Mark II magnetic detector for SPEAR

International Nuclear Information System (INIS)

Larsen, R.R.

1975-01-01

The Mark II Detector, presently in the design stage, is a SLAC/LBL detector project to replace the Mark I now in operation at SPEAR. While similar in concept to the Mark I it will have improved momentum resolution, shower detection, solid angle coverage for both triggering and tracking and a magnet design providing easier access to those particles transmitted through the aluminum coil

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.

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.

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.

NotaMark industrial laser marking system: a new security marking technology

Science.gov (United States)

Moreau, Vincent G.

2004-06-01

Up until now, the only variable alphanumeric data which could be added to banknotes was the number, applied by means of impact typographical numbering boxes. As an additional process or an alternative to this mechanical method, a non-contact laser marking process can be used offering high quality and greater levels of flexibility. For this purpose KBA-GIORI propose an exclusive laser marking solution called NotaMark. The laser marking process NotaMark is the ideal solution for applying variable data and personalizing banknotes (or any other security documents) with a very high resolution, for extremely large production volumes. A completely integrated solution has been developed comprised of laser light sources, marking head units, and covers and extraction systems. NotaMark allows the marking of variable data by removing locally and selectively, specific printed materials leaving the substrate itself untouched. A wide range of materials has already been tested extensively. NotaMark is a new security feature which is easy to identify and difficult to counterfeit, and which complies with the standard mechanical and chemical resistance tests in the security printing industry as well as with other major soiling tests. The laser marking process opens up a whole new range of design possibilities and can be used to create a primary security feature such as numbering, or to enhance the value of existing features.

Improvement of Clinical Skills through Pharmaceutical Education and Clinical Research.

Science.gov (United States)

Ishizaki, Junko

2017-01-01

Professors and teaching staff in the field of pharmaceutical sciences should devote themselves to staying abreast of relevant education and research. Similarly those in clinical pharmacies should contribute to the advancement of pharmaceutical research and the development of next generation pharmacists and pharmaceuticals. It is thought that those who work in clinical pharmacies should improve their own skills and expertise in problem-finding and -solving, i.e., "clinical skills". They should be keen to learn new standard treatments based on the latest drug information, and should try to be in a position where collecting clinical information is readily possible. In the case of pharmacists in hospitals and pharmacies, they are able to aim at improving their clinical skills simply through performing their pharmaceutical duties. On the other hand, when a pharmaceutical educator aims to improve clinical skills at a level comparable to those of clinical pharmacists, it is necessary to devote or set aside considerable time for pharmacist duties, in addition to teaching, which may result in a shortage of time for hands-on clinical practice and/or in a decline in the quality of education and research. This could be a nightmare for teaching staff in clinical pharmacy who aim to take part in such activities. Nonetheless, I believe that teaching staff in the clinical pharmacy area could improve his/her clinical skills through actively engaging in education and research. In this review, I would like to introduce topics on such possibilities from my own experiences.

An assessment of BWR [boiling water reactor] Mark-II containment challenges, failure modes, and potential improvements in performance

International Nuclear Information System (INIS)

Kelly, D.L.; Jones, K.R.; Dallman, R.J.; Wagner, K.C.

1990-07-01

This report assesses challenges to BWR Mark II containment integrity that could potentially arise from severe accidents. Also assessed are some potential improvements that could prevent core damage or containment failure, or could mitigate the consequences of such failure by reducing the release of fission products to the environment. These challenges and improvements are analyzed via a limited quantitative risk/benefit analysis of a generic BWR/4 reactor with Mark II containment. Point estimate frequencies of the dominant core damage sequences are obtained and simple containment event trees are constructed to evaluate the response of the containment to these severe accident sequences. The resulting containment release modes are then binned into source term release categories, which provide inputs to the consequence analysis. The output of the consequences analysis is used to construct an overall base case risk profile. Potential improvements and sensitivities are evaluated by modifying the event tree spilt fractions, thus generating a revised risk profile. Several important sensitivity cases are examined to evaluate the impact of phenomenological uncertainties on the final results. 75 refs., 25 figs., 65 tabs

The interplay of attention economics and computer-aided detection marks in screening mammography

Science.gov (United States)

Schwartz, Tayler M.; Sridharan, Radhika; Wei, Wei; Lukyanchenko, Olga; Geiser, William; Whitman, Gary J.; Haygood, Tamara Miner

2016-03-01

Introduction: According to attention economists, overabundant information leads to decreased attention for individual pieces of information. Computer-aided detection (CAD) alerts radiologists to findings potentially associated with breast cancer but is notorious for creating an abundance of false-positive marks. We suspected that increased CAD marks do not lengthen mammogram interpretation time, as radiologists will selectively disregard these marks when present in larger numbers. We explore the relevance of attention economics in mammography by examining how the number of CAD marks affects interpretation time. Methods: We performed a retrospective review of bilateral digital screening mammograms obtained between January 1, 2011 and February 28, 2014, using only weekend interpretations to decrease distractions and the likelihood of trainee participation. We stratified data according to reader and used ANOVA to assess the relationship between number of CAD marks and interpretation time. Results: Ten radiologists, with median experience after residency of 12.5 years (range 6 to 24,) interpreted 1849 mammograms. When accounting for number of images, Breast Imaging Reporting and Data System category, and breast density, increasing numbers of CAD marks was correlated with longer interpretation time only for the three radiologists with the fewest years of experience (median 7 years.) Conclusion: For the 7 most experienced readers, increasing CAD marks did not lengthen interpretation time. We surmise that as CAD marks increase, the attention given to individual marks decreases. Experienced radiologists may rapidly dismiss larger numbers of CAD marks as false-positive, having learned that devoting extra attention to such marks does not improve clinical detection.

Clinical simulation training improves the clinical performance of Chinese medical students

Directory of Open Access Journals (Sweden)

Ming-ya Zhang

2015-10-01

Full Text Available Background: Modern medical education promotes medical students’ clinical operating capacity rather than the mastery of theoretical knowledge. To accomplish this objective, clinical skill training using various simulations was introduced into medical education to cultivate creativity and develop the practical ability of students. However, quantitative analysis of the efficiency of clinical skill training with simulations is lacking. Methods: In the present study, we compared the mean scores of medical students (Jinan University who graduated in 2013 and 2014 on 16 stations between traditional training (control and simulative training groups. In addition, in a clinical skill competition, the objective structured clinical examination (OSCE scores of participating medical students trained using traditional and simulative training were compared. The data were statistically analyzed and qualitatively described. Results: The results revealed that simulative training could significantly enhance the graduate score of medical students compared with the control. The OSCE scores of participating medical students in the clinical skill competition, trained using simulations, were dramatically higher than those of students trained through traditional methods, and we also observed that the OSCE marks were significantly increased for the same participant after simulative training for the clinical skill competition. Conclusions: Taken together, these data indicate that clinical skill training with a variety of simulations could substantially promote the clinical performance of medical students and optimize the resources used for medical education, although a precise analysis of each specialization is needed in the future.

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.

[Study of continuous quality improvement for clinical laboratory processes via the platform of Hospital Group].

Science.gov (United States)

Song, Wenqi; Shen, Ying; Peng, Xiaoxia; Tian, Jian; Wang, Hui; Xu, Lili; Nie, Xiaolu; Ni, Xin

2015-05-26

The program of continuous quality improvement in clinical laboratory processes for complete blood count (CBC) was launched via the platform of Beijing Children's Hospital Group in order to improve the quality of pediatric clinical laboratories. Fifteen children's hospitals of Beijing Children's Hospital group were investigated using the method of Chinese adapted continuous quality improvement with PDCA (Plan-Do-Check-Action). The questionnaire survey and inter-laboratory comparison was conducted to find the existing problems, to analyze reasons, to set forth quality targets and to put them into practice. Then, targeted training was conducted to 15 children's hospitals and the second questionnaire survey, self examinations by the clinical laboratories was performed. At the same time, the Group's online internal quality control platform was established. Overall effects of the program were evaluated so that lay a foundation for the next stage of PDCA. Both quality of control system documents and CBC internal quality control scheme for all of clinical laboratories were improved through this program. In addition, standardization of performance verification was also improved, especially with the comparable verification rate of precision and internal laboratory results up to 100%. In terms of instrument calibration and mandatory diagnostic rates, only three out of the 15 hospitals (20%) failed to pass muster in 2014 from 46.67% (seven out of the 15 hospitals) in 2013. The abnormal data of intraday precision variance coefficients of the five CBC indicator parameters (WBC, RBC, Hb, Plt and Hct) of all the 15 laboratories accounted for 1.2% (2/165) in 2014, a marked decrease from 9.6% (14/145) in 2013. While the number of the hospitals using only one horizontal quality control object for daily quality control has dropped to three from five. The 15 hospitals organized a total of 263 times of training in 2014 from 101 times in 2013, up 160%. The quality improvement program for

Preoperative teaching and stoma marking in an inpatient population: a quality improvement process using a FOCUS-Plan-Do-Check-Act model.

Science.gov (United States)

Zimnicki, Katherine M

2015-01-01

Preoperative teaching and stoma marking are supported by research and included in clinical practice guidelines from the WOCN Society and others. Using a FOCUS-Plan-Do-Check-Act model of Total Quality Management, a multidisciplinary team was formed that developed a flow chart outlining the process of care for patients undergoing planned ostomy surgery that included an educational intervention that enabled staff nurses to perform preoperative stoma site marking and education. After 3 months, we found a statistically significant increase in the number of surgical patients who received these evidence-based interventions (14% vs 64%; χ = 9.32; P = .002).

Engaging Clinical Nurses in Quality Improvement Projects.

Science.gov (United States)

Moore, Susan; Stichler, Jaynelle F

2015-10-01

Clinical nurses have the knowledge and expertise required to provide efficient and proficient patient care. Time and knowledge deficits can prevent nurses from developing and implementing quality improvement or evidence-based practice projects. This article reviews a process for professional development of clinical nurses that helped them to define, implement, and analyze quality improvement or evidence-based practice projects. The purpose of this project was to educate advanced clinical nurses to manage a change project from inception to completion, using the Six Sigma DMAIC (Define, Measure, Analyze, Improve, Control) Change Acceleration Process as a framework. One-to-one mentoring and didactic in-services advanced the knowledge, appreciation, and practice of advanced practice clinicians who completed multiple change projects. The projects facilitated clinical practice changes, with improved patient outcomes; a unit cultural shift, with appreciation of quality improvement and evidence-based projects; and engagement with colleagues. Project outcomes were displayed in poster presentations at a hospital exposition for knowledge dissemination. Copyright 2015, SLACK Incorporated.

New genetic tools for improving SIT in Ceratitis capitata: embryonic lethality and sperm marking

International Nuclear Information System (INIS)

Schetelig, Marc F.; Wimmer, Ernst A.; Scolari, Francesca; Gasperi, Giuliano; Handler, Ernst A.

2006-01-01

Environment friendly sterile insect technique (SIT) is being applied effectively as a component of area-wide integrated pest management (AW-IPM) for Ceratitis capitata since 1970s. Nevertheless improved biological strategies are needed to increase the efficacy of AW-IPM. Transgenic approaches should increase and widen the applicability of such programmes to different pest species. In this respect two major strategies are followed: First an approach to cause sterility was designed without interfering with spermatogenesis to maintain males and their sperm as competitive as possible. We followed a strategy, which is based on the expression of a lethal factor under the control of a promoter that is active at early blastoderm stages. The system employs the ectopic expression of a hyperactive pro apoptotic gene that causes embryo-specific lethality when driven by the tetracycline-controlled trans activator tTA under the regulation of a cellularization gene enhancer/promoter. The system has been tested successfully in Drosophila melanogaster (Horn and Wimmer 2003). We tried the direct transfer of the Drosophila system to Ceratitis capitata by injecting the respective constructs that carry Drosophila-derived promoters. Unfortunately, the cellularization specific promoters from Drosophila seem not functional in Ceratitis. Therefore, the corresponding enhancers/promoters from Ceratitis were isolated and subsequently the tTA was brought independently under the control of each enhancer/promoter region. These constructs were injected in Ceratitis for further evaluation. Second, we have engineered a medfly strain carrying a sperm marking system. This strain carries two fluorescent markers. One (turboGFP) marker is under the control of the spermatogenesis specific b2-tubulin promoter from Ceratitis and is therefore sperm specifically expressed. The second (DsRed) is under the control of the poly ubiquitin promoter of Drosophila. Released males from this strain could be

New genetic tools for improving SIT in Ceratitis capitata: embryonic lethality and sperm marking

Energy Technology Data Exchange (ETDEWEB)

Schetelig, Marc F; Wimmer, Ernst A [Georg-August-University, Gottingen (Germany). Johann-Friedrich Blumenbach Institute of Zoology and Anthropology. Gottingen Center for Molecular Biosciences; Scolari, Francesca; Gasperi, Giuliano [Universita di Pavia (Italy). Dipt. di Biologia Animale; Handler, Ernst A [U.S. Department of Agriculture (USDA/ARS), Gainesville, FL (United States). Agricultural Research Service. Center for Medical, Agricultural and Veterinary Entomology

2006-07-01

Environment friendly sterile insect technique (SIT) is being applied effectively as a component of area-wide integrated pest management (AW-IPM) for Ceratitis capitata since 1970s. Nevertheless improved biological strategies are needed to increase the efficacy of AW-IPM. Transgenic approaches should increase and widen the applicability of such programmes to different pest species. In this respect two major strategies are followed: First an approach to cause sterility was designed without interfering with spermatogenesis to maintain males and their sperm as competitive as possible. We followed a strategy, which is based on the expression of a lethal factor under the control of a promoter that is active at early blastoderm stages. The system employs the ectopic expression of a hyperactive pro apoptotic gene that causes embryo-specific lethality when driven by the tetracycline-controlled trans activator tTA under the regulation of a cellularization gene enhancer/promoter. The system has been tested successfully in Drosophila melanogaster (Horn and Wimmer 2003). We tried the direct transfer of the Drosophila system to Ceratitis capitata by injecting the respective constructs that carry Drosophila-derived promoters. Unfortunately, the cellularization specific promoters from Drosophila seem not functional in Ceratitis. Therefore, the corresponding enhancers/promoters from Ceratitis were isolated and subsequently the tTA was brought independently under the control of each enhancer/promoter region. These constructs were injected in Ceratitis for further evaluation. Second, we have engineered a medfly strain carrying a sperm marking system. This strain carries two fluorescent markers. One (turboGFP) marker is under the control of the spermatogenesis specific b2-tubulin promoter from Ceratitis and is therefore sperm specifically expressed. The second (DsRed) is under the control of the poly ubiquitin promoter of Drosophila. Released males from this strain could be

Electronic health records improve clinical note quality.

Science.gov (United States)

Burke, Harry B; Sessums, Laura L; Hoang, Albert; Becher, Dorothy A; Fontelo, Paul; Liu, Fang; Stephens, Mark; Pangaro, Louis N; O'Malley, Patrick G; Baxi, Nancy S; Bunt, Christopher W; Capaldi, Vincent F; Chen, Julie M; Cooper, Barbara A; Djuric, David A; Hodge, Joshua A; Kane, Shawn; Magee, Charles; Makary, Zizette R; Mallory, Renee M; Miller, Thomas; Saperstein, Adam; Servey, Jessica; Gimbel, Ronald W

2015-01-01

The clinical note documents the clinician's information collection, problem assessment, clinical management, and its used for administrative purposes. Electronic health records (EHRs) are being implemented in clinical practices throughout the USA yet it is not known whether they improve the quality of clinical notes. The goal in this study was to determine if EHRs improve the quality of outpatient clinical notes. A five and a half year longitudinal retrospective multicenter quantitative study comparing the quality of handwritten and electronic outpatient clinical visit notes for 100 patients with type 2 diabetes at three time points: 6 months prior to the introduction of the EHR (before-EHR), 6 months after the introduction of the EHR (after-EHR), and 5 years after the introduction of the EHR (5-year-EHR). QNOTE, a validated quantitative instrument, was used to assess the quality of outpatient clinical notes. Its scores can range from a low of 0 to a high of 100. Sixteen primary care physicians with active practices used QNOTE to determine the quality of the 300 patient notes. The before-EHR, after-EHR, and 5-year-EHR grand mean scores (SD) were 52.0 (18.4), 61.2 (16.3), and 80.4 (8.9), respectively, and the change in scores for before-EHR to after-EHR and before-EHR to 5-year-EHR were 18% (pquality scores significantly improved over the 5-year time interval. The EHR significantly improved the overall quality of the outpatient clinical note and the quality of all its elements, including the core and non-core elements. To our knowledge, this is the first study to demonstrate that the EHR significantly improves the quality of clinical notes. © The Author 2014. Published by Oxford University Press on behalf of the American Medical Informatics Association.

Do clinicians use more question marks?

NARCIS (Netherlands)

Zijlmans, Maeike; Otte, Willem M; Van't Klooster, Maryse A; van Diessen, Eric; Leijten, Frans Ss; Sander, Josemir W

2015-01-01

OBJECTIVE: To quantify the use of question marks in titles of published studies. DESIGN AND SETTING: Literature review. PARTICIPANTS: All Pubmed publications between 1 January 2013 and 31 December 2013 with an available abstract. Papers were classified as being clinical when the search terms clin*,

The impact of preoperative stoma site marking on the incidence of complications, quality of life, and patient's independence.

Science.gov (United States)

Person, Benjamin; Ifargan, Ruth; Lachter, Jesse; Duek, Simon D; Kluger, Yoram; Assalia, Ahmad

2012-07-01

Preoperative stoma site marking and counseling aim to improve patients' rehabilitation and adaptation to a new medical condition. Objective studies are needed to provide evidence of the impact of care by stoma therapists. Key quality indicators include patients' quality of life, independence, and complication rates as affected by the variable modes of stoma site marking and planning. The aim of this study was to evaluate the impact of preoperative stoma site marking on patients' quality of life, independence, and complication rates. : A validated stoma quality-of-life questionnaire was used as the main assessment tool. Complications were noted on regular postoperative visits. This is a single-center, clinical study. The study was conducted at the Rambam Health Care Campus in Haifa, Israel. Rambam Health Care Campus is a tertiary university hospital. All patients who underwent an elective stoma creation between 2006 and 2008 were included. Evaluated parameters included demographics, stoma type, marking status, complication rates, quality of life, and independence parameters. : One hundred five patients (60 men and 45 women) were included, of whom 52 (49.5%) were preoperatively marked and 53 (50.5%) were not marked. Sixty stomas (57%) were permanent, and 45 (43%) stomas were temporary. The quality of life of patients whose stoma sites were preoperatively marked was significantly better than that of the unmarked patients (p stoma type. Preoperative stoma site marking is crucial for improving patients' postoperative quality of life, promoting their independence, and reducing the rates of postoperative complications. The role of the enterostomal therapist is very important in the ostomates' pre- and postoperative care.

Marking out the clinical expert/clinical leader/clinical scholar: perspectives from nurses in the clinical arena

OpenAIRE

Mannix, Judy; Wilkes, Lesley; Jackson, Debra

2013-01-01

Background Clinical scholarship has been conceptualised and theorised in the nursing literature for over 30?years but no research has captured nurses? clinicians? views on how it differs or is the same as clinical expertise and clinical leadership. The aim of this study was to determine clinical nurses? understanding of the differences and similarities between the clinical expert, clinical leader and clinical scholar. Methods A descriptive interpretative qualitative approach using semi-struct...

Interview with Professor Mark Wilcox.

Science.gov (United States)

Wilcox, Mark

2016-08-01

Mark Wilcox speaks to Georgia Patey, Commissioning Editor: Professor Mark Wilcox is a Consultant Microbiologist and Head of Microbiology at the Leeds Teaching Hospitals (Leeds, UK), the Professor of Medical Microbiology at the University of Leeds (Leeds, UK), and is the Lead on Clostridium difficile and the Head of the UK C. difficile Reference Laboratory for Public Health England (PHE). He was the Director of Infection Prevention (4 years), Infection Control Doctor (8 years) and Clinical Director of Pathology (6 years) at the Leeds Teaching Hospitals. He is Chair of PHE's Rapid Review Panel (reviews utility of infection prevention and control products for National Health Service), Deputy Chair of the UK Department of Health's Antimicrobial Resistance and Healthcare Associated Infection Committee and a member of PHE's HCAI/AR Programme Board. He is a member of UK/European/US working groups on C. difficile infection. He has provided clinical advice as part of the FDA/EMA submissions for the approval of multiple novel antimicrobial agents. He heads a healthcare-associated infection research team at University of Leeds, comprising approximately 30 doctors, scientists and nurses; projects include multiple aspects of C. difficile infection, diagnostics, antimicrobial resistance and the clinical development of new antimicrobial agents. He has authored more than 400 publications, and is the coeditor of Antimicrobial Chemotherapy (5th/6th/7th Editions, 15 December 2007).

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

International Nuclear Information System (INIS)

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

1999-01-01

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

The clinical nurse specialist: leadership in quality improvement.

Science.gov (United States)

Finkelman, Anita

2013-01-01

Healthcare delivery is in a crisis, requiring improvement. How to improve and who should assume more leadership are not clear. At the same time, the nursing profession struggles with a weak education system, graduating students who require major support for an extended time. There is also confusion related to nursing roles, particularly with nurses who have a graduate degree. The Institute of Medicine has published a series of reports about the healthcare system and need for improvement and describes a structure for improvement. The clinical nurse specialist is particularly suited to assume a major role in nursing leadership to guide staff and the healthcare system to better ensure improved care. There is great need to communicate that the clinical nurse specialist can and should assume this role. This will require a review and development of more quality improvement content and experiences in clinical nurse specialist educational programs, but much of the content is already in programs. The clinical nurse specialist works in systems, impacts systems, works with staff, and can thus reach more patients with improvement approaches.

Glass marking with diode-pumped Nd:YLF laser; Handotai reiki Nd:YLF laser ni yoru glass marking

Energy Technology Data Exchange (ETDEWEB)

Sakai, F.; Hayashi, K. [Sumitomo Heavy Industries, Ltd., Tokyo (Japan)

1996-08-20

The compact marking system based on a beam scanning system in which the fourth harmonic (FHG: 262 nm in wavelength) of a diode-pumped Nd:YLF (Nd:LiYf4) laser is used for the source of ultraviolet light is described. The result of application to the glass marking that caused a problem due to the generation of cracks is also explained. The machining characteristics significantly vary depending on the type of glass. During actual marking, sample processing must be beforehand carried out to optimize the processing conditions after confirming that there is no problem in practical use. For marking on the glass used for liquid-crystal board, it is valid to improve the density of a dot and increase the number of shots per dot for obtaining high visibility. However, cracks may occur in the clearance of each dot because of the thermal effect. Therefore, the processing conditions must be optimized according to the glass type and crack generation state. The generation of cracks can be suppressed by setting the processing conditions to the optimum level. As a result, satisfactory marking is obtained. 8 refs., 6 figs.

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.

Improving clinical drug development regulatory procedures for anticonvulsants

Directory of Open Access Journals (Sweden)

Janković Slobodan

2015-01-01

Full Text Available Background: Clinical development of antiepileptic drugs is demanding due to complex character of the disorder and to diversity of its forms and etiologies. Objective: The aim of this review was to suggest improvements in regulatory procedures for clinical development of antiepileptic drugs. Methods: The following databases of scientific articles were searched: MEDLINE, SCOPUS and SCINDEKS. In total 558 publications were retrieved. The types of articles selected were reviews, reports on clinical trials and letters to the Editor. Results: There are several changes of regulatory documents necessary for improving process of clinical development of antiepileptic drugs: preference of parallel groups design for add-on trials should be explicit; the noninferiority design for monotherapy clinical trials should be acceptable; restrictive formulations when trials of antiepileptic drugs in children are in question should be avoided; requirements in regard to the efficacy measures should be harmonized among the regulatory bodies; proactive attitude towards discovery of adverse events; and precise requirements for clinical trials specifically designed to prove anti-epileptogenic effects should be made clear. Conclusion: Current regulatory documents are incomplete in many aspects; an international effort to improve and harmonize guidelines for clinical development of antiepileptic drugs is necessary for improvement of this process.

Pursuing Improvement in Clinical Reasoning: The Integrated Clinical Education Theory.

Science.gov (United States)

Jessee, Mary Ann

2018-01-01

The link between clinical education and development of clinical reasoning is not well supported by one theoretical perspective. Learning to reason during clinical education may be best achieved in a supportive sociocultural context of nursing practice that maximizes reasoning opportunities and facilitates discourse and meaningful feedback. Prelicensure clinical education seldom incorporates these critical components and thus may fail to directly promote clinical reasoning skill. Theoretical frameworks supporting the development of clinical reasoning during clinical education were evaluated. Analysis of strengths and gaps in each framework's support of clinical reasoning development was conducted. Commensurability of philosophical underpinnings was confirmed, and complex relationships among key concepts were elucidated. Six key concepts and three tenets comprise an explanatory predictive theory-the integrated clinical education theory (ICET). ICET provides critical theoretical support for inquiry and action to promote clinical education that improves development of clinical reasoning skill. [J Nurs Educ. 2018;57(1):7-13.]. Copyright 2018, SLACK Incorporated.

Computerized tomographic simulation compared with clinical mark-up in palliative radiotherapy: A prospective study

International Nuclear Information System (INIS)

Haddad, Peiman; Cheung, Fred; Pond, Gregory; Easton, Debbie; Cops, Frederick; Bezjak, Andrea; McLean, Michael; Levin, Wilfred; Billingsley, Susan; Williams, Diane; Wong, Rebecca

2006-01-01

Purpose To evaluate the impact of computed tomographic (CT) planning in comparison to clinical mark-up (CM) for palliative radiation of chest wall metastases. Methods and Materials In patients treated with CM for chest wall bone metastases (without conventional simulation/fluoroscopy), two consecutive planning CT scans were acquired with and without an external marker to delineate the CM treatment field. The two sets of scans were fused for evaluation of clinical tumor volume (CTV) coverage by the CM technique. Under-coverage was defined as the proportion of CTV not covered by the CM 80% isodose. Results Twenty-one treatments (ribs 17, sternum 2, and scapula 2) formed the basis of our study. Due to technical reasons, comparable data between CM and CT plans were available for 19 treatments only. CM resulted in a mean CTV under-coverage of 36%. Eleven sites (58%) had an under-coverage of >20%. Mean volume of normal tissues receiving ≥80% of the dose was 5.4% in CM and 9.3% in CT plans (p = 0.017). Based on dose-volume histogram comparisons, CT planning resulted in a change of treatment technique from direct apposition to a tangential pair in 7 of 19 cases. Conclusions CT planning demonstrated a 36% under-coverage of CTV with CM of ribs and chest wall metastases

Improving clinical leadership and management in the NHS

Directory of Open Access Journals (Sweden)

Nicol ED

2012-08-01

Full Text Available Edward D Nicol1,21Department of Cardiology, Royal Brompton Hospital and Harefield NHS Trust, London, United Kingdom; 2Clinical Leadership Academy, School of Medicine, Keele University, Staffordshire, United KingdomAbstract: The National Health Service (NHS is one of the UKs most cherished but political public institutions, providing healthcare, free at the point of delivery. The English NHS must make £20bn efficiency savings in the next 3 years whilst in the midst of fundamental structural change outlined in the government's Health and Social Care Bill. This paper will explore the history of leadership and management in the NHS; the evolution of clinical leadership; national strategies to improve NHS clinical and managerial leadership and Lord Darzi's pivotal NHS review. It defines the kind of leadership and management required for today's NHS, looking to overcome some of the main challenges such as improving healthcare quality whilst making efficiency savings and engaging grass roots workers to deliver sustainable, long term improvements. Finally this manuscript makes suggestions as to where future investment is required to improve clinical leadership and management in the NHS.Keywords: clinical leadership, healthcare management, national health service

Handheld single photon emission computed tomography (handheld SPECT) navigated video-assisted thoracoscopic surgery of computer tomography-guided radioactively marked pulmonary lesions.

Science.gov (United States)

Müller, Joachim; Putora, Paul Martin; Schneider, Tino; Zeisel, Christoph; Brutsche, Martin; Baty, Florent; Markus, Alexander; Kick, Jochen

2016-09-01

Radioactive marking can be a valuable extension to minimally invasive surgery. The technique has been clinically applied in procedures involving sentinel lymph nodes, parathyroidectomy as well as interventions in thoracic surgery. Improvements in equipment and techniques allow one to improve the limits. Pulmonary nodules are frequently surgically removed for diagnostic or therapeutic reasons; here video-assisted thoracoscopic surgery (VATS) is the preferred technique. VATS might be impossible with nodules that are small or located deep in the lung. In this study, we examined the clinical application and safety of employing the newly developed handheld single photon emission tomography (handheld SPECT) device in combination with CT-guided radioactive marking of pulmonary nodules. In this pilot study, 10 subjects requiring surgical resection of a pulmonary nodule were included. The technique involved CT-guided marking of the target nodule with a 20-G needle, with subsequent injection of 25-30 MBq (effective: 7-14 MBq) Tc-99m MAA (Macro Albumin Aggregate). Quality control was made with conventional SPECT-CT to confirm the correct localization and exclude possible complications related to the puncture procedure. VATS was subsequently carried out using the handheld SPECT to localize the radioactivity intraoperatively and therefore the target nodule. A 3D virtual image was superimposed on the intraoperative visual image for surgical guidance. In 9 of the 10 subjects, the radioactive application was successfully placed directly in or in the immediate vicinity of the target nodule. The average size of the involved nodules was 9 mm (range 4-15). All successfully marked nodules were subsequently completely excised (R0) using VATS. The procedure was well tolerated. An asymptomatic clinically insignificant pneumothorax occurred in 5 subjects. Two subjects were found to have non-significant discrete haemorrhage in the infiltration canal of the needle. In a single subject, the

A Trust-Based Adaptive Probability Marking and Storage Traceback Scheme for WSNs

Science.gov (United States)

Liu, Anfeng; Liu, Xiao; Long, Jun

2016-01-01

Security is a pivotal issue for wireless sensor networks (WSNs), which are emerging as a promising platform that enables a wide range of military, scientific, industrial and commercial applications. Traceback, a key cyber-forensics technology, can play an important role in tracing and locating a malicious source to guarantee cybersecurity. In this work a trust-based adaptive probability marking and storage (TAPMS) traceback scheme is proposed to enhance security for WSNs. In a TAPMS scheme, the marking probability is adaptively adjusted according to the security requirements of the network and can substantially reduce the number of marking tuples and improve network lifetime. More importantly, a high trust node is selected to store marking tuples, which can avoid the problem of marking information being lost. Experimental results show that the total number of marking tuples can be reduced in a TAPMS scheme, thus improving network lifetime. At the same time, since the marking tuples are stored in high trust nodes, storage reliability can be guaranteed, and the traceback time can be reduced by more than 80%. PMID:27043566

Using road markings as a continuous cue for speed choice.

Science.gov (United States)

Charlton, Samuel G; Starkey, Nicola J; Malhotra, Neha

2018-08-01

The potential for using road markings to indicate speed limits was investigated in a driving simulator over the course of two sessions. Two types of experimental road markings, an "Attentional" set designed to provide visually distinct cues to indicate speed limits of 60, 80 and 100 km/h, and a "Perceptual" set designed to also affect drivers' perception of speed, were compared to a standard undifferentiated set of markings. Participants (n = 20 per group) were assigned to one of four experimental groups (Attentional-Explicit, Attentional-Implicit, Perceptual-Explicit, Perceptual-Implicit) or a Control group (n = 22; standard road markings). The Explicit groups were instructed about the meaning of the road markings while those in the Implicit and Control groups did not receive any explanation. Participants drove five 10 km simulated roads containing three speed zones (60, 80 and 100 km/h) during the first session. The participants returned to the laboratory approximately 3 days later to drive five more trials including roads they had not seen before, a trial that included a secondary task, and a trial where speed signs were removed and only markings were present. The findings indicated that both types of road markings improved drivers' compliance with speed limits compared to the control group, but that explicit instruction as to the meaning of the markings was needed to realise their full benefit. Although previous research has indicated the benefit of road markings used as warnings to indicate speed reductions in advance of horizontal or vertical curves, the findings of the present experiment also suggest that systematically associating road markings with specific speed limits may be a useful way to improve speed limit compliance and increase speed homogeneity. Copyright © 2018 The Authors. Published by Elsevier Ltd.. All rights reserved.

Skin markings in external radiotherapy by temporary tattooing with henna: Improvement of accuracy and increased patient comfort

International Nuclear Information System (INIS)

Wurstbauer, Karl; Sedlmayer, Felix; Kogelnik, H. Dieter

2001-01-01

Purpose: To guarantee invariable skin markings in patients undergoing a course of external radiotherapy, especially using conformal techniques. Cutaneous markings with henna also increase patient comfort, because washing and showering are allowed. Methods and Materials: Henna, a completely natural product, is a skin colorant with a history of 5,000 years. It is applied to the skin in the form of a paste. While drying, henna stains the superficial skin layers for several weeks, and the marked area can be exposed to water arbitrarily. In case of fading of the stain before the end of radiotherapy, the marking procedure can be repeated. From November 1998 until March 2000, we performed skin markings with henna in 158 patients with different tumor sites. The majority of patients received conformal radiotherapy techniques. All patients have been evaluated concerning durability of the markings, the required number of marking procedures per treatment course, and possible related side effects. Results: The median durability of henna staining is 23 days (range 12-48 days). On average, two marking procedures (range 1-4) are necessary for a patient treated with curative intent. Although washing and showering are freely permitted, no adverse cutaneous side effects (e.g., erythema, allergic reactions) have been observed. Conclusions: Skin marking by temporary tattooing with henna increases the accuracy of external radiotherapy. It yields stable and invariable markings for the entire course of radiotherapy and also increases the comfort of patients

Problems with ink skin markings for radiation field setups

International Nuclear Information System (INIS)

Endoh, Masaru; Saeki, Mituaki; Ishida, Yusei

1982-01-01

Ink skin markings are used in radiation therapy to aid in reproduction of treatment field setups or to indelibly outline field markings or tumors. We reported two cases of indelible ink skin for radiation field septa with minimal discomfort and dermatitis have been experienced for 6 months and above since end of radiotherapy. These indelible ink skin markings look like tattoo that will be big problems in the case of young female. We improved these problems by using of 10 percent silver nitrate instead of habitual skin ink. (author)

Improving Immunizations in Children: A Clinical Break-even Analysis.

Science.gov (United States)

Jones, Kyle Bradford; Spain, Chad; Wright, Hannah; Gren, Lisa H

2015-06-01

Immunizing the population is a vital public health priority. This article describes a resident-led continuous quality improvement project to improve the immunization rates of children under 3 years of age at two urban family medicine residency clinics in Salt Lake City, Utah, as well as a break-even cost analysis to the clinics for the intervention. Immunization records were distributed to provider-medical assistant teamlets daily for each pediatric patient scheduled in clinic to decrease missed opportunities. An outreach intervention by letter, followed by telephone call reminders, was conducted to reach children under 3 years of age who were behind on recommended immunizations for age (total n=457; those behind on immunizations n=101). Immunization rates were monitored at 3 months following start of intervention. A break-even analysis to the clinics for the outreach intervention was performed. Immunizations were improved from a baseline of 75.1% (n=133) and 79.6% (n=223) at the two clinics to 92.1% (n=163) and 89.6% (n=251), respectively, at 3 months following the start of intervention (Pbreak-even point required 36 immunizations to be administered. Significant improvement in the immunization rate of patients under 3 years of age at two family medicine residency training clinics was achieved through decreasing missed opportunities for immunization in clinic, and with outreach through letters and follow-up phone calls. The intervention showed positive revenue to both clinics. © 2015 Marshfield Clinic.

An industry-scale mass marking technique for tracing farmed fish escapees.

Directory of Open Access Journals (Sweden)

Fletcher Warren-Myers

Full Text Available Farmed fish escape and enter the environment with subsequent effects on wild populations. Reducing escapes requires the ability to trace individuals back to the point of escape, so that escape causes can be identified and technical standards improved. Here, we tested if stable isotope otolith fingerprint marks delivered during routine vaccination could be an accurate, feasible and cost effective marking method, suitable for industrial-scale application. We tested seven stable isotopes, (134Ba, (135Ba, (136Ba, (137Ba, (86Sr, (87Sr and (26Mg, on farmed Atlantic salmon reared in freshwater, in experimental conditions designed to reflect commercial practice. Marking was 100% successful with individual Ba isotopes at concentrations as low as 0.001 µg. g-1 fish and for Sr isotopes at 1 µg. g-1 fish. Our results suggest that 63 unique fingerprint marks can be made at low cost using Ba (0.0002 - 0.02 $US per mark and Sr (0.46 - 0.82 $US per mark isotopes. Stable isotope fingerprinting during vaccination is feasible for commercial application if applied at a company level within the world's largest salmon producing nations. Introducing a mass marking scheme would enable tracing of escapees back to point of origin, which could drive greater compliance, better farm design and improved management practices to reduce escapes.

Activating clinical trials: a process improvement approach.

Science.gov (United States)

Martinez, Diego A; Tsalatsanis, Athanasios; Yalcin, Ali; Zayas-Castro, José L; Djulbegovic, Benjamin

2016-02-24

The administrative process associated with clinical trial activation has been criticized as costly, complex, and time-consuming. Prior research has concentrated on identifying administrative barriers and proposing various solutions to reduce activation time, and consequently associated costs. Here, we expand on previous research by incorporating social network analysis and discrete-event simulation to support process improvement decision-making. We searched for all operational data associated with the administrative process of activating industry-sponsored clinical trials at the Office of Clinical Research of the University of South Florida in Tampa, Florida. We limited the search to those trials initiated and activated between July 2011 and June 2012. We described the process using value stream mapping, studied the interactions of the various process participants using social network analysis, and modeled potential process modifications using discrete-event simulation. The administrative process comprised 5 sub-processes, 30 activities, 11 decision points, 5 loops, and 8 participants. The mean activation time was 76.6 days. Rate-limiting sub-processes were those of contract and budget development. Key participants during contract and budget development were the Office of Clinical Research, sponsors, and the principal investigator. Simulation results indicate that slight increments on the number of trials, arriving to the Office of Clinical Research, would increase activation time by 11 %. Also, incrementing the efficiency of contract and budget development would reduce the activation time by 28 %. Finally, better synchronization between contract and budget development would reduce time spent on batching documentation; however, no improvements would be attained in total activation time. The presented process improvement analytic framework not only identifies administrative barriers, but also helps to devise and evaluate potential improvement scenarios. The strength

COMPUTER HARDWARE MARKING

CERN Multimedia

Groupe de protection des biens

2000-01-01

As part of the campaign to protect CERN property and for insurance reasons, all computer hardware belonging to the Organization must be marked with the words 'PROPRIETE CERN'.IT Division has recently introduced a new marking system that is both economical and easy to use. From now on all desktop hardware (PCs, Macintoshes, printers) issued by IT Division with a value equal to or exceeding 500 CHF will be marked using this new system.For equipment that is already installed but not yet marked, including UNIX workstations and X terminals, IT Division's Desktop Support Service offers the following services free of charge:Equipment-marking wherever the Service is called out to perform other work (please submit all work requests to the IT Helpdesk on 78888 or helpdesk@cern.ch; for unavoidable operational reasons, the Desktop Support Service will only respond to marking requests when these coincide with requests for other work such as repairs, system upgrades, etc.);Training of personnel designated by Division Leade...

Continuous quality improvement for the clinical decision unit.

Science.gov (United States)

Mace, Sharon E

2004-01-01

Clinical decision units (CDUs) are a relatively new and growing area of medicine in which patients undergo rapid evaluation and treatment. Continuous quality improvement (CQI) is important for the establishment and functioning of CDUs. CQI in CDUs has many advantages: better CDU functioning, fulfillment of Joint Commission on Accreditation of Healthcare Organizations mandates, greater efficiency/productivity, increased job satisfaction, better performance improvement, data availability, and benchmarking. Key elements include a database with volume indicators, operational policies, clinical practice protocols (diagnosis specific/condition specific), monitors, benchmarks, and clinical pathways. Examples of these important parameters are given. The CQI process should be individualized for each CDU and hospital.

Distinguishing butchery cut marks from crocodile bite marks through machine learning methods.

Science.gov (United States)

Domínguez-Rodrigo, Manuel; Baquedano, Enrique

2018-04-10

All models of evolution of human behaviour depend on the correct identification and interpretation of bone surface modifications (BSM) on archaeofaunal assemblages. Crucial evolutionary features, such as the origin of stone tool use, meat-eating, food-sharing, cooperation and sociality can only be addressed through confident identification and interpretation of BSM, and more specifically, cut marks. Recently, it has been argued that linear marks with the same properties as cut marks can be created by crocodiles, thereby questioning whether secure cut mark identifications can be made in the Early Pleistocene fossil record. Powerful classification methods based on multivariate statistics and machine learning (ML) algorithms have previously successfully discriminated cut marks from most other potentially confounding BSM. However, crocodile-made marks were marginal to or played no role in these comparative analyses. Here, for the first time, we apply state-of-the-art ML methods on crocodile linear BSM and experimental butchery cut marks, showing that the combination of multivariate taphonomy and ML methods provides accurate identification of BSM, including cut and crocodile bite marks. This enables empirically-supported hominin behavioural modelling, provided that these methods are applied to fossil assemblages.

Ultrafast lasers for precise and corrosion free marking on chirurgical steels

Science.gov (United States)

Neugebauer, Christoph; Aalderink, Dennis; Maurer, Erich; Faisst, Birgit; Budnicki, Aleksander

2017-02-01

The unique properties of ultrashort laser pulses and the decrease of invest pave the way to numerous novel applications. Even in the very price sensitive field of laser marking, ultrashort laser can compete due to a new cost structure and remarkable properties of the marking results. In this study we concentrated on industrial marking of medical equipment by using IR ultrashort lasers and compared the results with common marking laser systems. We demonstrate the benefits of ultrashort lasers marking on chirurgical devices, observing the influence of pulse energy, pulse duration, scanning velocity in respect to the visibility, corrosion resistance and long term durability under clinical conditions. Nowadays many parts and products are marked for the purpose of identification and traceability. One kind of laser marking is the well known annealing of stainless steel by nanosecond marking lasers. When annealing occurs a colored oxide layer grows due to the local heating of the material surface. Compared to the raw material, the annealed marking shows increased corrosion sensitivity. Regarding the traceability, the poor durability of the ns marking resulting in contrast reduction and the corrosion susceptibility are a huge problem. Therefore three different laser sources with ns-psfs pulse duration were observed. The focus rests on the realization of parameter studies (various lasers) and their effect on the corrosion and passivation behavior. Furthermore analysis of the oxide layers by use of EDX and XRD were performed to obtain further information on the composition and structure of the markings.

Improved modeling of clinical data with kernel methods.

Science.gov (United States)

Daemen, Anneleen; Timmerman, Dirk; Van den Bosch, Thierry; Bottomley, Cecilia; Kirk, Emma; Van Holsbeke, Caroline; Valentin, Lil; Bourne, Tom; De Moor, Bart

2012-02-01

Despite the rise of high-throughput technologies, clinical data such as age, gender and medical history guide clinical management for most diseases and examinations. To improve clinical management, available patient information should be fully exploited. This requires appropriate modeling of relevant parameters. When kernel methods are used, traditional kernel functions such as the linear kernel are often applied to the set of clinical parameters. These kernel functions, however, have their disadvantages due to the specific characteristics of clinical data, being a mix of variable types with each variable its own range. We propose a new kernel function specifically adapted to the characteristics of clinical data. The clinical kernel function provides a better representation of patients' similarity by equalizing the influence of all variables and taking into account the range r of the variables. Moreover, it is robust with respect to changes in r. Incorporated in a least squares support vector machine, the new kernel function results in significantly improved diagnosis, prognosis and prediction of therapy response. This is illustrated on four clinical data sets within gynecology, with an average increase in test area under the ROC curve (AUC) of 0.023, 0.021, 0.122 and 0.019, respectively. Moreover, when combining clinical parameters and expression data in three case studies on breast cancer, results improved overall with use of the new kernel function and when considering both data types in a weighted fashion, with a larger weight assigned to the clinical parameters. The increase in AUC with respect to a standard kernel function and/or unweighted data combination was maximum 0.127, 0.042 and 0.118 for the three case studies. For clinical data consisting of variables of different types, the proposed kernel function--which takes into account the type and range of each variable--has shown to be a better alternative for linear and non-linear classification problems

An innovative road marking quality assessment mechanism using computer vision

Directory of Open Access Journals (Sweden)

Kuo-Liang Lin

2016-06-01

Full Text Available Aesthetic quality acceptance for road marking works has been relied on subjective visual examination. Due to a lack of quantitative operation procedures, acceptance outcome can be biased and results in great quality variation. To improve aesthetic quality acceptance procedure of road marking, we develop an innovative road marking quality assessment mechanism, utilizing machine vision technologies. Using edge smoothness as a quantitative aesthetic indicator, the proposed prototype system first receives digital images of finished road marking surface and has the images processed and analyzed to capture the geometric characteristics of the marking. The geometric characteristics are then evaluated to determine the quality level of the finished work. System is demonstrated through two real cases to show how it works. In the end, a test comparing the assessment results between the proposed system and expert inspection is conducted to enhance the accountability of the proposed mechanism.

77 FR 41188 - Clinical Laboratory Improvement Advisory Committee (CLIAC)

Science.gov (United States)

2012-07-12

... to general issues related to improvement in clinical laboratory quality and laboratory medicine... DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention Clinical... patient-centeredness of laboratory services; revisions to the standards under which clinical laboratories...

Mark Tompkins Canaccord

OpenAIRE

Mark Tompkins Canaccord

2018-01-01

Mark Tompkins Canaccord is a senior technologist for ecosystem and water resources management in SEC SAID Oakland, California office. In his career which lasts over fifteen years Mark has worked on project involving lake restorations, clean water engineering, ecological engineering and management, hydrology, hydraulics, sediment transport and other projects for environmental planning all over the country. Mark Tompkins Canaccord tries to blend his skills of planning and engineering with s...

Reconfiguring trade mark law

DEFF Research Database (Denmark)

Elsmore, Matthew James

2013-01-01

-border setting, with a particular focus on small business and consumers. The article's overall message is to call for a rethink of received wisdom suggesting that trade marks are effective trade-enabling devices. The case is made for reassessing how we think about European trade mark law.......First, this article argues that trade mark law should be approached in a supplementary way, called reconfiguration. Second, the article investigates such a reconfiguration of trade mark law by exploring the interplay of trade marks and service transactions in the Single Market, in the cross...

Marked hyperandrogenicity in a 60-year-old woman

Directory of Open Access Journals (Sweden)

Khaled Aljenaee

2017-09-01

Full Text Available Markedly elevated androgen levels can lead to clinical virilization in females. Clinical features of virilization in a female patient, in association with biochemical hyperandrogenism, should prompt a search for an androgen-producing tumor, especially of ovarian or adrenal origin. We herein report the case of a 60-year-old woman of Pakistani origin who presented with the incidental finding of male pattern baldness and hirsutism. Her serum testosterone level was markedly elevated at 21 nmol/L (normal range: 0.4–1.7 nmol/L, while her DHEAS level was normal, indicating a likely ovarian source of her elevated testosterone. Subsequently, a CT abdomen-pelvis was performed, which revealed a bulky right ovary, confirmed on MRI of the pelvis as an enlarged right ovary, measuring 2.9 × 2.2 cm transaxially. A laparoscopic bilateral salpingo-oophorectomy was performed, and histopathological examination and immunohistochemistry confirmed the diagnosis of a Leydig cell tumor, a rare tumor accounting for 0.1% of ovarian tumors. Surgical resection led to normalization of testosterone levels.

In etanercept-treated psoriatic arthritis patients clinical improvement correlated with an increase of serum cortisol relative to other adrenal hormones.

Science.gov (United States)

Atzeni, F; Sarzi-Puttini, P; DePortu, S; Cutolo, M; Carrabba, M; Straub, R H

2008-01-01

In patients with rheumatoid arthritis (RA), long-term therapy with anti-tumor necrosis factor (TNF) antibodies sensitizes the pituitary gland and improves adrenal androgen secretion in prednisolone-naïve patients. However, whether this is similar in psoriatic arthritis (PsA) is not known. The aim of this study was to assess the effect of 12 weeks of etanercept treatment upon the function of the HPA axis in patients with PsA. Eleven prednisolone-naïve patients (mean age 47.3+/-8.9 years) with PsA were included. We measured serum levels of adrenocorticotropic hormone (ACTH), 17-hydroxyprogesterone (17OHP), cortisol, and androstenedione (ASD), at baseline and at 4 and 12 weeks after initiation of anti-TNF therapy (etanercept, 50 mg every week as a single dose by sc. injection). Clinical improvement was assessed using the Disease Activity Score-28 (DAS-28). Mean levels of serum ACTH, serum cortisol, serum 17OHP and serum ASD did not markedly change during 12 weeks of etanercept treatment. Similarly, the ratio of serum cortisol divided by serum ACTH did not change during 12 weeks of anti-TNF treatment. However, an increase of serum cortisol relative to serum 17OHP or ASD was related to clinical improvement. This indicates that improvement was linked to higher serum cortisol levels relative to others adrenal hormones. This is the first study to demonstrate baseline serum levels and the course of HPA axis-related hormones in patients with PsA. An increase of serum cortisol relative to others adrenocortical hormones (i.e., androstenedione and ACTH) was accompanied by clinical improvement.

Elimination or Minimization of Oscillation Marks: A Path To Improved Cast Surface Quality

Energy Technology Data Exchange (ETDEWEB)

Dr. Alan W. Cramb

2007-12-17

Oscillation marks are the most recognizable feature of continuous casting and can be related to the subsurface defects that can be found on product rolled from continuous cast slabs. The purpose of this work was to develop strategies that can be used on industrial continuous casters to reduce oscillation mark depth and, in particular, to minimize the formation of hook type defects that are prevalent on ultra low carbon grades. The major focus of the work was on developing a technique to allow heat transfer in the meniscus region of the continuous caster to be measured and the effect of mold slag chemistry and chrystallization to be documented. A new experimental technique was developed that allowed the effect of mold flux chemistry and chrystallization on the radiation heat transfer rate to be measured dynamically.

Parts Quality Management: Direct Part Marking via Data Matrix Symbols for Mission Assurance

Science.gov (United States)

Moss, Chantrice

2013-01-01

A United States Government Accountability Office (GAO) review of twelve NASA programs found widespread parts quality problems contributing to significant cost overruns, schedule delays, and reduced system reliability. Direct part-marking with Data Matrix symbols could significantly improve the quality of inventory control and parts lifecycle management. This paper examines the feasibility of using 15 marking technologies for use in future NASA programs. A structural analysis is based on marked material type, operational environment (e.g., ground, suborbital, orbital), durability of marks, ease of operation, reliability, and affordability. A cost-benefits analysis considers marking technology (data plates, label printing, direct part marking) and marking types (two-dimensional machine-readable, human-readable). Previous NASA parts marking efforts and historical cost data are accounted for, including in-house vs. outsourced marking. Some marking methods are still under development. While this paper focuses on NASA programs, results may be applicable to a variety of industrial environments.

Parts Quality Management: Direct Part Marking of Data Matrix Symbol for Mission Assurance

Science.gov (United States)

Moss, Chantrice; Chakrabarti, Suman; Scott, David W.

2013-01-01

A United States Government Accountability Office (GAO) review of twelve NASA programs found widespread parts quality problems contributing to significant cost overruns, schedule delays, and reduced system reliability. Direct part marking with Data Matrix symbols could significantly improve the quality of inventory control and parts lifecycle management. This paper examines the feasibility of using direct part marking technologies for use in future NASA programs. A structural analysis is based on marked material type, operational environment (e.g., ground, suborbital, Low Earth Orbit), durability of marks, ease of operation, reliability, and affordability. A cost-benefits analysis considers marking technology (label printing, data plates, and direct part marking) and marking types (two-dimensional machine-readable, human-readable). Previous NASA parts marking efforts and historical cost data are accounted for, including inhouse vs. outsourced marking. Some marking methods are still under development. While this paper focuses on NASA programs, results may be applicable to a variety of industrial environments.

Preoperative stoma site marking in the general surgery population.

Science.gov (United States)

Zimnicki, Katherine M

2013-01-01

Preoperative teaching and stoma site marking are supported by research and professional organizations as interventions that can reduce the incidence of problematic stomas and improve patient outcomes. This study investigated the translation of this research into practice in the acute care surgery population. A retrospective chart review using convenience sampling was conducted at a large urban hospital in the Midwestern United States. Thirty patients underwent a surgical procedure that resulted in the creation of a fecal ostomy over a 5-month period. Descriptive statistical analysis examined the reason for surgery, preoperative length of stay (LOS), the percentage of patients who received preoperative teaching and stoma marking and the relationship between preoperative LOS and the use of preoperative teaching and stoma marking. Twenty-one of 30 patients were admitted to hospital 24 hours or more before surgery. No participants were admitted urgently. Three (14%) of those admitted for more than 24 hours received preoperative marking or teaching. There was no significant relationship between preoperative LOS and preoperative teaching and stoma marking. The opportunity exists to promote successful adaptation in this surgical population through the implementation of the evidence-based interventions of preoperative teaching and stoma marking. Additional study is needed to determine barriers to their use as well as to develop effective implementation strategies.

BWR Mark I pressure suppression study: bench mark experiments

International Nuclear Information System (INIS)

Lai, W.; McCauley, E.W.

1977-01-01

Computer simulations representative of the wetwell of Mark I BWR's have predicted pressures and related phenomena. However, calculational predictions for purposes of engineering decision will be possible only if the code can be verified, i.e., shown to compute in accord with measured values. Described in the report is a set of single downcomer spherical flask bench mark experiments designed to produce quantitative data to validate various air-water dynamic computations; the experiments were performed since relevant bench mark data were not available from outside sources. Secondary purposes of the study were to provide a test bed for the instrumentation and post-experiment data processing techniques to be used in the Laboratory's reactor safety research program and to provide additional masurements for the air-water scaling study

Elemental marking of arthropod pests in agricultural systems: single and multigenerational marking

Science.gov (United States)

Jane Leslie Hayes

1991-01-01

Use of elemental markers to study movement of arthropod pests of field crops is reviewed. Trace elements, rubidium (Rb) and cesium (Cs), have provided a nondisruptive method of marking natural adult populations via developmental stage consumption of treated host plants. Multigenerational marking occurs with the transfer of elemental markers from marked adults to...

UID...Leaving Its Mark on the Universe

Science.gov (United States)

Schramm, Harry F., Jr.

2008-01-01

Since 1975 bar codes on products at the retail counter have been accepted as the standard for entering product identity for price determination. Since the beginning of the 21 st century, the Data Matrix symbol has become accepted as the bar code format that is marked directly on a part, assembly or product that is durable enough to identify that item for its lifetime. NASA began the studies for direct part marking Data Matrix symbols on parts during the Return to Flight activities after the Challenger Accident. Over the 20 year period that has elapsed since Challenger, a mountain of studies, analyses and focused problem solutions developed by and for NASA have brought about world changing results. NASA Technical Standard 6002 and NASA Handbook 6003 for Direct Part Marking Data Matrix Symbols on Aerospace Parts have formed the basis for most other standards on part marking internationally. NASA and its commercial partners have developed numerous products and methods that addressed the difficulties of collecting part identification in aerospace operations. These products enabled the marking of Data Matrix symbols in virtually every situation and the reading of symbols at great distances, severe angles, under paint and in the dark without a light. Even unmarkable delicate parts now have a process to apply a chemical mixture, recently trademarked as Nanocodes, that can be converted to Data Matrix information through software. The accompanying intellectual property is protected by ten patents, several of which are licensed. Direct marking Data Matrix on NASA parts dramatically decreases data entry errors and the number of parts that go through their life cycle unmarked, two major threats to sound configuration management and flight safety. NASA is said to only have people and stuff with information connecting them. Data Matrix is one of the most significant improvements since Challenger to the safety and reliability of that connection.

UID....Now That's Gonna Leave A Mark

Science.gov (United States)

Schramm, Harry F., Jr.

2008-01-01

Since 1975 bar codes on products at the retail counter have been accepted as the standard for entering product identity for price determination. Since the beginning of the 21 st century, the Data Matrix symbol has become accepted as the bar code format that is marked directly on a part, assembly or product that is durable enough to identify that item for its lifetime. NASA began the studies for direct part marking Data Matrix symbols on parts during the Return to Flight activities after the Challenger Accident. Over the 20 year period that has elapsed since Challenger, a mountain of studies, analyses and focused problem solutions developed by and for NASA have brought about world changing results. NASA Technical Standard 6002 and NASA Handbook 6003 for Direct Part Marking Data Matrix Symbols on Aerospace Parts have formed the basis for most other standards on part marking internationally. NASA and its commercial partners have developed numerous products and methods that addressed the difficulties of collecting part identification in aerospace operations. These products enabled the marking of Data Matrix symbols in virtually every situation and the reading of symbols at great distances, severe angles, under paint and in the dark without a light. Even unmarkable delicate parts now have a process to apply a chemical mixture, recently trademarked as Nanocodes, that can be converted to Data Matrix information through software. The accompanying intellectual property is protected by ten patents, several of which are licensed. Direct marking Data Matrix on NASA parts dramatically decreases data entry errors and the number of parts that go through their life cycle unmarked, two major threats to sound configuration management and flight safety. NASA is said to only have people and stuff with information connecting them. Data Matrix is one of the most significant improvements since Challenger to the safety and reliability of that connection.

Medical simulation-based education improves medicos' clinical skills.

Science.gov (United States)

Wang, Zhaoming; Liu, Qiaoyu; Wang, Hai

2013-03-01

Clinical skill is an essential part of clinical medicine and plays quite an important role in bridging medicos and physicians. Due to the realities in China, traditional medical education is facing many challenges. There are few opportunities for students to practice their clinical skills and their dexterities are generally at a low level. Medical simulation-based education is a new teaching modality and helps to improve medicos' clinical skills to a large degree. Medical simulation-based education has many significant advantages and will be further developed and applied.

Significance of chronic marked hyperglycemia on FDG-PET. Is it really problematic for clinical oncologic imaging?

International Nuclear Information System (INIS)

Hara, Tadashi; Higashi, Tatsuya; Nakamoto, Yuji

2009-01-01

The purpose of this study was to evaluate the adverse effects of chronic marked hyperglycemia on clinical diagnostic performance of positron emission tomography (PET) using 18 F-fluorodeoxyglucose (FDG). Fifty-seven scans of 54 patients, who received FDG-PET for the diagnosis of various cancer(s), and who showed high plasma glucose level of more than 200 mg/dl at the time of administration of FDG in spite of at least 4-h fasting, were retrospectively analyzed. In the clinical follow-up, this high plasma glucose was confirmed as chronic hyperglycemia derived from uncontrolled diabetes (n=32) and untreated diabetes (n=25). Based on the final diagnosis of malignancy obtained by histopathology or clinical follow-up for at least 6 months, the diagnostic performance of visual PET analysis was evaluated. Excluding nine scans of nine patients without sufficient follow-up, final diagnosis was obtained in 48 scans of 45 patients. In 36 scans of 36 patients, at least one malignant lesion was finally confirmed, and true-positive and false-negative results were obtained in 30 and six cases, respectively. Six cases showed false-negative results due to low FDG-avid pathological characteristics (hepatocellular carcinoma, etc.), chemotherapeutic effect or small tumor size. Overall, the patient-based sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy were 83, 83, 94, 63 and 83%, respectively. In lesion-based diagnosis, 56 of 75 lesions (74%) were depicted by PET, while 19 lesions were negative on PET, also due to low FDG-avid characteristics or small size (less than 15 mm). At the time of chronic hyperglycemia (not acute hyperglycemia), the adverse effect caused by high plasma glucose level was minimum. The FDG uptake of the tumor maintained a sufficiently high level for visual clinical diagnosis in most cases, except in the cases of low FDG-avid tumors or small lesions (15 mm in size). (author)

Cavernous hemangioma presenting marked hyperostosis

International Nuclear Information System (INIS)

Kobata, Hitoshi; Miyake, Hiroji; Kitamura, Junji; Kajikawa, Hiroshi; Ohta, Tomio

1988-01-01

The authors report here a case of hemangioma of the left parietal bone which presented headache and papilledema. This patient is a 37-year-old female who had, prior to admission, complained of increasing headache for one year and blurred vision for three months. She had no history of head injury. Local physical examinations revealed a slight bulging in her left parietal region which was insensitive to palpation and not adherent to the overlying scalp. Neurological examinations revealed bilateral papilledema and an incongruous bitemporal upper quadrant defect in the visual field. All the other neurological and laboratory data were normal. A plain skull roentogenogram showed a 9 x 9 cm osteolytic and characteristic honeycomb lesion in the parietal region. Systemic bone survey revealed a similar lesion in the right tibia which was not histologically examined. A marked accumulation of isotopes was detected on the bone scintigrams at both lesions. Selective external carotid angiograms demonstrated a tumor stain fed by the superficial temporal, occipital, and middle meningial arteries. CT scans of the brain and skull clearly showed a local thickening of and structural changes in the skull bone and also a mass effect on the brain and lateral ventricle. The lesioned bone was removed en bloc and replaced by an artificial bone. It was highly vascular, but not adherent to the overlying dura. The post-operative course was uneventful, and the headache and papilledema disappeared. Hemangioma of the skull presenting marked hyperostosis, as reported above, seems to be rare. In addition, in this case, skeletal angioma without any clinical manifestation was detected. Clinical and radiological pictures of the hemangioma of the skull and other bones were briefly discussed. (author)

Social Impacts of the Marking Scheme in Public Housing in Hong Kong

Science.gov (United States)

Yau, Yung

2012-01-01

To improve environmental hygiene in public housing estates in Hong Kong, the Housing Department launched the Marking Scheme for Tenancy Enforcement in Public Housing Estates in 2003. The marking scheme operates as a penalty-point system where sitting tenants will be expelled from their public housing units if they receive penalty points up to a…

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.

Learning to mark: a qualitative study of the experiences and concerns of medical markers

Directory of Open Access Journals (Sweden)

Cannings-John Rebecca

2006-04-01

Full Text Available Abstract Background Although there is published research on the methods markers use in marking various types of assessment, there is relatively little information on the processes markers use in approaching a marking exercise. This qualitative paper describes the preparation and experiences of general practice (GP teachers who undertake marking a written assessment in an undergraduate medical course. Methods Semi-structured interviews were conducted with seven of the 16 GP tutors on an undergraduate course. The purposive sample comprised two new markers, two who had marked for a couple of years and three experienced markers. Each respondent was interviewed twice, once following a formative assessment of a written case study, and again after a summative assessment. All interviews were audio-taped and analysed for emerging themes. A respondent validation exercise was conducted with all 16 GP tutors. Results Markers had internal concerns about their ability to mark fairly and made considerable efforts to calibrate their marking. They needed guidance and coaching when marking for the first time and adopted a variety of marking styles, reaching a decision through a number of routes. Dealing with pass/fail borderline scripts and the consequences of the mark on the student were particular concerns. Even experienced markers felt the need to calibrate their marks both internally and externally Conclusion Previous experience of marking appears to improve markers' confidence and is a factor in determining the role which markers adopt. Confidence can be improved by giving clear instructions, along with examples of marking. The authors propose that one method of providing this support and coaching could be by a process of peer review of a selection of papers prior to the main marking. New markers in particular would benefit from further guidance, however they are influenced by others early on in their marking career and course organisers should be mindful of

Designing a Clinical Data Warehouse Architecture to Support Quality Improvement Initiatives.

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Chelico, John D; Wilcox, Adam B; Vawdrey, David K; Kuperman, Gilad J

2016-01-01

Clinical data warehouses, initially directed towards clinical research or financial analyses, are evolving to support quality improvement efforts, and must now address the quality improvement life cycle. In addition, data that are needed for quality improvement often do not reside in a single database, requiring easier methods to query data across multiple disparate sources. We created a virtual data warehouse at NewYork Presbyterian Hospital that allowed us to bring together data from several source systems throughout the organization. We also created a framework to match the maturity of a data request in the quality improvement life cycle to proper tools needed for each request. As projects progress in the Define, Measure, Analyze, Improve, Control stages of quality improvement, there is a proper matching of resources the data needs at each step. We describe the analysis and design creating a robust model for applying clinical data warehousing to quality improvement.

Lujan Mark-4

Energy Technology Data Exchange (ETDEWEB)

Mocko, Michael Jeffrey [Los Alamos National Lab. (LANL), Los Alamos, NM (United States); Zavorka, Lukas [Los Alamos National Lab. (LANL), Los Alamos, NM (United States); Koehler, Paul E. [Los Alamos National Lab. (LANL), Los Alamos, NM (United States)

2017-11-13

This is a review of Mark-IV target neutronics design. It involved the major redesign of the upper tier, offering harder neutron spectra for upper-tier FPs; a redesign of the high-resolution (HR) moderator; and a preservation of the rest of Mark-III features.

TIAM1 variants improve clinical outcome in neuroblastoma.

Science.gov (United States)

Sanmartín, Elena; Yáñez, Yania; Fornés-Ferrer, Victoria; Zugaza, José L; Cañete, Adela; Castel, Victoria; Font de Mora, Jaime

2017-07-11

Identification of tumor driver mutations is crucial for improving clinical outcome using a personalized approach to the treatment of cancer. Neuroblastoma is a tumor of the peripheral sympathetic nervous system for which only a few driver alterations have been described including MYCN amplification and ALK mutations. We assessed 106 primary neuroblastoma tumors by next generation sequencing using a customized amplicon-based gene panel. Our results reveal that genetic variants in TIAM1 gene associate with better clinical outcome, suggesting a role for these TIAM1 variants in preventing progression of this disease. The detected variants are located within the different domains of TIAM1 that signal to the upstream regulator RAS and downstream effector molecules MYC and RAC, which are all implicated in neuroblastoma etiology and progression. Clinical outcome was improved in tumors where a TIAM1 variant was present concomitantly with either ALK mutation or MYCN amplification. Given the function of these signaling molecules in cell survival, proliferation, differentiation and neurite outgrowth, our data suggest that the TIAM1-mediated network is essential to neuroblastoma and thus, inhibiting TIAM1 reflects a rational strategy for improving therapy efficacy in neuroblastoma.

Minimal Marking: A Success Story

Science.gov (United States)

McNeilly, Anne

2014-01-01

The minimal-marking project conducted in Ryerson's School of Journalism throughout 2012 and early 2013 resulted in significantly higher grammar scores in two first-year classes of minimally marked university students when compared to two traditionally marked classes. The "minimal-marking" concept (Haswell, 1983), which requires…

Processes for Quality Improvements in Radiation Oncology Clinical Trials

International Nuclear Information System (INIS)

FitzGerald, T.J.; Urie, Marcia; Ulin, Kenneth; Laurie, Fran; Yorty, Jeffrey C.; Hanusik, Richard; Kessel, Sandy; Jodoin, Maryann Bishop; Osagie, Gani; Cicchetti, M. Giulia; Pieters, Richard; McCarten, Kathleen; Rosen, Nancy

2008-01-01

Quality assurance in radiotherapy (RT) has been an integral aspect of cooperative group clinical trials since 1970. In early clinical trials, data acquisition was nonuniform and inconsistent and computational models for radiation dose calculation varied significantly. Process improvements developed for data acquisition, credentialing, and data management have provided the necessary infrastructure for uniform data. With continued improvement in the technology and delivery of RT, evaluation processes for target definition, RT planning, and execution undergo constant review. As we move to multimodality image-based definitions of target volumes for protocols, future clinical trials will require near real-time image analysis and feedback to field investigators. The ability of quality assurance centers to meet these real-time challenges with robust electronic interaction platforms for imaging acquisition, review, archiving, and quantitative review of volumetric RT plans will be the primary challenge for future successful clinical trials

Image-guided system versus manual marking for toric intraocular lens alignment in cataract surgery

NARCIS (Netherlands)

Webers, V.S.C.; Bauer, N.J.C.; Visser, N.; Berendschot, T.T.J.M.; van den Biggelaar, F.J.H.M.; Nuijts, R.M.M.A.

2017-01-01

Purpose To compare the accuracy of toric intraocular lens (IOL) alignment using the Verion Image-Guided System versus a conventional manual ink-marking procedure. Setting University Eye Clinic Maastricht, Maastricht, the Netherlands. Design Prospective randomized clinical trial. Methods Eyes with

Using Relational Reasoning Strategies to Help Improve Clinical Reasoning Practice.

Science.gov (United States)

Dumas, Denis; Torre, Dario M; Durning, Steven J

2018-05-01

Clinical reasoning-the steps up to and including establishing a diagnosis and/or therapy-is a fundamentally important mental process for physicians. Unfortunately, mounting evidence suggests that errors in clinical reasoning lead to substantial problems for medical professionals and patients alike, including suboptimal care, malpractice claims, and rising health care costs. For this reason, cognitive strategies by which clinical reasoning may be improved-and that many expert clinicians are already using-are highly relevant for all medical professionals, educators, and learners.In this Perspective, the authors introduce one group of cognitive strategies-termed relational reasoning strategies-that have been empirically shown, through limited educational and psychological research, to improve the accuracy of learners' reasoning both within and outside of the medical disciplines. The authors contend that relational reasoning strategies may help clinicians to be metacognitive about their own clinical reasoning; such strategies may also be particularly well suited for explicitly organizing clinical reasoning instruction for learners. Because the particular curricular efforts that may improve the relational reasoning of medical students are not known at this point, the authors describe the nature of previous research on relational reasoning strategies to encourage the future design, implementation, and evaluation of instructional interventions for relational reasoning within the medical education literature. The authors also call for continued research on using relational reasoning strategies and their role in clinical practice and medical education, with the long-term goal of improving diagnostic accuracy.

Redesigning a clinical mentoring program for improved outcomes in the clinical training of clerks

OpenAIRE

Lin, Chia-Der; Lin, Blossom Yen-Ju; Lin, Cheng-Chieh; Lee, Cheng-Chun

2015-01-01

Introduction: Mentorship has been noted as critical to medical students adapting to clinical training in the medical workplace. A lack of infrastructure in a mentoring program might deter relationship building between mentors and mentees. This study assessed the effect of a redesigned clinical mentoring program from the perspective of clerks. The objective was to assess the benefits of the redesigned program and identify potential improvements.Methods: A redesigned clinical mentoring program ...

Mark Stock | NREL

Science.gov (United States)

Stock Mark Stock Scientific Visualization Specialist Mark.Stock@nrel.gov | 303-275-4174 Dr. Stock , virtual reality, parallel computing, and manipulation of large spatial data sets. As an artist, he creates . Stock built the SUNLIGHT artwork that is installed on the Webb Building in downtown Denver. In addition

Improving the accuracy of self-assessment of practical clinical skills using video feedback--the importance of including benchmarks.

Science.gov (United States)

Hawkins, S C; Osborne, A; Schofield, S J; Pournaras, D J; Chester, J F

2012-01-01

Isolated video recording has not been demonstrated to improve self-assessment accuracy. This study examines if the inclusion of a defined standard benchmark performance in association with video feedback of a student's own performance improves the accuracy of student self-assessment of clinical skills. Final year medical students were video recorded performing a standardised suturing task in a simulated environment. After the exercise, the students self-assessed their performance using global rating scales (GRSs). An identical self-assessment process was repeated following video review of their performance. Students were then shown a video-recorded 'benchmark performance', which was specifically developed for the study. This demonstrated the competency levels required to score full marks (30 points). A further self-assessment task was then completed. Students' scores were correlated against expert assessor scores. A total of 31 final year medical students participated. Student self-assessment scores before video feedback demonstrated moderate positive correlation with expert assessor scores (r = 0.48, p benchmark performance demonstration, self-assessment scores demonstrated a very strong positive correlation with expert scores (r = 0.83, p benchmark performance in combination with video feedback may significantly improve the accuracy of students' self-assessments.

Twenty years of Triga Mark I reactor use

International Nuclear Information System (INIS)

Stasiulevicius, R.; Maretti Junior, F.

1981-01-01

This work is a report on the 20 years of activities of the Triga Mark I, research reactor located in Belo Horizonte, Brazil. It contains also a list of publications, details of operation and improvements introduced in the reactor as well as some perspectives for its future. (A.C.A.S.)

Characteristics of Volunteer Coaches in a Clinical Process Improvement Program.

Science.gov (United States)

Morley, Katharine E; Barysauskas, Constance M; Carballo, Victoria; Kalibatas, Orinta; Rao, Sandhya K; Jacobson, Joseph O; Cummings, Brian M

The Partners Clinical Process Improvement Leadership Program provides quality improvement training for clinicians and administrators, utilizing graduates as volunteer peer coaches for mentorship. We sought to understand the factors associated with volunteer coach participation and gain insight into how to improve and sustain this program. Review of coach characteristics from course database and survey of frequent coaches. Out of 516 Partners Clinical Process Improvement Leadership Program graduates from March 2010 to June 2015, 117 (23%) individuals volunteered as coaches. Sixty-one (52%) individuals coached once, 31 (27%) coached twice, and 25 (21%) coached 3 or more times. There were statistically significant associations between coaching and occupation (P = .005), Partners Clinical Process Improvement Leadership Program course taken (P = .001), and course location (P = .007). Administrators were more likely to coach than physicians (odds ratio: 1.75, P = .04). Reasons for volunteering as a coach included further development of skills, desire to stay involved with program, and enjoying mentoring. Reasons for repeated coaching included maintaining quality improvement skills, expanding skills to a wider variety of projects, and networking. A peer graduate volunteer coach model is a viable strategy for interprofessional quality improvement mentorship. Strategies that support repeat coaching and engage clinicians should be promoted to ensure an experienced and diversified group of coaches.

CT in normal pressure hydrocephalus. Correlation between CT and clinical response to shunting

Energy Technology Data Exchange (ETDEWEB)

Fujita, K.; Nogaki, H.; Noda, M.; Kusunoki, T.; Tamaki, N. (Kobe Univ. (Japan). School of Medicine)

1981-02-01

CT scans were obtained on 33 patients (age 73y. to 31y.) with the diagnosis of normal pressure hydrocephalus. In each case, the diagnosis was made on the basis of the symptoms, CT and cisternographic findings. Underlying diseases of normal pressure hydrocephalus are ruptured aneurysms (21 cases), arteriovenous malformations (2 cases), head trauma (1 case), cerebrovascular accidents (1 case) and idiopathie (8 cases). Sixteen of 33 patients showed marked improvement, five, moderate or minimal improvement, and twelve, no change. The results were compared with CT findings and clinical response to shunting. CT findings were classified into five types, bases on the degree of periventricular hypodensity (P.V.H.), the extent of brain damage by underlying diseases, and the degree of cortical atrophy. In 17 cases of type (I), CT shows the presence of P.V.H. with or without minimal frontal lobe damage and no cortical atrophy. The good surgical improvements were achieved in all cases of type (I) by shunting. In 4 cases of type (II), CT shows the presence of P.V.H. and severe brain damage without cortical atrophy. The fair clinical improvements were achieved in 2 cases (50%) by shunting. In one case of type (III), CT shows the absence of P.V.H. without brain damage nor cortical atrophy. No clinical improvement was obtained by shunting in this type. In 9 cases of type (IV) with mild cortical atrophy, the fair clinical improvement was achieved in two cases (22%) and no improvement in 7 cases. In 2 cases of type (V) with moderate or marked cortical atrophy, no clinical improvement was obtained by shunting. In conclusion, it appeared from the present study that there was a good correlation between the result of shunting and the type of CT, and clinical response to shunting operation might be predicted by classification of CT findings.

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

Science.gov (United States)

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

2013-12-01

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

User-centered design to improve clinical decision support in primary care.

Science.gov (United States)

Brunner, Julian; Chuang, Emmeline; Goldzweig, Caroline; Cain, Cindy L; Sugar, Catherine; Yano, Elizabeth M

2017-08-01

A growing literature has demonstrated the ability of user-centered design to make clinical decision support systems more effective and easier to use. However, studies of user-centered design have rarely examined more than a handful of sites at a time, and have frequently neglected the implementation climate and organizational resources that influence clinical decision support. The inclusion of such factors was identified by a systematic review as "the most important improvement that can be made in health IT evaluations." (1) Identify the prevalence of four user-centered design practices at United States Veterans Affairs (VA) primary care clinics and assess the perceived utility of clinical decision support at those clinics; (2) Evaluate the association between those user-centered design practices and the perceived utility of clinical decision support. We analyzed clinic-level survey data collected in 2006-2007 from 170 VA primary care clinics. We examined four user-centered design practices: 1) pilot testing, 2) provider satisfaction assessment, 3) formal usability assessment, and 4) analysis of impact on performance improvement. We used a regression model to evaluate the association between user-centered design practices and the perceived utility of clinical decision support, while accounting for other important factors at those clinics, including implementation climate, available resources, and structural characteristics. We also examined associations separately at community-based clinics and at hospital-based clinics. User-centered design practices for clinical decision support varied across clinics: 74% conducted pilot testing, 62% conducted provider satisfaction assessment, 36% conducted a formal usability assessment, and 79% conducted an analysis of impact on performance improvement. Overall perceived utility of clinical decision support was high, with a mean rating of 4.17 (±.67) out of 5 on a composite measure. "Analysis of impact on performance

Redesigning a clinical mentoring program for improved outcomes in the clinical training of clerks

Directory of Open Access Journals (Sweden)

Chia-Der Lin

2015-09-01

Full Text Available Introduction: Mentorship has been noted as critical to medical students adapting to clinical training in the medical workplace. A lack of infrastructure in a mentoring program might deter relationship building between mentors and mentees. This study assessed the effect of a redesigned clinical mentoring program from the perspective of clerks. The objective was to assess the benefits of the redesigned program and identify potential improvements. Methods: A redesigned clinical mentoring program was launched in a medical center according to previous theoretical and practical studies on clinical training workplaces, including the elements of mentor qualifications, positive and active enhancers for mentor–mentee relationship building, the timing of mentoring performance evaluation, and financial and professional incentives. A four-wave web survey was conducted, comprising one evaluation of the former mentoring program and three evaluations of the redesigned clinical mentoring program. Sixty-four fifth-year medical students in clerkships who responded to the first wave and to at least two of the three following waves were included in the study. A structured and validated questionnaire encompassing 15 items on mentor performance and the personal characteristics of the clerks was used. Mixed linear models were developed for repeated measurements and to adjust for personal characteristics. Results: The results revealed that the redesigned mentoring program improved the mentors’ performance over time for most evaluated items regarding professional development and personal support provided to the mentees. Conclusions: Our findings serve as an improved framework for the role of the institution and demonstrate how institutional policies, programs, and structures can shape a clinical mentoring program. We recommend the adoption of mentorship schemes for other cohorts of medical students and for different learning and training stages involved in becoming a

Redesigning a clinical mentoring program for improved outcomes in the clinical training of clerks

Science.gov (United States)

Lin, Chia-Der; Lin, Blossom Yen-Ju; Lin, Cheng-Chieh; Lee, Cheng-Chun

2015-01-01

Introduction Mentorship has been noted as critical to medical students adapting to clinical training in the medical workplace. A lack of infrastructure in a mentoring program might deter relationship building between mentors and mentees. This study assessed the effect of a redesigned clinical mentoring program from the perspective of clerks. The objective was to assess the benefits of the redesigned program and identify potential improvements. Methods A redesigned clinical mentoring program was launched in a medical center according to previous theoretical and practical studies on clinical training workplaces, including the elements of mentor qualifications, positive and active enhancers for mentor–mentee relationship building, the timing of mentoring performance evaluation, and financial and professional incentives. A four-wave web survey was conducted, comprising one evaluation of the former mentoring program and three evaluations of the redesigned clinical mentoring program. Sixty-four fifth-year medical students in clerkships who responded to the first wave and to at least two of the three following waves were included in the study. A structured and validated questionnaire encompassing 15 items on mentor performance and the personal characteristics of the clerks was used. Mixed linear models were developed for repeated measurements and to adjust for personal characteristics. Results The results revealed that the redesigned mentoring program improved the mentors’ performance over time for most evaluated items regarding professional development and personal support provided to the mentees. Conclusions Our findings serve as an improved framework for the role of the institution and demonstrate how institutional policies, programs, and structures can shape a clinical mentoring program. We recommend the adoption of mentorship schemes for other cohorts of medical students and for different learning and training stages involved in becoming a physician. PMID

Surgical Process Improvement: Impact of a Standardized Care Model With Electronic Decision Support to Improve Compliance With SCIP Inf-9.

Science.gov (United States)

Cook, David J; Thompson, Jeffrey E; Suri, Rakesh; Prinsen, Sharon K

2014-01-01

The absence of standardization in surgical care process, exemplified in a "solution shop" model, can lead to unwarranted variation, increased cost, and reduced quality. A comprehensive effort was undertaken to improve quality of care around indwelling bladder catheter use following surgery by creating a "focused factory" model within the cardiac surgical practice. Baseline compliance with Surgical Care Improvement Inf-9, removal of urinary catheter by the end of surgical postoperative day 2, was determined. Comparison of baseline data to postintervention results showed clinically important reductions in the duration of indwelling bladder catheters as well as marked reduction in practice variation. Following the intervention, Surgical Care Improvement Inf-9 guidelines were met in 97% of patients. Although clinical quality improvement was notable, the process to accomplish this-identification of patients suitable for standardized pathways, protocol application, and electronic systems to support the standardized practice model-has potentially greater relevance than the specific clinical results. © 2013 by the American College of Medical Quality.

FDA, CE mark or something else?-Thinking fast and slow.

Science.gov (United States)

Mishra, Sundeep

There is a robust debate going on among the Medical Device stake-holders whether FDA is better or CE mark or something else. Currently process of obtaining an FDA approval is bogged down by ever-increasing unpredictability, inconsistency, prolonged time, and huge expense but CE mark has its own problems. Historically, the Japanese review process has tended to be the slowest among the big three but recently with the introduction of accelerated review process there has been a significant progress. While the goal of an innovator/manufacturer is to develop, manufacture and market a medical device that addresses an unmet clinical need, the requisite regulatory approval process can be very confusing. Not only there is a whole lot of jargon tossed around by regulatory affair professionals: "substantial equivalence," "PMDA," "CE mark," "Notified body," "510K" and "PMA" but the actual approval process can also be very tardy, inconsistent and expensive. Copyright © 2016 Cardiological Society of India. Published by Elsevier B.V. All rights reserved.

Laser marking as a result of applying reverse engineering

Science.gov (United States)

Mihalache, Andrei; Nagîţ, Gheorghe; Rîpanu, Marius Ionuţ; Slǎtineanu, Laurenţiu; Dodun, Oana; Coteaţǎ, Margareta

2018-05-01

The elaboration of a modern manufacturing technology needs a certain quantum of information concerning the part to be obtained. When it is necessary to elaborate the technology for an existing object, such an information could be ensured by using the principles specific to the reverse engineering. Essentially, in the case of this method, the analysis of the surfaces and of other characteristics of the part must offer enough information for the elaboration of the part manufacturing technology. On the other hand, it is known that the laser marking is a processing method able to ensure the transfer of various inscriptions or drawings on a part. Sometimes, the laser marking could be based on the analysis of an existing object, whose image could be used to generate the same object or an improved object. There are many groups of factors able to affect the results of applying the laser marking process. A theoretical analysis was proposed to show that the heights of triangles obtained by means of a CNC marking equipment depend on the width of the line generated by the laser spot on the workpiece surface. An experimental research was thought and materialized to highlight the influence exerted by the line with and the angle of lines intersections on the accuracy of the marking process. By mathematical processing of the experimental results, empirical mathematical models were determined. The power type model and the graphical representation elaborated on the base of this model offered an image concerning the influences exerted by the considered input factors on the marking process accuracy.

A case of temporal lobe epilepsy with improvement of clinical symptoms and single photon emission computed tomography findings after treatment with clonazepam.

Science.gov (United States)

Ide, M; Mizukami, K; Suzuki, T; Shiraishi, H

2000-10-01

A 26-year-old female presented psychomotor seizures, deja vu and amnestic syndrome after meningitis at the age of 14 years. Repeated electroencephalograms (EEG) demonstrated occasional spikes localized in the right temporal region in addition to a considerable amount of theta waves mainly in the right fronto-temporal region. Single photon emission computed tomography (SPECT) showed a marked hypoperfusion corresponding to the region in which the EEG showed abnormal findings, although magnetic resonance imaging (MRI) demonstrated no abnormal findings associated with the clinical features. Treatment with clonazepam in addition to sodium valproate resulted in a remarkable improvement of clinical symptoms (i.e. psychomotor seizures and deja vu), as well as of the EEG and SPECT findings. The present study suggests that SPECT is a useful method not only to determine the localization of regions associated with temporal lobe epilepsy but also to evaluate the effect of treatment in temporal lobe epilepsy.

Instructional scaffolding to improve students' skills in evaluating clinical literature.

Science.gov (United States)

Dawn, Stefani; Dominguez, Karen D; Troutman, William G; Bond, Rucha; Cone, Catherine

2011-05-10

To implement and assess the effectiveness of an activity to teach pharmacy students to critically evaluate clinical literature using instructional scaffolding and a Clinical Trial Evaluation Rubric. The literature evaluation activity centered on a single clinical research article and involved individual, small group, and large group instruction, with carefully structured, evidence-based scaffolds and support materials centered around 3 educational themes: (1) the reader's awareness of text organization, (2) contextual/background information and vocabulary, and (3) questioning, prompting, and self-monitoring (metacognition). Students initially read the article, scored it using the rubric, and wrote an evaluation. Students then worked individually using a worksheet to identify and define 4 to 5 vocabulary/concept knowledge gaps. They then worked in small groups and as a class to further improve their skills. Finally, they assessed the same article using the rubric and writing a second evaluation. Students' rubric scores for the article decreased significantly from a mean pre-activity score of 76.7% to a post-activity score of 61.7%, indicating that their skills in identifying weaknesses in the article's study design had improved. Use of instructional scaffolding in the form of vocabulary supports and the Clinical Trial Evaluation Rubric improved students' ability to critically evaluate a clinical study compared to lecture-based coursework alone.

Computer aided design (CAD) for electronics improvement of the nuclear channels of TRIGA Mark III reactor of the ININ

International Nuclear Information System (INIS)

Gonzalez M, J.L.; Rivero G, T.; Aguilar H, F.

2007-01-01

The 4 neutron measurement channels of the digital control console (CCD) of the TRIGA Mark III reactor (RTMIII) of the ININ, its were designed and built with the corresponding Quality Guarantee program, being achieved the one licensing to replace the old console. With the time they were carried out some changes to improve and to not solve some problems detected in the tests, verification and validation, requiring to modify the circuits originally designed. In this work the corrective actions carried out to eliminate the Non Conformity generated by these problems, being mentioned the advantages of using modern tools, as the software applied to the Attended Engineering by Computer, and those obtained results are presented. (Author)

Energy risk management through self-exciting marked point process

International Nuclear Information System (INIS)

Herrera, Rodrigo

2013-01-01

Crude oil is a dynamically traded commodity that affects many economies. We propose a collection of marked self-exciting point processes with dependent arrival rates for extreme events in oil markets and related risk measures. The models treat the time among extreme events in oil markets as a stochastic process. The main advantage of this approach is its capability to capture the short, medium and long-term behavior of extremes without involving an arbitrary stochastic volatility model or a prefiltration of the data, as is common in extreme value theory applications. We make use of the proposed model in order to obtain an improved estimate for the Value at Risk in oil markets. Empirical findings suggest that the reliability and stability of Value at Risk estimates improve as a result of finer modeling approach. This is supported by an empirical application in the representative West Texas Intermediate (WTI) and Brent crude oil markets. - Highlights: • We propose marked self-exciting point processes for extreme events in oil markets. • This approach captures the short and long-term behavior of extremes. • We improve the estimates for the VaR in the WTI and Brent crude oil markets

Measuring performance improvement: total organizational commitment or clinical specialization.

Science.gov (United States)

Caron, Aleece; Jones, Paul; Neuhauser, Duncan; Aron, David C

2004-01-01

Resources for hospitals are limited when they are faced with multiple publicly reported performance measures as tools to assess quality. The leadership in these organizations may choose to focus on 1 or 2 of these outcomes. An alternative approach is that the leadership may commit resources or create conditions that result in improved quality over a broad range of measures. We used aggregated data on mortality, length of stay, and obstetrical outcomes from Greater Cleveland Health Quality Choice data to test these theories. We used Pearson correlation analysis to determine of outcomes were correlated with one another. We used repeated-measures ANOVA to determine if an association existed between outcome and time and outcome and hospital. All of the outcomes across all hospitals demonstrate a trend of overall improvement. Both the Pearson and ANOVA result support the hypothesis for the organization-wide approach to quality improvement. Hospital that make improvements in one clinical area trend to make improvements in others. Hospitals that produce improvements in limited clinical or administrative areas may not have completely adopted CQI into their culture or may not have yet realized the benefits of their organizational commitments, but use some of the concepts to improve quality outcomes.

Influences of Phonological Context on Tense Marking in Spanish–English Dual Language Learners

Science.gov (United States)

Barlow, Jessica A.; Potapova, Irina; Pruitt-Lord, Sonja

2017-01-01

Purpose The emergence of tense-morpheme marking during language acquisition is highly variable, which confounds the use of tense marking as a diagnostic indicator of language impairment in linguistically diverse populations. In this study, we seek to better understand tense-marking patterns in young bilingual children by comparing phonological influences on marking of 2 word-final tense morphemes. Method In spontaneous connected speech samples from 10 Spanish–English dual language learners aged 56–66 months (M = 61.7, SD = 3.4), we examined marking rates of past tense -ed and third person singular -s morphemes in different environments, using multiple measures of phonological context. Results Both morphemes were found to exhibit notably contrastive marking patterns in some contexts. Each was most sensitive to a different combination of phonological influences in the verb stem and the following word. Conclusions These findings extend existing evidence from monolingual speakers for the influence of word-final phonological context on morpheme production to a bilingual population. Further, novel findings not yet attested in previous research support an expanded consideration of phonological context in clinical decision making and future research related to word-final morphology. PMID:28750415

Alcoholic Hepatitis Markedly Decreases the Capacity for Urea Synthesis.

Directory of Open Access Journals (Sweden)

Emilie Glavind

Full Text Available Data on quantitative metabolic liver functions in the life-threatening disease alcoholic hepatitis are scarce. Urea synthesis is an essential metabolic liver function that plays a key regulatory role in nitrogen homeostasis. The urea synthesis capacity decreases in patients with compromised liver function, whereas it increases in patients with inflammation. Alcoholic hepatitis involves both mechanisms, but how these opposite effects are balanced remains unclear. Our aim was to investigate how alcoholic hepatitis affects the capacity for urea synthesis. We related these findings to another measure of metabolic liver function, the galactose elimination capacity (GEC, as well as to clinical disease severity.We included 20 patients with alcoholic hepatitis and 7 healthy controls. The urea synthesis capacity was quantified by the functional hepatic nitrogen clearance (FHNC, i.e., the slope of the linear relationship between the blood α-amino nitrogen concentration and urea nitrogen synthesis rate during alanine infusion. The GEC was determined using blood concentration decay curves after intravenous bolus injection of galactose. Clinical disease severity was assessed by the Glasgow Alcoholic Hepatitis Score and Model for End-Stage Liver Disease (MELD score.The FHNC was markedly decreased in the alcoholic hepatitis patients compared with the healthy controls (7.2±4.9 L/h vs. 37.4±6.8 L/h, P<0.01, and the largest decrease was observed in those with severe alcoholic hepatitis (4.9±3.6 L/h vs. 9.9±4.9 L/h, P<0.05. The GEC was less markedly reduced than the FHNC. A negative correlation was detected between the FHNC and MELD score (rho = -0.49, P<0.05.Alcoholic hepatitis markedly decreases the urea synthesis capacity. This decrease is associated with an increase in clinical disease severity. Thus, the metabolic failure in alcoholic hepatitis prevails such that the liver cannot adequately perform the metabolic up-regulation observed in other stressful

Improving Patient Satisfaction in a Midsize Pediatric Hematology-Oncology Outpatient Clinic.

Science.gov (United States)

Fustino, Nicholas J; Kochanski, Justin J

2015-09-01

The study of patient satisfaction is a rapidly emerging area of importance within health care. High levels of patient satisfaction are associated with exceptional physician-patient communication, superior patient compliance, reduced risk of medical malpractice, and economic benefit in the value-based purchasing era. To our knowledge, no previous reports have evaluated methods to improve the patient experience within the pediatric hematology-oncology (PHO) outpatient clinic. Patient satisfaction was measured using returned Press-Ganey surveys at Blank Children's Hospital PHO outpatient clinic (UnityPoint Health). The aim of this study was to raise the overall patient satisfaction score to the 75th percentile and raise the care provider score (CP) to the 90th percentile nationally. After analyzing data from 2013, interventions were implemented in January 2014, including weekly review of returned surveys, review of goals and progress at monthly staff meetings, distribution of written materials addressing deficiencies, score transparency among providers, provider use of Web-based patient satisfaction training modules, devotion of additional efforts to address less satisfied demographics (new patient consultations), and more liberal use of service recovery techniques. In the PHO outpatient clinic, overall patient satisfaction improved from the 56th to 97th percentile. Care provider scores improved from the 70th to 99 th percentile. For new patients, overall satisfaction improved from the 27th to 92 nd percentile, and care provider scores improved from the 29th to 98 th percentile. Patient satisfaction was improved in a midsize PHO clinic by implementing provider- and staff-driven initiatives. A combination of minor behavioral changes among care providers and staff in conjunction with systems-related modifications drove improvement. Copyright © 2015 by American Society of Clinical Oncology.

Satisfaction and improvement of clinical experiment of student radiotechnologists

International Nuclear Information System (INIS)

Lyu, Kwang Yeul; Kim, Hyun Soo

2006-01-01

Clinical experiment is a set of experience to help student acquire technic, attitude and knowledge by participating in the clinical work. The radiotechnologists who are employed in departments of radiology serve as clinical instructors. Their responsibilities include teaching students them to become competent radiotechnologist. Clinical instructors often have no formal preparation in teaching student. The purpose of this study is to review some principals that will help clinical instructors support and foster the professional development of student radiotechnologists. The clinical instructor should be able to identify the qualities of instructor, the characteristics of feedback and use facilitation skills when is evaluated student performance. And the survey was performed to evaluate the satisfaction of student participated in clinical experiment, the purpose of this research is to fine the problems and improvements in clinical experiment of student radiotechnologist in Korea

The Mark II detector for the SLC

International Nuclear Information System (INIS)

Abrams, G.; Baden, A.R.; Boyer, J.; Butler, F.; Drell, P.S.; Fay, J.; Gidal, G.; Goldhaber, G.; Haggerty, J.; Harr, R.; Hearty, C.; Herrup, D.; Holmgren, S.O.; Jaffre, M.; Juricic, I.; Kadyk, J.A.; Kral, J.F.; Levi, M.E.; Lynch, G.R.; Richman, J.D.; Rouse, F.R.; Schaad, M.W.; Schmidke, W.B.; Schumm, B.A.; Trilling, G.H.; Wood, D.R.; Akerlof, C.; Bonvicini, G.; Chapman, J.; Chmeissani, M.; Frey, R.; Gero, E.; Hong, S.J.; Koska, W.; Nitz, D.; Petradza, M.; Thun, R.; Tschirhart, R.; Veltman, H.; Alexander, J.P.; Ballam, J.; Barklow, T.; Bartelt, J.; De Boer, W.; Boyarski, A.; Braune, K.; Bulos, F.; Burke, D.L.; Cords, D.; Coupal, D.P.; Destaebler, H.C.; Dorfan, J.M.; Feldman, G.J.; Fernandes, D.; Field, R.C.; Fordham, C.; Fujino, D.; Gan, K.K.; Glanzman, T.; Grosse-Wiesmann, P.; Hanson, G.; Hayes, K.; Himel, T.; Hutchinson, D.; Innes, W.R.; Jacobsen, R.G.; Jaros, J.A.; Jung, C.K.; Karlen, D.; Klein, S.R.; Koetke, D.; Komamiya, M.; Kowalski, L.A.; Kozanecki, W.; Lankford, A.J.; Larsen, R.R.; Lueth, V.; Mattison, T.; Moffeit, K.C.; Mueller, L.; Munger, C.T.; Nash, J.; Ong, R.A.; O'Shaughnessy, K.F.; Perl, J.; Perl, M.L.; Perrier, F.; Petersen, A.; Pitthan, R.; Riles, K.; Swartz, M.; Taylor, R.E.; Van Kooten, R.; Voruganti, P.; Weigend, A.; Woods, M.; Wormser, G.; Wright, R.; Alvarez, M.; Calvino, F.; Fernandez, E.; Ford, W.T.; Hinshaw, D.A.; Rankin, P.; Smith, J.G.; Wagner, S.R.; Weber, P.; White, S.L.; Averill, D.; Blockus, D.; Brabson, B.; Brom, J.M.; Murray, W.N.; Ogren, H.; Rust, D.R.; Snyder, A.; Yurko, M.; Barish, B.C.; Hawkes, C.M.; Hoenk, M.; Kuhlen, M.; Li, Z.; McKenna, J.A.; Milliken, B.D.; Nelson, M.E.; Peck, C.; Porter, F.C.; Soderstrom, E.; Stroynowski, R.; Weinstein, A.J.; Weir, A.J.; Wicklund, E.; Wolf, R.C.; Wu, D.Y.; Barnett, B.A.; Boswell, C.; Dauncey, P.; Drewer, D.C.; Harral, B.; Hylen, J.; Matthews, J.A.J.; Stoker, D.P.; Vejcik, S.; Breakstone, A.; Cence, R.J.; Gong, X.; Harris, F.A.; Koide, A.; Parker, S.I.; Green, A.; Lawrence Berkeley Lab., CA; California Univ., Berkeley

1989-01-01

The Mark II detector has been upgraded in preparation for its role as the first detector to take data at the Stanford Linear Collider. The new detector components include the central drift chamber, the time-of-flight system, the coil, the endcap electromagnetic calorimeters and the beam energy and luminosity measuring devices. There have also been improvements in detector hermeticity. All of the major components were installed for a test run at the PEP storage ring (√s=29 GeV) in 1985. This paper describes the upgraded detector, including its trigger and data acquisition systems, and gives performance figures for its components. Future improvements are also discussed. (orig.)

Evaluation of portable retroreflectometer for use on pavement marking materials.

Science.gov (United States)

1981-01-01

The subjective rating of the night visibility of pavement marking materials is difficult as it can be influenced by many variables. In an attempt to provide an improved method of determining the night visibility of these materials, a portable retrore...

Clinical performance feedback and quality improvement opportunities for perioperative physicians

Directory of Open Access Journals (Sweden)

Kaye AD

2014-05-01

Full Text Available Alan David Kaye,1 Olutoyin J Okanlawon,2 Richard D Urman21Department of Anesthesiology, Louisiana State University School of Medicine, New Orleans, LA, 2Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston MA, USAAbstract: Clinical performance feedback is an important component of the ongoing development and education of health care practitioners. For physicians, feedback about their clinical practice and outcomes is central to developing both confidence and competence at all stages of their medical careers. Cultural and financial infrastructures need to be in place, and the concept of feedback needs to be readily embraced and encouraged by clinical leadership and other stakeholders. The "buy-in" includes the expectation and view that feedback occurs on a routine basis, and those engaged in the process are both encouraged to participate and held accountable. Feedback must be part of an overarching quality improvement and physician education agenda; it is not meant to be an isolated, fragmented initiative that is typically undermined by lack of resources or systemic barriers to gaining improvement within programs. Effective feedback should be an integral part of clinical practice. Anesthesiologists and other perioperative physicians are identifying specialty-specific indicators that can be used when creating a broader quality improvement agenda. Placing a more immediate formal feedback strategy that focuses on goal-oriented behavior is rapidly becoming a mainstay. Physicians may use their individual feedback reports for reflection and designing personal development plans as lifelong learners and leaders in improving patient care.Keywords: physician education, outcomes measurement, performance improvement, anesthesiology

[Clinical data that are essential for the primary care clinical records: an experience of evaluation and improvement].

Science.gov (United States)

López-Picazo Ferrer, J J; Agulló Roca, F; Villaescusa Pedemonte, M; Cerezo Corbalán, J M

2002-06-30

To evaluate and improve the presence of essential clinical data in the clinical records of a primary care management area (PCMA) by means of an intervention programme. Intervention study without a control, using evaluation and improvement-of-quality methods. We chose 4 criteria from the minimum technical standards: personal history (PH), family background (FB), allergies to medicines (AM) and list of problems (LP). We evaluated overall compliance and compliance per primary care team (PCT) through batch quality acceptance of samples (LQAS), designed an intervention to improve the situation, and then re-evaluated. PCMA of Murcia (45 PCTs). Participants. 42 PCTs (3 were excluded because they had poor coverage in their records). These lasted 12 months (October 1999-October 2000) and involved the following: graphic report per PCT; session with the PCT; discussion on results and strategies in the Area Management Council; and inclusion of an explicit objective, with incentives, in the management contracts. Significant improvement of the four criteria of the PCMA (improvements: FB, 48.1%; PH, 51.1%; AM, 55.4%; LP, 50.9%). LQAS analysis: we rejected 24 batches (14.3%) at the 1st evaluation and 15 (9.0%) at the second, with FB being the criterion most rejected in both instances. Defects appeared in 14 PCT (33.3%; 3 PCT accounted for 41.7%) at the 1st evaluation, and 7 PCT at the re-evaluation (16.7%; 2 reaching 46.7%). The presence of essential clinical data in clinical records has improved. LQAS proved to be a rapid and simple method for evaluating, improving and monitoring quality in primary care.

Improving clinical decision support using data mining techniques

Science.gov (United States)

Burn-Thornton, Kath E.; Thorpe, Simon I.

1999-02-01

Physicians, in their ever-demanding jobs, are looking to decision support systems for aid in clinical diagnosis. However, clinical decision support systems need to be of sufficiently high accuracy that they help, rather than hinder, the physician in his/her diagnosis. Decision support systems with accuracies, of patient state determination, of greater than 80 percent, are generally perceived to be sufficiently accurate to fulfill the role of helping the physician. We have previously shown that data mining techniques have the potential to provide the underpinning technology for clinical decision support systems. In this paper, an extension of the work in reverence 2, we describe how changes in data mining methodologies, for the analysis of 12-lead ECG data, improve the accuracy by which data mining algorithms determine which patients are suffering from heart disease. We show that the accuracy of patient state prediction, for all the algorithms, which we investigated, can be increased by up to 6 percent, using the combination of appropriate test training ratios and 5-fold cross-validation. The use of cross-validation greater than 5-fold, appears to reduce the improvement in algorithm classification accuracy gained by the use of this validation method. The accuracy of 84 percent in patient state predictions, obtained using the algorithm OCI, suggests that this algorithm will be capable of providing the required accuracy for clinical decision support systems.

The status of the SLAC Linear Collider and of the Mark II detector

International Nuclear Information System (INIS)

Lankford, A.J.

1987-10-01

At SLAC we are currently involved in the exciting challenge of commissioning the first example of a new type of colliding beam accelerator, the SLAC Linear Collider, or SLC. The goals of the SLC are two-fold. It will explore the concept of linear colliders, and it will allow the study of physics on the Z 0 resonance. It accomplishes these goals by exploiting the existing SLAC linac and the large visible cross-section of approximately thirty nanobarns of the Z 0 . The MARK II detector will have the opportunity to be first to explore the physics in this regime. This paper briefly reports the status of the SLC and of the MARK II as of early October 1987, at which time commissioning efforts were interrupted in order to place the MARK II detector at the collision point and to incorporate some improvements to the SLC. The first portion of this report highlights some of the milestones achieved in the SLC commissioning and some of the problems encountered. The last portion outlines improvements made to the MARK II for physics at the SLC. 10 refs., 12 figs., 1 tab

Effective interventions on service quality improvement in a physiotherapy clinic.

Science.gov (United States)

Gharibi, Farid; Tabrizi, JafarSadegh; Eteraf Oskouei, MirAli; AsghariJafarabadi, Mohammad

2014-01-01

Service quality is considered as a main domain of quality associ-ated with non-clinical aspect of healthcare. This study aimed to survey and im-proves service quality of delivered care in the Physiotherapy Clinic affiliated with the Tabriz University of Medical Sciences, Tabriz, Iran. A quasi experimental interventional study was conducted in the Physiotherapy Clinic, 2010-2011. Data were collected using a validated and reli-able researcher made questionnaire with participation of 324 patients and their coadjutors. The study questionnaire consisted of 7 questions about demographic factors and 38 questions for eleven aspects of service quality. Data were then analyzed using paired samples t-test by SPSS16. In the pre intervention phase, six aspects of service quality including choice of provider, safety, prevention and early detection, dignity, autonomy and availability achieved non-acceptable scores. Following interventions, all aspects of the service quality improved and also total service quality score improved from 8.58 to 9.83 (PService quality can be improved by problem implementation of appropriate interventions. The acquired results can be used in health system fields to create respectful environments for healthcare customers.

46 CFR 185.602 - Hull markings.

Science.gov (United States)

2010-10-01

... 46 Shipping 7 2010-10-01 2010-10-01 false Hull markings. 185.602 Section 185.602 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) SMALL PASSENGER VESSELS (UNDER 100 GROSS TONS) OPERATIONS Markings Required § 185.602 Hull markings. (a) Each vessel must be marked as required by part 67...

Survival of radio-marked mallard ducklings in northeastern California

Science.gov (United States)

Mauser, D.M.; Jarvis, R.L.; Gilmer, D.S.

1994-01-01

Estimates of duckling survival are necessary to accurately assess recruitment of mallards (Anas platyrhynchos), yet few reliable estimates exist. During 1988-90, we estimated survival rates for 127 radio-marked mallard ducklings from 64 broods on Lower Klamath National Wildlife Refuge, California. In 1988, we restricted the survival estimate to the first 10 days post-hatch (S = 0.18, SE = 0.07). Survival from hatching to 50 days was 0.37 (SE = 0.09) in 1989 and 0.34 (SE = 0.07) in 1990. Total brood loss differed among years (P < 0.05); 81.2% in 1988 (n = 16), 36.8% in 1989 (n = 19), and 37.5% in 1990 (n = 24). Ninety-three percent of mortality occurred during the first 10 days of life. We detected no differences in the proportion of radio-marked ducklings fledged from early-hatched versus late-hatched nests (P = 0.74). During 1989-90, 16 females appeared to lose their entire brood; however, 3 radio-marked ducklings from 2 of these broods were fledged by other brood hens. Of 29 radio-marked ducklings that reached 44 days of life, 6 (20.7%) joined other broods. Habitat enhancement is the key to improving duckling survival because the large number of predator species that consume ducklings makes predator control difficult.

Evaluation of Criteria-Based Clinical Audit in Improving Quality of ...

African Journals Online (AJOL)

Erah

ABSTRACT. Study evaluated criteria–based clinical audit in measuring and improving quality of obstetric care for five life-threatening obstetric complications: obstetric haemorrhage, eclampsia, genital tract infections, obstructed labor and uterine rupture. Clinical management of 65 patients was audited using a 'before.

Mark Kostabi soovib muuta inimesi õnnelikumaks / Kalev Mark Kostabi

Index Scriptorium Estoniae

Kostabi, Kalev Mark, 1960-

2008-01-01

Kalev Mark Kostabi oma sisekujunduslikest eelistustest, ameeriklaste ja itaallaste kodude sisekujunduse erinevustest, kunstist kui ruumikujunduse ühest osast, oma New Yorgi ja Rooma korterite kujundusest

Improving the accuracy of admitted subacute clinical costing: an action research approach.

Science.gov (United States)

Hakkennes, Sharon; Arblaster, Ross; Lim, Kim

2017-08-01

Objective The aim of the present study was to determine whether action research could be used to improve the breadth and accuracy of clinical costing data in an admitted subacute setting Methods The setting was a 100-bed in-patient rehabilitation centre. Using a pre-post study design all admitted subacute separations during the 2011-12 financial year were eligible for inclusion. An action research framework aimed at improving clinical costing methodology was developed and implemented. Results In all, 1499 separations were included in the study. A medical record audit of a random selection of 80 separations demonstrated that the use of an action research framework was effective in improving the breadth and accuracy of the costing data. This was evidenced by a significant increase in the average number of activities costed, a reduction in the average number of activities incorrectly costed and a reduction in the average number of activities missing from the costing, per episode of care. Conclusions Engaging clinicians and cost centre managers was effective in facilitating the development of robust clinical costing data in an admitted subacute setting. Further investigation into the value of this approach across other care types and healthcare services is warranted. What is known about this topic? Accurate clinical costing data is essential for informing price models used in activity-based funding. In Australia, there is currently a lack of robust admitted subacute cost data to inform the price model for this care type. What does this paper add? The action research framework presented in this study was effective in improving the breadth and accuracy of clinical costing data in an admitted subacute setting. What are the implications for practitioners? To improve clinical costing practices, health services should consider engaging key stakeholders, including clinicians and cost centre managers, in reviewing clinical costing methodology. Robust clinical costing data has

27 CFR 28.193 - Export marks.

Science.gov (United States)

2010-04-01

... 27 Alcohol, Tobacco Products and Firearms 1 2010-04-01 2010-04-01 false Export marks. 28.193... Drawback Filing of Notice and Removal § 28.193 Export marks. In addition to the marks and brands required... chapter, the exporter shall mark the word “Export” on the Government side of each case or Government head...

27 CFR 28.103 - Export marks.

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2010-04-01

... 27 Alcohol, Tobacco Products and Firearms 1 2010-04-01 2010-04-01 false Export marks. 28.103... Manufacturing Bonded Warehouse § 28.103 Export marks. (a) General. In addition to the marks and brands required... provisions of part 19 of this chapter, the proprietor shall mark the word “Export” on the Government side of...

27 CFR 28.144 - Export marks.

Science.gov (United States)

2010-04-01

... 27 Alcohol, Tobacco Products and Firearms 1 2010-04-01 2010-04-01 false Export marks. 28.144... § 28.144 Export marks. (a) General Requirement. In addition to the marks and brands required to be... brewer shall mark the word “Export” on each container or case of beer, or the words “Beer concentrate for...

27 CFR 28.154 - Export marks.

Science.gov (United States)

2010-04-01

... 27 Alcohol, Tobacco Products and Firearms 1 2010-04-01 2010-04-01 false Export marks. 28.154..., for Exportation or Transfer to a Foreign-Trade Zone § 28.154 Export marks. In addition to the marks... provisions of part 19 of this chapter, the proprietor shall mark the word “Export” on the Government side of...

FDA, CE mark or something else?—Thinking fast and slow

Directory of Open Access Journals (Sweden)

Sundeep Mishra

2017-01-01

Full Text Available There is a robust debate going on among the Medical Device stake-holders whether FDA is better or CE mark or something else. Currently process of obtaining an FDA approval is bogged down by ever-increasing unpredictability, inconsistency, prolonged time, and huge expense but CE mark has its own problems. Historically, the Japanese review process has tended to be the slowest among the big three but recently with the introduction of accelerated review process there has been a significant progress. While the goal of an innovator/manufacturer is to develop, manufacture and market a medical device that addresses an unmet clinical need, the requisite regulatory approval process can be very confusing. Not only there is a whole lot of jargon tossed around by regulatory affair professionals: “substantial equivalence,” “PMDA,” “CE mark,” “Notified body,” “510K” and “PMA” but the actual approval process can also be very tardy, inconsistent and expensive.

Beyond clinical engagement: a pragmatic model for quality improvement interventions, aligning clinical and managerial priorities.

Science.gov (United States)

Pannick, Samuel; Sevdalis, Nick; Athanasiou, Thanos

2016-09-01

Despite taking advantage of established learning from other industries, quality improvement initiatives in healthcare may struggle to outperform secular trends. The reasons for this are rarely explored in detail, and are often attributed merely to difficulties in engaging clinicians in quality improvement work. In a narrative review of the literature, we argue that this focus on clinicians, at the relative expense of managerial staff, has proven counterproductive. Clinical engagement is not a universal challenge; moreover, there is evidence that managers-particularly middle managers-also have a role to play in quality improvement. Yet managerial participation in quality improvement interventions is often assumed, rather than proven. We identify specific factors that influence the coordination of front-line staff and managers in quality improvement, and integrate these factors into a novel model: the model of alignment. We use this model to explore the implementation of an interdisciplinary intervention in a recent trial, describing different participation incentives and barriers for different staff groups. The extent to which clinical and managerial interests align may be an important determinant of the ultimate success of quality improvement interventions. 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/

The 168/E at CERN and the MARK 2. An improved processor design

International Nuclear Information System (INIS)

Kunz, P.; Botterill, D.R.; Lord, D.; Edwards, A.; Fucci, A.; Lee, G.; Martin, B.; Mornacchi, G.; Scharff-Hansen, P.; Storr, M.

1981-01-01

In the first part of this paper the history of the 168/E work at CERN is reviewed, this is followed by a short description of the hardware and software in use and finally some examples of future applications are given. In the second part of the paper the limitations of the present 168/E design are discussed and the ways that a new design, Mark 2, could overcome them are presented. (orig.)

The Mark III vertex chamber and prototype test results

International Nuclear Information System (INIS)

Grab, C.

1987-07-01

A vertex chamber has been constructed for use in the Mark III experiment. The chamber is positioned inside the current main drift chamber and will be used to trigger data collection, to aid in vertex reconstruction, and to improve the momentum resolution. This paper discusses the chamber's construction and performance and tests of the prototype

Strategies for Improving Nursing Students' Mental Health Clinical Rotation.

Science.gov (United States)

Kroning, Maureen

2016-01-01

Mental illness is a huge problem many people face in the U.S. and around the world. The American Psychiatric Nurses Association indicates there is a shortage of nurses in every level and role in psychiatric-mental health nursing. Raising up a generation of nurses who want to work with the mentally ill is a challenge for nurse educators. The use of role playing and simulation in the learning lab prior to entering the clinical setting and reflective journaling in the clinical rotation can improve undergraduate nursing students' mental health clinical experience.

Identifying persistent and characteristic features in firearm tool marks on cartridge cases

Science.gov (United States)

Ott, Daniel; Soons, Johannes; Thompson, Robert; Song, John

2017-12-01

Recent concerns about subjectivity in forensic firearm identification have motivated the development of algorithms to compare firearm tool marks that are imparted on ammunition and to generate quantitative measures of similarity. In this paper, we describe an algorithm that identifies impressed tool marks on a cartridge case that are both consistent between firings and contribute strongly to a surface similarity metric. The result is a representation of the tool mark topography that emphasizes both significant and persistent features across firings. This characteristic surface map is useful for understanding the variability and persistence of the tool marks created by a firearm and can provide improved discrimination between the comparison scores of samples fired from the same firearm and the scores of samples fired from different firearms. The algorithm also provides a convenient method for visualizing areas of similarity that may be useful in providing quantitative support for visual comparisons by trained examiners.

MR-guided breast biopsy and hook wire marking using a low-field (0.23 T) scanner with optical instrument tracking

International Nuclear Information System (INIS)

Blanco Sequeiros, Roberto; Reinikainen, Heli; Blanco Sequeiros, Andreas M.; Ojala, Risto; Paeaekkoe, Eija; Tervonen, Osmo; Vaara, Teuvo

2007-01-01

The purpose of this study was to evaluate the technical feasibility of MR-guided percutaneous breast biopsy (LCNB) and breast hook wire marking in a low-field (0.23 T) MRI system with optical instrument tracking. MR-guided core biopsy and/or hook wire marking was performed on 13 lesions observable at MR imaging only. Seven breast LCNBs and 10 hook wire markings were performed under MR guidance on 11 patients. The diagnosis was confirmed by excision biopsy or mastectomy in 12 lesions and with histopathological and cytological diagnosis and 12-month clinical follow-up in one lesion. All lesions seen in the high-field scanner were also successfully identified and targeted in the low-field scanner. The following procedures were typically technically successful. There were difficulties due to unsatisfactory functioning of some core biopsy guns. Detailed description of low-field MR guidance and optical tracking in breast biopsies is provided. The procedure seems accurate and safe and provides means to obtain a histological diagnosis of a breast lesion only seen with MRI. The low-field biopsy system is comparable to the high-field MRI system. MR-compatible biopsy guns need to be improved. (orig.)

A pilot project to improve access to telepsychotherapy at rural clinics.

Science.gov (United States)

Adler, Geri; Pritchett, Lonique R; Kauth, Michael R; Nadorff, Danielle

2014-01-01

The U.S. Department of Veterans Affairs (VA) has pioneered telemental health (TMH) with over 500,000 TMH encounters over the past decade. VA community-based outpatient clinics were established to improve accessibility of mental healthcare for rural Veterans. Despite these clinics clinics and increased availability of TMH, many rural Veterans have difficulty receiving mental healthcare, particularly psychotherapy. Twelve therapists participated in a pilot project using TMH technologies to improve mental healthcare service delivery to rural Veterans treated at six community clinics. Therapists completed online training, and study staff communicated with them monthly and clinical leaders every other month. Therapists completed two questionnaires: before training and 10 months later. This article describes barriers and facilitators to the implementation of the project, as well as therapists' knowledge, confidence, and motivation regarding TMH. Two clinicians were offering telepsychotherapy after 10 months. At all six sites, unanticipated organizational constraints and administrative barriers delayed implementation; establishing organizational practices and therapists' motivation helped facilitate the process. Adopters of the project reported more positive views of the modality and did not worry about staffing, a concern of nonadopters. Despite barriers to implementation, lessons learned from this pilot project have led to improvements and changes in TMH processes. Results from the pilot showed that therapists providing telepsychotherapy had increased confidence, knowledge, and motivation. As TMH continues to expand, formalized decision-making with clinical leaders regarding project goals, better matching of therapists with this modality, and assessment of medical center and clinic readiness are recommended.

Community to clinic navigation to improve diabetes outcomes

Directory of Open Access Journals (Sweden)

Nancy E. Schoenberg

2017-03-01

Full Text Available Rural residents experience rates of Type 2 Diabetes Mellitus (T2DM that are considerably higher than their urban or suburban counterparts. Two primary modifiable factors, self-management and formal clinical management, have potential to greatly improve diabetes outcomes. “Community to Clinic Navigation to Improve Diabetes Outcomes,” is the first known randomized clinical trial pilot study to test a hybrid model of diabetes self-management education plus clinical navigation among rural residents with T2DM. Forty-one adults with T2DM were recruited from two federally qualified health centers in rural Appalachia from November 2014–January 2015. Community health workers provided navigation, including helping participants understand and implement a diabetes self-management program through six group sessions and, if needed, providing assistance in obtaining clinic visits (contacting providers' offices for appointments, making reminder calls, and facilitating transportation and dependent care. Pre and post-test data were collected on T2DM self-management, physical measures, demographics, psychosocial factors, and feasibility (cost, retention, and satisfaction. Although lacking statistical significance, some outcomes indicate trends in positive directions, including diet, foot care, glucose monitoring, and physical health, including decreased HbA1c and triglyceride levels. Process evaluations revealed high levels of satisfaction and feasibility. Due to the limited intervention dose, modest program expenditures (~$29,950, and a severely affected population most of whom had never received diabetes education, outcomes were not as robust as anticipated. Given high rates of satisfaction and retention, this culturally appropriate small group intervention holds promise for hard to reach rural populations. Modifications should include expanded recruitment venues, sample size, intervention dosage and longer term assessment.

High contrast laser marking of alumina

International Nuclear Information System (INIS)

Penide, J.; Quintero, F.; Riveiro, A.; Fernández, A.; Val, J. del; Comesaña, R.; Lusquiños, F.; Pou, J.

2015-01-01

Highlights: • Laser marking of alumina using near infrared (NIR) lasers was experimentally analyzed. • Color change produced by NIR lasers is due to thermally induced oxygen vacancies. • Laser marking results obtained using NIR lasers and green laser are compared. • High contrast marks on alumina were achieved. - Abstract: Alumina serves as raw material for a broad range of advanced ceramic products. These elements should usually be identified by some characters or symbols printed directly on them. In this sense, laser marking is an efficient, reliable and widely implemented process in industry. However, laser marking of alumina still leads to poor results since the process is not able to produce a dark mark, yielding bad contrast. In this paper, we present an experimental study on the process of marking alumina by three different lasers working in two wavelengths: 1064 nm (Near-infrared) and 532 nm (visible, green radiation). A colorimetric analysis has been carried out in order to compare the resulting marks and its contrast. The most suitable laser operating conditions were also defined and are reported here. Moreover, the physical process of marking by NIR lasers is discussed in detail. Field Emission Scanning Electron Microscopy, High Resolution Transmission Electron Microscopy and X-ray Photoelectron Spectroscopy were also employed to analyze the results. Finally, we propose an explanation for the differences of the coloration induced under different atmospheres and laser parameters. We concluded that the atmosphere is the key parameter, being the inert one the best choice to produce the darkest marks

Changing Context of Trade Mark Protection in India: A Review of the Trade Marks Act, 1999

OpenAIRE

Pathak, Akhileshwar

2004-01-01

With liberalisation and globalisation of the Indian economy, it has become possible for anyone to get into production and services in most of the sectors. This has led to rampant misuse and appropriation of trade marks. In an insulated economy, with monopoly markets, law protecting trade marks had a limited role. In the changed context, however, trade mark law will be a field of much interest for academics and practitioners. Towards this, the paper explores the formation of trade mark law in ...

Improved clinical documentation leads to superior reportable outcomes: An accurate representation of patient's clinical status.

Science.gov (United States)

Elkbuli, Adel; Godelman, Steven; Miller, Ashley; Boneva, Dessy; Bernal, Eileen; Hai, Shaikh; McKenney, Mark

2018-05-01

Clinical documentation can be an underappreciated. Trauma Centers (TCs) are now routinely evaluated for quality performance. TCs with poor documentation may not accurately reflect actual injury burden or comorbidities and can impact accuracy of mortality measures. Markers exist to adjust crude death rates for injury severity: observed over expected deaths (O/E) adjust for injury; Case Mix Index (CMI) reflects disease burden, and Severity of Illness (SOI) measures organ dysfunction. We aim to evaluate the impact of implementing a Clinical Documentation Improvement Program (CDIP) on reported outcomes. Review of 2-years of prospectively collected data for trauma patients, during the implementation of CDIP. A two-group prospective observational study design was used to evaluate the pre-implementation and the post-implementation phase of improved clinical documentation. T-test and Chi-Squared were used with significance defined as p deaths out of 1419 (3.45%), while post-implementation period, had 38 deaths out of 1454 (2.61%), (non-significant). There was however, a significant difference between O/E ratios. In the pre-phase, the O/E was 1.36 and 0.70 in the post-phase (p < 0.001). The two groups also differed on CMI with a pre-group mean of 2.48 and a post-group of 2.87 (p < 0.001), indicating higher injury burden in the post-group. SOI started at 2.12 and significantly increased to 2.91, signifying more organ system dysfunction (p < 0.018). Improved clinical documentation results in improved accuracy of measures of mortality, injury severity, and comorbidities and a more accurate reflection in O/E mortality ratios, CMI, and SOI. Copyright © 2018 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

Evaluating a mobile application for improving clinical laboratory test ordering and diagnosis.

Science.gov (United States)

Meyer, Ashley N D; Thompson, Pamela J; Khanna, Arushi; Desai, Samir; Mathews, Benji K; Yousef, Elham; Kusnoor, Anita V; Singh, Hardeep

2018-04-20

Mobile applications for improving diagnostic decision making often lack clinical evaluation. We evaluated if a mobile application improves generalist physicians' appropriate laboratory test ordering and diagnosis decisions and assessed if physicians perceive it as useful for learning. In an experimental, vignette study, physicians diagnosed 8 patient vignettes with normal prothrombin times (PT) and abnormal partial thromboplastin times (PTT). Physicians made test ordering and diagnosis decisions for 4 vignettes using each resource: a mobile app, PTT Advisor, developed by the Centers for Disease Control and Prevention (CDC)'s Clinical Laboratory Integration into Healthcare Collaborative (CLIHC); and usual clinical decision support. Then, physicians answered questions regarding their perceptions of the app's usefulness for diagnostic decision making and learning using a modified Kirkpatrick Training Evaluation Framework. Data from 368 vignettes solved by 46 physicians at 7 US health care institutions show advantages for using PTT Advisor over usual clinical decision support on test ordering and diagnostic decision accuracy (82.6 vs 70.2% correct; P < .001), confidence in decisions (7.5 vs 6.3 out of 10; P < .001), and vignette completion time (3:02 vs 3:53 min.; P = .06). Physicians reported positive perceptions of the app's potential for improved clinical decision making, and recommended it be used to address broader diagnostic challenges. A mobile app, PTT Advisor, may contribute to better test ordering and diagnosis, serve as a learning tool for diagnostic evaluation of certain clinical disorders, and improve patient outcomes. Similar methods could be useful for evaluating apps aimed at improving testing and diagnosis for other conditions.

Laser direct marking applied to rasterizing miniature Data Matrix Code on aluminum alloy

Science.gov (United States)

Li, Xia-Shuang; He, Wei-Ping; Lei, Lei; Wang, Jian; Guo, Gai-Fang; Zhang, Teng-Yun; Yue, Ting

2016-03-01

Precise miniaturization of 2D Data Matrix (DM) Codes on Aluminum alloy formed by raster mode laser direct part marking is demonstrated. The characteristic edge over-burn effects, which render vector mode laser direct part marking inadequate for producing precise and readable miniature codes, are minimized with raster mode laser marking. To obtain the control mechanism for the contrast and print growth of miniature DM code by raster laser marking process, the temperature field model of long pulse laser interaction with material is established. From the experimental results, laser average power and Q frequency have an important effect on the contrast and print growth of miniature DM code, and the threshold of laser average power and Q frequency for an identifiable miniature DM code are respectively 3.6 W and 110 kHz, which matches the model well within normal operating conditions. In addition, the empirical model of correlation occurring between laser marking parameters and module size is also obtained, and the optimal processing parameter values for an identifiable miniature DM code of different but certain data size are given. It is also found that an increase of the repeat scanning number effectively improves the surface finish of bore, the appearance consistency of modules, which has benefit to reading. The reading quality of miniature DM code is greatly improved using ultrasonic cleaning in water by avoiding the interference of color speckles surrounding modules.

Limited Awareness of the Essences of Certification or Compliance Markings on Medical Devices.

Science.gov (United States)

Foo, Jong Yong Abdiel; Tan, Xin Ji Alan

2017-06-01

Medical devices have been long used for odiagnostic, therapeutic or rehabilitation purposes. Currently, they can range from a low-cost portable device that is often used for personal health monitoring to high-end sophisticated equipment that can only be operated by trained professionals. Depending on the functional purposes, there are different certification or compliance markings on the device when it is sold. One common certification marking is the Conformité Européenne affixation but this has a range of certification mark numbering for a variety of functional purposes. While the regulators and medical device manufacturers understand the associated significance and clinical implications, these may not be apparent to the professionals (using or maintaining the device) and the general public. With portable healthcare devices and mobile applications gaining popularity, better awareness of certification marking will be needed. Particularly, there are differences in the allowed functional purposes and the associated cost derivations of devices with a seemingly similar nature. A preferred approach such as an easy-to-understand notation next to any certification marking on a device can aid in differentiation without the need to digest mountainous regulatory details.

Improving healthcare value through clinical community and supply chain collaboration.

Science.gov (United States)

Ishii, Lisa; Demski, Renee; Ken Lee, K H; Mustafa, Zishan; Frank, Steve; Wolisnky, Jean Paul; Cohen, David; Khanna, Jay; Ammerman, Joshua; Khanuja, Harpal S; Unger, Anthony S; Gould, Lois; Wachter, Patricia Ann; Stearns, Lauren; Werthman, Ronald; Pronovost, Peter

2017-03-01

We hypothesized that integrating supply chain with clinical communities would allow for clinician-led supply cost reduction and improved value in an academic health system. Three clinical communities (spine, joint, blood management) and one clinical community-like physician led team of surgeon stakeholders partnered with the supply chain team on specific supply cost initiatives. The teams reviewed their specific utilization and cost data, and the physicians led consensus-building conversations over a series of team meetings to agree to standard supply utilization. The spine and joint clinical communities each agreed upon a vendor capping model that led to cost savings of $3 million dollars and $1.5 million dollars respectively. The blood management decreased blood product utilization and achieved $1.2 million dollars savings. $5.6 million dollars in savings was achieved by a clinical community-like group of surgeon stakeholders through standardization of sutures and endomechanicals. Physician led clinical teams empowered to lead change achieved substantial supply chain cost savings in an academic health system. The model of combining clinical communities with supply chain offers hope for an effective, practical, and scalable approach to improving value and engaging physicians in other academic health systems. This clinician led model could benefit both private and academic health systems engaging in value optimization efforts. N/A. Copyright © 2016 Elsevier Inc. All rights reserved.

Experimental applications for the MARK-1 and MARK-1A pulsed ionizing radiation detection systems. Volume 3

International Nuclear Information System (INIS)

Harker, Y.D.; Lawrence, R.S.; Yoon, W.Y.; Lones, J.L.

1993-12-01

This report is the third volume in a three volume set describing the MARK series of pulsed ionizing radiation detection systems. This volume describes the MARK-1A detection system, compares it with the MARK-1 system, and describes the experimental testing of the detection systems. Volume 1 of this set presents the technical specifications for the MARK-1 detection system. Volume 2 is an operations manual specifically for the MARK-1 system, but it generally applies to the MARK-1A system as well. These detection systems operate remotely and detect photon radiation from a single or a multiple pulsed source. They contain multiple detector (eight in the MARK-1 and ten in the MARK-1A) for determination of does and incident photon effective energy. The multiple detector arrangement, having different detector sizes and shield thicknesses, provides the capability of determining the effective photon energy of the radiation spectrum. Dose measurements using these units are consistent with TLD measurements. The detection range is from 3 nanorads to 90 microrads per source burst; the response is linear over that range. Three units were built and are ready for field deployment

Insulin gene mutations resulting in early-onset diabetes: marked differences in clinical presentation, metabolic status, and pathogenic effect through endoplasmic reticulum retention

DEFF Research Database (Denmark)

Meur, Gargi; Simon, Albane; Harun, Nasret

2009-01-01

OBJECTIVE: Heterozygous mutations in the human preproinsulin (INS) gene are a cause of nonsyndromic neonatal or early-infancy diabetes. Here, we sought to identify INS mutations associated with maturity-onset diabetes of the young (MODY) or nonautoimmune diabetes in mid-adult life, and to explore...... the molecular mechanisms involved. RESEARCH DESIGN AND METHODS: The INS gene was sequenced in 16 French probands with unexplained MODY, 95 patients with nonautoimmune early-onset diabetes (diagnosed at ... with early-onset diabetes whose clinical presentation is compatible with MODY. These led to the production of (pre)proinsulin molecules with markedly different trafficking properties and effects on ER stress, demonstrating a range of molecular defects in the beta-cell....

Could clinical audit improve the diagnosis of pulmonary tuberculosis in Cuba, Peru and Bolivia?

Science.gov (United States)

Siddiqi, Kamran; Volz, Anna; Armas, L; Otero, L; Ugaz, R; Ochoa, E; Gotuzzo, E; Torrico, F; Newell, James N; Walley, J; Robinson, Mike; Dieltiens, G; Van der Stuyft, P

2008-04-01

To assess the effectiveness of clinical audit in improving the quality of diagnostic care provided to patients suspected of tuberculosis; and to understand the contextual factors which impede or facilitate its success. Twenty-six health centres in Cuba, Peru and Bolivia were recruited. Clinical audit was introduced to improve the diagnostic care for patients attending with suspected TB. Standards were based on the WHO and TB programme guidelines relating to the appropriate use of microscopy, culture and radiological investigations. At least two audit cycles were completed over 2 years. Improvement was determined by comparing the performance between two six-month periods pre- and post-intervention. Qualitative methods were used to ascertain facilitating and limiting contextual factors influencing change among healthcare professionals' clinical behaviour after the introduction of clinical audit. We found a significant improvement in 11 of 13 criteria in Cuba, in 2 of 6 criteria in Bolivia and in 2 of 5 criteria in Peru. Twelve out of 24 of the audit criteria in all three countries reached the agreed standards. Barriers to quality improvement included conflicting objectives for clinicians and TB programmes, poor coordination within the health system and patients' attitudes towards illness. Clinical audit may drive improvements in the quality of clinical care in resource-poor settings. It is likely to be more effective if integrated within and supported by the local TB programmes. We recommend developing and evaluating an integrated model of quality improvement including clinical audit.

Clinical Management of HIV Drug Resistance

Science.gov (United States)

Cortez, Karoll J.; Maldarelli, Frank

2011-01-01

Combination antiretroviral therapy for HIV-1 infection has resulted in profound reductions in viremia and is associated with marked improvements in morbidity and mortality. Therapy is not curative, however, and prolonged therapy is complicated by drug toxicity and the emergence of drug resistance. Management of clinical drug resistance requires in depth evaluation, and includes extensive history, physical examination and laboratory studies. Appropriate use of resistance testing provides valuable information useful in constructing regimens for treatment-experienced individuals with viremia during therapy. This review outlines the emergence of drug resistance in vivo, and describes clinical evaluation and therapeutic options of the individual with rebound viremia during therapy. PMID:21994737

Augmented marked graphs

CERN Document Server

Cheung, King Sing

2014-01-01

Petri nets are a formal and theoretically rich model for the modelling and analysis of systems. A subclass of Petri nets, augmented marked graphs possess a structure that is especially desirable for the modelling and analysis of systems with concurrent processes and shared resources.This monograph consists of three parts: Part I provides the conceptual background for readers who have no prior knowledge on Petri nets; Part II elaborates the theory of augmented marked graphs; finally, Part III discusses the application to system integration. The book is suitable as a first self-contained volume

Court presentation of bite mark evidence.

Science.gov (United States)

Drinnan, A J; Melton, M J

1985-12-01

The uniqueness of an individual's bite mark is generally accepted. The use of bite mark analysis to identify or exclude those suspected of crimes is now a well established activity in forensic dentistry. Although the techniques for evaluating bite mark evidence are extremely sophisticated, it is important that the courtroom presentation of such evidence should be as simple as possible and be directed towards those who must judge it. Dentists likely to be involved in the courtroom presentation of bite mark evidence should: be certain that their local law enforcement personnel are frequently updated on the techniques to be used for producing the optimum evidence needed to evaluate bite marks; become acquainted with the current techniques of evaluating bite mark evidence and understand their difficulties and pitfalls; meet with the lawyers (prosecution or defence) before a courtroom appearance, briefing them on the significance of the particular findings; prepare clear and easily understandable visual aids to present to the court the techniques used in the analysis and the bases for the conclusion reached; and offer conclusions derived from the bite mark investigation.

NIH Clinical Centers

Data.gov (United States)

Federal Laboratory Consortium — The NIH Clinical Center consists of two main facilities: The Mark O. Hatfield Clinical Research Center, which opened in 2005, houses inpatient units, day hospitals,...

Nuclear particle track-etched anti-bogus mark

International Nuclear Information System (INIS)

He Xiangming; Yan Yushun; Zhang Quanrong

2003-01-01

Nuclear particle track-etched anti-bogus mark is a new type of forgery-proof product after engraving gravure printing, thermocolour, fluorescence, laser hologram and metal concealed anti-bogus mark. The mark is manufactured by intricate high technology and the state strictly controlled sensitive nuclear facilities to ensure the mark not to be copied. The pattern of the mark is specially characterized by permeability of liquid to be discriminated from forgery. The genuine mark can be distinguished from sham one by transparent liquid (e.g. water), colorful pen and chemical reagent. The mark has passed the official examination of health safety. It is no danger of nuclear irradiation. (author)

High efficiency metal marking with CO2 laser and glass marking with excimer laser

DEFF Research Database (Denmark)

Bastue, Jens; Olsen, Flemmming Ove

1997-01-01

with a thoroughly tested ray-tracing model is presented and compared with experimental results. Special emphasis is put on two different applications namely marking in metal with TEA-CO2 laser and marking in glass with excimer laser. The results are evaluated on the basis of the achievable energy enhancement......Today, mask based laser materials processing and especially marking is widely used. However, the energy efficiency in such processes is very low [1].This paper gives a review of the results, that may be obtained using the energy enhancing technique [1]. Results of simulations performed...

Improvement of the clinical outcome in Ankylosing spondylitis by balneotherapy.

Science.gov (United States)

Yurtkuran, Merih; Ay, Alev; Karakoç, Yüksel

2005-07-01

This study is designed to show the efficacy of balneotherapy and balneotherapy (BT) + nonsteroid antiinflammatory drug (NSAID) use in Ankylosing spondylitis (AS) patients. In this prospective study, BT, BT+ NSAID and NSAID therapy in 61 patients with AS were evaluated by ASAS core set. BT group (21 patients) was treated only with BT for 20 min, once a day, 5 days a week, over a period of 3 weeks. BT+NSAID group (20 patients) was treated with 1000 mg naproxen as well as BT. NSAID group (20 patients) was treated with 1000 mg naproxen. All of the participants did respiratory and postural exercises for 20 min a day and for the whole study period. Each patient was evaluated on admission (before treatment), at the end of the therapy and 6 months after the treatment. At the end of the study, statistically significant improvement was observed in all the clinical parameters of the patients in BT (G1), BT+NSAID (G2) and NSAID (G3) groups. This significant symptomatic and clinical improvement was maintained even 6 months after the treatment. The changes from baseline to follow up were similar in G1 and G2 except duration of morning stiffness (DMS) and chest expansion (CE). Improvements in CE and DMS were better in G1 and G2, respectively. Improvements observed in G1 and G2 were superior to the improvements observed in G3 for the variables of morning pain, nocturnal pain, DMS, global well being of the patient, occiput-wall distance, CE, finger to floor distance and functional index. In Schober test, improvement observed in G1 was statistically superior to G3. We concluded that BT can be suggested as an effective symptomatic treatment modality in patients with AS. Furthermore, sufficient improvement in clinical parameters can be obtained by BT alone.

Improved quality monitoring of multi-center acupuncture clinical trials in China

Directory of Open Access Journals (Sweden)

Zheng Hui

2009-12-01

Full Text Available Abstract Background In 2007, the Chinese Science Division of the State Administration of Traditional Chinese Medicine(TCM convened a special conference to discuss quality control for TCM clinical research. Control and assurance standards were established to guarantee the quality of clinical research. This paper provides practical guidelines for implementing strict and reproducible quality control for acupuncture randomized controlled trials (RCTs. Methods A standard quality control program (QCP was established to monitor the quality of acupuncture trials. Case report forms were designed; qualified investigators, study personnel and data management personnel were trained. Monitors, who were directly appointed by the project leader, completed the quality control programs. They guaranteed data accuracy and prevented or detected protocol violations. Clinical centers and clinicians were audited, the randomization system of the centers was inspected, and the treatment processes were audited as well. In addition, the case report forms were reviewed for completeness and internal consistency, the eligibility and validity of the patients in the study was verified, and data was monitored for compliance and accuracy. Results and discussion The monitors complete their reports and submit it to quality assurance and the sponsors. Recommendations and suggestions are made for improving performance. By holding regular meetings to discuss improvements in monitoring standards, the monitors can improve quality and efficiency. Conclusions Supplementing and improving the existed guidelines for quality monitoring will ensure that large multi-centre acupuncture clinical trials will be considered as valid and scientifically stringent as pharmaceutical clinical trials. It will also develop academic excellence and further promote the international recognition of acupuncture.

Intranasal insulin to improve developmental delay in children with 22q13 deletion syndrome: an exploratory clinical trial.

Science.gov (United States)

Schmidt, H; Kern, W; Giese, R; Hallschmid, M; Enders, A

2009-04-01

The 22q13 deletion syndrome (Phelan-McDermid syndrome) is characterised by a global developmental delay, absent or delayed speech, generalised hypotonia, autistic behaviour and characteristic phenotypic features. Intranasal insulin has been shown to improve declarative memory in healthy adult subjects and in patients with Alzheimer disease. To assess if intranasal insulin is also able to improve the developmental delay in children with 22q13 deletion syndrome. We performed exploratory clinical trials in six children with 22q13 deletion syndrome who received intranasal insulin over a period of 1 year. Short-term (during the first 6 weeks) and long-term effects (after 12 months of treatment) on motor skills, cognitive functions, or autonomous functions, speech and communication, emotional state, social behaviour, behavioural disorders, independence in daily living and education were assessed. The children showed marked short-term improvements in gross and fine motor activities, cognitive functions and educational level. Positive long-term effects were found for fine and gross motor activities, nonverbal communication, cognitive functions and autonomy. Possible side effects were found in one patient who displayed changes in balance, extreme sensitivity to touch and general loss of interest. One patient complained of intermittent nose bleeding. We conclude that long-term administration of intranasal insulin may benefit motor development, cognitive functions and spontaneous activity in children with 22q13 deletion syndrome.

Comparison of the reference mark azimuth determination methods

Directory of Open Access Journals (Sweden)

Danijel Šugar

2013-03-01

Full Text Available The knowledge of the azimuth of the reference mark is of crucial importance in the determination of the declination which is defined as the ellipsoidal (geodetic azimuth of the geomagnetic meridian. The accuracy of the azimuth determination has direct impact on the accuracy of the declination. The orientation of the Declination-Inclination Magnetometer is usually carried out by sighting the reference mark in two telescope faces in order to improve the reliability of the observations and eliminate some instrumental errors. In this paper, different coordinate as well as azimuth determination methods using GNSS (Global Navigation Satellite System observation techniques within VPPS (High-Precision Positioning Service and GPPS (Geodetic-Precision Positioning Service services of the CROPOS (CROatian POsitioning System system were explained. The azimuth determination by the observation of the Polaris was exposed and it was subsequently compared with the observation of the Sun using hour-angle and zenith-distance method. The procedure of the calculation of the geodetic azimuth from the astronomic azimuth was explained. The azimuth results obtained by different methods were compared and the recommendations on the minimal distance between repeat station and azimuth mark were given. The results shown in this paper were based on the observations taken on the POKU_SV repeat station.

Coronary Stents: The Impact of Technological Advances on Clinical Outcomes.

Science.gov (United States)

Mennuni, Marco G; Pagnotta, Paolo A; Stefanini, Giulio G

2016-02-01

Percutaneous coronary interventions (PCI) were proposed in the late 1970s as an alternative to surgical coronary artery bypass grafting for the treatment of coronary artery disease. Important technological progress has been made since. Balloon angioplasty was replaced by bare metal stents, which allowed to permanently scaffold the coronary vessel avoiding acute recoil and abrupt occlusion. Thereafter, the introduction of early generation drug-eluting stents (DES) has significantly improved clinical outcomes, primarily by markedly reducing the risk of restenosis. New generation DES with thinner stent struts, novel durable or biodegradable polymer coatings, and new limus antiproliferative agents, have further improved upon the safety and efficacy profile of early generation DES. The present article aims to review the impact of technological advances on clinical outcomes in the field of PCI with coronary stents, and to provide a brief overview on clinical margins of improvement and unmet needs of available DES.

Frontline health care can be improved by bringing research into the clinic

DEFF Research Database (Denmark)

Steinhausen, Kirsten; Berghmans, Stephane; Højgaard, Liselotte

2011-01-01

Progress in clinical research has played a huge role in the great improvements in frontline health care achieved over the last 50 years, both in general practice and in hospitals.......Progress in clinical research has played a huge role in the great improvements in frontline health care achieved over the last 50 years, both in general practice and in hospitals....

[Quality assurance and quality improvement in medical practice. Part 3: Clinical audit in medical practice].

Science.gov (United States)

Godény, Sándor

2012-02-05

The first two articles in the series were about the definition of quality in healthcare, the quality approach, the importance of quality assurance, the advantages of quality management systems and the basic concepts and necessity of evidence based medicine. In the third article the importance and basic steps of clinical audit are summarised. Clinical audit is an integral part of quality assurance and quality improvement in healthcare, that is the responsibility of any practitioner involved in medical practice. Clinical audit principally measures the clinical practice against clinical guidelines, protocols and other professional standards, and sometimes induces changes to ensure that all patients receive care according to principles of the best practice. The clinical audit can be defined also as a quality improvement process that seeks to identify areas for service improvement, develop and carry out plans and actions to improve medical activity and then by re-audit to ensure that these changes have an effect. Therefore, its aims are both to stimulate quality improvement interventions and to assess their impact in order to develop clinical effectiveness. At the end of the article key points of quality assurance and improvement in medical practice are summarised.

Effect of artificial sunlight on the retention of external calcein marks on lake trout

Science.gov (United States)

Honeyfield, D.C.; Kehler, T.; Fletcher, J.W.; Mohler, J.W.

2008-01-01

When choosing a fish marking technique to address fishery related questions, it is important to consider factors that affect mark retention. Calcein, a chemical marking agent, is under investigation for potential use on fish. Two laboratory trials were conducted with calcein-marked lake trout Salvelinus namaycush to determine the effect of artificial sunlight on calcein mark intensity. In trial 1, fish exposed to 18,000 lx for 7 d lost 90% or more of the calcein mark intensity (relative to the colorimetric key, mg/L) on the head, body, ventral region, and pectoral fins relative to mark intensity in fish that were maintained in darkness. In trial 2, light intensity was reduced 2.5-3.0-fold. After 7 d of light exposure, calcein mark intensity on the head was reduced by 40-45% relative to mark intensity in fish that were held in darkness; by day 14, calcein mark intensity on the head was reduced by 55-60% relative to that of dark-treated fish. No further decline was observed in light-exposed fish, and head mark intensity values did not differ among days 14, 21, and 28 for this treatment group. Of the four areas evaluated, the head and pectoral fin were more easily read using a colorimetric key than the lateral or ventral regions of the fish. The concentration of calcein spotted on filter paper to devise the colorimetric key ranged from 1 to 100 mg/L. A difference of approximately 7 mg/L in apparent calcein mark intensity means for the head region could be detected using the colorimetric key. These trials showed that calcein mark intensity on lake trout declined when fish were exposed to artificial sunlight, and the use of a colorimetric key improved the objectivity of calcein mark intensity assessment.

46 CFR 160.176-23 - Marking.

Science.gov (United States)

2010-10-01

... of the vessel. (2) The type of vessel. (3) Specific purpose or limitation approved by the Coast Guard...: SPECIFICATIONS AND APPROVAL LIFESAVING EQUIPMENT Inflatable Lifejackets § 160.176-23 Marking. (a) General. Each inflatable lifejacket must be marked with the information required by this section. Each marking must be...

On-road Bicycle Pavement Markings

Data.gov (United States)

Allegheny County / City of Pittsburgh / Western PA Regional Data Center — A mile by mile breakdown of the on-street bicycle pavement markings installed within the City of Pittsburgh. These include bike lanes, shared lane markings...

Marks of Metal Copenhell

DEFF Research Database (Denmark)

2015-01-01

Planchebaseret udendørs udstilling på musikfestivalen Copenhell 18-20/6 2015. En mindre udgave af udstillingen Marks of Metal - Logodesign og visualitet i heavy metal. Udarbejdet i samarbejde med Mediemuseet.......Planchebaseret udendørs udstilling på musikfestivalen Copenhell 18-20/6 2015. En mindre udgave af udstillingen Marks of Metal - Logodesign og visualitet i heavy metal. Udarbejdet i samarbejde med Mediemuseet....

Ongoing Evaluation of Clinical Ethics Consultations as a Form of Continuous Quality Improvement.

Science.gov (United States)

Volpe, Rebecca

2017-01-01

Ongoing evaluation of a clinical ethics consultation service (ECS) allows for continuous quality improvement, a process-based, data-driven approach for improving the quality of a service. Evaluations by stakeholders involved in a consultation can provide real-time feedback about what is working well and what might need to be improved. Although numerous authors have previously presented data from research studies on the effectiveness of clinical ethics consultation, few ECSs routinely send evaluations as an ongoing component of their everyday clinical activities. The primary purpose of this article is to equip and encourage others to engage in ongoing evaluation of their own ECS. Toward that end, the following resources are shared: (1) the survey tool used to gather the evaluation data, (2) the procedure used to elicit and collate responses, and (3) how the resulting data are used to support continuous quality improvement and justify the continued financial support of the ECS to hospital administration. Copyright 2017 The Journal of Clinical Ethics. All rights reserved.

Circulatory Markings at Double-Lane Traffic Roundabout.

NARCIS (Netherlands)

Bie, Jing; Lo, Hong K.; Wong, S.C.

2008-01-01

This paper compares two types of circulatory markings at a double-lane traffic roundabout: the concentric marking scheme and the Alberta marking scheme. The effects of these two marking schemes on drivers' lane choice behavior, delay, and safety, are compared based on data collected from before and

7 CFR 160.32 - Marking containers.

Science.gov (United States)

2010-01-01

... 7 Agriculture 3 2010-01-01 2010-01-01 false Marking containers. 160.32 Section 160.32 Agriculture... STANDARDS FOR NAVAL STORES Analysis, Inspection, and Grading on Request § 160.32 Marking containers. The interested person shall provide any labor necessary for marking the containers, after the contents have been...

46 CFR 122.602 - Hull markings.

Science.gov (United States)

2010-10-01

... 46 Shipping 4 2010-10-01 2010-10-01 false Hull markings. 122.602 Section 122.602 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) SMALL PASSENGER VESSELS CARRYING MORE THAN 150....602 Hull markings. (a) Each vessel must be marked as required by part 67, subpart I, of this chapter...

Progress in Cell Marking for Synchrotron X-ray Computed Tomography

Science.gov (United States)

Hall, Christopher; Sturm, Erica; Schultke, Elisabeth; Arfelli, Fulvia; Menk, Ralf-Hendrik; Astolfo, Alberto; Juurlink, Bernhard H. J.

2010-07-01

Recently there has been an increase in research activity into finding ways of marking cells in live animals for pre-clinical trials. Development of certain drugs and other therapies crucially depend on tracking particular cells or cell types in living systems. Therefore cell marking techniques are required which will enable longitudinal studies, where individuals can be examined several times over the course of a therapy or study. The benefits of being able to study both disease and therapy progression in individuals, rather than cohorts are clear. The need for high contrast 3-D imaging, without harming or altering the biological system requires a non-invasive yet penetrating imaging technique. The technique will also have to provide an appropriate spatial and contrast resolution. X-ray computed tomography offers rapid acquisition of 3-D images and is set to become one of the principal imaging techniques in this area. Work by our group over the last few years has shown that marking cells with gold nano-particles (GNP) is an effective means of visualising marked cells in-vivo using x-ray CT. Here we report the latest results from these studies. Synchrotron X-ray CT images of brain lesions in rats taken using the SYRMEP facility at the Elettra synchrotron in 2009 have been compared with histological examination of the tissues. Some deductions are drawn about the visibility of the gold loaded cells in both light microscopy and x-ray imaging.

Stretch Marks

Science.gov (United States)

... completely without the help of a dermatologist or plastic surgeon. These doctors may use one of many types of treatments — from actual surgery to techniques like microdermabrasion and laser treatment — to reduce the appearance of stretch marks. These techniques are ...

High contrast laser marking of alumina

Science.gov (United States)

Penide, J.; Quintero, F.; Riveiro, A.; Fernández, A.; del Val, J.; Comesaña, R.; Lusquiños, F.; Pou, J.

2015-05-01

Alumina serves as raw material for a broad range of advanced ceramic products. These elements should usually be identified by some characters or symbols printed directly on them. In this sense, laser marking is an efficient, reliable and widely implemented process in industry. However, laser marking of alumina still leads to poor results since the process is not able to produce a dark mark, yielding bad contrast. In this paper, we present an experimental study on the process of marking alumina by three different lasers working in two wavelengths: 1064 nm (Near-infrared) and 532 nm (visible, green radiation). A colorimetric analysis has been carried out in order to compare the resulting marks and its contrast. The most suitable laser operating conditions were also defined and are reported here. Moreover, the physical process of marking by NIR lasers is discussed in detail. Field Emission Scanning Electron Microscopy, High Resolution Transmission Electron Microscopy and X-ray Photoelectron Spectroscopy were also employed to analyze the results. Finally, we propose an explanation for the differences of the coloration induced under different atmospheres and laser parameters. We concluded that the atmosphere is the key parameter, being the inert one the best choice to produce the darkest marks.

27 CFR 28.123 - Export marks.

Science.gov (United States)

2010-04-01

... 27 Alcohol, Tobacco Products and Firearms 1 2010-04-01 2010-04-01 false Export marks. 28.123..., or Transportation to a Manufacturing Bonded Warehouse § 28.123 Export marks. (a) General. In addition... filled under the provisions of part 24 of this chapter, the proprietor shall mark the word “Export” on...

Beyond δ : Tailoring marked statistics to reveal modified gravity

Science.gov (United States)

Valogiannis, Georgios; Bean, Rachel

2018-01-01

Models that seek to explain cosmic acceleration through modifications to general relativity (GR) evade stringent Solar System constraints through a restoring, screening mechanism. Down-weighting the high-density, screened regions in favor of the low density, unscreened ones offers the potential to enhance the amount of information carried in such modified gravity models. In this work, we assess the performance of a new "marked" transformation and perform a systematic comparison with the clipping and logarithmic transformations, in the context of Λ CDM and the symmetron and f (R ) modified gravity models. Performance is measured in terms of the fractional boost in the Fisher information and the signal-to-noise ratio (SNR) for these models relative to the statistics derived from the standard density distribution. We find that all three statistics provide improved Fisher boosts over the basic density statistics. The model parameters for the marked and clipped transformation that best enhance signals and the Fisher boosts are determined. We also show that the mark is useful both as a Fourier and real-space transformation; a marked correlation function also enhances the SNR relative to the standard correlation function, and can on mildly nonlinear scales show a significant difference between the Λ CDM and the modified gravity models. Our results demonstrate how a series of simple analytical transformations could dramatically increase the predicted information extracted on deviations from GR, from large-scale surveys, and give the prospect for a much more feasible potential detection.

27 CFR 28.223 - Export marks.

Science.gov (United States)

2010-04-01

... 27 Alcohol, Tobacco Products and Firearms 1 2010-04-01 2010-04-01 false Export marks. 28.223... Export marks. In addition to the marks and brands required to be placed on kegs, barrels, cases, crates... “Export” on each container or case before removal for export, for use on vessels or aircraft, or for...

Bedtime Blood Pressure Chronotherapy Significantly Improves Hypertension Management.

Science.gov (United States)

Hermida, Ramón C; Ayala, Diana E; Fernández, José R; Mojón, Artemio; Crespo, Juan J; Ríos, María T; Smolensky, Michael H

2017-10-01

Consistent evidence of numerous studies substantiates the asleep blood pressure (BP) mean derived from ambulatory BP monitoring (ABPM) is both an independent and a stronger predictor of cardiovascular disease (CVD) risk than are daytime clinic BP measurements or the ABPM-determined awake or 24-hour BP means. Hence, cost-effective adequate control of sleep-time BP is of marked clinical relevance. Ingestion time, according to circadian rhythms, of hypertension medications of 6 different classes and their combinations significantly improves BP control, particularly sleep-time BP, and reduces adverse effects. Copyright © 2017 Elsevier Inc. All rights reserved.

Improved outcome in acute myeloid leukemia patients enrolled in clinical trials

DEFF Research Database (Denmark)

Østgård, Lene Sofie Granfeldt; Nørgaard, Mette; Sengeløv, Henrik

2016-01-01

Clinical trials are critical to improve AML treatment. It remains, however, unclear if clinical trial participation per se affects prognosis and to what extent the patients selected for trials differ from those of patients receiving intensive therapy off-trial.We conducted a population-based coho...

46 CFR 78.50-5 - Hull markings.

Science.gov (United States)

2010-10-01

... 46 Shipping 3 2010-10-01 2010-10-01 false Hull markings. 78.50-5 Section 78.50-5 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) PASSENGER VESSELS OPERATIONS Markings on Vessels § 78.50-5 Hull markings. Vessels shall be marked as required by parts 67 and 69 of this chapter. [CGD 72...

46 CFR 196.40-5 - Hull markings.

Science.gov (United States)

2010-10-01

... 46 Shipping 7 2010-10-01 2010-10-01 false Hull markings. 196.40-5 Section 196.40-5 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) OCEANOGRAPHIC RESEARCH VESSELS OPERATIONS Markings on Vessels § 196.40-5 Hull markings. Vessels shall be marked as required by parts 67 and 69 of this chapter...

46 CFR 97.40-5 - Hull markings.

Science.gov (United States)

2010-10-01

... 46 Shipping 4 2010-10-01 2010-10-01 false Hull markings. 97.40-5 Section 97.40-5 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) CARGO AND MISCELLANEOUS VESSELS OPERATIONS Markings on Vessels § 97.40-5 Hull markings. Vessels shall be marked as required by parts 67 and 69 of this...

Engaging clinical nurses in quality and performance improvement activities.

Science.gov (United States)

Albanese, Madeline P; Evans, Dietra A; Schantz, Cathy A; Bowen, Margaret; Disbot, Maureen; Moffa, Joseph S; Piesieski, Patricia; Polomano, Rosemary C

2010-01-01

Nursing performance measures are an integral part of quality initiatives in acute care; however, organizations face numerous challenges in developing infrastructures to support quality improvement processes and timely dissemination of outcomes data. At the Hospital of the University of Pennsylvania, a Magnet-designated organization, extensive work has been conducted to incorporate nursing-related outcomes in the organization's quality plan and to integrate roles for clinical nurses into the Department of Nursing and organization's core performance-based programs. Content and strategies that promote active involvement of nurses and prepare them to be competent and confident stakeholders in quality initiatives are presented. Engaging clinical nurses in the work of quality and performance improvement is essential to achieving excellence in clinical care. It is important to have structures and processes in place to bring meaningful data to the bedside; however, it is equally important to incorporate outcomes into practice. When nurses are educated about performance and quality measures, are engaged in identifying outcomes and collecting meaningful data, are active participants in disseminating quality reports, and are able to recognize the value of these activities, data become one with practice.

LEAN SIX SIGMA TECHNIQUES TO IMPROVE OPHTHALMOLOGY CLINIC EFFICIENCY.

Science.gov (United States)

Ciulla, Thomas A; Tatikonda, Mohan V; ElMaraghi, Yehya A; Hussain, Rehan M; Hill, Amanda L; Clary, Julie M; Hattab, Eyas

2017-07-18

Ophthalmologists serve an increasing volume of a growing elderly population undergoing increasingly complex outpatient medical care, including extensive diagnostic testing and treatment. The resulting prolonged patient visit times ("patient flow times") limit quality, patient and employee satisfaction, and represent waste. Lean Six Sigma process improvement was used in a vitreoretinal practice to decrease patient flow time, demonstrating that this approach can yield significant improvement in health care. Process flow maps were created to determine the most common care pathways within clinic. Three months' visits from the electronic medical record system, which tracks patient task times at each process step in the office were collected. Care tasks and care pathways consuming the greatest time and variation were identified and modified. Follow-up analysis from 6 weeks' visits was conducted to assess improvement. Nearly all patients took one of five paths through the office. Patient flow was redesigned to reduce waiting room time by having staff members immediately start patients into one of those five paths; staffing was adjusted to address high demand tasks, and scheduling was optimized around derived predictors of patient flow times. Follow-up analysis revealed a statistically significant decline in mean patient flow time by 18% and inpatient flow time SD by 4.6%. Patient and employee satisfaction scores improved. Manufacturing industry techniques, such as Lean and Six Sigma, can be used to improve patient care, minimize waste, and enhance patient and staff satisfaction in outpatient clinics.

Guide to clinical PET in oncology: Improving clinical management of cancer patients

International Nuclear Information System (INIS)

2008-10-01

information on clinical PET in oncology for nuclear medicine physicians, radiologists and clinical practitioners. Possible ideas for cost effectiveness of clinical PET in oncology are mentioned. The information is also intended to be useful in decision making to improve clinical management of cancer patients when allocating resources dedicated to the health care system. This is a critical issue that is important for the development of both clinical oncology and nuclear medicine in IAEA member states. The IAEA can be instrumental in the advancement of programmes which focus on the IAEA's coordinated research projects and technical cooperation project

Nursing clinical practice changes to improve self-management in chronic obstructive pulmonary disease.

Science.gov (United States)

Padilha, J M; Sousa, P A F; Pereira, F M S

2018-03-01

To propose nursing clinical practice changes to improve the development of patient self-management. Chronic obstructive pulmonary disease is one of the main causes of chronic morbidity, loss of quality of life and high mortality rates. Control of the disease's progression, the preservation of autonomy in self-care and maintenance of quality of life are extremely challenging for patients to execute in their daily living. However, there is still little evidence to support nursing clinical practice changes to improve the development of self-management. A participatory action research study was performed in a medicine inpatient department and the outpatient unit of a Portuguese hospital. The sample comprised 52 nurses and 99 patients. For data collection, we used interviews, participant observation and content analysis. The main elements of nursing clinical practice that were identified as a focus for improvement measures were the healthcare model, the organization of healthcare and the documentation of a support decision-making process. The specific guidelines, the provision of material to support decision-making and the optimization of information sharing between professionals positively influenced the change process. This change improved the development of self-management skills related to the awareness of the need for 'change', hope, involvement, knowledge and abilities. The implemented changes have improved health-related behaviours and clinical outcomes. To support self-management development skills, an effective nursing clinical practice change is needed. This study has demonstrated the relevance of a portfolio of techniques and tools to help patients adopt healthy behaviours. The involvement and participation of nurses and patients in the conceptualization, implementation and evaluation of policy change are fundamental issues to improve the quality of nursing care and clinical outcomes. © 2017 International Council of Nurses.

MIH supplementation strategies: prospective clinical and laboratory trial.

Science.gov (United States)

Baroni, C; Marchionni, S

2011-03-01

The use of calcium-phosphate casein on hypomineralized molars (molar incisor hypomineralization, MIH) has been proposed but not clinically investigated. Qualitative and quantitative effects of supplementation with a calcium-phosphate casein product on MIH molars were monitored over a period of three years. Molar replicas, minimally invasive biopsies and their SEM microphotographs, plus ESEM/EDX semi-quantitative peaks of elements present in affected enamel were evaluated. Mineralization, morphology, and porosity appeared markedly improved, with calcium and phosphate levels reaching almost normal levels at three years' follow-up. The hypothesis tested was rejected, since calcium-phosphate casein improved enamel morphology in vivo.

Improving the quality of nurse clinical documentation for chronic patients at primary care clinics: A multifaceted intervention.

Science.gov (United States)

Mahomed, Ozayr H; Naidoo, Salsohni; Asmall, Shaidah; Taylor, Myra

2015-09-25

Deficiencies in record keeping practices have been reported at primary care level in the public health sector in South Africa. These deficiencies have the potential to negatively impact patient health outcomes as the break in information may hinder continuity of care. This disruption in information management has particular relevance for patients with chronic diseases. The aim of this study was to establish if the implementation of a structured clinical record (SCR) as an adjunct tool to the algorithmic guidelines for chronic disease management improved the quality of clinical records at primary care level. A quasi-experimental study (before and after study with a comparison group) was conducted across 30 primary health care clinics (PHCs) located in three districts in South Africa. Twenty PHCs that received the intervention were selected as intervention clinics and 10 facilities were selected as comparison facilities. The lot quality assurance sampling (LQAS) method was used to determine the number of records required to be reviewed per diagnostic condition per facility. There was a a statistically significant increase in the percentage of clinical records achieving compliance to the minimum criteria from the baseline to six months post-intervention for both HIV patients on antiretroviral treatment and patients with non-communicable diseases (hypertension and diabetes). A multifaceted intervention using a SCR to supplement the educational outreach component (PC 101 training) has demonstrated the potential for improving the quality of clinical records for patients with chronic diseases at primary care clinics in South Africa.

Mark Napier / Mark Napier ; interv. Tilman Baumgärtel

Index Scriptorium Estoniae

Napier, Mark

2006-01-01

Ameerika kunstnikust Mark Napierist (sünd. 1961) ja tema loomingust, 2001. a. tehtud meiliintervjuu kunstnikuga. Võrguteosest "The Digital Landfill" (1998), koos Andy Deckiga loodud tööst "GrafficJam" (1999), töödest "Shredder" (1998), "Feed", "Riot", "P-Soup" (2000), võrgukunstist ja muust

Dialectica Interpretation with Marked Counterexamples

Directory of Open Access Journals (Sweden)

Trifon Trifonov

2011-01-01

Full Text Available Goedel's functional "Dialectica" interpretation can be used to extract functional programs from non-constructive proofs in arithmetic by employing two sorts of higher-order witnessing terms: positive realisers and negative counterexamples. In the original interpretation decidability of atoms is required to compute the correct counterexample from a set of candidates. When combined with recursion, this choice needs to be made for every step in the extracted program, however, in some special cases the decision on negative witnesses can be calculated only once. We present a variant of the interpretation in which the time complexity of extracted programs can be improved by marking the chosen witness and thus avoiding recomputation. The achieved effect is similar to using an abortive control operator to interpret computational content of non-constructive principles.

Strategies to improve clinical management of community-acquired pneumonia

NARCIS (Netherlands)

Meijvis, S.C.A.

2012-01-01

Despite advances during the last few decades in the prevention, diagnosis and treatment of community-acquired pneumonia (CAP), its incidence remains high. In this thesis, strategies are described for improvement of the quality of clinical management in patients with pneumonia and for the reduction

Clinical and angiographic profile of patients with markedly elevated coronary calcium scores (≥1000) detected by electron beam computed tomography

International Nuclear Information System (INIS)

Almeda, Francis Q.; Shah, Rima; Senter, Shaun; Kason, Thomas T.; Haynie, Justin; Calvin, James E.; Kavinsky, Clifford J.; Snell, R. Jeffrey; Schaer, Gary L.; McLaughlin, Vallerie V.

2004-01-01

Objective: The objective of this study was to determine the clinical and angiographic profile of patients with extremely high coronary artery calcium scores (CACS; ≥1000) by electron beam computed tomography (EBCT). Methods: All patients at Rush University Medical Center who had a calcium score ≥1000 and a coronary angiogram performed from 1997 to 2002 were identified using a prospectively collected database. The baseline demographics, symptom status, and degree of coronary stenosis by angiography and subsequent rate of coronary intervention were compared with that of patients with calcium scores <1000. Results: The clinical and angiographic profile of patients with severe coronary calcification, detected by EBCT, revealed that patients with scores ≥1000 had a significantly higher prevalence of coronary stenosis ≥50% compared with patients with scores <1000 (97% vs. 57%, P<.001). The group with CACS ≥1000 was more likely to be male (90% vs. 75%, P=.027) and was older (64±8 vs. 59±10, P=.001) compared with the group with less severe calcification. Although there was a significantly higher rate of luminal stenosis detected by coronary angiography in the cohort with CACS ≥1000, there was no difference in subsequent percutaneous coronary intervention (PCI) and utilization of intracoronary stents between the two groups. Conclusions: A markedly elevated coronary calcium score (≥1000) is correlated with increasing age and is associated with an increased likelihood of coronary stenosis ≥50%. However, the decision to perform coronary angiography in patients with severe coronary calcification should not be based solely on these findings, but should remain primarily dependent on the degree of ischemia detected by clinical and functional assessment

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.

Has compliance with CLIA requirements really improved quality in US clinical laboratories?

Science.gov (United States)

Ehrmeyer, Sharon S; Laessig, Ronald H

2004-08-02

The Clinical Laboratory Improvement Amendments of 1988 (CLIA'88) mandate universal requirements for all U.S. clinical laboratory-testing sites. The intent of CLIA'88 is to ensure quality testing through a combination of minimum quality practices that incorporate total quality management concepts. These regulations do not contain established, objective indicators or measures to assess quality. However, there is an implicit assumption that compliance with traditionally accepted good laboratory practices--following manufacturers' directions, routinely analysing quality control materials, applying quality assurance principles, employing and assessing competent testing personnel, and participating in external quality assessment or proficiency testing (PT)--will result in improved test quality. The CLIA'88 regulations do include PT performance standards, which intentionally or unintentionally, define intra-laboratory performance. Passing PT has become a prime motivation for improving laboratory performance; it can also be used as an objective indicator to assess whether compliance to CLIA has improved intra-laboratory quality. Data from 1994 through 2002 indicate that the percentage of laboratories passing PT has increased. In addition to PT performance, subjective indicators of improved quality--frequency of inspection deficiencies, the number of government sanctions for non-compliance, and customer satisfaction--were evaluated. The results from these subjective indicators are more difficult to interpret but also seem to show improved quality in US clinical laboratories eleven years post-CLIA'88.

Responses of female rock lizards to multiple scent marks of males: effects of male age, male density and scent over-marking.

Science.gov (United States)

Martín, José; López, Pilar

2013-03-01

Scent-marked substrates may inform conspecifics on the characteristics of territorial males. Scent-marks of male Carpetan rock lizards (Iberolacerta cyreni) affect space use of females, which by selecting an area may increase the probability of mating with the male that has scent-marked that area. However, males do not hold exclusive territories, and scent-marks of different individual males are often together. This may provide complex information from multiple sources on the social structure. Here, we examined female preference in response to scent marks of various males and combinations in a laboratory experiment. Females preferred areas scent-marked by territorial old males against those scent-marked by young satellite-sneaker males. This reflected the known preference of females for mating with old males. In a second experiment, females preferred areas scent-marked by two males to areas of similar size marked by a single male. This may increase the probability of obtaining multiple copulations with different males, which may favour sperm competition and cryptic female choice, or may be a way to avoid infertile males. Finally, when we experimentally over-marked the scent-marks of an old male with scent-marks of a young male, females did not avoid, nor prefer, the over-marked area, suggesting that the quality of the old male may override the presence of a satellite male. We suggest that, irrespective of the causes underlying why a female selects a scent-marked area, this strategy may affect her reproductive success, which may have the same evolutionary consequences that "direct" mate choice decisions of other animals. Copyright © 2013 Elsevier B.V. All rights reserved.

What are the effective ways to translate clinical leadership into health care quality improvement?

Science.gov (United States)

McSherry, Robert; Pearce, Paddy

2016-01-01

The presence and/or absence of effective leaders in health care can have a stark consequence on the quality and outcomes of care. The delivery of safe, quality, compassionate health care is dependent on having effective clinical leaders at the frontline. In light of the Kirkup and Francis reports, this article explores some ways of translating clinical leadership into health care quality improvement. This is achieved by exploring what is clinical leadership and why and how this is important to health care quality improvement, clinical leadership, and a duty of candor, along with the importance clinical leadership plays in the provision of quality care improvement and outcomes. Clinical leaders are not predefined roles but emerge from the complex clinical setting by gaining an acquired expertise and from how they then internalize this to develop and facilitate sound relationships within a team. Clinical leaders are effective in facilitating innovation and change through improvement. This is achieved by recognizing, influencing, and empowering individuals through effective communication in order to share and learn from and with each other in practice. The challenge for health care organizations in regard to creating organizational cultures where a duty of candor exists is not to reinvent the wheel by turning something that is simple into something complex, which can become confusing to health care workers, patients, and the public. By focusing on the clinical leader's role and responsibilities we would argue they play a crucial and pivotal role in influencing, facilitating, supporting, and monitoring that this duty of candor happens in practice. This may be possible by highlighting where and how the duty of candor can be aligned within existing clinical governance frameworks.

A multidisciplinary three-phase approach to improve the clinical utility of patient safety indicators.

Science.gov (United States)

Najjar, Peter; Kachalia, Allen; Sutherland, Tori; Beloff, Jennifer; David-Kasdan, Jo Ann; Bates, David W; Urman, Richard D

2015-01-01

The AHRQ Patient Safety Indicators (PSIs) are used for calculation of risk-adjusted postoperative rates for adverse events. The payers and quality consortiums are increasingly requiring public reporting of hospital performance on these metrics. We discuss processes designed to improve the accuracy and clinical utility of PSI reporting in practice. The study was conducted at a 793-bed tertiary care academic medical center where PSI processes have been aggressively implemented to track patient safety events at discharge. A three-phased approach to improving administrative data quality was implemented. The initiative consisted of clinical review of all PSIs, documentation improvement, and provider outreach including active querying for patient safety events. This multidisciplinary effort to develop a streamlined process for PSI calculation reduced the reporting of miscoded PSIs and increased the clinical utility of PSI monitoring. Over 4 quarters, 4 of 41 (10%) PSI-11 and 9 of 138 (7%) PSI-15 errors were identified on review of clinical documentation and appropriate adjustments were made. A multidisciplinary, phased approach leveraging existing billing infrastructure for robust metric coding, ongoing clinical review, and frontline provider outreach is a novel and effective way to reduce the reporting of false-positive outcomes and improve the clinical utility of PSIs.

Percentage Retail Mark-Ups

OpenAIRE

Thomas von Ungern-Sternberg

1999-01-01

A common assumption in the literature on the double marginalization problem is that the retailer can set his mark-up only in the second stage of the game after the producer has moved. To the extent that the sequence of moves is designed to reflect the relative bargaining power of the two parties it is just as plausible to let the retailer move first. Furthermore, retailers frequently calculate their selling prices by adding a percentage mark-up to their wholesale prices. This allows a retaile...

Laser marking method and device

International Nuclear Information System (INIS)

Okazaki, Yuki; Aoki, Nobutada; Mukai, Narihiko; Sano, Yuji; Yamamoto, Seiji.

1997-01-01

An object is disposed in laser beam permeating liquid or gaseous medium. Laser beams such as CW laser or pulse laser oscillated from a laser device are emitted to the object to apply laser markings with less degradation of identification and excellent corrosion resistance on the surface of the object simply and easily. Upon applying the laser markings, a liquid or gas as a laser beam permeating medium is blown onto the surface of the object, or the liquid or gas in the vicinity of the object is sucked, the laser beam-irradiated portion on the surface can be cooled positively. Accordingly, the laser marking can be formed on the surface of the object with less heat affection to the object. In addition, if the content of a nitrogen gas in the laser beam permeating liquid medium is reduced by degassing to lower than a predetermined value, or the laser beam permeating gaseous medium is formed by an inert gas, a laser marking having high corrosion resistance and reliability can be formed on the surface of the objective member. (N.H.)

Improving the quality of nurse clinical documentation for chronic patients at primary care clinics: A multifaceted intervention

Directory of Open Access Journals (Sweden)

Ozayr H. Mahomed

2015-09-01

Full Text Available Background: Deficiencies in record keeping practices have been reported at primary care level in the public health sector in South Africa. These deficiencies have the potential to negatively impact patient health outcomes as the break in information may hinder continuity of care. This disruption in information management has particular relevance for patients with chronic diseases. Objectives: The aim of this study was to establish if the implementation of a structured clinical record (SCR as an adjunct tool to the algorithmic guidelines for chronic disease management improved the quality of clinical records at primary care level. Method: A quasi-experimental study (before and after study with a comparison group was conducted across 30 primary health care clinics (PHCs located in three districts in South Africa. Twenty PHCs that received the intervention were selected as intervention clinics and 10 facilities were selected as comparison facilities. The lot quality assurance sampling (LQAS method was used to determine the number of records required to be reviewed per diagnostic condition per facility. Results: There was a a statistically significant increase in the percentage of clinical records achieving compliance to the minimum criteria from the baseline to six months post-intervention for both HIV patients on antiretroviral treatment and patients with non-communicable diseases (hypertension and diabetes. Conclusions: A multifaceted intervention using a SCR to supplement the educational outreach component (PC 101 training has demonstrated the potential for improving the quality of clinical records for patients with chronic diseases at primary care clinics in South Africa.

Surgical assessment clinic - One stop emergency out-patient clinic for rapid assessment, reduced admissions and improved acute surgical service: A quality improvement study

Directory of Open Access Journals (Sweden)

Christina A.W. Macano

2017-11-01

Conclusion: By providing suitable guidance for referring practitioners we have optimised our clinic use significantly and improved our acute ambulatory surgical care. We have reduced admissions, provided rapid treatment and have established a service that helps address the ever increasing demand on acute services within the NHS.

Mark 4A project training evaluation

Science.gov (United States)

Stephenson, S. N.

1985-01-01

A participant evaluation of a Deep Space Network (DSN) is described. The Mark IVA project is an implementation to upgrade the tracking and data acquisition systems of the dSN. Approximately six hundred DSN operations and engineering maintenance personnel were surveyed. The survey obtained a convenience sample including trained people within the population in order to learn what training had taken place and to what effect. The survey questionnaire used modifications of standard rating scales to evaluate over one hundred items in four training dimensions. The scope of the evaluation included Mark IVA vendor training, a systems familiarization training seminar, engineering training classes, a on-the-job training. Measures of central tendency were made from participant rating responses. Chi square tests of statistical significance were performed on the data. The evaluation results indicated that the effects of different Mark INA training methods could be measured according to certain ratings of technical training effectiveness, and that the Mark IVA technical training has exhibited positive effects on the abilities of DSN personnel to operate and maintain new Mark IVA equipment systems.

Mark 4A project training evaluation

Science.gov (United States)

Stephenson, S. N.

1985-11-01

A participant evaluation of a Deep Space Network (DSN) is described. The Mark IVA project is an implementation to upgrade the tracking and data acquisition systems of the dSN. Approximately six hundred DSN operations and engineering maintenance personnel were surveyed. The survey obtained a convenience sample including trained people within the population in order to learn what training had taken place and to what effect. The survey questionnaire used modifications of standard rating scales to evaluate over one hundred items in four training dimensions. The scope of the evaluation included Mark IVA vendor training, a systems familiarization training seminar, engineering training classes, a on-the-job training. Measures of central tendency were made from participant rating responses. Chi square tests of statistical significance were performed on the data. The evaluation results indicated that the effects of different Mark INA training methods could be measured according to certain ratings of technical training effectiveness, and that the Mark IVA technical training has exhibited positive effects on the abilities of DSN personnel to operate and maintain new Mark IVA equipment systems.

A Study on introduction of Bench Marking in the power industry - concentrated on the Bench Marking issue in the power industry

Energy Technology Data Exchange (ETDEWEB)

Kwon, Hyuck Soo [Korea Energy Economics Institute, Euiwang (Korea)

1998-08-01

Recently it takes too much pains for enterprises to be adapted to the more complicated social structure. There are no guarantees to survive in competition only with improving service quality of a product, reducing cost by improving production efficiency, and reducing labors. To survive in a keen competition, it is important to acquire new management techniques and management theories. Among them, a benchmarking technique, improving competitive power through the analysis of top-ranking companies or companies with excellent results in a comparative sector, is in the spotlight recently. Therefore, the approaches to bench marking were discussed with the focus on the adaptation of KEPCO with a new paradigm. However, this study contained the limit of applying benchmarking technique due to its huge scale. Therefore, it was focused on brining up benchmarking issue by reflecting the basic problems of power industry to the developed countries. (author). 29 refs., 16 figs., 41 tabs.

Cooperative Shark Mark Recapture Database (MRDBS)

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — The Shark Mark Recapture Database is a Cooperative Research Program database system used to keep multispecies mark-recapture information in a common format for...

MarkIT büroo = Offices of MarkIT

Index Scriptorium Estoniae

2010-01-01

Tallinnas Pärnu mnt. 102C asuvas büroohoones paikneva MarkIT büroo sisekujundusest. Sisearhitektid Kard Männil (SAB Miu Miu Miu) ja Loreida Hein (Studio La), nende tähtsamate tööde loetelu. Valge büroomööbel on sisearhitektide projekteeritud. Graafika on sisearhitektid ise joonistanud

User’s guide for MapMark4GUI—A graphical user interface for the MapMark4 R package

Science.gov (United States)

Shapiro, Jason

2018-05-29

MapMark4GUI is an R graphical user interface (GUI) developed by the U.S. Geological Survey to support user implementation of the MapMark4 R statistical software package. MapMark4 was developed by the U.S. Geological Survey to implement probability calculations for simulating undiscovered mineral resources in quantitative mineral resource assessments. The GUI provides an easy-to-use tool to input data, run simulations, and format output results for the MapMark4 package. The GUI is written and accessed in the R statistical programming language. This user’s guide includes instructions on installing and running MapMark4GUI and descriptions of the statistical output processes, output files, and test data files.

What are the effective ways to translate clinical leadership into health care quality improvement?

Directory of Open Access Journals (Sweden)

McSherry R

2016-02-01

Full Text Available Robert McSherry,1 Paddy Pearce2 1School of Health and Social Care, University of Teesside, Middlesbrough, 2PKP Consulting, Yarm, United Kingdom Abstract: The presence and/or absence of effective leaders in health care can have a stark consequence on the quality and outcomes of care. The delivery of safe, quality, compassionate health care is dependent on having effective clinical leaders at the frontline. In light of the Kirkup and Francis reports, this article explores some ways of translating clinical leadership into health care quality improvement. This is achieved by exploring what is clinical leadership and why and how this is important to health care quality improvement, clinical leadership, and a duty of candor, along with the importance clinical leadership plays in the provision of quality care improvement and outcomes. Clinical leaders are not predefined roles but emerge from the complex clinical setting by gaining an acquired expertise and from how they then internalize this to develop and facilitate sound relationships within a team. Clinical leaders are effective in facilitating innovation and change through improvement. This is achieved by recognizing, influencing, and empowering individuals through effective communication in order to share and learn from and with each other in practice. The challenge for health care organizations in regard to creating organizational cultures where a duty of candor exists is not to reinvent the wheel by turning something that is simple into something complex, which can become confusing to health care workers, patients, and the public. By focusing on the clinical leader's role and responsibilities we would argue they play a crucial and pivotal role in influencing, facilitating, supporting, and monitoring that this duty of candor happens in practice. This may be possible by highlighting where and how the duty of candor can be aligned within existing clinical governance frameworks. Keywords: governance

'You can't just hit a button': an ethnographic study of strategies to repurpose data from advanced clinical information systems for clinical process improvement.

Science.gov (United States)

Morrison, Cecily; Jones, Matthew; Jones, Rachel; Vuylsteke, Alain

2013-04-10

Current policies encourage healthcare institutions to acquire clinical information systems (CIS) so that captured data can be used for secondary purposes, including clinical process improvement. Such policies do not account for the extra work required to repurpose data for uses other than direct clinical care, making their implementation problematic. This paper aims to analyze the strategies employed by clinical units to use data effectively for both direct clinical care and clinical process improvement. Ethnographic methods were employed. A total of 54 contextual interviews with health professionals spanning various disciplines and 18 hours of observation were carried out in 5 intensive care units in England using an advanced CIS. Case studies of how the extra work was achieved in each unit were derived from the data and then compared. We found that extra work is required to repurpose CIS data for clinical process improvement. Health professionals must enter data not required for clinical care and manipulation of this data into a machine-readable form is often necessary. Ambiguity over who should be responsible for this extra work hindered CIS data usage for clinical process improvement. We describe 11 strategies employed by units to accommodate this extra work, distributing it across roles. Seven of these motivated data entry by health professionals and four addressed the machine readability of data. Many of the strategies relied heavily on the skill and leadership of local clinical customizers. To realize the expected clinical process improvements by the use of CIS data, clinical leaders and policy makers need to recognize and support the redistribution of the extra work that is involved in data repurposing. Adequate time, funding, and appropriate motivation are needed to enable units to acquire and deliver the necessary skills in CIS customization.

Image-guided system versus manual marking for toric intraocular lens alignment in cataract surgery.

Science.gov (United States)

Webers, Valentijn S C; Bauer, Noel J C; Visser, Nienke; Berendschot, Tos T J M; van den Biggelaar, Frank J H M; Nuijts, Rudy M M A

2017-06-01

To compare the accuracy of toric intraocular lens (IOL) alignment using the Verion Image-Guided System versus a conventional manual ink-marking procedure. University Eye Clinic Maastricht, Maastricht, the Netherlands. Prospective randomized clinical trial. Eyes with regular corneal astigmatism of at least 1.25 diopters (D) that required cataract surgery and toric IOL implantation (Acrysof SN6AT3-T9) were randomly assigned to the image-guided group or the manual-marking group. The primary outcome was the alignment of the toric IOL based on preoperative images and images taken immediately after surgery. Secondary outcome measures were residual astigmatism, uncorrected distance visual acuity (UDVA), and complications. The study enrolled 36 eyes (24 patients). The mean toric IOL misalignment was significantly less in the image-guided group than in the manual group 1 hour (1.3 degrees ± 1.6 [SD] versus 2.8 ± 1.8 degrees; P = .02) and 3 months (1.7 ± 1.5 degrees versus 3.1 ± 2.1 degrees; P image-guided group and manual group, respectively (P > .05). The mean UDVA was 0.03 ± 0.10 logarithm of minimum angle of resolution (logMAR) and 0.04 ± 0.09 logMAR, respectively (both P > .05). No intraoperative complications occurred during any surgery. The IOL misalignment was significantly less with digital marking than with manual marking; this did not result in a better UDVA or lower residual refractive astigmatism. Copyright © 2017 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

Minimal Marking: A Success Story

Directory of Open Access Journals (Sweden)

Anne McNeilly

2014-11-01

Full Text Available The minimal-marking project conducted in Ryerson’s School of Journalism throughout 2012 and early 2013 resulted in significantly higher grammar scores in two first-year classes of minimally marked university students when compared to two traditionally marked classes. The “minimal-marking” concept (Haswell, 1983, which requires dramatically more student engagement, resulted in more successful learning outcomes for surface-level knowledge acquisition than the more traditional approach of “teacher-corrects-all.” Results suggest it would be effective, not just for grammar, punctuation, and word usage, the objective here, but for any material that requires rote-memory learning, such as the Associated Press or Canadian Press style rules used by news publications across North America.

Audit filters for improving processes of care and clinical outcomes in trauma systems.

Science.gov (United States)

Evans, Christopher; Howes, Daniel; Pickett, William; Dagnone, Luigi

2009-10-07

Traumatic injuries represent a considerable public health burden with significant personal and societal costs. The care of the severely injured patient in a trauma system progresses along a continuum that includes numerous interventions being provided by a multidisciplinary group of healthcare personnel. Despite the recent emphasis on quality of care in medicine, there has been little research to direct trauma clinicians and administrators on how optimally to monitor and improve upon the quality of care delivered within a trauma system. Audit filters are one mechanism for improving quality of care and are defined as specific clinical processes or outcomes of care that, when they occur, represent unfavorable deviations from an established norm and which prompt review and feedback. Although audit filters are widely utilized for performance improvement in trauma systems they have not been subjected to systematic review of their effectiveness. To determine the effectiveness of using audit filters for improving processes of care and clinical outcomes in trauma systems. Our search strategy included an electronic search of the Cochrane Injuries Group Specialized Register, the Cochrane EPOC Group Specialized Register, CENTRAL (The Cochrane Library 2008, Issue 4), MEDLINE, PubMed, EMBASE, CINAHL, and ISI Web of Science: (SCI-EXPANDED and CPCI-S). We handsearched the Journal of Trauma, Injury, Annals of Emergency Medicine, Academic Emergency Medicine, and Injury Prevention. We searched two clinical trial registries: 1) The World Health Organization International Clinical Trials Registry Platform and, 2) Clinical Trials.gov. We also contacted content experts for further articles. The most recent electronic search was completed in December 2008 and the handsearch was completed up to February 2009. We searched for randomized controlled trials, controlled clinical trials, controlled before-and-after studies, and interrupted time series studies that used audit filters as an

Male and female meadow voles Microtus pennsylvanicus respond differently to scent marks from the top- middle-, and bottom-scent donors of an over-mark

Directory of Open Access Journals (Sweden)

Michael H. FERKIN, Nicholas J. HOBBS, Benjamin D. FERKIN, Adam C.FERKIN, Daniel A. FERKIN

2011-08-01

Full Text Available Previous studies have shown that individuals responded preferentially to the mark of the top-scent donor relative to that of the bottom-scent donor of an over-mark. However, terrestrial mammals are likely to encounter over-marks consisting of the scent marks of more than two same-sex conspecifics in the intersections of runways, near the nests of sexually receptive female conspecifics, and inside and along the borders of the territories of conspecifics. We determined how meadow voles, Microtus pennsylvanicus, respond to the marks of the top-, middle-, and bottom-scent donors of an over-mark. We tested the hypothesis that voles exposed to an over-mark will respond preferentially to the scent marks that were deposited more recently, the scent marks that were on top or near the top of the over-mark, compared to the scent marks that were deposited earlier or near the bottom of the over-mark. Voles spent more time investigating the mark of the top-scent donor than that of the either the middle- or bottom-scent donor. However, males but not female voles spent more time investigating the middle-scent mark than the bottom-scent mark. We also tested the hypothesis that voles evaluate and respond to over-marks differently from single scent marks. Voles spent more time investigating the marks of the top-, middle-, and bottom-scent donors compared to scent marks that were not part of the over-mark. Voles can distinguish among the overlapping scent marks of three scent donors and sex differences exist in the values they appear to attach to each of these scent marks [Current Zoology 57 (4: 441–448, 2011].

Evaluation of copper for divider subassembly in MCO Mark IA and Mark IV scrap fuel baskets

International Nuclear Information System (INIS)

Graves, C.E.

1997-01-01

The K Basin Spent Nuclear Fuel (SNF) Project Multi-Canister Overpack (MCO) subprojection eludes the design and fabrication of a canister that will be used to confine, contain, and maintain fuel in a critically safe array to enable its removal from the K Basins, vacuum drying, transport, staging, hot conditioning, and interim storage (Goldinann 1997). Each MCO consists of a shell, shield plug, fuel baskets (Mark IA or Mark IV), and other incidental equipment. The Mark IA intact and scrap fuel baskets are a safety class item for criticality control and components necessary for criticality control will be constructed from 304L stainless steel. It is proposed that a copper divider subassembly be used in both Mark IA and Mark IV scrap baskets to increase the safety basis margin during cold vacuum drying. The use of copper would increase the heat conducted away from hot areas in the baskets out to the wall of the MCO by both radiative and conductive heat transfer means. Thus copper subassembly will likely be a safety significant component of the scrap fuel baskets. This report examines the structural, cost and corrosion consequences associated with using a copper subassembly in the stainless steel MCO scrap fuel baskets

Clinical Trials Infrastructure as a Quality Improvement Intervention in Low- and Middle-Income Countries.

Science.gov (United States)

Denburg, Avram; Rodriguez-Galindo, Carlos; Joffe, Steven

2016-06-01

Mounting evidence suggests that participation in clinical trials confers neither advantage nor disadvantage on those enrolled. Narrow focus on the question of a "trial effect," however, distracts from a broader mechanism by which patients may benefit from ongoing clinical research. We hypothesize that the existence of clinical trials infrastructure-the organizational culture, systems, and expertise that develop as a product of sustained participation in cooperative clinical trials research-may function as a quality improvement lever, improving the quality of care and outcomes of all patients within an institution or region independent of their individual participation in trials. We further contend that this "infrastructure effect" can yield particular benefits for patients in low- and middle-income countries (LMICs). The hypothesis of an infrastructure effect as a quality improvement intervention, if correct, justifies enhanced research capacity in LMIC as a pillar of health system development.

Virtual 3D tumor marking-exact intraoperative coordinate mapping improve post-operative radiotherapy

International Nuclear Information System (INIS)

Essig, Harald; Gellrich, Nils-Claudius; Rana, Majeed; Meyer, Andreas; Eckardt, André M; Kokemueller, Horst; See, Constantin von; Lindhorst, Daniel; Tavassol, Frank; Ruecker, Martin

2011-01-01

The quality of the interdisciplinary interface in oncological treatment between surgery, pathology and radiotherapy is mainly dependent on reliable anatomical three-dimensional (3D) allocation of specimen and their context sensitive interpretation which defines further treatment protocols. Computer-assisted preoperative planning (CAPP) allows for outlining macroscopical tumor size and margins. A new technique facilitates the 3D virtual marking and mapping of frozen sections and resection margins or important surgical intraoperative information. These data could be stored in DICOM format (Digital Imaging and Communication in Medicine) in terms of augmented reality and transferred to communicate patient's specific tumor information (invasion to vessels and nerves, non-resectable tumor) to oncologists, radiotherapists and pathologists

Virtual 3D tumor marking-exact intraoperative coordinate mapping improve post-operative radiotherapy

Directory of Open Access Journals (Sweden)

Essig Harald

2011-11-01

Full Text Available Abstract The quality of the interdisciplinary interface in oncological treatment between surgery, pathology and radiotherapy is mainly dependent on reliable anatomical three-dimensional (3D allocation of specimen and their context sensitive interpretation which defines further treatment protocols. Computer-assisted preoperative planning (CAPP allows for outlining macroscopical tumor size and margins. A new technique facilitates the 3D virtual marking and mapping of frozen sections and resection margins or important surgical intraoperative information. These data could be stored in DICOM format (Digital Imaging and Communication in Medicine in terms of augmented reality and transferred to communicate patient's specific tumor information (invasion to vessels and nerves, non-resectable tumor to oncologists, radiotherapists and pathologists.

Clinical audit training improves undergraduates' performance in root canal therapy.

Science.gov (United States)

Fong, J Y M; Tan, V J H; Lee, J R; Tong, Z G M; Foong, Y K; Tan, J M E; Parolia, A; Pau, A

2017-12-20

To evaluate the effectiveness of clinical audit-feedback cycle as an educational tool in improving the technical quality of root canal therapy (RCT) and compliance with record keeping performed by dental undergraduates. Clinical audit learning was introduced in Year 3 of a 5-year curriculum for dental undergraduates. During classroom activities, students were briefed on clinical audit, selected their audit topics in groups of 5 or 6 students, and prepared and presented their audit protocols. One chosen topic was RCT, in which 3 different cohorts of Year 3 students conducted retrospective audits of patients' records in 2012, 2014 and 2015 for their compliance with recommended record keeping criteria and their performance in RCT. Students were trained by and calibrated against an endodontist (κ ≥ 0.8). After each audit, the findings were reported in class, and recommendations were made for improvement in performance of RCT and record keeping. Students' compliance with published guidelines was presented and their RCT performances in each year were compared using the chi-square test. Overall compliance with of record keeping guidelines was 44.1% in 2012, 79.6% in 2014 and 94.6% in 2015 (P = .001). In the 2012 audit, acceptable extension, condensation and the absence of mishap were observed in 72.4, 75.7% and 91.5%; in the 2014 audit, 95.1%, 64.8% and 51.4%; and in 2015 audit, 96.4%, 82.1% and 92.8% of cases, respectively. In 2015, 76.8% of root canal fillings met all 3 technical quality criteria when compared to 48.6% in 2014 and 44.7% in 2012 (P = .001). Clinical audit-feedback cycle is an effective educational tool for improving dental undergraduates' compliance with record keeping and performance in the technical quality of RCT. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

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

Improving patient access to videofluoroscopy services: Role of the practitioner-led clinic

Energy Technology Data Exchange (ETDEWEB)

Newman, Roger D., E-mail: Roger.Newman@lthtr.nhs.uk [Dept. of Speech and Language Therapy, Lancashire Teaching Hospitals, Sharoe Green lane, Fulwood, Preston PR2 9HT (United Kingdom); University of Salford (United Kingdom); Nightingale, Julie [University of Salford (United Kingdom)

2011-11-15

Quality Issue: Although costly and time consuming, videofluoroscopic swallowing (VFS) examinations are the gold standard for imaging of oro-pharyngeal dysphagia, and demand is likely to increase with an ageing population. Traditional radiologist-led VFS services in the UK are gradually being replaced by practitioner-led clinics undertaken jointly by speech and language therapists and radiographers. This article explores the impact on patient access of a practitioner-led VFS clinic at a large teaching hospital. Initial Assessment: Specific information pertaining to VFS patient waiting times and service quality was collected for a twelve month period both pre- and post-clinic formation. Choice of Solution: Additional capacity was achieved with the introduction of the practitioner-led clinic, with overall patient access improving by 111%. Mean waiting times for in-patients reduced by 75%, many of whom had the procedure on the same day as referral, with out-patients waiting times reducing by 62.5%. Evaluation: The data demonstrates that patient access and report turnaround times are significantly improved, with no adverse effects as measured by inadequate studies, incorrect reports, complaints and documented radiation dose levels. Lessons Learnt: Practitioner-led VFS services can be recommended as a safe and efficient method of improving service provision.

Improving patient access to videofluoroscopy services: Role of the practitioner-led clinic

International Nuclear Information System (INIS)

Newman, Roger D.; Nightingale, Julie

2011-01-01

Quality Issue: Although costly and time consuming, videofluoroscopic swallowing (VFS) examinations are the gold standard for imaging of oro-pharyngeal dysphagia, and demand is likely to increase with an ageing population. Traditional radiologist-led VFS services in the UK are gradually being replaced by practitioner-led clinics undertaken jointly by speech and language therapists and radiographers. This article explores the impact on patient access of a practitioner-led VFS clinic at a large teaching hospital. Initial Assessment: Specific information pertaining to VFS patient waiting times and service quality was collected for a twelve month period both pre- and post-clinic formation. Choice of Solution: Additional capacity was achieved with the introduction of the practitioner-led clinic, with overall patient access improving by 111%. Mean waiting times for in-patients reduced by 75%, many of whom had the procedure on the same day as referral, with out-patients waiting times reducing by 62.5%. Evaluation: The data demonstrates that patient access and report turnaround times are significantly improved, with no adverse effects as measured by inadequate studies, incorrect reports, complaints and documented radiation dose levels. Lessons Learnt: Practitioner-led VFS services can be recommended as a safe and efficient method of improving service provision.

Improving patient access to an interventional US clinic.

Science.gov (United States)

Steele, Joseph R; Clarke, Ryan K; Terrell, John A; Brightmon, Tonya R

2014-01-01

A continuous quality improvement project was conducted to increase patient access to a neurointerventional ultrasonography (US) clinic. The clinic was experiencing major scheduling delays because of an increasing patient volume. A multidisciplinary team was formed that included schedulers, medical assistants, nurses, technologists, and physicians. The team created an Ishikawa diagram of the possible causes of the long wait time to the next available appointment and developed a flowchart of the steps involved in scheduling and completing a diagnostic US examination and biopsy. The team then implemented a staged intervention that included adjustments to staffing and room use (stage 1); new procedures for scheduling same-day add-on appointments (stage 2); and a lead technician rotation to optimize patient flow, staffing, and workflow (stage 3). Six months after initiation of the intervention, the mean time to the next available appointment had decreased from 25 days at baseline to 1 day, and the number of available daily appointments had increased from 38 to 55. These improvements resulted from a coordinated provider effort and had a net present value of more than $275,000. This project demonstrates that structural changes in staffing, workflow, and room use can substantially reduce scheduling delays for critical imaging procedures. © RSNA, 2014.

Alignment of the Measurement Scale Mark during Immersion Hydrometer Calibration Using an Image Processing System

OpenAIRE

Pe?a-Perez, Luis Manuel; Pedraza-Ortega, Jesus Carlos; Ramos-Arreguin, Juan Manuel; Arriaga, Saul Tovar; Fernandez, Marco Antonio Aceves; Becerra, Luis Omar; Hurtado, Efren Gorrostieta; Vargas-Soto, Jose Emilio

2013-01-01

The present work presents an improved method to align the measurement scale mark in an immersion hydrometer calibration system of CENAM, the National Metrology Institute (NMI) of Mexico, The proposed method uses a vision system to align the scale mark of the hydrometer to the surface of the liquid where it is immersed by implementing image processing algorithms. This approach reduces the variability in the apparent mass determination during the hydrostatic weighing in the calibration process,...

Improving clinical handover in a paediatric ward: implications for nursing management.

Science.gov (United States)

Mannix, Trudi; Parry, Yvonne; Roderick, Allison

2017-04-01

To describe how nursing staff in a paediatric ward improved the conduct of clinical handover, using a practise development approach. ISBAR (Identify, Situation, Background, Assessment and Recommendation) is a mnemonic tool to aid the safe transfer of patient information in clinical handover. The nurses identified the need to improve the use of ISBAR, and other issues related to handover that could compromise patient safety and constrain family-centred care. Sixty-one percent of nurses on the ward contributed to issue identification and the design of the educational material, including a set of written and video resources and incorporating the role of a handover coach. Staff performance was evaluated before and after access to the resources using self-administered Likert scales, observation and a focus group. After the intervention, there was a stronger relationship between the participants' understanding of ISBAR and their application of it in handover. Further, there were statistically significant increases in improved handover practises, including family inclusion and safety checks. A practise development approach is useful in the provision of education to guide clinical performance in patient handover. Nurse managers can use this approach to empower their staff to make positive changes to practise. © 2017 John Wiley & Sons Ltd.

An analysis of hospital brand mark clusters.

Science.gov (United States)

Vollmers, Stacy M; Miller, Darryl W; Kilic, Ozcan

2010-07-01

This study analyzed brand mark clusters (i.e., various types of brand marks displayed in combination) used by hospitals in the United States. The brand marks were assessed against several normative criteria for creating brand marks that are memorable and that elicit positive affect. Overall, results show a reasonably high level of adherence to many of these normative criteria. Many of the clusters exhibited pictorial elements that reflected benefits and that were conceptually consistent with the verbal content of the cluster. Also, many clusters featured icons that were balanced and moderately complex. However, only a few contained interactive imagery or taglines communicating benefits.

A nudge toward participation: Improving clinical trial enrollment with behavioral economics.

Science.gov (United States)

VanEpps, Eric M; Volpp, Kevin G; Halpern, Scott D

2016-07-20

Interventions informed by behavioral economics can address barriers to patient enrollment in clinical trials and improve recruitment efforts. Copyright © 2016, American Association for the Advancement of Science.

Assessment of follow-up sonography and clinical improvement among infants with congenital muscular torticollis.

Science.gov (United States)

Park, H-J; Kim, S S; Lee, S-Y; Lee, Y-T; Yoon, K; Chung, E-C; Rho, M-H; Kwag, H-J

2013-04-01

Infants grow rapidly, which causes the SCM to thicken physiologically. Therefore some cases of physiologically-thickened SCM can be confused with a poor response to physical therapy. There have been only a few quantitative ultrasonographic studies on the clinical outcome of rehabilitation for CMT. Our aim was to evaluate whether a new sonographic assessment method that uses the muscular thickness ratio of the SCM can help quantify the outcome of rehabilitation therapy for patients with CMT. We evaluated 48 patients (male/female, 17:31; mean age, 3.9 months) who were diagnosed with CMT and who underwent initial and follow-up sonography. The ratio of the thickness of the involved SCM to the thickness of the intact SCM (SCM thickness ratio) was calculated. A scoring system based on the range of motion of the neck was used to assess clinical improvement. The correlations between clinical improvement and the thickness of the involved muscle, the difference in involved muscle thickness, the SCM thickness ratio, and the difference in the SCM thickness ratio were evaluated with Spearman rank correlations. Follow-up Cheng scores were higher than initial scores; this difference indicates clinical resolution (follow-up, 4.90; initial, 3.38). The SCM thickness ratio at follow-up was lower than that at the initial evaluation (follow-up, 1.29-1.34; initial, 1.65-1.77). Intra- and interobserver agreements were excellent. Most variables were moderately correlated with clinical improvement (correlation coefficients, 0.36-0.509). R1 showed the highest correlation with clinical improvement (0.481 and 0.509), followed by the initial maximal thickness of the SCM (0.434 and 0.488). ΔP (P1-P2) and ΔR showed similar correlation coefficients with clinical improvement. Measurement of the SCM thickness ratio appears to overcome the problem of a false-positive diagnosis of clinical aggravation of CMT resulting from physiologic growth. R1 and ΔR are accurate objective measurements, which

Civilsamfundets ABC: M for Marked

DEFF Research Database (Denmark)

Lund, Anker Brink; Meyer, Gitte

2016-01-01

Bogstaveligt talt: Hvad er civilsamfundet? Anker Brink Lund og Gitte Meyer fra CBS Center for Civil Society Studies gennemgår civilsamfundet bogstav for bogstav. Vi er nået til M for Marked.......Bogstaveligt talt: Hvad er civilsamfundet? Anker Brink Lund og Gitte Meyer fra CBS Center for Civil Society Studies gennemgår civilsamfundet bogstav for bogstav. Vi er nået til M for Marked....

19 CFR 134.43 - Methods of marking specific articles.

Science.gov (United States)

2010-04-01

... 19 Customs Duties 1 2010-04-01 2010-04-01 false Methods of marking specific articles. 134.43...; DEPARTMENT OF THE TREASURY COUNTRY OF ORIGIN MARKING Method and Location of Marking Imported Articles § 134.43 Methods of marking specific articles. (a) Marking previously required by certain provisions of the...

Lessons learned : pavement marking warranty contract.

Science.gov (United States)

2013-12-01

In 2012, UDOT implemented a performance-based warranty on a portion of an I-15 pavement marking : project. The awarded contract requested a contractor warranty on the implemented markings for a total : duration of six years. This is the first time th...

Aerobic-Strength Exercise Improves Metabolism and Clinical State in Parkinson’s Disease Patients

Directory of Open Access Journals (Sweden)

Patrik Krumpolec

2017-12-01

Full Text Available Regular exercise ameliorates motor symptoms in Parkinson’s disease (PD. Here, we aimed to provide evidence that exercise brings additional benefits to the whole-body metabolism and skeletal muscle molecular and functional characteristics, which might help to explain exercise-induced improvements in the clinical state. 3-months supervised endurance/strength training was performed in early/mid-stage PD patients and age/gender-matched individuals (n = 11/11. The effects of exercise on resting energy expenditure (REE, glucose metabolism, adiposity, and muscle energy metabolism (31P-MRS were evaluated and compared to non-exercising PD patients. Two muscle biopsies were taken to determine intervention-induced changes in fiber type, mitochondrial content, and expression of genes related to muscle energy metabolism, as well as proliferative and regenerative capacity. Exercise improved the clinical disability score (MDS-UPDRS, bradykinesia, balance, walking speed, REE, and glucose metabolism and increased muscle expression of energy sensors (AMPK. However, the exercise-induced increase in muscle mass/strength, mitochondrial content, type II fiber size, and postexercise phosphocreatine (PCr recovery (31P-MRS were found only in controls. Nevertheless, MDS-UPDRS was associated with muscle AMPK and mechano-growth factor (MGF expression. Improvements in fasting glycemia were positively associated with muscle function and the expression of Sirt1 and Cox7a1, and the parameters of fitness/strength were positively associated with the expression of MyHC2, MyHC7, and MGF. Moreover, reduced bradykinesia was associated with better muscle metabolism (maximal oxidative capacity and postexercise PCr recovery; 31P-MRS. Exercise training improved the clinical state in early/mid-stage Parkinson’s disease patients, including motor functions and whole-body metabolism. Although the adaptive response to exercise in PD was different from that of controls, exercise

Integrating clinical performance improvement across physician organizations: the PhyCor experience.

Science.gov (United States)

Loeppke, R; Howell, J W

1999-02-01

There is a paucity of literature describing the implementation of clinical performance improvement (CPI) efforts across geographically dispersed multispecialty group practices and independent practice associations. PhyCor, a physician management company based in Nashville, Tennessee, has integrated CPI initiatives into its operating infrastructure. PhyCor CPI INITIATIVES: The strategic framework guiding PhyCor's CPI initiatives is built around a physician-driven, patient-centered model. Physician/administrator leadership teams develop and implement a clinical and financial strategic plan for performance improvement; adopt local clinical and operational performance indicators; and agree on and gain consensus with local physician champions to engage in CPI initiatives. The area/regional leadership councils integrate and coordinate regional medical management and CPI initiatives among local groups and independent practice associations. In addition to these councils and a national leadership council, condition-specific care management councils have also been established. These councils develop condition-specific protocols and outcome measures and lead the implementation of CPI initiatives at their own clinics. Key resources supporting CPI initiatives include information/knowledge management, education and training, and patient education and consumer decision support. Localized efforts in both the asthma care and diabetes management initiatives have led to some preliminary improvements in quality of care indicators. Physician leadership and strategic vision, CPI-oriented organizational infrastructure, broad-based physician involvement in CPI, providing access to performance data, parallel incentives, and creating a sense of urgency for accelerated change are all critical success factors to the implementation of CPI strategies at the local, regional, and national levels.

Minnesota Local Agency Pavement Marking : Mining Existing Data

Science.gov (United States)

2017-11-01

Pavement marking is important for safety. Maximizing pavement marking performance in terms of increased retroreflectivity, within limited budget constraints, allows agencies to make better decisions toward providing more effective pavement marking pe...

Appointment Template Redesign in a Women's Health Clinic Using Clinical Constraints to Improve Service Quality and Efficiency.

Science.gov (United States)

Huang, Y; Verduzco, S

2015-01-01

Patient wait time is a critical element of access to care that has long been recognized as a major problem in modern outpatient health care delivery systems. It impacts patient and medical staff productivity, stress, quality and efficiency of medical care, as well as health-care cost and availability. This study was conducted in a Women's Health Clinic. The objective was to improve clinic service quality by redesigning patient appointment template using the clinical constraints. The proposed scheduling template consisted of two key elements: the redesign of appointment types and the determination of the length of time slots using defined constraints. The re-classification technique was used for the redesign of appointment visit types to capture service variation for scheduling purposes. Then, the appointment length was determined by incorporating clinic constraints or goals, such as patient wait time, physician idle time, overtime, finish time, lunch hours, when the last appointment was scheduled, and the desired number of appointment slots, to converge the optimal length of appointment slots for each visit type. The redesigned template was implemented and the results indicated a 73% reduction in average patient waiting from the reported 40 to 11 minutes. The patient no-show rate was reduced by 4% from 24% to 20%. The morning section on average finished about 11:50 am. The clinic day was finished around 4:45 pm. Provider average idle time was estimated to be about 5 minutes, which can be used for charting/documenting patients. This study provided an alternative method of redesigning appointment scheduling templates using only the clinical constraints rather than the traditional way that required an objective function. This paper also documented the employed methods step by step in a real clinic setting. The implementation results concluded a significant improvement on patient wait time and no-show rate.

A Public-Private Partnership Improves Clinical Performance In A Hospital Network In Lesotho.

Science.gov (United States)

McIntosh, Nathalie; Grabowski, Aria; Jack, Brian; Nkabane-Nkholongo, Elizabeth Limakatso; Vian, Taryn

2015-06-01

Health care public-private partnerships (PPPs) between a government and the private sector are based on a business model that aims to leverage private-sector expertise to improve clinical performance in hospitals and other health facilities. Although the financial implications of such partnerships have been analyzed, few studies have examined the partnerships' impact on clinical performance outcomes. Using quantitative measures that reflected capacity, utilization, clinical quality, and patient outcomes, we compared a government-managed hospital network in Lesotho, Africa, and the new PPP-managed hospital network that replaced it. In addition, we used key informant interviews to help explain differences in performance. We found that the PPP-managed network delivered more and higher-quality services and achieved significant gains in clinical outcomes, compared to the government-managed network. We conclude that health care public-private partnerships may improve hospital performance in developing countries and that changes in management and leadership practices might account for differences in clinical outcomes. Project HOPE—The People-to-People Health Foundation, Inc.

Mark Twain: inocente ou pecador? = Mark Twain: innocent or sinner?

Directory of Open Access Journals (Sweden)

Heloisa Helou Doca

2009-01-01

Full Text Available A leitura cuidadosa do texto do “Tratado de Paris”, em 1900, leva Mark Twain a concluir que a intenção política norte-americana era, claramente, a de subjugação. Declara-se, abertamente, antiimperialista, nesse momento, apesar das inúmeras críticasrecebidas por antagonistas políticos que defendiam o establishment dos Estados Unidos. Após viajar para a Europa e Oriente, em 1867, como correspondente do jornal Daily Alta Califórnia, Mark Twain publica, em 1869, seu relato de viagem, The Innocents Abroad or TheNew Pilgrim’s Progress. Nosso estudo demonstra que o autor, apesar das diversas máscaras usadas em seus relatos, narra histórias, culturas e tradições, tanto da Europa quanto do Oriente, já com os olhos bem abertos pelo viés antiimperialista. Faz uso da paródia, sátira, ironia e humor para dessacralizar impérios, monarcas e a Igreja que subjugavam os mais fracos, iluminando, desde então, os estudos sobre culturas. Nosso estudo, outrossim, faz uma reflexão sobre cultura, tradição e o olhar do viajante, justificando o “olhar inocente” do narrador em seu relato.After carefully reading the Treaty of Paris in 1900, Mark Twain concluded that the goal of U.S. policy was clearly one ofsubjugation. He openly declared himself an anti-imperialist at that time, in spite of the numerous criticisms he received from political opponents who supported the United States status quo. After traveling to Europe and the East in 1867 as a correspondent for The DailyAlta California newspaper, Mark Twain published his travel report, The Innocents Abroad or The New Pilgrim’s Progress in 1869. Our study demonstrates that the author, in spite of using different guises in his reports, narrated histories, cultures and traditions – from both Europe and the East – with a viewpoint already imbued by his anti-imperialistic ideals. Twain made use of parody, satire, irony and humor within his texts in order to desecrate empires,monarchs and

Measures to Improve Diagnostic Safety in Clinical Practice.

Science.gov (United States)

Singh, Hardeep; Graber, Mark L; Hofer, Timothy P

2016-10-20

Timely and accurate diagnosis is foundational to good clinical practice and an essential first step to achieving optimal patient outcomes. However, a recent Institute of Medicine report concluded that most of us will experience at least one diagnostic error in our lifetime. The report argues for efforts to improve the reliability of the diagnostic process through better measurement of diagnostic performance. The diagnostic process is a dynamic team-based activity that involves uncertainty, plays out over time, and requires effective communication and collaboration among multiple clinicians, diagnostic services, and the patient. Thus, it poses special challenges for measurement. In this paper, we discuss how the need to develop measures to improve diagnostic performance could move forward at a time when the scientific foundation needed to inform measurement is still evolving. We highlight challenges and opportunities for developing potential measures of "diagnostic safety" related to clinical diagnostic errors and associated preventable diagnostic harm. In doing so, we propose a starter set of measurement concepts for initial consideration that seem reasonably related to diagnostic safety and call for these to be studied and further refined. This would enable safe diagnosis to become an organizational priority and facilitate quality improvement. Health-care systems should consider measurement and evaluation of diagnostic performance as essential to timely and accurate diagnosis and to the reduction of preventable diagnostic harm.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

Do employers prefer Mark over Mohammed?

NARCIS (Netherlands)

Iris Andriessen; Eline Nievers; Laila Faulk; Jaco Dagevos

2010-01-01

Original title: Liever Mark dan Mohammed? Does Mohammed have less chance of succeeding on the Dutch labour market than Mark, even though they both have the same qualifications and work experience? And are employers less friendly towards Sonaya than Paula? This study investigates the

Lean six sigma methodologies improve clinical laboratory efficiency and reduce turnaround times.

Science.gov (United States)

Inal, Tamer C; Goruroglu Ozturk, Ozlem; Kibar, Filiz; Cetiner, Salih; Matyar, Selcuk; Daglioglu, Gulcin; Yaman, Akgun

2018-01-01

Organizing work flow is a major task of laboratory management. Recently, clinical laboratories have started to adopt methodologies such as Lean Six Sigma and some successful implementations have been reported. This study used Lean Six Sigma to simplify the laboratory work process and decrease the turnaround time by eliminating non-value-adding steps. The five-stage Six Sigma system known as define, measure, analyze, improve, and control (DMAIC) is used to identify and solve problems. The laboratory turnaround time for individual tests, total delay time in the sample reception area, and percentage of steps involving risks of medical errors and biological hazards in the overall process are measured. The pre-analytical process in the reception area was improved by eliminating 3 h and 22.5 min of non-value-adding work. Turnaround time also improved for stat samples from 68 to 59 min after applying Lean. Steps prone to medical errors and posing potential biological hazards to receptionists were reduced from 30% to 3%. Successful implementation of Lean Six Sigma significantly improved all of the selected performance metrics. This quality-improvement methodology has the potential to significantly improve clinical laboratories. © 2017 Wiley Periodicals, Inc.

[Werkgartner's muzzle imprint mark--a literature study].

Science.gov (United States)

Geserick, Gunther; Vendura, Klaus; Wirth, Ingo

2009-01-01

Since Werkgartner described and correctly interpreted the muzzle imprint mark around the gunshot entrance wound in 1922, this finding has been generally accepted as a sign of a contact shot. In further studies, it could finally be clarified that the muzzle imprint mark is caused by the expansive power of the powder gases with pressure on and abrasion of the skin at the muzzle (weapon imprint). Its shape depends on the firearm, the ammunition and the anatomical conditions, but does not require a bullet. Examinations under a magnifying glass microscope and histological investigations can complete the macroscopic findings. Occasionally, the muzzle imprint mark requires a certain "drying period" in order to become clearly visible. In rare cases, muzzle imprint marks also form on textiles perforated by the projectile. Characteristically shaped muzzled imprint marks can provide clues to the type of the firearm and its position at the time of discharge.

19 CFR 11.9 - Special marking on certain articles.

Science.gov (United States)

2010-04-01

... 19 Customs Duties 1 2010-04-01 2010-04-01 false Special marking on certain articles. 11.9 Section... OF THE TREASURY PACKING AND STAMPING; MARKING Marking § 11.9 Special marking on certain articles. (a... of additional U.S. Note 4, Chapter 91. If any article so required to be marked is found not to be...

Alignment of the measurement scale mark during immersion hydrometer calibration using an image processing system.

Science.gov (United States)

Peña-Perez, Luis Manuel; Pedraza-Ortega, Jesus Carlos; Ramos-Arreguin, Juan Manuel; Arriaga, Saul Tovar; Fernandez, Marco Antonio Aceves; Becerra, Luis Omar; Hurtado, Efren Gorrostieta; Vargas-Soto, Jose Emilio

2013-10-24

The present work presents an improved method to align the measurement scale mark in an immersion hydrometer calibration system of CENAM, the National Metrology Institute (NMI) of Mexico, The proposed method uses a vision system to align the scale mark of the hydrometer to the surface of the liquid where it is immersed by implementing image processing algorithms. This approach reduces the variability in the apparent mass determination during the hydrostatic weighing in the calibration process, therefore decreasing the relative uncertainty of calibration.

Computer aided design (CAD) for electronics improvement of the nuclear channels of TRIGA Mark III reactor of the ININ; Diseno asistido por computadora (DAC) para mejorar la electronica de los canales nucleares del reactor TRIGA Mark III del ININ

Energy Technology Data Exchange (ETDEWEB)

Gonzalez M, J.L.; Rivero G, T.; Aguilar H, F. [ININ, 52750 La Marquesa, Estado de Mexico (Mexico)]. e-mail: jlgm@nuclear.inin.mx

2007-07-01

The 4 neutron measurement channels of the digital control console (CCD) of the TRIGA Mark III reactor (RTMIII) of the ININ, its were designed and built with the corresponding Quality Guarantee program, being achieved the one licensing to replace the old console. With the time they were carried out some changes to improve and to not solve some problems detected in the tests, verification and validation, requiring to modify the circuits originally designed. In this work the corrective actions carried out to eliminate the Non Conformity generated by these problems, being mentioned the advantages of using modern tools, as the software applied to the Attended Engineering by Computer, and those obtained results are presented. (Author)

49 CFR 178.338-18 - Marking.

Science.gov (United States)

2010-10-01

... pounds. (7) Maximum design density of lading (Max. Lading density), in pounds per gallon. (8) Material... cryogenic liquid, in hours, and the name of that cryogenic liquid (MRHT __ hrs, name of cryogenic liquid). Marked rated holding marking for additional cryogenic liquids may be displayed on or adjacent to the...

7 CFR 956.162 - Container markings.

Science.gov (United States)

2010-01-01

... 7 Agriculture 8 2010-01-01 2010-01-01 false Container markings. 956.162 Section 956.162... WALLA VALLEY OF SOUTHEAST WASHINGTON AND NORTHEAST OREGON Rules and Regulations § 956.162 Container markings. Effective April 15, 1997, no handler shall ship any container of Walla Walla Sweet Onions except...

Differential Signature of the Centrosomal MARK4 Isoforms in Glioma

Directory of Open Access Journals (Sweden)

Ivana Magnani

2011-01-01

Full Text Available Background: MAP/microtubule affinity-regulating kinase 4 (MARK4 is a serine-threonine kinase expressed in two spliced isoforms, MARK4L and MARK4S, of which MARK4L is a candidate for a role in neoplastic transformation. Methods: We performed mutation analysis to identify sequence alterations possibly affecting MARK4 expression. We then investigated the MARK4L and MARK4S expression profile in 21 glioma cell lines and 36 tissues of different malignancy grades, glioblastoma-derived cancer stem cells (GBM CSCs and mouse neural stem cells (NSCs by real-time PCR, immunoblotting and immunohistochemistry. We also analyzed the sub-cellular localisation of MARK4 isoforms in glioma and normal cell lines by immunofluorescence. Results: Mutation analysis rules out sequence variations as the cause of the altered MARK4 expression in glioma. Expression profiling confirms that MARK4L is the predominant isoform, whereas MARK4S levels are significantly decreased in comparison and show an inverse correlation with tumour grade. A high MARK4L/MARK4S ratio also characterizes undifferentiated cells, such as GBM CSCs and NSCs. Accordingly, only MARK4L is expressed in brain neurogenic regions. Moreover, while both MARK4 isoforms are localised to the centrosome and midbody in glioma and normal cells, the L isoform exhibits an additional nucleolar localisation in tumour cells. Conclusions: The observed switch towards MARK4L suggests that the balance between the MARK4 isoforms is carefully guarded during neural differentiation but may be subverted in gliomagenesis. Moreover, the MARK4L nucleolar localisation in tumour cells features this MARK4 isoform as a nucleolus-associated tumour marker.

Contrast enhancement of bite mark images using the grayscale mixer in ACR in Photoshop®.

Science.gov (United States)

Evans, Sam; Noorbhai, Suzanne; Lawson, Zoe; Stacey-Jones, Seren; Carabott, Romina

2013-05-01

Enhanced images may improve bite mark edge definition, assisting forensic analysis. Current contrast enhancement involves color extraction, viewing layered images by channel. A novel technique, producing a single enhanced image using the grayscale mix panel within Adobe Camera Raw®, has been developed and assessed here, allowing adjustments of multiple color channels simultaneously. Stage 1 measured RGB values in 72 versions of a color chart image; eight sliders in Photoshop® were adjusted at 25% intervals, all corresponding colors affected. Stage 2 used a bite mark image, and found only red, orange, and yellow sliders had discernable effects. Stage 3 assessed modality preference between color, grayscale, and enhanced images; on average, the 22 survey participants chose the enhanced image as better defined for nine out of 10 bite marks. The study has shown potential benefits for this new technique. However, further research is needed before use in the analysis of bite marks. © 2013 American Academy of Forensic Sciences.

Coronary artery anomalies and clinically important anatomy in patients with congenital heart disease: multislice CT findings

International Nuclear Information System (INIS)

Goo, Hyun Woo; Seo, Dong-Man; Yun, Tae-Jin; Park, Jeong-Jun; Park, In-Sook; Ko, Jae Kon; Kim, Young Hwee

2009-01-01

In patients with congenital heart disease, coronary artery anomalies are common and have different clinical importance from individuals with structurally normal hearts. Visibility of the coronary arteries by CT has markedly improved due to high temporal resolution and ECG-synchronized data acquisition. In this article we describe current multislice CT techniques for coronary artery imaging and illustrate coronary artery anomalies and clinically important coronary artery anatomy from the point of view of congenital heart disease. (orig.)

Coronary artery anomalies and clinically important anatomy in patients with congenital heart disease: multislice CT findings

Energy Technology Data Exchange (ETDEWEB)

Goo, Hyun Woo [University of Ulsan College of Medicine, Department of Radiology and Research Institute of Radiology, Asan Medical Center, Seoul (Korea); Seo, Dong-Man; Yun, Tae-Jin; Park, Jeong-Jun [University of Ulsan College of Medicine, Department of Pediatric Cardiac Surgery, Asan Medical Center, Seoul (Korea); Park, In-Sook; Ko, Jae Kon; Kim, Young Hwee [University of Ulsan College of Medicine, Department of Pediatric Cardiology, Asan Medical Center, Seoul (Korea)

2009-03-15

In patients with congenital heart disease, coronary artery anomalies are common and have different clinical importance from individuals with structurally normal hearts. Visibility of the coronary arteries by CT has markedly improved due to high temporal resolution and ECG-synchronized data acquisition. In this article we describe current multislice CT techniques for coronary artery imaging and illustrate coronary artery anomalies and clinically important coronary artery anatomy from the point of view of congenital heart disease. (orig.)

Marks on the petroleum fiscality

International Nuclear Information System (INIS)

2007-02-01

This document offers some marks on the petroleum fiscality in France: the taxes as the 'accises' and the 'TVA', the part of the taxes in the sale price at the service station, the comparison with other countries of Europe, the tax revenues and the Government budget. It provides also marks on the fuels prices formation (margins), the world petroleum markets (supply and demand) and the part of the petroleum companies on the petroleum market. (A.L.B.)

14 CFR 1203.501 - Applying derivative classification markings.

Science.gov (United States)

2010-01-01

... INFORMATION SECURITY PROGRAM Derivative Classification § 1203.501 Applying derivative classification markings. Persons who apply derivative classification markings shall: (a) Observe and respect original... 14 Aeronautics and Space 5 2010-01-01 2010-01-01 false Applying derivative classification markings...

Marked improvements in outcomes of contemporary percutaneous coronary intervention in patients with diabetes mellitus.

Science.gov (United States)

Freeman, Andrew M; Abbott, J Dawn; Jacobs, Alice K; Vlachos, Helen A; Selzer, Faith; Laskey, Warren K; Detre, Katherine M; Williams, David O

2006-12-01

We sought to determine if advances in percutaneous coronary intervention (PCI) are associated with better outcomes among patients with diabetes mellitus (DM). Patients with DM enrolled in the National Heart, Lung, and Blood Institute (NHLBI) early PTCA Registry (1985-1986) were compared to those in the subsequent contemporary Dynamic Registry (1999-2002) for in-hospital and one-year cardiovascular outcomes. The study population included 945 adults with DM, 325 from the PTCA Registry and 620 from the Dynamic Registry. Multivariable Cox regression models were built to estimate the risk of clinical events. Dynamic Registry patients were older, had more noncardiac comorbidities, and a lower mean ejection fraction (50.5% vs 57.8%, P diabetes had more advanced coronary disease, in-hospital and late adverse events were lower. A combination of the use of stents and an increase in adjunctive medical therapy are likely responsible for the observed improvements in outcomes in contemporary PCI.

Aluminum-Oxide Temperatures on the Mark VB, VE, VR, 15, and Mark 25 Assemblies

International Nuclear Information System (INIS)

Aleman, S.E.

2001-01-01

The task was to compute the maximum aluminum-oxide and oxide-coolant temperatures of assemblies cladded in 99+ percent aluminum. The assemblies considered were the Mark VB, VE, V5, 15 and 25. These assemblies consist of nested slug columns with individual uranium slugs cladded in aluminum cans. The CREDIT code was modified to calculate the oxide film thickness and the aluminum-oxide temperature at each axial increment. This information in this report will be used to evaluate the potential for cladding corrosion of the Mark 25 assembly

Clinical and immunohistochemical comparative study of the efficacy of carboxytherapy vs platelet-rich plasma in treatment of stretch marks.

Science.gov (United States)

Hodeib, Abeer A; Hassan, Ghada F R; Ragab, Marwa N M; Hasby, Eiman A

2018-01-07

Striae distensae are dermal scars with a linear atrophic depression. The exact origin of striae distensae remains unrevealed, but low expression of collagen and fibronectin genes in the affected tissue was found. Several treatment modalities have been proposed, yet no consistent modality is available. To evaluate and compare the efficacy and safety of carboxytherapy vs platelet-rich plasma (PRP) in treatment of stretch marks. This study included 20 patients with striae alba. Every patient received treatment in the form of PRP injection in their right side (group A) and carboxytherapy session in their left side (group B) every 3-4 weeks for 4 sessions. Skin biopsies were taken before and after treatment, and they were subjected to fibronectin immunohistochemical stain. There was a significant improvement in striae alba in both groups after than before treatment. There was no significant difference between both groups as regards either percentage of improvement, response (grading scale), or patient satisfaction. The fibronectin-stained area was significantly higher in both groups after than before treatment, and it was significantly higher after treatment in group (B) than group (A). Both methods were safe and effective with minimal side effects. There was no significant difference between both methods of treatments. This was confirmed histopathologically by fibronectin expression which is found to be low in striae and increased significantly after treatment. But fibronectin expression was higher in group (B) than (A). © 2018 Wiley Periodicals, Inc.

Does clinical supervision of healthcare professionals improve effectiveness of care and patient experience? A systematic review.

Science.gov (United States)

Snowdon, David A; Leggat, Sandra G; Taylor, Nicholas F

2017-11-28

To ensure quality of care delivery clinical supervision has been implemented in health services. While clinical supervision of health professionals has been shown to improve patient safety, its effect on other dimensions of quality of care is unknown. The purpose of this systematic review is to determine whether clinical supervision of health professionals improves effectiveness of care and patient experience. Databases MEDLINE, PsychINFO, CINAHL, EMBASE and AMED were searched from earliest date available. Additional studies were identified by searching of reference lists and citation tracking. Two reviewers independently applied inclusion and exclusion criteria. The quality of each study was rated using the Medical Education Research Study Quality Instrument. Data were extracted on effectiveness of care (process of care and patient health outcomes) and patient experience. Seventeen studies across multiple health professions (medical (n = 4), nursing (n = 7), allied health (n = 2) and combination of nursing, medical and/or allied health (n = 4)) met the inclusion criteria. The clinical heterogeneity of the included studies precluded meta-analysis. Twelve of 14 studies investigating 38,483 episodes of care found that clinical supervision improved the process of care. This effect was most predominant in cardiopulmonary resuscitation and African health settings. Three of six studies investigating 1756 patients found that clinical supervision improved patient health outcomes, namely neurological recovery post cardiopulmonary resuscitation (n = 1) and psychological symptom severity (n = 2). None of three studies investigating 1856 patients found that clinical supervision had an effect on patient experience. Clinical supervision of health professionals is associated with effectiveness of care. The review found significant improvement in the process of care that may improve compliance with processes that are associated with enhanced patient health

Unusual idiopathic normal pressure hydrocephalus patient with marked asymmetric and upper body parkinsonism

Directory of Open Access Journals (Sweden)

Kyunghun Kang

2016-01-01

Full Text Available Asymmetry of parkinsonian symptoms is strong evidence toward the diagnosis of Parkinson's disease (PD. Lower body parkinsonism is characteristic in idiopathic normal pressure hydrocephalus (INPH. We report an unusual INPH patient with marked asymmetric and upper body parkinsonism. An 83-year-old man presented with gait impairment and asymmetric clumsiness of movement. According to the Unified Parkinson's Disease Rating Scale (UPDRS, the motor subscore was 12 in the left limb and 8 in the right. The score was 14 for both the upper and lower body. After the cerebrospinal fluid tap test (CSFTT, he showed marked improvement in the upper body score. A loss of asymmetry of parkinsonian signs, with greater improvement in the left limb, was presented. Fluorinated N-3-fluoropropyl-2β-carbomethoxy-3β-(4-iodophenyl-nortropane (F-18 FP-CIT positron emission tomography (PET imaging was normal. In the differential diagnosis of elderly patients presenting with parkinsonism compatible with PD, we might need to consider a diagnosis of INPH.

Improving resident well-being and clinical learning environment through academic initiatives.

Science.gov (United States)

Lee, Nathaniel; Appelbaum, Nital; Amendola, Michael; Dodson, Kelley; Kaplan, Brian

2017-07-01

Organizational effects on job satisfaction, burnout, work-life balance, and perceived support have not been studied in the context of the clinical learning environment. We evaluated the relationship between academic resources and resident well-being, the clinical learning environment, and in-service examination performance of surgical residents. Residents of general surgery and surgical specialty programs were recruited from March 2016 through June 2016 across the Southeast, Mid-Atlantic, and Northeast regions. Program directors were asked to allow distribution of a paper survey or to forward an electronic survey link onto residents. Five dichotomous questions were asked regarding access to academic resources. Validated measures were obtained assessing resident well-being and perceived clinical learning environment. Data were analyzed through t-tests and chi-squared test of independence. We received 276 respondents across 50 programs. Residents perceiving adequate support to succeed had less burnout (P = 0.008), better resilience (P = 0.009), better job satisfaction (P workplace climate (P < 0.001), better organizational support (P < 0.001), and were more likely to have high performance on the in-service examination (P = 0.001). Specific resources including educational stipends, review questions, in-service board prep, and support for poor performers correlated with improved well-being and perceived clinical learning environment. Provision of academic resources has implications beyond in-service examination performance, correlating with improved resident well-being and perceptions of the clinical learning environment. Copyright © 2017 Elsevier Inc. All rights reserved.

Diverse and participative learning methodologies: a remedial teaching intervention for low marks dental students in Chile.

Science.gov (United States)

Alcota, Marcela; Muñoz, Andrea; González, Fermín E

2011-10-01

The purpose of this educational intervention was to diagnose the learning style of a group of low marks (i.e., grades) dental students in Chile and improve their academic achievement by means of remedial teaching. The intervention group was composed of ten students in endodontics and eleven in pedodontics with low marks. These two groups were mutually exclusive. The Kolb test of learning styles was applied to the low mark students group and to the rest of the class (n=72). Diverse methodologies were applied to the low marks students, such as seminars, case-based learning and problem-based learning, directed study, plenary discussions and debate, integration and questions, and web-based learning in an effort to cover all learning styles. Students' perceptions of the educational intervention were assessed by means of a questionnaire. The learning styles of the low marks group were mainly divergent (52.4 percent) and convergent (19 percent). Accommodators and assimilators were 14.3 percent each. The rest of the class showed a very distinct frequencies distribution: divergent 18 percent, convergent 20 percent, accommodators 28 percent, and assimilators 34 percent. After the educational intervention, the mean of the scores obtained by the intervention group in formal evaluations was higher than the average scores obtained before the intervention for both courses. Students' perceptions of the activities were that they were effective for their learning process (76 percent) and that the teaching methodologies were useful mainly to clarify concepts and contents from both courses (82 percent). We can conclude that the use of diverse and participative teaching methodologies in a remedial teaching intervention, to cover all the different learning styles of the students, contributes to improve their marks in formal evaluations.

Alignment of the Measurement Scale Mark during Immersion Hydrometer Calibration Using an Image Processing System

Directory of Open Access Journals (Sweden)

Jose Emilio Vargas-Soto

2013-10-01

Full Text Available The present work presents an improved method to align the measurement scale mark in an immersion hydrometer calibration system of CENAM, the National Metrology Institute (NMI of Mexico, The proposed method uses a vision system to align the scale mark of the hydrometer to the surface of the liquid where it is immersed by implementing image processing algorithms. This approach reduces the variability in the apparent mass determination during the hydrostatic weighing in the calibration process, therefore decreasing the relative uncertainty of calibration.

Alignment of the Measurement Scale Mark during Immersion Hydrometer Calibration Using an Image Processing System

Science.gov (United States)

Peña-Perez, Luis Manuel; Pedraza-Ortega, Jesus Carlos; Ramos-Arreguin, Juan Manuel; Arriaga, Saul Tovar; Fernandez, Marco Antonio Aceves; Becerra, Luis Omar; Hurtado, Efren Gorrostieta; Vargas-Soto, Jose Emilio

2013-01-01

The present work presents an improved method to align the measurement scale mark in an immersion hydrometer calibration system of CENAM, the National Metrology Institute (NMI) of Mexico, The proposed method uses a vision system to align the scale mark of the hydrometer to the surface of the liquid where it is immersed by implementing image processing algorithms. This approach reduces the variability in the apparent mass determination during the hydrostatic weighing in the calibration process, therefore decreasing the relative uncertainty of calibration. PMID:24284770

Reversibility of ventricular dysfunction: clinical experience in a medical office

Directory of Open Access Journals (Sweden)

Antonio Carlos Pereira Barretto

2001-12-01

Full Text Available OBJECTIVE - To describe clinical observations of marked improvement in ventricular dysfunction in a medical office environment under circumstances differing from those in study protocols and multicenter studies performed in hospital or with outpatient cohorts. METHODS - Eleven cardiac failure patients with marked ventricular dysfunction receiving treatment at a doctors office between 1994 and 1999 were studied. Their ages ranged from 20 and 66 years (mean 39.42±14.05 years; 7 patients were men, 4 were women. Cardiopathic etiologies were arterial hypertension in 5 patients, peripartum cardiomyopathy in 2, nondefined myocarditis in 2, and alcoholic cardiomyopathy in 4. Initial echocardiograms revealed left ventricular dilatation (average diastolic diameter, 69.45±8.15mm, reduced left ventricular ejection fraction (0.38±0.08 and left atrial dilatation (43.36±5.16mm. The therapeutic approach followed consisted of patient orientation, elimination of etiological or causal factors of cardiac failure, and prescription of digitalis, diuretics, and angiotensinconverting enzyme inhibitors. RESULTS - Following treatment, left ventricular ejection fraction changed to 0.63±0.09; left ventricular diameters changed to 57.18±8.13mm, and left atrium diameters changed to 37.27±8.05mm. Maximum improvement was noted after 16.9±8.63 (6 to 36 months. CONCLUSION - Patients with serious cardiac failure and ventricular dysfunction caused by hypertension, alcoholism, or myocarditis can experience marked improvement in ventricular dysfunction after undergoing appropriate therapy within the venue of the doctor's office.

Exploiting automatically generated databases of traffic signs and road markings for contextual co-occurrence analysis

Science.gov (United States)

Hazelhoff, Lykele; Creusen, Ivo M.; Woudsma, Thomas; de With, Peter H. N.

2015-11-01

Combined databases of road markings and traffic signs provide a complete and full description of the present traffic legislation and instructions. Such databases contribute to efficient signage maintenance, improve navigation, and benefit autonomous driving vehicles. A system is presented for the automated creation of such combined databases, which additionally investigates the benefit of this combination for automated contextual placement analysis. This analysis involves verification of the co-occurrence of traffic signs and road markings to retrieve a list of potentially incorrectly signaled (and thus potentially unsafe) road situations. This co-occurrence verification is specifically explored for both pedestrian crossings and yield situations. Evaluations on 420 km of road have shown that individual detection of traffic signs and road markings denoting these road situations can be performed with accuracies of 98% and 85%, respectively. Combining both approaches shows that over 95% of the pedestrian crossings and give-way situations can be identified. An exploration toward additional co-occurrence analysis of signs and markings shows that inconsistently signaled situations can successfully be extracted, such that specific safety actions can be directed toward cases lacking signs or markings, while most consistently signaled situations can be omitted from this analysis.

Does adding clinical data to administrative data improve agreement among hospital quality measures?

Science.gov (United States)

Hanchate, Amresh D; Stolzmann, Kelly L; Rosen, Amy K; Fink, Aaron S; Shwartz, Michael; Ash, Arlene S; Abdulkerim, Hassen; Pugh, Mary Jo V; Shokeen, Priti; Borzecki, Ann

2017-09-01

Hospital performance measures based on patient mortality and readmission have indicated modest rates of agreement. We examined if combining clinical data on laboratory tests and vital signs with administrative data leads to improved agreement with each other, and with other measures of hospital performance in the nation's largest integrated health care system. We used patient-level administrative and clinical data, and hospital-level data on quality indicators, for 2007-2010 from the Veterans Health Administration (VA). For patients admitted for acute myocardial infarction (AMI), heart failure (HF) and pneumonia we examined changes in hospital performance on 30-d mortality and 30-d readmission rates as a result of adding clinical data to administrative data. We evaluated whether this enhancement yielded improved measures of hospital quality, based on concordance with other hospital quality indicators. For 30-d mortality, data enhancement improved model performance, and significantly changed hospital performance profiles; for 30-d readmission, the impact was modest. Concordance between enhanced measures of both outcomes, and with other hospital quality measures - including Joint Commission process measures, VA Surgical Quality Improvement Program (VASQIP) mortality and morbidity, and case volume - remained poor. Adding laboratory tests and vital signs to measure hospital performance on mortality and readmission did not improve the poor rates of agreement across hospital quality indicators in the VA. Efforts to improve risk adjustment models should continue; however, evidence of validation should precede their use as reliable measures of quality. Published by Elsevier Inc.

Integrating utilization-focused evaluation with business process modeling for clinical research improvement.

Science.gov (United States)

Kagan, Jonathan M; Rosas, Scott; Trochim, William M K

2010-10-01

New discoveries in basic science are creating extraordinary opportunities to design novel biomedical preventions and therapeutics for human disease. But the clinical evaluation of these new interventions is, in many instances, being hindered by a variety of legal, regulatory, policy and operational factors, few of which enhance research quality, the safety of study participants or research ethics. With the goal of helping increase the efficiency and effectiveness of clinical research, we have examined how the integration of utilization-focused evaluation with elements of business process modeling can reveal opportunities for systematic improvements in clinical research. Using data from the NIH global HIV/AIDS clinical trials networks, we analyzed the absolute and relative times required to traverse defined phases associated with specific activities within the clinical protocol lifecycle. Using simple median duration and Kaplan-Meyer survival analysis, we show how such time-based analyses can provide a rationale for the prioritization of research process analysis and re-engineering, as well as a means for statistically assessing the impact of policy modifications, resource utilization, re-engineered processes and best practices. Successfully applied, this approach can help researchers be more efficient in capitalizing on new science to speed the development of improved interventions for human disease.

Serviceable pavement marking retroreflectivity levels : technical report.

Science.gov (United States)

2009-03-01

This research addressed an array of issues related to measuring pavement markings retroreflectivity, factors : related to pavement marking performance, subjective evaluation process, best practices for using mobile : retroreflectometers, sampling pav...

Transforming clinical practice guidelines and clinical pathways into fast-and-frugal decision trees to improve clinical care strategies.

Science.gov (United States)

Djulbegovic, Benjamin; Hozo, Iztok; Dale, William

2018-02-27

Contemporary delivery of health care is inappropriate in many ways, largely due to suboptimal Q5 decision-making. A typical approach to improve practitioners' decision-making is to develop evidence-based clinical practice guidelines (CPG) by guidelines panels, who are instructed to use their judgments to derive practice recommendations. However, mechanisms for the formulation of guideline judgments remains a "black-box" operation-a process with defined inputs and outputs but without sufficient knowledge of its internal workings. Increased explicitness and transparency in the process can be achieved by implementing CPG as clinical pathways (CPs) (also known as clinical algorithms or flow-charts). However, clinical recommendations thus derived are typically ad hoc and developed by experts in a theory-free environment. As any recommendation can be right (true positive or negative), or wrong (false positive or negative), the lack of theoretical structure precludes the quantitative assessment of the management strategies recommended by CPGs/CPs. To realize the full potential of CPGs/CPs, they need to be placed on more solid theoretical grounds. We believe this potential can be best realized by converting CPGs/CPs within the heuristic theory of decision-making, often implemented as fast-and-frugal (FFT) decision trees. This is possible because FFT heuristic strategy of decision-making can be linked to signal detection theory, evidence accumulation theory, and a threshold model of decision-making, which, in turn, allows quantitative analysis of the accuracy of clinical management strategies. Fast-and-frugal provides a simple and transparent, yet solid and robust, methodological framework connecting decision science to clinical care, a sorely needed missing link between CPGs/CPs and patient outcomes. We therefore advocate that all guidelines panels express their recommendations as CPs, which in turn should be converted into FFTs to guide clinical care. © 2018 John Wiley

["Practical clinical competence" - a joint programme to improve training in surgery].

Science.gov (United States)

Ruesseler, M; Schill, A; Stibane, T; Damanakis, A; Schleicher, I; Menzler, S; Braunbeck, A; Walcher, F

2013-12-01

Practical clinical competence is, as a result of the complexity of the required skills and the immediate consequences of their insufficient mastery, fundamentally important for undergraduate medical education. However, in the daily clinical routine, undergraduate training competes with patient care and experimental research, mostly to the disadvantage of the training of clinical skills and competencies. All students have to spend long periods in compulsory surgical training courses during their undergraduate studies. Thus, surgical undergraduate training is predestined to exemplarily develop, analyse and implement a training concept comprising defined learning objectives, elaborated teaching materials, analysed teaching methods, as well as objective and reliable assessment methods. The aim of this project is to improve and strengthen undergraduate training in practical clinical skills and competencies. The project is funded by the German Federal Ministry of Education and Research with almost two million Euro as a joint research project of the medical faculties of the universities of Frankfurt/Main, Gießen and Marburg, in collaboration with the German Society of Surgery, the German Society of Medical Education and the German Medical Students' Association. Nine packages in three pillars are combined in order to improve undergraduate medical training on a methodical, didactic and curricular level in a nation-wide network. Each partner of this network provides a systematic contribution to the project based on individual experience and competence. Based on the learning objectives, which were defined by the working group "Education" of the German Society of Surgery, teaching contents will be analysed with respect to their quality and will be available for both teachers and students as mobile learning tool (first pillar). The existing surgical curricula at the cooperating medical faculties will be analysed and teaching methods as well as assessment methods for clinical

46 CFR 108.645 - Markings on lifesaving appliances.

Science.gov (United States)

2010-10-01

... 46 Shipping 4 2010-10-01 2010-10-01 false Markings on lifesaving appliances. 108.645 Section 108.645 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) A-MOBILE OFFSHORE DRILLING UNITS DESIGN AND EQUIPMENT Equipment Markings and Instructions § 108.645 Markings on lifesaving appliances. (a...

25 CFR 141.16 - Price marking.

Science.gov (United States)

2010-04-01

... 25 Indians 1 2010-04-01 2010-04-01 false Price marking. 141.16 Section 141.16 Indians BUREAU OF... AND ZUNI RESERVATIONS General Business Practices § 141.16 Price marking. The price of each article... visible to the customer and that affords the customer a reasonable opportunity to learn the price of the...

46 CFR 199.176 - Markings on lifesaving appliances.

Science.gov (United States)

2010-10-01

... ARRANGEMENTS LIFESAVING SYSTEMS FOR CERTAIN INSPECTED VESSELS Requirements for All Vessels § 199.176 Markings on lifesaving appliances. (a) Lifeboats and rescue boats. Each lifeboat and rescue boat must be plainly marked as follows: (1) Each side of each lifeboat and rescue boat bow must be marked in block...

Influence of femtosecond laser marking on the corrosion resistance of stainless steels

International Nuclear Information System (INIS)

Valette, S.; Steyer, P.; Richard, L.; Forest, B.; Donnet, C.; Audouard, E.

2006-01-01

Marking is of prime importance in the field of biomaterials to allow the identification of surgical tools as well as prostheses. Nowadays, marking is often achieved by means of laser beam, which may modify the characteristics of the treated surfaces. The use of laser devices delivering nanosecond pulses is known to induce dramatic corrosion degradations during sterilization or decontamination processes of the biomaterials. The aim of the present study is to investigate the ability of femtosecond (pulse duration in the 10 -15 s range) laser treatments to avoid preferential corrosion processes of the marked areas, in order to extend the durability and the reliability of biomaterials. Experiments have been performed on martensitic Z30C13 and austenitic 316L stainless steels. Electrochemical measurements (cyclic polarization curves) were carried out to determine the passive state of samples before and after engraving, their corrosion rate and their susceptibility to localized corrosion. Further protracted immersion tests were also carried out to evaluate the natural long-term degradation of engraved parts. The electrochemical behavior is then explained on the basis of surface characterizations. Femtosecond laser marking is shown to provide an electrochemical ennoblement. Moreover, the chemical composition is not affected so that the passive character of both stainless steels is maintained, even improved if we consider the susceptibility to localized corrosion

PREOPERATIVE ENDOSCOPIC MARKING OF UNPALPABLE COLONIC TUMORS

Directory of Open Access Journals (Sweden)

A. L. Goncharov

2013-01-01

Full Text Available The identification of small colon lesions is one of the major problems in laparoscopic colonic resection.Research objective: to develop a technique of visualization of small tumors of a colon by preoperative endoscopic marking of a tumor.Materials and methods. In one day prior to operation to the patient after bowel preparation the colonoscopy is carried out. In the planned point near tumor on antimesentery edge the submucous infiltration of marking solution (Micky Sharpz blue tattoo pigment, UK is made. The volume of entered solution of 1–3 ml. In only 5 months of use of a technique preoperative marking to 14 patients with small (the size of 1–3 cm malignant tumors of the left colon is performed.Results. The tattoo mark was well visualized by during operation at 13 of 14 patients. In all cases we recorded no complications. Time of operation with preoperative marking averaged 108 min, that is significantly less in comparison with average time of operation with an intra-operative colonoscopy – 155 min (р < 0.001.Conclusions. The first experience of preoperative endoscopic marking of non palpable small tumors of a colon is encouraging. Performance of a technique wasn't accompanied by complications and allowed to reduce significantly time of operation and to simplify conditions of performance of operation.

49 CFR 1520.13 - Marking SSI.

Science.gov (United States)

2010-10-01

... SECURITY INFORMATION § 1520.13 Marking SSI. (a) Marking of paper records. In the case of paper records... back cover, including a binder cover or folder, if the document has a front and back cover; (2) Any.... 552 and 49 CFR parts 15 and 1520. (d) Other types of records. In the case of non-paper records that...

The improved Clinical Global Impression Scale (iCGI: development and validation in depression

Directory of Open Access Journals (Sweden)

Kadouri Alane

2007-02-01

Full Text Available Abstract Background The Clinical Global Impression scale (CGI is frequently used in medical care and clinical research because of its face validity and practicability. This study proposes to improve the reliability of the Clinical Global Impression (CGI scale in depressive disorders by the use of a semi-standardized interview, a new response format, and a Delphi procedure. Methods Thirty patients hospitalised for a major depressive episode were filmed at T1 (first week in hospital and at T2 (2 weeks later during a 5' specific interview. The Hamilton Depressive Rating Scale and the Symptom Check List were also rated. Eleven psychiatrists rated these videos using either the usual CGI response format or an improved response format, with or without a Delphi procedure. Results The new response format slightly improved (but not significantly the interrater agreement, the Delphi procedure did not. The best results were obtained when ratings by 4 independent raters were averaged. In this situation, intraclass correlation coefficients were about 0.9. Conclusion The Clinical Global Impression is a useful approach in psychiatry since it apprehends patients in their entirety. This study shows that it is possible to quantify such impressions with a high level of interrater agreement.

9 CFR 316.13 - Marking of outside containers.

Science.gov (United States)

2010-01-01

... 9 Animals and Animal Products 2 2010-01-01 2010-01-01 false Marking of outside containers. 316.13... INSPECTION AND CERTIFICATION MARKING PRODUCTS AND THEIR CONTAINERS § 316.13 Marking of outside containers. (a... domestic commerce is moved from an official establishment, the outside container shall bear an official...

Infrared technique for decoding of invisible laser markings

Science.gov (United States)

Haferkamp, Heinz; Jaeschke, Peter; Stein, Johannes; Goede, Martin

2002-03-01

Counterfeiting and product piracy continues to be an important issue not only for the Western industry, but also for the society in general. Due to the drastic increase in product imitation and the request for plagiarism protection as well as for reducing thefts there is a high interest in new protection methods providing new security features. The method presented here consists of security markings which are included below paint layers. These markings are invisible for the human eye due to the non-transparency of the upper layers in the visible spectral range. However, the markings can be detected by an infrared technique taking advantage on the partial transparency of the upper paint layers in the IR-region. Metal sheets are marked using laser radiation. The beam of a Nd:YAG-laser provides a modification of the surface structure, resulting in dark markings due to the annealing effect. After coating of the laser-marked material, the markings are invisible for the bare eye. In order to read out the invisible information below the coating, an infrared reflection technique is used. The samples are illuminated with halogen lamps or infrared radiators. Many coating materials (i. e. paints) show a certain transparency in the mid-infrared region, especially between 3 - 5 micrometers . The reflected radiation is detected using an IR-camera with a sensitivity range from 3.4 - 5 micrometers . Due to the different reflection properties between the markings and their surrounding, the information can be detected.

Forensic surface metrology: tool mark evidence.

Science.gov (United States)

Gambino, Carol; McLaughlin, Patrick; Kuo, Loretta; Kammerman, Frani; Shenkin, Peter; Diaczuk, Peter; Petraco, Nicholas; Hamby, James; Petraco, Nicholas D K

2011-01-01

Over the last several decades, forensic examiners of impression evidence have come under scrutiny in the courtroom due to analysis methods that rely heavily on subjective morphological comparisons. Currently, there is no universally accepted system that generates numerical data to independently corroborate visual comparisons. Our research attempts to develop such a system for tool mark evidence, proposing a methodology that objectively evaluates the association of striated tool marks with the tools that generated them. In our study, 58 primer shear marks on 9 mm cartridge cases, fired from four Glock model 19 pistols, were collected using high-resolution white light confocal microscopy. The resulting three-dimensional surface topographies were filtered to extract all "waviness surfaces"-the essential "line" information that firearm and tool mark examiners view under a microscope. Extracted waviness profiles were processed with principal component analysis (PCA) for dimension reduction. Support vector machines (SVM) were used to make the profile-gun associations, and conformal prediction theory (CPT) for establishing confidence levels. At the 95% confidence level, CPT coupled with PCA-SVM yielded an empirical error rate of 3.5%. Complementary, bootstrap-based computations for estimated error rates were 0%, indicating that the error rate for the algorithmic procedure is likely to remain low on larger data sets. Finally, suggestions are made for practical courtroom application of CPT for assigning levels of confidence to SVM identifications of tool marks recorded with confocal microscopy. Copyright © 2011 Wiley Periodicals, Inc.

Microscopic saw mark analysis: an empirical approach.

Science.gov (United States)

Love, Jennifer C; Derrick, Sharon M; Wiersema, Jason M; Peters, Charles

2015-01-01

Microscopic saw mark analysis is a well published and generally accepted qualitative analytical method. However, little research has focused on identifying and mitigating potential sources of error associated with the method. The presented study proposes the use of classification trees and random forest classifiers as an optimal, statistically sound approach to mitigate the potential for error of variability and outcome error in microscopic saw mark analysis. The statistical model was applied to 58 experimental saw marks created with four types of saws. The saw marks were made in fresh human femurs obtained through anatomical gift and were analyzed using a Keyence digital microscope. The statistical approach weighed the variables based on discriminatory value and produced decision trees with an associated outcome error rate of 8.62-17.82%. © 2014 American Academy of Forensic Sciences.

Improve the quality and service life of water-based pavement marking paints on pavements with high-iron aggregates.

Science.gov (United States)

2015-08-01

White pavement paint marking on airport runways was being discolored by rust-like staining. Discoloration is a critical safety : problem because white paint indicates runways and yellow paint is used for taxiways and aircraft parking. When the white ...

Diabetic and Obese Patient Clinical Outcomes Improve During a Care Management Implementation in Primary Care.

Science.gov (United States)

Holtrop, Jodi Summers; Luo, Zhehui; Piatt, Gretchen; Green, Lee A; Chen, Qiaoling; Piette, John

2017-10-01

To address the increasing burden of chronic disease, many primary care practices are turning to care management and the hiring of care managers to help patients coordinate their care and self-manage their conditions. Care management is often, but not always, proving effective at improving patient outcomes, but more evidence is needed. In this pair-matched cluster randomized trial, 5 practices implemented care management and were compared with 5 comparison practices within the same practice organization. Targeted patients included diabetic patients with a hemoglobin A1c >9% and nondiabetic obese patients. Clinical values tracked were A1c, blood pressure, low-density lipoprotein, microalbumin, and weight. Clinically important improvements were demonstrated in the intervention versus comparison practices, with diabetic patients improving A1c control and obese patients experiencing weight loss. There was a 12% relative increase in the proportion of patients meeting the clinical target of A1c management practices lost 5% or more of their body weight as compared with 10% of comparison patients (adjusted relative improvement, 15%; CI, 2%-28%). These findings add to the growing evidence-base for the effectiveness of care management as an effective clinical practice with regard to improving diabetes- and obesity-related outcomes.

Perception of scent over-marks by golden hamsters (Mesocricetus auratus): novel mechanisms for determining which individual's mark is on top.

Science.gov (United States)

Johnston, R E; Bhorade, A

1998-09-01

Hamsters preferentially remember or value the top scent of a scent over-mark. What cues do they use to do this? Using habituation-discrimination techniques, we exposed male golden hamsters (Mesocricetus auratus) on 3 to 4 trials to genital over-marks from 2 females and then tested subjects for their familiarity with these 2 scents compared with that of a novel female's secretion. Preferential memory for 1 of the 2 individuals' scents did not occur if the 2 marks did not overlap or did not overlap but differed in age, but it did occur if a region of overlap existed or 1 mark apparently occluded another (but did not overlap it). Thus, hamsters use regions of overlap and the spatial configuration of scents to evaluate over-marks. These phenomena constitute evidence for previously unsuspected perceptual abilities, including olfactory scene analysis, which is analogous to visual and auditory scene analysis.

Bite marks on skin and clay: A comparative analysis

Directory of Open Access Journals (Sweden)

R.K. Gorea

2014-12-01

Full Text Available Bite marks are always unique because teeth are distinctive. Bite marks are often observed at the crime scene in sexual and in physical assault cases on the skin of the victims and sometimes on edible leftovers in burglary cases. This piece of evidence is often ignored, but if properly harvested and investigated, bite marks may prove useful in apprehending and successfully prosecuting the criminals. Due to the importance of bite marks, we conducted a progressive randomised experimental study conducted on volunteers. A total of 188 bite marks on clay were studied. Based on these findings, 93.34% of the volunteers could be identified from the bite marks on the clay. In addition, 201 impressions on skin were studied, and out of these cases, 41.01% of the same volunteers could be identified based on the bite mark impressions on the skin.

Demand, capacity, and access of the outpatient clinic: A framework for analysis and improvement.

Science.gov (United States)

van Bussel, Erik Martijn; van der Voort, Marc Boudewijn Victor Rouppe; Wessel, Ronald N; van Merode, Godefridus G

2018-06-01

While theoretical frameworks for optimization of the outpatient processes are abundant, practical step-by-step analyses to give leads for improvement, to forecast capacity, and to support decision making are sparse. This article demonstrates how to evaluate and optimize the triad of demand, (future) capacity, and access time of the outpatient clinic using a structured six-step method. All individual logistical patient data of an orthopaedic outpatient clinic of one complete year were analysed using a 6-step method to evaluate demand, supply, and access time. Trends in the data were retrospectively analysed and evaluated for potential improvements. A model for decision making was tested. Both the analysis of the method and actual results were considered as main outcomes. More than 25 000 appointments were analysed. The 6-step method showed to be sufficient to result in valuable insights and leads for improvement. While the overall match between demand and capacity was considered adequate, the variability in capacity was much higher than in demand, thereby leading to delays in access time. Holidays and subsequent weeks showed to be of great influence for demand, capacity, and access time. Using the six-step method, several unfavourable characteristics of the outpatient clinic were revealed and a better match between demand, supply, and access time could have been reached with only minor adjustments. Last, a clinic specific prediction and decision model for demand and capacity was made using the 6-step method. The 6-step analysis can successfully be applied to redesign and improve the outpatient health care process. The results of the analysis showed that national holidays and variability in demand and capacity have a big influence on the outpatient clinic. Using the 6-step method, practical improvements in outpatient logistics were easily found and leads for future decision making were contrived. © 2018 The Authors Journal of Evaluation in Clinical Practice

Clinical impact of B-cell depletion with the anti-CD20 antibody rituximab in chronic fatigue syndrome: a preliminary case series

Directory of Open Access Journals (Sweden)

Mella Olav

2009-07-01

Full Text Available Abstract Background Chronic fatigue syndrome (CFS is a disease of unknown aetiology. A patient with CFS had unexpected, marked recovery of CFS symptoms lasting for five months during and after cytotoxic chemotherapy for Hodgkin's disease. We reasoned that the transient CFS recovery was related to methotrexate treatment, which induces immunomodulation in part through B-cell depletion. Methods In a case series, this patient and two additional CFS patients were B-cell depleted by infusion of the monoclonal anti-CD20 antibody rituximab. Results All three had improvement of all CFS symptoms. Patients 1 and 2 had major amelioration from 6 weeks after intervention, patient 3 slight improvement from the same time, but then improved markedly from 26 weeks after intervention. The symptomatic effect lasted until weeks 16, 18 and 44, respectively. At relapse, all were retreated with a single (patient 1 or double rituximab infusion (patients 2 and 3. Again, all three had marked symptom improvement, mimicking their first response. After new symptom recurrence, patients 1 and 2 were given weekly oral methotrexate, patient 1 having effect also from this agent. Patients 1 and 2 were again treated for a third rituximab infusion after new relapse, again with a marked clinical benefit. No unexpected toxicity was seen. Conclusion These observations suggest that B-lymphocytes are involved in CFS pathogenesis for a subset of patients. Benefit for all CFS symptoms, the delayed symptom relief following B-cell depletion, the kinetics of relapses, and the effect also from methotrexate treatment, provide suggestive evidence that B-cells play a significant role in the ongoing clinical features, and that CFS may be amenable to therapeutic interventions aimed at modifying B-cell number and function. More systematic investigations of this therapeutic strategy, and of its biological basis, are now needed.

Province wide clinical governance network for clinical audit for quality improvement in endometrial cancer management.

Science.gov (United States)

Mandato, Vincenzo Dario; Formisano, Debora; Pirillo, Debora; Ciarlini, Gino; Cerami, Lillo Bruno; Ventura, Alessandro; Spreafico, Lorenzo; Palmieri, Tamara; La Sala, Giovanni Battista; Abrate, Martino

2012-01-01

According to the hub-and-spoke model introduced in the Provincial Healthcare System of Reggio Emilia, early endometrial cancer is treated in peripheral low-volume hospitals (spokes) by general gynecologist, whereas more complex cancers are treated by gynecological oncologists at the main hospital (hub). To guarantee a uniformly high standard of care to all patients with endometrial cancer treated in hub and spoke hospitals of Reggio Emilia Province. The specialists of the 5 hospitals of Reggio Emilia Province instituted an inter hospital and multidisciplinary oncology group to write common and shared guidelines based on evidence-based medicine through the use of clinical audit. They valued the process indicators before and after guidelines introduction identifying the site of improvement and verifying the standard achievement. Diagnostic hysteroscopy use increased significantly from preguideline period, 53%, to postguideline period, 74%. Magnetic resonance use and accuracy increased significantly from preguideline to postguideline periods: 8.1% to 35.3% and 37.3% to 74.7%, respectively. Laparoscopy use increased from 1.6% (preguideline) to 18.6 (postguideline). Early surgical complications decreased from 16% (preguideline) to 9% (postguideline). Radiotherapy use increased from 14.% (preguideline) to 32.3% (postguideline). It is possible for a provincial oncology group to build an oncology network providing an improvement in the assistance of patients with endometrial cancer through the use of clinical audit. Clinical audit made it possible to obtain the full attendance of specialists of various disciplines involved in the treatment of endometrial cancer to optimize response time schematizing process.

Assessment of Clinical Risk Management System in Hospitals: An Approach for Quality Improvement.

Science.gov (United States)

Farokhzadian, Jamileh; Dehghan Nayeri, Nahid; Borhani, Fariba

2015-03-18

Clinical risks have created major problems in healthcare system such as serious adverse effects on patient safety and enhancing the financial burden for the healthcare. Thus, clinical risk management (CRM) system has been introduced for improving the quality and safety of services to health care. The aim of this study was to assess the status of CRM in the hospitals. A cross-sectional study was conducted on 200 nursing staff from three teaching hospitals affiliated with the Kerman University of Medical Sciences in southeast of Iran. Data were collected from the participants using questionnaire and observational checklist in quality improvement offices and selected wards. The data were analyzed using SPSS version 20. Almost, 57% of persons participated in at least one of training sessions on CRM. The status of CRM system was rated from weak to moderate (2.93±0.72- 3.18±0.66). Among the six domains of CRM system, the highest mean belonged to domain the monitoring of analysis, evaluation and risk control (3.18±0.72); the lowest mean belonged to domain the staff's knowledge, recognition and understanding of CRM (2.93±0.66). There were no integrated electronic systems for recording and analyzing clinical risks and incidents in the hospitals. Attempts have been made to establish CRM through improvement quality approach such as clinical governance and accreditation, but not enough, however, health care should move toward quality improvement and safe practice through the effective integration of CRM in organizational process.

Applying Process Improvement Methods to Clinical and Translational Research: Conceptual Framework and Case Examples.

Science.gov (United States)

Daudelin, Denise H; Selker, Harry P; Leslie, Laurel K

2015-12-01

There is growing appreciation that process improvement holds promise for improving quality and efficiency across the translational research continuum but frameworks for such programs are not often described. The purpose of this paper is to present a framework and case examples of a Research Process Improvement Program implemented at Tufts CTSI. To promote research process improvement, we developed online training seminars, workshops, and in-person consultation models to describe core process improvement principles and methods, demonstrate the use of improvement tools, and illustrate the application of these methods in case examples. We implemented these methods, as well as relational coordination theory, with junior researchers, pilot funding awardees, our CTRC, and CTSI resource and service providers. The program focuses on capacity building to address common process problems and quality gaps that threaten the efficient, timely and successful completion of clinical and translational studies. © 2015 The Authors. Clinical and Translational Science published by Wiley Periodicals, Inc.

Improving Clinical Trial Cohort Definition Criteria and Enrollment with Distributional Semantic Matching

OpenAIRE

Shao, Jianyin; Gouripeddi, Ramkiran; Facelli, Julio C.

2016-01-01

Shao, J., Gouripeddi, R., & Facelli, J.C. (2016). Improving Clinical Trial Cohort Definition Criteria and Enrollment with Distributional Semantic Matching (poster). Research Reproducibility 2016. Salt Lake City, UT, USA

49 CFR 172.317 - KEEP AWAY FROM HEAT handling mark.

Science.gov (United States)

2010-10-01

... 49 Transportation 2 2010-10-01 2010-10-01 false KEEP AWAY FROM HEAT handling mark. 172.317 Section... REQUIREMENTS, AND SECURITY PLANS Marking § 172.317 KEEP AWAY FROM HEAT handling mark. (a) General. For... of Division 5.2 must be marked with the KEEP AWAY FROM HEAT handling mark specified in this section...

Using TRIGA Mark II research reactor for irradiation with thermal neutrons

Energy Technology Data Exchange (ETDEWEB)

Kolšek, Aljaž, E-mail: aljaz.kolsek@gmail.com; Radulović, Vladimir, E-mail: vladimir.radulovic@ijs.si; Trkov, Andrej, E-mail: andrej.trkov@ijs.si; Snoj, Luka, E-mail: luka.snoj@ijs.si

2015-03-15

Highlights: • Monte Carlo N-Particle Transport Code was used to design and perform calculations. • Characterization of the TRIGA Mark II ex-core irradiation facilities was performed. • The irradiation device was designed in the TRIGA irradiation channel. • The use of the device improves the fraction of thermal neutron flux by 390%. - Abstract: Recently a series of test irradiations was performed at the JSI TRIGA Mark II reactor for the Fission Track-Thermoionization Mass Spectrometry (FT-TIMS) method, which requires a well thermalized neutron spectrum for sample irradiation. For this purpose the Monte Carlo N-Particle Transport Code (MCNP5) was used to computationally support the design of an irradiation device inside the TRIGA model and to support the actual measurements by calculating the neutron fluxes inside the major ex-core irradiation facilities. The irradiation device, filled with heavy water, was designed and optimized inside the Thermal Column and the additional moderation was placed inside the Elevated Piercing Port. The use of the device improves the ratio of thermal neutron flux to the sum of epithermal and fast neutron flux inside the Thermal Column Port by 390% and achieves the desired thermal neutron fluence of 10{sup 15} neutrons/cm{sup 2} in irradiation time of 20 h.

Mark Raidpere portreefotod Kielis

Index Scriptorium Estoniae

1999-01-01

Kieli Linnagaleriis avatud 2. Ars Baltica fototriennaalil 'Can You Hear Me?' esindab Eestit Mark Raidpere seeriaga 'Portreed 1998'. Näituse Eesti-poolne kuraator Anu Liivak, kataloogiteksti kirjutas Anders Härm. Tuntumaid osalejaid triennaalil Wolfgang Tillmans

Mark 1 Test Facility

Data.gov (United States)

Federal Laboratory Consortium — The Mark I Test Facility is a state-of-the-art space environment simulation test chamber for full-scale space systems testing. A $1.5M dollar upgrade in fiscal year...

Mark Raidpere näitused Pariisis ja Napolis / Mark Raidpere ; interv. Harry Liivrand

Index Scriptorium Estoniae

Raidpere, Mark

2008-01-01

Mark Raidpere videod "Vekovka", "Dedication / Pühendus", "Majestoso Mystico" näitusel Pariisis Michel Reini galeriis. Osaleb koos saksa fotograafi Sven Johnega näitusel Napolis. Kreekas Thessalonikis valminud filmist "1:1:1"

Prayer Marks in Immigrants from Bangladesh with Diabetes Who Live in Greece.

Science.gov (United States)

Papadakis, G; Zampelis, T; Michalopoulou, M; Konstantopoulos, K; Rosenberg, T; Chatzipanagiotou, S

2016-02-01

Prayer marks (PMs) are commonly occurring dermatologic changes in muslims who pray and develop over a long period of time as a consequence of repeated and extended pressure. PMs need careful examination especially for patients with diabetes, who are more vulnerable due to predisposing factors such as venous insufficiency and peripheral neuropathy. A total of 166 patients with diabetes (150 males, 16 females) and 65 normal subjects from Bangladesh were examined for the appearance of PMs. Twenty-eight patients (16.9 %) and one normal subject (1.5 %) had PMs. The marks were not itchy or painful and they were observed on the dorsal aspect of the left foot, which was attributed to a more typical prayer position that placed pressure on the left foot. PMs are not a rare clinical entity among muslim patients with diabetes and most clinicians should be aware of it as it can be the predominant cause of an ulcer.

TRANSITION METAL OXIDES AS MATERIALS FOR ADDITIVE LASER MARKING ON STAINLESS STEEL

Directory of Open Access Journals (Sweden)

Mihail Stoyanov Mihalev

2017-09-01

Full Text Available The product information plays an important role in the improvement of the manufacturing, allowing the tracking of the part through the full life cycle. Laser marking is one of the most versatile techniques for this purpose. In this paper, a modification of the powder bed selective laser melting for additive laser marking of stainless steel parts is presented. This modification is based on the use of only one transition metal oxide chemically bonded to the stainless steel substrate, without using any additional materials and cleaning substances. The resulting additive coatings, produced from initial MoO3 and WO3 powders, show strong adhesion, high hardness, long durability and a high optical contrast. For estimation of the chemical and structural properties, the Raman and X-Ray Diffraction (XRD spectroscopy have been implemented. A computer model of the process of the laser melting and re-solidification has been developed as well. A comparative analysis of the properties of both (MoO3 and WO3 additive coatings has been performed. An attempt for a qualitative explanation of the thermo-chemical phenomena during the marking process has been undertaken.

Improving secondary prevention screening in clinical encounters using mhealth among prelicensure master's entry clinical nursing students.

Science.gov (United States)

FitzGerald, Leah Z; Rorie, Anne; Salem, Benissa E

2015-04-01

To determine the feasibility and acceptability of a mHealth application among nursing students for health promotion and secondary prevention health recommendations for hospitalized adult patients. A pretest-posttest design with a convenience sample of 169 prelicensure master's entry clinical nursing students in a large urban public university. Survey questions assessed intention to use, perceived usefulness, perceived ease of use, subjective norm, voluntariness, clinical area relevance, output quality, and result demonstrability of the United States Preventive Services Task Force (USPSTF) evidence-based practice guidelines via the mHealth application. Descriptive statistics and frequencies were used to explore sociodemographics; paired t-tests were used to evaluate pre- and posttest differences. Pre- and posttest significant differences (p technology among prelicensure master's entry clinical nursing students in order to engage and foster translational learning and improve dissemination of secondary prevention screening guidelines among hospitalized patients. © 2015 Sigma Theta Tau International.

Mark retention of calcein in Cisco and Bloater

Science.gov (United States)

Chalupnicki, Marc A.; Mackey, Gregg; Nash, Kendra; Chiavelli, Richard; Johnson, James H.; Kehler, Thomas; Ringler, Neil H.

2016-01-01

Since 2012, a multi-agency initiative to restore these native forage species has been under way. Evaluating the restoration success of Cisco Coregonus artedi and Bloater C. hoyi in Lake Ontario waters requires methods to identify stocked fish. However, juvenile Cisco and Bloater are fragile; thus, mass marking techniques that reduce the handling of individual fish are required and have not previously been evaluated. In 2014–2015 we evaluated the usefulness of calcein (SE-MARK) as a marker on bony structures, including the otolith. Juvenile Bloater and Cisco (14, 100, 128 d old) were immersed in a calcein bath at 5,000 mg/L of water for 4 min to apply the chemical marker. Observations of the marking retention were evaluated 8 d following the treatment. All fish immersed in calcein had strong brilliant marks (rating scale 3) on all bony structures including scales, fin rays, jaw bones, and vertebrate. The otolith was the only hard structure that did not show a brilliant marking due to the opaque nature of the structure. Our results suggest that calcein produces a strong discernable mark on hard bony structures of Cisco and Bloater; however, long-term retention needs further study.

Victorian Audit of Surgical Mortality is associated with improved clinical outcomes.

Science.gov (United States)

Beiles, C Barry; Retegan, Claudia; Maddern, Guy J

2015-11-01

Improved outcomes are desirable results of clinical audit. The aim of this study was to use data from the Victorian Audit of Surgical Mortality (VASM) and the Victorian Admitted Episodes Dataset (VAED) to highlight specific areas of clinical improvement and reduction in mortality over the duration of the audit process. This study used retrospective, observational data from VASM and VAED. VASM data were reported by participating public and private health services, the Coroner and self-reporting surgeons across Victoria. Aggregated VAED data were supplied by the Victorian Department of Health. Assessment of outcomes was performed using chi-squared trend analysis over successive annual audit periods. Because initial collection of data was incomplete in the recruitment phase, statistical analysis was confined to the last 3-year period, 2010-2013. A 20% reduction in surgical mortality over the past 5 years has been identified from the VAED data. Progressive increase in both surgeon and hospital participation, significant reduction in both errors in management as perceived by assessors and increased direct consultant involvement in cases returned to theatre have been documented. The benefits of VASM are reflected in the association with a reduction of mortality and adverse clinical outcomes, which have clinical and financial benefits. It is a purely educational exercise and continued participation in this audit will ensure the highest standards of surgical care in Australia. This also highlights the valuable collaboration between the Victorian Department of Health and the RACS. © 2014 Royal Australasian College of Surgeons.

HYDROLOGIC AND FEATURE-BASED SURFACE ANALYSIS FOR TOOL MARK INVESTIGATION ON ARCHAEOLOGICAL FINDS

Directory of Open Access Journals (Sweden)

K. Kovács

2012-07-01

Full Text Available The improvement of detailed surface documentation methods provides unique tool mark-study opportunities in the field of archaeological researches. One of these data collection techniques is short-range laser scanning, which creates a digital copy of the object’s morphological characteristics from high-resolution datasets. The aim of our work was the accurate documentation of a Bronze Age sluice box from Mitterberg, Austria with a spatial resolution of 0.2 mm. Furthermore, the investigation of the entirely preserved tool marks on the surface of this archaeological find was also accomplished by these datasets. The methodology of this tool mark-study can be summarized in the following way: At first, a local hydrologic analysis has been applied to separate the various patterns of tools on the finds’ surface. As a result, the XYZ coordinates of the special points, which represent the edge lines of the sliding tool marks, were calculated by buffer operations in a GIS environment. During the second part of the workflow, these edge points were utilized to manually clip the triangle meshes of these patterns in reverse engineering software. Finally, circle features were generated and analysed to determine the different sections along these sliding tool marks. In conclusion, the movement of the hand tool could be reproduced by the spatial analysis of the created features, since the horizontal and vertical position of the defined circle centre points indicated the various phases of the movements. This research shows an exact workflow to determine the fine morphological structures on the surface of the archaeological find.

[Clinical trial data management and quality metrics system].

Science.gov (United States)

Chen, Zhao-hua; Huang, Qin; Deng, Ya-zhong; Zhang, Yue; Xu, Yu; Yu, Hao; Liu, Zong-fan

2015-11-01

Data quality management system is essential to ensure accurate, complete, consistent, and reliable data collection in clinical research. This paper is devoted to various choices of data quality metrics. They are categorized by study status, e.g. study start up, conduct, and close-out. In each category, metrics for different purposes are listed according to ALCOA+ principles such us completeness, accuracy, timeliness, traceability, etc. Some general quality metrics frequently used are also introduced. This paper contains detail information as much as possible to each metric by providing definition, purpose, evaluation, referenced benchmark, and recommended targets in favor of real practice. It is important that sponsors and data management service providers establish a robust integrated clinical trial data quality management system to ensure sustainable high quality of clinical trial deliverables. It will also support enterprise level of data evaluation and bench marking the quality of data across projects, sponsors, data management service providers by using objective metrics from the real clinical trials. We hope this will be a significant input to accelerate the improvement of clinical trial data quality in the industry.

Detection and recognition of road markings in panoramic images

Science.gov (United States)

Li, Cheng; Creusen, Ivo; Hazelhoff, Lykele; de With, Peter H. N.

2015-03-01

Detection of road lane markings is attractive for practical applications such as advanced driver assistance systems and road maintenance. This paper proposes a system to detect and recognize road lane markings in panoramic images. The system can be divided into four stages. First, an inverse perspective mapping is applied to the original panoramic image to generate a top-view road view, in which the potential road markings are segmented based on their intensity difference compared to the surrounding pixels. Second, a feature vector of each potential road marking segment is extracted by calculating the Euclidean distance between the center and the boundary at regular angular steps. Third, the shape of each segment is classified using a Support Vector Machine (SVM). Finally, by modeling the lane markings, previous falsely detected segments can be rejected based on their orientation and position relative to the lane markings. Our experiments show that the system is promising and is capable of recognizing 93%, 95% and 91% of striped line segments, blocks and arrows respectively, as well as 94% of the lane markings.

Donepezil improved memory in multiple sclerosis in a randomized clinical trial.

Science.gov (United States)

Krupp, L B; Christodoulou, C; Melville, P; Scherl, W F; MacAllister, W S; Elkins, L E

2004-11-09

To determine the effect of donepezil in treating memory and cognitive dysfunction in multiple sclerosis (MS). This single-center double-blind placebo-controlled clinical trial evaluated 69 MS patients with cognitive impairment who were randomly assigned to receive a 24-week treatment course of either donepezil (10 mg daily) or placebo. Patients underwent neuropsychological assessment at baseline and after 24 weeks of treatment. The primary outcome was change in verbal learning and memory on the Selective Reminding Test (SRT). Secondary outcomes included other tests of cognitive function, patient-reported change in memory, and clinician-reported impression of cognitive change. Donepezil-treated patients showed significant improvement in memory performance on the SRT compared to placebo (p = 0.043). The benefit of donepezil remained significant after controlling for various covariates including age, Expanded Disability Status Scale, baseline SRT score, reading ability, MS subtype, and sex. Donepezil-treated patients did not show significant improvements on other cognitive tests, but were more than twice as likely to report memory improvement than those in the placebo group (p = 0.006). The clinician also reported cognitive improvement in almost twice as many donepezil vs placebo patients (p = 0.036). No serious adverse events related to study medication occurred, although more donepezil (34.3%) than placebo (8.8%) subjects reported unusual/abnormal dreams (p = 0.010). Donepezil improved memory in MS patients with initial cognitive impairment in a single center clinical trial. A larger multicenter investigation of donepezil in MS is warranted in order to more definitively assess the efficacy of this intervention.

EcoMark 2.0

DEFF Research Database (Denmark)

Guo, Chenjuan; Yang, Bin; Andersen, Ove

2015-01-01

Eco-routing is a simple yet effective approach to substantially reducing the environmental impact, e.g., fuel consumption and greenhouse gas (GHG) emissions, of vehicular transportation. Eco-routing relies on the ability to reliably quantify the environmental impact of vehicles as they travel...... in a spatial network. The procedure of quantifying such vehicular impact for road segments of a spatial network is called eco-weight assignment. EcoMark 2.0 proposes a general framework for eco-weight assignment to enable eco-routing. It studies the abilities of six instantaneous and five aggregated models......, and experiments for assessing the utility of the impact models in assigning eco-weights. The application of EcoMark 2.0 indicates that the instantaneous model EMIT and the aggregated model SIDRA-Running are suitable for assigning eco-weights under varying circumstances. In contrast, other instantaneous models...

Interview with Mark Watson

Directory of Open Access Journals (Sweden)

Katy Shaw

2016-04-01

Full Text Available Mark Watson is a British comedian and novelist. His five novels to date – 'Bullet Points' (2004, 'A Light-Hearted Look At Murder' (2007, 'Eleven' (2010, 'The Knot' (2012 and 'Hotel Alpha' (2014 – explore human relationships and communities in contemporary society. His latest novel Hotel Alpha tells the story of an extraordinary hotel in London and two mysterious disappearances that raise questions no one seems willing to answer. External to the novel, readers can also discover more about the hotel and its inhabitants in one hundred extra stories that expand the world of the novel and can be found at http://www.hotelalphastories.com. In conversation here with Dr Katy Shaw, Mark offers some reflections on his writing process, the field of contemporary literature, and the vitality of the novel form in the twenty-first century.

Timing and context of dolphin clicks during and after mine simulator detection and marking in the open ocean

Directory of Open Access Journals (Sweden)

Sam H. Ridgway

2018-02-01

Full Text Available Two dolphins carrying cameras swam in the ocean as they searched for and marked mine simulators – buried, proud or moored. As the animals swam ahead of a boat they searched the ocean. Cameras on their harness recorded continuous sound and video. Once a target was detected, the dolphins received a marker to take to the simulator's location. During search and detection, dolphins made almost continuous trains of varying interval clicks. During the marking phase, shorter click trains were interrupted by periods of silence. As the dolphins marked simulators, they often produced victory squeals – pulse bursts that vary in duration, peak frequency and amplitude. Victory squeals were produced on 72% of marks. Sometimes after marking, or at other times during their long swims, the dolphins produced click packets. Packets typically consisted of two to 10 clicks with inter-click intervals of 7-117 ms followed by a silence of 223-983 ms. Click packets appeared unrelated with searching or marking. We suggest that the packets were used to improve signal to noise ratios for locating a boat or other distant object. Victory squeals produced when marking the targets suggest to us that the dolphins know when they have succeeded in this multipart task.

Recognition in context: Implications for trade mark law.

Science.gov (United States)

Humphreys, Michael S; McFarlane, Kimberley A; Burt, Jennifer S; Kelly, Sarah J; Weatherall, Kimberlee G; Burrell, Robert G

2017-10-01

Context effects in recognition have played a major role in evaluating theories of recognition. Understanding how context impacts recognition is also important for making sound trade mark law. Consumers attempting to discriminate between the brand they are looking for and a look-alike product often have to differentiate products which share a great deal of common context: positioning on the supermarket shelf, the type of store, aspects of the packaging, or brand claims. Trade mark and related laws aim to protect brands and reduce consumer confusion, but courts assessing allegations of trade mark infringement often lack careful empirical evidence concerning the impact of brand and context similarity, and, in the absence of such evidence, make assumptions about how consumers respond to brands that downplay the importance of context and focus on the similarity of registered marks. The experiments reported in this paper aimed to test certain common assumptions in trade mark law, providing evidence that shared context can cause mistakes even where brand similarity is low.

The ENDOCARE questionnaire guides European endometriosis clinics to improve the patient-centeredness of their care.

Science.gov (United States)

Dancet, E A F; Apers, S; Kluivers, K B; Kremer, J A M; Sermeus, W; Devriendt, C; Nelen, W L D M; D'Hooghe, T M

2012-11-01

How patient-centered are two included specialized endometriosis clinics relative to each other and how can they improve the patient-centeredness of their care? The validated ENDOCARE questionnaire (ECQ) reliably concluded that the adjusted overall patient-centeredness did not differ between the clinics, that each clinic was significantly more patient-centered for 2 out of 10 dimensions of patient-centered endometriosis care and that clinics 1 and 2 had to improve 8 and 13 specific care aspects, respectively. Patient-centered endometriosis care is essential to high-quality care and is defined by 10 dimensions. The ECQ was developed, validated and proved to be reliable in a European setting of self-reported endometriosis patients but had not yet been used at a clinic level for quality management. A cross-sectional survey was disseminated in 2011 to all 514 women diagnosed with endometriosis during a laparoscopy indicated for pain and/or infertility during a retrospective 2-year period (2009-2010) in two university clinics from two different European countries. In total 337 patients completed the ECQ (216 and 121 per clinic). Respondents had a mean age of 34.3 years. Three in four reported a surgical diagnosis of moderate or severe endometriosis and the majority reported surgical treatment by a multidisciplinary team. The ECQ assessed the 10 dimensions of patient-centeredness, more specifically whether the health-care performance, as perceived by patients, measured up to what is important to patients in general. The ECQ was completed by 337 respondents (response rate = 65.6%). Reliability and validity of the ECQ for use on clinic level were confirmed. Clinics did not differ in overall mean importance scores; importance rankings of the ECQ dimensions were almost identical. The overall patient-centeredness scores (PCS), adjusted for education level, did not discriminate between the clinics. However, the adjusted PCS for the dimensions 'clinic staff' and 'technical

Comprehensive Clinical Audits of Diagnostic Radiology Practices: A Tool for Quality Improvement. Quality Assurance Audit for Diagnostic Radiology Improvement and Learning (QUAADRIL)

International Nuclear Information System (INIS)

2011-01-01

Interest in quality assurance processes and quality improvement in diagnostic radiology is being driven by a number of factors. These include the high cost and complexity of radiological equipment, acknowledgement of the possibility of increasing doses to patients, and the importance of radiological diagnosis to patient management within the health care environment. To acknowledge these interests, clinical audits have been introduced and, in Europe, mandated under a European Directive (Council Directive 97/47/EURATOM). Comprehensive clinical audits focus on clinical management and infrastructure, patient related and technical procedures, and education and research. This publication includes a structured set of standards appropriate for diagnostic radiology, an audit guide to their clinical review, and data collection sheets for the rapid production of reports in audit situations. It will be a useful guide for diagnostic radiology facilities wishing to improve their service to patients through timely diagnosis with minimal radiation dose.

Comprehensive Clinical Audits of Diagnostic Radiology Practices: A Tool for Quality Improvement. Quality Assurance Audit for Diagnostic Radiology Improvement and Learning (QUAADRIL)

International Nuclear Information System (INIS)

2010-01-01

Interest in quality assurance processes and quality improvement in diagnostic radiology is being driven by a number of factors. These include the high cost and complexity of radiological equipment, acknowledgement of the possibility of increasing doses to patients, and the importance of radiological diagnosis to patient management within the health care environment. To acknowledge these interests, clinical audits have been introduced and, in Europe, mandated under a European Directive (Council Directive 97/47/EURATOM). Comprehensive clinical audits focus on clinical management and infrastructure, patient related and technical procedures, and education and research. This publication includes a structured set of standards appropriate for diagnostic radiology, an audit guide to their clinical review, and data collection sheets for the rapid production of reports in audit situations. It will be a useful guide for diagnostic radiology facilities wishing to improve their service to patients through timely diagnosis with minimal radiation dose.

The Acquisition of English Focus Marking by Non-Native Speakers

Science.gov (United States)

Baker, Rachel Elizabeth

This dissertation examines Mandarin and Korean speakers' acquisition of English focus marking, which is realized by accenting particular words within a focused constituent. It is important for non-native speakers to learn how accent placement relates to focus in English because appropriate accent placement and realization makes a learner's English more native-like and easier to understand. Such knowledge may also improve their English comprehension skills. In this study, 20 native English speakers, 20 native Mandarin speakers, and 20 native Korean speakers participated in four experiments: (1) a production experiment, in which they were recorded reading the answers to questions, (2) a perception experiment, in which they were asked to determine which word in a recording was the last prominent word, (3) an understanding experiment, in which they were asked whether the answers in recorded question-answer pairs had context-appropriate prosody, and (4) an accent placement experiment, in which they were asked which word they would make prominent in a particular context. Finally, a new group of native English speakers listened to utterances produced in the production experiment, and determined whether the prosody of each utterance was appropriate for its context. The results of the five experiments support a novel predictive model for second language prosodic focus marking acquisition. This model holds that both transfer of linguistic features from a learner's native language (L1) and features of their second language (L2) affect learners' acquisition of prosodic focus marking. As a result, the model includes two complementary components: the Transfer Component and the L2 Challenge Component. The Transfer Component predicts that prosodic structures in the L2 will be more easily acquired by language learners that have similar structures in their L1 than those who do not, even if there are differences between the L1 and L2 in how the structures are realized. The L2

Pitfalls of Internet-accessible diagnostic tests: inadequate performance of a CE-marked Chlamydia test for home use

OpenAIRE

Michel , Claude-Edouard C; Saison , Francis G; Joshi , Hrishikesh; Mahilum-Tapay , Lourdes M; Lee , Helen H

2009-01-01

Abstract Objectives: To evaluate the performance of a CE (Conformitee Europeenne)-marked home test for Chlamydia trachomatis (CT) that is available over the Internet. Methods: A total of 231 eligible women attending the Social Hygiene Clinic (SHC) or Obstetrics-Gynecology (OB-GYN) Clinic in Iloilo City, Philippines was recruited to an evaluation of the HandiLab-C Chlamydia home test (HandiLab-C). One vaginal swab was tested with HandiLab-C on-site and the second at Cambr...

Trade Mark Cluttering: An Exploratory Report Commissioned by UKIPO

OpenAIRE

von Graevenitz, Georg; Greenhalgh, Christine; Helmers, Christian; Schautschick, Philipp

2012-01-01

This report explores the problem of “cluttering” of trade mark registers. The report consists of two parts: the first presents a conceptual discussion of “cluttering” of trade mark registers. The second part provides an exploratory empirical analysis of trade mark applications at the UK Intellectual Property Office (UKIPO) and the European trade mark office (OHIM). This part contains results of a descriptive and an econometric analysis. According to our definition, cluttering arises where fir...

Evaluating online continuing medical education seminars: evidence for improving clinical practices.

Science.gov (United States)

Weston, Christine M; Sciamanna, Christopher N; Nash, David B

2008-01-01

The purpose of this study was to evaluate the potential for online continuing medical education (CME) seminars to improve quality of care. Primary care physicians (113) participated in a randomized controlled trial to evaluate an online CME series. Physicians were randomized to view either a seminar about type 2 diabetes or a seminar about systolic heart failure. Following the seminar, physicians were presented with 4 clinical vignettes and asked to describe what tests, treatments, counseling, or referrals they would recommend. Physicians who viewed the seminars were significantly more likely to recommend guideline-consistent care to patients in the vignettes. For example, physicians who viewed the diabetes seminar were significantly more likely to order an eye exam for diabetes patients (63%) compared with physicians in the control group (27%). For some guidelines there were no group differences. These results provide early evidence of the effectiveness of online CME programs to improve physician clinical practice.

32 CFR 2400.16 - Derivative classification markings.

Science.gov (United States)

2010-07-01

... SECURITY PROGRAM Derivative Classification § 2400.16 Derivative classification markings. (a) Documents... 32 National Defense 6 2010-07-01 2010-07-01 false Derivative classification markings. 2400.16..., as described in § 2400.12 of this part, the information may not be used as a basis for derivative...

Multiplexing clonality: combining RGB marking and genetic barcoding

Science.gov (United States)

Cornils, Kerstin; Thielecke, Lars; Hüser, Svenja; Forgber, Michael; Thomaschewski, Michael; Kleist, Nadja; Hussein, Kais; Riecken, Kristoffer; Volz, Tassilo; Gerdes, Sebastian; Glauche, Ingmar; Dahl, Andreas; Dandri, Maura; Roeder, Ingo; Fehse, Boris

2014-01-01

RGB marking and DNA barcoding are two cutting-edge technologies in the field of clonal cell marking. To combine the virtues of both approaches, we equipped LeGO vectors encoding red, green or blue fluorescent proteins with complex DNA barcodes carrying color-specific signatures. For these vectors, we generated highly complex plasmid libraries that were used for the production of barcoded lentiviral vector particles. In proof-of-principle experiments, we used barcoded vectors for RGB marking of cell lines and primary murine hepatocytes. We applied single-cell polymerase chain reaction to decipher barcode signatures of individual RGB-marked cells expressing defined color hues. This enabled us to prove clonal identity of cells with one and the same RGB color. Also, we made use of barcoded vectors to investigate clonal development of leukemia induced by ectopic oncogene expression in murine hematopoietic cells. In conclusion, by combining RGB marking and DNA barcoding, we have established a novel technique for the unambiguous genetic marking of individual cells in the context of normal regeneration as well as malignant outgrowth. Moreover, the introduction of color-specific signatures in barcodes will facilitate studies on the impact of different variables (e.g. vector type, transgenes, culture conditions) in the context of competitive repopulation studies. PMID:24476916

Improving outcomes in veterans with oropharyngeal squamous cell carcinoma through implementation of a multidisciplinary clinic.

Science.gov (United States)

Light, Tyler; Rassi, Edward El; Maggiore, Ronald J; Holland, John; Reed, Julie; Suriano, Kathleen; Stooksbury, Marcelle; Tobin, Nora; Gross, Neil; Clayburgh, Daniel

2017-06-01

Treatment of head and neck cancer is complex, and a multidisciplinary clinic may improve the coordination of care. The value of a head and neck multidisciplinary clinic has not yet been established in oropharyngeal squamous cell carcinoma (SCC). A retrospective review was conducted of Veterans Affairs patients with oropharyngeal SCC undergoing concurrent chemoradiation before and after implementation of the head and neck multidisciplinary clinic. Fifty-two patients before and 54 patients after multidisciplinary clinic were included in this study. Age, tobacco use, and p16+ status were similar between groups. With multidisciplinary clinic, time to treatment decreased, and utilization of supportive services, including speech pathology, dentistry, and nutrition increased. The 5-year disease-specific survival rate increased from 63% to 81% (p = .043) after implementation of the multidisciplinary clinic. Multivariate analysis showed that disease stage (p = .016), p16 status (p = .006), and multidisciplinary clinic participation (p = .042) were predictors of disease-specific survival. Implementation of a multidisciplinary clinic improved care coordination and disease-specific survival in patients with oropharyngeal SCC. © 2017 Wiley Periodicals, Inc. Head Neck 39: 1106-1112, 2017. © 2017 Wiley Periodicals, Inc.

Pheochromocytoma with Markedly Abnormal Liver Function Tests and Severe Leukocytosis

Directory of Open Access Journals (Sweden)

Chai Ryoung Eun

2014-03-01

Full Text Available Pheochromocytoma is a rare neuroendocrine tumor arising from the medulla of the adrenal glands, which causes an overproduction of catecholamines. The common symptoms are headache, palpitations, and sweating; however, various other clinical manifestations might also be present. Accurate diagnosis of pheochromocytoma is important because surgical treatment is usually successful, and associated clinical problems are reversible if treated early. A 49-year-old man with a history of uncontrolled hypertension and diabetes mellitus presented with chest pain, fever, and sweating. His liver function tests and white blood cell counts were markedly increased and his echocardiography results suggested stress-induced cardiomyopathy. His abdominal computed tomography showed a 5×5-cm-sized tumor in the left adrenal gland, and laboratory tests confirmed catecholamine overproduction. After surgical resection of the left adrenal gland, his liver function tests and white blood cell counts normalized, and echocardiography showed normal cardiac function. Moreover, his previous antihypertensive regimen was deescalated, and his previously uncontrolled blood glucose levels normalized without medication.

Using Quality Improvement Methods and Time-Driven Activity-Based Costing to Improve Value-Based Cancer Care Delivery at a Cancer Genetics Clinic.

Science.gov (United States)

Tan, Ryan Y C; Met-Domestici, Marie; Zhou, Ke; Guzman, Alexis B; Lim, Soon Thye; Soo, Khee Chee; Feeley, Thomas W; Ngeow, Joanne

2016-03-01

To meet increasing demand for cancer genetic testing and improve value-based cancer care delivery, National Cancer Centre Singapore restructured the Cancer Genetics Service in 2014. Care delivery processes were redesigned. We sought to improve access by increasing the clinic capacity of the Cancer Genetics Service by 100% within 1 year without increasing direct personnel costs. Process mapping and plan-do-study-act (PDSA) cycles were used in a quality improvement project for the Cancer Genetics Service clinic. The impact of interventions was evaluated by tracking the weekly number of patient consultations and access times for appointments between April 2014 and May 2015. The cost impact of implemented process changes was calculated using the time-driven activity-based costing method. Our study completed two PDSA cycles. An important outcome was achieved after the first cycle: The inclusion of a genetic counselor increased clinic capacity by 350%. The number of patients seen per week increased from two in April 2014 (range, zero to four patients) to seven in November 2014 (range, four to 10 patients). Our second PDSA cycle showed that manual preappointment reminder calls reduced the variation in the nonattendance rate and contributed to a further increase in patients seen per week to 10 in May 2015 (range, seven to 13 patients). There was a concomitant decrease in costs of the patient care cycle by 18% after both PDSA cycles. This study shows how quality improvement methods can be combined with time-driven activity-based costing to increase value. In this paper, we demonstrate how we improved access while reducing costs of care delivery. Copyright © 2016 by American Society of Clinical Oncology.

[The historical background and present development of evidence-based healthcare and clinical nursing].

Science.gov (United States)

Tsai, Jung-Mei

2014-12-01

Evidence-based healthcare (EBHC) emphasizes the integration of the best research evidence with patient values, specialist suggestions, and clinical circumstances during the process of clinical decision-making. EBHC is a recognized core competency in modern healthcare. Nursing is a professional discipline of empirical science that thrives in an environment marked by advances in knowledge and technology in medicine as well as in nursing. Clinical nurses must elevate their skills and professional qualifications, provide efficient and quality health services, and promote their proficiency in EBHC. The Institute of Medicine in the United States indicates that evidence-based research results often fail to disseminate efficiently to clinical decision makers. This problem highlights the importance of better promoting the evidence-based healthcare fundamentals and competencies to frontline clinical nurses. This article describes the historical background and present development of evidence-based healthcare from the perspective of modern clinical nursing in light of the importance of evidence-based healthcare in clinical nursing; describes the factors associated with evidence-based healthcare promotion; and suggests strategies and policies that may improve the promotion and application of EBHC in clinical settings. The authors hope that this paper provides a reference for efforts to improve clinical nursing in the realms of EBHC training, promotion, and application.

Marking for Structure using Boolean Feedback | Louw | Journal for ...

African Journals Online (AJOL)

This paper presents evidence that marking student texts with well considered checklists is more effective than marking by hand. An experiment conducted on first-year students illustrated that the checklists developed to mark introductions, conclusions and paragraphs yielded better revision results than handwritten ...

Tooth-marked small theropod bone: an extremely rare trace

DEFF Research Database (Denmark)

Jacobsen, Aase Roland

2001-01-01

Tooth-marked dinosaur bones provide insight into feeding behaviours and biting strategies of theropod dinosaurs. The majority of theropod tooth marks reported to date have been found on herbivorous dinosaur bones, although some tyrannosaurid bones with tooth marks have also been reported. In 1988...

7 CFR 920.303 - Container marking regulations.

Science.gov (United States)

2010-01-01

... 7 Agriculture 8 2010-01-01 2010-01-01 false Container marking regulations. 920.303 Section 920.303... Miscellaneous Provisions § 920.303 Container marking regulations. No handler shall ship any kiwifruit except in accordance with the following terms and conditions: (a) Each package or container of kiwifruit shall bear on...

27 CFR 19.612 - Authorized abbreviations to identify marks.

Science.gov (United States)

2010-04-01

... T Tax Determined TD Wine Spirits Addition WSA (Sec. 201, Pub. L. 85-859, 72 Stat. 1360, as amended... TAX AND TRADE BUREAU, DEPARTMENT OF THE TREASURY LIQUORS DISTILLED SPIRITS PLANTS Containers and Marks... to identify certain marks: Mark Abbreviation Completely Denatured Alcohol CDA Distilled Spirits...

The national hydrologic bench-mark network

Science.gov (United States)

Cobb, Ernest D.; Biesecker, J.E.

1971-01-01

The United States is undergoing a dramatic growth of population and demands on its natural resources. The effects are widespread and often produce significant alterations of the environment. The hydrologic bench-mark network was established to provide data on stream basins which are little affected by these changes. The network is made up of selected stream basins which are not expected to be significantly altered by man. Data obtained from these basins can be used to document natural changes in hydrologic characteristics with time, to provide a better understanding of the hydrologic structure of natural basins, and to provide a comparative base for studying the effects of man on the hydrologic environment. There are 57 bench-mark basins in 37 States. These basins are in areas having a wide variety of climate and topography. The bench-mark basins and the types of data collected in the basins are described.

Feasibility of encoding the Institute for Clinical Systems Improvement Depression Guideline using the Omaha System.

Science.gov (United States)

Monsen, Karen A; Neely, Claire; Oftedahl, Gary; Kerr, Madeleine J; Pietruszewski, Pam; Farri, Oladimeji

2012-08-01

Evidence-based clinical guidelines are being developed to bridge the gap between research and practice with the goals of improving health care quality and population health. However, disseminating, implementing, and ensuring ongoing use of clinical guidelines in practice settings is challenging. The purpose of this study was to demonstrate the feasibility of encoding evidence-based clinical guidelines using the Omaha System. Clinical documentation with Omaha System-encoded guidelines generates individualized, meaningful data suitable for program evaluation and health care quality research. The use of encoded guidelines within the electronic health record has potential to reinforce use of guidelines, and thus improve health care quality and population health. Research using Omaha System data generated by clinicians has potential to discover new knowledge related to guideline use and effectiveness. Copyright © 2012 Elsevier Inc. All rights reserved.

46 CFR 160.077-31 - PFD Marking.

Science.gov (United States)

2010-10-01

... Marking. (a) General. Each hybrid PFD must be marked with the applicable information required by this... text of special purpose or limitation and vessel(s) or vessel type(s), noted on approval certificate... and be presented in the exact order shown: Type [II, III, or V, as applicable] PFD [See paragraph (k...

Using an International Clinical Registry of Regional Anesthesia to Identify Targets for Quality Improvement

Science.gov (United States)

Sites, Brian D.; Barrington, Michael J.; Davis, Matthew

2014-01-01

Background Despite the widespread use of regional anesthesia, limited information on clinical performance exists. Institutions, therefore, have little knowledge of how they are performing in regards to both safety and effectiveness. In this study, we demonstrate how a medical institution (or physician/physician group) may use data from a multi-center clinical registry of regional anesthesia to inform quality improvement strategies. Methods We analyzed data from the International Registry of Regional Anesthesia that includes prospective data on peripheral regional anesthesia procedures from 19 centers located around the world. Using data from the clinical registry, we present summary statistics of the overall safety and effectiveness of regional anesthesia. Furthermore, we demonstrate, using a variety of performance measures, how these data can be used by hospitals to identify areas for quality improvement. To do so, we compare the performance of one member institution (a United States medical center in New Hampshire) to that of the other 18 member institutions of the clinical registry. Results The clinical registry contained information on 23,271 blocks that were performed between June 1, 2011, and May 1, 2014, on 16,725 patients. The overall success rate was 96.7%, immediate complication rate was 2.2%, and the all-cause 60-day rate of neurological sequelae was 8.3 (95% CI, 7.2–9.7) per 10,000. Registry wide major hospital events included 7 wrong site blocks, 3 seizures, 1 complete heart block, 1 retroperitoneal hematoma, and 3 pneumothoraces. For our reference medical center, we identified areas meriting quality improvement. Specifically, after accounting for differences in the age, sex, and health status of patient populations, the reference medical center appeared to rely more heavily on opioids for post procedure management, had higher patient pain scores, and experienced delayed discharge when compared with other member institutions. Conclusions To our

9 CFR 590.418 - Supervision of marking and packaging.

Science.gov (United States)

2010-01-01

... 9 Animals and Animal Products 2 2010-01-01 2010-01-01 false Supervision of marking and packaging...) Identifying and Marking Product § 590.418 Supervision of marking and packaging. (a) Evidence of label approval... has on file evidence that such official identification or packaging material bearing such official...

Containment performance improvement program

International Nuclear Information System (INIS)

Beckner, W.; Mitchell, J.; Soffer, L.; Chow, E.; Lane, J.; Ridgely, J.

1990-01-01

The Containment Performance Improvement (CPI) program has been one of the main elements in the US Nuclear Regulatory Commission's (NRC's) integrated approach to closure of severe accident issues for US nuclear power plants. During the course of the program, results from various probabilistic risk assessment (PRA) studies and from severe accident research programs for the five US containment types have been examined to identify significant containment challenges and to evaluate potential improvements. The five containment types considered are: the boiling water reactor (BMR) Mark I containment, the BWR Mark II containment, the BWR Mark III containment, the pressurized water reactor (PWR) ice condenser containment, and the PWR dry containments (including both subatmospheric and large subtypes). The focus of the CPI program has been containment performance and accident mitigation, however, insights are also being obtained in the areas of accident prevention and accident management

Improving critical thinking and clinical reasoning with a continuing education course.

Science.gov (United States)

Cruz, Dina Monteiro; Pimenta, Cibele Mattos; Lunney, Margaret

2009-03-01

Continuing education courses related to critical thinking and clinical reasoning are needed to improve the accuracy of diagnosis. This study evaluated a 4-day, 16-hour continuing education course conducted in Brazil.Thirty-nine nurses completed a pretest and a posttest consisting of two written case studies designed to measure the accuracy of nurses' diagnoses. There were significant differences in accuracy from pretest to posttest for case 1 (p = .008) and case 2 (p = .042) and overall (p = .001). Continuing education courses should be implemented to improve the accuracy of nurses' diagnoses.

Lane marking detection based on waveform analysis and CNN

Science.gov (United States)

Ye, Yang Yang; Chen, Hou Jin; Hao, Xiao Li

2017-06-01

Lane markings detection is a very important part of the ADAS to avoid traffic accidents. In order to obtain accurate lane markings, in this work, a novel and efficient algorithm is proposed, which analyses the waveform generated from the road image after inverse perspective mapping (IPM). The algorithm includes two main stages: the first stage uses an image preprocessing including a CNN to reduce the background and enhance the lane markings. The second stage obtains the waveform of the road image and analyzes the waveform to get lanes. The contribution of this work is that we introduce local and global features of the waveform to detect the lane markings. The results indicate the proposed method is robust in detecting and fitting the lane markings.

Statistical methods for the forensic analysis of striated tool marks

Energy Technology Data Exchange (ETDEWEB)

Hoeksema, Amy Beth [Iowa State Univ., Ames, IA (United States)

2013-01-01

In forensics, fingerprints can be used to uniquely identify suspects in a crime. Similarly, a tool mark left at a crime scene can be used to identify the tool that was used. However, the current practice of identifying matching tool marks involves visual inspection of marks by forensic experts which can be a very subjective process. As a result, declared matches are often successfully challenged in court, so law enforcement agencies are particularly interested in encouraging research in more objective approaches. Our analysis is based on comparisons of profilometry data, essentially depth contours of a tool mark surface taken along a linear path. In current practice, for stronger support of a match or non-match, multiple marks are made in the lab under the same conditions by the suspect tool. We propose the use of a likelihood ratio test to analyze the difference between a sample of comparisons of lab tool marks to a field tool mark, against a sample of comparisons of two lab tool marks. Chumbley et al. (2010) point out that the angle of incidence between the tool and the marked surface can have a substantial impact on the tool mark and on the effectiveness of both manual and algorithmic matching procedures. To better address this problem, we describe how the analysis can be enhanced to model the effect of tool angle and allow for angle estimation for a tool mark left at a crime scene. With sufficient development, such methods may lead to more defensible forensic analyses.

Can eye-tracking technology improve situational awareness in paramedic clinical education?

Science.gov (United States)

Williams, Brett; Quested, Andrew; Cooper, Simon

2013-01-01

Human factors play a significant part in clinical error. Situational awareness (SA) means being aware of one's surroundings, comprehending the present situation, and being able to predict outcomes. It is a key human skill that, when properly applied, is associated with reducing medical error: eye-tracking technology can be used to provide an objective and qualitative measure of the initial perception component of SA. Feedback from eye-tracking technology can be used to improve the understanding and teaching of SA in clinical contexts, and consequently, has potential for reducing clinician error and the concomitant adverse events.

Otolith marking of juvenile shortnose gar by immersion in oxytetracycline

Science.gov (United States)

Snow, Richard A.; Long, James M.

2017-01-01

Oxytetracycline (OTC) has been used to mark a variety of fish species at multiple developmental stages; however, there is little information on batch-marking Lepisosteidae. Juvenile Shortnose Gar Lepisosteus platostomus (53 ± 3 mm TL) were seined from an Oklahoma State University research pond and transported to the Oklahoma Fishery Research Lab. Juvenile Shortnose Gar were exposed to a range of OTC concentrations—0, 500, 600, and 700 mg/L—for 4, 5, or 6 h. Lapillus and sagitta otoliths were examined 14 d postexposure for mark presence and evaluation using fluorescent microscopy. Overall, 93.3% of otoliths exposed to OTC exhibited a mark. Concentration of OTC affected the mean mark quality, whereas duration and otolith type examined did not. However, as concentration increased, so did mortality, suggesting a balance is needed to achieve marking goals. Based on our findings, batch marking of Shortnose Gar can be successful at OTC concentrations from 500 to 700 mg/L for 4–6 h, although mark quality may vary and mortality rates increase at the higher concentrations and longer durations.

Using digital multimedia to improve parents' and children's understanding of clinical trials.

Science.gov (United States)

Tait, Alan R; Voepel-Lewis, Terri; Levine, Robert

2015-06-01

Data show that many research subjects have difficulty understanding study information using traditional paper consent documents. This study, therefore, was designed to evaluate the effect of an interactive multimedia program on improving parents' and children's understanding of clinical trial concepts and participation. Parents (n=148) and children (n=135) were each randomised to receive information regarding clinical trials using either a traditional paper format (TF) or an interactive iPad program (IP) with inline exercises. Participants' understanding of the information was assessed using semistructured interviews prior to (pretest) and after (post-test) receiving the information. Participants also completed a short survey to assess their perceptions of information delivery and satisfaction with the process. Regardless of the mode of information delivery, all participants demonstrated improved pretest to post-test understanding. While there were no statistical differences in parents' post-test understanding between the TF and IP groups, children in the IP group had significantly greater post-test understanding compared with children in the TF group (11.65 (4.1) vs 8.85 (4.1) (2.8, 1.4, 4.2) 0-18 scale where 18=complete understanding). Furthermore, the IP was found to be significantly 'easier to follow' and 'more effective' in presenting information compared with the TF. Results demonstrated the importance of providing information regarding clinical trial concepts to parents and children. Importantly, the ability of interactive multimedia to improve understanding of clinical trial concepts and satisfaction with information delivery, particularly among children, supports this approach as a novel and effective vehicle for enhancing the informed consent process. 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.

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.

Improving Layman Readability of Clinical Narratives with Unsupervised Synonym Replacement.

Science.gov (United States)

Moen, Hans; Peltonen, Laura-Maria; Koivumäki, Mikko; Suhonen, Henry; Salakoski, Tapio; Ginter, Filip; Salanterä, Sanna

2018-01-01

We report on the development and evaluation of a prototype tool aimed to assist laymen/patients in understanding the content of clinical narratives. The tool relies largely on unsupervised machine learning applied to two large corpora of unlabeled text - a clinical corpus and a general domain corpus. A joint semantic word-space model is created for the purpose of extracting easier to understand alternatives for words considered difficult to understand by laymen. Two domain experts evaluate the tool and inter-rater agreement is calculated. When having the tool suggest ten alternatives to each difficult word, it suggests acceptable lay words for 55.51% of them. This and future manual evaluation will serve to further improve performance, where also supervised machine learning will be used.

Radio-marking and in vivo imagery of oligonucleotides

International Nuclear Information System (INIS)

Kuehnast, Bertrand

2000-01-01

This research thesis is part of activities aimed at the development of new molecules like oligonucleotides. Its first objective was the development and validation of a marking method with fluorine-18 of oligonucleotides for their in-vivo pharmacological assessment with positron emission tomography (PET). Further investigations addressed the use of iodine-125 for oligonucleotide marking purpose. This radio-marking, and in vivo and ex vivo imagery techniques are described, and their potential is highlighted for the pharmacological assessment of different oligonucleotides

Marked improvement in the success rate of medical management of early pregnancy failure following the implementation of a novel institutional protocol and treatment guidelines: a follow-up study.

Science.gov (United States)

Colleselli, V; Nell, T; Bartosik, T; Brunner, C; Ciresa-Koenig, A; Wildt, L; Marth, C; Seeber, B

2016-11-01

To analyze the success rate, time to passage of tissue and subjective patient experience of a newly implemented protocol for medical management of early pregnancy failure (EPF) over a 2-year period. A retrospective chart review of all patients with early pregnancy failure primarily opting for medical management was performed. 200 mg mifepristone were administered orally, followed by a single vaginal dose of 800 mcg misoprostol after 36-48 h. We followed-up with our patients using a written questionnaire. 167 women were included in the present study. We observed an overall success rate of 92 %, defined as no need for surgical management after medication administration. We could not identify predictive values for success in a multivariate regression analysis. Most patients (84 %) passed tissue within 6 h after misoprostol administration. The protocol was well tolerated with a low incidence of side effects. Pain was managed well with sufficient analgesics. Responders to the questionnaire felt adequately informed prior to treatment and rated their overall experience as positive. The adaption of the institutional medical protocol resulted in a marked improvement of success rate when compared to the previously used protocol (92 vs. 61 %). We credit this increase to the adjusted medication schema as well as to targeted physician education on the expected course and interpretation of outcome measures. Our results underscore that the medical management of EPF is a safe and effective alternative to surgical evacuation in the clinical setting.

Combining clinical variables to optimize prediction of antidepressant treatment outcomes.

Science.gov (United States)

Iniesta, Raquel; Malki, Karim; Maier, Wolfgang; Rietschel, Marcella; Mors, Ole; Hauser, Joanna; Henigsberg, Neven; Dernovsek, Mojca Zvezdana; Souery, Daniel; Stahl, Daniel; Dobson, Richard; Aitchison, Katherine J; Farmer, Anne; Lewis, Cathryn M; McGuffin, Peter; Uher, Rudolf

2016-07-01

The outcome of treatment with antidepressants varies markedly across people with the same diagnosis. A clinically significant prediction of outcomes could spare the frustration of trial and error approach and improve the outcomes of major depressive disorder through individualized treatment selection. It is likely that a combination of multiple predictors is needed to achieve such prediction. We used elastic net regularized regression to optimize prediction of symptom improvement and remission during treatment with escitalopram or nortriptyline and to identify contributing predictors from a range of demographic and clinical variables in 793 adults with major depressive disorder. A combination of demographic and clinical variables, with strong contributions from symptoms of depressed mood, reduced interest, decreased activity, indecisiveness, pessimism and anxiety significantly predicted treatment outcomes, explaining 5-10% of variance in symptom improvement with escitalopram. Similar combinations of variables predicted remission with area under the curve 0.72, explaining approximately 15% of variance (pseudo R(2)) in who achieves remission, with strong contributions from body mass index, appetite, interest-activity symptom dimension and anxious-somatizing depression subtype. Escitalopram-specific outcome prediction was more accurate than generic outcome prediction, and reached effect sizes that were near or above a previously established benchmark for clinical significance. Outcome prediction on the nortriptyline arm did not significantly differ from chance. These results suggest that easily obtained demographic and clinical variables can predict therapeutic response to escitalopram with clinically meaningful accuracy, suggesting a potential for individualized prescription of this antidepressant drug. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

Field manual for identifying and preserving high-water mark data

Science.gov (United States)

Feaster, Toby D.; Koenig, Todd A.

2017-09-26

This field manual provides general guidance for identifying and collecting high-water marks and is meant to be used by field personnel as a quick reference. The field manual describes purposes for collecting and documenting high-water marks along with the most common types of high-water marks. The manual provides a list of suggested field equipment, describes rules of thumb and best practices for finding high-water marks, and describes the importance of evaluating each high-water mark and assigning a numeric uncertainty value as part of the flagging process. The manual also includes an appendix of photographs of a variety of high-water marks obtained from various U.S. Geological Survey field investigations along with general comments about the logic for the assigned uncertainty values.

A FMEA clinical laboratory case study: how to make problems and improvements measurable.

Science.gov (United States)

Capunzo, Mario; Cavallo, Pierpaolo; Boccia, Giovanni; Brunetti, Luigi; Pizzuti, Sante

2004-01-01

The authors have experimented the application of the Failure Mode and Effect Analysis (FMEA) technique in a clinical laboratory. FMEA technique allows: a) to evaluate and measure the hazards of a process malfunction, b) to decide where to execute improvement actions, and c) to measure the outcome of those actions. A small sample of analytes has been studied: there have been determined the causes of the possible malfunctions of the analytical process, calculating the risk probability index (RPI), with a value between 1 and 1,000. Only for the cases of RPI > 400, improvement actions have been implemented that allowed a reduction of RPI values between 25% to 70% with a costs increment of FMEA technique can be applied to the processes of a clinical laboratory, even if of small dimensions, and offers a high potential of improvement. Nevertheless, such activity needs a thorough planning because it is complex, even if the laboratory already operates an ISO 9000 Quality Management System.

Survival and reproduction of radio-marked adult spotted owls.

Science.gov (United States)

C.C. Foster; E.D. Forsman; E.C. Meslow; G.S. Miller; J.A. Reid; F.F. Wagner; A.B. Carey; J.B. Lint

1992-01-01

We compared survival, reproduction, and body mass of radio-marked and non radio-marked spotted owls (Strix occidentalis) to determine if backpack radios influenced reproduction or survival. In most study areas and years, there were no differences (P > 0.05) in survival of males and females or in survival of radio-marked versus banded owls. There...

Implementation of renal key performance indicators: promoting improved clinical practice.

Science.gov (United States)

Toussaint, Nigel D; McMahon, Lawrence P; Dowling, Gregory; Soding, Jenny; Safe, Maria; Knight, Richard; Fair, Kathleen; Linehan, Leanne; Walker, Rowan G; Power, David A

2015-03-01

In the Australian state of Victoria, the Renal Health Clinical Network (RHCN) of the Department of Health Victoria established a Renal Key Performance Indicator (KPI) Working Group in 2011. The group developed four KPIs related to chronic kidney disease and dialysis. A transplant working group of the RHCN developed two additional KPIs. The aim was to develop clinical indicators to measure performance of renal services to drive service improvement. A data collection and benchmarking programme was established, with data provided monthly to the Department using a purpose-designed website portal. The KPI Working Group is responsible for analysing data each quarter and ensuring indicators remain accurate and relevant. Each indicator has clear definitions and targets, and assess (i) patient education, (ii) timely creation of vascular access for haemodialysis, (iii) proportion of patients dialysing at home, (iv) incidence of dialysis-related peritonitis, (v) incidence of pre-emptive renal transplantation, and (vi) timely listing of patients for deceased donor transplantation. Most KPIs have demonstrated improved performance over time with limited gains notably in two: the proportion of patients dialysing at home (KPI 3) and timely listing patients for transplantation (KPI 6). KPI implementation has been established in Victoria for 2 years, providing performance data without additional funding. The six Victorian KPIs are measurable, relevant and modifiable, and implementation relies on enthusiasm and goodwill of physicians and nurses involved in collecting data. The KPIs require further evaluation, but adoption of a similar programme by other jurisdictions could lead to improved national outcomes. © 2014 Asian Pacific Society of Nephrology.

Sclerosing lymphangitis of the penis associated with marked penile oedema and skin erosions.

Science.gov (United States)

Karray, Mehdi; Litaiem, Noureddine; Jones, Mariem; Zeglaoui, Faten

2017-07-27

Sclerosing lymphangitis of the penis is a benign, under-reported condition consisting of a asymptomatic firm cord-like swelling around the coronal sulcus of the penis usually affecting men in the second or third decade of life. Penile oedema and erosions are rarely reported. Clinical signs may be remarkable contrasting with the self-limited character of the disease. We report a new case of sclerosing lymphangitis of the penis occurring in a 59-year-old patient marked by penile swelling and several overlying skin erosions, and discuss the clinical features and the pathogenesis aspects of the disease. © BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Bench-marking beam-beam simulations using coherent quadrupole effects

International Nuclear Information System (INIS)

Krishnagopal, S.; Chin, Y.H.

1992-06-01

Computer simulations are used extensively in the study of the beam-beam interaction. The proliferation of such codes raises the important question of their reliability, and motivates the development of a dependable set of bench-marks. We argue that rather than detailed quantitative comparisons, the ability of different codes to predict the same qualitative physics should be used as a criterion for such bench-marks. We use the striking phenomenon of coherent quadrupole oscillations as one such bench-mark, and demonstrate that our codes do indeed observe this behaviour. We also suggest some other tests that could be used as bench-marks

Bench-marking beam-beam simulations using coherent quadrupole effects

International Nuclear Information System (INIS)

Krishnagopal, S.; Chin, Y.H.

1992-01-01

Computer simulations are used extensively in the study of the beam-beam interaction. The proliferation of such codes raises the important question of their reliability, and motivates the development of a dependable set of bench-marks. We argue that rather than detailed quantitative comparisons, the ability of different codes to predict the same qualitative physics should be used as a criterion for such bench-marks. We use the striking phenomenon of coherent quadrupole oscillations as one such bench-mark, and demonstrate that our codes do indeed observe this behavior. We also suggest some other tests that could be used as bench-marks

The Information Literacy of Survey Mark Hunting: A Dialogue

Directory of Open Access Journals (Sweden)

Jennifer Galas

2016-11-01

Full Text Available In Brief: This article makes connections between the ACRL Framework for Information Literacy for Higher Education and the activity of survey mark hunting. After a brief review of the literature related to geographic information systems (GIS, information literacy, and gamification of learning, the authors enter into a dialogue in which they discover and describe the various ways information literacy is both required by and developed through the recreational activity of survey mark hunting. Through their dialogue they found that the activity of survey mark hunting relies on the construction of both information and its authority in ways contextualized within the communities that participate; that survey mark hunting is a conversation that builds on the past, where lived experience counts as evidence; and, that survey mark hunting is both a metaphor and embodied enactment of information literacy.

Factors influencing survival and mark retention in postmetamorphic boreal chorus frogs

Science.gov (United States)

Swanson, Jennifer E; Bailey, Larissa L.; Muths, Erin L.; Funk, W. Chris

2013-01-01

The ability to track individual animals is crucial in many field studies and often requires applying marks to captured individuals. Toe clipping has historically been a standard marking method for wild amphibian populations, but more recent marking methods include visual implant elastomer and photo identification. Unfortunately, few studies have investigated the influence and effectiveness of marking methods for recently metamorphosed individuals and as a result little is known about this life-history phase for most amphibians. Our focus was to explore survival probabilities, mark retention, and mark migration in postmetamorphic Boreal Chorus Frogs (Psuedacris maculata) in a laboratory setting. One hundred forty-seven individuals were assigned randomly to two treatment groups or a control group. Frogs in the first treatment group were marked with visual implant elastomer, while frogs in the second treatment group were toe clipped. Growth and mortality were recorded for one year and resulting data were analyzed using known-fate models in Program MARK. Model selection results suggested that survival probabilities of frogs varied with time and showed some variation among marking treatments. We found that frogs with multiple toes clipped on the same foot had lower survival probabilities than individuals in other treatments, but individuals can be marked by clipping a single toe on two different feet without any mark loss or negative survival effects. Individuals treated with visual implant elastomer had a mark migration rate of 4% and mark loss rate of 6%, and also showed very little negative survival impacts relative to control individuals.

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

Pressure ulcers, indentation marks and pain from cervical spine immobilization with extrication collars and headblocks: An observational study.

Science.gov (United States)

Ham, Wietske H W; Schoonhoven, Lisette; Schuurmans, Marieke J; Leenen, Luke P H

2016-09-01

To describe the occurrence and severity of pressure ulcers, indentation marks and pain from the extrication collar combined with headblocks. Furthermore, the influence of time, injury severity and patient characteristics on the development of pressure ulcers, indentation marks and pain was explored. Observational. Level one trauma centre in the Netherlands. Adult trauma patients admitted to the Emergency Department in an extrication collar combined with headblocks. Between January and December 2013, 342 patients were included. Study outcomes were incidence and severity of pressure ulcers, indentation marks and pain. The following dependent variables were collected: time in the cervical collar and headblocks, Glasgow Coma Scale, Mean Arterial Pressure, haemoglobin, Injury Severity Score, gender, age, and Body Mass Index. 75.4% of the patients developed a category 1 and 2.9% a category 2 pressure ulcer. Indentation marks were observed in 221 (64.6%) patients; 96 (28.1%) had severe indentation marks. Pressure ulcers and indentation marks were observed most frequently at the back, shoulders and chest. 63.2% experienced pain, of which, 38.5% experienced severe pain. Pain was mainly located at the occiput. Female patients experienced significantly more pain (NRS>3) compared to male patients (OR=2.14, 95% CI 1.21-3.80) None of the investigated variables significantly increased the probability of developing PUs or indentation marks. The high incidence of category 1 pressure ulcers and severe indentation marks indicate an increased risk for pressure ulcer development and may well lead to more severe PU lesions. Pain due to the application of the extrication collar and headblocks may lead to undesirable movement (in order to relieve the pressure) or to bias clinical examination of the cervical spine. It is necessary to revise the current practice of cervical spine immobilization. Copyright © 2016 Elsevier Ltd. All rights reserved.

Mark Antony’s Homoeroticism in Cicero’s second Philippic

Directory of Open Access Journals (Sweden)

Bruna Fernanda Abreu

2017-06-01

Full Text Available Considering the concept of homosexuality in the ancient Rome, we attempt to analise how Cicero expose the Mark Antony’s “homosexuality” in his second Philippic. This speech is characterized by political and, mainly, personal accusations from Cicero to Mark Antony, and the Mark Antony’s passivity in his intercourses can be considered a topos of this invective speech.

Do educational interventions improve nurses' clinical decision making and judgement? A systematic review.

Science.gov (United States)

Thompson, Carl; Stapley, Sally

2011-07-01

Despite the growing popularity of decision making in nursing curricula, the effectiveness of educational interventions to improve nursing judgement and decision making is unknown. We sought to synthesise and summarise the comparative evidence for educational interventions to improve nursing judgements and clinical decisions. A systematic review. Electronic databases: Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, CINAHL and PsycINFO, Social Sciences Citation Index, OpenSIGLE conference proceedings and hand searching nursing journals. Studies published since 1960, reporting any educational intervention that aimed to improve nurses' clinical judgements or decision making were included. Studies were assessed for relevance and quality. Data extracted included study design; educational setting; the nature of participants; whether the study was concerned with the clinical application of skills or the application of theory; the type of decision targeted by the intervention (e.g. diagnostic reasoning) and whether the evaluation of the intervention focused on efficacy or effectiveness. A narrative approach to study synthesis was used due to heterogeneity in interventions, study samples, outcomes and settings and incomplete reporting of effect sizes. From 5262 initial citations 24 studies were included in the review. A variety of educational approaches were reported. Study quality and content reporting was generally poor. Pedagogical theories were widely used but use of decision theory (with the exception of subjective expected utility theory implicit in decision analysis) was rare. The effectiveness and efficacy of interventions was mixed. Educational interventions to improve nurses' judgements and decisions are complex and the evidence from comparative studies does little to reduce the uncertainty about 'what works'. Nurse educators need to pay attention to decision, as well as pedagogical, theory in the design of interventions. Study design and

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

Science.gov (United States)

Esposito, Pasquale; Dal Canton, Antonio

2014-01-01

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

Rubber stamp templates for improving clinical documentation: A paper-based, m-Health approach for quality improvement in low-resource settings.

Science.gov (United States)

Kleczka, Bernadette; Musiega, Anita; Rabut, Grace; Wekesa, Phoebe; Mwaniki, Paul; Marx, Michael; Kumar, Pratap

2018-06-01

The United Nations' Sustainable Development Goal #3.8 targets 'access to quality essential healthcare services'. Clinical practice guidelines are an important tool for ensuring quality of clinical care, but many challenges prevent their use in low-resource settings. Monitoring the use of guidelines relies on cumbersome clinical audits of paper records, and electronic systems face financial and other limitations. Here we describe a unique approach to generating digital data from paper using guideline-based templates, rubber stamps and mobile phones. The Guidelines Adherence in Slums Project targeted ten private sector primary healthcare clinics serving informal settlements in Nairobi, Kenya. Each clinic was provided with rubber stamp templates to support documentation and management of commonly encountered outpatient conditions. Participatory design methods were used to customize templates to the workflows and infrastructure of each clinic. Rubber stamps were used to print templates into paper charts, providing clinicians with checklists for use during consultations. Templates used bubble format data entry, which could be digitized from images taken on mobile phones. Besides rubber stamp templates, the intervention included booklets of guideline compilations, one Android phone for digitizing images of templates, and one data feedback/continuing medical education session per clinic each month. In this paper we focus on the effect of the intervention on documentation of three non-communicable diseases in one clinic. Seventy charts of patients enrolled in the chronic disease program (hypertension/diabetes, n=867; chronic respiratory diseases, n=223) at one of the ten intervention clinics were sampled. Documentation of each individual patient encounter in the pre-intervention (January-March 2016) and post-intervention period (May-July) was scored for information in four dimensions - general data, patient assessment, testing, and management. Control criteria included

Improving superficial target delineation in radiation therapy with endoscopic tracking and registration

Energy Technology Data Exchange (ETDEWEB)

Weersink, R. A.; Qiu, J.; Hope, A. J.; Daly, M. J.; Cho, B. C. J.; DaCosta, R. S.; Sharpe, M. B.; Breen, S. L.; Chan, H.; Jaffray, D. A. [Radiation Medicine Program, Princess Margaret Hospital, Toronto, Ontario M5G 2M9 (Canada) and Ontario Cancer Institute, University Health Network, Toronto, Ontario M5G 2M9 (Canada); Radiation Medicine Program, Princess Margaret Hospital, Toronto, Ontario M5G 2M9 (Canada); Radiation Medicine Program, Princess Margaret Hospital, Toronto, Ontario M5G 2M9, Canada and Department of Radiation Oncology, University of Toronto, Toronto, Ontario M5G 2M9 (Canada); Radiation Medicine Program, Princess Margaret Hospital, Toronto, Ontario M5G 2M9 (Canada); Radiation Medicine Program, Princess Margaret Hospital, Toronto, Ontario M5G 2M9 (Canada) and Department of Radiation Oncology, University of Toronto, Toronto, Ontario M5G 2M9 (Canada); Radiation Medicine Program, Princess Margaret Hospital, Toronto, Ontario M5G 2M9, Canada and Ontario Cancer Institute, University Health Network, Toronto, Ontario M5G 2M9 (Canada); Radiation Medicine Program, Princess Margaret Hospital, Toronto, Ontario M5G 2M9 (Canada) and Department of Radiation Oncology, University of Toronto, Toronto, Ontario M5G 2M9 (Canada); Radiation Medicine Program, Princess Margaret Hospital, Toronto, Ontario M5G 2M9 (Canada); Radiation Medicine Program, Princess Margaret Hospital, Toronto, Ontario M5G 2M9 (Canada); Department of Radiation Oncology, University of Toronto, Toronto, Ontario M5G 2M9 (Canada) and Ontario Cancer Institute, University Health Network, Toronto, Ontario M5G 2M9 (Canada)

2011-12-15

Purpose: Target delineation within volumetric imaging is a critical step in the planning process of intensity modulated radiation therapy. In endoluminal cancers, endoscopy often reveals superficial areas of visible disease beyond what is seen on volumetric imaging. Quantitatively relating these findings to the volumetric imaging is prone to human error during the recall and contouring of the target. We have developed a method to improve target delineation in the radiation therapy planning process by quantitatively registering endoscopic findings contours traced on endoscopic images to volumetric imaging. Methods: Using electromagnetic sensors embedded in an endoscope, 2D endoscopic images were registered to computed tomography (CT) volumetric images by tracking the position and orientation of the endoscope relative to a CT image set. Regions-of-interest (ROI) in the 2D endoscopic view were delineated. A mesh created within the boundary of the ROI was projected onto the 3D image data, registering the ROI with the volumetric image. This 3D ROI was exported to clinical radiation treatment planning software. The precision and accuracy of the procedure was tested on two solid phantoms with superficial markings visible on both endoscopy and CT images. The first phantom was T-shaped tube with X-marks etched on the interior. The second phantom was an anatomically correct skull phantom with a phantom superficial lesion placed on the pharyngeal surface. Markings were contoured on the endoscope images and compared with contours delineated in the treatment planning system based on the CT images. Clinical feasibility was tested on three patients with early stage glottic cancer. Image-based rendering using manually identified landmarks was used to improve the registration. Results: Using the T-shaped phantom with X-markings, the 2D to 3D registration accuracy was 1.5-3.5 mm, depending on the endoscope position relative to the markings. Intraobserver standard variation was 0

Preoperative Site Marking: Are We Adhering to Good Surgical Practice?

Science.gov (United States)

Bathla, Sonia; Chadwick, Michael; Nevins, Edward J; Seward, Joanna

2017-06-29

Wrong-site surgery is a never event and a serious, preventable patient safety incident. Within the United Kingdom, national guidance has been issued to minimize the risk of such events. The mandate includes preoperative marking of all surgical patients. This study aimed to quantify regional variation in practice within general surgery and opinions of the surgeons, to help guide the formulation and implementation of a regional general surgery preoperative marking protocol. A SurveyMonkey questionnaire was designed and distributed to 120 surgeons within the Mersey region, United Kingdom. This included all surgical trainees in Mersey (47 registrars, 56 core trainees), 15 consultants, and 2 surgical care practitioners. This sought to ascertain their routine practice and how they would choose to mark for 12 index procedures in general surgery, if mandated to do so. A total of 72 responses (60%) were obtained to the SurveyMonkey questionnaire. Only 26 (36.1%) said that they routinely marked all of their patients preoperatively. The operating surgeon marked the patient in 69% of responses, with the remainder delegating this task. Markings were visible after draping in only 55.6% of marked cases. Based on our findings, surgeons may not be adhering to "Good Surgical Practice"; practice is widely variable and surgeons are largely opposed and resistant to marking patients unless laterality is involved. We suggest that all surgeons need to be actively engaged in the design of local marking protocols to gain support, change practice, and reduce errors.

Clinical Image Evaluation of Film Mammograms in Korea: Comparison with the ACR Standard

International Nuclear Information System (INIS)

Gwak, Yeon Joo; Kim, Hye Jung; Kwak, Jin Young; Son, Eun Ju; Ko, Kyung Hee; Lee, Jin Hwa; Lim, Hyo Soon; Lee, You Jin; Park, Ji Won; Shin, Kyung Min; Jang, Yun-Jin

2013-01-01

The goal of this study is to compare the overall quality of film mammograms taken according to the Korean standards with the American College of Radiology (ACR) standard for clinical image evaluation and to identify means of improving mammography quality in Korea. Four hundred and sixty eight sets of film mammograms were evaluated with respect to the Korean and ACR standards for clinical image evaluation. The pass and failure rates of mammograms were compared by medical facility types. Average scores in each category of the two standards were evaluated. Receiver operating characteristic curve analysis was used to identify an optimal Korean standard pass mark by taking the ACR standard as the reference standard. 93.6% (438/468) of mammograms passed the Korean standard, whereas only 80.1% (375/468) passed the ACR standard (p < 0.001). Non-radiologic private clinics had the lowest pass rate (88.1%: Korean standard, 71.8%: ACR standard) and the lowest total score (76.0) by the Korean standard. Average scores of positioning were lowest (19.3/29 by the Korean standard and 3.7/5 by the ACR standard). A cutoff score of 77.0 for the Korean standard was found to correspond to a pass level when the ACR standard was applied. We suggest that tighter regulations, such as, raising the Korean pass mark, subtracting more for severe deficiencies, or considering a very low scores in even a single category as failure, are needed to improve the quality of mammography in Korea

Frameworks for improvement: clinical audit, the plan-do-study-act cycle and significant event audit.

Science.gov (United States)

Gillam, Steve; Siriwardena, A Niroshan

2013-01-01

This is the first in a series of articles about quality improvement tools and techniques. We explore common frameworks for improvement, including the model for improvement and its application to clinical audit, plan-do-study-act (PDSA) cycles and significant event analysis (SEA), examining the similarities and differences between these and providing examples of each.

Case Study: Clinical Governance as an Approach to Improve Maternal and Newborn Health in 22 Hospitals in Indonesia.

Science.gov (United States)

Amelia, Dwirani; Suhowatsky, Stephanie; Baharuddin, Mohammad; Tholandi, Maya; Hyre, Anne; Sethi, Reena

Clinical governance is a concept used to improve management, accountability and the provision of quality healthcare. An approach to strengthen clinical governance as a means to improve the quality of maternal and newborn care in Indonesia was developed by the Expanding Maternal and Neonatal Survival (EMAS) Program. This case study presents findings and lessons learned from EMAS program experience in 22 hospitals where peer-to-peer mentoring supported staff in strengthening clinical governance from 2012-2015. Efforts resulted in improved hospital preparedness and significantly increased the odds of facility-level coverage for three evidence-based maternal and newborn healthcare interventions.

Importance of clinical toxicology teaching and its impact in improving knowledge: sharing experience from a workshop

International Nuclear Information System (INIS)

Khan, N.U.; Fayyaz, J.; Khan, U.R.; Feroze, A.

2013-01-01

Objective: To assess the impact of a one-day clinical toxicology workshop in improving knowledge. Methods: A one-day clinical toxicology workshop was conducted as a pre-conference workshop of the Annual Emergency Medicine Conference at the Aga Khan University Hospital, Karachi, in April 2012. The course was composed of poisoning-related common clinical scenarios. The pre-test and post-test understanding was used to assess the impact of the course in improving knowledge. The participants also evaluated the workshop as a whole thorough written evaluation forms. SPSS 19 was used for statistical analysis of the data. Result: There were 22 participants in the course. The pre-test mean score was 31.6+-15.1% (95% CI; 24-40; n=19) compared to the post-test the mean score of 56.0+-10.8% (95% CI; 47- 61; n=17). The positive difference was also statistically significant (p<0.001). The overall workshop was evaluated as excellent by 08 (47.46%) and very good by 10 (52.63%) participants. Conclusion: Short training in clinical toxicology improved knowledge of the participants. (author)

The Stingless Bee Melipona solani Deposits a Signature Mixture and Methyl Oleate to Mark Valuable Food Sources.

Science.gov (United States)

Alavez-Rosas, David; Malo, Edi A; Guzmán, Miguel A; Sánchez-Guillén, Daniel; Villanueva-Gutiérrez, Rogel; Cruz-López, Leopoldo

2017-10-01

Stingless bees foraging for food improve recruitment by depositing chemical cues on valuable food sites or pheromone marks on vegetation. Using gas chromatography/mass spectrometry and bioassays, we showed that Melipona solani foragers leave a mixture composed mostly of long chain hydrocarbons from their abdominal cuticle plus methyl oleate from the labial gland as a scent mark on rich food sites. The composition of hydrocarbons was highly variable among individuals and varied in proportions, depending on the body part. A wide ratio of compounds present in different body parts of the bees elicited electroantennogram responses from foragers and these responses were dose dependent. Generally, in bioassays, these bees prefer to visit previously visited feeders and feeders marked with extracts from any body part of conspecifics. The mean number of visits to a feeder was enhanced when synthetic methyl oleate was added. We propose that this could be a case of multi-source odor marking, in which hydrocarbons, found in large abundance, act as a signature mixture with attraction enhanced through deposition of methyl oleate, which may indicate a rich food source.

Virtual tool mark generation for efficient striation analysis in forensic science

Energy Technology Data Exchange (ETDEWEB)

Ekstrand, Laura [Iowa State Univ., Ames, IA (United States)

2012-01-01

In 2009, a National Academy of Sciences report called for investigation into the scienti c basis behind tool mark comparisons (National Academy of Sciences, 2009). Answering this call, Chumbley et al. (2010) attempted to prove or disprove the hypothesis that tool marks are unique to a single tool. They developed a statistical algorithm that could, in most cases, discern matching and non-matching tool marks made at di erent angles by sequentially numbered screwdriver tips. Moreover, in the cases where the algorithm misinterpreted a pair of marks, an experienced forensics examiner could discern the correct outcome. While this research served to con rm the basic assumptions behind tool mark analysis, it also suggested that statistical analysis software could help to reduce the examiner's workload. This led to a new tool mark analysis approach, introduced in this thesis, that relies on 3D scans of screwdriver tip and marked plate surfaces at the micrometer scale from an optical microscope. These scans are carefully cleaned to remove noise from the data acquisition process and assigned a coordinate system that mathematically de nes angles and twists in a natural way. The marking process is then simulated by using a 3D graphics software package to impart rotations to the tip and take the projection of the tip's geometry in the direction of tool travel. The edge of this projection, retrieved from the 3D graphics software, becomes a virtual tool mark. Using this method, virtual marks are made at increments of 5 and compared to a scan of the evidence mark. The previously developed statistical package from Chumbley et al. (2010) performs the comparison, comparing the similarity of the geometry of both marks to the similarity that would occur due to random chance. The resulting statistical measure of the likelihood of the match informs the examiner of the angle of the best matching virtual mark, allowing the examiner to focus his/her mark analysis on a smaller range of angles

Sensor fusion: lane marking detection and autonomous intelligent cruise control system

Science.gov (United States)

Baret, Marc; Baillarin, S.; Calesse, C.; Martin, Lionel

1995-12-01

In the past few years MATRA and RENAULT have developed an Autonomous Intelligent Cruise Control (AICC) system based on a LIDAR sensor. This sensor incorporating a charge coupled device was designed to acquire pulsed laser diode emission reflected by standard car reflectors. The absence of moving mechanical parts, the large field of view, the high measurement rate and the very good accuracy for distance range and angular position of targets make this sensor very interesting. It provides the equipped car with the distance and the relative speed of other vehicles enabling the safety distance to be controlled by acting on the throttle and the automatic gear box. Experiments in various real traffic situations have shown the limitations of this kind of system especially on bends. All AICC sensors are unable to distinguish between a bend and a change of lane. This is easily understood if we consider a road without lane markings. This fact has led MATRA to improve its AICC system by providing the lane marking information. Also in the scope of the EUREKA PROMETHEUS project, MATRA and RENAULT have developed a lane keeping system in order to warn of the drivers lack of vigilance. Thus, MATRA have spread this system to far field lane marking detection and have coupled it with the AICC system. Experiments will be carried out on roads to estimate the gain in performance and comfort due to this fusion.

Selection of gender marked morphemes in speech production

NARCIS (Netherlands)

Schriefers, H.J.; Jescheniak, J.D.; Hantsch, A.

2005-01-01

N.O. Schiller and A. Caramazza (2003) and A. Costa, D. Kovacic, E. Fedorenko, and A. Caramazza (2003) have argued that the processing of freestanding gender-marked morphemes (e.g., determiners) and bound gender-marked morphemes (e.g., adjective suffixes) during syntactic encoding in speech

Effect of real-time teledermatology on diagnosis, treatment and clinical improvement.

Science.gov (United States)

Al Quran, Hanadi A; Khader, Yousef Saleh; Ellauzi, Ziad Mohd; Shdaifat, Amjad

2015-03-01

We assessed the effect of real-time teledermatology consultations on diagnosis and disease management, patients' quality of life and time- and cost-savings. All consecutive patients with skin diseases attending teledermatology clinics at two rural hospitals in Jordan were included in the study. Patients were interviewed at their initial visit and again after eight weeks. Various questionnaires and forms, including quality of life questionnaires, were used to collect the data. Ninety teledermatology consultations were performed for 88 patients between September 2013 and January 2014. A diagnosis was established as part of the teledermatology consultation in 43% of patients and changed from that of the referring provider in 19% of patients. The treatment plan was established for 67% of patients and changed for 9% patients. The mean SF-8 score increased significantly (P < 0.005). The mean DLQI score decreased significantly (P < 0.005) indicating that there had been an improvement in the patients' quality of life since baseline. Most patients perceived that the visit to the teledermatology clinic required less travel time (96%), shorter waiting time (83%) and less cost (96%) than a visit to the specialist clinic at the main hospital. The patients' mean satisfaction score was 90.5 (SD 8.5), indicating a high level of satisfaction. Teledermatology resulted in changes in the patients' diagnosis and treatment plan, and was associated with improved health state and quality of life. © The Author(s) 2015 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

A method for studying knife tool marks on bone.

Science.gov (United States)

Shaw, Kai-Ping; Chung, Ju-Hui; Chung, Fang-Chun; Tseng, Bo-Yuan; Pan, Chih-Hsin; Yang, Kai-Ting; Yang, Chun-Pang

2011-07-01

The characteristics of knife tool marks retained on hard tissues can be used to outline the shape and angle of a knife. The purpose of this study was to describe such marks on bone tissues that had been chopped with knives. A chopping stage with a gravity accelerator and a fixed bone platform was designed to reconstruct the chopping action. A digital microscope was also used to measure the knife angle (θ) and retained V-shape tool mark angle (ψ) in a pig skull. The κ value (elasticity coefficient; θ/ψ) was derived and recorded after the knife angle (θ) and the accompanied velocity were compared with the proportional impulsive force of the knife and ψ on the bone. The constant impulsive force revealed a correlation between the V-shape tool mark angle (ψ) and the elasticity coefficient (κ). These results describe the tool marks--crucial in the medicolegal investigation--of a knife on hard tissues. © 2011 American Academy of Forensic Sciences.

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...

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

Science.gov (United States)

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

2014-07-01

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

Arginine as an adjuvant to chemotherapy improves clinical outcome in active tuberculosis

DEFF Research Database (Denmark)

Schön, T; Elias, D; Moges, F

2003-01-01

, and clinical symptoms after week 8. Secondary outcomes were sedimentation rate and levels of NO metabolites, arginine, citrulline, and tumour necrosis factor-a. Compared with the human immunodeficiency virus (HIV)-/TB+ placebo group, the HIV-/TB+ patients in the arginine group showed significant improvement......, defined as increased weight gain, higher sputum conversion rate and faster reduction of symptoms, such as cough. The arginine level increased after week 2 in the HIV-/TB+ arginine group (100.2 microM (range 90.5-109.9) versus 142.1 microM (range 114.1-170.1)) compared with the HIV-/TB+ placebo group (105.......5 microM (range 93.7-117.3) versus 95.7 microM (range 82.4-108.9)). HIV seroprevalence was 52.5%. No clinical improvement or increase in serum arginine was detected in arginine supplemented HIV+/TB+ patients compared with placebo. Arginine is beneficial as an adjuvant treatment in human immunodeficiency...

Variable features on Mars. VII - Dark filamentary markings on Mars

Science.gov (United States)

Veverka, J.

1976-01-01

The paper discusses the location, variability, and possible nature of well-developed patterns of dark filamentary markings in the Mariner 9 photographic records. Although not common on Mars, the markings are concentrated in at least two areas: Depressio Hellespontica and Cerberus/Trivium Charontis. In certain localities, strong winds are required to bring these markings into prominence. The dark filamentary markings seem to be true albedo features controlled by local topography, it being unlikely that they are free linear dunes. The distinctive criss-cross pattern seen in many of the pictures suggests that jointing provides the controlling topographic grid. At this stage it cannot be inferred whether the markings are erosional or depositional in character.

The Mark II Vertex Drift Chamber

International Nuclear Information System (INIS)

Alexander, J.P.; Baggs, R.; Fujino, D.

1989-03-01

We have completed constructing and begun operating the Mark II Drift Chamber Vertex Detector. The chamber, based on a modified jet cell design, achieves 30 μm spatial resolution and 2 gas mixtures. Special emphasis has been placed on controlling systematic errors including the use of novel construction techniques which permit accurate wire placement. Chamber performance has been studied with cosmic ray tracks collected with the chamber located both inside and outside the Mark II. Results on spatial resolution, average pulse shape, and some properties of CO 2 mixtures are presented. 10 refs., 12 figs., 1 tab

Group marking and peer assessment during a group poster presentation: the experiences and views of midwifery students.

Science.gov (United States)

Ohaja, Magdalena; Dunlea, Margaret; Muldoon, Kathryn

2013-09-01

Traditionally, written examination and clinical practice assessments are the main ways of deeming midwifery students fit and competent for practice. Contemporary academics in an effort to engage the students in the learning process have employed alternative teaching and assessment strategies. Among the alternative strategies are group projects after which members of the group are awarded the same grade, and peer assessment. With the purpose of informing the midwifery curricular, we utilised a qualitative descriptive approach to explore midwifery students' experiences and views on the use of group poster presentation for learning and assessment. The participants consisted of a purposive sample of 14 higher diploma midwifery students who were registered in a third level institution in Ireland. Semi-structured individual interviews were conducted following the completion of the poster presentation assessment. Permission to undertake the study was obtained from the college ethics committee. In this paper, we focus on the participants' views of group marking and peer assessment which are among the key elements that emerged in this study. While awarding a group mark was overall accepted, peer assessment proved a more contentious issue. Most of the participants found it challenging marking their friends. Reactions to group marks were very much influenced by the group dynamics. Copyright © 2012 Elsevier Ltd. All rights reserved.

Acceptance and stress effects of aircraft obstruction markings of wind turbines

International Nuclear Information System (INIS)

Pohl, Johannes; Hübner, Gundula; Mohs, Anja

2012-01-01

A dominant resistance factor against wind power projects seems to be their visual impact on the landscape. In addition stress effects from aircraft obstruction markings are an emerging topic related to acceptance. As the height of wind turbines increases, so does the number of mandatory obstruction markings. Recently, obstruction markings have caused a growing number of complaints from residents. Whether obstruction markings indeed cause stress or even substantial annoyance remains an open question. To analyse the stress impact of obstruction markings, we used environmental and stress psychology methodologies. Residents (N=420) with direct sight of turbines at 13 wind farms participated in a questionnaire survey. Evidence of substantial annoyance caused by obstruction markings was not found. However, residents exposed to xenon lights reported more intense and multifaceted stress responses than exposed to LED or colour markings on blades. Moreover, xenon lights negatively affected the general acceptance of wind energy. Additionally, synchronised navigation lights were found to be less annoying than non-synchronised lights under certain weather conditions. Markings with light intensity adjustment proved to be advantageous. To reduce stress and increase social acceptance of wind power, xenon lights should be abandoned, navigation lights synchronised, and light intensity adjustment applied. - Research highlights: ► Wind turbine obstruction markings influence the social acceptance of wind energy. ► Residents exposed to xenon lights reported more intense stress responses than exposed to LED or colour markings. ► Synchronised lights were found to be less annoying under certain weather conditions. ► Markings with light intensity adjustment proved to be advantageous. ► Evidence of substantial annoyance caused by obstruction markings was not found.

Administering and Detecting Protein Marks on Arthropods for Dispersal Research.

Science.gov (United States)

Hagler, James R; Machtley, Scott A

2016-01-28

Monitoring arthropod movement is often required to better understand associated population dynamics, dispersal patterns, host plant preferences, and other ecological interactions. Arthropods are usually tracked in nature by tagging them with a unique mark and then re-collecting them over time and space to determine their dispersal capabilities. In addition to actual physical tags, such as colored dust or paint, various types of proteins have proven very effective for marking arthropods for ecological research. Proteins can be administered internally and/or externally. The proteins can then be detected on recaptured arthropods with a protein-specific enzyme-linked immunosorbent assay (ELISA). Here we describe protocols for externally and internally tagging arthropods with protein. Two simple experimental examples are demonstrated: (1) an internal protein mark introduced to an insect by providing a protein-enriched diet and (2) an external protein mark topically applied to an insect using a medical nebulizer. We then relate a step-by-step guide of the sandwich and indirect ELISA methods used to detect protein marks on the insects. In this demonstration, various aspects of the acquisition and detection of protein markers on arthropods for mark-release-recapture, mark-capture, and self-mark-capture types of research are discussed, along with the various ways that the immunomarking procedure has been adapted to suit a wide variety of research objectives.

Rapid Eye Movement Sleep Behavior Disorder in Paraneoplastic Cerebellar Degeneration: Improvement with Immunotherapy.

Science.gov (United States)

Vale, Thiago Cardoso; Fernandes do Prado, Lucila Bizari; do Prado, Gilmar Fernandes; Povoas Barsottini, Orlando Graziani; Pedroso, José Luiz

2016-01-01

To report two female patients with paraneoplastic cerebellar degeneration (PCD) related to breast cancer that presented with rapid eye movement-sleep behavior disorder (RBD) and improved sleep symptoms with immunotherapy. The two patients were evaluated through clinical scale and polysomnography before and after therapy with intravenous immunoglobulin. RBD was successfully treated with immunotherapy in both patients. Score on the RBD screening questionnaire dropped from 10 to 1 or 0, allied with the normalization of polysomnographic findings. A marked improvement in RBD after immunotherapy in PCD raises the hypothesis that secondary RBD may be an immune-mediated sleep disorder. © 2016 Associated Professional Sleep Societies, LLC.

Provider Communication, Prompts, and Feedback to Improve HPV Vaccination Rates in Resident Clinics.

Science.gov (United States)

Rand, Cynthia M; Schaffer, Stanley J; Dhepyasuwan, Nui; Blumkin, Aaron; Albertin, Christina; Serwint, Janet R; Darden, Paul M; Humiston, Sharon G; Mann, Keith J; Stratbucker, William; Szilagyi, Peter G

2018-04-01

Human papillomavirus (HPV) vaccination rates lag behind vaccination rates for other adolescent vaccines; a bundled intervention may improve HPV vaccination rates. Our objective is to evaluate the impact of quality improvement (QI) training plus a bundled practice-based intervention (provider prompts plus communication skills training plus performance feedback) on improving HPV vaccinations in pediatric resident continuity clinics. Staff and providers in 8 resident clinics participated in a 12-month QI study. The intervention included training to strengthen provider communication about the HPV vaccine. Clinics also implemented provider prompts, received monthly performance feedback, and participated in learning collaborative calls. The primary outcome measure was eligible visits with vaccination divided by vaccine-eligible visits (captured HPV vaccination opportunities). Practices performed chart audits that were fed into monthly performance feedback on captured HPV vaccination opportunities. We used conditional logistic regression (conditioning on practice) to assess captured vaccination opportunities, with the time period of the study (before and after the QI intervention) as the independent variable. Overall, captured opportunities for HPV vaccination increased by 16.4 percentage points, from 46.9% to 63.3%. Special cause was demonstrated by centerline shift, with 8 consecutive points above the preintervention mean. On adjusted analyses, patients were more likely to receive a vaccine during, versus before, the intervention (odds ratio: 1.87; 95% confidence interval: 1.54-2.28). Captured HPV vaccination rates improved at both well-child and other visits (by 11.7 and 13.0 percentage points, respectively). A bundled intervention of provider prompts and training in communication skills plus performance feedback increased captured opportunities for HPV vaccination. Copyright © 2018 by the American Academy of Pediatrics.

Banner Marks of Ottoman Perıod at Giresun Museum

Directory of Open Access Journals (Sweden)

Gazanfer İLTAR

2015-12-01

Full Text Available The eleven banner marks among those that were brought together in 1926 to establish a museum at Tokat Gök Medrese (the Celestial Madrasa was sent to Giresun Museum in 1995 in order to be displayed together with other two thousand archaeological and ethnographic pieces. On the banner of one of these marks that was produced with brass hammering technique was written the date “1118/1706-1707”, which is indicated on its inventory record. Such marks that were decorated by using thuluth writing and vegetative motifs were made in the forms of round, drop, palmet and tulip. Generally, there exists a hilly part in the forms of palmet and drop on most of these marks which consist a handle and a body part. Additionally, there appear writings as “Allah, Muhammed, the words of Tawheed, Allah-Muhammed-Ali” on these marks. Today, the marks some of which are exhibited on the display cases and some of which are stored in museums are important in the sense of obtaining information about the art of metalworking in the period these marks were produced.

Identification markings for gemstones

International Nuclear Information System (INIS)

Dreschhoff, G.A.M.; Zeller, E.J.

1980-01-01

A method is described of providing permanent identification markings to gemstones such as diamond crystals by irradiating the cooled gemstone with protons in the desired pattern. The proton bombardment results in a reaction limited to a defined plane and converting the bombarded area of the plane into a different crystal lattice from that of the preirradiated stone. (author)

Factors affecting scent-marking behaviour in Eurasion beaver (Castor fiber)

NARCIS (Netherlands)

Rosell, F.; Nolet, B.A.

1997-01-01

We tested the hypothesis that a main function of territory marking in Eurasian beaver (Castor fiber) is defense of the territory. The results showed that: (1) beaver colonies with close neighbors scent-mark more often than isolated ones; (2) the number of scent markings increased significantly with

46 CFR 169.755 - Draft marks and draft indicating systems.

Science.gov (United States)

2010-10-01

... Section 169.755 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) NAUTICAL SCHOOLS SAILING SCHOOL VESSELS Vessel Control, Miscellaneous Systems, and Equipment Markings § 169.755 Draft marks and... projections of the marks onto a vertical plane are of uniform height equal to the vertical spacing between...

Time to improvement of pain and sleep quality in clinical trials of pregabalin for the treatment of fibromyalgia.

Science.gov (United States)

Arnold, Lesley M; Emir, Birol; Pauer, Lynne; Resnick, Malca; Clair, Andrew

2015-01-01

To determine the time to immediate and sustained clinical improvement in pain and sleep quality with pregabalin in patients with fibromyalgia. A post hoc analysis of four 8- to 14-week phase 2-3, placebo-controlled trials of fixed-dose pregabalin (150-600 mg/day) for fibromyalgia, comprising 12 pregabalin and four placebo treatment arms. A total of 2,747 patients with fibromyalgia, aged 18-82 years. Pain and sleep quality scores, recorded daily on 11-point numeric rating scales (NRSs), were analyzed to determine time to immediate improvement with pregabalin, defined as the first of ≥2 consecutive days when the mean NRS score was significantly lower for pregabalin vs placebo in those treatment arms with a significant improvement at endpoint, and time to sustained clinical improvement with pregabalin, defined as a ≥1-point reduction of the baseline NRS score of patient responders who had a ≥30% improvement on the pain NRS, sleep NRS, or Fibromyalgia Impact Questionnaire (FIQ) from baseline to endpoint, or who reported "much improved" or "very much improved" on the Patient Global Impression of Change (PGIC) at endpoint. Significant improvements in pain and sleep quality scores at endpoint vs placebo were seen in 8/12 and 11/12 pregabalin treatment arms, respectively (P < 0.05). In these arms, time to immediate improvements in pain or sleep occurred by day 1 or 2. Time to sustained clinical improvement occurred significantly earlier in pain, sleep, PGIC, and FIQ responders (P < 0.02) with pregabalin vs placebo. Both immediate and sustained clinical improvements in pain and sleep quality occurred faster with pregabalin vs placebo. Wiley Periodicals, Inc.

Incorporation of Scribes Into the Inflammatory Bowel Disease Clinic Improves Quality of Care and Physician Productivity.

Science.gov (United States)

Ewelukwa, Ofor; Perez, Roque; Carter, Lee Ellen; Fernandez, Alyka; Glover, Sarah

2018-02-15

Electronic health records (EHRs), despite their positive attributes, increase physician workload and decrease efficiency. The aim of this study was to evaluate the impact of scribes in the Inflammatory Bowel Disease Clinic on improvement of the physician-patient relationship, physician productivity, clinical efficiency, and achievement of some Physician Quality Reporting System (PQRS) metrics. We analyzed of pre- and postscribe data between fiscal years 2015 (FY15) and 2016 (FY16) using data from patients at the Inflammatory Bowel Clinic at the University of Florida. The main outcomes were patient satisfaction scores (PSS), qualitative physician interview, clinic appointment lengths, work relative value units (wRVUs), level of coding, revenue, and PQRS data on bone density screening and vaccination. PSS increased from 6.8/10 to 9.2/10 (P stress decreased. Clinic visits increased by 76, leading to an increase in work RVUs by 332.55, total charges billed by $71,439, and total charges collected by $27,387 between the first quarters of FY15 and FY16. The extra revenue for the first quarter was 536% higher than the salary of the scribe for the same period ($4302.84). There was a 1.8-fold increase in referrals for bone density scans and 2.9-fold and 4.8-fold increases in vaccination rates for influenza and pneumonia, respectively. The use of scribes improved the physician-patient relationship, clinical efficiency, physician productivity, bone density screening, and vaccinations for flu and pneumonia. If adopted by health systems, it may lead to significant cost savings and improved clinical outcomes.

Developing an Interdisciplinary, Team-Based Quality Improvement Leadership Training Program for Clinicians: The Partners Clinical Process Improvement Leadership Program.

Science.gov (United States)

Rao, Sandhya K; Carballo, Victoria; Cummings, Brian M; Millham, Frederick; Jacobson, Joseph O

Although there has been tremendous progress in quality improvement (QI) education for students and trainees in recent years, much less has been published regarding the training of active clinicians in QI. The Partners Clinical Process Improvement Leadership Program (CPIP) is a 6-day experiential program. Interdisciplinary teams complete a QI project framed by didactic sessions, interactive exercises, case-based problem sessions, and a final presentation. A total of 239 teams composed of 516 individuals have graduated CPIP. On completion, participant satisfaction scores average 4.52 (scale 1-5) and self-reported understanding of QI concepts improved. At 6 months after graduation, 66% of survey respondents reported sustained QI activity. Three opportunities to improve the program have been identified: (1) increasing faculty participation through online and tiered course offerings, (2) integrating the faculty-focused program with the trainee curriculum, and (3) developing a postgraduate curriculum to address the challenges of sustained improvement.

9 CFR 592.320 - Products that may bear the inspection mark.

Science.gov (United States)

2010-01-01

... 9 Animals and Animal Products 2 2010-01-01 2010-01-01 false Products that may bear the inspection... Marking Products § 592.320 Products that may bear the inspection mark. Products that are permitted to bear... products eligible to bear the inspection mark and may contain other edible ingredients. The official mark...

27 CFR 20.33 - Time of destruction of marks and brands.

Science.gov (United States)

2010-04-01

... marks and brands. 20.33 Section 20.33 Alcohol, Tobacco Products and Firearms ALCOHOL AND TOBACCO TAX AND... Administrative Provisions Marks and Brands § 20.33 Time of destruction of marks and brands. (a) Any person who... alcohol or specially denatured rum shall immediately destroy or obliterate the marks, brands, and labels...

Horizontal fissure on neonatal plain chest radiographs: clinical implications

International Nuclear Information System (INIS)

Konarzewska, J.; Zawadzka-Kepczynska, A.; Bianek-Bodzak, A.; Kawinska-Kilianczyk, A.; Domzalska-Popadiuk, I.

2005-01-01

Regardless of etiology, pleural fluid, even in small amounts, can be visualized on the neonatal chest x-ray picture within pulmonary fissures. It remains unclear whether a marked horizontal fissure unaccompanied by any other radiological symptoms is of diagnostic value or not. Ninety-one consecutive neonatal chest radiographs with marked horizontal fissure were retrospectively analyzed. The images were made between 1999 and 2005 on 69 newborns admitted to the Neonatology Department, Institute of Obstetrics and Gynecology, Medical University of Gdansk. Analysis of the radiographs was conducted independently by three radiologists based on the following criteria: fissure thickness (marked or thickened), bronchovascular markings (increased or normal), size and shape of the heart (normal or abnormal), presence or absence of pulmonary infiltration, atelectasis, and changes related to wet lung syndrome. Due to divergent interpretations, the ultimate interpretation was established by consensus in 25 cases. The radiological findings were compared with clinical data. The compatibility of the three independent interpreters was statistically significant (p<0.0001). Marked transverse fissure was the only radiological finding on 66 x-rays. In 63 cases (69.2%) the children were asymptomatic as well. In 3 cases (3.3%) clinical symptoms of respiratory tract infection occurred. On the other 25 images, horizontal fissure was accompanied by other radiological symptoms. Chest x-ray results corresponded with clinical symptoms in 24 cases (26.4%). One child (1.1%) with radiological evidence of wet lung syndrome did not present any typical clinical symptoms of it. Horizontal fissure noted on a neonatal chest x-ray seems to be of minor diagnostic value if not accompanied by any other radiological symptoms. (author)

Sustained improvement of intractable rheumatoid arthritis after total lymphoid irradiation

International Nuclear Information System (INIS)

Field, E.H.; Strober, S.; Hoppe, R.T.

1983-01-01

Total lymphoid irradiation (TLI) was administered to 11 patients who had intractable rheumatoid arthritis that was unresponsive to conventional medical therapy, including aspirin, multiple nonsteroidal antiinflammatory drugs, gold salts, and D-penicillamine. Total lymphoid irradiation was given as an alternative to cytotoxic drugs such as azathioprine and cyclophosphamide. After radiotherapy, 9 of the 11 patients showed a marked improvement in clinical disease activity as measured by morning stiffness, joint tenderness, joint swelling, and overall functional abilities. The mean improvement of disease activity in all patients ranged from 40-70 percent and has persisted throughout a 13-28 month followup period. This improvement permitted the mean daily steroid dose to be reduced by 54%. Complications included severe fatigue and other constitutional symptoms during radiotherapy, development of Felty's syndrome in 1 patient, and an exacerbation of rheumatoid lung disease in another. After therapy, all patients exhibited a profound T lymphocytopenia, and a reversal in their T suppressor/cytotoxic cell to helper cell ratio. The proliferative responses of peripheral blood mononuclear cells to phytohemagglutinin, concanavalin A, and allogeneic leukocytes (mixed leukocyte reaction) were markedly reduced, as was in vitro immunoglobulin synthesis after stimulation with pokeweed mitogen. Alterations in T cell numbers and function persisted during the entire followup period, except that the mixed leukocyte reaction showed a tendency to return to normal values

Ülar Mark: loome uut ja iga loomisega lammutame midagi / Ülar Mark ; intervjueerinud Mikk Salu

Index Scriptorium Estoniae

Mark, Ülar, 1968-

2010-01-01

Eesti Arhitektuurikeskuse juhatuse esimees, arhitekt Ülar Mark Tallinna arhitektuurist ja linna arengust, demokraatlikust linnaruumist. Pikemalt Solarise keskusest, vabadussambast, väikepoodide asemele suurte kaubanduskeskuste tulekust

Autoverification process improvement by Six Sigma approach: Clinical chemistry & immunoassay.

Science.gov (United States)

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

2018-05-01

This study examines effectiveness of a project to enhance an autoverification (AV) system through application of Six Sigma (DMAIC) process improvement strategies. Similar AV systems set up at three sites underwent examination and modification to produce improved systems while monitoring proportions of samples autoverified, the time required for manual review and verification, sample processing time, and examining characteristics of tests not autoverified. This information was used to identify areas for improvement and monitor the impact of changes. Use of reference range based criteria had the greatest impact on the proportion of tests autoverified. To improve AV process, reference range based criteria was replaced with extreme value limits based on a 99.5% test result interval, delta check criteria were broadened, and new specimen consistency rules were implemented. Decision guidance tools were also developed to assist staff using the AV system. The mean proportion of tests and samples autoverified improved from 90% for samples and >95% for tests across all three sites. The new AV system significantly decreased turn-around time and total sample review time (to about a third), however, time spent for manual review of held samples almost tripled. There was no evidence of compromise to the quality of testing process and process improvement methodology was successfully applied to AV systems resulting in an increase in overall test and sample AV by >90%, improved turn-around time, reduced time for manual verification, and with no obvious compromise to quality or error detection. Copyright © 2018 The Canadian Society of Clinical Chemists. Published by Elsevier Inc. All rights reserved.

7 CFR 319.37-10 - Marking and identity.

Science.gov (United States)

2010-01-01

... 7 Agriculture 5 2010-01-01 2010-01-01 false Marking and identity. 319.37-10 Section 319.37-10 Agriculture Regulations of the Department of Agriculture (Continued) ANIMAL AND PLANT HEALTH INSPECTION..., and Other Plant Products 1,2 § 319.37-10 Marking and identity. (a) Any restricted article for...

Piracetam improves cognitive deficits caused by chronic cerebral hypoperfusion in rats.

Science.gov (United States)

He, Zhi; Liao, Yun; Zheng, Min; Zeng, Fan-Dian; Guo, Lian-Jun

2008-06-01

Piracetam is the derivate of gamma-aminobutyric acid, which improves the cognition,memory,consciousness, and is widely applied in the clinical treatment of brain dysfunction. In the present experiments, we study the effects of piracetam on chronic cerebral hypoperfused rats and observe its influence on amino acids, synaptic plasticity in the Perforant path-CA3 pathway and apoptosis in vivo. Cerebral hypoperfusion for 30 days by occlusion of bilateral common carotid arteries induced marked amnesic effects along with neuron damage, including: (1) spatial learning and memory deficits shown by longer escape latency and shorter time spent in the target quadrant; (2) significant neuronal loss and nuclei condensation in the cortex and hippocampus especially in CA1 region; (3) lower induction rate of long term potentiation, overexpression of BAX and P53 protein, and lower content of excitatory and inhibitory amino acids in hippocampus. Oral administration of piracetam (600 mg/kg, once per day for 30 days) markedly improved the memory impairment, increased the amino acid content in hippocampus, and attenuated neuronal damage. The ability of piracetam to attenuate memory deficits and neuronal damage after hypoperfusion may be beneficial in cerebrovascular type dementia.

46 CFR 167.55-1 - Draft marks and draft indicating systems.

Science.gov (United States)

2010-10-01

... 46 Shipping 7 2010-10-01 2010-10-01 false Draft marks and draft indicating systems. 167.55-1... NAUTICAL SCHOOL SHIPS Special Markings Required § 167.55-1 Draft marks and draft indicating systems. (a... aft to the location of the draft marks, due to a raked stem or cut away skeg, the draft must be...

Tense Marking in the English Narrative Retells of Dual Language Preschoolers.

Science.gov (United States)

Gusewski, Svenja; Rojas, Raúl

2017-07-26

This longitudinal study investigated the emergence of English tense marking in young (Spanish-English) dual language learners (DLLs) over 4 consecutive academic semesters, addressing the need for longitudinal data on typical acquisition trajectories of English in DLL preschoolers. Language sample analysis was conducted on 139 English narrative retells elicited from 39 preschool-age (Spanish-English) DLLs (range = 39-65 months). Growth curve models captured within- and between-individual change in tense-marking accuracy over time. Tense-marking accuracy was indexed by the finite verb morphology composite and by 2 specifically developed adaptations. Individual tense markers were systematically described in terms of overall accuracy and specific error patterns. Tense-marking accuracy exhibited significant growth over time for each composite. Initially, irregular past-tense accuracy was higher than regular past-tense accuracy; over time, however, regular past-tense marking outpaced accuracy on irregular verbs. These findings suggest that young DLLs can achieve high tense-marking accuracy assuming 2 years of immersive exposure to English. Monitoring the growth in tense-marking accuracy over time and considering productive tense-marking errors as partially correct more precisely captured the emergence of English tense marking in this population with highly variable expressive language skills. https://doi.org/10.23641/asha.5176942.

Progressing quality control in environmental impact assessment beyond legislative compliance: An evaluation of the IEMA EIA Quality Mark certification scheme

International Nuclear Information System (INIS)

Bond, Alan; Fischer, Thomas B; Fothergill, Josh

2017-01-01

The effectiveness of Environmental Impact Assessment (EIA) systems is contingent on a number of control mechanisms: procedural; judicial; evaluative; public and government agency; professional; and development aid agency. If we assume that procedural and judicial controls are guaranteed in developed EIA systems, then progressing effectiveness towards an acceptable level depends on improving the performance of other control mechanisms over time. These other control mechanisms are either absent, or are typically centrally controlled, requiring public finances; this we argue is an unpopular model in times of greater Government austerity. Here we evaluate a market-based mechanism for improving the performance of evaluative and professional control mechanisms, the UK Institute of Environmental Management and Assessments' EIA Quality Mark. We do this by defining dimensions of effectiveness for the purposes of our evaluation, and by identifying international examples of the approaches taken to delivering the other control measures to validate the approach taken in the EIA Quality Mark. We then evaluate the EIA Quality Mark, when used in combination with legal procedures and an active judiciary, against the effectiveness dimensions and use time-series analysis of registrant data to examine its ability to progress practice. We conclude that the EIA Quality Mark has merit as a model for a market-based mechanism, and may prove a more financially palatable approach for delivering effective EIA in mature systems in countries that lack centralised agency oversight. It may, therefore, be of particular interest to some Member States of the European Union for ensuring forthcoming certification requirements stemming from recent amendments to the EIA Directive. - Highlights: • Quality control mechanisms in EIA are identified. • Effectiveness of EIA is conceptualised for evaluation purposes. • The UK IEMA EIA Quality Mark is introduced as a market-based mechanism. • The

Progressing quality control in environmental impact assessment beyond legislative compliance: An evaluation of the IEMA EIA Quality Mark certification scheme

Energy Technology Data Exchange (ETDEWEB)

Bond, Alan, E-mail: alan.bond@uea.ac.uk [School of Environmental Sciences, University of East Anglia (United Kingdom); Research Unit for Environmental Sciences and Management, North-West University (South Africa); Fischer, Thomas B, E-mail: fischer@liverpool.ac.uk [School of Environmental Sciences, University of Liverpool (United Kingdom); Fothergill, Josh, E-mail: j.fothergill@iema.net [Institute of Environmental Management and Assessment, Lincoln (United Kingdom)

2017-03-15

The effectiveness of Environmental Impact Assessment (EIA) systems is contingent on a number of control mechanisms: procedural; judicial; evaluative; public and government agency; professional; and development aid agency. If we assume that procedural and judicial controls are guaranteed in developed EIA systems, then progressing effectiveness towards an acceptable level depends on improving the performance of other control mechanisms over time. These other control mechanisms are either absent, or are typically centrally controlled, requiring public finances; this we argue is an unpopular model in times of greater Government austerity. Here we evaluate a market-based mechanism for improving the performance of evaluative and professional control mechanisms, the UK Institute of Environmental Management and Assessments' EIA Quality Mark. We do this by defining dimensions of effectiveness for the purposes of our evaluation, and by identifying international examples of the approaches taken to delivering the other control measures to validate the approach taken in the EIA Quality Mark. We then evaluate the EIA Quality Mark, when used in combination with legal procedures and an active judiciary, against the effectiveness dimensions and use time-series analysis of registrant data to examine its ability to progress practice. We conclude that the EIA Quality Mark has merit as a model for a market-based mechanism, and may prove a more financially palatable approach for delivering effective EIA in mature systems in countries that lack centralised agency oversight. It may, therefore, be of particular interest to some Member States of the European Union for ensuring forthcoming certification requirements stemming from recent amendments to the EIA Directive. - Highlights: • Quality control mechanisms in EIA are identified. • Effectiveness of EIA is conceptualised for evaluation purposes. • The UK IEMA EIA Quality Mark is introduced as a market-based mechanism. • The

Fast track-finding trigger processor for the SLAC/LBL Mark II Detector

International Nuclear Information System (INIS)

Brafman, H.; Breidenbach, M.; Hettel, R.; Himel, T.; Horelick, D.

1977-10-01

The SLAC/LBL Mark II Magnetic Detector consists of various particle detectors arranged in cylindrical symmetry located in and around an axial magnetic field. A versatile, programmable secondary trigger processor was designed and built to find curved tracks in the detector. The system operates at a 10 MHz clock rate with a total processing time of 34 μsec and is used to ''trigger'' the data processing computer, thereby rejecting background and greatly improving the data acquisition aspects of the detector-computer combination

Multi-Disciplinary Peer-Mark Moderation of Group Work

Science.gov (United States)

Willmot, Peter; Pond, Keith

2012-01-01

Self and peer assessment offers benefits for enhancing student learning. Peer moderation provides a convenient solution for awarding individual marks in group assignments. This paper provides a significant review of peer-mark moderation, and describes an award winning, web-based tool that was developed in the UK and is now spreading across the…

Mechanisms for Limiting Trade Mark Rights to Further Competition and Free Speech

DEFF Research Database (Denmark)

Ramsey, Lisa P; Schovsbo, Jens Hemmingsen

2013-01-01

This article evaluates the different mechanisms that nations use to limit trade mark rights to promote competition, free speech, and other public interests. It shows how EU and US trade mark laws seem to be converging towards a similar model which includes both (1) specific statutory defenses...... of these mechanisms for limiting trade mark rights to better protect the public interest in trade mark disputes. Finally, a proposal for reform is suggested. It consists of three parts: (1) domestic legislatures should revise their trade mark statutes to add more mandatory and specific limitations on trade mark...... to trade mark violations and (2) trade mark doctrines which give courts flexibility to permit unauthorized uses of marks that further the legitimate interests of the accused infringer and the public. Such a development should be welcomed and the article urges other nations to consider adopting one or both...

49 CFR 174.59 - Marking and placarding of rail cars.

Science.gov (United States)

2010-10-01

... 49 Transportation 2 2010-10-01 2010-10-01 false Marking and placarding of rail cars. 174.59... RAIL General Handling and Loading Requirements § 174.59 Marking and placarding of rail cars. No person may transport a rail car carrying hazardous materials unless it is marked and placarded as required by...

Bronchial and pulmonary scintigraphy with radioactively marked aerosols

International Nuclear Information System (INIS)

Wuerstle, T.

1982-01-01

In 97 patients with bronchitis, bronchial asthma, tuberculosis, sarcoidosis, pneumoconiosis, or tumors the mucociliary clearance and/or deposit pattern after inhalation of radioactively marked aerosols (1 mCi 99m Tc sulfur colloid) was studied. Normal values of the mucociliary 30 min. clearance for the central bronchial/lung periphery are 21%/15%. There was a decreased clearance with bronchitis (11/8%), bronchial asthma, emphysema, tuberculosis, sarcoidosis, trachiobronchial amyloidosis, pleural scarring or interstitial pneumona. Increased clearance (29/19%) was shown with pneumoconiosis. The correlation of deposit pattern and disease, for example, bronchitis, bronchial asthma, bullous emphysema, pleural scarring, partial lung resection, bronchopneumonia, or bronchial restriction, is described. In comparison of aerosol scintigraphy to perfusion scintigraphy and ventilation with gaseous xenon, the aerosol scintigraphy is superior to xenon for certain indications. The aerosol particles, which are larger in comparison to xenon, settle easier by obstructions or flow variations and thereby give better clinical indications of regional differences. (orig.) [de

Scent marking behavior as an odorant communication in mice

Science.gov (United States)

Arakawa, Hiroyuki; Blanchard, D. Caroline; Arakawa, Keiko; Dunlap, Christopher; Blanchard, Robert J.

2008-01-01

In rodents, where chemical signals play a particularly important role in determining intraspecies interactions including social dominance and intersexual relationships, various studies have shown that behavior is sensitive to conspecific odor cues. Mice use urinary scent marks for communication with individual conspecifics in many social contexts. Urinary scent involves genetic information about individuals such as species, sex, and individual identity as well as metabolic information such as social dominance, and reproductive and health status, which are mediated by chemical proteins in scent marks including the major histocompatibility complex and the major urinary proteins. The odor of the predator which can be considered to be a threatening signal for the prey also modulate mouse behavior in which scent marking is suppressed in response to the cat odor exposure in mice. These odorant chemicals are detected and recognized through two olfactory bulbs, the role of which in detection of chemosignals with biological relevant appears to be differential, but partly overlapped. Mice deposit scent marks toward conspecifics to maintain their social relationships, and inhibit scent marking in a context where natural predator, cat odor is contained. This suppression of scent marking is long-lasting (for at least 7 days) and context-dependent, while the odorant signaling to conspecifics tends to appear frequently (over 24 hrs but less than 7 days intervals) depending on the familiarity of each signal-recipient. It has been discussed that scent marking is a communicative behavior associated with territoriality toward conspecifics, indicating that the social signaling within species are sensitive to predator odor cues in terms of vulnerability to predation risk. PMID:18565582

Radioisotope cisternographic evaluation of hydrocephalus: Comparison with CT, MRI, and clinical findings

International Nuclear Information System (INIS)

Kwon, Soon Tae; Park, Cheong Hee; Kim, Hyeong Yeol; Kim, Dae Hong; Shin, Kyung Suk; Cho, June Sik; Lee, Kang Wook; Kim, Jae Moon

1993-01-01

To evaluate the clinical usefulness of radionuclide(RI) cisternography in patients with hydrocephalus, we retrospectively analyzed RI cisternographic findings of 47 patients by using our classification which was modified from Baum's and correlated them with CT(n=37) or MRI(n=10) findings and clinical outcome in selected patients with hydrocephalus(n=37). Modified RI cisternography patterns of 37 patients were type I in three case(8%), type II in seven(18%), type III-A in six(16%), no case of type III-B, type IV-A in 12(32%), and type IV-B in nine(24%). Ri cisternography enabled to differentiate communicating hydrocephalus(27 cases, 73%) from noncommunicating hydrocephalus(10 case, 27%). There was marked clinical improvement in 17 patients(46%), slight improvement in 11 patients(30%), and no improvement in nine patients(24%). The clinical outcome of patients with RI cisternographic type IV-B was worse than that of other types. CT and MRI could neither predict the clinical outcome nor differentiate type IV-B from type IV-A(P>0.05). Ventricular size index(VSI)was significantly higher in patients with type IV than that with other type(p<0.001). RI cisternographic patterns of communicating hydrocephalous were relatively correlated with clinical outcome(r=-0.53, p=.0010 . VIS(r=0.59, p=.001), and dilation of fourth ventricle(r=0.41, p<0.05). We suggest that our modified classification of RI cisternographic patterns can provide more strict physiological assessment of the CFS dynamics and RI cisternography may be still useful to differentiate communicating hydrocephalus from noncommunicating hydrocephalus and to predict the clinical outcome in conjunction with CT/ MR findings and clinical presentation

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.

27 CFR 26.106 - Marking containers of beer.

Science.gov (United States)

2010-04-01

... 27 Alcohol, Tobacco Products and Firearms 1 2010-04-01 2010-04-01 false Marking containers of beer... Liquors and Articles in Puerto Rico Beer § 26.106 Marking containers of beer. Containers of beer of Puerto... brewer; the serial number, capacity, and size of the container; the kind of beer; and the serial number...

27 CFR 26.97 - Marking containers of wine.

Science.gov (United States)

2010-04-01

... 27 Alcohol, Tobacco Products and Firearms 1 2010-04-01 2010-04-01 false Marking containers of wine... Liquors and Articles in Puerto Rico Wine § 26.97 Marking containers of wine. Containers of wine of Puerto... winemaker, the serial number of the container, the kind and taxable grade of the wine, the gallon content...

Progressive learning in endoscopy simulation training improves clinical performance: a blinded randomized trial.

Science.gov (United States)

Grover, Samir C; Scaffidi, Michael A; Khan, Rishad; Garg, Ankit; Al-Mazroui, Ahmed; Alomani, Tareq; Yu, Jeffrey J; Plener, Ian S; Al-Awamy, Mohamed; Yong, Elaine L; Cino, Maria; Ravindran, Nikila C; Zasowski, Mark; Grantcharov, Teodor P; Walsh, Catharine M

2017-11-01

A structured comprehensive curriculum (SCC) that uses simulation-based training (SBT) can improve clinical colonoscopy performance. This curriculum may be enhanced through the application of progressive learning, a training strategy centered on incrementally challenging learners. We aimed to determine whether a progressive learning-based curriculum (PLC) would lead to superior clinical performance compared with an SCC. This was a single-blinded randomized controlled trial conducted at a single academic center. Thirty-seven novice endoscopists were recruited and randomized to either a PLC (n = 18) or to an SCC (n = 19). The PLC comprised 6 hours of SBT, which progressed in complexity and difficulty. The SCC included 6 hours of SBT, with cases of random order of difficulty. Both groups received expert feedback and 4 hours of didactic teaching. Participants were assessed at baseline, immediately after training, and 4 to 6 weeks after training. The primary outcome was participants' performance during their first 2 clinical colonoscopies, as assessed by using the Joint Advisory Group Direct Observation of Procedural Skills assessment tool (JAG DOPS). Secondary outcomes were differences in endoscopic knowledge, technical and communication skills, and global performance in the simulated setting. The PLC group outperformed the SCC group during first and second clinical colonoscopies, measured by JAG DOPS (P PLC group had superior technical and communication skills and global performance in the simulated setting (P  .05). Our findings demonstrate the superiority of a PLC for endoscopic simulation, compared with an SCC. Challenging trainees progressively is a simple, theory-based approach to simulation whereby the performance of clinical colonoscopies can be improved. (Clinical trial registration number: NCT02000180.). Copyright © 2017 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.

Distance teaching using self-marking multiple choice questions.

Science.gov (United States)

Poore, P

1987-01-01

In Papua New Guinea health extension officers receive a 3-year course of training in college, followed by a period of in-service training in hospital. They are then posted to a health center, where they are in charge of all health services within their district. While the health extension officers received an excellent basic training, and were provided with books and appropriate, locally produced texts, they often spent months or even years after graduation in remote rural health centers with little communication from colleagues. This paper describes an attempt to improve communication, and to provide support inexpensively by post. Multiple choice questions, with a system for self-marking, were sent by post to rural health workers. Multiple choice questions are used in the education system in Papua New Guinea, and all health extension officers are familiar with the technique. The most obvious and immediate result was the great enthusiasm shown by the majority of health staff involved. In this way a useful exchange of correspondence was established. With this exchange of information and recognition of each other's problems, the quality of patient care must improve.

Levomilnacipran Extended-Release Treatment in Patients With Major Depressive Disorder: Improvements in Functional Impairment Categories

Science.gov (United States)

Gommoll, Carl P.; Chen, Changzheng; Greenberg, William M.; Ruth, Adam

2015-01-01

Objective: In this post hoc analysis, improvement in functional impairment in patients with major depressive disorder (MDD) treated with levomilnacipran extended release (ER) was evaluated by assessing shifts from more severe to less severe functional impairment categories on individual Sheehan Disability Scale (SDS) subscales. Method: SDS data were pooled from 5 phase II/III studies conducted between December 2006 and March 2012 of levomilnacipran ER versus placebo in adult patients with MDD (DSM-IV-TR criteria). Proportions of patients shifting from moderate-extreme baseline impairment (score ≥ 4) to mild-no impairment (score ≤ 3) at end of treatment were assessed for each SDS subscale. Proportions of patients shifting from marked-extreme (score ≥ 7) baseline impairment to moderate-no (score ≤ 6) or mild-no impairment (score ≤ 3) at end of treatment, and shifts in which patients worsened from moderate-no to marked-extreme impairment, were also evaluated. Results: A significantly higher proportion of patients treated with levomilnacipran ER than placebo-treated patients improved from more severe categories of functional impairment at baseline to less severe impairment categories across all SDS subscales: work/school, social life, and family life/home responsibilities (P impairment at baseline improved to mild or no impairment, compared with no more than 40% of placebo patients on any subscale. Almost half (42%–47%) of levomilnacipran ER–treated patients versus only about one-third (29%–34%) of placebo patients improved from marked-extreme to mild or no impairment across functional domains. Conclusions: These results suggest that functional improvement was observed across the SDS functional domains. To our knowledge, this is the first such categorical analysis of functional improvement, as measured by the SDS, for an antidepressant. Trial Registration: ClinicalTrials.gov identifiers: NCT00969709, NCT01377194, NCT00969150, and NCT01034462 and Eudra

Development of PAOT tool kit for work improvements in clinical nursing.

Science.gov (United States)

Jung, Moon-Hee

2014-01-01

The aim of this study was to develop an action checklist for educational training of clinical nurses. The study used qualitative and quantitative methods. Questionnaire items were extracted through in-depth interviews and a questionnaire survey. PASW version 19 and AMOS version 19 were used for data analyses. Reliability and validity were tested with both exploratory and confirmative factor analysis. The levels of the indicators related to goodness-of-fit were acceptable. Thus, a model kit of work improvements in clinical nursing was developed. It comprises 5 domains (16 action points): health promotion (5 action points), work management (3 action points), ergonomic work methods (3 action points), managerial policies and mutual support among staff members (3 action points), and welfare in the work area (2 action points).

Topography measurements and applications in ballistics and tool mark identifications*

Science.gov (United States)

Vorburger, T V; Song, J; Petraco, N

2016-01-01

The application of surface topography measurement methods to the field of firearm and toolmark analysis is fairly new. The field has been boosted by the development of a number of competing optical methods, which has improved the speed and accuracy of surface topography acquisitions. We describe here some of these measurement methods as well as several analytical methods for assessing similarities and differences among pairs of surfaces. We also provide a few examples of research results to identify cartridge cases originating from the same firearm or tool marks produced by the same tool. Physical standards and issues of traceability are also discussed. PMID:27182440

Mirror-mark tests performed on jackdaws reveal potential methodological problems in the use of stickers in avian mark-test studies.

Directory of Open Access Journals (Sweden)

Manuel Soler

Full Text Available Some animals are capable of recognizing themselves in a mirror, which is considered to be demonstrated by passing the mark test. Mirror self-recognition capacity has been found in just a few mammals having very large brains and only in one bird, the magpie (Pica pica. The results obtained in magpies have enormous biological and cognitive implications because the fact that magpies were able to pass the mark test meant that this species is at the same cognitive level with great apes, that mirror self-recognition has evolved independently in the magpie and great apes (which diverged 300 million years ago, and that the neocortex (which is not present in the bird's brains is not a prerequisite for mirror self-recognition as previously believed. Here, we have replicated the experimental design used on magpies to determine whether jackdaws (Corvus monedula are also capable of mirror self-recognition by passing the mark test. We found that our nine jackdaws showed a very high interest towards the mirror and exhibited self-contingent behavior as soon as mirrors were introduced. However, jackdaws were not able to pass the mark test: both sticker-directed actions and sticker removal were performed with a similar frequency in both the cardboard (control and the mirror conditions. We conclude that our jackdaws' behaviour raises non-trivial questions about the methodology used in the avian mark test. Our study suggests that the use of self-adhesive stickers on sensitive throat feathers may open the way to artefactual results because birds might perceive the stickers tactilely.

A quality assessment tool for markup-based clinical guidelines.

Science.gov (United States)

Shalom, Erez; Shahar, Yuval; Taieb-Maimon, Meirav; Lunenfeld, Eitan

2008-11-06

We introduce a tool for quality assessment of procedural and declarative knowledge. We developed this tool for evaluating the specification of mark-up-based clinical GLs. Using this graphical tool, the expert physician and knowledge engineer collaborate to perform scoring, using pre-defined scoring scale, each of the knowledge roles of the mark-ups, comparing it to a gold standard. The tool enables scoring the mark-ups simultaneously at different sites by different users at different locations.

Hypertrophic cardiomyopathy in infants: clinical features and natural history

International Nuclear Information System (INIS)

Maron, B.J.; Tajik, A.J.; Ruttenberg, H.D.; Graham, T.P.; Atwood, G.F.; Victorica, B.E.; Lie, J.T.; Roberts, W.C.

1982-01-01

The clinical and morphologic features of hypertrophic cardiomyopathy in 20 patients recognized as having cardiac disease in the first year of life are described. Fourteen of these 20 infants were initially suspected of having heart disease solely because a heart murmur was identified. However, the infants showed a variety of clinical findings, including signs of marked congestive heart failure (in the presence of nondilated ventricular cavities and normal or increased left ventricular contractility) and substantial cardiac enlargement on chest radiograph. Other findings were markedly different from those usually present in older children and adults with hypertrophic cardiomyopathy (e.g., right ventricular hypertrophy on the ECG and cyanosis). Consequently, in 14 infants, the initial clinical diagnosis was congenital cardiac malformation other than hypertrophic cardiomyopathy. The clinical course was variable in these patients, but the onset of marked congestive heart failure in the first year of life appeared to be an unfavorable prognostic sign; nine of the 11 infants with congestive heart failure died within the first year of life. In infants with hypertrophic cardiomyopathy, unlike older children and adults with this condition, sudden death was less common (two patients) than death due to progressive congestive heart failure

Aksel Mark: kõik algaski Otsal / Enn Nõu

Index Scriptorium Estoniae

Nõu, Enn, 1933-

2012-01-01

Arvustus: Mark Beijer, Mai. Landkänning : Brevväxling mellan Anu och Aksel Mark under deras första år som flyktingar från Estland 1944-45. Stockholm : Bokverksta´n Förlag, 2008; Allt började på Otsa : minnen från min barndom och skoláren. Stockholm : Beijer Bok & Skog, 2011

Object marking in Swahili: Definiteness, specificity, or both ...

African Journals Online (AJOL)

This article examines the role of object marking in relation to definiteness and specificity in Swahili. Object marking in general has attracted the attention of many scholars in the field of Bantu linguistics due to the complex nature of object markers (OMs) and varying functions they fulfil in Bantu. Opinions differ on the role of ...

Opioid growth factor improves clinical benefit and survival in patients with advanced pancreatic cancer

Directory of Open Access Journals (Sweden)

Jill P Smith

2010-03-01

Full Text Available Jill P Smith1, Sandra I Bingaman1, David T Mauger2, Harold H Harvey1, Laurence M Demers3, Ian S Zagon41Departments of Medicine, 2Public Health Sciences, 3Pathology, and 4Neurosciences and Anatomy, Pennsylvania State University, College of Medicine, Hershey Medical Center, Hershey, PA, USABackground: Advanced pancreatic cancer carries the poorest prognosis of all gastrointestinal malignancies. Once the tumor has spread beyond the margins of the pancreas, chemotherapy is the major treatment modality offered to patients; however, chemotherapy does not significantly improve survival.Objective: Opioid growth factor (OGF; [Met5]-enkephalin is a natural peptide that has been shown to inhibit growth of pancreatic cancer in cell culture and in nude mice. The purpose of this study was to evaluate the effects of OGF biotherapy on subjects with advanced pancreatic cancer who failed chemotherapy.Methods: In a prospective phase II open-labeled clinical trial, 24 subjects who failed standard chemotherapy for advanced pancreatic cancer were treated weekly with OGF 250 μg/kg intravenously. Outcomes measured included clinical benefit, tumor response by radiographic imaging, quality of life, and survival.Results: Clinical benefit response was experienced by 53% of OGF-treated patients compared to historical controls of 23.8% and 4.8% for gemcitabine and 5-fluorouracil (5-FU, respectively. Of the subjects surviving more than eight weeks, 62% showed either a decrease or stabilization in tumor size by computed tomography. The median survival time for OGF-treated patients was three times that of untreated patients (65.5 versus 21 days, p < 0.001. No adverse effects on hematologic or chemistry parameters were noted, and quality of life surveys suggested improvement with OGF. Limitations: Measurements other than survival were not allowed in control patients, and clinical benefit comparisons were made to historical controls.Conclusion: OGF biotherapy improves the

Mark Leonard : EL ei peakski olema suurvõim / Mark Leonard ; interv. Erkki Bahovski

Index Scriptorium Estoniae

Leonard, Mark

2008-01-01

Intervjuu Euroopa Välissuhete Nõukogu tegevdirektoriga, kes vastab küsimustele, mis puudutavad USA ja Euroopa suhteid, Euroopa Liidu välispoliitikat, Venemaa ja Euroopa Liidu suhteid pärast Gruusia konflikti. Ta peab murettekitavaks, et Venemaa üritab takistada euroopalike väärtuste levitamist oma naaberriikides. Vt. samas: Mark Leonard. Ilmunud ka Sirp : Diplomaatia 14. nov. nr. 11 lk. 13-14

Feasibility of Wii Fit training to improve clinical measures of balance in older adults.

Science.gov (United States)

Bieryla, Kathleen A; Dold, Neil M

2013-01-01

Numerous interventions have been proposed to improve balance in older adults with varying degrees of success. A novel approach may be to use an off-the-shelf video game system utilizing real-time force feedback to train older adults. The purpose of this study is to investigate the feasibility of using Nintendo's Wii Fit for training to improve clinical measures of balance in older adults and to retain the improvements after a period of time. Twelve healthy older adults (aged >70 years) were randomly divided into two groups. The experimental group completed training using Nintendo's Wii Fit game three times a week for 3 weeks while the control group continued with normal activities. Four clinical measures of balance were assessed before training, 1 week after training, and 1 month after training: Berg Balance Scale (BBS), Fullerton Advanced Balance (FAB) scale, Functional Reach (FR), and Timed Up and Go (TUG). Friedman two-way analysis of variance by ranks was conducted on the control and experimental group to determine if training using the Wii Balance Board with Wii Fit had an influence on clinical measures of balance. Nine older adults completed the study (experimental group n = 4, control group n = 5). The experimental group significantly increased their BBS after training while the control group did not. There was no significant change for either group with FAB, FR, and TUG. Balance training with Nintendo's Wii Fit may be a novel way for older adults to improve balance as measured by the BBS.

Increasing clinical, satisfaction, and financial performance through nurse-driven process improvement.

Science.gov (United States)

Sims, Caroline E

2003-02-01

Providers and regulatory agencies are increasing their demands for hospitals to document clinical quality and customer satisfaction at a decreased cost. Nurse leaders search for ways to meet these requirements while retaining their most valuable resource: healthcare workers (especially nurses). First-line leadership struggles with balancing quality, cost-effectiveness, and staff retention. The author discusses the planning, methodology, implementation, and outcomes of a staff driven process improvement initiative.

Reproducibility of Computer-Aided Detection Marks in Digital Mammography

International Nuclear Information System (INIS)

Kim, Seung Ja; Moon, Woo Kyung; Cho, Nariya; Kim, Sun Mi; Im, Jung Gi; Cha, Joo Hee

2007-01-01

To evaluate the performance and reproducibility of a computeraided detection (CAD) system in mediolateral oblique (MLO) digital mammograms taken serially, without release of breast compression. A CAD system was applied preoperatively to the fulfilled digital mammograms of two MLO views taken without release of breast compression in 82 patients (age range: 33 83 years; mean age: 49 years) with previously diagnosed breast cancers. The total number of visible lesion components in 82 patients was 101: 66 masses and 35 microcalcifications. We analyzed the sensitivity and reproducibility of the CAD marks. The sensitivity of the CAD system for first MLO views was 71% (47/66) for masses and 80% (28/35) for microcalcifications. The sensitivity of the CAD system for second MLO views was 68% (45/66) for masses and 17% (6/35) for microcalcifications. In 84 ipsilateral serial MLO image sets (two patients had bilateral cancers), identical images, regardless of the existence of CAD marks, were obtained for 35% (29/84) and identical images with CAD marks were obtained for 29% (23/78). Identical images, regardless of the existence of CAD marks, for contralateral MLO images were 65% (52/80) and identical images with CAD marks were obtained for 28% (11/39). The reproducibility of CAD marks for the true positive masses in serial MLO views was 84% (42/50) and that for the true positive microcalcifications was 0% (0/34). The CAD system in digital mammograms showed a high sensitivity for detecting masses and microcalcifications. However, reproducibility of microcalcification marks was very low in MLO views taken serially without release of breast compression. Minute positional change and patient movement can alter the images and result in a significant effect on the algorithm utilized by the CAD for detecting microcalcifications

Normal cellular radiosensitivity in an adult Fanconi anaemia patient with marked clinical radiosensitivity

International Nuclear Information System (INIS)

Marcou, Yiola; D'Andrea, Andrew; Jeggo, Penelope A.; Plowman, Piers N.

2001-01-01

Background: Fanconi anaemia is a rare disease associated with cellular sensitivity to chemicals (e.g. mitomycin C and diepoxybutane); variable but mild cellular radiosensitivity has also been reported. Materials and methods: A 32-year-old patient with Fanconi anaemia and tonsillar carcinoma, treated by radiotherapy, was found to exhibit profound clinical radiosensitivity. Confluent, ulcerating oropharyngeal mucositis developed after a conventionally fractionated dose of 34 Gy and healing was incomplete by 2 months after cessation of therapy. Results: Cellular radiosensitivity assays and RPLD studies from this patient did not suggest any major detectable radiosensitivity. Conclusion: There is a discrepancy between the observed clinical radiosensitivity and the usual 'predictive' radiosensitivity assays in this patient with Fanconi anaemia

Amoralist rationalism? A response to Joel Marks: commentary on "Animal abolitionism meets moral abolitionism: cutting the Gordian knot of applied ethics" by Joel Marks.

Science.gov (United States)

Lederman, Zohar

2014-06-01

In a recent article, Joel Marks presents the amoralist argument against vivisection, or animal laboratory experimentation. He argues that ethical theories that seek to uncover some universal morality are in fact useless and unnecessary for ethical deliberations meant to determine what constitutes an appropriate action in a specific circumstance. I agree with Marks' conclusion. I too believe that vivisection is indefensible, both from a scientific and philosophical perspective. I also believe that we should become vegan (unfortunately, like the two philosophers mentioned by Marks, I too am still struggling to reduce my meat and dairy consumption). However, I am in the dark as to Marks' vision of normative deliberations in the spirit of amoralism and desirism.

SU-F-J-116: Clinical Experience-Based Verification and Improvement of a 4DCT Program

Energy Technology Data Exchange (ETDEWEB)

Fogg, P; West, M; Aland, T [Genesis Cancer Care, Auchenflower, Qld (Australia)

2016-06-15

Purpose: To demonstrate the role of continuous improvement fulfilled by the Medical Physicist in clinical 4DCT and CBCT scanning. Methods: Lung (SABR and Standard) patients’ 4D respiratory motion and image data were reviewed over a 3, 6 and 12 month period following commissioning testing. By identifying trends of clinically relevant parameters and respiratory motions, variables were tested with a programmable motion phantom and assessed. Patient traces were imported to a motion phantom and 4DCT and CBCT imaging were performed. Cos6 surrogate and sup-inf motion was also programmed into the phantom to simulate the long exhale of patients for image contrast tests. Results: Patient surrogate motion amplitudes were 9.9+5.2mm (3–35) at 18+6bpm (6–30). Expiration/Inspiration time ratios of 1.4+0.5second (0.6–2.9) showed image contrast effects evident in the AveCT and 3DCBCT images. Small differences were found for patients with multiple 4DCT data sets. Patient motion assessments were simulated and verified with the phantom within 2mm. Initial image reviews to check for reconstructed artefacts and data loss identified a small number of patients with irregularities in the automatic placement of inspiration and expiration points. Conclusion: The Physicist’s involvement in the continuous improvements of a clinically commissioned technique, processes and workflows continues beyond the commissioning stage of a project. Our experience with our clinical 4DCT program shows that Physics presence is required at the clinical 4DCT scan to assist with technical aspects of the scan and also for clinical image quality assessment prior to voluming. The results of this work enabled the sharing of information from the Medical Physics group with the Radiation Oncologists and Radiation Therapists. This results in an improved awareness of clinical patient respiration variables and how they may affect 4D simulation images and also may also affect the treatment verification images.

Revised Mark 22 coolant temperature coefficients

International Nuclear Information System (INIS)

Graves, W.E.

1987-01-01

Coolant temperature coefficients for the Mark 22 charge published previously are non-conservative because of the neglect of a significant mechanism which has a positive contribution to reactivity. Even after correcting for this effect, dynamic tests made on a Mark VIB charge in the early 60's suggest the results are still non-conservative. This memorandum takes both of these sources of information into account in making a best estimate of the prompt (coolant plus metal) temperature coefficient. Although no safety issues arise from this work (the overall temperature coefficient still strongly contributes to reactor stability), it is obviously desirable to use best estimates for prompt coefficients in limits and other calculations

An open labeled, comparative clinical study on efficacy and tolerability of oral minipulse of steroid (OMP alone, OMP with PUVA and broad / narrow band UVB phototherapy in progressive vitiligo

Directory of Open Access Journals (Sweden)

Rath Namita

2008-01-01

Full Text Available Background: Several modalities of treatment have been tried in vitiligo with varied results; however, Indian data on comparative studies of two or more therapies are limited. Aims: We compared different phototherapy methods with an oral steroid as an adjunct to determine the method with the best tolerability and efficacy. Methods: Eighty-six patients with progressive vitiligo were randomly assigned to different study groups according to a continuous selection method over a period of one year. Group 1 was given OMP + PUVA, group 2 OMP + UVB (NB, group 3 OMP + UVB (BB and group 4 was given OMP alone. Each patient was followed up for six months and then released from treatment. Clinical evaluation was made at the end of three and six months. Results: In group 1 (OMP + PUVA, marked improvement was seen in 18.51% while moderate improvement was seen in 66.66% of the patients. Marked improvement was seen in 37.03% in group 2 (OMP + NB-UVB while 44.44% had moderate improvement. In group 3 (OMP + BB UVB, 8.33% showed marked improvement while moderate improvement was seen in 25% of the patients. Marked and moderate improvement was seen in 5 and 10% of group 4 (OMP patients, respectively. Conclusions: Our study compared four treatment modalities in vitiligo patients, out of which oral minipulse of steroids (OMP only had an adjunct value and was not very effective by itself. Narrow band UVB has a definite edge over broad band UVB and should be preferred when both options are available. NB-UVB and PUVA showed comparable efficacy.

22 CFR 226.91 - Marking.

Science.gov (United States)

2010-04-01

... Relations AGENCY FOR INTERNATIONAL DEVELOPMENT ADMINISTRATION OF ASSISTANCE AWARDS TO U.S. NON-GOVERNMENTAL ORGANIZATIONS Miscellaneous § 226.91 Marking. (a) USAID policy is that all programs, projects, activities... support of the American people through the United States Agency for International Development (USAID). The...

Maaväline lind Mark Raidpere / Fagira D. Morti

Index Scriptorium Estoniae

Fagira D. Morti, pseud., 1974-

2009-01-01

Soome Vabariigi president Tarja Halonen andis 28. veebruaril 2009. aastal Kumu Kunstimuuseumis videokunstnik Mark Raidperele üle Ars Fennica kunstipreemia. Meenutusi kunstniku EHI-s õppimise ajast, esimese näituse "Ilo" avamisest Vaal galeriis. Mark Raidpere loomingu mõistmisest

ASSESSING REFERRALS AND IMPROVING INFORMATION AVAILABILITY FOR CONSULTATIONS IN AN ACADEMIC ENDOCRINOLOGY CLINIC.

Science.gov (United States)

Hendrickson, Chase D; Saini, Saumya; Pothuloori, Avin; Mecchella, John N

2017-02-01

Outpatient specialty consultations rely on the timeliness and completeness of referral information to facilitate a valuable patient-specialist interaction. This project aimed to increase essential diagnostic information availability at the initial consultation for patients referred for common endocrine conditions frequently lacking such data-diabetes mellitus, thyroid nodule, thyrotoxicosis, and hypercalcemia. At an endocrinology clinic at an academic medical center in rural New England, providers see several thousand new patients annually, the majority of whom are referred by providers external to the clinic's healthcare system. Through consensus, endocrinology clinic providers agreed on the two or three data elements essential for a meaningful initial consultation for each. A quality improvement team employed a planned series of interventions based on previously published methods and an innovative approach: dissemination of a referral guideline, an assessment of referral adequacy in the endocrinology clinic workflow, coupled with focused requests for missing items, and a pre-visit lab appointment. Between April 2015 and March 2016, 762 referrals were reviewed. At baseline for the four conditions, referrals contained all essential elements only 27.5% (22 of 80) of the time. Over a 7-month period, the team implemented the interventions, with subsequent referrals containing all essential elements increasing to 75.5% (P<.0001), largely attributable to the pre-visit lab appointment. Incoming referrals that lack essential information are a significant problem in specialty care and may adversely affect patient experience, provider satisfaction, and clinic efficiency. Improvement may require innovative approaches, such as the potentially transferable and generalizable ones employed here. DHMC = Dartmouth-Hitchcock Medical Center EHR = electronic health record PDSA = Plan-Do-Study-Act.

Elimination of pain improves specificity of clinical diagnostic criteria for adult chronic rhinosinusitis.

Science.gov (United States)

Hirsch, Scott D; Reiter, Evan R; DiNardo, Laurence J; Wan, Wen; Schuman, Theodore A

2017-05-01

Determine whether the elimination of pain improves accuracy of clinical diagnostic criteria for adult chronic rhinosinusitis. Retrospective cohort study. History, symptoms, nasal endoscopy, and computed tomography (CT) results were analyzed for 1,186 adults referred to an academic otolaryngology clinic with presumptive diagnosis of chronic rhinosinusitis. Clinical diagnosis was rendered using the 1997 Rhinosinusitis Taskforce (RSTF) Guidelines and a modified version eliminating facial pain, ear pain, dental pain, and headache. Four hundred seventy-nine subjects (40%) met inclusion criteria. Among subjects positive by RSTF guidelines, 45% lacked objective evidence of sinonasal inflammation by CT, 48% by endoscopy, and 34% by either modality. Applying modified RSTF diagnostic criteria, 39% lacked sinonasal inflammation by CT, 38% by endoscopy, and 24% by either modality. Using either abnormal CT or endoscopy as the reference standard, modified diagnostic criteria yielded a statistically significant increase in specificity from 37.1% to 65.1%, with a nonsignificant decrease in sensitivity from 79.2% to 70.3%. Analysis of comorbidities revealed temporomandibular joint disorder, chronic cervical pain, depression/anxiety, and psychiatric medication use to be negatively associated with objective inflammation on CT or endoscopy. Clinical diagnostic criteria overestimate the prevalence of chronic rhinosinusitis. Removing facial pain, ear pain, dental pain, and headache increased specificity without a concordant loss in sensitivity. Given the high prevalence of sinusitis, improved clinical diagnostic criteria may assist primary care providers in more accurately predicting the presence of inflammation, thereby reducing inappropriate antibiotic use or delayed referral for evaluation of primary headache syndromes. 4. Laryngoscope, 127:1011-1016, 2017. © 2017 The American Laryngological, Rhinological and Otological Society, Inc.

THE MARK I BUSINESS SYSTEM SIMULATION MODEL

Science.gov (United States)

of a large-scale business simulation model as a vehicle for doing research in management controls. The major results of the program were the...development of the Mark I business simulation model and the Simulation Package (SIMPAC). SIMPAC is a method and set of programs facilitating the construction...of large simulation models. The object of this document is to describe the Mark I Corporation model, state why parts of the business were modeled as they were, and indicate the research applications of the model. (Author)

The Things of Caesar: Mark-ing the Plural (Mk 12:13–17

Directory of Open Access Journals (Sweden)

Warren Carter

2014-09-01

Full Text Available This article observes the rarely-discussed phenomenon that the Marcan paying-the-tax scene refers to tax in the singular, whilst the concluding saying uses the plural ‘the things of Caesar and of God’. The article accounts for this phenomenon by means of developing traditions. The section under the heading ‘Mark’s scene and saying about taxes (12:13–17’ counters the common claim that scene and saying originated as a unit from the historical Jesus. It proposes that whilst the saying may have originated with Jesus, the scene as we have it did not. The section under the heading ‘Social memory, orality, and a multi-referential saying?’ suggests some contexts that the saying about the things of Caesar addressed pre-Mark. And under the section ‘Trauma and Mark’s scene’ it is argued that Mark created a unit comprising scene and saying to negotiate the ‘ trauma’ of the 66–70 war. The unit evaluates freshly-asserted Roman power as idolatrous and blasphemous whilst simultaneously authorising the continued involvement of Jesus-believers in imperial society.

Figures in clinical trial reports: current practice & scope for improvement.

Science.gov (United States)

Pocock, Stuart J; Travison, Thomas G; Wruck, Lisa M

2007-11-19

Most clinical trial publications include figures, but there is little guidance on what results should be displayed as figures and how. To evaluate the current use of figures in Trial reports, and to make constructive suggestions for future practice. We surveyed all 77 reports of randomised controlled trials in five general medical journals during November 2006 to January 2007. The numbers and types of figures were determined, and then each Figure was assessed for its style, content, clarity and suitability. As a consequence, guidelines are developed for presenting figures, both in general and for each specific common type of Figure. Most trial reports contained one to three figures, mean 2.3 per article. The four main types were flow diagram, Kaplan Meier plot, Forest plot (for subgroup analyses) and repeated measures over time: these accounted for 92% of all figures published. For each type of figure there is a considerable diversity of practice in both style and content which we illustrate with selected examples of both good and bad practice. Some pointers on what to do, and what to avoid, are derived from our critical evaluation of these articles' use of figures. There is considerable scope for authors to improve their use of figures in clinical trial reports, as regards which figures to choose, their style of presentation and labelling, and their specific content. Particular improvements are needed for the four main types of figures commonly used.

Figures in clinical trial reports: current practice & scope for improvement

Directory of Open Access Journals (Sweden)

Travison Thomas G

2007-11-01

Full Text Available Abstract Background Most clinical trial publications include figures, but there is little guidance on what results should be displayed as figures and how. Purpose To evaluate the current use of figures in Trial reports, and to make constructive suggestions for future practice. Methods We surveyed all 77 reports of randomised controlled trials in five general medical journals during November 2006 to January 2007. The numbers and types of figures were determined, and then each Figure was assessed for its style, content, clarity and suitability. As a consequence, guidelines are developed for presenting figures, both in general and for each specific common type of Figure. Results Most trial reports contained one to three figures, mean 2.3 per article. The four main types were flow diagram, Kaplan Meier plot, Forest plot (for subgroup analyses and repeated measures over time: these accounted for 92% of all figures published. For each type of figure there is a considerable diversity of practice in both style and content which we illustrate with selected examples of both good and bad practice. Some pointers on what to do, and what to avoid, are derived from our critical evaluation of these articles' use of figures. Conclusion There is considerable scope for authors to improve their use of figures in clinical trial reports, as regards which figures to choose, their style of presentation and labelling, and their specific content. Particular improvements are needed for the four main types of figures commonly used.

Using lean principles to improve outpatient adult infusion clinic chemotherapy preparation turnaround times.

Science.gov (United States)

Lamm, Matthew H; Eckel, Stephen; Daniels, Rowell; Amerine, Lindsey B

2015-07-01

The workflow and chemotherapy preparation turnaround times at an adult infusion clinic were evaluated to identify opportunities to optimize workflow and efficiency. A three-phase study using Lean Six Sigma methodology was conducted. In phase 1, chemotherapy turnaround times in the adult infusion clinic were examined one year after the interim goal of a 45-minute turnaround time was established. Phase 2 implemented various experiments including a five-day Kaizen event, using lean principles in an effort to decrease chemotherapy preparation turnaround times in a controlled setting. Phase 3 included the implementation of process-improvement strategies identified during the Kaizen event, coupled with a final refinement of operational processes. In phase 1, the mean turnaround time for all chemotherapy preparations decreased from 60 to 44 minutes, and a mean of 52 orders for adult outpatient chemotherapy infusions was received each day. After installing new processes, the mean turnaround time had improved to 37 minutes for each chemotherapy preparation in phase 2. In phase 3, the mean turnaround time decreased from 37 to 26 minutes. The overall mean turnaround time was reduced by 26 minutes, representing a 57% decrease in turnaround times in 19 months through the elimination of waste and the implementation of lean principles. This reduction was accomplished through increased efficiencies in the workplace, with no addition of human resources. Implementation of Lean Six Sigma principles improved workflow and efficiency at an adult infusion clinic and reduced the overall chemotherapy turnaround times from 60 to 26 minutes. Copyright © 2015 by the American Society of Health-System Pharmacists, Inc. All rights reserved.