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Sample records for performance scale clinical

  1. Erythrocyte depletion from bone marrow: performance evaluation after 50 clinical-scale depletions with Spectra Optia BMC.

    Science.gov (United States)

    Kim-Wanner, Soo-Zin; Bug, Gesine; Steinmann, Juliane; Ajib, Salem; Sorg, Nadine; Poppe, Carolin; Bunos, Milica; Wingenfeld, Eva; Hümmer, Christiane; Luxembourg, Beate; Seifried, Erhard; Bonig, Halvard

    2017-08-11

    Red blood cell (RBC) depletion is a standard graft manipulation technique for ABO-incompatible bone marrow (BM) transplants. The BM processing module for Spectra Optia, "BMC", was previously introduced. We here report the largest series to date of routine quality data after performing 50 clinical-scale RBC-depletions. Fifty successive RBC-depletions from autologous (n = 5) and allogeneic (n = 45) BM transplants were performed with the Spectra Optia BMC apheresis suite. Product quality was assessed before and after processing for volume, RBC and leukocyte content; RBC-depletion and stem cell (CD34+ cells) recovery was calculated there from. Clinical engraftment data were collected from 26/45 allogeneic recipients. Median RBC removal was 98.2% (range 90.8-99.1%), median CD34+ cell recovery was 93.6%, minimum recovery being 72%, total product volume was reduced to 7.5% (range 4.7-23.0%). Products engrafted with expected probability and kinetics. Performance indicators were stable over time. Spectra Optia BMC is a robust and efficient technology for RBC-depletion and volume reduction of BM, providing near-complete RBC removal and excellent CD34+ cell recovery.

  2. Large-Scale Evaluation of Quality of Care in 6 Countries of Eastern Europe and Central Asia Using Clinical Performance and Value Vignettes.

    Science.gov (United States)

    Peabody, John W; DeMaria, Lisa; Smith, Owen; Hoth, Angela; Dragoti, Edmond; Luck, Jeff

    2017-09-27

    A significant determinant of population health outcomes is the quality of care provided for noncommunicable diseases, obstetric, and pediatric care. We present results on clinical practice quality in these areas as measured among nearly 4,000 providers working at more than 1,000 facilities in 6 Eastern European and Central Asian countries. This study was conducted between March 2011 and April 2013 in Albania, Armenia, Georgia, Kazakhstan, Kirov Province in Russia, and Tajikistan. Using a probability proportional-to-size sampling technique, based on number of hospital beds, we randomly selected within each country 42 hospitals and their associated primary health care clinics. Physicians and midwives within each clinical area of interest were randomly selected from each hospital and clinic and asked how they would care for simulated patients using Clinical Performance and Value (CPV) vignettes. Facility administrators were also asked to complete a facility survey to collect structural measures of quality. CPV vignettes were scored on a scale of 0% to 100% for each provider. We used descriptive statistics and t tests to identify significant differences in CPV scores between hospitals and clinics and rural vs. urban facilities, and ANOVA to identify significant differences in CPV scores across countries. We found that quality of care, as concurrently measured by performance on CPV vignettes, was generally poor and widely variable within and between countries. Providers in Kirov Province, Russia, had the highest overall performance, with an average score of 70.8%, while providers in Albania and Tajikistan had the lowest average score, each at 50.8%. The CPV vignettes with the lowest scores were for multiple noncommunicable disease risk factors and birth asphyxia. A considerable proportion (11%) of providers performed well on the CPV vignettes, regardless of country, facility, or structural resources available to them. Countries of Eastern Europe and Central Asia are

  3. Responsiveness, minimal detectable change, and minimal clinically important difference of the Nottingham Extended Activities of Daily Living Scale in patients with improved performance after stroke rehabilitation.

    Science.gov (United States)

    Wu, Ching-yi; Chuang, Li-ling; Lin, Keh-chung; Lee, Shin-da; Hong, Wei-hsien

    2011-08-01

    To determine the responsiveness, minimal detectable change (MDC), and minimal clinically important differences (MCIDs) of the Nottingham Extended Activities of Daily Living (NEADL) scale and to assess percentages of patients' change scores exceeding the MDC and MCID after stroke rehabilitation. Secondary analyses of patients who received stroke rehabilitation therapy. Medical centers. Patients with stroke (N=78). Secondary analyses of patients who received 1 of 4 rehabilitation interventions. Responsiveness (standardized response mean [SRM]), 90% confidence that a change score at this threshold or higher is true and reliable rather than measurement error (MDC(90)), and MCID on the NEADL score and percentages of patients exceeding the MDC(90) and MCID. The SRM of the total NEADL scale was 1.3. The MDC(90) value for the total NEADL scale was 4.9, whereas minima and maxima of the MCID for total NEADL score were 2.4 and 6.1 points, respectively. Percentages of patients exceeding the MDC(90) and MCID of the total NEADL score were 50.0%, 73.1%, and 32.1%, respectively. The NEADL is a responsive instrument relevant for measuring change in instrumental activities of daily living after stroke rehabilitation. A patient's change score has to reach 4.9 points on the total to indicate a true change. The mean change score of a stroke group on the total NEADL scale should achieve 6.1 points to be regarded as clinically important. Our findings are based on patients with improved NEADL performance after they received specific interventions. Future research with larger sample sizes is warranted to validate these estimates. Copyright © 2011 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  4. Validity of using a work habits scale for the daily evaluation of nurse anesthetists' clinical performance while controlling for the leniencies of the rating anesthesiologists.

    Science.gov (United States)

    Dexter, Franklin; Ledolter, Johannes; Hindman, Bradley J

    2017-11-01

    Anesthesiologists can provide psychometrically reliable daily evaluations of certified registered nurse anesthetist (CRNA) work habits for purposes of the mandatory ongoing professional practice evaluation (OPPE). Our goal was to evaluate the validity of assessing CRNA work habits. Observational study. Large teaching hospital. N=77 anesthesiologists evaluated work habits of N=67 CRNAs. The non-technical attribute of work habits was measured on a 6-item scale (e.g., 1="Only assumed responsibility when forced to, and failed to follow through consistently" versus 5="Consistently identified tasks and completed them efficiently and thoroughly"). One year of scores were used to assess validity. Each daily evaluation could also be accompanied by a written comment. Content analysis of comments was performed using two years of data. Statistical analyses were performed using mixed effects logistic regression, treating each anesthesiologist as a fixed effect to compensate for the leniency of their ratings. The N=77 anesthesiologists' response rate was 97.3%, obtained at a mean 2.93days after the request. The internal consistency of the scale was large: Cronbach's alpha 0.952. Controlling the false discovery rate at 5.0%, among the 67 CRNAs, 8 were significantly below average (each P≤0.0048) and 6 were above average (each P≤0.0018). During the 6months after CRNAs knew that their work habits scores would be used for OPPE, there were significant increases in the scores compared with the preceding 6months (odds ratio 1.93, Pwork habit scores or comments, were associated with greater odds of the CRNA's leniency-adjusted work habit scores equaling 5.00 (odds ratio 1.53, P=0.0004). Comments of negative sentiment made by the anesthesiologists were associated with greater odds of the leniency-adjusted work habit scores being work habits using the work habits scale, approximately half the comments of negative sentiment included the theme of work habits (92/153, 60.1%). Reporting

  5. Technology for Large-Scale Translation of Clinical Practice Guidelines: A Pilot Study of the Performance of a Hybrid Human and Computer-Assisted Approach.

    Science.gov (United States)

    Van de Velde, Stijn; Macken, Lieve; Vanneste, Koen; Goossens, Martine; Vanschoenbeek, Jan; Aertgeerts, Bert; Vanopstal, Klaar; Vander Stichele, Robert; Buysschaert, Joost

    2015-10-09

    The construction of EBMPracticeNet, a national electronic point-of-care information platform in Belgium, began in 2011 to optimize quality of care by promoting evidence-based decision making. The project involved, among other tasks, the translation of 940 EBM Guidelines of Duodecim Medical Publications from English into Dutch and French. Considering the scale of the translation process, it was decided to make use of computer-aided translation performed by certificated translators with limited expertise in medical translation. Our consortium used a hybrid approach, involving a human translator supported by a translation memory (using SDL Trados Studio), terminology recognition (using SDL MultiTerm terminology databases) from medical terminology databases, and support from online machine translation. This resulted in a validated translation memory, which is now in use for the translation of new and updated guidelines. The objective of this experiment was to evaluate the performance of the hybrid human and computer-assisted approach in comparison with translation unsupported by translation memory and terminology recognition. A comparison was also made with the translation efficiency of an expert medical translator. We conducted a pilot study in which two sets of 30 new and 30 updated guidelines were randomized to one of three groups. Comparable guidelines were translated (1) by certificated junior translators without medical specialization using the hybrid method, (2) by an experienced medical translator without this support, and (3) by the same junior translators without the support of the validated translation memory. A medical proofreader who was blinded for the translation procedure, evaluated the translated guidelines for acceptability and adequacy. Translation speed was measured by recording translation and post-editing time. The human translation edit rate was calculated as a metric to evaluate the quality of the translation. A further evaluation was made of

  6. EEHG Performance and Scaling Laws

    OpenAIRE

    Penn, Gregory

    2013-01-01

    This note will calculate the idealized performance of echo-enabled harmonic generation performance (EEHG), explore the parameter settings, and look at constraints determined by incoherent synchrotron radiation (ISR) and intrabeam scattering (IBS). Another important effect, time-of-flight variations related to transverse emittance, is included here but without detailed explanation because it has been described previously. The importance of ISR and IBS is that they lead to ...

  7. Premorbid functioning of patients with first-episode nonaffective psychosis: a comparison of deterioration in academic and social performance, and clinical correlates of Premorbid Adjustment Scale scores.

    Science.gov (United States)

    Monte, Ralph C; Goulding, Sandra M; Compton, Michael T

    2008-09-01

    Motivated by a previous study among male veterans [Allen, D.N., Frantom, L.V., Strauss, G.P., van Kammen, D.P., 2005. Differential patterns of premorbid academic and social deterioration in patients with schizophrenia. Schizophr. Res. 75, 389-397], the present analysis examined: (1) patterns of premorbid academic and social functioning during childhood, early adolescence, and late adolescence, and (2) associations between these premorbid functioning dimensions and a number of clinical variables. Data on premorbid functioning were collected using the Premorbid Adjustment Scale (PAS) in 95 hospitalized first-episode patients. Analyses were similar to those conducted by Allen and colleagues (2005). Deterioration was evident in both academic and social functioning from childhood to early adolescence, along with a pronounced/accelerated deterioration in academic functioning from early adolescence to late adolescence, occurring in both male and female patients. Age at onset of prodromal symptoms was predicted by childhood/early adolescent/late adolescent academic functioning scores, and age at onset of psychotic symptoms was significantly associated only with childhood academic functioning. Severity of negative symptoms was predicted by childhood and late adolescent social functioning scores, and severity of general psychopathology symptoms was predicted by late adolescent academic functioning, as well as childhood and late adolescent social functioning scores. Consistent with prior findings, deterioration in premorbid functioning appears to be more pronounced in the academic than social dimension of the PAS. Some PAS scores are predictive of ages at onset of prodrome/psychosis and severity of psychotic symptoms. Ongoing research on premorbid adjustment in schizophrenia may have implications for future prevention goals.

  8. Optimizing clinical drug product performance

    DEFF Research Database (Denmark)

    Dickinson, Paul A.; Kesisoglou, Filippos; Flanagan, Talia

    2016-01-01

    The aim of Biopharmaceutics Risk Assessment Roadmap (BioRAM) and the BioRAM Scoring Grid is to facilitate optimization of clinical performance of drug products. BioRAM strategy relies on therapy-driven drug delivery and follows an integrated systems approach for formulating and addressing critical...... questions and decision-making (J Pharm Sci. 2014,103(11): 3777-97). In BioRAM, risk is defined as not achieving the intended in vivo drug product performance, and success is assessed by time to decision-making and action. Emphasis on time to decision-making and time to action highlights the value of well....... Application of the BioRAM Scoring Grid is illustrated using published literature. Organizational considerations for implementing BioRAM strategy, including the interactions, function, and skillsets of the BioRAM group members, are also reviewed. As a creative and innovative systems approach, we believe...

  9. Cognitive performance in both clinical and non-clinical burnout

    NARCIS (Netherlands)

    Oosterholt, B.G.; Maes, J.H.R.; Linden, D. van der; Verbraak, M.J.P.M.; Kompier, M.A.J.

    2014-01-01

    Relatively little is known about cognitive performance in burnout. The aim of the present study was to further our knowledge on this topic by examining, in one study, cognitive performance in both clinical and non-clinical burnout while focusing on three interrelated aspects of cognitive

  10. [Development of Autogenic Training Clinical Effectiveness Scale (ATCES)].

    Science.gov (United States)

    Ikezuki, Makoto; Miyauchi, Yuko; Yamaguchi, Hajime; Koshikawa, Fusako

    2002-02-01

    The purpose of the present study was to develop a scale measuring clinical effectiveness of autogenic training. In Study 1, 167 undergraduates completed a survey of items concerning physical and mental states, which were thought to vary in the course of autogenic training. With item and factor analyses, 20 items were selected, and the resulting scale (ATCES) had high discrimination and clear factor structure. In Study 2, reliability and concurrent and clinical validity of the scale were examined with three groups of respondents: 85 mentally healthy, 31 control, 13 clinical persons. The scale showed a high test-retest correlation (r = .83) and alpha coefficient (alpha = .86). ATCES had a Pearson correlation coefficient of r = .56 with General Health Questionnaire (GHQ-12), and r = .73 with trait anxiety (STAI-T). And ATCES successfully discriminated the mentally healthy and clinical groups in terms of clinical effectiveness. These results demonstrated high reliability and sufficient concurrent and clinical validity of the new scale.

  11. Clinical Music Study Quality Assessment Scale (MUSIQUAS)

    NARCIS (Netherlands)

    Jaschke, A.C.; Eggermont, L.H.P.; Scherder, E.J.A.; Shippton, M.; Hiomonides, I.

    2013-01-01

    AIMS Quality assessment of studies is essential for the understanding and application of these in systematic reviews and meta analyses, the two “gold standards” of medical sciences. Publications in scientific journals have extensively used assessment scales to address poor methodological quality,

  12. The Influence of Scale on School Performance

    Directory of Open Access Journals (Sweden)

    Robert Bickel

    2000-05-01

    Full Text Available In this study, we investigate the joint influence of school and district size on school performance among schools with eighth grades (n=367 and schools with eleventh grades in Georgia (n=298. Schools are the unit of analysis in this study because schools are increasingly the unit on which states fix the responsibility to be accountable. The methodology further develops investigations along the line of evidence suggesting that the influence of size is contingent on socioeconomic status (SES. All previous studies have used a single-level regression model (i.e., schools or districts. This study confronts the issue of cross-level interaction of SES and size (i.e., schools and districts with a single-equation-relative-effects model to interpret the joint influence of school and district size on school performance (i.e., the dependent variable is a school-level variable. It also tests the equity of school-level outcomes jointly by school and district size. Georgia was chosen for study because previous single-level analysis there had revealed no influence of district size on performance (measured at the district level. Findings from this study show substantial cross-level influences of school and district size at the 8th grade, and weaker influences at the 11th grade. The equity effects, however, are strong at both grade levels and show a distinctive pattern of size interactions. Results are interpreted to draw implications for a "structuralist" view of school and district restructuring, with particular concern for schooling to serve impoverished communities. The authors argue the importance of a notion of "scaling" in the system of schooling, advocating the particular need to create smaller districts as well as smaller schools as a route to both school excellence and equity of school outcomes.

  13. Comparative prediction of nonepileptic events using MMPI-2 clinical scales, Harris Lingoes subscales, and restructured clinical scales.

    Science.gov (United States)

    Yamout, Karim Z; Heinrichs, Robin J; Baade, Lyle E; Soetaert, Dana K; Liow, Kore K

    2017-03-01

    The Minnesota Multiphasic Personality Inventory-2 (MMPI-2) is a psychological testing tool used to measure psychological and personality constructs. The MMPI-2 has proven helpful in identifying individuals with nonepileptic events/nonepileptic seizures. However, the MMPI-2 has had some updates that enhanced its original scales. The aim of this article was to test the utility of updated MMPI-2 scales in predicting the likelihood of non-epileptic seizures in individuals admitted to an EEG video monitoring unit. We compared sensitivity, specificity, and likelihood ratios of traditional MMPI-2 Clinical Scales against more homogenous MMPI-2 Harris-Lingoes subscales and the newer Restructured Clinical (RC) scales. Our results showed that the Restructured Scales did not show significant improvement over the original Clinical scales. However, one Harris-Lingoes subscale (HL4 of Clinical Scale 3) did show improved predictive utility over the original Clinical scales as well as over the newer Restructured Clinical scales. Our study suggests that the predictive utility of the MMPI-2 can be improved using already existing scales. This is particularly useful for those practitioners who are not invested in switching over to the newly developed MMPI-2 Restructured Form (MMPI-2 RF). Copyright © 2016 Elsevier Inc. All rights reserved.

  14. What predicts performance during clinical psychology training?

    OpenAIRE

    Scior, Katrina; Bradley, Caroline E; Potts, Henry W W; Woolf, Katherine; de C Williams, Amanda C

    2013-01-01

    Objectives While the question of who is likely to be selected for clinical psychology training has been studied, evidence on performance during training is scant. This study explored data from seven consecutive intakes of the UK's largest clinical psychology training course, aiming to identify what factors predict better or poorer outcomes. Design Longitudinal cross-sectional study using prospective and retrospective data. Method Characteristics at application were analysed in relation to a r...

  15. External validation and comparison of three pediatric clinical dehydration scales.

    Directory of Open Access Journals (Sweden)

    Joshua Jauregui

    Full Text Available OBJECTIVE: To prospectively validate three popular clinical dehydration scales and overall physician gestalt in children with vomiting or diarrhea relative to the criterion standard of percent weight change with rehydration. METHODS: We prospectively enrolled a non-consecutive cohort of children ≤ 18 years of age with an acute episode of diarrhea or vomiting. Patient weight, clinical scale variables and physician clinical impression, or gestalt, were recorded before and after fluid resuscitation in the emergency department and upon hospital discharge. The percent weight change from presentation to discharge was used to calculate the degree of dehydration, with a weight change of ≥ 5% considered significant dehydration. Receiver operating characteristics (ROC curves were constructed for each of the three clinical scales and physician gestalt. Sensitivity and specificity were calculated based on the best cut-points of the ROC curve. RESULTS: We approached 209 patients, and of those, 148 were enrolled and 113 patients had complete data for analysis. Of these, 10.6% had significant dehydration based on our criterion standard. The Clinical Dehydration Scale (CDS and Gorelick scales both had an area under the ROC curve (AUC statistically different from the reference line with AUCs of 0.72 (95% CI 0.60, 0.84 and 0.71 (95% CI 0.57, 0.85 respectively. The World Health Organization (WHO scale and physician gestalt had AUCs of 0.61 (95% CI 0.45, 0.77 and 0.61 (0.44, 0.78 respectively, which were not statistically significant. CONCLUSION: The Gorelick scale and Clinical Dehydration Scale were fair predictors of dehydration in children with diarrhea or vomiting. The World Health Organization scale and physician gestalt were not helpful predictors of dehydration in our cohort.

  16. External validation and comparison of three pediatric clinical dehydration scales.

    Science.gov (United States)

    Jauregui, Joshua; Nelson, Daniel; Choo, Esther; Stearns, Branden; Levine, Adam C; Liebmann, Otto; Shah, Sachita P

    2014-01-01

    To prospectively validate three popular clinical dehydration scales and overall physician gestalt in children with vomiting or diarrhea relative to the criterion standard of percent weight change with rehydration. We prospectively enrolled a non-consecutive cohort of children ≤ 18 years of age with an acute episode of diarrhea or vomiting. Patient weight, clinical scale variables and physician clinical impression, or gestalt, were recorded before and after fluid resuscitation in the emergency department and upon hospital discharge. The percent weight change from presentation to discharge was used to calculate the degree of dehydration, with a weight change of ≥ 5% considered significant dehydration. Receiver operating characteristics (ROC) curves were constructed for each of the three clinical scales and physician gestalt. Sensitivity and specificity were calculated based on the best cut-points of the ROC curve. We approached 209 patients, and of those, 148 were enrolled and 113 patients had complete data for analysis. Of these, 10.6% had significant dehydration based on our criterion standard. The Clinical Dehydration Scale (CDS) and Gorelick scales both had an area under the ROC curve (AUC) statistically different from the reference line with AUCs of 0.72 (95% CI 0.60, 0.84) and 0.71 (95% CI 0.57, 0.85) respectively. The World Health Organization (WHO) scale and physician gestalt had AUCs of 0.61 (95% CI 0.45, 0.77) and 0.61 (0.44, 0.78) respectively, which were not statistically significant. The Gorelick scale and Clinical Dehydration Scale were fair predictors of dehydration in children with diarrhea or vomiting. The World Health Organization scale and physician gestalt were not helpful predictors of dehydration in our cohort.

  17. Performance regression manager for large scale systems

    Science.gov (United States)

    Faraj, Daniel A.

    2017-08-01

    System and computer program product to perform an operation comprising generating, based on a first output generated by a first execution instance of a command, a first output file specifying a value of at least one performance metric, wherein the first output file is formatted according to a predefined format, comparing the value of the at least one performance metric in the first output file to a value of the performance metric in a second output file, the second output file having been generated based on a second output generated by a second execution instance of the command, and outputting for display an indication of a result of the comparison of the value of the at least one performance metric of the first output file to the value of the at least one performance metric of the second output file.

  18. Emotional intelligence, performance, and retention in clinical staff nurses.

    Science.gov (United States)

    Codier, Estelle; Kamikawa, Cindy; Kooker, Barbara M; Shoultz, Jan

    2009-01-01

    Emotional intelligence has been correlated with performance, retention, and organizational commitment in professions other than nursing. A 2006 pilot study provided the first evidence of a correlation between emotional intelligence and performance in clinical staff nurses. A follow-up study was completed, the purpose of which was to explore emotional intelligence, performance level, organizational commitment, and retention. A convenience sample of 350 nurses in a large medical center in urban Hawaii participated in this study. This article reports the findings pertaining to the subset of 193 clinical staff nurses who responded. The Mayer-Salovey-Caruso Emotional Intelligence Test instrument was used to measure emotional intelligence abilities. Performance was defined as ranking on a clinical ladder. Commitment was scored on a Likert scale. The following variables measured retention: total years in nursing, years in current job, total years anticipated in current job, and total anticipated career length. Emotional intelligence scores in clinical staff nurses correlated positively with both performance level and retention variables. Clinical staff nurses with higher emotional intelligence scores demonstrated higher performance, had longer careers, and greater job retention.

  19. Development of the Academic Performance Perception Scale

    Science.gov (United States)

    Gur, Recep

    2017-01-01

    Purpose: While numerous studies about academic performance that focused on only one factor, studies aiming to measure academicians' perceptions across many factors have not been observed in the literature. The current study aims to fill this gap and become a resource for upcoming studies. The aim of this study is to develop a valid and reliable…

  20. Scaling Lean in primary care: impacts on system performance.

    Science.gov (United States)

    Hung, Dorothy Y; Harrison, Michael I; Martinez, Meghan C; Luft, Harold S

    2017-03-01

    We examined a wide range of performance outcomes after Lean methodology-a leading strategy to enhance efficiency and patient value-was implemented and scaled across all primary care clinics in a nonprofit, ambulatory care delivery system. Using a stepped wedge approach, we assessed changes associated with the phased introduction of Lean-based redesigns across 46 primary care departments in 17 different clinic locations. Longitudinal analysis of operational metrics included: workflow efficiency, physician productivity, operating expenses, clinical quality, and satisfaction among patients, physicians, and staff. We used interrupted time series analysis with generalized linear mixed models to estimate Lean impacts over time. Projected outcomes in the absence of changes (ie, counterfactuals) were compared with observed outcomes after Lean redesigns were implemented, and mean differences were assessed using 95% bias-corrected bootstrap confidence intervals (CIs). We observed systemwide improvements in workflow efficiencies (eg, 95% CI, 5.8-10.4) and physician productivity (95% CI, 3.9-27.2), with no adverse effects on clinical quality. Patient satisfaction increased with respect to access to care (95% CI, 15.2-20.7), handling of personal issues (95% CI, 2.1-6.9), and overall experience of care (95% CI, 11.0-17.0), but decreased with respect to interactions with care providers (95% CI, -13.4 to -5.7). Departmental operating costs decreased, and annual staff and physician satisfaction scores increased particularly among early adopters, with key improvements in employee engagement, connection to purpose, relationships with staff, and physician time spent working. Lean redesigns can benefit primary care patients, physicians, and staff without negatively impacting the quality of clinical care. Study results may lead other delivery system leaders to innovate using Lean techniques and may further enhance support for Lean learning among public and private payers.

  1. Effective Rating Scale Development for Speaking Tests: Performance Decision Trees

    Science.gov (United States)

    Fulcher, Glenn; Davidson, Fred; Kemp, Jenny

    2011-01-01

    Rating scale design and development for testing speaking is generally conducted using one of two approaches: the measurement-driven approach or the performance data-driven approach. The measurement-driven approach prioritizes the ordering of descriptors onto a single scale. Meaning is derived from the scaling methodology and the agreement of…

  2. Diagnostic accuracy of clinical dehydration scales in children.

    Science.gov (United States)

    Falszewska, Anna; Dziechciarz, Piotr; Szajewska, Hania

    2017-08-01

    The aim of this study was to evaluate the diagnostic accuracy of the Clinical Dehydration Scale (CDS), the World Health Organization (WHO) scale, and the Gorelick scale for dehydration assessment in children. A prospective, observational study was carried out between October 2014 and December 2016. Eligible participants were children aged 1 month to 5 years with acute diarrhea. After hospital admission, each patient's weight was recorded and the degree of dehydration based on three scales was assessed. The reference standard was the percentage weight change between the discharge and admission weights. The main outcomes were the sensitivity, specificity, positive likelihood ratio (LR), and negative LR. Of 128 children enrolled in the study, complete data were available from 118 patients for analysis. Most of children presented with no or mild dehydration. Only the CDS showed limited value in confirming a diagnosis of dehydration ≥6% (positive LR 3.9, 95% CI 1.1 to 9.1), with no value in ruling it out (negative LR 0.6, 95% CI 0.2 to 0.99). In our cohort, the CDS was of limited diagnostic value in ruling in severe dehydration in children with acute gastroenteritis. The WHO and Gorelick scales were not helpful in the assessment of dehydration. What is Known : • Treatment of acute gastroenteritis (AGE) is based on assessing and correcting the degree of dehydration. • Several scales combining various signs and symptoms have been developed, including the Clinical Dehydration Scale (CDS), and the World Health Organization (WHO) scale, and the Gorelick scale. None of these scales is internationally accepted for best accuracy in diagnosing dehydration in children. What is New: • The CDS was of limited diagnostic value in ruling in severe dehydration in children with AGE. • The WHO and Gorelick scales were not helpful in the assessment of dehydration.

  3. Scaling the quality of clinical audit projects: a pilot study.

    Science.gov (United States)

    Millard, A D

    1999-06-01

    To pilot the development of a scale measuring the quality of audit projects through audit project reports. Statements about clinical audit projects were selected from existing instruments, assessing the quality of clinical audit projects, to form a Likert scale. The audit facilitators were based in Scottish health boards and trusts. The participants were audit facilitators known to have over 2 years experience of supporting clinical audit. The response at first test was 11 out of 14 and at the second test it was 27 out of 46. The draft scale was tested by 27 audit facilitators who expressed their strength of agreement or disagreement with each statement for three reports. Validity was assessed by test-re-test, item-total, and total-global indicator correlations. Of the 20 statements, 15 had satisfactory correlations with scale totals. Scale totals had good correlations with global indicators. Test-re-test correlation was modest. The wide range of responses means further research is needed to measure the consistency of audit facilitators' interpretations, perhaps comparing a trained group with an untrained group. There may be a need for a separate scale for reaudits. Educational impact is distinct from project impact generally. It may be more meaningful to treat the selection of projects and aims, methodology and impact separately as subscales and take a project profiling approach rather than attempting to produce a global quality index.

  4. Clinical Strategies for Sampling Word Recognition Performance.

    Science.gov (United States)

    Schlauch, Robert S; Carney, Edward

    2018-04-17

    Computer simulation was used to estimate the statistical properties of searches for maximum word recognition ability (PB max). These involve presenting multiple lists and discarding all scores but that of the 1 list that produced the highest score. The simulations, which model limitations inherent in the precision of word recognition scores, were done to inform clinical protocols. A secondary consideration was a derivation of 95% confidence intervals for significant changes in score from phonemic scoring of a 50-word list. The PB max simulations were conducted on a "client" with flat performance intensity functions. The client's performance was assumed to be 60% initially and 40% for a second assessment. Thousands of estimates were obtained to examine the precision of (a) single lists and (b) multiple lists using a PB max procedure. This method permitted summarizing the precision for assessing a 20% drop in performance. A single 25-word list could identify only 58.4% of the cases in which performance fell from 60% to 40%. A single 125-word list identified 99.8% of the declines correctly. Presenting 3 or 5 lists to find PB max produced an undesirable finding: an increase in the word recognition score. A 25-word list produces unacceptably low precision for making clinical decisions. This finding holds in both single and multiple 25-word lists, as in a search for PB max. A table is provided, giving estimates of 95% critical ranges for successive presentations of a 50-word list analyzed by the number of phonemes correctly identified.

  5. Towards Rectifying Performance at the Molecular Scale.

    Science.gov (United States)

    Zhang, Guang-Ping; Xie, Zhen; Song, Yang; Hu, Gui-Chao; Wang, Chuan-Kui

    2017-10-24

    Molecular diode, proposed by Mark Ratner and Arieh Aviram in 1974, is the first single-molecule device investigated in molecular electronics. As a fundamental device in an electric circuit, molecular diode has attracted an enduring and extensive focus during the past decades. In this review, the theoretical and experimental progresses of both charge-based and spin-based molecular diodes are summarized. For the charge-based molecular diodes, the rectifying properties originated from asymmetric molecules including D-σ-A, D-π-A, D-A, and σ-π type compounds, asymmetric electrodes, asymmetric nanoribbons, and their combination are analyzed. Correspondingly, the rectification mechanisms are discussed in detail. Furthermore, a series of strategies for modulating rectification performance is figured out. Discussion on concept of molecular spin diode is also involved based on a magnetic co-oligomer. At the same time, the intrinsic mechanism as well as the modulation of the spin-current rectification performance is introduced. Finally, several crucial issues that need to be addressed in the future are given.

  6. Scaling of neck performance requirements in side impacts

    NARCIS (Netherlands)

    Wismans, J.S.H.M.; Meijer, R.; Rodarius, C.; Been, B.W.

    2008-01-01

    Neck biofidelity performance requirements for different sized crash dummies and human body computer models are usually based on scaling of performance requirements derived for a 50th percentile body size. The objective of this study is to investigate the validity of the currently used scaling laws

  7. ADHD Rating Scale-IV: Checklists, Norms, and Clinical Interpretation

    Science.gov (United States)

    Pappas, Danielle

    2006-01-01

    This article reviews the "ADHD Rating Scale-IV: Checklist, norms, and clinical interpretation," is a norm-referenced checklist that measures the symptoms of attention deficit/hyperactivity disorder (ADHD) according to the diagnostic criteria of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV; American Psychiatric…

  8. Do pressure ulcer risk assessment scales improve clinical practice?

    Directory of Open Access Journals (Sweden)

    Jan Kottner

    2010-07-01

    Full Text Available Jan Kottner1, Katrin Balzer21Department of Nursing Science, Charité-Universitätsmedizin Berlin, Germany; 2Nursing Research Group, Institute for Social Medicine, Universitätsklinikum Schleswig-Holstein, Lübeck, GermanyAbstract: Standardized assessment instruments are deemed important for estimating pressure ulcer risk. Today, more than 40 so-called pressure ulcer risk assessment scales are available but still there is an ongoing debate about their usefulness. From a measurement point of view pressure ulcer (PU risk assessment scales have serious limitations. Empirical evidence supporting the validity of PU risk assessment scale scores is weak and obtained scores contain varying amounts of measurement error. The concept of pressure ulcer risk is strongly related to the general health status and severity of illness. A clinical impact due do the application of these scales could also not be demonstrated. It is questionable whether completion of standardized pressure ulcer risk scales in clinical practice is really needed.Keywords: Braden pressure ulcer, prevention, risk assessment, nursing assessment, predictive value, clinical effectiveness, review

  9. Performance Health Monitoring of Large-Scale Systems

    Energy Technology Data Exchange (ETDEWEB)

    Rajamony, Ram [IBM Research, Austin, TX (United States)

    2014-11-20

    This report details the progress made on the ASCR funded project Performance Health Monitoring for Large Scale Systems. A large-­scale application may not achieve its full performance potential due to degraded performance of even a single subsystem. Detecting performance faults, isolating them, and taking remedial action is critical for the scale of systems on the horizon. PHM aims to develop techniques and tools that can be used to identify and mitigate such performance problems. We accomplish this through two main aspects. The PHM framework encompasses diagnostics, system monitoring, fault isolation, and performance evaluation capabilities that indicates when a performance fault has been detected, either due to an anomaly present in the system itself or due to contention for shared resources between concurrently executing jobs. Software components called the PHM Control system then build upon the capabilities provided by the PHM framework to mitigate degradation caused by performance problems.

  10. Analysis of small-scale rotor hover performance data

    Science.gov (United States)

    Kitaplioglu, Cahit

    1990-01-01

    Rotor hover-performance data from a 1/6-scale helicopter rotor are analyzed and the data sets compared for the effects of ambient wind, test stand configuration, differing test facilities, and scaling. The data are also compared to full scale hover data. The data exhibited high scatter, not entirely due to ambient wind conditions. Effects of download on the test stand proved to be the most significant influence on the measured data. Small-scale data correlated resonably well with full scale data; the correlation did not improve with Reynolds number corrections.

  11. Psychometric evaluation of the Swedish version of the pure procrastination scale, the irrational procrastination scale, and the susceptibility to temptation scale in a clinical population.

    Science.gov (United States)

    Rozental, Alexander; Forsell, Erik; Svensson, Andreas; Forsström, David; Andersson, Gerhard; Carlbring, Per

    2014-01-01

    Procrastination is a prevalent self-regulatory failure associated with stress and anxiety, decreased well-being, and poorer performance in school as well as work. One-fifth of the adult population and half of the student population describe themselves as chronic and severe procrastinators. However, despite the fact that it can become a debilitating condition, valid and reliable self-report measures for assessing the occurrence and severity of procrastination are lacking, particularly for use in a clinical context. The current study explored the usefulness of the Swedish version of three Internet-administered self-report measures for evaluating procrastination; the Pure Procrastination Scale, the Irrational Procrastination Scale, and the Susceptibility to Temptation Scale, all having good psychometric properties in English. In total, 710 participants were recruited for a clinical trial of Internet-based cognitive behavior therapy for procrastination. All of the participants completed the scales as well as self-report measures of depression, anxiety, and quality of life. Principal Component Analysis was performed to assess the factor validity of the scales, and internal consistency and correlations between the scales were also determined. Intraclass Correlation Coefficient, Minimal Detectable Change, and Standard Error of Measurement were calculated for the Irrational Procrastination Scale. The Swedish version of the scales have a similar factor structure as the English version, generated good internal consistencies, with Cronbach's α ranging between .76 to .87, and were moderately to highly intercorrelated. The Irrational Procrastination Scale had an Intraclass Correlation Coefficient of .83, indicating excellent reliability. Furthermore, Standard Error of Measurement was 1.61, and Minimal Detectable Change was 4.47, suggesting that a change of almost five points on the scale is necessary to determine a reliable change in self-reported procrastination severity. The

  12. Susceptibility of the MMPI-2 Clinical, Restructured Clinical (RC), and Content Scales to Overreporting and Underreporting

    Science.gov (United States)

    Sellbom, Martin; Ben-Porath, Yossef S.; Graham, John R.; Arbisi, Paul A.; Bagby, R. Michael

    2005-01-01

    The authors examined and compared the susceptibility of three Minnesota Multiphasic Personality Inventory-2 (MMPI-2) scale sets (Clinical, Restructured Clinical [RC], and Content) to over- and underreporting using five analog samples. Two samples of 85 and 191 undergraduate students, respectively, took the MMPI-2 under underreporting versus…

  13. The Erectile Performance Anxiety Index: scale development and psychometric properties.

    Science.gov (United States)

    Telch, Michael J; Pujols, Yasisca

    2013-12-01

    Erectile dysfunction is a highly publicized and prevalent condition with marked adverse effects on men's social, emotional, and quality of life. Although several instruments have emerged for assessing erectile dysfunction and its impact on men's quality of life, none of the existing instruments provide a specific assessment of men's erectile performance anxiety. This article reports on the development and psychometric evaluation of the Erectile Performance Anxiety Index (EPAI)--a 10-item self-report scale designed to fill an important gap in the assessment of male erectile dysfunction. A total of 207 men ranging in age from 18 to 79 took part in the study. All subjects completed an online battery consisting of the EPAI, along with measures of related sexual functioning, social anxiety, state anxiety, and depressive symptoms. A small subset of study participants (N = 42) completed the EPAI a second time for determining test-retest reliability. Test-retest reliability was determined by Pearson's product-moment correlations. Internal reliability was assessed using Cronbach's alpha. Factor validity was evaluated by a maximum likelihood factor analysis with oblique rotation. Convergent and discriminant validity was assessed by comparing the strength of association between the EPAI and measures varying in their hypothesized shared variance with the construct of erectile performance anxiety. The EPAI demonstrated excellent internal consistency, with Cronbach's alpha = 0.93 and excellent test-retest reliability (r = 0.85) over an average period of 3.5 weeks. Results of an exploratory factor analysis revealed a one-factor solution that accounted for 63% of the total variance. Preliminary evidence supports the convergent and discriminant validity of the EPAI. Results support the use of the EPAI as a reliable, valid, and efficient instrument for the assessment of erectile performance anxiety. Potential research and clinical applications are discussed. © 2013 International

  14. Mixing and scale affect moving bed biofilm reactor (MBBR) performance

    NARCIS (Netherlands)

    Kamstra, Andries; Blom, Ewout; Terjesen, Bendik Fyhn

    2017-01-01

    Moving Bed Biofilm Reactors (MBBR) are used increasingly in closed systems for farming of fish. Scaling, i.e. design of units of increasing size, is an important issue in general bio-reactor design since mixing behaviour will differ between small and large scale. Research is mostly performed on

  15. Performance evaluation of thin wearing courses through scaled accelerated trafficking.

    Science.gov (United States)

    2014-01-01

    The primary objective of this study was to evaluate the permanent deformation (rutting) and fatigue performance of : several thin asphalt concrete wearing courses using a scaled-down accelerated pavement testing device. The accelerated testing : was ...

  16. Density dependence of reactor performance with thermal confinement scalings

    International Nuclear Information System (INIS)

    Stotler, D.P.

    1992-03-01

    Energy confinement scalings for the thermal component of the plasma published thus far have a different dependence on plasma density and input power than do scalings for the total plasma energy. With such thermal scalings, reactor performance (measured by Q, the ratio of the fusion power to the sum of the ohmic and auxiliary input powers) worsens with increasing density. This dependence is the opposite of that found using scalings based on the total plasma energy, indicating that reactor operation concepts may need to be altered if this density dependence is confirmed in future research

  17. The dutch social interaction anxiety scale and the social phobia scale: reliability, validity, and clinical utility.

    Science.gov (United States)

    de Beurs, Edwin; Tielen, Deirdre; Wollmann, Lisa

    2014-01-01

    The social interaction anxiety scale (SIAS) and the social phobia scale (SPS) assess anxiety in social interactions and fear of scrutiny by others. This study examines the psychometric properties of the Dutch versions of the SIAS and SPS using data from a large group of patients with social phobia and a community-based sample. Confirmatory factor analysis revealed that the SIAS is unidimensional, whereas the SPS is comprised of three subscales. The internal consistency of the scales and subscales was good. The concurrent and discriminant validity was supported and the scales were well able to discriminate between patients and community-based respondents. Cut-off values with excellent sensitivity and specificity are presented. Of all self-report measures included, the SPS was the most sensitive for treatment effects. Normative data are provided which can be used to assess whether clinically significant change has occurred in individual patients.

  18. The Dutch Social Interaction Anxiety Scale and the Social Phobia Scale: Reliability, Validity, and Clinical Utility

    Directory of Open Access Journals (Sweden)

    Edwin de Beurs

    2014-01-01

    Full Text Available The social interaction anxiety scale (SIAS and the social phobia scale (SPS assess anxiety in social interactions and fear of scrutiny by others. This study examines the psychometric properties of the Dutch versions of the SIAS and SPS using data from a large group of patients with social phobia and a community-based sample. Confirmatory factor analysis revealed that the SIAS is unidimensional, whereas the SPS is comprised of three subscales. The internal consistency of the scales and subscales was good. The concurrent and discriminant validity was supported and the scales were well able to discriminate between patients and community-based respondents. Cut-off values with excellent sensitivity and specificity are presented. Of all self-report measures included, the SPS was the most sensitive for treatment effects. Normative data are provided which can be used to assess whether clinically significant change has occurred in individual patients.

  19. Affordable, automatic quantitative fall risk assessment based on clinical balance scales and Kinect data.

    Science.gov (United States)

    Colagiorgio, P; Romano, F; Sardi, F; Moraschini, M; Sozzi, A; Bejor, M; Ricevuti, G; Buizza, A; Ramat, S

    2014-01-01

    The problem of a correct fall risk assessment is becoming more and more critical with the ageing of the population. In spite of the available approaches allowing a quantitative analysis of the human movement control system's performance, the clinical assessment and diagnostic approach to fall risk assessment still relies mostly on non-quantitative exams, such as clinical scales. This work documents our current effort to develop a novel method to assess balance control abilities through a system implementing an automatic evaluation of exercises drawn from balance assessment scales. Our aim is to overcome the classical limits characterizing these scales i.e. limited granularity and inter-/intra-examiner reliability, to obtain objective scores and more detailed information allowing to predict fall risk. We used Microsoft Kinect to record subjects' movements while performing challenging exercises drawn from clinical balance scales. We then computed a set of parameters quantifying the execution of the exercises and fed them to a supervised classifier to perform a classification based on the clinical score. We obtained a good accuracy (~82%) and especially a high sensitivity (~83%).

  20. Decreased attention to object size information in scale errors performers.

    Science.gov (United States)

    Grzyb, Beata J; Cangelosi, Angelo; Cattani, Allegra; Floccia, Caroline

    2017-05-01

    Young children sometimes make serious attempts to perform impossible actions on miniature objects as if they were full-size objects. The existing explanations of these curious action errors assume (but never explicitly tested) children's decreased attention to object size information. This study investigated the attention to object size information in scale errors performers. Two groups of children aged 18-25 months (N=52) and 48-60 months (N=23) were tested in two consecutive tasks: an action task that replicated the original scale errors elicitation situation, and a looking task that involved watching on a computer screen actions performed with adequate to inadequate size object. Our key finding - that children performing scale errors in the action task subsequently pay less attention to size changes than non-scale errors performers in the looking task - suggests that the origins of scale errors in childhood operate already at the perceptual level, and not at the action level. Copyright © 2017 Elsevier Inc. All rights reserved.

  1. Improving the Performance of the Extreme-scale Simulator

    Energy Technology Data Exchange (ETDEWEB)

    Engelmann, Christian [ORNL; Naughton III, Thomas J [ORNL

    2014-01-01

    Investigating the performance of parallel applications at scale on future high-performance computing (HPC) architectures and the performance impact of different architecture choices is an important component of HPC hardware/software co-design. The Extreme-scale Simulator (xSim) is a simulation-based toolkit for investigating the performance of parallel applications at scale. xSim scales to millions of simulated Message Passing Interface (MPI) processes. The overhead introduced by a simulation tool is an important performance and productivity aspect. This paper documents two improvements to xSim: (1) a new deadlock resolution protocol to reduce the parallel discrete event simulation management overhead and (2) a new simulated MPI message matching algorithm to reduce the oversubscription management overhead. The results clearly show a significant performance improvement, such as by reducing the simulation overhead for running the NAS Parallel Benchmark suite inside the simulator from 1,020\\% to 238% for the conjugate gradient (CG) benchmark and from 102% to 0% for the embarrassingly parallel (EP) and benchmark, as well as, from 37,511% to 13,808% for CG and from 3,332% to 204% for EP with accurate process failure simulation.

  2. Performance prediction of industrial centrifuges using scale-down models.

    Science.gov (United States)

    Boychyn, M; Yim, S S S; Bulmer, M; More, J; Bracewell, D G; Hoare, M

    2004-12-01

    Computational fluid dynamics was used to model the high flow forces found in the feed zone of a multichamber-bowl centrifuge and reproduce these in a small, high-speed rotating disc device. Linking the device to scale-down centrifugation, permitted good estimation of the performance of various continuous-flow centrifuges (disc stack, multichamber bowl, CARR Powerfuge) for shear-sensitive protein precipitates. Critically, the ultra scale-down centrifugation process proved to be a much more accurate predictor of production multichamber-bowl performance than was the pilot centrifuge.

  3. Indicators of suboptimal performance embedded in the Wechsler Memory Scale-Fourth Edition (WMS-IV)

    NARCIS (Netherlands)

    Bouman, Z.; Hendriks, M.P.H.; Schmand, B.A.; Kessels, R.P.C.; Aldenkamp, A.P.

    2016-01-01

    INTRODUCTION: Recognition and visual working memory tasks from the Wechsler Memory Scale-Fourth Edition (WMS-IV) have previously been documented as useful indicators for suboptimal performance. The present study examined the clinical utility of the Dutch version of the WMS-IV (WMS-IV-NL) for the

  4. Indicators of suboptimal performance embedded in the Wechsler Memory Scale-Fourth Edition (WMS-IV)

    NARCIS (Netherlands)

    Bouman, Zita; Hendriks, Marc P. H.; Schmand, Ben A.; Kessels, Roy P. C.; Aldenkamp, Albert P.

    2016-01-01

    Recognition and visual working memory tasks from the Wechsler Memory Scale-Fourth Edition (WMS-IV) have previously been documented as useful indicators for suboptimal performance. The present study examined the clinical utility of the Dutch version of the WMS-IV (WMS-IV-NL) for the identification of

  5. Indicators of suboptimal performance embedded in the Wechsler Memory Scale : Fourth Edition (WMS-IV)

    NARCIS (Netherlands)

    Bouman, Z.; Hendriks, M.P.H.; Schmand, B.A.; Kessels, R.P.C.; Aldenkamp, A.P.

    2016-01-01

    INTRODUCTION: Recognition and visual working memory tasks from the Wechsler Memory Scale-Fourth Edition (WMS-IV) have previously been documented as useful indicators for suboptimal performance. The present study examined the clinical utility of the Dutch version of the WMS-IV (WMS-IV-NL) for the

  6. Indicators of suboptimal performance embedded in the Wechsler Memory Scale-Fourth Edition (WMS-IV)

    NARCIS (Netherlands)

    Bouman, Zita; Hendriks, Marc P.H.; Schmand, Ben A.; Kessels, Roy P.C.; Aldenkamp, Albert P.

    2016-01-01

    Introduction. Recognition and visual working memory tasks from the Wechsler Memory Scale-Fourth Edition (WMS-IV) have previously been documented as useful indicators for suboptimal performance. The present study examined the clinical utility of the Dutch version of the WMS-IV (WMS-IV-NL) for the

  7. Psychological variables and Wechsler Adult Intelligence Scale-IV performance.

    Science.gov (United States)

    Gass, Carlton S; Gutierrez, Laura

    2017-01-01

    The MMPI-2 and WAIS-IV are commonly used together in neuropsychological evaluations yet little is known about their interrelationships. This study explored the potential influence of psychological factors on WAIS-IV performance in a sample of 180 predominantly male veteran referrals that underwent a comprehensive neuropsychological examination in a VA Medical Center. Exclusionary criteria included failed performance validity testing and self-report distortion on the MMPI-2. A Principal Components Analysis was performed on the 15 MMPI-2 content scales, yielding three broader higher-order psychological dimensions: Internalized Emotional Dysfunction (IED), Externalized Emotional Dysfunction (EED), and Fear. Level of IED was not related to performance on the WAIS-IV Full Scale IQ or its four indexes: (Verbal Comprehension, Perceptual Reasoning, Working Memory, and Processing Speed). EED was not related to WAIS-IV performance. Level of Fear, which encompasses health preoccupations (HEA) and distorted perceptions (BIZ), was significantly related to WAIS-IV Full Scale IQ and Verbal Comprehension. These results challenge the common use of high scores on the MMPI-2 IED measures (chiefly depression and anxiety) to explain deficient WAIS-IV performance. In addition, they provide impetus for further investigation of the relation between verbal intelligence and Fear.

  8. Strategic Factor Markets Scale Free Resources and Economic Performance

    DEFF Research Database (Denmark)

    Geisler Asmussen, Christian

    2015-01-01

    This paper analyzes how scale free resources, which can be acquired by multiple firms simultaneously and deployed against one another in product market competition, will be priced in strategic factor markets, and what the consequences are for the acquiring firms' performance. Based on a game-theo...

  9. Atomic scale simulations for improved CRUD and fuel performance modeling

    Energy Technology Data Exchange (ETDEWEB)

    Andersson, Anders David Ragnar [Los Alamos National Lab. (LANL), Los Alamos, NM (United States); Cooper, Michael William Donald [Los Alamos National Lab. (LANL), Los Alamos, NM (United States)

    2017-01-06

    A more mechanistic description of fuel performance codes can be achieved by deriving models and parameters from atomistic scale simulations rather than fitting models empirically to experimental data. The same argument applies to modeling deposition of corrosion products on fuel rods (CRUD). Here are some results from publications in 2016 carried out using the CASL allocation at LANL.

  10. Evaluation of aesthetic abdominal surgery using a new clinical scale.

    Science.gov (United States)

    Salles, Alessandra Grassi; Ferreira, Marcus Castro; do Nascimento Remigio, Adelina Fatima; Gemperli, Rolf

    2012-02-01

    Evaluation of outcomes after aesthetic surgery still is a challenge in plastic surgery. The evaluation frequently is based on subjective criteria. This study used a new clinical grading scale to evaluate aesthetic results for plastic surgeries to the abdomen. The method scores each of the following five parameters: volume of subcutaneous tissue, contour, excess of skin, aspect of the navel, and quality of the scar on the abdominal wall. The scale options are 0 (poor), 1 (fair), and 2 (good), and the total rate can range from 0 to 10. The study included 40 women ages 18-53 years. Of these 40 women, 20 underwent traditional abdominoplasty, and 20 had liposuction alone. Preoperatively and at least 1 year later, photographic results were analyzed and scored by three independent plastic surgeons. In the abdominoplasty group, the average grade rose from 2.9±0.4 to 6.8±0.4 postoperatively. In the liposuction group, the average grade was 5.3±0.5 preoperatively and 7.7±0.4 postoperatively. In both groups, the average postoperative grade was significantly higher than the preoperative grade. The mean scores for groups A and L were significantly different, demonstrating that the scale was sensitive in identifying different anatomic abnormalities in the abdomen. The rating scale used for the aesthetic evaluation of the abdomen was effective in the analysis of two different procedures: conventional abdominoplasty and liposuction. Abdominoplasty provided the greater gain according to a comparison of the pre- and postoperative scores.

  11. Indicators of suboptimal performance embedded in the Wechsler Memory Scale-Fourth Edition (WMS-IV)

    OpenAIRE

    Bouman, Zita; Hendriks, Marc PH; Schmand, Ben A; Kessels, Roy PC; Aldenkamp, Albert

    2016-01-01

    Introduction. Recognition and visual working memory tasks from the Wechsler Memory Scale-Fourth Edition (WMS-IV) have previously been documented as useful indicators for suboptimal performance. The present study examined the clinical utility of the Dutch version of the WMS-IV (WMS-IV-NL) for the identification of suboptimal performance using an analogue study design. Method. The patient group consisted of 59 mixed-etiology patients; the experimental malingerers were 50 healthy individuals...

  12. Indicators of suboptimal performance embedded in the Wechsler Memory Scale-Fourth Edition (WMS-IV)

    OpenAIRE

    Bouman, Zita; Hendriks, Marc P.H.; Schmand, Ben A.; Kessels, Roy P.C.; Aldenkamp, Albert P.

    2016-01-01

    Introduction. Recognition and visual working memory tasks from the Wechsler Memory Scale-Fourth Edition (WMS-IV) have previously been documented as useful indicators for suboptimal performance. The present study examined the clinical utility of the Dutch version of the WMS-IV (WMS-IV-NL) for the identification of suboptimal performance using an analogue study design.Method. The patient group consisted of 59 mixed-etiology patients; the experimental malingerers were 50 healthy individuals who ...

  13. Leverage hadoop framework for large scale clinical informatics applications.

    Science.gov (United States)

    Dong, Xiao; Bahroos, Neil; Sadhu, Eugene; Jackson, Tommie; Chukhman, Morris; Johnson, Robert; Boyd, Andrew; Hynes, Denise

    2013-01-01

    In this manuscript, we present our experiences using the Apache Hadoop framework for high data volume and computationally intensive applications, and discuss some best practice guidelines in a clinical informatics setting. There are three main aspects in our approach: (a) process and integrate diverse, heterogeneous data sources using standard Hadoop programming tools and customized MapReduce programs; (b) after fine-grained aggregate results are obtained, perform data analysis using the Mahout data mining library; (c) leverage the column oriented features in HBase for patient centric modeling and complex temporal reasoning. This framework provides a scalable solution to meet the rapidly increasing, imperative "Big Data" needs of clinical and translational research. The intrinsic advantage of fault tolerance, high availability and scalability of Hadoop platform makes these applications readily deployable at the enterprise level cluster environment.

  14. The development and performance testing of a biodegradable scale inhibitor

    Energy Technology Data Exchange (ETDEWEB)

    Hardy, Julie; Fidoe, Steve; Jones, Chris

    2006-03-15

    The oil industry is currently facing severe restrictions concerning the discharge of oil field chemicals into the environment. Many commonly used materials in both topside and downhole applications are phased for substitution for use in the North Sea, and more will be identified. The development of biodegradable and low toxicity chemicals, which afford equal or improved efficacy, compared to conventional technology, available at a competitive price, is a current industry challenge. A range of biodegradable materials are increasingly available, however their limited performance can result in a restricted range of applications. This paper discusses the development and commercialization of a readily biodegradable scale inhibitor, ideal for use in topside applications. This material offers a broad spectrum of activity, notably efficiency against barium sulphate, calcium sulphate and calcium carbonate scales, in a range of water chemistries. A range of performance testing, compatibility, stability and OCNS dataset will be presented. Comparisons with commonly used chemicals have been made to identify the superior performance of this phosphate ester. This paper will discuss a scale inhibitor suitable for use in a variety of conditions which offers enhanced performance combined with a favourable biodegradation profile. This material is of great benefit to the industry, particularly in North Sea applications. (author) (tk)

  15. Development and Psychometric Evaluation of a Clinical Global Impression for Schizoaffective Disorder Scale

    OpenAIRE

    Allen, Michael H; Daniel, David G; Revicki, Dennis A; Canuso, Carla M; Turkoz, Ibrahim; Fu, Dong-Jing; Alphs, Larry; Ishak, K. Jack; Bartko, John J; Lindenmayer, Jean-Pierre

    2012-01-01

    Objective: The Clinical Global Impression for Schizoaffective Disorder scale is a new rating scale adapted from the Clinical Global Impression scale for use in patients with schizoaffective disorder. The psychometric characteristics of the Clinical Global Impression for Schizoaffective Disorder are described.

  16. Perspectives on Clinical Informatics: Integrating Large-Scale Clinical, Genomic, and Health Information for Clinical Care

    Directory of Open Access Journals (Sweden)

    In Young Choi

    2013-12-01

    Full Text Available The advances in electronic medical records (EMRs and bioinformatics (BI represent two significant trends in healthcare. The widespread adoption of EMR systems and the completion of the Human Genome Project developed the technologies for data acquisition, analysis, and visualization in two different domains. The massive amount of data from both clinical and biology domains is expected to provide personalized, preventive, and predictive healthcare services in the near future. The integrated use of EMR and BI data needs to consider four key informatics areas: data modeling, analytics, standardization, and privacy. Bioclinical data warehouses integrating heterogeneous patient-related clinical or omics data should be considered. The representative standardization effort by the Clinical Bioinformatics Ontology (CBO aims to provide uniquely identified concepts to include molecular pathology terminologies. Since individual genome data are easily used to predict current and future health status, different safeguards to ensure confidentiality should be considered. In this paper, we focused on the informatics aspects of integrating the EMR community and BI community by identifying opportunities, challenges, and approaches to provide the best possible care service for our patients and the population.

  17. Centrifugal fans: Similarity, scaling laws, and fan performance

    Science.gov (United States)

    Sardar, Asad Mohammad

    Centrifugal fans are rotodynamic machines used for moving air continuously against moderate pressures through ventilation and air conditioning systems. There are five major topics presented in this thesis: (1) analysis of the fan scaling laws and consequences of dynamic similarity on modelling; (2) detailed flow visualization studies (in water) covering the flow path starting at the fan blade exit to the evaporator core of an actual HVAC fan scroll-diffuser module; (3) mean velocity and turbulence intensity measurements (flow field studies) at the inlet and outlet of large scale blower; (4) fan installation effects on overall fan performance and evaluation of fan testing methods; (5) two point coherence and spectral measurements conducted on an actual HVAC fan module for flow structure identification of possible aeroacoustic noise sources. A major objective of the study was to identity flow structures within the HVAC module that are responsible for noise and in particular "rumble noise" generation. Possible mechanisms for the generation of flow induced noise in the automotive HVAC fan module are also investigated. It is demonstrated that different modes of HVAC operation represent very different internal flow characteristics. This has implications on both fan HVAC airflow performance and noise characteristics. It is demonstrated from principles of complete dynamic similarity that fan scaling laws require that Reynolds, number matching is a necessary condition for developing scale model fans or fan test facilities. The physical basis for the fan scaling laws derived was established from both pure dimensional analysis and also from the fundamental equations of fluid motion. Fan performance was measured in a three times scale model (large scale blower) in air of an actual forward curved automotive HVAC blower. Different fan testing methods (based on AMCA fan test codes) were compared on the basis of static pressure measurements. Also, the flow through an actual HVAC

  18. Development of a performance anxiety scale for music students.

    Science.gov (United States)

    Çirakoğlu, Okan Cem; Şentürk, Gülce Çoskun

    2013-12-01

    In the present research, the Performance Anxiety Scale for Music Students (PASMS) was developed in three successive studies. In Study 1, the factor structure of PASMS was explored and three components were found: fear of stage (FES), avoidance (AVD) and symptoms (SMP). The internal consistency of the subscales of PASMS, which consisted of 27 items, varied between 0.89 and 0.91. The internal consistency for the whole scale was found to be 0.95. The correlations among PASMS and other anxiety-related measures were significant and in the expected direction, indicating that the scale has convergent validity. The construct validity of the scale was assessed in Study 2 by confirmatory factor analysis. After several revisions, the final tested model achieved acceptable fits. In Study 3, the 14-day test-retest reliability of the final 24-item version of PASMS was tested and found to be extremely high (0.95). In all three studies, the whole scale and subscale scores of females were significantly higher than for males.

  19. LAMMPS strong scaling performance optimization on Blue Gene/Q

    Energy Technology Data Exchange (ETDEWEB)

    Coffman, Paul; Jiang, Wei; Romero, Nichols A.

    2014-11-12

    LAMMPS "Large-scale Atomic/Molecular Massively Parallel Simulator" is an open-source molecular dynamics package from Sandia National Laboratories. Significant performance improvements in strong-scaling and time-to-solution for this application on IBM's Blue Gene/Q have been achieved through computational optimizations of the OpenMP versions of the short-range Lennard-Jones term of the CHARMM force field and the long-range Coulombic interaction implemented with the PPPM (particle-particle-particle mesh) algorithm, enhanced by runtime parameter settings controlling thread utilization. Additionally, MPI communication performance improvements were made to the PPPM calculation by re-engineering the parallel 3D FFT to use MPICH collectives instead of point-to-point. Performance testing was done using an 8.4-million atom simulation scaling up to 16 racks on the Mira system at Argonne Leadership Computing Facility (ALCF). Speedups resulting from this effort were in some cases over 2x.

  20. [Multicenter validation of the clinical dehydration scale for children].

    Science.gov (United States)

    Gravel, J; Manzano, S; Guimont, C; Lacroix, L; Gervaix, A; Bailey, B

    2010-12-01

    Dehydration is an important complication for sick children. The Clinical Dehydration Scale for children (CDS) measures dehydration based on 4 clinical signs: general appearance, eyes, saliva, and tears. To validate the association between the CDS and markers of dehydration in children aged 1 month to 5 years visiting emergency departments (EDs) for vomiting and/or diarrhea. An international prospective cohort study conducted in 3 university-affiliated EDs in 2009. Participants were a convenience sample of children aged 1-60 months presenting to the ED for acute vomiting and/or diarrhea. Following triage, a research nurse obtained informed consent and evaluated dehydration using the CDS. A few days after recovery, another research assistant weighed participants at home. The primary outcome was the percentage of dehydration calculated by the difference in weight at first evaluation and after recovery. Secondary outcomes included proportion of blood test measurements, intravenous use, hospitalization, and inter-rater agreement. During the study period, 264 children were recruited and data regarding weight and dehydration scores were complete for 219 (83%). According to the CDS, 88 had no dehydration, 159 some dehydration, and 15 moderate or severe dehydration. A Chi-square test showed a statistical association between CDS and weight gain, the occurrence of blood tests, intravenous rehydration, hospitalization, and abnormal plasmatic bicarbonate. Good inter-rater correlation was found among participants (linear weighted Kappa score of 0.65; (95% CI, 0.43-0.87). CDS categories correlate with markers of dehydration for young children complaining of vomiting and/or diarrhea in the ED. Copyright © 2010 Elsevier Masson SAS. All rights reserved.

  1. Small-scale tunnel test for blast performance

    International Nuclear Information System (INIS)

    Felts, J E; Lee, R J

    2014-01-01

    The data reported here provide a validation of a small-scale tunnel test as a tool to guide the optimization of new explosives for blast performance in tunnels. The small-scale arrangement consisted of a 2-g booster and 10-g sample mounted at the closed end of a 127 mm diameter by 4.6-m long steel tube with pressure transducers along its length. The three performance characteristics considered were peak pressure, initial energy release, and impulse. The relative performance from five explosives was compared to that from a 1.16-m diameter by 30-m long tunnel that used 2.27-kg samples. The peak pressure values didn't correlate between the tunnels. Partial impulse for the explosives did rank similarly. The initial energy release was determined from a one-dimensional point-source analysis, which nearly tracked with impulse suggesting additional energy released further down the tunnel for some explosives. This test is a viable tool for optimizing compositional variations for blast performance in target scenarios of similar geometry.

  2. Large scale and performance tests of the ATLAS online software

    International Nuclear Information System (INIS)

    Alexandrov; Kotov, V.; Mineev, M.; Roumiantsev, V.; Wolters, H.; Amorim, A.; Pedro, L.; Ribeiro, A.; Badescu, E.; Caprini, M.; Burckhart-Chromek, D.; Dobson, M.; Jones, R.; Kazarov, A.; Kolos, S.; Liko, D.; Lucio, L.; Mapelli, L.; Nassiakou, M.; Schweiger, D.; Soloviev, I.; Hart, R.; Ryabov, Y.; Moneta, L.

    2001-01-01

    One of the sub-systems of the Trigger/DAQ system of the future ATLAS experiment is the Online Software system. It encompasses the functionality needed to configure, control and monitor the DAQ. Its architecture is based on a component structure described in the ATLAS Trigger/DAQ technical proposal. Regular integration tests ensure its smooth operation in test beam setups during its evolutionary development towards the final ATLAS online system. Feedback is received and returned into the development process. Studies of the system behavior have been performed on a set of up to 111 PCs on a configuration which is getting closer to the final size. Large scale and performance test of the integrated system were performed on this setup with emphasis on investigating the aspects of the inter-dependence of the components and the performance of the communication software. Of particular interest were the run control state transitions in various configurations of the run control hierarchy. For the purpose of the tests, the software from other Trigger/DAQ sub-systems has been emulated. The author presents a brief overview of the online system structure, its components and the large scale integration tests and their results

  3. Measuring clinical management by physicians and nurses in European hospitals: development and validation of two scales.

    Science.gov (United States)

    Plochg, Thomas; Arah, Onyebuchi A; Botje, Daan; Thompson, Caroline A; Klazinga, Niek S; Wagner, Cordula; Mannion, Russell; Lombarts, Kiki

    2014-04-01

    Clinical management is hypothesized to be critical for hospital management and hospital performance. The aims of this study were to develop and validate professional involvement scales for measuring the level of clinical management by physicians and nurses in European hospitals. Testing of validity and reliability of scales derived from a questionnaire of 21 items was developed on the basis of a previous study and expert opinion and administered in a cross-sectional seven-country research project 'Deepening our Understanding of Quality improvement in Europe' (DUQuE). A sample of 3386 leading physicians and nurses working in 188 hospitals located in Czech Republic, France, Germany, Poland, Portugal, Spain and Turkey. Validity and reliability of professional involvement scales and subscales. Psychometric analysis yielded four subscales for leading physicians: (i) Administration and budgeting, (ii) Managing medical practice, (iii) Strategic management and (iv) Managing nursing practice. Only the first three factors applied well to the nurses. Cronbach's alpha for internal consistency ranged from 0.74 to 0.86 for the physicians, and from 0.61 to 0.81 for the nurses. Except for the 0.74 correlation between 'Administration and budgeting' and 'Managing medical practice' among physicians, all inter-scale correlations were measurement instrument can be used for international research on clinical management.

  4. Performance Analysis, Modeling and Scaling of HPC Applications and Tools

    Energy Technology Data Exchange (ETDEWEB)

    Bhatele, Abhinav [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States)

    2016-01-13

    E cient use of supercomputers at DOE centers is vital for maximizing system throughput, mini- mizing energy costs and enabling science breakthroughs faster. This requires complementary e orts along several directions to optimize the performance of scienti c simulation codes and the under- lying runtimes and software stacks. This in turn requires providing scalable performance analysis tools and modeling techniques that can provide feedback to physicists and computer scientists developing the simulation codes and runtimes respectively. The PAMS project is using time allocations on supercomputers at ALCF, NERSC and OLCF to further the goals described above by performing research along the following fronts: 1. Scaling Study of HPC applications; 2. Evaluation of Programming Models; 3. Hardening of Performance Tools; 4. Performance Modeling of Irregular Codes; and 5. Statistical Analysis of Historical Performance Data. We are a team of computer and computational scientists funded by both DOE/NNSA and DOE/ ASCR programs such as ECRP, XStack (Traleika Glacier, PIPER), ExaOSR (ARGO), SDMAV II (MONA) and PSAAP II (XPACC). This allocation will enable us to study big data issues when analyzing performance on leadership computing class systems and to assist the HPC community in making the most e ective use of these resources.

  5. Performance of clinical mammography: a nationwide study from Denmark

    DEFF Research Database (Denmark)

    Jensen, Allan; Vejborg, Ilse; Severinsen, Niels

    2006-01-01

    that clinical mammography worked best in patient populations of purely symptomatic women. Our data indicate that to increase the accuracy of clinical mammography at the community level, the presence of an experienced radiologist should be prioritized ahead of raising the clinic size.......Clinical mammography is the key tool for breast cancer diagnosis, but little is known about the impact of the organisational set-up on the performance. We evaluated whether organisational factors influence the performance of clinical mammography. Clinical mammography data from all clinics...... in Denmark in the year 2000 were collected and linked to cancer outcome. Use of the National Institute of Radiation Hygiene register for identification of radiology clinics ensured comprehensive nationwide registration. We used the final mammographic assessment at the end of the imaging work-up to determine...

  6. Adaptation and learning: characteristic time scales of performance dynamics.

    Science.gov (United States)

    Newell, Karl M; Mayer-Kress, Gottfried; Hong, S Lee; Liu, Yeou-Teh

    2009-12-01

    A multiple time scales landscape model is presented that reveals structures of performance dynamics that were not resolved in the traditional power law analysis of motor learning. It shows the co-existence of separate processes during and between practice sessions that evolve in two independent dimensions characterized by time scales that differ by about an order of magnitude. Performance along the slow persistent dimension of learning improves often as much and sometimes more during rest (memory consolidation and/or insight generation processes) than during a practice session itself. In contrast, the process characterized by the fast, transient dimension of adaptation reverses direction between practice sessions, thereby significantly degrading performance at the beginning of the next practice session (warm-up decrement). The theoretical model fits qualitatively and quantitatively the data from Snoddy's [Snoddy, G. S. (1926). Learning and stability. Journal of Applied Psychology, 10, 1-36] classic learning study of mirror tracing and other averaged and individual data sets, and provides a new account of the processes of change in adaptation and learning. 2009 Elsevier B.V. All rights reserved.

  7. Clinical and psychometric validation of the psychotic depression assessment scale

    DEFF Research Database (Denmark)

    Østergaard, Søren D; Pedersen, Christina H; Uggerby, Peter

    2015-01-01

    BACKGROUND: Recent studies have indicated that the 11-item Psychotic Depression Assessment Scale (PDAS), consisting of the 6-item melancholia subscale (HAM-D6) of the Hamilton Depression Rating Scale and 5 psychosis items from the Brief Psychiatric Rating Scale (BPRS), is a valid measure for the ...

  8. Factors of honeybee colony performances on sunflower at apiary scale

    Directory of Open Access Journals (Sweden)

    Kretzschmar André

    2017-11-01

    Full Text Available An observatory of honeybee colonies (Apis mellifera, consisting of at least 200 colonies, divided into 10 apiaries of 20 colonies, was monitored for three years on sunflower honeyflow (2015–2017. The purpose of this observatory is to understand which factors control colony performance during sunflower honeyflow in south-western France. From the temporal dynamics of weight gain, statistical analysis reveals a hierarchy of factors. First, variability in apiary scale performance is an image of the effect of resource variability. But, in addition to this primordial factor, two other factors contribute very significantly to performance. On the one hand, the amount of capped brood and the number of bees at the time of the installation of the apiary: these two elements testify to the vitality of the colony. The second remarkable factor is the Varroa load, which strongly penalizes performance beyond a certain threshold. The negative effect of the Varroa load on the colony performance is minimized in case of abondant sunflower honey flow.

  9. Performance evaluation of the DCMD desalination process under bench scale and large scale module operating conditions

    KAUST Repository

    Francis, Lijo; Ghaffour, NorEddine; Alsaadi, Ahmad Salem; Nunes, Suzana Pereira; Amy, Gary L.

    2014-01-01

    The flux performance of different hydrophobic microporous flat sheet commercial membranes made of poly tetrafluoroethylene (PTFE) and poly propylene (PP) was tested for Red Sea water desalination using the direct contact membrane distillation (DCMD) process, under bench scale (high δT) and large scale module (low δT) operating conditions. Membranes were characterized for their surface morphology, water contact angle, thickness, porosity, pore size and pore size distribution. The DCMD process performance was optimized using a locally designed and fabricated module aiming to maximize the flux at different levels of operating parameters, mainly feed water and coolant inlet temperatures at different temperature differences across the membrane (δT). Water vapor flux of 88.8kg/m2h was obtained using a PTFE membrane at high δT (60°C). In addition, the flux performance was compared to the first generation of a new locally synthesized and fabricated membrane made of a different class of polymer under the same conditions. A total salt rejection of 99.99% and boron rejection of 99.41% were achieved under extreme operating conditions. On the other hand, a detailed water characterization revealed that low molecular weight non-ionic molecules (ppb level) were transported with the water vapor molecules through the membrane structure. The membrane which provided the highest flux was then tested under large scale module operating conditions. The average flux of the latter study (low δT) was found to be eight times lower than that of the bench scale (high δT) operating conditions.

  10. Performance evaluation of the DCMD desalination process under bench scale and large scale module operating conditions

    KAUST Repository

    Francis, Lijo

    2014-04-01

    The flux performance of different hydrophobic microporous flat sheet commercial membranes made of poly tetrafluoroethylene (PTFE) and poly propylene (PP) was tested for Red Sea water desalination using the direct contact membrane distillation (DCMD) process, under bench scale (high δT) and large scale module (low δT) operating conditions. Membranes were characterized for their surface morphology, water contact angle, thickness, porosity, pore size and pore size distribution. The DCMD process performance was optimized using a locally designed and fabricated module aiming to maximize the flux at different levels of operating parameters, mainly feed water and coolant inlet temperatures at different temperature differences across the membrane (δT). Water vapor flux of 88.8kg/m2h was obtained using a PTFE membrane at high δT (60°C). In addition, the flux performance was compared to the first generation of a new locally synthesized and fabricated membrane made of a different class of polymer under the same conditions. A total salt rejection of 99.99% and boron rejection of 99.41% were achieved under extreme operating conditions. On the other hand, a detailed water characterization revealed that low molecular weight non-ionic molecules (ppb level) were transported with the water vapor molecules through the membrane structure. The membrane which provided the highest flux was then tested under large scale module operating conditions. The average flux of the latter study (low δT) was found to be eight times lower than that of the bench scale (high δT) operating conditions.

  11. Are self-report scales as effective as clinician rating scales in measuring treatment response in routine clinical practice?

    Science.gov (United States)

    Zimmerman, Mark; Walsh, Emily; Friedman, Michael; Boerescu, Daniela A; Attiullah, Naureen

    2018-01-01

    Recent treatment guidelines have suggested that outcome should be measured in routine clinical practice. In the present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project, we compared three self-report scales of depressive symptoms and the two most widely used clinician administered scales in treatment studies in their sensitivity to change and evaluation of treatment response in depressed patients treated in routine practice. At baseline and 4-month follow-up 153 depressed outpatients with DSM-IV MDD completed the Clinically Useful Depression Outcome Scale (CUDOS), Quick Inventory of Depressive Symptomatology-Self-report version (QIDS-SR), and Patient Health Questionnaire (PHQ-9). The patients were rated on the 17-item Hamilton Depression Rating Scale (HAMD) and the Montgomery-Asberg Depression Rating Scale (MADRS). On each scale treatment response was defined as a 50% or greater reduction in scores from baseline. While there were some differences in the percentage of patients considered to be responders on the different scales, a large effect size was found for each scale, with little variability amongst the scales. The level of agreement between the three self-report scales and the clinician rating scales was approximately the same LIMITATIONS: The present study was conducted in a single clinical practice in which the majority of the patients were white, female, and had health insurance. When measuring outcome in clinical practice the magnitude of change in depressive symptoms is as great on self-report scales as on clinician rating scales. Copyright © 2017 Elsevier B.V. All rights reserved.

  12. Correlations between commonly used clinical outcome scales and patient satisfaction after total knee arthroplasty.

    Science.gov (United States)

    Kwon, Sae Kwang; Kang, Yeon Gwi; Kim, Sung Ju; Chang, Chong Bum; Seong, Sang Cheol; Kim, Tae Kyun

    2010-10-01

    Patient satisfaction is becoming increasingly important as a crucial outcome measure for total knee arthroplasty. We aimed to determine how well commonly used clinical outcome scales correlate with patient satisfaction after total knee arthroplasty. In particular, we sought to determine whether patient satisfaction correlates better with absolute postoperative scores or preoperative to 12-month postoperative changes. Patient satisfaction was evaluated using 4 grades (enthusiastic, satisfied, noncommittal, and disappointed) for 438 replaced knees that were followed for longer than 1 year. Outcomes scales used the American Knee Society, Western Ontario McMaster University Osteoarthritis Index scales, and Short Form-36 scores. Correlation analyses were performed to investigate the relation between patient satisfaction and the 2 different aspects of the outcome scales: postoperative scores evaluated at latest follow-ups and preoperative to postoperative changes. The Western Ontario McMaster University Osteoarthritis Index scales function score was most strongly correlated with satisfaction (correlation coefficient=0.45). Absolute postoperative scores were better correlated with satisfaction than the preoperative to postoperative changes for all scales. Level IV (retrospective case series). Copyright © 2010 Elsevier Inc. All rights reserved.

  13. Effects of Clinical Mastitis on Reproductive Performance in Holstein Cows

    Directory of Open Access Journals (Sweden)

    A. Gunay

    2008-01-01

    Full Text Available The objective of this study was to determine the effects of clinical mastitis on reproductive performance in 135 early lactation cows. The animals were divided into two groups according to the occurrence of mastitis as follows: group I (n = 45, clinical mastitis prior to the first artificial insemination breeding; group II (n = 45, clinical mastitis after artificial insemination and being diagnosed pregnant. Forty-five cows without any mastitis served as control group. Calving to first service intervals were significantly longer (P P P < 0.05 in cows with clinical mastitis after first service (3.4 ± 0.9 than in cows with clinical mastitis before first service (2.1 ± 0.9 and in cows with no clinical mastitis (1.8 ± 0.8. This study indicated that clinical mastitis during early lactation in Holstein cows had a negative impact on their reproductive performance.

  14. Detecting comorbid Axis-II status among inpatients using the MMPI-2 Restructured Clinical Scales

    NARCIS (Netherlands)

    Kamphuis, J.H.; Arbisi, P.A.; Ben-Porath, Y.S.; McNulty, J.L.

    2008-01-01

    This study examined the differential diagnostic utility of the MMPI-2 Restructured Clinical Scales (RCS) and Clinical Scales (CS) in detecting a complex multivariate clinical phenomenon: that is, comorbid Axis-II status in two matched samples of inpatients. Psychiatric inpatients diagnosed with

  15. Development and psychometric evaluation of a clinical global impression for schizoaffective disorder scale.

    Science.gov (United States)

    Allen, Michael H; Daniel, David G; Revicki, Dennis A; Canuso, Carla M; Turkoz, Ibrahim; Fu, Dong-Jing; Alphs, Larry; Ishak, K Jack; Bartko, John J; Lindenmayer, Jean-Pierre

    2012-01-01

    The Clinical Global Impression for Schizoaffective Disorder scale is a new rating scale adapted from the Clinical Global Impression scale for use in patients with schizoaffective disorder. The psychometric characteristics of the Clinical Global Impression for Schizoaffective Disorder are described. Content validity was assessed using an investigator questionnaire. Inter-rater reliability was determined with 12 sets of videotaped interviews rated independently by two trained individuals. Test-retest reliability was assessed using 30 randomly selected raters from clinical trials who evaluated the same videos on separate occasions two weeks apart. Convergent and divergent validity and effect size were evaluated by comparing scores between the Clinical Global Impression for Schizoaffective Disorder and the Positive and Negative Syndrome Scale, 21-item Hamilton Rating Scale for Depression, and Young Mania Rating Scale scales using pooled patient data from two clinical trials. Clinical Global Impression for Schizoaffective Disorder scores were then linked to corresponding Positive and Negative Syndrome Scale scores. Content validity was strong. Inter-rater agreement was good to excellent for most scales and subscales (intra-class correlation coefficient ≥ 0.50). Test-retest showed good reproducibility, with intraclass correlation coefficients ranging from 0.444 to 0.898. Spearman correlations between Clinical Global Impression for Schizoaffective Disorder domains and corresponding symptom scales were 0.60 or greater, and effect sizes for Clinical Global Impression for Schizoaffective Disorder overall and domain scores were similar to Positive and Negative Syndrome Scale Young Mania Rating Scale, and 21-item Hamilton Rating Scale for Depression scores. Raters anticipated that the scale might be less effective in distinguishing negative from depressive symptoms, and, in fact, the results here may reflect that clinical reality. Multiple lines of evidence support the

  16. Dynamic Performance Characteristic Tests of Real Scale Lead Rubber Bearing for the Evaluation of Performance Criteria

    International Nuclear Information System (INIS)

    Kim, Min Kyu; Kim, Jung-Han; Choi, In-Kil

    2014-01-01

    Dynamic characteristic tests of full scale lead rubber bearing were performed for the evaluation of performance criteria of isolation system for nuclear power plants. For the dynamic test for a full scale rubber bearing, two 1500mm diameter lead rubber bearings were manufactured. The viewpoints of this dynamic test are determination of an ultimate shear strain level of lead rubber bearing, behavior of rubber bearing according to static and dynamic input motion, sinusoidal and random (earthquake) motion, and 1-dimentional and 2-dimensional input motion. In this study, seismic isolation device tests were performed for the evaluation of performance criteria of isolation system. Through this test, it can be recognized that in the case of considering a mechanical property test, dynamic and multi degree of loading conditions should be determined. But these differences should be examined how much affect to the global structural behavior

  17. Indicators of suboptimal performance embedded in the Wechsler Memory Scale-Fourth Edition (WMS-IV).

    Science.gov (United States)

    Bouman, Zita; Hendriks, Marc P H; Schmand, Ben A; Kessels, Roy P C; Aldenkamp, Albert P

    2016-01-01

    Recognition and visual working memory tasks from the Wechsler Memory Scale-Fourth Edition (WMS-IV) have previously been documented as useful indicators for suboptimal performance. The present study examined the clinical utility of the Dutch version of the WMS-IV (WMS-IV-NL) for the identification of suboptimal performance using an analogue study design. The patient group consisted of 59 mixed-etiology patients; the experimental malingerers were 50 healthy individuals who were asked to simulate cognitive impairment as a result of a traumatic brain injury; the last group consisted of 50 healthy controls who were instructed to put forth full effort. Experimental malingerers performed significantly lower on all WMS-IV-NL tasks than did the patients and healthy controls. A binary logistic regression analysis was performed on the experimental malingerers and the patients. The first model contained the visual working memory subtests (Spatial Addition and Symbol Span) and the recognition tasks of the following subtests: Logical Memory, Verbal Paired Associates, Designs, Visual Reproduction. The results showed an overall classification rate of 78.4%, and only Spatial Addition explained a significant amount of variation (p < .001). Subsequent logistic regression analysis and receiver operating characteristic (ROC) analysis supported the discriminatory power of the subtest Spatial Addition. A scaled score cutoff of <4 produced 93% specificity and 52% sensitivity for detection of suboptimal performance. The WMS-IV-NL Spatial Addition subtest may provide clinically useful information for the detection of suboptimal performance.

  18. Effects of Clinical Mastitis on Reproductive Performance in Holstein Cows

    OpenAIRE

    A. Gunay; U. Gunay

    2008-01-01

    The objective of this study was to determine the effects of clinical mastitis on reproductive performance in 135 early lactation cows. The animals were divided into two groups according to the occurrence of mastitis as follows: group I (n = 45), clinical mastitis prior to the first artificial insemination breeding; group II (n = 45), clinical mastitis after artificial insemination and being diagnosed pregnant. Forty-five cows without any mastitis served as control group. Calving to first serv...

  19. Electrostatic direct energy converter performance and cost scaling laws

    International Nuclear Information System (INIS)

    Hoffman, M.A.

    1977-08-01

    This study is concerned with electrostatic type direct energy converters for direct recovery of a large fraction of the plasma ion energy from fusion reactors. Simplified equations are presented for each of the important loss mechanisms in both single-stage direct converters and multistage ''Venetian Blind'' type direct converters. These equations can be used to estimate the efficiency and electric power output of the direct converter subsystem. Scaling relations for the cost of each major component in the direct converter subsystem are also given; these include the vacuum tank, direct converter modules, the DC power conditioning equipment, cryogenic vacuum pumping system and the thermal bottoming plant. The performance and cost scaling laws have been developed primarily for use in overall fusion power plant systems codes. However, to illustrate their utility, cost-effectiveness studies of two specific reference direct converter designs are presented in terms of the specific capital costs (i.e., the capital cost per unit electric power produced) for the Direct Converter Subsystem alone. Some examples of design improvements which can significantly reduce the specific capital costs of the Direct Converter Subsystem are also given

  20. Introducing a performance-based objective clinical examination into ...

    African Journals Online (AJOL)

    Purpose: To describe how a formative Objective Structured Clinical Examination was applied to fourth year pharmacy students at a university in Northern Cyprus. Methods: A blueprint-guided performance-based objective clinical examination was implemented. Group-prepared case scenarios based on course objectives ...

  1. Quantifying and visualizing site performance in clinical trials

    Directory of Open Access Journals (Sweden)

    Eric Yang

    2018-03-01

    Conclusions: The use of operational data from Covance Central Laboratories provides a unique perspective into the performance of clinical sites with respect to many important metrics such as patient enrollment and retention. These metrics can, in turn, be used to guide operational planning and site selection for new clinical trials, thereby accelerating recruitment, improving quality, and reducing cost.

  2. Learning strategies during clerkships and their effects on clinical performance.

    Science.gov (United States)

    van Lohuizen, M T; Kuks, J B M; van Hell, E A; Raat, A N; Cohen-Schotanus, J

    2009-11-01

    Previous research revealed relationships between learning strategies and knowledge acquisition. During clerkships, however, students' focus widens beyond mere knowledge acquisition as they further develop overall competence. This shift in focus can influence learning strategy use. We explored which learning strategies were used during clerkships and their relationship to clinical performance. Participants were 113 (78%) clerks at the university hospital or one of six affiliated hospitals. Learning strategies were assessed using the 'Approaches to Learning at Work Questionnaire' (deep, surface-rational and surface-disorganised learning). Clinical performance was calculated by taking the mean of clinical assessment marks. The relationship between learning strategies and clinical performance was explored using regression analysis. Most students (89%) did not clearly prefer a single learning strategy. No relationship was found between learning strategies and clinical performance. Since overall competence comprises integration of knowledge, skills and professional behaviour, we assume that students without a clear preference use more than one learning strategy. Finding no relationship between learning strategies and clinical performance reflects the complexity of clinical learning. Depending on circumstances it may be important to obtain relevant information quickly (surface-rational) or understand material thoroughly (deep). In future research we will examine when and why students use different learning strategies.

  3. Disclosure of investigators' recruitment performance in multicenter clinical trials

    DEFF Research Database (Denmark)

    Dal-Ré, Rafael; Moher, David; Gluud, Christian

    2011-01-01

    Rafael Dal-Ré and colleagues argue that the recruitment targets and performance of all site investigators in multi-centre clinical trials should be disclosed in trial registration sites before a trial starts, and when it ends.......Rafael Dal-Ré and colleagues argue that the recruitment targets and performance of all site investigators in multi-centre clinical trials should be disclosed in trial registration sites before a trial starts, and when it ends....

  4. A leprosy clinical severity scale for erythema nodosum leprosum: An international, multicentre validation study of the ENLIST ENL Severity Scale.

    Science.gov (United States)

    Walker, Stephen L; Sales, Anna M; Butlin, C Ruth; Shah, Mahesh; Maghanoy, Armi; Lambert, Saba M; Darlong, Joydeepa; Rozario, Benjamin Jewel; Pai, Vivek V; Balagon, Marivic; Doni, Shimelis N; Hagge, Deanna A; Nery, José A C; Neupane, Kapil D; Baral, Suwash; Sangma, Biliom A; Alembo, Digafe T; Yetaye, Abeba M; Hassan, Belaynesh A; Shelemo, Mohammed B; Nicholls, Peter G; Lockwood, Diana N J

    2017-07-01

    We wished to validate our recently devised 16-item ENLIST ENL Severity Scale, a clinical tool for measuring the severity of the serious leprosy associated complication of erythema nodosum leprosum (ENL). We also wished to assess the responsiveness of the ENLIST ENL Severity Scale in detecting clinical change in patients with ENL. Participants, recruited from seven centres in six leprosy endemic countries, were assessed using the ENLIST ENL Severity Scale by two researchers, one of whom categorised the severity of ENL. At a subsequent visit a further assessment using the scale was made and both participant and physician rated the change in ENL using the subjective categories of "Much better", "somewhat better", "somewhat worse" and "much worse" compared with "No change" or "about the same". 447 participants were assessed with the ENLIST ENL Severity Scale. The Cronbach alpha of the scale and each item was calculated to determine the internal consistency of the scale. The ENLIST ENL Severity Scale had good internal consistency and this improved following removal of six items to give a Cronbach's alpha of 0.77. The cut off between mild ENL and more severe disease was 9 determined using ROC curves. The minimal important difference of the scale was determined to be 5 using both participant and physician ratings of change. The 10-item ENLIST ENL Severity Scale is the first valid, reliable and responsive measure of ENL severity and improves our ability to assess and compare patients and their treatments in this severe and difficult to manage complication of leprosy. The ENLIST ENL Severity Scale will assist physicians in the monitoring and treatment of patients with ENL. The ENLIST ENL Severity Scale is easy to apply and will be useful as an outcome measure in treatment studies and enable the standardisation of other clinical and laboratory ENL research.

  5. DEVELOPING OF INDIVIDUAL INSTRUMENT PERFORMANCE ANXIETY SCALE: VALIDITY - RELIABILITY STUDY

    Directory of Open Access Journals (Sweden)

    Esra DALKIRAN

    2014-07-01

    Full Text Available The purpose of this study is to develop a scale unique to our culture, concerning  individual instrument performance anxiety of the students  who are getting instrument training  in the Department of Music Education. In the study, the descriptive research model is used and qualitative research techniques are utilized. The study population consists of the students attending the 23 universities which has Music Education Department. The sample of the study consists of 438 girls and 312 boys, totally 750 students  who are studying in the Department of Music Education of randomly selected 10 universities. As a result of the explanatory and confirmatory factor analyses that were performed, a one-dimensional structure consisting of 14 items was obtained. Also, t-scores and  the coefficient scores of total item correlation concerning the distinguishing power of the items, the difference in the scores of the set of lower and upper 27% was calculated, and it was observed that the items are distinguishing as a result of both analyses. Of the scale, Cronbach's alpha coefficient of internal consistency was calculated as .94, and test-retest reliability coefficient was calculated as .93. As a result, a valid and reliable assessment and evaluation instrument that measures the exam performance anxiety of the students studying in the Department of Music Education, has been developed.Extended AbstractsIntroductionAnxiety is a universal phenomenon which people experience once or a few times during lives. It was accepted as concern for the future or as an unpleasant emotional experience regarding probable hitches of the events (Di Tomasso & Gosch, 2002.In general, the occasions on which negative feelings are experienced cause anxiety to arise (Baltaş and Baltaş, 2000. People also feel anxious in dangerous situations. Anxiety may lead a person to be creative, while it may have hindering characteristics. Anxiety is that an individual considers him

  6. Improvements in cognition, quality of life, and physical performance with clinical Pilates in multiple sclerosis: a randomized controlled trial

    OpenAIRE

    K???k, Fadime; Kara, Bilge; Poyraz, Esra ?o?kuner; ?diman, Egemen

    2016-01-01

    [Purpose] The aim of this study was to determine the effects of clinical Pilates in multiple sclerosis patients. [Subjects and Methods] Twenty multiple sclerosis patients were enrolled in this study. The participants were divided into two groups as the clinical Pilates and control groups. Cognition (Multiple Sclerosis Functional Composite), balance (Berg Balance Scale), physical performance (timed performance tests, Timed up and go test), tiredness (Modified Fatigue Impact scale), depression ...

  7. Evaluating students' perception of their clinical placements - testing the clinical learning environment and supervision and nurse teacher scale (CLES + T scale) in Germany.

    Science.gov (United States)

    Bergjan, Manuela; Hertel, Frank

    2013-11-01

    Clinical nursing education in Germany has not received attention in nursing science and practice for a long time, as it often seems to be a more or less "formalized appendix" of nursing education. Several development projects of clinical education taking place are mainly focused on the qualification of clinical preceptors. However, the clinical context and its influence on learning processes have still not been sufficiently investigated. The aim of this study was the testing of a German version of the clinical learning environment and supervision and nurse teacher scale (CLES + T scale). The sample of the pilot study consists of first-, second- and third-year student nurses (n=240) of a university nursing school from January to March 2011. Psychometric testing of the instrument is carried out by selected methods of classical testing theories using SPPS 19. The results show transferability of all subcategories of the CLES + T scale in the non-academic nursing education system of a university hospital in Germany, without the teacher scale. The strongest factor is "supervisory relationship". The German version of the CLES + T scale may help to evaluate and compare traditional and new models in clinical nursing education. Copyright © 2012 Elsevier Ltd. All rights reserved.

  8. Monitoring worksite clinic performance using a cost-benefit tool.

    Science.gov (United States)

    Tao, Xuguang; Chenoweth, David; Alfriend, Amy S; Baron, David M; Kirkland, Tracie W; Scherb, Jill; Bernacki, Edward J

    2009-10-01

    The purpose of this study was to explore the usefulness of continuously assessing the return on investment (ROI) of worksite medical clinics as a means of evaluating clinic performance. Visit data from January 1, 2007, to December 31, 2008, were collected from all the on-site clinics operated for the Pepsi Bottling Group. An average system-wide ROI was calculated from the time of each clinic's opening and throughout the study period. A multivariate linear regression model was used to determine the association of average ROI with penetration/utilization rate and plant size. A total of 26 on-site clinics were actively running as of December 2008. The average ROI at the time of start up was 0.4, which increased to 1.2 at approximately 4 months and 1.6 at the end of the first year of operation. Overall, it seems that the cost of operating a clinic becomes equal to the cost of similar care purchased in the community (ROI = 1) at approximately 3 months after a clinic's opening and flattens out at the end of the first year. The magnitude of the ROI was closely related to the number of visits (a function of the penetration/utilization rate) and the size of the plant population served. Serial monitoring of ROIs is a useful metric in assessing on-site clinic performance and quantifying the effect of new initiatives aimed at increasing a clinic's cost effectiveness.

  9. Effects of Isometric Scaling on Vertical Jumping Performance

    Science.gov (United States)

    Bobbert, Maarten F.

    2013-01-01

    Jump height, defined as vertical displacement in the airborne phase, depends on vertical takeoff velocity. For centuries, researchers have speculated on how jump height is affected by body size and many have adhered to what has come to be known as Borelli’s law, which states that jump height does not depend on body size per se. The underlying assumption is that the amount of work produced per kg body mass during the push-off is independent of size. However, if a big body is isometrically downscaled to a small body, the latter requires higher joint angular velocities to achieve a given takeoff velocity and work production will be more impaired by the force-velocity relationship of muscle. In the present study, the effects of pure isometric scaling on vertical jumping performance were investigated using a biologically realistic model of the human musculoskeletal system. The input of the model, muscle stimulation over time, was optimized using jump height as criterion. It was found that when the human model was miniaturized to the size of a mouse lemur, with a mass of about one-thousandth that of a human, jump height dropped from 40 cm to only 6 cm, mainly because of the force-velocity relationship. In reality, mouse lemurs achieve jump heights of about 33 cm. By implication, the unfavourable effects of the small body size of mouse lemurs on jumping performance must be counteracted by favourable effects of morphological and physiological adaptations. The same holds true for other small jumping animals. The simulations for the first time expose and explain the sheer magnitude of the isolated effects of isometric downscaling on jumping performance, to be counteracted by morphological and physiological adaptations. PMID:23936494

  10. Effects of isometric scaling on vertical jumping performance.

    Directory of Open Access Journals (Sweden)

    Maarten F Bobbert

    Full Text Available Jump height, defined as vertical displacement in the airborne phase, depends on vertical takeoff velocity. For centuries, researchers have speculated on how jump height is affected by body size and many have adhered to what has come to be known as Borelli's law, which states that jump height does not depend on body size per se. The underlying assumption is that the amount of work produced per kg body mass during the push-off is independent of size. However, if a big body is isometrically downscaled to a small body, the latter requires higher joint angular velocities to achieve a given takeoff velocity and work production will be more impaired by the force-velocity relationship of muscle. In the present study, the effects of pure isometric scaling on vertical jumping performance were investigated using a biologically realistic model of the human musculoskeletal system. The input of the model, muscle stimulation over time, was optimized using jump height as criterion. It was found that when the human model was miniaturized to the size of a mouse lemur, with a mass of about one-thousandth that of a human, jump height dropped from 40 cm to only 6 cm, mainly because of the force-velocity relationship. In reality, mouse lemurs achieve jump heights of about 33 cm. By implication, the unfavourable effects of the small body size of mouse lemurs on jumping performance must be counteracted by favourable effects of morphological and physiological adaptations. The same holds true for other small jumping animals. The simulations for the first time expose and explain the sheer magnitude of the isolated effects of isometric downscaling on jumping performance, to be counteracted by morphological and physiological adaptations.

  11. Automating Performance Measures and Clinical Practice Guidelines: Differences and Complementarities.

    Science.gov (United States)

    Tu, Samson W; Martins, Susana; Oshiro, Connie; Yuen, Kaeli; Wang, Dan; Robinson, Amy; Ashcraft, Michael; Heidenreich, Paul A; Goldstein, Mary K

    2016-01-01

    Through close analysis of two pairs of systems that implement the automated evaluation of performance measures (PMs) and guideline-based clinical decision support (CDS), we contrast differences in their knowledge encoding and necessary changes to a CDS system that provides management recommendations for patients failing performance measures. We trace the sources of differences to the implementation environments and goals of PMs and CDS.

  12. Clinical utility of the Wechsler Adult Intelligence Scale-Fourth Edition after traumatic brain injury.

    Science.gov (United States)

    Donders, Jacobus; Strong, Carrie-Ann H

    2015-02-01

    The performance of 100 patients with traumatic brain injury (TBI) on the Wechsler Adult Intelligence Scale-Fourth Edition (WAIS-IV) was compared with that of 100 demographically matched neurologically healthy controls. Processing Speed was the only WAIS-IV factor index that was able to discriminate between persons with moderate-severe TBI on the one hand and persons with either less severe TBI or neurologically healthy controls on the other hand. The Processing Speed index also had acceptable sensitivity and specificity when differentiating between patients with TBI who either did or did not have scores in the clinically significant range on the Trail Making Test. It is concluded that WAIS-IV Processing Speed has acceptable clinical utility in the evaluation of patients with moderate-severe TBI but that it should be supplemented with other measures to assure sufficient accuracy in the diagnostic process. © The Author(s) 2014.

  13. The Dutch Social Interaction Anxiety Scale and the Social Phobia Scale: Reliability, Validity, and Clinical Utility

    OpenAIRE

    de Beurs, Edwin; Tielen, Deirdre; Wollmann, Lisa

    2014-01-01

    The social interaction anxiety scale (SIAS) and the social phobia scale (SPS) assess anxiety in social interactions and fear of scrutiny by others. This study examines the psychometric properties of the Dutch versions of the SIAS and SPS using data from a large group of patients with social phobia and a community-based sample. Confirmatory factor analysis revealed that the SIAS is unidimensional, whereas the SPS is comprised of three subscales. The internal consistency of the scales and subsc...

  14. Relationship Between the Functional Status Scale and the Pediatric Overall Performance Category and Pediatric Cerebral Performance Category Scales FREE

    Science.gov (United States)

    Pollack, Murray M.; Holubkov, Richard; Funai, Tomohiko; Clark, Amy; Moler, Frank; Shanley, Thomas; Meert, Kathy; Newth, Christopher J. L.; Carcillo, Joseph; Berger, John T.; Doctor, Allan; Berg, Robert A.; Dalton, Heidi; Wessel, David L.; Harrison, Rick E.; Dean, J. Michael; Jenkins, Tammara L.

    2015-01-01

    Importance Functional status assessment methods are important as outcome measures for pediatric critical care studies. Objective To investigate the relationships between the 2 functional status assessment methods appropriate for large-sample studies, the Functional Status Scale (FSS) and the Pediatric Overall Performance Category and Pediatric Cerebral Performance Category (POPC/PCPC) scales. Design, Setting, and Participants Prospective cohort study with random patient selection at 7 sites and 8 children’s hospitals with general/medical and cardiac/cardiovascular pediatric intensive care units (PICUs) in the Collaborative Pediatric Critical Care Research Network. Participants included all PICU patients younger than 18 years. Main Outcomes and Measures Functional Status Scale and POPC/PCPC scores determined at PICU admission (baseline) and PICU discharge. We investigated the association between the baseline and PICU discharge POPC/PCPC scores and the baseline and PICU discharge FSS scores, the dispersion of FSS scores within each of the POPC/PCPC ratings, and the relationship between the FSS neurologic components (FSS-CNS) and the PCPC. Results We included 5017 patients. We found a significant (P < .001) difference between FSS scores in each POPC or PCPC interval, with an FSS score increase with each worsening POPC/PCPC rating. The FSS scores for the good and mild disability POPC/PCPC ratings were similar and increased by 2 to 3 points for the POPC/PCPC change from mild to moderate disability, 5 to 6 points for moderate to severe disability, and 8 to 9 points for severe disability to vegetative state or coma. The dispersion of FSS scores within each POPC and PCPC rating was substantial and increased with worsening POPC and PCPC scores. We also found a significant (P < .001) difference between the FSS-CNS scores between each of the PCPC ratings with increases in the FSS-CNS score for each higher PCPC rating. Conclusions and Relevance The FSS and POPC/PCPC system

  15. Large scale implementation of clinical medication reviews in Dutch community pharmacies: Drug-related problems and interventions

    NARCIS (Netherlands)

    Kempen, Thomas G. H.; Van De Steeg-Van Gompel, Caroline H. P. A.; Hoogland, Petra; Liu, Yuqian; Bouvy, Marcel L.

    2014-01-01

    Background: Research on the benefits of clinical medication reviews (CMRs) performed by pharmacists has been conducted mostly in controlled settings and has been widely published. Less is known of the effects after large scale implementation in community pharmacies. An online CMR tool enabled the

  16. Concurrent Validity of the Millon Clinical Multiaxial Inventory Depression Scales.

    Science.gov (United States)

    Goldberg, Joel O.; And Others

    1987-01-01

    Compared two new measures of depression (Millon Multiaxial Inventory Dysthymia and Major Depression subscales) with two established instruments: Beck Depression Inventory, a self-report measure which emphasizes the cognitive-affective aspects of depression, and Hamilton Rating Scale for Depression, an interview measure that emphasizes somatic…

  17. Examination of Racial Differences on the MMPI-2 Clinical and Restructured Clinical Scales in an Outpatient Sample

    Science.gov (United States)

    Castro, Yessenia; Gordon, Kathryn H.; Brown, Jessica S.; Anestis, Joye C.; Joiner, Thomas E., Jr.

    2008-01-01

    The current study examined the possibility of differential predictive accuracy of selected Minnesota Multiphasic Personality Inventory-Second Edition (MMPI-2) clinical and Restructured Clinical (RC) scales in a group of Black and White mental health center clients. Results indicate that Black clients scored higher than White clients on one…

  18. Calculating Clinically Significant Change: Applications of the Clinical Global Impressions (CGI) Scale to Evaluate Client Outcomes in Private Practice

    Science.gov (United States)

    Kelly, Peter James

    2010-01-01

    The Clinical Global Impressions (CGI) scale is a therapist-rated measure of client outcome that has been widely used within the research literature. The current study aimed to develop reliable and clinically significant change indices for the CGI, and to demonstrate its application in private psychological practice. Following the guidelines…

  19. Validation of SCALE code package on high performance neutron shields

    International Nuclear Information System (INIS)

    Bace, M.; Jecmenica, R.; Smuc, T.

    1999-01-01

    The shielding ability and other properties of new high performance neutron shielding materials from the KRAFTON series have been recently published. A comparison of the published experimental and MCNP results for the two materials of the KRAFTON series, with our own calculations has been done. Two control modules of the SCALE-4.4 code system have been used, one of them based on one dimensional radiation transport analysis (SAS1) and other based on the three dimensional Monte Carlo method (SAS3). The comparison of the calculated neutron dose equivalent rates shows a good agreement between experimental and calculated results for the KRAFTON-N2 material.. Our results indicate that the N2-M-N2 sandwich type is approximately 10% inferior as neutron shield to the KRAFTON-N2 material. All values of neutron dose equivalent obtained by SAS1 are approximately 25% lower in comparison with the SAS3 results, which indicates proportions of discrepancies introduced by one-dimensional geometry approximation.(author)

  20. Barriers to using eHealth data for clinical performance feedback in Malawi: A case study.

    Science.gov (United States)

    Landis-Lewis, Zach; Manjomo, Ronald; Gadabu, Oliver J; Kam, Matthew; Simwaka, Bertha N; Zickmund, Susan L; Chimbwandira, Frank; Douglas, Gerald P; Jacobson, Rebecca S

    2015-10-01

    Sub-optimal performance of healthcare providers in low-income countries is a critical and persistent global problem. The use of electronic health information technology (eHealth) in these settings is creating large-scale opportunities to automate performance measurement and provision of feedback to individual healthcare providers, to support clinical learning and behavior change. An electronic medical record system (EMR) deployed in 66 antiretroviral therapy clinics in Malawi collects data that supervisors use to provide quarterly, clinic-level performance feedback. Understanding barriers to provision of eHealth-based performance feedback for individual healthcare providers in this setting could present a relatively low-cost opportunity to significantly improve the quality of care. The aims of this study were to identify and describe barriers to using EMR data for individualized audit and feedback for healthcare providers in Malawi and to consider how to design technology to overcome these barriers. We conducted a qualitative study using interviews, observations, and informant feedback in eight public hospitals in Malawi where an EMR system is used. We interviewed 32 healthcare providers and conducted seven hours of observation of system use. We identified four key barriers to the use of EMR data for clinical performance feedback: provider rotations, disruptions to care processes, user acceptance of eHealth, and performance indicator lifespan. Each of these factors varied across sites and affected the quality of EMR data that could be used for the purpose of generating performance feedback for individual healthcare providers. Using routinely collected eHealth data to generate individualized performance feedback shows potential at large-scale for improving clinical performance in low-resource settings. However, technology used for this purpose must accommodate ongoing changes in barriers to eHealth data use. Understanding the clinical setting as a complex adaptive

  1. Impact of stress on dentists' clinical performance. A systematic review.

    Science.gov (United States)

    Plessas, A; Delgado, M B; Nasser, M; Hanoch, Y; Moles, D R

    2018-03-01

    Dentistry is recognised as a stressful profession and dentists perceive their profession to be more stressful than other healthcare professions. While earlier studies have shown a link between stress and well-being among dentists, whether stress negatively impacts their clinical performance is an important and open question. We do know, however, that stress is associated with reduced performance in other health (and non-health) related professions. This systematic review aimed to answer the question: how does stress impact on dentists' clinical performance? This systematic review was registered in PROSPERO (CRD42016045756). The CINHAL, Embase, Medline, PsycINFO, EThOS and OpenGrey electronic databases were searched according to PRISMA guidelines. Two reviewers independently screened the citations for relevance. The citation list of potentially eligible papers was also searched. Prospective empirical studies were considered for inclusion. The inclusion criteria were applied at the full-text stage by the two same reviewers independently. The search yielded 3535 titles and abstracts. Twelve publications were considered potentially eligible, eleven of which were excluded as they did not meet the predefined inclusion criteria. This systematic review identified a gap in the literature as it found no empirical evidence quantifying the impact of stress on dentists' clinical performance. Prospective well-designed experimental simulation studies, comparing stress with non-stress situations on clinical performance and decision making, as well studies evaluating prospectively real-life dentists' performance under stress are warranted. Copyright© 2018 Dennis Barber Ltd.

  2. Study of the Relationship Between Nurse Self-Concept and Clinical Performance Among Nursing Students

    Directory of Open Access Journals (Sweden)

    Badiyepeymaie Jahromi

    2015-09-01

    Full Text Available Background Scholars believe that if nursing students appreciate the value of their services, their sense of professionalism will increase and performance will improve. Nevertheless, little is known about the relationship between nursing students’ professional self-concept and clinical performance. Objectives This study examines the relationship between nurse self-concept and clinical performance among nursing students. Patients and Methods This cross-sectional analytical study employed the census method. The sample comprised 86 senior and junior nursing students at Jahrom university of medical sciences. Nurse self-concept and clinical performance were measured by using the nurses’ self-concept questionnaire (NSCQ, and the 6-dimension scale of nurse performance (6-DSNP, respectively. Results The mean and standard deviation of nurse self-concept and clinical performance scores were 5.46 ± 1.11 and 2.94 ± 1.45, respectively. Nurse self-concept was related to clinical performance (r = 0.24, P = 0.02. Total NSCQ scores were significantly related to four of the 6-DSNP dimensions: planning and evaluation, interpersonal relations and communication, critical care, and leadership. Conclusions Attempts should be made to enhance students’ nurse self-concept during their education. Counseling, improving public respect for nurses, and implementing measures to enhance students’ professional self-concept are essential for improving their performance.

  3. Emotional intelligence and clinical performance/retention of nursing students

    Science.gov (United States)

    Marvos, Chelsea; Hale, Frankie B.

    2015-01-01

    Objective: This exploratory, quantitative, descriptive study was undertaken to explore the relationship between clinical performance and anticipated retention in nursing students. Methods: After approval by the university's Human Subjects Committee, a sample of 104 nursing students were recruited for this study, which involved testing with a valid and reliable emotional intelligence (EI) instrument and a self-report survey of clinical competencies. Results: Statistical analysis revealed that although the group average for total EI score and the 6 score subsets were in the average range, approximately 30% of the individual total EI scores and 30% of two branch scores, identifying emotions correctly and understanding emotions, fell in the less than average range. This data, as well as the analysis of correlation with clinical self-report scores, suggest recommendations applicable to educators of clinical nursing students. Conclusions: Registered nurses make-up the largest segment of the ever-growing healthcare workforce. Yet, retention of new graduates has historically been a challenge for the profession. Given the projected employment growth in nursing, it is important to identify factors which correlate with high levels of performance and job retention among nurses. There is preliminary evidence that EI a nontraditional intelligence measure relates positively not only with retention of clinical staff nurses, but with overall clinical performance as well. PMID:27981096

  4. Emotional intelligence and clinical performance/retention of nursing students

    Directory of Open Access Journals (Sweden)

    Chelsea Marvos

    2015-01-01

    Full Text Available Objective: This exploratory, quantitative, descriptive study was undertaken to explore the relationship between clinical performance and anticipated retention in nursing students. Methods: After approval by the university′s Human Subjects Committee, a sample of 104 nursing students were recruited for this study, which involved testing with a valid and reliable emotional intelligence (EI instrument and a self-report survey of clinical competencies. Results: Statistical analysis revealed that although the group average for total EI score and the 6 score subsets were in the average range, approximately 30% of the individual total EI scores and 30% of two branch scores, identifying emotions correctly and understanding emotions, fell in the less than average range. This data, as well as the analysis of correlation with clinical self-report scores, suggest recommendations applicable to educators of clinical nursing students. Conclusions: Registered nurses make-up the largest segment of the ever-growing healthcare workforce. Yet, retention of new graduates has historically been a challenge for the profession. Given the projected employment growth in nursing, it is important to identify factors which correlate with high levels of performance and job retention among nurses. There is preliminary evidence that EI "a nontraditional intelligence measure" relates positively not only with retention of clinical staff nurses, but with overall clinical performance as well.

  5. Quantifying and visualizing site performance in clinical trials.

    Science.gov (United States)

    Yang, Eric; O'Donovan, Christopher; Phillips, JodiLyn; Atkinson, Leone; Ghosh, Krishnendu; Agrafiotis, Dimitris K

    2018-03-01

    One of the keys to running a successful clinical trial is the selection of high quality clinical sites, i.e., sites that are able to enroll patients quickly, engage them on an ongoing basis to prevent drop-out, and execute the trial in strict accordance to the clinical protocol. Intuitively, the historical track record of a site is one of the strongest predictors of its future performance; however, issues such as data availability and wide differences in protocol complexity can complicate interpretation. Here, we demonstrate how operational data derived from central laboratory services can provide key insights into the performance of clinical sites and help guide operational planning and site selection for new clinical trials. Our methodology uses the metadata associated with laboratory kit shipments to clinical sites (such as trial and anonymized patient identifiers, investigator names and addresses, sample collection and shipment dates, etc.) to reconstruct the complete schedule of patient visits and derive insights about the operational performance of those sites, including screening, enrollment, and drop-out rates and other quality indicators. This information can be displayed in its raw form or normalized to enable direct comparison of site performance across studies of varied design and complexity. Leveraging Covance's market leadership in central laboratory services, we have assembled a database of operational metrics that spans more than 14,000 protocols, 1400 indications, 230,000 unique investigators, and 23 million patient visits and represents a significant fraction of all clinical trials run globally in the last few years. By analyzing this historical data, we are able to assess and compare the performance of clinical investigators across a wide range of therapeutic areas and study designs. This information can be aggregated across trials and geographies to gain further insights into country and regional trends, sometimes with surprising results. The

  6. Quantifying and visualizing site performance in clinical trials

    OpenAIRE

    Eric Yang; Christopher O'Donovan; JodiLyn Phillips; Leone Atkinson; Krishnendu Ghosh; Dimitris K. Agrafiotis

    2018-01-01

    Background: One of the keys to running a successful clinical trial is the selection of high quality clinical sites, i.e., sites that are able to enroll patients quickly, engage them on an ongoing basis to prevent drop-out, and execute the trial in strict accordance to the clinical protocol. Intuitively, the historical track record of a site is one of the strongest predictors of its future performance; however, issues such as data availability and wide differences in protocol complexity can co...

  7. Elevation discrepancies between MMPI-2 clinical and MMPI-2-RF restructured clinical (RC) scales in people with seizure disorders.

    Science.gov (United States)

    Bowden, Stephen C; White, Jessica R; Simpson, Leonie; Ben-Porath, Yossef S

    2014-05-01

    People with seizure disorders experience elevated rates of psychopathology, often undiagnosed and untreated. Accurate diagnosis of psychopathology remains an important goal of quality health care for people with seizure disorders. One of the most widely used dimensional measures of psychopathology is the Minnesota Multiphasic Personality Inventory-Second Edition (MMPI-2). Research in heterogeneous mental health samples suggests that the 2008 revision of this measure, the Minnesota Multiphasic Personality Inventory-Second Edition-Restructured Form (MMPI-2-RF), offers better construct fidelity and more cost-effective administration. This study seeks to extend research on MMPI-2-RF scale elevations to a sample of people with seizure disorders. In a consecutive, heterogeneous sample of people with seizure disorders, MMPI-2 and MMPI-2-RF scores were compared in terms of categorical classification agreement (clinically elevated versus not clinically elevated). Scores were also compared in terms of variance attributable to diagnosis-specific items, general demoralization, subtle items, social desirability, and demographic factors. Scores on MMPI-2 and MMPI-2-RF provided a statistically significant level of agreement between corresponding clinical diagnostic scales ranging from 68% to 84%. Most classification disagreement was attributable to MMPI-2 clinical scale elevations when MMPI-2-RF scales were not elevated. Regression analysis supported the interpretation that general demoralization, subtle items, social desirability, and demographic factors led to MMPI-2 clinical scale elevations. The results provide evidence that in the context of strong psychopathology classification agreement, the MMPI-2-RF restructured clinical scales provide better construct fidelity compared with the more trait heterogeneous MMPI-2 clinical scales. These results should encourage clinicians to use the MMPI-2 Restructured Form (MMPI-2-RF) for improved psychopathology assessment compared with

  8. Validation of the clinical dehydration scale for children with acute gastroenteritis.

    Science.gov (United States)

    Goldman, Ran D; Friedman, Jeremy N; Parkin, Patricia C

    2008-09-01

    We previously created a clinical dehydration scale. Our objective was to validate the clinical dehydration scale with a new cohort of patients with acute gastroenteritis who were assessed in a tertiary emergency department in a developed country. A prospective observational study was performed in an emergency department at a large pediatric tertiary center in Canada. Children 1 month to 5 years of age with symptoms of acute gastroenteritis who were assessed in the emergency department were enrolled consecutively during a 4-month period. The main outcome measures were length of stay, proportion of children receiving intravenous fluid rehydration, and proportions of children with abnormal serum pH values or bicarbonate levels. A total of 205 children were enrolled, with a mean age of 22.4 +/- 14.9 months; 103 (50%) were male. The distribution of severity categories was as follows: no dehydration (score of 0), n = 117 (57%); some dehydration (score of 1-4), n = 83 (41%); moderate/severe dehydration (score of 5-8), n = 5 (2%). The 3 dehydration categories were significantly different with respect to the validation hypotheses (length of stay, mean +/- SD: none, 245 +/- 181 minutes; some, 397 +/- 302 minutes; moderate/severe, 501 +/- 389 minutes; treatment with intravenous fluids: none, n =17, 15%; some, n = 41, 49%; moderate/severe, n = 4, 80%; number of vomiting episodes in the 7 days before the emergency department visit: none, 8.4 +/- 7.7 episodes; some, 13 +/- 10.7 episodes; moderate/severe, 30.2 +/- 14.8 episodes). The clinical dehydration scale and the 3 severity categories were valid for a prospectively enrolled cohort of patients who were assessed in our tertiary emergency department. The scoring system was valuable in predicting a longer length of stay and the need for intravenous fluid rehydration for children with symptoms of acute gastroenteritis.

  9. A clinical and SEM evaluation of the efficiency of sofscale gel and hand scaling and hand scaling alone.

    Science.gov (United States)

    Thomas, K; Vandana, K L; Reddy, V Ramesh

    2002-01-01

    The purpose of this study is to compose between hand scaling with abd without the calculus solvent gel (sofscale) and ultrasonic instrumentation at clinical and SEM level. 30 patients belonging to the age group of 17-50 year were selected. Patients selected were subjected to three different scaling modalities namely hand scaling (control), hand scaling using sofscale (Experimental quadrant A) and ultrasonic scaling (Experimental quadrant B), in three different quadrants. Case report forms were used to document the tooth sensitivity, soft tissue pain after scaling, patient preference of instrumentation, ease of calculus removal, patient comfort, soft tissue irritation, time taken for scaling, Bleeding while scaling, pre and post operative sulcus bleeding index. In addition to the clinical criteria, the teeth treated were extracted and evaluated using the scanning electron microscope to show potential effects on cemntal surfaces. No difference in tooth sensitivity was appreciated between control and experimental quadrant A. There was a higher degree of tooth sensitivity when treated with ultrasonic. Patients in control group appreciated a higher degree of soft tissue pain. Hand scaling using softscale produced a lesser amount of pain and treatment with ultrasoincs was the least painful. Most of the patients preferred ultrasonic scaling (70%) Calculus removal was easier. Hand scaling using sofscale gel results in more patient comfort when compared to hand scaling alone. There was no significant difference in patient comfort between handscaling using sofscale and ultrasonic scaling. The percentage of reduction of sulcus bleeding index showed no difference between the 3 scaling modalities SEM evaluation revealed that there was no significant difference the 3 scaling modalities in relation to residual calculus, cleaning efficiency and damage to the root surface. This study concluded that treatment with sofscale gel appears to be safe and effective method for removal

  10. Sustained effect of simulation-based ultrasound training on clinical performance: a randomized trial

    Science.gov (United States)

    Tolsgaard, M G; Ringsted, C; Dreisler, E; Nørgaard, L N; Petersen, J H; Madsen, M E; Freiesleben, N L C; Sørensen, J L; Tabor, A

    2015-01-01

    Objective To study the effect of initial simulation-based transvaginal sonography (TVS) training compared with clinical training only, on the clinical performance of residents in obstetrics and gynecology (Ob-Gyn), assessed 2 months into their residency. Methods In a randomized study, new Ob-Gyn residents (n = 33) with no prior ultrasound experience were recruited from three teaching hospitals. Participants were allocated to either simulation-based training followed by clinical training (intervention group; n = 18) or clinical training only (control group; n = 15). The simulation-based training was performed using a virtual-reality TVS simulator until an expert performance level was attained, and was followed by training on a pelvic mannequin. After 2 months of clinical training, one TVS examination was recorded for assessment of each resident's clinical performance (n = 26). Two ultrasound experts blinded to group allocation rated the scans using the Objective Structured Assessment of Ultrasound Skills (OSAUS) scale. Results During the 2 months of clinical training, participants in the intervention and control groups completed an average ± SD of 58 ± 41 and 63 ± 47 scans, respectively (P = 0.67). In the subsequent clinical performance test, the intervention group achieved higher OSAUS scores than did the control group (mean score, 59.1% vs 37.6%, respectively; P training leads to substantial improvement in clinical performance that is sustained after 2 months of clinical training. © 2015 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of the International Society of Ultrasound in Obstetrics and Gynecology. PMID:25580809

  11. Digital breast tomosynthesis versus digital mammography: a clinical performance study

    International Nuclear Information System (INIS)

    Gennaro, Gisella; Baldan, Enrica; Bezzon, Elisabetta; Polico, Ilaria; Proietti, Alessandro; Toffoli, Aida; Toledano, Alicia; Di Maggio, Cosimo; La Grassa, Manuela; Pescarini, Luigi; Muzzio, Pier Carlo

    2010-01-01

    To compare the clinical performance of digital breast tomosynthesis (DBT) with that of full-field digital mammography (FFDM) in a diagnostic population. The study enrolled 200 consenting women who had at least one breast lesion discovered by mammography and/or ultrasound classified as doubtful or suspicious or probably malignant. They underwent tomosynthesis in one view [mediolateral oblique (MLO)] of both breasts at a dose comparable to that of standard screen-film mammography in two views [craniocaudal (CC) and MLO]. Images were rated by six breast radiologists using the BIRADS score. Ratings were compared with the truth established according to the standard of care and a multiple-reader multiple-case (MRMC) receiver-operating characteristic (ROC) analysis was performed. Clinical performance of DBT compared with that of FFDM was evaluated in terms of the difference between areas under ROC curves (AUCs) for BIRADS scores. Overall clinical performance with DBT and FFDM for malignant versus all other cases was not significantly different (AUCs 0.851 vs 0.836, p = 0.645). The lower limit of the 95% CI or the difference between DBT and FFDM AUCs was -4.9%. Clinical performance of tomosynthesis in one view at the same total dose as standard screen-film mammography is not inferior to digital mammography in two views. (orig.)

  12. Effective Clinical Supervision in Substance Use Disorder Treatment Programs and Counselor Job Performance.

    Science.gov (United States)

    Rothrauff-Laschober, Tanja C; Eby, Lillian Turner de Tormes; Sauer, Julia B

    2013-01-01

    When mental health counselors have limited and/or inadequate training in substance use disorders (SUDs), effective clinical supervision (ECS) may advance their professional development. The purpose of the current study was to investigate whether ECS is related to the job performance of SUD counselors. Data were obtained in person via paper-and-pencil surveys from 392 matched SUD counselor-clinical supervisor dyads working in 27 SUD treatment organizations across the United States. ECS was rated by counselors and measured with five multi-item scales (i.e., sponsoring counselors' careers, providing challenging assignments, role modeling, accepting/confirming counselors' competence, overall supervisor task proficiency). Clinical supervisors rated counselors' job performance, which was measured with two multi-item scales (i.e., task performance, performance within supervisory relationship). Using mixed-effects models, we found that most aspects of ECS are related to SUD counselor job performance. Thus, ECS may indeed enhance counselors' task performance and performance within the supervisory relationship, and, as a consequence, offset limited formal SUD training.

  13. Translating Research into Clinical Scale Manufacturing of Mesenchymal Stromal Cells

    Directory of Open Access Journals (Sweden)

    Karen Bieback

    2010-01-01

    Full Text Available It sounds simple to obtain sufficient numbers of cells derived from fetal or adult human tissues, isolate and/or expand the stem cells, and then transplant an appropriate number of these cells into the patient at the correct location. However, translating basic research into routine therapies is a complex multistep process which necessitates product regulation. The challenge relates to managing the expected therapeutic benefits with the potential risks and to balance the fast move to clinical trials with time-consuming cautious risk assessment. This paper will focus on the definition of mesenchymal stromal cells (MSCs, and challenges and achievements in the manufacturing process enabling their use in clinical studies. It will allude to different cellular sources, special capacities of MSCs, but also to current regulations, with a special focus on accessory material of human or animal origin, like media supplements. As cellular integrity and purity, formulation and lot release testing of the final product, validation of all procedures, and quality assurance are of utmost necessity, these topics will be addressed.

  14. Impact of an educational intervention and clinical performance ...

    African Journals Online (AJOL)

    ... reduced (p=0.002 and p<0.001, respectively). Conclusion. This study demonstrates that adopting a relatively simple educational tool, making use of a clinical performance dashboard indicator and benchmarking practice can significantly reduce the level of neonatal sepsis while also reducing contaminated blood cultures.

  15. Performance indicators for clinical practice management in primary care in Portugal: consensus from a Delphi study.

    Science.gov (United States)

    Basto-Pereira, Miguel; Furtado, Sara Isabel Félix; Silva, Ricardo Jorge Pereira; Fachado González, Francisco; Vara Fernandes, Tito Manuel; Correia de Sousa, Jaime; Yaphe, John

    2015-03-01

    Performance indicators assessing the quality of medical care and linked to pay for performance may cause disagreement. Portuguese indicators included in recent health care reform are controversial. To obtain consensus from opinion leaders in family medicine regarding the performance indicators for practice management used in the evaluation of Family Health Units in Portugal. Eighty-nine specialists in primary care were invited to answer the following question in an online Delphi study: 'Which performance indicators should be assessed regarding the organization and management of clinical practice in primary care in Portugal?' A Likert scale was used to evaluate validity, reliability, feasibility and sensitivity to change. Twenty-seven experts participated in the second round and achieved a high degree of consensus. Eight categories were created for analysis. The experts suggested the use of existing indicators as well as new indicators. Thirty-nine indicators suggested by the experts are currently in use in Portugal. The assessment of the number of clinical acts performed, the number of administrative acts, and evaluation of the clinical demographic profile achieved a high degree of consensus. The expert panel suggested fifty new indicators. Five categories of these new indicators had a high degree of consensus, and three categories had a low degree of consensus. The expert panel recommended that performance indicators of practice management should first assess the quantity of clinical and administrative activities undertaken. These indicators must take into account the human and financial resources available to the clinic and its demographic context.

  16. Evaluation of performance of veterinary in-clinic hematology analyzers.

    Science.gov (United States)

    Rishniw, Mark; Pion, Paul D

    2016-12-01

    A previous study provided information regarding the quality of in-clinic veterinary biochemistry testing. However, no similar studies for in-clinic veterinary hematology testing have been conducted. The objective of this study was to assess the quality of hematology testing in veterinary in-clinic laboratories using results obtained from testing 3 levels of canine EDTA blood samples. Clinicians prepared blood samples to achieve measurand concentrations within, below, and above their RIs and evaluated the samples in triplicate using their in-clinic analyzers. Quality was assessed by comparison of calculated total error with quality requirements, determination of sigma metrics, use of a quality goal index, and agreement between in-clinic and reference laboratory instruments. Suitability for statistical quality control was determined using adaptations from the computerized program, EZRules3. Evaluation of 10 veterinary in-clinic hematology analyzers showed that these instruments often fail to meet quality requirements. At least 60% of analyzers reasonably determined RBC, WBC, HCT, and HGB, when assessed by most quality goal criteria; platelets were less reliably measured, with 80% deemed suitable for low platelet counts, but only 30% for high platelet counts, and automated differential leukocyte counts were generally considered unsuitable for clinical use with fewer than 40% of analyzers meeting the least stringent quality goal requirements. Fewer than 50% of analyzers were able to meet requirements for statistical quality control for any measurand. These findings reflect the current status of in-clinic hematology analyzer performance and provide a basis for future evaluations of the quality of veterinary laboratory testing. © 2016 American Society for Veterinary Clinical Pathology.

  17. Clinical laboratory as an economic model for business performance analysis.

    Science.gov (United States)

    Buljanović, Vikica; Patajac, Hrvoje; Petrovecki, Mladen

    2011-08-15

    To perform SWOT (strengths, weaknesses, opportunities, and threats) analysis of a clinical laboratory as an economic model that may be used to improve business performance of laboratories by removing weaknesses, minimizing threats, and using external opportunities and internal strengths. Impact of possible threats to and weaknesses of the Clinical Laboratory at Našice General County Hospital business performance and use of strengths and opportunities to improve operating profit were simulated using models created on the basis of SWOT analysis results. The operating profit as a measure of profitability of the clinical laboratory was defined as total revenue minus total expenses and presented using a profit and loss account. Changes in the input parameters in the profit and loss account for 2008 were determined using opportunities and potential threats, and economic sensitivity analysis was made by using changes in the key parameters. The profit and loss account and economic sensitivity analysis were tools for quantifying the impact of changes in the revenues and expenses on the business operations of clinical laboratory. Results of simulation models showed that operational profit of €470 723 in 2008 could be reduced to only €21 542 if all possible threats became a reality and current weaknesses remained the same. Also, operational gain could be increased to €535 804 if laboratory strengths and opportunities were utilized. If both the opportunities and threats became a reality, the operational profit would decrease by €384 465. The operational profit of the clinical laboratory could be significantly reduced if all threats became a reality and the current weaknesses remained the same. The operational profit could be increased by utilizing strengths and opportunities as much as possible. This type of modeling may be used to monitor business operations of any clinical laboratory and improve its financial situation by implementing changes in the next fiscal

  18. Clinical laboratory as an economic model for business performance analysis

    Science.gov (United States)

    Buljanović, Vikica; Patajac, Hrvoje; Petrovečki, Mladen

    2011-01-01

    Aim To perform SWOT (strengths, weaknesses, opportunities, and threats) analysis of a clinical laboratory as an economic model that may be used to improve business performance of laboratories by removing weaknesses, minimizing threats, and using external opportunities and internal strengths. Methods Impact of possible threats to and weaknesses of the Clinical Laboratory at Našice General County Hospital business performance and use of strengths and opportunities to improve operating profit were simulated using models created on the basis of SWOT analysis results. The operating profit as a measure of profitability of the clinical laboratory was defined as total revenue minus total expenses and presented using a profit and loss account. Changes in the input parameters in the profit and loss account for 2008 were determined using opportunities and potential threats, and economic sensitivity analysis was made by using changes in the key parameters. The profit and loss account and economic sensitivity analysis were tools for quantifying the impact of changes in the revenues and expenses on the business operations of clinical laboratory. Results Results of simulation models showed that operational profit of €470 723 in 2008 could be reduced to only €21 542 if all possible threats became a reality and current weaknesses remained the same. Also, operational gain could be increased to €535 804 if laboratory strengths and opportunities were utilized. If both the opportunities and threats became a reality, the operational profit would decrease by €384 465. Conclusion The operational profit of the clinical laboratory could be significantly reduced if all threats became a reality and the current weaknesses remained the same. The operational profit could be increased by utilizing strengths and opportunities as much as possible. This type of modeling may be used to monitor business operations of any clinical laboratory and improve its financial situation by

  19. Comparative Evaluation of Child Behavior Checklist-derived Scales in Children Clinically Referred for Emotional and Behavioural Dysregulation

    Directory of Open Access Journals (Sweden)

    Efstathios Papachristou

    2016-08-01

    Full Text Available Background: We recently developed the Child Behavior Checklist-Mania Scale (CBCL-MS, a novel and short instrument for the assessment of mania-like symptoms in children and adolescents derived from the CBCL item pool and have demonstrated its construct validity and temporal stability in a longitudinal general population sample. Objective: The aim of this study was to evaluate the construct validity of the 19-item CBCL-MS in a clinical sample and to compare its discriminatory ability to that of the 40-item CBCL-Dysregulation Profile (CBCL-DP and the 34-item CBCL-Externalizing Scale. Methods: The study sample comprised 202 children, aged 7-12 years, diagnosed with DSM-defined Attention Deficit Hyperactivity Disorder (ADHD, Conduct Disorder (CD, Oppositional Defiant Disorder (ODD and mood and anxiety disorders based on the Diagnostic Interview Schedule for Children. The construct validity of the CBCL-MS was tested by means of a confirmatory factor analysis. Receiver operating characteristics (ROC curves and logistic regression analyses adjusted for sex and age were used to assess the discriminatory ability relative to that of the (CBCL-DP and the CBCL-Externalizing Scale. Results: The CBCL-MS had excellent construct validity (CFI=0.97; TLI=0.96; RMSEA=0.04. Despite similar overall performance across scales, the clinical-range scores of the CBCL-DP and the CBCL-Externalizing Scale were associated with higher odds for ODD and CD while the clinical range scores for CBCL-MS were associated with higher odds for mood disorders. The overlap amongst the children who scored within the clinical range of each scale was over 90%. Conclusion: CBCL-MS has good construct validity in general population and clinical samples and is therefore suitable for both clinical practice and research.

  20. Validity of the German Version of the Continuous-Scale Physical Functional Performance 10 Test

    Directory of Open Access Journals (Sweden)

    Irene Härdi

    2017-01-01

    Full Text Available Background. The Continuous-Scale Physical Functional Performance 10 Test (CS-PFP 10 quantitatively assesses physical functional performance in older adults who have a broad range of physical functional ability. This study assessed the validity and reliability of the CS-PFP 10 German version. Methods. Forward-translations and backtranslations as well as cultural adaptions of the test were conducted. Participants were German-speaking Swiss community-dwelling adults aged 64 and older. Concurrent validity was assessed using Pearson correlation coefficients between CS-PFP 10 and gait velocity, Timed Up and Go Test, hand grip strength, SF-36 physical function domain, and Freiburger Physical Activity Questionnaire. Internal consistency was calculated by Cronbach’s alpha. Results. Backtranslation and cultural adaptions were accepted by the CS-PFP 10 developer. CS-PFP 10 total score and subscores (upper body strength, upper body flexibility, lower body strength, balance and coordination, and endurance correlated significantly with all measures of physical function tested. Internal consistency was high (Cronbach’s alpha 0.95–0.98. Conclusion. The CS-PFP 10 German version is valid and reliable for measuring physical functional performance in German-speaking Swiss community-dwelling older adults. Quantifying physical function is essential for clinical practice and research and provides meaningful insight into physical functional performance of older adults. This trial is registered with ClinicalTrials.gov NCT01539200.

  1. Engaging clinical nurses in quality and performance improvement activities.

    Science.gov (United States)

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

    2010-01-01

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

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

    Science.gov (United States)

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

    2017-12-20

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

  3. Clinical simulation training improves the clinical performance of Chinese medical students

    Directory of Open Access Journals (Sweden)

    Ming-ya Zhang

    2015-10-01

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

  4. Correlation Between Screening Mammography Interpretive Performance on a Test Set and Performance in Clinical Practice.

    Science.gov (United States)

    Miglioretti, Diana L; Ichikawa, Laura; Smith, Robert A; Buist, Diana S M; Carney, Patricia A; Geller, Berta; Monsees, Barbara; Onega, Tracy; Rosenberg, Robert; Sickles, Edward A; Yankaskas, Bonnie C; Kerlikowske, Karla

    2017-10-01

    Evidence is inconsistent about whether radiologists' interpretive performance on a screening mammography test set reflects their performance in clinical practice. This study aimed to estimate the correlation between test set and clinical performance and determine if the correlation is influenced by cancer prevalence or lesion difficulty in the test set. This institutional review board-approved study randomized 83 radiologists from six Breast Cancer Surveillance Consortium registries to assess one of four test sets of 109 screening mammograms each; 48 radiologists completed a fifth test set of 110 mammograms 2 years later. Test sets differed in number of cancer cases and difficulty of lesion detection. Test set sensitivity and specificity were estimated using woman-level and breast-level recall with cancer status and expert opinion as gold standards. Clinical performance was estimated using women-level recall with cancer status as the gold standard. Spearman rank correlations between test set and clinical performance with 95% confidence intervals (CI) were estimated. For test sets with fewer cancers (N = 15) that were more difficult to detect, correlations were weak to moderate for sensitivity (woman level = 0.46, 95% CI = 0.16, 0.69; breast level = 0.35, 95% CI = 0.03, 0.61) and weak for specificity (0.24, 95% CI = 0.01, 0.45) relative to expert recall. Correlations for test sets with more cancers (N = 30) were close to 0 and not statistically significant. Correlations between screening performance on a test set and performance in clinical practice are not strong. Test set performance more accurately reflects performance in clinical practice if cancer prevalence is low and lesions are challenging to detect. Copyright © 2017 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.

  5. Evaluation of stratification factors and score-scales in clinical trials of treatment of clinical mastitis in dairy cows.

    Science.gov (United States)

    Hektoen, L; Ødegaard, S A; Løken, T; Larsen, S

    2004-05-01

    There is often a need to reduce sample size in clinical trials due to practical limitations and ethical considerations. Better comparability between treatment groups by use of stratification in the design, and use of continuous outcome variables in the evaluation of treatment results, are two methods that can be used in order to achieve this. In this paper the choice of stratification factors in trials of clinical mastitis in dairy cows is investigated, and two score-scales for evaluation of clinical mastitis are introduced. The outcome in 57 dairy cows suffering from clinical mastitis and included in a clinical trial comparing homeopathic treatment, placebo and a standard antibiotic treatment is investigated. The strata of various stratification factors are compared across treatments to determine which other factors influence outcome. The two score scales, measuring acute and chronic mastitis symptoms, respectively, are evaluated on their ability to differentiate between patients classified from clinical criteria as responders or non-responders to treatment. Differences were found between the strata of the factors severity of mastitis, lactation number, previous mastitis this lactation and bacteriological findings. These factors influence outcome of treatment and appear relevant as stratification factors in mastitis trials. Both score scales differentiated between responders and non-responders to treatment and were found useful for evaluation of mastitis and mastitis treatment.

  6. Do clinical safety charts improve paramedic key performance indicator results? (A clinical improvement programme evaluation).

    Science.gov (United States)

    Ebbs, Phillip; Middleton, Paul M; Bonner, Ann; Loudfoot, Allan; Elliott, Peter

    2012-07-01

    Is the Clinical Safety Chart clinical improvement programme (CIP) effective at improving paramedic key performance indicator (KPI) results within the Ambulance Service of New South Wales? The CIP intervention area was compared with the non-intervention area in order to determine whether there was a statistically significant improvement in KPI results. The CIP was associated with a statistically significant improvement in paramedic KPI results within the intervention area. The strategies used within this CIP are recommended for further consideration.

  7. Full-scale ANANOX (R) system performance | Garuti | Water SA

    African Journals Online (AJOL)

    This paper reports the results of the first experimental investigations carried out on the only existing full-scale plant that makes use of the biological treatment system known as ANANOX(R). This system was first set up by the Italian research staff at ENEA (Agency for New Technologies, Energy and Environment) and consists ...

  8. Quality assurance of the clinical learning environment in Austria: Construct validity of the Clinical Learning Environment, Supervision and Nurse Teacher Scale (CLES+T scale).

    Science.gov (United States)

    Mueller, Gerhard; Mylonas, Demetrius; Schumacher, Petra

    2018-04-21

    Within nursing education, the clinical learning environment is of a high importance in regards to the development of competencies and abilities. The organization, atmosphere, and supervision in the clinical learning environment are only a few factors that influence this development. In Austria there is currently no valid instrument available for the evaluation of influencing factors. The aim of the study was to test the construct validity with principal component analysis as well as the internal consistency of the German Clinical Learning Environment, Supervision and Teacher Scale (CLES+T scale) in Austria. The present validation study has a descriptive-quantitative cross-sectional design. The sample consisted of 385 nursing students from thirteen training institutions in Austria. The data collection was carried out online between March and April 2016. Starting with a polychoric correlation matrix, a parallel analysis with principal component extraction and promax rotation was carried out due to the ordinal data. The exploratory ordinal factor analysis supported a four-component solution and explained 73% of the total variance. The internal consistency of all 25 items reached a Cronbach's α of 0.95 and the four components ranged between 0.83 and 0.95. The German version of the CLES+T scale seems to be a useful instrument for identifying potential areas of improvement in clinical practice in order to derive specific quality measures for the practical learning environment. Copyright © 2018 Elsevier Ltd. All rights reserved.

  9. Clinical quality performance in U.S. health centers.

    Science.gov (United States)

    Shi, Leiyu; Lebrun, Lydie A; Zhu, Jinsheng; Hayashi, Arthur S; Sharma, Ravi; Daly, Charles A; Sripipatana, Alek; Ngo-Metzger, Quyen

    2012-12-01

    To describe current clinical quality among the nation's community health centers and to examine health center characteristics associated with performance excellence. National data from the 2009 Uniform Data System. Health centers reviewed patient records and reported aggregate data to the Uniform Data System. Six measures were examined: first-trimester prenatal care, childhood immunization completion, Pap tests, low birth weight, controlled hypertension, and controlled diabetes. The top 25 percent performing centers were compared with lower performing (bottom 75 percent) centers on these measures. Logistic regressions were utilized to assess the impact of patient, provider, and institutional characteristics on health center performance. Clinical care and outcomes among health centers were generally comparable to national averages. For instance, 67 percent of pregnant patients received timely prenatal care (national = 68 percent), 69 percent of children achieved immunization completion (national = 67 percent), and 63 percent of hypertensive patients had blood pressure under control (national = 48 percent). Depending on the measure, centers with more uninsured patients were less likely to do well, while centers with more physicians and enabling service providers were more likely to do well. Health centers provide quality care at rates comparable to national averages. Performance may be improved by increasing insurance coverage among patients and increasing the ratios of physicians and enabling service providers to patients. © Health Research and Educational Trust.

  10. The MMPI-2 Restructured Clinical Scales in the Assessment of Posttraumatic Stress Disorder and Comorbid Disorders

    Science.gov (United States)

    Wolf, Erika J.; Miller, Mark W.; Orazem, Robert J.; Weierich, Mariann R.; Castillo, Diane T.; Milford, Jaime; Kaloupek, Danny G.; Keane, Terence M.

    2008-01-01

    This study examined the psychometric properties of the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) Restructured Clinical Scales (RCSs) in individuals with posttraumatic stress disorder (PTSD) receiving clinical services at Department of Veterans Affairs medical centers. Study 1 included 1,098 men who completed the MMPI-2 and were…

  11. Empirical Correlates and Expanded Interpretation of the MMPI-2-RF Restructured Clinical Scale 3 (Cynicism)

    Science.gov (United States)

    Ingram, Paul B.; Kelso, Kristy M.; McCord, David M.

    2011-01-01

    The recent release of the Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF) has received much attention from the clinical psychology community. Particular concerns have focused on Restructured Clinical Scale 3 (RC3; Cynicism). This article briefly reviews the major criticisms and responses regarding the restructuring of…

  12. ESMO-Magnitude of Clinical Benefit Scale version 1.1

    NARCIS (Netherlands)

    Cherny, N. I.; Dafni, U.; Bogaerts, J.; Latino, N. J.; Pentheroudakis, G.; Douillard, J. -Y.; Tabernero, J.; Zielinski, C.; Piccart, M. J.; de Vries, E. G. E.

    2017-01-01

    Background: The ESMO Magnitude of Clinical Benefit Scale (ESMO-MCBS) version 1.0 (v1.0) was published in May 2015 and was the first version of a validated and reproducible tool to assess the magnitude of clinical benefit from new cancer therapies. The ESMO-MCBS was designed to be a dynamic tool with

  13. Development and Validation of a Clarinet Performance Adjudication Scale

    Science.gov (United States)

    Abeles, Harold F.

    1973-01-01

    A basic assumption of this study is that there are generally agreed upon performance standards as evidenced by the use of adjudicators for evaluations at contests and festivals. An evaluation instrument was developed to enable raters to measure effectively those aspects of performance that have common standards of proficiency. (Author/RK)

  14. Connecting Performance Analysis and Visualization to Advance Extreme Scale Computing

    Energy Technology Data Exchange (ETDEWEB)

    Bremer, Peer-Timo [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); Mohr, Bernd [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); Schulz, Martin [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); Pasccci, Valerio [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); Gamblin, Todd [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); Brunst, Holger [Dresden Univ. of Technology (Germany)

    2015-07-29

    The characterization, modeling, analysis, and tuning of software performance has been a central topic in High Performance Computing (HPC) since its early beginnings. The overall goal is to make HPC software run faster on particular hardware, either through better scheduling, on-node resource utilization, or more efficient distributed communication.

  15. Psychometric Evaluation of the MMPI-2/MMPI-2-RF Restructured Clinical Scales in an Israeli Sample.

    Science.gov (United States)

    Shkalim, Eleanor

    2015-10-01

    The current study cross-culturally evaluated the psychometric properties of the Minnesota Multiphasic Personality Inventory-2 (MMPI-2)/MMPI-2-Restructured Form Restructured Clinical (RC) Scales in psychiatric settings in Israel with a sample of 100 men and 133 women. Participants were administered the MMPI-2 and were rated by their therapists on a 188-item Patient Description Form. Results indicated that in most instances the RC Scales demonstrated equivalent or better internal consistencies and improved intercorrelation patterns relative to their clinical counterparts. Furthermore, external analyses revealed comparable or improved convergent validity (with the exceptions of Antisocial Behavior [RC4] and Ideas of Persecution [RC6] among men), and mostly greater discriminant validity. Overall, the findings indicate that consistent with previous findings, the RC Scales generally exhibit comparable to improved psychometric properties over the Clinical Scales. Implications of the results, limitations, and recommendations for future research are discussed. © The Author(s) 2014.

  16. Strategic performance management: development of a performance measurement system at the Mayo Clinic.

    Science.gov (United States)

    Curtright, J W; Stolp-Smith, S C; Edell, E S

    2000-01-01

    Managing and measuring performance become exceedingly complex as healthcare institutions evolve into integrated health systems comprised of hospitals, outpatient clinics and surgery centers, nursing homes, and home health services. Leaders of integrated health systems need to develop a methodology and system that align organizational strategies with performance measurement and management. To meet this end, multiple healthcare organizations embrace the performance-indicators reporting system known as a "balanced scorecard" or a "dashboard report." This discrete set of macrolevel indicators gives senior management a fast but comprehensive glimpse of the organization's performance in meeting its quality, operational, and financial goals. The leadership of outpatient operations for Mayo Clinic in Rochester, Minnesota built on this concept by creating a performance management and measurement system that monitors and reports how well the organization achieves its performance goals. Internal stakeholders identified metrics to measure performance in each key category. Through these metrics, the organization links Mayo Clinic's vision, primary value, core principles, and day-to-day operations by monitoring key performance indicators on a weekly, monthly, or quarterly basis.

  17. INFLUENCE OF SCALE RATIO, ASPECT RATIO, AND PLANFORM ON THE PERFORMANCE OF SUPERCAVITATING HYDROFOILS.

    Science.gov (United States)

    performance of supercavitating hydrofoils. No appreciable scale effect was found for scale ratios up to 3 in the fully-cavitating flow region. The...overall performance of the hydrofoil by increasing the aspect ratio above 3, and (2) moderate taper ratio seems to be advantageous in view of the overall performance of supercavitating hydrofoils. (Author)

  18. Ownership and firm performance after large-scale privatization

    Czech Academy of Sciences Publication Activity Database

    Kočenda, Evžen; Švejnar, Jan

    -, č. 4143 (2003), s. 1-36 ISSN 0265-8003 Institutional research plan: CEZ:AV0Z7085904 Keywords : industrial organization * ownership * performance and privatization Subject RIV: AH - Economics www.cepr.org/pubs/dps/DP4143.asp

  19. A population study comparing screening performance of prototypes for depression and anxiety with standard scales

    Directory of Open Access Journals (Sweden)

    Christensen Helen

    2011-11-01

    Full Text Available Abstract Background Screening instruments for mental disorders need to be short, engaging, and valid. Current screening instruments are usually questionnaire-based and may be opaque to the user. A prototype approach where individuals identify with a description of an individual with typical symptoms of depression, anxiety, social phobia or panic may be a shorter, faster and more acceptable method for screening. The aim of the study was to evaluate the accuracy of four new prototype screeners for predicting depression and anxiety disorders and to compare their performance with existing scales. Methods Short and ultra-short prototypes were developed for Major Depressive Disorder (MDD, Generalised Anxiety Disorder (GAD, Panic Disorder (PD and Social Phobia (SP. Prototypes were compared to typical short and ultra-short self-report screening scales, such as the Centre for Epidemiology Scale, CES-D and the GAD-7, and their short forms. The Mini International Neuropsychiatric Interview (MINI version 6 1 was used as the gold standard for obtaining clinical criteria through a telephone interview. From a population sample, 225 individuals who endorsed a prototype and 101 who did not were administered the MINI. Receiver operating characteristic (ROC curves were plotted for the short and ultra short prototypes and for the short and ultra short screening scales. Results The study found that the rates of endorsement of the prototypes were commensurate with prevalence estimates. The short-form and ultra short scales outperformed the short and ultra short prototypes for every disorder except GAD, where the GAD prototype outperformed the GAD 7. Conclusions The findings suggest that people may be able to self-identify generalised anxiety more accurately than depression based on a description of a prototypical case. However, levels of identification were lower than expected. Considerable benefits from this method of screening may ensue if our prototypes can be

  20. Effects of basic clinical skills training on objective structured clinical examination performance.

    Science.gov (United States)

    Jünger, Jana; Schäfer, Sybille; Roth, Christiane; Schellberg, Dieter; Friedman Ben-David, Miriam; Nikendei, Christoph

    2005-10-01

    The aim of curriculum reform in medical education is to improve students' clinical and communication skills. However, there are contradicting results regarding the effectiveness of such reforms. A study of internal medicine students was carried out using a static group design. The experimental group consisted of 77 students participating in 7 sessions of communication training, 7 sessions of skills-laboratory training and 7 sessions of bedside-teaching, each lasting 1.5 hours. The control group of 66 students from the traditional curriculum participated in equally as many sessions but was offered only bedside teaching. Students' cognitive and practical skills performance was assessed using Multiple Choice Question (MCQ) testing and an objective structured clinical examination (OSCE), delivered by examiners blind to group membership. The experimental group performed significantly better on the OSCE than did the control group (P < 0.01), whereas the groups did not differ on the MCQ test (P < 0.15). This indicates that specific training in communication and basic clinical skills enabled students to perform better in an OSCE, whereas its effects on knowledge did not differ from those of the traditional curriculum. Curriculum reform promoting communication and basic clinical skills are effective and lead to an improved performance in history taking and physical examination skills.

  1. Performance of a novel wafer scale CMOS active pixel sensor for bio-medical imaging

    International Nuclear Information System (INIS)

    Esposito, M; Evans, P M; Wells, K; Anaxagoras, T; Konstantinidis, A C; Zheng, Y; Speller, R D; Allinson, N M

    2014-01-01

    Recently CMOS active pixels sensors (APSs) have become a valuable alternative to amorphous silicon and selenium flat panel imagers (FPIs) in bio-medical imaging applications. CMOS APSs can now be scaled up to the standard 20 cm diameter wafer size by means of a reticle stitching block process. However, despite wafer scale CMOS APS being monolithic, sources of non-uniformity of response and regional variations can persist representing a significant challenge for wafer scale sensor response. Non-uniformity of stitched sensors can arise from a number of factors related to the manufacturing process, including variation of amplification, variation between readout components, wafer defects and process variations across the wafer due to manufacturing processes. This paper reports on an investigation into the spatial non-uniformity and regional variations of a wafer scale stitched CMOS APS. For the first time a per-pixel analysis of the electro-optical performance of a wafer CMOS APS is presented, to address inhomogeneity issues arising from the stitching techniques used to manufacture wafer scale sensors. A complete model of the signal generation in the pixel array has been provided and proved capable of accounting for noise and gain variations across the pixel array. This novel analysis leads to readout noise and conversion gain being evaluated at pixel level, stitching block level and in regions of interest, resulting in a coefficient of variation ⩽1.9%. The uniformity of the image quality performance has been further investigated in a typical x-ray application, i.e. mammography, showing a uniformity in terms of CNR among the highest when compared with mammography detectors commonly used in clinical practice. Finally, in order to compare the detection capability of this novel APS with the technology currently used (i.e. FPIs), theoretical evaluation of the detection quantum efficiency (DQE) at zero-frequency has been performed, resulting in a higher DQE for this

  2. Performance of a novel wafer scale CMOS active pixel sensor for bio-medical imaging.

    Science.gov (United States)

    Esposito, M; Anaxagoras, T; Konstantinidis, A C; Zheng, Y; Speller, R D; Evans, P M; Allinson, N M; Wells, K

    2014-07-07

    Recently CMOS active pixels sensors (APSs) have become a valuable alternative to amorphous silicon and selenium flat panel imagers (FPIs) in bio-medical imaging applications. CMOS APSs can now be scaled up to the standard 20 cm diameter wafer size by means of a reticle stitching block process. However, despite wafer scale CMOS APS being monolithic, sources of non-uniformity of response and regional variations can persist representing a significant challenge for wafer scale sensor response. Non-uniformity of stitched sensors can arise from a number of factors related to the manufacturing process, including variation of amplification, variation between readout components, wafer defects and process variations across the wafer due to manufacturing processes. This paper reports on an investigation into the spatial non-uniformity and regional variations of a wafer scale stitched CMOS APS. For the first time a per-pixel analysis of the electro-optical performance of a wafer CMOS APS is presented, to address inhomogeneity issues arising from the stitching techniques used to manufacture wafer scale sensors. A complete model of the signal generation in the pixel array has been provided and proved capable of accounting for noise and gain variations across the pixel array. This novel analysis leads to readout noise and conversion gain being evaluated at pixel level, stitching block level and in regions of interest, resulting in a coefficient of variation ⩽1.9%. The uniformity of the image quality performance has been further investigated in a typical x-ray application, i.e. mammography, showing a uniformity in terms of CNR among the highest when compared with mammography detectors commonly used in clinical practice. Finally, in order to compare the detection capability of this novel APS with the technology currently used (i.e. FPIs), theoretical evaluation of the detection quantum efficiency (DQE) at zero-frequency has been performed, resulting in a higher DQE for this

  3. Validation of the Brazilian version of the Clinical Gait and Balance Scale and comparison with the Berg Balance Scale

    Directory of Open Access Journals (Sweden)

    Jussara Almeida Oliveira Baggio

    2013-09-01

    Full Text Available Objective To validate the Clinical Gait and Balance Scale (GABS for a Brazilian population of patients with Parkinson's disease (PD and to compare it to the Berg Balance Scale (BBS. Methods One hundred and seven PD patients were evaluated by shortened UPDRS motor scale (sUPDRSm, Hoehn and Yahr (HY, Schwab and England scale (SE, Falls Efficacy Scale International (FES-I, Freezing of Gait Questionnaire (FOG-Q, BBS and GABS. Results The internal consistency of the GABS was 0.94, the intra-rater and inter-rater reliability were 0.94 and 0.98 respectively. The area under the receiver operating characteristic (ROC curve was 0.72, with a sensitivity of 0.75 and specificity of 0.6, to discriminate patients with a history of falls in the last twelve months, for a cut-off score of 13 points. Conclusions Our study shows that the Brazilian version of the GABS is a reliable and valid instrument to assess gait and balance in PD.

  4. Evaluating Feed Delivery Performance in Scaled Double-Shell Tanks

    International Nuclear Information System (INIS)

    Lee, Kearn P.; Thien, Michael G.

    2013-01-01

    The Hanford Tank Operations Contractor (TOC) and the Hanford Waste Treatment and Immobilization Plant (WTP) contractor are both engaged in demonstrating mixing, sampling, and transfer system capability using simulated Hanford High-Level Waste (HLW) formulations. This work represents one of the remaining technical issues with the high-level waste treatment mission at Hanford. The TOCs' ability to adequately mix and sample high-level waste feed to meet the WTP WAC Data Quality Objectives must be demonstrated. The tank mixing and feed delivery must support both TOC and WTP operations. The tank mixing method must be able to remove settled solids from the tank and provide consistent feed to the WTP to facilitate waste treatment operations. Two geometrically scaled tanks were used with a broad spectrum of tank waste simulants to demonstrate that mixing using two rotating mixer jet pumps yields consistent slurry compositions as the tank is emptied in a series of sequential batch transfers. Testing showed that the concentration of slow settling solids in each transfer batch was consistent over a wide range of tank operating conditions. Although testing demonstrated that the concentration of fast settling solids decreased by up to 25% as the tank was emptied, batch-to-batch consistency improved as mixer jet nozzle velocity in the scaled tanks increased

  5. Two-year clinical performance of four adhesive strategies

    Directory of Open Access Journals (Sweden)

    Salah Hasab Mahmoud

    2016-01-01

    Full Text Available Objective: To assess the clinical performance of four adhesive strategies; 3-step etch-and-rinse Adper Scotchbond Multi-Purpose (SM, 2-step etch-and-rinse (Adper Single Bond-2 [S2], 2-step self-etch Adper Scotchbond SE (SE and 1-step self-etch (Adper Single Bond Universal [SU]. Materials and Methods: Eighty cervical cavities exhibiting dentin carious lesions were used. Four adhesives from the same manufacturer (3M ESPE, St. Paul, MN, USA representing different bonding strategies were used; SM (3-step etch-and-rinse, Adper S2 (2-step etch-and-rinse, SE (2-step self-etch and SU (1-step self-etch. Cavities were restored with a nanohybrid composite resin (Z-350XT - 3M ESPE, St. Paul, MN, USA, and clinically followed up for 24 months using the modified United States Public Health Service criteria. Results: The outcome of Wilcoxon signed rank test showed no significant difference among the groups for each adhesive material at different evaluation periods (P > 0.05. Furthermore, the Friedman test revealed that there was no significant difference between all materials in all evaluation criteria, except for marginal discoloration at 24-month evaluation period. At 24-month evaluation period, teeth restored with self-etch adhesives showed more marginal staining. Conclusions: The four bonding strategies used in the current study showed an acceptable 2-year clinical performance.

  6. A new scaling methodology for NO(x) emissions performance of gas burners and furnaces

    Science.gov (United States)

    Hsieh, Tse-Chih

    1997-11-01

    A general burner and furnace scaling methodology is presented, together with the resulting scaling model for NOsb{x} emissions performance of a broad class of swirl-stabilized industrial gas burners. The model is based on results from a set of novel burner scaling experiments on a generic gas burner and furnace design at five different scales having near-uniform geometric, aerodynamic, and thermal similarity and uniform measurement protocols. These provide the first NOsb{x} scaling data over the range of thermal scales from 30 kW to 12 MW, including input-output measurements as well as detailed in-flame measurements of NO, NOsb{x}, CO, Osb2, unburned hydrocarbons, temperature, and velocities at each scale. The in-flame measurements allow identification of key sources of NOsb{x} production. The underlying physics of these NOsb{x} sources lead to scaling laws for their respective contributions to the overall NOsb{x} emissions performance. It is found that the relative importance of each source depends on the burner scale and operating conditions. Simple furnace residence time scaling is shown to be largely irrelevant, with NOsb{x} emissions instead being largely controlled by scaling of the near-burner region. The scalings for these NOsb{x} sources are combined in a comprehensive scaling model for NOsb{x} emission performance. Results from the scaling model show good agreement with experimental data at all burner scales and over the entire range of turndown, staging, preheat, and excess air dilution, with correlations generally exceeding 90%. The scaling model permits design trade-off assessments for a broad class of burners and furnaces, and allows performance of full industrial scale burners and furnaces of this type to be inferred from results of small scale tests.

  7. Performance analysis of small-scale experimental facility of TWDEC

    International Nuclear Information System (INIS)

    Kawana, Ryoh; Ishikawa, Motoo; Takeno, Hiromasa; Yamamoto, Takayoshi; Yasaka, Yasuyoshi

    2008-01-01

    The objective of the present paper is to analyze small-scale experimental facilities of TWDEC (Travelling Wave type Direct Energy Converter) and to propose a modification in regard to a measuring device of the facilities by means of numerical simulation with the axisymmetrical two-dimensional approximation (a PIC method). The numerical simulation has given the following results: (1) tendency of the numerical results agree with the experimental results on the measured deceleration efficiency, (2) the deceleration efficiency measured in the experiment will increase if the radius of Faraday cup installed in the experiment increases and (3) the wave of condensation and rarefaction of measured electric charge density, which is averaged in the r-direction below the radius of Faraday cup, is not formed enough with a small radius of Faraday cup because of the r component of electric field which is induced by the electrode geometry

  8. Research on performance evaluation and anti-scaling mechanism of green scale inhibitors by static and dynamic methods

    International Nuclear Information System (INIS)

    Liu, D.

    2011-01-01

    Increasing environmental concerns and discharge limitations have imposed additional challenges in treating process waters. Thus, the concept of 'Green Chemistry' was proposed and green scale inhibitors became a focus of water treatment technology. Finding some economical and environmentally friendly inhibitors is one of the major research focuses nowadays. In this dissertation, the inhibition performance of different phosphonates as CaCO 3 scale inhibitors in simulated cooling water was evaluated. Homo-, co-, and ter-polymers were also investigated for their performance as Ca-phosphonate inhibitors. Addition of polymers as inhibitors with phosphonates could reduce Ca-phosphonate precipitation and enhance the inhibition efficiency for CaCO 3 scale. The synergistic effect of poly-aspartic acid (PASP) and Poly-epoxy-succinic acid (PESA) on inhibition of scaling has been studied using both static and dynamic methods. Results showed that the anti-scaling performance of PASP combined with PESA was superior to that of PASP or PESA alone for CaCO 3 , CaSO 4 and BaSO 4 scale. The influence of dosage, temperature and Ca 2+ concentration was also investigated in simulated cooling water circuit. Moreover, SEM analysis demonstrated the modification of crystalline morphology in the presence of PASP and PESA. In this work, we also investigated the respective inhibition effectiveness of copper and zinc ions for scaling in drinking water by the method of Rapid Controlled Precipitation (RCP). The results indicated that the zinc ion and copper ion were high efficient inhibitors of low concentration, and the analysis of SEM and IR showed that copper and zinc ions could affect the calcium carbonate germination and change the crystal morphology. Moreover, the influence of temperature and dissolved CO 2 on the scaling potential of a mineral water (Salvetat) in the presence of copper and zinc ions was studied by laboratory experiments. An ideal scale inhibitor should be a solid form

  9. Clinical performance feedback and quality improvement opportunities for perioperative physicians

    Directory of Open Access Journals (Sweden)

    Kaye AD

    2014-05-01

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

  10. Performance of full scale enhanced reductive dechlorination in clay till

    DEFF Research Database (Denmark)

    Damgaard, Ida; Bjerg, Poul Løgstrup; Jacobsen, Carsten S.

    2013-01-01

    At a low permeability clay till site contaminated with chlorinated ethenes (Gl. Kongevej, Denmark), enhanced reductive dechlorination (ERD) was applied by direct push injection of molasses and dechlorinating bacteria. The performance was investigated by long-term groundwater monitoring, and after 4...

  11. Does expressive timing in music performance scale proportionally with tempo?

    NARCIS (Netherlands)

    Desain, P.; Honing, H.

    1994-01-01

    Evidence is presented that expressive timing in music is not relationally invariant with global tempo. Our results stem from an analysis of repeated performances of Beethoven's variations on a Paisiello theme. Recordings were made of two pianists playing the pieces at three tempi. In contrast with

  12. Decreased attention to object size information in scale errors performers

    NARCIS (Netherlands)

    Grzyb, B.J.; Cangelosi, A.; Cattani, A.; Floccia, C.

    2017-01-01

    Young children sometimes make serious attempts to perform impossible actions on miniature objects as if they were full-size objects. The existing explanations of these curious action errors assume (but never explicitly tested) children’s decreased attention to object size information. This study

  13. [Clinical application and optimization of HEAD-US quantitative ultrasound assessment scale for hemophilic arthropathy].

    Science.gov (United States)

    Li, J; Guo, X J; Ding, X L; Lyu, B M; Xiao, J; Sun, Q L; Li, D S; Zhang, W F; Zhou, J C; Li, C P; Yang, R C

    2018-02-14

    Objective: To assess the feasibility of HEAD-US scale in the clinical application of hemophilic arthropathy (HA) and propose an optimized ultrasound scoring system. Methods: From July 2015 to August 2017, 1 035 joints ultrasonographic examinations were performed in 91 patients. Melchiorre, HEAD-US (Hemophilic Early Arthropathy Detection with UltraSound) and HEAD-US-C (HEAD-US in China) scale scores were used respectively to analyze the results. The correlations between three ultrasound scales and Hemophilia Joint Health Scores (HJHS) were evaluated. The sensitivity differences of the above Ultrasonic scoring systems in evaluation of HA were compared. Results: All the 91 patients were male, with median age of 16 (4-55) years old, including 86 cases of hemophilia A and 5 cases hemophilia B. The median ( P 25 , P 75 ) of Melchiorre, HEAD-US and HEAD-US-C scores of 1 035 joints were 2(0,6), 1(0,5) and 2(0,6), respectively, and the correlation coefficients compared with HJHS was 0.747, 0.762 and 0.765 respectively, with statistical significance ( P cases of asymptomatic joints, the positive rates of Melchiorre, HEAD-US-C and HEAD-US scale score were 25.0% (95% CI 20.6%-29.6%), 17.0% (95% CI 12.6%-21.1%) and 11.9% (95% CI 8.4%-15.7%) respectively, and the difference was statistically significant ( P joints of 40 patients. The difference in variation amplitude of HEAD-US-C scores and HEAD-US scores before and after joint bleeding was statistically significant ( P <0.001). Conclusion: Compared with Melchiorre, there were similar good correlations between HEAD-US, HEAD-US-C and HJHS. HEAD-US ultrasound scoring system is quick, convenient and simple to use. The optimized HEAD-US-C scale score is more sensitive than HEAD-US, especially for patients with HA who have subclinical state, which make up for insufficiency of sensitivity in HEAD-US scoring system.

  14. Assessing clinical reasoning abilities of medical students using clinical performance examination

    Directory of Open Access Journals (Sweden)

    Sunju Im

    2016-03-01

    Full Text Available Purpose: The purpose of this study is to investigate the reliability and validity of new clinical performance examination (CPX for assessing clinical reasoning skills and evaluating clinical reasoning ability of the students. Methods: Third-year medical school students (n=313 in Busan-Gyeongnam consortium in 2014 were included in the study. One of 12 stations was developed to assess clinical reasoning abilities. The scenario and checklists of the station were revised by six experts. Chief complaint of the case was rhinorrhea, accompanied by fever, headache, and vomiting. Checklists focused on identifying of the main problem and systematic approach to the problem. Students interviewed the patient and recorded subjective and objective findings, assessments, plans (SOAP note for 15 minutes. Two professors assessed students simultaneously. We performed statistical analysis on their scores and survey. Results: The Cronbach α of subject station was 0.878 and Cohen κ coefficient between graders was 0.785. Students agreed on CPX as an adequate tool to evaluate students’ performance, but some graders argued that the CPX failed to secure its validity due to their lack of understanding the case. One hundred eight students (34.5% identified essential problem early and only 58 (18.5% performed systematic history taking and physical examination. One hundred seventy-three of them (55.3% communicated correct diagnosis with the patient. Most of them had trouble in writing SOAP notes. Conclusion: To gain reliability and validity, interrater agreement should be secured. Students' clinical reasoning skills were not enough. Students need to be trained on problem identification, reasoning skills and accurate record-keeping.

  15. Development and Validation of a Rating Scale for Wind Jazz Improvisation Performance

    Science.gov (United States)

    Smith, Derek T.

    2009-01-01

    The purpose of this study was to construct and validate a rating scale for collegiate wind jazz improvisation performance. The 14-item Wind Jazz Improvisation Evaluation Scale (WJIES) was constructed and refined through a facet-rational approach to scale development. Five wind jazz students and one professional jazz educator were asked to record…

  16. Performance of mushroom fruiting for large scale commercial production

    International Nuclear Information System (INIS)

    Mat Rosol Awang; Rosnani Abdul Rashid; Hassan Hamdani Mutaat; Mohd Meswan Maskom

    2012-01-01

    The paper described the determination of mushroom fruiting yield, which is vital to economics of mushroom production. Consistency in mushroom yields enabling an estimation to be made for revenues and hence profitability could be predicted. It has been reported by many growers, there are a large variation in mushroom yields over different times of production. To assess such claims we have run four batches of mushroom fruiting and the performance fruiting body productions are presented. (author)

  17. Clinical-scale elutriation as a means of enriching antigen-presenting cells and manipulating alloreactivity.

    Science.gov (United States)

    Micklethwaite, Kenneth P; Garvin, Frances M; Kariotis, Melina R; Yee, Leng L; Hansen, Anna M; Antonenas, Vicki; Sartor, Mary M; Turtle, Cameron J; Gottlieb, David J

    2009-01-01

    Clinical-scale elutriation using the Elutra(c) has been shown to enrich monocytes reliably for immunotherapy protocols. Until now, a detailed assessment of the four (F1-F4) non-monocyte fractions derived from this process has not been performed. Using fluorescence-activated cell sorting (FACS), we performed phenotypic analyses to investigate the possible enrichment of T, B, natural killer (NK) and dendritic cells (DC) or their subsets in one or more Elutra fractions. Blood DC were enriched up to 10-fold in some fractions (F3 and F4) compared with the pre-elutriation apheresis product. This increased the number of DC that could be isolated from a given cell number by immunomagnetic separation. It was also found that CD62L(-) effector memory CD4(+) T cells were enriched in later fractions. In four of five cases tested, cells from F3 demonstrated decreased alloreactive proliferation in a mixed lymphocyte reaction compared with cells from the apheresis product. B cells were enriched in F1 compared with the apheresis product. In addition to providing enrichment of monocytes for the generation of DC, the Elutra enriches cell subsets that may be incorporated into and enhance existing immunotherapy and stem cell transplantation protocols.

  18. Enabling High Performance Large Scale Dense Problems through KBLAS

    KAUST Repository

    Abdelfattah, Ahmad

    2014-05-04

    KBLAS (KAUST BLAS) is a small library that provides highly optimized BLAS routines on systems accelerated with GPUs. KBLAS is entirely written in CUDA C, and targets NVIDIA GPUs with compute capability 2.0 (Fermi) or higher. The current focus is on level-2 BLAS routines, namely the general matrix vector multiplication (GEMV) kernel, and the symmetric/hermitian matrix vector multiplication (SYMV/HEMV) kernel. KBLAS provides these two kernels in all four precisions (s, d, c, and z), with support to multi-GPU systems. Through advanced optimization techniques that target latency hiding and pushing memory bandwidth to the limit, KBLAS outperforms state-of-the-art kernels by 20-90% improvement. Competitors include CUBLAS-5.5, MAGMABLAS-1.4.0, and CULAR17. The SYMV/HEMV kernel from KBLAS has been adopted by NVIDIA, and should appear in CUBLAS-6.0. KBLAS has been used in large scale simulations of multi-object adaptive optics.

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

    Science.gov (United States)

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

    2015-03-01

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

  20. Improved Clinical Performance and Teamwork of Pediatric Interprofessional Resuscitation Teams With a Simulation-Based Educational Intervention.

    Science.gov (United States)

    Gilfoyle, Elaine; Koot, Deanna A; Annear, John C; Bhanji, Farhan; Cheng, Adam; Duff, Jonathan P; Grant, Vincent J; St George-Hyslop, Cecilia E; Delaloye, Nicole J; Kotsakis, Afrothite; McCoy, Carolyn D; Ramsay, Christa E; Weiss, Matthew J; Gottesman, Ronald D

    2017-02-01

    To measure the effect of a 1-day team training course for pediatric interprofessional resuscitation team members on adherence to Pediatric Advanced Life Support guidelines, team efficiency, and teamwork in a simulated clinical environment. Multicenter prospective interventional study. Four tertiary-care children's hospitals in Canada from June 2011 to January 2015. Interprofessional pediatric resuscitation teams including resident physicians, ICU nurse practitioners, registered nurses, and registered respiratory therapists (n = 300; 51 teams). A 1-day simulation-based team training course was delivered, involving an interactive lecture, group discussions, and four simulated resuscitation scenarios, each followed by a debriefing. The first scenario of the day (PRE) was conducted prior to any team training. The final scenario of the day (POST) was the same scenario, with a slightly modified patient history. All scenarios included standardized distractors designed to elicit and challenge specific teamwork behaviors. Primary outcome measure was change (before and after training) in adherence to Pediatric Advanced Life Support guidelines, as measured by the Clinical Performance Tool. Secondary outcome measures were as follows: 1) change in times to initiation of chest compressions and defibrillation and 2) teamwork performance, as measured by the Clinical Teamwork Scale. Correlation between Clinical Performance Tool and Clinical Teamwork Scale scores was also analyzed. Teams significantly improved Clinical Performance Tool scores (67.3-79.6%; p Teamwork Scale scores (56.0-71.8%; p Teamwork Scale (R = 0.281; p teamwork during simulated pediatric resuscitation. A positive correlation between clinical and teamwork performance suggests that effective teamwork improves clinical performance of resuscitation teams.

  1. Who is Distressed Applying the Diabetes Related Distress Scale in a Diabetes Clinic

    Science.gov (United States)

    2017-06-09

    59 MDW /SGVU SUBJECT: Professional Presentation Approval 7APR 2017 1. Your paper, entitled Who is Distressed? Applying the Diabetes -Related Distress...Scale in A Diabetes Clinic presented at/published to American Diabetes Association 2017 Meeting, San Francisco, CA (National Conference), 9-16 June...as a publication/presentation, a new 59 MOW Form 3039 must be submitted for review and approval.) Using the Diabetes -Related Distress Scale in

  2. The impact of MRI combined with visual rating scales on the clinical diagnosis of dementia: a prospective study

    Energy Technology Data Exchange (ETDEWEB)

    Verhagen, Martijn V.; Guit, Gerard L. [Spaarne Gasthuis, Department of Radiology, Haarlem (Netherlands); Hafkamp, Gerrit Jan; Kalisvaart, Kees [Spaarne Gasthuis, Department of Geriatrics, Haarlem (Netherlands)

    2016-06-15

    Dementia is foremost a clinical diagnosis. However, in diagnosing dementia, it is advocated to perform at least one neuroimaging study. This has two purposes: to rule out potential reversible dementia (PRD), and to help determine the dementia subtype. Our first goal was to establish if MRI combined with visual rating scales changes the clinical diagnosis. The second goal was to demonstrate if MRI contributes to a geriatrician's confidence in the diagnosis. The dementia subtype was determined prior to and after MRI. Scoring scales used were: global cortical atrophy (GCA), medial temporal atrophy (MTA), and white matter hyperintensity measured according to the Fazekas scale. The confidence level of the geriatrician was determined using a visual analogue scale. One hundred and thirty-five patients were included. After MRI, the diagnosis changed in 23.7 % (CI 17.0 %-31.1 %) of patients. Change was due to vascular aetiology in 13.3 % of patients. PRD was found in 2.2 % of all patients. The confidence level in the diagnosis increased significantly after MRI (p = 0.001). MRI, combined with visual rating scales, has a significant impact on dementia subtype diagnosis and on a geriatrician's confidence in the final diagnosis. (orig.)

  3. The impact of MRI combined with visual rating scales on the clinical diagnosis of dementia: a prospective study

    International Nuclear Information System (INIS)

    Verhagen, Martijn V.; Guit, Gerard L.; Hafkamp, Gerrit Jan; Kalisvaart, Kees

    2016-01-01

    Dementia is foremost a clinical diagnosis. However, in diagnosing dementia, it is advocated to perform at least one neuroimaging study. This has two purposes: to rule out potential reversible dementia (PRD), and to help determine the dementia subtype. Our first goal was to establish if MRI combined with visual rating scales changes the clinical diagnosis. The second goal was to demonstrate if MRI contributes to a geriatrician's confidence in the diagnosis. The dementia subtype was determined prior to and after MRI. Scoring scales used were: global cortical atrophy (GCA), medial temporal atrophy (MTA), and white matter hyperintensity measured according to the Fazekas scale. The confidence level of the geriatrician was determined using a visual analogue scale. One hundred and thirty-five patients were included. After MRI, the diagnosis changed in 23.7 % (CI 17.0 %-31.1 %) of patients. Change was due to vascular aetiology in 13.3 % of patients. PRD was found in 2.2 % of all patients. The confidence level in the diagnosis increased significantly after MRI (p = 0.001). MRI, combined with visual rating scales, has a significant impact on dementia subtype diagnosis and on a geriatrician's confidence in the final diagnosis. (orig.)

  4. The clinical utility of the MMPI-2-RF Suicidal/Death Ideation Scale.

    Science.gov (United States)

    Gottfried, Emily; Bodell, Lindsay; Carbonell, Joyce; Joiner, Thomas

    2014-12-01

    Suicide is a major public health concern, with over 100 individuals dying by suicide per day in the United States alone. Therefore, suicide risk assessment is an essential aspect of mental health care. The Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF; Ben-Porath & Tellegen, 2008-2011; Tellegen & Ben-Porath, 2008) has a Suicidal/Death Ideation (SUI) scale consisting of 5 items that describe recent suicidal ideation or behaviors. Although this scale has clear face validity, few studies have examined the clinical utility of this scale. The purpose of the current study was to examine associations between the SUI scale and other established measures of suicidal ideation and behavior, including the Depressive Symptom Inventory Suicidality Subscale (DSI-SS; Metalsky & Joiner, 1997), Beck Scale for Suicide Ideation (BSS; Beck & Steer, 1991; Beck, Steer, & Ranieri, 1988), self-report of lifetime suicide attempts, and clinician ratings of suicide risk. Participants were 998 therapy- and assessment-seeking outpatients. Analyses indicated that the SUI scale was positively associated with other self-reported measures of suicidal ideation and behavior. Significant differences in SUI scale scores also emerged among the clinician rating categories of suicide risk. The SUI scale was able to predict previous suicide attempts over and above age, gender, and other MMPI-2-RF scales related to depression. Finally, relative risk ratios for suicide attempts indicate increased risk of suicidality, with higher T scores on the SUI scale. Overall, findings suggest that the MMPI-2-RF SUI scale may be a useful tool for identifying individuals at risk for suicidal ideation and behavior in clinical settings. (c) 2014 APA, all rights reserved.

  5. Dehydration and performance on clinical concussion measures in collegiate wrestlers.

    Science.gov (United States)

    Weber, Amanda Friedline; Mihalik, Jason P; Register-Mihalik, Johna K; Mays, Sally; Prentice, William E; Guskiewicz, Kevin M

    2013-01-01

    The effects of dehydration induced by wrestling-related weight-cutting tactics on clinical concussion outcomes, such as neurocognitive function, balance performance, and symptoms, have not been adequately studied. To evaluate the effects of dehydration on the outcome of clinical concussion measures in National Collegiate Athletic Association Division I collegiate wrestlers. Repeated-measures design. Clinical research laboratory. Thirty-two Division I healthy collegiate male wrestlers (age = 20.0 ± 1.4 years; height = 175.0 ± 7.5 cm; baseline mass = 79.2 ± 12.6 kg). Participants completed preseason concussion baseline testing in early September. Weight and urine samples were also collected at this time. All participants reported to prewrestling practice and postwrestling practice for the same test battery and protocol in mid-October. They had begun practicing weight-cutting tactics a day before prepractice and postpractice testing. Differences between these measures permitted us to evaluate how dehydration and weight-cutting tactics affected concussion measures. Sport Concussion Assessment Tool 2 (SCAT2), Balance Error Scoring System, Graded Symptom Checklist, and Simple Reaction Time scores. The Simple Reaction Time was measured using the Automated Neuropsychological Assessment Metrics. The SCAT2 measurements were lower at prepractice (P = .002) and postpractice (P < .001) when compared with baseline. The BESS error scores were higher at postpractice when compared with baseline (P = .015). The GSC severity scores were higher at prepractice (P = .011) and postpractice (P < .001) than at baseline and at postpractice when than at prepractice (P = .003). The number of Graded Symptom Checklist symptoms reported was also higher at prepractice (P = .036) and postpractice (P < .001) when compared with baseline, and at postpractice when compared with prepractice (P = .003). Our results suggest that it is important for wrestlers to be evaluated in a euhydrated state to

  6. Psychometric Analysis of the Barber Suggestibility Scale in a Clinical Population.

    Science.gov (United States)

    Pellicer Asensio, Xavier; Fusté Escolano, Adela; Ruiz Rodríguez, José

    2018-04-01

    The aim of the study was to administer the Barber suggestibility scale to a clinical population in Spain and to examine its psychometric properties therein. The reliability and factor structure of the adapted scale was compared with that of the original (American) scale and with data from two other versions (British and Puerto Rican samples). Sex differences in suggestibility were also analyzed. The Barber suggestibility scale was administered (without preliminaries) to a sample of 283 patients (130 women, 153 men) with a range of diagnoses: anxiety disorder (33.9%), substance-related and addictive disorder (25.8%), mood disorder (12.7%), somatic symptom disorder (4.6%), trauma- and stress-related disorder (3.5%), and other disorders (19.5%). Results indicated a higher degree of suggestibility among women, with the effect size being low (d = 0.26) for the objective subscale and moderate (d = 0.55) for the subjective subscale. Therefore, normative scores were reported by sex for both subscales. As a whole, the present clinical sample showed higher suggestibility than has been reported previously for nonclinical populations (p suggestibility scale showed a three-factor structure for the objective subscale and a more complex structure for the subjective subscale. These results suggest that the Barber suggestibility scale is a suitable instrument for assessing the degree of suggestibility in persons with a clinical disorder.

  7. Limited accessibility to designs and results of Japanese large-scale clinical trials for cardiovascular diseases.

    Science.gov (United States)

    Sawata, Hiroshi; Ueshima, Kenji; Tsutani, Kiichiro

    2011-04-14

    Clinical evidence is important for improving the treatment of patients by health care providers. In the study of cardiovascular diseases, large-scale clinical trials involving thousands of participants are required to evaluate the risks of cardiac events and/or death. The problems encountered in conducting the Japanese Acute Myocardial Infarction Prospective (JAMP) study highlighted the difficulties involved in obtaining the financial and infrastructural resources necessary for conducting large-scale clinical trials. The objectives of the current study were: 1) to clarify the current funding and infrastructural environment surrounding large-scale clinical trials in cardiovascular and metabolic diseases in Japan, and 2) to find ways to improve the environment surrounding clinical trials in Japan more generally. We examined clinical trials examining cardiovascular diseases that evaluated true endpoints and involved 300 or more participants using Pub-Med, Ichushi (by the Japan Medical Abstracts Society, a non-profit organization), websites of related medical societies, the University Hospital Medical Information Network (UMIN) Clinical Trials Registry, and clinicaltrials.gov at three points in time: 30 November, 2004, 25 February, 2007 and 25 July, 2009. We found a total of 152 trials that met our criteria for 'large-scale clinical trials' examining cardiovascular diseases in Japan. Of these, 72.4% were randomized controlled trials (RCTs). Of 152 trials, 9.2% of the trials examined more than 10,000 participants, and 42.8% examined between 1,000 and 10,000 participants. The number of large-scale clinical trials markedly increased from 2001 to 2004, but suddenly decreased in 2007, then began to increase again. Ischemic heart disease (39.5%) was the most common target disease. Most of the larger-scale trials were funded by private organizations such as pharmaceutical companies. The designs and results of 13 trials were not disclosed. To improve the quality of clinical

  8. Limited accessibility to designs and results of Japanese large-scale clinical trials for cardiovascular diseases

    Directory of Open Access Journals (Sweden)

    Tsutani Kiichiro

    2011-04-01

    Full Text Available Abstract Background Clinical evidence is important for improving the treatment of patients by health care providers. In the study of cardiovascular diseases, large-scale clinical trials involving thousands of participants are required to evaluate the risks of cardiac events and/or death. The problems encountered in conducting the Japanese Acute Myocardial Infarction Prospective (JAMP study highlighted the difficulties involved in obtaining the financial and infrastructural resources necessary for conducting large-scale clinical trials. The objectives of the current study were: 1 to clarify the current funding and infrastructural environment surrounding large-scale clinical trials in cardiovascular and metabolic diseases in Japan, and 2 to find ways to improve the environment surrounding clinical trials in Japan more generally. Methods We examined clinical trials examining cardiovascular diseases that evaluated true endpoints and involved 300 or more participants using Pub-Med, Ichushi (by the Japan Medical Abstracts Society, a non-profit organization, websites of related medical societies, the University Hospital Medical Information Network (UMIN Clinical Trials Registry, and clinicaltrials.gov at three points in time: 30 November, 2004, 25 February, 2007 and 25 July, 2009. Results We found a total of 152 trials that met our criteria for 'large-scale clinical trials' examining cardiovascular diseases in Japan. Of these, 72.4% were randomized controlled trials (RCTs. Of 152 trials, 9.2% of the trials examined more than 10,000 participants, and 42.8% examined between 1,000 and 10,000 participants. The number of large-scale clinical trials markedly increased from 2001 to 2004, but suddenly decreased in 2007, then began to increase again. Ischemic heart disease (39.5% was the most common target disease. Most of the larger-scale trials were funded by private organizations such as pharmaceutical companies. The designs and results of 13 trials were not

  9. Translation, adaptation, and validation of the Stanford Hypnotic Clinical Scale in Puerto Rico.

    Science.gov (United States)

    Deynes-Exclusa, Yazmin; Sayers-Montalvo, Sean K; Martinez-Taboas, Alfonso

    2011-04-01

    The only hypnotizability scale that has been translated and validated for the Puerto Rican population is the Barber Suggestibility Scale (BSS). In this article, the Stanford Hypnotic Clinical Scale (SHCS) was translated and validated for this population. The translated SHCS ("Escala Stanford de Hipnosis Clinica" [ESHC]) was administered individually to 100 Puerto Rican college students. There were no significant differences found between the norms of the original SHCS samples and the Spanish version of the SHCS. Both samples showed similar distributions. The Spanish version's internal reliability as well as the item discrimination index were adequate. The authors conclude that the ESHC is an adequate instrument to measure hypnotizability in the Puerto Rican population.

  10. Improvements in cognition, quality of life, and physical performance with clinical Pilates in multiple sclerosis: a randomized controlled trial.

    Science.gov (United States)

    Küçük, Fadime; Kara, Bilge; Poyraz, Esra Çoşkuner; İdiman, Egemen

    2016-03-01

    [Purpose] The aim of this study was to determine the effects of clinical Pilates in multiple sclerosis patients. [Subjects and Methods] Twenty multiple sclerosis patients were enrolled in this study. The participants were divided into two groups as the clinical Pilates and control groups. Cognition (Multiple Sclerosis Functional Composite), balance (Berg Balance Scale), physical performance (timed performance tests, Timed up and go test), tiredness (Modified Fatigue Impact scale), depression (Beck Depression Inventory), and quality of life (Multiple Sclerosis International Quality of Life Questionnaire) were measured before and after treatment in all participants. [Results] There were statistically significant differences in balance, timed performance, tiredness and Multiple Sclerosis Functional Composite tests between before and after treatment in the clinical Pilates group. We also found significant differences in timed performance tests, the Timed up and go test and the Multiple Sclerosis Functional Composite between before and after treatment in the control group. According to the difference analyses, there were significant differences in Multiple Sclerosis Functional Composite and Multiple Sclerosis International Quality of Life Questionnaire scores between the two groups in favor of the clinical Pilates group. There were statistically significant clinical differences in favor of the clinical Pilates group in comparison of measurements between the groups. Clinical Pilates improved cognitive functions and quality of life compared with traditional exercise. [Conclusion] In Multiple Sclerosis treatment, clinical Pilates should be used as a holistic approach by physical therapists.

  11. Performance on the Wechsler Adult Intelligence Scale-III in Japanese patients with schizophrenia.

    Science.gov (United States)

    Fujino, Haruo; Sumiyoshi, Chika; Sumiyoshi, Tomiki; Yasuda, Yuka; Yamamori, Hidenaga; Ohi, Kazutaka; Fujimoto, Michiko; Umeda-Yano, Satomi; Higuchi, Arisa; Hibi, Yumiko; Matsuura, Yukako; Hashimoto, Ryota; Takeda, Masatoshi; Imura, Osamu

    2014-07-01

    Patients with schizophrenia have been reported to perform worse than non-schizophrenic populations on neuropsychological tests, which may be affected by cultural factors. The aim of this study was to examine the performance of a sizable number of patients with schizophrenia on the Japanese version of the Wechsler Adult Intelligence Scale-III (WAIS-III) compared with healthy controls. Performance on the WAIS-III was evaluated in 157 Japanese patients with schizophrenia and in 264 healthy control subjects. All IQ scores and four indices from the WAIS-III were impaired for patients with schizophrenia compared with healthy controls. Processing Speed was markedly disturbed, approximately 2 SD below that of the healthy control group. Among the 13 subtests, Comprehension (z = -1.70, d = 1.55), Digit Symbol Coding (z = -1.84, d = 1.88), and Symbol Search (z = -1.85, d = 1.77) were profoundly impaired relative to the healthy controls. These results indicate that the pattern and degree of impairment, as evaluated by the WAIS-III, in Japanese patients are similar to those previously reported in English-speaking patients and that the deficits of some neuropsychological domains relevant to functional outcomes are universally characteristic of schizophrenia. © 2014 The Authors. Psychiatry and Clinical Neurosciences © 2014 Japanese Society of Psychiatry and Neurology.

  12. Relationship between oral clinical conditions and daily performances

    Directory of Open Access Journals (Sweden)

    Andréa Silveira Gomes

    2009-03-01

    Full Text Available The aim of this study was to assess the impact of oral status on the daily performances of civil servants from the Public Works and Waste Management Department of the city of Porto Alegre, located in Southern Brazil. A cross-sectional study was conducted on a representative sample composed of 276 civil servants with ages ranging from 35 to 44 years. The Oral Impacts on Daily Performances index developed was employed to measure impacts caused by oral clinical conditions. Oral examinations were performed after the interviews. Multinomial Logistic Regression Analysis was used. After adjusting for sex and educational level, the results showed that the subjects with high DMFT scores were 5.8 times (95% CI = 2.1-16.1 more likely to have high impacts on their everyday life than those with low DMFT scores. Subjects that presented some coronal caries were 4.3 times (95% CI = 1.9-9.8 more likely to have high impacts on their everyday life than those with no coronal caries. Dental status assessed through the DMFT index and coronal caries are important indicators of impacts on the everyday life of the studied population.

  13. The MMPI-2-Restructured Form and the Standard MMPI-2 Clinical Scales in Relation to DSM-IV

    NARCIS (Netherlands)

    Heijden, P.T. van der; Egger, J.I.M.; Rossi, G.M.P.; Grundel, G.; Derksen, J.J.L.

    2013-01-01

    In a Dutch sample of psychiatric outpatients (N = 94), we linked the Minnesota Multiphasic Personality Inventory–2 (MMPI-2; Butcher et al., 2001) Clinical scales and MMPI-2-Restructured Form (MMPI-2-RF; Ben-Porath & Tellegen, 2008) Higher-Order (H-O) scales, Restructured Clinical (RC) scales and

  14. Reliability Generalization: Exploring Variation of Reliability Coefficients of MMPI Clinical Scales Scores.

    Science.gov (United States)

    Vacha-Haase, Tammi; Kogan, Lori R.; Tani, Crystal R.; Woodall, Renee A.

    2001-01-01

    Used reliability generalization to explore the variance of scores on 10 Minnesota Multiphasic Personality Inventory (MMPI) clinical scales drawing on 1,972 articles in the literature on the MMPI. Results highlight the premise that scores, not tests, are reliable or unreliable, and they show that study characteristics do influence scores on the…

  15. The Strauss and Carpenter Prognostic Scale in subjects clinically at high risk of psychosis

    NARCIS (Netherlands)

    Nieman, D. H.; Velthorst, E.; Becker, H. E.; de Haan, L.; Dingemans, P. M.; Linszen, D. H.; Birchwood, M.; Patterson, P.; Salokangas, R. K. R.; Heinimaa, M.; Heinz, A.; Juckel, G.; von Reventlow, H. G.; Morrison, A.; Schultze-Lutter, F.; Klosterkötter, J.; Ruhrmann, S.; McGorry, Patrick D.; McGlashan, Thomas H.; Knapp, Martin; van de Fliert, Reinaud; Klaassen, Rianne; Picker, Heinz; Neumann, Meike; Brockhaus-Dumke, Anke; Pukrop, Ralf; Svirskis, Tanja; Huttunen, Jukka; Laine, Tiina; Ilonen, Tuula; Ristkari, Terja; Hietala, Jarmo; Skeate, Amanda; Gudlowski, Yehonala; Ozgürdal, Seza; French, Paul; Stevens, Helen

    2013-01-01

    To investigate the predictive value of the Strauss and Carpenter Prognostic Scale (SCPS) for transition to a first psychotic episode in subjects clinically at high risk (CHR) of psychosis. Two hundred and forty-four CHR subjects participating in the European Prediction of Psychosis Study were

  16. Measuring performance improvement: total organizational commitment or clinical specialization.

    Science.gov (United States)

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

    2004-01-01

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

  17. Radioimmunoassay of erythropoietin: analytical performance and clinical use in hematology.

    Science.gov (United States)

    Schlageter, M H; Toubert, M E; Podgorniak, M P; Najean, Y

    1990-10-01

    We report here the performance of a recently commercialized radioimmunoassay kit for determining erythropoietin (EPO) in serum or plasma. The lower detection limit of the method was 3 U/L. Precision, analyzed by the variation coefficients between different assay runs and in the same experiment, was always less than 10%; accuracy was assessed by recovery and dilution tests. In anemic patients (hematocrit 18-39%), the concentration of EPO was logarithmically related to hematocrit. A relatively large dispersion of the results was noted, as reported by others with various RIAs. Patients with severe renal failure demonstrated a very low EPO value, whatever the degree of their anemia. In some chronic anemias resulting from malignancy, EPO concentrations were also relatively low. In the polycythemia vera group, the EPO mean was below normal for greater than 95% of the patients, whatever their clinical stage (first evaluation, relapse, or remission). In contrast, 91% of the patients with pure erythrocytosis had a normal or increased EPO value, even when the etiology was unknown. Measurement of EPO concentration may be useful for the clinical differentiation of myeloproliferative disorders and, subsequently, for their prognosis and choice of treatment.

  18. Assessing Communication Skills of Medical Students in Objective Structured Clinical Examinations (OSCE)--A Systematic Review of Rating Scales.

    Science.gov (United States)

    Cömert, Musa; Zill, Jördis Maria; Christalle, Eva; Dirmaier, Jörg; Härter, Martin; Scholl, Isabelle

    2016-01-01

    Teaching and assessment of communication skills have become essential in medical education. The Objective Structured Clinical Examination (OSCE) has been found as an appropriate means to assess communication skills within medical education. Studies have demonstrated the importance of a valid assessment of medical students' communication skills. Yet, the validity of the performance scores depends fundamentally on the quality of the rating scales used in an OSCE. Thus, this systematic review aimed at providing an overview of existing rating scales, describing their underlying definition of communication skills, determining the methodological quality of psychometric studies and the quality of psychometric properties of the identified rating scales. We conducted a systematic review to identify psychometrically tested rating scales, which have been applied in OSCE settings to assess communication skills of medical students. Our search strategy comprised three databases (EMBASE, PsycINFO, and PubMed), reference tracking and consultation of experts. We included studies that reported psychometric properties of communication skills assessment rating scales used in OSCEs by examiners only. The methodological quality of included studies was assessed using the COnsensus based Standards for the selection of health status Measurement INstruments (COSMIN) checklist. The quality of psychometric properties was evaluated using the quality criteria of Terwee and colleagues. Data of twelve studies reporting on eight rating scales on communication skills assessment in OSCEs were included. Five of eight rating scales were explicitly developed based on a specific definition of communication skills. The methodological quality of studies was mainly poor. The psychometric quality of the eight rating scales was mainly intermediate. Our results reveal that future psychometric evaluation studies focusing on improving the methodological quality are needed in order to yield psychometrically

  19. Assessing Communication Skills of Medical Students in Objective Structured Clinical Examinations (OSCE) - A Systematic Review of Rating Scales

    Science.gov (United States)

    Cömert, Musa; Zill, Jördis Maria; Christalle, Eva; Dirmaier, Jörg; Härter, Martin; Scholl, Isabelle

    2016-01-01

    Background Teaching and assessment of communication skills have become essential in medical education. The Objective Structured Clinical Examination (OSCE) has been found as an appropriate means to assess communication skills within medical education. Studies have demonstrated the importance of a valid assessment of medical students’ communication skills. Yet, the validity of the performance scores depends fundamentally on the quality of the rating scales used in an OSCE. Thus, this systematic review aimed at providing an overview of existing rating scales, describing their underlying definition of communication skills, determining the methodological quality of psychometric studies and the quality of psychometric properties of the identified rating scales. Methods We conducted a systematic review to identify psychometrically tested rating scales, which have been applied in OSCE settings to assess communication skills of medical students. Our search strategy comprised three databases (EMBASE, PsycINFO, and PubMed), reference tracking and consultation of experts. We included studies that reported psychometric properties of communication skills assessment rating scales used in OSCEs by examiners only. The methodological quality of included studies was assessed using the COnsensus based Standards for the selection of health status Measurement INstruments (COSMIN) checklist. The quality of psychometric properties was evaluated using the quality criteria of Terwee and colleagues. Results Data of twelve studies reporting on eight rating scales on communication skills assessment in OSCEs were included. Five of eight rating scales were explicitly developed based on a specific definition of communication skills. The methodological quality of studies was mainly poor. The psychometric quality of the eight rating scales was mainly intermediate. Discussion Our results reveal that future psychometric evaluation studies focusing on improving the methodological quality are needed

  20. Scaling earthquake ground motions for performance-based assessment of buildings

    Science.gov (United States)

    Huang, Y.-N.; Whittaker, A.S.; Luco, N.; Hamburger, R.O.

    2011-01-01

    The impact of alternate ground-motion scaling procedures on the distribution of displacement responses in simplified structural systems is investigated. Recommendations are provided for selecting and scaling ground motions for performance-based assessment of buildings. Four scaling methods are studied, namely, (1)geometric-mean scaling of pairs of ground motions, (2)spectrum matching of ground motions, (3)first-mode-period scaling to a target spectral acceleration, and (4)scaling of ground motions per the distribution of spectral demands. Data were developed by nonlinear response-history analysis of a large family of nonlinear single degree-of-freedom (SDOF) oscillators that could represent fixed-base and base-isolated structures. The advantages and disadvantages of each scaling method are discussed. The relationship between spectral shape and a ground-motion randomness parameter, is presented. A scaling procedure that explicitly considers spectral shape is proposed. ?? 2011 American Society of Civil Engineers.

  1. Validity, reliability, and feasibility of clinical staging scales in dementia: a systematic review

    DEFF Research Database (Denmark)

    Rikkert, Marcel G M Olde; Tona, Klodiana Daphne; Janssen, Lieneke

    2011-01-01

    New staging systems of dementia require adaptation of disease management programs and adequate staging instruments. Therefore, we systematically reviewed the literature on validity and reliability of clinically applicable, multidomain, and dementia staging instruments. A total of 23 articles...... describing 12 staging instruments were identified (N = 6109 participants, age 65-87). Reliability was studied in most (91%) of the articles and was judged moderate to good. Approximately 78% of the articles evaluated concurrent validity, which was good to very good, while discriminant validity was assessed...... in only 25%. The scales can be applied in ±15 minutes. Clinical Dementia Rating (CDR), Global Deterioration scale (GDS), and Functional Assessment Staging (FAST) have been monitored on reliability and validity, and the CDR currently is the best-evidenced scale, also studied in international perspective...

  2. How Can the Evidence from Global Large-scale Clinical Trials for Cardiovascular Diseases be Improved?

    Science.gov (United States)

    Sawata, Hiroshi; Tsutani, Kiichiro

    2011-06-29

    Clinical investigations are important for obtaining evidence to improve medical treatment. Large-scale clinical trials with thousands of participants are particularly important for this purpose in cardiovascular diseases. Conducting large-scale clinical trials entails high research costs. This study sought to investigate global trends in large-scale clinical trials in cardiovascular diseases. We searched for trials using clinicaltrials.gov (URL: http://www.clinicaltrials.gov/) using the key words 'cardio' and 'event' in all fields on 10 April, 2010. We then selected trials with 300 or more participants examining cardiovascular diseases. The search revealed 344 trials that met our criteria. Of 344 trials, 71% were randomized controlled trials, 15% involved more than 10,000 participants, and 59% were funded by industry. In RCTs whose results were disclosed, 55% of industry-funded trials and 25% of non-industry funded trials reported statistically significant superiority over control (p = 0.012, 2-sided Fisher's exact test). Our findings highlighted concerns regarding potential bias related to funding sources, and that researchers should be aware of the importance of trial information disclosures and conflicts of interest. We should keep considering management and training regarding information disclosures and conflicts of interest for researchers. This could lead to better clinical evidence and further improvements in the development of medical treatment worldwide.

  3. How Can the Evidence from Global Large-scale Clinical Trials for Cardiovascular Diseases be Improved?

    Directory of Open Access Journals (Sweden)

    Tsutani Kiichiro

    2011-06-01

    Full Text Available Abstract Background Clinical investigations are important for obtaining evidence to improve medical treatment. Large-scale clinical trials with thousands of participants are particularly important for this purpose in cardiovascular diseases. Conducting large-scale clinical trials entails high research costs. This study sought to investigate global trends in large-scale clinical trials in cardiovascular diseases. Findings We searched for trials using clinicaltrials.gov (URL: http://www.clinicaltrials.gov/ using the key words 'cardio' and 'event' in all fields on 10 April, 2010. We then selected trials with 300 or more participants examining cardiovascular diseases. The search revealed 344 trials that met our criteria. Of 344 trials, 71% were randomized controlled trials, 15% involved more than 10,000 participants, and 59% were funded by industry. In RCTs whose results were disclosed, 55% of industry-funded trials and 25% of non-industry funded trials reported statistically significant superiority over control (p = 0.012, 2-sided Fisher's exact test. Conclusions Our findings highlighted concerns regarding potential bias related to funding sources, and that researchers should be aware of the importance of trial information disclosures and conflicts of interest. We should keep considering management and training regarding information disclosures and conflicts of interest for researchers. This could lead to better clinical evidence and further improvements in the development of medical treatment worldwide.

  4. Self-perceived versus objectively measured competence in performing clinical practical procedures by final year medical students

    OpenAIRE

    Katowa-Mukwato, Patricia; Banda, Sekelani

    2016-01-01

    Objectives To determine and compare the self-perceived and objectively measured competence in performing 14 core-clinical practical procedures by Final Year Medical Students of the University of Zambia. Methods The study included 56 out of 60 graduating University of Zambia Medical Students of the 2012/2013 academic year. Self-perceived competence: students rated their competence on 14 core- clinical practical procedures using a self-administered questionnaire on a 5-point Likert scale. Objec...

  5. Clinical nutrition and foodservice personnel in teaching hospitals have different perceptions of total quality management performance.

    Science.gov (United States)

    Chong, Y; Unklesbay, N; Dowdy, R

    2000-09-01

    To investigate the perceived total quality management (TQM) performance of their department by clinical nutrition managers and dietitians, and foodservice managers and supervisors, in hospital food and nutrition service departments. Using a 2-part questionnaire containing items about 3 constructs of TQM performance and demographic characteristics, participants rated their perceptions of TQM performance. Employees in 7 Council of Teaching Hospitals. Of the 128 possible respondents, 73 (57%) completed the study. Correlation analysis to identify relationships between demographic characteristics and TQM performance. Analysis of variance to investigate statistical differences among hospitals and between subject groups and types of employment positions. Three TQM constructs--organization, information, and quality management--were evaluated. The clinical nutrition manager and dietitian group had mean ratings between 3.1 and 4.7 (5-point Likert scale); the foodservice manager and supervisor group had mean ratings from 2.7 to 4.0. Education level was significantly correlated (r = 0.44) to performance of employee training in the clinical nutrition group. The number of employees directly supervised was negatively correlated (r = -0.21) to the performance of employee training in the foodservice group. As the dynamic roles of dietitians change, many dietitians will occupy management positions in organizations such as restaurants, health food stores, food processing/distribution companies, and schools. This study demonstrates how a TQM survey instrument could be applied to clinical nutrition and foodservice settings. Dietitians will need to assess TQM in their workplace facilities, especially because of the direct links of TQM to productivity and client satisfaction.

  6. Validation of the Oral Hygiene Habits Scale: Relationships with sociodemographic variables in the general and clinical population of Monterrey, Mexico.

    Directory of Open Access Journals (Sweden)

    Norma Rodríguez

    2016-12-01

    Full Text Available Several socioeconomic factors are associated with poor oral hygiene habits. A version of the Oral Hygiene Habits Scale (OHHS was developed in Mexico to measure these factors; however, its relationship with sociodemographic variables has not been studied. The verification of these relationships could contribute to the validation of the scale. Objective: To evaluate the relationship between oral hygiene habits and sociodemographic variables of sex, age, schooling, self-defined socioeconomic stratum, occupation and marital status in the general and clinical population of Monterrey, Mexico. Materials and Methods: A general population sample (GPS of 256 participants and a clinical sample (CPS of 240 participants were studied. The OHHS consisted of an eight-item Likert scale of 4 points ranging from 0 to 4. A descriptive correlational study was performed with a cross-sectional design. Data were analyzed using the Mann-Whitney U test, Kruskal-Wallis test, Spearman correlation coefficient, Cramer's V coefficient, and multivariate aligned rank test. Results: In GPS and CPS groups, OHHS was related to sex, schooling, socioeconomic stratum, occupation and marital status, but not to age. There were no significant interactions between the samples (GPS and CPS and sociodemographic variables. Conclusion: There is a statistically significant relationship between oral hygiene habits and some sociodemographic variables in the general and clinical population. This relationship supports the validity of the OHHS.

  7. Should we assess clinical performance in single patient encounters or consistent behaviors of clinical performance over a series of encounters? A qualitative exploration of narrative trainee profiles

    NARCIS (Netherlands)

    Oerlemans, M.; Dielissen, P.W.; Timmerman, A.; Ram, P.; Maiburg, B.; Muris, J.; Vleuten, C. van der

    2017-01-01

    BACKGROUND: A variety of tools have been developed to assess performance which typically use a single clinical encounter as a source for making competency inferences. This strategy may miss consistent behaviors. We therefore explored experienced clinical supervisors' perceptions of behavioral

  8. Outcome Rating Scale and Session Rating Scale in Psychological Practice: Clinical Utility of Ultra-Brief Measures

    Science.gov (United States)

    Campbell, Alistair; Hemsley, Samantha

    2009-01-01

    The validity and reliability of the Outcome Rating Scale (ORS) and the Session Rating Scale (SRS) were evaluated against existing longer measures, including the Outcome Questionnaire-45, Working Alliance Inventory, Depression Anxiety Stress Scale-21, Quality of Life Scale, Rosenberg Self-Esteem Scale and General Self-efficacy Scale. The measures…

  9. Association Between Undergraduate Performance Predictors and Academic and Clinical Performance of Osteopathic Medical Students.

    Science.gov (United States)

    Agahi, Farshad; Speicher, Mark R; Cisek, Grace

    2018-02-01

    Medical schools use a variety of preadmission indices to select potential students. These indices generally include undergraduate grade point average (GPA), Medical College Admission Test (MCAT) scores, and preadmission interviews. To investigate whether the admission indices used by Midwestern University Arizona College of Osteopathic Medicine are associated with the academic and clinical performance of their students. Associations between the prematriculation variables of undergraduate science GPA, undergraduate total GPA, MCAT component scores, and interview scores and the academic and clinical variables of the first- and second-year medical school GPA, Comprehensive Osteopathic Medical Licensing Examination-USA (COMLEX-USA) Level 1 and Level 2-Cognitive Evaluation (CE) total and discipline scores, scores in clinical rotations for osteopathic competencies, COMLEX-USA Level 2-Performance Evaluation passage, and match status were evaluated. Two-tailed Pearson product-moment correlations with a Bonferroni adjustment were used to examine these relationships. The traditional predictors of science and total undergraduate GPA as well as total and component MCAT scores had small to moderate associations with first- and second-year GPA, as well as COMLEX-USA Level 1 and Level 2-CE total scores. Of all predictors, only the MCAT biological sciences score had a statistically significant correlation with failure of the COMLEX-USA Level 2-Performance Evaluation examination (P=.009). Average interview scores were associated only with the osteopathic competency of medical knowledge (r=0.233; n=209; P=.001), as assessed by clerkship preceptors. No predictors were associated with scores in objective structured clinical encounters or with failing to match to a residency position. The data indicate that traditional predictors of academic performance (undergraduate GPA, undergraduate science GPA, and MCAT scores) have small to moderate association with medical school grades and

  10. Test-retest reliability of the Clinical Learning Environment, Supervision and Nurse Teacher (CLES + T) scale.

    Science.gov (United States)

    Gustafsson, Margareta; Blomberg, Karin; Holmefur, Marie

    2015-07-01

    The Clinical Learning Environment, Supervision and Nurse Teacher (CLES + T) scale evaluates the student nurses' perception of the learning environment and supervision within the clinical placement. It has never been tested in a replication study. The aim of the present study was to evaluate the test-retest reliability of the CLES + T scale. The CLES + T scale was administered twice to a group of 42 student nurses, with a one-week interval. Test-retest reliability was determined by calculations of Intraclass Correlation Coefficients (ICCs) and weighted Kappa coefficients. Standard Error of Measurements (SEM) and Smallest Detectable Difference (SDD) determined the precision of individual scores. Bland-Altman plots were created for analyses of systematic differences between the test occasions. The results of the study showed that the stability over time was good to excellent (ICC 0.88-0.96) in the sub-dimensions "Supervisory relationship", "Pedagogical atmosphere on the ward" and "Role of the nurse teacher". Measurements of "Premises of nursing on the ward" and "Leadership style of the manager" had lower but still acceptable stability (ICC 0.70-0.75). No systematic differences occurred between the test occasions. This study supports the usefulness of the CLES + T scale as a reliable measure of the student nurses' perception of the learning environment within the clinical placement at a hospital. Copyright © 2015 Elsevier Ltd. All rights reserved.

  11. Nonverbal cognitive development in children with cochlear implants: relationship between the Mullen Scales of Early Learning and later performance on the Leiter International Performance Scales-Revised.

    Science.gov (United States)

    Caudle, Susan E; Katzenstein, Jennifer M; Oghalai, John S; Lin, Jerry; Caudle, Donald D

    2014-02-01

    Methodologically, longitudinal assessment of cognitive development in young children has proven difficult because few measures span infancy through school age. This matter is further complicated when the child presents with a sensory deficit such as hearing loss. Few measures are validated in this population, and children who are evaluated for cochlear implantation are often reevaluated annually. The authors sought to evaluate the predictive validity of subscales of the Mullen Scales of Early Learning (MSEL) on Leiter International Performance Scales-Revised (LIPS-R) Full-Scale IQ scores. To further elucidate the relationship of these two measures, comparisons were also made with the Vineland Adaptive Behavior Scale-Second Edition (VABS), which provides a measure of adaptive functioning across the life span. Participants included 35 children (14 female, 21 male) who were evaluated both as part of the precandidacy process for cochlear implantation using the MSEL and VABS and following implantation with the LIPS-R and VABS. Hierarchical linear regression revealed that the MSEL Visual Reception subdomain score significantly predicted 52% of the variance in LIPS-R Full-Scale IQ scores at follow-up, F(1, 34) = 35.80, p < .0001, R (2) = .52, β = .72. This result suggests that the Visual Reception subscale offers predictive validity of later LIPS-R Full-Scale IQ scores. The VABS was also significantly correlated with cognitive variables at each time point.

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

    Directory of Open Access Journals (Sweden)

    Kadouri Alane

    2007-02-01

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

  13. Comparison of clinical and biochemical markers of dehydration with the clinical dehydration scale in children: a case comparison trial.

    Science.gov (United States)

    Tam, Ron K; Wong, Hubert; Plint, Amy; Lepage, Nathalie; Filler, Guido

    2014-06-16

    The clinical dehydration scale (CDS) is a quick, easy-to-use tool with 4 clinical items and a score of 1-8 that serves to classify dehydration in children with gastroenteritis as no, some or moderate/severe dehydration. Studies validating the CDS (Friedman JN) with a comparison group remain elusive. We hypothesized that the CDS correlates with a wide spectrum of established markers of dehydration, making it an appropriate and easy-to-use clinical tool. This study was designed as a prospective double-cohort trial in a single tertiary care center. Children with diarrhea and vomiting, who clinically required intravenous fluids for rehydration, were compared with minor trauma patients who required intravenous needling for conscious sedation. We compared the CDS with clinical and urinary markers (urinary electrolytes, proteins, ratios and fractional excretions) for dehydration in both groups using receiver operating characteristic (ROC) curves to determine the area under the curve (AUC). We enrolled 73 children (male = 36) in the dehydration group and 143 (male = 105) in the comparison group. Median age was 32 months (range 3-214) in the dehydration and 96 months (range 2.6-214 months, p dehydration group and 0 in the comparison group (p dehydrated group: difference in heart rate, diastolic blood pressure, urine sodium/potassium ratio, urine sodium, fractional sodium excretion, serum bicarbonate, and creatinine measurements. The best markers for dehydration were urine Na and serum bicarbonate (ROC AUC = 0.798 and 0.821, respectively). CDS was most closely correlated with serum bicarbonate (Pearson r = -0.3696, p = 0.002). Although serum bicarbonate is not the gold standard for dehydration, this study provides further evidence for the usefulness of the CDS as a dehydration marker in children. Registered at ClinicalTrials.gov (NCT00462527) on April 18, 2007.

  14. The Impact of Micro-Finance on the Performance of Small-Scale ...

    African Journals Online (AJOL)

    The Impact of Micro-Finance on the Performance of Small-Scale Enterprises: A Comparison of ... PROMOTING ACCESS TO AFRICAN RESEARCH ... the impact that the study-MFIs are making on their SMEs-client in the Wa Municipality.

  15. Three-dimensional analysis of free-electron laser performance using brightness scaled variables

    Directory of Open Access Journals (Sweden)

    M. Gullans

    2008-06-01

    Full Text Available A three-dimensional analysis of radiation generation in a free-electron laser (FEL is performed in the small signal regime. The analysis includes beam conditioning, harmonic generation, flat beams, and a new scaling of the FEL equations using the six-dimensional beam brightness. The six-dimensional beam brightness is an invariant under Liouvillian flow; therefore, any nondissipative manipulation of the phase space, performed, for example, in order to optimize FEL performance, must conserve this brightness. This scaling is more natural than the commonly used scaling with the one-dimensional growth rate. The brightness-scaled equations allow for the succinct characterization of the optimal FEL performance under various additional constraints. The analysis allows for the simple evaluation of gain enhancement schemes based on beam phase space manipulations such as emittance exchange and conditioning. An example comparing the gain in the first and third harmonics of round or flat and conditioned or unconditioned beams is presented.

  16. [Discussion on development of four diagnostic information scale for clinical re-evaluation of postmarketing herbs].

    Science.gov (United States)

    He, Wei; Xie, Yanming; Wang, Yongyan

    2011-12-01

    Post-marketing re-evaluation of Chinese herbs can well reflect Chinese medicine characteristics, which is the most easily overlooked the clinical re-evaluation content. Since little attention has been paid to this, study on the clinical trial design method was lost. It is difficult to improving the effectiveness and safety of traditional Chinese medicine. Therefore, more attention should be paid on re-evaluation of the clinical trial design method point about tcm syndrome such as the type of research program design, the study of Chinese medical information collection scale and statistical analysis methods, so as to improve the clinical trial design method study about tcm syndrome of Chinese herbs postmarketing re-evalutation status.

  17. Performance of small-scale photovoltaic systems and their potential for rural electrification in Ethiopia

    Energy Technology Data Exchange (ETDEWEB)

    Stutenbaeumer, Ulrich; Negash, Tesfaye; Abdi, Amensisa [Addis Ababa Univ., Dept. of Physics, Addis Ababa (Ethiopia)

    1999-09-01

    The performance of small-scale stand-alone photovoltaic systems is tested under the climatic conditions of Addis Ababa, Ethiopia. With climatic data obtained at a station in the Rift Valley, the photovoltaic systems performance is estimated for those climatic conditions. The economics of small-scale stand-alone photovoltaic system applications under Ethiopian conditions are analysed. The potential of photovoltaics for the rural electrification of Ethiopia is discussed. (Author)

  18. Deciphering the clinical effect of drugs through large-scale data integration

    DEFF Research Database (Denmark)

    Kjærulff, Sonny Kim

    . This work demonstrates the power of a strategy that uses clinical data mining in association with chemical biology in order to reduce the search space and aid identification of novel drug actions. The second article described in chapter 3 outlines a high confidence side-effect-drug interaction dataset. We...... demonstrates the importance of using high-confidence drug-side-effect data in deciphering the effect of small molecules in humans. In summary, this thesis presents computational systems chemical biology approaches that can help identify clinical effects of small molecules through large-scale data integration...

  19. Psychometric properties and clinical relevance of the adolescent sleep hygiene scale in Dutch adolescents.

    Science.gov (United States)

    de Bruin, Eduard J; van Kampen, Ris K A; van Kooten, Tamar; Meijer, Anne Marie

    2014-07-01

    This study investigated reliability, validity, and clinical relevance of the Adolescent Sleep Hygiene Scale (ASHS) in Dutch adolescents. The Dutch translation of the ASHS was administered to 186 normal-sleeping adolescents and 112 adolescents with insomnia. Their sleep variables were measured using sleep logs and questionnaires. From the insomnia group, scores were also obtained after six weeks of cognitive behavioral therapy for insomnia (n=58) or waiting list (n=22). The full scale of the ASHS had acceptable internal consistency. The results showed moderate to strong correlations of the ASHS (domains) with sleep quality, sleep duration and chronic sleep reduction. Furthermore, the Dutch ASHS was able to discriminate between normal sleepers and adolescents with insomnia, and scores of adolescents with insomnia improved after treatment. These findings confirm the importance of sleep hygiene in adolescent sleep, and contribute to the validity of the ASHS and its applicability in research and clinical practice. Copyright © 2014 Elsevier B.V. All rights reserved.

  20. Next-generation negative symptom assessment for clinical trials: validation of the Brief Negative Symptom Scale.

    Science.gov (United States)

    Strauss, Gregory P; Keller, William R; Buchanan, Robert W; Gold, James M; Fischer, Bernard A; McMahon, Robert P; Catalano, Lauren T; Culbreth, Adam J; Carpenter, William T; Kirkpatrick, Brian

    2012-12-01

    The current study examined the psychometric properties of the Brief Negative Symptom Scale (BNSS), a next-generation rating instrument developed in response to the NIMH sponsored consensus development conference on negative symptoms. Participants included 100 individuals with a DSM-IV diagnosis of schizophrenia or schizoaffective disorder who completed a clinical interview designed to assess negative, positive, disorganized, and general psychiatric symptoms, as well as functional outcome. A battery of anhedonia questionnaires and neuropsychological tests were also administered. Results indicated that the BNSS has excellent internal consistency and temporal stability, as well as good convergent and discriminant validity in its relationships with other symptom rating scales, functional outcome, self-reported anhedonia, and neuropsychological test scores. Given its brevity (13-items, 15-minute interview) and good psychometric characteristics, the BNSS can be considered a promising new instrument for use in clinical trials. Copyright © 2012 Elsevier B.V. All rights reserved.

  1. A review of empirical research related to the use of small quantitative samples in clinical outcome scale development.

    Science.gov (United States)

    Houts, Carrie R; Edwards, Michael C; Wirth, R J; Deal, Linda S

    2016-11-01

    There has been a notable increase in the advocacy of using small-sample designs as an initial quantitative assessment of item and scale performance during the scale development process. This is particularly true in the development of clinical outcome assessments (COAs), where Rasch analysis has been advanced as an appropriate statistical tool for evaluating the developing COAs using a small sample. We review the benefits such methods are purported to offer from both a practical and statistical standpoint and detail several problematic areas, including both practical and statistical theory concerns, with respect to the use of quantitative methods, including Rasch-consistent methods, with small samples. The feasibility of obtaining accurate information and the potential negative impacts of misusing large-sample statistical methods with small samples during COA development are discussed.

  2. Development of a clinical spasticity scale for evaluation of dogs with chronic thoracolumbar spinal cord injury.

    Science.gov (United States)

    Lewis, Melissa J; Olby, Natasha J

    2017-07-01

    OBJECTIVE To develop a spasticity scale for dogs with chronic deficits following severe spinal cord injury (SCI) for use in clinical assessment and outcome measurement in clinical trials. ANIMALS 20 chronically paralyzed dogs with a persistent lack of hind limb pain perception caused by an acute SCI at least 3 months previously. PROCEDURES Spasticity was assessed in both hind limbs via tests of muscle tone, clonus, and flexor and extensor spasms adapted from human scales. Measurement of patellar clonus duration and flexor spasm duration and degree was feasible. These components were used to create a canine spasticity scale (CSS; overall score range, 0 to 18). Temporal variation for individual dogs and interrater reliability were evaluated. Gait was quantified with published gait scales, and CSS scores were compared with gait scores and clinical variables. Owners were questioned regarding spasticity observed at home. RESULTS 20 dogs were enrolled: 18 with no apparent hind limb pain perception and 2 with blunted responses; 5 were ambulatory. Testing was well tolerated, and scores were repeatable between raters. Median overall CSS score was 7 (range, 3 to 11), and flexor spasms were the most prominent finding. Overall CSS score was not associated with age, SCI duration, lesion location, or owner-reported spasticity. Overall CSS score and flexor spasm duration were associated with gait scores. CONCLUSIONS AND CLINICAL RELEVANCE The CSS could be used to quantify hind limb spasticity in dogs with chronic thoracolumbar SCI and might be a useful outcome measure. Flexor spasms may represent an integral part of stepping in dogs with severe SCI.

  3. Validity and Reliability of Clinical Dementia Rating Scale among the Elderly in Iran

    Directory of Open Access Journals (Sweden)

    Nahid Sadeghi

    2012-10-01

    Full Text Available Background: The most common cause of dementia among the elderly is Alzheimer’s disease. Given the increasing population of the elderly, achieving a screening tool with high reliability and validity is an essential need for all communities. The main objective of the project was to determine the Persian version of Clinical Dementia Rating Scale (P-CDR1. Materials and Methods: Twenty subjects were randomly selected from among 150, 50-70 year old people, who were illiterate and not mentally retarded, residing in the nursing home; and they were given the Persian version of CDR scale (test. After three months, the group was given the test again. Results: The findings showed that from the specialists’ standpoint CDR scale had acceptable validity, and the test validity was achieved 0.05 at the significant level with Cronbach’s alpha and reliability coefficients 73% and 89%, respectively. Conclusion: CDR scale is a reliable instrument for evaluation of clinical dementia rating among the elderly in Iran. It can be used in screening dementia, Alzheimer, and diagnosis of the severity and stages of Alzheimer.

  4. Susceptibility of functional impairment scales to noncredible responses in the clinical evaluation of adult ADHD.

    Science.gov (United States)

    Fuermaier, Anselm B M; Tucha, Oliver; Koerts, Janneke; Butzbach, Marah; Weisbrod, Matthias; Aschenbrenner, Steffen; Tucha, Lara

    2018-05-01

    A growing body of research questions the reliance of symptom self-reports in the clinical evaluation of attention-deficit/hyperactivity disorder (ADHD) in adulthood. A recent study suggested that also impairment reports are vulnerable to noncredible responses, as derived from a simulation design using a global functional impairment scale. The present study aims to add evidence to this issue, by using an ADHD specific impairment scale in a simulation design on large samples. Impairment ratings on the Weiss Functional Impairment Rating Scale (WFIRS) of 62 patients with ADHD were compared to 142 healthy individuals who were instructed to show normal behavior. Furthermore, impairment ratings of patients with ADHD were compared to ratings of 330 healthy individuals who were randomly assigned to one of four simulation conditions that were instructed to complete the scale as if they had ADHD. Patients with ADHD reported higher levels of impairment than the healthy control group in all domains of life. Furthermore, individuals instructed to feign ADHD indicated higher levels of impairments in most domains of life compared to control participants and genuine patients with ADHD. The group differences between individuals feigning ADHD and individuals with genuine ADHD, however, were only small to moderate. Further analyses revealed that the WFRIS was not useful to successfully differentiate genuine from feigned ADHD. The present study confirms the conclusion that self-reported impairments are susceptible to noncredible responses and should be used with caution in the clinical evaluation of adult ADHD.

  5. Measurement-based Treatment of Residual Symptoms Using Clinically Useful Depression Outcome Scale: Korean Validation Study

    Science.gov (United States)

    Jeon, Sang Won; Han, Changsu; Ko, Young-Hoon; Yoon, Seo Young; Pae, Chi-Un; Choi, Joonho; Park, Yong Chon; Kim, Jong-Woo; Yoon, Ho-Kyoung; Ko, Seung-Duk; Patkar, Ashwin A.; Zimmerman, Mark

    2017-01-01

    Objective This study was aimed at evaluating the diagnostic validity of the Korean version of the Clinically Useful Depression Outcome Scale (CUDOS) with varying follow-up in a typical clinical setting in multiple centers. Methods In total, 891 psychiatric outpatients were enrolled at the time of their intake appointment. Current diagnostic characteristics were examined using the Structured Clinical Interview for DSM-IV (41% major depressive disorder). The CUDOS was measured and compared with three clinician rating scales and four self-report scales. Results The CUDOS showed excellent results for internal consistency (Cronbach’s α, 0.91), test-retest reliability (patients at intake, r=0.81; depressed patients in ongoing treatment, r=0.89), and convergent and discriminant validity (measures of depression, r=0.80; measures of anxiety and somatization, r=0.42). The CUDOS had a high ability to discriminate between different levels of depression severity based on the rating of Clinical Global Impression for depression severity and the diagnostic classification of major depression, minor depression, and non-depression. The ability of the CUDOS to identify patients with major depression was high (area under the receiver operating characteristic curve=0.867). A score of 20 as the optimal cutoff point was suggested when screening for major depression using the CUDOS (sensitivity=89.9%, specificity=69.5%). The CUDOS was sensitive to change after antidepressant treatment: patients with greater improvement showed a greater decrease in CUDOS scores (p<0.001). Conclusion The results of this multi-site outpatient study found that the Korean version of the CUDOS is a very useful measurement for research and for clinical practice. PMID:28138107

  6. External validation of the clinical dehydration scale for children with acute gastroenteritis.

    Science.gov (United States)

    Bailey, Benoit; Gravel, Jocelyn; Goldman, Ran D; Friedman, Jeremy N; Parkin, Patricia C

    2010-06-01

    The objective was to validate the clinical dehydration scale (CDS) for children with gastroenteritis in a different pediatric emergency department (ED) from where it was initially derived and validated. A prospective cohort study was performed in a tertiary care pediatric ED over a 1-year period. A sample of triage nurses were trained in applying the CDS. The CDS consists of four clinical characteristics (general appearance, eyes, mucous membranes, and tears), each of which are scored 0, 1, or 2 for a total score of 0 to 8, with 0 representing no dehydration; 1 to 4, some dehydration; and 5 to 8, moderate/severe dehydration. Children 1 month to 5 years of age with vomiting and/or diarrhea who had the CDS documented at triage and a final diagnosis of gastroenteritis, gastritis, or enteritis were enrolled. Exclusion criteria included a chronic disease, treatment with intravenous (IV) rehydration within the previous 24 hours, visit to the ED for the same illness in the 7 days prior to arrival, and diarrhea of more than 10 days' duration. The primary outcome was the length of stay (LOS) in the ED from the time of seeing a physician to discharge, analyzed with a Kruskal-Wallis test. From April 2008 to March 2009, 150 patients with a mean (+/-SD) age of 22 (+/-14) months (range = 4 months to 4 years) were enrolled. Fifty-six patients had no dehydration, 74 had some dehydration, and 20 had moderate/severe dehydration. The median LOS in the ED after being seen by a physician was significantly longer as children appeared more dehydrated according to the CDS: 54 minutes (interquartile range [IQR] = 26-175 minutes), 128 minutes (IQR = 25-334 minutes), and 425 minutes (IQR = 218-673 minutes) for the no, some, and moderate/severe dehydration groups, respectively (p children with gastroenteritis in a different pediatric center than the original one where it was developed. It is a good predictor of LOS in the ED after being seen by a physician. (c) 2010 by the Society for

  7. Minimal detectable change of the Personal and Social Performance scale in individuals with schizophrenia.

    Science.gov (United States)

    Lee, Shu-Chun; Tang, Shih-Fen; Lu, Wen-Shian; Huang, Sheau-Ling; Deng, Nai-Yu; Lue, Wen-Chyn; Hsieh, Ching-Lin

    2016-12-30

    The minimal detectable change (MDC) of the Personal and Social Performance scale (PSP) has not yet been investigated, limiting its utility in data interpretation. The purpose of this study was to determine the MDCs of the PSP administered by the same rater or different raters in individuals with schizophrenia. Participants with schizophrenia were recruited from two psychiatric community rehabilitation centers to complete the PSP assessments twice, 2 weeks apart, by the same rater or 2 different raters. MDC values were calculated from the coefficients of intra- and inter-rater reliability (i.e., intraclass correlation coefficients). Forty patients (mean age 36.9 years, SD 9.7) from one center participated in the intra-rater reliability study. Another 40 patients (mean age 44.3 years, SD 11.1) from the other center participated in the inter-rater study. The MDCs (MDC%) of the PSP were 10.7 (17.1%) for the same rater and 16.2 (24.1%) for different raters. The MDCs of the PSP appeared appropriate for clinical trials aiming to determine whether a real change in social functioning has occurred in people with schizophrenia. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  8. Direct Observation of Clinical Skills Feedback Scale: Development and Validity Evidence.

    Science.gov (United States)

    Halman, Samantha; Dudek, Nancy; Wood, Timothy; Pugh, Debra; Touchie, Claire; McAleer, Sean; Humphrey-Murto, Susan

    2016-01-01

    Construct: This article describes the development and validity evidence behind a new rating scale to assess feedback quality in the clinical workplace. Competency-based medical education has mandated a shift to learner-centeredness, authentic observation, and frequent formative assessments with a focus on the delivery of effective feedback. Because feedback has been shown to be of variable quality and effectiveness, an assessment of feedback quality in the workplace is important to ensure we are providing trainees with optimal learning opportunities. The purposes of this project were to develop a rating scale for the quality of verbal feedback in the workplace (the Direct Observation of Clinical Skills Feedback Scale [DOCS-FBS]) and to gather validity evidence for its use. Two panels of experts (local and national) took part in a nominal group technique to identify features of high-quality feedback. Through multiple iterations and review, 9 features were developed into the DOCS-FBS. Four rater types (residents n = 21, medical students n = 8, faculty n = 12, and educators n = 12) used the DOCS-FBS to rate videotaped feedback encounters of variable quality. The psychometric properties of the scale were determined using a generalizability analysis. Participants also completed a survey to gather data on a 5-point Likert scale to inform the ease of use, clarity, knowledge acquisition, and acceptability of the scale. Mean video ratings ranged from 1.38 to 2.96 out of 3 and followed the intended pattern suggesting that the tool allowed raters to distinguish between examples of higher and lower quality feedback. There were no significant differences between rater type (range = 2.36-2.49), suggesting that all groups of raters used the tool in the same way. The generalizability coefficients for the scale ranged from 0.97 to 0.99. Item-total correlations were all above 0.80, suggesting some redundancy in items. Participants found the scale easy to use (M = 4.31/5) and clear

  9. Use of Social Desirability Scales in Clinical Psychology: A Systematic Review.

    Science.gov (United States)

    Perinelli, Enrico; Gremigni, Paola

    2016-06-01

    There is still an open debate about the utility of social desirability indicators. This report systematically reviewed the use of social desirability scales in studies addressing social desirability in clinical psychology. A systematic review (January 2010-March 2015) was conducted, including 35 studies meeting the inclusion criteria of being published in peer-reviewed journals and describing quantitative findings about an association of social desirability with clinical psychology variables using a cross-sectional or longitudinal design. Social desirability was associated with self-reports of various clinical-psychological dimensions. Most of the included studies treated social desirability as a 1-dimensional variable and only 10 of 35 disentangled the impression management and self-deception components. Although theoretical literature does not consider social desirability a mere response bias, only 4 of the reviewed articles controlled for the possible suppressor effect of personality variables on social desirability, while the majority focused upon the stylistic (response bias) rather than the substantive (personality) nature of this construct. The present review highlighted some limitations in the use of social desirability scales in recent clinical psychology research and tried to offer a few suggestions for handling this issue. © 2016 Wiley Periodicals, Inc.

  10. An integrated model for the effects of self-reflection and clinical experiential learning on clinical nursing performance in nursing students: A longitudinal study.

    Science.gov (United States)

    Pai, Hsiang-Chu

    2016-10-01

    The use of clinical simulation in undergraduate nursing programs in Taiwan has gradually increased over the past 5years. Previous research has shown that students' experience of anxiety during simulated laboratory sessions influences their self-reflection and learning effectiveness. Thus, further study that tracks what influences students' clinical performance in actual clinical sites is vital. The aim of the study is to develop an integrated model that considers the associations among anxiety, self-reflection, and learning effectiveness and to understand how this model applies to student nurses' clinical performance while on clinical placement. This study used a correlational and longitudinal study design. The 80 nursing students, who ranged in age from 19 to 21 (mean=20.38, SD=0.56), were recruited from a nursing school in southern Taiwan. Data were collected during three phases of implementation using four questionnaires. During the first phase, the State-Trait Anxiety Inventory (STAI), Simulation Learning Effectiveness Scale (SLES), and Self-Reflection and Insight Scale (SRIS) were used after students completed the simulation course in the school simulation laboratory. Nursing students also completed the Holistic Nursing Competence Scale at 2months (Phase 2) and 4months (Phase 3) after clinical practice experience. In Phase 3, students again completed the STAI and SRIS. Partial least squares (PLS), a structural equation modeling (SEM) procedure, was used to test the research model. The findings showed that: (1) at the start of the simulation laboratory, anxiety had a significant negative effect on students' simulation learning effectiveness (SLE; β=-0.14, pself-reflection with insight (SRI; β=-0.52, pSelf-reflection also had a significant positive effect on simulation learning effectiveness (β=0.37, pself-reflection and insight also had a significant positive effect on nursing competence during the first 2months of practice in a clinical site (β=0.13; β=0

  11. Comparative Performance of Patient Health Questionnaire-9 and Edinburgh Postnatal Depression Scale for Screening Antepartum Depression

    Science.gov (United States)

    Zhong, Qiuyue; Gelaye, Bizu; Rondon, Marta; Sánchez, Sixto E; García, Pedro J; Sánchez, Elena; Barrios, Yasmin V; Simon, Gregory E.; Henderson, David C.; Cripe, Swee May; Williams, Michelle A

    2014-01-01

    Objective We sought to evaluate the psychometric properties of two widely used screening scales: the Patient Health Questionnaire (PHQ-9) and Edinburgh Postnatal Depression Scale (EPDS) among pregnant Peruvian women. Methods This cross-sectional study included 1,517 women receiving prenatal care from February 2012 to March 2013. A structured interview was used to collect data using PHQ-9 and EPDS. We examined reliability, construct and concurrent validity between two scales using internal consistency indices, factor structures, correlations, and Cohen’s kappa. Results Both scales had good internal consistency (Cronbach’s alpha > 0.8). Correlation between PHQ-9 and EPDS scores was fair (rho=0.52). Based on exploratory factor analysis (EFA), both scales yielded a two-factor structure. EFA including all items from PHQ-9 and EPDS yielded four factors, namely, “somatization”, “depression and suicidal ideation”, “anxiety and depression”, and “anhedonia”. The agreement between the two scales was generally fair at different cutoff scores with the highest Cohen’s kappa being 0.46. Conclusions Both the PHQ-9 and EPDS are reliable and valid scales for antepartum depression assessment. The PHQ-9 captures somatic symptoms, while EPDS detects depressive symptoms comorbid with anxiety during early pregnancy. Our findings suggest simultaneous administration of both scales may improve identification of antepartum depressive disorders in clinical settings. PMID:24766996

  12. Relationship between the clinical global impression of severity for schizoaffective disorder scale and established mood scales for mania and depression.

    Science.gov (United States)

    Turkoz, Ibrahim; Fu, Dong-Jing; Bossie, Cynthia A; Sheehan, John J; Alphs, Larry

    2013-08-15

    This analysis explored the relationship between ratings on HAM-D-17 or YMRS and those on the depressive or manic subscale of CGI-S for schizoaffective disorder (CGI-S-SCA). This post hoc analysis used the database (N=614) from two 6-week, randomized, placebo-controlled studies of paliperidone ER versus placebo in symptomatic subjects with schizoaffective disorder assessed using HAM-D-17, YMRS, and CGI-S-SCA scales. Parametric and nonparametric regression models explored the relationships between ratings on YMRS and HAM-D-17 and on depressive and manic domains of the CGI-S-SCA from baseline to the 6-week end point. A clinically meaningful improvement was defined as a change of 1 point in the CGI-S-SCA score. No adjustment was made for multiplicity. Multiple linear regression models suggested that a 1-point change in the depressive domain of CGI-S-SCA corresponded to an average 3.6-point (SE=0.2) change in HAM-D-17 score. Similarly, a 1-point change in the manic domain of CGI-S-SCA corresponded to an average 5.8-point (SE=0.2) change in YMRS score. Results were confirmed using local and cumulative logistic regression models in addition to equipercentile linking. Lack of subjects scoring over the complete range of possible scores may limit broad application of the analyses. Clinically meaningful score changes in depressive and manic domains of CGI-S-SCA corresponded to approximately 4- and 6-point score changes on HAM-D-17 and YMRS, respectively, in symptomatic subjects with schizoaffective disorder. Copyright © 2013 Elsevier B.V. All rights reserved.

  13. Including Performance Assessments in Accountability Systems: A Review of Scale-Up Efforts

    Science.gov (United States)

    Tung, Rosann

    2010-01-01

    The purpose of this literature and field review is to understand previous efforts at scaling up performance assessments for use across districts and states. Performance assessments benefit students and teachers by providing more opportunities for students to demonstrate their knowledge and complex skills, by providing teachers with better…

  14. Evaluating Performance Measurement Systems in Nonprofit Agencies: The Program Accountability Quality Scale (PAQS).

    Science.gov (United States)

    Poole, Dennis L.; Nelson, Joan; Carnahan, Sharon; Chepenik, Nancy G.; Tubiak, Christine

    2000-01-01

    Developed and field tested the Performance Accountability Quality Scale (PAQS) on 191 program performance measurement systems developed by nonprofit agencies in central Florida. Preliminary findings indicate that the PAQS provides a structure for obtaining expert opinions based on a theory-driven model about the quality of proposed measurement…

  15. Performance and scaling of locally-structured grid methods forpartial differential equations

    Energy Technology Data Exchange (ETDEWEB)

    Colella, Phillip; Bell, John; Keen, Noel; Ligocki, Terry; Lijewski, Michael; Van Straalen, Brian

    2007-07-19

    In this paper, we discuss some of the issues in obtaining high performance for block-structured adaptive mesh refinement software for partial differential equations. We show examples in which AMR scales to thousands of processors. We also discuss a number of metrics for performance and scalability that can provide a basis for understanding the advantages and disadvantages of this approach.

  16. Psychometric properties of the Depression Anxiety Stress Scales (DASS) in depressed clinical samples.

    Science.gov (United States)

    Page, Andrew C; Hooke, Geoffrey R; Morrison, David L

    2007-09-01

    The psychometric properties of the Depression Anxiety Stress Scales (DASS; Lovibond & Lovibond, 1995a) were examined in depressed psychiatric hospital samples. Three studies administered the DASS and other symptom measures at admission and discharge to consecutive adult hospital patients with a primary diagnosis of depression. Study 3 aimed to address problems with the DASS by extending the response options. Study 1 found that the DASS had good reliability and validity, was moderately sensitive to change, but the Depression Scale exhibited a ceiling effect. In Study 2, confirmatory factor analysis supported a three-factor structure and the DASS continued to demonstrate good psychometric properties, but the ceiling effect was replicated. Study 3 found that by extending the response scale to include an additional option, the factor structure of the instrument as a whole was maintained, the sensitivity to treatment was increased, but the ceiling effect was only marginally reduced. The psychometric properties of the DASS were sound in clinically depressed samples, but the Depression Scale exhibited a ceiling effect that could not be resolved with minor changes to the scale. Suggestions for revisions of the DASS are made.

  17. Scales

    Science.gov (United States)

    Scales are a visible peeling or flaking of outer skin layers. These layers are called the stratum ... Scales may be caused by dry skin, certain inflammatory skin conditions, or infections. Examples of disorders that ...

  18. Development of clinical pharmacy key performance indicators for hospital pharmacists using a modified Delphi approach.

    Science.gov (United States)

    Fernandes, Olavo; Gorman, Sean K; Slavik, Richard S; Semchuk, William M; Shalansky, Steve; Bussières, Jean-François; Doucette, Douglas; Bannerman, Heather; Lo, Jennifer; Shukla, Simone; Chan, Winnie W Y; Benninger, Natalie; MacKinnon, Neil J; Bell, Chaim M; Slobodan, Jeremy; Lyder, Catherine; Zed, Peter J; Toombs, Kent

    2015-06-01

    Key performance indicators (KPIs) are quantifiable measures of quality. There are no published, systematically derived clinical pharmacy KPIs (cpKPIs). A group of hospital pharmacists aimed to develop national cpKPIs to advance clinical pharmacy practice and improve patient care. A cpKPI working group established a cpKPI definition, 8 evidence-derived cpKPI critical activity areas, 26 candidate cpKPIs, and 11 cpKPI ideal attributes in addition to 1 overall consensus criterion. Twenty-six clinical pharmacists and hospital pharmacy leaders participated in an internet-based 3-round modified Delphi survey. Panelists rated 26 candidate cpKPIs using 11 cpKPI ideal attributes and 1 overall consensus criterion on a 9-point Likert scale. A meeting was facilitated between rounds 2 and 3 to debate the merits and wording of candidate cpKPIs. Consensus was reached if 75% or more of panelists assigned a score of 7 to 9 on the consensus criterion during the third Delphi round. All panelists completed the 3 Delphi rounds, and 25/26 (96%) attended the meeting. Eight candidate cpKPIs met the consensus definition: (1) performing admission medication reconciliation (including best-possible medication history), (2) participating in interprofessional patient care rounds, (3) completing pharmaceutical care plans, (4) resolving drug therapy problems, (5) providing in-person disease and medication education to patients, (6) providing discharge patient medication education, (7) performing discharge medication reconciliation, and (8) providing bundled, proactive direct patient care activities. A Delphi panel of hospital pharmacists was successful in determining 8 consensus cpKPIs. Measurement and assessment of these cpKPIs will serve to advance clinical pharmacy practice and improve patient care. © The Author(s) 2015.

  19. Cluster headache - clinical pattern and a new severity scale in a Swedish cohort.

    Science.gov (United States)

    Steinberg, Anna; Fourier, Carmen; Ran, Caroline; Waldenlind, Elisabet; Sjöstrand, Christina; Belin, Andrea Carmine

    2018-06-01

    Background The aim of this study was to investigate clinical features of a cluster headache cohort in Sweden and to construct and test a new scale for grading severity. Methods Subjects were identified by screening medical records for the ICD 10 code G44.0, that is, cluster headache. Five hundred participating research subjects filled in a questionnaire including personal, demographic and medical aspects. We constructed a novel scale for grading cluster headache in this cohort: The Cluster Headache Severity Scale, which included number of attacks per day, attack and period duration. The lowest total score was three and the highest 12, and we used the Cluster Headache Severity Scale to grade subjects suffering from cluster headache. We further implemented the scale by defining a cluster headache maximum severity subgroup with a high Cluster Headache Severity Scale score ≥ 9. Results A majority (66.7%) of the patients reported that attacks appear at certain time intervals. In addition, cluster headache patients who were current tobacco users or had a history of tobacco consumption had a later age of disease onset (31.7 years) compared to non-tobacco users (28.5 years). The Cluster Headache Severity Scale score was higher in the patient group reporting sporadic or no alcohol intake than in the groups reporting an alcohol consumption of three to four standard units per week or more. Maximum severity cluster headache patients were characterised by higher age at disease onset, greater use of prophylactic medication, reduced hours of sleep, and lower alcohol consumption compared to the non-cluster headache maximum severity group. Conclusion There was a wide variation of severity grade among cluster headache patients, with a very marked impact on daily living for the most profoundly affected.

  20. Small Scale Mixing Demonstration Batch Transfer and Sampling Performance of Simulated HLW - 12307

    Energy Technology Data Exchange (ETDEWEB)

    Jensen, Jesse; Townson, Paul; Vanatta, Matt [EnergySolutions, Engineering and Technology Group, Richland, WA, 99354 (United States)

    2012-07-01

    The ability to effectively mix, sample, certify, and deliver consistent batches of High Level Waste (HLW) feed from the Hanford Double Shell Tanks (DST) to the Waste treatment Plant (WTP) has been recognized as a significant mission risk with potential to impact mission length and the quantity of HLW glass produced. At the end of 2009 DOE's Tank Operations Contractor, Washington River Protection Solutions (WRPS), awarded a contract to EnergySolutions to design, fabricate and operate a demonstration platform called the Small Scale Mixing Demonstration (SSMD) to establish pre-transfer sampling capacity, and batch transfer performance data at two different scales. This data will be used to examine the baseline capacity for a tank mixed via rotational jet mixers to transfer consistent or bounding batches, and provide scale up information to predict full scale operational performance. This information will then in turn be used to define the baseline capacity of such a system to transfer and sample batches sent to WTP. The Small Scale Mixing Demonstration (SSMD) platform consists of 43'' and 120'' diameter clear acrylic test vessels, each equipped with two scaled jet mixer pump assemblies, and all supporting vessels, controls, services, and simulant make up facilities. All tank internals have been modeled including the air lift circulators (ALCs), the steam heating coil, and the radius between the wall and floor. The test vessels are set up to simulate the transfer of HLW out of a mixed tank, and collect a pre-transfer sample in a manner similar to the proposed baseline configuration. The collected material is submitted to an NQA-1 laboratory for chemical analysis. Previous work has been done to assess tank mixing performance at both scales. This work involved a combination of unique instruments to understand the three dimensional distribution of solids using a combination of Coriolis meter measurements, in situ chord length distribution

  1. Performance modeling of hybrid MPI/OpenMP scientific applications on large-scale multicore supercomputers

    KAUST Repository

    Wu, Xingfu; Taylor, Valerie

    2013-01-01

    In this paper, we present a performance modeling framework based on memory bandwidth contention time and a parameterized communication model to predict the performance of OpenMP, MPI and hybrid applications with weak scaling on three large-scale multicore supercomputers: IBM POWER4, POWER5+ and BlueGene/P, and analyze the performance of these MPI, OpenMP and hybrid applications. We use STREAM memory benchmarks and Intel's MPI benchmarks to provide initial performance analysis and model validation of MPI and OpenMP applications on these multicore supercomputers because the measured sustained memory bandwidth can provide insight into the memory bandwidth that a system should sustain on scientific applications with the same amount of workload per core. In addition to using these benchmarks, we also use a weak-scaling hybrid MPI/OpenMP large-scale scientific application: Gyrokinetic Toroidal Code (GTC) in magnetic fusion to validate our performance model of the hybrid application on these multicore supercomputers. The validation results for our performance modeling method show less than 7.77% error rate in predicting the performance of hybrid MPI/OpenMP GTC on up to 512 cores on these multicore supercomputers. © 2013 Elsevier Inc.

  2. Performance modeling of hybrid MPI/OpenMP scientific applications on large-scale multicore supercomputers

    KAUST Repository

    Wu, Xingfu

    2013-12-01

    In this paper, we present a performance modeling framework based on memory bandwidth contention time and a parameterized communication model to predict the performance of OpenMP, MPI and hybrid applications with weak scaling on three large-scale multicore supercomputers: IBM POWER4, POWER5+ and BlueGene/P, and analyze the performance of these MPI, OpenMP and hybrid applications. We use STREAM memory benchmarks and Intel\\'s MPI benchmarks to provide initial performance analysis and model validation of MPI and OpenMP applications on these multicore supercomputers because the measured sustained memory bandwidth can provide insight into the memory bandwidth that a system should sustain on scientific applications with the same amount of workload per core. In addition to using these benchmarks, we also use a weak-scaling hybrid MPI/OpenMP large-scale scientific application: Gyrokinetic Toroidal Code (GTC) in magnetic fusion to validate our performance model of the hybrid application on these multicore supercomputers. The validation results for our performance modeling method show less than 7.77% error rate in predicting the performance of hybrid MPI/OpenMP GTC on up to 512 cores on these multicore supercomputers. © 2013 Elsevier Inc.

  3. Plasma performance and scaling laws in the RFX-mod reversed-field pinch experiment

    International Nuclear Information System (INIS)

    Innocente, P.; Alfier, A.; Canton, A.; Pasqualotto, R.

    2009-01-01

    The large range of plasma currents (I p = 0.2-1.6 MA) and feedback-controlled magnetic boundary conditions of the RFX-mod experiment make it well suited to performing scaling studies. The assessment of such scaling, in particular those on temperature and energy confinement, is crucial both for improving the operating reversed-field pinch (RFP) devices and for validating the RFP configuration as a candidate for the future fusion reactors. For such a purpose scaling laws for magnetic fluctuations, temperature and energy confinement have been evaluated in stationary operation. RFX-mod scaling laws have been compared with those obtained from other RFP devices and numerical simulations. The role of the magnetic boundary has been analysed, comparing discharges performed with different active control schemes of the edge radial magnetic field.

  4. A Novel Method for Assessing Task Complexity in Outpatient Clinical-Performance Measures.

    Science.gov (United States)

    Hysong, Sylvia J; Amspoker, Amber B; Petersen, Laura A

    2016-04-01

    Clinical-performance measurement has helped improve the quality of health-care; yet success in attaining high levels of quality across multiple domains simultaneously still varies considerably. Although many sources of variability in care quality have been studied, the difficulty required to complete the clinical work itself has received little attention. We present a task-based methodology for evaluating the difficulty of clinical-performance measures (CPMs) by assessing the complexity of their component requisite tasks. Using Functional Job Analysis (FJA), subject-matter experts (SMEs) generated task lists for 17 CPMs; task lists were rated on ten dimensions of complexity, and then aggregated into difficulty composites. Eleven outpatient work SMEs; 133 VA Medical Centers nationwide. Clinical Performance: 17 outpatient CPMs (2000-2008) at 133 VA Medical Centers nationwide. Measure Difficulty: for each CPM, the number of component requisite tasks and the average rating across ten FJA complexity scales for the set of tasks comprising the measure. Measures varied considerably in the number of component tasks (M = 10.56, SD = 6.25, min = 5, max = 25). Measures of chronic care following acute myocardial infarction exhibited significantly higher measure difficulty ratings compared to diabetes or screening measures, but not to immunization measures ([Formula: see text] = 0.45, -0.04, -0.05, and -0.06 respectively; F (3, 186) = 3.57, p = 0.015). Measure difficulty ratings were not significantly correlated with the number of component tasks (r = -0.30, p = 0.23). Evaluating the difficulty of achieving recommended CPM performance levels requires more than simply counting the tasks involved; using FJA to assess the complexity of CPMs' component tasks presents an alternate means of assessing the difficulty of primary-care CPMs and accounting for performance variation among measures and performers. This in turn could be used in designing

  5. Publication trends of clinical trials performed in South Africa

    African Journals Online (AJOL)

    In addition, a manual search of the Open Access Journal of Clinical Trials databases and reference lists ... significant or negative findings or academics simply not completing the process of .... method on Microsoft Excel (USA). Determination of ...

  6. Optimization of a micro-scale, high throughput process development tool and the demonstration of comparable process performance and product quality with biopharmaceutical manufacturing processes.

    Science.gov (United States)

    Evans, Steven T; Stewart, Kevin D; Afdahl, Chris; Patel, Rohan; Newell, Kelcy J

    2017-07-14

    In this paper, we discuss the optimization and implementation of a high throughput process development (HTPD) tool that utilizes commercially available micro-liter sized column technology for the purification of multiple clinically significant monoclonal antibodies. Chromatographic profiles generated using this optimized tool are shown to overlay with comparable profiles from the conventional bench-scale and clinical manufacturing scale. Further, all product quality attributes measured are comparable across scales for the mAb purifications. In addition to supporting chromatography process development efforts (e.g., optimization screening), comparable product quality results at all scales makes this tool is an appropriate scale model to enable purification and product quality comparisons of HTPD bioreactors conditions. The ability to perform up to 8 chromatography purifications in parallel with reduced material requirements per run creates opportunities for gathering more process knowledge in less time. Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.

  7. PERFORMANCE DETERIORATION OF THERMOSIPHON SOLAR FLAT PLATE WATER HEATER DUE TO SCALING

    OpenAIRE

    arunachala umesh chandavar

    2011-01-01

    The performance of Flat plate Solar Water Heater deteriorates within five to twelve years of their installation due to factors related to manufacturing, operating conditions, lack of maintenance etc. Especially, problem due to scaling is significant as it is based on quality of water used. The remaining factors are system dependent and could be overcome by quality production. Software is developed by incorporating Hottel Whillier Bliss (H-W-B) equation to ascertain the effect of scaling o...

  8. Sepsis and meningitis in hospitalized children: performance of clinical signs and their prediction rules in a case-control study.

    Science.gov (United States)

    Verbakel, Jan Y; MacFaul, Roderick; Aertgeerts, Bert; Buntinx, Frank; Thompson, Matthew

    2014-06-01

    Feverish illness is a common presentation to acute pediatric services. Clinical staff faces the challenge of differentiating the few children with meningitis or sepsis from the majority with self-limiting illness. We aimed to determine the diagnostic value of clinical features and their prediction rules (CPR) for identifying children with sepsis or meningitis among those children admitted to a District General Hospital with acute febrile illness. Acutely ill children admitted to a District General Hospital in England were included in this case-control study between 2000 and 2005. We examined the diagnostic accuracy of individual clinical signs and 6 CPRs, including the National Institute for Clinical Excellence "traffic light" system, to determine clinical utility in identifying children with a diagnosis of sepsis or meningitis. Loss of consciousness, prolonged capillary refill, decreased alertness, respiratory effort, and the physician's illness assessment had high positive likelihood ratios (9-114), although with wide confidence intervals, to rule in sepsis or meningitis. The National Institute for Clinical Excellence traffic light system, the modified Yale Observation Scale, and the Pediatric Advanced Warning Score performed poorly with positive likelihood ratios ranging from 1 to 3. The pediatrician's overall illness assessment was the most useful feature to rule in sepsis or meningitis in these hospitalized children. Clinical prediction rules did not effectively rule in sepsis or meningitis. The modified Yale Observation Scale should be used with caution. Single clinical signs could complement these scores to rule in sepsis or meningitis. Further research is needed to validate these CPRs.

  9. Federated queries of clinical data repositories: Scaling to a national network.

    Science.gov (United States)

    Weber, Griffin M

    2015-06-01

    Federated networks of clinical research data repositories are rapidly growing in size from a handful of sites to true national networks with more than 100 hospitals. This study creates a conceptual framework for predicting how various properties of these systems will scale as they continue to expand. Starting with actual data from Harvard's four-site Shared Health Research Information Network (SHRINE), the framework is used to imagine a future 4000 site network, representing the majority of hospitals in the United States. From this it becomes clear that several common assumptions of small networks fail to scale to a national level, such as all sites being online at all times or containing data from the same date range. On the other hand, a large network enables researchers to select subsets of sites that are most appropriate for particular research questions. Developers of federated clinical data networks should be aware of how the properties of these networks change at different scales and design their software accordingly. Copyright © 2015 Elsevier Inc. All rights reserved.

  10. Enhanced clinical-scale manufacturing of TCR transduced T-cells using closed culture system modules.

    Science.gov (United States)

    Jin, Jianjian; Gkitsas, Nikolaos; Fellowes, Vicki S; Ren, Jiaqiang; Feldman, Steven A; Hinrichs, Christian S; Stroncek, David F; Highfill, Steven L

    2018-01-24

    Genetic engineering of T-cells to express specific T cell receptors (TCR) has emerged as a novel strategy to treat various malignancies. More widespread utilization of these types of therapies has been somewhat constrained by the lack of closed culture processes capable of expanding sufficient numbers of T-cells for clinical application. Here, we evaluate a process for robust clinical grade manufacturing of TCR gene engineered T-cells. TCRs that target human papillomavirus E6 and E7 were independently tested. A 21 day process was divided into a transduction phase (7 days) and a rapid expansion phase (14 days). This process was evaluated using two healthy donor samples and four samples obtained from patients with epithelial cancers. The process resulted in ~ 2000-fold increase in viable nucleated cells and high transduction efficiencies (64-92%). At the end of culture, functional assays demonstrated that these cells were potent and specific in their ability to kill tumor cells bearing target and secrete large quantities of interferon and tumor necrosis factor. Both phases of culture were contained within closed or semi-closed modules, which include automated density gradient separation and cell culture bags for the first phase and closed GREX culture devices and wash/concentrate systems for the second phase. Large-scale manufacturing using modular systems and semi-automated devices resulted in highly functional clinical-grade TCR transduced T-cells. This process is now in use in actively accruing clinical trials and the NIH Clinical Center and can be utilized at other cell therapy manufacturing sites that wish to scale-up and optimize their processing using closed systems.

  11. Inverse scaling trends for charge-trapping-induced degradation of FinFETs performance

    OpenAIRE

    Amoroso, Salvatore Maria; Georgiev, Vihar P.; Gerrer, Louis; Towie, Ewan; Wang, Xingsheng; Riddet, Craig; Brown, Andrew Robert; Asenov, Asen

    2014-01-01

    In this paper, we investigate the impact of a single discrete charge trapped at the top oxide interface on the performance of scaled nMOS FinFET transistors. The charge-trapping-induced gate voltage shift is simulated as a function of the device scaling and for several regimes of conduction-from subthreshold to ON-state. Contrary to what is expected for planar MOSFETs, we show that the trap impact decreases with scaling down the FinFET size and the applied gate voltage. By comparing drift-dif...

  12. Performance of Linear and Nonlinear Two-Leaf Light Use Efficiency Models at Different Temporal Scales

    Directory of Open Access Journals (Sweden)

    Xiaocui Wu

    2015-02-01

    Full Text Available The reliable simulation of gross primary productivity (GPP at various spatial and temporal scales is of significance to quantifying the net exchange of carbon between terrestrial ecosystems and the atmosphere. This study aimed to verify the ability of a nonlinear two-leaf model (TL-LUEn, a linear two-leaf model (TL-LUE, and a big-leaf light use efficiency model (MOD17 to simulate GPP at half-hourly, daily and 8-day scales using GPP derived from 58 eddy-covariance flux sites in Asia, Europe and North America as benchmarks. Model evaluation showed that the overall performance of TL-LUEn was slightly but not significantly better than TL-LUE at half-hourly and daily scale, while the overall performance of both TL-LUEn and TL-LUE were significantly better (p < 0.0001 than MOD17 at the two temporal scales. The improvement of TL-LUEn over TL-LUE was relatively small in comparison with the improvement of TL-LUE over MOD17. However, the differences between TL-LUEn and MOD17, and TL-LUE and MOD17 became less distinct at the 8-day scale. As for different vegetation types, TL-LUEn and TL-LUE performed better than MOD17 for all vegetation types except crops at the half-hourly scale. At the daily and 8-day scales, both TL-LUEn and TL-LUE outperformed MOD17 for forests. However, TL-LUEn had a mixed performance for the three non-forest types while TL-LUE outperformed MOD17 slightly for all these non-forest types at daily and 8-day scales. The better performance of TL-LUEn and TL-LUE for forests was mainly achieved by the correction of the underestimation/overestimation of GPP simulated by MOD17 under low/high solar radiation and sky clearness conditions. TL-LUEn is more applicable at individual sites at the half-hourly scale while TL-LUE could be regionally used at half-hourly, daily and 8-day scales. MOD17 is also an applicable option regionally at the 8-day scale.

  13. Problems of Clinical Nurse Performance Appraisal System: A Qualitative Study

    Directory of Open Access Journals (Sweden)

    Nasrin Nikpeyma

    2014-03-01

    Conclusion: The findings of this study reveal that the nurse performance appraisal system confronts with various problems. Some of these problems are related to organizational context while the others concerned structure, process and results of the performance appraisal system. In order to achieve high quality of patient care as the final goal of performance appraisal, changing and revision of this system is necessary.

  14. Safety Performance Evaluations for the Vehicle Based Movable Barriers Using Full Scale Crash Tests

    Directory of Open Access Journals (Sweden)

    Jin Minsoo

    2017-01-01

    Full Text Available The present study aims to develop a prototype of large-size movable barriers to protect roadside workers from incoming vehicles to the road work area with the following functions: maximization of work space in the right and left directions, convenient mobility, and minimization of impact without modification of the inside of movable barriers into traffic lanes and perform safety performance assessment on passengers through full scale crash tests. The large movable barrier was divided into folder type and telescope type and the development stage was now at the prototype phase. A full scale crash test was conducted prior to certification test at a level of 90%. The full scale crash test result showed that both types of folder type movable barrier and telescope type movable barrier satisfied the standard of the passenger safety performance evaluation at a level of 90%.

  15. Development of an evaluation performance scale for social educators in child protection centers

    Directory of Open Access Journals (Sweden)

    Juan Manuel Fernández Millán

    2013-09-01

    Full Text Available Purpose: In a context of economic crisis, as in the case of Spain, the evaluation of the performance of employees in any field is a key tool for improving worker efficiency. For those professions that are developed in order to provide basic social services to the people of its importance is even greater. Thereby, this study is focused on developing a Performance Rating Scale of Social Workers using BARS technique. Design/methodology/approach: We asked 11 experts to list those competencies they believed necessary to perform this task efficiently. Thereafter, we selected competencies what coincide with an Interjudge arrangement of at least 3. Then each competency was associated with two critical incidents and developed corresponding behavioral anchors. In addition, the scale has a collection of personal data such as age and time off work, often used as indicators defining performance. Finally, the scale was tested to a sample of 128 Social Workers working in interim child care centers and children and youth correctional centers. Findings and Originality/value: The results show that the scale meets the criteria required for validation psychometric (α= 0,873. Also, the scale could be factored (Kaiser-Meyer-Olkin=0,810. Three dimensions were obtained: team work, interpersonal skills and competencies of the work. Research limitations/implications: An appreciation of the lack of covariation between external criteria used as identifiers of good performance (age and number of sick leave and the employee's competence. This confirms the inadequacy of these criteria to predict performance. Necessitating the development of performance evaluation tools that include absenteeism and experience as predictors of performance measures. Practical implications: The inadequacy may be due to the usually confusion between work experience - seniority and sick leave - absenteeism. Originality/value: The study helps define the figure and the competences of social

  16. Performance/price estimates for cortex-scale hardware: a design space exploration.

    Science.gov (United States)

    Zaveri, Mazad S; Hammerstrom, Dan

    2011-04-01

    In this paper, we revisit the concept of virtualization. Virtualization is useful for understanding and investigating the performance/price and other trade-offs related to the hardware design space. Moreover, it is perhaps the most important aspect of a hardware design space exploration. Such a design space exploration is a necessary part of the study of hardware architectures for large-scale computational models for intelligent computing, including AI, Bayesian, bio-inspired and neural models. A methodical exploration is needed to identify potentially interesting regions in the design space, and to assess the relative performance/price points of these implementations. As an example, in this paper we investigate the performance/price of (digital and mixed-signal) CMOS and hypothetical CMOL (nanogrid) technology based hardware implementations of human cortex-scale spiking neural systems. Through this analysis, and the resulting performance/price points, we demonstrate, in general, the importance of virtualization, and of doing these kinds of design space explorations. The specific results suggest that hybrid nanotechnology such as CMOL is a promising candidate to implement very large-scale spiking neural systems, providing a more efficient utilization of the density and storage benefits of emerging nano-scale technologies. In general, we believe that the study of such hypothetical designs/architectures will guide the neuromorphic hardware community towards building large-scale systems, and help guide research trends in intelligent computing, and computer engineering. Copyright © 2010 Elsevier Ltd. All rights reserved.

  17. GENDER DIFFERENTIALS IN FACTORS AFFECTING PERFORMANCE OF SMALL-SCALE ENTERPRISES IN LAGOS STATE – NIGERIA

    Directory of Open Access Journals (Sweden)

    Yusuff Olabisi Sherifat

    2013-05-01

    Full Text Available There is a lack of empirical data segregation on factors affecting gender as the variable of interest. However, previous research had indicated several factors that affect business performances among small-scale enterprise owners. Using feminist theory and a descriptive survey research design, data were collected from fifty (50 small-scale enterprise owners that were purposively chosen across the study area. The findings show that the factors that were significant for female were significantly different from male. For female small scale enterprise owners, marital status (64% Age of Children (68%, Role Model/ advisors (58% were significant factors that affect their business performance. For male small-scale enterprise owners, Friends (70%, a lack of Government support (80%, inability to display innovativeness (78% and Risk-Taking (84% were significant for male. Lack of availability of capital and finances were significant for the two. Other factors that affect performance include friends, inadequate training and business location. Adequate knowledge of factors that affect gender enterprise performance will go a long way in alleviating these problems. Small-scale enterprises should be supported for poverty alleviation, especially among women and for the nation’s economic development

  18. Clinical validation of a non-heteronormative version of the Social Interaction Anxiety Scale (SIAS).

    Science.gov (United States)

    Lindner, Philip; Martell, Christopher; Bergström, Jan; Andersson, Gerhard; Carlbring, Per

    2013-12-19

    Despite welcomed changes in societal attitudes and practices towards sexual minorities, instances of heteronormativity can still be found within healthcare and research. The Social Interaction Anxiety Scale (SIAS) is a valid and reliable self-rating scale of social anxiety, which includes one item (number 14) with an explicit heteronormative assumption about the respondent's sexual orientation. This heteronormative phrasing may confuse, insult or alienate sexual minority respondents. A clinically validated version of the SIAS featuring a non-heteronormative phrasing of item 14 is thus needed. 129 participants with diagnosed social anxiety disorder, enrolled in an Internet-based intervention trial, were randomly assigned to responding to the SIAS featuring either the original or a novel non-heteronormative phrasing of item 14, and then answered the other item version. Within-subject, correlation between item versions was calculated and the two scores were statistically compared. The two items' correlations with the other SIAS items and other psychiatric rating scales were also statistically compared. Item versions were highly correlated and scores did not differ statistically. The two items' correlations with other measures did not differ statistically either. The SIAS can be revised with a non-heteronormative formulation of item 14 with psychometric equivalence on item and scale level. Implications for other psychiatric instruments with heteronormative phrasings are discussed.

  19. Can the Liebowitz Social Anxiety Scale - self-report version be used to differentiate clinical and non-clinical SAD groups among Brazilians?

    Science.gov (United States)

    Santos, Larissa F; Loureiro, Sonia R; Crippa, José A S; Osório, Flávia L

    2015-01-01

    The Liebowitz Social Anxiety Scale (LSAS) was the first evaluation instrument developed for screening for the signs and symptoms of Social Anxiety Disorder (SAD) and is currently still the most used worldwide. The aim of this study is to evaluate the ability of the LSAS - self-report version (LSAS-SR) to discriminate different Social Anxiety Disorder (SAD) clinical groups. The sample was composed of Brazilians university students, allocated into three different groups, i.e., cases (C=118), non-cases (NC=95) and subclinical cases (SC=39). To achieve the aim, calculations of the ROC Curve and ANOVA were performed. The results found were excellent regardless of the technique used, highlighting the discriminatory capacity of the LSAS-SR. The score equal to or greater than 32 is suggested as a cutoff score for the Brazilian population, since this presented balance between the standards evaluated and the ability to differentiate both clinical and subclinical SAD cases from non-cases. Despite the specific sample used in this study being composed only of university students, the use of the LSAS-SR can be indicated, in the Brazilian setting, for SAD screening in both clinical and research contexts.

  20. Design and validation of a clinical-scale bioreactor for long-term isolated lung culture.

    Science.gov (United States)

    Charest, Jonathan M; Okamoto, Tatsuya; Kitano, Kentaro; Yasuda, Atsushi; Gilpin, Sarah E; Mathisen, Douglas J; Ott, Harald C

    2015-06-01

    The primary treatment for end-stage lung disease is lung transplantation. However, donor organ shortage remains a major barrier for many patients. In recent years, techniques for maintaining lungs ex vivo for evaluation and short-term (advance to more complex interventions for lung repair and regeneration, the need for a long-term organ culture system becomes apparent. Herein we describe a novel clinical scale bioreactor capable of maintaining functional porcine and human lungs for at least 72 h in isolated lung culture (ILC). The fully automated, computer controlled, sterile, closed circuit system enables physiologic pulsatile perfusion and negative pressure ventilation, while gas exchange function, and metabolism can be evaluated. Creation of this stable, biomimetic long-term culture environment will enable advanced interventions in both donor lungs and engineered grafts of human scale. Copyright © 2015 Elsevier Ltd. All rights reserved.

  1. A numerical study of scale effects on performance of a tractor type podded propeller

    Directory of Open Access Journals (Sweden)

    Choi Jung-Kyu

    2014-06-01

    Full Text Available In this study, the scale effect on the performance of the podded propeller of tractor type is investigated. Turbulent flow computations are carried out for Reynolds numbers increasing progressively from model scale to full scale using the CFD analysis. The result of the flow calculation for model scale Reynolds numbers agrees well with that of the experiment of a large cavitation tunnel. The existing numerical analysis indicates that the performance of the podded propeller blades is mainly influenced by the advance coefficient and relatively little by the Reynolds number. However, the drag of pod housing with propeller in operation is different from that of pod housing without propeller due to the acceleration and swirl of propeller slipstream which is altered by propeller loading as well as the pressure recovery and friction according to Reynolds number, which suggests that the pod housing drag under the condition of propeller in operation is the key factor of the scale effect on the performance between model and full scale podded propellers. The so called ‘drag ratio’, which is the ratio of pod housing drag to total thrust of podded propeller, increases as the advance coefficient increases due to accelerated flow in the slipstream of the podded propeller. However, the increasing rate of the drag ratio reduces continuously as the Reynolds number increases from model to full scale progressively. The contribution of hydrodynamic forces, which acts on the parts composed of the pod housing with propeller operating in various loading conditions, to the thrust and the torque of the total propeller unit are presented for a range of Reynolds numbers from model to full scales.

  2. The clinical utility of the Cornell Scale for Depression in Dementia as a routine assessment in nursing homes.

    Science.gov (United States)

    Jeon, Yun-Hee; Li, Zhicheng; Low, Lee-Fay; Chenoweth, Lynn; O'Connor, Daniel; Beattie, Elizabeth; Liu, Zhixin; Brodaty, Henry

    2015-08-01

    To examine the clinical utility of the Cornell Scale for Depression in Dementia (CSDD) in nursing homes. 14 nursing homes in Sydney and Brisbane, Australia. 92 residents with a mean age of 85 years. Consenting residents were assessed by care staff for depression using the CSDD as part of their routine assessment. Specialist clinicians conducted assessment of depression using the Semi-structured Clinical Diagnostic Interview for DSM-IV-TR Axis I Disorders for residents without dementia or the Provisional Diagnostic Criteria for Depression in Alzheimer Disease for residents with dementia to establish expert clinical diagnoses of depression. The diagnostic performance of the staff completed CSDD was analyzed against expert diagnosis using receiver operating characteristic (ROC) curves. The CSDD showed low diagnostic accuracy, with areas under the ROC curve being 0.69, 0.68 and 0.70 for the total sample, residents with dementia and residents without dementia, respectively. At the standard CSDD cutoff score, the sensitivity and specificity were 71% and 59% for the total sample, 69% and 57% for residents with dementia, and 75% and 61% for residents without dementia. The Youden index (for optimizing cut-points) suggested different depression cutoff scores for residents with and without dementia. When administered by nursing home staff the clinical utility of the CSDD is highly questionable in identifying depression. The complexity of the scale, the time required for collecting relevant information, and staff skills and knowledge of assessing depression in older people must be considered when using the CSDD in nursing homes. Copyright © 2015 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.

  3. Relationship Between Academic Performance and Student Self-Assessment of Clinical Performance in the College of Podiatric Medicine and Surgery.

    Science.gov (United States)

    Yoho, Robert M; Vardaxis, Vassilios; Millonig, Kelsey

    2016-05-01

    Student self-assessment is viewed as an important tool in medical education. We sought to identify the relationship between student academic performance and third-year clinical performance self-assessment. No such study exists in podiatric medical education. Third-year podiatric medical students from the classes of 2012 through 2014 completed a self-assessment of their performance for each of five broad clinical podiatric medical domains (Professionalism, Medicine, Radiology, Surgery, and Biomechanics/Orthopedics). The assessment was completed after students finished the first 12 weeks of their third-year clinical rotations (PRE) and a second time at the conclusion of the third year (POST). The mean self-assessment score for PRE and POST surveys for all combined domains was determined for each student. This mean was compared with the student's 3-year cumulative grade point average (GPA). Students' clinical experiences for the year were essentially identical. No statistically significant correlation was identified between cumulative GPA and the PRE and POST clinical self-assessments or with the change between PRE and POST assessments based on the Pearson correlation test for each class separately or on the pooled data. Published studies in allopathic medical education have shown that students with lower GPAs tend to rate their clinical performance higher in initial clinical performance self-assessment. Our results show that student academic performance was not correlated with clinical performance self-assessment. These findings may be due to the explicit description of successful clinical competency completion, the orientation students receive before the start of clinical training, and the continuous feedback received from clinical preceptors.

  4. Modified bathroom scale and balance assessment: a comparison with clinical tests

    OpenAIRE

    Duch?ne, Jacques; Hewson, David; Rumeau, Pierre

    2016-01-01

    Frailty and detection of fall risk are major issues in preventive gerontology. A simple tool frequently used in daily life, a bathroom scale (balance quality tester: BQT), was modified to obtain information on the balance of 84 outpatients consulting at a geriatric clinic. The results computed from the BQT were compared to the values of three geriatric tests that are widely used either to detect a fall risk or frailty (timed get up and go: TUG; 10?m walking speed: WS; walking time: WT; one-le...

  5. Validation of the Rowland Universal Dementia Assessment Scale for multicultural screening in Danish memory clinics.

    Science.gov (United States)

    Nielsen, T Rune; Andersen, Birgitte Bo; Gottrup, Hanne; Lützhøft, Jan H; Høgh, Peter; Waldemar, Gunhild

    2013-01-01

    The Rowland Universal Dementia Assessment Scale (RUDAS) is a brief cognitive screening test that was developed to detect dementia in multicultural populations. The RUDAS has not previously been validated in multicultural populations outside of Australia. The aim of this study was to evaluate the diagnostic accuracy of the RUDAS in a multicultural sample of patients referred to Danish memory clinics. Data were collected from 137 consecutive patients (34 with an immigrant background) in three Danish memory clinics. All patients were given the RUDAS as a supplement to the standard diagnostic workup. Diagnostic accuracy for the RUDAS [area under the curve (AUC) = 0.838] was similar to that of the Mini-Mental State Examination (MMSE; AUC = 0.840). The cutoff score with the best balance of sensitivity, specificity and accuracy was multicultural patient populations. © 2013 S. Karger AG, Basel.

  6. Student´s self-assessment of clinical competence and objective clinical performance in OSCE evaluation

    OpenAIRE

    Jünger, J; Schellberg, D; Nikendei, C

    2006-01-01

    [english] Overestimating one's clinical competence can be dangerous to patient's safety. Therefore the goal of this study was to identify students with high confidence in their own clinical competence but low performance in objective assessment. 171 students in the 14 week course in internal medicine completed the clinical skills-related self-assessment expectations (SE) and were tested in a 12 station OSCE. Both measures were obtained within three days. In total we identified 16% of students...

  7. Clinical Performance of Emergency Surgical Officers in Southern ...

    African Journals Online (AJOL)

    GB

    The proportion of cesarean and instrumental deliveries over the total deliveries were 13% and 0.7%, respectively. Explorative laparotomies and appendectomies were the majority of the non-obstetric emergency operations. Interviewed staff in the respective hospitals stated that ESOs' clinical decision making, surgical skill ...

  8. The Eating Disorder Diagnostic Scale: psychometric features within a clinical population and a cut-off point to differentiate clinical patients from healthy controls

    NARCIS (Netherlands)

    Krabbenborg, M.A.M.; Danner, U.N.; Larsen, J.K.; van der Veer, N.; van Elburg, A.A.; de Ridder, D.T.; Evers, C.; Stice, E.; Engels, R.C.M.E.

    2012-01-01

    The Eating Disorder Diagnostic Scale (EDDS) is a brief self-report measure for diagnosing anorexia nervosa, bulimia nervosa and binge eating disorder. Research has provided evidence of the reliability and validity of this scale in non-clinical populations. Our study is the first to examine the

  9. [Application of the Smoking Scale for Primary Care (ETAP) in clinical practice].

    Science.gov (United States)

    González Romero, M P; Cuevas-Fernández, F J; Marcelino-Rodríguez, I; Covas, V J; Rodríguez Pérez, M C; Cabrera de León, A; Aguirre-Jaime, A

    2017-08-23

    To determine if the ETAP smoking scale, which measures accumulated exposure to tobacco, both actively and passively, is applicable and effective in the clinical practice of Primary Care for the prevention of acute myocardial infarction (AMI). Location Barranco Grande Health Centre in Tenerife, Spain. A study of 61 cases (AMI) and 144 controls. Sampling with random start, without matching. COR-II curves were analysed, and effectiveness was estimated using sensitivity and negative predictive value (NPV). A questionnaire was provided to participating family physicians on the applicability of ETAP in the clinic. The opinion of the participating physicians was unanimously favourable. ETAP was easy to use in the clinic, required less than 3min per patient, and was useful to reinforce the preventive intervention. The ETAP COR-II curve showed that 20years of exposure was the best cut-off point, with an area under the curve of 0.70 (95%CI: 0.62-0.78), and a combination of sensitivity (98%) and NPV (96%) for AMI. When stratifying age and gender, all groups achieved sensitivities and NPVs close to 100%, except for men aged ≥55years, in whom the NPV fell to 75%. The results indicate that ETAP is a valid tool that can be applied and be effective in the clinical practice of Primary Care for the prevention of AMI related to smoking exposure. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

  10. Modified Ashworth Scale (MAS) Model based on Clinical Data Measurement towards Quantitative Evaluation of Upper Limb Spasticity

    Science.gov (United States)

    Puzi, A. Ahmad; Sidek, S. N.; Mat Rosly, H.; Daud, N.; Yusof, H. Md

    2017-11-01

    Spasticity is common symptom presented amongst people with sensorimotor disabilities. Imbalanced signals from the central nervous systems (CNS) which are composed of the brain and spinal cord to the muscles ultimately leading to the injury and death of motor neurons. In clinical practice, the therapist assesses muscle spasticity using a standard assessment tool like Modified Ashworth Scale (MAS), Modified Tardiue Scale (MTS) or Fugl-Meyer Assessment (FMA). This is done subjectively based on the experience and perception of the therapist subjected to the patient fatigue level and body posture. However, the inconsistency in the assessment is prevalent and could affect the efficacy of the rehabilitation process. Thus, the aim of this paper is to describe the methodology of data collection and the quantitative model of MAS developed to satisfy its description. Two subjects with MAS of 2 and 3 spasticity levels were involved in the clinical data measurement. Their level of spasticity was verified by expert therapist using current practice. Data collection was established using mechanical system equipped with data acquisition system and LABVIEW software. The procedure engaged repeated series of flexion of the affected arm that was moved against the platform using a lever mechanism and performed by the therapist. The data was then analyzed to investigate the characteristics of spasticity signal in correspondence to the MAS description. Experimental results revealed that the methodology used to quantify spasticity satisfied the MAS tool requirement according to the description. Therefore, the result is crucial and useful towards the development of formal spasticity quantification model.

  11. Impact of scaling on the performance and reliability degradation of metal-contacts in NEMS devices

    KAUST Repository

    Dadgour, Hamed F.

    2011-04-01

    Nano-electro-mechanical switches (NEMS) offer new possibilities for the design of ultra energy-efficient systems; however, thus far, all the fabricated NEMS devices require high supply voltages that limit their applicability for logic designs. Therefore, research is being conducted to lower the operating voltages by scaling down the physical dimensions of these devices. However, the impact of device scaling on the electrical and mechanical properties of metal contacts in NEMS devices has not been thoroughly investigated in the literature. Such a study is essential because metal contacts play a critical role in determining the overall performance and reliability of NEMS. Therefore, the comprehensive analytical study presented in this paper highlights the performance and reliability degradations of such metal contacts caused by scaling. The proposed modeling environment accurately takes into account the impact of roughness of contact surfaces, elastic/plastic deformation of contacting asperities, and various inter-molecular forces between mating surfaces (such as Van der Waals and capillary forces). The modeling results are validated and calibrated using available measurement data. This scaling analysis indicates that the key contact properties of gold contacts (resistance, stiction and wear-out) deteriorate "exponentially" with scaling. Simulation results demonstrate that reliable (stiction-free) operation of very small contact areas (≈ 6nm x 6nm) will be a daunting task due to the existence of strong surface forces. Hence, contact degradation is identified as a major problem to the scaling of NEMS transistors. © 2011 IEEE.

  12. Optimizing fusion PIC code performance at scale on Cori Phase 2

    Energy Technology Data Exchange (ETDEWEB)

    Koskela, T. S.; Deslippe, J.

    2017-07-23

    In this paper we present the results of optimizing the performance of the gyrokinetic full-f fusion PIC code XGC1 on the Cori Phase Two Knights Landing system. The code has undergone substantial development to enable the use of vector instructions in its most expensive kernels within the NERSC Exascale Science Applications Program. We study the single-node performance of the code on an absolute scale using the roofline methodology to guide optimization efforts. We have obtained 2x speedups in single node performance due to enabling vectorization and performing memory layout optimizations. On multiple nodes, the code is shown to scale well up to 4000 nodes, near half the size of the machine. We discuss some communication bottlenecks that were identified and resolved during the work.

  13. [Evaluation of effects of quality scale for removable partial dentures in clinical application].

    Science.gov (United States)

    Lv, Jun-bang; Wu, Hui-liang; Zhang, Yan; Ke, Xiang-kang; Cao, Fu-xi; Gu, Liang; Wang, Xi-cai

    2013-02-01

    To evaluate the effects of quality scale for removable partial dentures (RPD)in clinical application. Quality scale for removable partial dentures was designed. Twelve items were devised for visual survey and try-in in base, artificial teeth, clasp, rest, connector and adjustment. The assessments were divided into 3 grades A, B and C. Four commercial dental laboratories were divided into experimental group and control group randomly. All RPD made in two groups were given score with the quality scale by single-blind method. In the experimental group,the technicians were familiar with the quality scale. The assessments were periodically feedbacked to administrative staffs and exchanges were carried out between doctors and technicians by telephone. No feedback information was provided in the control group. The assessments were compared between the two groups. The data was analyzed with SPSS17.0 software package. The scores of assessments for base, artificial teeth, clasp, rest, connector and adjustment in the experimental group were greater than that in the control group. The difference was significant between the two groups by analysis of variance (P<0.01). The grade A and C for RPD used acrylic resin, flexible resin and cast framework in the experimental group was 27.2%,39.5%,40.6% and 9.2%, 7.9%,7.2%, respectively. The grade B was in the majority. In the control group, the grade A and C was 9.4%,15.6%,15% and 40.6%,23.6%,25%,respectively. The majority was grade B and the grade C was significantly higher than the experimental group(P<0.05). Applying the quality scale of RPD can improve the fabricating quality of prosthesis.

  14. Module-scale analysis of pressure retarded osmosis: performance limitations and implications for full-scale operation.

    Science.gov (United States)

    Straub, Anthony P; Lin, Shihong; Elimelech, Menachem

    2014-10-21

    We investigate the performance of pressure retarded osmosis (PRO) at the module scale, accounting for the detrimental effects of reverse salt flux, internal concentration polarization, and external concentration polarization. Our analysis offers insights on optimization of three critical operation and design parameters--applied hydraulic pressure, initial feed flow rate fraction, and membrane area--to maximize the specific energy and power density extractable in the system. For co- and counter-current flow modules, we determine that appropriate selection of the membrane area is critical to obtain a high specific energy. Furthermore, we find that the optimal operating conditions in a realistic module can be reasonably approximated using established optima for an ideal system (i.e., an applied hydraulic pressure equal to approximately half the osmotic pressure difference and an initial feed flow rate fraction that provides equal amounts of feed and draw solutions). For a system in counter-current operation with a river water (0.015 M NaCl) and seawater (0.6 M NaCl) solution pairing, the maximum specific energy obtainable using performance properties of commercially available membranes was determined to be 0.147 kWh per m(3) of total mixed solution, which is 57% of the Gibbs free energy of mixing. Operating to obtain a high specific energy, however, results in very low power densities (less than 2 W/m(2)), indicating that the trade-off between power density and specific energy is an inherent challenge to full-scale PRO systems. Finally, we quantify additional losses and energetic costs in the PRO system, which further reduce the net specific energy and indicate serious challenges in extracting net energy in PRO with river water and seawater solution pairings.

  15. The Effect of Noise on Human Performance: A Clinical Trial

    Directory of Open Access Journals (Sweden)

    P Nassiri

    2013-04-01

    Full Text Available Background: Noise is defined as unwanted or meaningless sound that apart from auditory adverse health effects may distract attention from cues that are important for task performance. Human performance is influenced by many job-related factors and workplace conditions including noise level. Objective: To study the effect of noise on human performance. Methods: The participants included 40 healthy male university students. The experimental design consisted of 3 (sound pressure level x 3 (noise schedule x 2 (noise type factors. To investigate occupational skill performance, some specific test batteries were used: 1 steadiness test, 2 Minnesota manual dexterity test, 3 hand tool dexterity test, and 4 two-arm coordination test. Time duration of test completion was measured as speed response; to determine error response, the time taken during committing an error by participants while performing a task was measured. Results: Speed response obtained from the 4 tests in combined conditions of noise schedule, harmonic index, and sound pressure level was highest for (intermittent, treble, 95 dB, (continuous, treble, 95 dB, (continuous, treble, 85 dB and (intermittent, treble, 95 dB, respectively. Conclusion: Treble noise was found significant in reducing human performance; also, intermittent noise, especially at high pressure levels, was responsible for worsening environmental conditions during performing a task.

  16. Enabling Structured Exploration of Workflow Performance Variability in Extreme-Scale Environments

    Energy Technology Data Exchange (ETDEWEB)

    Kleese van Dam, Kerstin; Stephan, Eric G.; Raju, Bibi; Altintas, Ilkay; Elsethagen, Todd O.; Krishnamoorthy, Sriram

    2015-11-15

    Workflows are taking an Workflows are taking an increasingly important role in orchestrating complex scientific processes in extreme scale and highly heterogeneous environments. However, to date we cannot reliably predict, understand, and optimize workflow performance. Sources of performance variability and in particular the interdependencies of workflow design, execution environment and system architecture are not well understood. While there is a rich portfolio of tools for performance analysis, modeling and prediction for single applications in homogenous computing environments, these are not applicable to workflows, due to the number and heterogeneity of the involved workflow and system components and their strong interdependencies. In this paper, we investigate workflow performance goals and identify factors that could have a relevant impact. Based on our analysis, we propose a new workflow performance provenance ontology, the Open Provenance Model-based WorkFlow Performance Provenance, or OPM-WFPP, that will enable the empirical study of workflow performance characteristics and variability including complex source attribution.

  17. Clinical instructors' perceptions of behaviors that comprise entry-level clinical performance in physical therapist students: a qualitative study.

    Science.gov (United States)

    Jette, Diane U; Bertoni, Alicia; Coots, Renee; Johnson, Heidi; McLaughlin, Catherine; Weisbach, Cody

    2007-07-01

    The purpose of this study was to qualitatively explore clinical instructors' (CIs) perceptions of students' behaviors that comprise entry-level clinical performance, as well as how those perceptions were integrated into their decision making. The participants were 21 physical therapists who were CIs for physical therapist students. Using a grounded theory approach, we conducted interviews, asking the question, "What is it about students' performance that makes you see them as entry-level therapists?" We determined common themes among the interviews and developed a schema to explain the decision-making process. Participants identified 7 attributes that, when demonstrated to a sufficient degree, illustrated to them students' ability to practice at the entry level. Those attributes were knowledge, clinical skills, safety, clinical decision making, self-directed learning, interpersonal communication, and professional demeanor. Participants viewed these attributes in concert to form a subjective "gut feeling" that a student demonstrated entry-level performance. A final theme emerged suggesting a definition of entry-level performance as "mentored independence." Participants reported evaluating students' performance based on attributes similar to those suggested by the American Physical Therapy Association's Physical Therapist Clinical Performance Instrument and previous research. However, subjectivity also was involved in their decision about whether students were able to practice at the entry level. Participants also concluded that entry-level students need not be independent in all clinical situations.

  18. Understanding water delivery performance in a large-scale irrigation system in Peru

    NARCIS (Netherlands)

    Vos, J.M.C.

    2005-01-01

    During a two-year field study the performance of the water delivery was evaluated in a large-scale irrigation system on the north coast of Peru. Flow measurements were carried out along the main canals, along two secondary canals, and in two tertiary blocks in the Chancay-Lambayeque irrigation

  19. The Development of Hyper-MNP: Hyper-Media Navigational Performance Scale

    Science.gov (United States)

    Firat, Mehmet; Yurdakul, Isil Kabakci

    2016-01-01

    The present study aimed at developing a scale to evaluate navigational performance as a whole, which is one of the factors influencing learning in hyper media. In line with this purpose, depending on the related literature, an item pool of 15 factors was prepared, and these variables were decreased to 5 based on the views of 38 field experts. In…

  20. A pilot scale electrical infrared dry-peeling system for tomatoes: design and performance evaluation

    Science.gov (United States)

    A pilot scale infrared dry-peeling system for tomatoes was designed and constructed. The system consisted of three major sections including the IR heating, vacuum, and pinch roller sections. The peeling performance of the system was examined under different operational conditions using tomatoes with...

  1. Psychometric properties and clinical utility of the Scale for Suicidal Ideation (SSI in adolescents

    Directory of Open Access Journals (Sweden)

    Ruuttu Titta

    2005-02-01

    Full Text Available Abstract Background Accurate assessment of suicidality is of major importance in both clinical and research settings. The Scale for Suicidal Ideation (SSI is a well-established clinician-rating scale but its suitability to adolescents has not been studied. The aim of this study was to evaluate the reliability and validity, and to test an appropriate cutoff threshold for the SSI in a depressed adolescent outpatient population and controls. Methods 218 adolescent psychiatric outpatient clinic patients suffering from depressive disorders and 200 age- and sex-matched school-attending controls were evaluated by the SSI for presence and severity of suicidal ideation. Internal consistency, discriminative-, concurrent-, and construct validity as well as the screening properties of the SSI were evaluated. Results Cronbach's α for the whole SSI was 0.95. The SSI total score differentiated patients and controls, and increased statistically significantly in classes with increasing severity of suicidality derived from the suicidality items of the K-SADS-PL diagnostic interview. Varimax-rotated principal component analysis of the SSI items yielded three theoretically coherent factors suggesting construct validity. Area under the receiver operating characteristic (ROC curve was 0.84 for the whole sample and 0.80 for the patient sample. The optimal cutoff threshold for the SSI total score was 3/4 yielding sensitivity of 75% and specificity of 88.9% in this population. Conclusions SSI appears to be a reliable and a valid measure of suicidal ideation for depressed adolescents.

  2. Psychometric properties and clinical utility of the Scale for Suicidal Ideation (SSI) in adolescents.

    Science.gov (United States)

    Holi, Matti M; Pelkonen, Mirjami; Karlsson, Linnea; Kiviruusu, Olli; Ruuttu, Titta; Heilä, Hannele; Tuisku, Virpi; Marttunen, Mauri

    2005-02-03

    Accurate assessment of suicidality is of major importance in both clinical and research settings. The Scale for Suicidal Ideation (SSI) is a well-established clinician-rating scale but its suitability to adolescents has not been studied. The aim of this study was to evaluate the reliability and validity, and to test an appropriate cutoff threshold for the SSI in a depressed adolescent outpatient population and controls. 218 adolescent psychiatric outpatient clinic patients suffering from depressive disorders and 200 age- and sex-matched school-attending controls were evaluated by the SSI for presence and severity of suicidal ideation. Internal consistency, discriminative-, concurrent-, and construct validity as well as the screening properties of the SSI were evaluated. Cronbach's alpha for the whole SSI was 0.95. The SSI total score differentiated patients and controls, and increased statistically significantly in classes with increasing severity of suicidality derived from the suicidality items of the K-SADS-PL diagnostic interview. Varimax-rotated principal component analysis of the SSI items yielded three theoretically coherent factors suggesting construct validity. Area under the receiver operating characteristic (ROC) curve was 0.84 for the whole sample and 0.80 for the patient sample. The optimal cutoff threshold for the SSI total score was 3/4 yielding sensitivity of 75% and specificity of 88.9% in this population. SSI appears to be a reliable and a valid measure of suicidal ideation for depressed adolescents.

  3. A self-scaling, distributed information architecture for public health, research, and clinical care.

    Science.gov (United States)

    McMurry, Andrew J; Gilbert, Clint A; Reis, Ben Y; Chueh, Henry C; Kohane, Isaac S; Mandl, Kenneth D

    2007-01-01

    This study sought to define a scalable architecture to support the National Health Information Network (NHIN). This architecture must concurrently support a wide range of public health, research, and clinical care activities. The architecture fulfils five desiderata: (1) adopt a distributed approach to data storage to protect privacy, (2) enable strong institutional autonomy to engender participation, (3) provide oversight and transparency to ensure patient trust, (4) allow variable levels of access according to investigator needs and institutional policies, (5) define a self-scaling architecture that encourages voluntary regional collaborations that coalesce to form a nationwide network. Our model has been validated by a large-scale, multi-institution study involving seven medical centers for cancer research. It is the basis of one of four open architectures developed under funding from the Office of the National Coordinator of Health Information Technology, fulfilling the biosurveillance use case defined by the American Health Information Community. The model supports broad applicability for regional and national clinical information exchanges. This model shows the feasibility of an architecture wherein the requirements of care providers, investigators, and public health authorities are served by a distributed model that grants autonomy, protects privacy, and promotes participation.

  4. Clinical effects of pranayama on performance of rifle shooters

    Directory of Open Access Journals (Sweden)

    Amte Snehal Shekhar, Mistry Hetal M

    2014-07-01

    Full Text Available Background: Yoga has an enormous scientifically proven effect on man’s physical and psychological functioning. Pranayama constitute the most vital aspects of yoga. Various methods of pranayama have a sound scientific basis and are traditionally believed to produce equilibrium between psychic and somatic aspects of bodily functions. The link between body and mind is obligatory for the better performance of sports persons. Aim: The aim of the study is to find out the effect of pranayama on the performance of Rifle shooters by measuring the parameters like-breath holding time, lung functional capacity and shooting performance. Method: 52 state level shooters subjects were chosen from 2 centres between the age group of 15-30years. Out of them, 26 shooters were given training in the techniques of pranayama for 3weeks.The other 26 subjects served as control i.e. with out Pranayama training. Variables like shooting performance, breath holding time (BHT, peak expiratory flow rate (PEFR, respiratory rate (RR and pulse rate (PR were measured in both the groups. Results: The study showed highly significant improvement in all the five variables shooting performance (in mm, BHT, PEFR, RR and PR with p value of 3.62E-05, 2.78E-07, 1.31E-09, 0.013, 3.40E-04respectively. Conclusion: So it can be concluded that pranayama is efficacious for better performance of Rifle shooters and should be included in their training practice.

  5. Smelling Anxiety Chemosignals Impairs Clinical Performance of Dental Students.

    Science.gov (United States)

    Singh, Preet Bano; Young, Alix; Lind, Synnøve; Leegaard, Marie Cathinka; Capuozzo, Alessandra; Parma, Valentina

    2018-05-15

    Despite the fact that human body odors can transfer anxiety-related signals, the impact of such signals in real-life situations is scant. In this study, the effects of anxiety chemosignals on the performance of dental students operating on simulation units, wearing t-shirts imbued with human sweat and masked with eugenol were tested. Twenty-four 4th year dental students (17F) donated their body odors in two sessions (Anxiety and Rest). Twenty-four normosmic, sex- and age-matched test subjects who were3rd year dental students performed three dental procedures while smelling masked anxiety body odors, masked rest body odors or masker alone. The intensity and pleasantness ratings showed that the test subjects could not report perceptual differences between the odor conditions. When exposed to masked anxiety body odors the test subject's dental performance was significantly worse than when they were exposed to masked rest body odors and masker alone, indicating that their performance was modulated by exposure to the emotional tone of the odor. These findings call for a careful evaluation of the anxiety-inducing effects of body odors in performance-related tasks and provide the first ecological evaluation of human anxiety chemosignal communication.

  6. Modified distal shoe appliance--fabrication and clinical performance.

    Science.gov (United States)

    Gujjar, Kumar Raghav; Indushekar, K R; Amith, H V; Sharma, Shefali Li

    2012-01-01

    When the primary second molar is prematurely lost, mesial movement and migration of the permanent first molar often occurs. This is one of the most difficult problems of the developing dentition confronted by pediatric dentists. Use of a space maintainer that will guide the permanent first molar into its normal position is indicated. In cases with bilateral premature loss of primary molars, the conventional design of distal shoe poses a variety of problems and, therefore, necessitates a customized design for the eruption guidance of permanent first molars. The purpose of this case report is to discuss an innovative design of a distal shoe appliance, which was used with good clinical results.

  7. Performance of small-scale aero-derivative industrial gas turbines derived from helicopter engines

    Directory of Open Access Journals (Sweden)

    Barinyima Nkoi

    2013-12-01

    Full Text Available This paper considers comparative assessment of simple and advanced cycle small-scale aero-derivative industrial gas turbines derived from helicopter engines. More particularly, investigation was made of technical performance of the small-scale aero-derivative engine cycles based on existing and projected cycles for applications in industrial power generation, combined heat and power concept, rotating equipment driving, and/or allied processes. The investigation was done by carrying out preliminary design and performance simulation of a simple cycle (baseline two-spool small-scale aero-derivative turboshaft engine model, and some advanced counterpart aero-derivative configurations. The advanced configurations consist of recuperated and intercooled/recuperated engine cycles of same nominal power rating of 1.567 MW. The baseline model was derived from the conversion of an existing helicopter engine model. In doing so, design point and off-design point performances of the engine models were established. In comparing their performances, it was observed that to a large extent, the advanced engine cycles showed superior performance in terms of thermal efficiency, and specific fuel consumption. In numerical terms, thermal efficiencies of recuperated engine cycle, and intercooled/recuperated engine cycles, over the simple cycle at DP increased by 13.5%, and 14.5% respectively, whereas specific fuel consumption of these cycles over simple cycle at DP decreased by 12.5%, and 13% respectively. This research relied on open access public literature for data.

  8. Fluid flow measurements of Test Series A and B for the Small Scale Seal Performance Tests

    International Nuclear Information System (INIS)

    Peterson, E.W.; Lagus, P.L.; Lie, K.

    1987-12-01

    The degree of waste isolation achieved by a repository seal system is dependent upon the fluid flow characteristics, or permeability, of the seals. In order to obtain meaningful, site-specific data on the performance of various possible seal system components, a series of in situ experiments called the Small Scale Seal Performance Tests (SSSPT) are being conducted at the Waste Isolation Pilot Plant (WIPP). This report contains the results of gas flow, tracer penetration, and brine flow tests conducted on concrete seals in vertical (Test Series A) and horizontal (Test Series B) configurations. The test objectives were to evaluate the seal performance and to determine if there existed scaling effects which could influence future SSSPT designs. 3 refs., 77 figs

  9. Properties and Performance of SOFCs Produced on a Pre-Pilot Plant Scale

    DEFF Research Database (Denmark)

    Hagen, Anke; Menon, Mohan; Barfod, Rasmus

    2006-01-01

    specific cell resistance at 850 °C was found to be 0.24 Ω cm2 with a standard deviation of 0.05 Ω cm2. The variation in performance between the cells can be largely attributed to variations in the cathode performance. Experimental evidence will be presented on full 4 × 4 cm2 cells, symmetric cells with two......In the present paper, anode supported solid oxide fuel cells (SOFCs), produced on a pre-pilot plant scale in ten batches of ∼100 cells, are characterised with respect to performance. The main purpose was to evaluate the reproducibility of the scaled-up process. Based on 20 tests, the average area...

  10. Adjunctive use of essential oils following scaling and root planing -a randomized clinical trial.

    Science.gov (United States)

    Azad, Mohammad Fallah; Schwiertz, Andreas; Jentsch, Holger F R

    2016-06-07

    Hitherto no study has been published on the effect of the adjunctive administration of essential oils following scaling and root planing (SRP). This study describes the effect of a mouthrinse consisting of essential oils (Cymbopogon flexuosus, Thymus zygis and Rosmarinus officinalis) following SRP by clinical and microbiological variables in patients with generalized moderate chronic periodontitis. Forty-six patients (aged 40-65 years) with moderate chronic periodontitis were randomized in a double-blind study and rinsed their oral cavity following SRP with an essential oil mouthrinse (n  =  23) or placebo (n  =  23) for 14 days. Probing depth (PD), attachment level (AL), bleeding on probing (BOP) and modified sulcus bleeding index (SBI) were recorded at baseline and after 3 and 6 months. Subgingival plaque was taken for assessment of major bacteria associated with periodontitis. AL, PD, BOP and SBI were significantly improved in both groups after three (p   essential oils following SRP has a positive effect on clinical variables and on bacterial levels in the subgingival biofilm. 332-12-24092012, DRKS 00009387, German Clinical Trials Register, Freiburg i. Br., 16.09.2015.

  11. Analysis of Factors that Predict Clinical Performance in Medical School

    Science.gov (United States)

    White, Casey B.; Dey, Eric L.; Fantone, Joseph C.

    2009-01-01

    Academic achievement indices including GPAs and MCAT scores are used to predict the spectrum of medical student academic performance types. However, use of these measures ignores two changes influencing medical school admissions: student diversity and affirmative action, and an increased focus on communication skills. To determine if GPA and MCAT…

  12. Reliable and Valid Assessment of Clinical Bronchoscopy Performance

    DEFF Research Database (Denmark)

    Konge, Lars; Larsen, Klaus Richter; Clementsen, Paul

    2012-01-01

    : The interrater reliability was high, with Cronbach's a = 0.86. Assessment of 3 bronchoscopies by a single rater had a generalizability coefficient of 0.84. The correlation between experience and performance was good (Pearson correlation = 0.76). There were significant differences between the groups for all...

  13. Development and testing of the CALDs and CLES+T scales for international nursing students' clinical learning environments.

    Science.gov (United States)

    Mikkonen, Kristina; Elo, Satu; Miettunen, Jouko; Saarikoski, Mikko; Kääriäinen, Maria

    2017-08-01

    The purpose of this study was to develop and test the psychometric properties of the new Cultural and Linguistic Diversity scale, which is designed to be used with the newly validated Clinical Learning Environment, Supervision and Nurse Teacher scale for assessing international nursing students' clinical learning environments. In various developed countries, clinical placements are known to present challenges in the professional development of international nursing students. A cross-sectional survey. Data were collected from eight Finnish universities of applied sciences offering nursing degree courses taught in English during 2015-2016. All the relevant students (N = 664) were invited and 50% chose to participate. Of the total data submitted by the participants, 28% were used for scale validation. The construct validity of the two scales was tested by exploratory factor analysis, while their validity with respect to convergence and discriminability was assessed using Spearman's correlation. Construct validation of the Clinical Learning Environment, Supervision and Nurse Teacher scale yielded an eight-factor model with 34 items, while validation of the Cultural and Linguistic Diversity scale yielded a five-factor model with 21 items. A new scale was developed to improve evidence-based mentorship of international nursing students in clinical learning environments. The instrument will be useful to educators seeking to identify factors that affect the learning of international students. © 2017 John Wiley & Sons Ltd.

  14. Performance of Linear and Nonlinear Two-Leaf Light Use Efficiency Models at Different Temporal Scales

    DEFF Research Database (Denmark)

    Wu, Xiaocui; Ju, Weimin; Zhou, Yanlian

    2015-01-01

    The reliable simulation of gross primary productivity (GPP) at various spatial and temporal scales is of significance to quantifying the net exchange of carbon between terrestrial ecosystems and the atmosphere. This study aimed to verify the ability of a nonlinear two-leaf model (TL-LUEn), a linear...... two-leaf model (TL-LUE), and a big-leaf light use efficiency model (MOD17) to simulate GPP at half-hourly, daily and 8-day scales using GPP derived from 58 eddy-covariance flux sites in Asia, Europe and North America as benchmarks. Model evaluation showed that the overall performance of TL...

  15. Methodology to determine the technical performance and value proposition for grid-scale energy storage systems :

    Energy Technology Data Exchange (ETDEWEB)

    Byrne, Raymond Harry; Loose, Verne William; Donnelly, Matthew K.; Trudnowski, Daniel J.

    2012-12-01

    As the amount of renewable generation increases, the inherent variability of wind and photovoltaic systems must be addressed in order to ensure the continued safe and reliable operation of the nation's electricity grid. Grid-scale energy storage systems are uniquely suited to address the variability of renewable generation and to provide other valuable grid services. The goal of this report is to quantify the technical performance required to provide di erent grid bene ts and to specify the proper techniques for estimating the value of grid-scale energy storage systems.

  16. Efficient clinical-scale enrichment of lymphocytes for use in adoptive immunotherapy using a modified counterflow centrifugal elutriation program.

    Science.gov (United States)

    Powell, Daniel J; Brennan, Andrea L; Zheng, Zhaohui; Huynh, Hong; Cotte, Julio; Levine, Bruce L

    2009-01-01

    Clinical-scale lymphocyte enrichment from a leukapheresis product has been performed most routinely using costly magnetic bead separation systems that deplete monocytes, but this procedure may leave behind residual beads or antibodies in the enriched cell product. Counterflow centrifugal elutriation has been demonstrated previously to enrich monocytes efficiently for generation of dendritic cells. This study describes a modified elutriation procedure for efficient bead-free economical enrichment of lymphocytes from leukapheresis products from healthy donors and study subjects with human immunodeficiency virus (HIV) infection or malignancy. Modified program settings and conditions for the CaridianBCT Elutra device were investigated to optimize lymphocyte enrichment and recovery. Lymphocyte enrichment was measured using a novel approach utilizing cell sizing analysis on a Beckman Coulter Multisizer and confirmed by flow cytometry phenotypic analysis. Efficient enrichment and recovery of lymphocytes from leukapheresis cell products was achieved using modified elutriation settings for flow rate and fraction volume. Elutriation allowed for enrichment of larger numbers of lymphocytes compared with depletion of monocytes by bead adherence, with a trend toward increased lymphocyte purity and yield via elutriation, resulting in a substantial reduction in the cost of enrichment per cell. Importantly, significant lymphocyte enrichment could be accomplished using leukapheresis samples from healthy donors (n=12) or from study subjects with HIV infection (n=15) or malignancy (n=12). Clinical-scale closed-system elutriation can be performed efficiently for the selective enrichment of lymphocytes for immunotherapy protocols. This represents an improvement in cost, yield and purity over current methods that require the addition of monocyte-depleting beads.

  17. The impact of component performance on the overall cycle performance of small-scale low temperature organic Rankine cycles

    Science.gov (United States)

    White, M.; Sayma, A. I.

    2015-08-01

    Low temperature organic Rankine cycles offer a promising technology for the generation of power from low temperature heat sources. Small-scale systems (∼10kW) are of significant interest, however there is a current lack of commercially viable expanders. For a potential expander to be economically viable for small-scale applications it is reasonable to assume that the same expander must have the ability to be implemented within a number of different ORC applications. It is therefore important to design and optimise the cycle considering the component performance, most notably the expander, both at different thermodynamic conditions, and using alternative organic fluids. This paper demonstrates a novel modelling methodology that combines a previously generated turbine performance map with cycle analysis to establish at what heat source conditions optimal system performance can be achieved using an existing turbine design. The results obtained show that the same turbine can be effectively utilised within a number of different ORC applications by changing the working fluid. By selecting suitable working fluids, this turbine can be used to convert pressurised hot water at temperatures between 360K and 400K, and mass flow rates between 0.45kg/s and 2.7kg/s, into useful power with outputs between 1.5kW and 27kW. This is a significant result since it allows the same turbine to be implemented into a variety of applications, improving the economy of scale. This work has also confirmed the suitability of the candidate turbine for a range of low temperature ORC applications.

  18. Reliability and Validity of the Turkish Version of the Job Performance Scale Instrument.

    Science.gov (United States)

    Harmanci Seren, Arzu Kader; Tuna, Rujnan; Eskin Bacaksiz, Feride

    2018-02-01

    Objective measurement of the job performance of nursing staff using valid and reliable instruments is important in the evaluation of healthcare quality. A current, valid, and reliable instrument that specifically measures the performance of nurses is required for this purpose. The aim of this study was to determine the validity and reliability of the Turkish version of the Job Performance Instrument. This study used a methodological design and a sample of 240 nurses working at different units in four hospitals in Istanbul, Turkey. A descriptive data form, the Job Performance Scale, and the Employee Performance Scale were used to collect data. Data were analyzed using IBM SPSS Statistics Version 21.0 and LISREL Version 8.51. On the basis of the data analysis, the instrument was revised. Some items were deleted, and subscales were combined. The Turkish version of the Job Performance Instrument was determined to be valid and reliable to measure the performance of nurses. The instrument is suitable for evaluating current nursing roles.

  19. Empirical Correlates of Low Scores on MMPI-2/MMPI-2-RF Restructured Clinical Scales in a Sample of University Students

    Science.gov (United States)

    Avdeyeva, Tatyana V.; Tellegen, Auke; Ben-Porath, Yossef S.

    2012-01-01

    In the present study, the authors explored the meaning of low scores on the MMPI-2/MMPI-2-RF Restructured Clinical (RC) scales. Using responses of a sample of university students (N = 811), the authors examined whether low (T less than 39), within-normal-limits (T = 39-64), and high (T greater than 65) score levels on the RC scales are…

  20. Clinical utility of the Wechsler memory scale - fourth edition (WMS-IV) in patients with intractable temporal lobe epilepsy

    NARCIS (Netherlands)

    Bouman, Zita; Elhorst, Didi; Hendriks, Marc P H; Kessels, Roy P C; Aldenkamp, Albert P.

    2016-01-01

    Introduction: The Wechsler Memory Scale (WMS) is one of the most widely used test batteries to assess memory functions in patients with brain dysfunctions of different etiologies. This study examined the clinical validation of the Dutch Wechsler Memory Scale - Fourth Edition (WMS-IV-NL) in patients

  1. Clinical utility of the Wechsler Memory Scale - Fourth Edition (WMS-IV) in patients with intractable temporal lobe epilepsy

    NARCIS (Netherlands)

    Bouman, Z.; Elhorst, D.; Hendriks, M.P.H.; Kessels, R.P.C.; Aldenkamp, A.P.

    2016-01-01

    Introduction: The Wechsler Memory Scale (WMS) is one of the most widely used test batteries to assess memory functions in patients with brain dysfunctions of different etiologies. This study examined the clinical validation of the Dutch Wechsler Memory Scale-Fourth Edition (WMS-IV-NL) in patients

  2. STATISTICAL EVALUATION OF SMALL SCALE MIXING DEMONSTRATION SAMPLING AND BATCH TRANSFER PERFORMANCE - 12093

    Energy Technology Data Exchange (ETDEWEB)

    GREER DA; THIEN MG

    2012-01-12

    The ability to effectively mix, sample, certify, and deliver consistent batches of High Level Waste (HLW) feed from the Hanford Double Shell Tanks (DST) to the Waste Treatment and Immobilization Plant (WTP) presents a significant mission risk with potential to impact mission length and the quantity of HLW glass produced. DOE's Tank Operations Contractor, Washington River Protection Solutions (WRPS) has previously presented the results of mixing performance in two different sizes of small scale DSTs to support scale up estimates of full scale DST mixing performance. Currently, sufficient sampling of DSTs is one of the largest programmatic risks that could prevent timely delivery of high level waste to the WTP. WRPS has performed small scale mixing and sampling demonstrations to study the ability to sufficiently sample the tanks. The statistical evaluation of the demonstration results which lead to the conclusion that the two scales of small DST are behaving similarly and that full scale performance is predictable will be presented. This work is essential to reduce the risk of requiring a new dedicated feed sampling facility and will guide future optimization work to ensure the waste feed delivery mission will be accomplished successfully. This paper will focus on the analytical data collected from mixing, sampling, and batch transfer testing from the small scale mixing demonstration tanks and how those data are being interpreted to begin to understand the relationship between samples taken prior to transfer and samples from the subsequent batches transferred. An overview of the types of data collected and examples of typical raw data will be provided. The paper will then discuss the processing and manipulation of the data which is necessary to begin evaluating sampling and batch transfer performance. This discussion will also include the evaluation of the analytical measurement capability with regard to the simulant material used in the demonstration tests. The

  3. Clinical performance of different DF-4 implantable cardioverter defibrillator leads.

    Science.gov (United States)

    Sarrazin, Jean-François; Philippon, François; Sellier, Romain; André, Philippe; O'Hara, Gilles; Molin, Franck; Nault, Isabelle; Blier, Louis; Champagne, Jean

    2018-06-01

    Implantable cardioverter-defibrillator (ICD) DF-4 connectors have been introduced to facilitate defibrillator lead connection and to reduce the size of device header. There are limited data regarding the overall performance of those leads and no comparison between different ICD DF-4 leads. This is a cohort study of consecutive patients implanted with ICD DF-4 lead system at one University Centre between October 2010 and February 2015. A historical control group of patients with ICD DF-1 lead implantation was used for comparison. The following ICD DF-4 leads were evaluated: St. Jude Medical Durata 7122Q (St. Jude Medical, St. Paul, MN, USA), Medtronic Sprint Quattro Secure 6935 M (Medtronic Inc., Minneapolis, MN, USA), Boston Scientific Endotak Reliance 4-Site 0293 (Boston Scientific, Marlborough, MA, USA), and Boston Scientific Reliance 4-Front 0693. This study evaluated the acute and mid-term performances of those leads as well as complications. A total of 812 patients (age 63 ± 12 years, 80% male, left ventricular ejection fraction 31 ± 12%) underwent implantation of an ICD DF-4 lead. Acute and follow-up R-wave sensing and threshold were excellent. Compared to implantation, intrinsic R waves were higher at follow-up for Boston Scientific and Medtronic leads, and pacing lead impedances were lower for all leads at first follow-up (P < 0.001). The number of lead dislodgement or failure was similar between all leads. The estimated lead survival rates at 3 years were 95.6% for Boston Scientific Endotak 4-Site, 97.1% for Boston Scientific 4-Front, 97.7% for Medtronic Sprint Quattro, and 97.5% for St. Jude Durata (P  =  0.553). All ICD DF-4 leads had excellent acute and mid-term electrical performances. Longer follow-up will be necessary to confirm their sustained performance. © 2018 Wiley Periodicals, Inc.

  4. GPU accelerated CT reconstruction for clinical use: quality driven performance

    Science.gov (United States)

    Vaz, Michael S.; Sneyders, Yuri; McLin, Matthew; Ricker, Alan; Kimpe, Tom

    2007-03-01

    We present performance and quality analysis of GPU accelerated FDK filtered backprojection for cone beam computed tomography (CBCT) reconstruction. Our implementation of the FDK CT reconstruction algorithm does not compromise fidelity at any stage and yields a result that is within 1 HU of a reference C++ implementation. Our streaming implementation is able to perform reconstruction as the images are acquired; it addresses low latency as well as fast throughput, which are key considerations for a "real-time" design. Further, it is scaleable to multiple GPUs for increased performance. The implementation does not place any constraints on image acquisition; it works effectively for arbitrary angular coverage with arbitrary angular spacing. As such, this GPU accelerated CT reconstruction solution may easily be used with scanners that are already deployed. We are able to reconstruct a 512 x 512 x 340 volume from 625 projections, each sized 1024 x 768, in less than 50 seconds. The quoted 50 second timing encompasses the entire reconstruction using bilinear interpolation and includes filtering on the CPU, uploading the filtered projections to the GPU, and also downloading the reconstructed volume from GPU memory to system RAM.

  5. Medical Students' Use of Different Coping Strategies and Relationship With Academic Performance in Preclinical and Clinical Years.

    Science.gov (United States)

    Schiller, Jocelyn H; Stansfield, R Brent; Belmonte, David C; Purkiss, Joel A; Reddy, Rishindra M; House, Joseph B; Santen, Sally A

    2018-01-01

    Phenomenon: Medical students' coping abilities are important for academic success and emotional health. The authors explored differences in students' use of active, problem-solving strategies and emotional, inwardly directed approaches; the change in coping strategies used during medical school; and coping strategy impact on performance. One hundred eighty-three students completed the Ways of Coping Scale at matriculation and end of the 2nd and 3rd years. Frequency of each of 8 ways of coping, changes in coping strategy use over time, and relationship of coping method with preclinical and clinical scores were calculated. Students varied widely in use of coping mechanisms. Over time, students shifted to using emotional strategies more frequently while decreasing their use of active strategies. Coping strategies were unrelated to preclinical academic performance (R 2 = .09, adjusted R 2 = .04, ns) but were related to clinical performance (R 2 = .23, adjusted R 2 = .18, p performance and emotional methods associated with lower performance. Insights: Students decreased use of active coping strategies and increased use of emotional coping strategies over time, but emotional strategies were associated with poorer clinical academic performance. These shifts in coping methods may be detrimental to student performance and learning. Improving students' ability to cope should be an educational priority.

  6. Improving Large-scale Storage System Performance via Topology-aware and Balanced Data Placement

    Energy Technology Data Exchange (ETDEWEB)

    Wang, Feiyi [ORNL; Oral, H Sarp [ORNL; Vazhkudai, Sudharshan S [ORNL

    2014-01-01

    With the advent of big data, the I/O subsystems of large-scale compute clusters are becoming a center of focus, with more applications putting greater demands on end-to-end I/O performance. These subsystems are often complex in design. They comprise of multiple hardware and software layers to cope with the increasing capacity, capability and scalability requirements of data intensive applications. The sharing nature of storage resources and the intrinsic interactions across these layers make it to realize user-level, end-to-end performance gains a great challenge. We propose a topology-aware resource load balancing strategy to improve per-application I/O performance. We demonstrate the effectiveness of our algorithm on an extreme-scale compute cluster, Titan, at the Oak Ridge Leadership Computing Facility (OLCF). Our experiments with both synthetic benchmarks and a real-world application show that, even under congestion, our proposed algorithm can improve large-scale application I/O performance significantly, resulting in both the reduction of application run times and higher resolution simulation runs.

  7. Structure–performance characterization for carbon molecular sieve membranes using molecular scale gas probes

    KAUST Repository

    Rungta, Meha

    2015-04-01

    © 2015 Elsevier Ltd. All rights reserved. Understanding the relationship between carbon molecular sieve (CMS) pore structure and corresponding gas separation performance enables optimization for a given gas separation application. The final pyrolysis temperature and starting polymer precursor are the two critical parameters in controlling CMS performance. This study considers structure and performance changes of CMS derived from a commercially available polymer precursor at different pyrolysis temperatures. As reviewed in this paper, most traditional characterization methods based on microscopy, X-ray diffraction, spectroscopy, sorption-based pore size distribution measurements etc. provide limited information for relating separation performance to the CMS morphology and structural changes. A useful alternative approach based on different sized gases as molecular scale probes of the CMS pore structure was successfully used here in conjunction with separation data to provide critical insights into the structure-performance relationships of the engineered CMS.

  8. Twelve tips for assessing surgical performance and use of technical assessment scales

    DEFF Research Database (Denmark)

    Strandbygaard, Jeanett; Scheele, Fedde; Sørensen, Jette Led

    2017-01-01

    Using validated assessment scales for technical competence can help structure and standardize assessment and feedback for both the trainee and the supervisor and thereby avoid bias and drive learning. Correct assessment of operative skills can establish learning curves and allow adequate monitoring....... However, the assessment of surgical performance is not an easy task, since it includes many proxy parameters, which are hard to measure. Although numerous technical assessment scales exist, both within laparoscopic and open surgery, the validity evidence is often sparse, and this can raise doubts about...... reliability and educational outcome. Furthermore, the implementation of technical assessment scales varies due to several obstacles and doubts about accurate use. In this 12-tips article, we aim to give the readers a critical and useful appraisal of some of the common questions and misunderstandings regarding...

  9. Clinical utility of Standardised Assessment of Personality - Abbreviated Scale (SAPAS) among patients with first episode depression

    DEFF Research Database (Denmark)

    Bukh, Jens Drachmann; Bock, Camilla; Vinberg, Maj

    2010-01-01

    for comorbid personality disorder among patients suffering from depression would be of clinical use. METHOD: The present study aimed to assess the utility of the Standardised Assessment of Personality - Abbreviated Scale (SAPAS) as a screen for personality disorder in a population of patients recently......BACKGROUND: Personality disorder frequently co-occurs with depression and seems to be associated with a poorer outcome of treatment and increased risk for recurrences. However, the diagnosing of personality disorder can be lengthy and requires some training. Therefore, a brief screening interview...... diagnosed with first episode depression. A total number of 394 patients with an ICD-10 diagnosis of a single depressive episode were sampled consecutively via the Danish Psychiatric Central Research Register during a 2years inclusion period and assessed by the screening interview and, subsequently...

  10. Manufacturing human mesenchymal stem cells at clinical scale: process and regulatory challenges.

    Science.gov (United States)

    Jossen, Valentin; van den Bos, Christian; Eibl, Regine; Eibl, Dieter

    2018-05-01

    Human mesenchymal stem cell (hMSC)-based therapies are of increasing interest in the field of regenerative medicine. As economic considerations have shown, allogeneic therapy seems to be the most cost-effective method. Standardized procedures based on instrumented single-use bioreactors have been shown to provide billion of cells with consistent product quality and to be superior to traditional expansions in planar cultivation systems. Furthermore, under consideration of the complex nature and requirements of allogeneic hMSC-therapeutics, a new equipment for downstream processing (DSP) was successfully evaluated. This mini-review summarizes both the current state of the hMSC production process and the challenges which have to be taken into account when efficiently producing hMSCs for the clinical scale. Special emphasis is placed on the upstream processing (USP) and DSP operations which cover expansion, harvesting, detachment, separation, washing and concentration steps, and the regulatory demands.

  11. Performance Evaluations of Three Silt Fence Practices Using a Full-Scale Testing Apparatus

    Directory of Open Access Journals (Sweden)

    R. Alan Bugg

    2017-07-01

    Full Text Available Erosion and sediment controls on construction sites minimize environmental impacts from sediment-laden stormwater runoff. Silt fence, a widely specified perimeter control practice on construction projects used to retain sediment on-site, has limited performance-based testing data. Silt fence failures and resultant sediment losses are often the result of structural failure. To better understand silt fence performance, researchers at the Auburn University-Erosion and Sediment Control Testing Facility (AU-ESCTF have evaluated three silt fence options to determine possible shortcomings using standardized full-scale testing methods. These methods subject silt fence practices to simulated, in-field conditions typically experienced on-site without the variability of field testing or the limited application of small-scale testing. Three different silt fence practices were tested to evaluate performance, which included: (1 Alabama Department of Transportation (ALDOT Trenched Silt Fence, (2 ALDOT Sliced Silt Fence, and (3 Alabama Soil and Water Conservation Committee (AL-SWCC Trenched Silt Fence. This study indicates that the structural performance of a silt fence perimeter control is the most important performance factor in retaining sediment. The sediment retention performance of these silt fence practices was 82.7%, 66.9% and 90.5%, respectively. When exposed to large impoundment conditions, both ALDOT Trench and Sliced Silt Fence practices failed structurally, while the AL-SWCC Trenched Silt Fence did not experience structural failure.

  12. Evaluation of a clinical dehydration scale in children requiring intravenous rehydration.

    Science.gov (United States)

    Kinlin, Laura M; Freedman, Stephen B

    2012-05-01

    To evaluate the reliability and validity of a previously derived clinical dehydration scale (CDS) in a cohort of children with gastroenteritis and evidence of dehydration. Participants were 226 children older than 3 months who presented to a tertiary care emergency department and required intravenous rehydration. Reliability was assessed at treatment initiation, by comparing the scores assigned independently by a trained research nurse and a physician. Validity was assessed by using parameters reflective of disease severity: weight gain, baseline laboratory results, willingness of the physician to discharge the patient, hospitalization, and length of stay. Interobserver reliability was moderate, with a weighted κ of 0.52 (95% confidence interval [CI] 0.41, 0.63). There was no correlation between CDS score and percent weight gain, a proxy measure of fluid deficit (Spearman correlation coefficient = -0.03; 95% CI -0.18, 0.12). There were, however, modest and statistically significant correlations between CDS score and several other parameters, including serum bicarbonate (Pearson correlation coefficient = -0.35; 95% CI -0.46, -0.22) and length of stay (Pearson correlation coefficient = 0.24; 95% CI 0.11, 0.36). The scale's discriminative ability was assessed for the outcome of hospitalization, yielding an area under the receiver operating characteristic curve of 0.65 (95% CI 0.57, 0.73). In children administered intravenous rehydration, the CDS was characterized by moderate interobserver reliability and weak associations with objective measures of disease severity. These data do not support its use as a tool to dictate the need for intravenous rehydration or to predict clinical course.

  13. MMPI-2 validity, clinical and content scales, and the Fake Bad Scale for personal injury litigants claiming idiopathic environmental intolerance.

    Science.gov (United States)

    Staudenmayer, Herman; Phillips, Scott

    2007-01-01

    Idiopathic environmental intolerance (IEI) is a descriptor for nonspecific complaints that are attributed to environmental exposure. The Minnesota Multiphasic Personality Inventory 2 (MMPI-2) was administered to 50 female and 20 male personal injury litigants alleging IEI. The validity scales indicated no overreporting of psychopathology. Half of the cases had elevated scores on validity scales suggesting defensiveness, and a large number had elevations on Fake Bad Scale (FBS) suggesting overreporting of unauthenticated symptoms. The average T-score profile for females was defined by the two-point code type 3-1 (Hysteria-Hypochondriasis), and the average T-score profile for males was defined by the three-point code type 3-1-2 (Hysteria, Hypochondriasis-Depression). On the content scales, Health Concerns (HEA) scale was significantly elevated. Idiopathic environmental intolerance litigants (a) are more defensive about expressing psychopathology, (b) express distress through somatization, (c) use a self-serving misrepresentation of exaggerated health concerns, and (d) may exaggerate unauthenticated symptoms suggesting malingering.

  14. Using a plant health system framework to assess plant clinic performance in Uganda

    DEFF Research Database (Denmark)

    Danielsen, Solveig; Matsiko, Frank B.

    2016-01-01

    and expand, new analytical frameworks and tools are needed to identify factors influencing performance of services and systems in specific contexts, and to guide interventions. In this paper we apply a plant health system framework to assess plant clinic performance, using Uganda as a case study...... factors, influenced by basic operational and financial concerns, inter-institutional relations and public sector policies. Overall, there was a fairly close match between the plant health system attributes and plant clinic performance, suggesting that the framework can help explain system functioning....... A comparative study of plant clinics was carried out between July 2010 and September 2011 in the 12 districts where plant clinics were operating at that time. The framework enabled us to organise multiple issues and identify key features that affected the plant clinics. Clinic performance was, among other...

  15. 77 FR 30016 - Clinical Study Design and Performance of Hospital Glucose Sensors

    Science.gov (United States)

    2012-05-21

    ...] Clinical Study Design and Performance of Hospital Glucose Sensors AGENCY: Food and Drug Administration, HHS... Sensors.'' The purpose of this public meeting is to discuss clinical study design considerations and performance metrics for innovative glucose sensors intended to be used in hospital point of care settings...

  16. 42 CFR 493.1453 - Condition: Laboratories performing high complexity testing; clinical consultant.

    Science.gov (United States)

    2010-10-01

    ... Condition: Laboratories performing high complexity testing; clinical consultant. The laboratory must have a... 42 Public Health 5 2010-10-01 2010-10-01 false Condition: Laboratories performing high complexity testing; clinical consultant. 493.1453 Section 493.1453 Public Health CENTERS FOR MEDICARE & MEDICAID...

  17. 42 CFR 493.1415 - Condition: Laboratories performing moderate complexity testing; clinical consultant.

    Science.gov (United States)

    2010-10-01

    ... § 493.1415 Condition: Laboratories performing moderate complexity testing; clinical consultant. The laboratory must have a clinical consultant who meets the qualification requirements of § 493.1417 of this... 42 Public Health 5 2010-10-01 2010-10-01 false Condition: Laboratories performing moderate...

  18. Basic Pharmaceutical Sciences Examination as a Predictor of Student Performance during Clinical Training.

    Science.gov (United States)

    Fassett, William E.; Campbell, William H.

    1984-01-01

    A comparison of Basic Pharmaceutical Sciences Examination (BPSE) results with student performance evaluations in core clerkships, institutional and community externships, didactic and clinical courses, and related basic science coursework revealed the BPSE does not predict student performance during clinical instruction. (MSE)

  19. Sustained effect of simulation-based ultrasound training on clinical performance

    DEFF Research Database (Denmark)

    Tolsgaard, M G; Ringsted, C; Dreisler, E

    2015-01-01

    on a virtual-reality transvaginal ultrasound simulator until an expert performance level was attained followed by training on a pelvic mannequin. After two months of clinical training, one transvaginal ultrasound scan was recorded for assessment of participants' clinical performance. Two blinded ultrasound...

  20. SCALE: A modular code system for performing standardized computer analyses for licensing evaluation

    International Nuclear Information System (INIS)

    1997-03-01

    This Manual represents Revision 5 of the user documentation for the modular code system referred to as SCALE. The history of the SCALE code system dates back to 1969 when the current Computational Physics and Engineering Division at Oak Ridge National Laboratory (ORNL) began providing the transportation package certification staff at the U.S. Atomic Energy Commission with computational support in the use of the new KENO code for performing criticality safety assessments with the statistical Monte Carlo method. From 1969 to 1976 the certification staff relied on the ORNL staff to assist them in the correct use of codes and data for criticality, shielding, and heat transfer analyses of transportation packages. However, the certification staff learned that, with only occasional use of the codes, it was difficult to become proficient in performing the calculations often needed for an independent safety review. Thus, shortly after the move of the certification staff to the U.S. Nuclear Regulatory Commission (NRC), the NRC staff proposed the development of an easy-to-use analysis system that provided the technical capabilities of the individual modules with which they were familiar. With this proposal, the concept of the Standardized Computer Analyses for Licensing Evaluation (SCALE) code system was born. This manual covers an array of modules written for the SCALE package, consisting of drivers, system libraries, cross section and materials properties libraries, input/output routines, storage modules, and help files

  1. SCALE: A modular code system for performing standardized computer analyses for licensing evaluation

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1997-03-01

    This Manual represents Revision 5 of the user documentation for the modular code system referred to as SCALE. The history of the SCALE code system dates back to 1969 when the current Computational Physics and Engineering Division at Oak Ridge National Laboratory (ORNL) began providing the transportation package certification staff at the U.S. Atomic Energy Commission with computational support in the use of the new KENO code for performing criticality safety assessments with the statistical Monte Carlo method. From 1969 to 1976 the certification staff relied on the ORNL staff to assist them in the correct use of codes and data for criticality, shielding, and heat transfer analyses of transportation packages. However, the certification staff learned that, with only occasional use of the codes, it was difficult to become proficient in performing the calculations often needed for an independent safety review. Thus, shortly after the move of the certification staff to the U.S. Nuclear Regulatory Commission (NRC), the NRC staff proposed the development of an easy-to-use analysis system that provided the technical capabilities of the individual modules with which they were familiar. With this proposal, the concept of the Standardized Computer Analyses for Licensing Evaluation (SCALE) code system was born. This manual covers an array of modules written for the SCALE package, consisting of drivers, system libraries, cross section and materials properties libraries, input/output routines, storage modules, and help files.

  2. Skin and scales of teleost fish: Simple structure but high performance and multiple functions

    Science.gov (United States)

    Vernerey, Franck J.; Barthelat, Francois

    2014-08-01

    Natural and man-made structural materials perform similar functions such as structural support or protection. Therefore they rely on the same types of properties: strength, robustness, lightweight. Nature can therefore provide a significant source of inspiration for new and alternative engineering designs. We report here some results regarding a very common, yet largely unknown, type of biological material: fish skin. Within a thin, flexible and lightweight layer, fish skins display a variety of strain stiffening and stabilizing mechanisms which promote multiple functions such as protection, robustness and swimming efficiency. We particularly discuss four important features pertaining to scaled skins: (a) a strongly elastic tensile behavior that is independent from the presence of rigid scales, (b) a compressive response that prevents buckling and wrinkling instabilities, which are usually predominant for thin membranes, (c) a bending response that displays nonlinear stiffening mechanisms arising from geometric constraints between neighboring scales and (d) a robust structure that preserves the above characteristics upon the loss or damage of structural elements. These important properties make fish skin an attractive model for the development of very thin and flexible armors and protective layers, especially when combined with the high penetration resistance of individual scales. Scaled structures inspired by fish skin could find applications in ultra-light and flexible armor systems, flexible electronics or the design of smart and adaptive morphing structures for aerospace vehicles.

  3. Canadian Acute Respiratory Illness and Flu Scale (CARIFS) for clinical detection of influenza in children.

    Science.gov (United States)

    Fischer, Jason B; Prasad, Priya A; Coffin, Susan E; Alpern, Elizabeth R; Mistry, Rakesh D

    2014-10-01

    Validated clinical scales, such as the Canadian Acute Respiratory Illness and Flu Scale (CARIFS), have not been used to differentiate influenza (FLU) from other respiratory viruses. Secondary analysis of a prospective cohort presenting to the emergency department (ED) with an influenza-like infection from 2008 to 2010. Subjects were children aged 0 to 19 years who had a venipuncture and respiratory virus polymerase chain reaction. Demographics and CARIFS items were assessed during the ED visit; comparisons were made between FLU and non-FLU subjects. The 203 subjects had median age 30.5 months; 61.6% were male. Comorbid conditions (51.2%) were common. FLU was identified in 26.6%, and were older than non-FLU patients (69.7 vs 47.9 months, P = .02). Demographic, household factors, and mean CARIFS score did not differ between FLU (33.7), and non-FLU (32.0) (mean difference 1.6, 95% CI: -2.0 to 5.2) groups. CARIFS cannot discriminate between FLU and non-FLU infection in ED children with influenza-like infection. © The Author(s) 2014.

  4. Do Performance-Safety Tradeoffs Cause Hypometric Metabolic Scaling in Animals?

    Science.gov (United States)

    Harrison, Jon F

    2017-09-01

    Hypometric scaling of aerobic metabolism in animals has been widely attributed to constraints on oxygen (O 2 ) supply in larger animals, but recent findings demonstrate that O 2 supply balances with need regardless of size. Larger animals also do not exhibit evidence of compensation for O 2 supply limitation. Because declining metabolic rates (MRs) are tightly linked to fitness, this provides significant evidence against the hypothesis that constraints on supply drive hypometric scaling. As an alternative, ATP demand might decline in larger animals because of performance-safety tradeoffs. Larger animals, which typically reproduce later, exhibit risk-reducing strategies that lower MR. Conversely, smaller animals are more strongly selected for growth and costly neurolocomotory performance, elevating metabolism. Copyright © 2017 Elsevier Ltd. All rights reserved.

  5. Development of Export Performance Scale for Fresh Vegetable-Fruit Sector

    Directory of Open Access Journals (Sweden)

    Murat Keskinkılınç

    2018-06-01

    Full Text Available The purpose of this paper is to propose a scale for assessing the performance of foreign trade companies in fresh vegetable-fruit sector. As a first step, a qualitative interviews was conducted to the sample consists of the managers working in export companies. As a result of the interviews major problems of exporters were grouped. In the second phase of the study a questionnaire was formed and a survey was conducted to the larger sample. Subsequently, validity and reliability of the scales were determined by means of explanatory and confirmatory factor analyses and reliability analysis respectively. The theoretical contribution of this research is the development of a method for evaluation of export performance of foreign trade companies in fresh vegetable-fruit sector.

  6. Investigation of Micro- and Macro-Scale Transport Processes for Improved Fuel Cell Performance

    Energy Technology Data Exchange (ETDEWEB)

    Gu, Wenbin [General Motors LLC, Pontiac, MI (United States)

    2014-08-29

    This report documents the work performed by General Motors (GM) under the Cooperative agreement No. DE-EE0000470, “Investigation of Micro- and Macro-Scale Transport Processes for Improved Fuel Cell Performance,” in collaboration with the Penn State University (PSU), University of Tennessee Knoxville (UTK), Rochester Institute of Technology (RIT), and University of Rochester (UR) via subcontracts. The overall objectives of the project are to investigate and synthesize fundamental understanding of transport phenomena at both the macro- and micro-scales for the development of a down-the-channel model that accounts for all transport domains in a broad operating space. GM as a prime contractor focused on cell level experiments and modeling, and the Universities as subcontractors worked toward fundamental understanding of each component and associated interface.

  7. Current status on performance of CT colonography and clinical indications

    International Nuclear Information System (INIS)

    Laghi, Andrea; Rengo, Marco; Graser, Anno; Iafrate, Franco

    2013-01-01

    CT colonography (CTC) is a robust and reliable imaging test of the colon. Accuracy for the detection of colorectal cancer (CRC) is as high as conventional colonoscopy (CC). Identification of polyp is size dependent, with large lesions (≥10 mm) accurately detected and small lesions (6–9 mm) identified with moderate to good sensitivity. Recent studies show good sensitivity for the identification of nonpolypoid (flat) lesions as well. Current CTC indications include the evaluation of patients who had undergone a previous incomplete CC or those who are unfit for CC (elderly and frail individuals, patients with underlying severe clinical conditions, or with contraindication to sedation). CTC can also be efficiently used in the assessment of diverticular disease (excluding patients with acute diverticulitis, where the exam should be postponed), before laparoscopic surgery for CRC (to have an accurate localization of the lesion), in the evaluation of colonic involvement in the case of deep pelvic endometriosis (replacing barium enema). CTC is also a safe procedure in patients with colostomy. For CRC screening, CTC should be considered an opportunistic screening test (not available for population, or mass screening) to be offered to asymptomatic average-risk individuals, of both genders, starting at age 50. The use in individuals with positive family history should be discussed with the patient first. Absolute contraindication is to propose CTC for surveillance of genetic syndromes and chronic inflammatory bowel diseases (in particular, ulcerative colitis). The use of CTC in the follow-up after surgery for CRC is achieving interesting evidences despite the fact that literature data are still relatively weak in terms of numerosity of the studied populations. In patients who underwent previous polypectomy CTC cannot be recommended as first test because debate is still open. It is desirable that in the future CTC would be the first-line and only diagnostic test for

  8. Current status on performance of CT colonography and clinical indications

    Energy Technology Data Exchange (ETDEWEB)

    Laghi, Andrea, E-mail: andrea.laghi@uniroma1.it [Department of Radiological Sciences, Oncology and Pathology Sapienza – Università di Roma, Polo Pontino, I.C.O.T. Hospital, Via Franco Faggiana 43, 04100 Latina (Italy); Rengo, Marco [Department of Radiological Sciences, Oncology and Pathology Sapienza – Università di Roma, Polo Pontino, I.C.O.T. Hospital, Via Franco Faggiana 43, 04100 Latina (Italy); Graser, Anno [InstitutfürKlinische Radiologie, Klinikumder Ludwig-Maximilians-Universität München, Campus Großhadern, Marchioninistr. 15, 81377 München (Germany); Iafrate, Franco [Department of Radiological Sciences, Oncology and Pathology Sapienza – Università di Roma, Policlinico Umberto I, Viale Regina Elena 324, 00161 Rome (Italy)

    2013-08-15

    CT colonography (CTC) is a robust and reliable imaging test of the colon. Accuracy for the detection of colorectal cancer (CRC) is as high as conventional colonoscopy (CC). Identification of polyp is size dependent, with large lesions (≥10 mm) accurately detected and small lesions (6–9 mm) identified with moderate to good sensitivity. Recent studies show good sensitivity for the identification of nonpolypoid (flat) lesions as well. Current CTC indications include the evaluation of patients who had undergone a previous incomplete CC or those who are unfit for CC (elderly and frail individuals, patients with underlying severe clinical conditions, or with contraindication to sedation). CTC can also be efficiently used in the assessment of diverticular disease (excluding patients with acute diverticulitis, where the exam should be postponed), before laparoscopic surgery for CRC (to have an accurate localization of the lesion), in the evaluation of colonic involvement in the case of deep pelvic endometriosis (replacing barium enema). CTC is also a safe procedure in patients with colostomy. For CRC screening, CTC should be considered an opportunistic screening test (not available for population, or mass screening) to be offered to asymptomatic average-risk individuals, of both genders, starting at age 50. The use in individuals with positive family history should be discussed with the patient first. Absolute contraindication is to propose CTC for surveillance of genetic syndromes and chronic inflammatory bowel diseases (in particular, ulcerative colitis). The use of CTC in the follow-up after surgery for CRC is achieving interesting evidences despite the fact that literature data are still relatively weak in terms of numerosity of the studied populations. In patients who underwent previous polypectomy CTC cannot be recommended as first test because debate is still open. It is desirable that in the future CTC would be the first-line and only diagnostic test for

  9. Ultrasound for Appendicitis: Performance and Integration with Clinical Parameters

    Science.gov (United States)

    Löfvenberg, Fanny

    2016-01-01

    Objective. To evaluate the performance of ultrasound in pediatric appendicitis and the integration of US with the pediatric appendicitis score (PAS) and C-reactive protein (CRP). Method. An institution-based, retrospective study of children who underwent abdominal US for suspected appendicitis between 2012 and 2015 at a tertiary pediatric surgery center. US results were dichotomized, with a nonvisualized appendix considered as a negative examination. Results. In total, 438 children were included (mean 8.5 years, 54% boys), with an appendicitis rate of 29%. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for US were 82%, 97%, 92%, and 93%, respectively, without significant age or gender differences. Pediatric radiologists had significantly higher sensitivity compared to general radiologists, 88% and 71%, respectively (p appendicitis, regardless of age or gender, and should be the first choice of imaging modalities. Combining US with PAS and CRP may reduce several unnecessary admissions for in-hospital observation. PMID:28044133

  10. Multi-Scale Texturing of Metallic Surfaces for High Performance Military Systems

    Science.gov (United States)

    2015-08-17

    AISI 440C stainless steel balls of 3 mm radius and 690 HV hardness. The sliding time (20 min), amplitude (10.5 mm), frequency (1.5 Hz) and normal...texture form (e. g., micro-scale topography) on surface integrity measures and tribological wear performance were quantified. The ensuing results are... Tribological Applications, Submitted for publication (08 2015) TOTAL: 2 Books Number of Manuscripts: Patents Submitted Patents Awarded Awards Graduate Students

  11. Performing three-dimensional neutral particle transport calculations on tera scale computers

    International Nuclear Information System (INIS)

    Woodward, C.S.; Brown, P.N.; Chang, B.; Dorr, M.R.; Hanebutte, U.R.

    1999-01-01

    A scalable, parallel code system to perform neutral particle transport calculations in three dimensions is presented. To utilize the hyper-cluster architecture of emerging tera scale computers, the parallel code successfully combines the MPI message passing and paradigms. The code's capabilities are demonstrated by a shielding calculation containing over 14 billion unknowns. This calculation was accomplished on the IBM SP ''ASCI-Blue-Pacific computer located at Lawrence Livermore National Laboratory (LLNL)

  12. Clinical utility of the Wechsler Memory Scale - Fourth Edition (WMS-IV) in patients with intractable temporal lobe epilepsy.

    Science.gov (United States)

    Bouman, Zita; Elhorst, Didi; Hendriks, Marc P H; Kessels, Roy P C; Aldenkamp, Albert P

    2016-02-01

    The Wechsler Memory Scale (WMS) is one of the most widely used test batteries to assess memory functions in patients with brain dysfunctions of different etiologies. This study examined the clinical validation of the Dutch Wechsler Memory Scale - Fourth Edition (WMS-IV-NL) in patients with temporal lobe epilepsy (TLE). The sample consisted of 75 patients with intractable TLE, who were eligible for epilepsy surgery, and 77 demographically matched healthy controls. All participants were examined with the WMS-IV-NL. Patients with TLE performed significantly worse than healthy controls on all WMS-IV-NL indices and subtests (p<.01), with the exception of the Visual Working Memory Index including its contributing subtests, as well as the subtests Logical Memory I, Verbal Paired Associates I, and Designs II. In addition, patients with mesiotemporal abnormalities performed significantly worse than patients with lateral temporal abnormalities on the subtests Logical Memory I and Designs II and all the indices (p<.05), with the exception of the Auditory Memory Index and Visual Working Memory Index. Patients with either a left or a right temporal focus performed equally on all WMS-IV-NL indices and subtests (F(15, 50)=.70, p=.78), as well as the Auditory-Visual discrepancy score (t(64)=-1.40, p=.17). The WMS-IV-NL is capable of detecting memory problems in patients with TLE, indicating that it is a sufficiently valid memory battery. Furthermore, the findings support previous research showing that the WMS-IV has limited value in identifying material-specific memory deficits in presurgical patients with TLE. Copyright © 2015 Elsevier Inc. All rights reserved.

  13. Psychometric Evaluation of the Thought–Action Fusion Scale in a Large Clinical Sample

    Science.gov (United States)

    Meyer, Joseph F.; Brown, Timothy A.

    2015-01-01

    This study examined the psychometric properties of the 19-item Thought–Action Fusion (TAF) Scale, a measure of maladaptive cognitive intrusions, in a large clinical sample (N = 700). An exploratory factor analysis (n = 300) yielded two interpretable factors: TAF Moral (TAF-M) and TAF Likelihood (TAF-L). A confirmatory bifactor analysis was conducted on the second portion of the sample (n = 400) to account for possible sources of item covariance using a general TAF factor (subsuming TAF-M) alongside the TAF-L domain-specific factor. The bifactor model provided an acceptable fit to the sample data. Results indicated that global TAF was more strongly associated with a measure of obsessive-compulsiveness than measures of general worry and depression, and the TAF-L dimension was more strongly related to obsessive-compulsiveness than depression. Overall, results support the bifactor structure of the TAF in a clinical sample and its close relationship to its neighboring obsessive-compulsiveness construct. PMID:22315482

  14. Psychometric evaluation of the thought-action fusion scale in a large clinical sample.

    Science.gov (United States)

    Meyer, Joseph F; Brown, Timothy A

    2013-12-01

    This study examined the psychometric properties of the 19-item Thought-Action Fusion (TAF) Scale, a measure of maladaptive cognitive intrusions, in a large clinical sample (N = 700). An exploratory factor analysis (n = 300) yielded two interpretable factors: TAF Moral (TAF-M) and TAF Likelihood (TAF-L). A confirmatory bifactor analysis was conducted on the second portion of the sample (n = 400) to account for possible sources of item covariance using a general TAF factor (subsuming TAF-M) alongside the TAF-L domain-specific factor. The bifactor model provided an acceptable fit to the sample data. Results indicated that global TAF was more strongly associated with a measure of obsessive-compulsiveness than measures of general worry and depression, and the TAF-L dimension was more strongly related to obsessive-compulsiveness than depression. Overall, results support the bifactor structure of the TAF in a clinical sample and its close relationship to its neighboring obsessive-compulsiveness construct.

  15. Impact of technology scaling on analog and RF performance of SOI–TFET

    International Nuclear Information System (INIS)

    Kumari, P; Mishra, G P; Dash, S

    2015-01-01

    This paper presents both the analytical and simulation study of analog and RF performance for single gate semiconductor on insulator tunnel field effect transistor in an extensive manner. Here 2D drain current model has been developed using initial and final tunneling length of band-to-band process. The investigation is further extended to the quantitative and comprehensive analysis of analog parameters such as surface potential, electric field, tunneling path, and transfer characteristics of the device. The impact of scaling of gate oxide thickness and silicon body thickness on the electrostatic and RF performance of the device is discussed. The analytical model results are validated with TCAD sentaurus device simulation results. (paper)

  16. A Mountain-Scale Monitoring Network for Yucca Mountain Performance Confirmation

    International Nuclear Information System (INIS)

    Freifeld, Barry; Tsang, Yvonne

    2006-01-01

    Confirmation of the performance of Yucca Mountain is required by 10 CFR Part 63.131 to indicate, where practicable, that the natural system acts as a barrier, as intended. Hence, performance confirmation monitoring and testing would provide data for continued assessment during the pre-closure period. In general, to carry out testing at a relevant scale is always important, and in the case of performance confirmation, it is particularly important to be able to test at the scale of the repository. We view the large perturbation caused by construction of the repository at Yucca Mountain as a unique opportunity to study the large-scale behavior of the natural barrier system. Repository construction would necessarily introduce traced fluids and result in the creation of leachates. A program to monitor traced fluids and construction leachates permits evaluation of transport through the unsaturated zone and potentially downgradient through the saturated zone. A robust sampling and monitoring network for continuous measurement of important parameters, and for periodic collection of agrochemical samples, is proposed to observe thermo-hydrogeochemical changes near the repository horizon and down to the water table. The sampling and monitoring network can be used to provide data to (1) assess subsurface conditions encountered and changes in those conditions during construction and waste emplacement operations; and (2) for modeling to determine that the natural system is functioning as intended

  17. Performance estimation of Tesla turbine applied in small scale Organic Rankine Cycle (ORC) system

    International Nuclear Information System (INIS)

    Song, Jian; Gu, Chun-wei; Li, Xue-song

    2017-01-01

    Highlights: • One-dimensional model of the Tesla turbine is improved and applied in ORC system. • Working fluid properties and system operating conditions impact efficiency. • The influence of turbine efficiency on ORC system performance is evaluated. • Potential of using Tesla turbine in ORC systems is estimated. - Abstract: Organic Rankine Cycle (ORC) system has been proven to be an effective method for the low grade energy utilization. In small scale applications, the Tesla turbine offers an attractive option for the organic expander if an efficient design can be achieved. The Tesla turbine is simple in structure and is easy to be manufactured. This paper improves the one-dimensional model for the Tesla turbine, which adopts a non-dimensional formulation that identifies the dimensionless parameters that dictates the performance features of the turbine. The model is used to predict the efficiency of a Tesla turbine that is applied in a small scale ORC system. The influence of the working fluid properties and the operating conditions on the turbine performance is evaluated. Thermodynamic analysis of the ORC system with different organic working fluids and under various operating conditions is conducted. The simulation results reveal that the ORC system can generate a considerable net power output. Therefore, the Tesla turbine can be regarded as a potential choice to be applied in small scale ORC systems.

  18. A Hybrid Testbed for Performance Evaluation of Large-Scale Datacenter Networks

    DEFF Research Database (Denmark)

    Pilimon, Artur; Ruepp, Sarah Renée

    2018-01-01

    Datacenters (DC) as well as their network interconnects are growing in scale and complexity. They are constantly being challenged in terms of energy and resource utilization efficiency, scalability, availability, reliability and performance requirements. Therefore, these resource-intensive enviro......Datacenters (DC) as well as their network interconnects are growing in scale and complexity. They are constantly being challenged in terms of energy and resource utilization efficiency, scalability, availability, reliability and performance requirements. Therefore, these resource......-intensive environments must be properly tested and analyzed in order to make timely upgrades and transformations. However, a limited number of academic institutions and Research and Development companies have access to production scale DC Network (DCN) testing facilities, and resource-limited studies can produce...... misleading or inaccurate results. To address this problem, we introduce an alternative solution, which forms a solid base for a more realistic and comprehensive performance evaluation of different aspects of DCNs. It is based on the System-in-the-loop (SITL) concept, where real commercial DCN equipment...

  19. Optimization and scale up of microfluidic nanolipomer production method for preclinical and potential clinical trials.

    Science.gov (United States)

    Gdowski, Andrew; Johnson, Kaitlyn; Shah, Sunil; Gryczynski, Ignacy; Vishwanatha, Jamboor; Ranjan, Amalendu

    2018-02-12

    The process of optimization and fabrication of nanoparticle synthesis for preclinical studies can be challenging and time consuming. Traditional small scale laboratory synthesis techniques suffer from batch to batch variability. Additionally, the parameters used in the original formulation must be re-optimized due to differences in fabrication techniques for clinical production. Several low flow microfluidic synthesis processes have been reported in recent years for developing nanoparticles that are a hybrid between polymeric nanoparticles and liposomes. However, use of high flow microfluidic synthetic techniques has not been described for this type of nanoparticle system, which we will term as nanolipomer. In this manuscript, we describe the successful optimization and functional assessment of nanolipomers fabricated using a microfluidic synthesis method under high flow parameters. The optimal total flow rate for synthesis of these nanolipomers was found to be 12 ml/min and flow rate ratio 1:1 (organic phase: aqueous phase). The PLGA polymer concentration of 10 mg/ml and a DSPE-PEG lipid concentration of 10% w/v provided optimal size, PDI and stability. Drug loading and encapsulation of a representative hydrophobic small molecule drug, curcumin, was optimized and found that high encapsulation efficiency of 58.8% and drug loading of 4.4% was achieved at 7.5% w/w initial concentration of curcumin/PLGA polymer. The final size and polydispersity index of the optimized nanolipomer was 102.11 nm and 0.126, respectively. Functional assessment of uptake of the nanolipomers in C4-2B prostate cancer cells showed uptake at 1 h and increased uptake at 24 h. The nanolipomer was more effective in the cell viability assay compared to free drug. Finally, assessment of in vivo retention in mice of these nanolipomers revealed retention for up to 2 h and were completely cleared at 24 h. In this study, we have demonstrated that a nanolipomer formulation can be successfully

  20. Dysphonia in performers: toward a clinical definition of laryngology of the performing voice.

    Science.gov (United States)

    Guss, Joel; Sadoughi, Babak; Benson, Brian; Sulica, Lucian

    2014-05-01

    To identify causes of dysphonia in performers and compare causes and aspects of treatment of dysphonia in performers and nonperformers. Case-control study. A chart review of all new patients presenting with a chief complaint of dysphonia over a 1-year period was performed. The prevalence of laryngeal disorders was reviewed and differences between performers and nonperformers were analyzed. The odds ratio of the prevalence of each disorder was computed against performer status as a risk factor. Four hundred seventy-six new patients complaining of dysphonia presented over 12 months; 74 were vocal performers. The median duration of symptoms in performers was 90 days. Phonotraumatic lesions were significantly more prevalent in performers (63.5% vs. 28.6%, P fold swelling (4-fold increase in performers), pseudocysts (3-fold increase), and vocal fold hemorrhage/ectasia. Neurologic disorders (vocal fold paralysis and spasmodic dysphonia), neoplastic pathologies, and age-related phenomena (atrophy/presbyphonia) were significantly more common in nonperformers. Overall and diagnosis-specific rates of surgical intervention were equal between the two groups. Phonotraumatic injury is responsible for the majority of dysphonia in vocal performers, to a significantly greater extent than in nonperformers and requires the implementation of standard therapeutic strategies. Awareness of the specific risks and management needs of the performer is of paramount importance to the practice of laryngology of the performing voice. Copyright © 2014 The Voice Foundation. Published by Mosby, Inc. All rights reserved.

  1. Performance Validation and Scaling of a Capillary Membrane Solid-Liquid Separation System

    Energy Technology Data Exchange (ETDEWEB)

    Rogers, S; Cook, J; Juratovac, J; Goodwillie, J; Burke, T

    2011-10-25

    Algaeventure Systems (AVS) has previously demonstrated an innovative technology for dewatering algae slurries that dramatically reduces energy consumption by utilizing surface physics and capillary action. Funded by a $6M ARPA-E award, transforming the original Harvesting, Dewatering and Drying (HDD) prototype machine into a commercially viable technology has required significant attention to material performance, integration of sensors and control systems, and especially addressing scaling issues that would allow processing extreme volumes of algal cultivation media/slurry. Decoupling the harvesting, dewatering and drying processes, and addressing the rate limiting steps for each of the individual steps has allowed for the development individual technologies that may be tailored to the specific needs of various cultivation systems. The primary performance metric used by AVS to assess the economic viability of its Solid-Liquid Separation (SLS) dewatering technology is algae mass production rate as a function of power consumption (cost), cake solids/moisture content, and solids capture efficiency. An associated secondary performance metric is algae mass loading rate which is dependent on hydraulic loading rate, area-specific hydraulic processing capacity (gpm/in2), filter:capillary belt contact area, and influent algae concentration. The system is capable of dewatering 4 g/L (0.4%) algae streams to solids concentrations up to 30% with capture efficiencies of 80+%, however mass production is highly dependent on average cell size (which determines filter mesh size and percent open area). This paper will present data detailing the scaling efforts to date. Characterization and performance data for novel membranes, as well as optimization of off-the-shelf filter materials will be examined. Third party validation from Ohio University on performance and operating cost, as well as design modification suggestions will be discussed. Extrapolation of current productivities

  2. Referred Students' Performance on the Reynolds Intellectual Assessment Scales and the Wechsler Intelligence Scale for Children--Fourth Edition

    Science.gov (United States)

    Edwards, Oliver W.; Paulin, Rachel V.

    2007-01-01

    This study investigates the convergent relations of the Reynolds Intellectual Assessment Scales (RIAS) and the Wechsler Intelligence Scale for Children--Fourth Edition (WISC-IV). Data from counterbalanced administrations of each instrument to 48 elementary school students referred for psychoeducational testing were examined. Analysis of the 96…

  3. Assessing the performance of multi-purpose channel management measures at increasing scales

    Science.gov (United States)

    Wilkinson, Mark; Addy, Steve

    2016-04-01

    In addition to hydroclimatic drivers, sediment deposition from high energy river systems can reduce channel conveyance capacity and lead to significant increases in flood risk. There is an increasing recognition that we need to work with the interplay of natural hydrological and morphological processes in order to attenuate flood flows and manage sediment (both coarse and fine). This typically includes both catchment (e.g. woodland planting, wetlands) and river (e.g. wood placement, floodplain reconnection) restoration approaches. The aim of this work was to assess at which scales channel management measures (notably wood placement and flood embankment removal) are most appropriate for flood and sediment management in high energy upland river systems. We present research findings from two densely instrumented research sites in Scotland which regularly experience flood events and have associated coarse sediment problems. We assessed the performance of a range of novel trial measures for three different scales: wooded flow restrictors and gully tree planting at the small scale (transport to optimise performance. At the large scale, well designed flood embankment lowering can improve connectivity to the floodplain during low to medium return period events. However, ancillary works to stabilise the bank failed thus emphasising the importance of letting natural processes readjust channel morphology and hydrological connections to the floodplain. Although these trial measures demonstrated limited effects, this may be in part owing to restrictions in the range of hydroclimatological conditions during the study period and further work is needed to assess the performance under more extreme conditions. This work will contribute to refining guidance for managing channel coarse sediment problems in the future which in turn could help mitigate flooding using natural approaches.

  4. A Valid and Reliable Tool to Assess Nursing Students` Clinical Performance

    OpenAIRE

    Mehrnoosh Pazargadi; Tahereh Ashktorab; Sharareh Khosravi; Hamid Alavi majd

    2013-01-01

    Background: The necessity of a valid and reliable assessment tool is one of the most repeated issues in nursing students` clinical evaluation. But it is believed that present tools are not mostly valid and can not assess students` performance properly.Objectives: This study was conducted to design a valid and reliable assessment tool for evaluating nursing students` performance in clinical education.Methods: In this methodological study considering nursing students` performance definition; th...

  5. The DSM-5 Dimensional Anxiety Scales in a Dutch non-clinical sample: psychometric properties including the adult separation anxiety disorder scale.

    Science.gov (United States)

    Möller, Eline L; Bögels, Susan M

    2016-09-01

    With DSM-5, the American Psychiatric Association encourages complementing categorical diagnoses with dimensional severity ratings. We therefore examined the psychometric properties of the DSM-5 Dimensional Anxiety Scales, a set of brief dimensional scales that are consistent in content and structure and assess DSM-5-based core features of anxiety disorders. Participants (285 males, 255 females) completed the DSM-5 Dimensional Anxiety Scales for social anxiety disorder, generalized anxiety disorder, specific phobia, agoraphobia, and panic disorder that were included in previous studies on the scales, and also for separation anxiety disorder, which is included in the DSM-5 chapter on anxiety disorders. Moreover, they completed the Screen for Child Anxiety Related Emotional Disorders Adult version (SCARED-A). The DSM-5 Dimensional Anxiety Scales demonstrated high internal consistency, and the scales correlated significantly and substantially with corresponding SCARED-A subscales, supporting convergent validity. Separation anxiety appeared present among adults, supporting the DSM-5 recognition of separation anxiety as an anxiety disorder across the life span. To conclude, the DSM-5 Dimensional Anxiety Scales are a valuable tool to screen for specific adult anxiety disorders, including separation anxiety. Research in more diverse and clinical samples with anxiety disorders is needed. © 2016 The Authors International Journal of Methods in Psychiatric Research Published by John Wiley & Sons Ltd. © 2016 The Authors International Journal of Methods in Psychiatric Research Published by John Wiley & Sons Ltd.

  6. Optical ensemble analysis of intraocular lens performance through a simulated clinical trial with ZEMAX.

    Science.gov (United States)

    Zhao, Huawei

    2009-01-01

    A ZEMAX model was constructed to simulate a clinical trial of intraocular lenses (IOLs) based on a clinically oriented Monte Carlo ensemble analysis using postoperative ocular parameters. The purpose of this model is to test the feasibility of streamlining and optimizing both the design process and the clinical testing of IOLs. This optical ensemble analysis (OEA) is also validated. Simulated pseudophakic eyes were generated by using the tolerancing and programming features of ZEMAX optical design software. OEA methodology was verified by demonstrating that the results of clinical performance simulations were consistent with previously published clinical performance data using the same types of IOLs. From these results we conclude that the OEA method can objectively simulate the potential clinical trial performance of IOLs.

  7. Modelling and performance analysis of clinical pathways using the stochastic process algebra PEPA.

    Science.gov (United States)

    Yang, Xian; Han, Rui; Guo, Yike; Bradley, Jeremy; Cox, Benita; Dickinson, Robert; Kitney, Richard

    2012-01-01

    Hospitals nowadays have to serve numerous patients with limited medical staff and equipment while maintaining healthcare quality. Clinical pathway informatics is regarded as an efficient way to solve a series of hospital challenges. To date, conventional research lacks a mathematical model to describe clinical pathways. Existing vague descriptions cannot fully capture the complexities accurately in clinical pathways and hinders the effective management and further optimization of clinical pathways. Given this motivation, this paper presents a clinical pathway management platform, the Imperial Clinical Pathway Analyzer (ICPA). By extending the stochastic model performance evaluation process algebra (PEPA), ICPA introduces a clinical-pathway-specific model: clinical pathway PEPA (CPP). ICPA can simulate stochastic behaviours of a clinical pathway by extracting information from public clinical databases and other related documents using CPP. Thus, the performance of this clinical pathway, including its throughput, resource utilisation and passage time can be quantitatively analysed. A typical clinical pathway on stroke extracted from a UK hospital is used to illustrate the effectiveness of ICPA. Three application scenarios are tested using ICPA: 1) redundant resources are identified and removed, thus the number of patients being served is maintained with less cost; 2) the patient passage time is estimated, providing the likelihood that patients can leave hospital within a specific period; 3) the maximum number of input patients are found, helping hospitals to decide whether they can serve more patients with the existing resource allocation. ICPA is an effective platform for clinical pathway management: 1) ICPA can describe a variety of components (state, activity, resource and constraints) in a clinical pathway, thus facilitating the proper understanding of complexities involved in it; 2) ICPA supports the performance analysis of clinical pathway, thereby assisting

  8. [Validity and Reliability of the Korean Version Scale of the Clinical Learning Environment, Supervision and Nurse Teacher Evaluation Scale (CLES+T)].

    Science.gov (United States)

    Kim, Sun Hee; Yoo, So Yeon; Kim, Yae Young

    2018-02-01

    This study was conducted to evaluate the validity and reliability of the Korean version of the clinical learning environment, supervision and nurse teacher evaluation scale (CLES+T) that measures the clinical learning environment and the conditions associated with supervision and nurse teachers. The English CLES+T was translated into Korean with forward and back translation. Survey data were collected from 434 nursing students who had more than four days of clinical practice in Korean hospitals. Internal consistency reliability and construct validity using confirmatory and exploratory factor analysis were conducted. SPSS 20.0 and AMOS 22.0 programs were used for data analysis. The exploratory factor analysis revealed seven factors for the thirty three-item scale. Confirmatory factor analysis supported good convergent and discriminant validities. The Cronbach's alpha for the overall scale was .94 and for the seven subscales ranged from .78 to .94. The findings suggest that the 33-items Korean CLES+T is an appropriate instrument to measure Korean nursing students'clinical learning environment with good validity and reliability. © 2018 Korean Society of Nursing Science.

  9. Medical students' clinical performance of dealing with patients in the context of domestic violence.

    Science.gov (United States)

    Kong, Hyun-Hee; Im, Sunju; Seo, Ji-Hyun; Kim, Do-Kyong; Roh, HyeRin

    2018-03-01

    The aim of this study was to inquire about the clinical performance and determine the performance pattern of medical students in standardized patient (SP) based examinations of domestic violence (DV). The clinical performance sores in DV station with SP of third-year (n=111, in 2014) and 4th-year (n=143, in 2016) medical students of five universities in the Busan-Gyeongnam Clinical Skills Examination Consortium were subjected in this study. The scenarios and checklists of DV cases were developed by the case development committee of the consortium. The students' performance was compared with other stations encountered in SP. The items of the checklists were categorized to determine the performance pattern of students investigating DV into six domains: disclosure strategy (D), DV related history taking (H), checking the perpetrator's psychosocial state (P), checking the victim's condition (V), negotiating and persuading the interviewee (N), and providing information about DV (I). Medical students showed poorer performance in DV stations than in the other stations with SP in the same examination. Most students did confirm the perpetrator and commented on confidentiality but ignored the perpetrator's state and patient's physical and psychological condition. The students performed well in the domains of D, H, and I but performed poorly in domains P, V, and N. Medical students showed poor clinical performance in the DV station. They performed an 'event oriented interview' rather than 'patient centered' communication. An integrated educational program of DV should be set to improve students' clinical performance.

  10. Predicting failing performance on a standardized patient clinical performance examination: the importance of communication and professionalism skills deficits.

    Science.gov (United States)

    Chang, Anna; Boscardin, Christy; Chou, Calvin L; Loeser, Helen; Hauer, Karen E

    2009-10-01

    The purpose is to determine which assessment measures identify medical students at risk of failing a clinical performance examination (CPX). Retrospective case-control, multiyear design, contingency table analysis, n = 149. We identified two predictors of CPX failure in patient-physician interaction skills: low clerkship ratings (odds ratio 1.79, P = .008) and student progress review for communication or professionalism concerns (odds ratio 2.64, P = .002). No assessments predicted CPX failure in clinical skills. Performance concerns in communication and professionalism identify students at risk of failing the patient-physician interaction portion of a CPX. This correlation suggests that both faculty and standardized patients can detect noncognitive traits predictive of failing performance. Early identification of these students may allow for development of a structured supplemental curriculum with increased opportunities for practice and feedback. The lack of predictors in the clinical skills portion suggests limited faculty observation or feedback.

  11. From damselflies to pterosaurs: how burst and sustainable flight performance scale with size.

    Science.gov (United States)

    Marden, J H

    1994-04-01

    Recent empirical data for short-burst lift and power production of flying animals indicate that mass-specific lift and power output scale independently (lift) or slightly positively (power) with increasing size. These results contradict previous theory, as well as simple observation, which argues for degradation of flight performance with increasing size. Here, empirical measures of lift and power during short-burst exertion are combined with empirically based estimates of maximum muscle power output in order to predict how burst and sustainable performance scale with body size. The resulting model is used to estimate performance of the largest extant flying birds and insects, along with the largest flying animals known from fossils. These estimates indicate that burst flight performance capacities of even the largest extinct fliers (estimated mass 250 kg) would allow takeoff from the ground; however, limitations on sustainable power output should constrain capacity for continuous flight at body sizes exceeding 0.003-1.0 kg, depending on relative wing length and flight muscle mass.

  12. Analysis of Nurse's Clinical Education Performance based on Work Theory and The Indicator of Competence

    Directory of Open Access Journals (Sweden)

    Srinalesti Mahanani

    2016-09-01

    Full Text Available Introduction: Clinical Learning is a process of transformation of the student to become a professional nurse. Clinical Nurse Educator contributes to improve the quality of clinical learning because of variety of roles ranging from planning, implementing and evaluating learning clinical practice. Improving the quality of clinical practice learning, can be reached by improving the performance of Clinical Nurse Educator. The aim of this study was to know the effect of psychological variables and organizational variables to the competence and performance of Clinical Nurse Educators. Sample was Clinical Nurse Educators who work inpatient wards at Kediri Baptist Hospital inpatient wards. Method: This study was conducted in two stages. Phase I measure the competence and performance of Clinical Nurse Educator by Supervisor and students, as well as psychological variables and organizational variables by using questionnaires. Phase II was done by Focused Group Discussion to discuss about the variables that affect Clinical Nurse Educator performance. Data processed using Partial Least Square with α = 0.05, path coefficient = 0.5 and t table = 1.96. Result: The results of this research is showed that Performance Nurse Educator can be improved by increasing Individual Competence with path coefficient= 0.600 and t = 6.741. The individual competence will be increase by improving pscychological aspect nurse educator such as perception, personal aspect, motivation, learning skill and attitude with path coefficient = 0.518 and t = 2.715. Psycological Aspect can be increasing by improving Organization Variable such as Organization Resource, Salary, Organization Structure and Job Description with path coefficient = 0.825 and t = 19.658. Discussion: The conclusion of this result that increase of nurse educator competence and performance can be effort by improving psycological aspect and organizational variable Keywords: competence, performance, clinical nurse

  13. Methods for Quantifying the Uncertainties of LSIT Test Parameters, Test Results, and Full-Scale Mixing Performance Using Models Developed from Scaled Test Data

    International Nuclear Information System (INIS)

    Piepel, Gregory F.; Cooley, Scott K.; Kuhn, William L.; Rector, David R.; Heredia-Langner, Alejandro

    2015-01-01

    This report discusses the statistical methods for quantifying uncertainties in 1) test responses and other parameters in the Large Scale Integrated Testing (LSIT), and 2) estimates of coefficients and predictions of mixing performance from models that relate test responses to test parameters. Testing at a larger scale has been committed to by Bechtel National, Inc. and the U.S. Department of Energy (DOE) to ''address uncertainties and increase confidence in the projected, full-scale mixing performance and operations'' in the Waste Treatment and Immobilization Plant (WTP).

  14. Methods for Quantifying the Uncertainties of LSIT Test Parameters, Test Results, and Full-Scale Mixing Performance Using Models Developed from Scaled Test Data

    Energy Technology Data Exchange (ETDEWEB)

    Piepel, Gregory F. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Cooley, Scott K. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Kuhn, William L. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Rector, David R. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Heredia-Langner, Alejandro [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

    2015-05-01

    This report discusses the statistical methods for quantifying uncertainties in 1) test responses and other parameters in the Large Scale Integrated Testing (LSIT), and 2) estimates of coefficients and predictions of mixing performance from models that relate test responses to test parameters. Testing at a larger scale has been committed to by Bechtel National, Inc. and the U.S. Department of Energy (DOE) to “address uncertainties and increase confidence in the projected, full-scale mixing performance and operations” in the Waste Treatment and Immobilization Plant (WTP).

  15. Holistic rubric vs. analytic rubric for measuring clinical performance levels in medical students.

    Science.gov (United States)

    Yune, So Jung; Lee, Sang Yeoup; Im, Sun Ju; Kam, Bee Sung; Baek, Sun Yong

    2018-06-05

    Task-specific checklists, holistic rubrics, and analytic rubrics are often used for performance assessments. We examined what factors evaluators consider important in holistic scoring of clinical performance assessment, and compared the usefulness of applying holistic and analytic rubrics respectively, and analytic rubrics in addition to task-specific checklists based on traditional standards. We compared the usefulness of a holistic rubric versus an analytic rubric in effectively measuring the clinical skill performances of 126 third-year medical students who participated in a clinical performance assessment conducted by Pusan National University School of Medicine. We conducted a questionnaire survey of 37 evaluators who used all three evaluation methods-holistic rubric, analytic rubric, and task-specific checklist-for each student. The relationship between the scores on the three evaluation methods was analyzed using Pearson's correlation. Inter-rater agreement was analyzed by Kappa index. The effect of holistic and analytic rubric scores on the task-specific checklist score was analyzed using multiple regression analysis. Evaluators perceived accuracy and proficiency to be major factors in objective structured clinical examinations evaluation, and history taking and physical examination to be major factors in clinical performance examinations evaluation. Holistic rubric scores were highly related to the scores of the task-specific checklist and analytic rubric. Relatively low agreement was found in clinical performance examinations compared to objective structured clinical examinations. Meanwhile, the holistic and analytic rubric scores explained 59.1% of the task-specific checklist score in objective structured clinical examinations and 51.6% in clinical performance examinations. The results show the usefulness of holistic and analytic rubrics in clinical performance assessment, which can be used in conjunction with task-specific checklists for more efficient

  16. Effect of micro-scale texturing on the cutting tool performance

    Science.gov (United States)

    Vasumathy, D.; Meena, Anil

    2018-05-01

    The present study is mainly focused on the cutting performance of the micro-scale textured carbide tools while turning AISI 304 austenitic stainless steel under dry cutting environment. The texture on the rake face of the carbide tools was fabricated by laser machining. The cutting performance of the textured tools was further compared with conventional tools in terms of cutting forces, tool wear, machined surface quality and chip curl radius. SEM and EDS analyses have been also performed to better understand the tool surface characteristics. Results show that the grooves help in breaking the tool-chip contact leading to a lesser tool-chip contact area which results in reduced iron (Fe) adhesion to the tool.

  17. Performance ceramic red mass containing mill scale of rolling in different firing temperatures

    International Nuclear Information System (INIS)

    Meller, J.G.; Arnt, A.B.C; Rocha, M.R.

    2014-01-01

    This study aimed to evaluate the performance of the properties of samples of red clay with addition of mill scale steel. This residue consists of oxides of iron has the function replace pigments used in ceramic materials. The mechanical strength of the sintered material can be associated with reactions that occur during sintering, leading to the formation of compounds provided with good mechanical characteristics, particle size of the components and the structure of the dough piece after the compactation. After chemical and microstructural characterization diffraction and fluorescence X-rays, this residue was added in the proportion of 1.45% of a commercial ceramic mass. The formulations were subjected to different temperatures and performance of the formulations was evaluated for physical characteristics: loss on ignition, linear firing shrinkage, water absorption, flexural strength by 3 and intensity of tone. The loss on ignition and linear firing shrinkage tests relate to the sintering temperature with the performance of the tested formulations. (author)

  18. Effects of cadmium on the performance and microbiology of laboratory-scale lagoons treating domestic sewage.

    Science.gov (United States)

    Bonnet, J L; Bohatier, J; Pépin, D

    1999-06-01

    Two experiments were performed to assess the impact of cadmium on the sewage lagoon wastewater treatment process. For each one, three laboratory-scale pilot plants with one tank receiving the same raw effluent were used; one plant served as control and the other two were contaminated once only with cadmium. In the first study, the effects of a shock load of two concentrations of cadmium chloride (60 and 300 micrograms/l) on the plant performance, microbial populations (protists and bacteria) and enzyme activities were determined. Initially, most of the performance parameters were affected concentration-dependently. A reduction in the protist population density and some influence on the total bacterial population were observed, and the potential enzymatic activities were also modified. A second experiment with a lower cadmium concentration (30 micrograms/l), supplied as chloride or sulphate, still perturbed most of the parameters studied, and the effects of the two cadmium salts were identical.

  19. Overview of large scale experiments performed within the LBB project in the Czech Republic

    Energy Technology Data Exchange (ETDEWEB)

    Kadecka, P.; Lauerova, D. [Nuclear Research Institute, Rez (Czechoslovakia)

    1997-04-01

    During several recent years NRI Rez has been performing the LBB analyses of safety significant primary circuit pipings of NPPs in Czech and Slovak Republics. The analyses covered the NPPs with reactors WWER 440 Type 230 and 213 and WWER 1000 Type 320. Within the relevant LBB projects undertaken with the aim to prove the fulfilling of the requirements of LBB, a series of large scale experiments were performed. The goal of these experiments was to verify the properties of the components selected, and to prove the quality and/or conservatism of assessments used in the LBB-analyses. In this poster, a brief overview of experiments performed in Czech Republic under guidance of NRI Rez is presented.

  20. Prediction of Hydraulic Performance of a Scaled-Down Model of SMART Reactor Coolant Pump

    Energy Technology Data Exchange (ETDEWEB)

    Kwon, Sun Guk; Park, Jin Seok; Yu, Je Yong; Lee, Won Jae [Korea Atomic Energy Research Institute, Daejeon (Korea, Republic of)

    2010-08-15

    An analysis was conducted to predict the hydraulic performance of a reactor coolant pump (RCP) of SMART at the off-design as well as design points. In order to reduce the analysis time efficiently, a single passage containing an impeller and a diffuser was considered as the computational domain. A stage scheme was used to perform a circumferential averaging of the flux on the impeller-diffuser interface. The pressure difference between the inlet and outlet of the pump was determined and was used to compute the head, efficiency, and break horse power (BHP) of a scaled-down model under conditions of steady-state incompressible flow. The predicted curves of the hydraulic performance of an RCP were similar to the typical characteristic curves of a conventional mixed-flow pump. The complex internal fluid flow of a pump, including the internal recirculation loss due to reverse flow, was observed at a low flow rate.

  1. Grading the performance of clinical skills: lessons to be learned from the performing arts.

    Science.gov (United States)

    Roberts, Deborah

    2011-08-01

    The drift towards competency based nurse interventions has seen a growth in concern regarding the most appropriate methods of assessment of such competencies. Nurse educators and practitioners alike are struggling with the concept of measuring the performance of nursing skills; due to an uneasy relationship between competence, capability, intuition and expertise. Different currencies of value may be ascribed to the assessment of nursing practice, resulting in the use of subjective judgements together with the development of assessment criteria which have different weightings, depending on the values of the assessor. Within the performing arts, students' practice performance is also assessed, with seemingly many similarities between applying value to performance in dance or theatre and nursing. Within performing arts assessment a balancing act is also being played out between academic education and professional training (where complex performances are notoriously hard to evaluate). This paper explores the nature of assessment within the performing arts and makes suggestions regarding their application within the context of nurse education. If nursing is indeed a blend of art and science, then it seems sensible to look to the performing arts to see if lessons could be learned. Copyright © 2010 Elsevier Ltd. All rights reserved.

  2. Multi-scale high-performance fluid flow: Simulations through porous media

    KAUST Repository

    Perović, Nevena

    2016-08-03

    Computational fluid dynamic (CFD) calculations on geometrically complex domains such as porous media require high geometric discretisation for accurately capturing the tested physical phenomena. Moreover, when considering a large area and analysing local effects, it is necessary to deploy a multi-scale approach that is both memory-intensive and time-consuming. Hence, this type of analysis must be conducted on a high-performance parallel computing infrastructure. In this paper, the coupling of two different scales based on the Navier–Stokes equations and Darcy\\'s law is described followed by the generation of complex geometries, and their discretisation and numerical treatment. Subsequently, the necessary parallelisation techniques and a rather specific tool, which is capable of retrieving data from the supercomputing servers and visualising them during the computation runtime (i.e. in situ) are described. All advantages and possible drawbacks of this approach, together with the preliminary results and sensitivity analyses are discussed in detail.

  3. Development and performance evaluation of frustum cone shaped churn for small scale production of butter.

    Science.gov (United States)

    Kalla, Adarsh M; Sahu, C; Agrawal, A K; Bisen, P; Chavhan, B B; Sinha, Geetesh

    2016-05-01

    The present research was intended to develop a small scale butter churn and its performance by altering churning temperature and churn speed during butter making. In the present study, the cream was churned at different temperatures (8, 10 and 12 °C) and churn speeds (35, 60 and 85 rpm). The optimum parameters of churning time (40 min), moisture content (16 %) and overrun (19.42 %) were obtained when cream was churned at churning temperature of 10 °C and churn speed of 60 rpm. Using appropriate conditions of churning temperature and churn speed, high quality butter can be produced at cottage scale.

  4. E-ELT M5 field stabilisation unit scale 1 demonstrator design and performances evaluation

    Science.gov (United States)

    Casalta, J. M.; Barriga, J.; Ariño, J.; Mercader, J.; San Andrés, M.; Serra, J.; Kjelberg, I.; Hubin, N.; Jochum, L.; Vernet, E.; Dimmler, M.; Müller, M.

    2010-07-01

    The M5 Field stabilization Unit (M5FU) for European Extremely Large Telescope (E-ELT) is a fast correcting optical system that shall provide tip-tilt corrections for the telescope dynamic pointing errors and the effect of atmospheric tiptilt and wind disturbances. A M5FU scale 1 demonstrator (M5FU1D) is being built to assess the feasibility of the key elements (actuators, sensors, mirror, mirror interfaces) and the real-time control algorithm. The strict constraints (e.g. tip-tilt control frequency range 100Hz, 3m ellipse mirror size, mirror first Eigen frequency 300Hz, maximum tip/tilt range +/- 30 arcsec, maximum tiptilt error < 40 marcsec) have been a big challenge for developing the M5FU Conceptual Design and its scale 1 demonstrator. The paper summarises the proposed design for the final unit and demonstrator and the measured performances compared to the applicable specifications.

  5. Multi-scale high-performance fluid flow: Simulations through porous media

    KAUST Repository

    Perović, Nevena; Frisch, Jé rô me; Salama, Amgad; Sun, Shuyu; Rank, Ernst; Mundani, Ralf Peter

    2016-01-01

    Computational fluid dynamic (CFD) calculations on geometrically complex domains such as porous media require high geometric discretisation for accurately capturing the tested physical phenomena. Moreover, when considering a large area and analysing local effects, it is necessary to deploy a multi-scale approach that is both memory-intensive and time-consuming. Hence, this type of analysis must be conducted on a high-performance parallel computing infrastructure. In this paper, the coupling of two different scales based on the Navier–Stokes equations and Darcy's law is described followed by the generation of complex geometries, and their discretisation and numerical treatment. Subsequently, the necessary parallelisation techniques and a rather specific tool, which is capable of retrieving data from the supercomputing servers and visualising them during the computation runtime (i.e. in situ) are described. All advantages and possible drawbacks of this approach, together with the preliminary results and sensitivity analyses are discussed in detail.

  6. Performance of the first Japanese large-scale facility for radon inhalation experiments with small animals

    International Nuclear Information System (INIS)

    Ishimori, Y.; Mitsunobu, F.; Yamaoka, K.; Tanaka, H.; Kataoka, T.; Sakoda, A.

    2011-01-01

    A radon test facility for small animals was developed in order to increase the statistical validity of differences of the biological response in various radon environments. This paper illustrates the performances of that facility, the first large-scale facility of its kind in Japan. The facility has a capability to conduct approximately 150 mouse-scale tests at the same time. The apparatus for exposing small animals to radon has six animal chamber groups with five independent cages each. Different radon concentrations in each animal chamber group are available. Because the first target of this study is to examine the in vivo behaviour of radon and its effects, the major functions to control radon and to eliminate thoron were examined experimentally. Additionally, radon progeny concentrations and their particle size distributions in the cages were also examined experimentally to be considered in future projects. (authors)

  7. A high-performance dual-scale porous electrode for vanadium redox flow batteries

    Science.gov (United States)

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

    2016-09-01

    In this work, we present a simple and cost-effective method to form a dual-scale porous electrode by KOH activation of the fibers of carbon papers. The large pores (∼10 μm), formed between carbon fibers, serve as the macroscopic pathways for high electrolyte flow rates, while the small pores (∼5 nm), formed on carbon fiber surfaces, act as active sites for rapid electrochemical reactions. It is shown that the Brunauer-Emmett-Teller specific surface area of the carbon paper is increased by a factor of 16 while maintaining the same hydraulic permeability as that of the original carbon paper electrode. We then apply the dual-scale electrode to a vanadium redox flow battery (VRFB) and demonstrate an energy efficiency ranging from 82% to 88% at current densities of 200-400 mA cm-2, which is record breaking as the highest performance of VRFB in the open literature.

  8. Replicating the microbial community and water quality performance of full-scale slow sand filters in laboratory-scale filters.

    Science.gov (United States)

    Haig, Sarah-Jane; Quince, Christopher; Davies, Robert L; Dorea, Caetano C; Collins, Gavin

    2014-09-15

    Previous laboratory-scale studies to characterise the functional microbial ecology of slow sand filters have suffered from methodological limitations that could compromise their relevance to full-scale systems. Therefore, to ascertain if laboratory-scale slow sand filters (L-SSFs) can replicate the microbial community and water quality production of industrially operated full-scale slow sand filters (I-SSFs), eight cylindrical L-SSFs were constructed and were used to treat water from the same source as the I-SSFs. Half of the L-SSFs sand beds were composed of sterilized sand (sterile) from the industrial filters and the other half with sand taken directly from the same industrial filter (non-sterile). All filters were operated for 10 weeks, with the microbial community and water quality parameters sampled and analysed weekly. To characterize the microbial community phyla-specific qPCR assays and 454 pyrosequencing of the 16S rRNA gene were used in conjunction with an array of statistical techniques. The results demonstrate that it is possible to mimic both the water quality production and the structure of the microbial community of full-scale filters in the laboratory - at all levels of taxonomic classification except OTU - thus allowing comparison of LSSF experiments with full-scale units. Further, it was found that the sand type composing the filter bed (non-sterile or sterile), the water quality produced, the age of the filters and the depth of sand samples were all significant factors in explaining observed differences in the structure of the microbial consortia. This study is the first to the authors' knowledge that demonstrates that scaled-down slow sand filters can accurately reproduce the water quality and microbial consortia of full-scale slow sand filters. Copyright © 2014 Elsevier Ltd. All rights reserved.

  9. Examiner Assessments of Clinical Performance: What Do They Tell Us About Clinical Competence?

    Science.gov (United States)

    Maatsch, Jack L.

    1987-01-01

    This paper presents and interprets examiner and participant performance data obtained from an experimental field test of the test item and case simulation libraries of the American Board of Emergency Medicine Specialty Certificate Examination. Subjects were 94 medical students, residents, and emergency physicians. (Author/LMO)

  10. Self-perceived versus objectively measured competence in performing clinical practical procedures by final year medical students.

    Science.gov (United States)

    Katowa-Mukwato, Patricia; Banda, Sekelani

    2016-04-30

    To determine and compare the self-perceived and objectively measured competence in performing 14 core-clinical practical procedures by Final Year Medical Students of the University of Zambia. The study included 56 out of 60 graduating University of Zambia Medical Students of the 2012/2013 academic year. Self-perceived competence: students rated their competence on 14 core- clinical practical procedures using a self-administered questionnaire on a 5-point Likert scale. Objective competence: it was measured by Objective Structured Clinical Examination (OSCE) by faculty using predetermined rating scales. Rank order correlation test was performed for self-perceived and objectively measured competence. Two thirds 36 (66.7%) of the participants perceived themselves as moderately competent, 15 (27.8%) rated themselves as highly competent while 3 (5.6%) had low self-perception. With objective competence, the majority 52 (92.8%) were barely competent while 4 (7.2%) were absolutely competent. When overall self-perception was compared to objectively measured competence, there was a discordance which was demonstrated by a negative correlation (Spearman rho -.123). Significant numbers of students reported low self-competence in performing procedures such as endotracheal intubation, gastric lavage and cardiopulmonary resuscitation which most never performed during the clinical years of medical education. In addition, the negative correlation between self-perceived and objectively measured competence demonstrated the inability of students to assess and rate themselves objectively due to fear that others may know their weaknesses and realize that they are not as competent as expected at a specific level of training.

  11. Scale-dependent performances of CMIP5 earth system models in simulating terrestrial vegetation carbon

    Science.gov (United States)

    Jiang, L.; Luo, Y.; Yan, Y.; Hararuk, O.

    2013-12-01

    Mitigation of global changes will depend on reliable projection for the future situation. As the major tools to predict future climate, Earth System Models (ESMs) used in Coupled Model Intercomparison Project Phase 5 (CMIP5) for the IPCC Fifth Assessment Report have incorporated carbon cycle components, which account for the important fluxes of carbon between the ocean, atmosphere, and terrestrial biosphere carbon reservoirs; and therefore are expected to provide more detailed and more certain projections. However, ESMs are never perfect; and evaluating the ESMs can help us to identify uncertainties in prediction and give the priorities for model development. In this study, we benchmarked carbon in live vegetation in the terrestrial ecosystems simulated by 19 ESMs models from CMIP5 with an observationally estimated data set of global carbon vegetation pool 'Olson's Major World Ecosystem Complexes Ranked by Carbon in Live Vegetation: An Updated Database Using the GLC2000 Land Cover Product' by Gibbs (2006). Our aim is to evaluate the ability of ESMs to reproduce the global vegetation carbon pool at different scales and what are the possible causes for the bias. We found that the performance CMIP5 ESMs is very scale-dependent. While CESM1-BGC, CESM1-CAM5, CESM1-FASTCHEM and CESM1-WACCM, and NorESM1-M and NorESM1-ME (they share the same model structure) have very similar global sums with the observation data but they usually perform poorly at grid cell and biome scale. In contrast, MIROC-ESM and MIROC-ESM-CHEM simulate the best on at grid cell and biome scale but have larger differences in global sums than others. Our results will help improve CMIP5 ESMs for more reliable prediction.

  12. Evaluation of performance of seasonal precipitation prediction at regional scale over India

    Science.gov (United States)

    Mohanty, U. C.; Nageswararao, M. M.; Sinha, P.; Nair, A.; Singh, A.; Rai, R. K.; Kar, S. C.; Ramesh, K. J.; Singh, K. K.; Ghosh, K.; Rathore, L. S.; Sharma, R.; Kumar, A.; Dhekale, B. S.; Maurya, R. K. S.; Sahoo, R. K.; Dash, G. P.

    2018-03-01

    The seasonal scale precipitation amount is an important ingredient in planning most of the agricultural practices (such as a type of crops, and showing and harvesting schedules). India being an agroeconomic country, the seasonal scale prediction of precipitation is directly linked to the socioeconomic growth of the nation. At present, seasonal precipitation prediction at regional scale is a challenging task for the scientific community. In the present study, an attempt is made to develop multi-model dynamical-statistical approach for seasonal precipitation prediction at the regional scale (meteorological subdivisions) over India for four prominent seasons which are winter (from December to February; DJF), pre-monsoon (from March to May; MAM), summer monsoon (from June to September; JJAS), and post-monsoon (from October to December; OND). The present prediction approach is referred as extended range forecast system (ERFS). For this purpose, precipitation predictions from ten general circulation models (GCMs) are used along with the India Meteorological Department (IMD) rainfall analysis data from 1982 to 2008 for evaluation of the performance of the GCMs, bias correction of the model results, and development of the ERFS. An extensive evaluation of the performance of the ERFS is carried out with dependent data (1982-2008) as well as independent predictions for the period 2009-2014. In general, the skill of the ERFS is reasonably better and consistent for all the seasons and different regions over India as compared to the GCMs and their simple mean. The GCM products failed to explain the extreme precipitation years, whereas the bias-corrected GCM mean and the ERFS improved the prediction and well represented the extremes in the hindcast period. The peak intensity, as well as regions of maximum precipitation, is better represented by the ERFS than the individual GCMs. The study highlights the improvement of forecast skill of the ERFS over 34 meteorological subdivisions

  13. Performance and scaling of a novel locomotor structure: adhesive capacity of climbing gobiid fishes.

    Science.gov (United States)

    Maie, Takashi; Schoenfuss, Heiko L; Blob, Richard W

    2012-11-15

    Many species of gobiid fishes adhere to surfaces using a sucker formed from fusion of the pelvic fins. Juveniles of many amphidromous species use this pelvic sucker to scale waterfalls during migrations to upstream habitats after an oceanic larval phase. However, adults may still use suckers to re-scale waterfalls if displaced. If attachment force is proportional to sucker area and if growth of the sucker is isometric, then increases in the forces that climbing fish must resist might outpace adhesive capacity, causing climbing performance to decline through ontogeny. To test for such trends, we measured pressure differentials and adhesive suction forces generated by the pelvic sucker across wide size ranges in six goby species, including climbing and non-climbing taxa. Suction was achieved via two distinct growth strategies: (1) small suckers with isometric (or negatively allometric) scaling among climbing gobies and (2) large suckers with positively allometric growth in non-climbing gobies. Species using the first strategy show a high baseline of adhesive capacity that may aid climbing performance throughout ontogeny, with pressure differentials and suction forces much greater than expected if adhesion were a passive function of sucker area. In contrast, large suckers possessed by non-climbing species may help compensate for reduced pressure differentials, thereby producing suction sufficient to support body weight. Climbing Sicyopterus species also use oral suckers during climbing waterfalls, and these exhibited scaling patterns similar to those for pelvic suckers. However, oral suction force was considerably lower than that for pelvic suckers, reducing the ability for these fish to attach to substrates by the oral sucker alone.

  14. Working memory performance inversely predicts spontaneous delta and theta-band scaling relations.

    Science.gov (United States)

    Euler, Matthew J; Wiltshire, Travis J; Niermeyer, Madison A; Butner, Jonathan E

    2016-04-15

    Electrophysiological studies have strongly implicated theta-band activity in human working memory processes. Concurrently, work on spontaneous, non-task-related oscillations has revealed the presence of long-range temporal correlations (LRTCs) within sub-bands of the ongoing EEG, and has begun to demonstrate their functional significance. However, few studies have yet assessed the relation of LRTCs (also called scaling relations) to individual differences in cognitive abilities. The present study addressed the intersection of these two literatures by investigating the relation of narrow-band EEG scaling relations to individual differences in working memory ability, with a particular focus on the theta band. Fifty-four healthy adults completed standardized assessments of working memory and separate recordings of their spontaneous, non-task-related EEG. Scaling relations were quantified in each of the five classical EEG frequency bands via the estimation of the Hurst exponent obtained from detrended fluctuation analysis. A multilevel modeling framework was used to characterize the relation of working memory performance to scaling relations as a function of general scalp location in Cartesian space. Overall, results indicated an inverse relationship between both delta and theta scaling relations and working memory ability, which was most prominent at posterior sensors, and was independent of either spatial or individual variability in band-specific power. These findings add to the growing literature demonstrating the relevance of neural LRTCs for understanding brain functioning, and support a construct- and state-dependent view of their functional implications. Copyright © 2016 Elsevier B.V. All rights reserved.

  15. A visual analytics system for optimizing the performance of large-scale networks in supercomputing systems

    Directory of Open Access Journals (Sweden)

    Takanori Fujiwara

    2018-03-01

    Full Text Available The overall efficiency of an extreme-scale supercomputer largely relies on the performance of its network interconnects. Several of the state of the art supercomputers use networks based on the increasingly popular Dragonfly topology. It is crucial to study the behavior and performance of different parallel applications running on Dragonfly networks in order to make optimal system configurations and design choices, such as job scheduling and routing strategies. However, in order to study these temporal network behavior, we would need a tool to analyze and correlate numerous sets of multivariate time-series data collected from the Dragonfly’s multi-level hierarchies. This paper presents such a tool–a visual analytics system–that uses the Dragonfly network to investigate the temporal behavior and optimize the communication performance of a supercomputer. We coupled interactive visualization with time-series analysis methods to help reveal hidden patterns in the network behavior with respect to different parallel applications and system configurations. Our system also provides multiple coordinated views for connecting behaviors observed at different levels of the network hierarchies, which effectively helps visual analysis tasks. We demonstrate the effectiveness of the system with a set of case studies. Our system and findings can not only help improve the communication performance of supercomputing applications, but also the network performance of next-generation supercomputers. Keywords: Supercomputing, Parallel communication network, Dragonfly networks, Time-series data, Performance analysis, Visual analytics

  16. Problem-based learning versus a traditional educational methodology: a comparison of preclinical and clinical periodontics performance.

    Science.gov (United States)

    Rich, Sandra K; Keim, Robert G; Shuler, Charles F

    2005-06-01

    To evaluate efficacy of a problem-based learning (PBL) pedagogy in preclinical and clinical teaching, test scores of 234 undergraduate dental students from the conventionally taught classes of 2003 and 2004 were compared with scores of 274 dental students from the PBL classes of 2005 and 2006. Although the groups' means were close together, t-test analysis of scores revealed that PBL students performed significantly better than traditional (TRAD) students on midterm (p=.0001) and final (p=.015) examinations taken on student partner/mock patients. ANOVA comparing the classes with each other showed significant differences for the midterm and final, but not for the clinical examination. Further multiple comparison tests (Tukey HSD) for the midterm and final revealed that differences specifically reflected superior performance of PBL classes against one of the TRAD classes (2004). There was no difference in performance between PBL (n=134) and TRAD (n=233) students on examinations taken with actual clinical patients who were undergoing nonsurgical periodontal treatment. Over a two-year period, PBL students rated their program instructors at a mean of 4.41 on a Likert-type scale of 1 (not helpful) to 5 (outstanding). The program provides a PBL model for teaching preclinical and clinical skills supported by a four-year evaluation of manual skills outcomes.

  17. Durango: Scalable Synthetic Workload Generation for Extreme-Scale Application Performance Modeling and Simulation

    Energy Technology Data Exchange (ETDEWEB)

    Carothers, Christopher D. [Rensselaer Polytechnic Institute (RPI); Meredith, Jeremy S. [ORNL; Blanco, Marc [Rensselaer Polytechnic Institute (RPI); Vetter, Jeffrey S. [ORNL; Mubarak, Misbah [Argonne National Laboratory; LaPre, Justin [Rensselaer Polytechnic Institute (RPI); Moore, Shirley V. [ORNL

    2017-05-01

    Performance modeling of extreme-scale applications on accurate representations of potential architectures is critical for designing next generation supercomputing systems because it is impractical to construct prototype systems at scale with new network hardware in order to explore designs and policies. However, these simulations often rely on static application traces that can be difficult to work with because of their size and lack of flexibility to extend or scale up without rerunning the original application. To address this problem, we have created a new technique for generating scalable, flexible workloads from real applications, we have implemented a prototype, called Durango, that combines a proven analytical performance modeling language, Aspen, with the massively parallel HPC network modeling capabilities of the CODES framework.Our models are compact, parameterized and representative of real applications with computation events. They are not resource intensive to create and are portable across simulator environments. We demonstrate the utility of Durango by simulating the LULESH application in the CODES simulation environment on several topologies and show that Durango is practical to use for simulation without loss of fidelity, as quantified by simulation metrics. During our validation of Durango's generated communication model of LULESH, we found that the original LULESH miniapp code had a latent bug where the MPI_Waitall operation was used incorrectly. This finding underscores the potential need for a tool such as Durango, beyond its benefits for flexible workload generation and modeling.Additionally, we demonstrate the efficacy of Durango's direct integration approach, which links Aspen into CODES as part of the running network simulation model. Here, Aspen generates the application-level computation timing events, which in turn drive the start of a network communication phase. Results show that Durango's performance scales well when

  18. Developing of Individual Instrument Performance Anxiety Scale: ValidityReliability Study

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    Esra DALKIRAN

    2016-07-01

    Full Text Available In this study, it is intended to develop a scale unique to our culture, concerning individual instrument performance anxiety of the students who are getting instrument training in the Department of Music Education. In the study, the descriptive research model is used and qualitative research techniques are utilized. The study population consists of the students attending the 23 universities which has Music Education Department. The sample of the study consists of 438 girls and 312 boys, totally 750 students who are studying in the Department of Music Education of randomly selected 10 universities. As a result of the explanatory and confirmatory factor analyses that were performed, a onedimensional structure consisting of 14 items was obtained. Also, t-scores and the coefficient scores of total item correlation concerning the distinguishing power of the items, the difference in the scores of the set of lower and upper 27% was calculated, and it was observed that the items are distinguishing as a result of both analyses. Of the scale, Cronbach's alpha coefficient of internal consistency was calculated as .94, and test-retest reliability coefficient was calculated as .93. As a result, a valid and reliable assessment and evaluation instrument that measures the exam performance anxiety of the students studying in the Department of Music Education, has been developed.

  19. Minimal clinically important difference and the effect of clinical variables on the ankle osteoarthritis scale in surgically treated end-stage ankle arthritis.

    Science.gov (United States)

    Coe, Marcus P; Sutherland, Jason M; Penner, Murray J; Younger, Alastair; Wing, Kevin J

    2015-05-20

    There is much debate regarding the best outcome tool for use in foot and ankle surgery, specifically in patients with ankle arthritis. The Ankle Osteoarthritis Scale (AOS) is a validated, disease-specific score. The goals of this study were to investigate the clinical performance of the AOS and to determine a minimal clinically important difference (MCID) for it, using a large cohort of 238 patients undergoing surgery for end-stage ankle arthritis. Patients treated with total ankle arthroplasty or ankle arthrodesis were prospectively followed for a minimum of two years at a single site. Data on demographics, comorbidities, AOS score, Short Form-36 results, and the relationship between expectations and satisfaction were collected at baseline (preoperatively), at six and twelve months, and then yearly thereafter. A linear regression analysis examined the variables affecting the change in AOS scores between baseline and the two-year follow-up. An MCID in the AOS change score was then determined by employing an anchor question, which asked patients to rate their relief from symptoms after surgery. Surgical treatment of end-stage ankle arthritis resulted in a mean improvement (and standard deviation) of 31.2 ± 22.7 points in the AOS score two years after surgery. The MCID of the AOS change score was a mean of 28.0 ± 17.9 points. The change in AOS score was significantly affected by the preoperative AOS score, smoking, back pain, and age. Patients undergoing arthroplasty or arthrodesis for end-stage ankle arthritis experienced a mean improvement in AOS score that was greater than the estimated MCID (31.2 versus 28.0 points). Copyright © 2015 by The Journal of Bone and Joint Surgery, Incorporated.

  20. Sleep quantity, quality, and insomnia symptoms of medical students during clinical years. Relationship with stress and academic performance.

    Science.gov (United States)

    Alsaggaf, Mohammed A; Wali, Siraj O; Merdad, Roah A; Merdad, Leena A

    2016-02-01

    To determine sleep habits and sleep quality in medical students during their clinical years using validated measures; and to investigate associations with academic performance and psychological stress. In this cross-sectional study, medical students (n=320) were randomly selected from a list of all enrolled clinical-year students in a Saudi medical school from 2011-2012. Students filled a questionnaire including demographic and lifestyle factors, Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, and Perceived Stress Scale. Students acquired on average, 5.8 hours of sleep each night, with an average bedtime at 01:53. Approximately 8% reported acquiring sleep during the day, and not during nighttime. Poor sleep quality was present in 30%, excessive daytime sleepiness (EDS) in 40%, and insomnia symptoms in 33% of students. Multivariable regression models revealed significant associations between stress, poor sleep quality, and EDS. Poorer academic performance and stress were associated with symptoms of insomnia. Sleep deprivation, poor sleep quality, and EDS are common among clinical years medical students. High levels of stress and the pressure of maintaining grade point averages may be influencing their quality of sleep.

  1. Sleep quantity, quality, and insomnia symptoms of medical students during clinical years. Relationship with stress and academic performance

    Directory of Open Access Journals (Sweden)

    Mohammed A. Alsaggaf

    2016-02-01

    Full Text Available Objectives: To determine sleep habits and sleep quality in medical students during their clinical years using validated measures; and to investigate associations with academic performance and psychological stress. Methods: In this cross-sectional study, medical students (n=320 were randomly selected from a list of all enrolled clinical-year students in a Saudi medical school from 2011-2012. Students filled a questionnaire including demographic and lifestyle factors, Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, and Perceived Stress Scale. Results: Students acquired on average, 5.8 hours of sleep each night, with an average bedtime at 01:53. Approximately 8% reported acquiring sleep during the day, and not during nighttime. Poor sleep quality was present in 30%, excessive daytime sleepiness (EDS in 40%, and insomnia symptoms in 33% of students. Multivariable regression models revealed significant associations between stress, poor sleep quality, and EDS. Poorer academic performance and stress were associated with symptoms of insomnia. Conclusion: Sleep deprivation, poor sleep quality, and EDS are common among clinical years medical students. High levels of stress and the pressure of maintaining grade point averages may be influencing their quality of sleep.

  2. Health service accreditation as a predictor of clinical and organisational performance: a blinded, random, stratified study.

    Science.gov (United States)

    Braithwaite, Jeffrey; Greenfield, David; Westbrook, Johanna; Pawsey, Marjorie; Westbrook, Mary; Gibberd, Robert; Naylor, Justine; Nathan, Sally; Robinson, Maureen; Runciman, Bill; Jackson, Margaret; Travaglia, Joanne; Johnston, Brian; Yen, Desmond; McDonald, Heather; Low, Lena; Redman, Sally; Johnson, Betty; Corbett, Angus; Hennessy, Darlene; Clark, John; Lancaster, Judie

    2010-02-01

    Despite the widespread use of accreditation in many countries, and prevailing beliefs that accreditation is associated with variables contributing to clinical care and organisational outcomes, little systematic research has been conducted to examine its validity as a predictor of healthcare performance. To determine whether accreditation performance is associated with self-reported clinical performance and independent ratings of four aspects of organisational performance. Independent blinded assessment of these variables in a random, stratified sample of health service organisations. Acute care: large, medium and small health-service organisations in Australia. Study participants Nineteen health service organisations employing 16 448 staff treating 321 289 inpatients and 1 971 087 non-inpatient services annually, representing approximately 5% of the Australian acute care health system. Correlations of accreditation performance with organisational culture, organisational climate, consumer involvement, leadership and clinical performance. Results Accreditation performance was significantly positively correlated with organisational culture (rho=0.618, p=0.005) and leadership (rho=0.616, p=0.005). There was a trend between accreditation and clinical performance (rho=0.450, p=0.080). Accreditation was unrelated to organisational climate (rho=0.378, p=0.110) and consumer involvement (rho=0.215, p=0.377). Accreditation results predict leadership behaviours and cultural characteristics of healthcare organisations but not organisational climate or consumer participation, and a positive trend between accreditation and clinical performance is noted.

  3. Clinical skills-related learning goals of senior medical students after performance feedback.

    Science.gov (United States)

    Chang, Anna; Chou, Calvin L; Teherani, Arianne; Hauer, Karen E

    2011-09-01

    Lifelong learning is essential for doctors to maintain competence in clinical skills. With performance feedback, learners should be able to formulate specific and achievable learning goals in areas of need. We aimed to determine: (i) the type and specificity of medical student learning goals after a required clinical performance examination; (ii) differences in goal setting among low, average and high performers, and (iii) whether low performers articulate learning goals that are concordant with their learning needs. We conducted a single-site, multi-year, descriptive comparison study. Senior medical students were given performance benchmarks, individual feedback and guidelines on learning goals; each student was subsequently instructed to write two clinical skills learning goals. Investigators coded the learning goals for specificity, categorised the goals, and performed statistical analyses to determine their concordance with student performance level (low, average or high) in data gathering (history taking and physical examination) or communication skills. All 208 students each wrote two learning goals and most (n=200, 96%) wrote two specific learning goals. Nearly two-thirds of low performers in data gathering wrote at least one learning goal that referred to history taking or physical examination; one-third wrote learning goals pertaining to the organisation of the encounter. High performers in data gathering wrote significantly more patient education goals and significantly fewer history-taking goals than average or low performers. Only 50% of low performers in communication wrote learning goals related to communication skills. Low performers in communication were significantly more likely than average or high performers to identify learning goals related to improving performance in future examinations. The provision of performance benchmarking, individual feedback and brief written guidelines helped most senior medical students in our study to write specific

  4. The effect of primary sedimentation on full-scale WWTP nutrient removal performance.

    Science.gov (United States)

    Puig, S; van Loosdrecht, M C M; Flameling, A G; Colprim, J; Meijer, S C F

    2010-06-01

    Traditionally, the performance of full-scale wastewater treatment plants (WWTPs) is measured based on influent and/or effluent and waste sludge flows and concentrations. Full-scale WWTP data typically have a high variance which often contains (large) measurement errors. A good process engineering evaluation of the WWTP performance is therefore difficult. This also makes it usually difficult to evaluate effect of process changes in a plant or compare plants to each other. In this paper we used a case study of a full-scale nutrient removing WWTP. The plant normally uses presettled wastewater, as a means to increase the nutrient removal the plant was operated for a period by-passing raw wastewater (27% of the influent flow). The effect of raw wastewater addition has been evaluated by different approaches: (i) influent characteristics, (ii) design retrofit, (iii) effluent quality, (iv) removal efficiencies, (v) activated sludge characteristics, (vi) microbial activity tests and FISH analysis and, (vii) performance assessment based on mass balance evaluation. This paper demonstrates that mass balance evaluation approach helps the WWTP engineers to distinguish and quantify between different strategies, where others could not. In the studied case, by-passing raw wastewater (27% of the influent flow) directly to the biological reactor did not improve the effluent quality and the nutrient removal efficiency of the WWTP. The increase of the influent C/N and C/P ratios was associated to particulate compounds with low COD/VSS ratio and a high non-biodegradable COD fraction. Copyright 2010 Elsevier Ltd. All rights reserved.

  5. The Psychometric Properties of Turkish Version of Depression Anxiety Stress Scale-21 (DASS-21 in Community and Clinical Samples

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    Hakan SARICAM

    2018-04-01

    Full Text Available This paper presented the Turkish version of the Depression Anxiety Stress Scale-21 (DASS-21 in community and clinical samples, examined its psychometric properties. Construct validity and concurrent validity were conducted in validity studies. Depression Anxiety Stress Scale-42 (DASS-42 was used for concurrent validity. In reliability analysis, the instrument’s internal consistency and re-test reliability were studied. Results of explanatory factor analyses demonstrated that 21 items yielded three-factors. Results of confirmatory factor analyses for three-dimensional model showed that acceptable fit index values in community sample and perfect fit index values in clinical sample. Factor loadings ranged from .42 to .72. In the concurrent validity, significant positive relationships were found between DASS-42 and DASS-21. Cronbach alpha internal consistency coefficient was found as α= .87 for depression sub-scale, α= .85 for anxiety sub-scale and α= .81 for stress sub-scale in clinical sample. Moreover, test-retest reliability coefficient was obtained as r=.68 for depression sub-scale, r=.66 for anxiety sub-scale and r=.61 for stress sub-scale in community sample, and corrected item-total correlations ranged from .43 to .77 in clinical sample. In second study, DASS-21 discriminated the patients (depression mean score=10.83; anxiety mean score=10.39; stress mean score=11.85 from the healthy subjects (depression mean score=5.88; anxiety mean score=5.37; stress mean score=7.90 well (U=5310.50; 4748.50; 5562.50, p=0.00. According to psychometric properties, DASS-21 is a reliable and valid instrument in the assessment of depression, anxiety, stress levels. [JCBPR 2018; 7(1.000: 19-30

  6. The Psychometric Properties of Turkish Version of Depression Anxiety Stress Scale-21 (DASS-21) in Community and Clinical Samples

    OpenAIRE

    Hakan SARICAM

    2018-01-01

    This paper presented the Turkish version of the Depression Anxiety Stress Scale-21 (DASS-21) in community and clinical samples, examined its psychometric properties. Construct validity and concurrent validity were conducted in validity studies. Depression Anxiety Stress Scale-42 (DASS-42) was used for concurrent validity. In reliability analysis, the instruments internal consistency and re-test reliability were studied. Results of explanatory factor analyses demonstrated that 21 items yielded...

  7. Symptom severity scale of the DSM5 for schizophrenia, and other psychotic disorders: diagnostic validity and clinical feasibility.

    Science.gov (United States)

    Ritsner, Michael S; Mar, Maria; Arbitman, Marina; Grinshpoon, Alexander

    2013-06-30

    Innovations in DSM5 include dimensional diagnosis of schizophrenia (SZ) and other psychotic (OP) disorders using the symptom severity scale (SS-DSM5). We evaluated the psychometric properties and diagnostic validity of the SS-DSM5 scale using a cross-sectional design and an unselected convenience unselected sample of 314 inpatients and outpatients with SZ/OP and mood disorders who received standard care in routine clinical practice. The SS-DSM5 scale, the Clinical Global Impression-Severity scale (CGI-S), the Positive and Negative Syndrome Scale (PANSS), and the Bech-Rafaelsen Mania Scale (BRMS) were administered. Factor structure, reliability, internal consistency, convergent and diagnostic ability of the DSM5-SS were evaluated. Factor analysis indicated two latent factors underlying the SS-DSM5 (Psychotic and Deficit sub-scales). Cronbach's alpha was >0.70. Convergent validity of the SS-DSM5 was highly significant. Patients with SZ/PO disorders were correctly diagnosed (77.9%) using the SS-DSM5 scale (72% using PANSS). The agreement of the diagnostic decisions between the SS-DSM5 and PANSS was substantial for SZ/PO disorders (Kappa=0.75). Classifying participants with SZ/PO versus mood disorders using SS-DSM5 provided a sensitivity of 95%, and specificity of 34%. Thus, this study suggests that the SS-DSM5 has acceptable psychometric properties and that its use in clinical practice and research is feasible in clinical settings. The dimensional option for the diagnosis of schizophrenia and related disorders using SS-DSM5 is discussed. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  8. A Clinical Indications Prediction Scale Based on TWIST1 for Human Mesenchymal Stem Cells

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    Siddaraju V. Boregowda

    2016-02-01

    Full Text Available In addition to their stem/progenitor properties, mesenchymal stem cells (MSCs also exhibit potent effector (angiogenic, antiinflammatory, immuno-modulatory functions that are largely paracrine in nature. It is widely believed that effector functions underlie most of the therapeutic potential of MSCs and are independent of their stem/progenitor properties. Here we demonstrate that stem/progenitor and effector functions are coordinately regulated at the cellular level by the transcription factor Twist1 and specified within populations according to a hierarchical model. We further show that manipulation of Twist1 levels by genetic approaches or by exposure to widely used culture supplements including fibroblast growth factor 2 (Ffg2 and interferon gamma (IFN-gamma alters MSC efficacy in cell-based and in vivo assays in a predictable manner. Thus, by mechanistically linking stem/progenitor and effector functions our studies provide a unifying framework in the form of an MSC hierarchy that models the functional complexity of populations. Using this framework, we developed a CLinical Indications Prediction (CLIP scale that predicts how donor-to-donor heterogeneity and culture conditions impact the therapeutic efficacy of MSC populations for different disease indications.

  9. Large-scale adenovirus and poxvirus-vectored vaccine manufacturing to enable clinical trials.

    Science.gov (United States)

    Kallel, Héla; Kamen, Amine A

    2015-05-01

    Efforts to make vaccines against infectious diseases and immunotherapies for cancer have evolved to utilize a variety of heterologous expression systems such as viral vectors. These vectors are often attenuated or engineered to safely deliver genes encoding antigens of different pathogens. Adenovirus and poxvirus vectors are among the viral vectors that are most frequently used to develop prophylactic vaccines against infectious diseases as well as therapeutic cancer vaccines. This mini-review describes the trends and processes in large-scale production of adenovirus and poxvirus vectors to meet the needs of clinical applications. We briefly describe the general principles for the production and purification of adenovirus and poxvirus viral vectors. Currently, adenovirus and poxvirus vector manufacturing methods rely on well-established cell culture technologies. Several improvements have been evaluated to increase the yield and to reduce the overall manufacturing cost, such as cultivation at high cell densities and continuous downstream processing. Additionally, advancements in vector characterization will greatly facilitate the development of novel vectored vaccine candidates. Copyright © 2015 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

  10. Modified bathroom scale and balance assessment: a comparison with clinical tests.

    Science.gov (United States)

    Duchêne, Jacques; Hewson, David; Rumeau, Pierre

    2016-01-01

    Frailty and detection of fall risk are major issues in preventive gerontology. A simple tool frequently used in daily life, a bathroom scale (balance quality tester: BQT), was modified to obtain information on the balance of 84 outpatients consulting at a geriatric clinic. The results computed from the BQT were compared to the values of three geriatric tests that are widely used either to detect a fall risk or frailty (timed get up and go: TUG; 10 m walking speed: WS; walking time: WT; one-leg stand: OS). The BQT calculates four parameters that are then scored and weighted, thus creating an overall indicator of balance quality. Raw data, partial scores and the global score were compared with the results of the three geriatric tests. The WT values had the highest correlation with BQT raw data (r = 0.55), while TUG (r = 0.53) and WS (r = 0.56) had the highest correlation with BQT partial scores. ROC curves for OS cut-off values (4 and 5 s) were produced, with the best results obtained for a 5 s cut-off, both with the partial scores combined using Fisher's combination (specificity 85 %: 0.48), and with the empirical score (specificity 85 %: 8). A BQT empirical score of less than seven can detect fall risk in a community dwelling population.

  11. The Gap Between Clinical Research and Standard of Care: A Review of Frailty Assessment Scales in Perioperative Surgical Settings.

    Science.gov (United States)

    Stoicea, Nicoleta; Baddigam, Ramya; Wajahn, Jennifer; Sipes, Angela C; Arias-Morales, Carlos E; Gastaldo, Nicholas; Bergese, Sergio D

    2016-01-01

    The elderly population in the United States is increasing exponentially in tandem with risk for frailty. Frailty is described by a clinically significant state where a patient is at risk for developing complications requiring increased assistance in daily activities. Frailty syndrome studied in geriatric patients is responsible for an increased risk for falls, and increased mortality. In efforts to prepare for and to intervene in perioperative complications and general frailty, a universal scale to measure frailty is necessary. Many methods for determining frailty have been developed, yet there remains a need to define clinical frailty and, therefore, the most effective way to measure it. This article reviews six popular scales for measuring frailty and evaluates their clinical effectiveness demonstrated in previous studies. By identifying the most time-efficient, criteria comprehensive, and clinically effective scale, a universal scale can be implemented into standard of care and reduce complications from frailty in both non-surgical and surgical settings, especially applied to the perioperative surgical home model. We suggest further evaluation of the Edmonton Frailty Scale for inclusion in patient care.

  12. The Gap Between Clinical Research and Standard of Care: A Review of Frailty Assessment Scales in Perioperative Surgical Settings

    Directory of Open Access Journals (Sweden)

    Nicoleta Stoicea

    2016-07-01

    Full Text Available The elderly population in the United States is increasing exponentially in tandem with risk for frailty. Frailty is described by a clinically significant state where a patient is at risk for developing complications requiring increased assistance in daily activities. Frailty syndrome studied in geriatric patients is responsible for an increased risk for falls, and increased mortality. In efforts to prepare for and to intervene in perioperative complications and general frailty, a universal scale to measure frailty is necessary. Many methods for determining frailty have been developed, yet there remains a need to define clinical frailty and therefore the most effective way to measure it. This article reviews six popular scales for measuring frailty and evaluates their clinical effectiveness demonstrated in previous studies. By identifying the most time-efficient, criteria comprehensive, and clinically effective scale, a universal scale can be implemented into standard of care and reduce complications from frailty in both non-surgical and surgical settings, especially applied to the perioperative surgical home model. We suggest further evaluation of the Edmonton Frailty Scale for inclusion in patient care.

  13. Fault Transient Analysis and Protection Performance Evaluation within a Large-scale PV Power Plant

    Directory of Open Access Journals (Sweden)

    Wen Jinghua

    2016-01-01

    Full Text Available In this paper, a short-circuit test within a large-scale PV power plant with a total capacity of 850MWp is discussed. The fault currents supplied by the PV generation units are presented and analysed. According to the fault behaviour, the existing protection coordination principles with the plant are considered and their performances are evaluated. Moreover, these protections are examined in simulation platform under different operating situations. A simple measure with communication system is proposed to deal with the foreseeable problem about the current protection scheme in the PV power plant.

  14. Clinical utilisation of the "G.T. MSRS", the rating scale for mixed states: 35 cases report.

    Science.gov (United States)

    Tavormina, Giuseppe

    2015-09-01

    The knowledge of the clinical features of the mixed states and of the symptoms of the "mixity" of mood disorders is crucial: to mis-diagnose or mis-treat patients with these symptoms may increase the suicide risk and make worse the evolution of mood disorders. The rating scale "G.T. MSRS" has been designed to improve the clinical effectiveness of both psychiatrists and GPs by enabling them to make an early "general" diagnosis of mixed states. This study presents some cases in which the "G.T. MSRS" scale has been used, in order to demonstrate its usefullness.

  15. Clinical Utilisation and Usefullness of the Rating Scale of Mixed States, ("Gt-Msrs"): a Multicenter Study.

    Science.gov (United States)

    Tavormina, Giuseppe; Franza, Francesco; Stranieri, Giuseppe; Juli, Luigi; Juli, Maria Rosaria

    2017-09-01

    The rating scale "G.T. MSRS" has been designed to improve the clinical effectiveness of the clinician psychiatrists, by enabling them to make an early "general" diagnosis of mixed states. The knowledge of the clinical features of the mixed states and of the symptoms of the "mixity" of mood disorders is crucial: to mis-diagnose or mis-treat patients with these symptoms may increase the suicide risk and make worse the evolution of mood disorders going to the dysphoric state. This study is the second validation study of the "G.T. MSRS" rating scale, in order to demonstrate its usefullness.

  16. Narrative descriptions should replace grades and numerical ratings for clinical performance in medical education in the United States

    Directory of Open Access Journals (Sweden)

    Janice Lynn Hanson

    2013-11-01

    Full Text Available Background: In medical education, evaluation of clinical performance is based almost universally on rating scales for defined aspects of performance and scores on examinations and checklists. Unfortunately, scores and grades do not capture progress and competence among learners in the complex tasks and roles required to practice medicine. While the literature suggests serious problems with the validity and reliability of ratings of clinical performance based on numerical scores, the critical issue is not that judgments about what is observed vary from rater to rater but that these judgments are lost when translated into numbers on a scale. As the Next Accreditation System of the Accreditation Council on Graduate Medical Education (ACGME takes effect, medical educators have an opportunity to create new processes of evaluation to document and facilitate progress of medical learners in the required areas of competence.Proposal and initial experience: Narrative descriptions of learner performance in the clinical environment, gathered using a framework for observation that builds a shared understanding of competence among the faculty, promise to provide meaningful qualitative data closely linked to the work of physicians. With descriptions grouped in categories and matched to milestones, core faculty can place each learner along the milestones’ continua of progress. This provides the foundation for meaningful feedback to facilitate the progress of each learner as well as documentation of progress toward competence.Implications: This narrative evaluation system addresses educational needs as well as the goals of the Next Accreditation System for explicitly documented progress. Educators at other levels of education and in other professions experience similar needs for authentic assessment and, with meaningful frameworks that describe roles and tasks, may also find useful a system built on descriptions of learner performance in actual work settings

  17. Evaluation of the Short Parkinson's Evaluation Scale: a new friendly scale for the evaluation of Parkinson's disease in clinical drug trials.

    Science.gov (United States)

    Rabey, J M; Bass, H; Bonuccelli, U; Brooks, D; Klotz, P; Korczyn, A D; Kraus, P; Martinez-Martin, P; Morrish, P; Van Sauten, W; Van Hilten, B

    1997-08-01

    The extensive use of the Unified Parkinson's Disease Rating Scale (UPDRS) has revealed low interrater reliability in some items and redundancy in others. In view of these shortcomings, we have structured a new scale that includes a zero-to three-point scale for each item in the evaluation of PD. The mental axis includes memory, thought disorders, and depression. Activities of daily living (ADL) includes eight items: speech, eating, feeding, dressing, hygiene, handwriting, walking, and turning in bed. The motor examination includes eight items: speech, tremor, rest and posture, rigidity, finger tapping, arising from chair, gait, and postural stability. Complications of therapy were also included: dyskinesias, dystonia, motor fluctuations, and freezing episodes, collected by history. In addition, a global scoring for motor fluctuations that should complement the Hoehn and Yahr Scale was incorporated. In this report, we present a statistical analysis of the ADL, motor evaluation, and complications of therapy sections. Concerning the interrater reliability mean, Kendall's W values were >0.9 for most of the items in the Short Parkinson's Evaluation Scale (SPES). Kendall's W <0.8 (motor evaluation) was found for two items of the SPES and nine items of the UPDRS. The mean interrater reliability for both scales across all seven centers (seven Kendall's W for seven centers) (Mann-Whitney test) showed no statistical differences between the scales. Spearman's correlations between items of both scales were significant. Factor analysis of the SPES and UPDRS data revealed a four-factor solution that explained approximately 60% of the data. All participating centers found the SPES easier to apply and quicker to complete, when compared with the UPDRS. The results obtained strongly favor the introduction of SPES for clinical practice.

  18. Clinical observation on fibrin glue technique in pterygium surgery performed with limbal autograft transplantation

    Directory of Open Access Journals (Sweden)

    Hui Liu

    2013-07-01

    Full Text Available AIM: To compare the efficiency and safety of fibrin glue to suture technique in pterygium surgery performed with limbal autograft.METHODS: A prospective randomized clinical trial was carried out in 60 eyes of 48 patients operated for primary nasal pterygium. Autologous limbal graft taken from the superotemporal limbus was used to cover the sclera after pterygium excision under local anesthesia with 2% lidocaine. In 22 cases(30 eyes, the transplant was attached to the sclera with a fibrin tissue adhesive(group 1and in 26 cases(30 eyeswith 10-0 Virgin silk sutures(group 2. Patients were followed up at least for 3 months. Time of operation, matching degree of graft and visual analogue scale(VASscore were mainly observed and recorded. RESULTS: Patient symptoms were significantly less and biomicroscopic findings were better in group 1. Pterygium recurrence was seen in 1 case of group 1, and 1 case of group 2. Average surgery time was shorter(PCONCLUSION: Using fibrin glue for graft fixation in pterygium surgery causes significantly less postoperative pain and shortens surgery time significantly.

  19. Performance assessment of cogeneration and trigeneration systems for small scale applications

    International Nuclear Information System (INIS)

    Angrisani, Giovanni; Akisawa, Atsushi; Marrasso, Elisa; Roselli, Carlo; Sasso, Maurizio

    2016-01-01

    Highlights: • Indices and methods to assess the performance of polygeneration systems. • Index to evaluate the economic feasibility of trigeneration system is introduced. • Thermo-economic analysis is performed considering three commercial cogenerators. • Sensitivity analysis varying reference electric efficiency for European Countries. • Sensitivity analysis varying environmental and economic parameters. - Abstract: Cogeneration and trigeneration systems can contribute to the reduction of primary energy consumption and greenhouse gas emissions in residential and tertiary sectors, by reducing fossil fuels demand and grid losses with respect to conventional systems. To evaluate the performance of these systems, several indices and assessment methodologies can be used, due to the high complexity of such systems, which can consist of several energy conversion devices and can perform bidirectional interactions with external electric and thermal grids. In this paper, a review of the available indices and methodologies to assess the performances of polygeneration systems is provided. An index (TSS_t_r_i) aimed to assess the economic feasibility of a trigeneration system is also introduced and discussed. This activity started in the framework of the International Energy Agency Annex 54 project (“Integration of Micro-Generation and Related Energy Technologies in Buildings”), where research groups shared their expertise about methods applied in each Country to evaluate the performance of polygeneration systems. It was concluded that a thermo-economic analysis comparing the performance of a polygeneration system with those of a reference benchmark scenario, is a very suitable assessment method. Some of the reviewed methodologies are then applied to small scale commercial cogenerators. The sensitivity analysis is performed considering different reference average values of electric efficiency, unitary natural gas and electricity prices, and emission factors for

  20. Clinical problems with the performance of euthanasia and physician-assisted suicide in The Netherlands

    NARCIS (Netherlands)

    J.H. Groenewoud (Hanny); A. van der Heide (Agnes); B.D. Onwuteaka-Philipsen (Bregje); D.L. Willems (Dick); P.J. van der Maas (Paul); G. van der Wal (Gerrit)

    2000-01-01

    textabstractBACKGROUND AND METHODS: The characteristics and frequency of clinical problems with the performance of euthanasia and physician-assisted suicide are uncertain. We analyzed data from two studies of euthanasia and physician-assisted suicide in The

  1. Poorly Performing Physicians: Does the Script Concordance Test Detect Bad Clinical Reasoning?

    Science.gov (United States)

    Goulet, Francois; Jacques, Andre; Gagnon, Robert; Charlin, Bernard; Shabah, Abdo

    2010-01-01

    Introduction: Evaluation of poorly performing physicians is a worldwide concern for licensing bodies. The College des Medecins du Quebec currently assesses the clinical competence of physicians previously identified with potential clinical competence difficulties through a day-long procedure called the Structured Oral Interview (SOI). Two peer…

  2. A clinical comparison of cordless and conventional displacement systems regarding clinical performance and impression quality.

    Science.gov (United States)

    Acar, Özlem; Erkut, Selim; Özçelik, Tuncer Burak; Ozdemır, Erdem; Akçil, Mehtap

    2014-05-01

    It is not clear whether newly introduced cordless displacement systems are better able to manage gingiva than conventional systems. The purpose of this in vivo study was to evaluate the gingival management ability of 4 different displacement methods with a standardized subgingival preparation finish line. The effects of 4 displacement techniques on gingival management and impression quality were evaluated by means of 6 evaluation criteria. A subgingival preparation finish line of between 1 and 2 mm was ensured, and the buccal aspects of 252 (n=63) teeth were clinically assessed for ease of application, time spent, bleeding, remnants, and dilatation. The complete reproduction of the preparation finish line and the bubble and void formations on polyether impressions were also evaluated. The data were statistically analyzed with the χ(2) test (α=.05). The Bonferroni correction was used to control Type I error for the pairwise comparison groups (α=.008). Statistically significant differences were found for all criteria among the groups (Pimpression quality (Pimpression quality (P>.008). The retraction cap with paste group showed better results for ease of application, time spent, and bleeding than the aluminum chloride impregnated cord group (Pimpression qualities. Copyright © 2014 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.

  3. Performance Evaluation of Hadoop-based Large-scale Network Traffic Analysis Cluster

    Directory of Open Access Journals (Sweden)

    Tao Ran

    2016-01-01

    Full Text Available As Hadoop has gained popularity in big data era, it is widely used in various fields. The self-design and self-developed large-scale network traffic analysis cluster works well based on Hadoop, with off-line applications running on it to analyze the massive network traffic data. On purpose of scientifically and reasonably evaluating the performance of analysis cluster, we propose a performance evaluation system. Firstly, we set the execution times of three benchmark applications as the benchmark of the performance, and pick 40 metrics of customized statistical resource data. Then we identify the relationship between the resource data and the execution times by a statistic modeling analysis approach, which is composed of principal component analysis and multiple linear regression. After training models by historical data, we can predict the execution times by current resource data. Finally, we evaluate the performance of analysis cluster by the validated predicting of execution times. Experimental results show that the predicted execution times by trained models are within acceptable error range, and the evaluation results of performance are accurate and reliable.

  4. Large scale gas injection test (Lasgit) performed at the Aespoe Hard Rock Laboratory. Summary report 2008

    International Nuclear Information System (INIS)

    Cuss, R.J.; Harrington, J.F.; Noy, D.J.

    2010-02-01

    This report describes the set-up, operation and observations from the first 1,385 days (3.8 years) of the large scale gas injection test (Lasgit) experiment conducted at the Aespoe Hard Rock Laboratory. During this time the bentonite buffer has been artificially hydrated and has given new insight into the evolution of the buffer. After 2 years (849 days) of artificial hydration a canister filter was identified to perform a series of hydraulic and gas tests, a period that lasted 268 days. The results from the gas test showed that the full-scale bentonite buffer behaved in a similar way to previous laboratory experiments. This confirms the up-scaling of laboratory observations with the addition of considerable information on the stress responses throughout the deposition hole. During the gas testing stage, the buffer was continued to artificially hydrate. Hydraulic results, from controlled and uncontrolled events, show that the buffer continues to mature and has yet to reach full maturation. Lasgit has yielded high quality data relating to the hydration of the bentonite and the evolution in hydrogeological properties adjacent to the deposition hole. The initial hydraulic and gas injection tests confirm the correct working of all control and data acquisition systems. Lasgit has been in successful operation for in excess of 1,385 days

  5. Large scale gas injection test (Lasgit) performed at the Aespoe Hard Rock Laboratory. Summary report 2008

    Energy Technology Data Exchange (ETDEWEB)

    Cuss, R.J.; Harrington, J.F.; Noy, D.J. (British Geological Survey (United Kingdom))

    2010-02-15

    This report describes the set-up, operation and observations from the first 1,385 days (3.8 years) of the large scale gas injection test (Lasgit) experiment conducted at the Aespoe Hard Rock Laboratory. During this time the bentonite buffer has been artificially hydrated and has given new insight into the evolution of the buffer. After 2 years (849 days) of artificial hydration a canister filter was identified to perform a series of hydraulic and gas tests, a period that lasted 268 days. The results from the gas test showed that the full-scale bentonite buffer behaved in a similar way to previous laboratory experiments. This confirms the up-scaling of laboratory observations with the addition of considerable information on the stress responses throughout the deposition hole. During the gas testing stage, the buffer was continued to artificially hydrate. Hydraulic results, from controlled and uncontrolled events, show that the buffer continues to mature and has yet to reach full maturation. Lasgit has yielded high quality data relating to the hydration of the bentonite and the evolution in hydrogeological properties adjacent to the deposition hole. The initial hydraulic and gas injection tests confirm the correct working of all control and data acquisition systems. Lasgit has been in successful operation for in excess of 1,385 days

  6. Wechsler Adult Intelligence Scale-Fourth Edition performance in relapsing-remitting multiple sclerosis.

    Science.gov (United States)

    Ryan, Joseph J; Gontkovsky, Samuel T; Kreiner, David S; Tree, Heather A

    2012-01-01

    Forty patients with relapsing-remitting multiple sclerosis (MS) completed the 10 core Wechsler Adult Intelligence Scale-Fourth Edition (WAIS-IV) subtests. Means for age and education were 42.05 years (SD = 9.94) and 14.33 years (SD = 2.40). For all participants, the native language was English. The mean duration of MS diagnosis was 8.17 years (SD = 7.75), and the mean Expanded Disability Status Scale (EDSS; Kurtzke, 1983 ) score was 3.73 (SD = 1.41) with a range from 2.0 to 6.5. A control group of healthy individuals with similar demographic characteristics also completed the WAIS-IV and were provided by the test publisher. Compared to controls, patients with MS earned significantly lower subtest and composite scores. The patients' mean scores were consistently in the low-average to average range, and the patterns of performance across groups did not differ significantly, although there was a trend towards higher scores on the Verbal Comprehension Index (VCI) and lower scores on the Processing Speed Index (PSI). Approximately 78% of patients had actual Full Scale IQs that were significantly lower than preillness, demographically based IQ estimates.

  7. Constraints on muscle performance provide a novel explanation for the scaling of posture in terrestrial animals.

    Science.gov (United States)

    Usherwood, James R

    2013-08-23

    Larger terrestrial animals tend to support their weight with more upright limbs. This makes structural sense, reducing the loading on muscles and bones, which is disproportionately challenging in larger animals. However, it does not account for why smaller animals are more crouched; instead, they could enjoy relatively more slender supporting structures or higher safety factors. Here, an alternative account for the scaling of posture is proposed, with close parallels to the scaling of jump performance. If the costs of locomotion are related to the volume of active muscle, and the active muscle volume required depends on both the work and the power demanded during the push-off phase of each step (not just the net positive work), then the disproportional scaling of requirements for work and push-off power are revealing. Larger animals require relatively greater active muscle volumes for dynamically similar gaits (e.g. top walking speed)-which may present an ultimate constraint to the size of running animals. Further, just as for jumping, animals with shorter legs and briefer push-off periods are challenged to provide the power (not the work) required for push-off. This can be ameliorated by having relatively long push-off periods, potentially accounting for the crouched stance of small animals.

  8. Embedded Sensors and Controls to Improve Component Performance and Reliability -- Bench-scale Testbed Design Report

    Energy Technology Data Exchange (ETDEWEB)

    Melin, Alexander M. [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States); Kisner, Roger A. [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States); Drira, Anis [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States); Reed, Frederick K. [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States)

    2015-09-01

    Embedded instrumentation and control systems that can operate in extreme environments are challenging due to restrictions on sensors and materials. As a part of the Department of Energy's Nuclear Energy Enabling Technology cross-cutting technology development programs Advanced Sensors and Instrumentation topic, this report details the design of a bench-scale embedded instrumentation and control testbed. The design goal of the bench-scale testbed is to build a re-configurable system that can rapidly deploy and test advanced control algorithms in a hardware in the loop setup. The bench-scale testbed will be designed as a fluid pump analog that uses active magnetic bearings to support the shaft. The testbed represents an application that would improve the efficiency and performance of high temperature (700 C) pumps for liquid salt reactors that operate in an extreme environment and provide many engineering challenges that can be overcome with embedded instrumentation and control. This report will give details of the mechanical design, electromagnetic design, geometry optimization, power electronics design, and initial control system design.

  9. Development and Psychometric Evaluation of the Nursing Instructors? Clinical Teaching Performance Inventory

    OpenAIRE

    Farahani, Mansoureh A.; Ghasemi, Hormat Sadat Emamzadeh; Nikpeyma, Nasrin; Fereidouni, Zhila; Rassouli, Maryam

    2014-01-01

    Evaluation of nursing instructors? clinical teaching performance is a prerequisite to the quality assurance of nursing education. One of the most common procedures for this purpose is using student evaluations. This study was to develop and evaluate the psychometric properties of Nursing Instructors? Clinical Teaching Performance Inventory (NICTPI). The primary items of the inventory were generated by reviewing the published literature and the existing questionnaires as well as consulting wit...

  10. Predictors of placebo group decline in the Alzheimer's disease Assessment Scale-cognitive subscale (ADAS-Cog) in 24 week clinical trials of Alzheimer's disease.

    Science.gov (United States)

    Irizarry, Michael C; Webb, David J; Bains, Chanchal; Barrett, Steven J; Lai, Robert Y; Laroche, Janette P; Hosford, David; Maher-Edwards, Gareth; Weil, John G

    2008-07-01

    One limitation of several recent 24 week Alzheimer's disease (AD) clinical trials was the lack of cognitive decline detected by the AD Assessment Scale-cognitive subscale (ADAS-cog) in the placebo groups, possibly obscuring true medication effects. Data from 733 individuals in the placebo arms of six AD clinical trials performed 1996-1997 were pooled to examine the relationship of clinical, demographic, and genetic characteristics with the 24 week change in ADAS-cog. Baseline cognitive and functional status and the screening-to-baseline change in ADAS-cog were the strongest independent predictors of the 24 week change in ADAS-cog. The ADAS-cog did not detect progression in patients with mild dementia (screening Mini-Mental State Exam, MMSE, >or=20). The change in ADAS-cog from screening to baseline was inversely correlated with the 24 week change score; it was more difficult to detect cognitive decline at 24 weeks if individuals markedly worsened from screening to baseline. The effects of baseline MMSE and screening-to-baseline change in ADAS-cog generalized to the placebo group (N=106) of another AD study performed in 2004-2005. Overcoming lack of placebo decline in AD clinical trials will require scales more sensitive to cognitive decline in mild AD and strategies to reduce within-person variability in outcome measures.

  11. Study on the Contra-Rotating Propeller system design and full-scale performance prediction method

    Directory of Open Access Journals (Sweden)

    Keh-Sik Min

    2009-09-01

    Full Text Available A ship's screw-propeller produces thrust by rotation and, at the same time, generates rotational flow behind the propeller. This rotational flow has no contribution to the generation of thrust, but instead produces energy loss. By recovering part of the lost energy in the rotational flow, therefore, it is possible to improve the propulsion efficiency. The contra-rotating propeller (CRP system is the representing example of such devices. Unfortunately, however, neither a design method nor a full-scale performance prediction procedure for the CRP system has been well established yet. The authors have long performed studies on the CRP system, and some of the results from the authors’ studies shall be presented and discussed.

  12. Performance of automatic generation control mechanisms with large-scale wind power

    Energy Technology Data Exchange (ETDEWEB)

    Ummels, B.C.; Gibescu, M.; Paap, G.C. [Delft Univ. of Technology (Netherlands); Kling, W.L. [Transmission Operations Department of TenneT bv (Netherlands)

    2007-11-15

    The unpredictability and variability of wind power increasingly challenges real-time balancing of supply and demand in electric power systems. In liberalised markets, balancing is a responsibility jointly held by the TSO (real-time power balancing) and PRPs (energy programs). In this paper, a procedure is developed for the simulation of power system balancing and the assessment of AGC performance in the presence of large-scale wind power, using the Dutch control zone as a case study. The simulation results show that the performance of existing AGC-mechanisms is adequate for keeping ACE within acceptable bounds. At higher wind power penetrations, however, the capabilities of the generation mix are increasingly challenged and additional reserves are required at the same level. (au)

  13. Addendum to ''Test Plan: Small-Scale Seal Performance Tests (SSSPT)''

    International Nuclear Information System (INIS)

    Finley, R.E.

    1992-01-01

    This document describes activities that are intended to update the data base of fluid flow measurements made on expansive salt concrete (ESC) seals as part of the Small-Scale Seal Performance Tests (SSSPT). The original plans for the SSSPT experiments are described by Stormont (1985a and 1985b). These seals have previously been tested with brine and gas during the early stages (less than 450 days) after emplacement. The purpose of this Test Plan Addendum is to detail the activities necessary to, update the gas and brine measurements previously performed on the SSSPT Series A and Series B seals and to identify the key personnel responsible for implementing these activities. This addendum describes a limited undertaking and does NOT change the scope of the original test plan

  14. Measurement properties, feasibility and clinical utility of the Doloplus-2 pain scale in older adults with cognitive impairment: a systematic review.

    Science.gov (United States)

    Rostad, Hanne Marie; Utne, Inger; Grov, Ellen Karine; Puts, Martine; Halvorsrud, Liv

    2017-11-02

    The Doloplus-2 is a pain assessment scale for assessing pain in older adults with cognitive impairment. It is used in clinical practice and research. However, evidence for its measurement properties, feasibility and clinical utility remain incomplete. This systematic review synthesizes previous research on the measurement properties, feasibility and clinical utility of the scale. We conducted a systematic search in three databases (CINAHL, Medline and PsycINFO) for studies published in English, French, German, Dutch/Flemish or a Scandinavian language between 1990 and April 2017. We also reviewed the Doloplus-2 homepage and reference lists of included studies to supplement our search. Two reviewers independently reviewed titles and abstracts and performed the quality assessment and data abstraction. A total of 24 studies were included in this systematic review. The quality of the studies varied, but many lacked sufficient detail about the samples and response rates. The Doloplus-2 has been studied using diverse samples in a variety of settings; most study participants were in long-term care and in people with dementia. Sixteen studies addressed various aspects of the scale's feasibility and clinical utility, but their results are limited and inconsistent across settings and samples. Support for the scale's reliability, validity and responsiveness varied widely across the studies. Generally, the reliability coefficients reached acceptable benchmarks, but the evidence for different aspects of the scale's validity and responsiveness was incomplete. Additional high-quality studies are warranted to determine in which populations of older adults with cognitive impairment the Doloplus-2 is reliable, valid and feasible. The ability of the Doloplus-2 to meaningfully quantify pain, measure treatment response and improve patient outcomes also needs further investigation. PROSPERO reg. no.: CRD42016049697 registered 20. Oct. 2016.

  15. Assessing emotional status following acquired brain injury: the clinical potential of the depression, anxiety and stress scales.

    Science.gov (United States)

    Ownsworth, Tamara; Little, Trudi; Turner, Ben; Hawkes, Anna; Shum, David

    2008-10-01

    To investigate the clinical potential of the Depression, Anxiety and Stress Scales (DASS 42) and its shorter version (DASS 21) for assessing emotional status following acquired brain injury. Participants included 23 individuals with traumatic brain injury (TBI), 25 individuals with brain tumour and 29 non-clinical controls. Investigations of internal consistency, test-re-test reliability, theory-consistent differences, sensitivity to change and concurrent validity were conducted. Internal consistency of the DASS was generally acceptable (r > 0.70), with the exception of the anxiety scale for the TBI sample. Test-re-test reliability (1-3 weeks) was sound for the depression scale (r > 0.75) and significant but comparatively lower for other scales (r = 0.60-0.73, p scale (p DASS in the context of hospital discharge was demonstrated for depression and stress (p 0.05). Concurrent validity with the Hospital Anxiety and Depression Scale was significant for all scales of the DASS (p DASS following ABI, further research examining the factor structure of existing and modified versions of the DASS is recommended.

  16. Performance of the Visual Analogue Scale of Happiness and of the Cornell Scale for Depression in Dementia in the Tremembé Epidemiological Study, Brazil

    Directory of Open Access Journals (Sweden)

    Karolina G. César

    Full Text Available Depression is a major growing public health problem. Many population studies have found a significant relationship between depression and the presence of cognitive disorders. OBJECTIVE: To establish the correlation between the Visual Analogue Scale of Happiness and the Cornell Scale for Depression in Dementia in the population aged 60 years or over in the city of Tremembé, state of São Paulo, Brazil. METHODS: An epidemiological survey involving home visits was carried out in the city of Tremembé. The sample was randomly selected by drawing 20% of the population aged 60 years or older from each of the city's census sectors. In this single-phase study, the assessment included clinical history, physical and neurological examination, cognitive evaluation, and application of both the Cornell Scale and the Analogue Scale of Happiness for psychiatric symptoms. The presence of depressive symptoms was defined as scores greater than or equal to 8 points on the Cornell Scale. RESULTS: A total of 623 subjects were evaluated and of these 251 (40.3% had clinically significant depressive symptoms on the Cornell Scale, with a significant association with female gender (p<0.001 and with lower education (p=0.012. One hundred and thirty-six participants (21.8% chose the unhappiness faces, with a significant association with age (p<0.001, female gender (p=0.020 and low socioeconomic status (p=0.012. Although there was a statistically significant association on the correlation test, the correlation was not high (rho=0.47. CONCLUSION: The prevalence of depressive symptoms was high in this sample and the Visual Analogue Scale of Happiness and Cornell Scale for Depression in Dementia should not be used as similar alternatives for evaluating the presence of depressive symptoms, at least in populations with low educational level.

  17. Embedded Sensors and Controls to Improve Component Performance and Reliability -- Loop-scale Testbed Design Report

    Energy Technology Data Exchange (ETDEWEB)

    Melin, Alexander M. [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States); Kisner, Roger A. [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States)

    2016-09-01

    Embedded instrumentation and control systems that can operate in extreme environments are challenging to design and operate. Extreme environments limit the options for sensors and actuators and degrade their performance. Because sensors and actuators are necessary for feedback control, these limitations mean that designing embedded instrumentation and control systems for the challenging environments of nuclear reactors requires advanced technical solutions that are not available commercially. This report details the development of testbed that will be used for cross-cutting embedded instrumentation and control research for nuclear power applications. This research is funded by the Department of Energy's Nuclear Energy Enabling Technology program's Advanced Sensors and Instrumentation topic. The design goal of the loop-scale testbed is to build a low temperature pump that utilizes magnetic bearing that will be incorporated into a water loop to test control system performance and self-sensing techniques. Specifically, this testbed will be used to analyze control system performance in response to nonlinear and cross-coupling fluid effects between the shaft axes of motion, rotordynamics and gyroscopic effects, and impeller disturbances. This testbed will also be used to characterize the performance losses when using self-sensing position measurement techniques. Active magnetic bearings are a technology that can reduce failures and maintenance costs in nuclear power plants. They are particularly relevant to liquid salt reactors that operate at high temperatures (700 C). Pumps used in the extreme environment of liquid salt reactors provide many engineering challenges that can be overcome with magnetic bearings and their associated embedded instrumentation and control. This report will give details of the mechanical design and electromagnetic design of the loop-scale embedded instrumentation and control testbed.

  18. Performance investigation of a lab–scale latent heat storage prototype – Numerical results

    International Nuclear Information System (INIS)

    Niyas, Hakeem; Prasad, Sunku; Muthukumar, P.

    2017-01-01

    Highlights: • Developed a numerical tool for analyzing a shell-and-tube LHS system. • Effective heat capacity method is used for incorporating the latent heat. • Number of heat transfer fluid tubes and fins are optimized. • Partial charging/discharging is efficient than complete charging/discharging. • Numerically predicted values match well with the experimental results. - Abstract: In the current study, numerical analysis of the charging and discharging characteristics of a lab-scale latent heat storage (LHS) prototype is presented. A mathematical model is developed to analyze the performance characteristics of the LHS prototype of shell and tube heat exchanger configuration. Effective heat capacity (EHC) method is implemented to consider the latent heat of the phase change material (PCM) and Boussinesq approximation is used to incorporate the buoyancy effect of the molten layer of the PCM in the model. For proper modeling of velocities in the PCM, Darcy law’s source term is added. The governing equations involved in the model are solved using a finite element based software product, COMSOL Multiphysics 4.3a. The number of embedded tubes and fins on the embedded tubes are optimized based on the discharging time of the model. Various performance parameters such as charging/discharging time, energy storage/discharge rate and melt fraction are evaluated. Numerically predicted temperature variations of the model during charging and discharging processes were compared with the experimental data extracted from the lab-scale LHS prototype and a good agreement was found between them.

  19. Environmental performance evaluation of large-scale municipal solid waste incinerators using data envelopment analysis

    International Nuclear Information System (INIS)

    Chen, H.-W.; Chang, N.-B.; Chen, J.-C.; Tsai, S.-J.

    2010-01-01

    Limited to insufficient land resources, incinerators are considered in many countries such as Japan and Germany as the major technology for a waste management scheme capable of dealing with the increasing demand for municipal and industrial solid waste treatment in urban regions. The evaluation of these municipal incinerators in terms of secondary pollution potential, cost-effectiveness, and operational efficiency has become a new focus in the highly interdisciplinary area of production economics, systems analysis, and waste management. This paper aims to demonstrate the application of data envelopment analysis (DEA) - a production economics tool - to evaluate performance-based efficiencies of 19 large-scale municipal incinerators in Taiwan with different operational conditions. A 4-year operational data set from 2002 to 2005 was collected in support of DEA modeling using Monte Carlo simulation to outline the possibility distributions of operational efficiency of these incinerators. Uncertainty analysis using the Monte Carlo simulation provides a balance between simplifications of our analysis and the soundness of capturing the essential random features that complicate solid waste management systems. To cope with future challenges, efforts in the DEA modeling, systems analysis, and prediction of the performance of large-scale municipal solid waste incinerators under normal operation and special conditions were directed toward generating a compromised assessment procedure. Our research findings will eventually lead to the identification of the optimal management strategies for promoting the quality of solid waste incineration, not only in Taiwan, but also elsewhere in the world.

  20. Environmental performance evaluation of large-scale municipal solid waste incinerators using data envelopment analysis.

    Science.gov (United States)

    Chen, Ho-Wen; Chang, Ni-Bin; Chen, Jeng-Chung; Tsai, Shu-Ju

    2010-07-01

    Limited to insufficient land resources, incinerators are considered in many countries such as Japan and Germany as the major technology for a waste management scheme capable of dealing with the increasing demand for municipal and industrial solid waste treatment in urban regions. The evaluation of these municipal incinerators in terms of secondary pollution potential, cost-effectiveness, and operational efficiency has become a new focus in the highly interdisciplinary area of production economics, systems analysis, and waste management. This paper aims to demonstrate the application of data envelopment analysis (DEA)--a production economics tool--to evaluate performance-based efficiencies of 19 large-scale municipal incinerators in Taiwan with different operational conditions. A 4-year operational data set from 2002 to 2005 was collected in support of DEA modeling using Monte Carlo simulation to outline the possibility distributions of operational efficiency of these incinerators. Uncertainty analysis using the Monte Carlo simulation provides a balance between simplifications of our analysis and the soundness of capturing the essential random features that complicate solid waste management systems. To cope with future challenges, efforts in the DEA modeling, systems analysis, and prediction of the performance of large-scale municipal solid waste incinerators under normal operation and special conditions were directed toward generating a compromised assessment procedure. Our research findings will eventually lead to the identification of the optimal management strategies for promoting the quality of solid waste incineration, not only in Taiwan, but also elsewhere in the world. Copyright (c) 2010 Elsevier Ltd. All rights reserved.

  1. Feasibility of a shorter Goal Attainment Scaling method for a pediatric spasticity clinic - The 3-milestones GAS.

    Science.gov (United States)

    Krasny-Pacini, A; Pauly, F; Hiebel, J; Godon, S; Isner-Horobeti, M-E; Chevignard, M

    2017-07-01

    Goal Attainment Scaling (GAS) is a method for writing personalized evaluation scales to quantify progress toward defined goals. It is useful in rehabilitation but is hampered by the experience required to adequately "predict" the possible outcomes relating to a particular goal before treatment and the time needed to describe all 5 levels of the scale. Here we aimed to investigate the feasibility of using GAS in a clinical setting of a pediatric spasticity clinic with a shorter method, the "3-milestones" GAS (goal setting with 3 levels and goal rating with the classical 5 levels). Secondary aims were to (1) analyze the types of goals children's therapists set for botulinum toxin treatment and (2) compare the score distribution (and therefore the ability to predict outcome) by goal type. Therapists were trained in GAS writing and prepared GAS scales in the regional spasticity-management clinic they attended with their patients and families. The study included all GAS scales written during a 2-year period. GAS score distribution across the 5 GAS levels was examined to assess whether the therapist could reliably predict outcome and whether the 3-milestones GAS yielded similar distributions as the original GAS method. In total, 541 GAS scales were written and showed the expected score distribution. Most scales (55%) referred to movement quality goals and fewer (29%) to family goals and activity domains. The 3-milestones GAS method was feasible within the time constraints of the spasticity clinic and could be used by local therapists in cooperation with the hospital team. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  2. Effect of the gate scaling on the analogue performance of s-Si CMOS devices

    International Nuclear Information System (INIS)

    Fobelets, K; Calvo-Gallego, J; Velázquez-Pérez, J E

    2011-01-01

    In this contribution, we present a detailed study of the analogue performance of deep submicron strained n-channel Si/SiGe (s-Si) MOSFETs. The study was carried out using a 2D device simulator based on the hydrodynamic model and the impedance field method to self-consistently obtain the current noise at the device's terminals. The analysis focused on the possible benefits of the gate scaling on the ac and noise performance of the transistor for low-power applications while keeping constant the oxide thickness equal to 2 nm to guarantee negligible level of the gate tunnel current. For a drain to source bias of 50 mV, it was found that a pure scaling of the transistor's gate length under 32 nm is detrimental for subthreshold operation in terms of the subthreshold slope (S) and transconductance (g m ) but would lead to reasonably low values of the minimum noise figure (NF min ). For the sake of comparison, SOI MOSFETs with the same layout and operating under the same conditions were simulated. The SOI MOSFETs showed better immunity against the gate scaling in terms of S than the s-Si MOSFETs, but lower values of g m and a higher value of NF min at the same level of the drain current. Finally, the devices have been studied in the saturation region for a drain to source bias of 1 V. In this region, it was found that the dependence of the current level SOI or s-Si MOSFET may outperform its counterparts

  3. The Convergence of High Performance Computing and Large Scale Data Analytics

    Science.gov (United States)

    Duffy, D.; Bowen, M. K.; Thompson, J. H.; Yang, C. P.; Hu, F.; Wills, B.

    2015-12-01

    As the combinations of remote sensing observations and model outputs have grown, scientists are increasingly burdened with both the necessity and complexity of large-scale data analysis. Scientists are increasingly applying traditional high performance computing (HPC) solutions to solve their "Big Data" problems. While this approach has the benefit of limiting data movement, the HPC system is not optimized to run analytics, which can create problems that permeate throughout the HPC environment. To solve these issues and to alleviate some of the strain on the HPC environment, the NASA Center for Climate Simulation (NCCS) has created the Advanced Data Analytics Platform (ADAPT), which combines both HPC and cloud technologies to create an agile system designed for analytics. Large, commonly used data sets are stored in this system in a write once/read many file system, such as Landsat, MODIS, MERRA, and NGA. High performance virtual machines are deployed and scaled according to the individual scientist's requirements specifically for data analysis. On the software side, the NCCS and GMU are working with emerging commercial technologies and applying them to structured, binary scientific data in order to expose the data in new ways. Native NetCDF data is being stored within a Hadoop Distributed File System (HDFS) enabling storage-proximal processing through MapReduce while continuing to provide accessibility of the data to traditional applications. Once the data is stored within HDFS, an additional indexing scheme is built on top of the data and placed into a relational database. This spatiotemporal index enables extremely fast mappings of queries to data locations to dramatically speed up analytics. These are some of the first steps toward a single unified platform that optimizes for both HPC and large-scale data analysis, and this presentation will elucidate the resulting and necessary exascale architectures required for future systems.

  4. Is there a correlation between physicians' clinical impressions and patients' perceptions of change? Use of the Perceived Change Scale with inpatients with mental disorders

    Directory of Open Access Journals (Sweden)

    Gabriela Pavan

    Full Text Available Abstract Introduction: Assessment of the results of treatment for mental disorders becomes more complete when the patient's perspective is incorporated. Here, we aimed to evaluate the psychometric properties and application of the Perceived Change Scale - Patient version (PCS-P in a sample of inpatients with mental disorders. Methods: One hundred and ninety-one psychiatric inpatients answered the PCS-P and the Patients' Satisfaction with Mental Health Services Scale (SATIS and were evaluated in terms of clinical and sociodemographic data. An exploratory factor analysis (EFA was performed and internal consistency was calculated. The clinical impressions of the patient, family, and physician were correlated with the patient's perception of change. Results: The EFA indicated a psychometrically suitable four-factor solution. The PCS-P exhibited a coherent relationship with SATIS and had a Cronbach's alpha value of 0.856. No correlations were found between the physician's clinical global impression of improvement and the patient's perception of change, although a moderate positive correlation was found between the patients' clinical global impression of improvement and the change perceived by the patient. Conclusions: The PCS-P exhibited adequate psychometric proprieties in a sample of inpatients with mental disorders. The patient's perception of change is an important dimension for evaluation of outcomes in the treatment of mental disorders and differs from the physician's clinical impression of improvement. Evaluation of positive and negative perceptions of the various dimensions of the patient's life enables more precise consideration of the patient's priorities and interests.

  5. Correlating optical bench performance with clinical defocus curves in varifocal and trifocal intraocular lenses.

    Science.gov (United States)

    Plaza-Puche, Ana B; Alió, Jorge L; MacRae, Scott; Zheleznyak, Len; Sala, Esperanza; Yoon, Geunyoung

    2015-05-01

    To investigate the correlations existing between a trifocal intraocular lens (IOL) and a varifocal IOL using the "ex vivo" optical bench through-focus image quality analysis and the clinical visual performance in real patients by study of the defocus curves. This prospective, consecutive, nonrandomized, comparative study included a total of 64 eyes of 42 patients. Three groups of eyes were differentiated according to the IOL implanted: 22 eyes implanted with the varifocal Lentis Mplus LS-313 IOL (Oculentis GmbH, Berlin, Germany); 22 eyes implanted with the trifocal FineVision IOL (Physiol, Liege, Belgium), and 20 eyes implanted with the monofocal Acrysof SA60AT IOL (Alcon Laboratories, Inc., Fort Worth, TX). Visual outcomes and defocus curve were evaluated postoperatively. Optical bench through-focus performance was quantified by computing an image quality metric and the cross-correlation coefficient between an unaberrated reference image and captured retinal images from a model eye with a 3.0-mm artificial pupil. Statistically significant differences among defocus curves of different IOLs were detected for the levels of defocus from -4.00 to -1.00 diopters (D) (P < .01). Significant correlations were found between the optical bench image quality metric results and logMAR visual acuity scale in all groups (Lentis Mplus group: r = -0.97, P < .01; FineVision group: r = -0.82, P < .01; Acrys of group: r = -0.99, P < .01). Linear predicting models were obtained. Significant correlations were found between logMAR visual acuity and image quality metric for the multifocal and monofocal IOLs analyzed. This finding enables surgeons to predict visual outcomes from the optical bench analysis. Copyright 2015, SLACK Incorporated.

  6. Symptoms of anxiety in depression: assessment of item performance of the Hamilton Anxiety Rating Scale in patients with depression.

    Science.gov (United States)

    Vaccarino, Anthony L; Evans, Kenneth R; Sills, Terrence L; Kalali, Amir H

    2008-01-01

    Although diagnostically dissociable, anxiety is strongly co-morbid with depression. To examine further the clinical symptoms of anxiety in major depressive disorder (MDD), a non-parametric item response analysis on "blinded" data from four pharmaceutical company clinical trials was performed on the Hamilton Anxiety Rating Scale (HAMA) across levels of depressive severity. The severity of depressive symptoms was assessed using the 17-item Hamilton Depression Rating Scale (HAMD). HAMA and HAMD measures were supplied for each patient on each of two post-screen visits (n=1,668 observations). Option characteristic curves were generated for all 14 HAMA items to determine the probability of scoring a particular option on the HAMA in relation to the total HAMD score. Additional analyses were conducted using Pearson's product-moment correlations. Results showed that anxiety-related symptomatology generally increased as a function of overall depressive severity, though there were clear differences between individual anxiety symptoms in their relationship with depressive severity. In particular, anxious mood, tension, insomnia, difficulties in concentration and memory, and depressed mood were found to discriminate over the full range of HAMD scores, increasing continuously with increases in depressive severity. By contrast, many somatic-related symptoms, including muscular, sensory, cardiovascular, respiratory, gastro-intestinal, and genito-urinary were manifested primarily at higher levels of depression and did not discriminate well at lower HAMD scores. These results demonstrate anxiety as a core feature of depression, and the relationship between anxiety-related symptoms and depression should be considered in the assessment of depression and evaluation of treatment strategies and outcome.

  7. High performance Spark best practices for scaling and optimizing Apache Spark

    CERN Document Server

    Karau, Holden

    2017-01-01

    Apache Spark is amazing when everything clicks. But if you haven’t seen the performance improvements you expected, or still don’t feel confident enough to use Spark in production, this practical book is for you. Authors Holden Karau and Rachel Warren demonstrate performance optimizations to help your Spark queries run faster and handle larger data sizes, while using fewer resources. Ideal for software engineers, data engineers, developers, and system administrators working with large-scale data applications, this book describes techniques that can reduce data infrastructure costs and developer hours. Not only will you gain a more comprehensive understanding of Spark, you’ll also learn how to make it sing. With this book, you’ll explore: How Spark SQL’s new interfaces improve performance over SQL’s RDD data structure The choice between data joins in Core Spark and Spark SQL Techniques for getting the most out of standard RDD transformations How to work around performance issues i...

  8. CBCL Clinical Scales Discriminate ADHD Youth with Structured-Interview Derived Diagnosis of Oppositional Defiant Disorder (ODD)

    Science.gov (United States)

    Biederman, Joseph; Ball, Sarah W.; Monuteaux, Michael C.; Kaiser, Roselinde; Faraone, Stephen V.

    2008-01-01

    Objective: To evaluate the association between the clinical scales of the child behavior checklist (CBCL) and the comorbid diagnosis of oppositional defiant disorder (ODD) in a large sample of youth with attention deficit hyperactivity disorder (ADHD). Method: The sample consisted of 101 girls and 106 boys ages 6 to 17 with ADHD. Conditional…

  9. An analysis of correlations among four outcome scales employed in clinical trials of patients with major depressive disorder

    Directory of Open Access Journals (Sweden)

    Ahmed Saeeduddin

    2009-01-01

    Full Text Available Abstract Background The 17-item Hamilton Depression Rating Scale (HAM-D17 remains the 'gold standard' for measuring treatment outcomes in clinical trials of depressed patients. The Montgomery Ǻsberg Depression Rating Scale (MADRS, Clinical Global Impressions-Severity (CGI-S and -Improvement (CGI-I scales are also widely used. Objective This analysis of data from 22 double-blind, placebo-controlled clinical studies of venlafaxine in adult patients with major depressive disorder was aimed at assessing correlations among these 4 scales. Methods Changes from baseline for MADRS, HAM-D17 and CGI-S, and end point CGI-I scores and response (≥50% decrease from baseline HAM-D17 or MADRS, or CGI-S or CGI-I score ≤2 were analysed. Pearson correlation coefficients were calculated for all pairs of the four scales (HAM-D17/MADRS, HAM-D17/CGI-S, HAM-D17/CGI-I, MADRS/CGI-S, MADRS/CGI-I, CGI-S/CGI-I at different time points. Effect sizes were calculated using the Cohen d. Results Correlations were significant at all time points (p 17 or CGI-S for continuous measures and response. Conclusion Although MADRS and CGI-I were more sensitive to treatment effects, HAM-D17, MADRS, CGI-S and CGI-I scores present a consistent picture of response to venlafaxine treatment.

  10. Admission interview scores are associated with clinical performance in an undergraduate physiotherapy course: an observational study.

    Science.gov (United States)

    Edgar, Susan; Mercer, Annette; Hamer, Peter

    2014-12-01

    The purpose of this study was to determine if there is an association between admission interview score and subsequent academic and clinical performance, in a four-year undergraduate physiotherapy course. Retrospective observational study. 141 physiotherapy students enrolled in two entry year groups. Individual student performance in all course units, practical examinations, clinical placements as well as year level and overall Grade Point Average. Predictor variables included admission interview scores, admission academic scores and demographic data (gender, age and entry level). Interview score demonstrated a significant association with performance in three of six clinical placements through the course. This association was stronger than for any other admission criterion although effect sizes were small to moderate. Further, it was the only admission score to have a significant association with overall Clinical Grade Point Average for the two year groups analysed (r=0.322). By contrast, academic scores on entry showed significant associations with all year level Grade Point Averages except Year 4, the clinical year. This is the first study to review the predictive validity of an admission interview for entry into a physiotherapy course in Australia. The results show that performance in this admission interview is associated with overall performance in clinical placements through the course, while academic admission scoring is not. These findings suggest that there is a role for both academic and non-academic selection processes for entry into physiotherapy. Copyright © 2014 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.

  11. High-Performance Monitoring Architecture for Large-Scale Distributed Systems Using Event Filtering

    Science.gov (United States)

    Maly, K.

    1998-01-01

    Monitoring is an essential process to observe and improve the reliability and the performance of large-scale distributed (LSD) systems. In an LSD environment, a large number of events is generated by the system components during its execution or interaction with external objects (e.g. users or processes). Monitoring such events is necessary for observing the run-time behavior of LSD systems and providing status information required for debugging, tuning and managing such applications. However, correlated events are generated concurrently and could be distributed in various locations in the applications environment which complicates the management decisions process and thereby makes monitoring LSD systems an intricate task. We propose a scalable high-performance monitoring architecture for LSD systems to detect and classify interesting local and global events and disseminate the monitoring information to the corresponding end- points management applications such as debugging and reactive control tools to improve the application performance and reliability. A large volume of events may be generated due to the extensive demands of the monitoring applications and the high interaction of LSD systems. The monitoring architecture employs a high-performance event filtering mechanism to efficiently process the large volume of event traffic generated by LSD systems and minimize the intrusiveness of the monitoring process by reducing the event traffic flow in the system and distributing the monitoring computation. Our architecture also supports dynamic and flexible reconfiguration of the monitoring mechanism via its Instrumentation and subscription components. As a case study, we show how our monitoring architecture can be utilized to improve the reliability and the performance of the Interactive Remote Instruction (IRI) system which is a large-scale distributed system for collaborative distance learning. The filtering mechanism represents an Intrinsic component integrated

  12. PERFORMANCE DETERIORATION OF THERMOSIPHON SOLAR FLAT PLATE WATER HEATER DUE TO SCALING

    Directory of Open Access Journals (Sweden)

    arunachala umesh chandavar

    2011-12-01

    Full Text Available 0 0 1 340 1943 International Islamic University 16 4 2279 14.0 Normal 0 false false false EN-US JA X-NONE /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin:0cm; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Times New Roman";} The performance of Flat plate Solar Water Heater deteriorates within five to twelve years of their installation due to factors related to manufacturing, operating conditions, lack of maintenance etc. Especially, problem due to scaling is significant as it is based on quality of water used. The remaining factors are system dependent and could be overcome by quality production. Software is developed by incorporating Hottel Whillier Bliss (H-W-B equation to ascertain the effect of scaling on system efficiency in case of thermosiphon system. In case of clean thermosiphon system, the instantaneous efficiency calculated at 1000 W/m2 radiation is 72 % and it drops to 46 % for 3.7 mm scale thickness. The mass flow rate is reduced by 90 % for 3.7 mm scale thickness. Whereas, the average temperature drop of water in the tank is not critical due to considerable heat content in water under severe scaled condition.  But practically in case of major scale growth, some of the risers are likely to get blocked completely which leads to negligible temperature rise in the tank. ABSTRAK: Prestasi plat rata pemanas air suria merosot selepas lima hingga dua belas tahun  pemasangannya disebabkan faktor-faktor yang berkaitan dengan pembuatannya, cara kendaliannya, kurangnya penyelenggaraan dan sebagainya.  Terutama sekali, masalah disebabkan scaling (tembunan endapan mineral perlu diambil berat kerana ianya bergantung kepada kualiti air yang digunakan. Faktor-faktor selebihya bersandarkan sistem dan ia

  13. Performance of a pilot-scale, steam-blown, pressurized fluidized bed biomass gasifier

    Science.gov (United States)

    Sweeney, Daniel Joseph

    With the discovery of vast fossil resources, and the subsequent development of the fossil fuel and petrochemical industry, the role of biomass-based products has declined. However, concerns about the finite and decreasing amount of fossil and mineral resources, in addition to health and climate impacts of fossil resource use, have elevated interest in innovative methods for converting renewable biomass resources into products that fit our modern lifestyle. Thermal conversion through gasification is an appealing method for utilizing biomass due to its operability using a wide variety of feedstocks at a wide range of scales, the product has a variety of uses (e.g., transportation fuel production, electricity production, chemicals synthesis), and in many cases, results in significantly lower greenhouse gas emissions. In spite of the advantages of gasification, several technical hurdles have hindered its commercial development. A number of studies have focused on laboratory-scale and atmospheric biomass gasification. However, few studies have reported on pilot-scale, woody biomass gasification under pressurized conditions. The purpose of this research is an assessment of the performance of a pilot-scale, steam-blown, pressurized fluidized bed biomass gasifier. The 200 kWth fluidized bed gasifier is capable of operation using solid feedstocks at feedrates up to 65 lb/hr, bed temperatures up to 1600°F, and pressures up to 8 atm. Gasifier performance was assessed under various temperatures, pressure, and feedstock (untreated woody biomass, dark and medium torrefied biomass) conditions by measuring product gas yield and composition, residue (e.g., tar and char) production, and mass and energy conversion efficiencies. Elevated temperature and pressure, and feedstock pretreatment were shown to have a significant influence on gasifier operability, tar production, carbon conversion, and process efficiency. High-pressure and temperature gasification of dark torrefied biomass

  14. Clinical scale preparation and evaluation of {sup 131}I-Rituximab for Non-Hodgkin's lymphoma

    Energy Technology Data Exchange (ETDEWEB)

    Kameswaran, Mythili; Vimalnath, K. Viswanathan; Rajeswari, Ardhi; Joshi, Prahlad Vasudeo; Samuel, Grace [Bhabha Atomic Research Centre, Mumbai (India). Radiopharmaceuticals Div.; Sarma, H.D. [Bhabha Atomic Research Centre, Mumbai (India). Radiation Biology and Health Sciences Div.

    2014-09-01

    Radioimmunotherapy (RIT) with anti CD20 MoAb conjugated to a β{sup -} emitting radioisotope like {sup 131}I or {sup 90}Y has the added advantage of delivering radiation not only to tumor cells that bind the antibody but also due to a crossfire effect, to neighboring tumor cells inaccessible to the antibody. In order to make available an indigenous radioimmunotherapeutic agent for Non Hodgkin's Lymphoma (NHL), radioiodinated Rituximab has been prepared and evaluated at a clinical scale. Radioiodination of Rituximab was performed by the conventional Chloramine T method using 7.4 GBq Na{sup 131}I in a lead shielded plant. Six batches of radioiodination were prepared and characterized by electrophoresis and HPLC to evaluate the reproducibility of the product. The product remained stable retaining the radiochemical purity > 95% upto 5 days after radioiodination. In vitro cell binding studies and biodistribution studies in normal Swiss mice have indicated the potential of this molecule as a radioimmunotherapeutic agent for NHL. (orig.)

  15. The Mentalization-Based Therapy Adherence and Quality Scale (MBT-AQS): Reliability in a clinical setting

    DEFF Research Database (Denmark)

    Simonsen, Sebastian; Juul, Sophie; Kongerslev, Mickey

    2018-01-01

    The Mentalization-Based Treatment Adherence and Quality Scale (MBT-AQS) is a 17-item measure of treatment adherence and quality of individual mentalization-based therapy (MBT). Until now, reliability research on the scale has primarily been conducted by highly experienced raters from the Norwegian...... MBT therapists in a clinical setting following a brief one-day training course. The overall reliabilities for six raters were good for adherence (.67) and for quality (.62). Thus, the MBT-AQS was found to be an appropriate MBT adherence rating instrument with clinical and educational utility outside...... MBT Quality Lab who were part of its development. Hence, it can be questioned whether only experts in research settings can achieve satisfying levels of reliability on the scale. In this study, we investigated whether a satisfying level of reliability on the MBT-AQS could be obtained by experienced...

  16. Mapping the MMPI-2/MMPI-2-RF Restructured Clinical Scales Onto Mood Markers in an Israeli Sample.

    Science.gov (United States)

    Shkalim, Eleanor; Ben-Porath, Yossef S; Almagor, Moshe

    2016-01-01

    This study cross-culturally evaluated the Minnesota Multiphasic Personality Inventory-2/MMPI-2 Restructured Form (MMPI-2/MMPI-2-RF) emotion-focused Restructured Clinical (RC) Scales to examine whether their patterns of associations with positive affect (PA) and negative affect (NA) are as expected based on Tellegen, Watson, and Clark's ( 1999a , 1999b ) mood model. The sample was composed of 100 men and 133 women from psychiatric settings in Israel who completed the MMPI-2 and the Mood Check List (MCL; Zevon & Tellegen, 1982 ). Results indicated that RCd was substantially correlated with both PA and NA in opposite directions, and that RC2 and RC7 were more highly correlated with PA and NA, respectively. Further, when compared with their Clinical Scale counterparts, RC2 and RC7 exhibited comparable convergent validities and improved discriminant properties. Findings provide support for Tellegen et al.'s ( 2003 ) goal to link the RC scales to contemporary conceptualizations of mood.

  17. Cardiovascular performance of adult breeding sows fails to obey allometric scaling laws.

    Science.gov (United States)

    van Essen, G J; Vernooij, J C M; Heesterbeek, J A P; Anjema, D; Merkus, D; Duncker, D J

    2011-02-01

    In view of the remarkable decrease of the relative heart weight (HW) and the relative blood volume in growing pigs, we investigated whether HW, cardiac output (CO), and stroke volume (SV) of modern growing pigs are proportional to BW, as predicted by allometric scaling laws: HW (or CO or SV) = a·BW(b), in which a and b are constants, and constant b is a multiple of 0.25 (quarter-power scaling law). Specifically, we tested the hypothesis that both HW and CO scale with BW to the power of 0.75 (HW or CO = a·BW(0.75)) and SV scales with BW to the power of 1.00 (SV = a·BW(1.0)). For this purpose, 2 groups of pigs (group 1, consisting of 157 pigs of 50 ± 1 kg; group 2, consisting of 45 pigs of 268 ± 18 kg) were surgically instrumented with a flow probe or a thermodilution dilution catheter, under open-chest anesthetized conditions to measure CO and SV, after which HW was determined. The 95% confidence intervals of power-coefficient b for HW were 0.74 to 0.80, encompassing the predicted value of 0.75, suggesting that HW increased proportionally with BW, as predicted by the allometric scaling laws. In contrast, the 95% confidence intervals of power-coefficient b for CO and SV as measured with flow probes were 0.40 to 0.56 and 0.39 to 0.61, respectively, and values obtained with the thermodilution technique were 0.34 to 0.53 and 0.40 to 0.62, respectively. Thus, the 95% confidence limits failed to encompass the predicted values of b for CO and SV of 0.75 and 1.0, respectively. In conclusion, although adult breeding sows display normal heart growth, cardiac performance appears to be disproportionately low for BW. This raises concern regarding the health status of adult breeding sows.

  18. Are estimates of meaningful decline in mobility performance consistent among clinically important subgroups? (Health ABC Study).

    NARCIS (Netherlands)

    Perera, S.; Studenski, S.; Newman, A.; Simonsick, E.; Harris, T.; Schwartz, A.; Visser, M.

    2014-01-01

    Background: Meaningful change criteria help determine if function has improved or declined, but their magnitudes may vary across clinically relevant subgroups. We estimate meaningful decline in four common measures of physical performance in subgroups of older adults based on initial performance,

  19. Evaluation of Factors Affecting Continuous Performance Test Identical Pairs Version Score of Schizophrenic Patients in a Japanese Clinical Sample

    Directory of Open Access Journals (Sweden)

    Takayoshi Koide

    2012-01-01

    Full Text Available Aim. Cognitive impairment in schizophrenia strongly relates to social outcome and is a good candidate for endophenotypes. When we accurately measure drug efficacy or effects of genes or variants relevant to schizophrenia on cognitive impairment, clinical factors that can affect scores on cognitive tests, such as age and severity of symptoms, should be considered. To elucidate the effect of clinical factors, we conducted multiple regression analysis using scores of the Continuous Performance Test Identical Pairs Version (CPT-IP, which is often used to measure attention/vigilance in schizophrenia. Methods. We conducted the CPT-IP (4-4 digit and examined clinical information (sex, age, education years, onset age, duration of illness, chlorpromazine-equivalent dose, and Positive and Negative Symptom Scale (PANSS scores in 126 schizophrenia patients in Japanese population. Multiple regression analysis was used to evaluate the effect of clinical factors. Results. Age, chlorpromazine-equivalent dose, and PANSS-negative symptom score were associated with mean d′ score in patients. These three clinical factors explained about 28% of the variance in mean d′ score. Conclusions. As conclusion, CPT-IP score in schizophrenia patients is influenced by age, chlorpromazine-equivalent dose and PANSS negative symptom score.

  20. Minimum clinically important difference in lumbar spine surgery patients: a choice of methods using the Oswestry Disability Index, Medical Outcomes Study questionnaire Short Form 36, and pain scales.

    Science.gov (United States)

    Copay, Anne G; Glassman, Steven D; Subach, Brian R; Berven, Sigurd; Schuler, Thomas C; Carreon, Leah Y

    2008-01-01

    The impact of lumbar spinal surgery is commonly evaluated with three patient-reported outcome measures: Oswestry Disability Index (ODI), the physical component summary (PCS) of the Short Form of the Medical Outcomes Study (SF-36), and pain scales. A minimum clinically important difference (MCID) is a threshold used to measure the effect of clinical treatments. Variable threshold values have been proposed as MCID for those instruments despite a lack of agreement on the optimal MCID calculation method. This study has three purposes. First, to illustrate the range of values obtained by common anchor-based and distribution-based methods to calculate MCID. Second, to determine a statistically sound and clinically meaningful MCID for ODI, PCS, back pain scale, and leg pain scale in lumbar spine surgery patients. Third, to compare the discriminative ability of two anchors: a global health assessment and a rating of satisfaction with the results of the surgery. This study is a review of prospectively collected patient-reported outcomes data. A total of 454 patients from a large database of surgeries performed by the Lumbar Spine Study Group with a 1-year follow-up on either ODI or PCS were included in the study. Preoperative and 1-year postoperative scores for ODI, PCS, back pain scale, leg pain scale, health transition item (HTI) of the SF-36, and Satisfaction with Results scales. ODI, SF-36, and pain scales were administered before and 1 year after spinal surgery. Several candidate MCID calculation methods were applied to the data and the resulting values were compared. The HTI of the SF-36 was used as the anchor and compared with a second anchor (Satisfaction with Results scale). Potential MCID calculations yielded a range of values: fivefold for ODI, PCS, and leg pain, 10-fold for back pain. Threshold values obtained with the two anchors were very similar. The minimum detectable change (MDC) appears as a statistically and clinically appropriate MCID value. MCID values

  1. A Psychometric Comparison of the Clinical Assessment Interview for Negative Symptoms and the Brief Negative Symptom Scale.

    Science.gov (United States)

    Strauss, Gregory P; Gold, James M

    2016-11-01

    In 2005, the National Institute of Mental Health held a consensus development conference on negative symptoms of schizophrenia. Among the important conclusions of this meeting were that there are at least 5 commonly accepted domains of negative symptoms (blunted affect, alogia, avolition, anhedonia, asociality) and that new rating scales were needed to adequately assess these constructs. Two next-generation negative symptom scales resulted from this meeting: the Brief Negative Symptom Scale (BNSS) and Clinical Assessment Interview for Negative Symptoms (CAINS). Both measures are becoming widely used and studies have demonstrated good psychometric properties for each scale. The current study provides the first direct psychometric comparison of these scales. Participants included 65 outpatients diagnosed with schizophrenia or schizoaffective disorder who completed clinical interviews, questionnaires, and neuropsychological testing. Separate raters completed the BNSS and CAINS within the same week. Results indicated that both measures had good internal consistency, convergent validity, and discriminant validity. High correspondence was observed between CAINS and BNSS blunted affect and alogia items. Moderate convergence occurred for avolition and asociality items, and low convergence was seen among anhedonia items. Findings suggest that both scales have good psychometric properties, but that there are important distinctions among the items related to motivation and pleasure. © The Author 2016. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center. All rights reserved. For permissions, please email: journals.permissions@oup.com.

  2. Symptom assessment in early psychosis: The use of well-established rating scales in clinical high-risk and recent-onset populations

    OpenAIRE

    Fulford, Daniel; Pearson, Rahel; Stuart, Barbara K.; Fisher, Melissa; Mathalon, Daniel H.; Vinogradov, Sophia; Loewy, Rachel L.

    2014-01-01

    Symptom assessment in early psychosis research typically relies on scales validated in chronic schizophrenia samples. Our goal was to inform investigators who are selecting symptom scales for early psychosis research. We described measure characteristics, baseline scores, and scale inter-relationships in clinical high-risk (CHR) and recent-onset psychotic disorder (RO) samples using the Positive and Negative Syndrome Scale, Brief Psychiatric Rating Scale, Scale for the Assessment of Positive ...

  3. Scale-up, retention and HIV/STI prevalence trends among female sex workers attending VICITS clinics in Guatemala.

    Directory of Open Access Journals (Sweden)

    Sonia Morales-Miranda

    Full Text Available Since 2007, Guatemala integrated STI clinical service with an HIV prevention model into four existing public health clinics to prevent HIV infection, known as the VICITS strategy. We present the first assessment of VICITS scale-up, retention, HIV and STI prevalence trends, and risk factors associated with HIV infection among Female Sex Workers (FSW attending VICITS clinics in Guatemala.Demographic, behavioral and clinical data were collected using a standardized form. Data was analyzed by year and health center. HIV and STI prevalence were estimated from routine visits. Retention was estimated as the percent of new users attending VICITS clinics who returned for at least one follow-up visit to any VICITS clinic within 12 months. Separate multivariate logistic regression models were conducted to investigate factors associated with HIV infection and program retention.During 2007-2011 5,682 FSW visited a VICITS clinic for the first-time. HIV prevalence varied from 0.4% to 5.8%, and chlamydia prevalence from 0% to 14.3%, across sites. Attending the Puerto Barrios clinic, having a current syphilis infection, working primarily on the street, and using the telephone or internet to contact clients were associated with HIV infection. The number of FSW accessing VICITS annually increased from 556 to 2,557 (361% during the period. In 2011 retention varied across locations from 7.7% to 42.7%. Factors negatively impacting retention included current HIV diagnosis, having practiced sex work in another country, being born in Honduras, and attending Marco Antonio Foundation or Quetzaltenango clinic sites. Systematic time trends did not emerge, however 2008 and 2010 were characterized by reduced retention.Our data show local differences in HIV prevalence and clinic attendance that can be used to prioritize prevention activities targeting FSW in Guatemala. VICITS achieved rapid scale-up; however, a better understanding of the causes of low return rates is urgently

  4. Scale-up, retention and HIV/STI prevalence trends among female sex workers attending VICITS clinics in Guatemala.

    Science.gov (United States)

    Morales-Miranda, Sonia; Jacobson, Jerry O; Loya-Montiel, Itzel; Mendizabal-Burastero, Ricardo; Galindo-Arandi, César; Flores, Carlos; Chen, Sanny Y

    2014-01-01

    Since 2007, Guatemala integrated STI clinical service with an HIV prevention model into four existing public health clinics to prevent HIV infection, known as the VICITS strategy. We present the first assessment of VICITS scale-up, retention, HIV and STI prevalence trends, and risk factors associated with HIV infection among Female Sex Workers (FSW) attending VICITS clinics in Guatemala. Demographic, behavioral and clinical data were collected using a standardized form. Data was analyzed by year and health center. HIV and STI prevalence were estimated from routine visits. Retention was estimated as the percent of new users attending VICITS clinics who returned for at least one follow-up visit to any VICITS clinic within 12 months. Separate multivariate logistic regression models were conducted to investigate factors associated with HIV infection and program retention. During 2007-2011 5,682 FSW visited a VICITS clinic for the first-time. HIV prevalence varied from 0.4% to 5.8%, and chlamydia prevalence from 0% to 14.3%, across sites. Attending the Puerto Barrios clinic, having a current syphilis infection, working primarily on the street, and using the telephone or internet to contact clients were associated with HIV infection. The number of FSW accessing VICITS annually increased from 556 to 2,557 (361%) during the period. In 2011 retention varied across locations from 7.7% to 42.7%. Factors negatively impacting retention included current HIV diagnosis, having practiced sex work in another country, being born in Honduras, and attending Marco Antonio Foundation or Quetzaltenango clinic sites. Systematic time trends did not emerge, however 2008 and 2010 were characterized by reduced retention. Our data show local differences in HIV prevalence and clinic attendance that can be used to prioritize prevention activities targeting FSW in Guatemala. VICITS achieved rapid scale-up; however, a better understanding of the causes of low return rates is urgently needed.

  5. Extreme Postnatal Scaling in Bat Feeding Performance: A View of Ecomorphology from Ontogenetic and Macroevolutionary Perspectives.

    Science.gov (United States)

    Santana, Sharlene E; Miller, Kimberly E

    2016-09-01

    Ecomorphology studies focus on understanding how anatomical and behavioral diversity result in differences in performance, ecology, and fitness. In mammals, the determinate growth of the skeleton entails that bite performance should change throughout ontogeny until the feeding apparatus attains its adult size and morphology. Then, interspecific differences in adult phenotypes are expected to drive food resource partitioning and patterns of lineage diversification. However, Formal tests of these predictions are lacking for the majority of mammal groups, and thus our understanding of mammalian ecomorphology remains incomplete. By focusing on a fundamental measure of feeding performance, bite force, and capitalizing on the extraordinary morphological and dietary diversity of bats, we discuss how the intersection of ontogenetic and macroevolutionary changes in feeding performance may impact ecological diversity in these mammals. We integrate data on cranial morphology and bite force gathered through longitudinal studies of captive animals and comparative studies of free-ranging individuals. We demonstrate that ontogenetic trajectories and evolutionary changes in bite force are highly dependent on changes in body and head size, and that bats exhibit dramatic, allometric increases in bite force during ontogeny. Interspecific variation in bite force is highly dependent on differences in cranial morphology and function, highlighting selection for ecological specialization. While more research is needed to determine how ontogenetic changes in size and bite force specifically impact food resource use and fitness in bats, interspecific diversity in cranial morphology and bite performance seem to closely match functional differences in diet. Altogether, these results suggest direct ecomorphological relationships at ontogenetic and macroevolutionary scales in bats. © The Author 2016. Published by Oxford University Press on behalf of the Society for Integrative and Comparative

  6. Outcome After Radiosurgery for Brain Metastases in Patients With Low Karnofsky Performance Scale (KPS) Scores

    International Nuclear Information System (INIS)

    Chernov, Mikhail F.; Nakaya, Kotaro; Izawa, Masahiro; Hayashi, Motohiro; Usuba, Yuki; Kato, Koichi; Muragaki, Yoshihiro; Iseki, Hiroshi; Hori, Tomokatsu; Takakura, Kintomo

    2007-01-01

    Purpose: The objective of this retrospective study was evaluation of the outcome after stereotactic radiosurgery (SRS) in patients with intracranial metastases and poor performance status. Methods and Materials: Forty consecutive patients with metastatic brain tumors and Karnofsky performance scale (KPS) scores ≤50 (mean, 43 ± 8; median, 40) treated with SRS were analyzed. Poor performance status was caused by presence of intracranial metastases in 28 cases (70%) and resulted from uncontrolled extracerebral disease in 12 (30%). Results: Survival after SRS varied from 3 days to 11.5 months (mean, 3.8 ± 2.9 months; median, 3.3 months). Survival probability constituted 0.50 ± 0.07 at 3 months and 0.20 ± 0.05 at 6 months posttreatment. Cause of low KPS score (p = 0.0173) and presence of distant metastases beside the brain (p = 0.0308) showed statistically significant associations with overall survival in multivariate Cox proportional hazards regression analysis. Median survival was 6.0 months if low KPS score was caused by cerebral disease and distant metastases in regions beyond the brain were absent, 3.3 months if low KPS score was caused by cerebral disease and distant metastases in regions beyond the brain were present, and 1.0 month if poor performance status resulted from extracerebral disease. Conclusions: Identification of the cause of low KPS score (cerebral vs. extracerebral) in patients with metastatic brain tumor(s) may be important for prediction of the outcome after radiosurgical treatment. If poor patient performance status without surgical indications is caused by intracranial tumor(s), SRS may be a reasonable treatment option

  7. EFRT M-12 Issue Resolution: Comparison of Filter Performance at PEP and CUF Scale

    Energy Technology Data Exchange (ETDEWEB)

    Daniel, Richard C.; Billing, Justin M.; Bontha, Jagannadha R.; Brown, Christopher F.; Eslinger, Paul W.; Hanson, Brady D.; Huckaby, James L.; Karri, Naveen K.; Kimura, Marcia L.; Kurath, Dean E.; Minette, Michael J.

    2009-08-13

    Pacific Northwest National Laboratory (PNNL) has been tasked by Bechtel National Inc. (BNI) on the River Protection Project-Hanford Tank Waste Treatment and Immobilization Plant (RPP-WTP) project to perform research and development activities to resolve technical issues identified for the Pretreatment Facility (PTF). The Pretreatment Engineering Platform (PEP) was designed and constructed and is to be operated as part of a plan to respond to issue M12, Undemonstrated Leaching Processes. The PEP is a 1/4.5-scale test platform designed to simulate the WTP pretreatment caustic leaching, oxidative leaching, ultrafiltration solids concentration, and slurry washing processes. The PEP replicates the WTP leaching processes using prototypic equipment and control strategies. The PEP also includes non-prototypic ancillary equipment to support the core processing. Two operating scenarios are currently being evaluated for the ultrafiltration process (UFP) and leaching operations. The first scenario has caustic leaching performed in the UFP-2 ultrafiltration feed vessels (i.e., vessel UFP-VSL-T02A in the PEP and vessels UFP-VSL-00002A and B in the WTP PTF). The second scenario has caustic leaching conducted in the UFP-1 ultrafiltration feed-preparation vessels (i.e., vessels UFP-VSL-T01A and B in the PEP; vessels UFP-VSL-00001A and B in the WTP PTF). In both scenarios, 19-M sodium hydroxide solution (NaOH, caustic) is added to the waste slurry in the vessels to leach solid aluminum compounds (e.g., gibbsite, boehmite). Caustic addition is followed by a heating step that uses direct injection of steam to accelerate the leach process. Following the caustic leach, the vessel contents are cooled using vessel cooling jackets and/or external heat exchangers. The main difference between the two scenarios is that for leaching in UFP1, the 19-M NaOH is added to un-concentrated waste slurry (3 to 8 wt% solids), while for leaching in UFP2, the slurry is concentrated to nominally 20 wt

  8. EFRT M-12 Issue Resolution: Comparison of Filter Performance at PEP and CUF Scale

    International Nuclear Information System (INIS)

    Daniel, Richard C.; Billing, Justin M.; Bontha, Jagannadha R.; Brown, Christopher F.; Eslinger, Paul W.; Hanson, Brady D.; Huckaby, James L.; Karri, Naveen K.; Kimura, Marcia L.; Kurath, Dean E.; Minette, Michael J.

    2009-01-01

    Pacific Northwest National Laboratory (PNNL) has been tasked by Bechtel National Inc. (BNI) on the River Protection Project-Hanford Tank Waste Treatment and Immobilization Plant (RPP-WTP) project to perform research and development activities to resolve technical issues identified for the Pretreatment Facility (PTF). The Pretreatment Engineering Platform (PEP) was designed and constructed and is to be operated as part of a plan to respond to issue M12, Undemonstrated Leaching Processes. The PEP is a 1/4.5-scale test platform designed to simulate the WTP pretreatment caustic leaching, oxidative leaching, ultrafiltration solids concentration, and slurry washing processes. The PEP replicates the WTP leaching processes using prototypic equipment and control strategies. The PEP also includes non-prototypic ancillary equipment to support the core processing. Two operating scenarios are currently being evaluated for the ultrafiltration process (UFP) and leaching operations. The first scenario has caustic leaching performed in the UFP-2 ultrafiltration feed vessels (i.e., vessel UFP-VSL-T02A in the PEP and vessels UFP-VSL-00002A and B in the WTP PTF). The second scenario has caustic leaching conducted in the UFP-1 ultrafiltration feed-preparation vessels (i.e., vessels UFP-VSL-T01A and B in the PEP; vessels UFP-VSL-00001A and B in the WTP PTF). In both scenarios, 19-M sodium hydroxide solution (NaOH, caustic) is added to the waste slurry in the vessels to leach solid aluminum compounds (e.g., gibbsite, boehmite). Caustic addition is followed by a heating step that uses direct injection of steam to accelerate the leach process. Following the caustic leach, the vessel contents are cooled using vessel cooling jackets and/or external heat exchangers. The main difference between the two scenarios is that for leaching in UFP1, the 19-M NaOH is added to un-concentrated waste slurry (3 to 8 wt% solids), while for leaching in UFP2, the slurry is concentrated to nominally 20 wt

  9. Comparative performance evaluation of full-scale anaerobic and aerobic wastewater treatment processes in Brazil.

    Science.gov (United States)

    von Sperling, M; Oliveira, S C

    2009-01-01

    This article evaluates and compares the actual behavior of 166 full-scale anaerobic and aerobic wastewater treatment plants in operation in Brazil, providing information on the performance of the processes in terms of the quality of the generated effluent and the removal efficiency achieved. The observed results of effluent concentrations and removal efficiencies of the constituents BOD, COD, TSS (total suspended solids), TN (total nitrogen), TP (total phosphorus) and FC (faecal or thermotolerant coliforms) have been compared with the typical expected performance reported in the literature. The treatment technologies selected for study were: (a) predominantly anaerobic: (i) septic tank + anaerobic filter (ST + AF), (ii) UASB reactor without post-treatment (UASB) and (iii) UASB reactor followed by several post-treatment processes (UASB + POST); (b) predominantly aerobic: (iv) facultative pond (FP), (v) anaerobic pond followed by facultative pond (AP + FP) and (vi) activated sludge (AS). The results, confirmed by statistical tests, showed that, in general, the best performance was achieved by AS, but closely followed by UASB reactor, when operating with any kind of post-treatment. The effluent quality of the anaerobic processes ST + AF and UASB reactor without post-treatment was very similar to the one presented by facultative pond, a simpler aerobic process, regarding organic matter.

  10. The effect of various parameters of large scale radio propagation models on improving performance mobile communications

    Science.gov (United States)

    Pinem, M.; Fauzi, R.

    2018-02-01

    One technique for ensuring continuity of wireless communication services and keeping a smooth transition on mobile communication networks is the soft handover technique. In the Soft Handover (SHO) technique the inclusion and reduction of Base Station from the set of active sets is determined by initiation triggers. One of the initiation triggers is based on the strong reception signal. In this paper we observed the influence of parameters of large-scale radio propagation models to improve the performance of mobile communications. The observation parameters for characterizing the performance of the specified mobile system are Drop Call, Radio Link Degradation Rate and Average Size of Active Set (AS). The simulated results show that the increase in altitude of Base Station (BS) Antenna and Mobile Station (MS) Antenna contributes to the improvement of signal power reception level so as to improve Radio Link quality and increase the average size of Active Set and reduce the average Drop Call rate. It was also found that Hata’s propagation model contributed significantly to improvements in system performance parameters compared to Okumura’s propagation model and Lee’s propagation model.

  11. Performance of a pilot-scale compost biofilter treating gasoline vapor

    International Nuclear Information System (INIS)

    Wright, W.F.; Schroeder, E.D.; Chang, D.P.Y.

    1997-01-01

    A pilot-scale compost biofiltration system was operated as gasoline soil vapor extraction site in Hayward, California for one year. The media was composed of equal volumes of compost and perlite, a bulking agent. Supplements added included nitrogen (as KNO 3 ), a gasoline degrading microbial inoculum, buffer (crushed oyster shell), and water. The biofiltration system was composed of four identical units with outside dimensions of 1.2 x 1.2 x 1.2 m (4 x 4 x 4 ft) operated in an up-flow mode. The units were configured in parallel during the first eight months and then reconfigured to two parallel systems of two units in series. Air flux values ranged from 0.29 to 1.0 m 3 /m 2 per min. Inlet total petroleum hydrogen hydrocarbon (TPH gas ) concentrations ranged from 310 to 2,700 mg/m 3 . The average empty bed contact time was 2.2 min. Following start-up, performance of the individual biofilters varied considerably for a seven-month period. The principal factor affecting performance appeared to be bed moisture content. Overall TPH gas removals reached 90% for short periods in one unit, and BTEX removals were typically above 90%. Drying resulted in channeling and loss of bed activity. Management of bed moisture content improved over the study period, and recovery of system performance was achieved without replacement of bed media. Overall TPH gas removals exceeded 90% during the final 50 days of the study

  12. Compressor Performance Scaling in the Presence of Non-Uniform Flow

    Science.gov (United States)

    Hill, David Jarrod

    Fuselage-embedded engines in future aircraft will see increased flow distortions due to the ingestion of airframe boundary layers. This reduces the required propulsive power compared to podded engines. Inlet flow distortions mean that localized regions of flow within the fan and first stage compressor are operating at off-design conditions. It is important to weigh the benefit of increased vehicle propulsive efficiency against the resultant reduction in engine efficiency. High computational cost has limited most past research to single distortion studies. The objective of this thesis is to extract scaling laws for transonic compressor performance in the presence of various distortion patterns and intensities. The machine studied is the NASA R67 transonic compressor. Volumetric source terms are used to model rotor and stator blade rows. The modelling approach is an innovative combination of existing flow turning and loss models, combined with a compressible flow correction. This approach allows for a steady calculation to capture distortion transfer; as a result, the computational cost is reduced by two orders of magnitude. At peak efficiency, the rotor work coefficient and isentropic efficiency are matched within 1.4% of previously published experimental results. A key finding of this thesis is that, in non-uniform flow, the state-of-the-art loss model employed is unable to capture the impact of variations in local flow coefficient, limiting the analysis of local entropy generation. New insight explains the mechanism governing the interaction between a total temperature distortion and a compressor rotor. A parametric study comprising 16 inlet distortions reveals that for total temperature distortions, upstream flow redistribution and rotor diffusion factor changes are shown to scale linearly with distortion severity. Linear diffusion factor scaling does not hold true for total pressure distortions. For combined total temperature and total pressure distortions, the

  13. Towards Portable Large-Scale Image Processing with High-Performance Computing.

    Science.gov (United States)

    Huo, Yuankai; Blaber, Justin; Damon, Stephen M; Boyd, Brian D; Bao, Shunxing; Parvathaneni, Prasanna; Noguera, Camilo Bermudez; Chaganti, Shikha; Nath, Vishwesh; Greer, Jasmine M; Lyu, Ilwoo; French, William R; Newton, Allen T; Rogers, Baxter P; Landman, Bennett A

    2018-05-03

    High-throughput, large-scale medical image computing demands tight integration of high-performance computing (HPC) infrastructure for data storage, job distribution, and image processing. The Vanderbilt University Institute for Imaging Science (VUIIS) Center for Computational Imaging (CCI) has constructed a large-scale image storage and processing infrastructure that is composed of (1) a large-scale image database using the eXtensible Neuroimaging Archive Toolkit (XNAT), (2) a content-aware job scheduling platform using the Distributed Automation for XNAT pipeline automation tool (DAX), and (3) a wide variety of encapsulated image processing pipelines called "spiders." The VUIIS CCI medical image data storage and processing infrastructure have housed and processed nearly half-million medical image volumes with Vanderbilt Advanced Computing Center for Research and Education (ACCRE), which is the HPC facility at the Vanderbilt University. The initial deployment was natively deployed (i.e., direct installations on a bare-metal server) within the ACCRE hardware and software environments, which lead to issues of portability and sustainability. First, it could be laborious to deploy the entire VUIIS CCI medical image data storage and processing infrastructure to another HPC center with varying hardware infrastructure, library availability, and software permission policies. Second, the spiders were not developed in an isolated manner, which has led to software dependency issues during system upgrades or remote software installation. To address such issues, herein, we describe recent innovations using containerization techniques with XNAT/DAX which are used to isolate the VUIIS CCI medical image data storage and processing infrastructure from the underlying hardware and software environments. The newly presented XNAT/DAX solution has the following new features: (1) multi-level portability from system level to the application level, (2) flexible and dynamic software

  14. [Children's intelligence quotient following general anesthesia for dental care: a clinical observation by Chinese Wechsler young children scale of intelligence].

    Science.gov (United States)

    Xia, B; Wang, J H; Xiao, Y M; Liu, K Y; Yang, X D; Ge, L H

    2016-04-18

    It has been demonstrated that anesthetics exposure may lead to neurocognitive impairment in developing brain of animal models. However, for the limitation that the animal models cannot fully mimic the dose and duration in clinical settings especially for dental general anesthesia, the clinical significance of anesthetics exposure on developing central nervous system remains undetermined. Therefore, we conducted the current study in order to observe the fluctuation of intelligence quotient (IQ) after the administration of dental general anesthesia comparing to that before surgery. We conducted the current study in order to observe the fluctuation of intelligence quotient (IQ) after the administration of dental general anesthesia compared with that before surgery. Thirty two patients, ASA I, who were exposed to dental general anesthesia in Department of Pediatric Dentistry Peking University School and Hospital of Stomatology, aged 4 to 6.5 years, were enrolled in this prospective study. Patients with severe learning difficulties or communication disorders were excluded. Written and informed consent was obtained from each patients' family which was fully explained of the purpose and method of study. Their intelligence quotients were evaluated with the Chinese Wechsler young children scale of intelligence (Urban version) before and 2 weeks after dental anesthesia. They were treated by experienced pediatric dentists and the sevoflurane, propofol and nitrous oxide were used for general anesthesia by anesthetist. Articaine hydrochloride and epinephrine tartrate injections were used for their pulp treatment or extraction. The examiners and scorers for IQ had technical training in the test administration. All the patients were tested by the same examiner and with standardized guide language. Each subtest was scored according to the tool review. Verbal IQ and performance IQ consisted of relevant 5 subtests and full scale IQ. Statistical analyses were performed by SPSS 18

  15. The effect of clinical performance on the survival estimates of direct restorations

    Directory of Open Access Journals (Sweden)

    Kyou-Li Kim

    2013-02-01

    Full Text Available Objectives In most retrospective studies, the clinical performance of restorations had not been considered in survival analysis. This study investigated the effect of including the clinically unacceptable cases according to modified United States Public Health Service (USPHS criteria into the failed data on the survival analysis of direct restorations as to the longevity and prognostic variables. Materials and Methods Nine hundred and sixty-seven direct restorations were evaluated. The data of 204 retreated restorations were collected from the records, and clinical performance of 763 restorations in function was evaluated according to modified USPHS criteria by two observers. The longevity and prognostic variables of the restorations were compared with a factor of involving clinically unacceptable cases into the failures using Kaplan-Meier survival analysis and Cox proportional hazard model. Results The median survival times of amalgam, composite resin and glass ionomer were 11.8, 11.0 and 6.8 years, respectively. Glass ionomer showed significantly lower longevity than composite resin and amalgam. When clinically unacceptable restorations were included into the failure, the median survival times of them decreased to 8.9, 9.7 and 6.4 years, respectively. Conclusions After considering the clinical performance, composite resin was the only material that showed a difference in the longevity (p < 0.05 and the significantly higher relative risk of student group than professor group disappeared in operator groups. Even in the design of retrospective study, clinical evaluation needs to be included.

  16. Psychometric properties of the Ruminative Response Scale-short form in a clinical sample of patients with major depressive disorder

    Directory of Open Access Journals (Sweden)

    Parola N

    2017-05-01

    Full Text Available Nathalie Parola,1,2,* Xavier Yves Zendjidjian,1,3,* Marine Alessandrini,1 Karine Baumstarck,1 Anderson Loundou,1 Guillaume Fond,4,5 Fabrice Berna,4,6 Christophe Lançon,1–3 Pascal Auquier,1 Laurent Boyer1 1Public Health, Chronic Diseases and Quality of Life – Research Unit EA 3279, Aix-Marseille University, Marseille, 2Department of Psychiatry, Sainte-Marguerite University Hospital, Marseille, 3Department of Psychiatry, La Conception University Hospital, Marseille, 4Fondation FondaMental, Créteil, 5Department of Psychiatry and Addictology, Henri Mondor University Hospital, INSERM U955, Eq 15 Genetic Psychiatry and Psychopathology, Paris Est-Créteil University, Créteil, 6Department of Psychiatry, INSERM U1114, Fédération de Médecine Translationnelle de Strasbourg, Strasbourg University Hospital, Strasbourg, France *These authors contributed equally to this work Background: The Ruminative Response Scale (RRS-short form is one of the most widely used measures of rumination, comprising ten items and two components: reflection and brooding. The aim of this study was to investigate RRS validity and reliability in a clinical sample of French patients with major depressive disorder (MDD.Subjects and methods: Outpatients with a DSM-IV-TR diagnosis of MDD were recruited from a public academic hospital in France. Depressive symptoms were evaluated by the Beck Depression Inventory, anxiety by the State-Trait Anxiety Inventory – state scale, and quality of life by the 36-Item Short Form Health Survey (SF-36 questionnaire. Confirmatory factor analyses, item-dimension correlations, Cronbach’s α-coefficients, Rasch statistics, and external validity were tested. Differential item functioning analyses were performed for sex.Results: A total of 109 patients participated. The final reflection–brooding two-factor model of the RRS showed a good fit (root-mean-square error of approximation 0.041, comparative fit index 0.987, standardized root

  17. NHS Trusts' clinical research activity and overall CQC performance - Is there a correlation?

    Science.gov (United States)

    Jonker, L; Fisher, S J

    2015-11-01

    Since the late 2000's, the creation of the National Institute for Health Research (NIHR) has transformed clinical research activity in the United Kingdom. This study sought to establish if there is a link between clinical research activity and overall NHS Trust performance. Retrospective cohort study. Data for NHS Trust performance were obtained from public databases, namely the Care Quality Commission (CQC) 2013 risk rating for overall performance, and 2012-13 NIHR records for clinical research activity. Applying Spearman's rank analysis, none of the Trust categories showed a correlation with CQC risk rating: small hospitals, r = -0.062 (P = 0.76; n = 27); medium, r = -0.224 (P = 0.13; n = 47); large, r = -0.008 (P = 0.96; n = 57); academic, r = -0.18 (P = 0.41; n = 24). Similar results were observed when CQC risk rating was compared with the number of different clinical research studies conducted per Trust. The degree of NIHR National Portfolio clinical research activity is not significantly related to CQC risk rating, used as an indicator of overall NHS Trust performance. Other studies have previously shown that increased research activity correlates with improved mortality rates, one component of CQC risk rating scores. Alternative tools may have to be explored to evaluate the impact of clinical research on NHS Trusts and its patients. Copyright © 2015 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

  18. Impact of thermoelectric phenomena on phase-change memory performance metrics and scaling

    International Nuclear Information System (INIS)

    Lee, Jaeho; Asheghi, Mehdi; Goodson, Kenneth E

    2012-01-01

    The coupled transport of heat and electrical current, or thermoelectric phenomena, can strongly influence the temperature distribution and figures of merit for phase-change memory (PCM). This paper simulates PCM devices with careful attention to thermoelectric transport and the resulting impact on programming current during the reset operation. The electrothermal simulations consider Thomson heating within the phase-change material and Peltier heating at the electrode interface. Using representative values for the Thomson and Seebeck coefficients extracted from our past measurements of these properties, we predict a cell temperature increase of 44% and a decrease in the programming current of 16%. Scaling arguments indicate that the impact of thermoelectric phenomena becomes greater with smaller dimensions due to enhanced thermal confinement. This work estimates the scaling of this reduction in programming current as electrode contact areas are reduced down to 10 nm × 10 nm. Precise understanding of thermoelectric phenomena and their impact on device performance is a critical part of PCM design strategies. (paper)

  19. Performance of A Pilot-Scale Vermifilter for the Treatment of A Real Hospital Wastewater

    Directory of Open Access Journals (Sweden)

    Nahid Ghobadi

    2016-12-01

    Full Text Available In this study, the performance of a pilot-scale vermifilter (VF for the treatment of hospital wastewater using the earthworm species Eisenia fetida was evaluated. The earthworms’ gut acts as a bioreactor and can ingest the wastewater solid and liquid organic wastes and expel these as vermicompost. A pilot-scale vermifilter was installed and operated for 133 days in one of hospitals in Hamadan city; the designed system was fed with the influent passed through coarse and fine grillage and the sedimentation tank of the hospital’s sanitary collection system. In order to study the efficiency of the system, the variations of pH value, chemical oxygen demand (COD, biochemical oxygen demand (BOD5, and total suspended solids (TSS were measured. In addition, a conventional geofilter (GF without Earthworm was used as the experimental control. The vermifiltration caused a significant decrease in the levels of COD (75%, BOD5 (93%, and TSS (89% as well as neutralized pH in the wastewater. Also, these contents in the geofilter were observed to be 65%, 71%, and 71%, respectively. The vermifiltration technology can, therefore, be applied as an environmentally friendly method for hospital wastewater treatment.

  20. Incorporating Scale-Dependent Fracture Stiffness for Improved Reservoir Performance Prediction

    Science.gov (United States)

    Crawford, B. R.; Tsenn, M. C.; Homburg, J. M.; Stehle, R. C.; Freysteinson, J. A.; Reese, W. C.

    2017-12-01

    We present a novel technique for predicting dynamic fracture network response to production-driven changes in effective stress, with the potential for optimizing depletion planning and improving recovery prediction in stress-sensitive naturally fractured reservoirs. A key component of the method involves laboratory geomechanics testing of single fractures in order to develop a unique scaling relationship between fracture normal stiffness and initial mechanical aperture. Details of the workflow are as follows: tensile, opening mode fractures are created in a variety of low matrix permeability rocks with initial, unstressed apertures in the micrometer to millimeter range, as determined from image analyses of X-ray CT scans; subsequent hydrostatic compression of these fractured samples with synchronous radial strain and flow measurement indicates that both mechanical and hydraulic aperture reduction varies linearly with the natural logarithm of effective normal stress; these stress-sensitive single-fracture laboratory observations are then upscaled to networks with fracture populations displaying frequency-length and length-aperture scaling laws commonly exhibited by natural fracture arrays; functional relationships between reservoir pressure reduction and fracture network porosity, compressibility and directional permeabilities as generated by such discrete fracture network modeling are then exported to the reservoir simulator for improved naturally fractured reservoir performance prediction.

  1. Performance of a small-scale turbojet engine fed with traditional and alternative fuels

    International Nuclear Information System (INIS)

    Badami, M.; Nuccio, P.; Pastrone, D.; Signoretto, A.

    2014-01-01

    Highlights: • One synthetic fuel, one bio-fuel blend and one traditional kerosene were tested on a small-scale turbojet. • The three fuels were characterized and their chemical and physical specifications were compared. • The experimental results, in term of CO, UHC and NO x emissions, are discussed. • Emissions are compared with CFD analysis and semi-empirical equations found in literature. - Abstract: The growing use of aeronautical fuels, together with the increasing attention towards reduced environmental impact technologies, are driving governments and aeronautical companies to search for alternative aeronautical fuels to petroleum based kerosene. Analysis and measurements on real aeronautical turbines are complex and expensive; for this reason the use of parts of real engines or small size turbojets can be very interesting for research activities. The present paper describes the results of an experimental and numerical activity, regarding the influence of alternative fuels on the performance in term of emissions, on a small-scale turbojet engine with a nominal thrust of 80 N at 80,000 rpm. Three different fuels, a traditional Jet-A kerosene, a synthetic Gas To Liquid (GTL) fuel and a blend of 30% Jatropha Methyl Ester (JME) and 70% Jet-A, were tested. The experimental results, in term of CO, UHC and NO x emissions, are discussed and compared with results obtained from CFD analysis and from semi-empirical equations found in literature

  2. Performance of a pilot-scale continuous flow microbial electrolysis cell fed winery wastewater.

    Science.gov (United States)

    Cusick, Roland D; Bryan, Bill; Parker, Denny S; Merrill, Matthew D; Mehanna, Maha; Kiely, Patrick D; Liu, Guangli; Logan, Bruce E

    2011-03-01

    A pilot-scale (1,000 L) continuous flow microbial electrolysis cell was constructed and tested for current generation and COD removal with winery wastewater. The reactor contained 144 electrode pairs in 24 modules. Enrichment of an exoelectrogenic biofilm required ~60 days, which is longer than typically needed for laboratory reactors. Current generation was enhanced by ensuring adequate organic volatile fatty acid content (VFA/SCOD ≥ 0.5) and by raising the wastewater temperature (31 ± 1°C). Once enriched, SCOD removal (62 ± 20%) was consistent at a hydraulic retention time of 1 day (applied voltage of 0.9 V). Current generation reached a maximum of 7.4 A/m(3) by the planned end of the test (after 100 days). Gas production reached a maximum of 0.19 ± 0.04 L/L/day, although most of the product gas was converted to methane (86 ± 6%). In order to increase hydrogen recovery in future tests, better methods will be needed to isolate hydrogen gas produced at the cathode. These results show that inoculation and enrichment procedures are critical to the initial success of larger-scale systems. Acetate amendments, warmer temperatures, and pH control during startup were found to be critical for proper enrichment of exoelectrogenic biofilms and improved reactor performance.

  3. Generic Containment: Detailed comparison of containment simulations performed on plant scale

    International Nuclear Information System (INIS)

    Kelm, St.; Klauck, M.; Beck, S.; Allelein, H.-J.; Preusser, G.; Sangiorgi, M.; Klein-Hessling, W.; Bakalov, I.; Bleyer, A.; Bentaib, A.; Kljenak, I.; Stempniewicz, M.; Kostka, P.; Morandi, S.; Ada del Corno, B.; Bratfisch, C.; Risken, T.; Denk, L.; Parduba, Z.; Paci, S.

    2014-01-01

    Highlights: • Consequent implementation of the recommendations derived from the OECD/NEA ISP-47. • Phenomenological code-to-code comparison performed on plant scale. • Systematic identification and elimination of the user effect. • Identification of fundamental differences in the model basis. • Application to PAR system analysis. - Abstract: One outcome of the OECD/NEA ISP-47 activity was the recommendation to elaborate a ‘Generic Containment’ in order to allow comparing and rating the results obtained by different lumped-parameter models on plant scale. Within the European SARNET2 project ( (http://www.sar-net.eu)), such a Generic Containment nodalisation, based on a German PWR (1300 MW el ), was defined. This agreement on the nodalisation allows investigating the remaining differences among the results, especially the ‘user-effect’, related to the modelling choices, as well as fundamental differences in the underlying model basis in detail. The methodology applied in order to compare the different code predictions consisted of a series of three benchmark steps with increasing complexity as well as a systematic comparison of characteristic variables and observations. This paper summarises the benchmark series, the lessons learned during specifying the steps, comparing and discussing the results and finally gives an outlook on future steps

  4. An official American thoracic society workshop report: developing performance measures from clinical practice guidelines.

    Science.gov (United States)

    Kahn, Jeremy M; Gould, Michael K; Krishnan, Jerry A; Wilson, Kevin C; Au, David H; Cooke, Colin R; Douglas, Ivor S; Feemster, Laura C; Mularski, Richard A; Slatore, Christopher G; Wiener, Renda Soylemez

    2014-05-01

    Many health care performance measures are either not based on high-quality clinical evidence or not tightly linked to patient-centered outcomes, limiting their usefulness in quality improvement. In this report we summarize the proceedings of an American Thoracic Society workshop convened to address this problem by reviewing current approaches to performance measure development and creating a framework for developing high-quality performance measures by basing them directly on recommendations from well-constructed clinical practice guidelines. Workshop participants concluded that ideally performance measures addressing care processes should be linked to clinical practice guidelines that explicitly rate the quality of evidence and the strength of recommendations, such as the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) process. Under this framework, process-based performance measures would only be developed from strong recommendations based on high- or moderate-quality evidence. This approach would help ensure that clinical processes specified in performance measures are both of clear benefit to patients and supported by strong evidence. Although this approach may result in fewer performance measures, it would substantially increase the likelihood that quality-improvement programs based on these measures actually improve patient care.

  5. The impact of outpatient clinical teaching on students' academic performance in obstetrics and gynecology.

    Science.gov (United States)

    Hassan, Bahaeldin A; Elfaki, Omer A; Khan, Muhammed A

    2017-01-01

    Clinical teaching at outpatient settings is an essential part of undergraduate medical students' training. The increasing number of students in many medical schools and short hospital stays makes inpatient teaching alone insufficient to provide students with the required clinical skills. To make up this shortfall, outpatient clinical teaching has been implemented by our Department of Obstetrics and Gynecology, King Khalid University, KSA, throughout the academic year 2015-2016. The aim of this study was to evaluate the impact of clinical teaching at outpatient settings on the academic performance of our students. In this comparative retrospective study, the effects of outpatient clinical teaching of obstetrics and gynecology on the academic performance of student was assessed through an objective structured clinical examination (OSCE). During their course on obstetrics and gynecology, 58 students had their clinical teaching both at inpatient and outpatient settings and constituted "study group". The remaining 52 students had clinical teaching only at inpatient settings and were considered "control group". Students in both groups sat for OSCE at the end of week 8 of the gynecology course. Students in both groups sat for OSCE at the end of week 8 of the gynecology course. Four stations were used for assessment: obstetric history, gynecological history, obstetric physical examination of pregnant women, and gynecological procedure station. Twenty marks were allocated for each station giving a total score of 80. The OSCE scores for study group were compared with those of the control group using Student's t -test; p performance in OSCE. There is evidence of remarkable improvement in the mastery of clinical skills as manifested in the students' scores in physical examination and procedures stations. These results will encourage us to have clinical teaching in other disciplines at outpatient settings.

  6. Validity of the clinical and content scales of the Multiphasic Personality Inventory Minnesota 2 for the diagnosis of psychogenic non-epileptic seizures.

    Science.gov (United States)

    del Barrio, A; Jiménez-Huete, A; Toledano, R; García-Morales, I; Gil-Nagel, A

    2016-03-01

    The use of the Multiphasic Personality Inventory Minnesota 2 (MMPI-2) for the diagnosis of psychogenic non-epileptic seizures (PNES) is controversial. This study examines the validity of the clinical scales and, unlike previous works, the content scales. Cross-sectional study of 209 patients treated in the epilepsy unit. We performed a logistic regression analysis, taking video-electroencephalography as the reference test, and as predictor variables age, sex, IQ and clinical (model A) or content scales (model B) of the MMPI-2. The models were selected according to the Aikake index and compared using the DeLong test. We analyzed 37 patients with PNES alone, or combined with seizures, and 172 patients with seizures only. The model consisting of sex, Hs (hypochondriasis) and Pa (paranoia) showed a sensitivity of 77.1%, a specificity of 76.8%, a percentage of correct classification of 76.8%, and an area under the curve (AUC) of 0.836 for diagnosing CNEP. Model B, consisting of sex, HEA (health concerns) and FRS (fears), showed a sensitivity of 65.7%, a specificity of 78.0%, a percentage of correct classification of 75.9% and an AUC of 0.840. DeLong's test did not detect significant differences. The MMPI-2 has a moderate validity for the diagnosis of PNES in patients referred to an epilepsy unit. Using content scales does not significantly improve results from the clinical scales. Copyright © 2013 Sociedad Española de Neurología. Published by Elsevier España, S.L.U. All rights reserved.

  7. EFRT M-12 Issue Resolution: Comparison of Filter Performance at PEP and CUF Scale

    International Nuclear Information System (INIS)

    Daniel, Richard C.; Billing, Justin M.; Bontha, Jagannadha R.; Brown, Christopher F.; Eslinger, Paul W.; Hanson, Brady D.; Huckaby, James L.; Karri, Naveen K.; Kimura, Marcia L.; Kurath, Dean E.; Minette, Michael J.

    2010-01-01

    Pacific Northwest National Laboratory (PNNL) has been tasked by Bechtel National Inc. (BNI) on the River Protection Project-Hanford Tank Waste Treatment and Immobilization Plant (RPP-WTP) project to perform research and development activities to resolve technical issues identified for the Pretreatment Facility (PTF). The Pretreatment Engineering Platform (PEP) was designed, constructed, and operated as part of a plan to respond to issue M12, 'Undemonstrated Leaching Processes' of the External Flowsheet Review Team (EFRT) issue response plan.(a) The PEP is a 1/4.5-scale test platform designed to simulate the WTP pretreatment caustic leaching, oxidative leaching, ultrafiltration solids concentration, and slurry washing processes. The PEP replicates the WTP leaching processes using prototypic equipment and control strategies. The PEP also includes non-prototypic ancillary equipment to support the core processing.

  8. EFRT M-12 Issue Resolution: Comparison of Filter Performance at PEP and CUF Scale

    Energy Technology Data Exchange (ETDEWEB)

    Daniel, Richard C.; Billing, Justin M.; Bontha, Jagannadha R.; Brown, Christopher F.; Eslinger, Paul W.; Hanson, Brady D.; Huckaby, James L.; Karri, Naveen K.; Kimura, Marcia L.; Kurath, Dean E.; Minette, Michael J.

    2010-01-22

    Pacific Northwest National Laboratory (PNNL) has been tasked by Bechtel National Inc. (BNI) on the River Protection Project-Hanford Tank Waste Treatment and Immobilization Plant (RPP-WTP) project to perform research and development activities to resolve technical issues identified for the Pretreatment Facility (PTF). The Pretreatment Engineering Platform (PEP) was designed, constructed, and operated as part of a plan to respond to issue M12, “Undemonstrated Leaching Processes” of the External Flowsheet Review Team (EFRT) issue response plan.(a) The PEP is a 1/4.5-scale test platform designed to simulate the WTP pretreatment caustic leaching, oxidative leaching, ultrafiltration solids concentration, and slurry washing processes. The PEP replicates the WTP leaching processes using prototypic equipment and control strategies. The PEP also includes non-prototypic ancillary equipment to support the core processing.

  9. Functionally graded hardmetals and cermets: preparation, performance and production scale up

    International Nuclear Information System (INIS)

    Dreyer, K.; Kassel, D.; Daub, H.-W.; Berg, H. van den; Lengauer, W.; Garcia, J.; Ucakar, V.

    2001-01-01

    Sintering experiments were carried out to establish graded microstructures in hardmetals and cermets. The formation of these microstructural features was investigated as a function of nitrogen pressure, sintering temperature, sintering period and sintering profile. The nitrogen pressure influences the formation of carbonitride layers at the surface. Decreasing sintering temperature yields similar results as increasing nitrogen pressure. Upon prolonged sintering time a small growth of the outer carbonitride layer can only be obtained if a substantial WC grain growth is accepted. Variation of the sintering profile after dense sintering does not principally change the type of the graded microstructure. The laboratory experiments were scaled up in an industrial sinter/HIP furnace and showing good correspondence with each other. First turning cutting tests with different alloys show excellent performance in comparison to ungraded materials. (author)

  10. On the network protocol performance evaluation for large scale communication system of nuclear plant

    International Nuclear Information System (INIS)

    Song, K. S.; Lee, T. H.; Kim, H. R.; Kim, D. H.; Ku, I. S.

    1998-01-01

    Computer technology has been dramatically advanced and it is now natural to apply digital network technology into nuclear plants. Communication architecture for nuclear plant defines the coordination of safety reactor control, balance of plant, subsystem utilities, and plant monitoring functions, and how they are connected and their user interface to guarantee plant performance and guarantee safety requirements. Therefore, to implement a digital network for control and monitoring systems of advanced nuclear plant needs systematic design and evaluation procedures because of responsive and hard real-time process characteristics of nuclear plant. In this paper, we evaluate several digital network protocols in terms of network delay, link failure effects to hard real-time requirements with full scale traffic

  11. High performance nanostructured Silicon heterojunction for water splitting on large scales

    KAUST Repository

    Bonifazi, Marcella

    2017-11-02

    In past years the global demand for energy has been increasing steeply, as well as the awareness that new sources of clean energy are essential. Photo-electrochemical devices (PEC) for water splitting applications have stirred great interest, and different approach has been explored to improve the efficiency of these devices and to avoid optical losses at the interfaces with water. These include engineering materials and nanostructuring the device\\'s surfaces [1]-[2]. Despite the promising initial results, there are still many drawbacks that needs to be overcome to reach large scale production with optimized performances [3]. We present a new device that relies on the optimization of the nanostructuring process that exploits suitably disordered surfaces. Additionally, this device could harvest light on both sides to efficiently gain and store the energy to keep the photocatalytic reaction active.

  12. High performance nanostructured Silicon heterojunction for water splitting on large scales

    KAUST Repository

    Bonifazi, Marcella; Fu, Hui-chun; He, Jr-Hau; Fratalocchi, Andrea

    2017-01-01

    In past years the global demand for energy has been increasing steeply, as well as the awareness that new sources of clean energy are essential. Photo-electrochemical devices (PEC) for water splitting applications have stirred great interest, and different approach has been explored to improve the efficiency of these devices and to avoid optical losses at the interfaces with water. These include engineering materials and nanostructuring the device's surfaces [1]-[2]. Despite the promising initial results, there are still many drawbacks that needs to be overcome to reach large scale production with optimized performances [3]. We present a new device that relies on the optimization of the nanostructuring process that exploits suitably disordered surfaces. Additionally, this device could harvest light on both sides to efficiently gain and store the energy to keep the photocatalytic reaction active.

  13. Experimental performance of a piston expander in a small- scale organic Rankine cycle

    Science.gov (United States)

    Oudkerk, J. F.; Dickes, R.; Dumont, O.; Lemort, V.

    2015-08-01

    Volumetric expanders are suitable for more and more applications in the field of micro- and small-scale power system as waster heat recovery or solar energy. This paper present an experimental study carried out on a swatch-plate piston expander. The expander was integrated into an ORC test-bench using R245fa. The performances are evaluated in term of isentropic efficiency and filling factor. The maximum efficiency and power reached are respectively 53% and 2 kW. Inside cylinder pressure measurements allow to compute mechanical efficiency and drown P-V diagram. A semi-empirical simulation model is then proposed, calibrated and used to analyse the different sources of losses.

  14. Channel geometric scales effect on performance and optimization for serpentine proton exchange membrane fuel cell (PEMFC)

    Science.gov (United States)

    Youcef, Kerkoub; Ahmed, Benzaoui; Ziari, Yasmina; Fadila, Haddad

    2017-02-01

    A three dimensional computational fluid dynamics model is proposed in this paper to investigate the effect of flow field design and dimensions of bipolar plates on performance of serpentine proton exchange membrane fuel cell (PEMFC). A complete fuel cell of 25 cm2 with 25 channels have been used. The aim of the work is to investigate the effect of flow channels and ribs scales on overall performance of PEM fuel cell. Therefore, geometric aspect ratio parameter defined as (width of flow channel/width of rib) is used. Influences of the ribs and openings current collector scales have been studied and analyzed in order to find the optimum ratio between them to enhance the production of courant density of PEM fuel cell. Six kind of serpentine designs have been used in this paper included different aspect ratio varying from 0.25 to 2.33 while the active surface area and number of channels are keeping constant. Aspect ratio 0.25 corresponding of (0.4 mm channel width/ 1.6mm ribs width), and Aspect ratio2.33 corresponding of (0.6 mm channel width/ 1.4mm ribs width. The results show that the best flow field designs (giving the maximum density of current) are which there dimensions of channels width is minimal and ribs width is maximal (Γ≈0.25). Also decreasing width of channels enhance the pressure drop inside the PEM fuel cell, this causes an increase of gazes velocity and enhance convection process, therefore more power generation.

  15. Development of a modified equilibrium model for biomass pilot-scale fluidized bed gasifier performance predictions

    International Nuclear Information System (INIS)

    Rodriguez-Alejandro, David A.; Nam, Hyungseok; Maglinao, Amado L.; Capareda, Sergio C.; Aguilera-Alvarado, Alberto F.

    2016-01-01

    The objective of this work is to develop a thermodynamic model considering non-stoichiometric restrictions. The model validation was done from experimental works using a bench-scale fluidized bed gasifier with wood chips, dairy manure, and sorghum. The model was used for a further parametric study to predict the performance of a pilot-scale fluidized biomass gasifier. The Gibbs free energy minimization was applied to the modified equilibrium model considering a heat loss to the surroundings, carbon efficiency, and two non-equilibrium factors based on empirical correlations of ER and gasification temperature. The model was in a good agreement with RMS <4 for the produced gas. The parametric study ranges were 0.01 < ER < 0.99 and 500 °C < T < 900 °C to predict syngas concentrations and its LHV (lower heating value) for the optimization. Higher aromatics in tar were contained in WC gasification compared to manure gasification. A wood gasification tar simulation was produced to predict the amount of tars at specific conditions. The operating conditions for the highest quality syngas were reconciled experimentally with three biomass wastes using a fluidized bed gasifier. The thermodynamic model was used to predict the gasification performance at conditions beyond the actual operation. - Highlights: • Syngas from experimental gasification was used to create a non-equilibrium model. • Different types of biomass (HTS, DM, and WC) were used for gasification modelling. • Different tar compositions were identified with a simulation of tar yields. • The optimum operating conditions were found through the developed model.

  16. Boiling performance and material robustness of modified surfaces with multi scale structures for fuel cladding development

    Energy Technology Data Exchange (ETDEWEB)

    Jo, HangJin; Kim, Jin Man [Division of Advanced Nuclear Engineering, POSTECH, Pohang 790-784, Gyungbuk (Korea, Republic of); Yeom, Hwasung [Department of Nuclear Engineering and Engineering physics, UW-Madison, Madison, WI 53706, Unities States (United States); Lee, Gi Cheol [Department of Mechanical Engineering, POSTECH, Pohang 790-784, Gyungbuk (Korea, Republic of); Park, Hyun Sun, E-mail: hejsunny@postech.ac.kr [Division of Advanced Nuclear Engineering, POSTECH, Pohang 790-784, Gyungbuk (Korea, Republic of); Kiyofumi, Moriyama; Kim, Moo Hwan [Division of Advanced Nuclear Engineering, POSTECH, Pohang 790-784, Gyungbuk (Korea, Republic of); Sridharan, Kumar; Corradini, Michael [Department of Nuclear Engineering and Engineering physics, UW-Madison, Madison, WI 53706, Unities States (United States)

    2015-09-15

    Highlights: • We improved boiling performance and material robustness using surface modification. • We combined micro/millimeter post structures and nanoparticles with heat treatments. • Compactly-arranged micrometer posts had improved boiling performance. • CHF increased significantly due to capillary pumping by the deposited NP layers. • Sintering procedure increased mechanical strength of the NP coating surface. - Abstract: By regulating the geometrical characteristics of multi-scale structures and by adopting heat treatment for protective layer of nanoparticles (NPs), we improved critical heat flux (CHF), boiling heat transfer (BHT), and mechanical robustness of the modified surface. We fabricated 1-mm and 100-μm post structures and deposited NPs on the structured surface as a nano-scale structured layer and protective layer at the same time, then evaluated the CHF and BHT and material robustness of the modified surfaces. On the structured surfaces without NPs, the surface with compactly-arranged micrometer posts had improved CHF (118%) and BHT (41%). On the surface with structures on which NPs had been deposited, CHF increased significantly (172%) due to capillary pumping by the deposited NP layers. The heat treatment improved robustness of coating layer in comparison to the one of before heat treatment. In particular, low-temperature sintering increased the hardness of the modified surface by 140%. The increased mechanical strength of the NP coating is attributed to reduction in coating porosity during sintering. The combination of micrometer posts structures and sintered NP coating can increase the safety, efficiency and reliability of advanced nuclear fuel cladding.

  17. Boiling performance and material robustness of modified surfaces with multi scale structures for fuel cladding development

    International Nuclear Information System (INIS)

    Jo, HangJin; Kim, Jin Man; Yeom, Hwasung; Lee, Gi Cheol; Park, Hyun Sun; Kiyofumi, Moriyama; Kim, Moo Hwan; Sridharan, Kumar; Corradini, Michael

    2015-01-01

    Highlights: • We improved boiling performance and material robustness using surface modification. • We combined micro/millimeter post structures and nanoparticles with heat treatments. • Compactly-arranged micrometer posts had improved boiling performance. • CHF increased significantly due to capillary pumping by the deposited NP layers. • Sintering procedure increased mechanical strength of the NP coating surface. - Abstract: By regulating the geometrical characteristics of multi-scale structures and by adopting heat treatment for protective layer of nanoparticles (NPs), we improved critical heat flux (CHF), boiling heat transfer (BHT), and mechanical robustness of the modified surface. We fabricated 1-mm and 100-μm post structures and deposited NPs on the structured surface as a nano-scale structured layer and protective layer at the same time, then evaluated the CHF and BHT and material robustness of the modified surfaces. On the structured surfaces without NPs, the surface with compactly-arranged micrometer posts had improved CHF (118%) and BHT (41%). On the surface with structures on which NPs had been deposited, CHF increased significantly (172%) due to capillary pumping by the deposited NP layers. The heat treatment improved robustness of coating layer in comparison to the one of before heat treatment. In particular, low-temperature sintering increased the hardness of the modified surface by 140%. The increased mechanical strength of the NP coating is attributed to reduction in coating porosity during sintering. The combination of micrometer posts structures and sintered NP coating can increase the safety, efficiency and reliability of advanced nuclear fuel cladding

  18. Comparison of two different methods for evaluating the hydrodynamic performance of an industrial-scale fish-rearing unit

    DEFF Research Database (Denmark)

    Rasmussen, Michael R.; McLean, Ewen

    2004-01-01

    Laboratory-scale physical and mathematical models were evaluated for their utility in examining the hydrodynamic performance of a commercial fish-rearing tank. Each method was appraised with the common objective of predicting characteristic hydrodynamic behaviour of a full-scale tank. The two...

  19. Spanish validation of the adult Attention Deficit/Hyperactivity Disorder Rating Scale (ADHD-RS): relevance of clinical subtypes.

    Science.gov (United States)

    Richarte, Vanesa; Corrales, Montserrat; Pozuelo, Marian; Serra-Pla, Juanfran; Ibáñez, Pol; Calvo, Eva; Corominas, Margarida; Bosch, Rosa; Casas, Miquel; Ramos-Quiroga, Josep Antoni

    Adult attention deficit hyperactivity disorder (ADHD) has a prevalence between 2.5% and 4% of the general adult population. Over the past few decades, self-report measures have been developed for the current evaluation of adult ADHD. The ADHD-RS is a 18-items scale self-report version for assessing symptoms for ADHD DSM-IV. A validation of Spanish version of the ADHD-RS was performed. The sample consisted of 304 adult with ADHD and 94 controls. A case control study was carried out (adult ADHD vs. non ADHD). The diagnosis of ADHD was evaluated with the Structured Clinical Interview for DSM-IV (SCID-I) and the Conners Adult ADHD Diagnostic Interview for DSM-IV (CAADID-II). To determinate the internal validity of the two dimensions structure of ADHD-RS an exploratory factor analysis was performed. The α-coefficients were taken as a measure of the internal consistency of the dimensions considered. A logistic regression study was carried out to evaluate the model in terms of sensitivity, specificity, positive predictive value (PPV) and negative predictive values (NPV). Average age was 33.29 (SD=10.50) and 66% of subjects were men (there were no significant differences between the two groups). Factor analysis was done with a principal component analysis followed by a normalized varimax rotation. The Kaiser-Meyer-Olkin measure of sampling adequacy tests was .868 (remarkable) and the Bartlett's test of sphericity was 2 (153)=1,835.76, P<.0005, indicating the appropriateness of the factor analysis. This two-factor model accounted for 37.81% of the explained variance. The α-coefficient of the two factors was .84 and .82. The original strategy proposed 24 point for cut-off: sensitivity (81.9%), specificity (74.7%), PPV (50.0%), NPV (93.0%), kappa coefficient .78 and area under the curve (AUC) .89. The new score strategy proposed by our group suggests different cut-off for different clinical presentations. The 24 point is the best cut-off for ADHD combined presentation

  20. Performance of entrained flow and fluidised bed biomass gasifiers on different scales

    International Nuclear Information System (INIS)

    Tremel, Alexander; Becherer, Dominik; Fendt, Sebastian; Gaderer, Matthias; Spliethoff, Hartmut

    2013-01-01

    Highlights: ► Gasification of biomass in fluidised bed and entrained flow reactors is modelled. ► The systems are evaluated for a thermal input from 10 MW to 500 MW. ► Special attention is given to the preconditioning methods for biomass. ► Fluidised bed and entrained flow gasifiers are compared in terms of efficiency and costs. - Abstract: This biomass gasification process study compares the energetic and economic efficiencies of a dual fluidised bed and an oxygen-blown entrained flow gasifier from 10 MW th to 500 MW th . While fluidised bed gasification became the most applied technology for biomass in small and medium scale facilities, entrained flow gasification technology is still used exclusively for industrial scale coal gasification. Therefore, it is analysed whether and for which capacity the entrained flow technology is an energetically and economically efficient option for the thermo-chemical conversion of biomass. Special attention is given to the pre-conditioning methods for biomass to enable the application in an entrained flow gasifier. Process chains are selected for the two gasifier types and subsequently transformed to simulation models. The simulation results show that the performance of both gasifier types is similar for the production of a pressurised product gas (2.5 MPa). The cold gas efficiency of the fluidised bed is 76–79% and about 0.5–2 percentage points higher than for the entrained flow reactor. The net efficiencies of both technologies are similar and between 64% and 71% depending on scale. The auxiliary power consumption of the entrained flow reactor is caused mainly by the air separation unit, the oxygen compression, and the fuel pulverisation, whereas the fluidised bed requires additional power mainly for gas compression. The costs for the product gas are determined as between €4.2 cent/kWh (500 MW th ) and €7.4 cent/kWh (10 MW th ) in the economic analysis of both technologies. The study indicates that the

  1. The patient-specific functional scale: psychometrics, clinimetrics, and application as a clinical outcome measure.

    Science.gov (United States)

    Horn, Katyana Kowalchuk; Jennings, Sophie; Richardson, Gillian; Vliet, Ditte Van; Hefford, Cheryl; Abbott, J Haxby

    2012-01-01

    Systematic review of the literature. To summarize peer-reviewed literature on the reliability, validity, and responsiveness of the Patient-Specific Functional Scale (PSFS), and to identify its use as an outcome measure. Searches were performed of several electronic databases from 1995 to May 2010. Studies included were published articles containing (1) primary research investigating the psychometric and clinimetrics of the PSFS or (2) the implementation of the PSFS as an outcome measure. We assessed the methodological quality of studies included in the first category. Two hundred forty-two articles published from 1994 to May 2010 were identified. Of these, 66 met the inclusion criteria for this review, with 13 reporting the measurement properties of the PSFS, 55 implementing the PSFS as an outcome measure, and 2 doing both of the above. The PSFS was reported to be valid, reliable, and responsive in populations with knee dysfunction, cervical radiculopathy, acute low back pain, mechanical low back pain, and neck dysfunction. The PSFS was found to be reliable and responsive in populations with chronic low back pain. The PSFS was also reported to be valid, reliable, or responsive in individuals with a limited number of acute, subacute, and chronic conditions. This review found that the PSFS is also being used as an outcome measure in many other conditions, despite a lack of published evidence supporting its validity in these conditions. Although the use of the PSFS as an outcome measure is increasing in physiotherapy practice, there are gaps in the research literature regarding its validity, reliability, and responsiveness in many health conditions.

  2. Measurement of mean cerebral blood flow using SPECT and dementia rating scales in the memory clinic

    International Nuclear Information System (INIS)

    Kawahata, Nobuya; Daitoh, Nobuyuki; Shirai, Fumie; Yoshikawa, Ayumi; Gotoh, Chiharu

    1997-01-01

    We investigated the association between mean cerebral blood flow (mCBF) values using single photon emission computed tomography (SPECT) and cognitive performance scores of three dementia rating scales (ADAS, MMSE, HDS-R). Mean CBF was measured by the 123 I-IMP-ARG method in a selected group of 51 out-patients aged 41 to 90 years and by the 99m Tc-ECD method in the other group of 57 out-patients aged 51 to 91 years. Simple regressions were calculated for each of the neuropsychological clusters and mCBF values. In 123 I-IMP-ARG-SPECT study, there was a significant correlation between the mCBF values and HDS-R scores (R=0.37, p=0.01). 99m Tc-ECD-SPECT study revealed statistically significant correlations between the mCBF values and ADAS scores (R=-0.48, p 123 I-IMP-ARG-SPECT study and 99m Tc-ECD-SPECT study showed the progressive declines of mCBF with advancing cognitive dysfunctions. Using the cut-off point study (23/24 scores in MMSE and 20/21 scores in HDS-R), we have found that the patients with cognitive dysfunctions had lower mCBF values than the patients with those in each group of aged 60-69 years, 70-79 years, and 80-89 years. However, the difference of mCBF values between the groups with cognitive dysfunctions and without those had decreased gradually with advancing age. The present study suggests that SPECT can provide important functional informations to assess the cognitive impairment in patients with the memory disturbance. (author)

  3. A CFD Analysis of The Performance of Pin-Fin Laminar Flow Micro/Meso Scale Heat Exchangers

    National Research Council Canada - National Science Library

    Dimas, Sotirios

    2005-01-01

    A full three dimensional computational study was carried out using a finite-volume based solver for analyzing the performance of pin-fin based micro/meso scale heat exchangers with air as the working fluid...

  4. Computational intelligence for the Balanced Scorecard: studying performance trends of hemodialysis clinics.

    Science.gov (United States)

    Cattinelli, Isabella; Bolzoni, Elena; Chermisi, Milena; Bellocchio, Francesco; Barbieri, Carlo; Mari, Flavio; Amato, Claudia; Menzer, Marcus; Stopper, Andrea; Gatti, Emanuele

    2013-07-01

    The Balanced Scorecard (BSC) is a general, widely employed instrument for enterprise performance monitoring based on the periodic assessment of strategic Key Performance Indicators that are scored against preset targets. The BSC is currently employed as an effective management support tool within Fresenius Medical Care (FME) and is routinely analyzed via standard statistical methods. More recently, the application of computational intelligence techniques (namely, self-organizing maps) to BSC data has been proposed as a way to enhance the quantity and quality of information that can be extracted from it. In this work, additional methods are presented to analyze the evolution of clinic performance over time. Performance evolution is studied at the single-clinic level by computing two complementary indexes that measure the proportion of time spent within performance clusters and improving/worsening trends. Self-organizing maps are used in conjunction with these indexes to identify the specific drivers of the observed performance. The performance evolution for groups of clinics is modeled under a probabilistic framework by resorting to Markov chain properties. These allow a study of the probability of transitioning between performance clusters as time progresses for the identification of the performance level that is expected to become dominant over time. We show the potential of the proposed methods through illustrative results derived from the analysis of BSC data of 109 FME clinics in three countries. We were able to identify the performance drivers for specific groups of clinics and to distinguish between countries whose performances are likely to improve from those where a decline in performance might be expected. According to the stationary distribution of the Markov chain, the expected trend is best in Turkey (where the highest performance cluster has the highest probability, P=0.46), followed by Portugal (where the second best performance cluster dominates

  5. The scaling of performance and losses in miniature internal combustion engines

    Science.gov (United States)

    Menon, Shyam Kumar

    Miniature glow ignition internal combustion (IC) piston engines are an off--the--shelf technology that could dramatically increase the endurance of miniature electric power supplies and the range and endurance of small unmanned air vehicles provided their overall thermodynamic efficiencies can be increased to 15% or better. This thesis presents the first comprehensive analysis of small (system is developed that is capable of making reliable measurements of engine performance and losses in these small engines. Methodologies are also developed for measuring volumetric, heat transfer, exhaust, mechanical, and combustion losses. These instruments and techniques are used to investigate the performance of seven single-cylinder, two-stroke, glow fueled engines ranging in size from 15 to 450 g (0.16 to 7.5 cm3 displacement). Scaling rules for power output, overall efficiency, and normalized power are developed from the data. These will be useful to developers of micro-air vehicles and miniature power systems. The data show that the minimum length scale of a thermodynamically viable piston engine based on present technology is approximately 3 mm. Incomplete combustion is the most important challenge as it accounts for 60-70% of total energy losses. Combustion losses are followed in order of importance by heat transfer, sensible enthalpy, and friction. A net heat release analysis based on in-cylinder pressure measurements suggest that a two--stage combustion process occurs at low engine speeds and equivalence ratios close to 1. Different theories based on burning mode and reaction kinetics are proposed to explain the observed results. High speed imaging of the combustion chamber suggests that a turbulent premixed flame with its origin in the vicinity of the glow plug is the primary driver of combustion. Placing miniature IC engines on a turbulent combustion regime diagram shows that they operate in the 'flamelet in eddy' regime whereas conventional--scale engines operate

  6. Evaluation of the Clinical Performance of the HPV-Risk Assay Using the VALGENT-3 Panel.

    Science.gov (United States)

    Polman, N J; Oštrbenk, A; Xu, L; Snijders, P J F; Meijer, C J L M; Poljak, M; Heideman, D A M; Arbyn, M

    2017-12-01

    Human papillomavirus (HPV) testing is increasingly being incorporated into cervical cancer screening. The Validation of HPV Genotyping Tests (VALGENT) is a framework designed to evaluate the clinical performance of various HPV tests relative to that of the validated and accepted comparator test in a formalized and uniform manner. The aim of this study was to evaluate the clinical performance of the HPV-Risk assay with samples from the VALGENT-3 panel and to compare its performance to that of the clinically validated Hybrid Capture 2 assay (HC2). The VALGENT-3 panel comprises 1,300 consecutive samples from women participating in routine cervical cancer screening and is enriched with 300 samples from women with abnormal cytology. DNA was extracted from original ThinPrep PreservCyt medium aliquots, and HPV testing was performed using the HPV-Risk assay by investigators blind to the clinical data. HPV prevalence was analyzed, and the clinical performance of the HPV-Risk assay for the detection of cervical intraepithelial neoplasia grade 3 or worse (CIN3+) and CIN2 or worse (CIN2+) relative to the performance of HC2 was assessed. The sensitivity of the HPV-Risk assay for the detection of CIN3+ was similar to that of HC2 (relative sensitivity, 1.00; 95% confidence interval [CI], 0.95 to 1.05; P = 1.000), but the specificity of the HPV-Risk assay was significantly higher than that of HC2 (relative specificity, 1.02; 95% CI, 1.01 to 1.04; P performance of the HPV-Risk assay for the detection of CIN3+ and CIN2+ was noninferior to that of HC2, with all P values being ≤0.006. In conclusion, the HPV-Risk assay demonstrated noninferiority to the clinically validated HC2 by the use of samples from the VALGENT-3 panel for test validation and comparison. Copyright © 2017 Polman et al.

  7. The difference in learning culture and learning performance between a traditional clinical placement, a dedicated education unit and work-based learning.

    Science.gov (United States)

    Claeys, Maureen; Deplaecie, Monique; Vanderplancke, Tine; Delbaere, Ilse; Myny, Dries; Beeckman, Dimitri; Verhaeghe, Sofie

    2015-09-01

    An experiment was carried out on the bachelor's degree course in nursing with two new clinical placement concepts: workplace learning and the dedicated education centre. The aim was to establish a learning culture that creates a sufficiently high learning performance for students. The objectives of this study are threefold: (1) to look for a difference in the "learning culture" and "learning performance" in traditional clinical placement departments and the new clinical placement concepts, the "dedicated education centre" and "workplace learning"; (2) to assess factors influencing the learning culture and learning performance; and (3) to investigate whether there is a link between the learning culture and the learning performance. A non-randomised control study was carried out. The experimental group consisted of 33 final-year nursing undergraduates who were following clinical placements at dedicated education centres and 70 nursing undergraduates who undertook workplace learning. The control group consisted of 106 students who followed a traditional clinical placement. The "learning culture" outcome was measured using the Clinical Learning Environment, Supervision and Nurse Teacher scale. The "learning performance" outcome consisting of three competencies was measured using the Nursing Competence Questionnaire. The traditional clinical placement concept achieved the highest score for learning culture (plearning performance of which the dedicated education centres achieved the highest scores. The 3 clinical placement concepts showed marked differences in learning performance for the "assessment" competency (plearning can be seen as complementary clinical placement concepts. The organisation of clinical placements under the dedicated education centre concept and workplace learning is recommended for final-year undergraduate nursing students. Copyright © 2015 Elsevier Ltd. All rights reserved.

  8. Performance of combined clinical mammography and needle biopsy: a nationwide study from Denmark

    DEFF Research Database (Denmark)

    Jensen, Allan; Rank, Fritz; Dyreborg, Uffe

    2006-01-01

    Clinical mammography and needle biopsy are key tools for non-operative assessment of breast lesions. We evaluated the performance of all combined tests undertaken in Denmark in 2000. Clinical mammography and needle biopsy data were collected and linked to final cancer outcome, to determine sensit...... with a suspicious or malignant result indicated a high risk of cancer, and excisional diagnostic biopsy therefore still has an important role to play.......Clinical mammography and needle biopsy are key tools for non-operative assessment of breast lesions. We evaluated the performance of all combined tests undertaken in Denmark in 2000. Clinical mammography and needle biopsy data were collected and linked to final cancer outcome, to determine...

  9. Estimating premorbid general cognitive functioning for children and adolescents using the American Wechsler Intelligence Scale for Children-Fourth Edition: demographic and current performance approaches.

    Science.gov (United States)

    Schoenberg, Mike R; Lange, Rael T; Brickell, Tracey A; Saklofske, Donald H

    2007-04-01

    Neuropsychologic evaluation requires current test performance be contrasted against a comparison standard to determine if change has occurred. An estimate of premorbid intelligence quotient (IQ) is often used as a comparison standard. The Wechsler Intelligence Scale for Children-Fourth Edition (WISC-IV) is a commonly used intelligence test. However, there is no method to estimate premorbid IQ for the WISC-IV, limiting the test's utility for neuropsychologic assessment. This study develops algorithms to estimate premorbid Full Scale IQ scores. Participants were the American WISC-IV standardization sample (N = 2172). The sample was randomly divided into 2 groups (development and validation). The development group was used to generate 12 algorithms. These algorithms were accurate predictors of WISC-IV Full Scale IQ scores in healthy children and adolescents. These algorithms hold promise as a method to predict premorbid IQ for patients with known or suspected neurologic dysfunction; however, clinical validation is required.

  10. Performance of Clinical Signs in the Diagnosis of Dehydration in Children with Acute Gastroenteritis

    OpenAIRE

    Hoxha, Teuta; Xhelili, Luan; Azemi, Mehmedali; Avdiu, Muharrem; Ismaili-Jaha, Vlora; Efendija-Beqa, Urata; Grajcevci-Uka, Violeta

    2015-01-01

    Background: Acute evaluation and treatment of children presenting with dehydration represent one of the most common situation in the pediatric emergency department. To identify dehydration in infants and children before treatment, a number of symptoms and clinical signs have been evaluated. The aim of the study was to describe the performance of clinical signs in detecting dehydration in children. Methods: Two hundred children aged 1 month to 5 year were involved in our prospective study. The...

  11. Clinical Skills Performed By Iranian Emergency Nurses: Perceived Competency Levels and Attitudes Toward Expanding Professional Roles.

    Science.gov (United States)

    Hassankhani, Hadi; Hasanzadeh, Firooz; Powers, Kelly A; Dadash Zadeh, Abbas; Rajaie, Rouzbeh

    2018-03-01

    Emergency nurses play an important role in the care of critically ill and injured patients, and their competency to perform clinical skills is vital to safe and effective patient care. The aim of this study was to evaluate the frequency of clinical skills performed and perceived competency levels among Iranian emergency nurses. In addition, attitudes toward expanding the professional roles of Iranian emergency nurses were also assessed. In this descriptive correlational study, 319 emergency nurses from 30 hospitals in northwest Iran participated. Data were collected using a self-report questionnaire. Descriptive statistics and Pearson's correlation coefficient were used to present the findings. Overall competency of the emergency nurses was 73.31 ± 14.2, indicating a good level of perceived competence. The clinical skills most frequently performed were in the domains of organizational and workload competencies (3.43 ± 0.76), diagnostic function (3.25 ± 0.82), and the helping role (3.17 ± 0.83). A higher level of perceived competence was found for skills within these domains. Less frequently, participants performed skills within the domains of effective management of rapidly changing situations (2.70 ± 0.94) and administering and monitoring therapeutic interventions (2.60 ± 0.97); a lower perceived level of competence was noted for these clinical skills. There was a significant correlation between frequency of performing clinical skills and perceived competency level (r = 0.651, P skills. This has implications for nurse managers and educators who may consider offering more frequent experiential and educational opportunities to emergency nurses. Expansion of nurses' roles could also result in increased experience in clinical skills and higher levels of competency. Research is needed to investigate nurses' clinical competence using direct and observed measures. Copyright © 2017 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved.

  12. The Palliative Outcome Scale (POS) applied to clinical practice and research: an integrative review.

    Science.gov (United States)

    Rugno, Fernanda Capella; Carlo, Marysia Mara Rodrigues do Prado De

    2016-08-15

    to identify and evaluate the evidence found in the international scientific literature on the application of the Palliative Outcome Scale (POS) in clinical practice and research in Palliative Care (PC). integrative literature review, through the search of publications in journals indexed in PubMed / MEDLINE, LILACS, SciELO and CINAHL databases, between the years 1999 and 2014. the final sample consisted of 11 articles. In the data analysis, the articles were classified into 2 units of analysis (studies using the POS as a resource in research and studies using the POS in clinical practice), in which the information was presented in the form of sub-themes related to publications of the selected studies, highlighting the synthesis of the results. POS emerged as an important tool for measuring outcomes to assess the quality of life of patients and families, of the quality of care provided and the PC service organization. The international scientific literature on the application of POS proved to be relevant to the advancement and consolidation of the field of knowledge related to PC. identificar e avaliar as evidências encontradas na literatura científica internacional, referentes à aplicação da Palliative Outcome Scale (POS) na prática clínica e nas pesquisas em Cuidados Paliativos (CPs). revisão integrativa da literatura, por meio da busca de publicações nos periódicos indexados nas bases de dados PubMed/MEDLINE, LILACS, SciELO e CINAHL, entre os anos de 1999 e 2014. a amostra final do estudo constituiu-se de 11 artigos. Na análise dos dados, os artigos foram classificados em 2 unidades de análise (estudos que utilizam a POS como recurso na pesquisa e estudos que utilizam a POS na prática clínica), nas quais as informações foram apresentadas na forma de subtemas referentes às publicações dos estudos selecionados, com destaque para a síntese dos resultados. a POS se destacou como um importante instrumento de medidas de resultados para a avalia

  13. Documenting clinical performance problems among medical students: feedback for learner remediation and curriculum enhancement

    Directory of Open Access Journals (Sweden)

    Brian E. Mavis

    2013-07-01

    Full Text Available Introduction: We operationalized the taxonomy developed by Hauer and colleagues describing common clinical performance problems. Faculty raters pilot tested the resulting worksheet by observing recordings of problematic simulated clinical encounters involving third-year medical students. This approach provided a framework for structured feedback to guide learner improvement and curricular enhancement. Methods: Eighty-two problematic clinical encounters from M3 students who failed their clinical competency examination were independently rated by paired clinical faculty members to identify common problems related to the medical interview, physical examination, and professionalism. Results: Eleven out of 26 target performance problems were present in 25% or more encounters. Overall, 37% had unsatisfactory medical interviews, with ‘inadequate history to rule out other diagnoses’ most prevalent (60%. Seventy percent failed because of physical examination deficiencies, with missing elements (69% and inadequate data gathering (69% most common. One-third of the students did not introduce themselves to their patients. Among students failing based on standardized patient (SP ratings, 93% also failed to demonstrate competency based on the faculty ratings. Conclusions: Our review form allowed clinical faculty to validate pass/fail decisions based on standardized patient ratings. Detailed information about performance problems contributes to learner feedback and curricular enhancement to guide remediation planning and faculty development.

  14. What is the impact of a clinically related readmission measure on the assessment of hospital performance?

    Science.gov (United States)

    Khouri, Roger K; Hou, Hechuan; Dhir, Apoorv; Andino, Juan J; Dupree, James M; Miller, David C; Ellimoottil, Chad

    2017-11-28

    The Hospital Readmission Reduction Program (HRRP) penalizes hospitals for high all-cause unplanned readmission rates. Many have expressed concern that hospitals serving patient populations with more comorbidities, lower incomes, and worse self-reported health status may be disproportionately penalized by readmissions that are not clinically related to the index admission. The impact of including clinically unrelated readmissions on hospital performance is largely unknown. We sought to determine if a clinically related readmission measure would significantly alter the assessment of hospital performance. We analyzed Medicare claims for beneficiaries in Michigan admitted for pneumonia and joint replacement from 2011 to 2013. We compared each hospital's 30-day readmission rate using specifications from the HRRP's all-cause unplanned readmission measure to values calculated using a clinically related readmission measure. We found that the mean 30-day readmission rates were lower when calculated using the clinically related readmission measure (joint replacement: all-cause 5.8%, clinically related 4.9%, p impact hospital performance in the HRRP.

  15. Psychometric evaluation of the Swedish version of the pure procrastination scale, the irrational procrastination scale, and the susceptibility to temptation