Data was analyzed using SPSS 24 at a significance level of 0.05. A t-Test was used to compare results from the 2012 survey to that conducted in 2015. Two adopted Generalized Estimating Equations in addition to two linear models were used to assess the association between composites and patient safety culture outcomes. Results were also benchmarked against similar initiatives in Lebanon, Palestine and USA. Areas of strength in 2015 included Teamwork within units, and Organizational Learning-Continuous Improvement; areas requiring improvement included Non-Punitive Response to Error, and Staffing. Comparing results to the 2012 survey revealed improvement on some areas but non-punitive response to error and Staffing remained the lowest scoring composites in 2015. Regression highlighted significant association between managerial support, organizational learning and feedback and improved survey outcomes. Comparison to international benchmarks revealed that the hospital is performing at or

Brunswick improvement program

International Nuclear Information System (INIS)

Howe, P.W.

1985-01-01

The performance of the twin 790-MW Mark-4 boiling water reactors located at the Brunswick steam electric plant has historically been well below average. The plant experienced low availability, low capacity factors, high US Nuclear Regulatory Commission (NRC) violations, excessive radioactive waste generation, excessive licensee event reports (LERs), an unacceptable industrial safety record, poor SALP ratings, and numerous other deficiencies leading to unacceptable performance. In June 1982 it was determined that certain periodic tests (PT) had never been performed. While one unit was down for a refueling/modification outage, Carolina Power and Light (CP and L) elected to bring the other unit off line and perform an extensive self-examination. As a result, a number of needed improvements covering a wide range of plant activities were identified. CP and L elected to consolidate all the elements of the improvement into a single, plant-wide program. The consolidated program, called the Brunswick Improvement Program (BIP), was established. Major objectives of the BIP and measurable results are presented

Improving Loop Dependence Analysis

DEFF Research Database (Denmark)

Jensen, Nicklas Bo; Karlsson, Sven

2017-01-01

Programmers can no longer depend on new processors to have significantly improved single-thread performance. Instead, gains have to come from other sources such as the compiler and its optimization passes. Advanced passes make use of information on the dependencies related to loops. We improve th...

AGS slow extraction improvements

International Nuclear Information System (INIS)

Glenn, J.W.; Smith, G.A.; Sandberg, J.N.; Repeta, L.; Weisberg, H.

1979-01-01

Improvement of the straightness of the F5 copper septum increased the AGS slow extraction efficiency from approx. 80% to approx. 90%. Installation of an electrostatic septum at H2O, 24 betatron wavelengths upstream of F5, further improved the extraction efficiency to approx. 97%

Multi-Toxic Endpoints of the Foodborne Mycotoxins in Nematode Caenorhabditis elegans

Directory of Open Access Journals (Sweden)

Zhendong Yang

2015-12-01

Full Text Available Aflatoxins B1 (AFB1, deoxynivalenol (DON, fumonisin B1 (FB1, T-2 toxin (T-2, and zearalenone (ZEA are the major foodborne mycotoxins of public health concerns. In the present study, the multiple toxic endpoints of these naturally-occurring mycotoxins were evaluated in Caenorhabditis elegans model for their lethality, toxic effects on growth and reproduction, as well as influence on lifespan. We found that the lethality endpoint was more sensitive for T-2 toxicity with the EC50 at 1.38 mg/L, the growth endpoint was relatively sensitive for AFB1 toxic effects, and the reproduction endpoint was more sensitive for toxicities of AFB1, FB1, and ZEA. Moreover, the lifespan endpoint was sensitive to toxic effects of all five tested mycotoxins. Data obtained from this study may serve as an important contribution to knowledge on assessment of mycotoxin toxic effects, especially for assessing developmental and reproductive toxic effects, using the C. elegans model.

Nuclear safety. Improvement programme

International Nuclear Information System (INIS)

2000-01-01

In this brochure the improvement programme of nuclear safety of the Mochovce NPP is presented in detail. In 1996, a 'Mochovce NPP Nuclear Safety Improvement Programme' was developed in the frame of unit 1 and 2 completion project. The programme has been compiled as a continuous one, with the aim to reach the highest possible safety level at the time of commissioning and to establish good preconditions for permanent safety improvement in future. Such an approach is in compliance with the world's trends of safety improvement, life-time extension, modernisation and nuclear station power increase. The basic document for development of the 'Programme' is the one titled 'Safety Issues and their Ranking for WWER 440/213 NPP' developed by a group of IAEA experts. The following organisations were selected for solution of the safety measures: EUCOM (Consortium of FRAMATOME, France, and SIEMENS, Germany); SKODA Prague, a.s.; ENERGOPROJEKT Prague, a.s. (EGP); Russian organisations associated in ATOMENERGOEXPORT; VUJE Trnava, a.s

Improved radionuclide bone imaging agent injection needle withdrawal method can improve image quality

International Nuclear Information System (INIS)

Qin Yongmei; Wang Laihao; Zhao Lihua; Guo Xiaogang; Kong Qingfeng

2009-01-01

Objective: To investigate the improvement of radionuclide bone imaging agent injection needle withdrawal method on whole body bone scan image quality. Methods: Elbow vein injection syringe needle directly into the bone imaging agent in the routine group of 117 cases, with a cotton swab needle injection method for the rapid pull out the needle puncture point pressing, pressing moment. Improvement of 117 cases of needle injection method to put two needles into the skin swabs and blood vessels, pull out the needle while pressing two or more entry point 5min. After 2 hours underwent whole body bone SPECT imaging plane. Results: The conventional group at the injection site imaging agents uptake rate was 16.24%, improved group was 2.56%. Conclusion: The modified bone imaging agent injection needle withdrawal method, injection-site imaging agent uptake were significantly decreased whole body bone imaging can improve image quality. (authors)

Sensitive endpoints in extended one-generation reproductive toxicity study versus two generation?

DEFF Research Database (Denmark)

Christiansen, Sofie

. The protocol includes assessment of novel endpoints of concern and developmental landmarks such as anogenital distance, nipple retention (both sensitive endpoints for anti-androgenic effects in male offspring) and mammary gland development (sensitive endpoint for oestrogen action) and may also include...... during critical period of development in contrast to the parental generation. Retrospective analysis of available two-generation studies, however, indicate that the assessment included in the study of other endpoints in the male offspring such as histopathology of reproductive organs and semen quality...

Combining clinical microsystems and an experiential quality improvement curriculum to improve residency education in internal medicine.

Science.gov (United States)

Tess, Anjala V; Yang, Julius J; Smith, C Christopher; Fawcett, Caitlin M; Bates, Carol K; Reynolds, Eileen E

2009-03-01

Beth Israel Deaconess Medical Center's internal medicine residency program was admitted to the new Education Innovation Project accreditation pathway of the Accreditation Council of Graduate Medical Education to begin in July 2006. The authors restructured the inpatient medical service to create clinical microsystems in which residents practice throughout residency. Program leadership then mandated an active curriculum in quality improvement based in those microsystems. To provide the experience to every graduating resident, a core faculty in patient safety was trained in the basics of quality improvement. The authors hypothesized that such changes would increase the number of residents participating in quality improvement projects, improve house officer engagement in quality improvement work, enhance the culture of safety the residents perceive in their training environment, improve work flow on the general medicine ward rotations, and improve the overall educational experience for the residents on ward rotations.The authors describe the first 18 months of the intervention (July 2006 to January 2008). The authors assessed attitudes and the educational experience with surveys and evaluation forms. After the intervention, the authors documented residents' participation in projects that overlapped with hospital priorities. More residents reported roles in designing and implementing quality improvement changes. Residents also noted greater satisfaction with the quality of care they deliver. Fewer residents agreed or strongly agreed that the new admitting system interfered with communication. Ongoing residency program assessment showed an improved perception of workload, and educational ratings of rotations improved. The changes required few resources and can be transported to other settings.

Can training improve human performance

International Nuclear Information System (INIS)

Waylett, W.J. Jr.

1986-01-01

The nuclear industry has made a significant commitment to improve training through the implementation of performance-based training programs. Senior management expects that human performance improvement will result from this significant resource allocation. The author examines this hypothesis and discusses other issues that may interfere with enhancing human performance through training. The integration of quality improvement concepts to support training is also discussed by the author, who was a pioneer facilitator during the development of Florida Power and Light Company's Quality Improvement Program. Critical success factors are proposed based on the author's experience as a plant manager, training manager and quality facilitator

IMPROVING PATIENT SAFETY:

DEFF Research Database (Denmark)

Bagger, Bettan; Taylor Kelly, Hélène; Hørdam, Britta

Improving patient safety is both a national and international priority as millions of patients Worldwide suffer injury or death every year due to unsafe care. University College Zealand employs innovative pedagogical approaches in educational design. Regional challenges related to geographic......, social and cultural factors have resulted in a greater emphasis upon digital technology. Attempts to improve patient safety by optimizing students’ competencies in relation to the reporting of clinical errors, has resulted in the development of an interdisciplinary e-learning concept. The program makes...

Automated Student Model Improvement

Science.gov (United States)

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

2012-01-01

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

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.

An improvement project within urological care.

Science.gov (United States)

Khatami, Annelie; Rosengren, Kristina

2015-01-01

The purpose of this paper is to describe staff experiences in an on-going improvement project regarding patients with ureteral stones. A qualitative descriptive study based on eight group interviews and 48 narratives, was performed. Data were analysed using qualitative content analysis. Trustworthiness was ensured by using a well-documented improvement process method during six months. The results formed three categories: an absent comprehensive view; complexity; and vulnerability within the organisation. A holistic perspective regarding urological care at the micro-, meso- and macro-levels is needed to improve planning and caring processes. This study includes one team (six members, different health professionals) within the same urology department. Results show that staff need information, such as guidelines and support throughout the improvement work to deliver high-quality care. Moreover, there is a need for evidence-based guidelines at national level to support improvement work. Healthcare staff need to pay attention to all team member needs to improve urological care. Organisational and managerial aspect are needed to support clear and common goals regarding healthcare improvement work. Urological improvement projects, generally, are lacking, which is why this study is important to improve nephrolithiasis patient care.

Surrogate Endpoint Evaluation: Principal Stratification Criteria and the Prentice Definition.

Science.gov (United States)

Gilbert, Peter B; Gabriel, Erin E; Huang, Ying; Chan, Ivan S F

2015-09-01

A common problem of interest within a randomized clinical trial is the evaluation of an inexpensive response endpoint as a valid surrogate endpoint for a clinical endpoint, where a chief purpose of a valid surrogate is to provide a way to make correct inferences on clinical treatment effects in future studies without needing to collect the clinical endpoint data. Within the principal stratification framework for addressing this problem based on data from a single randomized clinical efficacy trial, a variety of definitions and criteria for a good surrogate endpoint have been proposed, all based on or closely related to the "principal effects" or "causal effect predictiveness (CEP)" surface. We discuss CEP-based criteria for a useful surrogate endpoint, including (1) the meaning and relative importance of proposed criteria including average causal necessity (ACN), average causal sufficiency (ACS), and large clinical effect modification; (2) the relationship between these criteria and the Prentice definition of a valid surrogate endpoint; and (3) the relationship between these criteria and the consistency criterion (i.e., assurance against the "surrogate paradox"). This includes the result that ACN plus a strong version of ACS generally do not imply the Prentice definition nor the consistency criterion, but they do have these implications in special cases. Moreover, the converse does not hold except in a special case with a binary candidate surrogate. The results highlight that assumptions about the treatment effect on the clinical endpoint before the candidate surrogate is measured are influential for the ability to draw conclusions about the Prentice definition or consistency. In addition, we emphasize that in some scenarios that occur commonly in practice, the principal strata sub-populations for inference are identifiable from the observable data, in which cases the principal stratification framework has relatively high utility for the purpose of effect

Surrogate Endpoint Evaluation: Principal Stratification Criteria and the Prentice Definition

Science.gov (United States)

Gilbert, Peter B.; Gabriel, Erin E.; Huang, Ying; Chan, Ivan S.F.

2015-01-01

A common problem of interest within a randomized clinical trial is the evaluation of an inexpensive response endpoint as a valid surrogate endpoint for a clinical endpoint, where a chief purpose of a valid surrogate is to provide a way to make correct inferences on clinical treatment effects in future studies without needing to collect the clinical endpoint data. Within the principal stratification framework for addressing this problem based on data from a single randomized clinical efficacy trial, a variety of definitions and criteria for a good surrogate endpoint have been proposed, all based on or closely related to the “principal effects” or “causal effect predictiveness (CEP)” surface. We discuss CEP-based criteria for a useful surrogate endpoint, including (1) the meaning and relative importance of proposed criteria including average causal necessity (ACN), average causal sufficiency (ACS), and large clinical effect modification; (2) the relationship between these criteria and the Prentice definition of a valid surrogate endpoint; and (3) the relationship between these criteria and the consistency criterion (i.e., assurance against the “surrogate paradox”). This includes the result that ACN plus a strong version of ACS generally do not imply the Prentice definition nor the consistency criterion, but they do have these implications in special cases. Moreover, the converse does not hold except in a special case with a binary candidate surrogate. The results highlight that assumptions about the treatment effect on the clinical endpoint before the candidate surrogate is measured are influential for the ability to draw conclusions about the Prentice definition or consistency. In addition, we emphasize that in some scenarios that occur commonly in practice, the principal strata sub-populations for inference are identifiable from the observable data, in which cases the principal stratification framework has relatively high utility for the purpose of

Improved Fourier-transform profilometry

International Nuclear Information System (INIS)

Mao Xianfu; Chen Wenjing; Su Xianyu

2007-01-01

An improved optical geometry of the projected-fringe profilometry technique, in which the exit pupil of the projecting lens and the entrance pupil of the imaging lens are neither at the same height above the reference plane nor coplanar, is discussed and used in Fourier-transform profilometry. Furthermore, an improved fringe-pattern description and phase-height mapping formula based on the improved geometrical generalization is deduced. Employing the new optical geometry, it is easier for us to obtain the full-field fringe by moving either the projector or the imaging device. Therefore the new method offers a flexible way to obtain reliable height distribution of a measured object

NCCDS configuration management process improvement

Science.gov (United States)

Shay, Kathy

1993-01-01

By concentrating on defining and improving specific Configuration Management (CM) functions, processes, procedures, personnel selection/development, and tools, internal and external customers received improved CM services. Job performance within the section increased in both satisfaction and output. Participation in achieving major improvements has led to the delivery of consistent quality CM products as well as significant decreases in every measured CM metrics category.

What is the most relevant standard of success in assisted reproduction? The next step to improving outcomes of IVF: consider the whole treatment.

OpenAIRE

Heijnen, E.M.; Macklon, Nick; Fauser, Bart

2004-01-01

textabstractChanging the way in which successful IVF treatment is defined offers a tool to improve efficacy while reducing costs and complications of treatment. Crucial to this paradigm shift is the move away from considering outcomes in terms of the single IVF cycle, and towards the started IVF treatment as a whole. We propose the most informative end-point of success in IVF to be the term singleton birth rate per started IVF treatment (or per given time period) in the overall context of pat...

Importance of soil-water relation in assessment endpoint in bioremediated soils: Plant growth and soil physical properties

International Nuclear Information System (INIS)

Li, X.; Sawatsky, N.

1995-01-01

Much effort has been focused on defining the end-point of bioremediated soils by chemical analysis (Alberta Tier 1 or CCME Guideline for Contaminated Soils) or toxicity tests. However, these tests do not completely assess the soil quality, or the capability of soil to support plant growth after bioremediation. This study compared barley (Hordeum vulgare) growth on: (i) non-contaminated, agricultural topsoil, (2) oil-contaminated soil (4% total extractable hydrocarbons, or TEH), and (3) oil-contaminated soil treated by bioremediation (< 2% TEH). Soil physical properties including water retention, water uptake, and water repellence were measured. The results indicated that the growth of barley was significantly reduced by oil-contamination of agricultural topsoil. Furthermore, bioremediation did not improve the barley yield. The lack of effects from bioremediation was attributed to development of water repellence in hydrocarbon contaminated soils. There seemed to be a critical water content around 18% to 20% in contaminated soils. Above this value the water uptake by contaminated soil was near that of the agricultural topsoil. For lower water contents, there was a strong divergence in sorptivity between contaminated and agricultural topsoil. For these soils, water availability was likely the single most important parameter controlling plant growth. This parameter should be considered in assessing endpoint of bioremediation for hydrocarbon contaminated soils

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

Science.gov (United States)

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

2011-04-01

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

The impact of endpoint measures in rheumatoid arthritis clinical trials

NARCIS (Netherlands)

van der Heide, A.; Jacobs, J. W.; Dinant, H. J.; Bijlsma, J. W.

1992-01-01

In clinical trials on the effectiveness of disease-modifying antirheumatic drugs (DMARDs) in patients with rheumatoid arthritis (RA), it is common to apply a large number of endpoint measures. This practice has several disadvantages. To determine which endpoint measures are most valuable, reports of

Improvability of assembly systems II: Improvability indicators and case study

Directory of Open Access Journals (Sweden)

S.-Y. Chiang

2000-01-01

Full Text Available Based on the performance analysis technique developed in Part I, this paper presents improvability indicators for assembly lines with unreliable machines. In particular, it shows that assembly lines are unimprovable with respect to workforce re-distribution if each buffer is, on the average, close to being half full. These lines are unimprovable with respect to buffer capacity re-distribution if each machine is starved and blocked with almost equal frequency. In addition, the paper provides indicators for identification of bottleneck machines and bottleneck buffers. Finally, the paper reports on an application of these improvability indicators in a case study at an automotive components plant.

Improved flywheel materials :

Energy Technology Data Exchange (ETDEWEB)

Boyle, Timothy J.; Bell, Nelson S; Ehlen, Mark Andrew; Anderson, Benjamin John; Miller, William Kenneth

2013-09-01

As alternative energy generating devices (i.e., solar, wind, etc) are added onto the electrical energy grid (AC grid), irregularities in the available electricity due to natural occurrences (i.e., clouds reducing solar input or wind burst increasing wind powered turbines) will be dramatically increased. Due to their almost instantaneous response, modern flywheel-based energy storage devices can act a mechanical mechanism to regulate the AC grid; however, improved spin speeds will be required to meet the necessary energy levels to balance these green energy variances. Focusing on composite flywheels, we have investigated methods for improving the spin speeds based on materials needs. The so-called composite flywheels are composed of carbon fiber (C-fiber), glass fiber, and a glue (resin) to hold them together. For this effort, we have focused on the addition of fillers to the resin in order to improve its properties. Based on the high loads required for standard meso-sized fillers, this project investigated the utility of ceramic nanofillers since they can be added at very low load levels due to their high surface area. The impact that TiO2 nanowires had on the final strength of the flywheel material was determined by a three-point-bend test. The results of the introduction of nanomaterials demonstrated an increase in strength of the flywheels C-fiber-resin moiety, with an upper limit of a 30% increase being reported. An analysis of the economic impact concerning the utilization of the nanowires was undertaken and after accounting for new-technology and additional production costs, return on improved-nanocomposite investment was approximated at 4-6% per year over the 20-year expected service life. Further, it was determined based on the 30% improvement in strength, this change may enable a 20-30% reduction in flywheel energy storage cost ($/kW-h).

Tablet computer enhanced training improves internal medicine exam performance.

Science.gov (United States)

Baumgart, Daniel C; Wende, Ilja; Grittner, Ulrike

2017-01-01

Traditional teaching concepts in medical education do not take full advantage of current information technology. We aimed to objectively determine the impact of Tablet PC enhanced training on learning experience and MKSAP® (medical knowledge self-assessment program) exam performance. In this single center, prospective, controlled study final year medical students and medical residents doing an inpatient service rotation were alternatingly assigned to either the active test (Tablet PC with custom multimedia education software package) or traditional education (control) group, respectively. All completed an extensive questionnaire to collect their socio-demographic data, evaluate educational status, computer affinity and skills, problem solving, eLearning knowledge and self-rated medical knowledge. Both groups were MKSAP® tested at the beginning and the end of their rotation. The MKSAP® score at the final exam was the primary endpoint. Data of 55 (tablet n = 24, controls n = 31) male 36.4%, median age 28 years, 65.5% students, were evaluable. The mean MKSAP® score improved in the tablet PC (score Δ + 8 SD: 11), but not the control group (score Δ- 7, SD: 11), respectively. After adjustment for baseline score and confounders the Tablet PC group showed on average 11% better MKSAP® test results compared to the control group (plearning to their respective training programs.

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

Science.gov (United States)

National Center on Safe Supportive Learning Environments, 2017

2017-01-01

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

School Climate Improvement Action Guide for Instructional Staff. School Climate Improvement Resource Package

Science.gov (United States)

National Center on Safe Supportive Learning Environments, 2017

2017-01-01

Improving school climate takes time and commitment from a variety of people in a variety of roles. This document outlines key action steps that instructional staff--including teachers, paraprofessionals, and others in the classroom who provide instruction or assistance--can take to support school climate improvements. Key action steps are provided…

School Climate Improvement Action Guide for District Leaders. School Climate Improvement Resource Package

Science.gov (United States)

National Center on Safe Supportive Learning Environments, 2017

2017-01-01

Improving school climate takes time and commitment from a variety of people in a variety of roles. This document outlines key action steps that district leaders--including superintendents, assistant superintendents, directors of student support services, or others--can take to support school climate improvements. Key action steps are provided for…

Biomechanical constraints on the feedforward regulation of endpoint stiffness.

Science.gov (United States)

Hu, Xiao; Murray, Wendy M; Perreault, Eric J

2012-10-01

Although many daily tasks tend to destabilize arm posture, it is still possible to have stable interactions with the environment by regulating the multijoint mechanics of the arm in a task-appropriate manner. For postural tasks, this regulation involves the appropriate control of endpoint stiffness, which represents the stiffness of the arm at the hand. Although experimental studies have been used to evaluate endpoint stiffness control, including the orientation of maximal stiffness, the underlying neural strategies remain unknown. Specifically, the relative importance of feedforward and feedback mechanisms has yet to be determined due to the difficulty separately identifying the contributions of these mechanisms in human experiments. This study used a previously validated three-dimensional musculoskeletal model of the arm to quantify the degree to which the orientation of maximal endpoint stiffness could be changed using only steady-state muscle activations, used to represent feedforward motor commands. Our hypothesis was that the feedforward control of endpoint stiffness orientation would be significantly constrained by the biomechanical properties of the musculoskeletal system. Our results supported this hypothesis, demonstrating substantial biomechanical constraints on the ability to regulate endpoint stiffness throughout the workspace. The ability to regulate stiffness orientation was further constrained by additional task requirements, such as the need to support the arm against gravity or exert forces on the environment. Together, these results bound the degree to which slowly varying feedforward motor commands can be used to regulate the orientation of maximum arm stiffness and provide a context for better understanding conditions in which feedback control may be needed.

Using implementation tools to design and conduct quality improvement projects for faster and more effective improvement.

Science.gov (United States)

Ovretveit, John; Mittman, Brian; Rubenstein, Lisa; Ganz, David A

2017-10-09

Purpose The purpose of this paper is to enable improvers to use recent knowledge from implementation science to carry out improvement changes more effectively. It also highlights the importance of converting research findings into practical tools and guidance for improvers so as to make research easier to apply in practice. Design/methodology/approach This study provides an illustration of how a quality improvement (QI) team project can make use of recent findings from implementation research so as to make their improvement changes more effective and sustainable. The guidance is based on a review and synthesis of improvement and implementation methods. Findings The paper illustrates how research can help a quality project team in the phases of problem definition and preparation, in design and planning, in implementation, and in sustaining and spreading a QI. Examples of the use of different ideas and methods are cited where they exist. Research limitations/implications The example is illustrative and there is little limited experimental evidence of whether using all the steps and tools in the one approach proposed do enable a quality team to be more effective. Evidence supporting individual guidance proposals is cited where it exists. Practical implications If the steps proposed and illustrated in the paper were followed, it is possible that quality projects could avoid waste by ensuring the conditions they need for success are in place, and sustain and spread improvement changes more effectively. Social implications More patients could benefit more quickly from more effective implementation of proven interventions. Originality/value The paper is the first to describe how improvement and implementation science can be combined in a tangible way that practical improvers can use in their projects. It shows how QI project teams can take advantage of recent advances in improvement and implementation science to make their work more effective and sustainable.

Improving operating room safety

Directory of Open Access Journals (Sweden)

Garrett Jill

2009-11-01

Full Text Available Abstract Despite the introduction of the Universal Protocol, patient safety in surgery remains a daily challenge in the operating room. This present study describes one community health system's efforts to improve operating room safety through human factors training and ultimately the development of a surgical checklist. Using a combination of formal training, local studies documenting operating room safety issues and peer to peer mentoring we were able to substantially change the culture of our operating room. Our efforts have prepared us for successfully implementing a standardized checklist to improve operating room safety throughout our entire system. Based on these findings we recommend a multimodal approach to improving operating room safety.

Improving inferior vena cava filter retrieval rates with the define, measure, analyze, improve, control methodology.

Science.gov (United States)

Sutphin, Patrick D; Reis, Stephen P; McKune, Angie; Ravanzo, Maria; Kalva, Sanjeeva P; Pillai, Anil K

2015-04-01

To design a sustainable process to improve optional inferior vena cava (IVC) filter retrieval rates based on the Define, Measure, Analyze, Improve, Control (DMAIC) methodology of the Six Sigma process improvement paradigm. DMAIC, an acronym for Define, Measure, Analyze, Improve, and Control, was employed to design and implement a quality improvement project to increase IVC filter retrieval rates at a tertiary academic hospital. Retrievable IVC filters were placed in 139 patients over a 2-year period. The baseline IVC filter retrieval rate (n = 51) was reviewed through a retrospective analysis, and two strategies were devised to improve the filter retrieval rate: (a) mailing of letters to clinicians and patients for patients who had filters placed within 8 months of implementation of the project (n = 43) and (b) a prospective automated scheduling of a clinic visit at 4 weeks after filter placement for all new patients (n = 45). The effectiveness of these strategies was assessed by measuring the filter retrieval rates and estimated increase in revenue to interventional radiology. IVC filter retrieval rates increased from a baseline of 8% to 40% with the mailing of letters and to 52% with the automated scheduling of a clinic visit 4 weeks after IVC filter placement. The estimated revenue per 100 IVC filters placed increased from $2,249 to $10,518 with the mailing of letters and to $17,022 with the automated scheduling of a clinic visit. Using the DMAIC methodology, a simple and sustainable quality improvement intervention was devised that markedly improved IVC filter retrieval rates in eligible patients. Copyright © 2015 SIR. Published by Elsevier Inc. All rights reserved.

Model-based software process improvement

Science.gov (United States)

Zettervall, Brenda T.

1994-01-01

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

School Climate Improvement Action Guide for School Leaders. School Climate Improvement Resource Package

Science.gov (United States)

National Center on Safe Supportive Learning Environments, 2017

2017-01-01

Improving school climate takes time and commitment from a variety of people in a variety of roles. This document outlines key action steps that school leaders--including principals, assistant/vice principals, and building leaders--can take to support school climate improvements. Key action steps are provided for the following strategies: (1)…

Inpatient preanalytic process improvements.

Science.gov (United States)

Wagar, Elizabeth A; Phipps, Ron; Del Guidice, Robert; Middleton, Lavinia P; Bingham, John; Prejean, Cheryl; Johnson-Hamilton, Martha; Philip, Pheba; Le, Ngoc Han; Muses, Waheed

2013-12-01

Phlebotomy services are a common target for preanalytic improvements. Many new, quality engineering tools have recently been applied in clinical laboratories. However, data on relatively few projects have been published. This example describes a complete application of current, quality engineering tools to improve preanalytic phlebotomy services. To decrease the response time in the preanalytic inpatient laboratory by 25%, to reduce the number of incident reports related to preanalytic phlebotomy, and to make systematic process changes that satisfied the stakeholders. The Department of Laboratory Medicine, General Services Section, at the University of Texas MD Anderson Cancer Center (Houston) is responsible for inpatient phlebotomy in a 24-hour operation, which serves 689 inpatient beds. The study director was project director of the Division of Pathology and Laboratory Medicine's Quality Improvement Section and was assisted by 2 quality technologists and an industrial engineer from MD Anderson Office of Performance Improvement. After implementing each solution, using well-recognized, quality tools and metrics, the response time for blood collection decreased by 23%, which was close to meeting the original responsiveness goal of 25%. The response time between collection and arrival in the laboratory decreased by 8%. Applicable laboratory-related incident reports were reduced by 43%. Comprehensive application of quality tools, such as statistical control charts, Pareto diagrams, value-stream maps, process failure modes and effects analyses, fishbone diagrams, solution prioritization matrices, and customer satisfaction surveys can significantly improve preset goals for inpatient phlebotomy.

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

Science.gov (United States)

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

2012-02-01

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

Statewide Quality Improvement Initiative to Reduce Early Elective Deliveries and Improve Birth Registry Accuracy.

Science.gov (United States)

Kaplan, Heather C; King, Eileen; White, Beth E; Ford, Susan E; Fuller, Sandra; Krew, Michael A; Marcotte, Michael P; Iams, Jay D; Bailit, Jennifer L; Bouchard, Jo M; Friar, Kelly; Lannon, Carole M

2018-04-01

To evaluate the success of a quality improvement initiative to reduce early elective deliveries at less than 39 weeks of gestation and improve birth registry data accuracy rapidly and at scale in Ohio. Between February 2013 and March 2014, participating hospitals were involved in a quality improvement initiative to reduce early elective deliveries at less than 39 weeks of gestation and improve birth registry data. This initiative was designed as a learning collaborative model (group webinars and a single face-to-face meeting) and included individual quality improvement coaching. It was implemented using a stepped wedge design with hospitals divided into three balanced groups (waves) participating in the initiative sequentially. Birth registry data were used to assess hospital rates of nonmedically indicated inductions at less than 39 weeks of gestation. Comparisons were made between groups participating and those not participating in the initiative at two time points. To measure birth registry accuracy, hospitals conducted monthly audits comparing birth registry data with the medical record. Associations were assessed using generalized linear repeated measures models accounting for time effects. Seventy of 72 (97%) eligible hospitals participated. Based on birth registry data, nonmedically indicated inductions at less than 39 weeks of gestation declined in all groups with implementation (wave 1: 6.2-3.2%, Pinitiative, they saw significant decreases in rates of early elective deliveries as compared with wave 3 (control; P=.018). All waves had significant improvement in birth registry accuracy (wave 1: 80-90%, P=.017; wave 2: 80-100%, P=.002; wave 3: 75-100%, Pinitiative enabled statewide spread of change strategies to decrease early elective deliveries and improve birth registry accuracy over 14 months and could be used for rapid dissemination of other evidence-based obstetric care practices across states or hospital systems.

SQIMSO: Quality Improvement for Small Software Organizations

OpenAIRE

Rabih Zeineddine; Nashat Mansour

2005-01-01

Software quality improvement process remains incomplete if it is not initiated and conducted through a wide improvement program that considers process quality improvement, product quality improvement and evolution of human resources. But, small software organizations are not capable of bearing the cost of establishing software process improvement programs. In this work, we propose a new software quality improvement model for small organizations, SQIMSO, based on three ...

SU-D-204-01: A Methodology Based On Machine Learning and Quantum Clustering to Predict Lung SBRT Dosimetric Endpoints From Patient Specific Anatomic Features

Energy Technology Data Exchange (ETDEWEB)

Lafata, K; Ren, L; Wu, Q; Kelsey, C; Hong, J; Cai, J; Yin, F [Duke University Medical Center, Durham, NC (United States)

2016-06-15

correlation between this feature and both endpoints. Conclusion: This pilot study shows that it is feasible to predict dose-volume endpoints based on patient-specific anatomic features. The developed methodology can potentially help to identify patients at risk for higher OAR doses, thus improving the efficiency of treatment planning. R01-184173.

Improved performance of the industry

International Nuclear Information System (INIS)

Jeffrey, R.

1994-01-01

The remarkable improvements in the performance of AGR stations is illustrated. The underlying reasons for this improvement are discussed, emphasizing both the operational performance factors which have led to higher sustained output and the managerial and cultural changes which have focused attention at all levels on the need to be competitive. It is concluded that the UK nuclear industry has become world class with more improvements to come, an asset to the UK. (Author)

Ergonomic Improvements for Foundries; FINAL

International Nuclear Information System (INIS)

Frank Peters; Patrick Patterson

2002-01-01

The goal of this project was to make improvements to the production systems of the steel casting industry through ergonomic improvements. Because of the wide variety of products, the wide range of product sizes, and the relatively small quantities of any particular product, manual operations remain a vital part of the production systems of the steel casting companies. Ergonomic improvements will assist the operators to more efficiently and consistently produce quality products

Improving Photosynthesis

Science.gov (United States)

Evans, John R.

2013-01-01

Photosynthesis is the basis of plant growth, and improving photosynthesis can contribute toward greater food security in the coming decades as world population increases. Multiple targets have been identified that could be manipulated to increase crop photosynthesis. The most important target is Rubisco because it catalyses both carboxylation and oxygenation reactions and the majority of responses of photosynthesis to light, CO2, and temperature are reflected in its kinetic properties. Oxygenase activity can be reduced either by concentrating CO2 around Rubisco or by modifying the kinetic properties of Rubisco. The C4 photosynthetic pathway is a CO2-concentrating mechanism that generally enables C4 plants to achieve greater efficiency in their use of light, nitrogen, and water than C3 plants. To capitalize on these advantages, attempts have been made to engineer the C4 pathway into C3 rice (Oryza sativa). A simpler approach is to transfer bicarbonate transporters from cyanobacteria into chloroplasts and prevent CO2 leakage. Recent technological breakthroughs now allow higher plant Rubisco to be engineered and assembled successfully in planta. Novel amino acid sequences can be introduced that have been impossible to reach via normal evolution, potentially enlarging the range of kinetic properties and breaking free from the constraints associated with covariation that have been observed between certain kinetic parameters. Capturing the promise of improved photosynthesis in greater yield potential will require continued efforts to improve carbon allocation within the plant as well as to maintain grain quality and resistance to disease and lodging. PMID:23812345

Improved reaction sintered silicon nitride. [protective coatings to improve oxidation resistance

Science.gov (United States)

Baumgartner, H. R.

1978-01-01

Processing treatments were applied to as-nitrided reaction sintered silicon nitride (RSSN) with the purposes of improving strength after processing to above 350 MN/m2 and improving strength after oxidation exposure. The experimental approaches are divided into three broad classifications: sintering of surface-applied powders; impregnation of solution followed by further thermal processing; and infiltration of molten silicon and subsequent carburization or nitridation of the silicon. The impregnation of RSSN with solutions of aluminum nitrate and zirconyl chloride, followed by heating at 1400-1500 C in a nitrogen atmosphere containing silicon monoxide, improved RSSN strength and oxidation resistance. The room temperature bend strength of RSSN was increased nearly fifty percent above the untreated strength with mean absolute strengths up to 420 MN/m2. Strengths of treated samples that were measured after a 12 hour oxidation exposure in air were up to 90 percent of the original as-nitrided strength, as compared to retained strengths in the range of 35 to 60 percent for untreated RSSN after the same oxidation exposure.

The success of opening single chronic total occlusion lesions to improve myocardialviabilitytrial (SOS-COMEDY)

Science.gov (United States)

Huang, Rongchong; Song, Xiantao; Zhang, Haishan; Tian, Wen; Huang, Zheng; Zhang, Xingwei; Yang, Junqing; Zhang, Dongfeng; Wu, Jian; Zhong, Lei; Ting, Henry H.

2018-01-01

Abstract Aims: Success of opening single (SOS)-comedy is a prospective multicenter study to compare the improvement in the decrease of myocardial viability by percutaneous coronary intervention (PCI) with that by optimal medical therapy (OMT) alone in patients with chronic total occlusion (CTO) of a single coronary artery. Methods and results: The risks and the benefits of both options (PCI and OMT) were listed in a CTO decision aid (DA). Eligible participants detected by invasive coronary angiography (ICA) or coronary computed tomography angiography (CCTA) were divided into PCI or OMT groups according to patients’ choice after shared-decision making process with DA. Participants will undergo positron emission tomography/computed tomography (PET/CT), cardiac magnetic resonance (CMR) and transthoracic echocardiography (TTE), and proceed to ICA and revascularization if possible. Blinded core laboratory interpretation will be performed for ICA, CCTA, PET/CT, CMR, and TTE. All participants will be followed up for 12 months. The primary endpoint is the improvement to the decrease of myocardial viability from baseline assessed with the use of PET/CT after 12-month follow-up. Conclusions: All of the patients are appropriately consented before enrolling in this study, which has been approved by the Ethics Committee. Results of SOS-COMEDY will be helpful to develop a strategy for single CTO patients. PMID:29668609

Improving Health Promotion Using Quality Improvement Techniques in Australian Indigenous Primary Health Care

Science.gov (United States)

Percival, Nikki; O’Donoghue, Lynette; Lin, Vivian; Tsey, Komla; Bailie, Ross Stewart

2016-01-01

Although some areas of clinical health care are becoming adept at implementing continuous quality improvement (CQI) projects, there has been limited experimentation of CQI in health promotion. In this study, we examined the impact of a CQI intervention on health promotion in four Australian Indigenous primary health care centers. Our study objectives were to (a) describe the scope and quality of health promotion activities, (b) describe the status of health center system support for health promotion activities, and (c) introduce a CQI intervention and examine the impact on health promotion activities and health centers systems over 2 years. Baseline assessments showed suboptimal health center systems support for health promotion and significant evidence-practice gaps. After two annual CQI cycles, there were improvements in staff understanding of health promotion and systems for planning and documenting health promotion activities had been introduced. Actions to improve best practice health promotion, such as community engagement and intersectoral partnerships, were inhibited by the way health center systems were organized, predominately to support clinical and curative services. These findings suggest that CQI can improve the delivery of evidence-based health promotion by engaging front line health practitioners in decision-making processes about the design/redesign of health center systems to support the delivery of best practice health promotion. However, further and sustained improvements in health promotion will require broader engagement of management, senior staff, and members of the local community to address organizational and policy level barriers. PMID:27066470

Improving health promotion using quality improvement techniques in Australian Indigenous primary health care

Directory of Open Access Journals (Sweden)

Nikki ePercival

2016-03-01

Full Text Available While some areas of clinical health care are becoming adept at implementing continuous quality improvement (CQI projects, there has been limited experimentation of CQI in health promotion. In this study, we examined the impact of a CQI intervention on health promotion in four Australian Indigenous primary health care centres. Our study objectives were to: (a describe the scope and quality of health promotion activities; (b describe the status of health centre system support for health promotion activities; and (c introduce a CQI intervention and examine the impact on health promotion activities and health centres systems over two years. Baseline assessments showed sub-optimal health centre systems support for health promotion and significant evidence-practice gaps. After two annual CQI cycles, there were improvements in staff understanding of health promotion and systems for planning and documenting health promotion activities had been introduced. Actions to improve best practice health promotion, such as community engagement and intersectoral partnerships, were inhibited by the way health centre systems were organized, predominately to support clinical and curative services. These findings suggest that CQI can improve the delivery of evidence based health promotion by engaging front line health practitioners in decision making processes about the design/redesign of health centre systems to support the delivery of best practice health promotion. However, further and sustained improvements in health promotion will require broader engagement of management, senior staff and members of the local community to address organisational and policy level barriers.

Improving Health Promotion Using Quality Improvement Techniques in Australian Indigenous Primary Health Care.

Science.gov (United States)

Percival, Nikki; O'Donoghue, Lynette; Lin, Vivian; Tsey, Komla; Bailie, Ross Stewart

2016-01-01

Although some areas of clinical health care are becoming adept at implementing continuous quality improvement (CQI) projects, there has been limited experimentation of CQI in health promotion. In this study, we examined the impact of a CQI intervention on health promotion in four Australian Indigenous primary health care centers. Our study objectives were to (a) describe the scope and quality of health promotion activities, (b) describe the status of health center system support for health promotion activities, and (c) introduce a CQI intervention and examine the impact on health promotion activities and health centers systems over 2 years. Baseline assessments showed suboptimal health center systems support for health promotion and significant evidence-practice gaps. After two annual CQI cycles, there were improvements in staff understanding of health promotion and systems for planning and documenting health promotion activities had been introduced. Actions to improve best practice health promotion, such as community engagement and intersectoral partnerships, were inhibited by the way health center systems were organized, predominately to support clinical and curative services. These findings suggest that CQI can improve the delivery of evidence-based health promotion by engaging front line health practitioners in decision-making processes about the design/redesign of health center systems to support the delivery of best practice health promotion. However, further and sustained improvements in health promotion will require broader engagement of management, senior staff, and members of the local community to address organizational and policy level barriers.

Identifying continuous quality improvement publications: what makes an improvement intervention 'CQI'?

Science.gov (United States)

O'Neill, Sean M; Hempel, Susanne; Lim, Yee-Wei; Danz, Marjorie S; Foy, Robbie; Suttorp, Marika J; Shekelle, Paul G; Rubenstein, Lisa V

2011-12-01

The term continuous quality improvement (CQI) is often used to refer to a method for improving care, but no consensus statement exists on the definition of CQI. Evidence reviews are critical for advancing science, and depend on reliable definitions for article selection. As a preliminary step towards improving CQI evidence reviews, this study aimed to use expert panel methods to identify key CQI definitional features and develop and test a screening instrument for reliably identifying articles with the key features. We used a previously published method to identify 106 articles meeting the general definition of a quality improvement intervention (QII) from 9427 electronically identified articles from PubMed. Two raters then applied a six-item CQI screen to the 106 articles. Per cent agreement ranged from 55.7% to 75.5% for the six items, and reviewer-adjusted intra-class correlation ranged from 0.43 to 0.62. 'Feedback of systematically collected data' was the most common feature (64%), followed by being at least 'somewhat' adapted to local conditions (61%), feedback at meetings involving participant leaders (46%), using an iterative development process (40%), being at least 'somewhat' data driven (34%), and using a recognised change method (28%). All six features were present in 14.2% of QII articles. We conclude that CQI features can be extracted from QII articles with reasonable reliability, but only a small proportion of QII articles include all features. Further consensus development is needed to support meaningful use of the term CQI for scientific communication.

Gene expression profiles in auricle skin as a possible additional endpoint for determination of sensitizers: A multi-endpoint evaluation of the local lymph node assay.

Science.gov (United States)

Tsuchiyama, Hiromi; Maeda, Akihisa; Nakajima, Mayumi; Kitsukawa, Mika; Takahashi, Kei; Miyoshi, Tomoya; Mutsuga, Mayu; Asaoka, Yoshiji; Miyamoto, Yohei; Oshida, Keiyu

2017-10-05

The murine local lymph node assay (LLNA) is widely used to test chemicals to induce skin sensitization. Exposure of mouse auricle skin to a sensitizer results in proliferation of local lymph node T cells, which has been measured by in vivo incorporation of H 3 -methyl thymidine or 5-bromo-2'-deoxyuridine (BrdU). The stimulation index (SI), the ratio of the mean proliferation in each treated group to that in the concurrent vehicle control group, is frequently used as a regulatory-authorized endpoint for LLNA. However, some non-sensitizing irritants, such as sodium dodecyl sulfate (SDS) or methyl salicylate (MS), have been reported as false-positives by this endpoint. In search of a potential endpoint to enhance the specificity of existing endpoints, we evaluated 3 contact sensitizers; (hexyl cinnamic aldehyde [HCA], oxazolone [OXA], and 2,4-dinitrochlorobenzene [DNCB]), 1 respiratory sensitizer (toluene 2,4-diisocyanate [TDI]), and 2 non-sensitizing irritants (MS and SDS) by several endpoints in LLNA. Each test substance was applied to both ears of female CBA/Ca mice daily for 3 consecutive days. The ears and auricle lymph node cells were analyzed on day 5 for endpoints including the SI value, lymph node cell count, cytokine release from lymph node cells, and histopathological changes and gene expression profiles in auricle skin. The SI values indicated that all the test substances induced significant proliferation of lymph node cells. The lymph node cell counts showed no significant changes by the non-sensitizers assessed. The inflammatory findings of histopathology were similar among the auricle skins treated by sensitizers and irritants. Gene expression profiles of cytokines IFN-γ, IL-4, and IL-17 in auricle skin were similar to the cytokine release profiles in draining lymph node cells. In addition, the gene expression of the chemokine CXCL1 and/or CXCL2 showed that it has the potential to discriminate sensitizers and non-sensitizing irritants. Our results

Right-handed currents at B→ K l+l− kinematic endpoint

Indian Academy of Sciences (India)

2017-10-09

Oct 9, 2017 ... The recent LHCb measured values of these observables are used to conclude an evidence of right-handed currents at the kinematic endpoint of this decay mode. As the conclusion is drawn at the maximum dilepton invariant mass square ( q 2 ) kinematic endpoint, it relies only on heavy quark symmetries ...

Status of the PSR improvement program

International Nuclear Information System (INIS)

Macek, R.J.; Fitzgerald, D.H.; Hoehn, M.V.; Ryder, R.D.; York, R.L.

1993-01-01

A program of improvements to increase intensity and improve reliability of the Los Alamos Proton Storage Ring (PSR) has been under way for several years. Reduction of stored beam loss rates by a factor of 4.6 since 1987 through exploitation of H 0 injection has allowed the average intensity to increase by a factor of two to 75μA. Reliability of the PSR and associated beam delivery systems has been improved by extensive rework of numerous subsystems. Radiation protection has been improved by additional shielding of Line D and extensive use of relatively fail-safe radiation detectors incorporated into an improved radiation security system

Capital Improvements Business Line

Science.gov (United States)

2012-08-08

NAVFAC Southwest Dan Waid Program & Business Mgmt NAVFAC SW Capital Improvements Business Line NAVFAC SW 8 August 2012 1 Report...REPORT TYPE 3. DATES COVERED 00-00-2012 to 00-00-2012 4. TITLE AND SUBTITLE Capital Improvements Business Line 5a. CONTRACT NUMBER 5b. GRANT...AVAILABILITY STATEMENT Approved for public release; distribution unlimited 13. SUPPLEMENTARY NOTES Presented at the 2012 Navy Gold Coast Small Business

Pollutant threshold concentration determination in marine ecosystems using an ecological interaction endpoint

International Nuclear Information System (INIS)

Wang, Changyou; Liang, Shengkang; Guo, Wenting; Yu, Hua; Xing, Wenhui

2015-01-01

The threshold concentrations of pollutants are determined by extrapolating single-species effect data to community-level effects. This assumes the most sensitive endpoint of the life cycle of individuals and the species sensitivity distribution from single-species toxic effect tests, thus, ignoring the ecological interactions. The uncertainties due to this extrapolation can be partially overcome using the equilibrium point of a customized ecosystem. This method incorporates ecological interactions and integrates the effects on growth, survival, and ingestion into a single effect measure, the equilibrium point excursion in the customized ecosystem, in order to describe the toxic effects on plankton. A case study showed that the threshold concentration of copper calculated with the endpoint of the equilibrium point was 10 μg L −1 , which is significantly different from the threshold calculated with a single-species endpoint. The endpoint calculated using this method provides a more relevant measure of the ecological impact than any single individual-level endpoint. - Highlights: • Ecotoxicological effect of exposure to copper was tested on a customized ecosystem. • Equilibrium point of biomasses in the customized ecosystem was used as an endpoint. • Exposure–response relationship in a community level was built on equilibrium point. • A threshold concentration incorporating ecological interactions was derived. - The equilibrium biomass incorporating ecological interactions in a customized ecosystem was used as an endpoint to calculate the threshold concentration at a community level

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

2016-05-06

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. Copyright © 2016 by the American

Adaptation improves face trustworthiness discrimination

Directory of Open Access Journals (Sweden)

Bruce D Keefe

2013-06-01

Full Text Available Adaptation to facial characteristics, such as gender and viewpoint, has been shown to both bias our perception of faces and improve facial discrimination. In this study, we examined whether adapting to two levels of face trustworthiness improved sensitivity around the adapted level. Facial trustworthiness was manipulated by morphing between trustworthy and untrustworthy prototypes, each generated by morphing eight trustworthy and eight untrustworthy faces respectively. In the first experiment, just-noticeable differences (JNDs were calculated for an untrustworthy face after participants adapted to an untrustworthy face, a trustworthy face, or did not adapt. In the second experiment, the three conditions were identical, except that JNDs were calculated for a trustworthy face. In the third experiment we examined whether adapting to an untrustworthy male face improved discrimination to an untrustworthy female face. In all experiments, participants completed a two-interval forced-choice adaptive staircase procedure, in which they judged which face was more untrustworthy. JNDs were derived from a psychometric function fitted to the data. Adaptation improved sensitivity to faces conveying the same level of trustworthiness when compared to no adaptation. When adapting to and discriminating around a different level of face trustworthiness there was no improvement in sensitivity and JNDs were equivalent to those in the no adaptation condition. The improvement in sensitivity was found to occur even when adapting to a face with different gender and identity. These results suggest that adaptation to facial trustworthiness can selectively enhance mechanisms underlying the coding of facial trustworthiness to improve perceptual sensitivity. These findings have implications for the role of our visual experience in the decisions we make about the trustworthiness of other individuals.

Improving Family Communication.

Science.gov (United States)

Medrano, Vilma; Bonilla, Gladys; Hernández, Ericka; Romanjek, Mariana Harnecker; Gómez, Adriana; Hernández, Jasón; Reyes, Marcela Ríos; Lindenberg, Cathy Strachan

2017-03-01

TeenSmart International harnesses the power and flexibility of technology to empower youth to take personal responsibility for their health and lifestyle choices. Access to the Internet via mobile phones is often cheaper than paying to connect to a wired broadband service, and in rural areas, mobile networks may be the only means of accessing the Internet. This study assessed the feasibility, acceptability, and impact of "cues to action" or brief motivating cell phone text messages to improve adolescent family communication and relationships. A quasi-experimental design using a voluntary sample of 100 Nicaraguan youth at high risk for poor family communication participated. Pre- and posttest quantitative measures using Student t statistical analysis, a focus group, and a participant testimony provided the evaluation evidence. Findings suggest that there are economic and motivational barriers to the use of text messages, but when barriers are eliminated, the behavioral results are positive. Youth who received two weekly text messages over a 6-month period demonstrated statistically significant improvements in family communication perceptions, attitudes, and behaviors, strengthening their family communications and relationships. Brief and personalized text messaging "cues to action" may be a cost-effective intervention to improve adolescent healthy lifestyle behaviors.

Improving patient handover between teams using a business improvement model: PDSA cycle.

Science.gov (United States)

Luther, Vishal; Hammersley, Daniel; Chekairi, Ahmed

2014-01-01

Medical admission units are continuously under pressure to move patients off the unit to outlying medical wards and allow for new admissions. In a typical district general hospital, doctors working in these medical wards reported that, on average, three patients each week arrived from the medical admission unit before any handover was received, and a further two patients arrived without any handover at all. A quality improvement project was therefore conducted using a 'Plan, Do, Study, Act' cycle model for improvement to address this issue. P - Plan: as there was no framework to support doctors with handover, a series of standard handover procedures were designed. D - Do: the procedures were disseminated to all staff, and championed by key stakeholders, including the clinical director and matron of the medical admission unit. S - STUDY: Measurements were repeated 3 months later and showed no change in the primary end points. A - ACT: The post take ward round sheet was redesigned, creating a checkbox for a medical admission unit doctor to document that handover had occurred. Nursing staff were prohibited from moving the patient off the ward until this had been completed. This later evolved into a separate handover sheet. Six months later, a repeat study revealed that only one patient each week was arriving before or without a verbal handover. Using a 'Plan, Do, Study, Act' business improvement tool helped to improve patient care.

Productivity quality improvement at UNC Geotech

International Nuclear Information System (INIS)

Jenkins, W.A.

1987-01-01

The program to improve productivity is presented in a series of view graphs. Key elements of the program are: CEO leadership and commitment; measurable improvements; specific annual goals; system for sharing benefits of improvements; practical training for employees; and intent to institutionalize

Improving requirements engineering by artefact orientation

NARCIS (Netherlands)

Méndez Fernández, Daniel; Wieringa, Roelf J.

2013-01-01

The importance of continuously improving requirements engineering (RE) has been recognised for many years. Similar to available software process improvement approaches, most RE improvement approaches focus on a normative and solution-driven assessment of companies rather than on a problem-driven RE

Turn-around improvements

International Nuclear Information System (INIS)

Redaelli, S.; Venturini Delsolaro, W.

2012-01-01

An efficient turn-around will be an important parameter for the integrated luminosity performance at LHC in 2012, when an operation with steady beam parameters and machine configuration will be achieved at the beginning of the run. Improvements of the operational cycle were already put successfully in place after the 2010 experience but additional ways to reduce the time required to setup collisions are possible. In this paper, the 2011 turn-around performance is reviewed and the benefits of the improvements from 2010 are presented. Phases of the operational cycle when further amelioration is possible are discussed and some proposal for a faster turn-around in 2012 are outlined. (authors)

Pregabalin Improves Pain Scores in Patients with Fibromyalgia Irrespective of Comorbid Osteoarthritis.

Science.gov (United States)

Argoff, Charles E; Emir, Birol; Whalen, Ed; Ortiz, Marie; Pauer, Lynne; Clair, Andrew

2016-11-01

Fibromyalgia (FM) is a chronic pain disorder with patients frequently suffering from comorbid conditions, including osteoarthritis (OA). Data on how FM patients with comorbid OA respond to recommended therapies (such as pregabalin) could help their treatment. This was a pooled exploratory analysis of three randomized placebo-controlled clinical trials of pregabalin in FM patients to assess the impact of comorbid OA on the response to pregabalin. Patients were divided into those with and without comorbid OA. Difference in change in least squares (LS) mean pain score at endpoint (assessed by 0-10 numeric rating scale, controlled for baseline pain score) with pregabalin (300 mg/day and 450 mg/day) vs placebo was assessed. Changes in Patient Global Impression of Change (PGIC) responders and Fibromyalgia Impact Questionnaire (FIQ) total score were also assessed. There were 1665 patients in the analysis set (558, placebo; 552, pregabalin 300 mg/day; 555, pregabalin 450 mg/day), including 296 with comorbid OA. Pregabalin 450 mg/day significantly improved the LS mean (95% confidence interval) difference in pain score vs placebo in patients with (0.99 [0.44, 1.55], P FIQ total score were observed in patients with and without comorbid OA. FM patients with or without comorbid OA respond to treatment with pregabalin 450mg/day with significant improvements in pain intensity scores. These data could provide guidance to healthcare professionals treating these patients. © 2016 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Three success factors for continual improvement in healthcare: an analysis of the reports of improvement team members.

Science.gov (United States)

Brandrud, Aleidis Skard; Schreiner, Ada; Hjortdahl, Per; Helljesen, Gro Sævil; Nyen, Bjørnar; Nelson, Eugene C

2011-03-01

The objectives of the Breakthrough Series Collaborative are to close the gap between what we know and what we do, and to contribute to continuous quality improvement (CQI) of healthcare through collaborative learning. The improvement efforts are guided by a systematic approach, combining professional and improvement knowledge. To explore what the improvement teams have learnt from participating in the collaborative and from dealing with promoting and inhibiting factors encountered. Qualitative interviews with 19 team members were conducted in four focus groups, using the Critical Incident Technique. A critical incident is one that makes significant contributions, either positively or negatively, to an activity. The elements of a culture of improvement are revealed by the critical incidents, and reflect the eight domains of knowledge, as a product of collaborative learning. The improvement knowledge and skills of individuals are important elements, but not enough to achieve sustainable changes. 90% of the material reflects the need for a system of CQI to solve the problems that organisations experience in trying to make lasting improvements. A pattern of three success factors for CQI emerges: (1) continuous and reliable information, including measurement, about best and current practice; (2) engagement of everybody in all phases of the improvement work: the patient and family, the leadership, the professional environment and the staff; and (3) an infrastructure based on improvement knowledge, with multidisciplinary teams, available coaching, learning systems and sustainability systems.

Endpoint-based parallel data processing in a parallel active messaging interface of a parallel computer

Science.gov (United States)

Archer, Charles J.; Blocksome, Michael A.; Ratterman, Joseph D.; Smith, Brian E.

2014-08-12

Endpoint-based parallel data processing in a parallel active messaging interface (`PAMI`) of a parallel computer, the PAMI composed of data communications endpoints, each endpoint including a specification of data communications parameters for a thread of execution on a compute node, including specifications of a client, a context, and a task, the compute nodes coupled for data communications through the PAMI, including establishing a data communications geometry, the geometry specifying, for tasks representing processes of execution of the parallel application, a set of endpoints that are used in collective operations of the PAMI including a plurality of endpoints for one of the tasks; receiving in endpoints of the geometry an instruction for a collective operation; and executing the instruction for a collective operation through the endpoints in dependence upon the geometry, including dividing data communications operations among the plurality of endpoints for one of the tasks.

Historical Improvement in Speed Skating Economy.

Science.gov (United States)

Noordhof, Dionne A; van Tok, Elmy; Joosten, Florentine S J G M; Hettinga, Florentina J; Hoozemans, Marco J M; Foster, Carl; de Koning, Jos J

2017-02-01

Half the improvement in 1500-m speed-skating world records can be explained by technological innovations and the other half by athletic improvement. It is hypothesized that improved skating economy is accountable for much of the athletic improvement. To determine skating economy in contemporary athletes and to evaluate the change in economy over the years. Contemporary skaters of the Dutch national junior team (n = 8) skated 3 bouts of 6 laps at submaximal velocity, from which skating economy was calculated (in mL O 2 ・ kg -1 ・ km -1 ). A literature search provided historic data on skating velocity and submaximal V̇O 2 (in mL ・ kg -1 ・ min -1 ), from which skating economy was determined. The association between year and skating economy was determined using linear-regression analysis. Correcting the change in economy for technological innovations resulted in an estimate of the association between year and economy due to athletic improvement. A mean (± SD) skating economy of 73.4 ± 6.4 mL O 2 ・ kg -1 ・ km -1 was found in contemporary athletes. Skating economy improved significantly over the historical time frame (-0.57 mL O 2 ・ kg -1 ・ km -1 ・ y -1 , 95% confidence interval [-0.84, -0.31]). In the final regression model for the klapskate era, with altitude as confounder, skating economy improved with a nonsignificant -0.58 mL O 2 ・ kg -1 ・ km -1 ・ y -1 ([-1.19, 0.035]). Skating economy was 73.4 ± 6.4 mL O 2 ・ kg -1 ・ km -1 in contemporary athletes and improved over the past ~50 y. The association between year and skating economy due to athletic improvement, for the klapskate era, approached significance, suggesting a possible improvement in economy over these years.

Pollutant threshold concentration determination in marine ecosystems using an ecological interaction endpoint.

Science.gov (United States)

Wang, Changyou; Liang, Shengkang; Guo, Wenting; Yu, Hua; Xing, Wenhui

2015-09-01

The threshold concentrations of pollutants are determined by extrapolating single-species effect data to community-level effects. This assumes the most sensitive endpoint of the life cycle of individuals and the species sensitivity distribution from single-species toxic effect tests, thus, ignoring the ecological interactions. The uncertainties due to this extrapolation can be partially overcome using the equilibrium point of a customized ecosystem. This method incorporates ecological interactions and integrates the effects on growth, survival, and ingestion into a single effect measure, the equilibrium point excursion in the customized ecosystem, in order to describe the toxic effects on plankton. A case study showed that the threshold concentration of copper calculated with the endpoint of the equilibrium point was 10 μg L(-1), which is significantly different from the threshold calculated with a single-species endpoint. The endpoint calculated using this method provides a more relevant measure of the ecological impact than any single individual-level endpoint. Copyright © 2015 Elsevier Ltd. All rights reserved.

The Gains from Improved Market Efficiency

DEFF Research Database (Denmark)

Persson, Karl Gunnar; Ejrnæs, Mette

faster, violations of the law of one price become smaller and hence less persistent. There were also significant gains from improved market efficiency but that improvement took place after the information ‘regime’ shifted from pre-telegraphic communication to a regime with swift transmission...... of information in an era which developed a sophisticated commercial press and telegraphic communication. Improved market efficiency probably stimulated trade more than falling transport costs......This paper looks at the gains from improved market efficiency in long-distance grain trade in the second half of the 19th century when violations of the law of one price were reduced due to improved information transmission. Two markets, a major export centre, Chicago, and a major importer...

Effectiveness of a program to improve antibiotic use in children hospitalized in a children's tertiary care facility in Argentina.

Science.gov (United States)

Ruvinsky, Silvina; Mónaco, Andrea; Pérez, Guadalupe; Taicz, Moira; Inda, Laura; Epelbaum, Carolina; Kijko, Ivana; Constanzo, Patricia; Bologna, Rosa

2014-04-01

Inadequate antibiotic use is associated with an increased emergence of resistant microorganisms, higher morbidity and mortality rates, and an impact on public health. To assess the effectiveness of a program aimed at improving the use of antimicrobials in patients hospitalized at Hospital Garrahan. Prospective, longitudinal, before and after study with no control group. From November 1st, 2010 to June 30th, 2011. Patients receiving parenteral antibiotics were included. Newborn infants, burned patients and those receiving prophylactic antibiotics were excluded. The periods before and after implementing discussion and monitoring workshops for antibiotic prescription and distributing treatment guidelines were compared. An univariate analysis and a multiple logistic regression study were performed (STATA 8.0). In the pre-intervention period,376 patients were included; of them, 35.6% had received inadequate treatment. The multiple regression analysis showed that the endpoints for inadequate antibiotic use were acute lower respiratory tract infection (OR: 3.80; 95% CI: 1.35-3.26; p=0.04), fever without a source in hospitalized patients (OR: 5.55; 95% CI: 2.43-12.6; p < 0.01), and febrile neutropenia (OR: 0.29; 95% CI: 0.10-0.7; p < 0.01). In the post-intervention period, 357 patients were included; 21.5% had received inadequate treatment. A reduction in inadequate antibiotic prescription was observed compared to the pre-intervention period (p < 0.01). The multiple regression analysis showed that endpoints for inadequate use were skin and soft tissue infections (OR: 0.33; 95% CI: 0.13-0.93; p = 0.035), and febrile neutropenia (OR: 0.48; 95% CI: 0.220.94; p= 0.04). The program was effective and allowed to improve antibiotic prescription practices in hospitalized children.

Evaluating Fidelity to a Modified NIATx Process Improvement Strategy for Improving HIV Services in Correctional Facilities.

Science.gov (United States)

Pankow, Jennifer; Willett, Jennifer; Yang, Yang; Swan, Holly; Dembo, Richard; Burdon, William M; Patterson, Yvonne; Pearson, Frank S; Belenko, Steven; Frisman, Linda K

2018-04-01

In a study aimed at improving the quality of HIV services for inmates, an organizational process improvement strategy using change teams was tested in 14 correctional facilities in 8 US states and Puerto Rico. Data to examine fidelity to the process improvement strategy consisted of quantitative ratings of the structural and process components of the strategy and qualitative notes that explicate challenges in maintaining fidelity to the strategy. Fidelity challenges included (1) lack of communication and leadership within change teams, (2) instability in team membership, and (3) issues with data utilization in decision-making to implement improvements to services delivery.

B cell increases and ex vivo IL-2 production as secondary endpoints for the detection of sensitizers in non-radioisotopic local lymph node assay using flow cytometry.

Science.gov (United States)

Jung, Kyoung-Mi; Jang, Won-Hee; Lee, Yong-Kyoung; Yum, Young Na; Sohn, Soojung; Kim, Bae-Hwan; Chung, Jin-Ho; Park, Young-Ho; Lim, Kyung-Min

2012-03-25

Non-radioisotopic local lymph node assay (LLNA) using 5-bromo-2'-deoxyuridine (BrdU) with flow cytometry (FCM) is gaining attention since it is free from the regulatory issues in traditional LLNA (tLLNA) accompanying in vivo uses of radioisotope, (3)H-thymidine. However, there is also concern over compromised performance of non-radioisotopic LLNA, raising needs for additional endpoints to improve the accuracy. With the full 22 reference substances enlisted in OECD Test Guideline No. 429, we evaluated the performance of LLNA:BrdU-FCM along with the concomitant measurements of B/T cell ratio and ex vivo cytokine production from isolated lymph node cells (LNCs) to examine the utility of these markers as secondary endpoints. Mice (Balb/c, female) were topically treated with substances on both ears for 3 days and then, BrdU was intraperitoneally injected on day 5. After a day, lymph nodes were isolated and undergone FCM to determine BrdU incorporation and B/T cell sub-typing with B220+ and CD3e+. Ex vivo cytokine production by LNCs was measured such as IL-2, IL-4, IL-6, IL-12, IFN-γ, MCP-1, GM-CSF and TNFα. Mice treated with sensitizers showed preferential increases in B cell population and the selective production of IL-2, which matched well with the increases in BrdU incorporation. When compared with guinea pig or human data, BrdU incorporation, B cell increase and IL-2 production ex vivo could successfully identify sensitizers with the accuracy comparable to tLLNA, suggesting that these markers may be useful for improving the accuracy of LLNA:BrdU-FCM or as stand-alone non-radioisotopic endpoints. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Improving Employees' Safety Awareness in Healthcare Organizations Using the DMAIC Quality Improvement Approach.

Science.gov (United States)

Momani, Amer; Hirzallah, Muʼath; Mumani, Ahmad

Occupational injuries and illnesses in healthcare can cause great human suffering, incur high cost, and have an adverse impact on the quality of patient care. One of the most effective solutions for addressing health and safety issues and improving decisions at the point of care rests in raising employees' safety awareness to recognize, avoid, or respond to potential problems before they arise. In this article, the DMAIC Six Sigma model (Define, Measure, Analyze, Improve, Control) is used as a systematic program to measure, improve, and sustain employees' safety awareness in healthcare organizations. We report on a case study using the model, which was implemented and validated at a local hospital. First, the occupational health and safety knowledge that each job requires was identified. Next, the degree of competence of jobholders to meet these requirements was assessed. Based on the assessment, different awareness-raising efforts were proposed and implemented. The results showed significant improvement in the overall safety awareness compliance assessed: from 74.2% to 84.4% (p < .001) after the intervention. The proposed model ensures that the organization's awareness-raising efforts serve its actual needs and produce optimized and sustained results that eventually lead to safer healthcare service.

Evaluation of an improved technique for lumen path definition and lumen segmentation of atherosclerotic vessels in CT angiography.

Science.gov (United States)

van Velsen, Evert F S; Niessen, Wiro J; de Weert, Thomas T; de Monyé, Cécile; van der Lugt, Aad; Meijering, Erik; Stokking, Rik

2007-07-01

Vessel image analysis is crucial when considering therapeutical options for (cardio-) vascular diseases. Our method, VAMPIRE (Vascular Analysis using Multiscale Paths Inferred from Ridges and Edges), involves two parts: a user defines a start- and endpoint upon which a lumen path is automatically defined, and which is used for initialization; the automatic segmentation of the vessel lumen on computed tomographic angiography (CTA) images. Both parts are based on the detection of vessel-like structures by analyzing intensity, edge, and ridge information. A multi-observer evaluation study was performed to compare VAMPIRE with a conventional method on the CTA data of 15 patients with carotid artery stenosis. In addition to the start- and endpoint, the two radiologists required on average 2.5 (SD: 1.9) additional points to define a lumen path when using the conventional method, and 0.1 (SD: 0.3) when using VAMPIRE. The segmentation results were quantitatively evaluated using Similarity Indices, which were slightly lower between VAMPIRE and the two radiologists (respectively 0.90 and 0.88) compared with the Similarity Index between the radiologists (0.92). The evaluation shows that the improved definition of a lumen path requires minimal user interaction, and that using this path as initialization leads to good automatic lumen segmentation results.

Evaluation of an improved technique for lumen path definition and lumen segmentation of atherosclerotic vessels in CT angiography

International Nuclear Information System (INIS)

Velsen, Evert F.S. van; Niessen, Wiro J.; Meijering, Erik; Stokking, Rik; Weert, Thomas T. de; Monye, Cecile de; Lugt, Aad van der

2007-01-01

Vessel image analysis is crucial when considering therapeutical options for (cardio-) vascular diseases. Our method, VAMPIRE (Vascular Analysis using Multiscale Paths Inferred from Ridges and Edges), involves two parts: a user defines a start- and endpoint upon which a lumen path is automatically defined, and which is used for initialization; the automatic segmentation of the vessel lumen on computed tomographic angiography (CTA) images. Both parts are based on the detection of vessel-like structures by analyzing intensity, edge, and ridge information. A multi-observer evaluation study was performed to compare VAMPIRE with a conventional method on the CTA data of 15 patients with carotid artery stenosis. In addition to the start- and endpoint, the two radiologists required on average 2.5 (SD: 1.9) additional points to define a lumen path when using the conventional method, and 0.1 (SD: 0.3) when using VAMPIRE. The segmentation results were quantitatively evaluated using Similarity Indices, which were slightly lower between VAMPIRE and the two radiologists (respectively 0.90 and 0.88) compared with the Similarity Index between the radiologists (0.92). The evaluation shows that the improved definition of a lumen path requires minimal user interaction, and that using this path as initialization leads to good automatic lumen segmentation results. (orig.)

Phenolic Esters of O-Desmethylvenlafaxine with Improved Oral Bioavailability and Brain Uptake

Directory of Open Access Journals (Sweden)

Yang Zhang

2013-12-01

Full Text Available O-Desmethylvenlafaxine (desvenlafaxine, ODV is a recently approved antidepressant which in some clinical studies failed to meet a satisfactory end-point. The aim of this study was to prepare a series of phenolic esters of ODV and evaluate their potential as ODV prodrugs with improved brain uptake. Fifteen phenolic esters (compounds 1a–o were synthesized and their pharmacokinetic profiles evaluated in rat. The four compounds producing the highest relative bioavailability of ODV in rat (compounds 1c, 1e, 1n, 1o were then studied to evaluate their brain uptake. Of these four compounds, compound 1n (the piperonylic acid ester of ODV demonstrated the highest Cmax of ODV both in the rat hypothalamus and total brain. Finally the pharmacokinetics of 1n were evaluated in beagle dog where the increase in relative bioavailability of ODV was found to be as great as in rat. This high relative bioavailability of ODV coupled with its good brain penetration make 1n the most promising candidate for development as an ODV prodrug.

Exercises to Improve Gait Abnormalities

Science.gov (United States)

... Articles Directories Videos Resources Contact Exercises to Improve Gait Abnormalities Home » Article Categories » Exercise and Fitness Font Size: A A A A Exercises to Improve Gait Abnormalities Next Page The manner of how a ...

Benchmarking for Cost Improvement. Final report

Energy Technology Data Exchange (ETDEWEB)

1993-09-01

The US Department of Energy`s (DOE) Office of Environmental Restoration and Waste Management (EM) conducted the Benchmarking for Cost Improvement initiative with three objectives: Pilot test benchmarking as an EM cost improvement tool; identify areas for cost improvement and recommend actions to address these areas; provide a framework for future cost improvement. The benchmarking initiative featured the use of four principal methods (program classification, nationwide cost improvement survey, paired cost comparison and component benchmarking). Interested parties contributed during both the design and execution phases. The benchmarking initiative was conducted on an accelerated basis. Of necessity, it considered only a limited set of data that may not be fully representative of the diverse and complex conditions found at the many DOE installations. The initiative generated preliminary data about cost differences and it found a high degree of convergence on several issues. Based on this convergence, the report recommends cost improvement strategies and actions. This report describes the steps taken as part of the benchmarking initiative and discusses the findings and recommended actions for achieving cost improvement. The results and summary recommendations, reported below, are organized by the study objectives.

Memory reactivation improves visual perception.

Science.gov (United States)

Amar-Halpert, Rotem; Laor-Maayany, Rony; Nemni, Shlomi; Rosenblatt, Jonathan D; Censor, Nitzan

2017-10-01

Human perception thresholds can improve through learning. Here we report findings challenging the fundamental 'practice makes perfect' basis of procedural learning theory, showing that brief reactivations of encoded visual memories are sufficient to improve perceptual discrimination thresholds. Learning was comparable to standard practice-induced learning and was not due to short training per se, nor to an epiphenomenon of primed retrieval enhancement. The results demonstrate that basic perceptual functions can be substantially improved by memory reactivation, supporting a new account of perceptual learning dynamics.

High volume improves outcomes: The argument for centralization of rectal cancer surgery.

Science.gov (United States)

Aquina, Christopher T; Probst, Christian P; Becerra, Adan Z; Iannuzzi, James C; Kelly, Kristin N; Hensley, Bradley J; Rickles, Aaron S; Noyes, Katia; Fleming, Fergal J; Monson, John R T

2016-03-01

Centralization of care to "centers of excellence" in Europe has led to improved oncologic outcomes; however, little is known regarding the impact of nonmandated regionalization of rectal cancer care in the United States. The Statewide Planning and Research Cooperative System (SPARCS) was queried for elective abdominoperineal and low anterior resections for rectal cancer from 2000 to 2011 in New York with the use of International Classification of Diseases, Ninth Revision codes. Surgeon volume and hospital volume were grouped into quartiles, and high-volume surgeons (≥ 10 resections/year) and hospitals (≥ 25 resections/year) were defined as the top quartile of annual caseload of rectal cancer resection and compared with the bottom 3 quartiles during analyses. Bivariate and multilevel regression analyses were performed to assess factors associated with restorative procedures, 30-day mortality, and temporal trends in these endpoints. Among 7,798 rectal cancer resections, the overall rate of no-restorative proctectomy and 30-day mortality decreased by 7.7% and 1.2%, respectively, from 2000 to 2011. In addition, there was a linear increase in the proportion of cases performed by both high-volume surgeons and high-volume hospitals and a decrease in the number of surgeons and hospitals performing rectal cancer surgery. High-volume surgeons at high-volume hospitals were associated independently with both less nonrestorative proctectomies (odds ratio 0.65, 95% confidence interval 0.48-0.89) and mortality (odds ratio 0.43, 95% confidence interval 0.21-0.87) rates. No patterns of significant improvement within the volume strata of the surgeon and hospitals were observed over time. This study suggests that the current trend toward regionalization of rectal cancer care to high-volume surgeons and high-volume centers has led to improved outcomes. These findings have implications regarding the policy of health care delivery in the United States, supporting referral to high

Teacher Research as Continuous Process Improvement

Science.gov (United States)

Ellis, Charles; Castle, Kathryn

2010-01-01

Purpose: Teacher research (inquiry) has been characterized as practice improvement, professional development and action research, among numerous names and descriptions. The purpose of this paper is to support the case that teacher research is also a form of quality improvement known as continuous process improvement (CPI).…

IMPACTS OF BUS STOP IMPROVEMENTS

Science.gov (United States)

2018-03-23

Improving bus stops by providing shelters, seating, signage, and sidewalks is relatively inexpensive and popular among riders and local officials. Making such improvements, however, is not often a priority for U.S. transit providers because of compet...

Effectiveness of a quality-improvement program in improving management of primary care practices

Science.gov (United States)

Szecsenyi, Joachim; Campbell, Stephen; Broge, Bjoern; Laux, Gunter; Willms, Sara; Wensing, Michel; Goetz, Katja

2011-01-01

Background: The European Practice Assessment program provides feedback and outreach visits to primary care practices to facilitate quality improvement in five domains (infrastructure, people, information, finance, and quality and safety). We examined the effectiveness of this program in improving management in primary care practices in Germany, with a focus on the domain of quality and safety. Methods: In a before–after study, 102 primary care practices completed a practice assessment using the European Practice Assessment instrument at baseline and three years later (intervention group). A comparative group of 102 practices was included that completed their first assessment using this instrument at the time of the intervention group’s second assessment. Mean scores were based on the proportion of indicators for which a positive response was achieved by all of the practices, on a scale of 0 to 100. Results: We found significant improvements in all domains between the first and second assessments in the intervention group. In the domain of quality and safety, improvements in scores (mean scores were based on the proportion of indicators for which a positive response was achieved by all of the practices, on a scale of 0 to 100) were observed in the following dimensions: complaint management (from a mean score of 51.2 at first assessment to 80.7 at second assessment); analysis of critical incidents (from 79.1 to 89.6); and quality development, quality policy (from 40.7 to 55.6). Overall scores at the time of the second assessment were significantly higher in the intervention group than in the comparative group. Interpretation: Primary care practices that completed the European Practice Assessment instrument twice over a three-year period showed improvements in practice management. Our findings show the value of the quality-improvement cycle in the context of practice assessment and the use of established organizational standards for practice management with the

Integration of quality improvement and cost-efficiency through industrial improvement techniques

Directory of Open Access Journals (Sweden)

Vink JP

2016-06-01

Full Text Available Jasper P Vink,1 Maxime T Rigaudy,1,2 Karl O Elmqvist11Imperial College Business School, Imperial College London, London, 2Hull York Medical School, York, UKIn this journal, Crema and Verbano1 discussed the importance of defining quality of health care and how quality can be improved through various industrial instruments and techniques. Quality of health care is a heavily debated topic that requires a wide scope of considerations across the many stakeholders of the health system. We acknowledge Crema and Verbano’s arguments that patient safety is a basic pillar of quality, upon which we would like to expand by highlighting the clinical effectiveness and patient-reported outcomes, which are the two further crucial components of quality. The arguments made regarding quality improvement techniques and cost efficiency in health care provision are insightful, yet appear to make a distinction between efforts to improve quality, eliminate waste from processes, and cut costs in health care provision. We would argue that in fact these achievements are all closely related and can be achieved simultaneously, if the industrial techniques of quality management are applied adequately.View the original paper by Crema and Verbano.

Nordic Walking improves daily physical activities in COPD: a randomised controlled trial

Directory of Open Access Journals (Sweden)

Breyer Marie-Kathrin

2010-08-01

Full Text Available Abstract Background In patients with COPD progressive dyspnoea leads to a sedentary lifestyle. To date, no studies exist investigating the effects of Nordic Walking in patients with COPD. Therefore, the aim was to determine the feasibility of Nordic Walking in COPD patients at different disease stages. Furthermore we aimed to determine the short- and long-term effects of Nordic Walking on COPD patients' daily physical activity pattern as well as on patients exercise capacity. Methods Sixty COPD patients were randomised to either Nordic Walking or to a control group. Patients of the Nordic Walking group (n = 30; age: 62 ± 9 years; FEV1: 48 ± 19% predicted underwent a three-month outdoor Nordic Walking exercise program consisting of one hour walking at 75% of their initial maximum heart rate three times per week, whereas controls had no exercise intervention. Primary endpoint: daily physical activities (measured by a validated tri-axial accelerometer; secondary endpoint: functional exercise capacity (measured by the six-minute walking distance; 6MWD. Assessment time points in both groups: baseline, after three, six and nine months. Results After three month training period, in the Nordic Walking group time spent walking and standing as well as intensity of walking increased (Δ walking time: +14.9 ± 1.9 min/day; Δ standing time: +129 ± 26 min/day; Δ movement intensity: +0.40 ± 0.14 m/s2 while time spent sitting decreased (Δ sitting time: -128 ± 15 min/day compared to baseline (all: p Conclusions Nordic Walking is a feasible, simple and effective physical training modality in COPD. In addition, Nordic Walking has proven to positively impact the daily physical activity pattern of COPD patients under short- and long-term observation. Clinical trial registration Nordic Walking improves daily physical activities in COPD: a randomised controlled trial - ISRCTN31525632

Cadastral Database Positional Accuracy Improvement

Science.gov (United States)

Hashim, N. M.; Omar, A. H.; Ramli, S. N. M.; Omar, K. M.; Din, N.

2017-10-01

Positional Accuracy Improvement (PAI) is the refining process of the geometry feature in a geospatial dataset to improve its actual position. This actual position relates to the absolute position in specific coordinate system and the relation to the neighborhood features. With the growth of spatial based technology especially Geographical Information System (GIS) and Global Navigation Satellite System (GNSS), the PAI campaign is inevitable especially to the legacy cadastral database. Integration of legacy dataset and higher accuracy dataset like GNSS observation is a potential solution for improving the legacy dataset. However, by merely integrating both datasets will lead to a distortion of the relative geometry. The improved dataset should be further treated to minimize inherent errors and fitting to the new accurate dataset. The main focus of this study is to describe a method of angular based Least Square Adjustment (LSA) for PAI process of legacy dataset. The existing high accuracy dataset known as National Digital Cadastral Database (NDCDB) is then used as bench mark to validate the results. It was found that the propose technique is highly possible for positional accuracy improvement of legacy spatial datasets.

A web-based endpoint adjudication system for interim analyses in clinical trials.

Science.gov (United States)

Nolen, Tracy L; Dimmick, Bill F; Ostrosky-Zeichner, Luis; Kendrick, Amy S; Sable, Carole; Ngai, Angela; Wallace, Dennis

2009-02-01

A data monitoring committee (DMC) is often employed to assess trial progress and review safety data and efficacy endpoints throughout a trail. Interim analyses performed for the DMC should use data that are as complete and verified as possible. Such analyses are complicated when data verification involves subjective study endpoints or requires clinical expertise to determine each subject's status with respect to the study endpoint. Therefore, procedures are needed to obtain adjudicated data for interim analyses in an efficient manner. In the past, methods for handling such data included using locally reported results as surrogate endpoints, adjusting analysis methods for unadjudicated data, or simply performing the adjudication as rapidly as possible. These methods all have inadequacies that make their sole usage suboptimal. For a study of prophylaxis for invasive candidiasis, adjudication of both study eligibility criteria and clinical endpoints prior to two interim analyses was required. Because the study was expected to enroll at a moderate rate and the sponsor required adjudicated endpoints to be used for interim analyses, an efficient process for adjudication was required. We created a web-based endpoint adjudication system (WebEAS) that allows for expedited review by the endpoint adjudication committee (EAC). This system automatically identifies when a subject's data are complete, creates a subject profile from the study data, and assigns EAC reviewers. The reviewers use the WebEAS to review the subject profile and submit their completed review form. The WebEAS then compares the reviews, assigns an additional review as a tiebreaker if needed, and stores the adjudicated data. The study for which this system was originally built was administratively closed after 10 months with only 38 subjects enrolled. The adjudication process was finalized and the WebEAS system activated prior to study closure. Some website accessibility issues presented initially. However

Improved flare tip design

Energy Technology Data Exchange (ETDEWEB)

Gogolek, P. [Natural Resources Canada, Ottawa, ON (Canada). CANMET Energy Technology Centre

2004-07-01

This paper discusses the testing procedures and development of an improved flare tip design. Design objectives included performance equal to or better than utility flares at low wind speed; conversion efficiency; fuel slip; smoking; significant improvement at high wind speed; and no increase in trace emissions. A description of the testing facility of the flare tip was provided, with reference to the fact that the facility allowed for realistic near full scale gas flares in a single-pass flare test facility. Other details of the facility included: an adjustable ceiling; high capacity variable speed fan; sampling ports along working section in stack; windows along working section; and air cooled walls, floor, and ceiling. The fuels used in the flare tip included natural gas, propane, gasoline and inert gases. Details of wind speed, appurtenances and turbulence generating grids were presented, with reference to continuous gas emission measurements. A list of design constraints was provided. Flare performance included wind speed, turbulence and fuel composition. A chart of conversion inefficiencies with a correlation of wind speed and turbulence, fuel flow and pipe size was also presented. Several new tip designs were fabricated for testing, with screening tests for comparison to basic pipe and ranking designs. Significant improvements were found in one of the new designs, including results with 30 per cent propane in fuel. Emissions reduction from 10 to 35 per cent were noted. It was concluded that future work should focus on evaluating improved tip for stability at low wind speeds. Fuel slips are the primary source of emissions, and it was recommended that further research is necessary to improve existing flare tips. tabs, figs.

Some possible improvements in scintillation calorimeters

International Nuclear Information System (INIS)

Lorenz, E.

1985-03-01

Two ideas for improvements of scintillation calorimeters will be presented: a) improved readout of scintillating, totally active electromagnetic calorimeters with combinations of silicon photodiodes and fluorescent panel collectors, b) use of time structure analysis on calorimetry, both for higher rate applications and improved resolution for hadron calorimeters. (orig.)

Do Clinical Practice Guidelines Improve Quality?

Science.gov (United States)

Baldassari, Cristina M

2017-07-01

Controversy exists surrounding how to best define and assess quality in the health care setting. Clinical practice guidelines (CPGs) have been developed to improve the quality of medical care by highlighting key clinical recommendations based on recent evidence. However, data linking CPGs to improvements in outcomes in otolaryngology are lacking. Numerous barriers contribute to difficulties in translating CPGs to improvements in quality. Future initiatives are needed to improve CPG adherence and define the impact of CPG recommendations on the quality of otolaryngologic care provided to our patients.

Implementation of a Quality Improvement Initiative: Improved Congenital Muscular Torticollis Outcomes in a Large Hospital Setting.

Science.gov (United States)

Strenk, Mariann L; Kiger, Michelle; Hawke, Jesse L; Mischnick, Amy; Quatman-Yates, Catherine

2017-06-01

The American Physical Therapy Association (APTA) published a guideline for congenital muscular torticollis (CMT) in 2013. Our division adopted the guideline as the institutional practice standard and engaged in a quality improvement (QI) initiative to increase the percentage of patients who achieved resolution of CMT within 6 months of evaluation. The aims of this report are to describe the QI activities conducted to improve patient outcomes and discuss the results and implications for other institutions and patient populations. This was a quality improvement study. In alignment with the Chronic Care Model and Model of Improvement, an aim and operationally defined key outcome and process measures were established. Interventions were tested using Plan-Do-Study-Act cycles. A CMT registry was established to store and manage data extracted from the electronic record over the course of testing. Statistical process control charts were used to monitor progress over time. The QI initiative resulted in an increase in the percentage of patients who achieved full resolution of CMT within a 6-month episode of care from 42% to 61% over an 18-month period. Themes that emerged as key drivers of improvement included: (1) timely, optimal access to care, (2) effective audit and clinician feedback, and (3) accurate, timely documentation. The initiative took place at a single institution with a supportive culture and strong QI resources, which may limit direct translation of interventions and findings to other institutions and patient populations. Improvement science methodologies provided the tools and structure to improve division-wide workflow and increase consistency in the implementation of the APTA CMT guideline. In doing so, significant CMT population outcome improvements were achieved. © 2017 American Physical Therapy Association

Modeling hard clinical end-point data in economic analyses.

Science.gov (United States)

Kansal, Anuraag R; Zheng, Ying; Palencia, Roberto; Ruffolo, Antonio; Hass, Bastian; Sorensen, Sonja V

2013-11-01

The availability of hard clinical end-point data, such as that on cardiovascular (CV) events among patients with type 2 diabetes mellitus, is increasing, and as a result there is growing interest in using hard end-point data of this type in economic analyses. This study investigated published approaches for modeling hard end-points from clinical trials and evaluated their applicability in health economic models with different disease features. A review of cost-effectiveness models of interventions in clinically significant therapeutic areas (CV diseases, cancer, and chronic lower respiratory diseases) was conducted in PubMed and Embase using a defined search strategy. Only studies integrating hard end-point data from randomized clinical trials were considered. For each study included, clinical input characteristics and modeling approach were summarized and evaluated. A total of 33 articles (23 CV, eight cancer, two respiratory) were accepted for detailed analysis. Decision trees, Markov models, discrete event simulations, and hybrids were used. Event rates were incorporated either as constant rates, time-dependent risks, or risk equations based on patient characteristics. Risks dependent on time and/or patient characteristics were used where major event rates were >1%/year in models with fewer health states (Models of infrequent events or with numerous health states generally preferred constant event rates. The detailed modeling information and terminology varied, sometimes requiring interpretation. Key considerations for cost-effectiveness models incorporating hard end-point data include the frequency and characteristics of the relevant clinical events and how the trial data is reported. When event risk is low, simplification of both the model structure and event rate modeling is recommended. When event risk is common, such as in high risk populations, more detailed modeling approaches, including individual simulations or explicitly time-dependent event rates, are

A MULTI-CENTER CLUSTER-RANDOMIZED TRIAL OF A MULTI-FACTORIAL INTERVENTION TO IMPROVE ANTIHYPERTENSIVE MEDICATION ADHERENCE AND BLOOD PRESSURE CONTROL AMONG PATIENTS AT HIGH CARDIOVASCULAR RISK (The COM99 study)*

Science.gov (United States)

Pladevall, Manel; Brotons, Carlos; Gabriel, Rafael; Arnau, Anna; Suarez, Carmen; de la Figuera, Mariano; Marquez, Emilio; Coca, Antonio; Sobrino, Javier; Divine, George; Heisler, Michele; Williams, L Keoki

2010-01-01

Background Medication non-adherence is common and results in preventable disease complications. This study assesses the effectiveness of a multifactorial intervention to improve both medication adherence and blood pressure control and to reduce cardiovascular events. Methods and Results In this multi-center, cluster-randomized trial, physicians from hospital-based hypertension clinics and primary care centers across Spain were randomized to receive and provide the intervention to their high-risk patients. Eligible patients were ≥50 years of age, had uncontrolled hypertension, and had an estimated 10-year cardiovascular risk greater than 30%. Physicians randomized to the intervention group counted patients’ pills, designated a family member to support adherence behavior, and provided educational information to patients. The primary outcome was blood pressure control at 6 months. Secondary outcomes included both medication adherence and a composite end-point of all cause mortality and cardiovascular-related hospitalizations. Seventy-nine physicians and 877 patients participated in the trial. The mean duration of follow-up was 39 months. Intervention patients were less likely to have an uncontrolled systolic blood pressure (odds ratio 0.62; 95% confidence interval [CI] 0.50–0.78) and were more likely to be adherent (OR 1.91; 95% CI 1.19–3.05) when compared with control group patients at 6 months. After five years 16% of the patients in the intervention group and 19% in the control group met the composite end-point (hazard ratio 0.97; 95% CI 0.67–1.39). Conclusions A multifactorial intervention to improve adherence to antihypertensive medication was effective in improving both adherence and blood pressure control, but it did not appear to improve long-term cardiovascular events. PMID:20823391

Quality improvement tools and processes.

Science.gov (United States)

Lau, Catherine Y

2015-04-01

The Model for Improvement and the Plan-Do-Study-Act cycle is a popular quality improvement (QI) tool for health care providers to successfully lead QI projects and redesign care processes. This tool has several distinct components that must be addressed in sequence to organize and critically evaluate improvement activities. Unlike other health sciences clinical research, QI projects and research are based on dynamic hypotheses that develop into observable, serial tests of change with continuous collection and feedback of performance data to stakeholders. Copyright © 2015 Elsevier Inc. All rights reserved.

Performance improvement: the organization's quest.

Science.gov (United States)

McKinley, C O; Parmer, D E; Saint-Amand, R A; Harbin, C B; Roulston, J C; Ellis, R A; Buchanan, J R; Leonard, R B

1999-01-01

In today's health care marketplace, quality has become an expectation. Stakeholders are demanding quality clinical outcomes, and accrediting bodies are requiring clinical performance data. The Roosevelt Institute's quest was to define and quantify quality outcomes, develop an organizational culture of performance improvement, and ensure customer satisfaction. Several of the organization's leaders volunteered to work as a team to develop a specific performance improvement approach tailored to the organization. To date, over 200 employees have received an orientation to the model and its philosophy and nine problem action and process improvement teams have been formed.

IMPROVING CONCEPTUAL DESIGN QUALITY

DEFF Research Database (Denmark)

Bush, Stuart; Robotham, Antony John

1999-01-01

designer to identify clear targets for design improvement and to measure the effectiveness of any new solution, whilst attention to QFD ensures customer requirements are still being satisfied.Often, SME's are not aware of many of the best design practices and so are not able to meet the demand......This paper will consider how Quality Function Deployment (QFD) and Design for Manufacture and Assembly (DFMA) processes can be used to improve the design quality of products at the concept stage. We appreciate that both QFD and DFMA are techniques that have been used for some time by mature product...... quality is maintained in design project work. The projects described have been carried out with products manufactured by small to medium sized enterprises (SME's), where we have found significant opportunities for product improvement. The quantitative nature of DFMA analysis results allows the novice...

A novel stent inflation protocol improves long-term outcomes compared with rapid inflation/deflation deployment method.

Science.gov (United States)

Vallurupalli, Srikanth; Kasula, Srikanth; Kumar Agarwal, Shiv; Pothineni, Naga Venkata K; Abualsuod, Amjad; Hakeem, Abdul; Ahmed, Zubair; Uretsky, Barry F

2017-08-01

High-pressure inflation for coronary stent deployment is universally performed. However, the duration of inflation is variable and does not take into account differences in lesion compliance. We developed a standardized "pressure optimization protocol" (POP) using inflation pressure stability rather than an arbitrary inflation time or angiographic balloon appearance for stent deployment. Whether this approach improves long-term outcomes is unknown. 792 patients who underwent PCI using either rapid inflation/deflation (n = 376) or POP (n = 416) between January 2009 and March 2014 were included. Exclusion criteria included PCI for acute myocardial infarction, in-stent restenosis, chronic total occlusion, left main, and saphenous vein graft lesions. Primary endpoint was target vessel failure [TVF = combined end point of target vessel revascularization (TVR), myocardial infarction, and cardiac death]. Outcomes were analyzed in the entire cohort and in a propensity analysis. Stent implantation using POP with a median follow-up of 1317 days was associated with lower TVF compared with rapid inflation/deflation (10.1 vs. 17.8%, P inflation/deflation (10 vs. 18%, P < 0.0001). Stent deployment using POP led to reduced TVF compared to rapid I/D. These results recommend this method to improve long-term outcomes. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

Persistent suicide risk in clinically improved schizophrenia patients: challenge of the suicidal dimension

Directory of Open Access Journals (Sweden)

Amresh Shrivastava

2010-09-01

Full Text Available Amresh Shrivastava1, Megan E Johnston2, Nilesh Shah3, Marco Innamorati4, Larry Stitt5, Meghana Thakar3, David Lester6, Maurizio Pompili4,71Silver Mind Hospital and Mental Health Foundation of India, Mumbai, India; 2Department of Psychology, University of Toronto, Toronto, ON, Canada; 3Lokmanya Tilak Municipal General Hospital, University of Mumbai, India; 4Department of Neurosciences, Mental Health and Sensory Functions, Suicide Prevention Center, Sant’Andrea Hospital, Sapienza University of Rome, Rome, Italy; 5Department of Biostatistics, The University of Western Ontario, London, ON, Canada; 6The Richard Stockton College of New Jersey, Pomona, NJ, USA; 7McLean Hospital, Harvard Medical School, Boston, MA, USABackground: Suicide is a major problem in schizophrenia, estimated to affect 9%–13% of patients. About 25% of schizophrenic patients make at least one suicide attempt in their lifetime. Current outcome measures do not address this problem, even though it affects quality of life and patient safety. The aim of this study was to assess suicidality in long-term clinically improved schizophrenia patients who were treated in a nongovernmental psychiatric treatment centre in Mumbai, India.Method: Participants were 61 patients out of 200 consecutive hospitalized first-episode patients with schizophrenia diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders who were much improved on the Clinical Global Impression Scale-Improvement (CGI-I scale at the endpoint of a 10-year follow-up. Clinical assessment tools included the Positive and Negative Syndrome Scale for Schizophrenia, CGI-I, Global Assessment of Functioning, and suicidality.Results: Many of the patients, although clinically improved, experienced emerging suicidality during the 10-year follow-up period. All of the patients reported significant suicidality (ie, suicide attempts, suicidal crises, or suicidal ideation at the end of the study, whereas only 83% had

Investigating the improver mechanisms of agricultural water ...

African Journals Online (AJOL)

Investigating the improver mechanisms of agricultural water management in karaj county from the viewpoints of the farmers. ... farmers and people, technical improvement of hydraulic structures, improvement of local people participation, improvement of water management, controlling the disturbance of external factors and ...

Creating Quality Improvement Culture in Public Health Agencies

Science.gov (United States)

Mahanna, Elizabeth; Joly, Brenda; Zelek, Michael; Riley, William; Verma, Pooja; Fisher, Jessica Solomon

2014-01-01

Objectives. We conducted case studies of 10 agencies that participated in early quality improvement efforts. Methods. The agencies participated in a project conducted by the National Association of County and City Health Officials (2007–2008). Case study participants included health directors and quality improvement team leaders and members. We implemented multiple qualitative analysis processes, including cross-case analysis and logic modeling. We categorized agencies according to the extent to which they had developed a quality improvement culture. Results. Agencies were conducting informal quality improvement projects (n = 4), conducting formal quality improvement projects (n = 3), or creating a quality improvement culture (n = 4). Agencies conducting formal quality improvement and creating a quality improvement culture had leadership support for quality improvement, participated in national quality improvement initiatives, had a greater number of staff trained in quality improvement and quality improvement teams that met regularly with decision-making authority. Agencies conducting informal quality improvement were likely to report that accreditation is the major driver for quality improvement work. Agencies creating a quality improvement culture were more likely to have a history of evidence-based decision-making and use quality improvement to address emerging issues. Conclusions. Our findings support previous research and add the roles of national public health accreditation and emerging issues as factors in agencies’ ability to create and sustain a quality improvement culture. PMID:24228680

Creating quality improvement culture in public health agencies.

Science.gov (United States)

Davis, Mary V; Mahanna, Elizabeth; Joly, Brenda; Zelek, Michael; Riley, William; Verma, Pooja; Fisher, Jessica Solomon

2014-01-01

We conducted case studies of 10 agencies that participated in early quality improvement efforts. The agencies participated in a project conducted by the National Association of County and City Health Officials (2007-2008). Case study participants included health directors and quality improvement team leaders and members. We implemented multiple qualitative analysis processes, including cross-case analysis and logic modeling. We categorized agencies according to the extent to which they had developed a quality improvement culture. Agencies were conducting informal quality improvement projects (n = 4), conducting formal quality improvement projects (n = 3), or creating a quality improvement culture (n = 4). Agencies conducting formal quality improvement and creating a quality improvement culture had leadership support for quality improvement, participated in national quality improvement initiatives, had a greater number of staff trained in quality improvement and quality improvement teams that met regularly with decision-making authority. Agencies conducting informal quality improvement were likely to report that accreditation is the major driver for quality improvement work. Agencies creating a quality improvement culture were more likely to have a history of evidence-based decision-making and use quality improvement to address emerging issues. Our findings support previous research and add the roles of national public health accreditation and emerging issues as factors in agencies' ability to create and sustain a quality improvement culture.

Activation time and material stiffness of sequential removable orthodontic appliances. Part 2: Dental improvements.

Science.gov (United States)

Clements, Karen Michelle; Bollen, Anne-Marie; Huang, Greg; King, Greg; Hujoel, Philippe; Ma, Tsun

2003-11-01

Fifty-one patients were enrolled in this study to explore the treatment effects of material stiffness and frequency of appliance change when using clear, sequential, removable appliances (aligners). Patients were stratified based on pretreatment peer assessment rating (PAR) scores and need for extractions. They were randomized into 4 treatment protocols: 1-week activation with soft material, 1-week activation with hard material, 2-week activation with soft material, and 2-week activation with hard material. Patients continued with their protocols until either the series of aligners was completed, or until it was determined that the aligner was not fitting well (study end point). Weighted PAR score and average incisor irregularity (AII) indexes were used to measure pretreatment and end-point study models, and average improvement was compared among the 4 groups. In addition to the evaluation of the 4 treatment groups, comparisons were made of the individual components of the PAR score to determine which occlusal components experienced the most correction with the aligners. The percentages and absolute extraction space closures were evaluated, and papillary bleeding scores before and during treatment were compared. Although no statistical difference was observed between the 4 treatment groups, a trend was noted with the 2-week frequency having a larger percentage of reduction in weighted PAR and AII scores, and greater extraction space closure. Anterior alignment was the most improved component, and buccal occlusion was the least improved. When analyzed by type of extraction, incisor extraction sites had a significantly greater percentage of closure than either maxillary or mandibular premolar extraction sites. A statistically significant decrease in mean average papillary bleeding score was found during treatment when compared with pretreatment scores, although this difference was not clinically significant.

23 CFR 1200.25 - Improvement plan.

Science.gov (United States)

2010-04-01

... 23 Highways 1 2010-04-01 2010-04-01 false Improvement plan. 1200.25 Section 1200.25 Highways... Implementation and Management of the Highway Safety Program § 1200.25 Improvement plan. If a review of the Annual... improvement plan. This plan will detail strategies, program activities, and funding targets to meet the...

Assessment of and Improvement Strategies for the Housing of Healthy Elderly: Improving Quality of Life

Directory of Open Access Journals (Sweden)

I-Ming Feng

2018-03-01

Full Text Available Global population is aging, particularly in developed countries and cities. Through the “Friendly Elderly Cities” and “Aging in Place” initiatives, various countries are making great efforts to improve the welfare and quality of life of the elderly, with the aim of catering to the physical and spiritual health as well as social welfare of the elderly. In this regard, the improvement of the housing environment of the elderly is one of the key factors in their quality of life and health. This study aims to effectively assess and improve the housing environment of the elderly in order to enhance their quality of life; it also aims to contribute the knowledge about improving elderly housing by applying an assessment framework using expert interviews and data collected from relevant literature. Using a mixed Multi-Criteria Decision Analysis model, a combination of the DEMATEL (Decision Making Trial and Evaluation Laboratory-based ANP (Analytic Network Process (DANP and the modified VlseKriterijumska Optimizacija I Kompromisno Resenje (VIKOR methods, and the investigations and assessments in the case study, this study proposes strategies and directions for improving elderly housing. The study results indicate that, as distinct from using traditional methodologies where the hypothesis criteria are mutually independent, the proposed hybrid model (examining real-life problems by considering the mutual influences of factors identifies a priority sequence wherein emphasis is placed on improving ventilation and air quality rather than adjustment of temperature. The systemic way of thinking shifts the focus from the most apparent problems to the root cause of the problems. Doing so avoids any mismatch of resource allocation in decision-making and thus maximizes the efficiency and sustainability of the improvement.

Bioremediation of hydrocarbon-contaminated soils: are treatability and ecotoxicity endpoints related?

International Nuclear Information System (INIS)

Visser, S.

1999-01-01

To determine if there is a relationship between biotreatability and ecotoxicity endpoints in a wide range of hydrocarbon-contaminated soils, including medium and heavy crude oil-contaminated flare pit wastes and lubrication oil contaminated soil, research was conducted. Each test material was analyzed for pH, water repellency, electrical conductivity, available N and P, total extractable hydrocarbons, oil and grease, and toxicity to seedling emergence, root elongation in barley, lettuce and canola, earthworm survival and luminescent bacteria (Microtox), prior to, and following three months of bioremediation in the laboratory. By monitoring soil respiration, progress of the bioremediation process and determination of a treatment endpoint were assessed. The time required to attain a treatment endpoint under laboratory conditions can range from 30 days to 100 days depending on the concentration of hydrocarbons and degree of weathering. Most flare pits are biotreatable, averaging a loss of 25-30% of hydrocarbons during bioremediation. Once a treatment endpoint is achieved, residual hydrocarbons contents almost always exceeds Alberta Tier I criteria for mineral oil and grease. As a result of bioremediation treatments, hydrophobicity is often reduced from severe to low. Many flare pit materials are still moderately to extremely toxic after reaching a treatment endpoint. (Abstract only)

Does ownership of improved dairy cow breeds improve child nutrition? A pathway analysis for Uganda.

Directory of Open Access Journals (Sweden)

Nassul S Kabunga

Full Text Available The promotion of livestock production is widely believed to support enhanced diet quality and child nutrition, but the empirical evidence for this causal linkage remains narrow and ambiguous. This study examines whether adoption of improved dairy cow breeds is linked to farm-level outcomes that translate into household-level benefits including improved child nutrition outcomes in Uganda. Using nationwide data from Uganda's National Panel Survey, propensity score matching is used to create an unbiased counterfactual, based on observed characteristics, to assess the net impacts of improved dairy cow adoption. All estimates were tested for robustness and sensitivity to variations in observable and unobservable confounders. Results based on the matched samples showed that households adopting improved dairy cows significantly increased milk yield-by over 200% on average. This resulted in higher milk sales and milk intakes, demonstrating the potential of this agricultural technology to both integrate households into modern value chains and increase households' access to animal source foods. Use of improved dairy cows increased household food expenditures by about 16%. Although undernutrition was widely prevalent in the study sample and in matched households, the adoption of improved dairy cows was associated with lower child stunting in adopter household. In scale terms, results also showed that holding larger farms tends to support adoption, but that this also stimulates the household's ability to achieve gains from adoption, which can translate into enhanced nutrition.

Quality Improvement Initiatives in Inflammatory Bowel Disease.

Science.gov (United States)

Berry, Sameer K; Siegel, Corey A; Melmed, Gil Y

2017-08-01

This article serves as an overview of several quality improvement initiatives in inflammatory bowel disease (IBD). IBD is associated with significant variation in care, suggesting poor quality of care. There have been several efforts to improve the quality of care for patients with IBD. Quality improvement (QI) initiatives in IBD are intended to be patient-centric, improve outcomes for individuals and populations, and reduce costs-all consistent with "the triple aim" put forth by the Institute for Healthcare Improvement (IHI). Current QI initiatives include the development of quality measure sets to standardize processes and outcomes, learning health systems to foster collaborative improvement, and patient-centered medical homes specific to patients with IBD in shared risk models of care. Some of these programs have demonstrated early success in improving patient outcomes, reducing costs, improving patient satisfaction, and facilitating patient engagement. However, further studies are needed to evaluate and compare the effects of these programs over time on clinical outcomes in order to demonstrate long-term value and sustainability.

Quality improvement and emerging global health priorities

Science.gov (United States)

Mensah Abrampah, Nana; Syed, Shamsuzzoha Babar; Hirschhorn, Lisa R; Nambiar, Bejoy; Iqbal, Usman; Garcia-Elorrio, Ezequiel; Chattu, Vijay Kumar; Devnani, Mahesh; Kelley, Edward

2018-01-01

Abstract Quality improvement approaches can strengthen action on a range of global health priorities. Quality improvement efforts are uniquely placed to reorient care delivery systems towards integrated people-centred health services and strengthen health systems to achieve Universal Health Coverage (UHC). This article makes the case for addressing shortfalls of previous agendas by articulating the critical role of quality improvement in the Sustainable Development Goal era. Quality improvement can stimulate convergence between health security and health systems; address global health security priorities through participatory quality improvement approaches; and improve health outcomes at all levels of the health system. Entry points for action include the linkage with antimicrobial resistance and the contentious issue of the health of migrants. The work required includes focussed attention on the continuum of national quality policy formulation, implementation and learning; alongside strengthening the measurement-improvement linkage. Quality improvement plays a key role in strengthening health systems to achieve UHC. PMID:29873793

Can an interprofessional tracheostomy team improve weaning to decannulation times? A quality improvement evaluation

Science.gov (United States)

Morrison, Melissa; Catalig, Marifel; Chris, Juliana; Pataki, Janos

2016-01-01

BACKGROUND: Percutaneous tracheostomy is a common procedure in the intensive care unit and, on patient transfer to the wards, there is a gap in ongoing tracheostomy management. There is some evidence that tracheostomy teams can shorten weaning to decannulation times. In response to lengthy weaning to decannulation times at Trillium Health Partners – Credit Valley Hospital site (Mississauga, Ontario), an interprofessional tracheostomy team, led by respiratory therapists and consisting of speech-language pathologists and intensive care physicians, was implemented. OBJECTIVE: To evaluate the interprofessional tracheostomy team and its impact on time from weaning off mechanical ventilation to decannulation; and time from weaning to speech-language pathology referral. METHODS: Performance metrics were collected retrospectively through chart review pre- and post-team implementation. The primary metrics evaluated were the time from weaning off mechanical ventilation to decannulation, and time to referral to speech-language pathology. RESULTS: Following implementation of the interprofessional tracheostomy team, there was no improvement in decannulation times or time from weaning to speech-language pathology referral. A significant improvement was noted in the average time to first tracheostomy tube change (36.2 days to 22.9 days; P=0.01) and average time to speech-language pathology referral following initial tracheostomy insertion (51.8 days to 26.3 days; P=0.01). CONCLUSION: An interprofessional tracheostomy team can improve the quality of tracheostomy care through earlier tracheostomy tube changes and swallowing assessment referrals. The lack of improved weaning to decannulation time was potentially due to poor adherence with established protocols as well as a change in mechanical ventilation practices. To validate the findings from this particular institution, a more rigorous quality improvement methodology should be considered in addition to strategies to improve

24 CFR 901.145 - Improvement Plan.

Science.gov (United States)

2010-04-01

... 24 Housing and Urban Development 4 2010-04-01 2010-04-01 false Improvement Plan. 901.145 Section... PUBLIC HOUSING MANAGEMENT ASSESSMENT PROGRAM § 901.145 Improvement Plan. (a) After receipt of the State... a PHA, or a RMC through the PHA, to prepare and submit to the State/Area Office an Improvement Plan...

45 CFR 1355.35 - Program improvement plans.

Science.gov (United States)

2010-10-01

... 45 Public Welfare 4 2010-10-01 2010-10-01 false Program improvement plans. 1355.35 Section 1355.35... plans. (a) Mandatory program improvement plan. (1) States found not to be operating in substantial conformity shall develop a program improvement plan. The program improvement plan must: (i) Be developed...

Improving performance on core processes of care.

Science.gov (United States)

Austin, John Matthew; Pronovost, Peter J

2016-06-01

This article describes the recent literature on using extrinsic and intrinsic motivators to improve performance on core processes of care, highlighting literature that describes general frameworks for quality improvement work. The literature supporting the effectiveness of extrinsic motivators to improve quality is generally positive for public reporting of performance, with mixed results for pay-for-performance. A four-element quality improvement framework developed by The Armstrong Institute at Johns Hopkins Medicine was developed with intrinsic motivation in mind. The clear definition and communication of goals are important for quality improvement work. Training clinicians in improvement science, such as lean sigma, teamwork, or culture change provides clinicians with the skills they need to drive the improvement work. Peer learning communities offer the opportunity for clinicians to engage with each other and offer support in their work. The transparent reporting of performance helps ensure accountability of performance ranging from individual clinicians to governance. Quality improvement work that is led by and engages clinicians offers the opportunity for the work to be both meaningful and sustainable. The literature supports approaching quality improvement work in a systematic way, including the key elements of communication, infrastructure building, training, transparency, and accountability.

Waste Management Process Improvement Project

International Nuclear Information System (INIS)

Atwood, J.; Borden, G.; Rangel, G. R.

2002-01-01

The Bechtel Hanford-led Environmental Restoration Contractor team's Waste Management Process Improvement Project is working diligently with the U.S. Department of Energy's (DOE) Richland Operations Office to improve the waste management process to meet DOE's need for an efficient, cost-effective program for the management of dangerous, low-level and mixed-low-level waste. Additionally the program must meet all applicable regulatory requirements. The need for improvement was highlighted when a change in the Groundwater/Vadose Zone Integration Project's waste management practices resulted in a larger amount of waste being generated than the waste management organization had been set up to handle

Sample size determination in clinical trials with multiple endpoints

CERN Document Server

Sozu, Takashi; Hamasaki, Toshimitsu; Evans, Scott R

2015-01-01

This book integrates recent methodological developments for calculating the sample size and power in trials with more than one endpoint considered as multiple primary or co-primary, offering an important reference work for statisticians working in this area. The determination of sample size and the evaluation of power are fundamental and critical elements in the design of clinical trials. If the sample size is too small, important effects may go unnoticed; if the sample size is too large, it represents a waste of resources and unethically puts more participants at risk than necessary. Recently many clinical trials have been designed with more than one endpoint considered as multiple primary or co-primary, creating a need for new approaches to the design and analysis of these clinical trials. The book focuses on the evaluation of power and sample size determination when comparing the effects of two interventions in superiority clinical trials with multiple endpoints. Methods for sample size calculation in clin...

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

Directory of Open Access Journals (Sweden)

Cathy Kande

2014-01-01

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

Can proprioception really be improved by exercises?

Science.gov (United States)

Ashton-Miller, J A; Wojtys, E M; Huston, L J; Fry-Welch, D

2001-05-01

There is little question that ankle disc training can improve ankle muscle motor performance in a unipedal balance task, most likely through improved strength and coordination [62] and possibly endurance. How much of the observed improvement in motor performance is due to improved ankle proprioception remains unknown. We have reviewed a number of theoretical ways in which training might improve proprioception for moderately challenging weight-bearing situations such as balancing on one leg. Although the relevant experiments have yet to be performed to test this hypothesis, any improvement would theoretically help to reduce injuries at these moderate levels of challenge. We question, however, whether these exercises can ever improve the reactive response required to prevent injury under the most challenging time-critical situations. If confirmed, this limitation needs to be acknowledged by authors and practitioners alike. Alternative protective strategies for the most challenging time-critical situations should be sought. We conclude that, despite their widespread acceptance, current exercises aimed at "improving proprioception" have not been demonstrated to achieve that goal. We have outlined theoretical scenarios by which proprioception might be improved, but these are speculative. The relevant experiments remain to be conducted. We argue that even if they were proven to improve proprioception, under the best circumstances such exercises could only prevent injury under slow to intermediate rate provocations to the joint musculoligamentous complex in question.

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

Science.gov (United States)

Galili, Tal; Meilijson, Isaac

2016-01-02

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

Towards improving highland ban.anas

African Journals Online (AJOL)

The most fertile land races belonged to 'Nakabululu' and 'Nfuuka' clone sets. Viable seeds were obtained from several land races indicating that genetic improvement ofthese highland bananas through cross breeding is possible. The fertile Iandraces should be cross-pollinated with improved diploids to produce resistant ...

Perspectives: The Continuous Improvement Trap

Science.gov (United States)

Arnold, David L.

2011-01-01

Accrediting agencies, legislators, pundits, and even higher educational professionals have become enamored with applying the language of continuous improvement to learning outcomes. The Southern Association of Colleges and Schools Commission on Colleges specifically uses the term "continuing improvement" in Core Standard 2.5, one of its…

Action research in collaborative improvement

NARCIS (Netherlands)

Middel, H.G.A.; Coghlan, David; Brennan, Louis; McNichols, Tim

2006-01-01

There is an increasing need to apply and transfer continuous improvement (CI) to inter-organisational processes. As such collaborative improvement (CoI) is emerging as a new concept within managerial literature and practice. This paper begins with a discussion on the logic and value of applying

Educational Intervention Improves Compliance With AAN Guidelines for Return Epilepsy Visits: A Quality Improvement Project.

Science.gov (United States)

Nelson, Gary R; Filloux, Francis M; Kerr, Lynne M

2016-10-01

In 2011, the American Academy of Neurology (AAN) released guidelines for return seizure visits detailing 8 points that should be addressed during such visits. These guidelines are designed to improve routine follow-up care for epilepsy patients. The authors performed a quality improvement project aimed at increasing compliance with these guidelines after educating providers about them. The authors performed a chart review before and after an intervention which included: education regarding the guidelines, providing materials to remind providers of the guidelines, and templates to facilitate compliance. The authors reviewed charts at 2 and 6 months after the intervention. Significant improvement in documentation of 4 of the 8 measures was observed after this educational intervention. This suggests that simple educational interventions may help providers change practice and can improve compliance with new guidelines while requiring minimal time and resources to implement. © The Author(s) 2016.

Four-factor prothrombin complex concentrate improves thrombin generation and prothrombin time in patients with bleeding complications related to rivaroxaban: a single-center pilot trial.

Science.gov (United States)

Schenk, Bettina; Goerke, Stephanie; Beer, Ronny; Helbok, Raimund; Fries, Dietmar; Bachler, Mirjam

2018-01-01

Direct oral anticoagulants (DOACs) pose a great challenge for physicians in life-threatening bleeding events. The aim of this study was to test the efficacy of reversing the DOAC rivaroxaban using four-factor PCC (prothrombin complex concentrate), a non-specific reversing agent. Patients with life-threatening bleeding events during rivaroxaban treatment were included and administered 25 U kg -1 of PCC. Blood samples were collected immediately prior to as well as after PCC treatment at predefined time intervals. The primary endpoint was defined as the difference in thrombin generation (TG) parameters ETP (endogenous thrombin potential) and C max (peak thrombin generation) prior to and ten minutes subsequent to PCC treatment. Thirteen patients, of whom the majority suffered from intra-cranial haemorrhage (ICH) or subdural haemorrhage (SDH), were included and administered PCC. The results show that the ETP (TG) significantly ( p  = 0.001) improved by 68% and C max (TG) by 54% (p = 0.001) during PCC treatment. In addition, the Quick value (prothrombin time: Quick PT ) significantly improved by 28% and the activated partial thromboplastin time (aPTT) was decreased by 7% ten minutes after PCC administration. C max was reduced at baseline, but not ETP, aPTT or Quick PT . Lag time until initiation (TG, t lag ), thromboelastometry clotting time (CT EXTEM ) and time to peak (TG, t max ) correlated best with measured rivaroxaban levels and were out of normal ranges at baseline, but did not improve after PCC administration. In 77% of the patients bleeding (ICH/SDH-progression) ceased following PCC administration. During the study three participants passed away due to other complications not related to PCC treatment. The possibility of thrombosis formation was also evaluated seven days after administering PCC and no thromboses were found. This study shows that use of PCC improved ETP, C max, Quick PT and aPTT. However, of these parameters, only C max was reduced at the

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.

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. PMID:24361020

Improving Communication in Design

DEFF Research Database (Denmark)

Maier, Anja; Doenmez, Denniz; Hepperle, Clemens

2011-01-01

Communication permeates every aspect of an engineer’s work – from clarifying product specifications to shaping social ties. This paper offers an overview of recommendations from literature to improve communication within and among engineering teams. We assume communication problems are often...... of tasks. To improve these factors in order to enable effective communication, this paper collates more than hundred recommendations from journal articles and textbooks published in the fields of engineering design, management science, sociology, and psychology. Recommendations include, for example...

Identifying continuous quality improvement publications: what makes an improvement intervention ‘CQI’?

Science.gov (United States)

Hempel, Susanne; Lim, Yee-Wei; Danz, Marjorie S; Foy, Robbie; Suttorp, Marika J; Shekelle, Paul G; Rubenstein, Lisa V

2011-01-01

Background The term continuous quality improvement (CQI) is often used to refer to a method for improving care, but no consensus statement exists on the definition of CQI. Evidence reviews are critical for advancing science, and depend on reliable definitions for article selection. Methods As a preliminary step towards improving CQI evidence reviews, this study aimed to use expert panel methods to identify key CQI definitional features and develop and test a screening instrument for reliably identifying articles with the key features. We used a previously published method to identify 106 articles meeting the general definition of a quality improvement intervention (QII) from 9427 electronically identified articles from PubMed. Two raters then applied a six-item CQI screen to the 106 articles. Results Per cent agreement ranged from 55.7% to 75.5% for the six items, and reviewer-adjusted intra-class correlation ranged from 0.43 to 0.62. ‘Feedback of systematically collected data’ was the most common feature (64%), followed by being at least ‘somewhat’ adapted to local conditions (61%), feedback at meetings involving participant leaders (46%), using an iterative development process (40%), being at least ‘somewhat’ data driven (34%), and using a recognised change method (28%). All six features were present in 14.2% of QII articles. Conclusions We conclude that CQI features can be extracted from QII articles with reasonable reliability, but only a small proportion of QII articles include all features. Further consensus development is needed to support meaningful use of the term CQI for scientific communication. PMID:21727199

Improved survival of baby boomer women with early-stage uterine cancer: A Surveillance, Epidemiology and End Results (SEER) Study.

Science.gov (United States)

Elshaikh, Mohamed A; Ruterbusch, Julie; Cote, Michele L; Cattaneo, Richard; Munkarah, Adnan R

2013-11-01

To study the prognostic impact of baby boomer (BB) generation on survival end-points of patients with early-stage endometrial carcinoma (EC). Data were obtained from the SEER registry between 1988-2009. Inclusion criteria included women who underwent hysterectomy for stage I-II EC. Patients were divided into two birth cohorts: BB (women born between 1946 and 1964) and pre-boomers (PB) (born between 1926 and 1945). A total of 30,956 patients were analyzed. Considering that women in the PB group were older than those of the BB generation, the statistical analysis was limited to women 50-59 years of age at the time of diagnosis (n=11,473). Baby boomers had a significantly higher percentage of endometrioid histology (pgeneration compared to the PB generation (p=0.0003) with a trend for improved uterine cancer-specific survival (p=0.0752). On multivariate analysis, birth cohort (BB vs. PB) was not a significant predictor of survival end-points. Factors predictive of survival included: tumor grade, FIGO stage, African-American race, and increased number of dissected LN. Our study suggests that the survival of BB women between 50-60 years of age is better compared to women in the PB generation. As more BB patients are diagnosed with EC, further research is warranted.

Practical Approaches to Quality Improvement for Radiologists.

Science.gov (United States)

Kelly, Aine Marie; Cronin, Paul

2015-10-01

Continuous quality improvement is a fundamental attribute of high-performing health care systems. Quality improvement is an essential component of health care, with the current emphasis on adding value. It is also a regulatory requirement, with reimbursements increasingly being linked to practice performance metrics. Practice quality improvement efforts must be demonstrated for credentialing purposes and for certification of radiologists in practice. Continuous quality improvement must occur for radiologists to remain competitive in an increasingly diverse health care market. This review provides an introduction to the main approaches available to undertake practice quality improvement, which will be useful for busy radiologists. Quality improvement plays multiple roles in radiology services, including ensuring and improving patient safety, providing a framework for implementing and improving processes to increase efficiency and reduce waste, analyzing and depicting performance data, monitoring performance and implementing change, enabling personnel assessment and development through continued education, and optimizing customer service and patient outcomes. The quality improvement approaches and underlying principles overlap, which is not surprising given that they all align with good patient care. The application of these principles to radiology practices not only benefits patients but also enhances practice performance through promotion of teamwork and achievement of goals. © RSNA, 2015.

A Modified LS+AR Model to Improve the Accuracy of the Short-term Polar Motion Prediction

Science.gov (United States)

Wang, Z. W.; Wang, Q. X.; Ding, Y. Q.; Zhang, J. J.; Liu, S. S.

2017-03-01

There are two problems of the LS (Least Squares)+AR (AutoRegressive) model in polar motion forecast: the inner residual value of LS fitting is reasonable, but the residual value of LS extrapolation is poor; and the LS fitting residual sequence is non-linear. It is unsuitable to establish an AR model for the residual sequence to be forecasted, based on the residual sequence before forecast epoch. In this paper, we make solution to those two problems with two steps. First, restrictions are added to the two endpoints of LS fitting data to fix them on the LS fitting curve. Therefore, the fitting values next to the two endpoints are very close to the observation values. Secondly, we select the interpolation residual sequence of an inward LS fitting curve, which has a similar variation trend as the LS extrapolation residual sequence, as the modeling object of AR for the residual forecast. Calculation examples show that this solution can effectively improve the short-term polar motion prediction accuracy by the LS+AR model. In addition, the comparison results of the forecast models of RLS (Robustified Least Squares)+AR, RLS+ARIMA (AutoRegressive Integrated Moving Average), and LS+ANN (Artificial Neural Network) confirm the feasibility and effectiveness of the solution for the polar motion forecast. The results, especially for the polar motion forecast in the 1-10 days, show that the forecast accuracy of the proposed model can reach the world level.

Guidelines for time-to-event end-point definitions in trials for pancreatic cancer. Results of the DATECAN initiative (Definition for the Assessment of Time-to-event End-points in CANcer trials).

Science.gov (United States)

Bonnetain, Franck; Bonsing, Bert; Conroy, Thierry; Dousseau, Adelaide; Glimelius, Bengt; Haustermans, Karin; Lacaine, François; Van Laethem, Jean Luc; Aparicio, Thomas; Aust, Daniela; Bassi, Claudio; Berger, Virginie; Chamorey, Emmanuel; Chibaudel, Benoist; Dahan, Laeticia; De Gramont, Aimery; Delpero, Jean Robert; Dervenis, Christos; Ducreux, Michel; Gal, Jocelyn; Gerber, Erich; Ghaneh, Paula; Hammel, Pascal; Hendlisz, Alain; Jooste, Valérie; Labianca, Roberto; Latouche, Aurelien; Lutz, Manfred; Macarulla, Teresa; Malka, David; Mauer, Muriel; Mitry, Emmanuel; Neoptolemos, John; Pessaux, Patrick; Sauvanet, Alain; Tabernero, Josep; Taieb, Julien; van Tienhoven, Geertjan; Gourgou-Bourgade, Sophie; Bellera, Carine; Mathoulin-Pélissier, Simone; Collette, Laurence

2014-11-01

Using potential surrogate end-points for overall survival (OS) such as Disease-Free- (DFS) or Progression-Free Survival (PFS) is increasingly common in randomised controlled trials (RCTs). However, end-points are too often imprecisely defined which largely contributes to a lack of homogeneity across trials, hampering comparison between them. The aim of the DATECAN (Definition for the Assessment of Time-to-event End-points in CANcer trials)-Pancreas project is to provide guidelines for standardised definition of time-to-event end-points in RCTs for pancreatic cancer. Time-to-event end-points currently used were identified from a literature review of pancreatic RCT trials (2006-2009). Academic research groups were contacted for participation in order to select clinicians and methodologists to participate in the pilot and scoring groups (>30 experts). A consensus was built after 2 rounds of the modified Delphi formal consensus approach with the Rand scoring methodology (range: 1-9). For pancreatic cancer, 14 time to event end-points and 25 distinct event types applied to two settings (detectable disease and/or no detectable disease) were considered relevant and included in the questionnaire sent to 52 selected experts. Thirty experts answered both scoring rounds. A total of 204 events distributed over the 14 end-points were scored. After the first round, consensus was reached for 25 items; after the second consensus was reached for 156 items; and after the face-to-face meeting for 203 items. The formal consensus approach reached the elaboration of guidelines for standardised definitions of time-to-event end-points allowing cross-comparison of RCTs in pancreatic cancer. Copyright © 2014 Elsevier Ltd. All rights reserved.

Who pays for tree improvement?

Science.gov (United States)

Tom D. Byram; E. M. Raley

2011-01-01

Tree improvement has been one of the most successful collaborative research efforts in history, eliciting participation from a wide variety of players. This effort has included state forestry agencies, research universities, integrated forest industries, and the USDA Forest Service. Tree improvement was organized through cooperatives whose objectives were to distribute...

The Architecture of School Improvement

Science.gov (United States)

Murphy, Joseph

2013-01-01

Purpose: The aim of this paper is to present a comprehensive framework for capturing the complex concept the authors call school improvement. Design/methodology/approach: The author begins by anchoring that framework on an historical understanding of school improvement. The framework itself is then presented. Five dimensions are described: the…

Solutions to Improve Educational Management Quality

OpenAIRE

Ramezan Jahanian; Masoomeh Motahari

2013-01-01

Nowadays, enhancing the quality in educational systems of different countries has gained especial importance and stand. Improving utilizing and increasing the quality in our country’s educational system is felt too. One of the utilizing factors in education system is to improve the educational management quality.In this article, effective factors in educational management quality and one of its improving solutions, thorough management quality, is analyzed.

A quality improvement project to improve admission temperatures in very low birth weight infants.

Science.gov (United States)

Lee, H C; Ho, Q T; Rhine, W D

2008-11-01

To review the results of a quality improvement (QI) project to improve admission temperatures of very low birth weight inborn infants. The neonatal intensive care unit at Lucile Packard Children's Hospital underwent a QI project to address hypothermic preterm newborns by staff education and implementing processes such as polyethylene wraps and chemical warming mattresses. We performed retrospective chart review of all inborn infants with birth weight project. The improvement was consistent and persisted over a 15-month period. After risk adjustment, the strongest predictor of hypothermia was being born in the period before implementation of the QI project (odds ratio 8.12, 95% confidence interval 4.63, 14.22). Although cesarean delivery was a strong risk factor for hypothermia prior to the project, it was no longer significant after the project. There was no significant difference in death or intraventricular hemorrhage detected between periods. There was a significant improvement in admission temperatures after a QI project, which persisted beyond the initial implementation period. Although there was no difference in mortality or intraventricular hemorrhage rates, we did not have sufficient power to detect small differences in these outcomes.

Evolutionary CANDU 9 plant improvements

International Nuclear Information System (INIS)

Yu, S.K.W.

1999-01-01

The CANDU 9 is a 935 MW(e) nuclear power plant (NPP) based on the multi-unit Darlington and Bruce B designs with additional enhancements from our ongoing engineering and research programs. Added to the advantages of using proven systems and components, CANDU 9 offers improvement features with enhanced safety, improved operability and maintenance including a control centre with advanced man-machine interface, and improved project delivery in both engineering and construction. The CANDU 9 NPP design incorporated safety enhancements through careful attention to emerging licensing and safety issues. The designers assessed, revised and evolved such systems as the moderator, end shield, containment and emergency core cooling (ECC) systems while providing an integrated final design that is more passive and severe-accident-immune. AECL uses a feedback process to incorporate lessons learned from operating plants, from current projects experiences and from the implementation or construction phase of previous projects. Most of the requirements for design improvements are based on a systematic review of current operating CANDU stations in the areas of design and reliability, operability, and maintainability. The CANDU 9 Control Centre provides plant staff with improved operability and maintainability capabilities due to the combination of systematic design with human factors engineering and enhanced operating and diagnostics features. The use of advanced engineering tools and modem construction methods will reduce project implementation risk on project costs and schedules. (author)

A REVIEW OF ORDER PICKING IMPROVEMENT METHODS

Directory of Open Access Journals (Sweden)

Johan Oscar Ong

2014-09-01

Full Text Available As a crucial and one of the most important parts of warehousing, order picking often raises discussion between warehousing professionals, resulting in various studies aiming to analyze how order picking activity can be improved from various perspective. This paper reviews various past researches on order picking improvement, and the various methods those studies analyzed or developed. This literature review is based on twenty research articles on order picking improvement viewed from four different perspectives: Automation (specifically, stock-to-picker system, storage assignment policy, order batching, and order picking sequencing. By reviewing these studies, we try to identify the most prevalent order picking improvement approach to order picking improvement. Keywords: warehousing; stock-to-picker; storage assignment; order batching; order picking sequencing; improvement

Leadership Development and School Improvement

Science.gov (United States)

Rhodes, Christopher; Brundrett, Mark

2009-01-01

The chosen focus of this special issue is timely given the burgeoning international interest and investment in leadership development and school improvement. In many countries leadership and improvement have been closely linked and there is no doubt that this linkage has an international reach. Together, these articles review and extend some of…

Renovated Parks Improve Physical Activity

Centers for Disease Control (CDC) Podcasts

We know that children who are physically active every day are less likely to develop chronic diseases as adults, including obesity. Dr. Sandy Slater, a researcher with the University of Illinois, Chicago Prevention Research Center, discusses how a park improvement project in Chicago helped engage communities to improve areas for play and activity.

Workers' Objectives in Quality Improvement.

Science.gov (United States)

Brossard, Michel

1990-01-01

A case study of quality circles in an appliance factory found that circle members and nonmembers obtained better working conditions by improving quality through the direct impact of their work on the company's market position. The study of the quality improvement process shows that workers seek more than psychological rewards for their…

Perceived Factors Associated with Sustained Improvement Following Participation in a Multicenter Quality Improvement Collaborative.

Science.gov (United States)

Stone, Sohini; Lee, Henry C; Sharek, Paul J

2016-07-01

The California Perinatal Quality Care Collaborative led the Breastmilk Nutrition Quality Improvement Collaborative from October 2009 to September 2010 to increase the percentage of very low birth weight infants receiving breast milk at discharge in 11 collaborative neonatal ICUs (NICUs). Observed increases in breast milk feeding and decreases in necrotizing enterocolitis persisted for 6 months after the collaborative ended. Eighteen to 24 months after the end of the collaborative, some sites maintained or further increased their gains, while others trended back toward baseline. A study was conducted to assess the qualitative factors that affect sustained improvement following participation. Collaborative leaders at each of the 11 NICUs that participated in the Breastmilk Nutrition Quality Improvement Collaborative were invited to participate in a site-specific one-hour phone interview. Interviews were recorded and transcribed and then analyzed using qualitative research analysis software to identify themes associated with sustained improvement. Eight of 11 invited centers agreed to participate in the interviews. Thematic saturation was achieved by the sixth interview, so further interviews were not pursued. Factors contributing to sustainability included physician involvement within the multidisciplinary teams, continuous education, incorporation of interventions into the daily work flow, and integration of a data-driven feedback system. Early consideration by site leaders of how to integrate best-practice interventions into the daily work flow, and ensuring physician commitment and ongoing education based in continuous data review, should enhance the likelihood of sustaining improvements. To maximize sustained success, future collaborative design should consider proactively identifying and supporting these factors at participating sites.

Improvements in fitness are not obligatory for exercise training-induced improvements in CV risk factors.

Science.gov (United States)

Hartman, Yvonne A W; Hopman, Maria T E; Schreuder, Tim H; Verheggen, Rebecca J H M; Scholten, Ralph R; Oudegeest-Sander, Madelijn H; Poelkens, Fleur; Maiorana, Andrew J; Naylor, Louise H; Willems, Peter H; Tack, Cees J; Thijssen, Dick H J; Green, Daniel J

2018-02-01

The purpose of this study was to assess whether changes in physical fitness relate to changes in cardiovascular risk factors following standardized, center-based and supervised exercise training programs in subjects with increased cardiovascular risk. We pooled data from exercise training studies of subjects with increased cardiovascular risk (n = 166) who underwent 8-52 weeks endurance training. We determined fitness (i.e., peak oxygen uptake) and traditional cardiovascular risk factors (body mass index, blood pressure, total cholesterol, high-density lipoprotein cholesterol), before and after training. We divided subjects into quartiles based on improvement in fitness, and examined whether these groups differed in terms of risk factors. Associations between changes in fitness and in cardiovascular risk factors were further tested using Pearson correlations. Significant heterogeneity was apparent in the improvement of fitness and individual risk factors, with nonresponder rates of 17% for fitness, 44% for body mass index, 33% for mean arterial pressure, 49% for total cholesterol, and 49% for high-density lipoprotein cholesterol. Neither the number, nor the magnitude, of change in cardiovascular risk factors differed significantly between quartiles of fitness change. Changes in fitness were not correlated with changes in cardiovascular risk factors (all P > 0.05). Our data suggest that significant heterogeneity exists in changes in peak oxygen uptake after training, while improvement in fitness did not relate to improvement in cardiovascular risk factors. In subjects with increased cardiovascular risk, improvements in fitness are not obligatory for training-induced improvements in cardiovascular risk factors. © 2018 The Authors. Physiological Reports published by Wiley Periodicals, Inc. on behalf of The Physiological Society and the American Physiological Society.

Design safety improvements of Kozloduy NPP

International Nuclear Information System (INIS)

Hinovski, I.

1999-01-01

Design safety improvements of Kozloduy NPP, discussed in detail, are concerned with: primary circuit integrity; reactor pressure vessel integrity; primary coolant piping integrity; primary coolant overpressure protection; leak before break status; design basis accidents and transients; severe accident analysis; improvements of safety and support systems; containment/confinement leak tightness and strength; seismic safety improvements; WWER-1000 control rod insertion; upgrading and modernization of Units 5 and 6; Year 2000 problem

Mapping social networks in software process improvement

DEFF Research Database (Denmark)

Tjørnehøj, Gitte; Nielsen, Peter Axel

2005-01-01

Software process improvement in small, agile organizations is often problematic. Model-based approaches seem to overlook problems. We have been seeking an alternative approach to overcome this through action research. Here we report on a piece of action research from which we developed an approach...... to map social networks and suggest how it can be used in software process improvement. We applied the mapping approach in a small software company to support the realization of new ways of improving software processes. The mapping approach was found useful in improving social networks, and thus furthers...... software process improvement....

Improving the Service with the Servqual Method

Science.gov (United States)

Midor, Katarzyna; Kučera, Marian

2018-03-01

At the time when economy is growing, there is strong competition in the market, and customers have increasingly higher expectations as regards quality of service and products. Under such conditions, organizations need to improve. One of the areas of improvement for an organization is to research the level of customer satisfaction. The article presents results of customer satisfaction surveys conducted by the Servqual method in a pharmaceutical service company. Use of this method allowed to improve the services provided by that pharmaceutical wholesaler, identify areas that need to be improved as soon as possible in order to improve the level of service provided.

An Adaptive Middleware for Improved Computational Performance

DEFF Research Database (Denmark)

Bonnichsen, Lars Frydendal

, we are improving computational performance by exploiting modern hardware features, such as dynamic voltage-frequency scaling and transactional memory. Adapting software is an iterative process, requiring that we continually revisit it to meet new requirements or realities; a time consuming process......The performance improvements in computer systems over the past 60 years have been fueled by an exponential increase in energy efficiency. In recent years, the phenomenon known as the end of Dennard’s scaling has slowed energy efficiency improvements — but improving computer energy efficiency...... is more important now than ever. Traditionally, most improvements in computer energy efficiency have come from improvements in lithography — the ability to produce smaller transistors — and computer architecture - the ability to apply those transistors efficiently. Since the end of scaling, we have seen...

Using Data to Improve Educational Practice

Directory of Open Access Journals (Sweden)

Matthijs Koopmans

2017-04-01

Full Text Available Review of the book “Action Research in the Classroom: Helping Teachers Assess and Improve their Work” by Sr. Mary Ann Jacobs and Bruce S. Cooper There are many ways in which research can contribute to the improvement of educational practice, and action research is one of them. Action research bridges the gap that typically separates research from practice by having practitioners conduct specific projects to address their own questions and improve their effectiveness based on the answers they obtain. One of the advantages of this type of research is that results are often immediately accessible and have actionable implications. Thus, action research is a good tool for making improvements to the field based on evidence.

Improving Family Communications

Science.gov (United States)

... Spread the Word Shop AAP Find a Pediatrician Family Life Medical Home Family Dynamics Adoption & Foster Care ... Listen Español Text Size Email Print Share Improving Family Communications Page Content Article Body How can I ...

Programs to improve plant performance

International Nuclear Information System (INIS)

Felmus, N.L.

1987-01-01

Looking toward the 1990's, we see a period in which our industry will face the challenge of improving the performance of the nuclear plants which are built and operating. The skills and technology are at hand to make good plant performance a reality and we believe the time has come to use them to achieve that end. As reserve margins decline, utilities and their regulators will increasingly seek to tap the unexploited capacity tied up in plants operating below their optimum availability. This paper describes a number of the programs, plant improvements and operations improvements which can yield a significant increase in nuclear plant availability and capacity factor now and into the 1990's. (author)

Improvements in backscatter measurement devices

International Nuclear Information System (INIS)

Saunders, J.; Hay, W.D.

1978-01-01

Improvements in measuring the thickness of a coating on a substrate by the technique of backscattered particles are described. These improvements enable the measurements to be carried out continuously as an integral part of the coating production line and also permit measurements where the coated elements are separated from one another by a predetermined distance. The former is achieved by situating the backscatter probe and detector on the rim of the measurement wheel and rotating this wheel at a speed such that the coated element and probe are stationary relative to one another. The latter improvement is achieved by an indexing apparatus which automatically positions the probe beside a coated element. (U.K.)

Improvement for BWR operator training

International Nuclear Information System (INIS)

Tsuchiya, Toshio; Masuda, Hisao; Isono, Tomoyuki; Noji, Kunio; Togo, Toshiki

1989-01-01

BWR Operator Training Center Corporation (BTC) was established in April 1971 for the purpose of training the operators from all BWR utilities in Japan. Since April 1974, more than 2600 operators and 1000 shift teams have been trained with the full-scope simulators in BTC up to the end of March 1988. To get the satisfactory results of the training, BTC has been making every effort to improve the facilities, the training materials, the instruction methods and the curricula. In this paper, such a series of recent improvements in the instruction methods and the curricula are presented that are effective to expand the knowledge and to improve the skills of middle or senior class operators. (author)

Baseline budgeting for continuous improvement.

Science.gov (United States)

Kilty, G L

1999-05-01

This article is designed to introduce the techniques used to convert traditionally maintained department budgets to baseline budgets. This entails identifying key activities, evaluating for value-added, and implementing continuous improvement opportunities. Baseline Budgeting for Continuous Improvement was created as a result of a newly named company president's request to implement zero-based budgeting. The president was frustrated with the mind-set of the organization, namely, "Next year's budget should be 10 to 15 percent more than this year's spending." Zero-based budgeting was not the answer, but combining the principles of activity-based costing and the Just-in-Time philosophy of eliminating waste and continuous improvement did provide a solution to the problem.

Design improvements in TRIGA reactors

International Nuclear Information System (INIS)

Batch, John M.

1970-01-01

There have been many design improvements to TRIGA reactor hardware in the past twelve years. One of the more important and most obvious improvements has been in the area of reactor instrumentation. The low profile, completely transistorized Mark III console was a great step forward in a low maintenance, high reliability instrumentation system. Other design improvements include the lazy susan specimen pickup assembly; the specimen container; an empty stainless steel fuel element which can be filled with samples and can be located anywhere in the core; the flexible fuel handling tool; a new fuel measuring tool design; the shock absorber on the adjustable transient rod drive; new testing and evaluation procedures on the thermocouples and other

Improved Biomass Cooking Stoves and Improved Stove Emission Equipment

Energy Technology Data Exchange (ETDEWEB)

HATFIELD, MICHAEL; Still, Dean

2013-04-15

In developing countries, there is an urgent need for access to safe, efficient, and more affordable cooking technologies. Nearly 2.5 billion people currently use an open fire or traditional cookstove to prepare their meals, and recent models predict that use of biomass for cooking will continue to be the dominant energy use in rural, resource-poor households through 2030. For these families, cooking poses serious risks to health, safety, and income. An alarming 4 million people, primarily women and children, die prematurely each year from indoor and outdoor exposure to the harmful emissions released by solid fuel combustion. Use of traditional stoves can also have a significant impact on deforestation and climate change. This dire situation creates a critical need for cookstoves that significantly and verifiably reduce fuel use and emissions in order to reach protective levels for human health and the environment. Additionally, advances in the scientific equipment needed to measure and monitor stove fuel use and emissions have not kept pace with the significant need within the industry. While several testing centers in the developed world may have hundred thousand-dollar emissions testing systems, organizations in the field have had little more than a thermometer, a scale, and subjective observations to quantify the performance of stove designs. There is an urgent need for easy-to-use, inexpensive, accurate, and robust stove testing equipment for use by laboratory and field researchers around the world. ASAT and their research partner, Aprovecho Research Center (ARC), have over thirty years of experience addressing these two needs, improved cookstoves and emissions monitoring equipment, with expertise spanning the full spectrum of development from conceptual design to product manufacturing and dissemination. This includes: 1) research, design, and verification of clean biomass cookstove technology and emissions monitoring equipment; 2) mass production of quality

A High Intensity Interval Training (HIIT)-Based Running Plan Improves Athletic Performance by Improving Muscle Power.

Science.gov (United States)

García-Pinillos, Felipe; Cámara-Pérez, Jose C; Soto-Hermoso, Víctor M; Latorre-Román, Pedro Á

2017-01-01

García-Pinillos, F, Cámara-Pérez, JC, Soto-Hermoso, VM, and Latorre-Román, PÁ. A High Intensity Interval Training (HIIT)-based running plan improves athletic performance by improving muscle power. J Strength Cond Res 31(1): 146-153, 2017-This study aimed to examine the effect of a 5-week high-intensity intermittent training (HIIT)-based running plan on athletic performance and to compare the physiological and neuromuscular responses during a sprint-distance triathlon before and after the HIIT period. Thirteen triathletes were matched into 2 groups: the experimental group (EG) and the control group (CG). The CG was asked to maintain their normal training routines, whereas the EG maintained only their swimming and cycling routines and modified their running routine. Participants completed a sprint-distance triathlon before (pretest) and after (posttest) the intervention period. In both pretest and posttest, the participants performed 4 jumping tests: before the race (baseline), postswim, postcycling, and postrun. Additionally, heart rate was monitored (HRmean), whereas rate of perceived exertion (RPE) and blood lactate accumulation (BLa) were registered after the race. No significant differences (p ≥ 0.05) between groups were found before HIIT intervention (at pretest). Significant group-by-training interactions were found in vertical jumping ability and athletic performance: the EG improved jumping performance (∼6-9%, p ≤ 0.05, effect size (ES) > 0.7), swimming performance (p = 0.013, ES = 0.438), and running time (p = 0.001, ES = 0.667) during the competition, whereas the CG remained unchanged (p ≥ 0.05, ES HIIT-based running plan combined with the high training volumes of these triathletes in swimming and cycling improved athletic performance during a sprint-distance triathlon. This improvement may be due to improved neuromuscular characteristics that were transferred into improved muscle power and work economy.

Substantial Improvements of Fuel Economy

DEFF Research Database (Denmark)

Jørgensen, Kaj; Nielsen, Lars H.

1996-01-01

The paper evaluates the scope for improving the energy and environmental impacts of road transport by means of electrical and hybrid propulsion. These technologies promise considerable improvements of the fuel economy compared to equivalent vehicles mas well as beneficial effects for the energy...... and traffic systems. A case study concerning passenger cars is analysed by means of computer simulation....

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

Science.gov (United States)

1991-09-01

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

Comparing three novel endpoints for developmental osteotoxicity in the embryonic stem cell test

International Nuclear Information System (INIS)

Nieden, Nicole I. zur; Davis, Lesley A.; Rancourt, Derrick E.

2010-01-01

Birth defects belong to the most serious side effects of pharmaceutical compounds or environmental chemicals. In vivo, teratogens most often affect the normal development of bones, causing growth retardation, limb defects or craniofacial malformations. The embryonic stem cell test (EST) is one of the most promising models that allow the in vitro prediction of embryotoxicity, with one of its endpoints being bone tissue development. The present study was designed to describe three novel inexpensive endpoints to assess developmental osteotoxicity using the model compounds penicillin G (non-teratogenic), 5-fluorouracil (strong teratogen) and all-trans retinoic acid (bone teratogen). These three endpoints were: quantification of matrix incorporated calcium by (1) morphometric analysis and (2) measurement of calcium levels as well as (3) activity of alkaline phosphatase, an enzyme involved in matrix calcification. To evaluate our data, we have compared the concentration curves and resulting ID 50 s of the new endpoints with mRNA expression for osteocalcin. Osteocalcin is an exclusive marker found only in mineralized tissues, is regulated upon compound treatment and reliably predicts the potential of a chemical entity acting as a bone teratogen. By comparing the new endpoints to quantitative expression of osteocalcin, which we previously identified as suitable to detect developmental osteotoxicity, we were ultimately able to illustrate IMAGE analysis and Ca 2+ deposition assays as two reliable novel endpoints for the EST. This is of particular importance for routine industrial assessment of novel compounds as these two new endpoints may substitute previously used molecular read-out methods, which are often costly and time-consuming.

Process safety improvement-Quality and target zero

Energy Technology Data Exchange (ETDEWEB)

Van Scyoc, Karl [Det Norske Veritas (U.S.A.) Inc., DNV Energy Solutions, 16340 Park Ten Place, Suite 100, Houston, TX 77084 (United States)], E-mail: karl.van.scyoc@dnv.com

2008-11-15

Process safety practitioners have adopted quality management principles in design of process safety management systems with positive effect, yet achieving safety objectives sometimes remain a distant target. Companies regularly apply tools and methods which have roots in quality and productivity improvement. The 'plan, do, check, act' improvement loop, statistical analysis of incidents (non-conformities), and performance trending popularized by Dr. Deming are now commonly used in the context of process safety. Significant advancements in HSE performance are reported after applying methods viewed as fundamental for quality management. In pursuit of continual process safety improvement, the paper examines various quality improvement methods, and explores how methods intended for product quality can be additionally applied to continual improvement of process safety. Methods such as Kaizen, Poke yoke, and TRIZ, while long established for quality improvement, are quite unfamiliar in the process safety arena. These methods are discussed for application in improving both process safety leadership and field work team performance. Practical ways to advance process safety, based on the methods, are given.

Process safety improvement-Quality and target zero

International Nuclear Information System (INIS)

Van Scyoc, Karl

2008-01-01

Process safety practitioners have adopted quality management principles in design of process safety management systems with positive effect, yet achieving safety objectives sometimes remain a distant target. Companies regularly apply tools and methods which have roots in quality and productivity improvement. The 'plan, do, check, act' improvement loop, statistical analysis of incidents (non-conformities), and performance trending popularized by Dr. Deming are now commonly used in the context of process safety. Significant advancements in HSE performance are reported after applying methods viewed as fundamental for quality management. In pursuit of continual process safety improvement, the paper examines various quality improvement methods, and explores how methods intended for product quality can be additionally applied to continual improvement of process safety. Methods such as Kaizen, Poke yoke, and TRIZ, while long established for quality improvement, are quite unfamiliar in the process safety arena. These methods are discussed for application in improving both process safety leadership and field work team performance. Practical ways to advance process safety, based on the methods, are given

Process safety improvement--quality and target zero.

Science.gov (United States)

Van Scyoc, Karl

2008-11-15

Process safety practitioners have adopted quality management principles in design of process safety management systems with positive effect, yet achieving safety objectives sometimes remain a distant target. Companies regularly apply tools and methods which have roots in quality and productivity improvement. The "plan, do, check, act" improvement loop, statistical analysis of incidents (non-conformities), and performance trending popularized by Dr. Deming are now commonly used in the context of process safety. Significant advancements in HSE performance are reported after applying methods viewed as fundamental for quality management. In pursuit of continual process safety improvement, the paper examines various quality improvement methods, and explores how methods intended for product quality can be additionally applied to continual improvement of process safety. Methods such as Kaizen, Poke yoke, and TRIZ, while long established for quality improvement, are quite unfamiliar in the process safety arena. These methods are discussed for application in improving both process safety leadership and field work team performance. Practical ways to advance process safety, based on the methods, are given.

Improved fluid-structure coupling

International Nuclear Information System (INIS)

McMaster, W.H.; Gong, E.Y.; Landram, C.S.

1981-01-01

In the computer code PELE-IC, an incompressible Eulerian hydrodynamic algorithm was coupled to a Lagrangian finite element shell algorithm for the analysis of pressure suppression in boiling water reactors. This effort also required the development of a free surface algorithm capable of handling expanding gas bubbles. These algorithms have been improved to strengthen the coupling and to add the capability for following the more complex free surfaces resulting from steam condensation. These improvements have also permitted more economical 2D calculations and have made it feasible to develop a 3D version. A compressible option using the acoustic approximation has also been added, furthering the usefulness of the code. The coupling improvements were made in three areas which are identified as (1) preferential coupling, (2) merged cell coupling, and (3) free surface-structure coupling, and are described. These algorithms have been additionally implemented in a three dimensional version of the code called PELE3D. This version has a free surface capability to follow expanding and contracting bubbles and is coupled to a curved rigid surface

RTEMS CENTRE- RTEMS Improvement

Science.gov (United States)

Silva, Helder; Constantino, Alexandre; Freitas, Daniel; Coutinho, Manuel; Faustino, Sergio; Sousa, Jose; Dias, Luis; Zulianello, Marco

2010-08-01

During the last two years, EDISOFT's RTEMS CENTRE team [1], jointly with the European Space Agency and with the support of the worldwide RTEMS community [2], have been developing an activity to facilitate the qualification of the real-time operating system RTEMS (Real-Time Operating System for Multiprocessor Systems). This paper intends to give a high level visibility of the progress and the results obtained in the RTEMS Improvement [3] activity. The primary objective [4] of the project is to improve the RTEMS product, its documentation and to facilitate the qualification of RTEMS for future space missions, taking into consideration the specific operational requirements. The sections below provide a brief overview of the RTEMS operating system and the activities performed in the RTEMS Improvement project, which includes the selection of API managers to be qualified, the tailoring process, the requirements analysis, the reverse engineering and design of the RTEMS, the quality assurance process, the ISVV activities, the test campaign, the results obtained, the criticality analysis and the facilitation of qualification process.

Osteochondral Biopsy Analysis Demonstrates That BST-CarGel Treatment Improves Structural and Cellular Characteristics of Cartilage Repair Tissue Compared With Microfracture

Science.gov (United States)

Méthot, Stéphane; Changoor, Adele; Tran-Khanh, Nicolas; Hoemann, Caroline D.; Stanish, William D.; Restrepo, Alberto; Shive, Matthew S.; Buschmann, Michael D.

2016-01-01

Objective The efficacy and safety of BST-CarGel, a chitosan-based medical device for cartilage repair, was compared with microfracture alone at 1 year during a multicenter randomized controlled trial (RCT) in the knee. The quality of repair tissue of osteochondral biopsies collected from a subset of patients was compared using blinded histological assessments. Methods The international RCT evaluated repair tissue quantity and quality by 3-dimensional quantitative magnetic resonance imaging as co-primary endpoints at 12 months. At an average of 13 months posttreatment, 21/41 BST-CarGel and 17/39 microfracture patients underwent elective second look arthroscopies as a tertiary endpoint, during which ICRS (International Cartilage Repair Society) macroscopic scoring was carried out, and osteochondral biopsies were collected. Stained histological sections were evaluated by blinded readers using ICRS I and II histological scoring systems. Collagen organization was evaluated using a polarized light microscopy score. Results BST-CarGel treatment resulted in significantly better ICRS macroscopic scores (P = 0.0002) compared with microfracture alone, indicating better filling, integration, and tissue appearance. Histologically, BST-CarGel resulted in a significant improvement of structural parameters—Surface Architecture (P = 0.007) and Surface/Superficial Assessment (P = 0.042)—as well as cellular parameters—Cell Viability (P = 0.006) and Cell Distribution (P = 0.032). No histological parameters were significantly better for the microfracture group. BST-CarGel treatment also resulted in a more organized repair tissue with collagen stratification more similar to native hyaline cartilage, as measured by polarized light microscopy scoring (P = 0.0003). Conclusion Multiple and independent analyses in this biopsy substudy demonstrated that BST-CarGel treatment results in improved structural and cellular characteristics of repair tissue at 1 year posttreatment compared with

Improving quality of care in substance abuse treatment using five key process improvement principles

Science.gov (United States)

Hoffman, Kim A.; Green, Carla A.; Ford, James H.; Wisdom, Jennifer P.; Gustafson, David H.; McCarty, Dennis

2012-01-01

Process and quality improvement techniques have been successfully applied in health care arenas, but efforts to institute these strategies in alcohol and drug treatment are underdeveloped. The Network for the Improvement of Addiction Treatment (NIATx) teaches participating substance abuse treatment agencies to use process improvement strategies to increase client access to, and retention in, treatment. NIATx recommends five principles to promote organizational change: 1) Understand and involve the customer; 2) Fix key problems; 3) Pick a powerful change leader; 4) Get ideas from outside the organization; and 5) Use rapid-cycle testing. Using case studies, supplemented with cross-agency analyses of interview data, this paper profiles participating NIATx treatment agencies that illustrate application of each principle. Results suggest that the most successful organizations integrate and apply most, if not all, of the five principles as they develop and test change strategies. PMID:22282129

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

Science.gov (United States)

Joshi, M S; Bernard, D B

1999-08-01

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

Developing a Continuous Improvement System

Science.gov (United States)

2016-09-16

disagree that continuous improvement is critical to an organization’s suc-cess, since conducting business using a status quo philosophy will not work...for implementing one of these processes include: better operational efficiency, increased customer satisfaction, improved employee morale ...when a problem in reliability or maintenance may become the greatest opportunity. As described in the January-February 2011 issue of Defense AT&L

Continuous improvement: A win-win process

International Nuclear Information System (INIS)

Lawrence, T.M.; Wichert, A.

1992-01-01

The strategies used within PanCanadian Petroleum Limited's production division to successfully introduce the continuous improvement (CI) process are discussed. Continuous improvement is an operating philosophy and management style which allows all employees to participate in and improve the way an organization performs its day-to-day business. In the CI work environment the supervisor's traditional role changes from one of monitoring and controlling, to one of inspiring, motivating and leading people by communicating a clear vision. Employees at all levels in the work environment are organized into teams and armed with a good working knowledge of the problem-solving tools which allow them to pursue and implement improvement initiatives. The outcome of the process is an ongoing win-win situation for both PanCanadian and its people. Employees are gaining more trust, eliminating job irritants, and enjoying their work in a team environment. The company is benefiting through increased production, improved safety and reduced operating expenses, thanks to the many innovative ideas introduced by employees. 4 refs

Improved models of dense anharmonic lattices

Energy Technology Data Exchange (ETDEWEB)

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

2017-01-15

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

Improved core protection calculator system algorithm

International Nuclear Information System (INIS)

Yoon, Tae Young; Park, Young Ho; In, Wang Kee; Bae, Jong Sik; Baeg, Seung Yeob

2009-01-01

Core Protection Calculator System (CPCS) is a digitized core protection system which provides core protection functions based on two reactor core operation parameters, Departure from Nucleate Boiling Ratio (DNBR) and Local Power Density (LPD). It generates a reactor trip signal when the core condition exceeds the DNBR or LPD design limit. It consists of four independent channels which adapted a two out of four trip logic. CPCS algorithm improvement for the newly designed core protection calculator system, RCOPS (Reactor COre Protection System), is described in this paper. New features include the improvement of DNBR algorithm for thermal margin, the addition of pre trip alarm generation for auxiliary trip function, VOPT (Variable Over Power Trip) prevention during RPCS (Reactor Power Cutback System) actuation and the improvement of CEA (Control Element Assembly) signal checking algorithm. To verify the improved CPCS algorithm, CPCS algorithm verification tests, 'Module Test' and 'Unit Test', would be performed on RCOPS single channel facility. It is expected that the improved CPCS algorithm will increase DNBR margin and enhance the plant availability by reducing unnecessary reactor trips

Improvement of foundation for inspection

Energy Technology Data Exchange (ETDEWEB)

NONE

2013-08-15

Japan Nuclear Energy Safety Organization has been carrying out improvement of inspection system for nuclear plants in Japan since 2003FY. The new inspection system was introduced into nuclear power plants in{sub -}2008FY. In this project, improvement of comprehensive plant performance assessment and management tool for the new inspection system are developed. In 2012FY, a trend analysis method of the plant performance was developed with reference to the IAEA literature. And the trend analysis was tried based on the results of the comprehensive plant performance assessment of all domestic plants except Fukushima-Daiichi Nuclear Power Station. In addition, the teaching materials for QMS training guideline were made. And improvement of a quality management system evaluation support tool was performed. (author)

Improvement of foundation for inspection

International Nuclear Information System (INIS)

2013-01-01

Japan Nuclear Energy Safety Organization has been carrying out improvement of inspection system for nuclear plants in Japan since 2003FY. The new inspection system was introduced into nuclear power plants in - 2008FY. In this project, improvement of comprehensive plant performance assessment and management tool for the new inspection system are developed. In 2012FY, a trend analysis method of the plant performance was developed with reference to the IAEA literature. And the trend analysis was tried based on the results of the comprehensive plant performance assessment of all domestic plants except Fukushima-Daiichi Nuclear Power Station. In addition, the teaching materials for QMS training guideline were made. And improvement of a quality management system evaluation support tool was performed. (author)

Combined Dual-Task Gait Training and Aerobic Exercise to Improve Cognition, Mobility, and Vascular Health in Community-Dwelling Older Adults at Risk for Future Cognitive Decline1.

Science.gov (United States)

Gregory, Michael A; Boa Sorte Silva, Narlon C; Gill, Dawn P; McGowan, Cheri L; Liu-Ambrose, Teresa; Shoemaker, J Kevin; Hachinski, Vladimir; Holmes, Jeff; Petrella, Robert J

2017-01-01

This 6-month experimental case series study investigated the effects of a dual-task gait training and aerobic exercise intervention on cognition, mobility, and cardiovascular health in community-dwelling older adults without dementia. Participants exercised 40 min/day, 3 days/week for 26 weeks on a Biodex GaitTrainer2 treadmill. Participants were assessed at baseline (V0), interim (V1: 12-weeks), intervention endpoint (V2: 26-weeks), and study endpoint (V3: 52-weeks). The study outcomes included: cognition [executive function (EF), processing speed, verbal fluency, and memory]; mobility: usual & dual-task gait (speed, step length, and stride time variability); and vascular health: ambulatory blood pressure, carotid arterial compliance, and intima-media thickness (cIMT). Fifty-six participants [age: 70(6) years; 61% female] were included in this study. Significant improvements following the exercise program (V2) were observed in cognition: EF (p = 0.002), processing speed (p coding (p memory [immediate recall (p dual-task gait speed (p = 0.002 and p dual-task gait training and aerobic exercise improved performance on a number of cognitive outcomes, while increasing usual & dual-task gait speed and step length in a sample of older adults without dementia.

Simplification to abacavir/lamivudine + atazanavir maintains viral suppression and improves bone and renal biomarkers in ASSURE, a randomized, open label, non-inferiority trial.

Directory of Open Access Journals (Sweden)

David A Wohl

Full Text Available Simplification of antiretroviral therapy in patients with suppressed viremia may minimize long-term adverse effects. The study's primary objective was to determine whether abacavir/lamivudine + atazanavir (ABC/3TC+ATV was virologically non-inferior to tenofovir/emtricitabine + atazanavir/ritonavir (TDF/FTC+ATV/r over 24 weeks in a population of virologically suppressed, HIV-1 infected patients.This open-label, multicenter, non-inferiority study enrolled antiretroviral experienced, HIV-infected adults currently receiving a regimen of TDF/FTC+ATV/r for ≥ 6 months with no history of virologic failure and whose HIV-1 RNA had been ≤ 75 copies/mL on 2 consecutive measurements including screening. Patients were randomized 1 ∶ 2 to continue current treatment or simplify to ABC/3TC+ATV.The primary endpoint was the proportion of patients with HIV-RNA<50 copies/mL at Week 24 by the Time to Loss of Virologic Response (TLOVR algorithm. Secondary endpoints included alternative measures of efficacy, adverse events (AEs, and fasting lipids. Exploratory endpoints included inflammatory, coagulation, bone, and renal biomarkers.After 24 weeks, ABC/3TC+ATV (n = 199 was non-inferior to TDF/FTC+ATV/r (n = 97 by both the primary analysis (87% in both groups and all secondary efficacy analyses. Rates of grade 2-4 AEs were similar between the two groups (40% vs 37%, respectively, but an excess of hyperbilirubinemia made the rate of grade 3-4 laboratory abnormalities higher in the TDF/FTC+ATV/r group (30% compared with the ABC/3TC+ATV group (13%. Lipid levels were stable except for HDL cholesterol, which increased significantly in the ABC/3TC+ATV group. Bone and renal biomarkers improved significantly between baseline and Week 24 in patients taking ABC/3TC+ATV, and the difference between groups was significant at Week 24. No significant changes occurred in any inflammatory or coagulation biomarker within or between treatment groups.After 24 weeks, simplification to

Functional molecular markers for crop improvement.

Science.gov (United States)

Kage, Udaykumar; Kumar, Arun; Dhokane, Dhananjay; Karre, Shailesh; Kushalappa, Ajjamada C

2016-10-01

A tremendous decline in cultivable land and resources and a huge increase in food demand calls for immediate attention to crop improvement. Though molecular plant breeding serves as a viable solution and is considered as "foundation for twenty-first century crop improvement", a major stumbling block for crop improvement is the availability of a limited functional gene pool for cereal crops. Advancement in the next generation sequencing (NGS) technologies integrated with tools like metabolomics, proteomics and association mapping studies have facilitated the identification of candidate genes, their allelic variants and opened new avenues to accelerate crop improvement through development and use of functional molecular markers (FMMs). The FMMs are developed from the sequence polymorphisms present within functional gene(s) which are associated with phenotypic trait variations. Since FMMs obviate the problems associated with random DNA markers, these are considered as "the holy grail" of plant breeders who employ targeted marker assisted selections (MAS) for crop improvement. This review article attempts to consider the current resources and novel methods such as metabolomics, proteomics and association studies for the identification of candidate genes and their validation through virus-induced gene silencing (VIGS) for the development of FMMs. A number of examples where the FMMs have been developed and used for the improvement of cereal crops for agronomic, food quality, disease resistance and abiotic stress tolerance traits have been considered.

Improve your communication skills

CERN Document Server

Barker, Alan

2016-01-01

Excellent communication skills are vital in today's workplace. Whether keeping the interest of a large audience, impressing a potential employer or simply winning the argument at an important meeting, sounding the part is key. This fourth edition of Improve Your Communication Skills is full of practical advice on all aspects of verbal and non-verbal communication. It gives vital tips on improving conversations and building rapport with colleagues, learning the skills of persuasion, and writing effective emails, letters and reports. This editionincludes new information focusing on communicating across borders and virtual teams and a new chapter on managing difficult conversations."

Engineering chloroplasts to improve Rubisco catalysis: prospects for translating improvements into food and fiber crops.

Science.gov (United States)

Sharwood, Robert E

2017-01-01

494 I. 495 II. 496 III. 496 IV. 499 V. 499 VI. 501 VII. 501 VIII. 502 IX. 505 X. 506 507 References 507 SUMMARY: The uncertainty of future climate change is placing pressure on cropping systems to continue to provide stable increases in productive yields. To mitigate future climates and the increasing threats against global food security, new solutions to manipulate photosynthesis are required. This review explores the current efforts available to improve carbon assimilation within plant chloroplasts by engineering Rubisco, which catalyzes the rate-limiting step of CO 2 fixation. Fixation of CO 2 and subsequent cycling of 3-phosphoglycerate through the Calvin cycle provides the necessary carbohydrate building blocks for maintaining plant growth and yield, but has to compete with Rubisco oxygenation, which results in photorespiration that is energetically wasteful for plants. Engineering improvements in Rubisco is a complex challenge and requires an understanding of chloroplast gene regulatory pathways, and the intricate nature of Rubisco catalysis and biogenesis, to transplant more efficient forms of Rubisco into crops. In recent times, major advances in Rubisco engineering have been achieved through improvement of our knowledge of Rubisco synthesis and assembly, and identifying amino acid catalytic switches in the L-subunit responsible for improvements in catalysis. Improving the capacity of CO 2 fixation in crops such as rice will require further advances in chloroplast bioengineering and Rubisco biogenesis. © 2016 The Author. New Phytologist © 2016 New Phytologist Trust.

Improving global health: counting reasons why.

Science.gov (United States)

Selgelid, Michael J

2008-08-01

This paper examines cumulative ethical and self-interested reasons why wealthy developed nations should be motivated to do more to improve health care in developing countries. Egalitarian and human rights reasons why wealthy nations should do more to improve global health are that doing so would (1) promote equality of opportunity (2) improve the situation of the worst-off, (3) promote respect of the human right to have one's most basic needs met, and (4) reduce undeserved inequalities in well-being. Utilitarian reasons for improving global health are that this would (5) promote the greater good of humankind, and (6) achieve enormous benefits while requiring only small sacrifices. Libertarian reasons are that this would (7) amend historical injustices and (8) meet the obligation to amend injustices that developed world countries have contributed to. Self-interested reasons why wealthy nations should do more to improve global health are that doing so would (9) reduce the threat of infectious diseases to developed countries, (10) promote developed countries' economic interests, and (11) promote global security. All of these reasons count, and together they add up to make an overwhelmingly powerful case for change. Those opposed to wealthy government funding of developing world health improvement would most likely appeal, implicitly or explicitly to the idea that coercive taxation for redistributive purposes would violate the right of an individual to keep his hard-earned income. The idea that this reason not to improve global health should outweigh the combination of rights and values embodied in the eleven reasons enumerated above, however is implausibly extreme, morally repugnant and perhaps imprudent.

Evolution and outcomes of a quality improvement program.

Science.gov (United States)

Thor, Johan; Herrlin, Bo; Wittlöv, Karin; Øvretveit, John; Brommels, Mats

2010-01-01

The purpose of this paper is to examine the outcomes and evolution over a five-year period of a Swedish university hospital quality improvement program in light of enduring uncertainty regarding the effectiveness of such programs in healthcare and how best to evaluate it. The paper takes the form of a case study, using data collected as part of the program, including quality indicators from clinical improvement projects and participants' program evaluations. Overall, 58 percent of the program's projects (39/67) demonstrated success. A greater proportion of projects led by female doctors demonstrated success (91 percent, n=11) than projects led by male doctors (51 percent, n=55). Facilitators at the hospital continuously adapted the improvement methods to the local context. A lack of dedicated time for improvement efforts was the participants' biggest difficulty. The dominant benefits included an increased ability to see the "bigger picture" and the improvements achieved for patients and employees. Quality measurement, which is important for conducting and evaluating improvement efforts, was weak with limited reliability. Nevertheless, the present study adds evidence about the effectiveness of healthcare improvement programs. Gender differences in improvement team leadership merit further study. Improvement program evaluation should assess the extent to which improvement methods are locally adapted and applied. This case study reports the outcomes of all improvement projects undertaken in one healthcare organization over a five-year period and provides in-depth insight into an improvement program's changeable nature.

Nurses improve migraine management in primary care

NARCIS (Netherlands)

Veenstra, Petra; Kollen, Boudewijn J.; de Jong, Gosse; Baarveld, Frans; van den Berg, J. S. Peter

Introduction Migraine is a common disorder with a high burden. Adequate treatment results in improvement of quality of life. Migraine patients are mainly treated by general practitioners (GPs), but there is still room for improvement. This study investigated whether primary care nurses could improve

Adoption of Improved Potato Varieties in Nepal

Directory of Open Access Journals (Sweden)

Samaya Gairhe

2017-05-01

Full Text Available Nepal is one of the top twenty countries where potato contributes substantially for the human diet. Enhancing adoption of improved potato varieties could impact on farmer’s income, household food and nutritional security. As such, using a multistage sampling procedure, a study was conducted to assess the determinants of improved potato varieties adoption in Nepal covering 180 samples in four districts, two in hills and two in Tarai region. The study revealed that; Kavre and Bardiya districts in the hills and Tarai, respectively, were dominated by improved potato varieties adoption. On the other hand, Dhankuta and Jhapa in the hills and Tarai, respectively, were dominated by local potato varieties adoption. The informal seed sources followed by agro-vet and market were the major sources for improved varietal adoption. Farmers’ accesses to training and formal seed sources were important factor determining improved potato varietal adoption. However, households with larger farm size were less likely to allocate more area for improved potato varieties as many of farmers were reluctant to take potato cultivation as agri-business and still follow subsistence farming. Potato R&D programs, therefore, need to strengthen formal seed system to enhance access to quality potato seeds and build producer’s capacity through regular training and exposer visits in order to improve adoption of improved potato varieties in Nepal.

Trial endpoints for drug approval in oncology: Chemoprevention.

Science.gov (United States)

Beitz, J

2001-04-01

As with other drugs, new drug applications for marketing approval of chemopreventive drugs must include data from adequate and well-controlled clinical trials that demonstrate effectiveness and safety for the intended use. This article summarizes the regulatory requirements for traditional marketing approval, as well as for approval under the accelerated approval regulations. Unlike traditional approval, accelerated approval is based on a surrogate endpoint that is reasonably likely to predict clinical benefit. Discussions with the Food and Drug Administration (FDA) regarding the validity of trial endpoints that may serve as surrogates for clinical benefit for accelerated approval should take place as early as possible in drug development. Meetings with the FDA to discuss these issues may be requested throughout the clinical development of a new drug.

Continuous improvement methods in the nuclear industry

International Nuclear Information System (INIS)

Heising, Carolyn D.

1995-01-01

The purpose of this paper is to investigate management methods for improved safety in the nuclear power industry. Process improvement management, methods of business process reengineering, total quality management, and continued process improvement (KAIZEN) are explored. The anticipated advantages of extensive use of improved process oriented management methods in the nuclear industry are increased effectiveness and efficiency in virtually all tasks of plant operation and maintenance. Important spin off include increased plant safety and economy. (author). 6 refs., 1 fig

Improving policy implementation through collaborative policymaking

DEFF Research Database (Denmark)

Ansell, Christopher; Sørensen, Eva; Torfing, Jacob

2017-01-01

We offer a fresh perspective on implementation problems by suggesting that collaborative policy design and adaptive policy implementation will help public policy makers to improve policy execution. Classical implementation theories have focused too narrowly on administrative stumbling blocks and ...... collaborative policymaking and adaptive policy implementation might work in theory and practice......We offer a fresh perspective on implementation problems by suggesting that collaborative policy design and adaptive policy implementation will help public policy makers to improve policy execution. Classical implementation theories have focused too narrowly on administrative stumbling blocks...... and New Public Management has reinforced the split between politics and administration. Attempts to improve policy implementation must begin by looking at policy design, which can be improved through collaboration and deliberation between upstream and downstream actors. We provide a broad overview of how...

Improvement in fatigue during Natalizumab treatment is linked to improvement in depression and day-time sleepiness

Directory of Open Access Journals (Sweden)

Iris-Katharina ePenner

2015-02-01

Full Text Available Background: Fatigue is a frequent symptom in multiple sclerosis (MS and often interrelated with depression and sleep disorders making symptomatic treatment decisions difficult. In the single-arm, observational phase IV TYNERGY study, relapsing-remitting MS patients showed a clinically meaningful decrease in fatigue over one year of treatment with natalizumab. Objective: To evaluate whether fatigue improvement might be directly linked to improved depression and daytime sleepiness. Methods: Patients were assessed regarding fatigue, depression, and daytime sleepiness. The relation between changes of the two latter symptoms and changes in fatigue was analysed. Results: After one year of natalizumab treatment, the majority of patients (>92% remained stable or improved in total, motor and cognitive fatigue. Proportion of patients without depression increased by 17% while proportions of mildly depressed patients or patients with potential major depression decreased by 5% and 12%, respectively. Proportion of patients classified as not being sleepy increased by 13% while proportions of sleepy and very sleepy patients decreased by 11% and 2%, respectively. Most importantly, improved depression and sleepiness were significantly related to improved fatigue. Conclusion: Our findings highlight the importance of patient-reported outcomes in identifying potential benefits of drug treatment beyond its well-established effects on disease activity and disability progression.

SEL's Software Process-Improvement Program

Science.gov (United States)

Basili, Victor; Zelkowitz, Marvin; McGarry, Frank; Page, Jerry; Waligora, Sharon; Pajerski, Rose

1995-01-01

The goals and operations of the Software Engineering Laboratory (SEL) is reviewed. For nearly 20 years the SEL has worked to understand, assess, and improve software and the development process within the production environment of the Flight Dynamics Division (FDD) of NASA's Goddard Space Flight Center. The SEL was established in 1976 with the goals of reducing: (1) the defect rate of delivered software, (2) the cost of software to support flight projects, and (3) the average time to produce mission-support software. After studying over 125 projects of FDD, the results have guided the standards, management practices, technologies, and the training within the division. The results of the studies have been a 75 percent reduction in defects, a 50 percent reduction in cost, and a 25 percent reduction in development time. Over time the goals of SEL have been clarified. The goals are now stated as: (1) Understand baseline processes and product characteristics, (2) Assess improvements that have been incorporated into the development projects, (3) Package and infuse improvements into the standard SEL process. The SEL improvement goal is to demonstrate continual improvement of the software process by carrying out analysis, measurement and feedback to projects with in the FDD environment. The SEL supports the understanding of the process by study of several processes including, the effort distribution, and error detection rates. The SEL assesses and refines the processes. Once the assessment and refinement of a process is completed, the SEL packages the process by capturing the process in standards, tools and training.

Genetic improvement of tropical acacias: achievements and ...

African Journals Online (AJOL)

The potential for genetic improvement in form traits and wood properties has also been demonstrated. Genetic improvement objectives must now give heavy weighting to improving disease resistance and tolerance. Ganoderma root rot and Ceratocystis stem wilt have destroyed large areas of acacia plantations in Indonesia ...

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.

Improvement of nuclear ship engineering simulation system. Hardware renewal and interface improvement of the integral type reactor

Energy Technology Data Exchange (ETDEWEB)

Takahashi, Hiroki; Kyoya, Masahiko; Shimazaki, Junya [Japan Atomic Energy Research Inst., Tokai, Ibaraki (Japan). Tokai Research Establishment; Kano, Tadashi [KCS, Co., Mito, Ibaraki (Japan); Takahashi, Teruo [Energis, Co., Kobe, Hyogo (Japan)

2001-10-01

JAERI had carried out the design study about a lightweight and compact integral type reactor (an advanced marine reactor) with passive safety equipment as a power source for the future nuclear ships, and completed an engineering design. We have developed the simulator for the integral type reactor to confirm the design and operation performance and to utilize the study of automation of the reactor operation. The simulator can be used also for future research and development of a compact reactor. However, the improvement in a performance of hardware and a human machine interface of software of the simulator were needed for future research and development. Therefore, renewal of hardware and improvement of software have been conducted. The operability of the integral-reactor simulator has been improved. Furthermore, this improvement with the hardware and software on the market brought about better versatility, maintainability, extendibility and transfer of the system. This report mainly focuses on contents of the enhancement in a human machine interface, and describes hardware renewal and the interface improvement of the integral type reactor simulator. (author)

Equipment improvements for performance enhancement

International Nuclear Information System (INIS)

Gaestel, P.; Guesnon, H.; Sauze, G.

1994-01-01

In order to enhance the reactor availability, several improvements on reactor equipment have been developed: design optimization for stator maintenance replacement in the main alternator; adjustment modification of stator coils in the main alternator for an easier maintenance; improvement of the fuel handling line (pole crane, transfer equipment, loading machine); development of a loose part trapping system in the steam generator secondary circuit. 1 tab

Improvement of radioisotope production technology

International Nuclear Information System (INIS)

Li Yongjian

1987-01-01

The widespreading and deepgoing applications of radioisotopes results the increasing demands on both quality and quantity. This in turn stimulating the production technology to be improved unceasingly to meet the different requirements on availability, variety, facility, purity, specific activity and specificity. The major approaches of achieving these improvements including: optimizing mode of production; enhancing irradiation conditions; amelioration target arrangement; adapting nuclear process and inventing chemical processing. (author)

Reduction of mesqa improvement costs

Directory of Open Access Journals (Sweden)

Mohamed Ahmed Saad ElFetyany

2017-10-01

Results show that using the revised approach brings down the cost of mesqa improvement from nearly 10,000LE/fed at present to about 6000LE/fed. These reductions based on the analyses of different mesqa modelling through the adoption of certain parameters such as feasibility of the revised design, effective application of continuous flow for water distribution, and downsizing of the capacity of improved mesqas.

Can verbal working memory training improve reading?

Science.gov (United States)

Banales, Erin; Kohnen, Saskia; McArthur, Genevieve

2015-01-01

The aim of the current study was to determine whether poor verbal working memory is associated with poor word reading accuracy because the former causes the latter, or the latter causes the former. To this end, we tested whether (a) verbal working memory training improves poor verbal working memory or poor word reading accuracy, and whether (b) reading training improves poor reading accuracy or verbal working memory in a case series of four children with poor word reading accuracy and verbal working memory. Each child completed 8 weeks of verbal working memory training and 8 weeks of reading training. Verbal working memory training improved verbal working memory in two of the four children, but did not improve their reading accuracy. Similarly, reading training improved word reading accuracy in all children, but did not improve their verbal working memory. These results suggest that the causal links between verbal working memory and reading accuracy may not be as direct as has been assumed.

Physical Activity Improves Quality of Life

Science.gov (United States)

... It Works Healthy Workplace Food and Beverage Toolkit Physical activity improves quality of life Updated:Mar 2,2015 ... proven to improve both mental and physical health. Physical activity boosts mental wellness. Regular physical activity can relieve ...

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...

Safety improvements of Temelin NPP

International Nuclear Information System (INIS)

Vita, J.

2000-01-01

A detailed overview is given of the efforts made to enhance the safety level of the plant considering recommendations of a number of assessment missions. A list is presented of 10 international missions of the IAEA at the Temelin plant, covering the period 1990 to 1998. For each mission the date and objective is given, the focus of the assessment is characterized, the international participation of experts is specified, and the main conclusions of the experts is reproduced. A commented list of 60 main design changes and safety improvements is also included, as they were implemented in the wake of various safety assessments. An overview of the Temelin safety improvement programme is attached, comprising brief descriptions of 30 planned improvement items together with the time schedules. (A.K.)

Improved radioanalytical methods

International Nuclear Information System (INIS)

Erickson, M.D.; Aldstadt, J.H.; Alvarado, J.S.; Crain, J.S.; Orlandini, K.A.; Smith, L.L.

1995-01-01

Methods for the chemical characterization of the environment are being developed under a multitask project for the Analytical Services Division (EM-263) within the US Department of Energy (DOE) Office of Environmental Management. This project focuses on improvement of radioanalytical methods with an emphasis on faster and cheaper routine methods. We have developed improved methods, for separation of environmental levels of technetium-99 and strontium-89/90, radium, and actinides from soil and water; and for separation of actinides from soil and water matrix interferences. Among the novel separation techniques being used are element- and class-specific resins and membranes. (The 3M Corporation is commercializing Empore trademark membranes under a cooperative research and development agreement [CRADA] initiated under this project). We have also developed methods for simultaneous detection of multiple isotopes using inductively coupled plasma-mass spectrometry (ICP-MS). The ICP-MS method requires less rigorous chemical separations than traditional radiochemical analyses because of its mass-selective mode of detection. Actinides and their progeny have been isolated and concentrated from a variety of natural water matrices by using automated batch separation incorporating selective resins prior to ICP-MS analyses. In addition, improvements in detection limits, sample volume, and time of analysis were obtained by using other sample introduction techniques, such as ultrasonic nebulization and electrothermal vaporization. Integration and automation of the separation methods with the ICP-MS methodology by using flow injection analysis is underway, with an objective of automating methods to achieve more reproducible results, reduce labor costs, cut analysis time, and minimize secondary waste generation through miniaturization of the process

12 CFR 541.16 - Improved residential real estate.

Science.gov (United States)

2010-01-01

... 12 Banks and Banking 5 2010-01-01 2010-01-01 false Improved residential real estate. 541.16... REGULATIONS AFFECTING FEDERAL SAVINGS ASSOCIATIONS § 541.16 Improved residential real estate. The term improved residential real estate means residential real estate containing offsite or other improvements...

Comparison of RNA-seq and microarray-based models for clinical endpoint prediction.

Science.gov (United States)

Zhang, Wenqian; Yu, Ying; Hertwig, Falk; Thierry-Mieg, Jean; Zhang, Wenwei; Thierry-Mieg, Danielle; Wang, Jian; Furlanello, Cesare; Devanarayan, Viswanath; Cheng, Jie; Deng, Youping; Hero, Barbara; Hong, Huixiao; Jia, Meiwen; Li, Li; Lin, Simon M; Nikolsky, Yuri; Oberthuer, André; Qing, Tao; Su, Zhenqiang; Volland, Ruth; Wang, Charles; Wang, May D; Ai, Junmei; Albanese, Davide; Asgharzadeh, Shahab; Avigad, Smadar; Bao, Wenjun; Bessarabova, Marina; Brilliant, Murray H; Brors, Benedikt; Chierici, Marco; Chu, Tzu-Ming; Zhang, Jibin; Grundy, Richard G; He, Min Max; Hebbring, Scott; Kaufman, Howard L; Lababidi, Samir; Lancashire, Lee J; Li, Yan; Lu, Xin X; Luo, Heng; Ma, Xiwen; Ning, Baitang; Noguera, Rosa; Peifer, Martin; Phan, John H; Roels, Frederik; Rosswog, Carolina; Shao, Susan; Shen, Jie; Theissen, Jessica; Tonini, Gian Paolo; Vandesompele, Jo; Wu, Po-Yen; Xiao, Wenzhong; Xu, Joshua; Xu, Weihong; Xuan, Jiekun; Yang, Yong; Ye, Zhan; Dong, Zirui; Zhang, Ke K; Yin, Ye; Zhao, Chen; Zheng, Yuanting; Wolfinger, Russell D; Shi, Tieliu; Malkas, Linda H; Berthold, Frank; Wang, Jun; Tong, Weida; Shi, Leming; Peng, Zhiyu; Fischer, Matthias

2015-06-25

Gene expression profiling is being widely applied in cancer research to identify biomarkers for clinical endpoint prediction. Since RNA-seq provides a powerful tool for transcriptome-based applications beyond the limitations of microarrays, we sought to systematically evaluate the performance of RNA-seq-based and microarray-based classifiers in this MAQC-III/SEQC study for clinical endpoint prediction using neuroblastoma as a model. We generate gene expression profiles from 498 primary neuroblastomas using both RNA-seq and 44 k microarrays. Characterization of the neuroblastoma transcriptome by RNA-seq reveals that more than 48,000 genes and 200,000 transcripts are being expressed in this malignancy. We also find that RNA-seq provides much more detailed information on specific transcript expression patterns in clinico-genetic neuroblastoma subgroups than microarrays. To systematically compare the power of RNA-seq and microarray-based models in predicting clinical endpoints, we divide the cohort randomly into training and validation sets and develop 360 predictive models on six clinical endpoints of varying predictability. Evaluation of factors potentially affecting model performances reveals that prediction accuracies are most strongly influenced by the nature of the clinical endpoint, whereas technological platforms (RNA-seq vs. microarrays), RNA-seq data analysis pipelines, and feature levels (gene vs. transcript vs. exon-junction level) do not significantly affect performances of the models. We demonstrate that RNA-seq outperforms microarrays in determining the transcriptomic characteristics of cancer, while RNA-seq and microarray-based models perform similarly in clinical endpoint prediction. Our findings may be valuable to guide future studies on the development of gene expression-based predictive models and their implementation in clinical practice.

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

MDSplus quality improvement project

International Nuclear Information System (INIS)

Fredian, Thomas W.; Stillerman, Joshua; Manduchi, Gabriele; Rigoni, Andrea; Erickson, Keith

2016-01-01

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

How to Improve the Quality of Screening Endoscopy in Korea: National Endoscopy Quality Improvement Program.

Science.gov (United States)

Cho, Yu Kyung

2016-07-01

In Korea, gastric cancer screening, either esophagogastroduodenoscopy or upper gastrointestinal series (UGIS), is performed biennially for adults aged 40 years or older. Screening endoscopy has been shown to be associated with localized cancer detection and better than UGIS. However, the diagnostic sensitivity of detecting cancer is not satisfactory. The National Endoscopy Quality Improvement (QI) program was initiated in 2009 to enhance the quality of medical institutions and improve the effectiveness of the National Cancer Screening Program (NCSP). The Korean Society of Gastrointestinal Endoscopy developed quality standards through a broad systematic review of other endoscopic quality guidelines and discussions with experts. The standards comprise five domains: qualifications of endoscopists, endoscopic unit facilities and equipment, endoscopic procedure, endoscopy outcomes, and endoscopic reprocessing. After 5 years of the QI program, feedback surveys showed that the perception of QI and endoscopic practice improved substantially in all domains of quality, but the quality standards need to be revised. How to avoid missing cancer in endoscopic procedures in daily practice was reviewed, which can be applied to the mass screening endoscopy. To improve the quality and effectiveness of NCSP, key performance indicators, acceptable quality standards, regular audit, and appropriate reimbursement are necessary.

Are students' impressions of improved learning through active learning methods reflected by improved test scores?

Science.gov (United States)

Everly, Marcee C

2013-02-01

To report the transformation from lecture to more active learning methods in a maternity nursing course and to evaluate whether student perception of improved learning through active-learning methods is supported by improved test scores. The process of transforming a course into an active-learning model of teaching is described. A voluntary mid-semester survey for student acceptance of the new teaching method was conducted. Course examination results, from both a standardized exam and a cumulative final exam, among students who received lecture in the classroom and students who had active learning activities in the classroom were compared. Active learning activities were very acceptable to students. The majority of students reported learning more from having active-learning activities in the classroom rather than lecture-only and this belief was supported by improved test scores. Students who had active learning activities in the classroom scored significantly higher on a standardized assessment test than students who received lecture only. The findings support the use of student reflection to evaluate the effectiveness of active-learning methods and help validate the use of student reflection of improved learning in other research projects. Copyright © 2011 Elsevier Ltd. All rights reserved.

Improved self-exclusion program: preliminary results.

Science.gov (United States)

Tremblay, Nicole; Boutin, Claude; Ladouceur, Robert

2008-12-01

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

Continuous Improvement in Action: Educators' Evidence Use for School Improvement

Science.gov (United States)

Cannata, Marisa; Redding, Christopher; Rubin, Mollie

2016-01-01

The focus of the article is the process educators use to interpret data to turn it into usable knowledge (Honig & Coburn, 2008) while engaging in a continuous improvement process. The authors examine the types of evidence educators draw upon, its perceived relevance, and the social context in which the evidence is examined. Evidence includes…

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

Science.gov (United States)

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

2015-01-01

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

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

Energy Technology Data Exchange (ETDEWEB)

Leroux, Marc

2010-09-15

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

Measuring a hospital's ability to improve.

Science.gov (United States)

Meurer, Steven J; Counte, Michael A; Rubio, Doris M; Arrington, Barbara

2004-01-01

The aim of this study was to test whether a recently developed measure of Continuous Quality Improvement (CQI) implementation can provide health care researchers and administrators with a tool to assist in understanding and with developing an appropriate structure for improvement efforts in hospitals. Two hundred respondents from 40 Missouri hospitals completed a 28-item survey addressing 8 domains of CQI. Overall, hospital scores showed low implementation of a structure that supports improvement efforts. All survey domains showed acceptable psychometric results. Leadership proved to be the most important domain of CQI because it differentiated well between all levels of the scale. Because of its ease of administration and analysis, and its reliability, validity, and level differentiation results, the researchers recommend the widespread use of this tool to understand and develop a hospital's organizational structure to support improvement activities.

A comparison of chemoembolization endpoints using angiographic versus transcatheter intraarterial perfusion/MR imaging monitoring.

Science.gov (United States)

Lewandowski, Robert J; Wang, Dingxin; Gehl, James; Atassi, Bassel; Ryu, Robert K; Sato, Kent; Nemcek, Albert A; Miller, Frank H; Mulcahy, Mary F; Kulik, Laura; Larson, Andrew C; Salem, Riad; Omary, Reed A

2007-10-01

Transcatheter arterial chemoembolization (TACE) is an established treatment for unresectable liver cancer. This study was conducted to test the hypothesis that angiographic endpoints during TACE are measurable and reproducible by comparing subjective angiographic versus objective magnetic resonance (MR) endpoints of TACE. The study included 12 consecutive patients who presented for TACE for surgically unresectable HCC or progressive hepatic metastases despite chemotherapy. All procedures were performed with a dedicated imaging system. Angiographic series before and after TACE were reviewed independently by three board-certified interventional radiologists. A subjective angiographic chemoembolization endpoint (SACE) classification scheme, modified from an established angiographic grading system in the cardiology literature, was designed to assist in reproducibly classifying angiographic endpoints. Reproducibility in SACE classification level was compared among operators, and MR imaging perfusion reduction was compared with SACE levels for each observer. Twelve patients successfully underwent 15 separate TACE sessions. SACE levels ranged from I through IV. There was moderate agreement in SACE classification (kappa = 0.46 +/- 0.12). There was no correlation between SACE level and MR perfusion reduction (r = 0.16 for one operator and 0.02 for the other two). Angiographic endpoints during TACE vary widely, have moderate reproducibility among operators, and do not correlate with functional MR imaging perfusion endpoints. Future research should aim to determine ideal angiographic and functional MR imaging endpoints for TACE according to outcome measures such as imaging response, pathologic response, and survival.

Human Resource Management for Continuous Improvement

DEFF Research Database (Denmark)

Jørgensen, Frances; Laugen, Bjørge Timenes; Boer, Harry

2007-01-01

This paper investigates the relationship between HRM practices and Continuous Improvement (CI) activities in order to gain an understanding of how the HRM function may be utilized to improve CI implementation success, and consequently, company performance. The paper begins with a brief review...... of the HRM and CI literature and then presents statistical analyses of data collected from the Continuous Improvement Network Survey (2003), which demonstrate that HRM has a significant effect on CI behaviour and company performance, with the strongest relationship between HRM, CI and performance occurring...

Congenital Adrenal Hyperplasia: Classification of Studies Employing Psychological Endpoints

Directory of Open Access Journals (Sweden)

Sandberg DavidE

2010-08-01

Full Text Available Psychological outcomes in persons with congenital adrenal hyperplasia (CAH have received substantial attention. The objectives of this paper were to (1 catalog psychological endpoints assessed in CAH outcome studies and (2 classify the conceptual/theoretical model shaping the research design and interpretation of CAH-related psychological effects. A total of 98 original research studies, published between 1955 and 2009, were categorized based on psychological endpoints examined as well as the research design and conceptual model guiding analysis and interpretation of data. The majority of studies (68% investigated endpoints related to psychosexual differentiation. The preponderance of studies (76% examined a direct relationship (i.e., inferring causality between prenatal androgen exposure and psychological outcomes. Findings are discussed in relation to the observed imbalance between theoretical interest in the role of prenatal androgens in shaping psychosexual differentiation and a broader conceptual model that examines the role of other potential factors in mediating or moderating the influence of CAH pathophysiology on psychological outcomes in both affected females and males. The latter approach offers to identify factors amenable to clinical intervention that enhance both health and quality of life outcomes in CAH as well as other disorders of sex development.

Continuous Improvement in Schools: Understanding the Practice

Science.gov (United States)

Anderson, Stephen; Kumari, Roshni

2009-01-01

This article investigates conceptually and practically what it means for schools to engage in the practice of continuous improvement. The analysis draws upon prior research and discussion to predict core elements of the practice of continuous improvement in schools. The predictions are then applied to a case study of continuous improvement efforts…

A Systems Approach to Rapid School Improvement

Science.gov (United States)

McCauley, Carlas

2018-01-01

To support systemic thinking about school improvement, the Center on School Turnaround at WestEd developed a framework to assist states, districts, and schools in leading and managing rapid improvement efforts. The framework, which is presented in this article, has four domains that have proved central to rapid, significant improvement: (1)…

21 CFR 314.510 - Approval based on a surrogate endpoint or on an effect on a clinical endpoint other than survival...

Science.gov (United States)

2010-04-01

... Serious or Life-Threatening Illnesses § 314.510 Approval based on a surrogate endpoint or on an effect on... well-controlled. The applicant shall carry out any such studies with due diligence. ...

Regular exercise improves the well-being of parents of children with cancer.

Science.gov (United States)

Halliday, Gail C; Miles, Gordon C P; Marsh, Julie A; Kotecha, Rishi S; Alessandri, Angela J

2017-12-01

Parents of children with cancer describe impaired physical and social functioning, sleep disturbance and poor mental health. Exercise-related interventions impact positively on these quality of life domains, but have not been examined in this population. The aim of this longitudinal pilot study was to explore the feasibility of a 12-week pedometer-monitored walking intervention among parents of children with cancer, assessing adherence to a set activity target of 70,000 steps per week, and to explore the benefits of physical activity on mental and physical health. Parents were provided with a pedometer and requested to achieve a daily step count of 10,000 steps per day for 12 weeks. Mood, well-being and psychological distress were examined using validated questionnaires (Profile of Mood States 2nd edition [POMS-2], Distress Thermometer for Parents [DT-P] and Depression Anxiety Stress Scales [DASS-42]) at baseline, midpoint (6 weeks) and endpoint (12 weeks) to identify changes in these domains with increased activity. Fifteen parents were recruited. The majority increased their counts during the first 4 weeks of the study and maintained this to week 8 (n = 12). Time-dependent improvements were identified in the following psychometric test outcomes at week 12: DT-P score (likelihood ratio test [LRT] P = 0.02), POMS-2 total mood disturbance (LRT P = 0.03), fatigue inertia (LRT P = 0.009), tension anxiety (LRT P = 0.007) and vigour activity (LRT P = 0.001). Mental health benefits of a pedometer-based exercise intervention for parents of children with cancer were identified. Such programs should be included in a holistic approach to improve the psychological outcomes of parents whose children are receiving treatment for cancer. © 2017 Wiley Periodicals, Inc.

DNA methylation–based immune response signature improves patient diagnosis in multiple cancers

Science.gov (United States)

Jeschke, Jana; Bizet, Martin; Calonne, Emilie; Dedeurwaerder, Sarah; Garaud, Soizic; Koch, Alexander; Larsimont, Denis; Salgado, Roberto; Van den Eynden, Gert; Willard Gallo, Karen; Defrance, Matthieu; Sotiriou, Christos

2017-01-01

BACKGROUND. The tumor immune response is increasingly associated with better clinical outcomes in breast and other cancers. However, the evaluation of tumor-infiltrating lymphocytes (TILs) relies on histopathological measurements with limited accuracy and reproducibility. Here, we profiled DNA methylation markers to identify a methylation of TIL (MeTIL) signature that recapitulates TIL evaluations and their prognostic value for long-term outcomes in breast cancer (BC). METHODS. MeTIL signature scores were correlated with clinical endpoints reflecting overall or disease-free survival and a pathologic complete response to preoperative anthracycline therapy in 3 BC cohorts from the Jules Bordet Institute in Brussels and in other cancer types from The Cancer Genome Atlas. RESULTS. The MeTIL signature measured TIL distributions in a sensitive manner and predicted survival and response to chemotherapy in BC better than did histopathological assessment of TILs or gene expression–based immune markers, respectively. The MeTIL signature also improved the prediction of survival in other malignancies, including melanoma and lung cancer. Furthermore, the MeTIL signature predicted differences in survival for malignancies in which TILs were not known to have a prognostic value. Finally, we showed that MeTIL markers can be determined by bisulfite pyrosequencing of small amounts of DNA from formalin-fixed, paraffin-embedded tumor tissue, supporting clinical applications for this methodology. CONCLUSIONS. This study highlights the power of DNA methylation to evaluate tumor immune responses and the potential of this approach to improve the diagnosis and treatment of breast and other cancers. FUNDING. This work was funded by the Fonds National de la Recherche Scientifique (FNRS) and Télévie, the INNOVIRIS Brussels Region BRUBREAST Project, the IUAP P7/03 program, the Belgian “Foundation against Cancer,” the Breast Cancer Research Foundation (BCRF), and the Fonds Gaston Ithier

Tracing Impact in a Usability Improvement Process

DEFF Research Database (Denmark)

Uldall-Espersen, Tobias; Frøkjær, Erik; Hornbæk, Kasper Anders Søren

2008-01-01

Analyzing usability improvement processes as they take place in real-life organizations is necessary to understand the practice of usability work. This paper describes a case study where the usability of an information system is improved and a relationship between the improvements...... and the evaluation efforts is established. Results show that evaluation techniques complemented each other by suggesting different kinds of usability improvement. Among the techniques applied, a combination of questionnaires and Metaphors of Human Thinking (MOT) showed the largest mean impact and MOT produced...... the largest number of impacts. Logging of real-life use of the system over 6 months indicated six aspects of improved usability, where significant differences among evaluation techniques were found. Concerning five of the six aspects Think Aloud evaluations and the above-mentioned combination of questionnaire...

Improving sample recovery

International Nuclear Information System (INIS)

Blanchard, R.J.

1995-09-01

This Engineering Task Plan (ETP) describes the tasks, i.e., tests, studies, external support and modifications planned to increase the recovery of the recovery of the waste tank contents using combinations of improved techniques, equipment, knowledge, experience and testing to better the recovery rates presently being experienced

Evaluating realized genetic gains from tree improvement.

Science.gov (United States)

J.B. St. Clair

1993-01-01

Tree improvement has become an essential part of the management of forest lands for wood production, and predicting yields and realized gains from forests planted with genetically-improved trees will become increasingly important. This paper discusses concepts of tree improvement and genetic gain important to growth and yield modeling, and reviews previous studies of...

Clinical engagement: improving healthcare together.

Science.gov (United States)

Riches, E; Robson, B

2014-02-01

Clinical engagement can achieve lasting change in the delivery of healthcare. In October 2011, Healthcare Improvement Scotland formulated a clinical engagement strategy to ensure that a progressive and sustainable approach to engaging healthcare professionals is firmly embedded in its health improvement and public assurance activities. The strategy was developed using a 90-day process, combining an evidence base of best practice and feedback from semi-structured interviews and focus groups. The strategy aims to create a culture where clinicians view working with Healthcare Improvement Scotland as a worthwhile venture, which offers a number of positive benefits such as training, career development and research opportunities. The strategy works towards developing a respectful partnership between Healthcare Improvement Scotland, the clinical community and key stakeholders whereby clinicians' contributions are recognised in a non-financial reward system. To do this, the organisation needs a sustainable infrastructure and an efficient, cost-effective approach to clinical engagement. There are a number of obstacles to achieving successful clinical engagement and these must be addressed as key drivers in its implementation. The implementation of the strategy is supported by an action and resource plan, and its impact will be monitored by a measurement plan to ensure the organisation reviews its approaches towards clinical engagement.

Modalities of hemodialysis: Quality improvement

Directory of Open Access Journals (Sweden)

Ayman Karkar

2012-01-01

Full Text Available Hemodialysis (HD treatment had, over many years, improved the survival rate of patients with end-stage renal disease. However, standard or conventional HD prescription is far from being optimal in replacing the function of normal kidneys. Its unphysiologic clearance pattern and inability to remove all types and sizes of uremic toxins results in inter- and intra-dialysis complications and an unacceptably high rate of cardiovascular morbidity and mortality. Efficiency of HD can be improved by increasing blood and dialysate flow rates, dialyzer size and surface area and duration and frequency of dialysis sessions. Home HD, where short daily or long slow nocturnal HD sessions can conveniently be performed, provides an excellent option for quality of life improvement and reduction in morbidity and mortality. Recent innovations in the specifications of HD machines and improvement in dialysis membranes characteristics and water treatment technology paved the way for achieving quality HD. These advancements have resulted in efficient implementation of adsorption, diffusion and/or convection principles using adsorption HD, hemofiltration, hemodiafiltration (HDF and online HDF modalities in order to achieve optimum HD. Implementation of these innovations resulted in better quality care achievements in clinical practice and reduction in morbidity and mortality rates among HD patients.

Improving surgical outcomes

Directory of Open Access Journals (Sweden)

Tony Walia

2008-12-01

Full Text Available Outcomes of cataract surgery are worse than we would like them to be. Community-based studies show that up to 40% of eyes have a postoperative presenting vision of < 6/60. Eyes with intraocular lenses (IOLs do better; however, it has been shown that even in prosperous middle-income countries, such as Venezuela, in 20% of pseudophakic eyes presenting vision was < 6/60 and in 15% best corrected vision was worse than 6/60.Poor outcomes matter. Patients deserve improved vision whenever possible and poor outcomes deter prospective patients from coming for surgery and probably reduce their willingness to pay for their treatment – particularly if they have to pay in advance!In this article, we offer some suggestions for improving the quality of cataract surgery. We admit that there is little evidence base for most of these suggestions and that some of them are controversial. However, we hope to stimulate debate.

Continue service improvement at CERN computing centre

International Nuclear Information System (INIS)

Lopez, M Barroso; Everaerts, L; Meinhard, H; Baehler, P; Haimyr, N; Guijarro, J M

2014-01-01

Using the framework of ITIL best practises, the service managers within CERN-IT have engaged into a continuous improvement process, mainly focusing on service operation. This implies an explicit effort to understand and improve all service management aspects in order to increase efficiency and effectiveness. We will present the requirements, how they were addressed and share our experiences. We will describe how we measure, report and use the data to continually improve both the processes and the services being provided. The focus is not the tool or the process, but the results of the continuous improvement effort from a large team of IT experts providing services to thousands of users, supported by the tool and its local team. This is not an initiative to address user concerns in the way the services are managed but rather an on-going working habit of continually reviewing, analysing and improving the service management processes and the services themselves, having in mind the currently agreed service levels and whose results also improve the experience of the users about the current services.

An optimization model for improving highway safety

Directory of Open Access Journals (Sweden)

Promothes Saha

2016-12-01

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

Improvements in SPECT technology for cerebral imaging

International Nuclear Information System (INIS)

Esser, P.D.

1985-01-01

Advancement in three major areas of SPECT (single photon emission computed tomography) technology have resulted in improved image quality for cerebral studies. In the first area, single-crystal camera electronics, extensive use of microprocessors, custom digital circuitry, an data bus architecture have allowed precise external control of all gantry motions and improved signal processing. The new digital circuitry permits energy, uniformity, and linearity corrections to be an integral part of the processing electronics. Calibration of these correlations is controlled by algorithms stored in the camera's memory. The second area of improved SPECT technology is camera collimation and related imaging techniques. In this area, system resolution has been improved without loss of sensitivity by decreasing the air gap between patient and collimator surface. Since cerebral studies characteristically image high-contrast regions less than 1 cm in size, image quality has been improved by increasing collimator resolution even at the expense of sensitivity. Increased resolution also improved image contrast for studies using 123 I-labeled pharmaceuticals with 3% to 4% 124 I contamination. 65 references

Improved immunocytochemical detection of daunomycin

DEFF Research Database (Denmark)

Ohara, Koji; Shin, Masashi; Larsson, Lars-Inge

2007-01-01

and mitochondria of heart muscle cells may help to improve our understanding of the cardiac toxicity of DM and related anthracyclin antibiotics. A number of ELISA tests were carried out in order to elucidate the mechanisms of H2O2-assisted antigen retrieval. A possible mechanism is that DM is reduced and converted......Improved immunocytochemical (ICC) detection of the anthracycline anticancer antibiotic daunomycin (DM) has been achieved by used of hydrogen peroxide oxidation prior to ICC staining for DM. The new method greatly enhanced the localization of DM accumulation in cardiac, smooth and skeletal muscle...... to its semiquinone and/or hydroquinone derivative in vivo. Oxidation by hydrogen peroxide acts to convert these derivatives back to the native antigen. The improved ICC methodology using oxidation to recreated native antigens from reduced metabolites may be helpful also with respect to the localization...

Delivery improvements for CANDU projects

International Nuclear Information System (INIS)

Stephen Yu; Ken Hedges

1998-01-01

Future CANDU design will continue to meet emerging design and performance requirements as expected by the operating utilities, and will integrate new technologies into both the product features and work processes. Elements of this risk reduction strategy include feedback of lessons learned from operating plants, project experiences from previous projects, and replication of successful systems and equipment. Project implementation risk is minimized by up-front engineering and licensing prior to contract start. Enhanced competitiveness of the CANDU products is ensured by incorporating improvements based on updated technology. This paper summarizes the strategy used to enhance competitiveness of the CANDU products and the measures introduced to minimize risk during project implementation. This strategy provides a balance between innovation and proven designs; and between the desire for safety and operational improvements and the cost to achieve the improvements

Continuous improvement of pump seals

International Nuclear Information System (INIS)

Wong, W.; Eyvindson, A.; Rhodes, D.B.

2003-01-01

Pump seal reliability continues to be an area needing improvement and ongoing vigilance. Methods have been developed for identifying and assessing factors relating to seal performance, selecting the most relevant ones for a specific station, and then focusing on the most significant aspects and how to improve. Discussion invariably addresses maintenance practices, seal design, monitoring capabilities, operating conditions, transients, and pump and motor design. Success in reliability improvement requires ongoing dialogue among the station operators, pump manufacturers and seal designers. AECL CAN-seals lead the nuclear industry in reliability and seal life. They effectively save operators millions of dollars in outage time and person-rem. This paper describes some of the significant developments in AECL's ongoing program in seal R and D, as well as recent new installations following the most demanding seal qualification programs to date. (author)

Restoration for the future: endpoints, targets, and indicators of progress and success

Science.gov (United States)

Daniel C. Dey; Callie Jo. Schweitzer

2014-01-01

Setting endpoints and targets in forest restoration is a complicated task that is best accomplished in cooperative partnerships that account for the ecology of the system, production of desired ecosystem goods and services, economics and well-being of society, and future environments. Clearly described and quantitative endpoints and intermediary targets are needed to...

Highly porous ceramic oxide aerogels having improved flexibility

Science.gov (United States)

Meador, Mary Ann B. (Inventor); Nguyen, Baochau N. (Inventor); Guo, Haiquan (Inventor)

2012-01-01

Ceramic oxide aerogels having improved flexibility are disclosed. Preferred embodiments exhibit high modulus and other strength properties despite their improved flexibility. The gels may be polymer cross-linked via organic polymer chains to further improve strength properties, without substantially detracting from the improved flexibility. Methods of making such aerogels are also disclosed.

Instrument ampersand controls section (IA) improvements

International Nuclear Information System (INIS)

Kramer, C.; Paul, J.

1993-01-01

This portion of the panel session briefly delineates improvements in the Instrument and Controls (IA) Section over the past few years. These improvements are listed briefly in summary form. The status of publication of the IA Section of AG-1 is reviewed

On the improving of finishing works

International Nuclear Information System (INIS)

Arzamaskov, V.N.; Bondarenko, I.Ya.; Pogozhev, I.M.

1986-01-01

Problems of the improvement of finishing works performed during the construction of power installations are considered. Recommendations on the improvement of the quality of these works, increase of labour productivity and decrease of a manual labour share on their implementation are given

One improved LSB steganography algorithm

Science.gov (United States)

Song, Bing; Zhang, Zhi-hong

2013-03-01

It is easy to be detected by X2 and RS steganalysis with high accuracy that using LSB algorithm to hide information in digital image. We started by selecting information embedded location and modifying the information embedded method, combined with sub-affine transformation and matrix coding method, improved the LSB algorithm and a new LSB algorithm was proposed. Experimental results show that the improved one can resist the X2 and RS steganalysis effectively.

Considerations in choosing a primary endpoint that measures durability of virological suppression in an antiretroviral trial.

Science.gov (United States)

Gilbert, P B; Ribaudo, H J; Greenberg, L; Yu, G; Bosch, R J; Tierney, C; Kuritzkes, D R

2000-09-08

At present, many clinical trials of anti-HIV-1 therapies compare treatments by a primary endpoint that measures the durability of suppression of HIV-1 replication. Several durability endpoints are compared. Endpoints are compared by their implicit assumptions regarding surrogacy for clinical outcomes, sample size requirements, and accommodations for inter-patient differences in baseline plasma HIV-1-RNA levels and in initial treatment response. Virological failure is defined by the non-suppression of virus levels at a prespecified follow-up time T(early virological failure), or by relapse. A binary virological failure endpoint is compared with three time-to-virological failure endpoints: time from (i) randomization that assigns early failures a failure time of T weeks; (ii) randomization that extends the early failure time T for slowly responding subjects; and (iii) virological response that assigns non-responders a failure time of 0 weeks. Endpoint differences are illustrated with Agouron's trial 511. In comparing high with low-dose nelfinavir (NFV) regimens in Agouron 511, the difference in Kaplan-Meier estimates of the proportion not failing by 24 weeks is 16.7% (P = 0.048), 6.5% (P = 0.29) and 22.9% (P = 0.0030) for endpoints (i), (ii) and (iii), respectively. The results differ because NFV suppresses virus more quickly at the higher dose, and the endpoints weigh this treatment difference differently. This illustrates that careful consideration needs to be given to choosing a primary endpoint that will detect treatment differences of interest. A time from randomization endpoint is usually recommended because of its advantages in flexibility and sample size, especially at interim analyses, and for its interpretation for patient management.

Improved Landau gauge fixing and discretisation errors

International Nuclear Information System (INIS)

Bonnet, F.D.R.; Bowman, P.O.; Leinweber, D.B.; Richards, D.G.; Williams, A.G.

2000-01-01

Lattice discretisation errors in the Landau gauge condition are examined. An improved gauge fixing algorithm in which O(a 2 ) errors are removed is presented. O(a 2 ) improvement of the gauge fixing condition displays the secondary benefit of reducing the size of higher-order errors. These results emphasise the importance of implementing an improved gauge fixing condition

Multidisciplinary team approach to traumatic spinal cord injuries: a single institution's quality improvement project.

Science.gov (United States)

Alizo, Georgina; Sciarretta, Jason D; Gibson, Stefanie; Muertos, Keely; Holmes, Sharon; Denittis, Felicia; Cheatle, Joseph; Davis, John; Pepe, Antonio

2018-04-01

A stepwise multidisciplinary team (MDT) approach to the injured trauma patient has been reported to have an overall benefit, with reduction in mortality and improved morbidity. Based on clinical experience, we hypothesized that implementation of a dedicated Spinal Cord Injury Service (SCIS) would impact outcomes of a patient specific population on the trauma service. The trauma center registry was retrospectively queried, from January 2011 through December 2015, for patients presenting with a spinal cord injury. In 2013, a twice weekly rounding SCIS MDT was initiated. This new multidisciplinary service, the post-SCIS, was compared to the 2011-2012 pre-SCIS. The two groups were compared across patient demographics, mechanism of injury, surgical procedures, and disposition at discharge. The primary outcome was mortality. Secondary endpoints also included the incidence of complications, hospital length of stay (HLOS), ICU LOS, ventilator free days, and all hospital-acquired infectious complications. Logistic regression and Student's t test were used to analyze data. Ninety-five patients were identified. Of these patients, 41 (43%) pre-SCIS and 54 (57%) post-SCIS patients were compared. Mean age was 46.9 years and 79% male. Overall, adjusted mortality rate between the two groups was significant with the implementation of the post-SCIS (p = 0.033). In comparison, the post-SCIS revealed shorter HLOS (23 vs 34.8 days, p = 0.004), increased ventilator free days (20.2 vs 63.3 days, p < 0.001), and less nosocomial infections (1.8 vs 22%, p = 0.002). While the post-SCIS mean ICU LOS was shorter (12 vs 17.9 days, p = 0.089), this relationship was not significant. The application of an SCIS team in addition to the trauma service suggests that a structured coordinated approach can have an expected improvement in hospital outcomes and shorter length of stays. We believe that this clinical collaboration provides distinct specialist perspectives and, therefore

Improved longitudinal gray and white matter atrophy assessment via application of a 4-dimensional hidden Markov random field model.

Science.gov (United States)

Dwyer, Michael G; Bergsland, Niels; Zivadinov, Robert

2014-04-15

SIENA and similar techniques have demonstrated the utility of performing "direct" measurements as opposed to post-hoc comparison of cross-sectional data for the measurement of whole brain (WB) atrophy over time. However, gray matter (GM) and white matter (WM) atrophy are now widely recognized as important components of neurological disease progression, and are being actively evaluated as secondary endpoints in clinical trials. Direct measures of GM/WM change with advantages similar to SIENA have been lacking. We created a robust and easily-implemented method for direct longitudinal analysis of GM/WM atrophy, SIENAX multi-time-point (SIENAX-MTP). We built on the basic halfway-registration and mask composition components of SIENA to improve the raw output of FMRIB's FAST tissue segmentation tool. In addition, we created LFAST, a modified version of FAST incorporating a 4th dimension in its hidden Markov random field model in order to directly represent time. The method was validated by scan-rescan, simulation, comparison with SIENA, and two clinical effect size comparisons. All validation approaches demonstrated improved longitudinal precision with the proposed SIENAX-MTP method compared to SIENAX. For GM, simulation showed better correlation with experimental volume changes (r=0.992 vs. 0.941), scan-rescan showed lower standard deviations (3.8% vs. 8.4%), correlation with SIENA was more robust (r=0.70 vs. 0.53), and effect sizes were improved by up to 68%. Statistical power estimates indicated a potential drop of 55% in the number of subjects required to detect the same treatment effect with SIENAX-MTP vs. SIENAX. The proposed direct GM/WM method significantly improves on the standard SIENAX technique by trading a small amount of bias for a large reduction in variance, and may provide more precise data and additional statistical power in longitudinal studies. Copyright © 2013 Elsevier Inc. All rights reserved.

Improving machinery reliability

CERN Document Server

Bloch, Heinz P

1998-01-01

This totally revised, updated and expanded edition provides proven techniques and procedures that extend machinery life, reduce maintenance costs, and achieve optimum machinery reliability. This essential text clearly describes the reliability improvement and failure avoidance steps practiced by best-of-class process plants in the U.S. and Europe.

Improvements for Optics Measurement and Corrections software

CERN Document Server

Bach, T

2013-01-01

This note presents the improvements for the OMC software during a 14 month technical student internship at CERN. The goal of the work was to improve existing software in terms of maintainability, features and performance. Significant improvements in stability, speed and overall development process were reached. The main software, a Java GUI at the LHC CCC, run for months without noteworthy problems. The overall running time of the software chain used for optics corrections was reduced from nearly half an hour to around two minutes. This was the result of analysing and improving several involved programs and algorithms.

A systematic comparison of recurrent event models for application to composite endpoints.

Science.gov (United States)

Ozga, Ann-Kathrin; Kieser, Meinhard; Rauch, Geraldine

2018-01-04

Many clinical trials focus on the comparison of the treatment effect between two or more groups concerning a rarely occurring event. In this situation, showing a relevant effect with an acceptable power requires the observation of a large number of patients over a long period of time. For feasibility issues, it is therefore often considered to include several event types of interest, non-fatal or fatal, and to combine them within a composite endpoint. Commonly, a composite endpoint is analyzed with standard survival analysis techniques by assessing the time to the first occurring event. This approach neglects that an individual may experience more than one event which leads to a loss of information. As an alternative, composite endpoints could be analyzed by models for recurrent events. There exists a number of such models, e.g. regression models based on count data or Cox-based models such as the approaches of Andersen and Gill, Prentice, Williams and Peterson or, Wei, Lin and Weissfeld. Although some of the methods were already compared within the literature there exists no systematic investigation for the special requirements regarding composite endpoints. Within this work a simulation-based comparison of recurrent event models applied to composite endpoints is provided for different realistic clinical trial scenarios. We demonstrate that the Andersen-Gill model and the Prentice- Williams-Petersen models show similar results under various data scenarios whereas the Wei-Lin-Weissfeld model delivers effect estimators which can considerably deviate under commonly met data scenarios. Based on the conducted simulation study, this paper helps to understand the pros and cons of the investigated methods in the context of composite endpoints and provides therefore recommendations for an adequate statistical analysis strategy and a meaningful interpretation of results.

Improving pediatric immunization rates: description of a resident-led clinical continuous quality improvement project.

Science.gov (United States)

Jones, Kyle Bradford; Gren, Lisa H; Backman, Richard

2014-09-01

Increased emphasis is being placed on the continuous quality improvement (CQI) education of residents of all specialties. This article describes a resident-led continuous quality improvement (CQI) project, based on a novel curriculum, to improve the immunization rates of children under 2 years old at the Madsen Family Health Center (MHC). All third-year residents were trained in the FOCUS-PDSA CQI methodology through concurrent didactic lectures and experience leading the CQI team. The CQI team included clinical staff led by a third-year family medicine resident and mentored by a member of the family medicine faculty. Immunization records were distributed to provider-medical assistant teamlets daily for each pediatric patient scheduled in clinic as the intervention. Compliance with the intervention (process measure), as well as immunization rates at 2 and 5 months post-intervention (outcome measure), were monitored. Immunization records were printed on 84% of clinic days from October 24, 2011 to March 31, 2012. The percentage of patients immunized at baseline was 66%. The percentage immunized as of December 31, 2011 was 96% and was 91% as of March 31, 2012. An important educational experience was organized for third-year family medicine residents through learning CQI skills, leading a CQI team, and directing a CQI project to completion. Significant improvement in the percentage of patients under 2 years old immunized at the MHC was achieved by presenting provider-medical assistant teamlets with immunization records of all pediatric patients on the daily clinic schedule.

Strategic Ambitions as drivers of improvement at DaimlerChrysler

NARCIS (Netherlands)

Bossink, B.A.G.

2002-01-01

Strategic ambitions can function as drivers of improvement in organizations. Continuous improvement is driven by strategic ambitions to: design quality into the structure of the organization; plan and control improvements; assure improvements; set and realize improvement goals; position the

Improving a mother to child HIV transmission programme through health system redesign: quality improvement, protocol adjustment and resource addition.

Directory of Open Access Journals (Sweden)

Michele S Youngleson

2010-11-01

Full Text Available Health systems that deliver prevention of mother to child transmission (PMTCT services in low and middle income countries continue to underperform, resulting in thousands of unnecessary HIV infections of newborns each year. We used a combination of approaches to health systems strengthening to reduce transmission of HIV from mother to infant in a multi-facility public health system in South Africa.All primary care sites and specialized birthing centers in a resource constrained sub-district of Cape Metro District, South Africa, were enrolled in a quality improvement (QI programme. All pregnant women receiving antenatal, intrapartum and postnatal infant care in the sub-district between January 2006 and March 2009 were included in the intervention that had a prototype-innovation phase and a rapid spread phase. System changes were introduced to help frontline healthcare workers to identify and improve performance gaps at each step of the PMTCT pathway. Improvement was facilitated and spread through the use of a Breakthrough Series Collaborative that accelerated learning and the spread of successful changes. Protocol changes and additional resources were introduced by provincial and municipal government. The proportion of HIV-exposed infants testing positive declined from 7.6% to 5%. Key intermediate PMTCT processes improved (antenatal AZT increased from 74% to 86%, PMTCT clients on HAART at the time of labour increased from 10% to 25%, intrapartum AZT increased from 43% to 84%, and postnatal HIV testing from 79% to 95% compared to baseline.System improvement methods, protocol changes and addition/reallocation of resources contributed to improved PMTCT processes and outcomes in a resource constrained setting. The intervention requires a clear design, leadership buy-in, building local capacity to use systems improvement methods, and a reliable data system. A systems improvement approach offers a much needed approach to rapidly improve under

Case Studies in Continuous Process Improvement

Science.gov (United States)

Mehta, A.

1997-01-01

This study focuses on improving the SMT assembly process in a low-volume, high-reliability environment with emphasis on fine pitch and BGA packages. Before a process improvement is carried out, it is important to evaluate where the process stands in terms of process capability.

Improving embryo quality in assisted reproduction

NARCIS (Netherlands)

Mantikou, E.

2013-01-01

The goal of this thesis was to improve embryo quality in assisted reproductive technologies by gaining more insight into human preimplantation embryo development and by improving in vitro culture conditions. To do so, we investigated an intriguing feature of the human preimplantation embryo, i.e.

Human Resource Management for Continuous Improvement

DEFF Research Database (Denmark)

Jørgensen, Frances; Boer, Harry; Laugen, Bjørge

2006-01-01

The objective of this paper is to investigate the relationship between HRM practices and Continuous Improvement (CI) activities in order to gain an understanding of how the HRM function may be utilized to improve CI implementation success, and consequently, organizational performance. The paper i...

Theoretical Frameworks to Guide School Improvement

Science.gov (United States)

Evans, Lisa; Thornton, Bill; Usinger, Janet

2012-01-01

A firm grounding in change theory can provide educational leaders with an opportunity to orchestrate meaningful organizational improvements. This article provides an opportunity for practicing leaders to review four major theories of organizational change--continuous improvement, two approaches to organizational learning, and appreciative inquiry.…

Productivity improvement opportunities at Navy public works activities

OpenAIRE

Dieffenbach, Richard Jacob

1992-01-01

Approved for public release; distribution is unlimited This study identifies six principal opportunities for productivity improvement at Navy Public Works in-house maintenance activities: improving work assignment, increasing shop supervisor effectiveness, reducing long lunches and early quits (through understanding of work impediments as demotivational contributors), improving service order management, improving job quality and miscellaneous opportunities. Activity "productivity opportu...

The Big Improvement in PISA 2009 Reading Achievements in Serbia: Improvement of the Quality of Education or Something Else?

Directory of Open Access Journals (Sweden)

Dragica Pavlović Babić

2011-01-01

Full Text Available The PISA 2009 results in Serbia show a big improvement in reading literacy compared to 2006 – the average score is 41 points higher, which is equal to the effect of a whole year of schooling in OECD countries and represents the second highest improvement ever recorded in a PISA study. In the present paper, we discuss potential reasons for such a big improvement based on analysis of the PISA 2009 reading achievements in different countries, with a special focus on countries from the same region (Croatia, Slovenia, Montenegro, Bulgaria, Romania and Albania. The analysis shows that the largest part of the improvement was realised at lower achieving levels, suggesting that the dominant method of teaching in schools is a traditional method oriented towards the acquisition and reproduction of academic knowledge. Findings of data analysis support the conclusion that the improvement is mainly the result of certain contextual factors, such as higher student motivation and a high level of official support for the PISA study in Serbia, rather than representing a real improvement in the quality of education.

Five criteria for using a surrogate endpoint to predict treatment effect based on data from multiple previous trials.

Science.gov (United States)

Baker, Stuart G

2018-02-20

A surrogate endpoint in a randomized clinical trial is an endpoint that occurs after randomization and before the true, clinically meaningful, endpoint that yields conclusions about the effect of treatment on true endpoint. A surrogate endpoint can accelerate the evaluation of new treatments but at the risk of misleading conclusions. Therefore, criteria are needed for deciding whether to use a surrogate endpoint in a new trial. For the meta-analytic setting of multiple previous trials, each with the same pair of surrogate and true endpoints, this article formulates 5 criteria for using a surrogate endpoint in a new trial to predict the effect of treatment on the true endpoint in the new trial. The first 2 criteria, which are easily computed from a zero-intercept linear random effects model, involve statistical considerations: an acceptable sample size multiplier and an acceptable prediction separation score. The remaining 3 criteria involve clinical and biological considerations: similarity of biological mechanisms of treatments between the new trial and previous trials, similarity of secondary treatments following the surrogate endpoint between the new trial and previous trials, and a negligible risk of harmful side effects arising after the observation of the surrogate endpoint in the new trial. These 5 criteria constitute an appropriately high bar for using a surrogate endpoint to make a definitive treatment recommendation. Published 2017. This article is a U.S. Government work and is in the public domain in the USA.

Georgia - Improved Learning Environment

Data.gov (United States)

Millennium Challenge Corporation — The school rehabilitation activity seeks to decrease student and teacher absenteeism, increase students’ time on task, and, ultimately, improve learning and labor...

A measure for provisional-and-urgent sanitary improvement in developing countries: septic-tank performance improvement.

Science.gov (United States)

Harada, H; Dong, N T; Matsui, S

2008-01-01

Although many cities have planed to develop sewerages in developing countries, sewerage establishment still requires huge investment and engineering efforts. Improvement of existing sanitation facilities may contribute the betterment of urban sanitation before sewerage establishment. The purpose of this study is to propose a measure to improve urban sanitation in areas where a sewerage development plan is proposed but has not been yet established, based on a case study in Hanoi, Vietnam. We found that 90.5% of human excreta flowed into septic tanks. However, 89.6% of septic tanks have never been desludged in the past and their performance was observed to be at a low level. The study also showed that if they introduce regular desludging with a frequency of once a year, they can eliminate 72.8% of COD loads from septic tanks. It was indicated that the performance can be dramatically recovered by regular desludging, which could contribute urban sanitation improvement in Hanoi. In conclusion, the performance recovery of septic tanks by regular desludging was proposed as a provisional-and-urgent measure for urban sanitation improvement, together with the septage treatment in sewage sludge treatment facilities, which should be established earlier than other facilities of sewage treatment systems. IWA Publishing 2008.

Partnership for Continuous Improvement

Science.gov (United States)

1990-01-01

The proceedings are presented of the sixth annual conference on quality control between NASA and its contractors. The emphasis is placed on a commitment to quality and excellence that guarantees mission success. A forum is provided for representatives from government, industry, and academia to exchange ideas and experiences, encouraging total quality performance that results in high quality products and services. Key points are highlighted from the presentations and activities are described that have resulted in a broad range of improvements in products and services from government, industry, and academia. Long term commitment to quality is an essential requirement that ensures future success. That commitment reinterates the dedication to excellence in space exploration and to national quality and productivity improvement.

Improving Student Behavior.

Science.gov (United States)

Green, Pamela; Gilbert, Janice T.

This report describes a program for improving the behavior of seventh and eighth grade students with learning disabilities in a self-contained classroom setting. Analysis of probable causes revealed that students demonstrated a lack of problem-solving skills, showed a low frustration tolerance, and exhibited poor self-concepts. Two major…

Multimodal Perioperative Analgesia Regimen to Improve Patient Outcomes After Total Knee Arthroplasty: A Multidisciplinary Quality Improvement Project.

Science.gov (United States)

Donahue, Rebecca E; Bradbury, George R; Zychowicz, Michael E; Muckler, Virginia C

2018-04-01

The primary aim of this quality improvement project was to improve mobilization for patients after total knee arthroscopy by developing and implementing a standardized, evidence-based, multimodal analgesia regimen and patient-educational video. Secondary outcomes included opioid consumption, pain, and length of stay. A pre-post implementation design was used to compare two independent samples. Patients were screened based on inclusion and exclusion criteria 1-2 weeks before surgery. The anesthesia provider made the final determination for inclusion. Data were collected by retrospective chart review. Following implementation, patients displayed significantly improved mobilization, reduced opioid consumption, and reduced length of stay. Patient-reported pain scores were similar or significantly lower in the postimplementation group. Variability of patient outcomes was reduced, and quality of care was improved by standardizing care and incorporating the best available evidence, consistent with organization's resources in the nonacademic-affiliated, community hospital setting. Published by Elsevier Inc.

Improved availability through reduction in rework

International Nuclear Information System (INIS)

Grosswald, M.; Lowman, J.

1985-01-01

The Florida Power and Light Company Quality Improvement Rework Identification Program is discussed. Establishment of the Quality Improvement Rework Identification Task Team, goals, and methods of the program are noted. Resulting from the program are reductions in failure frequency and positive incentives from a teamwork approach

The Legal Context for Teacher Improvement.

Science.gov (United States)

Belsches-Simmons, Grace; Bray, Judith

Teacher improvement programs must comply with federal and state constitutional requirements for due process, equal protection, and freedom of speech, as well as state and federal laws covering collective bargaining, civil rights, and the authority to institute improvement programs. This booklet explores these legal considerations, focusing on…

Improving the Greenlandic Greenhouse Gas Inventory

DEFF Research Database (Denmark)

Nielsen, Ole-Kenneth; Baunbæk, Lene; Gyldenkærne, Steen

The project to improve the Greenlandic greenhouse gas (GHG) inventory was undertaken due to the recommendations made by the UNFCCC review team in connection with the 2008 and 2009 submissions by the Kingdom of Denmark. The improvements made to the Greenlandic GHG emission inventory were substantial...

Reliability-How to Quantify and Improve?

Indian Academy of Sciences (India)

Home; Journals; Resonance – Journal of Science Education; Volume 5; Issue 5. Reliability - How to Quantify and Improve? - Improving the Health of Products. N K Srinivasan. General Article Volume 5 Issue 5 May 2000 pp 55-63. Fulltext. Click here to view fulltext PDF. Permanent link:

Using adapted quality-improvement approaches to strengthen community-based health systems and improve care in high HIV-burden sub-Saharan African countries.

Science.gov (United States)

Horwood, Christiane M; Youngleson, Michele S; Moses, Edward; Stern, Amy F; Barker, Pierre M

2015-07-01

Achieving long-term retention in HIV care is an important challenge for HIV management and achieving elimination of mother-to-child transmission. Sustainable, affordable strategies are required to achieve this, including strengthening of community-based interventions. Deployment of community-based health workers (CHWs) can improve health outcomes but there is a need to identify systems to support and maintain high-quality performance. Quality-improvement strategies have been successfully implemented to improve quality and coverage of healthcare in facilities and could provide a framework to support community-based interventions. Four community-based quality-improvement projects from South Africa, Malawi and Mozambique are described. Community-based improvement teams linked to the facility-based health system participated in learning networks (modified Breakthrough Series), and used quality-improvement methods to improve process performance. Teams were guided by trained quality mentors who used local data to help nurses and CHWs identify gaps in service provision and test solutions. Learning network participants gathered at intervals to share progress and identify successful strategies for improvement. CHWs demonstrated understanding of quality-improvement concepts, tools and methods, and implemented quality-improvement projects successfully. Challenges of using quality-improvement approaches in community settings included adapting processes, particularly data reporting, to the education level and first language of community members. Quality-improvement techniques can be implemented by CHWs to improve outcomes in community settings but these approaches require adaptation and additional mentoring support to be successful. More research is required to establish the effectiveness of this approach on processes and outcomes of care.

Windows with improved energy performances

DEFF Research Database (Denmark)

Laustsen, Jacob Birck; Svendsen, Svend

2003-01-01

Heat loss through windows represents a considerable part of the total heat loss from houses. However, apart from providing daylight access and view, windows offer a unique potential for solar gain to be exploited during the heating season. Until now valuation of the energy performance of windows...... has primary focused on the heat loss coefficient, U-value. However, as the U-value, especially for the glazing part, has improved considerably during the last years, the total solar energy transmittance, g-value, has become equally important to the total energy performance of windows. Improved energy...... resulted in a window with a positive net energy gain (in short the Net Gain Window), which means that it contributes to the space heating of the building. All improvements are based on existing technology and manufacturing methods. The results from this work show that the energy performances of windows can...

Nuclear Station Facilities Improvement Planning

International Nuclear Information System (INIS)

Hooks, R. W.; Lunardini, A. L.; Zaben, O.

1991-01-01

An effective facilities improvement program will include a plan for the temporary relocation of personnel during the construction of an adjoining service building addition. Since the smooth continuation of plant operation is of paramount importance, the phasing plan is established to minimize the disruptions in day-to-day station operation and administration. This plan should consider the final occupancy arrangements and the transition to the new structure; for example, computer hookup and phase-in should be considered. The nuclear industry is placing more emphasis on safety and reliability of nuclear power plants. In order to do this, more emphasis is placed on operations and maintenance. This results in increased size of managerial, technical and maintenance staffs. This in turn requires improved office and service facilities. The facilities that require improvement may include training areas, rad waste processing and storage facilities, and maintenance facilities. This paper discusses an approach for developing an effective program to plan and implement these projects. These improvement projects can range in magnitude from modifying a simple system to building a new structure to allocating space for a future project. This paper addresses the planning required for the new structures with emphasis on site location, space allocation, and internal layout. Since facility planning has recently been completed by Sargent and Leyden at six U. S. nuclear stations, specific examples from some of those plants are presented. Site planning and the establishment of long-range goals are of the utmost importance when undertaking a facilities improvement program for a nuclear station. A plan that considers the total site usage will enhance the value of both the new and existing facilities. Proper planning at the beginning of the program can minimize costs and maximize the benefits of the program

Improvements to Technical Specifications surveillance requirements

International Nuclear Information System (INIS)

Lobel, R.; Tjader, T.R.

1992-12-01

In August 1983 an NRC task group was formed to investigate problems with surveillance testing required by Technical Specifications, and to recommend approaches to effect improvements. NUREG-1024 (''Technical Specifications-Enhancing Safety Impact'') resulted, and it contained recommendations to review the basis for test frequencies; to ensure that the tests promote safety and do not degrade equipment; and to review surveillance tests so that they do not unnecessarily burden personnel. The Technical Specifications Improvement Program (TSIP) was established in December 1984 to provide the framework for rewriting and improving the Technical Specifications. As an element of the TSIP, all Technical Specifications surveillance requirements were comprehensively examined as recommended in NUREG-1024. The results of that effort are presented in this report. The study found that while some testing at power is essential to verify equipment and system operability, safety can be improved, equipment degradation decreased, and unnecessary personnel burden relaxed by reducing the amount of testing at power

Improving functional value of meat products.

Science.gov (United States)

Zhang, Wangang; Xiao, Shan; Samaraweera, Himali; Lee, Eun Joo; Ahn, Dong U

2010-09-01

In recent years, much attention has been paid to develop meat and meat products with physiological functions to promote health conditions and prevent the risk of diseases. This review focuses on strategies to improve the functional value of meat and meat products. Value improvement can be realized by adding functional compounds including conjugated linoneleic acid, vitamin E, n3 fatty acids and selenium in animal diets to improve animal production, carcass composition and fresh meat quality. In addition, functional ingredients such as vegetable proteins, dietary fibers, herbs and spices, and lactic acid bacteria can be directly incorporated into meat products during processing to improve their functional value for consumers. Functional compounds, especially peptides, can also be generated from meat and meat products during processing such as fermentation, curing and aging, and enzymatic hydrolysis. This review further discusses the current status, consumer acceptance, and market for functional foods from the global viewpoints. Future prospects for functional meat and meat products are also discussed.

PROPOSAL OF VOIVODESHIP ROAD SAFETY IMPROVEMENT PROGRAMME

Directory of Open Access Journals (Sweden)

Tomasz SZCZURASZEK

2016-07-01

Full Text Available The article presents a proposal of the ‘GAMBIT KUJAWSKO-POMORSKI’ Road Safety Improvement Programme. The main idea of the Programme is to establish and initiate systems that will be responsible for the most important areas of activity within road safety, including road safety control, supervision, and management systems in the whole Voivodeship. In total, the creation and start of nine such systems has been proposed, namely: the Road Safety Management, the Integrated Road Rescue Service, the Personnel Continuing Education, the Hazardous Road Behaviour Monitoring, the Social Education for Safe Behaviour on Road, the Teaching Personnel Improvement, the Area Development and Planning Process Improvement, the Road Infrastructure Design Quality Improvement, and the Road and Traffic Management Process Efficiency Improvement. The basic aim of each system has been discussed as well as the most important tasks implemented as its part. The Road Safety Improvement Programme for the Kujawsko-Pomorskie Voivodeship presented in this article is a part of the National Road Safety Programme 2013-2020. Moreover, it is not only an original programme in Poland, but also a universal project that may be adapted for other voivodeships as well.

Software Engineering Program: Software Process Improvement Guidebook

Science.gov (United States)

1996-01-01

The purpose of this document is to provide experience-based guidance in implementing a software process improvement program in any NASA software development or maintenance community. This guidebook details how to define, operate, and implement a working software process improvement program. It describes the concept of the software process improvement program and its basic organizational components. It then describes the structure, organization, and operation of the software process improvement program, illustrating all these concepts with specific NASA examples. The information presented in the document is derived from the experiences of several NASA software organizations, including the SEL, the SEAL, and the SORCE. Their experiences reflect many of the elements of software process improvement within NASA. This guidebook presents lessons learned in a form usable by anyone considering establishing a software process improvement program within his or her own environment. This guidebook attempts to balance general and detailed information. It provides material general enough to be usable by NASA organizations whose characteristics do not directly match those of the sources of the information and models presented herein. It also keeps the ideas sufficiently close to the sources of the practical experiences that have generated the models and information.

Endpoint behavior of the pion distribution amplitude in QCD sum rules with nonlocal condensates

International Nuclear Information System (INIS)

Mikhailov, S. V.; Pimikov, A. V.; Stefanis, N. G.

2010-01-01

Starting from the QCD sum rules with nonlocal condensates for the pion distribution amplitude, we derive another sum rule for its derivative and its ''integral derivatives''--defined in this work. We use this new sum rule to analyze the fine details of the pion distribution amplitude in the endpoint region x∼0. The results for endpoint-suppressed and flattop (or flatlike) pion distribution amplitudes are compared with those we obtained with differential sum rules by employing two different models for the distribution of vacuum-quark virtualities. We determine the range of values of the derivatives of the pion distribution amplitude and show that endpoint-suppressed distribution amplitudes lie within this range, while those with endpoint enhancement--flat-type or Chernyak-Zhitnitsky like--yield values outside this range.

Reporting and evaluation of HIV-related clinical endpoints in two multicenter international clinical trials

DEFF Research Database (Denmark)

Lifson, A; Rhame, F; Bellosa, W

2006-01-01

adjudication between reviewers before diagnostic certainty was assigned. CONCLUSION: Important requirements for HIV trials using clinical endpoints include objective definitions of "confirmed" and "probable," a formal reporting process with adequate information and supporting source documentation, evaluation......PURPOSE: The processes for reporting and review of progression of HIV disease clinical endpoints are described for two large phase III international clinical trials. METHOD: SILCAAT and ESPRIT are multicenter randomized HIV trials evaluating the impact of interleukin-2 on disease progression...... and death in HIV-infected patients receiving antiretroviral therapy. We report definitions used for HIV progression of disease endpoints, procedures for site reporting of such events, processes for independent review of reported events by an Endpoint Review Committee (ERC), and the procedure...

Diffusion of improved biomass stoves in China

International Nuclear Information System (INIS)

Daxiong Qiu; Shuhua Gu; Catania, P.; Kun Huang

1996-01-01

The large-scale utilization of inefficient biofuel stoves for cooking and heating in the rural areas of China can cause ecological and environmental problems; thus, in 1982, the Chinese government encouraged the diffusion of improved biomass stoves. From 1982 to 1994, these improved biomass stoves have been used by 144 million households or the equivalent of 90% of all improved stoves installed globally; 62% of the Chinese market has been penetrated. This paper presents the fundamental features of China's diffusion programme of improved biomass stoves, analyses of the future domestic market, and defines some of the lessons learned from the diffusion programme which may be applicable in other emerging nations. (Author)

24 Command Fire Improvement Action Program Plan

International Nuclear Information System (INIS)

GRIFFIN, G.B.

2000-01-01

Fluor Hanford (FH) is responsible for providing support to the Department of Energy Richland Operations Office (RL) in the implementation of the Hanford Emergency Preparedness (EP) program. During fiscal year 2000, a number of program improvements were identified from various sources including a major range fire (24 Command Fire). Evaluations of the emergency preparedness program have confirmed that it currently meets all requirements and that performance of personnel involved is good, however the desire to effect continuous improvement resulted in the development of this improvement program plan. This program plan defines the activities that will be performed in order to achieve the desired performance improvements

Improvement of uncertainty relations for mixed states

International Nuclear Information System (INIS)

Park, Yong Moon

2005-01-01

We study a possible improvement of uncertainty relations. The Heisenberg uncertainty relation employs commutator of a pair of conjugate observables to set the limit of quantum measurement of the observables. The Schroedinger uncertainty relation improves the Heisenberg uncertainty relation by adding the correlation in terms of anti-commutator. However both relations are insensitive whether the state used is pure or mixed. We improve the uncertainty relations by introducing additional terms which measure the mixtureness of the state. For the momentum and position operators as conjugate observables and for the thermal state of quantum harmonic oscillator, it turns out that the equalities in the improved uncertainty relations hold

Quality Improvement in Hospitals: Identifying and Understanding Behaviors

Directory of Open Access Journals (Sweden)

Lukasz M. Mazur

2012-01-01

Full Text Available Improving operational performance in hospitals is complicated, particularly if process improvement requires complex behavioral changes. Using single-loop and double-loop learning theory as a foundation, the purpose of this research is to empirically uncover key improvement behaviors and the factors that may be associated with such behaviors in hospitals. A two-phased approach was taken to collect data regarding improvement behaviors and associated factors, and data analysis was conducted using methods proposed by grounded theorists. The contributions of this research are twofold. First, five key behaviors related to process improvement are identified, namely Quick Fixing, Initiating, Conforming, Expediting, and Enhancing. Second, based on these observed behaviors, a set of force field diagrams is developed to structure and organize possible factors that are important to consider when attempting to change improvement behaviors. This begins to fill the gap in the knowledge about what factors drive effective improvement efforts in hospital settings.

The discipline of improvement: something old, something new?

Science.gov (United States)

Clarke, Charlotte L; Reed, Jan; Wainwright, David; McClelland, Siobhan; Swallow, Veronica; Harden, Jane; Walton, Graham; Walsh, Anna

2004-03-01

In response to calls to improve the efficacy of health care services, there is an increasing focus on the processes of achieving a continuous improvement of services and practices. One specific response is that of the NHS Modernization Agency and National Health Service University in relation to the Discipline of Improvement in Health and Social Care. This paper draws on a study that explored the underpinning knowledge base of the Discipline of Improvement and focuses on describing the framework that was developed. The two-dimensional framework is composed of five primary categories, which cross-link to 11 competencies. The study concludes that the Discipline of Improvement draws together a group of ideas that together cohere to form a distinctive model to aid the improvement of health care. While some of these ideas are well-established, the way in which the Discipline of Improvement makes connections between them offers something new to our understanding of change in the complex world of health care provision, and to nursing management.

Improving Employee Satisfaction Priority through Performance Control Matrix

Directory of Open Access Journals (Sweden)

Shun-Hsing Chen

2014-11-01

Full Text Available The study addresses Performance Control Matrix (PCM to determine service quality items of priority for improvement. Most businesses focus on customer satisfaction when undertaking surveys of satisfaction and dissatisfaction, while generally neglecting employee satisfaction. Therefore, this study develops an integrated model to improve service quality in Taiwanese finance industry employees. A questionnaire is designed to determine the priority of improvement objectives derived from certain questionnaire items that fall into the improvement zone of the PCM. Ten items are found to fall into the improvement zone of the PCM. The present results show that the finance industry employees surveyed in Taiwan were dissatisfied with their job security, salaries, annual bonus, and fair distribution of operational profits. The ten improvement items mostly belong to two dimensions - ‘Pay and Benefits’ and ‘Motivation’. The managers of the financial institutions should seek to improve these quality attributes by devoting more resources to these items, thus promoting employee satisfaction.

Piloting improved cookstoves in India.

Science.gov (United States)

Lewis, Jessica J; Bhojvaid, Vasundhara; Brooks, Nina; Das, Ipsita; Jeuland, Marc A; Patange, Omkar; Pattanayak, Subhrendu K

2015-01-01

Despite the potential of improved cookstoves to reduce the adverse environmental and health impacts of solid fuel use, their adoption and use remains low. Social marketing-with its focus on the marketing mix of promotion, product, price, and place-offers a useful way to understand household behaviors and design campaigns to change biomass fuel use. We report on a series of pilots across 3 Indian states that use different combinations of the marketing mix. We find sales varying from 0% to 60%. Behavior change promotion that combined door-to-door personalized demonstrations with information pamphlets was effective. When given a choice amongst products, households strongly preferred an electric stove over improved biomass-burning options. Among different stove attributes, reduced cooking time was considered most valuable by those adopting a new stove. Households clearly identified price as a significant barrier to adoption, while provision of discounts (e.g., rebates given if households used the stove) or payments in installments were related to higher purchase. Place-based factors such as remoteness and nongovernmental organization operations significantly affected the ability to supply and convince households to buy and use improved cookstoves. Collectively, these pilots point to the importance of continued and extensive testing of messages, pricing models, and different stove types before scale-up. Thus, we caution that a one-size-fits-all approach will not boost improved cookstove adoption.

Teaching Strategies to Improve Algebra Learning

Science.gov (United States)

Zbiek, Rose Mary; Larson, Matthew R.

2015-01-01

Improving student learning is the primary goal of every teacher of algebra. Teachers seek strategies to help all students learn important algebra content and develop mathematical practices. The new Institute of Education Sciences[IES] practice guide, "Teaching Strategies for Improving Algebra Knowledge in Middle and High School Students"…

Improved Spectroscopy of Minimal Walking Technicolor

DEFF Research Database (Denmark)

Kerrane, Eoin; Del Debbio, Luigi; Pica, Claudio

2010-01-01

We present an improved study of spectroscopic observables in the $SU(2)$ Yang-Mills theory with two adjoint fermions. We make an improvement on the precision of previous results which clarify the scale of finite volume effects present. This analysis adds to the evidence for near-conformal dynamic...

Play Therapy: Role in Reading Improvement.

Science.gov (United States)

Carmichael, Karla

1991-01-01

Reviews the literature concerning the role of play therapy (particularly sandplay and nondirected play therapy) in the improvement of reading. Suggests that the role of play therapy is to support the child, encourage the child, and build self-esteem thus creating the optimal learning environment for reading improvement. (RS)

Seven propositions of the science of improvement: exploring foundations.

Science.gov (United States)

Perla, Rocco J; Provost, Lloyd P; Parry, Gareth J

2013-01-01

The phrase "Science of Improvement" or "Improvement Science" is commonly used today by a range of people and professions to mean different things, creating confusion to those trying to learn about improvement. In this article, we briefly define the concepts of improvement and science, and review the history of the consideration of "improvement" as a science. We trace key concepts and ideas in improvement to their philosophical and theoretical foundation with a focus on Deming's System of Profound Knowledge. We suggest that Deming's system has a firm association with many contemporary and historic philosophic and scientific debates and concepts. With reference to these debates and concepts, we identify 7 propositions that provide the scientific and philosophical foundation for the science of improvement. A standard view of the science of improvement does not presently exist that is grounded in the philosophical and theoretical basis of the field. The 7 propositions outlined here demonstrate the value of examining the underpinnings of improvement. This is needed to both advance the field and minimize confusion about what the phrase "science of improvement" represents. We argue that advanced scientists of improvement are those who like Deming and Shewhart can integrate ideas, concepts, and models between scientific disciplines for the purpose of developing more robust improvement models, tools, and techniques with a focus on application and problem solving in real world contexts. The epistemological foundations and theoretical basis of the science of improvement and its reasoning methods need to be critically examined to ensure its continued development and relevance. If improvement efforts and projects in health care are to be characterized under the canon of science, then health care professionals engaged in quality improvement work would benefit from a standard set of core principles, a standard lexicon, and an understanding of the evolution of the science of

Methodological approach to organizational performance improvement process

OpenAIRE

Buble, Marin; Dulčić, Želimir; Pavić, Ivan

2017-01-01

Organizational performance improvement is one of the fundamental enterprise tasks. This especially applies to the case when the term “performance improvement” implies efficiency improvement measured by indicators, such as ROI, ROE, ROA, or ROVA/ROI. Such tasks are very complex, requiring implementation by means of project management. In this paper, the authors propose a methodological approach to improving the organizational performance of a large enterprise.

Quality improvement in pediatrics: past, present, and future.

Science.gov (United States)

Schwartz, Stephanie P; Rehder, Kyle J

2017-01-01

Almost two decades ago, the landmark report "To Err is Human" compelled healthcare to address the large numbers of hospitalized patients experiencing preventable harm. Concurrently, it became clear that the rapidly rising cost of healthcare would be unsustainable in the long-term. As a result, quality improvement methodologies initially rooted in other high-reliability industries have become a primary focus of healthcare. Multiple pediatric studies demonstrate remarkable quality and safety improvements in several domains including handoffs, catheter-associated blood stream infections, and other serious safety events. While both quality improvement and research are data-driven processes, significant differences exist between the two. Research utilizes a hypothesis driven approach to obtain new knowledge while quality improvement often incorporates a cyclic approach to translate existing knowledge into clinical practice. Recent publications have provided guidelines and methods for effectively reporting quality and safety work and improvement implementations. This review examines not only how quality improvement in pediatrics has led to improved outcomes, but also looks to the future of quality improvement in healthcare with focus on education and collaboration to ensure best practice approaches to caring for children.

[Sustainable process improvement with application of 'lean philosophy'].

Science.gov (United States)

Rouppe van der Voort, Marc B V; van Merode, G G Frits; Veraart, Henricus G N

2013-01-01

Process improvement is increasingly being implemented, particularly with the aid of 'lean philosophy'. This management philosophy aims to improve quality by reducing 'wastage'. Local improvements can produce negative effects elsewhere due to interdependence of processes. An 'integrated system approach' is required to prevent this. Some hospitals claim that this has been successful. Research into process improvement with the application of lean philosophy has reported many positive effects, defined as improved safety, quality and efficiency. Due to methodological shortcomings and lack of rigorous evaluations it is, however, not yet possible to determine the impact of this approach. It is, however, obvious that the investigated applications are fragmentary, with a dominant focus on the instrumental aspect of the philosophy and a lack of integration in a total system, and with insufficient attention to human aspects. Process improvement is required to achieve better and more goal-oriented healthcare. To achieve this, hospitals must develop integrated system approaches that combine methods for process design with continuous improvement of processes and with personnel management. It is crucial that doctors take the initiative to guide and improve processes in an integral manner.

Improvement attributes in healthcare: implications for integrated care.

Science.gov (United States)

Harnett, Patrick John

2018-04-16

Purpose Healthcare quality improvement is a key concern for policy makers, regulators, carers and service users. Despite a contemporary consensus among policy makers that integrated care represents a means to substantially improve service outcomes, progress has been slow. Difficulties achieving sustained improvement at scale imply that methods employed are not sufficient and that healthcare improvement attributes may be different when compared to prior reference domains. The purpose of this paper is to examine and synthesise key improvement attributes relevant to a complex healthcare change process, specifically integrated care. Design/methodology/approach This study is based on an integrative literature review on systemic improvement in healthcare. Findings A central theme emerging from the literature review indicates that implementing systemic change needs to address the relationship between vision, methods and participant social dynamics. Practical implications Accommodating personal and professional network dynamics is required for systemic improvement, especially among high autonomy individuals. This reinforces the need to recognise the change process as taking place in a complex adaptive system where personal/professional purpose/meaning is central to the process. Originality/value Shared personal/professional narratives are insufficiently recognised as a powerful change force, under-represented in linear and rational empirical improvement approaches.

42 CFR 441.474 - Quality assurance and improvement plan.

Science.gov (United States)

2010-10-01

... 42 Public Health 4 2010-10-01 2010-10-01 false Quality assurance and improvement plan. 441.474... improvement plan. (a) The State must provide a quality assurance and improvement plan that describes the State... pursue opportunities for system improvement. (b) The quality assurance and improvement plan shall also...

Improved Casting Furnace Conceptual Design

Energy Technology Data Exchange (ETDEWEB)

Fielding, Randall Sidney [Idaho National Lab. (INL), Idaho Falls, ID (United States); Tolman, David Donald [Idaho National Lab. (INL), Idaho Falls, ID (United States)

2017-02-01

In an attempt to ensure more consistent casting results and remove some schedule variance associated with casting, an improved casting furnace concept has been developed. The improved furnace uses the existing arc melter hardware and glovebox utilities. The furnace concept was designed around physical and operational requirements such as; a charge sized of less than 30 grams, high heating rates and minimal additional footprint. The conceptual model is shown in the report as well as a summary of how the requirements were met.

Gastroenterological endpoints in drug trials for cystic fibrosis

NARCIS (Netherlands)

Bodewes, Frank A. J. A.; Verkade, Henkjan J.; Wilschanski, Micheal

2016-01-01

The phenotype of cystic fibrosis includes a wide variety of clinical and biochemical gastrointestinal presentations. These gastrointestinal characteristics of the disease have come under renewed interest as potential outcome measures and clinical endpoints for therapeutic trials in cystic fibrosis.

Quality improvement in neurological surgery graduate medical education.

Science.gov (United States)

Parker, Scott L; McGirt, Matthew J; Asher, Anthony L; Selden, Nathan R

2015-04-01

There has been no formal, standardized curriculum for neurosurgical resident education in quality improvement. There are at least 2 reasons to integrate a formalized quality improvement curriculum into resident education: (1) increased emphasis on the relative quality and value (cost-effectiveness) of health care provided by individual physicians, and (2) quality improvement principles empower broader lifelong learning. An integrated quality improvement curriculum should comprise specific goals and milestones at each level of residency training. This article discusses the role and possible implementation of a national program for quality improvement in neurosurgical resident education. Copyright © 2015 Elsevier Inc. All rights reserved.