WorldWideScience

Sample records for patient flow improvement

  1. Process efficiency. Redesigning social networks to improve surgery patient flow.

    Science.gov (United States)

    Samarth, Chandrika N; Gloor, Peter A

    2009-01-01

    We propose a novel approach to improve throughput of the surgery patient flow process of a Boston area teaching hospital. A social network analysis was conducted in an effort to demonstrate that process efficiency gains could be achieved through redesign of social network patterns at the workplace; in conjunction with redesign of organization structure and the implementation of workflow over an integrated information technology system. Key knowledge experts and coordinators in times of crisis were identified and a new communication structure more conducive to trust and knowledge sharing was suggested. The new communication structure is scalable without compromising on coordination required among key roles in the network for achieving efficiency gains.

  2. Improvement of emergency department patient flow using lean thinking.

    Science.gov (United States)

    Sánchez, Miquel; Suárez, Montse; Asenjo, María; Bragulat, Ernest

    2018-05-01

    To apply lean thinking in triage acuity level-3 patients in order to improve emergency department (ED) throughtput and waiting time. A prospective interventional study. An ED of a tertiary care hospital. Triage acuity level-3 patients. To apply lean techniques such as value stream mapping, workplace organization, reduction of wastes and standardization by the frontline staff. Two periods were compared: (i) pre-lean: April-September, 2015; and (ii) post-lean: April-September, 2016. Variables included: median process time (time from beginning of nurse preparation to the end of nurse finalization after doctor disposition) of both discharged and transferred to observation patients; median length of stay; median waiting time; left without being seen, 72-h revisit and mortality rates, and daily number of visits. There was no additional staff or bed after lean implementation. Despite an increment in the daily number of visits (+8.3%, P lean implementation. No significant differences were registered in left without being seen rate (5.23% vs 4.95%), 72-h revisit rate (3.41% vs 3.93%), and mortality rate (0.23% vs 0.15%). Lean thinking is a methodology that can improve triage acuity level-3 patient flow in the ED, resulting in better throughput along with reduced waiting time.

  3. Flow Experience During Attentional Training Improves Cognitive Functions in Patients with Traumatic Brain Injury: An Exploratory Case Study

    Directory of Open Access Journals (Sweden)

    Kazuki Yoshida

    2014-12-01

    Conclusion: The results for Patient A suggested that the flow task was more effective than general OT for improving attention deficits. Moreover, the results for Patient B suggested that the flow task was more effective than the control task. Attention training inducing flow experience may thus facilitate improvement of attention.

  4. Web-Based Predictive Analytics to Improve Patient Flow in the Emergency Department

    Science.gov (United States)

    Buckler, David L.

    2012-01-01

    The Emergency Department (ED) simulation project was established to demonstrate how requirements-driven analysis and process simulation can help improve the quality of patient care for the Veterans Health Administration's (VHA) Veterans Affairs Medical Centers (VAMC). This project developed a web-based simulation prototype of patient flow in EDs, validated the performance of the simulation against operational data, and documented IT requirements for the ED simulation.

  5. Microvascular Blood Flow Improvement in Hyperglycemic Obese Adult Patients by Hypocaloric Diet.

    Science.gov (United States)

    Mastantuono, T; Di Maro, M; Chiurazzi, M; Battiloro, L; Starita, N; Nasti, G; Lapi, D; Iuppariello, L; Cesarelli, M; D'Addio, G; Colantuoni, A

    2016-11-01

    The present study was aimed to assess the changes in skin microvascular blood flow (SBF) in newly diagnosed hyperglycemic obese subjects, administered with hypocaloric diet. Adult patients were recruited and divided in three groups: NW group (n=54), NG (n=54) and HG (n=54) groups were constituted by normal weight, normoglycemic and hyperglycemic obese subjects, respectively. SBF was measured by laser Doppler perfusion monitoring technique and oscillations in blood flow were analyzed by spectral methods under baseline conditions, at 3 and 6 months of dietary treatment. Under resting conditions, SBF was lower in HG group than in NG and NW ones. Moreover, all subjects showed blood flow oscillations with several frequency components. In particular, hyperglycemic obese patients revealed lower spectral density in myogenic-related component than normoglycemic obese and normal weight ones. Moreover, post-occlusive reactive hyperemia (PORH) was impaired in hyperglycemic obese compared to normoglycemic and normal weigh subjects. After hypocaloric diet, in hyperglycemic obese patients there was an improvement in SBF accompanied by recovery in myogenic-related oscillations and arteriolar responses during PORH. In conclusion, hyperglycemia markedly affected peripheral microvascular function; hypocaloric diet ameliorated tissue blood flow.

  6. A comprehensive approach to improving patient flow in our hospitals--the 'left to right, over and under' concept.

    Science.gov (United States)

    Ardagh, Michael

    2015-08-21

    It is essential we manage the capacity of our hospitals so that acute demand can be accommodated without developing queues for care and backlogs of work. This paper presents a comprehensive model for improving patient flow in our hospitals by attending carefully to both the demand and capacity states of the hospital and maximising efficient flow of our acute patient journeys. The model includes attention to the patient journey as the central focus, with an overarching governance structure and an underpinning sophisticated operations structure.

  7. Patient flow improvement for an ophthalmic specialist outpatient clinic with aid of discrete event simulation and design of experiment.

    Science.gov (United States)

    Pan, Chong; Zhang, Dali; Kon, Audrey Wan Mei; Wai, Charity Sue Lea; Ang, Woo Boon

    2015-06-01

    Continuous improvement in process efficiency for specialist outpatient clinic (SOC) systems is increasingly being demanded due to the growth of the patient population in Singapore. In this paper, we propose a discrete event simulation (DES) model to represent the patient and information flow in an ophthalmic SOC system in the Singapore National Eye Centre (SNEC). Different improvement strategies to reduce the turnaround time for patients in the SOC were proposed and evaluated with the aid of the DES model and the Design of Experiment (DOE). Two strategies for better patient appointment scheduling and one strategy for dilation-free examination are estimated to have a significant impact on turnaround time for patients. One of the improvement strategies has been implemented in the actual SOC system in the SNEC with promising improvement reported.

  8. Albumin infusion improves renal blood flow autoregulation in patients with acute decompensation of cirrhosis and acute kidney injury.

    Science.gov (United States)

    Garcia-Martinez, Rita; Noiret, Lorette; Sen, Sambit; Mookerjee, Rajeshwar; Jalan, Rajiv

    2015-02-01

    In cirrhotic patients with renal failure, renal blood flow autoregulation curve is shifted to the right, which is consequent upon sympathetic nervous system activation and endothelial dysfunction. Albumin infusion improves renal function in cirrhosis by mechanisms that are incompletely understood. We aimed to determine the effect of albumin infusion on systemic haemodynamics, renal blood flow, renal function and endothelial function in patients with acute decompensation of cirrhosis and acute kidney injury. Twelve patients with refractory ascites and 10 patients with acute decompensation of cirrhosis and acute kidney injury were studied. Both groups were treated with intravenous albumin infusion, 40-60 g/days over 3-4 days. Cardiac and renal haemodynamics were measured. Endothelial activation/dysfunction was assessed using von Willebrand factor and serum nitrite levels. F2α Isoprostanes, resting neutrophil burst and noradrenaline levels were quantified as markers of oxidative stress, endotoxemia and sympathetic activation respectively. Albumin infusion leads to a shift in the renal blood flow autoregulation curve towards normalization, which resulted in a significant increase in renal blood flow. Accordingly, improvement of renal function was observed. In parallel, a significant decrease in sympathetic activation, inflammation/oxidative stress and endothelial activation/dysfunction was documented. Improvement of renal blood flow correlated with improvement in endothelial activation (r = 0.741, P renal function in acutely decompensated cirrhotic patients with acute kidney injury by impacting on renal blood flow autoregulation. This is possibly achieved through endothelial stabilization and a reduction in the sympathetic tone, endotoxemia and oxidative stress. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  9. Blood flow dynamic improvement with aneurysm repair detected by a patient-specific model of multiple aortic aneurysms.

    Science.gov (United States)

    Sughimoto, Koichi; Takahara, Yoshiharu; Mogi, Kenji; Yamazaki, Kenji; Tsubota, Ken'ichi; Liang, Fuyou; Liu, Hao

    2014-05-01

    Aortic aneurysms may cause the turbulence of blood flow and result in the energy loss of the blood flow, while grafting of the dilated aorta may ameliorate these hemodynamic disturbances, contributing to the alleviation of the energy efficiency of blood flow delivery. However, evaluating of the energy efficiency of blood flow in an aortic aneurysm has been technically difficult to estimate and not comprehensively understood yet. We devised a multiscale computational biomechanical model, introducing novel flow indices, to investigate a single male patient with multiple aortic aneurysms. Preoperative levels of wall shear stress and oscillatory shear index (OSI) were elevated but declined after staged grafting procedures: OSI decreased from 0.280 to 0.257 (first operation) and 0.221 (second operation). Graftings may strategically counter the loss of efficient blood delivery to improve hemodynamics of the aorta. The energy efficiency of blood flow also improved postoperatively. Novel indices of pulsatile pressure index (PPI) and pulsatile energy loss index (PELI) were evaluated to characterize and quantify energy loss of pulsatile blood flow. Mean PPI decreased from 0.445 to 0.423 (first operation) and 0.359 (second operation), respectively; while the preoperative PELI of 0.986 dropped to 0.820 and 0.831. Graftings contributed not only to ameliorate wall shear stress or oscillatory shear index but also to improve efficient blood flow. This patient-specific modeling will help in analyzing the mechanism of aortic aneurysm formation and may play an important role in quantifying the energy efficiency or loss in blood delivery.

  10. High-Flow Nasal Interface Improves Oxygenation in Patients Undergoing Bronchoscopy

    Directory of Open Access Journals (Sweden)

    Umberto Lucangelo

    2012-01-01

    Full Text Available During bronchoscopy hypoxemia is commonly found and oxygen supply can be delivered by interfaces fed with high gas flows. Recently, the high-flow nasal cannula (HFNC has been introduced for oxygen therapy in adults, but they have not been used so far during bronchoscopy in adults. Forty-five patients were randomly assigned to 3 groups receiving oxygen: 40 L/min through a Venturi mask (V40, N=15, nasal cannula (N40, N=15, and 60 L/min through a nasal cannula (N60, N=15 during bronchoscopy. Gas exchange and circulatory variables were sampled before (FiO2 = 0.21, at the end of bronchoscopy (FiO2 = 0.5, and thereafter (V40, FiO2 = 0.35. In 8 healthy volunteers oxygen was randomly delivered according to V40, N40, and N60 settings, and airway pressure was measured. At the end of bronchoscopy, N60 presented higher PaO2, PaO2/FiO2, and SpO2 than V40 and N40 that did not differ between them. In the volunteers (N60 median airway pressure amounted to 3.6 cmH2O. Under a flow rate of 40 L/min both the Venturi mask and HFNC behaved similarly, but nasal cannula associated with a 60 L/min flow produced the better results, thus indicating its use in mild respiratory dysfunctions.

  11. Symptomatic relief precedes improvement of myocardial blood flow in patients under spinal cord stimulation

    Directory of Open Access Journals (Sweden)

    Koulousakis Athanassios

    2005-05-01

    Full Text Available Abstract Background Spinal cord electrical stimulation (SCS has shown to be a treatment option for patients suffering from angina pectoris CCS III-IV although being on optimal medication and not suitable for conventional treatment strategies, e.g. CABG or PTCA. Although many studies demonstrated a clear symptomatic relief under SCS therapy, there are only a few short-term studies that investigated alterations in cardiac ischemia. Therefore doubts remain whether SCS has a direct effect on myocardial perfusion. Methods A prospective study to investigate the short- and long-term effect of spinal cord stimulation (SCS on myocardial ischemia in patients with refractory angina pectoris and coronary multivessel disease was designed. Myocardial ischemia was measured by MIBI-SPECT scintigraphy 3 months and 12 months after the beginning of neurostimulation. To further examine the relation between cardiac perfusion and functional status of the patients we measured exercise capacity (bicycle ergometry and 6-minute walk test, symptoms and quality of life (Seattle Angina Questionnaire [SAQ], as well. Results 31 patients (65 ± 11 SEM years; 25 male, 6 female were included into the study. The average consumption of short acting nitrates (SAN decreased rapidly from 12 ± 1.6 times to 3 ± 1 times per week. The walking distance and the maximum workload increased from 143 ± 22 to 225 ± 24 meters and 68 ± 7 to 96 ± 12 watt after 3 months. Quality of life increased (SAQ significantly after 3 month compared to baseline, as well. No further improvement was observed after one year of treament. Despite the symptomatic relief and the improvement in maximal workload computer based analysis (Emory Cardiac Toolbox of the MIBI-SPECT studies after 3 months of treatment did not show significant alterations of myocardial ischemia compared to baseline (16 patients idem, 7 with increase and 6 with decrease of ischemia, 2 patients dropped out during initial test phase

  12. Doppler Endoscopic Probe Monitoring of Blood Flow Improves Risk Stratification and Outcomes of Patients With Severe Nonvariceal Upper Gastrointestinal Hemorrhage.

    Science.gov (United States)

    Jensen, Dennis M; Kovacs, Thomas O G; Ohning, Gordon V; Ghassemi, Kevin; Machicado, Gustavo A; Dulai, Gareth S; Sedarat, Alireza; Jutabha, Rome; Gornbein, Jeffrey

    2017-05-01

    For 4 decades, stigmata of recent hemorrhage in patients with nonvariceal lesions have been used for risk stratification and endoscopic hemostasis. The arterial blood flow that underlies the stigmata rarely is monitored, but can be used to determine risk for rebleeding. We performed a randomized controlled trial to determine whether Doppler endoscopic probe monitoring of blood flow improves risk stratification and outcomes in patients with severe nonvariceal upper gastrointestinal hemorrhage. In a single-blind study performed at 2 referral centers we assigned 148 patients with severe nonvariceal upper gastrointestinal bleeding (125 with ulcers, 19 with Dieulafoy's lesions, and 4 with Mallory Weiss tears) to groups that underwent standard, visually guided endoscopic hemostasis (control, n = 76), or endoscopic hemostasis assisted by Doppler monitoring of blood flow under the stigmata (n = 72). The primary outcome was the rate of rebleeding after 30 days; secondary outcomes were complications, death, and need for transfusions, surgery, or angiography. There was a significant difference in the rates of lesion rebleeding within 30 days of endoscopic hemostasis in the control group (26.3%) vs the Doppler group (11.1%) (P = .0214). The odds ratio for rebleeding with Doppler monitoring was 0.35 (95% confidence interval, 0.143-0.8565) and the number needed to treat was 7. In a randomized controlled trial of patients with severe upper gastrointestinal hemorrhage from ulcers or other lesions, Doppler probe guided endoscopic hemostasis significantly reduced 30-day rates of rebleeding compared with standard, visually guided hemostasis. Guidelines for nonvariceal gastrointestinal bleeding should incorporate these results. ClinicalTrials.gov no: NCT00732212 (CLIN-013-07F). Copyright © 2017 AGA Institute. Published by Elsevier Inc. All rights reserved.

  13. Improving flow in the OR.

    Science.gov (United States)

    Blouin-Delisle, Charles Hubert; Drolet, Renee; Gagnon, Serge; Turcotte, Stephane; Boutet, Sylvie; Coulombe, Martin; Daneau, Eric

    2018-03-12

    Purpose The purpose of this paper is to increase efficiency in ORs without affecting quality of care by improving the workflow processes. Administrative processes independent of the surgical act can be challenging and may lead to clinical impacts such as increasing delays. The authors hypothesized that a Lean project could improve efficiency of surgical processes by reducing the length of stays in the recovery ward. Design/methodology/approach Two similar Lean projects were performed in the surgery departments of two hospitals of the Centre Hospitalier Universitaire de Québec: Hôtel Dieu de Quebec (HDQ) and Hôpital de l'Enfant Jesus (HEJ). The HDQ project designed around a Define, Measure, Analyse, Improve and Control process revision and a Kaizen workshop focused on patients who were hospitalized in a specific care unit after surgery and the HEJ project targeted patients in a post-operative ambulatory context. The recovery ward output delay was measured retrospectively before and after project. Findings For the HDQ Lean project, wasted time in the recovery ward was reduced by 62 minutes (68 percent reduction) between the two groups. The authors also observed an increase of about 25 percent of all admissions made in the daytime after the project compared to the time period before the project. For the HEJ Lean project, time passed in the recovery ward was reduced by 6 min (29 percent reduction). Originality/value These projects produced an improvement in the flow of the OR without targeting clinical practices in the OR itself. They demonstrated that change in administrative processes can have a great impact on the flow of clinical pathways and highlight the need for comprehensive and precise monitoring of every step of the elective surgery patient trajectory.

  14. Metformin, but not glimepiride, improves carotid artery diameter and blood flow in patients with type 2 diabetes mellitus

    Directory of Open Access Journals (Sweden)

    Helena Atroch Machado

    2012-07-01

    Full Text Available OBJECTIVE: To compare the effects of glimepiride and metformin on vascular reactivity, hemostatic factors and glucose and lipid profiles in patients with type 2 diabetes. METHODS: A prospective study was performed in 16 uncontrolled patients with diabetes previously treated with dietary intervention. The participants were randomized into metformin or glimepiride therapy groups. After four months, the patients were crossed over with no washout period to the alternative treatment for an additional four-month period on similar dosage schedules. The following variables were assessed before and after four months of each treatment: 1 fasting glycemia, insulin, catecholamines, lipid profiles and HbA1 levels; 2 t-PA and PAI-1 (antigen and activity, platelet aggregation and fibrinogen and plasminogen levels; and 3 the flow indices of the carotid and brachial arteries. In addition, at the end of each period, a 12-hour metabolic profile was obtained after fasting and every 2 hours thereafter. RESULTS: Both therapies resulted in similar decreases in fasting glucose, triglyceride and norepinephrine levels, and they increased the fibrinolytic factor plasminogen but decreased t-PA activity. Metformin caused lower insulin and pro-insulin levels and higher glucagon levels and increased systolic carotid diameter and blood flow. Neither metformin nor glimepiride affected endothelial-dependent or endothelial-independent vasodilation of the brachial artery. CONCLUSIONS: Glimepiride and metformin were effective in improving glucose and lipid profiles and norepinephrine levels. Metformin afforded more protection against macrovascular diabetes complications, increased systolic carotid artery diameter and total and systolic blood flow, and decreased insulin levels. As both therapies increased plasminogen levels but reduced t-PA activity, a coagulation process was likely still ongoing.

  15. Improving visit cycle time using patient flow analysis in a high-volume inner-city hospital-based ambulatory clinic serving minority New Yorkers.

    Science.gov (United States)

    Dhar, Sanjay; Michel, Raquel; Kanna, Balavenkatesh

    2011-01-01

    Patient waiting time and waiting room congestion are quality indicators that are related to efficiency of ambulatory care systems and patient satisfaction. Our main purpose was to test a program to decrease patient visit cycle time, while maintaining high-quality healthcare in a high-volume inner-city hospital-based clinic in New York City. Use of patient flow analysis and the creation of patient care teams proved useful in identifying areas for improvement, target, and measure effectiveness of interventions. The end result is reduced visit cycle time, improved provider team performance, and sustained patient care outcomes. © 2010 National Association for Healthcare Quality.

  16. A Case of Left Renal Vein Ligation in a Patient with Solitary Left Kidney Undergoing Liver Transplantation to Control Splenorenal Shunt and Improve Portal Venous Flow.

    Science.gov (United States)

    Martino, Rodrigo B; Júnior, Eserval Rocha; Manuel, Valdano; Rocha-Santos, Vinicius; D'Albuquerque, Luis Augusto C; Andraus, Wellington

    2017-10-11

    BACKGROUND Adequate portal venous flow is required for successful liver transplantation. Reduced venous flow and blood flow 'steal' by collateral vessels are a concern, and when there is a prominent splenorenal shunt present, ligation of the left renal vein has been recommended to improve portal venous blood flow. CASE REPORT A 51-year-old man who had undergone right nephrectomy in childhood required liver transplantation for liver cirrhosis and hepatocellular carcinoma due to hepatitis C virus (HCV) infection. The patient had no other comorbidity and no history of hepatorenal syndrome. At transplantation surgery, portal venous flow was poor and did not improve with ligation of shunt veins, but ligation of the left renal vein improved portal venous flow. On the first and fifth postoperative days, the patient was treated with basiliximab, a chimeric monoclonal antibody to the IL-2 receptor, and methylprednisolone. The calcineurin inhibitor, tacrolimus, was introduced on the fifth postoperative day. On the sixteenth postoperative day, renal color Doppler ultrasound showed normal left renal parenchyma; hepatic Doppler ultrasound showed good portal vein flow and preserved hepatic parenchyma in the liver transplant. CONCLUSIONS This case report has shown that in a patient with a single left kidney, left renal vein ligation is feasible and safe in a patient with no other risk factors for renal impairment following liver transplantation. Modification of postoperative immunosuppression to avoid calcineurin inhibitors in the very early postoperative phase may be important in promoting good recovery of renal function and to avoid the need for postoperative renal dialysis.

  17. Intensive insulin treatment improves forearm blood flow in critically ill patients: a randomized parallel design clinical trial.

    Science.gov (United States)

    Žuran, Ivan; Poredos, Pavel; Skale, Rafael; Voga, Gorazd; Gabrscek, Lucija; Pareznik, Roman

    2009-01-01

    Intensive insulin treatment of critically ill patients was seen as a promising method of treatment, though recent studies showed that reducing the blood glucose level below 6 mmol/l had a detrimental outcome. The mechanisms of the effects of insulin in the critically ill are not completely understood. The purpose of the study was to test the hypothesis that intensive insulin treatment may influence forearm blood flow independently of global hemodynamic indicators. The study encompassed 29 patients of both sexes who were admitted to the intensive care unit due to sepsis and required artificial ventilation as the result of acute respiratory failure. 14 patients were randomly selected for intensive insulin treatment (Group 1; blood glucose concentration 4.4-6.1 mmol/l), and 15 were selected for conventional insulin treatment (Group 2; blood glucose level 7.0 mmol/l-11.0 mmol/l). At the start of the study (t0, beginning up to 48 hours after admittance and the commencement of artificial ventilation), at 2 hours (t1), 24 hours (t2), and 72 hours (t3) flow in the forearm was measured for 60 minutes using the strain-gauge plethysmography method. Student's t-test of independent samples was used for comparisons between the two groups, and Mann-Whitney's U-test where appropriate. Linear regression analysis and the Pearson correlation coefficient were used to determine the levels of correlation. The difference in 60-minute forearm flow at the start of the study (t0) was not statistically significant between groups, while at t2 and t3 significantly higher values were recorded in Group 1 (t2; Group 1: 420.6 +/- 188.8 ml/100 ml tissue; Group 2: 266.1 +/- 122.2 ml/100 ml tissue (95% CI 30.9-278.0, P = 0.02); t3; Group 1: 369.9 +/- 150.3 ml/100 ml tissue; Group 2: 272.6 +/- 85.7 ml/100 ml tissue (95% CI 5.4-190.0, P = 0.04). At t1 a trend towards significantly higher values in Group 1 was noted (P = 0.05). The level of forearm flow was related to the amount of insulin infusion (r

  18. Quality initiatives: improving patient flow for a bone densitometry practice: results from a Mayo Clinic radiology quality initiative.

    Science.gov (United States)

    Aakre, Kenneth T; Valley, Timothy B; O'Connor, Michael K

    2010-03-01

    Lean Six Sigma process improvement methodologies have been used in manufacturing for some time. However, Lean Six Sigma process improvement methodologies also are applicable to radiology as a way to identify opportunities for improvement in patient care delivery settings. A multidisciplinary team of physicians and staff conducted a 100-day quality improvement project with the guidance of a quality advisor. By using the framework of DMAIC (define, measure, analyze, improve, and control), time studies were performed for all aspects of patient and technologist involvement. From these studies, value stream maps for the current state and for the future were developed, and tests of change were implemented. Comprehensive value stream maps showed that before implementation of process changes, an average time of 20.95 minutes was required for completion of a bone densitometry study. Two process changes (ie, tests of change) were undertaken. First, the location for completion of a patient assessment form was moved from inside the imaging room to the waiting area, enabling patients to complete the form while waiting for the technologist. Second, the patient was instructed to sit in a waiting area immediately outside the imaging rooms, rather than in the main reception area, which is far removed from the imaging area. Realignment of these process steps, with reduced technologist travel distances, resulted in a 3-minute average decrease in the patient cycle time. This represented a 15% reduction in the initial patient cycle time with no change in staff or costs. Radiology process improvement projects can yield positive results despite small incremental changes.

  19. Improving Patient Safety: Improving Communication.

    Science.gov (United States)

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

    2017-12-01

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

  20. Improved graft survival in highly sensitized patients undergoing renal transplantation after the introduction of a clinically validated flow cytometry crossmatch.

    LENUS (Irish Health Repository)

    Limaye, Sandhya

    2009-04-15

    Flow cytometric techniques are increasingly used in pretransplant crossmatching, although there remains debate regarding the clinical significance and predictive value of donor-specific antibodies detected by flow cytometry. At least some of the discrepancies between published studies may arise from differences in cutoffs used and lack of standardization of the test.

  1. Lean techniques to improve the flow of critically ill patients in a health region with its epicenter in the intensive care unit of a reference hospital.

    Science.gov (United States)

    Sirvent, J M; Gil, M; Alvarez, T; Martin, S; Vila, N; Colomer, M; March, E; Loma-Osorio, P; Metje, T

    2016-01-01

    To analyze whether the application of Lean techniques to improve the flow of critically ill patients in a health region with its epicenter in the intensive care unit (ICU) of a reference hospital. Observational study with pre and post intervention analysis. ICU of a reference hospital. We design projects and a value stream map of flow and compared pre and post intervention. We recorded demographic data, patient transfers by EMS for lack of beds and delay times in the discharge from ICU to ward. Multidisciplinary meetings and perform daily visual panel, with high priority ICU discharge. We promote temporary relocation of critically ill patients in other special areas of the hospital. We performed a professional satisfaction questionnaire with pre and post implementation of process. We make a statistical analysis of pre and post-intervention comparisons. We planned for 2013 and progressively implemented in 2014. Analysis of patients entering the critical process flow 1) evaluate patients who must transfer for lack of beds, focusing on a diagnosis: pre 10/22 vs. 3/21 post (P=.045); 2) analysis of time delay in the discharge from the ICU to ward: 360.8±163.9minutes in the first period vs. 276.7±149.5 in the second (P=.036); and 3) personal professional satisfaction questionnaire, with 6.6±1.5 points pre vs. 7.5±1.1 in post (P=.001). Analysis of indicators such as the ICU acquired infections, length of ICU stay, the rate of re-admissions and mortality, with no significant differences between the two periods. The application of Lean techniques in the critically ill process had a positive impact on improving patient flow within the health region, noting a decrease of transfers outside the region due to lack of beds, reduced delayed discharge from ICU to conventional ward and increased satisfaction of ICU professionals. Copyright © 2015 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.

  2. Realizing improved patient care through human-centered operating room design: a human factors methodology for observing flow disruptions in the cardiothoracic operating room.

    Science.gov (United States)

    Palmer, Gary; Abernathy, James H; Swinton, Greg; Allison, David; Greenstein, Joel; Shappell, Scott; Juang, Kevin; Reeves, Scott T

    2013-11-01

    Human factors engineering has allowed a systematic approach to the evaluation of adverse events in a multitude of high-stake industries. This study sought to develop an initial methodology for identifying and classifying flow disruptions in the cardiac operating room (OR). Two industrial engineers with expertise in human factors workflow disruptions observed 10 cardiac operations from the moment the patient entered the OR to the time they left for the intensive care unit. Each disruption was fully documented on an architectural layout of the OR suite and time-stamped during each phase of surgery (preoperative [before incision], operative [incision to skin closure], and postoperative [skin closure until the patient leaves the OR]) to synchronize flow disruptions between the two observers. These disruptions were then categorized. The two observers made a total of 1,158 observations. After the elimination of duplicate observations, a total of 1,080 observations remained to be analyzed. These disruptions were distributed into six categories such as communication, usability, physical layout, environmental hazards, general interruptions, and equipment failures. They were further organized into 33 subcategories. The most common disruptions were related to OR layout and design (33%). By using the detailed architectural diagrams, the authors were able to clearly demonstrate for the first time the unique role that OR design and equipment layout has on the generation of physical layout flow disruptions. Most importantly, the authors have developed a robust taxonomy to describe the flow disruptions encountered in a cardiac OR, which can be used for future research and patient safety improvements.

  3. Omega-3 fatty acid therapy dose-dependently and significantly decreased triglycerides and improved flow-mediated dilation, however, did not significantly improve insulin sensitivity in patients with hypertriglyceridemia.

    Science.gov (United States)

    Oh, Pyung Chun; Koh, Kwang Kon; Sakuma, Ichiro; Lim, Soo; Lee, Yonghee; Lee, Seungik; Lee, Kyounghoon; Han, Seung Hwan; Shin, Eak Kyun

    2014-10-20

    Experimental studies demonstrate that higher intake of omega-3 fatty acids (n-3 FA) improves insulin sensitivity, however, we reported that n-3 FA 2g therapy, most commonly used dosage did not significantly improve insulin sensitivity despite reducing triglycerides by 21% in patients. Therefore, we investigated the effects of different dosages of n-3 FA in patients with hypertriglyceridemia. This was a randomized, single-blind, placebo-controlled, parallel study. Age, sex, and body mass index were matched among groups. All patients were recommended to maintain a low fat diet. Forty-four patients (about 18 had metabolic syndrome/type 2 diabetes mellitus) in each group were given placebo, n-3 FA 1 (O1), 2 (O2), or 4 g (O4), respectively daily for 2 months. n-3 FA therapy dose-dependently and significantly decreased triglycerides and triglycerides/HDL cholesterol and improved flow-mediated dilation, compared with placebo (by ANOVA). However, each n-3 FA therapy did not significantly decrease high-sensitivity C-reactive protein and fibrinogen, compared with placebo. O1 significantly increased insulin levels and decreased insulin sensitivity (determined by QUICKI) and O2 significantly decreased plasma adiponectin levels relative to baseline measurements. Of note, when compared with placebo, each n-3 FA therapy did not significantly change insulin, glucose, adiponectin, glycated hemoglobin levels and insulin sensitivity (by ANOVA). We observed similar results in a subgroup of patients with the metabolic syndrome. n-3 FA therapy dose-dependently and significantly decreased triglycerides and improved flow-mediated dilation. Nonetheless, n-3 FA therapy did not significantly improve acute-phase reactants and insulin sensitivity in patients with hypertriglyceridemia, regardless of dosages. Copyright © 2014. Published by Elsevier Ireland Ltd.

  4. IMPROVING PATIENT SAFETY:

    DEFF Research Database (Denmark)

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

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

  5. Simulation-based patient flow analysis in an endoscopy unit

    DEFF Research Database (Denmark)

    Koo, Pyung-Hoi; Nielsen, Karl Brian; Jang, Jaejin

    2010-01-01

    One of the major elements in improving efficiency of healthcare services is patient flow. Patients require a variety of healthcare resources as they receive healthcare services. Poor management of patient flow results in long waiting time of patients, under/over utilization of medical resources......, low quality of care and high healthcare cost. This article addresses patient flow problems at a Gastrointestinal endoscopy unit. We attempt to analyze the main factors that contribute to the inefficient patient flow and process bottlenecks and to propose efficient patient scheduling and staff...

  6. 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

  7. Improved choked flow model for MARS code

    International Nuclear Information System (INIS)

    Chung, Moon Sun; Lee, Won Jae; Ha, Kwi Seok; Hwang, Moon Kyu

    2002-01-01

    Choked flow calculation is improved by using a new sound speed criterion for bubbly flow that is derived by the characteristic analysis of hyperbolic two-fluid model. This model was based on the notion of surface tension for the interfacial pressure jump terms in the momentum equations. Real eigenvalues obtained as the closed-form solution of characteristic polynomial represent the sound speed in the bubbly flow regime that agrees well with the existing experimental data. The present sound speed shows more reasonable result in the extreme case than the Nguyens did. The present choked flow criterion derived by the present sound speed is employed in the MARS code and assessed by using the Marviken choked flow tests. The assessment results without any adjustment made by some discharge coefficients demonstrate more accurate predictions of choked flow rate in the bubbly flow regime than those of the earlier choked flow calculations. By calculating the Typical PWR (SBLOCA) problem, we make sure that the present model can reproduce the reasonable transients of integral reactor system

  8. Fractional Flow Reserve-Guided Complete Revascularization Improves the Prognosis in Patients With ST-Segment-Elevation Myocardial Infarction and Severe Nonculprit Disease

    DEFF Research Database (Denmark)

    Lønborg, Jacob; Engstrøm, Thomas; Kelbæk, Henning

    2017-01-01

    , and severity of the noninfarct-related stenosis on the effect of fractional flow reserve-guided complete revascularization. METHODS AND RESULTS: In the DANAMI-3-PRIMULTI study (Primary PCI in Patients With ST-Elevation Myocardial Infarction and Multivessel Disease: Treatment of Culprit Lesion Only or Complete...

  9. Improving ecological response monitoring of environmental flows.

    Science.gov (United States)

    King, Alison J; Gawne, Ben; Beesley, Leah; Koehn, John D; Nielsen, Daryl L; Price, Amina

    2015-05-01

    Environmental flows are now an important restoration technique in flow-degraded rivers, and with the increasing public scrutiny of their effectiveness and value, the importance of undertaking scientifically robust monitoring is now even more critical. Many existing environmental flow monitoring programs have poorly defined objectives, nonjustified indicator choices, weak experimental designs, poor statistical strength, and often focus on outcomes from a single event. These negative attributes make them difficult to learn from. We provide practical recommendations that aim to improve the performance, scientific robustness, and defensibility of environmental flow monitoring programs. We draw on the literature and knowledge gained from working with stakeholders and managers to design, implement, and monitor a range of environmental flow types. We recommend that (1) environmental flow monitoring programs should be implemented within an adaptive management framework; (2) objectives of environmental flow programs should be well defined, attainable, and based on an agreed conceptual understanding of the system; (3) program and intervention targets should be attainable, measurable, and inform program objectives; (4) intervention monitoring programs should improve our understanding of flow-ecological responses and related conceptual models; (5) indicator selection should be based on conceptual models, objectives, and prioritization approaches; (6) appropriate monitoring designs and statistical tools should be used to measure and determine ecological response; (7) responses should be measured within timeframes that are relevant to the indicator(s); (8) watering events should be treated as replicates of a larger experiment; (9) environmental flow outcomes should be reported using a standard suite of metadata. Incorporating these attributes into future monitoring programs should ensure their outcomes are transferable and measured with high scientific credibility.

  10. Improving Ecological Response Monitoring of Environmental Flows

    Science.gov (United States)

    King, Alison J.; Gawne, Ben; Beesley, Leah; Koehn, John D.; Nielsen, Daryl L.; Price, Amina

    2015-05-01

    Environmental flows are now an important restoration technique in flow-degraded rivers, and with the increasing public scrutiny of their effectiveness and value, the importance of undertaking scientifically robust monitoring is now even more critical. Many existing environmental flow monitoring programs have poorly defined objectives, nonjustified indicator choices, weak experimental designs, poor statistical strength, and often focus on outcomes from a single event. These negative attributes make them difficult to learn from. We provide practical recommendations that aim to improve the performance, scientific robustness, and defensibility of environmental flow monitoring programs. We draw on the literature and knowledge gained from working with stakeholders and managers to design, implement, and monitor a range of environmental flow types. We recommend that (1) environmental flow monitoring programs should be implemented within an adaptive management framework; (2) objectives of environmental flow programs should be well defined, attainable, and based on an agreed conceptual understanding of the system; (3) program and intervention targets should be attainable, measurable, and inform program objectives; (4) intervention monitoring programs should improve our understanding of flow-ecological responses and related conceptual models; (5) indicator selection should be based on conceptual models, objectives, and prioritization approaches; (6) appropriate monitoring designs and statistical tools should be used to measure and determine ecological response; (7) responses should be measured within timeframes that are relevant to the indicator(s); (8) watering events should be treated as replicates of a larger experiment; (9) environmental flow outcomes should be reported using a standard suite of metadata. Incorporating these attributes into future monitoring programs should ensure their outcomes are transferable and measured with high scientific credibility.

  11. Improved modeling techniques for turbomachinery flow fields

    Energy Technology Data Exchange (ETDEWEB)

    Lakshminarayana, B. [Pennsylvania State Univ., University Park, PA (United States); Fagan, J.R. Jr. [Allison Engine Company, Indianapolis, IN (United States)

    1995-10-01

    This program has the objective of developing an improved methodology for modeling turbomachinery flow fields, including the prediction of losses and efficiency. Specifically, the program addresses the treatment of the mixing stress tensor terms attributed to deterministic flow field mechanisms required in steady-state Computational Fluid Dynamic (CFD) models for turbo-machinery flow fields. These mixing stress tensors arise due to spatial and temporal fluctuations (in an absolute frame of reference) caused by rotor-stator interaction due to various blade rows and by blade-to-blade variation of flow properties. These tasks include the acquisition of previously unavailable experimental data in a high-speed turbomachinery environment, the use of advanced techniques to analyze the data, and the development of a methodology to treat the deterministic component of the mixing stress tensor. Penn State will lead the effort to make direct measurements of the momentum and thermal mixing stress tensors in high-speed multistage compressor flow field in the turbomachinery laboratory at Penn State. They will also process the data by both conventional and conditional spectrum analysis to derive momentum and thermal mixing stress tensors due to blade-to-blade periodic and aperiodic components, revolution periodic and aperiodic components arising from various blade rows and non-deterministic (which includes random components) correlations. The modeling results from this program will be publicly available and generally applicable to steady-state Navier-Stokes solvers used for turbomachinery component (compressor or turbine) flow field predictions. These models will lead to improved methodology, including loss and efficiency prediction, for the design of high-efficiency turbomachinery and drastically reduce the time required for the design and development cycle of turbomachinery.

  12. Black Tea Increases Circulating Endothelial Progenitor Cells and Improves Flow Mediated Dilatation Counteracting Deleterious Effects from a Fat Load in Hypertensive Patients: A Randomized Controlled Study

    Science.gov (United States)

    Grassi, Davide; Draijer, Richard; Schalkwijk, Casper; Desideri, Giovambattista; D’Angeli, Anatolia; Francavilla, Sandro; Mulder, Theo; Ferri, Claudio

    2016-01-01

    (1) Background: Endothelial dysfunction predicts cardiovascular events. Circulating angiogenic cells (CACs) maintain and repair the endothelium regulating its function. Tea flavonoids reduce cardiovascular risk. We investigated the effects of black tea on the number of CACs and on flow-mediated dilation (FMD) before and after an oral fat in hypertensives; (2) Methods: In a randomized, double-blind, controlled, cross-over study, 19 patients were assigned to black tea (150 mg polyphenols) or a placebo twice a day for eight days. Measurements were obtained in a fasted state and after consuming whipping cream, and FMD was measured at baseline and after consumption of the products; (3) Results: Compared with the placebo, black tea ingestion increased functionally active CACs (36 ± 22 vs. 56 ± 21 cells per high-power field; p = 0.006) and FMD (5.0% ± 0.3% vs. 6.6% ± 0.3%, p FMD 1, 2, 3, and 4 h after consumption, with maximal response 2 h after intake (p FMD, while tea consumption counteracted FMD impairment (p < 0.0001); (4) Conclusions: We demonstrated the vascular protective properties of black tea by increasing the number of CACs and preventing endothelial dysfunction induced by acute oral fat load in hypertensive patients. Considering that tea is the most consumed beverage after water, our findings are of clinical relevance and interest. PMID:27854314

  13. Black Tea Increases Circulating Endothelial Progenitor Cells and Improves Flow Mediated Dilatation Counteracting Deleterious Effects from a Fat Load in Hypertensive Patients: A Randomized Controlled Study

    Directory of Open Access Journals (Sweden)

    Davide Grassi

    2016-11-01

    Full Text Available (1 Background: Endothelial dysfunction predicts cardiovascular events. Circulating angiogenic cells (CACs maintain and repair the endothelium regulating its function. Tea flavonoids reduce cardiovascular risk. We investigated the effects of black tea on the number of CACs and on flow-mediated dilation (FMD before and after an oral fat in hypertensives; (2 Methods: In a randomized, double-blind, controlled, cross-over study, 19 patients were assigned to black tea (150 mg polyphenols or a placebo twice a day for eight days. Measurements were obtained in a fasted state and after consuming whipping cream, and FMD was measured at baseline and after consumption of the products; (3 Results: Compared with the placebo, black tea ingestion increased functionally active CACs (36 ± 22 vs. 56 ± 21 cells per high-power field; p = 0.006 and FMD (5.0% ± 0.3% vs. 6.6% ± 0.3%, p < 0.0001. Tea further increased FMD 1, 2, 3, and 4 h after consumption, with maximal response 2 h after intake (p < 0.0001. Fat challenge decreased FMD, while tea consumption counteracted FMD impairment (p < 0.0001; (4 Conclusions: We demonstrated the vascular protective properties of black tea by increasing the number of CACs and preventing endothelial dysfunction induced by acute oral fat load in hypertensive patients. Considering that tea is the most consumed beverage after water, our findings are of clinical relevance and interest.

  14. New heavy crude oil flow improver increases delivery : application scenarios

    Energy Technology Data Exchange (ETDEWEB)

    Pierce, J.; Johnston, R.; Lauzon, P. [ConocoPhillips Specialty Products Inc., Houston, TX (United States)

    2009-07-01

    Flow improvers or drag reducing agents have been used for over 25 years as a method to increase fluid flow in hydrocarbon pipelines. The technology is effective in refined projects, light and medium crude oils. This paper presented a new development in flow improver technology that allows treatment of heavy crude oil slates. It discussed case studies of flow improver treatment of heavy oils in various pipeline system as well as factors that affect commercial success. tabs., figs.

  15. Prostate Cancer: Improving the Flow of Research.

    Science.gov (United States)

    Lawton, Colleen A F

    2018-04-01

    Prostate cancer is the most common nonskin cancer diagnosed in U.S. men and kills over 27 000 men annually. Thus, improving the outcomes for patients diagnosed with this disease is imperative. There has been a considerable amount of research done over the past several decades resulting in more cures than ever, but the death rate is still unacceptable. This oration addresses the progress that we have made over the past several decades and outlines the work yet to be done, as well as some processes to make that work happen. © RSNA, 2018.

  16. The three paradoxes of patient flow: an explanatory case study.

    Science.gov (United States)

    Kreindler, Sara A

    2017-07-12

    Health systems in many jurisdictions struggle to reduce Emergency Department congestion and improve patient flow across the continuum of care. Flow is often described as a systemic issue requiring a "system approach"; however, the implications of this idea remain poorly understood. Focusing on a Canadian regional health system whose flow problems have been particularly intractable, this study sought to determine what system-level flaws impede healthcare organizations from improving flow. This study drew primarily on qualitative data from in-depth interviews with 62 senior, middle and departmental managers representing the Region, its programs and sites; quantitative analysis of key flow indicators (1999-2012) and review of ~700 documents furnished important context. Examination of the interview data revealed that the most striking feature of the dataset was contradiction; accordingly, a technique of dialectical analysis was developed to examine observed contradictions at successively deeper levels. Analysis uncovered three paradoxes: "Many Small Successes and One Big Failure" (initiatives improve parts of the system but fail to fix underlying system constraints); "Your Innovation Is My Aggravation" (local innovation clashes with regional integration); and most critically, "Your Order Is My Chaos" (rules that improve service organization for my patients create obstacles for yours). This last emerges when some entities (sites/hospitals) define their patients in terms of their location in the system, while others (regional programs) define them in terms of their needs/characteristics. As accountability for improving flow was distributed among groups that thus variously defined their patients, local efforts achieved little for the overall system, and often clashed with each other. These paradoxes are indicative of a fundamental antagonism between the system's parts and the whole. An accretion of flow initiatives in all parts of the system will never add up to a system

  17. Improving Emergency Department flow through optimized bed utilization.

    Science.gov (United States)

    Chartier, Lucas Brien; Simoes, Licinia; Kuipers, Meredith; McGovern, Barb

    2016-01-01

    Over the last decade, patient volumes in the emergency department (ED) have grown disproportionately compared to the increase in staffing and resources at the Toronto Western Hospital, an academic tertiary care centre in Toronto, Canada. The resultant congestion has spilled over to the ED waiting room, where medically undifferentiated and potentially unstable patients must wait until a bed becomes available. The aim of this quality improvement project was to decrease the 90th percentile of wait time between triage and bed assignment (time-to-bed) by half, from 120 to 60 minutes, for our highest acuity patients. We engaged key stakeholders to identify barriers and potential strategies to achieve optimal flow of patients into the ED. We first identified multiple flow-interrupting challenges, including operational bottlenecks and cultural issues. We then generated change ideas to address two main underlying causes of ED congestion: unnecessary patient utilization of ED beds and communication breakdown causing bed turnaround delays. We subsequently performed seven tests of change through sequential plan-do-study-act (PDSA) cycles. The most significant gains were made by improving communication strategies: small gains were achieved through the optimization of in-house digital information management systems, while significant improvements were achieved through the implementation of a low-tech direct contact mechanism (a two-way radio or walkie-talkie). In the post-intervention phase, time-to-bed for the 90th percentile of high-acuity patients decreased from 120 minutes to 66 minutes, with special cause variation showing a significant shift in the weekly measurements.

  18. Improving Software Systems By Flow Control Analysis

    Directory of Open Access Journals (Sweden)

    Piotr Poznanski

    2012-01-01

    Full Text Available Using agile methods during the implementation of the system that meets mission critical requirements can be a real challenge. The change in the system built of dozens or even hundreds of specialized devices with embedded software requires the cooperation of a large group of engineers. This article presents a solution that supports parallel work of groups of system analysts and software developers. Deployment of formal rules to the requirements written in natural language enables using formal analysis of artifacts being a bridge between software and system requirements. Formalism and textual form of requirements allowed the automatic generation of message flow graph for the (sub system, called the “big-picture-model”. Flow diagram analysis helped to avoid a large number of defects whose repair cost in extreme cases could undermine the legitimacy of agile methods in projects of this scale. Retrospectively, a reduction of technical debt was observed. Continuous analysis of the “big picture model” improves the control of the quality parameters of the software architecture. The article also tries to explain why the commercial platform based on UML modeling language may not be sufficient in projects of this complexity.

  19. Efficiency improvements of electromagnetic flow control

    International Nuclear Information System (INIS)

    Spong, E.; Reizes, J.A.; Leonardi, E.

    2005-01-01

    In turbulent flow, frictional resistance and heat transfer are controlled to a large degree by the intensity of the turbulence fluctuations in the near vicinity of a surface. In the case of a weak electrically conducting fluid, such as seawater, turbulence intensity can be controlled by subjecting the fluid to electromagnetic fields. This technique, known as Electro-magneto-hydro-dynamic (EMHD) flow control, has been shown to have promise as a means of reducing the turbulence intensity, and hence heat transfer or frictional drag of turbulent boundary layers. Unfortunately EMHD flow control currently suffers from poor efficiency due to the high energy requirements of the electromagnetic field. A numerical study has been conducted in which a new electromagnetic actuator design has been developed to provide a more efficient spatial distribution of the electromagnetic forces. The new actuator design has then been coupled to an ideal flow sensor. A flow control subroutine, embedded in the numerical model, uses the velocity information from the ideal sensor to determine the appropriate actuating force to apply to the flow at each time step. The new actuator design has been shown to be capable of successfully attenuating a sequence of artificial low speed streaks in a simplified model of a low Reynolds number turbulent boundary layer. Thus, a potential solution to the poor efficiency of EMHD flow control has been offered by providing the means whereby the expensive electromagnetic forces can be strategically and sparingly applied to the flow

  20. Modification of Aortic Cannula With an Inlet Chamber to Induce Spiral Flow and Improve Outlet Flow.

    Science.gov (United States)

    Darlis, Nofrizalidris; Osman, Kahar; Padzillah, Muhamad Hasbullah; Dillon, Jeswant; Md Khudzari, Ahmad Zahran

    2018-05-01

    Physiologically, blood ejected from the left ventricle in systole exhibited spiral flow characteristics. This spiral flow has been proven to have several advantages such as lateral reduction of directed forces and thrombus formation, while it also appears to be clinically beneficial in suppressing neurological complications. In order to deliver spiral flow characteristics during cardiopulmonary bypass operation, several modifications have been made on an aortic cannula either at the internal or at the outflow tip; these modifications have proven to yield better hemodynamic performances compared to standard cannula. However, there is no modification done at the inlet part of the aortic cannula for inducing spiral flow so far. This study was carried out by attaching a spiral inducer at the inlet of an aortic cannula. Then, the hemodynamic performances of the new cannula were compared with the standard straight tip end-hole cannula. This is achieved by modeling the cannula and attaching the cannula at a patient-specific aorta model. Numerical approach was utilized to evaluate the hemodynamic performance, and a water jet impact experiment was used to demonstrate the jet force generated by the cannula. The new spiral flow aortic cannula has shown some improvements by reducing approximately 21% of impinging velocity near to the aortic wall, and more than 58% reduction on total force generated as compared to standard cannula. © 2017 International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc.

  1. Patients Provide Recommendations for Improving Patient Satisfaction.

    Science.gov (United States)

    Moore, Angelo D; Hamilton, Jill B; Krusel, Jessica L; Moore, LeeAntoinette G; Pierre-Louis, Bosny J

    2016-04-01

    National Committee for Quality Assurance recommends patient-centered medical homes incorporate input from patient populations; however, many health care organizations do not. This qualitative study used two open-ended questions from 148 active duty Army Soldiers and their family members to illicit recommendations for primary care providers and clinic leadership that would improve their health care experiences. Content analysis and descriptive statistics were used to analyze responses. Participant responses were related to four major themes: Access to Care, Interpersonal Interaction, Satisfaction of Care, and Quality of Care. Participants were overall satisfied with their care; however, spending less time waiting for appointments and to see the provider or specialist were the most frequently requested improvements related to Access to Care. For Interpersonal Interaction, 82% of the responses recommended that providers be more attentive listeners, courteous, patient, caring, and respectful. Decreasing wait times and improving interpersonal skills would improve health care experiences and patient satisfaction. Reprint & Copyright © 2016 Association of Military Surgeons of the U.S.

  2. An improved dosimeter having constant flow pump

    International Nuclear Information System (INIS)

    Baker, W.B.

    1980-01-01

    A dosemeter designed for individual use which can be used to monitor toxic radon gas and toxic related products of radon gas in mines and which incorporates a constant air stream flowing through the dosimeter is described. (U.K.)

  3. Regional cerebral blood flow in schizophrenic patients

    International Nuclear Information System (INIS)

    Sagawa, Katsuo; Sibuya, Isoo; Oiji, Arata; Kawakatsu, Sinobu; Morinobu, Shigeru; Totsuka, Shiro; Kinoshita, Osami; Yazaki, Mitsuyasu.

    1990-01-01

    Seventy-six schizophrenic patients were examined by a Xe-133 inhalation method to determine regional cerebral blood flow. A decreased blood flow was observed in the frontal lobe, especially in the right inferior part. In a study on the relationship between disease subtypes and regional cerebral blood flow, negative symptoms were found more predominantly associated with dissolution type than delusion type. In the group of dissolution type, a decreased blood flow was observed in both the right inferior frontal lobe and the right upper hemisphere, in comparison to the group of delution type. Patients presenting with auditory hallucination had a significantly higher incidence of both negative and positive symptoms, as compared with those not presenting with it. In such patients, a significantly decreased blood flow was also seen in the left upper frontal lobe and the bilateral parietal lobe. Xe-133 inhalation method should assist in evaluating brain function in schizophrenic patients, thus leading to the likelihood of developing a new treatment modality. (N.K.)

  4. Improving left ventricular segmentation in four-dimensional flow MRI using intramodality image registration for cardiac blood flow analysis.

    Science.gov (United States)

    Gupta, Vikas; Bustamante, Mariana; Fredriksson, Alexandru; Carlhäll, Carl-Johan; Ebbers, Tino

    2018-01-01

    Assessment of blood flow in the left ventricle using four-dimensional flow MRI requires accurate left ventricle segmentation that is often hampered by the low contrast between blood and the myocardium. The purpose of this work is to improve left-ventricular segmentation in four-dimensional flow MRI for reliable blood flow analysis. The left ventricle segmentations are first obtained using morphological cine-MRI with better in-plane resolution and contrast, and then aligned to four-dimensional flow MRI data. This alignment is, however, not trivial due to inter-slice misalignment errors caused by patient motion and respiratory drift during breath-hold based cine-MRI acquisition. A robust image registration based framework is proposed to mitigate such errors automatically. Data from 20 subjects, including healthy volunteers and patients, was used to evaluate its geometric accuracy and impact on blood flow analysis. High spatial correspondence was observed between manually and automatically aligned segmentations, and the improvements in alignment compared to uncorrected segmentations were significant (P  0.05). Our results demonstrate the efficacy of the proposed approach in improving left-ventricular segmentation in four-dimensional flow MRI, and its potential for reliable blood flow analysis. Magn Reson Med 79:554-560, 2018. © 2017 International Society for Magnetic Resonance in Medicine. © 2017 International Society for Magnetic Resonance in Medicine.

  5. Investigating improvements on redox flow batteries

    CSIR Research Space (South Africa)

    Swartbooi, AM

    2006-09-01

    Full Text Available storage devices coupled to most of their applications. Lead-acid batteries have long been used as the most economical option to store electricity in many small scale applications, but lately more interest have been shown in redox flow batteries. The low...

  6. 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

  7. Regional cerebral flows in hypertensive patients

    International Nuclear Information System (INIS)

    Britton, K.E.; Granowska, M.; Lee, T.Y.; Nimmon, C.C.; Rutland, M.

    1978-01-01

    The aim of this study is to develop a method for assessing the natural history of cerebrovascular disease in patients with hypertension in order that the effects of controlling hypertension may be judged. By developing a quantitative noninvasive method for measuring regional cerebral flow and internal carotid appearance times it is hoped that drugs intended to inhibit the continued formation of atheroma and drugs intended to aid the dissolution of atheroma, may be objectively evaluated. (Auth.)

  8. Transport: improving traffic flows in Stellenbosch

    CSIR Research Space (South Africa)

    Sinclair, M

    2012-07-01

    Full Text Available locally to achieve desired long term improvements. In this chapter the status quo of transport in Stellenbosch will be discussed, as well as specific problems and challenges that transport issues present for the town and the way forward towards...

  9. Improving flow distribution in influent channels using computational fluid dynamics.

    Science.gov (United States)

    Park, No-Suk; Yoon, Sukmin; Jeong, Woochang; Lee, Seungjae

    2016-10-01

    Although the flow distribution in an influent channel where the inflow is split into each treatment process in a wastewater treatment plant greatly affects the efficiency of the process, and a weir is the typical structure for the flow distribution, to the authors' knowledge, there is a paucity of research on the flow distribution in an open channel with a weir. In this study, the influent channel of a real-scale wastewater treatment plant was used, installing a suppressed rectangular weir that has a horizontal crest to cross the full channel width. The flow distribution in the influent channel was analyzed using a validated computational fluid dynamics model to investigate (1) the comparison of single-phase and two-phase simulation, (2) the improved procedure of the prototype channel, and (3) the effect of the inflow rate on flow distribution. The results show that two-phase simulation is more reliable due to the description of the free-surface fluctuations. It should first be considered for improving flow distribution to prevent a short-circuit flow, and the difference in the kinetic energy with the inflow rate makes flow distribution trends different. The authors believe that this case study is helpful for improving flow distribution in an influent channel.

  10. Forecasting the Emergency Department Patients Flow.

    Science.gov (United States)

    Afilal, Mohamed; Yalaoui, Farouk; Dugardin, Frédéric; Amodeo, Lionel; Laplanche, David; Blua, Philippe

    2016-07-01

    Emergency department (ED) have become the patient's main point of entrance in modern hospitals causing it frequent overcrowding, thus hospital managers are increasingly paying attention to the ED in order to provide better quality service for patients. One of the key elements for a good management strategy is demand forecasting. In this case, forecasting patients flow, which will help decision makers to optimize human (doctors, nurses…) and material(beds, boxs…) resources allocation. The main interest of this research is forecasting daily attendance at an emergency department. The study was conducted on the Emergency Department of Troyes city hospital center, France, in which we propose a new practical ED patients classification that consolidate the CCMU and GEMSA categories into one category and innovative time-series based models to forecast long and short term daily attendance. The models we developed for this case study shows very good performances (up to 91,24 % for the annual Total flow forecast) and robustness to epidemic periods.

  11. Can we improve patient safety?

    Science.gov (United States)

    Corbally, Martin Thomas

    2014-01-01

    Despite greater awareness of patient safety issues especially in the operating room and the widespread implementation of surgical time out World Health Organization (WHO), errors, especially wrong site surgery, continue. Most such errors are due to lapses in communication where decision makers fail to consult or confirm operative findings but worryingly where parental concerns over the planned procedure are ignored or not followed through. The WHO Surgical Pause/Time Out aims to capture these errors and prevent them, but the combination of human error and complex hospital environments can overwhelm even robust safety structures and simple common sense. Parents are the ultimate repository of information on their child's condition and planned surgery but are traditionally excluded from the process of Surgical Pause and Time Out, perhaps to avoid additional stress. In addition, surgeons, like pilots, are subject to the phenomenon of "plan-continue-fail" with potentially disastrous outcomes. If we wish to improve patient safety during surgery and avoid wrong site errors then we must include parents in the Surgical Pause/Time Out. A recent pilot study has shown that neither staff nor parents found it added to their stress, but, moreover, 100% of parents considered that it should be a mandatory component of the Surgical Pause nor does it add to the stress of surgery. Surgeons should be required to confirm that the planned procedure is in keeping with the operative findings especially in extirpative surgery and this "step back" should be incorporated into the standard Surgical Pause. It is clear that we must improve patient safety further and these simple measures should add to that potential.

  12. Numerical convergence improvements for porflow unsaturated flow simulations

    Energy Technology Data Exchange (ETDEWEB)

    Flach, Greg [Savannah River Site (SRS), Aiken, SC (United States). Savannah River National Lab. (SRNL)

    2017-08-14

    Section 3.6 of SRNL (2016) discusses various PORFLOW code improvements to increase modeling efficiency, in preparation for the next E-Area Performance Assessment (WSRC 2008) revision. This memorandum documents interaction with Analytic & Computational Research, Inc. (http://www.acricfd.com/default.htm) to improve numerical convergence efficiency using PORFLOW version 6.42 for unsaturated flow simulations.

  13. IMPROVED BIOMASS UTILIZATION THROUGH REMOTE FLOW SENSING

    Energy Technology Data Exchange (ETDEWEB)

    Washington University- St. Louis: Muthanna Al-Dahhan (Principal Investigator)

    2007-03-26

    The growth of the livestock industry provides a valuable source of affordable, sustainable, and renewable bioenergy, while also requiring the safe disposal of the large quantities of animal wastes (manure) generated at dairy, swine, and poultry farms. If these biomass resources are mishandled and underutilized, major environmental problems will be created, such as surface and ground water contamination, odors, dust, ammonia leaching, and methane emission. Anaerobic digestion of animal wastes, in which microorganisms break down organic materials in the absence of oxygen, is one of the most promising waste treatment technologies. This process produces biogas typically containing {approx}65% methane and {approx}35% carbon dioxide. The production of biogas through anaerobic digestion from animal wastes, landfills, and municipal waste water treatment plants represents a large source of renewable and sustainable bio-fuel. Such bio-fuel can be combusted directly, used in internal combustion engines, converted into methanol, or partially oxidized to produce synthesis gas (a mixture of hydrogen and carbon monoxide) that can be converted to clean liquid fuels and chemicals via Fischer-Tropsch synthesis. Different design and mixing configurations of anaerobic digesters for treating cow manure have been utilized commercially and/or tested on a laboratory scale. These digesters include mechanically mixed, gas recirculation mixed, and slurry recirculation mixed designs, as well as covered lagoon digesters. Mixing is an important parameter for successful performance of anaerobic digesters. It enhances substrate contact with the microbial community; improves pH, temperature and substrate/microorganism uniformity; prevents stratification and scum accumulation; facilitates the removal of biogas from the digester; reduces or eliminates the formation of inactive zones (dead zones); prevents settling of biomass and inert solids; and aids in particle size reduction. Unfortunately

  14. Regional cerebral blood flow in diabetic patients

    International Nuclear Information System (INIS)

    Nagamachi, Shigeki; Ono, Shinnichi; Nishikawa, Takushi

    1993-01-01

    N-isopropyl-p- 123 I-iodoamphetamine (IMP) was used to quantify the regional cerebral blood flow (r-CBF) in 11 diabetic patients (average age; 67.9 years) and 12 non-diabetic subjects (average age; 67.4 years), none of whom had (cerebrovascular disease (CVD) on CT studies. A reference sampling method by continuous arterial blood sampling was used to quantify r-CBF. There were no significant differences in physiological or laboratory data between diabetic and non-diabetic groups except for fasting plasma glucose and HbA 1c levels. The average of r-CBF in each region of cerebrum and cerebellum was significantly lower in diabetic group than that in the control group (p<0.01). These observations show that r-CBF of diabetic patients is reduced, even in the absence of findings of CVD on a CT study. (author)

  15. Evaluation of blood flow distribution asymmetry and vascular geometry in patients with Fontan circulation using 4-D flow MRI

    International Nuclear Information System (INIS)

    Jarvis, Kelly; Markl, Michael; Schnell, Susanne; Barker, Alex J.; Garcia, Julio; Chowdhary, Varun; Carr, James; Lorenz, Ramona; Rose, Michael; Robinson, Joshua D.; Rigsby, Cynthia K.

    2016-01-01

    Asymmetrical caval to pulmonary blood flow is suspected to cause complications in patients with Fontan circulation. The aim of this study was to test the feasibility of 4-D flow MRI for characterizing the relationship between 3-D blood flow distribution and vascular geometry. We hypothesized that both flow distribution and geometry can be calculated with low interobserver variability and will detect a direct relationship between flow distribution and Fontan geometry. Four-dimensional flow MRI was acquired in 10 Fontan patients (age: 16 ± 4 years [mean ± standard deviation], range: 9-21 years). The Fontan connection was isolated by 3-D segmentation to evaluate flow distribution from the inferior vena cava (IVC) and superior vena cava (SVC) to the left and right pulmonary arteries (LPA, RPA) and to characterize geometry (cross-sectional area, caval offset, vessel angle). Flow distribution results indicated SVC flow tended toward the RPA while IVC flow was more evenly distributed (SVC to RPA: 78% ± 28 [9-100], IVC to LPA: 54% ± 28 [4-98]). There was a significant relationship between pulmonary artery cross-sectional area and flow distribution (IVC to RPA: R"2=0.50, P=0.02; SVC to LPA: R"2=0.81, P=0.0004). Good agreement was found between observers and for flow distribution when compared to net flow values. Four-dimensional flow MRI was able to detect relationships between flow distribution and vessel geometry. Future studies are warranted to investigate the potential of patient specific hemodynamic analysis to improve diagnostic capability. (orig.)

  16. Evaluation of blood flow distribution asymmetry and vascular geometry in patients with Fontan circulation using 4-D flow MRI

    Energy Technology Data Exchange (ETDEWEB)

    Jarvis, Kelly; Markl, Michael [Northwestern University, Department of Radiology, Feinberg School of Medicine, Chicago, IL (United States); Northwestern University, Department of Biomedical Engineering, McCormick School of Engineering, Chicago, IL (United States); Schnell, Susanne; Barker, Alex J.; Garcia, Julio; Chowdhary, Varun; Carr, James [Northwestern University, Department of Radiology, Feinberg School of Medicine, Chicago, IL (United States); Lorenz, Ramona [University Medical Center Freiburg, Department of Radiology, Freiburg (Germany); Rose, Michael [Ann and Robert H. Lurie Children' s Hospital of Chicago, Department of Medical Imaging, Chicago, IL (United States); Robinson, Joshua D. [Northwestern University, Department of Pediatrics, Feinberg School of Medicine, Chicago, IL (United States); Ann and Robert H. Lurie Children' s Hospital of Chicago, Division of Cardiology, Chicago, IL (United States); Rigsby, Cynthia K. [Northwestern University, Department of Radiology, Feinberg School of Medicine, Chicago, IL (United States); Ann and Robert H. Lurie Children' s Hospital of Chicago, Department of Medical Imaging, Chicago, IL (United States)

    2016-10-15

    Asymmetrical caval to pulmonary blood flow is suspected to cause complications in patients with Fontan circulation. The aim of this study was to test the feasibility of 4-D flow MRI for characterizing the relationship between 3-D blood flow distribution and vascular geometry. We hypothesized that both flow distribution and geometry can be calculated with low interobserver variability and will detect a direct relationship between flow distribution and Fontan geometry. Four-dimensional flow MRI was acquired in 10 Fontan patients (age: 16 ± 4 years [mean ± standard deviation], range: 9-21 years). The Fontan connection was isolated by 3-D segmentation to evaluate flow distribution from the inferior vena cava (IVC) and superior vena cava (SVC) to the left and right pulmonary arteries (LPA, RPA) and to characterize geometry (cross-sectional area, caval offset, vessel angle). Flow distribution results indicated SVC flow tended toward the RPA while IVC flow was more evenly distributed (SVC to RPA: 78% ± 28 [9-100], IVC to LPA: 54% ± 28 [4-98]). There was a significant relationship between pulmonary artery cross-sectional area and flow distribution (IVC to RPA: R{sup 2}=0.50, P=0.02; SVC to LPA: R{sup 2}=0.81, P=0.0004). Good agreement was found between observers and for flow distribution when compared to net flow values. Four-dimensional flow MRI was able to detect relationships between flow distribution and vessel geometry. Future studies are warranted to investigate the potential of patient specific hemodynamic analysis to improve diagnostic capability. (orig.)

  17. Breaking down the silos to decrease internal diversions and patient flow delays.

    Science.gov (United States)

    Driscoll, Molly; Tobis, Kristen; Gurka, David; Serafin, Frederick; Carlson, Elizabeth

    2015-01-01

    Hospitals strive to admit patients to the units where caregiver competencies align with the patient's condition. When the hospital's census peaks, internal diversions and the associated risks increase, which are intensified when silos exist, as segregated care negatively impacts collaboration and patient safety. In this study, a 600+-bed academic, tertiary care specialty hospital experienced an increase in internal diversions. Within the neuroscience service line, emergent neuroscience transfers from outside hospitals had been declined or internally diverted because of capacity limitations. Formalized processes for improving collaboration between health care providers related to capacity issues were required to decrease internal diversions and improve patient flow and patient safety. A pilot project was conducted on neuroscience units during a process improvement initiative. A hospital-wide internal diversion plan was developed, identifying primary and secondary placement options for all patients requiring hospitalization to support patient flow and patient safety. Forecasting tools were developed to provide units' leadership with current information on expected admissions. Daily capacity huddles were instituted to increase collaboration between patient care units. The interventions trialed during the pilot decreased internal diversions and improved patient flow. The improved collaboration resulted in an 80% decrease in declinations of emergent intensive care unit transfers from outside hospitals due to capacity limitations and a 50% decrease in the number of these patients being internally diverted to alternate intensive care units. The interventions implemented minimized internal diversions and improved patient flow. The transparency of the patient placement process led to an increased collaboration between all participants.

  18. High-flow nasal cannula therapy for adult patients

    Science.gov (United States)

    Zhang, Jian; Lin, Ling; Pan, Konghan; Zhou, Jiancang

    2016-01-01

    High-flow nasal cannula (HFNC) oxygen therapy has several physiological advantages over traditional oxygen therapy devices, including decreased nasopharyngeal resistance, washing out of the nasopharyngeal dead space, generation of positive pressure in the pharynx, increasing alveolar recruitment in the lungs, humidification of the airways, increased fraction of inspired oxygen and improved mucociliary clearance. Recently, the use of HFNC in treating adult critical illness patients has significantly increased, and it is now being used in many patients with a range of different disease conditions. However, there are no established guidelines to direct the safe and effective use of HFNC for these patients. This review article summarizes the available published literature on the positive physiological effects, mechanisms of action, and the clinical applications of HFNC, compared with traditional oxygen therapy devices. The available literature suggests that HFNC oxygen therapy is an effective modality for the early treatment of critically adult patients. PMID:27698207

  19. Flow improvers for water injection based on surfactants

    Energy Technology Data Exchange (ETDEWEB)

    Oskarsson, H.; Uneback, I.; Hellsten, M.

    2006-03-15

    In many cases it is desirable to increase the flow of injection water when an oil well deteriorates. It is very costly in offshore operation to lay down an additional water pipe to the injection site. Flow improvers for the injection water will thus be the most cost-effective way to increase the flow rate. During the last years water-soluble polymers have also been applied for this purpose. These drag-reducing polymers are however only slowly biodegraded which has been an incentive for the development of readily biodegradable surfactants as flow improvers for injection water. A combination of a zwitterionic and an anionic surfactant has been tested in a 5.5 inch, 700 m long flow loop containing sulphate brine with salinity similar to sea water. A drag reduction between 75 and 80% was achieved with 119 ppm in solution of the surfactant blend at an average velocity of 1.9 m/s and between 50 and 55% at 2.9 m/s. The surfactants in this formulation were also found to be readily biodegradable in sea water and low bio accumulating which means they have an improved environmental profile compared to the polymers used today. Due to the self-healing properties of the drag-reducing structures formed by surfactants, these may be added before the pump section - contrary to polymers which are permanently destroyed by high shear forces. (Author)

  20. Enhancing sedimentation by improving flow conditions using parallel retrofit baffles.

    Science.gov (United States)

    He, Cheng; Scott, Eric; Rochfort, Quintin

    2015-09-01

    In this study, placing parallel-connected baffles in the vicinity of the inlet was proposed to improve hydraulic conditions for enhancing TSS (total suspended solids) removal. The purpose of the retrofit baffle design is to divide the large and fast inflow into smaller and slower flows to increase flow uniformity. This avoids short-circuiting and increases residence time in the sedimentation basin. The newly proposed parallel-connected baffle configuration was assessed in the laboratory by comparing its TSS removal performance and the optimal flow residence time with those from the widely used series-connected baffles. The experimental results showed that the parallel-connected baffles outperformed the series-connected baffles because it could disperse flow faster and in less space by splitting the large inflow into many small branches instead of solely depending on flow internal friction over a longer flow path, as was the case under the series-connected baffles. Being able to dampen faster flow before entering the sedimentation basin is critical to reducing the possibility of disturbing any settled particles, especially under high inflow conditions. Also, for a large sedimentation basin, it may be more economically feasible to deploy the proposed parallel retrofit baffle in the vicinity of the inlet than series-connected baffles throughout the entire settling basin. Crown Copyright © 2015. Published by Elsevier Ltd. All rights reserved.

  1. Requirements and benefits of flow forecasting for improving hydropower generation

    NARCIS (Netherlands)

    Dong, Xiaohua; Vrijling, J.K.; Dohmen-Janssen, Catarine M.; Ruigh, E.; Booij, Martijn J.; Stalenberg, B.; Hulscher, Suzanne J.M.H.; van Gelder, P.H.A.J.M.; Verlaan, M.; Zijderveld, A.; Waarts, P.

    2005-01-01

    This paper presents a methodology to identify the required lead time and accuracy of flow forecasting for improving hydropower generation of a reservoir, by simulating the benefits (in terms of electricity generated) obtained from the forecasting with varying lead times and accuracies. The

  2. Researchers' Roles in Patient Safety Improvement.

    Science.gov (United States)

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

    2016-03-01

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

  3. Effects of flow sheet implementation on physician performance in the management of asthmatic patients.

    Science.gov (United States)

    Ruoff, Gary

    2002-01-01

    This project focused on increasing compliance, in a large family practice group, with quality indicators for the management of asthma. The objective was to determine if use of a flow sheet incorporating the Global Initiative for Asthma (GINA) guidelines could improve compliance with those guidelines if the flow sheet was placed in patients' medical records. After review and selection of 14 clinical quality indicators, physicians in the practice implemented a flow sheet as an intervention. These flow sheets were inserted into the records of 122 randomly selected patients with asthma. Medical records were reviewed before the flow sheets were placed in the records, and again approximately 6 months later, to determine if there was a change in compliance with the quality indicators. Improvement of documentation was demonstrated in 13 of the 14 quality indicators. The results indicate that compliance with asthma management quality indicators can improve with the use of a flow sheet.

  4. A proactive transfer policy for critical patient flow management.

    Science.gov (United States)

    González, Jaime; Ferrer, Juan-Carlos; Cataldo, Alejandro; Rojas, Luis

    2018-02-17

    Hospital emergency departments are often overcrowded, resulting in long wait times and a public perception of poor attention. Delays in transferring patients needing further treatment increases emergency department congestion, has negative impacts on their health and may increase their mortality rates. A model built around a Markov decision process is proposed to improve the efficiency of patient flows between the emergency department and other hospital units. With each day divided into time periods, the formulation estimates bed demand for the next period as the basis for determining a proactive rather than reactive transfer decision policy. Due to the high dimensionality of the optimization problem involved, an approximate dynamic programming approach is used to derive an approximation of the optimal decision policy, which indicates that a certain number of beds should be kept free in the different units as a function of the next period demand estimate. Testing the model on two instances of different sizes demonstrates that the optimal number of patient transfers between units changes when the emergency patient arrival rate for transfer to other units changes at a single unit, but remains stable if the change is proportionally the same for all units. In a simulation using real data for a hospital in Chile, significant improvements are achieved by the model in key emergency department performance indicators such as patient wait times (reduction higher than 50%), patient capacity (21% increase) and queue abandonment (from 7% down to less than 1%).

  5. Uranium Dioxide Powder Flow ability Improvement Using Sol-Gel

    International Nuclear Information System (INIS)

    Juanda, D.; Sambodo Daru, G.

    1998-01-01

    The improvement of flow ability characteristics of uranium dioxide powder has been done using sol-gel process. To anticipate a pellet mass production with uniform pellet dimension, the uranium dioxide powder must be have a spherical form. Uranium dioxide spherical powder has been diluted in acid transformed into sol colloidal solution. To obtain uranium dioxide spherical form, the uranium sol-colloidal solution has been dropped in a hot paraffin ( at the temperature of 90 0 C) to form gelatinous colloid and then dried at 800 0 C, and sintered at the temperature of 1700 0 C. The flow ability of spherical uranium dioxide powder has been examined by using Flowmeter Hall (ASTM. B. 213-46T). The measurement result reveals that the spherical uranium dioxide powder has a flow ability twice than that of unprocessed uranium dioxide powder

  6. Improving urban wind flow predictions through data assimilation

    Science.gov (United States)

    Sousa, Jorge; Gorle, Catherine

    2017-11-01

    Computational fluid dynamic is fundamentally important to several aspects in the design of sustainable and resilient urban environments. The prediction of the flow pattern for example can help to determine pedestrian wind comfort, air quality, optimal building ventilation strategies, and wind loading on buildings. However, the significant variability and uncertainty in the boundary conditions poses a challenge when interpreting results as a basis for design decisions. To improve our understanding of the uncertainties in the models and develop better predictive tools, we started a pilot field measurement campaign on Stanford University's campus combined with a detailed numerical prediction of the wind flow. The experimental data is being used to investigate the potential use of data assimilation and inverse techniques to better characterize the uncertainty in the results and improve the confidence in current wind flow predictions. We consider the incoming wind direction and magnitude as unknown parameters and perform a set of Reynolds-averaged Navier-Stokes simulations to build a polynomial chaos expansion response surface at each sensor location. We subsequently use an inverse ensemble Kalman filter to retrieve an estimate for the probabilistic density function of the inflow parameters. Once these distributions are obtained, the forward analysis is repeated to obtain predictions for the flow field in the entire urban canopy and the results are compared with the experimental data. We would like to acknowledge high-performance computing support from Yellowstone (ark:/85065/d7wd3xhc) provided by NCAR.

  7. Improvements to TRAC models of condensing stratified flow. Pt. 1

    International Nuclear Information System (INIS)

    Zhang, Q.; Leslie, D.C.

    1991-12-01

    Direct contact condensation in stratified flow is an important phenomenon in LOCA analyses. In this report, the TRAC interfacial heat transfer model for stratified condensing flow has been assessed against the Bankoff experiments. A rectangular channel option has been added to the code to represent the experimental geometry. In almost all cases the TRAC heat transfer coefficient (HTC) over-predicts the condensation rates and in some cases it is so high that the predicted steam is sucked in from the normal outlet in order to conserve mass. Based on their cocurrent and countercurrent condensing flow experiments, Bankoff and his students (Lim 1981, Kim 1985) developed HTC models from the two cases. The replacement of the TRAC HTC with either of Bankoff's models greatly improves the predictions of condensation rates in the experiment with cocurrent condensing flow. However, the Bankoff HTC for countercurrent flow is preferable because it is based only on the local quantities rather than on the quantities averaged from the inlet. (author)

  8. The Akzo-Fina cold flow improvement process

    Energy Technology Data Exchange (ETDEWEB)

    Free, H.W.H.; Schockaert, T.; Sonnemans, J.W.M. (Akzo Chemicals B.V., Amersfoort (Netherlands). Hydroprocessing Catalysts)

    1993-09-01

    The Akzo-Fina CFI process is a very flexible process in which improvement of cold flow properties, desulfurization and hydroconversion are achieved. One of the main characteristics is the dewaxing obtained by the selective hydrocracking of normal paraffins combined with hydro-desulfurization and hydroconversion. Since its introduction in 1988, five licenses have been sold. The units currently run for heavy gasoil upgrading show an excellent performance and reach pour point improvements of over 50[degree]C, long cycle lengths and product sulfur levels well below 0.05 wt%. 2 figs., 2 tabs.

  9. Improved electrolyte for zinc-bromine flow batteries

    Science.gov (United States)

    Wu, M. C.; Zhao, T. S.; Wei, L.; Jiang, H. R.; Zhang, R. H.

    2018-04-01

    Conventional zinc bromide electrolytes offer low ionic conductivity and often trigger severe zinc dendrite growth in zinc-bromine flow batteries. Here we report an improved electrolyte modified with methanesulfonic acid, which not only improves the electrolyte conductivity but also ameliorates zinc dendrite. Experimental results also reveal that the kinetics and reversibility of Zn2+/Zn and Br2/Br- are improved in this modified electrolyte. Moreover, the battery's internal resistance is significantly reduced from 4.9 to 2.0 Ω cm2 after adding 1 M methanesulfonic acid, thus leading to an improved energy efficiency from 64% to 75% at a current density of 40 mA cm-2. More impressively, the battery is capable of delivering an energy efficiency of about 78% at a current density of as high as 80 mA cm-2 when the electrode is replaced by a thermally treated one. Additionally, zinc dendrite growth is found to be effectively suppressed in methanesulfonic acid supported media, which, as a result, enables the battery to be operated for 50 cycles without degradation, whereas the one without methanesulfonic acid suffers from significant decay after only 40 cycles, primarily due to severe zinc dendrite growth. These superior results indicate methanesulfonic acid is a promising supporting electrolyte for zinc-bromine flow batteries.

  10. Patient Education May Improve Perioperative Safety.

    NARCIS (Netherlands)

    de Haan, L.S.; Calsbeek, H; Wolff, André

    2016-01-01

    Importance: There is a growing interest in enabling ways for patients to participate in their own care to improve perioperative safety, but little is known about the effectiveness of interventions enhancing an active patient role. Objective: To evaluate the effect of patient participation on

  11. Can we Improve Patient Safety?

    Directory of Open Access Journals (Sweden)

    Martin Thomas Corbally

    2014-09-01

    Full Text Available Despite greater awareness of patient safety issues especially in the operating room and the widespread implementation of surgical time out (WHO,errors, especially wrong site surgery, continue. Most such errors are due to lapses in communication where decision makers fail to consult or confirm operative findings but worryingly where parental concerns over the planned procedure are ignored or not followed through. The WHO surgical pause / Time Out aims to capture these errors and prevent them but the combination of human error and complex hospital environments can overwhelm even robust safety structures and simple common sense. Parents are the ultimate repository of information on their child's condition and planned surgery but are traditionally excluded from the process of Surgical pause and Time Out perhaps to avoid additional stress. In addition surgeons, like pilots, are subject to the phenomenon of plan continue fail with potentially disastrous outcomes.

  12. Queueing network model for obstetric patient flow in a hospital.

    Science.gov (United States)

    Takagi, Hideaki; Kanai, Yuta; Misue, Kazuo

    2016-03-03

    A queueing network is used to model the flow of patients in a hospital using the observed admission rate of patients and the histogram for the length of stay for patients in each ward. A complete log of orders for every movement of all patients from room to room covering two years was provided to us by the Medical Information Department of the University of Tsukuba Hospital in Japan. We focused on obstetric patients, who are generally hospitalized at random times throughout the year, and we analyzed the patient flow probabilistically. On admission, each obstetric patient is assigned to a bed in one of the two wards: one for normal delivery and the other for high-risk delivery. Then, the patient may be transferred between the two wards before discharge. We confirm Little's law of queueing theory for the patient flow in each ward. Next, we propose a new network model of M/G/ ∞ and M/M/ m queues to represent the flow of these patients, which is used to predict the probability distribution for the number of patients staying in each ward at the nightly census time. Although our model is a very rough and simplistic approximation of the real patient flow, the predicted probability distribution shows good agreement with the observed data. The proposed method can be used for capacity planning of hospital wards to predict future patient load in each ward.

  13. Educate patients on billing policies to improve your bottom line.

    Science.gov (United States)

    May, Jonathan

    2006-01-01

    In no other industry are the consumers of goods or services so unaware and uninvolved in the reimbursement for the goods or services received. The United States healthcare industry has created and allowed to perpetuate a "hands-off" compensation approach that has created a consumer mentality proving quite difficult to change. In this article, the author describes the origin of this outdated approach and suggests a restructured office and clear communication with patients as starting points to change this deep-rooted mind-set. He describes how an up-front approach to patients' financial responsibilities and proactive staff can help reduce miscommunication between provider, patient, and insurance carrier and improve your practice's cash flow. The author also suggests that the patient's financial burden will continue to increase and offers tips to maintain positive patient relationships, improve your accounts receivable management, and protect you financially.

  14. Managing length of stay using patient flow--part 1.

    Science.gov (United States)

    Cesta, Toni

    2013-02-01

    This month we have discussed the fundamentals of patient flow and its related theories. We reviewed the concepts of demand and capacity management as they apply to the hospital setting. Patient flow requires daily diligence and attention. It should not be something focused on only on busy days, but should be managed each and every day. By taking a proactive approach to patient flow, the number of days your hospital will be bottlenecked can be reduced. Patient flow needs to be part of the daily activities of every case management department and should be factored in as a core role and function in a contemporary case management department. Patient flow needs to be addressed at the patient, departmental, and hospital level. In next month's issue we will continue our discussion on patient flow with a detailed review of specific examples that any case management department can use. We will also review all the departments and disciplines that contribute to patient flow and their role in it.

  15. Do water-saving technologies improve environmental flows?

    Science.gov (United States)

    Batchelor, Charles; Reddy, V. Ratna; Linstead, Conor; Dhar, Murli; Roy, Sumit; May, Rebecca

    2014-10-01

    Water saving and conservation technologies (WCTs) have been promoted widely in India as a practical means of improving the water use efficiency and freeing up water for other uses (e.g. for maintaining environmental flows in river systems). However, there is increasing evidence that, somewhat paradoxically, WCTs often contribute to intensification of water use by irrigated and rainfed farming systems. This occurs when: (1) Increased crop yields are coupled with increased consumptive water use and/or (2) Improved efficiency, productivity and profitability encourages farmers to increase the area cropped and/or to adopt multiple cropping systems. In both cases, the net effect is an increase in annual evapotranspiration that, particularly in areas of increasing water scarcity, can have the trade-off of reduced environmental flows. Recognition is also increasing that the claimed water savings of many WCTs may have been overstated. The root cause of this problem lies in confusion over what constitutes real water saving at the system or basin scales. The simple fact is that some of the water that is claimed to be ‘saved’ by WCTs would have percolated into the groundwater from where it can be and often is accessed and reused. Similarly, some of the “saved” runoff can be used downstream by, for example, farmers or freshwater ecosystems. This paper concludes that, particularly in areas facing increasing water scarcity, environmental flows will only be restored and maintained if they are given explicit (rather than theoretical or notional) attention. With this in mind, a simple methodology is proposed for deciding when and where WCTs may have detrimental impacts on environmental flows.

  16. Evaluation of approaches for improving diesel cold flow properties

    Energy Technology Data Exchange (ETDEWEB)

    Sharafutdinov, Ilshat; Stratiev, Dicho; Dinkov, Rossen [Lukoil Neftochim Bourgas AD, Bourgas (Bulgaria); Bachvarov, Assen [Edinburgh Univ. (United Kingdom); Petkov, Petko [Bourgas Univ. ' ' Assen Zlatarov' ' (Bulgaria)

    2012-06-15

    Four heavy diesel fractions (FBP according to ASTM D-2887 of about 420 C), one lower boilingmiddle distillate fraction (FBP according to ASTM D-2887 of 310 C) and kerosene fraction (FBP according to ASTM D-2887 of 271 C) obtained from the Lukoil Neftochim Burgas (LNB) process units during the processing of Russian Export Crude Blend (REBCO) along with four heavy diesel fractions (FBP according to ASTM D-2887 of about 370 C) obtained by fractionation of four crudes: Oil Blend, REBCO, Siberian Light Crude Oil (SLCO) and CPC (Caspian Consortium Pipeline) were investigated for their cold flow properties. It was found that undercutting diesel improves cloud point (CP) and cold filter plugging point (CFPP) by 4 C/10 C cut point. Blending of kerosene improves CP and CFPP by about 2 C/10% added kerosene. The treatment with CP depressants may improve CP by about 2 C if the proper combination diesel - depressant is selected and the improvement can reach up to 6 C for a definite diesel. The treatment with CFPP depressant is much more efficient achieving an improvement of 18 C. By assuming definite fuel prices (Platts) and by applying the LNB linear programming model using Honeywell's RPMS software it was found that catalytic dewaxing is the most efficient approach for producing diesel with improved cold flowproperties if the diesel yield from the dewaxing process is higher than 90%. (orig.)

  17. Improving Value for Patients with Eczema.

    Science.gov (United States)

    Block, Julie

    2018-04-01

    Chronic diseases now represent a cost majority in the United States health care system. Contributing factors to rising costs include expensive novel and emerging therapies, under-treatment of disease, under-management of comorbidities, and patient dissatisfaction with care results. Critical to identifying replicable improvement methods is a reliable model to measure value. If we understand value within healthcare consumerism to be equal to a patient's health outcome improvement over costs associated with care (Value=Outcomes/Costs), we can use this equation to measure the improvement of value. Research and literature show that patient activation-the skills and confidence that equip patients to become actively engaged in their health care-impact health outcomes, costs, and patient experience. Reaching patient activation through engagement methods including shared decision-making (SDM) lead to improved value of care received. The National Eczema Association (NEA) Shared Decision-Making Resource Center can be a transformative strategy to measure and evaluate value of health care interventions for eczema patients to advance a value-driven health care system in the United States. Through this Resource Center, NEA will measure patient value through their own perceptions using validated PRO instruments and other patient-generated health data. Assessment of this data will reveal findings that can assist researchers in evaluating the impact this care framework on patient-perceived value across other chronic diseases. Copyright © 2018 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

  18. Integrating Flow, Form, and Function for Improved Environmental Water Management

    Science.gov (United States)

    Albin Lane, Belize Arela

    Rivers are complex, dynamic natural systems. The performance of river ecosystem functions, such as habitat availability and sediment transport, depends on the interplay of hydrologic dynamics (flow) and geomorphic settings (form). However, most river restoration studies evaluate the role of either flow or form without regard for their dynamic interactions. Despite substantial recent interest in quantifying environmental water requirements to support integrated water management efforts, the absence of quantitative, transferable relationships between river flow, form, and ecosystem functions remains a major limitation. This research proposes a novel, process-driven methodology for evaluating river flow-form-function linkages in support of basin-scale environmental water management. This methodology utilizes publically available geospatial and time-series data and targeted field data collection to improve basic understanding of river systems with limited data and resource requirements. First, a hydrologic classification system is developed to characterize natural hydrologic variability across a highly altered, physio-climatically diverse landscape. Next, a statistical analysis is used to characterize reach-scale geomorphic variability and to investigate the utility of topographic variability attributes (TVAs, subreach-scale undulations in channel width and depth), alongside traditional reach-averaged attributes, for distinguishing dominant geomorphic forms and processes across a hydroscape. Finally, the interacting roles of flow (hydrologic regime, water year type, and hydrologic impairment) and form (channel morphology) are quantitatively evaluated with respect to ecosystem functions related to hydrogeomorphic processes, aquatic habitat, and riparian habitat. Synthetic river corridor generation is used to evaluate and isolate the role of distinct geomorphic attributes without the need for intensive topographic surveying. This three-part methodology was successfully

  19. IMPROVEMENT FOR AN ASSEMBLY FLOW FOR A GIVEN COMPONENT (1

    Directory of Open Access Journals (Sweden)

    Ancuţa BĂLTEANU,

    2017-05-01

    Full Text Available This study is carried out in a line of assembly of a finite wiring product. The assembly of this finished product is done in two specific sections. For the analysis of the activities in the assembly section, the timing method of the work stations was used. On the basis of the work times obtained and their centralization, the Keizen method was subsequently applied to obtain an improvement in the installation flow. Finally, a reduction in working times was achieved, as well as a more ergonomic arrangement of jobs. This paper is the first in a series of 3 papers to deal with this subject.

  20. Analytical Tools to Improve Optimization Procedures for Lateral Flow Assays

    Directory of Open Access Journals (Sweden)

    Helen V. Hsieh

    2017-05-01

    Full Text Available Immunochromatographic or lateral flow assays (LFAs are inexpensive, easy to use, point-of-care medical diagnostic tests that are found in arenas ranging from a doctor’s office in Manhattan to a rural medical clinic in low resource settings. The simplicity in the LFA itself belies the complex task of optimization required to make the test sensitive, rapid and easy to use. Currently, the manufacturers develop LFAs by empirical optimization of material components (e.g., analytical membranes, conjugate pads and sample pads, biological reagents (e.g., antibodies, blocking reagents and buffers and the design of delivery geometry. In this paper, we will review conventional optimization and then focus on the latter and outline analytical tools, such as dynamic light scattering and optical biosensors, as well as methods, such as microfluidic flow design and mechanistic models. We are applying these tools to find non-obvious optima of lateral flow assays for improved sensitivity, specificity and manufacturing robustness.

  1. An improved approach for flow-based cloud point extraction.

    Science.gov (United States)

    Frizzarin, Rejane M; Rocha, Fábio R P

    2014-04-11

    Novel strategies are proposed to circumvent the main drawbacks of flow-based cloud point extraction (CPE). The surfactant-rich phase (SRP) was directly retained into the optical path of the spectrophotometric cell, thus avoiding its dilution previously to the measurement and yielding higher sensitivity. Solenoid micro-pumps were exploited to improve mixing by the pulsed flow and also to modulate the flow-rate for retention and removal of the SRP, thus avoiding the elution step, often carried out with organic solvents. The heat released and the increase of the salt concentration provided by an on-line neutralization reaction were exploited to induce the cloud point without an external heating device. These innovations were demonstrated by the spectrophotometric determination of iron, yielding a linear response from 10 to 200 μg L(-1) with a coefficient of variation of 2.3% (n=7). Detection limit and sampling rate were estimated at 5 μg L(-1) (95% confidence level) and 26 samples per hour, respectively. The enrichment factor was 8.9 and the procedure consumed only 6 μg of TAN and 390 μg of Triton X-114 per determination. At the 95% confidence level, the results obtained for freshwater samples agreed with the reference procedure and those obtained for digests of bovine muscle, rice flour, brown bread and tort lobster agreed with the certified reference values. The proposed procedure thus shows advantages in relation to previously proposed approaches for flow-based CPE, being a fast and environmental friendly alternative for on-line separation and pre-concentration. Copyright © 2014 Elsevier B.V. All rights reserved.

  2. Improving Patient Satisfaction with Waiting Time

    Science.gov (United States)

    Eilers, Gayleen M.

    2004-01-01

    Waiting times are a significant component of patient satisfaction. A patient satisfaction survey performed in the author's health center showed that students rated waiting time lowest of the listed categories--A ratings of 58% overall, 63% for scheduled appointments, and 41% for the walk-in clinic. The center used a quality improvement process and…

  3. Improving patient satisfaction in glaucoma care

    Directory of Open Access Journals (Sweden)

    Islam S

    2017-12-01

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

  4. Improved dynamic CT angiography visualization by flow territory masking

    Directory of Open Access Journals (Sweden)

    Søren Christensen

    2015-01-01

    Full Text Available Backgound and Purpose: Computerized tomography (CT perfusion (or CTP source images from CT scanners with small detector widths can be used to create a dynamic CT angiogram (CTA similar to digital subtraction angiography (DSA. Because CTP studies use a single intravenous injection, all arterial territories enhance simultaneously, and individual arterial territories [i.e., anterior cerebral artery (ACA, middle cerebral artery (MCA, and posterior cerebral artery (PCA] cannot be delineated. This limits the ability to assess collateral flow patterns on dynamic CTAs. The aim of this study was to devise and test a postprocessing method to selectively color-label the major arterial territories on dynamic CTA. Materials and Methods: We identified 22 acute-stroke patients who underwent CTP on a 320-slice CT scanner within 6 h from symptom onset. For each case, two investigators independently generated an arterial territory map from CTP bolus arrival maps using a semiautomated method. The volumes of the arterial territories were calculated for each map and the average relative difference between these volumes was calculated for each case as a measure of interrater agreement. Arterial territory maps were superimposed on the dynamic CTA to create a vessel-selective dynamic CTA with color-coding of the main arterial territories. Two experts rated the arterial territory maps and the color-coded CTAs for consistency with expected arterial territories on a 3-point scale (excellent, moderate, poor. Results: Arterial territory maps were generated for all 22 patients. The median difference in arterial territory volumes between investigators was 2.2% [interquartile range (IQR 0.6-8.5%]. Based on expert review, the arterial territory maps and the vessel-selective dynamic CTAs showed excellent consistency with the expected arterial territories in 18 of 22 patients, moderate consistency in 2 patients, and poor consistency in another 2 patients. Conclusion: Using a

  5. The effect of blood cell count on coronary flow in patients with coronary slow flow phenomenon.

    Science.gov (United States)

    Soylu, Korhan; Gulel, Okan; Yucel, Huriye; Yuksel, Serkan; Aksan, Gokhan; Soylu, Ayşegül İdil; Demircan, Sabri; Yılmaz, Ozcan; Sahin, Mahmut

    2014-09-01

    The coronary slow flow phenomenon (CSFP) is a coronary artery disease with a benign course, but its pathological mechanisms are not yet fully understood.The purpose of this controlled study was to investigate the cellular content of blood in patients diagnosed with CSFP and the relationship of this with coronary flow rates. Selective coronary angiographies of 3368 patients were analyzed to assess Thrombolysis in Myocardial Infarction (TIMI) frame count (TFC) values. Seventy eight of them had CSFP, and their demographic and laboratory findings were compared with 61 patients with normal coronary flow. Patients' demographic characteristics were similar in both groups. Mean corrected TFC (cTFC) values were significantly elevated in CSFP patients (p<0.001). Furthermore, hematocrit and hemoglobin values, and eosinophil and basophil counts of the CSFP patients were significantly elevated compared to the values obtained in the control group (p=0.005, p=0.047, p=0.001 and p=0.002, respectively). The increase observed in hematocrit and eosinophil levels showed significant correlations with increased TFC values (r=0.288 and r=0.217, respectively). Significant changes have been observed in the cellular composition of blood in patients diagnosed with CSFP as compared to the patients with normal coronary blood flow. The increases in hematocrit levels and in the eosinophil and basophil counts may have direct or indirect effects on the rate of coronary blood flow.

  6. Abnormality in cerebellar blood flow in solo vertigo patients

    Energy Technology Data Exchange (ETDEWEB)

    Nagahori, Takeshi [Shakaihoken Takaoka Hospital, Toyama (Japan); Nishijima, Michiharu; Endo, Shunro; Takaku, Akira

    1997-03-01

    Little is known about the blood flow of the vertebrobasilar system as a cause of vertigo and dizziness. We used Xe-CT to study cerebellar blood flow in 53 patients who ranged in age from 35 to 85 years. The patients were divided into two groups. One of them was the vertigo group that comprised 28 patients with rotatory sensation, and the other, the non-vertigo group of 25 patients with a sensation other than rotation. At the stage of severe symptoms, there was decreased cerebellar blood flow in all patients of both, the vertigo and the non-vertigo groups, and a decrease in the bilateral cerebellar hemisphere was observed in five patients and in a unilateral hemisphere in three patients of the vertigo group. By comparison, in the non-vertigo group, unilateral decrease of cerebellar blood flow was observed in only one patient, and a bilateral decrease in five. At the stage of severe symptoms, the mean regional cerebellar blood flow was 40.5{+-}8.0 ml/100 g/min (n=16 sides) in the vertigo group and 45.3{+-}9.5 ml/100 g/min (n=12 sides) in the non-vertigo group. At the stage of moderate symptoms, blood flow image was normal in four of 14 vertigo patients and in seven of 12 non-vertigo patients. The mean regional blood flow was 47.8{+-}8.6 ml/100 g/min (n=28 sides) in the vertigo group and 47.1{+-}5.1 ml/100 g/min (n=24 sides) in the non-vertigo group. At the asymptomatic stage, a high proportion of normal blood flow images (nine of 16 vertigo patients and 10 of 10 non-vertigo patients) was observed. The mean regional cerebellar blood flow was 51.6{+-}10.7 ml/100 g/min (n=32 sides) in the vertigo group and 52.8{+-}8.5 ml/100 g/min (n=20 sides) in the non-vertigo group. This study demonstrates that a unilateral or bilateral decrease in blood flow of the vertebrobasilar system may cause vertigo and dizziness. It also shows that Xe-CT of the cerebellum may be a valuable examination modality for the diagnosis and treatment of vertigo and dizziness. (author)

  7. Abnormality in cerebellar blood flow in solo vertigo patients

    International Nuclear Information System (INIS)

    Nagahori, Takeshi; Nishijima, Michiharu; Endo, Shunro; Takaku, Akira

    1997-01-01

    Little is known about the blood flow of the vertebrobasilar system as a cause of vertigo and dizziness. We used Xe-CT to study cerebellar blood flow in 53 patients who ranged in age from 35 to 85 years. The patients were divided into two groups. One of them was the vertigo group that comprised 28 patients with rotatory sensation, and the other, the non-vertigo group of 25 patients with a sensation other than rotation. At the stage of severe symptoms, there was decreased cerebellar blood flow in all patients of both, the vertigo and the non-vertigo groups, and a decrease in the bilateral cerebellar hemisphere was observed in five patients and in a unilateral hemisphere in three patients of the vertigo group. By comparison, in the non-vertigo group, unilateral decrease of cerebellar blood flow was observed in only one patient, and a bilateral decrease in five. At the stage of severe symptoms, the mean regional cerebellar blood flow was 40.5±8.0 ml/100 g/min (n=16 sides) in the vertigo group and 45.3±9.5 ml/100 g/min (n=12 sides) in the non-vertigo group. At the stage of moderate symptoms, blood flow image was normal in four of 14 vertigo patients and in seven of 12 non-vertigo patients. The mean regional blood flow was 47.8±8.6 ml/100 g/min (n=28 sides) in the vertigo group and 47.1±5.1 ml/100 g/min (n=24 sides) in the non-vertigo group. At the asymptomatic stage, a high proportion of normal blood flow images (nine of 16 vertigo patients and 10 of 10 non-vertigo patients) was observed. The mean regional cerebellar blood flow was 51.6±10.7 ml/100 g/min (n=32 sides) in the vertigo group and 52.8±8.5 ml/100 g/min (n=20 sides) in the non-vertigo group. This study demonstrates that a unilateral or bilateral decrease in blood flow of the vertebrobasilar system may cause vertigo and dizziness. It also shows that Xe-CT of the cerebellum may be a valuable examination modality for the diagnosis and treatment of vertigo and dizziness. (author)

  8. 'Nudging' your patients toward improved oral health.

    Science.gov (United States)

    Scarbecz, Mark

    2012-08-01

    Behavioral economics combines research from the fields of psychology, neurology and economics to help people understand how people make choices in complex social and economic environments. The principles of behavioral economics increasingly are being applied in health care. The author describes how dental team members can use behavioral economics principles to improve patients' oral health. Dental patients must make complex choices about care, and dental team members must provide information to patients to help them make choices. Patients are subject to predictable biases and are prone to making errors. Dental team members can use this information to "nudge" patients in healthy directions by providing an appropriate mix of incentives, default options and feedback. Practice Implications. The suggestions the author presents may help dental team members choose strategies that maximize both patient welfare and the success of their practices, while preserving patient autonomy.

  9. Nasal highflow improves ventilation in patients with COPD

    Directory of Open Access Journals (Sweden)

    Bräunlich J

    2016-05-01

    Full Text Available Jens Bräunlich,* Marcus Köhler,* Hubert WirtzDepartment of Respiratory Medicine, University of Leipzig, Leipzig, Germany *These authors contributed equally to this workBackground: Nasal highflow (NHF provides a warmed and humidified air stream up to 60 L/min. Recent data demonstrated a positive effect in patients with acute hypoxemic respiratory failure, especially when caused by pneumonia. Preliminary data show a decrease in hypercapnia in patients with COPD. Therefore, NHF should be evaluated as a new ventilatory support device. This study was conducted to assess the impact of different flow rates on ventilatory parameters in patients with COPD.Materials and methods: This interventional clinical study was performed with patients suffering from severe COPD. The aim was to characterize flow-dependent changes in mean airway pressure, breathing volumes, breathing frequency, and decrease in partial pressure of CO2 (pCO2. Mean airway pressure was measured in the nasopharyngeal space (19 patients. To evaluate breathing volumes, we used a polysomnographic device (18 patients. All patients received 20 L/min, 30 L/min, 40 L/min, and 50 L/min and – to illustrate the effects – nasal continuous positive airway pressure and nasal bilevel positive airway pressure. Capillary blood gas analyses were performed in 54 patients with hypercapnic COPD before and two hours after the use of NHF. We compared the extent of decrease in pCO2 when using 20 L/min and 30 L/min. Additionally, comfort and dyspnea during the use of NHF were surveyed.Results: NHF resulted in a minor flow dependent increase in mean airway pressure. Tidal volume increased, and breathing rate decreased. The calculated minute volume decreased under NHF breathing. In spite of this fact, hypercapnia decreased with increasing flow (20 L/min vs 30 L/min. Additionally, an improvement in dyspnea was observed. The rapid shallow breathing index shows a decrease when using NHF.Conclusion: NHF

  10. Improving chemical species tomography of turbulent flows using covariance estimation.

    Science.gov (United States)

    Grauer, Samuel J; Hadwin, Paul J; Daun, Kyle J

    2017-05-01

    Chemical species tomography (CST) experiments can be divided into limited-data and full-rank cases. Both require solving ill-posed inverse problems, and thus the measurement data must be supplemented with prior information to carry out reconstructions. The Bayesian framework formalizes the role of additive information, expressed as the mean and covariance of a joint-normal prior probability density function. We present techniques for estimating the spatial covariance of a flow under limited-data and full-rank conditions. Our results show that incorporating a covariance estimate into CST reconstruction via a Bayesian prior increases the accuracy of instantaneous estimates. Improvements are especially dramatic in real-time limited-data CST, which is directly applicable to many industrially relevant experiments.

  11. The additional benefit of the ML Flow test to classify leprosy patients.

    Science.gov (United States)

    Bührer-Sékula, Samira; Illarramendi, Ximena; Teles, Rose B; Penna, Maria Lucia F; Nery, José Augusto C; Sales, Anna Maria; Oskam, Linda; Sampaio, Elizabeth P; Sarno, Euzenir N

    2009-08-01

    The use of the skin lesion counting classification leads to both under and over diagnosis of leprosy in many instances. Thus, there is a need to complement this classification with another simple and robust test for use in the field. Data of 202 untreated leprosy patients diagnosed at FIOCRUZ, Rio de Janeiro, Brazil, was analyzed. There were 90 patients classified as PB and 112 classified as MB according to the reference standard. The BI was positive in 111 (55%) patients and the ML Flow test in 116 (57.4%) patients. The ML Flow test was positive in 95 (86%) of the patients with a positive BI. The lesion counting classification was confirmed by both BI and ML Flow tests in 65% of the 92 patients with 5 or fewer lesions, and in 76% of the 110 patients with 6 or more lesions. The combination of skin lesion counting and the ML Flow test results yielded a sensitivity of 85% and a specificity of 87% for MB classification, and correctly classified 86% of the patients when compared to the standard reference. A considerable proportion of the patients (43.5%) with discordant test results in relation to standard classification was in reaction. The use of any classification system has limitations, especially those that oversimplify a complex disease such as leprosy. In the absence of an experienced dermatologist and slit skin smear, the ML Flow test could be used to improve treatment decisions in field conditions.

  12. Improving medication adherence in patients with hypertension

    DEFF Research Database (Denmark)

    Hedegaard, Ulla; Kjeldsen, Lene Juel; Pottegård, Anton

    2015-01-01

    BACKGROUND: and Purpose: In patients with hypertension, medication adherence is often suboptimal, thereby increasing the risk of ischemic heart disease and stroke. In a randomized trial, we investigated the effectiveness of a multifaceted pharmacist intervention in a hospital setting to improve...... medication adherence in hypertensive patients. Motivational interviewing was a key element of the intervention. METHODS: Patients (N=532) were recruited from 3 hospital outpatient clinics and randomized to usual care or a 6-month pharmacist intervention comprising collaborative care, medication review...... for persistence, blood pressure or hospital admission. CONCLUSIONS: A multifaceted pharmacist intervention in a hospital setting led to a sustained improvement in medication adherence for patients with hypertension. The intervention had no significant impact on blood pressure and secondary clinical outcomes....

  13. Novel biometric flow slab design for improvement of PEMFC performance

    Energy Technology Data Exchange (ETDEWEB)

    Wang, Chin-Tsan; Hu, Yuh-Chung; Zheng, Pei-Lun [Department of Mechanical and Electro-Mechanical Engineering, Center of Green Technology, National I Lan University, I Lan 26047 (China)

    2010-04-15

    Designing a better flow slab is important to cell performance because of its significant influence on the total pressure drop and flow uniformity. Two novel biometric flow slabs, BFF1 and BFF2, which are addressed in this study, are believed to enhance the capability of oxygen transportation and promote the liquid water removal. Hence, its possession of a higher flow uniformity and lower pressure drop would produce a better power performance than the serpentine and parallel flow. These findings with respect to the design of biometric flow slab could be useful to promote the cell performance of PEMFC, and could even be expanded to other cell types. (author)

  14. Nocturnal foot blood flow in patients with arterial insufficiency

    DEFF Research Database (Denmark)

    Jelnes, Rolf; Tønnesen, K H

    1984-01-01

    Twenty-four hour continuous recording of xenon (133Xe) wash-out from the forefoot was performed on patients with normal circulations (n = 10) and on patients with different degrees of arterial insufficiency (n = 36). During day hours the calculated subcutaneous blood flow in the forefoot was on a...

  15. Vertical integration increases opportunities for patient flow.

    Science.gov (United States)

    Radoccia, R A; Benvenuto, J A; Blancett, L

    1991-08-01

    New sources of patients will become more and more important in the next decade as hospitals continue to feel the squeeze of a competitive marketplace. Vertical integration, a distribution tool used in other industries, will be a significant tool for health care administrators. In the following article, the authors explain the vertical integration model that shows promise for other institutions.

  16. Improved Optical Flow Algorithm for a Intelligent Traffic Tracking System

    Directory of Open Access Journals (Sweden)

    Xia Yupeng

    2013-05-01

    Full Text Available It is known that to get the contours and segmentations of moving cars is the essential step of image processing in intelligent traffic tracking systems. As an effective way, the optical flow algorithm is widely used for this kind of applications. But in traditional gradient-based approaches, in order to make the data responding to the edges of moving objects expand to the area, which gray level is flat, it needs to keep the iteration times large enough. It takes a large amount of calculation time, and the accuracy of the result is not as good as expected. In order to improve the numerical reliability of image gradient data, Hessian matrix distinguishing, Gaussian filtering standard deviation amending, mean model amending and multi-image comparing, the four algorithms were investigated by applying them to track moving objects. From the experimental results, it is shown that both the calculation convergence speed and accuracy of our methods have greatly improved comparing with traditional algorithms, the feasibility and validity of those methods were confirmed.

  17. The Role of Cine Flow Magnetic Resonance Imaging in Patients with Chiari 0 Malformation.

    Science.gov (United States)

    Ozsoy, Kerem Mazhar; Oktay, Kadir; Cetinalp, Nuri Eralp; Gezercan, Yurdal; Erman, Tahsin

    2018-01-01

    To define the role of phase-contrast cine magnetic resonance imaging (MRI) in deciding the therapeutic strategy and underlying pathophysiology resulting in syrinx formation in patients with Chiari type 0 malformation. Seven patients who were admitted to our clinic with the diagnosis of Chiari 0 malformation from January 2005 to July 2016 were enrolled in the study. All patients underwent a detailed preoperative neurological examination. Entire neuroaxis MRI and phase-contrast cine MRI were obtained preoperatively and postoperatively. Seven patients (5 female and 2 male) with Chiari type 0 malformation fulfilled the inclusion criteria. All of the patients had absent cine flow at the craniovertebral junction except two patients. These five patients underwent surgical interventions; suboccipital decompression and duraplasty. All of them showed both clinical and radiological improvement in the postoperative period. Cine flow MRI appears to be a useful tool in the management of patients with Chiari 0 malformation. There was a good correlation between the clinical presentation and cine flow preoperatively, and between clinical improvement and cine flow in the postoperative period.

  18. Xerostomia, Hyposalivation, and Salivary Flow in Diabetes Patients

    Directory of Open Access Journals (Sweden)

    Rosa María López-Pintor

    2016-01-01

    Full Text Available The presence of xerostomia and hyposalivation is frequent among diabetes mellitus (DM patients. It is not clear if the presence of xerostomia and hyposalivation is greater in DM than non-DM patients. The aims of this systematic review are (1 to compare the prevalence rates of xerostomia, (2 to evaluate the salivary flow rate, and (3 to compare the prevalence rates of hyposalivation in DM versus non-DM population. This systematic review was conducted according to the PRISMA group guidelines by performing systematic literature searches in biomedical databases from 1970 until January 18th, 2016. All studies showed higher prevalence of xerostomia in DM patients in relation to non-DM population, 12.5%–53.5% versus 0–30%. Studies that analyzed the quantity of saliva in DM population in relation to non-DM patients reported higher flow rates in non-DM than in DM patients. The variation flow rate among different studies in each group (DM/CG is very large. Only one existing study showed higher hyposalivation prevalence in DM than non-DM patients (45% versus 2.5%. In addition, quality assessment showed the low quality of the existing studies. We recommend new studies that use more precise and current definitions concerning the determination and diagnosis of DM patients and salivary flow collection.

  19. Xerostomia, Hyposalivation, and Salivary Flow in Diabetes Patients.

    Science.gov (United States)

    López-Pintor, Rosa María; Casañas, Elisabeth; González-Serrano, José; Serrano, Julia; Ramírez, Lucía; de Arriba, Lorenzo; Hernández, Gonzalo

    2016-01-01

    The presence of xerostomia and hyposalivation is frequent among diabetes mellitus (DM) patients. It is not clear if the presence of xerostomia and hyposalivation is greater in DM than non-DM patients. The aims of this systematic review are (1) to compare the prevalence rates of xerostomia, (2) to evaluate the salivary flow rate, and (3) to compare the prevalence rates of hyposalivation in DM versus non-DM population. This systematic review was conducted according to the PRISMA group guidelines by performing systematic literature searches in biomedical databases from 1970 until January 18th, 2016. All studies showed higher prevalence of xerostomia in DM patients in relation to non-DM population, 12.5%-53.5% versus 0-30%. Studies that analyzed the quantity of saliva in DM population in relation to non-DM patients reported higher flow rates in non-DM than in DM patients. The variation flow rate among different studies in each group (DM/CG) is very large. Only one existing study showed higher hyposalivation prevalence in DM than non-DM patients (45% versus 2.5%). In addition, quality assessment showed the low quality of the existing studies. We recommend new studies that use more precise and current definitions concerning the determination and diagnosis of DM patients and salivary flow collection.

  20. Regional cerebral blood flow in the patient with brain tumor

    International Nuclear Information System (INIS)

    Tsuchida, Shohei

    1993-01-01

    Regional cerebral blood flow (rCBF) was measured with xenon-enhanced CT (Xe-CT) in 21 cases of intracranial tumors (13 meningiomas, 5 gliomas, 3 metastatic brain tumors). Peritumoral edema was graded as mild, moderate or severe based on the extent of edema on CT and MRI. According to intratumoral blood flow distribution patterns, three patterns were classified as central type with relatively high blood flow at the center of the tumor, homogeneous type with an almost homogeneous blood flow distribution, and marginal type with relatively high blood flow at the periphery of the tumor. High grade astrocytoma and metastatic brain tumor showed marginal type blood flow and moderate or severe edema except in one case. Five meningiomas with severe peritumoral edema revealed marginal type blood flow and four with mild peritumoral edema showed central type blood flow, except for one case. No correlation was found between the extent of peritumoral edema and histological subtype, tumor size, location, duration of clinical history, vascularization on angiogram, and mean blood flow in the tumor. These results suggest that blood flow distribution patterns within the tumor may affect the extension of peritumoral edema. Pre- and postoperative rCBFs were evaluated with Xe-CT and IMP-SPECT in 7 cases, mean rCBF of peritumoral edema was 6.2 ml/100 g/min preoperatively, and discrepancy between rCBF on Xe-CT and that on IMP-SPECT was shown in the remote cortical region ipsilateral to the tumor. Postoperative rCBF revealed an improved blood flow in both adjacent and remote areas, suggesting that the decreased blood flow associated with brain tumors might be relieved after surgery. (author) 53 refs

  1. Altered doppler flow patterns in cirrhosis patients: An overview

    Energy Technology Data Exchange (ETDEWEB)

    Iranpour, Pooya; Lall, Chandana; Houshyar, Roozbeh; Helmy, Mohammad; Yang, Albert; Ward, Garrett; Goodwin, Scott C. [Dept. of Radiology, University of California Irvine, Orange (United States); Choi, Joon Il [Dept. of Radiology, Seoul St. Mary' s Hospital, College of Medicine, The Catholic University of Korea, Seoul (Korea, Republic of)

    2016-01-15

    Doppler ultrasonography of the hepatic vasculature is an integral part of evaluating precirrhotic and cirrhotic patients. While the reversal of the portal venous flow is a well-recognized phenomenon, other flow patterns, although not as easily understood, may play an important role in assessing the disease status. This article discusses the different characteristic flow patterns observed from the portal vein, hepatic artery, and hepatic vein in patients with liver cirrhosis or related complications and procedures. Knowledge of these different flow patterns provides additional information that may reinforce the diagnosis of cirrhosis, help in staging, and offer prognostic information for determining the direction of therapy. Doppler ultrasonography is invaluable when liver transplantation is being considered and aids in the diagnosis of cirrhosis and portal hypertension.

  2. Interprofessional simulation to improve patient participation in transitional care.

    Science.gov (United States)

    Dyrstad, Dagrunn Nåden; Storm, Marianne

    2017-06-01

    Educating and training healthcare professionals is known to improve the quality of transitional care for older adults. Arranging interprofessional meetings for healthcare professionals might be useful to improve patient participation skills in transitional care. To describe the learning activities used in The Meeting Point programme, focusing on patient participation in transitional care, and assess whether they increase healthcare professionals' awareness of and competencies relating to patient participation in the transitional care of older patients. Data were collected as part of an educational intervention programme, The Meeting Point, including three seminars on 'Patient participation in the transitional care of older patients' and four follow-up meetings. Participants were nurses, care assistants, doctors, physiotherapists, patient coordinators and administrative personnel from hospital, nursing homes and home-based care services. The Meeting Point was organised around four pillars: introduction, teaching session, group work activity and plenary discussion. Qualitative data included log reports, summaries of meetings, notes from group work activities, and reports from participants and from follow-up meetings. Feedback from participants shows that they were satisfied with meeting healthcare professionals from other units of care. A film scenario was perceived relevant for group work activity and useful in focusing participants' attention to patient participation. Follow-up meetings show that some nursing home wards, the emergency department and one medical ward at the hospital continued with ongoing work to improve quality of care. Efforts included implementation of an observational waiting room with comfortable chairs, planning for discharge in hospital admission, a daily patient flow registration system and motivational interviewing during admission to nursing home. The description of the learning activities used at The Meeting Point seminars shows that they

  3. How benchmarking can improve patient nutrition.

    Science.gov (United States)

    Ellis, Jane

    Benchmarking is a tool that originated in business to enable organisations to compare their services with industry-wide best practice. Early last year the Department of Health published The Essence of Care, a benchmarking toolkit adapted for use in health care. It focuses on eight elements of care that are crucial to patients' experiences. Nurses and other health care professionals at a London NHS trust have begun a trust-wide benchmarking project. The aim is to improve patients' experiences of health care by sharing and comparing information, and by identifying examples of good practice and areas for improvement. The project began with two of the eight elements of The Essence of Care, with the intention of covering the rest later. This article describes the benchmarking process for nutrition and some of the consequent improvements in care.

  4. COUNTERCURRENT FLOW LIMITATION EXPERIMENTS AND MODELING FOR IMPROVED REACTOR SAFETY

    International Nuclear Information System (INIS)

    Vierow, Karen

    2008-01-01

    This project is investigating countercurrent flow and 'flooding' phenomena in light water reactor systems to improve reactor safety of current and future reactors. To better understand the occurrence of flooding in the surge line geometry of a PWR, two experimental programs were performed. In the first, a test facility with an acrylic test section provided visual data on flooding for air-water systems in large diameter tubes. This test section also allowed for development of techniques to form an annular liquid film along the inner surface of the 'surge line' and other techniques which would be difficult to verify in an opaque test section. Based on experiences in the air-water testing and the improved understanding of flooding phenomena, two series of tests were conducted in a large-diameter, stainless steel test section. Air-water test results and steam-water test results were directly compared to note the effect of condensation. Results indicate that, as for smaller diameter tubes, the flooding phenomena is predominantly driven by the hydrodynamics. Tests with the test sections inclined were attempted but the annular film was easily disrupted. A theoretical model for steam venting from inclined tubes is proposed herein and validated against air-water data. Empirical correlations were proposed for air-water and steam-water data. Methods for developing analytical models of the air-water and steam-water systems are discussed, as is the applicability of the current data to the surge line conditions. This report documents the project results from July 1, 2005 through June 30, 2008

  5. Electronic patient journey boards a vital piece of the puzzle in patient flow.

    Science.gov (United States)

    Clark, Kevin W; Moller, Susan; O'Brien, Lauri

    2014-06-01

    Internationally, there is growing interest in the applicability of visual management in healthcare, although little is known about the extent of its effectiveness. In the past 5 years technical advances have permitted the integration of all relevant data into a singular display that can improve staff efficiency, accelerate decisions, streamline workflow processes and reduce oversights and errors in clinical practice. The aim of the case study is to describe the features and application of electronic patient journey boards (EPJBs) as an enabler to accelerate patient flow that has been demonstrated and evaluated in Queensland Health hospitals. In 2012 and 2013 we collected ward-specific data that was sourced from the Queensland Hospital Admitted Patient Data Collection, determining the top 10 overnight diagnostic-related groups (DRGs) for each ward participating in the pilots. The Statistical Output Unit within Queensland Health then provided data and analysis on the ALOS for each of these DRGs for the period following an EPJB installation, along with the ALOS for the same DRGs for the corresponding period in the previous year. Patient length of stay reduced and display of estimated discharge dates improved with the introduction of EPJBs along with improved communication and information management resulting in time savings from 20 min per staff member per shift to 2.5h per ward a day. Queensland and South Australian Health systems have succeeded in 'making the hospital patient journey visible' through an innovative combination of information management and prominent display of key information related to patient care portrayed on large liquid crystal display (LCD) screens in hospital wards.

  6. Improving treatment in Hispanic/Latino patients.

    Science.gov (United States)

    Cersosimo, Eugenio; Musi, Nicolas

    2011-10-01

    The prevalence of type 2 diabetes mellitus is higher in Hispanic/Latino individuals living in the United States compared with their non-Hispanic white counterparts. Many factors contribute to the increased prevalence of type 2 diabetes, including biological characteristics, socioeconomic conditions, and cultural aspects. The contribution of genetics to the risk of type 2 diabetes in Hispanic/Latino patients is becoming increasingly clear, but this inherent risk factor cannot be modified. However, certain socioeconomic and cultural factors, such as reduced access to healthcare, language barriers, cultural beliefs, and lack of cultural competence by the healthcare provider, are modifiable and should be overcome in order to improve the management of type 2 diabetes in Hispanic/Latino patients. At the healthcare system level, policies should be put into place to reduce disparities between Hispanics/Latinos and non-Hispanic whites regarding health insurance coverage and access to healthcare. At the healthcare provider and patient level, cultural beliefs should be taken into consideration when selecting adequate treatment. Overall, type 2 diabetes management should be individualized by identifying the preferred language and level of acculturation for each patient. These considerations are necessary to further improve communication through culturally appropriate educational materials and programs. These strategies may help to overcome the barriers in the treatment of type 2 diabetes in Hispanic/Latino patients. Copyright © 2011 Elsevier Inc. All rights reserved.

  7. Domiciliary humidification improves lung mucociliary clearance in patients with bronchiectasis.

    Science.gov (United States)

    Hasani, A; Chapman, T H; McCool, D; Smith, R E; Dilworth, J P; Agnew, J E

    2008-01-01

    Inspired air humidification has been reported to show some benefit in bronchiectatic patients. We have investigated the possibility that one effect might be to enhance mucociliary clearance. Such enhancement might, if it occurs, help to lessen the risks of recurrent infective episodes. Using a radioaerosol technique, we measured lung mucociliary clearance before and after 7 days of domiciliary humidification. Patients inhaled high flow saturated air at 37 degrees C via a patient-operated humidification nasal inhalation system for 3 h per day. We assessed tracheobronchial mucociliary clearance from the retention of (99m)Tc-labelled polystyrene tracer particles monitored for 6 h, with a follow-up 24-h reading. Ten out of 14 initially recruited patients (age 37-75 years; seven females) completed the study (two withdrew after their initial screening and two prior to the initial clearance test). Seven patients studied were non-smokers; three were ex-smokers (1-9 pack-years). Initial tracer radioaerosol distribution was closely similar between pre- and post-treatment. Following humidification, lung mucociliary clearance significantly improved, the area under the tracheobronchial retention curve decreased from 319 +/- 50 to 271 +/- 46%h (p humidification treatment improved lung mucociliary clearance in our bronchiectatic patients. Given this finding plus increasing laboratory and clinical interest in humidification mechanisms and effects, we believe further clinical trials of humidification therapy are desirable, coupled with analysis of humidification effects on mucus properties and transport.

  8. Interplay of Proximal Flow Confluence and Distal Flow Divergence in Patient-Specific Vertebrobasilar System.

    Directory of Open Access Journals (Sweden)

    Xiaoping Yin

    Full Text Available Approximately one-quarter of ischemic strokes involve the vertebrobasilar arterial system that includes the upstream flow confluence and downstream flow divergence. A patient-specific hemodynamic analysis is needed to understand the posterior circulation. The objective of this study is to determine the distribution of hemodynamic parameters in the vertebrobasilar system, based on computer tomography angiography images. Here, the interplay of upstream flow confluence and downstream flow divergence was hypothesized to be a determinant factor for the hemodynamic distribution in the vertebrobasilar system. A computational fluid dynamics model was used to compute the flow fields in patient-specific vertebrobasilar models (n = 6. The inlet and outlet boundary conditions were the aortic pressure waveform and flow resistances, respectively. A 50% reduction of total outlet area was found to induce a ten-fold increase in surface area ratio of low time-averaged wall shear stress (i.e., TAWSS ≤ 4 dynes/cm2. This study enhances our understanding of the posterior circulation associated with the incidence of atherosclerotic plaques.

  9. Axiomatic Design of a Framework for the Comprehensive Optimization of Patient Flows in Hospitals

    Directory of Open Access Journals (Sweden)

    Gabriele Arcidiacono

    2017-01-01

    Full Text Available Lean Management and Six Sigma are nowadays applied not only to the manufacturing industry but also to service industry and public administration. The manifold variables affecting the Health Care system minimize the effect of a narrow Lean intervention. Therefore, this paper aims to discuss a comprehensive, system-based approach to achieve a factual holistic optimization of patient flows. This paper debates the efficacy of Lean principles applied to the optimization of patient flows and related activities, structures, and resources, developing a theoretical framework based on the principles of the Axiomatic Design. The demand for patient-oriented and efficient health services leads to use these methodologies to improve hospital processes. In the framework, patients with similar characteristics are clustered in families to achieve homogeneous flows through the value stream. An optimization checklist is outlined as the result of the mapping between Functional Requirements and Design Parameters, with the right sequence of the steps to optimize the patient flow according to the principles of Axiomatic Design. The Axiomatic Design-based top-down implementation of Health Care evidence, according to Lean principles, results in a holistic optimization of hospital patient flows, by reducing the complexity of the system.

  10. Axiomatic Design of a Framework for the Comprehensive Optimization of Patient Flows in Hospitals

    Science.gov (United States)

    Arcidiacono, Gabriele; Matt, Dominik T.; Rauch, Erwin

    2017-01-01

    Lean Management and Six Sigma are nowadays applied not only to the manufacturing industry but also to service industry and public administration. The manifold variables affecting the Health Care system minimize the effect of a narrow Lean intervention. Therefore, this paper aims to discuss a comprehensive, system-based approach to achieve a factual holistic optimization of patient flows. This paper debates the efficacy of Lean principles applied to the optimization of patient flows and related activities, structures, and resources, developing a theoretical framework based on the principles of the Axiomatic Design. The demand for patient-oriented and efficient health services leads to use these methodologies to improve hospital processes. In the framework, patients with similar characteristics are clustered in families to achieve homogeneous flows through the value stream. An optimization checklist is outlined as the result of the mapping between Functional Requirements and Design Parameters, with the right sequence of the steps to optimize the patient flow according to the principles of Axiomatic Design. The Axiomatic Design-based top-down implementation of Health Care evidence, according to Lean principles, results in a holistic optimization of hospital patient flows, by reducing the complexity of the system. © 2017 Gabriele Arcidiacono et al.

  11. Non-Invasive Mapping of Intraventricular Flow Patterns in Patients Treated with Left Ventricular Assist Devices

    Science.gov (United States)

    Miramontes, Marissa; Rossini, Lorenzo; Braun, Oscar; Brambatti, Michela; Almeida, Shone; Mizeracki, Adam; Martinez-Legazpi, Pablo; Benito, Yolanda; Bermejo, Javier; Kahn, Andrew; Adler, Eric; Del Álamo, Juan C.

    2017-11-01

    In heart failure patients, left ventricular (LV) assist devices (LVADs) decrease mortality and improve quality of life. We hypothesize echo color Doppler velocimetry (echo-CDV), an echocardiographic flow mapping modality, can non-invasively characterize the effect of LVAD support, optimize the device, thereby decreasing the stoke rate present in these patients. We used echo-CDV to image LV flow at baseline LVAD speed and during a ramp test in LVAD patients (Heartmate II, N =10). We tracked diastolic vortices and mapped blood stasis and cumulative shear. Compared to dilated cardiomyopathy (DCM) patients without LVADs, the flow had a less prominent diastolic vortex ring, and transited directly from mitral valve to cannula. Residence time and shear were significantly lower compared to healthy controls and DCMs. Aortic regurgitation and a large LV vortex presence or a direct mitral jet towards the cannula affected blood stasis region location and size. Flow patterns, residence time and shear depended on LV geometry, valve function and LVAD speed in a patient specific manner. This new methodology could be used with standard echo, hemodynamics and clinical information to find the flow optimizing LAVD setting minimizing stasis for each patient.

  12. Lean-driven improvements slash wait times, drive up patient satisfaction scores.

    Science.gov (United States)

    2012-07-01

    Administrators at LifePoint Hospitals, based in Brentwood, TN, used lean manufacturing techniques to slash wait times by as much as 30 minutes and achieve double-digit increases in patient satisfaction scores in the EDs at three hospitals. In each case, front-line workers took the lead on identifying opportunities for improvement and redesigning the patient-flow process. As a result of the new efficiencies, patient volume is up by about 25% at all three hospitals. At each hospital, the improvement process began with Kaizen, a lean process that involves bringing personnel together to flow-chart the current system, identify problem areas, and redesign the process. Improvement teams found big opportunities for improvement at the front end of the flow process. Key to the approach was having a plan up front to deal with non-compliance. To sustain improvements, administrators gather and disseminate key metrics on a daily basis.

  13. Improved flow velocity estimates from moving-boat ADCP measurements

    NARCIS (Netherlands)

    Vermeulen, B.; Hoitink, A.J.F.; Sassi, M.G.

    2014-01-01

    Acoustic Doppler current profilers (ADCPs) are the current standard for flow measurements in large-scale open water systems. Existing techniques to process vessel-mounted ADCP data assume homogeneous or linearly changing flow between the acoustic beams. This assumption is likely to fail but is

  14. Improved flow velocity estmates from oving-boat ADCO measurements

    NARCIS (Netherlands)

    Vermeulen, B.; Sassi, M.G.; Hoitink, A.J.F.

    2014-01-01

    Acoustic Doppler current profilers (ADCPs) are the current standard for flow measurements in large-scale open water systems. Existing techniques to process vessel-mounted ADCP data assume homogeneous or linearly changing flow between the acoustic beams. This assumption is likely to fail but is

  15. Improving patient safety through quality assurance.

    Science.gov (United States)

    Raab, Stephen S

    2006-05-01

    Anatomic pathology laboratories use several quality assurance tools to detect errors and to improve patient safety. To review some of the anatomic pathology laboratory patient safety quality assurance practices. Different standards and measures in anatomic pathology quality assurance and patient safety were reviewed. Frequency of anatomic pathology laboratory error, variability in the use of specific quality assurance practices, and use of data for error reduction initiatives. Anatomic pathology error frequencies vary according to the detection method used. Based on secondary review, a College of American Pathologists Q-Probes study showed that the mean laboratory error frequency was 6.7%. A College of American Pathologists Q-Tracks study measuring frozen section discrepancy found that laboratories improved the longer they monitored and shared data. There is a lack of standardization across laboratories even for governmentally mandated quality assurance practices, such as cytologic-histologic correlation. The National Institutes of Health funded a consortium of laboratories to benchmark laboratory error frequencies, perform root cause analysis, and design error reduction initiatives, using quality assurance data. Based on the cytologic-histologic correlation process, these laboratories found an aggregate nongynecologic error frequency of 10.8%. Based on gynecologic error data, the laboratory at my institution used Toyota production system processes to lower gynecologic error frequencies and to improve Papanicolaou test metrics. Laboratory quality assurance practices have been used to track error rates, and laboratories are starting to use these data for error reduction initiatives.

  16. Improving patient safety: lessons from rock climbing.

    Science.gov (United States)

    Robertson, Nic

    2012-02-01

    How to improve patient safety remains an intractable problem, despite large investment and some successes. Academics have argued that the root of the problem is a lack of a comprehensive 'safety culture' in hospitals. Other safety-critical industries such as commercial aviation invest heavily in staff training to develop such a culture, but comparable programmes are almost entirely absent from the health care sector. In rock climbing and many other dangerous activities, the 'buddy system' is used to ensure that safety systems are adhered to despite adverse circumstances. This system involves two or more people using simple checks and clear communication to prevent problems causing harm. Using this system as an example could provide a simple, original and entertaining way of introducing medical students to the idea that human factors are central to ensuring patient safety. Teaching the buddy system may improve understanding and acceptance of other patient safety initiatives, and could also be used by junior doctors as a tool to improve the safety of their practice. © Blackwell Publishing Ltd 2012.

  17. Improving patient safety in radiation oncology

    International Nuclear Information System (INIS)

    Hendee, William R.; Herman, Michael G.

    2011-01-01

    Beginning in the 1990s, and emphasized in 2000 with the release of an Institute of Medicine report, healthcare providers and institutions have dedicated time and resources to reducing errors that impact the safety and well-being of patients. But in January 2010 the first of a series of articles appeared in the New York Times that described errors in radiation oncology that grievously impacted patients. In response, the American Association of Physicists in Medicine and the American Society of Radiation Oncology sponsored a working meeting entitled ''Safety in Radiation Therapy: A Call to Action''. The meeting attracted 400 attendees, including medical physicists, radiation oncologists, medical dosimetrists, radiation therapists, hospital administrators, regulators, and representatives of equipment manufacturers. The meeting was cohosted by 14 organizations in the United States and Canada. The meeting yielded 20 recommendations that provide a pathway to reducing errors and improving patient safety in radiation therapy facilities everywhere.

  18. [Improving patient safety through voluntary peer review].

    Science.gov (United States)

    Kluge, S; Bause, H

    2015-01-01

    The intensive care unit (ICU) is one area of the hospital in which processes and communication are of primary importance. Errors in intensive care units can lead to serious adverse events with significant consequences for patients. Therefore quality and risk-management are important measures when treating critically ill patients. A pragmatic approach to support quality and safety in intensive care is peer review. This approach has gained significant acceptance over the past years. It consists of mutual visits by colleagues who conduct standardised peer reviews. These reviews focus on the systematic evaluation of the quality of an ICU's structure, its processes and outcome. Together with different associations, the State Chambers of Physicians and the German Medical Association have developed peer review as a standardized tool for quality improvement. The common goal of all stakeholders is the continuous and sustainable improvement in intensive care with peer reviews significantly increasing and improving communication between professions and disciplines. Peer reviews secure the sustainability of planned change processes and consequently lead the way to an improved culture of quality and safety.

  19. Salivary flow and corono-radicular caries in elderly patients

    OpenAIRE

    Campodónico Reategui, Carlos; Chein Villacampa, Sylvia; Benavente Lipa, Lourdes; Delgadillo Avila, Juana; Alvarez Paucar, Maria Angelica; Espinoza Escajadillo, Sofia; Vidal Goñi, Raúl; Ventocilla Huasupoma, Maria; Evaristo Chiyong, Teresa

    2014-01-01

    The aim of this study was to determine the correlation between hypo-salivation and corono-radicular caries in older adult patients, which analyzed the physicochemical properties of saliva (flow, pH), the frequency and location of the corono-radicular caries. Was selected a sample of 45 persons, adult patients over 60 years and another 18 to 26 years (control group), from service centers, hospitals and universities. The technique of collection of saliva, consisted of making chewing a piece of ...

  20. Xerostomia, Hyposalivation, and Salivary Flow in Diabetes Patients

    OpenAIRE

    L?pez-Pintor, Rosa Mar?a; Casa?as, Elisabeth; Gonz?lez-Serrano, Jos?; Serrano, Julia; Ram?rez, Luc?a; de Arriba, Lorenzo; Hern?ndez, Gonzalo

    2016-01-01

    The presence of xerostomia and hyposalivation is frequent among diabetes mellitus (DM) patients. It is not clear if the presence of xerostomia and hyposalivation is greater in DM than non-DM patients. The aims of this systematic review are (1) to compare the prevalence rates of xerostomia, (2) to evaluate the salivary flow rate, and (3) to compare the prevalence rates of hyposalivation in DM versus non-DM population. This systematic review was conducted according to the PRISMA group guideline...

  1. Integrative practices in hospitals and their impact on patient flow

    NARCIS (Netherlands)

    Drupsteen, J.; van der Vaart, T.; van Donk, D.P.

    2013-01-01

    Purpose - The aim of this paper is to investigate which integrative planning and control practices are used in hospitals and what their effects are on patient flow. Design/methodology/approach - The study is based on a three-hospital multi-case study carried out in The Netherlands. The main findings

  2. Improved flow cytometric assessment reveals distinct microvesicle (cell-derived microparticle signatures in joint diseases.

    Directory of Open Access Journals (Sweden)

    Bence György

    Full Text Available INTRODUCTION: Microvesicles (MVs, earlier referred to as microparticles, represent a major type of extracellular vesicles currently considered as novel biomarkers in various clinical settings such as autoimmune disorders. However, the analysis of MVs in body fluids has not been fully standardized yet, and there are numerous pitfalls that hinder the correct assessment of these structures. METHODS: In this study, we analyzed synovial fluid (SF samples of patients with osteoarthritis (OA, rheumatoid arthritis (RA and juvenile idiopathic arthritis (JIA. To assess factors that may confound MV detection in joint diseases, we used electron microscopy (EM, Nanoparticle Tracking Analysis (NTA and mass spectrometry (MS. For flow cytometry, a method commonly used for phenotyping and enumeration of MVs, we combined recent advances in the field, and used a novel approach of differential detergent lysis for the exclusion of MV-mimicking non-vesicular signals. RESULTS: EM and NTA showed that substantial amounts of particles other than MVs were present in SF samples. Beyond known MV-associated proteins, MS analysis also revealed abundant plasma- and immune complex-related proteins in MV preparations. Applying improved flow cytometric analysis, we demonstrate for the first time that CD3(+ and CD8(+ T-cell derived SF MVs are highly elevated in patients with RA compared to OA patients (p=0.027 and p=0.009, respectively, after Bonferroni corrections. In JIA, we identified reduced numbers of B cell-derived MVs (p=0.009, after Bonferroni correction. CONCLUSIONS: Our results suggest that improved flow cytometric assessment of MVs facilitates the detection of previously unrecognized disease-associated vesicular signatures.

  3. 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.

  4. Improving ICU risk management and patient safety.

    Science.gov (United States)

    Kielty, Lucy Ann

    2017-06-12

    Purpose The purpose of this paper is to describe a study which aimed to develop and validate an assessment method for the International Electrotechnical Commission (IEC) 80001-1 (IEC, 2010) standard (the Standard); raise awareness; improve medical IT-network project risk management processes; and improve intensive care unit patient safety. Design/methodology/approach An assessment method was developed and piloted. A healthcare IT-network project assessment was undertaken using a semi-structured group interview with risk management stakeholders. Participants provided feedback via a questionnaire. Descriptive statistics and thematic analysis was undertaken. Findings The assessment method was validated as fit for purpose. Participants agreed (63 per cent, n=7) that assessment questions were clear and easy to understand, and participants agreed (82 per cent, n=9) that the assessment method was appropriate. Participant's knowledge of the Standard increased and non-compliance was identified. Medical IT-network project strengths, weaknesses, opportunities and threats in the risk management processes were identified. Practical implications The study raised awareness of the Standard and enhanced risk management processes that led to improved patient safety. Study participants confirmed they would use the assessment method in future projects. Originality/value Findings add to knowledge relating to IEC 80001-1 implementation.

  5. Successful percutaneous coronary intervention significantly improves coronary sinus blood flow as assessed by transthoracic echocardiography.

    Science.gov (United States)

    Lyubarova, Radmila; Boden, William E; Fein, Steven A; Schulman-Marcus, Joshua; Torosoff, Mikhail

    2018-06-01

    Transthoracic echocardiography (TTE) has been used to assess coronary sinus blood flow (CSBF), which reflects total coronary arterial blood flow. Successful angioplasty is expected to improve coronary arterial blood flow. Changes in CSBF after percutaneous coronary intervention (PCI), as assessed by TTE, have not been systematically evaluated. TTE can be utilized to reflect increased CSBF after a successful, clinically indicated PCI. The study cohort included 31 patients (18 females, 62 ± 11 years old) referred for diagnostic cardiac catheterization for suspected coronary artery disease and possible PCI, when clinically indicated. All performed PCIs were successful, with good angiographic outcome. CSBF per cardiac cycle (mL/beat) was measured using transthoracic two-dimensional and Doppler flow imaging as the product of coronary sinus (CS) area and CS flow time-velocity integral. CSBF per minute (mL/min) was calculated as the product of heart rate and CSBF per cardiac cycle. In each patient, CSBF was assessed prospectively, before and after cardiac catheterization with and without clinically indicated PCI. Within- and between-group differences in CSBF before and after PCI were assessed using repeated measures analysis of variance. Technically adequate CSBF measurements were obtained in 24 patients (77%). In patients who did not undergo PCI, there was no significant change in CSBF (278.1 ± 344.1 versus 342.7 ± 248.5, p = 0.36). By contrast, among patients who underwent PCI, CSBF increased significantly (254.3 ± 194.7 versus 618.3 ± 358.5 mL/min, p < 0.01, p-interaction = 0.03). Other hemodynamic and echocardiographic parameters did not change significantly before and after cardiac catheterization in either treatment group. Transthoracic echocardiographic assessment can be employed to document CSBF changes after angioplasty. Future studies are needed to explore the clinical utility of this noninvasive metric.

  6. Improved simulation of peak flows under climate change: post-processing or composite opjective calibration?

    NARCIS (Netherlands)

    Zhang, Xujie; Booij, Martijn J.; Xu, YuePing

    2015-01-01

    Climate change is expected to have large impacts on peak flows. However, there may be bias in the simulation of peak flows by hydrological models. This study aims to improve the simulation of peak flows under climate change in Lanjiang catchment, east China, by comparing two approaches:

  7. Physically consistent data assimilation method based on feedback control for patient-specific blood flow analysis.

    Science.gov (United States)

    Ii, Satoshi; Adib, Mohd Azrul Hisham Mohd; Watanabe, Yoshiyuki; Wada, Shigeo

    2018-01-01

    This paper presents a novel data assimilation method for patient-specific blood flow analysis based on feedback control theory called the physically consistent feedback control-based data assimilation (PFC-DA) method. In the PFC-DA method, the signal, which is the residual error term of the velocity when comparing the numerical and reference measurement data, is cast as a source term in a Poisson equation for the scalar potential field that induces flow in a closed system. The pressure values at the inlet and outlet boundaries are recursively calculated by this scalar potential field. Hence, the flow field is physically consistent because it is driven by the calculated inlet and outlet pressures, without any artificial body forces. As compared with existing variational approaches, although this PFC-DA method does not guarantee the optimal solution, only one additional Poisson equation for the scalar potential field is required, providing a remarkable improvement for such a small additional computational cost at every iteration. Through numerical examples for 2D and 3D exact flow fields, with both noise-free and noisy reference data as well as a blood flow analysis on a cerebral aneurysm using actual patient data, the robustness and accuracy of this approach is shown. Moreover, the feasibility of a patient-specific practical blood flow analysis is demonstrated. Copyright © 2017 John Wiley & Sons, Ltd.

  8. 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.

  9. Improving the quality of palliative care for ambulatory patients with lung cancer

    DEFF Research Database (Denmark)

    von Plessen, Christian; Aslaksen, Aslak

    2005-01-01

    and energy in organisational aspects of care that could be better used in direct interaction with patients. DESIGN: Quality improvement study using direct observation and run and flow charts, and focus group meetings with patients and families regarding perceptions of the clinic and with staff regarding...

  10. [Assessment of maternal cerebral blood flow in patients with preeclampsia].

    Science.gov (United States)

    Mandić, Vesna; Miković, Zeljko; Dukić, Milan; Vasiljević, Mladenko; Filimonović, Dejan; Bogavac, Mirjana

    2005-01-01

    Systemic vasoconstriction in preeclamptic patients increases vascular resistance, and is manifested by increased arterial blood flow velocity. The aim of the study is to evaluate if there is a change of Doppler indices in maternal medial cerbral artery (MCA) in severe preeclampsia due to: 1) severity of clinical symptoms, 2) the begining of eclamptic attack and 3) the application of anticonvulsive therapy. A prospective clinical study included 92 pregnant women, gestational age 28-36 weeks. They were divided into three groups: normotensive (n=30), mild preeclampsia (n=33), and severe preeclampsia (n=29). We investigated maternal cerebral circulation by assessing the MCA. We registrated: pulsatility index (Pi), resistance index (Ri), systolic/diastolic ratio (S/D), and the maximum systolic, end diastolic and medium velocity. Patients with severe preeclampsia were divided into two subgroups. subgroup 1 included patients without symptoms of threatening eclampsia (n=18; 62.06%); while subgroup 2 included those with symptoms of preeclampsia (n=11; 37.94%). All patients with severe preeclampsia were treated with magnesium sulfate (MgSO4), and cerebral blood flow was measured before and after the treatment. Statistical analysis was done by oneway ANOVA, Student t-test and t-paired sample test. The difference was considered to be significant if ppreclampsia we found increased velocity values, Pi and Ri, especially in patients with signs of threatened eclampsia, suggesting that blood vessels changes are most prominent in severe preeclampsia. Cerebral blood flow meassurements can be used as a clinical test for the prediction of eclampsia. Magnesium-sulfate (MgSO4) has a signifficant role in prophylaxis and treatment of eclampsia, and, therefore, positive influence on reduction of cerebral ishemic lesions can be expected. We can conclude that changes of the cerebral blood flow can be evaluated by evaluating blood flow velocities in the medial cerebral artery. Velocities tend

  11. Renal transplantant blood flow in patients with acute tubular necrosis

    Energy Technology Data Exchange (ETDEWEB)

    Huic, D; Crnkovic, S; Bubic-Filipi, L J; Grosev, D; Dodig, P; Porapat, M; Puretic, Z [Univ. Hospital Rebro, Zagreb (Croatia)

    1997-09-01

    The aim of this study was to investigate the quantity of renal transport blood flow in patients affected by acute tubular necrosis (ATN). During the four years period two hundred and thirty-three studies were performed using {sup 99m}Tc pertechnetate and {sup 131}I - OIH. Renal blood flow was calculated from the first-pass time activity curves generated over the kidney and aorta and expressed as a percentage of cardiac output (RBF/CO). Renal transplant blood flow is clearly diminished in ATN, similar as in acute rejection, and significantly related to the graft function, what means that RBF/CO value could potentially serve as a prognostic factor in the graft function recovery from ATN.

  12. Improving Organizational Citizenship Behavior based on Flow Experience

    Directory of Open Access Journals (Sweden)

    Alecxandrina Deaconu

    2016-07-01

    Full Text Available Building on previous research on Organizational Citizenship Behavior (OCB and its influence on the performance of SMEs, this article intends to expand the investigation area to the concept of Flow and its relationship with OCB. In this paper we performed an analysis of the two theoretical constructs, we highlighted similarities and complementarities and we formulated arguments supporting the need to implement strategies that promote a state of flow. Our study points out that through these strategies, employees are encouraged to perform an extra role, beyond their formal duties, which generates an increase of OCB and favorable conditions for sustainable development.

  13. Renal embolic protection devices improve blood flow after stenting for atherosclerotic renal artery stenosis.

    Science.gov (United States)

    Paul, Timir K; Lee, John H; White, Christopher J

    2012-11-15

    We sought to measure angiographic renal frame counts (RFC), as a quantitative angiographic assessment of renal blood flow, to evaluate microvascular compromise due to atheroembolism associated with RAS. Atheroembolism associated with renal artery stenting (RAS) has been implicated as a cause for worsening renal function following successful intervention. Use of a distal embolic protection device (EPD) during RAS has been shown to be safe with debris capture in a high percentage of cases. However, objective benefit for renal function with EPD has been difficult to demonstrate. A control group of 30 consecutive patients (33 kidneys) who underwent RAS without EPD were compared with 33 consecutive patients (33 kidneys) who underwent RAS with EPD using RFC measurement. The prestent and poststent mean RFC for the control group was 30.4 ± 12.1 vs. 23.7 ± 9.9 (P = 0.002) and for the EPD group it was 42.6 ± 12.6 vs. 28.3 ± 9.2 (P renal blood flow, manifested by a greater reduction of the RFC (Δ RFC) 14.2 ± 15.2 vs. 6.7 ± 11.7 (P = 0.03) compared with the control group. The use of an EPD was associated with a much larger improvement in renal blood flow (lower RFC) following RAS. This suggests that EPD's may be effective in preventing renal atheroembolic injury and that a controlled trial measuring the impact of EPD's on renal blood flow following RAS should be performed. Copyright © 2012 Wiley Periodicals, Inc.

  14. Improved Flow Modeling in Transient Reactor Safety Analysis Computer Codes

    International Nuclear Information System (INIS)

    Holowach, M.J.; Hochreiter, L.E.; Cheung, F.B.

    2002-01-01

    A method of accounting for fluid-to-fluid shear in between calculational cells over a wide range of flow conditions envisioned in reactor safety studies has been developed such that it may be easily implemented into a computer code such as COBRA-TF for more detailed subchannel analysis. At a given nodal height in the calculational model, equivalent hydraulic diameters are determined for each specific calculational cell using either laminar or turbulent velocity profiles. The velocity profile may be determined from a separate CFD (Computational Fluid Dynamics) analysis, experimental data, or existing semi-empirical relationships. The equivalent hydraulic diameter is then applied to the wall drag force calculation so as to determine the appropriate equivalent fluid-to-fluid shear caused by the wall for each cell based on the input velocity profile. This means of assigning the shear to a specific cell is independent of the actual wetted perimeter and flow area for the calculational cell. The use of this equivalent hydraulic diameter for each cell within a calculational subchannel results in a representative velocity profile which can further increase the accuracy and detail of heat transfer and fluid flow modeling within the subchannel when utilizing a thermal hydraulics systems analysis computer code such as COBRA-TF. Utilizing COBRA-TF with the flow modeling enhancement results in increased accuracy for a coarse-mesh model without the significantly greater computational and time requirements of a full-scale 3D (three-dimensional) transient CFD calculation. (authors)

  15. Improving the implementation of pre-laboratory flow charts ...

    African Journals Online (AJOL)

    The aim of this research was to use different assessment methods by engaging all students in pre-laboratory flow charts with check lists by taking into account rather than giving a mark for attendance for their presence, based on principles of cooperative learning method by forming groups, promoting positive ...

  16. Emergency evacuation : how better interior design can improve passenger flow

    NARCIS (Netherlands)

    Boer, L.C.; Skjong, R.

    2001-01-01

    The paper presents some conclusions from the EU basic research project "MEPdesign" relevant for design of ship interiors. The findings are discussed with regard to passenger flow as a function of design parameters. The paper explains that current evacuation analyses may be overly optimistic. The

  17. Improving inpatient environments to support patient sleep.

    Science.gov (United States)

    DuBose, Jennifer R; Hadi, Khatereh

    2016-10-01

    Although sleep is important for healing, sleep deprivation is a major concern for patients in hospitals. The purpose of this review is to consolidate the observational and interventional studies that have been done to understand exogenous, non-pharmacological strategies for improving sleep in hospitals. We searched Medline, CINAHL, PsycINFO and the Web of Science databases for peer-reviewed articles published between 1970 and 2015 in English. A title review of 13,113 articles from four databases resulted in 783 articles that were further culled to 277 based on a review of the abstracts. The net result after reading the articles and a hand search was 42 articles. From each article we recorded the independent variables, methods used for measuring sleep and specific sleep outcomes reported. Noise is a modifiable cause of some sleep disruptions in hospitals, and when reduced can lead to more sleep. Earplugs and eye masks may help, but changing the sound and light environment is more effective. Calming music in the evening has been shown to be effective as well as daytime bright light exposure. Nursing care activities cause sleep disruption, but efforts at limiting interventions have not been demonstrated to improve sleep conditions. The research is hard to consolidate due to the multitude of independent variables and outcome metrics, but overall points to the potential for making meaningful improvements in the quality of patient sleep. © The Author 2016. Published by Oxford University Press in association with the International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  18. Methods and Models for Capacity and Patient Flow Analysis in Hospital Sector

    DEFF Research Database (Denmark)

    Kozlowski, Dawid

    at a private hospital in Denmark or at a hospital abroad if the public healthcare system is unable to provide treatment within the stated maximum waiting time guarantee. A queue modelling approach is used to analyse the potential negative consequences of the policy on the utilization of public hospital......This thesis is concerned about the novel applications of operations research methods for capacity and flow analysis within hospital sector. The first part of the thesis presents a detailed Discrete-Event Simulation (DES) model that has been developed as an analytical tool designed to facilitate...... by an improved patient flow. The specially developed structure of the model facilitates its reuse at different units, with no advanced modelling skills required in day-to-day use. This feature amplifies the usefulness of DES in conducting comprehensive patient flow analyses at any department with emergency...

  19. Health innovation for patient safety improvement

    Directory of Open Access Journals (Sweden)

    Renukha Sellappans

    2013-01-01

    Full Text Available Medication error has been identified as a major factor affecting patient safety. Many innovative efforts such as Computerised Physician Order Entry (CPOE, a Pharmacy Information System, automated dispensing machines and Point of Administration Systems have been carried out with the aim of improving medication safety. However, areas remain that require urgent attention. One main area will be the lack of continuity of care due to the breakdown of communication between multiple healthcare providers. Solutions may include consideration of “health smart cards” that carry vital patient medical information in the form of a “credit card” or use of the Malaysian identification card. However, costs and technical aspects associated with the implementation of this health smart card will be a significant barrier. Security and confidentiality, on the other hand, are expected to be of primary concern to patients. Challenges associated with the implementation of a health smart card might include physician buy-in for use in his or her everyday practice. Training and technical support should also be available to ensure the smooth implementation of this system. Despite these challenges, implementation of a health smart card moves us closer to seamless care in our country, thereby increasing the productivity and quality of healthcare.

  20. Health innovation for patient safety improvement.

    Science.gov (United States)

    Sellappans, Renukha; Chua, Siew Siang; Tajuddin, Nur Amani Ahmad; Mei Lai, Pauline Siew

    2013-01-01

    Medication error has been identified as a major factor affecting patient safety. Many innovative efforts such as Computerised Physician Order Entry (CPOE), a Pharmacy Information System, automated dispensing machines and Point of Administration Systems have been carried out with the aim of improving medication safety. However, areas remain that require urgent attention. One main area will be the lack of continuity of care due to the breakdown of communication between multiple healthcare providers. Solutions may include consideration of "health smart cards" that carry vital patient medical information in the form of a "credit card" or use of the Malaysian identification card. However, costs and technical aspects associated with the implementation of this health smart card will be a significant barrier. Security and confidentiality, on the other hand, are expected to be of primary concern to patients. Challenges associated with the implementation of a health smart card might include physician buy-in for use in his or her everyday practice. Training and technical support should also be available to ensure the smooth implementation of this system. Despite these challenges, implementation of a health smart card moves us closer to seamless care in our country, thereby increasing the productivity and quality of healthcare.

  1. Bilateral CBF measurements in patients with global and flow disturbances

    International Nuclear Information System (INIS)

    Fenske, A.; Meinig, G.; Kreysch, G.; Schuermann, K.

    1979-01-01

    The diagnostic value of the Xe-inhalation method, related to the clinical picture and to other noninvasive methods which had shown to a limited extent cerebral vascular lesions, is considered. In patients with angiomas, NPH and local cerebral vascular lesions, the inhalation technique seems to be a clinically useful and reliable examination method which is able to detect even small hemispheric and regional flow defects which were not sufficiently traceable by other methods. (Auth./C.F.)

  2. Developing models for patient flow and daily surge capacity research.

    Science.gov (United States)

    Asplin, Brent R; Flottemesch, Thomas J; Gordon, Bradley D

    2006-11-01

    Between 1993 and 2003, visits to U.S. emergency departments (EDs) increased by 26%, to a total of 114 million visits annually. At the same time, the number of U.S. EDs decreased by more than 400, and almost 200,000 inpatient hospital beds were taken out of service. In this context, the adequacy of daily surge capacity within the system is clearly an important issue. However, the research agenda on surge capacity thus far has focused primarily on large-scale disasters, such as pandemic influenza or a serious bioterrorism event. The concept of daily surge capacity and its relationship to the broader research agenda on patient flow is a relatively new area of investigation. In this article, the authors begin by describing the overlap between the research agendas on daily surge capacity and patient flow. Next, they propose two models that have potential applications for both daily surge capacity and hospitalwide patient-flow research. Finally, they identify potential research questions that are based on applications of the proposed research models.

  3. Restructuring patient flow logistics around patient care needs: implications and practicalities from three critical cases.

    Science.gov (United States)

    Villa, Stefano; Barbieri, Marta; Lega, Federico

    2009-06-01

    To make hospitals more patient-centered it is necessary to intervene on patient flow logistics. The study analyzes three innovative redesign projects implemented at three Italian hospitals. The three hospitals have reorganized patient flow logistics around patient care needs using, as proxies, the expected length of stay and the level of nursing assistance. In order to do this, they have extensively revised their logistical configuration changing: (1) the organization of wards, (2) the hospital's physical lay-out, (3) the capacity planning system, and (4) the organizational roles supporting the patient flow management. The study describes the changes implemented as well as the results achieved and draws some general lessons that provide useful hints for those other hospitals involved in such type of redesign projects. The paper ends by discussing some policy implications. In fact, the results achieved in the three cases investigated provide interesting material for further discussion on clinical, operational, and economic issues.

  4. Improving patient access to an interventional US clinic.

    Science.gov (United States)

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

    2014-01-01

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

  5. An Improved Simulation of the Diurnally Varying Street Canyon Flow

    Science.gov (United States)

    Yaghoobian, Neda; Kleissl, Jan; Paw U, Kyaw Tha

    2012-11-01

    The impact of diurnal variation of temperature distribution over building and ground surfaces on the wind flow and scalar transport in street canyons is numerically investigated using the PArallelized LES Model (PALM). The Temperature of Urban Facets Indoor-Outdoor Building Energy Simulator (TUF-IOBES) is used for predicting urban surface heat fluxes as boundary conditions for a modified version of PALM. TUF-IOBES dynamically simulates indoor and outdoor building surface temperatures and heat fluxes in an urban area taking into account weather conditions, indoor heat sources, building and urban material properties, composition of the building envelope (e.g. windows, insulation), and HVAC equipment. Temperature (and heat flux) distribution over urban surfaces of the 3-D raster-type geometry of TUF-IOBES makes it possible to provide realistic, high resolution boundary conditions for the numerical simulation of flow and scalar transport in an urban canopy. Compared to some previous analyses using uniformly distributed thermal forcing associated with urban surfaces, the present analysis shows that resolving non-uniform thermal forcings can provide more detailed and realistic patterns of the local air flow and pollutant dispersion in urban canyons.

  6. Improvement of Flow Characteristics for an Advanced Plasma Thruster

    International Nuclear Information System (INIS)

    Inutake, M.; Hosokawa, Y.; Sato, R.; Ando, A.; Tobari, H.; Hattori, K.

    2005-01-01

    A higher specific impulse and a larger thrust are required for a manned interplanetary space thruster. Until the realization of a fusion-plasma thruster, a magneto-plasma-dynamic arcjet (MPDA) powered by a fission reactor is one of the promising candidates for a manned Mars space thruster. The MPDA plasma is accelerated axially by a self-induced j x B force. Thrust performance of the MPDA is expected to increase by applying a magnetic nozzle instead of a solid nozzle. In order to get a much higher thruster performance, two methods have been investigated in the HITOP device, Tohoku University. One is to use a magnetic Laval nozzle in the vicinity of the MPDA muzzle for converting the high ion thermal energy to the axial flow energy. The other is to heat ions by use of an ICRF antenna in the divergent magnetic nozzle. It is found that by use of a small-sized Laval-type magnetic nozzle, the subsonic flow near the muzzle is converted to be supersonic through the magnetic Laval nozzle. A fast-flowing plasma is successfully heated by use of an ICRF antenna in the magnetic beach configuration

  7. Improved Flow-Field Structures for Direct Methanol Fuel Cells

    Energy Technology Data Exchange (ETDEWEB)

    Gurau, Bogdan [Nuvant Systems Inc., Crown Point, IN (United States)

    2013-05-31

    The direct methanol fuel cell (DMFC) is ideal if high energy-density liquid fuels are required. Liquid fuels have advantages over compressed hydrogen including higher energy density and ease of handling. Although state-of-the-art DMFCs exhibit manageable degradation rates, excessive fuel crossover diminishes system energy and power density. Although use of dilute methanol mitigates crossover, the concomitant lowering of the gross fuel energy density (GFED) demands a complex balance-of-plant (BOP) that includes higher flow rates, external exhaust recirculation, etc. An alternative approach is redesign of the fuel delivery system to accommodate concentrated methanol. NuVant Systems Inc. (NuVant) will maximize the GFED by design and assembly of a DMFC that uses near neat methanol. The approach is to tune the diffusion of highly concentrated methanol (to the anode catalytic layer) to the back-diffusion of water formed at the cathode (i.e. in situ generation of dilute methanol at the anode layer). Crossover will be minimized without compromising the GFED by innovative integration of the anode flow-field and the diffusion layer. The integrated flow-field-diffusion-layers (IFDLs) will widen the current and potential DMFC operating ranges and enable the use of cathodes optimized for hydrogen-air fuel cells.

  8. Quantification of hepatic flow distribution using particle tracking for patient specific virtual Fontan surgery

    Science.gov (United States)

    Yang, Weiguang; Vignon-Clementel, Irene; Troianowski, Guillaume; Shadden, Shawn; Mohhan Reddy, V.; Feinstein, Jeffrey; Marsden, Alison

    2010-11-01

    The Fontan surgery is the third and final stage in a palliative series to treat children with single ventricle heart defects. In the extracardiac Fontan procedure, the inferior vena cava (IVC) is connected to the pulmonary arteries via a tube-shaped Gore-tex graft. Clinical observations have shown that the absence of a hepatic factor, carried in the IVC flow, can cause pulmonary arteriovenous malformations. Although it is clear that hepatic flow distribution is an important determinant of Fontan performance, few studies have quantified its relation to Fontan design. In this study, we virtually implanted three types of grafts (T-junction, offset and Y-graft) into 5 patient specific models of the Glenn (stage 2) anatomy. We then performed 3D time-dependent simulations and systematically compared the IVC flow distribution, energy loss, and pressure levels in different surgical designs. A robustness test is performed to evaluate the sensitivity of hepatic distribution to pulmonary flow split. Results show that the Y-graft design effectively improves the IVC flow distribution, compared to traditional designs and that surgical designs could be customized on a patient-by-patient basis.

  9. Improved sensitivity and limit-of-detection of lateral flow devices using spatial constrictions of the flow-path.

    Science.gov (United States)

    Katis, Ioannis N; He, Peijun J W; Eason, Robert W; Sones, Collin L

    2018-05-03

    We report on the use of a laser-direct write (LDW) technique that allows the fabrication of lateral flow devices with enhanced sensitivity and limit of detection. This manufacturing technique comprises the dispensing of a liquid photopolymer at specific regions of a nitrocellulose membrane and its subsequent photopolymerisation to create impermeable walls inside the volume of the membrane. These polymerised structures are intentionally designed to create fluidic channels which are constricted over a specific length that spans the test zone within which the sample interacts with pre-deposited reagents. Experiments were conducted to show how these constrictions alter the fluid flow rate and the test zone area within the constricted channel geometries. The slower flow rate and smaller test zone area result in the increased sensitivity and lowered limit of detection for these devices. We have quantified these via the improved performance of a C-Reactive Protein (CRP) sandwich assay on our lateral flow devices with constricted flow paths which demonstrate an improvement in its sensitivity by 62x and in its limit of detection by 30x when compared to a standard lateral flow CRP device. Crown Copyright © 2018. Published by Elsevier B.V. All rights reserved.

  10. An Improved Ghost-cell Immersed Boundary Method for Compressible Inviscid Flow Simulations

    KAUST Repository

    Chi, Cheng

    2015-05-01

    This study presents an improved ghost-cell immersed boundary approach to represent a solid body in compressible flow simulations. In contrast to the commonly used approaches, in the present work ghost cells are mirrored through the boundary described using a level-set method to farther image points, incorporating a higher-order extra/interpolation scheme for the ghost cell values. In addition, a shock sensor is in- troduced to deal with image points near the discontinuities in the flow field. Adaptive mesh refinement (AMR) is used to improve the representation of the geometry efficiently. The improved ghost-cell method is validated against five test cases: (a) double Mach reflections on a ramp, (b) supersonic flows in a wind tunnel with a forward- facing step, (c) supersonic flows over a circular cylinder, (d) smooth Prandtl-Meyer expansion flows, and (e) steady shock-induced combustion over a wedge. It is demonstrated that the improved ghost-cell method can reach the accuracy of second order in L1 norm and higher than first order in L∞ norm. Direct comparisons against the cut-cell method demonstrate that the improved ghost-cell method is almost equally accurate with better efficiency for boundary representation in high-fidelity compressible flow simulations. Implementation of the improved ghost-cell method in reacting Euler flows further validates its general applicability for compressible flow simulations.

  11. Physiotherapy improves patient reported shoulder function and health status in patients with subacromial impingement syndrome

    DEFF Research Database (Denmark)

    Storgaard, Filip Holst; Pedersen, Christina Gravgaard; Jensen, Majbritt Lykke

    Physiotherapy improves patient reported shoulder function and health status in patients with subacromial impingement syndrome.......Physiotherapy improves patient reported shoulder function and health status in patients with subacromial impingement syndrome....

  12. EFFICACY OF LASER PULSE FREQUENCIES ON BLOOD FLOW IN TYPE 2 DIABETIC PATIENTS

    Directory of Open Access Journals (Sweden)

    Amir Nazih Wadee

    2017-04-01

    Full Text Available Background: Research reports had noted an apparent increase in cutaneous and deep blood flow as a result of low-intensity laser therapy (LLLT in normal subjects. The purpose of te study was to investigate the effective laser pulse frequency either (200 or 2000 Hz on improving blood flow in type 2 diabetic patients. Forty-five diabetic patients selected from out clinic of Kasr El-Aini Hospital, Cairo University assigned randomly into three groups. The blood flow volume, blood flow velocity and caliper of the blood vessel were evaluated before laser application and after twelve sessions using duplex Doppler ultrasound. Methods: Combined He-Ne and infrared LILT was administered three times a week for twelve sessions at intensity of 3 J, power 500 mW, 808 nm duration 15 min and pulse frequency 200 Hz for group I, 2000 Hz for group II, and sham LILT for group III on the sural artery at posterior aspect of dominant leg. Result: Paired t-test revealed that low pulse frequency (200 Hz LILT produced significant improvement in blood flow volume and blood flow velocity (t= 1.76, p= 0.001 and t= 2.8, p= 0.01 respectively (P<0.05. While there was no significant changes in caliper of the blood vessel of group I, blood flow volume, blood flow velocity or caliper of the blood vessel of group II and group III (t= 2.15, p= 1, t= 2.15, p= 1, t= 1.11 p= 0.31, t= 1.54, p= 0.15, t= 2.51, p= 1, t= 1.21 p= 0.33, t= 1.45, p= 0.15 respectively (P<0.05. ANOVA test in between groups revealed insignificant changes in all pre and post- measures except significant results in blood flow volume and velocity which indicating the superiority of group I on both group II and III by post hoc test. Conclusion: low pulse frequency of LILT (200 Hz could improve blood flow than high pulse frequency (2000 Hz.

  13. Fractional flow reserve guided percutaneous coronary intervention results in reduced ischemic myocardium and improved outcomes.

    Science.gov (United States)

    Sawant, Abhishek C; Bhardwaj, Aishwarya; Banerjee, Kinjal; Jobanputra, Yash; Kumar, Arnav; Parikh, Parth; Kandregula, Krishna C; Poddar, Kanhaiya; Ellis, Stephen G; Nair, Ravi; Corbelli, John; Kapadia, Samir

    2018-02-06

    To determine if fractional flow reserve guided percutaneous coronary intervention (FFR-guided PCI) is associated with reduced ischemic myocardium compared with angiography-guided PCI. Although FFR-guided PCI has been shown to improve outcomes, it remains unclear if it reduces the extent of ischemic myocardium at risk compared with angiography-guided PCI. We evaluated 380 patients (190 FFR-guided PCI cases and 190 propensity-matched controls) who underwent PCI from 2009 to 2014. Clinical, laboratory, angiographic, stress testing, and major adverse cardiac events [MACE] (all-cause mortality, recurrence of MI requiring PCI, stroke) data were collected. Mean age was 63 ± 11 years; the majority of patients were males (76%) and Caucasian (77%). Median duration of follow up was 3.4 [Range: 1.9, 5.0] years. Procedural complications including coronary dissection (2% vs. 0%, P = .12) and perforation (0% vs. 0%, P = 1.00) were similar between FFR-guided and angiography-guided PCI patients. FFR-guided PCI patients had lower unadjusted (14.7% vs. 23.2%, P = .04) and adjusted [OR = 0.58 (95% CI: 0.34-0.98)] risk of repeat revascularization at one year. FFR-guided PCI patients were less likely (23% vs. 32%, P = .02) to have ischemia and had lower (5.9% vs. 21.1%, P guided PCI, FFR-guided PCI results in less repeat revascularization and a lower incidence of post PCI ischemia translating into improved survival, without an increase in complications. © 2018 Wiley Periodicals, Inc.

  14. Luteal blood flow in patients undergoing GnRH agonist long protocol

    Directory of Open Access Journals (Sweden)

    Takasaki Akihisa

    2011-01-01

    Full Text Available Abstract Background Blood flow in the corpus luteum (CL is closely related to luteal function. It is unclear how luteal blood flow is regulated. Standardized ovarian-stimulation protocol with a gonadotropin-releasing hormone agonist (GnRHa long protocol causes luteal phase defect because it drastically suppresses serum LH levels. Examining luteal blood flow in the patient undergoing GnRHa long protocol may be useful to know whether luteal blood flow is regulated by LH. Methods Twenty-four infertile women undergoing GnRHa long protocol were divided into 3 groups dependent on luteal supports; 9 women were given ethinylestradiol plus norgestrel (Planovar orally throughout the luteal phase (control group; 8 women were given HCG 2,000 IU on days 2 and 4 day after ovulation induction in addition to Planovar (HCG group; 7 women were given vitamin E (600 mg/day orally throughout the luteal phase in addition to Planovar (vitamin E group. Blood flow impedance was measured in each CL during the mid-luteal phase by transvaginal color-pulsed-Doppler-ultrasonography and was expressed as a CL-resistance index (CL-RI. Results Serum LH levels were remarkably suppressed in all the groups. CL-RI in the control group was more than the cutoff value (0.51, and only 2 out of 9 women had CL-RI values Conclusion Patients undergoing GnRHa long protocol had high luteal blood flow impedance with very low serum LH levels. HCG administration improved luteal blood flow impedance. This suggests that luteal blood flow is regulated by LH.

  15. An improved mechanistic critical heat flux model for subcooled flow boiling

    Energy Technology Data Exchange (ETDEWEB)

    Kwon, Young Min [Korea Atomic Energy Research Institute, Taejon (Korea, Republic of); Chang, Soon Heung [Korea Advanced Institute of Science and Technology, Taejon (Korea, Republic of)

    1997-12-31

    Based on the bubble coalescence adjacent to the heated wall as a flow structure for CHF condition, Chang and Lee developed a mechanistic critical heat flux (CHF) model for subcooled flow boiling. In this paper, improvements of Chang-Lee model are implemented with more solid theoretical bases for subcooled and low-quality flow boiling in tubes. Nedderman-Shearer`s equations for the skin friction factor and universal velocity profile models are employed. Slip effect of movable bubbly layer is implemented to improve the predictability of low mass flow. Also, mechanistic subcooled flow boiling model is used to predict the flow quality and void fraction. The performance of the present model is verified using the KAIST CHF database of water in uniformly heated tubes. It is found that the present model can give a satisfactory agreement with experimental data within less than 9% RMS error. 9 refs., 5 figs. (Author)

  16. An improved mechanistic critical heat flux model for subcooled flow boiling

    Energy Technology Data Exchange (ETDEWEB)

    Kwon, Young Min [Korea Atomic Energy Research Institute, Taejon (Korea, Republic of); Chang, Soon Heung [Korea Advanced Institute of Science and Technology, Taejon (Korea, Republic of)

    1998-12-31

    Based on the bubble coalescence adjacent to the heated wall as a flow structure for CHF condition, Chang and Lee developed a mechanistic critical heat flux (CHF) model for subcooled flow boiling. In this paper, improvements of Chang-Lee model are implemented with more solid theoretical bases for subcooled and low-quality flow boiling in tubes. Nedderman-Shearer`s equations for the skin friction factor and universal velocity profile models are employed. Slip effect of movable bubbly layer is implemented to improve the predictability of low mass flow. Also, mechanistic subcooled flow boiling model is used to predict the flow quality and void fraction. The performance of the present model is verified using the KAIST CHF database of water in uniformly heated tubes. It is found that the present model can give a satisfactory agreement with experimental data within less than 9% RMS error. 9 refs., 5 figs. (Author)

  17. Doppler Flow Wire Evaluation of Renal Blood Flow Reserve in Hypertensive Patients with Normal Renal Arteries

    International Nuclear Information System (INIS)

    Beregi, Jean-Paul; Mounier-Vehier, Claire; Devos, Patrick; Gautier, Corinne; Libersa, Christian; McFadden, Eugene P.; Carre, Alain

    2000-01-01

    Purpose: To study the vasomotor responses of the renal microcirculation in patients with essential hypertension.Methods: We studied the reactivity of the renal microcirculation to papaverine, with intraarterial Doppler and quantitative arteriography, in 34 renal arteries of 19 hypertensive patients without significant renal artery stenosis. Isosorbide dinitrate was given to maximally dilate proximal renal arteries. APV (average peak blood flow velocity) was used as an index of renal blood flow.Results: Kidneys could be divided into two distinct subgroups based on their response to papaverine. An increase in APV of up to 55% occurred in 21 kidneys, an increase > 55% in 13 kidneys. Within each group the values were normally distributed. Both baseline APV and the effect of papaverine on mean velocity differed significantly between groups.Conclusion: There seems to be a subgroup of patients with essential hypertension that has an impaired reactivity to papaverine, consistent with a functional impairment of the renal microcirculation. Further studies are required to determine whether this abnormality contributes to or results from elevated blood pressure

  18. Improving patient experience in a pediatric ambulatory clinic: a mixed method appraisal of service delivery

    Directory of Open Access Journals (Sweden)

    Soeteman M

    2015-03-01

    Full Text Available Marijn Soeteman,1 Vera Peters,2 Jamiu O Busari1,3 1Department of Pediatrics, Atrium Medical Center, Heerlen, 2Faculty of Health, Medicine and Life Sciences, 3Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, University of Maastricht, Maastricht, the Netherlands Objective: In 2013, customer satisfaction surveys showed that patients were unhappy with the services provided at our ambulatory clinic. In response, we performed an appraisal of our services, which resulted in the development of a strategy to reduce waiting time and improve quality of service. Infrastructural changes to our clinic’s waiting room, consultation rooms, and back offices were performed, and schedules were redesigned to reduce wait time to 10 minutes and increase consultation time to 20 minutes. Our objective was to identify if this would improve 1 accessibility to caregivers and 2 quality of service and available amenities. Design: We conducted a multi-method survey using 1 a patient flow analysis to analyze the flow of service and understand the impact of our interventions on patient flow and 2 specially designed questionnaires to investigate patients’ perceptions of our wait time and how to improve our services. Results: The results showed that 79% of our respondents were called in to see a doctor within 20 minutes upon arrival. More patients (55% felt that 10–20 minutes was an acceptable wait time. We also observed a perceived increase in satisfaction with wait time (94%. Finally, a large number of patients (97% were satisfied with the quality of service and with the accessibility to caregivers (94%. Conclusion: The majority of our patients were satisfied with the accessibility to our ambulatory clinics and with the quality of services provided. The appraisal of our operational processes using a patient flow analysis also demonstrated how this strategy could effectively be applied to investigate and improve quality of

  19. Improved coupling of the conduction and flow equations in TRAC

    International Nuclear Information System (INIS)

    Addessio, F.L.

    1981-01-01

    Recent nuclear-reactor-systems modeling efforts have been directed toward the development of computer codes capable of simulating transients in short computational times. For this reason, a stability enhancing two-stem method (SETS) has been applied to the two-phase flow equations in the Transient Reactor Analysis Code (TRAC) allowing the Courant limit to be violated. Unfortunately, the coupling between the wall conduction equation and the fluid-dynamics equations is performed semi-implicitly, that is, the wall-heat transfer term, is evaluated using old-time heat-transfer coefficients and wall temperatures and new-time coolant temperatures. This coupling may lead to numerical instabilities at large time steps because of large variations in the heat-transfer coefficient in certain regimes of the boiling curve. Consequently, simply using new-time wall temperatures is not sufficient. A technique that also incorporates new-time heat-transfer coefficients must be used

  20. Kidney Rehabilitation Technology by Improving Blood Flow and Nerve Activation

    International Nuclear Information System (INIS)

    Mohd Jamil Hashim

    2016-01-01

    The rehabilitation of kidney is impossible from doctors point of view. Kidney failure happens when nephron in kidney fail to filter blood and water. Two major causes of kidney failure. First is the shrinkage of kidney and the second is the blockage of kidney medulla. Kidney shrinkage is because nephron damage due to long term diabetes (Nephrology expert point of view). Whereas blockage of kidney is due to food consume which in turn build up deposit at the blood duct connecting to the medulla. Experiment specimen own body. The rehabilitation methodology is to build up your blood flow system and nerve activation. Result from the study is through analyzing blood components such as creatinine, hemoglobin, urea and potassium. Conclusion, creatinine value has lowered and kidney shrinkage has normalize to its original size. It is hopeful I regain my health 100 % when my GFR reading achieved below 100. (author)

  1. Patients with migraine with aura have increased flow mediated dilation

    Directory of Open Access Journals (Sweden)

    Altamura Claudia

    2010-03-01

    Full Text Available Abstract Background Endothelium-derived nitric oxide (NO mediates the arterial dilation following a flow increase (i.e. flow-mediated dilation, FMD, easily assessed in the brachial artery. NO is also involved in cerebral hemodynamics and it is supposed to trigger vascular changes occurring during migraine. This study aimed at investigating whether migraine patients present an altered response to NO also in the peripheral artery system. Methods We enrolled 21 migraineurs (10 with aura [MwA], 11 without aura [MwoA], and 13 controls. FMD was evaluated with ultrasound in all subjects by measuring the percentage increase of the brachial artery diameter induced by hyperaemia reactive to sustained cuff inflation around the arm above systolic pressure. FMD values were then normalized for shear stress. Results Normalized FMD values were higher in patients with MwA (28.5 10-2%.s than in controls (9.0 10-2%.s and patients with MwoA (13.7 10-2%.s (p Conclusions Migraineurs with aura present an excessive arterial response to hyperaemia, likely as an effect of an increased sensitivity to endothelium-derived nitric oxide. This phenomenon observed peripherally might reflect similar characteristics in the cerebral circulation.

  2. An Improved Ghost-cell Immersed Boundary Method for Compressible Inviscid Flow Simulations

    KAUST Repository

    Chi, Cheng

    2015-01-01

    This study presents an improved ghost-cell immersed boundary approach to represent a solid body in compressible flow simulations. In contrast to the commonly used approaches, in the present work ghost cells are mirrored through the boundary

  3. Improving the spatial representation of basin hydrology and flow processes in the SWAT model

    OpenAIRE

    Rathjens, Hendrik

    2014-01-01

    This dissertation aims at improving the spatial representation of basin hydrology and flow processes in the SWAT model. Die vorliegende Dissertation stellt die methodischen Grundlage zur räumlich differenzierten Modellierung mit dem Modell SWAT dar.

  4. An improved ghost-cell immersed boundary method for compressible flow simulations

    KAUST Repository

    Chi, Cheng; Lee, Bok Jik; Im, Hong G.

    2016-01-01

    This study presents an improved ghost-cell immersed boundary approach to represent a solid body in compressible flow simulations. In contrast to the commonly used approaches, in the present work ghost cells are mirrored through the boundary

  5. Intelligent transportation systems in improving traffic flow in tourism destinations

    OpenAIRE

    Mrnjavac, Edna; Marsanic, Robert

    2007-01-01

    The rapid growth and development of motorisation combined with relatively small investments made to improving transportation infrastructure in cities, as well as in tourism destinations, has led to serious problems in the unobstructed movement of vehicles in public traffic areas. Traffic congestion on roadways, in ferryboat ports and at state borders during the summer months and year-round lines of cars going to or returning from work are a regular presence in traffic in most urban and touris...

  6. Cerebral blood flow is reduced in patients with sepsis syndrome

    International Nuclear Information System (INIS)

    Bowton, D.L.; Bertels, N.H.; Prough, D.S.; Stump, D.A.

    1989-01-01

    The relationship between sepsis-induced CNS dysfunction and changes in brain blood flow remains unknown, and animal studies examining the influence of sepsis on cerebral blood flow (CBF) do not satisfactorily address that relationship. We measured CBF and cerebrovascular reactivity to CO 2 in nine patients with sepsis syndrome using the 133 Xe clearance technique. Mean CBF was 29.6 +/- 15.8 (SD) ml/100 g.min, significantly lower than the normal age-matched value in this laboratory of 44.9 +/- 6.2 ml/100 g.min (p less than .02). This depression did not correlate with changes in mean arterial pressure. Despite the reduction in CBF, the specific reactivity of the cerebral vasculature to changes in CO 2 was normal, 1.3 +/- 0.9 ml/100 g.min/mm Hg. Brain blood flow is reduced in septic humans; the contribution of this reduction to the metabolic and functional changes observed in sepsis requires further study

  7. Awake craniotomy: improving the patient's experience.

    Science.gov (United States)

    Potters, Jan-Willem; Klimek, Markus

    2015-10-01

    Awake craniotomy patients are exposed to various stressful stimuli while their attention and vigilance is important for the success of the surgery. We describe several recent findings on the perception of awake craniotomy patients and address nonpharmacological perioperative factors that enhance the experience of awake craniotomy patients. These factors could also be applicable to other surgical patients. Proper preoperative counseling gives higher patient satisfaction and should be individually tailored to the patient. Furthermore, there is a substantial proportion of patients who have significant pain or fear during an awake craniotomy procedure. There is a possibility that this could induce post-traumatic stress disorder or related symptoms. Preoperative preparation is of utmost importance in awake craniotomy patients, and a solid doctor-patient relationship is an important condition. Nonpharmacological intraoperative management should focus on reduction of fear and pain by adaptation of the environment and careful and well considered communication.

  8. Salivary flow and xerostomia in patients with type 2 diabetes.

    Science.gov (United States)

    Carramolino-Cuéllar, Esther; Lauritano, Dorina; Silvestre, Francisco-Javier; Carinci, Francesco; Lucchese, Alberta; Silvestre-Rangil, Javier

    2018-05-01

    Saliva is secreted by the major and minor salivary glands. There are a number of physiological factors that can reduce this secretion such as age, sex, body weight, number of teeth present in the mouth or time of day. This decrease may also be caused by the use of certain drugs, radiotherapy for head and neck cancer, chronic rheumatic diseases such as Sjögren's syndrome and other systemic disorders such as diabetes mellitus (DM). Objective of this study was to investigate the effect of type 2 DM on salivary secretion and its relation to the sensation of xerostomia. Forty-seven patients with type 2 DM and 46 healthy individuals, aged 40-80, participated in the study. Samples of saliva were collected, at rest and after stimulation, at baseline and after the administration of a meal. A questionnaire of 10 items was used to define the patients' sensations of xerostomia. For statistical analysis, the Mann-Whitney test was used to assess the difference in salivary flow between the two groups and the relationship between the response to each of the questions and salivary flow levels. The degree of the patients' sensation of xerostomia was analysed by the Fisher test. There was a significant decrease in total saliva levels at rest in patients with type 2 DM compared to the control group. The study group also experienced higher levels of dryness at night and on waking as well as a greater sensation of lingual burning compared to the control group. © 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  9. Transferring skills in quality collaboratives focused on improving patient logistics

    NARCIS (Netherlands)

    J.W.M. Weggelaar-Jansen (Anne Marie); J.D.H. van Wijngaarden (Jeroen)

    2018-01-01

    textabstractA quality improvement collaborative, often used by the Institute for Healthcare Improvement, is used to educate healthcare professionals and improve healthcare at the same time. Our research focused on quality improvement collaboratives aiming to improve patient logistics and tried to

  10. 4D-MR flow analysis in patients after repair for tetralogy of Fallot

    International Nuclear Information System (INIS)

    Geiger, J.; Markl, M.; Jung, B.; Langer, M.; Grohmann, J.; Stiller, B.; Arnold, R.

    2011-01-01

    Comprehensive analysis of haemodynamics by 3D flow visualisation and retrospective flow quantification in patients after repair of tetralogy of Fallot (TOF). Time-resolved flow-sensitive 4D MRI (spatial resolution ∝ 2.5 mm, temporal resolution = 38.4 ms) was acquired in ten patients after repair of TOF and in four healthy controls. Data analysis included the evaluation of haemodynamics in the aorta, the pulmonary trunk (TP) and left (lPA) and right (rPA) pulmonary arteries by 3D blood flow visualisation using particle traces, and quantitative measurements of flow velocity. 3D visualisation of whole heart haemodynamics provided a comprehensive overview on flow pattern changes in TOF patients, mainly alterations in flow velocity, retrograde flow and pathological vortices. There was consistently higher blood flow in the rPA of the patients (rPA/lPA flow ratio: 2.6 ± 2.5 vs. 1.1 ± 0.1 in controls). Systolic peak velocity in the TP was higher in patients (1.9 m/s ± 0.7 m/s) than controls (0.9 m/s ± 0.1 m/s). 4D flow-sensitive MRI permits the comprehensive evaluation of blood flow characteristics in patients after repair of TOF. Altered flow patterns for different surgical techniques in the small patient cohort may indicate its value for patient monitoring and potentially identifying optimal surgical strategies. (orig.)

  11. 4D-MR flow analysis in patients after repair for tetralogy of Fallot

    Energy Technology Data Exchange (ETDEWEB)

    Geiger, J.; Markl, M.; Jung, B.; Langer, M. [University Hospital Freiburg, Department of Radiology, Medical Physics, Freiburg (Germany); Grohmann, J.; Stiller, B.; Arnold, R. [University Hospital Freiburg, Department of Congenital Heart Disease and Pediatric Cardiology, Freiburg (Germany)

    2011-08-15

    Comprehensive analysis of haemodynamics by 3D flow visualisation and retrospective flow quantification in patients after repair of tetralogy of Fallot (TOF). Time-resolved flow-sensitive 4D MRI (spatial resolution {proportional_to} 2.5 mm, temporal resolution = 38.4 ms) was acquired in ten patients after repair of TOF and in four healthy controls. Data analysis included the evaluation of haemodynamics in the aorta, the pulmonary trunk (TP) and left (lPA) and right (rPA) pulmonary arteries by 3D blood flow visualisation using particle traces, and quantitative measurements of flow velocity. 3D visualisation of whole heart haemodynamics provided a comprehensive overview on flow pattern changes in TOF patients, mainly alterations in flow velocity, retrograde flow and pathological vortices. There was consistently higher blood flow in the rPA of the patients (rPA/lPA flow ratio: 2.6 {+-} 2.5 vs. 1.1 {+-} 0.1 in controls). Systolic peak velocity in the TP was higher in patients (1.9 m/s {+-} 0.7 m/s) than controls (0.9 m/s {+-} 0.1 m/s). 4D flow-sensitive MRI permits the comprehensive evaluation of blood flow characteristics in patients after repair of TOF. Altered flow patterns for different surgical techniques in the small patient cohort may indicate its value for patient monitoring and potentially identifying optimal surgical strategies. (orig.)

  12. High Flow Nasal Cannula Therapy for Improving Obstructive Sleep Apnea: A Case Report

    Directory of Open Access Journals (Sweden)

    Se Joong Kim

    2015-06-01

    Full Text Available Although continuous positive airway pressure is the treatment of choice for obstructive sleep apnea, its compliance is low. Therefore, alternative therapeutic strategies are often required. High flow nasal cannula therapy uses an air compressor to deliver a constant flow of oxygen via the nasal cannula at a maximum of 60 L/m. It can produce positive end expiratory pressure and increase end expiratory pharyngeal pressure, which can help to alleviate upper airway obstruction. This is a case report of high flow nasal cannula therapy for a 71 year-old man. He had an obstructive sleep apnea and severe desaturation but failed to use continuous positive airway pressure. He underwent titration with high flow nasal cannula under polysomnography. Using high flow nasal cannula at an airflow of 45 L/m, his apnea-hypopnea, respiratory arousal and oxygen desaturation were improved. Importantly, he is very compliant with high flow nasal cannula therapy.

  13. Regional cerebral blood flow in older patients with chronic subdural hematoma

    International Nuclear Information System (INIS)

    Hoshi, Yutaka; Fuse, Masaaki; Iio, Masahiro; Fuziwara, Keigo; Kawaguchi, Shinichiro

    1978-01-01

    Regional cerebral blood flow (rCBF) was measured in 4 regions (frontal, parietal, occipital, and temporal) over the entire hemisphere using modified 133 Xe clearance method in 5 patients with chronic subdural hematoma. In 5 patients, rCBF was measured both pre- and postoperation and those values were compared. CBF (average cerebral blood flow) measurements were compared. CBF measurements were carried out in each patients respectively, that is before the operation and 3 weeks after the operation. Before the operation, the presence of chronic subdural hematoma, but brought about only slight or moderate generalized decrease in rCBF. The older patients presented subnormal values of 31.5 - 45.1 ml/100 g/min. Mean f sub(g) (the flow in the grey matter) of 5 patients was 66.8 +- 5.0 ml/100 g/min on the hematoma site, 58.1 +- 2.8 ml/100 g/min on the non-hematoma site before operation. Three weeks after operation mean f sub(g) was 65.5 +- 7.6 ml/100 g/min on the non-hematoma site, 64.2 +- 3.5 ml/100 g/min on the hematoma site, and CBFr of non-hematoma site was 40.2 +- 5.7 ml/100 g/min and that of hematoma site, 38.5 +- 8.8 ml/100 g/min. These figures are moderately smaller than that of the normal values. A comparison between regional flow values noted in patients of pre- and post-operation who has a removal of hematomas indicated that the flow values of non-hematoma site increased slightly 3 weeks after operation, inspite of the only slight or no improvement in neurological features. But the flow values (f sub(g), CBFr) of hematoma site decreased 3 weeks after operation. It seems that post-operative follow up of mean cerebral blood flow change might be of help in the assessment of prognosis of operation. (auth.)

  14. Regional cerebral blood flow in older patients with chronic subdural hematoma

    Energy Technology Data Exchange (ETDEWEB)

    Hoshi, Y; Fuse, M; Iio, M; Fuziwara, K; Kawaguchi, S [Tokyo Metropolitan Geriatric Medical Center (Japan)

    1978-02-01

    Regional cerebral blood flow (rCBF) was measured in 4 regions (frontal, parietal, occipital, and temporal) over the entire hemisphere using modified /sup 133/Xe clearance method in 5 patients with chronic subdural hematoma. In 5 patients, rCBF was measured both pre- and postoperation and those values were compared. CBF (average cerebral blood flow) measurements were compared. CBF measurements were carried out in each patients respectively, that is before the operation and 3 weeks after the operation. Before the operation, the presence of chronic subdural hematoma, but brought about only slight or moderate generalized decrease in rCBF. The older patients presented subnormal values of 31.5 - 45.1 ml/100 g/min. Mean f sub(g) (the flow in the grey matter) of 5 patients was 66.8 +- 5.0 ml/100 g/min on the hematoma site, 58.1 +- 2.8 ml/100 g/min on the non-hematoma site before operation. Three weeks after operation mean f sub(g) was 65.5 +- 7.6 ml/100 g/min on the non-hematoma site, 64.2 +- 3.5 ml/100 g/min on the hematoma site, and CBFr of non-hematoma site was 40.2 +- 5.7 ml/100 g/min and that of hematoma site, 38.5 +- 8.8 ml/100 g/min. These figures are moderately smaller than that of the normal values. A comparison between regional flow values noted in patients of pre- and post-operation who has a removal of hematomas indicated that the flow values of non-hematoma site increased slightly 3 weeks after operation, inspite of the only slight or no improvement in neurological features. But the flow values (f sub(g), CBFr) of hematoma site decreased 3 weeks after operation. It seems that post-operative follow up of mean cerebral blood flow change might be of help in the assessment of prognosis of operation.

  15. Implementation of hospital-wide reform at improving access and flow: Impact on time to antibiotics in the emergency department.

    Science.gov (United States)

    Roman, Cristina P; Poole, Susan G; Dooley, Michael J; Smit, De Villiers; Mitra, Biswadev

    2016-04-01

    ED overcrowding has been associated with increased mortality, morbidity and delays to essential treatment. It was hypothesised that hospital-wide reforms designed to improve patient access and flow, in addition to improving ED overcrowding, would impact on clinically important processes within the ED, such as timely delivery of antibiotics. A single pre-implementation and post-implementation prospective cohort study was conducted prior to and after a hospital-wide reform (Timely Quality Care (TQC)). Among patients who had intravenous antibiotics prescribed in the ED, data were prospectively collected on times of presentation, prescription and administration of antibiotics. Demographics and discharge diagnoses were retrospectively extracted. There were 380 cases included with 179 cases prior to introduction of the TQC model and 201 cases after its introduction. Time from presentation to administration of antibiotics improved significantly from 192 (99-320) min to 142 (81-209) min (P antibiotics were significantly reduced. These findings suggest that improved quality of care in this area may be achieved with processes aimed at improved hospital access and flow. Ongoing evaluation and vigilance is necessary to ensure sustainability and drive further improvements. © 2015 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

  16. An improved ghost-cell immersed boundary method for compressible flow simulations

    KAUST Repository

    Chi, Cheng

    2016-05-20

    This study presents an improved ghost-cell immersed boundary approach to represent a solid body in compressible flow simulations. In contrast to the commonly used approaches, in the present work ghost cells are mirrored through the boundary described using a level-set method to farther image points, incorporating a higher-order extra/interpolation scheme for the ghost cell values. A sensor is introduced to deal with image points near the discontinuities in the flow field. Adaptive mesh refinement (AMR) is used to improve the representation of the geometry efficiently in the Cartesian grid system. The improved ghost-cell method is validated against four test cases: (a) double Mach reflections on a ramp, (b) smooth Prandtl-Meyer expansion flows, (c) supersonic flows in a wind tunnel with a forward-facing step, and (d) supersonic flows over a circular cylinder. It is demonstrated that the improved ghost-cell method can reach the accuracy of second order in L1 norm and higher than first order in L∞ norm. Direct comparisons against the cut-cell method demonstrate that the improved ghost-cell method is almost equally accurate with better efficiency for boundary representation in high-fidelity compressible flow simulations. Copyright © 2016 John Wiley & Sons, Ltd.

  17. Guiding Inspiratory Flow: Development of the In-Check DIAL G16, a Tool for Improving Inhaler Technique

    Directory of Open Access Journals (Sweden)

    Mark Jeremy Sanders

    2017-01-01

    Full Text Available Portable inhalers are divisible into those that deliver medication by patient triggering (pMDIs: a gentle slow inhalation and those that use the patient’s inspiratory effort as the force for deaggregation and delivery (DPIs: a stronger deeper inspiratory effort. Patient confusion and poor technique are commonplace. The use of training tools has become standard practice, and unique amongst these is an inspiratory flow meter (In-Check which is able to simulate the resistance characteristics of different inhalers and, thereby, guide the patient to the correct effort. In-Check’s origins lie in the 1960s peak expiratory flow meters, the development of the Mini-Wright peak flow meter, and inspiratory flow assessment via the nose during the 1970s–1980s. The current device (In-Check DIAL G16 is the third iteration of the original 1998 training tool, with detailed and ongoing assessments of all common inhaler resistances (including combination and breath-actuated inhaler types summarised into resistance ranges that are preset within the device. The device works by interpolating one of six ranges with the inspiratory effort. Use of the tool has been shown to be contributory to significant improvements in asthma care and control, and it is being advocated for assessment and training in irreversible lung disease.

  18. Sub-piexl methods for improving vector quality in echo PIV flow, imaging technology.

    Science.gov (United States)

    Niu, Lili; Wang, Jing; Qian, Ming; Zheng, Hairong

    2009-01-01

    Developments of many cardiovascular problems have been shown to have a close relationship with arterial flow conditions. An ultrasound-based particle image velocimetry technique(Echo PIV) was recently developed to measure multi-component velocity vectors and local shear rates in arteries and opaque fluid flows by identifying and tracking flow tracers (ultrasound contrast microbubbles) within these flow fields. To improve the measurement accuracy, sub-pixel calculation method was adopted in this paper to maximize the ultrasound RF signal and B mode image correlation accuracy and increase the image spatial resolution. This algorithm is employed in processing both computer-generated particle image patterns and the B-mode images of microbubbles in rotating flows obtained by a high frame rate (up to 1000 frames per second) ultrasound imaging system. The results show the correlation of particle patterns and individual flow vector quality are improved and the overall flow mappings are also improved significantly. This would help the Echo PIV system to provide better multi-component velocity accuracy.

  19. Ultrasonic particle image velocimetry for improved flow gradient imaging: algorithms, methodology and validation

    International Nuclear Information System (INIS)

    Niu Lili; Qian Ming; Yu Wentao; Jin Qiaofeng; Ling Tao; Zheng Hairong; Wan Kun; Gao Shen

    2010-01-01

    This paper presents a new algorithm for ultrasonic particle image velocimetry (Echo PIV) for improving the flow velocity measurement accuracy and efficiency in regions with high velocity gradients. The conventional Echo PIV algorithm has been modified by incorporating a multiple iterative algorithm, sub-pixel method, filter and interpolation method, and spurious vector elimination algorithm. The new algorithms' performance is assessed by analyzing simulated images with known displacements, and ultrasonic B-mode images of in vitro laminar pipe flow, rotational flow and in vivo rat carotid arterial flow. Results of the simulated images show that the new algorithm produces much smaller bias from the known displacements. For laminar flow, the new algorithm results in 1.1% deviation from the analytically derived value, and 8.8% for the conventional algorithm. The vector quality evaluation for the rotational flow imaging shows that the new algorithm produces better velocity vectors. For in vivo rat carotid arterial flow imaging, the results from the new algorithm deviate 6.6% from the Doppler-measured peak velocities averagely compared to 15% of that from the conventional algorithm. The new Echo PIV algorithm is able to effectively improve the measurement accuracy in imaging flow fields with high velocity gradients.

  20. Regional cerebral blood flow in patients with hypertensive intracerebral hemorrhage

    International Nuclear Information System (INIS)

    Kuroda, Kiyoshi

    1982-01-01

    Regional cerebral blood flow (rCBF) was measured in 36 patients with hypertensive intracerebral hemorrhage (putaminal hemorrhage) treated surgically, using the Xenon-133 intracarotid injection method. The correlations between CBF in four regions, (the hemisphere, the frontal region, the sensori-motor area and the focal area) and the duration from the operation, the conscious level, the hematoma volume and motor function were investigated. Mean cerebral blood flow (MCBF), rCBF in sensori-motor area and in the focal area showed a value below 30 ml/100g/min. for any duration after the operation within one year. However, in the frontal region rCBF tends to increase from 4 months after the operation. There was a close correlation between the conscious level and CBF, especially in the frontal region. The higher CBF was noted in the better consciousness group. In hematoma cases the larger the hematoma volume (especially those over 31 ml)the lower the CBF in all three regions. In the focal area rCBF showed the lowest value among these three regions and was dependent on the hematoma volume, while frontal region revealed the highest flow value of them all, even in cases with a hematoma volume over 81 ml. There was a significant difference in rCBF between cases with severe motor disturbance and cases with moderate motor disturbance, except in the focal area. In the frontal region rCBF coincides rather well to the degree of motor disturbance. While, rCBF in the focal area was less than 30 ml/100g/min., and showed no correlation to motor function. (J.P.N.)

  1. Regional cerebral blood flow abnormalities in patients with primary hyperparathyroidism

    International Nuclear Information System (INIS)

    Cermik, Tevfik F.; Kaya, Meryem; Bedel, Deniz; Berkarda, Sakir; Yigitbasi, Oemer N.; Ugur-Altun, Betuel

    2007-01-01

    We assessed the alterations in regional cerebral blood flow (rCBF) in patients with primary hyperparathyroidism (PHP) before parathyroidectomy by semiquantitative analysis of brain single photon emission computed tomography (SPECT) images. Included in this prospective study were 14 patients (mean age 47.6 ± 10.4 years; 3 male, 11 female) and 10 control subjects (mean age 36.0 ± 8.5 years, 6 male, 4 female) were SPECT imaging was performed using a dual-headed gamma camera 60-90 min after intravenous administration of 925 MBq Tc-99m HMPAO. The corticocerebellar rCBF ratios were calculated from 52 brain areas and reference lower values (RLVs) were calculated from the rCBF ratios of control subjects. The regional ratios that were below the corresponding RLV were considered abnormal (hypoperfused). Hypoperfusion was shown in 171 out of 728 regions (23%) and there was a significant correlation between serum calcium, PTH levels and the sum of hypoperfused regions in the patient group (R = 0.75 and P = 0.001, and R = 0.75, P = 0.001, respectively). Significantly reduced rCBF were found in the following cortical regions: bilateral cingulate cortex, superior and inferior frontal cortex, anterior temporal cortex, precentral gyrus, postcentral gyrus and parietal cortex, and right posterior temporal cortex. Our results indicate that alterations in rCBF in patients with PHP can be demonstrated with brain SPECT. The correlation between serum calcium, PTH levels and the sum of hypoperfused regions indicates that there may be a strong relationship between rCBF abnormalities and increased levels of serum calcium and PTH. In addition, the degree of rCBF abnormalities could be determined by brain SPECT in PHP patients with or without psychiatric symptoms. (orig.)

  2. Regional cerebral blood flow abnormalities in patients with primary hyperparathyroidism

    Energy Technology Data Exchange (ETDEWEB)

    Cermik, Tevfik F. [Hospital of the University of Trakya, Department of Nuclear Medicine, Edirne (Turkey); Trakya Universitesi Hastanesi, Nukleer Tip Anabilim Dali, Gullapoglu Yerleskesi, Edirne (Turkey); Kaya, Meryem; Bedel, Deniz; Berkarda, Sakir; Yigitbasi, Oemer N. [Hospital of the University of Trakya, Department of Nuclear Medicine, Edirne (Turkey); Ugur-Altun, Betuel [Hospital of the University of Trakya, Department of Internal Medicine, Division of Endocrinology, Edirne (Turkey)

    2007-04-15

    We assessed the alterations in regional cerebral blood flow (rCBF) in patients with primary hyperparathyroidism (PHP) before parathyroidectomy by semiquantitative analysis of brain single photon emission computed tomography (SPECT) images. Included in this prospective study were 14 patients (mean age 47.6 {+-} 10.4 years; 3 male, 11 female) and 10 control subjects (mean age 36.0 {+-} 8.5 years, 6 male, 4 female) were SPECT imaging was performed using a dual-headed gamma camera 60-90 min after intravenous administration of 925 MBq Tc-99m HMPAO. The corticocerebellar rCBF ratios were calculated from 52 brain areas and reference lower values (RLVs) were calculated from the rCBF ratios of control subjects. The regional ratios that were below the corresponding RLV were considered abnormal (hypoperfused). Hypoperfusion was shown in 171 out of 728 regions (23%) and there was a significant correlation between serum calcium, PTH levels and the sum of hypoperfused regions in the patient group (R = 0.75 and P = 0.001, and R = 0.75, P = 0.001, respectively). Significantly reduced rCBF were found in the following cortical regions: bilateral cingulate cortex, superior and inferior frontal cortex, anterior temporal cortex, precentral gyrus, postcentral gyrus and parietal cortex, and right posterior temporal cortex. Our results indicate that alterations in rCBF in patients with PHP can be demonstrated with brain SPECT. The correlation between serum calcium, PTH levels and the sum of hypoperfused regions indicates that there may be a strong relationship between rCBF abnormalities and increased levels of serum calcium and PTH. In addition, the degree of rCBF abnormalities could be determined by brain SPECT in PHP patients with or without psychiatric symptoms. (orig.)

  3. Improving Patient Safety With the Military Electronic Health Record

    National Research Council Canada - National Science Library

    Charles, Marie-Jocelyne; Harmon, Bart J; Jordan, Pamela S

    2005-01-01

    The United States Department of Defense (DoD) has transformed health care delivery in its use of information technology to automate patient data documentation, leading to improvements in patient safety...

  4. Beyond consent--improving understanding in surgical patients.

    LENUS (Irish Health Repository)

    Mulsow, Jürgen J W

    2012-01-01

    Little is known of the actual understanding that underlies patient choices with regard to their surgical treatment. This review explores current knowledge of patient understanding and techniques that may be used to improve this understanding.

  5. Cerebral blood flow in patients with hypertensive intracerebral hemorrhage

    International Nuclear Information System (INIS)

    Sugiyama, Hirotaka

    1984-01-01

    Cerebral blood flow (CBF) is usually decreased in patients with hypertensive intracerebral hemorrhage. A total of 81 regional CBF measurements were performed using an Anger-type dynamic gamma camera with the Xe-133 intracarotid injection technique in 23 patients with thalamic hemorrhage, 18 with small putaminal hemorrhage, and 5 with large putaminal hemorrhage. The results were as follows: Bilateral CBF in thalamic hemorrhages was markedly reduced from 1 week to 2 or 3 weeks after onset; it then showed a tendency to increase from 4 weeks to 3 months. In putaminal hemorrhages, however, CBF in the affected hemisphere did not tend to increase despite increased CBF in the contralateral hemisphere. CBF of the affected hemisphere was plotted against the hematoma volume, and the biphasic curve showed an initial steep and subsequent gentle slope in both putaminal and thalamic hemorrhages. The degree of CBF reduction in the affected hemisphere was more evident in thalamic than in putaminal hemorrhages. However, the flow reduction in the contralateral hemisphere was more obvious in thalamic than in putaminal hemorrhages. Factors such as mean arterial blood pressure, partial pressure of arterial carbon dioxide, cerebrospinal fluid pressure, hematocrit and the degree of involvement of the internal capsule, as shown on CT scan were not directly related to CBF reduction. In conclusion, it is unlikely that the mass effect of the hematoma plays an important role in the discrepancy between CBF reduction in putaminal and thalamic hemorrhages. Rather, the discrepancy may result from the impairment of respective anatomical sites in the thalamic and putaminal regions. It is also suggested that ipsilateral as well as contralateral CBF reduction is probably caused by the decreased cortical metabolic demand. This may be based on the disruption of the transneural fiber pathways, which connect both the thalamus and putamen to the cerebral cortex. (author)

  6. Introduction of a Surgical Navigator in the Perioperative Process Improves Patient Satisfaction

    Directory of Open Access Journals (Sweden)

    Brett G Marshall

    2017-03-01

    Full Text Available Background: Patients who had received surgical services at Bellin Hospital reported anxiety with the surgical flow. This study tested the hypothesis that the introduction of a surgical navigator, someone who guided the patient and their accompanying others throughout the surgical process, would improve patient satisfaction. Methods: Ambulatory surgical patients were randomized to control and study groups. The study group patients were assigned a surgical navigator. Prior to discharge from the hospital, patients were asked to complete a patient satisfaction survey. Results: The study group had significantly higher mean scores (P value ≤ 0.026, top box scores (P value ≤ 0.021, and positive comments. Conclusion: The addition of a surgical navigator to the perioperative process significantly enhanced patient satisfaction in ambulatory surgical patients.

  7. Improved oxygen-activation method for determining water flow behind casing

    International Nuclear Information System (INIS)

    McKeon, D.C.; Scott, H.D.; Olesen, J.R.; Patton, G.L.; Mitchell, R.J.

    1991-01-01

    This paper reports on impulse activation which is a new oxygen-activation technique developed to detect vertical water flow and to provide a quantitative measure of water flow velocity and flow rate. Flow-loop measurements made over a wide range of water velocities are in good agreement with theoretical predictions. Measurements of up- and downward channel flow were made at the U.S. Environmental Protection Agency (EPA) leak test well in Ada, OK, to demonstrate the technique in a controlled environment and to confirm that EPA requirements have been met. A major advantage of this method over previous procedures is that a measurement is a known zero-flow zone is not required. The impulse-activation technique has improved sensitivity to both low and high flow rates. In the EPA leak test well, the technique successfully discriminated between 0- and 1.4 ft/min flow conditions. The lowest quantified velocity was 1.8 ft/min or 10 BWPD, significantly below the EPA requirement of 3 ft/min. The upper limit of detection has not been determined by exceeds 137 ft/min. The water flow log (WFL SM ) measurement uses the impulse-activation technique and a Dual-Bust SM , thermal-decay-time (TDT SM ) tool to detect water flow behind casing. An important application of this measurement is testing for fluid migration in the wellbore as part of the mechanical integrity testing process for Class I and II disposal wells. The new oxygen-activation measurement was used in numerous production wells to identify the presence of water flow behind casing. Additional applications include the identification of open fractures in horizontal wells and the quantification of water flow in the tubing/casing annulus in injection and production wells

  8. Improvement of quantum efficiency in green light-emitting diodes with pre-TMIn flow treatment

    International Nuclear Information System (INIS)

    Lee, Ya-Ju; Chen, Yi-Ching; Lu, Tien-Chang

    2011-01-01

    The effects of pre-trimethlyindium (TMIn) flow on the improved electrical characteristics and highly stable temperature properties of InGaN green light-emitting diodes (LEDs) are discussed. For the LED sample with a pre-TMIn flow treatment, the tunnelling of injected carriers associated with threading defects is significantly reduced, which promotes the diffusion-recombination of injected carriers, as well as the overall emission efficiency of the LED. In addition, the pre-TMIn flow treatment evidently reduces the dependence of external quantum efficiency on temperature and efficiency droop of green LEDs. As a result, we conclude that the pre-TMIn flow treatment is a promising scheme for the improvement of output performance of InGaN-based green LEDs.

  9. Improved evaluation of the coronary collateral circulation measuring the regional blood flow with 133Xe

    International Nuclear Information System (INIS)

    Franz, N.; Strangfeld, D.; Romaniuk, P.; Heublein, B.

    1988-01-01

    In 40 patients with angina pectoris catheter diagnostic measurements of the myocardial flow were carried out after intracoronary application of 133 Xe at rest and after oral application of Curantyl in order to obtain a better evaluation of coronary collaterals. The results show relations between angiographically detected coronary collaterals and the reduced coronary reserve. A quantitative measurement of collaterals from the angiogram facilitates a more precise evaluation of the relation between coronary sclerosis and myocardial flow. (author)

  10. Increasing Throughput: Results from a 42-Hospital Collaborative to Improve Emergency Department Flow.

    Science.gov (United States)

    Zocchi, Mark S; McClelland, Mark S; Pines, Jesse M

    2015-12-01

    An 18-month collaborative in 42 hospitals across 16 communities in the United States to improve emergency department (ED) flow was conducted from October 2010 through March 2012. Hospitals were invited to participate through the Aligning Forces for Quality (AF4Q) program. Each participating hospital identified one or more interventions to improve ED flow and submitted data on four measures of ED flow: discharged length of stay (LOS), admitted LOS, boarding time, and left without being seen (LWBS) rates. Participating hospitals also provided quarterly progress reports on challenges encountered and lessons learned. Univariate linear regression was used to assess the effectiveness of interventions at the hospital level, where an improvement was defined as a negative slope in one or more of the throughput indicators. Challenges and lessons learned were tabulated and described. A total of 172 interventions were implemented across the 42 hospitals. Two thirds (n = 28) demonstrated improvement on at least one measure of ED flow. Among hospitals demonstrating improvement, the average reduction in discharged LOS was 26 minutes (95% confidence interval [CI] 11 to 41); admitted LOS, 36.5 minutes (95% CI 20 to 53), boarding time, 20.9 minutes (95% CI 12 to 30), and LWBS seen rates decreased by 1.4 absolute percentage points (95% CI 0.2 to 2.7). Teams were frequently challenged by issues related to leadership, staff buy-in, and resource constraints. The majority of hospitals in this collaborative improved on one or more ED flow measures. Many challenges were shared across hospitals, demonstrating that successful approaches to ED flow improvement require certain fundamental elements, including engaged leadership and staff, and sufficient resources.

  11. Improvement of Measurement Accuracy of Coolant Flow in a Test Loop

    Energy Technology Data Exchange (ETDEWEB)

    Hong, Jintae; Kim, Jong-Bum; Joung, Chang-Young; Ahn, Sung-Ho; Heo, Sung-Ho; Jang, Seoyun [Korea Atomic Energy Research Institute, Daejeon (Korea, Republic of)

    2015-10-15

    In this study, to improve the measurement accuracy of coolant flow in a coolant flow simulator, elimination of external noise are enhanced by adding ground pattern in the control panel and earth around signal cables. In addition, a heating unit is added to strengthen the fluctuation signal by heating the coolant because the source of signals are heat energy. Experimental results using the improved system shows good agreement with the reference flow rate. The measurement error is reduced dramatically compared with the previous measurement accuracy and it will help to analyze the performance of nuclear fuels. For further works, out of pile test will be carried out by fabricating a test rig mockup and inspect the feasibility of the developed system. To verify the performance of a newly developed nuclear fuel, irradiation test needs to be carried out in the research reactor and measure the irradiation behavior such as fuel temperature, fission gas release, neutron dose, coolant temperature, and coolant flow rate. In particular, the heat generation rate of nuclear fuels can be measured indirectly by measuring temperature variation of coolant which passes by the fuel rod and its flow rate. However, it is very difficult to measure the flow rate of coolant at the fuel rod owing to the narrow gap between components of the test rig. In nuclear fields, noise analysis using thermocouples in the test rig has been applied to measure the flow velocity of coolant which circulates through the test loop.

  12. Effects of exercise training on calf muscle oxygen extraction and blood flow in patients with peripheral artery disease.

    Science.gov (United States)

    Baker, Wesley B; Li, Zhe; Schenkel, Steven S; Chandra, Malavika; Busch, David R; Englund, Erin K; Schmitz, Kathryn H; Yodh, Arjun G; Floyd, Thomas F; Mohler, Emile R

    2017-12-01

    We employed near-infrared optical techniques, diffuse correlation spectroscopy (DCS), and frequency-domain near-infrared spectroscopy (FD-NIRS) to test the hypothesis that supervised exercise training increases skeletal muscle microvascular blood flow and oxygen extraction in patients with peripheral artery disease (PAD) who experience claudication. PAD patients ( n = 64) were randomly assigned to exercise and control groups. Patients in the exercise group received 3 mo of supervised exercise training. Calf muscle blood flow and oxygen extraction were optically monitored before, during, and after performance of a graded treadmill protocol at baseline and at 3 mo in both groups. Additionally, measurements of the ankle-brachial index (ABI) and peak walking time (PWT) to maximal claudication were made during each patient visit. Supervised exercise training was found to increase the maximal calf muscle blood flow and oxygen extraction levels during treadmill exercise by 29% (13%, 50%) and 8% (1%, 12%), respectively [ P group population were significantly higher than corresponding changes in the control group ( P training also increased PWT by 49% (18%, 101%) ( P = 0.01). However, within statistical error, the ABI, resting calf muscle blood flow and oxygen extraction, and the recovery half-time for hemoglobin\\myoglobin desaturation following cessation of maximal exercise were not altered by exercise training. The concurrent monitoring of both blood flow and oxygen extraction with the hybrid DCS/FD-NIRS instrument revealed enhanced muscle oxidative metabolism during physical activity from exercise training, which could be an underlying mechanism for the observed improvement in PWT. NEW & NOTEWORTHY We report on noninvasive optical measurements of skeletal muscle blood flow and oxygen extraction dynamics before/during/after treadmill exercise in peripheral artery disease patients who experience claudication. The measurements tracked the effects of a 3-mo supervised

  13. Five easy equations for patient flow through an emergency department.

    Science.gov (United States)

    Madsen, Thomas Lill; Kofoed-Enevoldsen, Allan

    2011-10-01

    Queue models are effective tools for framing management decisions and Danish hospitals could benefit from awareness of such models. Currently, as emergency departments (ED) are under reorganization, we deem it timely to empirically investigate the applicability of the standard "M/M/1" queue model in order to document its relevance. We compared actual versus theoretical distributions of hourly patient flow from 27,000 patient cases seen at Frederiksberg Hospital's ED. Formulating equations for arrivals and capacity, we wrote and tested a five equation simulation model. The Poisson distribution fitted arrivals with an hour-of-the-day specific parameter. Treatment times exceeding 15 minutes were well-described by an exponential distribution. The ED can be modelled as a black box with an hourly capacity that can be estimated either as admissions per hour when the ED operates full hilt Poisson distribution or from the linear dependency of waiting times on queue number. The results show that our ED capacity is surprisingly constant despite variations in staffing. These findings led to the formulation of a model giving a compact framework for assessing the behaviour of the ED under different assumptions about opening hours, capacity and workload. The M/M/1 almost perfectly fits our. Thus modeling and simulations have contributed to the management process. not relevant. not relevant.

  14. Method and apparatus for improved melt flow during continuous strip casting

    Science.gov (United States)

    Follstaedt, Donald W.; King, Edward L.; Schneider, Ken C.

    1991-11-12

    The continuous casting of metal strip using the melt overflow process is improved by controlling the weir conditions in the nozzle to provide a more uniform flow of molten metal across the width of the nozzle and reducing the tendency for freezing of metal along the interface with refractory surfaces. A weir design having a sloped rear wall and tapered sidewalls and critical gap controls beneath the weir has resulted in the drastic reduction in edge tearing and a significant improvement in strip uniformity. The floor of the container vessel is preferably sloped and the gap between the nozzle and the rotating substrate is critically controlled. The resulting flow patterns observed with the improved casting process have reduced thermal gradients in the bath, contained surface slag and eliminated undesirable solidification near the discharge area by increasing the flow rates at those points.

  15. Sugammadex Improves Neuromuscular Function in Patients ...

    African Journals Online (AJOL)

    2018-02-23

    Feb 23, 2018 ... aminoglycosides), history of allergy to neuromuscular blocking agents, opioids or other drugs, and alcohol and drug dependence. Patients were divided into two ... titration microcalorimetry investigated the likelihood of the formation of complexes between sugammadex and other steroidal and nonsteroidal ...

  16. Optimizing resource allocation and patient flow: process analysis and reorganization in three chemotherapy outpatient clinics.

    Science.gov (United States)

    Holmes, Morgan; Bodie, Kelly; Porter, Geoffrey; Sullivan, Victoria; Tarasuk, Joy; Trembley, Jodie; Trudeau, Maureen

    2010-01-01

    Optimizing human and physical resources is a major concern for cancer care decision-makers and practitioners. This issue is particularly acute in the context of ambulatory out patient chemotherapy clinics, especially when - as is the case almost everywhere in the industrialized world - the number of people requiring systemic therapy is increasing while budgets, staffing and physical space remain static. Recent initiatives at three hospital-based chemotherapy units - in Halifax, Toronto and Kingston - shed light on the value of process analysis and reorganization for using existing human and physical resources to their full potential, improving patient flow and enhancing patient satisfaction. The steps taken in these settings are broadly applicable to other healthcare settings and would likely result in similar benefits in those environments.

  17. Coronary flow reserve in patients with diabetes mellitus and prediabetes.

    Science.gov (United States)

    Atar, Asli I; Altuner, Tugba Kayhan; Bozbas, Huseyin; Korkmaz, Mehmet E

    2012-07-01

    Abnormalities of coronary microcirculation have been reported in patients with diabetes mellitus (DM) even in the presence of normal coronary arteries. It is unknown when the microvascular effects on coronary arteries begin to appear in the DM disease course. Coronary flow reserve (CFR), determined by pharmacological stress transthoracic Doppler echocardiography, is a reliable indicator of coronary microvascular function. We sought to determine the coronary microvascular function of prediabetic patients compared to DM patients and normal population. Seventy-four subjects with normal coronary arteries were enrolled. DM and prediabetes were diagnosed according to American Diabetes Association criteria. All subjects had Doppler recordings of the left anterior descending artery with adenosine infusion at a rate of 0.014 mg/kg per minute. The demographical characteristics and laboratory findings of the three groups were similar (DM group: n = 25, mean age 62 ± 7 years, 19 females; prediabetic group: n = 25, mean age 64 ± 12 years, 21 females; control group: n = 24, mean age 63 ± 7 years, 15 females) except fasting glucose levels. CFR values of the three groups were significantly different (DM group: CFR = 1.75 ± 0.50; prediabetic group: CFR = 2.24 ± 0.43; control group: CFR = 2.38 ± 0.32, P < 0.001). CFR values of DM group were lower than those of prediabetic and control groups (DM vs. prediabetic: P < 0.001, DM vs. control: P < 0.001). However, CFR levels of prediabetic group were not different from those of the control group (P = 0.481). DM was an independent factor predictive of CFR < 2 (OR, 22.69; 95% CI, 6.47-79.51; P < 0.001). Coronary microvascular function seems to be normal in the prediabetic state, but dysfunction appears after DM becomes overt. © 2012, Wiley Periodicals, Inc.

  18. Effect of STA-proximal MCA bypass. Improvement of cerebral blood flow and metabolism and neuropsychological function

    International Nuclear Information System (INIS)

    Ogawa, Akira; Funayama, Masayuki; Miura, Kazuyuki; Ogasawara, Kuniaki; Suzuki, Michiyasu; Kuroda, Kiyoshi; Sasaki, Toshiaki

    1998-01-01

    We investigated cerebral blood flow (CBF) and metabolism in patients with hemodynamic ischemia by positron emission tomography (PET) and thermal diffusion flow meter. We also studied neuropsychological functions to evaluate the effects of surgical revascularization. Bypass surgery of the superficial temporal artery to the proximal middle cerebral artery was performed on 26 patients satisfying the following categories: stenosis or occlusive lesion in main cerebral arteries; no marked focus of infarction on CT or MRI. PET was performed before and 1 month after the operation, and CBF, the cerebral metabolic rate of oxygen (CMRO 2 ) and oxygen extraction fraction (OEF) were analyzed. Cerebrovascular reserve capacity (CVRC) was also calculated after acetazolamide challenge. CBF during the operation was continuously measured with a thermal diffusion flow meter. CO 2 response of CBF was analyzed before and after anastomosis. Neuropsychological functions were evaluated by Hasegawa dementia scale revised (HDS-R), mini-mental state examination (MMSE) and Wechsler adult intelligence scale revised (WAIS-R). Before the operation, increase in OEF accorded with the decrease in CBF, and a significant relationship between both CBF and CVRC, and OEF and CVRC was found. A decrease in CVRC was noted prior to a decrease in CBF and elevation of OEF. CVRC caused by acetazolamide might reflect CO 2 reactivity. Significant improvement of CBF and CVRC, and normalization of OEF were observed after the operation. Also, significant improvement of neuropsychological function was observed by HDS-R and WAIS-R. Disturbance in neuropsychological function might reflect elevation of OEF. (author)

  19. Coronary grafts flow and cardiac pacing modalities: how to improve perioperative myocardial perfusion.

    LENUS (Irish Health Repository)

    D'Ancona, Giuseppe

    2012-02-03

    OBJECTIVE: Aim of this study was to investigate modifications of coronary grafts flow during different pacing modalities after CABG. MATERIALS AND METHODS: Two separate prospective studies were conducted in patients undergoing CABG and requiring intraoperative epicardial pacing. In a first study (22 patients) coronary grafts flows were measured during dual chamber pacing (DDD) and during ventricular pacing (VVI). In a second study (10 patients) flows were measured during DDD pacing at different atrio-ventricular (A-V) delay periods. A-V delay was adjusted in 25 ms increments from 25 to 250 ms and flow measurements were performed for each A-V delay increment. A transit time flowmeter was used for the measurements. RESULTS: An average of 3.4 grafts\\/patient were performed. In the first study, average coronary graft flow was 47.4+\\/-20.8 ml\\/min during DDD pacing and 41.8+\\/-18.2 ml\\/min during VVI pacing (P = 0.0004). Furthermore average systolic pressure was 94.3+\\/-10.1 mmHg during DDD pacing and 89.6+\\/-12.2 mmHg during VVV pacing (P = 0.0007). No significant differences in diastolic pressure were recorded during the two different pacing modalities. In the second study, maximal flows were achieved during DDD pacing with an A-V delay of 175 ms (54+\\/-9.6 ml\\/min) and minimal flows were detected at 25 ms A-V delay (38.1+\\/-4.7 ml\\/min) (P=ns). No significant differences in systolic or diastolic blood pressure were noticed during the different A-V delays. CONCLUSION: Grafts flowmetry provides an extra tool to direct supportive measures such as cardiac pacing after CABG. DDD mode with A-V delay around 175 ms. should be preferred to allow for maximal myocardial perfusion via the grafts.

  20. Improved patient selection by stratified surgical intervention

    DEFF Research Database (Denmark)

    Wang, Miao; Bünger, Cody E; Li, Haisheng

    2015-01-01

    BACKGROUND CONTEXT: Choosing the best surgical treatment for patients with spinal metastases remains a significant challenge for spine surgeons. There is currently no gold standard for surgical treatments. The Aarhus Spinal Metastases Algorithm (ASMA) was established to help surgeons choose...... the most appropriate surgical intervention for patients with spinal metastases. PURPOSE: The purpose of this study was to evaluate the clinical outcome of stratified surgical interventions based on the ASMA, which combines life expectancy and the anatomical classification of patients with spinal metastases...... survival times in the five surgical groups determined by the ASMA were 2.1 (TS 0-4, TC 1-7), 5.1 (TS 5-8, TC 1-7), 12.1 (TS 9-11, TC 1-7 or TS 12-15, TC 7), 26.0 (TS 12-15, TC 4-6), and 36.0 (TS 12-15, TC 1-3) months. The 30-day mortality rate was 7.5%. Postoperative neurological function was maintained...

  1. Characterization of cardiac flow in heart disease patients by computational fluid dynamics and 4D flow MRI

    Science.gov (United States)

    Lantz, Jonas; Gupta, Vikas; Henriksson, Lilian; Karlsson, Matts; Persson, Ander; Carhall, Carljohan; Ebbers, Tino

    2017-11-01

    In this study, cardiac blood flow was simulated using Computational Fluid Dynamics and compared to in vivo flow measurements by 4D Flow MRI. In total, nine patients with various heart diseases were studied. Geometry and heart wall motion for the simulations were obtained from clinical CT measurements, with 0.3x0.3x0.3 mm spatial resolution and 20 time frames covering one heartbeat. The CFD simulations included pulmonary veins, left atrium and ventricle, mitral and aortic valve, and ascending aorta. Mesh sizes were on the order of 6-16 million cells, depending on the size of the heart, in order to resolve both papillary muscles and trabeculae. The computed flow field agreed visually very well with 4D Flow MRI, with characteristic vortices and flow structures seen in both techniques. Regression analysis showed that peak flow rate as well as stroke volume had an excellent agreement for the two techniques. We demonstrated the feasibility, and more importantly, fidelity of cardiac flow simulations by comparing CFD results to in vivo measurements. Both qualitative and quantitative results agreed well with the 4D Flow MRI measurements. Also, the developed simulation methodology enables ``what if'' scenarios, such as optimization of valve replacement and other surgical procedures. Funded by the Wallenberg Foundation.

  2. Patient Specific Multiscale Simulations of Blood Flow in Coronary Artery Bypass Surgery

    Science.gov (United States)

    Bangalore Ramachandra, Abhay; Sankaran, Sethuraman; Kahn, Andrew M.; Marsden, Alison L.

    2013-11-01

    Coronary artery bypass surgery is performed to revascularize blocked coronary arteries in roughly 400,000 patients per year in the US.While arterial grafts offer superior patency, vein grafts are used in more than 70% of procedures, as most patients require multiple grafts. Vein graft failure (approx. 50% within 10 years) remains a major clinical issue. Mounting evidence suggests that hemodynamics plays a key role as a mechano-biological stimulus contributing to graft failure. However, quantifying relevant hemodynamic quantities (e.g. wall shear stress) invivo is not possible directly using clinical imaging techniques. We numerically compute graft hemodynamics in a cohort of 3-D patient specific models using a stabilized finite element method. The 3D flow domain is coupled to a 0D lumped parameter circulatory model. Boundary conditions are tuned to match patient specific blood pressures, stroke volumes & heart rates. Results reproduce clinically observed coronary flow waveforms. We quantify differences in multiple hemodynamic quantities between arterial & venous grafts & discuss possible correlations between graft hemodynamics & clinically observed graft failure.Such correlations will provide further insight into mechanisms of graft failure and may lead to improved clinical outcomes.

  3. Improved CFD Model to Predict Flow and Temperature Distributions in a Blast Furnace Hearth

    Science.gov (United States)

    Komiyama, Keisuke M.; Guo, Bao-Yu; Zughbi, Habib; Zulli, Paul; Yu, Ai-Bing

    2014-10-01

    The campaign life of a blast furnace is limited by the erosion of hearth refractories. Flow and temperature distributions of the liquid iron have a significant influence on the erosion mechanism. In this work, an improved three-dimensional computational fluid dynamics model is developed to simulate the flow and heat transfer phenomena in the hearth of BlueScope's Port Kembla No. 5 Blast Furnace. Model improvements feature more justified input parameters in turbulence modeling, buoyancy modeling, wall boundary conditions, material properties, and modeling of the solidification of iron. The model is validated by comparing the calculated temperatures with the thermocouple data available, where agreements are established within ±3 pct. The flow distribution in the hearth is discussed for intact and eroded hearth profiles, for sitting and floating coke bed states. It is shown that natural convection affects the flow in several ways: for example, the formation of (a) stagnant zones preventing hearth bottom from eroding or (b) the downward jetting of molten liquid promoting side wall erosion, or (c) at times, a vortex-like peripheral flow, promoting the "elephant foot" type erosion. A significant influence of coke bed permeability on the macroscopic flow pattern and the refractory temperature is observed.

  4. Cavitation performance improvement of high specific speed mixed-flow pump

    International Nuclear Information System (INIS)

    Chen, T; Sun, Y B; Wu, D Z; Wang, L Q

    2012-01-01

    Cavitation performance improvement of large hydraulic machinery such as pump and turbine has been a hot topic for decades. During the design process of the pumps, in order to minimize size, weight and cost centrifugal and mixed-flow pump impellers are required to operate at the highest possible rotational speed. The rotational speed is limited by the phenomenon of cavitation. The hydraulic model of high-speed mixed-flow pump with large flow rate and high pumping head, which was designed based on the traditional method, always involves poor cavitation performance. In this paper, on the basis of the same hydraulic design parameters, two hydraulic models of high-speed mixed-flow pump were designed by using different methods, in order to investigate the cavitation and hydraulic performance of the two models, the method of computational fluid dynamics (CFD) was adopted for internal flow simulation of the high specific speed mixed-flow pump. Based on the results of numerical simulation, the influences of impeller parameters and three-dimensional configuration on pressure distribution of the blades' suction surfaces were analyzed. The numerical simulation results shows a better pressure distribution and lower pressure drop around the leading edge of the improved model. The research results could provide references to the design and optimization of the anti-cavitation blade.

  5. Improving quality of life in patients with hidradenitis suppurativa

    DEFF Research Database (Denmark)

    Dufour, D.N.; Esmann, S.; Jemec, G.B.

    2012-01-01

    Hidradenitis suppurativa is a chronic recurrent inflammatory skin disease with abscess formation and scarring predominantly in the inverse areas. The disease is often difficult to treat and patients experience a decreased quality of life (QoL) and related psychosocial morbidity. Current knowledge...... on improving QoL in patients with hidradenitis suppurativa is therefore reviewed. The literature is limited but indicates that there are two ways of improving patients' QoL: therapy of the somatic disease or psychosocial interventions....

  6. Lean Manufacturing Improves Emergency Department Throughput and Patient Satisfaction.

    Science.gov (United States)

    Kane, Marlena; Chui, Kristen; Rimicci, Janet; Callagy, Patrice; Hereford, James; Shen, Sam; Norris, Robert; Pickham, David

    2015-09-01

    A multidisciplinary team led by nursing leadership and physicians developed a plan to meet increasing demand and improve the patient experience in the ED without expanding the department's current resources. The approach included Lean tools and engaged frontline staff and physicians. Applying Lean management principles resulted in quicker service, improved patient satisfaction, increased capacity, and reduced resource utilization. Incorporating continuous daily management is necessary for sustainment of continuous improvement activities.

  7. Improving patient-centredness in partnership with female patients: a cluster RCT in fertility care

    NARCIS (Netherlands)

    Huppelschoten, A.G.; Nelen, W.L.D.M.; Westert, G.P.; Golde, R.J.T. van; Adang, E.M.M.; Kremer, J.A.M.

    2015-01-01

    QUESTION: What is the effect of a multifaceted intervention with participation of patients on improvement of patient-centredness in fertility care? SUMMARY ANSWER: A multifaceted intervention with participation of patients did not improve total patient-centredness scores provided by women in

  8. Transgene Flow from Glufosinate-Resistant Rice to Improved and Weedy Rice in China

    Directory of Open Access Journals (Sweden)

    Yong-liang LU

    2014-09-01

    Full Text Available The development of transgenic rice with novel traits in China can increase rice productivity, but transgene flow to improved or weedy rice has become a major concern. We aimed to evaluate the potential maximum frequencies of transgene flow from glufosinate-resistant rice to improved rice cultivars and weedy rice. Treatments were arranged in randomized complete blocks with three replicates. Experiments were conducted between 2009 and 2010 at the Center for Environmental Safety Supervision and Inspection for Genetically Modified Plants, China National Rice Research Institute, Hangzhou, China. Glufosinate-resistant japonica rice 99-1 was the pollen donor. The pollen recipients were two inbred japonica rice (Chunjiang 016 and Xiushui 09, two inbred indica rice (Zhongzu 14 and Zhongzao 22, two indica hybrid rice (Zhongzheyou 1 and Guodao 1, and one weedy indica rice (Taizhou weedy rice. The offspring of recipients were planted in the field and sprayed with a commercial dose of glufosinate. Leaf tissues of survivors were analyzed by polymerase chain reaction to detect the presence of the transgene. The frequency of gene flow ranged from 0 to 0.488%. In 2009, the order of gene flow frequency was as follows: weedy rice > Chunjiang 016 > Xiushui 09 and Zhongzu 14 > Guodao 1, Zhongzheyou 1 and Zhongzao 22. Gene flow frequencies were generally higher in 2009 than in 2010, but did not differ significantly among rice materials. Gene flow frequency was the highest in weedy rice followed by the inbred japonica rice. The risk of gene flow differed significantly between years and year-to-year variance could mask risk differences among pollen recipients. Gene flow was generally lesser in taller pollen recipients than in shorter ones, but plant height only accounted for about 30% of variation in gene flow. When flowering synchrony was maximized, as in this study, low frequencies of gene flow occurred from herbicide-resistant japonica rice to other cultivars and

  9. Peak expiratory flow as a predictor for the effectiveness of sport for patients with COPD.

    Science.gov (United States)

    Jungblut, S; Frickmann, H; Klingler, J; Zimmermann, B; Bargon, Joachim

    2006-01-31

    This study intended to find simple parameters that were able to determine the increase in physical performance as a result of sport in a group of patients with COPD (lung sport). We regularly investigated pulse, oxygenation and peak expiratory flow in participants with COPD of a "lung sport group", who participated in a structured weekly training program under professional supervision. Ten volunteers (7 females, 3 males, median of age = 69) with COPD (grade II-III) took part in the study. - The relative changes after 3 and 6 months were compared with the values of the first month of exercise. Measurements were carried out before exercise, after stamina training and at the end of the program. - Pulse and oxygenation did not show any changes. However, there was a significant improvement of peak flow after 6 months. - These peak flow changes represent further evidence of positive effects of sport in COPD and provide a parameter which allows the patients themselves to measure and evaluate the success of their physical activity.

  10. Studies on the hepatic hemodynamics of the patients with fatty liver by hepatic blood flow mapping

    International Nuclear Information System (INIS)

    Kubo, Shuichi; Okajima, Tugio; Yamazaki, Yasurou

    1991-01-01

    To investigate intrahepatic hemodynamics of the patients with fatty liver, the time to reach maximal enhancement (PT) of every 3 x 3 pixel was depicted by a gray scale throughout an area of maximal horizontal slice of CT of the liver to obtain blood flow mapping of the liver, and compared with those of normal, chronic hepatitis and cirrhosis. Mottles of deep gray, light gray or black pixels were distributed throughout the liver slice of fatty liver. Although the mean PT of a ROI of fatty liver was longer than normal and shorter than that of cirrhosis and the same as that of chronic hepatitis, the map of fatty liver was different from that of chronic hepatitis. When the distribution of PT was expressed by their histogram, it was known that PT of fatty liver had a wider range than that of chronic hepatitis. The range was the same as that of cirrhosis. In one case of fatty liver, the deep gray pixels was increased when fatty infiltration of the liver was improved. It was concluded that the intrahepatic blood flow of fatty liver was impaired in a way not similar to chronic hepatitis or liver cirrhosis, which could be clearly seen by hepatic blood flow mapping, and which seemed to be reversible with the improvement of fatty liver. (author)

  11. Architecture for improved mass transport and system performance in redox flow batteries

    Science.gov (United States)

    Houser, Jacob; Pezeshki, Alan; Clement, Jason T.; Aaron, Douglas; Mench, Matthew M.

    2017-05-01

    In this work, electrochemical performance and parasitic losses are combined in an overall system-level efficiency metric for a high performance, all-vanadium redox flow battery. It was found that pressure drop and parasitic pumping losses are relatively negligible for high performance cells, i.e., those capable of operating at a high current density while at a low flow rate. Through this finding, the Equal Path Length (EPL) flow field architecture was proposed and evaluated. This design has superior mass transport characteristics in comparison with the standard serpentine and interdigitated designs at the expense of increased pressure drop. An Aspect Ratio (AR) design is discussed and evaluated, which demonstrates decreased pressure drop compared to the EPL design, while maintaining similar electrochemical performance under most conditions. This AR design is capable of leading to improved system energy efficiency for flow batteries of all chemistries.

  12. [Effects of therapeutic complexes including balneoradonokinesitherapy, electromyostimulation and low-frequency magnetotherapy on regional blood flow in patients with postrraumatic gonarthritis].

    Science.gov (United States)

    Raspopova, E A; Udartsev, E Iu

    2006-01-01

    Balneoradonokinesitherapy alone and its combination with electrostimulation and low-frequency magnetotherapy were used for the treatment of regional blood flow disorders in 76 patients with posttraumatic gonarthritis. Balneoradonokinesitherapy in combination with electromyostimulation improved blood circulation. When low-frequency magnetotherapy was added to the latter complex, the regress of regional blood flow disorders of a damaged extremity was most significant.

  13. Interim Columbia and Snake rivers flow improvement measures for salmon: Final Supplemental Environmental Impact Statement (SEIS)

    Energy Technology Data Exchange (ETDEWEB)

    1993-03-01

    Public comments are sought on this final SEIS, which supplements the 1992 Columbia River Salmon Flow Measures Options Analysis (OA)/Environmental Impact Statement (EIS). The Corps of Engineers, in cooperation with the Bonneville Power Administration and the Bureau of Reclamation proposes five alternatives to improve flows of water in the lower Columbia-Snake rivers in 1993 and future years to assist the migration of juvenile and adult anadromous fish past eight hydropower dams. These are: (1) Without Project (no action) Alternative, (2) the 1992 Operation, (3) the 1992 Operation with Libby/Hungry Horse Sensitivity, (4) a Modified 1992 Operation with Improvements to Salmon Flows from Dworshak, and (5) a Modified 1992 Operation with Upper Snake Sensitivity. Alternative 4, Modified 1992 Operations, has been identified as the preferred alternative.

  14. Improved Performance of Personalized Ventilation by Control of the Convection Flow around Occupant Body

    DEFF Research Database (Denmark)

    Bolashikov, Zhecho Dimitrov; Melikov, Arsen Krikor; Krenek, Miroslav

    2009-01-01

    This paper reports on methods of control of the free convection flow around human body aiming at improvement of inhaled air quality for occupants at workstations with personalized ventilation (PV). Two methods of control were developed and explored: passive - blocking the free convection developm......This paper reports on methods of control of the free convection flow around human body aiming at improvement of inhaled air quality for occupants at workstations with personalized ventilation (PV). Two methods of control were developed and explored: passive - blocking the free convection......-scale test room with background mixing ventilation. Thermal manikin with realistic free convection flow was used. The PV supplied air from front/above towards the face. All measurements were performed under isothermal conditions at 20 °C and 26 °C. The air in the test room was mixed with tracer gas, while...

  15. Use of high-flow nasal cannula in obese patients receiving colonoscopy under intravenous propofol sedation: A case series

    Directory of Open Access Journals (Sweden)

    Chi Chan Lee

    Full Text Available Intravenous sedation during colonoscopy has become the standard practice in the United States given its higher patient satisfaction and procedural quality. This practice is not free of side effects as a significant proportion of patients undergoing this procedure tend to have respiratory depression and desaturation events. Obesity, as it relates to higher levels of body mass index (BMI has a positive correlation with the incidence of hypoxemia. During colonoscopy High flow nasal cannula (HFNC may potentially improve oxygen performance in patients receiving colonoscopy under intravenous sedation. Here we present 3 cases of patients undergoing adjunctive oxygen therapy with HFNC during colonoscopy with intravenous sedation. We found patients to have lower number of desaturation events and were satisfied with their experience. Keywords: High BMI (body mass index, HFNC (high-flow nasal cannula, Colonoscopy, Intravenous sedation, Obesity

  16. Subcutaneous blood flow in the temporal region of migraine patients

    International Nuclear Information System (INIS)

    Jensen, K.

    1987-01-01

    Subcutaneous blood flow in the temporal region (TSBF) was measured by the local 133 Xenon washout technique in 43 migraine patients; 19 were reexamined in the course of spontaneous attacks. During attacks, TSBF was normal compared to headache-free state. In 13 unilateral attacks, the median ipsilateral to contralateral ratio TSBF was 1: 1.276, (NS). During 30 deg C passive head-up tilt, TSBF descreased by a median of 27% during headache-free intervals and by a median, 21% during migraine attacks. The difference between the 2 occasions was not significant. Head-up tilt resulted in a median 4.5% increase in mean arterial blood pressure (MAP) and a median 5.3% increase in heart rate (HR) during headache-free intervals and 3.4% and 3.2% respectively during migraine attacks. These results are evidence against a vasomotor disturbance of the extracranial tissues during attacks of migraine. The cardio-vascular response to the orthostatic stimulus indicates a normal function of this part of the autonomic nervous system during migraine attacks. (author)

  17. Subcutaneous blood flow in the temporal region of migraine patients

    Energy Technology Data Exchange (ETDEWEB)

    Jensen, K.

    1987-01-01

    Subcutaneous blood flow in the temporal region (TSBF) was measured by the local 133 Xenon washout technique in 43 migraine patients; 19 were reexamined in the course of spontaneous attacks. During attacks, TSBF was normal compared to headache-free state. In 13 unilateral attacks, the median ipsilateral to contralateral ratio TSBF was 1: 1.276, (NS). During 30 deg C passive head-up tilt, TSBF descreased by a median of 27% during headache-free intervals and by a median, 21% during migraine attacks. The difference between the 2 occasions was not significant. Head-up tilt resulted in a median 4.5% increase in mean arterial blood pressure (MAP) and a median 5.3% increase in heart rate (HR) during headache-free intervals and 3.4% and 3.2% respectively during migraine attacks. These results are evidence against a vasomotor disturbance of the extracranial tissues during attacks of migraine. The cardio-vascular response to the orthostatic stimulus indicates a normal function of this part of the autonomic nervous system during migraine attacks.

  18. Cerebral blood flow in patients with thalamic hemorrhage, 2

    International Nuclear Information System (INIS)

    Ueda, Mikiya; Matsumoto, Yukihiro; Omiya, Nobuyuki; Mikami, Junichi; Sato, Hiroyuki; Inoue, Yoshitoshi; Okawara, Shuji; Matsuoka, Takahiro; Takeda, Satoshi.

    1989-01-01

    In twenty-nine patients with thalamic hemorrhage, single photon emission CT (SPECT) and CT were performed in the acute stage. Measurement of cerebral blood flow (CBF) was performed by the 133-Xe inhalation method using SPECT (Tomomatic 64). CT findings such as hematoma volume, involvement of internal capsule, ventricular hematoma and topographical localization of hematoma were investigated. We studied etiological analysis of decreased CBF in the acute stage. CBF values in the group of large-volume hematoma (≥10 ml) decreased moderately on the hematoma side and mildly on the nonhematoma side. CBF values in the group of small-volume hematoma (<10 ml) decreased mildly on the hematoma side but didn't decrease on the nonhematoma side. CBF values of the former on the hematoma side decreased significantly compared with the latter. Linear correlation between hematoma volume and CBF was significant. As to topographical localization, CBF values of the group which involved medial thalamus decreased significantly compared with the other group. Factors of involvement of internal capsule and ventricular hematoma didn't affect CBF values. In conclusion, major factors which affected decreased CBF in the acute stage were hematoma volume and tomographical localization. (author)

  19. Computational Fluid Dynamics Modeling to Improve Natural Flow Rate and Sweet Pepper Productivity in Greenhouse

    OpenAIRE

    W. Limtrakarn; P. Boonmongkol; A. Chompupoung; K. Rungprateepthaworn; J. Kruenate; P. Dechaumphai

    2012-01-01

    Natural flow rate and sweet peppers productivity in tropical greenhouse are improved by CFD simulation is the main objective of this research work. Most of the greenhouse types today are in the arch shape. To develop an improved greenhouse structure for the region, the arch type was built and used as the control model. Mae Sar Mai agriculture research station under the royal project foundation was selected as the field test site. Temperature sensors with data logger were installed to monitor ...

  20. 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.

  1. Effects of mouthwash interventions on xerostomia and unstimulated whole saliva flow rate among hemodialysis patients: A randomized controlled study.

    Science.gov (United States)

    Yu, I-Chen; Tsai, Yun-Fang; Fang, Ji-Tseng; Yeh, Mei-Ming; Fang, Jia-You; Liu, Chieh-Yu

    2016-11-01

    Dry mouth (xerostomia) is a common symptom in hemodialysis patients, which is associated with a reduced salivary flow. Xerostomia affects patients' oral health and quality of life. The aim of this study was to investigate using a mouthwash as a means to reduce xerostomia and improve saliva flow rates in hemodialysis patients. A randomized controlled trial. Three dialysis centers in Northern Taiwan served as the study sites. Patients were purposively sampled from three hemodialysis centers in Taiwan and randomly assigned to one of three groups: pure water mouthwash; n=41, licorice mouthwash; n=44, or no mouthwash (control); n=37. The Summated Xerostomia Inventory, and unstimulated whole salivary flow rate measured dry mouth and salivary flow, respectively. Data was collected at baseline, dialysis Day 5 and Day 10. One hundred twenty-two patients participated in this study. Baselines were adjusted for any imbalances in variables and generalized estimating equations analysed the data. Compared to control, a pure water mouthwash resulted in an increase in the unstimulated salivary flow rate of 25.85×10 -3 mL/min and 25.78×10 -3 mL/min (pXerostomia Inventory scores. The licorice mouthwash also significantly improved the unstimulated salivary flow rates to 114.92×10 -3 mL/min, and 131.61×10 -3 mL/min at Day 5 and Day 10, respectively (pXerostomia Inventory (pxerostomia. This suggests the use of a licorice mouthwash may effectively relieve feelings of dry mouth in hemodialysis patients. Copyright © 2016 Elsevier Ltd. All rights reserved.

  2. Measurement plans for process flow improvement in services and health care

    NARCIS (Netherlands)

    Kemper, B.; de Mast, J.

    2013-01-01

    The discussion of performance measurement is often on a conceptual, not operational, level; advice on the operational and practical matters of obtaining data for process flow improvement is scarce. We define a measurement plan and study four measurement study designs and corresponding methods and

  3. 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.

  4. Improvements to a Flow Sensor for Liquid Bismuth-Fed Hall Thrusters

    Science.gov (United States)

    Bonds, Kevin; Polzin, Kurt A.

    2010-01-01

    Recently, there has been significant interest in using bismuth metal as a propellant in Hall Thrusters [1, 2]. Bismuth offers some considerable cost, weight, and space savings over the traditional propellant--xenon. Quantifying the performance of liquid metal-fed Hall thrusters requires a very precise measure of the low propellant flow rates [1, 2]. The low flow rates (10 mg/sec) and the temperature at which free flowing liquid bismuth exists (above 300 C) preclude the use of off-the-shelf flow sensing equipment [3]. Therefore a new type of sensor is required. The hotspot bismuth flow sensor, described in Refs. [1-5] is designed to perform a flow rate measurement by measuring the velocity at which a thermal feature moves through a flow chamber. The mass flow rate can be determined from the time of flight of the thermal peak, [4, 5]. Previous research and testing has been concerned mainly with the generation of the thermal peak and it's subsequent detection. In this paper, we present design improvements to the sensor concept; and the results of testing conducted to verify the functionality of these improvements. A ceramic material is required for the sensor body (see Fig. 1), which must allow for active heating of the bismuth flow channel to keep the propellant in a liquid state. The material must be compatible with bismuth and must be bonded to conductive elements to allow for conduction of current into the liquid metal and measurement of the temperature in the flow. The new sensor requires fabrication techniques that will allow for a very small diameter flow chamber, which is required to produce useful measurements. Testing of various materials has revealed several that are potentially compatible with liquid bismuth. Of primary concern in the fabrication and testing of a robust, working prototype, is the compatibility of the selected materials with one another. Specifically, the thermal expansion rates of the materials relative to the ceramic body cannot expand so

  5. Improved patient-reported health impact of multiple sclerosis

    DEFF Research Database (Denmark)

    Macdonell, Richard; Nagels, Guy; Laplaud, David-Axel

    2016-01-01

    BACKGROUND: Multiple sclerosis (MS) is a debilitating disease that negatively impacts patients' lives. OBJECTIVE: ENABLE assessed the effect of long-term prolonged-release (PR) fampridine (dalfampridine extended release in the United States) treatment on patient-perceived health impact in patients...... with MS with walking impairment. METHODS: ENABLE was a 48-week, open-label, Phase 4 study of PR-fampridine 10 mg twice daily. Patients who showed any improvement in Timed 25-Foot Walk walking speed at weeks 2 and 4 and any improvement in 12-item MS Walking Scale score at week 4 remained on treatment....... The primary endpoint was change from baseline in 36-Item Short-Form Health Survey (SF-36) physical component summary (PCS) score. RESULTS: At week 4, 707/901 (78.5%) patients met the criteria to remain on treatment. Patients on treatment demonstrated significant and clinically meaningful improvements in SF-36...

  6. 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.

  7. Quality Improvement Project to Improve Patient Satisfaction With Pain Management: Using Human-Centered Design.

    Science.gov (United States)

    Trail-Mahan, Tracy; Heisler, Scott; Katica, Mary

    2016-01-01

    In this quality improvement project, our health system developed a comprehensive, patient-centered approach to improving inpatient pain management and assessed its impact on patient satisfaction across 21 medical centers. Using human-centered design principles, a bundle of 6 individual and team nursing practices was developed. Patient satisfaction with pain management, as measured by the Hospital Consumer Assessment of Healthcare Providers and Systems pain composite score, increased from the 25th to just under the 75th national percentile.

  8. Preoperative patient education: can we improve satisfaction and reduce anxiety?

    Directory of Open Access Journals (Sweden)

    Jaime Ortiz

    2015-02-01

    Full Text Available BACKGROUND AND OBJECTIVES: Patients' knowledge deficits concerning anesthesia and the anesthesiologist's role in their care may contribute to anxiety. The objective of this study was to develop anesthesia patient education materials that would help improve patient's satisfaction regarding their knowledge of the perioperative process and decrease anxiety in a community hospital with a large Spanish-speaking population. METHODS: A survey (Survey A in English and Spanish was administered to all adult anesthesiology preoperative clinic patients during a 4-week period. The data were analyzed and then a patient education handout was developed in both English and Spanish to assist with our patients' major concerns. A second survey (Survey B was administered that was completed after the education handout had been put into use at the clinic. The survey asked for basic demographic information and included questions on satisfaction with regard to understanding of anesthesia as well as worries regarding surgery and pain. RESULTS: In the patients who received the handout, statistically significant improvement was found in the questions that asked about satisfaction with regard to understanding of type of anesthesia, options for pain control, what patients are supposed to do on the day of surgery, and the amount of information given with regard to anesthetic plan. There was no difference in anxiety related to surgery in patients who received the educational handout compared to those patients who did not. CONCLUSIONS: Patient education handouts improved patient's satisfaction regarding their knowledge of the perioperative process but did not reduce anxiety related to surgery.

  9. MR evaluation of cervical CSF flow. An examination in patients with spinal canal stenosis

    Energy Technology Data Exchange (ETDEWEB)

    Iida, Makoto [Miyoshi General Hospital, Hiroshima (Japan); Kajima, Toshio; Miyasaka, Kenji; Nakanishi, Tadashi; Ono, Chiaki; Ito, Katsuhide

    1999-06-01

    To evaluate the flow dynamics of cerebrospinal fluid (CSF) throughout the cervical spine, 18 healthy controls and 14 patients with spinal canal stenosis were examined by phase-contrast cine MR. MR imaging was performed using a sagittal technique that is flow-sensitive in the craniocaudal direction. Flow encoding depicted craniocaudal flow as high intensity and caudocranial flow as low intensity. In this technique, either retrospective cardiac or peripheral gating was used to cover the complete cardiac cycle. This pulse sequence yielded 16 quantitative flow-encoded images per cardiac cycle. Using a region-of-interest cursor at each vertebral level, the graphs of flow-velocity versus time were generated. The recorded CSF at each vertebral level in the controls showed almost the same pattern in the change of flow in the craniocaudal direction, indicating that the onset of craniocaudal CSF flow was synchronous with the onset of cardiac systole in these subjects. At all vertebral levels, flow-velocity time curves showed the same variation in pattern. CSF flow was significantly lower in patients than in controls at each vertebral level (p<0.01). In addition, the flow patterns of the patients with spinal canal stenosis differed at each vertebral level. As a results, the total sum of the difference in velocity between graphs of two serial vertebrae at all sampling points (the area between the curves: ABC) per mean velocity amplitude in the patients was significantly higher than controls (p<0.05). Furthermore, the ABC per mean velocity amplitude at the stenotic level was significantly larger in the patients than that at the non-stenotic level (p<0.01). These data suggest that turbulent CSF flow occurs at the stenotic level. Thus, assessment of CSF flow dynamics is a useful adjunct to routine MRI in patients with spinal canal stenosis. (author)

  10. Flow cytometry of duodenal intraepithelial lymphocytes improves diagnosis of celiac disease in difficult cases.

    Science.gov (United States)

    Valle, Julio; Morgado, José Mario T; Ruiz-Martín, Juan; Guardiola, Antonio; Lopes-Nogueras, Miriam; García-Vela, Almudena; Martín-Sacristán, Beatriz; Sánchez-Muñoz, Laura

    2017-10-01

    Diagnosis of celiac disease is difficult when the combined results of serology and histology are inconclusive. Studies using flow cytometry of intraepithelial lymphocytes (IELs) have found that celiac patients have increased numbers of γδ IELs, along with a decrease in CD3-CD103 + IELs. The objective of this article is to assess the role of flow cytometric analysis of IELs in the diagnosis of celiac disease in difficult cases. A total of 312 patients with suspicion of celiac disease were included in the study. Duodenal biopsy samples were used for histological assessment and for flow cytometric analysis of IELs. In 46 out of 312 cases (14.7%) the combination of serology and histology did not allow the confirmation or exclusion of celiac disease. HLA typing had been performed in 42 of these difficult cases. Taking into account HLA typing and the response to a gluten-free diet, celiac disease was excluded in 30 of these cases and confirmed in the remaining 12. Flow cytometric analysis of IELs allowed a correct diagnosis in 39 out of 42 difficult cases (92.8%) and had a sensitivity of 91.7% (95% CI: 61.5% to 99.8%) and a specificity of 93.3% (95% CI: 77.9% to 99.2%) for the diagnosis of celiac disease in this setting. Flow cytometric analysis of IELs is useful for the diagnosis of celiac disease in difficult cases.

  11. Cerebral blood flow and cerebrovascular response to acetazolamide in patients with chronic alcoholism

    OpenAIRE

    Oishi, M; Mochizuki, Y; Takasu, T

    1997-01-01

    Cerebral blood flow and cerebrovascular response to acetazolamide were studied in 12 patients with chronic alcoholism and 12 age matched healthy controls. Blood flows in the cerebral cortex, thalamus, and putamen were significantly lower in the chronic alcoholic group than in the healthy control group. The increase in blood flow caused by acetazolamide did not show any significant difference between the two groups. These findings suggest that the decreased cerebral blood flow i...

  12. Recent improvements of the French liquid micro-flow reference facility

    Science.gov (United States)

    Florestan, Ogheard; Sandy, Margot; Julien, Savary

    2018-02-01

    According to the mission of the national reference laboratory, LNE-CETIAT achieved in 2012 the construction and accreditation of a modern and innovative calibration laboratory based on the gravimetric method. The measurement capabilities cover a flow rate range for liquid from 10 kg · h-1 down to 1 g · h-1 with expanded relative uncertainties from 0.1% to 0.6% (k  =  2). Since 2012, several theoretical and experimental studies have allowed a better knowledge and control over uncertainty sources and have decreased calibration time. When dealing with liquid micro-flow using a reference method such as the gravimetric method, several difficulties have to be overcome. The main improvements described in this paper relate to the enhancement of the evaporation trap system, the merging of the four dedicated measurement lines into one, and the implementation of a gravimetric dynamic ‘flying’ method for the calculation of the reference flow rate. The evaporation-avoiding system has been replaced by an oil layer in order to remove the possibility of condensation of water on both the weighed vessel and the immersed capillary. The article describes the experimental method used to quantify the effect of surface tension of water/oil/air interfaces on the weighed mass. The traditional static gravimetric method has been upgraded by a dynamic ‘flying’ gravimetric method. The article presents the newly implemented method, its validation and its advantages compared to the static method. The four dedicated weighing devices, dispatched over four sub-ranges of flow rate, have been merged leading to the use of only one weighing scale with the same uncertainties on the reference flow rate. The article discusses the new uncertainty budget over the full flow rate range capability. Finally, the article discusses the improvements still under development and the general prospects of liquid micro-flow metrology.

  13. Methods of measurement of myocardial blood flow in patients: a critical review

    International Nuclear Information System (INIS)

    Marcus, M.L.; Wilson, R.F.; White, C.W.

    1987-01-01

    During the past decade, major progress has been made in the evolution of technology directed toward the accurate measurement of regional myocardial perfusion in patients. The deficiencies of some of the older methods (thermodilution and gas clearance) are better appreciated and improved approaches (Doppler catheters, positron-emission tomography, and digital subtraction angiography) have been developed. The new approaches should play a major role in research and for most applications the older methods will gradually be replaced. Efforts to bring these new methods to community hospitals and practicing cardiologists should be stimulated. Doppler catheters, positron-emission tomography, and digital-subtraction angiography are commercially available and Doppler catheters and digital-subtraction angiography could be easily incorporated into routine cardiac catheterization procedures. The Doppler catheter is the most inexpensive and probably the simplest to apply. In our opinion, routine measurements of coronary flow reserve will significantly improve the care of patients with coronary obstructive disease and other diseases that impair myocardial perfusion. If coronary reserve measurements are used frequently, patient selection for coronary angioplasty and bypass surgery will no longer depend entirely on visual assessment of percent diameter stenosis, a very poor criterion in many situations. Also, patients with chest pain syndromes, normal coronary vessels, and impaired coronary reserve will be identified and perhaps some effective treatment for this condition will be devised. 77 references

  14. Lower urinary tract symptoms and urinary flow rates in female patients with hyperthyroidism.

    Science.gov (United States)

    Ho, Chen-Hsun; Chang, Tien-Chun; Guo, Ya-Jun; Chen, Shyh-Chyan; Yu, Hong-Jeng; Huang, Kuo-How

    2011-01-01

    To investigate lower urinary tract symptoms (LUTS) and voiding function in a cohort of hyperthyroid women. The autonomic nervous system (ANS) imbalance has been thought to cause LUTS in hyperthyroidism. Between January 2008 and December 2008, 65 newly diagnosed, untreated female hyperthyroid patients were enrolled in this study. Another 62 age-matched healthy women were enrolled as a control group. Demographics, LUTS, urinary flow rates, hyperthyroid symptoms, and serum levels of thyroid hormones were recorded before and after the medical treatment for hyperthyroidism. Compared with the control group, the hyperthyroid patients had a higher mean symptom score of frequency (1.15 ± 1.75 vs 0.31 ± 1.05, P = .01), incomplete emptying (0.91 ± 1.47 vs 0.29 ± 1.12, P = .02), straining (1.05 ± 0.85 vs 0.27 ± 0.51, P Hyperthyroid women demonstrated a lower mean peak flow rate (25.0 ± 5.3 vs 28.6 ± 6.1 mL/s, P = .02). After treatment, both LUTS and flow rates improved significantly. The severity of LUTS was associated with neither serum levels of thyroid hormone nor other hyperthyroid symptoms. Hyperthyroid women have worse LUTS and lower peak flow rates than healthy controls. However, the severity of LUTS is only mild (IPSS hyperthyroidism. The exact mechanisms of LUTS and/or lower urinary tract dysfunction in hyperthyroidism require further investigation. Copyright © 2011 Elsevier Inc. All rights reserved.

  15. Improved Diffuse Fluorescence Flow Cytometer Prototype for High Sensitivity Detection of Rare Circulating Cells In Vivo

    Science.gov (United States)

    Pestana, Noah Benjamin

    Accurate quantification of circulating cell populations is important in many areas of pre-clinical and clinical biomedical research, for example, in the study of cancer metastasis or the immune response following tissue and organ transplants. Normally this is done "ex-vivo" by drawing and purifying a small volume of blood and then analyzing it with flow cytometry, hemocytometry or microfludic devices, but the sensitivity of these techniques are poor and the process of handling samples has been shown to affect cell viability and behavior. More recently "in vivo flow cytometry" (IVFC) techniques have been developed where fluorescently-labeled cells flowing in a small blood vessel in the ear or retina are analyzed, but the sensitivity is generally poor due to the small sampling volume. To address this, our group recently developed a method known as "Diffuse Fluorescence Flow Cytometry" (DFFC) that allows detection and counting of rare circulating cells with diffuse photons, offering extremely high single cell counting sensitivity. In this thesis, an improved DFFC prototype was designed and validated. The chief improvements were three-fold, i) improved optical collection efficiency, ii) improved detection electronics, and iii) development of a method to mitigate motion artifacts during in vivo measurements. In combination, these improvements yielded an overall instrument detection sensitivity better than 1 cell/mL in vivo, which is the most sensitive IVFC system reported to date. Second, development and validation of a low-cost microfluidic device reader for analysis of ocular fluids is described. We demonstrate that this device has equivalent or better sensitivity and accuracy compared a fluorescence microscope, but at an order-of-magnitude reduced cost with simplified operation. Future improvements to both instruments are also discussed.

  16. TEL4Health – Mobile tools to improve patient safety

    NARCIS (Netherlands)

    Drachsler, Hendrik; Kalz, Marco; Specht, Marcus

    2013-01-01

    Drachsler, H., Kalz, M., & Specht, M. (2013, 10 October). TEL4Health – Mobile tools to improve patient safety. Presentation given at the blended learning platform of the Netherlands Organisation for Hospitals (Nederlandse Vereniging van Ziekenhuizen), Utrecht, The Netherlands.

  17. Inhaler Reminders Significantly Improve Asthma Patients' Use of Controller Medications

    Science.gov (United States)

    ... controller medications Share | Inhaler reminders significantly improve asthma patients’ use of controller medications Published Online: July 22, ... the burden and risk of asthma, but many patients do not use them regularly. This poor adherence ...

  18. Improving stroke care for patients at Cavan hospital [poster

    LENUS (Irish Health Repository)

    Murugasu, G Dr.

    2013-07-01

    Under the Quality and Continuing Care Directorate (QCCD) in stroke care Cavan General Hospital was identified as a hospital that received a large number of stroke and TIA patients. A programme was established to improve services to this population.

  19. Does external evaluation of laboratories improve patient safety?

    Science.gov (United States)

    Noble, Michael A

    2007-01-01

    Laboratory accreditation and External Quality Assessment (also called proficiency testing) are mainstays of laboratory quality assessment and performance. Both practices are associated with examples of improved laboratory performance. The relationship between laboratory performance and improved patient safety is more difficult to assess because of the many variables that are involved with patient outcome. Despite this difficulty, the argument to continue external evaluation of laboratories is too compelling to consider the alternative.

  20. Improving patient satisfaction with pain management using Six Sigma tools.

    Science.gov (United States)

    DuPree, Erin; Martin, Lisa; Anderson, Rebecca; Kathuria, Navneet; Reich, David; Porter, Carol; Chassin, Mark R

    2009-07-01

    Patient satisfaction as a direct and public measure of quality of care is changing the way hospitals address quality improvement. The feasibility of using the Six Sigma DMAIC (Define, Measure, Analyze, Improve, Control) methodology to improve patient satisfaction as it relates to pain management was evaluated. This project used the DMAIC methodology to improve patients' overall satisfaction with pain management on two inpatient units in an urban academic medical center. Pre- and postintervention patient surveys were conducted. The DMAIC methodology provided a data-driven structure to determine the optimal improvement strategies, as well as a long-term plan for maintaining any improvements. In addition, the Change Acceleration Process (CAP) was used throughout the project's various DMAIC stages to further the work of the team by creating a shared need to meet the objectives of the project. Overall satisfaction with pain management "excellent" ratings increased from 37% to 54%. Both units surpassed the goal of at least 50% of responses in the "excellent" category. Several key drivers of satisfaction with pain management were uncovered in the Analyze phase of the project, and each saw rating increases from the pre-intervention to postintervention surveys. Ongoing monitoring by the hospital inpatient satisfaction survey showed that the pain satisfaction score improved in subsequent quarters as compared with the pre-intervention period. The Six Sigma DMAIC methodology can be used successfully to improve patient satisfaction. The project led to measurable improvements in patient satisfaction with pain management, which have endured past the duration of the Six Sigma project. The Control phase of DMAIC allows the improvements to be incorporated into daily operations.

  1. Salivary flow and its relationship to oral signs and symptoms in patients with dry eyes.

    Science.gov (United States)

    Koseki, M; Maki, Y; Matsukubo, T; Ohashi, Y; Tsubota, K

    2004-03-01

    The aim of this study was to investigate oral symptoms and clinical parameters in dry eye patients. Subjective reports of the sensation of a dry mouth, salivary flow rates, and clinical parameters of oral disease related to three different types of dry eye patients were examined. There were 224 individuals, including dry eye patients and control subjects. The dry eye patients were classified into three types: patients with Sjögren's syndrome (SS-DE), patients without SS-DE (non-SS-DE), and patients with Stevens-Johnson syndrome (SJS-DE). Salivary flow rates were measured using two kinds of sialometry. Subjective and objective oral symptoms and signs were also examined. Over half of the dry eye patients complained of a dry mouth. The flow rates of their stimulated whole saliva and parotid saliva were significantly lower than those of the control groups (P Candida frequently occurred in dry eye patients.

  2. Improving the performance of a compression ignition engine by directing flow of inlet air

    Science.gov (United States)

    Kemper, Carlton

    1946-01-01

    The object of this report is to present the results of tests performed by the National Advisory Committee for Aeronautics to determine the effect on engine performance of directing the flow of the inlet air to a 5-inch by 7-inch cylinder, solid injection, compression ignition engine, After a few preliminary tests, comparative runs were made at a speed of 1500 r.p.m. with and without directed air flow. It was found that directing the flow of the inlet air toward the fuel injection valve gave steadier engine operation, and an appreciable increase in power, and decreased fuel consumption. The results indicate the possibility of improving the performance of a given type of combustion chamber without changing its shape and with no change in valve timing. They would also seem to prove that directional turbulence, set up before the inlet valve of a four-stroke cycle engine, continues in the engine cylinder throughout the compression stroke.

  3. Leukocyte and platelet depletion improves blood flow and function in a renal transplant model.

    Science.gov (United States)

    Yates, Phillip J; Hosgood, Sarah A; Nicholson, Michael L

    2012-01-01

    Donation after cardiac death (DCD) donors are an important source of organs for transplantation. Due to warm and cold ischemic injury, DCD kidneys undergo a significant reperfusion insult when transplanted. This is manifested clinically as a high incidence of delayed graft function (DGF) and primary non-function (PNF). The importance of leukocytes in the generation of reperfusion injury is pivotal. Using an ex vivo porcine model of kidney transplantation, the effects of reperfusion with leukocyte and platelet depleted blood (LDB) and whole blood (WB) on renal blood flow and function were compared. Hemodynamic measurements were recorded, and biochemical, hematological, and histologic samples taken at set time-points. Reperfusion with LDB improved renal blood flow significantly compared with WB reperfusion. In addition, there was a significant improvement in creatinine clearance and renal oxygen consumption, but not fractional excretion of sodium, acid-base homeostasis, urinary nitric oxide (NO), or 8-isoprostane levels. This study represents a good model for the initial reperfusion period in renal transplantation. Improvement in only some functional markers and neither urinary NO nor 8-isoprostane levels indicates that improved blood flow alone is not sufficient to reverse the severe ischemic insult endured by DCD kidneys. Copyright © 2012 Elsevier Inc. All rights reserved.

  4. Improving sensitivity in micro-free flow electrophoresis using signal averaging

    Science.gov (United States)

    Turgeon, Ryan T.; Bowser, Michael T.

    2009-01-01

    Microfluidic free-flow electrophoresis (μFFE) is a separation technique that separates continuous streams of analytes as they travel through an electric field in a planar flow channel. The continuous nature of the μFFE separation suggests that approaches more commonly applied in spectroscopy and imaging may be effective in improving sensitivity. The current paper describes the S/N improvements that can be achieved by simply averaging multiple images of a μFFE separation; 20–24-fold improvements in S/N were observed by averaging the signal from 500 images recorded for over 2 min. Up to an 80-fold improvement in S/N was observed by averaging 6500 images. Detection limits as low as 14 pM were achieved for fluorescein, which is impressive considering the non-ideal optical set-up used in these experiments. The limitation to this signal averaging approach was the stability of the μFFE separation. At separation times longer than 20 min bubbles began to form at the electrodes, which disrupted the flow profile through the device, giving rise to erratic peak positions. PMID:19319908

  5. The clinical study of cerebral blood flow imaging in patients with early syphilis

    International Nuclear Information System (INIS)

    Liu Zengli; Shi Xin; Wu Jinchang; Tang Jun; Zhong Jijun

    2003-01-01

    Objective: To study the clinical value of cerebral blood flow imaging for evaluation of patients with early syphilis. Methods: Fifty-three patients with early syphilis underwent cerebral blood flow imaging using 99 Tc m -ethylenecysteinate dimer(ECD). Regional cerebral blood flow (rCBF) changes were analyzed. Results: The acquired images of 53 patients were graded as 5 types. The rCBF was significantly depressed in 48 of 53 patients mainly in the areas dominated by anterior cerebral artery and middle cerebral artery. Conclusion: Treponema pallidum (TP) could start invading central nervous system at the early stage of infection

  6. 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.

  7. Kinesthetic taping improves walking function in patients with stroke

    DEFF Research Database (Denmark)

    Boeskov, Birgitte; Carver, Line Tornehøj; von Essen-Leise, Anders

    2014-01-01

    BACKGROUND: Stroke is an important cause of severe disability and impaired motor function. Treatment modalities that improve motor function in patients with stroke are needed. The objective of this study was to investigate the effect of kinesthetic taping of the anterior thigh and knee on maximal...... be a valuable adjunct in physical therapy and rehabilitation of patients with stroke....

  8. Which patients improve the most from arthritis rehabilitation?

    DEFF Research Database (Denmark)

    Hagel, Sofia; Lindqvist, Elisabet; Petersson, Ingemar F

    2014-01-01

    Objective: To study health-related quality of life (HRQoL) in arthritis rehabilitation performed by multidisciplinary teams in patients with chronic inflammatory arthritis. Predictors of change in health-related quality of life and the proportion of patients with clinical improvement were investi...

  9. Using Cognitive Load Theory to Understand and Improve Patient Handoffs

    NARCIS (Netherlands)

    Young, J.Q.

    2016-01-01

    Introduction Transfers of patients from one physician to another (handovers) are ubiquitous and occur with increasing frequency. Handovers are a common source of communication failures, which lead to medical errors and harm to patients. Considerable attention has focused on interventions to improve

  10. Improving Patient Safety Culture in Primary Care: A Systematic Review

    NARCIS (Netherlands)

    Verbakel, Natasha J.; Langelaan, Maaike; Verheij, Theo J. M.; Wagner, Cordula; Zwart, Dorien L. M.

    Background: Patient safety culture, described as shared values, attitudes and behavior of staff in a health-care organization, gained attention as a subject of study as it is believed to be related to the impact of patient safety improvements. However, in primary care, it is yet unknown, which

  11. Patient and provider perspectives on improving the linkage of HIV ...

    African Journals Online (AJOL)

    This study examined barriers and facilitators to the linkage of HIV-positive pregnant women from antenatal care (ANC) to long-term HIV care from patient and provider perspectives, following the implementation of a collaborative quality improvement project in Eastern Uganda. It also solicited recommendations for improving ...

  12. Coronary physiological assessment combining fractional flow reserve and index of microcirculatory resistance in patients undergoing elective percutaneous coronary intervention with grey zone fractional flow reserve.

    Science.gov (United States)

    Niida, Takayuki; Murai, Tadashi; Yonetsu, Taishi; Kanaji, Yoshihisa; Usui, Eisuke; Matsuda, Junji; Hoshino, Masahiro; Araki, Makoto; Yamaguchi, Masao; Hada, Masahiro; Ichijyo, Sadamitsu; Hamaya, Rikuta; Kanno, Yoshinori; Isobe, Mitsuaki; Kakuta, Tsunekazu

    2018-03-08

    The aim of this study is to investigate the association between fractional flow reserve (FFR) values and change in coronary physiological indices after elective percutaneous coronary intervention (PCI). Decision making for revascularization when FFR is 0.75-0.80 is controversial. A retrospective analysis was performed of 296 patients with stable angina pectoris who underwent physiological examinations before and after PCI. To investigate the differences of coronary flow improvement between territories with low-FFR (zone FFR (0.75-0.80), serial changes in physiological indices including mean transit time (Tmn), coronary flow reserve (CFR), and index of microcirculatory resistance (IMR) were compared between these two groups. Compared to low-FFR territories, grey-zone FFR territories showed significantly lower prevalence of Tmn shortening, CFR improvement, and decrease in IMR (Tmn shorting, 63.9% vs. 87.0%, P 51.3% vs. 63.3%, P = .040) and lower extent of their absolute changes (Tmn shorting, 0.06 (-0.03 to 0.16) vs. 0.22 (0.07-0.45), P zone FFR. Physiological assessment combining FFR and IMR may help identify patients who may benefit by PCI, particularly those in the grey zone. © 2018 Wiley Periodicals, Inc.

  13. Improving patient satisfaction through physician education, feedback, and incentives.

    Science.gov (United States)

    Banka, Gaurav; Edgington, Sarah; Kyulo, Namgyal; Padilla, Tony; Mosley, Virgie; Afsarmanesh, Nasim; Fonarow, Gregg C; Ong, Michael K

    2015-08-01

    Patient satisfaction has been associated with improved outcomes and become a focus of reimbursement. Evaluate an intervention to improve patient satisfaction. Nonrandomized, pre-post study that took place from 2011 to 2012. Large tertiary academic medical center. Internal medicine (IM) resident physicians, non-IM resident physicians, and adult patients of the resident physicians. IM resident physicians were provided with patient satisfaction education through a conference, real-time individualized patient satisfaction score feedback, monthly recognition, and incentives for high patient-satisfaction scores. Patient satisfaction on physician-related and overall satisfaction questions on the HCAHPS survey. We conducted a difference-in-differences regression analysis comparing IM and non-IM patient responses, adjusting for differences in patient characteristics. In our regression analysis, the percentage of patients who responded positively to all 3 physician-related Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) questions increased by 8.1% in the IM and 1.5% in the control cohorts (absolute difference 6.6%, P = 0.04). The percentage of patients who would definitely recommend this hospital to friends and family increased by 7.1% in the IM and 1.5% in the control cohorts (absolute difference 5.6%, P = 0.02). The national average for the HCAHPS outcomes studied improved by no more than 3.1%. This study was nonrandomized and was conducted at a single site. To our knowledge, this is the first intervention associated with a significant improvement in HCAHPS scores. This may serve as a model to increase patient satisfaction, hospital revenue, and train resident physicians. © 2015 Society of Hospital Medicine.

  14. Mortality in patients with TIMI 3 flow after PCI in relation to time delay to reperfusion.

    Science.gov (United States)

    Vichova, Teodora; Maly, Marek; Ulman, Jaroslav; Motovska, Zuzana

    2016-03-01

    Percutaneous coronary intervention (PCI) performed within 12 h from symptom onset enables complete blood flow restoration in infarct-related artery in 90% of patients. Nevertheless, even with complete restoration of epicardial blood flow in culprit vessel (postprocedural Thrombolysis in Myocardial Infarction (TIMI) flow grade 3), myocardial perfusion at tissue level may be insufficient. We hypothesized that the outcome of patients with STEMI/bundle branch block (BBB)-myocardial infarction and post-PCI TIMI 3 flow is related to the time to reperfusion. Observational study based on a retrospective analysis of population of 635 consecutive patients with STEMI/BBB-MI and post-PCI TIMI 3 flow from January 2009 to December 2011 (mean age 63 years, 69.6% males). Mortality of patients was evaluated in relation to the time from symptom onset to reperfusion. A total of 83 patients (13.07%) with postprocedural TIMI 3 flow after PCI had died at 1-year follow-up. Median TD in patients who survived was 3.92 h (iqr 5.43), in patients who died 6.0 h (iqr 11.42), P = 0.004. Multiple logistic regression analysis identified time delay ≥ 9 h as significantly related to 1-year mortality of patients with STEMI/BBB-MI and post-PCI TIMI 3 flow (OR 1.958, P = 0.026). Other significant variables associated with mortality in multivariate regression analysis were: left ventricle ejection fraction 65 years (P 2 (P PCI.

  15. Improving flow patterns and spillage characteristics of a box-type commercial kitchen hood.

    Science.gov (United States)

    Huang, Rong Fung; Chen, Jia-Kun; Han, Meng-Ji; Priyambodo, Yusuf

    2014-01-01

    A conventional box-type commercial kitchen hood and its improved version (termed the "IQV commercial kitchen hood") were studied using the laser-assisted smoke flow visualization technique and tracer-gas (sulfur hexafluoride) detection methods. The laser-assisted smoke flow visualization technique qualitatively revealed the flow field of the hood and the areas apt for leakages of hood containment. The tracer-gas concentration detection method measured the quantitative leakage levels of the hood containment. The oil mists that were generated in the conventional box-type commercial kitchen hood leaked significantly into the environment from the areas near the front edges of ceiling and side walls. Around these areas, the boundary-layer separation occurred, inducing highly unsteady and turbulent recirculating flow, and leading to spillages of hood containment due to inappropriate aerodynamic design at the front edges of the ceiling and side walls. The tracer-gas concentration measurements on the conventional box-type commercial kitchen hood showed that the sulfur hexafluoride concentrations detected at the hood face attained very large values on an order of magnitude about 10(3)-10(4) ppb. By combining the backward-offset narrow suction slot, deflection plates, and quarter-circular arcs at the hood entrance, the IQV commercial kitchen hood presented a flow field containing four backward-inclined cyclone flow structures. The oil mists generated by cooking were coherently confined in these upward-rising cyclone flow structures and finally exhausted through the narrow suction slot. The tracer-gas concentration measurements on the IQV commercial kitchen hood showed that the order of magnitude of the sulfur hexafluoride concentrations detected at the hood face is negligibly small--only about 10(0) ppb across the whole hood face.

  16. Improved Design of PECS to reduce Flow Instability for EU-APR1400

    International Nuclear Information System (INIS)

    Hwang, Do Hyun; Lee, Keunsung

    2014-01-01

    For EU-APR1400, PECS (Passive Ex-vessel corium retaining and Cooling System), so-called core catcher, was adopted to keep the integrity of basemat in containment by preventing MCCI (Molten Core Concrete Interaction) through retaining core debris and cooling corium outside the reactor vessel. In this paper, the improved design of PECS is presented to increase coolability by reducing flow instability in the region of cooling channel. In this paper, flow instability analysis was carried out using CFD code to find out the most improved design of PECS, which is to increase coolability by reducing bubble entrainment in the region of cooling channel. The reduction of bubble entrainment in the downcomer facilitates higher mass flow rates in the downcomer. Among presented four designed for the downcomer of PECS, the superstep design shows the highest mass flow rate and the lowest gas holdup in the downcomer as well as in the cooling channel. Compared with the existing design, the elimination of the horizontal part and the addition of an extra space above the vertical entrance to the downcomer seem to help the separation of the vapor

  17. Train flow chaos analysis based on an improved cellular automata model

    International Nuclear Information System (INIS)

    Meng, Xuelei; Xiang, Wanli; Jia, Limin; Xu, Jie

    2015-01-01

    To control the chaos in the railway traffic flow and offer valuable information for the dispatchers of the railway system, an improved cellular model is presented to detect and analyze the chaos in the traffic flow. We first introduce the working mechanism of moving block system, analyzing the train flow movement characteristics. Then we improve the cellular model on the evolution rules to adjust the train flow movement. We give the train operation steps from three cases: the trains running on a railway section, a train will arrive in a station and a train will departure from a station. We simulate 4 trains to run on a high speed section fixed with moving block system and record the distances between the neighbor trains and draw the Poincare section to analyze the chaos in the train operation. It is concluded that there is not only chaos but order in the train operation system with moving blocking system and they can interconvert to each other. The findings have the potential value in train dispatching system construction and offer supporting information for the daily dispatching work.

  18. Performance improvement of a cross-flow hydro turbine by air layer effect

    International Nuclear Information System (INIS)

    Choi, Y D; Yoon, H Y; Inagaki, M; Ooike, S; Kim, Y J; Lee, Y H

    2010-01-01

    The purpose of this study is not only to investigate the effects of air layer in the turbine chamber on the performance and internal flow of the cross-flow turbine, but also to suggest a newly developed air supply method. Field test is performed in order to measure the output power of the turbine by a new air supply method. CFD analysis on the performance and internal flow of the turbine is conducted by an unsteady state calculation using a two-phase flow model in order to embody the air layer effect on the turbine performance effectively.The result shows that air layer effect on the performance of the turbine is considerable. The air layer located in the turbine runner passage plays the role of preventing a shock loss at the runner axis and suppressing a recirculation flow in the runner. The location of air suction hole on the chamber wall is very important factor for the performance improvement. Moreover, the ratio between air from suction pipe and water from turbine inlet is also significant factor of the turbine performance.

  19. Pilot Study of Flow and Meaningfulness as Psychological Learning Concepts in Patient Education: A Short Report

    DEFF Research Database (Denmark)

    Nicic, Sara; Nørby, Karina; Bruun Johansen, Clea

    2014-01-01

    of this study was to investigate the applicability of these concepts of positive psychological theory in a patient education setting. Methods: This pilot study combines participating observation of group based patient education and 8 qualitative interviews with 4 patients with type 2 diabetes. Meaning......Abstract Background: The aim of this pilot study was to explore patient experiences of meaningfulness and flow related to group based patient education in type 2 diabetes. Meaningfulness and flow are underexposed as psychological learning concepts in patient education, and the ambition...

  20. Effectiveness of treatment with donepezil hydrochloride and changes in regional cerebral blood flow in patients with Alzheimer's disease

    International Nuclear Information System (INIS)

    Yoshida, Tsunetaka; Ha-Kawa, S.; Yoshimura, Masafumi; Nobuhara, Kenji; Kinoshita, Toshihiko; Sawada, Satoshi

    2007-01-01

    The objective of this study was to elucidate the relationship between the effects of donepezil hydrochloride (donepezil) and cerebral blood flow, and to evaluate the usefulness of cerebral blood flow imaging in assessing and predicting treatment effectiveness. The subjects were 29 outpatients (12 men and 17 women; age 50-82 years; mean age 69.2 years), who had received a diagnosis of Alzheimer's disease (AD). Efficacy was evaluated before donepezil administration; after 1 month, 3 months, and 6 months of drug administration; and at 1 year after completion of administration using the Japanese version of the Alzheimer's disease assessment scale-cognitive subscale (ADAS-cog), as a measure of cognitive function. The ADAS-cog has been frequently used to evaluate cognitive function in AD patients. Patients whose ADAS-cog scores improved by 3 or more points during the observation period were classified as responders, and those with no improvement were classified as nonresponders. 123 I-iofetamine (IMP) was used for single photon emission computed tomography cerebral blood flow scintigraphy. On the basis of ADAS-cog score improvement, 22 of the 29 patients were responders (7 men and 15 women; age 50-82 years; mean age 69.0 years) and seven were nonresponders (5 men and 2 women; age 61-80 years; mean age 70.0 years). The results indicate that a difference in cerebral blood flow responsiveness after 1 month of treatment distinguishes responders from nonresponders. After 1 month, blood flow was significantly decreased in all regions of nonresponders, whereas significant increases in blood flow were seen in the anterior frontal lobe and parietal lobe of responders. At that time point, blood flow in the basal ganglion differed significantly between the two groups, indicating that this difference in responsiveness after 1 month of treatment may distinguish responders from nonresponders. In cognitive function testing, the group that exhibited a complete response showed

  1. Interface flow process audit: using the patient's career as a tracer of quality of care and of system organisation

    Directory of Open Access Journals (Sweden)

    Jean-Pierre Unger

    2004-05-01

    Full Text Available Objectives: This case study aims to demonstrate the method's feasibility and capacity to improve quality of care. Several drawbacks attached to tracer condition and selected procedure audits oblige clinicians to rely on external evaluators. Interface flow process audit is an alternative method, which also favours integration of health care across institutions divide. Methods: An action research study was carried out to test the feasibility of interface flow process audit and its impact on quality improvement. An anonymous questionnaire was carried out to assess the participants' perception of the process. Results: In this study, interface flow process audit brought together general practitioners and hospital doctors to analyse the co-ordination of their activities across the primary-secondary interface. Human factors and organisational characteristics had a clear influence on implementation of the solutions. In general, the participants confirmed that the interface flow process audit helped them to analyse the quality of case management both at primary and secondary care level. Conclusions: The interface flow process audit appears a useful method for regular in-service self-evaluation. Its practice enabled to address a wide scope of clinical, managerial and economical problems. Bridging the primary-secondary care gap, interface flow process audit's focus on the patient's career combined with the broad scope of problems that can be analysed are particularly powerful features. The methodology would benefit from an evaluation of its practice on larger scale.

  2. Improved quality of life in hyperthyroidism patients after surgery.

    Science.gov (United States)

    Bukvic, Branka; Zivaljevic, Vladan; Sipetic, Sandra; Diklic, Aleksandar; Tausanovic, Katarina; Stojanovic, Dragos; Stevanovic, Dejan; Paunovic, Ivan

    2015-02-01

    The most common causes of hyperthyroidism are Graves disease (GD) and toxic nodular goiter (TNG). GD and TNG might influence patients' quality of life (QoL). The aim of our study was to analyze and compare the QoL of patients with GD with that of TNG patients and to evaluate the influence of surgical treatment on their QoL. A prospective case-control study was conducted at the Center for Endocrine surgery in Belgrade, Serbia. The ThyPRO questionnaire was used in the QoL assessment of the GD and TNG patients (31 and 28, respectively) pre- and post-operatively. All patients were receiving antithyroid drugs, and none of the patients were overtly hyperthyroid at the time of completing the preoperative questionnaire. The QoL of the GD patients was worse than that of the TNG patients, with significant differences in eye symptoms, anxiety, and sex life domains (P < 0.001, P = 0.005, and P = 0.004, respectively), preoperatively, and in eye symptoms, anxiety, emotional susceptibility, and overall QoL (P = 0.001, P = 0.027, P = 0.005 and P = 0.013, respectively), postoperatively. The improvement in QoL in the GD patients was significant after surgical treatment in all ThyPRO domains. In the TNG patients, the improvement was significant in all but one ThyPRO domain, sex life (P = 0.066). The QoL of GD patients is worse than those of TNG patients. Surgery may improve QoL in patients with GD and TNG even if they have achieved satisfying thyroid status with medication treatment, preoperatively. Copyright © 2015 Elsevier Inc. All rights reserved.

  3. Does receiving a copy of correspondence improve patients' satisfaction with their out-patient consultation?

    NARCIS (Netherlands)

    Saunders, N. C.; Georgalas, C.; Blaney, S. P. A.; Dixon, H.; Topham, J. H.

    2003-01-01

    It is standard practice to write to a patient's general practitioner (GP) following an out-patients consultation. This study set out to assess whether sending a copy of this letter to the patient improves their satisfaction with the consultation. Two hundred patients were randomly assigned to

  4. Patient handover in orthopaedics, improving safety using Information Technology.

    Science.gov (United States)

    Pearkes, Tim

    2015-01-01

    Good inpatient handover ensures patient safety and continuity of care. An adjunct to this is the patient list which is routinely managed by junior doctors. These lists are routinely created and managed within Microsoft Excel or Word. Following the merger of two orthopaedic departments into a single service in a new hospital, it was felt that a number of safety issues within the handover process needed to be addressed. This quality improvement project addressed these issues through the creation and implementation of a new patient database which spanned the department, allowing trouble free, safe, and comprehensive handover. Feedback demonstrated an improved user experience, greater reliability, continuity within the lists and a subsequent improvement in patient safety.

  5. Improving patients' and staff's experiences of acute care.

    Science.gov (United States)

    Chaplin, Rob; Crawshaw, Jacob; Hood, Chloe

    2015-03-01

    The aim of this audit was to assess the effect of the Quality Mark programme on the quality of acute care received by older patients by comparing the experiences of staff and older adults before and after the programme. Data from 31 wards in 12 acute hospitals were collected over two stages. Patients and staff completed questionnaires on the perceived quality of care on the ward. Patients rated improved experiences of nutrition, staff availability and dignity. Staff received an increase in training and reported better access to support, increased time and skill to deliver care and improved morale, leadership and teamwork. Problems remained with ward comfort and mealtimes. Overall, results indicated an improvement in ratings of care quality in most domains during Quality Mark data collection. Further audits need to explore ways of improving ward comfort and mealtime experience.

  6. Leveraging Interactive Patient Care Technology to Improve Pain Management Engagement.

    Science.gov (United States)

    Rao-Gupta, Suma; Kruger, David; Leak, Lonna D; Tieman, Lisa A; Manworren, Renee C B

    2017-12-15

    Most children experience pain in hospitals; and their parents report dissatisfaction with how well pain was managed. Engaging patients and families in the development and evaluation of pain treatment plans may improve perceptions of pain management and hospital experiences. The aim of this performance improvement project was to engage patients and families to address hospitalized pediatric patients' pain using interactive patient care technology. The goal was to stimulate conversations about pain management expectations and perceptions of treatment plan effectiveness among patients, parents, and health care teams. Plan-Do-Study-Act was used to design, develop, test, and pilot new workflows to integrate the interactive patient care technology system with the automated medication dispensing system and document actions from both systems into the electronic health record. The pediatric surgical unit and hematology/oncology unit of a free-standing, university-affiliated, urban children's hospital were selected to pilot this performance improvement project because of the high prevalence of pain from surgeries and hematologic and oncologic diseases, treatments, and invasive procedures. Documentation of pain assessments, nonpharmacologic interventions, and evaluation of treatment effectiveness increased. The proportion of positive family satisfaction responses for pain management significantly increased from fiscal year 2014 to fiscal year 2016 (p = .006). By leveraging interactive patient care technologies, patients and families were engaged to take an active role in pain treatment plans and evaluation of treatment outcomes. Improved active communication and partnership with patients and families can effectively change organizational culture to be more sensitive to patients' pain and patients' and families' hospital experiences. Copyright © 2017 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

  7. Using artificial intelligence to improve identification of nanofluid gas–liquid two-phase flow pattern in mini-channel

    Directory of Open Access Journals (Sweden)

    Jian Xiao

    2018-01-01

    Full Text Available This work combines fuzzy logic and a support vector machine (SVM with a principal component analysis (PCA to create an artificial-intelligence system that identifies nanofluid gas-liquid two-phase flow states in a vertical mini-channel. Flow-pattern recognition requires finding the operational details of the process and doing computer simulations and image processing can be used to automate the description of flow patterns in nanofluid gas-liquid two-phase flow. This work uses fuzzy logic and a SVM with PCA to improve the accuracy with which the flow pattern of a nanofluid gas-liquid two-phase flow is identified. To acquire images of nanofluid gas-liquid two-phase flow patterns of flow boiling, a high-speed digital camera was used to record four different types of flow-pattern images, namely annular flow, bubbly flow, churn flow, and slug flow. The textural features extracted by processing the images of nanofluid gas–liquid two-phase flow patterns are used as inputs to various identification schemes such as fuzzy logic, SVM, and SVM with PCA to identify the type of flow pattern. The results indicate that the SVM with reduced characteristics of PCA provides the best identification accuracy and requires less calculation time than the other two schemes. The data reported herein should be very useful for the design and operation of industrial applications.

  8. Using artificial intelligence to improve identification of nanofluid gas-liquid two-phase flow pattern in mini-channel

    Science.gov (United States)

    Xiao, Jian; Luo, Xiaoping; Feng, Zhenfei; Zhang, Jinxin

    2018-01-01

    This work combines fuzzy logic and a support vector machine (SVM) with a principal component analysis (PCA) to create an artificial-intelligence system that identifies nanofluid gas-liquid two-phase flow states in a vertical mini-channel. Flow-pattern recognition requires finding the operational details of the process and doing computer simulations and image processing can be used to automate the description of flow patterns in nanofluid gas-liquid two-phase flow. This work uses fuzzy logic and a SVM with PCA to improve the accuracy with which the flow pattern of a nanofluid gas-liquid two-phase flow is identified. To acquire images of nanofluid gas-liquid two-phase flow patterns of flow boiling, a high-speed digital camera was used to record four different types of flow-pattern images, namely annular flow, bubbly flow, churn flow, and slug flow. The textural features extracted by processing the images of nanofluid gas-liquid two-phase flow patterns are used as inputs to various identification schemes such as fuzzy logic, SVM, and SVM with PCA to identify the type of flow pattern. The results indicate that the SVM with reduced characteristics of PCA provides the best identification accuracy and requires less calculation time than the other two schemes. The data reported herein should be very useful for the design and operation of industrial applications.

  9. Performance Improvement Of Cross-Flow Filtration For High Level Waste Treatment

    International Nuclear Information System (INIS)

    Duignan, M.; Nash, C.; Poirier, M.

    2011-01-01

    In the interest of accelerating waste treatment processing, the DOE has funded studies to better understand filtration with the goal of improving filter fluxes in existing cross-flow equipment. The Savannah River National Laboratory (SRNL) was included in those studies, with a focus on start-up techniques, filter cake development, the application of filter aids (cake forming solid precoats), and body feeds (flux enhancing polymers). This paper discusses the progress of those filter studies. Cross-flow filtration is a key process step in many operating and planned waste treatment facilities to separate undissolved solids from supernate slurries. This separation technology generally has the advantage of self-cleaning through the action of wall shear stress created by the flow of waste slurry through the filter tubes. However, the ability of filter wall self-cleaning depends on the slurry being filtered. Many of the alkaline radioactive wastes are extremely challenging to filtration, e.g., those containing compounds of aluminum and iron, which have particles whose size and morphology reduce permeability. Unfortunately, low filter flux can be a bottleneck in waste processing facilities such as the Savannah River Modular Caustic Side Solvent Extraction Unit and the Hanford Waste Treatment Plant. Any improvement to the filtration rate would lead directly to increased throughput of the entire process. To date increased rates are generally realized by either increasing the cross-flow filter axial flowrate, limited by pump capacity, or by increasing filter surface area, limited by space and increasing the required pump load. SRNL set up both dead-end and cross-flow filter tests to better understand filter performance based on filter media structure, flow conditions, filter cleaning, and several different types of filter aids and body feeds. Using non-radioactive simulated wastes, both chemically and physically similar to the actual radioactive wastes, the authors performed

  10. PERFORMANCE IMPROVEMENT OF CROSS-FLOW FILTRATION FOR HIGH LEVEL WASTE TREATMENT

    Energy Technology Data Exchange (ETDEWEB)

    Duignan, M.; Nash, C.; Poirier, M.

    2011-01-12

    In the interest of accelerating waste treatment processing, the DOE has funded studies to better understand filtration with the goal of improving filter fluxes in existing cross-flow equipment. The Savannah River National Laboratory (SRNL) was included in those studies, with a focus on start-up techniques, filter cake development, the application of filter aids (cake forming solid precoats), and body feeds (flux enhancing polymers). This paper discusses the progress of those filter studies. Cross-flow filtration is a key process step in many operating and planned waste treatment facilities to separate undissolved solids from supernate slurries. This separation technology generally has the advantage of self-cleaning through the action of wall shear stress created by the flow of waste slurry through the filter tubes. However, the ability of filter wall self-cleaning depends on the slurry being filtered. Many of the alkaline radioactive wastes are extremely challenging to filtration, e.g., those containing compounds of aluminum and iron, which have particles whose size and morphology reduce permeability. Unfortunately, low filter flux can be a bottleneck in waste processing facilities such as the Savannah River Modular Caustic Side Solvent Extraction Unit and the Hanford Waste Treatment Plant. Any improvement to the filtration rate would lead directly to increased throughput of the entire process. To date increased rates are generally realized by either increasing the cross-flow filter axial flowrate, limited by pump capacity, or by increasing filter surface area, limited by space and increasing the required pump load. SRNL set up both dead-end and cross-flow filter tests to better understand filter performance based on filter media structure, flow conditions, filter cleaning, and several different types of filter aids and body feeds. Using non-radioactive simulated wastes, both chemically and physically similar to the actual radioactive wastes, the authors performed

  11. Collateral Flow and White Matter Disease in Patients with Internal Carotid Artery Occlusion.

    Science.gov (United States)

    Ishikawa, Mami; Sugawara, Hitoshi; Nagai, Mutsumi; Kusaka, Gen; Tanaka, Yuichi; Naritaka, Heiji

    2017-01-01

    When an internal carotid artery (ICA) occludes, a patient may develop cerebral infarction (CI). We investigated whether CI caused by ICA occlusion (ICAO) is associated with collateral flow through the anterior and posterior communicating arteries (ACoA and PCoA). In 100 patients with ICAO, we investigated CI and white matter disease by performing an MRI and the anatomy of the ACoA and PCoA were investigated by performing magnetic resonance angiography. All patients were divided into the symptomatic CI group or the no-CI group. The collateral flow pathway was estimated by the anterior cerebral artery (ACA)-PCoA score and the collateral flow volume after ICAO was estimated by the middle cerebral artery (MCA) flow score, based on how well the MCA was visualized. Of 100 patients with ICAO, the symptomatic CI group included 36 patients. ACA-PCoA score and white matter disease grades were significantly higher in the CI group (indicating poor collateral flow). More than 80% of patients with an ACA-PCoA score of 4 (poor collateral) experienced symptomatic CI. Thirty-one symptomatic CI patients (86%) had an MCA flow score of 1 or 2 (decreased MCA flow). The ACA-PCoA score and white matter disease grade may suggest an increased risk of CI following ICAO. © 2016 S. Karger AG, Basel.

  12. Effect of STA-proximal MCA bypass. Improvement of cerebral blood flow and metabolism and neuropsychological function

    Energy Technology Data Exchange (ETDEWEB)

    Ogawa, Akira; Funayama, Masayuki; Miura, Kazuyuki; Ogasawara, Kuniaki; Suzuki, Michiyasu; Kuroda, Kiyoshi; Sasaki, Toshiaki [Iwate Medical Univ., Morioka (Japan). School of Medicine

    1998-11-01

    We investigated cerebral blood flow (CBF) and metabolism in patients with hemodynamic ischemia by positron emission tomography (PET) and thermal diffusion flow meter. We also studied neuropsychological functions to evaluate the effects of surgical revascularization. Bypass surgery of the superficial temporal artery to the proximal middle cerebral artery was performed on 26 patients satisfying the following categories: stenosis or occlusive lesion in main cerebral arteries; no marked focus of infarction on CT or MRI. PET was performed before and 1 month after the operation, and CBF, the cerebral metabolic rate of oxygen (CMRO{sub 2}) and oxygen extraction fraction (OEF) were analyzed. Cerebrovascular reserve capacity (CVRC) was also calculated after acetazolamide challenge. CBF during the operation was continuously measured with a thermal diffusion flow meter. CO{sub 2} response of CBF was analyzed before and after anastomosis. Neuropsychological functions were evaluated by Hasegawa dementia scale revised (HDS-R), mini-mental state examination (MMSE) and Wechsler adult intelligence scale revised (WAIS-R). Before the operation, increase in OEF accorded with the decrease in CBF, and a significant relationship between both CBF and CVRC, and OEF and CVRC was found. A decrease in CVRC was noted prior to a decrease in CBF and elevation of OEF. CVRC caused by acetazolamide might reflect CO{sub 2} reactivity. Significant improvement of CBF and CVRC, and normalization of OEF were observed after the operation. Also, significant improvement of neuropsychological function was observed by HDS-R and WAIS-R. Disturbance in neuropsychological function might reflect elevation of OEF. (author)

  13. How patients can improve the accuracy of their medical records.

    Science.gov (United States)

    Dullabh, Prashila M; Sondheimer, Norman K; Katsh, Ethan; Evans, Michael A

    2014-01-01

    Assess (1) if patients can improve their medical records' accuracy if effectively engaged using a networked Personal Health Record; (2) workflow efficiency and reliability for receiving and processing patient feedback; and (3) patient feedback's impact on medical record accuracy. Improving medical record' accuracy and associated challenges have been documented extensively. Providing patients with useful access to their records through information technology gives them new opportunities to improve their records' accuracy and completeness. A new approach supporting online contributions to their medication lists by patients of Geisinger Health Systems, an online patient-engagement advocate, revealed this can be done successfully. In late 2011, Geisinger launched an online process for patients to provide electronic feedback on their medication lists' accuracy before a doctor visit. Patient feedback was routed to a Geisinger pharmacist, who reviewed it and followed up with the patient before changing the medication list shared by the patient and the clinicians. The evaluation employed mixed methods and consisted of patient focus groups (users, nonusers, and partial users of the feedback form), semi structured interviews with providers and pharmacists, user observations with patients, and quantitative analysis of patient feedback data and pharmacists' medication reconciliation logs. (1) Patients were eager to provide feedback on their medications and saw numerous advantages. Thirty percent of patient feedback forms (457 of 1,500) were completed and submitted to Geisinger. Patients requested changes to the shared medication lists in 89 percent of cases (369 of 414 forms). These included frequency-or dosage changes to existing prescriptions and requests for new medications (prescriptions and over-the counter). (2) Patients provided useful and accurate online feedback. In a subsample of 107 forms, pharmacists responded positively to 68 percent of patient requests for

  14. Improvement of Power Flow Calculation with Optimization Factor Based on Current Injection Method

    Directory of Open Access Journals (Sweden)

    Lei Wang

    2014-01-01

    Full Text Available This paper presents an improvement in power flow calculation based on current injection method by introducing optimization factor. In the method proposed by this paper, the PQ buses are represented by current mismatches while the PV buses are represented by power mismatches. It is different from the representations in conventional current injection power flow equations. By using the combined power and current injection mismatches method, the number of the equations required can be decreased to only one for each PV bus. The optimization factor is used to improve the iteration process and to ensure the effectiveness of the improved method proposed when the system is ill-conditioned. To verify the effectiveness of the method, the IEEE test systems are tested by conventional current injection method and the improved method proposed separately. Then the results are compared. The comparisons show that the optimization factor improves the convergence character effectively, especially that when the system is at high loading level and R/X ratio, the iteration number is one or two times less than the conventional current injection method. When the overloading condition of the system is serious, the iteration number in this paper appears 4 times less than the conventional current injection method.

  15. Improvements on digital inline holographic PTV for 3D wall-bounded turbulent flow measurements

    International Nuclear Information System (INIS)

    Toloui, Mostafa; Mallery, Kevin; Hong, Jiarong

    2017-01-01

    Three-dimensional (3D) particle image velocimetry (PIV) and particle tracking velocimetry (PTV) provide the most comprehensive flow information for unraveling the physical phenomena in a wide range of fluid problems, from microfluidics to wall-bounded turbulent flows. Compared with other 3D PIV techniques, such as tomographic PIV and defocusing PIV, the digital inline holographic PTV (DIH-PTV) provides 3D flow measurement solution with high spatial resolution, low cost optical setup, and easy alignment and calibration. Despite these advantages, DIH-PTV suffers from major limitations including poor longitudinal resolution, human intervention (i.e. requirement for manually determined tuning parameters during tracer field reconstruction and extraction), limited tracer concentration, small sampling volume and expensive computations, limiting its broad use for 3D flow measurements. In this study, we present our latest developments on minimizing these challenges, which enables high-fidelity DIH-PTV implementation to larger sampling volumes with significantly higher particle seeding densities suitable for wall-bounded turbulent flow measurements. The improvements include: (1) adjustable window thresholding; (2) multi-pass 3D tracking; (3) automatic wall localization; and (4) continuity-based out-of-plane velocity component computation. The accuracy of the proposed DIH-PTV method is validated with conventional 2D PIV and double-view holographic PTV measurements in smooth-wall turbulent channel flow experiments. The capability of the technique in characterization of wall-bounded turbulence is further demonstrated through its application to flow measurements for smooth- and rough-wall turbulent channel flows. In these experiments, 3D velocity fields are measured within sampling volumes of 14.7  ×  50.0  ×  14.4 mm 3 (covering the entire depth of the channel) with a velocity resolution of  <1.1 mm/vector. Overall, the presented DIH-PTV method and

  16. Improving Ambient Wind Environments of a Cross-flow Wind Turbine near a Structure by using an Inlet Guide Structure and a Flow Deflector

    Institute of Scientific and Technical Information of China (English)

    Tadakazu TANINO; Shinichiro NAKAO; Genki UEBAYASHI

    2005-01-01

    A cross-flow wind turbine near a structure was tested for the performance. The results showed that the performance of a cross-flow wind turbine near a structure was up to 30% higher than the one without a structure.In addition, we tried to get higher performance of a cross-flow wind turbine by using an Inlet Guide Structure and a Flow Deflector. An Inlet Guide Structure was placed on the edge of a structure and a Flow Deflector was set near a cross-flow wind turbine and can improve ambient wind environments of the wind turbine, the maximum power coefficients were about 15 to 40% higher and the tip speed ratio range showing the high power coefficient was wide and the positive gradients were steep apparently.

  17. Improved nutritional status in elderly patients 6 months after stroke

    DEFF Research Database (Denmark)

    Brynningsen, P K; Damsgaard, Else Marie; Husted, Steen

    2007-01-01

    INTRODUCTION: Nutritional status among stroke patients has received limited attention despite the fact, that it may have an influence on clinical outcome. Previous studies have estimated that 15-20 % of patients suffer from malnutrition in the acute phase of stroke, but so far no studies have...... focused on the late rehabilitation phase after stroke in the patients own home, where the attention on nutrition may be reduced. AIMS: To determine the prevalence of malnutrition during 6 months of stroke rehabilitation, and to investigate the association between nutritional status, functional recovery...... improvement for serum proteins, and 22 % of the patients were malnourished 6 months after stroke. Udgivelsesdato: null-null...

  18. A computational procedure to improve airfoil performance considering shape and flow interactions

    International Nuclear Information System (INIS)

    Darbandi, M.; Taghvaey, M.J.; Schneider, G.E.

    2004-01-01

    Despite remarkable progress in shape design issue, there is still room to work on this topic considering different flow field conditions and specific aerodynamic applications. Today, the optimization techniques are known as a major tool to reach the best possible aerodynamic shape for some specific conditions. In general direct optimization techniques, the optimization process is started from choosing a suitable primitive shape and the shape is improved by suitable considerations of the design objectives and constraints. In a similar attempt, we develop a new optimization strategy to improve the airfoil shape for specified applications. The strategy involves several stages. It includes to determine the flow conditions and design parameters, to establish the objective function, to select a suitable primitive shape, to generate a mechanism for inserting gradual shape changes, to generate grids around each defined shape, to solve the flow field for each separate shape, to collect the solution data, to change the discrete data to the continuous distribution functions, to construct the objective function, and to minimize the objective function using the steepest descent approach. No constraint function is incorporated into the constructed objective function. The cruise flight of an aircraft at an specified altitude is supposed to be the flow field conditions around the proposed airfoil. Nevertheless, the flow field is assumed to be viscous and compressible as well as turbulent. The procedure is tested starting from two generic airfoil shapes with and without camber. The developed algorithm works well for both cases; however, it may not converge to identical shapes if the primitive shapes are not identical. (author)

  19. A computational procedure to improve airfoil performance considering shape and flow interactions

    Energy Technology Data Exchange (ETDEWEB)

    Darbandi, M.; Taghvaey, M.J. [Sharif Univ. of Technology, Dept. of Aerospace Engineering, Tehran (Iran, Islamic Republic of)]. E-mail: darbandi@sharif.edu; Schneider, G.E. [Univ. of Waterloo, Dept. of Mechanical Engineering, Waterloo, Ontario (Canada)

    2004-07-01

    Despite remarkable progress in shape design issue, there is still room to work on this topic considering different flow field conditions and specific aerodynamic applications. Today, the optimization techniques are known as a major tool to reach the best possible aerodynamic shape for some specific conditions. In general direct optimization techniques, the optimization process is started from choosing a suitable primitive shape and the shape is improved by suitable considerations of the design objectives and constraints. In a similar attempt, we develop a new optimization strategy to improve the airfoil shape for specified applications. The strategy involves several stages. It includes to determine the flow conditions and design parameters, to establish the objective function, to select a suitable primitive shape, to generate a mechanism for inserting gradual shape changes, to generate grids around each defined shape, to solve the flow field for each separate shape, to collect the solution data, to change the discrete data to the continuous distribution functions, to construct the objective function, and to minimize the objective function using the steepest descent approach. No constraint function is incorporated into the constructed objective function. The cruise flight of an aircraft at an specified altitude is supposed to be the flow field conditions around the proposed airfoil. Nevertheless, the flow field is assumed to be viscous and compressible as well as turbulent. The procedure is tested starting from two generic airfoil shapes with and without camber. The developed algorithm works well for both cases; however, it may not converge to identical shapes if the primitive shapes are not identical. (author)

  20. Improved teaching-learning-based and JAYA optimization algorithms for solving flexible flow shop scheduling problems

    Science.gov (United States)

    Buddala, Raviteja; Mahapatra, Siba Sankar

    2017-11-01

    Flexible flow shop (or a hybrid flow shop) scheduling problem is an extension of classical flow shop scheduling problem. In a simple flow shop configuration, a job having `g' operations is performed on `g' operation centres (stages) with each stage having only one machine. If any stage contains more than one machine for providing alternate processing facility, then the problem becomes a flexible flow shop problem (FFSP). FFSP which contains all the complexities involved in a simple flow shop and parallel machine scheduling problems is a well-known NP-hard (Non-deterministic polynomial time) problem. Owing to high computational complexity involved in solving these problems, it is not always possible to obtain an optimal solution in a reasonable computation time. To obtain near-optimal solutions in a reasonable computation time, a large variety of meta-heuristics have been proposed in the past. However, tuning algorithm-specific parameters for solving FFSP is rather tricky and time consuming. To address this limitation, teaching-learning-based optimization (TLBO) and JAYA algorithm are chosen for the study because these are not only recent meta-heuristics but they do not require tuning of algorithm-specific parameters. Although these algorithms seem to be elegant, they lose solution diversity after few iterations and get trapped at the local optima. To alleviate such drawback, a new local search procedure is proposed in this paper to improve the solution quality. Further, mutation strategy (inspired from genetic algorithm) is incorporated in the basic algorithm to maintain solution diversity in the population. Computational experiments have been conducted on standard benchmark problems to calculate makespan and computational time. It is found that the rate of convergence of TLBO is superior to JAYA. From the results, it is found that TLBO and JAYA outperform many algorithms reported in the literature and can be treated as efficient methods for solving the FFSP.

  1. Leveraging information technology to drive improvement in patient satisfaction.

    Science.gov (United States)

    Nash, Mary; Pestrue, Justin; Geier, Peter; Sharp, Karen; Helder, Amy; McAlearney, Ann Scheck

    2010-01-01

    A healthcare organization's commitment to quality and the patient experience requires senior leader involvement in improvement strategies, and accountability for goals. Further, improvement strategies are most effective when driven by data, and in the world of patient satisfaction, evidence is growing that nurse leader rounding and discharge calls are strategic tactics that can improve patient satisfaction. This article describes how The Ohio State University Medical Center (OSUMC) leveraged health information technology (IT) to apply a data-driven strategy execution to improve the patient experience. Specifically, two IT-driven approaches were used: (1) business intelligence reporting tools were used to create a meaningful reporting system including dashboards, scorecards, and tracking reports and (2) an improvement plan was implemented that focused on two high-impact tactics and data to hardwire accountability. Targeted information from the IT systems enabled clinicians and administrators to execute these strategic tactics, and senior leaders to monitor achievement of strategic goals. As a result, OSUMC's inpatient satisfaction scores on the Hospital Consumer Assessment of Healthcare Providers and Systems survey improved from 56% nines and tens in 2006 to 71% in 2009. © 2010 National Association for Healthcare Quality.

  2. Fractional flow reserve versus angiography for guidance of PCI in patients with multivessel coronary artery disease (FAME)

    DEFF Research Database (Denmark)

    van Nunen, Lokien X; Zimmermann, Frederik M; Tonino, Pim A L

    2015-01-01

    BACKGROUND: In the Fractional Flow Reserve Versus Angiography for Multivessel Evaluation (FAME) study, fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) improved outcome compared with angiography-guided PCI for up to 2 years of follow-up. The aim in this study...... was to investigate whether the favourable clinical outcome with the FFR-guided PCI in the FAME study persisted over a 5-year follow-up. METHODS: The FAME study was a multicentre trial done in Belgium, Denmark, Germany, the Netherlands, Sweden, the UK, and the USA. Patients (aged ≥ 18 years) with multivessel coronary...... artery disease were randomly assigned to undergo angiography-guided PCI or FFR-guided PCI. Before randomisation, stenoses requiring PCI were identified on the angiogram. Patients allocated to angiography-guided PCI had revascularisation of all identified stenoses. Patients allocated to FFR-guided PCI had...

  3. Evaluating the effect of clinical decision units on patient flow in seven Canadian emergency departments.

    Science.gov (United States)

    Schull, Michael J; Vermeulen, Marian J; Stukel, Therese A; Guttmann, Astrid; Leaver, Chad A; Rowe, Brian H; Sales, Anne

    2012-07-01

    To evaluate the effect of emergency department (ED) clinical decision units (CDUs) on overall ED patient flow in a pilot project funded in 2008 by the Ontario Ministry of Health and Long-Term Care (MOHLTC). A retrospective analysis of unscheduled ED visits at seven CDU pilot and nine control sites was conducted using administrative data. The authors examined trends in CDU utilization and compared outcomes between pilot-CDU and control sites 1 year prior to implementation, with the first 18 months of CDU operation. Sites that were unsuccessful in their applications for CDU program funding served as controls. Outcomes included ED length of stay (LOS), admission rates, and ED revisit rates. At CDU sites, roughly 4% of ED patients were admitted to CDUs. The presence of a pilot-CDU was independently associated with a small reduction in ED LOS for all low-acuity patients (-0.14 hour, 95% confidence interval [CI]=-0.22 to -0.07) and nonadmitted patients (-0.11 hour, 95% CI=-0.16 to -0.07). A small independent effect on absolute hospital admission rate for all high-acuity patients (-0.8%, 95% CI=-1.5% to -0.03%) and moderate-acuity patients (-0.6%, 95% CI=-1.1% to -0.2%) was also observed. Pilot-CDUs were not associated with changes in ED revisit rates. With only 4% of ED patients admitted to CDUs, the potential for efficiency gains in these EDs was limited. Nonetheless, these findings suggest small improvements in the operation of the ED through CDU implementation. Although marginal, the observed effects of CDU operation were in the desired direction of reduced ED LOS, reduced admission rate, and no increase in ED revisit rate. © 2012 by the Society for Academic Emergency Medicine.

  4. Influence of ammonia flow rate for improving properties of polycrystalline GaN

    Science.gov (United States)

    Ariff, A.; Ahmad, M. A.; Hassan, Z.; Zainal, N.

    2018-06-01

    Post-annealing treatment in ammonia ambient is widely accepted for GaN material, but less works have been done to investigate the influence of the ammonia (NH3) flow rate for reducing the N-deficiency as well as improving the quality of the material. In this work, we investigated the influence of NH3 flow rate at 1, 2, 3, and 4 slm in improving properties of a ∼1 μm thick polycrystalline GaN layer. Our simulation work suggested that the uniformity of temperature and pressure gradient of the NH3 gas did not lead to the reduction of N-deficiency of the polycrystalline GaN layer. Instead, it was found that the mitigation of the N-deficiency was strongly influenced by the fluid velocity of the NH3 gas, which had passed over the layer. Either at lower or higher fluid velocity, the chance for the active N atoms to incorporate into the GaN lattice structure was low. Therefore, the N-deficiency on the polycrystalline GaN layer could not be minimized under these conditions. As measured by EDX, the N atoms incorporation was the most effective when the NH3 flow rate at 3 slm, suggesting the flow rate significantly improved the N-deficiency of the polycrystalline GaN layer. Furthermore, it favored the formation of larger hexagonal faceted grains, with the smallest FWHM of XRD peaks from the GaN diffractions in (10 1 bar 0), (0002) and (10 1 bar 1) orientations, while allowing the polycrystalline GaN layer to show sharp and intense emissions peak of NBE in a PL spectrum.

  5. Respiratory mechanics by least squares fitting in mechanically ventilated patients: application on flow-limited COPD patients.

    Science.gov (United States)

    Volta, Carlo A; Marangoni, Elisabetta; Alvisi, Valentina; Capuzzo, Maurizia; Ragazzi, Riccardo; Pavanelli, Lina; Alvisi, Raffaele

    2002-01-01

    Although computerized methods of analyzing respiratory system mechanics such as the least squares fitting method have been used in various patient populations, no conclusive data are available in patients with chronic obstructive pulmonary disease (COPD), probably because they may develop expiratory flow limitation (EFL). This suggests that respiratory mechanics be determined only during inspiration. Eight-bed multidisciplinary ICU of a teaching hospital. Eight non-flow-limited postvascular surgery patients and eight flow-limited COPD patients. Patients were sedated, paralyzed for diagnostic purposes, and ventilated in volume control ventilation with constant inspiratory flow rate. Data on resistance, compliance, and dynamic intrinsic positive end-expiratory pressure (PEEPi,dyn) obtained by applying the least squares fitting method during inspiration, expiration, and the overall breathing cycle were compared with those obtained by the traditional method (constant flow, end-inspiratory occlusion method). Our results indicate that (a) the presence of EFL markedly decreases the precision of resistance and compliance values measured by the LSF method, (b) the determination of respiratory variables during inspiration allows the calculation of respiratory mechanics in flow limited COPD patients, and (c) the LSF method is able to detect the presence of PEEPi,dyn if only inspiratory data are used.

  6. Evaluation of Marfan patients status post valve-sparing aortic root replacement with 4D flow.

    Science.gov (United States)

    Hope, Thomas A; Kvitting, John-Peder Escobar; Hope, Michael D; Miller, D Craig; Markl, Michael; Herfkens, Robert J

    2013-11-01

    Over the past two decades elective valve-sparing aortic root replacement (V-SARR) has become more common in the treatment of patients with aortic root and ascending aortic aneurysms. Currently there are little data available to predict complications in the post-operative population. The study goal was to determine if altered flow patterns in the thoracic aorta, as measured by MRI, are associated with complications after V-SARR. Time-resolved three-dimensional phase-contrast MRI (4D flow) was used to image 12 patients with Marfan syndrome after V-SARR. The patients were followed up for an average of 5.8 years after imaging and 8.2 years after surgery. Additionally 5 volunteers were imaged for comparison. Flow profiles were visualized during peak systole using streamlines. Wall shear stress estimates and normalized flow displacement were evaluated at multiple planes in the thoracic aorta. During the follow-up period, a single patient developed a Stanford Type B aortic dissection. At initial imaging, prior to the development of the dissection, the patient had altered flow patterns, wall shear stress estimates, and increased normalized flow displacement in the thoracic aorta in comparison to the remaining V-SARR patients and volunteers. This is the first follow-up study of patients after 4D flow imaging. An aortic dissection developed in one patient with altered flow patterns and hemodynamic stresses in the thoracic aorta. These results suggest that flow and altered hemodynamics may play a role in the development of post-operative intramural hematomas and dissections. Copyright © 2013 Elsevier Inc. All rights reserved.

  7. Relationship between spontaneous expiratory flow-volume curve pattern and air-flow obstruction in elderly COPD patients.

    Science.gov (United States)

    Nozoe, Masafumi; Mase, Kyoshi; Murakami, Shigefumi; Okada, Makoto; Ogino, Tomoyuki; Matsushita, Kazuhiro; Takashima, Sachie; Yamamoto, Noriyasu; Fukuda, Yoshihiro; Domen, Kazuhisa

    2013-10-01

    Assessment of the degree of air-flow obstruction is important for determining the treatment strategy in COPD patients. However, in some elderly COPD patients, measuring FVC is impossible because of cognitive dysfunction or severe dyspnea. In such patients a simple test of airways obstruction requiring only a short run of tidal breathing would be useful. We studied whether the spontaneous expiratory flow-volume (SEFV) curve pattern reflects the degree of air-flow obstruction in elderly COPD patients. In 34 elderly subjects (mean ± SD age 80 ± 7 y) with stable COPD (percent-of-predicted FEV(1) 39.0 ± 18.5%), and 12 age-matched healthy subjects, we measured FVC and recorded flow-volume curves during quiet breathing. We studied the SEFV curve patterns (concavity/convexity), spirometry results, breathing patterns, and demographics. The SEFV curve concavity/convexity prediction accuracy was examined by calculating the receiver operating characteristic curves, cutoff values, area under the curve, sensitivity, and specificity. Fourteen subjects with COPD had a concave SEFV curve. All the healthy subjects had convex SEFV curves. The COPD subjects who had concave SEFV curves often had very severe airway obstruction. The percent-of-predicted FEV(1)% (32.4%) was the most powerful SEFV curve concavity predictor (area under the curve 0.92, 95% CI 0.83-1.00), and had the highest sensitivity (0.93) and specificity (0.88). Concavity of the SEFV curve obtained during tidal breathing may be a useful test for determining the presence of very severe obstruction in elderly patients unable to perform a satisfactory FVC maneuver.

  8. Cerebral blood flow in patients with dementia of Alzheimer's type

    DEFF Research Database (Denmark)

    Postiglione, A; Lassen, N A; Holman, B L

    1993-01-01

    In the normal brain as well as in Alzheimer's disease (AD), regional cerebral blood flow (CBF) is coupled to metabolic demand and, therefore, changes in CBF reflect variations in neuronal metabolism. The use of radionuclide techniques, such as positron emission tomography (PET) and single photon...

  9. Cross-flow turbines: physical and numerical model studies towards improved array simulations

    Science.gov (United States)

    Wosnik, M.; Bachant, P.

    2015-12-01

    Cross-flow, or vertical-axis turbines, show potential in marine hydrokinetic (MHK) and wind energy applications. As turbine designs mature, the research focus is shifting from individual devices towards improving turbine array layouts for maximizing overall power output, i.e., minimizing wake interference for axial-flow turbines, or taking advantage of constructive wake interaction for cross-flow turbines. Numerical simulations are generally better suited to explore the turbine array design parameter space, as physical model studies of large arrays at large model scale would be expensive. However, since the computing power available today is not sufficient to conduct simulations of the flow in and around large arrays of turbines with fully resolved turbine geometries, the turbines' interaction with the energy resource needs to be parameterized, or modeled. Most models in use today, e.g. actuator disk, are not able to predict the unique wake structure generated by cross-flow turbines. Experiments were carried out using a high-resolution turbine test bed in a large cross-section tow tank, designed to achieve sufficiently high Reynolds numbers for the results to be Reynolds number independent with respect to turbine performance and wake statistics, such that they can be reliably extrapolated to full scale and used for model validation. To improve parameterization in array simulations, an actuator line model (ALM) was developed to provide a computationally feasible method for simulating full turbine arrays inside Navier--Stokes models. The ALM predicts turbine loading with the blade element method combined with sub-models for dynamic stall and flow curvature. The open-source software is written as an extension library for the OpenFOAM CFD package, which allows the ALM body force to be applied to their standard RANS and LES solvers. Turbine forcing is also applied to volume of fluid (VOF) models, e.g., for predicting free surface effects on submerged MHK devices. An

  10. A universal deep learning approach for modeling the flow of patients under different severities.

    Science.gov (United States)

    Jiang, Shancheng; Chin, Kwai-Sang; Tsui, Kwok L

    2018-02-01

    The Accident and Emergency Department (A&ED) is the frontline for providing emergency care in hospitals. Unfortunately, relative A&ED resources have failed to keep up with continuously increasing demand in recent years, which leads to overcrowding in A&ED. Knowing the fluctuation of patient arrival volume in advance is a significant premise to relieve this pressure. Based on this motivation, the objective of this study is to explore an integrated framework with high accuracy for predicting A&ED patient flow under different triage levels, by combining a novel feature selection process with deep neural networks. Administrative data is collected from an actual A&ED and categorized into five groups based on different triage levels. A genetic algorithm (GA)-based feature selection algorithm is improved and implemented as a pre-processing step for this time-series prediction problem, in order to explore key features affecting patient flow. In our improved GA, a fitness-based crossover is proposed to maintain the joint information of multiple features during iterative process, instead of traditional point-based crossover. Deep neural networks (DNN) is employed as the prediction model to utilize their universal adaptability and high flexibility. In the model-training process, the learning algorithm is well-configured based on a parallel stochastic gradient descent algorithm. Two effective regularization strategies are integrated in one DNN framework to avoid overfitting. All introduced hyper-parameters are optimized efficiently by grid-search in one pass. As for feature selection, our improved GA-based feature selection algorithm has outperformed a typical GA and four state-of-the-art feature selection algorithms (mRMR, SAFS, VIFR, and CFR). As for the prediction accuracy of proposed integrated framework, compared with other frequently used statistical models (GLM, seasonal-ARIMA, ARIMAX, and ANN) and modern machine models (SVM-RBF, SVM-linear, RF, and R-LASSO), the

  11. Multiplexed lateral flow biosensors: Technological advances for radically improving point-of-care diagnoses.

    Science.gov (United States)

    Li, Jia; Macdonald, Joanne

    2016-09-15

    Lateral flow biosensors are a leading technology in point-of-care diagnostics due to their simplicity, rapidness and low cost. Their primacy in this arena continues through technological breakthroughs such as multiplexing: the detection of more than one biomarker in a single assay. Multiplexing capacity is critical for improving diagnostic efficiency, enhancing the diagnostic precision for specific diseases and reducing diagnostic cost. Here we review, for the first time, the various types and strategies employed for creating multiplexed lateral flow biosensors. These are classified into four main categories in terms of specific application or multiplexing level, namely linear, parameter, spatial and conceptual. We describe the practical applications and implications for each approach and compare their advantages and disadvantages. Importantly, multiplexing is still subject to limitations of the traditional lateral flow biosensor, such as sensitivity and specificity. However, by pushing the limitations of the traditional medium into the multiplex arena, several technological breakthroughs are emerging with novel solutions that further expand the utility of lateral flow biosensing for point-of-care applications. Copyright © 2016 Elsevier B.V. All rights reserved.

  12. Critical transport issues for improving the performance of aqueous redox flow batteries

    Science.gov (United States)

    Zhou, X. L.; Zhao, T. S.; An, L.; Zeng, Y. K.; Wei, L.

    2017-01-01

    As the fraction of electricity generated from intermittent renewable sources (such as solar and wind) grows, developing reliable energy storage technologies to store electrical energy in large scale is of increasing importance. Redox flow batteries are now enjoying a renaissance and regarded as a leading technology in providing a well-balanced solution for current daunting challenges. In this article, state-of-the-art studies of the complex multicomponent transport phenomena in aqueous redox flow batteries, with a special emphasis on all-vanadium redox flow batteries, are reviewed and summarized. Rather than elaborating on the details of previous experimental and numerical investigations, this article highlights: i) the key transport issues in each battery's component that need to be tackled so that the rate capability and cycling stability of flow batteries can be significantly improved, ii) the basic mechanisms that control the active species/ion/electron transport behaviors in each battery's component, and iii) the key experimental and numerical findings regarding the correlations between the multicomponent transport processes and battery performance.

  13. Will Incremental Hemodialysis Preserve Residual Function and Improve Patient Survival?

    Science.gov (United States)

    Davenport, Andrew

    2015-01-01

    The progressive loss of residual renal function in peritoneal dialysis patients is associated with increased mortality. It has been suggested that incremental dialysis may help preserve residual renal function and improve patient survival. Residual renal function depends upon both patient related and dialysis associated factors. Maintaining patients in an over-hydrated state may be associated with better preservation of residual renal function but any benefit comes with a significant risk of cardiovascular consequences. Notably, it is only observational studies that have reported an association between dialysis patient survival and residual renal function; causality has not been established for dialysis patient survival. The tenuous connections between residual renal function and outcomes and between incremental hemodialysis and residual renal function should temper our enthusiasm for interventions in this area. PMID:25385441

  14. The feasibility of measuring renal blood flow using transesophageal echocardiography in patients undergoing cardiac surgery.

    Science.gov (United States)

    Yang, Ping-Liang; Wong, David T; Dai, Shuang-Bo; Song, Hai-Bo; Ye, Ling; Liu, Jin; Liu, Bin

    2009-05-01

    There is no reliable method to monitor renal blood flow intraoperatively. In this study, we evaluated the feasibility and reproducibility of left renal blood flow measurements using transesophageal echocardiography during cardiac surgery. In this prospective noninterventional study, left renal blood flow was measured with transesophageal echocardiography during three time points (pre-, intra-, and postcardiopulmonary bypass) in 60 patients undergoing cardiac surgery. Sonograms from 6 subjects were interpreted by 2 blinded independent assessors at the time of acquisition and 6 mo later. Interobserver and intraobserver reproducibility were quantified by calculating variability and intraclass correlation coefficients. Patients with Doppler angles of >30 degrees (20 of 60 subjects) were eliminated from renal blood flow measurements. Left renal blood flow was successfully measured and analyzed in 36 of 60 (60%) subjects. Both interobserver and intraobserver variability were renal blood flow measurements were good to excellent (intraclass correlation coefficients 0.604-0.999). Left renal arterial luminal diameter for the pre, intra, and postcardiopulmonary bypass phases, ranged from 3.8 to 4.1 mm, renal arterial velocity from 25 to 35 cm/s, and left renal blood flow from 192 to 299 mL/min. In patients undergoing cardiac surgery, it was feasible in 60% of the subjects to measure left renal blood flow using intraoperative transesophageal echocardiography. The interobserver and intraobserver reproducibility of renal blood flow measurements was good to excellent.

  15. Computational Fluid Dynamics Modeling to Improve Natural Flow Rate and Sweet Pepper Productivity in Greenhouse

    Directory of Open Access Journals (Sweden)

    W. Limtrakarn

    2012-01-01

    Full Text Available Natural flow rate and sweet peppers productivity in tropical greenhouse are improved by CFD simulation is the main objective of this research work. Most of the greenhouse types today are in the arch shape. To develop an improved greenhouse structure for the region, the arch type was built and used as the control model. Mae Sar Mai agriculture research station under the royal project foundation was selected as the field test site. Temperature sensors with data logger were installed to monitor variation of temperature inside the greenhouse. The measured temperature data were used as the boundary conditions for the CFD analysis. A new greenhouse model with two-step roof shape was designed and the air flow behavior was simulated by using CFD. Regarding CFD results the air flow rate of the new model is about 39% higher than that of old model. The maximum temperature of the new model is lower than that of the old one. The sweet paper growths in both greenhouse models were measured and compared. Results show that the new model obtains 4°C lower maximum temperature in day time, 97% in number and 90% in weight higher the first grade pepper productivity than the old one.

  16. Multi-modal intervention improved oral intake in hospitalized patients

    DEFF Research Database (Denmark)

    Holst, M; Beermann, T; Mortensen, M N

    2015-01-01

    BACKGROUND: Good nutritional practice (GNP) includes screening, nutrition plan and monitoring, and is mandatory for targeted treatment of malnourished patients in hospital. AIMS: To optimize energy- and protein-intake in patients at nutritional risk and to improve GNP in a hospital setting. METHODS......: A 12-months observational multi-modal intervention study was done, using the top-down and bottom-up principle. All hospitalized patients (>3 days) were included. Setting: A university hospital with 758 beds and all specialities. Measurements: Record audit of GNP, energy- and protein-intake by 24-h...... recall, patient interviews and staff questionnaire before and after the intervention. Interventions: Based on pre-measurements, nutrition support teams in each department made targeted action plans, supervised by an expert team. Education, diagnose-specific nutrition plans, improved menus and eating...

  17. Does Music Therapy Improve Anxiety and Depression in Alzheimer's Patients?

    Science.gov (United States)

    de la Rubia Ortí, José Enrique; García-Pardo, María Pilar; Iranzo, Carmen Cabañés; Madrigal, José Joaquin Cerón; Castillo, Sandra Sancho; Rochina, Mariano Julián; Gascó, Vicente Javier Prado

    2018-01-01

    To evaluate the effectiveness of the implementation of a short protocol of music therapy as a tool to reduce stress and improve the emotional state in patients with mild Alzheimer's disease. A sample of 25 patients with mild Alzheimer's received therapy based on the application of a music therapy session lasting 60 min. Before and after the therapy, patient saliva was collected to quantify the level of salivary cortisol using the Enzyme-Linked ImmunoSorbent Assay (ELISA) immunoassay technique and a questionnaire was completed to measure anxiety and depression (Hospital Anxiety and Depression Scale). The results show that the application of this therapy lowers the level of stress and decreases significantly depression and anxiety, establishing a linear correlation between the variation of these variables and the variation of cortisol. A short protocol of music therapy can be an alternative medicine to improve emotional variables in Alzheimer patients.

  18. Methods to improve patient recruitment and retention in stroke trials

    DEFF Research Database (Denmark)

    Berge, Eivind; Stapf, Christian; Al-Shahi Salman, Rustam

    2016-01-01

    Background: The success of randomized-controlled stroke trials is dependent on the recruitment and retention of a sufficient number of patients, but fewer than half of all trials meet their target number of patients. Methods: We performed a search and review of the literature, and conducted...... a survey and workshop among 56 European stroke trialists, to identify barriers, suggest methods to improve recruitment and retention, and make a priority list of interventions that merit further evaluation. Results: The survey and workshop identified a number of barriers to patient recruitment...... and retention, from patients’ incapacity to consent, to handicaps that prevent patients from participation in trial-specific follow-up. Methods to improve recruitment and retention may include simple interventions with individual participants, funding of research networks, and reimbursement of new treatments...

  19. Heliox delivered by high flow nasal cannula improves oxygenation in infants with respiratory syncytial virus acute bronchiolitis

    Directory of Open Access Journals (Sweden)

    Wael Seliem

    Full Text Available Abstract Objective: The objective of this study is to evaluate the hypothesis that use of heliox would result in improvement of gas exchange when used with high flow nasal cannula in infants with RSV acute bronchiolitis. Methods: All patients that met the inclusion criteria were randomized to either heliox (70:30 or air-oxygen mixture 30% via high flow nasal cannula at 8 L/min for a continuous 24 h. Measurements were taken at baseline, after 2 h, and at the end of the 24 h. Results: This prospective study included 48 patients. After 2 h of treatment with heliox, the oxygen saturation and PaO2 significantly improved when compared with the air-oxygen group, 98.3% vs. 92.9%, 62.0 mmHg vs. 43.6 mmHg (p = 0.04 and 0.01, respectively. Furthermore, PaO2/FiO2 ratio was significantly higher in the heliox group when compared with the air-oxygen group, 206.7 vs. 145.3. Nevertheless, CO2 showed better elimination when heliox was used, without significance. MWCA score dropped significantly in the heliox group, 2.2 points vs. 4.0 points in air-oxygen (p = 0.04, 2 h after starting the therapy. Conclusion: Transient improvement of oxygenation in infants with RSV acute bronchiolitis during the initial phase of the therapy is associated with heliox when provided with HFNC, may provide a precious time for other therapeutic agents to work or for the disease to resolve naturally, avoiding other aggressive interventions.

  20. Cerebrospinal fluid flow and production in patients with normal pressure hydrocephalus studied by MRI

    DEFF Research Database (Denmark)

    Gideon, P; Ståhlberg, F; Thomsen, C

    1994-01-01

    An interleaved velocity-sensitised fast low-angle shot pulse sequence was used to study cerebrospinal fluid (CSF) flow in the cerebral aqueduct, and supratentorial CSF production in 9 patients with normal pressure hydrocephalus (NPH) and 9 healthy volunteers. The peak aqueduct CSF flow, both caudal...

  1. 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.

  2. Patients' expectations and solutions for improving primary diabetes care.

    Science.gov (United States)

    Vachon, Brigitte; Huynh, Ai-Thuy; Breton, Mylaine; Quesnel, Louise; Camirand, Michel; Leblanc, Jeannette; Tardif, Sylvie

    2017-07-10

    Purpose The purpose of this paper is to document health care needs expressed by people living with diabetes, describe the solutions they envisaged for improving the quality of primary care (PC) services and empower them to make better use of PC services. Design/methodology/approach A participatory research approach was used. Six workshops were organised to provide diabetes patients with knowledge on available services and to engage them in sharing their experience. Group discussions were recorded. Data were analysed using the thematic analysis method. Findings In total, 79 persons living with diabetes for a mean of 13 years participated. Needs expressed were grouped under seven themes: assurance of satisfactory follow-up by a family physician, continuous access to services adapted to evolving needs, motivation to adopt and maintain healthy behaviours, maintenance of knowledge about diabetes, psychological support, financial constraints, and collaboration with secondary-level services. Patients proposed solutions for improving services that were grouped under five themes: facilitating access to services, disseminating information about available services, centralising diabetes information on the internet, offering personalised services and improving interprofessional collaboration. Practical implications Needs expressed by diabetic patients concern different aspects of care such as accessibility, organisation, coordination, and better dissemination and visibility of services. The solutions proposed by patients focussed on better access to information and interprofessional services. Originality/value The workshop format used in this study offers an original and interesting approach and tool for actively engaging patients in quality improvement of services.

  3. Managing multimorbidity: how can the patient experience be improved?

    Directory of Open Access Journals (Sweden)

    Stanimir Hasardzhiev

    2016-02-01

    Full Text Available Abstract The patient’s experience of their own healthcare is an important aspect of care quality that has been shown to improve clinical and other outcomes. Very little is currently known about patient experience in the management of multimorbidity, although preliminary evidence suggests that it may be poor. Individuals with multimorbidity report better experiences of care when they are knowledgeable and involved in the decision-making, when their care is well coordinated, and communication is good. A greater focus on disease prevention, stronger collaboration between health and social care services, and the provision of more integrated care for people with mental and physical health problems would also help to improve the patient experience. Advocacy groups can amplify the patient voice and improve access to care, as well as provide information and support to patients and their families. Patients have an important role in preventing multimorbidity and improving its management, and should be involved in the development of health policies and the delivery of healthcare services. Inequalities in access to quality healthcare must also be addressed. Journal of Comorbidity 2016;6(128–32

  4. [Does simulator-based team training improve patient safety?].

    Science.gov (United States)

    Trentzsch, H; Urban, B; Sandmeyer, B; Hammer, T; Strohm, P C; Lazarovici, M

    2013-10-01

    Patient safety became paramount in medicine as well as in emergency medicine after it was recognized that preventable, adverse events significantly contributed to morbidity and mortality during hospital stay. The underlying errors cannot usually be explained by medical technical inadequacies only but are more due to difficulties in the transition of theoretical knowledge into tasks under the conditions of clinical reality. Crew Resource Management and Human Factors which determine safety and efficiency of humans in complex situations are suitable to control such sources of error. Simulation significantly improved safety in high reliability organizations, such as the aerospace industry.Thus, simulator-based team training has also been proposed for medical areas. As such training is consuming in cost, time and human resources, the question of the cost-benefit ratio obviously arises. This review outlines the effects of simulator-based team training on patient safety. Such course formats are not only capable of creating awareness and improvements in safety culture but also improve technical team performance and emphasize team performance as a clinical competence. A few studies even indicated improvement of patient-centered outcome, such as a reduced rate of adverse events but further studies are required in this respect. In summary, simulator-based team training should be accepted as a suitable strategy to improve patient safety.

  5. Cooling improves the writing performance of patients with writer's cramp.

    Science.gov (United States)

    Pohl, Christoph; Happe, Jörg; Klockgether, Thomas

    2002-11-01

    Cooling of hand and forearm muscles by immersion in 15 degrees C cold water for 5 minutes improved the writing performance of patients with writer's cramp. Since abnormal processing of muscle spindle afferent discharges contributes to the pathology of writer's cramp, this effect might result from a reduction in muscle spindle activity by lowering muscle temperature. Cooling is a simple, cheap, and safe procedure, providing temporary relief for patients with writer's cramp. Copyright 2002 Movement Disorder Society

  6. Improving organizational climate for excellence in patient care.

    Science.gov (United States)

    Arnold, Edwin

    2013-01-01

    Managers in health care organizations today are expected to achieve higher-quality patient care at a lower cost. Developing and maintaining a positive organizational climate can help improve motivation and foster higher employee performance. In turn, this will help the organization deliver better patient care at a lower cost. This article offers metrics for assessing organizational climate, analyzes barriers to a positive climate, and explores strategies that managers can use to build the type of climate that fosters high performance.

  7. [Strategies for improving care of oncologic patients: SHARE Project results].

    Science.gov (United States)

    Reñones Crego, María de la Concepción; Fernández Pérez, Dolores; Vena Fernández, Carmen; Zamudio Sánchez, Antonio

    2016-01-01

    Cancer treatment is a major burden for the patient and its family that requires an individualized management by healthcare professionals. Nurses are in charge of coordinating care and are the closest healthcare professionals to patient and family; however, in Spain, there are not standard protocols yet for the management of oncology patients. The Spanish Oncology Nursing Society developed between 2012 and 2014 the SHARE project, with the aim of establishing strategies to improve quality of life and nursing care in oncology patients. It was developed in 3 phases. First, a literature search and review was performed to identify nursing strategies, interventions and tools to improve cancer patients' care. At the second stage, these interventions were agreed within a group of oncology nursing experts; and at the third phase, a different group of experts in oncology care categorized the interventions to identify the ones with highest priority and most feasible to be implemented. As a result, 3 strategic actions were identified to improve nursing care during cancer treatment: To provide a named nurse to carry out the follow up process by attending to the clinic or telephonic consultation, develop therapeutic education with adapted protocols for each tumor type and treatment and ensure specific training for nurses on the management of the cancer patients. Strategic actions proposed in this paper aim to improve cancer patients' healthcare and quality of life through the development of advanced nursing roles based on a higher level of autonomy, situating nurses as care coordinators to assure an holistic care in oncology patients. Copyright © 2016 Elsevier España, S.L.U. All rights reserved.

  8. A protective role of early collateral blood flow in patients with ST-segment elevation myocardial infarction.

    Science.gov (United States)

    Kim, Eun Kyoung; Choi, Jin-Ho; Song, Young Bin; Hahn, Joo-Yong; Chang, Sung-A; Park, Sung-Ji; Lee, Sang-Chol; Choi, Seung-Hyuk; Choe, Yeon Hyeon; Park, Seung Woo; Gwon, Hyeon-Cheol

    2016-01-01

    Conflict persists regarding whether the presence of early collateral blood flow to the infarct-related artery has an effective role in reducing infarct size and improving myocardial salvage in patients with ST-segment elevation myocardial infarction (STEMI). We sought to investigate the impact of the collateral circulation on myocardial salvage and infarct size in STEMI patients. In 306 patients who were diagnosed with STEMI and underwent cardiac magnetic resonance within 1 week after revascularization, initial collateral flow to the infarct-related artery was assessed by coronary angiography. Using cardiac magnetic resonance imaging, myocardial infarct size and salvage were measured. Among 247 patients with preprocedural Thrombolysis in Myocardial Infarction flow 0/1, 54 (22%) patients had good collaterals (Rentrop grade ≥ 2, Collateral Connection Score ≥ 2). Infarct size and area at risk were significantly smaller in patients with good collaterals than those with poor collaterals (infarct size: 17.1 ± 10.1 %LV vs 21.8 ± 10.5 %LV, P = .003, area at risk: 33.8 ± 16.8 %LV vs 38.8 ± 15.5 %LV, P = .039). There was a significant difference of myocardial salvage index between 2 groups (50.9% ± 15.0% vs 43.8% ± 18.5%, P = .005). Poor collateralization was an independent predictor for large infarct size (odd ratio 2.48 [1.28-4.80], P = .007). In patients with STEMI, the presence of well-developed collaterals to occluded coronary artery from the noninfarct vessel and its extent were independently associated with reduced infarct burden and improved myocardial salvage. Our results help explain why MI patients with well-developed collateralization have reduced mortality and morbidity. Copyright © 2015 Elsevier Inc. All rights reserved.

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

    Science.gov (United States)

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

    2017-08-02

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

  10. An Improved Macro Model of Traffic Flow with the Consideration of Ramps and Numerical Tests

    Directory of Open Access Journals (Sweden)

    Zhongke Shi

    2015-01-01

    Full Text Available We present an improved macro model for traffic flow based on the existing models. The equilibrium point equation of the model is obtained. The stop-and-go traffic phenomenon is described in phase plane and the relationship between traffic jams and system instability is clearly shown in the phase plane diagrams. Using the improved model, some traffic phenomena on a highway with ramps are found in this paper. The numerical simulation is carried out to investigate various nonlinear traffic phenomena with a single ramp generated by different initial densities and vehicle generation rates. According to the actual road sections of Xi’an-Baoji highways, the situations of morning peak with several ramps are also analyzed. All these results are consistent with real traffic, which shows that the improved model is reasonable.

  11. Using Patient-Reported Information to Improve Clinical Practice.

    Science.gov (United States)

    Schlesinger, Mark; Grob, Rachel; Shaller, Dale

    2015-12-01

    To assess what is known about the relationship between patient experience measures and incentives designed to improve care, and to identify how public policy and medical practices can promote patient-valued outcomes in health systems with strong financial incentives. Existing literature (gray and peer-reviewed) on measuring patient experience and patient-reported outcomes, identified from Medline and Cochrane databases; evaluations of pay-for-performance programs in the United States, Europe, and the Commonwealth countries. We analyzed (1) studies of pay-for-performance, to identify those including metrics for patient experience, and (2) studies of patient experience and of patient-reported outcomes to identify evidence of influence on clinical practice, whether through public reporting or private reporting to clinicians. First, we identify four forms of "patient-reported information" (PRI), each with distinctive roles shaping clinical practice: (1) patient-reported outcomes measuring self-assessed physical and mental well-being, (2) surveys of patient experience with clinicians and staff, (3) narrative accounts describing encounters with clinicians in patients' own words, and (4) complaints/grievances signaling patients' distress when treatment or outcomes fall short of expectations. Because these forms vary in crucial ways, each must be distinctively measured, deployed, and linked with financial incentives. Second, although the literature linking incentives to patients experience is limited, implementing pay-for-performance systems appears to threaten certain patient-valued aspects of health care. But incentives can be made compatible with the outcomes patients value if: (a) a sufficient portion of incentives is tied to patient-reported outcomes and experiences, (b) incentivized forms of PRI are complemented by other forms of patient feedback, and (c) health care organizations assist clinicians to interpret and respond to PRI. Finally, we identify roles for the

  12. Effect of perturbations and a meal on superior mesenteric artery flow in patients with orthostatic hypotension

    Science.gov (United States)

    Fujimura, J.; Camilleri, M.; Low, P. A.; Novak, V.; Novak, P.; Opfer-Gehrking, T. L.

    1997-01-01

    Our aims were to evaluate to role of superior mesenteric blood flow in the pathophysiology of orthostatic hypotension in patients with generalized autonomic failure. METHODS: Twelve patients with symptomatic neurogenic orthostatic hypotension and 12 healthy controls underwent superior mesenteric artery flow measurements using Doppler ultrasonography during head-up tilt and tilt plus meal ingestion. Autonomic failure was assessed using standard tests of the function of the sympathetic adrenergic, cardiovagal and postganglionic sympathetic sudomotor function. RESULTS: Superior mesenteric flow volume and time-averaged velocity were similar in patients and controls at supine rest; however, responses to cold pressor test and upright tilt were attenuated (p stress can be significantly attenuated by reducing the splanchnic-mesenteric volume increase in response to food. Evaluation of mesenteric flow in response to eating and head-up tilt provide important information on intra-abdominal sympathetic adrenergic function, and the ability of the patient to cope with orthostatic stress.

  13. Availability improvement of layer 2 seamless networks using OpenFlow.

    Science.gov (United States)

    Molina, Elias; Jacob, Eduardo; Matias, Jon; Moreira, Naiara; Astarloa, Armando

    2015-01-01

    The network robustness and reliability are strongly influenced by the implementation of redundancy and its ability of reacting to changes. In situations where packet loss or maximum latency requirements are critical, replication of resources and information may become the optimal technique. To this end, the IEC 62439-3 Parallel Redundancy Protocol (PRP) provides seamless recovery in layer 2 networks by delegating the redundancy management to the end-nodes. In this paper, we present a combination of the Software-Defined Networking (SDN) approach and PRP topologies to establish a higher level of redundancy and thereby, through several active paths provisioned via the OpenFlow protocol, the global reliability is increased, as well as data flows are managed efficiently. Hence, the experiments with multiple failure scenarios, which have been run over the Mininet network emulator, show the improvement in the availability and responsiveness over other traditional technologies based on a single active path.

  14. Improved and Reproducible Flow Cytometry Methodology for Nuclei Isolation from Single Root Meristem

    Directory of Open Access Journals (Sweden)

    Thaís Cristina Ribeiro Silva

    2010-01-01

    Full Text Available Root meristems have increasingly been target of cell cycle studies by flow cytometric DNA content quantification. Moreover, roots can be an alternative source of nuclear suspension when leaves become unfeasible and for chromosome analysis and sorting. In the present paper, a protocol for intact nuclei isolation from a single root meristem was developed. This proceeding was based on excision of the meristematic region using a prototypical slide, followed by short enzymatic digestion and mechanical isolation of nuclei during homogenization with a hand mixer. Such parameters were optimized for reaching better results. Satisfactory nuclei amounts were extracted and analyzed by flow cytometry, producing histograms with reduced background noise and CVs between 3.2 and 4.1%. This improved and reproducible technique was shown to be rapid, inexpensive, and simple for nuclear extraction from a single root tip, and can be adapted for other plants and purposes.

  15. Improving pain assessment and managment in stroke patients.

    Science.gov (United States)

    Nesbitt, Julian; Moxham, Sian; Ramadurai, Gopinath; Williams, Lucy

    2015-01-01

    Stroke patients can experience a variety of pain. Many stroke patients have co-morbidities such as osteoporosis, arthritis or diabetes causing diabetic neuropathy. As well as pain from other long term conditions, stroke patients can experience central post-stroke pain, headaches, and musculoskeletal issues such as hypertonia, contractures, spasticity, and subluxations. These stroke patients can also have communication difficulties in the form of expressive dysphasia and/or global aphasia. Communication difficulties can result in these patients not expressing their pain and therefore not having it assessed, leading to inadequate pain relief that could impact their rehabilitation and recovery. By implementing an observational measurement of pain such as the Abbey pain scale, patients with communication difficulties can have their pain assessed and recorded. Initially 30% of patients on the acute stroke ward did not have their pain assessed and adequately recorded and 15% of patients had inadequate pain relief. The patient was assessed if they were in pain and therefore not receiving adequate pain relief by measuring their pain on the Abbey pain scale. After introducing the Abbey pain scale and creating a nurse advocate, an improvement was shown such that only 5% of patients did not have their pain recorded and all had adequate pain relief.

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

    Science.gov (United States)

    Luther, Vishal; Hammersley, Daniel; Chekairi, Ahmed

    2014-01-01

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

  17. An artificial intelligence based improved classification of two-phase flow patterns with feature extracted from acquired images.

    Science.gov (United States)

    Shanthi, C; Pappa, N

    2017-05-01

    Flow pattern recognition is necessary to select design equations for finding operating details of the process and to perform computational simulations. Visual image processing can be used to automate the interpretation of patterns in two-phase flow. In this paper, an attempt has been made to improve the classification accuracy of the flow pattern of gas/ liquid two- phase flow using fuzzy logic and Support Vector Machine (SVM) with Principal Component Analysis (PCA). The videos of six different types of flow patterns namely, annular flow, bubble flow, churn flow, plug flow, slug flow and stratified flow are recorded for a period and converted to 2D images for processing. The textural and shape features extracted using image processing are applied as inputs to various classification schemes namely fuzzy logic, SVM and SVM with PCA in order to identify the type of flow pattern. The results obtained are compared and it is observed that SVM with features reduced using PCA gives the better classification accuracy and computationally less intensive than other two existing schemes. This study results cover industrial application needs including oil and gas and any other gas-liquid two-phase flows. Copyright © 2017 ISA. Published by Elsevier Ltd. All rights reserved.

  18. Patients' involvement in improvement initiatives: a qualitative systematic review.

    Science.gov (United States)

    van, Claire; McInerney, Patricia; Cooke, Richard

    2015-10-01

    Over the last 20 years, quality improvement in health has become an important strategy in health services in many countries. With the emphasis on quality health care, there has been a shift in social paradigms towards including service users in their own health on different levels. There is growing evidence in literature on the positive impact on health outcomes where patients are active participants in their personal care. There is however less information available on the broader influence of users on improvement in systems. The objective of this review was to identify the barriers and enablers to patients being involved in quality improvement efforts directed towards their own health care. This review considered studies that included adults and children of any age experiencing any health problem.The review considered studies that explored patient or user participation in quality improvement and the factors enabling and hindering this processThe qualitative component of this review considered studies that focused on qualitative data, including, but not limited to, designs such as phenomenology, grounded theory, ethnography, action research and feminist research. Other texts such as opinion papers and reports were also considered. The search strategy aimed to find both published and unpublished studies. A three-step search strategy was utilized in this review. The searches using all identified keywords and index terms included the databases PubMed, PsycINFO, Medline, Scopus, EBSCOhost and CINAHL.Qualitative, text and opinion papers were considered for inclusion in this review.Closely related concepts like community involvement, family involvement, patients' involvement in their own care (for example, in the case of shared decision making), and patient centeredness in the context of a consultation were excluded. Qualitative and textual papers selected for retrieval were assessed by two independent reviewers for authenticity prior to inclusion in the review using

  19. Improving a newly developed patient-reported outcome for thyroid patients, using cognitive interviewing

    DEFF Research Database (Denmark)

    Watt, Torquil; Rasmussen, Ase Krogh; Groenvold, Mogens

    2008-01-01

    Objective To improve a newly developed patient-reported outcome measure for thyroid patients using cognitive interviewing. Methods Thirty-one interviews using immediate retrospective and expansive probing were conducted among patients with non-toxic goiter (n = 4), nodular toxic goiter (n = 5) Gr...

  20. Improving Quality of Care in Patients with Liver Cirrhosis.

    Science.gov (United States)

    Saberifiroozi, Mehdi

    2017-10-01

    Liver cirrhosis is a major chronic disease in the field of digestive diseases. It causes more than one million deaths per year. Despite established evidence based guidelines, the adherence to standard of care or quality indicators are variable. Complete adherence to the recommendations of guidelines is less than 50%. To improve the quality of care in patients with cirrhosis, we need a more holistic view. Because of high rate of death due to cardiovascular disease and neoplasms, the care of comorbid conditions and risk factors such as smoking, hypertension, high blood sugar or cholesterol, would be important in addition to the management of primary liver disease. Despite a holistic multidisciplinary approach for this goal, the management of such patients should be patient centered and individualized. The diagnosis of underlying etiology and its appropriate treatment is the most important step. Definition and customizing the quality indicators for quality measure in patients are needed. Because most suggested quality indicators are designed for measuring the quality of care in decompensated liver cirrhosis, we need special quality indicators for compensated and milder forms of chronic liver disease as well. Training the patients for participation in their own management, design of special clinics with dedicated health professionals in a form of chronic disease model, is suggested for improvement of quality of care in this group of patients. Special day care centers by a dedicated gastroenterologist and a trained nurse may be a practical model for better management of such patients.

  1. The Psychosocial Improvement after Strabismus Surgery in Iranian Patients

    Directory of Open Access Journals (Sweden)

    Guita Ghiasi

    2013-10-01

    Full Text Available Purpose: To compare the psychosocial status before and after successful strabismus surgery on Iranian strabismic patientsMethods: One hundred twenty-four strabismic patients, older than 15 years were evaluated between 2009 and 2010. They were asked to complete a questionnaire about their psychosocial experiences, before and three months after successful strabismus surgery. Effects of strabismus on self-esteem, self-confidence, and self-assessment of intelligence, employment and interpersonal relationships were compared.Results: Fifty-six percent of patients had problems in adjusting to society, and 71% had developed a mannerism to camouflage their misalignment before surgery. The preoperative scores of self-esteem, self-confidence, and interpersonal relationship were 4.33±2.07, 4.23±2.53 and 6.06±2.33 which changed to 8.33±3.02, 7.29±2.89 and 6.72±3.17 after surgery, respectively (p<0.001 for all of values. More esotropic patients reported to be discriminated against compared to exotropic patients. Postoperatively, 79% of patients reported improvements in their ability to meet new people, and 82% in interpersonal relationships. Scores of self-confidence and self-esteem increased up to three and four units, respectively (p<0.001 for both values.Conclusion: Patients with strabismus have psychosocial problems and successful strabismus surgery improves their psychosocial status.

  2. Fire Source Accessibility of Water Mist Fire Suppression Improvement through Flow Method Control

    Energy Technology Data Exchange (ETDEWEB)

    Jung, Jun Ho; Kim, Hyeong Taek; Kim, Yun Jung; Park, Mun Hee [KHNP CRI, Daejeon (Korea, Republic of)

    2013-10-15

    Recently, nuclear power plants set CO{sub 2} fire suppression system. However it is hard to establish and to maintain and it also has difficulties performing function test. Therefore, it needs to develop a new fire suppression system to replace the existing CO{sub 2} fire suppression systems in nuclear power plant. In fact, already, there exist alternatives - gas fire suppression system or clean fire extinguishing agent, but it is hard to apply because it requires a highly complicated plan. However, water mist fire suppression system which has both water system and gas system uses small amount of water and droplet, so it is excellent at oxygen displacement and more suitable for nuclear power plant because it can avoid second damage caused by fire fighting water. This paper explains about enclosure effect of water mist fire suppression. And it suggests a study direction about water mist fire source approach improvement and enclosure effect improvement, using flow method control of ventilation system. Water mist fire suppression can be influenced by various variable. And flow and direction of ventilation system are important variable. Expectations of the plan for more fire source ventilation system is as in the following. It enhances enclosure effects of water mists, so it improves extinguish performance. Also the same effect as a inert gas injection causes can be achieved. Lastly, it is considered that combustible accessibility of water mists will increase because of descending air currents.

  3. Regional cerebral blood flow and the effects of nicardipine, a new cerebral vasodilator, in patients with neuropsychiatric symptoms

    International Nuclear Information System (INIS)

    Toyoda, Katsuhiro; Motomura, Naoyasu; Murata, Koen; Sakai, Toshiaki; Yoshioka, Michio; Tsutsumi, Shigetoshi.

    1984-01-01

    Regional cerebral blood flow (rCBF) was determined by 133 Xe inhalation method in 22 neuropsychiatric patients with an average age of 65.8 years -- 14 patients having cerebrovascular disturbance (Group 1) and 8 patients having endogenous or organic psychosis or neurological lesions (Group 2). Furthermore, nicardipine was orally administered to the patients and its effects on rCBF and on neuropsychiatric symptoms were examined. Regarding the mean and abnormal decrease of rCBF in the bilateral hemispheres and the frequency of ischemic foci, there was no significant difference between the groups. However, regional ischemic focus was more frequently observed in Group 1 than in Group 2. Long-term serial administration of nicardipine increased the rCBF and improved psychiatric symptoms in some of the patients in Group 1. (Namekawa, K.)

  4. Concurrent Chemoradiotherapy Improves Survival in Patients With Hypopharyngeal Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Paximadis, Peter, E-mail: ppaximad@med.wayne.edu [Department of Radiation Oncology, Wayne State University, Detroit, MI (United States); Yoo, George; Lin, Ho-Sheng; Jacobs, John [Department of Otolaryngology, Barbara Ann Karmanos Cancer Institute, Detroit, MI (United States); Sukari, Ammar [Department of Medical Oncology, Barbara Ann Karmanos Cancer Institute, Detroit, MI (United States); Dyson, Greg [Department of Oncology, Barbara Ann Karmanos Cancer Institute, Detroit, MI (United States); Christensen, Michael; Kim, Harold [Department of Radiation Oncology, Wayne State University, Detroit, MI (United States)

    2012-03-15

    Purpose: To retrospectively review our institutional experience with hypopharyngeal carcinoma with respect to treatment modality. Methods and Materials: A total of 70 patients with hypopharyngeal cancer treated between 1999 and 2009 were analyzed for functional and survival outcomes. The treatments included surgery alone (n = 5), surgery followed by radiotherapy (RT) (n = 3), surgery followed by chemoradiotherapy (CRT) (n = 13), RT alone (n = 2), CRT alone (n = 22), induction chemotherapy followed by RT (n = 3), and induction chemotherapy followed by CRT (n = 22). Results: The median follow-up was 18 months. The median overall survival and disease-free survival for all patients was 28.3 and 17.6 months, respectively. The 1- and 2-year local control rate for all patients was 87.1% and 80%. CRT, given either as primary therapy or in the adjuvant setting, improved overall survival and disease-free survival compared with patients not receiving CRT. The median overall survival and disease-free survival for patients treated with CRT was 36.7 and 17.6 months vs. 14.0 and 8.0 months, respectively (p < .01). Of the patients initially treated with an organ-preserving approach, 4 (8.2%) required salvage laryngectomy for local recurrence or persistent disease; 8 (16.3%) and 12 (24.5%) patients were dependent on a percutaneous gastrostomy and tracheostomy tube, respectively. The 2-year laryngoesophageal dysfunction-free survival rate for patients treated with an organ-preserving approach was estimated at 31.7%. Conclusions: Concurrent CRT improves survival in patients with hypopharyngeal cancer. CRT given with conventional radiation techniques yields poor functional outcomes, and future efforts should be directed at determining the feasibility of pharyngeal-sparing intensity-modulated radiotherapy in patients with hypopharyngeal tumors.

  5. How to improve patient satisfaction when patients are already satisfied: a continuous process-improvement approach.

    Science.gov (United States)

    Friesner, Dan; Neufelder, Donna; Raisor, Janet; Bozman, Carl S

    2009-01-01

    The authors present a methodology that measures improvement in customer satisfaction scores when those scores are already high and the production process is slow and thus does not generate a large amount of useful data in any given time period. The authors used these techniques with data from a midsized rehabilitation institute affiliated with a regional, nonprofit medical center. Thus, this article functions as a case study, the findings of which may be applicable to a large number of other healthcare providers that share both the mission and challenges faced by this facility. The methodology focused on 2 factors: use of the unique characteristics of panel data to overcome the paucity of observations and a dynamic benchmarking approach to track process variability over time. By focusing on these factors, the authors identify some additional areas for process improvement despite the institute's past operational success.

  6. Virtual sensory feedback for gait improvement in neurological patients

    Directory of Open Access Journals (Sweden)

    Yoram eBaram

    2013-10-01

    Full Text Available We review a treatment modality for movement disorders by sensory feedback. The natural closed-loop sensory-motor feedback system is imitated by a wearable virtual reality apparatus, employing body-mounted inertial sensors and responding dynamically to the patient’s own motion. Clinical trials have shown a significant gait improvement in patients with Parkinson's disease using the apparatus. In contrast to open-loop devices, which impose constant-velocity visual cues in a treadmill fashion, or rhythmic auditory cues in a metronome fashion, requiring constant vigilance and attention strategies, and in some cases, instigating freezing in Parkinson’s patients, the closed-loop device improved gait parameters and eliminated freezing in most patients, without side effects. Patients with multiple sclerosis, previous stroke, senile gait and cerebral palsy using the device also improved their balance and gait substantially. Training with the device has produced a residual improvement, suggesting virtual sensory feedback for the treatment of neurological movement disorders.

  7. Team Ward Rounds for Quality Improvement in Patient-Centred ...

    African Journals Online (AJOL)

    In this paper we describe a clinical practice change for evaluation and continuous quality improvement of in-patient services in our ACE unit, such as daily geriatrics (multi disciplinary) team ward rounds preceding traditional ward rounds by other managing teams. The geriatrics team rounds enabled the identification of ...

  8. Patient state index and cerebral blood flow changes during shoulder arthroscopy in beach chair position.

    Science.gov (United States)

    Buget, Mehmet Ilke; Atalar, Ata Can; Edipoglu, Ipek Saadet; Sungur, Zerrin; Sivrikoz, Nukhet; Karadeniz, Meltem; Saka, Esra; Kucukay, Suleyman; Senturk, Mert N

    2016-01-01

    The aim of the study were to demonstrate the possible hemodynamic changes and cerebral blood flow alterations in patients who were positioned from supine to beach chair position; and to detect if the position change causes any cortical activity alteration as measured by the 4-channeled electroencephalography monitor. 35 patients were included. Before the induction, mean arterial pressure and patient state index values were recorded (T0). After the intubation, doppler-ultrasonography of the patients' internal carotid and vertebral arteries were evaluated to acquire cerebral blood flow values from the formula. In supine position, mean arterial pressure, patient state index and cerebral blood flow values were recorded (T1) and the patient was positioned to beach chair position. After 5min all measurements were repeated (T2). Measurements of patient state index and mean arterial pressure were repeated after 20 (T3), and 40 (T4)min. There was a significant decrease between T0 and T1 in heart rate (80.5±11.6 vs. 75.9±14.4beats/min), MAP (105.8±21.9 vs. 78.9±18.4mmHg) and PSI (88.5±8.3 vs. 30.3±9.7) (all pstate index values (T1-T4) showed no significant change; however, comparing only T1 and T2 resulted in a statically significant decrease in patient state index. There was a significant decrease in cerebral blood flow after beach chair position. Beach chair position was associated with a decrease in cerebral blood flow and patient state index values. Patient state index was affected by the gravitational change of the cerebral blood flow; however, both factors were not directly correlated to each other. Moreover, the decrease in patient state index value was transient and returned to normal values within 20min. Copyright © 2015 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.

  9. [Patient state index and cerebral blood flow changes during shoulder arthroscopy in beach chair position].

    Science.gov (United States)

    Buget, Mehmet Ilke; Atalar, Ata Can; Edipoglu, Ipek Saadet; Sungur, Zerrin; Sivrikoz, Nukhet; Karadeniz, Meltem; Saka, Esra; Kucukay, Suleyman; Senturk, Mert N

    2016-01-01

    The aim of the study were to demonstrate the possible hemodynamic changes and cerebral blood flow alterations in patients who were positioned from supine to beach chair position; and to detect if the position change causes any cortical activity alteration as measured by the 4-channeled electroencephalography monitor. 35 patients were included. Before the induction, mean arterial pressure and patient state index values were recorded (T0). After the intubation, doppler-ultrasonography of the patients' internal carotid and vertebral arteries were evaluated to acquire cerebral blood flow values from the formula. In supine position, mean arterial pressure, patient state index and cerebral blood flow values were recorded (T1) and the patient was positioned to beach chair position. After 5min all measurements were repeated (T2). Measurements of patient state index and mean arterial pressure were repeated after 20 (T3), and 40 (T4)min. There was a significant decrease between T0 and T1 in heart rate (80.5±11.6 vs. 75.9±14.4beats/min), MAP (105.8±21.9 vs. 78.9±18.4mmHg) and PSI (88.5±8.3 vs. 30.3±9.7) (all pstate index values (T1-T4) showed no significant change; however, comparing only T1 and T2 resulted in a statically significant decrease in patient state index. There was a significant decrease in cerebral blood flow after beach chair position. Beach chair position was associated with a decrease in cerebral blood flow and patient state index values. Patient state index was affected by the gravitational change of the cerebral blood flow; however, both factors were not directly correlated to each other. Moreover, the decrease in patient state index value was transient and returned to normal values within 20min. Copyright © 2015 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

  10. Thin-coating as an alternative approach to improve flow properties of ibuprofen powder

    DEFF Research Database (Denmark)

    Genina, Natalja; Räikkönen, Heikki; Ehlers, Henrik

    2010-01-01

    In the present study, thin-coating as a potential method for improving flow properties of cohesive ibuprofen powder was introduced. Briefly, the technique was based on the successive deposition of ultrasound-assisted fine polymer mist onto the surface of the powdered active pharmaceutical...... ingredient (API), producing individual particles with a hydrophilic thin-coat. A 0.15% m/V aqueous solution of hydroxypropyl methylcellulose (HPMC) was used. Particle size and surface analysis revealed a decrease in the cohesiveness of ibuprofen powder and an increase in the homogeneity of particle surfaces...

  11. Laparoscopic Sleeve Gastrectomy Improves Olfaction Sensitivity in Morbidly Obese Patients.

    Science.gov (United States)

    Hancı, Deniz; Altun, Huseyin; Altun, Hasan; Batman, Burcin; Karip, Aziz Bora; Serin, Kursat Rahmi

    2016-03-01

    Olfactory abilities of the patients are known to be altered by eating and metabolic disorders, including obesity. There are only a number of studies investigating the effect of obesity on olfaction, and there is limited data on the changes in olfactory abilities of morbidly obese patients after surgical treatment. Here we investigated the changes in olfactory abilities of 54 morbidly obese patients (M/F, 22/32; age range 19-57 years; body mass index (BMI) range 30.5-63.0 kg/m(2)) after laparoscopic sleeve gastrectomy. A laparoscopic sleeve gastrectomy was performed by the same surgeon using five-port technique. Olfactory abilities were tested preoperatively and 1, 3, and 6 months after the surgery using a standardized Sniffin' Sticks Extended Test kit. Analyses of variance indicated statistically significant improvement in T, D, and I scores of morbidly obese patients within time factors (preoperative vs. 1, 3, and 6 months; 1 vs. 3 and 6 months; and 3 vs. 6 months; p < 0.001 for all). There was a statistically significant improvement in overall TDI scores with an increase from 25 to 41 during the 6 months follow-up period (p < 0.001 for all). Here, for the first time in literature, we were able to show the significant improvement in olfactory abilities of morbidly obese patients after laparoscopic sleeve gastrectomy.

  12. Relationship between preoperative radial artery and postoperative arteriovenous fistula blood flow in hemodialysis patients.

    Science.gov (United States)

    Sato, Michiko; Io, Hiroaki; Tanimoto, Mitsuo; Shimizu, Yoshio; Fukui, Mitsumine; Hamada, Chieko; Horikoshi, Satoshi; Tomino, Yasuhiko

    2012-01-01

    It is recommended that arteriovenous fistula (AVF) blood flow should be more than 425 ml/min before cannulation. However, the relationship between preoperative radial artery flow (RAF) and postoperative AVF blood flow has still not been examined. Sixty-one patients with end-stage kidney disease (ESKD) were examined. They had an AVF prepared at Juntendo University Hospital from July 2006 through August 2007. Preoperative RAF and postoperative AVF blood flows were measured by ultrasonography. AVF blood flow gradually increased after the operation. AVF blood flow was significantly correlated with preoperative RAF. When preoperative RAF exceeded 21.4 ml/min, AVF blood flow rose to more than 425 ml/min. The postoperative AVF blood flow in the group with RAF of more than 20 ml/min was significantly higher than that in those with less than 20 ml/min. Preoperative RAF of less than 20 ml/min had a significantly high risk of primary AVF failure within 8 months compared with that of more than 20 ml/min. It appears that measurement of RAF by ultrasonography is useful for estimating AVF blood flow postoperatively and can predict the risk of complications in ESKD patients.

  13. Cerebral blood flow and metabolism of the patients with a carotid stenosis evaluated by SPECT and 1H-MRS

    International Nuclear Information System (INIS)

    Uno, Masaaki; Nishi, Kyouko; Shinno, Kiyohito; Nagahiro, Shinji; Ohtsuka, Hideki; Harada, Masafumi

    1998-01-01

    We examined cerebral blood flow (CBF) and metabolic states in patients with a severe carotid stenosis by SPECT and proton MRS ( 1 H-MRS). SPECT using 99m Tc-HMPAO and 1 H-MRS were performed in twenty five patients with over 70% carotid stenosis. Moreover, 10 patients were evaluated by these methods after carotid endarterectomy (CEA). N-acetyl-aspartate (NAA) on the ipsilateral side was reduced in 17 patients (Group A) while NAA of other 8 patients was not reduced (Group B). In Group A, although regional CBF was reduced in only 4 of 17 patients, 11 patients showed decline of cerebral vasoreactivity evaluated by acetazolamide injection. Concentration of NAA and regional CBF showed significant correlations. After CEA, ipsilateral NAA was increased significantly compared to preoperative NAA level. In 6 of 7 patients in Group A, cerebral vasoreactivity also improved postoperatively. These results indicated that ipsilatereal NAA metabolism and cerebral vasoreactivity can be improved after CEA. SPECT and 1 H-MRS were useful to evaluate CBF and metabolism in patients with carotid stenosis. (author)

  14. Neuropsychological improvement in patients with cervical spondylotic myelopathy after posterior decompression surgery

    International Nuclear Information System (INIS)

    Hoshimaru, Minoru

    2010-01-01

    Patients with cervical spondylotic myelopathy sometimes complain of cognitive dysfunction, which may be coincidence. However, cognitive dysfunction may be related to disorders of the cervical spine and/or spinal cord. This study investigated cognitive dysfunction in patients with cervical spinal disorders. A total of 79 patients with cervical spondylotic myelopathy (40 women and 39 men, mean age 61.2 years) underwent cervical laminoplasty between January 2006 and July 2007. Ten of these 79 patients (7 women and 3 men, mean age 65.2 years) complained of moderate to severe memory disturbances. These 10 patients underwent neuroimaging studies and a battery of neuropsychological tests consisting of the mini-mental state examination, Kohs Block Design Test, Miyake Memory Test, Benton Visual Retention Test (BVRT), and 'kana-hiroi' test before and 3 months after surgery. Brain magnetic resonance imaging showed no organic brain lesions in the 10 patients, but single photon emission computed tomography demonstrated reduced regional cerebral blood flow in the posterior cortical areas in eight patients before surgery. Neuropsychological test scores showed statistically significant improvement after surgery in the Kohs Block Design Test and the BVRT, which measure visuospatial perception and reflect the function of the parietal and/or occipital lobes (p<0.05). The practice effect may have contributed to the neuropsychological improvements, but this study suggests that cervical spinal disorders may affect cognitive functions and that surgical treatment can ameliorate such effects. (author)

  15. Transcranial Direct Current Stimulation Improves Audioverbal Memory in Stroke Patients.

    Science.gov (United States)

    Kazuta, Toshinari; Takeda, Kotaro; Osu, Rieko; Tanaka, Satoshi; Oishi, Ayako; Kondo, Kunitsugu; Liu, Meigen

    2017-08-01

    The aim of this study was to investigate whether anodal transcranial direct current stimulation over the left temporoparietal area improved audioverbal memory performance in stroke patients. Twelve stroke patients with audioverbal memory impairment participated in a single-masked, crossover, and sham-controlled experiment. The anodal or sham transcranial direct current stimulation was applied during the Rey Auditory Verbal Learning Test, which evaluates the ability to recall a list of 15 heard words over five trials. The number of correctly recalled words was compared between the anodal and sham conditions and the influence of transcranial direct current stimulation on serial position effect of the 15 words was also examined. The increase in the number of correctly recalled words from the first to the fifth trial was significantly greater in the anodal condition than in the sham condition (P transcranial direct current stimulation over the left temporoparietal area improved audioverbal memory performance and induced the primacy effect in stroke patients.

  16. Improving Patients Experience in Peadiatric Emergency Waiting Room.

    Science.gov (United States)

    Ehrler, Frederic; Siebert, Johan; Wipfli, Rolf; Duret, Cyrille; Gervaix, Alain; Lovis, Christian

    2016-01-01

    When visiting the emergency department, the perception of the time spent in the waiting room before the beginning of the care, may influence patients' experience. Based on models of service evaluation, highlighting the importance of informing people about their waiting process and their place in the queue, we have developed an innovative information screen aiming at improving perception of time by patients. Following an iterative process, a group of experts including computer scientists, ergonomists and caregivers designed a solution adapted to the pediatric context. The solution includes a screen displaying five lanes representing triage levels. Patients are represented by individual avatars, drawn sequentially in the appropriate line. The interface has been designed using gamification principle, aiming at increasing acceptance, lowering learning curve and improving satisfaction. Questionnaire based evaluation results revealed high satisfaction from the 278 respondents even if the informative content was not always completely clear.

  17. The potential of crowdsourcing to improve patient-centered care.

    Science.gov (United States)

    Weiner, Michael

    2014-01-01

    Crowdsourcing (CS) is the outsourcing of a problem or task to a crowd. Although patient-centered care (PCC) may aim to be tailored to an individual's needs, the uses of CS for generating ideas, identifying values, solving problems, facilitating research, and educating an audience represent powerful roles that can shape both allocation of shared resources and delivery of personalized care and treatment. CS can often be conducted quickly and at relatively low cost. Pitfalls include bias, risks of research ethics, inadequate quality of data, inadequate metrics, and observer-expectancy effect. Health professionals and consumers in the US should increase their attention to CS for the benefit of PCC. Patients' participation in CS to shape health policy and decisions is one way to pursue PCC itself and may help to improve clinical outcomes through a better understanding of patients' perspectives. CS should especially be used to traverse the quality-cost curve, or decrease costs while preserving or improving quality of care.

  18. 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.

  19. Improved crystalline quality of AlN epitaxial layer on sapphire by introducing TMGa pulse flow into the nucleation stage

    Science.gov (United States)

    Wu, Hualong; Wang, Hailong; Chen, Yingda; Zhang, Lingxia; Chen, Zimin; Wu, Zhisheng; Wang, Gang; Jiang, Hao

    2018-05-01

    The crystalline quality of AlN epitaxial layers on sapphire substrates was improved by introducing trimethylgallium (TMGa) pulse flow into the growth of AlN nucleation layers. It was found that the density of both screw- and edge-type threading dislocations could be significantly reduced by introducing the TMGa pulse flow. With increasing TMGa pulse flow times, the lateral correlation length (i.e. the grain size) increases and the strain in the AlN epilayers changes from tensile state to compressive state. Unstrained AlN with the least dislocations and a smooth surface was obtained by introducing 2-times TMGa pulse flow. The crystalline improvement is attributed to enhanced lateral growth and improved crystalline orientation by the TMGa pulse flow.

  20. Investigating the use of patient involvement and patient experience in quality improvement in Norway

    DEFF Research Database (Denmark)

    Wiig, Siri; Storm, Marianne; Aase, Karina

    2013-01-01

    -fold: 1) to describe and analyze how governmental organizations expect acute hospitals to incorporate patient involvement and patient experiences into their quality improvement (QI) efforts and 2) to analyze how patient involvement and patient experiences are used by hospitals to try to improve...... the quality of care they provide. METHODS: This multi-level case study combines analysis of national policy documents and regulations at the macro level with semi-structured interviews and non-participant observation of key meetings and shadowing of staff at the meso and micro levels in two purposively...... in hospitals. The expectations span from systematic collection of patients' and family members' experiences for the purpose of improving service quality through establishing patient-oriented arenas for ongoing collaboration with staff to the support of individual involvement in decision making. However...

  1. Impact of pacing modality and biventricular pacing on cardiac output and coronary conduit flow in the post-cardiotomy patient.

    LENUS (Irish Health Repository)

    Healy, David G

    2012-02-03

    We have previously demonstrated the role of univentricular pacing modalities in influencing coronary conduit flow in the immediate post-operative period in the cardiac surgery patient. We wanted to determine the mechanism of this improved coronary conduit and, in addition, to explore the possible benefits with biventricular pacing. Sixteen patients undergoing first time elective coronary artery bypass grafting who required pacing following surgery were recruited. Comparison of cardiac output and coronary conduit flow was performed between VVI and DDD pacing with a single right ventricular lead and biventricular pacing lead placement. Cardiac output was measured using arterial pulse waveform analysis while conduit flow was measured using ultrasonic transit time methodology. Cardiac output was greatest with DDD pacing using right ventricular lead placement only [DDD-univentricular 5.42 l (0.7), DDD-biventricular 5.33 l (0.8), VVI-univentricular 4.71 l (0.8), VVI-biventricular 4.68 l (0.6)]. DDD-univentricular pacing was significantly better than VVI-univentricular (P=0.023) and VVI-biventricular pacing (P=0.001) but there was no significant advantage to DDD-biventricular pacing (P=0.45). In relation to coronary conduit flow, DDD pacing again had the highest flow [DDD-univentricular 55 ml\\/min (24), DDD-biventricular 52 ml\\/min (25), VVI-univentricular 47 ml\\/min (23), VVI-biventricular 50 ml\\/min (26)]. DDD-univentricular pacing was significantly better than VVI-univentricular (P=0.006) pacing but not significantly different to VVI-biventricular pacing (P=0.109) or DDD-biventricular pacing (P=0.171). Pacing with a DDD modality offers the optimal coronary conduit flow by maximising cardiac output. Biventricular lead placement offered no significant benefit to coronary conduit flow or cardiac output.

  2. CD4+ LYMPHOCYTES IMPROVE VENOUS BLOOD FLOW IN EXPERIMENTAL ARTERIOVENOUS FISTULAE

    Science.gov (United States)

    Duque, Juan C.; Martinez, Laisel; Mesa, Annia; Wei, Yuntao; Tabbara, Marwan; Salman, Loay H.; Vazquez-Padron, Roberto I.

    2015-01-01

    Background The role of immune cells in arteriovenous fistulae (AVF) maturation is poorly understood and has received, until quite recently, little attention. This study examines the role of T lymphocytes in AVF vascular remodeling. Methods Experimental fistulae were created in athymic rnu nude rats lacking mature T lymphocytes and euthymic control animals by anastomosing the left superior epigastric vein to the nearby femoral artery. Blood flow rates, wall morphology and histological changes were assessed in AVF 21 days after creation. The effect of CD4+ lymphocytes on AVF maturation in athymic animals was analyzed by adoptive transfer of cells after fistula creation. Results The absence of T lymphocytes compromised blood flow in experimental fistulae. Histopathological inspection of AVF from athymic rats revealed that T cell immunodeficiency negatively affected venous vascular remodeling, as evidenced by a reduced lumen, a thick muscular layer and a low number of inflammatory cells compared to control animals. Adoptive transfer of CD4+ lymphocytes from euthymic rats into athymic animals before and after fistula creation improved blood flow and reduced intima-media thickness. Conclusion These results point at the protective role of CD4+ lymphocytes in the remodeling of the AVF vascular wall. PMID:25999254

  3. Numerical Modelling Approaches for Assessing Improvements to the Flow Circulation in a Small Lake

    Directory of Open Access Journals (Sweden)

    Cheng He

    2011-01-01

    Full Text Available Kamaniskeg Lake is a long, narrow, and deep small lake located in the northern part of Ontario, Canada. The goals of this paper were to examine various options to improve the water quality in the northern part of the lake by altering the local hydraulic flow conditions. Towards this end, a preliminary screening suggested that the flow circulation could be increased around a central island (Mask Island in the northern part of the lake by opening up an existing causeway connecting the mainland and central island. Three-dimensional (3D hydraulic and transport models were adopted in this paper to investigate the hydraulic conditions under various wind forces and causeway structures. The modelling results show that opening the causeway in a few places is unlikely to generate a large flow circulation around the central island. Full circulation only appears to be possible if the causeway is fully removed and a strong wind blows in a favourable direction. The possible reasons for existing water quality variations at the intake of a local WTP (water treatment plant are also explored in the paper.

  4. An Improved Scale-Adaptive Simulation Model for Massively Separated Flows

    Directory of Open Access Journals (Sweden)

    Yue Liu

    2018-01-01

    Full Text Available A new hybrid modelling method termed improved scale-adaptive simulation (ISAS is proposed by introducing the von Karman operator into the dissipation term of the turbulence scale equation, proper derivation as well as constant calibration of which is presented, and the typical circular cylinder flow at Re = 3900 is selected for validation. As expected, the proposed ISAS approach with the concept of scale-adaptive appears more efficient than the original SAS method in obtaining a convergent resolution, meanwhile, comparable with DES in visually capturing the fine-scale unsteadiness. Furthermore, the grid sensitivity issue of DES is encouragingly remedied benefiting from the local-adjusted limiter. The ISAS simulation turns out to attractively represent the development of the shear layers and the flow profiles of the recirculation region, and thus, the focused statistical quantities such as the recirculation length and drag coefficient are closer to the available measurements than DES and SAS outputs. In general, the new modelling method, combining the features of DES and SAS concepts, is capable to simulate turbulent structures down to the grid limit in a simple and effective way, which is practically valuable for engineering flows.

  5. Caring for LGBTQ patients: Methods for improving physician cultural competence.

    Science.gov (United States)

    Klein, Elizabeth W; Nakhai, Maliheh

    2016-05-01

    This article summarizes the components of a curriculum used to teach family medicine residents and faculty about LGBTQ patients' needs in a family medicine residency program in the Pacific Northwest region of the United States. This curriculum was developed to provide primary care physicians and physicians-in-training with skills to provide better health care for LGBTQ-identified patients. The curriculum covers topics that range from implicit and explicit bias and appropriate terminology to techniques for crafting patient-centered treatment plans. Additionally, focus is placed on improving the understanding of specific and unique barriers to competent health care encountered by LGBTQ patients. Through facilitated discussion, learners explore the health disparities that disproportionately affect LGBTQ individuals and develop skills that will improve their ability to care for LGBTQ patients. The goal of the curriculum is to teach family medicine faculty and physicians in training how to more effectively communicate with and treat LGBTQ patients in a safe, non-judgmental, and welcoming primary care environment. © The Author(s) 2016.

  6. Coronary flow response to remote ischemic preconditioning is preserved in old cardiac patients.

    Science.gov (United States)

    Santillo, Elpidio; Migale, Monica; Balestrini, Fabrizio; Postacchini, Demetrio; Bustacchini, Silvia; Lattanzio, Fabrizia; Antonelli-Incalzi, Raffaele

    2017-10-20

    The effect of remote ischemic preconditioning (RIPC) on coronary flow in elderly cardiac patients has not been investigated yet. Thus, we aimed to study the change of coronary flow subsequent to RIPC in old patients with heart diseases and to identify its main correlates. Ninety-five elderly patients (aged ≥ 65 years) accessing cardiac rehabilitation ward underwent transthoracic ultrasound evaluation of peak diastolic flow velocity of left anterior descending artery. Measurements of coronary flow velocity were performed on baseline and after an RIPC protocol (three cycles of 5 min ischemia of right arm alternating 5 min reperfusion). Differences between subjects with coronary flow velocity change over or equal the 75° percentile (high-responders) and subjects with a coronary flow velocity change under the 75° percentile (low-responders) were assessed. In enrolled elderly heart patients, coronary flow velocity significantly augmented from baseline after RIPC [0.23 m/s (0.18-0.28) vs 0.27 m/s (0.22-0.36); p < 0.001 by Wilcoxon test]. High-responders to RIPC were significantly younger and in better functional status than low-responders. Heart failure resulted as the main variable associated with impairment of RIPC responsiveness (R 2  = 0.202; p = 0.002)]. Our sample of old cardiac patients presented a significant median increment of coronary flow velocity after RIPC. The magnitude of the observed change of coronary flow velocity was comparable to that previously described in healthy subjects. The coronary response to RIPC was attenuated by heart failure. Further research should define whether such RIPC responsiveness is associated with cardioprotection and carries prognostic implications.

  7. Diurnal variations in lower leg subcutaneous blood flow rate in patients with chronic venous leg ulcers

    DEFF Research Database (Denmark)

    Sindrup, J H; Kastrup, J; Kristensen, J K

    1991-01-01

    The blood flow rate in subcutaneous adipose tissue was measured on the lower legs of 11 patients with chronic lower-leg venous insufficiency and ulceration and in eight age-matched control subjects for 12-20 h, under ambulatory conditions, using the 133Xe wash-out technique with portable Cadmium...... telluride (CdTe(Cl)) detectors. In both groups, the change from an upright to a supine position at the beginning of the night period elicited an instantaneous increment in the blood flow rate of 30-40% with a decrease in the central and local postural sympathetic vasoconstrictor activity. After...... approximately 1 h of sleep, a considerable increase in blood flow rate was seen in both patient and control groups which persisted for nearly 100 min. In the patient group, the mean increase was 137% compared to a mean increase of 68% in the control group (P less than 0.01). The blood flow then returned...

  8. Developing patient-centred care: an ethnographic study of patient perceptions and influence on quality improvement.

    Science.gov (United States)

    Renedo, Alicia; Marston, Cicely

    2015-04-23

    Understanding quality improvement from a patient perspective is important for delivering patient-centred care. Yet the ways patients define quality improvement remains unexplored with patients often excluded from improvement work. We examine how patients construct ideas of 'quality improvement' when collaborating with healthcare professionals in improvement work, and how they use these understandings when attempting to improve the quality of their local services. We used in-depth interviews with 23 'patient participants' (patients involved in quality improvement work) and observations in several sites in London as part of a four-year ethnographic study of patient and public involvement (PPI) activities run by Collaborations for Leadership in Applied Health Research and Care for Northwest London. We took an iterative, thematic and discursive analytical approach. When patient participants tried to influence quality improvement or discussed different dimensions of quality improvement their accounts and actions frequently started with talk about improvement as dependent on collective action (e.g. multidisciplinary healthcare professionals and the public), but usually quickly shifted away from that towards a neoliberal discourse emphasising the role of individual patients. Neoliberal ideals about individual responsibility were taken up in their accounts moving them away from the idea of state and healthcare providers being held accountable for upholding patients' rights to quality care, and towards the idea of citizens needing to work on self-improvement. Participants portrayed themselves as governed by self-discipline and personal effort in their PPI work, and in doing so provided examples of how neoliberal appeals for self-regulation and self-determination also permeated their own identity positions. When including patient voices in measuring and defining 'quality', governments and public health practitioners should be aware of how neoliberal rationalities at the

  9. Determinants of leptomeningeal collateral flow in stroke patients with a middle cerebral artery occlusion

    International Nuclear Information System (INIS)

    Seeters, Tom van; Velthuis, Birgitta K.; Biessels, Geert Jan; Kappelle, L.J.; Graaf, Yolanda van der

    2016-01-01

    Poor leptomeningeal collateral flow is related to worse clinical outcome in acute ischemic stroke, but the factors that determine leptomeningeal collateral patency are largely unknown. We explored the determinants of leptomeningeal collateral flow and assessed their effect on the relation between leptomeningeal collateral flow and clinical outcome. We included 484 patients from the Dutch acute stroke study (DUST) with a middle cerebral artery (MCA) occlusion. The determinants of poor leptomeningeal collateral flow (≤50 % collateral filling) were identified with logistic regression. We calculated the relative risk (RR) of poor leptomeningeal collateral flow in relation to poor clinical outcome (90-day modified Rankin Scale 3-6) using Poisson regression and assessed whether the determinants of leptomeningeal collateral flow affected this relation. Leptomeningeal collateral flow was poor in 142 patients (29 %). In multivariable analyses, higher admission glucose level (odds ratio (OR) 1.1 per mmol/L increase (95 % CI 1.0-1.2)), a proximal MCA occlusion (OR 1.9 (95 % CI 1.3-3.0)), and an incomplete posterior circle of Willis (OR 1.7 (95 % CI 1.1-2.6)) were independently related to poor leptomeningeal collateral flow. Poor leptomeningeal collateral flow was related to poor clinical outcome (unadjusted RR 1.7 (95 % CI 1.4-2.0)), and this relation was not affected by the determinants of leptomeningeal collateral flow. Our study shows that admission glucose level, a proximal MCA occlusion, and an incomplete ipsilateral posterior circle of Willis are determinants of leptomeningeal collateral flow that represent a combination of congenital, acquired, and acute factors. After adjustment for these determinants, leptomeningeal collateral flow remains related to clinical outcome. (orig.)

  10. Determinants of leptomeningeal collateral flow in stroke patients with a middle cerebral artery occlusion

    Energy Technology Data Exchange (ETDEWEB)

    Seeters, Tom van; Velthuis, Birgitta K. [University Medical Center Utrecht, Department of Radiology, Utrecht (Netherlands); Biessels, Geert Jan; Kappelle, L.J. [University Medical Center Utrecht, Department of Neurology, Brain Center Rudolf Magnus, Utrecht (Netherlands); Graaf, Yolanda van der [University Medical Center Utrecht, Julius Center for Health Sciences and Primary Care, Utrecht (Netherlands); Collaboration: on behalf of the Dutch acute stroke study (DUST) investigators

    2016-10-15

    Poor leptomeningeal collateral flow is related to worse clinical outcome in acute ischemic stroke, but the factors that determine leptomeningeal collateral patency are largely unknown. We explored the determinants of leptomeningeal collateral flow and assessed their effect on the relation between leptomeningeal collateral flow and clinical outcome. We included 484 patients from the Dutch acute stroke study (DUST) with a middle cerebral artery (MCA) occlusion. The determinants of poor leptomeningeal collateral flow (≤50 % collateral filling) were identified with logistic regression. We calculated the relative risk (RR) of poor leptomeningeal collateral flow in relation to poor clinical outcome (90-day modified Rankin Scale 3-6) using Poisson regression and assessed whether the determinants of leptomeningeal collateral flow affected this relation. Leptomeningeal collateral flow was poor in 142 patients (29 %). In multivariable analyses, higher admission glucose level (odds ratio (OR) 1.1 per mmol/L increase (95 % CI 1.0-1.2)), a proximal MCA occlusion (OR 1.9 (95 % CI 1.3-3.0)), and an incomplete posterior circle of Willis (OR 1.7 (95 % CI 1.1-2.6)) were independently related to poor leptomeningeal collateral flow. Poor leptomeningeal collateral flow was related to poor clinical outcome (unadjusted RR 1.7 (95 % CI 1.4-2.0)), and this relation was not affected by the determinants of leptomeningeal collateral flow. Our study shows that admission glucose level, a proximal MCA occlusion, and an incomplete ipsilateral posterior circle of Willis are determinants of leptomeningeal collateral flow that represent a combination of congenital, acquired, and acute factors. After adjustment for these determinants, leptomeningeal collateral flow remains related to clinical outcome. (orig.)

  11. Performance evaluation of FlowCytomix assays to quantify cytokines in patients with rheumatoid arthritis

    Science.gov (United States)

    Wang, Xuefeng; Dong, Liyang; Liang, Yong; Ni, Hongchang; Tang, Jun; Xu, Chengcheng; Zhou, Yuepeng; Su, Yuting; Wang, Jun; Chen, Deyu; Mao, Chaoming

    2015-01-01

    Objectives: To compare the cytokine profile in RA patients and healthy control by using two methods-FlowCytomix assay and traditional ELISA. Methods: Cytokine levels were evaluated by FlowCytomix assay and ELISA in serum and supernatants of peripheral blood mononuclear cells (PBMC) cultures with and without stimulation by phytohaemagglutinin (PHA). Results: The levels of IL-6, IL-1β, and TNF-α were significantly higher in sera of RA patients than those of healthy controls. The levels of IL-22, IL-6, IL-1β, TNF-α, and IL-10 were higher in unstimulated PBMC culture supernatant of RA patients than those of healthy controls. PHA stimulation significantly increased the production of proinflammatory cytokines from PBMC with RA patients. Compared with detectable cytokine levels in sera, cytokine concentration in the supernatant of PBMCs was remarkably higher. FlowCytomix and ELISA showed significant correlation in detecting cytokines. However, the FlowCytomix assay detected more cytokines than ELISA. Conclusion: The supernatant of PBMCs provide a fine condition for the study of cytokine production because of the lack of interference factors in sera. The FlowCytomix assay is more sensitive than ELISA in detecting cytokines from RA patients. Multiple cytokine signatures using FlowCytomix assay may represent a more realistic approach in the future of personalized medicine in RA. PMID:26629129

  12. A single LipiFlow® Thermal Pulsation System treatment improves meibomian gland function and reduces dry eye symptoms for 9 months.

    Science.gov (United States)

    Greiner, Jack V

    2012-04-01

    To evaluate the effect of a single treatment with the LipiFlow(®) Thermal Pulsation System on signs of meibomian gland dysfunction (MGD) and dry eye symptoms over a 9-month period. Patients (n = 42 eyes, 21 subjects) diagnosed with MGD and dry eye symptoms were recruited for a non-significant risk, prospective, open-label, 1-month clinical trial. Patients received a single 12-minute treatment using the LipiFlow(®) Thermal Pulsation System on each eye. The LipiFlow(®) device applies heat to the conjunctival surfaces of the upper and lower inner eyelids while simultaneously applying pulsatile pressure to the outer eyelid surfaces to express the meibomian glands. Patient symptoms were evaluated using the Ocular Surface Disease Index (OSDI) and Standard Patient Evaluation for Eye Dryness (SPEED) dry eye questionnaires; tear break-up time was measured with the dry eye test (DET™); and meibomian gland function was evaluated using a standardized diagnostic expression technique. Data are presented for patient's pre-treatment (baseline) and at 1-month and 9-month post-treatment. Meibomian gland secretion scores improved significantly from baseline (4.4 ± 4.0) to 1-month post-treatment (11.3 ± 6.2; p dry eye disease, the LipiFlow(®) Thermal Pulsation System offers a technological advancement for the treatment of dry eye disease secondary to meibomian gland dysfunction. A single 12-minute LipiFlow(®) treatment results in up to 9 months of sustained improvement of meibomian gland function, tear break-up time and dry eye symptoms that are unparalleled with current dry eye treatments.

  13. Practice improvement, part II: update on patient communication technologies.

    Science.gov (United States)

    Roett, Michelle A; Coleman, Mary Thoesen

    2013-11-01

    Patient portals (ie, secure web-based services for patient health record access) and secure messaging to health care professionals are gaining popularity slowly. Advantages of web portals include timely communication and instruction, access to appointments and other services, and high patient satisfaction. Limitations include inappropriate use, security considerations, organizational costs, and exclusion of patients who are uncomfortable with or unable to use computers. Attention to the organization's strategic plan and office policies, patient and staff expectations, workflow and communication integration, training, marketing, and enrollment can facilitate optimal use of this technology. Other communication technologies that can enhance patient care include automated voice or text reminders and brief electronic communications. Social media provide another method of patient outreach, but privacy and access are concerns. Incorporating telehealthcare (health care provided via telephone or Internet), providing health coaching, and using interactive health communication applications can improve patient knowledge and clinical outcomes and provide social support. Written permission from the American Academy of Family Physicians is required for reproduction of this material in whole or in part in any form or medium.

  14. ECG Markers of Hemodynamic Improvement in Patients with Pulmonary Hypertension

    Directory of Open Access Journals (Sweden)

    Marcin Waligóra

    2018-01-01

    Full Text Available Introduction. Several diagnostic tests have been recommended for risk assessment in pulmonary hypertension (PH, but the role of electrocardiography (ECG in monitoring of PH patients has not been yet established. Therefore the aim of the study was to evaluate which ECG patterns characteristic for pulmonary hypertension can predict hemodynamic improvement in patients treated with targeted therapies. Methods. Consecutive patients with pulmonary arterial hypertension (PAH or chronic thromboembolic pulmonary hypertension (CTEPH were eligible to be included if they had had performed two consecutive right heart catheterization (RHC procedures before and after starting of targeted therapies. Patients were followed up from June 2009 to July 2017. ECG patterns of right ventricular hypertrophy according to American College of Cardiology Foundation were assessed. Results. We enrolled 80 patients with PAH and 11 patients with inoperable CTEPH. The follow-up RHC was performed within 12.6±10.0 months after starting therapy. Based on median change of pulmonary vascular resistance, we divided our patients into two subgroups: with and without significant hemodynamic improvement. RV1, max⁡RV1,2 + max⁡SI,aVL-SV1, and PII improved along with the improvement of hemodynamic parameters including PVR. They predicted hemodynamic improvement with similarly good accuracy as shown in ROC analysis: RV1 (AUC: 0.75; 95% CI: 0.63–0.84, PII (AUC: 0.67, 95% CI: 0.56–0.77, and max⁡RV1,2+max⁡SI,aVL-SV1 (0.73; 95% CI: 0.63–0.82. In Cox regression only change in RV1 remained significant mortality predictor (HR: 1.12, 95% CI: 1.01–1.24. Conclusion. Electrocardiogram may be useful in predicting hemodynamic effects of targeted therapy in precapillary pulmonary hypertension. Decrease of RV1, max⁡RV1,2+max⁡SI,aVL-SV1, and PII corresponds with hemodynamic improvement after treatment. Of these changes a decrease of R wave amplitude in V1 is associated with better

  15. Improving patient care through student leadership in team quality improvement projects.

    Science.gov (United States)

    Tschannen, Dana; Aebersold, Michelle; Kocan, Mary Jo; Lundy, Francene; Potempa, Kathleen

    2015-01-01

    In partnership with a major medical center, senior-level nursing students completed a root cause analysis and implementation plan to address a unit-specific quality issue. To evaluate the project, unit leaders were asked their perceptions of the value of the projects and impact on patient care, as well as to provide exemplars depicting how the student root cause analysis work resulted in improved patient outcome and/or unit processes. Liaisons noted benefits of having an RCA team, with positive impact on patient outcomes and care processes.

  16. Computer Simulation of Water Flowing inside Turbine HYE 10a, a Modern Method for Checking of the Structural Improvements

    Directory of Open Access Journals (Sweden)

    Florin Pomoja

    2013-05-01

    Full Text Available This paper presents theoretical results of flow simulations, performed on cross-flow type turbine of 8.25 kW, and also the results obtained on the improved turbine, with modified shapes for the rotor, case, and guiding palette.

  17. A novel class of laboratory middleware. Promoting information flow and improving computerized provider order entry.

    Science.gov (United States)

    Grisson, Ricky; Kim, Ji Yeon; Brodsky, Victor; Kamis, Irina K; Singh, Balaji; Belkziz, Sidi M; Batra, Shalini; Myers, Harold J; Demyanov, Alexander; Dighe, Anand S

    2010-06-01

    A central duty of the laboratory is to inform clinicians about the availability and usefulness of laboratory testing. In this report, we describe a new class of laboratory middleware that connects the traditional clinical laboratory information system with the rest of the enterprise, facilitating information flow about testing services. We demonstrate the value of this approach in efficiently supporting an inpatient order entry application. We also show that order entry monitoring and iterative middleware updates can enhance ordering efficiency and promote improved ordering practices. Furthermore, we demonstrate the value of algorithmic approaches to improve the accuracy and completeness of laboratory test searches. We conclude with a discussion of design recommendations for middleware applications and discuss the potential role of middleware as a sharable, centralized repository of laboratory test information.

  18. An improved sheep flock heredity algorithm for job shop scheduling and flow shop scheduling problems

    Directory of Open Access Journals (Sweden)

    Chandramouli Anandaraman

    2011-10-01

    Full Text Available Job Shop Scheduling Problem (JSSP and Flow Shop Scheduling Problem (FSSP are strong NP-complete combinatorial optimization problems among class of typical production scheduling problems. An improved Sheep Flock Heredity Algorithm (ISFHA is proposed in this paper to find a schedule of operations that can minimize makespan. In ISFHA, the pairwise mutation operation is replaced by a single point mutation process with a probabilistic property which guarantees the feasibility of the solutions in the local search domain. A Robust-Replace (R-R heuristic is introduced in place of chromosomal crossover to enhance the global search and to improve the convergence. The R-R heuristic is found to enhance the exploring potential of the algorithm and enrich the diversity of neighborhoods. Experimental results reveal the effectiveness of the proposed algorithm, whose optimization performance is markedly superior to that of genetic algorithms and is comparable to the best results reported in the literature.

  19. Improving Long-term Post-wildfire hydrologic simulations using ParFlow

    Science.gov (United States)

    Lopez, S. R.; Kinoshita, A. M.

    2015-12-01

    Wildfires alter the natural hydrologic processes within a watershed. After vegetation is burned, the combustion of organic material and debris settles into the soil creating a hydrophobic layer beneath the soil surface with varying degree of thickness and depth. Vegetation regrowth rates vary as a function of radiative exposure, burn severity, and precipitation patterns. Hydrologic models used by the Burned Area Emergency Response (BAER) teams use input data and model calibration constraints that are generally either one-dimensional, empirically-based models, or two-dimensional, conceptually-based models with lumped parameter distributions. These models estimate runoff measurements at the watershed outlet; however, do not provide a distributed hydrologic simulation at each point within the watershed. This work uses ParFlow, a three-dimensional, distributed hydrologic model to (1) correlate burn severity with hydrophobicity, (2) evaluate vegetation recovery rate on water components, and (3) improve flood prediction for managers to help with resource allocation and management operations in burned watersheds. ParFlow is applied to Devil Canyon (43 km2) in San Bernardino, California, which was 97% burned in the 2003 Old Fire. The model set-up uses a 30m-cell size resolution over a 6.7 km by 6.4 km lateral extent. The subsurface reaches 30 m and is assigned a variable cell thickness. Variable subsurface thickness allows users to explicitly consider the degree of recovery throughout the stages of regrowth. Burn severity maps from remotely sensed imagery are used to assign initial hydrophobic layer parameters and thickness. Vegetation regrowth is represented with satellite an Enhanced Vegetation Index. Pre and post-fire hydrologic response is evaluated using runoff measurements at the watershed outlet, and using water component (overland flow, lateral flow, baseflow) measurements.

  20. Improved quality of life in patients treated with Peptide radionuclides.

    Science.gov (United States)

    Traub-Weidinger, T; Raderer, M; Uffmann, M; Angelberger, P; Kurtaran, A; Leimer, M; Preitfellner, J; Dudczak, R; Virgolini, I

    2011-07-01

    10 patients after 3.7 GBq, and a skin reaction in one patient. Total accumulated kidney dose ranged between 4 and 64 Gy, with reduced creatinine clearance in two patients. Pain relief was achieved in three of three patients after ~3.7 GBq ERT within 4-6 months. Appetite, weight, Karnofsky score and general well-being had improved in patients with SD during and after therapy. Based on the results of this study conducted on a small group of patients, we conclude that PRRT may offer an alternative treatment option for SSTR-positive tumors, with only mild transient side-effects and a marked improvement in the quality of life.

  1. Improved Quality of Life in Patients Treated with Peptide Radionuclides

    International Nuclear Information System (INIS)

    Traub-Weidinger, T; Raderer, M.; Uffmann, M.; Angelberger, P.; Kurtaran, A.; Leimer, M.; Preitfellner, J.; Dudczak, R.; Virgolini, I.

    2011-01-01

    patients after 3.7 GBq, and a skin reaction in one patient. Total accumulated kidney dose ranged between 4 and 64 Gy, with reduced creatinine clearance in two patients. Pain relief was achieved in three of three patients after ~3.7 GBq ERT within 4–6 months. Appetite, weight, Karnofsky score and general well-being had improved in patients with SD during and after therapy. Based on the results of this study conducted on a small group of patients, we conclude that PRRT may offer an alternative treatment option for SSTR-positive tumors, with only mild transient side-effects and a marked improvement in the quality of life

  2. Transferring skills in quality collaboratives focused on improving patient logistics.

    Science.gov (United States)

    Weggelaar-Jansen, Anne Marie; van Wijngaarden, Jeroen

    2018-04-02

    A quality improvement collaborative, often used by the Institute for Healthcare Improvement, is used to educate healthcare professionals and improve healthcare at the same time. However, no prior research has been done on the knowledge and skills healthcare professionals need to achieve improvements or the extent to which quality improvement collaboratives help enhance both knowledge and skills. Our research focused on quality improvement collaboratives aiming to improve patient logistics and tried to identify which knowledge and skills are required and to what extent these were enhanced during the QIC. We defined skills important for logistic improvements in a three-phase Delphi study. Based on the Delphi results we made a questionnaire. We surveyed participants in a national quality improvement collaborative to assess the skills rated as 1) important, 2) available and 3) improved during the collaborative. At two sense-making meetings, experts reflected on our findings and hypothesized on how to improve (logistics) collaboratives. The Delphi study found 18 skills relevant for reducing patient access time and 21 for reducing throughput time. All skills retrieved from the Delphi study were scored as 'important' in the survey. Teams especially lacked soft skills connected to project and change management. Analytical skills increased the most, while more reflexive skills needed for the primary goal of the collaborative (reduce access and throughput times) increased modestly. At two sense-making meetings, attendees suggested four improvements for a quality improvement collaborative: 1) shift the focus to project- and change management skills; 2) focus more on knowledge transfer to colleagues; 3) teach participants to adapt the taught principles to their own situations; and 4) foster intra-project reflexive learning to translate gained insights to other projects (inter-project learning). Our findings seem to suggest that Quality collaboratives could benefit if more

  3. Virtual Patient Technology: Engaging Primary Care in Quality Improvement Innovations.

    Science.gov (United States)

    Blok, Amanda C; May, Christine N; Sadasivam, Rajani S; Houston, Thomas K

    2017-02-15

    Engaging health care staff in new quality improvement programs is challenging. We developed 2 virtual patient (VP) avatars in the context of a clinic-level quality improvement program. We sought to determine differences in preferences for VPs and the perceived influence of interacting with the VP on clinical staff engagement with the quality improvement program. Using a participatory design approach, we developed an older male smoker VP and a younger female smoker VP. The older male smoker was described as a patient with cardiovascular disease and was ethnically ambiguous. The female patient was younger and was worried about the impact of smoking on her pregnancy. Clinical staff were allowed to choose the VP they preferred, and the more they engaged with the VP, the more likely the VP was to quit smoking and become healthier. We deployed the VP within the context of a quality improvement program designed to encourage clinical staff to refer their patients who smoke to a patient-centered Web-assisted tobacco intervention. To evaluate the VPs, we used quantitative analyses using multivariate models of provider and practice characteristics and VP characteristic preference and analyses of a brief survey of positive deviants (clinical staff in practices with high rates of encouraging patients to use the quit smoking innovation). A total of 146 clinical staff from 76 primary care practices interacted with the VPs. Clinic staff included medical providers (35/146, 24.0%), nurse professionals (19/146, 13.0%), primary care technicians (5/146, 3.4%), managerial staff (67/146, 45.9%), and receptionists (20/146, 13.7%). Medical staff were mostly male, and other roles were mostly female. Medical providers (OR 0.031; CI 0.003-0.281; P=.002) and younger staff (OR 0.411; CI 0.177-0.952; P=.038) were less likely to choose the younger, female VP when controlling for all other characteristics. VP preference did not influence online patient referrals by staff. In high

  4. Flow-volume loops measured with electrical impedance tomography in pediatric patients with asthma.

    Science.gov (United States)

    Ngo, Chuong; Dippel, Falk; Tenbrock, Klaus; Leonhardt, Steffen; Lehmann, Sylvia

    2018-05-01

    Electrical impedance tomography (EIT) provides information on global and regional ventilation during tidal breathing and mechanical ventilation. During forced expiration maneuvers, the linearity of EIT and spirometric data has been documented in healthy persons. The present study investigates the potential diagnostic use of EIT in pediatric patients with asthma. EIT and spirometry were performed in 58 children with asthma (average age ± SD: 11.86 ± 3.13 years), and 58 healthy controls (average age ± SD: 12.12 ± 2.9 years). The correlation between EIT data and simultaneously acquired spirometric data were tested for FEV 1 , FEV 0.5 , MEF 75 , MEF 50 , and MEF 25 . Binary classification tests were performed for the EIT-derived Tiffeneau index FEV 1 /FVC and the bronchodilator test index ΔFEV 1 . Average flow-volume (FV) loops were generated for patients with pathologic spirometry to demonstrate the feasibility of EIT for graphic diagnosis of asthma. Spirometry and global EIT-based FV loops showed a strong correlation (P  0.9 in FEV 1 and FEV 0.5 ). In all criteria, the binary classification tests yielded high specificity (>93%), a high positive predictive value (≥75%) and a high negative predictive value (>80%), while sensitivity was higher in ΔFEV 1 (86.67%) and lower in FEV 1 /FVC (25% and 35.29%). A typical concave shape of the EIT-derived average FV loops was observed for asthmatic children with improvement after bronchospasmolysis. Global FV loops derived from EIT correlate well with spirometry. Positive bronchospasmolysis can be observed in EIT-derived FV loops. Flow-volume loops originated from EIT have a potential to visualize pulmonary function. © 2018 Wiley Periodicals, Inc.

  5. Direct compression of chitosan: process and formulation factors to improve powder flow and tablet performance.

    Science.gov (United States)

    Buys, Gerhard M; du Plessis, Lissinda H; Marais, Andries F; Kotze, Awie F; Hamman, Josias H

    2013-06-01

    Chitosan is a polymer derived from chitin that is widely available at relatively low cost, but due to compression challenges it has limited application for the production of direct compression tablets. The aim of this study was to use certain process and formulation variables to improve manufacturing of tablets containing chitosan as bulking agent. Chitosan particle size and flow properties were determined, which included bulk density, tapped density, compressibility and moisture uptake. The effect of process variables (i.e. compression force, punch depth, percentage compaction in a novel double fill compression process) and formulation variables (i.e. type of glidant, citric acid, pectin, coating with Eudragit S®) on chitosan tablet performance (i.e. mass variation, tensile strength, dissolution) was investigated. Moisture content of the chitosan powder, particle size and the inclusion of glidants had a pronounced effect on its flow ability. Varying the percentage compaction during the first cycle of a double fill compression process produced chitosan tablets with more acceptable tensile strength and dissolution rate properties. The inclusion of citric acid and pectin into the formulation significantly decreased the dissolution rate of isoniazid from the tablets due to gel formation. Direct compression of chitosan powder into tablets can be significantly improved by the investigated process and formulation variables as well as applying a double fill compression process.

  6. Extracting kinetic freeze-out temperature and radial flow velocity from an improved Tsallis distribution

    Energy Technology Data Exchange (ETDEWEB)

    Lao, Hai-Ling; Liu, Fu-Hu [Shanxi University, Institute of Theoretical Physics, Shanxi (China); Lacey, Roy A. [Stony Brook University, Departments of Chemistry and Physics, Stony Brook, NY (United States)

    2017-03-15

    We analyze the transverse-momentum (p{sub T}) spectra of identified particles (π{sup ±}, K{sup ±}, p, and anti p) produced in gold-gold (Au-Au) and lead-lead (Pb-Pb) collisions over a √(s{sub NN}) (center-of-mass energy per nucleon pair) range from 14.5 GeV (one of the Relativistic Heavy Ion Collider (RHIC) energies) to 2.76 TeV (one of the Large Hadron Collider (LHC) energies). For the spectra with a narrow p{sub T} range, an improved Tsallis distribution which is in fact the Tsallis distribution with radial flow is used. For the spectra with a wide p{sub T} range, a superposition of the improved Tsallis distribution and an inverse power law is used. Both the extracted kinetic freeze-out temperature (T{sub 0}) and radial flow velocity (β{sub T}) increase with the increase of √(s{sub NN}), which indicates a higher excitation and larger expansion of the interesting system at the LHC. Both the values of T{sub 0} and β{sub T} in central collisions are slightly larger than those in peripheral collisions, and they are independent of isospin and slightly dependent on mass. (orig.)

  7. Performance improvement of a PEMFC system controlling the cathode outlet air flow

    Energy Technology Data Exchange (ETDEWEB)

    Feroldi, Diego; Serra, Maria; Riera, Jordi [Institut de Robotica i Informatica Industrial, Universitat Politecnica de Catalunya-Consejo Superior de Investigaciones Cientificas, C. Llorens i Artigas 4, 08028 Barcelona (Spain)

    2007-06-10

    This paper presents a stationary and dynamic study of the advantages of using a regulating valve for the cathode outlet flow in combination with the compressor motor voltage as manipulated variables in a fuel cell system. At a given load current, the cathode input and output flow rate determine the cathode pressure and stoichiometry, and consequently determine the oxygen partial pressure, the generated voltage and the compressor power consumption. In order to maintain a high efficiency during operation, the cathode output regulating valve has to be adjusted to the operating conditions, specially marked by the current drawn from the stack. Besides, the appropriate valve manipulation produces an improvement in the transient response of the system. The influence of this input variable is exploited by implementing a predictive control strategy based on dynamic matrix control (DMC), using the compressor voltage and the cathode output regulating valve as manipulated variables. The objectives of this control strategy are to regulate both the fuel cell voltage and oxygen excess ratio in the cathode, and thus, to improve the system performance. All the simulation results have been obtained using the MATLAB-Simulink environment. (author)

  8. Significant Improvements in Pyranometer Nighttime Offsets Using High-Flow DC Ventilation

    Energy Technology Data Exchange (ETDEWEB)

    Kutchenreiter, Mark; Michalski, J.J.; Long, C.N.; Habte, Aron

    2017-05-22

    Accurate solar radiation measurements using pyranometers are required to understand radiative impacts on the Earth's energy budget, solar energy production, and to validate radiative transfer models. Ventilators of pyranometers, which are used to keep the domes clean and dry, also affect instrument thermal offset accuracy. This poster presents a high-level overview of the ventilators for single-black-detector pyranometers and black-and-white pyranometers. For single-black-detector pyranometers with ventilators, high-flow-rate (50-CFM and higher), 12-V DC fans lower the offsets, lower the scatter, and improve the predictability of nighttime offsets compared to lower-flow-rate (35-CFM), 120-V AC fans operated in the same type of environmental setup. Black-and-white pyranometers, which are used to measure diffuse horizontal irradiance, sometimes show minor improvement with DC fan ventilation, but their offsets are always small, usually no more than 1 W/m2, whether AC- or DC-ventilated.

  9. Energy efficiency enhancement of natural rubber smoking process by flow improvement using a CFD technique

    International Nuclear Information System (INIS)

    Tekasakul, Perapong; Promtong, Machimontorn

    2008-01-01

    A non-uniform flow and large temperature variation in a natural rubber smoking-room cause an inefficient use of energy. Flow uniformity and temperature variation can be improved by using a computational fluid dynamics (CFD) simulation. The effects of the size, position and number of gas supply ducts and ventilating lids which were at the inlets and the outlets of the smoking-room were investigated. The optimal rubber smoking-room of size 2.6 m x 6.2 m x 3.6 m contains 154 50 mm-diameter hot gas supply ducts, and four 0.25 x 0.25 m and four 0.25 x 0.20 m ventilating lids. The velocity distribution of this model in the rubber-hanging area was rather uniform. The average monitoring temperature of 54 positions was 62.1 deg. C. This model could reduce the temperature variation by a factor of three from the original room model, i.e., from 15 to 5.5 deg. C. In a further study, the heat input of an appropriate room model was finely adjusted to obtain a suitable temperature (60 deg. C) for the smoking process. It was found that an appropriate heat supply at this temperature is 11 kW. At this rate, the temperature variation is 5.3 deg. C. This improved model should help the rubber smoking cooperatives to achieve at least a 31.25% saving in energy

  10. Energy efficiency enhancement of natural rubber smoking process by flow improvement using a CFD technique

    Energy Technology Data Exchange (ETDEWEB)

    Tekasakul, Perapong [Energy Technology Research Center and Department of Mechanical Engineering, Faculty of Engineering, Prince of Songkla University, Hat Yai, Songkhla 90112 (Thailand)], E-mail: perapong.t@psu.ac.th; Promtong, Machimontorn [Division of Mechanical Engineering, School of Engineering and Resources, Walailak University, Nakhon Si Thammarat 80160 (Thailand)

    2008-09-15

    A non-uniform flow and large temperature variation in a natural rubber smoking-room cause an inefficient use of energy. Flow uniformity and temperature variation can be improved by using a computational fluid dynamics (CFD) simulation. The effects of the size, position and number of gas supply ducts and ventilating lids which were at the inlets and the outlets of the smoking-room were investigated. The optimal rubber smoking-room of size 2.6 m x 6.2 m x 3.6 m contains 154 50 mm-diameter hot gas supply ducts, and four 0.25 x 0.25 m and four 0.25 x 0.20 m ventilating lids. The velocity distribution of this model in the rubber-hanging area was rather uniform. The average monitoring temperature of 54 positions was 62.1 deg. C. This model could reduce the temperature variation by a factor of three from the original room model, i.e., from 15 to 5.5 deg. C. In a further study, the heat input of an appropriate room model was finely adjusted to obtain a suitable temperature (60 deg. C) for the smoking process. It was found that an appropriate heat supply at this temperature is 11 kW. At this rate, the temperature variation is 5.3 deg. C. This improved model should help the rubber smoking cooperatives to achieve at least a 31.25% saving in energy.

  11. Improved instrumentation for blood flow velocity measurements in the microcirculation of small animals

    International Nuclear Information System (INIS)

    Mesquita, Jayme Alves Jr. de; Bouskela, Eliete; Wajnberg, Eliane; Lopes de Melo, Pedro

    2007-01-01

    Microcirculation is the generic name of vessels with internal diameter less than 100 μm of the circulatory system, whose main functions are tissue nutrition and oxygen supply. In microcirculatory studies, it is important to know the amount of oxyhemoglobin present in the blood and how fast it is moving. The present work describes improvements introduced in a classical hardware-based instrument that has usually been used to monitor blood flow velocity in the microcirculation of small animals. It consists of a virtual instrument that can be easily incorporated into existing hardware-based systems, contributing to reduce operator related biases and allowing digital processing and storage. The design and calibration of the modified instrument are described as well as in vitro and in vivo results obtained with electrical models and small animals, respectively. Results obtained in in vivo studies showed that this new system is able to detect a small reduction in blood flow velocity comparing arteries and arterioles (p<0.002) and a further reduction in capillaries (p<0.0001). A significant increase in velocity comparing capillaries and venules (p<0.001) and venules and veins (p<0.001) was also observed. These results are in close agreement with biophysical principles. Moreover, the improvements introduced in the device allowed us to clearly observe changes in blood flow introduced by a pharmacological intervention, suggesting that the system has enough temporal resolution to track these microcirculatory events. These results were also in close conformity to physiology, confirming the high scientific potential of the modified system and indicating that this instrument can also be useful for pharmacological evaluations

  12. Cerebral blood flow autoregulation in patients with acute bacterial meningitis

    DEFF Research Database (Denmark)

    Møller, Kirsten

    2001-01-01

    Ph.d. afhandlingen omhandler sammenhængen mellem hjernens blodtilførsel (CBF) og middelarterietrykket (MAP) hos patienter med akut bakteriel meningitis. Hos raske er CBF uafhængig af MAP, hvilket kaldes CBF autoregulation. Svækket autoregulation antages at øge risikoen for cerebral hypoperfusion og...... iskæmi under episoder med lavt MAP, og for cerebral hyperperfusion og vasogent ødem ved højt MAP. CBF autoregulationen undersøgtes hos tyve voksne patienter med akut bakteriel meningitis i den tidlige sygdomsfase (... meningitis, men retableres ved klinisk restitution. Autoregulationen kan endvidere delvis retableres ved akut hyperventilation. Fundene har potentiel betydning for valg af supportiv terapi hos patienter med meningitis....

  13. Effects of emergency department expansion on emergency department patient flow.

    Science.gov (United States)

    Mumma, Bryn E; McCue, James Y; Li, Chin-Shang; Holmes, James F

    2014-05-01

    Emergency department (ED) crowding is an increasing problem associated with adverse patient outcomes. ED expansion is one method advocated to reduce ED crowding. The objective of this analysis was to determine the effect of ED expansion on measures of ED crowding. This was a retrospective study using administrative data from two 11-month periods before and after the expansion of an ED from 33 to 53 adult beds in an academic medical center. ED volume, staffing, and hospital admission and occupancy data were obtained either from the electronic health record (EHR) or from administrative records. The primary outcome was the rate of patients who left without being treated (LWBT), and the secondary outcome was total ED boarding time for admitted patients. A multivariable robust linear regression model was used to determine whether ED expansion was associated with the outcome measures. The mean (±SD) daily adult volume was 128 (±14) patients before expansion and 145 (±17) patients after. The percentage of patients who LWBT was unchanged: 9.0% before expansion versus 8.3% after expansion (difference = 0.6%, 95% confidence interval [CI] = -0.16% to 1.4%). Total ED boarding time increased from 160 to 180 hours/day (difference = 20 hours, 95% CI = 8 to 32 hours). After daily ED volume, low-acuity area volume, daily wait time, daily boarding hours, and nurse staffing were adjusted for, the percentage of patients who LWBT was not independently associated with ED expansion (p = 0.053). After ED admissions, ED intensive care unit (ICU) admissions, elective surgical admissions, hospital occupancy rate, ICU occupancy rate, and number of operational ICU beds were adjusted for, the increase in ED boarding hours was independently associated with the ED expansion (p = 0.005). An increase in ED bed capacity was associated with no significant change in the percentage of patients who LWBT, but had an unintended consequence of an increase in ED boarding hours. ED expansion alone does

  14. A Scholarly Pathway in Quality Improvement and Patient Safety.

    Science.gov (United States)

    Ferguson, Catherine C; Lamb, Geoffrey

    2015-10-01

    There are several challenges to teaching quality improvement (QI) and patient safety material to medical students, as successful programs should combine didactic and experiential teaching methods, integrate the material into the preclinical and clinical years, and tailor the material to the schools' existing curriculum. The authors describe the development, implementation, and assessment of the Quality Improvement and Patient Safety (QuIPS) Scholarly Pathway-a faculty-mentored, three-year experience for students interested in gaining exposure to QI and patient safety concepts at the Medical College of Wisconsin (MCW). The QuIPS pathway capitalized on the existing structure of scholarly pathways for MCW medical students, allowing QI and patient safety to be incorporated into the existing curriculum using didactic and experiential instruction and spanning preclinical and clinical education. Student reaction to the QuIPS pathway has been favorable. Preliminary data demonstrate that student knowledge as measured by the Quality Improvement Knowledge Assessment Tool significantly increased after the first year of implementation. A novel curriculum such as the QuIPS pathway provides an important opportunity to develop and test new assessment tools for curricula in systems-based practice and practice-based learning and improvement. The authors also hope that by bringing together local QI and patient safety experts and stakeholders during the curricular development process, they have laid the groundwork for the creation of a more pervasive curriculum that will reach all MCW students in the future. The model may be generalizable to other U.S. medical schools with scholarly pathways as well.

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

    Science.gov (United States)

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

    2018-03-01

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

  16. Regional cerebral blood flow study with 123I-IMP in patients with degenerative dementia

    International Nuclear Information System (INIS)

    Ohnishi, T.; Hoshi, H.; Nagamachi, S.; Jinnouchi, S.; Futami, S.; Watanabe, K.; Mitsuyama, Y.

    1991-01-01

    Regional cerebral blood flow was evaluated by single-photon emission CT (SPECT) with 123I-N-isopropyl-p-iodoamphetamine (123I-IMP) in 11 patients with dementia of the Alzheimer type, three patients with progressive dementia and motor neuron disease, and eight healthy control subjects. Regional blood flow measurements in the bilateral frontal, parietal association, and temporal cortices were lower in the Alzheimer dementia patients than in controls. Flow deficits in the parietal association cortex were demonstrated in all patients with Alzheimer-type dementia; these deficits were correlated with the severity of disease. Lateral hemispheric asymmetry was seen in nine of 11 patients with Alzheimer-type dementia. In all three patients with progressive dementia and motor neuron disease, flow deficits were demonstrated in the bilateral frontal and temporal cortices, but no flow deficits were seen in the parietal association cortex. Brain SPECT with 123I-IMP may be useful in the differential diagnosis and evaluation of the severity of degenerative dementia

  17. Prediction of effectiveness of shunting in patients with normal pressure hydrocephalus by cerebral blood flow measurement and computed tomography cisternography

    Energy Technology Data Exchange (ETDEWEB)

    Chang, Chia-Cheng; Kuwana, Nobumasa; Ito, Susumu; Ikegami, Tadashi [Yokohama Minami Kyosai Hospital (Japan)

    1999-11-01

    Measurement of cerebral blood flow (CBF) and computed tomography (CT) cisternography were performed in 37 patients with a tentative diagnosis of normal pressure hydrocephalus (NPH) to predict their surgical outcome. The mean CBF of the whole brain was measured quantitatively by single photon emission computed tomography with technetium-99m-hexamethylpropylene amine oxime before surgery. The results of CT cisternography were classified into four patients: type I, no ventricular stasis at 24 hours; type II, no ventricular stasis with delayed clearance of cerebral blush; type III, persistent ventricular stasis with prominent cerebral blush; type IV, persistent ventricular stasis with diminished cerebral blush and/or asymmetrical filling of the sylvian fissures. The mean CBF was significantly lower than that of age-matched controls (p<0.005). Patients with a favorable outcome had a significantly higher mean CBF than patients with an unfavorable outcome (p<0.005). Patients with the type I pattern did not respond to shunting. Some patients with type II and III patterns responded to shunting but improvement was unsatisfactory. Patients with type IV pattern responded well to shunting, and those with a mean CBF of 35 ml/100 g/min or over achieved a favorable outcome. The combination of CBF measurement and CT cisternography can improve the prediction of surgical outcome in patients with suspected NPH. (author)

  18. Prediction of effectiveness of shunting in patients with normal pressure hydrocephalus by cerebral blood flow measurement and computed tomography cisternography

    International Nuclear Information System (INIS)

    Chang, Chia-Cheng; Kuwana, Nobumasa; Ito, Susumu; Ikegami, Tadashi

    1999-01-01

    Measurement of cerebral blood flow (CBF) and computed tomography (CT) cisternography were performed in 37 patients with a tentative diagnosis of normal pressure hydrocephalus (NPH) to predict their surgical outcome. The mean CBF of the whole brain was measured quantitatively by single photon emission computed tomography with technetium-99m-hexamethylpropylene amine oxime before surgery. The results of CT cisternography were classified into four patients: type I, no ventricular stasis at 24 hours; type II, no ventricular stasis with delayed clearance of cerebral blush; type III, persistent ventricular stasis with prominent cerebral blush; type IV, persistent ventricular stasis with diminished cerebral blush and/or asymmetrical filling of the sylvian fissures. The mean CBF was significantly lower than that of age-matched controls (p<0.005). Patients with a favorable outcome had a significantly higher mean CBF than patients with an unfavorable outcome (p<0.005). Patients with the type I pattern did not respond to shunting. Some patients with type II and III patterns responded to shunting but improvement was unsatisfactory. Patients with type IV pattern responded well to shunting, and those with a mean CBF of 35 ml/100 g/min or over achieved a favorable outcome. The combination of CBF measurement and CT cisternography can improve the prediction of surgical outcome in patients with suspected NPH. (author)

  19. Correlation between ELISA and ML Flow assays applied to 60 Brazilian patients affected by leprosy

    NARCIS (Netherlands)

    Da Silva, Rozana C.; Lyon, Sandra; Lyon, Ana C.; Grossi, Maria A. F.; Lyon, Silvia H.; Bührer-Sékula, Samira; Antunes, Carlos M. F.

    2010-01-01

    Serological tests can be helpful in classifying leprosy patients as having either the paucibacillary or the multibacillary form. The aim of this study was to evaluate the concordance between two serological assays, i.e. ML Flow and ELISA, in a population of leprosy patients in Brazil. The

  20. 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.

  1. Integrating patient satisfaction into performance measurement to meet improvement challenges.

    Science.gov (United States)

    Smith, J E; Fisher, D L; Endorf-Olson, J J

    2000-05-01

    A Value Compass has been proposed to guide health care data collection. The "compass corners" represent the four types of data needed to meet health care customer expectations: appropriate clinical outcomes, improved functional status, patient satisfaction, and appropriate costs. Collection of all four types of data is necessary to select processes in need of improvement, guide improvement teams, and monitor the success of improvement efforts. INTEGRATED DATA AT BRYANLGH: BryanLGH Medical Center in Lincoln, Nebraska, has adopted multiple performance measurement systems to collect clinical outcome, financial, and patient satisfaction data into integrated databases. Data integration allows quality professionals at BryanLGH to identify quality issues from multiple perspectives and track the interrelated effects of improvement efforts. A CASE EXAMPLE: Data from the fourth quarter of 1997 indicated the need to improve processes related to cesarean section (C-section) deliveries. An interdisciplinary team was formed, which focused on educating nurses, physicians, and the community about labor support measures. Physicians were given their own rates of C-section deliveries. The C-section rate decreased from 27% to 19%, but per-case cost increased. PickerPLUS+ results indicated that BryanLGH obstetric patients reported fewer problems with receiving information than the Picker norm, but they reported more problems with the involvement of family members and friends. The data collected so far have indicated a decrease in the C-section rate and a need to continue to work on cost and psychosocial issues. A complete analysis of results was facilitated by integrated performance management systems. Successes have been easily tracked over time, and the need for further work on related processes has been clearly identified.

  2. Traditional Japanese Medicine Daikenchuto Improves Functional Constipation in Poststroke Patients

    Directory of Open Access Journals (Sweden)

    Takehiro Numata

    2014-01-01

    Full Text Available Poststroke patients with functional constipation, assessed by the Rome III criteria, from 6 hospitals were recruited in a study on the effects of the traditional Japanese medicine Daikenchuto (DKT on constipation. Thirty-four patients (17 men and 17 women; mean age: 78.1 ± 11.6 years were randomly assigned to 2 groups; all patients received conventional therapy for constipation, and patients in the DKT group received 15 g/day of DKT for 4 weeks. Constipation scoring system (CSS points and the gas volume score (GVS (the measure of the intestinal gas volume calculated from plain abdominal radiographs were recorded before and after a 4-week observation period. The total score on the CSS improved significantly in the DKT group compared to the control (P<0.01. In addition, scores for some CSS subcategories (frequency of bowel movements, feeling of incomplete evacuation, and need for enema/disimpaction significantly improved in the DKT group (P<0.01, P=0.049, and P=0.03, resp.. The GVS was also significantly reduced in the DKT group compared to the control (P=0.03. DKT in addition to conventional therapy is effective in treating functional constipation in poststroke patients. This study was a randomized controlled trial and was registered in the UMIN Clinical Trial Registry (no. UMIN000007393.

  3. How to Improve Patient Safety Culture in Croatian Hospitals?

    Science.gov (United States)

    Šklebar, Ivan; Mustajbegović, Jadranka; Šklebar, Duška; Cesarik, Marijan; Milošević, Milan; Brborović, Hana; Šporčić, Krunoslav; Petrić, Petar; Husedžinović, Ino

    2016-09-01

    Patient safety culture (PCS) has a crucial impact on the safety practices of healthcare delivery systems. The purpose of this study was to assess the state of PSC in Croatian hospitals and compare it with hospitals in the United States. The study was conducted in three public general hospitals in Croatia using the Croatian translation of the Hospital Survey of Patient Safety Culture (HSOPSC). A comparison of the results from Croatian and American hospitals was performed using a T-square test. We found statistically significant differences in all 12 PSC dimensions. Croatian responses were more positive in the two dimensions of Handoff s and Transitions and Overall Perceptions of Patient Safety. In the remaining ten dimensions, Croatian responses were less positive than in US hospitals, with the most prominent areas being Nonpunitive Response to Error, Frequency of Events Reported, Communication Openness, Teamwork within Units, Feedback & Communication about Error, Management Support for Patient Safety, and Staffing. Our findings show that PSC is significantly lower in Croatian than in American hospitals, particularly in the areas of Nonpunitive Response to Error, Leadership, Teamwork, Communication Openness and Staffing. This suggests that a more comprehensive system for the improvement of patient safety within the framework of the Croatian healthcare system needs to be developed. Our findings also help confirm that HSOPSC is a useful and appropriate tool for the assessment of PSC. HSOPSC highlights the PSC components in need of improvement and should be considered for use in national and international benchmarking.

  4. Spironolactone in chronic hemodialysis patients improves cardiac function

    International Nuclear Information System (INIS)

    Taheri, Shahram; Mortazavi, Mojhgan; Shahidi Shahrzad; Seirafian, Shiva; Pourmoghadas, Ali; Garakyaraghi, Mohammad; Eshaghian, Afrooz; Ghassami, Maryam

    2009-01-01

    We performed this study to assess whether low dose spironolactone could be administered in hemodialysis (HD) patients with moderate to severe heart failure to improve cardiovascular function and reduce hospitalization without inducing hyperkalemia. We enrolled 16 chronic HD patients with moderate to severe heart failure and left ventricle ejection fraction :5 45%. In a double blinded randomized placebo controlled study, one group of 8 patients received 25 mg of spironolactone after each dialysis session within six months, and the rest received a placebo. Echocardiography was performed on all the patients to assess ejection fraction and left ventricular mass during 12 hours after completion of hemodialysis at the beginning and the end of study. Serum potassium was measured predialysis every 4 weeks. The mean ejection fraction increased significantly more in spironolactone group during the study period than in the placebo group (6.2 + - 1.64 vs. 0.83 + - 4.9, P0.046). The mean left ventricular mass decreased in the spironolactone group, but increased significantly in the placebo group during the period (-8.4 + - 4.72 vs. 3 + -7.97. 95%, P= 0.021). The incidence of hyperkalemia was not significantly increased in the study or controlled groups. In conclusion, we found in this study that administration of spironolactone in chronic HD patients with moderate to severe heart failure substantially improved their cardiac function and decreases left ventricular mass without development of significant hyperkalemia. (author)

  5. Does stapes surgery improve tinnitus in patients with otosclerosis?

    Science.gov (United States)

    Ismi, Onur; Erdogan, Osman; Yesilova, Mesut; Ozcan, Cengiz; Ovla, Didem; Gorur, Kemal

    Otosclerosis (OS) is the primary disease of the human temporal bone characterized by conductive hearing loss and tinnitus. The exact pathogenesis of tinnitus in otosclerosis patients is not known and factors affecting the tinnitus outcome in otosclerosis patients are still controversial. To find the effect of stapedotomy on tinnitus for otosclerosis patients. Fifty-six otosclerosis patients with preoperative tinnitus were enrolled to the study. Pure tone average Air-Bone Gap values, preoperative tinnitus pitch, Air-Bone Gap closure at tinnitus frequencies were evaluated for their effect on the postoperative outcome. Low pitch tinnitus had more favorable outcome compared to high pitch tinnitus (p=0.002). Postoperative average pure tone thresholds Air-Bone Gap values were not related to the postoperative tinnitus (p=0.213). There was no statistically significant difference between postoperative Air-Bone Gap closure at tinnitus frequency and improvement of high pitch tinnitus (p=0.427). There was a statistically significant difference between Air-Bone Gap improvement in tinnitus frequency and low pitch tinnitus recovery (p=0.026). Low pitch tinnitus is more likely to be resolved after stapedotomy for patients with otosclerosis. High pitch tinnitus may not resolve even after closure of the Air-Bone Gap at tinnitus frequencies. Copyright © 2016 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.

  6. Approaches to improve adherence to pharmacotherapy in patients with schizophrenia.

    Science.gov (United States)

    Shuler, Kimberly M

    2014-01-01

    In patients with schizophrenia, nonadherence to prescribed medications increases the risk of patient relapse and hospitalization, key contributors to the costs associated with treatment. The objectives of this review were to evaluate the impact of nonadherence to pharmacotherapy in patients with schizophrenia as it relates to health care professionals, particularly social workers, and to identify effective team approaches to supporting patients based on studies assessing implementation of assertive community treatment teams. A systematic review of the medical literature was conducted by searching the Scopus database to identify articles associated with treatment adherence in patients with schizophrenia. Articles included were published from January 1, 2003, through July 15, 2013, were written in English, and reported findings concerning any and all aspects of nonadherence to prescribed treatment in patients with schizophrenia. Of 92 unique articles identified and formally screened, 47 met the inclusion criteria for the systematic review. The burden of nonadherence in schizophrenia is significant. Factors with the potential to affect adherence include antipsychotic drug class and formulation, patient-specific factors, and family/social support system. There is inconclusive evidence suggesting superior adherence with an atypical versus typical antipsychotic or with a long-acting injectable versus an oral formulation. Patient-specific factors that contribute to adherence include awareness/denial of illness, cognitive issues, stigma associated with taking medication, substance abuse, access to health care, employment/poverty, and insurance status. Lack of social or family support may adversely affect adherence, necessitating the assistance of health care professionals, such as social workers. Evidence supports the concept that an enhanced team-oriented approach to managing patients with schizophrenia improves adherence and supports corresponding reductions in relapse

  7. Improving quality of care among patients hospitalised with schizophrenia

    DEFF Research Database (Denmark)

    Jørgensen, Mette; Mainz, Jan; Svendsen, Marie Louise

    2015-01-01

    BACKGROUND: The effectiveness of systematic quality improvement initiatives in psychiatric care remains unclear. AIMS: To examine whether quality of care has changed following implementation of a systematic monitoring programme of hospital performance measures. METHOD: In a nationwide population.......27-1.62), psychoeducation (RR: 1.33, 95% CI: 1.19-1.48), psychiatric aftercare (RR: 1.06, 95% CI: 1.01-1.11) and suicide risk assessment (RR: 1.31, 95% CI: 1.21-1.42). CONCLUSIONS: Quality of care improved from 2004 to 2011 among patients hospitalised with schizophrenia in Denmark. DECLARATION OF INTEREST: None. COPYRIGHT...

  8. Financial versus Non-Financial Incentives for Improving Patient Experience.

    Science.gov (United States)

    Lee, Thomas H

    2015-05-01

    Delivering compassionate and coordinated care is a goal for all health care providers. Humans are not always consistent, though, both individually and collectively, and this is why everyone needs incentives to be at their best and to try to always be improving. The endlessly interesting question in patient experience is, what should those incentives look like? Should they be financial or nonfinancial? Dr. Thomas H. Lee explores what is most effective in regard to engaging and motivating physicians. While different approaches will work in different organizational cultures, financial incentives have their role in performance improvement. Compassionate coordinated care should be a social norm and be pursued by all health care organizations.

  9. Information flow to assess cardiorespiratory interactions in patients on weaning trials.

    Science.gov (United States)

    Vallverdú, M; Tibaduisa, O; Clariá, F; Hoyer, D; Giraldo, B; Benito, S; Caminal, P

    2006-01-01

    Nonlinear processes of the autonomic nervous system (ANS) can produce breath-to-breath variability in the pattern of breathing. In order to provide assess to these nonlinear processes, nonlinear statistical dependencies between heart rate variability and respiratory pattern variability are analyzed. In this way, auto-mutual information and cross-mutual information concepts are applied. This information flow analysis is presented as a short-term non linear analysis method to investigate the information flow interactions in patients on weaning trials. 78 patients from mechanical ventilation were studied: Group A of 28 patients that failed to maintain spontaneous breathing and were reconnected; Group B of 50 patients with successful trials. The results show lower complexity with an increase of information flow in group A than in group B. Furthermore, a more (weakly) coupled nonlinear oscillator behavior is observed in the series of group A than in B.

  10. Efficacy of high-flow oxygen by nasal cannula with active humidification in a patient with acute respiratory failure of neuromuscular origin.

    Science.gov (United States)

    Díaz-Lobato, Salvador; Folgado, Miguel Angel; Chapa, Angel; Mayoralas Alises, Sagrario

    2013-12-01

    The treatment of choice for patients with respiratory failure of neuromuscular origin, especially in patients with hypercapnic respiratory acidosis, is noninvasive ventilation (NIV). Endotracheal intubation and invasive ventilation are indicated for patients with severe respiratory compromise or failure of NIV. In recent years, high-flow oxygen therapy and active humidification devices have been introduced, and emerging evidence suggests that high-flow oxygen may be effective in various clinical settings, such as acute respiratory failure, after cardiac surgery, during sedation and analgesia, in acute heart failure, in hypoxemic respiratory distress, in do-not-intubate patients, in patients with chronic cough and copious secretions, pulmonary fibrosis, or cancer, in critical areas and the emergency department. We report on a patient with amyotrophic lateral sclerosis who arrived at the emergency department with acute hypercapnic respiratory failure. She did not tolerate NIV and refused intubation, but was treated successfully with heated, humidified oxygen via high-flow nasal cannula. Arterial blood analysis after an hour on high-flow nasal cannula showed improved pH, P(aCO2), and awareness. The respiratory acidosis was corrected, and she was discharged after 5 days of hospitalization. Her response to high-flow nasal cannula was similar to that expected with NIV. We discuss the mechanisms of action of heated, humidified high-flow oxygen therapy.

  11. Differential visceral blood flow in the hyperdynamic circulation of patients with liver cirrhosis.

    Science.gov (United States)

    McAvoy, N C; Semple, S; Richards, J M J; Robson, A J; Patel, D; Jardine, A G M; Leyland, K; Cooper, A S; Newby, D E; Hayes, P C

    2016-05-01

    With advancing liver disease and the development of portal hypertension, there are major alterations in somatic and visceral blood flow. Using phase-contrast magnetic resonance angiography, we characterised alterations in blood flow within the hepatic, splanchnic and extra-splanchnic circulations of patients with established liver cirrhosis. To compare blood flow in splanchnic and extra-splanchnic circulations in patients with varying degrees of cirrhosis and healthy controls. In a single-centre prospective study, 21 healthy volunteers and 19 patients with established liver disease (Child's stage B and C) underwent electrocardiogram-gated phase-contrast-enhanced 3T magnetic resonance angiography of the aorta, hepatic artery, portal vein, superior mesenteric artery, and the renal and common carotid arteries. In comparison to healthy volunteers, resting blood flow in the descending thoracic aorta was increased by 43% in patients with liver disease (4.31 ± 1.47 vs. 3.31 ± 0.80 L/min, P = 0.011). While portal vein flow was similar (0.83 ± 0.38 vs. 0.77 ± 0.35 L/min, P = 0.649), hepatic artery flow doubled (0.50 ± 0.46 vs. 0.25 ± 0.15 L/min, P = 0.021) and consequently total liver blood flow increased by 30% (1.33 ± 0.84 vs. 1.027 ± 0.5 L/min, P = 0.043). In patients with liver disease, superior mesenteric artery flow was threefold higher (0.65 ± 0.35 vs. 0.22 ± 0.13 L/min, P phenomenon. These circulatory disturbances may underlie many of the manifestations of advanced liver disease. © 2016 John Wiley & Sons Ltd.

  12. Determination of pump flow rate during cardiopulmonary bypass in obese patients avoiding hemodilution.

    Science.gov (United States)

    Santambrogio, Luisa; Leva, Cristian; Musazzi, Giorgio; Bruno, Piergiorgio; Vailati, Andrea; Zecchillo, Franco; Di Credico, Germano

    2009-01-01

    During cardiopulmonary bypass the pump flow is usually set on 2.4 L/min/m(2) of body surface area (BSA) to guarantee adequate tissue perfusion without differences for patient constitutional type. The present study attempts to evaluate the adequacy of pump flow rate in obese patients, considering the ideal weight instead of the real one, avoiding the overflow side effects and hemodilution. Obese patients with body mass index (BMI) > 30 presented for cardiac surgery were randomized in two groups: in one the cardiopulmonary bypass was led traditionally, in the other, pump flow rate was calculated on ideal BMI of 25. Demographics, preoperative tests, and monitoring data were registered. Mortality at hospital discharge and 30 days after were analyzed. The pump flow rate between the groups was different (4.46 vs. 4.87; p = 0.004); there were no differences in organ perfusion (SvO(2); diuresis) and mortality, but the study group presented fewer complications and blood transfusions. The BSA is widely used as the biometric unit to normalize physiologic parameters included pump flow rate, but it is disputable if this practice is correct also in obese patients. The study group, in which pump flow rate was set on ideal BSA, presented no difference in diuresis and mixed venous saturation but fewer complications and fewer perioperative blood transfusions.

  13. An improved multi-value cellular automata model for heterogeneous bicycle traffic flow

    Energy Technology Data Exchange (ETDEWEB)

    Jin, Sheng [College of Civil Engineering and Architecture, Zhejiang University, Hangzhou, 310058 China (China); Qu, Xiaobo [Griffith School of Engineering, Griffith University, Gold Coast, 4222 Australia (Australia); Xu, Cheng [Department of Transportation Management Engineering, Zhejiang Police College, Hangzhou, 310053 China (China); College of Transportation, Jilin University, Changchun, 130022 China (China); Ma, Dongfang, E-mail: mdf2004@zju.edu.cn [Ocean College, Zhejiang University, Hangzhou, 310058 China (China); Wang, Dianhai [College of Civil Engineering and Architecture, Zhejiang University, Hangzhou, 310058 China (China)

    2015-10-16

    This letter develops an improved multi-value cellular automata model for heterogeneous bicycle traffic flow taking the higher maximum speed of electric bicycles into consideration. The update rules of both regular and electric bicycles are improved, with maximum speeds of two and three cells per second respectively. Numerical simulation results for deterministic and stochastic cases are obtained. The fundamental diagrams and multiple states effects under different model parameters are analyzed and discussed. Field observations were made to calibrate the slowdown probabilities. The results imply that the improved extended Burgers cellular automata (IEBCA) model is more consistent with the field observations than previous models and greatly enhances the realism of the bicycle traffic model. - Highlights: • We proposed an improved multi-value CA model with higher maximum speed. • Update rules are introduced for heterogeneous bicycle traffic with maximum speed 2 and 3 cells/s. • Simulation results of the proposed model are consistent with field bicycle data. • Slowdown probabilities of both regular and electric bicycles are calibrated.

  14. An improved multi-value cellular automata model for heterogeneous bicycle traffic flow

    International Nuclear Information System (INIS)

    Jin, Sheng; Qu, Xiaobo; Xu, Cheng; Ma, Dongfang; Wang, Dianhai

    2015-01-01

    This letter develops an improved multi-value cellular automata model for heterogeneous bicycle traffic flow taking the higher maximum speed of electric bicycles into consideration. The update rules of both regular and electric bicycles are improved, with maximum speeds of two and three cells per second respectively. Numerical simulation results for deterministic and stochastic cases are obtained. The fundamental diagrams and multiple states effects under different model parameters are analyzed and discussed. Field observations were made to calibrate the slowdown probabilities. The results imply that the improved extended Burgers cellular automata (IEBCA) model is more consistent with the field observations than previous models and greatly enhances the realism of the bicycle traffic model. - Highlights: • We proposed an improved multi-value CA model with higher maximum speed. • Update rules are introduced for heterogeneous bicycle traffic with maximum speed 2 and 3 cells/s. • Simulation results of the proposed model are consistent with field bicycle data. • Slowdown probabilities of both regular and electric bicycles are calibrated

  15. Hemodynamic, biological, and right ventricular functional changes following intraatrial shunt repair in patients with flow-induced pulmonary hypertension.

    Science.gov (United States)

    Hsu, Chih-Hsin; Roan, Jun-Neng; Wang, Jieh-Neng; Huang, Chien-Chi; Shih, Chao-Jung; Chen, Jyh-Hong; Wu, Jing-Ming; Lam, Chen-Fuh

    2017-07-01

    Atrial septal defects may result in pulmonary hypertension and right heart remodeling. We analyzed improvements in patients with flow-induced pulmonary hypertension and the activation of endothelial progenitor cells after flow reduction. This prospective cohort study included 37 patients who were admitted for an occluder implantation. Blood samples were collected before and after the procedure. We determined the number of endothelial progenitor cells in outgrowth colonies and serum Hsp27 concentrations. Daily performance and cardiothoracic ratio were reevaluated later. Closure of the defect significantly reduced the pulmonary pressure and B-type natriuretic peptide levels. The cardiothoracic ratio and daily performance status also improved. The number of endothelial progenitor cell outgrowth colony-forming units significantly increased and was positively correlated with daily performance. In patients with enhanced colony formation, Hsp27 levels were significantly increased. The implantation of an occluder successfully improved hemodynamic, right ventricular, and daily performance. Qualitative enhancement of colony formation for endothelial progenitor cells was also noted and positively correlated with daily performance. Closure of defects may serve as a valid, reliable model to obtain a deeper understanding of the modulation of endothelial progenitor cell activity and its relationship with pulmonary hypertension prognosis. © 2017 Wiley Periodicals, Inc.

  16. 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

  17. [Primary care for diabetic patients: a quality improvement cycle].

    Science.gov (United States)

    Navarro-Martínez, A; Suárez-Beke, M P; Sánchez-Nicolás, J A; Lázaro-Aragues, P; de Jesús Jiménez-Vázquez, E; Huertas-de Mora, O

    2014-01-01

    The aim of this study was to evaluate and improve the quality of medical care provided to diabetic patients following the standards proposed by the American Diabetes Association. The study was conducted in three phases by analyzing data from the computerized clinical history of a sample of 340 patients. First phase (2010): cross-sectional, descriptive study which assessed the proportion of patients who met the standards related to the screening of diabetes, and goals of control and treatment. Subsequently, health professionals reviewed the results in order to promote the implementation of corrective action. Finally (2012), a new assessment with the same standards was performed. An increase in the number of patients treated with insulin (12.7% in 2010 and 20.2% in 2012) was observed (P < .01). There were also percentage increases in the number of patients who met the screening standards as regards analytical determinations: glycosylated hemoglobin (from 44.4% to 68.2%), lipid profile (47.6%-73.8%), creatinine (32.5% - 73.5%), and albumin-creatinine ratio (9.2%-24.4%) (P < .001). Only 6.4% (CI: 3.2- 9.8) of diabetic patients attained the composite target of glycosylated hemoglobin < 7%, blood pressure < 130/80 mmHg and low-density lipoprotein cholesterol < 100 mg/dl in 2012. This study shows that medical care has improved the goals related to analytical determinations and the number of insulin-treated diabetic type 2 patients. An optimal level was also maintained in metabolic control of diabetes, but there was still poor control of risk factors for cardiovascular disease. Copyright © 2014 SECA. Published by Elsevier Espana. All rights reserved.

  18. How to improve effectiveness of pegvisomant treatment in acromegalic patients.

    Science.gov (United States)

    Ragonese, M; Grottoli, S; Maffei, P; Alibrandi, A; Ambrosio, M R; Arnaldi, G; Bianchi, A; Puglisi, S; Zatelli, M C; De Marinis, L; Ghigo, E; Giustina, A; Maffezzoni, F; Martini, C; Trementino, L; Cannavo, S

    2018-05-01

    Pegvisomant (PEGV) treatment in acromegaly patients resistant to somatostatin analogues is less effective in the real life than in clinical trials. This is a multicenter, observational, retrospective, longitudinal study. The aim was to detect characteristics which improve long-term PEGV effectiveness. 87 acromegalic patients treated with PEGV have been enrolled in seven referral Italian centres. PEGV was administered for up to 4 years, at doses up titrated until IGF-1 normalization or to ≥ 30 mg/day. The rate of patients who reached IGF-1 normalization at last visit has been calculated. IGF-1 was normalized in 75.9% of patients after 1 year and in 89.6% at last visit. Disease control was associated with lower baseline GH, IGF-1 and IGF-1 xULN and was more frequent when baseline IGF-1 was  2.7 × ULN (p  1.0 mg/BMI/day were administered more frequently when baseline IGF-1 was > 2.0 × ULN (p = 0.03). PEGV resistance was associated with higher BMI (p = 0.006) and was more frequent when BMI was > 30 kg/m 2 (p = 0.07). There were no significant differences between patients treated with monotherapy or combined treatment. IGF-1 normalization, PEGV dose and rate of associated treatment were similar between males and females. PEGV effectiveness was independent from previous management. Diabetic patients needed higher doses of PEGV than non-diabetic ones. PEGV effectiveness improves when up titration is appropriate. Higher PEGV doses at start and a more rapid up-titration are necessary in patients with obesity and/or IGF-1 > 2.7 × ULN.

  19. LJUBLJANICA CONNECTS - Restoration of the Ljubljanica River corridor and improvement of the river's flow regime

    Science.gov (United States)

    Zabret, Katarina; Sapač, Klaudija; Šraj, Mojca; Bezak, Nejc; Sečnik, Matej; Vidmar, Andrej; Brilly, Mitja

    2016-04-01

    The project Ljubljanica connects is focused on improving connectivity and living conditions in Ljubljanica River which flows through capital city of Slovenia, Ljubljana. It represents living environment for endangered and Natura 2000 targeted fish species Danube Salmon (Hucho hucho), Danube Roach (Rutilus pigus) and Striped Chub (Leuciscus souffia). The project consists of four sets of activities: concrete restoration actions including improvement of two fish passes, monitoring of fish migration, monitoring of eco-hydrological parameters, and raising of public awareness. To improve living conditions the concrete restoration measures were performed. The reconstructions of sill and two fish passes on the Ljubljanica River have been implemented and barrier's lifting system on the weir was modernized. Above the sill in Zalog there is an oxbow which was disconnected with main river channel during the low flows. Interrupted inflow of fresh water caused very poor living conditions for animals in the oxbow. The raise of the sill helped to improve this situation. One of the fish passes included in the project is more than 100 years old whereas both are protected as cultural and technical heritage. None was working properly and due to the protection no visible nor drastic measures were allowed. With smaller improvements we managed to re-establish their operation. A lifting system of the barrier at the Ambrožev trg gate was outdated and did not allow precise regulation of the water level. Too fast raising of the barrier instantly caused deterioration of eco-hydrological conditions downstream. With modernization of the electromechanical equipment the situation is improved. The fish monitoring helps us to evaluate success of concrete restoration actions. The fish population status is monitored with marking the fish with Visible Implant Elastomer (VIE) tags. Regarding the location of catch we implant tags beneath transparent or translucent tissue combining different tag

  20. Improving Patient Safety in Anesthesia: A Success Story?

    International Nuclear Information System (INIS)

    Botney, Richard

    2008-01-01

    Anesthesia is necessary for surgery; however, it does not deliver any direct therapeutic benefit. The risks of anesthesia must therefore be as low as possible. Anesthesiology has been identified as a leader in improving patient safety. Anesthetic mortality has decreased, and in healthy patients can be as low as 1:250,000. Trends in anesthetic morbidity have not been as well defined, but it appears that the risk of injury is decreasing. Studies of error during anesthesia and Closed Claims studies have identified sources of risk and methods to reduce the risks associated with anesthesia. These include changes in technology, such as anesthetic delivery systems and monitors, the application of human factors, the use of simulation, and the establishment of reporting systems. A review of the important events in the past 50 years illustrates the many steps that have contributed to the improvements in anesthesia safety

  1. Low-Intensity Sprint Training With Blood Flow Restriction Improves 100-m Dash.

    Science.gov (United States)

    Behringer, Michael; Behlau, Daniel; Montag, Johannes C K; McCourt, Molly L; Mester, Joachim

    2017-09-01

    Behringer, M, Behlau, D, Montag, JCK, McCourt, ML, and Mester, J. Low-intensity sprint training with blood flow restriction improves 100-m dash. J Strength Cond Res 31(9): 2462-2472, 2017-We investigated the effects of practical blood flow restriction (pBFR) of leg muscles during sprint training on the 100-m dash time in well-trained sport students. Participants performed 6 × 100-m sprints at 60-70% of their maximal 100-m sprinting speed twice a week for 6 weeks, either with (intervention group [IG]; n = 12) or without pBFR (control group [CG]; n = 12). The 100-m dash time significantly decreased more in the IG (-0.38 ± 0.24 seconds) than in the CG (-0.16 ± 0.17 seconds). The muscle thickness of the rectus femoris increased only in the IG, whereas no group-by-time interactions were found for the muscle thickness of the biceps femoris and the biceps brachii. The maximal isometric force, measured using a leg press, did not change in either group. However, the rate of force development improved in the IG. Growth hormone, testosterone, insulin-like growth factor 1, and cortisol concentrations did not significantly differ between both groups at any measurement time point (pre, 1 minute, 20 minutes, 120 minutes, and 24 hours after the 6 all-out sprints of the first training session). The muscle damage marker h-FABP increased significantly more in the CG than in the IG. The pBFR improved the 100-m dash time significantly more than low-intensity sprint interval training alone. Other noted benefits of training with pBFR were a decreased level of muscle damage, a greater increase of the rectus femoris muscle thickness, and a higher rate of force development. However, the tested hormones were unable to explain the additional beneficial effects.

  2. Tumor blood flow, pO2, and radioresponse are improved by mild temperature hyperthermia

    International Nuclear Information System (INIS)

    Shakil, Abdus; Griffin, Robert J.; Song, Chang W.

    1997-01-01

    Purpose/Objective: The purpose of this study was to elucidate the changes in tumor blood flow, tumor pO 2 and the radiation response of the tumors caused by mild temperature hyperthermia (MTH). Materials And Methods: Experiments were carried out using the R3230 Adenocarcinoma (R3230 AC tumor), grown subcutaneously in the right hind limbs of male Fischer rats. Tumors were heated once at 40.5 deg.to 43.5 deg.C for 30 or 60 min, or twice at a 24 hr interval. Tumor blood flow and tumor pO 2 were measured immediately after the hyperthermic treatments or after 24 hr using a radioactive microsphere method and by an Eppendorf pO 2 Histograph, respectively. The influence of MTH on the effect of X-irradiation (250 kVp) on this tumor was investigated with tumor growth delay and the in vivo/in vitro excision assay for surviving tumor cell fraction. Results: Tumor blood flow and pO 2 increased upon heating for 30 min at 40.5 deg.C to 43.5 deg.C, but following 60 min heating, the pO 2 was similar to that in control tumors. The tumor blood flow increased about 1.4-fold and the tumor pO 2 increased more than 3 times after 30 min heating at 42.5 deg.C. Therefore, the in vivo/in vitro assay and the growth delay were carried out following treatment with 42.5 deg.C for 30 min. As shown in Table 1, the reduction in surviving fraction by MTH before radiation was markedly greater than that by MTH after radiation. Table 1 also shows that MTH alone caused no growth delay compared to control and while heat after radiation increased the growth delay by 2 days, MTH before radiation increased the growth delay by 5 days compared to radiation alone. Conclusion: The results indicate that MTH is effective in increasing tumor blood flow and oxygenation and that MTH for 30 min at 42.5 deg.C, applied before radiation, significantly improves the radiation response of R3230 AC tumors

  3. Improving Researcher-Patient Collaboration through Social Network Websites

    OpenAIRE

    Akindayo, Olayiwola; Dopgima, Cynthia

    2012-01-01

    Purpose: The main purpose of this study/thesis is to, through an interview with researchers in medical field in Jönköping,  provide an empirical analysis of the link or relationship between medical researcher and patient through social networking sites specifically for collaboration in order to improve relationships, dissemination of information and knowledge sharing. Background: The importance of social networking websites as a means of interaction between groups of individuals cannot be und...

  4. Linking Six Sigma to simulation: a new roadmap to improve the quality of patient care.

    Science.gov (United States)

    Celano, Giovanni; Costa, Antonio; Fichera, Sergio; Tringali, Giuseppe

    2012-01-01

    Improving the quality of patient care is a challenge that calls for a multidisciplinary approach, embedding a broad spectrum of knowledge and involving healthcare professionals from diverse backgrounds. The purpose of this paper is to present an innovative approach that implements discrete-event simulation (DES) as a decision-supporting tool in the management of Six Sigma quality improvement projects. A roadmap is designed to assist quality practitioners and health care professionals in the design and successful implementation of simulation models within the define-measure-analyse-design-verify (DMADV) or define-measure-analyse-improve-control (DMAIC) Six Sigma procedures. A case regarding the reorganisation of the flow of emergency patients affected by vertigo symptoms was developed in a large town hospital as a preliminary test of the roadmap. The positive feedback from professionals carrying out the project looks promising and encourages further roadmap testing in other clinical settings. The roadmap is a structured procedure that people involved in quality improvement can implement to manage projects based on the analysis and comparison of alternative scenarios. The role of Six Sigma philosophy in improvement of the quality of healthcare services is recognised both by researchers and by quality practitioners; discrete-event simulation models are commonly used to improve the key performance measures of patient care delivery. The two approaches are seldom referenced and implemented together; however, they could be successfully integrated to carry out quality improvement programs. This paper proposes an innovative approach to bridge the gap and enrich the Six Sigma toolbox of quality improvement procedures with DES.

  5. Correlation between voluntary cough and laryngeal cough reflex flows in patients with traumatic brain injury.

    Science.gov (United States)

    Lee, Sang Chul; Kang, Seong-Woong; Kim, Min Tae; Kim, Yong Kyun; Chang, Won Hyuk; Im, Sang Hee

    2013-08-01

    To correlate voluntary cough and laryngeal cough reflex (LCR) flows in patients with traumatic brain injury (TBI). Cross-sectional study. University rehabilitation hospital. Patients with TBI (n=25) and healthy controls (n=48). Not applicable. Peak cough flows (PCFs) and LCR flows were measured using a peak flow meter at the oral-nasal interface. The largest value of 3 attempts was recorded for PCF and LCR, respectively. LCR was elicited by 20% solution of pharmaceutic-grade citric acid dissolved in sterile .15M NaCl solution that was inhaled from a nebulizer. PCF was 447.4 ± 99.0 L/min in the control group and 211.7 ± 58.2 L/min in the patient group. LCR was 209.2 ± 63.8L/min in the control group and 170.0 ± 59.7 L/min in the patient group. Both PCF (P=.000) and LCR (P=.013) were significantly reduced in patients with TBI compared to that of the control group. LCR was strongly related to the PCF in both control (R=.645; P=.000) and patient (R=.711; P=.000) groups. As LCR can be measured as a numerical value and significantly correlates with PCF, LCR can be used to estimate cough ability of patients with TBI who cannot cooperate with PCF measurement. Copyright © 2013 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  6. Diaphragm pacing improves sleep in patients with amyotrophic lateral sclerosis.

    Science.gov (United States)

    Gonzalez-Bermejo, Jesus; Morélot-Panzini, Capucine; Salachas, François; Redolfi, Stefania; Straus, Christian; Becquemin, Marie-Hélène; Arnulf, Isabelle; Pradat, Pierre-François; Bruneteau, Gaëlle; Ignagni, Anthony R; Diop, Moustapha; Onders, Raymond; Nelson, Teresa; Menegaux, Fabrice; Meininger, Vincent; Similowski, Thomas

    2012-01-01

    In amyotrophic lateral sclerosis (ALS) patients, respiratory insufficiency is a major burden. Diaphragm conditioning by electrical stimulation could interfere with lung function decline by promoting the development of type 1 muscle fibres. We describe an ancillary study to a prospective, non-randomized trial (NCT00420719) assessing the effects of diaphragm pacing on forced vital capacity (FVC). Sleep-related disturbances being early clues to diaphragmatic dysfunction, we postulated that they would provide a sensitive marker. Stimulators were implanted laparoscopically in the diaphragm close to the phrenic motor point in 18 ALS patients for daily conditioning. ALS functioning score (ALSFRS), FVC, sniff nasal inspiratory pressure (SNIP), and polysomnographic recordings (PSG, performed with the stimulator turned off) were assessed before implantation and after four months of conditioning (n = 14). Sleep efficiency improved (69 ± 15% to 75 ± 11%, p = 0.0394) with fewer arousals and micro-arousals. This occurred against a background of deterioration as ALSFRS-R, FVC, and SNIP declined. There was, however, no change in NIV status or the ALSFRS respiratory subscore, and the FVC decline was mostly due to impaired expiration. Supporting a better diaphragm function, apnoeas and hypopnoeas during REM sleep decreased. In conclusion, in these severe patients not expected to experience spontaneous improvements, diaphragm conditioning improved sleep and there were hints at diaphragm function changes.

  7. Use of Patient-Authored Prehistory to Improve Patient Experiences and Accommodate Federal Law.

    Science.gov (United States)

    Warner, Michael J; Simunich, Thomas J; Warner, Margaret K; Dado, Joseph

    2017-02-01

    Although federal law grants patients the right to view and amend their medical records, few studies have proposed a process for patients to coauthor their subjective history in their medical record. Allowing patients to fully disclose and document their medical history is an important step to improve the diagnostic process. To evaluate patients' office experience before and after they authored their subjective medical history for the electronic health record. Patients were mailed a prehistory form and presurvey to be completed before their family medicine office visit. On arrival to the office, the prehistory form was scanned into the electronic health record while the content was transcribed by hospital staff into the appropriate fields in the history component of the encounter note. Postsurveys were given to patients to be completed after their visit. Pre- and postsurveys measured the patients' perception of office visit quality as well as completeness and accuracy of their electronic health record documentation before and after their appointment. Medical staff surveys were collected weekly to measure the staff's viewpoint of the federal law that allows patients to view and amend their medical records. Of 405 patients who were asked to participate, 263 patients aged 14 to 94 years completed a presurvey and a prehistory form. Of those 263 patients, 134 completed a postsurvey. The pre- and postsurveys showed improved patient satisfaction with the office visit and high scores for documentation accuracy and completeness. Before filling out the prehistory form, 116 of 249 patients (46.6%) agreed or strongly agreed that they felt more empowered in their health care by completing the prehistory form compared with 110 of 131 (84.0%) who agreed or strongly agreed after the visit (Pprehistory form beforehand to improve the patient experience while accommodating federal law.

  8. Blood flow in the forearm in patients with Rheumatoid arthritis and healthy subjects under local thermotherapy

    Directory of Open Access Journals (Sweden)

    C. Mucha

    2002-02-01

    Full Text Available Objectives: Muscle blood flow in the forearm of patients with rheuma-toid arthritis and healthy volunteers following treatment with temperature increasingarm baths, mudpacks and short- or decimeter-wave diathermy was studied in thisinvestigation. The aim of the study was to find out the difference of reactive hyperemia between the different temperature methods as well as the influence on theconsensual reaction. Subjects: Eighty patients with rheumatoid arthritis, stage 3 according toSteinbrocker, as well as 80 healthy human subjects had been assigned numerically in the four therapy- and controlgroups. Patients with diseases influencing the peripheral blood flow were excluded. Design: Blood flow was measured by venous occlusion plethysmography in both forearms with the subjects lyingsupine. The application of the local heat therapies had been excluded on the left forearm. The forearm blood flow wasmonitored before heat therapy, directly after as well as in two further 10 minutes intervals. An analysis of variancewas used to determine the influence on blood flow of the response to the heat therapies in patients with rheumatoidarthritis and healthy subjects.Results: Under homogeneous starting conditions and a statistically uniformed high blood flow in rest the reactive values of blood flow on the left-hand side of application and the right consensual side showed high significant differencesbetween all methods of therapy. Differences between the patients and the healthy subjects only showed tendencies withpartially lower reactions, concerning the patients with rheumatoid arthritis. All methods of heat therapy caused a statistically provable consensual reaction that turned out smaller after diathermic methods. Here the post therapeuticreaction of the blood flow on the side of application was also lower or rather shorter. Conclusion: Greater differences of the blood flow in rest between the patients with rheumatoid arthritis and healthysubjects

  9. Assessment of intracardiac flow and vorticity in the right heart of patients after repair of tetralogy of Fallot by flow-sensitive 4D MRI

    Energy Technology Data Exchange (ETDEWEB)

    Hirtler, Daniel [University Hospital Freiburg, Department of Congenital Heart Defects and Pediatric Cardiology (Heart Center, University of Freiburg), Freiburg (Germany); Garcia, Julio; Barker, Alex J. [Northwestern University Feinberg School of Medicine, Department of Radiology, Chicago, IL (United States); Geiger, Julia [University Childrens' Hospital Zurich, Department of Radiology, Zurich (Switzerland)

    2016-10-15

    To comprehensively and quantitatively analyse flow and vorticity in the right heart of patients after repair of tetralogy of Fallot (rTOF) compared with healthy volunteers. Time-resolved flow-sensitive 4D MRI was acquired in 24 rTOF patients and 12 volunteers. Qualitative flow evaluation was based on consensus reading of two observers. Quantitative analysis included segmentation of the right atrium (RA) and ventricle (RV) in a four-chamber view to extract volumes and regional haemodynamic information for computation of regional mean and peak vorticity. Right heart intra-atrial, intraventricular and outflow tract flow patterns differed considerably between rTOF patients and volunteers. Peak RA and mean RV vorticity was significantly higher in patients (p = 0.02/0.05). Significant negative correlations were found between patients' maximum and mean RV and RA vorticity and ventricular volumes (p < 0.05). The main pulmonary artery (MPA) regurgitant flow was associated with higher RA and RV vorticity, which was significant for RA maximum and RV mean vorticity (p = 0.01/0.03). The calculation of vorticity based on 4D flow data is an alternative approach to assess intracardiac flow changes in rTOF patients compared with qualitative flow visualization. Alterations in intracardiac vorticity could be relevant with regard to the development of RV dilation and impaired function. (orig.)

  10. Assessment of intracardiac flow and vorticity in the right heart of patients after repair of tetralogy of Fallot by flow-sensitive 4D MRI

    International Nuclear Information System (INIS)

    Hirtler, Daniel; Garcia, Julio; Barker, Alex J.; Geiger, Julia

    2016-01-01

    To comprehensively and quantitatively analyse flow and vorticity in the right heart of patients after repair of tetralogy of Fallot (rTOF) compared with healthy volunteers. Time-resolved flow-sensitive 4D MRI was acquired in 24 rTOF patients and 12 volunteers. Qualitative flow evaluation was based on consensus reading of two observers. Quantitative analysis included segmentation of the right atrium (RA) and ventricle (RV) in a four-chamber view to extract volumes and regional haemodynamic information for computation of regional mean and peak vorticity. Right heart intra-atrial, intraventricular and outflow tract flow patterns differed considerably between rTOF patients and volunteers. Peak RA and mean RV vorticity was significantly higher in patients (p = 0.02/0.05). Significant negative correlations were found between patients' maximum and mean RV and RA vorticity and ventricular volumes (p < 0.05). The main pulmonary artery (MPA) regurgitant flow was associated with higher RA and RV vorticity, which was significant for RA maximum and RV mean vorticity (p = 0.01/0.03). The calculation of vorticity based on 4D flow data is an alternative approach to assess intracardiac flow changes in rTOF patients compared with qualitative flow visualization. Alterations in intracardiac vorticity could be relevant with regard to the development of RV dilation and impaired function. (orig.)

  11. Strategies to improve self-management in heart failure patients.

    Science.gov (United States)

    Toback, Mehnosh; Clark, Nancy

    2017-02-01

    Heart failure is one of the most common causes of hospitalization, hospital readmission and death. Patients with heart failure have many complications, with multiple co-existing diagnoses which result in polypharmacy. Following instructions provided by many physicians, medication adjustments based on changes in their symptoms are required. Behavioral adjustments concerning diet and exercise regime are recommended. Therefore, the patient plays a crucial role in the management of heart failure. To review the available studies on heart failure self-management, and investigate educational, behavioral and psychosocial strategies that plays an important role to improve patient self-management. A literature review was conducted based upon the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidance. The articles identified through an extensive search using PubMed and UpToDate from 1999 to 2016. Improved self-management will increase compliance, promote patient quality-of-life, advance clinical outcomes, reduce hospital re-admission and will decrease hospitalization costs.

  12. Improving outpatient access and patient experiences in academic ambulatory care.

    Science.gov (United States)

    O'Neill, Sarah; Calderon, Sherry; Casella, Joanne; Wood, Elizabeth; Carvelli-Sheehan, Jayne; Zeidel, Mark L

    2012-02-01

    Effective scheduling of and ready access to doctor appointments affect ambulatory patient care quality, but these are often sacrificed by patients seeking care from physicians at academic medical centers. At one center, Beth Israel Deaconess Medical Center, the authors developed interventions to improve the scheduling of appointments and to reduce the access time between telephone call and first offered appointment. Improvements to scheduling included no redirection to voicemail, prompt telephone pickup, courteous service, complete registration, and effective scheduling. Reduced access time meant being offered an appointment with a physician in the appropriate specialty within three working days of the telephone call. Scheduling and access were assessed using monthly "mystery shopper" calls. Mystery shoppers collected data using standardized forms, rated the quality of service, and transcribed their interactions with schedulers. Monthly results were tabulated and discussed with clinical leaders; leaders and frontline staff then developed solutions to detected problems. Eighteen months after the beginning of the intervention (in June 2007), which is ongoing, schedulers had gone from using 60% of their registration skills to over 90%, customer service scores had risen from 2.6 to 4.9 (on a 5-point scale), and average access time had fallen from 12 days to 6 days. The program costs $50,000 per year and has been associated with a 35% increase in ambulatory volume across three years. The authors conclude that academic medical centers can markedly improve the scheduling process and access to care and that these improvements may result in increased ambulatory care volume.

  13. Patient-Centered Prescription Model to improve therapeutic adherence in patients with multimorbidity

    Directory of Open Access Journals (Sweden)

    Javier González-Bueno

    2018-05-01

    Full Text Available To date, interventions to improve medication adherence in patients with multimorbidity have shown modest and inconsistent efficacy among available studies. Thereby, we should define new approaches aimed at improving medication adherence tailored to effective prescribing, with a multidisciplinary approach and patient-centered. In this regard, the Patient-Centered Prescription Model has shown its usefulness on improving appropriateness of drug treatments in patients with clinical complexity. For that, this strategy addresses the following four steps: 1 Patient-Centered assessment; 2 Diagnosis-Centered assessment; 3 Medication-Centered assessment; and 4 Therapeutic Plan. We propose through a clinical case an adaptation of the Patient-Centered Prescription Model to enhance both appropriateness and medication adherence in patients with multimorbidity. To this end, we have included on its first step the Spanish version of a cross-culturally adapted scale for the multidimensional assessment of medication adherence. Furthermore, we suggest a set of interventions to be applied in the three remaining steps of the model. These interventions were firstly identified by an overview of systematic reviews and then selected by a panel of experts based on Delphi methodology. All of these elements have been considered appropriate in patients with multimorbidity according to three criteria: strength of their supporting evidence, usefulness in the target population and feasibility of implementation in clinical practice. The proposed approach intends to lay the foundations for an innovative way in tackling medication adherence in patients with multimorbidity.

  14. Improving the care of patients with cystic fibrosis (CF)

    Science.gov (United States)

    Khan, Ahsan Aftab; Nash, Edward F; Whitehouse, Joanna; Rashid, Rifat

    2017-01-01

    Background The West Midlands Adult Cystic Fibrosis (CF) Centre based at Birmingham Heartlands Hospital provides care for adults with CF in the West Midlands. People with CF are prone to pulmonary exacerbations, which often require inpatient admission for intravenous antibiotics. We observed that the admission process was efficient during working hours (9:00–17:00, Monday–Friday) when the CF team are routinely available, but out-of-working hours, there were delays in these patients being clerked and receiving their first antibiotic dose. We were concerned that this was resulting in quality and potential safety issues by causing delays in starting treatment and prolonging hospital inpatient stays. We therefore undertook a quality improvement project (QIP) aimed at addressing these issues. An initial survey showed median time to clerk of 5 hours, with 60% of patients missing their first dose of antibiotics and mean length of stay of 16 days. Methods We applied the Plan-Do-Study-Act (PDSA) cycle approach, with the first PDSA cycle involving raising awareness of the issue through education to doctors, nurses and patients. Results This led to a reduction of median time to clerk from 5 to 2 hours with 23% of patients missing their first antibiotic dose and mean length of stay reducing to 14 days. The second cycle involved introducing an admissions checklist and displaying education posters around the hospital, resulting in median time to clerk remaining at 2 hours but only 20% of patients missing their first antibiotic dose and the mean length of stay remaining at 14 days. Conclusion This QIP has improved the out-of-hours admissions process for adults with CF in our centre. We plan to review the longer term effects of the project including sustainability, effects on clinical outcomes and patient satisfaction. PMID:28959778

  15. Blood transfusion in preterm infants improves intestinal tissue oxygenation without alteration in blood flow.

    Science.gov (United States)

    Banerjee, J; Leung, T S; Aladangady, N

    2016-11-01

    The objective of the study was to investigate the splanchnic blood flow velocity and oximetry response to blood transfusion in preterm infants according to postnatal age. Preterm infants receiving blood transfusion were recruited to three groups: 1-7 (group 1; n = 20), 8-28 (group 2; n = 21) and ≥29 days of life (group 3; n = 18). Superior mesenteric artery (SMA) peak systolic (PSV) and diastolic velocities were measured 30-60 min pre- and post-transfusion using Doppler ultrasound scan. Splanchnic tissue haemoglobin index (sTHI), tissue oxygenation index (sTOI) and fractional tissue oxygen extraction (sFTOE) were measured from 15-20 min before to post-transfusion using near-infrared spectroscopy. The mean pretransfusion Hb in group 1, 2 and 3 was 11, 10 and 9 g/dl, respectively. The mean (SD) pretransfusion SMA PSV in group 1, 2 and 3 was 0·63 (0·32), 0·81 (0·33) and 0·97 (0·40) m/s, respectively, and this did not change significantly following transfusion. The mean (SD) pretransfusion sTOI in group 1, 2 and 3 was 36·7 (19·3), 44·6 (10·4) and 41·3 (10·4)%, respectively. The sTHI and sTOI increased (P transfusion in all groups. On multivariate analysis, changes in SMA PSV and sTOI following blood transfusion were not associated with PDA, feeding, pretransfusion Hb and mean blood pressure. Pretransfusion baseline splanchnic tissue oximetry and blood flow velocity varied with postnatal age. Blood transfusion improved intestinal tissue oxygenation without altering mesenteric blood flow velocity irrespective of postnatal ages. © 2016 International Society of Blood Transfusion.

  16. Low regional cerebral blood flow in burning mouth syndrome patients with depression.

    Science.gov (United States)

    Liu, B-L; Yao, H; Zheng, X-J; Du, G-H; Shen, X-M; Zhou, Y-M; Tang, G-Y

    2015-07-01

    The main aims of this study were to (i) investigate the emotional disorder status of patients with burning mouth syndrome (BMS) and (ii) detect regional cerebral blood flow in BMS patients with the application of combined single-photon emission computed tomography and computed tomography (SPECT/CT). The degree of pain was measured using the visual analysis scale, and emotional disorder with the self-rating anxiety scale, self-rating depression scale, and Hamilton depression rating scale in 29 patients with BMS and 10 healthy controls. SPECT/CT was performed in 29 patients with BMS and 10 healthy controls, and statistical parametric mapping method was used for between-group analyses. The incidence rate of depression in patients with BMS was 31.0%. Compared to the control group, patients with BMS displayed significantly different depression and anxiety scales (P < 0.05). Significantly lower regional cerebral blood flow in the left parietal and left temporal lobes was recorded for BMS patients with depression (P < 0.05). Patients with BMS experience more depression and anxious emotion. Moreover, depression in patients with BMS may be associated with lower regional cerebral blood flow in the left temporal and left parietal lobes. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  17. 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

  18. Myocardial blood flow in patients with coronary disease while in active employment

    International Nuclear Information System (INIS)

    Kahn, P.; Heeger, H.; Aldor, E.; Hanuschkrankenhaus, Vienna

    1975-01-01

    In the course of coronary angiographies the blood flow of the right and the left coronary artery was determined by the 133 Xe lavage method in 89 patients with coronary heart disease. There was a statistically significant difference between the flow values of the LCA and RCA, while there was none between the blood flow values of blue- and white-collar workers suffering from coronary artery disease. Also a significantly better blood circulation of the right as well as of the left coronary artery was found in female employees in comparison to male employees. (orig.) [de

  19. Can asthma control be improved by understanding the patient's perspective?

    Directory of Open Access Journals (Sweden)

    Østrem Anders

    2007-05-01

    agreement between the healthcare professional and patient on a predefined target regarding asthma control and a treatment plan to achieve this. Summary Optimum review of asthma is essential to improve control. A key priority is the development of simple and effective tools for identifying poor control for individual patients coupled with a tailored approach to treatment to enable patients to set and achieve realistic goals for asthma control.

  20. An improved liquid film model to predict the CHF based on the influence of churn flow

    International Nuclear Information System (INIS)

    Wang, Ke; Bai, Bofeng; Ma, Weimin

    2014-01-01

    The critical heat flux (CHF) for boiling crisis is one of the most important parameters in thermal management and safe operation of many engineering systems. Traditionally, the liquid film flow model for “dryout” mechanism shows a good prediction in heated annular two-phase flow. However, a general assumption that the initial entrained fraction at the onset of annular flow shows a lack of reasonable physical interpretation. Since the droplets have great momentum and the length of churn flow is short, the droplets in churn flow show an inevitable effect on the downstream annular flow. To address this, we considered the effect of churn flow and developed the original liquid film flow model in vertical upward flow by suggesting that calculation starts from the onset of churn flow rather than annular flow. The results indicated satisfactory predictions with the experimental data and the developed model provided a better understanding about the effect of flow pattern on the CHF prediction. - Highlights: •The general assumption of initial entrained fraction is unreasonable. •The droplets in churn flow show an inevitable effect on downstream annular flow. •The original liquid film flow model for prediction of CHF was developed. •The integration process was modified to start from the onset of churn flow

  1. An Improved Artificial Bee Colony Algorithm and Its Application to Multi-Objective Optimal Power Flow

    Directory of Open Access Journals (Sweden)

    Xuanhu He

    2015-03-01

    Full Text Available Optimal power flow (OPF objective functions involve minimization of the total fuel costs of generating units, minimization of atmospheric pollutant emissions, minimization of active power losses and minimization of voltage deviations. In this paper, a fuzzy multi-objective OPF model is established by the fuzzy membership functions and the fuzzy satisfaction-maximizing method. The improved artificial bee colony (IABC algorithm is applied to solve the model. In the IABC algorithm, the mutation and crossover operations of a differential evolution algorithm are utilized to generate new solutions to improve exploitation capacity; tent chaos mapping is utilized to generate initial swarms, reference mutation solutions and the reference dimensions of crossover operations to improve swarm diversity. The proposed method is applied to multi-objective OPF problems in IEEE 30-bus, IEEE 57-bus and IEEE 300-bus test systems. The results are compared with those obtained by other algorithms, which demonstrates the effectiveness and superiority of the IABC algorithm, and how the optimal scheme obtained by the proposed model can make systems more economical and stable.

  2. Emergency Department Waiting Times (EDWaT): A Patient Flow Management and Quality of Care Rating mHealth Application.

    Science.gov (United States)

    Househ, Mowafa; Yunus, Faisel

    2014-01-01

    Saudi hospital emergency departments (ED) have suffered from long waiting times, which have led to a delay in emergency patient care. The increase in the population of Saudi Arabia is likely to further stretch the healthcare services due to overcrowding leading to decreased healthcare quality, long patient waits, patient dissatisfaction, ambulance diversions, decreased physician productivity, and increased frustration among medical staff. This will ultimately put patients at risk for poor health outcomes. Time is of the essence in emergencies and to get to an ED that has the shortest waiting time can mean life or death for a patient, especially in cases of stroke and myocardial infarction. In this paper, we present our work on the development of a mHealth Application - EDWaT - that will: provide patient flow information to the emergency medical services staff, help in quick routing of patients to the nearest hospital, and provide an opportunity for patients to review and rate the quality of care received at an ED, which will then be forwarded to ED services administrators. The quality ratings will help patients to choose between two EDs with the same waiting time and distance from their location. We anticipate that the use of EDWaT will help improve ED wait times and the quality of care provision in Saudi hospitals EDs.

  3. Efficacy of blood flow restriction exercise during dialysis for end stage kidney disease patients: protocol of a randomised controlled trial.

    Science.gov (United States)

    Clarkson, Matthew J; Fraser, Steve F; Bennett, Paul N; McMahon, Lawrence P; Brumby, Catherine; Warmington, Stuart A

    2017-09-11

    Exercise during haemodialysis improves strength and physical function. However, both patients and clinicians are time poor, and current exercise recommendations add an excessive time burden making exercise a rare addition to standard care. Hypothetically, blood flow restriction exercise performed during haemodialysis can provide greater value for time spent exercising, reducing this time burden while producing similar or greater outcomes. This study will explore the efficacy of blood flow restriction exercise for enhancing strength and physical function among haemodialysis patients. This is a randomised controlled trial design. A total of 75 participants will be recruited from haemodialysis clinics. Participants will be allocated to a blood flow restriction cycling group, traditional cycling group or usual care control group. Both exercising groups will complete 3 months of cycling exercise, performed intradialytically, three times per week. The blood flow restriction cycling group will complete two 10-min cycling bouts separated by a 20-min rest at a subjective effort of 15 on a 6 to 20 rating scale. This will be done with pressurised cuffs fitted proximally on the active limbs during exercise at 50% of a pre-determined limb occlusion pressure. The traditional cycling group will perform a continuous 20-min bout of exercise at a subjective effort of 12 on the same subjective effort scale. These workloads and volumes are equivalent and allow for comparison of a common blood flow restriction aerobic exercise prescription and a traditional aerobic exercise prescription. The primary outcome measures are lower limb strength, assessed by a three repetition maximum leg extension test, as well as objective measures of physical function: six-minute walk test, 30-s sit to stand, and timed up and go. Secondary outcome measures include thigh muscle cross sectional area, body composition, routine pathology, quality of life, and physical activity engagement. This study will

  4. Improvement of the cold flow characteristics of biodiesel containing dissolved polymer wastes using acetone

    Directory of Open Access Journals (Sweden)

    Pouya Mohammadi

    2014-03-01

    Full Text Available Due to the fast fossil fuel depletion and at the same time global warming phenomenon anticipated for the next coming years, the necessity of developing alternative fuels e.g. biofuels (i.e. bioethanol, biodiesel, biogas and etc. has turned into an important concern. Recently, the application of the bio-solvency properties of biodiesel for recycling waste polymers has been highlighted. However, the impact of polymer dissolution on cold flow characteristics of biodiesel was never investigated. The present study was set to explore the impact of different solvents in stabilizing biodiesel-polymer solution. Among them, acetone was proved to be the best fuel stabilizer. Subsequently, cold flow characteristic i.e. cloud point, of the biodiesel-polymer-acetone fuel was found to have improved (decreased due to the inclusion of acetone. Finally, flash point analysis of the fuel blends containing acetone was done to ensured high safety of the fuel blend by dramatically increasing the flash point values of biodiesel-polymer fuel blends.

  5. Improved Characterization of Groundwater Flow in Heterogeneous Aquifers Using Granular Polyacrylamide (PAM) Gel as Temporary Grout

    Science.gov (United States)

    Klepikova, Maria V.; Roques, Clement; Loew, Simon; Selker, John

    2018-02-01

    The range of options for investigation of hydraulic behavior of aquifers from boreholes has been limited to rigid, cumbersome packers, and inflatable sleeves. Here we show how a new temporary borehole sealing technique using soft grains of polyacrylamide (PAM) gel as a sealing material can be used to investigate natural groundwater flow dynamics and discuss other possible applications of the technology. If no compressive stress is applied, the gel packing, with a permeability similar to open gravel, suppresses free convection, allowing for local temperature measurements and chemical sampling through free-flowing gel packing. Active heating laboratory and field experiments combined with temperature measurements along fiber optic cables were conducted in water-filled boreholes and boreholes filled with soft grains of polyacrylamide gel. The gel packing is shown to minimize the effect of free convection within the well column and enable detection of thin zones of relatively high or low velocity in a highly transmissive alluvial aquifer, thus providing a significant improvement compared to temperature measurements in open boreholes. Laboratory experiments demonstrate that under modest compressive stress to the gel media the permeability transitions from highly permeable to nearly impermeable grouting. Under this configuration the gel packing could potentially allow for monitoring local response pressure from the formation with all other locations in the borehole hydraulically isolated.

  6. Nattokinase improves blood flow by inhibiting platelet aggregation and thrombus formation.

    Science.gov (United States)

    Jang, Ja-Young; Kim, Tae-Su; Cai, Jingmei; Kim, Jihyun; Kim, Youngeun; Shin, Kyungha; Kim, Kwang Sei; Park, Sung Kyeong; Lee, Sung-Pyo; Choi, Ehn-Kyoung; Rhee, Man Hee; Kim, Yun-Bae

    2013-12-01

    The effects of nattokinase on the in vitro platelet aggregation and in vivo thrombosis were investigated in comparison with aspirin. Rabbit platelet-rich plasma was incubated with nattokinase and aggregation inducers collagen and thrombin, and the platelet aggregation rate was analyzed. Nattokinase significantly inhibited both the collagen- and thrombin-induced platelet aggregations. Nattokinase also reduced thromboxane B2 formation from collagen-activated platelets in a concentration-dependent manner. Rats were orally administered with nattokinase for 1 week, and their carotid arteries were exposed. Arterial thrombosis was induced by applying 35% FeCl3-soaked filter paper for 10 min, and the blood flow was monitored with a laser Doppler probe. Nattokinase delayed the FeCl3-induced arterial occlusion in a dose-dependent manner, doubling the occlusion time at 160 mg/kg. In addition, a high dose (500 mg/kg) of nattokinase fully prevented the occlusion, as achieved with aspirin (30 mg/kg). The results indicate that nattokinase extracted from fermented soybean inhibit platelet aggregation by blocking thromboxane formation, and thereby delay thrombosis following oxidative arterial wall injury. Therefore, it is suggested that nattokinase could be a good candidate without adverse effects for the improvement of blood flow.

  7. Preliminary study to improve the performance of SCWR-M during loss-of-flow accident

    Energy Technology Data Exchange (ETDEWEB)

    Liu, X.J., E-mail: xiaojingliu@sjtu.edu.cn [School of Nuclear Science and Engineering, Shanghai Jiao Tong University, 800 Dong Chuan Road, Shanghai 200240 (China); Sun, C.; Wang, Z.D.; Chai, X.; Xiong, J.B.; Yang, Y.H. [School of Nuclear Science and Engineering, Shanghai Jiao Tong University, 800 Dong Chuan Road, Shanghai 200240 (China); Cheng, X. [Institute of Fusion and Nuclear Technology, Karlsruhe Institute of Technology (KIT), Kaiserstr. 12, 76131 Karlsruhe (Germany)

    2016-10-15

    Highlights: • Validation of the ATHLET-SC code to the safety analysis for SCWR. • Loss of flow accident analysis for SCWR-M is performed. • The passive design parameter is optimized. • The optimized SCWR-M design shows a better safety performance. - Abstract: The SCWR-M is one of the conceptual core designs with mixed neutron spectrum (fast and thermal), which is developed at Shanghai Jiao Tong University. Some preliminary calculations of this new conceptual SCWR indicate the SCWR-M system gets better safety characteristics compared to other single spectrum supercritical water cooled reactors. Loss of flow accident (LOFA) is of particular importance among the abnormal events and accidents for SCWR-M. In order to perform the preliminary study to improve the current SCWR-M safety design, this paper presents the validation results of the ATHLET-SC code and optimization work for safety system design parameters of the ICS, ACC, GDCS based on LOFA analysis. The better performance of the optimized design parameters are demonstrated by comparison with the previous design.

  8. Regional cerebral blood flow changes in patients with internet addiction.

    Science.gov (United States)

    Otte, Andreas

    2016-01-01

    Dear Editor, Internet addiction (IA) has become a severe challenge of our modern world today, though little is known about its pathology. In this context, the interesting study by Liu et al. in the May-August 2016 issue of HJNM using 99m Tc-labelled ethylene biyldicysteinate dimer single photon emission tomography (SPET) at rest and after pharmaceutical (adenosine) stress is more than welcomed. As this seems to be the first perfusion SPET study in this indication, the obtained data may be discussed carefully. There are mainly the following questions: a) Regional cerebral blood flow (rCBF): There is no description on how the rCBF was calculated: Was it scaled relatively to the whole brain mean value or to the cerebellar mean value? b) P value threshold and clusters: There is no indication of whether the authors are performing any kind of correction for multiple comparisons in the statistical parametric mapping (SPM) t-test. This, combined with the use of a really "liberal" voxel P value of only 0.01 could be subject to providing many false positive results. Generally a P value threshold of 0.001 should be used. In addition, there is no information related to the clusters. For the question of the validity of parametric statistical methods used for the analysis of functional neuroimaging data, we would like to mention the important recent paper by Eklund et al. 2016. c) Data analysis: The authors state (p. 97): "As some abnormal rCBF in adenosine-stressed state might relate with normal responses to adenosine compared to resting state, we excluded those regions that showed abnormal rCBF in stressed state in healthy controls (Table 4) from those in IA group (Table 5). The rest abnormal regions were compared between the IA group and the control group". For this, with SPM a flexible factorial design with all the data rather than only t-tests would have been interesting to find out whether the difference between the groups at stress is the same difference observed between

  9. Renal blood flow and metabolism after cold ischaemia: peroperative measurements in patients with calculi

    DEFF Research Database (Denmark)

    Petersen, H K; Henriksen, Jens Henrik Sahl

    1984-01-01

    Peroperative measurements of renal blood flow (RBF), renal O2-uptake, and renal venous lactate/pyruvate (L/P) ratio were performed before and after a period of 30-71 min of hypothermic (10-15 degrees C) renal ischaemia in nine patients, undergoing surgery for renal calculi. Before ischaemia, RBF.......01) immediately after re-established perfusion and 36% (P less than 0.02) 30 min later. In one additional patient, who had a short warm ischaemia (8 min), the flow pattern was the same. As arterial pressure remained constant, the reduced RBF signifies an increased renal vascular resistance. Renal O2-uptake...... and renal venous L/P ratio were almost constant, indicating no significant anaerobic processes being involved in the flow response. None of the patients showed any signs of reactive hyperaemia. It is concluded that hypothermic renal ischaemia may be followed by an increased renal vascular resistance even...

  10. Effectiveness of Electrostimulation on Whole Salivary Flow Among Patients with Type 2 Diabetes Mellitus.

    Science.gov (United States)

    Dyasnoor, Sujatha; Kamath, Shwetha; Khader, Nishat Fatima Abdul

    2017-01-01

    Xerostomia and hyposalivation are associated with diabetes. Research is sparse regarding electrostimulation as a mainstream therapy for salivary gland hypofunction. To clinically evaluate the effectiveness of transcutaneous electric nerve stimulation (TENS) therapy in stimulating whole salivary flow among patients with xerostomia and hyposalivation caused by diabetes mellitus. Forty patients between age 30 to 75 years with diabetes mellitus categorized as controlled or uncontrolled who had subjective symptoms of xerostomia and an objective sign of hyposalivation were included in a prospective study. Unstimulated saliva through the "low forced spitting" method and stimulated saliva collection using TENS were assessed and compared. Longer-term effects of TENS application were evaluated by recalling the patient 24 hours later. A statistically significant increase in stimulated whole saliva after TENS application in continuous mode (p diabetes. Burst mode inferred a statistically significant decrease in salivary flow (p diabetes with xerostomia and hyposalivation, TENS was highly effective in stimulating whole salivary flow.

  11. Communication Skills Training for Physicians Improves Patient Satisfaction.

    Science.gov (United States)

    Boissy, Adrienne; Windover, Amy K; Bokar, Dan; Karafa, Matthew; Neuendorf, Katie; Frankel, Richard M; Merlino, James; Rothberg, Michael B

    2016-07-01

    Skilled physician communication is a key component of patient experience. Large-scale studies of exposure to communication skills training and its impact on patient satisfaction have not been conducted. We aimed to examine the impact of experiential relationship-centered physician communication skills training on patient satisfaction and physician experience. This was an observational study. The study was conducted at a large, multispecialty academic medical center. Participants included 1537 attending physicians who participated in, and 1951 physicians who did not participate in, communication skills training between 1 August 2013 and 30 April 2014. An 8-h block of interactive didactics, live or video skill demonstrations, and small group and large group skills practice sessions using a relationship-centered model. Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS), Clinician and Group Consumer Assessment of Healthcare Providers and Systems (CGCAHPS), Jefferson Scale of Empathy (JSE), Maslach Burnout Inventory (MBI), self-efficacy, and post course satisfaction. Following the course, adjusted overall CGCAHPS scores for physician communication were higher for intervention physicians than for controls (92.09 vs. 91.09, p communication scores (83.95 vs. 82.73, p = 0.22). Physicians reported high course satisfaction and showed significant improvement in empathy (116.4 ± 12.7 vs. 124 ± 11.9, p communication skills training improved patient satisfaction scores, improved physician empathy, self-efficacy, and reduced physician burnout. Further research is necessary to examine longer-term sustainability of such interventions.

  12. Remote ischemic conditioning improves coronary microcirculation in healthy subjects and patients with heart failure

    Directory of Open Access Journals (Sweden)

    Kono Y

    2014-08-01

    Full Text Available Yasushi Kono,1 Shota Fukuda,1 Akihisa Hanatani,2 Koki Nakanishi,2 Kenichiro Otsuka,2 Haruyuki Taguchi,1 Kenei Shimada2 1Department of Medicine, Osaka Ekisaikai Hospital, Osaka, Japan; 2Department of Internal Medicine and Cardiology, Osaka City University School of Medicine, Osaka, Japan Background: Remote ischemic conditioning (RIC is a treatment modality that suppresses inflammation and improves endothelial function, which are factors involved in the pathogenesis of heart failure (HF with reduced left ventricular ejection fraction. Coronary flow reserve (CFR is a physiological index of coronary microcirculation and is noninvasively measured by transthoracic Doppler echocardiography (TTDE. This study aimed to investigate the effects of RIC on CFR in healthy subjects and patients with HF, through the assessment by TTDE. Methods: Ten patients with HF with left ventricular ejection fraction of less than 40%, and ten healthy volunteers were enrolled in this study. RIC treatment was performed twice a day for 1 week. Our custom-made RIC device was programmed to automatically conduct 4 cycles of 5 minutes inflation and 5 minutes deflation of a blood pressure cuff to create intermittent arm ischemia. CFR measurements and laboratory tests were examined before, and after 1 week of RIC treatment. Results: One week of RIC treatment was well tolerated in both groups. RIC treatment increased CFR from 4.0±0.9 to 4.6±1.3 (mean ± standard deviation in healthy subjects (P=0.02, and from 1.9±0.4 to 2.3±0.7 in patients with HF (P=0.03, respectively. Systolic blood pressure in healthy subjects, and heart rate in HF patients decreased after RIC treatment (both P<0.01. Conclusion: This study demonstrated that a 1 week course of RIC treatment improved coronary microcirculation in healthy subjects and patients with HF associated with reduced left ventricular ejection fraction. Keyword: echocardiography, coronary flow reserve, heart failure, preconditioning

  13. Improvements in Low-cost Ultrasonic Measurements of Blood Flow in "by-passes" Using Narrow & Broad Band Transit-time Procedures

    Science.gov (United States)

    Ramos, A.; Calas, H.; Diez, L.; Moreno, E.; Prohías, J.; Villar, A.; Carrillo, E.; Jiménez, A.; Pereira, W. C. A.; Von Krüger, M. A.

    The cardio-pathology by ischemia is an important cause of death, but the re-vascularization of coronary arteries (by-pass operation) is an useful solution to reduce associated morbidity improving quality of life in patients. During these surgeries, the flow in coronary vessels must be measured, using non-invasive ultrasonic methods, known as transit time flow measurements (TTFM), which are the most accurate option nowadays. TTFM is a common intra-operative tool, in conjunction with classic Doppler velocimetry, to check the quality of these surgery processes for implanting grafts in parallel with the coronary arteries. This work shows important improvements achieved in flow-metering, obtained in our research laboratories (CSIC, ICIMAF, COPPE) and tested under real surgical conditions in Cardiocentro-HHA, for both narrowband NB and broadband BB regimes, by applying results of a CYTED multinational project (Ultrasonic & computational systems for cardiovascular diagnostics). mathematical models and phantoms were created to evaluate accurately flow measurements, in laboratory conditions, before our new electronic designs and low-cost implementations, improving previous ttfm systems, which include analogic detection, acquisition & post-processing, and a portable PC. Both regimes (NB and BB), with complementary performances for different conditions, were considered. Finally, specific software was developed to offer facilities to surgeons in their interventions.

  14. Traditional Japanese medicine daikenchuto improves functional constipation in poststroke patients.

    Science.gov (United States)

    Numata, Takehiro; Takayama, Shin; Tobita, Muneshige; Ishida, Shuichi; Katayose, Dai; Shinkawa, Mitsutoshi; Oikawa, Takashi; Aonuma, Takanori; Kaneko, Soichiro; Tanaka, Junichi; Kanemura, Seiki; Iwasaki, Koh; Ishii, Tadashi; Yaegashi, Nobuo

    2014-01-01

    Poststroke patients with functional constipation, assessed by the Rome III criteria, from 6 hospitals were recruited in a study on the effects of the traditional Japanese medicine Daikenchuto (DKT) on constipation. Thirty-four patients (17 men and 17 women; mean age: 78.1 ± 11.6 years) were randomly assigned to 2 groups; all patients received conventional therapy for constipation, and patients in the DKT group received 15 g/day of DKT for 4 weeks. Constipation scoring system (CSS) points and the gas volume score (GVS) (the measure of the intestinal gas volume calculated from plain abdominal radiographs) were recorded before and after a 4-week observation period. The total score on the CSS improved significantly in the DKT group compared to the control (P DKT group (P DKT group compared to the control (P = 0.03). DKT in addition to conventional therapy is effective in treating functional constipation in poststroke patients. This study was a randomized controlled trial and was registered in the UMIN Clinical Trial Registry (no. UMIN000007393).

  15. Improved Functional Performance in Geriatric Patients During Hospital Stay

    DEFF Research Database (Denmark)

    Karlsen, Anders; Loeb, Mads Rohde; Andersen, Kristine Bramsen

    2017-01-01

    OBJECTIVE: The aim of this work was to evaluate the time course of changes in strength and functional performance in elderly hospitalized medical patients. DESIGN: This was a prospective observational study in elderly medical patients of age 65 years or older at a geriatric department.Measurement......OBJECTIVE: The aim of this work was to evaluate the time course of changes in strength and functional performance in elderly hospitalized medical patients. DESIGN: This was a prospective observational study in elderly medical patients of age 65 years or older at a geriatric department.......Measurements were obtained on days 2 to 4, day 5 to 8, and days 9 to 13. Functional performance was measured with De Morton Mobility Index (DEMMI) test and a 30-second chair stand test (30-s CST). Muscular strength was measured with handgrip strength. Activity level was determined with accelerometry (Activ...... in 30-s CST (P performance of the lower extremities in geriatric patients improves moderately over the time of a hospital stay...

  16. Evaluation of plasma eosinophil count and mean platelet volume in patients with coronary slow flow

    Directory of Open Access Journals (Sweden)

    Mehmet Demir

    2014-01-01

    Full Text Available OBJECTIVE: The pathophysiology of coronary slow flow has not been clearly defined, although multiple abnormalities including arteritis, endothelial dysfunction, and atherothrombosis, have been reported. It is known that eosinophils play an important role in inflammation, endothelial dysfunction, and thrombosis. We aimed to compare the eosinophil counts of coronary slow flow patients versus healthy controls. METHODS: This study included 50 coronary slow flow patients (19 males, mean age 65.6±13.7 years and 30 healthy controls (10 males, mean age 57.86±11.6 years. These participants were evaluated using concurrent routine biochemical tests as well as neutrophil, lymphocyte, and eosinophil counts and mean platelet volume (MPV, which were obtained from the whole blood count. These parameters were compared between groups. RESULTS: The baseline characteristics of the study groups were comparable. The coronary slow flow patients had a higher mean platelet volume and eosinophil count than the control group (8.38±0.86 vs 6.28±1.6 fL and 0.31±0.42 vs 0.09±0.05; p<0.001 and 0.008, respectively. CONCLUSION: Our study demonstrated a relationship between eosinophil count and MPV in patients with coronary slow flow.

  17. Brain blood flow studies with single photon emission computed tomography in patients with plateau waves

    International Nuclear Information System (INIS)

    Hayashi, Minoru; Kobayashi, Hidenori; Kawano, Hirokazu; Handa, Yuji; Noguchi, Yoshiyuki; Shirasaki, Naoki; Hirose, Satoshi

    1986-01-01

    The authors studied brain blood flow with single photon emission computed tomography (SPECT) in two patients with plateau waves. The intracranial pressure and blood pressure were also monitored continuously in these patients. They included one patient with brain-tumor (rt. sphenoid ridge meningioma) and another with hydrocephalus after subarachnoid hemorrhage due to rupture of lt. internal carotid aneurysm. The intracranial pressure was monitored through an indwelling ventricular catheter attached to a pressure transducer. The blood pressure was recorded through an intraarterial catheter placed in the dorsalis pedis artery. Brain blood flow was studied with Headtome SET-011 (manufactured by Shimazu Co., Ltd.). For this flow measurement study, an intravenous injection of Xenon-133 of about 30 mCi was given via an antecubital vein. The position of the slice for the SPECT was selected so as to obtain information not only from the cerebral hemisphere but also from the brain stem : a cross section 25 deg over the orbito-meatal line, passing through the inferior aspect of the frontal horn, the basal ganglia, the lower recessus of the third ventricle and the brain stem. The results indicated that, in the cerebral hemisphere, plateau waves were accompanied by a decrease in blood flow, whereas, in the brain stem, the blood flow showed little change during plateau waves as compared with the interval phase between two plateau waves. These observations may explain why there is no rise in the blood pressure and why patients are often alert during plateau waves. (author)

  18. Regional cerebral blood flow during mechanical hyperventilation in patients with acute bacterial meningitis

    DEFF Research Database (Denmark)

    Møller, Kirsten; Høgh, Peter; Larsen, Fin Stolze

    2000-01-01

    Mechanical hyperventilation is often instituted in patients with acute bacterial meningitis when increased intracranial pressure is suspected. However, the effect on regional cerebral blood flow (CBF) is unknown. In this study, we measured regional CBF (rCBF) in patients with acute bacterial...... meningitis before and during short-term hyperventilation. In 17 patients with acute bacterial meningitis, absolute rCBF (in ml/100 g min-1) was measured during baseline ventilation and hyperventilation by single-photon emission computed tomography (SPECT) using intravenous 133Xe bolus injection. Intravenous...... in the frontal and parietal cortex as well as in the basal ganglia. Focal perfusion abnormalities were present in 10 of 12 patients. Regional cerebral blood flow abnormalities are frequent in patients with acute bacterial meningitis. Short-term hyperventilation does not enhance these abnormalities....

  19. Energy efficiency improvements utilising mass flow control and a ring topology in a district heating network

    International Nuclear Information System (INIS)

    Laajalehto, Tatu; Kuosa, Maunu; Mäkilä, Tapio; Lampinen, Markku; Lahdelma, Risto

    2014-01-01

    Heating and cooling have a major role in the energy sector, covering 46% of total final energy use worldwide. District heating (DH) is a significant technology for improving the energy efficiency of heating systems in communities, because it enables waste heat sources to be utilised economically and therefore significantly reduces the environmental impacts of power generation. As a result of new and more stringent construction regulations for buildings, the heat demands of individual buildings are decreasing and more energy-efficient heating systems have to be developed. In this study, the energy efficiency of a new DH system which includes both a new control system called mass flow control and a new network design called a ring network is examined. A topology in the Helsinki region is studied by using a commercial DH network modelling tool, Grades Heating. The district heating network is attached to a wood-burning heat station which has a heat recovery system in use. Examination is performed by means of both technical and economic analysis. The new non-linear temperature programme that is required is adopted for supply and return temperatures, which allows greater temperature cooling and smaller flow rates. Lower district heating water temperatures are essential when reducing the heat losses in the network and heat production. Mass flow control allows smaller pressure drops in the network and thus reduces the pumping power. The aim of this study was to determine the most energy-efficient DH water supply temperatures in the case network. If the ring network design is utilised, the district heating system is easier to control. As a result the total heat consumption within the heating season is reduced compared to traditional DH systems. On the basis of the results, the new DH system is significantly more energy-efficient in the case network that was examined than the traditional design. For example, average energy losses within the constraints (which consist of heat

  20. Landscape and flow metrics affecting the distribution of a federally-threatened fish: Improving management, model fit, and model transferability

    Science.gov (United States)

    Worthington, Thomas A.; Zhang, T.; Logue, Daniel R.; Mittelstet, Aaron R.; Brewer, Shannon K.

    2016-01-01

    Truncated distributions of pelagophilic fishes have been observed across the Great Plains of North America, with water use and landscape fragmentation implicated as contributing factors. Developing conservation strategies for these species is hindered by the existence of multiple competing flow regime hypotheses related to species persistence. Our primary study objective was to compare the predicted distributions of one pelagophil, the Arkansas River Shiner Notropis girardi, constructed using different flow regime metrics. Further, we investigated different approaches for improving temporal transferability of the species distribution model (SDM). We compared four hypotheses: mean annual flow (a baseline), the 75th percentile of daily flow, the number of zero-flow days, and the number of days above 55th percentile flows, to examine the relative importance of flows during the spawning period. Building on an earlier SDM, we added covariates that quantified wells in each catchment, point source discharges, and non-native species presence to a structured variable framework. We assessed the effects on model transferability and fit by reducing multicollinearity using Spearman’s rank correlations, variance inflation factors, and principal component analysis, as well as altering the regularization coefficient (β) within MaxEnt. The 75th percentile of daily flow was the most important flow metric related to structuring the species distribution. The number of wells and point source discharges were also highly ranked. At the default level of β, model transferability was improved using all methods to reduce collinearity; however, at higher levels of β, the correlation method performed best. Using β = 5 provided the best model transferability, while retaining the majority of variables that contributed 95% to the model. This study provides a workflow for improving model transferability and also presents water-management options that may be considered to improve the

  1. Stability Improvement of High-Pressure-Ratio Turbocharger Centrifugal Compressor by Asymmetric Flow Control-Part I: Non-Axisymmetrical Flow in Centrifugal Compressor.

    Science.gov (United States)

    Yang, Mingyang; Zheng, Xinqian; Zhang, Yangjun; Bamba, Takahiro; Tamaki, Hideaki; Huenteler, Joern; Li, Zhigang

    2013-03-01

    This is Part I of a two-part paper documenting the development of a novel asymmetric flow control method to improve the stability of a high-pressure-ratio turbocharger centrifugal compressor. Part I focuses on the nonaxisymmetrical flow in a centrifugal compressor induced by the nonaxisymmetrical geometry of the volute while Part II describes the development of an asymmetric flow control method to avoid the stall on the basis of the characteristic of nonaxisymmetrical flow. To understand the asymmetries, experimental measurements and corresponding numerical simulation were carried out. The static pressure was measured by probes at different circumferential and stream-wise positions to gain insights about the asymmetries. The experimental results show that there is an evident nonaxisymmetrical flow pattern throughout the compressor due to the asymmetric geometry of the overhung volute. The static pressure field in the diffuser is distorted at approximately 90 deg in the rotational direction of the volute tongue throughout the diffuser. The magnitude of this distortion slightly varies with the rotational speed. The magnitude of the static pressure distortion in the impeller is a function of the rotational speed. There is a significant phase shift between the static pressure distributions at the leading edge of the splitter blades and the impeller outlet. The numerical steady state simulation neglects the aforementioned unsteady effects found in the experiments and cannot predict the phase shift, however, a detailed asymmetric flow field structure is obviously obtained.

  2. Improved survival using specialized multidisciplinary board in sarcoma patients.

    Science.gov (United States)

    Blay, J-Y; Soibinet, P; Penel, N; Bompas, E; Duffaud, F; Stoeckle, E; Mir, O; Adam, J; Chevreau, C; Bonvalot, S; Rios, M; Kerbrat, P; Cupissol, D; Anract, P; Gouin, F; Kurtz, J-E; Lebbe, C; Isambert, N; Bertucci, F; Toumonde, M; Thyss, A; Piperno-Neumann, S; Dubray-Longeras, P; Meeus, P; Ducimetière, F; Giraud, A; Coindre, J-M; Ray-Coquard, I; Italiano, A; Le Cesne, A

    2017-11-01

    Sarcomas are rare but aggressive diseases. Specialized multidisciplinary management is not implemented for all patients in most countries. We investigated the impact of a multidisciplinary tumor board (MDTB) presentation before treatment in a nationwide study over 5 years. NETSARC (netsarc.org) is a network of 26 reference sarcoma centers with specialized MDTB, funded by the French National Cancer Institute to improve the outcome of sarcoma patients. Since 2010, presentation to an MDTB and second pathological review are mandatory for sarcoma patients in France. Patients' characteristics and follow-up are collected in a database regularly monitored and updated. The management and survival of patients presented to these MDTB before versus after initial treatment were analyzed. Out of the 12 528 patients aged ≥15 years, with a first diagnosis of soft tissue and visceral sarcoma obtained between 1 January 2010 and 31 December 2014, 5281 (42.2%) and 7247 (57.8%) were presented to the MDTB before and after the initiation of treatment, respectively. The former group had generally worse prognostic characteristics. Presentation to a MDTB before treatment was associated with a better compliance to clinical practice guidelines, for example, biopsy before surgery, imaging, quality of initial surgery, and less reoperations (all P sarcoma patients are significantly better when the initial treatment is guided by a pre-therapeutic specialized MDTB. © The Author 2017. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  3. Improving Pharmacists’ Targeting of Patients for Medication Review and Deprescription

    Directory of Open Access Journals (Sweden)

    Vanessa Marvin

    2018-04-01

    Full Text Available Background: In an acute hospital setting, a multi-disciplinary approach to medication review can improve prescribing and medicine selection in patients with frailty. There is a need for a clear understanding of the roles and responsibilities of pharmacists to ensure that interventions have the greatest impact on patient care. Aim: To use a consensus building process to produce guidance for pharmacists to support the identification of patients at risk from their medicines, and to articulate expected actions and escalation processes. Methods: A literature search was conducted and evidence used to establish a set of ten scenarios often encountered in hospitalised patients, with six or more possible actions. Four consultant physicians and four senior pharmacists ranked their levels of agreement with the listed actions. The process was redrafted and repeated until consensus was reached and interventions were defined. Outcome: Generalised guidance for reviewing older adults’ medicines was developed, alongside escalation processes that should be followed in a specific set of clinical situations. The panel agreed that both pharmacists and physicians have an active role to play in medication review, and face-to-face communication is always preferable to facilitate informed decision making. Only prescribers should deprescribe, however pharmacists who are not also trained as prescribers may temporarily “hold” medications in the best interests of the patient with appropriate documentation and a follow up discussion with the prescribing team. The consensus was that a combination of age, problematic polypharmacy, and the presence of medication-related problems, were the most important factors in the identification of patients who would benefit most from a comprehensive medication review. Conclusions: Guidance on the identification of patients on inappropriate medicines, and subsequent pharmacist-led intervention to prompt and promote deprescribing, has

  4. 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.

  5. 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.

  6. Kinetic therapy improves oxygenation in critically ill pediatric patients.

    Science.gov (United States)

    Schultz, Theresa Ryan; Lin, Richard; Francis, Barbara A; Hales, Roberta L; Colborn, Shawn; Napoli, Linda A; Helfaer, Mark A

    2005-07-01

    To compare changes in oxygenation after manual turning and percussion (standard therapy) and after automated rotation and percussion (kinetic therapy). Randomized crossover trial. General and cardiac pediatric intensive care units. Intubated and mechanically ventilated pediatric patients who had an arterial catheter and no contraindications to using a PediDyne bed. Patients were placed on a PediDyne bed (Kinetic Concepts) and received 18 hrs blocks of standard and kinetic therapy in an order determined by randomization. Arterial blood gases were measured every 2 hrs during each phase of therapy. Oxygenation index and arterial-alveolar oxygen tension difference [P(A-a)O(2)] were calculated. Indexes calculated at baseline and after each 18-hr phase of therapy were analyzed. Fifty patients were enrolled. Data from 15 patients were either not collected or not used due to reasons that included violation of protocol and inability to tolerate the therapies in the study. Indexes of oxygenation were not normally distributed and were compared using Wilcoxon signed rank testing. Both therapies led to improvements in oxygenation, but only those from kinetic therapy achieved statistical significance. In patients receiving kinetic therapy first, median oxygenation index decreased from 7.4 to 6.19 (p = .015). The median P(A-a)O(2) decreased from 165.2 to 126.4 (p = .023). There were continued improvements in oxygenation after the subsequent period of standard therapy, with the median oxygenation index decreasing to 5.52 and median P(A-a)O(2) decreasing to 116.0, but these changes were not significant (p = .365 and .121, respectively). When standard therapy was first, the median oxygenation index decreased from 8.83 to 8.71 and the median P(a-a)o(2) decreased from 195.4 to 186.6. Neither change was significant. Median oxygenation index after the subsequent period of kinetic therapy was significantly lower (7.91, p = .044) and median P(A-a)O(2) trended lower (143.4, p = .077

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

    Directory of Open Access Journals (Sweden)

    Cathy Kande

    2014-01-01

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

  8. A study of intraluminal flow in patients with aortic disease by cine magnetic resonance imaging

    International Nuclear Information System (INIS)

    Ohnishi, Shusaku; Fukui, Sugao; Kusuoka, Hideo; Kitabatake, Akira; Kamada, Takenobu.

    1990-01-01

    To evaluate the usefulness of cine magnetic resonance (MR) imaging in the diagnosis of aortic disease, we applied cine MR sequences with conventional spin echo (SE) sequence to 15 patients with aortic aneurysm and 5 patients with aortic dissection. ECG gated multi slice SE images (single echo) were obtained in transverse plane and the planes along the long axis of aorta. TE of SE sequence ranged from 15 to 32 msec. Cine MR images were obtained in 17 frames, where TR ranged from 30 to 60 msec and TE from 10 to 22 msec. We got these results as follows. For aortic aneurysm, SE images showed aneurysmal dilatation in thoracic aorta in 9 cases, and in abdominal aorta in 6 cases. Cine MR images showed us the intraluminal flow with high signal intensity. We could differentiate the slow flow image from mural thrombus using SE and cine MR sequences in the same plane. We could evaluate the dynamic flow image within a cavity of aneurysm and in in-flow and out-flow portions of aorta by cine MR imaging. For aortic dissection, SE images delineated the intimal tear and two separated lumens in all cases. We could obtain flow images within true and false lumen by cine MR imaging. The signal intensity within true lumen was higher than that within false lumen. It seemed to be due to the difference of flow velocity and the turbulence within false lumen. Entry to false lumen was seen as the interruption of dissected intima on SE images. Cine MR images clearly depicted the blood flow communication between two lumens through the entry. In 3 of 5 cases the blood flow through the entry was seen in both directions, from true to false lumen in systole and inversely in diastole. Thus, cine MR imaging will add the useful hemodynamic information in the diagnosis of aortic disease by conventional MR imaging. (author)

  9. Errors in laboratory medicine: practical lessons to improve patient safety.

    Science.gov (United States)

    Howanitz, Peter J

    2005-10-01

    Patient safety is influenced by the frequency and seriousness of errors that occur in the health care system. Error rates in laboratory practices are collected routinely for a variety of performance measures in all clinical pathology laboratories in the United States, but a list of critical performance measures has not yet been recommended. The most extensive databases describing error rates in pathology were developed and are maintained by the College of American Pathologists (CAP). These databases include the CAP's Q-Probes and Q-Tracks programs, which provide information on error rates from more than 130 interlaboratory studies. To define critical performance measures in laboratory medicine, describe error rates of these measures, and provide suggestions to decrease these errors, thereby ultimately improving patient safety. A review of experiences from Q-Probes and Q-Tracks studies supplemented with other studies cited in the literature. Q-Probes studies are carried out as time-limited studies lasting 1 to 4 months and have been conducted since 1989. In contrast, Q-Tracks investigations are ongoing studies performed on a yearly basis and have been conducted only since 1998. Participants from institutions throughout the world simultaneously conducted these studies according to specified scientific designs. The CAP has collected and summarized data for participants about these performance measures, including the significance of errors, the magnitude of error rates, tactics for error reduction, and willingness to implement each of these performance measures. A list of recommended performance measures, the frequency of errors when these performance measures were studied, and suggestions to improve patient safety by reducing these errors. Error rates for preanalytic and postanalytic performance measures were higher than for analytic measures. Eight performance measures were identified, including customer satisfaction, test turnaround times, patient identification

  10. Approaches to improve adherence to pharmacotherapy in patients with schizophrenia

    Directory of Open Access Journals (Sweden)

    Shuler KM

    2014-05-01

    enhanced team-oriented approach to managing patients with schizophrenia improves adherence and supports corresponding reductions in relapse rates, inpatient admissions, and associated costs. Conclusion: Optimization of medication and involvement of caregivers are important to promoting adherence. A multidisciplinary team approach may be invaluable in identifying barriers to adherence and helping schizophrenia patients overcome them. Keywords: medication adherence, schizophrenia, community mental health services, social work, psychiatric

  11. Trends in patient satisfaction in Dutch university medical centers: room for improvement for all

    NARCIS (Netherlands)

    Kleefstra, Sophia M.; Zandbelt, Linda C.; de Haes, Hanneke J. C. J. M.; Kool, Rudolf B.

    2015-01-01

    Results of patient satisfaction research provide hospitals areas for quality improvement. Although it may take several years to achieve such improvement, not all hospitals analyze changes in patient satisfaction over time structurally. Consequently, they lack information from patients' perspective

  12. Effects of Bacillus subtilis var. natto products on symptoms caused by blood flow disturbance in female patients with lifestyle diseases

    Science.gov (United States)

    Hitosugi, Masahito; Hamada, Katsuo; Misaka, Kazutaka

    2015-01-01

    The fermented soybean product natto is a popular traditional food in Japan and is considered a health supplement. NKCP®, a natto-derived dietary food supplement whose main component is bacillopeptidase F, has antithrombotic, fibrinolytic, and blood pressure-lowering effects. We examined whether daily intake of NKCP® effectively improves subjective symptoms in patients with lifestyle diseases in this cross-over, double-blind study. Fermented soya extract with subtilisin NAT (nattokinase) as the main component was used as an active placebo. A 4-week course of NKCP® significantly decreased the visual analog scale (VAS) score for shoulder stiffness from 42.3 to 32.4 (P=0.009), the VAS score for low back pain from 25.5 to 18.8 (P=0.02), and the VAS score for coldness of the extremities from 33.1 to 25.7 (P=0.002). However, no significant difference was found in the VAS score for headache. After a 4-week course of active placebo, no significant changes in the VAS score were found for any symptoms. The significant improvement in the symptoms secondary to blood flow disturbance was caused by the improvement in blood flow by NKCP®. The use of dietary supplements based on the Japanese traditional food natto helps to relieve subjective symptoms for patients with lifestyle diseases receiving medical care. PMID:25653551

  13. Patient reminder and recall interventions to improve immunization rates.

    Science.gov (United States)

    Jacobson Vann, Julie C; Jacobson, Robert M; Coyne-Beasley, Tamera; Asafu-Adjei, Josephine K; Szilagyi, Peter G

    2018-01-18

    Immunization rates for children and adults are rising, but coverage levels have not reached optimal goals. As a result, vaccine-preventable diseases still occur. In an era of increasing complexity of immunization schedules, rising expectations about the performance of primary care, and large demands on primary care providers, it is important to understand and promote interventions that work in primary care settings to increase immunization coverage. One common theme across immunization programs in many nations involves the challenge of implementing a population-based approach and identifying all eligible recipients, for example the children who should receive the measles vaccine. However, this issue is gradually being addressed through the availability of immunization registries and electronic health records. A second common theme is identifying the best strategies to promote high vaccination rates. Three types of strategies have been studied: (1) patient-oriented interventions, such as patient reminder or recall, (2) provider interventions, and (3) system interventions, such as school laws. One of the most prominent intervention strategies, and perhaps best studied, involves patient reminder or recall systems. This is an update of a previously published review. To evaluate and compare the effectiveness of various types of patient reminder and recall interventions to improve receipt of immunizations. We searched CENTRAL, MEDLINE, Embase and CINAHL to January 2017. We also searched grey literature and trial registers to January 2017. We included randomized trials, controlled before and after studies, and interrupted time series evaluating immunization-focused patient reminder or recall interventions in children, adolescents, and adults who receive immunizations in any setting. We included no-intervention control groups, standard practice activities that did not include immunization patient reminder or recall, media-based activities aimed at promoting immunizations

  14. Cerebral blood flow and cerebrovascular reserve capacity in patients with occlusion or severe stenosis of cerebral arterial trunk

    Energy Technology Data Exchange (ETDEWEB)

    Yoshinaga, Shinya; Tanaka, Akira; Nakayama, Yoshiya; Tomonaga, Masamichi [Fukuoka Univ., Chikushino (Japan). Chikushi Hospital

    1997-12-01

    The cerebral blood flow (CBF) and the cerebrovascular reserve capacity (CVRC) were sequentially measured using a xenon enhanced CT scan in patients with transient ischemic attack or minor stroke due to an occlusion or a severe stenosis of the cerebral arterial trunk. The patients consisted of twelve males and one female ranging from 37 to 71 years of age (53 years on average). The vascular lesion was located in the internal carotid artery (7 patients) and in the middle cerebral artery (6 patients). Eleven patients received antiplatelet drug therapy, while two other patients underwent STA-MCA anastomosis. The CBF measurements were initially done within one month after the attack and then from 6 to 24 months (12 months on average) after the first study. Only one of 13 patients demonstrated a reattack during the period of observation and the CVRC decreased to 0% from the 14% level observed prior to the reattack, although the CBF was preserved. In the other twelve patients without a reattack, the CVRC was found to improve to 29.4% from 9.9% with statistical significance, even though the CBF remained the same in the first study. This study suggests hemodynamic insult to be closely related to the decreased in the CVRC, while STA-MCA anastomosis does not for prevent hemodynamic reattack based on a decrease in the CVRC in the early stage. (author)

  15. An Improved Parametrized Representation of the Secondary He Neutral Flow in its Source Region

    Science.gov (United States)

    Wood, Brian E.

    2017-09-01

    Analysis of data from the Interstellar Boundary EXplorer (IBEX) has revealed the presence of a flow of neutral helium through the inner solar system that most likely emanates from the outer heliosheath, where a distinct population of neutral He is produced by charge exchange processes. This secondary He flow has been modeled using codes designed to study interstellar flows through the heliosphere, but a laminar flow is not a good approximation for the outer heliosheath. I present a simple parametrization for a more appropriate divergent flow, and demonstrate how the secondary He particles might provide a means to remotely measure the divergence of the ISM flow around the heliopause.

  16. Epoetin beta pegol ameliorates flow-mediated dilation with improving endothelial nitric oxide synthase coupling state in nonobese diabetic rats.

    Science.gov (United States)

    Serizawa, Kenichi; Yogo, Kenji; Tashiro, Yoshihito; Kawasaki, Ryohei; Endo, Koichi; Shimonaka, Yasushi; Hirata, Michinori

    2017-04-01

    Patients with diabetic nephropathy have a high cardiovascular mortality. Epoetin beta pegol (continuous erythropoietin receptor activator, C.E.R.A.) is a drug for the treatment of renal anemia. In this study, we investigated the effect of C.E.R.A. on vascular endothelial function as evaluated by flow-mediated dilation (FMD) and the relationship between hematopoiesis and FMD in diabetic nephropathy rats. Male Spontaneously Diabetic Torii rats (SDT, 22 weeks old) were used. C.E.R.A. (0.6, 1.2 μg/kg) was administered subcutaneously once every 2 weeks for 8 weeks. At 1 week after last administration (31 weeks old), we assessed FMD in the femoral arteries of anesthetized rats using a high-resolution ultrasound system. FMD was also measured 1 week after single C.E.R.A. treatment (5.0 μg/kg) to examine the influence of hematopoiesis. Flow-mediated dilation was significantly decreased in SDT rats before the start of C.E.R.A. treatment (22 weeks old). Repeated administration of C.E.R.A. dose-dependently improved FMD in SDT rats (31 weeks old) without changing blood glucose, nitroglycerin-induced vasodilation, or kidney function. Long-term administration of C.E.R.A. improved the state of endothelial nitric oxide synthase uncoupling in the femoral arteries of SDT rats, which showed a positive correlation with FMD. On the other hand, there was no correlation between FMD and Hb or Hct in SDT rats. Furthermore, at 1 week after single administration of C.E.R.A., FMD was not significantly improved although hemoglobin levels were comparable with levels following long-term C.E.R.A. Long-term treatment with C.E.R.A. improved FMD in SDT rats even after onset of endothelial dysfunction. © 2017 The Authors. Cardiovascular Therapeutics Published by John Wiley & Sons Ltd.

  17. Postoperative Reverse Remodeling and Symptomatic Improvement in Normal-Flow Low-Gradient Aortic Stenosis After Aortic Valve Replacement.

    Science.gov (United States)

    Carter-Storch, Rasmus; Møller, Jacob E; Christensen, Nicolaj L; Irmukhadenov, Akhmadjon; Rasmussen, Lars M; Pecini, Redi; Øvrehus, Kristian A; Søndergård, Eva V; Marcussen, Niels; Dahl, Jordi S

    2017-12-01

    Severe aortic stenosis (AS) most often presents with reduced aortic valve area (gradient (≥40 mm Hg; normal-flow high-gradient AS) or low mean gradient (normal-flow low-gradient [NFLG] AS). The benefit of aortic valve replacement (AVR) among NFLG patients is controversial. We compared the impact of NFLG condition on preoperative left ventricular (LV) remodeling and myocardial fibrosis and postoperative remodeling and symptomatic benefit. Eighty-seven consecutive patients with reduced aortic valve area and normal stroke volume index undergoing AVR underwent echocardiography, magnetic resonance imaging, a 6-minute walk test, and measurement of natriuretic peptides before and 1 year after AVR. Myocardial fibrosis was assessed from magnetic resonance imaging. Patients were stratified as NFLG or normal-flow high-gradient. In total, 33 patients (38%) had NFLG. Before AVR, they were characterized by similar symptom burden but less severe AS measured by aortic valve area index (0.50±0.09 versus 0.40±0.08 cm 2 /m 2 ; P gradient condition independently predicted change in LV mass index. Patients with NFLG had less severe AS and LV remodeling than patients with normal-flow high-gradient. Furthermore, NFLG patients experienced less reverse remodeling but the same symptomatic benefit. URL: http://www.clinicaltrials.gov. Unique identifier: NCT02316587. © 2017 American Heart Association, Inc.

  18. Cerebral blood flow and metabolism in patients with aphasia due to basal ganglionic lesion

    International Nuclear Information System (INIS)

    Kitamura, Shin; Kato, Toshiaki; Ujike, Takashi; Kuroki, Soemu; Terashi, Akiro

    1987-01-01

    Cerebral blood flow and metabolism in right handed eight patients with subcortical lesion and aphasia were measured to investigate the correlation between aphasia and functional changes in cerebral blood flow (CBF) and cerebral oxygen consumption (CMRO 2 ) in the cortex and the basal ganglionic region. All patients had no lesion in the cortex, but in the basal ganglionic region (putamen, caudate nucleus, internal capsule, and periventricular white matter) on CT images. Patients with bilateral lesion were excluded in this study. Six patients with cerebral infarction in the left basal ganglionic region and two patients with the left putammal hemorrhage were examined. Five patients had non fluent Broca's type speech, two patients had poor comprehension, fluent Wernicke-type speech and one patient was globally aphasic. CBF, CMRO 2 , and oxygen extraction fraction were measured by the positron emission tomography using 15 O 2 , C 15 O 2 inhalation technique. In addition to reduction of CBF and CMRO 2 in the basal ganglionic region, CBF and CMRO 2 decreased in the left frontal cortex especially posterior part in four patients with Broca's aphasia. In two patients with Wernicke type aphasia, CBF and CMRO 2 decreased in the basal ganglionic region and the left temporal cortex. In a globally aphasic patient, marked reduction of CBF and CMRO 2 was observed in the left frontal and temporal cortex, in addition to the basal ganglionic region. These results suggest that dysfunction of cortex as well as that of basal ganglionic region might be related to the occurence of aphasia. However, in one patient with Broca's ahasia, CBF and CMRO 2 were preserved in the cortex and metabolic reduction was observed in only basal ganglia. This case indicates the relation between basal ganglionic lesion and the occurrence of aphasia. These results suggest that measurements of cerebral blood flow and metabolism were necessary to study the responsible lesion for aphasia. (author)

  19. Improved Seam-Line Searching Algorithm for UAV Image Mosaic with Optical Flow.

    Science.gov (United States)

    Zhang, Weilong; Guo, Bingxuan; Li, Ming; Liao, Xuan; Li, Wenzhuo

    2018-04-16

    Ghosting and seams are two major challenges in creating unmanned aerial vehicle (UAV) image mosaic. In response to these problems, this paper proposes an improved method for UAV image seam-line searching. First, an image matching algorithm is used to extract and match the features of adjacent images, so that they can be transformed into the same coordinate system. Then, the gray scale difference, the gradient minimum, and the optical flow value of pixels in adjacent image overlapped area in a neighborhood are calculated, which can be applied to creating an energy function for seam-line searching. Based on that, an improved dynamic programming algorithm is proposed to search the optimal seam-lines to complete the UAV image mosaic. This algorithm adopts a more adaptive energy aggregation and traversal strategy, which can find a more ideal splicing path for adjacent UAV images and avoid the ground objects better. The experimental results show that the proposed method can effectively solve the problems of ghosting and seams in the panoramic UAV images.

  20. Hierarchical Nanogold Labels to Improve the Sensitivity of Lateral Flow Immunoassay

    Science.gov (United States)

    Serebrennikova, Kseniya; Samsonova, Jeanne; Osipov, Alexander

    2018-06-01

    Lateral flow immunoassay (LFIA) is a widely used express method and offers advantages such as a short analysis time, simplicity of testing and result evaluation. However, an LFIA based on gold nanospheres lacks the desired sensitivity, thereby limiting its wide applications. In this study, spherical nanogold labels along with new types of nanogold labels such as gold nanopopcorns and nanostars were prepared, characterized, and applied for LFIA of model protein antigen procalcitonin. It was found that the label with a structure close to spherical provided more uniform distribution of specific antibodies on its surface, indicative of its suitability for this type of analysis. LFIA using gold nanopopcorns as a label allowed procalcitonin detection over a linear range of 0.5-10 ng mL-1 with the limit of detection of 0.1 ng mL-1, which was fivefold higher than the sensitivity of the assay with gold nanospheres. Another approach to improve the sensitivity of the assay included the silver enhancement method, which was used to compare the amplification of LFIA for procalcitonin detection. The sensitivity of procalcitonin determination by this method was 10 times better the sensitivity of the conventional LFIA with gold nanosphere as a label. The proposed approach of LFIA based on gold nanopopcorns improved the detection sensitivity without additional steps and prevented the increased consumption of specific reagents (antibodies).

  1. Does hyperbaric oxygen treatment have the potential to increase salivary flow rate and reduce xerostomia in previously irradiated head and neck cancer patients? A pilot study

    DEFF Research Database (Denmark)

    Forner, Lone; Hansen, Ole Hyldegaard; von Brockdorff, Annet Schack

    2011-01-01

    in irradiated head and neck cancer patients. Eighty patients eligible for HBO treatment on the indication of prevention/treatment of osteoradionecrosis or soft tissue radiation injury were consecutively sampled, of whom 45 had hyposalivation (i.e. unstimulated whole saliva (UWS) flow rate......Irradiated head and neck cancer survivors treated in the Hyperbaric Oxygen (HBO) Unit, Copenhagen University Hospital, spontaneously reported improvement of radiation-induced dry mouth feeling. The aim of this pilot study was to evaluate salivary flow rate and xerostomia before and after HBO...

  2. Probiotic yogurt improves antioxidant status in type 2 diabetic patients.

    Science.gov (United States)

    Ejtahed, Hanie S; Mohtadi-Nia, Javad; Homayouni-Rad, Aziz; Niafar, Mitra; Asghari-Jafarabadi, Mohammad; Mofid, Vahid

    2012-05-01

    Oxidative stress plays a major role in the pathogenesis and progression of diabetes. Among various functional foods with an antioxidant effect, probiotic foods have been reported to repress oxidative stress. The objective of this clinical trial was to assess the effects of probiotic and conventional yogurt on blood glucose and antioxidant status in type 2 diabetic patients. Sixty-four patients with type 2 diabetes mellitus, 30 to 60 y old, were assigned to two groups in this randomized, double-blind, controlled clinical