20 CFR 411.597 - Will SSA periodically review the outcome payment system and the outcome-milestone payment system...

Science.gov (United States)

2010-04-01

... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false Will SSA periodically review the outcome payment system and the outcome-milestone payment system for possible modifications? 411.597 Section 411... Employment Network Payment Systems § 411.597 Will SSA periodically review the outcome payment system and the...

PREFACE: Focus section on superconducting power systems Focus section on superconducting power systems

Science.gov (United States)

Cardwell, D. A.; Amemiya, N.; Fair, R.

2012-01-01

This focus section of Superconductor Science and Technology looks at the properties, technology and applications of (RE)BCO and MgB2 based superconductors for power engineering systems. Both bulk and conductor forms of material are addressed, including elements of materials fabrication and processing, and the measurement of their applied properties for various levels of system application. The areas of research include ac losses in type II materials in power devices, cables and coated conductors, the development of high current dc cables and the application of superconductors in levitation devices, motors and fault current limiters. This focus section presents a broad cross-section of contemporary issues, that represent state-of-the-art for power applications of superconductors, and highlights the areas that require further development if commercial applications of these rapidly emerging materials are to be realised. It contains papers from some of the major groups in the field, including contributions from Europe, the USA and Japan, and describes devices that are relatively close to market.

Feasibility of Focused Stepping Practice During Inpatient Rehabilitation Poststroke and Potential Contributions to Mobility Outcomes.

Science.gov (United States)

Hornby, T George; Holleran, Carey L; Leddy, Abigail L; Hennessy, Patrick; Leech, Kristan A; Connolly, Mark; Moore, Jennifer L; Straube, Donald; Lovell, Linda; Roth, Elliot

2015-01-01

Optimal physical therapy strategies to maximize locomotor function in patients early poststroke are not well established. Emerging data indicate that substantial amounts of task-specific stepping practice may improve locomotor function, although stepping practice provided during inpatient rehabilitation is limited (inpatient rehabilitation following implementation of a focused training program to maximize stepping practice during clinical physical therapy sessions. Primary outcomes included distance and physical assistance required during a 6-minute walk test (6MWT) and balance using the Berg Balance Scale (BBS). Retrospective data analysis included multiple regression techniques to evaluate the contributions of demographics, training activities, and baseline motor function to primary outcomes at discharge. Median stepping activity recorded from patients was 1516 steps/d, which is 5 to 6 times greater than that typically observed. The number of steps per day was positively correlated with both discharge 6MWT and BBS and improvements from baseline (changes; r = 0.40-0.87), independently contributing 10% to 31% of the total variance. Stepping activity also predicted level of assistance at discharge and discharge location (home vs other facility). Providing focused, repeated stepping training was feasible early poststroke during inpatient rehabilitation and was related to mobility outcomes. Further research is required to evaluate the effectiveness of these training strategies on short- or long-term mobility outcomes as compared with conventional interventions. © The Author(s) 2015.

Feasibility study of a family-focused intervention to improve outcomes for children with FASD.

Science.gov (United States)

Reid, Natasha; Dawe, Sharon; Harnett, Paul; Shelton, Doug; Hutton, Lauren; O'Callaghan, Frances

2017-08-01

Growing evidence shows that children with fetal alcohol spectrum disorder (FASD) can benefit from interventions, and specifically interventions focused on improving self-regulation. However, novel ways of improving outcomes for children with FASD need further investigation so that programs target not only the individual child but also the family context, which includes the parent-child relationship. The current study aimed to evaluate the feasibility of an adapted version of the Parents under Pressure (PuP) program that addresses self-regulatory processes, through improving the parent-child relationship and the use of mindfulness-based strategies for both children and parents. This was a mixed methods study. Feasibility was examined by evaluating recruitment, data collection/outcome measures, and intervention procedures. The study used a phenomenological approach to obtain qualitative information from caregivers and a single-case experimental design to evaluate the preliminary participant responses to the intervention. Two out of three families completed treatment. The recruitment and intervention procedures were found to be suitable for and acceptable to the families involved. Some concerns were identified regarding the outcome measures that would need to be addressed in future research. Quantitative and qualitative outcomes were positive. The results provide preliminary support for the feasibility of an adapted version of the PuP program. Thus, offering a potential multi-component option, that aims to improve self-regulatory skills for children with FASD, through focusing on improving the parent-child relationship and incorporating mindfulness-based techniques for both parents and children. Copyright © 2017 Elsevier Ltd. All rights reserved.

Nova frequency conversion and focusing system

International Nuclear Information System (INIS)

Summers, M.A.; Seppala, L.G.; Williams, J.D.

1985-01-01

New developments in crystal array technology provided significant improvements in the mechanical design and optical performance of the Nova 2 omega/3 omega array hardware. The final Nova array configuration was tested on the Novette laser and on the first arm of Nova. Ten Nova 2 omega/3 omega crystal arrays were assembled and tested for crystal alignment and wave front distortion before installation on the Nova target chamber. Ten Nova focus lens positioners were assembled and tested last year. The positioning accuracy and repeatability of each assembly were evaluated before installation on the target chamber. A cylindrical focusing system was also developed for installation in the Nova lens positioner assembly. Finally, 10 completed frequency conversion and focusing systems were activated

Physics Education: Desired outcomes, minds, and learning systems

Science.gov (United States)

van Heuvelen, Alan

2000-11-01

Recent studies and surveys indicate that the workplace is looking for different outcomes than are emphasized in traditional physics instruction. Cognitive science has learned much about the operation of our minds. Physicists have now systematically studied student learning in physics for about 30 years. What has been learned from these different studies that can help us achieve the desired outcomes in our large (and small) introductory physics courses? The talk will focus on these three ideas: the desired outcomes, student minds (very brief), and pedagogical strategies and activities that help achieve these outcomes.

Final focus systems for linear colliders

International Nuclear Information System (INIS)

Helm, R.; Irwin, J.

1992-08-01

Final focus systems for linear colliders present many exacting challenges in beam optics, component design, and beam quality. Efforts to resolve these problems as they relate to a new generation of linear colliders are under way at several laboratories around the world. We will outline criteria for final focus systems and discuss the current state of understanding and resolution of the outstanding problems. We will discuss tolerances on alignment, field quality and stability for optical elements, and the implications for beam parameters such as emittance, energy spread, bunch length, and stability in position and energy. Beam-based correction procedures, which in principle can alleviate many of the tolerances, will be described. Preliminary results from the Final Focus Test Beam (FFTB) under construction at SLAC will be given. Finally, we mention conclusions from operating experience at the Stanford Linear Collider (SLC)

Final focus systems for linear colliders

International Nuclear Information System (INIS)

Helm, R.; Irwing, J.

1992-01-01

Final focus systems for linear colliders present many exacting challenges in beam optics, component design, and beam quality. Efforts to resolve these problems as they relate to a new generation of linear colliders are under way at several laboratories around the world. We outline criteria for final focus systems and discuss the current state of understanding and resolution of the outstanding problems. We discuss tolerances on alignment, field quality and stability for optical elements, and the implications for beam parameters such as emittance, energy spread , bunch length, and stability in position and energy. Beam-based correction procedures, which in principle can alleviate many of the tolerances, are described. Preliminary results from the Final Focus Test Beam (FFTB) under construction at SLAC are given. Finally, we mention conclusions from operating experience at the Stanford Linear Collider (SLC). (Author) 16 refs., 4 tabs., 6 figs

Radiation damping in focusing-dominated systems

International Nuclear Information System (INIS)

Huang, Zhirong; Chen, Pisin; Ruth, R.D.

1995-01-01

A quasi-classical method is developed to calculate the radiation damping of a relativistic particle in a straight, continuous focusing system. In one limiting case where the pitch angle of the particle θ p is much larger than the radiation opening angle 1/γ, the radiation power spectrum is similar to synchrotron radiation and the relative damping rate of the transverse action is proportional to the relative energy loss rate. In the other limiting case where θ p much-lt 1/γ, the radiation is dipole in nature and the relative damping rate of the transverse action is energy-independent and is much faster than the relative energy rate. Quantum excitation to the transverse action is absent in this focusing channel. These results can be extended to bent systems provided that the focusing field dominates over the bending field

Design of High Precise Focusing System in Laser Direct Writer

International Nuclear Information System (INIS)

Liang, Y Y; Tian, F; Luo, J B; Yang, G G

2006-01-01

In order to improve the accuracy and efficiency of fabricating lines with laser pattern generator, a novel focusing system was designed. Focusing system is based on optical off-axis detection principle. The detector is a two-quadrant photocell and the defocus signal is constructed by division. Focusing system has the character of second-order system with overdamp. The new embedded PID controller improves the performance of focusing system and upgrades the closed-loop precision to 0.2 μm. Furthermore focusing system has the fabrication capabilities for alterable-width lines under various defocus amount

Development of a focused ion beam micromachining system

Energy Technology Data Exchange (ETDEWEB)

Pellerin, J.G.; Griffis, D.; Russell, P.E.

1988-12-01

Focused ion beams are currently being investigated for many submicron fabrication and analytical purposes. An FIB micromachining system consisting of a UHV vacuum system, a liquid metal ion gun, and a control and data acquisition computer has been constructed. This system is being used to develop nanofabrication and nanomachining techniques involving focused ion beams and scanning tunneling microscopes.

20 CFR 411.550 - How are the outcome payments calculated under the outcome payment system?

Science.gov (United States)

2010-04-01

... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false How are the outcome payments calculated under the outcome payment system? 411.550 Section 411.550 Employees' Benefits SOCIAL SECURITY ADMINISTRATION... the outcome payments calculated under the outcome payment system? The amount of each monthly outcome...

Automatic focusing system of BSST in Antarctic

Science.gov (United States)

Tang, Peng-Yi; Liu, Jia-Jing; Zhang, Guang-yu; Wang, Jian

2015-10-01

Automatic focusing (AF) technology plays an important role in modern astronomical telescopes. Based on the focusing requirement of BSST (Bright Star Survey Telescope) in Antarctic, an AF system is set up. In this design, functions in OpenCV is used to find stars, the algorithm of area, HFD or FWHM are used to degree the focus metric by choosing. Curve fitting method is used to find focus position as the method of camera moving. All these design are suitable for unattended small telescope.

Patient and health professional views on rehabilitation practices and outcomes following total hip and knee arthroplasty for osteoarthritis:a focus group study

Directory of Open Access Journals (Sweden)

Backman Catherine L

2010-05-01

Full Text Available Abstract Background There is worldwide variation in rehabilitation practices after total hip arthroplasty (THA and total knee arthroplasty (TKA and no agreement on which interventions will lead to optimal short and long term patient outcomes. As a first step in the development of clinical practice guidelines for post-acute rehabilitation after THA and TKA, we explored experiences and attitudes about rehabilitation practices and outcomes in groups of individuals identified as key stakeholders. Methods Separate focus groups and interviews were conducted with patients (THA or TKA within past year and three health professional groups: allied health professionals (AHPs, orthopaedic surgeons, and other physicians, in Canada and the United States. Pairs of moderators led the focus groups using a standardized discussion guide. Discussions were audiotaped and transcribed verbatim. A content analysis within and across groups identified key themes. Results Eleven focus groups and eight interviews took place in six sites. Patients (n = 32 varied in age, stage of recovery, and surgical and rehabilitation experiences. Health professionals (n = 44 represented a range of disciplines, practice settings and years of experience. Six key themes emerged: 1 Let's talk (issues related to patient-health professional and inter-professional communication; 2 Expecting the unexpected (observations about unanticipated recovery experiences; 3 It's attitude that counts (the importance of the patient's positive attitude and participation in recovery; 4 It takes all kinds of support (along the continuum of care; 5 Barriers to recovery (at patient, provider and system levels, and 6 Back to normal (reflecting diversity of expected outcomes. Patients offered different, but overlapping views compared to health professionals regarding rehabilitation practices and outcomes following THA and TKA. Conclusion Results will inform subsequent phases of guideline development and ensure

Focused labeled proof systems for modal logic

OpenAIRE

Miller , Dale; Volpe , Marco

2015-01-01

International audience; Focused proofs are sequent calculus proofs that group inference rules into alternating positive and negative phases. These phases can then be used to define macro-level inference rules from Gentzen's original and tiny introduction and structural rules. We show here that the inference rules of labeled proof systems for modal logics can similarly be described as pairs of such phases within the LKF focused proof system for first-order classical logic. We consider the syst...

Regulatory focus, self-efficacy and outcome expectations as drivers of motivation to consume healthy food products.

Science.gov (United States)

Tudoran, Ana Alina; Scholderer, Joachim; Brunsø, Karen

2012-10-01

In this paper we apply the principle of Regulatory Focus Theory to investigate the interaction between self-efficacy and outcome expectations on individuals' intentions to adopt health behaviors. The participants, 959 individuals (Survey 1) and 2400 individuals (Survey 2), reported self-efficacy beliefs and outcome expectations with regard to the consumption of omega-3 supplements and omega-3-enriched food products. We found that the relationship prevention outcome expectations-intention was significantly attenuated at low levels of self-efficacy and strengthened at high levels of self-efficacy, respectively; whereas, the relationship promotion outcome expectations-intention was unaffected by the perceived levels of self-efficacy. The implications suggest that consumers' motivation to adopt healthy food products, such as omega-3 supplements and omega-3 enriched products, should be encouraged by stimulating promotion outcome expectations. However, when a prevention frame is used, the individuals' motivation should be significantly enhanced by self-efficacy beliefs. Copyright © 2012 Elsevier Ltd. All rights reserved.

HINS Linac front end focusing system R&D

Energy Technology Data Exchange (ETDEWEB)

Apollinari, G.; Carcagno, R.H.; Dimarco, J.; Huang, Y.; Kashikhin, V.V.; Orris, D.F.; Page, T.M.; Rabehl, R.; Sylvester, C.; Tartaglia, M.A.; Terechkine, I.; /Fermilab /Argonne

2008-08-01

This report summarizes current status of an R&D program to develop a focusing system for the front end of a superconducting RF linac. Superconducting solenoids will be used as focusing lenses in the low energy accelerating sections of the front end. The development of focusing lenses for the first accelerating section is in the production stage, and lens certification activities are in preparation at FNAL. The report contains information about the focusing lens design and performance, including solenoid, dipole corrector, and power leads, and about cryogenic system design and performance. It also describes the lens magnetic axis position measurement technique and discusses scope of an acceptance/certification process.

Development of the focus system for heaven-I

International Nuclear Information System (INIS)

Xiang Yihuai; Zhou Chuangzhi; Gong Kun; Ma Jinglong; Dai Hui; Shan Yusheng; Wang Naiyan

2003-01-01

This paper introduces the method of guiding the six KrF laser beams into target chamber and the development of focus system in MOPA angular multiplex system for Heaven-I. The six beams are focused to the vacuum target chamber by six plane-convex lenses. The focal spot on the target is measured by UV CCD camera, the diameter of the focal spot of six beams is 290 μm, the focusing power density on the target is 8 x 10 12 W/cm 2

FOCUS: a fire management planning system -- final report

Science.gov (United States)

Frederick W. Bratten; James B. Davis; George T. Flatman; Jerold W. Keith; Stanley R. Rapp; Theodore G. Storey

1981-01-01

FOCUS (Fire Operational Characteristics Using Simulation) is a computer simulation model for evaluating alternative fire management plans. This final report provides a broad overview of the FOCUS system, describes two major modules-fire suppression and cost, explains the role in the system of gaming large fires, and outlines the support programs and ways of...

Design and simulation of an accelerating and focusing system

Directory of Open Access Journals (Sweden)

A Sadeghipanah

2011-06-01

Full Text Available Electrostatic focusing lenses have a vast field of applications in electrostatic accelerators and particularly in electron guns. In this paper, we first express a parametric mathematical analysis of an electrostatic accelerator and focusing system for an electron beam. Next, we At design a system of electron emission slit, accelerating electrodes and focusing lens for an electron beam emitted from a cathode with 4 mm radius and 2 mA current, in a distance less than 10 cm and up to the energy of 30 keV with the beam divergence less than 5°. This is achieved by solving the yielded equations in mathematical analysis using MATLAB. At the end, we simulate the behavior of above electron beam in the designed accelerating and focusing system using CST EM Studio. The results of simulation are in high agreement with required specifications of the electron beam, showing the accuracy of the used method in analysis and design of the accelerating and focusing system.

Health systems performance in sub-Saharan Africa: governance, outcome and equity.

Science.gov (United States)

Olafsdottir, Anna E; Reidpath, Daniel D; Pokhrel, Subhash; Allotey, Pascale

2011-04-16

The literature on health systems focuses largely on the performance of healthcare systems operationalised around indicators such as hospital beds, maternity care and immunisation coverage. A broader definition of health systems however, needs to include the wider determinants of health including, possibly, governance and its relationship to health and health equity. The aim of this study was to examine the relationship between health systems outcomes and equity, and governance as a part of a process to extend the range of indicators used to assess health systems performance. Using cross sectional data from 46 countries in the African region of the World Health Organization, an ecological analysis was conducted to examine the relationship between governance and health systems performance. The data were analysed using multiple linear regression and a standard progressive modelling procedure. The under-five mortality rate (U5MR) was used as the health outcome measure and the ratio of U5MR in the wealthiest and poorest quintiles was used as the measure of health equity. Governance was measured using two contextually relevant indices developed by the Mo Ibrahim Foundation. Governance was strongly associated with U5MR and moderately associated with the U5MR quintile ratio. After controlling for possible confounding by healthcare, finance, education, and water and sanitation, governance remained significantly associated with U5MR. Governance was not, however, significantly associated with equity in U5MR outcomes. This study suggests that the quality of governance may be an important structural determinant of health systems performance, and could be an indicator to be monitored. The association suggests there might be a causal relationship. However, the cross-sectional design, the level of missing data, and the small sample size, forces tentative conclusions. Further research will be needed to assess the causal relationship, and its generalizability beyond U5MR as a health

Health systems performance in sub-Saharan Africa: governance, outcome and equity

Directory of Open Access Journals (Sweden)

Pokhrel Subhash

2011-04-01

Full Text Available Abstract Background The literature on health systems focuses largely on the performance of healthcare systems operationalised around indicators such as hospital beds, maternity care and immunisation coverage. A broader definition of health systems however, needs to include the wider determinants of health including, possibly, governance and its relationship to health and health equity. The aim of this study was to examine the relationship between health systems outcomes and equity, and governance as a part of a process to extend the range of indicators used to assess health systems performance. Methods Using cross sectional data from 46 countries in the African region of the World Health Organization, an ecological analysis was conducted to examine the relationship between governance and health systems performance. The data were analysed using multiple linear regression and a standard progressive modelling procedure. The under-five mortality rate (U5MR was used as the health outcome measure and the ratio of U5MR in the wealthiest and poorest quintiles was used as the measure of health equity. Governance was measured using two contextually relevant indices developed by the Mo Ibrahim Foundation. Results Governance was strongly associated with U5MR and moderately associated with the U5MR quintile ratio. After controlling for possible confounding by healthcare, finance, education, and water and sanitation, governance remained significantly associated with U5MR. Governance was not, however, significantly associated with equity in U5MR outcomes. Conclusion This study suggests that the quality of governance may be an important structural determinant of health systems performance, and could be an indicator to be monitored. The association suggests there might be a causal relationship. However, the cross-sectional design, the level of missing data, and the small sample size, forces tentative conclusions. Further research will be needed to assess the

20 CFR 411.545 - How are the outcome payments calculated under the outcome-milestone payment system?

Science.gov (United States)

2010-04-01

... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false How are the outcome payments calculated under the outcome-milestone payment system? 411.545 Section 411.545 Employees' Benefits SOCIAL SECURITY... are the outcome payments calculated under the outcome-milestone payment system? The amount of each...

Autofocus system and autofocus method for focusing on a surface

Science.gov (United States)

O'Neill, Mary Morabito

2017-05-23

An autofocus system includes an imaging device, a lens system and a focus control actuator that is configured to change a focus position of the imaging device in relation to a stage. The electronic control unit is configured to control the focus control actuator to a plurality of predetermined focus positions, and activate the imaging device to obtain an image at predetermined positions and then apply a spatial filter to the obtained images. This generates a filtered image for the obtained images. The control unit determines a focus score for the filtered images such that the focus score corresponds to a degree of focus in the obtained images. The control unit identifies a best focus position by comparing the focus score of the filtered images, and controls the focus control actuator to the best focus position corresponding to the highest focus score.

Final focus system for TLC

International Nuclear Information System (INIS)

Oide, K.

1988-11-01

A limit of the chromaticity correction for the final focus system of a TeV Linear Collider (TLC) is investigated. As the result, it becomes possible to increase the aperture of the final doublet with a small increase of the horizontal β function. The new optics design uses a final doublet of 0.5 mm half-aperture and 1.4 T pole-tip field. The length of the system is reduced from 400 m to 200 m by several optics changes. Tolerances for various machine errors with this optics are also studied. 5 refs., 7 figs., 2 tabs

The impact of childhood sexual abuse on the outcome of intensive trauma-focused treatment for PTSD.

Science.gov (United States)

Wagenmans, Anouk; Van Minnen, Agnes; Sleijpen, Marieke; De Jongh, Ad

2018-01-01

Background : It is assumed that PTSD patients with a history of childhood sexual abuse benefit less from trauma-focused treatment than those without such a history. Objective : To test whether the presence of a history of childhood sexual abuse has a negative effect on the outcome of intensive trauma-focused PTSD treatment. Method : PTSD patients, 83% of whom suffered from severe PTSD, took part in a therapy programme consisting of 2 × 4 consecutive days of Prolonged Exposure (PE) and EMDR therapy (eight of each). In between sessions, patients participated in sport activities and psycho-education sessions. No prior stabilization phase was implemented. PTSD symptom scores of clinician-administered and self-administered measures were analysed using the data of 165 consecutive patients. Pre-post differences were compared between four trauma groups; patients with a history of childhood sexual abuse before age 12 (CSA), adolescent sexual abuse (ASA; i.e. sexual abuse between 12 and 18 years of age), sexual abuse (SA) at age 18 and over, or no history of sexual abuse (NSA). Results : Large effect sizes were achieved for PTSD symptom reduction for all trauma groups (Cohen's d  = 1.52-2.09). For the Clinical Administered PTSD Scale (CAPS) and the Impact of Event Scale (IES), no differences in treatment outcome were found between the trauma (age) groups. For the PTSD Symptom Scale Self Report (PSS-SR), there were no differences except for one small effect between CSA and NSA. Conclusions : The results do not support the hypothesis that the presence of a history of childhood sexual abuse has a detrimental impact on the outcome of first-line (intensive) trauma-focused treatments for PTSD.

HINS Linac front end focusing system R and D

International Nuclear Information System (INIS)

Apollinari, G.; Carcagno, R.H.; Dimarco, J.; Huang, Y.; Kashikhin, V.V.; Orris, D.F.; Page, T.M.; Rabehl, R.; Sylvester, C.; Tartaglia, M.A.; Terechkine, I.; Fermilab; Argonne

2008-01-01

This report summarizes current status of an R and D program to develop a focusing system for the front end of a superconducting RF linac. Superconducting solenoids will be used as focusing lenses in the low energy accelerating sections of the front end. The development of focusing lenses for the first accelerating section is in the production stage, and lens certification activities are in preparation at FNAL. The report contains information about the focusing lens design and performance, including solenoid, dipole corrector, and power leads, and about cryogenic system design and performance. It also describes the lens magnetic axis position measurement technique and discusses scope of an acceptance/certification process

Association Between Physician Teamwork and Health System Outcomes After Coronary Artery Bypass Grafting.

Science.gov (United States)

Hollingsworth, John M; Funk, Russell J; Garrison, Spencer A; Owen-Smith, Jason; Kaufman, Samuel A; Pagani, Francis D; Nallamothu, Brahmajee K

2016-11-01

Patients undergoing coronary artery bypass grafting (CABG) must often see multiple providers dispersed across many care locations. To test whether teamwork (assessed with the bipartite clustering coefficient) among these physicians is a determinant of surgical outcomes, we examined national Medicare data from patients undergoing CABG. Among Medicare beneficiaries who underwent CABG between 2008 and 2011, we mapped relationships between all physicians who treated them during their surgical episodes, including both surgeons and nonsurgeons. After aggregating across CABG episodes in a year to construct the physician social networks serving each health system, we then assessed the level of physician teamwork in these networks with the bipartite clustering coefficient. Finally, we fit a series of multivariable regression models to evaluate associations between a health system's teamwork level and its 60-day surgical outcomes. We observed substantial variation in the level of teamwork between health systems performing CABG (SD for the bipartite clustering coefficient was 0.09). Although health systems with high and low teamwork levels treated beneficiaries with comparable comorbidity scores, these health systems differed over several sociocultural and healthcare capacity factors (eg, physician staff size and surgical caseload). After controlling for these differences, health systems with higher teamwork levels had significantly lower 60-day rates of emergency department visit, readmission, and mortality. Health systems with physicians who tend to work together in tightly-knit groups during CABG episodes realize better surgical outcomes. As such, delivery system reforms focused on building teamwork may have positive effects on surgical care. © 2016 American Heart Association, Inc.

The stabilisation of final focus system

Indian Academy of Sciences (India)

The StaFF (stabilisation of final focus) system will use interferometers to monitor the relative ... quadrupole magnets will be the most demanding application, where mutual and beam- ... interferometers to measure lines of a geodetic network to record relative motion between two beam ... coupled interferometer design.

Beam dynamics in the SLC final focus system

International Nuclear Information System (INIS)

Bambade, P.S.

1987-06-01

The SLC luminosity is reached by colliding beams focused to about 2 μm transverse sizes. The Final Focus System (FFS) must enable, beyond its basic optical design, the detection and correction of errors accumulated in the system. In this paper, after summarizing the design, we review the sensitivity to such errors and the ability to correct them. The overall tuning strategy involves three phases: single beam spot minimization, steering the beams in collision and luminosity optimization with beam-beam effects

[A focused sound field measurement system by LabVIEW].

Science.gov (United States)

Jiang, Zhan; Bai, Jingfeng; Yu, Ying

2014-05-01

In this paper, according to the requirement of the focused sound field measurement, a focused sound field measurement system was established based on the LabVIEW virtual instrument platform. The system can automatically search the focus position of the sound field, and adjust the scanning path according to the size of the focal region. Three-dimensional sound field scanning time reduced from 888 hours in uniform step to 9.25 hours in variable step. The efficiency of the focused sound field measurement was improved. There is a certain deviation between measurement results and theoretical calculation results. Focal plane--6 dB width difference rate was 3.691%, the beam axis--6 dB length differences rate was 12.937%.

Association Between Physician Teamwork and Health System Outcomes Following Coronary Artery Bypass Grafting

Science.gov (United States)

Hollingsworth, John M.; Funk, Russell J.; Garrison, Spencer A.; Owen-Smith, Jason; Kaufman, Samuel A.; Pagani, Francis D.; Nallamothu, Brahmajee K.

2017-01-01

Background Patients undergoing coronary artery bypass grafting (CABG) must often see multiple providers dispersed across many care locations. To test whether “teamwork” (assessed with the bipartite clustering coefficient) among these physicians is a determinant of surgical outcomes, we examined national Medicare data from patients undergoing CABG. Methods and Results Among Medicare beneficiaries who underwent CABG between 2008 and 2011, we mapped relationships between all physicians who treated them during their surgical episodes, including both surgeons and nonsurgeons. After aggregating across CABG episodes in a year to construct the physician social networks serving each health system, we then assessed the level of physician teamwork in these networks with the bipartite clustering coefficient. Finally, we fit a series of multivariable regression models to evaluate associations between a health system’s teamwork level and its 60-day surgical outcomes. We observed substantial variation in the level of teamwork between health systems performing CABG (standard deviation for the bipartite clustering coefficient was 0.09). While health systems with high and low teamwork levels treated beneficiaries with comparable comorbidity scores, these health systems differed over several sociocultural and healthcare capacity factors (e.g., physician staff size, surgical caseload). After controlling for these differences, health systems with higher teamwork levels had significantly lower 60-day rates of emergency department visit, readmission, and mortality. Conclusions Health systems with physicians who tend to work together in tightly knit groups during CABG episodes realize better surgical outcomes. As such, delivery system reforms focused on building teamwork may have positive effects on surgical care. PMID:28263939

Contrasting Internet and Face-to-Face Focus Groups for Children with Chronic Health Conditions: Outcomes and Participant Experiences

Directory of Open Access Journals (Sweden)

David B. Nicholas PhD

2010-03-01

Full Text Available In this study the authors examined Internet-mediated qualitative data collection methods among a sample of children with chronic health conditions. Specifically, focus groups via Internet technology were contrasted to traditional face-to-face focus groups. Internet focus groups consisted of asynchronous text-based chat rooms lasting a total of one week in duration. Participants comprised 23 children with cerebral palsy, spina bifida, or cystic fibrosis, who were assigned to either an Internet or face-to-face focus group. Focus group analysis and follow-up participant interviews identified a range of content outcomes and processes as well as participant experiences and preferences. Findings yielded differences in terms of the volume and nature of online and face-to-face data, and participants' affinity to focus group modality appeared to reflect differences in participant expectations for social engagement and interaction. This study identifies both benefits and limitations of asynchronous, text-based online focus groups. Implications and recommendations are discussed.

General method for final focus system design for circular colliders

Directory of Open Access Journals (Sweden)

Riccardo de Maria

2008-03-01

Full Text Available Colliders use final focus systems to reduce the transverse beam sizes at the interaction point in order to increase collision event rates. The maximum focal strength (gradient of the quadrupoles, and the maximum beam size in them, together limit the beam size reduction that is possible. The goal of a final focus system design is to find the best compromise between quadrupole aperture and quadrupole gradient, for the magnet technology that is used. This paper develops a design method that identifies the intrinsic limitations of a final focus system, validates the results of the method against realistic designs, and reports its application to the upgrade of the Large Hadron Collider final focus.

Development of focused ion beam systems with various ion species

International Nuclear Information System (INIS)

Ji Qing; Leung, K.-N.; King, Tsu-Jae; Jiang Ximan; Appleton, Bill R.

2005-01-01

Conventional focused ion beam systems employ a liquid-metal ion source (LMIS) to generate high-brightness beams, such as Ga + beams. Recently there has been an increased need for focused ion beams in areas like biological studies, advanced magnetic-film manufacturing and secondary-ion mass spectroscopy (SIMS). In this article, status of development on focused ion beam systems with ion species such as O 2 + , P + , and B + will be reviewed. Compact columns for forming focused ion beams from low energy (∼3keV), to intermediate energy (∼35keV) are discussed. By using focused ion beams, a SOI MOSFET is fabricated entirely without any masks or resist

Outcomes management of mechanically ventilated patients: utilizing informatics technology.

Science.gov (United States)

Smith, K R

1998-11-01

This article examines an informatics system developed for outcomes management of the mechanically ventilated adult population, focusing on weaning the patient from mechanical ventilation. The link between medical informatics and outcomes management is discussed, along with the development of methods, tools, and data sets for outcomes management of the mechanically ventilated adult population at an acute care academic institution. Pros and cons of this system are identified, and specific areas for improvement of future health care outcomes medical informatics systems are discussed.

Matching bunched beams to alternating gradient focusing systems

International Nuclear Information System (INIS)

Lysenko, W.P.

1980-07-01

A numerical procedure for generating phase-space distributions matched to alternating gradient focusing systems has been tested. For a smooth-focusing system a matched distribution can be calculated. With a particle tracing simulation code such a distribution can be followed while adiabatically deforming the focusing forces until an alternating gradient configuration is reached. The distribution remains matched; that is, the final distribution is periodic with the structure period. This method is useful because it can produce distributions matched to nonlinear forces. This is a feature that elliptical distributions, with ellipse parameters obtained from the Courant-Snyder theory, do not have. External nonlinearities, including nonlinear couplings, were included in our examples but space charge was not. This procedure is expected to work with space charge but will require a three-dimensional space charge calculation in the simulation code

Re-Imagining the Nature of (Student-Focused) Learning through Digital Technology

Science.gov (United States)

Hood, Nina

2018-01-01

Digital technology is frequently positioned as being central to the establishment of a 'future focused' education system that provides high quality student-focused learning opportunities and re-envisioned educational outcomes. While recognising the potential of technology, this paper explores some of the questions about its role in education and…

Plasma focus system: Design, construction and experiments

International Nuclear Information System (INIS)

Alacakir, A.; Akguen, Y.; Boeluekdemir, A. S.

2007-01-01

The aim of this work is to construct a compact experimental system for fusion research. The design, construction and experiments of the 3 kJ Mather type plasma focus machine is described. This machine is established for neutron yield and fast neutron radiography by D-D reaction which is given by D + D→ 3 He (0.82 MeV) + n (2.45 MeV) . Investigation of the geometry of plasma focus machine in the presence of high voltage drive and vacuum system setup is shown. 108 neutron per pulse and 200 kA peak current is obtained for many shots. Scintillator screen for fast neutron imaging, sensitive to 2.45 MeV neutrons, is also manufactured in our labs. Structural neutron shielding computations for safety is also completed

Multi-slit triode ion optical system with ballistic beam focusing

Energy Technology Data Exchange (ETDEWEB)

Davydenko, V., E-mail: V.I.Davydenko@inp.nsk.su; Amirov, V.; Gorbovsky, A.; Deichuli, P.; Ivanov, A.; Kolmogorov, A.; Kapitonov, V.; Mishagin, V.; Shikhovtsev, I.; Sorokin, A.; Stupishin, N. [Budker Institute of Nuclear Physics, Novosibirsk 630090 (Russian Federation); Karpushov, A. N. [Ecole Polytechnique Fédérale de Lausanne, Centre de Recherches en Physique des Plasmas (CRPP), CH-1015 Lausanne (Switzerland); Smirnov, A. [Tri Alpha Energy, Inc., Rancho Santa Margarita, California 92688 (United States); Uhlemann, R. [Institute of Energy and Climate Research-Plasma Physics, Research Center Juelich, 52425 Juelich (Germany)

2016-02-15

Multi-slit triode ion-optical systems with spherical electrodes are of interest for formation of intense focused neutral beams for plasma heating. At present, two versions of focusing multi-slit triode ion optical system are developed. The first ion optical system forms the proton beam with 15 keV energy, 140 A current, and 30 ms duration. The second ion optical system is intended for heating neutral beam injector of Tokamak Configuration Variable (TCV). The injector produces focused deuterium neutral beam with 35 keV energy, 1 MW power, and 2 s duration. In the later case, the angular beam divergence of the neutral beam is 20-22 mrad in the direction across the slits of the ion optical system and 12 mrad in the direction along the slits.

Effects of reducing blood pressure on cardiovascular outcomes and mortality in patients with type 2 diabetes: Focus on SGLT2 inhibitors and EMPA-REG OUTCOME.

Science.gov (United States)

Scheen, André J

2016-11-01

Empagliflozin, a sodium-glucose cotransporter type 2 (SGLT2) inhibitor, has shown a remarkable reduction in cardiovascular and all-cause mortality in patients with type 2 diabetes (T2D) and antecedents of cardiovascular disease in the EMPA-REG OUTCOME trial. This effect has been attributed to a hemodynamic rather than a metabolic effect, partly due to the osmotic/diuretic effect of empagliflozin and to the reduction in arterial blood pressure. The present review will: (1) summarize the results of specific studies having tested the blood pressure lowering effects of SGLT2 inhibitors; (2) describe the results of meta-analyses of trials having evaluated the effects on mortality and cardiovascular outcomes of lowering blood pressure in patients with T2D, with a special focus on baseline and target blood pressures; (3) compare the cardiovascular outcome results in EMPA-REG OUTCOME versus other major trials with antihypertensive agents in patients with T2D; and (4) evaluate post-hoc analyses from EMPA-REG OUTCOME, especially subgroups of patients of special interest regarding the blood pressure lowering hypothesis. Although BP reduction associated to empagliflozin therapy may partly contribute to the benefits reported in EMPA-REG OUTCOME, other mechanisms most probably play a greater role in the overall CV protection and reduction in mortality observed in this trial. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Do large-scale hospital- and system-wide interventions improve patient outcomes: a systematic review.

Science.gov (United States)

Clay-Williams, Robyn; Nosrati, Hadis; Cunningham, Frances C; Hillman, Kenneth; Braithwaite, Jeffrey

2014-09-03

While health care services are beginning to implement system-wide patient safety interventions, evidence on the efficacy of these interventions is sparse. We know that uptake can be variable, but we do not know the factors that affect uptake or how the interventions establish change and, in particular, whether they influence patient outcomes. We conducted a systematic review to identify how organisational and cultural factors mediate or are mediated by hospital-wide interventions, and to assess the effects of those factors on patient outcomes. A systematic review was conducted and reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Database searches were conducted using MEDLINE from 1946, CINAHL from 1991, EMBASE from 1947, Web of Science from 1934, PsycINFO from 1967, and Global Health from 1910 to September 2012. The Lancet, JAMA, BMJ, BMJ Quality and Safety, The New England Journal of Medicine and Implementation Science were also hand searched for relevant studies published over the last 5 years. Eligible studies were required to focus on organisational determinants of hospital- and system-wide interventions, and to provide patient outcome data before and after implementation of the intervention. Empirical, peer-reviewed studies reporting randomised and non-randomised controlled trials, observational, and controlled before and after studies were included in the review. Six studies met the inclusion criteria. Improved outcomes were observed for studies where outcomes were measured at least two years after the intervention. Associations between organisational factors, intervention success and patient outcomes were undetermined: organisational culture and patient outcomes were rarely measured together, and measures for culture and outcome were not standardised. Common findings show the difficulty of introducing large-scale interventions, and that effective leadership and clinical champions, adequate

Computerized method and system for designing an aerodynamic focusing lens stack

Science.gov (United States)

Gard, Eric [San Francisco, CA; Riot, Vincent [Oakland, CA; Coffee, Keith [Diablo Grande, CA; Woods, Bruce [Livermore, CA; Tobias, Herbert [Kensington, CA; Birch, Jim [Albany, CA; Weisgraber, Todd [Brentwood, CA

2011-11-22

A computerized method and system for designing an aerodynamic focusing lens stack, using input from a designer related to, for example, particle size range to be considered, characteristics of the gas to be flowed through the system, the upstream temperature and pressure at the top of a first focusing lens, the flow rate through the aerodynamic focusing lens stack equivalent at atmosphere pressure; and a Stokes number range. Based on the design parameters, the method and system determines the total number of focusing lenses and their respective orifice diameters required to focus the particle size range to be considered, by first calculating for the orifice diameter of the first focusing lens in the Stokes formula, and then using that value to determine, in iterative fashion, intermediate flow values which are themselves used to determine the orifice diameters of each succeeding focusing lens in the stack design, with the results being output to a designer. In addition, the Reynolds numbers associated with each focusing lens as well as exit nozzle size may also be determined to enhance the stack design.

Limbic system, the main focus of dementia syndrome

International Nuclear Information System (INIS)

Matsuzawa, Taiju

1990-01-01

Alzheimer disease and multi-infarct dementia are two entirely different diseases producing almost the same abnormalities as dementia syndrome. The statistical studies with MRI to locate the focus of dementia syndrome in the neocortex was an absolute failure. With MRI there is drastic atrophy and destruction of the amygdala and hippocampus suggesting the limbic system as the focus of dementia syndrome. Destruction of the limbic system in particular amygdala and hippocampus produced the functional obstruction brought about by the marked reduction in the glucose utilization with PET in the bilateral temporal, parietal and occipital association cortices. Although this type constitutes only about 1/5 of all dementia patients. It is considered the fundamental type of dementia syndrome. Aside from this, there is a type wherein simultaneous and symmetrical reductions in glucose utilization of the frontal association cortex and the motor association cortex in the anterior part of the neocortex. This is referred to as type II. It constitutes about 4/5 of all dementia patients which is far more than type I. Based on these results, it is thought that limbic system is the main focus of dementia syndrome. (author)

Portable linear-focused solar thermal energy collecting system

Science.gov (United States)

Miller, C. G.; Pohl, J. G. (Inventor)

1977-01-01

A solar heat collection system is provided by utilizing a line-focusing device that is effectively a cylindrically curved concentrator within a protected environment formed by a transparent inflatable casing. A target, such as a fluid or gas carrying conduit is positioned within or near the casing containing the concentrator, at the line focus of the concentrator. The casing can be inflated at the site of use by a low pressure air supply to form a unitary light weight structure. The collector, including casing, concentrator and target, is readily transportable and can be used either at ground level or on rooftops. The inflatable concentrator can be replaced with a rigid metal or other concentrator while maintaining the novel advantages of the whole solar heat collection system.

Assessing the children's views on foods and consumption of selected food groups: outcome from focus group approach.

Science.gov (United States)

Sharif Ishak, Sharifah Intan Zainun; Shohaimi, Shamarina; Kandiah, Mirnalini

2013-04-01

The food choices in childhood have high a probability of being carried through into their adulthood life, which then contributes to the risk of many non-communicable diseases. Therefore, there is a need to gather some information about children's views on foods which may influence their food choices for planning a related dietary intervention or programme. This paper aimed to explore the views of children on foods and the types of foods which are usually consumed by children under four food groups (snacks, fast foods, cereals and cereal products; and milk and dairy products) by using focus group discussions. A total of 33 school children aged 7-9 years old from Selangor and Kuala Lumpur participated in the focus groups. Focus groups were audio-taped, transcribed and analyzed according to the listed themes. The outcomes show that the children usually consumed snacks such as white bread with spread or as a sandwich, local cakes, fruits such as papaya, mango and watermelon, biscuits or cookies, tea, chocolate drink and instant noodles. Their choices of fast foods included pizza, burgers, French fries and fried chicken. For cereal products, they usually consumed rice, bread and ready-to-eat cereals. Finally, their choices of dairy products included milk, cheese and yogurt. The reasons for the food liking were taste, nutritional value and the characteristics of food. The outcome of this study may provide additional information on the food choices among Malaysian children, especially in urban areas with regard to the food groups which have shown to have a relationship with the risk of childhood obesity.

Assessing the children's views on foods and consumption of selected food groups: outcome from focus group approach

Science.gov (United States)

Sharif Ishak, Sharifah Intan Zainun; Kandiah, Mirnalini

2013-01-01

The food choices in childhood have high a probability of being carried through into their adulthood life, which then contributes to the risk of many non-communicable diseases. Therefore, there is a need to gather some information about children's views on foods which may influence their food choices for planning a related dietary intervention or programme. This paper aimed to explore the views of children on foods and the types of foods which are usually consumed by children under four food groups (snacks, fast foods, cereals and cereal products; and milk and dairy products) by using focus group discussions. A total of 33 school children aged 7-9 years old from Selangor and Kuala Lumpur participated in the focus groups. Focus groups were audio-taped, transcribed and analyzed according to the listed themes. The outcomes show that the children usually consumed snacks such as white bread with spread or as a sandwich, local cakes, fruits such as papaya, mango and watermelon, biscuits or cookies, tea, chocolate drink and instant noodles. Their choices of fast foods included pizza, burgers, French fries and fried chicken. For cereal products, they usually consumed rice, bread and ready-to-eat cereals. Finally, their choices of dairy products included milk, cheese and yogurt. The reasons for the food liking were taste, nutritional value and the characteristics of food. The outcome of this study may provide additional information on the food choices among Malaysian children, especially in urban areas with regard to the food groups which have shown to have a relationship with the risk of childhood obesity. PMID:23610606

Implementation of Outcome-Based Education in Universiti Putra Malaysia: A Focus on Students' Learning Outcomes

Science.gov (United States)

Mohayidin, Mohd Ghazali; Suandi, Turiman; Mustapha, Ghazali; Konting, Mohd. Majid; Kamaruddin, Norfaryanti; Man, Nor Azirawani; Adam, Azura; Abdullah, Siti Norziah

2008-01-01

The move towards applying outcome-based education in teaching and learning at tertiary education level has become an important topic in Malaysia. Apart from the three learning domains; namely, cognitive, psychomotor and affective, the Ministry of Higher Education has determined eight learning outcomes which are important in providing wholesome…

Self-focusing and defect characterization with the FAUST system

International Nuclear Information System (INIS)

Mahaut, S.; Cattiaux, G.; Roy, O.; Benoist, PH.

1996-01-01

The FAUST (Focusing Adaptative UltraSonic Tomography) system was developed at the French Atomic Energy Commission (CEA) to improve performances of ultrasonic non destructive testing in terms of adaptability to various control configurations and defect characterization. Unlike conventional techniques only allowing fixed focusing, this system can dynamically modify the characteristics of the ultrasonic beam. This system relies on optimized phased array transducers connected to a multi-channel acquisition system supplying amplitude and delay laws allowing to drive the ultrasonic beam. Previous works have demonstrated the skills of this system for ultrasonic beam forming. The reliability of the procedure was proved by comparison with theoretical results, while comparisons with experimental results provided by conventional transducer pointed out the improved capacities of the system. In the first part of paper, we briefly present the model used for the system validation. This field computational model developed at the CEA is used to design optimized phased array transducers dedicated to NDE configurations (immersed transducers used to focus through Fluid/Solid interfaces). Theoretical delay laws and related ultrasonic fields are also calculated from this model. In addition to its ability to dynamically form the ultrasonic beam by taking account of the control configuration, we investigate in the second part of the paper the capabilities of the system to extract informations from he received signals. The ability of the system to store the signals received by all the elements of the array allows one to perform different reconstruction procedures. Useful informations can be extracted from the received signals: experimentally measured delay laws can be determined from reflected signals to obtain an optimal imaging, while the related amplitude distribution over the array points out geometrical characteristics of the reflector. (authors)

Cosmological Final Focus Systems

International Nuclear Information System (INIS)

Irwin, J

2004-01-01

We develop the many striking parallels between the dynamics of light streams from distant galaxies and particle beams in accelerator final focus systems. Notably the deflections of light by mass clumps are identical to the kicks arising from the long-range beam-beam interactions of two counter-rotating particle beams (known as parasitic crossings). These deflections have sextupolar as well as quadrupolar components. We estimate the strength of such distortions for a variety of circumstances and argue that the sextupolar distortions from clumping within clusters may be observable. This possibility is enhanced by the facts that (1) the sextupolar distortions of background galaxies is a factor of 5 smaller than the quadrupolar distortion, (2) the angular orientation of the sextupolar and quadrupolar distortions from a mass distribution would be correlated, appearing as a slightly curved image, (3) these effects should be spatially clumped on the sky

Avatar Web-Based Self-Report Survey System Technology for Public Health Research: Technical Outcome Results and Lessons Learned.

Science.gov (United States)

Savel, Craig; Mierzwa, Stan; Gorbach, Pamina M; Souidi, Samir; Lally, Michelle; Zimet, Gregory; Interventions, Aids

2016-01-01

This paper reports on a specific Web-based self-report data collection system that was developed for a public health research study in the United States. Our focus is on technical outcome results and lessons learned that may be useful to other projects requiring such a solution. The system was accessible from any device that had a browser that supported HTML5. Report findings include: which hardware devices, Web browsers, and operating systems were used; the rate of survey completion; and key considerations for employing Web-based surveys in a clinical trial setting.

Alignment and focusing device for a multibeam laser system

International Nuclear Information System (INIS)

Sweatt, W.C.

1980-01-01

Large inertial confinement fusion laser systems have many beams focusing on a small target. The Antares system is a 24-beam CO 2 pulse laser. To produce uniform illumination, the 24 beams must be individually focused on (or near) the target's surface in a symmetric pattern. To assess the quality of a given beam, we will locate a Smartt (point diffraction) interferometer at the desired focal point and illuminate it with an alignment laser. The resulting fringe pattern shows defocus, lateral misalignment, and beam aberrations; all of which can be minimized by tilting and translating the focusing mirror and the preceding flat mirror. The device described in this paper will remotely translate the Smartt interferometer to any position in the target space and point it in any direction using a two-axis gimbal. The fringes produced by the interferometer are relayed out of the target vacuum shell to a vidicon by a train or prisms. We are designing four separate snap-in heads to mount on the gimbal; two of which are Smartt interferometers (for 10.6 μm and 633 nm) and two for pinholes, should we wish to put an alignment beam backwards through the system

Focusing Information Systems Post-Graduate Research Projects

Directory of Open Access Journals (Sweden)

Gail Ridley

1996-11-01

Full Text Available This paper reports on an investigation of mechanisms that assist Information Systems post-graduate research students to focus their projects. An evaluation is presented of the experiences of Information Systems research students in focussing their research projects based on a survey conducted of students who participated in two of the first three Information Systems doctoral consortia to be held in Australia. The survey sought to determine whether a doctoral consortium or 'systematic expert review' is the most valuable mechanism for focussing a research proposal. Systematic expert review was considered by the students to be more effective than the doctoral consortium process for the purpose of focussing their research project proposals.

Educational outcomes in a system of care for children with emotional disturbance.

Science.gov (United States)

Strompolis, Melissa; Vishnevsky, Tanya; Reeve, Charlie L; Munsell, Eylin Palamaro; Cook, James R; Kilmer, Ryan P

2012-01-01

In North Carolina, only 69% of high school students graduate in 4 years; however, recent data suggest that only 42% of students with mental and emotional disabilities graduate. MeckCARES, a system of care (SOC) in Mecklenburg County, North Carolina, is designed to serve youth with severe emotional disturbances and their families. The SOC philosophy is a prominent family-focused approach intended to provide comprehensive, coordinated networks of services, tailored to the needs of the child and family, while emphasizing the strengthening of natural community supports. In addition to other mental health objectives, a particular goal of MeckCARES is to address specific school-based needs of system-identified youth to improve educational outcomes and reduce the risk of dropping out. This study sought to assess empirically the impact that enrollment in MeckCARES has on graduation precursors; namely, grades, suspensions, and absences. This study found that, on average, enrollment in MeckCARES is not associated with positive changes in educational variables. Implications of these findings are discussed, as are future directions. For example, additional research is needed with more sensitive measurement and data collection procedures (i.e., access to graduation rates and Medicaid information) to adequately assess the impact of enrollment in MeckCARES on educational outcomes. © 2012 American Orthopsychiatric Association.

The Final Focus Test Beam laser referene system

International Nuclear Information System (INIS)

Bressler, V.E.; Ruland, R.E.

1993-05-01

The original design for the SLAC linac included an alignment reference system with 270 diffraction gratings situated along the 3000 meter linac. These gratings have provided SLAC with a global reference line repeatable to within 200 micro meters. For the Final Focus Test Beam, this laser system has been extended and 13 new diffraction gratings have been installed. Improvements targets and the availability of new instruments allows us to evaluate the performance of the laser reference system at the 510 micro meter level. An explanation of the system and the results of our evaluation are presented

Non-uniform hybrid strategy for architecting and modeling flight vehicle focused system-of-systems operations

Directory of Open Access Journals (Sweden)

Tian Yifeng

2016-02-01

Full Text Available To balance the contradiction between comprehensiveness of system-of-systems (SoS description and cost of modeling and simulation, a non-uniform hybrid strategy (NUHYS is proposed. NUHYS groups elements of an SoS operation into system community or relatively independent system based on contributors complexity and focus relationship according to the focus of SoS problem. Meanwhile, modeling methods are categorized based on details attention rate and dynamic attention rate, seeking for matching contributors. Taking helicopter rescue in earthquake relief as an example, the procedure of applying NUHYS and its effectiveness are verified.

Mind-Body Medicine and Immune System Outcomes: A Systematic Review

OpenAIRE

Wahbeh, Helané; Haywood, Ashley; Kaufman, Karen; Zwickey, Heather

2009-01-01

This study is a systematic review of mind-body interventions that used immune outcomes in order to: 1) characterize mind-body medicine studies that assessed immune outcomes, 2) evaluate the quality of mind-body medicine studies measuring immune system effects, and 3) systematically evaluate the evidence for mind-body interventions effect on immune system outcomes using existing formal tools. 111 studies with 4,777 subjects were reviewed. The three largest intervention type categories were Rel...

Preservice Teachers' Belief Systems toward Curricular Outcomes for Physical Education

Science.gov (United States)

Kulinna, Pamela Hodges; Brusseau, Timothy; Ferry, Matthew; Cothran, Donetta

2010-01-01

This study was grounded in the belief systems and physical activity literature and investigated preservice teachers' belief systems toward curricular outcomes for physical education programs. Preservice teachers (N = 486; men = 62%, women = 38%) from 18 U.S. colleges/universities shared their beliefs about curricular outcomes. Preservice teachers…

Sensor-Based Auto-Focusing System Using Multi-Scale Feature Extraction and Phase Correlation Matching

Directory of Open Access Journals (Sweden)

Jinbeum Jang

2015-03-01

Full Text Available This paper presents a novel auto-focusing system based on a CMOS sensor containing pixels with different phases. Robust extraction of features in a severely defocused image is the fundamental problem of a phase-difference auto-focusing system. In order to solve this problem, a multi-resolution feature extraction algorithm is proposed. Given the extracted features, the proposed auto-focusing system can provide the ideal focusing position using phase correlation matching. The proposed auto-focusing (AF algorithm consists of four steps: (i acquisition of left and right images using AF points in the region-of-interest; (ii feature extraction in the left image under low illumination and out-of-focus blur; (iii the generation of two feature images using the phase difference between the left and right images; and (iv estimation of the phase shifting vector using phase correlation matching. Since the proposed system accurately estimates the phase difference in the out-of-focus blurred image under low illumination, it can provide faster, more robust auto focusing than existing systems.

Public outcomes: Building a 21st century national innovation system that serves the public

Energy Technology Data Exchange (ETDEWEB)

Gover, J. [Sandia National Labs., Albuquerque, NM (United States); Huray, P.; Carayannis, E. [George Washington Univ., Washington, DC (United States)

1997-09-01

Federal R and D must be principally focused on solving public problems that the marketplace is failing to address. With few exceptions programs must be supported by roadmaps that show how the R and D is linked to public outcomes. Federal R and D and those who perform it must be judged in terms of the public outcomes. The overarching issues of federal R and D policy, what it should address, how to manage it, who should perform it, how to perform it, what works best, etc. are highly complex and lack a strong theoretical foundation. (In fact, the linear, assembly-line model used by policymakers is wrong.) It is time that policymakers recognize and acknowledge the uncertainty of their work and conduct a wide array of policy experiments (the authors consider SEMATECH such an experiment) that are supported by public outcome metrics. In addition to making federal R and D better address public needs, such an approach to policy making could raise the public`s interest in T and S policy. Of course, as in any experiment the results may be measured and if failures aren`t observed, it is likely that policies lack vision and imagination. It is time to abandon the budget driven federal R and D system where performers of federal R and D are treated as constituents, and replace it with a public problem--public outcome driven system where public problems are prioritized and the budget is distributed to agencies according to these priorities.

Progress and outcomes of health systems reform in the United Arab Emirates: a systematic review.

Science.gov (United States)

Koornneef, Erik; Robben, Paul; Blair, Iain

2017-09-20

The United Arab Emirates (UAE) government aspires to build a world class health system to improve the quality of healthcare and the health outcomes for its population. To achieve this it has implemented extensive health system reforms in the past 10 years. The nature, extent and success of these reforms has not recently been comprehensively reviewed. In this paper we review the progress and outcomes of health systems reform in the UAE. We searched relevant databases and other sources to identify published and unpublished studies and other data available between 01 January 2002 and 31 March 2016. Eligible studies were appraised and data were descriptively and narratively synthesized. Seventeen studies were included covering the following themes: the UAE health system, population health, the burden of disease, healthcare financing, healthcare workforce and the impact of reforms. Few, if any, studies prospectively set out to define and measure outcomes. A central part of the reforms has been the introduction of mandatory private health insurance, the development of the private sector and the separation of planning and regulatory responsibilities from provider functions. The review confirmed the commitment of the UAE to build a world class health system but amongst researchers and commentators opinion is divided on whether the reforms have been successful although patient satisfaction with services appears high and there are some positive indications including increasing coverage of hospital accreditation. The UAE has a rapidly growing population with a unique age and sex distribution, there have been notable successes in improving child and maternal mortality and extending life expectancy but there are high levels of chronic diseases. The relevance of the reforms for public health and their impact on the determinants of chronic diseases have been questioned. From the existing research literature it is not possible to conclude whether UAE health system reforms are

Focus detection by shearing interference of vortex beams for non-imaging systems.

Science.gov (United States)

Li, Xiongfeng; Zhan, Shichao; Liang, Yiyong

2018-02-10

In focus detection of non-imaging systems, the common image-based methods are not available. Also, interference techniques are seldom used because only the degree with hardly any direction of defocus can be derived from the fringe spacing. In this paper, we propose a vortex-beam-based shearing interference system to do focus detection for a focused laser direct-writing system, where a vortex beam is already involved. Both simulated and experimental results show that fork-like features are added in the interference patterns due to the existence of an optical vortex, which makes it possible to distinguish the degree and direction of defocus simultaneously. The theoretical fringe spacing and resolution of this method are derived. A resolution of 0.79 μm can be achieved under the experimental combination of parameters, and it can be further improved with the help of the image processing algorithm and closed-loop controlling in the future. Finally, the influence of incomplete collimation and the wedge angle of the shear plate is discussed. This focus detection approach is extremely appropriate for those non-imaging systems containing one or more focused vortex beams.

Stem cell transplantation as a dynamical system: are clinical outcomes deterministic?

Science.gov (United States)

Toor, Amir A; Kobulnicky, Jared D; Salman, Salman; Roberts, Catherine H; Jameson-Lee, Max; Meier, Jeremy; Scalora, Allison; Sheth, Nihar; Koparde, Vishal; Serrano, Myrna; Buck, Gregory A; Clark, William B; McCarty, John M; Chung, Harold M; Manjili, Masoud H; Sabo, Roy T; Neale, Michael C

2014-01-01

Outcomes in stem cell transplantation (SCT) are modeled using probability theory. However, the clinical course following SCT appears to demonstrate many characteristics of dynamical systems, especially when outcomes are considered in the context of immune reconstitution. Dynamical systems tend to evolve over time according to mathematically determined rules. Characteristically, the future states of the system are predicated on the states preceding them, and there is sensitivity to initial conditions. In SCT, the interaction between donor T cells and the recipient may be considered as such a system in which, graft source, conditioning, and early immunosuppression profoundly influence immune reconstitution over time. This eventually determines clinical outcomes, either the emergence of tolerance or the development of graft versus host disease. In this paper, parallels between SCT and dynamical systems are explored and a conceptual framework for developing mathematical models to understand disparate transplant outcomes is proposed.

Reliability of Cyber Physical Systems with Focus on Building Management Systems

DEFF Research Database (Denmark)

Lazarova-Molnar, Sanja; Shaker, Hamid Reza; Mohamed, Nader

2016-01-01

with our focus CPS, i.e. building management systems (BMS), which are not always safety critical per se, but under special circumstances they can become such. This certainly depends on the purpose of the building. We can easily imagine BMS of hospital buildings as safety-critical, but also BMS of buildings......Cyber-physical systems are slowly emerging to dominate our world. Cyber-physical systems (CPS) are systems that tightly integrates users, devices and software. Whereas many of these systems are obviously safety-critical systems, some of them become so under special circumstances. This is the case...... that store sensitive materials and equipment that could be of biological nature or encompassing sensitive technology that would need special temperature, humidity and light settings. For this reason, in this paper we would like to emphasize on the importance of reliability of CPS in general, with a special...

Integrated outcomes: where CIOs need to be thinking.

Science.gov (United States)

Shaha, S H

1998-09-01

Financial data have been the mainstay in health care organization business decision making. CIOs can lead efforts to add clinical and satisfaction data and create more customer-focused integrated outcomes systems.

Relationship between total quality management, critical paths, and outcomes management.

Science.gov (United States)

Lynn, P A

1996-09-01

Total quality management (TQM), clinical paths, and outcomes management are high-profile strategies in today's health care environment. Each strategy is distinct, yet there are interrelationships among them. TQM supports a customer-focused organizational culture, providing tools and techniques to identify and solve problems. Clinical paths are tools for enhancing patient care coordination and for identifying system-wide and patient population specific issues. Outcomes management is an integrated system for measuring the results in patient populations over time. There is a recent shift in outcomes measurement towards expanding both the nature of the outcomes examined and the timeframes in which they are studied.

Possibilities of achieving fusion reaction with a 4{pi} focusing system

Energy Technology Data Exchange (ETDEWEB)

Barsanti, G; Barsella, B; Camerini, M; Federighi, U; Musumeci, L; Talini, N [CAMEN., Leghorn (Italy)

1958-07-01

The 4{pi} focusing by means of an electromagnetic field is analysed. The following points considered: (a) The general solutions of system for equations of motion of a mass m with charge +e valid for arbitrary initial conditions. This is necessary for the consideration of imperfectly focused primary trajectories, of the effect of collisions in the vicinity of the origin and of ions produced in the neutral gas which diffuses into the reaction chamber. (b) Investigation of the primary ion injection system, of the density of the ions in the chamber and of the energy balance as a matter of principle. (c) The experimental apparatus needed for 4{pi} focusing of deuterons and a sketch of a fusion reactor.

Spanning maternal, newborn and child health (MNCH) and health systems research boundaries: conducive and limiting health systems factors to improving MNCH outcomes in West Africa.

Science.gov (United States)

Agyepong, Irene Akua; Kwamie, Aku; Frimpong, Edith; Defor, Selina; Ibrahim, Abdallah; Aryeetey, Genevieve C; Lokossou, Virgil; Sombie, Issiaka

2017-07-12

Despite improvements over time, West Africa lags behind global as well as sub-Saharan averages in its maternal, newborn and child health (MNCH) outcomes. This is despite the availability of an increasing body of knowledge on interventions that improve such outcomes. Beyond our knowledge of what interventions work, insights are needed on others factors that facilitate or inhibit MNCH outcome improvement. This study aimed to explore health system factors conducive or limiting to MNCH policy and programme implementation and outcomes in West Africa, and how and why they work in context. We conducted a mixed methods multi-country case study focusing predominantly, but not exclusively, on the six West African countries (Burkina Faso, Benin, Mali, Senegal, Nigeria and Ghana) of the Innovating for Maternal and Child Health in Africa initiative. Data collection involved non-exhaustive review of grey and published literature, and 48 key informant interviews. We validated our findings and conclusions at two separate multi-stakeholder meetings organised by the West African Health Organization. To guide our data collection and analysis, we developed a unique theoretical framework of the link between health systems and MNCH, in which we conceptualised health systems as the foundations, pillars and roofing of a shelter for MNCH, and context as the ground on which the foundation is laid. A multitude of MNCH policies and interventions were being piloted, researched or implemented at scale in the sub-region, most of which faced multiple interacting conducive and limiting health system factors to effective implementation, as well as contextual challenges. Context acted through its effect on health system factors as well as on the social determinants of health. To accelerate and sustain improvements in MNCH outcomes in West Africa, an integrated approach to research and practice of simultaneously addressing health systems and contextual factors alongside MNCH service delivery

Mind-Body Medicine and Immune System Outcomes: A Systematic Review.

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Wahbeh, Helané; Haywood, Ashley; Kaufman, Karen; Zwickey, Heather

2009-01-01

This study is a systematic review of mind-body interventions that used immune outcomes in order to: 1) characterize mind-body medicine studies that assessed immune outcomes, 2) evaluate the quality of mind-body medicine studies measuring immune system effects, and 3) systematically evaluate the evidence for mind-body interventions effect on immune system outcomes using existing formal tools. 111 studies with 4,777 subjects were reviewed. The three largest intervention type categories were Relaxation Training (n=25), Cognitive Based Stress Management (n=22), and Hypnosis (n=21). Half the studies were conducted with healthy subjects (n=51). HIV (n=18), cancer (n=13) and allergies (n=7) were the most prominent conditions examined in the studies comprising of non-healthy subjects. Natural killer cell and CD4 T lymphocyte measures were the most commonly studied outcomes. Most outcome and modality categories had limited or inconclusive evidence. Relaxation training had the strongest scientific evidence of a mind-body medicine affecting immune outcomes. Immunoglobulin A had the strongest scientific evidence for positive effects from mind-body medicine. Issues for mind-body medicine studies with immune outcomes are discussed and recommendations are made to help improve future clinical trials.

Transitions of interaction outcomes in a uni-directional consumer-resource system

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Wang, Y.; DeAngelis, D.L.

2011-01-01

A uni-directional consumer-resource system of two species is analyzed. Our aim is to understand the mechanisms that determine how the interaction outcomes depend on the context of the interaction; that is, on the model parameters. The dynamic behavior of the model is described and, in particular, it is demonstrated that no periodic orbits exist. Then the parameter (factor) space is shown to be divided into four regions, which correspond to the four forms of interaction outcomes; i.e. mutualism, commensalism, parasitism and amensalism. It is shown that the interaction outcomes of the system transition smoothly among these four forms when the parameters of the system are varied continuously. Varying each parameter individually or varying pairs of parameters can also lead to smooth transitions between the interaction outcomes. The analysis leads to both conditions for which each species achieves its maximal density, and situations in which periodic oscillations of the interaction outcomes emerge. ?? 2011 Elsevier Ltd.

A RECIPE FOR LINEAR COLLIDER FINAL FOCUS SYSTEM DESIGN

International Nuclear Information System (INIS)

Seryi, Andrei

2003-01-01

The design of Final Focus systems for linear colliders is challenging because of the large demagnifications needed to produce nanometer-sized beams at the interaction point. Simple first- and second-order matrix matching have proven insufficient for this task, and minimization of third- and higher-order aberrations is essential. An appropriate strategy is required for the latter to be successful. A recipe for Final Focus design, and a set of computational tools used to implement this approach, are described herein. An example of the use of this procedure is given

Organizational Climate, Services, and Outcomes in Child Welfare Systems

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Glisson, Charles; Green, Philip

2011-01-01

Objective: This study examines the association of organizational climate, casework services, and youth outcomes in child welfare systems. Building on preliminary findings linking organizational climate to youth outcomes over a 3-year follow-up period, the current study extends the follow-up period to 7 years and tests main, moderating and…

The interplay between regulatory focus and temporal distance in the health context.

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Berezowska, Aleksandra; Fischer, Arnout R H; van Trijp, Hans C M

2018-02-01

This study identifies how the interaction between temporal distance, regulatory focus, and framing of health outcomes affects individuals' intention to adopt a personalized nutrition service. A 2 (temporal distance: immediate health outcomes vs. delayed health outcomes) × 2 (regulatory focus: prevention vs. promotion) × 2 (health outcome framing: illness prevention vs. health promotion) full-factorial between-subjects design. In two experiments with samples of 236 and 242 students, regulatory focus was manipulated by asking participants to describe which academic outcomes they want to either achieve or prevent and how they aim to do this. Temporal distance and health outcome framing were manipulated by modifying descriptions of personalized nutrition services. To study the process through which temporal distance, regulatory focus, and health outcome framing affect adoption intention, measures of perceived privacy risk and perceived personalization benefit were included as mediators. The interaction between temporal distance and regulatory focus had a significant effect on adoption intention, perceived privacy risk, and perceived personalization benefit. For prevention-focused individuals' adoption intention was higher, perceived personalization benefit was higher, and perceived privacy risk was lower when health outcomes were immediate instead of delayed. These effects were not significant for promotion-focused individuals. Health outcome framing affected the interaction between temporal distance and regulatory focus, but only in Study 1. Only perceived personalization benefit served as a mediator. Tailoring temporal distance to individuals' regulatory focus increases adoption intention for personalized nutrition advice. Statement of contribution What is already known on this subject? Intention to adopt dietary recommendations results from a cognitive decision-making process. Regulatory focus and temporal distance are relevant for the adoption of dietary

Comparison of models for predicting outcomes in patients with coronary artery disease focusing on microsimulation

Directory of Open Access Journals (Sweden)

Masoud Amiri

2012-01-01

Full Text Available Background: Physicians have difficulty to subjectively estimate the cardiovascular risk of their patients. Using an estimate of global cardiovascular risk could be more relevant to guide decisions than using binary representation (presence or absence of risk factors data. The main aim of the paper is to compare different models of predicting the progress of a coronary artery diseases (CAD to help the decision making of physician. Methods: There are different standard models for predicting risk factors such as models based on logistic regression model, Cox regression model, dynamic logistic regression model, and simulation models such as Markov model and microsimulation model. Each model has its own application which can or cannot use by physicians to make a decision on treatment of each patient. Results: There are five main common models for predicting of outcomes, including models based on logistic regression model (for short-term outcomes, Cox regression model (for intermediate-term outcomes, dynamic logistic regression model, and simulation models such as Markov and microsimulation models (for long-term outcomes. The advantages and disadvantages of these models have been discussed and summarized. Conclusion: Given the complex medical decisions that physicians face in everyday practice, the multiple interrelated factors that play a role in choosing the optimal treatment, and the continuously accumulating new evidence on determinants of outcome and treatment options for CAD, physicians may potentially benefit from a clinical decision support system that accounts for all these considerations. The microsimulation model could provide cardiologists, researchers, and medical students a user-friendly software, which can be used as an intelligent interventional simulator.

Comparing 2 Whiplash Grading Systems to Predict Clinical Outcomes.

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Croft, Arthur C; Bagherian, Alireza; Mickelsen, Patrick K; Wagner, Stephen

2016-06-01

Two whiplash severity grading systems have been developed: Quebec Task Force on Whiplash-Associated Disorders (QTF-WAD) and the Croft grading system. The majority of clinical studies to date have used the modified grading system published by the QTF-WAD in 1995 and have demonstrated some ability to predict outcome. But most studies include only injuries of lower severity (grades 1 and 2), preventing a broader interpretation. The purpose of this study was assess the ability of these grading systems to predict clinical outcome within the context of a broader injury spectrum. This study evaluated both grading systems for their ability to predict the bivalent outcome, recovery, within a sample of 118 whiplash patients who were part of a previous case-control designed study. Of these, 36% (controls) had recovered, and 64% (cases) had not recovered. The discrete bivariate distribution between recovery status and whiplash grade was analyzed using the 2-tailed cross-tabulation statistics. Applying the criteria of the original 1993 Croft grading system, the subset comprised 1 grade 1 injury, 32 grade 2 injuries, 53 grade 3 injuries, and 32 grade 4 injuries. Applying the criteria of the modified (QTF-WAD) grading system, there were 1 grade 1 injury, 89 grade 2 injuries, and 28 grade 3 injuries. Both whiplash grading systems correlated negatively with recovery; that is, higher severity grades predicted a lower probability of recovery, and statistically significant correlations were observed in both, but the Croft grading system substantially outperformed the QTF-WAD system on this measure. The Croft grading system for whiplash injury severity showed a better predictive measure for recovery status from whiplash injuries as compared with the QTF-WAD grading system.

The Focus of Attention is similar to other memory systems rather than uniquely different

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Olivia eBeaudry

2014-02-01

Full Text Available According to some current theories, the Focus of Attention, part of working memory, represents items in a privileged state that is more accessible than items stored in other memory systems. One line of evidence supporting the distinction between the focus of attention and other memory systems is the finding that items in the focus of attention are immune to proactive interference (when something learned earlier impairs the ability to remember something learned more recently. The focus of attention, then, is held to be unique: it is the only memory system that is not susceptible to proactive interference. We review the literature used to support this claim, and although there are many studies in which proactive interference was not observed, we found more studies in which it was observed. We conclude that the focus of attention is not immune to proactive interference: items in the focus of attention are susceptible to proactive interference just like items in every other memory system. And, just as in all other memory systems, it is how the items are represented and processed that plays a critical role in determining whether proactive interference will be observed.

Decentralization and health system performance - a focused review of dimensions, difficulties, and derivatives in India.

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Panda, Bhuputra; Thakur, Harshad P

2016-10-31

One of the principal goals of any health care system is to improve health through the provision of clinical and public health services. Decentralization as a reform measure aims to improve inputs, management processes and health outcomes, and has political, administrative and financial connotations. It is argued that the robustness of a health system in achieving desirable outcomes is contingent upon the width and depth of 'decision space' at the local level. Studies have used different approaches to examine one or more facets of decentralization and its effect on health system functioning; however, lack of consensus on an acceptable framework is a critical gap in determining its quantum and quality. Theorists have resorted to concepts of 'trust', 'convenience' and 'mutual benefits' to explain, define and measure components of governance in health. In the emerging 'continuum of health services' model, the challenge lies in identifying variables of performance (fiscal allocation, autonomy at local level, perception of key stakeholders, service delivery outputs, etc.) through the prism of decentralization in the first place, and in establishing directed relationships among them. This focused review paper conducted extensive web-based literature search, using PubMed and Google Scholar search engines. After screening of key words and study objectives, we retrieved 180 articles for next round of screening. One hundred and four full articles (three working papers and 101 published papers) were reviewed in totality. We attempted to summarize existing literature on decentralization and health systems performance, explain key concepts and essential variables, and develop a framework for further scientific scrutiny. Themes are presented in three separate segments of dimensions, difficulties and derivatives. Evaluation of local decision making and its effect on health system performance has been studied in a compartmentalized manner. There is sparse evidence about innovations

Applying Diagnostics to Enhance Cable System Reliability (Cable Diagnostic Focused Initiative, Phase II)

Energy Technology Data Exchange (ETDEWEB)

Hartlein, Rick [Georgia Tech Research Corporation (GTRC), Atlanta, GA (United States). National Electric Energy Testing, Research and Applications Center (NEETRAC); Hampton, Nigel [Georgia Tech Research Corporation (GTRC), Atlanta, GA (United States). National Electric Energy Testing, Research and Applications Center (NEETRAC); Perkel, Josh [Georgia Tech Research Corporation (GTRC), Atlanta, GA (United States). National Electric Energy Testing, Research and Applications Center (NEETRAC); Hernandez, JC [Univ. de Los Andes, Merida (Venezuela); Elledge, Stacy [Georgia Tech Research Corporation (GTRC), Atlanta, GA (United States). National Electric Energy Testing, Research and Applications Center (NEETRAC); del Valle, Yamille [Georgia Tech Research Corporation (GTRC), Atlanta, GA (United States). National Electric Energy Testing, Research and Applications Center (NEETRAC); Grimaldo, Jose [Georgia Inst. of Technology, Atlanta, GA (United States). School of Electrical and Computer Engineering; Deku, Kodzo [Georgia Inst. of Technology, Atlanta, GA (United States). George W. Woodruff School of Mechanical Engineering

2016-02-01

The Cable Diagnostic Focused Initiative (CDFI) played a significant and powerful role in clarifying the concerns and understanding the benefits of performing diagnostic tests on underground power cable systems. This project focused on the medium and high voltage cable systems used in utility transmission and distribution (T&D) systems. While many of the analysis techniques and interpretations are applicable to diagnostics and cable systems outside of T&D, areas such as generating stations (nuclear, coal, wind, etc.) and other industrial environments were not the focus. Many large utilities in North America now deploy diagnostics or have changed their diagnostic testing approach as a result of this project. Previous to the CDFI, different diagnostic technology providers individually promoted their approach as the “the best” or “the only” means of detecting cable system defects.

Past-focused environmental comparisons promote proenvironmental outcomes for conservatives

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Baldwin, Matthew; Lammers, Joris

2016-01-01

Conservatives appear more skeptical about climate change and global warming and less willing to act against it than liberals. We propose that this unwillingness could result from fundamental differences in conservatives’ and liberals’ temporal focus. Conservatives tend to focus more on the past than do liberals. Across six studies, we rely on this notion to demonstrate that conservatives are positively affected by past- but not by future-focused environmental comparisons. Past comparisons largely eliminated the political divide that separated liberal and conservative respondents’ attitudes toward and behavior regarding climate change, so that across these studies conservatives and liberals were nearly equally likely to fight climate change. This research demonstrates how psychological processes, such as temporal comparison, underlie the prevalent ideological gap in addressing climate change. It opens up a promising avenue to convince conservatives effectively of the need to address climate change and global warming. PMID:27956619

Calculation of the illuminance distribution in the focal spot of a focusing system taking into account aberrations in this system and divergence of a focused laser beam

International Nuclear Information System (INIS)

Gitin, Andrey V

2007-01-01

The dependence of the focal-spot size of a 'deep' parabolic mirror reflector on the laser-beam divergence is analysed by the method of elementary reflections. The dependence of the focal-beam diameter of an ideal focusing optical system on the laser-beam parameters is described. The expression is obtained for calculating the illumination distribution in the focal spot of a 'deep' mirror reflector which takes into account both aberrations and light-gathering power of the reflector and the divergence of a focused laser beam. (optical systems)

TRIGLYCERIDES, ATHEROSCLEROSIS, AND CARDIOVASCULAR OUTCOME STUDIES: FOCUS ON OMEGA-3 FATTY ACIDS.

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Handelsman, Yehuda; Shapiro, Michael D

2017-01-01

To provide an overview of the roles of triglycerides and triglyceride-lowering agents in atherosclerosis in the context of cardiovascular outcomes studies. We reviewed the published literature as well as ClinicalTrials.gov entries for ongoing studies. Despite improved atherosclerotic cardiovascular disease (ASCVD) outcomes with statin therapy, residual risk remains. Epidemiologic data and recent genetic insights provide compelling evidence that triglycerides are in the causal pathway for the development of atherosclerosis, thereby renewing interest in targeting triglycerides to improve ASCVD outcomes. Fibrates, niacin, and omega-3 fatty acids (OM3FAs) are three classes of triglyceride-lowering drugs. Outcome studies with triglyceride-lowering agents have been inconsistent. With regard to OM3FAs, the JELIS study showed that eicosapentaenoic acid (EPA) significantly reduced major coronary events in statin-treated hypercholesterolemic patients. Regarding other agents, extended-release niacin and fenofibrate are no longer recommended as statin add-on therapy (by some guidelines, though not all) because of the lack of convincing evidence from outcome studies. Notably, subgroup analyses from the outcome studies have generated the hypothesis that triglyceride lowering may provide benefit in statin-treated patients with persistent hypertriglyceridemia. Two ongoing OM3FA outcome studies (REDUCE-IT and STRENGTH) are testing this hypothesis in high-risk, statin-treated patients with triglyceride levels of 200 to 500 mg/dL. There is consistent evidence that triglycerides are in the causal pathway of atherosclerosis but inconsistent evidence from cardiovascular outcomes studies as to whether triglyceride-lowering agents reduce cardiovascular risk. Ongoing outcomes studies will determine the role of triglyceride lowering in statin-treated patients with high-dose prescription OM3FAs in terms of improved ASCVD outcomes. AACE = American Association of Clinical Endocrinologists

Association between Systemic Diseases and Endodontic Outcome: A Systematic Review.

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Aminoshariae, Anita; Kulild, James C; Mickel, Andre; Fouad, Ashraf F

2017-04-01

To date, the relationships between systemic diseases and endodontic treatment outcomes remain poorly studied. Thus, the purpose of this systematic review was to evaluate the relationship between host-modifying factors and their association with endodontic outcomes. Two reviewers independently conducted a comprehensive literature search. The MEDLINE, Embase, Cochrane, and PubMed databases were searched. In addition, the bibliographies and gray literature of all relevant articles and textbooks were manually searched. There was no disagreement between the 2 reviewers. Sixteen articles met the inclusion criteria with moderate to high risk of bias. There was no article with low risk of bias. Available scientific evidence remains inconclusive as to whether diabetes and/or cardiovascular disease(s) may be associated with endodontic outcomes. Human immunodeficiency virus and oral bisphosphonate did not appear to be associated with endodontic outcomes. Although additional well-designed longitudinal clinical studies are needed, the results of this systematic review suggest that some systemic diseases may be correlated with endodontic outcomes. Copyright © 2016 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

Child welfare caseworkers as service brokers for youth in foster care: findings from project focus.

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Dorsey, Shannon; Kerns, Suzanne E U; Trupin, Eric W; Conover, Kate L; Berliner, Lucy

2012-02-01

Youth in the foster care system have substantially higher rates of mental health needs compared to the general population, yet they rarely receive targeted, evidence-based practices (EBPs). Increasingly emerging in the literature on mental health services is the importance of "brokers" or "gateway providers" of services. For youth in foster care, child welfare caseworkers often play this role. This study examines caseworker-level outcomes of Project Focus, a caseworker training and consultation model designed to improve emotional and behavioral outcomes for youth in foster care through increased linkages with EBPs. Project Focus was tested through a small, randomized trial involving four child welfare offices. Caseworkers in the Project Focus intervention group demonstrated an increased awareness of EBPs and a trend toward increased ability to identify appropriate EBP referrals for particular mental health problems but did not have significantly different rates of actual referral to EBPs. Dose of consultation was associated with general awareness of EBPs. Implications for practice and outcomes for youth are discussed.

Adjustable, short focal length permanent-magnet quadrupole based electron beam final focus system

Directory of Open Access Journals (Sweden)

J. K. Lim

2005-07-01

Full Text Available Advanced high-brightness beam applications such as inverse-Compton scattering (ICS depend on achieving of ultrasmall spot sizes in high current beams. Modern injectors and compressors enable the production of high-brightness beams having needed short bunch lengths and small emittances. Along with these beam properties comes the need to produce tighter foci, using stronger, shorter focal length optics. An approach to creating such strong focusing systems using high-field, small-bore permanent-magnet quadrupoles (PMQs is reported here. A final-focus system employing three PMQs, each composed of 16 neodymium iron boride sectors in a Halbach geometry has been installed in the PLEIADES ICS experiment. The field gradient in these PMQs is 560   T/m, the highest ever reported in a magnetic optics system. As the magnets are of a fixed field strength, the focusing system is tuned by adjusting the position of the three magnets along the beam line axis, in analogy to familiar camera optics. This paper discusses the details of the focusing system, simulation, design, fabrication, and experimental procedure in creating ultrasmall beams at PLEIADES.

The completed design of the SLC Final Focus System

International Nuclear Information System (INIS)

Murray, J.J.; Brown, K.L.; Fieguth, T.

1987-02-01

The design of the SLC Final Focus System has evolved from its initial conceptual design into its final form. This final design is described including a review of the critical decisions influencing the adoption of particular features. The creation of a feasible design has required that these decisions be tempered by practical considerations such as site constraints, correction of optical errors caused by imperfections, and accommodations requested by engineers and particle detector physicists. As this is the first such system to be built, it is hoped that the experience gained will be useful for the design of future systems

Planning for successful outcomes in the new millennium.

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Matthews, P

2000-02-01

The complexity of the health care environment will increase in the next millennium. Organizations must adopt an approach of selecting outcomes management solutions that are focused on data capture, analysis, and comparative reviews and reporting. They must decisively and creatively implement, in a phased approach, integrated solutions from existing robust systems, while considering future systems targeted for implementation. Outcomes management solutions must be integrated with the organization's information systems strategic plan. The successful organization must be able to turn business-critical data into information that supports both business and clinical decision-making activities. In short, health care organizations will have to become information-driven.

"I am a scientist": How setting conditions that enhance focused concentration positively relate to student motivation and achievement outcomes in inquiry-based science

Science.gov (United States)

Ellwood, Robin B.

This research investigated how student social interactions within two approaches to an inquiry-based science curriculum could be related to student motivation and achievement outcomes. This qualitative case study consisted of two cases, Off-Campus and On-Campus, and used ethnographic techniques of participant observation. Research participants included eight eighth grade girls, aged thirteen to fourteen years old. Data sources included formal and informal participant interviews, participant journal reflections, curriculum artifacts including quizzes, worksheets, and student-generated research posters, digital video and audio recordings, photographs, and researcher field notes. Data were transcribed verbatim and coded, then collapsed into emergent themes using NVIVO 9. The results of this research illustrate how setting conditions that promote focused concentration and communicative interactions can be positively related to student motivation and achievement outcomes in inquiry-based science. Participants in the Off-Campus case experienced more frequent states of focused concentration and out performed their peers in the On-Campus case on forty-six percent of classroom assignments. Off-Campus participants also designed and implemented a more cognitively complex research project, provided more in-depth analyses of their research results, and expanded their perceptions of what it means to act like a scientist to a greater extent than participants in the On-Campus case. These results can be understood in relation to Flow Theory. Student interactions that promoted the criteria necessary for initiating flow, which included having clearly defined goals, receiving immediate feedback, and maintaining a balance between challenges and skills, fostered enhanced student motivation and achievement outcomes. This research also illustrates the positive gains in motivation and achievement outcomes that emerge from student experiences with extended time in isolated areas referred to

Open-source, small-animal magnetic resonance-guided focused ultrasound system.

Science.gov (United States)

Poorman, Megan E; Chaplin, Vandiver L; Wilkens, Ken; Dockery, Mary D; Giorgio, Todd D; Grissom, William A; Caskey, Charles F

2016-01-01

MR-guided focused ultrasound or high-intensity focused ultrasound (MRgFUS/MRgHIFU) is a non-invasive therapeutic modality with many potential applications in areas such as cancer therapy, drug delivery, and blood-brain barrier opening. However, the large financial costs involved in developing preclinical MRgFUS systems represent a barrier to research groups interested in developing new techniques and applications. We aim to mitigate these challenges by detailing a validated, open-source preclinical MRgFUS system capable of delivering thermal and mechanical FUS in a quantifiable and repeatable manner under real-time MRI guidance. A hardware and software package was developed that includes closed-loop feedback controlled thermometry code and CAD drawings for a therapy table designed for a preclinical MRI scanner. For thermal treatments, the modular software uses a proportional integral derivative controller to maintain a precise focal temperature rise in the target given input from MR phase images obtained concurrently. The software computes the required voltage output and transmits it to a FUS transducer that is embedded in the delivery table within the magnet bore. The delivery table holds the FUS transducer, a small animal and its monitoring equipment, and a transmit/receive RF coil. The transducer is coupled to the animal via a water bath and is translatable in two dimensions from outside the magnet. The transducer is driven by a waveform generator and amplifier controlled by real-time software in Matlab. MR acoustic radiation force imaging is also implemented to confirm the position of the focus for mechanical and thermal treatments. The system was validated in tissue-mimicking phantoms and in vivo during murine tumor hyperthermia treatments. Sonications were successfully controlled over a range of temperatures and thermal doses for up to 20 min with minimal temperature overshoot. MR thermometry was validated with an optical temperature probe, and focus

A new adaptive light beam focusing principle for scanning light stimulation systems.

Science.gov (United States)

Bitzer, L A; Meseth, M; Benson, N; Schmechel, R

2013-02-01

In this article a novel principle to achieve optimal focusing conditions or rather the smallest possible beam diameter for scanning light stimulation systems is presented. It is based on the following methodology: First, a reference point on a camera sensor is introduced where optimal focusing conditions are adjusted and the distance between the light focusing optic and the reference point is determined using a laser displacement sensor. In a second step, this displacement sensor is used to map the topography of the sample under investigation. Finally, the actual measurement is conducted, using optimal focusing conditions in each measurement point at the sample surface, that are determined by the height difference between camera sensor and the sample topography. This principle is independent of the measurement values, the optical or electrical properties of the sample, the used light source, or the selected wavelength. Furthermore, the samples can be tilted, rough, bent, or of different surface materials. In the following the principle is implemented using an optical beam induced current system, but basically it can be applied to any other scanning light stimulation system. Measurements to demonstrate its operation are shown, using a polycrystalline silicon solar cell.

Setting the vision: applied patient-reported outcomes and smart, connected digital healthcare systems to improve patient-centered outcomes prediction in critical illness.

Science.gov (United States)

Wysham, Nicholas G; Abernethy, Amy P; Cox, Christopher E

2014-10-01

Prediction models in critical illness are generally limited to short-term mortality and uncommonly include patient-centered outcomes. Current outcome prediction tools are also insensitive to individual context or evolution in healthcare practice, potentially limiting their value over time. Improved prognostication of patient-centered outcomes in critical illness could enhance decision-making quality in the ICU. Patient-reported outcomes have emerged as precise methodological measures of patient-centered variables and have been successfully employed using diverse platforms and technologies, enhancing the value of research in critical illness survivorship and in direct patient care. The learning health system is an emerging ideal characterized by integration of multiple data sources into a smart and interconnected health information technology infrastructure with the goal of rapidly optimizing patient care. We propose a vision of a smart, interconnected learning health system with integrated electronic patient-reported outcomes to optimize patient-centered care, including critical care outcome prediction. A learning health system infrastructure integrating electronic patient-reported outcomes may aid in the management of critical illness-associated conditions and yield tools to improve prognostication of patient-centered outcomes in critical illness.

Note: Automated optical focusing on encapsulated devices for scanning light stimulation systems

International Nuclear Information System (INIS)

Bitzer, L. A.; Benson, N.; Schmechel, R.

2014-01-01

Recently, a scanning light stimulation system with an automated, adaptive focus correction during the measurement was introduced. Here, its application on encapsulated devices is discussed. This includes the changes an encapsulating optical medium introduces to the focusing process as well as to the subsequent light stimulation measurement. Further, the focusing method is modified to compensate for the influence of refraction and to maintain a minimum beam diameter on the sample surface

Sensor Selection method for IoT systems – focusing on embedded system requirements

Directory of Open Access Journals (Sweden)

Hirayama Masayuki

2016-01-01

Full Text Available Recently, various types of sensors have been developed. Using these sensors, IoT systems have become hot topics in embedded system domain. However, sensor selections for embedded systems are not well discussed up to now. This paper focuses on embedded system’s features and architecture, and proposes a sensor selection method which is composed seven steps. In addition, we applied the proposed method to a simple example – a sensor selection for computer scored answer sheet reader unit. From this case study, an idea to use FTA in sensor selection is also discussed.

A combined hands-on teaching programme and clinical pathway focused on pleural ultrasound and procedure supervision transforms pleural procedure outcomes.

Science.gov (United States)

Edwards, Timothy; Cook, Alistair; Salamonsen, Matthew; Bashirzadeh, Farzad; Fielding, David

2017-11-01

Management of pleural effusions is a common diagnostic and management problem. We reviewed the outcomes from pleural procedures after the instigation of pleural effusion management guidelines, focusing on pleural ultrasound and a hands-on teaching programme followed by procedure supervision that enabled many operators to perform such procedures. This is a retrospective analysis of all procedures performed for pleural effusions on medical patients. Outcomes were assessed prior to the instigation of pleural effusion management guidelines (pleural pathway) and hands-on teaching (January 2010 to June 2011) and following these interventions (January 2012 to June 2013). A total of 171 procedures involving 129 patients (pre-pathway group) and 146 procedures involving 115 patients (post-pathway group) was analysed. The rate of complications prior to the pleural pathway was 22.2% (38 of 171 procedures). Following the pathway, the rate of complications declined to 7.5% (11 of 146 procedures, P < 0.003). The use of pleural ultrasound increased dramatically (72.5 vs 90.2%). The number of patients who underwent repeated procedures (defined as ≥3) reduced dramatically (21 vs 7, P < 0.01). This improvement occurred using many supervised operators who completed the hands-on teaching programme (n = 32) and followed the pleural pathway (127 of 146 procedures). The instigation of a clinical pathway focused on the use of bedside pleural ultrasound, and teaching of drainage techniques with procedure supervision vastly improved patient outcomes. This not only allowed better quality of care for patients, it also provided the acquisition of new skills to medical staff, not limiting these skills to specialised staff. © 2017 Royal Australasian College of Physicians.

Implementation of learning outcome attainment measurement system in aviation engineering higher education

Science.gov (United States)

Salleh, I. Mohd; Mat Rani, M.

2017-12-01

This paper aims to discuss the effectiveness of the Learning Outcome Attainment Measurement System in assisting Outcome Based Education (OBE) for Aviation Engineering Higher Education in Malaysia. Direct assessments are discussed to show the implementation processes that become a key role in the successful outcome measurement system. A case study presented in this paper involves investigation on the implementation of the system in Aircraft Structure course for Bachelor in Aircraft Engineering Technology program in UniKL-MIAT. The data has been collected for five semesters, starting from July 2014 until July 2016. The study instruments used include the report generated in Learning Outcomes Measurements System (LOAMS) that contains information on the course learning outcomes (CLO) individual and course average performance reports. The report derived from LOAMS is analyzed and the data analysis has revealed that there is a positive significant correlation between the individual performance and the average performance reports. The results for analysis of variance has further revealed that there is a significant difference in OBE grade score among the report. Independent samples F-test results, on the other hand, indicate that the variances of the two populations are unequal.

Decentralization and health system performance – a focused review of dimensions, difficulties, and derivatives in India

Directory of Open Access Journals (Sweden)

Bhuputra Panda

2016-10-01

Full Text Available Abstract Introduction One of the principal goals of any health care system is to improve health through the provision of clinical and public health services. Decentralization as a reform measure aims to improve inputs, management processes and health outcomes, and has political, administrative and financial connotations. It is argued that the robustness of a health system in achieving desirable outcomes is contingent upon the width and depth of ‘decision space’ at the local level. Studies have used different approaches to examine one or more facets of decentralization and its effect on health system functioning; however, lack of consensus on an acceptable framework is a critical gap in determining its quantum and quality. Theorists have resorted to concepts of ‘trust’, ‘convenience’ and ‘mutual benefits’ to explain, define and measure components of governance in health. In the emerging ‘continuum of health services’ model, the challenge lies in identifying variables of performance (fiscal allocation, autonomy at local level, perception of key stakeholders, service delivery outputs, etc. through the prism of decentralization in the first place, and in establishing directed relationships among them. Methods This focused review paper conducted extensive web-based literature search, using PubMed and Google Scholar search engines. After screening of key words and study objectives, we retrieved 180 articles for next round of screening. One hundred and four full articles (three working papers and 101 published papers were reviewed in totality. We attempted to summarize existing literature on decentralization and health systems performance, explain key concepts and essential variables, and develop a framework for further scientific scrutiny. Themes are presented in three separate segments of dimensions, difficulties and derivatives. Results Evaluation of local decision making and its effect on health system performance has been

Five focus strategies to organize health care delivery.

Science.gov (United States)

Peltokorpi, Antti; Linna, Miika; Malmström, Tomi; Torkki, Paulus; Lillrank, Paul Martin

2016-01-01

The focused factory is one of the concepts that decision-makers have adopted for improving health care delivery. However, disorganized definitions of focus have led to findings that cannot be utilized systematically. The purpose of this paper is to discuss strategic options to focus health care operations. First the literature on focus in health care is reviewed revealing conceptual challenges. Second, a definition of focus in terms of demand and requisite variety is defined, and the mechanisms of focus are explicated. A classification of five focus strategies that follow the original idea to reduce variety in products and markets is presented. Finally, the paper examines managerial possibilities linked to the focus strategies. The paper proposes a framework of five customer-oriented focus strategies which aim at reducing variety in different characteristics of care pathways: population; urgency and severity; illnesses and symptoms; care practices and processes; and care outcomes. Empirical research is needed to evaluate the costs and benefits of the five strategies and about system-level effects of focused units on competition and coordination. Focus is an enabling condition that needs to be exploited using specific demand and supply management practices. It is essential to understand how focus mechanisms differ between strategies, and to select focus that fits with organization's strategy and key performance indicators. Compared to previous more resource-oriented approaches, this study provides theoretically solid and practically relevant customer-oriented framework for focusing in health care.

Pregnancy in complex CHD: focus on patients with Fontan circulation and patients with a systemic right ventricle.

Science.gov (United States)

Khan, Abigail; Kim, Yuli Y

2015-12-01

The majority of children with congenital heart disease (CHD) now survive into adulthood, and many women with CHD want to pursue pregnancy. Pregnancy represents a complex issue for the CHD care provider. It requires balancing the interests of the woman against the risk to her health during pregnancy, while also factoring in the long-term risks to her health and the risk to her fetus. Our knowledge about this subject has been historically limited by lack of data regarding the outcome of pregnancy in CHD; however, in recent years, more data have begun to emerge. In this review, we will summarise what is known about risk assessment in pregnant CHD patients. We provide a framework for healthcare providers managing pregnancy in this population, with focus on the systemic right ventricle and the Fontan operation.

WITHDRAWN: Nursing record systems: effects on nursing practice and healthcare outcomes.

Science.gov (United States)

Urquhart, Christine; Currell, Rosemary; Grant, Maria J; Hardiker, Nicholas R

2018-05-15

A nursing record system is the record of care that was planned or given to individual patients and clients by qualified nurses or other caregivers under the direction of a qualified nurse. Nursing record systems may be an effective way of influencing nurse practice. To assess the effects of nursing record systems on nursing practice and patient outcomes. For the original version of this review in 2000, and updates in 2003 and 2008, we searched: the Cochrane Effective Practice and Organisation of Care (EPOC) Group Specialised Register; MEDLINE, EMBASE, CINAHL, BNI, ISI Web of Knowledge, and ASLIB Index of Theses. We also handsearched: Computers, Informatics, Nursing (Computers in Nursing); Information Technology in Nursing; and the Journal of Nursing Administration. For this update, searches can be considered complete until the end of 2007. We checked reference lists of retrieved articles and other related reviews. Randomised controlled trials (RCTs), controlled before and after studies, and interrupted time series comparing one kind of nursing record system with another in hospital, community or primary care settings. The participants were qualified nurses, students or healthcare assistants working under the direction of a qualified nurse, and patients receiving care recorded or planned using nursing record systems. Two review authors (in two pairs) independently assessed trial quality and extracted data. We included nine trials (eight RCTs, one controlled before and after study) involving 1846 people. The studies that evaluated nursing record systems focusing on relatively discrete and focused problems, for example effective pain management in children, empowering pregnant women and parents, reducing loss of notes, reducing time spent on data entry of test results, reducing transcription errors, and reducing the number of pieces of paper in a record, all demonstrated some degree of success in achieving the desired results. Studies of nursing care planning

LEARN 2 MOVE 2-3: a randomized controlled trial on the efficacy of child-focused intervention and context-focused intervention in preschool children with cerebral palsy

Directory of Open Access Journals (Sweden)

Verschuren Olaf

2010-11-01

Full Text Available Abstract Background Little is known about the efficacy and the working mechanisms of physical and occupational therapy interventions for children with cerebral palsy (CP. In recent years a shift from a child-focused intervention approach to a more context-focused intervention approach can be recognized. Until now the evidence on the efficacy and the working mechanisms of these interventions for children with CP is inconclusive. This study aims to evaluate the efficacy and working mechanisms of two intervention approaches compared to regular care intervention in improving mobility and self-care skills of children (2-3 years with CP and their families: a child-focused intervention approach and a context-focused intervention approach. Methods/Design A multi-centre, randomized controlled trial research design will be used. Ninety-four children with CP (Gross Motor Function Classification System (GMFCS level I-IV; age 2 to 3 years, their parents, and service providers (physical and occupational therapists will be included. During a period of six months children will receive child-focused, context-focused or regular care intervention. Therapists will be randomly assigned to deliver either a child-focused intervention approach, a context-focused intervention approach or regular care intervention. Children follow their therapist into the allocated intervention arm. After the six months study-intervention period, all participants return to regular care intervention. Outcomes will be evaluated at baseline, after six months and at a three months follow-up period. Primary outcome is the capability of functional skills in self-care and mobility, using the Functional Skills Scale of the Pediatric Evaluation of Disability Inventory (PEDI. Other outcomes will be quality of life and the domains of the International Classification of Functioning, Disability and Health - for Children and Youth (ICF-CY, including body function and structure, activities (gross motor

Immersion and distancing during assimilation of problematic experiences in a good-outcome case of emotion-focused therapy.

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Barbosa, Eunice; Couto, Ana Bela; Basto, Isabel; Stiles, William B; Pinto-Gouveia, José; Salgado, João

2018-03-01

Some studies have suggested that a decrease in immersion (egocentric perspective on personal experiences) and an increase in distancing (observer perspective on personal experiences) are associated with the resolution of clinical problems and positive outcome in psychotherapy for depression. To help clarify how this change in perspectives relates to clinical change, the present study compared changes in immersion and distancing across therapy with progress in one client's assimilation of her problematic experiences. We analyzed all passages referring to the central problematic experience in a good-outcome case of emotion-focused therapy for depression using the Measure of Immersion and Distancing Speech and the Assimilation of Problematic Experiences Scale. Results showed that immersion and distancing were associated with different stages of assimilation. Immersion was associated with stages of emerging awareness and clarification of the problem and in the application of new understandings to daily life. Distancing was associated with problem-solving and attaining insight. The decrease of immersion and increase of distancing associated with therapeutic improvement should not be taken as a recommendation to avoid immersion and encourage distancing. Immersion and distancing may work as coordinated aspects of the processes of psychotherapeutic change.

The role of organizational control systems in employees’ organizational trust and performance outcomes

NARCIS (Netherlands)

Verburg, R.M.; Nienaber, A.; Searle, R.H.; Weibel, A.; Den Hartog, D.N.; Rupp, D.E.

2018-01-01

This study examined how organizational control is related to employees’ organizational trust. We specifically focus on how different forms of control (process, outcome, and normative) relate to employees’ trust in their employing organizations and examine whether such trust in turn relates

The National Outcomes Measurement System for Pediatric Speech-Language Pathology

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Mullen, Robert; Schooling, Tracy

2010-01-01

Purpose: The American Speech-Language-Hearing Association's (ASHA's) National Outcomes Measurement System (NOMS) was developed in the late 1990s. The primary purpose was to serve as a source of data for speech-language pathologists (SLPs) who found themselves called on to provide empirical evidence of the functional outcomes associated with their…

Severity scoring in the critically ill: part 2: maximizing value from outcome prediction scoring systems.

Science.gov (United States)

Breslow, Michael J; Badawi, Omar

2012-02-01

Part 2 of this review of ICU scoring systems examines how scoring system data should be used to assess ICU performance. There often are two different consumers of these data: lCU clinicians and quality leaders who seek to identify opportunities to improve quality of care and operational efficiency, and regulators, payors, and consumers who want to compare performance across facilities. The former need to know how to garner maximal insight into their care practices; this includes understanding how length of stay (LOS) relates to quality, analyzing the behavior of different subpopulations, and following trends over time. Segregating patients into low-, medium-, and high-risk populations is especially helpful, because care issues and outcomes may differ across this severity continuum. Also, LOS behaves paradoxically in high-risk patients (survivors often have longer LOS than nonsurvivors); failure to examine this subgroup separately can penalize ICUs with superior outcomes. Consumers of benchmarking data often focus on a single score, the standardized mortality ratio (SMR). However, simple SMRs are disproportionately affected by outcomes in high-risk patients, and differences in population composition, even when performance is otherwise identical, can result in different SMRs. Future benchmarking must incorporate strategies to adjust for differences in population composition and report performance separately for low-, medium- and high-acuity patients. Moreover, because many ICUs lack the resources to care for high-acuity patients (predicted mortality >50%), decisions about where patients should receive care must consider both ICU performance scores and their capacity to care for different types of patients.

Patient-focused goal planning process and outcome after spinal cord injury rehabilitation: quantitative and qualitative audit.

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Byrnes, Michelle; Beilby, Janet; Ray, Patricia; McLennan, Renee; Ker, John; Schug, Stephan

2012-12-01

To evaluate the process and outcome of a multidisciplinary inpatient goal planning rehabilitation programme on physical, social and psychological functioning for patients with spinal cord injury. Clinical audit: quantitative and qualitative analyses. Specialist spinal injury unit, Perth, Australia. Consecutive series of 100 newly injured spinal cord injury inpatients. MAIN MEASURE(S): The Needs Assessment Checklist (NAC), patient-focused goal planning questionnaire and goal planning progress form. The clinical audit of 100 spinal cord injured patients revealed that 547 goal planning meetings were held with 8531 goals stipulated in total. Seventy-five per cent of the goals set at the first goal planning meeting were achieved by the second meeting and the rate of goal achievements at subsequent goal planning meetings dropped to 56%. Based on quantitative analysis of physical, social and psychological functioning, the 100 spinal cord injury patients improved significantly from baseline to discharge. Furthermore, qualitative analysis revealed benefits consistently reported by spinal cord injury patients of the goal planning rehabilitation programme in improvements to their physical, social and psychological adjustment to injury. The findings of this clinical audit underpin the need for patient-focused goal planning rehabilitation programmes which are tailored to the individual's needs and involve a comprehensive multidisciplinary team.

The Role of Organizational Control Systems in Employees’ Organizational Trust and Performance Outcomes

NARCIS (Netherlands)

Verburg, R.M.; Nienaber, Ann Marie; Searle, Rosalind H.; Weibel, Antoinette; Den Hartog, Deanne N.; Rupp, Deborah E.

2018-01-01

This study examined how organizational control is related to employees’ organizational trust. We specifically focus on how different forms of control (process, outcome, and normative) relate to employees’ trust in their employing organizations and examine whether such trust in turn relates

Pathways towards chronic care-focused healthcare systems: evidence from Spain.

Science.gov (United States)

García-Goñi, Manuel; Hernández-Quevedo, Cristina; Nuño-Solinís, Roberto; Paolucci, Francesco

2012-12-01

Increasing healthcare expenditure is a matter of concern in many countries, particularly in relation to the underlying drivers of such escalation that include ageing, medical innovation, and changes in the burden of disease, such as the growing prevalence of chronic diseases. Most healthcare systems in developed countries have been designed to 'cure' acute episodes, rather than to 'manage' chronic conditions, and therefore they are not suitably or efficiently organized to respond to the changing needs and preferences of users. New models of chronic care provision have been developed to respond to the changing burden of disease and there is already considerable practical experience in several different countries showing their advantages but also the difficulties associated with their implementation. In this paper, we focus on the Spanish experience in terms of policy changes and pilot studies focused on testing the feasibility of moving towards chronic care models. In particular, we discuss a framework that identifies and analyses ten key prerequisites to achieving high performing chronic care-based healthcare systems and apply it to the current Spanish National Health System (NHS). We find that the design of the Spanish NHS already meets some of these pre-requisites. However, other features are still in their early stages of development or are being applied only in limited geographical and clinical contexts. We outline the policies that are being implemented and the pathway that the Spanish NHS is taking to address the crucial challenge of the transition towards an optimal health system focused on chronic care. Given the current evidence and trends, we expect that the pathway for developing a chronicity strategy being followed by the Spanish NHS will significantly transform its current healthcare delivery model in the next few years. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Benefits of SGLT2 Inhibitors beyond glycemic control - A focus on metabolic, cardiovascular, and renal outcomes.

Science.gov (United States)

Minze, Molly G; Will, Kayley; Terrell, Brian T; Black, Robin L; Irons, Brian K

2017-08-16

Sodium-glucose co-transporter 2 (SGLT2) inhibitors are a new pharmacotherapeutic class for the treatment of type 2 diabetes mellitus (T2DM). To evaluate beneficial effects of the SGLT2 inhibitors on metabolic, cardiovascular, and renal outcomes. A Pub-Med search (1966 to July 2017) was performed of published English articles using keywords sodium-glucose co-transporter 2 inhibitors, canagliflozin, dapagliflozin, and empagliflozin. A review of literature citations provided further references. The search identified 17clinical trials and 2 meta-analysis with outcomes of weight loss and blood pressure reduction with dapagliflozin, canagliflozin, or empagliflozin. Three randomized trials focused on either empagliflozin or canagliflozin and reduction of cardiovascular disease and progression of renal disease. SGLT2 inhibitors have a beneficial profile in the treatment of T2DM. They have evidence of reducing weight between 2.9 kilograms when used as monotherapy to 4.7 kilograms when used in combination with metformin, and reduce systolic blood pressure between 3 to 5 mmHg and reduce diastolic blood pressure approximately 2 mmHg. To date, reduction of cardiovascular events was seen specifically with empagliflozin in patients with T2DM and a history of cardiovascular disease. In the same population, empagliflozin was associated with slowing the progression of kidney disease. Moreover, patients with increased risk of cardiovascular disease treated with canagliflozin has decreased risk of death from cardiovascular causes, nonfatal MI, or nonfatal stroke. Data regarding these outcomes with dapagliflozin are underway. SGLT2 inhibitors demonstrate some positive metabolic effects. In addition, empagliflozin specifically has demonstrated reduction in cardiovascular events and delay in the progression of kidney disease in patients with T2DM and a history of cardiovascular disease. Further data is needed to assess if this is a class effect. Copyright© Bentham Science Publishers

Master's Degree in Management Information Systems with a Supply Chain Management Focus

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Ramaswamy, Kizhanatham V.; Boyd, Joseph L.; Desai, Mayur

2007-01-01

A graduate curriculum in Management Information Systems with a Supply Chain Management focus is presented. The motivation for this endeavor stems from the fact that the global scope of modern business organizations and the competitive environment in which they operate, requires an information system leveraged supply chain management system (SCM)…

Investigating the debate of home birth safety: A critical review of cohort studies focusing on selected infant outcomes.

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Elder, Heather R; Alio, Amina P; Fisher, Susan G

2016-07-01

There is a debate within the medical community regarding the safety of planned home births. The presumption of increased risk of maternal and infant morbidity and mortality at home due to limited access to life-saving interventions is not clearly supported by research. The aim of the present study was to assess strengths and limitations of the methodological approaches of cohort studies that compare home births with hospital births by focusing on selected infant outcomes. Studies were identified that assess the risk for at least one of three infant outcomes (mortality, Apgar score, and admission to the neonatal intensive care unit [NICU]) of home births compared with hospital births. Fifteen cohort studies were included. Two studies of low-risk births and two including higher risk births found home births to be at an increased risk of neonatal mortality. However, mortality is rare in developed nations and may not be the best measure of safety. When studies focused on low-risk pregnancies, planned birth location, and well-trained birth attendants, there was no difference in neonatal morbidity (Apgar score and NICU admission). Many methodological challenges were identified among these studies. This review contributes to the home birth published work by identifying key strengths and limitations that need to be accounted for in the interpretation of study findings and the development of future studies. Based on this review, the key variables that would strengthen future studies are birth attendant identification, documented planned birth location, and specification of the birth risk level. Uniformity of data collection and minimizing missing data are also critical. © 2016 Japan Academy of Nursing Science.

Structure and magnetic field of periodic permanent magnetic focusing system with open magnetic rings

International Nuclear Information System (INIS)

Peng Long; Li Lezhong; Yang Dingyu; Zhu Xinghua; Li Yuanxun

2011-01-01

The magnetic field along the central axis for an axially magnetized permanent magnetic ring was investigated by analytical and finite element methods. For open magnetic rings, both calculated and measured results show that the existence of the radial magnetic field creates a remarkable cosine distribution field along the central axis. A new structure of periodic permanent magnet focusing system with open magnetic rings is proposed. The structure provides a satisfactory magnetic field with a stable peak value of 120 mT for a traveling wave tube system. - Research highlights: → For open magnetic rings, both calculated and measured results show that the existence of the radial magnetic field creates a remarkable cosine distribution field along the central axis. → A new structure of periodic permanent magnet (PPM) focusing system with open magnetic rings is proposed. → The new PPM focusing system with open magnetic rings meets the requirements for TWT system.

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

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

2009-10-07

intervention for improving processes of care, morbidity, or mortality for severely injured patients. Two authors independently screened the search results, applied inclusion criteria, and extracted data. There were no studies identified that met the inclusion criteria for this review. We were unable to identify any studies of sufficient methodological quality to draw conclusions regarding the effectiveness of audit filters as a performance improvement intervention in trauma systems. Future research using rigorous study designs should focus on the relative effectiveness of audit filters in comparison to alternative quality improvement strategies at improving processes of care, functional outcomes, and mortality for injured patients.

Solar thermal power systems point-focusing thermal and electric applications projects. Volume 1: Executive summary

Science.gov (United States)

Marriott, A.

1980-01-01

The activities of the Point-Focusing Thermal and Electric Applications (PETEA) project for the fiscal year 1979 are summarized. The main thrust of the PFTEA Project, the small community solar thermal power experiment, was completed. Concept definition studies included a small central receiver approach, a point-focusing distributed receiver system with central power generation, and a point-focusing distributed receiver concept with distributed power generation. The first experiment in the Isolated Application Series was initiated. Planning for the third engineering experiment series, which addresses the industrial market sector, was also initiated. In addition to the experiment-related activities, several contracts to industry were let and studies were conducted to explore the market potential for point-focusing distributed receiver (PFDR) systems. System analysis studies were completed that looked at PFDR technology relative to other small power system technology candidates for the utility market sector.

Instructions to Adopt an External Focus Enhance Muscular Endurance

Science.gov (United States)

Marchant, David C.; Greig, Matt; Bullough, Jonathan; Hitchen, Daniel

2011-01-01

The influence of internal (movement focus) and external (outcome focus) attentional-focusing instructions on muscular endurance were investigated using three exercise protocols with experienced exercisers. Twenty-three participants completed a maximal repetition, assisted bench-press test on a Smith's machine. An external focus of attention…

Focus is key: Panic-focused interpretations are associated with symptomatic improvement in panic-focused psychodynamic psychotherapy.

Science.gov (United States)

Keefe, John R; Solomonov, Nili; Derubeis, Robert J; Phillips, Alexander C; Busch, Fredric N; Barber, Jacques P; Chambless, Dianne L; Milrod, Barbara L

2018-04-18

This study examines whether, in panic-focused psychodynamic psychotherapy (PFPP), interpretations of conflicts that underlie anxiety (panic-focused or PF-interpretations) are specifically associated with subsequent panic disorder (PD) symptom improvement, over and above the provision of non-symptom-focused interpretations. Technique use in Sessions 2 and 10 of a 24-session PFPP protocol was assessed for the 65 patients with complete outcome data randomized to PFPP in a two-site trial of psychotherapies for PD. Sessions were rated in 15-min segments for therapists' use of PF-interpretations, non-PF-interpretations, and PF-clarifications. Robust regressions were conducted to examine the relationship between these interventions and symptom change subsequent to the sampled session. Interpersonal problems were examined as a moderator of the relationship of PF-interpretations to symptom change. At Session 10, but not at Session 2, patients who received a higher degree of PF-interpretations experienced greater subsequent improvement in panic symptoms. Non-PF-interpretations were not predictive. Patients with more interpersonal distress benefitted particularly from the use of PF-interpretations at Session 10. By the middle phase of PFPP, panic-focused interpretations may drive subsequent improvements in panic symptoms, especially among patients with higher interpersonal distress. Interpretations of conflict absent a panic focus may not be especially helpful.

Three-Dimensional Design of a Non-Axisymmetric Periodic Permanent Magnet Focusing System

CERN Document Server

Chen Chi Ping; Radovinsky, Alexey; Zhou, Jing

2005-01-01

A three-dimensional (3D) design is presented of a non-axisymmetric periodic permanent magnet focusing system which will be used to focus a large-aspect-ratio, ellipse-shaped, space-charge-dominated electron beam. In this design, an analytic theory is used to specify the magnetic profile for beam transport. The OPERA3D code is used to compute and optimize a realizable magnet system. Results of the magnetic design are verified by two-dimensional particle-in-cell and three-dimensional trajectory simulations of beam propagation using PFB2D and OMNITRAK, respectively. Results of fabrication tolerance studies are discussed.

Acoustic field of focusing phased array probe and the scanning system

International Nuclear Information System (INIS)

Murai, J.; Miura, S.; Ida, T.; Shiraiwa, T.; Miya, T.

1997-01-01

Acoustic field of a point focusing cylindrical linear array probe, in which focusing in the axial direction of cylinder is done by the phased linear array and focusing in the orthogonal direction is done geometrically, was studied by numerical calculation and an optimum design of phased array probe for focusing has been obtained. In generally speaking, the beam width at focus point decreases with decrease of width of each transducer element and with increase of synthetic aperture made by total elements. If the number of total array elements excited as one pulse is limited, the above conditions are contradicted. Thus, an optimum element width exists for the best focusing. On the above consideration, we can get focusing ability of phased array nearly as same as geometrical focusing. A developed transducer is a linear array of polymer piezoelectric material of cylindrical shape, of which radius is from 50 mm to 75 mm. The frequency is 10 Mhz and the beam width of 0.5 mm (depending on aperture) in the orthogonal direction to the cylinder axis and 0.7 mm width in the cylinder axis (phased array focusing) have been obtained. A delay circuit for exciting the transducer was newly designed to give maximum performance to the array regarding to accuracy, stability, easy control and etc. A c-scan ultrasonic testing system equipped with this transducer has sixteen times inspection speed compared to the single probe instrument.

The Financial Analysis with Focus of Risks in the Banking System

Directory of Open Access Journals (Sweden)

Aleisky González-Duany

2017-06-01

Full Text Available The article consists in exposes the importance, need and convenience to develop a financial analysis with focus of risks in the banking activity to avoid damages and to take exactly and opportunity decisions. This analysis linked with bank risks will allow to the banking system measuring the efficiency in the different services that you render, detecting the different inherent risks to the financial activity with a former focus before, for the sake of giving fulfillment to the organizational goals

A conceptual design of Final Focus Systems for linear colliders

International Nuclear Information System (INIS)

Brown, K.L.

1987-06-01

Linear colliders are a relatively recent development in the evolution of particle accelerators. This report discusses some of the approaches that have been considered for the design of Final Focus Systems to demagnify the beam exiting from a linac to the small size suitable for collisions at the interaction point. The system receiving the most attention is the one adopted for the SLAC Linear Collider. However, the theory and optical techniques discussed should be applicable to the design efforts for future machines

EDITORIAL: Focus on Mechanical Systems at the Quantum Limit FOCUS ON MECHANICAL SYSTEMS AT THE QUANTUM LIMIT

Science.gov (United States)

Aspelmeyer, Markus; Schwab, Keith

2008-09-01

diverse backgrounds and approaches of the researchers. As diverse as the approaches are the manifold of goals and perspectives for operating mechanical systems close to or within the quantum regime. Already now, nanomechanical sensors achieve single-molecule mass detection and magnetic resonance force detection from single-electron spins although they are operated far from quantum. Quantum-limited mechanical devices promise a new technology with hitherto unachieved performance for high-resolution sensing. This is also of high relevance for macroscopic mechanical resonators used in gravitational wave detectors. Furthermore, the increasing capability to couple mechanical modes to individual quantum systems raises the interesting question of whether mechanics can serve as a quantum bus in hybrid implementations of quantum information processing. Finally, the possibility of generating quantum superposition states that involve displacements of a massive macroscopic object (such as the center of mass of a mechanical beam) provides a completely new parameter regime for testing quantum theory over the amazing range from nanomechanical objects of several picograms up to gram-scale mirrors used in gravitational wave interferometers. We are looking forward to these fascinating developments! This Focus Issue is intended to highlight the present status of the field and to provide both introduction and motivation for students and researchers who want to get familiar with this exciting area or even want to join it. It also complements the conference activities of our community during the last year, where a series of dedicated invited sessions at several international conferences (APS March Meeting 2008, CLEO/QELS 2008, OSA Frontiers in Optics 2008, PQE 2008/2009 etc) culminated in the first Gordon Conference on 'Mechanical Systems at the Quantum Limit'. Given the fast development of the field it was not surprising to see that during the collection of the following contributions new

Establishing and evaluating the key functions of an interactive systems framework using an assets-getting to outcomes intervention.

Science.gov (United States)

Chinman, Matthew; Acosta, Joie; Ebener, Patricia; Q Burkhart; Clifford, Michael; Corsello, Maryann; Duffey, Tim; Hunter, Sarah; Jones, Margaret; Lahti, Michel; Malone, Patrick S; Paddock, Susan; Phillips, Andrea; Savell, Susan; Scales, Peter C; Tellett-Royce, Nancy

2012-12-01

Community practitioners can face difficulty in achieving outcomes demonstrated by prevention science. Building a community practitioner's prevention capacity-the knowledge and skills needed to conduct critical prevention practices-could improve the quality of prevention and its outcomes. The purpose of this article is to: (1) describe how an intervention called Assets-Getting To Outcomes (AGTO) was used to establish the key functions of the ISF and present early lessons learned from that intervention's first 6 months and (2) examine whether there is an empirical relationship between practitioner capacity at the individual level and the performance of prevention at the program level-a relationship predicted by the ISF but untested. The article describes an operationalization of the ISF in the context of a five-year randomized controlled efficacy trial that combines two complementary models designed to build capacity: Getting To Outcomes (GTO) and Developmental Assets. The trial compares programs and individual practitioners from six community-based coalitions using AGTO with programs and practitioners from six similar coalitions that are not. In this article, we primarily focus on what the ISF calls innovation specific capacity and discuss how the combined AGTO innovation structures and uses feedback about its capacity-building activities, which can serve as a model for implementing the ISF. Focus group discussions used to gather lessons learned from the first 6 months of the AGTO intervention suggest that while the ISF may have been conceptualized as three distinct systems, in practice they are less distinct. Findings from the baseline wave of data collection of individual capacity and program performance suggest that practitioner capacity predicts, in part, performance of prevention programs. Empirically linking practitioner capacity and performance of prevention provides empirical support for both the ISF and AGTO.

Social Work Assessment Notes: A Comprehensive Outcomes-Based Hospice Documentation System.

Science.gov (United States)

Hansen, Angela Gregory; Martin, Ellen; Jones, Barbara L; Pomeroy, Elizabeth C

2015-08-01

This article describes the development of an integrated psychosocial patient and caregiver assessment and plan of care for hospice social work documentation. A team of hospice social workers developed the Social Work Assessment Notes as a quality improvement project in collaboration with the information technology department. Using the Social Work Assessment Tool as an organizing framework, this comprehensive hospice social work documentation system is designed to integrate assessment, planning, and outcomes measurement. The system was developed to guide the assessment of patients' and caregivers' needs related to end-of-life psychosocial issues, to facilitate collaborative care plan development, and to measure patient- and family-centered outcomes. Goals established with the patient and the caregiver are documented in the plan of care and become the foundation for patient-centered, strengths-based interventions. Likert scales are used to assign numerical severity levels for identified issues and progress made toward goals and to track the outcome of social work interventions across nine psychosocial constructs. The documentation system was developed for use in an electronic health record but can be used for paper charting. Future plans include automated aggregate outcomes measurement to identify the most effective interventions and best practices in end-of-life care.

A Dynamic Alignment System for the Final Focus Test Beam

International Nuclear Information System (INIS)

Ruland, R.E.; Bressler, V.E.; Fischer, G.; Plouffe, D.; SLAC

2005-01-01

The Final Focus Test Beam (FFTB) was conceived as a technological stepping stone on the way to the next linear collider. Nowhere is this more evident than with the alignment subsystems. Alignment tolerances for components prior to beam turn are almost an order of magnitude smaller than for previous projects at SLAC. Position monitoring systems which operate independent of the beam are employed to monitor motions of the components locally and globally with unprecedented precision. An overview of the FFTB alignment system is presented herein

Chronic stress impacts the cardiovascular system: animal models and clinical outcomes.

Science.gov (United States)

Golbidi, Saeid; Frisbee, Jefferson C; Laher, Ismail

2015-06-15

Psychological stresses are associated with cardiovascular diseases to the extent that cardiovascular diseases are among the most important group of psychosomatic diseases. The longstanding association between stress and cardiovascular disease exists despite a large ambiguity about the underlying mechanisms. An array of possibilities have been proposed including overactivity of the autonomic nervous system and humoral changes, which then converge on endothelial dysfunction that initiates unwanted cardiovascular consequences. We review some of the features of the two most important stress-activated systems, i.e., the humoral and nervous systems, and focus on alterations in endothelial function that could ensue as a result of these changes. Cardiac and hematologic consequences of stress are also addressed briefly. It is likely that activation of the inflammatory cascade in association with oxidative imbalance represents key pathophysiological components of stress-induced cardiovascular changes. We also review some of the commonly used animal models of stress and discuss the cardiovascular outcomes reported in these models of stress. The unique ability of animals for adaptation under stressful conditions lessens the extrapolation of laboratory findings to conditions of human stress. An animal model of unpredictable chronic stress, which applies various stress modules in a random fashion, might be a useful solution to this predicament. The use of stress markers as indicators of stress intensity is also discussed in various models of animal stress and in clinical studies. Copyright © 2015 the American Physiological Society.

Airbreathing Hypersonic Systems Focus at NASA Langley Research Center

Science.gov (United States)

Hunt, James L.; Rausch, Vincent L.

1998-01-01

This paper presents the status of the airbreathing hypersonic airplane and space-access vehicle design matrix, reflects on the synergies and issues, and indicates the thrust of the effort to resolve the design matrix and to focus/advance systems technology maturation. Priority is given to the design of the vision operational vehicles followed by flow-down requirements to flight demonstrator vehicles and their design for eventual consideration in the Future-X Program.

Auditory Outcomes with Hearing Rehabilitation in Children with Unilateral Hearing Loss: A Systematic Review.

Science.gov (United States)

Appachi, Swathi; Specht, Jessica L; Raol, Nikhila; Lieu, Judith E C; Cohen, Michael S; Dedhia, Kavita; Anne, Samantha

2017-10-01

Objective Options for management of unilateral hearing loss (UHL) in children include conventional hearing aids, bone-conduction hearing devices, contralateral routing of signal (CROS) aids, and frequency-modulating (FM) systems. The objective of this study was to systematically review the current literature to characterize auditory outcomes of hearing rehabilitation options in UHL. Data Sources PubMed, EMBASE, Medline, CINAHL, and Cochrane Library were searched from inception to January 2016. Manual searches of bibliographies were also performed. Review Methods Studies analyzing auditory outcomes of hearing amplification in children with UHL were included. Outcome measures included functional and objective auditory results. Two independent reviewers evaluated each abstract and article. Results Of the 249 articles identified, 12 met inclusion criteria. Seven articles solely focused on outcomes with bone-conduction hearing devices. Outcomes favored improved pure-tone averages, speech recognition thresholds, and sound localization in implanted patients. Five studies focused on FM systems, conventional hearing aids, or CROS hearing aids. Limited data are available but suggest a trend toward improvement in speech perception with hearing aids. FM systems were shown to have the most benefit for speech recognition in noise. Studies evaluating CROS hearing aids demonstrated variable outcomes. Conclusions Data evaluating functional and objective auditory measures following hearing amplification in children with UHL are limited. Most studies do suggest improvement in speech perception, speech recognition in noise, and sound localization with a hearing rehabilitation device.

Do hedonic motives moderate regulatory focus motives? Evidence from the framing of persuasive messages.

Science.gov (United States)

Malaviya, Prashant; Brendl, C Miguel

2014-01-01

Research on regulatory focus has established a regulatory matching effect: The persuasiveness of a message is enhanced when regulatory orientations of message and perceiver match (i.e., both are promotion or both are prevention). We report evidence that varying the hedonic outcome reverses this effect. We manipulated hedonic outcome by explicitly stating pleasurable versus painful outcomes as part of the message frame as well as by priming perceivers to focus on either pleasurable or painful outcomes. When both message and perceiver were focused on pleasurable outcomes, we replicated the regulatory matching effect. However, the matching effect reversed when the hedonic outcome of the message was opposed to that of the perceiver (i.e., one was pleasurable and the other painful). Under these conditions, messages that mismatched the perceivers' regulatory orientation were more persuasive (i.e., promotion message for a prevention oriented perceiver or vice versa). We also examined the persuasion effects when both message and perceiver were focused on painful outcomes and found that the regulatory matching effect re-emerged. The reversal of the regulatory matching effect by hedonic outcome strongly suggests that hedonic motives (approach of pleasure vs. avoidance of pain) and regulatory focus motives are distinct constructs. This is important because contrary to theoretical statements these constructs have often been confounded.

Electron beam final focus system for Thomson scattering at ELBE

Energy Technology Data Exchange (ETDEWEB)

Krämer, J.M., E-mail: jmkr@danfysik.dk [Danfysik A/S, Gregersensvej 8, 2630 Taastrup (Denmark); Helmholtz-Zentrum Dresden-Rossendorf, Institute of Radiation Physics, Bautzner Landstrasse 400, 01328 Dresden (Germany); Technische Universität Dresden, 01069 Dresden (Germany); Budde, M.; Bødker, F. [Danfysik A/S, Gregersensvej 8, 2630 Taastrup (Denmark); Irman, A.; Jochmann, A. [Helmholtz-Zentrum Dresden-Rossendorf, Institute of Radiation Physics, Bautzner Landstrasse 400, 01328 Dresden (Germany); Kristensen, J.P. [Danfysik A/S, Gregersensvej 8, 2630 Taastrup (Denmark); Lehnert, U.; Michel, P. [Helmholtz-Zentrum Dresden-Rossendorf, Institute of Radiation Physics, Bautzner Landstrasse 400, 01328 Dresden (Germany); Schramm, U. [Helmholtz-Zentrum Dresden-Rossendorf, Institute of Radiation Physics, Bautzner Landstrasse 400, 01328 Dresden (Germany); Technische Universität Dresden, 01069 Dresden (Germany)

2016-09-11

The design of an electron beam final focus system (FFS) aiming for high-flux laser-Thomson backscattering X-ray sources at ELBE is presented. A telescope system consisting of four permanent magnet based quadrupoles was found to have significantly less chromatic aberrations than a quadrupole doublet or triplet as commonly used. Focusing properties like the position of the focal plane and the spot size are retained for electron beam energies between 20 and 30 MeV by adjusting the position of the quadrupoles individually on a motorized stage. The desired ultra-short electron bunches require an increased relative energy spread up to a few percent and, thus, second order chromatic effects must be taken into account. We also present the design and test results of the permanent magnet quadrupoles. Adjustable shunts allow for correction of the field strength and compensation of deviations in the permanent magnet material. For a beam emittance of 13 mm mrad, we predict focal spot sizes of about 40 μm (rms) and divergences of about 10 mrad using the FFS.

Electron beam final focus system for Thomson scattering at ELBE

CERN Document Server

Krämer, J.M.; Bødker, F.; Irman, A.; .Jochmann A.; Kristensen, J.P.; Lehnert U., HZDR; Michel, P.; Schrammb, U.; 10.1016/j.nima.2015.10.067

2016-01-01

The design of an electron beam final focus system (FFS) aiming for high-flux laser-Thomson backscattering X-ray sources at ELBE is presented. A telescope system consisting of four permanent magnet based quadrupoles was found to have significantly less chromatic aberrations than a quadrupole doublet or triplet as commonly used. Focusing properties like the position of the focal plane and the spot size are retained for electron beam energies between 20 and 30 MeV by adjusting the position of the quadrupoles individually on a motorized stage. The desired ultra-short electron bunches require an increased relative energy spread up to a few percent and, thus, second order chromatic effects must be taken into account. We also present the design and test results of the permanent magnet quadrupoles. Adjustable shunts allow for correction of the field strength and compensation of deviations in the permanent magnet material. For a beam emittance of 13 mm mrad, we predict focal spot sizes of about 40 μm (rms) and diverg...

Electron Beam Final Focus System For Thomson Scattering At Elbe

CERN Document Server

Krämer, J.M.; Bødkera, F.; Irman, A.; Jochmann, A.; Kristensena, J.P.; Lehnert, U.; Michel, P.; Schramm, U.; 10.1016/j.nima.2015.10.067

2016-01-01

The design of an electron beam final focus system (FFS) aiming for high-flux laser-Thomson backscattering X-ray sources at ELBE is presented. A telescope system consisting of four permanent magnet based quadrupoles was found to have significantly less chromatic aberrations than a quadrupole doublet or triplet as commonly used. Focusing properties like the position of the focal plane and the spot size are retained for electron beam energies between 20 and 30 MeV by adjusting the position of the quadrupoles individually on a motorized stage. The desired ultra-short electron bunches require an increased relative energy spread up to a few percent and, thus, second order chromatic effects must be taken into account. We also present the design and test results of the permanent magnet quadrupoles. Adjustable shunts allow for correction of the field strength and compensation of deviations in the permanent magnet material. For a beam emittance of 13 mm mrad, we predict focal spot sizes of about 40 μm (rms) and diverg...

On Energy Efficient Mobile Hydraulic Systems : with Focus on Linear Actuation

OpenAIRE

Heybroek, Kim

2017-01-01

In this dissertation, energy efficient hydraulic systems are studied. The research focuses on solutions for linear actuators in mobile applications, with emphasis on construction machines. Alongside the aspect of energy efficiency, the thesis deals with competing aspects in hydraulic system design found in the development of construction machines. Simulation models and controls for different concepts are developed, taking the whole machine into account. In line with this work, several proof o...

A focused air-pulse system for optical-coherence-tomography-based measurements of tissue elasticity

International Nuclear Information System (INIS)

Wang, Shang; Larin, K V; Li, Jiasong; Vantipalli, S; Twa, M D; Manapuram, R K; Aglyamov, S; Emelianov, S

2013-01-01

Accurate non-invasive assessment of tissue elasticity in vivo is required for early diagnostics of many tissue abnormalities. We have developed a focused air-pulse system that produces a low-pressure and short-duration air stream, which can be used to excite transient surface waves (SWs) in soft tissues. System characteristics were studied using a high-resolution analog pressure transducer to describe the excitation pressure. Results indicate that the excitation pressure provided by the air-pulse system can be easily controlled by the air source pressure, the angle of delivery, and the distance between the tissue surface and the port of the air-pulse system. Furthermore, we integrated this focused air-pulse system with phase-sensitive optical coherence tomography (PhS-OCT) to make non-contact measurements of tissue elasticity. The PhS-OCT system is used to assess the group velocity of SW propagation, which can be used to determine Young’s modulus. Pilot experiments were performed on gelatin phantoms with different concentrations (10%, 12% and 14% w/w). The results demonstrate the feasibility of using this focused air-pulse system combined with PhS-OCT to estimate tissue elasticity. This easily controlled non-contact technique is potentially useful to study the biomechanical properties of ocular and other tissues in vivo. (letter)

Artificial Neural Network System to Predict the Postoperative Outcome of Percutaneous Nephrolithotomy.

Science.gov (United States)

Aminsharifi, Alireza; Irani, Dariush; Pooyesh, Shima; Parvin, Hamid; Dehghani, Sakineh; Yousofi, Khalilolah; Fazel, Ebrahim; Zibaie, Fatemeh

2017-05-01

To construct, train, and apply an artificial neural network (ANN) system for prediction of different outcome variables of percutaneous nephrolithotomy (PCNL). We calculated predictive accuracy, sensitivity, and precision for each outcome variable. During the study period, all adult patients who underwent PCNL at our institute were enrolled in the study. Preoperative and postoperative variables were recorded, and stone-free status was assessed perioperatively with computed tomography scans. MATLAB software was used to design and train the network in a feed forward back-propagation error adjustment scheme. Preoperative and postoperative data from 200 patients (training set) were used to analyze the effect and relative relevance of preoperative values on postoperative parameters. The validated adequately trained ANN was used to predict postoperative outcomes in the subsequent 254 adult patients (test set) whose preoperative values were serially fed into the system. To evaluate system accuracy in predicting each postoperative variable, predicted values were compared with actual outcomes. Two hundred fifty-four patients (155 [61%] males) were considered the test set. Mean stone burden was 6702.86 ± 381.6 mm 3 . Overall stone-free rate was 76.4%. Fifty-four out of 254 patients (21.3%) required ancillary procedures (shockwave lithotripsy 5.9%, transureteral lithotripsy 10.6%, and repeat PCNL 4.7%). The accuracy and sensitivity of the system in predicting different postoperative variables ranged from 81.0% to 98.2%. As a complex nonlinear mathematical model, our ANN system is an interconnected data mining tool, which prospectively analyzes and "learns" the relationships between variables. The accuracy and sensitivity of the system for predicting the stone-free rate, the need for blood transfusion, and post-PCNL ancillary procedures ranged from 81.0% to 98.2%.The stone burden and the stone morphometry were among the most significant preoperative characteristics that

Alternate financial incentives in multi-tiered formulary systems to improve accountability for outcomes.

Science.gov (United States)

Chung, Richard S; Taira, Deborah A; Noh, Charles

2003-01-01

Drug manufacturer rebates paid to health plans and pharmacy benefit management companies have come under increased public scrutiny. Over the past several years, numerous articles have appeared in the literature encouraging a shift to a more quality-based decision-making process for health plan drug formularies. To propose a new basis for formulary placement decisions that would include consideration of health-plan-specific measures (clinical outcomes, total cost, adherence, and appropriateness of care) and align incentives for health plans, physicians, pharmacists, and pharmaceutical companies to promote high-quality care. The proposed approach builds on key components of the Pharmacy's Framework for Drug Therapy Management in the 21st Century and the Academy of Managed Care Pharmacy's Format for Formulary Submission, including a focus on patient outcomes and evidence-based decision making. The proposed approach would lessen the influence of drug manufacturer rebates on formulary placement by shifting the focus to appropriateness of care, clinical outcomes, patient adherence, and total cost of care. Pharmaceutical manufacturers would benefit from the focus on adherence to drug therapy and total cost of care. Health plans and pharmacy benefit management companies would gain in that they may be able to reduce efforts in drug utilization review as pharmaceutical manufacturers are given incentives to market their drugs more appropriately. Physicians and pharmacists would benefit because the rebate money would be used to provide quality-based financial incentives related to adherence and appropriate use of drugs. The implementation of this approach would be difficult and require cooperation from employers, pharmacists, pharmaceutical manufacturers, health plans, and pharmacy benefit management companies. Aspects of this approach could be incorporated into existing pharmacy benefit management processes to encourage the delivery of high-quality health care.

Collecting, Integrating, and Disseminating Patient-Reported Outcomes for Research in a Learning Healthcare System.

Science.gov (United States)

Harle, Christopher A; Lipori, Gloria; Hurley, Robert W

2016-01-01

Advances in health policy, research, and information technology have converged to increase the electronic collection and use of patient-reported outcomes (PROs). Therefore, it is important to share lessons learned in implementing PROs in research information systems. The purpose of this case study is to describe a novel information system for electronic PROs and lessons learned in implementing that system to support research in an academic health center. The system incorporates freely available and commercial software and involves clinical and research workflows that support the collection, transformation, and research use of PRO data. The software and processes that comprise the system serve three main functions, (i) collecting electronic PROs in clinical care, (ii) integrating PRO data with non-patient generated clinical data, and (iii) disseminating data to researchers through the institution's research informatics infrastructure, including the i2b2 (Informatics for Integrating Biology and the Bedside) system. Our successful design and implementation was driven by three overarching strategies. First, we selected and implemented multiple interfaced technologies to support PRO collection, management, and research use. Second, we aimed to use standardized approaches to measuring PROs, sending PROs between systems, and disseminating PROs. Finally, we focused on using technologies and processes that aligned with existing clinical research information management strategies within our organization. These experiences and lessons may help future implementers and researchers enhance the scale and sustainable use of systems for research use of PROs.

On capillary self-focusing in a microfluidic system

Energy Technology Data Exchange (ETDEWEB)

Hein, M; Seemann, R [Experimental Physics, Saarland University, D-66123 Saarbrücken (Germany); Afkhami, S, E-mail: r.seemann@physik.uni-saarland.de, E-mail: shahriar.afkhami@njit.edu [Department of Mathematical Sciences, New Jersey Institute of Technology, Newark, NJ 07102 (United States)

2016-12-15

A computational framework is developed to address capillary self-focusing in step emulsification. The microfluidic system consists of a single shallow and wide microchannel that merges into a deep reservoir. A continuum approach coupled with a volume of fluid method is used to model the capillary self-focusing effect. The original governing equations are reduced using the Hele-Shaw approximation. We show that the interface between the two fluids takes the shape of a neck narrowing in the flow direction just before entering the reservoir, in agreement with our experimental observations. Our computational model relies on the assumption that the pressure at the boundary, where the fluid exits into the reservoir, is the uniform pressure in the reservoir. We investigate this hypothesis by comparing the numerical results with experimental data. We conjecture that the pressure boundary condition becomes important when the width of the neck is comparable to the depth of the microchannel. A correction to the exit pressure boundary condition is then proposed, which is determined by comparison with experimental data. We also present the experimental observations and the numerical results of the transitions of breakup regimes. (paper)

Pediatric Intubation by Paramedics in a Large Emergency Medical Services System: Process, Challenges, and Outcomes.

Science.gov (United States)

Prekker, Matthew E; Delgado, Fernanda; Shin, Jenny; Kwok, Heemun; Johnson, Nicholas J; Carlbom, David; Grabinsky, Andreas; Brogan, Thomas V; King, Mary A; Rea, Thomas D

2016-01-01

Pediatric intubation is a core paramedic skill in some emergency medical services (EMS) systems. The literature lacks a detailed examination of the challenges and subsequent adjustments made by paramedics when intubating children in the out-of-hospital setting. We undertake a descriptive evaluation of the process of out-of-hospital pediatric intubation, focusing on challenges, adjustments, and outcomes. We performed a retrospective analysis of EMS responses between 2006 and 2012 that involved attempted intubation of children younger than 13 years by paramedics in a large, metropolitan EMS system. We calculated the incidence rate of attempted pediatric intubation with EMS and county census data. To summarize the intubation process, we linked a detailed out-of-hospital airway registry with clinical records from EMS, hospital, or autopsy encounters for each child. The main outcome measures were procedural challenges, procedural success, complications, and patient disposition. Paramedics attempted intubation in 299 cases during 6.3 years, with an incidence of 1 pediatric intubation per 2,198 EMS responses. Less than half of intubations (44%) were for patients in cardiac arrest. Two thirds of patients were intubated on the first attempt (66%), and overall success was 97%. The most prevalent challenge was body fluids obscuring the laryngeal view (33%). After a failed first intubation attempt, corrective actions taken by paramedics included changing equipment (33%), suctioning (32%), and repositioning the patient (27%). Six patients (2%) experienced peri-intubation cardiac arrest and 1 patient had an iatrogenic tracheal injury. No esophageal intubations were observed. Of patients transported to the hospital, 86% were admitted to intensive care and hospital mortality was 27%. Pediatric intubation by paramedics was performed infrequently in this EMS system. Although overall intubation success was high, a detailed evaluation of the process of intubation revealed specific

Partner Pronoun Use, Communal Coping, and Abstinence during Couple-Focused Intervention for Problematic Alcohol Use.

Science.gov (United States)

Rentscher, Kelly E; Soriano, Emily C; Rohrbaugh, Michael J; Shoham, Varda; Mehl, Matthias R

2017-06-01

Communal coping-a process in which romantic partners view a problem as ours rather than yours or mine, and take collaborative action to address it -has emerged as an important predictor of health and treatment outcomes. In a study of partners' pronoun use prior to and during couple-focused alcohol interventions, we examined first-person plural (we-talk) and singular (I-talk) pronouns as linguistic markers of communal coping and behavioral predictors of treatment outcome. Thirty-three couples in which one partner abused alcohol were selected from a randomized control trial (N = 63) of couple-focused Cognitive-Behavioral or Family Systems Therapy if they had unambiguously successful or unsuccessful treatment outcomes (i.e., patient maintained abstinence for 30 days prior to treatment termination or had more than one heavy drinking day in the same period). Pronoun measures for each partner were obtained via computerized text analysis from transcripts of partners' speech, derived from a videotaped pretreatment interaction task and three subsequent therapy sessions. Spouse we-talk during the intervention (accounting for pretreatment we-talk), as an index of communal orientation, uniquely predicted successful treatment outcomes. In contrast, both patient and spouse I-talk during the intervention (accounting for pretreatment I-talk), as a marker of individualistic orientation, uniquely predicted unsuccessful outcomes, especially when distinguishing active and passive (I vs. me/my) pronoun forms. Results strengthen evidence for the prognostic significance of spouse behavior for patient health outcomes and for communal coping (indexed via pronoun use) as a potential mechanism of change in couple-focused interventions for health problems. © 2015 Family Process Institute.

Direct marketing of parenting programs: comparing a promotion-focused and a prevention-focused strategy.

Science.gov (United States)

Salari, Raziye; Backman, Anna

2017-06-01

: For parenting programs to achieve a public health impact, it is necessary to develop more effective marketing strategies to increase public awareness of these programs and promote parental participation. In this article, we compared a promotion-focused and a prevention-focused strategy via two studies. : We designed two ads inviting parents to participate in a universal parenting program; one ad focused on the program increasing the likelihood of positive outcomes for children (promotion-focused) and the other on the program reducing the likelihood of negative outcomes (prevention-focused). In study I, the two ads were run online simultaneously. Those who clicked on an ad were directed to a website where they could read about and sign up for the program. In study II, a community sample of 706 parents answered a questionnaire about the ads. : In study I, over 85 days, the prevention ad generated more clicks. There was no difference in the number of pages visited on the website nor in the number of parents who signed up for the program. In study II, parents showed a preference for the promotion ad, perceiving it as more relevant and rating it as more effective in getting them interested in the program. : A prevention strategy may be more effective in drawing public attention, in general. However, a promotion strategy is more likely to reach parents, in particular, and inspire them to consider participating in parenting programs. These strategies should be developed further and tested in both general and clinical populations. © The Author 2016. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.

A Design of Real-time Automatic Focusing System for Digital Still Camera Using the Passive Sensor Error Minimization

Energy Technology Data Exchange (ETDEWEB)

Kim, K.S. [Samsung Techwin Co., Ltd., Seoul (Korea); Kim, D.Y. [Bucheon College, Bucheon (Korea); Kim, S.H. [University of Seoul, Seoul (Korea)

2002-05-01

In this paper, the implementation of a new AF(Automatic Focusing) system for a digital still camera is introduced. The proposed system operates in real-time while adjusting focus after the measurement of distance to an object using a passive sensor, which is different from a typical method. In addition, measurement errors were minimized by using the data acquired empirically, and the optimal measuring time was obtained using EV(Exposure Value) which is calculated from CCD luminance signal. Moreover, this system adopted an auxiliary light source for focusing in absolute dark conditions, which is very hard for CCD image processing. Since this is an open-loop system adjusting focus immediately after the distance measurement, it guarantees real-time operation. The performance of this new AF system was verified by comparing the focusing value curve obtained from AF experiment with the one from the measurement by MF(Manual-Focusing). In both case, edge detector was used for various objects and backgrounds. (author). 9 refs., 11 figs., 5 tabs.

Clinical outcomes and cost-effectiveness of brief guided parent-delivered cognitive behavioural therapy and solution-focused brief therapy for treatment of childhood anxiety disorders: a randomised controlled trial.

Science.gov (United States)

Creswell, Cathy; Violato, Mara; Fairbanks, Hannah; White, Elizabeth; Parkinson, Monika; Abitabile, Gemma; Leidi, Alessandro; Cooper, Peter J

2017-07-01

Half of all lifetime anxiety disorders emerge before age 12 years; however, access to evidence-based psychological therapies for affected children is poor. We aimed to compare the clinical outcomes and cost-effectiveness of two brief psychological treatments for children with anxiety referred to routine child mental health settings. We hypothesised that brief guided parent-delivered cognitive behavioural therapy (CBT) would be associated with better clinical outcomes than solution-focused brief therapy and would be cost-effective. We did this randomised controlled trial at four National Health Service primary child and mental health services in Oxfordshire, UK. Children aged 5-12 years referred for anxiety difficulties were randomly allocated (1:1), via a secure online minimisation tool, to receive brief guided parent-delivered CBT or solution-focused brief therapy, with minimisation for age, sex, anxiety severity, and level of parental anxiety. The allocation sequence was not accessible to the researcher enrolling participants or to study assessors. Research staff who obtained outcome measurements were masked to group allocation and clinical staff who delivered the intervention did not measure outcomes. The primary outcome was recovery, on the basis of Clinical Global Impressions of Improvement (CGI-I). Parents recorded patient-level resource use. Quality-adjusted life-years (QALYs) for use in cost-utility analysis were derived from the Child Health Utility 9D. Assessments were done at baseline (before randomisation), after treatment (primary endpoint), and 6 months after treatment completion. We did analysis by intention to treat. This trial is registered with the ISCRTN registry, number ISRCTN07627865. Between March 23, 2012, and March 31, 2014, we randomly assigned 136 patients to receive brief guided parent-delivered CBT (n=68) or solution-focused brief therapy (n=68). At the primary endpoint assessment (June, 2012, to September, 2014), 40 (59%) children in

Drift compression and final focus systems for heavy ion inertial fusion

Energy Technology Data Exchange (ETDEWEB)

de Hoon, Michiel Jan Laurens [Univ. of California, Berkeley, CA (United States)

2001-01-01

Longitudinal compression of space-charge dominated beams can be achieved by imposing a head-to-tail velocity tilt on the beam. This tilt has to be carefully tailored, such that it is removed by the longitudinal space-charge repulsion by the time the beam reaches the end of the drift compression section. The transverse focusing lattice should be designed such that all parts of the beam stay approximately matched, while the beam smoothly expands transversely to the larger beam radius needed in the final focus system following drift compression. In this thesis, several drift compression systems were designed within these constraints, based on a given desired pulse shape at the end of drift compression systems were designed within these constraints, based on a given desired pulse shape at the end of drift compression. The occurrence of mismatches due to a rapidly increasing current was analyzed. In addition, the sensitivity of drift compression to errors in the initial velocity tilt and current profile was studied. These calculations were done using a new computer code that accurately calculates the longitudinal electric field in the space-charge dominated regime.

How changing quality management influenced PGME accreditation: a focus on decentralization and quality improvement.

Science.gov (United States)

Akdemir, Nesibe; Lombarts, Kiki M J M H; Paternotte, Emma; Schreuder, Bas; Scheele, Fedde

2017-06-02

Evaluating the quality of postgraduate medical education (PGME) programs through accreditation is common practice worldwide. Accreditation is shaped by educational quality and quality management. An appropriate accreditation design is important, as it may drive improvements in training. Moreover, accreditors determine whether a PGME program passes the assessment, which may have major consequences, such as starting, continuing or discontinuing PGME. However, there is limited evidence for the benefits of different choices in accreditation design. Therefore, this study aims to explain how changing views on educational quality and quality management have impacted the design of the PGME accreditation system in the Netherlands. To determine the historical development of the Dutch PGME accreditation system, we conducted a document analysis of accreditation documents spanning the past 50 years and a vision document outlining the future system. A template analysis technique was used to identify the main elements of the system. Four themes in the Dutch PGME accreditation system were identified: (1) objectives of accreditation, (2) PGME quality domains, (3) quality management approaches and (4) actors' responsibilities. Major shifts have taken place regarding decentralization, residency performance and physician practice outcomes, and quality improvement. Decentralization of the responsibilities of the accreditor was absent in 1966, but this has been slowly changing since 1999. In the future system, there will be nearly a maximum degree of decentralization. A focus on outcomes and quality improvement has been introduced in the current system. The number of formal documents striving for quality assurance has increased enormously over the past 50 years, which has led to increased bureaucracy. The future system needs to decrease the number of standards to focus on measurable outcomes and to strive for quality improvement. The challenge for accreditors is to find the right

Peritumoral Artery Scoring System: a Novel Scoring System to Predict Renal Function Outcome after Laparoscopic Partial Nephrectomy.

Science.gov (United States)

Zhang, Ruiyun; Wu, Guangyu; Huang, Jiwei; Shi, Oumin; Kong, Wen; Chen, Yonghui; Xu, Jianrong; Xue, Wei; Zhang, Jin; Huang, Yiran

2017-06-06

The present study aimed to assess the impact of peritumoral artery characteristics on renal function outcome prediction using a novel Peritumoral Artery Scoring System based on computed tomography arteriography. Peritumoral artery characteristics and renal function were evaluated in 220 patients who underwent laparoscopic partial nephrectomy and then validate in 51 patients with split and total glomerular filtration rate (GFR). In particular, peritumoral artery classification and diameter were measured to assign arteries into low, moderate, and high Peritumoral Artery Scoring System risk categories. Univariable and multivariable logistic regression analyses were then used to determine risk factors for major renal functional decline. The Peritumoral Artery Scoring System and four other nephrometry systems were compared using receiver operating characteristic curve analysis. The Peritumoral Artery Scoring System was significantly superior to the other systems for predicting postoperative renal function decline (p system was a superior independent predictor of estimated glomerular filtration rate (eGFR) decline (area-under-the-curve = 0.865, p renal function outcome after laparoscopic partial nephrectomy.

Clinician Perspectives of Barriers to Effective Implementation of a Rapid Response System in an Academic Health Centre: A Focus Group Study

Directory of Open Access Journals (Sweden)

John Rihari-Thomas

2017-08-01

Full Text Available Background Systemic and structural issues of rapid response system (RRS models can hinder implementation. This study sought to understand the ways in which acute care clinicians (physicians and nurses experience and negotiate care for deteriorating patients within the RRS. Methods Physicians and nurses working within an Australian academic health centre within a jurisdictional-based model of clinical governance participated in focus group interviews. Verbatim transcripts were analysed using thematic content analysis. Results Thirty-four participants (21 physicians and 13 registered nurses [RNs] participated in six focus groups over five weeks in 2014. Implementing the RRS in daily practice was a process of informal communication and negotiation in spite of standardised protocols. Themes highlighted several systems or organisational-level barriers to an effective RRS, including (1 responsibility is inversely proportional to clinical experience; (2 actions around system flexibility contribute to deviation from protocol; (3 misdistribution of resources leads to perceptions of inadequate staffing levels inhibiting full optimisation of the RRS; and (4 poor communication and documentation of RRS increases clinician workloads. Conclusion Implementing a RRS is complex and multifactorial, influenced by various inter- and intra-professional factors, staffing models and organisational culture. The RRS is not a static model; it is both reflexive and iterative, perpetually transforming to meet healthcare consumer and provider demands and local unit contexts and needs. Requiring more than just a strong initial implementation phase, new models of care such as a RRS demand good governance processes, ongoing support and regular evaluation and refinement. Cultural, organizational and professional factors, as well as systems-based processes, require consideration if RRSs are to achieve their intended outcomes in dynamic healthcare settings.

Consequences of Collective-Focused Leadership and Differentiated Individual-Focused Leadership : Development and Testing of an Organizational-Level Model

OpenAIRE

Kunze, Florian; de Jong, Simon Barend; Bruch, Heike

2016-01-01

Recent advances in leadership research suggest that collective-focused leadership climate and differentiated individual-focused leadership might simultaneously, yet oppositely, affect collective outcomes. The present study extends this literature by addressing open questions regarding theory, methods, statistics, and level of analysis. Therefore, a new and more parsimonious theoretical model is developed on the organizational-level of analysis. Drawing on the commitment literature, we argue f...

Spherical aberration of an optical system and its influence on depth of focus.

Science.gov (United States)

Mikš, Antonín; Pokorný, Petr

2017-06-10

This paper analyzes the influence of spherical aberration on the depth of focus of symmetrical optical systems for imaging of axial points. A calculation of a beam's caustics is discussed using ray equations in the image plane and considering longitudinal spherical aberration as well. Concurrently, the influence of aberration coefficients on extremes of such a curve is presented. Afterwards, conditions for aberration coefficients are derived if the Strehl definition should be the same in two symmetrically placed planes with respect to the paraxial image plane. Such conditions for optical systems with large aberrations are derived with the use of geometric-optical approximation where the gyration diameter of the beam in given planes of the optical system is evaluated. Therefore, one can calculate aberration coefficients in such a way that the optical system generates a beam of rays that has the gyration radius in a given interval smaller than the defined limit value. Moreover, one can calculate the maximal depth of focus of the optical system respecting the aforementioned conditions.

Organizational culture focused on quality management and benefits derived from an ERP system implementation

Directory of Open Access Journals (Sweden)

Oscar F. Bustinza

2013-01-01

Full Text Available Purpose: Organizational culture focused on quality management aims to meet customer needs and enhance teamwork, being oriented toward a dynamic process of continuous improvement. The purpose of this paper is to analyze whether, indeed, the quality-oriented culture has an effect on the management of business processes. In doing so, we analyze their relationship with the benefits of a resource management system or ERP.Design/methodology/approach: A survey is used to collect data, with valid questionnaires obtained for 200 Spain based respondents. Empirical analysis utilises Structural Equation Modelling (SEM.Findings: The results confirm that firm's commitment with quality management, customer focus, and confidence of workers has a positive effect on the results of operational, strategic and managerial benefits derived from an ERP system implementation. However, there is not relationship between customer focus and organizational benefits, neither to increase system capacity.Originality/value: The present study analyzes the relationship between quality-oriented culture and the resource management systems of the firm clarifying their strengths and limitations. In this sense, the customer orientation may limit the flexibility of business as require a lot of resources, and generate dissatisfaction among workers resulting from the attention to customer complaints.

Systemic effects of periodontitis: Lessons learned from research on atherosclerotic vascular disease and adverse pregnancy outcomes

Science.gov (United States)

Papapanou, Panos N.

2015-01-01

Studies conducted over the past 25 years have focused on the role of periodontitis, an inflammatory condition of microbial etiology that destroys the tooth supporting tissues, as a systemic inflammatory stressor that can act as an independent risk factor of atherosclerotic vascular disease (AVSD) and adverse pregnancy outcomes (APOs). It has been suggested that periodontitis-associated bacteremias and systemic dissemination of inflammatory mediators produced in the periodontal tissues may result in systemic inflammation and endothelial dysfunction, while bacteria of oral origin may translocate into the feto-placental unit. Epidemiologic studies largely support an association between periodontitis and ASVD / APOs independent of known confounders; indeed, periodontitis has been shown to confer statistically significantly elevated risk for clinical events associated with ASVD and APOs in multivariable adjustments. On the other hand, intervention studies demonstrate that although periodontal therapy reduces systemic inflammation and improves endothelial function, it has no positive effect on the incidence of APOs. Studies of the effects of periodontal interventions on ASVD-related clinical events are lacking. This review summarizes key findings from mechanistic, association and intervention studies and attempts to reconcile the seemingly contradictory evidence that originates from different lines of investigation. PMID:26388299

System-justifying ideologies and academic outcomes among first-year Latino college students.

Science.gov (United States)

O'Brien, Laurie T; Mars, Dustin E; Eccleston, Collette

2011-10-01

The present study examines the relationship between system-justifying ideologies and academic outcomes among 78 first-year Latino college students (21 men, 57 women, mean age = 18.1 years) attending a moderately selective West Coast university. Endorsement of system-justifying ideologies was negatively associated with grade point average (GPA); however it was positively associated with feelings of belonging at the university. In addition, system-justifying ideologies were negatively associated with perceptions of personal discrimination. In contrast, ethnic identity centrality was unrelated to GPA, feelings of belonging, and perceptions of personal discrimination once the relationship between system-justifying ideologies and these outcomes was statistically taken into account. The results of the present study suggest that endorsement of system-justifying ideologies may be a double-edged sword for Latino college students, involving trade-offs between academic success and feelings of belonging.

Probing LINEAR Collider Final Focus Systems in SuperKEKB

CERN Document Server

Thrane, Paul Conrad Vaagen

2017-01-01

A challenge for future linear collider final focus systems is the large chromaticity produced by the final quadrupoles. SuperKEKB will be correcting high levels of chromaticity using the traditional scheme which has been also proposed for the CLIC FFS. We present early simulation results indicating that lowering β*у in the SuperKEKB Low Energy Ring might be possible given on-axis injection and low bunch current, opening the possibility of testing chromaticity correction beyond FFTB level, similar to ILC and approaching that of CLIC. CLIC – Note – 1077

Self-focused and other-focused resiliency: Plausible mechanisms linking early family adversity to health problems in college women.

Science.gov (United States)

Coleman, Sulamunn R M; Zawadzki, Matthew J; Heron, Kristin E; Vartanian, Lenny R; Smyth, Joshua M

2016-01-01

This study examined whether self-focused and other-focused resiliency help explain how early family adversity relates to perceived stress, subjective health, and health behaviors in college women. Female students (N = 795) participated between October 2009 and May 2010. Participants completed self-report measures of early family adversity, self-focused (self-esteem, personal growth initiative) and other-focused (perceived social support, gratitude) resiliency, stress, subjective health, and health behaviors. Using structural equation modeling, self-focused resiliency associated with less stress, better subjective health, more sleep, less smoking, and less weekend alcohol consumption. Other-focused resiliency associated with more exercise, greater stress, and more weekend alcohol consumption. Early family adversity was indirectly related to all health outcomes, except smoking, via self-focused and other-focused resiliency. Self-focused and other-focused resiliency represent plausible mechanisms through which early family adversity relates to stress and health in college women. This highlights areas for future research in disease prevention and management.

Outcome based commissioning: lessons from contracting out employment and skills programmes in Australia and the USA

OpenAIRE

Finn, Dan

2010-01-01

Despite the relative effectiveness of recent reforms to the employment and skills system the Leitch Review (1996)identified some key problems. Welfare to work programmes had few incentives to focus on skills, job retention and progression; the skills system had little focus on employment outcomes; and the targets and incentives in both systems did not encourage a joined-up service for individuals or employers. The UK Commission for Employment and Skills (UKCES) subsequently proposed the integ...

Does Focus of Attention Improve Snatch Lift Kinematics?

Science.gov (United States)

Schutts, Kyle S; Wu, Will F W; Vidal, Anthony D; Hiegel, Jamie; Becker, James

2017-10-01

Recent motor control literature has demonstrated that using verbal instructions to direct a performer's attention externally (i.e., toward the movement outcome) enhances motor skill performance. The purpose of this study was to investigate how an athlete's focus of attention impacts kinematic performance of the snatch. Using a counterbalanced within-participant design, 12 competitively trained athletes (8 male and 4 female athletes) performed 2 instructional blocks of 3 snatch repetitions at 80% of their most recent training 1 repetition maximum. Blocks of internal and external instructions were given to the athlete in a random fashion. Results showed that, when focusing internally, athletes significantly (p ≤ 0.05) increased elbow velocity relative to focusing externally, whereas the external instructions significantly increased horizontal barbell velocity, relative to internal instructions. Additionally, an internal focus resulted in significantly larger barbell-cervical-hip angles at maximum height of the barbell compared with an external focus, indicating that the athletes squatted under the barbell too soon. This information adds to the literature suggesting small changes in coaching instructions can impact performance significantly. It is recommended that coaches use instructions that direct an athlete's attention externally, toward the movement outcome, rather than the action itself.

Managing Safety and Operations: The Effect of Joint Management System Practices on Safety and Operational Outcomes.

Science.gov (United States)

Tompa, Emile; Robson, Lynda; Sarnocinska-Hart, Anna; Klassen, Robert; Shevchenko, Anton; Sharma, Sharvani; Hogg-Johnson, Sheilah; Amick, Benjamin C; Johnston, David A; Veltri, Anthony; Pagell, Mark

2016-03-01

The aim of this study was to determine whether management system practices directed at both occupational health and safety (OHS) and operations (joint management system [JMS] practices) result in better outcomes in both areas than in alternative practices. Separate regressions were estimated for OHS and operational outcomes using data from a survey along with administrative records on injuries and illnesses. Organizations with JMS practices had better operational and safety outcomes than organizations without these practices. They had similar OHS outcomes as those with operations-weak practices, and in some cases, better outcomes than organizations with safety-weak practices. They had similar operational outcomes as those with safety-weak practices, and better outcomes than those with operations-weak practices. Safety and operations appear complementary in organizations with JMS practices in that there is no penalty for either safety or operational outcomes.

Treatment of Phonological Disorder: A Feasibility Study With Focus on Outcome Measures.

Science.gov (United States)

Smit, Ann Bosma; Brumbaugh, Klaire Mann; Weltsch, Barbara; Hilgers, Melanie

2018-02-20

In a feasibility study for a randomized controlled trial of treatments for phonological disorders conducted over a period of 8 months, we examined 6 clinically relevant outcome measures. We took steps to reduce error variance and to maximize systematic variance. Six children received traditional treatment (Van Riper, 1939), and 7 received expansion points (Smit, 2000), a treatment program with both phonological and traditional elements. Outcome measures, which were applied to both word list and conversational samples, included percentage of consonants correct (PCC; Shriberg & Kwiatkowski, 1982), PCC for late and/or difficult (L/D) consonants and number of L/D consonants acquired. In repeated-measures analyses of variance, all measures showed significant differences from pretreatment to posttreatment, and the word list measures were associated with very high power values. In analyses of covariance for between-groups contrasts, the adjusted expansion points mean exceeded the adjusted traditional treatment mean for every measure; however, no differences reached significance. For the L/D PCC (conversation) measure, the contrast between groups was associated with a large effect size. We recommend that practitioners use outcome measures related to a word list. We recommend that researchers consider using L/D PCC on the basis of conversational samples to detect differences among treatment groups. https://doi.org/10.23641/asha.5872677.

Beam-based alignment and tuning procedures for e+e- collider final focus systems

International Nuclear Information System (INIS)

Bulos, F.; Burke, D.; Helm, R.; Irwin, J.; Odian, A.; Roy, G.; Ruth, R.; Yamamoto

1991-01-01

For future linear colliders, with very small emittances and beam sizes and demanding tolerances on final focus system alignment and magnet errors, it becomes increasingly important to use the beam as a diagnostic tool. The authors report here procedures they have identified and will be implemented in the Final Focus Test Beam at SLAC incorporating (1) quadrupole strength changes, (2) central orbit modifications, (3) spot size measurements, and (4) beam stability monitoring

Introduction to Focus Issue: Complex network perspectives on flow systems.

Science.gov (United States)

Donner, Reik V; Hernández-García, Emilio; Ser-Giacomi, Enrico

2017-03-01

During the last few years, complex network approaches have demonstrated their great potentials as versatile tools for exploring the structural as well as dynamical properties of dynamical systems from a variety of different fields. Among others, recent successful examples include (i) functional (correlation) network approaches to infer hidden statistical interrelationships between macroscopic regions of the human brain or the Earth's climate system, (ii) Lagrangian flow networks allowing to trace dynamically relevant fluid-flow structures in atmosphere, ocean or, more general, the phase space of complex systems, and (iii) time series networks unveiling fundamental organization principles of dynamical systems. In this spirit, complex network approaches have proven useful for data-driven learning of dynamical processes (like those acting within and between sub-components of the Earth's climate system) that are hidden to other analysis techniques. This Focus Issue presents a collection of contributions addressing the description of flows and associated transport processes from the network point of view and its relationship to other approaches which deal with fluid transport and mixing and/or use complex network techniques.

Mild-moderate congenital hearing loss: secular trends in outcomes across four systems of detection.

Science.gov (United States)

Carew, P; Mensah, F K; Rance, G; Flynn, T; Poulakis, Z; Wake, M

2018-01-01

Universal newborn hearing screening (UNHS) targets moderate or greater hearing loss. However, UNHS also frequently detects children with mild loss that results in many receiving early treatment. The benefits of this approach are not yet established. We aimed to (i) compare language and psychosocial outcomes between four hearing loss detection systems for children aged 5-8 years with congenital mild-moderate hearing loss; (ii) determine whether age of detection predicts outcomes; and (iii) compare outcomes between children identified via well-established UNHS and the general population. Linear regression adjusted for potential confounding factors was used throughout. Via a quasi-experimental design, language and psychosocial outcomes were compared across four population-based Australian systems of hearing loss detection: opportunistic detection, born 1991-1993, n = 50; universal risk factor referral, born 2003-2005, n = 34; newly established UNHS, born 2003-2005, n = 41; and well-established UNHS, born 2007-2010, n = 21. In pooled analyses, we examined whether age of detection predicted outcomes. Outcomes were similarly compared between the current well-established UNHS system and typically developing children in the Early Language in Victoria Study, born 2003, n = 1217. Age at diagnosis and hearing aid fitting fell steadily across the four systems. For moderate losses, mean expressive language (P for trend .05) and receptive vocabulary (P for trend .06) improved across the four systems, but benefit was not obvious for mild losses. In pooled analyses, diagnosis before age six months predicted better language outcomes for moderate losses. Children with mild-moderate losses exposed to well-established UNHS continue to experience expressive language scores well below children in the general population (adjusted mean difference -8.9 points, 95% CI -14.7 to -3.1). Treatment arising from UNHS appears to be clearly benefitting children with moderate hearing

The strategic use of outcome information.

Science.gov (United States)

Thompson, D I; Sirio, C; Holt, P

2000-10-01

Most health care executives see outcome measurement as a technical or tactical matter rather than as a strategic tool. Accordingly, provider investment in outcome measurement and management is relatively small. Nevertheless, outcome information can be key to achieving an organization's strategic objectives. Advances in risk adjustment and improvements in technology for data collection and analysis have made outcome measurement a practical tool for individual hospital use. Strategically integrated outcome measurement efforts can give providers a competitive advantage over organizations that only use outcomes tactically. One of the best examples of an acute care provider that has used outcome information for strategic advantage is Intermountain Health Care (IHC; Salt Lake City). In 1997 IHC made clinical quality and outcomes the primary focus of its five-year strategic plan. To support the new strategy IHC's board of trustees approved the development of an outcome information system that generated data along clinical processes of care and the creation of a new management structure to use these data to hold professionals accountable and to set and achieve clinical improvement goals. From 1996 to 1999, IHC's share of the commercial health care market in Utah increased from roughly 50% to about 62% of the market, with the result that it has stopped actively marketing its services. Health care executives will not willingly invest in outcomes until they believe that they have business value. Therefore, making the business case for outcomes can help improve the quality of health care and the lives of individuals.

Training and Maintaining System-Wide Reliability in Outcome Management.

Science.gov (United States)

Barwick, Melanie A; Urajnik, Diana J; Moore, Julia E

2014-01-01

The Child and Adolescent Functional Assessment Scale (CAFAS) is widely used for outcome management, for providing real time client and program level data, and the monitoring of evidence-based practices. Methods of reliability training and the assessment of rater drift are critical for service decision-making within organizations and systems of care. We assessed two approaches for CAFAS training: external technical assistance and internal technical assistance. To this end, we sampled 315 practitioners trained by external technical assistance approach from 2,344 Ontario practitioners who had achieved reliability on the CAFAS. To assess the internal technical assistance approach as a reliable alternative training method, 140 practitioners trained internally were selected from the same pool of certified raters. Reliabilities were high for both practitioners trained by external technical assistance and internal technical assistance approaches (.909-.995, .915-.997, respectively). 1 and 3-year estimates showed some drift on several scales. High and consistent reliabilities over time and training method has implications for CAFAS training of behavioral health care practitioners, and the maintenance of CAFAS as a global outcome management tool in systems of care.

Positive Youth Development and Nutrition: Interdisciplinary Strategies to Enhance Student Outcomes

Science.gov (United States)

Edwards, Oliver W.; Cheeley, Taylor

2016-01-01

Educational policies require the use of data and progress monitoring frameworks to guide instruction and intervention in schools. As a result, different problem-solving models such as multitiered systems of supports (MTSS) have emerged that use these frameworks to improve student outcomes. However, problem-focused models emphasize negative…

Beam-based alignment and tuning procedures for e+e- collider final focus systems

International Nuclear Information System (INIS)

Bulos, F.; Burke, D.; Helm, R.; Irwin, J.; Odian, A.; Roy, G.; Ruth, R.; Yamamoto, N.

1991-05-01

For future linear colliders, with very small emittances and beam sizes and demanding tolerances on final focus system alignment and magnet errors, it becomes increasingly important to use the beam as a diagnostic tool. We report here procedures we have identified and will be implemented in the Final Focus Test Beam at SLAC incorporating (1) quadrupole strength changes, (2) central orbit modifications, (3) spot size measurements, and (4) beam stability monitoring. 3 refs., 4 figs., 3 tabs

The interplay between regulatory focus and temporal distance in the health context

NARCIS (Netherlands)

Berezowska, Aleksandra; Fischer, Arnout R.H.; Trijp, van Hans C.M.

2018-01-01

Objectives: This study identifies how the interaction between temporal distance, regulatory focus, and framing of health outcomes affects individuals' intention to adopt a personalized nutrition service. Design: A 2 (temporal distance: immediate health outcomes vs. delayed health outcomes) × 2

Integrated single grating compressor for variable pulse front tilt in simultaneously spatially and temporally focused systems.

Science.gov (United States)

Block, Erica; Thomas, Jens; Durfee, Charles; Squier, Jeff

2014-12-15

A Ti:Al(3)O(2) multipass chirped pulse amplification system is outfitted with a single-grating, simultaneous spatial and temporal focusing (SSTF) compressor platform. For the first time, this novel design has the ability to easily vary the beam aspect ratio of an SSTF beam, and thus the degree of pulse-front tilt at focus, while maintaining a net zero-dispersion system. Accessible variation of pulse front tilt gives full spatiotemporal control over the intensity distribution at the focus and could lead to better understanding of effects such as nonreciprocal writing and SSTF-material interactions.

Pulmonary function tests as outcomes for systemic sclerosis interstitial lung disease.

Science.gov (United States)

Caron, Melissa; Hoa, Sabrina; Hudson, Marie; Schwartzman, Kevin; Steele, Russell

2018-06-30

Interstitial lung disease (ILD) is the leading cause of morbidity and mortality in systemic sclerosis (SSc). We performed a systematic review to characterise the use and validation of pulmonary function tests (PFTs) as surrogate markers for systemic sclerosis-associated interstitial lung disease (SSc-ILD) progression.Five electronic databases were searched to identify all relevant studies. Included studies either used at least one PFT measure as a longitudinal outcome for SSc-ILD progression ( i.e. outcome studies) and/or reported at least one classical measure of validity for the PFTs in SSc-ILD ( i.e. validation studies).This systematic review included 169 outcome studies and 50 validation studies. Diffusing capacity of the lung for carbon monoxide ( D LCO ) was cumulatively the most commonly used outcome until 2010 when it was surpassed by forced vital capacity (FVC). FVC (% predicted) was the primary endpoint in 70.4% of studies, compared to 11.3% for % predicted D LCO Only five studies specifically aimed to validate the PFTs: two concluded that D LCO was the best measure of SSc-ILD extent, while the others did not favour any PFT. These studies also showed respectable validity measures for total lung capacity (TLC).Despite the current preference for FVC, available evidence suggests that D LCO and TLC should not yet be discounted as potential surrogate markers for SSc-ILD progression. Copyright ©ERS 2018.

Fertility and pregnancy outcome in women with systemic sclerosis.

Science.gov (United States)

Steen, V D; Medsger, T A

1999-04-01

To determine fertility and pregnancy outcome in women with systemic sclerosis (SSc; scleroderma) who had disease onset before age 45 years. All living women with scleroderma who had first been evaluated at the University of Pittsburgh Scleroderma Clinic after January 1, 1972 were sent a detailed self-administered questionnaire in 1986 specifically concerning pregnancy outcomes and infertility. This group was compared with 2 race- and age-matched control groups, one comprising women with rheumatoid arthritis (RA) and one comprising healthy neighborhood women identified by random-digit dialing. We determined the number, history, treatment, and outcome of women who either had never been pregnant or had attempted to become pregnant unsuccessfully for more than 1 year. We also obtained data regarding pregnancy outcomes, including the frequency of miscarriage, premature births, small full-term infants, perinatal deaths, and births of live healthy infants. The study group comprised 214 women with SSc, 167 with RA, and 105 neighborhood controls. There were no significant differences in the overall rates of miscarriage, premature births, small full-term births, or neonatal deaths between the 3 groups. Women with SSc were more likely than those without SSc to have adverse outcomes of pregnancy after the onset of their rheumatic disease, particularly premature births (also seen in RA women after disease onset) and small full-term infants. Although a significantly greater number of women with SSc had never been pregnant, there were no significant differences in the frequency of never having been pregnant or of infertility in the 3 groups after adjustment for contributing factors. This study indicates that women with SSc have acceptable pregnancy outcomes compared with those of women with other rheumatic disease and healthy neighborhood controls. Infertility was not a frequent problem. We believe that there are no excessive pregnancy risks to women with SSc or their infants

Teleophthalmology: improving patient outcomes?

Directory of Open Access Journals (Sweden)

Sreelatha OK

2016-02-01

Full Text Available Omana Kesary Sreelatha,1 Sathyamangalam VenkataSubbu Ramesh2 1Ophthalmology Department, Sultan Qaboos University Hospital, Muscat, Oman; 2Department of Optometry, School of Allied Health Sciences, Manipal University, Manipal, India Abstract: Teleophthalmology is gaining importance as an effective eye care delivery modality worldwide. In many developing countries, teleophthalmology is being utilized to provide quality eye care to the underserved urban population and the unserved remote rural population. Over the years, technological innovations have led to improvement in evidence and teleophthalmology has evolved from a research tool to a clinical tool. The majority of the current teleophthalmology services concentrate on patient screening and appropriate referral to experts. Specialty care using teleophthalmology services for the pediatric group includes screening as well as providing timely care for retinopathy of prematurity (ROP. Among geriatric eye diseases, specialty teleophthalmology care is focused toward screening and referral for diabetic retinopathy (DR, glaucoma, age-related macular degeneration (ARMD, and other sight-threatening conditions. Comprehensive vision screening and refractive error services are generally covered as part of most of the teleophthalmology methods. Over the past decades, outcome assessment of health care system includes patients’ assessments on their health, care, and services they receive. Outcomes, by and large, remain the ultimate validators of the effectiveness and quality of medical care. Teleophthalmology produces the same desired clinical outcome as the traditional system. Remote portals allow specialists to provide care over a larger region, thereby improving health outcomes and increasing accessibility of specialty care to a larger population. A high satisfaction level and acceptance is reported in the majority of the studies because of increased accessibility and reduced traveling cost and time

Optimising waste treatment and energy systems - focusing on spatial and temporal issues

DEFF Research Database (Denmark)

Pizarro Alonso, Amalia Rosa; Münster, Marie; Ravn, H.

The aim of the TOPWASTE project is to evaluate current and future optimal treatment of waste fractions in terms of economy and the environment, with a focus on recycling versus Waste-to-Energy technologies. After optimization of the waste management system, results must be analysed so...

Limbic system, the main focus of dementia syndrome; A study with MRI and PET

Energy Technology Data Exchange (ETDEWEB)

Matsuzawa, Taiju [Morinosato Hospital, Atsugi, Kanagawa (Japan)

1990-12-01

Alzheimer disease and multi-infarct dementia are two entirely different diseases producing almost the same abnormalities as dementia syndrome. The statistical studies with MRI to locate the focus of dementia syndrome in the neocortex was an absolute failure. With MRI there is drastic atrophy and destruction of the amygdala and hippocampus suggesting the limbic system as the focus of dementia syndrome. Destruction of the limbic system in particular amygdala and hippocampus produced the functional obstruction brought about by the marked reduction in the glucose utilization with PET in the bilateral temporal, parietal and occipital association cortices. Although this type constitutes only about 1/5 of all dementia patients. It is considered the fundamental type of dementia syndrome. Aside from this, there is a type wherein simultaneous and symmetrical reductions in glucose utilization of the frontal association cortex and the motor association cortex in the anterior part of the neocortex. This is referred to as type II. It constitutes about 4/5 of all dementia patients which is far more than type I. Based on these results, it is thought that limbic system is the main focus of dementia syndrome. (author).

User Impact of Literacy on Treatment Outcomes Quality Regional Financial Information System

Directory of Open Access Journals (Sweden)

Iskandar MUDA

2017-06-01

Full Text Available This study aims to determine the effectiveness of the Outcomes of the Quality Regional Financial Information System. The research is an explanatory survey exploration that explains the relationship between some variables. The population of this study is formed by 7 District Municipalities in North Sumatra. The sample comprises 197 respondents; the sampling process is a purposive random one. Variables used include User Literacy, Regional Information System, Role Ambiguity, Training and Local Government Finance Report. Treatment Outcomes Quality systems have a significant effect on the accuracy of Local Government Financial Statement Presentation. Role Ambiguity has no significant effect on the accuracy of Local Government Financial Statement Presentation. Training does not significantly influence the accuracy of Government Financial Statements literacy. The findings of this study provide recommendations for improvement of the performance manager in North Sumatra, which thus supporting the implementation of a good government system.

Do the Critical Success Factors from Learning Analytics Predict Student Outcomes?

Science.gov (United States)

Strang, Kenneth David

2016-01-01

This article starts with a detailed literature review of recent studies that focused on using learning analytics software or learning management system data to determine the nature of any relationships between online student activity and their academic outcomes within university-level business courses. The article then describes how data was…

Family-Focused Autism Spectrum Disorder Research: A Review of the Utility of Family Systems Approaches

Science.gov (United States)

Cridland, Elizabeth K.; Jones, Sandra C.; Magee, Christopher A.; Caputi, Peter

2014-01-01

A family member with an autism spectrum disorder presents pervasive and bidirectional influences on the entire family system, suggesting a need for family-focused autism spectrum disorder research. While there has been increasing interest in this research area, family-focused autism spectrum disorder research can still be considered relatively…

Evaluating Red Reflex and Surgeon Preference Between Nearly-Collimated and Focused Beam Microscope Illumination Systems.

Science.gov (United States)

Cionni, Robert J; Pei, Ron; Dimalanta, Ramon; Lubeck, David

2015-08-01

To evaluate the intensity and stability of the red reflex produced by ophthalmic surgical microscopes with nearly-collimated versus focused illumination systems and to assess surgeon preference in a simulated surgical setting. This two-part evaluation consisted of postproduction surgical video analysis of red reflex intensity and a microscope use and preference survey completed by 13 experienced cataract surgeons. Survey responses were based on bench testing and experience in a simulated surgical setting. A microscope with nearly-collimated beam illumination and two focused beam microscopes were assessed. Red reflex intensity and stability were greater with the nearly-collimated microscope illumination system. In the bench testing survey, surgeons reported that the red reflex was maintained over significantly greater distances away from pupillary center, and depth of focus was numerically greater with nearly-collimated illumination relative to focused illumination. Most participating surgeons (≥64%) reported a preference for the microscope with nearly-collimated illumination with regard to red reflex stability, depth of focus, visualization, surgical working distance, and perceived patient comfort. The microscope with nearly-collimated illumination produced a more intense and significantly more stable red reflex and was preferred overall by more surgeons. This is the first report of an attempt to quantify red reflex intensity and stability and to evaluate surgically-relevant parameters between microscope systems. The data and methods presented here may provide a basis for future studies attempting to quantify differences between surgical microscopes that may affect surgeon preference and microscope use in ophthalmic surgery.

Planar real polynomial differential systems of degree n > 3 having a weak focus of high order

International Nuclear Information System (INIS)

Llibre, J.; Rabanal, R.

2008-06-01

We construct planar polynomial differential systems of even (respectively odd) degree n > 3, of the form linear plus a nonlinear homogeneous part of degree n having a weak focus of order n 2 -1 (respectively (n 2 -1)/2 ) at the origin. As far as we know this provides the highest order known until now for a weak focus of a polynomial differential system of arbitrary degree n. (author)

Integrating patient reported outcomes with clinical cancer registry data: a feasibility study of the electronic Patient-Reported Outcomes From Cancer Survivors (ePOCS) system.

Science.gov (United States)

Ashley, Laura; Jones, Helen; Thomas, James; Newsham, Alex; Downing, Amy; Morris, Eva; Brown, Julia; Velikova, Galina; Forman, David; Wright, Penny

2013-10-25

Routine measurement of Patient Reported Outcomes (PROs) linked with clinical data across the patient pathway is increasingly important for informing future care planning. The innovative electronic Patient-reported Outcomes from Cancer Survivors (ePOCS) system was developed to integrate PROs, collected online at specified post-diagnostic time-points, with clinical and treatment data in cancer registries. This study tested the technical and clinical feasibility of ePOCS by running the system with a sample of potentially curable breast, colorectal, and prostate cancer patients in their first 15 months post diagnosis. Patients completed questionnaires comprising multiple Patient Reported Outcome Measures (PROMs) via ePOCS within 6 months (T1), and at 9 (T2) and 15 (T3) months, post diagnosis. Feasibility outcomes included system informatics performance, patient recruitment, retention, representativeness and questionnaire completion (response rate), patient feedback, and administration burden involved in running the system. ePOCS ran efficiently with few technical problems. Patient participation was 55.21% (636/1152) overall, although varied by approach mode, and was considerably higher among patients approached face-to-face (61.4%, 490/798) than by telephone (48.8%, 21/43) or letter (41.0%, 125/305). Older and less affluent patients were less likely to join (both Pplanning and for targeting service provision.

Design optimization of the International Linear Collider Final Focus System with a long L*

CERN Document Server

Plassard, Fabien

This Master's Thesis work has been done in the Aerospace Engineering master's programme framework and carried out at the European Organization for Nuclear Research (CERN). It was conducted under the 500 GeV e-e+ International Linear Collider (ILC) study and focused on the design and performance optimization of the Final Focus System (FFS). The purpose of the final focus system of the future linear colliders (ILC and CLIC) is to demagnify the beam to the required transverse size at the interaction point (IP). The FFS is designed for a flat-beam in a compact way based on a local chromaticity correction which corrects both horizontal and vertical chromaticities simultaneously. An alternative FFS configuration based on the traditional scheme with two dedicated chromatic correction sections for horizontal and vertical chromaticities and a long L * option has been developed. A longer free space between the last quadrupole and the IP allows to place the last quadrupole on a stable ground, with fewer engineering ...

Operational experience with optical matching in the SLC Final Focus System

International Nuclear Information System (INIS)

Bambade, P.; Burchat, P.; Burke, D.

1989-01-01

In the SLC Final Focus System, all components of transverse phase-space and the couplings between them must be controlled to minimize the beam size at the interaction point. After summarizing the experimental algorithm and the on-line tuning programs, we present a consistent set of measurements and describe our present understanding of the various contributions to this beam size. 17 refs., 9 figs

Genetic Variation in the Dopamine System Influences Intervention Outcome in Children with Cerebral Palsy

Directory of Open Access Journals (Sweden)

Rochellys Diaz Heijtz

2018-02-01

Interpretation: Naturally occurring genetic variation in the dopamine system can influence treatment outcomes in children with cerebral palsy. A polygenic dopamine score might be valid for treatment outcome prediction and for designing individually tailored interventions for children with cerebral palsy.

Unmanned Carrier-Based Aircraft System: Debate over Systems Role Led to Focus on Aerial Refueling

Science.gov (United States)

2016-03-24

Unmanned Carrier-Based Aircraft System: Debate over System’s Role Led to Focus on Aerial Refueling Prior to February 2016, the Navy had planned to...Background In a May 2015 report, we found that the intended mission and required capabilities of UCLASS were under review as there was debate ...environments, or largely strike with limited surveillance capability operating in highly contested environments.2 This debate delayed the expected

System for deuterium-tritium mixture filling the working chamber of a dense plasma focus device

International Nuclear Information System (INIS)

Bondar', A.I.; Vyskubov, V.P.; Gerasimov, S.A.

1981-01-01

A gas-vacuum system designed for filling the gas-discharge chamber of a plasma focus device with equal-coaponent deuterium-tritium mixture is described. The system consists of a unit for gaseous mixture prepa ration and a unit for mixture absorption and device evacuation. The system provides the gaseous mixture purification of O 2 and N 2 impurities. Final tritium content in the gas-discharge chamber after tritium removal is not greater than 2x10 8 Bq/l. Tritium content in a sealed box in which the device is placed does not exceed 30 Bq/l that is less than limiting safe value. The conclusion is made that the described system design gives an opportunity to begin experimental studies at plasma focus devices with deuterium-tritium mixture [ru

Implementing a Childhood Cancer Outcomes Surveillance System Within a Population-Based Cancer Registry

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Oscar Ramirez

2018-03-01

Full Text Available Purpose: Approximately 80% of cases of childhood cancer occur in low- and middle-income countries and are associated with high mortality rates. Assessing outcomes is essential for designing effective strategies to improve outcomes equally worldwide. We implemented a real-time surveillance system, VIGICANCER, embedded in a population-based cancer registry (PBCR to assess childhood cancer outcomes. Methods: VIGICANCER was established in 2009 as an integral part of Cali’s PBCR to collect real-time data on outcomes of patients (age < 19 years with a new diagnosis of cancer treated in pediatric oncology units in Cali, Colombia. Baseline and follow-up data (death, relapse, treatment abandonment, second neoplasms were collected from medical records, hospital discharge logs, pathology reports, death certificates, and the National Public Health Insurance database. A quality assurance process was implemented for the system. Results: From 2009 to 2013, data from 1,242 patients were included in VIGICANCER: 32% of patients were younger than 5 years, 55% were male, and 15% were Afro-descendants. International Classification of Childhood Cancer group I diagnoses predominated in all age groups except children younger than 1 year old, in whom CNS tumors predominated. Five-year overall survival for all cancers was 51.7% (95% CI, 47.9% to 55.4% for children (< 15 years, and 39.4% (95% CI, 29.8% to 50.5% for adolescents (15 to 18.9 years. Five-year overall survival for acute lymphoblastic leukemia was 55.6% (95% CI, 48.5% to 62.2%. Conclusion: Our study demonstrates the feasibility of implementing a real-time childhood cancer outcomes surveillance system embedded in a PBCR that can guide interventions to improve clinical outcomes in low- and middle-income countries.

Gamified systems development focused on edutertainment and player: an analysis of Bartle and Marczewski archetipes

Directory of Open Access Journals (Sweden)

Shelley Navari Christianini

2016-05-01

Full Text Available This paper presents a development methodology about gamification systems, in which discuss the learning in these media from entertainment, concept defined as Edutertainment. By employing gamification in this type of production, it is believed that the investigation must be focused only on the playing techniques. However, from a literature review, it was found that the focus should be on the player, considering their feelings and real motivations to stay in the system. As a result, it is providing a comparative overview on the theories of Bartle (1996, 2005 and Marczewski (2015 with the main differences between player types in gaming environments and gamification systems, especially with regard to motivational strategies in the context of education.

Quality and integration of public health information systems: A systematic review focused on immunization and vital records systems.

Science.gov (United States)

Vest, Joshua R; Kirk, Hilary M; Issel, L Michele

2012-01-01

Public health professionals rely on quantitative data for the daily practice of public health as well as organizational decision making and planning. However, several factors work against effective data sharing among public health agencies in the US. This review characterizes the reported barriers and enablers of effective use of public health IS from an informatics perspective. A systematic review of the English language literature for 2005 to 2011 followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) format. The review focused on immunization information systems (IIS) and vital records information systems (VRIS). Systems were described according to the structural aspects of IS integration and data quality. Articles describing IIS documented issues pertaining to the distribution of the system, the autonomy of the data providers, the heterogeneous nature of information sharing as well as the quality of the data. Articles describing VRIS were focused much more heavily on data quality, particularly whether or not the data were free from errors. For state and local practitioners to effectively utilize data, public health IS will have to overcome the challenges posed by a large number of autonomous data providers utilizing a variety of technologies.

Understanding local-scale drivers of biodiversity outcomes in terrestrial protected areas.

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Barnes, Megan D; Craigie, Ian D; Dudley, Nigel; Hockings, Marc

2017-07-01

Conservation relies heavily on protected areas (PAs) maintaining their key biodiversity features to meet global biodiversity conservation goals. However, PAs have had variable success, with many failing to fully maintain their biodiversity features. The current literature concerning what drives variability in PA performance is rapidly expanding but unclear, sometimes contradictory, and spread across multiple disciplines. A clear understanding of the drivers of successful biodiversity conservation in PAs is necessary to make them fully effective. Here, we conduct a comprehensive assessment of the current state of knowledge concerning the drivers of biological outcomes within PAs, focusing on those that can be addressed at local scales. We evaluate evidence in support of potential drivers to identify those that enable more successful outcomes and those that impede success and provide a synthetic review. Interactions are discussed where they are known, and we highlight gaps in understanding. We find that elements of PA design, management, and local and national governance challenges, species and system ecology, and sociopolitical context can all influence outcomes. Adjusting PA management to focus on actions and policies that influence the key drivers identified here could improve global biodiversity outcomes. © 2016 New York Academy of Sciences.

Optimization of an electrostatic quadrupole doublet focusing systems

Energy Technology Data Exchange (ETDEWEB)

Hussein, Oday A., E-mail: oah@sc.nahrainuniv.edu.iq [Department of Physics, College of Science, Al-Nahrain University, Baghdad (Iraq); Sise, Omer [Department of Science Education, Faculty of Education, Suleyman Demirel University, Isparta (Turkey)

2017-05-15

Highlights: • The imaging properties of an electrostatic quadrupole doublet lens were analyzed with the aid of computer simulation. • The optimal electrode voltages which lead to stigmatic image in both planes of the quadrupole doublet lens with minimum spot size at position sensitive detector (PSD) were found for two operation modes: point-to-point focusing and parallel-to-point focusing. • The imaging properties of are very sensitive to the lunching angle of the electron-beam. - Abstract: The imaging properties of an electrostatic quadrupole doublet lens were analyzed with the aid of computer simulation. The optimal electrode voltages which lead to stigmatic image in both planes of the quadrupole doublet lens with minimum spot size at position sensitive detector (PSD) were found for two operation modes: point-to-point focusing and parallel-to-point focusing. The optical properties as: Magnifications, spot sizes in the image plane and aberration figures were discussed. The results showed that the focusing of the lens was strong in the xy-plane in comparison with the focusing in the xz-plane. The distortion of the image was greater when the image position will be close to the lens in comparison with object position. Also, the imaging properties were very sensitive to the lunching angle of the electron-beam.

Attentional Focusing Instructions and Force Production

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David C Marchant

2011-01-01

Full Text Available Research progress assessing the role of attentional focusing instructions on skill acquisition and performance has lead researchers to apply this approach to force production tasks. Initial converging evidence indicates that force production tasks are sensitive to verbal instruction; externally focused instructions (onto movement outcomes, or onto the object force is being exerted against are shown to be more beneficial than internally focused instructions (focusing attention onto the movements being executed. These benefits are observed for maximal and accurate force production, as well as the maintenance of force production in prolonged tasks. A range of mechanisms are identified supporting the proposal that an external focus promotes movement efficiency in line with energy and effort conservation. Future research is required to assess how this developing body of work interacts with the broader understanding of psychological and physiological factors implicated in the effective production, maintenance and limitation of maximal or sub-maximal forces.

Effects of attentional focus on walking stability in elderly.

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de Melker Worms, Jonathan L A; Stins, John F; van Wegen, Erwin E H; Verschueren, Sabine M P; Beek, Peter J; Loram, Ian D

2017-06-01

Balance performance in the elderly is related to psychological factors such as attentional focus. We investigated the effects of internal vs. external focus of attention and fall history on walking stability in healthy older adults. Walking stability of twenty-eight healthy older adults was assessed by applying random unilateral decelerations on a split-belt treadmill and analysing the resulting balance recovery movements. The internal focus instruction was: concentrate on the movement of your legs, whereas the external focus instruction was: concentrate on the movement of the treadmill. In both conditions participants were asked to look ahead at a screen. Outcome measures were coefficient of variation of step length and step width, and characteristics of the centre of mass velocity time-series as analysed using statistical parametric mapping. Fall history was assessed using a questionnaire. After each perturbation participants required two to three strides to regain a normal gait pattern, as determined by the centre of mass velocity response. No effects were found of internal and external focus of attention instructions and fall history on any of the outcome measures. We conclude that, compared to an internal focus of attention instruction, external focus to the walking surface does not lead to improved balance recovery responses to gait perturbations in the elderly. Copyright © 2017 Elsevier B.V. All rights reserved.

Preliminary study on development of 300 Kv compact focused gaseous ion beam system

Energy Technology Data Exchange (ETDEWEB)

Ohkubo, T.; Ishii, Y.; Kamiya, T. [Takasaki Advanced Radiation Research Institute, Japan Atomic Energy Agency (JAEA) 1233 Watanuki-machi, Takasaki, Gunma, 370-1292 (Japan); Miyake, Y. [Beam Seiko Instruments Inc., 2-10-1 Kamata, Ohta-ku, Tokyo, 144-0052 (Japan)

2013-04-19

A new 300 kV compact focused gaseous ion beam (gas-FIB) system with three-stage acceleration lens was constructed at JAEA. The preliminary experiments of formation of the focused gaseous ion beams were carried out to show the availability of the gas-FIB system as a writing tool for 3D proton lithography. As a result of the experiments, it was proved that the focal point was kept at the same position under changing the kinetic energy but with keeping the kinetic energy ratio constant, which was defined as the ratio of kinetic energy in object side to that in image side for the third acceleration lens. This characteristic of the gas-FIB is a good point to advance the 3D proton lithography changing penetration depth in a sample by varying the beam energy.

Preliminary study on development of 300 Kv compact focused gaseous ion beam system

International Nuclear Information System (INIS)

Ohkubo, T.; Ishii, Y.; Kamiya, T.; Miyake, Y.

2013-01-01

A new 300 kV compact focused gaseous ion beam (gas-FIB) system with three-stage acceleration lens was constructed at JAEA. The preliminary experiments of formation of the focused gaseous ion beams were carried out to show the availability of the gas-FIB system as a writing tool for 3D proton lithography. As a result of the experiments, it was proved that the focal point was kept at the same position under changing the kinetic energy but with keeping the kinetic energy ratio constant, which was defined as the ratio of kinetic energy in object side to that in image side for the third acceleration lens. This characteristic of the gas-FIB is a good point to advance the 3D proton lithography changing penetration depth in a sample by varying the beam energy.

Donabedian's structure-process-outcome quality of care model: Validation in an integrated trauma system.

Science.gov (United States)

Moore, Lynne; Lavoie, André; Bourgeois, Gilles; Lapointe, Jean

2015-06-01

According to Donabedian's health care quality model, improvements in the structure of care should lead to improvements in clinical processes that should in turn improve patient outcome. This model has been widely adopted by the trauma community but has not yet been validated in a trauma system. The objective of this study was to assess the performance of an integrated trauma system in terms of structure, process, and outcome and evaluate the correlation between quality domains. Quality of care was evaluated for patients treated in a Canadian provincial trauma system (2005-2010; 57 centers, n = 63,971) using quality indicators (QIs) developed and validated previously. Structural performance was measured by transposing on-site accreditation visit reports onto an evaluation grid according to American College of Surgeons criteria. The composite process QI was calculated as the average sum of proportions of conformity to 15 process QIs derived from literature review and expert opinion. Outcome performance was measured using risk-adjusted rates of mortality, complications, and readmission as well as hospital length of stay (LOS). Correlation was assessed with Pearson's correlation coefficients. Statistically significant correlations were observed between structure and process QIs (r = 0.33), and process and outcome QIs (r = -0.33 for readmission, r = -0.27 for LOS). Significant positive correlations were also observed between outcome QIs (r = 0.37 for mortality-readmission; r = 0.39 for mortality-LOS and readmission-LOS; r = 0.45 for mortality-complications; r = 0.34 for readmission-complications; 0.63 for complications-LOS). Significant correlations between quality domains observed in this study suggest that Donabedian's structure-process-outcome model is a valid model for evaluating trauma care. Trauma centers that perform well in terms of structure also tend to perform well in terms of clinical processes, which in turn has a favorable influence on patient outcomes

Lens subluxation grading system: predictive value for ectopia lentis surgical outcomes

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Mauro Waiswol

2009-03-01

Full Text Available Objective: To present a classification system to grade ectopia lentis and to assess its usefulness as a predictor for surgical outcomes. Methods: Fifty-one eyes of 28 patients with either simple (19 patients or Marfan syndrome-associated ectopia lentis (nine patients with variable degrees of subluxation were operated on. Lens subluxation intensity was graded according to the lens subluxation grading system (LSGS from grade 1 (lens on the whole pupillary area up to grade 4 (lens absent from the pupillary area. Thirty eyes underwent cataract extraction (“dry” aspiration with endocapsular ring and in-the-bag intraocular lens (IOL implantation. Twenty-one eyes underwent cataract extraction (“dry” aspiration with scleral fixation of the IOL. The predictive value of the LSGS was assessed by analyzing the post-operative outcomes, including visual acuity (VA, endothelial cell loss, and complications for each grade on the grading system. Rresults: Patients were classified into grade 1 (19.6%, grade 2 (51% and grade 3 (29.4%. Post-operative VA was lower for eyes with larger degrees of subluxation. The higher the subluxation grade, the higher the endothelial cell loss, as well as, the frequency of vitreous loss and surgical time. Higher subluxation grades prevented optimal surgical outcomes with endocapsular ring and in-the-bag IOL implantation. Cconclusions: The LSGS provides an estimate of the surgical success of ectopia lentis. Adequate standardization of lens subluxation is crucial for understanding studies dealing with the surgical correction of this disorder.

Beyond the bench and the bedside: economic and health systems dimensions of global childhood cancer outcomes.

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Denburg, Avram E; Knaul, Felicia M; Atun, Rifat; Frazier, Lindsay A; Barr, Ronald D

2014-03-01

Globally, the number of new cases of childhood cancer continues to rise, with a widening gulf in outcomes across countries, despite the availability of effective cure options for many pediatric cancers. Economic forces and health system realities are deeply embedded in the foundation of disparities in global childhood cancer outcomes. A truly global effort to close the childhood cancer divide therefore requires systemic solutions. Analysis of the economic and health system dimensions of childhood cancer outcomes is essential to progress in childhood cancer survival around the globe. The conceptual power of this approach is significant. It provides insight into how and where pediatric oncology entwines with broader political and economic conditions, and highlights the mutual benefit derived from systems-oriented solutions. © 2013 Wiley Periodicals, Inc.

Strategies to control costs and quality: a focus on outcomes research for disease management.

Science.gov (United States)

Villagra, Victor

2004-04-01

Rapid adoption of disease management has outpaced systematic evaluation of its net value in improving health outcomes and mitigating healthcare cost. This article identifies areas in which outcomes research in disease management is needed to demonstrate its value or to enhance its performance. Patient identification for disease management relies on administrative database queries but the trade-offs in sensitivity, specificity, and predictive value of alternative queries are not well known. Large-scale deployment, rapid patient engagement, and repeated interactions between patients and nurses could be important attributes for attaining measurable improvements in quality and cost reduction over short periods of time, but these hypothesis need to be tested. There is a trend toward integration of multiple chronic disease management programs onto a single platform. To support this trend, there is a need for a corresponding set of integrated clinical guidelines or "meta-guidelines" that combine the contents of individual practice guidelines. The relative contribution of various disease management interventions in improving clinical results, lowering costs, and their respective ease of implementation is not known. Research leading to a better understanding of tradeoffs could lead to more rational resource allocation and better overall outcomes. Coordination between disease management programs and physician practices is lacking. Research aimed at defining operational and technical interfaces and cultural and behavioral professional adjustments necessary to achieve integration and coordination is needed. The lack of a consistent analytical framework for evaluating clinical and financial outcomes has made comparisons of reported results impossible and has rendered many reports unreliable. Theoretical work on a standard methodology that integrates clinical and financial outcomes and empiric validation is needed.

Reconciliation of international administrative coding systems for comparison of colorectal surgery outcome.

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Munasinghe, A; Chang, D; Mamidanna, R; Middleton, S; Joy, M; Penninckx, F; Darzi, A; Livingston, E; Faiz, O

2014-07-01

Significant variation in colorectal surgery outcomes exists between different countries. Better understanding of the sources of variable outcomes using administrative data requires alignment of differing clinical coding systems. We aimed to map similar diagnoses and procedures across administrative coding systems used in different countries. Administrative data were collected in a central database as part of the Global Comparators (GC) Project. In order to unify these data, a systematic translation of diagnostic and procedural codes was undertaken. Codes for colorectal diagnoses, resections, operative complications and reoperative interventions were mapped across the respective national healthcare administrative coding systems. Discharge data from January 2006 to June 2011 for patients who had undergone colorectal surgical resections were analysed to generate risk-adjusted models for mortality, length of stay, readmissions and reoperations. In all, 52 544 case records were collated from 31 institutions in five countries. Mapping of all the coding systems was achieved so that diagnosis and procedures from the participant countries could be compared. Using the aligned coding systems to develop risk-adjusted models, the 30-day mortality rate for colorectal surgery was 3.95% (95% CI 0.86-7.54), the 30-day readmission rate was 11.05% (5.67-17.61), the 28-day reoperation rate was 6.13% (3.68-9.66) and the mean length of stay was 14 (7.65-46.76) days. The linkage of international hospital administrative data that we developed enabled comparison of documented surgical outcomes between countries. This methodology may facilitate international benchmarking. Colorectal Disease © 2014 The Association of Coloproctology of Great Britain and Ireland.

ACCOUNTING INFORMATION SYSTEMS: AN APPROACH FOCUSED ON OBJECTS WITH INTELLIGENT AGENTS

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Marcelo Botelho da Costa Moraes

2010-01-01

Full Text Available Accounting aims at the treatment of information related to economic events within organizations. In order to do so, the double entry method is used (debt and credit accounting, which only considers monetary variations. With the development of information technologies, accounting information systems are born. In the 1980’s, the REA model (economic Resources, economic Events and economic Agents is created, which focuses on accounting information records, based on the association of economic resources, economic events and economic agents. The objective of this work is to demonstrate an object-oriented modeling with intelligent agents use, for information development and analysis focused on users. The proposed model is also analyzed according to accounting information quality, necessary for accounting information users, capable to comply with the needs of different user groups, with advantages in applications.

Pediatric Early Warning Score Systems, Nurses Perspective - A Focus Group Study

DEFF Research Database (Denmark)

Jensen, Claus Sixtus; Nielsen, Pia Bonde; Olesen, Hanne Vebert

2018-01-01

PURPOSE: Pediatric early warning score (PEWS) systems are used to monitor pediatric patients' vital signs and facilitate the treatment of patients at risk of deteriorating. The aim of this study was to gain knowledge about nurses' experiences with PEWS and to highlight factors facilitating...... and impeding the use of PEWS tools in clinical practice. DESIGN AND METHODS: An exploratory qualitative design was chosen using focus group interviews to gain a deeper understanding of nurses' experiences with PEWS. A total of five focus group interviews were conducted at three hospitals, and a qualitative......'s - a challenge, v) PEWS helps to visualize the need for escalating care, vi) an inflexible and challenging tool, and vii) supportive tools enhance the nurses' experiences of PEWS positively. CONCLUSIONS: Our findings suggest that attention should be given to nurses' perceptions of how both clinical judgment...

Effects of patient health literacy, patient engagement and a system-level health literacy attribute on patient-reported outcomes: a representative statewide survey.

Science.gov (United States)

Kaphingst, Kimberly A; Weaver, Nancy L; Wray, Ricardo J; Brown, Melissa L R; Buskirk, Trent; Kreuter, Matthew W

2014-10-07

The effects of health literacy are thought to be based on interactions between patients' skill levels and health care system demands. Little health literacy research has focused on attributes of health care organizations. We examined whether the attribute of individuals' experiences with front desk staff, patient engagement through bringing questions to a doctor visit, and health literacy skills were related to two patient-reported outcomes. We administered a telephone survey with two sampling frames (i.e., household landline, cell phone numbers) to a randomly selected statewide sample of 3358 English-speaking adult residents of Missouri. We examined two patient-reported outcomes - whether or not respondents reported knowing more about their health and made better choices about their health following their last doctor visit. Multivariable logistic regression models were used to examine the independent contributions of predictor variables (i.e., front desk staff, bringing questions to a doctor visit, health literacy skills). Controlling for self-reported health, having a personal doctor, time since last visit, number of chronic conditions, health insurance, and sociodemographic characteristics, respondents who had a good front desk experience were 2.65 times as likely (95% confidence interval [CI]: 2.13, 3.30) and those who brought questions were 1.73 times as likely (95% CI: 1.32, 2.27) to report knowing more about their health after seeing a doctor. In a second model, respondents who had a good front desk experience were 1.57 times as likely (95% CI: 1.26, 1.95) and those who brought questions were 1.66 times as likely (95% CI: 1.29, 2.14) to report making better choices about their health after seeing a doctor. Patients' health literacy skills were not associated with either outcome. Results from this representative statewide survey may indicate that one attribute of a health care organization (i.e., having a respectful workforce) and patient engagement through

Maternal nutrition and birth outcomes.

Science.gov (United States)

Abu-Saad, Kathleen; Fraser, Drora

2010-01-01

In this review, the authors summarize current knowledge on maternal nutritional requirements during pregnancy, with a focus on the nutrients that have been most commonly investigated in association with birth outcomes. Data sourcing and extraction included searches of the primary resources establishing maternal nutrient requirements during pregnancy (e.g., Dietary Reference Intakes), and searches of Medline for "maternal nutrition"/[specific nutrient of interest] and "birth/pregnancy outcomes," focusing mainly on the less extensively reviewed evidence from observational studies of maternal dietary intake and birth outcomes. The authors used a conceptual framework which took both primary and secondary factors (e.g., baseline maternal nutritional status, socioeconomic status of the study populations, timing and methods of assessing maternal nutritional variables) into account when interpreting study findings. The authors conclude that maternal nutrition is a modifiable risk factor of public health importance that can be integrated into efforts to prevent adverse birth outcomes, particularly among economically developing/low-income populations.

Learning-Focused Leadership and Leadership Support: Meaning and Practice in Urban Systems

Science.gov (United States)

Knapp, Michael S.; Copland, Michael A.; Honig, Meredith I.; Plecki, Margaret L.; Portin, Bradley S.

2010-01-01

This report synthesizes what has been learned about how leaders in urban systems focus their leadership on the improvement of learning, and what it takes to support their leadership in these settings. The report brings together findings from three sub-study strands, concerned with efforts in seven urban districts to: a) invest staffing and other…

Persistent systemic inflammation is associated with poor clinical outcomes in COPD

DEFF Research Database (Denmark)

Agustí, Alvar; Edwards, Lisa D; Rennard, Stephen I

2012-01-01

Because chronic obstructive pulmonary disease (COPD) is a heterogeneous condition, the identification of specific clinical phenotypes is key to developing more effective therapies. To explore if the persistence of systemic inflammation is associated with poor clinical outcomes in COPD we assessed...

Beyond 1984: The Positive and Negative Potential of Computer Supported School Focused Information Systems.

Science.gov (United States)

Klein, Susan S.

Although educators' use of computers to track student and school information with the attendant positive and negative outcomes is still in an early stage of development, accessible data from such systems could improve the objective rationality of educational and instructional decision-making as long as no one places unwarranted credibility in the…

Influence of focus of attention, reinvestment and fall history on elderly gait stability

NARCIS (Netherlands)

de Melker Worms, Jonathan L.A.; Stins, John F.; van Wegen, Erwin E.H.; Loram, Ian D.; Beek, Peter J.

2017-01-01

Falls represent a substantial risk in the elderly. Previous studies have found that a focus on the outcome or effect of the movement (external focus of attention) leads to improved balance performance, whereas a focus on the movement execution itself (internal focus of attention) impairs balance

Prosthetists' perceptions and use of outcome measures in clinical practice: Long-term effects of focused continuing education.

Science.gov (United States)

Hafner, Brian J; Spaulding, Susan E; Salem, Rana; Morgan, Sara J; Gaunaurd, Ignacio; Gailey, Robert

2017-06-01

Continuing education is intended to facilitate clinicians' skills and knowledge in areas of practice, such as administration and interpretation of outcome measures. To evaluate the long-term effect of continuing education on prosthetists' confidence in administering outcome measures and their perceptions of outcomes measurement in clinical practice. Pretest-posttest survey methods. A total of 66 prosthetists were surveyed before, immediately after, and 2 years after outcomes measurement education and training. Prosthetists were grouped as routine or non-routine outcome measures users, based on experience reported prior to training. On average, prosthetists were just as confident administering measures 1-2 years after continuing education as they were immediately after continuing education. In all, 20% of prosthetists, initially classified as non-routine users, were subsequently classified as routine users at follow-up. Routine and non-routine users' opinions differed on whether outcome measures contributed to efficient patient evaluations (79.3% and 32.4%, respectively). Both routine and non-routine users reported challenges integrating outcome measures into normal clinical routines (20.7% and 45.9%, respectively). Continuing education had a long-term impact on prosthetists' confidence in administering outcome measures and may influence their clinical practices. However, remaining barriers to using standardized measures need to be addressed to keep practitioners current with evolving practice expectations. Clinical relevance Continuing education (CE) had a significant long-term impact on prosthetists' confidence in administering outcome measures and influenced their clinical practices. In all, approximately 20% of prosthetists, who previously were non-routine outcome measure users, became routine users after CE. There remains a need to develop strategies to integrate outcome measurement into routine clinical practice.

Beam self-excited rf cavity driver for a deflector or focusing system

International Nuclear Information System (INIS)

Wadlinger, E.A.

1996-01-01

A bunched beam from and accelerator can excite and power an rf cavity which then drives either a deflecting or focusing (including nonlinear focusing) rf cavity with and amplitude related to beam current. Rf power, generated when a bunched beam loses energy to an rf field when traversing an electric field that opposes the particle's motion, is used to drive a separate (or the same) cavity to either focus or deflect the beam. The deflected beam can be stopped by an apertures or directed to a different area of a target depending on beam current. The beam-generated rf power can drive a radio-frequency quadrupole (RFQ) that can change the focusing properties of a beam channel as a function of beam current (space- charge force compensation or modifying the beam distribution on a target). An rf deflector can offset a beam to a downstream sextupole, effectively producing a position-dependent quadrupole field. The combination of rf deflector plus sextupole will produce a beam current dependent quadropole-focusing force. A static quadrupole magnet plus another rf deflector can place the beam back on the optic axis. This paper describes the concept, derives the appropriate equations for system analysis, and fives examples. A variation on this theme is to use the wake field generated in an rf cavity to cause growth in the beam emittance. The beam current would then be apertured by emittance defining slits

Beam self-excited rf cavity driver for a deflector or focusing system

International Nuclear Information System (INIS)

Wadlinger, E.A.

1996-01-01

A bunched beam from an accelerator can excite and power an rf cavity which then drives either a deflecting or focusing (including nonlinear focusing) rf cavity with an amplitude related to beam current. Rf power, generated when a bunched beam loses energy to an rf field when traversing an electric field that opposes the particle's motion, is used to drive a separate (or the same) cavity to either focus or deflect the beam. The deflected beam can be stopped by an aperture or directed to a different area of a target depending on beam current. The beam-generated rf power can drive a radiofrequency quadrupole that can change the focusing properties of a beam channel as a function of beam current (space-charge-force compensation or modifying the beam distribution on a target). An rf deflector can offset a beam to a downstream sextupole, effectively producing a position-dependent quadrupole field. The combination of rf deflector plus sextupole will produce a beam current dependent quadrupole-focusing force. A static quadrupole magnet plus another rf deflector can place the beam back on the optic axis. This paper describes the concept, derives the appropriate equations for system analysis, and gives examples. A variation on this theme is to use the wake field generated in an rf cavity to cause growth in the beam emittance. The beam current would then be apertured by emittance defining slits. (author)

Effects of external focus of attention on balance: a short review.

Science.gov (United States)

Park, Sun Hee; Yi, Chae Woo; Shin, Ju Yong; Ryu, Young Uk

2015-12-01

[Purpose] The present study reviewed studies that examined the effects of attentional focus on balance. [Methods] Keywords such as "attentional", "focus", and "balance" were used to find relevant research papers in PubMed (www.ncbi.nlm.nih.gov/pubmed). Forty-five papers were found, and 18 of them were used for this study, excluding review papers and papers irrelevant to the topic of this study. [Results] Among the papers used for the review, the number of papers in which external focus produced effective outcomes was 15 (83.3%). The number of papers in which both external and internal focus produced effective outcomes was 2 (11.1%). The number of paper in which no instruction about attentional focus was effective was 1 (5.5%), and the number of papers in which internal focus was effective was zero. [Conclusion] This short review suggests clinical implications about how physical therapists can use attentional focus for balance rehabilitation of patients. Instructions about external focus of attention can generally be useful as a method to improve posture and balance control. Furthermore, the present reviews indicates that external focus of attention would be more useful in a rehabilitation stage in which the difficulty level of balance performance is gradually increased.

Puzzle-solving in psychology : The neo-Galtonian vs. nomothetic research focuses

NARCIS (Netherlands)

Vautier, Stephane; Lacot, Emilie; Veldhuis, Michiel

We compare the neo-Galtonian and nomothetic approaches of psychological research. While the former focuses on summarized statistics that depict average subjects, the latter focuses on general facts of form 'if conditions then restricted outcomes'. The nomothetic approach does not require

Testing an mHealth momentary assessment Routine Outcome Monitoring application: a focus on restoration of daily life positive mood states.

Directory of Open Access Journals (Sweden)

Jim van Os

Full Text Available Routine Outcome Monitoring (ROM is used as a means to enrich the process of treatment with feedback on patient outcomes, facilitating patient involvement and shared decision making. While traditional ROM measures focus on retrospective accounts of symptoms, novel mHealth technology makes it possible to collect real life, in-the-moment ambulatory data that allow for an ecologically valid assessment of personalized and contextualized emotional and behavioural adjustment in the flow daily life (mROM.In a sample of 34 patients with major depressive disorder, treated with antidepressants, the combined effect of treatment and natural course was examined over a period of 18 weeks with Ecological Momentary Assessment (EMA. EMA consisted of repeated, within-subject, mini-measurements of experience (eg positive affect, negative affect, medication side effects and context (eg stressors, situations, activities at 10 unselected semi-random moments per day, for a period of six days, repeated three times over the 18-week period (baseline, week 6 and week 18.EMA measures of emotional and behavioural adjustment were sensitive to the effects of treatment and natural course over the 18-week period, particularly EMA measures focussing on positive mood states and the ability to use natural rewards (impact of positive events on positive mood states, with standardized effect sizes of 0.4-0.5. EMA measures of activities, social interaction, stress-sensitivity and negative mood states were also sensitive to change over time.This study supports the use of mROM as a means to involve the patient in the process of needs assessment and treatment. EMA data are meaningful to the patient, as they reflect daily life circumstances. Assessment of treatment response with mROM data allows for an interpretation of the effect of treatment at the level of daily life emotional and social adjustment--as an index of health, obviating the need for an exclusive focus on traditional measures

Lung and colorectal cancer treatment and outcomes in the Veterans Affairs health care system

International Nuclear Information System (INIS)

Zullig, Leah L; Williams, Christina D; Fortune-Britt, Alice G

2015-01-01

Lung cancer (LC) and colorectal cancer (CRC) are the second- and third-most commonly diagnosed cancers in the Veterans Affairs (VA) health care system. While many studies have evaluated the treatment quality and outcomes of various aspects of VA LC and CRC care, there are no known reviews synthesizing this information across studies. The purpose of this literature review was to describe LC and CRC treatment (ie, surgical and nonsurgical) and outcomes (eg, mortality, psychosocial, and other) in the VA health care system as reported in the existing peer-reviewed scientific literature. We identified potential articles through a search of published literature using the PubMed electronic database. Our search strategy identified articles containing Medical Subject Headings terms and keywords addressing veterans or veterans’ health and LC and/or CRC. We limited articles to those published in the previous 11 years (January 1, 2003 through December 31, 2013). A total of 230 articles were retrieved through the search. After applying the selection criteria, we included 74 studies (34 LC, 47 CRC, and seven both LC and CRC). VA provides a full array of treatments, often with better outcomes than other health care systems. More work is needed to assess patient-reported outcomes

Meningococcal Two-Partner Secretion Systems and Their Association with Outcome in Patients with Meningitis

Science.gov (United States)

Piet, Jurgen R.; van Ulsen, Peter; ur Rahman, Sadeeq; Bovenkerk, Sandra; Bentley, Stephen D.

2016-01-01

Two-partner secretion (TPS) systems export large TpsA proteins to the surface and extracellular milieu. In meningococci, three different TPS systems exist, and of these, TPS system 2 (TPS2) and TPS3 can be detected by the host's immune system. We evaluated the distribution of TPS systems among clinical isolates from two prospective cohort studies comprising 373 patients with meningococcal meningitis. TPS system 1 was present in 91% of isolates, and system 2 and/or 3 was present in 67%. The TPS system distribution was related to clonal complexes. Infection with strains with TPS2 and/or TPS3 resulted in less severe disease and better outcomes than infection with strains without these systems. Using whole-blood stimulation experiments, we found no differences in the host cytokine response between patients infected with TPS system 2 and 3 knockout strains and patients infected with a wild-type strain. In conclusion, meningococcal TPS system 2 and/or 3 is associated with disease severity and outcome in patients with meningitis. PMID:27324486

Focus On: Neurotransmitter Systems

Science.gov (United States)

Valenzuela, C. Fernando; Puglia, Michael P.; Zucca, Stefano

2011-01-01

Neurotransmitter systems have been long recognized as important targets of the developmental actions of alcohol (i.e., ethanol). Short- and long-term effects of ethanol on amino acid (e.g., γ-aminobutyric acid and glutamate) and biogenic amine (e.g., serotonin and dopamine) neurotransmitters have been demonstrated in animal models of fetal alcohol spectrum disorders (FASD). Researchers have detected ethanol effects after exposure during developmental periods equivalent to the first, second, and third trimesters of human pregnancy. Results support the recommendation that pregnant women should abstain from drinking—even small quantities—as effects of ethanol on neurotransmitter systems have been detected at low levels of exposure. Recent studies have elucidated new mechanisms and/or consequences of the actions of ethanol on amino acid and biogenic amine neurotransmitter systems. Alterations in these neurotransmitter systems could, in part, be responsible for many of the conditions associated with FASD, including (1) learning, memory, and attention deficits; (2) motor coordination impairments; (3) abnormal responsiveness to stress; and (4) increased susceptibility to neuropsychiatric disorders, such as substance abuse and depression, and also neurological disorders, such as epilepsy and sudden infant death syndrome. However, future research is needed to conclusively establish a causal relationship between these conditions and developmental dysfunctions in neurotransmitter systems. PMID:23580048

EPA Region 7 Aquatic Focus Areas (ECO_RES.R7_AQUATIC_FOCUS_AREAS)

Data.gov (United States)

U.S. Environmental Protection Agency — This shapefile consists of 347 individual Aquatic Ecological System (AES) polygons that are the Aquatic Conservation Focus Areas for EPA Region 7. The focus areas...

Using value-based analysis to influence outcomes in complex surgical systems.

Science.gov (United States)

Kirkpatrick, John R; Marks, Stanley; Slane, Michele; Kim, Donald; Cohen, Lance; Cortelli, Michael; Plate, Juan; Perryman, Richard; Zapas, John

2015-04-01

Value-based analysis (VBA) is a management strategy used to determine changes in value (quality/cost) when a usual practice (UP) is replaced by a best practice (BP). Previously validated in clinical initiatives, its usefulness in complex systems is unknown. To answer this question, we used VBA to correct deficiencies in cardiac surgery at Memorial Healthcare System. Cardiac surgery is a complex surgical system that lends itself to VBA because outcomes metrics provided by the Society of Thoracic Surgeons provide an estimate of quality; cost is available from Centers for Medicare and Medicaid Services and other contemporary sources; the UP can be determined; and the best practice can be established. Analysis of the UP at Memorial Healthcare System revealed considerable deficiencies in selection of patients for surgery; the surgery itself, including choice of procedure and outcomes; after care; follow-up; and control of expenditures. To correct these deficiencies, each UP was replaced with a BP. Changes included replacement of most of the cardiac surgeons; conversion to an employed physician model; restructuring of a heart surgery unit; recruitment of cardiac anesthesiologists; introduction of an interactive educational program; eliminating unsafe practices; and reducing cost. There was a significant (p value (quality/cost) in a complex surgical system. Copyright © 2015 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

The role of employee HR attributions in the relationship between high-performance work systems and employee outcomes

NARCIS (Netherlands)

van de Voorde, F.C.; Beijer, Susanne

2015-01-01

Although research has shown that the use of high-performance work systems (HPWS) is associated with employee outcomes, our knowledge of the meanings employees attach to HPWS systems and how these shape employee outcomes is still limited. This study examines the signalling impact of enacted HPWS on

Verbal-motor attention-focusing instructions influence kinematics and performance on a golf-putting task.

Science.gov (United States)

Munzert, Jörn; Maurer, Heiko; Reiser, Mathias

2014-01-01

The authors examined how varying the content of verbal-motor instructions and requesting an internal versus external focus influenced the kinematics and outcome of a golf putting task. On Day 1, 30 novices performed 120 trials with the instruction to focus attention either on performing a pendulum-like movement (internal) or on the desired ball path (external). After 20 retention trials on Day 2, they performed 20 transfer trials with the opposite instruction. Group differences for retention and a group by block interaction showed that external instruction enhanced movement outcome. Kinematic data indicated that specific instruction content influenced outcomes by eliciting changes in movement execution. Switching from the external to the internal focus instruction resulted in a more pendulum-like movement.

02A. Design, Methods, and Outcomes for Recent Clinical Trials Utilizing Ayurvedic Medicine, Yoga, and Meditation

Science.gov (United States)

Saper, Robert; Vinjamury, Sivarama; Elder, Charles

2013-01-01

Focus Area: Integrative Approaches to Care The panel discussants will present on the outcomes of four recent pragmatic trials covering the spectrum of Ayurvedic medicine, yoga, and meditation as therapeutic approaches for both acute and chronic conditions. The presenters will discuss: (1) a pilot study of a whole-systems Ayurveda and Yoga Therapy intervention for obesity; (2) a comparative effectiveness randomized controlled trial of hatha yoga, physical therapy, and education for non-specific chronic low back pain in low-income minority populations; (3) an investigation of the therapeutic usefulness of Shirodhara (Ayurvedic oil dripping therapy) as a treatment for insomnia; and (4) a discussion of the evidence base supporting implementation of meditation interventions in schools and workplace settings. Discussants will present information on study designs, research methodology, and outcome measure selection to highlight special considerations in conducting research on whole medical systems that use multi-target therapies and focus on patient-centered outcomes. Ayurvedic medicine and yoga are characterized by low-cost, noninvasive interventions that can be usefully offered as part of an integrative medicine therapeutic approach.

Regulation of Calcitriol Biosynthesis and Activity: Focus on Gestational Vitamin D Deficiency and Adverse Pregnancy Outcomes

Directory of Open Access Journals (Sweden)

Andrea Olmos-Ortiz

2015-01-01

Full Text Available Vitamin D has garnered a great deal of attention in recent years due to a global prevalence of vitamin D deficiency associated with an increased risk of a variety of human diseases. Specifically, hypovitaminosis D in pregnant women is highly common and has important implications for the mother and lifelong health of the child, since it has been linked to maternal and child infections, small-for-gestational age, preterm delivery, preeclampsia, gestational diabetes, as well as imprinting on the infant for life chronic diseases. Therefore, factors that regulate vitamin D metabolism are of main importance, especially during pregnancy. The hormonal form and most active metabolite of vitamin D is calcitriol. This hormone mediates its biological effects through a specific nuclear receptor, which is found in many tissues including the placenta. Calcitriol synthesis and degradation depend on the expression and activity of CYP27B1 and CYP24A1 cytochromes, respectively, for which regulation is tissue specific. Among the factors that modify these cytochromes expression and/or activity are calcitriol itself, parathyroid hormone, fibroblast growth factor 23, cytokines, calcium and phosphate. This review provides a current overview on the regulation of vitamin D metabolism, focusing on vitamin D deficiency during gestation and its impact on pregnancy outcomes.

The proposed alignment system for the Final Focus Test Beam at SLAC

International Nuclear Information System (INIS)

Ruland, R.E.; Fischer, G.E.

1990-09-01

This report describes the current state of work in progress with respect to the geometry, alignment requirements, scenarios, and hardware for meeting the tolerances of the Final Focus Test Beam (FFTB) at SLAC. The methods and systems proposed acknowledge that component motion at the micron level, from whatever cause (ground motion, thermal effects, etc.) must be measured on-line and compensated for on relatively short time scales. To provide an integrated alignment/positioning package, some unique designs for reference systems, calibration of effect electric and magnetic centers, and component movers are introduced. 24 refs., 28 figs

Total hip arthroplasty outcomes assessment using functional and radiographic scores to compare canine systems.

Science.gov (United States)

Iwata, D; Broun, H C; Black, A P; Preston, C A; Anderson, G I

2008-01-01

A retrospective multi-centre study was carried out in order to compare outcomes between cemented and uncemented total hip arthoplasties (THA). A quantitative orthopaedic outcome assessment scoring system was devised in order to relate functional outcome to a numerical score, to allow comparison between treatments and amongst centres. The system combined a radiographic score and a clinical score. Lower scores reflect better outcomes than higher scores. Consecutive cases of THA were included from two specialist practices between July 2002 and December 2005. The study included 46 THA patients (22 uncemented THA followed for 8.3 +/- 4.7M and 24 cemented THA for 26.0 +/- 15.7M) with a mean age of 4.4 +/- 3.3 years at surgery. Multi-variable linear and logistical regression analyses were performed with adjustments for age at surgery, surgeon, follow-up time, uni- versus bilateral disease, gender and body weight. The differences between treatment groups in terms of functional scores or total scores were not significant (p > 0.05). Radiographic scores were different between treatment groups. However, these scores were usually assessed within two months of surgery and proved unreliable predictors of functional outcome (p > 0.05). The findings reflect relatively short-term follow-up, especially for the uncemented group, and do not include clinician-derived measures, such as goniometry and thigh circumference. Longer-term follow-up for the radiographic assessments is essential. A prospective study including the clinician-derived outcomes needs to be performed in order to validate the outcome instrument in its modified form.

System safety education focused on system management

Science.gov (United States)

Grose, V. L.

1971-01-01

System safety is defined and characteristics of the system are outlined. Some of the principle characteristics include role of humans in hazard analysis, clear language for input and output, system interdependence, self containment, and parallel analysis of elements.

Association between periodontal diseases and systemic diseases

Directory of Open Access Journals (Sweden)

Patrícia Weidlich

2008-08-01

Full Text Available Current evidence suggests that periodontal disease may be associated with systemic diseases. This paper reviewed the published data about the relationship between periodontal disease and cardiovascular diseases, adverse pregnancy outcomes, diabetes and respiratory diseases, focusing on studies conducted in the Brazilian population. Only a few studies were found in the literature focusing on Brazilians (3 concerning cardiovascular disease, 7 about pregnancy outcomes, 9 about diabetes and one regarding pneumonia. Although the majority of them observed an association between periodontitis and systemic conditions, a causal relationship still needs to be demonstrated. Further studies, particularly interventional well-designed investigations, with larger sample sizes, need to be conducted in Brazilian populations.

Using the Human Systems Simulation Laboratory at Idaho National Laboratory for Safety Focused Research

Energy Technology Data Exchange (ETDEWEB)

Joe, Jeffrey .C; Boring, Ronald L.

2016-07-01

Under the United States (U.S.) Department of Energy (DOE) Light Water Reactor Sustainability (LWRS) program, researchers at Idaho National Laboratory (INL) have been using the Human Systems Simulation Laboratory (HSSL) to conduct critical safety focused Human Factors research and development (R&D) for the nuclear industry. The LWRS program has the overall objective to develop the scientific basis to extend existing nuclear power plant (NPP) operating life beyond the current 60-year licensing period and to ensure their long-term reliability, productivity, safety, and security. One focus area for LWRS is the NPP main control room (MCR), because many of the instrumentation and control (I&C) system technologies installed in the MCR, while highly reliable and safe, are now difficult to replace and are therefore limiting the operating life of the NPP. This paper describes how INL researchers use the HSSL to conduct Human Factors R&D on modernizing or upgrading these I&C systems in a step-wise manner, and how the HSSL has addressed a significant gap in how to upgrade systems and technologies that are built to last, and therefore require careful integration of analog and new advanced digital technologies.

Is Textbook Outcome a valuable composite measure for short-term outcomes of gastrointestinal treatments in the Netherlands using hospital information system data? A retrospective cohort study.

Science.gov (United States)

Salet, Nèwel; Bremmer, Rolf H; Verhagen, Marc A M T; Ekkelenkamp, Vivian E; Hansen, Bettina E; de Jonge, Pieter J F; de Man, Rob A

2018-03-01

To develop a feasible model for monitoring short-term outcome of clinical care trajectories for hospitals in the Netherlands using data obtained from hospital information systems for identifying hospital variation. Retrospective analysis of collected data from hospital information systems combined with clinical indicator definitions to define and compare short-term outcomes for three gastrointestinal pathways using the concept of Textbook Outcome. 62 Dutch hospitals. 45 848 unique gastrointestinal patients discharged in 2015. A broad range of clinical outcomes including length of stay, reintervention, readmission and doctor-patient counselling. Patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) for gallstone disease (n=4369), colonoscopy for inflammatory bowel disease (IBD; n=19 330) and colonoscopy for colorectal cancer screening (n=22 149) were submitted to five suitable clinical indicators per treatment. The percentage of all patients who met all five criteria was 54%±9% (SD) for ERCP treatment. For IBD this was 47%±7% of the patients, and for colon cancer screening this number was 85%±14%. This study shows that reusing data obtained from hospital information systems combined with clinical indicator definitions can be used to express short-term outcomes using the concept of Textbook Outcome without any excess registration. This information can provide meaningful insight into the clinical care trajectory on the level of individual patient care. Furthermore, this concept can be applied to many clinical trajectories within gastroenterology and beyond for monitoring and improving the clinical pathway and outcome for patients. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Predicting IVF Outcome: A Proposed Web-based System Using Artificial Intelligence.

Science.gov (United States)

Siristatidis, Charalampos; Vogiatzi, Paraskevi; Pouliakis, Abraham; Trivella, Marialenna; Papantoniou, Nikolaos; Bettocchi, Stefano

2016-01-01

To propose a functional in vitro fertilization (IVF) prediction model to assist clinicians in tailoring personalized treatment of subfertile couples and improve assisted reproduction outcome. Construction and evaluation of an enhanced web-based system with a novel Artificial Neural Network (ANN) architecture and conformed input and output parameters according to the clinical and bibliographical standards, driven by a complete data set and "trained" by a network expert in an IVF setting. The system is capable to act as a routine information technology platform for the IVF unit and is capable of recalling and evaluating a vast amount of information in a rapid and automated manner to provide an objective indication on the outcome of an artificial reproductive cycle. ANNs are an exceptional candidate in providing the fertility specialist with numerical estimates to promote personalization of healthcare and adaptation of the course of treatment according to the indications. Copyright © 2016 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.

Mediterranea Forecasting System: a focus on wave-current coupling

Science.gov (United States)

Clementi, Emanuela; Delrosso, Damiano; Pistoia, Jenny; Drudi, Massimiliano; Fratianni, Claudia; Grandi, Alessandro; Pinardi, Nadia; Oddo, Paolo; Tonani, Marina

2016-04-01

The Mediterranean Forecasting System (MFS) is a numerical ocean prediction system that produces analyses, reanalyses and short term forecasts for the entire Mediterranean Sea and its Atlantic Ocean adjacent areas. MFS became operational in the late 90's and has been developed and continuously improved in the framework of a series of EU and National funded programs and is now part of the Copernicus Marine Service. The MFS is composed by the hydrodynamic model NEMO (Nucleus for European Modelling of the Ocean) 2-way coupled with the third generation wave model WW3 (WaveWatchIII) implemented in the Mediterranean Sea with 1/16 horizontal resolution and forced by ECMWF atmospheric fields. The model solutions are corrected by the data assimilation system (3D variational scheme adapted to the oceanic assimilation problem) with a daily assimilation cycle, using a background error correlation matrix varying seasonally and in different sub-regions of the Mediterranean Sea. The focus of this work is to present the latest modelling system upgrades and the related achieved improvements. In order to evaluate the performance of the coupled system a set of experiments has been built by coupling the wave and circulation models that hourly exchange the following fields: the sea surface currents and air-sea temperature difference are transferred from NEMO model to WW3 model modifying respectively the mean momentum transfer of waves and the wind speed stability parameter; while the neutral drag coefficient computed by WW3 model is passed to NEMO that computes the turbulent component. In order to validate the modelling system, numerical results have been compared with in-situ and remote sensing data. This work suggests that a coupled model might be capable of a better description of wave-current interactions, in particular feedback from the ocean to the waves might assess an improvement on the prediction capability of wave characteristics, while suggests to proceed toward a fully

The Implementation of Data Warehouse and OLAP for Rehabilitation Outcome Evaluation: ReDWinE System

Science.gov (United States)

Guo, Fei-Ran; Parmanto, Bambang; Irrgang, James J.; Wang, Jiunjie; Fang, Huaijin

2000-01-01

We created a data warehouse and OLAP system on the web for outcome evaluation of rehabilitation services. Thirteen outcome indicators were use in this research. Efficiency of therapists and clinics, expected utility of treatments and graphic patterns were generated for data exploration, data mining and decision support. Users can retrieve plenty of graphs and statistical tables without knowing database structure or attributes. Our experiences showed that multi-dimensional database and OLAP could serve as a decision support system.

Treatment with budesonide/formoterol pressurized metered-dose inhaler in patients with asthma: a focus on patient-reported outcomes

Directory of Open Access Journals (Sweden)

Richard D O'Connor

2011-01-01

Full Text Available Richard D O'ConnorSharp Rees-Stealy Medical Group, San Diego, CA, USAAbstract: In the United States, budesonide/formoterol pressurized metered-dose inhaler (pMDI is approved for treatment of asthma in patients aged ≥12 years whose asthma is not adequately controlled with an inhaled corticosteroid (ICS or whose disease severity clearly warrants treatment with an ICS and a long-acting β2-adrenergic agonist. This article reviews studies of budesonide/formoterol pMDI in patients with persistent asthma, with a particular focus on patient-reported outcomes (eg, perceived onset of effect, patient satisfaction with treatment, health-related quality of life [HRQL], global assessments, sleep quality and quantity, as these measures reflect patient perceptions of asthma control and disease burden. A search of PubMed and respiratory meetings was performed to identify relevant studies. In two pivotal budesonide/formoterol pMDI studies in adolescents and adults, greater efficacy and similar tolerability were shown with budesonide/formoterol pMDI 160/9 µg and 320/9 µg twice daily versus its monocomponents or placebo. In those studies, improvements in HRQL, patient satisfaction, global assessments of asthma control, and quality of sleep also favored budesonide/formoterol pMDI compared with one or both of its monocomponents or placebo. Budesonide/formoterol pMDI has a rapid onset of effect (within 15 minutes that patients can feel, an attribute that may have benefits for treatment adherence. In summary, budesonide/formoterol pMDI is effective and well tolerated and has additional therapeutic benefits that may be important from the patient’s perspective.Keywords: budesonide, formoterol, patient-reported outcomes, efficacy, tolerability, onset of effect

Economic and ecological outcomes of flexible biodiversity offset systems.

Science.gov (United States)

Habib, Thomas J; Farr, Daniel R; Schneider, Richard R; Boutin, Stan

2013-12-01

The commonly expressed goal of biodiversity offsets is to achieve no net loss of specific biological features affected by development. However, strict equivalency requirements may complicate trading of offset credits, increase costs due to restricted offset placement options, and force offset activities to focus on features that may not represent regional conservation priorities. Using the oil sands industry of Alberta, Canada, as a case study, we evaluated the economic and ecological performance of alternative offset systems targeting either ecologically equivalent areas (vegetation types) or regional conservation priorities (caribou and the Dry Mixedwood natural subregion). Exchanging dissimilar biodiversity elements requires assessment via a generalized metric; we used an empirically derived index of biodiversity intactness to link offsets with losses incurred by development. We considered 2 offset activities: land protection, with costs estimated as the net present value of profits of petroleum and timber resources to be paid as compensation to resource tenure holders, and restoration of anthropogenic footprint, with costs estimated from existing restoration projects. We used the spatial optimization tool MARXAN to develop hypothetical offset networks that met either the equivalent-vegetation or conservation-priority targets. Networks that required offsetting equivalent vegetation cost 2-17 times more than priority-focused networks. This finding calls into question the prudence of equivalency-based systems, particularly in relatively undeveloped jurisdictions, where conservation focuses on limiting and directing future losses. Priority-focused offsets may offer benefits to industry and environmental stakeholders by allowing for lower-cost conservation of valued ecological features and may invite discussion on what land-use trade-offs are acceptable when trading biodiversity via offsets. Resultados Económicos y Ecológicos de Sistemas de Compensación de

Maternal arsenic exposure and birth outcomes: a comprehensive review of the epidemiologic literature focused on drinking water.

Science.gov (United States)

Bloom, Michael S; Surdu, Simona; Neamtiu, Iulia A; Gurzau, Eugen S

2014-09-01

Inorganic arsenic (iAs) is a human toxicant to which populations may be exposed through consumption of geogenically contaminated groundwater. A growing body of experimental literature corroborates the reproductive toxicity of iAs; however, the results of human studies are inconsistent. Therefore, we conducted a comprehensive review of epidemiologic studies focused on drinking water iAs exposure and birth outcomes to assess the evidence for causality and to make recommendations for future study. We reviewed 18 English language papers assessing birth weight, gestational age, and birth size. Thirteen of the studies were conducted among populations with frequent exposure to high-level groundwater iAs contamination (>10 μg/L) and five studies were conducted in areas without recognized contamination. Most studies comprised small samples and used cross-sectional designs, often with ecologic exposure assessment strategies, although several large prospective investigations and studies with individual-level measurements were also reported. We conclude that: (1) the epidemiologic evidence for an increased risk of low birth weight (water iAs contamination quality epidemiologic studies are necessary to more definitively assess the risk. Copyright © 2014 Elsevier GmbH. All rights reserved.

A homogeneous focusing system for diode lasers and its applications in metal surface modification

Science.gov (United States)

Wang, Fei; Zhong, Lijing; Tang, Xiahui; Xu, Chengwen; Wan, Chenhao

2018-06-01

High power diode lasers are applied in many different areas, including surface modification, welding and cutting. It is an important technical trend in laser processing of metals in the future. This paper aims to analyze the impact of the shape and homogeneity of the focal spot of the diode laser on surface modification. A focusing system using the triplet lenses for a direct output diode laser which can be used to eliminate coma aberrations is studied. A rectangular stripe with an aspect ratio from 8:1 to 25:1 is obtained, in which the power is homogeneously distributed along the fast axis, the power is 1117.6 W and the peak power intensity is 1.1587 × 106 W/cm2. This paper also presents a homogeneous focusing system by use of a Fresnel lens, in which the incident beam size is 40 × 40 mm2, the focal length is 380 mm, and the dimension of the obtained focal spot is 2 × 10 mm2. When the divergence angle of the incident light is in the range of 12.5-20 mrad and the pitch is 1 mm, the obtained homogeneity in the focal spot is the optimum (about 95.22%). Experimental results show that the measured focal spot size is 2.04 × 10.39 mm2. This research presents a novel design of homogeneous focusing systems for high power diode lasers.

Lens subluxation grading system: predictive value for ectopia lentis surgical outcomes

OpenAIRE

Mauro Waiswol; Niro Kasahara

2009-01-01

Objective: To present a classification system to grade ectopia lentis and to assess its usefulness as a predictor for surgical outcomes. Methods: Fifty-one eyes of 28 patients with either simple (19 patients) or Marfan syndrome-associated ectopia lentis (nine patients) with variable degrees of subluxation were operated on. Lens subluxation intensity was graded according to the lens subluxation grading system (LSGS) from grade 1 (lens on the whole pupillary area) up to grade 4 (lens absent fro...

Effects of Environmental Design on Patient Outcome

DEFF Research Database (Denmark)

Laursen, Jannie; Danielsen, Anne Kjaergaard; Rosenberg, Jacob

2014-01-01

OBJECTIVE: The aim of this systematic review was to assess how inpatients were affected by the built environment design during their hospitalization. BACKGROUND: Over the last decade, the healthcare system has become increasingly aware of how focus on healthcare environment might affect patient....... The following databases were searched: Medline/PubMed, Cinahl, and Embase. Inclusion criteria were randomized clinical trials (RCTs) investigating the effect of built environment design interventions such as music, natural murals, and plants in relation to patients' health outcome. RESULTS: Built environment...... satisfaction. The focus on environmental design has become a field with great potential because of its possible impact on cost control while improving quality of care. METHODS: A systematic literature search was conducted to identify current and past studies about evidence-based healthcare design...

A New Method for Research on the Center-Focus Problem of Differential Systems

OpenAIRE

Zhou, Zhengxin

2014-01-01

We will introduce Mironenko’s method to discuss the Poincaré center-focus problem, and compare the methods of Lyapunov and Mironenko. We apply the Mironenko method to discuss the qualitative behavior of solutions of some planar polynomial differential systems and derive the sufficient conditions for a critical point to be a center.

The mechanical design for the WEAVE prime focus corrector system

Science.gov (United States)

Abrams, Don Carlos; Dee, Kevin; Agócs, Tibor; Lhome, Emilie; Peñate, José; Jaskó, Attila; Bányai, Evelin; Burgal, José A.; Dalton, Gavin; Middleton, Kevin; Bonifacio, Piercarlo; Aguerri, J. Alfonso L.; Trager, S. C.; Balcells, Marc

2014-08-01

WEAVE is the next-generation, wide-field, optical spectroscopy facility for the William Herschel Telescope (WHT) in La Palma, Canary Islands, Spain. The WHT will undergo a significant adaptation to accommodate this facility. A two- degree Prime Focus Corrector (PFC), that includes an Atmospheric Dispersion Compensator, is being planned and is currently in its final design phase. To compensate for the effects of temperature-induced image degradation, the entire PFC system will be translated along the telescope optical axis. The optical system comprises six lenses, the largest of which will have a diameter of 1.1m. Now that the optical elements are in production, the designs for the lens cells and the mounting arrangements are being analysed to ensure that the image quality of the complete system is better than 1.0 arcsec (80% encircled energy diameter) over the full field of view. The new PFC system is designed to be routinely interchanged with the existing top-end ring. This will maximise the versatility of the WHT and allow the two top-end systems to be interchanged as dictated by the scientific needs of the astronomers that will use WEAVE and other instruments on the telescope. This manuscript describes the work that has been carried out in developing the designs for the mechanical subsystems and the plans for mounting the lenses to attain an optical performance that is commensurate with the requirements derived from planning the WEAVE surveys.

The Impact of Natural Disasters on Youth: A Focus on Emerging Research beyond Internalizing Disorders.

Science.gov (United States)

Self-Brown, Shannon; Lai, Betty; Patterson, Alexandria; Glasheen, Theresa

2017-08-01

This paper reviews youth outcomes following exposure to natural disaster, with a focus on three relatively understudied outcomes: externalizing behavior problems, physical health, and posttraumatic growth. Recent, high-impact studies focusing on each outcome are summarized. Studies highlighted in this review utilize innovative and comprehensive approaches to improve our current understanding of youth broad-based physical and mental health outcomes beyond PTSD. The review concludes with recommendations to advance the field of youth disaster research by exploring how disasters may impact children across multiple domains, as well as using cutting edge ecobiological approaches and advanced modeling strategies to better understand how youth adjust and thrive following natural disaster.

Relationship-Focused Child Care Practices: Quality of Care and Child Outcomes for Children in Poverty

Science.gov (United States)

Owen, Margaret Tresch; Klausli, Julia F.; Mata-Otero, Ana-Maria; Caughy, Margaret O'Brien

2008-01-01

Research Findings: Child care delivery practices promoting continuous, primary caregiver-child relationships (relationship-focused child care) were evaluated for 223 preschool-age children (45% African American, 55% Latino) attending child care centers serving low-income children. Both relationship-focused and non-relationship-focused centers were…

Focus Cities : Improving the Living Environment in Underserved ...

International Development Research Centre (IDRC) Digital Library (Canada)

Papers. Urban Poverty and Environment Programme : Colombo; monitoring and evaluation component; monitoring findings as of December 2008 - April 2009; outcome mapping no. 2. 129292.pdf. Papers. Statistical handbook on baseline survey : part 1; data tables; (Focus City Programme : Community based Assessment ...

Cofimvaba: Innovative and systemic technology application in rural, education focused, agri-based development initiatives

CSIR Research Space (South Africa)

Van Rensburg, J

2012-10-01

Full Text Available In this presentation the author shares current learning on the use of more targeted and systemic ICT for development as well as broader technology for development education and LED-focused interventions in the science, engineering and technology...

The Cold Mass Support System and the Helium Cooling System for the MICE Focusing Solenoid

International Nuclear Information System (INIS)

Yang, Stephanie Q.; Green, Michael A.; Lau, Wing W.; Senanayake, Rohan S.; Witte, Holger

2006-01-01

The heart of the absorber focus coil (AFC) module for the muon ionization cooling experiment (MICE) is the two-coil superconducting solenoid that surrounds the muon absorber. The superconducting magnet focuses the muons that are cooled using ionization cooling, in order to improve the efficiency of cooling. The coils of the magnet may either be run in the solenoid mode (both coils operate at the same polarity) or the gradient (the coils operate at opposite polarity). The AFC magnet cold mass support system is designed to carry a longitudinal force up to 700 kN. The AFC module will be cooled using three pulse tube coolers that produce 1.5 W of cooling at 4.2 K. One of the coolers will be used to cool the liquid (hydrogen or helium) absorber used for ionization cooling. The other two coolers will cool the superconducting solenoid. This report will describe the MICE AFC magnet. The cold mass supports will be discussed. The reasons for using a pulsed tube cooler to cool this superconducting magnet will also be discussed

Experiential self-focus writing as a facilitator of processing an interpersonal hurt.

Science.gov (United States)

Liao, Kelly Yu-Hsin; Wei, Meifen; Russell, Daniel W; Abraham, W Todd

2012-10-01

This study examined the effects of experiential self-focus writing on changes in psychological outcomes (i.e., unforgiveness and negative affect) after an interpersonal hurt and the buffering effects of experiential self-focus writing on the association between anger rumination and these psychological outcomes. A sample of 182 college students who had experienced interpersonal hurt were randomly assigned to either the experiential self-focus writing condition, in which participants wrote about their feelings and experiences related to the hurt, or to a control writing condition in which they wrote about a recent neutral event. Latent growth curve analyses indicated that changes in unforgiveness over time did not differ between the experiential self-focus writing and the control writing conditions. However, relative to the control writing condition, negative affect decreased faster during writing and increased more slowly at follow-ups in the experiential self-focus writing condition. The results supported the hypothesis that negative affect resulting from an interpersonal hurt would significantly decrease over time among participants in the experiential self-focus writing group compared with the control group. Implications of experiential self-focus writing for interpersonal hurt and directions for future studies are discussed. © 2012 Wiley Periodicals, Inc.

Biomarkers, lactate, and clinical scores as outcome predictors in systemic poisons exposures.

Science.gov (United States)

Lionte, C; Sorodoc, V; Tuchilus, C; Cimpoiesu, D; Jaba, E

2017-07-01

Acute exposure to systemic poisons represents an important challenge in clinical toxicology. We aimed to analyze the potential role of cardiac biomarkers, routine laboratory tests, and clinical scores as morbidity and in-hospital mortality predictors in patients intoxicated with various systemic poisons. We conducted a prospective study on adults acutely exposed to systemic poisons. We determined the PSS, Glasgow Coma Scale (GCS), and we performed electrocardiogram, laboratory tests, lactate and cardiac biomarkers (which were reassessed 4 h, respectively 6 h later). Of 120 patients included, 45% developed complications, 19.2% had a poor outcome, and 5% died. Multivariate logistic regression sustained lactate (odds ratio (OR) 1.58; confidence interval (CI) 95%: 0.97-2.59; p 0.066), MB isoenzyme of creatine kinase (6h-CKMB; OR 1.08; CI 95%: 1.02-1.16; p 0.018) as predictors for a poor outcome. A GCS poisons exposure. Receiver operating characteristic analysis showed that brain natriuretic peptide (area under the curve (AUC), 0.96; CI 95%: 0.92-0.99; p poisons exposure.

Validation of Patient-Reported Outcomes Measurement Information System Computerized Adaptive Tests Against the Foot and Ankle Outcome Score for 6 Common Foot and Ankle Pathologies.

Science.gov (United States)

Koltsov, Jayme C B; Greenfield, Stephen T; Soukup, Dylan; Do, Huong T; Ellis, Scott J

2017-08-01

The field of foot and ankle surgery lacks a widely accepted gold-standard patient-reported outcome instrument. With the changing infrastructure of the medical profession, more efficient patient-reported outcome tools are needed to reduce respondent burden and increase participation while providing consistent and reliable measurement across multiple pathologies and disciplines. The primary purpose of the present study was to validate 3 Patient-Reported Outcomes Measurement Information System computer adaptive tests (CATs) most relevant to the foot and ankle discipline against the Foot and Ankle Outcome Score (FAOS) and the Short Form 12 general health status survey in patients with 6 common foot and ankle pathologies. Patients (n = 240) indicated for operative treatment for 1 of 6 common foot and ankle pathologies completed the CATs, FAOS, and Short Form 12 at their preoperative surgical visits, 1 week subsequently (before surgery), and at 6 months postoperatively. The psychometric properties of the instruments were assessed and compared. The Patient-Reported Outcomes Measurement Information System CATs each took less than 1 minute to complete, whereas the FAOS took 6.5 minutes, and the Short Form 12 took 3 minutes. CAT scores were more normally distributed and had fewer floor and ceiling effects than those on the FAOS, which reached as high as 24%. The CATs were more precise than the FAOS and had similar responsiveness and test-retest reliability. The physical function and mobility CATs correlated strongly with the activities subscale of the FAOS, and the pain interference CAT correlated strongly with the pain subscale of the FAOS. The CATs and FAOS were responsive to changes with operative treatment for 6 common foot and ankle pathologies. The CATs performed as well as or better than the FAOS in all aspects of psychometric validity. The Patient-Reported Outcomes Measurement Information System CATs show tremendous potential for improving the study of patient

Inertial confinement fusion driver enhancements: Final focusing systems and compact heavy-ion driver designs

International Nuclear Information System (INIS)

Bieri, R.L.

1991-01-01

Required elements of an inertial confinement fusion power plant are modeled and discussed. A detailed analysis of two critical elements of candidate drivers is done, and new component designs are proposed to increase the credibility and feasibility of each driver system. An analysis of neutron damage to the final elements of a laser focusing system is presented, and multilayer -- dielectric mirrors are shown to have damage lifetimes which axe too short to be useful in a commercial power plant. A new final-focusing system using grazing incidence metal mirrors to protect sensitive laser optics is designed and shown to be effective in extending the lifetime of the final focusing system. The reflectivities and damage limits of grazing incidence metal mirrors are examined in detail, and the required mirror sizes are shown to be compatible with the beam sizes and illumination geometries currently envisioned for laser drivers. A detailed design and analysis is also done for compact arrays of superconducting magnetic quadrupoles, which are needed in a multi-beam heavy-ion driver. The new array model is developed in more detail than some previous conceptual designs and models arrays which are more compact than arrays scaled from existing single -- quadrupole designs. The improved integrated model for compact arrays is used to compare the effects of various quadrupole array design choices on the size and cost of a heavy-ion driver. Array design choices which significantly affect the cost of a heavy-ion driver include the choice of superconducting material and the thickness of the collar used to support the winding stresses. The effect of these array design choices on driver size and cost is examined and the array model is used to estimate driver cost savings and performance improvements attainable with aggressive quadrupole array designs with high-performance superconductors

Lung Infections in Systemic Rheumatic Disease: Focus on Opportunistic Infections.

Science.gov (United States)

Di Franco, Manuela; Lucchino, Bruno; Spaziante, Martina; Iannuccelli, Cristina; Valesini, Guido; Iaiani, Giancarlo

2017-01-29

Systemic rheumatic diseases have significant morbidity and mortality, due in large part to concurrent infections. The lung has been reported among the most frequent sites of infection in patients with rheumatic disease, who are susceptible to developing pneumonia sustained both by common pathogens and by opportunistic microorganisms. Patients with rheumatic disease show a peculiar vulnerability to infectious complications. This is due in part to intrinsic disease-related immune dysregulation and in part to the immunosuppressive treatments. Several therapeutic agents have been associated to a wide spectrum of infections, complicating the management of rheumatic diseases. This review discusses the most frequent pulmonary infections encountered in rheumatic diseases, focusing on opportunistic agents, consequent diagnostic challenges and appropriate therapeutic strategies.

Positioning device for MRI-guided high intensity focused ultrasound system

Energy Technology Data Exchange (ETDEWEB)

Damianou, Christakis [Frederick Institute of Technology (FIT), Limassol (Cyprus); MEDSONIC, LTD, Limassol (Cyprus); Ioannides, Kleanthis [Polikliniki Igia, Limassol (Cyprus); Milonas, Nicos [Frederick Institute of Technology (FIT), Limassol (Cyprus)

2008-04-15

A prototype magnetic resonance imaging (MRI)- compatible positioning device was used to move an MRI-guided high intensity focused ultrasound (HIFU) transducer. The positioning device has three user-controlled degrees of freedom that allow access to various targeted lesions. The positioning device was designed and fabricated using construction materials selected for compatibility with high magnetic fields and fast switching magnetic field gradients encountered inside MRI scanners. The positioning device incorporates only MRI compatible materials such as piezoelectric motors, plastic sheets, brass screws, plastic pulleys and timing belts. The HIFU/MRI system includes the multiple subsystems (a) HIFU system, (b) MR imaging, (c) Positioning device (robot) and associate drivers, (d) temperature measurement, (e) cavitation detection, (f) MRI compatible camera, and (g) Soft ware. The MRI compatibility of the system was successfully demonstrated in a clinical high-field MRI scanner. The ability of the robot to accurately move the transducer thus creating discrete and overlapping lesions in biological tissue was tested successfully. A simple, cost effective, portable positioning device has been developed which can be used in virtually any clinical MRI scanner since it can be sited on the scanner's table. The propagation of HIFU can use either a lateral or superior-inferior approach. Discrete and large lesions were created successfully with reproducible results. (orig.)

Investigating the relationship between costs and outcomes for English mental health providers: a bi-variate multi-level regression analysis.

Science.gov (United States)

Moran, Valerie; Jacobs, Rowena

2018-06-01

Provider payment systems for mental health care that incentivize cost control and quality improvement have been a policy focus in a number of countries. In England, a new prospective provider payment system is being introduced to mental health that should encourage providers to control costs and improve outcomes. The aim of this research is to investigate the relationship between costs and outcomes to ascertain whether there is a trade-off between controlling costs and improving outcomes. The main data source is the Mental Health Minimum Data Set (MHMDS) for the years 2011/12 and 2012/13. Costs are calculated using NHS reference cost data while outcomes are measured using the Health of the Nation Outcome Scales (HoNOS). We estimate a bivariate multi-level model with costs and outcomes simultaneously. We calculate the correlation and plot the pairwise relationship between residual costs and outcomes at the provider level. After controlling for a range of demographic, need, social, and treatment variables, residual variation in costs and outcomes remains at the provider level. The correlation between residual costs and outcomes is negative, but very small, suggesting that cost-containment efforts by providers should not undermine outcome-improving efforts under the new payment system.

Expanded studies of linear collider final focus systems at the Final Focus Test Beam

International Nuclear Information System (INIS)

Tenenbaum, P.G.

1995-12-01

In order to meet their luminosity goals, linear colliders operating in the center-of-mass energy range from 3,50 to 1,500 GeV will need to deliver beams which are as small as a few Manometers tall, with x:y aspect ratios as large as 100. The Final Focus Test Beam (FFTB) is a prototype for the final focus demanded by these colliders: its purpose is to provide demagnification equivalent to those in the future linear collider, which corresponds to a focused spot size in the FFTB of 1.7 microns (horizontal) by 60 manometers (vertical). In order to achieve the desired spot sizes, the FFTB beam optics must be tuned to eliminate aberrations and other errors, and to ensure that the optics conform to the desired final conditions and the measured initial conditions of the beam. Using a combination of incoming-beam diagnostics. beam-based local diagnostics, and global tuning algorithms, the FFTB beam size has been reduced to a stable final size of 1.7 microns by 70 manometers. In addition, the chromatic properties of the FFTB have been studied using two techniques and found to be acceptable. Descriptions of the hardware and techniques used in these studies are presented, along with results and suggestions for future research

Expanded studies of linear collider final focus systems at the Final Focus Test Beam

Energy Technology Data Exchange (ETDEWEB)

Tenenbaum, Peter Gregory [Stanford Univ., CA (United States)

1995-12-01

In order to meet their luminosity goals, linear colliders operating in the center-of-mass energy range from 3,50 to 1,500 GeV will need to deliver beams which are as small as a few Manometers tall, with x:y aspect ratios as large as 100. The Final Focus Test Beam (FFTB) is a prototype for the final focus demanded by these colliders: its purpose is to provide demagnification equivalent to those in the future linear collider, which corresponds to a focused spot size in the FFTB of 1.7 microns (horizontal) by 60 manometers (vertical). In order to achieve the desired spot sizes, the FFTB beam optics must be tuned to eliminate aberrations and other errors, and to ensure that the optics conform to the desired final conditions and the measured initial conditions of the beam. Using a combination of incoming-beam diagnostics. beam-based local diagnostics, and global tuning algorithms, the FFTB beam size has been reduced to a stable final size of 1.7 microns by 70 manometers. In addition, the chromatic properties of the FFTB have been studied using two techniques and found to be acceptable. Descriptions of the hardware and techniques used in these studies are presented, along with results and suggestions for future research.

Final focus system tuning studies towards Compact Linear Collider feasibility

Science.gov (United States)

Marin, E.; Latina, A.; Tomás, R.; Schulte, D.

2018-01-01

In this paper we present the latest results regarding the tuning study of the baseline design of the final focus system of the Compact Linear Collider (CLIC-FFS). CLIC aims to provide collisions to the experiments at a luminosity above 1034 c m-2 s-1 . In order to deliver such luminosity in a single pass machine, the vertical beam size at the interaction point (IP) is reduced to about 1 nm, which imposes unprecedented tuning difficulties to the system. In previous studies, 90% of the machines reached 90% of the nominal luminosity at the expense of 18 000 luminosity measurements, when considering beam position monitor errors and transverse misalignments of magnets for a single beam case. In the present study, additional static imperfections as, roll misalignments, strength v2.epss are included. Moreover both e- and e+ beamlines are properly simulated. A new tuning procedure based on linear and nonlinear knobs is implemented to effectively cure the most relevant beam size aberrations at the IP. The obtained results for single and double beam studies under solely static imperfections are presented.

Outcome Mapping Virtual Learning Community - Phase II | IDRC ...

International Development Research Centre (IDRC) Digital Library (Canada)

The first phase of the project (103520) focused on developing the Outcome ... as distance learning) and strategically communicating Outcome Mapping to key ... an organization based in India with South Asian reach, to facilitate exchange ...

Irrational reactions to negative outcomes: evidence for two conceptual systems.

Science.gov (United States)

Epstein, S; Lipson, A; Holstein, C; Huh, E

1992-02-01

According to cognitive-experiential self-theory (CEST), individuals have 2 systems for processing information, a rational system and an experiential system. Research conducted under norm theory (NT) has provided impressive evidence of an if only (IO) effect associated with postoutcome processing of aversive events that are highly consistent with formulations in CEST. Two studies involving vignettes adapted from NT were conducted that tested 4 hypotheses and corollaries derived from CEST. It was demonstrated, in support of hypotheses, that the IO effect can be obtained with ratings of one's own and of a protagonist's specific behaviors, as well as with ratings of a protagonist's diffuse emotions (the usual procedure); that a rational orientation decreases the IO effect; that increasing the intensity of outcomes increases it; and that priming the experiential system reduces people's ability to subsequently think rationally. The theoretical and research implications of these findings are discussed.

Teacher Planning in a learning outcome perspective

DEFF Research Database (Denmark)

Bremholm, Jesper; Skott, Charlotte Krog

2017-01-01

. In this study, use of participatory observation has permitted us to gain insight into the practices of two teams of teachers in mathematics and Danish, and thus to identify barriers in teachers’ planning that seem to impede a learning outcome approach. However, further analysis shows how these barriers......Like most European countries, Denmark is facing dramatic educational changes towards a focus on learning outcome. This focus enhances the importance of teachers’ planning. However, research studies highlight the plight of teachers facing severe challenges when trying to fulfil the requirements...

Laser-nucleated acoustic cavitation in focused ultrasound.

Science.gov (United States)

Gerold, Bjoern; Kotopoulis, Spiros; McDougall, Craig; McGloin, David; Postema, Michiel; Prentice, Paul

2011-04-01

Acoustic cavitation can occur in therapeutic applications of high-amplitude focused ultrasound. Studying acoustic cavitation has been challenging, because the onset of nucleation is unpredictable. We hypothesized that acoustic cavitation can be forced to occur at a specific location using a laser to nucleate a microcavity in a pre-established ultrasound field. In this paper we describe a scientific instrument that is dedicated to this outcome, combining a focused ultrasound transducer with a pulsed laser. We present high-speed photographic observations of laser-induced cavitation and laser-nucleated acoustic cavitation, at frame rates of 0.5×10(6) frames per second, from laser pulses of energy above and below the optical breakdown threshold, respectively. Acoustic recordings demonstrated inertial cavitation can be controllably introduced to the ultrasound focus. This technique will contribute to the understanding of cavitation evolution in focused ultrasound including for potential therapeutic applications. © 2011 American Institute of Physics

Mapping Learning Outcomes and Assignment Tasks for SPIDER Activities

Directory of Open Access Journals (Sweden)

Lyn Brodie

2011-05-01

Full Text Available Modern engineering programs have to address rapidly changing technical content and have to enable students to develop transferable skills such as critical evaluation, communication skills and lifelong learning. This paper introduces a combined learning and assessment activity that provides students with opportunities to develop and practice their soft skills, but also extends their theoretical knowledge base. Key tasks included self directed inquiry, oral and written communication as well as peer assessment. To facilitate the SPIDER activities (Select, Prepare and Investigate, Discuss, Evaluate, Reflect, a software tool has been implemented in the learning management system Moodle. Evidence shows increased student engagement and better learning outcomes for both transferable as well as technical skills. The study focuses on generalising the relationship between learning outcomes and assignment tasks as well as activities that drive these tasks. Trail results inform the approach. Staff evaluations and their views of assignments and intended learning outcomes also supported this analysis.

Design of a new type synchronous focusing mechanism

Science.gov (United States)

Zhang, Jintao; Tan, Ruijun; Chen, Zhou; Zhang, Yongqi; Fu, Panlong; Qu, Yachen

2018-05-01

Aiming at the dual channel telescopic imaging system composed of infrared imaging system, low-light-level imaging system and image fusion module, In the fusion of low-light-level images and infrared images, it is obvious that using clear source images is easier to obtain high definition fused images. When the target is imaged at 15m to infinity, focusing is needed to ensure the imaging quality of the dual channel imaging system; therefore, a new type of synchronous focusing mechanism is designed. The synchronous focusing mechanism realizes the focusing function through the synchronous translational imaging devices, mainly including the structure of the screw rod nut, the shaft hole coordination structure and the spring steel ball eliminating clearance structure, etc. Starting from the synchronous focusing function of two imaging devices, the structure characteristics of the synchronous focusing mechanism are introduced in detail, and the focusing range is analyzed. The experimental results show that the synchronous focusing mechanism has the advantages of ingenious design, high focusing accuracy and stable and reliable operation.

A method to assess obstetric outcomes using the 10-Group Classification System: a quantitative descriptive study.

LENUS (Irish Health Repository)

Rossen, Janne

2017-01-01

Internationally, the 10-Group Classification System (TGCS) has been used to report caesarean section rates, but analysis of other outcomes is also recommended. We now aim to present the TGCS as a method to assess outcomes of labour and delivery using routine collection of perinatal information.

Conceptual design of bend, compression, and final focus components of ILSE [Induction Linac System Experiment

International Nuclear Information System (INIS)

Lee, E.P.; Fong, C.; Mukherjee, S.; Thur, W.

1989-03-01

The Induction Linac System Experiment (ILSE) includes a 180/degree/ bend system, drift compression line and a final focus, which test the analogous features of a heavy ion driver for inertial fusion. These components are novel in their transport of a space-charge-dominated ion beam with large head-to-tail velocity tilt. Their conceptual design is presented, including calculations of the beam envelope, momentum dispersion, and engineering design of magnets, vacuum system, diagnostics, alignment, and support. 3 refs., 5 figs

Nephrologists’ Perspectives on Defining and Applying Patient-Centered Outcomes in Hemodialysis

Science.gov (United States)

Winkelmayer, Wolfgang C.; Wheeler, David C.; van Biesen, Wim; Tugwell, Peter; Manns, Braden; Hemmelgarn, Brenda; Harris, Tess; Crowe, Sally; Ju, Angela; O’Lone, Emma; Evangelidis, Nicole; Craig, Jonathan C.

2017-01-01

Background and objectives Patient centeredness is widely advocated as a cornerstone of health care, but it is yet to be fully realized, including in nephrology. Our study aims to describe nephrologists’ perspectives on defining and implementing patient-centered outcomes in hemodialysis. Design, setting, participants, & measurements Face-to-face, semistructured interviews were conducted with 58 nephrologists from 27 dialysis units across nine countries, including the United States, the United Kingdom, Australia, Austria, Belgium, Canada, Germany, Singapore, and New Zealand. Transcripts were thematically analyzed. Results We identified five themes on defining and implementing patient-centered outcomes in hemodialysis: explicitly prioritized by patients (articulated preferences and goals, ascertaining treatment burden, defining hemodialysis success, distinguishing a physician-patient dichotomy, and supporting shared decision making), optimizing wellbeing (respecting patient choice, focusing on symptomology, perceptible and tangible, and judging relevance and consequence), comprehending extensive heterogeneity of clinical and quality of life outcomes (distilling diverse priorities, highly individualized, attempting to specify outcomes, and broadening context), clinically hamstrung (professional deficiency, uncertainty and complexity in measurement, beyond medical purview, specificity of care, mechanistic mindset [focused on biochemical targets and comorbidities], avoiding alarm, and paradoxical dilemma), and undermined by system pressures (adhering to overarching policies, misalignment with mandates, and resource constraints). Conclusions Improving patient-centered outcomes is regarded by nephrologists to encompass strategies that address patient goals and improve wellbeing and treatment burden in patients on hemodialysis. However, efforts are hampered by ambiguities about how to prioritize, measure, and manage the plethora of critical comorbidities and broader

Health and imaging outcomes in axial spondyloarthritis

NARCIS (Netherlands)

Machado, P.M.

2016-01-01

This thesis focuses on the assessment and monitoring of health and imaging outcomes in axial spondyloarthritis (SpA) and the relationship between these outcomes. Four major contributions to the understanding and management of axial SpA were made: 1) the improvement and facilitation of the assessment

INTRODUCTION: Focus on Climate Engineering: Intentional Intervention in the Climate System

Science.gov (United States)

2009-12-01

Geoengineering techniques for countering climate change have been receiving much press recently as a `Plan B' if a global deal to tackle climate change is not agreed at the COP15 negotiations in Copenhagen this December. However, the field is controversial as the methods may have unforeseen consequences, potentially making temperatures rise in some regions or reducing rainfall, and many aspects remain under-researched. This focus issue of Environmental Research Letters is a collection of research articles, invited by David Keith, University of Calgary, and Ken Caldeira, Carnegie Institution, that present and evaluate different methods for engineering the Earth's climate. Not only do the letters in this issue highlight various methods of climate engineering but they also detail the arguments for and against climate engineering as a concept. Further reading Focus on Geoengineering at http://environmentalresearchweb.org/cws/subject/tag=geoengineering IOP Conference Series: Earth and Environmental Science is an open-access proceedings service available at www.iop.org/EJ/journal/ees Focus on Climate Engineering: Intentional Intervention in the Climate System Contents Modification of cirrus clouds to reduce global warming David L Mitchell and William Finnegan Climate engineering and the risk of rapid climate change Andrew Ross and H Damon Matthews Researching geoengineering: should not or could not? Martin Bunzl Of mongooses and mitigation: ecological analogues to geoengineering H Damon Matthews and Sarah E Turner Toward ethical norms and institutions for climate engineering research David R Morrow, Robert E Kopp and Michael Oppenheimer On the possible use of geoengineering to moderate specific climate change impacts Michael C MacCracken The impact of geoengineering aerosols on stratospheric temperature and ozone P Heckendorn, D Weisenstein, S Fueglistaler, B P Luo, E Rozanov, M Schraner, L W Thomason and T Peter The fate of the Greenland Ice Sheet in a geoengineered

The Signal Detection and Control Circuit Design for Confocal Auto-Focus System

OpenAIRE

Yin Liu; Jin Yu; Zeqiang Mo

2016-01-01

Based on the demands of Confocal Auto-Focus system, the implementation method of signal measurement circuit and control circuit is given. Using the high performance instrumental amplifier AD620BN, low noise precision FET Op amplifier AD795JRZ and ultralow offset voltage Op amplifier OP07EP, a signal measurement circuit used to converse the two differential light intensity signal to electric signal is designed. And a control circuit which takes MCU MSP430F149 as core processes the former signa...

Predictors of public support for nutrition-focused policy, systems and environmental change strategies in Los Angeles County, 2013.

Science.gov (United States)

Robles, Brenda; Kuo, Tony

2017-01-13

Since 2010, federal and local agencies have invested broadly in a variety of nutrition-focused policy, systems and environmental change (PSE) initiatives in Los Angeles County (LAC). To date, little is known about whether the public supports such efforts. We address this gap in the literature by examining predictors of support for a variety of PSEs. Voters residing in LAC (n=1007) were randomly selected to participate in a cross-sectional telephone survey commissioned by the LAC Department of Public Health. The survey asked questions about attitudes towards the obesity epidemic, nutrition knowledge and behaviours, public opinions about changing business practices/government policies related to nutrition, and sociodemographics. A factor analysis informed outcome variable selection (ie, type of PSEs). Multivariable regression analyses were performed to examine predictors of public support. Predictors in the regression models included (primary regressor) community economic hardship; (control variables) political affiliation, sex, age, race and income; and (independent variables) perceptions about obesity, perceived health and weight status, frequency reading nutrition labels, ease of finding healthy and unhealthy foods, and food consumption behaviours (ie, fruit and vegetables, non-diet soda, fast-food and sit-down restaurant meals). 3 types of PSE outcome variables were identified: promotional/incentivising, limiting/restrictive and business practices. Community economic hardship was not found to be a significant predictor of public support for any of the 3 PSE types. However, Republican party affiliation, being female and perceiving obesity as a serious health problem were. These findings have implications for public health practice and community planning in local health jurisdictions. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Final focus test beam

International Nuclear Information System (INIS)

1991-03-01

This report discusses the following: the Final Focus Test Beam Project; optical design; magnets; instrumentation; magnetic measurement and BPM calibration; mechanical alignment and stabilization; vacuum system; power supplies; control system; radiation shielding and personnel protection; infrastructure; and administration

Analytical approach to chromatic correction in the final focus system of circular colliders

Directory of Open Access Journals (Sweden)

Yunhai Cai

2016-11-01

Full Text Available A conventional final focus system in particle accelerators is systematically analyzed. We find simple relations between the parameters of two focus modules in the final telescope. Using the relations, we derive the chromatic Courant-Snyder parameters for the telescope. The parameters are scaled approximately according to (L^{*}/β_{y}^{*}δ, where L^{*} is the distance from the interaction point to the first quadrupole, β_{y}^{*} the vertical beta function at the interaction point, and δ the relative momentum deviation. Most importantly, we show how to compensate its chromaticity order by order in δ by a traditional correction module flanked by an asymmetric pair of harmonic multipoles. The method enables a circular Higgs collider with 2% momentum aperture and illuminates a path forward to 4% in the future.

To craft or not to craft : The relationships between regulatory focus, job crafting and work outcomes

NARCIS (Netherlands)

Brenninkmeijer, Veerle; Hekkert-Koning, Marleen

2015-01-01

Purpose – The purpose of this paper is to examine relationships between regulatory focus, job crafting, work engagement and perceived employability. Regulatory focus theory distinguishes between promotion-focused individuals, who strive for growth and development, and preventionfocussed individuals,

Testing a theory of organizational culture, climate and youth outcomes in child welfare systems: a United States national study.

Science.gov (United States)

Williams, Nathaniel J; Glisson, Charles

2014-04-01

Theories of organizational culture and climate (OCC) applied to child welfare systems hypothesize that strategic dimensions of organizational culture influence organizational climate and that OCC explains system variance in youth outcomes. This study provides the first structural test of the direct and indirect effects of culture and climate on youth outcomes in a national sample of child welfare systems and isolates specific culture and climate dimensions most associated with youth outcomes. The study applies multilevel path analysis (ML-PA) to a U.S. nationwide sample of 2,380 youth in 73 child welfare systems participating in the second National Survey of Child and Adolescent Well-being. Youths were selected in a national, two-stage, stratified random sample design. Youths' psychosocial functioning was assessed by caregivers' responses to the Child Behavior Checklist at intake and at 18-month follow-up. OCC was assessed by front-line caseworkers' (N=1,740) aggregated responses to the Organizational Social Context measure. Comparison of the a priori and subsequent trimmed models confirmed a reduced model that excluded rigid organizational culture and explained 70% of the system variance in youth outcomes. Controlling for youth- and system-level covariates, systems with more proficient and less resistant organizational cultures exhibited more functional, more engaged, and less stressful climates. Systems with more proficient cultures and more engaged, more functional, and more stressful climates exhibited superior youth outcomes. Findings suggest child welfare administrators can support service effectiveness with interventions that improve specific dimensions of culture and climate. Copyright © 2013 Elsevier Ltd. All rights reserved.

Action, outcome, and value: a dual-system framework for morality.

Science.gov (United States)

Cushman, Fiery

2013-08-01

Dual-system approaches to psychology explain the fundamental properties of human judgment, decision making, and behavior across diverse domains. Yet, the appropriate characterization of each system is a source of debate. For instance, a large body of research on moral psychology makes use of the contrast between "emotional" and "rational/cognitive" processes, yet even the chief proponents of this division recognize its shortcomings. Largely independently, research in the computational neurosciences has identified a broad division between two algorithms for learning and choice derived from formal models of reinforcement learning. One assigns value to actions intrinsically based on past experience, while another derives representations of value from an internally represented causal model of the world. This division between action- and outcome-based value representation provides an ideal framework for a dual-system theory in the moral domain.

Teacher Ethnicity, Student Ethnicity, and Student Outcomes

Science.gov (United States)

Driessen, Geert

2015-01-01

A review of the empirical literature was conducted to establish the relation between teacher and student ethnicity, and cognitive and noncognitive student outcomes. It was hypothesized that ethnic teacher-student congruence results in more favorable outcomes for especially minority students. A total of 24 quantitative studies focusing on primary…

PERIODONTAL INFECTIONS AS A RISK FACTOR FOR VARIOUS SYSTEMIC DISEASES

OpenAIRE

Solanki, Gaurav; Solanki, Renu

2012-01-01

A healthy periodontium is needed for the general well being of an individual. However, periodontal diseases are common and periodontal infections are increasingly associated with systemic diseases. The literature is focused on the association between periodontal infections and systemic diseases. The individuals with periodontal disease may be at higher risk for adverse medical outcomes including cardiovascular diseases, respiratory infections, adverse pregnancy outcomes, rheumatoid arthritis ...

Network operating system focus technology

Science.gov (United States)

1985-01-01

An activity structured to provide specific design requirements and specifications for the Space Station Data Management System (DMS) Network Operating System (NOS) is outlined. Examples are given of the types of supporting studies and implementation tasks presently underway to realize a DMS test bed capability to develop hands-on understanding of NOS requirements as driven by actual subsystem test beds participating in the overall Johnson Space Center test bed program. Classical operating system elements and principal NOS functions are listed.

Conceptual foundations of inclusive systems in and around schools for early school leaving prevention: An emotional-relational focus

Directory of Open Access Journals (Sweden)

Downes Paul

2017-01-01

Full Text Available Against the background of the EU2020 headline target of reducing early school leaving to 10% across Europe, this article examines the conceptual foundations of the understanding of inclusive systems for early school leaving prevention that has emerged in EU policy documents and research reports in recent years. Traditionally, inclusive education has referred to a focus on children with special educational needs. However, this conceptual review examines how inclusion is increasingly being examined in broader terms.This review seeks to critically reconstruct foundational understandings of systems and resilience in developmental and educational psychology. A systems focus on inclusion needs to address the neglect in psychology of system blockages and power imbalances. Resilience is typically framed as the capacity of the individual to navigate their way to environmental resources. This places the onus of accessibility onto the individual’s efforts rather than a concern with responsive systems accessible to marginalised groups. A concern with inclusive systems goes beyond not only the well-established framework of individual resilience in developmental psychology, but also beyond its expansion into resilient systems, as these omit a focus on outreach and multidisciplinary teams in systems of care for integrated services. Common principles for a framework of inclusive systems include children’s voices, equality and non-discrimination, parental involvement that is integrated holistically with family support, and lifelong learning principles for schools. Illustrative examples of these principles for reforming authoritarian teaching and discriminatory bullying, for opening schools to the local community and for targeting those with highest levels of need are highlighted.

Content validity and nursing sensitivity of community-level outcomes from the Nursing Outcomes Classification (NOC).

Science.gov (United States)

Head, Barbara J; Aquilino, Mary Lober; Johnson, Marion; Reed, David; Maas, Meridean; Moorhead, Sue

2004-01-01

To evaluate the content validity and nursing sensitivity of six community-level outcomes from the Nursing Outcomes Classification (NOC; Johnson, Maas, & Moorhead, 2000). A survey research design was used. Questionnaires were mailed to 300 public health nursing experts; 102 nurses responded. Experts evaluated between 11 and 30 indicators for each of the six outcomes for: (a) importance of the indicators for measuring the outcome, and (b) influence of nursing on the indicators. Content validity and nursing sensitivity of the outcomes were estimated with a modified Fehring technique. All outcomes were deemed important; only Community Competence had an outcome content validity score < .80. The outcome sensitivity score for Community Health: Immunity was .80; other outcome scores ranged from .62-.70. Indicator ratios for all 102 indicators met the study criterion for importance, with 87% designated as critical and 13% as supplemental. Sensitivity ratios reflected judgments that 45% of the indicators were sensitive to nursing intervention. The study provided evidence of outcome content validity and nursing sensitivity of the study outcomes; further validation research is recommended, followed by testing of the study outcomes in clinical practice. Community-level nursing-sensitive outcomes will potentially enable study of the efficacy and effectiveness of public health interventions focused on improving health of populations and communities.

Sex Differences in Psychiatric Disease: A Focus on the Glutamate System

Directory of Open Access Journals (Sweden)

Megan M. Wickens

2018-06-01

Full Text Available Alterations in glutamate, the primary excitatory neurotransmitter in the brain, are implicated in several psychiatric diseases. Many of these psychiatric diseases display epidemiological sex differences, with either males or females exhibiting different symptoms or disease prevalence. However, little work has considered the interaction of disrupted glutamatergic transmission and sex on disease states. This review describes the clinical and preclinical evidence for these sex differences with a focus on two conditions that are more prevalent in women: Alzheimer's disease and major depressive disorder, and three conditions that are more prevalent in men: schizophrenia, autism spectrum disorder, and attention deficit hyperactivity disorder. These studies reveal sex differences at multiple levels in the glutamate system including metabolic markers, receptor levels, genetic interactions, and therapeutic responses to glutamatergic drugs. Our survey of the current literature revealed a considerable need for more evaluations of sex differences in future studies examining the role of the glutamate system in psychiatric disease. Gaining a more thorough understanding of how sex differences in the glutamate system contribute to psychiatric disease could provide novel avenues for the development of sex-specific pharmacotherapies.

Outcome expectancy and self-efficacy: theoretical implications of an unresolved contradiction.

Science.gov (United States)

Williams, David M

2010-11-01

According to self-efficacy theory, self-efficacy--defined as perceived capability to perform a behavior--causally influences expected outcomes of behavior, but not vice versa. However, research has shown that expected outcomes causally influence self-efficacy judgments, and some authors have argued that this relationship invalidates self-efficacy theory. Bandura has rebutted those arguments saying that self-efficacy judgments are not invalidated when influenced by expected outcomes. This article focuses on a contradiction in Bandura's rebuttal. Specifically, Bandura has argued (a) expected outcomes cannot causally influence self-efficacy, but (b) self-efficacy judgments remain valid when causally influenced by expected outcomes. While the debate regarding outcome expectancies and self-efficacy has subsided in recent years, the inattention to this contradiction has led to a disproportionate focus on self-efficacy as a causal determinant of behavior at the expense of expected outcomes.

Comparison of HIV-1 genotypic resistance test interpretation systems in predicting virological outcomes over time

NARCIS (Netherlands)

D. Frentz (Dineke); C.A.B. Boucher (Charles); M. Assel (Matthias); A. de Luca (Andrea); M. Fabbiani (Massimiliano); F. Incardona (Francesca); P. Libin (Pieter); N. Manca (Nino); V. Müller (Viktor); B.O. Nualláin (Breanndán); R. Paredes (Roger); M. Prosperi (Mattia); E. Quiros-Roldan (Eugenia); L. Ruiz (Lidia); P.M.A. Sloot (Peter); C. Torti (Carlo); A.M. Vandamme (Anne Mieke); K. Laethem (Kristel); M. Zazzi (Maurizio); D.A.M.C. van de Vijver (David)

2010-01-01

textabstractBackground: Several decision support systems have been developed to interpret HIV-1 drug resistance genotyping results. This study compares the ability of the most commonly used systems (ANRS, Rega, and Stanford's HIVdb) to predict virological outcome at 12, 24, and 48 weeks.

Extended capture range for focus-diverse phase retrieval in segmented aperture systems using geometrical optics.

Science.gov (United States)

Jurling, Alden S; Fienup, James R

2014-03-01

Extending previous work by Thurman on wavefront sensing for segmented-aperture systems, we developed an algorithm for estimating segment tips and tilts from multiple point spread functions in different defocused planes. We also developed methods for overcoming two common modes for stagnation in nonlinear optimization-based phase retrieval algorithms for segmented systems. We showed that when used together, these methods largely solve the capture range problem in focus-diverse phase retrieval for segmented systems with large tips and tilts. Monte Carlo simulations produced a rate of success better than 98% for the combined approach.

Depressive Symptoms and Conversational Self-Focus in Adolescents’ Friendships

Science.gov (United States)

Schwartz-Mette, Rebecca A.; Rose, Amanda J.

2015-01-01

This multi-method, longitudinal study considered the interplay among depressive symptoms, aversive interpersonal behavior, and interpersonal rejection in early and middle adolescents’ friendships. In particular, the study examined a newly identified interpersonal process, conversational self-focus (i.e., the tendency to redirect conversations about problems to focus on the self). Traditional interpersonal theories of depression suggest that individuals with depressive symptoms engage in aversive behaviors (such as conversational self-focus) and are rejected by others. However, in the current study, not all adolescents with depressive symptoms engaged in conversational self-focus and were rejected by friends. Instead, conversational self-focus moderated prospective relations of depressive symptoms and later friendship problems such that only adolescents with depressive symptoms who engaged in conversational self-focus were rejected by friends. These findings are consistent with current conceptualizations of the development of psychopathology that highlight heterogeneity among youth who share similar symptoms and the possibility of multifinality of outcomes. PMID:25640911

Project-Based Learning: A Promising Approach to Improving Student Outcomes. Issue Focus

Science.gov (United States)

Quint, Janet; Condliffe, Barbara

2018-01-01

The concept of project-based learning (PBL) has garnered wide support among a number of K-12 education policy advocates and funders. PBL is viewed as an approach that enables students to develop the "21st century competencies"--cognitive and socioemotional skills--needed for success in college and careers. This issue focus, pulling from…

Final focus nomenclature

International Nuclear Information System (INIS)

Erickson, R.

1986-01-01

The formal names and common names for all devices in the final focus system of the SLC are listed. The formal names consist of a device type designator, microprocessor designator, and a four-digit unit number

Improving outcomes of first‐episode psychosis: an overview

Science.gov (United States)

Fusar‐Poli, Paolo; McGorry, Patrick D.; Kane, John M.

2017-01-01

Outcomes of psychotic disorders are associated with high personal, familiar, societal and clinical burden. There is thus an urgent clinical and societal need for improving those outcomes. Recent advances in research knowledge have opened new opportunities for ameliorating outcomes of psychosis during its early clinical stages. This paper critically reviews these opportunities, summarizing the state‐of‐the‐art knowledge and focusing on recent discoveries and future avenues for first episode research and clinical interventions. Candidate targets for primary universal prevention of psychosis at the population level are discussed. Potentials offered by primary selective prevention in asymptomatic subgroups (stage 0) are presented. Achievements of primary selected prevention in individuals at clinical high risk for psychosis (stage 1) are summarized, along with challenges and limitations of its implementation in clinical practice. Early intervention and secondary prevention strategies at the time of a first episode of psychosis (stage 2) are critically discussed, with a particular focus on minimizing the duration of untreated psychosis, improving treatment response, increasing patients’ satisfaction with treatment, reducing illicit substance abuse and preventing relapses. Early intervention and tertiary prevention strategies at the time of an incomplete recovery (stage 3) are further discussed, in particular with respect to addressing treatment resistance, improving well‐being and social skills with reduction of burden on the family, treatment of comorbid substance use, and prevention of multiple relapses and disease progression. In conclusion, to improve outcomes of a complex, heterogeneous syndrome such as psychosis, it is necessary to globally adopt complex models integrating a clinical staging framework and coordinated specialty care programmes that offer pre‐emptive interventions to high‐risk groups identified across the early stages of the disorder

Maximal violation of a bipartite three-setting, two-outcome Bell inequality using infinite-dimensional quantum systems

International Nuclear Information System (INIS)

Pal, Karoly F.; Vertesi, Tamas

2010-01-01

The I 3322 inequality is the simplest bipartite two-outcome Bell inequality beyond the Clauser-Horne-Shimony-Holt (CHSH) inequality, consisting of three two-outcome measurements per party. In the case of the CHSH inequality the maximal quantum violation can already be attained with local two-dimensional quantum systems; however, there is no such evidence for the I 3322 inequality. In this paper a family of measurement operators and states is given which enables us to attain the maximum quantum value in an infinite-dimensional Hilbert space. Further, it is conjectured that our construction is optimal in the sense that measuring finite-dimensional quantum systems is not enough to achieve the true quantum maximum. We also describe an efficient iterative algorithm for computing quantum maximum of an arbitrary two-outcome Bell inequality in any given Hilbert space dimension. This algorithm played a key role in obtaining our results for the I 3322 inequality, and we also applied it to improve on our previous results concerning the maximum quantum violation of several bipartite two-outcome Bell inequalities with up to five settings per party.

Air Pollution Monitoring Changes to Accompany the Transition from a Control to a Systems Focus

Directory of Open Access Journals (Sweden)

Daniel A. Vallero

2016-11-01

Full Text Available During the 20th century, air pollution control technologies grew at an amazingly rapid rate. Air quality in much of the industrialized world greatly improved as the efficiencies of these technologies improved. This continued improvement in pollution control has more recently been complemented with measures to prevent the emission of air pollutants. The previous, exclusive focus on treatment requires systems thinking. This review provides a framework for this Special Issue of Sustainability by describing the new tools that are needed to support this new, broader focus, including life cycle assessments, exposure models, and sustainable design.

Enhancing the Effectiveness of Consumer-Focused Health Information Technology Systems Through eHealth Literacy

DEFF Research Database (Denmark)

Kayser, Lars; Kushniruk, Andre; Osborne, Richard H

2015-01-01

BACKGROUND: eHealth systems and applications are increasingly focused on supporting consumers to directly engage with and use health care services. Involving end users in the design of these systems is critical to ensure a generation of usable and effective eHealth products and systems. Often...... the end users engaged for these participatory design processes are not actual representatives of the general population, and developers may have limited understanding about how well they might represent the full range of intended users of the eHealth products. As a consequence, resulting information...... model with the domains of a new concept of eHealth literacy. METHODS: This approach expands an existing method for supporting health IT system development, which advocates use of a three-dimensional user-task-context matrix to comprehensively identify the users of health IT systems, and what their needs...

Final focus nomenclature

Energy Technology Data Exchange (ETDEWEB)

Erickson, R.

1986-08-08

The formal names and common names for all devices in the final focus system of the SLC are listed. The formal names consist of a device type designator, microprocessor designator, and a four-digit unit number. (LEW)

Outcome of out-of-hospital cardiac arrest--why do physicians withhold resuscitation attempts?

DEFF Research Database (Denmark)

Horsted, Tina I; Rasmussen, Lars S; Lippert, Freddy K

2004-01-01

To describe the outcome of out-of-hospital cardiac arrest (OHCA) with a focus on why physicians withhold resuscitation attempts.......To describe the outcome of out-of-hospital cardiac arrest (OHCA) with a focus on why physicians withhold resuscitation attempts....

Plasma focus matching conditions

International Nuclear Information System (INIS)

Soliman, H.M.; Masoud, M.M.; Elkhalafawy, T.A.

1988-01-01

A snow-plough and slug models have been used to obtain the optimum matching conditions of the plasma in the focus. The dimensions of the plasma focus device are, inner electrode radius = 2 cm, outer electrode radius = 5.5 cm, and its length = 8 cm. It was found that the maximum magnetic energy of 12.26 kJ has to be delivered to plasma focus whose density is 10 19 /cm 3 at focusing time of 2.55 μs and with total external inductance of 24.2 n H. The same method is used to evaluate the optimum matching conditions for the previous coaxial discharge system which had inner electrode radius = 1.6 cm, outer electrode radius = 3.3 cm and its length = 31.5 cm. These conditions are charging voltage = 12 kV, capacity of the condenser bank = 430 μf, plasma focus density = 10 19 /cm 3 focusing time = 8 μs and total external inductance = 60.32 n H.3 fig., 2 tab

Choosing an Optimal e-Portfolio System for the Institution

OpenAIRE

YAMAMOTO, Toshiyuki

2010-01-01

Implementing an e-Portfolio system to enhance educational processes and outcomes has been becoming a hot issue among the Japanese universities that are ambitious in resetting their mission statements. In such universities, defining purposes, clearly stating what to be focused, learning processes, and expected outcomes are the critical issues in the development of their original e-Portfolio system. However, not all institutions are aware that e-Portfolio has advantages and disadvantages. One o...

Portable test bench for the studies concerning ion sources and ion beam extraction and focusing systems

International Nuclear Information System (INIS)

Cordero Lopez, F.

1961-01-01

A portable test bench is described, which was designed to check ion sources, ion beam extraction and focusing systems before its use in a 600 KeV Cockcroft-Walton accelerator. The vacuum possibilities of the system are specially analyzed in connection with its particular use. The whole can be considered as a portable accelerator of low energy (50 keV). (Author)

Organisational stressors, coping, and outcomes in competitive sport.

Science.gov (United States)

Arnold, Rachel; Fletcher, David; Daniels, Kevin

2017-04-01

Organisational stressors are associated with positive and negative outcomes in extant literature; however, little is known about which demands predict which outcomes. Extant theory and literature also suggests that coping style may influence an individual's resilience or vulnerability to stressors and, subsequently, their psychological responses and outcomes. The purpose of this study was, therefore, to examine the main effects of organisational stressors and coping styles on various outcomes (e.g., positive and negative affect, performance satisfaction). Sport performers (n = 414) completed measures of organisational stressors, coping styles, positive and negative affect, and performance satisfaction. Multiple regression analyses revealed positive relationships of both goals and development stressors (duration and intensity) and team and culture stressors (frequency and intensity) on negative affect. Furthermore, problem-focused coping was positively related to positive affect, and emotion-focused coping was positively related to negative affect. This study furthers theoretical knowledge regarding the associations that both organisational stressors (and their dimensions) and coping styles can have with various outcomes, and practical understanding regarding the optimal design of stress management interventions.

Improving patient safety: patient-focused, high-reliability team training.

Science.gov (United States)

McKeon, Leslie M; Cunningham, Patricia D; Oswaks, Jill S Detty

2009-01-01

Healthcare systems are recognizing "human factor" flaws that result in adverse outcomes. Nurses work around system failures, although increasing healthcare complexity makes this harder to do without risk of error. Aviation and military organizations achieve ultrasafe outcomes through high-reliability practice. We describe how reliability principles were used to teach nurses to improve patient safety at the front line of care. Outcomes include safety-oriented, teamwork communication competency; reflections on safety culture and clinical leadership are discussed.

The Single Logon Application: an enabler for access to disparate systems in a patient-focused care environment.

Science.gov (United States)

SooHoo, S. L.; Aabedi, F.; Wagenet, R. C.; Dorst, M.; Stempson, M.

1995-01-01

The presence of separate, independent systems for patient results is a common problem in many institutions. The Single Logon Application (SLA) was developed to mitigate the problems presented by these disparate systems, and its use was a key component in a Patient-Focused Care (PFC) implementation. PMID:8563263

MS PHD'S PDP: Vision, Design, Implementation, and Outcomes of a Minority-Focused Earth System Sciences Program

Science.gov (United States)

Habtes, S. Y.; Mayo, M.; Ithier-Guzman, W.; Pyrtle, A. J.; Williamson Whitney, V.

2007-05-01

As minorities are predicted to comprise at least 33% of the US population by the year 2010, their representation in the STEM fields, including the ocean sciences, is still poorly established. In order to advance the goal of better decision making, the Ocean Sciences community must achieve greater levels of diversity in membership. To achieve this objective of greater diversity in the sciences, the Minorities Striving and Pursuing Higher Degrees of Success in Earth System Science® Professional Development Program (MS PHD'S PDP), which was launched in 2003, is supported via grants from NASA's Office of Earth Science, and NSF's Directorate for Geosciences. The MS PHD'S PDP is designed to provide professional and mentoring experiences that facilitate the advancement of minorities committed to achieving outstanding Earth System Science careers. The MS PHD'S PDP is structured in three phases, connected by engagement in a virtual community, continuous peer and mentor to mentee interactions, and the professional support necessary for ensuring the educational success of the student participants. Since the pilot program in 2003, the MSPHD'S PDP, housed at the University of South Florida's College of Marine Science, has produced 4 cohorts of students. Seventy-five have completed the program; of those 6 have earned their doctoral degrees. Of the 45 current participants 10 are graduate students in Marine Science and 15 are still undergraduates, the remaining 10 participants are graduate students in other STEM fields. Since the implementation of the MSPHD'S PDP a total of 87 students and 33 scientist mentors have become part of the MSPHD'S virtual community, helping to improve the learning environment for current and future participants as well as build a community of minority students that encourages each other to pursue their academic degrees.

Progress and outcomes of health systems reform in the United Arab Emirates: A systematic review

NARCIS (Netherlands)

E.J. Koornneef (Erik J.); P.B.M. Robben (Paul); Blair, I. (Iain)

2017-01-01

textabstractBackground: The United Arab Emirates (UAE) government aspires to build a world class health system to improve the quality of healthcare and the health outcomes for its population. To achieve this it has implemented extensive health system reforms in the past 10 years. The nature, extent

Is there a Relationship between Patient Satisfaction and Favorable Surgical Outcomes?

Science.gov (United States)

Tevis, Sarah E.; Kennedy, Gregory D.; Kent, K. Craig

2015-01-01

Summary Satisfaction of patients with their health care is gaining importance as a measure of hospital quality due to public reporting of these values and an increasing connection between hospital reimbursement and scores on the current tool to measure satisfaction, the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. We found that high hospital and surgical volume and low rates of risk-adjusted mortality are associated with high patient satisfaction. However, other favorable patient outcomes are not consistently associated with positive satisfaction scores on HCAHPS. Contributors to patients' perceptions of their care are likely multifactorial and not related just to outcomes traditionally assessed by surgeons or hospitals. Moving in a direction of patient centered care, with a focus on increased understanding and involvement of patients in the care process, will likely strengthen the relationship between surgical outcomes and patient satisfaction. PMID:26299501

A Review of Psychotherapy Outcome Research: Considerations for School-Based Mental Health Providers

Science.gov (United States)

Zirkelback, Emily A.; Reese, Robert J.

2010-01-01

Evaluating psychotherapeutic outcome is an important endeavor given psychology's focus on identifying effective treatments. There is ample evidence to suggest that psychotherapy interventions for children and adolescents are effective. Unfortunately, the child and adolescent psychotherapy outcome literature lags behind the adult-focused outcome…

Acid-Base Learning Outcomes for Students in an Introductory Organic Chemistry Course

Science.gov (United States)

Stoyanovich, Carlee; Gandhi, Aneri; Flynn, Alison B.

2015-01-01

An outcome-based approach to teaching and learning focuses on what the student demonstrably knows and can do after instruction, rather than on what the instructor teaches. This outcome-focused approach can then guide the alignment of teaching strategies, learning activities, and assessment. In organic chemistry, mastery of organic acid-base…

Bringing the frame into focus: the influence of regulatory fit on processing fluency and persuasion.

Science.gov (United States)

Lee, Angela Y; Aaker, Jennifer L

2004-02-01

This research demonstrates that people's goals associated with regulatory focus moderate the effect of message framing on persuasion. The results of 6 experiments show that appeals presented in gain frames are more persuasive when the message is promotion focused, whereas loss-framed appeals are more persuasive when the message is prevention focused. These regulatory focus effects suggesting heightened vigilance against negative outcomes and heightened eagerness toward positive outcomes are replicated when perceived risk is manipulated. Enhanced processing fluency leading to more favorable evaluations in conditions of compatibility appears to underlie these effects. The findings underscore the regulatory fit principle that accounts for the persuasiveness of message framing effects and highlight how processing fluency may contribute to the "feeling right" experience when the strategy of goal pursuit matches one's goal.

Relationship styles of self-focused autonomy, other-focused connection, and mutuality among Mexican American and European American college students.

Science.gov (United States)

Neff, Kristin D; Brabeck, Kalina M; Kearney, Lisa K

2006-10-01

The author examined relationship styles of self-focused autonomy (SFA), other-focused connection (OFC), and mutuality among 415 European and Mexican American young adults in 2 U.S. colleges. Mutuality was the most commonly reported style for both ethnic groups, although Mexican American men were more likely than the others to indicate that they had the SFA style. Mexican American participants perceived their fathers' styles as SFA more often than did the others regarding either of their parents' styles. Mutuality was associated with the best mental-health outcomes regardless of gender or ethnicity. The present results indicate that the cultural influences on autonomy and connection are complex and that collectivistic cultural contexts may sometimes promote autonomy concerns in men.

Task-focused modeling in automated agriculture

Science.gov (United States)

Vriesenga, Mark R.; Peleg, K.; Sklansky, Jack

1993-01-01

Machine vision systems analyze image data to carry out automation tasks. Our interest is in machine vision systems that rely on models to achieve their designed task. When the model is interrogated from an a priori menu of questions, the model need not be complete. Instead, the machine vision system can use a partial model that contains a large amount of information in regions of interest and less information elsewhere. We propose an adaptive modeling scheme for machine vision, called task-focused modeling, which constructs a model having just sufficient detail to carry out the specified task. The model is detailed in regions of interest to the task and is less detailed elsewhere. This focusing effect saves time and reduces the computational effort expended by the machine vision system. We illustrate task-focused modeling by an example involving real-time micropropagation of plants in automated agriculture.

Use of the quality management system "JACIE" and outcome after hematopoietic stem cell transplantation.

Science.gov (United States)

Gratwohl, Alois; Brand, Ronald; McGrath, Eoin; van Biezen, Anja; Sureda, Anna; Ljungman, Per; Baldomero, Helen; Chabannon, Christian; Apperley, Jane

2014-05-01

Competent authorities, healthcare payers and hospitals devote increasing resources to quality management systems but scientific analyses searching for an impact of these systems on clinical outcome remain scarce. Earlier data indicated a stepwise improvement in outcome after allogeneic hematopoietic stem cell transplantation with each phase of the accreditation process for the quality management system "JACIE". We therefore tested the hypothesis that working towards and achieving "JACIE" accreditation would accelerate improvement in outcome over calendar time. Overall mortality of the entire cohort of 107,904 patients who had a transplant (41,623 allogeneic, 39%; 66,281 autologous, 61%) between 1999 and 2006 decreased over the 14-year observation period by a factor of 0.63 per 10 years (hazard ratio: 0.63; 0.58-0.69). Considering "JACIE"-accredited centers as those with programs having achieved accreditation by November 2012, at the latest, this improvement was significantly faster in "JACIE"-accredited centers than in non-accredited centers (approximately 5.3% per year for 49,459 patients versus approximately 3.5% per year for 58,445 patients, respectively; hazard ratio: 0.83; 0.71-0.97). As a result, relapse-free survival (hazard ratio 0.85; 0.75-0.95) and overall survival (hazard ratio 0.86; 0.76-0.98) were significantly higher at 72 months for those patients transplanted in the 162 "JACIE"-accredited centers. No significant effects were observed after autologous transplants (hazard ratio 1.06; 0.99-1.13). Hence, working towards implementation of a quality management system triggers a dynamic process associated with a steeper reduction in mortality over the years and a significantly improved survival after allogeneic stem cell transplantation. Our data support the use of a quality management system for complex medical procedures.

Cardiovascular disease outcomes: priorities today, priorities tomorrow for research and community health.

Science.gov (United States)

Yancy, Clyde W

2012-01-01

The disparities and differences in heart disease and stroke among Black, White and Hispanic populations tell a compelling and continuing story that should drive research agendas to improve health outcomes. With Black men and women having the highest prevalence of hypertension, Black females having higher rates of coronary heart disease, stroke and breast cancer than White females, and Blacks, at all ages, having a greater risk for stroke mortality than Whites, researchers and health care providers must understand the clinical appropriateness of treatment for different states of disease among distinct populations. Further, to eliminate health disparities, the health care systems and legal regulatory climate must facilitate access to care while biases, prejudices and stereotyping by health care providers and all those in the health care system must be eliminated. Importantly, research continues to illustrate that many are dying prematurely or have advanced stages of disease because of disparate care. This article explores four strategies to address inequitable care and to work toward eliminating poorer health outcomes among minorities. First, those who deliver health care must adopt a quality-focused approach that improves the care of all patients while facilitating the reduction and elimination of health disparities. Second, cultural awareness and cultural competency must be improved. Third, we must remove barriers to access and promote public policies that lead to greater health awareness and healthier environments. Lastly, but most importantly, we need a prevention focus as the reduction in the onset of disease is the first step towards improving health outcomes.

The Role of Organizational Control Systems in Employees' Organizational Trust and Performance Outcomes.

Science.gov (United States)

Verburg, Robert M; Nienaber, Ann-Marie; Searle, Rosalind H; Weibel, Antoinette; Den Hartog, Deanne N; Rupp, Deborah E

2018-04-01

This study examined how organizational control is related to employees' organizational trust. We specifically focus on how different forms of control (process, outcome, and normative) relate to employees' trust in their employing organizations and examine whether such trust in turn relates positively to employee job performance (task performance and organizational citizenship behavior). In addition, and in response to the recommendations of past research, we examined these relationships in a high control and compliance-based cultural context. Using data from 105 employee-supervisor dyads from professional services firms in Singapore, we find support for our hypothesized model. The implications of the results for theory and practice, and directions for future research, are discussed.

The Role of Organizational Control Systems in Employees’ Organizational Trust and Performance Outcomes

Science.gov (United States)

Verburg, Robert M.; Nienaber, Ann-Marie; Searle, Rosalind H.; Weibel, Antoinette; Den Hartog, Deanne N.; Rupp, Deborah E.

2017-01-01

This study examined how organizational control is related to employees’ organizational trust. We specifically focus on how different forms of control (process, outcome, and normative) relate to employees’ trust in their employing organizations and examine whether such trust in turn relates positively to employee job performance (task performance and organizational citizenship behavior). In addition, and in response to the recommendations of past research, we examined these relationships in a high control and compliance-based cultural context. Using data from 105 employee–supervisor dyads from professional services firms in Singapore, we find support for our hypothesized model. The implications of the results for theory and practice, and directions for future research, are discussed. PMID:29568213

Learning Program for Enhancing Visual Literacy for Non-Design Students Using a CMS to Share Outcomes

Science.gov (United States)

Ariga, Taeko; Watanabe, Takashi; Otani, Toshio; Masuzawa, Toshimitsu

2016-01-01

This study proposes a basic learning program for enhancing visual literacy using an original Web content management system (Web CMS) to share students' outcomes in class as a blog post. It seeks to reinforce students' understanding and awareness of the design of visual content. The learning program described in this research focuses on to address…

Feasibility test of a UK-scalable electronic system for regular collection of patient-reported outcome measures and linkage with clinical cancer registry data: The electronic Patient-reported Outcomes from Cancer Survivors (ePOCS system

Directory of Open Access Journals (Sweden)

Velikova Galina

2011-10-01

Full Text Available Abstract Background Cancer survivors can face significant physical and psychosocial challenges; there is a need to identify and predict which survivors experience what sorts of difficulties. As highlighted in the UK National Cancer Survivorship Initiative, routine post-diagnostic collection of patient reported outcome measures (PROMs is required; to be most informative, PROMs must be linked and analysed with patients' diagnostic and treatment information. We have designed and built a potentially cost-efficient UK-scalable electronic system for collecting PROMs via the internet, at regular post-diagnostic time-points, for linking these data with patients' clinical data in cancer registries, and for electronically managing the associated patient monitoring and communications; the electronic Patient-reported Outcomes from Cancer Survivors (ePOCS system. This study aims to test the feasibility of the ePOCS system, by running it for 2 years in two Yorkshire NHS Trusts, and using the Northern and Yorkshire Cancer Registry and Information Service. Methods/Design Non-metastatic breast, colorectal and prostate cancer patients (largest survivor groups, within 6 months post-diagnosis, will be recruited from hospitals in the Yorkshire Cancer Network. Participants will be asked to complete PROMS, assessing a range of health-related quality-of-life outcomes, at three time-points up to 15 months post-diagnosis, and subsequently to provide opinion on the ePOCS system via a feedback questionnaire. Feasibility will be examined primarily in terms of patient recruitment and retention rates, the representativeness of participating patients, the quantity and quality of collected PROMs data, patients' feedback, the success and reliability of the underpinning informatics, and the system running costs. If sufficient data are generated during system testing, these will be analysed to assess the health-related quality-of-life outcomes reported by patients, and to explore

CO{sub 2} laser beam cutting with long-focused optics system

Energy Technology Data Exchange (ETDEWEB)

Okimura, Koji [Mitsubishi Heavy Industries, Ltd., Kobe Shipyard and Machinery Works, Kobe, Hyogo (Japan); Nagura, Yasumi; Ishide, Takashi; Hiramoto, Yoneo

1999-07-01

In cutting the decommissioned nuclear facility, it is required to ensure the safety for dismantling workers, to control the amount of wastes generated by cutting, to reduce the costs, etc. Recently, the laser power has increased remarkably and its application tests are carried out at various fields. In this work, cutting tests were carried out with the CO{sub 2} laser having a long-focused optics system of the meter scale. Then, in the optics system of 5 m focal length, it is possible to cut the steel plates of 30 and 40 mm thickness with the laser power of 20 and 40 kW respectively and 42 mm out diameter steel pipe of 5 mm thickness with that of 20 kW without using assistant gas. This cutting process can be developed such a new dismantling method that may dismantle crowded overhead pipes without a scaffolding, so it is expected to ensure the safety for dismantling workers, to decrease the amount of total radiation exposure and to reduce the costs. (author)

Process research on Emotionally Focused Therapy (EFT) for couples: linking theory to practice.

Science.gov (United States)

Greenman, Paul S; Johnson, Susan M

2013-03-01

The focus of this article is on the link among theory, process, and outcome in the practice of Emotionally Focused Therapy (EFT) for couples. We describe the EFT model of change and the EFT perspective on adult love as the reflection of underlying attachment processes. We outline the manner in which theory and research inform EFT interventions. This leads into a detailed review of the literature on the processes of change in EFT. We highlight the client responses and therapist operations that have emerged from process research and their relation to treatment outcomes. We discuss the implications of this body of research for clinical practice and training. © FPI, Inc.

Leaf LIMS: A Flexible Laboratory Information Management System with a Synthetic Biology Focus.

Science.gov (United States)

Craig, Thomas; Holland, Richard; D'Amore, Rosalinda; Johnson, James R; McCue, Hannah V; West, Anthony; Zulkower, Valentin; Tekotte, Hille; Cai, Yizhi; Swan, Daniel; Davey, Robert P; Hertz-Fowler, Christiane; Hall, Anthony; Caddick, Mark

2017-12-15

This paper presents Leaf LIMS, a flexible laboratory information management system (LIMS) designed to address the complexity of synthetic biology workflows. At the project's inception there was a lack of a LIMS designed specifically to address synthetic biology processes, with most systems focused on either next generation sequencing or biobanks and clinical sample handling. Leaf LIMS implements integrated project, item, and laboratory stock tracking, offering complete sample and construct genealogy, materials and lot tracking, and modular assay data capture. Hence, it enables highly configurable task-based workflows and supports data capture from project inception to completion. As such, in addition to it supporting synthetic biology it is ideal for many laboratory environments with multiple projects and users. The system is deployed as a web application through Docker and is provided under a permissive MIT license. It is freely available for download at https://leaflims.github.io .

Particle Accelerator Focus Automation

Directory of Open Access Journals (Sweden)

Lopes José

2017-08-01

Full Text Available The Laboratório de Aceleradores e Tecnologias de Radiação (LATR at the Campus Tecnológico e Nuclear, of Instituto Superior Técnico (IST has a horizontal electrostatic particle accelerator based on the Van de Graaff machine which is used for research in the area of material characterization. This machine produces alfa (He+ and proton (H+ beams of some μA currents up to 2 MeV/q energies. Beam focusing is obtained using a cylindrical lens of the Einzel type, assembled near the high voltage terminal. This paper describes the developed system that automatically focuses the ion beam, using a personal computer running the LabVIEW software, a multifunction input/output board and signal conditioning circuits. The focusing procedure consists of a scanning method to find the lens bias voltage which maximizes the beam current measured on a beam stopper target, which is used as feedback for the scanning cycle. This system, as part of a wider start up and shut down automation system built for this particle accelerator, brings great advantages to the operation of the accelerator by turning it faster and easier to operate, requiring less human presence, and adding the possibility of total remote control in safe conditions.

Particle Accelerator Focus Automation

Science.gov (United States)

Lopes, José; Rocha, Jorge; Redondo, Luís; Cruz, João

2017-08-01

The Laboratório de Aceleradores e Tecnologias de Radiação (LATR) at the Campus Tecnológico e Nuclear, of Instituto Superior Técnico (IST) has a horizontal electrostatic particle accelerator based on the Van de Graaff machine which is used for research in the area of material characterization. This machine produces alfa (He+) and proton (H+) beams of some μA currents up to 2 MeV/q energies. Beam focusing is obtained using a cylindrical lens of the Einzel type, assembled near the high voltage terminal. This paper describes the developed system that automatically focuses the ion beam, using a personal computer running the LabVIEW software, a multifunction input/output board and signal conditioning circuits. The focusing procedure consists of a scanning method to find the lens bias voltage which maximizes the beam current measured on a beam stopper target, which is used as feedback for the scanning cycle. This system, as part of a wider start up and shut down automation system built for this particle accelerator, brings great advantages to the operation of the accelerator by turning it faster and easier to operate, requiring less human presence, and adding the possibility of total remote control in safe conditions.

Development and application of course-embedded assessment system for program outcome evaluation in the Korean nursing education: A pilot study.

Science.gov (United States)

Park, Jee Won; Seo, Eun Ji; You, Mi-Ae; Song, Ju-Eun

2016-03-01

Program outcome evaluation is important because it is an indicator for good quality of education. Course-embedded assessment is one of the program outcome evaluation methods. However, it is rarely used in Korean nursing education. The study purpose was to develop and apply preliminarily a course-embedded assessment system to evaluate one program outcome and to share our experiences. This was a methodological study to develop and apply the course-embedded assessment system based on the theoretical framework in one nursing program in South Korea. Scores for 77 students generated from the three practicum courses were used. The course-embedded assessment system was developed following the six steps suggested by Han's model as follows. 1) One program outcome in the undergraduate program, "nursing process application ability", was selected and 2) the three clinical practicum courses related to the selected program outcome were identified. 3) Evaluation tools including rubric and items were selected for outcome measurement and 4) performance criterion, the educational goal level for the program, was established. 5) Program outcome was actually evaluated using the rubric and evaluation items in the three practicum courses and 6) the obtained scores were analyzed to identify the achievement rate, which was compared with the performance criterion. Achievement rates for the selected program outcome in adult, maternity, and pediatric nursing practicum were 98.7%, 100%, and 66.2% in the case report and 100% for all three in the clinical practice, and 100%, 100%, and 87% respectively for the conference. These are considered as satisfactory levels when compared with the performance criterion of "at least 60% or more". Course-embedded assessment can be used as an effective and economic method to evaluate the program outcome without running an integrative course additionally. Further studies to develop course-embedded assessment systems for other program outcomes in nursing

Out-of-focus effects on microscale schlieren measurements of mass transport in a microfluidic device

Science.gov (United States)

Chen, Shao-Tuan; Sun, Chen-li

2016-08-01

The microscale schlieren technique provides a means for a non-invasive, full-field measurement for mixing microfluidics with excellent sensitivity and resolution. Nevertheless, an out-of-focus effect due to microscopic optics may lead to undesirable errors in quantifying the gradient information at high degrees of magnification. If the channel in the microfluidic device under study is too deep, light deflection caused by inhomogeneity located far from the focal plane may contributes little to the intensity change on the image plane. To address this issue, we propose the use of a weighting function that approximates a Gaussian profile with an optical-system-dependable width. We assume that the resultant intensity change is proportional to a weighted sum of the gradient across the channel depth and acquire micro-schlieren images of fluid mixing in a T-junction microchannel at various positions along the optical axis. For each objective, the width of the weighting function is then determined iteratively by curve fitting the ratio of changes in grayscale readouts for out-of-focus and focus micro-schlieren images. The standard deviation in the Gaussian distribution facilitates the quantification of the out-of-focus effect. In addition, we measure the sensitivities of a microscale schlieren system equipped with different objectives and compare the values to the model. Despite its better resolution, we find that an objective with higher magnification suffers from a more severe out-of-focus effect and a loss of sensitivity. Equations are proposed for estimations of the standard deviation and the sensitivity of microscale schlieren measurements. The outcome will facilitate the selection of proper microchannel depths for various microscale schlieren systems or vice versa, thus improving the precision of micro-schlieren measurements in microfluidic devices.

Environmental Outcomes in the South African Learnership System ...

African Journals Online (AJOL)

Since 1994, the published environmental goals and objectives of the South African Government include environmental education outcomes in all education and ... of manifest and latent environmental outcomes distributed across learnerships and SETAs; a strong influence of occupational health and safety legislation; and a ...

Maternal, Fetal and Neonatal Outcomes in Pregnant Women with Systemic Lupus Erythematosus: A Comprehensive Review Study

Directory of Open Access Journals (Sweden)

Fatemeh Zahra Karimi

2017-11-01

Full Text Available Background:Systemic lupus erythematosus (SLE is an autoimmune disease with multiple organ involvement and periods of relapse and remission that mainly affects young women of childbearing age. In this regard the reproductive health is an important issue. Although diagnosis, treatment and management of pregnancy in SLE women have been improved recently, but the main concern is effects of SLE on maternal, fetal and neonatal outcomes. This study aimed to investigate the maternal, fetal and neonatal outcomes in pregnant women with SLE. Materials and Methods: The databases of PubMed, Medline, Scopus and Web of Science as well as domestic database (Persian such as SID, Magiran, Irandoc, and Google Scholar were searched with using keywords such as" Systemic lupus erythematosus"; "Pregnancy"; "Neonatal lupus"; "maternal, fetus or neonatal outcome";  and equivalent Persian words. Included were all Persian and English articles, published between 2000 and May 2017. Finally, a total of 77 studies were included. Results: Adverse perinatal outcomes increase in pregnancies with lupus. Outcomes include respiratory, cardiovascular, blood and skin disorders in mothers; stillbirth, spontaneous, and recurrent abortion in fetuses and neonatal lupus, prematurity, intrauterine growth restriction (IUGR, and small for gestational age (SGA in neonates, respectively. Conclusion: Pregnant women with SLE are at high risk due to increased complications for both mother and fetus. It seems broad control of the women before fertilization, so that they be at full remission in the beginning of pregnancy and the disease activity be in complete control, it can help to improve outcomes of pregnancy and so better results can be expected.

Synthesis of focusing-and-deflection columns

International Nuclear Information System (INIS)

Szilagyi, M.; Mui, P.H.

1995-01-01

Szilagyi and Szep have demonstrated that focusing lenses of high performances can be constructed from a column of circular plate electrodes. Later, Szilagyi modified that system to include dipole, quadrupole, and octupole components by partitioning each plate into eight equal sectors. It has already been shown that the additional quadrupole components can indeed bring about substantial improvements in the focusing of charged particle beams. In this article, that design procedure is expanded to construct columns capable of both focusing and deflecting particle beams by just introducing additional dipole components. In this new design, the geometry of the system remains unchanged. The only extra complication is the demand for more individual controls of the sector voltages. Two sample designs, one for negative ions and one for electrons, are presented showing that in both cases a ±2.3 mrad diverging beam can be focused down to a spot of less than 50 nm in radius over a scanning circular area of radius 0.25 mm. The details of the two systems are given in Sec. IV along with the source conditions. The performance of the negative ion system is found to be comparable to the published data. For the relativistic electron system, the interaction of individual components to reduce various aberrations is investigated. copyright 1995 American Vacuum Society

System geometry optimization for molecular breast tomosynthesis with focusing multi-pinhole collimators

Science.gov (United States)

van Roosmalen, Jarno; Beekman, Freek J.; Goorden, Marlies C.

2018-01-01

Imaging of 99mTc-labelled tracers is gaining popularity for detecting breast tumours. Recently, we proposed a novel design for molecular breast tomosynthesis (MBT) based on two sliding focusing multi-pinhole collimators that scan a modestly compressed breast. Simulation studies indicate that MBT has the potential to improve the tumour-to-background contrast-to-noise ratio significantly over state-of-the-art planar molecular breast imaging. The aim of the present paper is to optimize the collimator-detector geometry of MBT. Using analytical models, we first optimized sensitivity at different fixed system resolutions (ranging from 5 to 12 mm) by tuning the pinhole diameters and the distance between breast and detector for a whole series of automatically generated multi-pinhole designs. We evaluated both MBT with a conventional continuous crystal detector with 3.2 mm intrinsic resolution and with a pixelated detector with 1.6 mm pixels. Subsequently, full system simulations of a breast phantom containing several lesions were performed for the optimized geometry at each system resolution for both types of detector. From these simulations, we found that tumour-to-background contrast-to-noise ratio was highest for systems in the 7 mm-10 mm system resolution range over which it hardly varied. No significant differences between the two detector types were found.

A final focus system for the Next Linear Collider

International Nuclear Information System (INIS)

Zimmermann, F.; Brown, K.; Emma, P.; Helm, R.; Irwin, J.; Tenenbaum, P.; Wilson, P.

1995-06-01

The final focus of the Next Linear Collider (NLC) demagnifies electron and positron beams of 250--750 GeV energy down to a transverse size of about 2.5 x 350 nm 2 at the interaction point (IP). The basic layout, momentum bandwidth, vibration tolerances, wakefield effects, and the tunability of the proposed final focus design are discussed. Also a perspective is given on the crab cavity and on effects of the solenoid field in the interaction region

Diabetes Outcomes in the Indian Health System During the Era of the Special Diabetes Program for Indians and the Government Performance and Results Act

Science.gov (United States)

Wilson, Charlton; Gilliland, Susan; Cullen, Theresa; Moore, Kelly; Roubideaux, Yvette; Valdez, Lorraine; Vanderwagen, William; Acton, Kelly

2005-01-01

Objectives. We reviewed changes in blood glucose, blood pressure, and cholesterol levels among American Indians and Alaska Natives between 1995 and 2001 to estimate the quality of diabetes care in the Indian Health Service (IHS) health care delivery system. Methods. We conducted a cross-sectional analysis of data from the Indian Health Service Diabetes Care and Outcomes Audit. Results. Adjusted mean Hemoglobin A1c (HbA1c) levels (7.9% vs 8.9%) and mean diastolic blood pressure levels (76 vs 79 mm Hg) were lower in 2001 than in 1995, respectively. A similar pattern was observed for mean total cholesterol (193 vs 208 mg/dL) and triglyceride (235 vs 257 mg/dL) levels in 2001 and 1995, respectively. Conclusions. We identified changes in intermediate clinical outcomes over the period from 1995 to 2001 that may reflect the global impact of increased resource allocation and improvements in processes on the quality of diabetes care, and we describe the results that may be achieved when community, health program, and congressional initiatives focus on common goals. PMID:16051933

Identification of desired outcomes for school nursing practice.

Science.gov (United States)

Selekman, Janice; Guilday, Patricia

2003-12-01

The Scope and Standards of Professional School Nursing Practice states that school nurses should evaluate the quality and effectiveness of their practice. School nurses have not yet identified and adopted outcomes by which this effectiveness can be measured. This study used focus groups during a national meeting of school nurse leaders to identify the desired outcomes that could be used to measure the efficacy of school nursing practice. Ten desired outcome themes were identified with numerous specific indicators as possible ways to measure the desired outcome in each theme. The student-, school-, and nurse-focused outcome themes were as follows: (a) increased student seat time, (b) receipt of first aid and acute care measures, (c) receipt of competent health-related interventions or skills, (d) meeting of the comprehensive needs of children with chronic conditions, (e) enhanced school health via wellness promotion and disease prevention measures, (f) referrals, (g) safe environment, (h) enhanced school health via community outreach, (i) cost-effective school nurse services, and (j) student, parent, and staff satisfaction. The school nurse participants were supportive of having potential outcomes identified and unanimously endorsed the findings at the conclusion of the study. They have provided a comprehensive framework from which evaluation tools can be developed to measure the efficacy of school nursing.

Focus stacking: Comparing commercial top-end set-ups with a semi-automatic low budget approach. A possible solution for mass digitization of type specimens.

Science.gov (United States)

Brecko, Jonathan; Mathys, Aurore; Dekoninck, Wouter; Leponce, Maurice; VandenSpiegel, Didier; Semal, Patrick

2014-01-01

In this manuscript we present a focus stacking system, composed of commercial photographic equipment. The system is inexpensive compared to high-end commercial focus stacking solutions. We tested this system and compared the results with several different software packages (CombineZP, Auto-Montage, Helicon Focus and Zerene Stacker). We tested our final stacked picture with a picture obtained from two high-end focus stacking solutions: a Leica MZ16A with DFC500 and a Leica Z6APO with DFC290. Zerene Stacker and Helicon Focus both provided satisfactory results. However, Zerene Stacker gives the user more possibilities in terms of control of the software, batch processing and retouching. The outcome of the test on high-end solutions demonstrates that our approach performs better in several ways. The resolution of the tested extended focus pictures is much higher than those from the Leica systems. The flash lighting inside the Ikea closet creates an evenly illuminated picture, without struggling with filters, diffusers, etc. The largest benefit is the price of the set-up which is approximately € 3,000, which is 8 and 10 times less than the LeicaZ6APO and LeicaMZ16A set-up respectively. Overall, this enables institutions to purchase multiple solutions or to start digitising the type collection on a large scale even with a small budget.

Focus stacking: Comparing commercial top-end set-ups with a semi-automatic low budget approach. A possible solution for mass digitization of type specimens

Directory of Open Access Journals (Sweden)

Jonathan Brecko

2014-12-01

Full Text Available In this manuscript we present a focus stacking system, composed of commercial photographic equipment. The system is inexpensive compared to high-end commercial focus stacking solutions. We tested this system and compared the results with several different software packages (CombineZP, Auto-Montage, Helicon Focus and Zerene Stacker. We tested our final stacked picture with a picture obtained from two high-end focus stacking solutions: a Leica MZ16A with DFC500 and a Leica Z6APO with DFC290. Zerene Stacker and Helicon Focus both provided satisfactory results. However, Zerene Stacker gives the user more possibilities in terms of control of the software, batch processing and retouching. The outcome of the test on high-end solutions demonstrates that our approach performs better in several ways. The resolution of the tested extended focus pictures is much higher than those from the Leica systems. The flash lighting inside the Ikea closet creates an evenly illuminated picture, without struggling with filters, diffusers, etc. The largest benefit is the price of the set-up which is approximately € 3,000, which is 8 and 10 times less than the LeicaZ6APO and LeicaMZ16A set-up respectively. Overall, this enables institutions to purchase multiple solutions or to start digitising the type collection on a large scale even with a small budget.

The use of focus groups in the development of the PROMIS pediatrics item bank.

Science.gov (United States)

Walsh, Tasanee R; Irwin, Debra E; Meier, Andrea; Varni, James W; DeWalt, Darren A

2008-06-01

To understand differences in perceptions of patient-reported outcome domains between children with asthma and children from the general population. We used this information in the development of patient-reported outcome items for the Patient-Reported Outcomes Measurement Information System Pediatrics project. We conducted focus groups composed of ethnically, racially, and geographically diverse youth (8-12, 13-17 years) from the general population and youth with asthma. We performed content analysis to identify important themes. We identified five unique and different challenges that may confront youth with asthma as compared to general population youth: (1) They experience more difficulties when participating in physical activities; (2) They may experience anxiety about having an asthma attack at anytime and anywhere; (3) They may experience sleep disturbances and fatigue secondary to their asthma symptoms; (4) Their health condition has a greater effect on their emotional well-being and interpersonal relationships; and (5) Youth with asthma report that asthma often leaves them with insufficient energy to complete their school activities, especially physical activities. The results confirm unique experiences for children with asthma across a broad range of health domains and enhance the breadth of all domains when creating an item bank.

The Role of Physiotherapy Extended Scope Practitioners in Musculoskeletal care with Focus on Decision Making and Clinical Outcomes: A Systematic Review of Quantitative and Qualitative Research.

Science.gov (United States)

Thompson, Jonathan; Yoward, Samantha; Dawson, Pamela

2017-06-01

Physiotherapy extended scope practitioner (ESP) roles are widely utilized in the management of musculoskeletal conditions. The present article reviews the current literature, with particular emphasis on the decision-making process, patient/clinician interaction and clinical outcomes. A systematic review of musculoskeletal extended scope practice was carried out. The review focused on the outcome of interventions, and the interactions and decision-making processes between ESPs and their patients. A wide search strategy was employed, through multiple databases, grey literature and experts in the field. Qualitative and quantitative studies alike were included and a mixed-methods synthesis approach was undertaken in analysing the findings of included studies. A total of 476 articles were identified for inclusion, 25 of which (22 quantitative and three qualitative) meeting the criteria for full quality appraisal and synthesis. It was not possible to conduct a meta-analysis owing to data heterogeneity. The results showed high patient satisfaction with the ESP role, support for ESP staff listing patients for orthopaedic surgery, a high positive correlation of decision making between ESPs and orthopaedic surgeons and evidence of a positive impact on patient outcomes. Qualitative themes reflected the importance of ESP clinical decision making and interpersonal skills and their role in patient education. There is broad support for the physiotherapy ESP role and evidence of favourable outcomes from ESP intervention. Clinical decisions made by ESPs correlate well with those of medical colleagues, although there is a lack of detail explaining the ESP decision-making process itself and the influences and mechanisms by which this occurs. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

Y2K: Focus on systems

International Nuclear Information System (INIS)

Dillner, M.

1999-01-01

During the past three years the Pacific Northwest National Laboratory has been actively working with the US DOE to understand the Y2K impacts that exist and perform appropriate remediation of critical systems. The Y2K problem has the potential for affecting software, hardware, embedded chips, control devices as well as telephone and power equipment. Successful Y2K remediation requires that a risk assessment be performed based on a view of the 'complete' system (e.g. input, outputs, infrastructure, operating systems, communication mechanisms, and development tools as compilers). All DOE facilities have followed the Y2K life cycle of system inventory, assessment (system and risk), renovation, testing, transition planning, implementation, validation and business continuity planning. Within this process, each organization has used the particular systems life-cycle methodology. The Pacific Northwest National Laboratory would like to share lessons learned about the entire Year 2000 program particularly in the areas of performing Year 2000 assessments, the identification of appropriate system remediation, and project mechanisms

Intensive Care Nurses’ Belief Systems Regarding the Health Economics: A Focused Ethnography

Science.gov (United States)

Heydari, Abbas; Vafaee-Najar, Ali; Bakhshi, Mahmoud

2016-01-01

Background: Health care beliefs can have an effect on the efficiency and effectiveness of nursing practices. Nevertheless, how belief systems impact on the economic performance of intensive care unit (ICU) nurses is not known. This study aimed to explore the ICU nurses’ beliefs and their effect on nurse’s: practices and behavior patterns regarding the health economics. Methods: In this study, a focused ethnography method was used. Twenty-four informants from ICU nurses and other professional individuals were purposively selected and interviewed. As well, 400 hours of ethnographic observations were used for data collection. Data analysis was performed using the methods described by Miles and Huberman (1994). Findings: Eight beliefs were found that gave meaning to ICU nurse’s practices regarding the health economics. 1. The registration of medications and supplies disrupt the nursing care; 2. Monitoring and auditing improve consumption; 3. There is a fear of possible shortage in the future; 4. Supply and replacement of equipment is difficult; 5. Higher prices lead to more accurate consumption; 6. The quality of care precedes the costs; 7. Clinical Guidelines are abundant but useful; and 8. Patient economy has priority over hospital economy. Maintaining the quality of patient care with least attention to hospital costs was the main focus of the beliefs formed up in the ICU regarding the health economics. Conclusions: ICU nurses’ belief systems have significantly shaped in relation to providing a high-quality care. Although high quality of care can lead to a rise in the effectiveness of nursing care, cost control perspective should also be considered in planning for improve the quality of care. Therefore, it is necessary to involve the ICU nurses in decision-making about unit cost management. They must become familiar with the principles of heath care economics and productivity by applying an effective cost management program. It may be optimal to implement the

Intensive Care Nurses' Belief Systems Regarding the Health Economics: A Focused Ethnography.

Science.gov (United States)

Heydari, Abbas; Vafaee-Najar, Ali; Bakhshi, Mahmoud

2016-09-01

Health care beliefs can have an effect on the efficiency and effectiveness of nursing practices. Nevertheless, how belief systems impact on the economic performance of intensive care unit (ICU) nurses is not known. This study aimed to explore the ICU nurses' beliefs and their effect on nurse's practices and behavior patterns regarding the health economics. In this study, a focused ethnography method was used. Twenty-four informants from ICU nurses and other professional individuals were purposively selected and interviewed. As well, 400 hours of ethnographic observations were used for data collection. Data analysis was performed using the methods described by Miles and Huberman (1994). Eight beliefs were found that gave meaning to ICU nurse's practices regarding the health economics. 1. The registration of medications and supplies disrupt the nursing care; 2.Monitoring and auditing improve consumption; 3.There is a fear of possible shortage in the future; 4.Supply and replacement of equipment is difficult; 5.Higher prices lead to more accurate consumption; 6.The quality of care precedes the costs; 7. Clinical Guidelines are abundant but useful; and 8.Patient economy has priority over hospital economy. Maintaining the quality of patient care with least attention to hospital costs was the main focus of the beliefs formed up in the ICU regarding the health economics. ICU nurses' belief systems have significantly shaped in relation to providing a high-quality care. Although high quality of care can lead to a rise in the effectiveness of nursing care, cost control perspective should also be considered in planning for improve the quality of care. Therefore, it is necessary to involve the ICU nurses in decision-making about unit cost management. They must become familiar with the principles of heath care economics and productivity by applying an effective cost management program. It may be optimal to implement the reforms in various aspects, such as the hospital

Qualitative and quantitative outcomes of audience response systems as an educational tool in a plastic surgery residency program.

Science.gov (United States)

Arneja, Jugpal S; Narasimhan, Kailash; Bouwman, David; Bridge, Patrick D

2009-12-01

In-training evaluations in graduate medical education have typically been challenging. Although the majority of standardized examination delivery methods have become computer-based, in-training examinations generally remain pencil-paper-based, if they are performed at all. Audience response systems present a novel way to stimulate and evaluate the resident-learner. The purpose of this study was to assess the outcomes of audience response systems testing as compared with traditional testing in a plastic surgery residency program. A prospective 1-year pilot study of 10 plastic surgery residents was performed using audience response systems-delivered testing for the first half of the academic year and traditional pencil-paper testing for the second half. Examination content was based on monthly "Core Quest" curriculum conferences. Quantitative outcome measures included comparison of pretest and posttest and cumulative test scores of both formats. Qualitative outcomes from the individual participants were obtained by questionnaire. When using the audience response systems format, pretest and posttest mean scores were 67.5 and 82.5 percent, respectively; using traditional pencil-paper format, scores were 56.5 percent and 79.5 percent. A comparison of the cumulative mean audience response systems score (85.0 percent) and traditional pencil-paper score (75.0 percent) revealed statistically significantly higher scores with audience response systems (p = 0.01). Qualitative outcomes revealed increased conference enthusiasm, greater enjoyment of testing, and no user difficulties with the audience response systems technology. The audience response systems modality of in-training evaluation captures participant interest and reinforces material more effectively than traditional pencil-paper testing does. The advantages include a more interactive learning environment, stimulation of class participation, immediate feedback to residents, and immediate tabulation of results for the

Improving hip surgery patients’ outcomes:

DEFF Research Database (Denmark)

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

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

Prognostic Factors for Peritonitis Outcome

NARCIS (Netherlands)

van Esch, Sadie; Krediet, Raymond T.; Struijk, Dirk G.

2012-01-01

Despite advances in treatment and prevention, peritonitis remains a major problem in peritoneal dialysis (PD) patients with often technique failure as a consequence. The last decades the focus of PD peritonitis has changed from lowering peritonitis incidence to improvement of peritonitis outcome.

Social-ecological outcomes in recreational fisheries: The interaction of lakeshore development and stocking

Science.gov (United States)

Ziegler, Jacob P.; Golebie, Elizabeth J.; Jones, Stuart E.; Weidel, Brian C.; Solomon, Christopher T.

2017-01-01

Many ecosystems continue to experience rapid transformations due to processes like land use change and resource extraction. A systems approach to maintaining natural resources focuses on how interactions and feedbacks among components of complex social‐ecological systems generate social and ecological outcomes. In recreational fisheries, residential shoreline development and fish stocking are two widespread human behaviors that influence fisheries, yet emergent social‐ecological outcomes from these potentially interacting behaviors remain under explored. We applied a social‐ecological systems framework using a simulation model and empirical data to determine whether lakeshore development is likely to promote stocking through its adverse effects on coarse woody habitat and thereby also on survival of juvenile and adult fish. We demonstrate that high lakeshore development is likely to generate dependency of the ecosystem on the social system, in the form of stocking. Further, lakeshore development can interact with social‐ecological processes to create deficits for state‐level governments, which threatens the ability to fund further ecosystem subsidies. Our results highlight the value of a social‐ecological framework for maintaining ecosystem services like recreational fisheries.

Designing a Prognostic Scoring System for Predicting the Outcomes of Proximal Fifth Metatarsal Fractures at 20 Weeks

Directory of Open Access Journals (Sweden)

Mohammad Ali Tahririan

2015-03-01

Full Text Available Background: Fractures of the proximal fifth metatarsal bone are among the most common fractures observed in the foot and their classification and management has been subject to much discussion and disagreement. In this study, we aim to identify and quantify the effect of possible predictors of the outcome of the treatment of proximal fifth metatarsal fractures. Methods: Patients with established proximal fifth metatarsal fractures were enrolled in this prospective cohort and the outcome of their treatment was assessed using the AOFAS mid foot scale at 6 and 20 weeks. Results: 143 patients were included in the study. Our study showed that displacement, weight and type III fractures were significant independent predictors of poor outcome at 6 weeks while at 20 weeks in addition to these factors, gender and diabetes mellitus were also shown to be significant independent predictors of poor outcome. A scoring system was designed by assigning weight to these factors and it was shown to be a strong predictor of outcome at 20 weeks. Conclusion: We recommend that our scoring system would help surgeons to decide whether patients’ prognostic factors are significant enough for him/her to opt for a surgical approach to treatment rather than a conservative approach.

Learning Outcomes in Affective Domain within Contemporary Architectural Curricula

Science.gov (United States)

Savic, Marko; Kashef, Mohamad

2013-01-01

Contemporary architectural education has shifted from the traditional focus on providing students with specific knowledge and skill sets or "inputs" to outcome based, student-centred educational approach. Within the outcome based model, students' performance is assessed against measureable objectives that relate acquired knowledge…

Does Family Structure Affect Children's Educational Outcomes? NBER Working Paper Series.

Science.gov (United States)

Pollak, Robert A.; Ginther, Donna K.

This paper examines correlations between children's educational outcomes and family structure. Although popular discussions focus on distinctions between two-parent and single-parent families, earlier research shows that outcomes for stepchildren are similar to outcomes for children in single-parent families, and earlier researchers suggested that…

Systems fragility: The sociology of chaos.

Science.gov (United States)

Hodges, Lori R

2016-01-01

This article examines the concept of community fragility in emergency management from a systems perspective. Using literature that addresses fragility in four areas of complex systems, including ecosystems, social systems, sociotechnical systems, and complex adaptive systems, a theoretical framework focused on the emergency management field is created. These findings illustrate how community fragility factors can be used in the emergency management field to not only improve overall outcomes after disaster but also build less fragile systems and communities in preparation for future disasters.

Consequences of Parenting on Adolescent Outcomes

Directory of Open Access Journals (Sweden)

Donna Hancock Hoskins

2014-09-01

Full Text Available In recent years, substantial gains have been made in our understanding of the influence of parenting behaviors and styles on adolescent emotional and behavioral outcomes. Empirical work focusing on the associations between parenting and adolescent outcomes is important because the influence of parenting during adolescence continues to affect behaviors into adulthood. Additionally, there has been considerable attention paid to the mechanisms that shape parenting that then influence adolescent outcomes. For instance, researchers have found that neighborhood conditions moderated the association between parenting and adolescent development. In this paper, several covariates and contextual effects associated with parenting and adolescent outcomes will be discussed. Also, parental behaviors, parental styles and adolescent outcomes are discussed in this literature review. This review provides an assessment of the literature on parenting and adolescent outcomes from the past decade and includes advancements in parenting research. The review concludes with a summary of major research findings, as well as a consideration of future directions and implications for practice and policy.

Extended depth of focus contact lenses vs. two commercial multifocals: Part 1. Optical performance evaluation via computed through-focus retinal image quality metrics

Directory of Open Access Journals (Sweden)

Ravi C. Bakaraju

2018-01-01

Conclusion: With the through focus retinal image quality as the gauge of optical performance, we demonstrated that the prototype EDOF designs were less susceptible to variations in pupil, inherent ocular aberrations and decentration, compared to the commercial designs. To ascertain whether these incremental improvements translate to a clinically palpable outcome requires investigation through human trials.

Multifunctional pulse generator for high-intensity focused ultrasound system

Science.gov (United States)

Tamano, Satoshi; Yoshizawa, Shin; Umemura, Shin-Ichiro

2017-07-01

High-intensity focused ultrasound (HIFU) can achieve high spatial resolution for the treatment of diseases. A major technical challenge in implementing a HIFU therapeutic system is to generate high-voltage high-current signals for effectively exciting a multichannel HIFU transducer at high efficiencies. In this paper, we present the development of a multifunctional multichannel generator/driver. The generator can produce a long burst as well as an extremely high-voltage short pulse of pseudosinusoidal waves (trigger HIFU) and second-harmonic superimposed waves for HIFU transmission. The transmission timing, waveform, and frequency can be controlled using a field-programmable gate array (FPGA) via a universal serial bus (USB) microcontroller. The hardware is implemented in a compact printed circuit board. The test results of trigger HIFU reveal that the power consumption and the temperature rise of metal-oxide semiconductor field-effect transistors were reduced by 19.9% and 38.2 °C, respectively, from the previous design. The highly flexible performance of the novel generator/driver is demonstrated in the generation of second-harmonic superimposed waves, which is useful for cavitation-enhanced HIFU treatment, although the previous design exhibited difficulty in generating it.

Measurement of the speed of sound in trabecular bone by using a time reversal acoustics focusing system

Energy Technology Data Exchange (ETDEWEB)

Lee, Kang Il [Kangwon National University, Chuncheon (Korea, Republic of); Choi, Bok-Kyoung [Maritime Security Research Center, KIOST, Ansan (Korea, Republic of)

2014-10-15

A new method for measuring the speed of sound (SOS) in trabecular bone by using a time reversal acoustics (TRA) focusing system was proposed and validated with measurements obtained by using the conventional pulse-transmission technique. The SOS measured in 14 bovine femoral trabecular bone samples by using the two methods was highly correlated each other, although the SOS measured by using the TRA focusing system was slightly lower by an average of 2.2 m/s. The SOS measured by using the two methods showed high correlation coefficients of r = 0.92 with the apparent bone density, consistent with the behavior in human trabecular bone in vitro. These results prove the efficacy of the new method based on the principle of TRA to measure the SOS in trabecular bone.

Assessments in outcome evaluation in aphasia therapy

DEFF Research Database (Denmark)

Isaksen, Jytte; Brouwer, Catherine E.

2015-01-01

Abstract Outcomes of aphasia therapy in Denmark are documented in evaluation sessions in which both the person with aphasia and the speech-language therapist take part. The participants negotiate agreements on the results of therapy. By means of conversation analysis, we study how such agreements...... on therapy outcome are reached interactionally. The sequential analysis of 34 video recordings focuses on a recurrent method for reaching agreements in these outcome evaluation sessions. In and through a special sequence of conversational assessment it is claimed that the person with aphasia has certain...

A framework for outcome-level evaluation of in-service training of health care workers.

Science.gov (United States)

O'Malley, Gabrielle; Perdue, Thomas; Petracca, Frances

2013-10-01

In-service training is a key strategic approach to addressing the severe shortage of health care workers in many countries. However, there is a lack of evidence linking these health care worker trainings to improved health outcomes. In response, the United States President's Emergency Plan for AIDS Relief's Human Resources for Health Technical Working Group initiated a project to develop an outcome-focused training evaluation framework. This paper presents the methods and results of that project. A general inductive methodology was used for the conceptualization and development of the framework. Fifteen key informant interviews were conducted to explore contextual factors, perceived needs, barriers and facilitators affecting the evaluation of training outcomes. In addition, a thematic analysis of 70 published articles reporting health care worker training outcomes identified key themes and categories. These were integrated, synthesized and compared to several existing training evaluation models. This formed an overall typology which was used to draft a new framework. Finally, the framework was refined and validated through an iterative process of feedback, pilot testing and revision. The inductive process resulted in identification of themes and categories, as well as relationships among several levels and types of outcomes. The resulting framework includes nine distinct types of outcomes that can be evaluated, which are organized within three nested levels: individual, organizational and health system/population. The outcome types are: (1) individual knowledge, attitudes and skills; (2) individual performance; (3) individual patient health; (4) organizational systems; (5) organizational performance; (6) organizational-level patient health; (7) health systems; (8) population-level performance; and (9) population-level health. The framework also addresses contextual factors which may influence the outcomes of training, as well as the ability of evaluators to

Viral Infections in Pregnancy: A Focus on Ebola Virus.

Science.gov (United States)

Olgun, Nicole S

2018-01-30

During gestation, the immune response of the placenta to viruses and other pathogens plays an important role in determining a pregnant woman's vulnerability toward infectious diseases. Located at the maternal- fetal interface, trophoblast cells serve to minimize the spread of viruses between the host and developing fetus through an intricate system of innate antiviral immune signaling. Adverse pregnancy outcomes, ranging from learning disabilities to preterm birth and fetal death, are all documented results of a viral breach in the placental barrier. Viral infections during pregnancy can also be spread through blood and vaginal secretions, and during the post-natal period, via breast milk. Thus, even in the absence of vertical transmission of viral infection to the fetus, maternal health can still be compromised and threaten the pregnancy. The most common viral DNA isolates found in gestation are adenovirus, cytomegalovirus, and enterovirus. However, with the recent pandemic of Ebola virus, and the first documented case of a neonate to survive due to experimental therapies in 2017, it is becoming increasingly apparent that the changing roles and impacts of viral infection during pregnancy needs to be better understood, while strategies to minimize adverse pregnancy outcomes need to be identified. This review focuses on the adverse impacts of viral infection during gestation, with an emphasis on Ebola virus. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

Concepts in context: Processing mental state concepts with internal or external focus involves different neural systems

Science.gov (United States)

Oosterwijk, Suzanne; Mackey, Scott; Wilson-Mendenhall, Christine; Winkielman, Piotr; Paulus, Martin P.

2015-01-01

According to embodied cognition theories concepts are contextually-situated and grounded in neural systems that produce experiential states. This view predicts that processing mental state concepts recruits neural regions associated with different aspects of experience depending on the context in which people understand a concept. This neuroimaging study tested this prediction using a set of sentences that described emotional (e.g., fear, joy) and non-emotional (e.g., thinking, hunger) mental states with internal focus (i.e. focusing on bodily sensations and introspection) or external focus (i.e. focusing on expression and action). Consistent with our predictions, data suggested that the inferior frontal gyrus, a region associated with action representation, was engaged more by external than internal sentences. By contrast, the ventromedial prefrontal cortex, a region associated with the generation of internal states, was engaged more by internal emotion sentences than external sentence categories. Similar patterns emerged when we examined the relationship between neural activity and independent ratings of sentence focus. Furthermore, ratings of emotion were associated with activation in the medial prefrontal cortex, whereas ratings of activity were associated with activation in the inferior frontal gyrus. These results suggest that mental state concepts are represented in a dynamic way, using context-relevant interoceptive and sensorimotor resources. PMID:25748274

Assessing the quality of the volume-outcome relationship in uro-oncology.

Science.gov (United States)

Mayer, Erik K; Purkayastha, Sanjay; Athanasiou, Thanos; Darzi, Ara; Vale, Justin A

2009-02-01

To assess systematically the quality of evidence for the volume-outcome relationship in uro-oncology, and thus facilitate the formulating of health policy within this speciality, as 'Implementation of Improving Outcome Guidance' has led to centralization of uro-oncology based on published studies that have supported a 'higher volume-better outcome' relationship, but improved awareness of methodological drawbacks in health service research has questioned the strength of this proposed volume-outcome relationship. We systematically searched previous relevant reports and extracted all articles from 1980 onwards assessing the volume-outcome relationship for cystectomy, prostatectomy and nephrectomy at the institution and/or surgeon level. Studies were assessed for their methodological quality using a previously validated rating system. Where possible, meta-analytical methods were used to calculate overall differences in outcome measures between low and high volume healthcare providers. In all, 22 studies were included in the final analysis; 19 of these were published in the last 5 years. Only four studies appropriately explored the effect of both the institution and surgeon volume on outcome measures. Mortality and length of stay were the most frequently measured outcomes. The median total quality scores within each of the operation types were 8.5, 9 and 8 for cystectomy, prostatectomy and nephrectomy, respectively (possible maximum score 18). Random-effects modelling showed a higher risk of mortality in low-volume institutions than in higher-volume institutions for both cystectomy and nephrectomy (odds ratio 1.88, 95% confidence interval 1.54-2.29, and 1.28, 1.10-1.49, respectively). The methodological quality of volume-outcome research as applied to cystectomy, prostatectomy and nephrectomy is only modest at best. Accepting several limitations, pooled analysis confirms a higher-volume, lower-mortality relationship for cystectomy and nephrectomy. Future research should

Systems of educational specialization and labor market outcomes in Norway, Australia and the Netherlands

NARCIS (Netherlands)

van de Werfhorst, H.G.

2004-01-01

To account for differences between systems of education of highly educated societies, we argue that the impact of academic discipline (field of study) on labor market outcomes should be central. Three modifications of earlier typologies are needed to account for cross-national differences in the

Self-focused Motives Undermine the Emotional Rewards of Recalled Prosocial Behavior

OpenAIRE

Wiwad, Dylan; Aknin, Lara

2017-01-01

Past research has demonstrated that engaging in and reflecting upon past instances of prosocial behavior promote happiness. Yet, people provide help for a myriad of reasons. Do the motives for giving impact its emotional consequences? In three experiments (N > 680), we compared the emotional outcomes of recalling a past instance of prosocial behavior motivated by self-focused and other-focused concerns. Using both between and within subjects designs, we find that recalling an instance of o...

Prospects and Agendas of Korea Energy Policy for the 21st Century - Focused on the Nuclear Administrative system.

Energy Technology Data Exchange (ETDEWEB)

Ahn, Moon Suk [Korean Association for Policy Studies, Seoul (Korea, Republic of); Kim, Tae Young [University of Seoul, Seoul (Korea, Republic of); Lee, Kee Sik; Lee, Sang Pal [Korea University, Seoul (Korea, Republic of); Kang, Kun Bok [ChungNam University, Taejon (Korea, Republic of); Kim, Jong Sun [Defnense Staff Institute, Seoul (Korea, Republic of); Park, Kuk Hum [Ansung University, Ansung (Korea, Republic of)

1997-12-01

It is often said that the 21st century will be an era of harsh competition among countries under the WTO regime. Thus, energy problems might become the very problem of national survival, particularly to those counties like korea which have achieved economic growth through export-oriented policies, but with few energy resources. Recognizing that energy security is one of the demanding problems Korea faces, this study analyzes current and future energy problems, pinpoints policy agendas on which the Korean government has to focus, and suggests alternative administrative systems which can effectively deal with energy problems. In doing so, this study focuses more on nuclear energy and its administrative system. 31 refs., 8 tabs., 6 figs. (author)

Better Policies Accelerate Clean Energy Transition. Policy brief - Focus on energy system flexibility

DEFF Research Database (Denmark)

Karimi, Farid; Lund, Peter; Skytte, Klaus

2018-01-01

The use of variable renewable energy sources will increase in the Nordic and Baltic countries in the future. This will call for increased flexibility in the electricity market to ensure both high energy security and efficient use of renewable power in all circumstances. The barriers and hence also...... policies to energy system flexibility are numerous. In this brief, we focus on policy recommendations for two important barriers to flexibility in the Nordic electricity market, namely insufficient market signals to some stakeholders, and uneven market frameworks for different renewable energy resources...

Immigration Ethnic Diversity and Political Outcomes

DEFF Research Database (Denmark)

Harmon, Nikolaj Arpe

2017-01-01

I study the impact of immigration and increasing ethnic diversity on political outcomes in immigrant-receiving countries, focusing on immigration and election outcomes in Danish municipalities 1981-2001. A rich set of control variables isolates ethnic diversity effects from those of other immigrant...... characteristics and a novel IV strategy based on historical housing stock data addresses issues of endogenous location choices of immigrants. Increases in local ethnic diversity lead to right-ward shifts in election outcomes by shifting electoral support away from traditional "big government" left-wing parties...... and towards anti-immigrant nationalist parties in particular. These effects appear in both local and national elections....

Central nervous system histoplasmosis: Multicenter retrospective study on clinical features, diagnostic approach and outcome of treatment.

Science.gov (United States)

Wheat, Joseph; Myint, Thein; Guo, Ying; Kemmer, Phebe; Hage, Chadi; Terry, Colin; Azar, Marwan M; Riddell, James; Ender, Peter; Chen, Sharon; Shehab, Kareem; Cleveland, Kerry; Esguerra, Eden; Johnson, James; Wright, Patty; Douglas, Vanja; Vergidis, Pascalis; Ooi, Winnie; Baddley, John; Bamberger, David; Khairy, Raed; Vikram, Holenarasipur R; Jenny-Avital, Elizabeth; Sivasubramanian, Geetha; Bowlware, Karen; Pahud, Barbara; Sarria, Juan; Tsai, Townson; Assi, Maha; Mocherla, Satish; Prakash, Vidhya; Allen, David; Passaretti, Catherine; Huprikar, Shirish; Anderson, Albert

2018-03-01

Central nervous system (CNS) involvement occurs in 5 to 10% of individuals with disseminated histoplasmosis. Most experience has been derived from small single center case series, or case report literature reviews. Therefore, a larger study of central nervous system (CNS) histoplasmosis is needed in order to guide the approach to diagnosis, and treatment.A convenience sample of 77 patients with histoplasmosis infection of the CNS was evaluated. Data was collected that focused on recognition of infection, diagnostic techniques, and outcomes of treatment.Twenty nine percent of patients were not immunosuppressed. Histoplasma antigen, or anti-Histoplasma antibodies were detected in the cerebrospinal fluid (CSF) in 75% of patients. One year survival was 75% among patients treated initially with amphotericin B, and was highest with liposomal, or deoxycholate formulations. Mortality was higher in immunocompromised patients, and patients 54 years of age, or older. Six percent of patients relapsed, all of whom had the acquired immunodeficiency syndrome (AIDS), and were poorly adherent with treatment.While CNS histoplasmosis occurred most often in immunocompromised individuals, a significant proportion of patients were previously, healthy. The diagnosis can be established by antigen, and antibody testing of the CSF, and serum, and antigen testing of the urine in most patients. Treatment with liposomal amphotericin B (AMB-L) for at least 1 month; followed by itraconazole for at least 1 year, results in survival among the majority of individuals. Patients should be followed for relapse for at least 1 year, after stopping therapy.

Low-SES Students and College Outcomes: The Role of AP® Fee Reductions. Research Report No. 2011-9

Science.gov (United States)

Wyatt, Jeffrey N.; Mattern, Krista D.

2011-01-01

The College Board offers fee reductions to students based on eligibility for free and reduced-price lunch in an attempt to introduce the benefits of AP® Exam participation to students most at risk in the education system. This report examined college outcomes of low-SES students with a focused investigation comparing students who took an AP Exam…

Effect of adjuvant systemic treatment on cosmetic outcome and late normal-tissue reactions after breast conservation

DEFF Research Database (Denmark)

Johansen, Jørgen; Overgaard, Jens; Overgaard, Marie

2007-01-01

To investigate whether adjuvant treatment with CMF or tamoxifen predisposes to an unfavorable cosmetic outcome or increased breast morbidity after radiotherapy in breast conservation. Data from 266 patients who entered a randomized breast conservation trial (DBCG-82TM protocol) was analyzed......-risk patients: premenopausal patients (n = 67) received eight cycles of CMF intravenously (600/40/600 mg per m(2)) every fourth week; postmenopausal patients (n = 27) received 30 mg of tamoxifen daily for one year. Clinical assessments included cosmetic outcome, breast fibrosis, skin telangiectasia....... In premenopausal patients, systemic treatment with CMF independently predicted a fair/poor cosmetic outcome, RR = 2.2 (95% CI 1.2-4.2), as well as increased skin telangiectasia, RR = 3.3 (1.4-8.2). There was no impact of tamoxifen treatment on cosmetic outcome in postmenopausal patients (p = 0.32). However...

Preparing Teachers to Deliver Gender-Focused Sexuality/HIV Education: A Case Study from Nigeria

Science.gov (United States)

Wood, Susan Y.; Rogow, Deborah; Stines, Frederica

2015-01-01

Evidence shows that a focus on gender and power in sexuality/HIV education increases the likelihood of achieving positive sexual health outcomes, and international agencies have called for a shift to a gender-focused approach. However, questions remain about the implementation of such programmes, including how best to prepare teachers to deliver…

A case study investigation of practices and beliefs of teachers at a STEM-focused elementary school

Science.gov (United States)

Martin, Billy J.

Proponents of STEM education have highlighted the need for increasing STEM skills among students. To address this need, there have been recommendations to create new STEM-focused schools, a majority of which are to be STEM-focused elementary and middle schools. However, STEM school research remains focused on outcomes at the secondary and postsecondary level, with little attention being given to knowing more about the role that elementary education plays in STEM outcomes. Case study design was used to investigate teachers at one STEM-focused elementary school to identify the practices and beliefs reported as important in STEM teaching and learning. Using survey and in-depth interviews, it was found that designation as a STEM-focused school promotes the use of more inquiry-oriented teaching practices and facilitates the use of strategies for developing confidence and competence in STEM among staff and students. The information uncovered in this study could provide leaders of any organization desiring to become a STEM-focused institution information about specific beliefs and practices that have the greatest potential to support changes in teaching.

On Track for Success: The Use of Early Warning Indicator and Intervention Systems to Build a Grad Nation

Science.gov (United States)

Bruce, Mary; Bridgeland, John M.; Fox, Joanna Hornig; Balfanz, Robert

2011-01-01

Over the past decade, schools, districts, and states have become increasingly savvy with data collection and analysis to drive student outcomes. The development and use of Early Warning Indicator and Intervention Systems (EWS) are at the cutting edge of the data- driven, outcomes-focused, high-impact education movement. These systems can increase…

Thermal self-focusing with multiple beams

International Nuclear Information System (INIS)

Craxton, R.S.; McCrory, R.L.

1986-07-01

Self-focusing in underdense plasmas in the presence of overlapping beams is of interest for multibeam laser-irradiation systems. The hydrodynamics/ray-tracing simulation code SAGE is used to model thermal self-focusing in two-dimensional line-focus geometry with beams incident obliquely at different angles. The conjecture that multiple overlapping beams may suppress self-focusing is investigated for parameters appropriate to reactor-sized targets; in particular, the dependence upon intensity, scale length and pulse width is examined. While the full problem is three-dimensional, insight may be gained from two-dimensional simulations

Clinical outcomes of hydronephrosis in patients with systemic lupus erythematosus.

Science.gov (United States)

Hong, Seokchan; Kim, Yong-Gil; Ahn, Soo Min; Bae, Seung-Hyeon; Lim, Doo-Ho; Kim, Jeong Kon; Lee, Chang-Keun; Yoo, Bin

2016-12-01

Hydronephrosis is a rare complication of systemic lupus erythematosus (SLE). Bladder and/or gastrointestinal involvement in SLE are associated with development of hydronephrosis, but the management and treatment outcomes of hydronephrosis are largely unknown. Therefore, we investigated the clinical manifestations and factors associated with the treatment response in patients with SLE complicated by hydronephrosis. A retrospective analysis was performed of all 634 SLE patients who underwent computed tomography and/or ultrasonography between January 1998 and December 2013. We reviewed the clinical characteristics and treatment outcomes of patients with SLE-associated hydronephrosis. Hydronephrosis was identified in 15 patients with SLE complicated by cystitis and/or enteritis. All patients were treated initially with moderate to high doses of corticosteroids. A follow-up imaging study showed that 11 (73.3%) of 15 patients experienced improvements in hydronephrosis, and urinary obstruction was resolved without urological intervention in the majority of these patients (8/11, 72.7%). The four patients who experienced no improvement in hydronephrosis were older than those who responded to treatment (median age [interquartile range]; 43.0 [37.5-53.0] years vs. 28.0 [21.0-38.5] years; P = 0.026). In addition, delayed treatment (≥ 1 month after onset of symptoms) with corticosteroids was more frequently observed in the non-responding patients than in the responding patients (P = 0.011). Our findings suggest that treatment with corticosteroids alone leads to favorable outcomes in patients with SLE-associated hydronephrosis, except when treatment is delayed, particularly in elderly patients. © 2015 Asia Pacific League of Associations for Rheumatology and Wiley Publishing Asia Pty Ltd.

High-Intensity Focused Ultrasound Treatment for Advanced Pancreatic Cancer

Directory of Open Access Journals (Sweden)

Yufeng Zhou

2014-01-01

Full Text Available Pancreatic cancer is under high mortality but has few effective treatment modalities. High-intensity focused ultrasound (HIFU is becoming an emerging approach of noninvasively ablating solid tumor in clinics. A variety of solid tumors have been tried on thousands of patients in the last fifteen years with great success. The principle, mechanism, and clinical outcome of HIFU were introduced first. All 3022 clinical cases of HIFU treatment for the advanced pancreatic cancer alone or in combination with chemotherapy or radiotherapy in 241 published papers were reviewed and summarized for its efficacy, pain relief, clinical benefit rate, survival, Karnofsky performance scale (KPS score, changes in tumor size, occurrence of echogenicity, serum level, diagnostic assessment of outcome, and associated complications. Immune response induced by HIFU ablation may become an effective way of cancer treatment. Comments for a better outcome and current challenges of HIFU technology are also covered.

Patient Care Outcomes: Implications for the Military Health Services Systems

Science.gov (United States)

1991-05-05

regionalization as a data driven decision. There is a growing body of information that supports the use of regionalization.7- 13 Overall, higher volume is...outcomes. American Journal of Hospital Pharmacy, 45, 1376-1378. 59. Epstein, A. M. (1990). The outcomes movement --will it get us where we want to go...Outcome assessment. (1987). New England Journal of Medicine, 317(4), 251-252. 177. Partridge, C. J. (1982). The outcome of physiotherapy and its

Embedding Affective Learning Outcomes in Library Instruction

Directory of Open Access Journals (Sweden)

Ellysa Stern Cahoy

2012-12-01

Full Text Available While information literacy in higher education has long been focused on cognitive learning outcomes, attention must be paid to students’ affective, emotional needs throughout the research process. This article identifies models for embedding affective learning outcomes within information literacy instruction, and provides strategies to help librarians discover, articulate, and address students’ self-efficacy, motivation, emotions and attitudes. Worksheets to assist in creating affective learning outcomes are included to bring structure to an area of learning that is often challenging to articulate and measure. Also included in the article are the results of a recent survey of instruction librarians’ familiarity and inclusion of affective learning outcomes within teaching and learning initiatives.

The development of a preliminary ultrasonographic scoring system for features of hand osteoarthritis.

LENUS (Irish Health Repository)

Keen, H I

2008-05-01

Painful osteoarthritis (OA) of the hand is common and a validated ultrasound (US) scoring system would be valuable for epidemiological and therapeutic outcome studies. US is increasingly used to assess peripheral joints, though most of the US focus in rheumatic diseases has been on rheumatoid arthritis. We aimed to develop a preliminary US hand OA scoring system, initially focusing on relevant pathological features with potentially high reliability.

Study on Differential Algebraic Method of Aberrations up to Arbitrary Order for Combined Electromagnetic Focusing Systems

Institute of Scientific and Technical Information of China (English)

CHENG Min; TANG Tiantong; YAO Zhenhua; ZHU Jingping

2001-01-01

Differential algebraic method is apowerful technique in computer numerical analysisbased on nonstandard analysis and formal series the-ory. It can compute arbitrary high order derivativeswith excellent accuracy. The principle of differentialalgebraic method is applied to calculate high orderaberrations of combined electromagnetic focusing sys-tems. As an example, third-order geometric aberra-tion coefficients of an actual combined electromagneticfocusing system were calculated. The arbitrary highorder aberrations are conveniently calculated by dif-ferential algebraic method and the fifth-order aberra-tion diagrams are given.

Effects of diagnosis-related group payment system on appendectomy outcomes.

Science.gov (United States)

Kim, Tae Hyun; Park, Eun-Cheol; Jang, Sung-In; Jang, Suk-Yong; Lee, Sang Ah; Choi, Jae Woo

2016-12-01

The voluntary diagnosis-related group (DRG) payment system was introduced in 2002. Since July 2013, the Korean government has mandated DRG participation for all hospitals. The main purpose of this study was to examine the effects of mandatory DRG participation on various outcome metrics for appendectomy patients. We collected inpatient DRG data for 280,062 appendectomy patients between 2007 and 2014 using the Health Insurance Review and Assessment database. We examined patient outcome metrics such as length of stay (LOS), total medical cost, spillover, and readmission rate, according to hospital size. As a result of DRG participation, the average LOS for patients decreased (adjusted ratio: 0.83 [large hospitals], 0.83 [small hospitals]; 95% confidence interval [CI]: 0.82-0.84, 0.82-0.84), the total medical costs of patients increased (adjusted ratio: 1.23 [large hospitals], 1.35 [small hospitals]; 95% CI: 1.22-1.24, 1.34-1.36), the spillover of patients increased (adjusted ratio: 2.10 [large hospitals], 2.30 [small hospitals]; 95% CI: 2.03-2.18, 2.16-2.45), and the readmission rates of appendectomy patients decreased (adjusted ratio: 0.85 [large hospitals], 0.49 [small hospitals]; 95% CI: 0.77-0.94, 0.42-0.57). The mandatory implementation of the DRG payment system in South Korea has led to significant reductions in LOS and readmission rates for appendectomy patients. However, any resulting expansion of outpatient services may result in unnecessary resource usage rather than improving medical quality. Policy makers should consider the various implications reflected by these results when considering DRGs for other diseases. Copyright © 2016 Elsevier Inc. All rights reserved.

Comparison of focused cognitive training and portable "brain-games" on functional outcomes for vocational rehabilitation participants.

Science.gov (United States)

Bell, Morris D; Laws, Holly; Pittman, Brian; Johannesen, Jason K

2018-01-29

Cognitive remediation performed in a cognitive laboratory was compared with a sham control using portable brain games to study effects on vocational, neurocognitive, and functional outcomes for participants with psychotic disorders in vocational rehabilitation (VR). Seventy-seven participants (61% schizophrenia, 39% other psychosis) in transitional (45.5%) or supported employment (54.5%) were randomly assigned to 6 months of portable cognitive-games (CG) or cognitive remediation (CR) plus a weekly goal-setting group, and evaluated during training, post-training and at 12 months. Overall rates of employment did not differ significantly at 12-month follow-up; however, VR + CG attained employment more rapidly during training. A significant time by condition interaction favored VR + CR on Quality of Life Total Score and Instrumental Functioning over 12 months. Neurocognitive outcomes favored VR + CR, particularly on attention. Training hours related significantly to neurocognitive improvement regardless of condition. No differences were found in training adherence despite portability for VR + CG. Results indicate that VR + CR had significantly greater effect than VR + CG on neurocognition and community functioning, but not on employment outcome. Job attainment rates during the training period revealed a potential advantage for portable training raising new questions concerning how cognitive remediation can be most effectively integrated with VR.

Workload and surgeon's specialty for outcome after colorectal cancer surgery

DEFF Research Database (Denmark)

Archampong, David; Borowski, David; Wille-Jørgensen, Peer

2012-01-01

A large body of research has focused on investigating the effects of healthcare provider volume and specialization on patient outcomes including outcomes of colorectal cancer surgery. However there is conflicting evidence about the role of such healthcare provider characteristics in the management...

Drug delivery from the oral cavity: a focus on mucoadhesive buccal drug delivery systems.

Science.gov (United States)

Shinkar, Dattatraya Manohar; Dhake, Avinash Sridhar; Setty, Chitral Mallikarjuna

2012-01-01

Since the early 1980s the concept of mucoadhesion has gained considerable interest in pharmaceutical technology. The various advantages associated with these systems made buccal drug delivery as a novel route of drug administration. It prolongs the residence time of the dosage form at the site of application. These systems remain in close contact with the absorption tissue, the mucous membrane, and thus contribute to improved and/or better therapeutic performance of the drug and of both local and systemic effects. This review highlights the anatomy and structure of oral mucosa, mechanism and theories of mucoadhesion, factors affecting mucoadhesion, characteristics and properties of desired mucoadhesive polymers, various types of dosage forms, and general considerations in design of mucoadhesive buccal dosage forms, permeation enhancers, and evaluation methods. Over the past few decades the mucoadhesive buccal drug delivery system has received a great deal of attention to develop mucoadhesive dosage forms to enable the prolonged retention at the site of action, providing a controlled release of drug for improved therapeutic outcome. Mucoadhesive drug delivery gives facility to include a permeation enhancer/enzyme inhibitor or pHmodifier in the formulation and versatility in designing as multidirectional or unidirectional release systems for local and systemic action. Local delivery to tissues of the oral cavity has a number of applications, including treatment of local conditions such as periodontal disease, bacterial and fungal infections, and aphthous stomatitis and vesiculo bullous diseases. For the treatment of chronic diseases, the mucoadhesive buccal drug delivery system allows easily accessibility and is generally well-accepted for administeringdrugs by systemic action.

Modified Early Warning System improves patient safety and clinical outcomes in an academic community hospital

Directory of Open Access Journals (Sweden)

Chirag Mathukia

2015-04-01

Full Text Available Background and objective: Severe adverse events such as cardiac arrest and death are often heralded by abnormal vital signs hours before the event. This necessitates an organized track and trigger approach of early recognition and response to subtle changes in a patient's condition. The Modified Early Warning System (MEWS is one of such systems that use temperature, blood pressure, pulse, respiratory rate, and level of consciousness with each progressive higher score triggering an action. Root cause analysis for mortalities in our institute has led to the implementation of MEWS in an effort to improve patient outcomes. Here we discuss our experience and the impact of MEWS implementation on patient care at our community academic hospital. Methods: MEWS was implemented in a protocolized manner in June 2013. The following data were collected from non-ICU wards on a monthly basis from January 2010 to June 2014: 1 number of rapid response teams (RRTs per 100 patient-days (100PD; 2 number of cardiopulmonary arrests ‘Code Blue’ per 100PD; and 3 result of each RRT and Code Blue (RRT progressed to Code Blue, higher level of care, ICU transfer, etc.. Overall inpatient mortality data were also analyzed. Results: Since the implementation of MEWS, the number of RRT has increased from 0.24 per 100PD in 2011 to 0.38 per 100PD in 2013, and 0.48 per 100PD in 2014. The percentage of RRTs that progressed to Code Blue, an indicator of poor outcome of RRT, has been decreasing. In contrast, the numbers of Code Blue in non-ICU floors has been progressively decreasing from 0.05 per 100PD in 2011 to 0.02 per 100PD in 2013 and 2014. These improved clinical outcomes are associated with a decline of overall inpatient mortality rate from 2.3% in 2011 to 1.5% in 2013 and 1.2% in 2014. Conclusions: Implementation of MEWS in our institute has led to higher rapid response system utilization but lower cardiopulmonary arrest events; this is associated with a lower mortality

Superconducting quadrupoles for the SLC final focus

International Nuclear Information System (INIS)

Erickson, R.; Fieguth, T.; Murray, J.J.

1987-01-01

The final focus system of the SLC will be upgraded by replacing the final quadrupoles with higher gradient superconducting magnets positioned closer to the interaction point. The parameters of the new system have been chosen to be compatible with the experimental detectors with a minimum of changes to other final focus components. These parameter choices are discussed along with the expected improvement in SLC performance

Superconducting quadrupoles for the SLC final focus

International Nuclear Information System (INIS)

Erickson, R.; Fieguth, T.; Murray, J.J.

1987-01-01

The final focus system of the SLC will be upgraded by replacing the final quadrupoles with higher gradient supperconducting magnets positioned closer to the interaction point. The parameters of the new system have been chosen to be compatible with the experimental detectors with a minimum of changes to other final focus components. These parameter choices are discussed along with the expected improvement in SLC performance

Organizational change, patient-focused care: an Australian perspective.

Science.gov (United States)

Braithwaite, J

1995-08-01

Hospitals throughout the world are attempting to improve organizational performance through a variety of means. The focus in this paper is on a leading teaching hospital in Australia for a review of current management strategy. In a time of shrinking resources, management adopted a multi-faceted change management program including restructuring the organization, becoming more patient-focused via a product-line management approach and emphasising efficiency and cost-reduction measures. The next stage in management thinking is to place greater emphasis on patient-focused care. It is concluded this has the propensity to yield substantial further benefits, including improved financial and quality of care outcomes, in the Australian as well as the British and wider Organization for Economic Co-operation and Development (OECD) context. 'Professionally, we have committed ourselves to creating caring environments that promote healing. We cannot meet this goal until we make a commitment to be patient-focused and give up being nurse-focused or facility-focused' (Kerfort and LeClair, 1991). 'In a customer-driven [organization], the distribution of roles is different. The organization is decentralized, with responsibility delegated to those who until now have comprised the order-obeying bottom level of the pyramid. The traditional, hierarchical corporate structure, in other words, is beginning to give way to a flattened, more horizontal structure' (Carlzon, 1987).

Outdoor performance analysis of a 1090× point-focus Fresnel high concentrator photovoltaic/thermal system with triple-junction solar cells

International Nuclear Information System (INIS)

Xu, Ning; Ji, Jie; Sun, Wei; Han, Lisheng; Chen, Haifei; Jin, Zhuling

2015-01-01

Graphical abstract: A high concentrator photovoltaic/thermal (HCPV/T) system based on point-focus Fresnel lens has been set up in this work. The concentrator has a geometric concentration ratio of 1090× and uniform irradiation distribution can be obtained on solar cells. The system produces both electricity and heat. Performance of the system has been investigated based on the outdoor measurement in a clear day. The HCPV/T system presents an instantaneous electrical efficiency of 28% and a highest instantaneous thermal efficiency of 54%, respectively. Experimental results show that direct irradiation affects the electrical performance of the system dominantly. Fitting results of electrical performance offer simple and reliable methods to analyze the system performance. - Highlights: • A point-focus Fresnel lens photovoltaic/thermal system is proposed and studied. • The system presents an instantaneous electrical efficiency of 28%. • The system has a highest instantaneous thermal efficiency of 54%. • Direct irradiation has the dominant effect on the electrical performance. • Fitting results offer simple and reliable methods to analyze system performances. - Abstract: A high concentrator photovoltaic/thermal (HCPV/T) system based on point-focus Fresnel lens has been set up in this work. The concentrator has a geometric concentration ratio of 1090× and uniform irradiation distribution can be obtained on solar cells. The system produces both electricity and heat. Performance of the system has been investigated based on the outdoor measurement in a clear day. The HCPV/T system presents an instantaneous electrical efficiency of 28% and a highest instantaneous thermal efficiency of 54%, which means the overall efficiency of the system can be more than 80%. A mathematical model for calculating cell temperature is proposed to solve difficult measurement of cell temperature in a system. Moreover, characteristics of electrical performance under various direct

The Immune System Bridges the Gut Microbiota with Systemic Energy Homeostasis: Focus on TLRs, Mucosal Barrier, and SCFAs.

Science.gov (United States)

Spiljar, Martina; Merkler, Doron; Trajkovski, Mirko

2017-01-01

The gut microbiota is essential for the development and regulation of the immune system and the metabolism of the host. Germ-free animals have altered immunity with increased susceptibility to immunologic diseases and show metabolic alterations. Here, we focus on two of the major immune-mediated microbiota-influenced components that signal far beyond their local environment. First, the activation or suppression of the toll-like receptors (TLRs) by microbial signals can dictate the tone of the immune response, and they are implicated in regulation of the energy homeostasis. Second, we discuss the intestinal mucosal surface is an immunologic component that protects the host from pathogenic invasion, is tightly regulated with regard to its permeability and can influence the systemic energy balance. The short chain fatty acids are a group of molecules that can both modulate the intestinal barrier and escape the gut to influence systemic health. As modulators of the immune response, the microbiota-derived signals influence functions of distant organs and can change susceptibility to metabolic diseases.

Validation of birth outcomes from the Society for Assisted Reproductive Technology Clinic Outcome Reporting System (SART CORS): population-based analysis from the Massachusetts Outcome Study of Assisted Reproductive Technology (MOSART).

Science.gov (United States)

Stern, Judy E; Gopal, Daksha; Liberman, Rebecca F; Anderka, Marlene; Kotelchuck, Milton; Luke, Barbara

2016-09-01

To assess the validity of outcome data reported to the Society for Assisted Reproductive Technology Clinic Outcome Reporting System (SART CORS) compared with data from vital records and the birth defects registry in Massachusetts. Longitudinal cohort. Not applicable. A total of 342,035 live births and fetal deaths from Massachusetts mothers giving birth in the state from July 1, 2004, to December 31, 2008; 9,092 births and fetal deaths were from mothers who had conceived with the use of assisted reproductive technology (ART) and whose cycle data had been reported to the SART CORS. Not applicable. Percentage agreement between maternal race and ethnicity, delivery outcome (live birth or fetal death), plurality (singleton, twin, or triplet+), delivery date, and singleton birth weight reported in the SART CORS versus vital records; sensitivity and specificity for birth defects among singletons as reported in the SART CORS versus the Massachusetts Birth Defects Monitoring Program (BDMP). There was >95% agreement between the SART CORS and vital records for fields of maternal race/ethnicity, live birth/fetal death, and plurality; birth outcome date was within 1 day with 94.9% agreement and birth weight was within 100 g with 89.6% agreement. In contrast, sensitivity for report of any birth defect was 38.6%, with a range of 18.4%-50.0%, for specific birth defect categories. Although most SART CORS outcome fields are accurately reported, birth defect variables showed poor sensitivity compared with the gold standard data from the BDMP. We suggest that reporting of birth defects be discontinued. Copyright © 2016 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

Scanner focus metrology and control system for advanced 10nm logic node

Science.gov (United States)

Oh, Junghun; Maeng, Kwang-Seok; Shin, Jae-Hyung; Choi, Won-Woong; Won, Sung-Keun; Grouwstra, Cedric; El Kodadi, Mohamed; Heil, Stephan; van der Meijden, Vidar; Hong, Jong Kyun; Kim, Sang-Jin; Kwon, Oh-Sung

2018-03-01

Immersion lithography is being extended beyond the 10-nm node and the lithography performance requirement needs to be tightened further to ensure good yield. Amongst others, good on-product focus control with accurate and dense metrology measurements is essential to enable this. In this paper, we will present new solutions that enable onproduct focus monitoring and control (mean and uniformity) suitable for high volume manufacturing environment. We will introduce the concept of pure focus and its role in focus control through the imaging optimizer scanner correction interface. The results will show that the focus uniformity can be improved by up to 25%.

Workload and surgeon's specialty for outcome after colorectal cancer surgery

DEFF Research Database (Denmark)

Archampong, David; Borowski, David; Wille-Jørgensen, Peer

2012-01-01

A large body of research has focused on investigating the effects of healthcare provider volume and specialization on patient outcomes including outcomes of colorectal cancer surgery. However there is conflicting evidence about the role of such healthcare provider characteristics in the management...... of colorectal cancer....

"AfterZone:" Outcomes for Youth Participating in Providence's Citywide After-School System. Executive Summary

Science.gov (United States)

Kauh, Tina J.

2011-01-01

This executive summary highlights the main findings from our participation and outcomes analysis of the "AfterZone" initiative--a citywide system-building effort in Providence, Rhode Island, that aims to provide high-quality, accessible out-of-school-time services to middle school youth. The summary briefly defines the AfterZone's unique…

Sacral Nerve Stimulation for Constipation: Suboptimal Outcome and Adverse Events

DEFF Research Database (Denmark)

Maeda, Yasuko; Lundby, Lilli; Buntzen, Steen

2010-01-01

Sacral nerve stimulation is an emerging treatment for patients with severe constipation. There has been no substantial report to date on suboptimal outcomes and complications. We report our experience of more than 6 years by focusing on incidents and the management of reportable events.......Sacral nerve stimulation is an emerging treatment for patients with severe constipation. There has been no substantial report to date on suboptimal outcomes and complications. We report our experience of more than 6 years by focusing on incidents and the management of reportable events....

Trust dynamics in a large system implementation

DEFF Research Database (Denmark)

Schlichter, Bjarne Rerup; Rose, Jeremy

2013-01-01

outcomes, but largely ignored the dynamics of trust relations. Giddens, as part of his study of modernity, theorises trust dynamics in relation to abstract social systems, though without focusing on information systems. We use Giddens’ concepts to investigate evolving trust relationships in a longitudinal......A large information systems implementation (such as Enterprise Resource Planning systems) relies on the trust of its stakeholders to succeed. Such projects impact diverse groups of stakeholders, each with their legitimate interests and expectations. Levels of stakeholder trust can be expected...... case analysis of a large Integrated Hospital System implementation for the Faroe Islands. Trust relationships suffered a serious breakdown, but the project was able to recover and meet its goals. We develop six theoretical propositions theorising the relationship between trust and project outcomes...

Maternal employment and birth outcomes

DEFF Research Database (Denmark)

Wüst, Miriam

selection of mothers between pregnancies drives the results, I focus on mothers whose change in employment status is likely not to be driven by underlying health (unemployed mothers and students). Given generous welfare bene ts and strict workplace regulations in Denmark, my findings support a residual......I use Danish survey and administrative data to examine the impact of maternal employment during pregnancy on birth outcomes. As healthier mothers are more likely to work and health shocks to mothers may impact employment and birth outcomes, I combine two strategies: First, I control extensively...... for time-varying factors that may correlate with employment and birth outcomes, such as pre-pregnancy family income and maternal occupation, pregnancy-related health shocks, maternal sick listing, and health behaviors (smoking and alcohol consumption). Second, to account for remaining time...

Project (inverted exclamation mark)EXITO!: success through diversity and universality for outcomes improvement among Hispanic home care patients.

Science.gov (United States)

Woerner, Louise; Espinosa, Javier; Bourne, Susan; O'Toole, Marie; Ingersoll, Gail L

2009-01-01

The National Health Disparities Report notes that Hispanics have poorer quality of care in 23 of 38 core measures. The result of this disparity is great personal and health system costs, which could be reduced. Prior studies have focused on access and language. We studied outcomes improvement. The purpose of this project was to develop a replicable theory-based outcomes improvement model for delivery of nursing care to Hispanic patients. The Leininger Sunrise Enabler approach was used to design a program specific to the cultural needs of a home care population. Outcome and Assessment Information Set (OASIS) data from 125 unduplicated home care patients were tracked. Nursing care delivery was analyzed using ethnographic research techniques. Delivery of nursing care using a culturally congruent approach reduced acute hospitalization and emergent care visits. Medication management and customer and nursing satisfaction also improved. National standards for culturally and linguistically appropriate services in health care help reduce healthcare disparities, but improving Hispanic outcomes requires moving beyond symptoms and symptom management to transcultural care. The estimated savings to the health care system are significant.

The impact of high performance work systems in Irish companies: an examination of company and employee outcomes

OpenAIRE

Mkamwa, Thadeus F.

2010-01-01

This study examines the impact of High Performance Work Systems (HPWS) on company and employee-level performance outcomes. At the company level, the study examines the outcomes of HPWS usage on innovation, productivity and turnover. The study uses data collected from 132 companies in Ireland who participated in a general manager (GM) and human resource (HR) manager survey conducted in 2006. This study shows that an extensive application ...

Impact of collateral circulation on early outcome and risk of hemorrhagic complications after systemic thrombolysis.

Science.gov (United States)

Brunner, Freimuth; Tomandl, Bernd; Hanken, Katrin; Hildebrandt, Helmut; Kastrup, Andreas

2014-12-01

In stroke patients, collateral flow can rapidly be assessed on computed tomography angiography (CTA). In this study, the impact of baseline collaterals on early outcome and risk of symptomatic intracerebral hemorrhages after systemic thrombolysis in patients with proximal arterial occlusions within the anterior circulation were analyzed. Collateralization scores were determined on the CT angiography source images (0 = absent; 1 ≤ 50%, 2 > 50% but collateral filling) of patients with distal intracranial carotid artery and/or M1 segment occlusions treated from 2008 to December 2011. A collateral score of 0 to 1 was designated as poor and 2 to 3 as good collateral vessel status. Outcome variables included in hospital mortality, favorable outcome at discharge (modified Rankin score ≤ 2), and rates of symptomatic intracerebral hemorrhage based on the European-Australasian Acute Stroke Study II definition. Among 246 subjects (mean age of 74 years; median National Institutes of Health Stroke Scale N at admission 14), 205 patients (83%) had good collaterals, whereas 41 patients (17%) had poor collaterals, respectively. Patients with poor collaterals had significantly higher rates of in-hospital mortality (41% vs. 12%, P collaterals. The grade of collateralization was independently associated with in-hospital mortality (P collaterals have a poor early functional outcome and high rates of symptomatic intracerebral hemorrhage after systemic thrombolysis. Since similar findings have also been reported after endovascular therapy, strategies to improve collateral blood flow should be assessed in this patient population. © 2012 The Authors. International Journal of Stroke © 2012 World Stroke Organization.

Can a science-based definition of acupuncture improve clinical outcomes?

Science.gov (United States)

Priebe, Ted; Stumpf, Steven H; Zalunardo, Rod

2017-05-01

Research on acupuncture has been muddled by attempts to bridge the ancient with the modern. Barriers to effectiveness research are reflected in recurring conflicts that include disagreement on use of the most basic terms, lack of standard intervention controls, and the absence of functional measures for assessing treatment effect. Acupuncture research has stalled at the "placebo barrier" wherein acupuncture is "no better than placebo." The most widely recognized comparative effectiveness research in acupuncture does not compare acupuncture treatment protocols within groups, thereby, mutating large scale effectiveness studies into large scale efficacy trials. Too often research in acupuncture attempts to tie outcomes to traditional belief systems thereby limiting usefulness of the research. The acupuncture research paradigm needs to focus more closely on a scientific definition of treatments and outcomes that compare protocols in terms of prevalent clinical issues such as relative effectiveness for treating pain.

Auras in temporal lobe epilepsy with hippocampal sclerosis: relation to seizure focus laterality and post surgical outcome.

Science.gov (United States)

Ferrari-Marinho, Taíssa; Caboclo, Luís Otávio S F; Marinho, Murilo M; Centeno, Ricardo S; Neves, Rafael S C; Santana, Maria Teresa C G; Brito, Fernanda S; Junior, Henrique Carrete; Yacubian, Elza Márcia T

2012-05-01

We examined the relationship between presence and frequency of different types of auras and side of lesion and post surgical outcomes in 205 patients with medically intractable mesial temporal lobe epilepsy (MTLE) with unilateral hippocampal sclerosis (HS). With respect to the number of auras, multiple auras were not associated with side of lesion (p=0.551). The side of HS was not associated with the type of auras reported. One hundred fifty-seven patients were operated. The occurrence of multiple auras was not associated with post-surgical outcome (p=0.740). The presence of extratemporal auras was significantly higher in patients with poor outcome. In conclusion, this study suggests that the presence of extratemporal auras in patients with MTLE-HS possibly reflects extratemporal epileptogenicity in these patients, who otherwise showed features suggestive of TLE. Therefore, TLE-HS patients undergoing pre-surgical evaluation and presenting clinical symptoms suggestive of extratemporal involvement should be more extensively evaluated to avoid incomplete resection of the epileptogenic zone. Copyright © 2012 Elsevier Inc. All rights reserved.

Solution-Focused Self-Help for Improving University Students' Well-Being

Science.gov (United States)

Pakrosnis, Rytis; Cepukiene, Viktorija

2015-01-01

Along with positive developments in psychology, the self-help movement is becoming widespread, based on the belief that people are capable of growing and achieving positive change with only minimal help. This article addresses the potential of a solution-focused self-help tool to improve university students' well-being by comparing its outcome to…

A commercial outcome prediction system for university technology transfer using neural networks

OpenAIRE

Chu, Ling

2007-01-01

This thesis was submitted for the degree of Doctor of Philosophy and awarded by Brunel University, 26/03/2007. This thesis presents a commercial outcome prediction system (CPS) capable of predicting the likely future monetary return that would be generated by an invention. The CPS is designed to be used by university technology transfer offices for invention assessment purposes, and is based on the data from their historical invention cases. It is aimed at improving technology transfer off...

Social-ecological outcomes in recreational fisheries: the interaction of lakeshore development and stocking.

Science.gov (United States)

Ziegler, Jacob P; Golebie, Elizabeth J; Jones, Stuart E; Weidel, Brian C; Solomon, Christopher T

2017-01-01

Many ecosystems continue to experience rapid transformations due to processes like land use change and resource extraction. A systems approach to maintaining natural resources focuses on how interactions and feedbacks among components of complex social-ecological systems generate social and ecological outcomes. In recreational fisheries, residential shoreline development and fish stocking are two widespread human behaviors that influence fisheries, yet emergent social-ecological outcomes from these potentially interacting behaviors remain under explored. We applied a social-ecological systems framework using a simulation model and empirical data to determine whether lakeshore development is likely to promote stocking through its adverse effects on coarse woody habitat and thereby also on survival of juvenile and adult fish. We demonstrate that high lakeshore development is likely to generate dependency of the ecosystem on the social system, in the form of stocking. Further, lakeshore development can interact with social-ecological processes to create deficits for state-level governments, which threatens the ability to fund further ecosystem subsidies. Our results highlight the value of a social-ecological framework for maintaining ecosystem services like recreational fisheries. © 2016 by the Ecological Society of America.

Radiation damage and waste management options for the sombrero final focus system and neutron dumps

International Nuclear Information System (INIS)

Reyes, S.; Latkowski, J.F.; Meier, W.R.; Reyes, S.

2000-01-01

Previous studies of the safety and environmental aspects of the SOMBRERO inertial fusion energy (IFE) power plant design did not completely address the issues associated with the final focus system. While past work calculated neutron fluences for a grazing incidence metal mirror (GIMM) and a final focus mirror, scattering off of the final optical component was not included, and thus, fluences in the final focus mirror were significantly underestimated. In addition, past work did not consider neutron-induced gamma-rays. Finally, power plant lifetime waste volumes may have been underestimated as neutron activation of the neutron dumps and building structure were not addressed. In the present work, a modified version of the SOMBRERO target building is presented where a significantly larger open solid-angle fraction (5%) is used to enhance beam smoothing of a diode-pumped solid-state laser (DPSSL). The GIMMs are replaced with transmissive fused silica wedges and have been included in three-dimensional neutron and photon transport calculations. This work shows that a power plant with a large open solid-angle fraction, needed for beam smoothing with a DPSSL, is acceptable from tritium breeding, and neutron activation points-of-view. (authors)

Dissociable brain systems mediate vicarious learning of stimulus-response and action-outcome contingencies.

Science.gov (United States)

Liljeholm, Mimi; Molloy, Ciara J; O'Doherty, John P

2012-07-18

Two distinct strategies have been suggested to support action selection in humans and other animals on the basis of experiential learning: a goal-directed strategy that generates decisions based on the value and causal antecedents of action outcomes, and a habitual strategy that relies on the automatic elicitation of actions by environmental stimuli. In the present study, we investigated whether a similar dichotomy exists for actions that are acquired vicariously, through observation of other individuals rather than through direct experience, and assessed whether these strategies are mediated by distinct brain regions. We scanned participants with functional magnetic resonance imaging while they performed an observational learning task designed to encourage either goal-directed encoding of the consequences of observed actions, or a mapping of observed actions to conditional discriminative cues. Activity in different parts of the action observation network discriminated between the two conditions during observational learning and correlated with the degree of insensitivity to outcome devaluation in subsequent performance. Our findings suggest that, in striking parallel to experiential learning, neural systems mediating the observational acquisition of actions may be dissociated into distinct components: a goal-directed, outcome-sensitive component and a less flexible stimulus-response component.

Socioeconomic status can affect pregnancy outcomes and complications, even with a universal healthcare system.

Science.gov (United States)

Kim, Min Kyoung; Lee, Seung Mi; Bae, Sung-Hee; Kim, Hyun Joo; Lim, Nam Gu; Yoon, Seok-Jun; Lee, Jin Yong; Jo, Min-Woo

2018-01-05

Low socioeconomic status can increase the risk of adverse pregnancy outcomes, but it remains unclear whether this negative association is attributed to inadequate prenatal care. Korea has been adopting a universal healthcare system. All Korean citizens must be enrolled National Health Insurance (NHI) or be recipient of Medical Aid (MA). In addition, Korean government launched a financial support system for antenatal care for all pregnant women in 2008. Therefore, in theory, there is no financial barrier to receive prenatal cares regardless of someone's social class. However, it is still unclear whether adverse pregnancy outcomes observed in low-income women are attributable to low SES or to economic barriers specific to the utilization of medical services. The purpose of this study was to investigate whether socioeconomic status affects pregnancy outcomes after the introduction of this support system, which allows all pregnant women to receive adequate prenatal care regardless of socioeconomic status. Using the National Health Insurance database in Korea, we selected women who gave birth between January 1, 2010 and December 31, 2010. As a proxy indicator reflecting socioeconomic status, we classified subjects as MA recipient ("low" SES) or a NHI beneficiary ("middle/high" SES). In the MA group, 29.4% women received inadequate prenatal care, compared to 11.4% in the NHI group. Mothers in the MA group were more likely to have an abortion (30.1%), rather than deliver a baby, than those in the NHI group (20.7%, P < 0.001). Mothers in the MA group were also more likely to undergo a Caesarean delivery (45.8%; NHI group: 39.6%, P < 0.001), and have preeclampsia (1.5%; NHI group: 0.6%, P < 0.001), obstetric hemorrhage (4.7%; NHI group: 3.9%, P = 0.017), and a preterm delivery (2.1%; NHI group: 1.4%, P < 0.001) than those in the NHI group. Women in the MA group tended to show higher rates of abortion, Caesarean delivery, preeclampsia, preterm delivery

Technology and outcomes assessment in lung transplantation.

Science.gov (United States)

Yusen, Roger D

2009-01-15

Lung transplantation offers the hope of prolonged survival and significant improvement in quality of life to patients that have advanced lung diseases. However, the medical literature lacks strong positive evidence and shows conflicting information regarding survival and quality of life outcomes related to lung transplantation. Decisions about the use of lung transplantation require an assessment of trade-offs: do the potential health and quality of life benefits outweigh the potential risks and harms? No amount of theoretical reasoning can resolve this question; empiric data are needed. Rational analyses of these trade-offs require valid measurements of the benefits and harms to the patients in all relevant domains that affect survival and quality of life. Lung transplant systems and registries mainly focus outcomes assessment on patient survival on the waiting list and after transplantation. Improved analytic approaches allow comparisons of the survival effects of lung transplantation versus continued waiting. Lung transplant entities do not routinely collect quality of life data. However, the medical community and the public want to know how lung transplantation affects quality of life. Given the huge stakes for the patients, the providers, and the healthcare systems, key stakeholders need to further support quality of life assessment in patients with advanced lung disease that enter into the lung transplant systems. Studies of lung transplantation and its related technologies should assess patients with tools that integrate both survival and quality of life information. Higher quality information obtained will lead to improved knowledge and more informed decision making.

Prospective study of Centurion® versus Infiniti® phacoemulsification systems: surgical and visual outcomes.

Science.gov (United States)

Oh, Lawrence J; Nguyen, Chu Luan; Wong, Eugene; Wang, Samuel S Y; Francis, Ian C

2017-01-01

To evaluate surgical outcomes (SOs) and visual outcomes (VOs) in cataract surgery comparing the Centurion ® phacoemulsification system (CPS) with the Infiniti ® phacoemulsification system (IPS). Prospective, consecutive study in a single-site private practice. Totally 412 patients undergoing cataract surgery with either the CPS using the 30-degree balanced ® tip ( n =207) or the IPS using the 30-degree Kelman ® tip ( n =205). Intraoperative and postoperative outcomes were documented prospectively up to one month follow-up. Nuclear sclerosis (NS) grade, cumulated dissipated energy (CDE), preoperative corrected distance visual acuity (CDVA), and CDVA at one month were recorded. CDE was 13.50% less in the whole CPS compared with the whole IPS subcohort. In eyes with NS grade III or greater, CDE was 28.87% less with CPS ( n =70) compared with IPS ( n =44) ( P =0.010). Surgical complications were not statistically different between the two subcohorts ( P =0.083), but in the one case of vitreous loss using the CPS, CDVA of 6/4 was achieved at one month. The mean CDVAs (VOs) at one month for NS grade III and above cataracts were -0.17 logMAR (6/4.5) in the CPS and -0.15 logMAR (6/4.5) in the IPS subcohort respectively ( P =0.033). CDE is 28.87% less, and VOs are significantly improved, in denser cataracts in the CPS compared with the IPS. The authors recommend the CPS for cases with denser nuclei.

SINGLE-CASE INVESTIGATION OF AN EMOTION-FOCUSED THERAPY GROUP FOR ANXIETY AND DEPRESSION

Directory of Open Access Journals (Sweden)

Adèle Lafrance Robinson

2012-11-01

Full Text Available Emotion-focused therapy (EFT is an evidence-based treatment for depression and trauma and has shown promise for other presentations including anxiety. Minimal research exists investigating the outcomes of emotion-focused therapy in a group setting. The current research presents a mixed-method single-case study of one client’s experiences and outcomes following a nine-week EFT group for depression and anxiety. Weekly measures of session-feelings evaluations were collected. Follow-up measures, including a qualitative interview, were administered one year post-treatment. Pre-, post-, and follow-up measures assessed depression, anxiety, and emotional regulation. Results showed clinically significant improvements in anxiety, depression, and emotional regulation over time. Indirect and direct evidence of client change were detected. Five super-ordinate themes with sub-themes emerged from the qualitative analysis.

Microcoaxial cataract surgery outcomes: comparison of 1.8 mm system and 2.2 mm system.

Science.gov (United States)

Lee, Kyung-Min; Kwon, Hyung-Goo; Joo, Choun-Ki

2009-05-01

To compare clinical outcomes of a 1.8 mm and a 2.2 mm microcoaxial cataract surgery system. Department of Ophthalmology and Visual Science, Kangnam St. Mary's Hospital, College of Medicine, Catholic University of Korea, Seoul, Korea. In a prospective study, eyes were randomly selected to have phacoemulsification using a Stellaris system or an Intrepid Infiniti system. The initial incision size was 1.8 mm and 2.2 mm, respectively. Measured intraoperative parameters included phacoemulsification time, mean cumulative dissipated ultrasound energy (CDE), change in incision size at each step of surgery, and total volume of balanced salt solution (BSS) used. The best corrected visual acuity (BCVA), corneal astigmatism, corneal thickness, and endothelial cell count were evaluated preoperatively and postoperatively. The study evaluated 86 eyes of 78 patients (43 eyes in each group). There were no significant differences in postoperative BCVA, surgically induced astigmatism, or amount of BSS used between the 2 systems (P >.05). However, for high-density cataracts, the 1.8 mm group had a greater change between the initial incision size and the incision size after phacoemulsification (P = .019, nuclear opalescence [NO] NO3; P = .001, NO4), a longer phacoemulsification time (P = .013, NO3), greater mean CDE (P = .005, NO3; P = .001, NO4), and greater corneal endothelial cell loss (P = .003, NO4). Both systems were safe and effective in microcoaxial phacoemulsification. The 1.8 mm system performed better with cortical-type cataract and the 2.2 mm system, with high-density nuclear-type cataract.

Misery loves company: team dissonance and the influence of supervisor-focused interpersonal justice climate on team cohesiveness.

Science.gov (United States)

Stoverink, Adam C; Umphress, Elizabeth E; Gardner, Richard G; Miner, Kathi N

2014-11-01

The organizational justice literature has examined the effects of supervisor-focused interpersonal justice climate, or a team's shared perception of the dignity and respect it receives from its supervisor, on a number of important outcomes directed at organizational authorities. Considerably less is known about the potential influence of these shared perceptions on coworker-directed outcomes. In 2 experiments, we predict that a low (unfair) supervisor-focused interpersonal justice climate generates greater team cohesiveness than a high (fair) supervisor-focused interpersonal justice climate. We further examine the process through which this effect occurs. Drawing from cognitive dissonance theory, we predict that low (vs. high) supervisor-focused interpersonal justice climate generates greater team dissonance, or shared psychological discomfort, for team members and that this dissonance serves as an underlying mechanism through which supervisor-focused interpersonal justice climate influences a team's cohesiveness. Our results demonstrate support for these predictions in that low supervisor-focused interpersonal justice climate led to higher levels of both team dissonance and team cohesiveness than did high supervisor-focused interpersonal justice climate, and team dissonance mediated this relationship. Implications and areas for future research are discussed. (PsycINFO Database Record (c) 2014 APA, all rights reserved).

Development of a High Intensity Focused Ultrasound (HIFU) Hydrophone System

International Nuclear Information System (INIS)

Schafer, Mark E.; Gessert, James

2009-01-01

The growing clinical use of High Intensity Focused Ultrasound (HIFU) has driven a need for reliable, reproducible measurements of HIFU acoustic fields. We have previously presented data on a reflective scatterer approach, incorporating several novel features for improved bandwidth, reliability, and reproducibility [Proc. 2005 IEEE Ultrasonics Symposium, 1739-1742]. We now report on several design improvements which have increase the signal to noise ratio of the system, and potentially reduced the cost of implementation. For the scattering element, we now use an artificial sapphire material to provide a more uniform radiating surface. The receiver is a segmented, truncated spherical structure with a 10 cm radius; the scattering element is positioned at the center of the sphere. The receiver is made from 25 micron thick, biaxially stretched PVDF, with a Pt-Au electrode on the front surface. In the new design, a specialized backing material provides the stiffness required to maintain structural stability, while at the same time providing both electrical shielding and ultrasonic absorption. Compared with the previous version, the new receiver design has improved the noise performance by 8-12 dB; the new scattering sphere has reduced the scattering loss by another 14 dB, producing an effective sensitivity of -298 dB re 1 microVolt/Pa. The design trade-off still involves receiver sensitivity with effective spot size, and signal distortion from the scatter structure. However, the reduced cost and improved repeatability of the new scatter approach makes the overall design more robust for routine waveform measurements of HIFU systems.

Industrial & Engineering Systems Career Cluster ITAC for Career-Focused Education: Transportation Sub-Cluster. Integrated Technical & Academic Competencies.

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Ohio State Univ., Columbus. Vocational Instructional Materials Lab.

Designed for Ohio educators responsible for planning programs to prepare high school students for careers in transportation, this document presents an overview of Ohio's Integrated Technical and Academic Competencies (ITAC) system of career-focused education and specific information about the transportation subcluster of the industrial and…

Single High Intensity Focused Ultrasound Session as a Whole Gland Primary Treatment for Clinically Localized Prostate Cancer: 10-Year Outcomes

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Ksenija Limani

2014-01-01

Full Text Available Objectives. To assess the treatment outcomes of a single session of whole gland high intensity focused ultrasound (HIFU for patients with localized prostate cancer (PCa. Methods. Response rates were defined using the Stuttgart and Phoenix criteria. Complications were graded according to the Clavien score. Results. At a median follow-up of 94months, 48 (44.4% and 50 (46.3% patients experienced biochemical recurrence for Phoenix and Stuttgart definition, respectively. The 5- and 10-year actuarial biochemical recurrence free survival rates were 57% and 40%, respectively. The 10-year overall survival rate, cancer specific survival rate, and metastasis free survival rate were 72%, 90%, and 70%, respectively. Preoperative high risk category, Gleason score, preoperative PSA, and postoperative nadir PSA were independent predictors of oncological failure. 24.5% of patients had self-resolving LUTS, 18.2% had urinary tract infection, and 18.2% had acute urinary retention. A grade 3b complication occurred in 27 patients. Pad-free continence rate was 87.9% and the erectile dysfunction rate was 30.8%. Conclusion. Single session HIFU can be alternative therapy for patients with low risk PCa. Patients with intermediate risk should be informed about the need of multiple sessions of HIFU and/or adjuvant treatments and HIFU performed very poorly in high risk patients.

Introduction to focus issue: intrinsic and designed computation: information processing in dynamical systems--beyond the digital hegemony.

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Crutchfield, James P; Ditto, William L; Sinha, Sudeshna

2010-09-01

How dynamical systems store and process information is a fundamental question that touches a remarkably wide set of contemporary issues: from the breakdown of Moore's scaling laws--that predicted the inexorable improvement in digital circuitry--to basic philosophical problems of pattern in the natural world. It is a question that also returns one to the earliest days of the foundations of dynamical systems theory, probability theory, mathematical logic, communication theory, and theoretical computer science. We introduce the broad and rather eclectic set of articles in this Focus Issue that highlights a range of current challenges in computing and dynamical systems.

Adherence in pediatric kidney transplant recipients: solutions for the system.

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Steinberg, Elizabeth A; Moss, Mary; Buchanan, Cindy L; Goebel, Jens

2018-03-01

Non-adherence remains a significant problem among pediatric (and adult) renal transplant recipients. Non-adherence among solid organ transplant recipients results in US$15-100 million annual costs. Estimates of non-adherence range from 30 to 70% among pediatric patients. Research demonstrates that a 10% decrement in adherence is associated with 8% higher hazard of graft failure and mortality. Focus has begun to shift from patient factors that impact adherence to the contributing healthcare and systems factors. The purpose of this review is to describe problems within the systems implicated in non-adherence and potential solutions that may be related to positive adherence outcomes. Systems issues include insurance and legal regulations, provider and care team barriers to optimal care, and difficulties with transitioning to adult care. Potential solutions include recognition of how systems can work together to improve patient outcomes through improvements in insurance programs, a multi-disciplinary care team approach, evidence-based medical management, pharmacy-based applications and interventions to simplify medication regimens, improved transition protocols, and telehealth/technology-based multi-component interventions. However, there remains a significant lack of reliability in the application of these potential solutions to systems issues that impact patient adherence. Future efforts should accordingly focus on these efforts, likely by leveraging quality improvement and related principles, and on the investigation of the efficacy of these interventions to improve adherence and graft outcomes.

Self vs. Other Focus: Predicting Professionalism Remediation of Emergency Medicine Residents.

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Thaxton, Robert E; Jones, Woodson S; Hafferty, Fred W; April, Carolyn W; April, Michael D

2018-01-01

Unprofessionalism is a major reason for resident dismissal from training. Because of the high stakes involved, residents and educators alike would benefit from information predicting whether they might experience challenges related to this competency. Our objective was to correlate the outcome of professionalism-related remedial actions during residency with the predictor variable of resident response to a standardized interview question: "Why is Medicine important to you?" We conducted a professional development quality improvement (QI) initiative to improve resident education and mentorship by achieving a better understanding of each resident's reasons for valuing a career in medicine. This initiative entailed an interview administered to each resident beginning emergency medicine training at San Antonio Military Medical Center during 2006-2013. The interviews uniformly began with the standardized question "Why is Medicine important to you?" The residency program director documented a free-text summary of each response to this question, the accuracy of which was confirmed by the resident. We analyzed the text of each resident's response after a review of the QI data suggested an association between responses and professionalism actions (retrospective cohort design). Two associate investigators blinded to all interview data, remedial actions, and resident identities categorized each text response as either self-focused (e.g., "I enjoy the challenge") or other-focused (e.g., "I enjoy helping patients"). Additional de-identified data collected included demographics, and expressed personal importance of politics and religion. The primary outcome was a Clinical Competency Committee professionalism remedial action. Of 114 physicians starting residency during 2006-2013, 106 (93.0%) completed the interview. There was good inter-rater reliability in associate investigator categorization of resident responses as either self-focused or other-focused (kappa coefficient 0

Physiotherapy and low back pain - part iii: outcomes research utilising the biosychosocial model: psychosocial outcomes

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L. D. Bardin

2003-02-01

has evolved that necessitates the use of a biopsychosocial model, focusing on illness rather than disease and incorporating the biological, psychological and social aspects that are important to understand and to study LBP in its chronic form. Traditional outcome measures that measure elements within the biological component are limited to assess the spectrum of impacts caused by chronic low back pain (CLBP and the validity, reliability and sensitivity of some of these measures has been questioned.Few physiologic tests of spine function are clinically meaningful to patients, objective physical findings can be absent, and in CLBP disability and activity intolerance are often disproportional to the original injury. Biological outcomes should be complemented by outcomes of the psychosocial aspects of back pain that measure the considerable functional and emotional impact on the quality of life of patients experiencing low back dysfunction. Outcomes research is an analysis of clinical practice as it actually occurs and can  make a valuable contribution to understanding the multidimensional impact of LBP. Psychosocial aspects of the biopsychosocial model for outcomes research are discussed in part III: functional status/disability, psychological impairment, patient satisfaction, health related quality of life

Gene-environment interaction in Major Depression: focus on experience-dependent biological systems

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Nicola eLopizzo

2015-05-01

Full Text Available Major Depressive Disorder (MDD is a multifactorial and polygenic disorder, where multiple and partially overlapping sets of susceptibility genes interact each other and with the environment, predisposing individuals to the development of the illness. Thus, MDD results from a complex interplay of vulnerability genes and environmental factors that act cumulatively throughout individual's lifetime. Among these environmental factors, stressful life experiences, especially those occurring early in life, have been suggested to exert a crucial impact on brain development, leading to permanent functional changes that may contribute to life long risk for mental health outcomes. In this review we will discuss how genetic variants (polymorphisms, SNPs within genes operating in neurobiological systems that mediate stress response and synaptic plasticity, can impact, by themselves, the vulnerability risk for MDD; we will also consider how this MDD risk can be further modulated when gene X environment interaction is taken into account. Finally, we will discuss the role of epigenetic mechanisms, and in particular of DNA methylation and miRNAs expression changes, in mediating the effect of the stress on the vulnerability risk to develop MDD. Taken together, in this review we aim to underlie the role of genetic and epigenetic processes involved in stress and neuroplasticity related biological systems on development of MDD after exposure to early life stress, thereby building the basis for future research and clinical interventions.

Effect of adjuvant systemic treatment on cosmetic outcome and late normal-tissue reactions after breast conservation

International Nuclear Information System (INIS)

Johansen, Joergen; Overgaard, Jens; Overgaard, Marie

2007-01-01

To investigate whether adjuvant treatment with CMF or tamoxifen predisposes to an unfavorable cosmetic outcome or increased breast morbidity after radiotherapy in breast conservation. Data from 266 patients who entered a randomized breast conservation trial (DBCG-82TM protocol) was analyzed. The patients were treated with lumpectomy and axillary dissection followed by external beam radiotherapy to the residual breast. High-risk patients (n 94), as well as 31 low-risk patients, received additional radiation to the regional lymph nodes. Adjuvant systemic treatment was given to all high-risk patients: premenopausal patients (n = 67) received eight cycles of CMF intravenously (600/40/600 mg/m 2 ) every fourth week; postmenopausal patients (n = 27) received 30 mg of tamoxifen daily for one year. Clinical assessments included cosmetic outcome, breast fibrosis, skin telangiectasia, and dyspigmentation which were scored on a 4-point categorical scale after median 6.6 years. The observations were analyzed in multivariate logistic regression analysis which included potential risk factors on outcome related to systemic treatment, surgery, radiation technique, tumor, and patient characteristics. In premenopausal patients, systemic treatment with CMF independently predicted a fair/poor cosmetic outcome, RR = 2.2 (95% CI 1.2-4.2), as well as increased skin telangiectasia, RR = 3.3 (1.4-8.2). There was no impact of tamoxifen treatment on cosmetic outcome in postmenopausal patients (p 0.32). However, univariate analysis showed that tamoxifen was significantly associated with breast fibrosis (p <0.004), as was radiation to the regional lymph nodes (p <0.0001). A strong interaction between axillary irradiation and tamoxifen treatment occurred since 26 of 27 high-risk postmenopausal patients had received both tamoxifen and axillary irradiation. In multivariate regression analysis, axillary irradiation independently predicted moderate/severe breast fibrosis with a relative risk of 5

Magnetically focused liquid drop radiator

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Botts, Thomas E.; Powell, James R.; Lenard, Roger

1986-01-01

A magnetically focused liquid drop radiator for application in rejecting rgy from a spacecraft, characterized by a magnetizable liquid or slurry disposed in operative relationship within the liquid droplet generator and its fluid delivery system, in combination with magnetic means disposed in operative relationship around a liquid droplet collector of the LDR. The magnetic means are effective to focus streams of droplets directed from the generator toward the collector, thereby to assure that essentially all of the droplets are directed into the collector, even though some of the streams may be misdirected as they leave the generator. The magnetic focusing means is also effective to suppress splashing of liquid when the droplets impinge on the collector.

Effectiveness of focused meditation for patients with chronic low back pain-A randomized controlled clinical trial.

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Michalsen, Andreas; Kunz, Natalie; Jeitler, Michael; Brunnhuber, Stefan; Meier, Larissa; Lüdtke, Rainer; Büssing, Arndt; Kessler, Christian

2016-06-01

We aimed to evaluate the effectiveness of an 8-week meditation program (focused meditation) in patients with chronic low-back pain. A randomized clinical trial was conducted on 68 patients (55 years;75% female) with chronic low-back pain who scored >40mm on a 100mm Visual-Analogue-Scale. Subjects were allocated to an 8-week meditation program (focused meditation) with weekly 75min classes or to a self-care exercise program with a wait-list offer for meditation. Both groups were instructed to practice at home. Outcomes were assessed baseline and after 4 and 8 weeks. The primary outcome measure was the change in mean back pain at rest after 8 weeks. Secondary outcomes included function, pain-related bothersomeness, perceived stress, quality-of-life (QOL), and psychological outcomes. Twelve (meditation) and 4 (exercise) patients were lost to follow-up. The primary outcome, pain at rest after 8 weeks, was reduced from 59.3±13.9mm to 40.8±21.8mm with meditation vs. 52.9±11.8mm to 37.3±18.2mm with exercise (adjusted group difference: -1.4 (95%CI:11.6;8.8;p=n.s.) Perceived stress was significantly more reduced with meditation (p=0.011). No significant treatment effects were found for other secondary outcomes as pain-related bothersomeness, function, quality-of-life and psychological scores, although the meditation group consistently showed non-significant better improvements compared to the exercise group. Focused meditation and self-care exercise lead to comparable, symptomatic improvements in patients with chronic low back pain. Future studies should include longer-term follow-ups and develop guided meditation programs to support compliance. Copyright © 2016 Elsevier Ltd. All rights reserved.

Patient-specific system for prognosis of surgical treatment outcomes of human cardiovascular system

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Golyadkina, Anastasiya A.; Kalinin, Aleksey A.; Kirillova, Irina V.; Kossovich, Elena L.; Kossovich, Leonid Y.; Menishova, Liyana R.; Polienko, Asel V.

2015-03-01

Object of study: Improvement of life quality of patients with high stroke risk ia the main goal for development of system for patient-specific modeling of cardiovascular system. This work is dedicated at increase of safety outcomes for surgical treatment of brain blood supply alterations. The objects of study are common carotid artery, internal and external carotid arteries and bulb. Methods: We estimated mechanical properties of carotid arteries tissues and patching materials utilized at angioplasty. We studied angioarchitecture features of arteries. We developed and clinically adapted computer biomechanical models, which are characterized by geometrical, physical and mechanical similarity with carotid artery in norm and with pathology (atherosclerosis, pathological tortuosity, and their combination). Results: Collaboration of practicing cardiovascular surgeons and specialists in the area of Mathematics and Mechanics allowed to successfully conduct finite-element modeling of surgical treatment taking into account various features of operation techniques and patching materials for a specific patient. Numerical experiment allowed to reveal factors leading to brain blood supply decrease and atherosclerosis development. Modeling of carotid artery reconstruction surgery for a specific patient on the basis of the constructed biomechanical model demonstrated the possibility of its application in clinical practice at approximation of numerical experiment to the real conditions.

Outcomes of patients calling emergency medical services for suspected acute cardiovascular disease

DEFF Research Database (Denmark)

Schoos, Mikkel Malby; Sejersten, Maria Sejersten; Baber, Usman

2015-01-01

Adequate health care is increasingly dependent on prehospital systems and cardiovascular (CV) disease remains the most common cause for hospital admission. However the prevalence of CV dispatches of emergency medical services (EMS) is not well reported and survival data described in clinical trials......, this study emphasizes the need for an efficient prehospital phase with focus on CV disease and proper triage of patients suitable for invasive evaluation if the outcomes of acute heart disease are to be improved further in the current international context of hospitals merging into highly specialized...

Outcome of focused pre-Ramadan education on metabolic and glycaemic parameters in patients with type 2 diabetes mellitus.

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El Toony, Lobna F; Hamad, Dina Ali; Omar, Omar Mohammed

2018-04-25

Ramadan fasting is associated with the risk of acute complications including hypoglycaemia. Therefore, patients' education before Ramadan and follow up during Ramadan is essential for safe fasting. To evaluate the effect of pre-Ramadan education program on biochemical parameters and the risk of hypoglycaemia in patients with type 2 diabetes mellitus. A prospective interventional controlled design was carried out on 320 Muslim patients with type 2 diabetes. They were divided into 2 groups; the control group (n = 200) who received standard diabetic care and the intervention group (n = 120) who received focused individualized diabetic education sessions before Ramadan. The study was carried out on 3 phases (before, during and after Ramadan). Post-education change of hypoglycaemia risk and biochemical parameters during Ramadan fasting were the primary outcomes. Fasting blood glucose decreased significantly during, and after Ramadan in both groups (P patients in the intervention group vs. 19.5% in the control group. Post Ramadan reduction of HbA1c patients before Ramadan to 55.8% after Ramadan). Low-density lipoprotein cholesterol decreased in the intervention group (P = 0.024). The body weight of the patients did not significantly change in both groups. There was a significant impact of pre-Ramadan educational program on reduction of hypoglycaemic risk and other acute complications, reduction of low-density lipoprotein cholesterol and improvement of high-density lipoprotein cholesterol. Therefore, it is recommended for the fasting patients especially those with high and very high risk during Ramadan. Copyright © 2018. Published by Elsevier Ltd.

Continuous Quality Improvement and Comprehensive Primary Health Care: A Systems Framework to Improve Service Quality and Health Outcomes.

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McCalman, Janya; Bailie, Ross; Bainbridge, Roxanne; McPhail-Bell, Karen; Percival, Nikki; Askew, Deborah; Fagan, Ruth; Tsey, Komla

2018-01-01

Continuous quality improvement (CQI) processes for improving clinical care and health outcomes have been implemented by primary health-care services, with resultant health-care impacts. But only 10-20% of gain in health outcomes is contributed by health-care services; a much larger share is determined by social and cultural factors. This perspective paper argues that health care and health outcomes can be enhanced through applying CQI as a systems approach to comprehensive primary health care. Referring to the Aboriginal and Torres Strait Islander Australian context as an example, the authors provide a systems framework that includes strategies and conditions to facilitate evidence-based and local decision making by primary health-care services. The framework describes the integration of CQI vertically to improve linkages with governments and community members and horizontally with other sectors to influence the social and cultural determinants of health. Further, government and primary health-care service investment is required to support and extend integration and evaluation of CQI efforts vertically and horizontally.

Medical consequences of Chernobyl with focus on the endocrine system: Part 1.

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Foley, Thomas P; Límanová, Zdeňka; Potluková, Eliška

2015-01-01

In the last 70 years, atomic disasters have occurred several times. The nuclear power plant accident at Chernobyl in 1986 in North-Central Ukraine was a unique experience in population exposures to radiation by all ages, and ongoing studies have brought a large amount of information on effects of radiation on human organism. Concerning the deteriorating global security situation and the strong rhetoric of some of the world leaders, the knowledge on the biological effects of ionizing radiation and the preventive measures designed to decrease the detrimental effects of radiation gains a new dimension, and involves all of us. This review focuses on the long-term effects of Chernobyl catastrophe especially on the endocrine system in children and in adults, and includes a summary of preventive measures in case of an atomic disaster.

Medical Consequences of Chernobyl with Focus on the Endocrine System - Part 2.