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Sample records for outcomes reliably improve

  1. Improving machinery reliability

    CERN Document Server

    Bloch, Heinz P

    1998-01-01

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

  2. The National Surgical Quality Improvement Program 30-Day Challenge: Microsurgical Breast Reconstruction Outcomes Reporting Reliability

    Directory of Open Access Journals (Sweden)

    Austin D. Chen

    2018-03-01

    Conclusion:. For immediate, free-tissue breast reconstruction, the ACS-NSQIP may be reliable for monitoring and comparing SSI, WD, URO, and URA rates. However, clinicians may find it useful to understand limitations of the ACS-NSQIP for complications and risk factors, as it may underreport complications occurring beyond 30 days.

  3. Improving Power Converter Reliability

    DEFF Research Database (Denmark)

    Ghimire, Pramod; de Vega, Angel Ruiz; Beczkowski, Szymon

    2014-01-01

    of a high-power IGBT module during converter operation, which may play a vital role in improving the reliability of the power converters. The measured voltage is used to estimate the module average junction temperature of the high and low-voltage side of a half-bridge IGBT separately in every fundamental......The real-time junction temperature monitoring of a high-power insulated-gate bipolar transistor (IGBT) module is important to increase the overall reliability of power converters for industrial applications. This article proposes a new method to measure the on-state collector?emitter voltage...... is measured in a wind power converter at a low fundamental frequency. To illustrate more, the test method as well as the performance of the measurement circuit are also presented. This measurement is also useful to indicate failure mechanisms such as bond wire lift-off and solder layer degradation...

  4. Steam generator reliability improvement project

    International Nuclear Information System (INIS)

    Blomgren, J.C.; Green, S.J.

    1987-01-01

    Upon successful completion of its research and development technology transfer program, the Electric Power Research Institute's Steam Generator Owners Group (SGOG II) will disband in December 1986 and be replaced in January 1987 by a successor project, the Steam Generator Reliability Project (SGRP). The new project, funded in the EPRI base program, will continue the emphasis on reliability and life extension that was carried forward by SGOG II. The objectives of SGOG II have been met. Causes and remedies have been identified for tubing corrosion problems, such as stress corrosion cracking and pitting, and steam generator technology has been improved in areas such as tube wear prediction and nondestructive evaluation (NDE). These actions have led to improved reliability of steam generators. Now the owners want to continue with a centrally managed program that builds on what has been learned. The goal is to continue to improve steam generator reliability and solve small problems before they become large problems

  5. Steam generator reliability improvement project

    International Nuclear Information System (INIS)

    Blomgren, J.C.; Green, S.J.

    1987-01-01

    Upon successful completion of its research and development technology transfer program, the Electric Power Research Institute's (EPRI's) Steam Generator Owners Group (SGOG II) will disband in December 1986, and be replaced in January 1987, by a successor project, the Steam Generator Reliability Project (SGRP). The new project, funded in the EPRI base program, will continue to emphasize reliability and life extension, which were carried forward by SGOG II. The objectives of SGOG II have been met. Causes and remedies have been identified for tubing corrosion problems such as stress corrosion cracking and pitting, and steam generator technology has been improved in areas such as tube wear prediction and nondestructive evaluation. These actions have led to improved reliability of steam generators. Now the owners want to continue with a centrally managed program that builds on what has been learned. The goal is to continue to improve steam generator reliability and to solve small problems before they become large problems

  6. Teaming up to improve reliability

    International Nuclear Information System (INIS)

    Malone, E.A.; Ayres, D.J.; Lear, R.C. van

    1989-01-01

    Responding to increasingly stringent regulatory requirements, Babcock and Wilcox has teamed up with three specialist companies to provide services for nuclear utilities aiming to improve the performance of their valves and actuators. The services, which are outlined here, include inspection, repair, overhaul and valve and actuator reliability programmes. (author)

  7. PWR system reliability improvement activities

    International Nuclear Information System (INIS)

    Yoshikawa, Yuichiro

    1985-01-01

    In Japan lacking in energy resources, it is our basic energy policy to accelerate the development program of nuclear power, thereby reducing our dependence. As referred to in the foregoing, every effort has been exerted on our part to improve the PWR system reliability by dint of the so-called 'HOMEMADE' TQC activities, which is our brain-child as a result of applying to the energy industry the quality control philosophy developed in the field of manufacturing industry

  8. Improving surgical outcomes

    Directory of Open Access Journals (Sweden)

    Tony Walia

    2008-12-01

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

  9. 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

  10. Improved reliability of power modules

    DEFF Research Database (Denmark)

    Baker, Nick; Liserre, Marco; Dupont, Laurent

    2014-01-01

    Power electronic systems play an increasingly important role in providing high-efficiency power conversion for adjustable-speed drives, power-quality correction, renewable-energy systems, energy-storage systems, and electric vehicles. However, they are often presented with demanding operating...... environments that challenge the reliability aspects of power electronic techniques. For example, increasingly thermally stressful environments are seen in applications such as electric vehicles, where ambient temperatures under the hood exceed 150 °C, while some wind turbine applications can place large...

  11. Reliability-How to Quantify and Improve?

    Indian Academy of Sciences (India)

    Home; Journals; Resonance – Journal of Science Education; Volume 5; Issue 5. Reliability - How to Quantify and Improve? - Improving the Health of Products. N K Srinivasan. General Article Volume 5 Issue 5 May 2000 pp 55-63. Fulltext. Click here to view fulltext PDF. Permanent link:

  12. Improving Reliability of a Residency Interview Process

    Science.gov (United States)

    Serres, Michelle L.; Gundrum, Todd E.

    2013-01-01

    Objective. To improve the reliability and discrimination of a pharmacy resident interview evaluation form, and thereby improve the reliability of the interview process. Methods. In phase 1 of the study, authors used a Many-Facet Rasch Measurement model to optimize an existing evaluation form for reliability and discrimination. In phase 2, interviewer pairs used the modified evaluation form within 4 separate interview stations. In phase 3, 8 interviewers individually-evaluated each candidate in one-on-one interviews. Results. In phase 1, the evaluation form had a reliability of 0.98 with person separation of 6.56; reproducibly, the form separated applicants into 6 distinct groups. Using that form in phase 2 and 3, our largest variation source was candidates, while content specificity was the next largest variation source. The phase 2 g-coefficient was 0.787, while confirmatory phase 3 was 0.922. Process reliability improved with more stations despite fewer interviewers per station—impact of content specificity was greatly reduced with more interview stations. Conclusion. A more reliable, discriminating evaluation form was developed to evaluate candidates during resident interviews, and a process was designed that reduced the impact from content specificity. PMID:24159209

  13. Improving reliability of a residency interview process.

    Science.gov (United States)

    Peeters, Michael J; Serres, Michelle L; Gundrum, Todd E

    2013-10-14

    To improve the reliability and discrimination of a pharmacy resident interview evaluation form, and thereby improve the reliability of the interview process. In phase 1 of the study, authors used a Many-Facet Rasch Measurement model to optimize an existing evaluation form for reliability and discrimination. In phase 2, interviewer pairs used the modified evaluation form within 4 separate interview stations. In phase 3, 8 interviewers individually-evaluated each candidate in one-on-one interviews. In phase 1, the evaluation form had a reliability of 0.98 with person separation of 6.56; reproducibly, the form separated applicants into 6 distinct groups. Using that form in phase 2 and 3, our largest variation source was candidates, while content specificity was the next largest variation source. The phase 2 g-coefficient was 0.787, while confirmatory phase 3 was 0.922. Process reliability improved with more stations despite fewer interviewers per station-impact of content specificity was greatly reduced with more interview stations. A more reliable, discriminating evaluation form was developed to evaluate candidates during resident interviews, and a process was designed that reduced the impact from content specificity.

  14. Improving the safety and reliability of Monju

    International Nuclear Information System (INIS)

    Itou, Kazumoto; Maeda, Hiroshi; Moriyama, Masatoshi

    1998-01-01

    Comprehensive safety review has been performed at Monju to determine why the Monju secondary sodium leakage accident occurred. We investigated how to improve the situation based on the results of the safety review. The safety review focused on five aspects of whether the facilities for dealing with the sodium leakage accident were adequate: the reliability of the detection method, the reliability of the method for preventing the spread of the sodium leakage accident, whether the documented operating procedures are adequate, whether the quality assurance system, program, and actions were properly performed and so on. As a result, we established for Monju a better method of dealing with sodium leakage accidents, rapid detection of sodium leakage, improvement of sodium drain facilities, and way to reduce damage to Monju systems after an accident. We also improve the operation procedures and quality assurance actions to increase the safety and reliability of Monju. (author)

  15. Heroic Reliability Improvement in Manned Space Systems

    Science.gov (United States)

    Jones, Harry W.

    2017-01-01

    System reliability can be significantly improved by a strong continued effort to identify and remove all the causes of actual failures. Newly designed systems often have unexpected high failure rates which can be reduced by successive design improvements until the final operational system has an acceptable failure rate. There are many causes of failures and many ways to remove them. New systems may have poor specifications, design errors, or mistaken operations concepts. Correcting unexpected problems as they occur can produce large early gains in reliability. Improved technology in materials, components, and design approaches can increase reliability. The reliability growth is achieved by repeatedly operating the system until it fails, identifying the failure cause, and fixing the problem. The failure rate reduction that can be obtained depends on the number and the failure rates of the correctable failures. Under the strong assumption that the failure causes can be removed, the decline in overall failure rate can be predicted. If a failure occurs at the rate of lambda per unit time, the expected time before the failure occurs and can be corrected is 1/lambda, the Mean Time Before Failure (MTBF). Finding and fixing a less frequent failure with the rate of lambda/2 per unit time requires twice as long, time of 1/(2 lambda). Cutting the failure rate in half requires doubling the test and redesign time and finding and eliminating the failure causes.Reducing the failure rate significantly requires a heroic reliability improvement effort.

  16. Improvement of the reliability on nondestructive inspection

    International Nuclear Information System (INIS)

    Song, Sung Jin; Kim, Young H.; Lee, Hyang Beom; Shin, Young Kil; Jung, Hyun Jo; Park, Ik Keun; Park, Eun Soo

    2002-03-01

    Retaining reliabilities of nondestructive testing is essential for the life-time maintenance of Nuclear Power Plant. The nondestructive testing methods which are frequently used in the Nuclear Power Plant are eddy current testing for the inspection of steam generator tubes and ultrasonic testing for the inspection of weldments. In order to improve reliabilities of ultrasonic testing and eddy current testing, the subjects carried out in this study are as follows : development of BEM analysis technique for ECT of SG tube, development of neural network technique for the intelligent analysis of ECT flaw signals of SG tubes, development of RFECT technology for the inspection of SG tube, FEM analysis of ultrasonic scattering field, evaluation of statistical reliability of PD-RR test of ultrasonic testing and development of multi-Gaussian beam modeling technique to predict accurate signal of signal beam ultrasonic testing with the efficiency in calculation time

  17. Improvement of the reliability on nondestructive inspection

    Energy Technology Data Exchange (ETDEWEB)

    Song, Sung Jin; Kim, Young H. [Sungkyunkwan Univ., Suwon (Korea, Republic of); Lee, Hyang Beom [Soongsil Univ., Seoul (Korea, Republic of); Shin, Young Kil [Kunsan National Univ., Gunsan (Korea, Republic of); Jung, Hyun Jo [Wonkwang Univ., Iksan (Korea, Republic of); Park, Ik Keun; Park, Eun Soo [Seoul Nationl Univ., Seoul (Korea, Republic of)

    2002-03-15

    Retaining reliabilities of nondestructive testing is essential for the life-time maintenance of Nuclear Power Plant. The nondestructive testing methods which are frequently used in the Nuclear Power Plant are eddy current testing for the inspection of steam generator tubes and ultrasonic testing for the inspection of weldments. In order to improve reliabilities of ultrasonic testing and eddy current testing, the subjects carried out in this study are as follows : development of BEM analysis technique for ECT of SG tube, development of neural network technique for the intelligent analysis of ECT flaw signals of SG tubes, development of RFECT technology for the inspection of SG tube, FEM analysis of ultrasonic scattering field, evaluation of statistical reliability of PD-RR test of ultrasonic testing and development of multi-Gaussian beam modeling technique to predict accurate signal of signal beam ultrasonic testing with the efficiency in calculation time.

  18. Reliability of risk-adjusted outcomes for profiling hospital surgical quality.

    Science.gov (United States)

    Krell, Robert W; Hozain, Ahmed; Kao, Lillian S; Dimick, Justin B

    2014-05-01

    Quality improvement platforms commonly use risk-adjusted morbidity and mortality to profile hospital performance. However, given small hospital caseloads and low event rates for some procedures, it is unclear whether these outcomes reliably reflect hospital performance. To determine the reliability of risk-adjusted morbidity and mortality for hospital performance profiling using clinical registry data. A retrospective cohort study was conducted using data from the American College of Surgeons National Surgical Quality Improvement Program, 2009. Participants included all patients (N = 55,466) who underwent colon resection, pancreatic resection, laparoscopic gastric bypass, ventral hernia repair, abdominal aortic aneurysm repair, and lower extremity bypass. Outcomes included risk-adjusted overall morbidity, severe morbidity, and mortality. We assessed reliability (0-1 scale: 0, completely unreliable; and 1, perfectly reliable) for all 3 outcomes. We also quantified the number of hospitals meeting minimum acceptable reliability thresholds (>0.70, good reliability; and >0.50, fair reliability) for each outcome. For overall morbidity, the most common outcome studied, the mean reliability depended on sample size (ie, how high the hospital caseload was) and the event rate (ie, how frequently the outcome occurred). For example, mean reliability for overall morbidity was low for abdominal aortic aneurysm repair (reliability, 0.29; sample size, 25 cases per year; and event rate, 18.3%). In contrast, mean reliability for overall morbidity was higher for colon resection (reliability, 0.61; sample size, 114 cases per year; and event rate, 26.8%). Colon resection (37.7% of hospitals), pancreatic resection (7.1% of hospitals), and laparoscopic gastric bypass (11.5% of hospitals) were the only procedures for which any hospitals met a reliability threshold of 0.70 for overall morbidity. Because severe morbidity and mortality are less frequent outcomes, their mean

  19. Piping reliability improvement through passive seismic supports

    International Nuclear Information System (INIS)

    Baltus, R.; Rubbers, A.

    1999-01-01

    The nuclear plants designed in the 1970's were equipped with large quantities of snubbers in auxiliary piping systems. The experience revealed a poor performance of snubbers during periodic inspection, while non-nuclear facility piping survived through strong earthquakes. Consequently, seismic design rules evolved towards more realistic criteria and passive dynamic supports were developed to reduce snubber quantities. These solutions improve the pipe reliability during normal operation while reducing the radiation exposure in a sample line is presented with the impact on pipe stresses compared to the results obtained with passive supports named Limit Stops. (author)

  20. SLAC modulator system improvements and reliability results

    International Nuclear Information System (INIS)

    Donaldson, A.R.

    1998-06-01

    In 1995, an improvement project was completed on the 244 klystron modulators in the linear accelerator. The modulator system has been previously described. This article offers project details and their resulting effect on modulator and component reliability. Prior to the project, the authors had collected four operating cycles (1991 through 1995) of MTTF data. In this discussion, the '91 data will be excluded since the modulators operated at 60 Hz. The five periods following the '91 run were reviewed due to the common repetition rate at 120 Hz

  1. Improvement of reliability of heater and condenser

    International Nuclear Information System (INIS)

    Yamagishi, Hiroki

    1988-01-01

    Recently, the diversification of the operation modes of power plants has advanced as well as daily start and stop and weekly start and stop operations, as the result, the needs for the reliability improvement of various heat exchangers around steam turbines heighten. In newly constructed plants, the design to meet this demand is carried out, but also in existing platns, the application of the latest technology is investigated. As for the reliability of condensers, aluminum brass cooling tubes have been used by doing the optimal maintenance and taking the measures against deposit attack. In the case of requiring high reliability, the examples of adopting titanium cooling tubes increased. The technology of titanium tube condensers, completely assembled condensers, the replacement of existing brass tubes with titanium tubes and so on are discussed. In the case of feed heaters, the deterioration phenomena due to the lapse of long years, such as the attack of steel tube inlet, the drain attack on the external surfaces of steel tubes, the ammonia attack of aluminum brass tubes and the adhesion of scale to heaters, are explained, and the countermeasures are shown. (Kako, I.)

  2. Advanced solutions for operational reliability improvements

    Energy Technology Data Exchange (ETDEWEB)

    Holmberg, K [VTT Manufacturing Technology, Espoo (Finland)

    1998-12-31

    A great number of new technical tools are today developed for improved operational reliability of machines and industrial equipment. Examples of such techniques and tools recently developed at the Technical Research Centre of Finland (VTT) are: metallographic approach for steam-piping lifetime estimation, an expert system AURORA for corrosion prediction and material selection, an automatic image-processing-based on-line wear particle analysis system, microsensors for condition monitoring, a condition monitoring and expert system, CEPDIA, for the diagnosis of centrifugal pumps, a machine tool analysis and diagnostic expert system, non-leakage magnetic fluid seals with extended lifetime and diamond-like surface coatings on components with decreased friction and wear properties. A hyperbook-supported holistic approach to problem solving in maintenance and reliability engineering has been developed to help the user achieve a holistic understanding of the problem and its relationships, to navigate among the several technical tools and methods available, and to find those suitable for his application. (orig.)

  3. Advanced solutions for operational reliability improvements

    Energy Technology Data Exchange (ETDEWEB)

    Holmberg, K. [VTT Manufacturing Technology, Espoo (Finland)

    1997-12-31

    A great number of new technical tools are today developed for improved operational reliability of machines and industrial equipment. Examples of such techniques and tools recently developed at the Technical Research Centre of Finland (VTT) are: metallographic approach for steam-piping lifetime estimation, an expert system AURORA for corrosion prediction and material selection, an automatic image-processing-based on-line wear particle analysis system, microsensors for condition monitoring, a condition monitoring and expert system, CEPDIA, for the diagnosis of centrifugal pumps, a machine tool analysis and diagnostic expert system, non-leakage magnetic fluid seals with extended lifetime and diamond-like surface coatings on components with decreased friction and wear properties. A hyperbook-supported holistic approach to problem solving in maintenance and reliability engineering has been developed to help the user achieve a holistic understanding of the problem and its relationships, to navigate among the several technical tools and methods available, and to find those suitable for his application. (orig.)

  4. 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...

  5. 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.

  6. 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.

  7. Reliability

    OpenAIRE

    Condon, David; Revelle, William

    2017-01-01

    Separating the signal in a test from the irrelevant noise is a challenge for all measurement. Low test reliability limits test validity, attenuates important relationships, and can lead to regression artifacts. Multiple approaches to the assessment and improvement of reliability are discussed. The advantages and disadvantages of several different approaches to reliability are considered. Practical advice on how to assess reliability using open source software is provided.

  8. software reliability: failures, consequences and improvement

    African Journals Online (AJOL)

    BARTH EKWUEME

    2009-07-16

    Jul 16, 2009 ... function of time, but it is believed that some modeling technique for software reliability is reaching propensity, by ..... February 25, 1991 during the Gulf war, the chopping ... Let us consider a few key concepts that apply to both.

  9. Improvement of standards on functional reliability of electric power systems

    International Nuclear Information System (INIS)

    Barinov, V.A.; Volkov, G.A.; Kalita, V.V.; Kogan, F.L.; Makarov, S.F.; Manevich, A.S.; Mogirev, V.V.; Sin'chugov, F.I.; Skopintsev, V.A.; Khvoshchinskaya, Z.G.

    1993-01-01

    Analysis of the most principal aspects of the existing standards and requirements on assuring safety and stability of electric power systems (EPS) and effective (reliable and economical) power supply of consumers is given. The reliability is determined as ability to accomplish the assigned functions. Basic recommendations on improving the standards regulating the safety and reliability of the NPP functioning are formulated

  10. The Outcome and Assessment Information Set (OASIS): A Review of Validity and Reliability

    Science.gov (United States)

    O’CONNOR, MELISSA; DAVITT, JOAN K.

    2015-01-01

    The Outcome and Assessment Information Set (OASIS) is the patient-specific, standardized assessment used in Medicare home health care to plan care, determine reimbursement, and measure quality. Since its inception in 1999, there has been debate over the reliability and validity of the OASIS as a research tool and outcome measure. A systematic literature review of English-language articles identified 12 studies published in the last 10 years examining the validity and reliability of the OASIS. Empirical findings indicate the validity and reliability of the OASIS range from low to moderate but vary depending on the item studied. Limitations in the existing research include: nonrepresentative samples; inconsistencies in methods used, items tested, measurement, and statistical procedures; and the changes to the OASIS itself over time. The inconsistencies suggest that these results are tentative at best; additional research is needed to confirm the value of the OASIS for measuring patient outcomes, research, and quality improvement. PMID:23216513

  11. Enhance pump reliability through improved inservice testing

    International Nuclear Information System (INIS)

    Healy, J.J.

    1990-01-01

    EPRI has undertaken a study to assess the effectiveness of existing testing programs to accurately monitor and predict performance changes before either pump performance degrades or an actual failure occurs. Anticipated changes in inservice testing techniques are directed towards enhancing the validity of test data, ensuring its repeatability, and avoiding deterioration of the pump assembly. There is a new-found interest in test programs of all types that has occurred, in part, because of an increase in reported pump degradation and pump failure. Inservice testing of pumps, which has long been a basis for assuring operability, has apparently produced an opposite effect; namely, the appearance of a reduction in reliability

  12. Revised scoring and improved reliability for the Communication Patterns Questionnaire.

    Science.gov (United States)

    Crenshaw, Alexander O; Christensen, Andrew; Baucom, Donald H; Epstein, Norman B; Baucom, Brian R W

    2017-07-01

    The Communication Patterns Questionnaire (CPQ; Christensen, 1987) is a widely used self-report measure of couple communication behavior and is well validated for assessing the demand/withdraw interaction pattern, which is a robust predictor of poor relationship and individual outcomes (Schrodt, Witt, & Shimkowski, 2014). However, no studies have examined the CPQ's factor structure using analytic techniques sufficient by modern standards, nor have any studies replicated the factor structure using additional samples. Further, the current scoring system uses fewer than half of the total items for its 4 subscales, despite the existence of unused items that have content conceptually consistent with those subscales. These characteristics of the CPQ have likely contributed to findings that subscale scores are often troubled by suboptimal psychometric properties such as low internal reliability (e.g., Christensen, Eldridge, Catta-Preta, Lim, & Santagata, 2006). The present study uses exploratory and confirmatory factor analyses on 4 samples to reexamine the factor structure of the CPQ to improve scale score reliability and to determine if including more items in the subscales is warranted. Results indicate that a 3-factor solution (constructive communication and 2 demand/withdraw scales) provides the best fit for the data. That factor structure was confirmed in the replication samples. Compared with the original scales, the revised scales include additional items that expand the conceptual range of the constructs, substantially improve reliability of scale scores, and demonstrate stronger associations with relationship satisfaction and sensitivity to change in therapy. Implications for research and treatment are discussed. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

  13. Developing methods for establishing improved plant reliability

    International Nuclear Information System (INIS)

    Zebroski, E.L.; Lapides, M.E.; Johnson, L.

    1976-01-01

    The current average capacity factor for nuclear electric generating facilities is approximately 60 percent, virtually the same as that for large, modern fossil-fired units. There is a clear cost advantage for nuclear electrical generation in comparison to coal-fired units at a common performance level. Because of the accelerated increase in capital and fuel costs of coal-fired units, the nuclear units will usually exhibit a cost advantage even when operating at lower capacity factor values. The incentives for improvement follow from the utility objectives to provide electricity at the most economical rates possible and are reflected in reduced system fuel costs and capital requirements. These objectives require maximizing the productivity of existing or planned investments in nuclear generation. The requirements are to: (1) achieve and sustain the highest capacity factor consistent with each utility's electric transmission system configuration and demand; (2) accelerate the rate of attainment of operational ''maturity'' of new generation; and (3) avoid low-probability but large-consequence forced-outage events. Nuclear unit productivity improvement involves utilities, regulatory agencies and industrial and government research and development organizations; the efforts appropriate to each organization were identified in a previous study. Since no foreseeable set of warranties begins to cover the consequential costs of low performance, the greatest incentive for improvement rests with each individual utility. The paper addresses the methodology and information sources for productivity actions by utilities during unit procurement and design phases

  14. Improved reliability of residential heat pumps; Foerbaettrad driftsaekerhet hos villavaermepumpar

    Energy Technology Data Exchange (ETDEWEB)

    Haglund Stignor, Caroline; Larsson, Kristin; Jensen, Sara; Larsson, Johan; Berg, Johan; Lidbom, Peter; Rolfsman, Lennart

    2012-07-01

    Today, heat pump heating systems are common in Swedish single-family houses. Many owners are pleased with their installation, but statistics show that a certain number of heat pumps break every year, resulting in high costs for both insurance companies and owners. On behalf of Laensfoersaekringars Forskningsfond, SP Energy Technology has studied the cause of the most common failures for residential heat pumps. The objective of the study was to suggest what measures to be taken to reduce the number of failures, i.e. improving the reliability of heat pumps. The methods used were analysis of public failure statistics and sales statistics and interviews with heat pump manufacturers, installers, service representatives and assessors at Laensfoersaekringar. In addition, heat pump manuals have been examined and literature searches for various methods for durability tests have been performed. Based on the outcome from the interviews the most common failures were categorized by if they; 1. Could have been prevented by better operation and maintenance of the heat pump. 2. Caused by a poorly performed installation. 3. Could have been prevented if certain parameters had been measured, recorded and followed up. 4. Are due to poor quality of components or systems. However, the results show that many of the common failures fall into several different categories and therefore, different types of measures must be taken to improve the operational reliability of residential heat pumps. The interviews tell that failures often are caused by poor installation, neglected maintenance and surveillance, and poor quality of standard components or that components are used outside their declared operating range. The quality of the installations could be improved by increasing installers' knowledge about heat pumps and by requiring that an installation protocol shall be filled-in. It is also important that the owner of the heat pump performs the preventive maintenance recommended by the

  15. Improved reliability of residential heat pumps; Foerbaettrad driftsaekerhet hos villavaermepumpar

    Energy Technology Data Exchange (ETDEWEB)

    Haglund Stignor, Caroline; Larsson, Kristin; Jensen, Sara; Larsson, Johan; Berg, Johan; Lidbom, Peter; Rolfsman, Lennart

    2012-07-01

    Today, heat pump heating systems are common in Swedish single-family houses. Many owners are pleased with their installation, but statistics show that a certain number of heat pumps break every year, resulting in high costs for both insurance companies and owners. On behalf of Laensfoersaekringars Forskningsfond, SP Energy Technology has studied the cause of the most common failures for residential heat pumps. The objective of the study was to suggest what measures to be taken to reduce the number of failures, i.e. improving the reliability of heat pumps. The methods used were analysis of public failure statistics and sales statistics and interviews with heat pump manufacturers, installers, service representatives and assessors at Laensfoersaekringar. In addition, heat pump manuals have been examined and literature searches for various methods for durability tests have been performed. Based on the outcome from the interviews the most common failures were categorized by if they; 1. Could have been prevented by better operation and maintenance of the heat pump. 2. Caused by a poorly performed installation. 3. Could have been prevented if certain parameters had been measured, recorded and followed up. 4. Are due to poor quality of components or systems. However, the results show that many of the common failures fall into several different categories and therefore, different types of measures must be taken to improve the operational reliability of residential heat pumps. The interviews tell that failures often are caused by poor installation, neglected maintenance and surveillance, and poor quality of standard components or that components are used outside their declared operating range. The quality of the installations could be improved by increasing installers' knowledge about heat pumps and by requiring that an installation protocol shall be filled-in. It is also important that the owner of the heat pump performs the preventive maintenance recommended by the

  16. Assessment of power reliability and improvement potential by using ...

    African Journals Online (AJOL)

    This paper presents the use of smart reclosers for improving reliability of a distribution system of one of the major cities of Ethiopia. As frequent power interruptions are posing a huge problem to the life of the people and the economy, finding a solution to the problem is very essential. Electric reliability has affected social well ...

  17. SOFC Systems with Improved Reliability and Endurance

    Energy Technology Data Exchange (ETDEWEB)

    Ghezel-Ayagh, Hossein [Fuelcell Energy, Incorporated, Danbury, CT (United States)

    2015-12-31

    The overall goal of this U.S. Department of Energy (DOE) sponsored project was the development of Solid Oxide Fuel Cell (SOFC) technology suitable for ultra-efficient central power generation systems utilizing coal and natural gas fuels and featuring greater than 90% carbon dioxide capture. The specific technical objective of this project was to demonstrate, via analyses and testing, progress towards adequate stack life (≥ 4 years) and stack performance stability (degradation rate ≤ 0.2% per 1000 hours) in a low-cost SOFC stack design. This final technical report summarizes the progress made during the project period of 27 months. Significant progress was made in the areas of cell and stack technology development, stack module development, sub-scale module tests, and Proof-of-Concept Module unit design, fabrication and testing. The work focused on cell and stack materials and designs, balance-of-plant improvements, and performance evaluation covering operating conditions and fuel compositions anticipated for commercially-deployed systems. In support of performance evaluation under commercial conditions, this work included the design, fabrication, siting, commissioning, and operation of a ≥ 50 kWe proof-of-concept module (PCM) power plant, based upon SOFC cell and stack technology developed to date by FuelCell Energy, Inc. (FCE) under the Office of Fossil Energy’s Solid Oxide Fuel Cells program. The PCM system was operated for at least 1000 hours on natural gas fuel at FCE’s facility. The factory cost of the SOFC stack was estimated to be at or below the DOE’s high-volume production cost target (2011 $).

  18. Improvement of human reliability analysis method for PRA

    International Nuclear Information System (INIS)

    Tanji, Junichi; Fujimoto, Haruo

    2013-09-01

    It is required to refine human reliability analysis (HRA) method by, for example, incorporating consideration for the cognitive process of operator into the evaluation of diagnosis errors and decision-making errors, as a part of the development and improvement of methods used in probabilistic risk assessments (PRAs). JNES has been developed a HRA method based on ATHENA which is suitable to handle the structured relationship among diagnosis errors, decision-making errors and operator cognition process. This report summarizes outcomes obtained from the improvement of HRA method, in which enhancement to evaluate how the plant degraded condition affects operator cognitive process and to evaluate human error probabilities (HEPs) which correspond to the contents of operator tasks is made. In addition, this report describes the results of case studies on the representative accident sequences to investigate the applicability of HRA method developed. HEPs of the same accident sequences are also estimated using THERP method, which is most popularly used HRA method, and comparisons of the results obtained using these two methods are made to depict the differences of these methods and issues to be solved. Important conclusions obtained are as follows: (1) Improvement of HRA method using operator cognitive action model. Clarification of factors to be considered in the evaluation of human errors, incorporation of degraded plant safety condition into HRA and investigation of HEPs which are affected by the contents of operator tasks were made to improve the HRA method which can integrate operator cognitive action model into ATHENA method. In addition, the detail of procedures of the improved method was delineated in the form of flowchart. (2) Case studies and comparison with the results evaluated by THERP method. Four operator actions modeled in the PRAs of representative BWR5 and 4-loop PWR plants were selected and evaluated as case studies. These cases were also evaluated using

  19. Strategy for continuous improvement in IC manufacturability, yield, and reliability

    Science.gov (United States)

    Dreier, Dean J.; Berry, Mark; Schani, Phil; Phillips, Michael; Steinberg, Joe; DePinto, Gary

    1993-01-01

    Continual improvements in yield, reliability and manufacturability measure a fab and ultimately result in Total Customer Satisfaction. A new organizational and technical methodology for continuous defect reduction has been established in a formal feedback loop, which relies on yield and reliability, failed bit map analysis, analytical tools, inline monitoring, cross functional teams and a defect engineering group. The strategy requires the fastest detection, identification and implementation of possible corrective actions. Feedback cycle time is minimized at all points to improve yield and reliability and reduce costs, essential for competitiveness in the memory business. Payoff was a 9.4X reduction in defectivity and a 6.2X improvement in reliability of 256 K fast SRAMs over 20 months.

  20. Reliability improvement: where do we go from here

    International Nuclear Information System (INIS)

    Haueter, R.L.

    1976-01-01

    The present programs and the future plans in the area of power-plant productivity and reliability data collection and analyses are discussed. The shortcomings of the past industry efforts toward improving plant productivity are described, and some suggestions for improvement are presented

  1. Improving Reliability, Security, and Efficiency of Reconfigurable Hardware Systems (Habilitation)

    NARCIS (Netherlands)

    Ziener, Daniel

    2017-01-01

    In this treatise,  my research on methods to improve efficiency, reliability, and security of reconfigurable hardware systems, i.e., FPGAs, through partial dynamic reconfiguration is outlined. The efficiency of reconfigurable systems can be improved by loading optimized data paths on-the-fly on an

  2. Cost benefit justification of nuclear plant reliability improvement

    International Nuclear Information System (INIS)

    El-Sayed, M.A.H.; Abdelmonem, N.M.

    1986-01-01

    Nuclear power costs are evaluated on the bases of general ground rules (a) vary from time to time (b) vary from country to another (c) even vary from one reactor type to another. The main objective of an electric utility is to provide the electric energy to the different consummers at the lowest possible cost with reasonable reliability level. Rapid increase of the construction costs and fuel prices in recent years have stimulated a great deal of interest in improving the reliability and productivity of new and existing power plants. One of the most important areas is the improvement of the secondary steam loop and the reactor cooling system. The method for evaluating the reliability of steam loop and cooling system utilizes the cut-set technique. The developed method can be easily used to show to what extent the overall reliability of the nuclear plant is affected by the possible failures in the steam and cooling subsystem. The cost reliability trade-off analysis is used to evaluate alternative schemes in the design with a view towards meeting a high reliability goal. Based on historical or estimated failure and repair rate, the reliability of the alternate scheme can be calculated

  3. Improving the Reliability of Case-Based Reasoning Systems

    Directory of Open Access Journals (Sweden)

    Xu Xu

    2010-09-01

    also discussed in this paper, especially the property that whether inter-feature of case exists redundancy. After that, the reliability of an individual suggested solution is studied. To illustrate these ideas, some experiments and their results are discussed in this paper. The results of experiments show a new route concerning on how to improve the reliability of a CBR system at an overall level.

  4. Does quality improvement work in neonatology improve clinical outcomes?

    Science.gov (United States)

    Ellsbury, Dan L; Clark, Reese H

    2017-04-01

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

  5. Technology and equipment to improve reliability of pipeline transport

    Science.gov (United States)

    Suleimanov, D. F.; Shulayev, N. S.; Bondar, K. E.; Laponov, S. V.; Uzinger, A. A.

    2017-10-01

    The article is dedicated to development of technology and hardware design of method pipeline transport reliability improving by improving the isolated coating properties modified by microwave radiation. The article describes the technology of the modification process of the coating and instrumentation production, which allows improving operational properties not only in stationary conditions in the manufacture of the insulation coating, but also during its replacement in the field.

  6. Cost benefit justification of nuclear plant reliability improvement

    International Nuclear Information System (INIS)

    El-Sayed, M.A.H.; Abdelmonem, N.M.

    1985-01-01

    The design of the secondary steam loop of the nuclear power plant has a significant effect on the reliability of the plant. Moreover, the necessity to cool a reactor safely has increased the reliability demanded from the system. The rapidly rising construction costs and fuel prices in recent years have stimulated a great deal in optimizing the productivity of a nuclear power plant through reliability improvement of the secondary steamloop and the reactor cooling system. A method for evaluating the reliability of steam loop and cooling system of a nuclear power plant is presented. The method utilizes the cut-set technique. The developed method can be easily used to show to what extent the overall reliability of the nuclear plant is affected by the possible failures in the steam and cooling subsystem. A model for calculating the increase in the nuclear plant productivity resulting from a proposed improvement in the two subsystems reliability is discussed. The model takes into account the capital cost of spare parts for several components, replacement energy, operating and maintenance costs

  7. Severe acute pancreatitis : Improving outcome

    NARCIS (Netherlands)

    van Brunschot, S.

    2018-01-01

    This thesis contains results of 8 years of clinical research performed to improve the treatment of patients with acute pancreatitis. The first part of this thesis focusses on diagnostics and the prevention of complications. The applicability of the revised Atlanta classification for acute

  8. On Improving Reliability of SRAM-Based Physically Unclonable Functions

    Directory of Open Access Journals (Sweden)

    Arunkumar Vijayakumar

    2017-01-01

    Full Text Available Physically unclonable functions (PUFs have been touted for their inherent resistance to invasive attacks and low cost in providing a hardware root of trust for various security applications. SRAM PUFs in particular are popular in industry for key/ID generation. Due to intrinsic process variations, SRAM cells, ideally, tend to have the same start-up behavior. SRAM PUFs exploit this start-up behavior. Unfortunately, not all SRAM cells exhibit reliable start-up behavior due to noise susceptibility. Hence, design enhancements are needed for improving reliability. Some of the proposed enhancements in literature include fuzzy extraction, error-correcting codes and voting mechanisms. All enhancements involve a trade-off between area/power/performance overhead and PUF reliability. This paper presents a design enhancement technique for reliability that improves upon previous solutions. We present simulation results to quantify improvement in SRAM PUF reliability and efficiency. The proposed technique is shown to generate a 128-bit key in ≤0.2 μ s at an area estimate of 4538 μ m 2 with error rate as low as 10 − 6 for intrinsic error probability of 15%.

  9. Some approaches to system reliability improvement in engineering design

    International Nuclear Information System (INIS)

    Shen, Kecheng.

    1990-01-01

    In this thesis some approaches to system reliability improvement in engineering design are studied. In particular, the thesis aims at developing alternative methodologies for ranking of component importance which are more related to the design practice and which are more useful in system synthesis than the existing ones. It also aims at developing component reliability models by means of stress-strength interference which will enable both component reliability prediction and design for reliability. A new methodology for ranking of component importance is first developed based on the notion of the increase of the expected system yield. This methodology allows for incorporation of different improvement actions at the component level such as parallel redundancy, standby redundancy, burn-in, minimal repair and perfect replacement. For each of these improvement actions, the increase of system reliability is studied and used as the component importance measure. A possible connection between the commonly known models of component lifetimes and the stress-strength interference models is suggested. Under some general conditions the relationship between component failure rate and the stress and strength distribution characteristics is studied. A heuristic approach for obtaining bounds on failure probability through stress-strength interference is also presented. A case study and a worked example are presented, which illustrate and verify the developed importance measures and their applications in the analytical as well as synthetical work of engineering design. (author)

  10. Designing incentive market mechanisms for improving restructured power system reliabilities

    DEFF Research Database (Denmark)

    Ding, Yi; Østergaard, Jacob; Wu, Qiuwei

    2011-01-01

    state. The reliability management of producers usually cannot be directly controlled by the system operators in a restructured power system. Producers may have no motivation to improve their reliabilities, which can result in serious system unreliability issues in the new environment. Incentive market...... mechanisms for improving the restructured power system reliabilities have been designed in this paper. In the proposed incentive mechanisms, penalty will be implemented on a producer if the failures of its generator(s) result in the variation of electricity prices. Incentive market mechanisms can motivate......In a restructured power system, the monopoly generation utility is replaced by different electricity producers. There exists extreme price volatility caused by random failures by generation or/and transmission systems. In these cases, producers' profits can be much higher than those in the normal...

  11. System ergonomics as an approach to improve human reliability

    International Nuclear Information System (INIS)

    Bubb, H.

    1988-01-01

    The application of system technics on ergonomical problems is called system ergonomics. This enables improvements of human reliability by design measures. The precondition for this is the knowledge of how information processing is performed by man and machine. By a separate consideration of sensory processing, cognitive processing, and motory processing it is possible to have a more exact idea of the system element 'man'. The system element 'machine' is well described by differential equations which allow an ergonomical assessment of the manouverability. The knowledge of information processing of man and machine enables a task analysis. This makes appear on one hand the human boundaries depending on the different properties of the task and on the other hand suitable ergonomical solution proposals which improve the reliability of the total system. It is a disadvantage, however, that the change of human reliability by such measures may not be quoted numerically at the moment. (orig.)

  12. Orthogeriatric care: improving patient outcomes

    Directory of Open Access Journals (Sweden)

    Tarazona-Santabalbina FJ

    2016-06-01

    Full Text Available Francisco José Tarazona-Santabalbina,1,2 Ángel Belenguer-Varea,1,2 Eduardo Rovira,1,2 David Cuesta-Peredó1,21Geriatric Medicine Unit, Internal Medicine Department, Hospital Universitario de la Ribera, 2Medical School, Universidad Católica de Valencia San vicente Mártir, Valencia, SpainAbstract: Hip fractures are a very serious socio-economic problem in western countries. Since the 1950s, orthogeriatric units have introduced improvements in the care of geriatric patients admitted to hospital because of hip fractures. During this period, these units have reduced mean hospital stays, number of complications, and both in-hospital mortality and mortality over the middle term after hospital discharge, along with improvements in the quality of care and a reduction in costs. Likewise, a recent clinical trial has reported greater functional gains among the affected patients. Studies in this field have identified the prognostic factors present upon admission or manifesting themselves during admission and that increase the risk of patient mortality or disability. In addition, improved care afforded by orthogeriatric units has proved to reduce costs. Nevertheless, a number of management issues remain to be clarified, such as the optimum anesthetic, analgesic, and thromboprophylactic protocols; the type of diagnostic and therapeutic approach best suited to patients with cognitive problems; or the efficiency of the programs used in convalescence units or in home rehabilitation care. Randomized clinical trials are needed to consolidate the evidence in this regard. Keywords: hip fractures, geriatric assessment, orthogeriatric care, recovery of function, mortality

  13. Improvement on reliability of control system in power plant

    International Nuclear Information System (INIS)

    Taguchi, S.; Mizumoto, T.; Hirose, Y.; Kashiwai, J.; Takami, I.; Shono, M.; Roji, Y.; Kizaki, S.

    1985-01-01

    Studies made of Japanese PWR operating experiences have revealed that failures in the control system are the primary causes of unscheduled shutdowns. An attempt has, therefore, been made to improve the reliability of the control system in order to raise the plant reliability. The following are the procedures applied to solve the issue; study of operating experiences, fault tree analysis and failure mode and effects analysis. Improvement measures are developed for the control system whose failure threatens to cause the plant trip during the plant life. These systems are the main feedwater control system, rod control system, pressurizer control system and main steam control system in the primary control system. As a result, the plant unavailability is expected to be reduced significantly by applying the improvements. The improvements are applied to the plants under construction and the operating plants in co-operation with utilities and vendors. (author)

  14. Developing a system engineering program to improve performance and reliability

    International Nuclear Information System (INIS)

    Keuter, D.

    1985-01-01

    After several maintenance, operational, and equipment problems last year, Trojan set out on a mission to improve plant performance and reliability by strengthening its on-site engineering organization. This paper presents Trojan's plans in developing an on-site system engineering organization

  15. Improvement of plant reliability in PT. Badak LNG plant

    International Nuclear Information System (INIS)

    Achmad, S.; Somantri, A.

    1997-01-01

    PT. Badak's LNG sales commitment has been steadily increasing, therefore, there has been more emphasis to improve and maintain the LNG plant reliability. From plant operation historical records, Badak LNG plant experienced a high number of LNG process train trips and down time for 1977 through 1988. The highest annual number of LNG plant trips (50 times) occurred in 1983 and the longest LNG process train down time (1259 train-hours) occurred in 1988. Since 1989, PT. Badak has been able to reduce the number of LNG process train trips and down time significantly. In 1994 the number of LNG process train trips and was 18 times and the longest LNG process train down time was 377 train-hours. This plant reliability improvement was achieved by implementing plant reliability improvement programs beginning with the design of the new facilities and continuing with the maintenance and modification of the existing facilities. To improve reliability of the existing facilities, PT. Badak has been implementing comprehensive maintenance programs, to reduce the frequency and down time of the plant, such as Preventive and Predictive Maintenance as well as procurement material improvement since PT. Badak location is in a remote area. By implementing the comprehensive reliability maintenance, PT. Badak has been able to reduce the LNG process train trips to 18 and down time to 337 train hours in 1994 with the subsequent maintenance cost reduction. The average PT. Badak plant availability from 1985 to 1995 is 94.59%. New facilities were designed according to the established PT. Badak design philosophy, master plan and specification. Design of new facilities was modified to avoid certain problems from past experience. (au)

  16. Reliability improvement of multiversion software by exchanging modules

    International Nuclear Information System (INIS)

    Shima, Kazuyuki; Matsumoto, Ken-ichi; Torii, Koji

    1996-01-01

    In this paper, we proposes a method to improve reliability of multiversion software. In CER proposed in, checkpoints are put in versions of program and errors of versions are detected and recovered at the checkpoints. It prevent versions from failing and improve the reliability of multiversion software. But it is point out that CER decreases the reliability of the multiversion software if the detection and recovery of errors are assumed to be able to fail. In the method proposed in this paper, versions of program are developed following the same module specifications. When failures of versions of program are detected, faulty modules are identified and replaced them to other modules. It create versions without faulty modules and improve the reliability of multiversion software. The failure probability of multiversion software is estimated to become about a hundredth of the failure probability by the proposed method where the failure probability of each version is 0.000698, the number of versions is 5 and the number of modules is 20. (author)

  17. 78 FR 69018 - Improving the Resiliency of Mobile Wireless Communications Networks; Reliability and Continuity...

    Science.gov (United States)

    2013-11-18

    ... consumers value overall network reliability and quality in selecting mobile wireless service providers, they...-125] Improving the Resiliency of Mobile Wireless Communications Networks; Reliability and Continuity... (Reliability NOI) in 2011 to ``initiate a comprehensive examination of issues regarding the reliability...

  18. Reliability improvement methods for sapphire fiber temperature sensors

    Science.gov (United States)

    Schietinger, C.; Adams, B.

    1991-08-01

    Mechanical, optical, electrical, and software design improvements can be brought to bear in the enhancement of fiber-optic sapphire-fiber temperature measurement tool reliability in harsh environments. The optical fiber thermometry (OFT) equipment discussed is used in numerous process industries and generally involves a sapphire sensor, an optical transmission cable, and a microprocessor-based signal analyzer. OFT technology incorporating sensors for corrosive environments, hybrid sensors, and two-wavelength measurements, are discussed.

  19. Monolithic QCL design approaches for improved reliability and affordability

    Science.gov (United States)

    Law, K. K.

    2013-12-01

    Many advances have been made recently in mid-wave infrared and long-wave infrared quantum cascade lasers (QCLs) technologies, and there is an increasing demand for these laser sources for ever expanding Naval, DoD and homeland security applications. We will discuss in this paper a portfolio of various Naval Air Warfare Weapons Division's current and future small business innovative research programs and efforts on significantly improving QCLs' performance, affordability, and reliability.

  20. Reliability Improved Cooperative Communication over Wireless Sensor Networks

    Directory of Open Access Journals (Sweden)

    Zhuangbin Chen

    2017-10-01

    Full Text Available With the development of smart devices and connection technologies, Wireless Sensor Networks (WSNs are becoming increasingly intelligent. New or special functions can be obtained by receiving new versions of program codes to upgrade their software systems, forming the so-called smart Internet of Things (IoT. Due to the lossy property of wireless channels, data collection in WSNs still suffers from a long delay, high energy consumption, and many retransmissions. Thanks to wireless software-defined networks (WSDNs, software in sensors can now be updated to help them transmit data cooperatively, thereby achieving more reliable communication. In this paper, a Reliability Improved Cooperative Communication (RICC data collection scheme is proposed to improve the reliability of random-network-coding-based cooperative communications in multi-hop relay WSNs without reducing the network lifetime. In WSNs, sensors in different positions can have different numbers of packets to handle, resulting in the unbalanced energy consumption of the network. In particular, nodes in non-hotspot areas have up to 90% of their original energy remaining when the network dies. To efficiently use the residual energy, in RICC, high data transmission power is adopted in non-hotspot areas to achieve a higher reliability at the cost of large energy consumption, and relatively low transmission power is adopted in hotspot areas to maintain the long network lifetime. Therefore, high reliability and a long network lifetime can be obtained simultaneously. The simulation results show that compared with other scheme, RICC can reduce the end-to-end Message Fail delivering Ratio (MFR by 59.4%–62.8% under the same lifetime with a more balanced energy utilization.

  1. Test-Retest Reliability of Dual-Task Outcome Measures in People With Parkinson Disease.

    Science.gov (United States)

    Strouwen, Carolien; Molenaar, Esther A L M; Keus, Samyra H J; Münks, Liesbeth; Bloem, Bastiaan R; Nieuwboer, Alice

    2016-08-01

    Dual-task (DT) training is gaining ground as a physical therapy intervention in people with Parkinson disease (PD). Future studies evaluating the effect of such interventions need reliable outcome measures. To date, the test-retest reliability of DT measures in patients with PD remains largely unknown. The purpose of this study was to assess the reliability of DT outcome measures in patients with PD. A repeated-measures design was used. Patients with PD ("on" medication, Mini-Mental State Examination score ≥24) performed 2 cognitive tasks (ie, backward digit span task and auditory Stroop task) and 1 functional task (ie, mobile phone task) in combination with walking. Tasks were assessed at 2 time points (same hour) with an interval of 6 weeks. Test-retest reliability was assessed for gait while performing each secondary task (DT gait) for both cognitive tasks while walking (DT cognitive) and for the functional task while walking (DT functional). Sixty-two patients with PD (age=39-89 years, Hoehn and Yahr stages II-III) were included in the study. Intraclass correlation coefficients (ICCs) showed excellent reliability for DT gait measures, ranging between .86 and .95 when combined with the digit span task, between .86 and .95 when combined with the auditory Stroop task, and between .72 and .90 when combined with the mobile phone task. The standard error of measurements for DT gait speed varied between 0.06 and 0.08 m/s, leading to minimal detectable changes between 0.16 and 0.22 m/s. With regard to DT cognitive measures, reaction times showed good-to-excellent reliability (digit span task: ICC=.75; auditory Stroop task: ICC=.82). The results cannot be generalized to patients with advanced disease or to other DT measures. In people with PD, DT measures proved to be reliable for use in clinical studies and look promising for use in clinical practice to assess improvements after DT training. Large effects, however, are needed to obtain meaningful effect sizes.

  2. Improved FTA methodology and application to subsea pipeline reliability design.

    Science.gov (United States)

    Lin, Jing; Yuan, Yongbo; Zhang, Mingyuan

    2014-01-01

    An innovative logic tree, Failure Expansion Tree (FET), is proposed in this paper, which improves on traditional Fault Tree Analysis (FTA). It describes a different thinking approach for risk factor identification and reliability risk assessment. By providing a more comprehensive and objective methodology, the rather subjective nature of FTA node discovery is significantly reduced and the resulting mathematical calculations for quantitative analysis are greatly simplified. Applied to the Useful Life phase of a subsea pipeline engineering project, the approach provides a more structured analysis by constructing a tree following the laws of physics and geometry. Resulting improvements are summarized in comparison table form.

  3. Grant Peer Review: Improving Inter-Rater Reliability with Training.

    Science.gov (United States)

    Sattler, David N; McKnight, Patrick E; Naney, Linda; Mathis, Randy

    2015-01-01

    This study developed and evaluated a brief training program for grant reviewers that aimed to increase inter-rater reliability, rating scale knowledge, and effort to read the grant review criteria. Enhancing reviewer training may improve the reliability and accuracy of research grant proposal scoring and funding recommendations. Seventy-five Public Health professors from U.S. research universities watched the training video we produced and assigned scores to the National Institutes of Health scoring criteria proposal summary descriptions. For both novice and experienced reviewers, the training video increased scoring accuracy (the percentage of scores that reflect the true rating scale values), inter-rater reliability, and the amount of time reading the review criteria compared to the no video condition. The increase in reliability for experienced reviewers is notable because it is commonly assumed that reviewers--especially those with experience--have good understanding of the grant review rating scale. The findings suggest that both experienced and novice reviewers who had not received the type of training developed in this study may not have appropriate understanding of the definitions and meaning for each value of the rating scale and that experienced reviewers may overestimate their knowledge of the rating scale. The results underscore the benefits of and need for specialized peer reviewer training.

  4. Evolution and outcomes of a quality improvement program.

    Science.gov (United States)

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

    2010-01-01

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

  5. Do Municipal Mergers Improve Fiscal Outcomes?

    DEFF Research Database (Denmark)

    Hansen, Sune Welling; Houlberg, Kurt; Holm Pedersen, Lene

    2014-01-01

    Improved fiscal management is a frequent justification for promoting boundary consolidations. However, whether or not this is actually the case is rarely placed under rigorous empirical scrutiny. Hence, this article investigates if fiscal outcomes are improved when municipalities are merged....... The basic argument is that the conceptualisation of fiscal management in political science is often too narrow as it focuses on the budget and pays hardly any attention to balances in the final accounts and debts – elements of management which are central to policy making. On this background, the causal...... relationship between municipal mergers and fiscal outcomes is analysed. Measured on the balance between revenues and expenses, liquid assets and debts, municipal mergers improve the fiscal outcomes of the municipalities in a five-year perspective, although the pre-reform effects tend to be negative...

  6. System 80+ Design and Licensing : Improving Plant Reliability

    International Nuclear Information System (INIS)

    Newman, Robert E.

    1989-01-01

    The U. S. nuclear industry is striving to improve plant reliability and availability through improved plant design, component designs and plant maintenance. In an effort to improve safety and to demonstrate that commercial nuclear power is economically competitive with other energy sources, the utilities, nuclear vendors, architect engineers and constructors, and component suppliers are all participating in an industry-wide effort to develop improved Light Water Reactor (LWR) designs that are based upon the many years of successful LWR operation. In an age when the world faces the environmental pressures of the greenhouse effect and acid rain, electricity generated from nuclear energy must play an increasing role in the energy picture of Korea, the United States and the rest of the world. This paper discusses the plant availability requirement that has been established by the industry-wide effort mentioned above. After briefly describing Combustion Engineering's program for development of the System 80 Plus standard design and the participation of the Korea Advanced Energy Research Institute (KAERI) in the program, the paper then describes the design features that are being incorporated into System 80+. The industry ALRR Program has established a very ambitious criterion of 87% for the plant availability of future nuclear units. To satisfy such a requirement, the next generation of nuclear plants will include a great many design improvements that reflect the hundreds of years of operating experience that we have accrued. C-ESA's System 80+ will include a number of design changes that improve operating margins and make the plant easier to operate and maintain. Not surprisingly, there is a great deal of overlap between improved safety and improved reliability. In the end, our design will satisfy the future needs of the utilities, the regulators, and the public. C-E is very pleased that KAERI is working with US to achieve these important goals

  7. Can life coaching improve health outcomes?

    DEFF Research Database (Denmark)

    Ammentorp, Jette

    26. Ammentorp J, Uhrenfeldt L, Angel F, Ehrensvärd, Carlsen E, Kofoed P-E. Can life coaching improve health outcomes? – A systematic review of intervention studies. Poster presented at the International Conference on Communication in Healthcare, Montreal Canada, 30 Sept 2013.......26. Ammentorp J, Uhrenfeldt L, Angel F, Ehrensvärd, Carlsen E, Kofoed P-E. Can life coaching improve health outcomes? – A systematic review of intervention studies. Poster presented at the International Conference on Communication in Healthcare, Montreal Canada, 30 Sept 2013....

  8. The commissioning of CMS sites: Improving the site reliability

    International Nuclear Information System (INIS)

    Belforte, S; Fisk, I; Flix, J; Hernandez, J M; Klem, J; Letts, J; Magini, N; Saiz, P; Sciaba, A

    2010-01-01

    The computing system of the CMS experiment works using distributed resources from more than 60 computing centres worldwide. These centres, located in Europe, America and Asia are interconnected by the Worldwide LHC Computing Grid. The operation of the system requires a stable and reliable behaviour of the underlying infrastructure. CMS has established a procedure to extensively test all relevant aspects of a Grid site, such as the ability to efficiently use their network to transfer data, the functionality of all the site services relevant for CMS and the capability to sustain the various CMS computing workflows at the required scale. This contribution describes in detail the procedure to rate CMS sites depending on their performance, including the complete automation of the program, the description of monitoring tools, and its impact in improving the overall reliability of the Grid from the point of view of the CMS computing system.

  9. Reliability improvement through alternative designs-A case study

    International Nuclear Information System (INIS)

    Kumar, Saurabh; Chattopadhyay, Gopi; Kumar, Uday

    2007-01-01

    In today's competitive world, reliability of equipment is extremely important to maintain quality and delivery deadlines. This is achieved by using proper maintenance and design changes for unreliable subsystems and components of a complex system. It is significant to develop a strategy for maintenance, replacement and design changes related to those subsystems and components. An analysis of down time along with causes is essential to identify the unreliable components and subsystems. This paper presents an analysis of failure data of solenoid coils of automatic internal grinding machine used in a bearing manufacturing plant. It analyses various replacement and change of design options such as introduction of pneumatic system in place of electromagnetic solenoids for improvement of reliability of the plunger movement mechanism

  10. Photovoltaic module reliability improvement through application testing and failure analysis

    Science.gov (United States)

    Dumas, L. N.; Shumka, A.

    1982-01-01

    During the first four years of the U.S. Department of Energy (DOE) National Photovoltatic Program, the Jet Propulsion Laboratory Low-Cost Solar Array (LSA) Project purchased about 400 kW of photovoltaic modules for test and experiments. In order to identify, report, and analyze test and operational problems with the Block Procurement modules, a problem/failure reporting and analysis system was implemented by the LSA Project with the main purpose of providing manufacturers with feedback from test and field experience needed for the improvement of product performance and reliability. A description of the more significant types of failures is presented, taking into account interconnects, cracked cells, dielectric breakdown, delamination, and corrosion. Current design practices and reliability evaluations are also discussed. The conducted evaluation indicates that current module designs incorporate damage-resistant and fault-tolerant features which address field failure mechanisms observed to date.

  11. Improving inspection reliability through operator selection and training

    International Nuclear Information System (INIS)

    McGrath, Bernard; Carter, Luke

    2013-01-01

    A number of years ago the UK's Health and Safety Executive sponsored a series of three PANI projects investigating the application of manual ultrasonics, which endeavoured to establish the necessary steps that ensure a reliable inspection is performed. The results of the three projects were each reported separately on completion and also presented at number of international conferences. This paper summarises the results of these projects from the point of view of operator performance. The correlation of operator ultrasonic performance with results of aptitude tests is presented along with observations on the impact of training and qualifications of the operators. The results lead to conclusions on how the selection and training of operators could be modified to improve reliability of inspections.

  12. Zero tolerance for failure. An AREVA initiative to improve reliability

    International Nuclear Information System (INIS)

    Lippert, Hans-Joachim; Gentet, Guy; Mollard, Pierre; Garner, Norman

    2010-01-01

    Significant improvements in fuel reliability have been realized over the past 2 decades, but total elimination of failures has remained elusive. Driving reliability to higher levels requires a philosophy that does not accept that even infrequent and isolated failures are inevitable - it was on this foundation that Areva's Zero Tolerance for Failure (ZTF) initiative was established. This is not in itself either a program or project, but a fundamental shift in the way of thinking about work according to the following four principles: - Failures are avoidable, - Zero failures are our goal, - We will respond rapidly to any failure, - We succeed when we fix failures in a way that precludes recurrence. The shift to a ZTF philosophy is a broad change in corporate culture that expands the concept of failure far beyond cases where fuel rod cladding integrity is breached. While this paper specifically illustrates the ways in which ZTF has shaped the company's response to enhancing fuel rod reliability, ZTF extends to any failures of fuel products to deliver expected levels of performance, manufacturing processes to meet specifications and high first-pass acceptance criteria, and beyond to error-free performance of engineering analyses and cycle design and licensing services. Application of ZTF to enhancing fuel reliability deploys efforts in the areas of manufacturing, human factors, design, R and D, processes and product strategy. In order to achieve the necessary improvements, a number of important actions have been initiated across regions and facilities. In addition to these global scale projects and measures, each region contributes by adopting measures which are relevant to its particular activities and market needs. (orig.)

  13. Preoperative exercise training to improve postoperative outcomes

    NARCIS (Netherlands)

    Valkenet, K.

    2017-01-01

    It is common knowledge that better preoperative physical fitness is associated with better postoperative outcomes. However, as a result of aging of the population and improved surgical and anaesthesia techniques, the proportion of frail patients with decreased physical fitness levels undergoing

  14. Will Interventions Targeting Conscientiousness Improve Aging Outcomes?

    Science.gov (United States)

    English, Tammy; Carstensen, Laura L.

    2014-01-01

    The articles appearing in this special section discuss the role that conscientiousness may play in healthy aging. Growing evidence suggests that conscientious individuals live longer and healthier lives. However, the question remains whether this personality trait can be leveraged to improve long-term health outcomes. We argue that even though it…

  15. Improvement of Steam Generator Reliability for GEN-IV SFR

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Seong O; Kim Se Yun; Kim, Seok Hoon; Eoh, Jae Hyuk; Lee, Hyeong Yeon; Choi, Byung Seon

    2005-11-15

    The R and D items performed in this study were selected from the R and D task of ' Reliability improvement of Steam Generator' of GEN-IV SFR Component Design and BOP. Since this project deals with one of the most important issues for a GEN-IV SFR system, it needs to enhance the domestic technical backgrounds associated with the corresponding R and D items even for a very short period by 2005. This study provides the R and D results for i) Development of assessment methodology for dissimilar metal weld and ii) Development of multi-dimensional simulation methodology for a SWR event in a SFR steam generator.

  16. Improvement of Steam Generator Reliability for GEN-IV SFR

    International Nuclear Information System (INIS)

    Kim, Seong O; Kim Se Yun; Kim, Seok Hoon; Eoh, Jae Hyuk; Lee, Hyeong Yeon; Choi, Byung Seon

    2005-11-01

    The R and D items performed in this study were selected from the R and D task of ' Reliability improvement of Steam Generator' of GEN-IV SFR Component Design and BOP. Since this project deals with one of the most important issues for a GEN-IV SFR system, it needs to enhance the domestic technical backgrounds associated with the corresponding R and D items even for a very short period by 2005. This study provides the R and D results for i) Development of assessment methodology for dissimilar metal weld and ii) Development of multi-dimensional simulation methodology for a SWR event in a SFR steam generator

  17. Test-Retest Reliability of Dual-Task Outcome Measures in People With Parkinson Disease

    NARCIS (Netherlands)

    Strouwen, C.; Molenaar, E.A.; Keus, S.H.; Munks, L.; Bloem, B.R.; Nieuwboer, A.

    2016-01-01

    BACKGROUND: Dual-task (DT) training is gaining ground as a physical therapy intervention in people with Parkinson disease (PD). Future studies evaluating the effect of such interventions need reliable outcome measures. To date, the test-retest reliability of DT measures in patients with PD remains

  18. Parallel paths to improve heart failure outcomes

    DEFF Research Database (Denmark)

    Albert, Nancy M.

    2013-01-01

    -based, heart failure guidelines improves clinical outcomes. Thus, nurses and patients are on parallel paths related to setting the foundation for improved self-care adherence in advanced heart failure. Through research, we found that nurses were not adequately prepared as heart failure educators...... and that patients did not believe they were able to control heart failure. In 2 educational intervention studies that aimed to help patients understand that they could control fluid management and follow a strict daily fluid limit, patients had improved clinical outcomes. Thus, misperceptions about heart failure......Gaps and disparities in delivery of heart failure education by nurses and performance in accomplishing self-care behaviors by patients with advanced heart failure may be factors in clinical decompensation and unplanned consumption of health care. Is nurse-led education effectively delivered before...

  19. Improvement of Equipment reliability for Auxiliary Feed Water System

    Energy Technology Data Exchange (ETDEWEB)

    Deok, Lee Sang; Kwan, Lee Yong [KEPCO International Nuclear Graduate School, Ulsan (Korea, Republic of)

    2013-10-15

    According to AP913 ER) of INPO, Number of the event related to equipment is higher than others like external or human performance. In the top 25 systems, Auxiliary feed water system is the seventh highest among systems. AWFS consists of many component and complex system and Main Function of AFWS is to supply feedwater to the steam generators for the removal of heat from the RCS(Reactor Coolant System) in event the main feedwater system is unavailable following a transient or accident. Reliability of component means how well operate on demands and monitoring is necessary to keep track of condition of component. If component performance is lower than the required value, corrective action for failure mode should be done. The objective of this study is focused to improve of AF pump by adding the tasks of SHR(System Health Report) into the task of system engineer walkdown of PMT(Preventive Maintenance Template). Increasing the reliability of AF pump will contribute to improvement of reliability of AFWS. Based on operating history, there was high vibration of AF pump during performance test. In that case, there were a lot of maintenance works for normal operation of AF pump. Vibration problem related pump can't be detected by tasks of SE walkdown because it's not running during normal operation except for surveillance test. CHR(Component Health Report) of AF pump in AFWS can be made from necessary part which means monitoring and functional failure because problem of Stand-by pump can be covered by conducting monitoring and analysis of functional failure. To improve reliability of AF pump, walkdown of PMT and SHR should be conducted both in accordance with surveillance test frequency. Health of AF pump based on operation history can be verified first and then can find out which parts of pump are weak. Finally, weak part can be managed intensively and failure can be reduced according to SE walkdown. But this work can be risky and burdensome because all parts of

  20. Advanced reliability improvement of AC-modules (ARIA)

    International Nuclear Information System (INIS)

    Rooij, P.; Real, M.; Moschella, U.; Sample, T.; Kardolus, M.

    2001-09-01

    The AC-module is a relatively new development in PV-system technology and offers significant advantages over conventional PV-systems with a central inverter : e.g. increased modularity, ease of installation and freedom of system design. The Netherlands and Switzerland have a leading position in the field of AC-modules, both in terms of technology and of commercial and large-scale application. An obstacle towards large-scale market introduction of AC-modules is that the reliability and operational lifetime of AC-modules and the integrated inverters in particular are not yet proven. Despite the advantages, no module-integrated inverter has yet achieved large scale introduction. The AC-modules will lower the barrier towards market penetration. But due to the great interest in the new AC-module technology there is the risk of introducing a not fully proven product. This may damage the image of PV-systems. To speed up the development and to improve the reliability, research institutes and PV-industry will address the aspects of reliability and operational lifetime of AC-modules. From field experiences we learn that in general the inverter is still the weakest point in PV-systems. The lifetime of inverters is an important factor on reliability. Some authors are indicating a lifetime of 1.5 years, whereas the field experiences in Germany and Switzerland have shown that for central inverter systems, an availability of 97% has been achieved in the last years. From this point of view it is highly desirable that the operational lifetime and reliability of PV-inverters and especially AC-modules is demonstrated/improved to make large scale use of PV a success. Module Integrated Inverters will most likely be used in modules in the power range between 100 and 300 Watt DC-power. These are modules with more than 100 cells in series, assuming that the module inverter will benefit from the higher voltage. Hot-spot is the phenomenon that can occur when one or more cells of a string

  1. Outcomes-focused knowledge translation: a framework for knowledge translation and patient outcomes improvement.

    Science.gov (United States)

    Doran, Diane M; Sidani, Souraya

    2007-01-01

    Regularly accessing information that is current and reliable continues to be a challenge for front-line staff nurses. Reconceptualizing how nurses access information and designing appropriate decision support systems to facilitate timely access to information may be important for increasing research utilization. An outcomes-focused knowledge translation framework was developed to guide the continuous improvement of patient care through the uptake of research evidence and feedback data about patient outcomes. The framework operationalizes the three elements of the PARIHS framework at the point of care. Outcomes-focused knowledge translation involves four components: (a) patient outcomes measurement and real-time feedback about outcomes achievement; (b) best-practice guidelines, embedded in decision support tools that deliver key messages in response to patient assessment data; (c) clarification of patients' preferences for care; and (d) facilitation by advanced practice nurses and practice leaders. In this paper the framework is described and evidence is provided to support theorized relationships among the concepts in the framework. The framework guided the design of a knowledge translation intervention aimed at continuous improvement of patient care and evidence-based practice, which are fostered through real-time feedback data about patient outcomes, electronic access to evidence-based resources at the point of care, and facilitation by advanced practice nurses. The propositions in the framework need to be empirically tested through future research.

  2. Reliability and validity of the Health Outcomes Burn Questionnaire for infants and children in The Netherlands

    NARCIS (Netherlands)

    van Baar, M. E.; Essink-Bot, M. L.; Oen, I. M. M. H.; Dokter, J.; Boxma, H.; Hinson, M. I.; van Loey, N. E. E.; Faber, A. W.; van Beeck, E. F.

    2006-01-01

    The Health Outcomes Burn Questionnaire (HOBQ) is a self-administered questionnaire to monitor outcome after burns in young children. This study aimed to assess feasibility, reliability and validity of the Dutch version of the HOBQ. The HOBQ was adapted into Dutch and tested in a population of

  3. Improving Acquisition Outcomes with Contextual Ambidexterity

    DEFF Research Database (Denmark)

    Meglio, Olimpia; King, David R.; Risberg, Annette

    2015-01-01

    The results of research on mergers and acquisitions often point to a need to improve acquisition outcomes and lessen the organizational turmoil that can often follow integration efforts. We assert that viewing acquisition integration through the lens of contextual ambidexterity may improve...... acquisition outcomes in two ways: by providing an integrated solution to the economic and social tensions in acquisitions, and by enabling managers to effectively confront the competing needs of task and human integration. We also posit that by building on contextual ambidexterity, we can extend...... the possibilities for both research and practice regarding task and human integration in acquisitions. We also emphasize the role of an integration manager and integration mechanisms in enabling contextual ambidexterity for successful acquisition integration. Finally, we identify implications for research...

  4. Push for Progress Inspired Improved Outcomes

    Directory of Open Access Journals (Sweden)

    Jacob L. Bidwell

    2017-11-01

    Full Text Available The author and issue editor describes the changing faces of health care as well as movements undertaken by U.S. health systems over the last two decades to improve the treatment and documented outcomes of minority or impoverished patients and to understand the impact of cultural differences on patient care. While much progress has been made, achieving health equity will require the continued efforts of many working toward this goal.

  5. Improved reliability, maintainability and safety through elastomer upgrading

    International Nuclear Information System (INIS)

    Wensel, R.; Wittich, K.C.

    1995-01-01

    Equipment in nuclear plants has historically contained whatever elastomer each component supplier traditionally used for corresponding non-nuclear service. The resulting proliferation of elastomer compounds, many of which are far from optimal for the service conditions (e.g., pressure, temperature, radiation, etc.), has multiplied the costs to provide station reliability, maintainability and safety. Cost-effective improvements are being achieved in CANDU plants by upgrading and standardizing on a handful of high performing elastomer compounds. These upgraded materials offer significant gains in service life over the materials they replace (often by factors of 2 or more). This rationalization of elastomer compounds also facilitates the EQ process for safety-related equipment. Detailed test data on aging is currently being generated for these specific elastomers, encompassing the conditions and media (air, water, oil) common in CANDU service. Two key elements characterize this testing. First, each result is specific to the compound used in the test, and second, it is specific to the tested failure mode (e.g., compression set, extrusion, fracture, etc.). Having fewer, but more thoroughly tested compounds, avoids the penalty (associated with poorly characterized materials) of having to replace parts prematurely because of conservatism, while maintaining safe, reliable service. This paper provides an overview of this approach covering: the benefits of compound rationalization; and the how and why of establishing relevant failure criteria; appropriate quality assurance to maintain EQ; procurement, storage and handling guidelines; and monitoring and predicting in-service degradation. (author)

  6. Improving Electronic Sensor Reliability by Robust Outlier Screening

    Directory of Open Access Journals (Sweden)

    Federico Cuesta

    2013-10-01

    Full Text Available Electronic sensors are widely used in different application areas, and in some of them, such as automotive or medical equipment, they must perform with an extremely low defect rate. Increasing reliability is paramount. Outlier detection algorithms are a key component in screening latent defects and decreasing the number of customer quality incidents (CQIs. This paper focuses on new spatial algorithms (Good Die in a Bad Cluster with Statistical Bins (GDBC SB and Bad Bin in a Bad Cluster (BBBC and an advanced outlier screening method, called Robust Dynamic Part Averaging Testing (RDPAT, as well as two practical improvements, which significantly enhance existing algorithms. Those methods have been used in production in Freescale® Semiconductor probe factories around the world for several years. Moreover, a study was conducted with production data of 289,080 dice with 26 CQIs to determine and compare the efficiency and effectiveness of all these algorithms in identifying CQIs.

  7. Improving the reliability of fishery predictions under climate change

    DEFF Research Database (Denmark)

    Brander, Keith

    2015-01-01

    The increasing number of publications assessing impacts of climate change on marine ecosystems and fisheries attests to rising scientific and public interest. A selection of recent papers, dealing more with biological than social and economic aspects, is reviewed here, with particular attention...... to the reliability of projections of climate impacts on future fishery yields. The 2014 Intergovernmental Panel on Climate Change (IPCC) report expresses high confidence in projections that mid- and high-latitude fish catch potential will increase by 2050 and medium confidence that low-latitude catch potential...... understanding of climate impacts, such as how to improve coupled models from physics to fish and how to strengthen confidence in analysis of time series...

  8. Developing Predictive Maintenance Expertise to Improve Plant Equipment Reliability

    International Nuclear Information System (INIS)

    Wurzbach, Richard N.

    2002-01-01

    On-line equipment condition monitoring is a critical component of the world-class production and safety histories of many successful nuclear plant operators. From addressing availability and operability concerns of nuclear safety-related equipment to increasing profitability through support system reliability and reduced maintenance costs, Predictive Maintenance programs have increasingly become a vital contribution to the maintenance and operation decisions of nuclear facilities. In recent years, significant advancements have been made in the quality and portability of many of the instruments being used, and software improvements have been made as well. However, the single most influential component of the success of these programs is the impact of a trained and experienced team of personnel putting this technology to work. Changes in the nature of the power generation industry brought on by competition, mergers, and acquisitions, has taken the historically stable personnel environment of power generation and created a very dynamic situation. As a result, many facilities have seen a significant turnover in personnel in key positions, including predictive maintenance personnel. It has become the challenge for many nuclear operators to maintain the consistent contribution of quality data and information from predictive maintenance that has become important in the overall equipment decision process. These challenges can be met through the implementation of quality training to predictive maintenance personnel and regular updating and re-certification of key technology holders. The use of data management tools and services aid in the sharing of information across sites within an operating company, and with experts who can contribute value-added data management and analysis. The overall effectiveness of predictive maintenance programs can be improved through the incorporation of newly developed comprehensive technology training courses. These courses address the use of

  9. Use of Human Reliability Insights to Improve Decision-Making

    International Nuclear Information System (INIS)

    Julius, J. A.; Moieni, P.; Grobbelaar, J.; Kohlhepp, K.

    2016-01-01

    This paper describes the use of insights obtained during the development and application of human reliability analysis (HRA) as part of a probabilistic risk assessment (PRA) to support decision-making, including improvements to operations, training, and safety culture. Insights have been gained from the development and application of HRA as part of a PRA for nuclear power plants in the USA, Europe and Asia over the last two decades. These models consist of Level 1 and Level 2 PRA models of internal and external events, during full power and shutdown modes of plant operation. These insights include the use of human factors information to improve the qualitative portion of the HRA. The subsequent quantification in the HRA effectively prioritises the contributors to the unreliability of operator actions, and the process facilitates the identification of the factors that are important to the success of the operator actions. Additionally, the tools and techniques also allow for the evaluation of key assumptions and sources of uncertainty. The end results have been used to effectively support decision-making for day-to-day plant operations as well as licensing issues. HRA results have been used to provide feedback and improvements to plant procedures, operator training and other areas contributing the plant safety culture. Examples of the types of insights are presented in this paper. (author)

  10. Network information improves cancer outcome prediction.

    Science.gov (United States)

    Roy, Janine; Winter, Christof; Isik, Zerrin; Schroeder, Michael

    2014-07-01

    Disease progression in cancer can vary substantially between patients. Yet, patients often receive the same treatment. Recently, there has been much work on predicting disease progression and patient outcome variables from gene expression in order to personalize treatment options. Despite first diagnostic kits in the market, there are open problems such as the choice of random gene signatures or noisy expression data. One approach to deal with these two problems employs protein-protein interaction networks and ranks genes using the random surfer model of Google's PageRank algorithm. In this work, we created a benchmark dataset collection comprising 25 cancer outcome prediction datasets from literature and systematically evaluated the use of networks and a PageRank derivative, NetRank, for signature identification. We show that the NetRank performs significantly better than classical methods such as fold change or t-test. Despite an order of magnitude difference in network size, a regulatory and protein-protein interaction network perform equally well. Experimental evaluation on cancer outcome prediction in all of the 25 underlying datasets suggests that the network-based methodology identifies highly overlapping signatures over all cancer types, in contrast to classical methods that fail to identify highly common gene sets across the same cancer types. Integration of network information into gene expression analysis allows the identification of more reliable and accurate biomarkers and provides a deeper understanding of processes occurring in cancer development and progression. © The Author 2012. Published by Oxford University Press. For Permissions, please email: journals.permissions@oup.com.

  11. CBT competence in novice therapists improves anxiety outcomes.

    Science.gov (United States)

    Brown, Lily A; Craske, Michelle G; Glenn, Daniel E; Stein, Murray B; Sullivan, Greer; Sherbourne, Cathy; Bystritsky, Alexander; Welch, Stacy S; Campbell-Sills, Laura; Lang, Ariel; Roy-Byrne, Peter; Rose, Raphael D

    2013-02-01

    This study explores the relationships between therapist variables (cognitive behavioral therapy [CBT] competence, and CBT adherence) and clinical outcomes of computer-assisted CBT for anxiety disorders delivered by novice therapists in a primary care setting. Participants were recruited for a randomized controlled trial of evidence-based treatment, including computer-assisted CBT, versus treatment as usual. Therapists (anxiety clinical specialists; ACSs) were nonexpert clinicians, many of whom had no prior experience in delivering psychotherapy (and in particular, very little experience with CBT). Trained raters reviewed randomly selected treatment sessions from 176 participants and rated therapists on measures of CBT competence and CBT adherence. Patients were assessed at baseline and at 6-, 12-, and 18-month follow-ups on measures of anxiety, depression, and functioning, and an average Reliable Change Index was calculated as a composite measure of outcome. CBT competence and CBT adherence were entered as predictors of outcome, after controlling for baseline covariates. Higher CBT competence was associated with better clinical outcomes whereas CBT adherence was not. Also, CBT competence was inversely correlated with years of clinical experience and trended (not significantly, though) down as the study progressed. CBT adherence was inversely correlated with therapist tenure in the study. Therapist competence was related to improved clinical outcomes when CBT for anxiety disorders was delivered by novice clinicians with technology assistance. The results highlight the value of the initial training for novice therapists as well as booster training to limit declines in therapist adherence. © 2012 Wiley Periodicals, Inc.

  12. Improving reliability in south Ajax with IntelliTEAM

    Energy Technology Data Exchange (ETDEWEB)

    Starck, A.P. [Veridian Connections Inc., Ajax, ON (Canada)

    2010-07-01

    Veridian Connections Incorporated is a local electricity distribution company in Ontario that is faced with end of life feeder cables and an aging system. Most of the feeders are combined overhead and underground cables supplied from several substations with a limited transfer capability. The commercial activity in the utility's service area is intolerant to sustained outages. Although the initial plan was to replace the cables, capital and time constraints led the utility to chose the IntelliTEAM 2 system to improve reliability, by reducing the frequency, duration and impact of outages. The unique system is based on submersible switchgear, PulseClosing and includes the substation breakers as IntelliTEAM devices. The current plan to implement a smart grid turns sustained outages into momentary outages; reduces the number of customers affected by a sustained failure; improves the ability to transfer loads; and reduces stresses on aged cables. The self healing system restores customers in less than a minute and provides visibility to SCADA operators through a high speed SpeedNet radio system. tabs., figs.

  13. Improving Information Technology Curriculum Learning Outcomes

    Directory of Open Access Journals (Sweden)

    Derrick L Anderson

    2017-06-01

    The case study research methodology has been selected to conduct the inquiry into this phenomenon. This empirical inquiry facilitates exploration of a contemporary phenomenon in depth within its real-life context using a variety of data sources. The subject of analysis will be two Information Technology classes composed of a combination of second year and third year students; both classes have six students, the same six students. Contribution It is the purpose of this research to show that the use of improved approaches to learning will produce more desirable learning outcomes. Findings The results of this inquiry clearly show that the use of the traditional behaviorist based pedagogic model to achieve college and university IT program learning outcomes is not as effective as a more constructivist based andragogic model. Recommendations Instruction based purely on either of these does a disservice to the typical college and university level learner. The correct approach lies somewhere in between them; the most successful outcome attainment would be the product of incorporating the best of both. Impact on Society Instructional strategies produce learning outcomes; learning outcomes demonstrate what knowledge has been acquired. Acquired knowledge is used by students as they pursue professional careers and other ventures in life. Future Research Learning and teaching approaches are not “one-size-fits-all” propositions; different strategies are appropriate for different circumstances and situations. Additional research should seek to introduce vehicles that will move learners away from one the traditional methodology that has been used throughout much of their educational careers to an approach that is better suited to equip them with the skills necessary to meet the challenges awaiting them in the professional world.

  14. Cognitive outcome and reliable change indices two years following bilateral subthalamic nucleus deep brain stimulation.

    Science.gov (United States)

    Williams, Amy E; Arzola, Gladys Marina; Strutt, Adriana M; Simpson, Richard; Jankovic, Joseph; York, Michele K

    2011-06-01

    Subthalamic nucleus deep brain stimulation (STN-DBS) is currently the treatment of choice for medication-resistant levodopa-related motor complications in patients with Parkinson's disease (PD). While STN-DBS often results in meaningful motor improvements, consensus regarding long-term neuropsychological outcome continues to be debated. We assessed the cognitive outcomes of 19 STN-DBS patients compared to a group of 18 medically-managed PD patients on a comprehensive neuropsychological battery at baseline and two years post-surgery. Patients did not demonstrate changes in global cognitive functioning on screening measures. However, neuropsychological results revealed impairments in nonverbal recall, oral information processing speed, and lexical and semantic fluency in STN-DBS patients compared to PD controls 2 years post-surgery in these preliminary analyses. Additionally, reliable change indices revealed that approximately 50% of STN-DBS patients demonstrated significant declines in nonverbal memory and oral information processing speed compared to 25-30% of PD controls, and 26% of STN-DBS patients declined on lexical fluency compared to 11% of PD patients. Approximately 30% of both groups declined on semantic fluency. The number of STN-DBS patients who converted to dementia 2 years following surgery was not significantly different from the PD participants (32% versus 16%, respectively). Our results suggest that neuropsychological evaluations may identify possible mild cognitive changes following surgery. Copyright © 2011 Elsevier Ltd. All rights reserved.

  15. Domestic manufacturing and reliability improvement of reactor water recirculation equipment

    International Nuclear Information System (INIS)

    Kobayashi, Hidekazu; Oi, Masao; Shida, Toichi; Yokomori, Takashi

    1982-01-01

    The reactor coolant recirculation system is one of the important systems to control the reactor output in BWR nuclear power plants. Its components require high reliability and maintainability as well as controllability. For many Japanese nuclear power plants, recirculation pumps, fluid couplings and others have been imported so far. Hitachi Ltd. has established a domestic manufacturing organization through the development and test of these equipment. The fundamental design conditions for these equipment are the improvement of the rate of utilization of plant facility, the capability to follow load, and output power stability. In this paper, the specifications, the investigation of moment of inertia and the design features of recirculation pumps, driving motors and variable frequency power supply systems are described. The paper also reports on the combination test implemented to evaluate the recirculation system. The combination test includes the test using water rheostat for the power source facility and the loading test for a recirculation pump. The application of those system equipment to an actual plant was analyzed and evaluated on a basis of the test data obtained. The result showed that the equipment can achieve the rate of change of reactor power of 30%/min. Those equipment have been employed for No. 2 reactor plant of the Fukushima No. 2 Nuclear Power Station, the Tokyo Electric Power Co., Inc. (Wakatsuki, Y.)

  16. Diversity combining in laser Doppler vibrometry for improved signal reliability

    International Nuclear Information System (INIS)

    Dräbenstedt, Alexander

    2014-01-01

    Because of the speckle nature of the light reflected from rough surfaces the signal quality of a vibrometer suffers from varying signal power. Deep signal outages manifest themselves as noise bursts and spikes in the demodulated velocity signal. Here we show that the signal quality of a single point vibrometer can be substantially improved by diversity reception. This concept is widely used in RF communication and can be transferred into optical interferometry. When two statistically independent measurement channels are available which measure the same motion on the same spot, the probability for both channels to see a signal drop-out at the same time is very low. We built a prototype instrument that uses polarization diversity to constitute two independent reception channels that are separately demodulated into velocity signals. Send and receive beams go through different parts of the aperture so that the beams can be spatially separated. The two velocity channels are mixed into one more reliable signal by a PC program in real time with the help of the signal power information. An algorithm has been developed that ensures a mixing of two or more channels with minimum resulting variance. The combination algorithm delivers also an equivalent signal power for the combined signal. The combined signal lacks the vast majority of spikes that are present in the raw signals and it extracts the true vibration information present in both channels. A statistical analysis shows that the probability for deep signal outages is largely decreased. A 60 fold improvement can be shown. The reduction of spikes and noise bursts reduces the noise in the spectral analysis of vibrations too. Over certain frequency bands a reduction of the noise density by a factor above 10 can be shown

  17. Study on the improvement of nuclear fuel cladding reliability

    International Nuclear Information System (INIS)

    Rheem, Karp Soon; Han, Jung Ho; Jeong, Yong Hwan; Lee, Deok Hyun

    1987-12-01

    In order to improve the nuclear fuel cladding reliability for high burn-up fuels, the corrosion resistance of laser beam surface treated and β-quenched zircaloys and the mechanical characteristics including fatigue, burst, and out-of-pile PCMI characteristics of heat treated zircaloys were investigated. In addition, the inadiation characteristics of Ko-Ri reactor fuel claddings was examined. It was found that the wasteside corrosion resistance of commercial zircaloys was improved remarkably by laser beam surface treatment. The out-of-pile transient cladding failures were investigated in terms of hoop stress versus time-to-failures by means of mandrel loading units at 25 deg C and 325 deg C. Fatigue characteristics of the β-quenched and as-received zircaloy cladding were investigated by using an internal oil pressurization method which can simulate the load-following operation cycle. The results were in good agreement with the existing data obtained by conventional methods for commercial zircaloys. Burst tests were performed with commercial and the β-quenched zircaloys in high pressure argon gas atmosphere as a function of burst temperature. The burst stress decreased linearly in the α phase region up to 600 deg C and hereafter the decrement of the burst stress decreased gradually with temperature in the β-phase region. For the first time, the burst characteristic of the irradiated zircaloy-4 cladding tubes released from Ko-Ri nuclear power unit 1 was investigated, and attempts were made to trace the cause of cladding failures by examining the failed structure and fret marks by debris. (Author)

  18. Reliability assessment and correlation analysis of evaluating orthodontic treatment outcome in Chinese patients

    OpenAIRE

    Song, Guang-Ying; Zhao, Zhi-He; Ding, Yin; Bai, Yu-Xing; Wang, Lin; He, Hong; Shen, Gang; Li, Wei-Ran; Baumrind, Sheldon; Geng, Zhi; Xu, Tian-Min

    2013-01-01

    This study aimed to assess the reliability of experienced Chinese orthodontists in evaluating treatment outcome and to determine the correlations between three diagnostic information sources. Sixty-nine experienced Chinese orthodontic specialists each evaluated the outcome of orthodontic treatment of 108 Chinese patients. Three different information sources: study casts (SC), lateral cephalometric X-ray images (LX) and facial photographs (PH) were generated at the end of treatment for 108 pat...

  19. Comparison of reliability and responsiveness of patient-reported clinical outcome measures in knee osteoarthritis rehabilitation.

    Science.gov (United States)

    Williams, Valerie J; Piva, Sara R; Irrgang, James J; Crossley, Chad; Fitzgerald, G Kelley

    2012-08-01

    Secondary analysis, pretreatment-posttreatment observational study. To compare the reliability and responsiveness of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the Knee Outcome Survey activities of daily living subscale (KOS-ADL), and the Lower Extremity Functional Scale (LEFS) in individuals with knee osteoarthritis (OA). The WOMAC is the current standard in patient-reported measures of function in patients with knee OA. The KOS-ADL and LEFS were designed for potential use in patients with knee OA. If the KOS-ADL and LEFS are to be considered viable alternatives to the WOMAC for measuring patient-reported function in individuals with knee OA, they should have measurement properties comparable to the WOMAC. It would also be important to determine whether either of these instruments may be superior to the WOMAC in terms of reliability or responsiveness in this population. Data from 168 subjects with knee OA, who participated in a rehabilitation program, were used in the analyses. Reliability and responsiveness of each outcome measure were estimated at follow-ups of 2, 6, and 12 months. Reliability was estimated by calculating the intraclass correlation coefficient (ICC2,1) for subjects who were unchanged in status from baseline at each follow-up time, based on a global rating of change score. To examine responsiveness, the standard error of the measurement, minimal detectable change, minimal clinically important difference, and the Guyatt responsiveness index were calculated for each outcome measure at each follow-up time. All 3 outcome measures demonstrated reasonable reliability and responsiveness to change. Reliability and responsiveness tended to decrease somewhat with increasing follow-up time. There were no substantial differences between outcome measures for reliability or any of the 3 measures of responsiveness at any follow-up time. The results do not indicate that one outcome measure is more reliable or responsive than

  20. An accurate and efficient reliability-based design optimization using the second order reliability method and improved stability transformation method

    Science.gov (United States)

    Meng, Zeng; Yang, Dixiong; Zhou, Huanlin; Yu, Bo

    2018-05-01

    The first order reliability method has been extensively adopted for reliability-based design optimization (RBDO), but it shows inaccuracy in calculating the failure probability with highly nonlinear performance functions. Thus, the second order reliability method is required to evaluate the reliability accurately. However, its application for RBDO is quite challenge owing to the expensive computational cost incurred by the repeated reliability evaluation and Hessian calculation of probabilistic constraints. In this article, a new improved stability transformation method is proposed to search the most probable point efficiently, and the Hessian matrix is calculated by the symmetric rank-one update. The computational capability of the proposed method is illustrated and compared to the existing RBDO approaches through three mathematical and two engineering examples. The comparison results indicate that the proposed method is very efficient and accurate, providing an alternative tool for RBDO of engineering structures.

  1. New Methods for Building-In and Improvement of Integrated Circuit Reliability

    NARCIS (Netherlands)

    van der Pol, J.A.; van der Pol, Jacob Antonius

    2000-01-01

    Over the past 30 years the reliability of semiconductor products has improved by a factor of 100 while at the same time the complexity of the circuits has increased by a factor 105. This 7-decade reliability improvement has been realised by implementing a sophisticated reliability assurance system

  2. Fatigue is a reliable, sensitive and unique outcome measure in rheumatoid arthritis.

    LENUS (Irish Health Repository)

    Minnock, Patricia

    2009-12-01

    Fatigue is an important symptom in patients with RA. Measurement of fatigue in clinical trials and in clinical practice requires scales that are reproducible, sensitive to change and practical. This study examined the reliability and sensitivity to change of fatigue and its relative independence as an outcome measure in RA.

  3. Perforated peptic ulcer: How to improve outcome?

    DEFF Research Database (Denmark)

    Møller, Morten Hylander; Adamsen, Sven; Wøjdemann, Morten

    2008-01-01

    Despite the introduction of histamine H(2)-receptor antagonists, proton-pump inhibitors and the discovery of Helicobacter pylori, both the incidence of emergency surgery for perforated peptic ulcer and the mortality rate for patients undergoing surgery for peptic ulcer perforation have increased...... with an emphasis on risks that are preventable. A systematic review including randomized studies was carried out. There are a limited number of studies of patients with peptic ulcer perforation. Most of these studies are of low evidential status. Only a few randomized, controlled trials have been published...... to improve the outcome of patients with peptic ulcer perforation, sepsis needs to be factored into the existing knowledge and treatment Udgivelsesdato: 2008/8/27...

  4. Improving Outcomes Following Penetrating Colon Wounds

    Science.gov (United States)

    Miller, Preston R.; Fabian, Timothy C.; Croce, Martin A.; Magnotti, Louis J.; Elizabeth Pritchard, F.; Minard, Gayle; Stewart, Ronald M.

    2002-01-01

    . More destructive injuries were managed in the CP group (27% vs. 19%). Abscess rate was lower in the CP group (27% vs. 37%), as was suture line leak rate (7% vs. 14%). Colon related mortality in the CP group was 5% as compared with 12% in the PS group. Conclusions The clinical pathway for destructive colon wound management has improved outcomes as measured by anastomotic leak rates and colon related mortality. The data demonstrated the need for colostomy in the face of shock and comorbidities. Institution of this pathway results in colostomy for only 7% of all colon wounds. PMID:12035033

  5. Improving Metrological Reliability of Information-Measuring Systems Using Mathematical Modeling of Their Metrological Characteristics

    Science.gov (United States)

    Kurnosov, R. Yu; Chernyshova, T. I.; Chernyshov, V. N.

    2018-05-01

    The algorithms for improving the metrological reliability of analogue blocks of measuring channels and information-measuring systems are developed. The proposed algorithms ensure the optimum values of their metrological reliability indices for a given analogue circuit block solution.

  6. Fuel R and D to improve fuel reliability

    International Nuclear Information System (INIS)

    Yang, Rosa; Cheng, Bo; Deshon, Jeff; Edsinger, Kurt; Ozer, Odelli

    2006-01-01

    Light water reactor fuel is operating in an increasingly challenging environment. Fuel burnup extension and cycle length increase both can increase the local duty. Reactor water chemistry modifications for the purpose of protection the plant system materials have the potential of increasing fuel surface deposition and cladding corrosion and hydriding. The status of fuel performance in US reactors is summarized and an update of the Fuel Reliability Program' established by the utility industry to ensure reliability is provided. (author)

  7. Reliability and validity analysis of the open-source Chinese Foot and Ankle Outcome Score (FAOS).

    Science.gov (United States)

    Ling, Samuel K K; Chan, Vincent; Ho, Karen; Ling, Fona; Lui, T H

    2017-12-21

    Develop the first reliable and validated open-source outcome scoring system in the Chinese language for foot and ankle problems. Translation of the English FAOS into Chinese following regular protocols. First, two forward-translations were created separately, these were then combined into a preliminary version by an expert committee, and was subsequently back-translated into English. The process was repeated until the original and back translations were congruent. This version was then field tested on actual patients who provided feedback for modification. The final Chinese FAOS version was then tested for reliability and validity. Reliability analysis was performed on 20 subjects while validity analysis was performed on 50 subjects. Tools used to validate the Chinese FAOS were the SF36 and Pain Numeric Rating Scale (NRS). Internal consistency between the FAOS subgroups was measured using Cronbach's alpha. Spearman's correlation was calculated between each subgroup in the FAOS, SF36 and NRS. The Chinese FAOS passed both reliability and validity testing; meaning it is reliable, internally consistent and correlates positively with the SF36 and the NRS. The Chinese FAOS is a free, open-source scoring system that can be used to provide a relatively standardised outcome measure for foot and ankle studies. Copyright © 2017 Elsevier Ltd. All rights reserved.

  8. Reliability of computerized cephalometric outcome predictions of mandibular set-back surgery

    Directory of Open Access Journals (Sweden)

    Stefanović Neda

    2011-01-01

    Full Text Available Introduction. A successful treatment outcome in dentofacial deformity patients commonly requires combined orthodontic-surgical therapy. This enables us to overcome functional, aesthetic and psychological problems. Since most patients state aesthetics as the primary motive for seeking therapy, cephalometric predictions of treatment outcome have become the essential part of treatment planning, especially in combined orthodontic-surgical cases. Objective. The aim of this study was to evaluate the validity and reliability of computerized orthognathic surgery outcome predictions generated using the Nemotec Dental Studio NX 2005 software. Methods. The sample of the study consisted of 31 patients diagnosed with mandibular prognathism who were surgically treated at the Hospital for Maxillofacial Surgery in Belgrade. Investigation was done on lateral cephalograms made before and after surgical treatment. Cephalograms were digitized and analyzed using computer software. According to measurements made on superimposed pre- and postsurgical cephalograms, the patients were retreated within the software and the predictions were assessed by measuring seven angular and three linear parameters. Prediction measurements were then compared with the actual outcome. Results. Results showed statistically significant changes between posttreatment and predicted values for parameters referring to lower lip and mentolabial sulcus position. Conclusion. Computerized cephalometric predictions for hard-tissue structures in the sagittal and vertical planes, as well as the VTO parameters, generated using the Nemotec Dental Studio NX 2005 software are reliable, while lower lip and mentolabial sulcus position predictions are not reliable enough.

  9. The Reliability and Predictive Ability of a Biomarker of Oxidative DNA Damage on Functional Outcomes after Stroke Rehabilitation

    Directory of Open Access Journals (Sweden)

    Yu-Wei Hsieh

    2014-04-01

    Full Text Available We evaluated the reliability of 8-hydroxy-2'-deoxyguanosine (8-OHdG, and determined its ability to predict functional outcomes in stroke survivors. The rehabilitation effect on 8-OHdG and functional outcomes were also assessed. Sixty-one stroke patients received a 4-week rehabilitation. Urinary 8-OHdG levels were determined by liquid chromatography–tandem mass spectrometry. The test-retest reliability of 8-OHdG was good (interclass correlation coefficient = 0.76. Upper-limb motor function and muscle power determined by the Fugl-Meyer Assessment (FMA and Medical Research Council (MRC scales before rehabilitation showed significant negative correlation with 8-OHdG (r = −0.38, r = −0.30; p < 0.05. After rehabilitation, we found a fair and significant correlation between 8-OHdG and FMA (r = −0.34 and 8-OHdG and pain (r = 0.26, p < 0.05. Baseline 8-OHdG was significantly correlated with post-treatment FMA, MRC, and pain scores (r = −0.34, −0.31, and 0.25; p < 0.05, indicating its ability to predict functional outcomes. 8-OHdG levels were significantly decreased, and functional outcomes were improved after rehabilitation. The exploratory study findings conclude that 8-OHdG is a reliable and promising biomarker of oxidative stress and could be a valid predictor of functional outcomes in patients. Monitoring of behavioral indicators along with biomarkers may have crucial benefits in translational stroke research.

  10. Evaluation and improvement in nondestructive examination (NDE) reliability for inservice inspection of light water reactors

    International Nuclear Information System (INIS)

    Doctor, S.R.; Andersen, E.S.; Bowey, R.E.; Diaz, A.A.; Good, M.S.; Heasler, P.G.; Hockey, R.L.; Simonen, F.A.; Spanner, J.C.; Taylor, T.T.; Vo, T.V.

    1991-01-01

    This program is intended to establish the effectiveness, reliability and adequacy of inservice inspection of reactor pressure vessels and primary piping systems and the impact of ISI reliability on system integrity. The objectives of the program include: (a) determine the effectiveness and reliability of ultrasonic inservice inspection (ISI) performed on commercial, light water reactor pressure vessels and piping; (b) recommend Code changes to the inspection procedures to improve the reliability of ISI; (c) using fracture mechanics analysis, determine the impact of NDE unreliability on system safety and determine the level of inspection reliability required to assure a suitably low failure probability; (d) evaluate the degree of reliability improvement which could be achieved using improved NDE techniques; and (e) based on importance of component to safety, material properties, service conditions, and NDE uncertainties, formulate improved inservice inspection criteria (including sampling plan, frequency, and reliability of inspection) for revisions to ASME Section XI and regulatory requirements needed to assure suitably low failure probabilities

  11. International cooperation - a way to improve reliability and safety

    International Nuclear Information System (INIS)

    John, A.

    1998-01-01

    The mission of the World Association of Nuclear Operators (WANO) is highlighted, and WANO's Peer Review programme is described. At the Dukovany nuclear power plant, a Peer Review was undertaken in December 1997. The results gave evidence of a good level of safety, reliability and culture of operation of the plant. (P.A.)

  12. Improvement of AC motor reliability from technique standardization

    International Nuclear Information System (INIS)

    Muniz, P.R.; Faria, M.D.R.; Mendes, M.P.; Silva, J.N.; Dos Santos, J.D.

    2005-01-01

    The purpose of this paper is to explain the increase of reliability of motors serviced in the Electrical Maintenance Shop of Companhia Siderurgica de Tubarao by standardization of the technique based on Brazilian and International Standards, manufacturer's recommendations and the experience of the maintenance staff. (author)

  13. Improving Reliability and Durability of Efficient and Clean Energy Systems

    Energy Technology Data Exchange (ETDEWEB)

    Singh, Prabhakar [Univ. of Connecticut, Storrs, CT (United States)

    2010-08-01

    Overall objective of the research program was to develop an in-depth understanding of the degradation processes in advanced electrochemical energy conversion systems. It was also the objective of the research program to transfer the technology to participating industries for implementation in manufacturing of cost effective and reliable integrated systems.

  14. Motivational tools to improve probationer treatment outcomes.

    Science.gov (United States)

    Taxman, Faye S; Walters, Scott T; Sloas, Lincoln B; Lerch, Jennifer; Rodriguez, Mayra

    2015-07-01

    Motivational interviewing (MI) is a promising practice to increase motivation, treatment retention, and reducing recidivism among offender populations. Computer-delivered interventions have grown in popularity as a way to change behaviors associated with drug and alcohol use. Motivational Assistance Program to Initiate Treatment (MAPIT) is a three arm, multisite, randomized controlled trial, which examines the impact of Motivational interviewing (MI), a motivational computer program (MC), and supervision as usual (SAU) on addiction treatment initiation, engagement, and retention. Secondary outcomes include drug/alcohol use, probation progress, recidivism (i.e., criminal behavior) and HIV/AIDS testing and treatment among probationers. Participant characteristics are measured at baseline, 2, and 6 months after assignment. The entire study will include 600 offenders, with each site recruiting 300 offenders (Baltimore City, Maryland and Dallas, Texas). All participants will go through standard intake procedures for probation and participate in probation requirements as usual. After standard intake, participants will be recruited and screened for eligibility. The results of this clinical trial will fill a gap in knowledge about ways to motivate probationers to participate in addiction treatment and HIV care. This randomized clinical trial is innovative in the way it examines the use of in-person vs. technological approaches to improve probationer success. NCT01891656. Copyright © 2015. Published by Elsevier Inc.

  15. QA support for TFTR reliability improvement program in preparation for DT operation

    International Nuclear Information System (INIS)

    Parsells, R.F.; Howard, H.P.

    1987-01-01

    As TFTR approaches experiments in the Q=1 regime, machine reliability becomes a major variable in achieving experimental objectives. This paper describes the methods used to quantify current reliability levels, levels required for D-T operations, proposed methods for reliability growth and improvement, and tracking of reliability performance in that growth. Included in this scope are data collection techniques and short comings, bounding current reliability on the upper end, and requirements for D-T operations. Problem characterization through Pareto diagrams provides insight into recurrent failure modes and the use of Duane plots for charting of reliability changes both cumulative and instantaneous, is explained and demonstrated

  16. Improvement of the reliability graph with general gates to analyze the reliability of dynamic systems that have various operation modes

    Energy Technology Data Exchange (ETDEWEB)

    Shin, Seung Ki [Div. of Research Reactor System Design, Korea Atomic Energy Research Institute, Daejeon (Korea, Republic of); No, Young Gyu; Seong, Poong Hyun [Dept. of Nuclear and Quantum Engineering, Korea Advanced Institute of Science and Technology, Daejeon (Korea, Republic of)

    2016-04-15

    The safety of nuclear power plants is analyzed by a probabilistic risk assessment, and the fault tree analysis is the most widely used method for a risk assessment with the event tree analysis. One of the well-known disadvantages of the fault tree is that drawing a fault tree for a complex system is a very cumbersome task. Thus, several graphical modeling methods have been proposed for the convenient and intuitive modeling of complex systems. In this paper, the reliability graph with general gates (RGGG) method, one of the intuitive graphical modeling methods based on Bayesian networks, is improved for the reliability analyses of dynamic systems that have various operation modes with time. A reliability matrix is proposed and it is explained how to utilize the reliability matrix in the RGGG for various cases of operation mode changes. The proposed RGGG with a reliability matrix provides a convenient and intuitive modeling of various operation modes of complex systems, and can also be utilized with dynamic nodes that analyze the failure sequences of subcomponents. The combinatorial use of a reliability matrix with dynamic nodes is illustrated through an application to a shutdown cooling system in a nuclear power plant.

  17. Improvement of the reliability graph with general gates to analyze the reliability of dynamic systems that have various operation modes

    International Nuclear Information System (INIS)

    Shin, Seung Ki; No, Young Gyu; Seong, Poong Hyun

    2016-01-01

    The safety of nuclear power plants is analyzed by a probabilistic risk assessment, and the fault tree analysis is the most widely used method for a risk assessment with the event tree analysis. One of the well-known disadvantages of the fault tree is that drawing a fault tree for a complex system is a very cumbersome task. Thus, several graphical modeling methods have been proposed for the convenient and intuitive modeling of complex systems. In this paper, the reliability graph with general gates (RGGG) method, one of the intuitive graphical modeling methods based on Bayesian networks, is improved for the reliability analyses of dynamic systems that have various operation modes with time. A reliability matrix is proposed and it is explained how to utilize the reliability matrix in the RGGG for various cases of operation mode changes. The proposed RGGG with a reliability matrix provides a convenient and intuitive modeling of various operation modes of complex systems, and can also be utilized with dynamic nodes that analyze the failure sequences of subcomponents. The combinatorial use of a reliability matrix with dynamic nodes is illustrated through an application to a shutdown cooling system in a nuclear power plant

  18. Reliability Improved Design for a Safety System Channel

    International Nuclear Information System (INIS)

    Oh, Eung Se; Kim, Yun Goo

    2016-01-01

    Nowadays, these systems are implemented with a same platform type, such as a qualified programmable logic controller (PLC). The platform intensively uses digital communication with fiber-optic links to reduce cabling costs and to achieve effective signal isolation. These communication interface and redundancies within a channel increase the complexness of an overall system design. This paper proposes a simpler channel architecture design to reduce the complexity and to enhance overall channel reliability. Simplified safety channel configuration is proposed and the failure probabilities are compared with baseline safety channel configuration using an estimated generic value. The simplified channel configuration achieves 40 percent failure reduction compare to baseline safety channel configuration. If this configuration can be implemented within a processor module, overall safety channel reliability is increase and costs of fabrication and maintenance will be greatly reduced

  19. Reliability Improved Design for a Safety System Channel

    Energy Technology Data Exchange (ETDEWEB)

    Oh, Eung Se; Kim, Yun Goo [KHNP, Daejeon (Korea, Republic of)

    2016-05-15

    Nowadays, these systems are implemented with a same platform type, such as a qualified programmable logic controller (PLC). The platform intensively uses digital communication with fiber-optic links to reduce cabling costs and to achieve effective signal isolation. These communication interface and redundancies within a channel increase the complexness of an overall system design. This paper proposes a simpler channel architecture design to reduce the complexity and to enhance overall channel reliability. Simplified safety channel configuration is proposed and the failure probabilities are compared with baseline safety channel configuration using an estimated generic value. The simplified channel configuration achieves 40 percent failure reduction compare to baseline safety channel configuration. If this configuration can be implemented within a processor module, overall safety channel reliability is increase and costs of fabrication and maintenance will be greatly reduced.

  20. Equipment reliability process improvement and preventive maintenance optimization

    International Nuclear Information System (INIS)

    Darragi, M.; Georges, A.; Vaillancourt, R.; Komljenovic, D.; Croteau, M.

    2004-01-01

    The Gentilly-2 Nuclear Power Plant wants to optimize its preventive maintenance program through an Integrated Equipment Reliability Process. All equipment reliability related activities should be reviewed and optimized in a systematic approach especially for aging plants such as G2. This new approach has to be founded on best practices methods with the purpose of the rationalization of the preventive maintenance program and the performance monitoring of on-site systems, structures and components (SSC). A rational preventive maintenance strategy is based on optimized task scopes and frequencies depending on their applicability, critical effects on system safety and plant availability as well as cost-effectiveness. Preventive maintenance strategy efficiency is systematically monitored through degradation indicators. (author)

  1. Web server's reliability improvements using recurrent neural networks

    DEFF Research Database (Denmark)

    Madsen, Henrik; Albu, Rǎzvan-Daniel; Felea, Ioan

    2012-01-01

    In this paper we describe an interesting approach to error prediction illustrated by experimental results. The application consists of monitoring the activity for the web servers in order to collect the specific data. Predicting an error with severe consequences for the performance of a server (t...... usage, network usage and memory usage. We collect different data sets from monitoring the web server's activity and for each one we predict the server's reliability with the proposed recurrent neural network. © 2012 Taylor & Francis Group...

  2. Quantitative outcome measures for systemic sclerosis-related Microangiopathy - Reliability of image acquisition in Nailfold Capillaroscopy.

    Science.gov (United States)

    Dinsdale, Graham; Moore, Tonia; O'Leary, Neil; Berks, Michael; Roberts, Christopher; Manning, Joanne; Allen, John; Anderson, Marina; Cutolo, Maurizio; Hesselstrand, Roger; Howell, Kevin; Pizzorni, Carmen; Smith, Vanessa; Sulli, Alberto; Wildt, Marie; Taylor, Christopher; Murray, Andrea; Herrick, Ariane L

    2017-09-01

    Nailfold capillaroscopic parameters hold increasing promise as outcome measures for clinical trials in systemic sclerosis (SSc). Their inclusion as outcomes would often naturally require capillaroscopy images to be captured at several time points during any one study. Our objective was to assess repeatability of image acquisition (which has been little studied), as well as of measurement. 41 patients (26 with SSc, 15 with primary Raynaud's phenomenon) and 10 healthy controls returned for repeat high-magnification (300×) videocapillaroscopy mosaic imaging of 10 digits one week after initial imaging (as part of a larger study of reliability). Images were assessed in a random order by an expert blinded observer and 4 outcome measures extracted: (1) overall image grade and then (where possible) distal vessel locations were marked, allowing (2) vessel density (across the whole nailfold) to be calculated (3) apex width measurement and (4) giant vessel count. Intra-rater, intra-visit and intra-rater inter-visit (baseline vs. 1week) reliability were examined in 475 and 392 images respectively. A linear, mixed-effects model was used to estimate variance components, from which intra-class correlation coefficients (ICCs) were determined. Intra-visit and inter-visit reliability estimates (ICCs) were (respectively): overall image grade, 0.97 and 0.90; vessel density, 0.92 and 0.65; mean vessel width, 0.91 and 0.79; presence of giant capillary, 0.68 and 0.56. These estimates were conditional on each parameter being measurable. Within-operator image analysis and acquisition are reproducible. Quantitative nailfold capillaroscopy, at least with a single observer, provides reliable outcome measures for clinical studies including randomised controlled trials. Copyright © 2017 Elsevier Inc. All rights reserved.

  3. Assessment and Improving Methods of Reliability Indices in Bakhtar Regional Electricity Company

    Directory of Open Access Journals (Sweden)

    Saeed Shahrezaei

    2013-04-01

    Full Text Available Reliability of a system is the ability of a system to do prospected duties in future and the probability of desirable operation for doing predetermined duties. Power system elements failures data are the main data of reliability assessment in the network. Determining antiseptic parameters is the goal of reliability assessment by using system history data. These parameters help to recognize week points of the system. In other words, the goal of reliability assessment is operation improving and decreasing of the failures and power outages. This paper is developed to assess reliability indices of Bakhtar Regional Electricity Company up to 1393 and the improving methods and their effects on the reliability indices in this network. DIgSILENT Power Factory software is employed for simulation. Simulation results show the positive effect of improving methods in reliability indices of Bakhtar Regional Electricity Company.

  4. Narrative therapy for adults with major depressive disorder: improved symptom and interpersonal outcomes.

    Science.gov (United States)

    Vromans, Lynette P; Schweitzer, Robert D

    2011-01-01

    This study investigated depressive symptom and interpersonal relatedness outcomes from eight sessions of manualized narrative therapy for 47 adults with major depressive disorder. Post-therapy, depressive symptom improvement (d=1.36) and proportions of clients achieving reliable improvement (74%), movement to the functional population (61%), and clinically significant improvement (53%) were comparable to benchmark research outcomes. Post-therapy interpersonal relatedness improvement (d=.62) was less substantial than for symptoms. Three-month follow-up found maintenance of symptom, but not interpersonal gains. Benchmarking and clinical significance analyses mitigated repeated measure design limitations, providing empirical evidence to support narrative therapy for adults with major depressive disorder.

  5. Aviation Fuel System Reliability and Fail-Safety Analysis. Promising Alternative Ways for Improving the Fuel System Reliability

    Directory of Open Access Journals (Sweden)

    I. S. Shumilov

    2017-01-01

    Full Text Available The paper deals with design requirements for an aviation fuel system (AFS, AFS basic design requirements, reliability, and design precautions to avoid AFS failure. Compares the reliability and fail-safety of AFS and aircraft hydraulic system (AHS, considers the promising alternative ways to raise reliability of fuel systems, as well as elaborates recommendations to improve reliability of the pipeline system components and pipeline systems, in general, based on the selection of design solutions.It is extremely advisable to design the AFS and AHS in accordance with Aviation Regulations АП25 and Accident Prevention Guidelines, ICAO (International Civil Aviation Association, which will reduce risk of emergency situations, and in some cases even avoid heavy disasters.ATS and AHS designs should be based on the uniform principles to ensure the highest reliability and safety. However, currently, this principle is not enough kept, and AFS looses in reliability and fail-safety as compared with AHS. When there are the examined failures (single and their combinations the guidelines to ensure the AFS efficiency should be the same as those of norm-adopted in the Regulations АП25 for AHS. This will significantly increase reliability and fail-safety of the fuel systems and aircraft flights, in general, despite a slight increase in AFS mass.The proposed improvements through the use of components redundancy of the fuel system will greatly raise reliability of the fuel system of a passenger aircraft, which will, without serious consequences for the flight, withstand up to 2 failures, its reliability and fail-safety design will be similar to those of the AHS, however, above improvement measures will lead to a slightly increasing total mass of the fuel system.It is advisable to set a second pump on the engine in parallel with the first one. It will run in case the first one fails for some reasons. The second pump, like the first pump, can be driven from the

  6. Improving Outcomes for Workers with Mental Retardation

    Science.gov (United States)

    Fornes, Sandra; Rocco, Tonette S.; Rosenberg, Howard

    2008-01-01

    This research presents an analysis of factors predicting job retention, job satisfaction, and job performance of workers with mental retardation. The findings highlight self-determination as a critical skill in predicting the three important employee outcomes. The study examined a hypothesized job retention model and the outcome of the three…

  7. Improving Pupil Referral Unit Outcomes: Pupil Perspectives

    Science.gov (United States)

    Michael, Siobhan; Frederickson, Norah

    2013-01-01

    Concern has been expressed about the quality of alternative provision for young people with social, emotional and behavioural difficulties, and the poor academic and social outcomes many experience. Little research has sought the views of the young people themselves regarding the enablers and barriers to positive outcomes they have encountered. A…

  8. [Reliability of nursing outcomes classification label "Knowledge: cardiac disease management (1830)" in outpatients with heart failure].

    Science.gov (United States)

    Cañón-Montañez, Wilson; Oróstegui-Arenas, Myriam

    2015-01-01

    To determine the reliability (internal consistency, inter-rater reproducibility and level of agreement) of nursing outcome: "Knowledge: cardiac disease management (1830)" of the version published in Spanish, in outpatients with heart failure. A reliability study was conducted on 116 outpatients with heart failure. Six indicators of nursing outcome were operationalized. All participants were assessed simultaneously by two evaluators. Three evaluation periods were defined: initial (at baseline), final (a month later), and follow-up (two months later). Internal consistency by Cronbach alpha coefficient, inter-rater reproducibility with intraclass correlation coefficient of reproducibility or agreement and level agreement using the 95% limits of Bland and Altman. Cronbach's alpha was 0.83 (95% CI: 0.77 - 0.89) in the final evaluation, and follow-up values of 0.85 (95% CI: 0.82-0.89) and 0.83 (95% CI: 0.78 - 0.88) were found for the first and second evaluator, respectively. The intraclass correlation coefficient showed values greater 0.9 in the three evaluation periods in both the random and mixed model. The Bland-Altman 95% limits of agreement were close to zero in the three evaluations performed. The questionnaire operationalized to assess the nursing outcome: "Knowledge: cardiac disease management (1830)" in its Spanish version, is a reliable method to measure skills and knowledge in outpatients with heart failure in the Colombian context. Copyright © 2015 Elsevier España, S.L.U. All rights reserved.

  9. Improving Stochastic Communication Network Performance: Reliability vs. Throughput

    Science.gov (United States)

    1991-12-01

    increased to one. 2) arc survivabil.. ities will be increased in increments of one tenths. and 3) the costs to increase- arc si’rvivabilities were equal and...This reliability value is leni used to maximize the associated expected flow. For Net work A. a bIdget of (8)() pro(duces a tradcoff point at (.58.37...Network B for a buidgel of 2000 which allows a nel \\\\ork relial)ilitv of one to be achieved and a bidget of 1200 which allows for ;, maximum 57

  10. Reliability improvement of wire bonds subjected to fatigue stresses.

    Science.gov (United States)

    Ravi, K. V.; Philofsky, E. M.

    1972-01-01

    The failure of wire bonds due to repeated flexure when semiconductor devices are operated in an on-off mode has been investigated. An accelerated fatigue testing apparatus was constructed and the major fatigue variables, aluminum alloy composition, and bonding mechanism, were tested. The data showed Al-1% Mg wires to exhibit superior fatigue characteristics compared to Al-1% Cu or Al-1% Si and ultrasonic bonding to be better than thermocompression bonding for fatigue resistance. Based on these results highly reliable devices were fabricated using Al-1% Mg wire with ultrasonic bonding which withstood 120,000 power cycles with no failures.

  11. Modulator reliability and bandwidth improvement: replacing tetrodes with MOSFETs

    International Nuclear Information System (INIS)

    Donaldson, A.R.

    1982-01-01

    Three types of power MOS field effect transistors were studied with the intent of replacing a parallel pair of vacuum tube tetrodes in a linear modulator. The tetrodes have the shortest lifetimes of any other tubes in the system. The FETs offer definite performance advantages when compared to bipolar transistors and definite cost advantages when compared to vacuum tubes. Replacement of the tetrodes does however require careful consideration of voltage, current and to a lesser extent bandwidth capability in order to enhance overall modulator reliability without compromising present performance

  12. Improving perinatal outcome: towards individualized care

    NARCIS (Netherlands)

    Kazemier, B.M.

    2015-01-01

    Unfortunately not all pregnancies and deliveries take place without complications. Complications during pregnancy or delivery can lead to maternal morbidity and poor perinatal outcomes such as perinatal mortality or (severe) neonatal morbidity. First assessment in antenatal care is to distinguish

  13. Managing the effects of aging and reliability improvement

    International Nuclear Information System (INIS)

    Hall, R.E.; Taylor, J.H.; Boccio, J.L.

    1987-01-01

    Over recent years the electric power generating community has acknowledged the importance of the aging process on plant safety and availability. To cope with time-dependent degradation phenomenon that can affect active as well as passive components and lead to unacceptable, unanticipated failures requires research into the mechanisms of the aging process, advances in productive methods for assessing the aging impact on risk and availability, and a better understanding of power plant operations so that strategies for defending against this pervasive stress can be developed. This paper discusses current research advances and presents a framework to aid in the systematic integration of these three needs. As such it is anchored to research being conducted at Brookhaven National Laboratory in the areas of plant aging, life extension, reliability, performance indication, and risk assessment. The current question facing the industry can be simply stated. ''How can an acceptable level of safety and availability be maintained throughout the operational life of a nuclear power plant?'' The complexity of this question indicates that managing aging effects must be a continuous, coordinated process integrated with day-to-day tactical plant operation decisions. This implies that aging and reliability programs must be systemic properties of an organization's management, and that research into aging technology must be closely linked

  14. Improving risk assessment by defining consistent and reliable system scenarios

    Directory of Open Access Journals (Sweden)

    B. Mazzorana

    2009-02-01

    Full Text Available During the entire procedure of risk assessment for hydrologic hazards, the selection of consistent and reliable scenarios, constructed in a strictly systematic way, is fundamental for the quality and reproducibility of the results. However, subjective assumptions on relevant impact variables such as sediment transport intensity on the system loading side and weak point response mechanisms repeatedly cause biases in the results, and consequently affect transparency and required quality standards. Furthermore, the system response of mitigation measures to extreme event loadings represents another key variable in hazard assessment, as well as the integral risk management including intervention planning. Formative Scenario Analysis, as a supplement to conventional risk assessment methods, is a technique to construct well-defined sets of assumptions to gain insight into a specific case and the potential system behaviour. By two case studies, carried out (1 to analyse sediment transport dynamics in a torrent section equipped with control measures, and (2 to identify hazards induced by woody debris transport at hydraulic weak points, the applicability of the Formative Scenario Analysis technique is presented. It is argued that during scenario planning in general and with respect to integral risk management in particular, Formative Scenario Analysis allows for the development of reliable and reproducible scenarios in order to design more specifically an application framework for the sustainable assessment of natural hazards impact. The overall aim is to optimise the hazard mapping and zoning procedure by methodologically integrating quantitative and qualitative knowledge.

  15. Improving Reliability and Operational Availability of Military Systems

    National Research Council Canada - National Science Library

    Koehn, Phillip

    2004-01-01

    ...: overhaul and prognostics asset management strategies. It is shown that the prognostics approach leads to improved operational availability by anticipating failure and reducing administrative and logistics delays...

  16. Construct validity and reliability of the Finnish version of the Knee Injury and Osteoarthritis Outcome Score.

    Science.gov (United States)

    Multanen, Juhani; Honkanen, Mikko; Häkkinen, Arja; Kiviranta, Ilkka

    2018-05-22

    The Knee Injury and Osteoarthritis Outcome Score (KOOS) is a commonly used knee assessment and outcome tool in both clinical work and research. However, it has not been formally translated and validated in Finnish. The purpose of this study was to translate and culturally adapt the KOOS questionnaire into Finnish and to determine its validity and reliability among Finnish middle-aged patients with knee injuries. KOOS was translated and culturally adapted from English into Finnish. Subsequently, 59 patients with knee injuries completed the Finnish version of KOOS, Western Ontario and McMaster Osteoarthritis Index (WOMAC), Short-Form 36 Health Survey (SF-36) and Numeric Pain Rating Scale (Pain-NRS). The same KOOS questionnaire was re-administered 2 weeks later. Psychometric assessment of the Finnish KOOS was performed by testing its construct validity and reliability by using internal consistency, test-retest reliability and measurement error. The floor and ceiling effects were also examined. The cross-cultural adaptation revealed only minor cultural differences and was well received by the patients. For construct validity, high to moderate Spearman's Correlation Coefficients were found between the KOOS subscales and the WOMAC, SF-36, and Pain-NRS subscales. The Cronbach's alpha was from 0.79 to 0.96 for all subscales indicating acceptable internal consistency. The test-retest reliability was good to excellent, with Intraclass Correlation Coefficients ranging from 0.73 to 0.86 for all KOOS subscales. The minimal detectable change ranged from 17 to 34 on an individual level and from 2 to 4 on a group level. No floor or ceiling effects were observed. This study yielded an appropriately translated and culturally adapted Finnish version of KOOS which demonstrated good validity and reliability. Our data indicate that the Finnish version of KOOS is suitable for assessment of the knee status of Finnish patients with different knee complaints. Further studies are needed to

  17. The impact of intrinsic motivation on session attendance and reliable cognitive improvement in cognitive remediation in schizophrenia.

    Science.gov (United States)

    Bryce, S D; Lee, S J; Ponsford, J L; Lawrence, R J; Tan, E J; Rossell, S L

    2018-06-20

    Cognitive remediation (CR) is considered a potentially effective method of improving cognitive function in people with schizophrenia. Few studies, however, have explored the role of intrinsic motivation on treatment utilization or training outcomes in CR in this population. This study explored the impact of task-specific intrinsic motivation on attendance and reliable cognitive improvement in a controlled trial comparing CR with a computer game (CG) playing control. Forty-nine participants with schizophrenia or schizoaffective disorder, allocated to 10 weeks of group-based CR (n = 25) or CG control (n = 24), provided complete outcome data at baseline. Forty-three participants completed their assigned intervention. Cognition, psychopathology and intrinsic motivation were measured at baseline and end-treatment. Regression analyses explored the relative contribution of baseline motivation and other clinical factors to session attendance as well as the association of baseline and change in intrinsic motivation with the odds of reliable cognitive improvement (calculated using reliable change indices). Baseline reports of perceived program value were the only significant multivariable predictor of session attendance when including global cognition and psychiatric symptomatology. The odds of reliable cognitive improvement significantly increased with greater improvements in program interest and value from baseline to end-treatment. Motivational changes over time were highly variable between participants. Task-specific intrinsic motivation in schizophrenia may represent an important patient-related factor that contributes to session attendance and cognitive improvements in CR. Regular evaluation and enhancement of intrinsic motivation in cognitively enhancing interventions may optimize treatment engagement and the likelihood of meaningful training outcomes. Copyright © 2018 Elsevier B.V. All rights reserved.

  18. Managing the effects of aging and reliability improvement

    International Nuclear Information System (INIS)

    Hall, R.E.; Gunther, W.; Boccio, J.L.

    1989-01-01

    Over recent years the electric power generating community has acknowledged the importance of the aging process on plant safety and availability. To cope with time-dependent degradation phenomena that can affect active as well as passive components and lead to unacceptable, unanticipated failures requires research into the mechanisms of the aging process, advances in predictive methods for assessing the aging impact on risk and availability, and a better understanding of power plant operations so that strategies for defending against this pervasive stress can be developed. This paper discusses current research advances and presents a framework to aid in the systematic integration of these three needs. It also discusses current research in the aging effect on electric components. As such it is anchored to research being conducted at Brookhaven National Laboratory in the areas of plant aging, life extension, reliability, performance indication, and risk assessment. (orig.)

  19. Managing the effects of aging and reliability improvement

    International Nuclear Information System (INIS)

    Hall, R.E.; Gunther, W.; Boccio, J.L.

    1988-01-01

    Over recent years the electric power generating community has acknowledged the importance of the aging process on plant safety and availability. To cope with time-dependent degradation phenomena that can affect active as well as passive components and lead to unacceptable, unanticipated failures requires research into the mechanisms of the aging process, advances in predictive methods for assessing the aging impact on risk and availability, and a better understanding of power plant operations so that strategies for defending against this pervasive stress can be developed. This paper discusses current research advances and presents a framework to aid in the systematic integration of these three needs. As such it is anchored to research being conducted at Brookhaven National laboratory in the areas of plant aging, life extension, reliability, performance indication, and risk assessment

  20. Improving the reliability of stator insulation system in rotating machines

    International Nuclear Information System (INIS)

    Gupta, G.K.; Sedding, H.G.; Culbert, I.M.

    1997-01-01

    Reliable performance of rotating machines, especially generators and primary heat transport pump motors, is critical to the efficient operation on nuclear stations. A significant number of premature machine failures have been attributed to the stator insulation problems. Ontario Hydro has attempted to assure the long term reliability of the insulation system in critical rotating machines through proper specifications and quality assurance tests for new machines and periodic on-line and off-line diagnostic tests on machines in service. The experience gained over the last twenty years is presented in this paper. Functional specifications have been developed for the insulation system in critical rotating machines based on engineering considerations and our past experience. These specifications include insulation stress, insulation resistance and polarization index, partial discharge levels, dissipation factor and tip up, AC and DC hipot tests. Voltage endurance tests are specified for groundwall insulation system of full size production coils and bars. For machines with multi-turn coils, turn insulation strength for fast fronted surges in specified and verified through tests on all coils in the factory and on samples of finished coils in the laboratory. Periodic on-line and off-line diagnostic tests were performed to assess the condition of the stator insulation system in machines in service. Partial discharges are measured on-line using several techniques to detect any excessive degradation of the insulation system in critical machines. Novel sensors have been developed and installed in several machines to facilitate measurements of partial discharges on operating machines. Several off-line tests are performed either to confirm the problems indicated by the on-line test or to assess the insulation system in machines which cannot be easily tested on-line. Experience with these tests, including their capabilities and limitations, are presented. (author)

  1. Evaluation and improvement in nondestructive examination (NDE) reliability for inservice inspection of light water reactors

    International Nuclear Information System (INIS)

    Doctor, S.R.; Deffenbaugh, J.D.; Good, M.S.; Green, E.R.; Heasler, P.G.; Simonen, F.A.; Spanner, J.C.; Taylor, T.T.

    1988-01-01

    The Evaluation and Improvement of NDE Reliability for Inservice Inspection of Light Water Reactor (NDE Reliability) program at the Pacific Northwest Laboratory was established by the NRC to determine the reliability of current inservice inspection (ISI) techniques and to develop recommendations that will ensure a suitably high inspection reliability. The objectives of this program include determining the reliability of ISI performed on the primary systems of commercial light-water reactors (LWRs); using probabilistic fracture mechanics analysis to determine the impact of NDE unreliability on system safety; and evaluating reliability improvements that can be achieved with improved and advanced technology. A final objective is to formulate recommended revisions to ASME Code and Regulatory requirements, based on material properties, service conditions, and NDE uncertainties. The program scope is limited to ISI of the primary systems including the piping, vessel, and other inspected components. This is a progress report covering the programmatic work from October 1986 through September 1987

  2. Evaluation and improvement in nondestructive examination (NDE) reliability for inservice inspection of light water reactors

    International Nuclear Information System (INIS)

    Doctor, S.R.; Deffenbaugh, J.D.; Good, M.S.; Green, E.R.; Heasler, P.G.; Simonen, F.A.; Spanner, J.C.; Taylor, T.T.

    1988-01-01

    The Evaluation and Improvement of NDE Reliability for Inservice Inspection of Light Water Reactors (NDE Reliability) program at the Pacific Northwest Laboratory was established by the NRC to determine the reliability of current inservice inspection (ISI) techniques and to develop recommendations that will ensure a suitably high inspection reliability. The objectives of this program include determining the reliability of ISI performed on the primary systems of commercial light-water reactors (LWRs); using probabilistic fracture mechanics analysis to determine the impact of NDE unreliability on system safety; and evaluating reliability improvements that can be achieved with improved and advanced technology. A final objective is to formulate recommended revisions to ASME Code and Regulatory requirements, based on material properties, service conditions and NDE uncertainties. The program scope is limited to ISI of the primary systems including the piping, vessel, and other inspected components. This is a progress report covering the programmatic work from October 1986 through September 1987. (author)

  3. TESTING METHODS FOR MECHANICALLY IMPROVED SOILS: RELIABILITY AND VALIDITY

    Directory of Open Access Journals (Sweden)

    Ana Petkovšek

    2017-10-01

    Full Text Available A possibility of in-situ mechanical improvement for reducing the liquefaction potential of silty sands was investigated by using three different techniques: Vibratory Roller Compaction, Rapid Impact Compaction (RIC and Soil Mixing. Material properties at all test sites were investigated before and after improvement with the laboratory and the in situ tests (CPT, SDMT, DPSH B, static and dynamic load plate test, geohydraulic tests. Correlation between the results obtained by different test methods gave inconclusive answers.

  4. Pathways: improving outcomes, not just 'cookbook medicine'.

    Science.gov (United States)

    O'Malley, S

    1997-04-01

    A Kaiser Permanente medical director cites four benefits to be derived from using clinical guidelines: better outcomes, faster patient recovery, reduced costs, and increased physician accountability. And, he notes, physicians are free to deviate from the guidelines--so long as they can justify their actions.

  5. Monitoring outcomes with relational databases: does it improve quality of care?

    Science.gov (United States)

    Clemmer, Terry P

    2004-12-01

    There are 3 key ingredients in improving quality of medial care: 1) using a scientific process of improvement, 2) executing the process at the lowest possible level in the organization, and 3) measuring the results of any change reliably. Relational databases when used within these guidelines are of great value in these efforts if they contain reliable information that is pertinent to the project and used in a scientific process of quality improvement by a front line team. Unfortunately, the data are frequently unreliable and/or not pertinent to the local process and is used by persons at very high levels in the organization without a scientific process and without reliable measurement of the outcome. Under these circumstances the effectiveness of relational databases in improving care is marginal at best, frequently wasteful and has the potential to be harmful. This article explores examples of these concepts.

  6. Improving the Reliability of Tinnitus Screening in Laboratory Animals.

    Science.gov (United States)

    Jones, Aikeen; May, Bradford J

    2017-02-01

    Behavioral screening remains a contentious issue for animal studies of tinnitus. Most paradigms base a positive tinnitus test on an animal's natural tendency to respond to the "sound" of tinnitus as if it were an actual sound. As a result, animals with tinnitus are expected to display sound-conditioned behaviors when no sound is present or to miss gaps in background sounds because tinnitus "fills in the gap." Reliable confirmation of the behavioral indications of tinnitus can be problematic because the reinforcement contingencies of conventional discrimination tasks break down an animal's tendency to group tinnitus with sound. When responses in silence are rewarded, animals respond in silence regardless of their tinnitus status. When responses in silence are punished, animals stop responding. This study introduces stimulus classification as an alternative approach to tinnitus screening. Classification procedures train animals to respond to the common perceptual features that define a group of sounds (e.g., high pitch or narrow bandwidth). Our procedure trains animals to drink when they hear tinnitus and to suppress drinking when they hear other sounds. Animals with tinnitus are revealed by their tendency to drink in the presence of unreinforced probe sounds that share the perceptual features of the tinnitus classification. The advantages of this approach are illustrated by taking laboratory rats through a testing sequence that includes classification training, the experimental induction of tinnitus, and postinduction screening. Behavioral indications of tinnitus are interpreted and then verified by simulating a known tinnitus percept with objective sounds.

  7. Improving the reliability of emergency diesel generators through sustained maintenance

    International Nuclear Information System (INIS)

    Reddy, R.

    2000-01-01

    In Nuclear Power Stations Emergency Diesel Generators are vital safety related equipment which ensures power supply to essential equipment during loss of power. In view of their importance Reliability of Diesel generators should be very high. Since these Diesel generators are standby equipment and operate only during demand or during surveillance checks, their demand failure probability should be very low and once they operate their operational availability should be very high. Madras Atomic Power Station at Kalpakkam, India consists two pressurised heavy water Reactors each rated at 220 MWe. To supply standby power each unit has two Diesel Generators of I 500 kW capacity each. The Diesel Engine is 16 cylinder 'V' type engine and is cranked by Air starting motor and is connected to generator whose rating at 100% load is 1500 KW. During commissioning and in the initial years of operation these Diesel Generators have encountered many problems. Major problem was Diesel Engine failing to start on demand. This was due to non engagement of air motor pinion with ring gear or continued engagement air motor even after the engine had picked up speed and failure of timer to initiate multiple starts after initial incomplete starts Apart from these there were problems like fuel oil leaks, high jacket water temperatures, low fuel oil pressure trips. Another major problem was with excitation system. How these problems were dealt with thereby reducing the demand failure probability and increasing the operational availability are discussed in this paper. (author)

  8. Cross-cultural adaptation, validation, and reliability of the Michigan Hand Outcomes Questionnaire among Persian population.

    Science.gov (United States)

    Ebrahimzadeh, Mohammad H; Birjandinejad, Ali; Kachooei, Amir Reza

    2015-01-01

    We aimed to validate a cross-culturally adapted version of the Persian Michigan Hand Outcomes Questionnaire (MHOQ). We followed the Beaton's guideline to translate the questionnaire to Persian. We administered the final version to 223 patients among which 79 patients returned 3 days later to respond to the Persian MHOQ for the second time. In the first visit, respondents also filled the Disabilities of the Arm Shoulder and Hand (DASH) and rated the pain based on the Visual Analogue Scale (VAS). Cronbach's alpha for the total MHOQ was 0.79 which showed good internal consistency. Intraclass correlation coefficient (ICC) for the total MHOQ was 0.84 which demonstrated good reliability between test and retest. The absolute correlation coefficient between total MHOQ and the DASH was as high as 0.74. Persian version of the MHOQ proved to be a reliable and valid instrument to be implemented among Persian population with the hand and wrist disorders.

  9. Improving Punctuality and Transfer Reliability by Railway Timetable Optimization

    NARCIS (Netherlands)

    Goverde, R.M.P.

    1999-01-01

    The Dutch railway network is operated close to capacity with the current safety system. This leaves little space for control by process operators by which a delayed train can cause severe delay propagation. The NS currently invest a large amount in punctuality improvement of the railway operations.

  10. Advanced surface protection for improved reliability PCB systems (ASPIS)

    NARCIS (Netherlands)

    Ballantyne, A.; Forrest, G.; Goosey, M.; Griguceviciene, A.; Juodkazyte, J.; Kellner, R.; Kosenko, A.; Ramanauskas, R.; Ryder, K.; Selskis, A.; Tarozaite, R.; Veninga, E.

    2012-01-01

    Purpose - The purpose of this paper is to detail progress on the European Commission supported FP7 ASPIS project that is undertaking a multi-faceted approach to develop novel and improved nickel-gold (ENIG) solderable finish chemistries and processes in order to overcome issues such as "black pad"

  11. [The choice of color in fixed prosthetics: what steps should be followed for a reliable outcome?].

    Science.gov (United States)

    Vanheusden, Alain; Mainjot, Amélie

    2004-01-01

    The creation of a perfectly-matched esthetic fixed restoration is undeniably one of the most difficult challenges in modern dentistry. The final outcome depends on several essential steps: the use of an appropriate light source, the accurate analysis and correct evaluation of patient's teeth parameters (morphology, colour, surface texture,...), the clear and precise transmission of this data to the laboratory and the sound interpretation of it by a dental technician who masters esthetic prosthetic techniques perfectly. The purpose of this paper was to give a reproducible clinical method to the practitioner in order to achieve a reliable dental colorimetric analysis.

  12. Improving perinatal outcome: towards individualized care

    OpenAIRE

    Kazemier, B.M.

    2015-01-01

    Unfortunately not all pregnancies and deliveries take place without complications. Complications during pregnancy or delivery can lead to maternal morbidity and poor perinatal outcomes such as perinatal mortality or (severe) neonatal morbidity. First assessment in antenatal care is to distinguish women who require standard care from those requiring special attention. At the moment, we can make some global risk assessments, but are not able to give a women a risk assessment that is adapted for...

  13. Reliability of patient-reported outcomes in rheumatoid arthritis patients: an observational prospective study.

    Science.gov (United States)

    Studenic, Paul; Stamm, Tanja; Smolen, Josef S; Aletaha, Daniel

    2016-01-01

    Patient-reported outcomes (PROs) such as pain, patient global assessment (PGA) and fatigue are regularly assessed in RA patients. In the present study, we aimed to explore the reliability and smallest detectable differences (SDDs) of these PROs, and whether the time between assessments has an impact on reliability. Forty RA patients on stable treatment reported the three PROs daily over two subsequent months. We assessed the reliability of these measures by calculating intraclass correlation coefficients (ICCs) and the SDDs for 1-, 7-, 14- and 28-day test-retest intervals. Overall, SDD and ICC were 25 mm and 0.67 for pain, 25 mm and 0.71 for PGA and 30 mm and 0.66 for fatigue, respectively. SDD was higher with longer time period between assessments, ranging from 19 mm (1-day intervals) to 30 mm (28-day intervals) for pain, 19 to 33 mm for PGA, and 26 to 34 mm for fatigue; correspondingly, ICC was smaller with longer intervals, and ranged between the 1- and the 28-day interval from 0.80 to 0.50 for pain, 0.83 to 0.57 for PGA and 0.76 to 0.58 for fatigue. The baseline simplified disease activity index did not have any influence on reliability. Lower baseline PRO scores led to smaller SDDs. Reliability of pain, PGA and fatigue measurements is dependent on the tested time interval and the baseline levels. The relatively high SDDs, even for patients in the lowest tertiles of their PROs, indicate potential issues for assessment of the presence of remission. © The Author 2015. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  14. Reliability improvement: where do we go from here. The role of codes and standards

    International Nuclear Information System (INIS)

    Davidson, R.H.

    1976-01-01

    The role of codes and standards in contributing to the future improvement is discussed. The Nuclear Plant Reliability Data System is examined. It is suggested that two systems of the type are needed. One system should focus on component and system reliability while the other should focus on system availability, capacity factor, and fixed outage rate assessment

  15. Training Improves Interobserver Reliability for the Diagnosis of Scaphoid Fracture Displacement

    NARCIS (Netherlands)

    Buijze, Geert A.; Guitton, Thierry G.; van Dijk, C. Niek; Ring, David; Osterman, A. Lee; Wahegaonkar, Abhijeet L.; Ladd, Amy; Barquet, Antonio; van Vugt, Arie B.; Shyam, Ashok K.; Swigart, Carrie; Coles, Chad P.; Zalavras, Charalampos; Goldfarb, Charles A.; Cassidy, Charles; Allan, Christopher; Beingessner, Daphne; Kalainov, David M.; Eygendaal, Denise; Sancheti, Parag; Feibel, Robert J.; Rocha, Steve; Grosso, Elena; Frihagen, Frede; Dyer, George S. M.; Athwal, George S.; Goslings, J. Carel; Della Rocca, Gregory J.; Harris, Ian; Fanuele, Jason C.; Lawton, Jeff; Jiuliano, John; McAuliffe, John; Capo, John T.; Conflitti, Joseph M.; Segalman, Keith; Egol, Kenneth; Ponsen, Kornelis J.; Jeray, Kyle; Lattanza, Lisa; Catalano, Louis; Swiontkowski, Marc; Boyer, Martin; Richardson, Martin; Soong, Maximillian; Baskies, Michael; Prayson, Michael; McKee, Michael; Chen, Neal C.; Kloen, Peter

    2012-01-01

    The diagnosis of displacement in scaphoid fractures is notorious for poor interobserver reliability. We tested whether training can improve interobserver reliability and sensitivity, specificity, and accuracy for the diagnosis of scaphoid fracture displacement on radiographs and CT scans. Sixty-four

  16. Reliability database development and plant performance improvement effort at Korea Hydro and Nuclear Power Co

    International Nuclear Information System (INIS)

    Oh, S. J.; Hwang, S. W.; Na, J. H.; Lim, H. S.

    2008-01-01

    Nuclear utilities in recent years have focused on improved plant performance and equipment reliability. In U.S., there is a movement toward process integration. Examples are INPO AP-913 equipment reliability program and the standard nuclear performance model developed by NEI. Synergistic effect from an integrated approach can be far greater than as compared to individual effects from each program. In Korea, PSA for all Korean NPPs (Nuclear Power Plants) has been completed. Plant performance monitoring and improvement is an important goal for KHNP (Korea Hydro and Nuclear Power Company) and a risk monitoring system called RIMS has been developed for all nuclear plants. KHNP is in the process of voluntarily implementing maintenance rule program similar to that in U.S. In the future, KHNP would like to expand the effort to equipment reliability program and to achieve highest equipment reliability and improved plant performance. For improving equipment reliability, the current trend is moving toward preventive/predictive maintenance from corrective maintenance. With the emphasis on preventive maintenance, the failure cause and operation history and environment are important. Hence, the development of accurate reliability database is necessary. Furthermore, the database should be updated regularly and maintained as a living program to reflect the current status of equipment reliability. This paper examines the development of reliability database system and its application of maintenance optimization or Risk Informed Application (RIA). (authors)

  17. Improving STEM Student Learning Outcomes with GIS

    Science.gov (United States)

    Montgomery, W. W.

    2013-12-01

    Longitudinal data collection initiated a decade ago as part of a successful NSF-CCLI grant proposal has resulted in a large - and growing - sample (200+) of students who report on their perceptions of self-improvement in Technology, Critical Thinking, and Quantitative Reasoning proficiencies upon completion of an introductory (200-level) GIS course at New Jersey City University, a Hispanic-Serving and Minority Institution in Jersey City, NJ. Results from student satisfaction surveys indicate that, not surprisingly, 80% of respondents report improved confidence in Technology Literacy. Critical Thinking proficiency is judged to be significantly improved by 60% of respondents. On the other hand, Quantitative Reasoning proficiency confidence is improved in only 30% of students. This latter finding has prompted the instructor to search for more easily recognizable (to the student) ways of embedding quantitative reasoning into the course, as it is obvious to any GIS professional that there is an enormous amount of quantitative reasoning associated with this technology. A second post-course questionnaire asks students to rate themselves in these STEM proficiency areas using rubrics. Results mirror those from the self-satisfaction surveys. On a 5-point Likkert scale, students tend to see themselves improving about one letter grade on average in each proficiency area. The self-evaluation rubrics are reviewed by the instructor and are judged to be accurate for about 75% of the respondents.

  18. Improving QST Reliability – More Raters, Tests or Occasions? A Multivariate Generalizability Study

    DEFF Research Database (Denmark)

    O'Neill, Søren; O'Neill, Lotte

    2015-01-01

    The reliability of quantitative sensory testing (QST) is affected by the error attributable to both test occasion and rater (examiner) as well as interactions between them. Most reliability studies only account for one source of error. The present study employed a fully-crossed, multivariate...... threshold, intensity, tolerance and modulation with mechanical, thermal and chemical stimuli. The classical test-retest and inter-rater reliability (0.19... procedures. Reliability was improved more by repeated testing on separate occasions opposed to repeated testing by different raters....

  19. Multimodal strategies to improve surgical outcome

    DEFF Research Database (Denmark)

    Kehlet, Henrik; Wilmore, Douglas W

    2002-01-01

    OBJECTIVE: To evaluate the effect of modifying perioperative care in noncardiac surgical patients on morbidity, mortality, and other outcome measures. BACKGROUND: New approaches in pain control, introduction of techniques that reduce the perioperative stress response, and the more frequent use...... anesthesia in elective operations, and pilot studies of fast track surgical procedures using the multimodality approach. RESULTS: The introduction of newer approaches to perioperative care has reduced both morbidity and mortality in surgical patients. In the future, most elective operations will become day...... surgical procedures or require only 1 to 2 days of postoperative hospitalization. Reorganization of the perioperative team (anesthesiologists, surgeons, nurses, and physical therapists) will be essential to achieve successful fast track surgical programs. CONCLUSIONS: Understanding perioperative...

  20. Improving Learning Outcome Using Six Sigma Methodology

    Science.gov (United States)

    Tetteh, Godson A.

    2015-01-01

    Purpose: The purpose of this research paper is to apply the Six Sigma methodology to identify the attributes of a lecturer that will help improve a student's prior knowledge of a discipline from an initial "x" per cent knowledge to a higher "y" per cent of knowledge. Design/methodology/approach: The data collection method…

  1. Improved Yield, Performance and Reliability of High-Actuator-Count Deformable Mirrors, Phase I

    Data.gov (United States)

    National Aeronautics and Space Administration — The project team will conduct processing and design research aimed at improving yield, performance, and reliability of high-actuator-count micro-electro-mechanical...

  2. Reliability Improvement of Power Converters by Means of Condition Monitoring of IGBT Modules

    DEFF Research Database (Denmark)

    Choi, Ui Min; Blaabjerg, Frede; Jørgensen, S.

    2017-01-01

    Power electronic systems have gradually gained an important status in a wide range of industrial applications such as renewable generation, motor drives, automotive, and railway transportation. Accordingly, recent research makes an effort to improve the reliability of power electronic systems...

  3. Reliability Evaluation and Improvement Approach of Chemical Production Man - Machine - Environment System

    Science.gov (United States)

    Miao, Yongchun; Kang, Rongxue; Chen, Xuefeng

    2017-12-01

    In recent years, with the gradual extension of reliability research, the study of production system reliability has become the hot topic in various industries. Man-machine-environment system is a complex system composed of human factors, machinery equipment and environment. The reliability of individual factor must be analyzed in order to gradually transit to the research of three-factor reliability. Meanwhile, the dynamic relationship among man-machine-environment should be considered to establish an effective blurry evaluation mechanism to truly and effectively analyze the reliability of such systems. In this paper, based on the system engineering, fuzzy theory, reliability theory, human error, environmental impact and machinery equipment failure theory, the reliabilities of human factor, machinery equipment and environment of some chemical production system were studied by the method of fuzzy evaluation. At last, the reliability of man-machine-environment system was calculated to obtain the weighted result, which indicated that the reliability value of this chemical production system was 86.29. Through the given evaluation domain it can be seen that the reliability of man-machine-environment integrated system is in a good status, and the effective measures for further improvement were proposed according to the fuzzy calculation results.

  4. The Reliability of In-Training Assessment when Performance Improvement Is Taken into Account

    Science.gov (United States)

    van Lohuizen, Mirjam T.; Kuks, Jan B. M.; van Hell, Elisabeth A.; Raat, A. N.; Stewart, Roy E.; Cohen-Schotanus, Janke

    2010-01-01

    During in-training assessment students are frequently assessed over a longer period of time and therefore it can be expected that their performance will improve. We studied whether there really is a measurable performance improvement when students are assessed over an extended period of time and how this improvement affects the reliability of the…

  5. Reliability of patterns of hippocampal sclerosis as predictors of postsurgical outcome.

    Science.gov (United States)

    Thom, Maria; Liagkouras, Ioannis; Elliot, Kathryn J; Martinian, Lillian; Harkness, William; McEvoy, Andrew; Caboclo, Luis O; Sisodiya, Sanjay M

    2010-09-01

    Around one-third of patients undergoing temporal lobe surgery for the treatment of intractable temporal lobe epilepsy with hippocampal sclerosis (HS) fail to become seizure-free. Identifying reliable predictors of poor surgical outcome would be helpful in management. Atypical patterns of HS may be associated with poorer outcomes. Our aim was to identify atypical HS cases from a large surgical series and to correlate pathology with clinical and outcome data. Quantitative neuropathologic evaluation on 165 hippocampal surgical specimens and 21 control hippocampi was carried out on NeuN-stained sections. Neuronal densities (NDs) were measured in CA4, CA3, CA2, and CA1 subfields. The severity of granule cell dispersion (GCD) was assessed. Comparison with control ND values identified the following patterns based on the severity and distribution of neuronal loss: classical HS (CHS; n = 60) and total HS (THS; n = 39). Atypical patterns were present in 30% of cases, including end-folium sclerosis (EFS; n = 5), CA1 predominant pattern (CA1p; n = 9), and indeterminate HS (IHS, n = 35). No HS was noted in 17 cases. Poorest outcomes were noted for no-HS, and CA1p groups with 33-44% International League Against Epilepsy (ILAE) class I at up to 2 years follow-up compared to 69% for CHS (p < 0.05). GCD associated with HS type (p < 0.01), but not with outcome. These findings support the identification and delineation of atypical patterns of HS using quantitative methods. Atypical patterns may represent distinct clinicopathologic subtypes and may have predictive value following epilepsy surgery. Wiley Periodicals, Inc. © 2010 International League Against Epilepsy.

  6. Utilizing a disease management approach to improve ESRD patient outcomes.

    Science.gov (United States)

    Anand, Shaan; Nissenson, Allen R

    2002-01-01

    In this era of processes and systems to improve quality, disease management is one methodology to improve care delivery and outcomes for patients with chronic kidney disease (CKD). In most disease management systems a senior renal nurse coordinates all aspects of the patient's care and ensures that the prescribed and necessary care is delivered for both CKD-related and comorbid conditions. The nurse also continually monitors outcomes on quality indicators and key performance measures. These outcome data are then aggregated and analyzed, are compared with local and national benchmarks, and drive the continuous quality improvement (CQI) process. Such a system attempts to centralize the currently fragmented care delivery system, continually improve patient outcomes, and conserve scarce economic resources. Early data suggest a disease management approach may improve both the morbidity and mortality of CKD patients.

  7. Improving Outcomes in Patients With Sepsis.

    Science.gov (United States)

    Armen, Scott B; Freer, Carol V; Showalter, John W; Crook, Tonya; Whitener, Cynthia J; West, Cheri; Terndrup, Thomas E; Grifasi, Marissa; DeFlitch, Christopher J; Hollenbeak, Christopher S

    2016-01-01

    Sepsis mortality may be improved by early recognition and appropriate treatment based on evidence-based guidelines. An intervention was developed that focused on earlier identification of sepsis, early antimicrobial administration, and an educational program that was disseminated throughout all hospital units and services. There were 1331 patients with sepsis during the intervention period and 1401 patients with sepsis during the control period. After controlling for expected mortality, patients in the intervention period had 30% lower odds of dying (odds ratio = 0.70, 95% confidence interval [CI] = 0.57 to 0.84). They also had 1.07 fewer days on average in the intensive care unit (95% CI = -1.98 to -0.16), 2.15 fewer hospital days (95% CI = -3.45 to -0.86), and incurred on average $1949 less in hospital costs, although the effect on costs was not statistically significant. Continued incremental improvement and sustainment is anticipated through organizational oversight, continued education, and initiation of an automated electronic sepsis alert function. © The Author(s) 2014.

  8. Evaluation and improvement of nondestructive evaluation reliability for inservice inspection of light water reactors

    International Nuclear Information System (INIS)

    Bates, D.J.; Deffenbaugh, J.D.; Good, M.S.; Heasler, P.G.; Mart, G.A.; Simonen, F.A.; Spanner, J.C.; Taylor, T.T.; Van Fleet, L.G.

    1987-01-01

    The Evaluation and Improvement of NDE Reliability for Inservice Inspection (ISI) of Light Water Reactors (NDE Reliability) Program at Pacific Northwest Laboratory (PNL) was established to determine the reliability of current ISI techniques and to develop recommendations that will ensure a suitably high inspection reliability. The objectives of this NRC program are to: determine the reliability of ultrasonic ISI performed on commercial light-water reactor (LWR) primary systems, using probabilistic fracture mechanics analysis, determine the impact of NDE unreliability on system safety and determine the level of inspection reliability required to ensure a suitably low failure probability, evaluate the degree of reliability improvement that could be achieved using improved and advanced NDE techniques, based on material properties, service conditions, and NDE uncertainties, recommend revisions to ASME Code, Section XI, and Regulatory Requirements that will ensure suitably low failure probabilities. The scope of this program is limited to ISI of primary systems; the results and recommendations may also be applicable to Class II piping systems

  9. Improved Reliability-Based Optimization with Support Vector Machines and Its Application in Aircraft Wing Design

    Directory of Open Access Journals (Sweden)

    Yu Wang

    2015-01-01

    Full Text Available A new reliability-based design optimization (RBDO method based on support vector machines (SVM and the Most Probable Point (MPP is proposed in this work. SVM is used to create a surrogate model of the limit-state function at the MPP with the gradient information in the reliability analysis. This guarantees that the surrogate model not only passes through the MPP but also is tangent to the limit-state function at the MPP. Then, importance sampling (IS is used to calculate the probability of failure based on the surrogate model. This treatment significantly improves the accuracy of reliability analysis. For RBDO, the Sequential Optimization and Reliability Assessment (SORA is employed as well, which decouples deterministic optimization from the reliability analysis. The improved SVM-based reliability analysis is used to amend the error from linear approximation for limit-state function in SORA. A mathematical example and a simplified aircraft wing design demonstrate that the improved SVM-based reliability analysis is more accurate than FORM and needs less training points than the Monte Carlo simulation and that the proposed optimization strategy is efficient.

  10. Improving outcomes in patients with psoriasis.

    Science.gov (United States)

    Tidman, Michael J

    2013-01-01

    Psoriasis is a heterogeneous inflammatory disorder that targets the skin and joints. It affects 1.3-2% of the population. The diagnosis of plaque psoriasis is usually straightforward, a helpful diagnostic clue is the tendency for silver scales to appear after gentle scratching of a lesion. Stress, streptococcal infection and drugs including beta-blockers, antimalarials and lithium may precipitate or exacerbate psoriasis. Psoriasis, especially when severe, predisposes to metabolic syndrome, and patients with psoriasis are at increased risk of ischaemic heart disease, hypertension, stroke, type 2 diabetes and hyperlipidaemia. Additionally, psoriasis sufferers appear at increased risk of uveitis, inflammatory boweldisease, lymphoma, non-melanoma skin cancer, COPD and venous thromboembolism. Psoriasis should be assessed on the basis of: severity, impact on physical, psychological and social wellbeing, symptoms of arthritis and the presence of comorbidities. Poor response to topical therapy may be as much to do with lack of compliance as with lack of efficacy. The number of treatments each day should be kept to a minimum, and patients should be reviewed after four weeks when initiating or changing topical therapy to improve adherence to treatment and assess response. The majority of patients with psoriasis can be managed in primary care, although specialist care may be necessary at some point in up to 60% of cases. Patients with erythrodermic or generalised pustular psoriasis should be referred for a same day dermatological opinion, and if psoriatic arthritis is suspected, early referral for a rheumatological opinion is recommended.

  11. Reliability and validity of the foot and ankle outcome score: a validation study from Iran.

    Science.gov (United States)

    Negahban, Hossein; Mazaheri, Masood; Salavati, Mahyar; Sohani, Soheil Mansour; Askari, Marjan; Fanian, Hossein; Parnianpour, Mohamad

    2010-05-01

    The aims of this study were to culturally adapt and validate the Persian version of Foot and Ankle Outcome Score (FAOS) and present data on its psychometric properties for patients with different foot and ankle problems. The Persian version of FAOS was developed after a standard forward-backward translation and cultural adaptation process. The sample included 93 patients with foot and ankle disorders who were asked to complete two questionnaires: FAOS and Short-Form 36 Health Survey (SF-36). To determine test-retest reliability, 60 randomly chosen patients completed the FAOS again 2 to 6 days after the first administration. Test-retest reliability and internal consistency were assessed using intraclass correlation coefficient (ICC) and Cronbach's alpha, respectively. To evaluate convergent and divergent validity of FAOS compared to similar and dissimilar concepts of SF-36, the Spearman's rank correlation was used. Dimensionality was determined by assessing item-subscale correlation corrected for overlap. The results of test-retest reliability show that all the FAOS subscales have a very high ICC, ranging from 0.92 to 0.96. The minimum Cronbach's alpha level of 0.70 was exceeded by most subscales. The Spearman's correlation coefficient for convergent construct validity fell within 0.32 to 0.58 for the main hypotheses presented a priori between FAOS and SF-36 subscales. For dimensionality, the minimum Spearman's correlation coefficient of 0.40 was exceeded by most items. In conclusion, the results of our study show that the Persian version of FAOS seems to be suitable for Iranian patients with various foot and ankle problems especially lateral ankle sprain. Future studies are needed to establish stronger psychometric properties for patients with different foot and ankle problems.

  12. Role of Video Games in Improving Health-Related Outcomes

    Science.gov (United States)

    Primack, Brian A.; Carroll, Mary V.; McNamara, Megan; Klem, Mary Lou; King, Brandy; Rich, Michael O.; Chan, Chun W.; Nayak, Smita

    2012-01-01

    Context Video games represent a multibillion-dollar industry in the U.S. Although video gaming has been associated with many negative health consequences, it may also be useful for therapeutic purposes. The goal of this study was to determine whether video games may be useful in improving health outcomes. Evidence acquisition Literature searches were performed in February 2010 in six databases: the Center on Media and Child Health Database of Research, MEDLINE, CINAHL, PsycINFO, EMBASE, and the Cochrane Central Register of Controlled Trials. Reference lists were hand-searched to identify additional studies. Only RCTs that tested the effect of video games on a positive, clinically relevant health consequence were included. Study selection criteria were strictly defined and applied by two researchers working independently. Study background information (e.g., location, funding source), sample data (e.g., number of study participants, demographics), intervention and control details, outcomes data, and quality measures were abstracted independently by two researchers. Evidence synthesis Of 1452 articles retrieved using the current search strategy, 38 met all criteria for inclusion. Eligible studies used video games to provide physical therapy, psychological therapy, improved disease self-management, health education, distraction from discomfort, increased physical activity, and skills training for clinicians. Among the 38 studies, a total of 195 health outcomes were examined. Video games improved 69% of psychological therapy outcomes, 59% of physical therapy outcomes, 50% of physical activity outcomes, 46% of clinician skills outcomes, 42% of health education outcomes, 42% of pain distraction outcomes, and 37% of disease self-management outcomes. Study quality was generally poor; for example, two thirds (66%) of studies had follow-up periods of video games to improve health outcomes, particularly in the areas of psychological therapy and physical therapy. RCTs with

  13. Reliability improvement in GaN HEMT power device using a field plate approach

    Science.gov (United States)

    Wu, Wen-Hao; Lin, Yueh-Chin; Chin, Ping-Chieh; Hsu, Chia-Chieh; Lee, Jin-Hwa; Liu, Shih-Chien; Maa, Jer-shen; Iwai, Hiroshi; Chang, Edward Yi; Hsu, Heng-Tung

    2017-07-01

    This study investigates the effect of implementing a field plate on a GaN high-electron-mobility transistor (HEMT) to improve power device reliability. The results indicate that the field plate structure reduces the peak electrical field and interface traps in the device, resulting in higher breakdown voltage, lower leakage current, smaller current collapse, and better threshold voltage control. Furthermore, after high voltage stress, steady dynamic on-resistance and gate capacitance degradation improvement were observed for the device with the field plate. This demonstrates that GaN device reliability can be improved by using the field plate approach.

  14. Reliability improvements on Thales RM2 rotary Stirling coolers: analysis and methodology

    Science.gov (United States)

    Cauquil, J. M.; Seguineau, C.; Martin, J.-Y.; Benschop, T.

    2016-05-01

    The cooled IR detectors are used in a wide range of applications. Most of the time, the cryocoolers are one of the components dimensioning the lifetime of the system. The cooler reliability is thus one of its most important parameters. This parameter has to increase to answer market needs. To do this, the data for identifying the weakest element determining cooler reliability has to be collected. Yet, data collection based on field are hardly usable due to lack of informations. A method for identifying the improvement in reliability has then to be set up which can be used even without field return. This paper will describe the method followed by Thales Cryogénie SAS to reach such a result. First, a database was built from extensive expertizes of RM2 failures occurring in accelerate ageing. Failure modes have then been identified and corrective actions achieved. Besides this, a hierarchical organization of the functions of the cooler has been done with regard to the potential increase of its efficiency. Specific changes have been introduced on the functions most likely to impact efficiency. The link between efficiency and reliability will be described in this paper. The work on the two axes - weak spots for cooler reliability and efficiency - permitted us to increase in a drastic way the MTTF of the RM2 cooler. Huge improvements in RM2 reliability are actually proven by both field return and reliability monitoring. These figures will be discussed in the paper.

  15. ANALYSIS OF POWER SYSTEM RELIABILITY IMPROVEMENT FOR 74-BUS RADIAL DISTRIBUTION SYSTEM

    OpenAIRE

    Su Mon Myint*

    2018-01-01

    In Myanmar, electric power system planning is widely constructed because of more and more load growth and facing with failure of electricity, outage problems and system shut-down. Thus, not only making new power system network but also improving reliability of the existing system using suitable methods is very important to provide an adequate supply of electrical energy to its customers as economically and reliably as possible with an acceptable degree of continuity and quality that is design...

  16. Equipment reliability improvement process; implementation in Almaraz NPP and Trillo NPP

    International Nuclear Information System (INIS)

    Risquez Bailon, Aranzazu; Gutierrez Fernandez, Eduardo

    2010-01-01

    The Equipment Reliability Improvement Process (INPO AP-913) is a non-regulatory process developed by the US Nuclear Industry for improving Plants Availability. This Process integrates and coordinates a broad range of equipment reliability activities into one process, performed by the Plant in a non-centralized way. The integration and coordination of these activities will allow plant personnel to evaluate the trends of important station equipment, develop and implement long-term equipment health plans, monitor equipment performance and condition, and make adjustments to preventive maintenance tasks and frequencies based on equipment operating experience, if necessary, arbitrating operational and design improvements, to reach a Failure-free Operation. This paper describes the methodology of Equipment Reliability Improvement Process, being focused on main aspects of the implementation process, relating to the scope and establishment of an Equipment Reliability Monitoring Plan, which should include and complement the existing mechanisms and organizations in the Plant to monitor the condition and performance of the equipments, with the common aim of achieving an operation free of failures. The paper will describe the tools that Iberdrola Ingenieria has developed to support the implementation and monitoring of the Equipment Reliability Improvement Process, as well as the results and lessons learned from its implementation in Almaraz NPP and Trillo NPP. (authors)

  17. Reliability assessment and correlation analysis of evaluating orthodontic treatment outcome in Chinese patients.

    Science.gov (United States)

    Song, Guang-Ying; Zhao, Zhi-He; Ding, Yin; Bai, Yu-Xing; Wang, Lin; He, Hong; Shen, Gang; Li, Wei-Ran; Baumrind, Sheldon; Geng, Zhi; Xu, Tian-Min

    2014-03-01

    This study aimed to assess the reliability of experienced Chinese orthodontists in evaluating treatment outcome and to determine the correlations between three diagnostic information sources. Sixty-nine experienced Chinese orthodontic specialists each evaluated the outcome of orthodontic treatment of 108 Chinese patients. Three different information sources: study casts (SC), lateral cephalometric X-ray images (LX) and facial photographs (PH) were generated at the end of treatment for 108 patients selected randomly from six orthodontic treatment centers throughout China. Six different assessments of treatment outcome were made by each orthodontist using data from the three information sources separately and in combination. Each assessment included both ranking and grading for each patient. The rankings of each of the 69 judges for the 108 patients were correlated with the rankings of each of the other judges yielding 13 873 Spearman rs values, ranging from -0.08 to +0.85. Of these, 90% were greater than 0.4, showing moderate-to-high consistency among the 69 orthodontists. In the combined evaluations, study casts were the most significant predictive component (R(2)=0.86, P<0.000 1), while the inclusion of lateral cephalometric films and facial photographs also contributed to a more comprehensive assessment (R(2)=0.96, P<0.000 1). Grading scores for SC+LX and SC+PH were highly significantly correlated with those for SC+LX+PH (r(SC+LX)vs.(SC+LX+PH)=0.96, r(SC+PH)vs.(SC+LX+PH)=0.97), showing that either SC+LX or SC+PH is an excellent substitute for all three combined assessment.

  18. The Social Responsibility Performance Outcomes Model: Building Socially Responsible Companies through Performance Improvement Outcomes.

    Science.gov (United States)

    Hatcher, Tim

    2000-01-01

    Considers the role of performance improvement professionals and human resources development professionals in helping organizations realize the ethical and financial power of corporate social responsibility. Explains the social responsibility performance outcomes model, which incorporates the concepts of societal needs and outcomes. (LRW)

  19. Device Performance and Reliability Improvements of AlGaBN/GaN/Si MOSFET

    Science.gov (United States)

    2016-02-04

    AFRL-AFOSR-JP-TR-2016-0037 Device Performance and Reliablity Improvements of AlGaBN/GaN/Si MOSFET Robert Wallace UNIVERSITY OF TEXAS AT DALLAS Final...GaN/Si MOSFET 5a.  CONTRACT NUMBER 5b.  GRANT NUMBER FA2386-14-1-4069 5c.  PROGRAM ELEMENT NUMBER 61102F 6. AUTHOR(S) Robert Wallace 5d.  PROJECT...AOARD Grant FA2386-14-1-4069 Device Performance and Reliability Improvements of AlGaN/GaN/Si MOSFET US 12 month extension (2014 – 2015) for current

  20. A dissociation between engagement and learning: Enthusiastic instructions fail to reliably improve performance on a memory task.

    Directory of Open Access Journals (Sweden)

    Benjamin A Motz

    Full Text Available Despite widespread assertions that enthusiasm is an important quality of effective teaching, empirical research on the effect of enthusiasm on learning and memory is mixed and largely inconclusive. To help resolve these inconsistencies, we conducted a carefully-controlled laboratory experiment, investigating whether enthusiastic instructions for a memory task would improve recall accuracy. Scripted videos, either enthusiastic or neutral, were used to manipulate the delivery of task instructions. We also manipulated the sequence of learning items, replicating the spacing effect, a known cognitive technique for memory improvement. Although spaced study reliably improved test performance, we found no reliable effect of enthusiasm on memory performance across two experiments. We did, however, find that enthusiastic instructions caused participants to respond to more item prompts, leaving fewer test questions blank, an outcome typically associated with increased task motivation. We find no support for the popular claim that enthusiastic instruction will improve learning, although it may still improve engagement. This dissociation between motivation and learning is discussed, as well as its implications for education and future research on student learning.

  1. A dissociation between engagement and learning: Enthusiastic instructions fail to reliably improve performance on a memory task.

    Science.gov (United States)

    Motz, Benjamin A; de Leeuw, Joshua R; Carvalho, Paulo F; Liang, Kaley L; Goldstone, Robert L

    2017-01-01

    Despite widespread assertions that enthusiasm is an important quality of effective teaching, empirical research on the effect of enthusiasm on learning and memory is mixed and largely inconclusive. To help resolve these inconsistencies, we conducted a carefully-controlled laboratory experiment, investigating whether enthusiastic instructions for a memory task would improve recall accuracy. Scripted videos, either enthusiastic or neutral, were used to manipulate the delivery of task instructions. We also manipulated the sequence of learning items, replicating the spacing effect, a known cognitive technique for memory improvement. Although spaced study reliably improved test performance, we found no reliable effect of enthusiasm on memory performance across two experiments. We did, however, find that enthusiastic instructions caused participants to respond to more item prompts, leaving fewer test questions blank, an outcome typically associated with increased task motivation. We find no support for the popular claim that enthusiastic instruction will improve learning, although it may still improve engagement. This dissociation between motivation and learning is discussed, as well as its implications for education and future research on student learning.

  2. Improving the reliability of fuel Enusa; Mejora de la fiabilidad del combustible en Enusa

    Energy Technology Data Exchange (ETDEWEB)

    Choithramani, S.; Quecedo, M.

    2015-07-01

    ENUSA is committed to providing our customers with fuel designs that meet their needs for operational efficiency, power, energy, performance and reliability. ENUSAs current fuel designs, covering BWR and PWR technologies, incorporate highest performance with proven reliability features developed along nuclear power operation history. As of January 2015, ENUSA has manufactured more than 20.000 fuel assemblies (around half BWR and half PWR), with operating conditions reflecting varying reactor power densities, cycle lengths, operating strategies and water chemistry environments. This experience brings the knowledge to model our fuel behavior and acts as the principal instrument to identify and characterize the failure mechanisms of our fuel. Based on the information obtained from all this years of operation, ENUSA has progressively developed and implemented numerous mitigating actions identified upon the knowledge on failure mechanisms, which are the bases for the fuel reliability improvement program. Contemporaneously to this implementation, a positive trend on ENUSA fuel reliability has been observed. (Author)

  3. Reliability and Validity of the Self-Efficacy for Exercise in Epilepsy and the Outcome Expectations for Exercise in Epilepsy Scales.

    Science.gov (United States)

    Dustin, Irene; Resnick, Barbara; Galik, Elizabeth; Klinedinst, N Jennifer; Michael, Kathleen; Wiggs, Edythe

    2017-04-01

    The purpose of this study was to test the psychometric properties of the revised Self-Efficacy for Exercise With Epilepsy (SEE-E) and Outcome Expectations for Exercise with Epilepsy (OEE-E) when used with people with epilepsy. The SEE-E and OEE-E were given in face-to-face interviews to 26 persons with epilepsy in an epilepsy clinic. There was some evidence of validity based on Rasch analysis INFIT and OUTFIT statistics. There was some evidence of reliability for the SEE-E and OEE-E based on person and item separation reliability indexes. These measures can be used to identify persons with epilepsy who have low self-efficacy and outcome expectations for exercise and guide design of interventions to strengthen these expectations and thereby improve exercise behavior.

  4. Cost/worth assessment of reliability improvement in distribution networks by means of artificial intelligence

    Energy Technology Data Exchange (ETDEWEB)

    Bouhouras, Aggelos S.; Labridis, Dimitris P.; Bakirtzis, Anastasios G. [Power Systems Laboratory, Aristotle University of Thessaloniki, Dept. of Electrical and Computer Engineering, 54124 Thessaloniki (Greece)

    2010-06-15

    A major challenge for the power utilities today is to ensure a high level of reliability of supply to customers. Two main factors determine the feasibility of a project that improves the reliability of supply: the project cost (investment and operational) and the benefits that result from the implementation of the project. This paper examines the implementation of an Artificial Intelligence System in an urban distribution network, capable to locate and isolate short circuit faults in the feeder, thus accomplishing immediate restoration of electric supply to the customers. The paper describes the benefits of the project, which are supply reliability improvement and distribution network loss reduction through network reconfigurations. By comparison of the project benefits and costs the economic feasibility of such a project for an underground distribution feeder in Greece is demonstrated. (author)

  5. Advancements in valve technology and industry lessons lead to improved plant reliability and cost savings

    International Nuclear Information System (INIS)

    Sharma, V.; Kalsi, M.S.

    2005-01-01

    Plant reliability and safety hinges on the proper functioning of several valves. Recent advancements in valve technology have resulted in new analytical and test methods for evaluating and improving valve and actuator reliability. This is especially significant in critical service applications in which the economic impact of a valve failure on production, outage schedules and consequential damages far surpasses the initial equipment purchase price. This paper presents an overview of recent advances in valve technology driven by reliability concerns and cost savings objectives without comprising safety in the Nuclear Power Industry. This overview is based on over 27 years of experience in supporting US and International nuclear power utilities, and contributing to EPRI, and NSSS Owners' Groups in developing generic models/methodologies to address industry wide issues; performing design basis reviews; and implementing plant-wide valve reliability improvement programs. Various analytical prediction software and hardware solutions and training seminars are now available to implement valve programs covering power plants' lifecycle from the construction phase through life extension and power up rate. These tools and methodologies can enhance valve-engineering activities including the selection, sizing, proper application, condition monitoring, failure analysis, and condition based maintenance optimization with a focus on potential bad actors. This paper offers two such examples, the Kalsi Valve and Actuator Program (KVAP) and Check Valve Analysis and Prioritization (CVAP) [1-3, 8, 9, 11-13]. The advanced, validated torque prediction models incorporated into KVAP software for AOVs and MOVs have improved reliability of margin predictions and enabled cost savings through elimination of unwarranted equipment modifications. CVAP models provides a basis to prioritize the population of valves recommended for preventive maintenance, inspection and/or modification, allowing

  6. reliability reliability

    African Journals Online (AJOL)

    eobe

    Corresponding author, Tel: +234-703. RELIABILITY .... V , , given by the code of practice. However, checks must .... an optimization procedure over the failure domain F corresponding .... of Concrete Members based on Utility Theory,. Technical ...

  7. Outcomes management: incorporating and sustaining processes critical to using outcome data to guide practice improvement.

    Science.gov (United States)

    Hodges, Kay; Wotring, James R

    2012-04-01

    An outcomes management system (OMS) greatly facilitates an organization or state achieving requirements regarding accountability and use of empirically based interventions. A case example of the authors' experience with a successful and enduring OMS is presented, followed by a review of the literature and a proposed model delineating the key components and benefits of an OMS. Building capacity to measure performance requires embedding utilization of youth-specific, clinically meaningful outcome data into the organization's processes and structures. An OMS measures outcomes associated with services, facilitates implementation of evidence-based practices, informs case decision making, enables better and more efficient clinical management, and provides aggregated information used to improve services. A case-specific supervisory model based on instantaneously available information, including progress to date, helps maximize consumer outcomes. Continuous quality improvement activities, which are databased and goal-oriented, become a positive change management tool. This paper describes organizational processes that facilitate the development of a highly functional OMS.

  8. Precision of lumbar intervertebral measurements: does a computer-assisted technique improve reliability?

    Science.gov (United States)

    Pearson, Adam M; Spratt, Kevin F; Genuario, James; McGough, William; Kosman, Katherine; Lurie, Jon; Sengupta, Dilip K

    2011-04-01

    Comparison of intra- and interobserver reliability of digitized manual and computer-assisted intervertebral motion measurements and classification of "instability." To determine if computer-assisted measurement of lumbar intervertebral motion on flexion-extension radiographs improves reliability compared with digitized manual measurements. Many studies have questioned the reliability of manual intervertebral measurements, although few have compared the reliability of computer-assisted and manual measurements on lumbar flexion-extension radiographs. Intervertebral rotation, anterior-posterior (AP) translation, and change in anterior and posterior disc height were measured with a digitized manual technique by three physicians and by three other observers using computer-assisted quantitative motion analysis (QMA) software. Each observer measured 30 sets of digital flexion-extension radiographs (L1-S1) twice. Shrout-Fleiss intraclass correlation coefficients for intra- and interobserver reliabilities were computed. The stability of each level was also classified (instability defined as >4 mm AP translation or 10° rotation), and the intra- and interobserver reliabilities of the two methods were compared using adjusted percent agreement (APA). Intraobserver reliability intraclass correlation coefficients were substantially higher for the QMA technique THAN the digitized manual technique across all measurements: rotation 0.997 versus 0.870, AP translation 0.959 versus 0.557, change in anterior disc height 0.962 versus 0.770, and change in posterior disc height 0.951 versus 0.283. The same pattern was observed for interobserver reliability (rotation 0.962 vs. 0.693, AP translation 0.862 vs. 0.151, change in anterior disc height 0.862 vs. 0.373, and change in posterior disc height 0.730 vs. 0.300). The QMA technique was also more reliable for the classification of "instability." Intraobserver APAs ranged from 87 to 97% for QMA versus 60% to 73% for digitized manual

  9. Improving fMRI reliability in presurgical mapping for brain tumours.

    Science.gov (United States)

    Stevens, M Tynan R; Clarke, David B; Stroink, Gerhard; Beyea, Steven D; D'Arcy, Ryan Cn

    2016-03-01

    Functional MRI (fMRI) is becoming increasingly integrated into clinical practice for presurgical mapping. Current efforts are focused on validating data quality, with reliability being a major factor. In this paper, we demonstrate the utility of a recently developed approach that uses receiver operating characteristic-reliability (ROC-r) to: (1) identify reliable versus unreliable data sets; (2) automatically select processing options to enhance data quality; and (3) automatically select individualised thresholds for activation maps. Presurgical fMRI was conducted in 16 patients undergoing surgical treatment for brain tumours. Within-session test-retest fMRI was conducted, and ROC-reliability of the patient group was compared to a previous healthy control cohort. Individually optimised preprocessing pipelines were determined to improve reliability. Spatial correspondence was assessed by comparing the fMRI results to intraoperative cortical stimulation mapping, in terms of the distance to the nearest active fMRI voxel. The average ROC-r reliability for the patients was 0.58±0.03, as compared to 0.72±0.02 in healthy controls. For the patient group, this increased significantly to 0.65±0.02 by adopting optimised preprocessing pipelines. Co-localisation of the fMRI maps with cortical stimulation was significantly better for more reliable versus less reliable data sets (8.3±0.9 vs 29±3 mm, respectively). We demonstrated ROC-r analysis for identifying reliable fMRI data sets, choosing optimal postprocessing pipelines, and selecting patient-specific thresholds. Data sets with higher reliability also showed closer spatial correspondence to cortical stimulation. ROC-r can thus identify poor fMRI data at time of scanning, allowing for repeat scans when necessary. ROC-r analysis provides optimised and automated fMRI processing for improved presurgical mapping. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence

  10. Training less-experienced faculty improves reliability of skills assessment in cardiac surgery.

    Science.gov (United States)

    Lou, Xiaoying; Lee, Richard; Feins, Richard H; Enter, Daniel; Hicks, George L; Verrier, Edward D; Fann, James I

    2014-12-01

    Previous work has demonstrated high inter-rater reliability in the objective assessment of simulated anastomoses among experienced educators. We evaluated the inter-rater reliability of less-experienced educators and the impact of focused training with a video-embedded coronary anastomosis assessment tool. Nine less-experienced cardiothoracic surgery faculty members from different institutions evaluated 2 videos of simulated coronary anastomoses (1 by a medical student and 1 by a resident) at the Thoracic Surgery Directors Association Boot Camp. They then underwent a 30-minute training session using an assessment tool with embedded videos to anchor rating scores for 10 components of coronary artery anastomosis. Afterward, they evaluated 2 videos of a different student and resident performing the task. Components were scored on a 1 to 5 Likert scale, yielding an average composite score. Inter-rater reliabilities of component and composite scores were assessed using intraclass correlation coefficients (ICCs) and overall pass/fail ratings with kappa. All components of the assessment tool exhibited improvement in reliability, with 4 (bite, needle holder use, needle angles, and hand mechanics) improving the most from poor (ICC range, 0.09-0.48) to strong (ICC range, 0.80-0.90) agreement. After training, inter-rater reliabilities for composite scores improved from moderate (ICC, 0.76) to strong (ICC, 0.90) agreement, and for overall pass/fail ratings, from poor (kappa = 0.20) to moderate (kappa = 0.78) agreement. Focused, video-based anchor training facilitates greater inter-rater reliability in the objective assessment of simulated coronary anastomoses. Among raters with less teaching experience, such training may be needed before objective evaluation of technical skills. Published by Elsevier Inc.

  11. Tamsulosin therapy improved the outcome of ureterorenoscopy for ...

    African Journals Online (AJOL)

    Introduction: Tamsulosin is an α-1A-specific blocker inducing selective relaxation of ureteral smooth muscle and inhibition of ureteral spasms leading to ureteral dilatation that can facilitates retrograde ureterorenoscopy (URS). Objective: To assess the efficacy of tamsulosin in improving the outcome of URS management of ...

  12. Technology Improvement for the High Reliability LM-2F Launch Vehicle

    Institute of Scientific and Technical Information of China (English)

    QIN Tong; RONG Yi; ZHENG Liwei; ZHANG Zhi

    2017-01-01

    The Long March 2F (LM-2F) launch vehicle,the only launch vehicle designed for manned space flight in China,successfully launched the Tiangong 2 space laboratory and the Shenzhou ll manned spaceship into orbits in 2016 respectively.In this study,it introduces the technological improvements for enhancing the reliability of the LM-2F launch vehicle in the aspects of general technology,control system,manufacture and ground support system.The LM2F launch vehicle will continue to provide more contributions to the Chinese Space Station Project with its high reliability and 100% success rate.

  13. Complex method to calculate objective assessments of information systems protection to improve expert assessments reliability

    Science.gov (United States)

    Abdenov, A. Zh; Trushin, V. A.; Abdenova, G. A.

    2018-01-01

    The paper considers the questions of filling the relevant SIEM nodes based on calculations of objective assessments in order to improve the reliability of subjective expert assessments. The proposed methodology is necessary for the most accurate security risk assessment of information systems. This technique is also intended for the purpose of establishing real-time operational information protection in the enterprise information systems. Risk calculations are based on objective estimates of the adverse events implementation probabilities, predictions of the damage magnitude from information security violations. Calculations of objective assessments are necessary to increase the reliability of the proposed expert assessments.

  14. Embedded Sensors and Controls to Improve Component Performance and Reliability Conceptual Design Report

    Energy Technology Data Exchange (ETDEWEB)

    Kisner, R.; Melin, A.; Burress, T.; Fugate, D.; Holcomb, D.; Wilgen, J.; Miller, J.; Wilson, D.; Silva, P.; Whitlow, L.; Peretz, F.

    2012-09-15

    The objective of this project is to demonstrate improved reliability and increased performance made possible by deeply embedding instrumentation and controls (I&C) in nuclear power plant (NPP) components and systems. The project is employing a highly instrumented canned rotor, magnetic bearing, fluoride salt pump as its I&C technology demonstration platform. I&C is intimately part of the basic millisecond-by-millisecond functioning of the system; treating I&C as an integral part of the system design is innovative and will allow significant improvement in capabilities and performance. As systems become more complex and greater performance is required, traditional I&C design techniques become inadequate and more advanced I&C needs to be applied. New I&C techniques enable optimal and reliable performance and tolerance of noise and uncertainties in the system rather than merely monitoring quasistable performance. Traditionally, I&C has been incorporated in NPP components after the design is nearly complete; adequate performance was obtained through over-design. By incorporating I&C at the beginning of the design phase, the control system can provide superior performance and reliability and enable designs that are otherwise impossible. This report describes the progress and status of the project and provides a conceptual design overview for the platform to demonstrate the performance and reliability improvements enabled by advanced embedded I&C.

  15. Evaluation of Smart Grid Technologies Employed for System Reliability Improvement: Pacific Northwest Smart Grid Demonstration Experience

    Energy Technology Data Exchange (ETDEWEB)

    Agalgaonkar, Yashodhan P.; Hammerstrom, Donald J.

    2017-06-01

    The Pacific Northwest Smart Grid Demonstration (PNWSGD) was a smart grid technology performance evaluation project that included multiple U.S. states and cooperation from multiple electric utilities in the northwest region. One of the local objectives for the project was to achieve improved distribution system reliability. Toward this end, some PNWSGD utilities automated their distribution systems, including the application of fault detection, isolation, and restoration and advanced metering infrastructure. In light of this investment, a major challenge was to establish a correlation between implementation of these smart grid technologies and actual improvements of distribution system reliability. This paper proposes using Welch’s t-test to objectively determine and quantify whether distribution system reliability is improving over time. The proposed methodology is generic, and it can be implemented by any utility after calculation of the standard reliability indices. The effectiveness of the proposed hypothesis testing approach is demonstrated through comprehensive practical results. It is believed that wider adoption of the proposed approach can help utilities to evaluate a realistic long-term performance of smart grid technologies.

  16. [Reliability and validity of assessment of educational outcomes obtained by students of Medical Rescue at Medical University of Warsaw].

    Science.gov (United States)

    Panczyk, Mariusz; Stachacz, Grzegorz; Gałązkowski, Robert; Gotlib, Joanna

    2016-01-01

    In the interest of preservation of high degree of objectivity of information about students' educational outcomes, a system of assessment needs to meet criteria of appropriate reliability and validity. Analysis of reliability and validity of the system of assessment of students' educational outcomes for courses followed by an examination and covered by a curriculum in Medical Rescue at Medical University of Warsaw (MU W). A retrospective study enrolling a group of 421 students of eight subsequent full education cycles. Detailed data concerning grades for fourteen courses followed by an examination in the entire course of studies were collected. Reliability (Cronbach's alpha coefficient) and criteria validity (Spearman's rank correlation) were assessed. Internal consistency was estimated using a multiple regression model. The levels of assessment reliability for the general university, pre-clinical, and clinical scopes amounted to alpha: 0.42, 0.53, and 0.70, respectively. The strongest positive correlations between the results of pre-clinical and clinical trainings were found for the Anatomy course (r ≈ 0.30). Only in the case of the Pharmacology course it was found that students' achievements in this field were significantly correlated with all other courses of clinical training. The influence of educational outcomes in particular areas of clinical training on the final grade for the entire course of studies was diverse (β regression between 0.04 and 0.11). While the Pharmacology course had the strongest impact on final results, the Surgery course had the least influence on students' final grades (β = 0.04). 1. Sufficient reliability of the system of assessment of educational outcomes in Medical Rescue showed good precision and repeatability of assessment. 2. A low level of validity was caused by a failure to keep the appropriateness of the assessment of educational outcomes in several clinical courses. 3. Prognostic and diagnostic validity of methods used for

  17. Planning Irreversible Electroporation in the Porcine Kidney: Are Numerical Simulations Reliable for Predicting Empiric Ablation Outcomes?

    International Nuclear Information System (INIS)

    Wimmer, Thomas; Srimathveeravalli, Govindarajan; Gutta, Narendra; Ezell, Paula C.; Monette, Sebastien; Maybody, Majid; Erinjery, Joseph P.; Durack, Jeremy C.; Coleman, Jonathan A.; Solomon, Stephen B.

    2015-01-01

    PurposeNumerical simulations are used for treatment planning in clinical applications of irreversible electroporation (IRE) to determine ablation size and shape. To assess the reliability of simulations for treatment planning, we compared simulation results with empiric outcomes of renal IRE using computed tomography (CT) and histology in an animal model.MethodsThe ablation size and shape for six different IRE parameter sets (70–90 pulses, 2,000–2,700 V, 70–100 µs) for monopolar and bipolar electrodes was simulated using a numerical model. Employing these treatment parameters, 35 CT-guided IRE ablations were created in both kidneys of six pigs and followed up with CT immediately and after 24 h. Histopathology was analyzed from postablation day 1.ResultsAblation zones on CT measured 81 ± 18 % (day 0, p ≤ 0.05) and 115 ± 18 % (day 1, p ≤ 0.09) of the simulated size for monopolar electrodes, and 190 ± 33 % (day 0, p ≤ 0.001) and 234 ± 12 % (day 1, p ≤ 0.0001) for bipolar electrodes. Histopathology indicated smaller ablation zones than simulated (71 ± 41 %, p ≤ 0.047) and measured on CT (47 ± 16 %, p ≤ 0.005) with complete ablation of kidney parenchyma within the central zone and incomplete ablation in the periphery.ConclusionBoth numerical simulations for planning renal IRE and CT measurements may overestimate the size of ablation compared to histology, and ablation effects may be incomplete in the periphery

  18. Improving the reliability of nuclear reprocessing by application of computers and mathematical modelling

    International Nuclear Information System (INIS)

    Gabowitsch, E.; Trauboth, H.

    1982-01-01

    After a brief survey of the present and expected future state of nuclear energy utilization, which should demonstrate the significance of nuclear reprocessing, safety and reliability aspects of nuclear reprocessing plants (NRP) are considered. Then, the principal possibilities of modern computer technology including computer systems architecture and application-oriented software for improving the reliability and availability are outlined. In this context, two information systems being developed at the Nuclear Research Center Karlsruhe (KfK) are briefly described. For design evaluation of certain areas of a large NRP mathematical methods and computer-aided tools developed, used or being designed by KfK are discussed. In conclusion, future research to be pursued in information processing and applied mathematics in support of reliable operation of NRP's is proposed. (Auth.)

  19. Splenectomy Does Not Improve Long-Term Outcome After Stroke.

    Science.gov (United States)

    Zierath, Dannielle; Shen, Angela; Stults, Astiana; Olmstead, Theresa; Becker, Kyra J

    2017-02-01

    Immune responses to brain antigens after stroke contribute to poor outcome. We hypothesized that splenectomy would lessen the development of such responses and improve outcome. Male Lewis rats (275-350 g) underwent 2-hour middle cerebral artery occlusion immediately after splenectomy or sham splenectomy. Animals were survived to 4 weeks (672 hrs), and immune responses to myelin basic protein determined at euthanasia. Infarct volume was determined in a subset of animals euthanized at 72 hours. Behavioral outcomes were assessed to 672 hours. Splenectomy was associated with worse neurological scores early after stroke, but infarct size at 72 hours was similar in both groups. Behavioral outcomes and immune responses to myelin basic protein were also similar among splenectomized and sham-operated animals 672 hours after middle cerebral artery occlusion. Splenectomy did not alter the immune responses to brain antigens or improve outcome after stroke. Differences between this study and other studies of splenectomy and stroke are examined. © 2017 American Heart Association, Inc.

  20. Improving patient outcomes through registered dietitian order writing.

    Science.gov (United States)

    Roberts, Susan R

    2013-10-01

    Traditionally, registered dietitians (RD) have not had order writing privileges in most patient-care facilities and rely on physicians to implement their recommendations. Research has demonstrated that this model results in a high percentage of RD recommendations not being ordered. Timely nutrition interventions are important due to the prevalence of malnutrition in the hospital setting and when RD recommendations are implemented, important outcomes are improved. In addition, several studies have demonstrated that when RDs have order writing privileges, which allows more assurance that an intervention will occur and timely interventions, improved outcomes, such as improved nutrition status, better management of electrolytes and glycemic control, reaching goal calories sooner, reduction in inappropriate parenteral nutrition use, cost savings, and less error with electronic order entry. The process for implementation and outcomes of an RD order writing program at 1 large, urban, tertiary medical center is described. The program has been successful, but the implementation process required multiple years and ongoing monitoring through data collection to ensure success. RDs interested in order writing privileges must consider federal and state regulations, their individual scope of practice (relevant training and competency assessment), and how to obtain approval from the appropriate hospital governing committees. RDs who obtain order writing privileges must understand "with privilege comes responsibility" and should plan to conduct outcomes research to promote the value and acceptance of RD order writing by regulatory agencies at all levels and hospital leaders, for instance physicians and administrators.

  1. Application of Six Sigma towards improving surgical outcomes.

    Science.gov (United States)

    Shukla, P J; Barreto, S G; Nadkarni, M S

    2008-01-01

    Six Sigma is a 'process excellence' tool targeting continuous improvement achieved by providing a methodology for improving key steps of a process. It is ripe for application into health care since almost all health care processes require a near-zero tolerance for mistakes. The aim of this study is to apply the Six Sigma methodology into a clinical surgical process and to assess the improvement (if any) in the outcomes and patient care. The guiding principles of Six Sigma, namely DMAIC (Define, Measure, Analyze, Improve, Control), were used to analyze the impact of double stapling technique (DST) towards improving sphincter preservation rates for rectal cancer. The analysis using the Six Sigma methodology revealed a Sigma score of 2.10 in relation to successful sphincter preservation. This score demonstrates an improvement over the previous technique (73% over previous 54%). This study represents one of the first clinical applications of Six Sigma in the surgical field. By understanding, accepting, and applying the principles of Six Sigma, we have an opportunity to transfer a very successful management philosophy to facilitate the identification of key steps that can improve outcomes and ultimately patient safety and the quality of surgical care provided.

  2. Outcomes validity and reliability of the modified Rankin scale: implications for stroke clinical trials: a literature review and synthesis.

    Science.gov (United States)

    Banks, Jamie L; Marotta, Charles A

    2007-03-01

    The modified Rankin scale (mRS), a clinician-reported measure of global disability, is widely applied for evaluating stroke patient outcomes and as an end point in randomized clinical trials. Extensive evidence on the validity of the mRS exists across a large but fragmented literature. As new treatments for acute ischemic stroke are submitted for agency approval, an appreciation of the mRS's attributes, specifically its relationship to other stroke evaluation scales, would be valuable for decision-makers to properly assess the impact of a new drug on treatment paradigms. The purpose of this report is to assemble and systematically assess the properties of the mRS to provide decision-makers with pertinent evaluative information. A Medline search was conducted to identify reports in the peer-reviewed medical literature (1957-2006) that provide information on the structure, validation, scoring, and psychometric properties of the mRS and its use in clinical trials. The selection of articles was based on defined criteria that included relevance, study design and use of appropriate statistical methods. Of 224 articles identified by the literature search, 50 were selected for detailed assessment. Inter-rater reliability with the mRS is moderate and improves with structured interviews (kappa 0.56 versus 0.78); strong test-re-test reliability (kappa=0.81 to 0.95) has been reported. Numerous studies demonstrate the construct validity of the mRS by its relationships to physiological indicators such as stroke type, lesion size, perfusion and neurological impairment. Convergent validity between the mRS and other disability scales is well documented. Patient comorbidities and socioeconomic factors should be considered in properly applying and interpreting the mRS. Recent analyses suggest that randomized clinical trials of acute stroke treatments may require a smaller sample size if the mRS is used as a primary end point rather than the Barthel Index. Multiple types of evidence

  3. Reliability and responsiveness of the Self-Efficacy in Assessing, Training and Spotting wheelchair skills (SEATS) outcome measure.

    Science.gov (United States)

    Rushton, Paula W; Smith, Emma M; Miller, William C; Kirby, R Lee; Daoust, Geneviève

    2018-01-31

    The aim of this study was to evaluate the internal consistency, test-retest reliability and responsiveness of the Self-Efficacy in Assessing, Training and Spotting manual wheelchair skills (SEATS-M) and Self-Efficacy in Assessing, Training and Spotting power wheelchair skills (SEATS-P). A 2-week test-retest design was used with a convenience sample of occupational and physical therapists who worked at a provincial rehabilitation centre (inpatient and outpatient services). Sixteen participants completed the SEATS-M and 18 participants completed the SEATS-P. For the SEATS-M assessment, training, spotting and documentation sections, Cronbach's alpha coefficients ranged from 0.90 to 0.97, the 2-week intraclass correlation coefficients (ICC 1,1 ) ranged from 0.81 to 0.95, the standard error of measurements (SEM) ranged from 5.06 to 8.70 and the smallest real differences (SRD) ranged from 6.24 to 8.18. For the SEATS-P assessment, training, spotting and documentation sections, Cronbach's alpha coefficients ranged from 0.83 to 0.92, the ICCs ranged from 0.72 to 0.86, the SEMs ranged from 4.54 to 8.91 and the SRDs ranged from 5.90 to 8.27. There is preliminary evidence that both the SEATS-M and the SEATS-P have high internal consistency, good test-retest reliability and support for responsiveness. These tools can be used in evaluating clinician self-efficacy with assessing, training, spotting and documenting wheelchair skills included on the Wheelchair Skills Test. Implications for Rehabilitation There is preliminary evidence that the SEATS-M and SEATS-P are reliable and responsive outcome measures that can be used to evaluate the self-efficacy of clinicians to administer the Wheelchair Skills Program. Measurement of clinicians' self-efficacy in this area of practice may enable an enhanced understanding of the areas in which clinicians lack self-efficacy, thereby informing the development of improved knowledge translation interventions.

  4. Training improves interobserver reliability for the diagnosis of scaphoid fracture displacement.

    Science.gov (United States)

    Buijze, Geert A; Guitton, Thierry G; van Dijk, C Niek; Ring, David

    2012-07-01

    The diagnosis of displacement in scaphoid fractures is notorious for poor interobserver reliability. We tested whether training can improve interobserver reliability and sensitivity, specificity, and accuracy for the diagnosis of scaphoid fracture displacement on radiographs and CT scans. Sixty-four orthopaedic surgeons rated a set of radiographs and CT scans of 10 displaced and 10 nondisplaced scaphoid fractures for the presence of displacement, using a web-based rating application. Before rating, observers were randomized to a training group (34 observers) and a nontraining group (30 observers). The training group received an online training module before the rating session, and the nontraining group did not. Interobserver reliability for training and nontraining was assessed by Siegel's multirater kappa and the Z-test was used to test for significance. There was a small, but significant difference in the interobserver reliability for displacement ratings in favor of the training group compared with the nontraining group. Ratings of radiographs and CT scans combined resulted in moderate agreement for both groups. The average sensitivity, specificity, and accuracy of diagnosing displacement of scaphoid fractures were, respectively, 83%, 85%, and 84% for the nontraining group and 87%, 86%, and 87% for the training group. Assuming a 5% prevalence of fracture displacement, the positive predictive value was 0.23 in the nontraining group and 0.25 in the training group. The negative predictive value was 0.99 in both groups. Our results suggest training can improve interobserver reliability and sensitivity, specificity and accuracy for the diagnosis of scaphoid fracture displacement, but the improvements are slight. These findings are encouraging for future research regarding interobserver variation and how to reduce it further.

  5. Improved radiograph measurement inter-observer reliability by use of statistical shape models

    Energy Technology Data Exchange (ETDEWEB)

    Pegg, E.C., E-mail: elise.pegg@ndorms.ox.ac.uk [University of Oxford, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Nuffield Orthopaedic Centre, Windmill Road, Oxford OX3 7LD (United Kingdom); Mellon, S.J., E-mail: stephen.mellon@ndorms.ox.ac.uk [University of Oxford, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Nuffield Orthopaedic Centre, Windmill Road, Oxford OX3 7LD (United Kingdom); Salmon, G. [University of Oxford, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Nuffield Orthopaedic Centre, Windmill Road, Oxford OX3 7LD (United Kingdom); Alvand, A., E-mail: abtin.alvand@ndorms.ox.ac.uk [University of Oxford, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Nuffield Orthopaedic Centre, Windmill Road, Oxford OX3 7LD (United Kingdom); Pandit, H., E-mail: hemant.pandit@ndorms.ox.ac.uk [University of Oxford, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Nuffield Orthopaedic Centre, Windmill Road, Oxford OX3 7LD (United Kingdom); Murray, D.W., E-mail: david.murray@ndorms.ox.ac.uk [University of Oxford, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Nuffield Orthopaedic Centre, Windmill Road, Oxford OX3 7LD (United Kingdom); Gill, H.S., E-mail: richie.gill@ndorms.ox.ac.uk [University of Oxford, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Nuffield Orthopaedic Centre, Windmill Road, Oxford OX3 7LD (United Kingdom)

    2012-10-15

    Pre- and post-operative radiographs of patients undergoing joint arthroplasty are often examined for a variety of purposes including preoperative planning and patient assessment. This work examines the feasibility of using active shape models (ASM) to semi-automate measurements from post-operative radiographs for the specific case of the Oxford™ Unicompartmental Knee. Measurements of the proximal tibia and the position of the tibial tray were made using the ASM model and manually. Data were obtained by four observers and one observer took four sets of measurements to allow assessment of the inter- and intra-observer reliability, respectively. The parameters measured were the tibial tray angle, the tray overhang, the tray size, the sagittal cut position, the resection level and the tibial width. Results demonstrated improved reliability (average of 27% and 11.2% increase for intra- and inter-reliability, respectively) and equivalent accuracy (p > 0.05 for compared data values) for all of the measurements using the ASM model, with the exception of the tray overhang (p = 0.0001). Less time (15 s) was required to take measurements using the ASM model compared with manual measurements, which was significant. These encouraging results indicate that semi-automated measurement techniques could improve the reliability of radiographic measurements.

  6. Improved radiograph measurement inter-observer reliability by use of statistical shape models

    International Nuclear Information System (INIS)

    Pegg, E.C.; Mellon, S.J.; Salmon, G.; Alvand, A.; Pandit, H.; Murray, D.W.; Gill, H.S.

    2012-01-01

    Pre- and post-operative radiographs of patients undergoing joint arthroplasty are often examined for a variety of purposes including preoperative planning and patient assessment. This work examines the feasibility of using active shape models (ASM) to semi-automate measurements from post-operative radiographs for the specific case of the Oxford™ Unicompartmental Knee. Measurements of the proximal tibia and the position of the tibial tray were made using the ASM model and manually. Data were obtained by four observers and one observer took four sets of measurements to allow assessment of the inter- and intra-observer reliability, respectively. The parameters measured were the tibial tray angle, the tray overhang, the tray size, the sagittal cut position, the resection level and the tibial width. Results demonstrated improved reliability (average of 27% and 11.2% increase for intra- and inter-reliability, respectively) and equivalent accuracy (p > 0.05 for compared data values) for all of the measurements using the ASM model, with the exception of the tray overhang (p = 0.0001). Less time (15 s) was required to take measurements using the ASM model compared with manual measurements, which was significant. These encouraging results indicate that semi-automated measurement techniques could improve the reliability of radiographic measurements

  7. Reliability and validity of the German version of the Utrecht Questionnaire for Outcome Assessment in Aesthetic Rhinoplasty (D-OAR).

    Science.gov (United States)

    Spiekermann, Christoph; Rudack, Claudia; Stenner, Markus

    2017-11-01

    The outcome of aesthetic rhinoplasty is determined by the patient's subjective satisfaction with the nasal appearance which is difficult to assess. The Utrecht Questionnaire for Outcome Assessment in Aesthetic Rhinoplasty (OAR) is a brief and reliable instrument to assess the influence of the subjective nasal appearance on quality of life in patients undergoing aesthetic rhinoplasty. Preoperative application of this questionnaire reveals important aspects and possible disturbances of the body image which could be negative predictors concerning the result. On the other hand, it represents an appropriate tool to assess the postoperative outcome. The aim of this study was to determine the validity, reliability and responsiveness of the adapted German version of the OAR (D-OAR). The adaption of the OAR to German language was performed by a forward and backward translation process. Patients undergoing rhinoplasty were asked to complete the D-OAR preoperatively, 1, 3 and 12 months after procedure and healthy volunteers without any nasal complaints served as controls to test validity, reliability and responsiveness. An excellent internal consistency, a good test-retest reliability and good inter-item and item-total correlations demonstrated a good reliability of the D-OAR. The convincing validity of the adapted version was proven by an excellent discriminant and a sufficient content validity. Significant differences between pre- and postoperative D-OAR scores revealed a good responsiveness of the instrument. Hence, with a sufficient validity, reliability and sensitivity to changes, the D-OAR is a short and helpful instrument to assess the subjective perception of the nasal appearance in German patients.

  8. The Portuguese version of the Outcome Questionnaire (OQ-45): Normative data, reliability, and clinical significance cut-offs scores.

    Science.gov (United States)

    Machado, Paulo P P; Fassnacht, Daniel B

    2015-12-01

    The Outcome Questionnaire (OQ-45) is one of the most extensively used standardized self-report instruments to monitor psychotherapy outcomes. The questionnaire is designed specifically for the assessment of change during psychotherapy treatments. Therefore, it is crucial to provide norms and clinical cut-off values for clinicians and researchers. The current study aims at providing study provides norms, reliability indices, and clinical cut-off values for the Portuguese version of the scale. Data from two large non-clinical samples (high school/university, N = 1,669; community, N = 879) and one clinical sample (n = 201) were used to investigate psychometric properties and derive normative data for all OQ-45 subscales and the total score. Significant and substantial differences were found for all subscales between the clinical and non-clinical sample. The Portuguese version also showed adequate reliabilities (internal consistency, test-retest), which were comparable to the original version. To assess individual clinical change, clinical cut-off values and reliable change indices were calculated allowing clinicians and researchers to monitor and evaluate clients' individual change. The Portuguese version of the OQ-45 is a reliable instrument with comparable Portuguese norms and cut-off scores to those from the original version. This allows clinicians and researchers to use this instrument for evaluating change and outcome in psychotherapy. This study provides norms for non-clinical and clinical Portuguese samples and investigates the reliability (internal consistency and test-retest) of the OQ-45. Cut-off values and reliable change index are provided allowing clinicians to evaluate clinical change and clients' response to treatment, monitoring the quality of mental health care services. These can be used, in routine clinical practice, as benchmarks for treatment progress and to empirically base clinical decisions such as continuation of treatment or considering

  9. Multidisciplinary in-hospital teams improve patient outcomes: A review.

    Science.gov (United States)

    Epstein, Nancy E

    2014-01-01

    The use of multidisciplinary in-hospital teams limits adverse events (AE), improves outcomes, and adds to patient and employee satisfaction. Acting like "well-oiled machines," multidisciplinary in-hospital teams include "staff" from different levels of the treatment pyramid (e.g. staff including nurses' aids, surgical technicians, nurses, anesthesiologists, attending physicians, and others). Their enhanced teamwork counters the "silo effect" by enhancing communication between the different levels of healthcare workers and thus reduces AE (e.g. morbidity/mortality) while improving patient and healthcare worker satisfaction. Multiple articles across diverse disciplines incorporate a variety of concepts of "teamwork" for staff covering emergency rooms (ERs), hospital wards, intensive care units (ICUs), and most critically, operating rooms (ORs). Cohesive teamwork improved communication between different levels of healthcare workers, and limited adverse events, improved outcomes, decreased the length of stay (LOS), and yielded greater patient "staff" satisfaction. Within hospitals, delivering the best medical/surgical care is a "team sport." The goals include: Maximizing patient safety (e.g. limiting AE) and satisfaction, decreasing the LOS, and increasing the quality of outcomes. Added benefits include optimizing healthcare workers' performance, reducing hospital costs/complications, and increasing job satisfaction. This review should remind hospital administrators of the critical need to keep multidisciplinary teams together, so that they can continue to operate their "well-oiled machines" enhancing the quality/safety of patient care, while enabling "staff" to optimize their performance and enhance their job satisfaction.

  10. Prenatal emotion management improves obstetric outcomes: a randomized control study.

    Science.gov (United States)

    Huang, Jian; Li, He-Jiang; Wang, Jue; Mao, Hong-Jing; Jiang, Wen-Ying; Zhou, Hong; Chen, Shu-Lin

    2015-01-01

    Negative emotions can cause a number of prenatal problems and disturb obstetric outcomes. We determined the effectiveness of prenatal emotional management on obstetric outcomes in nulliparas. All participants completed the PHQ-9 at the baseline assessment. Then, the participants were randomly assigned to the emotional management (EM) and usual care (UC) groups. The baseline evaluation began at 31 weeks gestation and the participants were followed up to 42 days postpartum. Each subject in the EM group received an extra EM program while the participants in the UC groups received routine prenatal care and education only. The PHQ-9 and Edinburgh Postnatal Depression scale (EPDS) were used for assessment. The EM group had a lower PHQ-9 score at 36 weeks gestation, and 7 and 42 days after delivery (P Prenatal EM intervention could control anxiety and depressive feelings in nulliparas, and improve obstetric outcomes. It may serve as an innovative approach to reduce the cesarean section rate in China.

  11. Patient web portals to improve diabetes outcomes: a systematic review.

    Science.gov (United States)

    Osborn, Chandra Y; Mayberry, Lindsay Satterwhite; Mulvaney, Shelagh A; Hess, Rachel

    2010-12-01

    Patient web portals (PWPs), defined as the integration of electronic medical records and patient health records, have been related to enhanced patient outcomes. A literature review was conducted to characterize the design and evaluation of PWPs to improve health care processes and outcomes in diabetes. A summary of 26 articles revealed the positive impact PWPs have on patient outcomes, patient-provider communication, disease management, and access to and patient satisfaction with health care. Innovative and useful approaches included the evaluation of specific components of the PWPs, assessing the impact of PWPs on mediators of health behaviors, such as patient distress, identification of barriers to use, and patient willingness to pay for access. Future research should focus on relevant processes that mediate patient and provider use, impact on health care utilization, and a patient-centered approach to the design and integration of educational opportunities afforded through PWPs.

  12. Improved Reliability of SiC Pressure Sensors for Long Term High Temperature Applications

    Science.gov (United States)

    Okojie, R. S.; Nguyen, V.; Savrun, E.; Lukco, D.

    2011-01-01

    We report advancement in the reliability of silicon carbide pressure sensors operating at 600 C for extended periods. The large temporal drifts in zero pressure offset voltage at 600 C observed previously were significantly suppressed to allow improved reliable operation. This improvement was the result of further enhancement of the electrical and mechanical integrity of the bondpad/contact metallization, and the introduction of studded bump bonding on the pad. The stud bump contact promoted strong adhesion between the Au bond pad and the Au die-attach. The changes in the zero offset voltage and bridge resistance over time at temperature were explained by the microstructure and phase changes within the contact metallization, that were analyzed with Auger electron spectroscopy (AES) and field emission scanning electron microscopy (FE-SEM).

  13. Good performance in Japan is proof of continuing safety and reliability improvement practice

    International Nuclear Information System (INIS)

    Sumi, Y.

    1987-01-01

    Nuclear power is a vital energy supply source for both security and economy for such countries as Japan whose sources of energy are dependent on imported materials. This is the very reason why Japan gives her national priority to the improvement of nuclear power safety and reliability. As of the end of 1986, total nuclear power capacity owned and operated by private utility companies in Japan amounted to 24521 MW with 32 units sharing -- 19% of the total generating capacity. Moreover, during 1986 these units scored a remarkably high capacity factor of 76.2% and shared almost 28% of the nationwide electric power production, thereby contributing to a considerable saving of imported sources of energy. This outstanding record has been achieved by the parties concerned who dedicated themselves to furthering nuclear plant safety and reliability improvement. In this connection, this paper summarizes those key factors contributing to the good nuclear power plant performance of the Kansai Electric Power Company

  14. Attitude Control of Quad-rotor by Improving the Reliability of Multi-Sensor System

    Energy Technology Data Exchange (ETDEWEB)

    Yu, Dong Hyeon; Chong, Kil To [Chon-bok National University, Jeonju (Korea, Republic of); Park, Jong Ho [Seonam University, Namwon (Korea, Republic of); Ryu, Ji Hyoung [ETRI, Daejeon (Korea, Republic of)

    2015-05-15

    This paper presents the results of study for improving the reliability of quadrotor attitude control by applying a multi-sensor along with a data fusion algorithm. First, a mathematical model of the quadrotor dynamics was developed. Then, using the quadrotor mathematical model, simulations were performed using the improved reliability multi-sensor data as the inputs. From the simulation results, we designed a Gimbal-equipped quadrotor system. With the quadrotor in a hover state, we performed experiments according to the angle change of the user's specifications . We then calculated the attitude control data from the actual experimental data. Furthermore, with additional simulations, we verified the performance of the designed quadrotor attitude control system with multiple sensors.

  15. Improvements in the consistency of fabrication and the reliability of nuclear fuels through quality assurance

    International Nuclear Information System (INIS)

    Sifferlen, R.

    1976-01-01

    By establishing correlations between rejection level and fabrication parameters, quality assurance can guide corrective action for improving the consistency of fabrication and the reliability of fuel elements. The author cites examples relating to the quality of the uranium in metallic fuels, the influence of the parent metal on the welding of zirconium alloys, the behaviour of the springs inside the cladding during the welding of plugs and the behaviour of uranium oxide pellets. (author)

  16. Improved Binocular Outcomes Following Binocular Treatment for Childhood Amblyopia.

    Science.gov (United States)

    Kelly, Krista R; Jost, Reed M; Wang, Yi-Zhong; Dao, Lori; Beauchamp, Cynthia L; Leffler, Joel N; Birch, Eileen E

    2018-03-01

    Childhood amblyopia can be treated with binocular games or movies that rebalance contrast between the eyes, which is thought to reduce depth of interocular suppression so the child can experience binocular vision. While visual acuity gains have been reported following binocular treatment, studies rarely report gains in binocular outcomes (i.e., stereoacuity, suppression) in amblyopic children. Here, we evaluated binocular outcomes in children who had received binocular treatment for childhood amblyopia. Data for amblyopic children enrolled in two ongoing studies were pooled. The sample included 41 amblyopic children (6 strabismic, 21 anisometropic, 14 combined; age 4-10 years; ≤4 prism diopters [PD]) who received binocular treatment (20 game, 21 movies; prescribed 9-10 hours treatment). Amblyopic eye visual acuity and binocular outcomes (Randot Preschool Stereoacuity, extent of suppression, and depth of suppression) were assessed at baseline and at 2 weeks. Mean amblyopic eye visual acuity (P suppression (P = 0.003) were reduced from baseline at the 2-week visit (87% game adherence, 100% movie adherence). Depth of suppression was reduced more in children aged suppression was correlated with a larger depth of suppression reduction at 2 weeks (P = 0.001). After 2 weeks, binocular treatment in amblyopic children improved visual acuity and binocular outcomes, reducing the extent and depth of suppression and improving stereoacuity. Binocular treatments that rebalance contrast to overcome suppression are a promising additional option for treating amblyopia.

  17. Assessing motivation for work environment improvements: internal consistency, reliability and factorial structure.

    Science.gov (United States)

    Hedlund, Ann; Ateg, Mattias; Andersson, Ing-Marie; Rosén, Gunnar

    2010-04-01

    Workers' motivation to actively take part in improvements to the work environment is assumed to be important for the efficiency of investments for that purpose. That gives rise to the need for a tool to measure this motivation. A questionnaire to measure motivation for improvements to the work environment has been designed. Internal consistency and test-retest reliability of the domains of the questionnaire have been measured, and the factorial structure has been explored, from the answers of 113 employees. The internal consistency is high (0.94), as well as the correlation for the total score (0.84). Three factors are identified accounting for 61.6% of the total variance. The questionnaire can be a useful tool in improving intervention methods. The expectation is that the tool can be useful, particularly with the aim of improving efficiency of companies' investments for work environment improvements. Copyright 2010 Elsevier Ltd. All rights reserved.

  18. Depression Care Management: Can Employers Purchase Improved Outcomes?

    Directory of Open Access Journals (Sweden)

    Kathryn Rost

    2011-01-01

    Full Text Available Fourteen vendors are currently selling depression care management products to US employers after randomized trials demonstrate improved work outcomes. The research team interviewed 10 (71.4% of these vendors to compare their products to four key components of interventions demonstrated to improve work outcomes. Five of 10 depression products incorporate all four key components, three of which are sold by health maintenance organizations (HMOs; however, HMOs did not deliver these components at the recommended intensity and/or duration. Only one product delivered by a disease management company delivered all four components of care at the recommended intensity and duration. This “voltage drop,” which we anticipate will increase with product implementation, suggests that every delivery system should carefully evaluate the design of its depression product before implementation for its capacity to deliver evidence-based care, repeating these evaluations as new evidence emerges.

  19. 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

  20. TIAM1 variants improve clinical outcome in neuroblastoma.

    Science.gov (United States)

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

    2017-07-11

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

  1. Active Thermal Control for Reliability Improvement of MOS-gated Power Devices

    DEFF Research Database (Denmark)

    Soldati, Alessandro; Concari, Carlo; Dossena, Fabrizio

    2017-01-01

    reliability and lifetime. These figures can then be improved, which eases the adoption of electrification in markets, such as transportation, where they are still below target values. The proposed ATC method leaves electric load parameters untouched, while acting dynamically on gate parameters, namely voltage...... and resistance. A model-predictive control (MPC) strategy is used to determine the most suitable parameters to use. Simulations of the control scheme are presented first, to predict the potential benefits on temperature swing amplitude, and the consequent improvements in terms of device lifetime are inferred...

  2. A Simulation Model for Machine Efficiency Improvement Using Reliability Centered Maintenance: Case Study of Semiconductor Factory

    Directory of Open Access Journals (Sweden)

    Srisawat Supsomboon

    2014-01-01

    Full Text Available The purpose of this study was to increase the quality of product by focusing on the machine efficiency improvement. The principle of the reliability centered maintenance (RCM was applied to increase the machine reliability. The objective was to create preventive maintenance plan under reliability centered maintenance method and to reduce defects. The study target was set to reduce the Lead PPM for a test machine by simulating the proposed preventive maintenance plan. The simulation optimization approach based on evolutionary algorithms was employed for the preventive maintenance technique selection process to select the PM interval that gave the best total cost and Lead PPM values. The research methodology includes procedures such as following the priority of critical components in test machine, analyzing the damage and risk level by using Failure Mode and Effects Analysis (FMEA, calculating the suitable replacement period through reliability estimation, and optimizing the preventive maintenance plan. From the result of the study it is shown that the Lead PPM of test machine can be reduced. The cost of preventive maintenance, cost of good product, and cost of lost product were decreased.

  3. Which is the most useful patient-reported outcome in femoroacetabular impingement? Test-retest reliability of six questionnaires.

    Science.gov (United States)

    Hinman, Rana S; Dobson, Fiona; Takla, Amir; O'Donnell, John; Bennell, Kim L

    2014-03-01

    The most reliable patient-reported outcomes (PROs) for people with femoroacetabular impingement (FAI) is unknown because there have been no direct comparisons of questionnaires. Thus, the aim was to evaluate the test-retest reliability of six existing PROs in a single cohort of young active people with hip/groin pain consistent with a clinical diagnosis of FAI. Young adults with clinical FAI completed six PRO questionnaires on two occasions, 1-2 weeks apart. The PROs were modified Harris Hip Score, Hip dysfunction and Osteoarthritis Score, Hip Outcome Score, Non-Arthritic Hip Score, International Hip Outcome Tool, Copenhagen Hip and Groin Outcome Score. 30 young adults (mean age 24 years, SD 4 years, range 18-30 years; 15 men) with stable symptoms participated. Intraclass correlation coefficient(3,1) values ranged from 0.73 to 0.93 (95% CI 0.38 to 0.98) indicating that most questionnaires reached minimal reliability benchmarks. Measurement error at the individual level was quite large for most questionnaires (minimal detectable change (MDC95) 12.4-35.6, 95% CI 8.7 to 54.0). In contrast, measurement error at the group level was quite small for most questionnaires (MDC95 2.2-7.3, 95% CI 1.6 to 11). The majority of the questionnaires were reliable and precise enough for use at the group level. Samples of only 23-30 individuals were required to achieve acceptable measurement variation at the group level. Further direct comparisons of these questionnaires are required to assess other measurement properties such as validity, responsiveness and meaningful change in young people with FAI.

  4. Parents' self-efficacy, outcome expectations, and self-reported task performance when managing atopic dermatitis in children: instrument reliability and validity.

    Science.gov (United States)

    Mitchell, Amy E; Fraser, Jennifer A

    2011-02-01

    Support and education for parents faced with managing a child with atopic dermatitis is crucial to the success of current treatments. Interventions aiming to improve parent management of this condition are promising. Unfortunately, evaluation is hampered by lack of precise research tools to measure change. To develop a suite of valid and reliable research instruments to appraise parents' self-efficacy for performing atopic dermatitis management tasks; outcome expectations of performing management tasks; and self-reported task performance in a community sample of parents of children with atopic dermatitis. The Parents' Eczema Management Scale (PEMS) and the Parents' Outcome Expectations of Eczema Management Scale (POEEMS) were developed from an existing self-efficacy scale, the Parental Self-Efficacy with Eczema Care Index (PASECI). Each scale was presented in a single self-administered questionnaire, to measure self-efficacy, outcome expectations, and self-reported task performance related to managing child atopic dermatitis. Each was tested with a community sample of parents of children with atopic dermatitis, and psychometric evaluation of the scales' reliability and validity was conducted. A community-based convenience sample of 120 parents of children with atopic dermatitis completed the self-administered questionnaire. Participants were recruited through schools across Australia. Satisfactory internal consistency and test-retest reliability was demonstrated for all three scales. Construct validity was satisfactory, with positive relationships between self-efficacy for managing atopic dermatitis and general perceived self-efficacy; self-efficacy for managing atopic dermatitis and self-reported task performance; and self-efficacy for managing atopic dermatitis and outcome expectations. Factor analyses revealed two-factor structures for PEMS and PASECI alike, with both scales containing factors related to performing routine management tasks, and managing the

  5. Engineering, maintenance, and initiatives to improve LAMPF beam availability and system reliability

    International Nuclear Information System (INIS)

    Harris, H.W.; DeHaven, R.A.; Hart, V.E.; Parsons, W.M.; Sturrock, J.C.

    1992-01-01

    Two different requirements are driving engineering studies and hardware development to improve LAMPF. The first is concerned with component and system improvements to increase beam availability during the LAMPF production cycle. Hardware changes in RF, power supplies, and magnets are being implemented to increase mean time between failure and reduce time to replace or repair failed units. A joint LAMPF-Industry project is on-going to improve reliability of RF components. A component test stand is being refurbished to include significant development capability. The second approach includes several changes that will increase the duty factor of the existing accelerator. Major changes are being evaluated for replacing the front end of the accelerator. Other changes improving the high brightness capability could result in a new performance plateau for LAMPF. 2 refs., 2 figs

  6. Engineering, maintenance, and new initiatives to improve LAMPF beam availability and system reliability

    International Nuclear Information System (INIS)

    Harris, H.W.; DeHaven, R.A.; Hart, V.E.; Parsons, W.M.; Sturrock, J.C.

    1992-01-01

    Two different requirements are driving engineering studies and hardware development to improve LAMPF. The first is concerned with component and system improvements to increase beam availability during the LAMPF production cycle. Hardware changes in RF, power supplies, and magnets are being implemented to increase mean time between failure and reduce time to replace or repair failed units. A joint LAMPF-Industry project is on-going to improve reliability of RF components. A component test stand is being refurbished to include significant development capability. The second approach includes several changes that will increase the duty factor of the existing accelerator. Major changes are being evaluated for replacing the front end of the accelerator. Other changes improving high brightness capability could result in a new performance plateau for LAMPF

  7. The Reliability and Predictive Ability of a Biomarker of Oxidative DNA Damage on Functional Outcomes after Stroke Rehabilitation

    Science.gov (United States)

    Hsieh, Yu-Wei; Lin, Keh-Chung; Korivi, Mallikarjuna; Lee, Tsong-Hai; Wu, Ching-Yi; Wu, Kuen-Yuh

    2014-01-01

    We evaluated the reliability of 8-hydroxy-2′-deoxyguanosine (8-OHdG), and determined its ability to predict functional outcomes in stroke survivors. The rehabilitation effect on 8-OHdG and functional outcomes were also assessed. Sixty-one stroke patients received a 4-week rehabilitation. Urinary 8-OHdG levels were determined by liquid chromatography–tandem mass spectrometry. The test-retest reliability of 8-OHdG was good (interclass correlation coefficient = 0.76). Upper-limb motor function and muscle power determined by the Fugl-Meyer Assessment (FMA) and Medical Research Council (MRC) scales before rehabilitation showed significant negative correlation with 8-OHdG (r = −0.38, r = −0.30; p rehabilitation, we found a fair and significant correlation between 8-OHdG and FMA (r = −0.34) and 8-OHdG and pain (r = 0.26, p rehabilitation. The exploratory study findings conclude that 8-OHdG is a reliable and promising biomarker of oxidative stress and could be a valid predictor of functional outcomes in patients. Monitoring of behavioral indicators along with biomarkers may have crucial benefits in translational stroke research. PMID:24743892

  8. Improved reliability of wind turbine towers with active tuned mass dampers (ATMDs)

    Science.gov (United States)

    Fitzgerald, Breiffni; Sarkar, Saptarshi; Staino, Andrea

    2018-04-01

    Modern multi-megawatt wind turbines are composed of slender, flexible, and lightly damped blades and towers. These components exhibit high susceptibility to wind-induced vibrations. As the size, flexibility and cost of the towers have increased in recent years, the need to protect these structures against damage induced by turbulent aerodynamic loading has become apparent. This paper combines structural dynamic models and probabilistic assessment tools to demonstrate improvements in structural reliability when modern wind turbine towers are equipped with active tuned mass dampers (ATMDs). This study proposes a multi-modal wind turbine model for wind turbine control design and analysis. This study incorporates an ATMD into the tower of this model. The model is subjected to stochastically generated wind loads of varying speeds to develop wind-induced probabilistic demand models for towers of modern multi-megawatt wind turbines under structural uncertainty. Numerical simulations have been carried out to ascertain the effectiveness of the active control system to improve the structural performance of the wind turbine and its reliability. The study constructs fragility curves, which illustrate reductions in the vulnerability of towers to wind loading owing to the inclusion of the damper. Results show that the active controller is successful in increasing the reliability of the tower responses. According to the analysis carried out in this paper, a strong reduction of the probability of exceeding a given displacement at the rated wind speed has been observed.

  9. Reliability of infarct volumetry: Its relevance and the improvement by a software-assisted approach.

    Science.gov (United States)

    Friedländer, Felix; Bohmann, Ferdinand; Brunkhorst, Max; Chae, Ju-Hee; Devraj, Kavi; Köhler, Yvette; Kraft, Peter; Kuhn, Hannah; Lucaciu, Alexandra; Luger, Sebastian; Pfeilschifter, Waltraud; Sadler, Rebecca; Liesz, Arthur; Scholtyschik, Karolina; Stolz, Leonie; Vutukuri, Rajkumar; Brunkhorst, Robert

    2017-08-01

    Despite the efficacy of neuroprotective approaches in animal models of stroke, their translation has so far failed from bench to bedside. One reason is presumed to be a low quality of preclinical study design, leading to bias and a low a priori power. In this study, we propose that the key read-out of experimental stroke studies, the volume of the ischemic damage as commonly measured by free-handed planimetry of TTC-stained brain sections, is subject to an unrecognized low inter-rater and test-retest reliability with strong implications for statistical power and bias. As an alternative approach, we suggest a simple, open-source, software-assisted method, taking advantage of automatic-thresholding techniques. The validity and the improvement of reliability by an automated method to tMCAO infarct volumetry are demonstrated. In addition, we show the probable consequences of increased reliability for precision, p-values, effect inflation, and power calculation, exemplified by a systematic analysis of experimental stroke studies published in the year 2015. Our study reveals an underappreciated quality problem in translational stroke research and suggests that software-assisted infarct volumetry might help to improve reproducibility and therefore the robustness of bench to bedside translation.

  10. Translation and Adaptation of Knee Injury and Osteoarthritis Outcome Score (KOOS in to Persian and Testing Persian Version Reliability Among Iranians with Osteoarthritis

    Directory of Open Access Journals (Sweden)

    Solaleh Saraei-Pour

    2007-04-01

    Full Text Available Objective: To achieve a reliable tool for measuring health related quality of life among Iranians with knee osteoarthritis, by translating and culturally adapting the Knee injury and Osteoarthritis Outcome Score(KOOS to Persian and testing the reliability and internal consistency of the Iranian version. Materials & Methods: It was a non experimental methodology study. KOOS was translated and adapted culturally to Persian language and culture in three phases with respect to IQOLA project. For examining test-retest reliability Iranians version of KOOS was corresponded twice with in at least two days or at most one week interval, by 30 Iranian people with knee OA whom were referred to Municipality and 110 physiotherapy clinics of Tehran with PT order by physicians. It was a non experimental methodological research and we used sample of convenience and non probability design for sampling. Psychometric evaluation: the collected data from the questionnaires was rated and analyzed with SPSS software from the aspects of test-retest reliability, absolute reliability, subscale and item internal consistency. Results: Internal consistency which was calculated by Cronbach '&alpha was high for all the subscales (at least 0.76, except for "symptom" subscale which was moderate, and showed that items of each subscale measured the same construct. Item internal consistency after correction for overlap, was higher than optimal value (0.4, except for the items of" symptom" subscale , which demonstrated good item internal consistency. SEM and ICC which were used for evaluating the absolute and test-retest reliability in respect showed that all the subscales had good test-retest reliability (0.7 and the absolute reliability was also very good in such away that the highest calculated SEM for Persian version was 7.44 which was less than Minimal Perceptible Clinical Improvement (MPCI that is estimated 8 to 10 for the KOOS questionnaire. Conclusion: With the Persian

  11. The standardized surgical approach improves outcome of gallbladder cancer

    Directory of Open Access Journals (Sweden)

    Igna Dorian

    2007-05-01

    Full Text Available Abstract Background The objective of this study was to examine the extent of surgical procedures, pathological findings, complications and outcome of patients treated in the last 12 years for gallbladder cancer. Methods The impact of a standardized more aggressive approach compared with historical controls of our center with an individual approach was examined. Of 53 patients, 21 underwent resection for cure and 32 for palliation. Results Overall hospital mortality was 9% and procedure related mortality was 4%. The standardized approach in UICC stage IIa, IIb and III led to a significantly improved outcome compared to patients with an individual approach (Median survival: 14 vs. 7 months, mean+/-SEM: 26+/-7 vs. 17+/-5 months, p = 0.014. The main differences between the standardized and the individual approach were anatomical vs. atypical liver resection, performance of systematic lymph dissection of the hepaticoduodenal ligament and the resection of the common bile duct. Conclusion Anatomical liver resection, proof for bile duct infiltration and, in case of tumor invasion, radical resection and lymph dissection of the hepaticoduodenal ligament are essential to improve outcome of locally advanced gallbladder cancer.

  12. Substation design improvement with a probabilistic reliability approach using the TOPASE program

    Energy Technology Data Exchange (ETDEWEB)

    Bulot, M.; Heroin, G.; Bergerot, J-L.; Le Du, M. [Electricite de France (France)

    1997-12-31

    TOPASE, (the French acronym for Probabilistic Tools and Data Processing for the Analysis of Electric Systems), developed by Electricite de France (EDF) to perform reliability studies on transmission substations, was described. TOPASE serves a dual objective of assisting in the automation of HV substation studies, as well as enabling electrical systems experts who are not necessarily specialists in reliability studies to perform such studies. The program is capable of quantifying the occurrence rate of undesirable events and of identifying critical equipment and the main incident scenarios. The program can be used to improve an existing substation, to choose an HV structure during the design stage, or to choose a system of protective devices. Data collected during 1996 and 1997 will be analyzed to identify useful experiences and to validate the basic concepts of the program. 4 figs.

  13. ERP application of real-time vdc-enabled last planner system for planning reliability improvement

    DEFF Research Database (Denmark)

    Cho, S.; Sørensen, Kristian Birch; Fischer, M.

    2009-01-01

    The Last Planner System (LPS) has since its introduction in 1994 become a widely used method of AEC practitioners for improvement of planning reliability and tracking and monitoring of project progress. However, the observations presented in this paper indicate that the last planners...... and coordinators are in need of a new system that integrates the existing LPS with Virtual Design and Construction (VDC), Enterprise Resource Planning (ERP) systems, and automatic object identification by means of Radio Frequency Identification (RFID) technology. This is because current practice of the LPS...... implementations is guesswork-driven, textual report-generated, hand-updated, and even interpersonal trust-oriented, resulting in less accurate and reliable plans. This research introduces a prototype development of the VREL (VDC + RFID + ERP + LPS) integration to generate a real-time updated cost + physical...

  14. STUDIES ON IGBT MODULE TO IMPROVE THE RELIABILITY OF POWER ELECTRONIC SYSTEMS

    DEFF Research Database (Denmark)

    Choi, Uimin

    component level to converter level. It is divided into two main parts: the first part, which consists of Chapters 2 and 3, is reliability studies of the IGBT module regarding thermal stresses and the second part, composed of Chapters 4 and 5, discusses strategies to improve the reliability and availability...... are presented. Then, in Chapter 3, the effect of junction temperature swing duration t△Tj on the lifetime of the transfer molded Intelligent Power IGBT Module is investigated and modeled based on the power cycling test results. In addition, the physics-of-failure analysis results of the tested modules...... are presented. Finally, in Chapters 4 and 5, open-circuit fault detection and fault-tolerant control methods are proposed for two kinds of neutral-point clamped three-level inverters T-type and NPC inverters. One of main contributions in this project is the development of an apparatus and methodology...

  15. Prediction method of long-term reliability in improving residual stresses by means of surface finishing

    International Nuclear Information System (INIS)

    Sera, Takehiko; Hirano, Shinro; Chigusa, Naoki; Okano, Shigetaka; Saida, Kazuyoshi; Mochizuki, Masahito; Nishimoto, Kazutoshi

    2012-01-01

    Surface finishing methods, such as Water Jet Peening (WJP), have been applied to welds in some major components of nuclear power plants as a counter measure to Primary Water Stress Corrosion Cracking (PWSCC). In addition, the methods of surface finishing (buffing treatment) is being standardized, and thus the buffing treatment has been also recognized as the well-established method of improving stress. On the other hand, the long-term stability of peening techniques has been confirmed by accelerated test. However, the effectiveness of stress improvement by surface treatment is limited to thin layers and the effect of complicated residual stress distribution in the weld metal beneath the surface is not strictly taken into account for long-term stability. This paper, therefore, describes the accelerated tests, which confirmed that the long-term stability of the layer subjected to buffing treatment was equal to that subjected to WJP. The long-term reliability of very thin stress improved layer was also confirmed through a trial evaluation by thermal elastic-plastic creep analysis, even if the effect of complicated residual stress distribution in the weld metal was excessively taken into account. Considering the above findings, an approach is proposed for constructing the prediction method of the long-term reliability of stress improvement by surface finishing. (author)

  16. Evaluating test-retest reliability in patient-reported outcome measures for older people: A systematic review.

    Science.gov (United States)

    Park, Myung Sook; Kang, Kyung Ja; Jang, Sun Joo; Lee, Joo Yun; Chang, Sun Ju

    2018-03-01

    This study aimed to evaluate the components of test-retest reliability including time interval, sample size, and statistical methods used in patient-reported outcome measures in older people and to provide suggestions on the methodology for calculating test-retest reliability for patient-reported outcomes in older people. This was a systematic literature review. MEDLINE, Embase, CINAHL, and PsycINFO were searched from January 1, 2000 to August 10, 2017 by an information specialist. This systematic review was guided by both the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist and the guideline for systematic review published by the National Evidence-based Healthcare Collaborating Agency in Korea. The methodological quality was assessed by the Consensus-based Standards for the selection of health Measurement Instruments checklist box B. Ninety-five out of 12,641 studies were selected for the analysis. The median time interval for test-retest reliability was 14days, and the ratio of sample size for test-retest reliability to the number of items in each measure ranged from 1:1 to 1:4. The most frequently used statistical methods for continuous scores was intraclass correlation coefficients (ICCs). Among the 63 studies that used ICCs, 21 studies presented models for ICC calculations and 30 studies reported 95% confidence intervals of the ICCs. Additional analyses using 17 studies that reported a strong ICC (>0.09) showed that the mean time interval was 12.88days and the mean ratio of the number of items to sample size was 1:5.37. When researchers plan to assess the test-retest reliability of patient-reported outcome measures for older people, they need to consider an adequate time interval of approximately 13days and the sample size of about 5 times the number of items. Particularly, statistical methods should not only be selected based on the types of scores of the patient-reported outcome measures, but should also be described clearly in

  17. Near-misses are an opportunity to improve patient safety: adapting strategies of high reliability organizations to healthcare.

    Science.gov (United States)

    Van Spall, Harriette; Kassam, Alisha; Tollefson, Travis T

    2015-08-01

    Near-miss investigations in high reliability organizations (HROs) aim to mitigate risk and improve system safety. Healthcare settings have a higher rate of near-misses and subsequent adverse events than most high-risk industries, but near-misses are not systematically reported or analyzed. In this review, we will describe the strategies for near-miss analysis that have facilitated a culture of safety and continuous quality improvement in HROs. Near-miss analysis is routine and systematic in HROs such as aviation. Strategies implemented in aviation include the Commercial Aviation Safety Team, which undertakes systematic analyses of near-misses, so that findings can be incorporated into Standard Operating Procedures (SOPs). Other strategies resulting from incident analyses include Crew Resource Management (CRM) for enhanced communication, situational awareness training, adoption of checklists during operations, and built-in redundancy within systems. Health care organizations should consider near-misses as opportunities for quality improvement. The systematic reporting and analysis of near-misses, commonplace in HROs, can be adapted to health care settings to prevent adverse events and improve clinical outcomes.

  18. Is magnetic resonance imaging reliable in predicting clinical outcome after articular cartilage repair of the knee?

    NARCIS (Netherlands)

    de Windt, T.S.; Welsch, G.H.; Brittberg, M.; Vonk, L.A.; Marlovits, S.; Trattnig, S.; Saris, Daniël B.F.

    2013-01-01

    Background: While MRI can provide a detailed morphological evaluation after articular cartilage repair, its additional value in determining clinical outcome has yet to be determined. Purpose: To evaluate the correlation between MRI and clinical outcome after cartilage repair and to identify

  19. Evaluation and improvement in nondestructive examination (NDE) reliability for in-service inspection of light water reactors

    International Nuclear Information System (INIS)

    Deffenbaugh, J.D.; Good, M.S.; Green, E.R.; Heasler, P.G.; Simonen, F.A.; Spanner, J.C.; Taylor, T.T.

    1988-01-01

    The evaluation and improvement of NDE Reliability for In-service Inspection (ISI) of Light Water Reactors (NDE Reliability) Program at Pacific Northwest Laboratory (PNL) was established to determine the reliability of current ISI techniques and to develop recommendations that will ensure a suitably high inspection reliability. The objectives of this NRC program are to: determine the reliability of ultrasonic ISI performed on commercial light-water reactor (LWR) primary systems; determine the impact of NDE unreliability on system safety and determine the level of inspection reliability required to ensure a suitably low failure probability using probabilistic fracture mechanics analysis; evaluate the degree of reliability improvement that could be achieved using improved and advanced NDE technique; and recommend revisions to ASME Code, Section XI, and Regulatory Requirements, based on material properties, service conditions, and NDE uncertainties, that will ensure suitably low failure probabilities. The program consists of three basic tasks: a Piping task, a Pressure Vessel task, and an Evaluation and Improvement in NDE Reliability task. The major efforts were concentrated in the Piping task and the Evaluation and Improvement in NDE Reliability task

  20. Improving utility conservation programs: outcomes, interventions, and evaluations

    Energy Technology Data Exchange (ETDEWEB)

    Condelli, L; Archer, D; Aronson, E; Curbow, B; McLeod, B; Pettigrew, T F; White, L T; Yates, S

    1984-06-01

    Four major California utility companies have active energy conservation programs mandated by the State's Public Utilities Commission (CPUC). These companies evaluate their programs and send reports of the evaluations to the CPUC. A review of 213 of these reports revealed a marketing research approach toward promoting conservation. Advertising and informational campaigns characterize most programs, and attitudes and self-reported behavior were the major outcome measures. This approach is shown to be ineffective. Suggestions for improvement include: (1) the use of actual energy consumption as the primary outcome measure in evaluating conservation programs; (2) the abandonment of conventional advertising, and the use of it only for the promotion of ''hard'' interventions; (3) increased use of social diffusion methods to disseminate information; (4) the design of more effective educational material by incorporating cognitive social psychological principles; and (5) the utilization of ''hard'' interventions that have a direct, verifiable link to conservation.

  1. Standardized Treatment of Neonatal Status Epilepticus Improves Outcome.

    Science.gov (United States)

    Harris, Mandy L; Malloy, Katherine M; Lawson, Sheena N; Rose, Rebecca S; Buss, William F; Mietzsch, Ulrike

    2016-12-01

    We aimed to decrease practice variation in treatment of neonatal status epilepticus by implementing a standardized protocol. Our primary goal was to achieve 80% adherence to the algorithm within 12 months. Secondary outcome measures included serum phenobarbital concentrations, number of patients progressing from seizures to status epilepticus, and length of hospital stay. Data collection occurred for 6 months prior and 12 months following protocol implementation. Adherence of 80% within 12 months was partially achieved in patients diagnosed in our hospital; in pretreated patients, adherence was not achieved. Maximum phenobarbital concentrations were decreased (56.8 vs 41.0 µg/mL), fewer patients progressed from seizures to status epilepticus (46% vs 36%), and hospital length of stay decreased by 9.7 days in survivors. In conclusion, standardized, protocol-driven treatment of neonatal status epilepticus improves consistency and short-term outcome. © The Author(s) 2016.

  2. Reliability of lower limb transcranial magnetic stimulation outcomes in the ipsi- and contralesional hemispheres of adults with chronic stroke.

    Science.gov (United States)

    Beaulieu, Louis-David; Massé-Alarie, Hugo; Ribot-Ciscar, Edith; Schneider, Cyril

    2017-07-01

    To investigate the ability of transcranial magnetic stimulation (TMS) outcomes in the chronic stroke population to (i) track individual plastic changes and (ii) detect differences between individuals. To this end, intrarater "test-retest" reliability (relative and absolute) was tested for the ipsilesional and contralesional hemispheres. Thirteen participants with a unilateral stroke (≥6months ago) and sensorimotor impairments were enrolled. Single and paired-pulse TMS outcomes were obtained from the primary motor cortex (M1) representation of the tibialis anterior muscle in both hemispheres and at two sessions separated by one week. The standard error of the measurement (SEM eas ), minimal detectable change (MDC) and intraclass correlation coefficient (ICC) were studied. Active motor threshold and latency of motor evoked potentials provided the lowest SEM eas and highest ICCs for both ipsi- and contralesional hemispheres. However, MDC were generally large, thus questioning the use of TMS outcomes to track individual plastic changes of M1. Our study provided supporting evidence of good to excellent intrarater reliability for a few TMS outcomes and proposed recommendations on the interpretation and the use of that knowledge in future work. Psychometric properties of TMS measures should be further addressed in order to better understand how to refine their use in clinical settings. Copyright © 2017 International Federation of Clinical Neurophysiology. Published by Elsevier B.V. All rights reserved.

  3. The readability of psychosocial wellness patient resources: improving surgical outcomes.

    Science.gov (United States)

    Kugar, Meredith A; Cohen, Adam C; Wooden, William; Tholpady, Sunil S; Chu, Michael W

    2017-10-01

    Patient education is increasingly accessed with online resources and is essential for patient satisfaction and clinical outcomes. The average American adult reads at a seventh grade level, and the National Institute of Health (NIH) and the American Medical Association (AMA) recommend that information be written at a sixth-grade reading level. Health literacy plays an important role in the disease course and outcomes of all patients, including those with depression and likely other psychiatric disorders, although this is an area in need of further study. The purpose of this study was to collect and analyze written, online mental health resources on the Veterans Health Administration (VA) website, and other websites, using readability assessment instruments. An internet search was performed to identify written patient education information regarding mental health from the VA (the VA Mental Health Website) and top-rated psychiatric hospitals. Seven mental health topics were included in the analysis: generalized anxiety disorder, bipolar, major depressive disorder, posttraumatic stress disorder, schizophrenia, substance abuse, and suicide. Readability analyses were performed using the Gunning Fog Index, the Flesch-Kincaid Grade Level, the Coleman-Liau Index, the SMOG Readability Formula, and the Automated Readability Index. These scores were then combined into a Readability Consensus score. A two-tailed t-test was used to compare the mean values, and statistical significance was set at P readability consensus than six of the top psychiatric hospitals (P readability consensus for mental health information on all websites analyzed was 9.52. Online resources for mental health disorders are more complex than recommended by the NIH and AMA. Efforts to improve readability of mental health and psychosocial wellness resources could benefit patient understanding and outcomes, especially in patients with lower literacy. Surgical outcomes are correlated with patient mental

  4. Community to clinic navigation to improve diabetes outcomes

    Directory of Open Access Journals (Sweden)

    Nancy E. Schoenberg

    2017-03-01

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

  5. Leveraging Behavioral Economics to Improve Heart Failure Care and Outcomes.

    Science.gov (United States)

    Chang, Leslie L; DeVore, Adam D; Granger, Bradi B; Eapen, Zubin J; Ariely, Dan; Hernandez, Adrian F

    2017-08-22

    Behavioral challenges are often present in human illness, so behavioral economics is increasingly being applied in healthcare settings to better understand why patients choose healthy or unhealthy behaviors. The application of behavioral economics to healthcare settings parallels recent shifts in policy and reimbursement structures that hold providers accountable for outcomes that are dependent on patient behaviors. Numerous studies have examined the application of behavioral economics principles to policy making and health behaviors, but there are limited data on applying these concepts to the management of chronic conditions, such as heart failure (HF). Given its increasing prevalence and high associated cost of care, HF is a paradigm case for studying novel approaches to improve health care; therefore, if we can better understand why patients with HF make the choices they do, then we may be more poised to help them manage their medications, influence daily behaviors, and encourage healthy decision making. In this article, we will give a brief explanation of the core behavioral economics concepts that apply to patients with HF. We will also examine how to craft these concepts into tools such as financial incentives and social networks that may improve the management of patients with HF. We believe that behavioral economics can help us understand barriers to change, encourage positive behaviors, and offer additional approaches to improving the outcomes of patients with HF. © 2017 American Heart Association, Inc.

  6. Do workplace physical activity interventions improve mental health outcomes?

    Science.gov (United States)

    Chu, A H Y; Koh, D; Moy, F M; Müller-Riemenschneider, F

    2014-06-01

    Mental health is an important issue in the working population. Interventions to improve mental health have included physical activity. To review evidence for the effectiveness of workplace physical activity interventions on mental health outcomes. A literature search was conducted for studies published between 1990 and August 2013. Inclusion criteria were physical activity trials, working populations and mental health outcomes. Study quality was assessed using the Jadad scale. Of 3684 unique articles identified, 17 met all selection criteria, including 13 randomized controlled trials, 2 comparison trials and 2 controlled trials. Studies were grouped into two key intervention areas: physical activity and yoga exercise. Of eight high-quality trials, two provided strong evidence for a reduction in anxiety, one reported moderate evidence for an improvement in depression symptoms and one provided limited evidence on relieving stress. The remaining trials did not provide evidence on improved mental well-being. Workplace physical activity and yoga programmes are associated with a significant reduction in depressive symptoms and anxiety, respectively. Their impact on stress relief is less conclusive. © The Author 2014. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  7. Innovative Outcome Assessment in Graduate Business Education and Continuous Improvement

    Directory of Open Access Journals (Sweden)

    Chattopadhyay Satya P.

    2014-11-01

    Full Text Available The changed environment of global economy with painful austerity and restructuring measures causing severe economic dislocations in many diverse parts of the world have brought into focus the usefulness and value of management education in general and graduate management education in particular. The various accrediting bodies in America, Europe and Asia in recent years have shifted their emphasis to ensuring that learning outcomes of students in the program are tied to the goals and missions of the academic institution and meet the needs of the external partners of the academic enterprise that the students go on to serve. This has resulted in rapid advances in the field of innovative outcome assessment, and measurement of competency in performing higher order tasks as well as demonstration of traits related to successful transition into the business world and contribution to the success of the enterprise where the students are employed. The mere assessment/measurement of traits is not the end, but rather the first step in the cycle of continuous improvement in the tradition of the Plan-Do-Study-Act tradition of TQM. The goal is to identify shortcomings or opportunities for improvement via the assessment process and then to “close the loop” by introducing planned changes to improve system performance.

  8. Assessing Academic Advising Outcomes Using Social Cognitive Theory: A Validity and Reliability Study

    Science.gov (United States)

    Erlich, Richard J.; Russ-Eft, Darlene F.

    2012-01-01

    The validity and reliability of three instruments, the "Counselor Rubric for Gauging Student Understanding of Academic Planning," micro-analytic questions, and the "Student Survey for Understanding Academic Planning," all based on social cognitive theory, were tested as means to assess self-efficacy and self-regulated learning in college academic…

  9. Commitment to COT verification improves patient outcomes and financial performance.

    Science.gov (United States)

    Maggio, Paul M; Brundage, Susan I; Hernandez-Boussard, Tina; Spain, David A

    2009-07-01

    After an unsuccessful American College of Surgery Committee on Trauma visit, our level I trauma center initiated an improvement program that included (1) hiring new personnel (trauma director and surgeons, nurse coordinator, orthopedic trauma surgeon, and registry staff), (2) correcting deficiencies in trauma quality assurance and process improvement programs, and (3) development of an outreach program. Subsequently, our trauma center had two successful verifications. We examined the longitudinal effects of these efforts on volume, patient outcomes and finances. The Trauma Registry was used to derive data for all trauma patients evaluated in the emergency department from 2001 to 2007. Clinical data analyzed included number of admissions, interfacility transfers, injury severity scores (ISS), length of stay, and mortality for 2001 to 2007. Financial performance was assessed for fiscal years 2001 to 2007. Data were divided into patients discharged from the emergency department and those admitted to the hospital. Admissions increased 30%, representing a 7.6% annual increase (p = 0.004), mostly due to a nearly fivefold increase in interfacility transfers. Severe trauma patients (ISS >24) increased 106% and mortality rate for ISS >24 decreased by 47% to almost half the average of the National Trauma Database. There was a 78% increase in revenue and a sustained increase in hospital profitability. A major hospital commitment to Committee on Trauma verification had several salient outcomes; increased admissions, interfacility transfers, and acuity. Despite more seriously injured patients, there has been a major, sustained reduction in mortality and a trend toward decreased intensive care unit length of stay. This resulted in a substantial increase in contribution to margin (CTM), net profit, and revenues. With a high level of commitment and favorable payer mix, trauma center verification improves outcomes for both patients and the hospital.

  10. Role of recent research in improving check valve reliability at nuclear power plants

    International Nuclear Information System (INIS)

    Kalsi, M.S.; Horst, C.L.; Wang, J.K.; Sharma, V.

    1990-01-01

    Check valve failures at nuclear power plants in recent years have led to serious safety concerns, and caused extensive damage to other plant components which had a significant impact on plant availability. In order to understand the failure mechanism and improve the reliability of check valves, a systematic research effort was proposed by Kalsi Engineering, Inc. to U.S. Nuclear Regulatory Commission (NRC). The overall goal of the research was to develop models for predicting the performance and degradation of swing check valves in nuclear power plant systems so that appropriate preventive maintenance or design modifications can be performed to improve the reliability of check valves. Under Phase I of this research, a large matrix of tests was run with instrumented swing check valves to determine the stability of the disc under a variety of upstream flow disturbances, covering a wide range of disc stop positions and flow velocities in two different valve sizes. The goals of Phase II research were to develop predictive models which quantify the anticipated degradation of swing check valves that have flow disturbances closely upstream of the valve and are operating under flow velocities that do not result in full disc opening. This research allows the inspection/maintenance activities to be focussed on those check valves that are more likely to suffer premature degradation. The quantitative wear and fatigue prediction methodology can be used to develop a sound preventive maintenance program. The results of the research also show the improvements in check valve performance/reliability that can be achieved by certain modifications in the valve design

  11. Housing improvements for health and associated socio-economic outcomes.

    Science.gov (United States)

    Thomson, Hilary; Thomas, Sian; Sellstrom, Eva; Petticrew, Mark

    2013-02-28

    The well established links between poor housing and poor health indicate that housing improvement may be an important mechanism through which public investment can lead to health improvement. Intervention studies which have assessed the health impacts of housing improvements are an important data resource to test assumptions about the potential for health improvement. Evaluations may not detect long term health impacts due to limited follow-up periods. Impacts on socio-economic determinants of health may be a valuable proxy indication of the potential for longer term health impacts. To assess the health and social impacts on residents following improvements to the physical fabric of housing. Twenty seven academic and grey literature bibliographic databases were searched for housing intervention studies from 1887 to July 2012 (ASSIA; Avery Index; CAB Abstracts; The Campbell Library; CINAHL; The Cochrane Library; COPAC; DH-DATA: Health Admin; EMBASE; Geobase; Global Health; IBSS; ICONDA; MEDLINE; MEDLINE In-Process & Other Non-Indexed Citations; NTIS; PAIS; PLANEX; PsycINFO; RIBA; SCIE; Sociological Abstracts; Social Science Citations Index; Science Citations Index expanded; SIGLE; SPECTR). Twelve Scandinavian grey literature and policy databases (Libris; SveMed+; Libris uppsök; DIVA; Artikelsök; NORART; DEFF; AKF; DSI; SBI; Statens Institut for Folkesundhed; Social.dk) and 23 relevant websites were searched. In addition, a request to topic experts was issued for details of relevant studies. Searches were not restricted by language or publication status. Studies which assessed change in any health outcome following housing improvement were included. This included experimental studies and uncontrolled studies. Cross-sectional studies were excluded as correlations are not able to shed light on changes in outcomes. Studies reporting only socio-economic outcomes or indirect measures of health, such as health service use, were excluded. All housing improvements which

  12. Dental Emergencies: Management Strategies That Improve Outcomes [Digest].

    Science.gov (United States)

    Pedigo, Ryan Anthony; Zaurova, Milana

    2017-06-22

    Points & Pearls is a digest of Emergency Medicine Practice . Acute dental emergencies are a common chief complaint presenting to emergency departments, and they are increasing substantially in frequency. The diagnosis and management of dental emergencies is a core competency of the emergency clinician, and proper therapeutic strategies can significantly improve cosmetic and functional outcomes for patients. This issue provides a systematic review of the literature on common acute traumatic and atraumatic dental emergencies with a focus on the historical and physical examination findings that must be understood to identify life-threatening infections, relieve pain, salvage natural teeth, and communicate with specialists in the further management of patients after emergency treatment.

  13. Operating experience and reliability improvements on the 5 kW CW klystron at Jefferson Lab

    International Nuclear Information System (INIS)

    Nelson, R.; Holben, S.

    1997-01-01

    With substantial operating hours on the RF system, considerable information on reliability of the 5 kW CW klystrons has been obtained. High early failure rates led to examination of the operating conditions and failure modes. Internal ceramic contamination caused premature failure of gun potting material and ultimate tube demise through arcing or ceramic fracture. A planned course of reporting and reconditioning of approximately 300 klystrons, plus careful attention to operating conditions and periodic analysis of operational data, has substantially reduced the failure rate. It is anticipated that implementation of planned supplemental monitoring systems for the klystrons will allow most catastrophic failures to be avoided. By predicting end of life, tubes can be changed out before they fail, thus minimizing unplanned downtime. Initial tests have also been conducted on this same klystron operated at higher voltages with resultant higher output power. The outcome of these tests will provide information to be considered for future upgrades to the accelerator

  14. Lecture 8: Data Reliability at CERN and Ideas on How to Improve it

    CERN Multimedia

    CERN. Geneva

    2013-01-01

    The talk will give an overview of data management activities at CERN focusing on the ongoing research activities aiming to improve data and service reliability. Alberto Pace is a member if the IT department at CERN where he leads the Data and Storage services group ensuring a coherent development process for Physics Data management activities, strongly driven by operational and user needs. He has more than 25 years experience in computing services, infrastructure, software engineering, accelerator control and accelerator operation. He graduated in Electronic Engineering from Politecnico di Milano (Italy).

  15. Improvement in the reliability of shells for light water reactors by manufacturing from hollow ingots

    International Nuclear Information System (INIS)

    Bocquet, P.; Blondeau, R.; Poitrault, I.; Badeau, J.P.; Dumont, R.

    1989-01-01

    The example of forging shells for PWR type reactors is proposed to show how the choice of the manufacturing process may be of prime importance for the component integrity by the reduction of the detrimental effects of segregations. The forging shells (20MnMoNi55) manufactured from hollow ingot are free of any segregation in the critical area located just at the internal surface and sub-surface. Manufacturing problems associated to these segregations in shells issued from conventional ingots, in particular welding difficulties for cladding, have been reduced or eleminated. The reliability of these components present an improved resistance to irradiation embrittlement. (DG)

  16. A review of manufacturing metrology for improved reliability of silicon photovoltaic modules

    Science.gov (United States)

    Davis, Kristopher O.; Walters, Joseph; Schneller, Eric; Seigneur, Hubert; Brooker, R. Paul; Scardera, Giuseppe; Rodgers, Marianne P.; Mohajeri, Nahid; Shiradkar, Narendra; Dhere, Neelkanth G.; Wohlgemuth, John; Rudack, Andrew C.; Schoenfeld, Winston V.

    2014-10-01

    In this work, the use of manufacturing metrology across the supply chain to improve crystalline silicon (c-Si) photovoltaic (PV) module reliability and durability is addressed. Additionally, an overview and summary of a recent extensive literature survey of relevant measurement techniques aimed at reducing or eliminating the probability of field failures is presented. An assessment of potential gaps is also given, wherein the PV community could benefit from new research and demonstration efforts. This review is divided into three primary areas representing different parts of the c-Si PV supply chain: (1) feedstock production, crystallization and wafering; (2) cell manufacturing; and (3) module manufacturing.

  17. Improving the reliability of peer-reviewed publications: We are all in it together

    Directory of Open Access Journals (Sweden)

    Stephen A. Bustin

    2016-03-01

    Full Text Available The current, and welcome, focus on standardization of techniques and transparency of reporting in the biomedical, peer-reviewed literature is commendable. However, that focus has been intermittent as well as lacklustre and so failed to tackle the alarming lack of reliability and reproducibly of biomedical research. Authors have access to numerous recommendations, ranging from simple standards dealing with technical issues to those regulating clinical trials, suggesting that improved reporting guidelines are not the solution. The elemental solution is for editors to require meticulous implementation of their journals’ instructions for authors and reviewers and stipulate that no paper is published without a transparent, complete and accurate materials and methods section.

  18. Improving the reliability of GUB-20000 gamma unit for large laboratory animals irradiation

    International Nuclear Information System (INIS)

    Videnskij, V.G.

    1994-01-01

    GUB-20000 gamma unit for large laboratory animals irradiation is described and results of investigation into its reliability improvement are considered. Cables of superstrength high-modular (SSHM) polymer fibre and capron fiber were tested to establish their applicability in the above unit. Samples were exposed to gamma-radiation and fast electrons and were tested for tensile properties. Application of SSHM-fiber cables to modernize the GUB-20000 unit was found to be perspective due to superhigh radiation strength. 5 refs., 1 tab

  19. Improved structural integrity through advances in reliable residual stress measurement: the impact of ENGIN-X

    Science.gov (United States)

    Edwards, L.; Santisteban, J. R.

    The determination of accurate reliable residual stresses is critical to many fields of structural integrity. Neutron stress measurement is a non-destructive technique that uniquely provides insights into stress fields deep within engineering components and structures. As such, it has become an increasingly important tool within engineering, leading to improved manufacturing processes to reduce stress and distortion as well as to the definition of more precise lifing procedures. This paper describes the likely impact of the next generation of dedicated engineering stress diffractometers currently being constructed and the utility of the technique using examples of residual stresses both beneficial and detrimental to structural integrity.

  20. Mining protein interactomes to improve their reliability and support the advancement of network medicine

    KAUST Repository

    Alanis Lobato, Gregorio

    2015-09-23

    High-throughput detection of protein interactions has had a major impact in our understanding of the intricate molecular machinery underlying the living cell, and has permitted the construction of very large protein interactomes. The protein networks that are currently available are incomplete and a significant percentage of their interactions are false positives. Fortunately, the structural properties observed in good quality social or technological networks are also present in biological systems. This has encouraged the development of tools, to improve the reliability of protein networks and predict new interactions based merely on the topological characteristics of their components. Since diseases are rarely caused by the malfunction of a single protein, having a more complete and reliable interactome is crucial in order to identify groups of inter-related proteins involved in disease etiology. These system components can then be targeted with minimal collateral damage. In this article, an important number of network mining tools is reviewed, together with resources from which reliable protein interactomes can be constructed. In addition to the review, a few representative examples of how molecular and clinical data can be integrated to deepen our understanding of pathogenesis are discussed.

  1. An improved IEEE 802.11 protocol for reliable data transmission in power distribution fault diagnosis

    Energy Technology Data Exchange (ETDEWEB)

    Campoccia, F.; Di Silvestre, M.L.; Sanseverino, E.R.; Zizzo, G. [Palermo Univ., Palermo (Italy)

    2010-10-15

    In power systems, on-line transmission between local units and the central unit can be done by means of power line communications or wireless technology. During an electrical fault, the reliability of the distribution system depends on the security of the timely protective and restorative actions on the network. This paper focused on the WiFi system because of its economy and ease of installation. However, WiFi systems are typically managed by the IEEE 802.11 protocol, which is not reliable in terms of security in data communication. In WiFi networks, data is divided into packets and sent in succession to reduce errors within the radio channel. The IEEE 802.11 protocol has high probability for loss of packets or delay in their transmission. In order to ensure the reliability of data transmission times between two terminal units connected by WiFi stations, a new protocol was derived by modifying the IEEE 802.11. The improvements of the new protocol were highlighted and its capability for the diagnostic service was verified. The modified protocol eliminates the danger of collisions between packets and optimizes the transmission time for sending information. 6 refs., 7 tabs., 8 figs.

  2. Bootstrap analysis of designed experiments for reliability improvement with a non-constant scale parameter

    International Nuclear Information System (INIS)

    Wang, Guodong; He, Zhen; Xue, Li; Cui, Qingan; Lv, Shanshan; Zhou, Panpan

    2017-01-01

    Factors which significantly affect product reliability are of great interest to reliability practitioners. This paper proposes a bootstrap-based methodology for identifying significant factors when both location and scale parameters of the smallest extreme value distribution vary over experimental factors. An industrial thermostat experiment is presented, analyzed, and discussed as an illustrative example. The analysis results show that 1) the misspecification of a constant scale parameter may lead to misidentify spurious effects; 2) the important factors identified by different bootstrap methods (i.e., percentile bootstrapping, bias-corrected percentile bootstrapping, and bias-corrected and accelerated percentile bootstrapping) are different; 3) the number of factors affecting 10th percentile lifetime significantly is less than the number of important factors identified at 63.21th percentile. - Highlights: • Product reliability is improved by design of experiments under both scale and location parameters of smallest extreme value distribution vary with experimental factors. • A bootstrap-based methodology is proposed to identify important factors which affect 100pth lifetime percentile significantly. • Bootstrapping confidence intervals associating experimental factors are obtained by using three bootstrap methods (i.e., percentile bootstrapping, bias-corrected percentile bootstrapping, and bias-corrected and accelerated percentile bootstrapping). • The important factors identified by different bootstrap methods are different. • The number of factors affecting 10th percentile significantly is less than the number of important factors identified at 63.21th percentile.

  3. Mining protein interactomes to improve their reliability and support the advancement of network medicine

    Directory of Open Access Journals (Sweden)

    Gregorio eAlanis-Lobato

    2015-09-01

    Full Text Available High-throughput detection of protein interactions has had a major impact in our understanding of the intricate molecular machinery underlying the living cell, and has permitted the construction of very large protein interactomes. The protein networks that are currently available are incomplete and a significant percentage of their interactions are false positives. Fortunately, the structural properties observed in good quality social or technological networks are also present in biological systems. This has encouraged the development of tools, to improve the reliability of protein networks and predict new interactions based merely on the topological characteristics of their components. Since diseases are rarely caused by the malfunction of a single protein, having a more complete and reliable interactome is crucial in order to identify groups of inter-related proteins involved in disease aetiology. These system components can then be targeted with minimal collateral damage. In this article, an important number of network mining tools is reviewed, together with resources from which reliable protein interactomes can be constructed. In addition to the review, a few representative examples of how molecular and clinical data can be integrated to deepen our understanding of pathogenesis are discussed.

  4. Improving Outcome of Psychosocial Treatments by Enhancing Memory and Learning

    Science.gov (United States)

    Harvey, Allison G.; Lee, Jason; Williams, Joseph; Hollon, Steven D.; Walker, Matthew P.; Thompson, Monique A.; Smith, Rita

    2014-01-01

    Mental disorders are prevalent and lead to significant impairment. Progress toward establishing treatments has been good. However, effect sizes are small to moderate, gains may not persist, and many patients derive no benefit. Our goal is to highlight the potential for empirically-supported psychosocial treatments to be improved by incorporating insights from cognitive psychology and research on education. Our central question is: If it were possible to improve memory for content of sessions of psychosocial treatments, would outcome substantially improve? This question arises from five lines of evidence: (a) mental illness is often characterized by memory impairment, (b) memory impairment is modifiable, (c) psychosocial treatments often involve the activation of emotion, (d) emotion can bias memory and (e) memory for psychosocial treatment sessions is poor. Insights from scientific knowledge on learning and memory are leveraged to derive strategies for a transdiagnostic and transtreatment cognitive support intervention. These strategies can be applied within and between sessions and to interventions delivered via computer, the internet and text message. Additional novel pathways to improving memory include improving sleep, engaging in exercise and imagery. Given that memory processes change across the lifespan, services to children and older adults may benefit from cognitive support. PMID:25544856

  5. Improving outcomes of emergency bowel surgery using nela model

    International Nuclear Information System (INIS)

    Sultan, R.; Zafar, H.

    2018-01-01

    To find outcomes of emergency bowel surgery and review the processes involved in the care of these patients on the same template used in National Emergency Laparotomy Audit (NELA). Study Design:An audit. Place and Duration of Study:Surgery Department, The Aga Khan University Hospital, Karachi, from December 2013 to November 2014. Methodology:Patients undergone emergency bowel surgery during the review period were included. Demographic data, type of admission, ASA grade, urgency of surgery, P-POSSUM score, indication of surgery, length of stay and outcome was recorded. Data was then compared with the data published by NELA team in their first report. P-value for categorical variables was calculated using Chi-square tests. Results:Although the patients were younger with nearly same spectrum of disease, the mortality rate was significantly more than reported in NELA (24% versus 11%, p=0.004). Comparison showed that care at AKUH was significantly lacking in terms of proper preoperative risk assessment and documentation, case booking to operating room timing, intraoperative goal directed fluid therapy using cardiac output monitoring, postoperative intensive care for highest risk patients and review of elderly patients by MCOP specialist. Conclusion:This study helped in understanding the deficiencies in the care of patients undergoing emergency bowel surgery and alarmingly poor outcomes in a very systematic manner. In view of results of this study, it is planned to do interventions in the deficient areas to improve care given to these patients and their outcomes with the limited resources of a developing country. (author)

  6. Accounting for measurement reliability to improve the quality of inference in dental microhardness research: a worked example.

    Science.gov (United States)

    Sever, Ivan; Klaric, Eva; Tarle, Zrinka

    2016-07-01

    Dental microhardness experiments are influenced by unobserved factors related to the varying tooth characteristics that affect measurement reproducibility. This paper explores the appropriate analytical tools for modeling different sources of unobserved variability to reduce the biases encountered and increase the validity of microhardness studies. The enamel microhardness of human third molars was measured by Vickers diamond. The effects of five bleaching agents-10, 16, and 30 % carbamide peroxide, and 25 and 38 % hydrogen peroxide-were examined, as well as the effect of artificial saliva and amorphous calcium phosphate. To account for both between- and within-tooth heterogeneity in evaluating treatment effects, the statistical analysis was performed in the mixed-effects framework, which also included the appropriate weighting procedure to adjust for confounding. The results were compared to those of the standard ANOVA model usually applied. The weighted mixed-effects model produced the parameter estimates of different magnitude and significance than the standard ANOVA model. The results of the former model were more intuitive, with more precise estimates and better fit. Confounding could seriously bias the study outcomes, highlighting the need for more robust statistical procedures in dental research that account for the measurement reliability. The presented framework is more flexible and informative than existing analytical techniques and may improve the quality of inference in dental research. Reported results could be misleading if underlying heterogeneity of microhardness measurements is not taken into account. The confidence in treatment outcomes could be increased by applying the framework presented.

  7. Reducing variability of workforce as a tool to improve plan reliability

    DEFF Research Database (Denmark)

    Wandahl, Søren; Yicheng, S.; Zygmunt, K. J.

    Variability of flow is recognized as the greatest obstacle to production management. Since the work flow and labour flow are two dominators of work performance, it is important to manage them simultaneously. The objective of this paper is to examine whether by reducing the variance of a labour flow......, a plan reliability can be improved, therefore, three different construction labour data sets have been examined by utilizing Monte Carlo Simulation, to analyze the probability to finish simulated projects within a certain time. The research findings revealed that reducing variance in the workforce flow...... does not necessarily shorten the project length, nevertheless it increases probability to finish the tasks within a critical path duration. Additionally, it was concluded, that reducing the variance of crew allocation can improve the productivity....

  8. Engineering of electrical systems of nuclear power stations for improved reliability

    International Nuclear Information System (INIS)

    Narasinga Rao, S.N.; Ramanathan, K.; Choudhary, N.N.

    1977-01-01

    Operational problems experienced in electrical systems/equipment of the Tarapur Atomic Power Station (TAPS) and the Rajasthan Atomic Power Station (RAPS) and their solutions are dealt in detail. This experience has led to new design concepts which are being introduced for improved reliability in design of the Madras Atomic Power Project (MAPP) and the Narora Atomic Power Project (NAPP). Saline pollution on switchyard equipments was the major problem of the TAPS due to its coastal location. Saline pollution resulted in flash over of insulators and failure of clamps. The problem was solved by suitable changes in insulators, conductors, transformers, switches and arranging portable live line washing of the switchyard equipment. In MAPP which is also located on coast, an indoor switchyard is built. NAPP is located in a seismic zone, therefore, all equipment is specified for appropriate seismic duty. Various other improvements are described. (M.G.B.)

  9. Improved Reliability of Single-Phase PV Inverters by Limiting the Maximum Feed-in Power

    DEFF Research Database (Denmark)

    Yang, Yongheng; Wang, Huai; Blaabjerg, Frede

    2014-01-01

    Grid operation experiences have revealed the necessity to limit the maximum feed-in power from PV inverter systems under a high penetration scenario in order to avoid voltage and frequency instability issues. A Constant Power Generation (CPG) control method has been proposed at the inverter level...... devices, allowing a quantitative prediction of the power device lifetime. A study case on a 3 kW single-phase PV inverter has demonstrated the advantages of the CPG control in terms of improved reliability.......Grid operation experiences have revealed the necessity to limit the maximum feed-in power from PV inverter systems under a high penetration scenario in order to avoid voltage and frequency instability issues. A Constant Power Generation (CPG) control method has been proposed at the inverter level....... The CPG control strategy is activated only when the DC input power from PV panels exceeds a specific power limit. It enables to limit the maximum feed-in power to the electric grids and also to improve the utilization of PV inverters. As a further study, this paper investigates the reliability performance...

  10. Researching and improving the reliability of reactor protection system of Qinshan nuclear power plant

    International Nuclear Information System (INIS)

    Jiang Zuyue; Sheng Jiannan

    1997-01-01

    Due to the original design defects of the Reactor Protection System (RPS) of Qinshan Nuclear Power Plant, this system has brought about a number of reactor shutdown accidents and Engineered Safety Features (ESF) mis-activation events which have seriously endangered safe and steady operation of the nuclear power plant. So over three years have been spent on research on the reform of the original design on the premise that the general wiring of the system should remain the same and that the system size should also remain small to be contained in the original cabinets. The following improvements were made: (1) Increase the system's anti-disturbance capability. The system's zero volt bus floating designs were modified to surmount the disturbance resulting from the bad isolation performance of impedance-isolated amplifier; Double grounds have been added to logical modules to surmount the disturbance resulting from zero volt floating bus during the replacement of single module with two connectors; The opto-coupling circuit in its oscillation input stage of Engineered Safety Features have been improved to increase its reliability. (2)Modify to output activation part of the system. The new type of output relays were selected and the relay activation circuits were redesigned in which switcher activation mode is used instead of amplifier activation mode so as to increase the reliability of relay operation and reduce the power consumption; CMOS buffer gates in the input and output stage of the circuit were used to match TTL circuits to CMOS circuits of the system

  11. Improving human reliability through better nuclear power plant system design. Progress report

    International Nuclear Information System (INIS)

    Golay, M.W.

    1995-01-01

    The project on open-quotes Development of a Theory of the Dependence of Human Reliability upon System Designs as a Means of Improving Nuclear Power Plant Performanceclose quotes has been undertaken in order to address the important problem of human error in advanced nuclear power plant designs. Most of the creativity in formulating such concepts has focused upon improving the mechanical reliability of safety related plant systems. However, the lack of a mature theory has retarded similar progress in reducing the likely frequencies of human errors. The main design mechanism used to address this class of concerns has been to reduce or eliminate the human role in plant operations and accident response. The plan of work being pursued in this project is to perform a set of experiments involving human subject who are required to operate, diagnose and respond to changes in computer-simulated systems, relevant to those encountered in nuclear power plants. In the tests the systems are made to differ in complexity in a systematic manner. The computer program used to present the problems to be solved also records the response of the operator as it unfolds. Ultimately this computer is also to be used in compiling the results of the project. The work of this project is focused upon nuclear power plant applications. However, the persuasiveness of human errors in using all sorts of electromechanical machines gives it a much greater potential importance. Because of this we are attempting to pursue our work in a fashion permitting broad generalizations

  12. Utilizing clad piping to improve process plant piping integrity, reliability, and operations

    International Nuclear Information System (INIS)

    Chakravarti, B.

    1996-01-01

    During the past four years carbon steel piping clad with type 304L (UNS S30403) stainless steel has been used to solve the flow accelerated corrosion (FAC) problem in nuclear power plants with exceptional success. The product is designed to allow ''like for like'' replacement of damaged carbon steel components where the carbon steel remains the pressure boundary and type 304L (UNS S30403) stainless steel the corrosion allowance. More than 3000 feet of piping and 500 fittings in sizes from 6 to 36-in. NPS have been installed in the extraction steam and other lines of these power plants to improve reliability, eliminate inspection program, reduce O and M costs and provide operational benefits. This concept of utilizing clad piping in solving various corrosion problems in industrial and process plants by conservatively selecting a high alloy material as cladding can provide similar, significant benefits in controlling corrosion problems, minimizing maintenance cost, improving operation and reliability to control performance and risks in a highly cost effective manner. This paper will present various material combinations and applications that appear ideally suited for use of the clad piping components in process plants

  13. Video training and certification program improves reliability of postischemic neurologic deficit measurement in the rat.

    Science.gov (United States)

    Taninishi, Hideki; Pearlstein, Molly; Sheng, Huaxin; Izutsu, Miwa; Chaparro, Rafael E; Goldstein, Larry B; Warner, David S

    2016-12-01

    Scoring systems are used to measure behavioral deficits in stroke research. Video-assisted training is used to standardize stroke-related neurologic deficit scoring in humans. We hypothesized that a video-assisted training and certification program can improve inter-rater reliability in assessing neurologic function after middle cerebral artery occlusion in rats. Three expert raters scored neurologic deficits in post-middle cerebral artery occlusion rats using three published systems having different complexity levels (3, 18, or 48 points). The system having the highest point estimate for the correlation between neurologic score and infarct size was selected to create a video-assisted training and certification program. Eight trainee raters completed the video-assisted training and certification program. Inter-rater agreement ( Κ: score) and agreement with expert consensus scores were measured before and after video-assisted training and certification program completion. The 48-point system correlated best with infarct size. Video-assisted training and certification improved agreement with expert consensus scores (pretraining = 65 ± 10, posttraining = 87 ± 14, 112 possible scores, P  0.4 (pretraining = 4, posttraining = 9), and number of categories with an improvement in the Κ: score from pretraining to posttraining (n = 6). Video-assisted training and certification improved trainee inter-rater reliability and agreement with expert consensus behavioral scores in rats after middle cerebral artery occlusion. Video-assisted training and certification may be useful in multilaboratory preclinical studies. © The Author(s) 2015.

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

    Science.gov (United States)

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

    2015-01-01

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

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

    Science.gov (United States)

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

    2015-10-01

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

  16. Reliability and validity of the Dutch version of the foot and ankle outcome score (FAOS)

    NARCIS (Netherlands)

    van den Akker-Scheek, Inge; Seldentuis, Arnoud; Reininga, Inge H. F.; Stevens, Martin

    2013-01-01

    Background: The Foot and Ankle Outcome Score (FAOS) is a patient-reported questionnaire measuring symptoms and functional limitations of the foot and ankle. Aim is to translate and culturally adapt the Dutch version of the FAOS and to investigate internal consistency, validity, repeatability and

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

    Science.gov (United States)

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

    2017-06-01

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

  18. Reducing negative affect and increasing rapport improve interracial mentorship outcomes.

    Science.gov (United States)

    Leitner, Jordan B; Ayduk, Özlem; Boykin, C Malik; Mendoza-Denton, Rodolfo

    2018-01-01

    Research suggests that interracial mentoring relationships are strained by negative affect and low rapport. As such, it stands to reason that strategies that decrease negative affect and increase rapport should improve these relationships. However, previous research has not tested this possibility. In video-chats (Studies 1 and 2) and face-to-face meetings (Study 3), we manipulated the degree of mutual self-disclosure between mentees and mentors, a strategy that has been shown to reduce negative affect and increase rapport. We then measured negative affect and rapport as mediators, and mentee performance (quality of speech delivered; Studies 1 and 3) and mentor performance (warmth and helpfulness; Studies 2 and 3) as key outcomes. Results revealed that increased self-disclosure decreased negative affect and increased rapport for both mentees and mentors. Among mentees, decreased negative affect predicted better performance (Studies 1 and 3). Among mentors, increased rapport predicted warmer feedback (Studies 2 and 3). These effects remained significant when we meta-analyzed data across studies (Study 4), and also revealed the relationship of rapport to more helpful feedback. Findings suggest that affect and rapport are key features in facilitating positive outcomes in interracial mentoring relationships.

  19. Improvement in Outcomes of Clinical Islet Transplantation: 1999–2010

    Science.gov (United States)

    Barton, Franca B.; Rickels, Michael R.; Alejandro, Rodolfo; Hering, Bernhard J.; Wease, Stephen; Naziruddin, Bashoo; Oberholzer, Jose; Odorico, Jon S.; Garfinkel, Marc R.; Levy, Marlon; Pattou, Francois; Berney, Thierry; Secchi, Antonio; Messinger, Shari; Senior, Peter A.; Maffi, Paola; Posselt, Andrew; Stock, Peter G.; Kaufman, Dixon B.; Luo, Xunrong; Kandeel, Fouad; Cagliero, Enrico; Turgeon, Nicole A.; Witkowski, Piotr; Naji, Ali; O’Connell, Philip J.; Greenbaum, Carla; Kudva, Yogish C.; Brayman, Kenneth L.; Aull, Meredith J.; Larsen, Christian; Kay, Tom W.H.; Fernandez, Luis A.; Vantyghem, Marie-Christine; Bellin, Melena; Shapiro, A.M. James

    2012-01-01

    OBJECTIVE To describe trends of primary efficacy and safety outcomes of islet transplantation in type 1 diabetes recipients with severe hypoglycemia from the Collaborative Islet Transplant Registry (CITR) from 1999 to 2010. RESEARCH DESIGN AND METHODS A total of 677 islet transplant-alone or islet-after-kidney recipients with type 1 diabetes in the CITR were analyzed for five primary efficacy outcomes and overall safety to identify any differences by early (1999–2002), mid (2003–2006), or recent (2007–2010) transplant era based on annual follow-up to 5 years. RESULTS Insulin independence at 3 years after transplant improved from 27% in the early era (1999–2002, n = 214) to 37% in the mid (2003–2006, n = 255) and to 44% in the most recent era (2007–2010, n = 208; P = 0.006 for years-by-era; P = 0.01 for era alone). C-peptide ≥0.3 ng/mL, indicative of islet graft function, was retained longer in the most recent era (P islet reinfusion rate was lower: 48% by 1 year in 2007–2010 vs. 60–65% in 1999–2006 (P islet graft function (P islet transplantation in recipients who received transplants in 2007–2010 compared with those in 1999–2006, with fewer islet infusions and adverse events per recipient. PMID:22723582

  20. Adaptive Programming Improves Outcomes in Drug Court: An Experimental Trial.

    Science.gov (United States)

    Marlowe, Douglas B; Festinger, David S; Dugosh, Karen L; Benasutti, Kathleen M; Fox, Gloria; Croft, Jason R

    2012-04-01

    Prior studies in Drug Courts reported improved outcomes when participants were matched to schedules of judicial status hearings based on their criminological risk level. The current experiment determined whether incremental efficacy could be gained by periodically adjusting the schedule of status hearings and clinical case-management sessions in response to participants' ensuing performance in the program. The adjustments were made pursuant to a priori criteria specified in an adaptive algorithm. Results confirmed that participants in the full adaptive condition (n = 62) were more than twice as likely as those assigned to baseline-matching only (n = 63) to be drug-abstinent during the first 18 weeks of the program; however, graduation rates and the average time to case resolution were not significantly different. The positive effects of the adaptive program appear to have stemmed from holding noncompliant participants more accountable for meeting their attendance obligations in the program. Directions for future research and practice implications are discussed.

  1. Does professional-centred training improve consultation outcomes?

    DEFF Research Database (Denmark)

    Parkin, Tracey; Barnard, K.; Cradock, S.

    2006-01-01

    discussed and decisions made. Patients also completed the Health Care Climate Questionnaire (HCCQ). Pre-training results were fed back to the professionals to provide an objective measure of current practice. Training day one comprised 10 minutes' observation of videoed consultations of each professional......This study aimed to examine whether professional-centred training improves consultation outcomes. Using a pre- and post-data collection design. Immediately after consultations, professionals and patients completed a consultation review sheet which was coded for the level of agreement on issues...... in order to identify strengths and training needs. Each professional identified key areas of their consultation that they felt needed further development. Training day two centred on goal setting and negotiating agendas as these were identified as priority areas requiring more skills. Data from 110...

  2. Equity and improvement in outcome of breast cancer in Denmark

    DEFF Research Database (Denmark)

    Andreasen, A H; Mouridsen, H T; Andersen, K W

    1994-01-01

    The trend in the prognosis for female breast cancer patients was investigated by comparing Kaplan-Meier survival curves of different patient cohorts diagnosed during the period 1948-87. The study is based on 71,448 patients from the Danish Cancer Registry. The cohorts were defined by age...... in other parts of Denmark. For patients diagnosed in 1978-87 the prognosis, however, reached an equal level in all parts of the country. Thus, it is reasonable to assume that the national programme introduced in 1977 by the Danish Breast Cancer Cooperative Group (DBCG) has played an important role...... and not only brought about therapeutic improvements in breast cancer treatment in Denmark, but also ensured equity in the outcome on a national scale....

  3. Citation analysis did not provide a reliable assessment of core outcome set uptake.

    Science.gov (United States)

    Barnes, Karen L; Kirkham, Jamie J; Clarke, Mike; Williamson, Paula R

    2017-06-01

    The aim of the study was to evaluate citation analysis as an approach to measuring core outcome set (COS) uptake, by assessing whether the number of citations for a COS report could be used as a surrogate measure of uptake of the COS by clinical trialists. Citation data were obtained for COS reports published before 2010 in five disease areas (systemic sclerosis, rheumatoid arthritis, eczema, sepsis and critical care, and female sexual dysfunction). Those publications identified as a report of a clinical trial were examined to identify whether or not all outcomes in the COS were measured in the trial. Clinical trials measuring the relevant COS made up a small proportion of the total number of citations for COS reports. Not all trials citing a COS report measured all the recommended outcomes. Some trials cited the COS reports for other reasons, including the definition of a condition or other trial design issues addressed by the COS report. Although citation data can be readily accessed, it should not be assumed that the citing of a COS report indicates that a trial has measured the recommended COS. Alternative methods for assessing COS uptake are needed. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

  4. [Examination of safety improvement by failure record analysis that uses reliability engineering].

    Science.gov (United States)

    Kato, Kyoichi; Sato, Hisaya; Abe, Yoshihisa; Ishimori, Yoshiyuki; Hirano, Hiroshi; Higashimura, Kyoji; Amauchi, Hiroshi; Yanakita, Takashi; Kikuchi, Kei; Nakazawa, Yasuo

    2010-08-20

    How the maintenance checks of the medical treatment system, including start of work check and the ending check, was effective for preventive maintenance and the safety improvement was verified. In this research, date on the failure of devices in multiple facilities was collected, and the data of the trouble repair record was analyzed by the technique of reliability engineering. An analysis of data on the system (8 general systems, 6 Angio systems, 11 CT systems, 8 MRI systems, 8 RI systems, and the radiation therapy system 9) used in eight hospitals was performed. The data collection period assumed nine months from April to December 2008. Seven items were analyzed. (1) Mean time between failures (MTBF) (2) Mean time to repair (MTTR) (3) Mean down time (MDT) (4) Number found by check in morning (5) Failure generation time according to modality. The classification of the breakdowns per device, the incidence, and the tendency could be understood by introducing reliability engineering. Analysis, evaluation, and feedback on the failure generation history are useful to keep downtime to a minimum and to ensure safety.

  5. Improved Reliability of Small Molecule Organic Solar Cells by Double Anode Buffer Layers

    Directory of Open Access Journals (Sweden)

    Pao-Hsun Huang

    2014-01-01

    Full Text Available An optimized hybrid planar heterojunction (PHJ of small molecule organic solar cells (SM-OSCs based on copper phthalocyanine (CuPc as donor and fullerene (C60 as acceptor was fabricated, which obviously enhanced the performance of device by sequentially using both MoO3 and pentacene as double anode buffer layers (ABL, also known as hole extraction layer (HEL. A series of the vacuum-deposited ABL, acting as an electron and exciton blocking layer, were examined for their characteristics in SM-OSCs. The performance and reliability were compared between conventional ITO/ABL/CuPc/C60/BCP/Ag cells and the new ITO/double ABL/CuPc/C60/BCP/Ag cells. The effect on the electrical properties of these materials was also investigated to obtain the optimal thickness of ABL. The comparison shows that the modified cell has an enhanced reliability compared to traditional cells. The improvement of lifetime was attributed to the idea of double layers to prevent humidity and oxygen from diffusing into the active layer. We demonstrated that the interfacial extraction layers are necessary to avoid degradation of device. That is to say, in normal temperature and pressure, a new avenue for the device within double buffer layers has exhibited the highest values of open circuit voltage (Voc, fill factor (FF, and lifetime in this work compared to monolayer of ABL.

  6. Control Strategies for Improving Energy Efficiency and Reliability in Autonomous Microgrids with Communication Constraints

    Directory of Open Access Journals (Sweden)

    Francisco Martins Portelinha Júnior

    2017-09-01

    Full Text Available Microgrids are a feasible path to deploy smart grids, an intelligent and highly automated power system. Their operation demands a dedicated communication infrastructure to manage, control and monitor the intermittent sources of energy and loads. Therefore, smart devices will be connected to support the growth of grid smartness increasing the dependency on communication networks, which consumes a high amount of power. In an energy-limited scenario, one of the main issues is to enhance the power supply time. Therefore, this paper proposes a hybrid methodology for microgrid energy management, integrated with a communication infrastructure to improve and to optimize islanded microgrid operation at maximum energy efficiency. The hybrid methodology applies some control management rules, such as intentional load shedding, priority load management, and communication energy saving. These energy saving rules establish a trade-off between increasing microgrid energy availability and communication system reliability. To achieve a compromised solution, a continuous time Markov chain model describes the impact of energy saving policies into system reliability. The proposed methodology is simulated and tested with the help of the modified IEEE 34 node test-system.

  7. Daily Readiness Huddles in Radiology-Improving Communication, Coordination, and Problem-Solving Reliability.

    Science.gov (United States)

    Donnelly, Lane F

    Deploying an intentional daily management process is a key part to create high-reliability culture. Key components described in the literature for a successfully daily management process include leadership standard work, visual controls, daily accountability processes, and the discipline to stick to the process over the long term. We believe that the institution of a daily readiness huddle has helped us better coordinate and communicate as a department and improved our ability to deliver imaging services on a daily basis. The daily readiness huddle has enabled us to more rapidly identify issues and has brought accountability to seeing solutions to those issues brought to fruition. In addition, it has helped with team building, including between the radiologists and the nonphysician staff. Copyright © 2017 Elsevier Inc. All rights reserved.

  8. Improving human reliability through better nuclear power plant system design: Program for advanced nuclear power studies

    International Nuclear Information System (INIS)

    Golay, M.W.

    1993-01-01

    The project on ''Development of a Theory of the Dependence of Human Reliability upon System Designs as a Means of Improving Nuclear Power Plant Performance'' was been undertaken in order to address the problem of human error in advanced nuclear power plant designs. Lack of a mature theory has retarded progress in reducing likely frequencies of human errors. Work being pursued in this project is to perform a set of experiments involving human subjects who are required to operate, diagnose and respond to changes in computer-simulated systems, relevant to those encountered in nuclear power plants, which are made to differ in complexity in a systematic manner. The computer program used to present the problems to be solved also records the response of the operator as it unfolds

  9. Reliability improvement for anisotropic biased compensated α/β contamination meter

    Energy Technology Data Exchange (ETDEWEB)

    Coulon, R., E-mail: romain.coulon@cea.fr [CEA, LIST, Laboratoire Capteurs et Architectures Electroniques, F-91191 Gif-sur-Yvette (France); Montagu, T. [CEA, LIST, Laboratoire de Modélisation et Simulation des Systèmes, F-91191 Gif-sur-Yvette (France); Schoepff, V. [CEA, LIST, Laboratoire Capteurs et Architectures Electroniques, F-91191 Gif-sur-Yvette (France); Menaa, N.; Ulmann, A. Gallozzi; Blanc de Lanaute, N. [CANBERRA France, F-78182 St Quentin en Yvelines (France)

    2016-11-21

    Nuclear instruments such as alpha/beta contamination meter are frequently used in a compensated mode where the contribution of gamma radiation background is compensated by a guard detector. The signal of interest is then the subtraction of counting from both channels. In practice, the noise signal measured by the guard detector is not strictly equal to the noise contribution into the first detector due to anisotropic biases. The random error (under Poisson assumption) is taken into account to build a hypothesis test. The system is also designed to minimize the systematic error but in some cases, this bias could not be completely removed. The measurement system then shows different behavior when the surrounding environment changes exhibiting inopportune false alarms. A method allowing the false alarms to be suppressed is addressed in this study for compensated measurement. An improvement in terms of reliability has been proven.

  10. Improved mechanical reliability of MEMS electret based vibration energy harvesters for automotive applications

    International Nuclear Information System (INIS)

    Renaud, M; Goedbloed, M; De Nooijer, C; Van Schaijk, R; Fujita, T

    2014-01-01

    Current commercial wireless tire pressure monitoring systems (TPMS) require a battery as electrical power source. The battery limits the lifetime of the TPMS. This limit can be circumvented by replacing the battery by a vibration energy harvester. Autonomous wireless TPMS powered by MEMS electret based vibration energy harvester have been demonstrated. A remaining technical challenge to attain the grade of commercial product with these autonomous TPMS is the mechanical reliability of the MEMS harvester. It should survive the harsh conditions imposed by the tire environment, particularly in terms of mechanical shocks. As shown in this article, our first generation of harvesters has a shock resilience of 400 g, which is far from being sufficient for the targeted application. In order to improve this aspect, several types of shock absorbing structures are investigated. With the best proposed solution, the shock resilience of the harvesters is brought above 2500 g

  11. Reducing Variability of Workforce as a Tool to Improve Plan Reliability

    DEFF Research Database (Denmark)

    Shen, Yicheng; Zygmunt, Katarzyna Julia; Wandahl, Søren

    2017-01-01

    Variability of flow is recognized as one of the greatest obstacles to production management. Since the work flow and labour flow are two dominators of work performance, it is important to manage them simultaneously. The objective of this paper is to examine if an increased plan reliability could...... of the workforce flow does not necessarily shorten the project length, nevertheless it increases probability to finish the tasks within a critical path duration. Additionally, it was concluded, that reducing the variance of crew allocation can improve the productivity....... be reached by reducing the variance of a labour flow. Therefore, three different construction labour data sets have been examined by utilizing Monte Carlo Simulation, to analyze the probability to finish simulated projects within a certain time. The research findings revealed that reducing variance...

  12. Advanced control systems to improve nuclear power plant reliability and efficiency

    International Nuclear Information System (INIS)

    1997-07-01

    The TECDOC is the result of a series of an advisory and consultants meetings held by the IAEA in 1995-1996 in Vienna (March 1995), in Erlangen Germany (December 1995), in Garching, Germany (June 1996) and in Vienna (November 1996). It was prepared with the participation and contributions of experts from Austria, Canada, Finland, France, Germany, the Republic of Korea, Norway, the Russian Federation, the United Kingdom and the United States of America. The publication not only describes advanced control systems for the improvement of nuclear power plant reliability and efficiency, but also provides a road map to guide interested readers to plan and execute an advanced instrumentation and control project. The subjects include: identification of needs and requirements, justification for safety and user acceptance, and the development of an engineering process. The report should be of interest to nuclear power plant staff, I and C system designers and integrators as well as regulators and researchers. Refs, figs, tabs

  13. INPO's role in the improvement of nuclear plant safety and reliability

    International Nuclear Information System (INIS)

    Pate, Z.T.

    1985-01-01

    The Institute of Nuclear Power Operations (INPO) is a nonprofit, nongovernment corporation dedicated to promoting safe and reliable operation and quality construction of nuclear power plants. The institute is supported by the US nuclear utility industry. All US utilities building or operating nuclear power plants are INPO members. INPO's many activities fall within four major program areas: (1) Evaluations: INPO conducts detailed evaluations of all US operating plants, utility corporate support of nuclear programs, and nuclear projects under active construction. Events analysis and information exchange: INPO reviews plant reports of abnormal or unusual events and reports the lessons learned to the industry. INPO also fosters improved industry communications through a worldwide telecommunications network. (3) Training and accreditation: INPO assists utilities, including international participants, in developing quality training programs; and (4) Assistance: the Institute provides various forms of assistance to members and participants. INPO places emphasis on visits to facilities to aid members and participants in various program or operational areas

  14. Some improvements on adaptive genetic algorithms for reliability-related applications

    International Nuclear Information System (INIS)

    Ye Zhisheng; Li Zhizhong; Xie Min

    2010-01-01

    Adaptive genetic algorithms (GAs) have been shown to be able to improve GA performance in reliability-related optimization studies. However, there are different ways to implement adaptive GAs, some of which are even in conflict with each other. In this study, a simple parameter-adjusting method using mean and variance of each generation is introduced. This method is used to compare two of such conflicting adaptive GA methods: GAs with increasing mutation rate and decreasing crossover rate and GAs with decreasing mutation rate and increasing crossover rate. The illustrative examples indicate that adaptive GAs with decreasing mutation rate and increasing crossover rate finally yield better results. Furthermore, a population disturbance method is proposed to avoid local optimum solutions. This idea is similar to exotic migration to a tribal society. To solve the problem of large solution space, a variable roughening method is also embedded into GA. Two case studies are presented to demonstrate the effectiveness of the proposed method.

  15. Improving the Reliability of LDP through the Divergence of Power Supply for LDP

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Bang Sil [KHNP CRI, Daejeon (Korea, Republic of)

    2016-10-15

    The representative operating systems are Large Display Panel (LDP), Operator Workstation (OWS), Computerized Procedure System (CPS). The LDP provides the information which is plant essential safety function, plant operating mode, the state of major operating variable and the important alarm to operator continuously. In case of malfunction and switchover fail of the inverter, it is possible to occur the power loss of LDP. The power of LDP and operator console workstation had been supplied by only 2 non-safety Power Line1/Power Line2 (P.L1/P.L2). This study mentioned the divergence of power for LDP as method of power loss caused by unreliability of inverter. Ultimately, LDP power line has been added, and then it is more improved on the safety of LDP operation than before. So Shin-Kori 3,4 can enhance the reliability and economic, safety of plant.

  16. Some improvements on adaptive genetic algorithms for reliability-related applications

    Energy Technology Data Exchange (ETDEWEB)

    Ye Zhisheng, E-mail: yez@nus.edu.s [Department of Industrial and Systems Engineering, National University of Singapore, Singapore 119 260 (Singapore); Li Zhizhong [Department of Industrial Engineering, Tsinghua University, beijing 100084 (China); Xie Min [Department of Industrial and Systems Engineering, National University of Singapore, Singapore 119 260 (Singapore)

    2010-02-15

    Adaptive genetic algorithms (GAs) have been shown to be able to improve GA performance in reliability-related optimization studies. However, there are different ways to implement adaptive GAs, some of which are even in conflict with each other. In this study, a simple parameter-adjusting method using mean and variance of each generation is introduced. This method is used to compare two of such conflicting adaptive GA methods: GAs with increasing mutation rate and decreasing crossover rate and GAs with decreasing mutation rate and increasing crossover rate. The illustrative examples indicate that adaptive GAs with decreasing mutation rate and increasing crossover rate finally yield better results. Furthermore, a population disturbance method is proposed to avoid local optimum solutions. This idea is similar to exotic migration to a tribal society. To solve the problem of large solution space, a variable roughening method is also embedded into GA. Two case studies are presented to demonstrate the effectiveness of the proposed method.

  17. Efforts to improve safety and reliability of nuclear power plants in Kyushu Electric Power

    International Nuclear Information System (INIS)

    Yamamoto, Satoshi

    2014-01-01

    After the Fukushima accident, Kyushu Electric Power Co. took emergency safety measures requested by government to ensure power supply, coolant supply pumps and cooling water so as to keep cooling fuels in the reactor and spent fuel storage pool in case of losses of ordinary cooling capability caused by earthquake and tsunami. In order to improve safety and reliability of nuclear power plants, further efforts based on lessons learned from the Fukushima accident had been made to diversify corresponding equipment of safety measures in terms of prevention of core damage, prevention of containment failure, mitigation of radioactive materials release, cooling of spent fuel pit and ensurance of power supply, and to enhance emergency response capability so as to make operational management more complete. Additional safety measures applicable to new regulatory requirements against severe accidents were in progress. This article introduced details of such activities. (T. Tanaka)

  18. Advanced control systems to improve nuclear power plant reliability and efficiency

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1997-07-01

    The TECDOC is the result of a series of an advisory and consultants meetings held by the IAEA in 1995-1996 in Vienna (March 1995), in Erlangen Germany (December 1995), in Garching, Germany (June 1996) and in Vienna (November 1996). It was prepared with the participation and contributions of experts from Austria, Canada, Finland, France, Germany, the Republic of Korea, Norway, the Russian Federation, the United Kingdom and the United States of America. The publication not only describes advanced control systems for the improvement of nuclear power plant reliability and efficiency, but also provides a road map to guide interested readers to plan and execute an advanced instrumentation and control project. The subjects include: identification of needs and requirements, justification for safety and user acceptance, and the development of an engineering process. The report should be of interest to nuclear power plant staff, I and C system designers and integrators as well as regulators and researchers. Refs, figs, tabs.

  19. A Method for Improving Reliability of Radiation Detection using Deep Learning Framework

    International Nuclear Information System (INIS)

    Chang, Hojong; Kim, Tae-Ho; Han, Byunghun; Kim, Hyunduk; Kim, Ki-duk

    2017-01-01

    Radiation detection is essential technology for overall field of radiation and nuclear engineering. Previously, technology for radiation detection composes of preparation of the table of the input spectrum to output spectrum in advance, which requires simulation of numerous predicted output spectrum with simulation using parameters modeling the spectrum. In this paper, we propose new technique to improve the performance of radiation detector. The software in the radiation detector has been stagnant for a while with possible intrinsic error of simulation. In the proposed method, to predict the input source using output spectrum measured by radiation detector is performed using deep neural network. With highly complex model, we expect that the complex pattern between data and the label can be captured well. Furthermore, the radiation detector should be calibrated regularly and beforehand. We propose a method to calibrate radiation detector using GAN. We hope that the power of deep learning may also reach to radiation detectors and make huge improvement on the field. Using improved radiation detector, the reliability of detection would be confident, and there are many tasks remaining to solve using deep learning in nuclear engineering society.

  20. Does acellular dermal matrix really improve aesthetic outcome in tissue expander/implant-based breast reconstruction?

    Science.gov (United States)

    Ibrahim, Ahmed M S; Koolen, Pieter G L; Ganor, Oren; Markarian, Mark K; Tobias, Adam M; Lee, Bernard T; Lin, Samuel J; Mureau, Marc A M

    2015-06-01

    The expectation for improved results by women undergoing postmastectomy reconstruction has steadily risen. A majority of these operations are tissue expander/implant-based breast reconstructions. Acellular dermal matrix (ADM) offers numerous advantages in these procedures. Thus far, the evidence to justify improved aesthetic outcome has solely been based on surgeon opinion. The purpose of this study was to assess aesthetic outcome following ADM use in tissue expander/implant-based breast reconstruction by a panel of blinded plastic surgeons. Mean aesthetic results of patients who underwent tissue expander/implant-based breast reconstruction with (n = 18) or without ADM (n = 20) were assessed with objective grading of preoperative and postoperative photographs by five independent blinded plastic surgeons. Absolute observed agreement as well as weighted Fleiss Kappa (κ) test statistics were calculated to assess inter-rater variability. When ADM was incorporated, the overall aesthetic score was improved by an average of 12.1 %. In addition, subscale analyses revealed improvements in breast contour (35.2 %), implant placement (20.7 %), lower pole projection (16.7 %), and inframammary fold definition (13.8 %). Contour (p = 0.039), implant placement (p = 0.021), and overall aesthetic score (p = 0.022) reached statistical significance. Inter-rater reliability showed mostly moderate agreement. Mean aesthetic scores were higher in the ADM-assisted breast reconstruction cohort including the total aesthetic score which was statistically significant. Aesthetic outcome alone may justify the added expense of incorporating biologic mesh. Moreover, ADM has other benefits which may render it cost-effective. Larger prospective studies are needed to provide plastic surgeons with more definitive guidelines for ADM use. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the

  1. Improved prediction of breast cancer outcome by identifying heterogeneous biomarkers.

    Science.gov (United States)

    Choi, Jonghwan; Park, Sanghyun; Yoon, Youngmi; Ahn, Jaegyoon

    2017-11-15

    Identification of genes that can be used to predict prognosis in patients with cancer is important in that it can lead to improved therapy, and can also promote our understanding of tumor progression on the molecular level. One of the common but fundamental problems that render identification of prognostic genes and prediction of cancer outcomes difficult is the heterogeneity of patient samples. To reduce the effect of sample heterogeneity, we clustered data samples using K-means algorithm and applied modified PageRank to functional interaction (FI) networks weighted using gene expression values of samples in each cluster. Hub genes among resulting prioritized genes were selected as biomarkers to predict the prognosis of samples. This process outperformed traditional feature selection methods as well as several network-based prognostic gene selection methods when applied to Random Forest. We were able to find many cluster-specific prognostic genes for each dataset. Functional study showed that distinct biological processes were enriched in each cluster, which seems to reflect different aspect of tumor progression or oncogenesis among distinct patient groups. Taken together, these results provide support for the hypothesis that our approach can effectively identify heterogeneous prognostic genes, and these are complementary to each other, improving prediction accuracy. https://github.com/mathcom/CPR. jgahn@inu.ac.kr. Supplementary data are available at Bioinformatics online. © The Author (2017). Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com

  2. Test-Retest Reliability of Handgrip Strength as an Outcome Measure in Patients With Symptoms of Shoulder Impingement Syndrome.

    Science.gov (United States)

    Savva, Christos; Mougiaris, Paraskevas; Xadjimichael, Christoforos; Karagiannis, Christos; Efstathiou, Michalis

    The purpose of this study was to investigate the degree of test-retest reliability of grip strength measurement using a hand dynamometer in patients with shoulder impingement syndrome. A total of 19 patients (10 women and 9 men; mean ± standard deviation age, 33.2 ± 12.9 years; range 18-59 years) with shoulder impingement syndrome were measured using a hand dynamometer by the same data collector in 2 different testing sessions with a 7-day interval. During each session, patients were encouraged to exert 3 maximal isometric contractions on the affected hand and the mean value of the 3 efforts (measured in kilogram-force [Kgf]) was used for data analysis. The intraclass correlation coefficient (ICC 2,1 ) as well as the standard error of measurement (SEM) and Bland-Altman plot were used to estimate the degree of test-retest reliability and the measurement error, respectively. Grip strength data analysis revealed an ICC 2,1 score of 0.94, which, based on the Shrout classification, is considered as excellent test-retest reliability of grip strength measurement. The small values of SEMs reported in both sessions (SEM 1 , 2.55 Kgf; SEM 2 , 2.39 Kgf) and the small width of the 95% limits of agreement in the Bland-Altman plot (ranging from -7.39 Kgf to 7.03 Kgf) reflected the measurement precision and the narrow variation of the differences during the 2 testing sessions. Results from this study identified excellent test-retest reliability of grip strength measurement in shoulder impingement syndrome, indicating its potential use as an outcome measure in clinical practice. Copyright © 2018. Published by Elsevier Inc.

  3. The Toronto outcome measure for craniofacial prosthetics: reliability and validity of a condition-specific quality-of-life instrument.

    Science.gov (United States)

    Anderson, James D; Johnston, Dennis A; Haugh, Gil S; Kiat-Amnuay, Sudarat; Gettleman, Lawrence

    2013-01-01

    The purpose of this study was to refine the Toronto Outcome Measure for Craniofacial Prosthetics (TOMCP), present evidence for its reliability and validity, and use the instrument to explore differences in quality of life between prostheses made with chlorinated polyethylene (CPE) (experimental) and silicone (control). As part of a multicenter prospective controlled randomized double-blind single-crossover clinical trial of the two materials, the TOMCP was administered at the start and end of two 4-month study arms, during which 42 patients wore prostheses made from one material then the other. Reliability was assessed at the crossover. To determine validity of the TOMCP, the Linear Analogue Self-Assessment (LASA-12) and the Short-Form 8 (SF-8) were also administered with the TOMCP. The TOMCP was reduced by removing items that were unreliable, had poorly distributed answers, showed increased internal consistency after their removal, or were too highly correlated with more than one other item. The tests of reliability and validity were then repeated. Finally, the reduced instrument was used to test for differences in quality of life between prostheses made of the two materials. The item reduction tactics pared the 52-item instrument down to 27 items. The correlations of both TOMCP versions with the LASA-12 and the SF-8 were found to be statistically significant, providing evidence of the validity of the TOMCP. The instrument revealed significantly better quality of life with silicone rather than CPE prostheses. Both versions of the TOMCP were found to be reliable and valid. The instrument was able to show differences in quality of life between two materials.

  4. Improving the Test-Retest Reliability of Resting State fMRI by Removing the Impact of Sleep.

    Science.gov (United States)

    Wang, Jiahui; Han, Junwei; Nguyen, Vinh T; Guo, Lei; Guo, Christine C

    2017-01-01

    Resting state functional magnetic resonance imaging (rs-fMRI) provides a powerful tool to examine large-scale neural networks in the human brain and their disturbances in neuropsychiatric disorders. Thanks to its low demand and high tolerance, resting state paradigms can be easily acquired from clinical population. However, due to the unconstrained nature, resting state paradigm is associated with excessive head movement and proneness to sleep. Consequently, the test-retest reliability of rs-fMRI measures is moderate at best, falling short of widespread use in the clinic. Here, we characterized the effect of sleep on the test-retest reliability of rs-fMRI. Using measures of heart rate variability (HRV) derived from simultaneous electrocardiogram (ECG) recording, we identified portions of fMRI data when subjects were more alert or sleepy, and examined their effects on the test-retest reliability of functional connectivity measures. When volumes of sleep were excluded, the reliability of rs-fMRI is significantly improved, and the improvement appears to be general across brain networks. The amount of improvement is robust with the removal of as much as 60% volumes of sleepiness. Therefore, test-retest reliability of rs-fMRI is affected by sleep and could be improved by excluding volumes of sleepiness as indexed by HRV. Our results suggest a novel and practical method to improve test-retest reliability of rs-fMRI measures.

  5. Improving the Test-Retest Reliability of Resting State fMRI by Removing the Impact of Sleep

    Directory of Open Access Journals (Sweden)

    Jiahui Wang

    2017-05-01

    Full Text Available Resting state functional magnetic resonance imaging (rs-fMRI provides a powerful tool to examine large-scale neural networks in the human brain and their disturbances in neuropsychiatric disorders. Thanks to its low demand and high tolerance, resting state paradigms can be easily acquired from clinical population. However, due to the unconstrained nature, resting state paradigm is associated with excessive head movement and proneness to sleep. Consequently, the test-retest reliability of rs-fMRI measures is moderate at best, falling short of widespread use in the clinic. Here, we characterized the effect of sleep on the test-retest reliability of rs-fMRI. Using measures of heart rate variability (HRV derived from simultaneous electrocardiogram (ECG recording, we identified portions of fMRI data when subjects were more alert or sleepy, and examined their effects on the test-retest reliability of functional connectivity measures. When volumes of sleep were excluded, the reliability of rs-fMRI is significantly improved, and the improvement appears to be general across brain networks. The amount of improvement is robust with the removal of as much as 60% volumes of sleepiness. Therefore, test-retest reliability of rs-fMRI is affected by sleep and could be improved by excluding volumes of sleepiness as indexed by HRV. Our results suggest a novel and practical method to improve test-retest reliability of rs-fMRI measures.

  6. Social protection: potential for improving HIV outcomes among adolescents.

    Science.gov (United States)

    Cluver, Lucie D; Hodes, Rebecca J; Sherr, Lorraine; Orkin, F Mark; Meinck, Franziska; Lim Ah Ken, Patricia; Winder-Rossi, Natalia E; Wolfe, Jason; Vicari, Marissa

    2015-01-01

    Advances in biomedical technologies provide potential for adolescent HIV prevention and HIV-positive survival. The UNAIDS 90-90-90 treatment targets provide a new roadmap for ending the HIV epidemic, principally through antiretroviral treatment, HIV testing and viral suppression among people with HIV. However, while imperative, HIV treatment and testing will not be sufficient to address the epidemic among adolescents in Southern and Eastern Africa. In particular, use of condoms and adherence to antiretroviral therapy (ART) remain haphazard, with evidence that social and structural deprivation is negatively impacting adolescents' capacity to protect themselves and others. This paper examines the evidence for and potential of interventions addressing these structural deprivations. New evidence is emerging around social protection interventions, including cash transfers, parenting support and educational support ("cash, care and classroom"). These interventions have the potential to reduce the social and economic drivers of HIV risk, improve utilization of prevention technologies and improve adherence to ART for adolescent populations in the hyper-endemic settings of Southern and Eastern Africa. Studies show that the integration of social and economic interventions has high acceptability and reach and that it holds powerful potential for improved HIV, health and development outcomes. Social protection is a largely untapped means of reducing HIV-risk behaviours and increasing uptake of and adherence to biomedical prevention and treatment technologies. There is now sufficient evidence to include social protection programming as a key strategy not only to mitigate the negative impacts of the HIV epidemic among families, but also to contribute to HIV prevention among adolescents and potentially to remove social and economic barriers to accessing treatment. We urge a further research and programming agenda: to actively combine programmes that increase availability of

  7. Reliability and validity of adapted French Canadian version of Scoliosis Research Society Outcomes Questionnaire (SRS-22) in Quebec.

    Science.gov (United States)

    Beauséjour, Marie; Joncas, Julie; Goulet, Lise; Roy-Beaudry, Marjolaine; Parent, Stefan; Grimard, Guy; Forcier, Martin; Lauriault, Sophie; Labelle, Hubert

    2009-03-15

    Prospective validation study of a cross-cultural adaptation of the Scoliosis Research Society (SRS) Outcomes Questionnaire. To provide a French Canadian version of the SRS Outcomes Questionnaire and to empirically test its response in healthy adolescents and adolescent idiopathic scoliosis (AIS) patients in Québec. The SRS Outcomes Questionnaire is widely used for the assessment of health-related quality of life in AIS patients. French translation and back-translation of the SRS-22 (SRS-22-fv) were done by an expert committee. Its reliability was measured using the coefficient of internal consistency, construct validity with a factorial analysis, concurrent validity by using the short form-12 and discriminant validity using ANOVA and multivariate linear regression, on 145 AIS patients, 44 patients with non clinically significant scoliosis (NCSS), and 64 healthy patients. The SRS-22-fv showed a good global internal consistency (AIS: Cronbach alpha = 0.86, NCSS: 0.81, and controls: 0.79) and in all of its domains for AIS patients. The factorial structure was coherent with the original questionnaire (47.4% of explained variance). High correlation coefficients were obtained between SRS-22-fv and short form-12 corresponding domains. Boys had higher scores than girls, scores worsened with age, and with increasing body mass index. Mean Total, Pain, Self-image, and Satisfaction scores, were correlated with Cobb angle. Adjusted regression models showed statistically significant differences between the AIS, NCSS, and control groups in the Total, Pain, and Function scores. The SRS-22-fv showed satisfactory reliability, factorial, concurrent, and discriminant validity. This study provides scores in a significant group of healthy adolescents and demonstrates a clear gradient in response between subjects with AIS, NCSS, and controls.

  8. Reliability, Validity, and Responsiveness of InFLUenza Patient-Reported Outcome (FLU-PRO©) Scores in Influenza-Positive Patients.

    Science.gov (United States)

    Powers, John H; Bacci, Elizabeth D; Guerrero, M Lourdes; Leidy, Nancy Kline; Stringer, Sonja; Kim, Katherine; Memoli, Matthew J; Han, Alison; Fairchok, Mary P; Chen, Wei-Ju; Arnold, John C; Danaher, Patrick J; Lalani, Tahaniyat; Ridoré, Michelande; Burgess, Timothy H; Millar, Eugene V; Hernández, Andrés; Rodríguez-Zulueta, Patricia; Smolskis, Mary C; Ortega-Gallegos, Hilda; Pett, Sarah; Fischer, William; Gillor, Daniel; Macias, Laura Moreno; DuVal, Anna; Rothman, Richard; Dugas, Andrea; Ruiz-Palacios, Guillermo M

    2018-02-01

    To assess the reliability, validity, and responsiveness of InFLUenza Patient-Reported Outcome (FLU-PRO©) scores for quantifying the presence and severity of influenza symptoms. An observational prospective cohort study of adults (≥18 years) with influenza-like illness in the United States, the United Kingdom, Mexico, and South America was conducted. Participants completed the 37-item draft FLU-PRO daily for up to 14 days. Item-level and factor analyses were used to remove items and determine factor structure. Reliability of the final tool was estimated using Cronbach α and intraclass correlation coefficients (2-day reliability). Convergent and known-groups validity and responsiveness were assessed using global assessments of influenza severity and return to usual health. Of the 536 patients enrolled, 221 influenza-positive subjects comprised the analytical sample. The mean age of the patients was 40.7 years, 60.2% were women, and 59.7% were white. The final 32-item measure has six factors/domains (nose, throat, eyes, chest/respiratory, gastrointestinal, and body/systemic), with a higher order factor representing symptom severity overall (comparative fit index = 0.92; root mean square error of approximation = 0.06). Cronbach α was high (total = 0.92; domain range = 0.71-0.87); test-retest reliability (intraclass correlation coefficient, day 1-day 2) was 0.83 for total scores and 0.57 to 0.79 for domains. Day 1 FLU-PRO domain and total scores were moderately to highly correlated (≥0.30) with Patient Global Rating of Flu Severity (except nose and throat). Consistent with known-groups validity, scores differentiated severity groups on the basis of global rating (total: F = 57.2, P FLU-PRO score improvement by day 7 than did those who did not, suggesting score responsiveness. Results suggest that FLU-PRO scores are reliable, valid, and responsive to change in influenza-positive adults. Copyright © 2018 International Society for Pharmacoeconomics and Outcomes

  9. Hypothetical Outcome Plots Outperform Error Bars and Violin Plots for Inferences about Reliability of Variable Ordering.

    Science.gov (United States)

    Hullman, Jessica; Resnick, Paul; Adar, Eytan

    2015-01-01

    Many visual depictions of probability distributions, such as error bars, are difficult for users to accurately interpret. We present and study an alternative representation, Hypothetical Outcome Plots (HOPs), that animates a finite set of individual draws. In contrast to the statistical background required to interpret many static representations of distributions, HOPs require relatively little background knowledge to interpret. Instead, HOPs enables viewers to infer properties of the distribution using mental processes like counting and integration. We conducted an experiment comparing HOPs to error bars and violin plots. With HOPs, people made much more accurate judgments about plots of two and three quantities. Accuracy was similar with all three representations for most questions about distributions of a single quantity.

  10. Hypothetical Outcome Plots Outperform Error Bars and Violin Plots for Inferences about Reliability of Variable Ordering.

    Directory of Open Access Journals (Sweden)

    Jessica Hullman

    Full Text Available Many visual depictions of probability distributions, such as error bars, are difficult for users to accurately interpret. We present and study an alternative representation, Hypothetical Outcome Plots (HOPs, that animates a finite set of individual draws. In contrast to the statistical background required to interpret many static representations of distributions, HOPs require relatively little background knowledge to interpret. Instead, HOPs enables viewers to infer properties of the distribution using mental processes like counting and integration. We conducted an experiment comparing HOPs to error bars and violin plots. With HOPs, people made much more accurate judgments about plots of two and three quantities. Accuracy was similar with all three representations for most questions about distributions of a single quantity.

  11. Can prebiotics and probiotics improve therapeutic outcomes for undernourished individuals?

    Science.gov (United States)

    Sheridan, Paul O; Bindels, Laure B; Saulnier, Delphine M; Reid, Gregor; Nova, Esther; Holmgren, Kerstin; O'Toole, Paul W; Bunn, James; Delzenne, Nathalie; Scott, Karen P

    2014-01-01

    It has become clear in recent years that the human intestinal microbiota plays an important role in maintaining health and thus is an attractive target for clinical interventions. Scientists and clinicians have become increasingly interested in assessing the ability of probiotics and prebiotics to enhance the nutritional status of malnourished children, pregnant women, the elderly, and individuals with non-communicable disease-associated malnutrition. A workshop was held by the International Scientific Association for Probiotics and Prebiotics (ISAPP), drawing on the knowledge of experts from industry, medicine, and academia, with the objective to assess the status of our understanding of the link between the microbiome and under-nutrition, specifically in relation to probiotic and prebiotic treatments for under-nourished individuals. These discussions led to four recommendations:   (1) The categories of malnourished individuals need to be differentiated To improve treatment outcomes, subjects should first be categorized based on the cause of malnutrition, additional health-concerns, differences in the gut microbiota, and sociological considerations. (2) Define a baseline "healthy" gut microbiota for each category Altered nutrient requirement (for example, in pregnancy and old age) and individual variation may change what constitutes a healthy gut microbiota for the individual. (3) Perform studies using model systems to test the effectiveness of potential probiotics and prebiotics against these specific categories These should illustrate how certain microbiota profiles can be altered, as members of different categories may respond differently to the same treatment. (4) Perform robust well-designed human studies with probiotics and/or prebiotics, with appropriate, defined primary outcomes and sample size These are critical to show efficacy and understand responder and non-responder outcomes. It is hoped that these recommendations will lead to new approaches that

  12. The new health-care quality: value, outcomes, and continuous improvement.

    Science.gov (United States)

    O'Connor, S J; Lanning, J A

    1991-01-01

    No longer convinced that their viewpoint on quality is the only one, different stakeholders in the health-care arena are sharing perspectives to piece together the quality picture. Although still preoccupied with the cost of health care, purchasers are concerned about value--efficiency, appropriateness, and effectiveness--as well as price. Faced with evidence of medically unnecessary procedures and unexamined medical theory, practitioners are searching for appropriateness guidelines, useful outcome measures, and methods to elicit informed patient preferences about elective surgeries. Underlying this search for reliable indicators of quality--now expanded to include patient satisfaction--is a new interest in the Japanese notion of "Kaizen" or continuous quality improvement. The end product of this ferment may determine whether good medicine drives out the bad--or vice versa.

  13. Validity and reliability of the Turkish version of the Optimality Index-US (OI-US) to assess maternity care outcomes.

    Science.gov (United States)

    Yucel, Cigdem; Taskin, Lale; Low, Lisa Kane

    2015-12-01

    Although obstetrical interventions are used commonly in Turkey, there is no standardized evidence-based assessment tool to evaluate maternity care outcomes. The Optimality Index-US (OI-US) is an evidence-based tool that was developed for the purpose of measuring aggregate perinatal care processes and outcomes against an optimal or best possible standard. This index has been validated and used in Netherlands, USA and UK until now. The objective of this study was to adapt the OI-US to assess maternity care outcomes in Turkey. Translation and back translation were used to develop the Optimality Index-Turkey (OI-TR) version. To evaluate the content validity of the OI-TR, an expert panel group (n=10) reviewed the items and evidence-based quality of the OI-TR for application in Turkey. Following the content validity process, the OI-TR was used to assess 150 healthy and 150 high-risk pregnant women who gave birth at a high volume, urban maternity hospital in Turkey. The scores between the two groups were compared to assess the discriminant validity of the OI-TR. The percentage of agreement between two raters and the Kappa statistic were calculated to evaluate the reliability. Content validity was established for the OI-TR by an expert group. Discriminant validity was confirmed by comparing the OI scores of healthy pregnant women (mean OI score=77.65%) and those of high-risk pregnant women (mean OI score=78.60%). The percentage of agreement between the two raters was 96.19, and inter-rater agreement was provided for each item in the OI-TR. OI-TR is a valid and reliable tool that can be used to assess maternity care outcomes in Turkey. The results of this study indicate that although the risk statuses of the women differed, the type of care they received was essentially the same, as measured by the OI-TR. Care was not individualised based on risk and for a majority of items was inconsistent with evidence based practice, which is not optimal. Use of the OI-TR will help to

  14. Which postoperative complications matter most after bariatric surgery? Prioritizing quality improvement efforts to improve national outcomes.

    Science.gov (United States)

    Daigle, Christopher R; Brethauer, Stacy A; Tu, Chao; Petrick, Anthony T; Morton, John M; Schauer, Philip R; Aminian, Ali

    2018-01-12

    National quality programs have been implemented to decrease the burden of adverse events on key outcomes in bariatric surgery. However, it is not well understood which complications have the most impact on patient health. To quantify the impact of specific bariatric surgery complications on key clinical outcomes. The Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database. Data from patients who underwent primary bariatric procedures were retrieved from the MBSAQIP 2015 participant use file. The impact of 8 specific complications (bleeding, venous thromboembolism [VTE], leak, wound infection, pneumonia, urinary tract infection, myocardial infarction, and stroke) on 5 main 30-day outcomes (end-organ dysfunction, reoperation, intensive care unit admission, readmission, and mortality) was estimated using risk-adjusted population attributable fractions. The population attributable fraction is a calculated measure taking into account the prevalence and severity of each complication. The population attributable fractions represents the percentage reduction in a given outcome that would occur if that complication were eliminated. In total, 135,413 patients undergoing sleeve gastrectomy (67%), Roux-en-Y gastric bypass (29%), adjustable gastric banding (3%), and duodenal switch (1%) were included. The most common complications were bleeding (.7%), wound infection (.5%), urinary tract infection (.3%), VTE (.3%), and leak (.2%). Bleeding and leak were the largest contributors to 3 of 5 examined outcomes. VTE had the greatest effect on readmission and mortality. This study quantifies the impact of specific complications on key surgical outcomes after bariatric surgery. Bleeding and leak were the complications with the largest overall effect on end-organ dysfunction, reoperation, and intensive care unit admission after bariatric surgery. Furthermore, our findings suggest that an initiative targeting reduction of post-bariatric surgery

  15. Reliability of gadolinium-enhanced magnetic resonance imaging findings and their correlation with clinical outcome in patients with sciatica.

    Science.gov (United States)

    el Barzouhi, Abdelilah; Vleggeert-Lankamp, Carmen L A M; Lycklama à Nijeholt, Geert J; Van der Kallen, Bas F; van den Hout, Wilbert B; Koes, Bart W; Peul, Wilco C

    2014-11-01

    Gadolinium-enhanced magnetic resonance imaging (Gd-MRI) is often performed in the evaluation of patients with persistent sciatica after lumbar disc surgery. However, correlation between enhancement and clinical findings is debated, and limited data are available regarding the reliability of enhancement findings. To evaluate the reliability of Gd-MRI findings and their correlation with clinical findings in patients with sciatica. Prospective observational evaluation of patients who were enrolled in a randomized trial with 1-year follow-up. Patients with 6- to 12-week sciatica, who participated in a multicentre randomized clinical trial comparing an early surgery strategy with prolonged conservative care with surgery if needed. In total 204 patients underwent Gd-MRI at baseline and after 1 year. Patients were assessed by means of the Roland Disability Questionnaire (RDQ) for sciatica, visual analog scale (VAS) for leg pain, and patient-reported perceived recovery at 1 year. Kappa coefficients were used to assess interobserver reliability. In total, 204 patients underwent Gd-MRI at baseline and after 1 year. Magnetic resonance imaging findings were correlated to the outcome measures using the Mann-Whitney U test for continuous data and Fisher exact tests for categorical data. Poor-to-moderate agreement was observed regarding Gd enhancement of the herniated disc and compressed nerve root (kappa0.95). Of the 59 patients with an enhancing herniated disc at 1 year, 86% reported recovery compared with 100% of the 12 patients with nonenhancing herniated discs (p=.34). Of the 12 patients with enhancement of the most affected nerve root at 1 year, 83% reported recovery compared with 85% of the 192 patients with no enhancement (p=.69). Patients with and without enhancing herniated discs or nerve roots at 1 year reported comparable outcomes on RDQ and VAS-leg pain. Reliability of Gd-MRI findings was poor-to-moderate and no correlation was observed between enhancement and

  16. Shock reliability analysis and improvement of MEMS electret-based vibration energy harvesters

    International Nuclear Information System (INIS)

    Renaud, M; Goedbloed, M; De Nooijer, C; Van Schaijk, R; Fujita, T

    2015-01-01

    Vibration energy harvesters can serve as a replacement solution to batteries for powering tire pressure monitoring systems (TPMS). Autonomous wireless TPMS powered by microelectromechanical system (MEMS) electret-based vibration energy harvester have been demonstrated. The mechanical reliability of the MEMS harvester still has to be assessed in order to bring the harvester to the requirements of the consumer market. It should survive the mechanical shocks occurring in the tire environment. A testing procedure to quantify the shock resilience of harvesters is described in this article. Our first generation of harvesters has a shock resilience of 400 g, which is far from being sufficient for the targeted application. In order to improve this aspect, the first important aspect is to understand the failure mechanism. Failure is found to occur in the form of fracture of the device’s springs. It results from impacts between the anchors of the springs when the harvester undergoes a shock. The shock resilience of the harvesters can be improved by redirecting these impacts to nonvital parts of the device. With this philosophy in mind, we design three types of shock absorbing structures and test their effect on the shock resilience of our MEMS harvesters. The solution leading to the best results consists of rigid silicon stoppers covered by a layer of Parylene. The shock resilience of the harvesters is brought above 2500 g. Results in the same range are also obtained with flexible silicon bumpers, which are simpler to manufacture. (paper)

  17. The experiences to improve plant performance and reliability of Ko-Ri nuclear power plants

    Energy Technology Data Exchange (ETDEWEB)

    Kang, Ho Weon [Korea Electric Power Corp. Ko-Ri nuclear power division, Ko-Ri (Korea, Republic of)

    1998-07-01

    This paper provides a discussion of the lessons learned from operational experience and the future plans to improve performance of the Ko-Ri plant. To operate nuclear power plants safely with good performance is the only way to mitigate the negative image of nuclear power generation to the public and to enhance the economical benefit compared to other electrical generation method. Therefore, in a continuous effort to overcome a negative challenge from outside, we have driven an aggressive 'OCTF' campaign as part of safety. As a result of our efforts, the following remarkable achievements have been accomplished. (1) 3 times of OCTF during recent three years (2) Selected twice as a top notch power plant on the list of NEI magazine in terms of plant capacity factor (3) No scram recorded in 1997 for all 4 units at Ko-Ri site. Ko-Ri is now undergoing the large scale plant betterment projects for retaking-off our operating performance to the level of new challenge target. Such improvement of critical components in the reactor coolant system and turbine system greatly contribute to increase the safety and reliability of the plant and to shortening of the planned outage period as well as to reduction of radiation exposure and radwaste. (Cho, G. S.). 5 tabs., 10 figs.

  18. Shock reliability analysis and improvement of MEMS electret-based vibration energy harvesters

    Science.gov (United States)

    Renaud, M.; Fujita, T.; Goedbloed, M.; de Nooijer, C.; van Schaijk, R.

    2015-10-01

    Vibration energy harvesters can serve as a replacement solution to batteries for powering tire pressure monitoring systems (TPMS). Autonomous wireless TPMS powered by microelectromechanical system (MEMS) electret-based vibration energy harvester have been demonstrated. The mechanical reliability of the MEMS harvester still has to be assessed in order to bring the harvester to the requirements of the consumer market. It should survive the mechanical shocks occurring in the tire environment. A testing procedure to quantify the shock resilience of harvesters is described in this article. Our first generation of harvesters has a shock resilience of 400 g, which is far from being sufficient for the targeted application. In order to improve this aspect, the first important aspect is to understand the failure mechanism. Failure is found to occur in the form of fracture of the device’s springs. It results from impacts between the anchors of the springs when the harvester undergoes a shock. The shock resilience of the harvesters can be improved by redirecting these impacts to nonvital parts of the device. With this philosophy in mind, we design three types of shock absorbing structures and test their effect on the shock resilience of our MEMS harvesters. The solution leading to the best results consists of rigid silicon stoppers covered by a layer of Parylene. The shock resilience of the harvesters is brought above 2500 g. Results in the same range are also obtained with flexible silicon bumpers, which are simpler to manufacture.

  19. Carbohydrate ingestion improves performance of a new reliable test of soccer performance.

    Science.gov (United States)

    Currell, Kevin; Conway, Steve; Jeukendrup, Asker E

    2009-02-01

    The aim of the study was to investigate the reliability of a new test of soccer performance and evaluate the effect of carbohydrate (CHO) on soccer performance. Eleven university footballers were recruited and underwent 3 trials in a randomized order. Two of the trials involved ingesting a placebo beverage, and the other, a 7.5% maltodextrin solution. The protocol comprised a series of ten 6-min exercise blocks on an outdoor Astroturf pitch, separated by the performance of 2 of the 4 soccer-specific tests, making the protocol 90 min in duration. The intensity of the exercise was designed to be similar to the typical activity pattern during soccer match play. Participants performed skill tests of dribbling, agility, heading, and shooting throughout the protocol. The coefficients of variation for dribbling, agility, heading, and shooting were 2.2%, 1.2%, 7.0%, and 2.8%, respectively. The mean combined placebo scores were 42.4 +/- 2.7 s, 43.1 +/- 3.7 s, 210 +/- 34 cm, and 212 +/- 17 points for agility, dribbling, heading, and kicking, respectively. CHO ingestion led to a combined agility time of 41.5 +/- 0.8 s, for dribbling 41.7 +/- 3.5 s, 213 +/- 11 cm for heading, and 220 +/- 5 points for kicking accuracy. There was a significant improvement in performance for dribbling, agility, and shooting (p soccer performance, and ingesting CHO leads to an improvement in soccer performance.

  20. The experiences to improve plant performance and reliability of Ko-Ri nuclear power plants

    International Nuclear Information System (INIS)

    Kang, Ho Weon

    1998-01-01

    This paper provides a discussion of the lessons learned from operational experience and the future plans to improve performance of the Ko-Ri plant. To operate nuclear power plants safely with good performance is the only way to mitigate the negative image of nuclear power generation to the public and to enhance the economical benefit compared to other electrical generation method. Therefore, in a continuous effort to overcome a negative challenge from outside, we have driven an aggressive 'OCTF' campaign as part of safety. As a result of our efforts, the following remarkable achievements have been accomplished. (1) 3 times of OCTF during recent three years (2) Selected twice as a top notch power plant on the list of NEI magazine in terms of plant capacity factor (3) No scram recorded in 1997 for all 4 units at Ko-Ri site. Ko-Ri is now undergoing the large scale plant betterment projects for retaking-off our operating performance to the level of new challenge target. Such improvement of critical components in the reactor coolant system and turbine system greatly contribute to increase the safety and reliability of the plant and to shortening of the planned outage period as well as to reduction of radiation exposure and radwaste. (Cho, G. S.). 5 tabs., 10 figs

  1. Improved Patient Outcomes by Normalizing Sympathovagal Balance: Differentiating Syncope—Precise Subtype Differentiation Leads to Improved Outcomes

    Directory of Open Access Journals (Sweden)

    Nicholas L. DePace

    2018-01-01

    Full Text Available Syncope is difficult to definitively diagnose, even with tilt-table testing and beat-to-beat blood pressure measurements, the gold-standard. Both are qualitative, subjective assessments. There are subtypes of syncope associated with autonomic conditions for which tilt-table testing is not useful. Heart rate variability analyses also include too much ambiguity. Three subtypes of syncope are differentiated: vasovagal syncope (VVS due to parasympathetic excess (VVS-PE, VVS with abnormal heart rate response (VVS-HR, and VVS without PE (VVS-PN. P&S monitoring (ANSAR, Inc., Philadelphia, PA differentiates subtypes in 2727 cardiology patients (50.5% female; average age: 57 years; age range: 12–100 years, serially tested over four years (3.3 tests per patient, average. P&S monitoring noninvasively, independently, and simultaneously measures parasympathetic and sympathetic (P&S activity, including the normal P-decrease followed by an S-increase with head-up postural change (standing. Syncope, as an S-excess (SE with stand, is differentiated from orthostatic dysfunction (e.g., POTS as S-withdrawal with stand. Upon standing, VVS-PE is further differentiated as SE with PE, VVS-HR as SE with abnormal HR, and VVS-PN as SE with normal P- and HR-responses. Improved understanding of the underlying pathophysiology by more accurate subtyping leads to more precise therapy and improved outcomes.

  2. Increased scientific rigor will improve reliability of research and effectiveness of management

    Science.gov (United States)

    Sells, Sarah N.; Bassing, Sarah B.; Barker, Kristin J.; Forshee, Shannon C.; Keever, Allison; Goerz, James W.; Mitchell, Michael S.

    2018-01-01

    Rigorous science that produces reliable knowledge is critical to wildlife management because it increases accurate understanding of the natural world and informs management decisions effectively. Application of a rigorous scientific method based on hypothesis testing minimizes unreliable knowledge produced by research. To evaluate the prevalence of scientific rigor in wildlife research, we examined 24 issues of the Journal of Wildlife Management from August 2013 through July 2016. We found 43.9% of studies did not state or imply a priori hypotheses, which are necessary to produce reliable knowledge. We posit that this is due, at least in part, to a lack of common understanding of what rigorous science entails, how it produces more reliable knowledge than other forms of interpreting observations, and how research should be designed to maximize inferential strength and usefulness of application. Current primary literature does not provide succinct explanations of the logic behind a rigorous scientific method or readily applicable guidance for employing it, particularly in wildlife biology; we therefore synthesized an overview of the history, philosophy, and logic that define scientific rigor for biological studies. A rigorous scientific method includes 1) generating a research question from theory and prior observations, 2) developing hypotheses (i.e., plausible biological answers to the question), 3) formulating predictions (i.e., facts that must be true if the hypothesis is true), 4) designing and implementing research to collect data potentially consistent with predictions, 5) evaluating whether predictions are consistent with collected data, and 6) drawing inferences based on the evaluation. Explicitly testing a priori hypotheses reduces overall uncertainty by reducing the number of plausible biological explanations to only those that are logically well supported. Such research also draws inferences that are robust to idiosyncratic observations and

  3. Improved reliability, accuracy and quality in automated NMR structure calculation with ARIA

    Energy Technology Data Exchange (ETDEWEB)

    Mareuil, Fabien [Institut Pasteur, Cellule d' Informatique pour la Biologie (France); Malliavin, Thérèse E.; Nilges, Michael; Bardiaux, Benjamin, E-mail: bardiaux@pasteur.fr [Institut Pasteur, Unité de Bioinformatique Structurale, CNRS UMR 3528 (France)

    2015-08-15

    In biological NMR, assignment of NOE cross-peaks and calculation of atomic conformations are critical steps in the determination of reliable high-resolution structures. ARIA is an automated approach that performs NOE assignment and structure calculation in a concomitant manner in an iterative procedure. The log-harmonic shape for distance restraint potential and the Bayesian weighting of distance restraints, recently introduced in ARIA, were shown to significantly improve the quality and the accuracy of determined structures. In this paper, we propose two modifications of the ARIA protocol: (1) the softening of the force field together with adapted hydrogen radii, which is meaningful in the context of the log-harmonic potential with Bayesian weighting, (2) a procedure that automatically adjusts the violation tolerance used in the selection of active restraints, based on the fitting of the structure to the input data sets. The new ARIA protocols were fine-tuned on a set of eight protein targets from the CASD–NMR initiative. As a result, the convergence problems previously observed for some targets was resolved and the obtained structures exhibited better quality. In addition, the new ARIA protocols were applied for the structure calculation of ten new CASD–NMR targets in a blind fashion, i.e. without knowing the actual solution. Even though optimisation of parameters and pre-filtering of unrefined NOE peak lists were necessary for half of the targets, ARIA consistently and reliably determined very precise and highly accurate structures for all cases. In the context of integrative structural biology, an increasing number of experimental methods are used that produce distance data for the determination of 3D structures of macromolecules, stressing the importance of methods that successfully make use of ambiguous and noisy distance data.

  4. Support Vector Machine Analysis of Functional Magnetic Resonance Imaging of Interoception Does Not Reliably Predict Individual Outcomes of Cognitive Behavioral Therapy in Panic Disorder with Agoraphobia

    Directory of Open Access Journals (Sweden)

    Benedikt Sundermann

    2017-06-01

    Full Text Available BackgroundThe approach to apply multivariate pattern analyses based on neuro imaging data for outcome prediction holds out the prospect to improve therapeutic decisions in mental disorders. Patients suffering from panic disorder with agoraphobia (PD/AG often exhibit an increased perception of bodily sensations. The purpose of this investigation was to assess whether multivariate classification applied to a functional magnetic resonance imaging (fMRI interoception paradigm can predict individual responses to cognitive behavioral therapy (CBT in PD/AG.MethodsThis analysis is based on pretreatment fMRI data during an interoceptive challenge from a multicenter trial of the German PANIC-NET. Patients with DSM-IV PD/AG were dichotomized as responders (n = 30 or non-responders (n = 29 based on the primary outcome (Hamilton Anxiety Scale Reduction ≥50% after 6 weeks of CBT (2 h/week. fMRI parametric maps were used as features for response classification with linear support vector machines (SVM with or without automated feature selection. Predictive accuracies were assessed using cross validation and permutation testing. The influence of methodological parameters and the predictive ability for specific interoception-related symptom reduction were further evaluated.ResultsSVM did not reach sufficient overall predictive accuracies (38.0–54.2% for anxiety reduction in the primary outcome. In the exploratory analyses, better accuracies (66.7% were achieved for predicting interoception-specific symptom relief as an alternative outcome domain. Subtle information regarding this alternative response criterion but not the primary outcome was revealed by post hoc univariate comparisons.ConclusionIn contrast to reports on other neurofunctional probes, SVM based on an interoception paradigm was not able to reliably predict individual response to CBT. Results speak against the clinical applicability of this technique.

  5. Reliability and validity of the Dutch version of the American Burn Association/Shriners Hospital for Children Burn Outcomes Questionnaire (5-18 years of age)

    NARCIS (Netherlands)

    van Baar, Margriet E.; Essink-Bot, Marie-Louise; Oen, Irma M. M. H.; Dokter, Jan; Boxma, Han; Hinson, Michelle I.; van Loey, Nancy E. E.; Faber, Albertus W.; van Beeck, Ed F.

    2006-01-01

    The American Burn Association/Shriners Hospital for Children Burn Outcomes Questionnaire (BOQ) is a self-administered questionnaire to monitor functional outcome after burns in children and adolescents. This study aimed to assess feasibility, reliability, and validity of the Dutch BOQ. The BOQ was

  6. Reliable Mechanochemistry: Protocols for Reproducible Outcomes of Neat and Liquid Assisted Ball-mill Grinding Experiments.

    Science.gov (United States)

    Belenguer, Ana M; Lampronti, Giulio I; Sanders, Jeremy K M

    2018-01-23

    The equilibrium outcomes of ball mill grinding can dramatically change as a function of even tiny variations in the experimental conditions such as the presence of very small amounts of added solvent. To reproducibly and accurately capture this sensitivity, the experimentalist needs to carefully consider every single factor that can affect the ball mill grinding reaction under investigation, from ensuring the grinding jars are clean and dry before use, to accurately adding the stoichiometry of the starting materials, to validating that the delivery of solvent volume is accurate, to ensuring that the interaction between the solvent and the powder is well understood and, if necessary, a specific soaking time is added to the procedure. Preliminary kinetic studies are essential to determine the necessary milling time to achieve equilibrium. Only then can exquisite phase composition curves be obtained as a function of the solvent concentration under ball mill liquid assisted grinding (LAG). By using strict and careful procedures analogous to the ones here presented, such milling equilibrium curves can be obtained for virtually all milling systems. The system we use to demonstrate these procedures is a disulfide exchange reaction starting from the equimolar mixture of two homodimers to obtain at equilibrium quantitative heterodimer. The latter is formed by ball mill grinding as two different polymorphs, Form A and Form B. The ratio R = [Form B] / ([Form A] + [Form B]) at milling equilibrium depends on the nature and concentration of the solvent in the milling jar.

  7. Interprofessional Collaborative Practice to Improve Patient Outcomes: A Pilot Study

    Directory of Open Access Journals (Sweden)

    Jennifer Styron

    2014-06-01

    Full Text Available This project focused on a pilot project implemented during the 2013-2014 academic year. The overall purpose was to facilitate interprofessional collaborative practice innovations through the development of leadership, core competencies, and the use of technology, especially among nurses. Nursing, medicine, and physician assistant students were educated on the IOM competencies for interprofessional teams and the core competencies identified by the Interprofessional Education Collaborative Expert Panel [1] to develop knowledge, skills, and attitudes needed to practice in the collaborative practice environments. The project addressed four goals: Develop faculty expertise and leadership in interprofessional collaborative practice to provide a current, high quality education to nursing, physician assistant, and medical students; Implement a culturally responsive and respectful collaborative interprofessional practice curriculum to prepare nurses, physician assistants, and medical students to deliver high quality, efficient, team-based care in a dynamically evolving environment; Focus interprofessional collaborative practice education on models and practices that lead to improvement in patient outcomes; and Evaluate the program and disseminate best practices. Findings from this pilot include strategies to engage different health professions' students and faculty, partnering with community agencies, building an effective interprofessional team to guide the project, and seeking funding for extension and expansion of the offerings.

  8. Improving conservation outcomes with insights from local experts and bureaucracies.

    Science.gov (United States)

    Haenn, Nora; Schmook, Birgit; Reyes, Yol; Calmé, Sophie

    2014-08-01

    We describe conservation built on local expertise such that it constitutes a hybrid form of traditional and bureaucratic knowledge. Researchers regularly ask how local knowledge might be applied to programs linked to protected areas. By examining the production of conservation knowledge in southern Mexico, we assert local expertise is already central to conservation. However, bureaucratic norms and social identity differences between lay experts and conservation practitioners prevent the public valuing of traditional knowledge. We make this point by contrasting 2 examples. The first is a master's thesis survey of local experts regarding the biology of the King Vulture (Sarcoramphus papa) in which data collection took place in communities adjacent to the Calakmul Biosphere Reserve. The second is a workshop sponsored by the same reserve that instructed farmers on how to monitor endangered species, including the King Vulture. In both examples, conservation knowledge would not have existed without traditional knowledge. In both examples, this traditional knowledge is absent from scientific reporting. On the basis of these findings, we suggest conservation outcomes may be improved by recognizing the knowledge contributions local experts already make to conservation programming. © 2014 Society for Conservation Biology.

  9. AMCP Partnership Forum: Improving Quality, Value, and Outcomes with Patient-Reported Outcomes.

    Science.gov (United States)

    2018-03-01

    Patient-reported outcomes (PROs), which provide a direct measure of a patient's health status or treatment preferences, represent a key component of the shift toward patient-centered health care. PROs can measure the state of a patient's disease-specific and overall health throughout the care continuum, enabling them to have a variety of uses for key health care stakeholders. Currently, PROs are used in drug development, aligning patient and clinician goals in care, quality-of-care measures, and coverage and reimbursement decisions. While there have been significant strides by key health care stakeholders to further the development and use of PROs, there are a number of challenges limiting more widespread use. In light of these current challenges and the potential for PROs to improve health care quality and value, on October 19, 2017, the Academy of Managed Care Pharmacy convened a forum of key stakeholders representing patients, payers, providers, government, and pharmaceutical companies to discuss and identify solutions to the current challenges and barriers to further use of PROs. These discussions informed the development of participants' ideal future state in which PROs maximize the goals of all health care stakeholders and the actionable steps required to make the future state a reality. While stakeholders shared unique perspectives throughout the forum, they had consensus on 2 overarching issues: the importance of PROs in defining value, improving patient care, and implementing value-based payment models and the need for strong organizational and operational systems to achieve optimal adoption and use. Participants identified several key challenges in PRO use and adoption: achieving a representative patient population, inclusion of PRO data in medication labels, the necessity for both standardized and customizable PROs, and operational and organizational barriers to collecting and analyzing PROs. To overcome these challenges, participants recommended that

  10. How Case-Based Reasoning on e-Community Knowledge Can Be Improved Thanks to Knowledge Reliability

    OpenAIRE

    Gaillard , Emmanuelle; Lieber , Jean; Nauer , Emmanuel; Cordier , Amélie

    2014-01-01

    International audience; This paper shows that performing case-based reasoning (CBR) on knowledge coming from an e-community is improved by taking into account knowledge reliability. MKM (meta-knowledge model) is a model for managing reliability of the knowledge units that are used in the reasoning process. For this, MKM uses meta-knowledge such as belief, trust and reputation, about knowledge units and users. MKM is used both to select relevant knowledge to conduct the reasoning process, and ...

  11. Improving the reliability of the prognosis of radiation exposures using data assimilation

    International Nuclear Information System (INIS)

    Twenhoefel, C.J.W.; Eleveld, H.

    2003-01-01

    Full text: During large-scale nuclear accidents quantitative risk estimates usually underlie a countermeasure strategy. Because of the overwhelming social and economical impact of countermeasures not only the speed but also the reliability of the underlying calculations are of prime importance. Real-time atmospheric dispersion models are an important tool to support the decision-makers with spatial and temporal information on the dispersion forecast and the extent of the expected contamination. Due to the stochastic and chaotic nature of the atmosphere the real-time calculation of air dispersion is quite complicated. The accuracy of the calculated spatial and temporal distributions of air concentration, deposition and the corresponding radiation levels is limited due to uncertainties in the applied dispersion algorithms, limitations in knowledge and availability of atmospheric input data and knowledge of the release and the release conditions during an emergency. To improve the prognosis of the radiation exposure it is envisaged to use the on-line data of the National Radioactivity Monitoring Network. In a first step the monitored gamma radiation levels are related to the calculated external radiation levels from source term estimates based on the plant status. In the next step both the results of air dispersion model calculations and the data of the monitoring network are compared using RIVM's dispersion model validation tool [1-2]. From this a quantitative measure for the agreement between a model run and a particular measurement set can be deduced. This will be followed by a data assimilation technique based an RIVM's validation tool which provides an improved reliability of the prognosis when compared to intermediate, i.e. previous model runs. An uncertainty and sensitivity analysis of the air dispersion model must identify the relevant input parameters. In the absence of elevated levels on our monitoring network the Kincaid data set will be used to demonstrate

  12. Quality improvement in practice: improving diabetes care and patient outcomes in Aboriginal Community Controlled Health Services.

    Science.gov (United States)

    Stoneman, Alice; Atkinson, David; Davey, Maureen; Marley, Julia V

    2014-10-07

    Management of chronic disease, including diabetes, is a central focus of most Aboriginal Community Controlled Health Services (ACCHSs) in Australia. We have previously demonstrated that diabetes monitoring and outcomes can be improved and maintained over a 10-year period at Derby Aboriginal Health Service (DAHS). While continuous quality improvement (CQI) has been shown to improve service delivery rates and clinical outcome measures, the process of interpreting audit results and developing strategies for improvement is less well described. This paper describes the evaluation of care of patients with type 2 diabetes mellitus (T2DM) and features of effective CQI in ACCHSs in the remote Kimberley region of north Western Australia. Retrospective audit of records for Aboriginal and Torres Strait Islander primary care patients aged ≥15 years with a confirmed diagnosis of T2DM at four Kimberley ACCHSs from 1 July 2011 to 30 June 2012. Interviews with health service staff and focus group discussions with patients post audit. diabetes care related activities, clinical outcome measures and factors influencing good diabetes related care and effective CQI. A total of 348 patients from the four ACCHSs were included in the study. Clinical care activities were generally high across three of the four health services (at least 71% of patients had cholesterol recorded, 89% blood pressure, 84% HbA1c). Patients from DAHS had lower median cholesterol levels (4.4 mmol/L) and the highest proportion of patients meeting clinical targets for HbA1c (31% v 16% ACCHS-3; P = 0.02). Features that facilitated good care included clearly defined staff roles for diabetes management, support and involvement of Aboriginal Health Workers, efficient recall systems, and well-coordinated allied health services. Effective CQI features included seamless and timely data collection, local ownership of the process, openness to admitting deficiencies and willingness to embrace change. Well

  13. Improving Reliability of Embedded Systems through Dynamic Memory Manager Optimization using Grammatical Evolution

    OpenAIRE

    Colmenar, J. Manuel; Risco-Martin, Jose L.; Atienza Alonso, David; Garnica, Oscar; Hidalgo, Jose I.; Lanchares, Juan

    2010-01-01

    Technology scaling has offered advantages to embedded systems, such as increased performance, more available memory and reduced energy consumption. However, scaling also brings a number of problems like reliability degradation mechanisms. The intensive activity of devices and high operating temperatures are key factors for reliability degradation in latest technology nodes. Focusing on embedded systems, the memory is prone to suffer reliability problems due to the intensive use of dynamic mem...

  14. Morning versus evening induction of labour for improving outcomes.

    Science.gov (United States)

    Bakker, Jannet J H; van der Goes, Birgit Y; Pel, Maria; Mol, Ben Willem J; van der Post, Joris A M

    2013-02-28

    Induction of labour is a common intervention in obstetric practice. Traditionally, in most hospitals induction of labour with medication starts early in the morning, with the start of the working day for the day shift. In human and animal studies spontaneous onset of labour is proven to have a circadian rhythm with a preference for start of labour in the evening. Moreover, when spontaneous labour starts in the evening, the total duration of labour and delivery shortens and fewer obstetric interventions are needed. Based on these observations one might assume that starting induction of labour in the evening, in harmony with the circadian rhythm of natural birth, is more beneficial for both mother and child. To assess whether induction of labour starting in the evening, coinciding with the endogenous circadian rhythm, improves the outcome of labour compared with induction of labour starting in the early morning, organised to coincide with office hours. We contacted the Trials Search Co-ordinator to search the Cochrane Pregnancy and Childbirth Group's Trials Register (28 February 2012). In addition, we searched MEDLINE (1966 to 16 February 2012) and EMBASE (1980 to 16 February 2012). We included all published and unpublished randomised controlled trials. We excluded trials that employed quasi-random methods of treatment allocation. Two review authors independently assessed trials for inclusion and risk of bias. Two review authors independently extracted data. Data were checked for accuracy. Where necessary, we contacted study authors for additional information. The search resulted in 2693 articles that we screened on title and abstract for eligibility.Thirteen studies were selected for full text assessment. We included three randomised trials involving 1150 women. Two trials compared the administration of prostaglandins in the morning versus the evening in women with an unfavourable cervix, and one trial compared induction of labour in the morning versus the evening

  15. Embedded Sensors and Controls to Improve Component Performance and Reliability: Conceptual Design Report

    Energy Technology Data Exchange (ETDEWEB)

    Kisner, Roger A [ORNL; Melin, Alexander M [ORNL; Burress, Timothy A [ORNL; Fugate, David L [ORNL; Holcomb, David Eugene [ORNL; Wilgen, John B [ORNL; Miller, John M [ORNL; Wilson, Dane F [ORNL; Silva, Pamela C [ORNL; Whitlow, Lynsie J [ORNL; Peretz, Fred J [ORNL

    2012-10-01

    The overall project objective is to demonstrate improved reliability and increased performance made possible by deeply embedding instrumentation and controls (I&C) in nuclear power plant components. The project is employing a highly instrumented canned rotor, magnetic bearing, fluoride salt pump as its I&C technology demonstration vehicle. The project s focus is not primarily on pump design, but instead is on methods to deeply embed I&C within a pump system. However, because the I&C is intimately part of the basic millisecond-by-millisecond functioning of the pump, the I&C design cannot proceed in isolation from the other aspects of the pump. The pump will not function if the characteristics of the I&C are not embedded within the design because the I&C enables performance of the basic function rather than merely monitoring quasi-stable performance. Traditionally, I&C has been incorporated in nuclear power plant (NPP) components after their design is nearly complete; adequate performance was obtained through over-design. This report describes the progress and status of the project and provides a conceptual design overview for the embedded I&C pump.

  16. Virtualization of Legacy Instrumentation Control Computers for Improved Reliability, Operational Life, and Management.

    Science.gov (United States)

    Katz, Jonathan E

    2017-01-01

    Laboratories tend to be amenable environments for long-term reliable operation of scientific measurement equipment. Indeed, it is not uncommon to find equipment 5, 10, or even 20+ years old still being routinely used in labs. Unfortunately, the Achilles heel for many of these devices is the control/data acquisition computer. Often these computers run older operating systems (e.g., Windows XP) and, while they might only use standard network, USB or serial ports, they require proprietary software to be installed. Even if the original installation disks can be found, it is a burdensome process to reinstall and is fraught with "gotchas" that can derail the process-lost license keys, incompatible hardware, forgotten configuration settings, etc. If you have running legacy instrumentation, the computer is the ticking time bomb waiting to put a halt to your operation.In this chapter, I describe how to virtualize your currently running control computer. This virtualized computer "image" is easy to maintain, easy to back up and easy to redeploy. I have used this multiple times in my own lab to greatly improve the robustness of my legacy devices.After completing the steps in this chapter, you will have your original control computer as well as a virtual instance of that computer with all the software installed ready to control your hardware should your original computer ever be decommissioned.

  17. Improving accuracy and reliability of 186-keV measurements for unattended enrichment monitoring

    International Nuclear Information System (INIS)

    Ianakiev, Kiril D.; Boyer, Brian D.; Swinhoe, Martyn T.; Moss, Cal E.; Goda, Joetta M.; Favalli, Andrea; Lombardi, Marcie; Paffet, Mark T.; Hill, Thomas R.; MacArthur, Duncan W.; Smith, Morag K.

    2010-01-01

    Improving the quality of safeguards measurements at Gas Centrifuge Enrichment Plants (GCEPs), whilst reducing the inspection effort, is an important objective given the number of existing and new plants that need to be safeguarded. A useful tool in many safeguards approaches is the on-line monitoring of enrichment in process pipes. One aspect of this measurement is a simple, reliable and precise passive measurement of the 186-keV line from 235 U. (The other information required is the amount of gas in the pipe. This can be obtained by transmission measurements or pressure measurements). In this paper we describe our research efforts towards such a passive measurement system. The system includes redundant measurements of the 186-keV line from the gas and separately from the wall deposits. The design also includes measures to reduce the effect of the potentially important background. Such an approach would practically eliminate false alarms and can maintain the operation of the system even with a hardware malfunction in one of the channels. The work involves Monte Carlo modeling and the construction of a proof-of-principle prototype. We will carry out experimental tests with UF 6 gas in pipes with and without deposits in order to demonstrate the deposit correction.

  18. Improvements in valve reliability due to implementation of effective condition monitoring programs

    International Nuclear Information System (INIS)

    Hale, Stan

    2003-01-01

    Modern diagnostic systems for motor-operated valves, pneumatic control valves and checkvalves have facilitated a shift in the maintenance philosophy for valves and actuators in nuclear power plants from schedule based to condition-based maintenance (CBM). This shift enables plant management to focus resources and schedule priority on the plant equipment that warrants attention thereby not wasting resources or increasing the human factors risk on equipment that has not degraded. The most recent initiatives combine condition monitoring with risk/safety insights to focus attention and resonances on the right equipment at the right time consistent with each component's safety-significance. The activities of the ASME working groups responsible for nuclear O and M codes have kept pace with the technology and process improvements necessary to maximize the technical and economic benefits of condition based and risk informed maintenance. This paper discusses adoption of valve condition monitoring in the nuclear power industry, changes to ASME codes and standards during the 90's to facilitate adoption of condition monitoring technology for in-service testing and recent efforts to combine risk insights with condition monitoring strategies to achieve the highest level of valve reliability and nuclear safety without over inflating maintenance cost. (author)

  19. Ambipolarity reduction in DMG asymmetric vacuum dielectric Schottky Barrier GAA MOSFET to improve hot carrier reliability

    Science.gov (United States)

    Kumar, Manoj; Haldar, Subhasis; Gupta, Mridula; Gupta, R. S.

    2017-11-01

    An explicit surface potential and subthreshold current model for novel Dual Metal Gate (DMG) Asymmetric Vacuum (AV) as gate dielectric Schottky Barrier (SB) Cylindrical Gate All Around (CGAA) MOSFET with the incorporation of localized charges (Nf) is developed to provide excellent immunity against threshold voltage (Vth) degradation due to hot carriers. Hot carrier induced Localized Charges (LC) either positive or negative leads to degrade the threshold of the device. The major advantage of the proposed DMG-AV-SB-CGAA MOSFET is that it mitigates the ambipolar behavior thus offering very good on current to off current ratio; and also reduces the electron temperature which leads to less hot carrier generation thus lesser degradation in Vth and improved Hot Carrier reliability. The surface potential is determined for three different regions by solving 1-D Poisson's and 2-D Laplace equation through separation of variable method to facilitate an optimal model for calculating the subthreshold drain current from Si-SiO2 interface boundary. The developed model results are in good agreement with that of ATLAS-TCAD simulation.

  20. Assessment of Student Professional Outcomes for Continuous Improvement

    Science.gov (United States)

    Keshavarz, Mohsen; Baghdarnia, Mostafa

    2013-01-01

    This article describes a method for the assessment of professional student outcomes (performance-type outcomes or soft skills). The method is based upon group activities, research on modern electrical engineering topics by individual students, classroom presentations on chosen research topics, final presentations, and technical report writing.…

  1. Can pegylated interferon improve the outcome of polycythemia vera patients?

    Directory of Open Access Journals (Sweden)

    Elena Crisà

    2017-01-01

    Full Text Available Abstract Pegylated interferon (peg-IFN was proven by phase II trials to be effective in polycythemia vera (PV; however, it is not clear whether it could improve patient outcome compared to hydroxyurea (HU. Here, we present an observational study on 65 PV patients aged 65 years or younger, who received either peg-IFN (30 or HU (35 according to the physician choice. Median follow-up was 75 months. The two cohorts were comparable for patient and disease characteristics. Eighty-seven percent of the patients treated with peg-INF responded, with a CR rate of 70% as compared to 100 and 49% with HU, respectively. Discontinuation rate was similar in the two groups (20% in peg-IFN vs 17% in HU. JAK2 allele burden was monitored in peg-INF arm only, and a reduction was observed in 88% of the patients. No thrombotic events were observed during peg-IFN treatment compared to three on HU. Disease progression to myelofibrosis or acute myeloid leukemia occurred to a patient only in peg-INF, compared to three in HU. Overall, three second malignancies were observed during the study, two in patients who received HU only, and one in a patient largely treated HU who received also peg-IFN for 3 months. Overall survival was significantly better for peg-IFN patients compared to HU, p = 0.027. Our study, albeit limited by small patient and event number and lack of randomization, confirms the efficacy of peg-INF in PV and shows a significant survival advantage for peg-INF-treated patients. Waiting for confirming data from the ongoing phase III trials, our study can support peg-INF as a first-line treatment option for PV, at least for younger patients.

  2. An Integrated Care Initiative to Improve Patient Outcome in Schizophrenia.

    Science.gov (United States)

    Mayer-Amberg, Norbert; Woltmann, Rainer; Walther, Stefanie

    2015-01-01

    The optimal treatment of schizophrenia patients requires integration of medical and psychosocial inputs. In Germany, various health-care service providers and institutions are involved in the treatment process. Early and continuous treatment is important but often not possible because of the fragmented medical care system in Germany. The Integrated Care Initiative Schizophrenia has implemented a networked care concept in the German federal state of Lower Saxony that integrates various stakeholders of the health care system. In this initiative, office-based psychiatrists, specialized nursing staff, psychologists, social workers, hospitals, psychiatric institutional outpatient's departments, and other community-based mental health services work together in an interdisciplinary approach. Much emphasis is placed on psychoeducation. Additional efforts cover socio-therapy, visiting care, and family support. During the period from October 2010 (start of the initiative) to December 2012, first experiences and results of quality indicators were collected of 713 registered patients and summarized in a quality monitoring report. In addition, standardized patient interviews were conducted, and duration of hospital days was recorded in 2013. By the end of 2012, patients had been enrolled for an average of 18.7 months. The overall patient satisfaction measured in a patient survey in June 2013 was high and the duration of hospital days measured in a pre-post analysis in July 2013 was reduced by 44%. Two years earlier than planned, the insurance fund will continue the successfully implemented Integrated Care Initiative and adopt it in the regular care setting. This initiative can serve as a learning case for how to set up and measure integrated care systems that may improve outcomes for patients suffering from schizophrenia.

  3. An Integrated Care Initiative to Improve Patient Outcome in Schizophrenia

    Directory of Open Access Journals (Sweden)

    Norbert eMayer-Amberg

    2016-01-01

    Full Text Available The optimal treatment of schizophrenia patients requires integration of medical and psychosocial inputs. In Germany, various healthcare service providers and institutions are involved in the treatment process. Early and continuous treatment is important but often not possible because of the fragmented medical care system in Germany. The current work is a quality monitoring report of a novel care setting, called Integrated Care Initiative Schizophrenia. It has implemented a networked care concept in the German federal state of Lower Saxony that integrates various stakeholders of the health care system. In this initiative, office-based psychiatrists, specialised nursing staff, psychologists, social workers, hospitals, psychiatric institutional outpatient’s departments and other community-based mental health services work together in an interdisciplinary approach. Much emphasis is placed on psychoeducation. Additional efforts cover socio-therapy, visiting care, and family support. During the period from October 2010 (start of the initiative to December 2012, first experiences and results of quality indicators were collected of 713 registered patients and summarised in a quality monitoring report. In addition, standardised patient interviews were conducted, and duration of hospital days was recorded in 2013. By the end of 2012, patients had been enrolled for an average of 18.7 months. The overall patient satisfaction measured in a patient survey in June 2013 was high and the duration of hospital days measured in a pre-post analysis in July 2013 was reduced by 44%. Two years earlier than planned, the insurance fund will continue the successfully implemented integrated care initiative and adopt it in the regular care setting. This initiative can serve as a learning case for how to set up and measure integrated care systems that may improve outcomes for patients suffering from schizophrenia.

  4. Improving vascular access outcomes: attributes of arteriovenous fistula cannulation success

    Science.gov (United States)

    Harwood, Lori E.; Wilson, Barbara M.; Oudshoorn, Abe

    2016-01-01

    Background Arteriovenous fistulas (AVFs) are the preferred access for hemodialysis (HD) yet they are underutilized. Cannulation of the fistula is a procedure requiring significant skill development and refinement and if not done well can have negative consequences for patients. The nurses' approach, attitude and skill with cannulation impacts greatly on the patient experience. Complications from miscannulation or an inability to needle fistulas can result in the increased use of central venous catheters. Some nurses remain in a state of a ‘perpetual novice’ resulting in a viscous cycle of negative patient consequences (bruising, pain), further influencing patients' decisions not to pursue a fistula or abandon cannulation. Method This qualitative study used organizational development theory (appreciative inquiry) and research method to determine what attributes/activities contribute to successful cannulation. This can be applied to interventions to promote change and skill development in staff members who have not advanced their proficiency. Eighteen HD nurses who self-identified with performing successful cannulation participated in audio-recorded interviews. The recordings were transcribed verbatim. The data were analyzed using content analysis. Results Four common themes, including patient-centered care, teamwork, opportunity and skill and nurse self-awareness, represented successful fistula cannulation. Successful cannulation is more than a learned technique to correctly insert a needle, but rather represents contextual influences and interplay between the practice environment and personal attributes. Conclusions Practice changes based on these results may improve cannulation, decrease complications and result in better outcomes for patients. Efforts to nurture positive patient experiences around cannulation may influence patient decision-making regarding fistula use. PMID:26985384

  5. Improving health outcomes with better patient understanding and education

    Directory of Open Access Journals (Sweden)

    Robert John Adams

    2010-10-01

    Full Text Available Robert John AdamsThe Health Observatory, The Queen Elizabeth Hospital Campus, The University of Adelaide, Woodville, South Australia, AustraliaAbstract: A central plank of health care reform is an expanded role for educated consumers interacting with responsive health care teams. However, for individuals to realize the benefits of health education also requires a high level of engagement. Population studies have documented a gap between expectations and the actual performance of behaviours related to participation in health care and prevention. Interventions to improve self-care have shown improvements in self-efficacy, patient satisfaction, coping skills, and perceptions of social support. Significant clinical benefits have been seen from trials of self-management or lifestyle interventions across conditions such as diabetes, coronary heart disease, heart failure and rheumatoid arthritis. However, the focus of many studies has been on short-term outcomes rather that long term effects. There is also some evidence that participation in patient education programs is not spread evenly across socio economic groups. This review considers three other issues that may be important in increasing the public health impact of patient education. The first is health literacy, which is the capacity to seek, understand and act on health information. Although health literacy involves an individual’s competencies, the health system has a primary responsibility in setting the parameters of the health interaction and the style, content and mode of information. Secondly, much patient education work has focused on factors such as attitudes and beliefs. That small changes in physical environments can have large effects on behavior and can be utilized in self-management and chronic disease research. Choice architecture involves reconfiguring the context or physical environment in a way that makes it more likely that people will choose certain behaviours. Thirdly

  6. Improving Outcomes in the Nigeria Healthcare Sector through Public ...

    African Journals Online (AJOL)

    Nigeria's healthcare sector over the years has continued to degenerate with health indicators ... in service delivery as well as increases access to quality healthcare. ... Key words: Nigeria, Healthcare Sector, Health Outcomes, Health Indicators, ...

  7. Improving motor reliability in nuclear power plants: Volume 1, Performance evaluation and maintenance practices

    International Nuclear Information System (INIS)

    Subudhi, M.; Gunther, W.E.; Taylor, J.H.; Sugarman, A.C.; Sheets, M.W.

    1987-11-01

    This report constitutes the first of the three volumes under this NUREG. The report presents recommendations for developing a cost-effective program for performance evaluation and maintenance of electric motors in nuclear power plants. These recommendations are based on current industry practices, available techniques for monitoring degradation in motor components, manufacturer's recommendations, operating experience, and results from two laboratory tests on aged motors. Two laboratory test reports on a small and a large motor are presented in separate volumes of this NUREG. These provide the basis for the various functional indicators recommended for maintenance programs in this report. The overall preventive maintenance program is separated into two broad areas of activity aimed at mitigating the potential effects of equipment aging: Performance Evaluation and Equipment Maintenance. The latter involves actually maintaining the condition of the equipment while the former involves those activities undertaken to monitor degradation due to aging. These monitoring methods are further categorized into periodic testing, surveillance testing, continuous monitoring and inspections. This study focuses on the methods and procedures for performing the above activities to maintain the motors operationally ready in a nuclear facility. This includes an assessment of various functional indicators to determine their suitability for trending to monitor motor component condition. The intrusiveness of test methods and the present state-of-the-art for using the test equipment in a plant environment are discussed. In conclusion, implementation of the information provided in this report, will improve motor reliability in nuclear power plants. The study indicates the kinds of tests to conduct, how and when to conduct them, and to which motors the tests should be applied. 44 refs., 12 figs., 13 tabs

  8. Journey Toward High Reliability: A Comprehensive Safety Program to Improve Quality of Care and Safety Culture in a Large, Multisite Radiation Oncology Department.

    Science.gov (United States)

    Woodhouse, Kristina Demas; Volz, Edna; Maity, Amit; Gabriel, Peter E; Solberg, Timothy D; Bergendahl, Howard W; Hahn, Stephen M

    2016-05-01

    High-reliability organizations (HROs) focus on continuous identification and improvement of safety issues. We sought to advance a large, multisite radiation oncology department toward high reliability through the implementation of a comprehensive safety culture (SC) program at the University of Pennsylvania Department of Radiation Oncology. In 2011, with guidance from safety literature and experts in HROs, we designed an SC framework to reduce radiation errors. All state-reported medical events (SRMEs) from 2009 to 2016 were retrospectively reviewed and plotted on a control chart. Changes in SC grade were assessed using the Agency for Healthcare Research and Quality Hospital Survey. Outcomes measured included the number of radiation treatment fractions and days between SRMEs, as well as SC grade. Multifaceted safety initiatives were implemented at our main academic center and across all network sites. Postintervention results demonstrate increased staff fundamental safety knowledge, enhanced peer review with an electronic system, and special cause variation of SRMEs on control chart analysis. From 2009 to 2016, the number of days and fractions between SRMEs significantly increased, from a mean of 174 to 541 days (P safety framework. Our multifaceted initiatives, focusing on culture and system changes, can be successfully implemented in a large academic radiation oncology department to yield measurable improvements in SC and outcomes. Copyright © 2016 by American Society of Clinical Oncology.

  9. Improving energy audit process and report outcomes through planning initiatives

    Science.gov (United States)

    Sprau Coulter, Tabitha L.

    Energy audits and energy models are an important aspect of the retrofit design process, as they provide project teams with an opportunity to evaluate a facilities current building systems' and energy performance. The information collected during an energy audit is typically used to develop an energy model and an energy audit report that are both used to assist in making decisions about the design and implementation of energy conservation measures in a facility. The current lack of energy auditing standards results in a high degree of variability in energy audit outcomes depending on the individual performing the audit. The research presented is based on the conviction that performing an energy audit and producing a value adding energy model for retrofit buildings can benefit from a revised approach. The research was divided into four phases, with the initial three phases consisting of: 1.) process mapping activity - aimed at reducing variability in the energy auditing and energy modeling process. 2.) survey analysis -- To examine the misalignment between how industry members use the top energy modeling tools compared to their intended use as defined by software representatives. 3.) sensitivity analysis -- analysis of the affect key energy modeling inputs are having on energy modeling analysis results. The initial three phases helped define the need for an improved energy audit approach that better aligns data collection with facility owners' needs and priorities. The initial three phases also assisted in the development of a multi-criteria decision support tool that incorporates a House of Quality approach to guide a pre-audit planning activity. For the fourth and final research phase explored the impacts and evaluation methods of a pre-audit planning activity using two comparative energy audits as case studies. In each case, an energy audit professionals was asked to complete an audit using their traditional methods along with an audit which involved them first

  10. Reliability-Based Design Optimization of Trusses with Linked-Discrete Design Variables using the Improved Firefly Algorithm

    Directory of Open Access Journals (Sweden)

    N. M. Okasha

    2016-04-01

    Full Text Available In this paper, an approach for conducting a Reliability-Based Design Optimization (RBDO of truss structures with linked-discrete design variables is proposed. The sections of the truss members are selected from the AISC standard tables and thus the design variables that represent the properties of each section are linked. Latin hypercube sampling is used in the evaluation of the structural reliability. The improved firefly algorithm is used for the optimization solution process. It was found that in order to use the improved firefly algorithm for efficiently solving problems of reliability-based design optimization with linked-discrete design variables; it needs to be modified as proposed in this paper to accelerate its convergence.

  11. Demonstrating the reliability of transdiagnostic mHealth Routine Outcome Monitoring in mental health services using experience sampling technology.

    Directory of Open Access Journals (Sweden)

    Simone J W Verhagen

    Full Text Available Routine Outcome Monitoring (ROM should provide a dynamic, within-treatment forward feedback loop to guide individual treatment decisions across diagnostic categories. It has been suggested that the Experience Sampling Method (ESM, capturing the film of daily life adaptive processes, offers a flexible, personalised and transdiagnostic feedback system for monitoring and adapting treatment strategies. This is the first study that uses an ESM application (the PsyMate™ as a routine mobile-ROM (mROM tool in an ambulatory mental health setting.To demonstrate adequate psychometric properties of the PsyMate™ app assessing both symptom severity levels as well as daily life functioning.In a transdiagnostic sample of 64 outpatients, an mROM protocol (ESM for 6 days, at 10 semi-random moments a day and a standard ROM instrument (HADS were administered at baseline and at three-month follow-up. We measured positive affect (PA, negative affect (NA, quality of sleep, positive social interaction, activity-related stress, tiredness, and feeling unwell.Subjects completed 53% of the measurements at baseline (N = 64 and 48% at follow-up (N = 29. Factor analysis and subsequent reliability analysis of PA and NA confirmed the two constructs. Significant and meaningful correlations were found between PA, NA and HADS scores (ranging from r = .4 to r = .7. Multilevel analyses yielded significant change scores for all measures.The ESM-based, transdiagnostic mROM tool can be used reliably in clinical settings: it shows adequate psychometric properties, as well as concurrent validity and sensitivity to change over time with respect to relevant ROM constructs. Person-tailored items can be added. In addition, mROM offers added value over standard symptom-based ROM, as it provides information on adaptive functioning in the daily environment of patients.

  12. Improving electrical power systems reliability through locally controlled distributed curtailable load

    Science.gov (United States)

    Dehbozorgi, Mohammad Reza

    2000-10-01

    Improvements in power system reliability have always been of interest to both power companies and customers. Since there are no sizable electrical energy storage elements in electrical power systems, the generated power should match the load demand at any given time. Failure to meet this balance may cause severe system problems, including loss of generation and system blackouts. This thesis proposes a methodology which can respond to either loss of generation or loss of load. It is based on switching of electric water heaters using power system frequency as the controlling signal. The proposed methodology encounters, and the thesis has addressed, the following associated problems. The controller must be interfaced with the existing thermostat control. When necessary to switch on loads, the water in the tank should not be overheated. Rapid switching of blocks of load, or chattering, has been considered. The contributions of the thesis are: (A) A system has been proposed which makes a significant portion of the distributed loads connected to a power system to behave in a predetermined manner to improve the power system response during disturbances. (B) The action of the proposed system is transparent to the customers. (C) The thesis proposes a simple analysis for determining the amount of such loads which might be switched and relates this amount to the size of the disturbances which can occur in the utility. (D) The proposed system acts without any formal communication links, solely using the embedded information present system-wide. (E) The methodology of the thesis proposes switching of water heater loads based on a simple, localized frequency set-point controller. The thesis has identified the consequent problem of rapid switching of distributed loads, which is referred to as chattering. (F) Two approaches have been proposed to reduce chattering to tolerable levels. (G) A frequency controller has been designed and built according to the specifications required to

  13. Follow-up of CT-derived airway wall thickness : Correcting for changes in inspiration level improves reliability

    NARCIS (Netherlands)

    Pompe, Esther; van Rikxoort, Eva M; Mets, Onno M; Charbonnier, Jean-Paul; Kuhnigk, Jan-Martin; de Koning, Harry J; Oudkerk, Matthijs; Vliegenthart, Rozemarijn; Zanen, Pieter; Lammers, Jan-Willem J; van Ginneken, Bram; de Jong, Pim A; Mohamed Hoesein, Firdaus A A

    2016-01-01

    OBJECTIVES: Airway wall thickness (AWT) is affected by changes in lung volume. This study evaluated whether correcting AWT on computed tomography (CT) for differences in inspiration level improves measurement agreement, reliability, and power to detect changes over time. METHODS: Participants of the

  14. Follow-up of CT-derived airway wall thickness : Correcting for changes in inspiration level improves reliability

    NARCIS (Netherlands)

    Pompe, Esther; van Rikxoort, Eva M.; Mets, Onno M.; Charbonnier, Jean-Paul; Kuhnigk, Jan-Martin; de Koning, Harry J.; Oudkerk, Matthijs; Vliegenthart, Rozemarijn; Zanen, Pieter; Lammers, Jan-Willem J.; van Ginneken, Bram; de Jong, Pim A.; Hoesein, Firdaus A. A. Mohamed

    2016-01-01

    Objectives: Airway wall thickness (AWT) is affected by changes in lung volume. This study evaluated whether correcting AWT on computed tomography (CT) for differences in inspiration level improves measurement agreement, reliability, and power to detect changes over time. Methods: Participants of the

  15. Improvement in reliability and accuracy of heater tube eddy current testing by integration with an appropriate destructive test

    International Nuclear Information System (INIS)

    Giovanelli, F.; Gabiccini, S.; Tarli, R.; Motta, P.

    1988-01-01

    A specially developed destructive test is described showing how the reliability and accuracy of a non-destructive technique can be improved if it is suitably accompanied by an appropriate destructive test. The experiment was carried out on samples of AISI 304L tubes from the low-pressure (LP) preheaters of a BWR 900 MW nuclear plant. (author)

  16. Typhoid outbreak in Songkhla, Thailand 2009-2011: clinical outcomes, susceptibility patterns, and reliability of serology tests.

    Directory of Open Access Journals (Sweden)

    Wannee Limpitikul

    Full Text Available OBJECTIVE: To determine the clinical manifestations and outcomes, the reliability of Salmonella enterica serotype Typhi (S ser. Typhi IgM and IgG rapid tests, and the susceptibility patterns and the response to treatment during the 2009-2011 typhoid outbreak in Songkhla province in Thailand. METHOD: The medical records of children aged <15 years with S ser. Typhi bacteremia were analysed. The efficacy of the typhoid IgM and IgG rapid tests and susceptibility of the S ser. Typhi to the current main antibiotics used for typhoid (amoxicillin, ampicillin, cefotaxime, ceftriaxone, co-trimoxazole, and ciprofloxacin, were evaluated. RESULTS: S ser. Typhi bacteremia was found in 368 patients, and all isolated strains were susceptible to all 6 antimicrobials tested. Most of the patients were treated with ciprofloxacin for 7-14 days. The median time (IQR of fever before treatment and duration of fever after treatment were 5 (4, 7 days and 4 (3, 5 days, respectively. Complications of ascites, lower respiratory symptoms, anemia (Hct <30%, and ileal perforation were found in 7, 7, 22, and 1 patients, respectively. None of the patients had recurrent infection or died. The sensitivities of the typhoid IgM and IgG tests were 58.3% and 25.6% respectively, and specificities were 74.1% and 50.5%, respectively. CONCLUSION: Most of the patients were diagnosed at an early stage and treated with a good outcome. All S ser. Typhi strains were susceptible to standard first line antibiotic typhoid treatment. The typhoid IgM and IgG rapid tests had low sensitivity and moderate specificity.

  17. Role of Leadership in Narrowing the Gap between Science and Practice: Improving Treatment Outcomes at the Systems Level.

    Science.gov (United States)

    Saeed, Sy Atezaz; Bloch, Richard M; Silver, Stuart

    2015-09-01

    It's been well documented that health care does not reliably transfer what we know from science into clinical practice. As a result, Americans do not always receive the care suggested by the scientific evidence. Despite the best intentions of a dedicated and skilled healthcare workforce, this can often lead to poor clinical outcomes. As research and technology rapidly advance, this gap between science and practice appears to be widening. There is an increasing public concern about a lack of access to appropriate treatment, pervasiveness of unsafe practices, and wasteful uses of precious health care resources leading to suboptimum treatment outcomes. Leadership has a critical role in creating and sustaining the environment that supports health services for individuals and populations that increase the likelihood of desired health outcomes and are consistent with current professional knowledge. Leadership has some responsibility to improve outcomes by insuring effective use of evidence-based treatment guidelines; measurement-based care; knowledge and skills management; care coordination; and information technologies. This paper addresses leadership issues in these components of a system's ability to improve treatment outcomes.

  18. High-Leverage Leadership: Improving Outcomes in Educational Settings

    Science.gov (United States)

    Mongon, Denis; Chapman, Christopher

    2011-01-01

    Globalisation of world trade, international media, technological innovation and social change are creating opportunities and challenges that today's pupils will inherit and build on. A pupil's academic, technical and social capacity will define their success or failure. Therefore, educational outcomes and well-being for young people across…

  19. Implementation of a clinical pathway may improve alcohol treatment outcome

    DEFF Research Database (Denmark)

    Nielsen, Anette Søgaard; Nielsen, Bent

    2015-01-01

    This article describes the design, implementation, and evaluation of a clinical pathway system in a two-cohort quasi-experimental study before and after implementation, controlling for confounders. The main outcome measures were retention in care and sensible alcohol use (defined as abstinent...

  20. Inside Quality Reform: Early Results on Using Outcomes for Improvement

    Science.gov (United States)

    El-Khawas, Elaine

    2014-01-01

    This article offers evidence on ways in which assessment of student learning outcomes made a difference for some academic institutions in the United States. It offers perspectives on the internal changes that took place, especially within academic programmes. Even after the capacity for assessment was developed, challenges remained in evaluating…

  1. Caregiver-mediated exercises for improving outcomes after stroke

    NARCIS (Netherlands)

    Vloothuis, Judith D.M.; Mulder, Marijn; Veerbeek, Janne M.; Konijnenbelt, Manin; Visser-Meily, Johanna M.A.; Ket, Johannes C.F.; Kwakkel, Gert; van Wegen, Erwin E.H.

    2016-01-01

    Background: Stroke is a major cause of long-term disability in adults. Several systematic reviews have shown that a higher intensity of training can lead to better functional outcomes after stroke. Currently, the resources in inpatient settings are not always sufficient and innovative methods are

  2. Improving treatment outcome assessment in a mouse tuberculosis model.

    Science.gov (United States)

    Mourik, Bas C; Svensson, Robin J; de Knegt, Gerjo J; Bax, Hannelore I; Verbon, Annelies; Simonsson, Ulrika S H; de Steenwinkel, Jurriaan E M

    2018-04-09

    Preclinical treatment outcome evaluation of tuberculosis (TB) occurs primarily in mice. Current designs compare relapse rates of different regimens at selected time points, but lack information about the correlation between treatment length and treatment outcome, which is required to efficiently estimate a regimens' treatment-shortening potential. Therefore we developed a new approach. BALB/c mice were infected with a Mycobacterium tuberculosis Beijing genotype strain and were treated with rifapentine-pyrazinamide-isoniazid-ethambutol (R p ZHE), rifampicin-pyrazinamide-moxifloxacin-ethambutol (RZME) or rifampicin-pyrazinamide-moxifloxacin-isoniazid (RZMH). Treatment outcome was assessed in n = 3 mice after 9 different treatment lengths between 2-6 months. Next, we created a mathematical model that best fitted the observational data and used this for inter-regimen comparison. The observed data were best described by a sigmoidal E max model in favor over linear or conventional E max models. Estimating regimen-specific parameters showed significantly higher curative potentials for RZME and R p ZHE compared to RZMH. In conclusion, we provide a new design for treatment outcome evaluation in a mouse TB model, which (i) provides accurate tools for assessment of the relationship between treatment length and predicted cure, (ii) allows for efficient comparison between regimens and (iii) adheres to the reduction and refinement principles of laboratory animal use.

  3. Semen molecular and cellular features: these parameters can reliably predict subsequent ART outcome in a goat model

    Directory of Open Access Journals (Sweden)

    Mereu Paolo

    2009-11-01

    Full Text Available Abstract Currently, the assessment of sperm function in a raw or processed semen sample is not able to reliably predict sperm ability to withstand freezing and thawing procedures and in vivo fertility and/or assisted reproductive biotechnologies (ART outcome. The aim of the present study was to investigate which parameters among a battery of analyses could predict subsequent spermatozoa in vitro fertilization ability and hence blastocyst output in a goat model. Ejaculates were obtained by artificial vagina from 3 adult goats (Capra hircus aged 2 years (A, B and C. In order to assess the predictive value of viability, computer assisted sperm analyzer (CASA motility parameters and ATP intracellular concentration before and after thawing and of DNA integrity after thawing on subsequent embryo output after an in vitro fertility test, a logistic regression analysis was used. Individual differences in semen parameters were evident for semen viability after thawing and DNA integrity. Results of IVF test showed that spermatozoa collected from A and B lead to higher cleavage rates (0

  4. Improve Outcomes Study subjects Chemistry Teaching and Learning Strategies through independent study with the help of computer-based media

    Science.gov (United States)

    Sugiharti, Gulmah

    2018-03-01

    This study aims to see the improvement of student learning outcomes by independent learning using computer-based learning media in the course of STBM (Teaching and Learning Strategy) Chemistry. Population in this research all student of class of 2014 which take subject STBM Chemistry as many as 4 class. While the sample is taken by purposive as many as 2 classes, each 32 students, as control class and expriment class. The instrument used is the test of learning outcomes in the form of multiple choice with the number of questions as many as 20 questions that have been declared valid, and reliable. Data analysis techniques used one-sided t test and improved learning outcomes using a normalized gain test. Based on the learning result data, the average of normalized gain values for the experimental class is 0,530 and for the control class is 0,224. The result of the experimental student learning result is 53% and the control class is 22,4%. Hypothesis testing results obtained t count> ttable is 9.02> 1.6723 at the level of significance α = 0.05 and db = 58. This means that the acceptance of Ha is the use of computer-based learning media (CAI Computer) can improve student learning outcomes in the course Learning Teaching Strategy (STBM) Chemistry academic year 2017/2018.

  5. A Meta-Analysis of Educational Data Mining on Improvements in Learning Outcomes

    Science.gov (United States)

    AlShammari, Iqbal A.; Aldhafiri, Mohammed D.; Al-Shammari, Zaid

    2013-01-01

    A meta-synthesis study was conducted of 60 research studies on educational data mining (EDM) and their impacts on and outcomes for improving learning outcomes. After an overview, an examination of these outcomes is provided (Romero, Ventura, Espejo, & Hervas, 2008; Romero, "et al.", 2011). Then, a review of other EDM-related research…

  6. Using Cross-Cultural Dimensions Exercises to Improve and Measure Learning Outcomes in International Business Courses

    Science.gov (United States)

    Zainuba, Mohamed; Rahal, Ahmad

    2012-01-01

    This article proposes an approach for using cross-cultural dimensions exercises to improve and measure learning outcomes in international business courses. The following key issues are highlighted: (a) what are the targeted learning outcomes to be assessed, (b) how to measure the accomplishment of these learning outcomes, (c) the input measures…

  7. Material Selection for Cable Gland to Improved Reliability of the High-hazard Industries

    Science.gov (United States)

    Vashchuk, S. P.; Slobodyan, S. M.; Deeva, V. S.; Vashchuk, D. S.

    2018-01-01

    The sealed cable glands (SCG) are available to ensure safest connection sheathed single wire for the hazard production facility (nuclear power plant and others) the same as pilot cable, control cables, radio-frequency cables et al. In this paper, we investigate the specifics of the material selection of SCG with the express aim of hazardous man-made facility. We discuss the safe working conditions for cable glands. The research indicates the sintering powdered metals cables provide the reliability growth due to their properties. A number of studies have demonstrated the verification of material selection. On the face of it, we make findings indicating that double glazed sealed units could enhance reliability. We had evaluated sample reliability under fire conditions, seismic load, and pressure containment failure. We used the samples mineral insulated thermocouple cable.

  8. Automation of CT-based haemorrhagic stroke assessment for improved clinical outcomes: study protocol and design.

    Science.gov (United States)

    Chinda, Betty; Medvedev, George; Siu, William; Ester, Martin; Arab, Ali; Gu, Tao; Moreno, Sylvain; D'Arcy, Ryan C N; Song, Xiaowei

    2018-04-19

    Haemorrhagic stroke is of significant healthcare concern due to its association with high mortality and lasting impact on the survivors' quality of life. Treatment decisions and clinical outcomes depend strongly on the size, spread and location of the haematoma. Non-contrast CT (NCCT) is the primary neuroimaging modality for haematoma assessment in haemorrhagic stroke diagnosis. Current procedures do not allow convenient NCCT-based haemorrhage volume calculation in clinical settings, while research-based approaches are yet to be tested for clinical utility; there is a demonstrated need for developing effective solutions. The project under review investigates the development of an automatic NCCT-based haematoma computation tool in support of accurate quantification of haematoma volumes. Several existing research methods for haematoma volume estimation are studied. Selected methods are tested using NCCT images of patients diagnosed with acute haemorrhagic stroke. For inter-rater and intrarater reliability evaluation, different raters will analyse haemorrhage volumes independently. The efficiency with respect to time of haematoma volume assessments will be examined to compare with the results from routine clinical evaluations and planimetry assessment that are known to be more accurate. The project will target the development of an enhanced solution by adapting existing methods and integrating machine learning algorithms. NCCT-based information of brain haemorrhage (eg, size, volume, location) and other relevant information (eg, age, sex, risk factor, comorbidities) will be used in relation to clinical outcomes with future project development. Validity and reliability of the solution will be examined for potential clinical utility. The project including procedures for deidentification of NCCT data has been ethically approved. The study involves secondary use of existing data and does not require new consent of participation. The team consists of clinical neuroimaging

  9. A rule induction approach to improve Monte Carlo system reliability assessment

    International Nuclear Information System (INIS)

    Rocco S, Claudio M.

    2003-01-01

    A Decision Tree (DT) approach to build empirical models for use in Monte Carlo reliability evaluation is presented. The main idea is to develop an estimation algorithm, by training a model on a restricted data set, and replacing the Evaluation Function (EF) by a simpler calculation, which provides reasonably accurate model outputs. The proposed approach is illustrated with two systems of different size, represented by their equivalent networks. The robustness of the DT approach as an approximated method to replace the EF is also analysed. Excellent system reliability results are obtained by training a DT with a small amount of information

  10. Improved outcome after relapse in children with acute myeloid leukaemia

    DEFF Research Database (Denmark)

    Abrahamsson, Jonas; Clausen, Niels; Gustafsson, Göran

    2007-01-01

    investigated. The study included all 146 children in the Nordic countries diagnosed with AML between 1988 and 2003, who relapsed. Data on disease characteristics and relapse treatment were related to outcome. Sixty-six percentage achieved remission with survival after relapse (5 years) 34 +/- 4%. Of 122......In the Nordic Society for Paediatric Haematology and Oncology paediatric study acute myeloid leukaemia (AML) 93, event-free survival was 50% and overall survival was 66%, indicating that many patients were cured following relapse. Factors influencing outcome in children with relapsed AML were...... patients who received re-induction therapy, 77% entered remission with 40 +/- 5% survival. Remission rates were similar for different re-induction regimens but fludarabine, cytarabine, granulocyte colony-stimulating factor-based therapy had low treatment-related mortality. Prognostic factors for survival...

  11. Scoring haemophilic arthropathy on X-rays: improving inter- and intra-observer reliability and agreement using a consensus atlas

    Energy Technology Data Exchange (ETDEWEB)

    Foppen, Wouter; Schaaf, Irene C. van der; Beek, Frederik J.A. [University Medical Center Utrecht, Department of Radiology (Netherlands); Verkooijen, Helena M. [University Medical Center Utrecht, Department of Radiology (Netherlands); University Medical Center Utrecht, Julius Center for Health Sciences and Primary Care, Utrecht (Netherlands); Fischer, Kathelijn [University Medical Center Utrecht, Julius Center for Health Sciences and Primary Care, Utrecht (Netherlands); University Medical Center Utrecht, Van Creveldkliniek, Department of Hematology, Utrecht (Netherlands)

    2016-06-15

    The radiological Pettersson score (PS) is widely applied for classification of arthropathy to evaluate costly haemophilia treatment. This study aims to assess and improve inter- and intra-observer reliability and agreement of the PS. Two series of X-rays (bilateral elbows, knees, and ankles) of 10 haemophilia patients (120 joints) with haemophilic arthropathy were scored by three observers according to the PS (maximum score 13/joint). Subsequently, (dis-)agreement in scoring was discussed until consensus. Example images were collected in an atlas. Thereafter, second series of 120 joints were scored using the atlas. One observer rescored the second series after three months. Reliability was assessed by intraclass correlation coefficients (ICC), agreement by limits of agreement (LoA). Median Pettersson score at joint level (PS{sub joint}) of affected joints was 6 (interquartile range 3-9). Using the consensus atlas, inter-observer reliability of the PS{sub joint} improved significantly from 0.94 (95 % confidence interval (CI) 0.91-0.96) to 0.97 (CI 0.96-0.98). LoA improved from ±1.7 to ±1.1 for the PS{sub joint}. Therefore, true differences in arthropathy were differences in the PS{sub joint} of >2 points. Intra-observer reliability of the PS{sub joint} was 0.98 (CI 0.97-0.98), intra-observer LoA were ±0.9 points. Reliability and agreement of the PS improved by using a consensus atlas. (orig.)

  12. Editorial: Improving cataract outcomes through good postoperative care

    Directory of Open Access Journals (Sweden)

    Nick Astbury

    2016-10-01

    Full Text Available Cataract surgery is one of the most successful and frequently performed operations worldwide, and yet cataract remains the commonest cause of global blindness. This is in part due to the shortage and uneven distribution of trained personnel in some countries. More worryingly, a high rate of cataract blindness also reflects poor visual outcomes after surgery, as has been documented in many RAAB (rapid assessment of avoidable blindness studies.

  13. Timely bystander CPR improves outcomes despite longer EMS times.

    Science.gov (United States)

    Park, Gwan Jin; Song, Kyoung Jun; Shin, Sang Do; Lee, Kyung Won; Ahn, Ki Ok; Lee, Eui Jung; Hong, Ki Jeong; Ro, Young Sun

    2017-08-01

    This study aimed to determine the impact of bystander CPR on clinical outcomes in patients with increasing response time from collapse to EMS response. A population-based observational study was conducted in patients with witnessed out-of-hospital cardiac arrest (OHCA) of presumed cardiac etiology from 2012 to 2014. The time interval from collapse to CPR by EMS providers was categorized into quartile groups: fastest group (bystander CPR and the time interval from collapse to CPR by EMS providers. A total of 15,354 OHCAs were analyzed. Bystander CPR was performed in 8591 (56.0%). Survival to hospital discharge occurred in 1632 (10.6%) and favorable neurological outcome in 996 (6.5%). In an interaction model of bystander CPR, compared to the fastest group, adjusted odds ratios (AORs) (95% CIs) for survival to discharge were 0.89 (0.66-1.20) in the fast group, 0.76 (0.57-1.02) in the late group, and 0.52 (0.37-0.73) in the latest group. For favorable neurological outcome, AORs were 1.12 (0.77-1.62) in the fast group, 0.90 (0.62-1.30) in the late group, 0.59 (0.38-0.91) in the latest group. The survival from OHCA decreases as the ambulance response time increases. The increase in mortality and worsening neurologic outcomes appear to be mitigated in those patients who receive bystander CPR. Copyright © 2017 Elsevier Inc. All rights reserved.

  14. Obstetrical APS : Is there a place for hydroxychloroquine to improve the pregnancy outcome?

    NARCIS (Netherlands)

    Mekinian, Arsene; Costedoat-Chalumeau, Nathalie; Masseau, Agathe; Tincani, Angela; De Caroli, Sara; Alijotas-Reig, Jaume; Ruffatti, Amelia; Ambrozic, Ales; Botta, Angela; Le Guern, Véronique; Fritsch-Stork, Ruth; Nicaise-Roland, Pascale; Carbonne, Bruno; Carbillon, Lionel; Fain, Olivier

    2015-01-01

    The use of the conventional APS treatment (the combination of low-dose aspirin and LMWH) dramatically improved the obstetrical prognosis in primary obstetrical APS (OAPS). The persistence of adverse pregnancy outcome raises the need to find other drugs to improve obstetrical outcome.

  15. Item Analysis to Improve Reliability for an Internal Medicine Undergraduate OSCE

    Science.gov (United States)

    Auewarakul, Chirayu; Downing, Steven M.; Praditsuwan, Rungnirand; Jaturatamrong, Uapong

    2005-01-01

    Utilization of objective structured clinical examinations (OSCEs) for final assessment of medical students in Internal Medicine requires a representative sample of OSCE stations. The reliability and generalizability of OSCE scores provides validity evidence for OSCE scores and supports its contribution to the final clinical grade of medical…

  16. Inducement of Design Parameters for Reliability Improvement of Servo Actuator for Hydraulic Valve Operation

    Energy Technology Data Exchange (ETDEWEB)

    Sung, Baek Ju; Kim, Do Sik [Korea Institute of Machinery and Materials, Daejeon (Korea, Republic of)

    2014-05-15

    The precision hydraulic valve is widely used in various industrial field like aircraft, automobile, and general machinery. Servo actuator is the most important device for driving the precise hydraulic valve. The reliable operation of servo actuator effects on the overall hydraulic system. The performance of servo actuator relies on frequency response and step response according to arbitrary input signal. In this paper, we performed the analysis for the components of servo actuator to satisfy the reliable operation and response characteristics through the reliability analysis, and also induced the design parameters to realize the reliable operation and fast response characteristics of servo actuator for hydraulic valve operation through the empirical knowledge of experts and electromagnetic theories. We suggested the design equations to determine the values of design parameters of servo actuator as like bobbin size, length of yoke and plunger and turn number of coil, and verified the achieved design values through FEM analysis and performance tests using some prototypes of servo actuators adapted in hydraulic valve.

  17. Indirect thermal control for improved reliability of Modular Multilevel Converter by utilizing circulating current

    DEFF Research Database (Denmark)

    Dowlatabadi, Mohammadkazem Bakhshizadeh; Ma, Ke; Loh, Poh Chiang

    2015-01-01

    semiconductor devices are comprehensively investigated. Also a novel control strategy by utilizing the circulating current is proposed to enhance the reliability performance of MMC in order to limit the amplitude of thermal cycles. It is concluded that the circulating current may change the losses and thermal...

  18. Improving Phrap-based assembly of the rat using "reliable" overlaps.

    Directory of Open Access Journals (Sweden)

    Michael Roberts

    2008-03-01

    Full Text Available The assembly methods used for whole-genome shotgun (WGS data have a major impact on the quality of resulting draft genomes. We present a novel algorithm to generate a set of "reliable" overlaps based on identifying repeat k-mers. To demonstrate the benefits of using reliable overlaps, we have created a version of the Phrap assembly program that uses only overlaps from a specific list. We call this version PhrapUMD. Integrating PhrapUMD and our "reliable-overlap" algorithm with the Baylor College of Medicine assembler, Atlas, we assemble the BACs from the Rattus norvegicus genome project. Starting with the same data as the Nov. 2002 Atlas assembly, we compare our results and the Atlas assembly to the 4.3 Mb of rat sequence in the 21 BACs that have been finished. Our version of the draft assembly of the 21 BACs increases the coverage of finished sequence from 93.4% to 96.3%, while simultaneously reducing the base error rate from 4.5 to 1.1 errors per 10,000 bases. There are a number of ways of assessing the relative merits of assemblies when the finished sequence is available. If one views the overall quality of an assembly as proportional to the inverse of the product of the error rate and sequence missed, then the assembly presented here is seven times better. The UMD Overlapper with options for reliable overlaps is available from the authors at http://www.genome.umd.edu. We also provide the changes to the Phrap source code enabling it to use only the reliable overlaps.

  19. Improving Outcomes in the Nigeria Healthcare Sector through Public ...

    African Journals Online (AJOL)

    PPP) model in the Country's healthcare sector. Public - Private Interaction offers opportunity of leveraging private sector investment in the sector and further enhances improvements in service delivery as well as increases access to quality ...

  20. Pregnancy after bariatric surgery: improving outcomes for mother and child

    Directory of Open Access Journals (Sweden)

    González I

    2016-12-01

    Full Text Available Irene González,1 Albert Lecube,2 Miguel Ángel Rubio,3 Pedro Pablo García-Luna4 1Endocrinology and Nutrition Department, Complejo Hospitalario Universitario de Huelva, Huelva, Spain; 2Endocrinology and Nutrition Department, Arnau de Vilanova University Hospital, Lleida Biomedicine Research Institute (IRB-Lleida, CIBER in Diabetes and Associated Metabolic Disorders (CIBERDEM, Lleida University, Lleida, Spain; 3Endocrinology and Nutrition Department, Hospital Clínico San Carlos, IDISSC, Madrid, Spain; 4Endocrinology and Nutrition Department, Hospitales Universitarios Virgen del Rocío, Seville, Spain Abstract: The significant increase in the prevalence of obesity has led to an increase in the number of obese women who become pregnant. In this setting, in recent years, there has been an exponential rise in the number of bariatric procedures, with approximately half of them performed in women of childbearing age, and a remarkable surge in the number of women who become pregnant after having undergone bariatric surgery (BS. These procedures entail the risk of nutritional deficiencies, and nutrition is a crucial aspect during pregnancy. Therefore, knowledge and awareness of the consequences of these techniques on maternal and fetal outcomes is essential. Current evidence suggests a better overall obstetric outcome after BS, in comparison to morbid obese women managed conservatively, with a reduction in the prevalence of gestational diabetes mellitus, pregnancy-associated hypertensive disorders, macrosomia, and congenital defects. However, the risk of potential maternal nutritional deficiencies and newborns small for gestational age cannot be overlooked. Results concerning the incidence of preterm delivery and the number of C-sections are less consistent. In this paper, we review the updated evidence regarding the impact of BS on pregnancy. Keywords: bariatric surgery, pregnancy, maternal and fetal outcomes, gestational diabetes mellitus, small for

  1. Does fluoroscopy improve outcomes in paediatric forearm fracture reduction?

    International Nuclear Information System (INIS)

    Menachem, S.; Sharfman, Z.T.; Perets, I.; Arami, A.; Eyal, G.; Drexler, M.; Chechik, O.

    2016-01-01

    Aim: To compare the radiographic results of paediatric forearm fracture reduced with and without fluoroscopic enhancement to investigate whether fractures reduced under fluoroscopic guidance would have smaller residual deformities and lower rates of re-reduction and surgery. Materials and methods: A retrospective cohort analysis was conducted comparing paediatric patients with acute forearm fracture in two trauma centres. Demographics and radiographic data from paediatric forearm fractures treated in Trauma Centre A with the aid of a C-arm fluoroscopy were compared to those treated without fluoroscopy in Trauma Centre B. Re-reduction, late displacement, post-reduction deformity, and need for surgical intervention were compared between the two groups. Results: The cohort included 229 children (175 boys and 54 girls, mean age 9.41±3.2 years, range 1–16 years) with unilateral forearm fractures (83 manipulated with fluoroscopy and 146 without). Thirty-four (15%) children underwent re-reduction procedures in the emergency department. Fifty-three (23%) children had secondary displacement in the cast, of which 18 were operated on, 20 were re-manipulated, and the remaining 15 were kept in the cast with an acceptable deformity. Twenty-nine additional children underwent operation for reasons other than secondary displacement. There were no significant differences in re-reduction and surgery rates or in post-reduction deformities between the two groups. Conclusion: The use of fluoroscopy during reduction of forearm fractures in the paediatric population apparently does not have a significant effect on patient outcomes. Reductions performed without fluoroscopy were comparably accurate in correcting deformities in both coronal and sagittal planes. - Highlights: • Compared outcomes of pediatric forearm fracture reduction with and without fluoroscopy. • The use of fluoroscopy during reduction of forearm fractures in the pediatric population apparently does not have a

  2. Digital audio recordings improve the outcomes of patient consultations

    DEFF Research Database (Denmark)

    Wolderslund, Maiken; Kofoed, Poul-Erik; Holst, René

    2017-01-01

    OBJECTIVES: To investigate the effects on patients' outcome of the consultations when provided with: a Digital Audio Recording (DAR) of the consultation and a Question Prompt List (QPL). METHODS: This is a three-armed randomised controlled cluster trial. One group of patients received standard care......, while the other two groups received either the QPL in combination with a recording of their consultation or only the recording. Patients from four outpatient clinics participated: Paediatric, Orthopaedic, Internal Medicine, and Urology. The effects were evaluated by patient-administered questionnaires...

  3. Improvement of the clinical outcome in Ankylosing spondylitis by balneotherapy.

    Science.gov (United States)

    Yurtkuran, Merih; Ay, Alev; Karakoç, Yüksel

    2005-07-01

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

  4. Sarcopenia: assessment of disease burden and strategies to improve outcomes

    Science.gov (United States)

    Liguori, Ilaria; Russo, Gennaro; Aran, Luisa; Bulli, Giulia; Curcio, Francesco; Della-Morte, David; Gargiulo, Gaetano; Testa, Gianluca; Cacciatore, Francesco; Bonaduce, Domenico; Abete, Pasquale

    2018-01-01

    Life expectancy is increasing worldwide, with a resultant increase in the elderly population. Aging is characterized by the progressive loss of skeletal muscle mass and strength – a phenomenon called sarcopenia. Sarcopenia has a complex multifactorial pathogenesis, which involves not only age-related changes in neuromuscular function, muscle protein turnover, and hormone levels and sensitivity, but also a chronic pro-inflammatory state, oxidative stress, and behavioral factors – in particular, nutritional status and degree of physical activity. According to the operational definition by the European Working Group on Sarcopenia in Older People (EWGSOP), the diagnosis of sarcopenia requires the presence of both low muscle mass and low muscle function, which can be defined by low muscle strength or low physical performance. Moreover, biomarkers of sarcopenia have been identified for its early detection and for a detailed identification of the main pathophysiological mechanisms involved in its development. Because sarcopenia is associated with important adverse health outcomes, such as frailty, hospitalization, and mortality, several therapeutic strategies have been identified that involve exercise training, nutritional supplementation, hormonal therapies, and novel strategies and are still under investigation. At the present time, only physical exercise has showed a positive effect in managing and preventing sarcopenia and its adverse health outcomes. Thus, further well-designed and well-conducted studies on sarcopenia are needed. PMID:29785098

  5. Rib fractures in trauma patients: does operative fixation improve outcome?

    Science.gov (United States)

    Majak, Peter; Næss, Pål A

    2016-12-01

    Renewed interest in surgical fixation of rib fractures has emerged. However, conservative treatment is still preferred at most surgical departments. We wanted to evaluate whether operative treatment of rib fractures may benefit severely injured patients. Several studies report a reduction in mechanical ventilation time, ICU length of stay (LOS), hospital LOS, pneumonia, need for tracheostomy, pain and costs in operatively treated patients with multiple rib fractures compared with patients treated nonoperatively. Although patient selection and timing of the operation seem crucial for successful outcome, no consensus exists. Mortality reduction has only been shown in a few studies. Most studies are retrospective cohort and case-control studies. Only four randomized control trials exist. Conservative treatment, consisting of respiratory assistance and pain control, is still the treatment of choice in the vast majority of patients with multiple rib fractures. In selected patients, operative fixation of fractured ribs within 72 h postinjury may lead to better outcome. More randomized control trials are needed to further determine who benefits from surgical fixation of rib fractures.

  6. Deflation of gastric band balloon in pregnancy for improving outcomes.

    Science.gov (United States)

    Jefferys, Amanda E; Siassakos, Dimitrios; Draycott, Tim; Akande, Valentine A; Fox, Robert

    2013-04-30

    In line with the rise in the prevalence of obesity, an increasing number of women of childbearing age are undergoing laparoscopic adjustable gastric banding (LAGB), resulting in an increasing number of pregnancies with a band in place. Currently, there is no consensus on optimal band management in pregnancy. Some clinicians advocate leaving the band balloon inflated to reduce gestational weight gain and associated adverse perinatal outcomes. However, there are concerns that maintaining balloon inflation during pregnancy might increase the risk of band complications and adversely affect fetal development and/or growth as a result of reduced nutritional intake. To compare maternal and perinatal outcomes for elective gastric band balloon deflation versus intention to maintain balloon inflation during pregnancy. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 September 2012) and the Web of Science database (1940 to September 2012). Randomised-controlled trials comparing elective deflation of the gastric band balloon with intention to maintain balloon inflation in pregnant women who have undergone LAGB. Two review authors independently assessed studies for inclusion. No studies met the criteria for inclusion in the review. To date no randomised controlled trials exist that compare elective deflation of the gastric band balloon in pregnancy versus intention to maintain balloon inflation. Further research is needed to define the optimum management of the gastric band balloon in pregnancy.

  7. The reliability improvement plan of hot cell examination data by introducing of Kolas

    International Nuclear Information System (INIS)

    Hong, Kwon Pyo; Park, Dae Gyu; Ahn, Sang Bok; Choo, Yong Sun; Song, Wung Sup; Jung, Yang Hong; Yoo, Byung Ok; Baik, Seung Je; Lim, Nam Jin; Nam Ju Hee

    2000-01-01

    For enhancement of hot cell data reliability produced at Irradiated Material Examination Facility in KAERI,Korea a project to introduce Kolas of National Quality Assurance Institute. By Kolas introduction the examination data currently produced would be reinforced by additional function of uncertainty evaluation and would obtained more reliable data. The all of data collected would be quality controlled, so that it would be re-traceable. Presently at IMEF shock test, tension test, dimension measurement test, hardness test, density test, and composition analysis test will be subject to Kolas. It is also planned to expand the number of test items in near future. At the end of 2000 year IMEF aims to secure the certificate issued by the National Quality Assurance Institute. (Hong, J. S.)

  8. Improvement of the reliability and efficiency of the NPP operation by training high-skilled personnel

    International Nuclear Information System (INIS)

    Korolev, V.V.; Sereda, G.A.

    1981-01-01

    Nuclear power at the modern stage of development is characterized by utilization of large power commercial reactors high technical specifications and economic parameters of which can be provided only at high reliability of the equipment and high qualification of the personnel. Special educational institution - Institute of nuclear engineering is organized for education of the operation personnel of high qualification for modern NPPs. Discussed are some problems occurring in this connection [ru

  9. A Framework to Improve Communication and Reliability Between Cloud Consumer and Provider in the Cloud

    OpenAIRE

    Vivek Sridhar

    2014-01-01

    Cloud services consumers demand reliable methods for choosing appropriate cloud service provider for their requirements. Number of cloud consumer is increasing day by day and so cloud providers, hence requirement for a common platform for interacting between cloud provider and cloud consumer is also on the raise. This paper introduces Cloud Providers Market Platform Dashboard. This will act as not only just cloud provider discoverability but also provide timely report to consumer on cloud ser...

  10. How simulation of failure risk can improve structural reliability - application to pressurized components and pipes

    OpenAIRE

    Cioclov, Dimitru Dragos

    2013-01-01

    Probabilistic methods for failure risk assessment are introduced, with reference to load carrying structures, such as pressure vessels (PV) and components of pipes systems. The definition of the failure risk associated with structural integrity is made in the context of the general approach to structural reliability. Sources of risk are summarily outlined with emphasis on variability and uncertainties (V&U) which might be encountered in the analysis. To highlight the problem, in its practical...

  11. The improvement of the connections reliability in a local communication system

    International Nuclear Information System (INIS)

    Buisson, J.; Sanchis, P.

    1986-01-01

    The local communication systems used in the management of the industrial processes must fulfil more severe conditions concerning the reliability and safety than those used in bureaucratics. After mentioning the specific requirements the solutions for the realization of a local industrial communication system are presented. Studies to develop an optical fibers coupling system for a linear network used for the transmission in a hostile medium are mentioned

  12. Optimized work control process to improve safety and reliability in a risk-based and deregulated environment

    International Nuclear Information System (INIS)

    Anderson, Jon G.; Jeffries, Jeffrey D. E.; Mairs, Todd P.; Rahn, Frank J.

    1999-01-01

    This paper provides an overview of strategic models to assist power generating plants to improve their work control processes. These models include mechanisms to continually keep the process up to date. Included in the work control process are elements for system cost/performance analysis, life-cycle maintenance planning, on-line scheduling and look-ahead techniques, and schedule implementation to conduct work on the asset. The paper also discusses how risk management associated with work control issues that effect the safety and reliability, as well as O and M costs, is integrated into this strategy. The work control process is a pervasive and critical element in the successful implementation of operations and work management programs. While providing a method to implement maintenance activities in a cost-effective manner, the work control process improves plant safety and system reliability

  13. Earlier surgery improves outcomes from painful chronic pancreatitis

    Science.gov (United States)

    Ke, Nengwen; Jia, Dan; Huang, Wei; Nunes, Quentin M.; Windsor, John A.; Liu, Xubao; Sutton, Robert

    2018-01-01

    Abstract The timing of surgery for painful chronic pancreatitis (CP) may affect outcomes. Clinical course, Izbicki pain scores, and pancreatic function were retrospectively compared and analyzed between patients undergoing either early or late surgery (pancreatic mass +/− ductal dilatation (47% vs 27%, P insufficiency (60% vs 72%, P = .034); there were no other significant differences. The early group had longer hospital stay (14.4 vs 12.2 days, P = .009), but no difference in complications. Significantly greater pain relief followed early surgery (complete 69% vs 47%, partial 22% vs 37%, none 8% vs 16%, P = .01) with lower rates of exocrine (60% vs 80%, P = .005) and endocrine insufficiency (36% vs 53%, P = .033). Our data indicate that early surgery results in higher rates of pain relief and pancreatic sufficiency than late surgery for chronic pancreatitis patients. Frey and Berne procedures showed better results than other surgical procedures. PMID:29742705

  14. Circumferential fusion improves outcome in comparison with instrumented posterolateral fusion

    DEFF Research Database (Denmark)

    Videbaek, Tina S; Christensen, Finn B; Soegaard, Rikke

    2006-01-01

    with respect to all four DPQ categories: daily activities, work/leisure, anxiety/depression, and social interest. The Oswestry Disability Index supported these results (P ...STUDY DESIGN: Prospective randomized clinical study with a 5- to 9-year follow-up period. OBJECTIVE: The aim of the present study was to analyze the long-term outcome with respect to functional disability, pain, and general health of patients treated by means of circumferential lumbar fusion...... in comparison with those treated by means of instrumented posterolateral lumbar fusion. SUMMARY OF BACKGROUND DATA: Circumferential fusion has become a common procedure in lumbar spinal fusion both as a primary and salvage procedure. However, the claimed advantages of circumferential fusion over conventional...

  15. Toward improved public health outcomes from urban nature.

    Science.gov (United States)

    Shanahan, Danielle F; Lin, Brenda B; Bush, Robert; Gaston, Kevin J; Dean, Julie H; Barber, Elizabeth; Fuller, Richard A

    2015-03-01

    There is mounting concern for the health of urban populations as cities expand at an unprecedented rate. Urban green spaces provide settings for a remarkable range of physical and mental health benefits, and pioneering health policy is recognizing nature as a cost-effective tool for planning healthy cities. Despite this, limited information on how specific elements of nature deliver health outcomes restricts its use for enhancing population health. We articulate a framework for identifying direct and indirect causal pathways through which nature delivers health benefits, and highlight current evidence. We see a need for a bold new research agenda founded on testing causality that transcends disciplinary boundaries between ecology and health. This will lead to cost-effective and tailored solutions that could enhance population health and reduce health inequalities.

  16. Sexuality and fertility in men with hypospadias; improved outcome.

    Science.gov (United States)

    Örtqvist, L; Fossum, M; Andersson, M; Nordenström, A; Frisén, L; Holmdahl, G; Nordenskjöld, A

    2017-03-01

    The aim of this study was to investigate sexual function and fertility in adult men born with hypospadias. Patients born with hypospadias, age-matched controls, and a group of circumcised men completed a questionnaire constructed to reflect their psychosexual situation and fertility. Core gender identity, sexual orientation, and gender role behavior was also assessed. 167 patients [63% distal, 24% mid shaft and 13% proximal, mean age 34 (19-54) years], 169 controls from the general population [mean age 33 (19-48) years] and 47 controls circumcised because of phimosis (mean age 26 [19-44]) participated and completed the questionnaire. There were no differences in having a partner, reported fertility, age at sexarche (mean age 17.8), number of sex partners or sexual interest between the patients and controls. More patients than controls reported anejaculation. Reported glanular sensitivity was lower in hypospadias patients and circumcised controls compared with non-circumcised controls. The odds of being satisfied with their sexual life increased with a higher penile perception score in patients (OR = 1.54, p = 0.01). There was no association with penile length. Sexual orientation, core gender identity and gender role behavior were sex-typical in both patients and controls. Patients with proximal hypospadias had a lower reported fertility, experienced anejaculation more often, and were less satisfied with their sexual life. Men born with hypospadias have a good long-term outcome concerning sexual function and fertility. Men born with proximal hypospadias have a more impaired outcome concerning both sexual function and fertility. As satisfaction with genital appearance is important for sexual life satisfaction, clinical, and psychological follow-up into adulthood is especially important in boys born with proximal hypospadias. © 2016 American Society of Andrology and European Academy of Andrology.

  17. Improving outcome after traumatic brain injury--progress and challenges.

    Science.gov (United States)

    Gentleman, D

    1999-01-01

    This article describes the rapid advances in the head injury field which have taken place within the professional lifetime of many doctors in practice today. These have led to a better understanding of what happens in the injured brain and how these events might be manipulated to achieve better outcomes. Clinical tools we now take for granted, like the CT scanner and the Glasgow Coma Scale, were new developments 25 years ago. They provided a foundation on which clinicians and basic scientists could build what we now know: what to assess in the patient, how to respond to certain findings, what imaging to do, how to plan treatment rationally, how to minimise brain damage at different stages after injury, how to predict and measure outcome, what disabled survivors need, and how to organise the service to do the greatest good for the most people. Some of these topics raise as many questions as answers. The head injury field may be broad but it has essential unity. At one extreme, some patients have a life-threatening illness where the acts and omissions of the clinical team can powerfully influence not only survival but its quality. Later the drama of the acute phase gives way to the 'hidden disabilities' of the long-term deficits which so many survivors have. At the other end of the severity spectrum is the relatively vast number of people who suffer an apparently mild head injury, a few of whom deteriorate and need urgent treatment, and many of whom have unspectacular but, nevertheless, disabling problems. The article attempts to address this broad canvas. Clinicians, neuroscientists, policy makers, and service users must work together to address the major scientific, individual, and population challenges posed by head injury. Much has already been achieved, but much remains to be done, especially in translating 'what we know' into 'what we do'.

  18. Improved Grade Outcomes with an E-Mailed "Grade Nudge"

    Science.gov (United States)

    Smith, Ben O.; White, Dustin R.; Kuzyk, Patricia C.; Tierney, James E.

    2018-01-01

    Information provided at the moment a person makes a decision can influence behavior in predictable ways. The United Kingdom's Behavioural Insights Team have used this idea to help improve the insulation of lofts, collect taxes, and even reduce litter. The authors of this article developed software that appends a personalized message to each…

  19. A Measurement Model of Microgenetic Transfer for Improving Instructional Outcomes

    Science.gov (United States)

    Pavlik, Philip I., Jr.; Yudelson, Michael; Koedinger, Kenneth R.

    2015-01-01

    Efforts to improve instructional task design often make reference to the mental structures, such as "schemas" (e.g., Gick & Holyoak, 1983) or "identical elements" (Thorndike & Woodworth, 1901), that are common to both the instructional and target tasks. This component based (e.g., Singley & Anderson, 1989) approach…

  20. Improving Pharmacy Student Communication Outcomes Using Standardized Patients.

    Science.gov (United States)

    Gillette, Chris; Rudolph, Michael; Rockich-Winston, Nicole; Stanton, Robert; Anderson, H Glenn

    2017-08-01

    Objective. To examine whether standardized patient encounters led to an improvement in a student pharmacist-patient communication assessment compared to traditional active-learning activities within a classroom setting. Methods. A quasi-experimental study was conducted with second-year pharmacy students in a drug information and communication skills course. Student patient communication skills were assessed using high-stakes communication assessment. Results. Two hundred and twenty students' data were included. Students were significantly more likely to have higher scores on the communication assessment when they had higher undergraduate GPAs, were female, and taught using standardized patients. Similarly, students were significantly more likely to pass the assessment on the first attempt when they were female and when they were taught using standardized patients. Conclusion. Incorporating standardized patients within a communication course resulted in improved scores as well as first-time pass rates on a communication assessment than when using different methods of active learning.

  1. Partnering with diabetes educators to improve patient outcomes

    OpenAIRE

    Burke SD; Sherr D; Lipman RD

    2014-01-01

    Sandra D Burke,1,2 Dawn Sherr,3 Ruth D Lipman3 1American Association of Diabetes Educators, Chicago, IL, USA; 2University of Illinois at Chicago College of Nursing, Urbana, IL, USA; 3Science and Practice, American Association of Diabetes Educators, Chicago, IL, USA Abstract: Diabetes is a chronic, progressive disease that affects millions worldwide. The paradigm of diabetes management has shifted to focus on empowering the person with diabetes to manage the disease successfully and to improv...

  2. Improved outcome in solitary bone plasmacytomata with combined therapy.

    Science.gov (United States)

    Avilés, A; Huerta-Guzmán, J; Delgado, S; Fernández, A; Díaz-Maqueo, J C

    1996-09-01

    Solitary bone plasmacytoma (SBP) is a rare presentation of plasma cell dyscrasias. Radiotherapy has been considered the treatment of choice, however, most patients will develop multiple myeloma, 3 to 10 years after initial diagnosis and treatment. No innovations have been introduced in the treatment of SBP in the last 30 years. We began a prospective clinical trial to assess the efficacy and toxicity of adjuvant chemotherapy with low doses of melphalan and prednisone administered to patients with SBP after radiation therapy in an attempt to improve the disease-free survival and overall survival. Between 1982 and 1989, 53 patients with SBP were randomly assigned to be treated with either local radiotherapy with doses ranged from 4000 to 5000 cGy to achieve local control of disease (28 patients) or the same radiotherapy schedule followed by melphalan and prednisone given every 6 weeks for 3 years (25 patients). After a median follow-up of 8.9 years, disease-free survival and overall survival were improved in patients who were treated with combined therapy, 22 patients remain alive and free of disease in the combined treatment group compared to only 13 patients in the radiotherapy group (p radiotherapy in patients with SBP improved duration of remission and survival without severe side-effects. However, as with other studies in SBP, the group was too small to draw definitive conclusions and more controlled clinical trials are necessary to define the role of this therapeutic approach in patients with SBP.

  3. Reliability Calculations

    DEFF Research Database (Denmark)

    Petersen, Kurt Erling

    1986-01-01

    Risk and reliability analysis is increasingly being used in evaluations of plant safety and plant reliability. The analysis can be performed either during the design process or during the operation time, with the purpose to improve the safety or the reliability. Due to plant complexity and safety...... and availability requirements, sophisticated tools, which are flexible and efficient, are needed. Such tools have been developed in the last 20 years and they have to be continuously refined to meet the growing requirements. Two different areas of application were analysed. In structural reliability probabilistic...... approaches have been introduced in some cases for the calculation of the reliability of structures or components. A new computer program has been developed based upon numerical integration in several variables. In systems reliability Monte Carlo simulation programs are used especially in analysis of very...

  4. Comparison of different reliability improving investment strategies of Finnish medium-voltage distribution systems

    Energy Technology Data Exchange (ETDEWEB)

    Laagland, H.

    2012-07-01

    The electricity distribution sector in Finland is highly regulated and the return on investments in distribution networks is low. Low profits don't make the electricity distribution sector attractive to outside investors. During the second regulatory period of 2008-2011 incentives are included into the Finnish regulation model which allows higher profits for the network owners for right allocated network investments leading to lower operation and interruption costs. The goal of the thesis is to find cost-effective medium-voltage distribution system investment strategies for the Finnish power distribution companies with respect to the incentives of the second regulatory period. In this work the sectionalisation concept is further developed by deriving equations for a homogeneous electricity distribution system for the economical and reliability indices as a function of the number of sectionalisation zones. The cost-effective medium-voltage distribution system investment strategies are found by studying the technical and economic interaction of feeder automation on different network structures. Ten feeder automation schemes have been applied to six urban/rural area generic feeders and two real rural area feeders of a distribution company in western Finland. The analytical approach includes modelling of the feeders and feeder functions and calculation of the economical and reliability indices. The following investment areas are included: different electricity distribution systems, new substation, new switching station, central earth-fault current compensation, cabling and feeder automation. The value of the results of this work is that they reveal the influence that feeder automation has on the reliability and economy of different distribution structures. This created transparency enables a national and/or distribution company network investment strategy to optimise the economic benefits of investments. (orig.)

  5. Implantable cardioverter defibrillator specific rehabilitation improves health cost outcomes

    DEFF Research Database (Denmark)

    Berg, Selina Kikkenborg; Zwisler, Ann-Dorthe; Koch, Mette Bjerrum

    2015-01-01

    OBJECTIVE: The Copenhagen Outpatient ProgrammE - implantable cardioverter defibrillator (COPE-ICD) trial included patients with implantable cardioverter defibrillators in a randomized controlled trial of rehabilitation. After 6-12 months significant differences were found in favour of the rehabil...... was -6,789 USD/-5,593 Euro in favour of rehabilitation. CONCLUSION: No long-term health outcome benefits were found for the rehabilitation programme. However, the rehabilitation programme resulted in a reduction in total attributable direct costs....... of the rehabilitation group for exercise capacity, general and mental health. The aim of this paper is to explore the long-term health effects and cost implications associated with the rehabilitation programme; more specifically, (i) to compare implantable cardioverter defibrillator therapy history and mortality...... between rehabilitation and usual care groups; (ii) to examine the difference between rehabilitation and usual care groups in terms of time to first admission; and (iii) to determine attributable direct costs. METHODS: Patients with first-time implantable cardioverter defibrillator implantation (n = 196...

  6. Cognitive behavioral therapy for suicidal behaviors: improving patient outcomes

    Directory of Open Access Journals (Sweden)

    Mewton L

    2016-03-01

    Full Text Available Louise Mewton,1 Gavin Andrews2 1National Health and Medical Research Council Centre for Research Excellence in Mental Health and Substance Use, National Drug and Alcohol Research Centre, University of New South Wales, 2Clinical Research Unit for Anxiety and Depression (CRUfAD, St Vincent's Hospital, Sydney, NSW, Australia Abstract: This systematic review provides an overview of the effectiveness of cognitive behavioral therapy (CBT in reducing suicidal cognitions and behavior in the adult population. We identified 15 randomized controlled trials of CBT for adults (aged 18 years and older that included suicide-related cognitions or behaviors as an outcome measure. The studies were identified from PsycINFO searches, reference lists, and a publicly available database of psychosocial interventions for suicidal behaviors. This review identified some evidence of the use of CBT in the reduction of both suicidal cognitions and behaviors. There was not enough evidence from clinical trials to suggest that CBT focusing on mental illness reduces suicidal cognitions and behaviors. On the other hand, CBT focusing on suicidal cognitions and behaviors was found to be effective. Given the current evidence, clinicians should be trained in CBT techniques focusing on suicidal cognitions and behaviors that are independent of the treatment of mental illness. Keywords: suicidal behaviors, suicidal cognitions, CBT

  7. Beyond redundancy how geographic redundancy can improve service availability and reliability of computer-based systems

    CERN Document Server

    Bauer, Eric; Eustace, Dan

    2012-01-01

    "While geographic redundancy can obviously be a huge benefit for disaster recovery, it is far less obvious what benefit is feasible and likely for more typical non-catastrophic hardware, software, and human failures. Georedundancy and Service Availability provides both a theoretical and practical treatment of the feasible and likely benefits of geographic redundancy for both service availability and service reliability. The text provides network/system planners, IS/IT operations folks, system architects, system engineers, developers, testers, and other industry practitioners with a general discussion about the capital expense/operating expense tradeoff that frames system redundancy and georedundancy"--

  8. Improving Reliability of a fire-fighting pump set with Axiomatic Design

    Directory of Open Access Journals (Sweden)

    Arcidiacono Gabriele

    2017-01-01

    Full Text Available This paper introduces a case study featuring Axiomatic Design and Multi-Level Hierarchical model (MLH applied to redesign a fire-fighting pump set. In particular, two different design concepts are presented to be applied to the supporting frame of the system to limit a vibration problem that can arise during potential malfunctioning of the fire-fighting pump. The selection of the best design has been carried out through reliability evaluation process and through the cost of failure based on the MLH model.

  9. Reliability and Maintainability Model (RAM): User and Maintenance Manual. Part 2; Improved Supportability Analysis

    Science.gov (United States)

    Ebeling, Charles E.

    1996-01-01

    This report documents the procedures for utilizing and maintaining the Reliability & Maintainability Model (RAM) developed by the University of Dayton for the National Aeronautics and Space Administration (NASA) Langley Research Center (LaRC). The purpose of the grant is to provide support to NASA in establishing operational and support parameters and costs of proposed space systems. As part of this research objective, the model described here was developed. This Manual updates and supersedes the 1995 RAM User and Maintenance Manual. Changes and enhancements from the 1995 version of the model are primarily a result of the addition of more recent aircraft and shuttle R&M data.

  10. Follow-up of CT-derived airway wall thickness: Correcting for changes in inspiration level improves reliability

    Energy Technology Data Exchange (ETDEWEB)

    Pompe, Esther, E-mail: e.pompe@umcutrecht.nl [Department of Respiratory Medicine, University Medical Center Utrecht, Utrecht (Netherlands); Rikxoort, Eva M. van [Department of Radiology, Radboud University Medical Center, Nijmegen (Netherlands); Mets, Onno M. [Department of Radiology, University Medical Center Utrecht, Utrecht (Netherlands); Charbonnier, Jean-Paul [Department of Radiology, Radboud University Medical Center, Nijmegen (Netherlands); Kuhnigk, Jan-Martin [Institute for Medical Image Computing, Fraunhofer MEVIS, Bremen (Germany); Koning, Harry J. de [Department of Public Health, Erasmus Medical Center, Rotterdam (Netherlands); Oudkerk, Matthijs [University of Groningen, University Medical Center Groningen, Groningen, Department of Radiology (Netherlands); Vliegenthart, Rozemarijn [University of Groningen, University Medical Center Groningen, Groningen, Department of Radiology (Netherlands); University of Groningen, University Medical Center Groningen, Center for Medical Imaging-North East Netherlands, Groningen (Netherlands); Zanen, Pieter; Lammers, Jan-Willem J. [Department of Respiratory Medicine, University Medical Center Utrecht, Utrecht (Netherlands); Ginneken, Bram van [Department of Radiology, Radboud University Medical Center, Nijmegen (Netherlands); Jong, Pim A. de; Mohamed Hoesein, Firdaus A.A. [Department of Radiology, University Medical Center Utrecht, Utrecht (Netherlands)

    2016-11-15

    Objectives: Airway wall thickness (AWT) is affected by changes in lung volume. This study evaluated whether correcting AWT on computed tomography (CT) for differences in inspiration level improves measurement agreement, reliability, and power to detect changes over time. Methods: Participants of the Dutch-Belgian lung cancer screening trial who underwent 3-month repeat CT for an indeterminate pulmonary nodule were included. AWT on CT was calculated by the square root of the wall area at a theoretical airway with an internal perimeter of 10 mm (Pi10). The scan with the highest lung volume was labelled as the reference scan and the scan with the lowest lung volume was labelled as the comparison scan. Pi10 derived from the comparison scan was corrected by multiplying it with the ratio of CT lung volume of the comparison scan to CT lung volume on the reference scan. Agreement of uncorrected and corrected Pi10 was studied with the Bland-Altman method, reliability with intra-class correlation coefficients (ICC), and power to detect changes over time was calculated. Results: 315 male participants were included. Limit of agreement and reliability for Pi10 was −0.61 to 0.57 mm (ICC = 0.87), which improved to −0.38 to 0.37 mm (ICC = 0.94) after correction for inspiration level. To detect a 15% change over 3 months, 71 subjects are needed for Pi10 and 26 subjects for Pi10 adjusted for inspiration level. Conclusions: Correcting Pi10 for differences in inspiration level improves reliability, agreement, and power to detect changes over time.

  11. Linking Quality Assurance to Performance Improvement to Produce a High Reliability Organization

    International Nuclear Information System (INIS)

    Silvey, Andrea B.; Warrick, Louise H.

    2008-01-01

    Three basic change management models are currently used in healthcare to produce and sustain quality improvement. We have presented the context to determine where any particular organization stands within these paradigms. We also have introduced a change-management tool used to assess, plan, and monitor leadership effort and commitment to quality improvement and culture change activities, tracked as 'momentum for change.' This 'momentum' is measured at eight discrete levels, from recognizing a performance gap to officially implementing changes intended to improve quality

  12. Improving reliability of state estimation programming and computing suite based on analyzing a fault tree

    Directory of Open Access Journals (Sweden)

    Kolosok Irina

    2017-01-01

    Full Text Available Reliable information on the current state parameters obtained as a result of processing the measurements from systems of the SCADA and WAMS data acquisition and processing through methods of state estimation (SE is a condition that enables to successfully manage an energy power system (EPS. SCADA and WAMS systems themselves, as any technical systems, are subject to failures and faults that lead to distortion and loss of information. The SE procedure enables to find erroneous measurements, therefore, it is a barrier for the distorted information to penetrate into control problems. At the same time, the programming and computing suite (PCS implementing the SE functions may itself provide a wrong decision due to imperfection of the software algorithms and errors. In this study, we propose to use a fault tree to analyze consequences of failures and faults in SCADA and WAMS and in the very SE procedure. Based on the analysis of the obtained measurement information and on the SE results, we determine the state estimation PCS fault tolerance level featuring its reliability.

  13. Why Do Long-Distance Travelers Have Improved Pancreatectomy Outcomes?

    Science.gov (United States)

    Jindal, Manila; Zheng, Chaoyi; Quadri, Humair S; Ihemelandu, Chukwuemeka U; Hong, Young K; Smith, Andrew K; Dudeja, Vikas; Shara, Nawar M; Johnson, Lynt B; Al-Refaie, Waddah B

    2017-08-01

    Centralization of complex surgical care has led patients to travel longer distances. Emerging evidence suggested a negative association between increased travel distance and mortality after pancreatectomy. However, the reason for this association remains largely unknown. We sought to unravel the relationships among travel distance, receiving pancreatectomy at high-volume hospitals, delayed surgery, and operative outcomes. We identified 44,476 patients who underwent pancreatectomy for neoplasms between 2004 and 2013 at the reporting facility from the National Cancer Database. Multivariable analyses were performed to examine the independent relationships between increments in travel distance mortality (30-day and long-term survival) after adjusting for patient demographics, comorbidity, cancer stage, and time trend. We then examined how additional adjustment of procedure volume affected this relationship overall and among rural patients. Median travel distance to undergo pancreatectomy increased from 16.5 to 18.7 miles (p for trend pancreatectomy, it was also related to higher odds of receiving pancreatectomy at a high-volume hospital and lower postoperative mortality. In multivariable analysis, difference in mortality among patients with varying travel distance was attenuated by adjustment for procedure volume. However, longest travel distance was still associated with a 77% lower 30-day mortality rate than shortest travel among rural patients, even when accounting for procedure volume. Our large national study found that the beneficial effect of longer travel distance on mortality after pancreatectomy is mainly attributable to increase in procedure volume. However, it can have additional benefits on rural patients that are not explained by volume. Distance can represent a surrogate for rural populations. Copyright © 2017 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

  14. Improvement of perinatal outcome in diabetic pregnant women.

    Science.gov (United States)

    Szilagyi, A; Szabo, I

    2001-01-01

    Obstetrical and perinatal outcomes in newborns of diabetic pregnant women depend on metabolic control and fetal surveillance during pregnancy. The effects of fetal surveillance on perinatal mortality and morbidity was analyzed in diabetic pregnant women with appropriate glucose control in our regional center for diabetes and pregnancy. 480 deliveries complicated by frank or gestational diabetes occurred in our Department in the period of 1988-1999. Perinatal mortality and morbidity, prevalence of premature deliveries, methods of fetal surveillance, options for respiratory distress syndrome (RDS) profilaxis, cesarean section rate, timing of delivery and its indications and occurrence of malformations have been analyzed. It was found that malformation rate and perinatal mortality may be reduced to even lower level than that of in healthy pregnant women by appropriate glucose control and by using the latest methods of intrauterine fetal surveillance including cardiotocography (non stress test and oxytocin challenge test), doppler fetal artery velocimetry and fetal pulse oximetry. Timing of delivery was needed in 35% of the cases with IDDM and 15% of gestational diabetes due to chronic placental insufficiency. If labour induction was needed before the 38 weeks, amniocentesis was performed to test fetal lung maturity. Direct fetal glucocorticoid administration was used to enhance fetal lung maturation in 14 cases. C-section rate was slightly higher than that of in non diabetic pregnant women. Our perinatal morbidity data (macrosomia, hyperbilirubinemia, hypoglycemia, injuries, infections) are comparable with the data from the literature. Although perinatal mortality with the help of thorough fetal surveillance is even better in diabetic pregnant women than in non diabetic patients, future eye should be focused on factors affecting perinatal morbidity, because it is still higher than in newborns of healthy mothers.

  15. Effective colonoscopy training techniques: strategies to improve patient outcomes

    Directory of Open Access Journals (Sweden)

    Papanikolaou IS

    2016-03-01

    Full Text Available Ioannis S Papanikolaou,1 Pantelis S Karatzas,2 Lazaros T Varytimiadis,2 Athanasios Tsigaridas,2 Michail Galanopoulos,2 Nikos Viazis,2 Dimitrios G Karamanolis21Hepato-gastroenterology Unit, 2nd Department of Internal Medicine, Attikon University General Hospital, University of Athens, 2Gastroenterology Department, Evangelismos Hospital, Athens, GreeceAbstract: Colonoscopy has substantially evolved during the last 20 years and many different training techniques have been developed in order to improve the performance of endoscopists. The most known are mechanical simulators, virtual reality simulators, computer-simulating endoscopy, magnetic endoscopic imaging, and composite and explanted animal organ simulators. Current literature generally indicates that the use of simulators improves performance of endoscopists and enhances safety of patients, especially during the initial phase of training. Moreover, newer endoscopes and imaging techniques such as high-definition colonoscopes, chromocolonoscopy with dyes spraying, and third-eye retroscope have been incorporated in everyday practice, offering better visualization of the colon and detection of polyps. Despite the abundance of these different technological features, training devices are not widely used and no official guideline or specified training algorithm or technique for lower gastrointestinal endoscopy has been evolved. In this review, we present the most important training methods currently available and evaluate these using existing literature. We also try to propose a training algorithm for novice endoscopists.Keywords: endoscopy, colonoscopy, teaching techniques, simulator, endoscopists, colon, polyps

  16. Effective colonoscopy training techniques: strategies to improve patient outcomes.

    Science.gov (United States)

    Papanikolaou, Ioannis S; Karatzas, Pantelis S; Varytimiadis, Lazaros T; Tsigaridas, Athanasios; Galanopoulos, Michail; Viazis, Nikos; Karamanolis, Dimitrios G

    2016-01-01

    Colonoscopy has substantially evolved during the last 20 years and many different training techniques have been developed in order to improve the performance of endoscopists. The most known are mechanical simulators, virtual reality simulators, computer-simulating endoscopy, magnetic endoscopic imaging, and composite and explanted animal organ simulators. Current literature generally indicates that the use of simulators improves performance of endoscopists and enhances safety of patients, especially during the initial phase of training. Moreover, newer endoscopes and imaging techniques such as high-definition colonoscopes, chromocolonoscopy with dyes spraying, and third-eye retroscope have been incorporated in everyday practice, offering better visualization of the colon and detection of polyps. Despite the abundance of these different technological features, training devices are not widely used and no official guideline or specified training algorithm or technique for lower gastrointestinal endoscopy has been evolved. In this review, we present the most important training methods currently available and evaluate these using existing literature. We also try to propose a training algorithm for novice endoscopists.

  17. Clinical outcome and complications using a polyaxial locking plate in the treatment of displaced proximal humerus fractures. A reliable system?

    Science.gov (United States)

    Königshausen, M; Kübler, L; Godry, H; Citak, M; Schildhauer, T A; Seybold, D

    2012-02-01

    The surgical treatment of displaced proximal humeral fractures (ORIF) is a perpetual challenge to the surgeon. For this reason, the principle of polyaxiality was developed to provide an improved primary stability of the fracture through better anchorage of the screws, especially in osteoporotic bone. The aim of this study was to present clinical results with the polyaxial locking plate in the operative treatment of proximal humerus fractures in order to determine whether the technique of polyaxiality leads to better functional outcome and lower complication rates in comparison to monoaxial plates in the literature. Seventy-three patients with displaced proximal humeral fractures were treated surgically with the polyaxial locking Suture Plate™ (Arthrex(®)) between 03/2007 and 06/2009. Fifty-two of the patients (mean age, 69.9 ± 12.1) were included in a radiographical and clinical examination using the Constant score (CS) and the Disabilities of the Arm, Shoulder and Hand score (DASH). The follow-up examinations were on average 13.9 ± 4.5 months (10-27 months) after surgical treatment. The mean CS of the patients was 66.0 ± 13.7 points, the age- and gender-related CS was 90.9% ± 20.0% and the mean DASH score was 23.8 ± 19.8 points for the injured side. The patients with a nearly anatomical reduction of their fracture (n = 13) reached a significantly higher CS (75.1 ± 8.5; p = 0.004) and DASH-score (13.6 ± 11.6; p = 0.043) and none of these patients had a complication. The complications were identified in 12 (23.1%) cases, 5 of which involved loss of reduction. All of these 5 cases were lacking of initial medial column support and 4 of which were type C2.3 AO-Classification. The data show that the combination of angular stability with the possibility of variable polyaxial screw direction is a good concept for reduction and fixation of displaced proximal humeral fractures, but anatomical reduction and medial support remain important preconditions for a good

  18. How effective are interventions to improve social outcomes among offenders with personality disorder: a systematic review.

    Science.gov (United States)

    Connell, Catriona; Furtado, Vivek; McKay, Elizabeth A; Singh, Swaran P

    2017-11-17

    Offenders with personality disorder are supported by health, criminal justice, social care and third sector services. These services are tasked with reducing risk, improving health and improving social outcomes. Research has been conducted into interventions that reduce risk or improve health. However, interventions to improve social outcomes are less clearly defined. To review the effectiveness of interventions to improve social outcomes we conducted a systematic review using Cochrane methodology, expanded to include non-randomised trials. Anticipated high heterogeneity of the studies informed narrative synthesis. Eleven studies met inclusion criteria. Five contained extractable data. No high-quality studies were identified. Outcomes measured clustered around employment and social functioning. Interventions vary and their mechanisms for influencing social outcomes are poorly operationalised. Although change was observed in employment rates, there was no evidence for the effectiveness of these interventions. There is a lack of evidence for effective interventions that improve social outcomes. Further research is recommended to reach consensus on the outcomes of importance, identify the factors that influence these and design theoretically-informed and evidence-based interventions.

  19. Preimplantation genetic diagnosis to improve pregnancy outcomes in subfertility.

    Science.gov (United States)

    Simpson, Joe Leigh

    2012-12-01

    Pre-implantation genetic diagnosis provides prenatal genetic diagnosis before implantation, thus allowing detection of chromosomal abnormalities and their exclusion from embryo transfer in assisted reproductive technologies. Polar body, blastomere or trophectoderm can each be used to obtain requisite genetic or embryonic DNA. Pre-implantation genetic diagnosis for excluding unbalanced translocations is well accepted, and pre-implantation genetic diagnosis aneuploidy testing to avoid repeated pregnancy losses in couples having recurrent aneuploidy is efficacious in reducing miscarriages. Controversy remains about whether pre-implantation genetic diagnosis aneuploidy testing improves take home pregnancy rates, for which reason adherence to specific indications is recommended while the issue is being adjudicated. Current recommendations are for obligatory 24 chromosome testing, most readily using array comparative genome hybridisation. Copyright © 2012 Elsevier Ltd. All rights reserved.

  20. The reliability of in-training assessment when performance improvement is taken into account

    NARCIS (Netherlands)

    van Lohuizen, M.T.; Kuks, J.B.; van Hell, E.A.; Raat, A.N.; Stewart, R.E.; Cohen-Schotanus, J.

    2010-01-01

    During in-training assessment students are frequently assessed over a longer period of time and therefore it can be expected that their performance will improve. We studied whether there really is a measurable performance improvement when students are assessed over an extended period of time and how

  1. Improving Marking Reliability of Scientific Writing with the Developing Understanding of Assessment for Learning Programme

    Science.gov (United States)

    Bird, Fiona L.; Yucel, Robyn

    2013-01-01

    The Developing Understanding of Assessment for Learning (DUAL) programme was developed with the dual aims of improving both the quality and consistency of feedback students receive and the students' ability to use that feedback to improve. DUAL comprises a range of processes (including marking rubrics, sample reports, moderation discussions and…

  2. Managing congenital hyperinsulinism: improving outcomes with a multidisciplinary approach

    Directory of Open Access Journals (Sweden)

    Ackermann AM

    2015-07-01

    Full Text Available Amanda M Ackermann, Andrew A Palladino Division of Endocrinology and Diabetes, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA Abstract: Congenital hyperinsulinism (CHI is the most common cause of persistent hypoglycemia in pediatric patients and is associated with significant risk of hypoglycemic seizures and developmental delays. CHI results from mutations in at least nine genes that play a role in regulating beta-cell insulin secretion. Thus, patients with CHI have dysregulated insulin secretion that is unresponsive to blood glucose level. Each different genetic etiology of CHI is associated with particular clinical characteristics that affect management decisions. Given the broad phenotypic spectrum and relatively rare prevalence of CHI, it is important that patients with CHI be evaluated by clinicians experienced with CHI and the multiple subspecialty services that are necessary for the management of the disorder. In this review, we summarize the pathophysiology and genetic causes of CHI and then focus primarily on the most common genetic cause (mutations in the ATP-gated potassium [KATP] channel for further discussion of diagnosis, medical and surgical management, and potential acute and chronic complications. We provide insight from relevant published studies and reports, in addition to anecdotal information from our center’s clinical experience in caring for over 400 patients with CHI. Careful assessment of each patient’s individual pathophysiology is necessary to determine the appropriate treatment regimen, and continued close follow-up and monitoring of disease- and treatment-related complications are essential. Although significant improvements have been made in the past several years with regard to diagnosis and management, given the continued high morbidity rate in patients with CHI, improved diagnostic techniques and new therapeutic options would be welcomed. Keywords: hypoglycemia, hyperinsulinism, beta

  3. Novel prostate brachytherapy technique: Improved dosimetric and clinical outcome

    International Nuclear Information System (INIS)

    Nobes, Jenny P.; Khaksar, Sara J.; Hawkins, Maria A.; Cunningham, Melanie J.; Langley, Stephen E.M.; Laing, Robert W.

    2008-01-01

    Purpose: Erectile dysfunction following prostate brachytherapy is reported to be related to dose received by the penile bulb. To minimise this, whilst preserving prostate dosimetry, we have developed a technique for I-125 seed brachytherapy using both stranded seeds and loose seeds delivered with a Mick applicator, and implanted via the sagittal plane on trans-rectal ultrasound. Materials and methods: Post-implant dosimetry and potency rates were compared in 120 potent patients. In Group 1, 60 patients were treated using a conventional technique of seeds implanted in a modified-uniform distribution. From January 2005, a novel technique was developed using stranded seeds peripherally and centrally distributed loose seeds implanted via a Mick applicator (Group 2). The latter technique allows greater flexibility when implanting the seeds at the apex. Each patient was prescribed a minimum peripheral dose of 145 Gy. No patients received external beam radiotherapy or hormone treatment. There was no significant difference in age or pre-implant potency score (mean IIEF-5 score 22.4 vs. 22.6, p = 0.074) between the two groups. Results: The new technique delivers lower penile bulb doses (D 25 as %mPD - Group 1: 61.2 ± 35.7, Group 2: 29.7 ± 16.0, p 50 as %mPD - Group 1: 45.8 ± 26.9, Group 2: 21.4 ± 11.7, p 90 - Group 1: 147 Gy ± 21.1, Group 2: 155 Gy ± 16.7, p = 0.03). At 2 years, the potency rate was also improved: Group 1: 61.7%; Group 2: 83.3% (p = 0.008). Conclusions: In this study, the novel brachytherapy technique using both peripheral stranded seeds and central loose seeds delivered via a Mick applicator results in a lower penile bulb dose whilst improving prostate dosimetry, and may achieve higher potency rates

  4. Assessment and support during early labour for improving birth outcomes.

    Science.gov (United States)

    Kobayashi, Shinobu; Hanada, Nobutsugu; Matsuzaki, Masayo; Takehara, Kenji; Ota, Erika; Sasaki, Hatoko; Nagata, Chie; Mori, Rintaro

    2017-04-20

    The progress of labour in the early or latent phase is usually slow and may include painful uterine contractions. Women may feel distressed and lose their confidence during this phase. Support and assessment interventions have been assessed in two previous Cochrane Reviews. This review updates and replaces these two reviews, which have become out of date. To investigate the effectiveness of assessment and support interventions for women during early labour.In order to measure the effectiveness of the interventions, we compared the duration of labour, the rate of obstetrical interventions, and the rate of other maternal or neonatal outcomes. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register, ClinicalTrials.gov, the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (31 October 2016) and reference lists of retrieved studies. Randomised controlled trials of any assessment or support intervention in the latent phase of labour. We planned to include cluster-randomised trials if they were eligible. We did not include quasi-randomised trials. Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy. We resolved any disagreement by discussion or by involving a third assessor. The quality of the evidence was assessed using the GRADE approach. We included five trials with a total of 10,421 pregnant women in this review update. The trials were conducted in the UK, Canada and America. The trials compared interventions in early labour versus usual care. We examined three comparisons: early labour assessment versus immediate admission to hospital; home visits by midwives versus usual care (telephone triage); and one-to-one structured midwifery care versus usual care. These trials were at moderate- risk of bias mainly because blinding women and staff to these interventions is not generally feasible. For important outcomes we assessed evidence using

  5. Water chemistry data acquisition, processing, evaluation and diagnostic systems in Light Water Reactors: Future improvement of plant reliability and safety

    International Nuclear Information System (INIS)

    Uchida, S.; Takiguchi, H.; Ishigure, K.

    2006-01-01

    Data acquisition, processing and evaluation systems have been applied in major Japanese PWRs and BWRs to provide (1) reliable and quick data acquisition with manpower savings in plant chemical laboratories and (2) smooth and reliable information transfer among chemists, plant operators, and supervisors. Data acquisition systems in plants consist of automatic and semi-automatic instruments for chemical analyses, e. g., X-ray fluorescence analysis and ion chromatography, while data processing systems consist of PC base-sub-systems, e.g., data storage, reliability evaluation, clear display, and document preparation for understanding the plant own water chemistry trends. Precise and reliable evaluations of water chemistry data are required in order to improve plant reliability and safety. For this, quality assurance of the water chemistry data acquisition system is needed. At the same time, theoretical models are being applied to bridge the gaps between measured water chemistry data and the information desired to understand the interaction of materials and cooling water in plants. Major models which have already been applied for plant evaluation are: (1) water radiolysis models for BWRs and PWRs; (2) crevice radiolysis model for SCC in BWRs; and (3) crevice pH model for SG tubing in PWRs. High temperature water chemistry sensors and automatic plant diagnostic systems have been applied in only restricted areas. ECP sensors are gaining popularity as tools to determine the effects of hydrogen injection in BWR systems. Automatic plant diagnostic systems based on artificial intelligence will be more popular after having sufficient experience with off line diagnostic systems. (author)

  6. Improving Reliability of Service Operation Using FMEA Review and New Opportunity for Investigations

    Science.gov (United States)

    Sutrisno, Agung; Gunawan, Indra

    2016-01-01

    Despite its growing contribution to the global economy, investigation on the application status of service FMEA study to support realization of reliable service operation is very limited in literature. Motivated by such situation, the paper presented an initial survey on the status and research gaps in developing and applying FMEA in service sectors. Systematic preliminary survey using specific criteria are undertaken. Our study indicated that development and application of service FMEA are partially addressing the characteristics of service operations and it is still applied into the good deed and profit oriented operations. Opportunities for further investigation pertaining to advancement of its decision supporting tool for service risk appraisal, its modification to cope with sustainability related requirements and application of service FMEA in not for profit oriented operations are presented as new avenues for further investigation

  7. Improving Reliability of High Power Quasi-CW Laser Diode Arrays for Pumping Solid State Lasers

    Science.gov (United States)

    Amzajerdian, Farzin; Meadows, Byron L.; Baker, Nathaniel R.; Barnes, Bruce W.; Baggott, Renee S.; Lockard, George E.; Singh, Upendra N.; Kavaya, Michael J.

    2005-01-01

    Most Lidar applications rely on moderate to high power solid state lasers to generate the required transmitted pulses. However, the reliability of solid state lasers, which can operate autonomously over long periods, is constrained by their laser diode pump arrays. Thermal cycling of the active regions is considered the primary reason for rapid degradation of the quasi-CW high power laser diode arrays, and the excessive temperature rise is the leading suspect in premature failure. The thermal issues of laser diode arrays are even more drastic for 2-micron solid state lasers which require considerably longer pump pulses compared to the more commonly used pump arrays for 1-micron lasers. This paper describes several advanced packaging techniques being employed for more efficient heat removal from the active regions of the laser diode bars. Experimental results for several high power laser diode array devices will be reported and their performance when operated at long pulsewidths of about 1msec will be described.

  8. Using Model Replication to Improve the Reliability of Agent-Based Models

    Science.gov (United States)

    Zhong, Wei; Kim, Yushim

    The basic presupposition of model replication activities for a computational model such as an agent-based model (ABM) is that, as a robust and reliable tool, it must be replicable in other computing settings. This assumption has recently gained attention in the community of artificial society and simulation due to the challenges of model verification and validation. Illustrating the replication of an ABM representing fraudulent behavior in a public service delivery system originally developed in the Java-based MASON toolkit for NetLogo by a different author, this paper exemplifies how model replication exercises provide unique opportunities for model verification and validation process. At the same time, it helps accumulate best practices and patterns of model replication and contributes to the agenda of developing a standard methodological protocol for agent-based social simulation.

  9. Improving Wind Turbine Drivetrain Reliability Using a Combined Experimental, Computational, and Analytical Approach

    Energy Technology Data Exchange (ETDEWEB)

    Guo, Y.; van Dam, J.; Bergua, R.; Jove, J.; Campbell, J.

    2015-03-01

    Nontorque loads induced by the wind turbine rotor overhang weight and aerodynamic forces can greatly affect drivetrain loads and responses. If not addressed properly, these loads can result in a decrease in gearbox component life. This work uses analytical modeling, computational modeling, and experimental data to evaluate a unique drivetrain design that minimizes the effects of nontorque loads on gearbox reliability: the Pure Torque(R) drivetrain developed by Alstom. The drivetrain has a hub-support configuration that transmits nontorque loads directly into the tower rather than through the gearbox as in other design approaches. An analytical model of Alstom's Pure Torque drivetrain provides insight into the relationships among turbine component weights, aerodynamic forces, and the resulting drivetrain loads. Main shaft bending loads are orders of magnitude lower than the rated torque and are hardly affected by wind conditions and turbine operations.

  10. A new method for improving the reliability of fracture toughness surveillance of nuclear pressure vessel by neutron irradiated embrittlement

    International Nuclear Information System (INIS)

    Zhang Xinping; Shi Yaowu

    1992-01-01

    In order to obtain more information from neutron irradiated sample specimens and raise the reliability of fracture toughness surveillance test, it has more important significance to repeatedly exploit the broken Charpy-size specimen which had been tested in surveillance test. In this work, on the renewing design and utilization for Charpy-size specimens, 9 data of fracture toughness can be gained from one pre-cracked side-grooved Charpy-size specimen while at the preset usually only 1 to 3 data of fracture toughness can be obtained from one Chharpy-size specimen. Thus, it is found that the new method would obviously improve the reliability of fracture toughness surveillance test and evaluation. Some factors which affect the reasonable design of pre-cracked deep side-groove Charpy-size compound specimen have been discussed

  11. Reliability improvement of PMZNT relaxor ferroelectrics through surface modification by MnO2 doping against electroplating-induced degradation

    International Nuclear Information System (INIS)

    Cao Jiangli; Li Longtu; Gui Zhilun

    2003-01-01

    Electroplating treatment, scanning electron microscopy (SEM) observation, X-ray photoelectron spectroscopy (XPS) and X-ray diffraction (XRD) analyses were conducted to investigate the reliability improvement of lead magnesium niobate-based ceramics (PMZNT) through MnO 2 vaporous doping against hydrogen reduction during electroplating. The results showed that manganese dopant was reduced to be +3 oxidation state during the sintering and Mn 3+ was incorporated into the perovskite lattice; however, only the outermost ceramics surface was doped while 50 μm beneath kept unchanged. This technique proved to enhance the reliability of PMZNT against electroplating significantly without changing the dielectric properties of ceramics body. Based on the above results, the modification mechanism of MnO 2 vaporous doping was analyzed from the viewpoint of defect chemistry

  12. Improving accuracy of overhanging structures for selective laser melting through reliability characterization of single track formation on thick powder beds

    DEFF Research Database (Denmark)

    Mohanty, Sankhya; Hattel, Jesper Henri

    2016-01-01

    Repeatability and reproducibility of parts produced by selective laser melting is a standing issue, and coupled with a lack of standardized quality control presents a major hindrance towards maturing of selective laser melting as an industrial scale process. Consequently, numerical process...... modelling has been adopted towards improving the predictability of the outputs from the selective laser melting process. Establishing the reliability of the process, however, is still a challenge, especially in components having overhanging structures.In this paper, a systematic approach towards...... establishing reliability of overhanging structure production by selective laser melting has been adopted. A calibrated, fast, multiscale thermal model is used to simulate the single track formation on a thick powder bed. Single tracks are manufactured on a thick powder bed using same processing parameters...

  13. Customized Care: An intervention to Improve Communication and health outcomes in multimorbidity

    Directory of Open Access Journals (Sweden)

    Marsha N. Wittink

    2016-12-01

    Conclusions: With better communication about everyday challenges, patients and PCPs can have more informed discussions about health care options that positively influence patient outcomes. We expect that Customized Care will improve patient-PCP communication about day-to-day challenges, which can lead to better health outcomes.

  14. Improvement of mechanical reliability by patterned silver/Indium-Tin-Oxide structure for flexible electronic devices

    International Nuclear Information System (INIS)

    Baek, Kyunghyun; Jang, Kyungsoo; Lee, Youn-Jung; Ryu, Kyungyul; Choi, Woojin; Kim, Doyoung; Yi, Junsin

    2013-01-01

    We report the effect of silver (Ag)-buffer layer Indium-Tin-Oxide (ITO) film on a polyethylene terephthalate substrate on the electrical, optical and reliable properties for transparent–flexible displays. The electrical and optical characteristics of an ITO-only film and an Ag-layer-inserted ITO film are measured and compared to assess the applicability of the triple layered structure in flexible displays. The sheet resistance, the resistivity and the light transmittance of the ITO-only film were 400 Ω/sq, 1.33 × 10 −3 Ω-cm and 99.2%, while those of the ITO film inserted with a 10 nm thick Ag layer were 165 Ω/sq, 4.78 × 10 −4 Ω-cm and about 97%, respectively. To evaluate the mechanical reliability of the different ITO films, bending tests were carried out. After the dynamic bending test of 900 cycles, the sheet resistance of the ITO film inserted with the Ag layer changed from 154 Ω/sq to 475 Ω/sq, about a 3-time increase but that of the ITO-only film changed from 400 Ω/sq to 61,986 Ω/sq, about 150-time increase. When the radius is changed from 25 mm to 20 mm in the static bending test, the sheet resistance of the ITO-only film changed from 400 to 678.3 linearly whereas that of the Ag-layer inserted ITO film changed a little from 154.4 to 154.9. These results show that Ag-layer inserted ITO film had better mechanical characteristics than the ITO-only film. - Highlights: ► Transparent flexible electrode fabricated on glass substrate. ► Electrode fabricated using vertically-patterned design on glass substrate. ► Optimization of the vertical patterns ► Application of the vertically-patterned electrode in transparent–flexible electronics

  15. Improving preimplantation genetic diagnosis (PGD) reliability by selection of sperm donor with the most informative haplotype.

    Science.gov (United States)

    Malcov, Mira; Gold, Veronica; Peleg, Sagit; Frumkin, Tsvia; Azem, Foad; Amit, Ami; Ben-Yosef, Dalit; Yaron, Yuval; Reches, Adi; Barda, Shimi; Kleiman, Sandra E; Yogev, Leah; Hauser, Ron

    2017-04-26

    The study is aimed to describe a novel strategy that increases the accuracy and reliability of PGD in patients using sperm donation by pre-selecting the donor whose haplotype does not overlap the carrier's one. A panel of 4-9 informative polymorphic markers, flanking the mutation in carriers of autosomal dominant/X-linked disorders, was tested in DNA of sperm donors before PGD. Whenever the lengths of donors' repeats overlapped those of the women, additional donors' DNA samples were analyzed. The donor that demonstrated the minimal overlapping with the patient was selected for IVF. In 8 out of 17 carriers the markers of the initially chosen donors overlapped the patients' alleles and 2-8 additional sperm donors for each patient were haplotyped. The selection of additional sperm donors increased the number of informative markers and reduced misdiagnosis risk from 6.00% ± 7.48 to 0.48% ±0.68. The PGD results were confirmed and no misdiagnosis was detected. Our study demonstrates that pre-selecting a sperm donor whose haplotype has minimal overlapping with the female's haplotype, is critical for reducing the misdiagnosis risk and ensuring a reliable PGD. This strategy may contribute to prevent the transmission of affected IVF-PGD embryos using a simple and economical procedure. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. DNA testing of donors was approved by the institutional Helsinki committee (registration number 319-08TLV, 2008). The present study was approved by the institutional Helsinki committee (registration number 0385-13TLV, 2013).

  16. High-risk bladder cancer: improving outcomes with perioperative chemotherapy

    Directory of Open Access Journals (Sweden)

    Daniel Y.C. Heng

    2011-12-01

    Full Text Available Despite treatment with radical cystectomy and pelvic lymph node dissection, muscle invasive bladder cancer has a relapse rate of 50%. Patients can develop regionally advanced or metastatic disease that ultimately leads to death. The addition of neoadjuvant or adjuvant chemotherapy to reduce the risk of relapse and death has been extensively studied over the past two decades. Two contemporary trials coupled with a recent meta-analysis evaluating neoadjuvant chemotherapy demonstrated a modest but real improvement in overall survival. This has made neoadjuvant chemotherapy a standard of care. Clinical trials evaluating adjuvant chemotherapy in patients with high-risk disease have been plagued with statistical flaws and have, therefore, been unable to define the survival impact of this approach. It is hoped that ongoing adjuvant trials that are powered to detect small but meaningful clinical differences will clarify the benefit of chemotherapy after cystectomy. Since there are theoretical advantages and disadvantages to each of these approaches, both are widely used in North America. The evidence behind each approach and potential future developments in this field will be described.

  17. Machine perfusion for improving outcomes following renal transplant: current perspectives

    Directory of Open Access Journals (Sweden)

    Cannon RM

    2016-03-01

    Full Text Available Robert M Cannon,1 Glen A Franklin1,2 1The Hiram C Polk Jr MD Department of Surgery, University of Louisville, 2Kentucky Organ Donor Affiliates, Louisville, KY, USAAbstract: There is a disparity between the number of kidneys available for transplantation and the number of patients awaiting an organ while on dialysis. The current kidney waiting list in the US contains more than 100,000 patients. This need has led to the inclusion of older donors with worsening renal function, as well as greater utilization of kidneys from non-heartbeating (donation after cardiac death donors. Coinciding with this trend has been a growing interest in technology to improve the function of these more marginal organs, the most important of which currently is machine perfusion (MP of donated kidneys after procurement. While this technology has no standard guidelines currently for comprehensive use, there are many studies that demonstrate higher organ yield and function after a period of MP. Particularly with the older donor and during donation after cardiac death cases, MP may offer some significant benefits. This manuscript reviews all of the current literature regarding MP and its role in renal transplantation. We will discuss both the experience in Europe and the US using machine perfusion for donated kidneys.Keywords: machine perfusion, renal transplantation, kidney pumping, renal failure, organ donation

  18. The Reliability and Validity of the Outcome Rating Scale: A Replication Study of a Brief Clinical Measure

    National Research Council Canada - National Science Library

    Bringhurst, David L; Watson, Curtis W; Miller, Scott D; Duncan, Barry L

    2004-01-01

    ... (Miller, Duncan, Brown, Sparks, AND Claud, 2003). This article reports the findings of an independent replication study evaluating the reliability and concurrent validity of the ORS as studied in a non-clinical sample...

  19. Low cost corrosion and oxidation resistant coatings for improved system reliability, Phase I

    Data.gov (United States)

    National Aeronautics and Space Administration — In order to improve high-temperature oxidation and corrosion resistance of critical superalloy components in turbine engines innovative processing methods must be...

  20. Validity and reliability of the Dutch version of the Copenhagen Hip And Groin Outcome Score (HAGOS-NL in patients with hip pathology.

    Directory of Open Access Journals (Sweden)

    Hilde Giezen

    Full Text Available The Copenhagen Hip And Groin Outcome Score (HAGOS was developed to assess disease-specific consequences in young to middle-aged, physically active hip and/or groin patients. The study aimed to determine validity and reliability of the Dutch version of the HAGOS (HAGOS-NL for middle-aged patients with hip complaints.To assess validity, 117 participants completed five questionnaires: HAGOS-NL, international Hip Outcome Tool (iHOT-12NL, Hip disability and Osteoarthritis Outcome Score (HOOS, RAND-36 Health Survey and Tegner activity scale. Structural validity was determined by conducting confirmatory factor analysis. Construct validity was analyzed by formulating predefined hypotheses regarding relationships between the HAGOS-NL and subscales of the iHOT-12NL, HOOS, RAND-36 and Tegner activity scale. The HAGOS-NL was filled out again by 67 patients to explore test-retest reliability. Reliability was assessed in terms of Cronbach's alpha, Intraclass Correlation Coefficient (ICC, Standard Error of Measurement (SEM and Minimal Detectable Change (MDC. The Bland and Altman method was used to explore absolute agreement.Factor analysis confirmed that the HAGOS-NL consists of six subscales. All hypotheses were confirmed, indicating good construct validity. Internal consistency was good, with Cronbach's alpha values ranging from 0.89 to 0.98. Test-retest reliability was considered good, with ICC values of 0.80 and higher. The SEM ranged from 6.6 to 12.3, and MDC at individual level from 18.3 to 34.1 and at group level from 2.3 to 4.4. Bland and Altman analyses showed no bias.The HAGOS-NL is a reliable and valid instrument for measuring pain, physical functioning and quality of life in middle-aged patients with hip complaints.

  1. Nuclear power plant safety and reliability improvements derived from operational experience analysis

    International Nuclear Information System (INIS)

    Zebroski, E.L.; Rosen, S.L.

    1983-01-01

    The frequency and distribution of significant events at operating nuclear power plants can be used as one of several indices to obtain a preliminary indication of unit and/or utility performance in the development and implementation of improvements aimed at reducing the probability or consequences of troublesome events. Initial data of this type are presented along with qualifications on the validity of such indicators. Planned further steps to improve this as a performance indicator are noted

  2. Improving Neurodevelopmental Outcomes in Children with Congenital Heart Disease: An Intervention Study

    Science.gov (United States)

    2017-10-01

    AWARD NUMBER: W81XWH-16-1-0741 TITLE: Improving Neurodevelopmental Outcomes in Children with Congenital Heart Disease: An Intervention Study...2017 4. TITLE AND SUBTITLE Improving Neurodevelopmental Outcomes in Children with Congenital Heart Disease: An Intervention Study 5a. CONTRACT NUMBER...the most prevalent, and arguably the most distressing, long-term morbidity in the burgeoning population with congenital heart disease (CHD). Deficits

  3. Role of video games in improving health-related outcomes: a systematic review.

    Science.gov (United States)

    Primack, Brian A; Carroll, Mary V; McNamara, Megan; Klem, Mary Lou; King, Brandy; Rich, Michael; Chan, Chun W; Nayak, Smita

    2012-06-01

    Video games represent a multibillion-dollar industry in the U.S. Although video gaming has been associated with many negative health consequences, it also may be useful for therapeutic purposes. The goal of this study was to determine whether video games may be useful in improving health outcomes. Literature searches were performed in February 2010 in six databases: the Center on Media and Child Health Database of Research, MEDLINE, CINAHL, PsycINFO, EMBASE, and the Cochrane Central Register of Controlled Trials. Reference lists were hand-searched to identify additional studies. Only RCTs that tested the effect of video games on a positive, clinically relevant health consequence were included. Study selection criteria were strictly defined and applied by two researchers working independently. Study background information (e.g., location, funding source); sample data (e.g., number of study participants, demographics); intervention and control details; outcomes data; and quality measures were abstracted independently by two researchers. Of 1452 articles retrieved using the current search strategy, 38 met all criteria for inclusion. Eligible studies used video games to provide physical therapy, psychological therapy, improved disease self-management, health education, distraction from discomfort, increased physical activity, and skills training for clinicians. Among the 38 studies, a total of 195 health outcomes were examined. Video games improved 69% of psychological therapy outcomes, 59% of physical therapy outcomes, 50% of physical activity outcomes, 46% of clinician skills outcomes, 42% of health education outcomes, 42% of pain distraction outcomes, and 37% of disease self-management outcomes. Study quality was generally poor; for example, two thirds (66%) of studies had follow-up periods of video games to improve health outcomes, particularly in the areas of psychological therapy and physical therapy. RCTs with appropriate rigor will help build evidence in this

  4. Reliability and construct validity of the Spanish version of the 6-item CTS symptoms scale for outcomes assessment in carpal tunnel syndrome.

    Science.gov (United States)

    Rosales, Roberto S; Martin-Hidalgo, Yolanda; Reboso-Morales, Luis; Atroshi, Isam

    2016-03-03

    The purpose of this study was to assess the reliability and construct validity of the Spanish version of the 6-item carpal tunnel syndrome (CTS) symptoms scale (CTS-6). In this cross-sectional study 40 patients diagnosed with CTS based on clinical and neurophysiologic criteria, completed the standard Spanish versions of the CTS-6 and the disabilities of the arm, shoulder and hand (QuickDASH) scales on two occasions with a 1-week interval. Internal-consistency reliability was assessed with the Cronbach alpha coefficient and test-retest reliability with the intraclass correlation coefficient, two way random effect model and absolute agreement definition (ICC2,1). Cross-sectional precision was analyzed with the Standard Error of the Measurement (SEM). Longitudinal precision for test-retest reliability coefficient was assessed with the Standard Error of the Measurement difference (SEMdiff) and the Minimal Detectable Change at 95 % confidence level (MDC95). For assessing construct validity it was hypothesized that the CTS-6 would have a strong positive correlation with the QuickDASH, analyzed with the Pearson correlation coefficient (r). The standard Spanish version of the CTS-6 presented a Cronbach alpha of 0.81 with a SEM of 0.3. Test-retest reliability showed an ICC of 0.85 with a SRMdiff of 0.36 and a MDC95 of 0.7. The correlation between CTS-6 and the QuickDASH was concordant with the a priori formulated construct hypothesis (r 0.69) CONCLUSIONS: The standard Spanish version of the 6-item CTS symptoms scale showed good internal consistency, test-retest reliability and construct validity for outcomes assessment in CTS. The CTS-6 will be useful to clinicians and researchers in Spanish speaking parts of the world. The use of standardized outcome measures across countries also will facilitate comparison of research results in carpal tunnel syndrome.

  5. Platlet Rich Plasma (PRP) Improves Fat Grafting Outcomes.

    Science.gov (United States)

    Modarressi, Ali

    2013-01-01

    Autologous fat transfer offers many qualities of a ideal soft tissue filler. Main advantages of fat grafting ensue from the fact that the lipoaspirate tissue is an abundant source of regenerative pluripotential cells. However, the reported rates of fat cell survival vary greatly in the medical literature (10-90%). Different techniques of harvesting, processing, and reinjecting the fat cells are so claimed to be responsible for these differences, without any agreement concerning the best way to process. To address this important disadvantage, we propose the addition of autologous platelet rich plasma (PRP) which is known as a natural reservoir of growth factors stimulating tissue repair and regeneration. This approach is completely autologous and immediately employed without any type of preconditioning. Platelets rich plasma (PRP) preparation included bleeding of 8 ml of blood from patient's peripheral vein in Regen Lab© tubes containing sodium citrate anticoagulant. The whole blood was centrifugated at 1500 g during 3 min. As Regen-tubes contained a special gel separator, 99 % of red blood cells were discarded from the plasma at the bottom of the gel, and >90% of platelets were harvested in 4 ml of plasma on the top of the gel, called the platelet-rich plasma (PRP). The purified fat prepared by Coleman technique was mixed with different amount of PRP for in vitro, in vivo (mice) and clinical experiments: >50% of PRP for skin rejuvenation, superficial scars correction, infraorbital region, ..., and for 20% of PRP with 80% of purified fat for deep filler indication (nasolabial folds, lips, or soft tissue defect). In vitro studies demonstrated that PRP increased fat cells survival rate and stem cells differentiation. Animal models showed that fat graft survival rate was significantly increased by addition of PRP. Several clinical cases confirmed the improvement of wound healing and fat grafting survival in facial reconstruction and aesthetic cases by association of

  6. Assessment of reliability, validity, responsiveness and minimally important change of the German Hip dysfunction and osteoarthritis outcome score (HOOS) in patients with osteoarthritis of the hip.

    Science.gov (United States)

    Arbab, Dariusch; van Ochten, Johannes H M; Schnurr, Christoph; Bouillon, Bertil; König, Dietmar

    2017-12-01

    Patient-reported outcome measures are a critical tool in evaluating the efficacy of orthopedic procedures. The intention of this study was to evaluate reliability, validity, responsiveness and minimally important change of the German version of the Hip dysfunction and osteoarthritis outcome score (HOOS). The German HOOS was investigated in 251 consecutive patients before and 6 months after total hip arthroplasty. All patients completed HOOS, Oxford-Hip Score, Short-Form (SF-36) and numeric scales for pain and disability. Test-retest reliability, internal consistency, floor and ceiling effects, construct validity and minimal important change were analyzed. The German HOOS demonstrated excellent test-retest reliability with intraclass correlation coefficient values > 0.7. Cronbach´s alpha values demonstrated strong internal consistency. As hypothesized, HOOS subscales strongly correlated with corresponding OHS and SF-36 domains. All subscales showed excellent (effect size/standardized response means > 0.8) responsiveness between preoperative assessment and postoperative follow-up. The HOOS and all subdomains showed higher changes than the minimal detectable change which indicates true changes. The German version of the HOOS demonstrated good psychometric properties. It proved to be valid, reliable and responsive to the changes instrument for use in patients with hip osteoarthritis undergoing total hip replacement.

  7. Improving Predictions with Reliable Extrapolation Schemes and Better Understanding of Factorization

    Science.gov (United States)

    More, Sushant N.

    New insights into the inter-nucleon interactions, developments in many-body technology, and the surge in computational capabilities has led to phenomenal progress in low-energy nuclear physics in the past few years. Nonetheless, many calculations still lack a robust uncertainty quantification which is essential for making reliable predictions. In this work we investigate two distinct sources of uncertainty and develop ways to account for them. Harmonic oscillator basis expansions are widely used in ab-initio nuclear structure calculations. Finite computational resources usually require that the basis be truncated before observables are fully converged, necessitating reliable extrapolation schemes. It has been demonstrated recently that errors introduced from basis truncation can be taken into account by focusing on the infrared and ultraviolet cutoffs induced by a truncated basis. We show that a finite oscillator basis effectively imposes a hard-wall boundary condition in coordinate space. We accurately determine the position of the hard-wall as a function of oscillator space parameters, derive infrared extrapolation formulas for the energy and other observables, and discuss the extension of this approach to higher angular momentum and to other localized bases. We exploit the duality of the harmonic oscillator to account for the errors introduced by a finite ultraviolet cutoff. Nucleon knockout reactions have been widely used to study and understand nuclear properties. Such an analysis implicitly assumes that the effects of the probe can be separated from the physics of the target nucleus. This factorization between nuclear structure and reaction components depends on the renormalization scale and scheme, and has not been well understood. But it is potentially critical for interpreting experiments and for extracting process-independent nuclear properties. We use a class of unitary transformations called the similarity renormalization group (SRG) transformations to

  8. Improving the Transmission System Reliability for the 154kV Radial Network Operation

    Energy Technology Data Exchange (ETDEWEB)

    Choo, Jin Boo; Yoo, Myeong Ho; Yoon, Young Beum; Kim, Tae Won [Korea Electric Power Research Institute, Taejon (Korea, Republic of); Lee, Gi Won; Chung, Beom Jin; Jung, Jung Won; Park, Kyu Hyun; Lee, Myung Hee; Kim, Hyun Jong; Kim, Chae Hee [KEYIN CO., (Korea, Republic of)

    1996-12-31

    Analyzing that 154kV radial network current ed operated, we developed Automatic Power Reconfiguration System(APRS) which restore blackout area. It consists of special data acquisition system(DAU) and central monitoring system for reason of protecting currently operating power system. In addition, it communicates using optical communication network for high speed data transmission and accuracy. An Accuracy of operation and stability of the developed system is tested using Real Time Digital Simulator in 3-bus equivalent model system. In An Outage case, our developed system can restore a blackout area in three second. An ability of the restoration of a blackout was verified by simulations. For the field test, the developed system was set up at SINCHON S/S, SESOMUN S/S, SINDANG S/S and MAJANG S/S governed by Seoul Power Transmission Center. If the system reliability is proved for a one year test in real power system, application of the system will be extended to the other substations.

  9. [Improving care for cleft lip and palate patients: uniform and patient-orientated outcome measures].

    Science.gov (United States)

    Haj, M; de Gier, H H W; van Veen-van der Hoek, M; Versnel, S L; van Adrichem, L N; Wolvius, E B; Hazelzet, J A; Koudstaal, M J

    2018-02-01

    The quality of care for patients with cleft lip and palate is extremely variable across the world. Treatment protocols differ and methods of data registration are not uniform. Improving this care by means of comparative research is challenging. The best treatment programmes can be identified by uniformly registering patient-orientated outcomes and comparing the outcomes with those of other treatment centres. That knowledge can be used to improve one's own care. An international team consisting of specialists and cleft lip and palate patients has developed a set of outcome measures that are considered by patients to be most important. This team is coordinated by the International Consortium of Health Outcomes Measurement (ICHOM). The cleft lip and palate outcome set can be used by all centres worldwide in following up on cleft lip and palate patients. In the Erasmus Medical Centre in Rotterdam, the 'Zorgmonitor Schisis' (Care Monitor Cleft Lip and Palate) has been built, an application in which these outcome measures are collected at fixed times. Implementing this set of outcome measures in other cleft lip and palate treatment centres and using the outcomes as (inter)national benchmarks will result in transparency and the improvement of the treatment of cleft lip and palate worldwide.

  10. Brachial plexus surgery: the role of the surgical technique for improvement of the functional outcome

    Directory of Open Access Journals (Sweden)

    Leandro Pretto Flores

    2011-08-01

    Full Text Available OBJECTIVE: The study aims to demonstrate the techniques employed in surgery of the brachial plexus that are associated to evidence-based improvement of the functional outcome of these patients. METHOD: A retrospective study of one hundred cases of traumatic brachial plexus injuries. Comparison between the postoperative outcomes associated to some different surgical techniques was demonstrated. RESULTS: The technique of proximal nerve roots grafting was associated to good results in about 70% of the cases. Significantly better outcomes were associated to the Oberlin's procedure and the Sansak's procedure, while the improvement of outcomes associated to phrenic to musculocutaneous nerve and the accessory to suprascapular nerve transfer did not reach statistical significance. Reinnervation of the hand was observed in less than 30% of the cases. CONCLUSION: Brachial plexus surgery renders satisfactory results for reinnervation of the proximal musculature of the upper limb, however the same good outcomes are not usually associated to the reinnervation of the hand.

  11. Reliability database of IEA-R1 Brazilian research reactor: Applications to the improvement of installation safety

    International Nuclear Information System (INIS)

    Oliveira, P.S.P.; Tondin, J.B.M.; Martins, M.O.; Yovanovich, M.; Ricci Filho, W.

    2010-01-01

    In this paper the main features of the reliability database being developed at Ipen-Cnen/SP for IEA-R1 reactor are briefly described. Besides that, the process for collection and updating of data regarding operation, failure and maintenance of IEA-R1 reactor components is presented. These activities have been conducted by the reactor personnel under the supervision of specialists in Probabilistic Safety Analysis (PSA). The compilation of data and subsequent calculation are based on the procedures defined during an IAEA Coordinated Research Project which Brazil took part in the period from 2001 to 2004. In addition to component reliability data, the database stores data on accident initiating events and human errors. Furthermore, this work discusses the experience acquired through the development of the reliability database covering aspects like improvements in the reactor records as well as the application of the results to the optimization of operation and maintenance procedures and to the PSA carried out for IEA-R1 reactor. (author)

  12. Get rid of it: To what extent might improved reliability reduce self-generation in Nigeria?

    International Nuclear Information System (INIS)

    Oseni, Musiliu O.

    2016-01-01

    Despite the global concerns surrounding the threats of climate change to both human health and sustainable environments, gasoline- or diesel-powered generators with non-negligible emissions have become a popular choice among Nigerian households due to the poor publicly provided electricity. This study examines the extent to which an improvement in publicly supplied electricity may reduce backup generation and, by implication, reduce emissions from Nigerian homes. The results from a random-effects probit analysis reveal that, although improved electricity service quality would significantly reduce self-generation, self-generation would continue in the country, especially among rich and educated households. The study concludes by highlighting the policy implications of the findings. - Highlights: •We study how improved electricity supply might reduce self-generation in Nigeria. •Households use their generators less than 40% of times they suffer outages. •Improved service quality would significantly reduce self-generation. •However, self-generation would continue among rich and educated households. •Import tariff and pollution tax can be used to further reduce self-generation.

  13. Value Driven Outcomes (VDO): a pragmatic, modular, and extensible software framework for understanding and improving health care costs and outcomes.

    Science.gov (United States)

    Kawamoto, Kensaku; Martin, Cary J; Williams, Kip; Tu, Ming-Chieh; Park, Charlton G; Hunter, Cheri; Staes, Catherine J; Bray, Bruce E; Deshmukh, Vikrant G; Holbrook, Reid A; Morris, Scott J; Fedderson, Matthew B; Sletta, Amy; Turnbull, James; Mulvihill, Sean J; Crabtree, Gordon L; Entwistle, David E; McKenna, Quinn L; Strong, Michael B; Pendleton, Robert C; Lee, Vivian S

    2015-01-01

    To develop expeditiously a pragmatic, modular, and extensible software framework for understanding and improving healthcare value (costs relative to outcomes). In 2012, a multidisciplinary team was assembled by the leadership of the University of Utah Health Sciences Center and charged with rapidly developing a pragmatic and actionable analytics framework for understanding and enhancing healthcare value. Based on an analysis of relevant prior work, a value analytics framework known as Value Driven Outcomes (VDO) was developed using an agile methodology. Evaluation consisted of measurement against project objectives, including implementation timeliness, system performance, completeness, accuracy, extensibility, adoption, satisfaction, and the ability to support value improvement. A modular, extensible framework was developed to allocate clinical care costs to individual patient encounters. For example, labor costs in a hospital unit are allocated to patients based on the hours they spent in the unit; actual medication acquisition costs are allocated to patients based on utilization; and radiology costs are allocated based on the minutes required for study performance. Relevant process and outcome measures are also available. A visualization layer facilitates the identification of value improvement opportunities, such as high-volume, high-cost case types with high variability in costs across providers. Initial implementation was completed within 6 months, and all project objectives were fulfilled. The framework has been improved iteratively and is now a foundational tool for delivering high-value care. The framework described can be expeditiously implemented to provide a pragmatic, modular, and extensible approach to understanding and improving healthcare value. © The Author 2014. Published by Oxford University Press on behalf of the American Medical Informatics Association.

  14. Value Driven Outcomes (VDO): a pragmatic, modular, and extensible software framework for understanding and improving health care costs and outcomes

    Science.gov (United States)

    Kawamoto, Kensaku; Martin, Cary J; Williams, Kip; Tu, Ming-Chieh; Park, Charlton G; Hunter, Cheri; Staes, Catherine J; Bray, Bruce E; Deshmukh, Vikrant G; Holbrook, Reid A; Morris, Scott J; Fedderson, Matthew B; Sletta, Amy; Turnbull, James; Mulvihill, Sean J; Crabtree, Gordon L; Entwistle, David E; McKenna, Quinn L; Strong, Michael B; Pendleton, Robert C; Lee, Vivian S

    2015-01-01

    Objective To develop expeditiously a pragmatic, modular, and extensible software framework for understanding and improving healthcare value (costs relative to outcomes). Materials and methods In 2012, a multidisciplinary team was assembled by the leadership of the University of Utah Health Sciences Center and charged with rapidly developing a pragmatic and actionable analytics framework for understanding and enhancing healthcare value. Based on an analysis of relevant prior work, a value analytics framework known as Value Driven Outcomes (VDO) was developed using an agile methodology. Evaluation consisted of measurement against project objectives, including implementation timeliness, system performance, completeness, accuracy, extensibility, adoption, satisfaction, and the ability to support value improvement. Results A modular, extensible framework was developed to allocate clinical care costs to individual patient encounters. For example, labor costs in a hospital unit are allocated to patients based on the hours they spent in the unit; actual medication acquisition costs are allocated to patients based on utilization; and radiology costs are allocated based on the minutes required for study performance. Relevant process and outcome measures are also available. A visualization layer facilitates the identification of value improvement opportunities, such as high-volume, high-cost case types with high variability in costs across providers. Initial implementation was completed within 6 months, and all project objectives were fulfilled. The framework has been improved iteratively and is now a foundational tool for delivering high-value care. Conclusions The framework described can be expeditiously implemented to provide a pragmatic, modular, and extensible approach to understanding and improving healthcare value. PMID:25324556

  15. Multimodal Perioperative Analgesia Regimen to Improve Patient Outcomes After Total Knee Arthroplasty: A Multidisciplinary Quality Improvement Project.

    Science.gov (United States)

    Donahue, Rebecca E; Bradbury, George R; Zychowicz, Michael E; Muckler, Virginia C

    2018-04-01

    The primary aim of this quality improvement project was to improve mobilization for patients after total knee arthroscopy by developing and implementing a standardized, evidence-based, multimodal analgesia regimen and patient-educational video. Secondary outcomes included opioid consumption, pain, and length of stay. A pre-post implementation design was used to compare two independent samples. Patients were screened based on inclusion and exclusion criteria 1-2 weeks before surgery. The anesthesia provider made the final determination for inclusion. Data were collected by retrospective chart review. Following implementation, patients displayed significantly improved mobilization, reduced opioid consumption, and reduced length of stay. Patient-reported pain scores were similar or significantly lower in the postimplementation group. Variability of patient outcomes was reduced, and quality of care was improved by standardizing care and incorporating the best available evidence, consistent with organization's resources in the nonacademic-affiliated, community hospital setting. Published by Elsevier Inc.

  16. The theory of music, mood and movement to improve health outcomes.

    Science.gov (United States)

    Murrock, Carolyn J; Higgins, Patricia A

    2009-10-01

    This paper presents a discussion of the development of a middle-range nursing theory of the effects of music on physical activity and improved health outcomes. Due to the high rate of physical inactivity and the associated negative health outcomes worldwide, nurses need new evidence-based theories and interventions to increase physical activity. The theory of music, mood and movement (MMM) was developed from physical activity guidelines and music theory using the principles of statement and theory synthesis. The concepts of music, physical activity and health outcomes were searched using the CINAHL, MEDLINE, ProQuest Nursing and Allied Health Source, PsycINFO and Cochrane Library databases covering the years 1975-2008. The theory of MMM was synthesized by combining the psychological and physiological responses of music to increase physical activity and improve health outcomes. It proposes that music alters mood, is a cue for movement, and makes physical activity more enjoyable leading to improved health outcomes of weight, blood pressure, blood sugar and cardiovascular risk factor management, and improved quality of life. As it was developed from the physical activity guidelines, the middle-range theory is prescriptive, produces testable hypotheses, and can guide nursing research and practice. The middle-range theory needs to be tested to determine its usefulness for nurses to develop physical activity programmes to improve health outcomes across various cultures.

  17. Improvement of Reliability of Diffusion Tensor Metrics in Thigh Skeletal Muscles.

    Science.gov (United States)

    Keller, Sarah; Chhabra, Avneesh; Ahmed, Shaheen; Kim, Anne C; Chia, Jonathan M; Yamamura, Jin; Wang, Zhiyue J

    2018-05-01

    Quantitative diffusion tensor imaging (DTI) of skeletal muscles is challenging due to the bias in DTI metrics, such as fractional anisotropy (FA) and mean diffusivity (MD), related to insufficient signal-to-noise ratio (SNR). This study compares the bias of DTI metrics in skeletal muscles via pixel-based and region-of-interest (ROI)-based analysis. DTI of the thigh muscles was conducted on a 3.0-T system in N = 11 volunteers using a fat-suppressed single-shot spin-echo echo planar imaging (SS SE-EPI) sequence with eight repetitions (number of signal averages (NSA) = 4 or 8 for each repeat). The SNR was calculated for different NSAs and estimated for the composite images combining all data (effective NSA = 48) as standard reference. The bias of MD and FA derived by pixel-based and ROI-based quantification were compared at different NSAs. An "intra-ROI diffusion direction dispersion angle (IRDDDA)" was calculated to assess the uniformity of diffusion within the ROI. Using our standard reference image with NSA = 48, the ROI-based and pixel-based measurements agreed for FA and MD. Larger disagreements were observed for the pixel-based quantification at NSA = 4. MD was less sensitive than FA to the noise level. The IRDDDA decreased with higher NSA. At NSA = 4, ROI-based FA showed a lower average bias (0.9% vs. 37.4%) and narrower 95% limits of agreement compared to the pixel-based method. The ROI-based estimation of FA is less prone to bias than the pixel-based estimations when SNR is low. The IRDDDA can be applied as a quantitative quality measure to assess reliability of ROI-based DTI metrics. Copyright © 2018 Elsevier B.V. All rights reserved.

  18. New design of engineered safety features-component control system to improve performance and reliability

    International Nuclear Information System (INIS)

    Kim, S.T.; Jung, H.W.; Lee, S.J.; Cho, C.H.; Kim, D.H.; Kim, H.

    2006-01-01

    Full text: Full text: The Engineered Safety Features-Component Control System (ESF-CCS) controls the engineered safety features of a Nuclear Power Plant such as Solenoid Operated Valves (SOV), Motor Operated Valves (MOV), pumps, dampers, etc. to mitigate the effects of a Design Basis Accident (DBA) or an abnormal operation. ESF-CCS serves as an interface system between the Plant Protection System (PPS) and remote actuation devices. ESF-CCS is composed of fault tolerant Group Controllers GC, Loop Controllers (LC), ESF-CCS Test and Interface Processor (ETIP) and Cabinet Operator Module (COM) and Control Channel Gateway (CCG) etc. GCs in each division are designed to be fully independent triple configuration, which perform system level NSSS and BOP ESFAS logic (2-out-of-4 logic and l-out-of-2 logic, respectively) making it possible to test each GC individually during normal operation. In the existing configuration, the safety-related plant component control is part of the Plant Control System (PCS) non-safety system. For increased safety and reliability, this design change incorporates this part into the LCs, and is therefore designed according to the safety-critical system procedures. The test and diagnosis capabilities of ETIP and COM are reinforced. By means of an automatic periodic test for all main functions of the system, it is possible to quickly determine an abnormal status of the system, and to decrease the elapsed time for tests, thus effectively increasing availability. ESF-CCS consists of four independent divisions (A, B, C, and D) in the Advanced Power Reactor 1400 (APR1400). One prototype division is being manufactured and will be tested

  19. Good validity and reliability of the forgotten joint score in evaluating the outcome of total knee arthroplasty

    DEFF Research Database (Denmark)

    Thomsen, Morten G; Latifi, Roshan; Kallemose, Thomas

    2016-01-01

    . We investigated the validity and reliability of the FJS. Patients and methods - A Danish version of the FJS questionnaire was created according to internationally accepted standards. 360 participants who underwent primary TKA were invited to participate in the study. Of these, 315 were included...... in a validity study and 150 in a reliability study. Correlation between the Oxford knee score (OKS) and the FJS was examined and test-retest evaluation was performed. A ceiling effect was defined as participants reaching a score within 15% of the maximum achievable score. Results - The validity study revealed...... of the FJS (ICC? 0.79). We found a high level of internal consistency (Cronbach's? = 0.96). The ceiling effect for the FJS was 16%, as compared to 37% for the OKS. Interpretation - The FJS showed good construct validity and test-retest reliability. It had a lower ceiling effect than the OKS. The FJS appears...

  20. Trial protocol OPPTIMUM– Does progesterone prophylaxis for the prevention of preterm labour improve outcome?

    Directory of Open Access Journals (Sweden)

    Norman Jane E

    2012-08-01

    Full Text Available Abstract Background Preterm birth is a global problem, with a prevalence of 8 to 12% depending on location. Several large trials and systematic reviews have shown progestogens to be effective in preventing or delaying preterm birth in selected high risk women with a singleton pregnancy (including those with a short cervix or previous preterm birth. Although an improvement in short term neonatal outcomes has been shown in some trials these have not consistently been confirmed in meta-analyses. Additionally data on longer term outcomes is limited to a single trial where no difference in outcomes was demonstrated at four years of age of the child, despite those in the “progesterone” group having a lower incidence of preterm birth. Methods/Design The OPPTIMUM study is a double blind randomized placebo controlled trial to determine whether progesterone prophylaxis to prevent preterm birth has long term neonatal or infant benefit. Specifically it will study whether, in women with singleton pregnancy and at high risk of preterm labour, prophylactic vaginal natural progesterone, 200 mg daily from 22 – 34 weeks gestation, compared to placebo, improves obstetric outcome by lengthening pregnancy thus reducing the incidence of preterm delivery (before 34 weeks, improves neonatal outcome by reducing a composite of death and major morbidity, and leads to improved childhood cognitive and neurosensory outcomes at two years of age. Recruitment began in 2009 and is scheduled to close in Spring 2013. As of May 2012, over 800 women had been randomized in 60 sites. Discussion OPPTIMUM will provide further evidence on the effectiveness of vaginal progesterone for prevention of preterm birth and improvement of neonatal outcomes in selected groups of women with singleton pregnancy at high risk of preterm birth. Additionally it will determine whether any reduction in the incidence of preterm birth is accompanied by improved childhood outcome. Trial

  1. Improving Academic Outcomes for Disadvantaged Students: Scaling up Individualized Tutorials. Policy Proposal 2016-02

    Science.gov (United States)

    Ander, Roseanna; Guryan, Jonathan; Ludwig, Jens

    2016-01-01

    Improving the educational outcomes of economically disadvantaged children is a policy priority in the United States, and yet relatively little progress has been made in recent decades. Education reforms that aim to help economically disadvantaged students often focus on improving the quality with which grade-level material is taught, or the…

  2. Moneyball for Head Start: Using Data, Evidence, and Evaluation to Improve Outcomes for Children and Families

    Science.gov (United States)

    Mead, Sara; Mitchel, Ashley LiBetti

    2016-01-01

    Head Start is a valuable federal program that improves the lives of our nation's most vulnerable children and their families. Research shows that Head Start programs improve children's learning at school entry and have a positive impact on long-term life outcomes. Research also suggests that Head Start could have a stronger impact on children's…

  3. Does Professional Development of Preschool Teachers Improve Child Socio-Emotional Outcomes?

    DEFF Research Database (Denmark)

    Jensen, Bente; Jensen, Peter; Rasmussen, Astrid Würtz

    From 2011 to 2013 a randomized controlled trial has been run in Danish preschools to obtain evidence on improvements of early childhood education by providing training to the preschool teachers. The purpose of the intervention is to improve child socio-emotional outcomes (measured by SDQ...

  4. Experience-based design for integrating the patient care experience into healthcare improvement: Identifying a set of reliable emotion words.

    Science.gov (United States)

    Russ, Lauren R; Phillips, Jennifer; Brzozowicz, Keely; Chafetz, Lynne A; Plsek, Paul E; Blackmore, C Craig; Kaplan, Gary S

    2013-12-01

    Experience-based design is an emerging method used to capture the emotional content of patient and family member healthcare experiences, and can serve as the foundation for patient-centered healthcare improvement. However, a core tool-the experience-based design questionnaire-requires words with consistent emotional meaning. Our objective was to identify and evaluate an emotion word set reliably categorized across the demographic spectrum as expressing positive, negative, or neutral emotions for experience-based design improvement work. We surveyed 407 patients, family members, and healthcare workers in 2011. Participants designated each of 67 potential emotion words as positive, neutral, or negative based on their emotional perception of the word. Overall agreement was assessed using the kappa statistic. Words were selected for retention in the final emotion word set based on 80% simple agreement on classification of meaning across subgroups. The participants were 47.9% (195/407) patients, 19.4% (33/407) family members and 32.7% (133/407) healthcare staff. Overall agreement adjusted for chance was moderate (k=0.55). However, agreement for positive (k=0.69) and negative emotions (k=0.68) was substantially higher, while agreement in the neutral category was low (k=0.11). There were 20 positive, 1 neutral, and 14 negative words retained for the final experience-based design emotion word set. We identified a reliable set of emotion words for experience questionnaires to serve as the foundation for patient-centered, experience-based redesign of healthcare. Incorporation of patient and family member perspectives in healthcare requires reliable tools to capture the emotional content of care touch points. Copyright © 2013 Elsevier Inc. All rights reserved.

  5. Cycle chemistry monitoring system as means of improving the reliability of the equipment at the power plants

    Science.gov (United States)

    Yegoshina, O. V.; Voronov, V. N.; Yarovoy, V. O.; Bolshakova, N. A.

    2017-11-01

    There are many problems in domestic energy at the present that require urgent solutions in the near future. One of these problems - the aging of the main and auxiliary equipment. Wear of equipment is the cause of decrease reliability and efficiency of power plants. Reliability of the equipment are associated with the introduction of cycle chemistry monitoring system. The most damageable equipment’s are boilers (52.2 %), turbines (12.6 %) and heating systems (12.3 %) according to the review of failure rate on the power plants. The most part of the damageability of the boiler is heated surfaces (73.2 %). According to the Russian technical requirements, the monitoring systems are responsible to reduce damageability the boiler heating surfaces and to increase the reliability of the equipment. All power units capacity of over 50 MW are equipped with cycle chemistry monitoring systems in order to maintain water chemistry within operating limits. The main idea of cycle chemistry monitoring systems is to improve water chemistry at power plants. According to the guidelines, cycle chemistry monitoring systems of a single unit depends on its type (drum or once-through boiler) and consists of: 20…50 parameters of on-line chemical analyzers; 20…30 «grab» sample analyses (daily) and about 15…20 on-line monitored operating parameters. The operator of modern power plant uses with many data at different points of steam/water cycle. Operators do not can estimate quality of the cycle chemistry due to the large volume of daily and every shift information and dispersion of data, lack of systematization. In this paper, an algorithm for calculating the quality index developed for improving control the water chemistry of the condensate, feed water and prevent scaling and corrosion in the steam/water cycle.

  6. Predictors of improvement in observed functional ability in patients with fibromyalgia as an outcome of rehabilitation

    DEFF Research Database (Denmark)

    Amris, Kirstine; Luta, George; Christensen, Robin

    2016-01-01

    OBJECTIVE: To investigate predictors of improvement in observed ability to manage activities of daily living as an outcome of rehabilitation in fibromyalgia. METHODS: Exploratory analyses used data from the Interdisciplinary Rehabilitation and Evaluation Programme for Patients with Chronic...... Widespread Pain (the IMPROvE study); a randomized controlled trial including 191 females with fibromyalgia randomized (1:1) to rehabilitation or a waiting list. The primary outcome was observed activities of daily living ability evaluated with the Assessment of Motor and Process Skills (AMPS) 6 months post...

  7. Validity, Reliability And Responsiveness Of Patient-Reported Outcome Questionnaires When Assessing Hip And Groin Disability: A Systematic Review

    DEFF Research Database (Denmark)

    Thorborg, Kristian; Roos, Ewa; Bartels, Else Marie

    2010-01-01

    disability based on a systematic review of evidence of validity, reliability and responsiveness of these instruments. Methods MEDLINE, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials, PsycINFO, SportsDiscus and Web of Science were all searched up to January 2009. Two reviewers independently...

  8. Reliable B cell epitope predictions: impacts of method development and improved benchmarking

    DEFF Research Database (Denmark)

    Kringelum, Jens Vindahl; Lundegaard, Claus; Lund, Ole

    2012-01-01

    biomedical applications such as; rational vaccine design, development of disease diagnostics and immunotherapeutics. However, experimental mapping of epitopes is resource intensive making in silico methods an appealing complementary approach. To date, the reported performance of methods for in silico mapping...... evaluation data set improved from 0.712 to 0.727. Our results thus demonstrate that given proper benchmark definitions, B-cell epitope prediction methods achieve highly significant predictive performances suggesting these tools to be a powerful asset in rational epitope discovery. The updated version...

  9. Improved resolution and reliability in dynamic PET using Bayesian regularization of MRTM2

    DEFF Research Database (Denmark)

    Agn, Mikael; Svarer, Claus; Frokjaer, Vibe G.

    2014-01-01

    This paper presents a mathematical model that regularizes dynamic PET data by using a Bayesian framework. We base the model on the well known two-parameter multilinear reference tissue method MRTM2 and regularize on the assumption that spatially close regions have similar parameters. The developed...... model is compared to the conventional approach of improving the low signal-to-noise ratio of PET data, i.e., spatial filtering of each time frame independently by a Gaussian kernel. We show that the model handles high levels of noise better than the conventional approach, while at the same time...

  10. Improved reliability in skeletal age assessment using a pediatric hand MR scanner with a 0.3T permanent magnet.

    Science.gov (United States)

    Terada, Yasuhiko; Kono, Saki; Uchiumi, Tomomi; Kose, Katsumi; Miyagi, Ryo; Yamabe, Eiko; Fujinaga, Yasunari; Yoshioka, Hiroshi

    2014-01-01

    The purpose of this study was to improve the reliability and validity of skeletal age assessment using an open and compact pediatric hand magnetic resonance (MR) imaging scanner. We used such a scanner with 0.3-tesla permanent magnet to image the left hands of 88 healthy children (aged 3.4 to 15.7 years, mean 8.8 years), and 3 raters (2 orthopedic specialists and a radiologist) assessed skeletal age using those images. We measured the strength of agreement in ratings by values of weighted Cohen's κ and the proportion of cases excluded from rating because of motion artifact and inappropriate positioning. We compared the current results with those of a previous study in which 93 healthy children (aged 4.1 to 16.4 years, mean 9.7 years) were examined with an adult hand scanner. The κ values between raters exceeded 0.80, which indicates almost perfect agreement, and most were higher than those of the previous study. The proportion of cases excluded from rating because of motion artifact or inappropriate positioning was also reduced. The results indicate that use of the compact pediatric hand scanner improved the reliability and validity of skeletal age assessments.

  11. Improvement of Steam Turbine Operational Performance and Reliability with using Modern Information Technologies

    Science.gov (United States)

    Brezgin, V. I.; Brodov, Yu M.; Kultishev, A. Yu

    2017-11-01

    The report presents improvement methods review in the fields of the steam turbine units design and operation based on modern information technologies application. In accordance with the life cycle methodology support, a conceptual model of the information support system during life cycle main stages (LC) of steam turbine unit is suggested. A classifying system, which ensures the creation of sustainable information links between the engineer team (manufacture’s plant) and customer organizations (power plants), is proposed. Within report, the principle of parameterization expansion beyond the geometric constructions at the design and improvement process of steam turbine unit equipment is proposed, studied and justified. The report presents the steam turbine unit equipment design methodology based on the brand new oil-cooler design system that have been developed and implemented by authors. This design system combines the construction subsystem, which is characterized by extensive usage of family tables and templates, and computation subsystem, which includes a methodology for the thermal-hydraulic zone-by-zone oil coolers design calculations. The report presents data about the developed software for operational monitoring, assessment of equipment parameters features as well as its implementation on five power plants.

  12. Improving the power of an efficacy study of a social and emotional learning program: application of generalizability theory to the measurement of classroom-level outcomes.

    Science.gov (United States)

    Mashburn, Andrew J; Downer, Jason T; Rivers, Susan E; Brackett, Marc A; Martinez, Andres

    2014-04-01

    Social and emotional learning programs are designed to improve the quality of social interactions in schools and classrooms in order to positively affect students' social, emotional, and academic development. The statistical power of group randomized trials to detect effects of social and emotional learning programs and other preventive interventions on setting-level outcomes is influenced by the reliability of the outcome measure. In this paper, we apply generalizability theory to an observational measure of the quality of classroom interactions that is an outcome in a study of the efficacy of a social and emotional learning program called The Recognizing, Understanding, Labeling, Expressing, and Regulating emotions Approach. We estimate multiple sources of error variance in the setting-level outcome and identify observation procedures to use in the efficacy study that most efficiently reduce these sources of error. We then discuss the implications of using different observation procedures on both the statistical power and the monetary costs of conducting the efficacy study.

  13. Incentives for improving human resource outcomes in health care: overview of reviews.

    Science.gov (United States)

    Misfeldt, Renee; Linder, Jordana; Lait, Jana; Hepp, Shelanne; Armitage, Gail; Jackson, Karen; Suter, Esther

    2014-01-01

    To review the effectiveness of financial and nonfinancial incentives for improving the benefits (recruitment, retention, job satisfaction, absenteeism, turnover, intent to leave) of human resource strategies in health care. Overview of 33 reviews published from 2000 to 2012 summarized the effectiveness of incentives for improving human resource outcomes in health care (such as job satisfaction, turnover rates, recruitment, and retention) that met the inclusion criteria and were assessed by at least two research members using the Assessment of Multiple Systematic Reviews quality assessment tool. Of those, 13 reviews met the quality criteria and were included in the overview. Information was extracted on a description of the review, the incentives considered, and their impact on human resource outcomes. The information on the relationship between incentives and outcomes was assessed and synthesized. While financial compensation is the best-recognized approach within an incentives package, there is evidence that health care practitioners respond positively to incentives linked to the quality of the working environments including opportunities for professional development, improved work life balance, interprofessional collaboration, and professional autonomy. There is less evidence that workload factors such as job demand, restructured staffing models, re-engineered work designs, ward practices, employment status, or staff skill mix have an impact on human resource outcomes. Overall, evidence of effective strategies for improving outcomes is mixed. While financial incentives play a key role in enhancing outcomes, they need to be considered as only one strategy within an incentives package. There is stronger evidence that improving the work place environment and instituting mechanisms for work-life balance need to be part of an overall strategy to improve outcomes for health care practitioners.

  14. How do aggregated patient-reported outcome measures data stimulate health care improvement? A realist synthesis

    Science.gov (United States)

    Dalkin, Sonia; Gibbons, Elizabeth; Wright, Judy; Valderas, Jose Maria; Meads, David; Black, Nick

    2017-01-01

    Objectives Internationally, there has been considerable debate about the role of data in supporting quality improvement in health care. Our objective was to understand how, why and in what circumstances the feedback of aggregated patient-reported outcome measures data improved patient care. Methods We conducted a realist synthesis. We identified three main programme theories underlying the use of patient-reported outcome measures as a quality improvement strategy and expressed them as nine ‘if then’ propositions. We identified international evidence to test these propositions through searches of electronic databases and citation tracking, and supplemented our synthesis with evidence from similar forms of performance data. We synthesized this evidence through comparing the mechanisms and impact of patient-reported outcome measures and other performance data on quality improvement in different contexts. Results Three programme theories were identified: supporting patient choice, improving accountability and enabling providers to compare their performance with others. Relevant contextual factors were extent of public disclosure, use of financial incentives, perceived credibility of the data and the practicality of the results. Available evidence suggests that patients or their agents rarely use any published performance data when selecting a provider. The perceived motivation behind public reporting is an important determinant of how providers respond. When clinicians perceived that performance indicators were not credible but were incentivized to collect them, gaming or manipulation of data occurred. Outcome data do not provide information on the cause of poor care: providers needed to integrate and interpret patient-reported outcome measures and other outcome data in the context of other data. Lack of timeliness of performance data constrains their impact. Conclusions Although there is only limited research evidence to support some widely held theories of how

  15. Application of material databases for improved reliability of reactor pressure vessels

    International Nuclear Information System (INIS)

    Griesbach, T.J.; Server, W.L.; Beaudoin, B.F.; Burgos, B.N.

    1994-01-01

    A vital part of reactor vessel Life Cycle Management program must begin with an accurate characterization of the vessel material properties. Uncertainties in vessel material properties or use of bounding values may result in unnecessary conservatisms in vessel integrity calculations. These conservatisms may be eliminated through a better understanding of the material properties in reactor vessels, both in the unirradiated and irradiated conditions. Reactor vessel material databases are available for quantifying the chemistry and Charpy shift behavior of individual heats of reactor vessel materials. Application of the databases for vessels with embrittlement concerns has proven to be an effective embrittlement management tool. This paper presents details of database development and applications which demonstrate the value of using material databases for improving material chemistry and for maximizing the data from integrated material surveillance programs

  16. Improved and reliable synthesis of 3'-azido-2',3'-dideoxyguanosine derivatives.

    Science.gov (United States)

    Timoshchuk, Victor A; Hogrefe, Richard I; Vaghefi, Morteza M

    2004-01-01

    An improved synthesis of N2-protected-3'-azido-2',3'-dideoxyguanosine 20 and 23 is described. Deoxygenation of 2'-O-alkyl (and/or aryl) sulfonyl-5'-dimethoxytritylguanosine coupled with [1,2]-hydride shift rearrangement gave protected 9-(2-deoxythreo-pentofuranosyl)guanines (10, 12 and 16). This rearrangement was accomplished in high yield with a high degree of stereoselectivity using lithium triisobutylborohydride (L-Selectride). Compounds 10, 12 and 16 were transformed into 3'-O-mesylates (18 and 21), which can be used for 3'-substitution. The 3'-azido nucleosides were obtained by treatment of 18 and 21 with lithium azide. This procedure is reproducible with a good overall yield.

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

    Science.gov (United States)

    Leff, Ellen W

    2004-05-01

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

  18. Reliability engineering

    International Nuclear Information System (INIS)

    Lee, Chi Woo; Kim, Sun Jin; Lee, Seung Woo; Jeong, Sang Yeong

    1993-08-01

    This book start what is reliability? such as origin of reliability problems, definition of reliability and reliability and use of reliability. It also deals with probability and calculation of reliability, reliability function and failure rate, probability distribution of reliability, assumption of MTBF, process of probability distribution, down time, maintainability and availability, break down maintenance and preventive maintenance design of reliability, design of reliability for prediction and statistics, reliability test, reliability data and design and management of reliability.

  19. Visual working memory in deaf children with diverse communication modes: improvement by differential outcomes.

    Science.gov (United States)

    López-Crespo, Ginesa; Daza, María Teresa; Méndez-López, Magdalena

    2012-01-01

    Although visual functions have been proposed to be enhanced in deaf individuals, empirical studies have not yet established clear evidence on this issue. The present study aimed to determine whether deaf children with diverse communication modes had superior visual memory and whether their performance was improved by the use of differential outcomes. Severely or profoundly deaf children who employed spoken Spanish, Spanish Sign Language (SSL), and both spoken Spanish and SSL modes of communication were tested in a delayed matching-to-sample task for visual working memory assessment. Hearing controls were used to compare performance. Participants were tested in two conditions, differential outcome and non-differential outcome conditions. Deaf groups with either oral or SSL modes of communication completed the task with less accuracy than bilingual and control hearing children. In addition, the performances of all groups improved through the use of differential outcomes. Copyright © 2011 Elsevier Ltd. All rights reserved.

  20. Improved Mechanical Performance Fracture Properties and Reliability of Radical-Cured Thermosets

    Energy Technology Data Exchange (ETDEWEB)

    Redline, Erica Marie [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Bolintineanu, Dan S. [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Lane, J. Matthew [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Stevens, Mark J. [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Alam, Todd M. [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Celina, Mathias C. [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States)

    2016-10-01

    The aim of this study was to alter polymerization chemistry to improve network homogeneity in free-radical crosslinked systems. It was hypothesized that a reduction in heterogeneity of the network would lead to improved mechanical performance. Experiments and simulations were carried out to investigate the connection between polymerization chemistry, network structure and mechanical properties. Experiments were conducted on two different monomer systems - the first is a single monomer system, urethane dimethacrylate (UDMA), and the second is a two-monomer system consisting of bisphenol A glycidyl dimethacrylate (BisGMA) and triethylene glycol dimethacrylate (TEGDMA) in a ratio of 70/30 BisGMA/TEGDMA by weight. The methacrylate systems were crosslinked using traditional radical polymeriza- tion (TRP) with azobisisobutyronitrile (AIBN) or benzoyl peroxide (BPO) as an initiator; TRP systems were used as the control. The monomers were also cross-linked using activator regenerated by electron transfer atom transfer radical polymerization (ARGET ATRP) as a type of controlled radical polymerization (CRP). FTIR and DSC were used to monitor reac- tion kinetics of the systems. The networks were analyzed using NMR, DSC, X-ray diffraction (XRD), atomic force microscopy (AFM), and small angle X-ray scattering (SAXS). These techniques were employed in an attempt to quantify differences between the traditional and controlled radical polymerizations. While a quantitative methodology for characterizing net- work morphology was not established, SAXS and AFM have shown some promising initial results. Additionally, differences in mechanical behavior were observed between traditional and controlled radical polymerized thermosets in the BisGMA/TEGDMA system but not in the UDMA materials; this finding may be the result of network ductility variations between the two materials. Coarse-grained molecular dynamics simulations employing a novel model of the CRP reaction were carried out for

  1. Human reliability

    International Nuclear Information System (INIS)

    Bubb, H.

    1992-01-01

    This book resulted from the activity of Task Force 4.2 - 'Human Reliability'. This group was established on February 27th, 1986, at the plenary meeting of the Technical Reliability Committee of VDI, within the framework of the joint committee of VDI on industrial systems technology - GIS. It is composed of representatives of industry, representatives of research institutes, of technical control boards and universities, whose job it is to study how man fits into the technical side of the world of work and to optimize this interaction. In a total of 17 sessions, information from the part of ergonomy dealing with human reliability in using technical systems at work was exchanged, and different methods for its evaluation were examined and analyzed. The outcome of this work was systematized and compiled in this book. (orig.) [de

  2. The effect of plant reliability improvement in the cost of generating electricity

    International Nuclear Information System (INIS)

    Nejat, S.; Sanders, R.C.; Tsoulfanidis, N.

    1982-01-01

    The objective of this investigation is to study the economic benefits in operating a nuclear power plant, as a result of improving the availability of the secondary (steam) loop of the plant. A new method has been developed to obtain availability, frequency of failure, probability and frequency of operation, cycle time, and uptime for different capacity states of a parallel series system having components with failure and repair rates distributed exponentially in time. The method has been applied to different subsystems, systems, and the secondary loop of a plant as a whole. The effect of having spare parts for several components, as measured by savings in the generation of electricity, is also studied. The Kettelle algorithm was applied to determine optimal allocation of spare parts to achieve maximum availability or minimum cost of electricity, subject to a fixed spare parts budget. The savings per year for optimal spare parts allocation and different spare parts budgets were obtained. The results show that the utility will save its customers a large amount of money if spare parts are purchased, especially at the beginning of the plant operation, and are allocated judiciously

  3. Improvement in Device Performance and Reliability of Organic Light-Emitting Diodes through Deposition Rate Control

    Directory of Open Access Journals (Sweden)

    Shun-Wei Liu

    2014-01-01

    Full Text Available We demonstrated a fabrication technique to reduce the driving voltage, increase the current efficiency, and extend the operating lifetime of an organic light-emitting diode (OLED by simply controlling the deposition rate of bis(10-hydroxybenzo[h]qinolinato beryllium (Bebq2 used as the emitting layer and the electron-transport layer. In our optimized device, 55 nm of Bebq2 was first deposited at a faster deposition rate of 1.3 nm/s, followed by the deposition of a thin Bebq2 (5 nm layer at a slower rate of 0.03 nm/s. The Bebq2 layer with the faster deposition rate exhibited higher photoluminescence efficiency and was suitable for use in light emission. The thin Bebq2 layer with the slower deposition rate was used to modify the interface between the Bebq2 and cathode and hence improve the injection efficiency and lower the driving voltage. The operating lifetime of such a two-step deposition OLED was 1.92 and 4.6 times longer than that of devices with a single deposition rate, that is, 1.3 and 0.03 nm/s cases, respectively.

  4. Embedded Sensors and Controls to Improve Component Performance and Reliability -- Bench-scale Testbed Design Report

    Energy Technology Data Exchange (ETDEWEB)

    Melin, Alexander M. [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States); Kisner, Roger A. [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States); Drira, Anis [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States); Reed, Frederick K. [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States)

    2015-09-01

    Embedded instrumentation and control systems that can operate in extreme environments are challenging due to restrictions on sensors and materials. As a part of the Department of Energy's Nuclear Energy Enabling Technology cross-cutting technology development programs Advanced Sensors and Instrumentation topic, this report details the design of a bench-scale embedded instrumentation and control testbed. The design goal of the bench-scale testbed is to build a re-configurable system that can rapidly deploy and test advanced control algorithms in a hardware in the loop setup. The bench-scale testbed will be designed as a fluid pump analog that uses active magnetic bearings to support the shaft. The testbed represents an application that would improve the efficiency and performance of high temperature (700 C) pumps for liquid salt reactors that operate in an extreme environment and provide many engineering challenges that can be overcome with embedded instrumentation and control. This report will give details of the mechanical design, electromagnetic design, geometry optimization, power electronics design, and initial control system design.

  5. Reliability and Validity of the Medical Outcomes Study Short Form-12 Version 2 (SF-12v2) in Adults with Non-Cancer Pain

    Science.gov (United States)

    Hayes, Corey J.; Bhandari, Naleen Raj; Kathe, Niranjan; Payakachat, Nalin

    2017-01-01

    Limited evidence exists on how non-cancer pain (NCP) affects an individual’s health-related quality of life (HRQoL). This study aimed to validate the Medical Outcomes Study Short Form-12 Version 2 (SF-12v2), a generic measure of HRQoL, in a NCP cohort using the Medical Expenditure Panel Survey Longitudinal Files. The SF Mental Component Summary (MCS12) and SF Physical Component Summary (PCS12) were tested for reliability (internal consistency and test-retest reliability) and validity (construct: convergent and discriminant; criterion: concurrent and predictive). A total of 15,716 patients with NCP were included in the final analysis. The MCS12 and PCS12 demonstrated high internal consistency (Cronbach’s alpha and Mosier’s alpha > 0.8), and moderate and high test-retest reliability, respectively (MCS12 intraclass correlation coefficient (ICC): 0.64; PCS12 ICC: 0.73). Both scales were significantly associated with a number of chronic conditions (p reliable and valid measure of HRQoL for patients with NCP. PMID:28445438

  6. Assessment of leg muscles mechanical capacities: Which jump, loading, and variable type provide the most reliable outcomes?

    Science.gov (United States)

    García-Ramos, Amador; Feriche, Belén; Pérez-Castilla, Alejandro; Padial, Paulino; Jaric, Slobodan

    2017-07-01

    This study aimed to explore the strength of the force-velocity (F-V) relationship of lower limb muscles and the reliability of its parameters (maximum force [F 0 ], slope [a], maximum velocity [V 0 ], and maximum power [P 0 ]). Twenty-three men were tested in two different jump types (squat and countermovement jump: SJ and CMJ), performed under two different loading conditions (free weight and Smith machine: Free and Smith) with 0, 17, 30, 45, 60, and 75 kg loads. The maximum and averaged values of F and V were obtained for the F-V relationship modelling. All F-V relationships were strong and linear independently whether observed from the averaged across the participants (r ≥ 0.98) or individual data (r = 0.94-0.98), while their parameters were generally highly reliable (F 0 [CV: 4.85%, ICC: 0.87], V 0 [CV: 6.10%, ICC: 0.82], a [CV: 10.5%, ICC: 0.81], and P 0 [CV: 3.5%, ICC: 0.93]). Both the strength of the F-V relationships and the reliability of their parameters were significantly higher for (1) the CMJ over the SJ, (2) the Free over the Smith loading type, and (3) the maximum over the averaged F and V variables. In conclusion, although the F-V relationships obtained from all the jumps tested were linear and generally highly reliable, the less appropriate choice for testing the F-V relationship could be through the averaged F and V data obtained from the SJ performed either in a Free weight or in a Smith machine. Insubstantial differences exist among the other combinations tested.

  7. Measuring Outcomes for Dysphagia: Validity and Reliability of the European Portuguese Eating Assessment Tool (P-EAT-10).

    Science.gov (United States)

    Nogueira, Dália Santos; Ferreira, Pedro Lopes; Reis, Elizabeth Azevedo; Lopes, Inês Sousa

    2015-10-01

    The purpose of this study was to evaluate the validity and the reliability of the European Portuguese version of the EAT-10 (P-EAT-10). This research was conducted in three phases: (i) cultural and linguistic adaptation; (ii) feasibility and reliability test; and (iii) validity tests. The final sample was formed by a cohort of 520 subjects. The P-EAT-10 index was compared for socio-demographic and clinic variables. It was also compared for both dysphagic and non-dysphagic groups as well as for the results of the 3Oz wst. Lastly, the P-EAT-10 scores were correlated with the EuroQol Group Portuguese EQ-5D index. The Cronbach's α obtained for the P-EAT-10 scale was 0.952 and it remained excellent even if any item was deleted. The item-total and the intraclass correlation coefficients were very good. The P-EAT-10 mean of the non-dysphagic cohort was 0.56 and that of the dysphagic cohort was 14.26, the mean comparison between the 3Oz wst groups and the P-EAT-10 scores were significant. A significant higher perception of QoL was also found among the non-dysphagic subjects. P-EAT-10 is a valid and reliable measure that may be used to document dysphagia which makes it useful both for screening in clinical practice and in research.

  8. Designing and Assessing the Validity and Reliability of the Hospital Readiness Assessment Tools to Conducting Quality Improvement Program

    Directory of Open Access Journals (Sweden)

    Kamal Gholipoor

    2016-09-01

    Full Text Available Background and objectives : Identifying the readiness of hospital and its strengths and weaknesses can be useful in developing appropriate planning and situation analyses and management to getting effective in clinical audit programs. The aim of this study was to design and assess the validity of the Hospital Readiness Assessment Tools to conduct quality improvement and clinical audit programs. Material and Methods: In this study, based on the results of a systematic review of literature, an initial questionnaire with 77 items was designed. Questionnaire content validity was reviewed by experts in the field of hospital management and quality improvement in Tabriz University of Medical Sciences. For this purpose, 20 questionnaires were sent to experts. Finally, 15 participants returned completed questionnaire. Questionnaire validity was reviewed and confirmed based on Content Validity Index and Content Validity Ratio. Questionnaire reliability was confirmed based on Cronbach's alpha index (α = 0.96 in a pilot study by participation of 30 hospital managers. Results: The results showed that the final questionnaire contains 54 questions as nine category as: data and information (9 items, teamwork (12 questions, resources (5 questions, patient and education (5, intervention design and implementation (5 questions, clinical audit management (4 questions, human resources (6 questions, evidence and standard (4 items and evaluation and feedback (4 items. The final questionnaire content validity index was 0.91 and final questionnaire Cronbach's alpha coefficient was 0.96. Conclusion: Considering the relative good validity and reliability of the designed tool in this study, it appears that the questionnaire can be used to identify and assess the readiness of hospitals for quality improvement and clinical audit program implementation

  9. Validity and reliability of Thai version of the Foot and Ankle Outcome Score in patients with arthritis of the foot and ankle.

    Science.gov (United States)

    Angthong, Chayanin

    2016-12-01

    Although the Foot and Ankle Outcome Score (FAOS) is commonly used in several languages for a variety of foot disorders, it has not been validated specifically for foot and ankle arthritic conditions. The aims of the present study were to translate the original English FAOS into Thai and to evaluate the validity and reliability of the Thai version of the FAOS for the foot and ankle arthritic conditions. The original FAOS was translated into Thai using forward-backward translation. The Thai FAOS and validated Thai Short Form-36 (SF-36 ® ) questionnaires were distributed to 44 Thai patients suffering from arthritis of the foot and ankle to complete. For validation, Thai FAOS scores were correlated with SF-36 scores. Test-retest reliability and internal consistency were also analyzed in this study. The Thai FAOS score demonstrated sufficient correlation with SF-36 total score in Pain (Pearson's correlation coefficient (r)=0.45, p=0.002), Symptoms (r=0.45, p=0.002), Activities of Daily Living (ADL) (r=0.47, p=0.001), and Quality of Life (QOL) (r=0.38, p=0.011) subscales. The Sports and Recreational Activities (Sports & Rec) subscale did not correlate significantly with the SF-36 ® (r=0.20, p=0.20). Cronbach's alpha, a measure of internal consistency, for the five subscales was as follows: Pain, 0.94 (pvalidity for the evaluation of foot and ankle arthritis. Although reliability was satisfactory for the major subscale ADL, it was not sufficient for the minor subscales. Our findings suggest that it can be used as a disease-specific instrument to evaluate foot and ankle arthritis and can complement other reliable outcome surveys. Copyright © 2015 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.

  10. Improving the Reliability of Decision-Support Systems for Nuclear Emergency Management by Leveraging Software Design Diversity

    Directory of Open Access Journals (Sweden)

    Tudor B. Ionescu

    2016-03-01

    Full Text Available This paper introduces a novel method of continuous verification of simulation software used in decision-support systems for nuclear emergency management (DSNE. The proposed approach builds on methods from the field of software reliability engineering, such as N-Version Programming, Recovery Blocks, and Consensus Recovery Blocks. We introduce a new acceptance test for dispersion simulation results and a new voting scheme based on taxonomies of simulation results rather than individual simulation results. The acceptance test and the voter are used in a new scheme, which extends the Consensus Recovery Block method by a database of result taxonomies to support machine-learning. This enables the system to learn how to distinguish correct from incorrect results, with respect to the implemented numerical schemes. Considering that decision-support systems for nuclear emergency management are used in a safety-critical application context, the methods introduced in this paper help improve the reliability of the system and the trustworthiness of the simulation results used by emergency managers in the decision making process. The effectiveness of the approach has been assessed using the atmospheric dispersion forecasts of two test versions of the widely used RODOS DSNE system.

  11. The Cambridge Otology Quality of Life Questionnaire: an otology-specific patient-recorded outcome measure. A paper describing the instrument design and a report of preliminary reliability and validity.

    Science.gov (United States)

    Martin, T P C; Moualed, D; Paul, A; Ronan, N; Tysome, J R; Donnelly, N P; Cook, R; Axon, P R

    2015-04-01

    The Cambridge Otology Quality of Life Questionnaire (COQOL) is a patient-recorded outcome measurement (PROM) designed to quantify the quality of life of patients attending otology clinics. Item-reduction model. A systematically designed long-form version (74 items) was tested with patient focus groups before being presented to adult otology patients (n. 137). Preliminary item analysis tested reliability, reducing the COQOL to 24 questions. This was then presented in conjunction with the SF-36 (V1) questionnaire to a total of 203 patients. Subsequently, these were re-presented at T + 3 months, and patients recorded whether they felt their condition had improved, deteriorated or remained the same. Non-responders were contacted by post. A correlation between COQOL scores and patient perception of change was examined to analyse content validity. Teaching hospital and university psychology department. Adult patients attending otology clinics with a wide range of otological conditions. Item reliability measured by item–total correlation, internal consistency and test– retest reliability. Validity measured by correlation between COQOL scores and patient-reported symptom change. Reliability: the COQOL showed excellent internal consistency at both initial presentation (a = 0.90) and 3 months later (a = 0.93). Validity: One-way analysis of variance showed a significant difference between groups reporting change and those reporting no change in quality of life (F(2, 80) = 5.866, P < 0.01). The COQOL is the first otology-specific PROM. Initial studies demonstrate excellent reliability and encouraging preliminary criterion validity: further studies will allow a deeper validation of the instrument.

  12. Has growth mixture modeling improved our understanding of how early change predicts psychotherapy outcome?

    Science.gov (United States)

    Koffmann, Andrew

    2017-03-02

    Early change in psychotherapy predicts outcome. Seven studies have used growth mixture modeling [GMM; Muthén, B. (2001). Second-generation structural equation modeling with a combination of categorical and continuous latent variables: New opportunities for latent class-latent growth modeling. In L. M. Collins & A. G. Sawyers (Eds.), New methods for the analysis of change (pp. 291-322). Washington, DC: American Psychological Association] to identify patient classes based on early change but have yielded conflicting results. Here, we review the earlier studies and apply GMM to a new data set. In a university-based training clinic, 251 patients were administered the Outcome Questionnaire-45 [Lambert, M. J., Hansen, N. B., Umphress, V., Lunnen, K., Okiishi, J., Burlingame, G., … Reisinger, C. W. (1996). Administration and scoring manual for the Outcome Questionnaire (OQ 45.2). Wilmington, DE: American Professional Credentialing Services] at each psychotherapy session. We used GMM to identify class structure based on change in the first six sessions and examined trajectories as predictors of outcome. The sample was best described as a single class. There was no evidence of autoregressive trends in the data. We achieved better fit to the data by permitting latent variables some degree of kurtosis, rather than to assume multivariate normality. Treatment outcome was predicted by the amount of early improvement, regardless of initial level of distress. The presence of sudden early gains or losses did not further improve outcome prediction. Early improvement is an easily computed, powerful predictor of psychotherapy outcome. The use of GMM to investigate the relationship between change and outcome is technically complex and computationally intensive. To date, it has not been particularly informative.

  13. The Perceived Personal Control (PPC) questionnaire as an outcome of genetic counseling: reliability and validity of the instrument.

    NARCIS (Netherlands)

    Smets, E.M.A.; Pieterse, A.H.; Aalfs, C.M.; Ausems, M.G.E.M.; Dulmen, A.M. van

    2006-01-01

    The perceived personal control (PPC) questionnaire was developed by Berkenstadt and colleagues as an outcome measure for the evaluation of the process of genetic counseling. The present study aimed to further assess the psychometric properties of a Dutch version of the instrument. Data were used

  14. USING A TOTAL QUALITY STRATEGY IN A NEW PRACTICAL APPROACH FOR IMPROVING THE PRODUCT RELIABILITY IN AUTOMOTIVE INDUSTRY

    Directory of Open Access Journals (Sweden)

    Cristiano Fragassa

    2014-09-01

    Full Text Available In this paper a Total Quality Management strategy is proposed, refined and used with the aim at improving the quality of large-mass industrial products far beyond the technical specifications demanded at the end-customer level. This approach combines standard and non-standard tools used for Reliability, Availability and Maintainability analysis. The procedure also realizes a stricter correlation between theoretical evaluation methods and experimental evidences as part of a modern integrated method for strengthening quality in design and process. A commercial Intake Manifold, largely spread in the market, is used as test-case for the validation of the methodology. As general additional result, the research underlines the impact of Total Quality Management and its tools on the development of innovation.

  15. Application of space and aviation technology to improve the safety and reliability of nuclear power plant operations. Final report

    International Nuclear Information System (INIS)

    1980-04-01

    This report investigates various technologies that have been developed and utilized by the aerospace community, particularly the National Aeronautics and Space Administration (NASA) and the aviation industry, that would appear to have some potential for contributing to improved operational safety and reliability at commercial nuclear power plants of the type being built and operated in the United States today. The main initiator for this study, as well as many others, was the accident at the Three Mile Island (TMI) nuclear power plant in March 1979. Transfer and application of technology developed by NASA, as well as other public and private institutions, may well help to decrease the likelihood of similar incidents in the future

  16. Cross-cultural adaptation and validation of the reliability of the Thai version of the Hip disability and Osteoarthritis Outcome Score (HOOS).

    Science.gov (United States)

    Trathitiphan, Warayos; Paholpak, Permsak; Sirichativapee, Winai; Wisanuyotin, Taweechok; Laupattarakasem, Pat; Sukhonthamarn, Kamolsak; Jeeravipoolvarn, Polasak; Kosuwon, Weerachai

    2016-10-01

    HOOS was developed as an extension of the Western Ontario and McMaster Universities' Osteoarthritis Index questionnaire for measuring symptoms and functional limitations related to the hip(s) of patients with osteoarthritis. To determine the validity and reliability of the Thai version of the Hip disability and Osteoarthritis Outcome Score (HOOS) vis-à-vis hip osteoarthritis, the original HOOS was translated into a Thai version of HOOS, according to international recommendations. Patients with hip osteoarthritis (n = 57; 25 males) were asked to complete the Thai version of HOOS twice: once then again after a 3-week interval. The test-retest reliability was analyzed using the intraclass correlation coefficient (ICC). Internal consistencies were analyzed using Cronbach's alpha, while the construct validity was tested by comparing the Thai HOOS with the Thai modified SF-36 and calculating the Spearman's rank correlation coefficients. The Thai HOOS produced good reliability (i.e., the ICC was greater than 0.9 in all five subscales). All of the Cronbach's alpha showed that the Thai HOOS had high internal consistency (Cronbach's alpha greater than 0.8), especially for the pain and ADL subscales (0.89 and 0.90, respectively). The Spearman's rank correlation for all five subscales of the Thai HOOS had moderate correlation with the Bodily Pain subscale of the Thai SF-36. The pain subscale of the Thai HOOS had a high correlation with the Vitality and Social Function subscales of the Thai SF-36 (r = 0.55 and 0.54)-with which the symptom subscale had a moderate correlation. The Thai version of HOOS had excellent internal consistency, excellent test-retest reliability, and good construct validity. It can be used as a reliable tool for assessing quality of life for patients with hip osteoarthritis in Thailand.

  17. Reliability and validity of a modified MEDFICTS dietary fat screener in South African schoolchildren are determined by use and outcome measures.

    Science.gov (United States)

    Wenhold, Friedeburg Anna Maria; MacIntyre, Una Elizabeth; Rheeder, Paul

    2014-06-01

    In South Africa, noncommunicable diseases and obesity are increasing and also affect children. No validated assessment tools for fat intake are available. To determine test-retest reliability and relative validity of a pictorial modified meats, eggs, dairy, fried foods, fats in baked goods, convenience foods, table fats, and snacks (MEDFICTS) dietary fat screener. We determined test-retest reliability and diagnostic accuracy with the modified MEDFICTS as the index test and a 3-day weighed food record and parental completion of the screener as primary and secondary reference methods, respectively. Grade-six learners (aged 12 years, 4 months) in an urban, middle-class school (n=93) and their parents (n=72). Portion size, frequency of intake, final score, and classification of fat intake of the modified MEDFICTS, and percent energy from fat, saturated fatty acids, and cholesterol of the food record. For categorical data agreement was based on kappa statistics, McNemar's test for symmetry, and diagnostic performance parameters. Continuous data were analyzed with correlations, mean differences, the Bland-Altman method, and receiver operating characteristics. The classification of fat intake by the modified MEDFICTS was test-retest reliable. Final scores of the group did not differ between administrations (P=0.86). The correlation of final scores between administrations was significant for girls only (r=0.58; P=0.01). Reliability of portion size and frequency of intake scores depended on the food category. For girls the screener final score was significantly (P90%), but chance corrected agreement between the classifications was poor. Parents did not agree with their children. Test-retest reliability and relative validity of a modified MEDFICTS dietary fat screener in South African schoolchildren depended on the use and outcome measures applied. Copyright © 2014 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.

  18. The French nuclear power plant reactor building containment contributions of prestressing and concrete performances in reliability improvements and cost savings

    International Nuclear Information System (INIS)

    Rouelle, P.; Roy, F.

    1998-01-01

    The Electricite de France's N4 CHOOZ B nuclear power plant, two units of the world's largest PWR model (1450 Mwe each), has earned the Electric Power International's 1997 Powerplant Award. This lead NPP for EDF's N4 series has been improved notably in terms of civil works. The presentation will focus on the Reactor Building's inner containment wall which is one of the main civil structures on a technical and safety point of view. In order to take into account the necessary evolution of the concrete technical specification such as compressive strength low creep and shrinkage, the HSC/HPC has been used on the last N4 Civaux 2 NPP. As a result of the use of this type of professional concrete, the containment withstands an higher internal pressure related to severe accident and ensures higher level of leak-tightness, thus improving the overall safety of the NPP. On that occasion, a new type of prestressing has been tested locally through 55 C 15 S tendons using a new C 1500 FE Jack. These updated civil works techniques shall allow EDF to ensure a Reactor Containment lifespan for more than 50 years. The gains in terms of reliability and cost saving of these improved techniques will be developed hereafter

  19. Quality Improvement Process in a Large Intensive Care Unit: Structure and Outcomes.

    Science.gov (United States)

    Reddy, Anita J; Guzman, Jorge A

    2016-11-01

    Quality improvement in the health care setting is a complex process, and even more so in the critical care environment. The development of intensive care unit process measures and quality improvement strategies are associated with improved outcomes, but should be individualized to each medical center as structure and culture can differ from institution to institution. The purpose of this report is to describe the structure of quality improvement processes within a large medical intensive care unit while using examples of the study institution's successes and challenges in the areas of stat antibiotic administration, reduction in blood product waste, central line-associated bloodstream infections, and medication errors. © The Author(s) 2015.

  20. Quality Improvement in Anesthesiology - Leveraging Data and Analytics to Optimize Outcomes.

    Science.gov (United States)

    Valentine, Elizabeth A; Falk, Scott A

    2018-03-01

    Quality improvement is at the heart of practice of anesthesiology. Objective data are critical for any quality improvement initiative; when possible, a combination of process, outcome, and balancing metrics should be evaluated to gauge the value of an intervention. Quality improvement is an ongoing process; iterative reevaluation of data is required to maintain interventions, ensure continued effectiveness, and continually improve. Dashboards can facilitate rapid analysis of data and drive decision making. Large data sets can be useful to establish benchmarks and compare performance against other providers, practices, or institutions. Audit and feedback strategies are effective in facilitating positive change. Copyright © 2017 Elsevier Inc. All rights reserved.