Sample records for medical center wright-patterson

  1. (Environmental investigation of ground water contamination at Wright- Patterson Air Force Base, Ohio)

    Energy Technology Data Exchange (ETDEWEB)


    This Health and Safety Plan (HSP) was developed for the Environmental Investigation of Ground-water Contamination Investigation at Wright-Patterson Air Force Base near Dayton, Ohio, based on the projected scope of work for the Phase 1, Task 4 Field Investigation. The HSP describes hazards that may be encountered during the investigation, assesses the hazards, and indicates what type of personal protective equipment is to be used for each task performed. The HSP also addresses the medical monitoring program, decontamination procedures, air monitoring, training, site control, accident prevention, and emergency response.

  2. (Environmental investigation of ground water contamination at Wright-Patterson Air Force Base, Ohio)

    Energy Technology Data Exchange (ETDEWEB)


    This report presents information concerning field procedures employed during the monitoring, well construction, well purging, sampling, and well logging at the Wright-Patterson Air Force Base. Activities were conducted in an effort to evaluate ground water contamination.

  3. Hydrogeology, simulated ground-water flow, and ground-water quality, Wright-Patterson Air Force Base, Ohio (United States)

    Dumouchelle, D.H.; Schalk, C.W.; Rowe, G.L.; De Roche, J.T.


    Ground water is the primary source of water in the Wright-Patterson Air Force Base area. The aquifer consists of glacial sands and gravels that fill a buried bedrock-valley system. Consolidated rocks in the area consist of poorly permeable Ordovician shale of the Richmondian stage, in the upland areas, the Brassfield Limestone of Silurian age. The valleys are filled with glacial sediments of Wisconsinan age consisting of clay-rich tills and coarse-grained outwash deposits. Estimates of hydraulic conductivity of the shales based on results of displacement/recovery tests range from 0.0016 to 12 feet per day; estimates for the glacial sediments range from less than 1 foot per day to more than 1,000 feet per day. Ground water flow from the uplands towards the valleys and the major rivers in the region, the Great Miami and the Mad Rivers. Hydraulic-head data indicate that ground water flows between the bedrock and unconsolidated deposits. Data from a gain/loss study of the Mad River System and hydrographs from nearby wells reveal that the reach of the river next to Wright-Patterson Air Force Base is a ground-water discharge area. A steady-state, three-dimensional ground-water-flow model was developed to simulate ground-water flow in the region. The model contains three layers and encompasses about 100 square miles centered on Wright-Patterson Air Force Base. Ground water enters the modeled area primarily by river leakage and underflow at the model boundary. Ground water exits the modeled area primarily by flow through the valleys at the model boundaries and through production wells. A model sensitivity analysis involving systematic changes in values of hydrologic parameters in the model indicates that the model is most sensitive to decreases in riverbed conductance and vertical conductance between the upper two layers. The analysis also indicates that the contribution of water to the buried-valley aquifer from the bedrock that forms the valley walls is about 2 to 4

  4. Environmental Assessment for the National Museum of the United States Air Force Addition, Wright-Patterson Air Force Base, Ohio (United States)


    AUTHOR(S) 5d. PROJECT NUMBER 5e. TASK NUMBER 5f. WORK UNIT NUMBER 7. PERFORMING ORGANIZATION NAME(S) AND ADDRESS(ES) United States Air Force 88th...Air Base Wing Wright-Patterson Air Force Base, Ohio 8. PERFORMING ORGANIZATION REPORT NUMBER 9. SPONSORING/MONITORING AGENCY NAME(S) AND ADDRESS(ES...visitors nationwide and from foreign countries. Softball and soccer fields are located adjacent to the Museum grounds and are operated by the 88 Air

  5. [Environmental investigation of ground water contamination at Wright- Patterson Air Force Base, Ohio]. Volume 4, Health and Safety Plan (HSP); Phase 1, Task 4 Field Investigation report: Draft

    Energy Technology Data Exchange (ETDEWEB)


    This Health and Safety Plan (HSP) was developed for the Environmental Investigation of Ground-water Contamination Investigation at Wright-Patterson Air Force Base near Dayton, Ohio, based on the projected scope of work for the Phase 1, Task 4 Field Investigation. The HSP describes hazards that may be encountered during the investigation, assesses the hazards, and indicates what type of personal protective equipment is to be used for each task performed. The HSP also addresses the medical monitoring program, decontamination procedures, air monitoring, training, site control, accident prevention, and emergency response.

  6. Technical and economic assessment for asbestos abatement within Facility 20470, Wright-Patterson Air Force Base, Ohio

    International Nuclear Information System (INIS)

    Gibson, S.M.; Ogle, R.B.


    This report presents the results of a technical and economic assessment of available alternatives for asbestos abatement within Facility 20470 at the Wright-Patterson Air Force Base in Dayton, Ohio. Each alternative was screened on the basis of technical feasibility, environmental impact, economics, and fulfillment of the IRP goals. Four alternatives for study are: establishing a special operations and maintenance program; enclosure; encapsulation with sealants; and removal, disposal, and replacement. Each of these alternatives was assessed for capability to control the release of asbestos fibers within Facility 20470. Alternatives 1 and 4 were determined to be acceptable, while Alternatives 2 and 3 were found to be unacceptable. 2 refs., 6 figs

  7. [Environmental investigation of ground water contamination at Wright-Patterson Air Force Base, Ohio

    International Nuclear Information System (INIS)


    This Removal Action System Design has been prepared as a Phase I Volume for the implementation of the Phase II removal action at Wright-Patterson Air Force Base (WPAFB) near Dayton, Ohio. The objective of the removal action is to prevent, to the extent practicable, the migration of ground water contaminated with chlorinated volatile organic compounds (VOCS) across the southwest boundary of Area C. The Phase 1, Volume 9 Removal Action System Design compiles the design documents prepared for the Phase II Removal Action. These documents, which are presented in Appendices to Volume 9, include: Process Design, which presents the 30 percent design for the ground water treatment system (GWTS); Design Packages 1 and 2 for Earthwork and Road Construction, and the Discharge Pipeline, respectively; no drawings are included in the appendix; Design Package 3 for installation of the Ground Water Extraction Well(s); Design Package 4 for installation of the Monitoring Well Instrumentation; and Design Package 5 for installation of the Ground Water Treatment System; this Design Package is incorporated by reference because of its size

  8. (Environmental investigation of ground water contamination at Wright-Patterson Air Force Base, Ohio)

    Energy Technology Data Exchange (ETDEWEB)


    An environmental investigation of ground water conditions has been undertaken at Wright-Patterson Air Force Base (WPAFB), Ohio to obtain data to assist in the evaluation of a potential removal action to prevent, to the extent practicable, migration of the contaminated ground water across Base boundaries. Field investigations were limited to the central section of the southwestern boundary of Area C and the Springfield Pike boundary of Area B. Further, the study was limited to a maximum depth of 150 feet below grade. Three primary activities of the field investigation were: (1) installation of 22 monitoring wells, (2) collection and analysis of ground water from 71 locations, (3) measurement of ground water elevations at 69 locations. Volatile organic compounds including trichloroethylene, perchloroethylene, and/or vinyl chloride were detected in concentrations exceeding Maximum Contaminant Levels (MCL) at three locations within the Area C investigation area. Ground water at the Springfield Pike boundary of Area B occurs in two primary units, separated by a thicker-than-expected clay layers. One well within Area B was determined to exceed the MCL for trichloroethylene.

  9. Defense Base Realignment and Closure Budget Data for the Closure of Gentile Air Force Station, Dayton, Ohio, and Realignment of Defense Logistics Agency Components to Wright-Patterson Air Force Base, Ohio

    National Research Council Canada - National Science Library


    .... This report provides the results of the audit of two projects, valued at $5.5 million, for the closure of Gentile Air Force Station, Dayton, Ohio, and realignment to Wright-Patterson Air Force Base, Ohio, of two Defense Logistics Agency components...

  10. [Environmental investigation of ground water contamination at Wright-Patterson Air Force Base, Ohio]. Volume 3, Appendix A, Draft standard operating procedures and elements: Sampling and Analysis Plan (SAP): Phase 1, Task 4, Field Investigation, Draft

    Energy Technology Data Exchange (ETDEWEB)


    This report presents information concerning field procedures employed during the monitoring, well construction, well purging, sampling, and well logging at the Wright-Patterson Air Force Base. Activities were conducted in an effort to evaluate ground water contamination.

  11. [Environmental investigation of ground water contamination at Wright-Patterson Air Force Base, Ohio]. Volume 5, Field Investigation report

    Energy Technology Data Exchange (ETDEWEB)


    An environmental investigation of ground water conditions has been undertaken at Wright-Patterson Air Force Base (WPAFB), Ohio to obtain data to assist in the evaluation of a potential removal action to prevent, to the extent practicable, migration of the contaminated ground water across Base boundaries. Field investigations were limited to the central section of the southwestern boundary of Area C and the Springfield Pike boundary of Area B. Further, the study was limited to a maximum depth of 150 feet below grade. Three primary activities of the field investigation were: (1) installation of 22 monitoring wells, (2) collection and analysis of ground water from 71 locations, (3) measurement of ground water elevations at 69 locations. Volatile organic compounds including trichloroethylene, perchloroethylene, and/or vinyl chloride were detected in concentrations exceeding Maximum Contaminant Levels (MCL) at three locations within the Area C investigation area. Ground water at the Springfield Pike boundary of Area B occurs in two primary units, separated by a thicker-than-expected clay layers. One well within Area B was determined to exceed the MCL for trichloroethylene.

  12. Wright-Patterson Air Force Base: The First Century (United States)


    aside in 1934 to house a Transient Camp for temporary workers employed under Depression -era programs. During 1934 and 1935, these men labored on...The 445th Airlift Wing upgraded from C-141s to C-5As between 2005 and 2007, before transitioning to C-17s in 2012. The Centennial of Flight was a...December 2002 on Wright Brothers Hill. The event initiated the nation’s commemoration of the Centennial of Flight. These actions symbolized the

  13. Information Analysis Centers in the Department of Defense. Revision (United States)


    Combat Data Information Center (CDIC) and the Aircraft Survivability Model Repository ( ASMR ) into the Survivability/Vulnerability Information Analysis...Information Center (CDIC) and the Aircraft Survivability Model Respository ( ASMR ). The CDIC was a central repository for combat and test data related to...and ASMR were operated under the technical monitorship of the Flight Dynamics Laboratory at Wright-Patterson AFB, Ohio and were located in Flight

  14. AFRL Materials and Manufacturing Directorate (United States)

    Flight Wright-Patterson Medical Clinic Contact Us Search Wright-Patterson Air Force Base: AFRL Logo AFRL follow in footsteps of legendary WWII flight nurse New satellite communication technology positioned for commanders with new decision making tools Public Health Education Division: Educating to Protect AFRL ENSPIRE

  15. Department of Defense Expenditure Plans (United States)


    317 Aberdeen Proving Ground MD Replace Windows and Renovate Lounge Area, 4508 700 B 318 Aberdeen Proving Ground MD Replace Three Boilers, 525 500 E ...Rt 235 630 O 1137 Wright Patterson AFB OH Replace Perimeter Fence - Gate 26c Along E Bank of Mad River 644 O 1138 Wright Patterson AFB OH Replacec...Energy E Roofs R Utilities U Pavement/roads/grounds P Barracks B Quality of Life Q Operations O Medical M Family Housing F American Recovery and

  16. Environmental Assessment for the AFIT Master Plan, Wright-Patterson Air Force Base, Ohio, 88th Air Base Wing (United States)


    Creek during a base-wide mist net survey (BHE 2001). Radio tracking of these two bats confirmed the presence of a maternity colony in a dead slippery ... elm (Ulmus rubra) in a woodlot on the campus of Wright State University. No sightings of Indiana bats have been reported within the area of the

  17. The Seated Soldier Study: Posture and Body Shape in Vehicle Seats (United States)


    lasers in four towers arranged in a square create a line on the subject as they move synchronously from top to bottom. Two cameras on each of the four...of the scanner being assembled and the scanner draped with curtains to control light and provide privacy. UNCLASSIFIED UNCLASSIFIED 22 Figure 16...with special reference to the limbs. WADC Technical Report No. 55-159. Wright-Patterson Air Force Base, OH: Wright Air Development Center

  18. A Review of Selected Literature on Stresses Affecting Soldiers in Combat (United States)


    14 W. D. Chiles . Psycho logicat Stress as a Theoretical Concept, WADC Technical Report 57-457, Wright Air Development Center, Wright- Patterson AFB...placing the bulb of the thermometer in a water saturated 1M. J. Duke, N. Findikyan, J. Anderson, and S. B. Sells. Stress /N Vih ,:;. [I. ’ stress. Concern with fatigue and its effects have led to a considerable amount of work in the past two decades. Chiles , Alluisi, and Adams 30

  19. Wright-Fisher diffusion bridges. (United States)

    Griffiths, Robert C; Jenkins, Paul A; Spanò, Dario


    The trajectory of the frequency of an allele which begins at x at time 0 and is known to have frequency z at time T can be modelled by the bridge process of the Wright-Fisher diffusion. Bridges when x=z=0 are particularly interesting because they model the trajectory of the frequency of an allele which appears at a time, then is lost by random drift or mutation after a time T. The coalescent genealogy back in time of a population in a neutral Wright-Fisher diffusion process is well understood. In this paper we obtain a new interpretation of the coalescent genealogy of the population in a bridge from a time t∈(0,T). In a bridge with allele frequencies of 0 at times 0 and T the coalescence structure is that the population coalesces in two directions from t to 0 and t to T such that there is just one lineage of the allele under consideration at times 0 and T. The genealogy in Wright-Fisher diffusion bridges with selection is more complex than in the neutral model, but still with the property of the population branching and coalescing in two directions from time t∈(0,T). The density of the frequency of an allele at time t is expressed in a way that shows coalescence in the two directions. A new algorithm for exact simulation of a neutral Wright-Fisher bridge is derived. This follows from knowing the density of the frequency in a bridge and exact simulation from the Wright-Fisher diffusion. The genealogy of the neutral Wright-Fisher bridge is also modelled by branching Pólya urns, extending a representation in a Wright-Fisher diffusion. This is a new very interesting representation that relates Wright-Fisher bridges to classical urn models in a Bayesian setting. Copyright © 2017 Elsevier Inc. All rights reserved.

  20. Toxic Hazards Research Unit Annual Technical Report: 1985 (United States)


    varnish makers’ and painters’ naphtha, Toxicol. Appl. Pharmacol., 32:263-281. Carpenter, C. P.. E. R. Kinkead, D. L. Geary, L. J. Sullivan, Jr., and J...and Pharmacology of Inorganic and Fluorine Contairnin Compounds, AMRL-TR-67-224, Aerospace Medical Research Laboiatory, Wright-Patterson Air Force Base

  1. James Homer Wright: a biography of the enigmatic creator of the Wright stain on the occasion of its centennial. (United States)

    Lee, Robert E; Young, Robert H; Castleman, Benjamin


    James Homer Wright (1869-1928), the eldest son of a Pittsburgh glass merchant, was educated in Baltimore and practiced pathology in Boston from 1893 until his death in 1928. In 1896, when not quite 27 years old, he assumed directorship of the newly founded Pathology Laboratory at the Massachusetts General Hospital, a post he held for the next 30 years. He is remembered eponymously by the blood cell stain that bears his name and the Homer Wright pseudorosettes of neuroblastoma, but he made many additional contributions to pathology. These include the following: determination of the cellular lineage of multiple myeloma, identification of the megakaryocyte as the cell of origin of blood platelets, recognition of the cell of origin of the neuroblastoma, demonstration of spirochetes in syphilitic aneurysms of the aorta, and clarification of misconceptions about actinomycosis. Additionally, Wright coauthored, with Dr. Frank B. Mallory, the book Pathological Technique, which was a staple of laboratories for >40 years and exemplifies Wright's wide-ranging interests in, and contributions to, practical aspects of pathology including staining, culture and frozen section techniques, photography, and development of the rotary microtome. He received Honorary Doctor of Science Degrees from Harvard University, the University of Maryland (his alma mater), and the University of Missouri. He was the recipient of the Gross prize in 1905 for his publication on actinomycosis and the Boylston Medical Prize in 1908 for his discovery of the origin of platelets, and he was inducted into the American Academy of Arts and Sciences in 1915. Although shy and somewhat austere in the workplace, a different side was shown by his anonymously sending flowers to a young Norwegian opera singer whom he subsequently married. The pathology laboratories of the Massachusetts General Hospital were named the "James Homer Wright Pathology Laboratories" in 1956. Today James Homer Wright is remembered and

  2. Quantitative Methods for Determining U.S. Air Force Crew Cushion Comfort (United States)


    Directorate Biosciences and Protection Division Biomechanics Branch Wright Patterson AFB OH 45433-7947 Form Approved REPORT DOCUMENTATION PAGE OMB No...Division Biomechanics Branch Wright-Patterson AFB OH 45433-7947 9. SPONSORING I MONITORING AGENCY NAME(S) AND ADDRESS(ES) 10. SPONSOR/MONITOR’S...workstations were constructed utilizing ejection seat long-term flight. mockups and foot pedal assemblies modified to simulate the ACES II seat in the F-16

  3. An automated full-symmetry Patterson search method

    International Nuclear Information System (INIS)

    Rius, J.; Miravitlles, C.


    A full-symmetry Patterson search method is presented that performs a molecular coarse rotation search in vector space and orientation refinement using the σ function. The oriented molecule is positioned using the fast translation function τ 0 , which is based on the automated interpretation of τ projections using the sum function. This strategy reduces the number of Patterson-function values to be stored in the rotation search, and the use of the τ 0 function minimizes the required time for the development of all probable rotation search solutions. The application of this method to five representative test examples is shown. (orig.)

  4. Developing Reliable Telemedicine Platforms with Unreliable and Limited Communication Bandwidth (United States)


    AFRL-SA-WP-TR-2017-0019 Developing Reliable Telemedicine Platforms with Unreliable and Limited Communication Bandwidth Peter F...Wright-Patterson AFB, OH 45433-7913 DISTRIBUTION STATEMENT A. Approved for public release. Distribution is unlimited. STINFO COPY NOTICE AND...invention that may relate to them. Qualified requestors may obtain copies of this report from the Defense Technical Information Center (DTIC) (http

  5. 76 FR 55933 - Federal Property Suitable as Facilities To Assist the Homeless (United States)


    ... written expression of interest to HHS, addressed to Theresa Ritta, Division of Property Management... Management Division, Naval Facilities Engineering Command, Washington Navy Yard, 1330 Patterson Ave., SW... Area Ohio Facility 30089 5490 Pearson Wright Patterson AFB OH 45433 Landholding Agency: Air Force...

  6. The Impact of Goal Setting and Empowerment on Governmental Matrix Organizations (United States)


    shared. In a study of matrix management, Eduardo Vasconcellos further describes various matrix structures in the Galbraith model. In a functional...Technology/LAR, Wright-Patterson AFB OH, 1992. Vasconcellos , Eduardo . "A Model For a Better Understanding of the Matrix Structure," IEEE Transactions on...project matrix, the project manager maintains more influence and the structure lies to the right-of center ( Vasconcellos , 1979:58). Different Types of

  7. 77 FR 75503 - Wright Brothers Day, 2012 (United States)


    ... Wright pursued their lifelong dream. Like so many Americans before and after them, these two men achieved... stay ahead of the curve and keep America moving forward. With their game-changing feat, the Wright...

  8. Learning to Fly: The Wright Brothers' Adventure. A Guide for Educators and Students with Activities in Aeronautics (United States)

    Storm, R.; Benson, T.; Galica, C.; McCredie, P.


    This guide was produced by the NASA Glenn Research Center Office of Educational Programs in Cleveland, OH, and the NASA Aerospace Educational Coordinating Committee. It includes activity modules for students, including the history of the Wright Brothers and their family in Dayton, Ohio and flight experimentation in Kitty Hawk, North Carolina. Student activities such as building models of the Wright Brothers glider and writing press releases of the initial flight are included.

  9. Toxic Hazards Research Unit Annual Technical Report: 1984 (United States)


    exposed to TOCP exhibited the classic lesions of delayed neuropathy (Smith and Lillie, 1931; Barnes and Denz, 1953; (avanagh, 1954; and Fenton , 1955...Safety of *.i Chemicals in Food, Drugs, and Cosmetics , The staff of the Divi- sion of Pharmacology of the Federal Food and Drug Administration, Austin...Annual Technical Report: 1967, AMRL-TR-67-137 (AD 834723), Aerospace Medical Research Laboratory, Wright-Patterson Air Force Base, Ohio. Fenton , J. C

  10. Richrd Wright: a reluctant comrade


    Torres, Stela


    Richard Wright's works have often been disregarded by scholars as a mere form of propaganda in which the writer pleads the cause of the Communist Party. We must admit, however, that although Wright poses questions in his novels and short stories which are political by nature (for instance, how can the black man as an oppressed, divided, unauthentic being participate effectively in his struggle for liberation from a racist society?), the alternatives he envisages seem quite unorthodox when con...

  11. Wright Flyer Project (United States)


    The wind tunnel test results have been published in the literature as summarized at the end of this report. As part of the education program, an introduction to engineering course module was designed and tested on 80 freshman engineering students at Old Dominion University. The five-week module required that five-person teams design, build and fly a radio-controlled airplane using only the wind tunnel data developed by the Wright brothers in 1902. That module is described in Sparks and Ash (2001). The Principal Investigator has co-authored one dozen publications resulting from this research, as listed at the end of this report. The Principal Investigator has given fourteen lectures on the Wright brother testing program and has appeared in two documentary television programs (summarized at the end of this report). Speaking invitations have continued since the completion of the project.

  12. The flowering of pathology as a medical discipline in Boston, 1892-c.1950: W.T. Councilman, FB Mallory, JH Wright, SB Wolbach and their descendants. (United States)

    Louis, David N; O'Brien, Michael J; Young, Robert H


    During most of the nineteenth century, the discipline of pathology in Boston made substantial strides as a result of physicians and surgeons who practiced pathology on a part-time basis. The present essay tells the subsequent story, beginning in 1892, when full-time pathologists begin to staff the medical schools and hospitals of Boston. Three individuals from this era deserve special mention: William T Councilman, Frank Burr Mallory and James Homer Wright, with Councilman remembered primarily as a visionary and teacher, Mallory as a trainer of many pathologists, and Wright as a scientist. Together with S Burt Wolbach in the early-to-mid-twentieth century, these pathologists went on to train the next generation of pathologists-a generation that then populated the various hospitals that were developed in Boston in the early 1900s. This group of seminal pathologists in turn formed the diagnostically strong, academically productive, pathology departments that grew in Boston over the remainder of the twentieth century.

  13. Application of Patterson-function direct methods to materials characterization. (United States)

    Rius, Jordi


    The aim of this article is a general description of the so-called Patterson-function direct methods (PFDM), from their origin to their present state. It covers a 20-year period of methodological contributions to crystal structure solution, most of them published in Acta Crystallographica Section A. The common feature of these variants of direct methods is the introduction of the experimental intensities in the form of the Fourier coefficients of origin-free Patterson-type functions, which allows the active use of both strong and weak reflections. The different optimization algorithms are discussed and their performances compared. This review focuses not only on those PFDM applications related to powder diffraction data but also on some recent results obtained with electron diffraction tomography data.

  14. Application of Patterson-function direct methods to materials characterization

    Directory of Open Access Journals (Sweden)

    Jordi Rius


    Full Text Available The aim of this article is a general description of the so-called Patterson-function direct methods (PFDM, from their origin to their present state. It covers a 20-year period of methodological contributions to crystal structure solution, most of them published in Acta Crystallographica Section A. The common feature of these variants of direct methods is the introduction of the experimental intensities in the form of the Fourier coefficients of origin-free Patterson-type functions, which allows the active use of both strong and weak reflections. The different optimization algorithms are discussed and their performances compared. This review focuses not only on those PFDM applications related to powder diffraction data but also on some recent results obtained with electron diffraction tomography data.

  15. Frank Lloyd Wright in the Soviet Union

    Directory of Open Access Journals (Sweden)

    Brian A. Spencer


    Full Text Available In 1937 the First All-Union Congress of Soviet Architects was held in Moscow. The congress brought  architects from all areas of the  Soviet Union. Under the auspices of Vsesoiuvnoe Obshchestvo Kul'turnoi Sviazi s zagranitsei (VOKS it invited international architects from Europe and North and South America.  The Organizing Committee of the Union of Soviet Architects invited Frank Lloyd Wright from the United States. Frank Lloyd Wright presented his philosophy and exhibited his work, specifically his designs for the weekend home for E. J. Kaufmann "Fallingwater" and the drawings for the S.C. Johnson Administration. Frank Lloyd Wright's presentation did not focus heavily on the architecture but, rather the spirit of the Russian and Soviet vision.

  16. Human Resources Data in Weapon System Design: An Initial Plan for Development of a Unified Data Base. (United States)


    tems such as D-195, D-220, etc. 11. Provides a standardized methodology for the selection of systems, subsystems to be used as the historical baseline...Graham, R. S., & Hilgeman, .1. B. A methodological approach to the analysis and automatic handling of task information for systems in the conceptual phase...AMRL- TR-63-78 AD-419 018, Wright-Patterson AFB, Ohio: Aerospace Medical Reserach Laboratories, August 1963. 46. Reed, L. E., Snyder, M. T., Baran, H

  17. Er: YLF Laser Development (United States)


    Force Wright Aeronautical Laboratory, AFAL/DHO, Wright-Patterson AFB, OH 45433. WL/AFSC( IST ) ltr, 12 Apr 1991 UNCLASSIFIED AD NUMBER LIMITATION CHANGES TO...ju^i^zs.^iu •Lbbrtbataafetiu.*. i ! mtotfffiflaiai WP1— 1 ’ »■■■«I HIU I I .1 III ll.lll. VIH IWII

  18. Sir Almroth Wright: pioneer immunologist. (United States)

    Ellis, Harold


    This year marks the 150th anniversary of the birth of Almroth Edward Wright, whose pioneer work in immunology saved countless lives, especially in the First World War, but whose name and work are all but forgotten today. Wright was born in 1861 in Middleton Tyas, Yorkshire, where his father, an Irish protestant and considerable Hebrew scholar, was the minister. Almroth's Swedish mother, the daughter of NW Almroth, governor of the mint in Stockholm, was responsible for his unusual first name. She had the rare distinction of having served as a nurse with Florence Nightingale in the hospital at Scutari in the Crimean War.

  19. Because Everyone Has a Story to Tell: Interview with Andrew Wright (United States)

    Floris, Flora Debora


    This article presents an interview with Andrew Wright, a widely recognized author, illustrator, storyteller, and teacher trainer. Wright has published many ELT books, authored six "Spellbinder" graded readers (1992-1994), and a collection of short stories. As a teacher trainer, Wright worked extensively with both teachers and students in…

  20. Utilizing a Rapid Prototyping Approach in the Building of a Hypermedia-Based Reference Station. (United States)

    Sell, Dan

    This paper discusses the building of a hypermedia-based reference station at the Wright Laboratory Technical Library, Wright-Patterson Air Force Base, Ohio. Following this, the paper focuses on an electronic user survey from which data is collected and analysis is made. The survey data is used in a rapid prototyping approach, which is defined as…

  1. Information Processing and Collective Behavior in a Model Neuronal System (United States)


    were invited to visit the 711th Human Performance Wing at Wright Patterson AFB to give a briefing on our work. We also presented our work at AFRL in...for an AFOSR project headed by Steve Reppert on Monarch Butterfly navigation. We visited the Reppert lab at the UMASS Medical School and have had many...the requested briefing at the 711th Human Performance Wing . It is a natural extension of the original aims of the grant, as the suprachiasmatic

  2. Aerospace Transparency Research Compendium

    National Research Council Canada - National Science Library

    Pinkus, Alan


    ... (ARRL), located at Wright-Patterson AFB OH, has advanced aerospace transparency technology through the investigative research of numerous optical and visual parameters inherent in aerospace transparencies...


    Directory of Open Access Journals (Sweden)

    Martina Zbašnik-Senegačnik


    Full Text Available Frank Lloyd Wright is the greatest American architect and oneof the greatest architects the world. His career began at theend of the 19th century, during the great architectural boom inChicago, under the mentorship of Louis Henry Sullivan, fromwhom he adopted and then perfected the concepts of organicarchitecture and the Prairie house. During the Depressionyears, Wright developed a cheaper and simpler variant of thePrairie house: the Usonian house.Wright's architecture is characterised by an entirely newapproach to building design, particularly the design of houses.He reduced the number of rooms by combining their functionsin a large living space with a central fireplace. He used largeglazed areas to connect the external environment of the housewith the interior. The natural environment of the prairie wasthe inspiration for the horizontal lines that characterised hisarchitecture. His buildings are low in height, close to humanscale and with a great feeling for the natural setting in whichthey are built. He selected materials from the surroundingarea and the principal decoration of his architecture was thenatural structure of the material.The paper presents the ideas of organic architecture, thePrairie house, the Usonian house, along with the best examplesof Wright's architecture and the criteria he employed in theselection of materials and construction technologies. Theenvironmental aspect of his philosophy of the use of materialsis considered in the discussion section.Wright may be considered a pioneer of sustainable architecture.

  4. Medical service plans in academic medical centers. (United States)

    Siegel, B


    Medical service plans are of major importance to academic medical centers and are becoming increasingly so each year as evidenced by growing dependence of medical schools on resulting funds. How these funds are generated and used varies among schools. The procedures may affect the governance of the institution, modifying the authority of the central administration or the clinical departments. Recent developments in federal legislation, such as health maintenance organizations and amendments (Section 227) to the Social Security Act, and the future development of national health insurance will certainly have an effect on how academic medical centers organize their clinical activities. How successfully various medical schools deal with the dynamic problem may well determine their future survival.

  5. A Policy Analysis of Using Unit Costs as a Means of Performance Measurement in the Air Force Science and Technology Program (United States)


    demonstrate, is that there is more than one way to account for S &T costs and evaluate its program performance. The first option evaluated considers...Personal Communication. Wright Laboratory, Wright-Patterson AFB OH, 14 May 1991. Horngren , Charles T. and George Foster. Cost Accounting A Managerial...78 Programmatic Feedback ........ 79 S &T as Overhead............79 Scoring the Options............80 Unit Costs ................8 Programmatic

  6. Women in History--Marian Wright Edelman: Crusader for Civil and Children's Rights (United States)

    Mills, Shirley J.


    This article profiles Marian Wright Edelman, a crusader for civil and children's rights. She was born June 6, 1939, at a time when prejudice and segregation were the norm. The Wright family lived in a small, southern town of Bennetsville, South Carolina, where Marian was the youngest of five children. Her father, the Reverend Arthur Jerome Wright,…

  7. 77 FR 75616 - Procurement List; Additions (United States)


    .... 611, 1919 E Grange Ave., Milwaukee, WI NPA: Easter Seals Southeast Wisconsin, Inc., South Milwaukee... B, Bldg. 39, Wright-Patterson AFB, Dayton, OH NPA: Goodwill Easter Seals Miami Valley, Dayton, OH...

  8. Integrated Life-Cycle Framework for Maintenance, Monitoring and Reliability of Naval Ship Structures (United States)


    uncertainty in quantitative risk and policy analysis, Cambridge Univer- sity Press. NEVES, L. C, FRANGOPOL, D. M., AND CRUZ , P. J. 2006 Probabilistic lifetime...L. C, FRANGOPOL, D. M., AND CRUZ , P. J. 2006 Probabilistic life- time-oriented multiobjective optimization of bridge maintenance: single...Wright Aeronautical Laboratory. Wright- Patterson Air Force Base, Dayton, Ohio; 1981. [5| Chung H-Y, Manuel L, Frank KH. Optimal inspection

  9. Adaptive Kronrod-Patterson integration of non-linear finite-element matrices

    DEFF Research Database (Denmark)

    Janssen, Hans


    inappropriate discretization. In response, this article develops adaptive integration, based on nested Kronrod-Patterson-Gauss integration schemes: basically, the integration order is adapted to the locally observed grade of non-linearity. Adaptive integration is developed based on a standard infiltration...

  10. The age of the earth: the approach of Clair Cameron Patterson

    International Nuclear Information System (INIS)

    Trouillet, F.


    This article is a practical physics course designed for high school students that illustrates the Patterson's approach to determine the age of the earth. In 1953, the result published by Patterson (4.55 ± 0.07)*10 9 y was the first correct estimation of the age of the earth. His approach is based on the idea that the isotopic composition of meteorites can give information on the origin of the solar system. He assumed that meteorites and earth were formed at the same time and from a common homogeneous material (in terms of lead and uranium isotopic compositions). Patterson determined the isotopic lead composition of meteorite samples and inferred the age of the earth. The first part of the article gives the kinetics equations of Pb 206 and Pb 207 , these 2 lead isotopes were present originally and have been created since through the decay of U 238 and U 235 respectively. The second part present the application to experimental data from 5 meteorite samples. A conclusion is drawn that highlights the limits of the method: the measurement of the lead composition of the samples is very delicate to do because the meteorites contain very low amounts of lead (about 1 ppm) and the crossing of the atmosphere could have contaminated them with lead from humane activities. (A.C.)

  11. Patterson-Stevenson-Fontaine syndrome: 30-year follow-up and clinical details of a further affected case

    Energy Technology Data Exchange (ETDEWEB)

    Wilkie, A.O.M. [John Radcliffe Hospital, Oxford (United Kingdom); Goodacre, T.E.E. [Radcliffe Infirmary NHS Trust, Oxford (United Kingdom)


    The nosology of the acrofacial dysostoses was reviewed extensively. The Patterson-Stevenson-Fontaine syndrome (MIM 183700) is a rare variant, characterized by variable oligosyndactyly of the feet, unusual ears, deafness, cleft palate and autosomal dominant inheritance. The original description by Patterson and Stevenson concerned an affected father and son; a second family with four affected individuals (some of whom also had learning difficulties) in three generations was described by Fontaine et al. Opitz et al. stated {open_quotes}A follow-up of these patients is strongly urged....{close_quotes} Recently we reviewed the son originally described by Patterson and Stevenson, who is now an adult (case JL). One of his three sons (case AL) has inherited the same condition. 6 refs., 3 figs.

  12. La arquitectura tardía de Frank Lloyd Wright, el primer maestro moderno


    González Capitel, Antón


    1. La arquitectura tardía de Frank Lloyd Wright, el primer maestro moderno l. l. Un Wright renovado. Talleres y residencias l. l. l. Nuevas casas de Wright en su segunda «edad de oro»: un neoplasticismo orgánico en la casa de la Cascada l. l. 2. Geometrías y disposiciones alternativas l. 2. Arquitectura y ciudad orgánicas 1. 2. 1. El desarrollo de la arquitectura orgánica 1. 3. Arquitecturas relacionadas con la de Frank Lloyd Wright entre los emigrados europeos: Schindler y...

  13. Management of Contracts for F110 Engine Procurements

    National Research Council Canada - National Science Library

    Granetto, Paul


    This audit was performed in response to an allegation to the Defense Hotline that the Wright-Patterson Air Force Base Procurement Contracting Office made poor procurement decisions on F110 aircraft engine contracts...

  14. A Dictionary of Acquisition and Contracting Terms

    National Research Council Canada - National Science Library

    Colyer, Timothy


    This thesis is part of a joint research project between stndents of the Naval Postgraduate School in Monterey, CA and the Air Force Institute of Technology, Wright- Patterson Air Force Base, Dayton, OH...

  15. Advertising by academic medical centers. (United States)

    Larson, Robin J; Schwartz, Lisa M; Woloshin, Steven; Welch, H Gilbert


    Many academic medical centers have increased their use of advertising to attract patients. While the content of direct-to-consumer pharmaceutical advertisements (ads) has been studied, to our knowledge, advertising by academic medical centers has not. We aimed to characterize advertising by the nation's top academic medical centers. We contacted all 17 medical centers named to the US News & World Report 2002 honor roll of "America's Best Hospitals" for a semistructured interview regarding their advertising practices. In addition, we obtained and systematically analyzed all non-research-related print ads placed by these institutions in their 5 most widely circulating local newspapers during 2002. Of the 17 institutions, 16 reported advertising to attract patients; 1 stated, "We're just word of mouth." While all 17 centers confirmed the presence of an institutional review board process for approving advertising to attract research subjects, none reported a comparable process for advertising to attract patients. We identified 127 unique non-research-related print ads for the 17 institutions during 2002 (mean, 7.5; range, 0-39). Three ads promoted community events with institution sponsorship, 2 announced genuine public services, and 122 were aimed at attracting patients. Of the latter group, 36 ads (29.5%) promoted the medical center as a whole, while 65 (53.3%) promoted specific clinical departments and 21 (17.2%) promoted single therapeutic interventions or diagnostic tests. The most commonly used marketing strategies included appealing to emotions (61.5%), highlighting institution prestige (60.7%), mentioning a symptom or disease (53.3%), and promoting introductory lectures or special offers likely to lead to further business (47.5%). Of the 21 ads for single interventions, most were for unproved (38.1%) or cosmetic (28.6%) procedures. While more than half of these ads presented benefits, none quantified their positive claims and just 1 mentioned potential harms

  16. Characterizing customers at medical center farmers' markets. (United States)

    Kraschnewski, Jennifer L; George, Daniel R; Rovniak, Liza S; Monroe, Diana L; Fiordalis, Elizabeth; Bates, Erica


    Approximately 100 farmers' markets operate on medical center campuses. Although these venues can uniquely serve community health needs, little is known about customer characteristics and outreach efforts. Intercept survey of markets and market customers between August 2010 and October 2011 at three medical centers in different geographic regions of the US (Duke University Medical Center, Cleveland Clinic, and Penn State Hershey Medical Center) were conducted. Markets reported serving 180-2,000 customers per week and conducting preventive medicine education sessions and community health programs. Customers (n = 585) across markets were similar in sociodemographic characteristics--most were middle-aged, white, and female, who were employees of their respective medical center. Health behaviors of customers were similar to national data. The surveyed medical center farmers' markets currently serve mostly employees; however, markets have significant potential for community outreach efforts in preventive medicine. If farmers' markets can broaden their reach to more diverse populations, they may play an important role in contributing to community health.

  17. Structural disorder in the decagonal Al-Co-Ni. I. Patterson analysis of diffuse x-ray scattering data

    International Nuclear Information System (INIS)

    Kobas, Miroslav; Weber, Thomas; Steurer, Walter


    The three-dimensional (3D) difference Patterson (autocorrelation) function of a disordered quasicrystal (Edagawa phase) has been analyzed. 3D diffuse x-ray diffraction data were collected in situ at 300, 1070, and 1120 K. A method, the punch-and-fill technique, has been developed for separating diffuse scattering and Bragg reflections. Its potential and limits are discussed in detail. The different Patterson maps are interpreted in terms of intercluster correlations as a function of temperature. Both at high and low temperatures, the clusters decorate the vertices of the same quasiperiodic covering. At low temperatures, for the disordered part of the structure, short-range intercluster correlations are present, whereas at higher temperatures, medium-range intercluster correlations are formed. This indicates disorder mainly inside clusters at low temperatures, whereas at higher temperatures disorder takes place inside larger superclusters. Qualitatively, the Patterson maps may be interpreted by intercluster correlations mainly inside pentagonal superclusters below 1120 K, and inside the larger decagonal superclusters at 1120 K. The results of our diffraction study are published in two parts. Part I focuses on the 3D Patterson analysis based on experimental data, Part II reports modeling of structural disorder in decagonal Al-Co-Ni

  18. A Study of the Linen and Laundry Control Procedures at the U.S. Air Force Medical Center, Wright-Patterson Air Force Base, Ohio. (United States)


    effective accounting system for "tracking" of inventory and its ccsts is a very real requirement. S ecurity A matter of considerable concern should be...The Wash. Modern Nursing Home; March 1971. Danks , R.T. Automation For A New Central Laundry. Hospitals; J.A.TI.A.; 16 September 1971. Durham, R.C

  19. Acute Dermal Irritation Study of Six Jet Fuels in New Zealand White Rabbits: Comparison of Four Bio-Based Jet Fuels with Two Petroleum JP-8 Fuels (United States)


    Shafer University of Dayton Research Institute Wright-Patterson AFB OH David R. Mattie Bioeffects Division Molecular Bioeffects Branch February...master schedule for the company. Metasys DDC Electronic Environmental Control System Controls and monitors animal room environmental conditions

  20. An Analysis of Contract Management Processes at the Space and Missile Systems Center and the Air Force Life Cycle Management Center (Wright-Patterson) Using the Contract Management Maturity Model (United States)


    graduation, Capt Chang’s next assignment is at Los Angeles Air Force Base in the Space and Missile Systems Center (SMC). Capt Chang is unmarried with... married to the former Ms. Laura Hazzard, and they have three children, Madden, and twins Aubrey and Tyler. Captain Keith V. Philaphandeth is an Air...2012 SPONSORED RESEARCH TOPICS Acquisition Management  Acquiring Combat Capability via Public-Private Partnerships (PPPs)  BCA: Contractor vs

  1. A Comparative Analysis of Patient Access Modes at Wilford Hall United States Air Force Medical Center and Selected Civilian Medical Centers (United States)


    In A COMPARATIVE ANALYSIS OF PATIENT ACCESS MODES AT WILFORD HALL UNITED STATES AIR FORCE MEDICAL CENTER N AND SELECTED CIVILIAN MEDICAL CENTERS0 N...current patient access modes at WHMC and several civilian medical centers of comparable size. This project has pursued the subject of patient access in...selected civilian medical centers which are comparable to WHMC in size, specialty mix, workload, and mission, providing responsive and efficient patient

  2. Modern housing design: prefabricated and modular design in Frank Lloyd Wright's architecture

    Directory of Open Access Journals (Sweden)

    Ana Tagliari


    Full Text Available This paper investigates the residential architecture of Frank Lloyd Wright, especially the designs which were conceived from an idea of prefabricated, modular, low-cost, and high-scale construction. Wright's organic designs originated from a material-based grid, which at the same time organized and provided freedom to create spaces and forms. This study reviews Wright's work, from his first Midwest designs that relied on brick, through an intermediary phase in California when he made intense use of concrete blocks, until his last phase, the usonian houses, which featured wood paneling. During his early career, the concept and the methodology of Wright's ideas greatly contributed to a better understanding of his architecture, his apprentices and his followers. The economy and rationalization found in the projects reviewed are of great importance as the analysis of historical proposals helps us understand the topic in question.

  3. Academic Medical Centers as digital health catalysts. (United States)

    DePasse, Jacqueline W; Chen, Connie E; Sawyer, Aenor; Jethwani, Kamal; Sim, Ida


    Emerging digital technologies offer enormous potential to improve quality, reduce cost, and increase patient-centeredness in healthcare. Academic Medical Centers (AMCs) play a key role in advancing medical care through cutting-edge medical research, yet traditional models for invention, validation and commercialization at AMCs have been designed around biomedical initiatives, and are less well suited for new digital health technologies. Recently, two large bi-coastal Academic Medical Centers, the University of California, San Francisco (UCSF) through the Center for Digital Health Innovation (CDHI) and Partners Healthcare through the Center for Connected Health (CCH) have launched centers focused on digital health innovation. These centers show great promise but are also subject to significant financial, organizational, and visionary challenges. We explore these AMC initiatives, which share the following characteristics: a focus on academic research methodology; integration of digital technology in educational programming; evolving models to support "clinician innovators"; strategic academic-industry collaboration and emergence of novel revenue models. Copyright © 2014 Elsevier Inc. All rights reserved.

  4. 75 FR 80669 - Wright Brothers Day, 2010 (United States)


    ... curious minds eager to transform and advance the world around them. Just as the Wright brothers... making great progress in ushering in a new commercial space industry that can help boost our economy...

  5. Characterizing customers at medical center farmers’ markets1 (United States)

    Kraschnewski, Jennifer L.; George, Daniel R.; Rovniak, Liza S.; Monroe, Diana L.; Fiordalis, Elizabeth; Bates, Erica


    Approximately 100 farmers’ markets operate on medical center campuses. Although these venues can uniquely serve community health needs, little is known about customer characteristics and outreach efforts. Intercept survey of markets and market customers between August 2010-October 2011 at three medical centers in different geographic regions of the US: Duke University Medical Center, Cleveland Clinic, and Penn State Hershey Medical Center were conducted. Markets reported serving 180–2000 customers per week and conducting preventive medicine education sessions and community health programs. Customers (n=585) across markets were similar in sociodemographic characteristics – most were middle-aged, white, and female, who were employees of their respective medical center. Health behaviors of customers were similar to national data. The surveyed medical center farmers’ markets currently serve mostly employees; however, markets have significant potential for community outreach efforts in preventive medicine. If farmers’ markets can broaden their reach to more diverse populations, they may play an important role in contributing to community health. PMID:24421001

  6. Looking and Learning: The Solomon R. Guggenheim Museum, Frank Lloyd Wright (United States)

    Vatsky, Sharon


    Frank Lloyd Wright was born and raised on the farmlands of Wisconsin. His mother had a vision that her son would become a great architect. Wright was raised with strong guiding principles, a love of nature, a belief in the unity of all things, and a respect for discipline and hard work. He created the philosophy of "organic architecture," which…

  7. Closing the Gap: An Analysis of Options for Improving the USAF Fighter Fleet from 2105 to 2035 (United States)


    Lanchester Equations. Graduate Research Paper, (Wright Patterson AFB: Air Force Institute of Technology, 2011), 45 58 John P. Geiss,. et al. Blue...Gilbert, Ronald E. Strategic Implications of US Fighter Force Reductions: Air to Air Combat Modelling Using Lanchester Equations. Graduate Research Paper

  8. Rehabilitation R@D Progress Reports, 1992-1993. Volume 30-31 (United States)


    Armstrong Laboratory AL/CFBS, Wright Patterson Air Force Base, Dayton, OH 45433; School of Biomedical and Human Factors Engineering, Wright State...Ruth Gannon, MS; Herbert Andrew Leeper, PhD; Nancy Thomas-Stonell, BSc, DSP; Philip Doyle, PhD; Morris Milner, PhD; Ava-Lee Kotler , MSc Hugh MacMillan...Korres E 281 Kotler A 289 Kozak K 213 Kraft MR 371 Krag MH 216 Krajbich I 35 Kralj A 86 Krick H 8 481 Author Index Krouskop T 176 Kula J 215

  9. Medical Waste Management in Community Health Centers. (United States)

    Tabrizi, Jafar Sadegh; Rezapour, Ramin; Saadati, Mohammad; Seifi, Samira; Amini, Behnam; Varmazyar, Farahnaz


    Non-standard management of medical waste leads to irreparable side effects. This issue is of double importance in health care centers in a city which are the most extensive system for providing Primary Health Care (PHC) across Iran cities. This study investigated the medical waste management standards observation in Tabriz community health care centers, northwestern Iran. In this triangulated cross-sectional study (qualitative-quantitative), data collecting tool was a valid checklist of waste management process developed based on Iranian medical waste management standards. The data were collected in 2015 through process observation and interviews with the health center's staff. The average rate of waste management standards observance in Tabriz community health centers, Tabriz, Iran was 29.8%. This case was 22.8% in dimension of management and training, 27.3% in separating and collecting, 31.2% in transport and temporary storage, and 42.9% in sterilization and disposal. Lack of principal separation of wastes, inappropriate collecting and disposal cycle of waste and disregarding safety tips (fertilizer device performance monitoring, microbial cultures and so on) were among the observed defects in health care centers supported by quantitative data. Medical waste management was not in a desirable situation in Tabriz community health centers. The expansion of community health centers in different regions and non-observance of standards could predispose to incidence the risks resulted from medical wastes. So it is necessary to adopt appropriate policies to promote waste management situation.

  10. Intertwining of the Wright-Fisher diffusion

    Czech Academy of Sciences Publication Activity Database

    Hudec, Tobiáš


    Roč. 53, č. 4 (2017), s. 730-746 ISSN 0023-5954 Institutional support: RVO:67985556 Keywords : Intertwining of Markov processes * Wright-Fisher diffusion * pure birth process Subject RIV: BA - General Mathematics OBOR OECD: Statistics and probability Impact factor: 0.379, year: 2016

  11. Ergonomic and anthropometric issues of the forward Apache crew station

    NARCIS (Netherlands)

    Oudenhuijzen, A.J.K.


    This paper describes the anthropometric accommodation in the Apache crew systems. These activities are part of a comprehensive project, in a cooperative effort from the Armstrong Laboratory at Wright Patterson Air Force Base (Dayton, Ohio, USA) and TNO Human Factors Research Institute (TNO HFRI) in

  12. Demographic monitoring of Wright fishhook cactus (United States)

    Ronald J. Kass


    Wright fishhook cactus (Sclerocactus wrightiae Benson) is a small barrel cactus endemic to the San Rafael Swell in south-central Utah. It was listed as an endangered species in 1979 due to its small population size, threats of over-collecting, and development associated with oil and gas. Demographic monitoring was initiated in 1993 with the following objectives: to...

  13. Exact simulation of conditioned Wright-Fisher models. (United States)

    Zhao, Lei; Lascoux, Martin; Waxman, David


    Forward and backward simulations play an increasing role in population genetics, in particular when inferring the relative importance of evolutionary forces. It is therefore important to develop fast and accurate simulation methods for general population genetics models. Here we present an exact simulation method that generates trajectories of an allele׳s frequency in a finite population, as described by a general Wright-Fisher model. The method generates conditioned trajectories that start from a known frequency at a known time, and which achieve a specific final frequency at a known final time. The simulation method applies irrespective of the smallness of the probability of the transition between the initial and final states, because it is not based on rejection of trajectories. We illustrate the method on several different populations where a Wright-Fisher model (or related) applies, namely (i) a locus with 2 alleles, that is subject to selection and mutation; (ii) a locus with 3 alleles, that is subject to selection; (iii) a locus in a metapopulation consisting of two subpopulations of finite size, that are subject to selection and migration. The simulation method allows the generation of conditioned trajectories that can be used for the purposes of visualisation, the estimation of summary statistics, and the development/testing of new inferential methods. The simulated trajectories provide a very simple approach to estimating quantities that cannot easily be expressed in terms of the transition matrix, and can be applied to finite Markov chains other than the Wright-Fisher model. Copyright © 2014 Elsevier Ltd. All rights reserved.

  14. A Methodology for Conus APOE Reception Planning. (United States)


    mentioned, the reception process is a service-type system, which produces services to be rendered to the personnel and cargo flowing through it. The... Heizer , Ramon N. Chief, Supply Systems Branch, Dir- ectorate of Distribution, DCS/Logistics Operations, HQ AFLC, Wright-Patterson AFB OH. Personal inter

  15. Editing Procedure for Anthropometric Survey Data (United States)


    prs. lli e er 21 A=S(I,1)/N, B=S(I,2)/N, C=S(I,3)/N, D=S(I,4)/N and, Mean = A + S(I,3) Standard Deviation = /B - A*A Veta I = (C - 3BA + 2A3...Aerospace Medical Research Laboratory (AMRL), Wright-Patterson Air Force Base. The authors wish to extend their thanks to C. E . Clauser, Sandra...W (-> u ɛ CO CT> a X! 0 +J rH C -H (U A! -P M-l • C 0 — •H CO CO u * a; x: QJ 0-.+J .p (0 C 0) — cu E +> TH 6

  16. Estate of Behringer v. Medical Center at Princeton. (United States)


    Dr. William Behringer, a staff member at the Medical Center at Princeton, was diagnosed with AIDS. Afterwards, Behringer received numerous phone calls from various people expressing awareness of his illness, and his surgical privileges at the Center were suspended. He sued the Medical Center, alleging a breach of confidentiality and discrimination. The Superior Court of New Jersey, Mercer County, held that the Medical Center had breached its duty of confidentiality when it failed to take reasonable precautions to prevent Behringer's AIDS diagnosis from becoming public knowledge. Nevertheless, although New Jersey's anti-discrimination statutes protected Dr. Behringer from having his surgical privileges revoked, the Medical Center demonstrated a reasonable risk to patients that justified suspending Dr. Behringer's privileges, or alternatively, requiring his patients' informed consent before operating. The court found that the risk included not only actual HIV transmission, but also the possibility of surgical accidents.

  17. Award for Distinguished Contributions to Research in Public Policy: Charlotte J. Patterson (United States)

    American Psychologist, 2009


    Charlotte J. Patterson, winner of the Award for Distinguished Contributions to Research in Public Policy, is cited as the world's expert on psychological research on children and youths raised by lesbian and gay parents. Her early analytic syntheses of the literature on the subject greatly influenced other researchers in child and family…

  18. Wilbur and Orville Wright: A Bibliography Commemorating the One-Hundredth Anniversary of the First Powered Flight, December 17, 1903. Revised (United States)

    Renstrom, Arthur G. (Compiler); Goldblatt, Roberta W.; Minkus, Carl; Berube, Karen L.; Launius, Roger (Technical Monitor)


    This annotated bibliography of material about Wilbur and Orville Wright and the first powered flight, commemorates the one hundredth anniversary of the event. This publication represents an updated version of the classic, "Wilbur and Orville Wright: A Bibliography Commemorating the Hundredth Anniversary of the Birth of Wilbur Wright, April 16, 1867" which was originally published in 1968. Aspects of the Wright brothers' lives covered include: their published writings, biographical references, airplanes used and flight records, airplane components, patents, court records, Wright companies and schools, the Wright-Smithsonian controversy, monuments and museums, memorials, medals and honors, memorabilia, art, poetry, music, motion pictures and juvenile publications. An index is included.

  19. Single and simultaneous binary mergers in Wright-Fisher genealogies. (United States)

    Melfi, Andrew; Viswanath, Divakar


    The Kingman coalescent is a commonly used model in genetics, which is often justified with reference to the Wright-Fisher (WF) model. Current proofs of convergence of WF and other models to the Kingman coalescent assume a constant sample size. However, sample sizes have become quite large in human genetics. Therefore, we develop a convergence theory that allows the sample size to increase with population size. If the haploid population size is N and the sample size is N 1∕3-ϵ , ϵ>0, we prove that Wright-Fisher genealogies involve at most a single binary merger in each generation with probability converging to 1 in the limit of large N. Single binary merger or no merger in each generation of the genealogy implies that the Kingman partition distribution is obtained exactly. If the sample size is N 1∕2-ϵ , Wright-Fisher genealogies may involve simultaneous binary mergers in a single generation but do not involve triple mergers in the large N limit. The asymptotic theory is verified using numerical calculations. Variable population sizes are handled algorithmically. It is found that even distant bottlenecks can increase the probability of triple mergers as well as simultaneous binary mergers in WF genealogies. Copyright © 2018 Elsevier Inc. All rights reserved.

  20. Learning-Centered Leadership: A Conceptual Foundation (United States)

    Murphy, Joseph; Elliott, Stephen N.; Goldring, Ellen; Porter, Andrew C.


    The purpose of this analysis is to describe the research base that undergirds the emerging concept of learning-centered leadership. We begin with our definition of leadership. Leadership is "the process of influencing others to achieve mutually agreed upon purposes for the organization" (Patterson, 1993, p. 3). Next, we make a number of…

  1. Particulate Characterization and Control Evaluation for Carbon Fiber Composite Aircraft Crash Recovery Operations (United States)


    Advanced Composite Office, Wright-Patterson BEE Flight, and USAFSAM for their help procuring the materials and supplies needed to perform this study...that would occur during an aircraft crash. The JP-8 was then 26 ignited with a butane lighter and allowed to burn to extinction . A burning ACM

  2. Quantum Confined Semiconductors - In-House Interim Research (United States)


    Laboratory, Materials & Manufacturing Directorate, Wright Patterson AFB, OH 45433-7707, USA blnstituto de Ciencias Fisicas, Universidad Nacional Aut6noma...111is work was supported by the Ai1· Force Office of Scientific Research (AFRU RS E, Dr. Kitt Reinhardt). • Also with lnstituto de Ciencias Fisicas

  3. Aircraft Fire Sentry. Volume 2. Appendices (United States)


    including New Mexico Engineering Research Institute (NMERI), National Institute of Standards and Technology (NIST), Wright-Patterson AFB, and AFESC at...Installation Remove the mounting bracket from the smoke alarm by depresing the release tab marked "PRESS" (see Figure 1. pg. 5). Pivot the bracket awey from and

  4. The Pilot Staffing Conundrum: A Delphi Study (United States)


    Project, AFIT/ GMO /LAL/98J-2. School of Logistics and Acquisition Management, Air Force Institute of Technology (AU), Wright Patterson AFB, OH, June...Kafer, John H. Relationship of Airline Pilot Demand and Air Force Pilot Retention. Graduate Research Project, AFIT/ GMO /LAL/98J-11. School of Logistics

  5. Johnson Space Center Health and Medical Technical Authority (United States)

    Fogarty, Jennifer A.


    1.HMTA responsibilities: a) Assure program/project compliance with Agency health and medical requirements at identified key decision points. b) Certify that programs/projects comply with Agency health and medical requirements prior to spaceflight missions. c) Assure technical excellence. 2. Designation of applicable NASA Centers for HMTA implementation and Chief Medical Officer (CMO) appointment. 3. Center CMO responsible for HMTA implementation for programs and projects at the center. JSC HMTA captured in "JSC HMTA Implementation Plan". 4. Establishes specifics of dissenting opinion process consistent with NASA procedural requirements.

  6. 76 FR 79019 - Wright Brothers Day, 2011 (United States)


    ... with earnings from their bicycle shop, gathering data on wing shape using a home-built wind tunnel and... the Wright brothers over a century ago. To reaffirm our role as the engine that drives science and..., must we press onward, exploring new frontiers of science, technology, and imagination in pursuit of a...

  7. 78 FR 76969 - Wright Brothers Day, 2013 (United States)


    ... champion STEM education in their communities. As we remember the Wright brothers, let us not forget another... results. That is why my Administration is dedicated to improving education in the vital fields of science... underrepresented groups, and through Race to the Top, we are raising standards and making STEM education a priority...

  8. Proceedings of the Triservice Corrosion of Military Equipment Conference (1974) Held at Dayton, Ohio on 29-31 Oct 1974. Volume 1. Sessions 1 through 3 (United States)


    Wright-Patterson AFB, Ohio 45433 A. L. Jackman P. 0. Box 98 Magna, Utah 84044 Elwln L. Jang Sacramento ALC/NANCA McClellan AFB, California 95652...Ttje Project Manager was Mr. Fredric H. Harf and the Research Adviser was Dr. Hugh R. Gray of the Materials and Structures Division, NASA Lewis

  9. Medical waste management in Jordan: A study at the King Hussein Medical Center

    International Nuclear Information System (INIS)

    Oweis, Rami; Al-Widyan, Mohamad; Al-Limoon, Ohood


    As in many other developing countries, the generation of regulated medical waste (RMW) in Jordan has increased significantly over the last few decades. Despite the serious impacts of RMW on humans and the environment, only minor attention has been directed to its proper handling and disposal. This study was conducted in the form of a case study at one of Jordan's leading medical centers, namely, the King Hussein Medical Center (KHMC). Its purpose was to report on the current status of medical waste management at KHMC and propose possible measures to improve it. In general, it was found that the center's administration was reasonably aware of the importance of medical waste management and practiced some of the measures to adequately handle waste generated at the center. However, it was also found that significant voids were present that need to be addressed in the future including efficient segregation, the use of coded and colored bags, better handling and transfer means, and better monitoring and tracking techniques, as well as the need for training and awareness programs for the personnel

  10. The Wright Brothers and their First Flight

    Indian Academy of Sciences (India)

    Home; Journals; Resonance – Journal of Science Education; Volume 8; Issue 12. The Wright Brothers and their First Flight. O N Ramesh. Article-in-a-Box Volume 8 Issue 12 December 2003 pp 3-4. Fulltext. Click here to view fulltext PDF. Permanent link: ...

  11. Renormalization analysis of catalytic Wright-Fisher diffusions

    Czech Academy of Sciences Publication Activity Database

    Swart, Jan M.; Fleischmann, K.


    Roč. 2006, č. 11 (2006), s. 585-654 ISSN 1083-6489 R&D Projects: GA ČR GA201/06/1323 Institutional research plan: CEZ:AV0Z10750506 Keywords : renormalization * catalytic Wright-Fisher diffusion * embedded particle system * extinction * unbounded growth * interacting diffusions * universality Subject RIV: BA - General Mathematics Impact factor: 0.676, year: 2006

  12. An Artist in the University Medical Center. Review. (United States)

    James, A. Everette, Jr.


    Reviews "An Artist in the University Medical Center" (M. Lesser, New Orleans: Tulane University Press, 1989), in which the artist captures the human side of the complex Tulane Medical Center in New Orleans (Louisiana). The interplay of drawings, etchings, watercolors, and prose conveys traditions of nurturing in the hospital. (SLD)

  13. Introducing Darwinism to Toronto's post-1887 reconstituted medical school. (United States)

    Court, John P M


    Charles Darwin's scientific paradigm was largely welcomed in Canadian academic biology and medicine, while reaction among other faculty and laypeople ranged from interest to outrage. In 1874, Ramsay Wright, a Darwinian-era biologist from Edinburgh, was appointed to the University of Toronto's Chair of Natural History. Over his 38-year career Wright integrated the evolutionary perspective into medical and biology teaching without accentuating its controversial source. He also applied the emerging German experimental research model and laboratory technology. This study identifies five categories of scientific and personal influences upon Wright through archival research on biographical sources and his writings.

  14. U.S. academic medical centers under the managed health care environment. (United States)

    Guo, K


    This research investigates the impact of managed health care on academic medical centers in the United States. Academic medical centers hold a unique position in the U.S. health care system through their missions of conducting cutting-edge biomedical research, pursuing clinical and technological innovations, providing state-of-the-art medical care and producing highly qualified health professionals. However, policies to control costs through the use of managed care and limiting resources are detrimental to academic medical centers and impede the advancement of medical science. To survive the threats of managed care in the health care environment, academic medical centers must rely on their upper level managers to derive successful strategies. The methods used in this study include qualitative approaches in the form of key informants and case studies. In addition, a survey questionnaire was sent to 108 CEOs in all the academic medical centers in the U.S. The findings revealed that managers who perform the liaison, monitor, entrepreneur and resource allocator roles are crucial to ensure the survival of academic medical centers, so that academic medical centers can continue their missions to serve the general public and promote their well-being.

  15. The Wright Science Colloquia Entering the Nano-World

    CERN Multimedia


    In 1965, Intel co-founder Gordon Moore made an astonishing prediction - that every two years processing power would double. This prediction has always proved accurate. Accordingly, the first Intel processor produced in 1975 was equipped with 2,300 transistors whereas the latest edition has 55 million. Today we have this extraordinary process of miniaturisation to thank for cell phones, computers and other, ever more compact electronic marvels. But where will the miniaturisation race end? What will happen when electronic etchings reach the size of an atom? These questions are on the programme of the 10th Wright Science Colloquia from 18 to 22 November. Five world-renowned specialists will explain to the general public the saga of miniaturisation. The Wright Colloquia take place every two years in Geneva and aim to inform the general public about the latest advances in science.   Monday 18 November: 'Shaping the World at the Atomic Scale', by Donald Eigler, IBM, Almaden, USA.   Tuesday 19...

  16. An Analysis of the Predicted Benefits of Multi-Year Procurement (United States)


    concerned with these issues. The researchers were especially concerned with model sensitivity to parameters used in the financial sector. Model validation is...TECHNOLOGY (ATC) WRIGHT-PATTERSON AIR FORCE BASE, OH 45433 qEK•Y TO RrNov O i 5 April 1982 suata Survey of Educacion With Industry Students To LS I fully

  17. Man and his contribution to radiological protection -- a tribute to Wade Patterson

    Energy Technology Data Exchange (ETDEWEB)

    Thomas, R., LLNL


    Henry Wade Patterson died in Lakeview, Oregon, on 7 October 1997. With his passing, we lost not only one of the most significant figures of the health physics profession but a most personable colleague and friend. His career at the University of California, both at Berkeley and Livermore, spanned five decades and he was generally regarded to be the first professional accelerator health physicist.

  18. An academic medical center under prolonged rocket attack--organizational, medical, and financial considerations. (United States)

    Bar-El, Yaron; Michaelson, Moshe; Hyames, Gila; Skorecki, Karl; Reisner, Shimon A; Beyar, Rafael


    The Rambam Medical Center, the major academic health center in northern Israel, serving a population of two million and providing specialized tertiary care, was exposed to an unprecedented experience during the Second Lebanon War in the summer of 2006. For more than one month, it was subjected to continuous rocket attacks, but it continued to provide emergency and routine medical services to the civilian population and also served the military personnel who were evacuated from the battlefront. To accomplish the goals of serving the population while itself being under fire, the Rambam Medical Center had to undertake major organizational decisions, which included maximizing safety within the hospital by shifting patients and departments, ensuring that the hospital was properly fortified, managing the health professional teams' work schedules, and providing needed services for the families of employees. The Rambam Medical Center's Level I trauma center expertise included multidisciplinary teams and extensive collaborations; modern imaging modalities usually reserved for peacetime medical practice were frequently used. The function of the hospital teams during the war was efficient and smooth, based on the long-term actions taken to prepare for disasters and wartime conditions. Routine hospital services continued, although at 60% of normal occupancy. Financial losses incurred were primarily due to the decrease in revenue-generating activity. The two most important components of managing the hospital under these conditions are (1) the ability to arrive at prompt and meaningful decisions with respect to the organizational and medical hospital operations and (2) the leadership and management of the professional staff and teams.

  19. Passion play: Will Wright and games for science learning (United States)

    Ching, Dixie


    Researchers and instructional designers are exploring the possibilities of using video games to support STEM education in the U.S., not only because they are a popular media form among youth, but also because well-designed games often leverage the best features of inquiry learning. Those interested in using games in an educational capacity may benefit from an examination of the work of video game designer Will Wright. Wright designs through a constructivist lens and his open-ended, sandbox games ( SimCity, The Sims, Spore) present wide "possibility spaces" that allow players to exercise their critical thinking and problem solving skills. His games invoke a delight in discovery that inspire creative acts and interest-driven learning both during and outside of the game. Finally, he reminds us that failure-based learning is a viable strategy for building expertise and understanding.

  20. Space power technology for the twenty-first century (SPT21)

    International Nuclear Information System (INIS)

    Borger, W.U.; Massie, L.D.


    During the spring and summer months of 1987, the Aero Propulsion Laboratory of the Air Force Wright Aeronautical Laboratories, Wright-Patterson AFB, Ohio in cooperation with the Air Force Space Technology Center at Kirtland AFB, New Mexico, undertook an initiative to develop a Strategic Plan for Space Power Technology Development. The initiative was called SPT21, Space Power Technology for the Twenty-First Century. The planning process involved the participation of other Government organizations (U.S. Army, Navy, DOE and NASA) along with major aerospace companies and universities. Following an SPT21 kickoff meeting on 28 May 1987, detailed strategic planning was accomplished through seven (7) Space Power Technology Discipline Workshops commencing in June 1987 and concluding in August 1987. Technology Discipline Workshops were conducted in the following areas: (1) Solar Thermal Dynamic Power Systems (2) Solar Photovoltaic Cells and Arrays (3) Thermal Management Technology (4) Energy Storage Technology (5) Nuclear Power Systems Technology (6) Power Conditioning, Distribution and Control and (7) Systems Technology/Advanced Concepts. This technical paper summarizes the planning process and describes the salient findings and conclusions of the workshops


    Yust-Katz, Shlomit; Limon, Dror; Abu-Shkara, Ramez; Siegal, Tali


    Neuro-oncology is a subspecialty attracting physicians from medical disciplines such as neurology, neurosurgery, pediatrics, oncology, and radiotherapy. It deals with diagnosis and management of primary brain tumors, as well as metastatic and non-metastatic neurological manifestations that frequently affect cancer patients including brain metastases, paraneoplastic syndromes and neurological complications of cancer treatment. A neuro-oncology unit was established in Davidoff Cancer Center at Rabin Medical Center. It provides a multidisciplinary team approach for management of brain tumors and services, such as expert outpatient clinics and inpatient consultations for the departments of oncology, hematology, bone marrow transplantation and other departments in the Rabin Medical Center. In addition, expert consultation is frequently provided to other hospitals that treat cancer patients with neurological manifestations. The medical disciplines that closely collaborate for the daily management of neuro-oncology patients include radiotherapy, hematology, oncology, neuro-surgery, neuro-radiology and neuro-pathology. The neuro-oncology center is also involved in clinical and laboratory research conducted in collaboration with researchers in Israel and abroad. The new service contributes substantially to the improved care of cancer patients and to the advance of research topics in the field of neuro-oncology.

  2. 77 FR 22298 - Intent To Grant an Exclusive Patent License (United States)


    ... Public Law 96-517, as amended; the Department of the Air Force announces its intention to grant PS Engineering, Inc., a corporation of the State of Tennessee, having a place of business at 9800 Martel Road... Command Law Office, AFMCLO/JAZ, 2240 B Street, Rm D-14, Wright-Patterson AFB, OH 45433-7109; Facsimile...

  3. [Patient-centered medicine for tuberculosis medical services]. (United States)

    Fujita, Akira; Narita, Tomoyo


    The 2011 edition of Specific Guiding Principles for Tuberculosis Prevention calls for a streamlined medical services system capable of providing medical care that is customized to the patient's needs. The new 21st Century Japanese version of the Directly Observed Treatment Short Course (DOTS) expands the indication of DOTS to all tuberculosis (TB) patients in need of treatment. Hospital DOTS consists of comprehensive, patient-centered support provided by a DOTS care team. For DOTS in the field, health care providers should select optimal administration support based on patient profiles and local circumstances. In accordance with medical fee revisions for 2012, basic inpatient fees have been raised and new standards for TB hospitals have been established, the result of efforts made by the Japanese Society for Tuberculosis and other associated groups. It is important that the medical care system be improved so that patients can actively engage themselves as a member of the team, for the ultimate goal of practicing patient-centered medicine. We have organized this symposium to explore the best ways for practicing patient-centered medicine in treating TB. It is our sincere hope that this symposium will lead to improved medical treatment for TB patients. 1. Providing patient-centered TB service via utilization of collaborative care pathway: Akiko MATSUOKA (Hiroshima Prefectural Tobu Public Health Center) We have been using two types of collaborative care pathway as one of the means of providing patient-centered TB services since 2008. The first is the clinical pathway, which is mainly used by TB specialist doctors to communicate with local practitioners on future treatment plan (e.g. medication and treatment duration) of patients. The clinical pathway was first piloted in Onomichi district and its use was later expanded to the whole of Hiroshima prefecture. The second is the regional care pathway, which is used to share treatment progress, test results and other

  4. Consumerism: forcing medical practices toward patient-centered care. (United States)

    Ozmon, Jeff


    Consumerism has been apart of many industries over the years; now consumerism may change the way many medical practices deliver healthcare. With the advent of consumer-driven healthcare, employers are shifting the decision-making power to their employees. Benefits strategies like health savings accounts and high-deductible insurance plans now allow the patients to control how and where they spend their money on medical care. Practices that seek to attract the more affluent and informed consumers are beginning to institute patient-centered systems designs that invite patients to actively participate in their healthcare. This article will outline the changes in the healthcare delivery system facing medical practices, the importance of patient-centered care, and six strategies to implement to change toward more patient-centered care.

  5. Implementing the patient-centered medical home in complex adaptive systems: Becoming a relationship-centered patient-centered medical home. (United States)

    Flieger, Signe Peterson

    This study explores the implementation experience of nine primary care practices becoming patient-centered medical homes (PCMH) as part of the New Hampshire Citizens Health Initiative Multi-Stakeholder Medical Home Pilot. The purpose of this study is to apply complex adaptive systems theory and relationship-centered organizations theory to explore how nine diverse primary care practices in New Hampshire implemented the PCMH model and to offer insights for how primary care practices can move from a structural PCMH to a relationship-centered PCMH. Eighty-three interviews were conducted with administrative and clinical staff at the nine pilot practices, payers, and conveners of the pilot between November and December 2011. The interviews were transcribed, coded, and analyzed using both a priori and emergent themes. Although there is value in the structural components of the PCMH (e.g., disease registries), these structures are not enough. Becoming a relationship-centered PCMH requires attention to reflection, sensemaking, learning, and collaboration. This can be facilitated by settings aside time for communication and relationship building through structured meetings about PCMH components as well as the implementation process itself. Moreover, team-based care offers a robust opportunity to move beyond the structures to focus on relationships and collaboration. (a) Recognize that PCMH implementation is not a linear process. (b) Implementing the PCMH from a structural perspective is not enough. Although the National Committee for Quality Assurance or other guidelines can offer guidance on the structural components of PCMH implementation, this should serve only as a starting point. (c) During implementation, set aside structured time for reflection and sensemaking. (d) Use team-based care as a cornerstone of transformation. Reflect on team structures and also interactions of the team members. Taking the time to reflect will facilitate greater sensemaking and learning and

  6. Scientific Research Program for Power, Energy, and Thermal Technologies. Task Order 0001: Power, Thermal and Control Technologies and Processes Experimental Research (United States)


    a variable-speed screw compressor (Fairchild Controls Corporation) controlled by a Yaskawa A-1000 motor drive. Screw compressors are appropriate...public release; distribution unlimited. See additional restrictions described on inside pages STINFO COPY AIR FORCE...RESEARCH LABORATORY AEROSPACE SYSTEMS DIRECTORATE WRIGHT-PATTERSON AIR FORCE BASE, OH 45433-7541 AIR FORCE MATERIEL COMMAND UNITED STATES AIR FORCE

  7. Programmed Control of Optical Grating Scales for Visual Research. (United States)


    A -AOO .9 AIR FORCE INST OF TECH WRIGHT-PATTERSON AFB OH SCHOO--ETC F/6 14/2 PROGRAMMED CONTROL OF OPTI CAL GRATING SCALES FOR VISUAL RESEARC --ETC(fl...custom system for AMRL. The cost in memory parts alone was $40,000, a good indication that the market is not over-priced. Ca-? western Reserve

  8. Jet Fuel Exacerbated Noise-Induced Hearing Loss: Focus on Prediction of Central Auditory Processing Dysfunction (United States)


    standard deviation). 4.3.3 Lipid Class Determination for Partition Coefficient Prediction. Research was conducted on methods to quantify...Advancement of Military Medicine Aeromedical Research Department United States Air Force School of Aerospace Medicine Wright-Patterson AFB OH...Report for Oct 2015 to Mar 2017 Air Force Research Laboratory 711th Human Performance Wing Airman Systems Directorate Bioeffects Division

  9. Electrically Reconfigurable Liquid Crystalline Mirrors (Postprint) (United States)


    focus on dynamic reconfiguration of the reflection band gap of polymer-stabilized cholesteric liquid crystals (PSCLCs). Recent research has reported the...public release: distribution unlimited. © 2018 AMERICAN CHEMICAL SOCIETY (STINFO COPY) AIR FORCE RESEARCH LABORATORY MATERIALS AND MANUFACTURING...MONITORING AGENCY ACRONYM(S) Air Force Research Laboratory Materials and Manufacturing Directorate Wright-Patterson Air Force Base, OH

  10. The Holiversity. A Perspective on the Wright Report. (United States)

    Adelman, Howard

    After a decade of almost unlimited funds, the universities in Ontario are faced not only with declining enrollments but with an attack on their very function and role. The Wright Report, the final version of the Report of the Commission on Post-Secondary Education in Ontario, appeared early in 1973. It has engendered major controversy, and its…

  11. Lessons learned: mobile device encryption in the academic medical center. (United States)

    Kusche, Kristopher P


    The academic medical center is faced with the unique challenge of meeting the multi-faceted needs of both a modern healthcare organization and an academic institution, The need for security to protect patient information must be balanced by the academic freedoms expected in the college setting. The Albany Medical Center, consisting of the Albany Medical College and the Albany Medical Center Hospital, was challenged with implementing a solution that would preserve the availability, integrity and confidentiality of business, patient and research data stored on mobile devices. To solve this problem, Albany Medical Center implemented a mobile encryption suite across the enterprise. Such an implementation comes with complexities, from performance across multiple generations of computers and operating systems, to diversity of application use mode and end user adoption, all of which requires thoughtful policy and standards creation, understanding of regulations, and a willingness and ability to work through such diverse needs.

  12. Characteristics of medical teachers using student-centered teaching methods. (United States)

    Kim, Kyong-Jee; Hwang, Jee-Young


    This study investigated characteristics of medical teachers who have adopted student-centered teaching methods into their teaching. A 24-item questionnaire consisted of respondent backgrounds, his or her use of student-centered teaching methods, and awareness of the school's educational objectives and curricular principles was administered of faculty members at a private medical school in Korea. Descriptive statistics and chi-square analysis were conducted to compare faculty use of student-centered approaches across different backgrounds and awareness of curricular principles. Overall response rate was 70% (N=140/200), approximately 25% (n=34) of whom were using student-centered teaching methods. Distributions in the faculty use of student-centered teaching methods were significantly higher among basic sciences faculty (versus clinical sciences faculty), with teaching experiences of over 10 years (versus less than 10 years), and who were aware of the school's educational objectives and curricular principles. Our study indicates differences in medical faculty's practice of student-centered teaching across disciplines, teaching experiences, and their understanding of the school's educational objectives curricular principles. These findings have implications for faculty development and institutional support to better promote faculty use of student-centered teaching approaches.

  13. Measuring the efficiency of dental departments in medical centers: a nonparametric analysis approach. (United States)

    Wang, Su-Chen; Tsai, Chi-Cheng; Huang, Shun-Te; Hong, Yu-Jue


    Data envelopment analysis (DEA), a cross-sectional study design based on secondary data analysis, was used to evaluate the relative operational efficiency of 16 dental departments in medical centers in Taiwan in 1999. The results indicated that 68.7% of all dental departments in medical centers had poor performance in terms of overall efficiency and scale efficiency. All relatively efficient dental departments were in private medical centers. Half of these dental departments were unable to fully utilize available medical resources. 75.0% of public medical centers did not take full advantage of medical resources at their disposal. In the returns to scale, 56.3% of dental departments in medical centers exhibited increasing returns to scale, due to the insufficient scale influencing overall hospital operational efficiency. Public medical centers accounted for 77.8% of the institutions affected. The scale of dental departments in private medical centers was more appropriate than those in public medical centers. In the sensitivity analysis, the numbers of residents, interns, and published papers were used to assess teaching and research. Greater emphasis on teaching and research in medical centers has a large effect on the relative inefficiency of hospital operation. Dental departments in private medical centers had a higher mean overall efficiency score than those in public medical centers, and the overall efficiency of dental departments in non-university hospitals was greater than those in university hospitals. There was no information to evaluate the long-term efficiency of each dental department in all hospitals. A different combination of input and output variables, using common multipliers for efficiency value measurements in DEA, may help establish different pioneering dental departments in hospitals.

  14. Opportunity for Collaboration Between Radiation Injury Treatment Network Centers and Medical Toxicology Specialists. (United States)

    Davlantes, Elizabeth; Shartar, Samuel; Venero, Jennifer; Steck, Alaina; Langston, Amelia; Kazzi, Ziad N


    The Radiation Injury Treatment Network (RITN) comprises >50 centers across the United States that are poised to care for victims of a radiation emergency. The network is organized around bone marrow transplant centers because these facilities excel in both radiation medicine and the care of patients with severe bone marrow depression. A radiation emergency may cause not only irradiation from an external source but also internal contamination with radioactive material. Because medical toxicologists are trained in radiation injury management and have expertise in the management of internal contamination, RITN centers may benefit from partnerships with medical toxicology resources, which may be located at academic medical centers, hospital inpatient clinical services, outpatient clinics, or poison control centers. We determined the locations of existing RITN centers and assessed their proximity to various medical toxicology resources, including medical toxicology fellowship programs, inpatient toxicology services, outpatient toxicology clinics, and poison control centers. Data were derived from publicly available Internet sources in March 2015. The majority of RITN centers do not have a medical toxicology fellowship, an inpatient toxicology service, or an outpatient toxicology clinic within the same institution. Fifty-seven percent of RITN centers have at least one of these resources located in the same city, however, and 73% of centers have at least one of these resources or a poison control center within the same city. Ninety-five percent of RITN centers have at least one medical toxicology resource within the state. Most RITN centers are located in the same city as at least one medical toxicology resource. Establishing relationships between RITN centers and medical toxicologists needs to be explored further.

  15. Engineered Surfaces to Control Secondary Electron Yield for Multipactor Suppression (United States)


    Air Force Institute of Technology AFIT Scholar Theses and Dissertations 9-14-2017 Engineered Surfaces to Control Secondary Electron Yield for...Multipactor Suppression James M. Sattler Follow this and additional works at: Part of the Electrical and Electronics Commons... TECHNOLOGY Wright-Patterson Air Force Base, Ohio DISTRIBUTION STATEMENT A. APPROVED FOR PUBLIC RELEASE; DISTRIBUTION UNLIMITED

  16. Cholesteric Liquid Crystal Glass Platinum Acetylides (United States)


    M. Krein AFRL/RXAP Ronald F. Ziolo, Eduardo Arias, and Ivana Moggio 2Centro de Investigacion en Quimica Aplicada(CIQA) Albert Fratini... Quimica Aplicada(CIQA), Boulevard Enrique Reyna Albert Fratini - Department of Chemistry, University of Dayton Yuriy Garbovskiy and Anatoliy...Force Research Laboratory Materials and Manufacturing Directorate Wright-Patterson Air Force Base, OH 45433-7750 Centro de Investigacion en Quimica

  17. Air Force Officer Qualifying Test Form T: Initial Item-, Test-, Factor-, and Composite-Level Analyses (United States)


    used to qualify applicants for ROTC and OTS officer commissioning programs. The Pilot, Combat Systems Officer (CSO), and Air Battle Manager ( ABM ...AIR FORCE RESEARCH LABORATORY 711 HUMAN PERFORMANCE WING, AIRMAN SYSTEMS DIRECTORATE, WRIGHT-PATTERSON AIR FORCE BASE, OH 45433 AIR FORCE MATERIEL...Warfighter Interface Division Airman Systems Directorate This report is published in the interest of scientific and technical information exchange, and

  18. Comprehensive Clinical Phenotyping & Genetic Mapping for the Discovery of Autism Susceptibility Genes (United States)


    teaching students with autism spectrum disorders 4.52 Learn strategies for incorporating IEP goals and district standard into daily teaching...W403 Columbus, OH 43205 Final Report Comprehensive Clinical Phenotyping & Genetic Mapping for the Discovery of Autism Susceptibility Genes...QFOXGHDUHDFRGH 1.0 Summary In 2006, the Central Ohio Registry for Autism (CORA) was initiated as a collaboration between Wright-Patterson Air

  19. Assisting Defense Conversion Technology Transfer Efforts. A Case Study of Ohio’s Miami Valley. (United States)


    Contracting Division, Wright-Patterson AFB OH. Official Letter Correspondence. 24 January 1994. Bryman , Alan. Research Methods and Organization Studies...Washington DC: 22 February 1993. Cooper, Donald R. and C. William Emory. Business Research Methods (Tifth Edition). Chicago: Richard D. Irwin, was collected to address the research objective through a case study methodology. First, it describes and justifies the specific method used

  20. Application Development for Optimizing Patient Placement on Aeromedical Evacuation Flights: Proof-of-Concept (United States)


    PROGRAM ELEMENT NUMBER 6. AUTHOR(S) Brittany Fouts, Jennifer Serres, Ray Hill, Frank Ciarallo 5d. PROJECT NUMBER 5e. TASK NUMBER 5f...APPENDIX A – Flowchart for Graphical Prototype ...................................................................... 9 APPENDIX B – Proof-of-Concept App...would like to thank the programming team at the Department of Operational Analysis at the Air Force Institute of Technology at Wright-Patterson Air

  1. Academic medical center libraries on the Web. (United States)

    Tannery, N H; Wessel, C B


    Academic medical center libraries are moving towards publishing electronically, utilizing networked technologies, and creating digital libraries. The catalyst for this movement has been the Web. An analysis of academic medical center library Web pages was undertaken to assess the information created and communicated in early 1997. A summary of present uses and suggestions for future applications is provided. A method for evaluating and describing the content of library Web sites was designed. The evaluation included categorizing basic information such as description and access to library services, access to commercial databases, and use of interactive forms. The main goal of the evaluation was to assess original resources produced by these libraries.

  2. "Ingraham v. Wright" and the Decline of Due Process. (United States)

    Clark, Gerard J.


    Suggests that the constitutional questions in "Ingraham vs Wright" lend credence to a concern that the Court is seeking to eliminate all due process intervention outside of the incorporation and privacy cases and to limit even these cases to defenses of a criminal prosecution. Available from Suffolk University Law Review Office, 41…

  3. St. Luke's Medical Center: technologizing health care

    International Nuclear Information System (INIS)

    Tumanguil, S.S.


    The computerization of the St. Luke's Medical Center improved the hospital administration and management, particularly in nuclear medicine department. The use of computer-aided X-ray simulator machine and computerized linear accelerator machine in diagnosing and treating cancer are the most recent medical technological breakthroughs that benefited thousands of Filipino cancer patients. 4 photos

  4. Religious Literacy or Spiritual Awareness? Comparative Critique of Andrew Wright's and David Hay's Approaches to Spiritual Education (United States)

    Filipsone, Anta


    On the basis of a comparison of the educational approaches of Andrew Wright and David Hay this paper illustrates the persisting problem of dichotomising cognitive and trans-cognitive aspects of spiritual development and education. Even though both Wright and Hay speak of the same topic--spirituality and spiritual education--they define these terms…

  5. Lessons from cognitive neuropsychology for cognitive science: a reply to Patterson and Plaut (2009). (United States)

    Coltheart, Max


    A recent article in this journal (Patterson & Plaut, 2009) argued that cognitive neuropsychology has told us very little over the past 30 or 40 years about "how the brain accomplishes its cognitive business." This may well be true, but it is not important, because the principal aim of cognitive neuropsychology is not to learn about the brain. Its principal aim is instead to learn about the mind, that is, to elucidate the functional architecture of cognition. I show that this is so (a) via extensive quotations from leading figures in this field and (b) by analysis of the subject matter of articles in the leading journal in the field, Cognitive Neuropsychology. Recent reviews of the past 25 years of work in this field (Coltheart & Caramazza, 2006) have concluded that cognitive neuropsychology has told us much about the functional architecture of cognition in a variety of cognitive domains. Patterson and Plaut (2009) did not consider this aim of cognitive neuropsychology. Therefore, their conclusions that cognitive neuropsychology has not been successful, and that this is because the particular methods it uses are flawed, are not justified. Copyright © 2009 Cognitive Science Society, Inc.

  6. Patient Workload Profile: National Naval Medical Center (NNMC), Bethesda, MD. (United States)


    AD-A09a 729 WESTEC SERVICES NC SAN DIEGOCA0S / PATIENT WORKLOAD PROFILE: NATIONAL NAVAL MEDICAL CENTER NNMC),- ETC(U) JUN 80 W T RASMUSSEN, H W...provides site workload data for the National Naval Medical Center (NNMC) within the following functional support areas: Patient Appointment...on managing medical and patient data, thereby offering the health care provider and administrator more powerful capabilities in dealing with and

  7. Defining the medical imaging requirements for a rural health center

    CERN Document Server


    This book establishes the criteria for the type of medical imaging services that should be made available to rural health centers, providing professional rural hospital managers with information that makes their work more effective and efficient. It also offers valuable insights into government, non-governmental and religious organizations involved in the planning, establishment and operation of medical facilities in rural areas. Rural health centers are established to prevent patients from being forced to travel to distant urban medical facilities. To manage patients properly, rural health centers should be part of regional and more complete systems of medical health care installations in the country on the basis of a referral and counter-referral program, and thus, they should have the infrastructure needed to transport patients to urban hospitals when they need more complex health care. The coordination of all the activities is only possible if rural health centers are led by strong and dedicated managers....

  8. Assessing the Academic Medical Center as a Supportive Learning Community (United States)

    Gannon, Sam C.


    Academic medical centers are well-known for their emphasis on teaching, research and public service; however, like most large, bureaucratic organizations, they oftentimes suffer from an inability to learn as an organization. The role of the research administrator in the academic medical center has grown over time as the profession itself has…


    Bornstein, Jacob


    The Galilee Medical Center (GMC) is unique in several aspects. Firstly, in the clinical aspect: In recent years, led by the Director of Medical Center, Dr. Masad Barhoum, a considerable momentum of development has taken place to reduce health discrepancies between the center and the periphery. Despite the under- financing of the health system in the Galilee, the GMC opened new clinical departments, introduced advanced medical technology and key staff members were added. This approach is depicted in publications presented in the current issue. Secondly, the aspect of medicine standoff: The GMC is the nearest hospital to the border with neighboring countries. It is also a tertiary center for trauma, due to the establishment of the Department of Neurosurgery, Department of Oral and Maxillofacial Surgery and the Departments of Orthopedic Surgery, general invasive radiology and invasive radiology of the brain. In recent years, the medical center treated hundreds of victims of the civil war in Syria, a third of them - women and children. The injured patients presented unique medical problems that are described in the papers in this issue. Thirdly, the research aspect: The medical center is the main teaching facility of medical students of the Faculty of Medicine in the Galilee of Bar-Ilan University. The Faculty of Medicine, led by the Dean, Prof. Ran Tur-Kaspa, promotes research and teaching in the medical center. Even before the establishment of the Faculty of Medicine, former hospital director, Prof. Shaul Shasha, not only extolled the importance of research, but established a research laboratory years ago. The laboratory continues to pursue translational research by the physicians of the medical center, led by Dr. Shifra Sela and Prof. Batya Kristal, and supported by the current medical center director, Dr. Masad Barhoum. Several studies conducted in this research laboratory are published herewith. With these unique aspects and despite the discrimination in funding

  10. De-Dopplerization of Acoustic Measurements (United States)


    accurate measurement of aircraft location to resample the time signal to account for the compression and expansion of acoustic wavefronts. Correcting...AFRL-RH-WP-TR-2017-0043 DE-DOPPLERIZATION OF ACOUSTIC MEASUREMENTS Frank Mobley, PhD 711 HPW/RHCB Wright-Patterson AFB OH...TITLE AND SUBTITLE DE-DOPPLERIZATION OF ACOUSTIC MEASUREMENTS 5a. CONTRACT NUMBER In-House 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER

  11. Pressure Scalings and Influence Region Research (United States)



  12. Respiratory Highlights, 2016 - 2017 Influenza Season (2 October 2016 - 31 September 2017) (United States)


    Medicine Public Health and Preventive Medicine Dept/PHR 2510 Fifth St., Bldg. 840 Wright-Patterson AFB, OH 45433-7913 8. PERFORMING ORGANIZATION...Surveillance Program Cleared, 88PA, Case # 2018-1051, 5 Mar 2018. 1 USAF School of Aerospace Medicine & Defense Health Agency...influenza from an infected child with a history of swine contact at an agricultural event in Texas. The HA gene from select influenza positives was

  13. Examining U.S. Irregular Warfare Doctrine (United States)


    Muslim leaders, this manual also provides inspiration to the Al-Qaeda undercover member. These are especially useful in convincing the young...A “Air Power: An Enduring Illusion,” The Economist (24 August 2006). Accessed via: AFIT/ILM/ENS/08-04 DEPARTMENT OF THE AIR FORCE AIR UNIVERSITY AIR FORCE INSTITUTE OF TECHNOLOGY Wright-Patterson

  14. Design and Characterization of a Secure Automatic Dependent Surveillance-Broadcast Prototype (United States)


    M-041 DEPARTMENT OF THE AIR FORCE AIR UNIVERSITY AIR FORCE INSTITUTE OF TECHNOLOGY Wright-Patterson Air Force Base, Ohio DISTRIBUTION STATEMENT A...of Engineering and Management Air Force Institute of Technology Air University Air Education and Training Command in Partial Fulfillment of the...Cyclic Redundancy Check CSV comma separated value CUT component under test DDC digital down conversion DF Downlink Format DUC digital up conversion

  15. Training Affects Variability in Training Performance both Within and Across Jobs (United States)


    was measured by a verbal/ math composite derived from the US military enlistment test, the Armed Services Vocational Aptitude Battery. Training...performance was assessed by written tests of job-related knowledge content. Predictive validity of the verbal/ math composite ranged from .124 to .836...146, Room 122 Wright-Patterson AFB, OH 45433-7511 Malcolm James Ree Department of Leadership Studies School of Business and Leadership Our

  16. A Study of Facilities and Infrastructure Planning, Prioritization, and Assessment at Federal Security Laboratories (United States)


    Support Agency Air Force Real Property Agency Wright-Patterson Air Force Base (AFB), OH; Kirtland AFB, New Mexico ; Eglin AFB, Florida; Edwards...with the State of New Mexico Finance Authority to finance the development of a new facility. Laboratories communicated frequently with State and...modernization requirement based on Replacement Plant Value, depreciation , expected service life, and residual value at the end of the expected service life

  17. Molecular Verification of Cryptops hortensis (Scolopendromorpha: Cryptopidae) in theNearctic Region (United States)


    Journal Article 3. DATES COVERED (From – To) March – April 2016 4. TITLE AND SUBTITLE Molecular Verification of Cryptops hortensis...PROJECT NUMBER 5e. TASK NUMBER 5f. WORK UNIT NUMBER 7. PERFORMING ORGANIZATION NAME(S) AND ADDRESS(ES) USAF School of Aerospace Medicine ...Public Health and Preventive Medicine Dept/PHR 2510 Fifth St., Bldg. 840 Wright-Patterson AFB, OH 45433-7913 8. PERFORMING ORGANIZATION REPORT

  18. A Study of Cumulative Trauma Disorders of the Upper Extremities and Occupation in Wright-Patterson Adir Force Base Civilian Personnel. (United States)


    Workers: Individual, Ergonomie and Work Organizational Factors," Ergonomics, 38: 763- 776 (April 1995). Brogmus, G.E. and R. Marko. "The...Naval Health Research Center, San Diego CA, June 1988 (AD-A199920). Keyserling, W. M. and others. "A Checklist For Evaluating Ergonomie Risk Factors

  19. Women's Center Volunteer Intern Program: Building Community While Advancing Social and Gender Justice (United States)

    Murray, Margaret A.; Vlasnik, Amber L.


    This program description explores the purpose, structure, activities, and outcomes of the volunteer intern program at the Wright State University Women's Center. Designed to create meaningful, hands-on learning experiences for students and to advance the center's mission, the volunteer intern program builds community while advancing social and…

  20. Patient-centered medical home model: do school-based health centers fit the model? (United States)

    Larson, Satu A; Chapman, Susan A


    School-based health centers (SBHCs) are an important component of health care reform. The SBHC model of care offers accessible, continuous, comprehensive, family-centered, coordinated, and compassionate care to infants, children, and adolescents. These same elements comprise the patient-centered medical home (PCMH) model of care being promoted by the Affordable Care Act with the hope of lowering health care costs by rewarding clinicians for primary care services. PCMH survey tools have been developed to help payers determine whether a clinician/site serves as a PCMH. Our concern is that current survey tools will be unable to capture how a SBHC may provide a medical home and therefore be denied needed funding. This article describes how SBHCs might meet the requirements of one PCMH tool. SBHC stakeholders need to advocate for the creation or modification of existing survey tools that allow the unique characteristics of SBHCs to qualify as PCMHs.

  1. [Patient-centered care. Improvement of communication between university medical centers and general practitioners for patients in neuro-oncology]. (United States)

    Renovanz, M; Keric, N; Richter, C; Gutenberg, A; Giese, A


    Communication between university medical centers and general practitioners (GP) is becoming increasingly more important in supportive patient care. A survey among GPs was performed with the primary objective to assess their opinion on current workflow and communication between GPs and the university medical center. The GPs were asked to score (grades 1-6) their opinion on the current interdisciplinary workflow in the care of patients with brain tumors, thereby rating communication between a university medical center in general and the neuro-oncology outpatient center in particular. Questionnaires were sent to1000 GPs and the response rate was 15 %. The mean scored evaluation of the university medical center in general was 2.62 and of the neuro-oncological outpatient clinic 2.28 (range 1-6). The most often mentioned issues to be improved were easier/early telephone information (44 %) and a constantly available contact person (49 %). Interestingly, > 60 % of the GPs indicated they would support web-based tumor boards for interdisciplinary and palliative neuro-oncological care. As interdisciplinary care for neuro-oncology patients is an essential part of therapy, improvement of communication between GPs and university medical centers is indispensable. Integrating currently available electronic platforms under data protection aspects into neuro-oncological palliative care could be an interesting tool in order to establish healthcare networks and could find acceptance with GPs.

  2. Supply chain optimization at an academic medical center. (United States)

    Labuhn, Jonathan; Almeter, Philip; McLaughlin, Christopher; Fields, Philip; Turner, Benjamin


    A successful supply chain optimization project that leveraged technology, engineering principles, and a technician workflow redesign in the setting of a growing health system is described. With continued rises in medication costs, medication inventory management is increasingly important. Proper management of central pharmacy inventory and floor-stock inventory in automated dispensing cabinets (ADCs) can be challenging. In an effort to improve control of inventory costs in the central pharmacy of a large academic medical center, the pharmacy department implemented a supply chain optimization project in collaboration with the medical center's inhouse team of experts on process improvement and industrial engineering. The project had 2 main components: (1) upgrading and reconfiguring carousel technology within an expanded central pharmacy footprint to generate accurate floor-stock inventory replenishment reports, which resulted in efficiencies within the medication-use system, and (2) implementing a technician workflow redesign and algorithm to right-size the ADC inventory, which decreased inventory stockouts (i.e., incidents of depletion of medication stock) and improved ADC user satisfaction. Through a multifaceted approach to inventory management, the number of stockouts per month was decreased and ADC inventory was optimized, resulting in a one-time inventory cost savings of $220,500. Copyright © 2017 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

  3. Richard Wright, Toni Morrison, and United States book clubs

    Directory of Open Access Journals (Sweden)

    Mark Madigan


    Full Text Available This essay focuses on the influence of commercial book clubs in the United States. It will examine the country's oldest commercial book club, the Book-of-the-Month Club (BOMC, Oprah's Book Club (OBC, which bears the name of its founder, television personality Oprah Winfrey, and their roles in the careers of two African-American authors, Richard Wright and Toni Morrison.

  4. The wounded male persona and the mysterious feminine in the poetry of James Wright: a study in the transformation of the self. (United States)

    Graves, M; Schermer, V L


    James Wright's work is multilayered. Taken as a whole, which Annie Wright's beautiful compilation, Above the River, allows one to do, Wright's poems (as well as his masterful "prose poems") have a pattern akin to a mythic cycle. "Mythemes" (Lévi-Strauss, 1979) recur as dialectic opposites from one poem to another, whether the abandoned male and mysterious woman, humankind and nature, blindness and seeing, secrets and revelation. Suggestive and symbolic forms such as birds, horses, earth, sky, the destitute, rivers, and adolescence weave themselves throughout in inner and outer "landscapes" of images and experiential moments. There is a frequent shift of "gestalts" between the inner world and external reality. Such a "blooming, buzzing confusion" of internal and external referents might appear to be psychotic and imply a loss of "reality testing." Chassaguet-Smirgel (1988), citing Oscar Wilde's The Picture of Dorian Gray as an example, contended that the artist narrowly averts psychosis by transforming it into a work of art. Surrealists, for whom the psychoanalyst Jacques Lacan was an important figure (cf. Sarup, 1992, pp. 17-27), elevated psychosis to the status of art, and Wright has been considered to be a surrealistic poet, although he himself denied such an affiliation. Hall (Wright, 1990, Introduction, pp. xxiii-xxxvii) suggests that Wright, in addition to an extensive history of alcoholism, from which he seemed to recover towards the end of his life, suffered from a major mental illness, which included episodes of severe depression, hospitalizations, and at least one suicide attempt. The severity of the asceticism and the extreme damage to the self in some Wright's work suggests their roots in early traumatic experiences. (A terribly damaged yet heroic personage, whose disfigurement perhaps symbolizes the poet's trauma, is "Hook" [ATR, pp. 315-316], about a man who gives his last few cents to the poet with a hook replacing his amputated hand.) Not enough is

  5. The dangers of eating away from home: review | Wright | South ...

    African Journals Online (AJOL)

    The dangers of eating away from home: review. JP Wright. Full Text: EMAIL FULL TEXT EMAIL FULL TEXT · DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT · AJOL African Journals Online. HOW TO USE AJOL... for Researchers · for Librarians · for Authors · FAQ's · More about AJOL · AJOL's Partners · Terms and ...

  6. The Manned Spacecraft Center and medical technology (United States)

    Johnston, R. S.; Pool, S. L.


    A number of medically oriented research and hardware development programs in support of manned space flights have been sponsored by NASA. Blood pressure measuring systems for use in spacecraft are considered. In some cases, complete new bioinstrumentation systems were necessary to accomplish a specific physiological study. Plans for medical research during the Skylab program are discussed along with general questions regarding space-borne health service systems and details concerning the Health Services Support Control Center.

  7. Connecticut Children's Medical Center multi-year branding campaign. (United States)

    Botvin, J


    As the only children's hospital in the state, Connecticut Children's Medical Center was challenged by the inherent complacency of parents. It met the challenge through a multi-level marketing effort which included television and radio, community outreach and strong media relations. By emphasizing the unique nature of children, the campaign affirms the need for a specialized children's health center.

  8. Effects of the Ordering of Natural Selection and Population Regulation Mechanisms on Wright-Fisher Models. (United States)

    He, Zhangyi; Beaumont, Mark; Yu, Feng


    We explore the effect of different mechanisms of natural selection on the evolution of populations for one- and two-locus systems. We compare the effect of viability and fecundity selection in the context of the Wright-Fisher model with selection under the assumption of multiplicative fitness. We show that these two modes of natural selection correspond to different orderings of the processes of population regulation and natural selection in the Wright-Fisher model. We find that under the Wright-Fisher model these two different orderings can affect the distribution of trajectories of haplotype frequencies evolving with genetic recombination. However, the difference in the distribution of trajectories is only appreciable when the population is in significant linkage disequilibrium. We find that as linkage disequilibrium decays the trajectories for the two different models rapidly become indistinguishable. We discuss the significance of these findings in terms of biological examples of viability and fecundity selection, and speculate that the effect may be significant when factors such as gene migration maintain a degree of linkage disequilibrium. Copyright © 2017 He et al.

  9. An Analysis of Measures Used to Evaluate the Air Force Critical Item Program (United States)


    example of a histogram. Cause & Effect Diagram. The cause and effect diagram was introduced in 1953 by Dr. Kaoru Ishikawa in summarizing the opinions of...Personal Interview. Air Force Institute of Technology, School of Engineering, Wright-Patterson AFB OH, 24 April 1991. 31. Ishikawa , Dr. Kaoru . Guide to...collected. How the data are collected will determine which measurement techniques are appropriate. Ishikawa classifies data collection into five categories

  10. Evaluation of a Damage Accumulation Monitoring System as an Individual Aircraft Tracking Concept (United States)


    series of cinematic picture frames. The real life situation is even more complicated because the aircraft experiences intermediate loading states as...Fighter Attack Spectrum on Crack Growth, Air Force Flight Dynamics Laboratory (FBE), Wright- Patterson AFB, Ohio, 45433, AFFDL-TR-76-112, March 1977...Pennsylvania, 19874, Report Number NADC-77194-60, March 29, 1980. 209 10. G. E. Lambert and D. F. Bryan, The Influence of Fleet Variability on Crack Growth

  11. Treatability Study in Support of the Intrinsic Remediation Option at the Current Fire Training Area, Westover Air Reserves Base, Chicopee, Massachusetts (United States)


    Winter, 1987, p. 64-71. Bartha , R., 1986, Biotechnology of petroleum pollutant biodegradation: Microbial Ecology , vol. 12, p. 155-172. Bauman, B., 1991...Prepared for Air Force Systems Command, Wright-Patterson Air Force Base, Ohio, June. Atlas , R.M., 1981, Microbial degradation of petroleum hydrocarbons...of jet fuel and gasoline, including the BTEX compounds (e.g., lamison et at., 1975; Atlas , 1981, 1984, 1988; Gibson and Subramanian, 1984; Reinhard et

  12. Challenges of Enterprise Wide AM for Air Force Sustainment (United States)


    processes for AM across the Air Force enterprise. The opportunity for cost-effective readiness is important, and using a value chain approach that takes...December 2016 Naguy is chief of the Air Force Life Cycle Management Center’s Product Support Engineering Division at Wright Patterson Air Force Base in...produc- tion that can address many current Air Force supply chain challenges. It also can reduce weight through lightweight design while potentially

  13. B-1 Systems Approach to Training. Volume 3. Appendix B. Bibliography and Data Collection Trips (United States)


    the Fourth Annual Symposium on Psychology in the Air Force, 1974, ~ •—- ~ - --- - Creelman , J.A., Evaluation of Approach Training Procedures...of Engineering Psychology , American Psychologist, 1972, 27 (7), 615-622. Adams, J.A., and Hufford, I.E., Effects of Programmed Perceptual Training on...Control, Wright-Patterson Air Force Base, Ohio, April 7-9, 1970. Aldrich, T.B., Proceedings of the Annual Symposium on Psychology in the Air Force (2nd

  14. The Reliability of Clinical Measurements of Forward Bending Obtained by the Use of the Modified Fingertip-to-Floor Method (United States)


    Calabro, 1982; Macrae & Wright, 1969) and other forms of arthritis (Schober, 1937). Clinicians also use measurements of lumbar flexion to help determine...Clinical Biomechanics, 1, 20-26. Buswell, J. (1982). Low back pain: A comparison of two treatment programmes. New Zealand Journal of Physiotherapy ...Gilles, J., Haldeman, J. & Patterson, C. (1975). Low back pain: A study of 50 patients on a group exercise program. Physiotherapy Canada, 27. 71-77

  15. C-130J Breathing Resistance Study (United States)


    scientific and technical information exchange , and its publication does not constitute the Government’s approval or disapproval of its ideas or findings...regulator and MBU- 20/P oxygen mask, was supplied gaseous Aviators’ Breathing Oxygen (ABO). The regulator was operated in various operating modes, at...Generating System (OBOGS) Laboratory, Area B, Wright-Patterson AFB OH. The CRU-73 oxygen regulator was supplied with 50 pounds/square inch of gaseous

  16. The Digital Thread as the Key Enabler (United States)


    Inject pivot points into acquisition allowing for programs to change direction based upon advances in technology, changes in threat and technical management for the Air Force Materiel Command at Wright-Patterson Air Force Base in Ohio. Y ou are down in the trenches trying to...workforce requires the right training, data, physics- based tools and facilities. Owning the technical baseline is one of the five priorities of the

  17. An Assessment of the Uniform Funding Policy of DoD Directive 3200.11. (United States)


    34 Unpublished master’s thesis. GSM/SM/73-10, AFIT/EN, Wright-Patterson AFB OH 45433, 7 January 1974. Horngren , Charles T. Cost Accounting : A Management...reverse side if noceeeary aid identify by block number) Uniform Funding Policy Test Facilities Test and Evaluation Cost Accounting Accounting 20...segregated from overhead as a cost accounting device in both Government and industry. Historically, this distinc- tion has merely aided distribution of total

  18. Life-Cycle Costs of Alternative ICBM Second Stage Designs (United States)


    of Logistics, Air Force Institute of Technology (AU), Wright-Patterson AFB OH, 1992. 34. Horngren , Charles T. and George Foster. Cost Accounting ; A...Managerial Emphasis (Sixth Edition). Englewood Cliffs NJ: Prentice-Hall, Inc., 1987. 35. Horngren , Charles T. and George Foster. Cost Accounting ; A...our research. We would also like to thank those involved with the 1991 Small ICBM Operations and Support cost estimate. Your assistance with the O& S

  19. A Study of Facilities and Infrastructure Planning, Prioritization, and Assessment at Federal Security Laboratories (Revised) (United States)


    Engineer Support Agency Air Force Real Property Agency Wright-Patterson Air Force Base (AFB), OH; Kirtland AFB, New Mexico ; Eglin AFB, Florida...emergency response to their site. • Sandia works with the State of New Mexico Finance Authority to finance the development of a new facility...algorithms specific to an F&I type to generate the modernization requirement based on Replacement Plant Value, depreciation , expected service life, and

  20. A Comparison of the Usefulness of the Facilities Management Program in the Graduate School of Systems and Logistics and Similar Programs in Civilian Institutions as Perceived by Former Students (United States)


    8217 043FCCBCAAACCEGEFFEEEDGGFFEEGFFFFEGEECFFED6OGFEAFE’FIHBI 0441CC AABC ABA AA AA AA A AFEEAA AA AA A A AOF A A A AAG AA A A AAA FHAL’ 045 F C FAA A CAGOGGOA FF00 FOB El’C...thesis. SLSR 13-69, A"FT/SL, Wright-Patterson AFE Ofil, August, 1968. AD 846434. Hale, Captain Jerry W., and Captain Basil E. Rooney. "A Deter

  1. Formation of the U.S. Air Force Aviator Post Traumatic Stress Disorder Study Group (United States)


    Wood, III, John Heaton, Mark Hubner, Nicole Rhodes 5d. PROJECT NUMBER 5e. TASK NUMBER 5f. WORK UNIT NUMBER 7. PERFORMING ORGANIZATION... Questionnaire -9 PIQ performance intelligence quotient PTSD post-traumatic stress disorder RPA remotely piloted aircraft USAF U.S. Air Force VIQ verbal intelligence quotient ...Human Performance Wing U.S. Air Force School of Aerospace Medicine Aerospace Medicine Department 2510 Fifth St., Bldg. 840 Wright-Patterson AFB, OH

  2. Theories that narrate the world: Ronald A. Fisher's mass selection and Sewall Wright's shifting balance. (United States)

    Rosales, Alirio


    Theories are composed of multiple interacting components. I argue that some theories have narratives as essential components, and that narratives function as integrative devices of the mathematical components of theories. Narratives represent complex processes unfolding in time as a sequence of stages, and hold the mathematical elements together as pieces in the investigation of a given process. I present two case studies from population genetics: R. A. Fisher's "mas selection" theory, and Sewall Wright's shifting balance theory. I apply my analysis to an early episode of the "R. A. Fisher - Sewall Wright controversy." Copyright © 2017 Elsevier Ltd. All rights reserved.

  3. Patient-Centered Tools for Medication Information Search. (United States)

    Wilcox, Lauren; Feiner, Steven; Elhadad, Noémie; Vawdrey, David; Tran, Tran H


    Recent research focused on online health information seeking highlights a heavy reliance on general-purpose search engines. However, current general-purpose search interfaces do not necessarily provide adequate support for non-experts in identifying suitable sources of health information. Popular search engines have recently introduced search tools in their user interfaces for a range of topics. In this work, we explore how such tools can support non-expert, patient-centered health information search. Scoping the current work to medication-related search, we report on findings from a formative study focused on the design of patient-centered, medication-information search tools. Our study included qualitative interviews with patients, family members, and domain experts, as well as observations of their use of Remedy, a technology probe embodying a set of search tools. Post-operative cardiothoracic surgery patients and their visiting family members used the tools to find information about their hospital medications and were interviewed before and after their use. Domain experts conducted similar search tasks and provided qualitative feedback on their preferences and recommendations for designing these tools. Findings from our study suggest the importance of four valuation principles underlying our tools: credibility, readability, consumer perspective, and topical relevance.

  4. Survey Analysis of Military Parishes: The Wright-Patterson AFB Catholic Parish Example. (United States)


    had scores which varied from mass to mass--sense of prayerfulness, singing, sense of community, and performance of guitar group--shown in Table 14. 17...significance is that the 1980 ratings were better than the 1978 ratings for all liturgy planning areas. An overall average liturgy planning score was...calculated for each indi- vidual who rated any of the topics. Those scores indicate generally positive perceptions of the liturgies. Eighty-six

  5. Wright Science Colloquium 2004

    CERN Document Server


    "Stem cells and regenerative medicine. Living a longer life?" For the first time in history, human beings are in a position to modify their own biological fate. This is due to the past 20 years of basic research in life sciences, which have led to discoveries of great impact, not only on our scientific knowledge, but also on a variety of domains outside science itself. Our society is disconcerted by this biological revolution and the underlying instrumentalisation of human beings. Therefore, it is the right time to think about these extraordinary developments, to know where we stand and to try to imagine the future, in order to foresee both the benefits and the dangers of what will unavoidably occur. From 15 to 19 November, the XIth edition of the Colloquia Wright that are held every two years in Geneva with the aim of presenting the latest scientific findings to the general public, will deal with this new and difficult question for the society. Five world-famous scientists will present lectures every da...

  6. Wright Science Colloquium 2004

    CERN Multimedia


    "Stem cells and regenerative medicine. Living a longer life?" For the first time in history, human beings are in a position to modify their own biological fate. This is due to the past 20 years of basic research in life sciences, which have led to discoveries of great impact, not only on our scientific knowledge, but also on a variety of domains outside science itself. Our society is disconcerted by this biological revolution and the underlying instrumentalisation of human beings. Therefore, it is the right time to think about these extraordinary developments, to know where we stand and to try to imagine the future, in order to foresee both the benefits and the dangers of what will unavoidably occur. From 15 to 19 November, the XIth edition of the Colloquia Wright that are held every two years in Geneva with the aim of presenting the latest scientific findings to the general public, will deal with this new and difficult question for the society. Five world-famous scientists will present lectures every...

  7. Addition of Olfactory Stimuli to Virtual Reality Simulations for Medical Training Applications (United States)


    81 Newman, R.I., Hunt, D.L. and Rhodes, F. (1966) Effect of music on employee attitude and productivity in a skateboard factory. Journal of a skateboard factory. Journal of Applied Psychology, g0, 493-496. Patterson, R. (1994) Cyberspace surgery. Canadian Medical Association Journal, 1M

  8. Digital Documentation of Frank Lloyd Wright's Masterpiece, Fallingwater (United States)

    Jerome, P.; Emilio, D.


    Since 1988, the professional staff of Architectural Preservation Studio (APS) has been involved with the conservation of Frank Lloyd Wright's Fallingwater in Mill Run, PA. Designed and erected from 1935 to 1939 as a weekend home for the Kauffman family, the complex consists of the main house and guest house. After five years of reports and prototype repairs, we produced a two-volume master plan. Using original Frank Lloyd Wright drawings from Avery Library as background drawings, we measured every surface and reproduced the drawings in CAD, also developing elevations of every room. Stone-by-stone drawings of every flagstone floor and terrace scheduled to be lifted were also created using overlapping film photography that was assembled into a photo mosaic. By 2005, we designed, administered and completed a four-phase exterior restoration, with the paint-stripping and repainting of interior rooms being performed during the brief winter period when the building is closed to the public on an ongoing basis. In 2016, we were invited back to the site to review conditions and advise on routine maintenance. At that time we proposed to re-document the buildings, this time using laser-scanning. Laser-scanning of the exterior was performed in May of 2016, and of the interior in March 2017, each over the course of four days. This paper will make a comparison between manual and digital techniques in terms of Fallingwater's documentation.

  9. Military Construction: Renovation Plans at the Portsmouth Naval Medical Center

    National Research Council Canada - National Science Library


    The Portsmouth Naval Medical Center is a teaching hospital that provides comprehensive health care services to active duty forces and, when space is available, provides medical services to other DOD beneficiaries (i.e...

  10. Effect of Ethylene Inhibitors on Quality Attributes of Apricot cv. Modesto and Patterson during Storage Efecto de los Inhibidores de Etileno sobre Atributos de Calidad de Damascos, Variedades Modesto y Patterson durante Almacenamiento

    Directory of Open Access Journals (Sweden)

    Héctor Valdés


    Full Text Available Apricot (Prunus armeniaca L. fruit are highly susceptible to flesh softening, loss of flavor and fruit decay, particularly during postharvest storage. Most of these quality changes observed during fruit ripening are under ethylene regulation. We performed a study with the objective of determining the effect of 1-methylcyclopropene (1-MCP and aminoethoxyvinylglycine (AVG applications on quality attributes of Modesto and Patterson apricot cultivars. 1-MCP was applied at a rate of 1000 and 10 000 nL L-1 of SmartFresh™, and AVG at a rate 100 and 1000 mg L-1 of Retain®. Quality evaluations were performed after 20 and 30 days of cold storage and after a shelf-life period of 3-4 days at 20 °C. In general, both ethylene inhibitors were effective in reducing the ethylene production rate, especially in Patterson. Fruit softening and color development showed ethylene-dependent behavior, with significant reductions for both varieties in fruit treated with 1-MCP and AVG. On the other hand, soluble solids concentration and titratable acidity showed an ethylene-independent pattern, i.e. they were not affected by ethylene inhibitors applications. Among volatile compounds identified, esters and aldehydes showed ethylene-dependent behavior in both varieties. On the other hand, alcohols and terpenes were not affected by ethylene inhibition, suggesting ethylene-independent behavior.El damasco (Prunus armeniaca L. es muy susceptible al ablandamiento de la pulpa, pérdida de sabor y pudriciones, especialmente durante postcosecha. Muchos de estos cambios que ocurren durante maduración son regulados por etileno. El objetivo del presente trabajo fue determinar el cambio de la calidad de damascos var. Modesto y Patterson tratados con 1-metilciclopropeno (1-MCP y aminoetoxivinilglicina (AVG. Las dosis utilizadas fueron de 1000 y 10 000 nL L-1 de 1-MCP (SmartFresh™, 100 y 1000 mg L-1 de AVG (Retain® 15% p/p y su respectivo testigo. Las evaluaciones se realizaron

  11. Multisensory Integration for Pilot Spatial Orientation (United States)


    1993-0022). Wright-Patterson AFB, OH: Air Force Armstrong Laboratories. Gilson, R.D., Ventola, R.W., & Fenton , R.E. (1975). A kinesthetic...Ventola, R.W., & Fenton , R.E. (1975). A kinesthetic-tactual display for stall deterrence. In Eleventh Annual Conference on Manual Control (NASA TM...M., L) 2 = Impact (H, M, L) 3 = Persistence/Difficulty to work-around (H, M., L) 4 = Overall Severity: 1=Severe, 2=Major, 3=Minor, 4= Cosmetic

  12. Damage Tolerant Repair Techniques for Pressurized Aircraft Fuselages (United States)


    RepoW Techniques for Prwurized Aircraft AXWdOg 4.9 Summary and Conclusions The basics of adhesive bonded repairs for aluminum aircraft fuselages have... of cruise altitude and bending stresses in the plate at the tip of one-sided reinforcements (chapter 5). The expanded Rose model was transformed into a...DEPARTMEN1 OF THE AIR FORCE AGENCY REPORT NUMBER AFIT/CI 2950 P STREET WRIGHT-PATTERSON AFB OH 45433-7765 11. SUPPLEMENTARY NOTES Usa. DISTRUISUIOII

  13. KC-46A Tanker Modernization (KC-46A) (United States)


    Program Startup Workshop with the assistance from Defense Acquisition University at Wright-Patterson Air Force Base, Ohio. July 8 - 10, 2013: The KC-46A...Selected Acquisition Report (SAR) RCS: DD-A&T(Q&A)823-387 KC-46A Tanker Modernization (KC-46A) As of FY 2017 President’s Budget Defense Acquisition ...Deliveries and Expenditures 48 Operating and Support Cost 49 Common Acronyms and Abbreviations for MDAP Programs Acq O&M - Acquisition

  14. A Wind Tunnel Investigation of Joined Wing Scissor Morphing (United States)


    would use the low sweep for carrier landing and subsonic cruise, and use the high sweep for 12 supersonic flight [13]. According to Raymer [19...Wright-Patterson AFB, Ohio: Air Force Institute of Technology, 2005. 12. Katz, Joseph, Shaun Byrne, and Robert Hahl. "Stall Resistance Features of...Lifting-Body Airplane Configurations." Journal of Aircraft 2nd ser. 36 (1999): 471-474. 13. Kress, Robert W. "Variable Sweep Wing Design." AIAA 83

  15. Airplane crash

    International Nuclear Information System (INIS)

    Brunner, P.


    In May, 1974, a severe airplane crash occurred near Springfield, llinois; the crew of three and a courier were killed. The plane was carrying a large container of controlled water with a slight amount of 60 Co. A survey of the crash site by Air Force detectives and the radiological assistance team from Wright--Patterson Air Force Base indicated no radioactivity. Experiences of the incident were used to develop guidelines for future emergency preparedness

  16. Fatigue Crack Growth and Fracture Behavior of As-Cast Ti-43.5Al-4Nb-1Mo-0.1B (TNM) Compared to Ti-48Al-2Nb-2Cr (4822) (Postprint) (United States)


    unlimited. © ELSEVIER LTD (STINFO COPY) AIR FORCE RESEARCH LABORATORY MATERIALS AND MANUFACTURING DIRECTORATE WRIGHT-PATTERSON AIR FORCE BASE, OH...published in Intermetallics, Vol. 91, 17 Sep 2017. © 2017 Elsevier Ltd. The U.S. Government is joint author of the work and has the right to use, modify...M.S. Dahar). Intermetallics 91 (2017) 158–168 Available online 17 September 2017 0966-9795/ © 2017 Elsevier Ltd. All rights reserved. MARK 1

  17. Consistency of the Relations of Cognitive Ability and Personality Traits to Pilot Training Performance (United States)


    MAB-II scores. The univariate Case II correction ( Thorndike , 1949) was used for the NEO-PI-R scores due to a lack of sufficient data to apply the...pilot training, AFRL-RH-WP-TR-2013-0081. Wright-Patterson AFB, OH: Air Force Research Laboratory, Decision Making Division. Thorndike , R. L...NEO domain scores were corrected using the univariate Case 2 ( Thorndike , 1949) method. Correlations in the column labeled rfc were corrected for both

  18. Warfighter Effectiveness Research Center Biannual Newsletter. Volume 1, Issue 2, June 2015 (United States)


    leadership assess- ment. The project is funded by ARI and the WERC PI is Capt Steve Raymer . Dr. Robert Patterson Visits from AFRL Dr. Robert Patterson...Systems Dr. Robert Patterson (AFRL) Potpourri Series Researcher Profile: Captain Katrina Powell Captain Katrina Powell graduated from the Virginia

  19. Die Ärztliche Zentralbibliothek des Universitätsklinikums Hamburg-Eppendorf / The Medical Library of the University Medical Center Hamburg-Eppendorf

    Directory of Open Access Journals (Sweden)

    Kintzel, Melanie


    Full Text Available This article introduces the Medical Library of the University Medical Center Hamburg-Eppendorf. Firstly, history, role and status of the library within the University Medical Center are illustrated, followed by a description of the library’s facilities and services. Finally, recent projects are presented as well as a selection of key figures.

  20. Sewall Wright's equation Deltaq=(q(1-q) partial differentialw/ partial differentialq)/2w. (United States)

    Edwards, A W


    An equation of Sewall Wright's expresses the change in the frequency of an allele under selection at a multiallelic locus as a function of the gradient of the mean fitness "surface" in the direction in which the relative proportions of the other alleles do not change. An attempt to derive this equation using conventional vector calculus shows that this description leads to a different equation and that the purported gradient in Wright's equation is not a gradient of the mean fitness surface except in the diallelic case, where the two equations are the same. It is further shown that if Fisher's angular transformation is applied to the diallelic case the genic variance is exactly equal to one-eighth of the square of the gradient of the mean fitness with respect to the transformed gene frequency. Copyright 2000 Academic Press.

  1. Marketing the academic medical center group practice. (United States)

    Eudes, J A; Divis, K L


    From a marketing perspective, there are many differences between private and academic medical center (AMC) group practices. Given the growing competition between the two, write John Eudes and Kathy Divis, it is important for the AMC group practice to understand and use these differences to develop a competitive market advantage.

  2. Using Technology, Clinical Workflow Redesign, and Team Solutions to Achieve the Patient Centered Medical Home (United States)


    Redesign, and Team Solutions to Achieve the Patient Centered Medical Home LTC Nicole Kerkenbush, MHA, MN Army Medical Department, Office of the...TITLE AND SUBTITLE Using Technology, Clinical Workflow Redesign, and Team Solutions to Achieve the Patient Centered Medical Home 5a. CONTRACT...Describe how these tools are being used to implement the Patient Centered Medical Home care model 2 2011 MHS Conference MEDCOM AHLTA Provider Satisfaction

  3. An Analysis of Medication Errors at the Military Medical Center: Implications for a Systems Approach for Error Reduction

    National Research Council Canada - National Science Library

    Scheirman, Katherine


    An analysis was accomplished of all inpatient medication errors at a military academic medical center during the year 2000, based on the causes of medication errors as described by current research in the field...

  4. Ecopoetic Encounters: Amnesia and Nostalgia in Alexis Wright's Environmental Fiction


    Barras Arnaud


    In Carpentaria (2006) and The Swan Book (2013), Alexis Wright establishes an allegorical mode where she reimagines Europeans' first encounters with Australia from an Aboriginal environmental perspective. In this narrative system, the discovery of Australia is not realised by exploring colonisers, but by vulnerable strangers who apprehend the continent both experientially and linguistically. In Carpentaria, the Stranger-figure of Elias Smith is left amnesic after surviving a shipwreck during a...

  5. The portrait of a prophet – why is Wright not right about Jesus?

    African Journals Online (AJOL)


    suited to describe the portrait of Jesus emanating from the sources at hand. He furthermore .... Wright maintains that Jesus retold Israel's story, both explicitly and implicitly, as ..... of which were engraved in the palms of their hands. To reduce ...

  6. LA ESTRUCTURA ORGÁNICA EN LOS RASCACIELOS DE FRANK LLOYD WRIGHT / The organic structure in the skyscrapers of Frank Lloyd Wright

    Directory of Open Access Journals (Sweden)

    Alfonso Diaz Segura, Ricardo Meri de la Maza, Bartolomé Serra Soriano


    Full Text Available RESUMEN La estructura de la modernidad, en general, está al servicio de una nueva concepción espacial fluida y continua, condensada en torno al concepto de “planta libre”. Sin embargo, la riqueza y complejidad de articulación que adquieren las plantas, no se observa en la sección de los edificios, especialmente si se trata de rascacielos. El principio de crecimiento por superposición de plantas iguales y el carácter utilitario de la estructura en esta tipología, anularon su carácter iconográfico y su integración espacial. Frank Lloyd Wright, de modo natural, desarrolla una estructura para sus escasos rascacielos que integra espacio y forma, superando así tanto la simplificación funcional de la Escuela de Chicago, como el valor iconográfico de las experiencias europeas.SUMMARY In general, the structure of modernity serves a new, fluid and continuous, spatial conception, condensed around the “free floor” concept. However, the wealth and complexity of articulation that these floors acquire are not seen in the section of the buildings, especially in the case of skyscrapers. The principle of growth by superimposition of equal floors and the utilitarian character of the structure in this type of building, nullify the iconographic character of the structure and its spatial integration. Frank Lloyd Wright develops a structure for his few skyscrapers that integrates space and form in a natural way, thus surpassing both the functional simplification of the Chicago School, and the iconographic value of the European experiences.

  7. Investigating Medication Errors in Educational Health Centers of Kermanshah

    Directory of Open Access Journals (Sweden)

    Mohsen Mohammadi


    Full Text Available Background and objectives : Medication errors can be a threat to the safety of patients. Preventing medication errors requires reporting and investigating such errors. The present study was conducted with the purpose of investigating medication errors in educational health centers of Kermanshah. Material and Methods: The present research is an applied, descriptive-analytical study and is done as a survey. Error Report of Ministry of Health and Medical Education was used for data collection. The population of the study included all the personnel (nurses, doctors, paramedics of educational health centers of Kermanshah. Among them, those who reported the committed errors were selected as the sample of the study. The data analysis was done using descriptive statistics and Chi 2 Test using SPSS version 18. Results: The findings of the study showed that most errors were related to not using medication properly, the least number of errors were related to improper dose, and the majority of errors occurred in the morning. The most frequent reason for errors was staff negligence and the least frequent was the lack of knowledge. Conclusion: The health care system should create an environment for detecting and reporting errors by the personnel, recognizing related factors causing errors, training the personnel and create a good working environment and standard workload.

  8. Invertendo a “Passagem Atlântica”: O “regresso” de Richard Wright a África

    Directory of Open Access Journals (Sweden)

    Ana Luísa Saraiva


    Full Text Available O texto discute o sentido polémico do “regresso” a África que Richard Wright inscreve em Black Power e a forma como a narrativa da viagem subverte a “Middle Passage”. O sujeito narrativo orienta o leitor através de uma incursão pessoal nos muitos sentidos da modernidade e desdobra a noção de “destino comum”, já apontada em 12 Million Black Voices. Contudo, qualquer sentido de comunidade é aqui necessariamente ambíguo, por estar sempre relacionado com questões de raça e identidade. Black Power é uma narrativa importante para o conceito de modernidade e assinala uma mudança significativa na produção literária de Wright para uma vertente não-ficcional. Esta segunda fase da sua obra contém, no entanto, um paradoxo crucial: enquanto se volta para o exterior, para o mundo mais global, Wright tenta, simultaneamente, inscrever-se como referência sobre o locus do qual nunca poderia demarcar‑se: África. Em Black Power, a duboisiana “color line” desdobra‑se em múltiplas dimensões.

  9. Characterization and Modeling of a Control Moment Gyroscope (United States)


    pre- conditioner for the input state before passing into the inner loop, as shown in Figure 30. In Figure 30, m is the motor angle and x is the state...Characterization and Modeling of a Control Moment Gyroscope THESIS 2d Lt, Dylan Penn, B.S. AFIT-ENY-MS-15-M-235 DEPARTMENT OF THE AIR FORCE AIR ...UNIVERSITY AIR FORCE INSTITUTE OF TECHNOLOGY Wright-Patterson Air Force Base, Ohio DISTRIBUTION STATEMENT A APPROVED FOR PUBLIC RELEASE; DISTRIBUTION

  10. Interaction of Jet Fuel Hydrocarbon Components with Red Blood Cells and Hemoglobin (United States)


    Directorate (RHDJ), Wright-Patterson AFB, OH. The authors would like to thank Maj. Paul Eden, Nicole Schaeublin, Christin Grabinski, Dr. Jeff Gearhart...We would also like to thank LtCol. Norman Fox (Laboratory Flight Commander), Mrs. Nersa Loh (Supervisor, Transfusion Services), and Mr. Dan Fischer ...Approximately 7.8 mg of hemoglobin sample was concentrated into a total volume of 5 mL of Fischer PBS pH 7.5 buffer using an Amicon Centrifugal Filter Unit

  11. 5th International Conference on Cryocoolers

    CERN Document Server


    The Cryocoolers 5 proceedings archives the contributions of leading international experts at the 5th International Cryocooler Conference that was held in Monterey, California on August 18-19, 1988. The authors submitted twenty six papers describing advancements and applications of cryocoolers in the temperature range below 80K. This year's conference was hosted by the U.S. Naval Postgraduate School in Monterey, California, and the conference proceedings reproduced here were published by the Wright-Patterson AFB in Ohio.

  12. Very Low Cost Expendable Harassment System Design Study. Volume 3 (United States)


    testing involves placing a pitot tube rake in the plane of the propeller to determine C-22 iJi;.^*.^^^...--^ ;:„.-:■. ■ ■.■■.VI:-I ^v ?sammaa*mmwm i...ii^.Maj!iiiilH||^,J)||IHi|KI^ Henry , George 1975b Personal Interviews. Foreign Technology Divlsion/ETTS, Wright-Patterson AFB, OH, 15 June - 25...E-Systems, Inc., Melpar Division, Falls Church, VA: 8 July - 15 September 1975. Rose, Henry , Engineer 1975b Telephone Conversation. Sensenich

  13. An Investigation of the Relationship between Stressful Life Events and Psychological, Behavioral and Physiological Outcomes (United States)


    LOU DEcISIO LATITUDE *Figure 2-2. Demand vs Control Model. 4roa ’Jb Psychological Factors and Coronarý Heart Disease" by Karasek . Theorell . Schwartz...Wright-Patterson AFB OH, AD A134381- Karasek , R.A., Baker, D., Marxer, F., Ahebom, A., & Theorell , T. (1981). Job Decision Latitude, Job Demands, and...hormones have been shown to promote CHD in "* •animal experiments (Kornitzer et al., 1982). Applying this process to the job environment scenario, Karasek

  14. Operation of medical accelerator PATRO at Hyogo Ion Beam Medical Center

    International Nuclear Information System (INIS)

    Itano, A.; Akagi, T.; Higashi, A.; Fukushima, S.; Fujita, A.; Honda, Y.; Isa, H.; Nishikigouri, K.


    PATRO (Particle Accelerator for Therapy, Radiology and Oncology) is a medical accelerator facility for hadrontherapy of cancer at Hyogo Ion Beam Medical Center (HIBMC). Beam particles are proton (230 MeV) and carbon (320 MeV/u). After the beam commissioning and the tuning of irradiation system in 2000, we performed the clinical trials with proton and carbon beams from May 2001 until July 2002. We operated the accelerator for about 11,000 hours since the beginning of the beam tuning until the end of the clinical trials and for about 5,000 hours during the clinical trials. No serious troubles happened during the clinical trials. The stability and the reproducibility of the beams were well proved. (author)

  15. 76 FR 1211 - Union Pacific Railroad Company-Abandonment Exemption-In Wright County, IA (United States)


    ... DEPARTMENT OF TRANSPORTATION Surface Transportation Board [Docket No. AB 33 (Sub-No. 293X)] Union Pacific Railroad Company--Abandonment Exemption--In Wright County, IA Union Pacific Railroad Company (UP) filed a verified notice of exemption under 49 CFR 1152 subpart F--Exempt Abandonments to abandon a line...

  16. Neuroblastoma - remembering the three physicians who described it a century ago: James Homer Wright, William Pepper, and Robert Hutchison

    International Nuclear Information System (INIS)

    Rothenberg, Alexis B.; Berdon, Walter E.; D'Angio, Giulio J.; Yamashiro, Darrell J.; Cowles, Robert A.


    Neuroblastoma is often widespread at the time of diagnosis. Three physicians between 1900 and 1910 played an important role in the pathologic definition of neuroblastoma and its route of spread in relation to the age of the patient. These findings eventually led to the advances in treatment and decreased morbidity of today. In 1910 James Homer Wright was the first to recognize the tumor as being of primitive neural cell origin, calling it neuroblastoma and emphasizing the bundle of cells termed rosettes. While Wright recognized the neural nature of the tumor, the authors of previous reports had described its two distinct patterns of spread. In 1901 William Pepper published a series of infants with massive hepatic infiltration associated with adrenal tumors without spread to bone, and in 1907 Robert Grieve Hutchison reported his experience with a similar pathologic process in older infants and children who had orbital and skull metastases. Wright's valuable unifying concept served to tie together the descriptions of Pepper and Hutchison. A century later the names of these physicians should be remembered - Wright, who defined the adrenal tumor as of primitive neural origin, Pepper for his clinically accurate report of massive liver involvement in the infant, and Hutchison for describing the propensity of the tumor to spread to bone in older children. (orig.)

  17. A management plan for hospitals and medical centers facing radiation incidents. (United States)

    Davari, Fereshteh; Zahed, Arash


    Nowadays, application of nuclear technology in different industries has largely expanded worldwide. Proportionately, the risk of nuclear incidents and the resulting injuries have, therefore, increased in recent years. Preparedness is an important part of the crisis management cycle; therefore efficient preplanning seems crucial to any crisis management plan. Equipped with facilities and experienced personnel, hospitals naturally engage with the response to disasters. The main purpose of our study was to present a practical management pattern for hospitals and medical centers in case they encounter a nuclear emergency. In this descriptive qualitative study, data were collected through experimental observations, sources like Safety manuals released by the International Atomic Energy Agency and interviews with experts to gather their ideas along with Delphi method for polling, and brainstorming. In addition, the 45 experts were interviewed on three targeted using brainstorming and Delphi method. We finally proposed a management plan along with a set of practicality standards for hospitals and medical centers to optimally respond to nuclear medical emergencies when a radiation incident happens nearby. With respect to the great importance of preparedness against nuclear incidents adoption and regular practice of nuclear crisis management codes for hospitals and medical centers seems quite necessary.

  18. Early experiences with big data at an academic medical center. (United States)

    Halamka, John D


    Beth Israel Deaconess Medical Center (BIDMC), an academic health care institution affiliated with Harvard University, has been an early adopter of electronic applications since the 1970s. Various departments of the medical center and the physician practice groups affiliated with it have implemented electronic health records, filmless imaging, and networked medical devices to such an extent that data storage at BIDMC now amounts to three petabytes and continues to grow at a rate of 25 percent a year. Initially, the greatest technical challenge was the cost and complexity of data storage. However, today the major focus is on transforming raw data into information, knowledge, and wisdom. This article discusses the data growth, increasing importance of analytics, and changing user requirements that have shaped the management of big data at BIDMC. Project HOPE—The People-to-People Health Foundation, Inc.

  19. Kitchenette: Hell or Home? Different"Kitchenette"Images Created by Richard Wright and Gwendolyn Brooks%Kitchenette:Hell or Home?Different"Kitchenette"Images Created by Richard Wright and Gwendolyn Brooks

    Institute of Scientific and Technical Information of China (English)



    How the southern black migrants navigate and survive the northern urban space is a question profoundly explored and realistically documented in many migration narratives in African American literature. This paper concentrates on the image of Chicago"kitchenette"in the works of Richard Wright and Gwendolyn Brooks, in an attempt to demonstrate the different inter-pretations of migrant spaces on the urban landscape.

  20. Artificial intelligence within AFSC (United States)

    Gersh, Mark A.


    Information on artificial intelligence research in the Air Force Systems Command is given in viewgraph form. Specific research that is being conducted at the Rome Air Development Center, the Space Technology Center, the Human Resources Laboratory, the Armstrong Aerospace Medical Research Laboratory, the Armamant Laboratory, and the Wright Research and Development Center is noted.

  1. Trends in the Use of Medical Imaging to Diagnose Appendicitis at an Academic Medical Center. (United States)

    Repplinger, Michael D; Weber, Andrew C; Pickhardt, Perry J; Rajamanickam, Victoria P; Svenson, James E; Ehlenbach, William J; Westergaard, Ryan P; Reeder, Scott B; Jacobs, Elizabeth A


    To quantify the trends in imaging use for the diagnosis of appendicitis. A retrospective study covering a 22-year period was conducted at an academic medical center. Patients were identified by International Classification of Diseases-9 diagnosis code for appendicitis. Medical record data extraction of these patients included imaging test used (ultrasound, CT, or MRI), gender, age, and body mass index (BMI). The proportion of patients undergoing each scan was calculated by year. Regression analysis was performed to determine whether age, gender, or BMI affected imaging choice. The study included a total of 2,108 patients, including 967 (43.5%) females and 599 (27%) children (imaging used for the diagnosis of appendicitis decreased over time (P medical center, CT use increased more than 20-fold. However, no statistically significant trend was found for increased use of ultrasound or MRI. Copyright © 2016 American College of Radiology. Published by Elsevier Inc. All rights reserved.

  2. Patient-centered medical homes for patients with disabilities. (United States)

    Hernandez, Brigida; Damiani, Marco; Wang, T Arthur; Driscoll, Carolyn; Dellabella, Peter; LePera, Nicole; Mentari, Michael


    The patient-centered medical home is an innovative approach to improve health care outcomes. To address the unique needs of patients with intellectual and developmental disabilities (IDDs), a large health care provider reevaluated the National Committee for Quality Assurance's 6 medical home standards: (a) enhance access and continuity, (b) identify and manage patient populations, (c) plan and manage care, (d) provide self-care and community support, (e) track and coordinate care, and (f) measure and improve performance. This article describes issues to consider when serving patients with IDDs.

  3. 97 Medical Apparatuses tested at the Academic Medical Center (AMC) Amsterdam for interference by WLAN/WiFi signals

    NARCIS (Netherlands)

    Hensbroek, R.


    This research describes the influence of WLAN 1 signals on medical apparatuses in the Academic Medical Center (AMC) Amsterdam. The results in this report were obtained by testing medical equipment with WLAN signals. A comparable research was reported earlier. See TNO report KvL/P&Z 2007.117 dated

  4. Study and application of the balloon frame system to the industrialization of housing: the case of the American System-Built Houses of Frank Lloyd Wright

    Directory of Open Access Journals (Sweden)

    B. Serra Soriano


    Full Text Available Within his large architectural production, Frank Lloyd Wright had the opportunity to experiment with the timber industrialization, linking a traditional material with the modern sense of architecture. Wood and Frank Lloyd Wright are inseparable from the balloon frame system, a system which he will use at his first housing and through which he will materialize the spatial decomposition concept. The research on the particular American System-Built Houses case will serve to show the earliest experiences of Wright with the industry, whose conclusions he would use for subsequent researches on prefabrication.

  5. PASTE: patient-centered SMS text tagging in a medication management system. (United States)

    Stenner, Shane P; Johnson, Kevin B; Denny, Joshua C


    To evaluate the performance of a system that extracts medication information and administration-related actions from patient short message service (SMS) messages. Mobile technologies provide a platform for electronic patient-centered medication management. MyMediHealth (MMH) is a medication management system that includes a medication scheduler, a medication administration record, and a reminder engine that sends text messages to cell phones. The object of this work was to extend MMH to allow two-way interaction using mobile phone-based SMS technology. Unprompted text-message communication with patients using natural language could engage patients in their healthcare, but presents unique natural language processing challenges. The authors developed a new functional component of MMH, the Patient-centered Automated SMS Tagging Engine (PASTE). The PASTE web service uses natural language processing methods, custom lexicons, and existing knowledge sources to extract and tag medication information from patient text messages. A pilot evaluation of PASTE was completed using 130 medication messages anonymously submitted by 16 volunteers via a website. System output was compared with manually tagged messages. Verified medication names, medication terms, and action terms reached high F-measures of 91.3%, 94.7%, and 90.4%, respectively. The overall medication name F-measure was 79.8%, and the medication action term F-measure was 90%. Other studies have demonstrated systems that successfully extract medication information from clinical documents using semantic tagging, regular expression-based approaches, or a combination of both approaches. This evaluation demonstrates the feasibility of extracting medication information from patient-generated medication messages.

  6. Environmental Assessment, Glide Slope/Clear Zone Obstructions, Wright-Patterson Air Force Base, Ohio (United States)


    the Integrated Cultural Resources Managemen t Plan. Historic resou rces determined to be eligible fo r listing on the National Register of Histo ric... Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington VA 22202-4302. Respondents should be aware that notwithstanding any other...and clear zones (CZs) at WPAr B in order to protect human hea lth and safety by providing adequate clearance for aircraft operations . The existing

  7. 3 CFR 8466 - Proclamation 8466 of December 16, 2009. Wright Brothers Day, 2009 (United States)


    ... alter our world. Today, we honor the enduring American spirit of creativity and innovation that made the.... In these challenging times, the story of Orville and Wilbur Wright reminds us of what can be accomplished when imagination is joined with tenacity. Their spirit lives on in every garage and basement...

  8. The portrait of a prophet – why is Wright not right about Jesus ...

    African Journals Online (AJOL)

    question and then bases a reconstruction of Jesus on this answer. What, then, are his sources and how does he apply them to arrive at these conclusions? This article presents the portrait Wright painted of the historical Jesus and investigates how it was arrived at. HTS Theological Studies/Teologiese Studies Vol.

  9. Ada Compiler Validation Summary Report: Certificate Number 890711W1. 10109 Concurrent Computer Corporation C(3) Ada, Version R02-02.00 Concurrent Computer Corporation 3280 MPS (United States)


    Wright-Patterson ATB Dayton, OH, USA Ada Joint Prograr Office United States De artment of Defense " * ’ , Washington, DC 2 301-3061 i4. I 10 k A$ -h-Y...dependent but is permitted by the Ada Standard. Six classes of tests are used. These tests are designed to perform checks at compile time, at link time...the direction of the AVF according to procedures establizhed by the Ada Joia ,, Program Office and administered by the Ada Validation Organization (AVO

  10. Probing into the Secret of the Chinese Air Force. (United States)



  11. The Patient-Centered Medical Home Neighbor: A Critical Concept for a Redesigned Healthcare Delivery System (United States)


    Sharing Knowledge: Achieving Breakthrough Performance 2010 Military Health System Conference The Patient -Centered Medical Home Neighbor: A Critical...DATE 25 JAN 2011 2. REPORT TYPE 3. DATES COVERED 00-00-2011 to 00-00-2011 4. TITLE AND SUBTITLE The Patient -Centered Medical Home Neighbor: A...Conference What is the Patient -Centered Medical Home?  …a vision of health care as it should be  …a framework for organizing systems of care at both the

  12. Access to patient-centered medical home among Ohio's Children with Special Health Care Needs. (United States)

    Conrey, Elizabeth J; Seidu, Dazar; Ryan, Norma J; Chapman, Dj Sam


    Medical homes deliver primary care that is accessible, continuous, comprehensive, family centered, coordinated, compassionate and culturally effective. Children with special health care needs (CSHCN) require a wide range of support to maintain health, making medical home access particularly important. We sought to understand independent risk factors for lacking access. We analyzed Ohio, USA data from the National Survey of Children with Special Health Care Needs (2005-2006). Among CSHCN, 55.6% had medical home access. The proportion achieving each medical home component was highest for having a personal doctor/nurse and lowest for receiving coordinated care, family-centered care and referrals. Specific subsets of CSHCN were significantly and independently more likely to lack medical home access: Hispanic (AOR=3.08), moderate/high severity of difficulty (AOR=2.84), and any public insurance (AOR=1.60). Efforts to advance medical home access must give special attention to these CSHCN populations and improvements must be made to referral access, family-centered care, and care coordination.

  13. A management plan for hospitals and medical centers facing radiation incidents

    Directory of Open Access Journals (Sweden)

    Fereshteh Davari


    Full Text Available Background: Nowadays, application of nuclear technology in different industries has largely expanded worldwide. Proportionately, the risk of nuclear incidents and the resulting injuries have, therefore, increased in recent years. Preparedness is an important part of the crisis management cycle; therefore efficient preplanning seems crucial to any crisis management plan. Equipped with facilities and experienced personnel, hospitals naturally engage with the response to disasters. The main purpose of our study was to present a practical management pattern for hospitals and medical centers in case they encounter a nuclear emergency. Materials and Methods: In this descriptive qualitative study, data were collected through experimental observations, sources like Safety manuals released by the International Atomic Energy Agency and interviews with experts to gather their ideas along with Delphi method for polling, and brainstorming. In addition, the 45 experts were interviewed on three targeted using brainstorming and Delphi method. Results: We finally proposed a management plan along with a set of practicality standards for hospitals and medical centers to optimally respond to nuclear medical emergencies when a radiation incident happens nearby. Conclusion: With respect to the great importance of preparedness against nuclear incidents adoption and regular practice of nuclear crisis management codes for hospitals and medical centers seems quite necessary.

  14. The patient-centered medical home neighbor: A primary care physician's view. (United States)

    Sinsky, Christine A


    The American College of Physicians' position paper on the patient-centered medical home neighbor (PCMH-N) extends the work of the patient-centered medical home (PCMH) as a means of improving the delivery of health care. Recognizing that the PCMH does not exist in isolation, the PCMH-N concept outlines expectations for comanagement, communication, and care coordination and broadens responsibility for safe, effective, and efficient care beyond primary care to include physicians of all specialties. As such, it is a fitting follow-up to the PCMH and moves further down the road toward improved care for complex patients. Yet, there is more work to be done. Truly transforming the U.S. health care system around personalized medical homes embedded in highly functional medical neighborhoods will require better staffing models; more robust electronic information tools; aligned incentives for quality and efficiency within payment and regulatory policies; and a culture of greater engagement of patients, their families, and communities.

  15. El Hotel Imperial de Tokyo de Frank Lloyd Wright. Un monumento del siglo XX redivivo

    Directory of Open Access Journals (Sweden)

    Fernando Vegas López-Manzanares


    Full Text Available El texto describe el arco temporal que discurre desde el nacimiento del hotel hasta el momento de su reconstrucción. En primer lugar, indaga en la genealogía del proyecto, para abundar posteriormente en los entresijos de su construcción. Su supuesta condición indemne tras el terremoto de Kanto dio alas a Wright para reivindicar su genialidad y permitió su mitificación, aunque este hecho no sirviera para evitar las bombas en la segunda guerra mundial, ni su demolición posterior. Al hilo del discurso, se realiza una incursión en el mundo de las patologías que afectan a las obras de Wright, en la destrucción de algunas de ellas y en la relación personal del arquitecto con el mundo de la restauración.

  16. Analysis of the bioclimatic strategies used by Frank Lloyd Wright in the Jacobs I house

    Directory of Open Access Journals (Sweden)

    M. Beltrán-Fernández


    Full Text Available Frank Lloyd Wright is considered one of the most influential architects of modern architecture due to the spatial and aesthetic qualities of his work. However, the importance of Wright’s construction and environmental solutions has been usually overlooked. In order to evaluate these qualities, the first house that Wright designed for the Jacobs family (Wisconsin, USA, 1937 has been analyzed. This well-known building has been much studied, and its architectural value much celebrated, but without analysing the advantages of the bioclimatic principles over interior environment. But how can the influence of this bioclimatic architecture be measured in terms of thermal comfort? Does the selected orientation improve interior comfort? And what about the natural ventilation or the deep overhangs? In order to assess this, a digital model for energy simulation has been built using Revit and Design Builder.

  17. Understanding Richard Wright's "Black Boy": A Student Casebook to Issues, Sources, and Historical Documents. (United States)

    Felgar, Robert

    In "Black Boy," Richard Wright triumphs over an ugly, racist world by fashioning an inspiring, powerful, beautiful, and fictionalized autobiography. To help students understand and appreciate his story in the cultural, political, racial, social, and literary contexts of its time, this casebook provides primary historical documents,…

  18. Space power subsystem sizing

    International Nuclear Information System (INIS)

    Geis, J.W.


    This paper discusses a Space Power Subsystem Sizing program which has been developed by the Aerospace Power Division of Wright Laboratory, Wright-Patterson Air Force Base, Ohio. The Space Power Subsystem program (SPSS) contains the necessary equations and algorithms to calculate photovoltaic array power performance, including end-of-life (EOL) and beginning-of-life (BOL) specific power (W/kg) and areal power density (W/m 2 ). Additional equations and algorithms are included in the spreadsheet for determining maximum eclipse time as a function of orbital altitude, and inclination. The Space Power Subsystem Sizing program (SPSS) has been used to determine the performance of several candidate power subsystems for both Air Force and SDIO potential applications. Trade-offs have been made between subsystem weight and areal power density (W/m 2 ) as influenced by orbital high energy particle flux and time in orbit

  19. Supporting the underdog: feminism, animal rights and citizenship in the work of Alice Morgan Wright and Edith Goode. (United States)

    Birke, L


    In this article, the author examines the overlap between feminism and animal causes, particularly through the lives of two women, the sculptor, Alice Morgan Wright (1881-1975), and her friend, Edith Goode (1882-1970). Feminism and animal causes had connections in the late nineteenth century, particularly in campaigns to abolish vivisection. Wright and Goode held to these politics throughout their lives, and were "precursors of a generation yet to come" who would argue the connections - as many ecofeminists do today. Both women were involved in suffrage campaigns, and continued to be involved in women's organisations such as the National Woman's Party. They were, however, opposed to all injustice, including human mistreatment of animals. Feminism was, to Wright and Goode, part of a wider set of problems; animal cruelty reflected a greater barbarism leading to mistreatment of humans. Accordingly, they actively campaigned for legislation to protect animals and the environment, and lobbied the fledgling United Nations to include such measures. That challenge to the United Nations represented a unique attempt to bring animals into citizenship' a move being made again today, through initiatives such as the Great Ape Project.

  20. 76 FR 71045 - Center for Biologics Evaluation and Research Report of Scientific and Medical Literature and... (United States)


    ...] Center for Biologics Evaluation and Research Report of Scientific and Medical Literature and Information... period for the notice on its report of scientific and medical literature and information concerning the... ``Center for Biologics Evaluation and Research Report of Scientific and Medical Literature and Information...

  1. Walter Reed Army Medical Center's Internet-based electronic health portal. (United States)

    Abbott, Kevin C; Boocks, Carl E; Sun, Zhengyi; Boal, Thomas R; Poropatich, Ronald K


    Use of the World Wide Web (WWW) and electronic media to facilitate medical care has been the subject of many reports in the popular press. However, few reports have documented the results of implementing electronic health portals for essential medical tasks, such as prescription refills and appointments. At Walter Reed Army Medical Center, "Search & Learn" medical information, Internet-based prescription refills and patient appointments were established in January 2001. A multiphase retrospective analysis was conducted to determine the use of the "Search & Learn" medical information and the relative number of prescription refills and appointments conducted via the WWW compared with conventional methods. From January 2001 to May 2002, there were 34,741 refills and 819 appointments made over the Internet compared with 2,275,112 refills and approximately 500,000 appointments made conventionally. WWW activity accounted for 1.52% of refills and 0.16% of appointments. There was a steady increase in this percentage over the time of the analysis. In April of 2002, the monthly average of online refills had risen to 4.57% and online appointments were at 0.27%. Online refills were projected to account for 10% of all prescriptions in 2 years. The "Search & Learn" medical information portion of our web site received 147,429 unique visits during this same time frame, which was an average of 326 visitors per day. WWW-based methods of conducting essential medical tasks accounted for a small but rapidly increasing percentage of total activity at Walter Reed Army Medical Center. Subsequent phases of analysis will assess demographic and geographic factors and aid in the design of future systems to increase use of the Internet-based systems.

  2. Decentralizing constrained-efficient allocations in the Lagos–Wright pure currency economy


    Bajaj, Ayushi; Hu, Tai Wei; Rocheteau, Guillaume; Silva, Mario Rafael


    This paper offers two ways to decentralize the constrained-efficient allocation of the Lagos–Wright (2005) pure currency economy. The first way has divisible money, take-it-or-leave-it offers by buyers, and a transfer scheme financed by money creation. If agents are sufficiently patient, the first best is achieved for finite money growth rates. If agents are impatient, the equilibrium allocation approaches the constrained-efficient allocation asymptotically as the money growth rate tends to i...

  3. 78 FR 74163 - Harrison Medical Center, a Subsidiary of Franciscan Health System Bremerton, Washington; Notice... (United States)


    ... DEPARTMENT OF LABOR Employment and Training Administration [TA-W-83,070] Harrison Medical Center, a Subsidiary of Franciscan Health System Bremerton, Washington; Notice of Negative Determination... workers of Harrison Medical Center, a subsidiary of Franciscan Health System, Bremerton, Washington...

  4. 78 FR 10610 - TRICARE; Demonstration Project for Participation in Maryland Multi-Payer Patient Centered Medical... (United States)


    ... National Committee on Quality Assurance Patient Centered Medical Home (PPC-PCMH) recognition criteria... quality improvements. TMA Defense Health Cost Assessment and Evaluation (DHCAPE) staff will calculate... Maryland Multi-Payer Patient Centered Medical Home Program (MMPCMHP) Demonstration AGENCY: Department of...

  5. Roles of Medical Record and Statistic Staff on Research at the Tawanchai Center. (United States)

    Pattaranit, Rumpan; Chantachum, Vasana; Lekboonyasin, Orathai; Pradubwong, Suteera


    The medical record and statistic staffs play a crucial role behind the achievements of treatment and research of physicians, nurses and other health care professionals. The medical record and statistic staff are in charge of keeping patient medical records; creating databases; presenting information; sorting patient's information; providing patient medical records and related information for various medical teams and researchers; Besides, the medical record and statistic staff have collaboration with the Center of Cleft Lip-Palate, Khon Kaen University in association with the Tawanchai Project. The Tawanchai Center is an organization, involving multidisciplinary team which aims to continuing provide care for patients with cleft lip and palate and craniofacial deformities who need a long term of treatment since newborns until the age of 19 years. With support and encouragement from the Tawanchai team, the medical record and statistic staff have involved in research under the Tawanchai Centre since then and produced a number of publications locally and internationally.

  6. Evaluation of a Program to Teach Medical Students about Alcoholism. (United States)

    Siegal, Harvey A.; And Others


    The Week-end Intervention Program (WIP) used by Wright State University School of Medicine, which assesses the alcohol problems of those convicted of offenses such as drunk driving and then assists in finding treatment, is described. The impact of the program in educating medical students about alcoholism is discussed. (MLW)

  7. Critical Care Organizations in Academic Medical Centers in North America: A Descriptive Report. (United States)

    Pastores, Stephen M; Halpern, Neil A; Oropello, John M; Kostelecky, Natalie; Kvetan, Vladimir


    With the exception of a few single-center descriptive reports, data on critical care organizations are relatively sparse. The objectives of our study were to determine the structure, governance, and experience to date of established critical care organizations in North American academic medical centers. A 46-item survey questionnaire was electronically distributed using Survey Monkey to the leadership of 27 identified critical care organizations in the United States and Canada between September 2014 and February 2015. A critical care organization had to be headed by a physician and have primary governance over the majority, if not all, of the ICUs in the medical center. We received 24 responses (89%). The majority of the critical care organizations (83%) were called departments, centers, systems, or operations committees. Approximately two thirds of respondents were from larger (> 500 beds) urban institutions, and nearly 80% were primary university medical centers. On average, there were six ICUs per academic medical center with a mean of four ICUs under critical care organization governance. In these ICUs, intensivists were present in-house 24/7 in 49%; advanced practice providers in 63%; hospitalists in 21%; and telemedicine coverage in 14%. Nearly 60% of respondents indicated that they had a separate hospital budget to support data management and reporting, oversight of their ICUs, and rapid response teams. The transition from the traditional model of ICUs within departmentally controlled services or divisions to a critical care organization was described as gradual in 50% and complete in only 25%. Nearly 90% indicated that their critical care organization governance structure was either moderately or highly effective; a similar number suggested that their critical care organizations were evolving with increasing domain and financial control of the ICUs at their respective institutions. Our survey of the very few critical care organizations in North American

  8. Development of a longitudinal integrated clerkship at an academic medical center. (United States)

    Poncelet, Ann; Bokser, Seth; Calton, Brook; Hauer, Karen E; Kirsch, Heidi; Jones, Tracey; Lai, Cindy J; Mazotti, Lindsay; Shore, William; Teherani, Arianne; Tong, Lowell; Wamsley, Maria; Robertson, Patricia


    In 2005, medical educators at the University of California, San Francisco (UCSF), began developing the Parnassus Integrated Student Clinical Experiences (PISCES) program, a year-long longitudinal integrated clerkship at its academic medical center. The principles guiding this new clerkship were continuity with faculty preceptors, patients, and peers; a developmentally progressive curriculum with an emphasis on interdisciplinary teaching; and exposure to undiagnosed illness in acute and chronic care settings. Innovative elements included quarterly student evaluation sessions with all preceptors together, peer-to-peer evaluation, and oversight advising with an assigned faculty member. PISCES launched with eight medical students for the 2007/2008 academic year and expanded to 15 students for 2008/2009. Compared to UCSF's traditional core clerkships, evaluations from PISCES indicated significantly higher student satisfaction with faculty teaching, formal didactics, direct observation of clinical skills, and feedback. Student performance on discipline-specific examinations and United States Medical Licensing Examination step 2 CK was equivalent to and on standardized patient examinations was slightly superior to that of traditional peers. Participants' career interests ranged from primary care to surgical subspecialties. These results demonstrate that a longitudinal integrated clerkship can be implemented successfully at a tertiary care academic medical center.

  9. Investigation of Electrodeposited Alloys and Pure Metals as Substitutes for Zinc and Cadmium for Protective Finishes for Steel Parts of Aircraft (United States)


    H- iSt .»^iifeäu tau ji.j iÄüi ,j WtoSSWi.Ä^/VJSänssMSw Reproduced by n@ & © © [j cjiiiiL 10 DQCumtnTS Office WRIGHT-PATTERSON •a-s •a a 4 Ortrt O r-4 O ii ° ° _ ÖS3 III 8 a a «aw o •-< VC- VIH o • • «H O O •3-3 3 o o A an 4* & o CM CM •33

  10. A Study of USN Aircrew Attitudes Regarding Technology’s Ability to Replace the Naval Flight Officer on Typical Combat Missions Carrier Based Aircraft are Tasked to Perform (United States)


    Management, Air Force Institute of Technology (AU), Wright Patterson AFB CH, 1991. Horngren , Charles T. and George Foster. Cost Accounting : A Managerial...Submit - TotalCastOPnperewldSubmnit * s ((I eEnter this figure in column 13(c)(1) SHORE ESTAILISHMENT COST TO PREPARE AND SUBMIT PAY GRADE No OR ORYRT...W’IC QUALIT’Y TI15?SrTF-* AFIT/GSM/LAR/93S- 1 A SILMY OF USN AIRCREW ATTIU2 RECARDING TE*L ’ S ABILITY TO REPLACE THE NAVAL FLICHT OFFICER ON TYPICAL

  11. Business Case Analysis of the Walter Reed Army Medical Center Medical/Surgical Prime Vendor Generation III Service Level Electron Program

    National Research Council Canada - National Science Library

    Markot, Peter B


    ...) staffing and medical/surgical services offered under the Prime Vendor (PV) Generation III contract would provide the best supply chain management solution for Walter Reed Army Medical Center (WRAMC...

  12. Patient-Centered Medical Home in chronic obstructive pulmonary disease

    Directory of Open Access Journals (Sweden)

    Ortiz G


    Full Text Available Gabriel Ortiz1, Len Fromer21Pediatric Pulmonary Services, El Paso, TX; 2Department of Family Medicine, David Geffen School of Medicine, UCLA, Los Angeles, CA, USAAbstract: Chronic obstructive pulmonary disease (COPD is a progressive and debilitating but preventable and treatable disease characterized by cough, phlegm, dyspnea, and fixed or incompletely reversible airway obstruction. Most patients with COPD rely on primary care practices for COPD management. Unfortunately, only about 55% of US outpatients with COPD receive all guideline-recommended care. Proactive and consistent primary care for COPD, as for many other chronic diseases, can reduce hospitalizations. Optimal chronic disease management requires focusing on maintenance rather than merely acute rescue. The Patient-Centered Medical Home (PCMH, which implements the chronic care model, is a promising framework for primary care transformation. This review presents core PCMH concepts and proposes multidisciplinary team-based PCMH care strategies for COPD.Keywords: Patient-Centered Medical Home, chronic care model, chronic obstructive pulmonary disease, patient education, physician assistants, nurse practitioners

  13. DOE Center of Excellence in Medical Laser Applications. Final report, December 1, 1994--November 30, 1997

    Energy Technology Data Exchange (ETDEWEB)

    Jacques, S.L.


    An engineering network of collaborating medical laser laboratories are developing laser and optical technologies for medical diagnosis and therapy and are translating the engineering into medical centers in Portland OR, Houston TX, and Galveston TX. The Center includes the University of Texas M.D. Anderson Cancer Center, the University of Texas-Austin, Texas A and M University, Rice University, the University Texas Medical Branch-Galveston, Oregon Medical Laser Center (Providence St. Vincent Medical Center, Oregon Health Sciences University, and Oregon Graduate Institute, Portland, OR), and the University of Oregon. Diagnostics include reflectance, fluorescence, Raman IR, laser photoacoustics, optical coherence tomography, and several new video techniques for spectroscopy and imaging. Therapies include photocoagulation therapy, laser welding, pulsed laser ablation, and light-activated chemotherapy of cancer (photodynamic therapy, or PDT). Medical applications reaching the clinic include optical monitoring of hyperbilirubinemia in newborns, fluorescence detection of cervical dysplasia, laser thrombolysis of blood clots in heart attack and brain stroke, photothermal coagulant of benign prostate hyperplasia, and PDT for both veterinary and human cancer. New technologies include laser optoacoustic imaging of breast tumors and hemorrhage in head trauma and brain stroke, quality control monitoring of dosimetry during PDT for esophageal and lung cancer, polarization video reflectometry of skin cancer, laser welding of artificial tissue replacements, and feedback control of laser welding.

  14. Relating calls to US poison centers for potential exposures to medications to Centers for Disease Control and Prevention reporting of influenza-like illness. (United States)

    Beauchamp, Gillian A; McKeown, Nathanael J; Rodriguez, Sergio; Spyker, Daniel A


    The Centers for Disease Control (CDC) monitors influenza like illness (ILI) and the National Poison Data System (NPDS) warehouses call data uploaded by US poison centers regarding reported exposures to medication. We examined the relationship between calls to poison centers regarding reported exposures to medications commonly used to treat ILI and weekly reports of ILI. The CDC reports ILI, by age group, for each of 10 Health and Human Services (HHS) regions. We examined NPDS summary data from calls reported to poison centers regarding reported exposures to acetaminophen, cough/cold medications, and promethazine, for the same weeks, age groups, and HHS regions for influenza seasons 2000-2013. ILI and NPDS exposures were examined using graphical plots, descriptive statistics, stepwise regression analysis, and Geographic Information Systems (GIS). About 5,101,841 influenza-like illness cases were reported to the CDC, and 2,122,940 calls regarding reported exposures to medications commonly used to treat ILI, were reported by poison centers to the NPDS over the 13 flu seasons. Analysis of stepwise models of the linear untransformed data involving 24 NPDS data groups and for 60 ILI measures, over the 13 influenza seasons, demonstrated that reported exposures to medications used to treat ILI correlated with reported cases of ILI with a median R(2 )=( )0.489 (min R(2 )=( )0.248, max R(2 )=( )0.717), with mean ± SD of R(2 )=( )0.494 ± 0.121. Median number of parameters used (degrees of freedom - 1) was 7. NPDS data regarding poison center calls for selected ILI medication exposures were highly correlated with CDC ILI data. Since NPDS data are available in real time, it provides complimentary ILI monitoring. This approach may provide public health value in predicting other illnesses which are not currently as thoroughly monitored.

  15. Darwinism after Mendelism: the case of Sewall Wright's intellectual synthesis in his shifting balance theory of evolution (1931). (United States)

    Hodge, Jonathan


    Historians of science have long been agreeing: what many textbooks of evolutionary biology say, about the histories of Darwinism and the New Synthesis, is just too simple to do justice to the complexities revealed to critical scholarship and historiography. There is no current consensus, however, on what grand narratives should replace those textbook histories. The present paper does not offer to contribute directly to any grand, consensual, narrational goals; but it does seek to do so indirectly by showing how, in just one individual case, details of intellectual biography connect with big picture issues. To this end, I examine here how very diverse scientific and metaphysical commitments were integrated in Sewall Wright's own personal synthesis of biology and philosophy. Taking as the decisive text the short final section of Wright's long 1931 paper on 'Evolution in Mendelian populations,' I examine how his shifting balance theory (SBT) related to his optimum breeding strategy research, his physiological genetics, his general theory of homogenising and heterogenesing causation and his panpsychist view of mind and matter; and I discuss how understanding these relations can clarify Wright's place in the longue durée of evolutionary thought. Copyright © 2010 Elsevier Ltd. All rights reserved.

  16. Hospital CIO Explains Blockchain Potential: An Interview with Beth Israel Deaconess Medical Center's John Halamka. (United States)

    Mertz, Leslie


    Work is already underway to bring blockchain technology to the healthcare industry, and hospital administrators are trying to figure out what it can do for them, their clinicians, and their patients. That includes administrators at Beth Israel Deaconess Medical Center, a leading academic medical center located in Boston.

  17. A Study to Determine Patient Waiting Time at the Outpatient Pharmacy at Wilford Hall USAF Medical Center (United States)


    at Wilford Hall USAF Medical Center significantly reduced the patient wait time at the main outpatient pharmacy. Satellite pharmacies have been ).’l...PRESENTING TO WINDOW 1, 19 MAR 88. 47 C:. A’.’E-:A: -ESCRIRTIONS PER PATIENT ...........48 H. WILFORD HALL MEDICAL CENTER OUTPATIENT QUESTIONNAIRE...that wait times at tne outpatient pharmacy were excessive. It was this concern that motivated the Medical Center Administrator to request that patient

  18. Development of a longitudinal integrated clerkship at an academic medical center

    Directory of Open Access Journals (Sweden)

    Ann Poncelet


    Full Text Available In 2005, medical educators at the University of California, San Francisco (UCSF, began developing the Parnassus Integrated Student Clinical Experiences (PISCES program, a year-long longitudinal integrated clerkship at its academic medical center. The principles guiding this new clerkship were continuity with faculty preceptors, patients, and peers; a developmentally progressive curriculum with an emphasis on interdisciplinary teaching; and exposure to undiagnosed illness in acute and chronic care settings. Innovative elements included quarterly student evaluation sessions with all preceptors together, peer-to-peer evaluation, and oversight advising with an assigned faculty member. PISCES launched with eight medical students for the 2007/2008 academic year and expanded to 15 students for 2008/2009. Compared to UCSF's traditional core clerkships, evaluations from PISCES indicated significantly higher student satisfaction with faculty teaching, formal didactics, direct observation of clinical skills, and feedback. Student performance on discipline-specific examinations and United States Medical Licensing Examination step 2 CK was equivalent to and on standardized patient examinations was slightly superior to that of traditional peers. Participants’ career interests ranged from primary care to surgical subspecialties. These results demonstrate that a longitudinal integrated clerkship can be implemented successfully at a tertiary care academic medical center.

  19. Integration of pharmacists into a patient-centered medical home. (United States)

    Scott, Mollie Ashe; Hitch, Bill; Ray, Lisa; Colvin, Gaye


    To define the joint principles of the patient-centered medical home (PCMH) and describe the integration of pharmacists into a PCMH. Family medicine residency training program in North Carolina from 2001 to 2011. Mountain Area Health Education Family Health Center is a family medicine residency training program that is part of the North Carolina Area Health Education Center system. The goal of the organization is to train and retain health care students and residents. The practice is recognized as a level III PCMH by the National Committee for Quality Assurance (NCQA) and seeks to provide quality, safe, patient-centered care according to the joint principles of PCMH. Pharmacists, nurses, nutritionists, care managers, Spanish translators, and behavioral medicine specialists work collaboratively with physicians to provide seamless, comprehensive care. The Department of Pharmacotherapy is embedded in the family medicine clinic. Three pharmacists and two pharmacy residents are involved in providing direct patient care services, ensuring access to community resources, assisting patients with transitions of care, providing interprofessional education, and participating in continuous quality improvement initiatives. The pharmacists serve as clinical pharmacist practitioners and provide medication therapy management services in a pharmacotherapy clinic, anticoagulation clinics, and an osteoporosis clinic and via an inpatient family medicine service. Multiple learners such as student pharmacists, pharmacy residents, and family medicine residents rotate through the various pharmacy clinics to learn about pharmacotherapeutic principles and the role of the pharmacist in PCMH. PCMH is a comprehensive, patient-centered, team-based approach to population management in the primary care setting. Pharmacists play a vital role in PCMH and make fundamental contributions to patient care across health care settings. Such innovations in the ambulatory care setting create a unique niche

  20. Early Lessons on Bundled Payment at an Academic Medical Center. (United States)

    Jubelt, Lindsay E; Goldfeld, Keith S; Blecker, Saul B; Chung, Wei-Yi; Bendo, John A; Bosco, Joseph A; Errico, Thomas J; Frempong-Boadu, Anthony K; Iorio, Richard; Slover, James D; Horwitz, Leora I


    Orthopaedic care is shifting to alternative payment models. We examined whether New York University Langone Medical Center achieved savings under the Centers for Medicare and Medicaid Services Bundled Payments for Care Improvement initiative. This study was a difference-in-differences study of Medicare fee-for-service patients hospitalized from April 2011 to June 2012 and October 2013 to December 2014 for lower extremity joint arthroplasty, cardiac valve procedures, or spine surgery (intervention groups), or for congestive heart failure, major bowel procedures, medical peripheral vascular disorders, medical noninfectious orthopaedic care, or stroke (control group). We examined total episode costs and costs by service category. We included 2,940 intervention episodes and 1,474 control episodes. Relative to the trend in the control group, lower extremity joint arthroplasty episodes achieved the greatest savings: adjusted average episode cost during the intervention period decreased by $3,017 (95% confidence interval [CI], -$6,066 to $31). For cardiac procedures, the adjusted average episode cost decreased by $2,999 (95% CI, -$8,103 to $2,105), and for spinal fusion, it increased by $8,291 (95% CI, $2,879 to $13,703). Savings were driven predominantly by shifting postdischarge care from inpatient rehabilitation facilities to home. Spinal fusion index admission costs increased because of changes in surgical technique. Under bundled payment, New York University Langone Medical Center decreased total episode costs in patients undergoing lower extremity joint arthroplasty. For patients undergoing cardiac valve procedures, evidence of savings was not as strong, and for patients undergoing spinal fusion, total episode costs increased. For all three conditions, the proportion of patients referred to inpatient rehabilitation facilities upon discharge decreased. These changes were not associated with an increase in index hospital length of stay or readmission rate

  1. Revisions to the PETROS 4 Shell Response Code. (United States)


    change in the corresponding curvature tensor 𔃿’. DD(JLA) ftA cl &y()j * -. ,:"DD2(J,LA) DEL See ZETA 146,156 DELBAR 71 See ZETA 409 DELNOR See EQUIL2...Cleveland, OH 44135 1 AFML (LLN, Dr. Nicholas) 1 Bell Helicopter Textron Wright-Patterson AFB, OH 45433 ATTN: Mr. Nile Fischer P.O. Box 482 I ASD/ENFTV, Mr...2406A 1 Texas A&M University 1000 Western Avenue Dept Aerospace Eng West Lynn, MA 01905 ATTN: Dr. W. Haisler College Station, TX 77843 I Kaman Tempo

  2. Application of software technology to a future spacecraft computer design (United States)

    Labaugh, R. J.


    A study was conducted to determine how major improvements in spacecraft computer systems can be obtained from recent advances in hardware and software technology. Investigations into integrated circuit technology indicated that the CMOS/SOS chip set being developed for the Air Force Avionics Laboratory at Wright Patterson had the best potential for improving the performance of spaceborne computer systems. An integral part of the chip set is the bit slice arithmetic and logic unit. The flexibility allowed by microprogramming, combined with the software investigations, led to the specification of a baseline architecture and instruction set.

  3. Dealing With Deans and Academic Medical Center Leadership: Advice From Leaders. (United States)

    Sanfilippo, Fred; Powell, Deborah; Folberg, Robert; Tykocinski, Mark


    The 2017 Association of Pathology Chairs Annual Meeting included a session for department chairs and other department leaders on "how to deal with deans and academic medical center leadership." The session was focused on discussing ways to foster positive relationships with university, medical school, and health system leaders, and productively address issues and opportunities with them. Presentations and a panel discussion were provided by 4 former pathology chairs who subsequently have served as medical deans and in other leadership positions including university provost, medical center CEO, and health system board chair. There was a strong consensus among the participants on how best to deal with superiors about problems, conflicts, and requests for additional resources and authority. The importance of teamwork and accountability in developing a constructive and collaborative relationship with leaders and peers was discussed in detail. Effectiveness in communication, negotiation, and departmental advocacy were highlighted as important skills. As limited resources and increased regulations have become growing problems for universities and health systems, internal stress and competition have increased. In this rapidly changing environment, advice on how chairs can interact most productively with institutional leaders is becoming increasingly important.

  4. Physician Payment Methods and the Patient-Centered Medical Home: Comment on "A Troubled Asset Relief Program for the Patient-Centered Medical Home". (United States)

    Quinn, Kevin

    This commentary analyzes the patient-centered medical home (PCMH) model within a framework of the 8 basic payment methods in health care. PCMHs are firmly within the fee-for-service tradition. Changes to the process and structure of the Resource Based Relative Value Scale, which underlies almost all physician fee schedules, could make PCMHs more financially viable. Of the alternative payment methods being considered, shared savings models are unlikely to transform medical practice whereas capitation models place unrealistic expectations on providers to accept epidemiological risk. Episode payment may strike a feasible balance for PCMHs, with newly available episode definitions presenting opportunities not previously available.

  5. Home medication support for childhood cancer: family-centered design and testing. (United States)

    Walsh, Kathleen E; Biggins, Colleen; Blasko, Deb; Christiansen, Steven M; Fischer, Shira H; Keuker, Christopher; Klugman, Robert; Mazor, Kathleen M


    Errors in the use of medications at home by children with cancer are common, and interventions to support correct use are needed. We sought to (1) engage stakeholders in the design and development of an intervention to prevent errors in home medication use, and (2) evaluate the acceptability and usefulness of the intervention. We convened a multidisciplinary team of parents, clinicians, technology experts, and researchers to develop an intervention using a two-step user-centered design process. First, parents and oncologists provided input on the design. Second, a parent panel and two oncology nurses refined draft materials. In a feasibility study, we used questionnaires to assess usefulness and acceptability. Medication error rates were assessed via monthly telephone interviews with parents. We successfully partnered with parents, clinicians, and IT experts to develop Home Medication Support (HoMeS), a family-centered Web-based intervention. HoMeS includes a medication calendar with decision support, a communication tool, adverse effect information, a metric conversion chart, and other information. The 15 families in the feasibility study gave HoMeS high ratings for acceptability and usefulness. Half recorded information on the calendar to indicate to other caregivers that doses were given; 34% brought it to the clinic to communicate with their clinician about home medication use. There was no change in the rate of medication errors in this feasibility study. We created and tested a stakeholder-designed, Web-based intervention to support home chemotherapy use, which parents rated highly. This tool may prevent serious medication errors in a larger study. Copyright © 2014 by American Society of Clinical Oncology.

  6. A taxonomic revision of the genus Primnoisis Studer [& Wright], 1887 (Coelenterata: Octocorallia: Isididae) using morphological and molecular data. (United States)

    Moore, Kirrily; Alderslade, Philip; Miller, Karen


    A complete taxonomic revision of the genus Primnoisis (Isididae) is presented herein, based on original type material of all nominal species and additional specimens from deep-water surveys in sub-temperate and Antarctic waters. A multi-disciplinary approach was used combining morphological characteristics such as colonial branching patterns, polyp structure, sclerite form and arrangement, together with phylogenetic reconstructions using two mitochondrial gene regions (mtMutS and igr1-cox1). The genus Primnoisis is retained with 7 of the 8 nominal species validated (P. antarctica Wright & Studer, 1889, P. rigida Wright & Studer, 1889, P. ambigua Wright & Studer, 1889, P. delicatula Hickson, 1907, P. fragilis Kükenthal, 1912, P. formosa Gravier, 1913 and P. mimas Bayer & Stefani, 1987), with the eighth (P. sparsa Wright & Studer, 1889), synonymised with P. antarctica. In addition, the species Mopsea gracilis Gravier, 1913 is reassigned to Primnoisis and an additional five new species are described (P. chatham n. sp., P. erymna n. sp., P. millerae n. sp., P. niwa n. sp. and P. tasmani n. sp). Most of the species fell into two clear groups, defined both by morphology and genetic grouping, for which two new sub-genera are proposed (P. (Primnoisis) n. subg. and P. (Delicatisis) n. subg.). Three species, P. ambigua, P. mimas and P. tasmani, could not be placed reliably in either sub-genus due to distinctive morphological features or genetic dissimilarity. It was not possible to confirm the monophyly of the genus due to unresolved relationships with the closely related genus Notisis Gravier, 1913 and an undescribed genus of Mopseinae.

  7. Tracking Active Learning in the Medical School Curriculum: A Learning-Centered Approach. (United States)

    McCoy, Lise; Pettit, Robin K; Kellar, Charlyn; Morgan, Christine


    Medical education is moving toward active learning during large group lecture sessions. This study investigated the saturation and breadth of active learning techniques implemented in first year medical school large group sessions. Data collection involved retrospective curriculum review and semistructured interviews with 20 faculty. The authors piloted a taxonomy of active learning techniques and mapped learning techniques to attributes of learning-centered instruction. Faculty implemented 25 different active learning techniques over the course of 9 first year courses. Of 646 hours of large group instruction, 476 (74%) involved at least 1 active learning component. The frequency and variety of active learning components integrated throughout the year 1 curriculum reflect faculty familiarity with active learning methods and their support of an active learning culture. This project has sparked reflection on teaching practices and facilitated an evolution from teacher-centered to learning-centered instruction.

  8. Environmental Assessment for New Veterinary Clinic at Wright Patterson Air Force Base, Dayton, Ohio (United States)


    English sparrow (Passer domesticus), mockingbird (Mimus polyglottos), and red- winged black bird (Agelaius phoeniceus). 3.3.3 Threatened and...addition, airfield safety zones have been established under AICUZ to minimize the number of people who would be injured or killed if an aircraft

  9. Environmental Assessment for the Hilltop Community Services District, Wright-Patterson Air Force Base, Ohio (United States)


    land  complexes. Small areas of residual soils over  limestone  and shale  bedrock  exist on steep slopes in the  eastern portion of Area B.  The two...cultural resources, environmental justice/protection of children, geology , land use, water resources, infrastructure, and visual resources...disproportionately or adversely affected by the action. Geology and Soils (EA Se1ction 4.4): There would be no excess fill excavated during site preparation and

  10. An Analysis of Shelf Space Allocation at the Wright-Patterson Air Force Base Commissary. (United States)


    Company performed a major shelf space allocation study involving 59 of their stores. The study involved planning and executing a shelf by shelf reset...Betty Crocker Chocolate .a9 2 Betty CrocKer Yellow .93 3 Betty Crocker Devils Food .92 4 Betty Crocker Choc . Choc . Chip .94 5 Betty Crocker German...Headquarters Air Force Commissary Services. ACOS Executive Summary. 28 January 19d6. 12. deadquarters Air Force Commissary Services. Store _Layout

  11. Environmental Assessment for the Aeromedical Evacuation Formal Training Unit, Wright-Patterson Air Force Base (United States)


    pennsylvanica), White Ash (Fraxinus americana), Shingle Oak (Quercus imbricaria), Northern Red Oak (Quercus rubra), Slippery Elm (Ulmus rubra...American Elm (Ulmus americana), Eastern Cottonwood (Populus deltoides), Silver Maple (Acer saccharinum), Sassafras (Sassafras albidum), Post Oak (Quercus

  12. United States academic medical centers: priorities and challenges amid market transformation. (United States)

    Thompson, Irene M; Anason, Barbara


    United States academic medical centers (AMCs) have upheld their long-standing reputation for excellence by teaching and training the next generation of physicians, supporting medical research, providing world-class medical care, and offering breakthrough treatments for highly complex medical cases. In recent years, the pace and direction of change reshaping the American health care industry has created a set of new and profound challenges that AMC leaders must address in order to sustain their institutions. University HealthSystem Consortium (UHC) is an alliance of 116 leading nonprofit academic medical centers and 276 of their affiliated hospitals, all of which are focused on delivering world-class patient care. Formed in 1984, UHC fosters collaboration with and among its members through its renowned programs and services in the areas of comparative data and analytics, performance improvement, supply chain management, strategic research, and public policy. Each year, UHC surveys the executives of its member institutions to understand the issues they view as most critical to sustaining the viability and success of their organizations. The results of UHC's most recent 2011 member survey, coupled with a 2012 Strategic Health Perspectives Harris Interactive presentation, based in parton surveys of major health care industry stakeholders reveal the most important and relevant issues and opportunities that hospital leaders face today, as the United States health care delivery system undergoes a period of unprecedented transformation.

  13. Results of an Institutional LGBT Climate Survey at an Academic Medical Center. (United States)

    Chester, Sean D; Ehrenfeld, Jesse M; Eckstrand, Kristen L


    The purpose of this study was to characterize the climate and culture experienced by lesbian, gay, bisexual, and transgender (LGBT) employees and students at one large academic medical center. An anonymous, online institutional climate survey was used to assess the attitudes and experiences of LGBT employees and students. There were 42 LGBT and 14 non-LGBT survey participants. Results revealed that a surprisingly large percentage of LGBT individuals experienced pressure to remain "closeted" and were harassed despite medical center policies of non-discrimination. Continuing training, inclusive policies and practices, and the development of mechanisms to address LGBT-specific harassment are necessary for improving institutional climate.

  14. Marion duPont Scott Equine Medical Center uses innovative lameness treatment


    Lee, Kate


    Virginia Tech's Marion duPont Scott Equine Medical Center is now offering an equine lameness therapy that prevents further degeneration of the affected joint and offers a longer-lasting benefit than traditional steroid treatment.

  15. Meeting changing conditoins at the Rhode Island Medical Center cogeneration plant

    International Nuclear Information System (INIS)

    Galamaga, D.P.; Bowen, P.T.


    The Rhode Island Department of Mental Health, Retardation and Hospitals is one state department in Rhode Island whose basic function is to provide services to seriously disabled individuals throughout the state. Savings in operating expenses from the Rhode Island Medical Center Central Power Plant have accruded to provide operating funds for the major programs. Operating under a Director who reports to the Governor of Rhode Island, the Department has three major divisions, approximately 2500 employees, and a budget of 200 million dollars. Its operations extend throughout the state and the major focus for hospital or institutional levels of care reside in three major locations, the Dr. U.E. Zambarano Memorial Hospital in northern Rhode Island, the Dr. Joseph Ladd Center in southern Rhode Island, and the Rhode Island Medical Center in the middle of the state. Besides these institution-based operations, the Department sponsors a wide range of rehabilitative programming in the community other through direct operations of facilities such as group homes or through contracts with private non-profit providers of service

  16. Tracking Active Learning in the Medical School Curriculum: A Learning-Centered Approach (United States)

    McCoy, Lise; Pettit, Robin K; Kellar, Charlyn; Morgan, Christine


    Background: Medical education is moving toward active learning during large group lecture sessions. This study investigated the saturation and breadth of active learning techniques implemented in first year medical school large group sessions. Methods: Data collection involved retrospective curriculum review and semistructured interviews with 20 faculty. The authors piloted a taxonomy of active learning techniques and mapped learning techniques to attributes of learning-centered instruction. Results: Faculty implemented 25 different active learning techniques over the course of 9 first year courses. Of 646 hours of large group instruction, 476 (74%) involved at least 1 active learning component. Conclusions: The frequency and variety of active learning components integrated throughout the year 1 curriculum reflect faculty familiarity with active learning methods and their support of an active learning culture. This project has sparked reflection on teaching practices and facilitated an evolution from teacher-centered to learning-centered instruction. PMID:29707649

  17. A User-Centered Cooperative Information System for Medical Imaging Diagnosis. (United States)

    Gomez, Enrique J.; Quiles, Jose A.; Sanz, Marcos F.; del Pozo, Francisco


    Presents a cooperative information system for remote medical imaging diagnosis. General computer-supported cooperative work (CSCW) problems addressed are definition of a procedure for the design of user-centered cooperative systems (conceptual level); and improvement of user feedback and optimization of the communication bandwidth in highly…

  18. Trends in HPC and Data Center Power, Packaging, and Cooling

    CERN Multimedia

    CERN. Geneva


    air vs liquid-cooling, and metrics to track it all will be discussed. About the speaker Michael K. Patterson is a Senior Principal Engineer in the Technical Computing Group - Systems Architecture & Pathfinding at the Intel Corporation, in Dupont, Washington, where he works in the power, thermal, and energy-efficient-performance areas of High Performance Computing. The work covers silicon level activity, through platform and rack-level solutions, and on up to interface with Data Center power and cooling technologies. He did his undergraduate work at Purdue University, received his MS degree in Management from Rensselaer Polytechnic Institute, an...

  19. The financial management of research centers and institutes at U.S. medical schools: findings from six institutions. (United States)

    Mallon, William T


    To explore three questions surrounding the financial management of research centers and institutes at U.S. medical schools: How do medical schools allocate institutional funds to centers and institutes? How and by whom are those decisions made? What are the implications of these decision-making models on the future of the academic biomedical research enterprise? Using a qualitative research design, the author and associates interviewed over 150 faculty members and administrators at six medical schools and their parent universities in 2004. Interview data were transcribed, coded, and analyzed using a grounded theory approach. This methodology generated rich descriptions and explanations of the six medical schools, which can produce extrapolations to, but not necessarily generalizable findings to, other institutions and settings. An examination of four dimensions of financial decision-making-funding timing, process, structure, and culture-produces two essential models of how medical schools approach the financial management of research centers. In the first, a "charity" model, center directors make hat-in-hand appeals directly to the dean, the result of which may depend on individual negotiation skills and personal relationships. In the second, a "planned-giving" model, the process for obtaining and renewing funds is institutionalized, agreed upon, and monitored. The ways in which deans, administrators, department chairs, and center directors attend to, decide upon, and carry out financial decisions can influence how people throughout the medical school think about interdisciplinary and collaborative activities marshalled though centers and institutes.

  20. Determination of Patterson group symmetry from sparse multi-crystal data sets in the presence of an indexing ambiguity. (United States)

    Gildea, Richard J; Winter, Graeme


    Combining X-ray diffraction data from multiple samples requires determination of the symmetry and resolution of any indexing ambiguity. For the partial data sets typical of in situ room-temperature experiments, determination of the correct symmetry is often not straightforward. The potential for indexing ambiguity in polar space groups is also an issue, although methods to resolve this are available if the true symmetry is known. Here, a method is presented to simultaneously resolve the determination of the Patterson symmetry and the indexing ambiguity for partial data sets. open access.

  1. Satellite medical centers project (United States)

    Aggarwal, Arvind


    World class health care for common man at low affordable cost: anywhere, anytime The project envisages to set up a national network of satellite Medical centers. Each SMC would be manned by doctors, nurses and technicians, six doctors, six nurses, six technicians would be required to provide 24 hour cover, each SMC would operate 24 hours x 7 days. It would be equipped with the Digital telemedicine devices for capturing clinical patient information and investigations in the form of voice, images and data and create an audiovisual text file - a virtual Digital patient. Through the broad band connectivity the virtual patient can be sent to the central hub, manned by specialists, specialists from several specialists sitting together can view the virtual patient and provide a specialized opinion, they can see the virtual patient, see the examination on line through video conference or even PCs, talk to the patient and the doctor at the SMC and controlle capturing of information during examination and investigations of the patient at the SMC - thus creating a virtual Digital consultant at the SMC. Central hub shall be connected to the doctors and consultants in remote locations or tertiary care hospitals any where in the world, thus creating a virtual hub the hierarchical system shall provide upgradation of knowledge to thedoctors in central hub and smc and thus continued medical education and benefit the patient thru the world class treatment in the smc located at his door step. SMC shall be set up by franchisee who shall get safe business opportunity with high returns, patients shall get Low cost user friendly worldclass health care anywhere anytime, Doctors can get better meaningful selfemplyment with better earnings, flexibility of working time and place. SMC shall provide a wide variety of services from primary care to world class Global consultation for difficult patients.

  2. Impact of a pharmacy technician-centered medication reconciliation program on medication discrepancies and implementation of recommendations. (United States)

    Kraus, Sarah K; Sen, Sanchita; Murphy, Michelle; Pontiggia, Laura


    To evaluate the impact of a pharmacy-technician centered medication reconciliation (PTMR) program by identifying and quantifying medication discrepancies and outcomes of pharmacist medication reconciliation recommendations. A retrospective chart review was performed on two-hundred patients admitted to the internal medicine teaching services at Cooper University Hospital in Camden, NJ. Patients were selected using a stratified systematic sample approach and were included if they received a pharmacy technician medication history and a pharmacist medication reconciliation at any point during their hospital admission. Pharmacist identified medication discrepancies were analyzed using descriptive statistics, bivariate analyses. Potential risk factors were identified using multivariate analyses, such as logistic regression and CART. The priority level of significance was set at 0.05. Three-hundred and sixty-five medication discrepancies were identified out of the 200 included patients. The four most common discrepancies were omission (64.7%), non-formulary omission (16.2%), dose discrepancy (10.1%), and frequency discrepancy (4.1%). Twenty-two percent of pharmacist recommendations were implemented by the prescriber within 72 hours. A PTMR program with dedicated pharmacy technicians and pharmacists identifies many medication discrepancies at admission and provides opportunities for pharmacist reconciliation recommendations.

  3. Impact of a pharmacy technician-centered medication reconciliation program on medication discrepancies and implementation of recommendations

    Directory of Open Access Journals (Sweden)

    Kraus SK


    Full Text Available Objectives: To evaluate the impact of a pharmacy-technician centered medication reconciliation (PTMR program by identifying and quantifying medication discrepancies and outcomes of pharmacist medication reconciliation recommendations. Methods: A retrospective chart review was performed on two-hundred patients admitted to the internal medicine teaching services at Cooper University Hospital in Camden, NJ. Patients were selected using a stratified systematic sample approach and were included if they received a pharmacy technician medication history and a pharmacist medication reconciliation at any point during their hospital admission. Pharmacist identified medication discrepancies were analyzed using descriptive statistics, bivariate analyses. Potential risk factors were identified using multivariate analyses, such as logistic regression and CART. The priority level of significance was set at 0.05. Results: Three-hundred and sixty-five medication discrepancies were identified out of the 200 included patients. The four most common discrepancies were omission (64.7%, non-formulary omission (16.2%, dose discrepancy (10.1%, and frequency discrepancy (4.1%. Twenty-two percent of pharmacist recommendations were implemented by the prescriber within 72 hours. Conclusion: A PTMR program with dedicated pharmacy technicians and pharmacists identifies many medication discrepancies at admission and provides opportunities for pharmacist reconciliation recommendations.

  4. An Architecture for Continuous Data Quality Monitoring in Medical Centers. (United States)

    Endler, Gregor; Schwab, Peter K; Wahl, Andreas M; Tenschert, Johannes; Lenz, Richard


    In the medical domain, data quality is very important. Since requirements and data change frequently, continuous and sustainable monitoring and improvement of data quality is necessary. Working together with managers of medical centers, we developed an architecture for a data quality monitoring system. The architecture enables domain experts to adapt the system during runtime to match their specifications using a built-in rule system. It also allows arbitrarily complex analyses to be integrated into the monitoring cycle. We evaluate our architecture by matching its components to the well-known data quality methodology TDQM.

  5. Dos modos de situarse en el lugar : Monticello de Thomas Jefferson y Taliesin de F. Lloyd Wright

    Directory of Open Access Journals (Sweden)

    Juan Antonio Cortés


    Full Text Available


    El artículo consiste en una descripción comparada de dos edificios: Monticello ‐la casa que Thomas Jefferson construyó para sí mismo en Virginia‐ y Taliesin ‐la casa y estudio de Frank Lloyd Wright en Wisconsin‐. El texto estudia en primer lugar las fuentes arquitectónicas y la evolución del proyecto de Monticello, para centrarse después en la explicación de Taliesin. Hay una cierta similitud en el modo en que Monticello y las casas de  Wright ‐en concreto la Ward Willitts‐ se extienden  horizontalmente en el terreno y, volviendo a Taliesin, la tesis  principal del texto es que tanto la residencia de Jefferson como la de Wright se asientan sobre una colina, pero Monticello  ‘corona’ su cima, mientras que Taliesin la bordea, se sitúa como  una ‘ceja’ respecto a la misma. En definitiva, de este  último edificio se puede afirmar que es una ‘casa natural’, que  logra una plena integración entre arquitectura y naturaleza.

    Palabras clave

    casa, proyecto, evolución, corona, natural


    This article consists of a comparative description of two buildings: Monticello, Thomas Jefferson’s residence which he  built for himself in Virginia, and Taliesin, the studio and home of Frank Lloyd Wright in Wisconsin. First, the text studies the  architectural references and evolution of the project for  Monticello, in order to later focus on explaining Taliesin. There is a certain similarity in the way that Monticello and Wright’s  houses (especially the Ward Willits House extend horizontally  across the land. The thesis of this article is that both Jefferson’s and Wright’s residences rest upon a hill, but Monticello crowns  the top while Taliesin borders it like an eyebrow. In conclusion, we can say that Taliesin is a “natural house”, which manages to fully integrate its architecture with nature

  6. Collaboration, Reputation, and Ethics in American Academic Life: Hans H. Gerth and C. Wright Mills. (United States)

    Oakes, Guy; Vidich, Arthur J.

    Using the collaboration between sociologist C. Wright Mills and Hans H. Gerth and their studies of the work of Max Weber as a point of departure for a sustained discussion of academic ethics, this book explores how concealment, secrecy, and deception contribute to the building of academic reputation and how the balance of knowledge and power in a…

  7. Richard Wright's Thematic Treatment of Women in "Uncle Tom's Children,""Black Boy," and "Native Son." (United States)

    Brewton, Butler E.

    Richard Wright's literary work emphasizes a contrast between black women and white women. Although both are "givers" to black boys, the nature of what they give is different. The black woman gives physical life, feeds it, and protects it at the expense of spiritual or creative vitality. Her goal is to survive bodily, to breathe, to have…

  8. The economic impact and multiplier effect of a family practice clinic on an academic medical center. (United States)

    Schneeweiss, R; Ellsbury, K; Hart, L G; Geyman, J P


    Academic medical centers are facing the need to expand their primary care referral base in an increasingly competitive medical environment. This study describes the medical care provided during a 1-year period to 6304 patients registered with a family practice clinic located in an academic medical center. The relative distribution of primary care, secondary referrals, inpatient admissions, and their associated costs are presented. The multiplier effect of the primary care clinic on the academic medical center was substantial. For every $1 billed for ambulatory primary care, there was $6.40 billed elsewhere in the system. Each full-time equivalent family physician generated a calculated sum of $784,752 in direct, billed charges for the hospital and $241,276 in professional fees for the other specialty consultants. The cost of supporting a primary care clinic is likely to be more than offset by the revenues generated from the use of hospital and referral services by patients who received care in the primary care setting.

  9. Promoting cancer screening within the patient centered medical home. (United States)

    Sarfaty, Mona; Wender, Richard; Smith, Robert


    While consensus has grown that primary care is the essential access point in a high-performing health care system, the current model of primary care underperforms in both chronic disease management and prevention. The Patient Centered Medical Home model (PCMH) is at the center of efforts to reinvent primary care practice, and is regarded as the most promising approach to addressing the burden of chronic disease, improving health outcomes, and reducing health spending. However, the potential for the medical home to improve the delivery of cancer screening (and preventive services in general) has received limited attention in both conceptualization and practice. Medical home demonstrations to date have included few evidence-based preventive services in their outcome measures, and few have evaluated the effect of different payment models. Decreasing use of hospitals and emergency rooms and an emphasis on improving chronic care represent improvements in effective delivery of healthcare, but leave opportunities for reducing the burden of cancer untouched. Data confirm that what does or does not happen in the primary care setting has a substantial impact on cancer outcomes. Insofar as cancer is the leading cause of death before age 80, the PCMH model must prioritize adherence to cancer screening according to recommended guidelines, and systems, financial incentives, and reimbursements must be aligned to achieve that goal. This article explores capacities that are needed in the medical home model to facilitate the integration of cancer screening and other preventive services. These capacities include improved patient access and communication, health risk assessments, periodic preventive health exams, use of registries that store cancer risk information and screening history, ability to track and follow up on tests and referrals, feedback on performance, and payment models that reward cancer screening. Copyright © 2011 American Cancer Society, Inc.

  10. Towards a person-centered medical education: challenges and imperatives (I

    Directory of Open Access Journals (Sweden)

    Andrew Miles


    Full Text Available It is increasingly claimed that modern medicine has entered into crisis —a crisis of knowledge (uncertainty over what counts as “evidence” for decision-making and what does not, care (a deficit in sympathy, empathy, compassion, dignity, autonomy, patient safety (neglect, iatrogenic injury, malpractice, excess deaths, economic costs (which threaten to bankrupt health systems worldwide and clinical and institutional governance (a failure of basic and advanced management, inspirational and transformational leadership. We believe such a contention to be essentially correct. In the current article, we ask how the delineated components of the crisis can be individually understood in order to allow them to be collectively addressed. We ask how a transition can be effected away from impersonal, decontextualized and fragmented services in the direction of newer models of service provision that are personalized, contextualized and integrated. How, we ask, can we improve healthcare outcomes while simultaneously containing or lowering their costs? In initial answer to such questions —which are of considerable political as well as clinical significance— we assert that a new approach has become necessary, particularly in the context of the current epidemic of multi-morbid and socially complex long term illness. This new approach, we argue, is represented by the development and application of the concepts and methods of person-centered healthcare (PCH, a philosophy and technique in the care of the sick that enables clinicians and health systems to re-introduce humanistic ideals into clinical practice alongside continuing scientific advance, thereby restoring to medicine the humanism it has lost in over a century of empiricism. But the delivery of a person-centered healthcare within health systems requires a person-centered education and training. In this article we consider, then, why person-centered teaching innovations in the undergraduate medical

  11. Selection and construction of nuclear and radiation emergency medical center in a region

    International Nuclear Information System (INIS)

    Wang Guojun; He Xu; Liao Li; Gao Dong


    Three level of first-class comprehensive hospital is an important force of nuclear and radiation accident rescue, has a very rich experience in response to nuclear and radiation accidents and deal with large quantities of the sick and wounded. With the foundation and the ability of the construction and operation of medical emergency rescue center. This paper according to the median model location theory of emergency center, combined with the specific situation of the nuclear and radiation accident in Hunan Province, reference location, rescue experience, emergency allocation of resources, teaching and research capacity, establish regional medical emergency center of nuclear and radiation accidents based on three level of first-class comprehensive hospital, break the traditional concept that the center must be provincial capital,form a multi-level, three-dimensional, network of emergency hospital rescue system. The main duties of the center are accident emergency response, on-site treatment and technical guidance of accident, psychological grooming. The author propose building measures according to the duties of the center: increase national and provincial financial investment, carry out training, drills and first aid knowledge missionaries regularly, innovative materials management, speed up the construction of information platform, establish and improve the hospital rescue system, improve organization institution and system of plans, reengineering rescue process. (authors)

  12. Cost-Benefit Analysis of Radiation Therapy Services at Tripler Army Medical Center

    National Research Council Canada - National Science Library

    Diehl, Diane S


    The purpose of this analysis was to examine the costs and benefits associated with continuance of "in-house" radiation therapy services to eligible beneficiaries at Tripler Army Medical Center (TAMC...

  13. Key Elements of Clinical Physician Leadership at an Academic Medical Center (United States)

    Dine, C. Jessica; Kahn, Jeremy M; Abella, Benjamin S; Asch, David A; Shea, Judy A


    Background A considerable body of literature in the management sciences has defined leadership and how leadership skills can be attained. There is considerably less literature about leadership within medical settings. Physicians-in-training are frequently placed in leadership positions ranging from running a clinical team or overseeing a resuscitation effort. However, physicians-in-training rarely receive such training. The objective of this study was to discover characteristics associated with effective physician leadership at an academic medical center for future development of such training. Methods We conducted focus groups with medical professionals (attending physicians, residents, and nurses) at an academic medical center. The focus group discussion script was designed to elicit participants' perceptions of qualities necessary for physician leadership. The lead question asked participants to imagine a scenario in which they either acted as or observed a physician leader. Two independent reviewers reviewed transcripts to identify key domains of physician leadership. Results Although the context was not specified, the focus group participants discussed leadership in the context of a clinical team. They identified 4 important themes: management of the team, establishing a vision, communication, and personal attributes. Conclusions Physician leadership exists in clinical settings. This study highlights the elements essential to that leadership. Understanding the physician attributes and behaviors that result in effective leadership and teamwork can lay the groundwork for more formal leadership education for physicians-in-training. PMID:22379520

  14. The Impact of Grading on a Curve: Assessing the Results of Kulick and Wright's Simulation Analysis (United States)

    Bailey, Gary L.; Steed, Ronald C.


    Kulick and Wright concluded, based on theoretical mathematical simulations of hypothetical student exam scores, that assigning exam grades to students based on the relative position of their exam performance scores within a normal curve may be unfair, given the role that randomness plays in any given student's performance on any given exam.…

  15. Gender Disparities in Faculty Rank: Factors that Affect Advancement of Women Scientists at Academic Medical Centers

    Directory of Open Access Journals (Sweden)

    Cristina M. López


    Full Text Available While a significant portion of women within academic science are employed within medical schools, women faculty in these academic medical centers are disproportionately represented in lower faculty ranks. The medical school setting is a critical case for both understanding and advancing women in basic sciences. This study highlights the findings from focus groups conducted with women faculty across Assistant, Associate, and Full Professor ranks (n = 35 in which they discussed barriers and facilitators for advancement of women basic scientists at an academic medical center. Qualitative analysis demonstrated several emergent themes that affect women’s advancement, including gendered expectation norms (e.g., good citizenship, volunteerism, work-life balance, mentorship/sponsorship, adoption of a team science approach, tenure process milestones, soft money research infrastructure, institution specific policies (or lack thereof, and operating within an MD-biased culture. These findings are compared with the extant literature of women scientists in STEM institutions. Factors that emerged from these focus groups highlight the need for evidence-based interventions in the often overlooked STEM arena of academic medical centers.

  16. Beamed Energy Propulsion by Means of Target Ablation

    International Nuclear Information System (INIS)

    Rosenberg, Benjamin A.


    This paper describes hundreds of pendulum tests examining the beamed energy conversion efficiency of different metal targets coated with multiple liquid enhancers. Preliminary testing used a local laser with photographic paper targets, with no liquid, water, canola oil, or methanol additives. Laboratory experimentation was completed at Wright-Patterson AFB using a high-powered laser, and ballistic pendulums of aluminum, titanium, or copper. Dry targets, and those coated with water, methanol and oil were repeatedly tested in laboratory conditions. Results were recorded on several high-speed digital video cameras, and the conversion efficiency was calculated. Paper airplanes successfully launched using BEP were likewise recorded

  17. The Wright Science Colloquia - Entering the Nano-World

    CERN Multimedia


    In 1965, Intel co-founder Gordon Moore made an astonishing prediction - that every year processing power would double. Although it was corrected to a period of 18 to 24 months in 1975, this prediction has always proved accurate. Accordingly, the first Intel processor produced in 1975 was equipped with 2,300 transistors whereas the latest edition has 55 million. That means 55 million etched components crammed into an area of about a square centimetre! Today we have this extraordinary process of miniaturisation to thank for cell phones, computers and other, ever more compact electronic marvels. But where will the miniaturisation race end? What will happen when electronic etchings reach the nano-scale (a millionth of a millimetre), approaching the size of an atom? How can we even start to comprehend this nano-world, whose laws are so different from our own, human-sized world? These fascinating questions are on the programme of the 10th Wright Science Colloquia from 18 to 22 November. Five world-renowned specia...

  18. 38 CFR 17.351 - Grants for the replacement and upgrading of equipment at Veterans Memorial Medical Center. (United States)


    ... replacement and upgrading of equipment at Veterans Memorial Medical Center. 17.351 Section 17.351 Pensions... Philippines § 17.351 Grants for the replacement and upgrading of equipment at Veterans Memorial Medical Center. Grants to assist the Republic of the Philippines in the replacement and upgrading of equipment and in...

  19. Clinical skill center: a review of present situation and importance in medical education curriculum

    Directory of Open Access Journals (Sweden)

    Haleh Talaei


    Full Text Available Clinical skill centers were designed in 1960, offers innovative, more effective clinical health care and treatment curriculum. Clinical skill center (CSC can provide a special facility for clinical and communication skills practice in a setting outside hospital wards in order to train students with enough confidence of confronting real patients. Learning clinical skills in these centers are not patient-dependent and by practicing on manikins and simulated models errors in real patients can be prevented. Moreover, possible feedback of this method can be used for evaluation and can improve quality and quantity of the education. This review intends to determine the purpose, undertaking, and structure of CSC. The study emphasizes the importance of integrating the clinical skill centers into the teaching curriculum of medical universities. Apparently, organizing clinical skill centers can play an important role for improving the quality and quantity of the educational system and consequently post-graduate performance. The authors recommend this program can be a solution for having both the knowledge and skill of diagnosis and treatment seasonal and rare diseases. Key words clinical skill center, medical education, curriculum

  20. A modified Wright-Fisher model that incorporates Ne: A variant of the standard model with increased biological realism and reduced computational complexity. (United States)

    Zhao, Lei; Gossmann, Toni I; Waxman, David


    The Wright-Fisher model is an important model in evolutionary biology and population genetics. It has been applied in numerous analyses of finite populations with discrete generations. It is recognised that real populations can behave, in some key aspects, as though their size that is not the census size, N, but rather a smaller size, namely the effective population size, Ne. However, in the Wright-Fisher model, there is no distinction between the effective and census population sizes. Equivalently, we can say that in this model, Ne coincides with N. The Wright-Fisher model therefore lacks an important aspect of biological realism. Here, we present a method that allows Ne to be directly incorporated into the Wright-Fisher model. The modified model involves matrices whose size is determined by Ne. Thus apart from increased biological realism, the modified model also has reduced computational complexity, particularly so when Ne⪡N. For complex problems, it may be hard or impossible to numerically analyse the most commonly-used approximation of the Wright-Fisher model that incorporates Ne, namely the diffusion approximation. An alternative approach is simulation. However, the simulations need to be sufficiently detailed that they yield an effective size that is different to the census size. Simulations may also be time consuming and have attendant statistical errors. The method presented in this work may then be the only alternative to simulations, when Ne differs from N. We illustrate the straightforward application of the method to some problems involving allele fixation and the determination of the equilibrium site frequency spectrum. We then apply the method to the problem of fixation when three alleles are segregating in a population. This latter problem is significantly more complex than a two allele problem and since the diffusion equation cannot be numerically solved, the only other way Ne can be incorporated into the analysis is by simulation. We have

  1. "Who Did Archaeology in the United States Before There Were Archaeologists and Why? Preprofessional Archaeologies of the Nineteenth Century." by Thomas C. Patterson. In Processual and Postprocessual Archaeologies, edited by Robert W. Preucel, Center for A

    Directory of Open Access Journals (Sweden)

    Alice B. Kehoe


    Full Text Available Patterson's paper is a condensation of two he had presented in 1988 and 1989, at conferences previous to the Carbondale Visiting Scholar Conference of 1989. He characterizes the early United States as harboring two contrasting political philosophies, agrarian versus mercantile capitalism. The agrarians, of whom Thomas Jefferson is of course the most illustrious example, followed the physiocrats in believing agricultural land to be the foundation of societies, therefore the manifest destiny of the new Republic was to conquer, and colonize more land. The mercantilists, primarily in Boston, emphasized civilization as the refinement of technologies, social order, and tastes. Both philosophies were cast in Enlightenment terms.

  2. Quantitative Analysis of Contributing Factors Affecting Patient Satisfaction in Family Medicine Service Clinics at Brooke Army Medical Center (United States)


    Predictors of patient satisfaction for Brooke Army Medical Center Family Medicine Service primary care clinics was performed. Data was obtained from...Factors Affecting Patient Satisfaction in Family Medicine Service Clinics at Brooke Army Medical Center Presented to MAJ Eric Schmacker, Ph.D. All patients ’ medical information was protected at all times and under no circumstances will be discussed or released to any outside agency


    Ronen, Ohad; Assadi, Nidal; Sela, Eyal


    For two years the State of Israel has been treating casualties from the Syrian civil war. The Galilee Medical Center in Nahariya is the main hospital for this humanitarian mission. Objectives: To evaluate the demographic and clinical characteristics of the casualties that were treated in our department. Information from medical records of all Syrian casualties evacuated to the Galilee Medical Center were evaluated. Between March 2013 and December 2014, 450 casualties were evacuated to the Galilee Medical Center. Of those, 45 were treated in the Department of Otolaryngology - Head and Neck Surgery. Of the 45 cases, 43 were male (95.5%) and the mean age was 30.4 years (range 1-79 years). There was a significant difference in terms of gender (p Syria, and 12 died. Of all Syrian injured treated in the ENT department, the vast majority were young men. The main cause of injury was gunshot wounds. It is likely that the lack of protective gear that exist in western armies is a factor in the complex injuries treated at the Galilee Medical Center.

  4. A 5-year scientometric analysis of research centers affiliated to Tehran University of Medical Sciences (United States)

    Yazdani, Kamran; Rahimi-Movaghar, Afarin; Nedjat, Saharnaz; Ghalichi, Leila; Khalili, Malahat


    Background: Since Tehran University of Medical Sciences (TUMS) has the oldest and highest number of research centers among all Iranian medical universities, this study was conducted to evaluate scientific output of research centers affiliated to Tehran University of Medical Sciences (TUMS) using scientometric indices and the affecting factors. Moreover, a number of scientometric indicators were introduced. Methods: This cross-sectional study was performed to evaluate a 5-year scientific performance of research centers of TUMS. Data were collected through questionnaires, annual evaluation reports of the Ministry of Health, and also from Scopus database. We used appropriate measures of central tendency and variation for descriptive analyses. Moreover, uni-and multi-variable linear regression were used to evaluate the effect of independent factors on the scientific output of the centers. Results: The medians of the numbers of papers and books during a 5-year period were 150.5 and 2.5 respectively. The median of the "articles per researcher" was 19.1. Based on multiple linear regression, younger age centers (p=0.001), having a separate budget line (p=0.016), and number of research personnel (p<0.001) had a direct significant correlation with the number of articles while real properties had a reverse significant correlation with it (p=0.004). Conclusion: The results can help policy makers and research managers to allocate sufficient resources to improve current situation of the centers. Newly adopted and effective scientometric indices are is suggested to be used to evaluate scientific outputs and functions of these centers. PMID:26157724

  5. The Institute for Safe Medication Practices and Poison Control Centers: Collaborating to Prevent Medication Errors and Unintentional Poisonings. (United States)

    Vaida, Allen J


    This article provides an overview on the Institute for Safe Medication Practices (ISMP), the only independent nonprofit organization in the USA devoted to the prevention of medication errors. ISMP developed the national Medication Errors Reporting Program (MERP) and investigates and analyzes errors in order to formulate recommendations to prevent further occurrences. ISMP works closely with the US Food and Drug Administration (FDA), drug manufacturers, professional organizations, and others to promote changes in package design, practice standards, and healthcare practitioner and consumer education. By collaborating with ISMP to share and disseminate information, Poison Control centers, emergency departments, and toxicologists can help decrease unintentional and accidental poisonings.

  6. Patient-centered medical homes in Louisiana had minimal impact on Medicaid population's use of acute care and costs. (United States)

    Cole, Evan S; Campbell, Claudia; Diana, Mark L; Webber, Larry; Culbertson, Richard


    The patient-centered medical home model of primary care has received considerable attention for its potential to improve outcomes and reduce health care costs. Yet little information exists about the model's ability to achieve these goals for Medicaid patients. We sought to evaluate the effect of patient-centered medical home certification of Louisiana primary care clinics on the quality and cost of care over time for a Medicaid population. We used a quasi-experimental pre-post design with a matched control group to assess the effect of medical home certification on outcomes. We found no impact on acute care use and modest support for reduced costs and primary care use among medical homes serving higher proportions of chronically ill patients. These findings provide preliminary results related to the ability of the patient-centered medical home model to improve outcomes for Medicaid beneficiaries. The findings support a case-mix-adjusted payment policy for medical homes going forward. Project HOPE—The People-to-People Health Foundation, Inc.

  7. 76 FR 59407 - Center for Biologics Evaluation and Research Report of Scientific and Medical Literature and... (United States)


    ...] Center for Biologics Evaluation and Research Report of Scientific and Medical Literature and Information... Administration (FDA) is announcing the availability of its report of scientific and medical literature and... Research Report of Scientific and Medical Literature and Information on Non-Standardized Allergenic...

  8. Activities of an ethics consultation service in a Tertiary Military Medical Center. (United States)

    Waisel, D B; Vanscoy, S E; Tice, L H; Bulger, K L; Schmelz, J O; Perucca, P J


    The Joint Commission on Accreditation of Healthcare Organizations requires hospitals to have a mechanism to address issues of medical ethics. Most hospitals, especially those in the military, have an ethics committee composed solely of members who serve as an additional duty. To enhance the ethics consultation service, the 59th Medical Wing created a position under the chief of the medical staff for a full-time, fellowship-trained, medical ethicist. After establishment of this position, the number of consultations increased, a systematic program for caregiver education was developed and delivered, and an organizational presence was achieved by instituting positions on the institutional review board, the executive committee of the medical staff, and the credentials committee. Issues in medical care are becoming increasingly complicated, due in large part to financial stresses and technological advancements. Ethics consultation can help prevent and resolve many of these problems. This report discusses the activities of the first year of a full-time ethicist in a tertiary military medical center.

  9. Aerial radiological survey of the US Department of Energy's Mound Facility, Miamisburg, Ohio

    International Nuclear Information System (INIS)


    An aerial radiological survey to measure terrestrial gamma radiation was carried out by helicopter over an area centered on Mound Facility, a 180 acre area adjacent to the southern edge of the city of Miamisburg, Ohio. This survey was part of an effort to document background radiation levels around nuclear processing and handling facilities owned or contracted by the United States Department of Energy (DOE). Survey activities were conducted and performed by EG and G for the DOE. Wright-Patterson Air Force Base served as the survey base of operations. During the survey, gamma ray data were collected over a 12.3 km 2 area by flying an east-west grid of lines spaced 61 m apart, flying slowly over several selected areas, and hovering over several spots of interest. The processed data indicated that the on-site radioactivity was primarily due to radionuclides currently being handled or processed at the Facility, and that lesser activity could be attributed to previously handled or processed nuclear materials. Off-site data showed the radioactivity to be that only due to naturally occurring radionuclides

  10. Implementation of epic beaker anatomic pathology at an academic medical center

    Directory of Open Access Journals (Sweden)

    John Larry Blau


    Full Text Available Background: Beaker is a relatively new laboratory information system (LIS offered by Epic Systems Corporation as part of its suite of health-care software and bundled with its electronic medical record, EpicCare. It is divided into two modules, Beaker anatomic pathology (Beaker AP and Beaker Clinical Pathology. In this report, we describe our experience implementing Beaker AP version 2014 at an academic medical center with a go-live date of October 2015. Methods: This report covers preimplementation preparations and challenges beginning in September 2014, issues discovered soon after go-live in October 2015, and some post go-live optimizations using data from meetings, debriefings, and the project closure document. Results: We share specific issues that we encountered during implementation, including difficulties with the proposed frozen section workflow, developing a shared specimen source dictionary, and implementation of the standard Beaker workflow in large institution with trainees. We share specific strategies that we used to overcome these issues for a successful Beaker AP implementation. Several areas of the laboratory-required adaptation of the default Beaker build parameters to meet the needs of the workflow in a busy academic medical center. In a few areas, our laboratory was unable to use the Beaker functionality to support our workflow, and we have continued to use paper or have altered our workflow. In spite of several difficulties that required creative solutions before go-live, the implementation has been successful based on satisfaction surveys completed by pathologists and others who use the software. However, optimization of Beaker workflows has continued to be an ongoing process after go-live to the present time. Conclusions: The Beaker AP LIS can be successfully implemented at an academic medical center but requires significant forethought, creative adaptation, and continued shared management of the ongoing product by

  11. Burnout among nurses working in medical and educational centers in Shahrekord, Iran (United States)

    Moghaddasi, Jaefar; Mehralian, Hossein; Aslani, Yousef; Masoodi, Reza; Amiri, Masoud


    Background: Nursing burnout is the main characteristic of job stress that is a delayed reaction to chronic stressful situations in the workplace which could affect nurses who do not have sufficient emotional energy to cope and communicate with different types of patients. There is also sometimes this belief that they do not have the required capabilities for their jobs. The aim of this study was the evaluation of burnout among nurses working in medical and educational centers in Shahrekord. Materials and Methods: This descriptive study was performed on 340 nurses working in medical and educational centers in Shahrekord in 2009. Samples were selected using proportionate random sampling. Demographic information and the Maslach Burnout Inventory (MBI) were filled in for all nurses. Results: Burnout was considerable among nurses. The results showed that 34.6, 28.8, and 95.7% of the nurses had emotional exhaustion (EE), high depersonalization (DP), and high reduced personal accomplishment (PA), respectively. The mean scores (± standard deviation) for EE, DP, and PA were 22.77 (12.44), 6.99 (6.23), and 32.20 (9.26), respectively. Conclusions: Our results showed that burnout was noticeable among nurses working in medical and educational centers in Shahrekord. Disproportionate relationship between the number of nurses, workload, and income was the most important factor affecting nursing burnout. Due to the importance of nursing in the health-care system, policy makers should adopt suitable strategies for increasing the satisfaction of nurses. PMID:24403925

  12. User-centered design of a mobile medication management. (United States)

    Sedlmayr, Brita; Schöffler, Jennifer; Prokosch, Hans-Ulrich; Sedlmayr, Martin


    The use of a nationwide medication plan has been promoted as an effective strategy to improve patient safety in Germany. However, the medication plan only exists as a paper-based version, which is related to several problems, that could be circumvented by an electronic alternative. The main objective of this study was to report on the development of a mobile interface concept to support the management of medication information. The human-centered design (UCD) process was chosen. First the context of use was analyzed, and personas and an interaction concept were designed. Next, a paper prototype was developed and evaluated by experts. Based on those results, a medium-fidelity prototype was created and assessed by seven end-users who performed a thinking-aloud test in combination with a questionnaire based on the System Usability Scale (SUS). Initially for one persona/user type, an interface design concept was developed, which received an average SUS-Score of 92.1 in the user test. Usability problems have been solved so that the design concept could be fixed for a future implementation. Contribution: The approach of the UCD process and the methods involved can be applied by other researchers as a framework for the development of similar applications.

  13. Wright-Patterson AFB, Ohio Revised Uniform Summary of Surface Weather Observations (RUSSWO). Parts A-F. (United States)


    LSTI: ISO -1700 ............. [..........................................NO" ........". OT5...................................................... I WIND...90.3 91.1 91.3 91.4 91.6 92.6 91.b 9i.T 91.7 91.7 91.7 E iso 51.i8 - 76.9 82.1 8b. 90.7 90.7 92.s 92.7 92.8 93.0 93.0 93.0 93.1 93.1 93.1 93.1 FE 2000...97.4 91.4 97.% 91.4 97.4 GE 27003 55.1 79.4 84.4 90.1 95.7 96.8 97.1 98.0 88.1 98.1 98.1 98.1 91.3 98.1 98.1 98.1 UE 18001 55.1 79.5 84.5 90.? 95.8 96.9

  14. Environmental Assessment for BRAC Facilities and Remote Field Training Site, Wright-Patterson Air Force Base (United States)


    survey (BHE, 2001). Radio tracking of these two bats confirmed the presence of a maternity colony in a dead slippery elm (Ulmus rubra) in a woodlot...The most common trees observed were black walnut (Juglans nigra), elm (Ulmus spp.), eastern cottonwood, willow, ash (Fraxinus americana), sycamore

  15. Quality improvement in healthcare delivery utilizing the patient-centered medical home model. (United States)

    Akinci, Fevzi; Patel, Poonam M


    Despite the fact that the United States dedicates so much of its resources to healthcare, the current healthcare delivery system still faces significant quality challenges. The lack of effective communication and coordination of care services across the continuum of care poses disadvantages for those requiring long-term management of their chronic conditions. This is why the new transformation in healthcare known as the patient-centered medical home (PCMH) can help restore confidence in our population that the healthcare services they receive is of the utmost quality and will effectively enhance their quality of life. Healthcare using the PCMH model is delivered with the patient at the center of the transformation and by reinvigorating primary care. The PCMH model strives to deliver effective quality care while attempting to reduce costs. In order to relieve some of our healthcare system distresses, organizations can modify their delivery of care to be patient centered. Enhanced coordination of services, better provider access, self-management, and a team-based approach to care represent some of the key principles of the PCMH model. Patients that can most benefit are those that require long-term management of their conditions such as chronic disease and behavioral health patient populations. The PCMH is a feasible option for delivery reform as pilot studies have documented successful outcomes. Controversy about the lack of a medical neighborhood has created concern about the overall sustainability of the medical home. The medical home can stand independently and continuously provide enhanced care services as a movement toward higher quality care while organizations and government policy assess what types of incentives to put into place for the full collaboration and coordination of care in the healthcare system.

  16. Cross-cultural medical education: can patient-centered cultural competency training be effective in non-Western countries? (United States)

    Ho, Ming-Jung; Yao, Grace; Lee, Keng-Lin; Beach, Mary Catherine; Green, Alexander R


    No evidence addresses the effectiveness of patient-centered cultural competence training in non-Western settings. To examine whether a patient-centered cultural competency curriculum improves medical students' skills in eliciting the patients' perspective and exploring illness-related social factors. Fifty-seven medical students in Taiwan were randomly assigned to either the control (n = 27) or one of two intervention groups: basic (n = 15) and extensive (n = 15). Both intervention groups received two 2-hour patient-centered cultural competency workshops. In addition, the extensive intervention group received a 2-hour practice session. The control group received no training. At the end of the clerkship, all students were evaluated with an objective structured clinical examination (OSCE). Students in the extensive intervention group scored significantly higher than the basic intervention and control groups in eliciting the patient's perspective (F = 18.38, p social factors (F = 6.66, p = 0.003, eta(2) = 0.20). Patient-centered cultural competency training can produce improvement in medical students' cross-cultural communication skills in non-Western settings, especially when adequate practice is provided.

  17. Spectrum of tablet computer use by medical students and residents at an academic medical center

    Directory of Open Access Journals (Sweden)

    Robert Robinson


    Full Text Available Introduction. The value of tablet computer use in medical education is an area of considerable interest, with preliminary investigations showing that the majority of medical trainees feel that tablet computers added value to the curriculum. This study investigated potential differences in tablet computer use between medical students and resident physicians.Materials & Methods. Data collection for this survey was accomplished with an anonymous online questionnaire shared with the medical students and residents at Southern Illinois University School of Medicine (SIU-SOM in July and August of 2012.Results. There were 76 medical student responses (26% response rate and 66 resident/fellow responses to this survey (21% response rate. Residents/fellows were more likely to use tablet computers several times daily than medical students (32% vs. 20%, p = 0.035. The most common reported uses were for accessing medical reference applications (46%, e-Books (45%, and board study (32%. Residents were more likely than students to use a tablet computer to access an electronic medical record (41% vs. 21%, p = 0.010, review radiology images (27% vs. 12%, p = 0.019, and enter patient care orders (26% vs. 3%, p < 0.001.Discussion. This study shows a high prevalence and frequency of tablet computer use among physicians in training at this academic medical center. Most residents and students use tablet computers to access medical references, e-Books, and to study for board exams. Residents were more likely to use tablet computers to complete clinical tasks.Conclusions. Tablet computer use among medical students and resident physicians was common in this survey. All learners used tablet computers for point of care references and board study. Resident physicians were more likely to use tablet computers to access the EMR, enter patient care orders, and review radiology studies. This difference is likely due to the differing educational and professional demands placed on

  18. Community pharmacist collaboration with a patient-centered medical home: Establishment of a patient-centered medical neighborhood and payment model. (United States)

    Luder, Heidi R; Shannon, Pam; Kirby, James; Frede, Stacey M

    To determine the feasibility of a partnership between a community pharmacy and a patient-centered medical home (PCMH) by measuring the impact on office- and patient-level clinical outcomes. Kroger Pharmacy and a PCMH practice in Cincinnati, OH. The Kroger Co. is a large grocery store chain that operates 102 pharmacies in the Cincinnati-Dayton marketing area. The PCMH practice is an accredited PCMH office serving more than 9000 patients in the Cincinnati area. In a medical neighborhood, a PCMH coordinates care with other local specialty practices or partners. A partnership between the community pharmacy chain and the PCMH was established to create a medical neighborhood. The pharmacist spent 2 half-days per week at the PCMH. The pharmacist provided initial medication therapy management appointments in the PCMH and offered follow-up services in the office, the pharmacy, or both, depending on patient preference. The pharmacy received a capitated payment per patient per month for a predetermined number of 1000 high-risk patients. Office-level changes in clinical outcomes such as A1C, blood pressure, and lipid measures were collected and compared with those of a similar control office. In addition, patient-level outcomes such as change in A1C, blood pressure, lipids, and weight were measured. One hundred five patients were seen by the pharmacist during the study period, with 1.5% of the total managed at the office. There was a statistically significant increase in influenza vaccinations received. On a patient level, A1C and systolic blood pressure significantly improved. This project represents an exciting opportunity for community pharmacists to expand their scope of services through direct partnership with PCMHs and maintain a sustainable reimbursement structure. Copyright © 2018. Published by Elsevier Inc.

  19. Development of a Hospital-based Massage Therapy Course at an Academic Medical Center. (United States)

    Dion, Liza J; Cutshall, Susanne M; Rodgers, Nancy J; Hauschulz, Jennifer L; Dreyer, Nikol E; Thomley, Barbara S; Bauer, Brent


    Massage therapy is offered increasingly in US medical facilities. Although the United States has many massage schools, their education differs, along with licensure and standards. As massage therapy in hospitals expands and proves its value, massage therapists need increased training and skills in working with patients who have various complex medical concerns, to provide safe and effective treatment. These services for hospitalized patients can impact patient experience substantially and provide additional treatment options for pain and anxiety, among other symptoms. The present article summarizes the initial development and description of a hospital-based massage therapy course at a Midwest medical center. A hospital-based massage therapy course was developed on the basis of clinical experience and knowledge from massage therapists working in the complex medical environment. This massage therapy course had three components in its educational experience: online learning, classroom study, and a 25-hr shadowing experience. The in-classroom study portion included an entire day in the simulation center. The hospital-based massage therapy course addressed the educational needs of therapists transitioning to work with interdisciplinary medical teams and with patients who have complicated medical conditions. Feedback from students in the course indicated key learning opportunities and additional content that are needed to address the knowledge and skills necessary when providing massage therapy in a complex medical environment. The complexity of care in medical settings is increasing while the length of hospital stay is decreasing. For this reason, massage provided in the hospital requires more specialized training to work in these environments. This course provides an example initial step in how to address some of the educational needs of therapists who are transitioning to working in the complex medical environment.

  20. The patient-centered medical home: an ethical analysis of principles and practice. (United States)

    Braddock, Clarence H; Snyder, Lois; Neubauer, Richard L; Fischer, Gary S


    The patient-centered medical home (PCMH), with its focus on patient-centered care, holds promise as a way to reinvigorate the primary care of patients and as a necessary component of health care reform. While its tenets have been the subject of review, the ethical dimensions of the PCMH have not been fully explored. Consideration of the ethical foundations for the core principles of the PCMH can and should be part of the debate concerning its merits. The PCMH can align with the principles of medical ethics and potentially strengthen the patient-physician relationship and aspects of health care that patients value. Patient choice and these ethical considerations are central and at least as important as the economic and practical arguments in support of the PCMH, if not more so. Further, the ethical principles that support key concepts of the PCMH have implications for the design and implementation of the PCMH. This paper explores the PCMH in light of core principles of ethics and professionalism, with an emphasis both on how the concept of the PCMH may reinforce core ethical principles of medical practice and on further implications of these principles.

  1. Evaluation of the ASCO Value Framework for Anticancer Drugs at an Academic Medical Center. (United States)

    Wilson, Leslie; Lin, Tracy; Wang, Ling; Patel, Tanuja; Tran, Denise; Kim, Sarah; Dacey, Katie; Yuen, Courtney; Kroon, Lisa; Brodowy, Bret; Rodondi, Kevin


    Anticancer drug prices have increased by an average of 12% each year from 1996 to 2014. A major concern is that the increasing cost and responsibility of evaluating treatment options are being shifted to patients. This research compared 2 value-based pricing models that were being considered for use at the University of California, San Francisco (UCSF) Medical Center to address the growing burden of high-cost cancer drugs while improving patient-centered care. The Medication Outcomes Center (MOC) in the Department of Clinical Pharmacy, University of California, San Francisco (UCSF), School of Pharmacy focuses on assessing the value of medication-related health care interventions and disseminating findings to the UCSF Medical Center. The High Cost Oncology Drug Initiative at the MOC aims to assess and adopt tools for the critical assessment and amelioration of high-cost cancer drugs. The American Society of Clinical Oncology (ASCO) Value Framework (2016 update) and a cost-effectiveness analysis (CEA) framework were identified as potential tools for adoption. To assess 1 prominent value framework, the study investigators (a) asked 8 clinicians to complete the ASCO Value Framework for 11 anticancer medications selected by the MOC; (b) reviewed CEAs assessing the drugs; (c) generated descriptive statistics; and (d) analyzed inter-rater reliability, convergence validity, and ranking consistency. On the scale of -20 to 180, the mean ASCO net health benefit (NHB) total score across 11 drugs ranged from 7.6 (SD = 7.8) to 53 (SD = 9.8). The Kappa coefficient (κ) for NHB scores across raters was 0.11, which is categorized as "slightly reliable." The combined κ score was 0.22, which is interpreted as low to fair inter-rater reliability. Convergent validity indicates that the correlation between NHB scores and CEA-based incremental cost-effectiveness ratios (ICERs) was low (-0.215). Ranking of ICERs, ASCO scores, and wholesale acquisition costs indicated different results

  2. The First Nine Months of Editing Wittgenstein - Letters from G.E.M. Anscombe and Rush Rhees to G.H. von Wright

    Directory of Open Access Journals (Sweden)

    Christian Eric Erbacher


    Full Text Available The National Library of Finland (NLF and the Von Wright and Wittgenstein Archives at the University of Helsinki (WWA keep the collected correspondence of Georg Henrik von Wright, Wittgenstein’s friend and successor at Cambridge and one of the three literary executors of Wittgenstein’s Nachlass. Among von Wright’s correspondence partners, Elizabeth Anscombe and Rush Rhees are of special interest to Wittgenstein scholars as the two other trustees of the Wittgenstein papers. Thus, von Wright’s collections held in Finland promise to shed light on the context of decades of editorial work that made Wittgenstein’s later philosophy available to all interested readers. In this text, we present the letters which von Wright received from Anscombe and Rhees during the first nine months after Wittgenstein’s death. This correspondence provides a vivid picture of the literary executors as persons and of their developing relationships. The presented letters are beautiful examples of what the correspondence as a whole has to offer; it depicts – besides facts of editing – the story of three philosophers, whose conversing voices unfold the human aspects of inheriting Wittgenstein’s Nachlass. Their story does not only deal with editing the papers of an eminent philosopher, but with the attempt to do justice to the man they knew, to his philosophy and to his wishes for publication.

  3. Development of a Risk-Based Decision-Support-Model for Protecting an Urban Medical Center from a Nuclear Explosion

    International Nuclear Information System (INIS)

    Ben-Dor, G.; Shohet, I.M.; Ornai, D.; Brosh, B.


    Nuclear explosion is the worst man-made physical threat on the human society. The nuclear explosion includes several consequences, some of them are immediate and others are long term. The major influences are: long duration blast, extreme thermal release, nuclear radiations, and electro-magnetic pulse (EMP). Their damage range is very wide. When nuclear explosion occurs above or in an urban area it is possible that one or more medical centers will be affected. Medical centers include several layers of structures defined by their resistance capacity to the nuclear explosion influences, beginning with the structure's frame and ending with different systems and with vulnerable medical critical infrastructures such as communications, medical gas supply, etc. A comprehensive literature survey revealed that in spite of the necessity and the importance of medical centers in the daily life and especially in emergency and post nuclear explosion, there is a lack of research on this topic

  4. Marion duPont Scott Equine Medical Center offers new treatment for lameness


    Musick, Marjorie


    The Virginia-Maryland Regional College of Veterinary Medicine's Marion duPont Scott Equine Medical Center has begun offering a new therapy for treating lameness associated with osteoarthritis and cartilage damage in horses, a problem that affects all segments of the equine industry.

  5. Creating and sustainable development of specialized centers as a way to improve quality of medical care

    Directory of Open Access Journals (Sweden)

    V. I. Guzeva


    Full Text Available Quality of care is evaluated on the completeness of the survey, the correct diagnosis, treatment efficacy, and its duration. Improving the quality and efficiency of medical care for children with paroxysmal disorders of consciousness is one of topical problems of neurology.Aim. The aim of the work is to justify the relationship between improving the quality of health care and sustainable development in the modern conditions of specialized medical centers on the example of the work on the identification and treatment of children with paroxysmal disorders of consciousness of the Center for diagnosis and treatment of epilepsy, and sleep disorders in children and adolescents at the department neurology, neurosurgery and medical genetics SPbGPMU.Materials and methods. For more accurate diagnosis and treatment at the Center conducted a comprehensive examination, including video-EEG оf 527 children aged 1 month to 18 years. A clinical trial study included medical cases, assessment of neurological and somatic status, the study of seizure types and forms of the disease. Instrumental methods of examination were determined by EEG and MRI studies of the brain.Main results. Comprehensive survey of sick children with monitoring video-EEG revealed that 317 children (60,1% had epileptic paroxysms and 210 children (39,8% – non-epileptic paroxysms. Correction treatment was performed in 284 (89,5% children with epileptic paroxysms and altered the treatment in 190 (90,4% children with epileptic paroxysms.Conclusion. The presented clinical data show the high effectiveness of the Centre in the diagnosis and treatment of children with paroxysmal disorders of consciousness. The accumulated experience in the Center confirms the relevance of the creation of the structure of scientific and educational institutions specialized centers in which patients will be given to high-quality medical care.

  6. Factors that influence the choice to work in rural township health centers among 4,669 clinical medical students from five medical universities in Guangxi, China. (United States)

    Qing, Yunbo; Hu, Guijie; Chen, Qingyun; Peng, Hailun; Li, Kailan; Wei, Jinling; Yi, Yanhua


    To produce competent undergraduate-level medical doctors for rural township health centers (THCs), the Chinese government mandated that medical colleges in Central and Western China recruit rural-oriented, tuition-waived medical students (RTMSs) starting in 2010. This study aimed to identify and assess factors that influence the choice to work in rural township health centers among both RTMSs and other students from five medical universities in Guangxi, China. An internet-based self-administered questionnaire survey was conducted with medical students in Guangxi province. Multinomial logistic regression was used to identify factors related to the attitudes toward work in a rural township health center. Among 4,669 medical students, 1,523 (33%) had a positive attitude and 2,574 (55%) had a neutral attitude toward working in THCs. Demographic characteristics, personal job concerns, and knowledge of THCs were associated with the choice of a career in THCs. The factors related to a positive attitude included the following: three-year program, a rural-oriented medical program, being male, an expectation of working in a county or township, a focus on medical career development, some perceived difficulty of getting a job, having family support, sufficient knowledge of THCs, optimism toward THC development, seeking lower working pressure, and a lower expected monthly salary. Male students in a three-year program or a rural-oriented tuition-waived medical education program were more likely to work in THCs. Selecting medical students through interviews to identify their family support and intentions to work in THCs would increase recruitment and retention. Establishing favorable policies and financial incentives to improve living conditions and the social status of rural physicians is necessary.

  7. Factors that influence the choice to work in rural township health centers among 4,669 clinical medical students from five medical universities in Guangxi, China

    Directory of Open Access Journals (Sweden)

    Yunbo Qing


    Full Text Available Purpose: To produce competent undergraduate-level medical doctors for rural township health centers (THCs, the Chinese government mandated that medical colleges in Central and Western China recruit rural-oriented, tuition-waived medical students (RTMSs starting in 2010. This study aimed to identify and assess factors that influence the choice to work in rural township health centers among both RTMSs and other students from five medical universities in Guangxi, China. Methods: An internet-based self-administered questionnaire survey was conducted with medical students in Guangxi province. Multinomial logistic regression was used to identify factors related to the attitudes toward work in a rural township health center. Results: Among 4,669 medical students, 1,523 (33% had a positive attitude and 2,574 (55% had a neutral attitude toward working in THCs. Demographic characteristics, personal job concerns, and knowledge of THCs were associated with the choice of a career in THCs. The factors related to a positive attitude included the following: three-year program, a rural-oriented medical program, being male, an expectation of working in a county or township, a focus on medical career development, some perceived difficulty of getting a job, having family support, sufficient knowledge of THCs, optimism toward THC development, seeking lower working pressure, and a lower expected monthly salary. Conclusion: Male students in a three-year program or a rural-oriented tuition-waived medical education program were more likely to work in THCs. Selecting medical students through interviews to identify their family support and intentions to work in THCs would increase recruitment and retention. Establishing favorable policies and financial incentives to improve living conditions and the social status of rural physicians is necessary.

  8. Prospects for rebuilding primary care using the patient-centered medical home. (United States)

    Landon, Bruce E; Gill, James M; Antonelli, Richard C; Rich, Eugene C


    Existing research suggests that models of enhanced primary care lead to health care systems with better performance. What the research does not show is whether such an approach is feasible or likely to be effective within the U.S. health care system. Many commentators have adopted the model of the patient-centered medical home as policy shorthand to address the reinvention of primary care in the United States. We analyze potential barriers to implementing the medical home model for policy makers and practitioners. Among others, these include developing new payment models, as well as the need for up-front funding to assemble the personnel and infrastructure required by an enhanced non-visit-based primary care practice and methods to facilitate transformation of existing practices to functioning medical homes.

  9. Collaborating to improve the global competitiveness of US academic medical centers. (United States)

    Allen, Molly; Garman, Andrew; Johnson, Tricia; Hohmann, Samuel; Meurer, Steve


    President Obama announced the National Export Initiative in his 2010 State of the Union address and set the ambitious goal of doubling US exports by the end of 2014 to support millions of domestic jobs. Understanding the competitive position of US health care in the global market for international patients, University Health System Consortium (UHC), an alliance of 116 academic medical centers and 272 of their affiliated hospitals, representing 90 percent of the nation's non-profit academic medical centers partnered with Rush University, a private University in Chicago, IL and the International Trade Administration of the US Department of Commerce International Trade Administration (ITA) to participate in the Market Development Cooperator Program. The goal of this private-public partnership is to increase the global competitiveness of the US health care industry, which represents over 16 percent of the GDP, amongst foreign health care providers. This article provides an overview of the US health care market and outlines the aims of the US Cooperative for International Patient Programs, the end result of the partnership between UHC, ITA and Rush University.

  10. Syndrome surveillance of fentanyl-laced heroin outbreaks: Utilization of EMS, Medical Examiner and Poison Center databases. (United States)

    Moore, P Quincy; Weber, Joseph; Cina, Steven; Aks, Steven


    Describe surveillance data from three existing surveillance systems during an unexpected fentanyl outbreak in a large metropolitan area. We performed a retrospective analysis of three data sets: Chicago Fire Department EMS, Cook County Medical Examiner, and Illinois Poison Center. Each included data from January 1, 2015 through December 31, 2015. EMS data included all EMS responses in Chicago, Illinois, for suspected opioid overdose in which naloxone was administered and EMS personnel documented other criteria indicative of opioid overdose. Medical Examiner data included all deaths in Cook County, Illinois, related to heroin, fentanyl or both. Illinois Poison Center data included all calls in Chicago, Illinois, related to fentanyl, heroin, and other prescription opioids. Descriptive statistics using Microsoft Excel® were used to analyze the data and create figures. We identified a spike in opioid-related EMS responses during an 11-day period from September 30-October 10, 2015. Medical Examiner data showed an increase in both fentanyl and mixed fentanyl/heroin related deaths during the months of September and October, 2015 (375% and 550% above the median, respectively.) Illinois Poison Center data showed no significant increase in heroin, fentanyl, or other opioid-related calls during September and October 2015. Our data suggests that EMS data is an effective real-time surveillance mechanism for changes in the rate of opioid overdoses. Medical Examiner's data was found to be valuable for confirmation of EMS surveillance data and identification of specific intoxicants. Poison Center data did not correlate with EMS or Medical Examiner data. Copyright © 2017 Elsevier Inc. All rights reserved.

  11. Program review of the USDA Center for Medical, Agricultural and Veterinary Entomology (United States)

    The USDA-ARS Center for Medical, Agricultural and Veterinary Entomology (CMAVE) has a history that starts in 1932 in Orlando to develop methods to control mosquitoes, including malaria vectors under conditions simulating those of the south Pacific jungles, and other insects affecting man and animals...

  12. Challenges and Opportunities to Improve Cervical Cancer Screening Rates in US Health Centers through Patient-Centered Medical Home Transformation

    Directory of Open Access Journals (Sweden)

    Olga Moshkovich


    Full Text Available Over the last 50 years, the incidence of cervical cancer has dramatically decreased. However, health disparities in cervical cancer screening (CCS persist for women from racial and ethnic minorities and those residing in rural and poor communities. For more than 45 years, federally funded health centers (HCs have been providing comprehensive, culturally competent, and quality primary health care services to medically underserved communities and vulnerable populations. To enhance the quality of care and to ensure more women served at HCs are screened for cervical cancer, over eight HCs received funding to support patient-centered medical home (PCMH transformation with goals to increase CCS rates. The study conducted a qualitative analysis using Atlas.ti software to describe the barriers and challenges to CCS and PCMH transformation, to identify potential solutions and opportunities, and to examine patterns in barriers and solutions proposed by HCs. Interrater reliability was assessed using Cohen’s Kappa. The findings indicated that HCs more frequently described patient-level barriers to CCS, including demographic, cultural, and health belief/behavior factors. System-level barriers were the next commonly cited, particularly failure to use the full capability of electronic medical records (EMRs and problems coordinating with external labs or providers. Provider-level barriers were least frequently cited.

  13. Medication therapy management clinic: perception of healthcare professionals in a University medical center setting

    Directory of Open Access Journals (Sweden)

    Shah M


    Full Text Available Objective: To determine the overall perception and utilization of the pharmacist managed medication therapy management (MTM clinic services, by healthcare professionals in a large, urban, university medical care setting.Methods: This was a cross-sectional, anonymous survey sent to 195 healthcare professionals, including physicians, nurses, and pharmacists at The University of Illinois Outpatient Care Center to determine their perception and utilization of the MTM clinic. The survey consisted of 12 questions and was delivered through a secure online application. Results: Sixty-two healthcare professionals (32% completed the survey. 82% were familiar with the MTM clinic, and 63% had referred patients to the clinic. Medication adherence and disease state management was the most common reason for referral. Lack of knowledge on the appropriate referral procedure was the prominent reason for not referring patients to the MTM clinic. Of the providers that were aware of MTM services, 44% rated care as ‘excellent’, 44% as ‘good’, 5% as ‘fair’, and 0% stated ‘poor’. Strengths of MTM clinic identified by healthcare providers included in-depth education to patients, close follow-up, and detailed medication reconciliation provided by MTM clinic pharmacists. Of those familiar with MTM clinic, recommendations included; increase marketing efforts to raise awareness of the MTM clinic service, create collaborative practice agreements between MTM pharmacists and physicians, and ensure that progress notes are more concise.Conclusion: In a large, urban, academic institution MTM clinic is perceived as a valuable resource to optimize patient care by providing patients with in-depth education as it relates to their prescribed medications and disease states. These identified benefits of MTM clinic lead to frequent patient referrals specifically for aid with medication adherence and disease state management.

  14. Fisher-Wright model with deterministic seed bank and selection. (United States)

    Koopmann, Bendix; Müller, Johannes; Tellier, Aurélien; Živković, Daniel


    Seed banks are common characteristics to many plant species, which allow storage of genetic diversity in the soil as dormant seeds for various periods of time. We investigate an above-ground population following a Fisher-Wright model with selection coupled with a deterministic seed bank assuming the length of the seed bank is kept constant and the number of seeds is large. To assess the combined impact of seed banks and selection on genetic diversity, we derive a general diffusion model. The applied techniques outline a path of approximating a stochastic delay differential equation by an appropriately rescaled stochastic differential equation. We compute the equilibrium solution of the site-frequency spectrum and derive the times to fixation of an allele with and without selection. Finally, it is demonstrated that seed banks enhance the effect of selection onto the site-frequency spectrum while slowing down the time until the mutation-selection equilibrium is reached. Copyright © 2016 Elsevier Inc. All rights reserved.

  15. Information technology leadership in academic medical centers: a tale of four cultures. (United States)

    Friedman, C P


    Persons and groups within academic medical centers bring consistent and predictable viewpoints to planning and decision making. The varied professional and academic cultures of these individuals appear to account primarily for the diversity of their viewpoints. Understanding these professional cultures can help leaders achieve some predictability in the complex environments for which they are responsible. Leaders in information technology in particular, in order to be successful, must become part-time anthropologists, immersing themselves in the varied workplaces of their constituents to understand the work they do and the cultures that have grown up around this work. Only in this way will they be able to manage the challenges that arise continuously as the technology and the needs it can address change over time. In this article, the author briefly describes the concept of culture, portrays four specific professional cultures that typically coexist in academic medical centers, and argues that understanding these cultures is absolutely critical to effective management and use of information resources.

  16. Outsourcing your medical practice call center: how to choose a vendor to ensure regulatory compliance. (United States)

    Johnson, Bill


    Medical practices receive hundreds if not thousands of calls every week from patients, payers, pharmacies, and others. Outsourcing call centers can be a smart move to improve efficiency, lower costs, improve customer care, ensure proper payer management, and ensure regulatory compliance. This article discusses how to know when it's time to move to an outsourced call center, the benefits of making the move, how to choose the right call center, and how to make the transition. It also provides tips on how to manage the call center to ensure the objectives are being met.

  17. An approach to human-centered design of nuclear medical equipment: the system of caption of the thyroid

    International Nuclear Information System (INIS)

    Santos, Isaac J.A. Luquetti; Silva, Carlos Borges da; Santana, Marcos; Carvalho, Paulo Victor R.; Oliveira, Mauro Vitor de; Mol, Antonio Carlos Mol; Grecco, Claudio Henrique; Augusto, Silas Cordeiro


    Technology plays an important role in modern medical centers, making health care increasingly complex, relying on complex technical equipment. This technical complexity is particularly noticeable in the nuclear medicine and can increase the risks for human error. Human error has many causes such as performance shaping factors, organizational factors and user interface design. Poorly design human system interfaces of nuclear medical equipment can increase the risks for human error. If all nuclear medical equipment had been designed with good user interfaces, incidents and accidents could be reduced as well as he time required to learn how to use the equipment. Although some manufacturers of nuclear medical equipment have already integrate human factors principles in their products, there is still a need to steer the development of nuclear medical technology toward more human-centered approach. The aim of this paper is to propose a methodology that contributes to the design, development and evaluation of nuclear medical equipment and human system interface, towards a human-centered approach. This methodology includes the ergonomic approach, based on the operator activity analysis, together with human factors standards and guidelines, questionnaires and user based testing. We describe a case study in which this methodology is being applied in evaluation of the thyroid uptake system, getting essential information and data, that ill be used in development of a new system. (author)

  18. Creating a longitudinal integrated clerkship with mutual benefits for an academic medical center and a community health system. (United States)

    Poncelet, Ann Noelle; Mazotti, Lindsay A; Blumberg, Bruce; Wamsley, Maria A; Grennan, Tim; Shore, William B


    The longitudinal integrated clerkship is a model of clinical education driven by tenets of social cognitive theory, situated learning, and workplace learning theories, and built on a foundation of continuity between students, patients, clinicians, and a system of care. Principles and goals of this type of clerkship are aligned with primary care principles, including patient-centered care and systems-based practice. Academic medical centers can partner with community health systems around a longitudinal integrated clerkship to provide mutual benefits for both organizations, creating a sustainable model of clinical training that addresses medical education and community health needs. A successful one-year longitudinal integrated clerkship was created in partnership between an academic medical center and an integrated community health system. Compared with traditional clerkship students, students in this clerkship had better scores on Clinical Performance Examinations, internal medicine examinations, and high perceptions of direct observation of clinical skills.Advantages for the academic medical center include mitigating the resources required to run a longitudinal integrated clerkship while providing primary care training and addressing core competencies such as systems-based practice, practice-based learning, and interprofessional care. Advantages for the community health system include faculty development, academic appointments, professional satisfaction, and recruitment.Success factors include continued support and investment from both organizations' leadership, high-quality faculty development, incentives for community-based physician educators, and emphasis on the mutually beneficial relationship for both organizations. Development of a longitudinal integrated clerkship in a community health system can serve as a model for developing and expanding these clerkship options for academic medical centers.

  19. Implementing the patient-centered medical home in residency education. (United States)

    Doolittle, Benjamin R; Tobin, Daniel; Genao, Inginia; Ellman, Matthew; Ruser, Christopher; Brienza, Rebecca


    In recent years, physician groups, government agencies and third party payers in the United States of America have promoted a Patient-centered Medical Home (PCMH) model that fosters a team-based approach to primary care. Advocates highlight the model's collaborative approach where physicians, mid-level providers, nurses and other health care personnel coordinate their efforts with an aim for high-quality, efficient care. Early studies show improvement in quality measures, reduction in emergency room visits and cost savings. However, implementing the PCMH presents particular challenges to physician training programs, including institutional commitment, infrastructure expenditures and faculty training. Teaching programs must consider how the objectives of the PCMH model align with recent innovations in resident evaluation now required by the Accreditation Council of Graduate Medical Education (ACGME) in the US. This article addresses these challenges, assesses the preliminary success of a pilot project, and proposes a viable, realistic model for implementation at other institutions.

  20. Diversity leadership: the Rush University Medical Center experience. (United States)

    Clapp, J R


    Meeting the challenges of diversity is crucial, and within healthcare organizations a particularly strong case exists for a diversity strategy. Rush University Medical Center in 2006 was at an important juncture. Since its founding, the organization had made notable progress toward advancing diversity and inclusiveness. On the other hand, many diversity-related problems continued. Rush convened a committee to review the work of the institution in this area. The committee's report called for changes, and a Diversity Leadership Group (DLG) model was established. This article documents the progress made since 2006 through implementation of the DLG model. The changes prescribed for Rush are presented as recommendations and challenges that other healthcare organizations may find applicable to their own institutions.

  1. SU-E-P-01: An Informative Review On the Role of Diagnostic Medical Physicist in the Academic and Private Medical Centers

    International Nuclear Information System (INIS)

    Weir, V; Zhang, J


    Purpose: The role of physicist in the academic and private hospital environment continues to evolve and expand. This becomes more obvious with the newly revised requirements of the Joint Commission (JC) on imaging modalities and the continued updated requirements of ACR accreditation for medical physics (i.e., starting in June 2014, a physicists test will be needed before US accreditation). We provide an informative review on the role of diagnostic medical physicist and hope that our experience will expedite junior physicists in understanding their role in medical centers, and be ready to more opportunities. Methods: Based on our experience, diagnostic medical physicists in both academic and private medical centers perform several clinical functions. These include providing clinical service and physics support, ensuring that all ionizing radiation devices are tested and operated in compliance with the State and Federal laws, regulations and guidelines. We also discuss the training and education required to ensure that the radiation exposure to patients and staff is as low as reasonably achievable. We review the overlapping roles of medical and health physicist in some institutions. Results: A detailed scheme on the new requirements (effective 7/1/2014) of the JC is provided. In 2015, new standards for fluoroscopy, cone beam CT and the qualifications of staff will be phased in. A summary of new ACR requirements for different modalities is presented. Medical physicist have other duties such as sitting on CT and fluoroscopy committees for protocols design, training of non-radiologists to meet the new fluoroscopy rules, as well as helping with special therapies such as Yittrium 90 cases. Conclusion: Medical physicists in both academic and private hospitals are positioned to be more involved and prominent. Diagnostic physicists need to be more proactive to involve themselves in the day to day activities of the radiology department

  2. SU-E-P-01: An Informative Review On the Role of Diagnostic Medical Physicist in the Academic and Private Medical Centers

    Energy Technology Data Exchange (ETDEWEB)

    Weir, V [Baylor Health Care System, Dallas, TX (United States); Zhang, J [University of Kentucky, Lexington, KY (United States)


    Purpose: The role of physicist in the academic and private hospital environment continues to evolve and expand. This becomes more obvious with the newly revised requirements of the Joint Commission (JC) on imaging modalities and the continued updated requirements of ACR accreditation for medical physics (i.e., starting in June 2014, a physicists test will be needed before US accreditation). We provide an informative review on the role of diagnostic medical physicist and hope that our experience will expedite junior physicists in understanding their role in medical centers, and be ready to more opportunities. Methods: Based on our experience, diagnostic medical physicists in both academic and private medical centers perform several clinical functions. These include providing clinical service and physics support, ensuring that all ionizing radiation devices are tested and operated in compliance with the State and Federal laws, regulations and guidelines. We also discuss the training and education required to ensure that the radiation exposure to patients and staff is as low as reasonably achievable. We review the overlapping roles of medical and health physicist in some institutions. Results: A detailed scheme on the new requirements (effective 7/1/2014) of the JC is provided. In 2015, new standards for fluoroscopy, cone beam CT and the qualifications of staff will be phased in. A summary of new ACR requirements for different modalities is presented. Medical physicist have other duties such as sitting on CT and fluoroscopy committees for protocols design, training of non-radiologists to meet the new fluoroscopy rules, as well as helping with special therapies such as Yittrium 90 cases. Conclusion: Medical physicists in both academic and private hospitals are positioned to be more involved and prominent. Diagnostic physicists need to be more proactive to involve themselves in the day to day activities of the radiology department.

  3. Implementation of Patient-Centered Medical Homes in Adult Primary Care Practices. (United States)

    Alexander, Jeffrey A; Markovitz, Amanda R; Paustian, Michael L; Wise, Christopher G; El Reda, Darline K; Green, Lee A; Fetters, Michael D


    There has been relatively little empirical evidence about the effects of patient-centered medical home (PCMH) implementation on patient-related outcomes and costs. Using a longitudinal design and a large study group of 2,218 Michigan adult primary care practices, our study examined the following research questions: Is the level of, and change in, implementation of PCMH associated with medical surgical cost, preventive services utilization, and quality of care in the following year? Results indicated that both level and amount of change in practice implementation of PCMH are independently and positively associated with measures of quality of care and use of preventive services, after controlling for a variety of practice, patient cohort, and practice environmental characteristics. Results also indicate that lower overall medical and surgical costs are associated with higher levels of PCMH implementation, although change in PCMH implementation did not achieve statistical significance. © The Author(s) 2015.

  4. Integration of pharmacists into patient-centered medical homes in federally qualified health centers in Texas. (United States)

    Wong, Shui Ling; Barner, Jamie C; Sucic, Kristina; Nguyen, Michelle; Rascati, Karen L

    To describe the integration and implementation of pharmacy services in patient-centered medical homes (PCMHs) as adopted by federally qualified health centers (FQHCs) and compare them with usual care (UC). Four FQHCs (3 PCMHs, 1 UC) in Austin, TX, that provide care to the underserved populations. Pharmacists have worked under a collaborative practice agreement with internal medicine physicians since 2005. All 4 FQHCs have pharmacists as an integral part of the health care team. Pharmacists have prescriptive authority to initiate and adjust diabetes medications. The PCMH FQHCs instituted co-visits, where patients see both the physician and the pharmacist on the same day. PCMH pharmacists are routinely proactive in collaborating with physicians regarding medication management, compared with UC in which pharmacists see patients only when referred by a physician. Four face-to-face, one-on-one semistructured interviews were conducted with pharmacists working in 3 PCMH FQHCs and 1 UC FQHC to compare the implementation of PCMH with emphasis on 1) structure and workflow, 2) pharmacists' roles, and 3) benefits and challenges. On co-visit days, the pharmacist may see the patient before or after physician consultation. Pharmacists in 2 of the PCMH facilities proactively screen to identify diabetes patients who may benefit from pharmacist services, although the UC clinic pharmacists see only referred patients. Strengths of the co-visit model include more collaboration with physicians and more patient convenience. Payment that recognizes the value of PCMH is one PCMH principle that is not fully implemented. PCMH pharmacists in FQHCs were integrated into the workflow to address specific patient needs. Specifically, full-time in-house pharmacists, flexible referral criteria, proactive screening, well defined collaborative practice agreement, and open scheduling were successful strategies for the underserved populations in this study. However, reimbursement plans and provider

  5. Energy Survey of Eisenhower Army Medical Center, Fort Gordon, Augusta, Georgia. Volume 2. Appendices

    National Research Council Canada - National Science Library


    ...) including low cost/no cost ECO's and perform complete evaluations of each. Energy equipment replacement projects already underway, approved, or planned by the Medical Center staff will be factored into the evaluations...

  6. Communications and Collaboration Keep San Francisco VA Medical Center Project on Track

    International Nuclear Information System (INIS)

    Federal Energy Management Program


    This case study about energy saving performance contacts (ESPCs) presents an overview of how the Veterans Affairs Medical Center in San Francisco established an ESPC contract and the benefits derived from it. The Federal Energy Management Program instituted these special contracts to help federal agencies finance energy-saving projects at their facilities

  7. Comparison and alignment of an academic medical center's strategic goals with ASHP initiatives. (United States)

    Engels, Melanie J; Chaffee, Bruce W; Clark, John S


    An academic medical center's strategic goals were compared and aligned with the 2015 ASHP Health-System Pharmacy Initiative and the Pharmacy Practice Model Initiative (PPMI). The department's pharmacy practice model steering committee identified potential solutions to narrow prioritized gaps using a modified nominal group technique and a multivoting dot technique. Five priority solutions were identified and assigned to work groups to develop business plans, which included admission medication history and reconciliation for high-risk patients and those with complex medication regimens, pharmacist provision of discharge counseling to high-risk patients and those with complex medication regimens, improved measurement and reporting of the impact of PPMI programs on patient outcomes, implementation of a departmentwide formalized peer review and evaluation process, and the greeting of every patient at some time during his or her visit by a pharmacy team member. Stakeholders evaluated the business plans based on feasibility, financial return on investment, and anticipated safety enhancements. The solution that received the highest priority ranking and was subsequently implemented was "improved measurement and reporting of the impact of PPMI programs on patient outcomes." A defined process was followed for identifying gaps among current practices at an academic medical center and the 2015 ASHP Health-System Pharmacy Initiative and the PPMI. A key priority to better document the impact of pharmacists on patient care was identified for our department by using a nominal group technique brainstorming process and a multivoting dot technique and creating standardized business plans for five potential priority projects. Copyright © 2015 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

  8. Development of a pharmacy student research program at a large academic medical center. (United States)

    McLaughlin, Milena M; Skoglund, Erik; Bergman, Scott; Scheetz, Marc H


    A program to promote research by pharmacy students created through the collaboration of an academic medical center and a college of pharmacy is described. In 2009, Midwestern University Chicago College of Pharmacy and Northwestern Memorial Hospital (NMH) expanded their existing partnership by establishing a program to increase opportunities for pharmacy students to conduct clinical-translational research. All professional year 1, 2, or 3 students at the college, as well as professional year 4 students on rotation at NMH, can participate in the program. Central to the program's infrastructure is the mentorship of student leads by faculty- and hospital-based pharmacists. The mentors oversee the student research projects and guide development of poster presentations; student leads mentor junior students and assist with orientation and training activities. Publication of research findings in the peer-reviewed literature is a key program goal. In the first four years after program implementation, participation in a summer research program grew nearly 10-fold (mainly among incoming professional year 2 or 3 students, and student poster presentations at national pharmacy meetings increased nearly 20-fold; the number of published research articles involving student authors increased from zero in 2009 to three in 2012 and two in 2013. A collaborative program between an academic medical center and a college of pharmacy has enabled pharmacy students to conduct research at the medical center and has been associated with increases in the numbers of poster presentations and publications involving students. Copyright © 2015 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

  9. Phased implementation of AT and T PACS at Duke University Medical Center

    International Nuclear Information System (INIS)

    Stockbridge, C.; Ravin, C.E.


    ''Help me communicate more quickly and more effectively with referring clinicians''. This request was the driving behind the installation of the AT and T CommView System at Duke. The CommView System is a type of Digital Image Management System and Picture Archival Communication System whose chief purpose is to deliver interpolated diagnostic images to referring clinicians and attending physicians. The system acquires electronic images from modalities in a diagnostic imaging facility, stores these images in computer managed patient files and distributes these on demand over fiber optic cable to Display Consoles. The CommView System was designed at AT and T Bell Labs; it uses fiber optic ribbon cable between buildings fused to multistrand lightguide building cables to distribute images, typically around a medical center or campus at data transfer rates of 40 Mbps. This paper gives the rationale used in designing a start-up network and placing the initial equipment for a field of the AT and T CommView System in the Radiology Department of Duke University Medical Center

  10. Strategies for the Integration of Medical and Health Representation within Law Enforcement Intelligence Fusion Centers

    National Research Council Canada - National Science Library

    Morrissey, James F


    Terrorism-related intelligence gathering, analysis and information dissemination would be improved and enhanced by including a medical and health element in law enforcement intelligence fusion centers...

  11. Parental Perceptions of Family Centered Care in Medical Homes of Children with Neurodevelopmental Disabilities. (United States)

    Zajicek-Farber, Michaela L; Lotrecchiano, Gaetano R; Long, Toby M; Farber, Jon Matthew


    Life course theory sets the framework for strong inclusion of family centered care (FCC) in quality medical homes of children with neurodevelopmental disabilities (CNDD). The purpose of this study was to explore the perceptions of families with their experiences of FCC in medical homes for CNDD. Using a structured questionnaire, the Family-Centered Care Self-Assessment Tool developed by Family Voices, this study surveyed 122 parents of CNDD in a large urban area during 2010-2012. Data collected information on FCC in the provision of primary health care services for CNDD and focused on family-provider partnerships, care setting practices and policies, and community services. Frequency analysis classified participants' responses as strengths in the "most of the time" range, and weaknesses in the "never" range. Only 31 % of parents were satisfied with the primary health care their CNDD received. Based on an accepted definition of medical home services, 16 % of parents reported their CNDD had most aspects of a medical home, 64 % had some, and 20 % had none. Strengths in FCC were primarily evident in the family-provider partnership and care settings when focused on meeting the medical care needs of the child. Weaknesses in FCC were noted in meeting the needs of families, coordination, follow-up, and support with community resources. Improvements in key pediatric health care strategies for CNDD are recommended. CNDD and their families have multifaceted needs that require strong partnerships among parents, providers, and communities. Quality medical homes must include FCC and valued partnerships with diverse families and community-based providers.

  12. Detection of alkaline phosphatase in canine cells previously stained with Wright-Giemsa and its utility in differentiating osteosarcoma from other mesenchymal tumors. (United States)

    Ryseff, Julia K; Bohn, Andrea A


    Osteosarcoma (OSA) is a common primary bone tumor in dogs. Demonstration of alkaline phosphatase (ALP) reactivity by tumor cells on unstained slides is useful in differentiating osteosarcoma from other types of sarcoma. However, unstained slides are not always available. The objectives of this study were to evaluate the diagnostic utility of detecting ALP expression in differentiating osteosarcoma from other sarcomas in dogs using cytologic material previously stained with Wright-Giemsa stain and to assess the sensitivity and specificity of ALP expression for diagnosing osteosarcoma using a specific protocol. Archived aspirates of histologically confirmed sarcomas in dogs that had been previously stained with Wright-Giemsa stain were treated with 5-bromo, 4-chloro, 3-indolyl phosphate/nitroblue tetrazolium (BCIP/NBT) as a substrate for ALP. Cells were evaluated for expression of ALP after incubation with BCIP/NBT for 1 hour. Sensitivity and specificity of ALP expression for diagnosis of OSA were calculated. In samples from 83 dogs, cells from 15/17 OSAs and from 4/66 tumors other than OSA (amelanotic melanoma, gastrointestinal stromal tumor, collision tumor, and anaplastic sarcoma) expressed ALP. Sensitivity and specificity of ALP expression detected using BCIP/NBT substrate applied to cells previously stained with Wright-Giemsa stain for OSA were 88 and 94%, respectively. ALP expression detected using BCIP/NBT substrate applied to previously stained cells is useful in differentiating canine OSA from other mesenchymal neoplasms. © 2012 American Society for Veterinary Clinical Pathology.

  13. On the scene: American University of Beirut Medical Center, Beirut, Lebanon. (United States)

    Mouro, Gladys; Tashjian, Hera; Daaboul, Tania; Kozman, Katia; Alwan, Farah; Shamoun, Anthony


    American University of Beirut Medical Center is the first Magnet hospital in the Middle East. In this article, authors reflect back on the journey to excellence, specifically in establishing shared governance in a challenging cultural and organizational milieu. Perspectives from nurses at different levels are included to highlight their experiences throughout the journey. Evolution of the organization's shared governance model is described and initiatives of the councils are illustrated.

  14. A new concept for medical imaging centered on cellular phone technology.

    Directory of Open Access Journals (Sweden)

    Yair Granot


    Full Text Available According to World Health Organization reports, some three quarters of the world population does not have access to medical imaging. In addition, in developing countries over 50% of medical equipment that is available is not being used because it is too sophisticated or in disrepair or because the health personnel are not trained to use it. The goal of this study is to introduce and demonstrate the feasibility of a new concept in medical imaging that is centered on cellular phone technology and which may provide a solution to medical imaging in underserved areas. The new system replaces the conventional stand-alone medical imaging device with a new medical imaging system made of two independent components connected through cellular phone technology. The independent units are: a a data acquisition device (DAD at a remote patient site that is simple, with limited controls and no image display capability and b an advanced image reconstruction and hardware control multiserver unit at a central site. The cellular phone technology transmits unprocessed raw data from the patient site DAD and receives and displays the processed image from the central site. (This is different from conventional telemedicine where the image reconstruction and control is at the patient site and telecommunication is used to transmit processed images from the patient site. The primary goal of this study is to demonstrate that the cellular phone technology can function in the proposed mode. The feasibility of the concept is demonstrated using a new frequency division multiplexing electrical impedance tomography system, which we have developed for dynamic medical imaging, as the medical imaging modality. The system is used to image through a cellular phone a simulation of breast cancer tumors in a medical imaging diagnostic mode and to image minimally invasive tissue ablation with irreversible electroporation in a medical imaging interventional mode.

  15. Examining Health Information Technology Implementations: Case of the Patient-Centered Medical Home (United States)

    Behkami, Nima A.


    It has been shown that the use of Health Information Technology (HIT) is associated with reduced cost and increased quality of care. This dissertation examined the use of registries in Patient Centered Medical Home (PCMH) practices. A survey questionnaire was sent to a nationwide group of clinics certified for being a PCMH. They were asked to…

  16. Transformation of an academic medical center: lessons learned from restructuring and downsizing. (United States)

    Woodard, B; Fottler, M D; Kilpatrick, A O


    This article reviews management literature on health care transformation and describes the processes, including restructuring, job redesign, and downsizing, involved in one academic medical center's experience. The article concludes with lessons learned at each of the stages of the transformation process: planning, implementation, and process continuation. Managerial implications for similar transformation efforts in other health care organizations are suggested.

  17. Analysis of the drug formulary and the purchasing process at a Moroccan university medical center. (United States)

    Lachhab, Z; Serragui, S; Hassar, M; Cherrah, Y; Errougani, A; Ahid, S


    To give an overview of the pharmaceutical policy in the largest medical center in Morocco, a developing country in socio-economic transition. This is an analytical descriptive study of the drug formulary and the purchasing process carried out at the Ibn Sina University Medical Center. Our formulary included 830 drugs belonging to 14 classes according to the Anatomical, Therapeutic and Chemical (ATC) Classification System. There was a respective predominance of class N (21.8%), class B (13.5%), and class J (12.6%). Injectable route was dominant (46%). Drugs had a significant actual benefit in 70% (according to the French Data), reimbursable in 42.8%, essential in 29.2% according to World Health Organization (WHO) list, and in 36.9% according to the Moroccan list. The calls for tenders included 542 drugs representing 65% of the formulary, and the attribution rate was 71%. The main reason for non-attribution was the lack of offers. Generics accounted for 45% by volume and 26.5% by value. With this first study, we were able to identify key indicators on drugs used in the largest medical center in Morocco. The current challenge is to introduce pharmacoeconomics in decision making concerning the updates of the drug formulary.

  18. Analysis of the Service Quality of Medical Centers Using Servqual Model (Case:Shaheed Rahnemoon Hospital

    Directory of Open Access Journals (Sweden)

    H Zare Ahmadabadi


    Full Text Available Introduction: Many organizations, especially service oriented ones, relative to their goals and mission, have a special view towards quality phenomena and its management. Methods: This paper analyzes medical service quality in one case; The internal section of Shaheed Rahnemoon Hospital Based on the basis of gap analysis model and Servqual technique. A questionnaire was designed and applied to measure expectations and perceptions of patients and personnel of the hospital. Results: On application of non-parametric statistical tests, we propose certain recommendations. These tests drive on five conceptual dimensions of service quality including intangibility, responsiveness, reliability, assurance and empathy. Results show that patients in this section were satisfied from the service provider’s responsiveness, but there are significant differences between expectations and perceptions in other dimensions. Conclusion: The service quality analysis models are useful for managers of medical centers to distinguish gaps between the two sides of service representation; patients and medical centers personnel. Ultimately, they can reinforce strengths and control weaknesses.

  19. Patient-centered communication in digital medical encounters. (United States)

    Alpert, Jordan M; Dyer, Karen E; Lafata, Jennifer Elston


    Patients are increasingly using the secure messaging function available through online patient portals to communicate with their health care providers, yet little is known about the characteristics of conversations that occur. The goal of this study is to describe the types of messages initiated by patients communicating via patient portals and to assess whether providers employ patient-centered strategies in their electronic responses. A total of 193 messages from 58 message threads between patients and providers were collected during a one-week period in a large health care system. Content analysis of patient messages was conducted and deductive analysis of provider responses was employed for two types of patient-centered communication, provider use of supportive talk and partnership building. Patients sent nearly double the number of messages compared to providers (65% versus 35%). Patient messages expressed concern, sought medical solutions and requested assistance with administrative tasks. Over half (53.4%) of provider replies did not contain language reflective of either partnership building or supportive talk. Partnership building language and supportive talk occurred at lower rates than documented in the literature on in-person encounters. This may represent a lost opportunity to strengthen the patient-provider relationship. As secure messaging is increasingly utilized as a form of patient-provider communication, it is important to understand how aspects of this communication channel, including the patient-centeredness of the language used by providers, impact patient-provider relationships and patient outcomes. Copyright © 2017 Elsevier B.V. All rights reserved.

  20. Patient-Centered Medical Home Undergraduate Internship, Benefits to a Practice Manager: Case Study. (United States)

    Sasnett, Bonita; Harris, Susie T; White, Shelly

    Health services management interns become practice facilitators for primary care clinics interested in pursuing patient-centered recognition for their practice. This experience establishes a collaborative relationship between the university and clinic practices where students apply their academic training to a system of documentation to improve the quality of patient care delivery. The case study presents the process undertaken, benefits, challenges, lessons learned, and recommendations for intern, practice mangers, and educators. The practice manager benefits as interns become Patient-Centered Medical Home facilitators and assist practice managers in the recognition process.

  1. A review of Curtiss-Wright rotary engine developments with respect to general aviation potential (United States)

    Jones, C.


    Aviation related rotary (Wankel-type) engine tests, possible growth directions and relevant developments at Curtiss-Wright have been reviewed. Automotive rotary engines including stratified charge are described and flight test results of rotary aircraft engines are presented. The current 300 HP engine prototype shows basic durability and competitive performance potential. Recent parallel developments have separately confirmed the geometric advantages of the rotary engine for direct injected unthrottled stratified charge. Specific fuel consumption equal to or better than pre- or swirl-chamber diesels, low emission and multi-fuel capability have been shown by rig tests of similar rotary engine.

  2. Environmental Assessment for the Expansion and Renovation of Dog Kennels, Wright-Patterson Air Force Base, Ohio (United States)


    leucocephala), killdeer (Charities vociferous), English sparrow (Passer domesticus), mockingbird (Mimus polyglottos), and red-winged blackbird (Agelaius...or killed . The project site should be examined daily for snakes, and if any eastern massasaugas are found, all work shall cease and the USFWS shall...airfield safety zones were established under AICUZ to minimize the number of people who would be injured or killed if an aircraft crashed. Three safety

  3. Environmental Assessment for Explosives Ordnance Disposal Proficiency Training Range at Wright-Patterson Air Force Base, Ohio (United States)


    ANTIOCH UNIVERSITY V1E1N JOE LEASING SPECIALIST EXCEL PM VIEW JOB NEWS PHOTOS & VIDEOS i~.-... --: i\\ ... I ,. j ... ’TouchdoW"n Jesus ’ i n...t Bald Eoglr - Wloll!rwll’/ c::::J Blllllng Star Skm Bom 209 Commttr=t Plrtwav P.D.Bax12B CottageGrovt.WI SJ$27·0128 phone: 606-839~1998 fu...line and the base hospital . The views of the residents of the Brick Quarters were solicited through the public notice put in the Dayton Daily News and

  4. Lessons Learned from Implementing the Patient-Centered Medical Home

    Directory of Open Access Journals (Sweden)

    Ellen P. Green


    Full Text Available The Patient-Centered Medical Home (PCMH is a primary care model that provides coordinated and comprehensive care to patients to improve health outcomes. This paper addresses practical issues that arise when transitioning a traditional primary care practice into a PCMH recognized by the National Committee for Quality Assurance (NCQA. Individual organizations' experiences with this transition were gathered at a PCMH workshop in Alexandria, Virginia in June 2010. An analysis of their experiences has been used along with a literature review to reveal common challenges that must be addressed in ways that are responsive to the practice and patients’ needs. These are: NCQA guidance, promoting provider buy-in, leveraging electronic medical records, changing office culture, and realigning workspace in the practice to accommodate services needed to carry out the intent of PCMH. The NCQA provides a set of standards for implementing the PCMH model, but these standards lack many specifics that will be relied on in location situations. While many researchers and providers have made critiques, we see this vagueness as allowing for greater flexibility in how a practice implements PCMH.

  5. Medical-Legal Partnerships At Veterans Affairs Medical Centers Improved Housing And Psychosocial Outcomes For Vets. (United States)

    Tsai, Jack; Middleton, Margaret; Villegas, Jennifer; Johnson, Cindy; Retkin, Randye; Seidman, Alison; Sherman, Scott; Rosenheck, Robert A


    Medical-legal partnerships-collaborations between legal professionals and health care providers that help patients address civil legal problems that can affect health and well-being-have been implemented at several Veterans Affairs (VA) medical centers to serve homeless and low-income veterans with mental illness. We describe the outcomes of veterans who accessed legal services at four partnership sites in Connecticut and New York in the period 2014-16. The partnerships served 950 veterans, who collectively had 1,384 legal issues; on average, the issues took 5.4 hours' worth of legal services to resolve. The most common problems were related to VA benefits, housing, family issues, and consumer issues. Among a subsample of 148 veterans who were followed for one year, we observed significant improvements in housing, income, and mental health. Veterans who received more partnership services showed greater improvements in housing and mental health than those who received fewer services, and those who achieved their predefined legal goals showed greater improvements in housing status and community integration than those who did not. Medical-legal partnerships represent an opportunity to expand cross-sector, community-based partnerships in the VA health care system to address social determinants of mental health.

  6. An analytics approach to designing patient centered medical homes. (United States)

    Ajorlou, Saeede; Shams, Issac; Yang, Kai


    Recently the patient centered medical home (PCMH) model has become a popular team based approach focused on delivering more streamlined care to patients. In current practices of medical homes, a clinical based prediction frame is recommended because it can help match the portfolio capacity of PCMH teams with the actual load generated by a set of patients. Without such balances in clinical supply and demand, issues such as excessive under and over utilization of physicians, long waiting time for receiving the appropriate treatment, and non-continuity of care will eliminate many advantages of the medical home strategy. In this paper, by using the hierarchical generalized linear model with multivariate responses, we develop a clinical workload prediction model for care portfolio demands in a Bayesian framework. The model allows for heterogeneous variances and unstructured covariance matrices for nested random effects that arise through complex hierarchical care systems. We show that using a multivariate approach substantially enhances the precision of workload predictions at both primary and non primary care levels. We also demonstrate that care demands depend not only on patient demographics but also on other utilization factors, such as length of stay. Our analyses of a recent data from Veteran Health Administration further indicate that risk adjustment for patient health conditions can considerably improve the prediction power of the model.

  7. Research Strategies for Academic Medical Centers: A Framework for Advancements toward Translational Excellence (United States)

    Haley, Rand; Champagne, Thomas J., Jr.


    This review article presents a simplified framework for thinking about research strategy priorities for academic medical centers (AMCs). The framework can serve as a precursor to future advancements in translational medicine and as a set of planning guideposts toward ultimate translational excellence. While market pressures, reform uncertainties,…

  8. Neuro psychiatry 1943: the role of documentary film in the dissemination of medical knowledge and promotion of the U.K. psychiatric profession. (United States)

    Jones, Edgar


    In 1943, Basil Wright produced a documentary film about the treatment of servicemen and civilians with psychological disorders at Mill Hill Emergency Medical Service Hospital. Funded by the Ministry of Information, Neuro Psychiatry was shot to convince influential clinicians and policy makers in North America that the British had developed expertise in the management of psychiatric casualties. By emphasizing novel and apparently effective interventions and excluding severe or intractable cases from the film, Wright encouraged an optimistic sense of achievement. Filmed at a time when victory was considered an eventual outcome, the picture presented a health service to which all had access without charge. Children and unemployed women, two groups excluded under the 1911 National Insurance Act, had been required to pay for healthcare in the prewar period and were shown receiving free treatment from the Emergency Medical Service. However, the therapeutic optimism presented in the film proved premature. Most U.K. battle casualties arose in the latter half of the conflict and follow-up studies failed to confirm the positive outcome statistics reported in the film. Aubrey Lewis, clinical director of the hospital, criticized research projects conducted at Mill Hill for a lack of rigor. The cinematographic skills of Wright and director Michael Hankinson, together with their reformist agenda, created a clinical presentation that emphasized achievements without acknowledging the limitations not only of the therapies offered by doctors but also the resources available to a nation at war.

  9. Neuro Psychiatry 1943: The Role of Documentary Film in the Dissemination of Medical Knowledge and Promotion of the U.K. Psychiatric Profession (United States)

    Jones, Edgar


    In 1943, Basil Wright produced a documentary film about the treatment of servicemen and civilians with psychological disorders at Mill Hill Emergency Medical Service Hospital. Funded by the Ministry of Information, Neuro Psychiatry was shot to convince influential clinicians and policy makers in North America that the British had developed expertise in the management of psychiatric casualties. By emphasizing novel and apparently effective interventions and excluding severe or intractable cases from the film, Wright encouraged an optimistic sense of achievement. Filmed at a time when victory was considered an eventual outcome, the picture presented a health service to which all had access without charge. Children and unemployed women, two groups excluded under the 1911 National Insurance Act, had been required to pay for healthcare in the prewar period and were shown receiving free treatment from the Emergency Medical Service. However, the therapeutic optimism presented in the film proved premature. Most U.K. battle casualties arose in the latter half of the conflict and follow-up studies failed to confirm the positive outcome statistics reported in the film. Aubrey Lewis, clinical director of the hospital, criticized research projects conducted at Mill Hill for a lack of rigor. The cinematographic skills of Wright and director Michael Hankinson, together with their reformist agenda, created a clinical presentation that emphasized achievements without acknowledging the limitations not only of the therapies offered by doctors but also the resources available to a nation at war. PMID:23134695

  10. Joint marketing cites excellence: Fairview-University Medical Center advertises cooperatively with University of Minnesota Physicians. (United States)

    Botvin, Judith D


    Fairview-University Medical Center and University of Minnesota Physicians, both in Minneapolis, are enjoying the benefits of a co-branded advertising campaign. It includes print ads, brochures, and other marketing devices.

  11. Inappropriate Dietary and Occupational Patterns: Major Risk Factors Associated With Brucellosis in the Area Covered by Karaj Health Center No. 2

    Directory of Open Access Journals (Sweden)

    Yosef Khani


    Full Text Available Background: Brucellosis is one of the most common diseases among humans and livestock. Using contaminated and unpasteurized dairy products, having contact with infected livestock and, in general, inappropriate dietary patterns, as well as lack of hygiene, can be noted as the most common modes of transmission for such a disease. Objectives: Since the establishment of Alborz province in Iran and, accordingly, Alborz university of medical sciences, Karaj, Iran, there has been no study on the epidemiological situation of the disease. Therefore, the present study examines the epidemiology of Brucellosis at Karaj Health center No. 2, Karaj, Iran, during 2011 - 2012. Patients and Methods: This research was a cross-sectional descriptive study, on patients with Brucellosis, during 2011 - 2012, in the area covered by Karaj health center No. 2, Karaj, Iran. The data about all suspected cases, collected from polyclinic, laboratories and health centers, and confirmed by Wright, combs Wright and 2ME tests were reviewed. After recording the demographic data and laboratory results, they were entered into STATA 11 software and analyzed. Results: The number of patients reported in this study was 67. The incidence of the disease during 2011 - 2012 was, respectively, 3.75 and 4.6 per hundred thousand and the average incidence of the disease was 4.2 per hundred thousand. The highest rate of infection, in terms of occupation, was found among ranchers (40.29%. In 100% of the cases, there was a history of consumption of cottage cheese, fresh cow milk or other unpasteurized dairy products. Considering the incidence season, most cases of the disease (38.80% had occurred in the spring. In terms of gender, 56.71% were male and 43.28% of patients were female. As well, in terms of age, more 50% of the patients were in the age groups of 31 - 40 and 41 - 50 years old. Conclusions: Given the occurrence of more cases of the disease among individuals with risk factors, such as

  12. Subtask 3.9 - Direct Coal Liquefaction Process Development

    Energy Technology Data Exchange (ETDEWEB)

    Aulich, Ted; Sharma, Ramesh


    The Energy and Environmental Research Center (EERC), in partnership with the U.S. Department of Energy (DOE) and Accelergy Corporation, an advanced fuels developer with technologies exclusively licensed from ExxonMobil, undertook Subtask 3.9 to design, build, and preliminarily operate a bench-scale direct coal liquefaction (DCL) system capable of converting 45 pounds/hour of pulverized, dried coal to a liquid suitable for upgrading to fuels and/or chemicals. Fabrication and installation of the DCL system and an accompanying distillation system for off-line fractionation of raw coal liquids into 1) a naphtha middle distillate stream for upgrading and 2) a recycle stream was completed in May 2012. Shakedown of the system was initiated in July 2012. In addition to completing fabrication of the DCL system, the project also produced a 500-milliliter sample of jet fuel derived in part from direct liquefaction of Illinois No. 6 coal, and submitted the sample to the Air Force Research Laboratory (AFRL) at Wright Patterson Air Force Base, Dayton, Ohio, for evaluation. The sample was confirmed by AFRL to be in compliance with all U.S. Air Force-prescribed alternative aviation fuel initial screening criteria.

  13. Master's Level Graduate Training in Medical Physics at the University of Colorado Health Sciences Center. (United States)

    Ibbott, Geoffrey S.; Hendee, William R.


    Describes the master's degree program in medical physics developed at the University of Colorado Health Sciences Center. Required courses for the program, and requirements for admission are included in the appendices. (HM)

  14. Confidence Intervals for System Reliability and Availability of Maintained Systems Using Monte Carlo Techniques (United States)


    DTIC _JUN ,I 51982 UNITED STATES AIR FORCE AIR UNIVERSITY E AIR FORCE INSTITUTE OF TECHNOLOGY Wright-Patterson Air-force Base,Ohio S 2 B 14 Best...t’re Air F:or- e -ns"it’.,, e of Technclogy Air Uv-ýerz.tyj in Partial 𔄁ulfilIThent Reýquirements fol- ,-hth D,ýýr.e c4" MastLer of’ OperaZ-ins...iesearc- VeTA 3 MohamedO ’’’’Jo SpD’ Fas.abal-la Lt. C ol. Egyplt.’.an Army Gradua~’p ( ler ons Research December 1981 Approcved fL~r pu>ý’

  15. Stakeholder Perspectives on Changes in Hypertension Care Under the Patient-Centered Medical Home. (United States)

    O'Donnell, Alison J; Bogner, Hillary R; Cronholm, Peter F; Kellom, Katherine; Miller-Day, Michelle; McClintock, Heather F de Vries; Kaye, Elise M; Gabbay, Robert


    Hypertension is a major modifiable risk factor for cardiovascular and kidney disease, yet the proportion of adults whose hypertension is controlled is low. The patient-centered medical home (PCMH) is a model for care delivery that emphasizes patient-centered and team-based care and focuses on quality and safety. Our goal was to investigate changes in hypertension care under PCMH implementation in a large multipayer PCMH demonstration project that may have led to improvements in hypertension control. The PCMH transformation initiative conducted 118 semistructured interviews at 17 primary care practices in southeastern Pennsylvania between January 2011 and January 2012. Clinicians (n = 47), medical assistants (n = 26), office administrators (n = 12), care managers (n = 11), front office staff (n = 7), patient educators (n = 4), nurses (n = 4), social workers (n = 4), and other administrators (n = 3) participated in interviews. Study personnel used thematic analysis to identify themes related to hypertension care. Clinicians described difficulties in expanding services under PCMH to meet the needs of the growing number of patients with hypertension as well as how perceptions of hypertension control differed from actual performance. Staff and office administrators discussed achieving patient-centered hypertension care through patient education and self-management support with personalized care plans. They indicated that patient report cards were helpful tools. Participants across all groups discussed a team- and systems-based approach to hypertension care. Practices undergoing PCMH transformation may consider stakeholder perspectives about patient-centered, team-based, and systems-based approaches as they work to optimize hypertension care.

  16. Benefits of the effective dose equivalent concept at a medical center

    International Nuclear Information System (INIS)

    Vetter, R.J.; Classic, K.L.


    A primary objective of the recommendations of the International Committee on Radiological Protection Publication 26 is to insure that no source of radiation exposure is unjustified in relation to its benefits. This objective is consistent with goals of the Radiation Safety Committee and Institutional Review Board at medical centers where research may involve radiation exposure of human subjects. The effective dose equivalent concept facilitates evaluation of risk by those who have little or no knowledge of quantities or biological effects of radiation. This paper presents effective dose equivalent data used by radiation workers and those who evaluate human research protocols as these data relate to personal dosimeter reading, entrance skin exposure, and target organ dose. The benefits of using effective dose equivalent to evaluate risk of medical radiation environments and research protocols are also described

  17. Health Care Provider Burnout in a United States Military Medical Center During a Period of War. (United States)

    Sargent, Paul; Millegan, Jeffrey; Delaney, Eileen; Roesch, Scott; Sanders, Martha; Mak, Heather; Mallahan, Leonard; Raducha, Stephanie; Webb-Murphy, Jennifer


    Provider burnout can impact efficiency, empathy, and medical errors. Our study examines burnout in a military medical center during a period of war. A survey including the Maslach Burnout Inventory (MBI), deployment history, and work variables was distributed to health care providers. MBI subscale means were calculated and associations between variables were analyzed. Approximately 60% of 523 respondents were active duty and 34% had deployed. MBI subscale means were 19.99 emotional exhaustion, 4.84 depersonalization, and 40.56 personal accomplishment. Frustration over administrative support was associated with high emotional exhaustion and depersonalization; frustration over life/work balance was associated with high emotional exhaustion. Levels of burnout in our sample were similar to civilian medical centers. Sources of frustration were related to administrative support and life/work balance. Deployment had no effect on burnout levels. Reprint & Copyright © 2016 Association of Military Surgeons of the U.S.

  18. Patient-centered medical home initiatives expanded in 2009-13: providers, patients, and payment incentives increased. (United States)

    Edwards, Samuel T; Bitton, Asaf; Hong, Johan; Landon, Bruce E


    Patient-centered medical home initiatives are central to many efforts to reform the US health care delivery system. To better understand the extent and nature of these initiatives, in 2013 we performed a nationwide cross-sectional survey of initiatives that included payment reform incentives in their models, and we compared the results to those of a similar survey we conducted in 2009. We found that the number of initiatives featuring payment reform incentives had increased from 26 in 2009 to 114 in 2013. The number of patients covered by these initiatives had increased from nearly five million to almost twenty-one million. We also found that the proportion of time-limited initiatives--those with a planned end date--was 20 percent in 2013, a decrease from 77 percent in 2009. Finally, we found that the dominant payment model for patient-centered medical homes remained fee-for-service payments augmented by per member per month payments and pay-for-performance bonuses. However, those payments and bonuses were higher in 2013 than they were in 2009, and the use of shared-savings models was greater. The patient-centered medical home model is likely to continue both to become more common and to play an important role in delivery system reform. Project HOPE—The People-to-People Health Foundation, Inc.

  19. Academic season does not influence cardiac surgical outcomes at US Academic Medical Centers. (United States)

    Lapar, Damien J; Bhamidipati, Castigliano M; Mery, Carlos M; Stukenborg, George J; Lau, Christine L; Kron, Irving L; Ailawadi, Gorav


    Previous studies have demonstrated the influence of academic season on outcomes in select surgical populations. However, the influence of academic season has not been evaluated nationwide in cardiac surgery. We hypothesized that cardiac surgical outcomes were not significantly influenced by time of year at both cardiothoracic teaching hospitals and non-cardiothoracic teaching hospitals nationwide. From 2003 to 2007, a weighted 1,614,394 cardiac operations were evaluated using the Nationwide Inpatient Sample database. Patients undergoing cardiac operations at cardiothoracic teaching and non-cardiothoracic teaching hospitals were identified using the Association of American Medical College's Graduate Medical Education Tracking System. Hierarchic multivariable logistic regression analyses were used to estimate the effect of academic quarter on risk-adjusted outcomes. Mean patient age was 65.9 ± 10.9 years. Women accounted for 32.8% of patients. Isolated coronary artery bypass grafting was the most common operation performed (64.7%), followed by isolated valve replacement (19.3%). The overall incidence of operative mortality and composite postoperative complication rate were 2.9% and 27.9%, respectively. After accounting for potentially confounding risk factors, timing of operation by academic quarter did not independently increase risk-adjusted mortality (p = 0.12) or morbidity (p = 0.24) at academic medical centers. Risk-adjusted mortality and morbidity for cardiac operations were not associated with time of year in the US at teaching and nonteaching hospitals. Patients should be reassured of the safety of performance of cardiac operations at academic medical centers throughout a given academic year. Copyright © 2011 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

  20. Current neurotrauma treatment practice in secondary medical service centers

    International Nuclear Information System (INIS)

    Suehiro, Eiichi; Yoshino, Hiroko; Koizumi, Hiroyasu; Yoneda, Hiroshi; Suzuki, Michiyasu


    Despite neurotrauma treatment practices comprising a significant amount of neurosurgical work for secondary medical service centers, little attention has been placed on neurotrauma cases and evaluation of current neurotrauma treatment practices is limited. Therefore we investigated current neurotrauma practices in our hospital located in a Japanese suburban city. We analyzed 439 patients with traumatic brain injury (TBI) admitted to our hospital between April 2004 and October 2010. Patients were divided into three groups based on the Glasgow Coma Scale (GCS) score on admission: mild TBI (GCS 14-15) in 252 patients (57.4%), moderate TBI (GCS 9-13) in 116 patients (26.4%), and severe TBI (GCS 3-8) in 71 patients (16.2%). Age, gender, alcohol consumption, cause of injury, cranial CT findings, neurosurgical procedure, length of hospital stay, and clinical outcome were analyzed. The average age of the patients was 59.2 years old. Male patients comprised 65%. Alcohol consumption was reported in 81 cases (18.5%), most of them with moderate TBI. Fall (208 cases, 47.4%) was the most frequent cause of injury, followed by traffic accident (115 cases, 26.2%) and high fall (73 cases, 16.6%). Acute subdural hematoma (174 cases, 39.6%) was most frequently seen in cranial CT findings on admission, which significantly increased with severity. A neurosurgical procedure was performed for 70 cases (15.9%), of which 15 (6.0%) were mild TBI and 18 (15.5%) were moderate TBI. The average hospital stay was 20.8 days, which significantly increased with severity. The overall rate of favorable outcome was 82.7%, and mortality was 8.2%; outcome deteriorated with severity. Some mild and moderate TBI cases had deteriorated and required surgery or resulted in death. These findings suggest that cautious treatment is necessary even in mild to moderate TBI cases which are often encountered in secondary medical service centers. (author)

  1. Impact of Mobile Dose-Tracking Technology on Medication Distribution at an Academic Medical Center. (United States)

    Kelm, Matthew; Campbell, Udobi


    Medication dose-tracking technologies have the potential to improve efficiency and reduce costs associated with re-dispensing doses reported as missing. Data describing this technology and its impact on the medication use process are limited. The purpose of this study is to assess the impact of dose-tracking technology on pharmacy workload and drug expense at an academic, acute care medical center. Dose-tracking technology was implemented in June 2014. Pre-implementation data were collected from February to April 2014. Post-implementation data were collected from July to September 2014. The primary endpoint was the percent of re-dispensed oral syringe and compounded sterile product (CSP) doses within the pre- and post-implementation periods per 1,000 discharges. Secondary endpoints included pharmaceutical expense generated from re-dispensing doses, labor costs, and staff satisfaction with the medication distribution process. We observed an average 6% decrease in re-dispensing of oral syringe and CSP doses from pre- to post-implementation (15,440 vs 14,547 doses; p = .047). However, when values were adjusted per 1,000 discharges, this trend did not reach statistical significance (p = .074). Pharmaceutical expense generated from re-dispensing doses was significantly reduced from pre- to post-implementation ($834,830 vs $746,466 [savings of $88,364]; p = .047). We estimated that $2,563 worth of technician labor was avoided in re-dispensing missing doses. We also saw significant improvement in staff perception of technology assisting in reducing missing doses (p = .0003), as well as improvement in effectiveness of resolving or minimizing missing doses (p = .01). The use of mobile dose-tracking technology demonstrated meaningful reductions in both the number of doses re-dispensed and cost of pharmaceuticals dispensed.

  2. Wright tariffs in the Spanish electricity industry: the case of residential consumption

    International Nuclear Information System (INIS)

    Castro-Rodriguez, F.


    In this paper a capacity price model is developed for the Spanish electricity industry which allows the presentation of the Spanish utilization level tariffs as an example of duration tariffs (Wright tariffs) when duration is approximated by the ratio of consumption to power used. Using this model and data on the residential consumption of electricity, several optimal two-part tariffs are computed, considering different hypothesis on the configuration of the generating equipment. It has been found that the optimal tariff maintaining universal service increases welfare if the generating equipment and the output assignment to the different technologies are taken as given. Furthermore, if the regulator is concerned not only with efficiency, but also with distributive issues, then welfare losses associated with the existing regulatory regime are even larger

  3. Religion and politics in conflict: Paul Stuart Wright and the 1964 coup

    Directory of Open Access Journals (Sweden)

    Márcio Ananias Ferreira Vilela


    Full Text Available In this article, we seek to understand the implications of Paulo Stuart Wright´s political and religious action. Beginning with the civil and military coup of 1964, it suffered a strong reaction from majority sectors in the Presbyterian Church of Brazil that started to perceive him as a threat to the religious community and to society itself. The following period was marked by an intense political conflict in Brazil. This contributed for the person in question to be expelled from the Church, have his mandate as a state representative for Santa Catarina impeached, be exiled, live in clandestinity and, later on in the 1970s, be murdered by the organs of repression. Thus, his trajectory bears many similarities to those of others who marked the recent history of Brazil.

  4. International student exchange and the medical curriculum: evaluation of a medical sciences translational physiology course in Brazil. (United States)

    Morris, Mariana; Jones, T David; Rocha, Maria Jose Alves; Fazan, Rubens; Chapleau, Mark W; Salgado, Helio C; Johnson, Alan Kim; Irigoyen, Maria Claudia; Michelini, Lisete C; Goldstein, David L


    The objective of the present study was to conduct a short-term international course on translational physiology for medical students from Wright State University and the University of Iowa. The goals were to 1) provide students with an exposure to the academic, cultural, and medical environments in Brazil; 2) promote awareness of the global medical community; and 3) provide an academic course focused on translational physiology. An evaluation of the students was conducted to determine whether such a short-term course might be useful in the medical curriculum. The 2-wk course was held in the summer of 2005 at the University of São Paulo School of Medicine in Ribeirão Preto, Brazil, for 23 American students. The program included presentations of basic and clinical topics, meetings with medical students, and clinical presentations. The program finished with student attendance at a scientific meeting sponsored by the Brazilian Society of Hypertension. Student surveys evaluated issues related to perceived treatment, Brazilian medical school environment, culture and personal attributes, and career aspirations. The international Medical Sciences Translational Physiology course for medical students provided a brief, but intense, experience. It gave students a picture of the medical environment in Brazil and an appreciation for the differences and similarities in cultures. Most students reported that it was a positive experience that would be beneficial to their careers. In conclusion, a short-term international course provides an efficient means for medical students to experience aspects of global medical science.

  5. [Management of medical care for the victims of road accidents in traumatology centers of Saint-Petersburg]. (United States)

    Tulupov, A N; Afonchikov, V Iu; Chikin, A E; Taniia, S Sh; Ganin, A S


    The number of road accidents, fatal outcomes and victims exceeded in 1.5 times in Saint-Petersburg in comparison with Moscow. At the average, 600 victims were treated in each of 6 first-level traumatology centers every year. The quantity of patients, who were admitted to 3 second-level traumatology centers, numbered 10 times less. About 300 people entered to others hospitals. The lethality consisted of 15%, 20% and 37%, respectively. There are a lot of matters, that should be discussed, such as an importance of better treatment financing of multitrauma by using compulsory medical insurance system, an optimization of pre-admission treatment and a necessity of patient delivery by mobile medical team using the anaesthesiology and resuscitation.

  6. Publications in academic medical centers: technology-facilitated culture clash. (United States)

    Berner, Eta S


    Academic culture has a set of norms, expectations, and values that are sometimes tacit and sometimes very explicit. In medical school and other health professions educational settings, probably the most common norm includes placing a high value on peer-reviewed research publications, which are seen as the major evidence of scholarly productivity. Other features of academic culture include encouraging junior faculty and graduate students to share their research results at professional conferences and lecturing with slides as a major way to convey information. Major values that faculty share with journal editors include responsible conduct of research and proper attribution of others' words and ideas. Medical school faculty also value technology and are often quick to embrace technological advances that can assist them in their teaching and research. This article addresses the effects of technology on three aspects of academic culture: education, presentations at professional meetings, and research publications.The technologies discussed include online instruction, dissemination of conference proceedings on the Internet, plagiarism-detection software, and new technologies deployed by the National Center for Biotechnology Information, the home of PubMed. The author describes how the ease of deploying new technologies without faculty changing their norms and behavior in the areas of teaching and research can lead to conflicts of values among key stakeholders in the academic medical community, including faculty, journal editors, and professional associations. The implications of these conflicts and strategies for managing them are discussed.

  7. Treatment of Post-Traumatic Stress Disorder Nightmares at a Veterans Affairs Medical Center (United States)

    Detweiler, Mark B.; Pagadala, Bhuvaneshwar; Candelario, Joseph; Boyle, Jennifer S.; Detweiler, Jonna G.; Lutgens, Brian W.


    The effectiveness of medications for PTSD in general has been well studied, but the effectiveness of medicatio.ns prescribed specifically for post-traumatic stress disorder (PTSD) nightmares is less well known. This retrospective chart review examined the efficacy of various medications used in actual treatment of PTSD nightmares at one Veteran Affairs Hospital. Records at the Salem, VA Veterans Affairs Medical Center (VAMC) were examined from 2009 to 2013 to check for the efficacy of actual treatments used in comparis.on with treatments suggested in three main review articles. The final sample consisted of 327 patients and 478 separate medication trials involving 21 individual medications plus 13 different medication combinations. The three most frequently utilized medications were prazosin (107 trials), risperidone (81 trials), and quetiapine (72 trials). Five medications had 20 or more trials with successful results (partial to full nightmare cessation) in >50% of trials: risperidone (77%, 1.0–6.0 mg), clonidine (63%, 0.1–2.0 mg), quetiapine (50%, 12.5–800.0 mg), mirtazapine (50%; 7.5–30.0 mg), and terazosin (64%, 50.0–300.0 mg). Notably, olanzapine (2.5–10.0) was successful (full remission) in all five prescription trials in five separate patients. Based on the clinical results, the use of risperidone, clonidine, terazosin, and olanzapine warrants additional investigation in clinically controlled trials as medications prescribed specifically for PTSD nightmares. PMID:27999253

  8. Patient-Centered Medical Home and Family Burden in Attention-Deficit Hyperactivity Disorder. (United States)

    Ronis, Sarah D; Baldwin, Constance D; Blumkin, Aaron; Kuhlthau, Karen; Szilagyi, Peter G


    Attention-deficit hyperactivity disorder (ADHD) can impair child health and functioning, but its effects on the family's economic burden are not well understood. The authors assessed this burden in US families of children with ADHD, and the degree to which access to a patient-centered medical home (PCMH) might reduce this burden. We conducted cross-sectional analyses of 2005-2006 and 2009-2010 National Surveys of Children with Special Health Care Needs, focusing on families of children with ADHD. They defined family economic burden as (1) family financial problems (annual expenses for the child's health care or illness-related financial problems for the family) and/or (2) family employment problems (job loss, work time loss, or failure to change jobs to avoid insurance loss). Relative risk models assessed associations between PCMH and family economic burden, adjusted for child age, sex, ethnicity, ADHD severity, poverty status, caregiver education, and insurance. In 2009, 26% of families reported financial problems because of the child's ADHD, 2.1% reported out-of-pocket expenses >5% of income, and 36% reported employment problems. Only 38% reported care that met all 5 criteria for a PCMH (similar to rates in 2005-2006). In multivariable analysis, care in a PCMH was associated with 48% lower relative risk (RR) of financial problems (RR = 0.52, p family-centered care and care coordination were more strongly associated with lower burden. The economic burdens of families with ADHD are significant but may be alleviated by family-centered care and care coordination in a medical home.

  9. [Medical fault or professional negligence? Case studies in two recovery nutrition centers in Niger]. (United States)

    Halidou Doudou, M; Manzo, M L; Guero, D


    In developing countries such as Niger, the risk of medical malpractice is ubiquitous in health, jeopardizing patient safety. The aim of this work was to contribute to patients' safety and respect of code of ethics and conduct in the exercise of the medical profession. The reported cases involved two children under 5 years who were admitted to nutrition rehabilitation centers, died as a result of medical malpractice. In Niger, there are no statistics on this phenomenon and a few cases found have always been considered "accident" or "fate." The establishment of an observatory collections of such information should improve their frequency, consequences and propose a prevention plan. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  10. Impact of a Patient-Centered Medical Home on Access, Quality, and Cost (United States)


    Effec- tiveness Data and Information Set metrics, and composite measures for access, patient satisfaction, provider communica- tion, and customer service...reduced health care costs. The patient -centered medical home (PCMH) concept is “an approach to providing comprehensive primary care [in] a health care... patient at the right place and right time” is vital to the appro- priate utilization of health care services across a broad spec- trum of patient needs

  11. Measuring the Cost of the Patient-Centered Medical Home: A Cost-Accounting Approach. (United States)

    Lieberthal, Robert D; Payton, Colleen; Sarfaty, Mona; Valko, George

    To explore the cost for individual practices to become more patient-centered, we inventoried and calculated the cost of costly activities involved in implementing the Patient-Centered Medical Home (PCMH) as defined by the National Committee for Quality Assurance. There were 3 key findings. The cost of each PCMH-related clinical activity can be classified in 1 of 3 major categories. Cost offsets can be used to defray part of the cost recognition. The cost of PCMH transformation varied by practice with no clear level or pattern of costs. Our study suggests that small- and medium-sized practices may experience difficulty with the financial burden of PCMH recognition.

  12. Information geometry and population genetics the mathematical structure of the Wright-Fisher model

    CERN Document Server

    Hofrichter, Julian; Tran, Tat Dat


    The present monograph develops a versatile and profound mathematical perspective of the Wright--Fisher model of population genetics. This well-known and intensively studied model carries a rich and beautiful mathematical structure, which is uncovered here in a systematic manner. In addition to approaches by means of analysis, combinatorics and PDE, a geometric perspective is brought in through Amari's and Chentsov's information geometry. This concept allows us to calculate many quantities of interest systematically; likewise, the employed global perspective elucidates the stratification of the model in an unprecedented manner. Furthermore, the links to statistical mechanics and large deviation theory are explored and developed into powerful tools. Altogether, the manuscript provides a solid and broad working basis for graduate students and researchers interested in this field.

  13. [Medical centers--methods, purpose and benefits]. (United States)

    Schrappe, Matthias


    The German hospital sector is characterized by a profound deficit in organizational integration. The implementation of centers as one way to improve the situation is complicated by the heterogeneity of the concept and understanding of the term "center". The author proposes to distinguish between functional, divisional and process-oriented centers. In German hospitals where the transition from functional to divisional organization is under way matrix elements can be expected to be introduced into organizational practice. Process-oriented centers like breast centers represent matrix components by simultaneously applying functional and process-oriented perspectives. Matrix components map the complexity of clinical structures, but increase coordination and management load and should be applied only to a limited number of care processes.

  14. Detecting Postpartum Depression in Referents to Medical and Health Centers in Hamadan City

    Directory of Open Access Journals (Sweden)

    F. Shobeiri


    Full Text Available Introduction & Objective: Pregnancy and childbirth are significant developmental excitable for most women. Physical, intrapersonal and relational adaptations are needed to adjust successfully to pregnancy and delivery. Postpartum depression is a serious psychiatric disorder and the adverse impact on infants has been noted. The purpose of this study was to detect postpartum depression in referents to medical and health centers in Hamadan city.Materials & Methods: A descriptive and cross-sectional study involving 400 women completed the Beck Depression Inventory (BDI within 2-8 weeks of delivery was conducted in urban health centers in Hamadan city, Iran. Data were collected through interviews with women in the clinics in the health centers. Data processing and statistical analysis were performed using SPSS 10.0.Results: The results revealed that majority of women (68.0% were considered normal. Depression was detected in 32.0% of women. Out of these 19.0, 4.0 and 9.0% were mild, moderate and severe depression, respectively. There were statistically significant differences between postpartum depression and age, number of delivery, education, job and husband's job (P=0.000.Conclusion: Nearly 32.0% of selected women had depression. Therefore, it is important for medical personnel to be well versed in the course and treatment of postpartum depression. Post partum depression should be screened and treated as early as possible for several reasons. It can cause significant suffering for the woman who experiences it, and it can have deleterious consequences for the newborn.

  15. Strategi Public Relations Dalam Membangun Branding Rumah Sakit Telogorejo Menjadi Semarang Medical Center


    Pertiwi, Rifka Ayu; Naryoso, Agus; Luqman, Yanuar


    ViiiSTRATEGI PUBLIC RELATIONS DALAM MEMBANGUN BRANDINGRUMAH SAKIT TELOGOREJO MENJADI SEMARANG MEDICALCENTERAbstrakPerubahan brand merupakan hal yang sering terjadi pada sebuah institusi atauperusahaan. Hal ini menjadi salah satu pekerjaan humas yang bersangkutan dalammendapatkan kesadaran target audiens terhadap Perubahan brand tersebut.RS Telogorejo melakukan Perubahan brand menjadi Semarang MedicalCenter. Sedangkan brand RS Telogorejo sudah melekat di benak target audienssebagai rumah sakit...


    Directory of Open Access Journals (Sweden)

    I. M. Spivak


    Full Text Available Stressful situations in the work of a pediatric medical facility's call center are associated with patients' violation of social communication norms and aggressive behavior, as well as the operator's professional/maternal conflict. The following psychological resources facilitate better stress resistance of operators: self-confidence, mature and rational attitude, personal activity, inner satisfaction, optimism, emotional breadth and emotional colleague support. 

  17. Financial impact of hand surgery programs on academic medical centers. (United States)

    Hasan, Jafar S; Chung, Kevin C; Storey, Amy F; Bolg, Mary L; Taheri, Paul A


    This study analyzes the financial performance of hand surgery in the Department of Surgery at the University of Michigan. This analysis can serve as a reference for other medical centers in the financial evaluation of a hand surgery program. Fiscal year 2004 billing records for all patients (n = 671) who underwent hand surgery procedures were examined. The financial data were separated into professional revenues and costs (relating to the hand surgery program in the Section of Plastic Surgery) and into facility revenues and costs (relating to the overall University of Michigan Health System). Professional net revenue was calculated by applying historical collection rates to procedural and clinic charges. Facility revenue was calculated by applying historical collection rates to the following charge categories: inpatient/operating room, clinic facility, neurology/electromyography, radiology facilities, and occupational therapy. Total professional costs were calculated by adding direct costs and allocated overhead costs. Facility costs were obtained from the hospital's cost accounting system. Professional and facility incomes were calculated by subtracting costs from revenues. The net professional revenue and total costs were 1,069,836 and 1,027,421 dollars, respectively. Professional operating income was 42,415 dollars, or 3.96 percent of net professional revenue. Net facility revenue and total costs were 5,500,606 and 4,592,534 dollars, respectively. Facility operating income was 908,071 dollars, or 16.51 percent of net facility revenues. While contributing to the academic mission of the institution, hand surgery is financially rewarding for the Department of Surgery. In addition, hand surgery activity contributes substantially to the financial well-being of the academic medical center.

  18. Building Brains, Forging Futures: A Call to Action for the Family-Centered Medical Home (United States)

    Kraft, Colleen


    The family-centered medical home describes an approach to providing comprehensive primary care. Research advances in developmental neuroscience, genetics, and epigenetics offer a framework for understanding the dynamic process of brain development. It is this process that sets the life-course trajectory for an individual; in turn, a child's…

  19. Opportunities for social workers in the patient centered medical home. (United States)

    Hawk, Mary; Ricci, Edmund; Huber, George; Myers, Marcella


    The Patient Centered Medical Home (PCMH) has been hailed as one method of improving chronic care outcomes in the United States. A number of studies have underscored the importance of the social work role within the PCMH, yet little existing research explores the social worker as a driver of improved patient care. The Pennsylvania Chronic Care Initiative was created with a primary goal of increasing the number of practices that were recognized as PCMH by the National Committee for Quality Assurance. This article describes findings from in-depth qualitative interviews with representatives from seven primary care practices, in which the authors examined barriers and facilitators to implementation of the initiative. Barriers to implementation included small practice size, payer-driven care, not having a strong physician champion, variability within patient populations, and high implementation costs. Facilitators included having a social worker coordinate behavioral health services, clinical nurse case managers, preexisting models of outcomes-driven care, and being part of an integrated health delivery and financing system. Recommendations strengthening the role of medical social workers in primary care practices are discussed.

  20. Collaboration between a college of pharmacy and a for-profit health system at an academic medical center. (United States)

    Bird, Matthew L; Dunn, Rebecca L; Hagemann, Tracy M; Burton, Michael E; Britton, Mark L; St Cyr, Mark B


    The genesis and growth of a successful 14-year partnership between the University of Oklahoma (OU) college of pharmacy and the OU Medical Center (OUMC) department of pharmacy are described. Pursuant to a 1998 joint operating agreement, the medical center and pharmacy school have achieved a high degree of collaboration on a wide range of educational and clinical initiatives. The close relationship has conferred a number of benefits on both institutions, including (1) expanded experiential education opportunities for pharmacy students, (2) joint faculty and staff funding arrangements that have facilitated the development and accreditation of OU pharmacy residency programs, and (3) patient care initiatives that have increased awareness of pharmacists' important contributions in areas such as venous thromboembolism prophylaxis, antibiotic stewardship, and core measures compliance. In addition to the formal integration of the college of pharmacy into the OUMC organizational structure, ongoing teamwork by clinicians and administrators at the two institutions has strengthened the 14-year partnership while helping to identify creative solutions to evolving communications, technology, and reimbursement challenges. Potential growth opportunities include the expansion of pharmacy services into additional service areas and greater involvement by OU pharmacy school faculty in the training of medical, nursing, and allied health professionals. A large for-profit academic medical center and a college of pharmacy developed a successful collaboration that is mutually beneficial and provides increased clinical, educational, and scholarly opportunities, advancing the mission of both institutions.

  1. Additional Evidence Is Needed to Recommend Acquiring a Dog to Families of Children with Autism Spectrum Disorder: A Response to Wright and Colleagues (United States)

    Crossman, Molly K.; Kazdin, Alan E.


    Caregivers of children with autism spectrum disorder are vulnerable to overstated benefits of interventions, and such overstatements are common with interventions involving animals. This response to Wright, Hall, Hames, Hardmin, Mills, the Paws Team, and Mills' (2015) article, "Acquiring a Pet Dog Significantly Reduces Stress of Primary…

  2. Ontario pharmacists practicing in family health teams and the patient-centered medical home. (United States)

    Dolovich, Lisa


    The patient-centered medical home (PCMH) approach continues to gather momentum in the United States and Canada as a broad approach to reform the delivery of the complete primary care system. The family health team (FHT) model implemented in Ontario, Canada, best mirrors the PCMH approach of the United States. The integration of pharmacists as key members of the health care team providing on-site, in-office coordinated care to FHT patients was included from the start of planning the FHT model and represents a substantial opportunity for pharmacists to realize their professional vision. Several research projects in Canada and elsewhere have contributed to providing evidence to support the integration of pharmacists into primary care practice sites. Two major research programs, the Seniors Medication Assessment Research Trial (SMART) cluster randomized controlled trial and the Integrating Family Medicine and Pharmacy to Advance Primary Care Therapeutics (IMPACT) multipronged demonstration project made substantial contributions to evidence-informed policy decisions supporting the integration of pharmacists into FHTs. These projects can provide useful information to support the integration of pharmacists into the PCMH and to encourage further research to better measure the effect of the pharmacist from the holistic patient-centered perspective.

  3. [Medical equipment companies and their ties with technology development centers in Mexico]. (United States)

    Hernández, B; Arredondo, A; Cruz, C; Sánchez, E; Damián, T


    The purpose of this study was to determine the characteristics of the companies that produce, distribute, and service medical equipment in Mexico and the factors related to whether or not they had established ties with research and technology development centers. The data analyzed came from a survey of such companies carried out in Mexico City and environs in 1989. The information was updated in 1991. Multivariate analyses were carried out in order to identify the characteristics of companies that had established ties or wished to do so and the areas of interest of those companies. Of 208 companies surveyed, only 23% had ties with research centers. The companies that had such ties or were interested in establishing them tended to invest in research and to have made plans for expansion. The establishment of ties appeared to be a two-way process, with positive consequences for the companies involved, the research centers, and the health sector. It was concluded that it would be advantageous to design programs to promote ties with companies having the characteristics mentioned.

  4. Putting patients first: a novel patient-centered model for medical enterprise success. (United States)

    Dhawan, Naveen


    This article introduces a new way of viewing patient-customers. It encourages a greater emphasis on patients' needs and the importance of considering dimensions of the patient experience to better serve them. It also draws from examples in the general business world as they can be applied to medical enterprises. The author introduces a model that directs all business activities toward the end consumer with an underlying guidance by patient needs. A business is advised to understand its customer, design a patient-directed vision, and focus on creating a unique customer experience. The article delineates key action items for physicians and administrators that will allow them to better meet their patient-customers' needs and develop loyalty. By practicing a patient-centered approach and following these guidelines, one may ensure greater success of the medical enterprise.

  5. Positioning academic medical centers and teaching hospitals to thrive in the next decade. (United States)

    Morris, D E


    Market share for academic medical centers and teaching hospitals will decline over the next five years necessitating new strategies to ensure growth and profitability. These types of institutions are, however, in a strong position to compete and gain market share locally by building a defensible competitive advantage. This article offers three avenues for increasing market share: networking, brand name product differentiation, and business diversification.

  6. Shuffled Frog Leaping Algorithm for Preemptive Project Scheduling Problems with Resource Vacations Based on Patterson Set

    Directory of Open Access Journals (Sweden)

    Yi Han


    Full Text Available This paper presents a shuffled frog leaping algorithm (SFLA for the single-mode resource-constrained project scheduling problem where activities can be divided into equant units and interrupted during processing. Each activity consumes 0–3 types of resources which are renewable and temporarily not available due to resource vacations in each period. The presence of scarce resources and precedence relations between activities makes project scheduling a difficult and important task in project management. A recent popular metaheuristic shuffled frog leaping algorithm, which is enlightened by the predatory habit of frog group in a small pond, is adopted to investigate the project makespan improvement on Patterson benchmark sets which is composed of different small and medium size projects. Computational results demonstrate the effectiveness and efficiency of SFLA in reducing project makespan and minimizing activity splitting number within an average CPU runtime, 0.521 second. This paper exposes all the scheduling sequences for each project and shows that of the 23 best known solutions have been improved.

  7. Cerebral angioplasty practice at major medical centers in the United States

    International Nuclear Information System (INIS)

    Chaturvedi, S.; St Pierre, M.E.; Bertasio, B.


    Concern has been expressed recently regarding the proliferation of angioplasty and/or stenting of cerebral vessels. However, little is known about the volume of angioplasties being performed or the number of experienced interventionalists. A questionnaire was mailed to directors of accredited radiology residency programs in the United States, to define the level of expertise available at teaching hospitals in terms of angioplasty and/or stenting. Of 200 programs surveyed, 111 responded (56 %). Of 111 program directors 47 (42 %) indicated that cerebral angioplasty was being performed at their center. The greatest experience is currently for angioplasty of post-subarachnoid hemorrhage vasospasm (mean 16 procedures performed) and the least experience for dilation of basilar artery atherosclerosis (mean five procedures performed). The reported stroke and/or death rate in centers performing angioplasty of the extracranial carotid system is 1.5 %. Comparisons with other medical specialties (e. g., cardiologists, neurologists, neurosurgeons) are necessary to determine the full scope of extracranial neurovascular procedures being performed and the corresponding complication rates. (orig.)

  8. Installation Restoration Program. Phase II. Confirmation/Quantification Stage I for Wright-Patterson Air Force Base, Dayton, Ohio. (United States)


    nitrate, chlor- ide, sulfate, boron, iron manga - nese, sodium, TOC, TOX, and phenol. Sample six leachate seeps for specific conductance, chlor- ide...Primary Drinking Water Standard of 10 mg/l for nitrate. No boron, iron or manga - nese were found in MW-17. Sodium was detected at 35 mg/l in the well...Thomas, 1976, "Control Pro- Leis, W., and A. Metry, " Multimedia Pathways of Con- gram for Leachate Affecting a Multiple Aquifer System, taminant

  9. Impact on Seniors of the Patient-Centered Medical Home: Evidence from a Pilot Study (United States)

    Fishman, Paul A.; Johnson, Eric A.; Coleman, Kathryn; Larson, Eric B.; Hsu, Clarissa; Ross, Tyler R.; Liss, David; Tufano, James; Reid, Robert J.


    Purpose: To assess the impact on health care cost and quality among seniors of a patient-centered medical home (PCMH) pilot at Group Health Cooperative, an integrated health care system in Washington State. Design and Methods: A prospective before-and-after evaluation of the experience of seniors receiving primary care services at 1 pilot clinic…

  10. Radiation safety knowledge of medical center radiology technologists in southern Taiwan

    Energy Technology Data Exchange (ETDEWEB)

    Su Wen-Chuan; Huang Ying-Fong; Chen Cheng-Chung; Chang Pao-Shu [Kaohsiung Medical University, Taiwan (China)


    People who live in Taiwan are getting more and more afraid of radiation. Sometimes the phobia results from distorted knowledge. Radiology technologists, in one hand, are more well-educated in radiation and, in the other hand, have more chance to expose to radiation when they are operating radiation producing medical instruments in their daily life. So we are interested in whether they have enough knowledge to protect themselves. We pick up the radiology technology board examination to make the questionnaire for this study. The population is the radiology technologists who work at department of diagnostic radiology, of radiation therapy and nuclear medicine in medical centers. Statistics is then used to see the relationship between knowledge and the factors including gender, age and career period. Based on statistics, we find out that there is significant correlation between the knowledge with age or education level. Elder or lower education level ones has worse knowledge. Continued education may be highly recommended for radiology technologists to avoid occupational radiation injury. (author)

  11. Radiation safety knowledge of medical center radiology technologists in southern Taiwan

    International Nuclear Information System (INIS)

    Su Wen-Chuan; Huang Ying-Fong; Chen Cheng-Chung; Chang Pao-Shu


    People who live in Taiwan are getting more and more afraid of radiation. Sometimes the phobia results from distorted knowledge. Radiology technologists, in one hand, are more well-educated in radiation and, in the other hand, have more chance to expose to radiation when they are operating radiation producing medical instruments in their daily life. So we are interested in whether they have enough knowledge to protect themselves. We pick up the radiology technology board examination to make the questionnaire for this study. The population is the radiology technologists who work at department of diagnostic radiology, of radiation therapy and nuclear medicine in medical centers. Statistics is then used to see the relationship between knowledge and the factors including gender, age and career period. Based on statistics, we find out that there is significant correlation between the knowledge with age or education level. Elder or lower education level ones has worse knowledge. Continued education may be highly recommended for radiology technologists to avoid occupational radiation injury. (author)

  12. Laser diagnostics of atomic hydrogen and oxygen production in rf and microwave plasma discharges

    International Nuclear Information System (INIS)

    Preppernau, B.L.


    The research for this thesis involved the application of two-photon allowed laser-induced fluorescence (TALIF) to the study of atomic hydrogen and oxygen production in industrial scale radio-frequency and microwave plasma discharge apparatus. Absolute atomic hydrogen concentration profiles were measured in a Gaseous Electronics Conference Reference Cell installed at Wright-Patterson AFB, Ohio operating with a simple H 2 discharge. Two-dimensional atomic hydrogen concentration profiles were also measured in an ASTEX HPMM microwave plasma diamond deposition reactor during actual diamond growth. In addition absolute atomic oxygen concentrations were measured in the ASTEX system. Particular attention as paid to refining the concentration calibration technique and in determining a correction to account for the collisional quenching of excited state fluorescence in high pressure gases

  13. Surgeon leadership in the coding, billing, and contractual negotiations for fenestrated endovascular aortic aneurysm repair increases medical center contribution margin and physician reimbursement. (United States)

    Aiello, Francesco; Durgin, Jonathan; Daniel, Vijaya; Messina, Louis; Doucet, Danielle; Simons, Jessica; Jenkins, James; Schanzer, Andres


    Fenestrated endovascular aneurysm repair (FEVAR) allows endovascular treatment of thoracoabdominal and juxtarenal aneurysms previously outside the indications of use for standard devices. However, because of considerable device costs and increased procedure time, FEVAR is thought to result in financial losses for medical centers and physicians. We hypothesized that surgeon leadership in the coding, billing, and contractual negotiations for FEVAR procedures will increase medical center contribution margin (CM) and physician reimbursement. At the UMass Memorial Center for Complex Aortic Disease, a vascular surgeon with experience in medical finances is supported to manage the billing and coding of FEVAR procedures for medical center and physician reimbursement. A comprehensive financial analysis was performed for all FEVAR procedures (2011-2015), independent of insurance status, patient presentation, or type of device used. Medical center CM (actual reimbursement minus direct costs) was determined for each index FEVAR procedure and for all related subsequent procedures, inpatient or outpatient, 3 months before and 1 year subsequent to the index FEVAR procedure. Medical center CM for outpatient clinic visits, radiology examinations, vascular laboratory studies, and cardiology and pulmonary evaluations related to FEVAR were also determined. Surgeon reimbursement for index FEVAR procedure, related adjunct procedures, and assistant surgeon reimbursement were also calculated. All financial analyses were performed and adjudicated by the UMass Department of Finance. The index hospitalization for 63 FEVAR procedures incurred $2,776,726 of direct costs and generated $3,027,887 in reimbursement, resulting in a positive CM of $251,160. Subsequent related hospital procedures (n = 26) generated a CM of $144,473. Outpatient clinic visits, radiologic examinations, and vascular laboratory studies generated an additional CM of $96,888. Direct cost analysis revealed that grafts

  14. Evolutionary Game Dynamics in a Fitness-Dependent Wright-Fisher Process with Noise

    International Nuclear Information System (INIS)

    Quan Ji; Wang Xianjia


    Evolutionary game dynamics in finite size populations can be described by a fitness-dependent Wright-Fisher process. We consider symmetric 2x2 games in a well-mixed population. In our model, two parameters to describe the level of player's rationality and noise intensity in environment are introduced. In contrast with the fixation probability method that used in a noiseless case, the introducing of the noise intensity parameter makes the process an ergodic Markov process and based on the limit distribution of the process, we can analysis the evolutionary stable strategy (ESS) of the games. We illustrate the effects of the two parameters on the ESS of games using the Prisoner's dilemma games (PDG) and the snowdrift games (SG). We also compare the ESS of our model with that of the replicator dynamics in infinite size populations. The results are determined by simulation experiments. (general)

  15. A Study to Evaluate the Organization and the Operating Procedures of the Patient Assistance Function at Brooke Army Medical Center, Fort Sam Houston, Texas (United States)


    15 March 1979. 59Interview with Wendy L. Farace , Head Nurse, Obstetrics/Gynecology Clinic, Brooke Army Medical Center, Fort Sam Houston, Texas, 8...6 February 1979. Farace , Wendy L. Head Nurse, Obstetrica/Gynecology Clinic, Brooke Army Medical Center, Fort Sam Houston, Texas. Interview, 8 January

  16. An Analysis of Information Technology Adoption by IRBs of Large Academic Medical Centers in the United States. (United States)

    He, Shan; Botkin, Jeffrey R; Hurdle, John F


    The clinical research landscape has changed dramatically in recent years in terms of both volume and complexity. This poses new challenges for Institutional Review Boards' (IRBs) review efficiency and quality, especially at large academic medical centers. This article discusses the technical facets of IRB modernization. We analyzed the information technology used by IRBs in large academic institutions across the United States. We found that large academic medical centers have a high electronic IRB adoption rate; however, the capabilities of electronic IRB systems vary greatly. We discuss potential use-cases of a fully exploited electronic IRB system that promise to streamline the clinical research work flow. The key to that approach utilizes a structured and standardized information model for the IRB application. © The Author(s) 2014.

  17. Improvements in self-efficacy for engaging in patient-centered communication following a course in peer-supervision and communication for medical students

    DEFF Research Database (Denmark)

    Lassesen, Berit; O Connor, Maja; Kjær, Louise Binow

    and Department of Psychology and Behavioral Science, Aarhus University, Aarhus, Denmark; 3Center for Medical Education, Aarhus University, Aarhus, Denmark.; Aim: The aim was to evaluate the outcome of a training course in peer-supervision and communication with the aim of improving medical...... student self-efficacy for engaging in patient-centered communication and examine the influence of course-related motivation to learn, course-related self-efficacy, and medical student well-being at baseline. Methods: A total of 127 graduate school medical students in clinical clerkship who participated...... in a course in peer-supervision and communication completed a pre-course questionnaire package including: 1) The Patient-Centeredness Self-Efficacy Questionnaire (PCSEQ), 2) Course-Related Motivation to Learn (CRML), 3) Course-Related Self-Efficacy (CRSE), and 4) the Medical Student Well-Being Index (MSWBI...

  18. Health information security: a case study of three selected medical centers in iran. (United States)

    Hajrahimi, Nafiseh; Dehaghani, Sayed Mehdi Hejazi; Sheikhtaheri, Abbas


    Health Information System (HIS) is considered a unique factor in improving the quality of health care activities and cost reduction, but today with the development of information technology and use of internet and computer networks, patients' electronic records and health information systems have become a source for hackers. This study aims at checking health information security of three selected medical centers in Iran using AHP fuzzy and TOPSIS compound model. To achieve that security measures were identified, based on the research literature and decision making matrix using experts' points of view. Among the 27 indicators, seven indicators were selected as effective indicators and Fuzzy AHP technique was used to determine the importance of security indicators. Based on the comparisons made between the three selected medical centers to assess the security of health information, it is concluded that Chamran hospital has the most acceptable level of security and attention in three indicators of "verification and system design, user access management, access control system", Al Zahra Hospital in two indicators of "access management and network access control" and Amin Hospital in "equipment safety and system design". In terms of information security, Chamran Hospital ranked first, Al-Zahra Hospital ranked second and Al- Zahra hospital has the third place.

  19. Survey on prevalence and causes of self-medication in women referring to health centers in Ahwaz, in 2013

    Directory of Open Access Journals (Sweden)

    Pourandoght Afshary


    Full Text Available Background: Today, considerable advances achieved in different scientific fields have led to an ever-increasing access of people to various medications and their unauthorized consumption, which negatively affects the healthcare and treatment system. Thus, this study was conducted to determine the Prevalence and causes of this phenomenon in the female population of Ahwaz. Material and Methods: In this Cross-sectional study364 Women referring to seven health centers in Ahwaz were selected randomly and based on the family medical file number and by proportional distribution to each center and semi-structured questionnaires were completed through interviews. The data were analyzed by Chi square test and logistic regression. P<0.05 was considered significant. Results: Self-medication was observed in 70.1% of women. The most frequent group  was those above the age of 30. The most common self-medication case was urogenitaldisorders (58.7%. there was a significant relation between education (p<0.003 and number of births (p=0.003 and unauthorized drug consumption. The most causes for synthetic drug use were previous illness background (48.6% and high medication costs (50.6%, and about herbal drugs were high medication costs (41.1%, and the effectiveness of these products about medicinal herbs (38.1 %. Conclusion: High rate of self-medication in the studied society necessitates training on proper use of drugs through the use of social media.

  20. Learning from Primary Health Care Centers in Nepal: reflective writings on experiential learning of third year Nepalese medical students


    Dhital, Rolina; Subedi, Madhusudan; Prasai, Neeti; Shrestha, Karun; Malla, Milan; Upadhyay, Shambhu


    Background Medical education can play important role in cultivating the willingness among the medical students to work in underprivileged areas after their graduation. Experiential learning through early exposure to primary health care centers could help students better understand the opportunities and challenges of such settings. However, the information on the real experiences and reflections of medical students on the rural primary health care settings from low-income countries like Nepal ...

  1. Teaching Health Center Graduate Medical Education Locations Predominantly Located in Federally Designated Underserved Areas. (United States)

    Barclift, Songhai C; Brown, Elizabeth J; Finnegan, Sean C; Cohen, Elena R; Klink, Kathleen


    Background The Teaching Health Center Graduate Medical Education (THCGME) program is an Affordable Care Act funding initiative designed to expand primary care residency training in community-based ambulatory settings. Statute suggests, but does not require, training in underserved settings. Residents who train in underserved settings are more likely to go on to practice in similar settings, and graduates more often than not practice near where they have trained. Objective The objective of this study was to describe and quantify federally designated clinical continuity training sites of the THCGME program. Methods Geographic locations of the training sites were collected and characterized as Health Professional Shortage Area, Medically Underserved Area, Population, or rural areas, and were compared with the distribution of Centers for Medicare and Medicaid Services (CMS)-funded training positions. Results More than half of the teaching health centers (57%) are located in states that are in the 4 quintiles with the lowest CMS-funded resident-to-population ratio. Of the 109 training sites identified, more than 70% are located in federally designated high-need areas. Conclusions The THCGME program is a model that funds residency training in community-based ambulatory settings. Statute suggests, but does not explicitly require, that training take place in underserved settings. Because the majority of the 109 clinical training sites of the 60 funded programs in 2014-2015 are located in federally designated underserved locations, the THCGME program deserves further study as a model to improve primary care distribution into high-need communities.

  2. Final Environmental Assessment for National Air & Space Intelligence Center and US Air Force School of Aerospace Medicine Field Training Activities at Wright-Patterson Air Force Base, Ohio (United States)


    1997. Flushing Responses to Wintering Bald Eagles to Military Activity. Journal of Wildlife Management. 61(4):1307-1313. Telesco, D.J. and F.T. van ... Manen . 2006. Do black bears respond to military weapons training? The Journal of Wildlife Management. 70(1): 222-229. Whittaker, D. and R.L...patrol use. The dog may be on or offleash in the rear seat, on a stable platform, only. 2. l. 7. Assigning the dog team a cargo van or three-pack pickup

  3. Systemic lupus erythematosus and thyroid disease - Experience in a single medical center in Taiwan. (United States)

    Liu, Yu-Chuan; Lin, Wen-Ya; Tsai, Ming-Chin; Fu, Lin-Shien


    To investigate the association of systemic lupus erythematosus (SLE) with thyroid diseases in a medical center in central Taiwan. This is a retrospective cohort of 2796 SLE patients in a tertiary referral medical center from 2000 to 2013. We screened SLE by catastrophic illness registration from national insurance bureau; and thyroid diseases by ICD 9 codes, then confirmed by thyroid function test, auto-antibody, medical and/or surgical intervention. We compared the rate of hyperthyroidism, hypothyroidism and autoimmune thyroid disease (AITD) in SLE patients and the 11,184 match controls. We calculated the rate of these thyroid diseases and positive antibodies to thyroglobulin (ATGAb), thyroid peroxidase (TPOAb) in SLE patients grouped by the presence of overlap syndrome and anti-dsDNA antibody. We also compared the association of thyroid diseases to severe SLE conditions, including renal, central nervous system (CNS) involvement, and thrombocytopenia. Compared to the matched controls, the cumulative incidence of thyroid disease, including hyperthyroidism, hypothyroidism and AITD, were all higher in SLE patients (p hyperthyroidism. SLE patients with thyroid diseases also carry higher risk for severe complications such as renal involvement (p = 0.024) central nervous system involvement (p hyperthyroidism, hypothyroidism, and AITD than the matched control. Among lupus patients, the risks of thyroid diseases are even higher in the presence of overlap syndrome. SLE patients with thyroid diseases had higher risk of renal and CNS involvement. Copyright © 2017. Published by Elsevier B.V.

  4. Looking at the work of Raul Lino, in comparison with Frank Lloyd Wright: from the Arts & Crafts, the nature, the organic and the house

    Directory of Open Access Journals (Sweden)

    José Manuel Fernandes


    Full Text Available El texto hace un análisis comparativo de las obras de Raul Lino (1879-1974, portugués, y Frank Lloyd Wright (1867-1959, de Estados Unidos- dos arquitectos (casi contemporáneos, cada uno exponente de la cultura y la sociedad de su tiempo y de su espacio de vida y de trabajo.El artículo se refiere al contexto histórico y cultural del primer periodo creativo de estos autores. En este contexto trata de las obras de John Ruskin y William Morris, creadores del Arts & Crafts, así como de las características de este movimiento artístico, de las peculiaridades del Deutscher Werkbund y de los trabajos de Sullivan y Berlage. Acerca de Lino y Wright, este artículo presenta la “comprensión del mundo” que tenían: sus temas conceptuales y arquitectónicos, así como los movimientos estéticos y culturales asociados a sus trabajos - “Casa Portuguesa” y “Arquitectura Orgánica”. Se exponen y analizan los “seis principios” de Wright y los “seis principios” de Lino -destacando los aspectos comunes de las concepciones de ambos autores. Se describen y ejemplifican, también, algunos de los temas y materiales arquitectónicos comunes en la primera fase de las obras los arquitectos. Así mismo, se estudia con mayor profundidad el diseño de obras concretas, casas, de su autoría, en sus similitudes y contrastes.

  5. Holistic Health Care for the Medically Uninsured: The Church Health Center of Memphis


    Morris, G. Scott


    The Church Health Center (CHC) in Memphis was founded in 1987 to provide quality, affordable health care for working, uninsured people and their families. With numerous, dedicated financial supporters and health care volunteers, CHC has become the largest faith-based health care organization of its type nationally, serving >61,000 patients. CHC embraces a holistic approach to health by promoting wellness in every dimension of life. It offers on-site services including medical care, dentistry,...

  6. An intelligent algorithm for identification of optimum mix of demographic features for trust in medical centers in Iran. (United States)

    Yazdanparast, R; Zadeh, S Abdolhossein; Dadras, D; Azadeh, A


    Healthcare quality is affected by various factors including trust. Patients' trust to healthcare providers is one of the most important factors for treatment outcomes. The presented study identifies optimum mixture of patient demographic features with respect to trust in three large and busy medical centers in Tehran, Iran. The presented algorithm is composed of adaptive neuro-fuzzy inference system and statistical methods. It is used to deal with data and environmental uncertainty. The required data are collected from three large hospitals using standard questionnaires. The reliability and validity of the collected data is evaluated using Cronbach's Alpha, factor analysis and statistical tests. The results of this study indicate that middle age patients with low level of education and moderate illness severity and young patients with high level of education, moderate illness severity and moderate to weak financial status have the highest trust to the considered medical centers. To the best of our knowledge this the first study that investigates patient demographic features using adaptive neuro-fuzzy inference system in healthcare sector. Second, it is a practical approach for continuous improvement of trust features in medical centers. Third, it deals with the existing uncertainty through the unique neuro-fuzzy approach. Copyright © 2018 Elsevier B.V. All rights reserved.

  7. Using Technology to Enhance Teaching of Patient-Centered Interviewing for Early Medical Students. (United States)

    Kaltman, Stacey; Talisman, Nicholas; Pennestri, Susan; Syverson, Eleri; Arthur, Paige; Vovides, Yianna


    Effective strategies for teaching communication skills to health professions students are needed. This article describes the design and evaluation of immersive and interactive video simulations for medical students to practice basic communication skills. Three simulations were developed, focusing on patient-centered interviewing techniques such as using open-ended questions, reflections, and empathic responses while assessing a patient's history of present illness. First-year medical students were randomized to simulation or education-as-usual arms. Students in the simulation arm were given access to three interactive video simulations developed using Articulate Storyline, an e-learning authoring tool, to practice and receive feedback on patient-centered interviewing techniques to prepare for their Observed Structured Clinical Examination (OSCE). Trained raters evaluated videos of two OSCE cases for each participant to assess specific communication skills used during the history of present illness component of the interview. Eighty-seven percent of the students in the simulation arm interacted with at least one simulation during the history of present illness. For both OSCE cases, students in the simulation arm asked significantly more open-ended questions. Students in the simulation arm asked significantly fewer closed-ended questions and offered significantly more empathic responses in one OSCE case. No differences were found for reflections. Students reported that the simulations helped improve their communication skills. The use of interactive video simulations was found to be feasible to incorporate into the curriculum and was appealing to students. In addition, students in the simulation arm displayed more behaviors consistent with the patient-centered interviewing model practiced in the simulations. Continued development and research are warranted.

  8. Multipayer patient-centered medical home implementation guided by the chronic care model. (United States)

    Gabbay, Robert A; Bailit, Michael H; Mauger, David T; Wagner, Edward H; Siminerio, Linda


    A unique statewide multipayer ini Pennsylvania was undertaken to implement the Patient-Centered Medical Home (PCMH) guided by the Chronic Care Model (CCM) with diabetes as an initial target disease. This project represents the first broad-scale CCM implementation with payment reform across a diverse range of practice organizations and one of the largest PCMH multipayer initiatives. Practices implemented the CCM and PCMH through regional Breakthrough Series learning collaboratives, supported by Improving Performance in Practice (IPIP) practice coaches, with required monthly quality reporting enhanced by multipayer infrastructure payments. Some 105 practices, representing 382 primary care providers, were engaged in the four regional collaboratives. The practices from the Southeast region of Pennsylvania focused on diabetes patients (n = 10,016). During the first intervention year (May 2008-May 2009), all practices achieved at least Level 1 National Committee for Quality Assurance (NCQA) Physician Practice Connections Patient-Centered Medical Home (PPC-PCMH) recognition. There was significant improvement in the percentage of patients who had evidence-based complications screening and who were on therapies to reduce morbidity and mortality (statins, angiotensin-converting enzyme inhibitors). In addition, there were small but statistically significant improvements in key clinical parameters for blood pressure and cholesterol levels, with the greatest absolute improvement in the highest-risk patients. Transforming primary care delivery through implementation of the PCMH and CCM supported by multipayer infrastructure payments holds significant promise to improve diabetes care.

  9. [Work satisfaction, quality of life and leisure time of residents at the Soroka University Medical Center, Beer Sheba, Israel]. (United States)

    Acker, Asaf; Perry, Zvi; Reuveni, Haim; Toker, Asaf


    Work dissatisfaction among physicians worldwide continues to rise over the last few decades, mainly due to declining professional prestige, tack of self fulfillment, time pressure and tack of leisure time. Physicians' burnout is a major result of dissatisfaction, causing doctors to leave the medical profession, and to provide lower quality of care. To examine the work satisfaction, quality of life and leisure time of residents in the Soroka University Medical Center. A validated questionnaire was delivered during the second half of 2004 to 252 residents in the Soroka University Medical Center The data was analyzed using the SPSS 12 for windows program. Descriptive analysis, parametric Students' T Test [where pleisure time. Further attention must be given to these matters--a step which will eventually improve patient care, and delay, to some extent, the burnout of physicians.

  10. Relationships among communication competence, self-efficacy, and job satisfaction in Korean nurses working in the emergency medical center setting. (United States)

    Park, Min Sook; Jeoung, Yeonok; Lee, Hye Kyung; Sok, Sohyune R


    The communication competence of nurses working in emergency medical center settings is essential to establish a therapeutic nurse-patient relationship. Education and strategic development are required to improve the communication competence of emergency room (ER) nurses. This study was conducted to determine the relationships among individual communication competence, self-efficacy, and job satisfaction in Korean nurses in the emergency medical center setting. A cross-sectional descriptive design was adopted. The study sample included 214 nurses at 11 emergency medical centers in Seoul and Kyunggi-Do, Korea. Measures used included the Global Interpersonal Communication Competence, self-efficacy scale, and job satisfaction scale. The collected data were analyzed using the SPSS version 18.0 statistical software program and included descriptive statistics (frequency, percentage, mean, standard deviation, independent t test, analysis of variance, and Pearson's correlation coefficient). The degrees of communication competence and self-efficacy of ER nurses were good, with higher scores than the median values. However, the degree of job satisfaction was poor, indicating a lower score than the median value. Religious affiliation and previous participation in communication education each had a significant impact on communication competence. Religious affiliation and time of worse duty each had a significant impact on self-efficacy. Length of career (year) in the emergency medical center and type of hospital each had a significant impact on job satisfaction. Positive correlations were identified among communication competence, self-efficacy, and job satisfaction. This study supported the presence of significant correlations among communication competence, self-efficacy, and job satisfaction. Thus, it is necessary to develop training programs that are customized to individual characteristics such as self-efficacy and job satisfaction to improve the communicative competence

  11. Using Learner-Centered, Simulation-Based Training to Improve Medical Students’ Procedural Skills

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    Serkan Toy


    Full Text Available Purpose: To evaluate the effectiveness of a learner-centered, simulation-based training developed to help medical students improve their procedural skills in intubation, arterial line placement, lumbar puncture, and central line insertion. Method: The study participants were second and third year medical students. Anesthesiology residents provided the training and evaluated students’ procedural skills. Two residents were present at each station to train the medical students who rotated through all 4 stations. Pre/posttraining assessment of confidence, knowledge, and procedural skills was done using a survey, a multiple-choice test, and procedural checklists, respectively. Results: In total, 24 students were trained in six 4-hour sessions. Students reported feeling significantly more confident, after training, in performing all 4 procedures on a real patient ( P < .001. Paired-samples t tests indicated statistically significant improvement in knowledge scores for intubation, t (23 = −2.92, P < .001, and arterial line placement, t (23 = −2.75, P < .001. Procedural performance scores for intubation ( t (23 = −17.29, P < .001, arterial line placement ( t (23 = −19.75, P < .001, lumbar puncture ( t (23 = −16.27, P < .001, and central line placement ( t (23 = −17.25, P < .001 showed significant improvement. Intraclass correlation coefficients indicated high reliability in checklist scores for all procedures. Conclusions: The simulation sessions allowed each medical student to receive individual attention from 2 residents for each procedure. Students’ written comments indicated that this training modality was well received. Results showed that medical students improved their self-confidence, knowledge, and skills in the aforementioned procedures.

  12. Implementation of Epic Beaker Clinical Pathology at an academic medical center

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    Matthew D Krasowski


    Full Text Available Background: Epic Beaker Clinical Pathology (CP is a relatively new laboratory information system (LIS operating within the Epic suite of software applications. To date, there have not been any publications describing implementation of Beaker CP. In this report, we describe our experience in implementing Beaker CP version 2012 at a state academic medical center with a go-live of August 2014 and a subsequent upgrade to Beaker version 2014 in May 2015. The implementation of Beaker CP was concurrent with implementations of Epic modules for revenue cycle, patient scheduling, and patient registration. Methods: Our analysis covers approximately 3 years of time (2 years preimplementation of Beaker CP and roughly 1 year after using data summarized from pre- and post-implementation meetings, debriefings, and the closure document for the project. Results: We summarize positive aspects of, and key factors leading to, a successful implementation of Beaker CP. The early inclusion of subject matter experts in the design and validation of Beaker workflows was very helpful. Since Beaker CP does not directly interface with laboratory instrumentation, the clinical laboratories spent extensive preimplementation effort establishing middleware interfaces. Immediate challenges postimplementation included bar code scanning and nursing adaptation to Beaker CP specimen collection. The most substantial changes in laboratory workflow occurred with microbiology orders. This posed a considerable challenge with microbiology orders from the operating rooms and required intensive interventions in the weeks following go-live. In postimplementation surveys, pathology staff, informatics staff, and end-users expressed satisfaction with the new LIS. Conclusions: Beaker CP can serve as an effective LIS for an academic medical center. Careful planning and preparation aid the transition to this LIS.

  13. Strom Thurmond Biomedical Research Center at the Medical Univesity for South Carolina Charleston, South Carolina

    Energy Technology Data Exchange (ETDEWEB)


    The Department of Energy (DOE) has prepared an Environmental Assessment (EA) evaluating the proposed construction and operation of the Strom Thurmond Biomedical Research Center (Center) at the Medical University of South Carolina (MUSC), Charleston, SC. The DOE is evaluating a grant proposal to authorize the MUSC to construct, equip and operate the lower two floors of the proposed nine-story Center as an expansion of on-going clinical research and out-patient diagnostic activities of the Cardiology Division of the existing Gazes Cardiac Research Institute. Based on the analysis in the EA, the DOE has determined that the proposed action does not constitute a major federal action significantly affecting the quality of the human environment within the meaning of the NEPA. Therefore, the preparation of an Environmental Impact Statement is not required.

  14. PL-1 program system for generalized Patterson superpositions. [PL1GEN, SYMPL1, and ALSPL1, in PL/1 for IBM 360/65 computer

    Energy Technology Data Exchange (ETDEWEB)

    Hubbard, C.R.; Babich, M.W.; Jacobson, R.A.


    A new system of three programs written in PL/1 can calculate symmetry and Patterson superposition maps for triclinic, monoclinic, and orthorhombic space groups as well as any space group reducible to one of these three. These programs are based on a system of FORTRAN programs developed at Ames Laboratory, but are more general and have expanded utility, especially with regard to large unit cells. The program PLIGEN calculates a direct access data set, SYMPL1 calculates a direct access symmetry map, and ALSPL1 calculates a superposition map using one or multiple superpositions. A detailed description of the use of these programs including symbolic program listings is included. 2 tables.

  15. Patient-centered medical homes improve care for adults with chronic conditions. (United States)

    Pourat, Nadereh; Lavarreda, Shana Alex; Snyder, Sophie


    The success of health care reform implementation in 2014 partly depends on more efficient delivery of care to the millions of California residents eligible to gain insurance. Emerging evidence supports the effectiveness of the patient-centered medical home (PCMH) as a potential model of care delivery, which improves health outcomes and reduces costs. Among other principles, PCMH entails receipt of care from a personal doctor, who coordinates the patient's care and develops an individualized treatment plan for the patient. These principles are particularly essential in delivery of care to those with chronic conditions who require more intensive care management. Using the 2009 California Health Interview Survey (CHIS 2009), this policy brief indicates that patients who reported meeting these fundamental PCMH principles were more likely to have visited the doctor and to have received flu shots, and they also had better communication with providers than those who did not report meeting these PCMH principles. The data also showed that uninsured individuals, Medi-Cal beneficiaries, those at or below 133% of the federal poverty level, Latinos, and Asian-Americans were less likely to report meeting all three PCMH principles. These findings highlight the population groups that would most benefit from the PCMH care delivery model, particularly Medi-Cal beneficiaries and those eligible for Covered California, the California health benefits exchange.

  16. Using an expanded outcomes framework and continuing education evidence to improve facilitation of patient-centered medical home recognition and transformation. (United States)

    Van Hoof, Thomas J; Kelvey-Albert, Michele; Katz, Matthew; Lalime, Ken; Sacks, Ken; Meehan, Thomas P


    The patient-centered medical home is a model for delivering primary care in the United States. Primary care clinicians and their staffs require assistance in understanding the innovation and in applying it to practice. The purpose of this article is to describe and to critique a continuing education program that is relevant to, and will become more common in, primary care. A multifaceted educational strategy prepared 20 primary care private practices to achieve National Committee for Quality Assurance Level 3 recognition as Patient-Centered Medical Homes. Eighteen (90%) practices submitted an application to the National Committee for Quality Assurance. On the first submission attempt, 13 of 18 (72%) achieved Level 3 recognition and 5 (28%) achieved Level 1 recognition. An interactive multifaceted educational strategy can be successful in preparing primary care practices for Patient-Centered Medical Homes recognition, but the strategy may not ensure transformation. Future educational activities should consider an expanded outcomes framework and the evidence of effective continuing education to be more successful with recognition and transformation.

  17. Plastic Surgery Complications from Medical Tourism Treated in a U.S. Academic Medical Center. (United States)

    Ross, Kimberly M; Moscoso, Andrea V; Bayer, Lauren R; Rosselli-Risal, Liliana; Orgill, Dennis P


    Medical tourism is a growing, multi-billion dollar industry fueled by improvements in the global transportation infrastructure. The authors studied patients living in the United States who travel to other countries for plastic surgical procedures and returned to have their complications treated in the authors' center. A retrospective patient evaluation was performed. Patients who had presented to an urban tertiary academic hospital plastic surgery service with complications or complaints associated with plastic surgery performed in a developing country were studied. The authors collected demographic information, types of surgery performed, destinations, insurance coverage, and complications. Seventy-eight patients were identified over 7 years. Most commonly, complications were seen following abdominoplasty (n = 35), breast augmentation (n = 25), and foreign body injections (n = 15). Eighteen patients underwent multiple procedures in one operative setting. The most common destination country was the Dominican Republic (n = 59). Complications included surgical-site infections (n = 14), pain (n = 14), and wound healing complications (n = 12). Eighty-six percent of patients (n = 67) relied on their medical insurance to pay for their follow-up care or manage their complications, with the most common type of health insurance coverage being Massachusetts Medicaid (n = 48). Cosmetic surgery performed in developing countries can carry substantial risks of complications that can be challenging to patients, primary care providers, insurers, and plastic surgical teams not associated with the original surgery. These complications pose significant burdens on our public health systems.

  18. A Study of Civilian Registered Nurse Recruitment at Madigan Army Medical Center, Tacoma, Washington. (United States)


    34 May, 1981, "Nurse, Where Are You?" Judy Armstrong . 5 1nitial Report and Preliminary Recommendations, National Commission on Nursing (September 1981...Interview with Ms. R. Marsh, Staffing Specialist, Force Develop- ment Division, Madigan Army Medical Center, Tacoma, WA (Dec 81) 20Philip Kotler ...Marketing Management. Boston: Allyn and Bacon, Inc., 1980. Kotler , Philip. Marketing for Nonprofit Institutions. Englewood Cliffs, N.D.: Prentice-Hall


    Directory of Open Access Journals (Sweden)

    Zoryana Kocherga


    Full Text Available Current system of medical education in Ukraine needs improvement and reforms in order to enhance the proficiency of doctors and paramedics. Training of practical/technical skills, communication, as well as teamwork skills is considerably important.The use of simulation techniques and methods in medical education is called simulation training in medicine. Medical skills are acquired through cognitive (knowledge and psychomotor (practice skills. The first medical simulation centers appeared in Ukraine in 2006 according to the order of the Ministry of Health Care of Ukraine.On June 20, 2013, a new simulation training center was opened in Ivano-Frankivsk on the base of Regional Perinatal Center. Similar medical simulation centers were opened in the second half of 2013 in Volyn and Vinnytsia regions under the Ukrainian-Swiss Mother and Child Health Programme, which started in the area of perinatology. Their goal is to improve the teamwork of all specialists involved in the process of delivery and neonatal intensive care,as well as to engage internship doctors and senior medical students in clinical skills training programmes.The use of simulation techniques and training programs offers a powerful platform to study and practice clinical reasoning behaviors and patterns.


    Directory of Open Access Journals (Sweden)

    Lyubomira Koeva-Dimitrova


    Full Text Available The capital structure analysis of medical institutions is related to the assessment of their financial sustainability. The degree of their financial sustainability indicates the extent to which the medical institution is exposed to financial risk. This financial risk is related to the use of foreign capital (debts, loans, etc. and it is defined as the probability of insolvency and possible bankruptcy due to the existence of debts which could not be repaid at some point in the foreseeable future. Objective: To analyze the capital structure of the medical diagnostic-consultative centers in Varna city and on this basis to assess their long-term solvency and existence of financial risk. Materials and Methods: The materials for the study are the published annual financial statements (up to 05. 01. 2016 in the Commercial Register for the period from year 2008 to 2014 of all MDCCs (Medical Diagnostic Consultative centers, registered in Varna - 9 in total. In the study are applied logical-mathematical methods (comparison, grouping, detail, graphical method; financial and accounting analysis (balance sheet analysis; analysis of absolute ratios for financial sustainability. Results: Upon analysis of the capital structure of MDCC's are studied the main absolute indicators characterizing the conditions for financial sustainability and the existence of financial risk regarding the solvency. A table represents the overall assessment of the degree of financial sustainability of the companies according to the type and structure of the fulfilled criteria. It was ascertained that for year 2014, DCC 3, 4, 5 and 8 have met all the conditions and according to them these hospitals have very high financial sustainability. DCC 7 has an average financial sustainability, DCC 1 and 2 are in a financial crisis and DCC 6 and 9 are facing bankruptcy. It must be emphasized that nearly half of the studied health care organizations (DCC 1, 2, 6 and 9 need urgent intervention by

  1. Increasing Therapist Productivity: Using Lean Principles in the Rehabilitation Department of an Academic Medical Center. (United States)

    Johnson, Diana; Snedeker, Kristie; Swoboda, Michael; Zalieckas, Cheryl; Dorsey, Rachel; Nohe, Cassandra; Smith, Paige; Roche, Renuka

    The Department of Rehabilitation Services, within the University of Maryland Medical Center's 650-bed academic medical center, was experiencing difficulty in meeting productivity standards. Therapists in the outpatient division believed they were not spending enough time performing billable patient care activities. Therapists in the inpatient division had difficulty keeping pace with the volume of incoming referrals. Collectively, these issues caused dissatisfaction among referral sources and frustration among the staff within the rehabilitation department. The department undertook a phased approach to address these issues that included examining the evidence, using Lean process improvement principles, and employing transformational leadership strategies to drive improvements in productivity and efficiency. The lessons learned support the importance of having meaningful metrics appropriate for the patient population served, the use of Lean as an effective tool for improving productivity in rehabilitation departments, the impact of engaging staff at the grassroots level, and the importance of having commitment from leaders. The study findings have implications for not only rehabilitation and hospital leadership, but CEOs and managers of any business who need to eliminate waste or increase staff productivity.


    Directory of Open Access Journals (Sweden)

    I. V. Tolmachyov


    Full Text Available There is the big issue in medical education which is students don’t have enough skills. Often even with theoretical knowledge graduate medical students need to improve their skills by working with patients. Obviously it can be a risk for patients and takes quite long time. This situation could be changed with applying simulation technologies in medical education. Medical education with virtual simulators allows reducing the time of skills development and improving the quality of training. The aims of this work are developing informational model and creating clinical scenarios of emergency states in the Medical Simulation Center.Objectives:– to analyze the process of scenario conducting;– to create clinical scenarios of emergency states (anaphylactic shock, hypovolemic shock, obstructive shock with specialist’s help.The scenarios consist of sections such as main aim, skills, required mannequins, preparation of the mannequins, preparation of medical equipment and instruments for the scenario, preparation of special materials, scenario description, guide for operator, information for trainees.By analyzing the process of scenario conducting the key participants were defined who are operator, assistant, trainer, trainees. Also the main scenario stages were defined. Based on the stages diagram of variants of scenario conducting was designed.As an example there are fragments of scenario “Obstructive shock – a pulmonary embolism” in this article. Learn skills are cognitive, technical, social ones.Results. This paper presents an analysis of the clinical scenario conducting. Information model was developed which based on object-oriented decomposition. The model is the diagram of variants of scenario conducting. Scenario’s structure for emergency states was formulated. The scenarios are anaphylactic shock, hypovolemic shock, obstructive shock (pulmonary embolism, tension pneumothorax, pulmonary edema, hypertensive crisis, respiratory

  3. Expansion of the consultation-liaison psychiatry paradigm at a university medical center: integration of diversified clinical and funding models. (United States)

    Bourgeois, James A; Hilty, Donald M; Klein, Sally C; Koike, Alan K; Servis, Mark E; Hales, Robert E


    The perspective of the contemporary Consultation-Liason Service (CLS) psychiatrist is increasingly one of consultant to medical and surgical colleagues in models other than inpatient medical and surgical units. Simultaneously, the need for a clinically and educationally robust inpatient CLS persists despite funding pressures. The University of California, Davis Medical Center Department of Psychiatry has made use of creative organizational and financial models to accomplish the inpatient CLS clinical and educational missions in a fiscally responsible manner. In addition, the department has in recent years expanded the delivery of psychiatry consultation-liaison clinical and educational services to other models of care delivery, broadening the role and influence of the CLS. Several of the initiatives described in this paper parallel an overall evolution of the practice of consultation-liaison psychiatry in response to managed care influences and other systems pressures. This consultation-liaison paradigm expansion with diversified sources of funding support facilitates the development of consultation-liaison psychiatry along additional clinical, administrative, research, and educational dimensions. Other university medical centers may consider adaptation of some of the initiatives described here to their institutions.

  4. The Wright Institute Sanctuary Project: Development and Proposed Evaluation of a Graduate Training Program Providing Clinical Services to Asylum Seekers in the Bay Area (United States)

    Padilla, Brenda Lisa


    This study highlights the development of a graduate training program at The Wright Institute in Berkeley, CA, which provides assessment services for undocumented immigrants seeking asylum. This program focuses on the needs of a general asylum seeking population, with a specific relevance to some of the populations that may be served in the…

  5. 75 FR 6401 - Medical Devices Regulated by the Center for Biologics Evaluation and Research; Availability of... (United States)


    ... Biologics Evaluation and Research (HFM-17), Food and Drug Administration, suite 200N, 1401 Rockville Pike... DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration [Docket No. FDA-2009-M-0513] Medical Devices Regulated by the Center for Biologics Evaluation and Research; Availability of Summaries...

  6. Usual Primary Care Provider Characteristics of a Patient-Centered Medical Home and Mental Health Service Use. (United States)

    Jones, Audrey L; Cochran, Susan D; Leibowitz, Arleen; Wells, Kenneth B; Kominski, Gerald; Mays, Vickie M


    The benefits of the patient-centered medical home (PCMH) over and above that of a usual source of medical care have yet to be determined, particularly for adults with mental health disorders. To examine qualities of a usual provider that align with PCMH goals of access, comprehensiveness, and patient-centered care, and to determine whether PCMH qualities in a usual provider are associated with the use of mental health services (MHS). Using national data from the Medical Expenditure Panel Survey, we conducted a lagged cross-sectional study of MHS use subsequent to participant reports of psychological distress and usual provider and practice characteristics. A total of 2,358 adults, aged 18-64 years, met the criteria for serious psychological distress and reported on their usual provider and practice characteristics. We defined "usual provider" as a primary care provider/practice, and "PCMH provider" as a usual provider that delivered accessible, comprehensive, patient-centered care as determined by patient self-reporting. The dependent variable, MHS, included self-reported mental health visits to a primary care provider or mental health specialist, counseling, and psychiatric medication treatment over a period of 1 year. Participants with a usual provider were significantly more likely than those with no usual provider to have experienced a primary care mental health visit (marginal effect [ME] = 8.5, 95 % CI = 3.2-13.8) and to have received psychiatric medication (ME = 15.5, 95 % CI = 9.4-21.5). Participants with a PCMH were additionally more likely than those with no usual provider to visit a mental health specialist (ME = 7.6, 95 % CI = 0.7-14.4) and receive mental health counseling (ME = 8.5, 95 % CI = 1.5-15.6). Among those who reported having had any type of mental health visit, participants with a PCMH were more likely to have received mental health counseling than those with only a usual provider (ME = 10.0, 95 % CI

  7. Discharge against medical advice in a pediatric emergency center in the State of Qatar

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    Hala Abdulateef


    Full Text Available Objective: The objective of this study was to analyze cases that had left the Pediatric Emergency Center Al Sadd, Doha (PEC against medical advice, with the aim of developing policies to help reduce this occurrence. Methodology: All patients that were admitted to the main PEC observation room for treatment and/or investigation and subsequently left against medical advice from February 18, 2007 to June 18, 2007, were followed by a phone call, and a questionnaire, which was completed by the departmental patient representative. Results: 99,133 patients attended the facility during the study period. Of those, 106 left the facility against medical advice. Ninety-four guardians were successfully contacted. 90% of the cases were in children below 2 years of age. In 87% of the cases the mother was the main decision maker for leaving against medical advice. Domestic obligations were the leading cause of DAMA (discharge against medical advice, reported in 45% of the cases. Respondents reported that the consequences of DAMA were well explained by medical staff before they left the facility however, they had not met with the departmental patient representative during their stay. Conclusion:As the majority of DAMA cases occurred in infants, medical staff should address the concerns of this group early on in the course of treatment. Maintaining communication and providing support, in particular for mothers of higher risk groups may help to reduce the rate of DAMA cases.

  8. Gatekeepers as Care Providers: The Care Work of Patient-centered Medical Home Clerical Staff. (United States)

    Solimeo, Samantha L; Ono, Sarah S; Stewart, Kenda R; Lampman, Michelle A; Rosenthal, Gary E; Stewart, Greg L


    International implementation of the patient-centered medical home (PCMH) model for delivering primary care has dramatically increased in the last decade. A majority of research on PCMH's impact has emphasized the care provided by clinically trained staff. In this article, we report our ethnographic analysis of data collected from Department of Veterans Affairs staff implementing PACT, the VA version of PCMH. Teams were trained to use within-team delegation, largely accomplished through attention to clinical licensure, to differentiate staff in providing efficient, patient-centered care. In doing so, PACT may reinforce a clinically defined culture of care that countermands PCMH ideals. Such competing rubrics for care are brought into relief through a focus on the care work performed by clerks. Ethnographic analysis identifies clerks' care as a kind of emotional dirty work, signaling important areas for future anthropological study of the relationships among patient-centered care, stigma, and clinical authority. © 2016 by the American Anthropological Association.

  9. Incorporating the principles of the patient- centered medical home into a student-run free clinic

    Directory of Open Access Journals (Sweden)

    Riddle MC


    Full Text Available Megan C Riddle,1,* Jiahui Lin,3,* Jonathan B Steinman,2 Joshua D Salvi,2 Margaret M Reynolds,3 Anne S Kastor,3,† Christina Harris,4 Carla Boutin-Foster3 1Department of Psychiatry and Behavioral Sciences, University of Washington, 2Weill Cornell/Rockefeller/Sloan-Kettering Tri-Institutional MD–PhD Program, 3Department of Internal Medicine, Weill Cornell Medical College, New York, NY, 4Department of Medicine, Division of General Internal Medicine, VA Greater Los Angeles Healthcare System, David Geffen School of Medicine at UCLA, LA, USA *These authors contributed equally to this work †Anne S Kastor passed away on July 5, 2013. Abstract: As the health care delivery landscape changes, medical schools must develop creative strategies for preparing future physicians to provide quality care in this new environment. Despite the growing prominence of the patient-centered medical home (PCMH as an effective model for health care delivery, few medical schools have integrated formal education on the PCMH into their curricula. Incorporating the PCMH model into medical school curricula is important to ensure that students have a comprehensive understanding of the different models of health care delivery and can operate effectively as physicians. The authors provide a detailed description of the process by which the Weill Cornell Community Clinic (WCCC, a student-run free clinic, has integrated PCMH principles into a service-learning initiative. The authors assessed patient demographics, diagnoses, and satisfaction along with student satisfaction. During the year after a PCMH model was adopted, 112 students and 19 licensed physicians volunteered their time. A review of the 174 patients seen from July 2011 to June 2012 found that the most common medical reasons for visits included management of hypertension, hyperlipidemia, diabetes, gastrointestinal conditions, arthritis, anxiety, and depression. During the year after the adoption of the PCMH model, 87

  10. Statement of the American Psychological Association in response to the "joint principles: integrating behavioral health care into the patient-centered medical home". (United States)

    Anderson, Norman B; Belar, Cynthia D; Cubic, Barbara A; Garrison, Ellen G; Johnson, Suzanne Bennett; Kaslow, Nadine J


    Comments on the article "Joint principles: Integrating behavioral health care into the patient-centered medical home" (see record 2014-24217-011), presented by the Working Party Group on Integrated Behavioral Healthcare. The American Psychological Association (APA) shares concerns about the lack of reference to behavioral health care in the original 2007 Joint Principles of the Patient-Centered Medical Home for which this new document is intended to supplement but not replace. The decision to support the supplemental Joint Principles was not an easy one for APA, as there is one area of significant concern. That concern is related to the use of the term "physician-directed medical practice"

  11. Using a Lego-based communications simulation to introduce medical students to patient-centered interviewing. (United States)

    Harding, S R; D'Eon, M F


    Teaching patient-centered interviewing skills to medical students can be challenging. We have observed that 1st-year medical students, in particular, do not feel free to concentrate on the interviewing skills because they are preoccupied with complicated technical medical knowledge. The Lego simulation we use with our 1st-year students as part of a professional-skills course overcomes that difficulty. The Lego activity is a role play analogous to a doctor-patient interview that uses identical sets of Legos for the "doctor" and for the "patients" and a small construction that represents a patient history. With a simple questionnaire, data were collected from students at different points during instruction. Results indicate that the Lego activity was very effective in helping students learn the importance of open-ended questioning. It also was rated as highly as the very dynamic interactive part of the instructional session. The effectiveness of the Lego activity may be due to the properties of analogies.

  12. Set up and operation for medical radiation exposure quality control system of health promotion center

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Jung Su; Kim, Jung Min [Korea University,Seoul (Korea, Republic of); Jung, Hae Kyoung [Dept. of Diagnostic Radiology, CHA Bundang Medical Center, CHA University, Sungnam (Korea, Republic of)


    In this study, standard model of medical radiation dosage quality control system will be suggested and the useful of this system in clinical field will be reviewed. Radiation dosage information of modalities are gathered from digital imaging and communications in medicine(DICOM) standard data(such as DICOM dose SR and DICOM header) and stored in database. One CT scan, two digital radiography modalities and two mammography modalities in one health promotion center in Seoul are used to derive clinical data for one month. After 1 months research with 703 CT scans, the study shows CT 357.9 mGy·cm in abdomen and pelvic CT, 572.4 mGy·cm in brain without CT, 55.9 mGy·cm in calcium score/heart CT, screening CT at 54 mGy·cm in chest screening CT(low dose screening CT scan), 284.99 mGy·cm in C-spine CT and 341.85 mGy·cm in L-spine CT as health promotion center reference level of each exam. And with 1955 digital radiography cases, it shows 274.0 mGy·cm{sup 2} and for mammography 6.09 mGy is shown based on 536 cases. The use of medical radiation shall comply with the principles of justification and optimization. This quality management of medical radiation exposure must be performed in order to follow the principle. And the procedure to reduce the radiation exposure of patients and staff can be achieved through this. The results of this study can be applied as a useful tool to perform the quality control of medical radiation exposure.

  13. Set up and operation for medical radiation exposure quality control system of health promotion center

    International Nuclear Information System (INIS)

    Kim, Jung Su; Kim, Jung Min; Jung, Hae Kyoung


    In this study, standard model of medical radiation dosage quality control system will be suggested and the useful of this system in clinical field will be reviewed. Radiation dosage information of modalities are gathered from digital imaging and communications in medicine(DICOM) standard data(such as DICOM dose SR and DICOM header) and stored in database. One CT scan, two digital radiography modalities and two mammography modalities in one health promotion center in Seoul are used to derive clinical data for one month. After 1 months research with 703 CT scans, the study shows CT 357.9 mGy·cm in abdomen and pelvic CT, 572.4 mGy·cm in brain without CT, 55.9 mGy·cm in calcium score/heart CT, screening CT at 54 mGy·cm in chest screening CT(low dose screening CT scan), 284.99 mGy·cm in C-spine CT and 341.85 mGy·cm in L-spine CT as health promotion center reference level of each exam. And with 1955 digital radiography cases, it shows 274.0 mGy·cm"2 and for mammography 6.09 mGy is shown based on 536 cases. The use of medical radiation shall comply with the principles of justification and optimization. This quality management of medical radiation exposure must be performed in order to follow the principle. And the procedure to reduce the radiation exposure of patients and staff can be achieved through this. The results of this study can be applied as a useful tool to perform the quality control of medical radiation exposure

  14. Medical and Rehabilitation Centers in Children’s Houses — New Opportunities for Treatment and Rehabilitation of Children

    Directory of Open Access Journals (Sweden)

    I.V. Balychevtseva


    Full Text Available The article presents data on the opening of medical and rehabilitations centers at the children’s houses of Donetsk region. Approaches, terms, possibilities and methods of rehabilitations used during the treatment and restoration of disabled children are provided.


    Directory of Open Access Journals (Sweden)

    I. N. Chernomurov


    Full Text Available Introduction of modern information systems is one of the important objectives of medicine, as it contributes to higher availability of medical services for the population. Public relations of medical organizations involve websites of these organizations, outdoor advertising and other information sources. However, obtainment of competent inquiry answers by telephone remains a problem. People often choose between organizations depending on quality of the obtained information. Apparently, the issue can be resolved by establishing call centers that are not merely communications centers, but are staffed with competent trained personnel, who support the organization’s interaction with patients (or the legal representatives thereof. The article presents the authors’ experience of establishing a call center dedicated to the organization’s public image development, as well as higher demand of the available services and promotion thereof. The fulfilled modernization resulted in a sharp increase in the amount of calls received (1,500‑1,600 within the working hours; 900 – before modernization and reduction in the number of complaints of busy line. 

  16. Humanities mini-course curricula for midcareer health professionals at the Penn State Milton S. Hershey Medical Center. (United States)

    Myers, Kimberly R; George, Daniel R


    The field of medical humanities has traditionally focused on medical students and, more recently, on premedical undergraduates. Comparatively little formal humanities pedagogy has been dedicated to midcareer health professionals. To address this lack, the Department of Humanities at the Pennsylvania State University College of Medicine and the Milton S. Hershey Medical Center designed eight annual humanities mini-courses for faculty and staff throughout the college and medical center.These mini-courses fell into four categories: reading, reflection, and discussion; creative expression; technology; and ethics. They were geared toward midcareer health professionals who were seeking new intellectual and creative stimulation and variety in daily routine. They also provided humanities faculty the opportunity to devote attention to topics that capitalize on their professional training and that interest them personally.Participants indicated a high degree of satisfaction with the mini-courses for four principal reasons: (1) learning the tools and methodologies of a new discipline or domain other than biomedicine, (2) using their minds and training in uncustomary ways, (3) forming new alliances with colleagues (which served to lessen the sense of professional isolation), and (4) enjoying a respite from the stressful flow of the workday. Humanities faculty facilitators provided more mixed responses but agreed that conducting the mini-courses had been a positive overall experience.Although this article provides a foundational framework for the development of a humanities mini-course series, the authors encourage others to replicate these curricula in other medical settings as an important step toward a robust pedagogy designed for midcareer health care professionals.

  17. The patient-centered medical home in oncology: from concept to reality. (United States)

    Page, Ray D; Newcomer, Lee N; Sprandio, John D; McAneny, Barbara L


    In recent years, the cost of providing quality cancer care has been subject to an epic escalation causing concerns on the verge of a health care crisis. Innovative patient-management models in oncology based on patient-centered medical home (PCMH) principles, coupled with alternative payments to traditional fee for service (FFS), such as bundled and episodes payment are now showing evidence of effectiveness. These efforts have the potential to bend the cost curve while also improving quality of care and patient satisfaction. However, going forward with FFS alternatives, there are several performance-based payment options with an array of financial risks and rewards. Most novel payment options convey a greater financial risk and accountability on the provider. Therefore, the oncology medical home (OMH) can be a way to mitigate some financial risks by sharing savings with the payer through better global care of the patient, proactively preventing complications, emergency department (ED) visits, and hospitalizations. However, much of the medical home infrastructure that is required to reduced total costs of cancer care comes as an added expense to the provider. As best-of-practice quality standards are being elucidated and refined, we are now at a juncture where payers, providers, policymakers, and other stakeholders should work in concert to expand and implement the OMH framework into the variety of oncology practice environments to better equip them to assimilate into the new payment reform configurations of the future.

  18. Utilization of a Marketing Strategy at Naval Regional Medical Center Great Lakes, Great Lakes, Illinois (United States)


    22 Analysis of the Mare.....................22 Development of the Marketing Mix .. .......... 29 A Marketing Mix --Recommendations...problem. Marketing strategy, marketing mix and ultimately the marketing orientation will allow hospitals to persevere and possibly thrive in a are currently being met at Naval Regional Medical Center Great Lakes. The fourth objective is to demonstrate an appropriate marketing mix for

  19. Disruptive innovation in academic medical centers: balancing accountable and academic care. (United States)

    Stein, Daniel; Chen, Christopher; Ackerly, D Clay


    Numerous academic medicine leaders have argued that academic referral centers must prepare for the growing importance of accountability-driven payment models by adopting population health initiatives. Although this shift has merit, execution of this strategy will prove significantly more problematic than most observers have appreciated. The authors describe how successful implementation of an accountable care health strategy within a referral academic medical center (AMC) requires navigating a critical tension: The academic referral business model, driven by tertiary-level care, is fundamentally in conflict with population health. Referral AMCs that create successful value-driven population health systems within their organizations will in effect disrupt their own existing tertiary care businesses. The theory of disruptive innovation suggests that balancing the push and pull of academic and accountable care within a single organization is achievable. However, it will require significant shifts in resource allocation and changes in management structure to enable AMCs to make the inherent difficult choices and trade-offs that will ensue. On the basis of the theories of disruptive innovation, the authors present recommendations for how academic health systems can successfully navigate these issues as they transition toward accountability-driven care.

  20. Mandibular Fracture Patterns at a Medical Center in Central Taiwan: A 3-Year Epidemiological Review. (United States)

    Lin, Fu-Yu; Wu, Chao-I; Cheng, Hsu-Tang


    Mandibular fractures constitute a major portion of maxillofacial trauma and may lead to considerable functional and aesthetic sequelae if treatment is inadequate or delayed. An epidemiology study on mandibular fractures may guide the preventive efforts of the Taiwan public health care system. Therefore, a retrospective review was conducted at a medical center in central Taiwan to evaluate the current mandibular fracture epidemiology.The medical records and digitized radiographs of 198 patients who received treatment for mandibular fractures during a 3-year period (from October 2010 to September 2013) at a medical center in central Taiwan were reviewed to obtain demographic and injury data.The average age was 29.4 years (3-82 years). Patients aged 21 to 30 years sustained the most mandibular fractures (62 patients, 31.3%). The overall sex distribution (male to female) ratio was 1.8. Motor-vehicle accidents (MVAs) were the most common mechanism of injury (162 patients, 82%), and scooter and motorcycle riders wearing partial-coverage helmets constituted the majority of patients. A chart review identified 198 patients with 335 mandibular fractures; 113 patients (57.1%) had multiple mandibular fractures. The most common fracture sites were the symphysis and parasymphysis regions (38.9%), followed by the condyle (26.0%), angle (14.3%), body (14.3%), and ramus (6.6%).MVAs are the major cause of mandibular fractures in central Taiwan, and patients aged Taiwan. Copyright © 2017 The Authors. Published by Wolters Kluwer Health, Inc. All rights reserved.

  1. Natural hybridization between Vanilla claviculata (W. Wright) Sw. and V. barbellata Rchb.f. (Orchidaceae): genetic, morphological, and pollination experimental data

    DEFF Research Database (Denmark)



    Vanilla claviculata (W. Wright) Sw. and V. barbellata Rchb.f. grow sympatrically in the southwestern part of herto Rico. At three localities in the range of the two species, individuals with flowers that appeared different from previously known species were found. To test whether these were hybrids...... the hypothesis that the individuals are hybrids, which is further augmented by interspecific pollination experiments between the putative parental species. This is the first case of natural hybridization reported in the genus Vanilla....

  2. Effects of internal marketing on nurse job satisfaction and organizational commitment: example of medical centers in Southern Taiwan. (United States)

    Chang, Ching-Sheng; Chang, Hsin-Hsin


    As nurses typically represent the largest percentage of employees at medical centers, their role in medical care is exceptionally important and becoming more so over time. The quality and functions of nurses impact greatly on medical care quality. The concept of internal marketing, with origins in the field of market research, argues that enterprises should value and respect their employees by treating them as internal customers. Such a marketing concept challenges traditional marketing methods, which focus on serving external customers only. The main objective of internal marketing is to help internal customers (employees) gain greater job satisfaction, which should promote job performance and facilitate the organization accomplishing its ultimate business objectives. A question in the medical service industry is whether internal marketing can similarly increase the job satisfaction of nurses and enhance their commitment to the organization. This study aimed to explore the relational model of nurse perceptions related to internal marketing, job satisfaction, and organizational commitment by choosing nurses from two medical centers in Southern Taiwan as research subjects. Of 450 questionnaire distributed, 300 valid questionnaires were returned, giving a response rate of 66.7%. After conducting statistical analysis and estimation using structural equation modeling, findings included: (1) job satisfaction has positive effects on organizational commitment; (2) nurse perceptions of internal marketing have positive effects on job satisfaction; and (3) nurse perceptions of internal marketing have positive effects on organizational commitment.

  3. A model for training medical student innovators: the Harvard Medical School Center for Primary Care Abundance Agents of Change program. (United States)

    Duong, David B; Sullivan, Erin E; Minter-Jordan, Myechia; Giesen, Lindsay; Ellner, Andrew L


    In 2013, the Harvard Medical School Center for Primary Care established the Abundance Agents of Change (AoC) program to promote interprofessional learning and innovation, increase partnership between 15 academic and community health centers (CHCs) in Boston's most under-served communities, and increase medical student interest in primary care careers. The AoC is modeled in the form of a 'grants challenge', offering $20,000 to interprofessional student teams to develop an innovative solution that addresses a healthcare delivery need identified by CHCs. The program's initial two years were characterized by a four-stage process which included working with CHCs and crafting a request for proposals, forming interprofessional 20 student teams comprising students from across and outside of Harvard University, training students using a systems-based innovation curriculum, and performing program evaluation. Our evaluation data from cohorts 1 and 2 of the AoC program demonstrate that we succeeded in training students as innovators and members of interprofessional teams. We also learned valuable lessons regarding creating better alignment with CHC priorities, extending the program cycle from 12 to 18 months, and changing the way funding is disbursed to 25 students, which will be incorporated in later versions of the program. Based on our experience and evaluation data, we believe that this program is a replicable way to train students as innovators and members of interprofessional teams to address the current complex healthcare environment.

  4. Improving access to care through the patient-centered medical home. (United States)

    North, Stephen W; McElligot, James; Douglas, Gaye; Martin, Amanda


    School-based health centers (SBHCs) serve an essential role in providing access to high-quality, comprehensive care to underserved children and adolescents in more than 2,000 schools across the United States. SBHCs are an essential component of the health care safety net, and their role in the patient-centered medical home (PCMH) continues to evolve as both collaborating partners and, when fully functioning, independent PCMHs. The American Academy of Pediatrics (AAP) supports the use of SBHCs, citing the proven benefits and exciting potential as justification, but also offers caution and recommends a focus on communication within the community. Traditional "brick and mortar" SBHCs are more likely to be located in urban communities (54.2% urban versus 18.0% rural) and be in schools with more students, allowing for a greater return on investment. Current SBHCs are located in schools with an average population of 997 students. The need for a large school population to help an SBHC approach financial viability excludes children in rural communities who are more likely to attend a school with fewer than 500 students, be poor, and have difficulty accessing health care.2 The expansion of telehealth technologies allows the creation of solutions to decrease geographic barriers that have limited the growth of SBHCs in rural communities. Telehealth school-based health centers (tSBHCs) that exclusively provide services through telemedicine are operating and developing in communities where geographic barriers and financial challenges have prevented the establishment of brick and mortar SBHCs. TSBHCs are beginning to increase the number and variety of services they provide through the use of telehealth to include behavioral health, nutrition services, and pediatric specialists. Understanding the role of tSBHCs in the growth of the PCMH model is critical for using these tools to continue to improve child and adolescent health. Copyright 2014, SLACK Incorporated.

  5. A nationwide survey of patient centered medical home demonstration projects. (United States)

    Bitton, Asaf; Martin, Carina; Landon, Bruce E


    The patient centered medical home has received considerable attention as a potential way to improve primary care quality and limit cost growth. Little information exists that systematically compares PCMH pilot projects across the country. Cross-sectional key-informant interviews. Leaders from existing PCMH demonstration projects with external payment reform. We used a semi-structured interview tool with the following domains: project history, organization and participants, practice requirements and selection process, medical home recognition, payment structure, practice transformation, and evaluation design. A total of 26 demonstrations in 18 states were interviewed. Current demonstrations include over 14,000 physicians caring for nearly 5 million patients. A majority of demonstrations are single payer, and most utilize a three component payment model (traditional fee for service, per person per month fixed payments, and bonus performance payments). The median incremental revenue per physician per year was $22,834 (range $720 to $91,146). Two major practice transformation models were identified--consultative and implementation of the chronic care model. A majority of demonstrations did not have well-developed evaluation plans. Current PCMH demonstration projects with external payment reform include large numbers of patients and physicians as well as a wide spectrum of implementation models. Key questions exist around the adequacy of current payment mechanisms and evaluation plans as public and policy interest in the PCMH model grows.

  6. The outcome of the first 1000 cases of LASIK performed at the king Hussein Medical Center

    Energy Technology Data Exchange (ETDEWEB)

    Abdallat, W [King Hussein Medical Centre, Amman (Jordan). Dept. of Ophthalmology


    The current study evaluates the refractive and visual outcome of patients who had laser in situ keratomileusis (LASIK) performed at the refractive center at King Hussein Medical centre in Jordan. The predictability of LASIK surgery in terms of refractive and visual outcome results is very good with mild regression in refraction over time. (author).

  7. The outcome of the first 1000 cases of LASIK performed at the king Hussein Medical Center

    International Nuclear Information System (INIS)

    Abdallat, W


    The current study evaluates the refractive and visual outcome of patients who had laser in situ keratomileusis (LASIK) performed at the refractive center at King Hussein Medical centre in Jordan. The predictability of LASIK surgery in terms of refractive and visual outcome results is very good with mild regression in refraction over time. (author).

  8. Patient-centered medical home transformation with payment reform: patient experience outcomes. (United States)

    Heyworth, Leonie; Bitton, Asaf; Lipsitz, Stuart R; Schilling, Thad; Schiff, Gordon D; Bates, David W; Simon, Steven R


    To examine changes in patient experience across key domains of the patient-centered medical home (PCMH) following practice transformation with Lean quality improvement methodology inclusive of payment reform. Pre-intervention/post-intervention analysis of intervention with a comparison group, a quasi-experimental design. We surveyed patients following office visits at the intervention (n = 2502) and control (n = 1622) practices during the 15-month period before and 14-month period after PCMH Lean transformation (April-October 2009). We measured and compared pre-intervention and post-intervention levels of patient satisfaction and other indicators of patient-centered care. Propensity weights adjusted for potential case-mix differences in intervention and control groups; propensity-adjusted proportions accounted for physician-level clustering. More intervention patients were very satisfied with their care after the PCMH Lean intervention (68%) compared with pre-intervention (62%). Among control patients, there was no corresponding increase in satisfaction (63% very satisfied pre-intervention vs 64% very satisfied post-intervention). This comparison resulted in a statistical trend (P = .10) toward greater overall satisfaction attributable to the intervention. Post-intervention, patients in the intervention practice consistently rated indicators of patient-centered care higher than patients in the control practice, particularly in the personal physician and communication domain. In this domain, intervention patients reported superior provider explanations, time spent, provider concern, and follow-up instructions compared with control participants, whereas control group ratings fell in the post-intervention period (P for difference Lean enhancement with payment reform, patient experience was sustained or improved across key PCMH domains.

  9. Introducing quality assurance and medical audit into the UCSF medical center curriculum. (United States)

    Barbaccia, J C


    The experience gained by a medical school faculty in developing and piloting a course for undergraduate medical students in medical care evaluation led to a similar effort for house staff. It is recognized that if the profession is to fulfill the demand by society for social accountability in the use of resources for health care, medical care assessment and quality assurance mechanisms must become an intimate part of the clinical experience of medical students and house officers. Teaching these subjects requires a theoretical framework; introduction of content and skills appropriate to the level of the student and continuation of progressively more advanced training throughout medical education; use of assessment and quality assurance techniques by clinician-teachers themselves to provide models for the student; and continued evolution of pedagogic approach and course content based on developments in the area.

  10. Fall Injuries and Related Factors of Elderly Patients at a Medical Center in Taiwan


    Tsai, Li-Yun; Tsay, Shiow-Luan; Hsieh, Ruey-Kuen; Yu, Shu; Tsai, Jung-Mei; Chien, Hui-Hsien; Liu, Shu-Jung


    Background: Elderly patients have a high incidence of falls and injuries in hospitals due to various reasons. The aims of this study were to explore the characteristics and factors associated with fall injuries among elderly patients. Methods: A retrospective survey study was conducted. Data were retrieved from the patient safety reporting system of a medical center in Taiwan query for patient fall incidents of elderly patients aged 65 years or older between 2010 and 2012. Statistics were ...

  11. "Bacterial infections in visceral leishmaniasis in Children’s Medical Center 1966-2000 "

    Directory of Open Access Journals (Sweden)

    "Tabatabaei P "


    Full Text Available Background: Bacterial infections are seen in patients with visceral leishmaniasis. This study was conducted to determine the incidence of such infections and the more common infections agents. Materials and Methods: During the 15-years period in a prospective study from 1986 to 2000, 123 patients with visceral leishmaniasis were studied in the Children Medical Center. Results: From all the cases, 41 (33 percent patients had Also bacterial infections. Respiratory tract, urinary system, Middle ear were the most common sites of infection. Conclusion: When bacterial Infection is suspected in these patients, empiric antibiotic therapy should be started immediately after appropriate diagnostic procedures are taken.

  12. Establishment of exposure dose assessment laboratory in National Radiation Emergency Medical Center (NREMC)

    Energy Technology Data Exchange (ETDEWEB)

    Yoo, Jae Ryong; Ha, Wi Ho; Yoon, Seok Won; Han, Eun Ae; Lee, Seung Sook [Korea Institute of Radiological and Medical Sciences, Seoul (Korea, Republic of)


    As unclear industry grown, 432 of the nuclear power plants are operating and 52 of NPPs are under construction currently. Increasing use of radiation or radioisotopes in the field of industry, medical purpose and research such as non-destructive examination, computed tomography and x-ray, etc. constantly. With use of nuclear or radiation has incidence possibility for example the Fukushima NPP incident, the Goiania accident and the Chernobyl Nuclear accident. Also the risk of terror by radioactive material such as Radiological Dispersal Device(RDD) etc. In Korea, since the 'Law on protection of nuclear facilities and countermeasure for radioactive preparedness was enacted in 2003, the Korean institute of Radiological and Medical Sciences(KIRAMS) was established for the radiation emergency medical response in radiological disaster due to nuclear accident, radioactive terror and so on. Especially National Radiation Emergency Medical Center(NREMC) has the duty that is protect citizens from nuclear, radiological accidents or radiological terrors through the emergency medical preparedness. The NREMC was established by the 39-article law on physical protection of nuclear material and facilities and measures for radiological emergencies. Dose assessment or contamination survey should be performed which provide the radiological information for medical response. For this reason, the NREMC establish and re-organized dose assessment system based on the existing dose assessment system of the NREMC recently. The exposure dose could be measured by physical and biological method. With these two methods, we can have conservative dose assessment result. Therefore the NREMC established the exposure dose assessment laboratory which was re-organized laboratory space and introduced specialized equipment for dose assessment. This paper will report the establishment and operation of exposure dose assessment laboratory for radiological emergency response and discuss how to enhance

  13. Impact of type 1 diabetes mellitus on the family is reduced with the medical home, care coordination, and family-centered care. (United States)

    Katz, Michelle L; Laffel, Lori M; Perrin, James M; Kuhlthau, Karen


    To examine whether the medical home, care coordination, or family-centered care was associated with less impact of type 1 diabetes mellitus (T1D) on families' work, finances, time, and school attendance. With the 2005 to 2006 National Survey of Children with Special Health Care Needs, we compared impact in children with T1D (n = 583) with that in children with other special health care needs (n = 39 944) and children without special health care needs (n = 4945). We modeled the associations of the medical home, care coordination, and family-centered care with family impact in T1D. Seventy-five percent of families of children with T1D reported a major impact compared with 45% of families of children with special health care needs (P families of children without special health care needs (P families of children with T1D, 35% reported restricting work, 38% reported financial impact, 41% reported medical expenses >$1000/year, 24% reported spending ≥11 hours/week caring or coordination care, and 20% reported ≥11 school absences/year. The medical home, care coordination, and family-centered care were associated with less work and financial impact. In childhood T1D, most families experience major impact. Better systems of health care delivery may help families reduce some of this impact. Copyright © 2012 Mosby, Inc. All rights reserved.

  14. Commercial Crew Medical Ops (United States)

    Heinbaugh, Randall; Cole, Richard


    Provide commercial partners with: center insight into NASA spaceflight medical experience center; information relative to both nominal and emergency care of the astronaut crew at landing site center; a basis for developing and sharing expertise in space medical factors associated with returning crew.

  15. A Three-Year Experience of Medical Thoracoscopy at A Tertiary Care Center of Himalayan Region

    Directory of Open Access Journals (Sweden)

    Rakhee Sodhi


    Full Text Available Introduction: Medical thoracoscopy is a minimally invasive procedure for diagnosing and treating pleural diseases. Despite its proven role in diagnostic and therapeutic purposes, it is infrequently used, which could be because of cost of equipment and lack of training. We analyzed our initial 3 years record of thoracoscopy at Himalayan Institute of Medical Sciences, a tertiary care center in Himalayan region of north India. Materials and Methods: This cross-sectional study was to analyze our experience of medical thoracoscopy which was started in Jan 2011 at our center. All patients who underwent thoracoscopy during the period between Jan 2011 to Dec 2013 were included in the study. Thoracoscopy was performed for diagnosis of undiagnosed pleural effusions. Clinical, radiological, cytological & histopathological data of the patients were collected prospectively and analysed. Results: The diagnostic yield for a pleuroscopic pleural biopsy in our study was 87.23% (41/47. Malignancy was diagnosed histopathologically in 70.2% (33/47 patients (both primary & metastatic pleural carcinoma and tuberculosis in 10.6% (5/47. There was no mortality related to procedure. Only three patients had minor complications like subcutaneous emphysema which was mild and resolved by second post-procedure day. Pain at intercostal drain site was observed in some patients. Conclusion: Thoracoscopy is an easy outpatient procedure and an excellent diagnostic tool for pleural effusion of uncertain etiology. It has low complication rate even in settings where the procedure is just started. It should be included in the armamentarium of tools for management of pleural effusion.

  16. Financial impact of tertiary care in an academic medical center. (United States)

    Huber, T S; Carlton, L M; O'Hern, D G; Hardt, N S; Keith Ozaki, C; Flynn, T C; Seeger, J M


    To analyze the financial impact of three complex vascular surgical procedures to both an academic hospital and a department of surgery and to examine the potential impact of decreased reimbursements. The cost of providing tertiary care has been implicated as one potential cause of the financial difficulties affecting academic medical centers. Patients undergoing revascularization for chronic mesenteric ischemia, elective thoracoabdominal aortic aneurysm repair, and treatment of infected aortic grafts at the University of Florida were compared with those undergoing elective infrarenal aortic reconstruction and carotid endarterectomy. Hospital costs and profit summaries were obtained from the Clinical Resource Management Office. Departmental costs and profit summary were estimated based on the procedural relative value units (RVUs), the average clinical cost per RVU ($33.12), surgeon charges, and the collection rate for the vascular surgery division (30.2%) obtained from the Faculty Group Practice. Surgeon work effort was analyzed using the procedural work RVUs and the estimated total care time. The analyses were performed for all payors and the subset of Medicare patients, and the potential impact of a 15% reduction in hospital and physician reimbursement was analyzed. Net hospital income was positive for all but one of the tertiary care procedures, but net losses were sustained by the hospital for the mesenteric ischemia and infected aortic graft groups among the Medicare patients. In contrast, the estimated reimbursement to the department of surgery for all payors was insufficient to offset the clinical cost of providing the RVUs for all procedures, and the estimated losses were greater for the Medicare patients alone. The surgeon work effort was dramatically higher for the tertiary care procedures, whereas the reimbursement per work effort was lower. A 15% reduction in reimbursement would result in an estimated net loss to the hospital for each of the tertiary

  17. Photo-medical valley. 'Photo medical research center'

    International Nuclear Information System (INIS)

    Kawanishi, Shunichi; Daido, Hiroyuki; Tajima, Toshiki


    To develop a much more compact cancer diagnosis and therapeutic instrument using high intensity laser technology, Japan Atomic Energy Agency (JAEA) has successfully proposed this novel effort to the Ministry of Education, Culture, Sports, Science and Technology (MEXT) program as the creation of a 'photo-medical industrial valley' base in 2007 fiscal year. In this report, a new laser techniques to drive controlled ion beams is described. It is very important approach to realize a laser-driven ion accelerator. (author)

  18. Patient experience in a coordinated care model featuring diabetes self-management education integrated into the patient-centered medical home. (United States)

    Janiszewski, Debra; O'Brian, Catherine A; Lipman, Ruth D


    The purpose of this study is to gain insight about patient experience of diabetes self-management education in a patient-centered medical home. Six focus groups consisting of 37 people with diabetes, diverse in race and ethnicity, were conducted at 3 sites. Participants described their experience in the program and their challenges in diabetes self-management; they also suggested services to meet their diabetes care needs. The most common theme was ongoing concerns about care and support. There was much discussion about the value of the support provided by health navigators integrated in the diabetes health care team. Frequent concerns expressed by participants centered on personal challenges in engaging in healthy lifestyle behaviors. Ongoing programmatic support of self-management goals was widely valued. Individuals who received health care in a patient-centered medical home and could participate in diabetes self-management education with integrated support valued both activities. The qualitative results from this study suggest need for more formalized exploration of effective means to meet the ongoing support needs of people with diabetes. © 2015 The Author(s).

  19. Performance test of electron cyclotron resonance ion sources for the Hyogo Ion Beam Medical Center (United States)

    Sawada, K.; Sawada, J.; Sakata, T.; Uno, K.; Okanishi, K.; Harada, H.; Itano, A.; Higashi, A.; Akagi, T.; Yamada, S.; Noda, K.; Torikoshi, M.; Kitagawa, A.


    Two electron cyclotron resonance (ECR) ion sources were manufactured for the accelerator facility at the Hyogo Ion Beam Medical Center. H2+, He2+, and C4+ were chosen as the accelerating ions because they have the highest charge to mass ratio among ion states which satisfy the required intensity and quality. The sources have the same structure as the 10 GHz ECR source at the Heavy Ion Medical Accelerator in Chiba except for a few improvements in the magnetic structure. Their performance was investigated at the Sumitomo Heavy Industries factory before shipment. The maximum intensity was 1500 μA for H2+, 1320 μA for He2+, and 580 μA for C4+ at the end of the ion source beam transport line. These are several times higher than required. Sufficient performance was also observed in the flatness and long-term stability of the pulsed beams. These test results satisfy the requirements for medical use.

  20. Characterizing complexity in socio-technical systems: a case study of a SAMU Medical Regulation Center. (United States)

    Righi, Angela Weber; Wachs, Priscila; Saurin, Tarcísio Abreu


    Complexity theory has been adopted by a number of studies as a benchmark to investigate the performance of socio-technical systems, especially those that are characterized by relevant cognitive work. However, there is little guidance on how to assess, systematically, the extent to which a system is complex. The main objective of this study is to carry out a systematic analysis of a SAMU (Mobile Emergency Medical Service) Medical Regulation Center in Brazil, based on the core characteristics of complex systems presented by previous studies. The assessment was based on direct observations and nine interviews: three of them with regulator of emergencies medical doctor, three with radio operators and three with telephone attendants. The results indicated that, to a great extent, the core characteristics of complexity are magnified) due to basic shortcomings in the design of the work system. Thus, some recommendations are put forward with a view to reducing unnecessary complexity that hinders the performance of the socio-technical system.

  1. Impact of a reengineered electronic error-reporting system on medication event reporting and care process improvements at an urban medical center. (United States)

    McKaig, Donald; Collins, Christine; Elsaid, Khaled A


    A study was conducted to evaluate the impact of a reengineered approach to electronic error reporting at a 719-bed multidisciplinary urban medical center. The main outcome of interest was the monthly reported medication errors during the preimplementation (20 months) and postimplementation (26 months) phases. An interrupted time series analysis was used to describe baseline errors, immediate change following implementation of the current electronic error-reporting system (e-ERS), and trend of error reporting during postimplementation. Errors were categorized according to severity using the National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP) Medication Error Index classifications. Reported errors were further analyzed by reporter and error site. During preimplementation, the monthly reported errors mean was 40.0 (95% confidence interval [CI]: 36.3-43.7). Immediately following e-ERS implementation, monthly reported errors significantly increased by 19.4 errors (95% CI: 8.4-30.5). The change in slope of reported errors trend was estimated at 0.76 (95% CI: 0.07-1.22). Near misses and no-patient-harm errors accounted for 90% of all errors, while errors that caused increased patient monitoring or temporary harm accounted for 9% and 1%, respectively. Nurses were the most frequent reporters, while physicians were more likely to report high-severity errors. Medical care units accounted for approximately half of all reported errors. Following the intervention, there was a significant increase in reporting of prevented errors and errors that reached the patient with no resultant harm. This improvement in reporting was sustained for 26 months and has contributed to designing and implementing quality improvement initiatives to enhance the safety of the medication use process.

  2. Moral dilemmas faced by hospitals in time of war: the Rambam Medical Center during the second Lebanon war. (United States)

    Bar-El, Yaron; Reisner, Shimon; Beyar, Rafael


    Rambam Medical Center, the only tertiary care center and largest hospital in northern Israel, was subjected to continuous rocket attacks in 2006. This extreme situation posed serious and unprecedented ethical dilemmas to the hospital management. An ambiguous situation arose that required routine patient care in a tertiary modern hospital together with implementation of emergency measures while under direct fire. The physicians responsible for hospital management at that time share some of the moral dilemmas faced, the policy they chose to follow, and offer a retrospective critical reflection in this paper. The hospital's first priority was defined as delivery of emergency surgical and medical services to the wounded from the battlefields and home front, while concomitantly providing the civilian population with all elective medical and surgical services. The need for acute medical service was even more apparent as the situation of conflict led to closure of many ambulatory clinics, while urgent or planned medical care such as open heart surgery and chemotherapy continued. The hospital management took actions to minimize risks to patients, staff, and visitors during the ongoing attacks. Wards were relocated to unused underground spaces and corridors. However due to the shortage of shielded spaces, not all wards and patients could be relocated to safer areas. Modern warfare will most likely continue to involve civilian populations and institutes, blurring the division between peaceful high-tech medicine and the rough battlefront. Hospitals in high war-risk areas must be prepared to function and deliver treatment while under fire or facing similar threats.

  3. Lessons learned from a pharmacy practice model change at an academic medical center. (United States)

    Knoer, Scott J; Pastor, John D; Phelps, Pamela K


    The development and implementation of a new pharmacy practice model at an academic medical center are described. Before the model change, decentralized pharmacists responsible for order entry and verification and clinical specialists were both present on the care units. Staff pharmacists were responsible for medication distribution and sterile product preparation. The decentralized pharmacists handling orders were not able to use their clinical training, the practice model was inefficient, and few clinical services were available during evenings and weekends. A task force representing all pharmacy department roles developed a process and guiding principles for the model change, collected data, and decided on a model. Teams consisting of decentralized pharmacists, decentralized pharmacy technicians, and team leaders now work together to meet patients' pharmacy needs and further departmental safety, quality, and cost-saving goals. Decentralized service hours have been expanded through operational efficiencies, including use of automation (e.g., computerized provider order entry, wireless computers on wheels used during rounds with physician teams). Nine clinical specialist positions were replaced by five team leader positions and four pharmacists functioning in decentralized roles. Additional staff pharmacist positions were shifted into decentralized roles, and the hospital was divided into areas served by teams including five to eight pharmacists. Technicians are directly responsible for medication distribution. No individual's job was eliminated. The new practice model allowed better alignment of staff with departmental goals, expanded pharmacy hours and services, more efficient medication distribution, improved employee engagement, and a staff succession plan.

  4. The effect of work shift configurations on emergency medical dispatch center response. (United States)

    Montassier, Emmanuel; Labady, Julien; Andre, Antoine; Potel, Gilles; Berthier, Frederic; Jenvrin, Joel; Penverne, Yann


    It has been proved that emergency medical dispatch centers (EMDC) save lives by promoting an appropriate allocation of emergency medical service resources. Indeed, optimal dispatcher call duration is pivotal to reduce the time gap between the time a call is placed and the delivery of medical care. However, little is known about the impact of work shift configurations (i.e., work shift duration and work shift rotation throughout the day) and dispatcher call duration. Thus, the objective of our study was to assess the effect of work shift configurations on dispatcher call duration. During a 1-year study period, we analyzed the dispatcher call durations for medical and trauma calls during the 4 different work shift rotations (day, morning, evening, and night) and during the 10-hour work shift of each dispatcher in the EMDC of Nantes. We extracted dispatcher call durations from our advanced telephone system, configured with CC Pulse + (Genesys, Alcatel Lucent), and collected them in a custom designed database (Excel, Microsoft). Afterward, we analyzed these data using linear mixed effects models. During the study period, our EMDC received 408,077 calls. Globally, the mean dispatcher call duration was 107 ± 45 seconds. Based on multivariate linear mixed effects models, the dispatcher call duration was affected by night work shift and work shift duration greater than 8 hours, increasing it by about 10 ± 1 seconds and 4 ± 1 seconds, respectively (both p work shift rotation and duration, with longer durations seen over night shifts and shifts over 8 hours. While these differences are small and may not have clinical significance, they may have implications for EMDC efficiency.

  5. Patient-centered medical home cyberinfrastructure current and future landscape. (United States)

    Finkelstein, Joseph; Barr, Michael S; Kothari, Pranav P; Nace, David K; Quinn, Matthew


    The patient-centered medical home (PCMH) is an approach that evolved from the understanding that a well-organized, proactive clinical team working in a tandem with well-informed patients is better able to address the preventive and disease management needs in a guideline-concordant manner. This approach represents a fundamental shift from episodic acute care models and has become an integral part of health reform supported on a federal level. The major aspects of PCMH, especially pertinent to its information infrastructure, have been discussed by an expert panel organized by the Agency for Healthcare Research and Quality at the Informatics for Consumer Health Summit. The goal of this article is to summarize the panel discussions along the four major domains presented at the summit: (1) PCMH as an Evolving Model of Healthcare Delivery; (2) Health Information Technology (HIT) Applications to Support the PCMH; (3) Current HIT Landscape of PCMH: Challenges and Opportunities; and (4) Future HIT Landscape of PCMH: Federal Initiatives on Health Informatics, Legislation, and Standardization. Copyright © 2011 American Journal of Preventive Medicine. All rights reserved.

  6. Wright Research and Development Center Test Facilities Handbook (United States)


    Variable Temperature (2-400K) and Field (0-5 Tesla) Squid Susceptometer Variable Temperature (10-80K) and Field (0-10 Tesla) Transport Current...determine products of combustion using extraction type probes INSTRUMENTATION: Mini computer/data acquisiton system Networking provides access to recorder, Masscomp MC-500 computer with acquisition digitizer, laser and ink -jet printers,lo-pass filters, pulse code modulation AVAILABILITY

  7. Crafting Flight: Aircraft Pioneers and the Contributions of the Men and Women of NASA Langley Research Center (United States)

    Schultz, James


    While this is a self-contained history of NASA Langley Research Center's contributions to flight, many other organizations around the country played a vital role in the work described in this book.When you pass through the front gates of NASA Langley Research Center you are entering an extraordinary place. You could easily miss that fact, however. A few years cross-state bicycle tour passed through the Center. As interesting as looping around Center was, the riders observed that nothing about the vaguely industrial site fit the conventional stereotypes of what high tech looks like. NASA Langley does not fit many stereotypes. It takes a close examination to discover the many ways it has contributed to development of flight. As part of the national celebrations commemorating the 100th anniversary of the Wright brothers first flight, James Schultz, an experienced journalist with a gift for translating the language of engineers and scientists into prose that nonspecialists can comprehend, has revised and expanded Winds of Change , his wonderful guide to the Center. This revised book, Crafting Flight , invites you inside. You will read about one of the Nation s oldest research and development facilities, a place of imagination and ingenuity.

  8. Effects of a pain education program in Complementary and Alternative Medicine treatment utilization at a VA medical center. (United States)

    Cosio, David; Lin, Erica H


    Past studies have shown that U.S. Veterans are consumers of CAM. However, more than 75% of Veteran non-users report they would utilize these treatment options if made available. Thus, Veterans may not be fully aware of the CAM options currently available to them in the current U.S. VA health care system. The current study tested the hypothesis that Veterans would report an increase in CAM utilization after completing a formal pain education program in a VA medical center. The study used a quasi-experimental, one-group, pre/post-test design. Midwestern, U.S. VA Medical Center. The responses from 103 Veterans who elected to participate in the program and the assessment measures were included in the outcome analyses. "Pain Education School" is a 12-week, educational program that is open to all Veterans and their families. It is a comprehensive program that introduces patients to 23 different disciplines at the VA Medical Center that deal with chronic, non-cancer pain. An adaptation of the Complementary and Alternative Medicine Questionnaire(©), SECTION A: Use of Alternative Health Care Providers. There was a significant difference found in overall utilization of CAM after completing the pain education program. The most utilized CAM modality was the chiropractor; the least utilized were hypnosis and aromatherapy. Not all health care systems or providers may have access to an education-focused, professionally driven program as an amenity. However, lessons can be learned from this study in terms of what pain providers may be able to accomplish in their practice. Published by Elsevier Ltd.

  9. Effects of nonlinear error correction of measurements obtained by peak flowmeter using the Wright scale to assess asthma attack severity in children

    Directory of Open Access Journals (Sweden)

    Stamatović Dragana


    Full Text Available Introduction: Monitoring of peak expiratory flow (PEF is recommended in numerous guidelines for management of asthma. Improvements in calibration methods have demonstrated the inaccuracy of original Wright scale of peak flowmeter. A new standard, EN 13826 that was applied to peak flowmeter was adopted on 1st September 2004 by some European countries. Correction of PEF readings obtained with old type devices for measurement is possible by Dr M. Miller’s original predictive equation. Objective. Assessment of PEF correction effect on the interpretation of measurement results and management decisions. Method. In children with intermittent (35 or stable persistent asthma (75 aged 6-16 years, there were performed 8393 measurements of PEF by Vitalograph normal-range peak flowmeter with traditional Wright scale. Readings were expressed as percentage of individual best values (PB before and after correction. The effect of correction was analyzed based on The British Thoracic Society guidelines for asthma attack treatment. Results. In general, correction reduced the values of PEF (p<0.01. The highest mean percentage error (20.70% in the measured values was found in the subgroup in which PB ranged between 250 and 350 l/min. Nevertheless, the interpretation of PEF after the correction in this subgroup changed in only 2.41% of measurements. The lowest mean percentage error (15.72%, and, at the same time, the highest effect of correction on measurement results interpretation (in 22.65% readings were in children with PB above 450 l/min. In 73 (66.37% subjects, the correction changed the clinical interpretation of some values of PEF after correction. In 13 (11.8% patients, some corrected values indicated the absence or a milder degree of airflow obstruction. In 27 (24.54% children, more than 10%, and in 12 (10.93%, more than 20% of the corrected readings indicated a severe degree of asthma exacerbation that needed more aggressive treatment. Conclusion

  10. [Causes of death in patients with HIV infection in two Tunisian medical centers]. (United States)

    Chelli, Jihène; Bellazreg, Foued; Aouem, Abir; Hattab, Zouhour; Mesmia, Hèla; Lasfar, Nadia Ben; Hachfi, Wissem; Masmoudi, Tasnim; Chakroun, Mohamed; Letaief, Amel


    Antiretroviral tritherapy has contributed to a considerable reduction in HIV-related mortality. The causes of death are dominated by opportunistic infections in developing countries and by cardiovascular diseases and cancer in developed countries. To determine the causes and risk factors associated with death in HIV-infected patients in two Tunisian medical centers. cross-sectional study of HIV-infected patients over 15 years treated at Sousse and Monastir medical centers between 2000 and 2014. Death was considered related to HIV if its primary cause was AIDS-defining illness or if it was due to an opportunistic infection of unknown etiology with CD4 cause wasn't an AIDS defining illness or if it was due to an unknown cause if no information was available. Two hundred thirteen patients, 130 men (61%) and 83 women (39%), average age 40 ± 11 years were enrolled in the study. Fifty four patients died, the mortality rate was 5.4/100 patients/year. Annual mortality rate decreased from 5.8% in 2000-2003 to 2.3% in 2012-2014. Survival was 72% at 5 years and 67% at 10 years. Death events were associated with HIV in 70.4% of cases. The leading causes of death were pneumocystis carinii pneumonia and cryptococcal meningitis in 6 cases (11%) each. Mortality risk factors were a personal history of opportunistic infections, duration of antiretroviral therapy < 12 months and smoking. Strengthening screening, early initiation of antiretroviral therapy and fight against tobacco are needed to reduce mortality in patients infected with HIV in Tunisia.

  11. PACS and its hospital-wide implementation: A case study at the Madigan Army Medical Center

    International Nuclear Information System (INIS)

    Choi, Hyung Sik; Kim, Yong Min; Smith, Donald V.; Bender, Gregory N.


    PACS represents the future of radiology in modern hospitals. Workstations and databases can be developed to substantially increase clinician's productivity, improve diagnostic accuracy, and make a large amount of knowledge and patient information available on-line to the physician. Currently, there are several hospitals in the process of implementing a total PACS system. They include Madigan Army Medical Center (Tacoma, Washington), VA Hospital in Baltimore, and Hammersmith Hospital in London (1). In order to provide the radiologist, the clinicians, and other health personnel in Korea with the general concept of PACS and its up-to-date status report, we describe the MDIS system being implemented in MAMC (Madigan Army Medical Center) which is the first hospital-wide large-scale PACS in the world. The major PACS components in MAMC have been installed since March 1992 and the full system implementation will be completed by summer 1993. The goal of the MDIS system in MAMC is to increase to more than 90% filmless by the end of 1993. In this paper, we discuss the introduction and background of PACS and its potential benefits, the current status of PACS installation in MAMC and the future plan, and the flow of image data and text information in MAMC

  12. Assessment of diabetic teleretinal imaging program at the Portland Department of Veterans Affairs Medical Center. (United States)

    Tsan, Grace L; Hoban, Keely L; Jun, Weon; Riedel, Kevin J; Pedersen, Amy L; Hayes, John


    We conducted a retrospective chart review of 200 diabetic patients who had teleretinal imaging performed between January 1, 2010, and January 1, 2011, at Portland Department of Veterans Affairs (VA) Medical Center outpatient clinics to assess the effectiveness of the diabetic teleretinal imaging program. Twenty patients (10%) had diabetic retinopathy. Ninety percent of the available teleretinal imaging studies were of adequate quality for interpretation. In accordance with local VA policy at that time, all teleretinal imaging patients should have been referred for a dilated retinal examination the following year. Image readers referred 97.5% of the patients to eye clinics for subsequent eye examinations, but the imagers scheduled appointments for only 80% of these patients. The redundancy rate, i.e., patients who had an eye examination within the past 6 mo, was 11%; the duplicate recall rate, i.e., patients who had a second teleretinal imaging performed within 1 yr of the eye examination, was 37%. Rates of timely diabetic eye examinations at clinics with teleretinal imaging programs, particularly when teleretinal imaging and eye clinics were colocated at the same community-based outpatient clinic, were higher than those without a teleretinal imaging program. We concluded that the Portland VA Medical Center's teleretinal imaging program was successful in increasing the screening rate for diabetic retinopathy.

  13. Evaluation of Managerial Needs for Palliative Care Centers: Perspectives of Medical Directors. (United States)

    Kafadar, Didem; Ince, Nurhan; Akcakaya, Adem; Gumus, Mahmut


    Palliative therapies have an important role in increasing the quality of healthcare and in dealing with physical and psychosocial problems due to cancer. We here aimed to evaluate the managerial perspectives and opinions of the hospital managers and clinical directors about specialized palliative care centers. This study was conducted in two large-scale hospitals in which oncology care is given with medical directors (n:70). A questionnaire developed by the researchers asking about demographic characteristics and professional experience, opinions and suggestions of medical directors about providing and integrating palliative care into healthcare was used and responses were analyzed. Potential barriers in providing palliative care (PC) and integrating PC into health systems were perceived as institutional by most of the doctors (97%) and nurses (96%). Social barriers were reported by 54% of doctors and 82% of nurses. Barriers due to interest and knowledge of health professionals about PC were reported by 76% of doctors and 75% of nurses. Among encouragement ideas to provide PC were dealing with staff educational needs (72%), improved working conditions (77%) and establishing a special PC unit (49)%. An independent PC unit was suggested by 27.7% of participants and there was no difference between the hospitals. To overcome the barriers for integration of PC into health systems, providing education for health professionals and patient relatives, raising awareness in society, financial arrangements and providing infrastructure were suggested. The necessity for planning and programming were emphasized. In our study, the opinions and perspectives of hospital managers and clinical directors were similar to current approaches. Managerial needs for treating cancer in efficient cancer centers, increasing the capacity of health professionals to provide care in every stage of cancer, effective education planning and patient care management were emphasized.

  14. Medication Errors in Hospitals: A Study of Factors Affecting Nursing Reporting in a Selected Center Affiliated with Shahid Beheshti University of Medical Sciences

    Directory of Open Access Journals (Sweden)

    HamidReza Mirzaee


    Full Text Available Background: Medication errors are mentioned as the most common important challenges threatening healthcare system in all countries worldwide. This study is conducted to investigate the most significant factors in refusal to report medication errors among nursing staff.Methods: The cross-sectional study was conducted on all nursing staff of a selected Education& Treatment Center in 2013. Data was collected through a teacher made questionnaire. The questionnaires’ face and content validity was confirmed by experts and for measuring its reliability test-retest was used. Data was analyzed by descriptive and analytic statistics. 16th  version of SPSS was also used for related statistics.Results: The most important factors in refusal to report medication errors respectively are: lack of reporting system in the hospital(3.3%, non-significance of reporting medication errors to hospital authorities and lack of appropriate feedback(3.1%, and lack of a clear definition for a medication error (3%. there was a significant relationship between the most important factors of refusal to report medication errors and work shift (p:0.002, age(p:0.003, gender(p:0.005, work experience(p<0.001 and employment type of nurses(p:0.002.Conclusion: Factors pertaining to management in hospitals as well as the fear of the consequences of reporting are two broad fields among the factors that make nurses not report their medication errors. In this regard, providing enough education to nurses, boosting the job security for nurses, management support and revising related processes and definitions are some factors that can help decreasing medication errors and increasing their report in case of occurrence.

  15. The Comparison between Teacher Centered and Student Centered Educational Methods

    Directory of Open Access Journals (Sweden)

    M Anvar


    Full Text Available Background and Purpose: Various approaches to learning are suggested & practiced. The traditional medical education were more teacher centered oriented . In this method the students’ involvement in the process of learning is not remarkable, but the new approach to medical education supports the students involvement. This study evaluated the various method of lecturing considering students involvements.Methods: One hundred two first year medical and nursing students involved in this study and their opinion about these two methods of learning were obtained by filling of a questionnaire. The subject of the lectures was “general psychology” which was carried out 50% by the students and 50% by the teacher. The statistical analysis was carried out by SPSS program.Results: Considering students opinion in student-centered method the various aspect of learning such as mutual understanding, use of textbooks and references were significantly increased , whereasother aspects of learning such as self esteem, study time, innovation, and study attitude though were improved, but were not significant as compared with teacher centered method. In teacher-centeredmethod the understanding of the subjects was significantly increased .Other aspects of learning such as motivation and concentration were improved but not significantly as compared with studentcentered method.Conclusion: As the result showed student centered method was favored in several aspects of learning while in teacher centered method only understanding of the subject was better . Careful choice of teaching method to provide a comprehensive learning experience should take into account these differences.Key words: TEACHER CENTERED, STUDENT CENTERED, LEARNING

  16. Governing Academic Medical Center Systems: Evaluating and Choosing Among Alternative Governance Approaches. (United States)

    Chari, Ramya; O'Hanlon, Claire; Chen, Peggy; Leuschner, Kristin; Nelson, Christopher


    The ability of academic medical centers (AMCs) to fulfill their triple mission of patient care, medical education, and research is increasingly being threatened by rising financial pressures and resource constraints. Many AMCs are, therefore, looking to expand into academic medical systems, increasing their scale through consolidation or affiliation with other health care systems. As clinical operations grow, though, the need for effective governance becomes even more critical to ensure that the business of patient care does not compromise the rest of the triple mission. Multi-AMC systems, a model in which multiple AMCs are governed by a single body, pose a particular challenge in balancing unity with the needs of component AMCs, and therefore offer lessons for designing AMC governance approaches. This article describes the development and application of a set of criteria to evaluate governance options for one multi-AMC system-the University of California (UC) and its five AMCs. Based on a literature review and key informant interviews, the authors identified criteria for evaluating governance approaches (structures and processes), assessed current governance approaches using the criteria, identified alternative governance options, and assessed each option using the identified criteria. The assessment aided UC in streamlining governance operations to enhance their ability to respond efficiently to change and to act collectively. Although designed for UC and a multi-AMC model, the criteria may provide a systematic way for any AMC to assess the strengths and weaknesses of its governance approaches.

  17. Intestinal parasitism in preschool and school students treated in the EsSalud Medical Center of Celendín, Cajamarca

    Directory of Open Access Journals (Sweden)

    Jimmy Rinaldo Morales Del Pino


    Full Text Available OBJETIVES: Intestinal parasitism in preschool and school students treated in the EsSalud Medical Center of Celendín, Cajamarca MATERIAL AND METHODS: Observational, descriptive, cross-sectional research, conducted between July 2015 and January 2016 in the clinical laboratory service of EsSalud Medical Center of Celendín, Cajamarca. A data collection sheet was used for each participant to collect clinical data, demographic data and personal interaction. Parasitological samples of 96 children were processed by using direct examination, test of Graham and spontaneous sedimentation technique. Univariate analysis was used to find frequencies, percentages and standard deviations, and for the bivariate analysis we used Chi-square and Fisher's exact tests to associate the degree of parasitism with each variable obtained. RESULTS: The prevalence was 90.6% (87/96. Blastocystis hominis 81.2%, iodamoeba bütschlii 6.3%, Endolimax nana 19.8%, Entamoeba coli 35.4%, Chilomastix mesnilii 13.5%, Giardia lamblia 9.4%, Enterobius vermicularis 16.7% was found and Ascaris lumbricoides 1.0%. 20.8% (20/96 of the participants had similar structures to Urbanorum spp. Multiparasitism predominated (60.4% and there was a statistically significant association between the level of education and parasitical degree (p = 0.017. CONCLUSIONS: There was a high prevalence of parasitic infections in children in preschool and school age of Celendín district attended at the EsSalud medical center being Blastocystis hominis parasite the most predominant.

  18. Assessment of Wearable Technology for Integrated Decision Support (United States)


    absorption of red  light by oxygen‐bound (or unbound)  hemoglobin   in the blood (see figure 9).  The measurement  is achieved by  shining both  red  light...Leadership  &  Education , Personnel, and Facilities (DOTMLPF) assessment. There may, however, be a clear  value  in keeping these decision support tools closer...Soldier mission sets.  The “Signature TrRacking for Optimized  Nutrition  and traininG” (STRONG) Lab at Air Force Research Labs at Wright Patterson Air

  19. The Wonder and Enrichment of Teaching Wright Morris's "A Fight between a White Boy and a Black Boy in the Dusk of a Fall Afternoon in Omaha, Nebraska." (United States)

    McCaffrey, Jerrine


    Outlines a teaching method for Wright Morris's "A Fight Between a White Boy and a Black Boy in the Dusk of a Fall Afternoon in Omaha, Nebraska." Proposes that the story provides and opportunity to introduce stream-of-consciousness writing and to convey the significance of memory recall. (PM)

  20. How to market an affiliation. St. Elizabeth Hospital and Mercy Medical Center affiliate to create Affinity Health System. (United States)


    When Wisconsin's St. Elizabeth Hospital and Mercy Medical Center affiliated to create Affinity Health System, Inc., strategic planning and a solid marketing plan carefully executed were instrumental in its success. A corporate identity campaign and product line identification were follow-up phases to the merger approval.

  1. What killed Karl Patterson Schmidt? Combined venom gland transcriptomic, venomic and antivenomic analysis of the South African green tree snake (the boomslang), Dispholidus typus. (United States)

    Pla, Davinia; Sanz, Libia; Whiteley, Gareth; Wagstaff, Simon C; Harrison, Robert A; Casewell, Nicholas R; Calvete, Juan J


    Non-front-fanged colubroid snakes comprise about two-thirds of extant ophidian species. The medical significance of the majority of these snakes is unknown, but at least five species have caused life-threatening or fatal human envenomings. However, the venoms of only a small number of species have been explored. A combined venomic and venom gland transcriptomic approach was employed to characterise of venom of Dispholidus typus (boomslang), the snake that caused the tragic death of Professor Karl Patterson Schmidt. The ability of CroFab™ antivenom to immunocapture boomslang venom proteins was investigated using antivenomics. Transcriptomic-assisted proteomic analysis identified venom proteins belonging to seven protein families: three-finger toxin (3FTx); phospholipase A 2 (PLA 2 ); cysteine-rich secretory proteins (CRISP); snake venom (SV) serine proteinase (SP); C-type lectin-like (CTL); SV metalloproteinases (SVMPs); and disintegrin-like/cysteine-rich (DC) proteolytic fragments. CroFab™ antivenom efficiently immunodepleted some boomslang SVMPs. The present work is the first to address the overall proteomic profile of D. typus venom. This study allowed us to correlate the toxin composition with the toxic activities of the venom. The antivenomic analysis suggested that the antivenom available at the time of the unfortunate accident could have exhibited at least some immunoreactivity against the boomslang SVMPs responsible for the disseminated intravascular coagulation syndrome that caused K.P. Schmidt's fatal outcome. This study may stimulate further research on other non-front-fanged colubroid snake venoms capable of causing life-threatening envenomings to humans, which in turn should contribute to prevent fatal human accidents, such as that unfortunately suffered by K.P. Schmidt. Copyright © 2017 The Author(s). Published by Elsevier B.V. All rights reserved.

  2. Aerospace medicine at Brooks AFB, TX: hail and farewell. (United States)

    Nunneley, Sarah A; Webb, James T


    With the impending termination of USAF operations at Brooks Air Force Base (AFB) in San Antonio, TX, it is time to consider its historic role in Aerospace Medicine. The base was established in 1917 as a flight training center for the U.S. Army Air Service and in 1926 became home to its School of Aviation Medicine. The school moved to San Antonio's Randolph Field in 1931, but in 1959 it returned to Brooks where it occupied new facilities to support its role as a national center for U.S. Air Force aerospace medicine, including teaching, clinical medicine, and research. The mission was then expanded to encompass support of U.S. military and civilian space programs. With the abrupt termination of the military space program in 1969, research at Brooks focused on clinical aviation medicine and support of advanced military aircraft while continuing close cooperation with NASA in support of orbital spaceflight and the journey to the Moon. Reorganization in the 1990s assigned all research functions at Brooks to the Human Systems Division and its successors, leaving to USAFSAM the missions related to clinical work and teaching. In 2002 the USAF and the city of San Antonio implemented shared operation of Brooks as a "City-Base" in the hope of deflecting threatened closure. Nevertheless, under continuing pressure to consolidate military facilities in the United States, the 2005 Base Closure and Realignment Commission ordered Brooks closed by 2011, with its aerospace medicine functions relocated to new facilities at Wright-Patterson AFB in Dayton, OH.

  3. Hospitalist and Internal Medicine Leaders' Perspectives of Early Discharge Challenges at Academic Medical Centers. (United States)

    Patel, Hemali; Fang, Margaret C; Mourad, Michelle; Green, Adrienne; Wachter, Robert M; Murphy, Ryan D; Harrison, James D


    Improving early discharges may improve patient flow and increase hospital capacity. We conducted a national survey of academic medical centers addressing the prevalence, importance, and effectiveness of early-discharge initiatives. We assembled a list of hospitalist and general internal medicine leaders at 115 US-based academic medical centers. We emailed each institutional representative a 30-item online survey regarding early-discharge initiatives. The survey included questions on discharge prioritization, the prevalence and effectiveness of early-discharge initiatives, and barriers to implementation. We received 61 responses from 115 institutions (53% response rate). Forty-seven (77%) "strongly agreed" or "agreed" that early discharge was a priority. "Discharge by noon" was the most cited goal (n = 23; 38%) followed by "no set time but overall goal for improvement" (n = 13; 21%). The majority of respondents reported early discharge as more important than obtaining translators for non-English-speaking patients and equally important as reducing 30-day readmissions and improving patient satisfaction. The most commonly reported factors delaying discharge were availability of postacute care beds (n = 48; 79%) and patient-related transport complications (n = 44; 72%). The most effective early discharge initiatives reported involved changes to the rounding process, such as preemptive identification and early preparation of discharge paperwork (n = 34; 56%) and communication with patients about anticipated discharge (n = 29; 48%). There is a strong interest in increasing early discharges in an effort to improve hospital throughput and patient flow. © 2017 Society of Hospital Medicine.

  4. Advantages and Disadvantages of the Patient-Centered Medical Home: A Critical Analysis and Lessons Learned. (United States)

    Budgen, Jacqueline; Cantiello, John

    This article provides a detailed examination of the pros and cons associated with patient-centered medical homes (PCMHs). Opinions and findings from those who have studied PCMHs and those who have been directly involved with this type of health care model are outlined. Key lessons from providers are detailed, and critical success factors are highlighted. This synthesized analysis serves to lend evidence to health care managers and providers who are considering implementation of the PCMH model.

  5. Implementing the patient-centered medical home model for chronic disease care in small medical practices: practice group characteristics and physician understanding. (United States)

    Baxter, Louisa; Nash, David B


    Strengthening primary care may improve health outcomes and restrain spending. The patient-centered medical home (PCMH) model is endorsed as a tool to achieve this. Early evaluations in large group practices demonstrate improvements in some health outcomes. Evidence is lacking from small medical practices that deliver the majority of primary health care. This was a national survey of 200 physicians that explored perceptions of PCMH. There was considerable interest in adoption of the model; however, providing PCMH care was seen as an extension of traditional roles that requires additional reimbursement. No differentiation was made among a variety of payment models to do this. All joint principle components of the model were identified as important: extending access and information technology were the most contentious. There was consensus that PCMH might improve the quality of primary care; however, tension between wider societal benefits and rising costs for individual practices was a challenge to implementation.

  6. Clinical trials of boron neutron capture therapy [in humans] [at Beth Israel Deaconess Medical Center][at Brookhaven National Laboratory

    International Nuclear Information System (INIS)

    Wallace, Christine


    Assessment of research records of Boron Neutron Capture Therapy was conducted at Brookhaven National Laboratory and Beth Israel Deaconess Medical Center using the Code of Federal Regulations, FDA Regulations and Good Clinical Practice Guidelines. Clinical data were collected FR-om subjects' research charts, and differences in conduct of studies at both centers were examined. Records maintained at Brookhaven National Laboratory were not in compliance with regulatory standards. Beth Israel's records followed federal regulations. Deficiencies discovered at both sites are discussed in the reports

  7. Hemolytic disease of the newborn caused by anti-Wright (anti-Wra): case report and review of literature. (United States)

    Squires, Amanda; Nasef, Nehad; Lin, Yulia; Callum, Jeannie; Khadawardi, Emad M; Drolet, Christine; Core, David; Simmons, Brian


    Antibodies to red cell antigens that are found at low frequency in the general population are rare causes of hemolytic disease of the newborn. To understand how to detect these cases, we provide a basic review of routine antenatal maternal antibody testing and report a case of a neonate with severe HDN caused by anti-Wright (anti-Wra), successfully managed with transfusion, phototherapy, and high-dose intravenous immunoglobulin. When hemolysis in a newborn is suspected in the absence of major blood group incompatibility or commonly detected maternal red cell antibodies, a direct antiglobulin test should be performed. A positive DAT should alert the clinician to the presence of maternal antibodies against low-incidence antigens. Antibodies to the Wra antigen are one such rare cause of HDN.

  8. Reduction of medication costs after detoxification for medication-overuse headache. (United States)

    Shah, Asif M; Bendtsen, Lars; Zeeberg, Peter; Jensen, Rigmor H


    To examine whether detoxifying patients with medication-overuse headache can reduce long-term medication costs. Direct costs of medications in medication-overuse headache have been reported to be very high but have never been calculated on the basis of exact register data. Long-term economic savings obtained by detoxification have never been investigated. We conducted a registry-based observational retrospective follow-up study on 336 medication-overuse headache patients treated and discharged from the Danish Headache Center over a 2-year period. By means of the Danish Register of Medicinal Product Statistics, we collected information on the costs and use of prescription-only medication 1 year before admission and 1 year after discharge from Danish Headache Center. The average medication costs per patient per year decreased with 24%, from US$971 before treatment to US$737 after (P = .001), and the average medication use decreased with 14.4% (P = .02). Savings were most pronounced for patients overusing triptans. In this group, the average medication costs per patient per year decreased with 43% (P headache at a tertiary headache center has a long-lasting effect on the medication costs and use, in particular among patients overusing triptans. The results may not be generalizable to all countries and may be sensitive to the costs of triptans. © 2012 American Headache Society.

  9. VA announces aggressive new approach to produce rapid improvements in VA medical centers

    Directory of Open Access Journals (Sweden)

    Robbins RA


    Full Text Available No abstract available. Article truncated at 150 words. The U.S. Department of Veterans Affairs (VA announced steps that it is taking as part of an aggressive new approach to produce rapid improvements at VA’s low-performing medical facilities nationwide (1. VA defines its low-performing facilities as those medical centers that receive the lowest score in its Strategic Analytics for Improvement and Learning (SAIL star rating system, or a one-star rating out of five. The SAIL star rating was initiated in 2016 and uses a variety of measures including mortality, length of hospital stay, readmission rates, hospital complications, physician productivity and efficiency. A complete listing of the VA facilities, their star ratings and the metrics used to determine the ratings is available through the end of fiscal year 2017 (2. Based on the latest ratings, the VA currently has 15 one-star facilities including Denver, Loma Linda, and Phoenix in the Southwest (Table 1. Table 1. VA facilities with one-star ratings …

  10. A Nationwide Survey of Patient Centered Medical Home Demonstration Projects (United States)

    Bitton, Asaf; Martin, Carina


    Background The patient centered medical home has received considerable attention as a potential way to improve primary care quality and limit cost growth. Little information exists that systematically compares PCMH pilot projects across the country. Design Cross-sectional key-informant interviews. Participants Leaders from existing PCMH demonstration projects with external payment reform. Measurements We used a semi-structured interview tool with the following domains: project history, organization and participants, practice requirements and selection process, medical home recognition, payment structure, practice transformation, and evaluation design. Results A total of 26 demonstrations in 18 states were interviewed. Current demonstrations include over 14,000 physicians caring for nearly 5 million patients. A majority of demonstrations are single payer, and most utilize a three component payment model (traditional fee for service, per person per month fixed payments, and bonus performance payments). The median incremental revenue per physician per year was $22,834 (range $720 to $91,146). Two major practice transformation models were identified—consultative and implementation of the chronic care model. A majority of demonstrations did not have well-developed evaluation plans. Conclusion Current PCMH demonstration projects with external payment reform include large numbers of patients and physicians as well as a wide spectrum of implementation models. Key questions exist around the adequacy of current payment mechanisms and evaluation plans as public and policy interest in the PCMH model grows. Electronic supplementary material The online version of this article (doi:10.1007/s11606-010-1262-8) contains supplementary material, which is available to authorized users. PMID:20467907

  11. Needs Assessment for Research Use of High-Throughput Sequencing at a Large Academic Medical Center.

    Directory of Open Access Journals (Sweden)

    Albert Geskin

    Full Text Available Next Generation Sequencing (NGS methods are driving profound changes in biomedical research, with a growing impact on patient care. Many academic medical centers are evaluating potential models to prepare for the rapid increase in NGS information needs. This study sought to investigate (1 how and where sequencing data is generated and analyzed, (2 research objectives and goals for NGS, (3 workforce capacity and unmet needs, (4 storage capacity and unmet needs, (5 available and anticipated funding resources, and (6 future challenges. As a precursor to informed decision making at our institution, we undertook a systematic needs assessment of investigators using survey methods. We recruited 331 investigators from over 60 departments and divisions at the University of Pittsburgh Schools of Health Sciences and had 140 respondents, or a 42% response rate. Results suggest that both sequencing and analysis bottlenecks currently exist. Significant educational needs were identified, including both investigator-focused needs, such as selection of NGS methods suitable for specific research objectives, and program-focused needs, such as support for training an analytic workforce. The absence of centralized infrastructure was identified as an important institutional gap. Key principles for organizations managing this change were formulated based on the survey responses. This needs assessment provides an in-depth case study which may be useful to other academic medical centers as they identify and plan for future needs.

  12. Performance enhancement using a balanced scorecard in a Patient-centered Medical Home. (United States)

    Fields, Scott A; Cohen, Deborah


    Oregon Health & Science University Family Medicine implemented a balanced scorecard within our clinics that embraces the inherent tensions between care quality, financial productivity, and operational efficiency. This data-driven performance improvement process involved: (1) consensus-building around specific indicators to be measured, (2) developing and refining the balanced scorecard, and (3) using the balanced scorecard in the quality improvement process. Developing and implementing the balanced scorecard stimulated an important culture shift among clinics; practice members now actively use data to recognize successes, understand emerging problems, and make changes in response to these problems. Our experience shows how Patient-centered Medical Homes can be enhanced through use of information technology and evidence-based tools that support improved decision making and performance and help practices develop into learning organizations.

  13. Report to Congress on abnormal occurrences, October-December 1986

    International Nuclear Information System (INIS)


    Section 208 of the Energy Reorganization Act of 1974 identifies an abnormal occurrence as an unscheduled incident or event which the Nuclear Regulatory Commission determines to be significant from the standpoint of public health or safety and requires a quarterly report of such events to be made to Congress. This report covers the period from October 1 to December 31, 1986. The report states that for this reporting period, there were three abnormal occurrences at the nuclear power plants licensed to operate. The events were (1) loss of low pressure service water systems at Oconee, (2) degraded safety systems due to incorrect torque switch settings on Rotors motor operators at Catawba and McGuire Nuclear Stations, and (3) a secondary system pipe break resulting in the death of four persons at Surry Unit 2. There were six abnormal occurrences at the other NRC licensees. One involved release of americium-241 inside a waste storage building at Wright-Patterson Air Force Base; three involved medical misadministrations, one therapeutic and two diagnostic; one involved a suspension of license for servicing teletherapy and radiography units; and one involved an immediately effective order modifying license and order to show cause issued to an industrial radiography company. There were no abnormal occurrences reported by the Agreement States. The report also contains information updating some previously reported abnormal occurrences

  14. Technologies in the patient-centered medical home: examining the model from an enterprise perspective. (United States)

    Hughes, Cortney L; Marshall, Capt Robert; Murphy, Edward; Mun, Seong K


    Fee-for-service reimbursement has fragmented the healthcare system. Providers are paid based on the number of services rendered instead of quality, leading to the cost of care rising at a faster rate than its value. One approach to counter this is the Patient-Centered Medical Home (PCMH), a primary care model that emphasizes team-based medicine, a partnership between patients and providers, and expanded access and communication. The transition to PCMH is facilitated by innovative technologies, such as telemedicine for additional services, electronic medical records to document patients' health needs, and online portals for electronic visits and communication between patients and providers. Implementing these technologies involves tremendous investment of funds and time from practices and healthcare organizations. Although PCMH does not require such technologies, they facilitate its success, as care coordination and population management necessitated by the model are difficult to do without. This article argues that there is a paradox in PCMH and technology is at its center. Although PCMH intends to be cost effective by reducing hospital admissions and ER visits through providing better preventative services, it is actually a financial risk due to the very real upfront costs of implementing and sustaining technologies needed to carry out the intent of the PCMH model, which may not be made up immediately, if ever. This article delves into the rationale behind why payers, providers, and patients have adopted PCMH regardless of this risk and in doing so, maps out the roles that innovative technologies play in the conversion to PCMH.

  15. Adherence to clinical practice guidelines for the treatment of candidemia at a Veterans Affairs Medical Center


    Ashong, Chester N.; Hunter, Andrew S.; Mansouri, M. David; Cadle, Richard M.; Hamill, Richard J.; Musher, Daniel M.


    Objectives: The primary objective of this study was to examine the appropriateness of candidemia management at a Veterans Affairs Medical Center as recommended by the 2009 Infectious Diseases Society of America (IDSA) guidelines for treatment of Candida infections. Methods: A retrospective analysis of 94 adult patients with blood cultures positive for Candida spp. was performed. Patients were stratified by severity of disease into two groups: non-neutropenic, mild-moderate disease (Group 1, n...

  16. Medical student and medical school teaching faculty perceptions of conflict of interest. (United States)

    Andresen, Nicholas S; Olson, Tyler S; Krasowski, Matthew D


    Attitudes towards conflict of interest (COI) and COI policy are shaped during medical school and influence both the education of medical students and their future medical practice. Understanding the current attitudes of medical students and medical school teaching faculty may provide insight into what is taught about COI and COI policy within the 'hidden' medical curriculum. Differences between medical student and medical school teaching faculty perceptions of COI and COI policy have not been compared in detail. The authors surveyed first year medical students and medical school teaching faculty at one academic medical center. The response rate was 98.7% (150/152) for students and 34.2% (69/202) for faculty. Students were less likely than faculty to agree that lecturers should disclose COI to any learners (4.06 vs. 4.31, p = 0.01), but more likely to agree that COI disclosure decreases the presentation of biased material (3.80 vs. 3.21, p < 0.001). Student and faculty responses for all other questions were not different. Many of these responses suggest student and faculty support for stronger COI policy at academic medical centers. Students and faculty perceptions regarding COI and COI policy are largely similar, but differ in terms of the perceived effectiveness of COI disclosure. This study also suggests that medical students and medical school teaching faculty support for stronger COI policy at academic medical centers.

  17. Nurses' perception of ethical climate at a large academic medical center. (United States)

    Lemmenes, Donna; Valentine, Pamela; Gwizdalski, Patricia; Vincent, Catherine; Liao, Chuanhong


    Nurses are confronted daily with ethical issues while providing patient care. Hospital ethical climates can affect nurses' job satisfaction, organizational commitment, retention, and physician collaboration. At a metropolitan academic medical center, we examined nurses' perceptions of the ethical climate and relationships among ethical climate factors and nurse characteristics. We used a descriptive correlational design and nurses (N = 475) completed Olson's Hospital Ethical Climate Survey. Data were analyzed using STATA. Approvals by the Nursing Research Council and Institutional Review Board were obtained; participants' rights were protected. Nurses reported an ethical climate total mean score of 3.22 ± 0.65 that varied across factors; significant differences were found for ethical climate scores by nurses' age, race, and specialty area. These findings contribute to what is known about ethical climate and nurses' characteristics and provides the foundation to develop strategies to improve the ethical climate in work settings. © The Author(s) 2016.

  18. Impacts of Initial Transformation to a Patient-Centered Medical Home on Diabetes Outcomes in Federally Qualified Health Centers in Florida. (United States)

    Kinsell, Heidi S; Hall, Allyson G; Harman, Jeffrey S; Tewary, Sweta; Brickman, Andrew


    Federally qualified health centers (FQHCs) in Florida see large numbers of vulnerable patients with diabetes. Patient-centered medical home (PCMH) models can lead to improvements in health for patients with chronic conditions and cost savings for providers. Therefore, FQHCs are increasingly moving to PCMH models of care. The study objective was to examine the effects of initial transformation to a level 3 National Committee for Quality Assurance (NCQA) certified PCMH in 2011, on clinical diabetes outcomes among 27 clinic sites from a network of FQHCs in Florida. We used de-identified, longitudinal electronic health record (EHR) data from 2010-2012 and multivariate logistic regression to analyze the effects of initial transformation on the odds of having well-controlled HbA1c, body mass index (BMI), and blood pressure (BP) among vulnerable patients with diabetes. Models controlled for clustering by year, patient, and organizational characteristics. Overall, transformation to a PCMH was associated with 19% greater odds of having well-controlled HbA1c values with no statistically significant impact on BMI or BP. Subanalyses showed transformation had less of an effect on BP for African American patients and HbA1c control for Medicare enrollees but a greater effect on weight control for patients older than 35 years. Transformation to a PCMH in FQHCs appears to improve the health of vulnerable patients with diabetes, with less improvement for subsets of patients. Future research should seek to understand the heterogeneous effects of patient-centered transformation on various subgroups.

  19. Cultural Awareness Among Nursing Staff at an Academic Medical Center. (United States)

    McElroy, Jennifer; Smith-Miller, Cheryl A; Madigan, Catherine K; Li, Yin


    The goal is to identify areas for targeted improvement in regard to cultural awareness and competence among nursing staff and in the work environment. Many facilities have initiated programs to facilitate cultural competence development among nursing staff; however, there has been little examination of the effect of these initiatives, assessment of experienced nurses' cultural awareness, or investigation of nurse leader's role in promoting cultural competence in the literature. In this cross-sectional descriptive study, a cultural awareness survey was modified and electronically distributed to all registered nurses and assistive personnel at an academic medical center. The modified survey instrument showed good reliability and validity among the study population. Most nursing staff exhibited a moderate to high level of cultural awareness and held positive opinions about nursing leadership and the work environment with regard to cultural issues. In increasingly diverse work environments, assessing the cultural awareness of nursing staff enables nurse leaders to evaluate efforts in promoting cultural competence and to identify specific areas in which to target staff development efforts and leadership training.

  20. Applications of population genetics to animal breeding, from wright, fisher and lush to genomic prediction. (United States)

    Hill, William G


    Although animal breeding was practiced long before the science of genetics and the relevant disciplines of population and quantitative genetics were known, breeding programs have mainly relied on simply selecting and mating the best individuals on their own or relatives' performance. This is based on sound quantitative genetic principles, developed and expounded by Lush, who attributed much of his understanding to Wright, and formalized in Fisher's infinitesimal model. Analysis at the level of individual loci and gene frequency distributions has had relatively little impact. Now with access to genomic data, a revolution in which molecular information is being used to enhance response with "genomic selection" is occurring. The predictions of breeding value still utilize multiple loci throughout the genome and, indeed, are largely compatible with additive and specifically infinitesimal model assumptions. I discuss some of the history and genetic issues as applied to the science of livestock improvement, which has had and continues to have major spin-offs into ideas and applications in other areas.