WorldWideScience

Sample records for policy improvement center

  1. Networking to Improve Nutrition Policy Research.

    Science.gov (United States)

    Kim, Sonia A; Blanck, Heidi M; Cradock, Angie; Gortmaker, Steven

    2015-09-10

    Effective nutrition and obesity policies that improve the food environments in which Americans live, work, and play can have positive effects on the quality of human diets. The Centers for Disease Control and Prevention's (CDC's) Nutrition and Obesity Policy Research and Evaluation Network (NOPREN) conducts transdisciplinary practice-based policy research and evaluation to foster understanding of the effectiveness of nutrition policies. The articles in this special collection bring to light a set of policies that are being used across the United States. They add to the larger picture of policies that can work together over time to improve diet and health.

  2. Networking to Improve Nutrition Policy Research

    OpenAIRE

    Kim, Sonia A.; Blanck, Heidi M.; Cradock, Angie; Gortmaker, Steven

    2015-01-01

    Effective nutrition and obesity policies that improve the food environments in which Americans live, work, and play can have positive effects on the quality of human diets. The Centers for Disease Control and Prevention’s (CDC’s) Nutrition and Obesity Policy Research and Evaluation Network (NOPREN) conducts transdisciplinary practice-based policy research and evaluation to foster understanding of the effectiveness of nutrition policies. The articles in this special collection bring to light a...

  3. Developing Low-Cost Solutions to Improve Public Policy: The Work of MDRC's Center for Applied Behavioral Science. Issue Focus

    Science.gov (United States)

    MDRC, 2016

    2016-01-01

    Many social policy and education programs start from the assumption that people act in their best interest. But behavioral science shows that people often weigh intuition over reason, make inconsistent choices, and put off big decisions. The individuals and families who need services and the staff who provide them are no exception. From city…

  4. Optimization of Overflow Policies in Call Centers

    DEFF Research Database (Denmark)

    Koole, G.M.; Nielsen, B.F.; Nielsen, T.B.

    2015-01-01

    . A Markov decision chain is used to determine the optimal policy. This policy outperforms considerably the ones used most often in practice, which use a fixed threshold. The present method can be used also for other call-center models and other situations where performance is based on actual waiting times...

  5. Improving Productivity via QWL Centers.

    Science.gov (United States)

    Bentley, Marion T.; Hansen, Gary B.

    1980-01-01

    Gives a brief history of productivity improvement legislation in the United States and of the development and demise of the National Center for Productivity and Quality of Working Life (QWL). Describes existing productivity and QWL centers, including their locations, scope, services, and activities, and urges greater support at the federal level.…

  6. A translation table for patient-centered comparative effectiveness research: guidance to improve the value of research for clinical and health policy decision-making.

    Science.gov (United States)

    Tunis, Sean R; Messner, Donna A; Mohr, Penny; Gliklich, Richard E; Dubois, Robert W

    2012-05-01

    This article provides background and context for a series of papers stemming from a collaborative effort by Outcome Sciences, Inc., the National Pharmaceutical Council and the Center for Medical Technology Policy to use a stakeholder-driven process to develop a decision tool to select appropriate methods for comparative effectiveness research. The perceived need and origins of the 'translation table' concept for method selection are described and the legislative history and role of the Patient-Centered Outcomes Research Institute are reviewed. The article concludes by stressing the significance of this effort for future health services and clinical research, and the importance of consulting end-users--patients, providers, payers and policy-makers--in the process of defining research questions and approaches to them.

  7. Improving EU biofuels policy?

    DEFF Research Database (Denmark)

    Swinbank, Alan; Daugbjerg, Carsten

    2013-01-01

    to be 'like' a compliant biofuel. A more economically rational way to reduce GHG emissions, and one that might attract greater public support, would be for the RED to reward emission reductions along the lines of the FQD. Moreover, this modification would probably make the provisions more acceptable...... in the WTO, as there would be a clearer link between policy measures and the objective of reductions in GHG emissions; and the combination of the revised RED and the FQD would lessen the commercial incentive to import biofuels with modest GHG emission savings, and thus reduce the risk of trade tension....

  8. Improving policy implementation through collaborative policymaking

    DEFF Research Database (Denmark)

    Ansell, Christopher; Sørensen, Eva; Torfing, Jacob

    2017-01-01

    We offer a fresh perspective on implementation problems by suggesting that collaborative policy design and adaptive policy implementation will help public policy makers to improve policy execution. Classical implementation theories have focused too narrowly on administrative stumbling blocks and ...... collaborative policymaking and adaptive policy implementation might work in theory and practice......We offer a fresh perspective on implementation problems by suggesting that collaborative policy design and adaptive policy implementation will help public policy makers to improve policy execution. Classical implementation theories have focused too narrowly on administrative stumbling blocks...... and New Public Management has reinforced the split between politics and administration. Attempts to improve policy implementation must begin by looking at policy design, which can be improved through collaboration and deliberation between upstream and downstream actors. We provide a broad overview of how...

  9. Developing Child-Centered Social Policies: When Professionalism Takes Over

    Directory of Open Access Journals (Sweden)

    Nicole Hennum

    2014-08-01

    Full Text Available No nation today can be understood as being fully child-centered, but many are pursuing social policies heavily favoring children. The emphasis on individual rights and the growth of scientific knowledge underpinning many of these policies have led to the improvement of the lives of a great many children. Paradoxically, these same knowledge bases informing social policies often produce representations and images of children and their parents that are detrimental for both of these groups. Using Norwegian child welfare policies and practices as examples, I will examine some of the possible pitfalls of child-centered praxis. The key question here is one asking whether the scientific frame central to child welfare professionalism has positioned children and parents as objects rather than subjects in their own lives and, in so doing, required them to live up to standards of life defined for them by experts. A central question will involve exploring the extent to which scientific knowledge has erased political and ethical considerations from the field when assessing social problems.

  10. Corporate Accounting Policy Efficiency Improvement

    Directory of Open Access Journals (Sweden)

    Elena K. Vorobei

    2013-01-01

    Full Text Available The article is focused on the issues of efficient use of different methods of tax accounting for the optimization of income tax expenses and their consolidation in corporate accounting policy. The article makes reasoned conclusions, concerning optimal selection of depreciation methods for tax and bookkeeping accounting and their consolidation in corporate accounting policy and consolidation of optimal methods of cost recovery in production, considering business environment. The impact of the selected methods on corporate income tax rates and corporate property tax rates was traced and tax recovery was estimated.

  11. Online scheduling policies for multiclass call centers with impatient customers

    NARCIS (Netherlands)

    Jouini, O.; Pot, S.A.; Koole, G.M.; Dallery, Y.

    2010-01-01

    We consider a call center with two classes of impatient customers: premium and regular classes. Modeling our call center as a multiclass GI / GI / s + M queue, we focus on developing scheduling policies that satisfy a target ratio constraint on the abandonment probabilities of premium customers to

  12. CMS Nonpayment Policy, Quality Improvement, and Hospital-Acquired Conditions: An Integrative Review.

    Science.gov (United States)

    Bae, Sung-Heui

    This integrative review synthesized evidence on the consequences of the Centers for Medicare & Medicaid Services (CMS) nonpayment policy on quality improvement initiatives and hospital-acquired conditions. Fourteen articles were included. This review presents strong evidence that the CMS policy has spurred quality improvement initiatives; however, the relationships between the CMS policy and hospital-acquired conditions are inconclusive. In future research, a comprehensive model of implementation of the CMS nonpayment policy would help us understand the effectiveness of this policy.

  13. National Quality Improvement Center on Early Childhood

    Science.gov (United States)

    Browne, Charlyn Harper

    2014-01-01

    The national Quality Improvement Center on early Childhood (QIC-eC) funded four research and demonstration projects that tested child maltreatment prevention approaches. The projects were guided by several key perspectives: the importance of increasing protective factors in addition to decreasing risk factors in child maltreatment prevention…

  14. Improving care at cystic fibrosis centers through quality improvement.

    Science.gov (United States)

    Kraynack, Nathan C; McBride, John T

    2009-10-01

    Quality improvement (QI) using a clinical microsystems approach provides cystic fibrosis (CF) centers the opportunity to make a significant positive impact on the health of their patients. The availability of center-specific outcomes data and the support of the Cystic Fibrosis Foundation are important advantages for these quality improvement efforts. This article illustrates how the clinical microsystems methodology can improve care delivery and outcomes by describing the gradual application of quality improvement principles over the past 5 years by the CF team at the Lewis Walker Cystic Fibrosis Center at Akron Children's Hospital in Akron, Ohio. Using the example of a project to improve the pulmonary function of the pediatric patients at our center as a framework, we describe the QI process from the initial team-building phase, through the assessment of care processes, standardization of care, and developing a culture of continuous improvement. We outline how enthusiastic commitment from physician leadership, clinical managers and central administration, the availability of coaches, and an appreciation of the importance of measurement, patient involvement, communication, and standardization are critical components for successful process improvement. Copyright Thieme Medical Publishers.

  15. Towards Patient-Centered Conflicts of Interest Policy

    Directory of Open Access Journals (Sweden)

    Peter D. Young

    2018-02-01

    Full Text Available Financial conflicts of interest exist between industry and physicians, and these relationships have the power to influence physicians’ medical practice. Transparency about conflicts matters for ensuring adequate informed consent, controlling healthcare expenditure, and encouraging physicians’ reflection on professionalism. The US Centers for Medicare & Medicaid Services (CMS launched the Open Payments Program (OPP to publicly disclose and bring transparency to the relationships between industry and physicians in the United States. We set out to explore user awareness of the database and the ease of accessibility to disclosed information, however, as we show, both awareness and actual use are very low. Two practical policies can greatly enhance its intended function and help alleviate ethical tension. The first is to provide data for individual physicians not merely in absolute terms, but in meaningful context, that is, in relation to the zip code, city, and state averages. The second increases access to the OPP dataset by adding hyperlinks from physicians’ professional websites directly to their Open Payments disclosure pages. These changes considerably improve transparency and the utility of available data, and can furthermore enhance professionalism and accountability by encouraging physicians to reflect more actively on their own practices.

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

    Science.gov (United States)

    Weiner, Michael

    2014-01-01

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

  17. EDUCATIONAL POLICIES AND INITIATIVES FOR IMPROVED PERFORMANCE

    Directory of Open Access Journals (Sweden)

    Flavia, CAIA

    2015-03-01

    Full Text Available According to Gartner estimates, due to increased variety, speed and data volume, by 2015 there will be a global demand of 4.4 million professionals for real-time analysis of data from sources with different structures, but only one third of the demand will be met. The purpose of this research is to identify possible solutions for improved academic results in the IT domain, considering the time management policies, the content and the student motivations, as well as the business strategy tendencies. These proposals are targeted toward meeting the IT specialists demand. The research is composed of two parts: the first explores the Romanian IT labour market characteristics, while the second investigates the academic education policies that can help mitigate deficiencies and attain higher performance. The deficiencies are identified through a series of statistical research and analysis based on national level databases, adopting a quantitative approach. The policies proposed are supported by a flow model developed considering the students' activity, motivation, traits and results, measured and analysed quantitatively.

  18. An Investigation of Creative Climate of University R&D Centers and Policy Implications for Innovation in China

    DEFF Research Database (Denmark)

    Zhou, Chunfang; Rasmussen, Palle; Chemi, Tatiana

    2017-01-01

    The chapter focuses on the influences of science and technology (S&T) policies on creative climate of university R&D centers in China that provide policy implications for improving roles of university R&D in innovation system. The empirical data came from two questionnaire surveys, one...... is with members from R&D centers, another with leaders of S&T fund management sectors in universities. The results demonstrate both strengths and weaknesses of creative climate of university R&D centers. This leads to implications such as to improve a more comprehensive innovation Measurement system and to build...

  19. Using public policy to improve outcomes for asthmatic children in schools.

    Science.gov (United States)

    Lynn, Jewlya; Oppenheimer, Sophie; Zimmer, Lorena

    2014-12-01

    School-based services to improve asthma management need to be accompanied by public policies that can help sustain services, scale effective interventions, create greater equity across schools, and improve outcomes for children. Several national organizations, including the Centers for Disease Control and Prevention, have recommended specific public policies the adoption of which in school settings can improve asthma outcomes for children. Although many states and school districts have adopted some of these policies, adoption is not universal, and implementation is not always successful, leaving inequities in children's access to asthma services and supports. These issues can be addressed by changing public policy. Policy change is a complex process, but it is one that will benefit from greater involvement by asthma experts, including the researchers who generate the knowledge base on what services, supports, and policies have the best outcomes for children. Asthma experts can participate in the policy process by helping to build awareness of the need for school-based asthma policy, estimating the costs associated with policy options and with inaction, advocating for the selection of specific policies, assisting in implementation (including providing feedback), conducting the research that can evaluate the effectiveness of implementation, and ultimately providing information back into the policy process to allow for improvements to the policies. Copyright © 2014 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

  20. Putting women at the center: a review of Indian policy to address person-centered care in maternal and newborn health, family planning and abortion

    Directory of Open Access Journals (Sweden)

    Aradhana Srivastava

    2017-07-01

    Full Text Available Abstract Background Person-centered care is a critical component of quality care, essential to enable treatment adherence, and maximize health outcomes. Improving the quality of health services is a key strategy to achieve the new global target of zero preventable maternal deaths by 2030. Recognizing this, the Government of India has in the last decade initiated a number of strategies to address quality of care in health and family welfare services. Methods We conducted a policy review of quality improvement strategies in India from 2005 to 15, covering three critical areas– maternal and newborn health, family planning, and abortion (MNHFP + A. Based on Walt and Gilson’s policy triangle framework, we analyzed the extent to which policies incorporated person-centered care, while identifying unaddressed issues. Data was sourced from Government of India websites, scientific and grey literature databases. Results Twenty-two national policy documents, comprising two policy statements and 20 implementation guidelines of specific schemes were included in the review. Quality improvement strategies span infrastructure, commodities, human resources, competencies, and accountability that are driving quality assurance in MNHFP + A services. However, several implementation challenges have affected compliance with person-centered care, thereby affecting utilization and outcomes. Conclusion Focus on person-centered care in Indian MNHFP + A policy has increased in recent years. Nevertheless, some aspects must still be strengthened, such as positive interpersonal behavior, information sharing and promptness of care. Implementation can be improved through better provider training, patient feedback and monitoring mechanisms. Moreover, unless persisting structural challenges are addressed implementation of person-centered care in facilities will not be effective.

  1. Improving policy making through government-industry policy learning: The case of a novel Swedish policy framework

    International Nuclear Information System (INIS)

    Stigson, Peter; Dotzauer, Erik; Yan Jinyue

    2009-01-01

    Climate change poses an unprecedented challenge for policy makers. This paper analyzes how industry sector policy expertise can contribute to improved policy making processes. Previous research has identified that policy making benefit by including non-governmental policy analysts in learning processes. Recent climate and energy policy developments, including amendments and the introduction of new initiatives, have rendered current policy regimes as novel to both governments and the industry. This increases business investment risk perceptions and may thus reduce the effectiveness and efficiency of the policy framework. In order to explore how government-industry policy learning can improve policy making in this context, this article studied the Swedish case. A literature survey analyzed how policy learning had been previously addressed, identifying that the current situation regarding novel policies had been overlooked. Interviews provided how industrial actors view Swedish policy implementation processes and participatory aspects thereof. The authors conclude that an increased involvement of the industry sector in policy design and management processes can be an important measure to improve the effectiveness and efficiency of climate and energy policies

  2. Server rack for improved data center management

    Science.gov (United States)

    Bermudez Rodriguez, Sergio A.; Hamann, Hendrik F.; Wehle, Hans-Dieter

    2018-01-09

    Methods and systems for data center management include collecting sensor data from one or more sensors in a rack; determining a location and identifying information for each asset in the rack using a set of asset tags associated with respective assets; communicating the sensor and asset location to a communication module; receiving an instruction from the communication module; and executing the received instruction to change a property of the rack.

  3. IMPROVING THE EFFECTIVENESS OF EXCHANGE RATE POLICY IN CONTEMPORARY VIETNAM

    Directory of Open Access Journals (Sweden)

    The Dong Phung

    2014-01-01

    Full Text Available The article discusses the issue of effectiveness of exchange rate policy in contemporary Vietnam, along with the assessment of the mechanism of this policy from 1989 to the present day. The author analyzes constraints of implementing the exchange rate policy in the past and gives recommendations aimed at improving its efficiency nowadays.

  4. Improving adolescent health policy: incorporating a framework for assessing state-level policies.

    Science.gov (United States)

    Brindis, Claire D; Moore, Kristin

    2014-01-01

    Many US policies that affect health are made at the state, not the federal, level. Identifying state-level policies and data to analyze how different policies affect outcomes may help policy makers ascertain the usefulness of their public policies and funding decisions in improving the health of adolescent populations. A framework for describing and assessing the role of federal and state policies on adolescent health and well-being is proposed; an example of how the framework might be applied to the issue of teen childbearing is included. Such a framework can also help inform analyses of whether and how state and federal policies contribute to the variation across states in meeting adolescent health needs. A database on state policies, contextual variables, and health outcomes data can further enable researchers and policy makers to examine how these factors are associated with behaviors they aim to impact.

  5. Beyond Foucault: Toward a User-Centered Approach to Sexual Harassment Policy.

    Science.gov (United States)

    Ranney, Frances J.

    2000-01-01

    Discusses how United States national policy regarding sexual harassment exemplifies the Foucauldian paradigm in its attempt to regulate sexuality through seemingly authorless texts. Proposes a user-centered approach to policy drafting that values the knowledge of workers as users and makers of workplace policy. Argues that regulation through such…

  6. Improved input-legitimacy and efficient policies?

    DEFF Research Database (Denmark)

    Agger, Annika

    The call for more innovative public policies is increasing as many governments are faced with complex problems and increased demands. Public resources are considered to be scarce and the expectations among citizens and their demands to public services are often huge. As a result, there has been a...

  7. Strategic plans for the Hardwood Tree Improvement and Regeneration Center

    Science.gov (United States)

    Charles H. Michler; Keith E. Woeste

    2002-01-01

    The mission of the Hardwood Tree Improvement and Regeneration Center (HTIRC) at Purdue University is to advance the science of hardwood tree improvement and genomics in the central hardwood region of the United States by: developing and disseminating knowledge on improving the genetic quality of hardwood tree species; conserving fine hardwood germplasm; developing...

  8. National evaluation of policies on individual financial conflicts of interest in Canadian academic health science centers.

    Science.gov (United States)

    Lexchin, Joel; Sekeres, Melanie; Gold, Jennifer; Ferris, Lorraine E; Kalkar, Sunila R; Wu, Wei; Van Laethem, Marleen; Chan, An-Wen; Moher, David; Maskalyk, M James; Taback, Nathan; Rochon, Paula A

    2008-11-01

    Conflicts of interest (COI) in research are an important emerging topic of investigation and are frequently cited as a serious threat to the integrity of human participant research. To study financial conflicts of interest (FCOI) policies for individual investigators working in Canadian academic health centers. Survey instrument containing 61 items related to FCOI. All Canadian academic health science centers (universities with faculties of medicine, faculties of medicine and teaching hospitals) were requested to provide their three primary FCOI policies. Number of all centers and teaching hospitals with policies addressing each of the 61 items related to FCOI. Only one item was addressed by all 74 centers. Thirteen items were present in fewer than 25% of centers. Fewer than one-quarter of hospitals required researchers to disclose FCOI to research participants. The role of research ethics boards (REBs) in hospitals was marginal. Asking centers to identify only three policies may not have inclusively identified all FCOI policies in use. Additionally, policies at other levels might apply. For instance, all institutions receiving federal grant money must comply with the Tri-Council Policy Statement: Ethical Conduct for Research Involving Humans. Canadian centers within the same level (for instance, teaching hospitals) differ significantly in the areas that their policies address and these policies differ widely in their coverage. Presently, no single policy in any Canadian center informs researchers about the broad range of individual FCOI issues. Canadian investigators need to understand the environment surrounding FCOI, be able to access and follow the relevant policies and be confident that they can avoid entering into a FCOI.

  9. Effects of Quality Improvement System for Child Care Centers

    Science.gov (United States)

    Ma, Xin; Shen, Jianping; Kavanaugh, Amy; Lu, Xuejin; Brandi, Karen; Goodman, Jeff; Till, Lance; Watson, Grace

    2011-01-01

    Using multiple years of data collected from about 100 child care centers in Palm Beach County, Florida, the authors studied whether the Quality Improvement System (QIS) made a significant impact on quality of child care centers. Based on a pre- and postresearch design spanning a period of 13 months, QIS appeared to be effective in improving…

  10. Quality Improvement Policies in a Supply Chain with Stackelberg Games

    Directory of Open Access Journals (Sweden)

    Gang Xie

    2014-01-01

    Full Text Available We first analyze quality and price decisions in a supply chain with two Stackelberg games: Manufacturer’s Stackelberg (MS and Supplier’s Stackelberg (SS. Then, we investigate how equilibrium solutions are influenced by proposed quality improvement policies: coordination and manufacturer’s involvement. Also, we derive the conditions under which the policies can be implemented in both MS and SS strategies. Numerical experiments illustrate the problems and several related issues are discussed. The results suggest that proposed quality improvement policies can realize Pareto improvement for the supply chain performance.

  11. Senior Centers and Policy Advocacy: Changing Public Perceptions

    Science.gov (United States)

    Pardasani, Manoj; Goldkind, Lauri

    2012-01-01

    As critical components of the aging continuum of care, senior centers promote older adult health and well-being by providing opportunities for recreation, socialization, nutrition, health education, and access to vital social services. Nationally, a vast network of 11,000 senior centers serves over four million older adults annually. As the United…

  12. Policy modeling for energy efficiency improvement in US industry

    International Nuclear Information System (INIS)

    Worrell, Ernst; Price, Lynn; Ruth, Michael

    2001-01-01

    We are at the beginning of a process of evaluating and modeling the contribution of policies to improve energy efficiency. Three recent policy studies trying to assess the impact of energy efficiency policies in the United States are reviewed. The studies represent an important step in the analysis of climate change mitigation strategies. All studies model the estimated policy impact, rather than the policy itself. Often the policy impacts are based on assumptions, as the effects of a policy are not certain. Most models only incorporate economic (or price) tools, which recent studies have proven to be insufficient to estimate the impacts, costs and benefits of mitigation strategies. The reviewed studies are a first effort to capture the effects of non-price policies. The studies contribute to a better understanding of the role of policies in improving energy efficiency and mitigating climate change. All policy scenarios results in substantial energy savings compared to the baseline scenario used, as well as substantial net benefits to the U.S. economy

  13. Improving Youth Employment Policies in Francophone Africa | IDRC ...

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

    Africa's persistent job crisis calls for more effective employment policies, including training programs and support for job searches. This project will address the crisis through recommendations that will improve employment policies in francophone Africa. Youth employment initiatives in Africa Over the last two decades, ...

  14. University of Illinois at Chicago Health Policy Center - Funding

    Data.gov (United States)

    U.S. Department of Health & Human Services — 1991-2015. Centers for Disease Control and Prevention (CDC). State Tobacco Activities Tracking and Evaluation (STATE) System. Funding Data, Appropriations...

  15. Model-Driven Policy Framework for Data Centers

    DEFF Research Database (Denmark)

    Caba, Cosmin Marius; Kentis, Angelos Mimidis; Soler, José

    2016-01-01

    . Moreover, the lack of simple solutions for managing the configuration and behavior of the DC components makes the DC hard to configure and slow in adapting to changes in business needs. In this paper, we propose a model-driven framework for policy-based management for DCs, to simplify not only the service...

  16. Clean Energy Solutions Center: Assisting Countries with Clean Energy Policy

    Science.gov (United States)

    advice on financing instruments. In a recent keynote to the Climate and Clean Energy Investment Forum renewable energy technologies in the country. Informing Energy Access and Clean Energy Project Finance understanding and knowledge of how to design policies that enable financing and encourage investment in clean

  17. Dynamic call center routing policies using call waiting and agent idle times

    NARCIS (Netherlands)

    Chan, W.; Koole, G.M.; L'Ecuyer, P.

    2014-01-01

    We study call routing policies for call centers with multiple call types and multiple agent groups. We introduce new weight-based routing policies where each pair (call type, agent group) is given a matching priority defined as an affine combination of the longest waiting time for that call type and

  18. Ethics policy review: a case study in quality improvement.

    Science.gov (United States)

    Frolic, Andrea Nadine; Drolet, Katherine

    2013-02-01

    Policy work is often cited as one of the primary functions of Hospital Ethics Committees (HECs), along with consultation and education. Hospital policies can have far reaching effects on a wide array of stakeholders including, care providers, patients, families, the culture of the organisation and the community at large. In comparison with the wealth of information available about the emerging practice of ethics consultation, relatively little attention has been paid to the policy work of HECs. In this paper, we hope to advance the development of best practices in HEC policy work by describing the quality improvement process that we undertook at Hamilton Health Sciences, Hamilton, Ontario, Canada. In the first section of the paper we describe the context of our HEC policy work, and the shortcomings of our historical review process. In subsequent sections, we detail the quality improvement project we undertook in 2010, the results of the project and the specific tools we developed to enhance the quality of HEC policy work. Our goal in sharing this organisational case study is to prompt other HECs to publish qualitative descriptions of their policy work, in order to generate a body of knowledge that can inform the development of best practices for ethics policy review.

  19. BSLD threshold driven power management policy for HPC centers

    OpenAIRE

    Etinski, Maja; Corbalán González, Julita; Labarta Mancho, Jesús José; Valero Cortés, Mateo

    2010-01-01

    In this paper, we propose a power-aware parallel job scheduler assuming DVFS enabled clusters. A CPU frequency assignment algorithm is integrated into the well established EASY backfilling job scheduling policy. Running a job at lower frequency results in a reduction in power dissipation and accordingly in energy consumption. However, lower frequencies introduce a penalty in performance. Our frequency assignment algorithm has two adjustable parameters in order to enable fine grain energy-perf...

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

    Science.gov (United States)

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

    2016-01-01

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

  1. Plain packaging: an opportunity for improved international policy coherence?

    Science.gov (United States)

    Lencucha, Raphael; Drope, Jeffrey

    2015-01-01

    This paper highlights two salient challenges at the intersection of tobacco control and macroeconomic policy-making: (i) the use of trade and investment disputes to undermine and/or stall tobacco control legislation and (ii) the inconsistency, and thus unpredictability, of country positions across the two spheres. In the interest of improving international policy coherence, the authors suggest possible solutions to these two challenges at the national and intergovernmental levels. PMID:23723441

  2. Communication Strategies to Counter Stigma and Improve Mental Illness and Substance Use Disorder Policy.

    Science.gov (United States)

    McGinty, Emma; Pescosolido, Bernice; Kennedy-Hendricks, Alene; Barry, Colleen L

    2018-02-01

    Despite the high burden and poor rates of treatment associated with mental illness and substance use disorders, public support for allocating resources to improving treatment for these disorders is low. A growing body of research suggests that effective policy communication strategies can increase public support for policies benefiting people with these conditions. In October 2015, the Center for Mental Health and Addiction Policy Research at Johns Hopkins University convened an expert forum to identify what is currently known about the effectiveness of such policy communication strategies and produce recommendations for future research. One of the key conclusions of the forum was that communication strategies using personal narratives to engage audiences have the potential to increase public support for policies benefiting persons with mental illness or substance use disorders. Specifically, narratives combining personal stories with depictions of structural barriers to mental illness and substance use disorder treatment can increase the public's willingness to invest in the treatment system. Depictions of mental illness and violence significantly increase public stigma toward people with mental illness and are no more effective in increasing willingness to invest in mental health services than nonstigmatizing messages about structural barriers to treatment. Future research should prioritize development and evaluation of communication strategies to increase public support for evidence-based substance use disorder policies, including harm reduction policies-such as needle exchange programs-and policies expanding treatment.

  3. Stochastic abstract policies: generalizing knowledge to improve reinforcement learning.

    Science.gov (United States)

    Koga, Marcelo L; Freire, Valdinei; Costa, Anna H R

    2015-01-01

    Reinforcement learning (RL) enables an agent to learn behavior by acquiring experience through trial-and-error interactions with a dynamic environment. However, knowledge is usually built from scratch and learning to behave may take a long time. Here, we improve the learning performance by leveraging prior knowledge; that is, the learner shows proper behavior from the beginning of a target task, using the knowledge from a set of known, previously solved, source tasks. In this paper, we argue that building stochastic abstract policies that generalize over past experiences is an effective way to provide such improvement and this generalization outperforms the current practice of using a library of policies. We achieve that contributing with a new algorithm, AbsProb-PI-multiple and a framework for transferring knowledge represented as a stochastic abstract policy in new RL tasks. Stochastic abstract policies offer an effective way to encode knowledge because the abstraction they provide not only generalizes solutions but also facilitates extracting the similarities among tasks. We perform experiments in a robotic navigation environment and analyze the agent's behavior throughout the learning process and also assess the transfer ratio for different amounts of source tasks. We compare our method with the transfer of a library of policies, and experiments show that the use of a generalized policy produces better results by more effectively guiding the agent when learning a target task.

  4. Improving drug policy: The potential of broader democratic participation.

    Science.gov (United States)

    Ritter, Alison; Lancaster, Kari; Diprose, Rosalyn

    2018-05-01

    Policies concerned with illicit drugs vex governments. While the 'evidence-based policy' paradigm argues that governments should be informed by 'what works', in practice policy makers rarely operate this way. Moreover the evidence-based policy paradigm fails to account for democratic participatory processes, particularly how community members and people who use drugs might be included. The aim of this paper is to explore the political science thinking about democratic participation and the potential afforded in 'deliberative democracy' approaches, such as Citizens Juries and other mini-publics for improved drug policy processes. Deliberative democracy, through its focus on inclusion, equality and reasoned discussion, shows potential for drug policy reform and shifts the focus from reliance on and privileging of experts and scientific evidence. But the very nature of this kind of 'deliberation' may delimit participation, notably through its insistence on authorised modes of communication. Other forms of participation beyond reasoned deliberation aligned with the ontological view that participatory processes themselves are constitutive of subject positions and policy problems, may generate opportunities for considering how the deleterious effects of authorised modes of communication might be overcome. Copyright © 2018 Elsevier B.V. All rights reserved.

  5. Capturing User Needs to Improve Processes at EOSDIS Data Centers

    Science.gov (United States)

    Sofinowski, E. J.; Boquist, C. L.

    2009-12-01

    Since 2004 the Earth Observing System Data and Information System (EOSDIS) has conducted an annual comprehensive survey of user satisfaction using the American Customer Satisfaction Index (ACSI). Customer satisfaction ratings for EOSDIS consistently rate better than the overall government ratings. As part of the survey users are asked to submit comments concerning their experiences and interests. These user comments provide valuable insight into the effect of data center processes on users' experiences. Although user satisfaction has remained high, their preferences have changed with the rapid advances in web-based services. This analysis investigates the correlation between user comments, process changes or capability improvements at the individual data centers, and whether the changes at the data centers and web sites show a corresponding increase in user satisfaction. We will evaluate the comments in the areas of Product Search, Product Selection and Order, Delivery, Product Quality and Customer Support.

  6. Policy Pathways: Improving the Fuel Economy of Road Vehicles - A policy package

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2012-07-01

    The transportation sector accounts for approximately one-fifth of global final energy consumption and will account for nearly all future growth in oil use, particularly for road vehicles. The right policy mix can allow countries to improve the fuel economy of road vehicles, which in turn can enhance energy security and reduce CO2 emissions. Improving the Fuel Economy of Road Vehicles highlights lessons learned and examples of good practices from countries with experience in implementing fuel economy policies for vehicles. The report, part of the IEA’s Policy Pathway series, outlines key steps in planning, implementation, monitoring and evaluation. It complements the IEA Technology Roadmap: Fuel Economy for Road Vehicles, which outlines technical options, potentials, and costs towards improvement in the near, medium and long term.

  7. Evaluation of Nutrition and Physical Activity Policies and Practices in Child Care Centers within Rural Communities.

    Science.gov (United States)

    Foster, Jaime S; Contreras, Dawn; Gold, Abby; Keim, Ann; Oscarson, Renee; Peters, Paula; Procter, Sandra; Remig, Valentina; Smathers, Carol; Mobley, Amy R

    2015-10-01

    Although some researchers have examined nutrition and physical activity policies within urban child care centers, little is known about the potentially unique needs of rural communities. Child care centers serving preschool children located within low-income rural communities (n = 29) from seven states (Indiana, Kansas, Michigan, North Dakota, Ohio, South Dakota, and Wisconsin) were assessed to determine current nutrition and physical activity (PA) practices and policies. As part of a large-scale childhood obesity prevention project, the Community Healthy Living Index's previously validated Early Childhood Program Assessment Tool was used to collect data. Descriptive statistical analysis was conducted to identify high-priority areas. Healthy People 2020 and the Academy of Nutrition and Dietetics' recommendations for nutrition and PA policies in child care centers were used as benchmarks. Reports of not fully implementing (nutrition-related policies or practices within rural early child care centers were identified. Centers not consistently serving a variety of fruits (48%), vegetables (45%), whole grains (41%), limiting saturated fat intake (31%), implementing healthy celebration guidelines (41%), involving children in mealtime (62%), and referring families to nutrition assistance programs (24%) were identified. More than one third of centers also had limited structured PA opportunities. Although eligible, only 48% of the centers participated in the Child and Adult Care Food Program. Overall, centers lacked parental outreach, staff training, and funding/resources to support nutrition and PA. These results provide insight into where child care centers within low-income, rural communities may need assistance to help prevent childhood obesity.

  8. Improving the Science-Policy Interface of Biodiversity Research Projects

    NARCIS (Netherlands)

    Neßhöver, C.; Timaeus, J.; Wittmer, H.; Krieg, A.; Geamana, N.; Van den Hove, S.; Young, J.; Watt, A.

    2013-01-01

    Against the background of a continuing biodiversity loss there is a strong need to improve the interfaces between science and policy. Many approaches for such interfaces exist, the most recent being the Intergovernmental Platform on Biodiversity and Ecosystem Services (IPBES). A less prominent

  9. Improving School Leadership. Volume 1: Policy and Practice

    Science.gov (United States)

    OECD Publishing (NJ3), 2008

    2008-01-01

    As countries strive to reform education systems and improve student results, school leadership is high on education policy agendas. But in many countries, the men and women who run schools are overburdened, underpaid and near retirement. And few people are lining up for their jobs. Based on an OECD study of school leadership practices and policies…

  10. MARKETING POLICIES THROUGH THE INTERNET: THE CASE OF SKIING CENTERS IN GREECE

    Directory of Open Access Journals (Sweden)

    Panagiotis LEFAKIS

    2012-09-01

    Full Text Available Lately, Internet constitutes a major tool for transactions in every aspect and supports innovative marketing policies. Broadband Internet has become “the key to success” for businesses, as it offers various advantages and benefits through Internet marketing (e-marketing policies. In Greece, mountainous areas are usually covered with snow during winter months; so, skiing centers have become an important asset for winter tourism. The Internet evolution and the development of network infrastructure enhance marketing policies for winter tourism activities. This paper studies the use of marketing policies in Greek skiing centers through the Internet, such as promotional activities, website interactivity, accommodation & entertainment information, online weather forecast, guest book, etc Therefore, the paper aims to optimize and evaluate skiing centers in Greece, qualitatively and quantitatively according to e-marketing policies used as criteria, based on the multicriteria method of PROMETHEE II and further to classify them in groups. Finally we identify and describe the optimum group of skiing centers to be used as a model with enhanced customer communication services.

  11. Does ICT Policy Improve Interorganisational ICT for SMEs? A Dutch Policy Evaluation Study

    NARCIS (Netherlands)

    Plomp, M.G.A.; Batenburg, R.S.; Den Hertog, P.

    2011-01-01

    Interorganisational ICT has become critical for the performance of both small and large organisations. SMEs however, traditionally lag behind in the uptake of these systems. In many countries, various policy programmes are initiated to improve ICT uptake by SMEs and support them in digital linking

  12. Does ICT policy improve interorganisational ICT for SMEs? A Dutch policy evaluation study.

    NARCIS (Netherlands)

    Plomp, M.G.A.; Batenburg, R.S.; Hertog, P. den

    2011-01-01

    Interorganisational ICT has become critical for the performance of both small and large organisations. SMEs however, traditionally lag behind in the uptake of these systems. In many countries, various policy programmes are initiated to improve ICT uptake by SMEs and support them in digital linking

  13. Administrator Perceptions of School Improvement Policies in a High-Impact Policy Setting

    Directory of Open Access Journals (Sweden)

    MARIO S. TORRES

    2008-10-01

    Full Text Available This study investigated school administrators’ perceptions of school improvement policies in a high-impact policy environment by measuring the impact of accountability, site-based management, professional development, and scheduling reform on the three dependent variables of a academic outcomes, b staff morale, and c parent and community involvement. Using a convenience sampling method, 49 public school principals from Texas participated and an online survey was constructed to gather both quantitative (i.e., Likert scale and qualitative (i.e., open ended response data. The findings clearly point to principals, regardless of geographical district type and grade level school type, viewing less controversial and more intrinsically oriented policies (i.e., site-based management and professional development as having a greater positive impact on outcomes as a whole than more radical alternatives (i.e., accountability and time and schedule reform. The evidence suggests that more aggressive school improvement policy approaches are likely failing to generate enough convincing outcomes to generate high commitment and confidence from school leaders. Further studies may look at the interaction of policy impact with minority student enrollments and with subgroup populations.

  14. Policy considerations for improving influenza vaccination rates among pregnant women.

    Science.gov (United States)

    Mollard, Elizabeth K; Guenzel, Nicholas; Brown, Peggy A; Keeler, Heidi J; Cramer, Mary E

    2014-01-01

    Influenza exposure during pregnancy can cause severe health problems for both the mother and her offspring, including an increased risk of mortality. Influenza vaccination during all trimesters of pregnancy is safe and effective, and recommended by professional organizations such as the American College of Obstetrics and Gynecology. Despite these recommendations, the U.S. vaccination rates remain low in this high-risk population. A policy analysis based on the five-part method identified by Teitelbaum and Wilensky () addresses factors to consider in identifying the best voluntary policy options to improve the vaccination rates. The authors provide discussion of the background, landscape, and stakeholder interests and the pros and cons of two voluntary policy options to increase vaccination. The policy options include: (a) financial incentives for providers and (b) an education emphasis for providers and staff. The authors conclude that based on considerations of cost, provider preference, and practicality of implementation, a continuing educational intervention is the preferred policy venue to increase vaccination rates. © 2014 Wiley Periodicals, Inc.

  15. Improving tsunami resiliency: California's Tsunami Policy Working Group

    Science.gov (United States)

    Real, Charles R.; Johnson, Laurie; Jones, Lucile M.; Ross, Stephanie L.; Kontar, Y.A.; Santiago-Fandiño, V.; Takahashi, T.

    2014-01-01

    California has established a Tsunami Policy Working Group to facilitate development of policy recommendations for tsunami hazard mitigation. The Tsunami Policy Working Group brings together government and industry specialists from diverse fields including tsunami, seismic, and flood hazards, local and regional planning, structural engineering, natural hazard policy, and coastal engineering. The group is acting on findings from two parallel efforts: The USGS SAFRR Tsunami Scenario project, a comprehensive impact analysis of a large credible tsunami originating from an M 9.1 earthquake in the Aleutian Islands Subduction Zone striking California’s coastline, and the State’s Tsunami Preparedness and Hazard Mitigation Program. The unique dual-track approach provides a comprehensive assessment of vulnerability and risk within which the policy group can identify gaps and issues in current tsunami hazard mitigation and risk reduction, make recommendations that will help eliminate these impediments, and provide advice that will assist development and implementation of effective tsunami hazard risk communication products to improve community resiliency.

  16. State Primary Stroke Center Policies in the US: Rural Health Issues.

    NARCIS (Netherlands)

    Slade, C.; O'Toole, Laurence J.; Rho, E.

    2012-01-01

    Objective: To explore the relationship between state primary stroke center (PSC) designation policy implementation and access to optimal stroke care for residents of rural areas. Materials and Methods: Primary data were collected during the period September 2008–August 2009. Following content

  17. Improving Safe Sleep Modeling in the Hospital through Policy Implementation.

    Science.gov (United States)

    Heitmann, Rachel; Nilles, Ester K; Jeans, Ashley; Moreland, Jackie; Clarke, Chris; McDonald, Morgan F; Warren, Michael D

    2017-11-01

    Introduction Sleep-related infant deaths are major contributors to Tennessee's high infant mortality rate. The purpose of this initiative was to evaluate the impact of policy-based efforts to improve modeling of safe sleep practices by health care providers in hospital settings across Tennessee. Methods Safe sleep policies were developed and implemented at 71 hospitals in Tennessee. Policies, at minimum, were required to address staff training on the American Academy of Pediatrics' safe sleep recommendations, correct modeling of infant safe sleep practices, and parent education. Hospital data on process measures related to training and results of crib audits were compiled for analysis. Results The overall observance of infants who were found with any risk factors for unsafe sleep decreased 45.6% (p ≤ 0.001) from the first crib audit to the last crib audit. Significant decreases were noted for specific risk factors, including infants found asleep not on their back, with a toy or object in the crib, and not sleeping in a crib. Significant improvements were observed at hospitals where printed materials or video were utilized for training staff compared to face-to-face training. Discussion Statewide implementation of the hospital policy intervention resulted in significant reductions in infants found in unsafe sleep situations. The most common risk factors for sleep-related infant deaths can be modeled in hospitals. This effort has the potential to reduce sleep-related infant deaths and ultimately infant mortality.

  18. A Variable Service Broker Routing Policy for data center selection in cloud analyst

    Directory of Open Access Journals (Sweden)

    Ahmad M. Manasrah

    2017-07-01

    Full Text Available Cloud computing depends on sharing distributed computing resources to handle different services such as servers, storage and applications. The applications and infrastructures are provided as pay per use services through data center to the end user. The data centers are located at different geographic locations. However, these data centers can get overloaded with the increase number of client applications being serviced at the same time and location; this will degrade the overall QoS of the distributed services. Since different user applications may require different configuration and requirements, measuring the user applications performance of various resources is challenging. The service provider cannot make decisions for the right level of resources. Therefore, we propose a Variable Service Broker Routing Policy – VSBRP, which is a heuristic-based technique that aims to achieve minimum response time through considering the communication channel bandwidth, latency and the size of the job. The proposed service broker policy will also reduce the overloading of the data centers by redirecting the user requests to the next data center that yields better response and processing time. The simulation shows promising results in terms of response and processing time compared to other known broker policies from the literature.

  19. The Centers for Medicare and Medicaid Services (CMS) two midnight rule: policy at odds with reality.

    Science.gov (United States)

    Huntington, Ciara R; Blair, Laurel J; Cox, Tiffany C; Prasad, Tanushree; Kercher, Kent W; Augenstein, Vedra A; Heniford, B Todd

    2016-02-01

    To reduce costs, the Centers for Medicare and Medicaid Services (CMS) implemented new policies governing which patients are automatically admitted as inpatients (staying greater than "two midnights") and which require additional justification with physician documentation to be admitted. This study examines procedures missing from the Medicare Inpatient Only (MIO) list and uses national data to evaluate its appropriateness. Non-MIO procedures were identified from the current MIO list. Utilizing relevant billing codes, procedures were queried in the National Surgery Quality Improvement Program database for length of stay (LOS), percentage requiring >2 day stay, and inpatient status from 2005 to 2012. In addition, a separate analysis was performed for patients 65 years old or older who would qualify for Medicare. A majority of patients stayed more than 2 days for several procedures not included on the MIO list (% staying >2 days, mean LOS), including component separation (79.1%, 5.9 ± 12.3 days), diagnostic laparoscopy (64.2%, 5.5 ± 11.9 days), laparoscopic splenectomy (60.0%, 9.0 ± 13.6 days), open recurrent ventral hernia repair (58.2%, 6.3 ± 9.0 days), laparoscopic esophageal surgery (46.4%, 5.3 ± 13.3 days), and laparoscopic ventral hernia repair (24.7%, 2.5 ± 8.8 days). In patients ≥65 years, the average LOS was longer than the general population; for example, 40.2% of laparoscopic appendectomies and 38.7% of laparoscopic cholecystectomies in this older group required more than two nights in the hospital. In 92.3% of procedures examined, patients ≥65 years required greater than two nights in the hospital with an average LOS of 2.5-10.7 days. Commonly encountered non-MIO surgical procedures have national precedents for inpatient status. Before enacting policy, CMS and other regulatory bodies should consider current data to ensure rules are evidence-based and applicable.

  20. Improving the Efficient of Ernie Turner Center. Final Progress Report

    Energy Technology Data Exchange (ETDEWEB)

    Fredeen, Amy

    2011-03-21

    The objective of this project was to complete the specifications and drawings for a variable speed kitchen exhaust system and the boiler heating system which when implemented will improve the heating efficiency of the building. The design work was focused in two key areas: kitchen ventilation and heating for the Ernie Turner Center building (ETC). RSA completed design work and issued a set of 100% drawings. RSA also worked with a cost estimator to put together a detailed cost estimate for the project. The design components are summarized.

  1. Association Between Academic Medical Center Pharmaceutical Detailing Policies and Physician Prescribing.

    Science.gov (United States)

    Larkin, Ian; Ang, Desmond; Steinhart, Jonathan; Chao, Matthew; Patterson, Mark; Sah, Sunita; Wu, Tina; Schoenbaum, Michael; Hutchins, David; Brennan, Troyen; Loewenstein, George

    2017-05-02

    In an effort to regulate physician conflicts of interest, some US academic medical centers (AMCs) enacted policies restricting pharmaceutical representative sales visits to physicians (known as detailing) between 2006 and 2012. Little is known about the effect of these policies on physician prescribing. To analyze the association between detailing policies enacted at AMCs and physician prescribing of actively detailed and not detailed drugs. The study used a difference-in-differences multivariable regression analysis to compare changes in prescribing by physicians before and after implementation of detailing policies at AMCs in 5 states (California, Illinois, Massachusetts, Pennsylvania, and New York) that made up the intervention group with changes in prescribing by a matched control group of similar physicians not subject to a detailing policy. Academic medical center implementation of policies regulating pharmaceutical salesperson visits to attending physicians. The monthly within-drug class market share of prescriptions written by an individual physician for detailed and nondetailed drugs in 8 drug classes (lipid-lowering drugs, gastroesophageal reflux disease drugs, diabetes drugs, antihypertensive drugs, hypnotic drugs approved for the treatment of insomnia [sleep aids], attention-deficit/hyperactivity disorder drugs, antidepressant drugs, and antipsychotic drugs) comparing the 10- to 36-month period before implementation of the detailing policies with the 12- to 36-month period after implementation, depending on data availability. The analysis included 16 121 483 prescriptions written between January 2006 and June 2012 by 2126 attending physicians at the 19 intervention group AMCs and by 24 593 matched control group physicians. The sample mean market share at the physician-drug-month level for detailed and nondetailed drugs prior to enactment of policies was 19.3% and 14.2%, respectively. Exposure to an AMC detailing policy was associated with a

  2. Potentials and policy implications of energy and material efficiency improvement

    Energy Technology Data Exchange (ETDEWEB)

    Worrell, Ernst; Levine, Mark; Price, Lynn; Martin, Nathan; van den Broek, Richard; Block, Kornelis

    1997-01-01

    There is a growing awareness of the serious problems associated with the provision of sufficient energy to meet human needs and to fuel economic growth world-wide. This has pointed to the need for energy and material efficiency, which would reduce air, water and thermal pollution, as well as waste production. Increasing energy and material efficiency also have the benefits of increased employment, improved balance of imports and exports, increased security of energy supply, and adopting environmentally advantageous energy supply. A large potential exists for energy savings through energy and material efficiency improvements. Technologies are not now, nor will they be, in the foreseeable future, the limiting factors with regard to continuing energy efficiency improvements. There are serious barriers to energy efficiency improvement, including unwillingness to invest, lack of available and accessible information, economic disincentives and organizational barriers. A wide range of policy instruments, as well as innovative approaches have been tried in some countries in order to achieve the desired energy efficiency approaches. These include: regulation and guidelines; economic instruments and incentives; voluntary agreements and actions, information, education and training; and research, development and demonstration. An area that requires particular attention is that of improved international co-operation to develop policy instruments and technologies to meet the needs of developing countries. Material efficiency has not received the attention that it deserves. Consequently, there is a dearth of data on the qualities and quantities for final consumption, thus, making it difficult to formulate policies. Available data, however, suggest that there is a large potential for improved use of many materials in industrialized countries.

  3. Improving biomedical journals' ethical policies: the case of research misconduct.

    Science.gov (United States)

    Bosch, Xavier

    2014-09-01

    Scientific journals may incur scientific error if articles are tainted by research misconduct. While some journals' ethical policies, especially those on conflicts of interest, have improved over recent years, with some adopting a uniform approach, only around half of biomedical journals, principally those with higher impact factors, currently have formal misconduct policies, mainly for handling allegations. Worryingly, since a response to allegations would reasonably require an a priori definition, far fewer journals have publicly available definitions of misconduct. While some journals and editors' associations have taken significant steps to prevent and detect misconduct and respond to allegations, the content, visibility of and access to these policies varies considerably. In addition, while the lack of misconduct policies may prompt and maintain a de novo approach for journals, potentially causing stress, publication delays and even legal disputes, the lack of uniformity may be a matter of contention for research stakeholders such as editors, authors and their institutions, and publishers. Although each case may need an individual approach, I argue that posting highly visible, readily accessible, comprehensive, consistent misconduct policies could prevent the publication of fraudulent papers, increase the number of retractions of already published papers and, perhaps, reduce research misconduct. Although legally problematic, a concerted approach, with sharing of information between editors, which is clearly explained in journal websites, could also help. Ideally, journals, editors' associations, and publishers should seek consistency and homogenise misconduct policies to maintain public confidence in the integrity of biomedical research publications. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  4. University of Michigan Comprehensive Cancer Center opportunities for improvement project.

    Science.gov (United States)

    Breslin, Tara M; Waldinger, Marcy; Silver, Samuel M

    2014-02-01

    The University of Michigan Comprehensive Cancer Center (UMCCC) Opportunities for Improvement project involved a detailed patient-level medical record review, feedback to medical providers and clinical leadership, and discussion of potential predictors of discordant or delayed care. The medical record review revealed that reasons for discordant or delayed care were well documented by clinical providers, and medical comorbidity was the most common predisposing factor. Another common theme was the difficulty in obtaining treatment records for patients who received a portion of their care outside UMCCC. The project provided a valuable opportunity to examine established processes of care and data collection and consider how the newly implemented electronic health record might support future efforts aimed at improving efficiency and communication among providers.

  5. Creating Healthier, More Equitable Communities By Improving Governance And Policy.

    Science.gov (United States)

    Dubowitz, Tamara; Orleans, Tracy; Nelson, Christopher; May, Linnea Warren; Sloan, Jennifer C; Chandra, Anita

    2016-11-01

    How can healthier, more equitable communities be created? This is a key question for public health. Even though progress has been made in understanding the impact of social, physical, and policy factors on population health, there is much room for improvement. With this in mind, the Robert Wood Johnson Foundation made creating healthier, more equitable communities the third of four Action Areas in its Culture of Health Action Framework. This Action Area focuses on the interplay of three drivers-the physical environment, social and economic conditions, and policy and governance-in influencing health equity. In this article we review some of the policy and governance challenges confronting decisionmakers as they seek to create healthy communities on a broad scale. We use these challenges as a framework for understanding where the most critical gaps still exist, where the links could be exploited more effectively, and where there are opportunities for further research and policy development. Project HOPE—The People-to-People Health Foundation, Inc.

  6. Product Recall Policies and Their Improvement in Korea

    Directory of Open Access Journals (Sweden)

    Huh Kyungok

    2016-12-01

    Full Text Available This article aims to investigate recall policies for product safety in Korea and make suggestions for future improvements. Problematic issues in current recall policies are reviewed and analyzed. Based on survey results and previous studies, this article discusses the consumer perception of a recall. Consumers tend to regard a recall as a signal of poor quality. Furthermore, regulatory differences and weak penalties remain as obstacles to improving the recall system. Suggestions for the betterment of recall policies are derived from consultations with an expert panel and the application of other appropriate methods. At first, despite an increasing number of recall cases in Korea, it turns out that consumers are not highly sensitive to recalls, although their perceptions are mostly negative. Secondly, regulatory inconsistencies and difference problems are primarily attributable to the existence of many separate rules and regulations by product category. Thirdly, the information concerning recalls is limited, which creates an inefficient environment in which manufacturers are reluctant to voluntarily recall a defective product and consumer participation rates are too low. Therefore, the government should induce consumers to have more positive perceptions of recalls whilst concurrently reinforcing the related rules and regulations in accordance with international standards.

  7. Enhanced policies for the improvement of electricity efficiencies

    International Nuclear Information System (INIS)

    Blok, Kornelis

    2005-01-01

    Energy-efficiency improvement is considered as an important option to limit greenhouse gas emissions. In this paper, the possibilities to implement new policies to improve the efficiency of electricity end-use are explored. The following policy actions are considered: - introduction of a '1 W standard' for standby power consumption of appliances;- incremental standards for large electric appliances;- design guidelines for small electric appliances;- a technology-forcing standard for lighting;- a motor-drive program;- a program directed at the reduction of electricity use during empty-office hours;- actual energy performance requirements for service-sector buildings. The implementation of these programs will contribute substantially to reaching greenhouse gas emission targets in the European Union (total estimated effect to be 200-350 Mton CO 2 emission reduction in the year 2020). However, to reach these targets a very substantial effort is required, both in terms of policy ambition, force of the applied instruments, and implementation efforts. In the case of electric appliances, regulatory instruments may need wider application. And, in order to attain the substantial potential savings in motor-drive systems, an effort comparable to the effort to promote renewable electricity in the European Union may be both justified and necessary

  8. 77 FR 22691 - Fees on Health Insurance Policies and Self-Insured Plans for the Patient-Centered Outcomes...

    Science.gov (United States)

    2012-04-17

    ... 1545-BK59 Fees on Health Insurance Policies and Self-Insured Plans for the Patient-Centered Outcomes... certain health insurance policies and plan sponsors of certain self-insured health plans to fund the... health insurance policies) or R. Lisa Mojiri-Azad at (202) 622-6080 (regarding self- insured health...

  9. 77 FR 72721 - Fees on Health Insurance Policies and Self-Insured Plans for the Patient-Centered Outcomes...

    Science.gov (United States)

    2012-12-06

    ... 1545-BK59 Fees on Health Insurance Policies and Self-Insured Plans for the Patient-Centered Outcomes... Patient Protection and Affordable Care Act on issuers of certain health insurance policies and plan... arrangements) or Rebecca L. Baxter at (202) 622-3970 (regarding health insurance policies). SUPPLEMENTARY...

  10. Improving Pain Care with Project ECHO in Community Health Centers.

    Science.gov (United States)

    Anderson, Daren; Zlateva, Ianita; Davis, Bennet; Bifulco, Lauren; Giannotti, Tierney; Coman, Emil; Spegman, Douglas

    2017-10-01

    Pain is an extremely common complaint in primary care, and patient outcomes are often suboptimal. This project evaluated the impact of Project ECHO Pain videoconference case-based learning sessions on knowledge and quality of pain care in two Federally Qualified Health Centers. Quasi-experimental, pre-post intervention, with comparison group. Two large, multisite federally qualified health centers in Connecticut and Arizona. Intervention (N = 10) and comparison (N = 10) primary care providers. Primary care providers attended 48 weekly Project ECHO Pain sessions between January and December 2013, led by a multidisciplinary pain specialty team. Surveys and focus groups assessed providers' pain-related knowledge and self-efficacy. Electronic health record data were analyzed to evaluate opioid prescribing and specialty referrals. Compared with control, primary care providers in the intervention had a significantly greater increase in pain-related knowledge and self-efficacy. Providers who attended ECHO were more likely to use formal assessment tools and opioid agreements and refer to behavioral health and physical therapy compared with control providers. Opioid prescribing decreased significantly more among providers in the intervention compared with those in the control group. Pain is an extremely common and challenging problem, particularly among vulnerable patients such as those cared for at the more than 1,200 Federally Qualified Health Centers in the United States. In this study, attendance at weekly Project ECHO Pain sessions not only improved knowledge and self-efficacy, but also altered prescribing and referral patterns, suggesting that knowledge acquired during ECHO sessions translated into practice changes. © 2017 American Academy of Pain Medicine.

  11. Brazil: improved environmental policy in spite of the financial crisis

    International Nuclear Information System (INIS)

    Kasa, Sjur; Naess, Lars Otto

    2002-01-01

    Globalization is often thought of as being associated with increasing environmental problems. In particular this is true in connection with dramatic financial crises. Experience from the financial crisis in Brazil in 1998 to 1999, however, shows a more varied picture in which parts of the environmental policy were indeed improved. The article also discusses how representative the example of Brazil might be for generalization and points out that the reaction of Brazil on the financial crisis was mitigated by that country being a strong democracy with robust institutions

  12. The impact of managed care and current governmental policies on an urban academic health care center.

    Science.gov (United States)

    Rodriguez, J L; Peterson, D J; Muehlstedt, S G; Zera, R T; West, M A; Bubrick, M P

    2001-10-01

    Managed care and governmental policies have restructured hospital reimbursement. We examined reimbursement trends in trauma care to assess the impact of this market driven change on an urban academic health center. Patients injured between January 1997 and December 1999 were analyzed for Injury Severity Score (ISS), length of hospital stay, hospital cost, payer, and reimbursement. Between 1997 and 1999, the volume of patients with an ISS less than 9 increased and length of stay decreased. In addition, overall cost, payment, and profit margin increased. Commercially insured patients accounted for this margin increase, because the margins of managed care and government insured patients experienced double-digit decreases. Patients with ISS of 9 or greater also experienced a volume increase and a reduction in length of stay; however, costs within this group increased greater than payments, thereby reducing profit margin. Whereas commercially insured patients maintained their margin, managed care and government insured patients did not (double- and triple-digit decreases). Managed care and current governmental policies have a negative impact on urban academic health center reimbursement. Commercial insurers subsidize not only the uninsured but also the government insured and managed care patients as well. National awareness of this issue and policy action are paramount to urban academic health centers and may also benefit commercial insurers.

  13. Improving the transition of care in patients transferred through the ochsner medical center transfer center.

    Science.gov (United States)

    Amedee, Ronald G; Maronge, Genevieve F; Pinsky, William W

    2012-01-01

    Patient transfers from other hospitals within the Ochsner Health System to the main campus are coordinated through a Transfer Center that was established in fall 2008. We analyzed the transfer process to assess distinct opportunities to enhance the overall transition of patient care. We surveyed internal medicine residents and nocturnists to determine their satisfaction with transfers in terms of safety, efficiency, and usefulness of information provided at the time of transfer. After a kaizen event at which complementary goals for the institution and members of the study team were recognized and implemented, we resurveyed the group to evaluate improvement in the transfer process. The preintervention average satisfaction score was 1.18 (SD=0.46), while the postintervention score was 3.7 (SD=1.01). A t test showed a significant difference in the average scores between the preintervention and postintervention surveys (Pkaizen event), data were collected that facilitated fewer and higher quality handoffs that were performed in less time. In addition, the process resulted in increased awareness of the value of resident participation in institutional quality improvement projects.

  14. Toward a Better Union: Improving the Effectiveness of Foreign Policies

    Science.gov (United States)

    2014-06-01

    Montville, “Foreign Policy According to Freud ,” Foreign Policy no. 45 (Winter) (1981), 155. 325 Chigas, Track Two (Citizen) Diplomacy. 326 See Jeri...Joseph Montville. “Foreign Policy According to Freud .” Foreign Policy no. 45 (Winter) (1981): 145-157. Di, He. The Great Powers in East Asia - 1953-1960

  15. Improving of State Regional Policy Mechanism at Risks` Conditions

    Directory of Open Access Journals (Sweden)

    Roman Tarasovich Lukysha

    2015-10-01

    Full Text Available Modernization and innovatization were defined as the ways of improvement of the state policy of regional development from the safety perspective. They stipulate the following: 1 avoidance of the possible risks of the development of regions providing for the refusal of the unreliable programs and projects, unreasonable taking on credit and other kinds of loans; 2 risk sharing and convergence, as well as the reduction of their influence on the results of administrative activity; 3 determination and prevention of negative effect of risks. It was offered to carry out the improvement of the state policy of the development of regions with the help of the forming of stable organizational and informational network and system. It was specified that the difference between the latter is in the fact that the organizational and informational system concerns the financial side of administrative activity in regions. This means that it ensures the observance of the principle of transparency. While the organizational and informational network reflects its procedural side with the concept of openness being the basis of such activity. The improvement of the procedure of the organization of state administration of risks of the regional development was proved. It was established that organization of the state administration of the risks of regions development has a form of a chain: “provision of power and powers to the public authority → establishment of the new structural unit or addition of the existing administrative formations, approval of the functional regulations, official duties, etc. → competitive selection of the officials, their training, retraining, consulting → performance by them of the direct tasks on the detection and the prevention of the negative influence of dangers and threats.”

  16. Faculty development to improve teaching at a health sciences center: a needs assessment.

    Science.gov (United States)

    Scarbecz, Mark; Russell, Cynthia K; Shreve, Robert G; Robinson, Melissa M; Scheid, Cheryl R

    2011-02-01

    There has been increasing interest at health science centers in improving the education of health professionals by offering faculty development activities. In 2007-08, as part of an effort to expand education-related faculty development offerings on campus, the University of Tennessee Health Science Center surveyed faculty members in an effort to identify faculty development activities that would be of interest. Factor analysis of survey data indicated that faculty interests in the areas of teaching and learning can be grouped into six dimensions: development of educational goals and objectives, the use of innovative teaching techniques, clinical teaching, improving traditional teaching skills, addressing teaching challenges, and facilitating participation. There were significant differences in the level of interest in education-related faculty development activities by academic rank and by the college of appointment. Full professors expressed somewhat less interest in faculty development activities than faculty members of lower ranks. Faculty members in the Colleges of Medicine and Dentistry expressed somewhat greater interest in faculty development to improve traditional teaching skills. The policy implications of the survey results are discussed, including the need for faculty development activities that target the needs of specific faculty groups.

  17. Improving flight condition situational awareness through Human Centered Design.

    Science.gov (United States)

    Craig, Carol

    2012-01-01

    In aviation, there is currently a lack of accurate and timely situational information, specifically weather data, which is essential when dealing with the unpredictable complexities that can arise while flying. For example, weather conditions that require immediate evasive action by the flight crew, such as isolated heavy rain, micro bursts, and atmospheric turbulence, require that the flight crew receive near real-time and precise information about the type, position, and intensity of those conditions. Human factors issues arise in considering how to display the various sources of weather information to the users of that information and how to integrate this display into the existing environment. In designing weather information display systems, it is necessary to meet the demands of different users, which requires an examination of the way in which the users process and use weather information. Using Human Centered Design methodologies and concepts will result in a safer, more efficient and more intuitive solution. Specific goals of this approach include 1) Enabling better fuel planning; 2) Allowing better divert strategies; 3) Ensuring pilots, navigators, dispatchers and mission planners are referencing weather from the same sources; 4) Improving aircrew awareness of aviation hazards such as turbulence, icing, hail and convective activity; 5) Addressing inconsistent availability of hazard forecasts outside the United States Air Defense Identification Zone (ADIZ); and 6) Promoting goal driven approaches versus event driven (prediction).

  18. FLEXIBLE AND IMPROVED IMPLEMENTATION OF THE EUROPEAN NEIGHBOURHOOD POLICY

    Directory of Open Access Journals (Sweden)

    Marcela SLUSARCIUC

    2014-10-01

    Full Text Available The European Neighbourhood Policy is at crossroads meaning that the actual frame of geopolitical movements imposes a new reshaping mainly on the Eastern side caused by the Ukraine issue. The implementation of the ENP through the European Neighbourhood Partnership Instrument, financial umbrella for the Joint Operational Programmes (JOPs, is already a challenging exercise for the Member States working together with the Partner Countries in order to develop an area of prosperity and good neighbourliness. This paper proposes a pack of features and recommendations arisen from the experiences gained by the implementation bodies of the JOPs along the European Union Eastern border, beneficiaries and other experts in cross-border cooperation. The main issues approached aim the improvement of the future cross-border programmes in terms of flexibility, transparency and efficiency: stakeholders consultation all along the programme cycle, a new mix of funding sources, gradual involvement of new types of beneficiaries and programme evaluation.

  19. Survey of Policies and Guidelines on Antioxidant Use for Cancer Prevention, Treatment, and Survivorship in North American Cancer Centers: What Do Institutions Perceive as Evidence?

    Science.gov (United States)

    Hong, Gyeongyeon; White, Jennifer; Zhong, Lihong; Carlson, Linda E

    2015-07-01

    Health care policies and guidelines that are clear and consistent with research evidence are important for maximizing clinical outcomes. To determine whether cancer centers in Canada and the United States had policies and/or guidelines about antioxidant use, and whether policies were aligned with the evidence base, we reviewed current research evidence in the field, and we undertook a survey of the policies and guidelines on antioxidant use at cancer institutions across North America. A survey of policies and guidelines on antioxidant use and the development and communication of the policies and guidelines was conducted by contacting cancer institutions in North America. We also conducted a Website search for each institution to explore any online resources. Policies and guidelines on antioxidant use were collected from 78 cancer institutions. Few cancer institutions had policies (5%) but most provided guidelines (69%). Antioxidants from diet were generally encouraged at cancer institutions, consistent with the current research evidence. In contrast, specific antioxidant supplements were generally not recommended at cancer institutions. Policies and guidelines were developed using evidence-based methods (53%), by consulting another source (35%), or through discussions/conference (26%), and communicated mainly through online resources (65%) or written handouts (42%). For cancer institutions that had no policy or guideline on antioxidants, lack of information and lack of time were the most frequently cited reasons. Policies and guidelines on antioxidants from diet were largely consistent with the research evidence. Policies and guidelines on antioxidant supplements during treatment were generally more restrictive than the research evidence might suggest, perhaps due to the specificity of results and the inability to generalize findings across antioxidants, adding to the complexity of their optimal and safe use. Improved communication of comprehensive research

  20. Improving health through policies that promote active travel

    DEFF Research Database (Denmark)

    de Nazelle, Audrey; Nieuwenhuijsen, Mark J; Antó, Josep M

    2011-01-01

    Substantial policy changes to control obesity, limit chronic disease, and reduce air pollution emissions, including greenhouse gasses, have been recommended. Transportation and planning policies that promote active travel by walking and cycling can contribute to these goals, potentially yielding...

  1. Toward a better union: improving the effectiveness of foreign policies

    OpenAIRE

    Bradshaw, Daniel J.

    2014-01-01

    Approved for public release; distribution is unlimited A fundamental characteristic of state-state interaction in a globalized system is the explicitness with which states communicate their foreign policies to each other. In order to understand the role and the importance of foreign policy explicitness in the global foreign policy system, I first created a simple mesh model of the actors and institutions that form the U.S. foreign policy system. By optimizing this model with various system...

  2. 77 FR 47573 - Fees on Health Insurance Policies and Self-Insured Plans for the Patient-Centered Outcomes...

    Science.gov (United States)

    2012-08-09

    ... DEPARTMENT OF THE TREASURY Internal Revenue Service 26 CFR Parts 40 and 46 [REG-136008-11] RIN 1545-BK59 Fees on Health Insurance Policies and Self-Insured Plans for the Patient-Centered Outcomes... on issuers of certain health insurance policies and plan sponsors of certain self-insured health...

  3. Policy improvement by a model-free Dyna architecture.

    Science.gov (United States)

    Hwang, Kao-Shing; Lo, Chia-Yue

    2013-05-01

    The objective of this paper is to accelerate the process of policy improvement in reinforcement learning. The proposed Dyna-style system combines two learning schemes, one of which utilizes a temporal difference method for direct learning; the other uses relative values for indirect learning in planning between two successive direct learning cycles. Instead of establishing a complicated world model, the approach introduces a simple predictor of average rewards to actor-critic architecture in the simulation (planning) mode. The relative value of a state, defined as the accumulated differences between immediate reward and average reward, is used to steer the improvement process in the right direction. The proposed learning scheme is applied to control a pendulum system for tracking a desired trajectory to demonstrate its adaptability and robustness. Through reinforcement signals from the environment, the system takes the appropriate action to drive an unknown dynamic to track desired outputs in few learning cycles. Comparisons are made between the proposed model-free method, a connectionist adaptive heuristic critic, and an advanced method of Dyna-Q learning in the experiments of labyrinth exploration. The proposed method outperforms its counterparts in terms of elapsed time and convergence rate.

  4. Alcohol Control Policies in 46 African Countries: Opportunities for Improvement.

    Science.gov (United States)

    Ferreira-Borges, Carina; Esser, Marissa B; Dias, Sónia; Babor, Thomas; Parry, Charles D H

    2015-07-01

    There is little information on the extent to which African countries are addressing alcohol consumption and alcohol-related harm, which suggests that evaluations of national alcohol policies are needed in this region. The aim of this article is to examine the strength of a mix of national alcohol control policies in African countries, as well as the relationship between alcohol policy restrictiveness scores and adult alcohol per capita consumption (APC) among drinkers at the national level. We examined national alcohol policies of 46 African countries, as of 2012, in four regulatory categories (price, availability, marketing and drink-driving), and analyzed the restrictiveness of national alcohol policies using an adapted Alcohol Policy Index (API). To assess the validity of the policy restrictiveness scores, we conducted correlational analyses between policy restrictiveness scores and APC among drinkers in 40 countries. Countries attained a mean score of 44.1 of 100 points possible, ranging from 9.1 (Sao Tomé and Principe) to 75.0 (Algeria), with low scores indicating low policy restrictiveness. Policy restrictiveness scores were negatively correlated with and APC among drinkers (rs = -0.353, P = 0.005). There is great variation in the strength of alcohol control policies in countries throughout the African region. Tools for comparing the restrictiveness of alcohol policies across countries are available and are an important instrument to monitor alcohol policy developments. The negative correlation between policy restrictiveness and alcohol consumption among drinkers suggests the need for stronger alcohol policies as well as increased training and capacity building at the country level. © The Author 2015. Medical Council on Alcohol and Oxford University Press. All rights reserved.

  5. Stakeholder engagement for improved school policy: development and implementation.

    Science.gov (United States)

    2010-01-01

    The health and education departments of government share a responsibility for promoting the health of children through policies in the school setting. These policies can be enhanced through the involvement of such stakeholders as school personnel, students, parents or caregivers, health professionals, the non-profit sector and industry. Although there is little evidence-based literature on the roles of stakeholders in school policy development and implementation, stakeholder involvement appears to be critical throughout the policy process. This article discusses stakeholder involvement in the development and implementation of school policies that promote and support healthy eating and physical activity. Canadian examples illustrate stakeholder engagement in this context.

  6. Health at the center of health systems reform: how philosophy can inform policy.

    Science.gov (United States)

    Sturmberg, Joachim P; Martin, Carmel M; Moes, Mark M

    2010-01-01

    Contemporary views hold that health and disease can be defined as objective states and thus should determine the design and delivery of health services. Yet health concepts are elusive and contestable. Health is neither an individual construction, a reflection of societal expectations, nor only the absence of pathologies. Based on philosophical and sociological theory, empirical evidence, and clinical experience, we argue that health has simultaneously objective and subjective features that converge into a dynamic complex-adaptive health model. Health (or its dysfunction, illness) is a dynamic state representing complex patterns of adaptation to body, mind, social, and environmental challenges, resulting in bodily homeostasis and personal internal coherence. The "balance of health" model-emergent, self-organizing, dynamic, and adaptive-underpins the very essence of medicine. This model should be the foundation for health systems design and also should inform therapeutic approaches, policy decision-making, and the development of emerging health service models. A complex adaptive health system focused on achieving the best possible "personal" health outcomes must provide the broad policy frameworks and resources required to implement people-centered health care. People-centered health systems are emergent in nature, resulting in locally different but mutually compatible solutions across the whole health system.

  7. Threats to the Sustainability of the Outsourced Call Center Industry in the Philippines: Implications for Language Policy

    Science.gov (United States)

    Friginal, Eric

    2009-01-01

    This study overviews current threats to the sustainability of the outsourced call center industry in the Philippines and discusses implications for macro and micro language policies given the use of English in this cross-cultural interactional context. This study also summarizes the present state of outsourced call centers in the Philippines, and…

  8. The potential conflict between policy and ethics in caring for undocumented immigrants at academic health centers.

    Science.gov (United States)

    Cacari Stone, Lisa; Steimel, Leah; Vasquez-Guzman, Estela; Kaufman, Arthur

    2014-04-01

    Academic health centers (AHCs) are at the forefront of delivering care to the diverse medically underserved and uninsured populations in the United States, as well as training the majority of the health care workforce, who are professionally obligated to serve all patients regardless of race or immigration status. Despite AHCs' central leadership role in these endeavors, few consolidated efforts have emerged to resolve potential conflicts between national, state, and local policies that exclude certain classifications of immigrants from receiving federal public assistance and health professionals' social missions and ethical oath to serve humanity. For instance, whereas the 2010 Patient Protection and Affordable Care Act provides a pathway to insurance coverage for more than 30 million Americans, undocumented immigrants and legally documented immigrants residing in the United States for less than five years are ineligible for Medicaid and excluded from purchasing any type of coverage through state exchanges. To inform this debate, the authors describe their experience at the University of New Mexico Hospital (UNMH) and discuss how the UNMH has responded to this challenge and overcome barriers. They offer three recommendations for aligning AHCs' social missions and professional ethics with organizational policies: (1) that AHCs determine eligibility for financial assistance based on residency rather than citizenship, (2) that models of medical education and health professions training provide students with service-learning opportunities and applied community experience, and (3) that frontline staff and health care professionals receive standardized training on eligibility policies to minimize discrimination towards immigrant patients.

  9. Healthy caregivers-healthy children (HC2) phase 2: Integrating culturally sensitive childhood obesity prevention strategies into childcare center policies.

    Science.gov (United States)

    Messiah, Sarah E; Lebron, Cynthia; Moise, Rhoda; Sunil Mathew, M; Sardinas, Krystal; Chang, Catherina; Palenzuela, Joanne; Walsh, Jennifer; Shelnutt, Karla P; Spector, Rachel; Altare, Fiorella; Natale, Ruby

    2017-02-01

    Despite the high prevalence of obesity among preschool-aged children, most states lack childcare center (CCC) nutrition and physical activity policies. The Healthy Caregivers, Healthy Children (HC) Phase 2 project is examining the relationship between the CCC nutrition and physical activity environment and child dietary intake/physical activity patterns and body mass index (BMI). A total of 24 "Quality Counts" (Miami Dade County, Florida's Quality Rating Improvement System [QRIS)]) CCCs serving low resource families with ≥50 2-to-5year olds attending have been randomized to either intervention (n=12) or control (n=12). The HC2 intervention arm CCCs receive implementation of a daily curricula for (1) teachers/parents; (2) children; (3) snack, beverage, physical activity, and screen time policies; and (4) technical assistance with menu modifications. Control arm schools receive an attention control safety curriculum. HC2 is delivered once a month in year 1, quarterly in year 2 and will be disseminated throughout the Quality Counts network in year 3. Primary outcome measures include the Environment and Policy Assessment and Observation tool (EPAO), standardized dietary intake and physical activity patterns surveys, and child BMI. The 'Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM)' framework will guide the interpretation of outcome measures. CCCs are in need of evidence-based standardized nutrition and physical activity policies. The intersection of RE-AIM and early childhood obesity prevention in the childcare setting could generate robust and new information to the field about potential barriers, facilitators, adoption, and sustainability in this setting. Copyright © 2016 Elsevier Inc. All rights reserved.

  10. Common pathways toward informing policy and environmental strategies to promote health: a study of CDC's Prevention Research Centers.

    Science.gov (United States)

    Neri, Elizabeth M; Stringer, Kate J; Spadaro, Antonia J; Ballman, Marie R; Grunbaum, Jo Anne

    2015-03-01

    This study examined the roles academic researchers can play to inform policy and environmental strategies that promote health and prevent disease. Prevention Research Centers (PRCs) engage in academic-community partnerships to conduct applied public health research. Interviews were used to collect data on the roles played by 32 PRCs to inform policy and environmental strategies that were implemented between September 2009 and September 2010. Descriptive statistics were calculated in SAS 9.2. A difference in roles played was observed depending on whether strategies were policy or environmental. Of the policy initiatives, the most common roles were education, research, and partnership. In contrast, the most prevalent roles the PRCs played in environmental approaches were research and providing health promotion resources. Academic research centers play various roles to help inform policy and environmental strategies. © 2014 Society for Public Health Education.

  11. Recent Improvements in IERS Rapid Service/Prediction Center Products

    National Research Council Canada - National Science Library

    Stamatakos, N; Luzum, B; Wooden, W

    2007-01-01

    ...) at USNO has made several improvements to its combination and pre- diction products. These improvements are due to the inclusion of new input data sources as well as modifications to the combination and prediction algorithms...

  12. Servicom policy intervention: Improving service quality in Nigerian ...

    African Journals Online (AJOL)

    In this case study we examine the raison d'être and implementation of a policy intervention, which was promulgated in 2005 for the purpose of eradicating inefficiency and corruption, and inculcating customer orientation in the Nigerian public sector. The policy goes by the acronym 'SERVICOM' -'service compact with all ...

  13. School Policies and Practices that Improve Indoor Air Quality

    Science.gov (United States)

    Jones, Sherry Everett; Smith, Alisa M.; Wheeler, Lani S.; McManus, Tim

    2010-01-01

    Background: To determine whether schools with a formal indoor air quality management program were more likely than schools without a formal program to have policies and practices that promote superior indoor air quality. Methods: This study analyzed school-level data from the 2006 School Health Policies and Programs Study, a national study of…

  14. 78 FR 45231 - Medicare and Medicaid Programs; Initial Approval of Center for Improvement in Healthcare Quality...

    Science.gov (United States)

    2013-07-26

    ... DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services [CMS-3280-FN] Medicare and Medicaid Programs; Initial Approval of Center for Improvement in Healthcare Quality's (CIHQ's) Hospital Accreditation Program AGENCY: Centers for Medicare and Medicaid Services, HHS. ACTION: Final...

  15. Improved custom statistics visualization for CA Performance Center data

    CERN Document Server

    Talevi, Iacopo

    2017-01-01

    The main goal of my project is to understand and experiment the possibilities that CA Performance Center (CA PC) offers for creating custom applications to display stored information through interesting visual means, such as maps. In particular, I have re-written some of the network statistics web pages in order to fetch data from new statistics modules in CA PC, which has its own API, and stop using the RRD data.

  16. Baselining the New GSFC Information Systems Center: The Foundation for Verifiable Software Process Improvement

    Science.gov (United States)

    Parra, A.; Schultz, D.; Boger, J.; Condon, S.; Webby, R.; Morisio, M.; Yakimovich, D.; Carver, J.; Stark, M.; Basili, V.; hide

    1999-01-01

    This paper describes a study performed at the Information System Center (ISC) in NASA Goddard Space Flight Center. The ISC was set up in 1998 as a core competence center in information technology. The study aims at characterizing people, processes and products of the new center, to provide a basis for proposing improvement actions and comparing the center before and after these actions have been performed. The paper presents the ISC, goals and methods of the study, results and suggestions for improvement, through the branch-level portion of this baselining effort.

  17. [Patient-centered care. Improvement of communication between university medical centers and general practitioners for patients in neuro-oncology].

    Science.gov (United States)

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

    2015-12-01

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

  18. Policy Forum Improving the screening and treatment of hypertension ...

    African Journals Online (AJOL)

    2008-12-27

    Dec 27, 2008 ... advantages and disadvantages associated with screening and referral. Policy Option 3: ... Skill-building approaches such as training with healthcare workers or .... Science and Technology, Grand Challenges Canada and.

  19. servicom policy intervention: improving service quality in nigerian ...

    African Journals Online (AJOL)

    Admin

    customer orientation in the Nigerian public sector. The policy goes by ..... Graham Effect' (Arnold, Cooper and Robertson,. 1995). .... system and budgeting time and money to pursue services ... customer relationships, and facilitating a safe and.

  20. Outcome Evaluation of a Policy-Mandated Lifestyle and Environmental Modification Program in a National Job Training Center.

    Science.gov (United States)

    Jimenez, Elizabeth Yakes; Harris, Amanda; Luna, Donald; Velasquez, Daniel; Slovik, Jonathan; Kong, Alberta

    2017-06-01

    Excess weight gain is common when adolescents become young adults, but there are no obesity prevention or weight management interventions that have been tested for emerging adults who follow non-traditional post-secondary paths, such as enrolling in job training programs. We evaluated Healthy Eating & Active Lifestyles (HEALs), a policy-mandated lifestyle education/environmental modification program, at a job training center for low-income 16-24 year olds. We examined average change in body mass index (BMI) z-score from baseline to 6 months for emerging adults (aged 16-24 years) in pre-HEALs implementation (n = 125) and post-HEALs implementation (n = 126) cohorts living at the job training center, by baseline weight status. In both cohorts, average BMI z-score significantly increased from baseline to 6 months for students with BMI < 25. Average BMI z-score significantly decreased for the overweight (BMI 25 to <30; -0.11, p = .03) and obese (BMI ≥ 30; -0.11, p = .001) students only within the post-HEALs cohort; changes within the pre-HEALs cohort and between cohorts were not significant. HEALs may promote positive weight-related trends for overweight/obese students, but prevention efforts for non-overweight/obese students need to be improved.

  1. CDC's Prevention Status Reports: Monitoring the Status of Public Health Policies and Practices for Improved Performance and Accountability.

    Science.gov (United States)

    Young, Andrea C; Lowry, Garry; Mumford, Karen; Graaf, Christine

    Increasing the adoption and implementation of evidence-based policies and practices is a key strategy for improving public health. Although there is widespread agreement about the importance of implementing evidence-based public health policies and practices, there are gaps between what has been shown to be effective and what is implemented at the state level. The Centers for Disease Control and Prevention (CDC) developed the Prevention Status Reports (PSRs), a performance measurement system, to highlight evidence-based public health policies and practices and catalyze state performance and quality improvement efforts across the nation. CDC selected a set of 10 topics representing some of the most important public health challenges in the nation. Stakeholders, including state health departments and other partners, helped conceptualize the PSRs and informed the development of the PSR framework, which provides an organizational structure for the system. CDC subject matter experts developed criteria for selecting policies and practices, indicators for each policy and practice, and a criteria-based rating system for each indicator. The PSRs were developed for all 50 states and the District of Columbia. The PSRs were developed and serve as a performance measurement system for monitoring the adoption, reach, and implementation fidelity of evidence-based public health policies and practices nationwide. The PSRs include 33 policy and practice indicators across the 10 health topics. They use a simple 3-level rating system-green, yellow, and red-to report the extent to which each state (and the District of Columbia) has implemented the policy or practice in accordance with supporting evidence or expert recommendations. Results from aggregate analyses show positive change or improvement. The PSRs are a unique part of CDC's work to improve the performance and accountability of the public health system, serving as both a monitoring tool and a call to action to improve health

  2. The Hardwood Tree Improvement and Regeneration Center: its strategic plans for sustaining the hardwood resource

    Science.gov (United States)

    Charles H. Michler; Michael J. Bosela; Paula M. Pijut; Keith E. Woeste

    2003-01-01

    A regional center for hardwood tree improvement, genomics, and regeneration research, development and technology transfer will focus on black walnut, black cherry, northern red oak and, in the future, on other fine hardwoods as the effort is expanded. The Hardwood Tree Improvement and Regeneration Center (HTIRC) will use molecular genetics and genomics along with...

  3. Continuous quality improvement in the ambulatory endoscopy center.

    Science.gov (United States)

    Johanson, John F

    2002-04-01

    What does quality assessment have to do with the practicing gastroenterologist? Why should one spend the time and effort to incorporate CQI activities into an already busy practice? First and foremost, quality improvement should directly benefit the patient by ensuring that they receive the highest quality of care possible. For example, comparing endoscopic use or outcomes, such as procedure success or complications, with national standards or other endoscopists in the same community may identify physicians who could benefit from additional training. Similar analyses may likewise identify outstanding physicians who might serve as resources for other physicians. Surveys of patient satisfaction may reveal deficiencies, which might be unknown to a physician who is otherwise technically excellent; deficiencies that would never have been uncovered by traditional measures of quality. Second, applying the techniques of CQI to study one's own practice can provide a competitive edge when vying for managed care or corporate contracts. In this regard, CQI can be used to document physician or practice performance through tracking of endoscopic use, procedure success and complication rates, and patient satisfaction. Finally, the rising concern among various patient advocacy groups has led to an increased emphasis on quality improvement, and in most cases it is a required activity as part of the accreditation process. Steps to quality improvement There is more to quality improvement than simply selecting and implementing a performance improvement plan. A number of steps have been suggested to achieve fundamental improvement in the quality of medical care [3]. The first is to use outcomes management for improvement rather than for judgment. One of the major criticisms of QA is that it will be used to judge physicians providing care. It is feared that CQI will be used to identify poor performers who will then be punished. This strategy leads to fear and inhibits an honest pursuit

  4. Changing structure to improve function: one academic health center's experience.

    Science.gov (United States)

    Alexander, B; Davis, L; Kohler, P O

    1997-04-01

    Academic health centers (AHCs) have been under siege for the past few years, with decreased federal and state funding for educational and research programs and increasing competition in the health care marketplace. In addition, many AHCs are burdened with the bureaucratic red tape of large educational institutions, which makes agility in responding to a demanding health care market difficult. The authors describe the response to these threats by Oregon Health Sciences University (OHSU), an approach that has been different from those of most similar institutions. OHSU chose to change its structure from being part of the state system of higher education to being an independent public corporation. The authors outline the political process of building widespread support for the legislation passed in 1995, the key features of the restructuring, the challenges faced before and after the transition to a public corporation, and lessons learned in this metamorphosis to a new form.

  5. Improving hospital weekend handover: a user-centered, standardised approach.

    Science.gov (United States)

    Mehra, Avi; Henein, Christin

    2014-01-01

    Clinical Handover remains one of the most perilous procedures in medicine (1). Weekend handover has emerged as a key area of concern with high variability in handover processes across hospitals (1,2,4, 5-10). Studying weekend handover processes within medicine at an acute teaching hospital revealed huge variability in documented content and structure. A total of 12 different pro formas were in use by the medical day-team to handover to the weekend team on-call. A Likert-survey of doctors revealed 93% felt the current handover system needed improvement with 71% stating that it did not ensure patient safety (Chi-squared, p-value RCP) guidelines (2), with direct end-user input. Results following implementation revealed a considerable improvement in documented ceiling of care, urgency of task and team member assignment with 100% uptake of the new proforma at both 4-week and 6-month post-implementation analyses. 88% of doctors surveyed perceived that the new proforma improved patient safety (p<0.01, n=25), with 62% highlighting that it allowed doctors to work more efficiently. Results also revealed that 44% felt further improvements were needed and highlighted electronic solutions and handover training as main priorities. Handover briefing was subsequently incorporated into junior doctor induction and education modules delivered, with good feedback. Following collaboration with key stakeholders and with end-user input, integrated electronic handover software was designed and funding secured. The software is currently under final development. Introducing a standardized handover proforma can be an effective initial step in improving weekend handover. Handover education and end-user involvement are key in improving the process. Electronic handover solutions have been shown to significantly increase the quality of handover and are worth considering (9, 10).

  6. Modified Vivaldi antenna with improved gain and phase center stability

    DEFF Research Database (Denmark)

    Zhang, Shuai

    2016-01-01

    A modified Vivaldi antenna is proposed with improved gain and phase centre stability. By applying a high permittivity dielectric substrate, the realized gain is enlarged while maintaining the compactness of the designed antenna. With a redistributed comb-shape corrugation the phase centre stabili...... of the antenna is significantly improved. The designed modified Vivaldi antenna covers the lower UWB band of 3.1-5 GHz with a realized gain higher than 10 dBi. A stable phase centre and radiation patterns over the operating band are realized....

  7. Abuja workshop calls for evidence-based policies to improve ...

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

    2016-10-17

    Oct 17, 2016 ... Innovative interventions to improve maternal and child health in Nigeria were ... identify gaps and recommend solutions to improve health services in the country. ... Using home visits and educational entertainment to improve ...

  8. Improving healthcare recruitment: the jupiter medical center experience.

    Science.gov (United States)

    Uomo, Paul Dell; Schwieters, Jill

    2009-04-01

    Hospitals that want to improve their recruitment efforts should: Make recruitment a priority within the organization. Take steps to reduce high vacancy rates and turnover among first-year employees. Develop a recruitment marketing plan for key positions. Establish human resources metrics to track costs and effectiveness of recruiting efforts. Enhance the recruitment process for hiring managers and job candidates.

  9. The Centers of Strategic Research of Foreign Policy of the Republic of Turkey: the General Characteristic and Stages of Functioning

    Directory of Open Access Journals (Sweden)

    Алим Видадиевич Сулейманов

    2010-12-01

    Full Text Available Changes and complication of an existing international political situation provide new challenges for diplomacy of every state. During making of foreign policy decisions complete and deep understanding of a subject of policy is required. Because of this matter in many countries of the world there are special nongovernmental organizations that provide the qualitative analysis of internal and foreign politics situation. In the given article the centers of strategic research which are carrying out the analysis of foreign policy of Turkish Republic are characterized. Their structure, level and scale of expertise and also stages of functioning are analyzed.

  10. Towards improved policy processes for promoting innovation in renewable electricity technologies in the UK

    International Nuclear Information System (INIS)

    Foxon, T.J.; Pearson, P.J.G.

    2007-01-01

    This paper analyses recent, current and potential future relations between policy processes and substantive outcomes in UK low carbon innovation policy, focussing on policies relating to renewable electricity generation technologies. It examines the development of policy processes relating to the adoption and implementation of the Renewables Obligation and how these may affect the current and likely future success of the Obligation in promoting low carbon innovation. It examines the new policy and institutional processes put in place in the 2003 Energy White Paper and argues that these are unlikely to provide the strategic long-term framework needed to realise the ambitious goals for UK energy policy set out in the White Paper. Finally, it outlines some suggestions for further development of policy processes to facilitate improved delivery of these goals, based on guiding principles for sustainable innovation policy processes, developed by the authors and their colleagues

  11. Handling Practicalities in Agricultural Policy Optimization for Water Quality Improvements

    Science.gov (United States)

    Bilevel and multi-objective optimization methods are often useful to spatially target agri-environmental policy throughout a watershed. This type of problem is complex and is comprised of a number of practicalities: (i) a large number of decision variables, (ii) at least two inte...

  12. German Bowel Cancer Center: An Attempt to Improve Treatment Quality

    Directory of Open Access Journals (Sweden)

    Olof Jannasch

    2015-01-01

    Full Text Available Background. Colorectal cancer remains the second most common cause of death from malignancies, but treatment results show high diversity. Certified bowel cancer centres (BCC are the basis of a German project for improvement of treatment. The aim of this study was to analyze if certification would enhance short-term outcome in rectal cancer surgery. Material and Methods. This quality assurance study included 8197 patients with rectal cancer treated between 1 January 2008 and 31 December 2010. We compared cohorts treated in certified and noncertified hospitals regarding preoperative variables and perioperative outcomes. Outcomes were verified by matched-pair analysis. Results. Patients of noncertified hospitals had higher ASA-scores, higher prevalence of risk factors, more distant metastases, lower tumour localization, lower frequency of pelvic MRI, and higher frequencies of missing values and undetermined TNM classifications (significant differences only. Outcome analysis revealed more general complications in certified hospitals (20.3% versus 17.4%, p=0.03. Both cohorts did not differ significantly in percentage of R0-resections, intraoperative complications, anastomotic leakage, in-hospital death, and abdominal wall dehiscence. Conclusions. The concept of BCC is a step towards improving the structural and procedural quality. This is a good basis for improving outcome quality but cannot replace it. For a primary surgical disease like rectal cancer a specific, surgery-targeted program is still needed.

  13. An Improved Distribution Policy with a Maintenance Aspect for an Urban Logistic Problem

    Directory of Open Access Journals (Sweden)

    Nadia Ndhaief

    2017-07-01

    Full Text Available In this paper, we present an improved distribution plan supporting an urban distribution center (UDC to solve the last mile problem of urban freight. This is motivated by the need of UDCs to satisfy daily demand in time under a high service level in allocated urban areas. Moreover, these demands could not be satisfied in individual cases because the delivery rate can be less than daily demand and/or affected by random failure or maintenance actions of vehicles. The scope of our work is to focus on a UDC, which needs to satisfy demands in a finite horizon. To that end, we consider a distribution policy on two sequential plans, a distribution plan correlated to a maintenance plan using a subcontracting strategy with several potential urban distribution centers (UDCs and performing preventive maintenance to ensure deliveries for their allocated urban area. The choice of subcontractor will depend on distance, environmental and availability criteria. In doing so, we define a mathematical model for searching the best distribution and maintenance plans using a subcontracting strategy. Moreover, we consider delay for the next periods with an expensive penalty. Finally, we present a numerical example illustrating the benefits of our approach.

  14. Strategies for improving family engagement during family-centered rounds.

    Science.gov (United States)

    Kelly, Michelle M; Xie, Anping; Carayon, Pascale; DuBenske, Lori L; Ehlenbach, Mary L; Cox, Elizabeth D

    2013-04-01

    Family-centered rounds (FCR) are recommended as standard practice in the pediatric inpatient setting; however, limited data exist on best practices promoting family engagement during rounds. To identify strategies to enhance family engagement during FCR using a recognized systems engineering approach. In this qualitative study, stimulated recall interviews using video-recorded rounding sessions were conducted with participants representing the various stakeholders on rounds (15 parents/children and 22 healthcare team [HCT] members) from 4 inpatient services at a children's hospital in Wisconsin. On video review, participants were asked to provide strategies that would increase family engagement on FCR. Qualitative content analysis of interview transcripts was performed in an iterative process. We identified 21 categories of strategies corresponding to 2 themes related to the structure and process of FCR. Strategies related to the structure of FCR were associated with all five recognized work system elements: people (HCT composition), tasks (HCT roles), organization (scheduling of rounds and HCT training), environment (location of rounds and HCT positioning), and tools and technologies (computer use). Strategies related to the FCR process were associated with three rounding phases: before (HCT and family preparation), during (eg, introductions, presentation content, communication style), and after (follow-up) FCR. We identified a range of strategies to enhance family engagement during FCR. These strategies both confirm prior work on the importance of the content and style of communication on rounds and highlight other factors within the hospital work system, like scheduling and computer use, which may affect family engagement in care. Copyright © 2013 Society of Hospital Medicine.

  15. Hospital-Acquired Pressure Ulcers at Academic Medical Centers in the United States, 2008-2012: Tracking Changes Since the CMS Nonpayment Policy.

    Science.gov (United States)

    Padula, William V; Makic, Mary Beth F; Wald, Heidi L; Campbell, Jonathan D; Nair, Kavita V; Mishra, Manish K; Valuck, Robert J

    2015-06-01

    In 2007, the Centers for Medicare & Medicaid Services (CMS) announced its intention to no longer reimburse hospitals for costs associated with hospital-acquired pressure ulcers (HAPUs) and a list of other hospital-acquired conditions (HACs), which was followed by enactment of the nonpayment policy in October 2008. This study was conducted to define changes in HAPU incidence and variance since 2008. In a retrospective observational study, HAPU cases were identified at 210 University HealthSystem Consortium (UHC) academic medical centers in the United States. HAPU incidence rates were calculated as a ratio of HAPU cases to the total number of UHC inpatients between the first quarter of 2008 and the second quarter of 2012. HAPU cases were defined by multiple criteria: not present on admission (POA); coded for stage III or IV pressure ulcers; and a length of stay greater than four days. Among the UHC hospitals between 2008 and June 2012, 10,386 HAPU cases were identified among 4.08 million inpatients. The HAPU incidence rate decreased significantly from 11.8 cases per 1,000 inpatients in 2008 to 0.8 cases per 1,000 in 2012 (p CMS non-payment policy as a significant covariate of changing trends in HAPU incidence rates. HAPU incidence rates decreased significantly among 210 UHC AMCs after the enactment of the CMS nonpayment policy. The hospitals appeared to be reacting efficiently to economic policy incentives by improving prevention efforts.

  16. Policy Options for the Improvement of the European Patent System

    DEFF Research Database (Denmark)

    Schovsbo, Jens Hemmingsen; Cowin, Robin; Van de Eijck, Wim

    2007-01-01

    , the Working Group recognizes that the protection and enforcement of the rights of inventors through the patent system must be done in a manner to stimulate innovation and the diffusion of knowledge. In order to propose meaningful policy options that meet these objectives as much as possible, the evidence put......The present report is based on an independent, policy-oriented investigation of the current European patent system. The central premise of the report is that the patent system has so far been a positive factor in promoting innovation and the diffusion of knowledge, and thus that the system...... is contributing in a constructive way to economic and social welfare objectives. In acknowledging the importance of the patent system in relation to many aspects of society, it is also essential to continually evaluate whether the system is working as effectively as it could be. In addition, because of some...

  17. Can a District-Level Teacher Salary Incentive Policy Improve Teacher Recruitment and Retention? Policy Brief 13-4

    Science.gov (United States)

    Hough, Heather J.; Loeb, Susanna

    2013-01-01

    In this policy brief, Heather Hough and Susanna Loeb examine the effect of the Quality Teacher and Education Act of 2008 (QTEA) on teacher recruitment, retention, and overall teacher quality in the San Francisco Unified School District (SFUSD). They provide evidence that a salary increase can improve a school district's attractiveness within their…

  18. Batch Policy Gradient Methods for Improving Neural Conversation Models

    OpenAIRE

    Kandasamy, Kirthevasan; Bachrach, Yoram; Tomioka, Ryota; Tarlow, Daniel; Carter, David

    2017-01-01

    We study reinforcement learning of chatbots with recurrent neural network architectures when the rewards are noisy and expensive to obtain. For instance, a chatbot used in automated customer service support can be scored by quality assurance agents, but this process can be expensive, time consuming and noisy. Previous reinforcement learning work for natural language processing uses on-policy updates and/or is designed for on-line learning settings. We demonstrate empirically that such strateg...

  19. Global Goal Setting for Improving National Governance and Policy

    NARCIS (Netherlands)

    Biermann, F.; Stevens, C.; Bernstein, S.; Gupta, A.; Kanie, N.; Nilsson, M.; Scobie, M.

    2017-01-01

    Can better governance, in itself, be a subject for global goal setting? This question stands at the center of this chapter, which focuses on the inclusion of “governance goals” in global goal-setting mechanisms, especially the Sustainable Development Goals agreed upon by the UN General Assembly in

  20. Patient-centered medical homes improve care for adults with chronic conditions.

    Science.gov (United States)

    Pourat, Nadereh; Lavarreda, Shana Alex; Snyder, Sophie

    2013-05-01

    The success of health care reform implementation in 2014 partly depends on more efficient delivery of care to the millions of California residents eligible to gain insurance. Emerging evidence supports the effectiveness of the patient-centered medical home (PCMH) as a potential model of care delivery, which improves health outcomes and reduces costs. Among other principles, PCMH entails receipt of care from a personal doctor, who coordinates the patient's care and develops an individualized treatment plan for the patient. These principles are particularly essential in delivery of care to those with chronic conditions who require more intensive care management. Using the 2009 California Health Interview Survey (CHIS 2009), this policy brief indicates that patients who reported meeting these fundamental PCMH principles were more likely to have visited the doctor and to have received flu shots, and they also had better communication with providers than those who did not report meeting these PCMH principles. The data also showed that uninsured individuals, Medi-Cal beneficiaries, those at or below 133% of the federal poverty level, Latinos, and Asian-Americans were less likely to report meeting all three PCMH principles. These findings highlight the population groups that would most benefit from the PCMH care delivery model, particularly Medi-Cal beneficiaries and those eligible for Covered California, the California health benefits exchange.

  1. Expanding Public/Private Partnerships For Improving Basic Education through School Sponsorship in the Dominican Republic. Final Report. Basic Education and Policy Support Activity.

    Science.gov (United States)

    Craig, Patricia; Kane, Michael

    The Basic Education and Policy Support Activity (BEPS), a new five-year initiative sponsored by United States Agency for International Development's (USAID) Center for Human Capacity Development, is designed to improve the quality, effectiveness, and access to formal and nonformal basic education. BEPS operates through both core funds and buy-ins…

  2. Emergency department overcrowding: Quality improvement in a Taiwan Medical Center.

    Science.gov (United States)

    Hsu, Chen-Mei; Liang, Li-Lin; Chang, Yun-Te; Juang, Wang-Chuan

    2018-04-14

    Overcrowding of hospital emergency departments (ED) is a worldwide health problem. The Taiwan Joint Commission on Hospital Accreditation has stressed the importance of finding solutions to overcrowding, including, reducing the number of patients with >48 h stay in the ED. Moreover, the Ministry of Health and Welfare aims at transferring non-critical patients to district or regional hospitals. We report the results of our Quality Improvement Project (QIP) on ED overcrowding, especially focusing on reducing length of stay (LOS) in ED. For QIP, the following 3 action plans were initiated: 1) Changing the choice architecture of patients' willingness to transfer from opt-in to opt-out; 2) increasing the turnover rate of beds and daily monitoring of the number of free beds for boarding ED patients; 3) reevaluation of patients with a LOS of >32 h after the morning shift. Transfer rates increased minimally after implementation of this project, but the sample size was too small to achieve statistical significance. No significant increase was observed in the number of free medical beds, but discharge rates after 12 pm decreased significantly (p 32 h were reevaluated first. After QIP, the proportion of LOSs of >48 h dropped significantly. Changing the choice architecture may require further systemic effort and a longer observation duration. Higher-level administrators will need to formulate a more comprehensive bed management plan to speed up the turnover rate of free inpatient beds. Copyright © 2018. Published by Elsevier B.V.

  3. Improving policy responses to the risk of air pollution.

    Science.gov (United States)

    Rabl, Ari; Nathwani, Jatin; Pandey, Mahesh; Hurley, Fintan

    2007-02-01

    This paper offers a brief review of the need for cost-benefit analysis (CBA) and the available policy instruments for air pollution. To prioritize different possible actions, one needs to know which source of pollution causes how much damage. This requires an impact pathway analysis, that is, an analysis of the chain emission --> dispersion --> dose-response function --> monetary valuation. The methodology for this is described and illustrated with the results of the ExternE (External Costs of Energy) project series of the European Commission. Two examples of an application to CBA are shown: one where a proposed reduction of emission limits is justified, and one where it is not. It is advisable to subject any proposed regulation to a CBA, including an analysis of the uncertainties. Even if the uncertainties are large and a policy decision may have to take other considerations into account, a well-documented CBA clarifies the issues and provides a basis for rational discussion. One of the main sources of uncertainty lies in the monetary valuation of premature mortality, the dominant contribution to the damage cost of air pollution. As an alternative, an innovative policy tool is described, the Life Quality Index (LQI), a compound indicator comprising societal wealth and life expectancy. It is applied to the Canada-wide standards for particulate matter and ozone. Regardless of monetary valuation, a 50% reduction of PM10 concentrations in Europe and North America has been shown to yield a population-average life expectancy increase on the order of 4 to 5 mo.

  4. A formal communication process: Pathway to improved policy making

    International Nuclear Information System (INIS)

    Benson, A.; Robison, A.C.; Seidler, P.E.

    1993-01-01

    This paper will examine the efforts made and the steps taken by the US DOE's Office of Civilian Radioactive Waste Management (DOE/OCRWM) to establish and keep open lines of communication with officials in Nye County, Nevada, the location of Yucca Mountain, the site of a proposed high-level nuclear waste repository. These efforts include creating policies and procedures for conducting oversight of the Yucca Mountain Site Characterization Project (YMP), as well as developing programs for engaging in technical studies, requests for impact assistance and financial assistance, and ensuring there's a continuous flow of information to the residents of Nevada

  5. Continuous Improvement in Schools and Districts: Policy Considerations

    Science.gov (United States)

    Best, Jane; Dunlap, Allison

    2014-01-01

    Discussions about improving public education often focus on outcomes without considering how schools and districts can accomplish those outcomes. Research shows that using a continuous improvement process has proven successful in healthcare, manufacturing, and technology, and may hold potential for use in education as well. This brief defines and…

  6. How Can Placement Policy Improve Math Remediation Outcomes? Evidence from Experimentation in Community Colleges

    Science.gov (United States)

    Ngo, Federick; Melguizo, Tatiana

    2016-01-01

    Changing placement policy may help to improve developmental education student outcomes in community colleges, but there is little understanding of the impacts of these reforms. We take advantage of heterogeneous placement policy in a large urban community college district in California to compare the effects of math remediation under different…

  7. A Peer-to-Peer Mentoring Program for In-Center Hemodialysis: A Patient-Centered Quality Improvement Program.

    Science.gov (United States)

    St Clair Russell, Jennifer; Southerland, Shiree; Huff, Edwin D; Thomson, Maria; Meyer, Klemens B; Lynch, Janet R

    2017-01-01

    A patient-centered quality improvement program implemented in one Virginia hemodialysis facility sought to determine if peer-to-peer (P2P) programs can assist patients on in-center hemodialysis with self-management and improve outcomes. Using a single-arm, repeatedmeasurement, quasi-experimental design, 46 patients participated in a four-month P2P intervention. Outcomes include knowledge, self-management behaviors, and psychosocial health indicators: self-efficacy, perceived social support, hemodialysis social support, and healthrelated quality of life (HRQoL). Physiological health indicators included missed and shortened treatments, arteriovenous fistula placement, interdialytic weight gain, serum phosphorus, and hospitalizations. Mentees demonstrated increased knowledge, self-efficacy, perceived social support, hemodialysis social support, and HRQoL. Missed treatments decreased. Mentors experienced increases in knowledge, self-management, and social support. A P2P mentoring program for in-center hemodialysis can benefit both mentees and mentors. Copyright© by the American Nephrology Nurses Association.

  8. Suggestions of Policy Direction to Improve the Housing Quality in South Korea

    Directory of Open Access Journals (Sweden)

    Miyeon Park

    2016-05-01

    Full Text Available Following the recent global climate changes, many countries, including developed nations, are announcing greenhouse gas (GHG reduction targets and are actively participating in reducing GHG. Therefore, the role of the building sector on reducing GHG is being emphasized, and the establishment of policy structures for both making environmentally friendly capacity compulsory and improving the housing quality is being demanded. South Korea is also developing a policy for improving housing quality, but in order to achieve more competitive growth, this must be preceded by an analysis of current policy status within various countries on improving housing quality. This study aims to suggest direction about policies that will improve the housing quality in South Korea. For this, the policies of major countries were able to categorize and compare according to three major categories (performance, function, and aesthetics, and seven factors (safety, durability, cost and maintenance, response to residents’ needs, habitability, energy saving, and building design regarding housing quality. As a result, from the performance aspect, policy directions were suggested for safe housing, the urban environment, regeneration of quality stock, and the usage of existing stock; from the functional aspect, policies for improving housing quality that responds to the aging population and energy saving housing were suggested; from the aesthetic aspect, housing designs that consider the urban environment were suggested.

  9. Reducing the Number of Uninsured Children: Outreach and Enrollment Efforts. Testimony of Donna Cohen Ross, Center on Budget and Policy Priorities, before the Senate Finance Committee.

    Science.gov (United States)

    Ross, Donna Cohen

    This testimony of Donna Cohen Ross describes the Center on Budget and Policy Priorities' work to reduce the number of uninsured children. The Center specializes in programs and policies affecting low- and moderate-income families, including issues related to health coverage for the uninsured. It works with many groups on strategies to identify…

  10. Symptomatic improvement reported after receiving Reiki at a cancer infusion center.

    Science.gov (United States)

    Marcus, Dawn A; Blazek-O'Neill, Betsy; Kopar, Jennifer L

    2013-03-01

    To evaluate patient-perceived benefits from receiving Reiki at a cancer infusion center. During a 6-month period, adults at a university hospital receiving Reiki through volunteer services were invited to complete a survey asking about perceived changes after Reiki. Changes in pain, mood, distress, sleep, and appetite were rated on a 5-point scale from no benefit to great benefit. Surveys were distributed after completing treatment and were returned in postage-paid envelops. A total of 145 surveys were completed (34.5% response rate), with 47 participants seen in the cancer infusion center and 98 in other areas of the hospital. Reiki was rated as a positive experience by 94% at the cancer center and 93% of others, with 92% at the cancer center and 86% of others interested in receiving additional Reiki sessions. Symptomatic improvement was similar for people at the cancer center and others, respectively, with much to great improvement for 89% and 86% for relaxation, 75% and 75% for anxiety/worry, 81% and 78% for improved mood, 43% and 35% for improved sleep, 45% and 49% for reduced pain, 38% and 43% for reduced isolation/loneliness, 75% and 63% for improved attitude, and 30% and 30% for improved appetite. Response was unaffected by previous exposure to Reiki, massage, or other touch therapy. Reiki results in a broad range of symptomatic benefits, including improvements in common cancer-related symptoms.

  11. Compensation in Swedish infrastructure projects and suggestions on policy improvements

    Directory of Open Access Journals (Sweden)

    Jesper Persson

    2015-07-01

    Full Text Available Environmental compensation includes a range of activities intended to counterbalance such negative impacts of development projects that remain in the environment after all preventive and corrective measures have been fully implemented. Sweden, being a member state of the European Union (EU, must implement environmental compensation under EU directives such as the Habitat Directive. However, like in other countries, implementation is not yet widespread in Sweden, and new practices and guidelines remain to be developed both nationally and at European level. This need is all the more urgent considering that the European Commission estimates that, within the EU, about 100,000 hectares of land is converted from its natural state each year. The aim of this paper is to describe current environmental-compensation practices in Swedish road and railway projects and to discuss issues of vital importance to the development of compensation policy, such as what to compensate for, how much, and how. A national inventory was performed, for the first time in Sweden, to identify compensation measures in road and railway projects. Data were collected from a national mailing list including 141 officials at county administrative boards (CABs, internal e-mail correspondence within the Swedish Transport Administration and databases of court decisions. The inventory focused on compensation measures ordered by virtue of the Swedish Environmental Code. In addition, two case studies were carried out to investigate the planning of compensation measures. The results showed that CABs and courts rarely order compensation in infrastructure projects, even though this is possible under Swedish law. Between 1999 and 2012, 37 cases (i.e. permits issued were found for which compensation was ordered. Of these cases, 76% concerned compensation for encroachments on minor habitats such as small ponds and cairns. No CAB ordered compensation for non-protected areas. Compensation ratios

  12. Abuja workshop calls for evidence-based policies to improve ...

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

    2016-09-21

    17 oct. 2016 ... Innovative interventions to improve maternal and child health in Nigeria were the focus of a workshop in Abuja on September 21, 2016. Nigeria has the second highest absolute number of maternal deaths and perinatal deaths in the world, contributing to approximately 15% of all maternal deaths worldwide.

  13. Policies to improve biomass-electricity generation in Brazil

    International Nuclear Information System (INIS)

    Coelho, Suani T.; Bolognini, Marly F.; Zylbersztajn, David

    1999-01-01

    Electricity consumption in Brazil has grown twice from 1979 to 1994 and, for the future, official forecasts estimate high risks of deficit. Brazilian generation system presents highly seasonal characteristics due to its hydroelectric origin and sugar cane origin electricity could be used as complementation for the dry period, instead of conventional thermoelectric power plants, with the corresponding environmental advantages. Nowadays, most sugar/alcohol industries in the state of Sao Paulo are energy self-sufficient and some of them already export a small electricity surplus to the grid. The potential for such surplus is significant, moreover with the introduction of more efficient technologies, but prices are not yet attractive when compared to conventional market prices, besides the existing barriers related to the current legislation. On the other hand, existing studies show that more efficient technologies become competitive when externalities are included. This paper analyses worthing methodologies, externalities-based decisions and policy mechanisms to guide governments, planners, decision-makers and managers in the correct evaluation of bioenergy use and production faced to other alternatives. (Author)

  14. 78 FR 16679 - Center for Drug Evaluation and Research Medical Policy Council; Request for Comments

    Science.gov (United States)

    2013-03-18

    ... consistent, predictable communication of medical policy decisions to the public through guidance, notice and... protection, (6) bioresearch monitoring, (7) good clinical practice, (8) counter-terrorism drug development...

  15. Quality Improvement Initiative in School-Based Health Centers across New Mexico

    Science.gov (United States)

    Booker, John M.; Schluter, Janette A.; Carrillo, Kris; McGrath, Jane

    2011-01-01

    Background: Quality improvement principles have been applied extensively to health care organizations, but implementation of quality improvement methods in school-based health centers (SBHCs) remains in a developmental stage with demonstration projects under way in individual states and nationally. Rural areas, such as New Mexico, benefit from the…

  16. Evaluating the Improvement of Sustainability of Sports Industry Policy Based on MADM

    Directory of Open Access Journals (Sweden)

    Kuang-Hua Hu

    2016-06-01

    Full Text Available The influence of globalization on sports has turned out to be a popular issue widely discussed by researchers. Improvement to the sustainability of sports industry policy is an important and challenging issue, and related are inherently multiple attribute decision making (MADM problems that can be strategically important to economic systems. The purpose of this study is to set up a new sustainability sports industry policy evaluation model that addresses the main causal factors and amends the priorities. A MADM model is combined with DEMATEL, DANP, and VIKOR for the evaluation and improvement of the sustainability of sports industry policy. The improvement priorities according to the domain expert interviews are in the following order: promotion and assistance of government policy (A, sports venues and facilities (D, enterprise sponsorship of sports quality (E, expert human resources (B, and finally sports competitions and events (C.

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

    Science.gov (United States)

    May, Jonathan

    2006-01-01

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

  18. The mobilize center: an NIH big data to knowledge center to advance human movement research and improve mobility.

    Science.gov (United States)

    Ku, Joy P; Hicks, Jennifer L; Hastie, Trevor; Leskovec, Jure; Ré, Christopher; Delp, Scott L

    2015-11-01

    Regular physical activity helps prevent heart disease, stroke, diabetes, and other chronic diseases, yet a broad range of conditions impair mobility at great personal and societal cost. Vast amounts of data characterizing human movement are available from research labs, clinics, and millions of smartphones and wearable sensors, but integration and analysis of this large quantity of mobility data are extremely challenging. The authors have established the Mobilize Center (http://mobilize.stanford.edu) to harness these data to improve human mobility and help lay the foundation for using data science methods in biomedicine. The Center is organized around 4 data science research cores: biomechanical modeling, statistical learning, behavioral and social modeling, and integrative modeling. Important biomedical applications, such as osteoarthritis and weight management, will focus the development of new data science methods. By developing these new approaches, sharing data and validated software tools, and training thousands of researchers, the Mobilize Center will transform human movement research. © The Author 2015. Published by Oxford University Press on behalf of the American Medical Informatics Association.

  19. Comparative effectiveness of quality improvement interventions for pressure ulcer prevention in academic medical centers in the United States.

    Science.gov (United States)

    Padula, William V; Makic, Mary Beth F; Mishra, Manish K; Campbell, Jonathan D; Nair, Kavita V; Wald, Heidi L; Valuck, Robert J

    2015-06-01

    Prevention of pressure ulcers, one of the hospital-acquired conditions (HACs) targeted by the 2008 nonpayment policy of the Centers for Medicare & Medicaid Services (CMS), is a critical issue. This study was conducted to determine the comparative effectiveness of quality improvement (QI) interventions associated with reduced hospital-acquired pressure ulcer (HAPU) rates. In an quasi-experimental design, interrupted time series analyses were conducted to determine the correlation between HAPU incidence rates and adoption of QI interventions. Among University HealthSystem Consortium hospitals, 55 academic medical centers were surveyed from September 2007 through February 2012 for adoption patterns of QI interventions for pressure ulcer prevention, and hospital-level data for 5,208 pressure ulcer cases were analyzed. Between- and within-hospital reduction significance was tested with t-tests post-CMS policy intervention. Fifty-three (96%) of the 55 hospitals used QI interventions for pressure ulcer prevention. The effect size analysis identified five effective interventions that each reduced pressure ulcer rates by greater than 1 case per 1,000 patient discharges per quarter: leadership initiatives, visual tools, pressure ulcer staging, skin care, and patient nutrition. The greatest reductions in rates occurred earlier in the adoption process (pprevention protocol for pressure ulcers. Hospitals can not only use these findings from this study as part of a QI bundle for preventing HAPUs.

  20. Adoption and Design of Emerging Dietary Policies to Improve Cardiometabolic Health in the US.

    Science.gov (United States)

    Huang, Yue; Pomeranz, Jennifer; Wilde, Parke; Capewell, Simon; Gaziano, Tom; O'Flaherty, Martin; Kersh, Rogan; Whitsel, Laurie; Mozaffarian, Dariush; Micha, Renata

    2018-04-14

    Suboptimal diet is a leading cause of cardiometabolic disease and economic burdens. Evidence-based dietary policies within 5 domains-food prices, reformulation, marketing, labeling, and government food assistance programs-appear promising at improving cardiometabolic health. Yet, the extent of new dietary policy adoption in the US and key elements crucial to define in designing such policies are not well established. We created an inventory of recent US dietary policy cases aiming to improve cardiometabolic health and assessed the extent of their proposal and adoption at federal, state, local, and tribal levels; and categorized and characterized the key elements in their policy design. Recent federal dietary policies adopted to improve cardiometabolic health include reformulation (trans-fat elimination), marketing (mass-media campaigns to increase fruits and vegetables), labeling (Nutrition Facts Panel updates, menu calorie labeling), and food assistance programs (financial incentives for fruits and vegetables in the Supplemental Nutrition Assistance Program (SNAP) and Women, Infant and Children (WIC) program). Federal voluntary guidelines have been proposed for sodium reformulation and food marketing to children. Recent state proposals included sugar-sweetened beverage (SSB) taxes, marketing restrictions, and SNAP restrictions, but few were enacted. Local efforts varied significantly, with certain localities consistently leading in the proposal or adoption of relevant policies. Across all jurisdictions, most commonly selected dietary targets included fruits and vegetables, SSBs, trans-fat, added sugar, sodium, and calories; other healthy (e.g., nuts) or unhealthy (e.g., processed meats) factors were largely not addressed. Key policy elements to define in designing these policies included those common across domains (e.g., level of government, target population, dietary target, dietary definition, implementation mechanism), and domain-specific (e.g., media channels

  1. Air Quality in Mexico City: Policies Implemented for its Improvement

    Science.gov (United States)

    Paramo, V.

    2007-12-01

    Ozone and suspended particles (PM) are two pollutants in the atmosphere of Mexico City Metropolitan Area (MCMA) that still exceed the recommended Mexican health standards. The other criteria pollutants very seldom exceed their corresponding standards. In 2006, the maximum ozone concentrations were above the health standard (0.11 ppm in 1 hour) during 59 percent of the days for an average of 2.2 hours and 130 points of the Air Quality Index (Índice Metropolitano de la Calidad del Aire - IMECA). In contrast, in 1991, 98 percent of the days exceeded the ozone health standard for an average of 6.6 hours and 200 IMECA points. With regards to PM10, in 2006, 80 percent of the sampled concentrations were below the health standard of 120 µg/m3 in 24 hours. However, the annual health standard of 50 µg/m3 is still exceeded. The air quality management in the MCMA is a difficult task due to several adverse factors. The main one is the large population that increased from nearly 15 million in 1992 to more than 18 million at present. As a result, the urban area grows in the adjoined municipalities of the State of Mexico. The vehicular fleet increases also to almost 4 million and the number of industrial facilities is at present 50,000. Consequently, the fuel consumption is very high. The daily energy consumption is estimated to be 44 million liters of equivalent of gasoline. Despite the fact that the air quality has improved in recent years, the related health standards are still exceeded and therefore it is necessary to continue applying the most cost-effective actions to improve the environment quality. Some actions that have contributed most to the reduction of pollutant emissions are the following: Continuous update of the inspection and maintenance program of the vehicular fleet; substitution of the catalytic converters at the end of their useful life; self-regulation of the diesel fleet; use of alternative fuels; update the No-Driving-Day program; establishment of more

  2. Patient-Centered Prescription Model to improve therapeutic adherence in patients with multimorbidity

    Directory of Open Access Journals (Sweden)

    Javier González-Bueno

    2018-05-01

    Full Text Available To date, interventions to improve medication adherence in patients with multimorbidity have shown modest and inconsistent efficacy among available studies. Thereby, we should define new approaches aimed at improving medication adherence tailored to effective prescribing, with a multidisciplinary approach and patient-centered. In this regard, the Patient-Centered Prescription Model has shown its usefulness on improving appropriateness of drug treatments in patients with clinical complexity. For that, this strategy addresses the following four steps: 1 Patient-Centered assessment; 2 Diagnosis-Centered assessment; 3 Medication-Centered assessment; and 4 Therapeutic Plan. We propose through a clinical case an adaptation of the Patient-Centered Prescription Model to enhance both appropriateness and medication adherence in patients with multimorbidity. To this end, we have included on its first step the Spanish version of a cross-culturally adapted scale for the multidimensional assessment of medication adherence. Furthermore, we suggest a set of interventions to be applied in the three remaining steps of the model. These interventions were firstly identified by an overview of systematic reviews and then selected by a panel of experts based on Delphi methodology. All of these elements have been considered appropriate in patients with multimorbidity according to three criteria: strength of their supporting evidence, usefulness in the target population and feasibility of implementation in clinical practice. The proposed approach intends to lay the foundations for an innovative way in tackling medication adherence in patients with multimorbidity.

  3. Increasing Internal Stakeholder Consensus about a University Science Center's Outreach Policies and Procedures

    Science.gov (United States)

    Fisher, Richard D.

    For decades the United States has tried to increase the number of students pursuing science, technology, engineering, and mathematics (STEM) education and careers. Educators and policy makers continue to seek strategies to increase the number of students in the STEM education pipeline. Public institutions of higher education are involved in this effort through education and public outreach (EPO) initiatives. Arizona State University opened its largest research facility, the new Interdisciplinary Science and Technology Building IV (ISTB4) in September, 2012. As the new home of the School of Earth & Space Exploration (SESE), ISTB4 was designed to serve the school's dedication to K-12 education and public outreach. This dissertation presents a menu of ideas for revamping the EPO program for SESE. Utilizing the Delphi method, I was able to clarify which ideas would be most supported, and those that would not, by a variety of important SESE stakeholders. The study revealed that consensus exists in areas related to staffing and expansion of free programming, whereas less consensus exist in the areas of fee-based programs. The following most promising ideas for improving the SESE's EPO effort were identified and will be presented to SESE's incoming director in July, 2013: (a) hire a full-time director, theater manager, and program coordinator; (b) establish a service-learning requirement obligating undergraduate SESE majors to serve as docent support for outreach programs; (c) obligate all EPO operations to advise, assist, and contribute to the development of curricula, activities, and exhibits; (d) perform a market and cost analysis of other informational education venues offering similar programming; (3) establish a schedule of fee-based planetarium and film offerings; and (f) create an ISTB4 centric, fee-based package of programs specifically correlated to K12 education standards that can be delivered as a fieldtrip experience.

  4. Increasing Use of Research Findings in Improving Evidence-Based Health Policy at the National Level

    Directory of Open Access Journals (Sweden)

    Meiwita Budiharsana

    2017-11-01

    Full Text Available In February 2016, the Minister of Health decided to increase the use of research findings in improving the quality of the national health policy and planning. The Ministry of Health has instructed the National Institute of Health Research and Development or NIHRD to play a stronger role of monitoring and evaluating all health programs, because “their opinion and research findings should be the basis for changes in national health policies and planning”. Compared to the past, the Ministry of Health has increased the research budget for evidence-based research tremendously. However, there is a gap between the information needs of program and policy-makers and the information offered by researchers. A close dialogue is needed between the users (program managers, policy makers and planners and the suppliers (researchers and evaluators to ensure that the evidence-based supplied by research is useful for programs, planning and health policy.

  5. Improving Academic Outcomes for Disadvantaged Students: Scaling up Individualized Tutorials. Policy Proposal 2016-02

    Science.gov (United States)

    Ander, Roseanna; Guryan, Jonathan; Ludwig, Jens

    2016-01-01

    Improving the educational outcomes of economically disadvantaged children is a policy priority in the United States, and yet relatively little progress has been made in recent decades. Education reforms that aim to help economically disadvantaged students often focus on improving the quality with which grade-level material is taught, or the…

  6. Going the Extra Mile: Improved Survival for Pancreatic Cancer Patients Traveling to High-volume Centers.

    Science.gov (United States)

    Lidsky, Michael E; Sun, Zhifei; Nussbaum, Daniel P; Adam, Mohamed A; Speicher, Paul J; Blazer, Dan G

    2017-08-01

    This study compares outcomes following pancreaticoduodenectomy (PD) for patients treated at local, low-volume centers and those traveling to high-volume centers. Although outcomes for PD are superior at high-volume institutions, not all patients live in proximity to major medical centers. Theoretical advantages for undergoing surgery locally exist. The 1998 to 2012 National Cancer Data Base was queried for T1-3N0-1M0 pancreatic adenocarcinoma patients who underwent PD. Travel distances to treatment centers were calculated. Overlaying the upper and lower quartiles of travel distance with institutional volume established short travel/low-volume (ST/LV) and long travel/high-volume (LT/HV) cohorts. Overall survival was evaluated. Of 7086 patients, 773 ST/LV patients traveled ≤6.3 (median 3.2) miles to centers performing ≤3.3 PDs yearly, and 758 LT/HV patients traveled ≥45 (median 97.3) miles to centers performing ≥16 PDs yearly. LT/HV patients had higher stage disease (P travel to a high-volume center remained associated with reduced long-term mortality (hazard ratio 0.75, P travel burden, patients treated at high-volume centers had improved perioperative outcomes, short-term mortality, and overall survival. These data support ongoing efforts to centralize care for patients undergoing PD.

  7. Public say food regulatory policies to improve health in Western Australia are important: population survey results

    OpenAIRE

    Pollard, Christina M; Daly, Alison; Moore, Michael; Binns, Colin W

    2013-01-01

    Objective To investigate the level of support among Western Australian adults for food control policies to improve diet, reduce obesity and protect the environment. Methods Attitudes towards government food control policies on food labelling, food advertising, and the supply of environmentally friendly food data were pooled from two Nutrition Monitoring Survey Series telephone surveys of 2,147 adults aged 18?64 years collected in 2009 and 2012. Descriptive and logistic regression analyses wer...

  8. Evaluation of an improved technique for automated center lumen line definition in cardiovascular image data

    International Nuclear Information System (INIS)

    Gratama van Andel, Hugo A.F.; Meijering, Erik; Vrooman, Henri A.; Stokking, Rik; Lugt, Aad van der; Monye, Cecile de

    2006-01-01

    The aim of the study was to evaluate a new method for automated definition of a center lumen line in vessels in cardiovascular image data. This method, called VAMPIRE, is based on improved detection of vessel-like structures. A multiobserver evaluation study was conducted involving 40 tracings in clinical CTA data of carotid arteries to compare VAMPIRE with an established technique. This comparison showed that VAMPIRE yields considerably more successful tracings and improved handling of stenosis, calcifications, multiple vessels, and nearby bone structures. We conclude that VAMPIRE is highly suitable for automated definition of center lumen lines in vessels in cardiovascular image data. (orig.)

  9. Increased Utilization of Primary Health Care Centers for Birthing Care in Tamil Nadu, India: A Visible Impact of Policies, Initiatives, and Innovations

    Science.gov (United States)

    Pandian, Jayanthi; Suresh, Saradha; Desikachari, B. R.; Padmanaban, P.

    2013-01-01

    Background: Tamil Nadu has been showing an increasing trend in institutional deliveries since early 1990's and has now achieved near 100%. Among the institutional deliveries, a change was observed since 2006, wherein primary health centers (PHCs) showed a four-fold increase in deliveries, while other public and private health facilities showed a decline, despite equal access to all categories of health facilities. What led to this increased utilization of PHCs for birthing care? Material and Methods: Policies, documents, and published reports of the Government of Tamil Nadu (GoTN) were reviewed and interviews were conducted with the various stakeholders involved in providing birthing care in the PHCs. This study analyzes the impact of the policies and supply side initiatives and innovations which led to increase utilization of the PHCs for birthing care. Results: Scaling up of 24 × 7 services in all PHCs, upgrading PHCs with good infrastructure, human resources, and women friendly services have helped to boost the image of the PHCs. Pro-women policies like maternity benefit schemes, birth companionship, providing food, and compulsory stay for 48 h following delivery have attracted women towards PHC. Innovative strategies like maternity picnics and use of expected date of delivery (EDD) chart for follow-up have made women choose PHCs, while periodic reviews and support to staff has improved service delivery. Conclusion: Women centered policies, efficient managerial systems, quality care, and innovative marketing of services have together contributed to increased utilization of PHCs for birthing. Other states could explore the possibility of replicating this model to make optimal use the PHC facilities. PMID:26664836

  10. Improvement of the center boring device for the irradiated fuel pellets

    Energy Technology Data Exchange (ETDEWEB)

    Usami, Koji; Onozawa, Atsushi; Kimura, Yasuhiko; Sakuraba, Naotoshi; Shiina, Hidenori; Harada, Akito; Nakata, Masahito [Japan Atomic Energy Agency, Nuclear Science Research Inst., Tokai, Ibaraki (Japan)

    2012-03-15

    The power ramp tests performed at JMTR in Oarai R and D Center are objected to study the safety margin of the high burnup fuels. One of the important parameters measured during this test is the center temperature of the fuel pellet. For this measurement, a thermocouple is installed into the hole bored at the pellet center by the center boring device, which can fix the fuel pellet with the frozen CO{sub 2} gas during its boring process. At the Reactor Fuel Examination Facility (RFEF) in Tokai R and D Center, several improvements were applied for the previous boring device to gain its performance and reliability. The major improvements are the change of the drill bit, modification of the boring process and the optimization of the remote operability. The mock-up test will be performed with the irradiated fuel pellet to confirm the benefit of improvement. This study was conducted under a contract with the Nuclear and Industrial Safety Agency (NISA) of the Ministry of Economy, Trade and Industry (METI). (author)

  11. Changes in chronic disease management among community health centers (CHCs) in China: Has health reform improved CHC ability?

    Science.gov (United States)

    Wang, Zhaoxin; Shi, Jianwei; Wu, Zhigui; Xie, Huiling; Yu, Yifan; Li, Ping; Liu, Rui; Jing, Limei

    2017-07-01

    Since the 1980s, China has been criticized for its mode of chronic disease management (CDM) that passively provides treatment in secondary and tertiary hospitals but lacks active prevention in community health centers (CHCs). Since there are few systematic evaluations of the CHCs' methods for CDM, this study aimed to analyze their abilities. On the macroperspective, we searched the literature in China's largest and most authoritative databases and the official websites of health departments. Literature was used to analyze the government's efforts in improving CHCs' abilities to perform CDM. At the microlevel, we examined the CHCs' longitudinal data after the New Health Reform in 2009, including financial investment, facilities, professional capacities, and the conducted CDM activities. A policy analysis showed that there was an increasing tendency towards government efforts in developing CDM, and the peak appeared in 2009. By evaluating the reform at CHCs, we found that there was an obvious increase in fiscal and public health subsidies, large-scale equipment, general practitioners, and public health physicians. The benefited vulnerable population in this area also rose significantly. However, rural centers were inferior in their CDM abilities compared with urban ones, and the referral system is still not effective in China. This study showed that CHCs are increasingly valued in managing chronic diseases, especially after the New Health Reform in 2009. However, we still need to improve collaborative management for chronic diseases in the community and strengthen the abilities of CHCs, especially in rural areas. Copyright © 2017 John Wiley & Sons, Ltd.

  12. Effects of a randomized intervention to improve workplace social capital in community health centers in China.

    Science.gov (United States)

    Sun, Xiaojie; Zhang, Nan; Liu, Kun; Li, Wen; Oksanen, Tuula; Shi, Lizheng

    2014-01-01

    To examine whether workplace social capital improved after implementing a workplace social capital intervention in community health centers in China. This study was conducted in 20 community health centers of similar size in Jinan of China during 2012-2013. Using the stratified site randomization, 10 centers were randomized into the intervention group; one center was excluded due to leadership change in final analyses. The baseline survey including 447 staff (response rate: 93.1%) was conducted in 2012, and followed by a six-month workplace social capital intervention, including team building courses for directors of community health centers, voluntarily public services, group psychological consultation, and outdoor training. The follow-up survey in July 2013 was responded to by 390 staff members (response rate: 86.9%). Workplace social capital was assessed with the translated and culturally adapted scale, divided into vertical and horizontal dimensions. The facility-level intervention effects were based on all baseline (n = 427) and follow-up (n = 377) respondents, except for Weibei respondents. We conducted a bivariate Difference-in-Difference analysis to estimate the facility-level intervention effects. No statistically significant intervention effects were observed at the center level; the intervention increased the facility-level workplace social capital, and its horizontal and vertical dimensions by 1.0 (p = 0.24), 0.4 (p = 0.46) and 0.8 (p = 0.16), respectively. The comprehensive intervention seemed to slightly improve workplace social capital in community health centers of urban China at the center level. High attrition rate limits any causal interpretation of the results. Further studies are warranted to test these findings.

  13. Developing Student-Centered Learning Model to Improve High Order Mathematical Thinking Ability

    Science.gov (United States)

    Saragih, Sahat; Napitupulu, Elvis

    2015-01-01

    The purpose of this research was to develop student-centered learning model aiming to improve high order mathematical thinking ability of junior high school students of based on curriculum 2013 in North Sumatera, Indonesia. The special purpose of this research was to analyze and to formulate the purpose of mathematics lesson in high order…

  14. 20 CFR 670.210 - How are center facility improvements and new construction handled?

    Science.gov (United States)

    2010-04-01

    ... 20 Employees' Benefits 3 2010-04-01 2010-04-01 false How are center facility improvements and new construction handled? 670.210 Section 670.210 Employees' Benefits EMPLOYMENT AND TRAINING ADMINISTRATION, DEPARTMENT OF LABOR THE JOB CORPS UNDER TITLE I OF THE WORKFORCE INVESTMENT ACT Site Selection and Protection...

  15. Fort Collins Science Center- Policy Analysis and Science Assistance Branch : Integrating social, behavioral, economic and biological sciences

    Science.gov (United States)

    2010-01-01

    The Fort Collins Science Center's Policy Analysis and Science Assistance (PASA) Branch is a team of approximately 22 scientists, technicians, and graduate student researchers. PASA provides unique capabilities in the U.S. Geological Survey by leading projects that integrate social, behavioral, economic, and biological analyses in the context of human-natural resource interactions. Resource planners, managers, and policymakers in the U.S. Departments of the Interior (DOI) and Agriculture (USDA), State and local agencies, as well as international agencies use information from PASA studies to make informed natural resource management and policy decisions. PASA scientists' primary functions are to conduct both theoretical and applied social science research, provide technical assistance, and offer training to advance performance in policy relevant research areas. Management and research issues associated with human-resource interactions typically occur in a unique context, involve difficult to access populations, require knowledge of both natural/biological science in addition to social science, and require the skill to integrate multiple science disciplines. In response to these difficult contexts, PASA researchers apply traditional and state-of-the-art social science methods drawing from the fields of sociology, demography, economics, political science, communications, social-psychology, and applied industrial organization psychology. Social science methods work in concert with our rangeland/agricultural management, wildlife, ecology, and biology capabilities. The goal of PASA's research is to enhance natural resource management, agency functions, policies, and decision-making. Our research is organized into four broad areas of study.

  16. User-centered design to improve clinical decision support in primary care.

    Science.gov (United States)

    Brunner, Julian; Chuang, Emmeline; Goldzweig, Caroline; Cain, Cindy L; Sugar, Catherine; Yano, Elizabeth M

    2017-08-01

    A growing literature has demonstrated the ability of user-centered design to make clinical decision support systems more effective and easier to use. However, studies of user-centered design have rarely examined more than a handful of sites at a time, and have frequently neglected the implementation climate and organizational resources that influence clinical decision support. The inclusion of such factors was identified by a systematic review as "the most important improvement that can be made in health IT evaluations." (1) Identify the prevalence of four user-centered design practices at United States Veterans Affairs (VA) primary care clinics and assess the perceived utility of clinical decision support at those clinics; (2) Evaluate the association between those user-centered design practices and the perceived utility of clinical decision support. We analyzed clinic-level survey data collected in 2006-2007 from 170 VA primary care clinics. We examined four user-centered design practices: 1) pilot testing, 2) provider satisfaction assessment, 3) formal usability assessment, and 4) analysis of impact on performance improvement. We used a regression model to evaluate the association between user-centered design practices and the perceived utility of clinical decision support, while accounting for other important factors at those clinics, including implementation climate, available resources, and structural characteristics. We also examined associations separately at community-based clinics and at hospital-based clinics. User-centered design practices for clinical decision support varied across clinics: 74% conducted pilot testing, 62% conducted provider satisfaction assessment, 36% conducted a formal usability assessment, and 79% conducted an analysis of impact on performance improvement. Overall perceived utility of clinical decision support was high, with a mean rating of 4.17 (±.67) out of 5 on a composite measure. "Analysis of impact on performance

  17. Improving Energy Efficiency Through Technology. Trends, Investment Behaviour and Policy Design

    Energy Technology Data Exchange (ETDEWEB)

    Florax, R.J.G.M. [Purdue University, West Lafayette, IN (United States); De Groot, H.L.F. [VU University, Amsterdam (Netherlands); Mulder, P. [Tinbergen Institute, Amsterdam (Netherlands)] (eds.)

    2011-10-15

    This innovative book explores the adoption of energy-saving technologies and their impact on energy efficiency improvements. It contains a mix of theoretical and empirical contributions, and combines and compares economic and physical indicators to monitor and analyse trends in energy efficiency. The authors pay considerable attention to empirical research on the determinants of energy-saving investment including uncertainty, energy-price volatility and subsidies. They also discuss the role of energy modelling in policy design and the potential effect of energy policies on technology diffusion in energy-extensive sectors. Written from a multi-disciplinary perspective, this book will appeal to academics and graduates in the areas of energy-saving technologies, energy economics and natural resource economics, as well as policy makers - particularly those in energy policy.

  18. Music, Policy, and Place-Centered Education: Finding Space for Adaptability

    Science.gov (United States)

    Schmidt, Patrick K.

    2012-01-01

    As a volatile educative space, musical education must be interwoven with other concerns and other more encompassing constructs if it is to build robust, meaningful, and complex learning outcomes. This paper attempts to do this by placing music education and a complex understanding of policy side by side, and outlining what people can learn from…

  19. Countering Center Gossip--Guidelines for Implementing an Anti-Gossip Policy.

    Science.gov (United States)

    Copeland, Margaret Leitch; Bruno, Holly Elissa

    2001-01-01

    Discusses gossip in early childhood settings as a threat to professionalism. Identifies reasons for staff gossip, provides guidance for developing an anti-gossip program policy, and presents an activity to distinguish gossip and shared information. Discusses how directors can influence parents' discussions with staff and get staff to confront each…

  20. Donkey in Disguise: Jack Jennings and the Center on Education Policy

    Science.gov (United States)

    Forster, Greg

    2006-01-01

    With the passage of the No Child Left Behind Act (NCLB), the proliferation of high school exit exams, the success of school choice initiatives, and a dozen other smaller if more bitter battles, education has become one of the hottest policy topics in Washington. That means there is a booming market for education experts, especially those who claim…

  1. How Can Pricing and Reimbursement Policies Improve Affordable Access to Medicines? Lessons Learned from European Countries.

    Science.gov (United States)

    Vogler, Sabine; Paris, Valérie; Ferrario, Alessandra; Wirtz, Veronika J; de Joncheere, Kees; Schneider, Peter; Pedersen, Hanne Bak; Dedet, Guillaume; Babar, Zaheer-Ud-Din

    2017-06-01

    This article discusses pharmaceutical pricing and reimbursement policies in European countries with regard to their ability to ensure affordable access to medicines. A frequently applied pricing policy is external price referencing. While it provides some benchmark for policy-makers and has been shown to be able to generate savings, it may also contribute to delay in product launch in countries where medicine prices are low. Value-based pricing has been proposed as a policy that promotes access while rewarding useful innovation; however, implementing it has proven quite challenging. For high-priced medicines, managed-entry agreements are increasingly used. These agreements allow policy-makers to manage uncertainty and obtain lower prices. They can also facilitate earlier market access in case of limited evidence about added therapeutic value of the medicine. However, these agreements raise transparency concerns due to the confidentiality clause. Tendering as used in the hospital and offpatent outpatient sectors has been proven to reduce medicine prices but it requires a robust framework and appropriate design with clear strategic goals in order to prevent shortages. These pricing and reimbursement policies are supplemented by the widespread use of Health Technology Assessment to inform decision-making, and by strategies to improve the uptake of generics, and also biosimilars. While European countries have been implementing a set of policy options, there is a lack of thorough impact assessments of several pricing and reimbursement policies on affordable access. Increased cooperation between authorities, experience sharing and improving transparency on price information, including the disclosure of confidential discounts, are opportunities to address current challenges.

  2. The use of a policy dialogue to facilitate evidence-informed policy development for improved access to care: the case of the Winnipeg Central Intake Service (WCIS).

    Science.gov (United States)

    Damani, Zaheed; MacKean, Gail; Bohm, Eric; DeMone, Brie; Wright, Brock; Noseworthy, Tom; Holroyd-Leduc, Jayna; Marshall, Deborah A

    2016-10-18

    Policy dialogues are critical for developing responsive, effective, sustainable, evidence-informed policy. Our multidisciplinary team, including researchers, physicians and senior decision-makers, comprehensively evaluated The Winnipeg Central Intake Service, a single-entry model in Winnipeg, Manitoba, to improve patient access to hip/knee replacement surgery. We used the evaluation findings to develop five evidence-informed policy directions to help improve access to scheduled clinical services across Manitoba. Using guiding principles of public participation processes, we hosted a policy roundtable meeting to engage stakeholders and use their input to refine the policy directions. Here, we report on the use and input of a policy roundtable meeting and its role in contributing to the development of evidence-informed policy. Our evidence-informed policy directions focused on formal measurement/monitoring of quality, central intake as a preferred model for service delivery, provincial scope, transparent processes/performance indicators, and patient choice of provider. We held a policy roundtable meeting and used outcomes of facilitated discussions to refine these directions. Individuals from our team and six stakeholder groups across Manitoba participated (n = 44), including patients, family physicians, orthopaedic surgeons, surgical office assistants, Winnipeg Central Intake team, and administrators/managers. We developed evaluation forms to assess the meeting process, and collected decision-maker partners' perspectives on the value of the policy roundtable meeting and use of policy directions to improve access to scheduled clinical services after the meeting, and again 15 months later. We analyzed roundtable and evaluation data using thematic analysis to identify key themes. Four key findings emerged. First, participants supported all policy directions, with revisions and key implementation considerations identified. Second, participants felt the policy roundtable

  3. A model to improve the accuracy of US Poison Center data collection.

    Science.gov (United States)

    Krenzelok, E P; Reynolds, K M; Dart, R C; Green, J L

    2014-01-01

    Over 2 million human exposure calls are reported annually to United States regional poison information centers. All exposures are documented electronically and submitted to the American Association of Poison Control Center's National Poison Data System. This database represents the largest data source available on the epidemiology of pharmaceutical and non-pharmaceutical poisoning exposures. The accuracy of these data is critical; however, research has demonstrated that inconsistencies and inaccuracies exist. This study outlines the methods and results of a training program that was developed and implemented to enhance the quality of data collection using acetaminophen exposures as a model. Eleven poison centers were assigned randomly to receive either passive or interactive education to improve medical record documentation. A task force provided recommendations on educational and training strategies and the development of a quality-measurement scorecard to serve as a data collection tool to assess poison center data quality. Poison centers were recruited to participate in the study. Clinical researchers scored the documentation of each exposure record for accuracy. Results. Two thousand two hundred cases were reviewed and assessed for accuracy of data collection. After training, the overall mean quality scores were higher for both the passive (95.3%; + 1.6% change) and interactive intervention groups (95.3%; + 0.9% change). Data collection accuracy improved modestly for the overall accuracy score and significantly for the substance identification component. There was little difference in accuracy measures between the different training methods. Despite the diversity of poison centers, data accuracy, specifically substance identification data fields, can be improved by developing a standardized, systematic, targeted, and mandatory training process. This process should be considered for training on other important topics, thus enhancing the value of these data in

  4. Pulmonary Hypertension Care Center Network: Improving Care and Outcomes in Pulmonary Hypertension.

    Science.gov (United States)

    Sahay, Sandeep; Melendres-Groves, Lana; Pawar, Leena; Cajigas, Hector R

    2017-04-01

    Pulmonary hypertension (PH) is a chronic, progressive, life-threatening disease that requires expert multidisciplinary care. To facilitate this level of care, the Pulmonary Hypertension Association established across the United States a network of pulmonary hypertension care centers (PHCCs) with special expertise in PH, particularly pulmonary arterial hypertension, to raise the overall quality of care and outcomes for patients with this life-threatening disease. Since the inception of PHCCs in September 2014, to date 35 centers have been accredited in the United States. This model of care brings together physicians and specialists from other disciplines to provide care, facilitate basic and clinical research, and educate the next generation of providers. PHCCs also offer additional opportunities for improvements in PH care. The patient registry offered through the PHCCs is an organized system by which data are collected to evaluate the outcomes of patients with PH. This registry helps in detecting variations in outcomes across centers, thus identifying opportunities for improvement. Multiple tactics were undertaken to implement the strategic plan, training, and tools throughout the PHCC network. In addition, strategies to foster collaboration between care center staff and individuals with PH and their families are the cornerstone of the PHCCs. The Pulmonary Vascular Network of the American College of Chest Physicians believes this to be a positive step that will improve the quality of care delivered in the United States to patients with PH. Copyright © 2016 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

  5. Improvements in Off-Center Focusing in an X-ray Streak Camera

    International Nuclear Information System (INIS)

    McDonald, J W; Weber, F; Holder, J P; Bell, P M

    2003-01-01

    Due to the planar construction of present x-ray streak tubes significant off-center defocusing is observed in both static and dynamic images taken with one-dimensional resolution slits. Based on the streak tube geometry curved photocathodes with radii of curvature ranging from 3.5 to 18 inches have been fabricated. We report initial off-center focusing performance data on the evaluation of these ''improved'' photocathodes in an X-ray streak camera and an update on the theoretical simulations to predict the optimum cathode curvature

  6. Food Price Policies May Improve Diet but Increase Socioeconomic Inequalities in Nutrition.

    Science.gov (United States)

    Darmon, Nicole; Lacroix, Anne; Muller, Laurent; Ruffieux, Bernard

    2016-01-01

    Unhealthy eating is more prevalent among women and people with a low socioeconomic status. Policies that affect the price of food have been proposed to improve diet quality. The study's objective was to compare the impact of food price policies on the nutritional quality of food baskets chosen by low-income and medium-income women. Experimental economics was used to simulate a fruit and vegetable subsidy and a mixed policy subsidizing healthy products and taxing unhealthy ones. Food classification was based on the Score of Nutritional Adequacy of Individual Foods, Score of Nutrients to Be Limited nutrient profiling system. Low-income (n = 95) and medium-income (n = 33) women selected a daily food basket first at current prices and then at policy prices. Energy density (ED) and the mean adequacy ratio (MAR) were used as nutritional quality indicators. At baseline, low-income women selected less healthy baskets than medium-income women (less fruit and vegetables, more unhealthy products, higher ED, lower MAR). Both policies improved nutritional quality (fruit and vegetable quantities increased, ED decreased, the MAR increased), but the magnitude of the improvement was often lower among low-income women. For instance, ED decreased by 5.3% with the fruit and vegetable subsidy and by 7.3% with the mixed subsidy, whereas decreases of 13.2 and 12.6%, respectively, were recorded for the medium-income group. Finally, both policies improved dietary quality, but they increased socioeconomic inequalities in nutrition. © 2016 S. Karger AG, Basel.

  7. Does Agency Competition Improve the Quality of Policy Analysis? Evidence from OMB and CBO Fiscal Projections

    Science.gov (United States)

    Krause, George A.; Douglas, James W.

    2006-01-01

    Public management scholars often claim that agency competition provides an effective institutional check on monopoly authority, and hence, leads to improvement of administrative performance in public sector agencies. This logic was central for creating the Congressional Budget Office (CBO) in 1975 to challenge the policy information provided by…

  8. Improved generation of single nitrogen-vacancy centers in diamond by ion implantation

    Energy Technology Data Exchange (ETDEWEB)

    Naydenov, Boris; Beck, Johannes; Steiner, Matthias; Balasubramanian, Gopalakrishnan; Jelezko, Fedor; Wrachtrup, Joerg [3. Institute of Physics, University of Stuttgart (Germany); Richter, Vladimir; Kalish, Rafi [Solid State Institute, Technion City, Haifa (Israel); Achard, Jocelyn [Laboratoire d' Ingenieurie des Materiaux et des Hautes Pressions, CNRS, Villetaneuse (France)

    2010-07-01

    Nitrogen-vacancy (NV) centers in diamond have recently attracted the attention of many research groups due to their possible application as quantum bits (qubits), ultra low magnetic field sensors and single photon sources. These color centers can be produced by nitrogen ion implantation, although the yield is usually below 5 % at low ion energies. Here we report an increase of the NV production efficiency by subsequently implanting carbon ions in the area of implanted nitrogen ions. This method improves the production yield by more than 50 %. We also show that very low nitrogen concentration (below 0.1 ppb) in diamond can be determined by converting the intrinsic nitrogen atoms to single NV centers and detecting the latter using a confocal microscope.

  9. Improving the Performance of Water Policies: Evidence from Drought in Spain

    Directory of Open Access Journals (Sweden)

    Mohamed Taher Kahil

    2016-01-01

    Full Text Available Water scarcity is a critical environmental issue worldwide, especially in arid and semiarid regions. In those regions, climate change projections suggest further reductions in freshwater supplies and increases of the recurrence, longevity and intensity of drought events. At present, one important question for policy debate is the identification of water policies that could address the mounting water scarcity problems. Suitable policies should improve economic efficiency, achieve environmental sustainability, and meet equity needs. This paper develops and applies an integrated hydro-economic model that links hydrological, economic and environmental elements to such issues. The model is used to conduct a direct comparison of water markets, water pricing and institutional cooperation, based on their economic, environmental and equity outcomes. The analysis is performed in the Jucar Basin of Spain, which is a good natural experiment for studying water scarcity and climate change policies. Results indicate that both institutional and water market policies are high performing instruments to limit the economic damage costs of droughts, achieving almost the same social benefits. However, the environmental effects of water markets are worrying. Another important finding is that water pricing is a poor policy option not only in terms of private and environmental benefits but also in terms of equity.

  10. Improving the evidence base for energy policy: The role of systematic reviews

    International Nuclear Information System (INIS)

    Sorrell, Steve

    2007-01-01

    The concept of evidence-based policy and practice (EBPP) has gained increasing prominence in the UK over the last 10 years and now plays a dominant role in a number of policy areas, including healthcare, education, social work, criminal justice and urban regeneration. But despite this substantial, influential and growing activity, the concept remains largely unknown to policymakers and researchers within the energy field. This paper defines EBPP, identifies its key features and examines the potential role of systematic reviews of evidence in a particular area of policy. It summarises the methods through which systematic reviews are achieved; discusses their advantages and limitations; identifies the particular challenges they face in the energy policy area; and assesses whether and to what extent they can usefully be applied to contemporary energy policy questions. The concept is illustrated with reference to a proposed review of evidence for a 'rebound effect' from improved energy efficiency. The paper concludes that systematic reviews may only be appropriate for a subset of energy policy questions and that research-funding priorities may need to change if their use is to become more widespread

  11. Improving societal acceptance of rad waste management policy decisions: an approach based on complex intelligence

    International Nuclear Information System (INIS)

    Rao, Suman

    2008-01-01

    In today's context elaborate public participation exercises are conducted around the world to elicit and incorporate societal risk perceptions into nuclear policy Decision-Making. However, on many occasions, such as in the case of rad waste management, the society remains unconvinced about these decisions. This naturally leads to the questions: are techniques for incorporating societal risk perceptions into the rad waste policy decision making processes sufficiently mature? How could societal risk perceptions and legal normative principles be better integrated in order to render the decisions more equitable and convincing to society? Based on guidance from socio-psychological research this paper postulates that a critical factor for gaining/improving societal acceptance is the quality and adequacy of criteria for option evaluation that are used in the policy decision making. After surveying three rad waste public participation cases, the paper identifies key lacunae in criteria abstraction processes as currently practiced. A new policy decision support model CIRDA: Complex Intelligent Risk Discourse Abstraction model that is based on the heuristic of Risk-Risk Analysis is proposed to overcome these lacunae. CIRDA's functionality of rad waste policy decision making is modelled as a policy decision-making Abstract Intelligent Agent and the agent program/abstraction mappings are presented. CIRDA is then applied to a live (U.K.) rad waste management case and the advantages of this method as compared to the Value Tree Method as practiced in the GB case are demonstrated. (author)

  12. Fiscal policy to improve diets and prevent noncommunicable diseases: from recommendations to action.

    Science.gov (United States)

    Thow, Anne Marie; Downs, Shauna M; Mayes, Christopher; Trevena, Helen; Waqanivalu, Temo; Cawley, John

    2018-03-01

    The World Health Organization has recommended that Member States consider taxing energy-dense beverages and foods and/or subsidizing nutrient-rich foods to improve diets and prevent noncommunicable diseases. Numerous countries have either implemented taxes on energy-dense beverages and foods or are considering the implementation of such taxes. However, several major challenges to the implementation of fiscal policies to improve diets and prevent noncommunicable diseases remain. Some of these challenges relate to the cross-sectoral nature of the relevant interventions. For example, as health and economic policy-makers have different administrative concerns, performance indicators and priorities, they often consider different forms of evidence in their decision-making. In this paper, we describe the evidence base for diet-related interventions based on fiscal policies and consider the key questions that need to be asked by both health and economic policy-makers. From the health sector's perspective, there is most evidence for the impact of taxes and subsidies on diets, with less evidence on their impacts on body weight or health. We highlight the importance of scope, the role of industry, the use of revenue and regressive taxes in informing policy decisions.

  13. Improved Management of Water and Natural Resources Requires Open, Cognizant, Adaptive Science and Policy

    Science.gov (United States)

    Glynn, P. D.; Voinov, A. A.; Shapiro, C. D.; Jenni, K. E.

    2017-12-01

    Water issues impact the availability and use of other natural resources as well as environmental conditions. In an increasingly populated hyper-connected world, water issues are increasingly "wicked problems": complex problems with high uncertainties and no independent observers. Water is essential to life, and life affects water quality and availability. Scientists, managers, decision-makers, and the greater public all have a stake in improving the management of water resources. In turn, they are part of the systems that they are studying, deciding on, affecting, or trying to improve. Governance of water issues requires greater accessibility, traceability, and accountability (ATA) in science and policy. Water-related studies and decision-making need transdisciplinary science, inclusive participatory processes, and consideration and acceptance of multiple perspectives. Biases, Beliefs, Heuristics, and Values (BBHV) shape much of our perceptions and knowledge, and inevitably, affect both science and policy. Understanding the role of BBHV is critical to (1) understanding individual and group judgments and choices, (2) recognizing potential differences between societal "wants" and societal "needs", and (3) identifying "winners" and "losers" of policy decisions. Societal acceptance of proposed policies and actions can be fostered by enhancing participatory processes and by providing greater ATA in science, in policy, and in development of the laws, rules, and traditions that constrain decision-making. An adaptive science-infused governance framework is proposed that seeks greater cognizance of the role of BBHV in shaping science and policy choices and decisions, and that also seeks "Open Traceable Accountable Policy" to complement "Open Science". We discuss the limitations of the governance that we suggest, as well as tools and approaches to help implementation.

  14. Strategies to improve chronic disease management in seven metro Boston community health centers.

    Science.gov (United States)

    Ndumele, Chima D; Russell, Beverley E; Ayanian, John Z; Landon, Bruce E; Keegan, Thomas; O'Malley, A James; Hicks, Leroi S

    2009-01-01

    The Community, Health Center, and Academic Medicine Partnership Project (CHAMPP) is a partnership between medical researchers, community health centers (CHCs), and a community advisory committee focused on reducing cardiovascular morbidity related to hypertension and diabetes for non-Hispanic Black and Hispanic populations in Boston, Massachusetts. We conducted site visits at seven participating CHCs, located in Boston. The visits were to solicit health center staff opinions about site-specific barriers and enabling factors for optimum preventative cardiovascular care for racial/ethnic minority patients receiving hypertension and diabetes care at their centers. Site visits included a tour of each health center and a series of directed interviews with center personnel. Site visit notes were reviewed to identify themes that emerged during the course of each site visit. A summary matrix was developed for each health center, which included information regarding the most salient and persistent themes of the visit. Site visits uncovered several patient-, provider-, CHC-, and community-based factors that either facilitate or hinder optimal care of chronic disease patients. Commonly referenced barriers included the need for improved patient adherence to provider recommendations; insufficient time for providers to address complex health issues presented by patients and the need for a broader range of healthier food options in surrounding communities. Interactive patient groups and community health workers (CHWs) have been well received when implemented. Recommendations included adopting case management as a part of usual care for chronic disease patients; additionally, widespread implementation of CHWs may to provide a platform for more comprehensive care for patients.

  15. Improvement of the knee center of rotation during walking after opening wedge high tibial osteotomy.

    Science.gov (United States)

    Kim, Kyungsoo; Feng, Jun; Nha, Kyung Wook; Park, Won Man; Kim, Yoon Hyuk

    2015-06-01

    Accurate measurement of the center of rotation of the knee joint is indispensable for prediction of joint kinematics and kinetics in musculoskeletal models. However, no study has yet identified the knee center of rotations during several daily activities before and after high tibial osteotomy surgery, which is one surgical option for treating knee osteoarthritis. In this study, an estimation method for determining the knee joint center of rotation was developed by applying the optimal common shape technique and symmetrical axis of rotation approach techniques to motion-capture data and validated for typical activities (walking, squatting, climbing up stairs, walking down stairs) of 10 normal subjects. The locations of knee joint center of rotations for injured and contralateral knees of eight subjects with osteoarthritis, both before and after high tibial osteotomy surgery, were then calculated during walking. It was shown that high tibial osteotomy surgery improved the knee joint center of rotation since the center of rotations for the injured knee after high tibial osteotomy surgery were significantly closer to those of the normal healthy population. The difference between the injured and contralateral knees was also generally reduced after surgery, demonstrating increased symmetry. These results indicate that symmetry in both knees can be recovered in many cases after high tibial osteotomy surgery. Moreover, the recovery of center of rotation in the injured knee was prior to that of symmetry. This study has the potential to provide fundamental information that can be applied to understand abnormal kinematics in patients, diagnose knee joint disease, and design a novel implants for knee joint surgeries. © IMechE 2015.

  16. An improved algorithm of laser spot center detection in strong noise background

    Science.gov (United States)

    Zhang, Le; Wang, Qianqian; Cui, Xutai; Zhao, Yu; Peng, Zhong

    2018-01-01

    Laser spot center detection is demanded in many applications. The common algorithms for laser spot center detection such as centroid and Hough transform method have poor anti-interference ability and low detection accuracy in the condition of strong background noise. In this paper, firstly, the median filtering was used to remove the noise while preserving the edge details of the image. Secondly, the binarization of the laser facula image was carried out to extract target image from background. Then the morphological filtering was performed to eliminate the noise points inside and outside the spot. At last, the edge of pretreated facula image was extracted and the laser spot center was obtained by using the circle fitting method. In the foundation of the circle fitting algorithm, the improved algorithm added median filtering, morphological filtering and other processing methods. This method could effectively filter background noise through theoretical analysis and experimental verification, which enhanced the anti-interference ability of laser spot center detection and also improved the detection accuracy.

  17. Task shifting of HIV/AIDS case management to Community Health Service Centers in urban China: a qualitative policy analysis.

    Science.gov (United States)

    Ma, Fuchang; Lv, Fan; Xu, Peng; Zhang, Dapeng; Meng, Sining; Ju, Lahong; Jiang, Huihui; Ma, Liping; Sun, Jiangping; Wu, Zunyou

    2015-07-02

    The growing number of people living with HIV/AIDS (PLWHA) in China points to an increased need for case management services of HIV/AIDS. This study sought to explore the challenges and enablers in shifting the HIV/AIDS case management services from Centers for Disease Control and Prevention (CDCs) to Community Health Service Centers (CHSCs) in urban China. A qualitative method based on the Health Policy Triangle (HPT) framework was employed to gain in-depth insights into four elements of the task shifting strategy. This included a review on published literature and health policy documents, 15 focus group discussions (FGDs) and 30 in-depth interviews (IDIs) with four types of key actors from three cities in China. A total of 78 studies and 17 policy files at the national, municipal and local levels were obtained and reviewed comprehensively. Three semi-structured interview guides were used to explore key actors' views on shifting the HIV/AIDS case management services to CHSCs. It is necessary and feasible for CHSCs to engage in case management services for PLWHA in local communities. The increasing number of PLWHA and shortage of qualified health professionals in CDCs made shifting case management services downwards to CHSCs an urgent agenda. CHSCs' wide distribution, technical capacity, accessibility and current practice enabled them to carry out case management services for PLWHA. However our findings indicated several challenges in this task shifting process. Those challenges included lack of specific policy and stable financial support for CHSCs, inadequate manpower, relatively low capacity for health service delivery, lack of coordination among sectors, PLWHA's fear for discrimination and privacy disclosure in local communities, which may compromise the effectiveness and sustainability of those services. Shifting the HIV/AIDS case management services from CDCs to CHSCs is a new approach to cope with the rising number of PLWHA in China, but it should be

  18. Archival policies and collections database for the Woods Hole Science Center's marine sediment samples

    Science.gov (United States)

    Buczkowski, Brian J.; Kelsey, Sarah A.

    2007-01-01

    The Woods Hole Science Center of the U.S. Geological Survey (USGS) has been an active member of the Woods Hole research community, Woods Hole, Massachusetts, for over 40 years. In that time there have been many projects that involved the collection of sediment samples conducted by USGS scientists and technicians for the research and study of seabed environments and processes. These samples were collected at sea or near shore and then brought back to the Woods Hole Science Center (WHSC) for analysis. While at the center, samples are stored in ambient temperature, refrigerated and freezing conditions ranging from +2º Celsius to -18º Celsius, depending on the best mode of preparation for the study being conducted or the duration of storage planned for the samples. Recently, storage methods and available storage space have become a major concern at the WHSC. The core and sediment archive program described herein has been initiated to set standards for the management, methods, and duration of sample storage. A need has arisen to maintain organizational consistency and define storage protocol. This handbook serves as a reference and guide to all parties interested in using and accessing the WHSC's sample archive and also defines all the steps necessary to construct and maintain an organized collection of geological samples. It answers many questions as to the way in which the archive functions.

  19. Impact of MELD allocation policy on survival outcomes after liver transplantation: a single-center study in northeast Brazil

    Directory of Open Access Journals (Sweden)

    Thales Paulo Batista

    2011-01-01

    Full Text Available OBJECTIVE: To analyze the impact of model for end-stage liver disease (MELD allocation policy on survival outcomes after liver transplantation (LT. INTRODUCTION: Considering that an ideal system of grafts allocation should also ensure improved survival after transplantation, changes in allocation policies need to be evaluated in different contexts as an evolutionary process. METHODS: A retrospective cohort study was carried out among patients who underwent LT at the University of Pernambuco. Two groups of patients transplanted before and after the MELD allocation policy implementation were identified and compared using early postoperative mortality and post-LT survival as end-points. RESULTS: Overall, early postoperative mortality did not significantly differ between cohorts (16.43% vs. 8.14%; p = 0.112. Although at 6 and 36-months the difference between pre-vs. post-MELD survival was only marginally significant (p = 0.066 and p = 0.063; respectively, better short, medium and long-term post-LT survival were observed in the post-MELD period. Subgroups analysis showed special benefits to patients categorized as nonhepatocellular carcinoma (non-HCC and moderate risk, as determined by MELD score (15-20. DISCUSSION: This study ensured a more robust estimate of how the MELD policy affected post-LT survival outcomes in Brazil and was the first to show significantly better survival after this new policy was implemented. Additionally, we explored some potential reasons for our divergent survival outcomes. CONCLUSION: Better survival outcomes were observed in this study after implementation of the MELD criterion, particularly amongst patients categorized as non-HCC and moderate risk by MELD scoring. Governmental involvement in organ transplantation was possibly the main reason for improved survival.

  20. A MODEL FOR INTEGRATED SOFTWARE TO IMPROVE COMMUNICATION POLICY IN DENTAL TECHNICAL LABS

    Directory of Open Access Journals (Sweden)

    Minko M. Milev

    2017-06-01

    Full Text Available Introduction: Integrated marketing communications (IMC are all kinds of communications between organisations and customers, partners, other organisations and society. Aim: To develop and present an integrated software model, which can improve the effectiveness of communications in dental technical services. Material and Methods: The model of integrated software is based on recommendations of a total of 700 respondents (students of dental technology, dental physicians, dental technicians and patients of dental technical laboratories in Northeastern Bulgaria. Results and Discussion: We present the benefits of future integrated software to improve the communication policy in the dental technical laboratory that meets the needs of fast cooperation and well-built communicative network between dental physicians, dental technicians, patients and students. Conclusion: The use of integrated communications could be a powerful unified approach to improving the communication policy between all players at the market of dental technical services.

  1. Improving Primary Care with Human-Centered Design and Partnership-Based Leadership

    Directory of Open Access Journals (Sweden)

    May-Lynn Andresen

    2017-06-01

    Full Text Available Objective: The purpose of this quality improvement project was to empower and activate first-line staff (FLS to improve the six-month depression remission rate in a primary care clinic. Background: Lack of workforce engagement has been identified as an emerging national problem in health care and health care leaders have urged practice redesign to foster the Triple Aim of improved population health, improved care experience, and reduced cost of care (Berwick et al., 2008. Depression is difficult to manage and often exacerbates chronic illnesses and shortens lifespans, yet despite known effective treatments, six-month remission rates are low and care practices are often inadequate. Engaging in empowering leadership behaviors has demonstrated improvement in motivation, work outcomes, and empowerment in various industry settings across the world. Core approaches include: enhancing staff self-determination, encouraging participation in decision-making, and ensuring that staff have the knowledge and tools to achieve their performance goals, in addition to leadership communications that increase confidence in staff’s potential to perform at high levels, and their recognition that their efforts have an impact on improving organizational effectiveness. Methods: In this outpatient setting, care was siloed, staff were disengaged and a hierarchical paradigm was evident. Human-centered design principles were employed to intensively explore stakeholders’ experiences and to deeply engage end users in improving depression remission rates by creating, participating, and partnering in solutions. Leadership was educated in and deployed empowering leadership behaviors, which were synergistic with design thinking, and fostered empowerment. Results: Pre- and post-surveys demonstrated statistically significant improvement in empowerment. The six-month depression remission rate increased 167%, from 7.3% (N=261 to 19.4% (N=247. Conclusion: The convergence of

  2. Innovation in user-centered skills and performance improvement for sustainable complex service systems.

    Science.gov (United States)

    Karwowski, Waldemar; Ahram, Tareq Z

    2012-01-01

    In order to leverage individual and organizational learning and to remain competitive in current turbulent markets it is important for employees, managers, planners and leaders to perform at high levels over time. Employee competence and skills are extremely important matters in view of the general shortage of talent and the mobility of employees with talent. Two factors emerged to have the greatest impact on the competitiveness of complex service systems: improving managerial and employee's knowledge attainment for skills, and improving the training and development of the workforce. This paper introduces the knowledge-based user-centered service design approach for sustainable skill and performance improvement in education, design and modeling of the next generation of complex service systems. The rest of the paper cover topics in human factors and sustainable business process modeling for the service industry, and illustrates the user-centered service system development cycle with the integration of systems engineering concepts in service systems. A roadmap for designing service systems of the future is discussed. The framework introduced in this paper is based on key user-centered design principles and systems engineering applications to support service competitiveness.

  3. How do I provide leukapheresis products? Blood center experience and evidence for process improvement.

    Science.gov (United States)

    Ginzburg, Yelena; Kessler, Debra; Narici, Manlio; Caltabiano, Melinda; Rebosa, Mark; Strauss, Donna; Shaz, Beth

    2013-10-01

    The past few decades have seen a resurgence of interest in leukapheresis products to improve the survival of infected patients with neutropenia. These products have a short shelf life and require donor stimulation with dexamethasone before collection. Additionally, a system with good communications and logistical support is essential. A recent survey of blood centers in North America revealed that the majority of centers collecting leukapheresis products use steroid-stimulated donors. The survey results suggested that an analysis of the process and potential process improvement would be of interest to the transfusion medicine community. Data from 2008 to 2011 regarding donor selection, donor dexamethasone stimulation, leukapheresis collection, and correlations between potentially pertinent variables for process improvement were analyzed. Results from an analysis of cost are also included. We evaluate 432 leukapheresis donations and demonstrate correlations between 1) pre- and poststimulation white blood cell (WBC) count (pproduct granulocyte yield (pimprovement in granulocyte quality and yield can be accomplished in dexamethasone-stimulated donors, by selecting eligible donors with relatively high normal prestimulation WBC counts and/or previously good responses to dexamethasone, increasing the duration between dexamethasone stimulation and granulocyte collection, and maintaining optimal hematocrit (5%-10%) in granulocyte collections. Because the majority of surveyed blood centers collecting stimulated granulocytes use steroids alone, modifications presented here may prove useful. Further assessment of correlation between granulocyte yield and clinical outcome will await results of additional studies. © 2012 American Association of Blood Banks.

  4. An Employee-Centered Care Model Responds to the Triple Aim: Improving Employee Health.

    Science.gov (United States)

    Fox, Kelly; McCorkle, Ruth

    2018-01-01

    Health care expenditures, patient satisfaction, and timely access to care will remain problematic if dramatic changes in health care delivery models are not developed and implemented. To combat this challenge, a Triple Aim approach is essential; Innovation in payment and health care delivery models is required. Using the Donabedian framework of structure, process, and outcome, this article describes a nurse-led employee-centered care model designed to improve consumers' health care experiences, improve employee health, and increase access to care while reducing health care costs for employees, age 18 and older, in a corporate environment.

  5. Implantation, evaluation and improvement of the diffusion code package developed by the RIS0 Research Center

    International Nuclear Information System (INIS)

    Koide, M.C.M.

    1983-01-01

    The evaluation and improvement of the diffusion code package developed by the RIS0 Research Center of Denmark have been performed. The improvements made in the package consisted in the presentation of their manuals. In order to reduce the process time of the codes an analitical boundary condition capable of representing the effects of the baffle and the reflector on the flux distribution has been calculated. Such boundary condition was obtained using a one-dimensional medium in the framework of the two group diffusion theory. The results showed that the application of this boundary condition produces very accurate results and an appreciable economy of processing time. (author) [pt

  6. Policy directions in urban health in developing countries--the slum improvement approach.

    Science.gov (United States)

    Harpham, T; Stephens, C

    1992-07-01

    The urban development, or housing, sector has a longer experience of addressing the problems of the urban poor in developing countries than the health sector. In recent years the policy of 'slum improvement', which involves both sectors, has attracted the support of international donors. This article documents the development of the slum improvement approach and addresses key issues of the approach which have implications for health planning: covering the poorest dwellers; relocation; land tenure; gentrification; debt burdens and the impact on women. Questions about the approach which still need answering are defined and a summary of the constraints in slum improvement and potential solutions is presented.

  7. Improving the implementation of health workforce policies through governance: a review of case studies.

    Science.gov (United States)

    Dieleman, Marjolein; Shaw, Daniel Mp; Zwanikken, Prisca

    2011-04-12

    Responsible governance is crucial to national development and a catalyst for achieving the Millennium Development Goals. To date, governance seems to have been a neglected issue in the field of human resources for health (HRH), which could be an important reason why HRH policy formulation and implementation is often poor. This article aims to describe how governance issues have influenced HRH policy development and to identify governance strategies that have been used, successfully or not, to improve HRH policy implementation in low- and middle-income countries (LMIC). We performed a descriptive literature review of HRH case studies which describe or evaluate a governance-related intervention at country or district level in LMIC. In order to systematically address the term 'governance' a framework was developed and governance aspects were regrouped into four dimensions: 'performance', 'equity and equality', 'partnership and participation' and 'oversight'. In total 16 case studies were included in the review and most of the selected studies covered several governance dimensions. The dimension 'performance' covered several elements at the core of governance of HRH, decentralization being particularly prominent. Although improved equity and/or equality was, in a number of interventions, a goal, inclusiveness in policy development and fairness and transparency in policy implementation did often not seem adequate to guarantee the corresponding desirable health workforce scenario. Forms of partnership and participation described in the case studies are numerous and offer different lessons. Strikingly, in none of the articles was 'partnerships' a core focus. A common theme in the dimension of 'oversight' is local-level corruption, affecting, amongst other things, accountability and local-level trust in governance, and its cultural guises. Experiences with accountability mechanisms for HRH policy development and implementation were lacking. This review shows that the term

  8. Comprehensive smoke-free policies: a tool for improving preconception health?

    Science.gov (United States)

    Klein, Elizabeth G; Liu, Sherry T; Conrey, Elizabeth J

    2014-01-01

    Lower income women are at higher risk for preconception and prenatal smoking, are less likely to spontaneously quit smoking during pregnancy, and have higher prenatal relapse rates than women in higher income groups. Policies prohibiting tobacco smoking in public places are intended to reduce exposure to secondhand smoke; additionally, since these policies promote a smoke-free norm, there have been associations between smoke-free policies and reduced smoking prevalence. Given the public health burden of smoking, particularly among women who become pregnant, our objective was to assess the impact of smoke-free policies on the odds of preconception smoking among low-income women. We estimated the odds of preconception smoking among low-income women in Ohio between 2002 and 2009 using data from repeated cross-sectional samples of women participating in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). A logistic spline regression was applied fitting a knot at the point of enforcement of the Ohio Smoke-free Workplace Act to evaluate whether this policy was associated with changes in the odds of smoking. After adjusting for individual- and environmental-level factors, the Ohio Smoke-free Workplace Act was associated with a small, but statistically significant reduction in the odds of preconception smoking in WIC participants. Comprehensive smoke-free policies prohibiting smoking in public places and workplaces may also be associated with reductions in smoking among low-income women. This type of policy or environmental change strategy may promote a tobacco-free norm and improve preconception health among a population at risk for smoking.

  9. Increased Adoption of Quality Improvement Interventions to Implement Evidence-Based Practices for Pressure Ulcer Prevention in U.S. Academic Medical Centers.

    Science.gov (United States)

    Padula, William V; Mishra, Manish K; Makic, Mary Beth F; Wald, Heidi L; Campbell, Jonathan D; Nair, Kavita V; Valuck, Robert J

    2015-12-01

    In 2008, the U.S. Centers for Medicare and Medicaid Services enacted a nonpayment policy for stage III and IV hospital-acquired pressure ulcers (HAPUs), which incentivized hospitals to improve prevention efforts. In response, hospitals looked for ways to support implementation of evidence-based practices for HAPU prevention, such as adoption of quality improvement (QI) interventions. The objective of this study was to quantify adoption patterns of QI interventions for supporting evidence-based practices for HAPU prevention. This study surveyed wound care specialists working at hospitals within the University HealthSystem Consortium. A questionnaire was used to retrospectively describe QI adoption patterns according to 25 HAPU-specific QI interventions into four domains: leadership, staff, information technology (IT), and performance and improvement. Respondents indicated QI interventions implemented between 2007 and 2012 to the nearest quarter and year. Descriptive statistics defined patterns of QI adoption. A t-test and statistical process control chart established statistically significant increase in adoption following nonpayment policy enactment in October 2008. Increase are described in terms of scope (number of QI domains employed) and scale (number of QI interventions within domains). Fifty-three of the 55 hospitals surveyed reported implementing QI interventions for HAPU prevention. Leadership interventions were most frequent, increasing in scope from 40% to 63% between 2008 and 2012; "annual programs to promote pressure ulcer prevention" showed the greatest increase in scale. Staff interventions increased in scope from 32% to 53%; "frequent consult driven huddles" showed the greatest increase in scale. IT interventions increased in scope from 31% to 55%. Performance and improvement interventions increased in scope from 18% to 40%, with "new skin care products . . ." increasing the most. Academic medical centers increased adoption of QI interventions

  10. Improving patient-centered communication while using an electronic health record: Report from a curriculum evaluation.

    Science.gov (United States)

    Fogarty, Colleen T; Winters, Paul; Farah, Subrina

    2016-05-01

    Researchers and clinicians are concerned about the impact of electronic health record use and patient-centered communication. Training about patient-centered clinical communication skills with the electronic health record may help clinicians adapt and remain patient-centered. We developed an interactive workshop eliciting challenges and opportunities of working with the electronic health record in clinical practice, introduction of specific patient-centered behaviors and mindful practice techniques, and video demonstrating contrasts in common behavior and "better practices." One hundred thirty-nine resident physicians and faculty supervisors in five residency training programs at the University of Rochester Medical Center participated in the workshops. Participants were asked to complete an 11-item survey of behaviors related to their use of the electronic health record prior to training and after attending training. We used paired t-tests to assess changes in self-reported behavior from pre-intervention to post-intervention. We trained 139 clinicians in the workshops; 110 participants completed the baseline assessment and 39 completed both the baseline and post-intervention assessment. Data from post-curriculum respondents found a statistically significant increase in "I told the patient when turning my attention from the patient to the computer," from 60% of the time prior to the training to 70% of the time after. Data from our program evaluation demonstrated improvement in one communication behavior. Sample size limited the detection of other changes; further research should investigate effective training techniques for patient-centered communication while using the electronic health record. © The Author(s) 2016.

  11. 75 FR 22357 - Center for Nutrition Policy and Promotion; Agency Information Collection Activities; Current...

    Science.gov (United States)

    2010-04-28

    ... achieving the President's Open Government Initiative and increase access to socially relevant technologies... entrepreneurs, software developers, and students for developing innovative software applications using a... not only increase access to socially relevant technologies that seek to improve eating and physical...

  12. Improvements in middle school student dietary intake after implementation of the Texas Public School Nutrition Policy.

    Science.gov (United States)

    Cullen, Karen Weber; Watson, Kathy; Zakeri, Issa

    2008-01-01

    We assessed the effect of the Texas Public School Nutrition Policy on middle school student lunchtime food consumption. Three years of lunch food records were collected from middle school students in southeast Texas: baseline (2001-2002), after local district changes (2002-2003), and 1 year after implementation of the Texas Public School Nutrition Policy (2005-2006). Students recorded amount and source of foods and beverages they consumed. Analysis of variance and covariance and nonparametric tests were used to compare intake after the policy change with intake during the 2 previous years. After implementation of the nutrition policy, student lunch consumption of vegetables, milk, and several nutrients increased (protein, fiber, vitamins A and C, calcium, and sodium), and consumption of less desirable items (sweetened beverages, snack chips) decreased, as did percentage of energy from fat. Most of the desired nutrients and foods (vegetables and milk) were obtained from the National School Lunch Program meal. Fewer sweetened beverages, candy, chips, and dessert foods were purchased and consumed, but more of these items were brought from home and purchased from the snack bar. Overall, state school nutrition policies can improve the healthfulness of foods consumed by students at lunch.

  13. Modern Russian Demographic Policy in the Field of Fertility: Results and Areas for Improvement

    Directory of Open Access Journals (Sweden)

    Larisa Alekseevna Popova

    2016-05-01

    Full Text Available During last years in Russia the active state demographic policy, directed on the support of second and subsequent births, is leading. The article describes its evolution, evaluates efficiency and recommends directions of its improvement. It was detected, that increment of measures of demographic policy by introduction in 2011 the regional maternity capitals to a third child in addition to the federal capital to a second child gave a perceptible positive results. It allowed continuing the positive trend of fertility already in the condition of the beginning deterioration the age structure of the women in the childbearing age; maximally realize the births, which were postponed by the older generations; to increase number of children on account of additional births; to enhance the family component of fertility. Despite of concerns, the growth of reproductive attitudes happened not only in the older cohorts of the population. Conducted in 2013 sociological research gives grounds to expect, that minorities generations 1990 years of birth, which will be determine prospects of fertility, will reach the level of slightly expanded reproduction of population. In the conditions of deterioration the age structure of fertile contingents the demographic policy must be elongated and improved. All components of economic demographic measures must be saved, including child allowances to needy families, but with increasing the horizon of its assignment to adulthood of child. The directions of maternity capitals realizations must be expanded. During the develop of new measures of demographic policy need to focus on psychological measures of formation the value orientations of the population in area of number of children, on improvement of qualitative structure of fertility and strengthening of the family institute. The economic measures need to redirect on the second births, which are more family. The general line of family demographic policy is the increasing of

  14. Modeling policy mix to improve the competitiveness of Indonesian palm oil industry

    Energy Technology Data Exchange (ETDEWEB)

    Silitonga, R. Y.H.; Siswanto, J.; Simatupang, T.; Bahagia, S.N.

    2016-07-01

    The purpose of this research is to develop a model that will explain the impact of government policies to the competitiveness of palm oil industry. The model involves two commodities in this industry, namely crude palm oil (CPO) and refined palm oil (RPO), each has different added value. The model built will define the behavior of government in controlling palm oil industry, and their interactions with macro-environment, in order to improve the competitiveness of the industry. Therefore the first step was to map the main activities in this industry using value chain analysis. After that a conceptual model was built, where the output of the model is competitiveness of the industry based on market share. The third step was model formulation. The model is then utilized to simulate the policy mix given by government in improving the competitiveness of Palm Oil Industry. The model was developed using only some policies which give direct impact to the competitiveness of the industry. For macro environment input, only price is considered in this model. The model can simulate the output of the industry for various government policies mix given to the industry. This research develops a model that can represent the structure and relationship between industry, government and macro environment, using value chain analysis and hierarchical multilevel system approach. (Author)

  15. Modeling policy mix to improve the competitiveness of Indonesian palm oil industry

    Directory of Open Access Journals (Sweden)

    Roland Y H Silitonga

    2016-04-01

    Full Text Available Purpose: The purpose of this research is to develop a model that will explain the impact of government policies to the competitiveness of palm oil industry. The model involves two commodities in this industry, namely crude palm oil (CPO and refined palm oil (RPO, each has different added value. Design/methodology/approach: The model built will define the behavior of government in controlling palm oil industry, and their interactions with macro-environment, in order to improve the competitiveness of the industry. Therefore the first step was to map the main activities in this industry using value chain analysis. After that a conceptual model was built, where the output of the model is competitiveness of the industry based on market share. The third step was model formulation. The model is then utilized to simulate the policy mix given by government in improving the competitiveness of Palm Oil Industry. Research limitations/implications: The model was developed using only some policies which give direct impact to the competitiveness of the industry. For macro environment input, only price is considered in this model. Practical implications: The model can simulate the output of the industry for various government policies mix given to the industry. Originality/value: This research develops a model that can represent the structure and relationship between industry, government and macro environment, using value chain analysis and hierarchical multilevel system approach.

  16. Policy issues for improving monitoring and evaluation of agricultural extension programmes in Nigeria

    Directory of Open Access Journals (Sweden)

    Akinnagbe O. Matthew

    2016-06-01

    Full Text Available Monitoring and evaluation are important, yet, frequently neglected functions in most organisations. In Nigeria, many programmes have been established over the years but only little monitoring and evaluation have been carried out because of many implementation problems and lack of realistic and/or stable policy framework. This paper was designed to X-ray policy issues for improving monitoring and evaluation of agricultural programmes in Nigeria. Inductive and deductive reasoning through a review of relevant literature was used in this philosophical paper. To improve the performance of agricultural extension programmes in Nigeria, the following policy issues must be addressed: The questions of what should be monitored or evaluated, when should monitoring and/or evaluation be carried out and who should monitor and/or evaluate; and the methodology to be adopted in any project should be included in any agricultural programmes and/or policies. Manpower and financial resources, effective communication and the issue of accountability must be properly considered. The tools for monitoring and evaluation are also very crucial. The paper concluded that planning a good agricultural programme is not a problem in Nigeria but poor implementation is, as a result of poor monitoring and evaluation. Therefore, attention should be on when, how and who should be involved in monitoring and evaluation.

  17. Increase the glyde path diameter improves the centering ability of F6 Skytaper.

    Science.gov (United States)

    Troiano, Giuseppe; Dioguardi, Mario; Cocco, Armando; Zhurakivska, Khrystyna; Ciavarella, Domenico; Muzio, Lorenzo Lo

    2018-01-01

    The aim of this study was to assess the impact of glide path preparation, performed with PathGlider 0.15 (Komet Brasseler GmbH & Co., Lemgo, Germany) and PathGlider 0.20 (Komet Brasseler GmbH & Co., Lemgo, Germany), on the centering ability of 25-size F6 Skytaper in J-shape simulated root canals, compared with no glide path executed. Sixty J-shaped ISO 15 0.02 taper endo training blocks (Dentsply Maillefer) were assigned to three groups ( n = 20 for each group). Photographic images were taken on endoblocks before and after shaping procedures. After superimposition, the software AutoCAD 2013 (Autodesk Inc., San Rafael, USA) was used for record the centering and shaping ability at 9 different levels from the apex. Shaping procedures including the using of PathGlider 0.20 resulted in a lower amount of resin removed and in a clear improvement of centering ability of the Skytaper 0.25 at almost all reference point levels. Within the limitations of this study, it could be concluded that the glide path procedure, performed with the PathGlider 0.20 before the shaping with 25-size F6 Skytaper, might determine a lower amount of resin removed and a better centering ability compared with the groups without glide path procedure and those treated with PathGlider 0.15.

  18. Improving the Quality of the Supply-Demand-Match in Vocational Education and Training by Anticipation and "Matching Policy"

    Science.gov (United States)

    Lassnigg, Lorenz

    2008-01-01

    This article discusses the implications of a framework to improve matching supply and demand in VET by a policy to improve quality by using anticipation and foresight approaches. Analysis of the Austrian anticipation system identified some basic aspects such as policy. The analysis focused on two issues: the observation and measurement of…

  19. Improved Screening Mammogram Workflow by Maximizing PACS Streamlining Capabilities in an Academic Breast Center.

    Science.gov (United States)

    Pham, Ramya; Forsberg, Daniel; Plecha, Donna

    2017-04-01

    The aim of this study was to perform an operational improvement project targeted at the breast imaging reading workflow of mammography examinations at an academic medical center with its associated breast centers and satellite sites. Through careful analysis of the current workflow, two major issues were identified: stockpiling of paperwork and multiple worklists. Both issues were considered to cause significant delays to the start of interpreting screening mammograms. Four workflow changes were suggested (scanning of paperwork, worklist consolidation, use of chat functionality, and tracking of case distribution among trainees) and implemented in July 2015. Timestamp data was collected 2 months before (May-Jun) and after (Aug-Sep) the implemented changes. Generalized linear models were used to analyze the data. The results showed significant improvements for the interpretation of screening mammograms. The average time elapsed for time to open a case reduced from 70 to 28 min (60 % decrease, p workflow for diagnostic mammograms at large unaltered even with increased volume of mammography examinations (31 % increase of 4344 examinations for May-Jun to 5678 examinations for Aug-Sep). In conclusion, targeted efforts to improve the breast imaging reading workflow for screening mammograms in a teaching environment provided significant performance improvements without affecting the workflow of diagnostic mammograms.

  20. Powerplant productivity improvement study: policy analysis and incentive assessment. Final report

    Energy Technology Data Exchange (ETDEWEB)

    None

    1979-05-01

    Policy options that the Illinois Commerce Commission might adopt in order to promote improved power plant productivity for existing units in Illinois are identified and analyzed. These policy options would generally involve either removing existing disincentives and/or adding direct incentives through the regulatory process. The following activities are reported: in-depth review of existing theoretical and empirical literature in the areas of power plant reliability, regulatory utility efficiency and performance incentives, and impacts of various regulatory mechanisms such as the Fuel Adjustment Clauses on productivity; contacts with other state public utility commissions known to be investigating or implementing productivity improvement incentive mechanisms; documentation and analysis of incentive mechanisms adopted or under consideration in other states; analysis of current regulatory practice in Illinois as it relates to power plant productivity incentives and disincentives; identification of candidate incentive mechanisms for consideration by the Illinois Commerce Commission; and analysis and evaluation of these candidates. 72 references, 8 figures.

  1. "Harnessing genomics to improve health in India" – an executive course to support genomics policy

    Directory of Open Access Journals (Sweden)

    Acharya Tara

    2004-05-01

    Full Text Available Abstract Background The benefits of scientific medicine have eluded millions in developing countries and the genomics revolution threatens to increase health inequities between North and South. India, as a developing yet also industrialized country, is uniquely positioned to pioneer science policy innovations to narrow the genomics divide. Recognizing this, the Indian Council of Medical Research and the University of Toronto Joint Centre for Bioethics conducted a Genomics Policy Executive Course in January 2003 in Kerala, India. The course provided a forum for stakeholders to discuss the relevance of genomics for health in India. This article presents the course findings and recommendations formulated by the participants for genomics policy in India. Methods The course goals were to familiarize participants with the implications of genomics for health in India; analyze and debate policy and ethical issues; and develop a multi-sectoral opinion leaders' network to share perspectives. To achieve these goals, the course brought together representatives of academic research centres, biotechnology companies, regulatory bodies, media, voluntary, and legal organizations to engage in discussion. Topics included scientific advances in genomics, followed by innovations in business models, public sector perspectives, ethics, legal issues and national innovation systems. Results Seven main recommendations emerged: increase funding for healthcare research with appropriate emphasis on genomics; leverage India's assets such as traditional knowledge and genomic diversity in consultation with knowledge-holders; prioritize strategic entry points for India; improve industry-academic interface with appropriate incentives to improve public health and the nation's wealth; develop independent, accountable, transparent regulatory systems to ensure that ethical, legal and social issues are addressed for a single entry, smart and effective system; engage the public and

  2. Quality improvement in healthcare delivery utilizing the patient-centered medical home model.

    Science.gov (United States)

    Akinci, Fevzi; Patel, Poonam M

    2014-01-01

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

  3. Evaluation of Wind Power Forecasts from the Vermont Weather Analytics Center and Identification of Improvements

    Energy Technology Data Exchange (ETDEWEB)

    Optis, Michael [National Renewable Energy Lab. (NREL), Golden, CO (United States); Scott, George N. [National Renewable Energy Lab. (NREL), Golden, CO (United States); Draxl, Caroline [National Renewable Energy Lab. (NREL), Golden, CO (United States)

    2018-02-02

    The goal of this analysis was to assess the wind power forecast accuracy of the Vermont Weather Analytics Center (VTWAC) forecast system and to identify potential improvements to the forecasts. Based on the analysis at Georgia Mountain, the following recommendations for improving forecast performance were made: 1. Resolve the significant negative forecast bias in February-March 2017 (50% underprediction on average) 2. Improve the ability of the forecast model to capture the strong diurnal cycle of wind power 3. Add ability for forecast model to assess internal wake loss, particularly at sites where strong diurnal shifts in wind direction are present. Data availability and quality limited the robustness of this forecast assessment. A more thorough analysis would be possible given a longer period of record for the data (at least one full year), detailed supervisory control and data acquisition data for each wind plant, and more detailed information on the forecast system input data and methodologies.

  4. Reorganizing the General Clinical Research Center to improve the clinical and translational research enterprise.

    Science.gov (United States)

    Allen, David; Ripley, Elizabeth; Coe, Antoinette; Clore, John

    2013-12-01

    In 2010, Virginia Commonwealth University (VCU) was granted a Clinical and Translational Science Award which prompted reorganization and expansion of their clinical research infrastructure. A case study approach is used to describe the implementation of a business and cost recovery model for clinical and translational research and the transformation of VCU's General Clinical Research Center and Clinical Trials Office to a combined Clinical Research Services entity. We outline the use of a Plan, Do, Study, Act cycle that facilitated a thoughtful transition process, which included the identification of required changes and cost recovery processes for implementation. Through this process, the VCU Center for Clinical and Translational Research improved efficiency, increased revenue recovered, reduced costs, and brought a high level of fiscal responsibility through financial reporting.

  5. Improving Initiation and Tracking of Research Projects at an Academic Health Center: A Case Study.

    Science.gov (United States)

    Schmidt, Susanne; Goros, Martin; Parsons, Helen M; Saygin, Can; Wan, Hung-Da; Shireman, Paula K; Gelfond, Jonathan A L

    2017-09-01

    Research service cores at academic health centers are important in driving translational advancements. Specifically, biostatistics and research design units provide services and training in data analytics, biostatistics, and study design. However, the increasing demand and complexity of assigning appropriate personnel to time-sensitive projects strains existing resources, potentially decreasing productivity and increasing costs. Improving processes for project initiation, assigning appropriate personnel, and tracking time-sensitive projects can eliminate bottlenecks and utilize resources more efficiently. In this case study, we describe our application of lean six sigma principles to our biostatistics unit to establish a systematic continual process improvement cycle for intake, allocation, and tracking of research design and data analysis projects. The define, measure, analyze, improve, and control methodology was used to guide the process improvement. Our goal was to assess and improve the efficiency and effectiveness of operations by objectively measuring outcomes, automating processes, and reducing bottlenecks. As a result, we developed a web-based dashboard application to capture, track, categorize, streamline, and automate project flow. Our workflow system resulted in improved transparency, efficiency, and workload allocation. Using the dashboard application, we reduced the average study intake time from 18 to 6 days, a 66.7% reduction over 12 months (January to December 2015).

  6. Improving the quality of health services organization structure by reengineering: circular design and clinical case impact in an academic medical center.

    Science.gov (United States)

    Lartin-Drake, J M; Curran, C; Gillis-Donovan, J; Kruger, N R; Ziegenfuss, J T; Ostrem, J; Zanotti, M

    1996-01-01

    Innovation to improve the quality of structure and process in health care organization is reported in this case example of change in an academic medical center. Interactive planning and the circular organization design concept were the driving principles and methods. This report presents the needs for and initial obstructions to change, planning and project design work, a description of the change process, and illustrative accomplishments to date--two cases, one of conscious sedation policy and one of nuisance pages. Evaluative criteria for judging the progress and lessons of the project regarding key design characteristics also are included.

  7. Report on the feasibility study for improving electric motor service centers in Ghana

    Energy Technology Data Exchange (ETDEWEB)

    Hsu, J.S.; Jallouk, P.A.; Staunton, R.H.

    1999-12-10

    On March 3 and 4, 1998, a visit was made to Oak Ridge National Laboratory (ORNL) by two officials from Ghana: Mr. I.K. Mintah, Acting Executive Director, Technical Wing, Ministry of Mines and Energy (MOME) and Dr. A.K. Ofosu-Ahenkorah, Coordinator, Energy Efficiency and Conservation Program, MOME. As a result of this visit, Dr. John S. Hsu of ORNL was invited by MOME to visit the Republic of Ghana in order to study the feasibility of improving electric motor service centers in Ghana.

  8. Improvement of quality with Nuclear Power Training Center (NTC) operator training

    International Nuclear Information System (INIS)

    Matsumoto, Y.

    2005-01-01

    Nuclear Power Training Center (NTC) was established in 1972 for PWR operator training. As the result of introduction of quality assurance management into NTC operator training, it became possible to confirm each step of systematic approach to training (SAT) process and then feedback process became clearer. Simulation models were modified based on domestic or overseas accidents cases and so training was improved using simulators closer to actual plants. Also a new multipurpose simulator with modified reactor coolant system (RCS) visual display device (RVD) and parameter-event-log (PEL) device was introduced in 2003 to provide more information so as to upgrade knowledge level of operators. (T. Tanaka)

  9. Effect of the Uniform Accident and Sickness Policy Provision Law on alcohol screening and intervention in trauma centers.

    Science.gov (United States)

    Gentilello, Larry M; Donato, Anthony; Nolan, Susan; Mackin, Robert E; Liebich, Franesa; Hoyt, David B; LaBrie, Richard A

    2005-09-01

    Alcohol screening and intervention in trauma centers are widely recommended. The Uniform Accident and Sickness Policy Provision Law (UPPL) exists in most states, and allows insurers to refuse payment for treatment of injuries in patients with a positive alcohol or drug test. This article analyzed the UPPL's impact on screening and reimbursement, measured the knowledge of legislators about substance use problems in trauma centers, and determined their opinions about substance use-related exclusions in insurance contracts for trauma care. A nationwide survey of members of the American Association for the Surgery of Trauma was conducted. A separate survey of legislators who are members of the Senate, House, or Assembly and serve in some leadership role on committees responsible for insurance in their state was also performed. Ninety-eight trauma surgeon and 56 legislator questionnaires were analyzed. Surgeons' familiarity with the UPPL was limited; only 13% believed they practiced in a UPPL state, but 70% actually did. Despite lack of knowledge of the statute, 24% reported an alcohol- or drug-related insurance denial in the past 6 months. This appeared to affect screening practices; the majority of surgeons (51.5%) do not routinely measure blood alcohol concentration, even though over 91% believe blood alcohol concentration testing is important. Most (82%) indicated that if there were no insurance barriers, they would be willing to establish a brief alcohol intervention program in their center. Legislators were aware of the impact of substance use on trauma centers. They overwhelmingly agreed (89%) that alcohol problems are treatable, and 80% believed it is a good idea to offer counseling in trauma centers. As with surgeons, the majority (53%) were not sure whether the UPPL existed in their state, but they favored prohibiting alcohol-related exclusions by a 2:1 ratio, with strong bipartisan support. The study documents strong support for screening and intervention

  10. Improving building energy efficiency in India: State-level analysis of building energy efficiency policies

    Energy Technology Data Exchange (ETDEWEB)

    Yu, Sha; Tan, Qing; Evans, Meredydd; Kyle, Page; Vu, Linh; Patel, Pralit L.

    2017-11-01

    India is expected to add 40 billion m2 of new buildings till 2050. Buildings are responsible for one third of India’s total energy consumption today and building energy use is expected to continue growing driven by rapid income and population growth. The implementation of the Energy Conservation Building Code (ECBC) is one of the measures to improve building energy efficiency. Using the Global Change Assessment Model, this study assesses growth in the buildings sector and impacts of building energy policies in Gujarat, which would help the state adopt ECBC and expand building energy efficiency programs. Without building energy policies, building energy use in Gujarat would grow by 15 times in commercial buildings and 4 times in urban residential buildings between 2010 and 2050. ECBC improves energy efficiency in commercial buildings and could reduce building electricity use in Gujarat by 20% in 2050, compared to the no policy scenario. Having energy codes for both commercial and residential buildings could result in additional 10% savings in electricity use. To achieve these intended savings, it is critical to build capacity and institution for robust code implementation.

  11. Public say food regulatory policies to improve health in Western Australia are important: population survey results.

    Science.gov (United States)

    Pollard, Christina M; Daly, Alison; Moore, Michael; Binns, Colin W

    2013-10-01

    To investigate the level of support among Western Australian adults for food control policies to improve diet, reduce obesity and protect the environment. Attitudes towards government food control policies on food labelling, food advertising, and the supply of environmentally friendly food data were pooled from two Nutrition Monitoring Survey Series telephone surveys of 2,147 adults aged 18-64 years collected in 2009 and 2012. Descriptive and logistic regression analyses were conducted using survey module of STATA 12. The majority of adults believe it is important that government regulates food policy options under consideration: nutrition information on food labels (97% versus 2% who think it is not important); health rating on food labels (95% versus 3%); food advertising (83% versus 11%); and the supply of environmentally friendly food (86% versus 9%). Community perception is that government control or regulation of food labelling, food advertising and the supply of environmentally friendly food is important. Curbing excess weight gain and related disease burden is a public health priority. Australian governments are considering food regulatory interventions to assist the public to improve their dietary intake. These findings should provide reassurance to government officials considering these regulatory measures. © 2013 The Authors. ANZJPH © 2013 Public Health Association of Australia.

  12. Voluntary agreements with white certificates for energy efficiency improvement as a hybrid policy instrument

    International Nuclear Information System (INIS)

    Oikonomou, V.; Patel, M.K.; Rietbergen, M.; Van der Gaast, W.

    2009-01-01

    In this paper we examine the implementation of a combined policy scheme that consists of a traditional instrument, the voluntary agreements (VAs), and an innovative one, the white certificates (WhC). The basic structure of this scheme is that energy suppliers who undertake an energy efficiency obligation under a white certificate scheme can make use of voluntary actions to enhance investments in innovative energy savings projects. Energy suppliers and other market parties can additionally or in parallel participate in voluntary agreements and set energy efficiency targets. For fulfilling their voluntary agreement target, these market parties can receive tax exemptions or receive white certificates that they can sell in the market. Transaction costs and baseline definition for demonstrating energy efficiency improvement deserve special attention. This policy can assist a country to enhance energy efficiency improvement while it stimulates innovation. Cost effectiveness can be higher than the case of stand-alone policy instruments, since more financing options are available for more expensive projects. Nevertheless, the added value of the scheme lies more in the implementation of innovative measures for enhanced energy efficiency. Furthermore, market parties can discover more business opportunities in energy efficiency and establish a green image; hence an integrated scheme should achieve higher political acceptability. (author)

  13. Policies for accelerating access to clean energy, improving health, advancing development, and mitigating climate change.

    Science.gov (United States)

    Haines, Andy; Smith, Kirk R; Anderson, Dennis; Epstein, Paul R; McMichael, Anthony J; Roberts, Ian; Wilkinson, Paul; Woodcock, James; Woods, Jeremy

    2007-10-06

    The absence of reliable access to clean energy and the services it provides imposes a large disease burden on low-income populations and impedes prospects for development. Furthermore, current patterns of fossil-fuel use cause substantial ill-health from air pollution and occupational hazards. Impending climate change, mainly driven by energy use, now also threatens health. Policies to promote access to non-polluting and sustainable sources of energy have great potential both to improve public health and to mitigate (prevent) climate disruption. There are several technological options, policy levers, and economic instruments for sectors such as power generation, transport, agriculture, and the built environment. However, barriers to change include vested interests, political inertia, inability to take meaningful action, profound global inequalities, weak technology-transfer mechanisms, and knowledge gaps that must be addressed to transform global markets. The need for policies that prevent dangerous anthropogenic interference with the climate while addressing the energy needs of disadvantaged people is a central challenge of the current era. A comprehensive programme for clean energy should optimise mitigation and, simultaneously, adaption to climate change while maximising co-benefits for health--eg, through improved air, water, and food quality. Intersectoral research and concerted action, both nationally and internationally, will be required.

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

    Directory of Open Access Journals (Sweden)

    V. I. Guzeva

    2016-01-01

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

  15. Measuring improvement in knowledge of drug policy reforms following a police education program in Tijuana, Mexico.

    Science.gov (United States)

    Arredondo, J; Strathdee, S A; Cepeda, J; Abramovitz, D; Artamonova, I; Clairgue, E; Bustamante, E; Mittal, M L; Rocha, T; Bañuelos, A; Olivarria, H O; Morales, M; Rangel, G; Magis, C; Beletsky, L

    2017-11-08

    Mexico's 2009 "narcomenudeo reform" decriminalized small amounts of drugs, shifting some drug law enforcement to the states and mandating drug treatment diversion instead of incarceration. Data from Tijuana suggested limited implementation of this harm reduction-oriented policy. We studied whether a police education program (PEP) improved officers' drug and syringe policy knowledge, and aimed to identify participant characteristics associated with improvement of drug policy knowledge. Pre- and post-training surveys were self-administered by municipal police officers to measure legal knowledge. Training impact was assessed through matched paired nominal data using McNemar's tests. Multivariable logistic regression was used to identify predictors of improved legal knowledge, as measured by officers' ability to identify conceptual legal provisions related to syringe possession and thresholds of drugs covered under the reform. Of 1750 respondents comparing pre- versus post training, officers reported significant improvement (p < 0.001) in their technical understanding of syringe possession (56 to 91%) and drug amounts decriminalized, including marijuana (9 to 52%), heroin (8 to 71%), and methamphetamine (7 to 70%). The training was associated with even greater success in improving conceptual legal knowledge for syringe possession (67 to 96%) (p < 0.001), marijuana (16 to 91%), heroin (11 to 91%), and methamphetamine (11 to 89%). In multivariable modeling, those with at least a high school education were more likely to exhibit improvement of conceptual legal knowledge of syringe possession (adjusted odds ratio [aOR] 2.6, 95% CI 1.4-3.2) and decriminalization for heroin (aOR 2.7, 95% CI 1.3-4.3), methamphetamine (aOR 2.2, 95% CI 1.4-3.2), and marijuana (aOR 2.5, 95% CI 1.6-4). Drug policy reform is often necessary, but not sufficient to achieve public health goals because of gaps in translating formal laws to policing practice. To close such gaps, PEP initiatives

  16. Measuring improvement in knowledge of drug policy reforms following a police education program in Tijuana, Mexico

    Directory of Open Access Journals (Sweden)

    J. Arredondo

    2017-11-01

    Full Text Available Abstract Background Mexico’s 2009 “narcomenudeo reform” decriminalized small amounts of drugs, shifting some drug law enforcement to the states and mandating drug treatment diversion instead of incarceration. Data from Tijuana suggested limited implementation of this harm reduction-oriented policy. We studied whether a police education program (PEP improved officers’ drug and syringe policy knowledge, and aimed to identify participant characteristics associated with improvement of drug policy knowledge. Methods Pre- and post-training surveys were self-administered by municipal police officers to measure legal knowledge. Training impact was assessed through matched paired nominal data using McNemar’s tests. Multivariable logistic regression was used to identify predictors of improved legal knowledge, as measured by officers’ ability to identify conceptual legal provisions related to syringe possession and thresholds of drugs covered under the reform. Results Of 1750 respondents comparing pre- versus post training, officers reported significant improvement (p < 0.001 in their technical understanding of syringe possession (56 to 91% and drug amounts decriminalized, including marijuana (9 to 52%, heroin (8 to 71%, and methamphetamine (7 to 70%. The training was associated with even greater success in improving conceptual legal knowledge for syringe possession (67 to 96% (p < 0.001, marijuana (16 to 91%, heroin (11 to 91%, and methamphetamine (11 to 89%. In multivariable modeling, those with at least a high school education were more likely to exhibit improvement of conceptual legal knowledge of syringe possession (adjusted odds ratio [aOR] 2.6, 95% CI 1.4–3.2 and decriminalization for heroin (aOR 2.7, 95% CI 1.3–4.3, methamphetamine (aOR 2.2, 95% CI 1.4–3.2, and marijuana (aOR 2.5, 95% CI 1.6–4. Conclusions Drug policy reform is often necessary, but not sufficient to achieve public health goals because of gaps in translating

  17. A needs assessment of health information technology for improving care coordination in three leading patient-centered medical homes.

    Science.gov (United States)

    Richardson, Joshua E; Vest, Joshua R; Green, Cori M; Kern, Lisa M; Kaushal, Rainu

    2015-07-01

    We investigated ways that patient-centered medical homes (PCMHs) are currently using health information technology (IT) for care coordination and what types of health IT are needed to improve care coordination. A multi-disciplinary team of researchers conducted semi-structured telephone interviews with 28 participants from 3 PCMHs in the United States. Participants included administrators and clinicians from PCMHs, electronic health record (EHR) and health information exchange (HIE) representatives, and policy makers. Participants identified multiple barriers to care coordination using current health IT tools. We identified five areas in which health IT can improve care coordination in PCMHs: 1) monitoring patient populations, 2) notifying clinicians and other staff when specific patients move across care settings, 3) collaborating around patients, 4) reporting activities, and 5) interoperability. To accomplish these tasks, many participants described using homegrown care coordination systems separate from EHRs. The participants in this study have resources, experience, and expertise with using health IT for care coordination, yet they still identified multiple areas for improvement. We hypothesize that focusing health IT development in the five areas we identified can enable more effective care coordination. Key findings from this work are that homegrown systems apart from EHRs are currently used to support care coordination and, also, that reporting tools are key components of care coordination. New health IT that enables monitoring, notifying, collaborating, reporting, and interoperability would enhance care coordination within PCMHs beyond what current health IT enables. © The Author 2015. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  18. Improving pain care through implementation of the Stepped Care Model at a multisite community health center

    Directory of Open Access Journals (Sweden)

    Anderson DR

    2016-11-01

    Full Text Available Daren R Anderson,1 Ianita Zlateva,1 Emil N Coman,2 Khushbu Khatri,1 Terrence Tian,1 Robert D Kerns3 1Weitzman Institute, Community Health Center, Inc., Middletown, 2UCONN Health Disparities Institute, University of Connecticut, Farmington, 3VA Connecticut Healthcare System, West Haven, CT, USA Purpose: Treating pain in primary care is challenging. Primary care providers (PCPs receive limited training in pain care and express low confidence in their knowledge and ability to manage pain effectively. Models to improve pain outcomes have been developed, but not formally implemented in safety net practices where pain is particularly common. This study evaluated the impact of implementing the Stepped Care Model for Pain Management (SCM-PM at a large, multisite Federally Qualified Health Center. Methods: The Promoting Action on Research Implementation in Health Services framework guided the implementation of the SCM-PM. The multicomponent intervention included: education on pain care, new protocols for pain assessment and management, implementation of an opioid management dashboard, telehealth consultations, and enhanced onsite specialty resources. Participants included 25 PCPs and their patients with chronic pain (3,357 preintervention and 4,385 postintervention cared for at Community Health Center, Inc. Data were collected from the electronic health record and supplemented by chart reviews. Surveys were administered to PCPs to assess knowledge, attitudes, and confidence. Results: Providers’ pain knowledge scores increased to an average of 11% from baseline; self-rated confidence in ability to manage pain also increased. Use of opioid treatment agreements and urine drug screens increased significantly by 27.3% and 22.6%, respectively. Significant improvements were also noted in documentation of pain, pain treatment, and pain follow-up. Referrals to behavioral health providers for patients with pain increased by 5.96% (P=0.009. There was no

  19. The digital divide at an urban community health center: implications for quality improvement and health care access.

    Science.gov (United States)

    Denizard-Thompson, Nancy M; Feiereisel, Kirsten B; Stevens, Sheila F; Miller, David P; Wofford, James L

    2011-06-01

    Health care policy encourages better electronic connectivity between patient and the office practice. However, whether patients are able to partner with the practice in using communication technologies is not known. We sought to determine (1) the proportion of clinic patients who use internet and cell phone text messaging technologies, (2) the level of patient interest in using these technologies for the purpose of managing clinical appointments and patient education. Consecutive adult patients, clinicians and staff at an urban community health center were surveyed during a one-week period in order to estimate the frequency of technology use by patients. A total of 308 survey cards were collected during the designated week (response rate of 85% (308/362). One-third (34.0%, 105) of surveyed patients used the internet and text messaging daily or weekly, while nearly two-thirds (59.7%, 182) never used these technologies. There were no racial or gender differences in the proportion of patients who used the internet daily or weekly. In contrast, African-Americans used text messaging more often than whites (28.2 vs. 21.4%, P 50) used the internet and text messaging more often than older patients (50.6 vs. 16.6%, 44.3 vs. 7.3%, respectively). Despite the low use of both technologies, patient's interest in managing clinic appointments was high (40.3% for the Internet and 56.8% for text messaging). Clinicians and staff estimated patient's daily/weekly use of internet and cellphone messaging at 40.3% (± 22.0), and 56.8% (± 25.7), respectively. Most patients at this urban community health center reported never using the internet or cell phone text messaging. Clinicians overestimated technology use by patients. Planning for clinic infrastructure, quality improvement, and patient education should include assessment of technology use patterns by patients.

  20. Improved quality monitoring of multi-center acupuncture clinical trials in China

    Directory of Open Access Journals (Sweden)

    Zheng Hui

    2009-12-01

    Full Text Available Abstract Background In 2007, the Chinese Science Division of the State Administration of Traditional Chinese Medicine(TCM convened a special conference to discuss quality control for TCM clinical research. Control and assurance standards were established to guarantee the quality of clinical research. This paper provides practical guidelines for implementing strict and reproducible quality control for acupuncture randomized controlled trials (RCTs. Methods A standard quality control program (QCP was established to monitor the quality of acupuncture trials. Case report forms were designed; qualified investigators, study personnel and data management personnel were trained. Monitors, who were directly appointed by the project leader, completed the quality control programs. They guaranteed data accuracy and prevented or detected protocol violations. Clinical centers and clinicians were audited, the randomization system of the centers was inspected, and the treatment processes were audited as well. In addition, the case report forms were reviewed for completeness and internal consistency, the eligibility and validity of the patients in the study was verified, and data was monitored for compliance and accuracy. Results and discussion The monitors complete their reports and submit it to quality assurance and the sponsors. Recommendations and suggestions are made for improving performance. By holding regular meetings to discuss improvements in monitoring standards, the monitors can improve quality and efficiency. Conclusions Supplementing and improving the existed guidelines for quality monitoring will ensure that large multi-centre acupuncture clinical trials will be considered as valid and scientifically stringent as pharmaceutical clinical trials. It will also develop academic excellence and further promote the international recognition of acupuncture.

  1. Food price policies improve diet quality while increasing socioeconomic inequalities in nutrition

    Science.gov (United States)

    2014-01-01

    Background Prices are an important determinant of food choices. Consequently, food price policies (subsidies and/or taxes) are proposed to improve the nutritional quality of diets. The aim of the present study was to explore the impact of food price policies on the expenditures and nutritional quality of the food baskets chosen by low- and medium-income households. Methods Experimental economics was used to examine two price manipulations: i) a fruit and vegetable price subsidy named “fruit and vegetables condition”; ii) a healthy-product subsidy coupled with an unhealthy-product tax named “nutrient profile condition”. The nutrient profiling system called SAIN,LIM was used. This system classifies each individual food according to its overall nutritional quality which then allows for a food item to be taxed or subsidized. Women from low- (n = 95) and medium-incomes (n = 33) selected a daily food basket, first, at current prices and then at manipulated prices. The redistributive effects of experimental conditions were assessed by comparing the extent of savings induced by subsidies and of costs generated by the tax on the two income groups. Energy density (kcal/100 g), free sugars (% energy) and the mean adequacy ratio (MAR) were used as nutritional quality indicators. Results At baseline (before price manipulations), low-income women selected less expensive and less healthy baskets than medium-income ones. After price manipulations expenditures for both income group decreased significantly, whereas, the nutritional quality improved (energy density decreased, the MAR increased). Additionally, the redistributive effects were less favourable for low-income women and their nutritional quality improvements from baseline were significantly lower. Conclusion Low-income women derived fewer financial and nutritional benefits from implemented food subsidies and taxes than medium-income women. This outcome suggests that food price policies may improve diet

  2. Food price policies improve diet quality while increasing socioeconomic inequalities in nutrition.

    Science.gov (United States)

    Darmon, Nicole; Lacroix, Anne; Muller, Laurent; Ruffieux, Bernard

    2014-05-20

    Prices are an important determinant of food choices. Consequently, food price policies (subsidies and/or taxes) are proposed to improve the nutritional quality of diets. The aim of the present study was to explore the impact of food price policies on the expenditures and nutritional quality of the food baskets chosen by low- and medium-income households. Experimental economics was used to examine two price manipulations: i) a fruit and vegetable price subsidy named "fruit and vegetables condition"; ii) a healthy-product subsidy coupled with an unhealthy-product tax named "nutrient profile condition". The nutrient profiling system called SAIN,LIM was used. This system classifies each individual food according to its overall nutritional quality which then allows for a food item to be taxed or subsidized. Women from low- (n = 95) and medium-incomes (n = 33) selected a daily food basket, first, at current prices and then at manipulated prices. The redistributive effects of experimental conditions were assessed by comparing the extent of savings induced by subsidies and of costs generated by the tax on the two income groups. Energy density (kcal/100 g), free sugars (% energy) and the mean adequacy ratio (MAR) were used as nutritional quality indicators. At baseline (before price manipulations), low-income women selected less expensive and less healthy baskets than medium-income ones. After price manipulations expenditures for both income group decreased significantly, whereas, the nutritional quality improved (energy density decreased, the MAR increased). Additionally, the redistributive effects were less favourable for low-income women and their nutritional quality improvements from baseline were significantly lower. Low-income women derived fewer financial and nutritional benefits from implemented food subsidies and taxes than medium-income women. This outcome suggests that food price policies may improve diet quality while increasing socio

  3. Improving Customer Waiting Time at a DMV Center Using Discrete-Event Simulation

    Science.gov (United States)

    Arnaout, Georges M.; Bowling, Shannon

    2010-01-01

    Virginia's Department of Motor Vehicles (DMV) serves a customer base of approximately 5.6 million licensed drivers and ID card holders and 7 million registered vehicle owners. DMV has more daily face-to-face contact with Virginia's citizens than any other state agency [1]. The DMV faces a major difficulty in keeping up with the excessively large customers' arrival rate. The consequences are queues building up, stretching out to the entrance doors (and sometimes even outside) and customers complaining. While the DMV state employees are trying to serve at their fastest pace, the remarkably large queues indicate that there is a serious problem that the DMV faces in its services, which must be dealt with rapidly. Simulation is considered as one of the best tools for evaluating and improving complex systems. In this paper, we use it to model one of the DMV centers located in Norfolk, VA. The simulation model is modeled in Arena 10.0 from Rockwell systems. The data used is collected from experts of the DMV Virginia headquarter located in Richmond. The model created was verified and validated. The intent of this study is to identify key problems causing the delays at the DMV centers and suggest possible solutions to minimize the customers' waiting time. In addition, two tentative hypotheses aiming to improve the model's design are tested and validated.

  4. Assurance of Myeloid Growth Factor Administration in an Infusion Center: Pilot Quality Improvement Initiative.

    Science.gov (United States)

    Ramirez, Pamela Maree; Peterson, Barry; Holtshopple, Christine; Borja, Kristina; Torres, Vincent; Valdivia-Peppers, Lucille; Harriague, Julio; Joe, Melanie D

    2017-12-01

    Four incident reports involving missed doses of myeloid growth factors (MGFs) triggered the need for an outcome-driven initiative. From March 1, 2015, to February 29, 2016, at University of California Irvine Health Chao Infusion Center, 116 of 3,300 MGF doses were missed (3.52%), including pegfilgrastim, filgrastim, and sargramostim. We hypothesized that with the application of Lean Six Sigma methodology, we would achieve our primary objective of reducing the number of missed MGF doses to < 0.5%. This quality improvement initiative was conducted at Chao Infusion Center as part of a Lean Six Sigma Green Belt Certification Program. Therefore, Lean Six Sigma principles and tools were used throughout each phase of the project. Retrospective and prospective medical record reviews and data analyses were performed to evaluate the extent of the identified problem and impact of the process changes. Improvements included systems applications, practice changes, process modifications, and safety-net procedures. Preintervention, 24 missed doses (20.7%) required patient supportive care measures, resulting in increased hospital costs and decreased quality of care. Postintervention, from June 8, 2016, to August 7, 2016, zero of 489 MGF doses were missed after 2 months of intervention ( P < .001). Chao Infusion Center reduced missed doses from 3.52% to 0%, reaching the goal of < 0.5%. The establishment of simplified and standardized processes with safety checks for error prevention increased quality of care. Lean Six Sigma methodology can be applied by other institutions to produce positive outcomes and implement similar practice changes.

  5. Comprehensive stroke centers may be associated with improved survival in hemorrhagic stroke.

    Science.gov (United States)

    McKinney, James S; Cheng, Jerry Q; Rybinnik, Igor; Kostis, John B

    2015-05-06

    Comprehensive stroke centers (CSCs) provide a full spectrum of neurological and neurosurgical services to treat complex stroke patients. CSCs have been shown to improve clinical outcomes and mitigate disparities in ischemic stroke patients. It is believed that CSCs also improve outcomes in hemorrhagic stroke. We used the Myocardial Infarction Data Acquisition System (MIDAS) database, which includes data on patients discharged with a primary diagnosis of intracerebral hemorrhage (ICH; International Classification of Diseases, Ninth Revision [ICD-9] 431) and subarachnoid hemorrhage (SAH; ICD-9 430) from all nonfederal acute care hospitals in New Jersey (NJ) between 1996 and 2012. Out-of-hospital deaths were assessed by matching MIDAS records with NJ death registration files. The primary outcome variable was 90-day all-cause mortality. The primary independent variable was CSC versus primary stroke center (PSC) and nonstroke center (NSC) admission. Multivariate logistic models were used to measure the effects of available covariates. Overall, 36 981 patients were admitted with a primary diagnosis of ICH or SAH during the study period, of which 40% were admitted to a CSC. Patients admitted to CSCs were more likely to have neurosurgical or endovascular interventions than those admitted to a PSC/NSC (18.9% vs. 4.7%; Pmortality (35.0% vs. 40.3%; odds ratio, 0.93; 95% confidence interval, 0.89 to 0.97) for hemorrhagic stroke. This was particularly true for those admitted with SAH. Hemorrhagic stroke patients admitted to CSCs are more likely to receive neurosurgical and endovascular treatments and be alive at 90 days than patients admitted to other hospitals. © 2015 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

  6. "Harnessing genomics to improve health in Africa" – an executive course to support genomics policy

    Directory of Open Access Journals (Sweden)

    Singer Peter A

    2005-01-01

    Full Text Available Abstract Background Africa in the twenty-first century is faced with a heavy burden of disease, combined with ill-equipped medical systems and underdeveloped technological capacity. A major challenge for the international community is to bring scientific and technological advances like genomics to bear on the health priorities of poorer countries. The New Partnership for Africa's Development has identified science and technology as a key platform for Africa's renewal. Recognizing the timeliness of this issue, the African Centre for Technology Studies and the University of Toronto Joint Centre for Bioethics co-organized a course on Genomics and Public Health Policy in Nairobi, Kenya, the first of a series of similar courses to take place in the developing world. This article presents the findings and recommendations that emerged from this process, recommendations which suggest that a regional approach to developing sound science and technology policies is the key to harnessing genome-related biotechnology to improve health and contribute to human development in Africa. Methods The objectives of the course were to familiarize participants with the current status and implications of genomics for health in Africa; to provide frameworks for analyzing and debating the policy and ethical questions; and to begin developing a network across different sectors by sharing perspectives and building relationships. To achieve these goals the course brought together a diverse group of stakeholders from academic research centres, the media, non-governmental, voluntary and legal organizations to stimulate multi-sectoral debate around issues of policy. Topics included scientific advances in genomics innovation systems and business models, international regulatory frameworks, as well as ethical and legal issues. Results Seven main recommendations emerged: establish a network for sustained dialogue among participants; identify champions among politicians; use the

  7. Diversifying Schools and Leveraging School Improvement: A Comparative Analysis of the English Radical, and Singapore Conservative, Specialist Schools' Policies

    Science.gov (United States)

    Dimmock, Clive

    2011-01-01

    Within the context of fierce global economic competition, school diversification and specialist schools have been seen by governments as cornerstones of education policy to engineer school improvement in both England and Singapore for more than a decade. In both systems, the policy has manifested in different school types, school names and…

  8. Optimized Policies for Improving Fairness of Location-based Relay Selection

    DEFF Research Database (Denmark)

    Nielsen, Jimmy Jessen; Olsen, Rasmus Løvenstein; Madsen, Tatiana Kozlova

    2013-01-01

    For WLAN systems in which relaying is used to improve throughput performance for nodes located at the cell edge, node mobility and information collection delays can have a significant impact on the performance of a relay selection scheme. In this paper we extend our existing Markov Chain modeling...... framework for relay selection to allow for efficient calculation of relay policies given either mean throughput or kth throughput percentile as optimization criterium. In a scenario with static access point, static relay, and a mobile destination node, the kth throughput percentile optimization...

  9. Accelerating Energy Efficiency Improvements in Room Air Conditioners in India: Potential, Costs-Benefits, and Policies

    OpenAIRE

    Abhyankar, N; Shah, N; Park, WY; Phadke, AA

    2017-01-01

    Rising incomes, increasing urbanization, and large cooling demand prompted by India’s hot, humid climate are driving increasing uptake of room air conditioners (ACs). Air conditioning already accounts for 40-60% of summer peak load in large Indian cities such as Delhi and is on track to contribute 140 gigawatts (GW) ( 30%) to peak demand in 2030. India’s standards and labeling policies improved the market average efficiency of room ACs by about 35% between 2006 and 2016 (3% per year) even as ...

  10. Improving the care of older persons in Australian prisons using the Policy Delphi method.

    Science.gov (United States)

    Patterson, Karen; Newman, Claire; Doona, Katherine

    2016-09-01

    There are currently no internationally recognised and approved processes relating to the care of older persons with dementia in prison. This research aimed to develop tools and procedures related to managing the care of, including the identification and assessment of, older persons with dementia who are imprisoned in New South Wales, Australia. A modified approach to the Policy Delphi method, using both surveys and facilitated discussion groups, enabled experts to come together to discuss improving the quality of care provision for older persons with dementia in prison and achieve research aims. © The Author(s) 2014.

  11. Improving Australia's renewable energy project policy and planning: A multiple stakeholder analysis

    International Nuclear Information System (INIS)

    Martin, Nigel; Rice, John

    2015-01-01

    Renewable Energy (RE) is part of Australia's and the world's energy supply matrix with over A$100 billion spent annually on RE projects since 2007. Businesses seeking to invest in RE projects, particularly in the wind and solar energy sectors, may face an onerous collection of planning approvals and permitting processes that impede investment and implementation. In this study, we draw on international and domestic stakeholder inputs to a governmental inquiry in Australia to show how RE projects might be approved in shortened timeframes with reduced associated costs. The process mapping and stakeholder analysis demonstrates that RE supply projects can benefit from standardized approval processes and documentation, a 360° deep engagement with stakeholders, and expanded electricity grid access in resource areas, augmented through supportive public policy and planning frameworks. In addition, stakeholder objections to project approval and implementation streamlining were used to contrast the efficacy of the proposed changes in policy. -- Highlights: •Highlights the over A$200 billion spent annually on global RE projects. •Describes a typical two stage, multi-layered governance RE project approval process. •Exposes long 3 year and multi-million dollar cost approvals for RE projects. •Identifies multi-million dollar remote grid connections as an RE project impediment. •Outlines RE project policy and guidelines shortcomings and proposed improvements

  12. Working to improve the management of sarcoma patients across Europe: a policy checklist.

    Science.gov (United States)

    Kasper, Bernd; Lecointe-Artzner, Estelle; Wait, Suzanne; Boldon, Shannon; Wilson, Roger; Gronchi, Alessandro; Valverde, Claudia; Eriksson, Mikael; Dumont, Sarah; Drove, Nora; Kanli, Athanasia; Wartenberg, Markus

    2018-04-16

    The Sarcoma Policy Checklist was created by a multidisciplinary expert group to provide policymakers with priority areas to improve care for sarcoma patients. This paper draws on this research, by looking more closely at how France, Germany, Italy, Spain, Sweden and the United Kingdom are addressing each of these priority areas. It aims to highlight key gaps in research, policy and practice, as well as ongoing initiatives that may impact the future care of sarcoma patients in different European countries. A pragmatic review of the published and web-based literature was undertaken. Telephone interviews were conducted in each country with clinical and patient experts to substantiate findings. Research findings were discussed within the expert group and developed into five core policy recommendations. The five identified priority areas were: the development of designated and accredited centres of reference; more professional training; multidisciplinary care; greater incentives for research and innovation; and more rapid access to effective treatments. Most of the countries studied have ongoing initiatives addressing many of these priorities; however, many are in early stages of development, or require additional funding and resources. Gaps in access to quality care are particularly concerning in many of Europe's lower-resourced countries. Equitable access to information, clinical trials, innovative treatments and quality specialist care should be available to all sarcoma patients. Achieving this across Europe will require close collaboration between all stakeholders at both the national and European level.

  13. Improving access to care through the patient-centered medical home.

    Science.gov (United States)

    North, Stephen W; McElligot, James; Douglas, Gaye; Martin, Amanda

    2014-02-01

    School-based health centers (SBHCs) serve an essential role in providing access to high-quality, comprehensive care to underserved children and adolescents in more than 2,000 schools across the United States. SBHCs are an essential component of the health care safety net, and their role in the patient-centered medical home (PCMH) continues to evolve as both collaborating partners and, when fully functioning, independent PCMHs. The American Academy of Pediatrics (AAP) supports the use of SBHCs, citing the proven benefits and exciting potential as justification, but also offers caution and recommends a focus on communication within the community. Traditional "brick and mortar" SBHCs are more likely to be located in urban communities (54.2% urban versus 18.0% rural) and be in schools with more students, allowing for a greater return on investment. Current SBHCs are located in schools with an average population of 997 students. The need for a large school population to help an SBHC approach financial viability excludes children in rural communities who are more likely to attend a school with fewer than 500 students, be poor, and have difficulty accessing health care.2 The expansion of telehealth technologies allows the creation of solutions to decrease geographic barriers that have limited the growth of SBHCs in rural communities. Telehealth school-based health centers (tSBHCs) that exclusively provide services through telemedicine are operating and developing in communities where geographic barriers and financial challenges have prevented the establishment of brick and mortar SBHCs. TSBHCs are beginning to increase the number and variety of services they provide through the use of telehealth to include behavioral health, nutrition services, and pediatric specialists. Understanding the role of tSBHCs in the growth of the PCMH model is critical for using these tools to continue to improve child and adolescent health. Copyright 2014, SLACK Incorporated.

  14. Clearing the air: improving smoke-free policy compliance at the national oncology hospital in Armenia.

    Science.gov (United States)

    Movsisyan, Narine K; Petrosyan, Varduhi; Harutyunyan, Arusyak; Petrosyan, Diana; Stillman, Frances

    2014-12-13

    Smoke-free policies shown to reduce population exposure to secondhand smoke (SHS) are the norm in hospitals in many countries around the world. Armenia, a transition economy in the South Caucasus, has one of the highest male smoking rates in the European region. Although smoking in healthcare facilities has been banned since 2005, compliance with this ban has been poor due to lack of implementation and enforcement mechanisms and social acceptability of smoking. The study aimed to develop and test a model intervention to address the lack of compliance with the de jure smoking ban. The national oncology hospital was chosen as the intervention site. This study used employee surveys and objective measurements of respirable particles (PM2.5) and air nicotine as markers of indoor air pollution before and after the intervention. The intervention developed in partnership with the hospital staff included an awareness campaign on SHS hazards, creation of no-smoking environment and building institutional capacity through training of nursing personnel on basics of tobacco control. The survey analysis included paired t-test and McNemar's test. The log-transformed air nicotine and PM2.5 data were analyzed using paired t-test. The survey showed significant improvement in the perceived quality of indoor air, reduced worksite exposure to SHS and increased employees' awareness of the smoke-free policy. The number of employees reporting compliance with the hospital smoke-free policy increased from 36.0% to 71.9% (p Armenia that have failed to implement the adopted smoke-free policies.

  15. Medical-Legal Partnerships At Veterans Affairs Medical Centers Improved Housing And Psychosocial Outcomes For Vets.

    Science.gov (United States)

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

    2017-12-01

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

  16. Active learning and student-centered pedagogy improve student attitudes and performance in introductory biology.

    Science.gov (United States)

    Armbruster, Peter; Patel, Maya; Johnson, Erika; Weiss, Martha

    2009-01-01

    We describe the development and implementation of an instructional design that focused on bringing multiple forms of active learning and student-centered pedagogies to a one-semester, undergraduate introductory biology course for both majors and nonmajors. Our course redesign consisted of three major elements: 1) reordering the presentation of the course content in an attempt to teach specific content within the context of broad conceptual themes, 2) incorporating active and problem-based learning into every lecture, and 3) adopting strategies to create a more student-centered learning environment. Assessment of our instructional design consisted of a student survey and comparison of final exam performance across 3 years-1 year before our course redesign was implemented (2006) and during two successive years of implementation (2007 and 2008). The course restructuring led to significant improvement of self-reported student engagement and satisfaction and increased academic performance. We discuss the successes and ongoing challenges of our course restructuring and consider issues relevant to institutional change.

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

    Directory of Open Access Journals (Sweden)

    Srisawat Supsomboon

    2014-01-01

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

  18. Improving emergency management through shared information processing - considerations in Emergency Operations Center design

    International Nuclear Information System (INIS)

    DeBusk, R.E.; Walker, J.A.

    1987-01-01

    An Emergency Operations Center (EOC) is a shared information processing facility. Although seemingly obvious, many EOCs are designed and operated based on other criteria. The results, measured in terms of response effectiveness, are difficult to determine. A review of some recent disasters reveals a pattern of poor performance for the EOCs involved. These conclusions are tentative because so little research has been done on the design, operation, or evaluation of emergency operations centers. The EOC is not an onsite response command post but a facility removed from the response where tactical and strategic decisions are made based on information from the response site and elsewhere. The EOC is therefore the central focus of emergency information processing and higher-level decision making. Examining existing EOCs, several common functions emerge. These functions can be described in terms of shared information processing. However, many factors impact the design and operation of EOCs. Politics, budgets, and personal ambition are only a few such factors. Examining EOC design and operation in terms of shared information processing operationalized in the seven principal functions within the EOC provides a framework for establishing principles of EOC design and operation. In the response to emergencies such as Bhopal or Chernobyl the stakes are high. Applying new techniques and technologies of management systems can improve the probability of success. This research is a beginning step - to understand how EOCs function, to define the system. Predictive or prescriptive analysis must wait until sufficient empirical data is available to complete a descriptive model for EOC operations

  19. Improvements to PATRIC, the all-bacterial Bioinformatics Database and Analysis Resource Center

    Science.gov (United States)

    Wattam, Alice R.; Davis, James J.; Assaf, Rida; Boisvert, Sébastien; Brettin, Thomas; Bun, Christopher; Conrad, Neal; Dietrich, Emily M.; Disz, Terry; Gabbard, Joseph L.; Gerdes, Svetlana; Henry, Christopher S.; Kenyon, Ronald W.; Machi, Dustin; Mao, Chunhong; Nordberg, Eric K.; Olsen, Gary J.; Murphy-Olson, Daniel E.; Olson, Robert; Overbeek, Ross; Parrello, Bruce; Pusch, Gordon D.; Shukla, Maulik; Vonstein, Veronika; Warren, Andrew; Xia, Fangfang; Yoo, Hyunseung; Stevens, Rick L.

    2017-01-01

    The Pathosystems Resource Integration Center (PATRIC) is the bacterial Bioinformatics Resource Center (https://www.patricbrc.org). Recent changes to PATRIC include a redesign of the web interface and some new services that provide users with a platform that takes them from raw reads to an integrated analysis experience. The redesigned interface allows researchers direct access to tools and data, and the emphasis has changed to user-created genome-groups, with detailed summaries and views of the data that researchers have selected. Perhaps the biggest change has been the enhanced capability for researchers to analyze their private data and compare it to the available public data. Researchers can assemble their raw sequence reads and annotate the contigs using RASTtk. PATRIC also provides services for RNA-Seq, variation, model reconstruction and differential expression analysis, all delivered through an updated private workspace. Private data can be compared by ‘virtual integration’ to any of PATRIC's public data. The number of genomes available for comparison in PATRIC has expanded to over 80 000, with a special emphasis on genomes with antimicrobial resistance data. PATRIC uses this data to improve both subsystem annotation and k-mer classification, and tags new genomes as having signatures that indicate susceptibility or resistance to specific antibiotics. PMID:27899627

  20. User-Centered Design for Developing Interventions to Improve Clinician Recommendation of Human Papillomavirus Vaccination.

    Science.gov (United States)

    Henninger, Michelle L; Mcmullen, Carmit K; Firemark, Alison J; Naleway, Allison L; Henrikson, Nora B; Turcotte, Joseph A

    2017-01-01

    Human papillomavirus (HPV) is the most common sexually transmitted infection in the US and is associated with multiple types of cancer. Although effective HPV vaccines have been available since 2006, coverage rates in the US remain much lower than with other adolescent vaccinations. Prior research has shown that a strong recommendation from a clinician is a critical determinant in HPV vaccine uptake and coverage. However, few published studies to date have specifically addressed the issue of helping clinicians communicate more effectively with their patients about the HPV vaccine. To develop one or more novel interventions for helping clinicians make strong and effective recommendations for HPV vaccination. Using principles of user-centered design, we conducted qualitative interviews, interviews with persons from analogous industries, and a data synthesis workshop with multiple stakeholders. Five potential intervention strategies targeted at health care clinicians, youth, and their parents were developed. The two most popular choices to pursue were a values-based communication strategy and a puberty education workbook. User-centered design is a useful strategy for developing potential interventions to improve the rate and success of clinicians recommending the HPV vaccine. Further research is needed to test the effectiveness and acceptability of these interventions in clinical settings.

  1. An integrated methodology for process improvement and delivery system visualization at a multidisciplinary cancer center.

    Science.gov (United States)

    Singprasong, Rachanee; Eldabi, Tillal

    2013-01-01

    Multidisciplinary cancer centers require an integrated, collaborative, and stream-lined workflow in order to provide high quality of patient care. Due to the complex nature of cancer care and continuing changes to treatment techniques and technologies, it is a constant struggle for centers to obtain a systemic and holistic view of treatment workflow for improving the delivery systems. Project management techniques, Responsibility matrix and a swim-lane activity diagram representing sequence of activities can be combined for data collection, presentation, and evaluation of the patient care. This paper presents this integrated methodology using multidisciplinary meetings and walking the route approach for data collection, integrated responsibility matrix and swim-lane activity diagram with activity time for data representation and 5-why and gap analysis approach for data analysis. This enables collection of right detail of information in a shorter time frame by identifying process flaws and deficiencies while being independent of the nature of the patient's disease or treatment techniques. A case study of a multidisciplinary regional cancer centre is used to illustrate effectiveness of the proposed methodology and demonstrates that the methodology is simple to understand, allowing for minimal training of staff and rapid implementation. © 2011 National Association for Healthcare Quality.

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

    Directory of Open Access Journals (Sweden)

    Olga Moshkovich

    2015-01-01

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

  3. Policy

    African Journals Online (AJOL)

    A paper presented at the Economic Commission for Africa. Second Meeting of ... solutions to their own challenges. However, the age ..... is highly complementary to improved varieties of fertilizer [26]. ... still the subject of debate on ethical, legal, bio- diversity and .... The dimensions of sustainable agriculture are multiple [30] ...

  4. The Remuneration Policy in the Budgetary Sphere of Ukraine: Main Trends, Shortcomings, Suggestions for Improvement

    Directory of Open Access Journals (Sweden)

    Tsymbaliuk Svitlana O.

    2017-09-01

    Full Text Available The aim of the work is to identify the main trends and shortcomings of the remuneration policy in the budgetary sphere of Ukraine and develop proposals for its improvement. There determined the main problems of the remuneration policy in the budgetary sphere, including the low level and unsatisfactory wage differentiation, intersectoral imbalances in remuneration, rigid framework of a unified tariff net, lack of an objective methodology for assessing the complexity of duties and work of employees, and forming qualification groups for labor remuneration. It was determined that the reform of the minimum wage institution led to an increase in the leveling of the remuneration of employees of various categories and professional groups, which practically led to the destruction of the tariff remuneration system in the budgetary sphere. The necessity of reforming the policy of employee remuneration in the budgetary sphere is substantiated. There formulated directions for improving the tariff labor remuneration: construction of a unified tariff net based on flexible principles, formation of qualification groups for labor remuneration to develop a unified remuneration scale, development of a methodology for evaluating positions and jobs, and ensuring an objective pay gap between two related qualifying groups. With the aim of renewing the ratios for various categories and professional groups, it is important to reduce the gap between the subsistence minimum and the minimum wage. Prospects for further research should be the development of a methodology for evaluating positions and job for an objective comparison of the complexity of tasks and responsibilities of budgetary sector employees, substantiating qualification ratios in wages, forming indicators to determine the basic wages of employees within the developed ranges.

  5. Dynamic water allocation policies improve the global efficiency of storage systems

    Science.gov (United States)

    Niayifar, Amin; Perona, Paolo

    2017-06-01

    Water impoundment by dams strongly affects the river natural flow regime, its attributes and the related ecosystem biodiversity. Fostering the sustainability of water uses e.g., hydropower systems thus implies searching for innovative operational policies able to generate Dynamic Environmental Flows (DEF) that mimic natural flow variability. The objective of this study is to propose a Direct Policy Search (DPS) framework based on defining dynamic flow release rules to improve the global efficiency of storage systems. The water allocation policies proposed for dammed systems are an extension of previously developed flow redistribution rules for small hydropower plants by Razurel et al. (2016).The mathematical form of the Fermi-Dirac statistical distribution applied to lake equations for the stored water in the dam is used to formulate non-proportional redistribution rules that partition the flow for energy production and environmental use. While energy production is computed from technical data, riverine ecological benefits associated with DEF are computed by integrating the Weighted Usable Area (WUA) for fishes with Richter's hydrological indicators. Then, multiobjective evolutionary algorithms (MOEAs) are applied to build ecological versus economic efficiency plot and locate its (Pareto) frontier. This study benchmarks two MOEAs (NSGA II and Borg MOEA) and compares their efficiency in terms of the quality of Pareto's frontier and computational cost. A detailed analysis of dam characteristics is performed to examine their impact on the global system efficiency and choice of the best redistribution rule. Finally, it is found that non-proportional flow releases can statistically improve the global efficiency, specifically the ecological one, of the hydropower system when compared to constant minimal flows.

  6. Intra Sector Policy Interventions for Improvement of Iranian Health Financing System

    Directory of Open Access Journals (Sweden)

    Peivand Bastani

    2013-09-01

    Full Text Available Background and purpose: To determine an appropriate financial model for the health system of Iran, several studies have been conducted. But it seems that these studies were not comprehensive and further investigation is required. So to design a valid and enforceable mechanism, the study of policy interventions will be considered through consensus of all stakeholders. This investigation was done to determine the necessary policies and internal interventions for health care system financial improvement in Iran. Materials and methods: The present work was carried out through investigating all key stakeholders in the medical system and the related sectors in Iran, along with the analysis of internal and external communication by using SWOT and STEEP.V methods. Results: Strategic management of health-care costs, the development of a new financial system, clarity of costs, benefiting from health national accounts, the regulation of budget based on operations, preparing the credit of per capita from prepayment and risk accumulation, the development of referral systems and mechanisms, the establishment of public fund for services purchase, preventing the involvement of insurances in non-insurance cases, competing services with the private sector and increasing resources for the promotion of equality level have been determined as the key proposed interventions. Conclusion: It seems that the interventions based to the development of improving health financial system including the deployment of full accrual basis instead of cash basis, preparing and using services cost and operational budgeting and finally, cost management and productivity are the prerequisites of reforming health financial system.

  7. The difficulties of "polluter pays" policy in agricultural pollution in UK and methods to improve it

    Institute of Scientific and Technical Information of China (English)

    2008-01-01

    Agricultural wastes pollution became serious after great improvement in technology and the encouragement of production for the government since the end of the World War Ⅱ. Economists and environmental scholars suggested that "polluter pays" policy be employed in agricultural pollution control. However, it was hard to implement "'polluter pays " policy alone in agricultural wastes pollution. In practice, there were two social factors which contributed to the improvement of water quality in the southwest of United Kingdom. One method is to communicate with farmers and then give farmers some advice or exhortation on facilities and management. The other method is to get up a telephone hotline for public to report water quality and probable pollution. Therefore, the consideration and combination of social factors in the control of agricultural wastes pollution are necessary and important. Education of basic natural sciences relevant to agricultural pollution, system management of agricultural pollutants and laws relevant to agricultural pollution is suggested to be the third social factor that British government can consider.

  8. Preliminary statement on general policy for rulemaking to improve nuclear power plant licensing

    International Nuclear Information System (INIS)

    1978-11-01

    In June 1977 an NRC study group seeking to identify ways to improve the effectiveness of NRC nuclear power plant licensing procedures, recommended (among other measures) that rulemaking should be considered for the generic resolution of certain major issues that are presently litigated in individual licensing proceedings (NUREG--0292). In response to a Commission directive, the staff prepared an interim statement of general policy and plans for rulemaking, which the Commission approved for publication n the Federal Register at Affirmation Session 78-7 held on October 26, 1978. This interim policy statement fully supports Executive Order 12044 of March 23, 1978, requesting improvement of existing and future government regulations so as to be as simple and clear as possible and avoid imposing unnecessary burdens on the economy, on individuals, on public and private organizations, or on State and local governments. This NUREG publication includes the full text of the Federal Register notice published concurrently. Also provided are Enclosures A and B which contain more complete information than is presented in the FR notice regarding the selection and discussion of issues proposed by the staff for generic rulemaking. However, the discussion of issues avoids being overly specific about the likely outcome of rulemaking in order to stimulate creative public and industry comments as desirable inputs to shaping the ultimate form of generic rules

  9. Enhancement of anesthesiology in-training exam performance with institution of an academic improvement policy.

    Science.gov (United States)

    Joseph, Julie A; Terry, Chris M; Waller, Eva J; Bortsov, Andrey V; Zvara, David A; Mayer, David C; Martinelli, Susan M

    2014-01-01

    Anesthesiology resident physicians across the United States complete an annual in-training examination (ITE). The ITE evaluates resident knowledge and provides personalized feedback to guide future study in low scoring sections(1). Performance on the ITE correlates with outcomes on the American Board of Anesthesiology (ABA) written board examination(2). Over the last several years, declining ITE scores were observed at the University of North Carolina (UNC). In response to this decline, our department reprioritized the ITE by instituting an academic improvement policy (AIP). The AIP employed both reward for satisfactory achievement and consequence for under-performance to elevate the ITE as a "high stakes" examination. Our hypothesis was that implementation of this AIP would improve ITE scores. ITE scores were compiled from 150 residents in the Department of Anesthesiology at UNC for graduating classes from 2004-2015. Data is presented as the number of residents scoring below the 20th percentile when compared to the national distribution before and after the AIP. In addition, average USMLE Step 1 three-digit scores for each graduating class were compared to average ITE percentile scores of the corresponding graduating class (USMLE does not provide percentile scores). Between 2009 and 2013, the number of residents who scored below the 20th percentile on the ITE increased steadily to a peak of 10 in 2011. After implementation of the AIP in July 2011, there was an 80% decrease in those scoring below the 20th percentile, from 10 to 2 residents (pITE scores improved after implementation of an academic improvement policy.

  10. Using Learner-Centered, Simulation-Based Training to Improve Medical Students’ Procedural Skills

    Directory of Open Access Journals (Sweden)

    Serkan Toy

    2017-03-01

    Full Text Available Purpose: To evaluate the effectiveness of a learner-centered, simulation-based training developed to help medical students improve their procedural skills in intubation, arterial line placement, lumbar puncture, and central line insertion. Method: The study participants were second and third year medical students. Anesthesiology residents provided the training and evaluated students’ procedural skills. Two residents were present at each station to train the medical students who rotated through all 4 stations. Pre/posttraining assessment of confidence, knowledge, and procedural skills was done using a survey, a multiple-choice test, and procedural checklists, respectively. Results: In total, 24 students were trained in six 4-hour sessions. Students reported feeling significantly more confident, after training, in performing all 4 procedures on a real patient ( P < .001. Paired-samples t tests indicated statistically significant improvement in knowledge scores for intubation, t (23 = −2.92, P < .001, and arterial line placement, t (23 = −2.75, P < .001. Procedural performance scores for intubation ( t (23 = −17.29, P < .001, arterial line placement ( t (23 = −19.75, P < .001, lumbar puncture ( t (23 = −16.27, P < .001, and central line placement ( t (23 = −17.25, P < .001 showed significant improvement. Intraclass correlation coefficients indicated high reliability in checklist scores for all procedures. Conclusions: The simulation sessions allowed each medical student to receive individual attention from 2 residents for each procedure. Students’ written comments indicated that this training modality was well received. Results showed that medical students improved their self-confidence, knowledge, and skills in the aforementioned procedures.

  11. A multicriteria decision making approach applied to improving maintenance policies in healthcare organizations.

    Science.gov (United States)

    Carnero, María Carmen; Gómez, Andrés

    2016-04-23

    decision-making group. This approach is better suited to actual health care organization practice and depending on the subsystem analysed, improvements are introduced that are not included in normal maintenance policies; in this way, not only have different maintenance policies been suggested, but also alternatives that, in each case and according to viability, provide a more complete decision tool for the maintenance manager.

  12. Final priority; technical assistance to improve state data capacity--National Technical Assistance Center to improve state capacity to accurately collect and report IDEA data. Final priority.

    Science.gov (United States)

    2013-05-20

    The Assistant Secretary for Special Education and Rehabilitative Services announces a priority under the Technical Assistance to Improve State Data Capacity program. The Assistant Secretary may use this priority for competitions in fiscal year (FY) 2013 and later years. We take this action to focus attention on an identified national need to provide technical assistance (TA) to States to improve their capacity to meet the data collection and reporting requirements of the Individuals with Disabilities Education Act (IDEA). We intend this priority to establish a TA center to improve State capacity to accurately collect and report IDEA data (Data Center).

  13. Improving the quality of numerical software through user-centered design

    Energy Technology Data Exchange (ETDEWEB)

    Pancake, C. M., Oregon State University

    1998-06-01

    The software interface - whether graphical, command-oriented, menu-driven, or in the form of subroutine calls - shapes the user`s perception of what software can do. It also establishes upper bounds on software usability. Numerical software interfaces typically are based on the designer`s understanding of how the software should be used. That is a poor foundation for usability, since the features that are ``instinctively right`` from the developer`s perspective are often the very ones that technical programmers find most objectionable or most difficult to learn. This paper discusses how numerical software interfaces can be improved by involving users more actively in design, a process known as user-centered design (UCD). While UCD requires extra organization and effort, it results in much higher levels of usability and can actually reduce software costs. This is true not just for graphical user interfaces, but for all software interfaces. Examples show how UCD improved the usability of a subroutine library, a command language, and an invocation interface.

  14. VA announces aggressive new approach to produce rapid improvements in VA medical centers

    Directory of Open Access Journals (Sweden)

    Robbins RA

    2018-02-01

    Full Text Available No abstract available. Article truncated at 150 words. The U.S. Department of Veterans Affairs (VA announced steps that it is taking as part of an aggressive new approach to produce rapid improvements at VA’s low-performing medical facilities nationwide (1. VA defines its low-performing facilities as those medical centers that receive the lowest score in its Strategic Analytics for Improvement and Learning (SAIL star rating system, or a one-star rating out of five. The SAIL star rating was initiated in 2016 and uses a variety of measures including mortality, length of hospital stay, readmission rates, hospital complications, physician productivity and efficiency. A complete listing of the VA facilities, their star ratings and the metrics used to determine the ratings is available through the end of fiscal year 2017 (2. Based on the latest ratings, the VA currently has 15 one-star facilities including Denver, Loma Linda, and Phoenix in the Southwest (Table 1. Table 1. VA facilities with one-star ratings …

  15. Improvement of the Oracle setup and database design at the Heidelberg ion therapy center

    International Nuclear Information System (INIS)

    Hoeppner, K.; Haberer, T.; Mosthaf, J.M.; Peters, A.; Thomas, M.; Welde, A.; Froehlich, G.; Juelicher, S.; Schaa, V. R.W.; Schiebel, W.; Steinmetz, S.

    2012-01-01

    The HIT (Heidelberg Ion Therapy) center is an accelerator facility for cancer therapy using both carbon ions and protons, located at the university hospital in Heidelberg. It provides three therapy treatment rooms: two with fixed beam exit (both in clinical use), and a unique gantry with a rotating beam head, currently under commissioning. The backbone of the proprietary accelerator control system consists of an Oracle database running on a Windows server, storing and delivering data of beam cycles, error logging, measured values, and the device parameters and beam settings for about 100,000 combinations of energy, beam size and particle rate used in treatment plans. Since going operational, we found some performance problems with the current database setup. Thus, we started an analysis that focused on the following topics: hardware resources of the database server, configuration of the Oracle instance, and a review of the database design that underwent several changes since its original design. The analysis revealed issues on all fields. The outdated server will be replaced by a state-of-the-art machine soon. We will present improvements of the Oracle configuration, the optimization of SQL statements, and the performance tuning of database design by adding new indexes which proved directly visible in accelerator operation, while data integrity was improved by additional foreign key constraints. (authors)

  16. Improving energy efficiency of dedicated cooling system and its contribution towards meeting an energy-optimized data center

    International Nuclear Information System (INIS)

    Cho, Jinkyun; Kim, Yundeok

    2016-01-01

    Highlights: • Energy-optimized data center’s cooling solutions were derived for four different climate zones. • We studied practical technologies of green data center that greatly improved energy efficiency. • We identified the relationship between mutually dependent factors in datacenter cooling systems. • We evaluated the effect of the dedicated cooling system applications. • Power Usage Effectiveness (PUE) was computed with energy simulation for data centers. - Abstract: Data centers are approximately 50 times more energy-intensive than general buildings. The rapidly increasing energy demand for data center operation has motivated efforts to better understand data center electricity use and to identify strategies that reduce the environmental impact. This research is presented analytical approach to the energy efficiency optimization of high density data center, in a synergy with relevant performance analysis of corresponding case study. This paper builds on data center energy modeling efforts by characterizing climate and cooling system differences among data centers and then evaluating their consequences for building energy use. Representative climate conditions for four regions are applied to data center energy models for several different prototypical cooling types. This includes cooling system, supplemental cooling solutions, design conditions and controlling the environment of ICT equipment were generally used for each climate zone, how these affect energy efficiency, and how the prioritization of system selection is derived. Based on the climate classification and the required operating environmental conditions for data centers suggested by the ASHRAE TC 9.9, a dedicated data center energy evaluation tool was taken to examine the potential energy savings of the cooling technology. Incorporating economizer use into the cooling systems would increase the variation in energy efficiency among geographic regions, indicating that as data centers

  17. Measuring the value of process improvement initiatives in a preoperative assessment center using time-driven activity-based costing.

    Science.gov (United States)

    French, Katy E; Albright, Heidi W; Frenzel, John C; Incalcaterra, James R; Rubio, Augustin C; Jones, Jessica F; Feeley, Thomas W

    2013-12-01

    The value and impact of process improvement initiatives are difficult to quantify. We describe the use of time-driven activity-based costing (TDABC) in a clinical setting to quantify the value of process improvements in terms of cost, time and personnel resources. Difficulty in identifying and measuring the cost savings of process improvement initiatives in a Preoperative Assessment Center (PAC). Use TDABC to measure the value of process improvement initiatives that reduce the costs of performing a preoperative assessment while maintaining the quality of the assessment. Apply the principles of TDABC in a PAC to measure the value, from baseline, of two phases of performance improvement initiatives and determine the impact of each implementation in terms of cost, time and efficiency. Through two rounds of performance improvements, we quantified an overall reduction in time spent by patient and personnel of 33% that resulted in a 46% reduction in the costs of providing care in the center. The performance improvements resulted in a 17% decrease in the total number of full time equivalents (FTE's) needed to staff the center and a 19% increase in the numbers of patients assessed in the center. Quality of care, as assessed by the rate of cancellations on the day of surgery, was not adversely impacted by the process improvements. © 2013 Published by Elsevier Inc.

  18. Patient-Centered Tablet Application for Improving Medication Adherence after a Drug-Eluting Stent.

    Science.gov (United States)

    Shah, Vicki; Dileep, Anandu; Dickens, Carolyn; Groo, Vicki; Welland, Betty; Field, Jerry; Baumann, Matthew; Flores, Jose D; Shroff, Adhir; Zhao, Zhongsheng; Yao, Yingwei; Wilkie, Diana J; Boyd, Andrew D

    2016-01-01

    This study's objective was to evaluate a patient-centered educational electronic tablet application, "My Interventional Drug-Eluting Stent Educational App" (MyIDEA) to see if there was an increase in patient knowledge about dual antiplatelet therapy (DAPT) and medication possession ratio (MPR) compared to treatment as usual. In a pilot project, 24 elderly (≥50 years old) research participants were recruited after a drug-eluting stent. Eleven were randomized to the control arm and 13 to the interventional arm. All the participants completed psychological and knowledge questionnaires. Adherence was assessed through MPR, which was calculated at 3 months for all participants who were scheduled for second and third follow-up visits. Relative to control, the interventional group had a 10% average increase in MPR. As compared to the interventional group, more patients in the control group had poor adherence (<80% MPR). The psychological data revealed a single imbalance in anxiety between the control and interventional groups. On average, interventional participants spent 21 min using MyIDEA. Consumer health informatics has enabled us to engage patients with their health data using novel methods. Consumer health technology needs to focus more on patient knowledge and engagement to improve long-term health. MyIDEA takes a unique approach in targeting DAPT from the onset. MyIDEA leverages patient-centered information with clinical care and the electronic health record highlighting the patients' role as a team member in their own health care. The patients think critically about adverse events and how to solve issues before leaving the hospital.

  19. Patient Centered Tablet Application for improving medication adherence after a Drug Eluting Stent

    Directory of Open Access Journals (Sweden)

    Vicki Shah

    2016-12-01

    Full Text Available Background/Aims: This study’s objective was to evaluate a patient-centered educational electronic tablet application, My Interventional Drug-Eluting Stent Educational App (MyIDEA to see if there was an increase in patient knowledge about dual antiplatelet therapy (DAPT and medication possession ratio (MPR compared to treatment as usual. Methods: In a pilot project, 24 elderly (≥50 years-old research participants were recruited after a Drug Eluting Stent. 11 were randomized to the control arm and 13 to the interventional arm. All participants completed psychological and knowledge questionnaires. Adherence was assessed through MPR, which was calculated at three months for all participants who were scheduled for a second and third follow-up visit.Results: Relative to control, the interventional group had a 10% average increase in MPR. As compared to the interventional group, more patients in the control group had poor adherence (<80% MPR. The psychological data revealed a single imbalance in anxiety between the control and interventional groups. On average interventional participants spent 21 minutes using MyIDEA. Discussion: Consumer health informatics has enabled us to engage patients with their health data using novel methods. Consumer health technology needs to focus more on patient knowledge and engagement to improve long term health. MyIDEA takes a unique approach in targeting DAPT from the onset.Conclusion: MyIDEA leverages patient centered information with clinical care and the electronic health record highlighting the patients’ role as a team member in their own healthcare. The patients think critically about adverse events and how to solve issues before leaving the hospital.

  20. Baltic Eye: Focusing on Science and Communication to Improve Policy Making for the Baltic Sea Environment

    Science.gov (United States)

    McCrackin, M. L.

    2016-12-01

    In order to better communicate relevant scientific knowledge to policy- and decision makers, Stockholm University and the Baltic Sea 2020 Foundation partnered to create Baltic Eye in 2014. Seven scientists and two communicators constitute the core team of this initiative. The team integrates communications with scientific analysis and synthesis of Baltic Sea environmental issues. In the past year, the team has focused on two main issues: fisheries management and microplastics. Baltic Sea cod stocks are in poor condition, with large numbers of small individuals. Baltic Eye recommended improvements to the European Union's multiannual fisheries plan to better align with ecosystem-based management principles: prioritization of cod stock recovery, greater consideration of natural variability of temperature and salinity (which affects cod spawning success), and inclusion of mechanisms to adjust quotas in the event of major environmental changes. Communications included policy briefs and debate articles targeted to the European Parliament, national government ministries, and non-governmental organizations. Every year, up to 40 tons of microplastics from personal care products are released in the Baltic Sea catchment. Baltic Eye raised awareness of the issue and made recommended ways to reduce microplastic emissions. Communications included a public presentation to journalists, politicians, and representatives of Swedish government ministries. A policy brief was provided Heads of Delegates of the Helsinki Commission (for protrection of the Baltic Sea environment) in advance of a meeting to develop a plan of action for marine litter. Researchers were interviewed for radio, TV, and print media in Sweden, Finland, and Germany. Next steps are to engage with multinational manufacturers about plans to voluntarily phase out microplastics in personal care products.

  1. Non destructive examinations and degradations: the use of feedback experience to improve maintenance policy

    International Nuclear Information System (INIS)

    Champigny, F.

    2007-01-01

    In France, since 1995, 58 pressurized water reactors have been operating to produce electricity. These reactors were built from 1975 to the beginning of nineties and are ranked in 4 standardized series, 900 MWe CP0 types, 900 MWe CPY types, 1300 MWe types and 1400 MWe types. The plants have undergone evolutions taking into account the feedback experience for manufacturing and construction, net power growth but also maintenance operations. In 1977 the first maintenance programs were based upon the American experience using ASME section XI code. As and when required, they have been modified with the events appeared during the operation. First of them concerned the steam generator tubes with the discover of the first primary water stress corrosion cracking at the end of the seventies then the under-clad cracking phenomenon in the 900 MWe pressure vessel nozzles. At the beginning of years 2000, the new departmental order dedicated to operation required to check and modify, if necessary, the maintenance policy to better take into account the possible damages, fast fracture studies for primary and secondary systems and, last but not least, qualification processes for non destructive examinations. These new requirements have induced a rewriting of the maintenance policies and inspection programs in the way to be more consistent with the need of an improved availability of the plants while keeping a high safety level. Through few examples, we show how the approaches and the practices have been modified in terms of non-destructive examination (NDE) and particularly the impact of the NDE qualification results. In addition, examples of the important choices between in-service inspection and repair policy are also described. (author)

  2. Advancing a conceptual model to improve maternal health quality: The Person-Centered Care Framework for Reproductive Health Equity.

    Science.gov (United States)

    Sudhinaraset, May; Afulani, Patience; Diamond-Smith, Nadia; Bhattacharyya, Sanghita; Donnay, France; Montagu, Dominic

    2017-11-06

    Background: Globally, substantial health inequities exist with regard to maternal, newborn and reproductive health. Lack of access to good quality care-across its many dimensions-is a key factor driving these inequities. Significant global efforts have been made towards improving the quality of care within facilities for maternal and reproductive health. However, one critically overlooked aspect of quality improvement activities is person-centered care. Main body: The objective of this paper is to review existing literature and theories related to person-centered reproductive health care to develop a framework for improving the quality of reproductive health, particularly in low and middle-income countries. This paper proposes the Person-Centered Care Framework for Reproductive Health Equity, which describes three levels of interdependent contexts for women's reproductive health: societal and community determinants of health equity, women's health-seeking behaviors, and the quality of care within the walls of the facility. It lays out eight domains of person-centered care for maternal and reproductive health. Conclusions: Person-centered care has been shown to improve outcomes; yet, there is no consensus on definitions and measures in the area of women's reproductive health care. The proposed Framework reviews essential aspects of person-centered reproductive health care.

  3. Location, Allocation and Routing of Temporary Health Centers in Rural Areas in Crisis, Solved by Improved Harmony Search Algorithm

    Directory of Open Access Journals (Sweden)

    Mahdi Alinaghian

    2017-01-01

    Full Text Available In this paper, an uncertain integrated model for simultaneously locating temporary health centers in the affected areas, allocating affected areas to these centers, and routing to transport their required good is considered. Health centers can be settled in one of the affected areas or in a place out of them; therefore, the proposed model offers the best relief operation policy when it is possible to supply the goods of affected areas (which are customers of goods directly or under coverage. Due to that the problem is NP-Hard, to solve the problem in large-scale, a meta-heuristic algorithm based on harmony search algorithm is presented and its performance has been compared with basic harmony search algorithm and neighborhood search algorithm in small and large scale test problems. The results show that the proposed harmony search algorithm has a suitable efficiency.

  4. IMPROVING GALACTIC CENTER ASTROMETRY BY REDUCING THE EFFECTS OF GEOMETRIC DISTORTION

    International Nuclear Information System (INIS)

    Yelda, S.; Ghez, A. M.; Clarkson, W.; Lu, J. R.; Matthews, K.; Anderson, J.; Do, T.

    2010-01-01

    We present significantly improved proper motion measurements of the Milky Way's central stellar cluster. These improvements are made possible by refining our astrometric reference frame with a new geometric optical distortion model for the W. M. Keck II 10 m telescope's adaptive optics camera (NIRC2) in its narrow field mode. For the first time, this distortion model is constructed from on-sky measurements and is made available to the public in the form of FITS files. When applied to widely dithered images, it produces residuals in the separations of stars that are a factor of ∼3 smaller compared with the outcome using previous models. By applying this new model, along with corrections for differential atmospheric refraction, to widely dithered images of SiO masers at the Galactic center (GC), we improve our ability to tie into the precisely measured radio Sgr A*-rest frame. The resulting infrared reference frame is ∼2-3 times more accurate and stable than earlier published efforts. In this reference frame, Sgr A* is localized to within a position of 0.6 mas and a velocity of 0.09 mas yr -1 , or ∼3.4 km s -1 at 8 kpc (1σ). Also, proper motions for members of the central stellar cluster are more accurate, although less precise, due to the limited number of these wide field measurements. These proper motion measurements show that, with respect to Sgr A*, the central stellar cluster has no rotation in the plane of the sky to within 0.3 mas yr -1 arcsec -1 , has no net translational motion with respect to Sgr A* to within 0.1 mas yr -1 , and has net rotation perpendicular to the plane of the sky along the Galactic plane, as has previously been observed. While earlier proper motion studies defined a reference frame by assuming no net motion of the stellar cluster, this approach is fundamentally limited by the cluster's intrinsic dispersion and therefore will not improve with time. We define a reference frame with SiO masers and this reference frame's stability

  5. Commentary: A call to leadership: the role of the academic medical center in driving sustainable health system improvement through performance measurement.

    Science.gov (United States)

    Nedza, Susan M

    2009-12-01

    As the government attempts to address the high cost of health care in the United States, the issues being confronted include variations in the quality of care administered and the inconsistent application of scientifically proven treatments. To improve quality, methods of measurement and reporting with rewards or, eventually, penalties based on performance, must be developed. To date, well-intentioned national policy initiatives, such as value-based purchasing, have focused primarily on the measurement of discrete events and on attempts to construct incentives. While important, the current approach alone cannot improve quality, ensure equitability, decrease variability, and optimize value. Additional thought-leadership is required, both theoretical and applied. Academic medical centers' (AMCs') scholarly and practical participation is needed. Although quality cannot be sustainably improved without measurement, the existing measures alone do not ensure quality. There is not enough evidence to support strong measure development and, further, not enough insight regarding whether the existing measures have their intended effect of enhancing health care delivery that results in quality outcomes for patients. Perhaps the only way that the United States health care system will achieve a standard of quality care is through the strong embrace, effective engagement, intellectual insights, educational contributions, and practical applications in AMCs. Quality will never be achieved through public policies or national initiatives alone but instead through the commitment of the academic community to forward the science of performance measurement and to ensure that measurement leads to better health outcomes for our nation.

  6. Pain and Policy Studies Group: Two Decades of Working to Address Regulatory Barriers to Improve Opioid Availability and Accessibility Around the World.

    Science.gov (United States)

    Cleary, James F; Maurer, Martha A

    2018-02-01

    For two decades, the Pain & Policy Studies Group (PPSG), a global research program at the University of Wisconsin Carbone Cancer Center, has worked passionately to fulfill its mission of improving pain relief by achieving balanced access to opioids worldwide. PPSG's early work highlighted the conceptual framework of balance leading to the development of the seminal guidelines and criteria for evaluating opioid policy. It has collaborated at the global level with United Nations agencies to promote access to opioids and has developed a unique model of technical assistance to help national governments assess regulatory barriers to essential medicines for pain relief and amend existing or develop new legislation that facilitates appropriate and adequate opioid prescribing according to international standards. This model was initially applied in regional workshops and individual country projects and then adapted for PPSG's International Pain Policy Fellowship, which provides long-term mentoring and support for several countries simultaneously. The PPSG disseminates its work online in several ways, including an extensive Web site, news alerts, and through several social media outlets. PPSG has become the focal point for expertise on policy governing drug control and medicine and pharmacy practice related to opioid availability and pain relief. Copyright © 2017 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

  7. From policy to practice in the Affordable Care Act: Training center for New York State's health insurance programs.

    Science.gov (United States)

    Selwyn, Casey; Senter, Lindsay

    2016-09-01

    The United States currently faces the large, logistical undertaking of enrolling millions of Americans into a complex Affordable Care Act (ACA) system within a short period of time. One way states have addressed this implementation challenge is through the development of consumer assistance programs. In these programs, health care professionals-known as "Assistors"-are trained in insurance enrollment services to help consumers navigate the complex application and plan selection process, with the ultimate goal of optimizing enrollment rates. Cicatelli Associates Inc. (CAI), a non-profit capacity building organization, has served as the Statewide Training Center for New York's Health Insurance Program Initiative since 2013, before the ACA Marketplace roll-out occurred. This article presents a narrative of CAI's experiences and promising practices related to training and developing of the Assistor workforce in New York State (NYS). By the end of the second enrollment period (February 2015), NYS trained and certified over 11,000 Assistors (1); CAI trained fifteen percent of this total workforce. As a result of this intensive workforce training effort, NYS observed extremely high rates of facilitated enrollment, and overall success with the roll-out process. Through this initiative, CAI has garnered key insights for other organizations that engage in similar work, as well as state policymakers considering how to integrate and bolster the Assistor programs in their states. These lessons include: the necessity of ensuring that Assistors are armed with all technical concepts and messages; ensuring that Assistors are motivated to work through a change process; the constructive feedback process that can occur when these Assistors directly communicate issues to the state; and the transformation of public opinion that can occur when Assistors provide good customer service and can effectively promote statewide and federal ACA policies and benefits. Copyright © 2016 Elsevier

  8. Variation in monitoring and treatment policies for intracranial hypertension in traumatic brain injury: A survey in 66 neurotrauma centers participating in the CENTER-TBI study

    NARCIS (Netherlands)

    M.C. Cnossen (Maryse); Huijben, J.A. (Jilske A.); van der Jagt, M. (Mathieu); Volovici, V. (Victor); van Essen, T. (Thomas); S. Polinder (Suzanne); D. Nelson (David); Ercole, A. (Ari); Stocchetti, N. (Nino); Citerio, G. (Giuseppe); W.C. Peul (Wilco); A.I.R. Maas (Andrew I.R.); D.K. Menon (David ); E.W. Steyerberg (Ewout W.); Lingsma, H.F. (Hester F.); Adams, H. (Hadie); Alessandro, M. (Masala); J.E. Allanson (Judith); Amrein, K. (Krisztina); Andaluz, N. (Norberto); N. Andelic (Nada); Andrea, N. (Nanni); L. Andreassen (Lasse); Anke, A. (Audny); Antoni, A. (Anna); Ardon, H. (Hilko); Audibert, G. (Gérard); Auslands, K. (Kaspars); Azouvi, P. (Philippe); Baciu, C. (Camelia); Bacon, A. (Andrew); Badenes, R. (Rafael); Baglin, T. (Trevor); R.H.M.A. Bartels (Ronald); P. Barzo (P.); Bauerfeind, U. (Ursula); R. Beer (Ronny); Belda, F.J. (Francisco Javier); B.-M. Bellander (Bo-Michael); A. Belli (Antonio); Bellier, R. (Rémy); H. Benali (Habib); Benard, T. (Thierry); M. Berardino (Maurizio); L. Beretta (Luigi); Beynon, C. (Christopher); Bilotta, F. (Federico); H. Binder (Harald); Biqiri, E. (Erta); Blaabjerg, M. (Morten); Lund, S.B. (Stine Borgen); Bouzat, P. (Pierre); Bragge, P. (Peter); Brazinova, A. (Alexandra); F. Brehar (Felix); Brorsson, C. (Camilla); Buki, A. (Andras); M. Bullinger (Monika); Bucková, V. (Veronika); Calappi, E. (Emiliana); P. Cameron (Peter); Carbayo, L.G. (Lozano Guillermo); Carise, E. (Elsa); K.L.H. Carpenter (Keri L.H.); Castaño-León, A.M. (Ana M.); Causin, F. (Francesco); Chevallard, G. (Giorgio); A. Chieregato (Arturo); G. Citerio (Giuseppe); Cnossen, M. (Maryse); M. Coburn (Mark); J.P. Coles (Jonathan P.); Cooper, J.D. (Jamie D.); Correia, M. (Marta); A. Covic (Amra); N. Curry (Nicola); E. Czeiter (Endre); M. Czosnyka (Marek); Dahyot-Fizelier, C. (Claire); F. Damas (François); P. Damas (Pierre); H. Dawes (Helen); De Keyser, V. (Véronique); F.D. Corte (Francesco); B. Depreitere (Bart); Ding, S. (Shenghao); D.W.J. Dippel (Diederik); K. Dizdarevic (Kemal); Dulière, G.-L. (Guy-Loup); Dzeko, A. (Adelaida); G. Eapen (George); Engemann, H. (Heiko); A. Ercole (Ari); P. Esser (Patrick); Ezer, E. (Erzsébet); M. Fabricius (Martin); V.L. Feigin (V.); Feng, J. (Junfeng); Foks, K. (Kelly); F. Fossi (Francesca); Francony, G. (Gilles); J. Frantzén (Janek); Freo, U. (Ulderico); S.K. Frisvold (Shirin Kordasti); Furmanov, A. (Alex); Gagliardo, P. (Pablo); D. Galanaud (Damien); G. Gao (Guoyi); K. Geleijns (Karin); A. Ghuysen (Alexandre); Giraud, B. (Benoit); Glocker, B. (Ben); Gomez, P.A. (Pedro A.); Grossi, F. (Francesca); R.L. Gruen (Russell); Gupta, D. (Deepak); J.A. Haagsma (Juanita); E. Hadzic (Ermin); I. Haitsma (Iain); J.A. Hartings (Jed); R. Helbok (Raimund); E. Helseth (Eirik); Hertle, D. (Daniel); S. Hill (Sean); Hoedemaekers, A. (Astrid); S. Hoefer (Stefan); P.J. Hutchinson (Peter J.); Håberg, K.A. (Kristine Asta); B.C. Jacobs (Bart); Janciak, I. (Ivan); K. Janssens (Koen); Jiang, J.-Y. (Ji-Yao); Jones, K. (Kelly); Kalala, J.-P. (Jean-Pierre); Kamnitsas, K. (Konstantinos); Karan, M. (Mladen); Karau, J. (Jana); A. Katila (Ari); M. Kaukonen (Maija); Keeling, D. (David); Kerforne, T. (Thomas); N. Ketharanathan (Naomi); Kettunen, J. (Johannes); Kivisaari, R. (Riku); A.G. Kolias (Angelos G.); Kolumbán, B. (Bálint); E.J.O. Kompanje (Erwin); D. Kondziella (Daniel); L.-O. Koskinen (Lars-Owe); Kovács, N. (Noémi); F. Kalovits (Ferenc); A. Lagares (Alfonso); L. Lanyon (Linda); S. Laureys (Steven); Lauritzen, M. (Martin); F.E. Lecky (Fiona); C. Ledig (Christian); R. Lefering; V. Legrand (Valerie); Lei, J. (Jin); L. Levi (Leon); R. Lightfoot (Roger); H.F. Lingsma (Hester); D. Loeckx (Dirk); Lozano, A. (Angels); Luddington, R. (Roger); Luijten-Arts, C. (Chantal); Maas, A.I.R. (Andrew I.R.); MacDonald, S. (Stephen); MacFayden, C. (Charles); M. Maegele (Marc); M. Majdan (Marek); Major, S. (Sebastian); A. Manara (Alex); Manhes, P. (Pauline); G. Manley (Geoffrey); Martin, D. (Didier); C. Martino (Costanza); Maruenda, A. (Armando); H. Maréchal (Hugues); Mastelova, D. (Dagmara); Mattern, J. (Julia); McMahon, C. (Catherine); Melegh, B. (Béla); Menon, D. (David); T. Menovsky (Tomas); Morganti-Kossmann, C. (Cristina); Mulazzi, D. (Davide); Mutschler, M. (Manuel); H. Mühlan (Holger); Negru, A. (Ancuta); Nelson, D. (David); E. Neugebauer (Eddy); V.F. Newcombe (Virginia F.); Noirhomme, Q. (Quentin); Nyirádi, J. (József); M. Oddo (Mauro); A.W. Oldenbeuving; M. Oresic (Matej); Ortolano, F. (Fabrizio); A. Palotie (Aarno); P.M. Parizel; Patruno, A. (Adriana); J.-F. Payen (Jean-François); Perera, N. (Natascha); V. Perlbarg (Vincent); Persona, P. (Paolo); Peul, W. (Wilco); N. Pichon (Nicolas); Piilgaard, H. (Henning); A. Piippo (Anna); S.P. Floury (Sébastien Pili); M. Pirinen (Matti); H. Ples (Horia); Polinder, S. (Suzanne); Pomposo, I. (Inigo); M. Psota (Marek); P. Pullens (Pim); L. Puybasset (Louis); A. Ragauskas (Arminas); R. Raj (Rahul); Rambadagalla, M. (Malinka); Rehorcíková, V. (Veronika); J.K.J. Rhodes (Jonathan K.J.); S. Richardson (Sylvia); S. Ripatti (Samuli); S. Rocka (Saulius); Rodier, N. (Nicolas); Roe, C. (Cecilie); Roise, O. (Olav); C.M.A.A. Roks (Gerwin); Romegoux, P. (Pauline); J. Rosand (Jonathan); Rosenfeld, J. (Jeffrey); C. Rosenlund (Christina); G. Rosenthal (Guy); R. Rossaint (Rolf); S. Rossi (Sandra); Rostalski, T. (Tim); D. Rueckert (Daniel); de Ruiz, A.F. (Arcaute Felix); M. Rusnák (Martin); Sacchi, M. (Marco); Sahakian, B. (Barbara); J. Sahuquillo (Juan); O. Sakowitz (Oliver); Sala, F. (Francesca); Sanchez-Pena, P. (Paola); Sanchez-Porras, R. (Renan); Sandor, J. (Janos); Santos, E. (Edgar); N. Sasse (Nadine); Sasu, L. (Luminita); Savo, D. (Davide); I.B. Schipper (Inger); Schlößer, B. (Barbara); S. Schmidt (Silke); Schneider, A. (Annette); H. Schoechl (Herbert); G.G. Schoonman; Rico, F.S. (Frederik Schou); E. Schwendenwein (Elisabeth); Schöll, M. (Michael); Sir, O. (özcan); T. Skandsen (Toril); Smakman, L. (Lidwien); D. Smeets (Dominique); Smielewski, P. (Peter); Sorinola, A. (Abayomi); E. Stamatakis (Emmanuel); S. Stanworth (Simon); Stegemann, K. (Katrin); Steinbüchel, N. (Nicole); R. Stevens (Robert); W. Stewart (William); E.W. Steyerberg (Ewout); N. Stocchetti (Nino); Sundström, N. (Nina); Synnot, A. (Anneliese); J. Szabó (József); J. Söderberg (Jeannette); F.S. Taccone (Fabio); Tamás, V. (Viktória); Tanskanen, P. (Päivi); A. Tascu (Alexandru); Taylor, M.S. (Mark Steven); Te, A.B. (Ao Braden); O. Tenovuo (Olli); Teodorani, G. (Guido); A. Theadom (Alice); Thomas, M. (Matt); D. Tibboel (Dick); C.M. Tolias (Christos M.); Tshibanda, J.-F.L. (Jean-Flory Luaba); Tudora, C.M. (Cristina Maria); P. Vajkoczy (Peter); Valeinis, E. (Egils); Hecke, W.V. (Wim Van); Praag, D.V. (Dominique Van); Dirk, V.R. (Van Roost); Vlierberghe, E.V. (Eline Van); Vyvere, T.V. (Thijs vande); Vanhaudenhuyse, A. (Audrey); A. Vargiolu (Alessia); E. Vega (Emmanuel); J. Verheyden (Jan); Vespa, P.M. (Paul M.); A. Vik (Anne); R. Vilcinis (Rimantas); Vizzino, G. (Giacinta); C.L.A.M. Vleggeert-Lankamp (Carmen); V. Volovici (Victor); P. Vulekovic (Peter); Vámos, Z. (Zoltán); Wade, D. (Derick); Wang, K.K.W. (Kevin K.W.); Wang, L. (Lei); E.D. Wildschut (Enno); G. Williams (Guy); Willumsen, L. (Lisette); Wilson, A. (Adam); Wilson, L. (Lindsay); Winkler, M.K.L. (Maren K.L.); P. Ylén (Peter); Younsi, A. (Alexander); M. Zaaroor (Menashe); Zhang, Z. (Zhiqun); Zheng, Z. (Zelong); Zumbo, F. (Fabrizio); de Lange, S. (Stefanie); G.C.W. De Ruiter (Godard C.W.); den Boogert, H. (Hugo); van Dijck, J. (Jeroen); T.A. van Essen (T.); C.M. van Heugten (Caroline M.); M. van der Jagt (Mathieu); J. van der Naalt (Joukje)

    2017-01-01

    textabstractBackground: No definitive evidence exists on how intracranial hypertension should be treated in patients with traumatic brain injury (TBI). It is therefore likely that centers and practitioners individually balance potential benefits and risks of different intracranial pressure (ICP)

  9. Parental Leave Policy as a Strategy to Improve Outcomes among Premature Infants.

    Science.gov (United States)

    Greenfield, Jennifer C; Klawetter, Susanne

    2016-02-01

    Although gains have been made in premature birth rates among racial and ethnic minority and low socioeconomic status populations, tremendous disparities still exist in both prematurity rates and health outcomes for preterm infants. Parental involvement is known to improve health outcomes for preterm babies. However, a gap in evidence exists around whether parental involvement can help ameliorate the disparities in both short- and long-term out-comes for their preterm children. Families more likely to experience preterm birth are also less likely to have access to paid leave and thus experience significant systemic barriers to involvement, especially when their newborns are hospitalized. This article describes the research gap in this area and explores pathways by which social workers may ameliorate disparities in preterm birth outcomes through practice, policy, and research.

  10. World Health Organization global policy for improvement of oral health--World Health Assembly 2007

    DEFF Research Database (Denmark)

    Petersen, Poul Erik

    2008-01-01

    The World Health Organization (WHO) Global Oral Health Programme has worked hard over the past five years to increase the awareness of oral health worldwide as an important component of general health and quality of life. Meanwhile, oral disease is still a major public health problem in high income...... countries and the burden of oral disease is growing in many low- and middle income countries. In the World Oral Health Report 2003, the WHO Global Oral Health Programme formulated the policies and the necessary actions for the improvement of oral health. The strategy is that oral disease prevention...... and the promotion of oral health needs to be integrated with chronic disease prevention and general health promotion as the risks to health are linked. The World Health Assembly (WHA) and the Executive Board (EB) are supreme governance bodies of WHO and for the first time in 25 years oral health was subject...

  11. Improving energy decisions towards better scientific policy advice for a safe and secure future energy system

    CERN Document Server

    Droste-Franke, Bert; Kaiser, M; Schreurs, Miranda; Weber, Christoph; Ziesemer, Thomas

    2015-01-01

    Managing a successful transition of the current energy supply system to less carbon emitting options, ensuring a safe and secure supply during the whole process and in the long term, is one of the largest challenges of our time. Various approaches and first implementations show that it is not only technological issue, but also a matter of societal acceptance and acceptability, considering basic ethic values of the society. The main foci of the book are, thus, to develop an understanding about the specific challenges of the scientific policy advice in the area, to explore typical current approaches for the analysis of future energy systems and to develop criteria for the quality assessment and guidelines for the improvement of such studies. The book provides assistance to the interpretation of existing studies and guidelines for setting up and carrying out new analyses as well as for communicating and applying the results. Thereby, it aims to support the involved actors such as the respective scientific expert...

  12. Combining Correlation-Based and Reward-Based Learning in Neural Control for Policy Improvement

    DEFF Research Database (Denmark)

    Manoonpong, Poramate; Kolodziejski, Christoph; Wörgötter, Florentin

    2013-01-01

    Classical conditioning (conventionally modeled as correlation-based learning) and operant conditioning (conventionally modeled as reinforcement learning or reward-based learning) have been found in biological systems. Evidence shows that these two mechanisms strongly involve learning about...... associations. Based on these biological findings, we propose a new learning model to achieve successful control policies for artificial systems. This model combines correlation-based learning using input correlation learning (ICO learning) and reward-based learning using continuous actor–critic reinforcement...... learning (RL), thereby working as a dual learner system. The model performance is evaluated by simulations of a cart-pole system as a dynamic motion control problem and a mobile robot system as a goal-directed behavior control problem. Results show that the model can strongly improve pole balancing control...

  13. School food policy at Dutch primary schools: room for improvement? Cross-sectional findings from the INPACT study.

    Science.gov (United States)

    van Ansem, Wilke Jc; Schrijvers, Carola Tm; Rodenburg, Gerda; Schuit, Albertine J; van de Mheen, Dike

    2013-04-12

    Schools can play an important role in the prevention of obesity, e.g. by providing an environment that stimulates healthy eating habits and by developing a food policy to provide such an environment. The effectiveness of a school food policy is affected by the content of the policy, its implementation and its support by parents, teachers and principals. The aim of this study is to detect opportunities to improve the school food policy and/or implementation at Dutch primary schools. Therefore, this study explores the school food policy and investigates schools' (teachers and principals) and parents' opinion on the school food policy. Data on the schools' perspective of the food policy was collected from principals and teachers by means of semi-structured interviews. In total 74 principals and 72 teachers from 83 Dutch primary schools were interviewed. Data on parental perceptions about the school food policy were based on a cross-sectional survey among 1,429 parents from the same schools. Most principals (87.1%) reported that their school had a written food policy; however in most cases the rules were not clearly defined. Most of the principals (87.8%) believed that their school paid sufficient attention to nutrition and health. Teachers and principals felt that parents were primarily responsible to encourage healthy eating habits among children, while 49.8% of the parents believed that it is also a responsibility of the school to foster healthy eating habits among children. Most parents reported that they appreciated the school food policy and comply with the food rules. Parents' opinion on the enforcement of the school food policy varied: 28.1% believed that the school should enforce the policy more strongly, 32.1% was satisfied, and 39.8% had no opinion on this topic. Dutch primary schools could play a more important role in fostering healthy eating habits among children. The school food policy could be improved by clearly formulating food rules, simplifying

  14. The Crucible simulation: Behavioral simulation improves clinical leadership skills and understanding of complex health policy change.

    Science.gov (United States)

    Cohen, Daniel; Vlaev, Ivo; McMahon, Laurie; Harvey, Sarah; Mitchell, Andy; Borovoi, Leah; Darzi, Ara

    2017-05-11

    The Health and Social Care Act 2012 represents the most complex National Health Service reforms in history. High-quality clinical leadership is important for successful implementation of health service reform. However, little is known about the effectiveness of current leadership training. This study describes the use of a behavioral simulation to improve the knowledge and leadership of a cohort of medical doctors expected to take leadership roles in the National Health Service. A day-long behavioral simulation (The Crucible) was developed and run based on a fictitious but realistic health economy. Participants completed pre- and postsimulation questionnaires generating qualitative and quantitative data. Leadership skills, knowledge, and behavior change processes described by the "theory of planned behavior" were self-assessed pre- and postsimulation. Sixty-nine medical doctors attended. Participants deemed the simulation immersive and relevant. Significant improvements were shown in perceived knowledge, capability, attitudes, subjective norms, intentions, and leadership competency following the program. Nearly one third of participants reported that they had implemented knowledge and skills from the simulation into practice within 4 weeks. This study systematically demonstrates the effectiveness of behavioral simulation for clinical management training and understanding of health policy reform. Potential future uses and strategies for analysis are discussed. High-quality care requires understanding of health systems and strong leadership. Policymakers should consider the use of behavioral simulation to improve understanding of health service reform and development of leadership skills in clinicians, who readily adopt skills from simulation into everyday practice.

  15. Improved Discovery and Re-Use of Oceanographic Data through a Data Management Center

    Science.gov (United States)

    Rauch, S.; Allison, M. D.; Groman, R. C.; Chandler, C. L.; Galvarino, C.; Gegg, S. R.; Kinkade, D.; Shepherd, A.; Wiebe, P. H.; Glover, D. M.

    2013-12-01

    Effective use and reuse of ecological data are not only contingent upon those data being well-organized and documented, but also upon data being easily discoverable and accessible by others. As funding agency and publisher policies begin placing more emphasis on, or even requiring, sharing of data, some researchers may feel overwhelmed in determining how best to manage and share their data. Other researchers may be frustrated by the inability to easily find data of interest, or they may be hesitant to use datasets that are poorly organized and lack complete documentation. In all of these scenarios, the data management and sharing process can be facilitated by data management centers, as demonstrated by the Biological and Chemical Oceanography Data Management Office (BCO-DMO). BCO-DMO was created in 2006 to work with investigators to manage data from research funded by the Division of Ocean Sciences (OCE) Biological and Chemical Oceanography Sections and the Division of Polar Programs (PLR) Antarctic Organisms and Ecosystems Program of the US National Science Foundation (NSF). BCO-DMO plays a role throughout the data lifecycle, from the early stages of offering support to researchers in developing data management plans to the final stages of depositing data in a permanent archive. An overarching BCO-DMO goal is to provide open access to data through a system that enhances data discovery and reuse. Features have been developed that allow users to find data of interest, assess fitness for purpose, and download the data for reuse. Features that enable discovery include both text-based and geospatial-based search interfaces, as well as a semantically-enabled faceted search [1]. BCO-DMO data managers work closely with the contributing investigators to develop robust metadata, an essential component to enable data reuse. The metadata, which describe data acquisition and processing methods, instrumentation, and parameters, are enhanced by the mapping of local vocabulary

  16. [A 6-year evaluation of dyslipidemia in a health center: Importance of improvement actions].

    Science.gov (United States)

    Antón-García, F; Correcher-Salvador, E; Rodríguez-Lagos, F A; González-Caminero, S

    2014-01-01

    Dyslipidemia, especially an increased LDL-cholesterol, has been shown to be one of the most important risk factors in the genesis of coronary involvement. The prevalence of dyslipidemias in Spain is high. The objective of this study is to assess the progress of dyslipidemic patients in our health center over a 6-year period, and see if there has been any improvement in its control after the presentation of the evaluation of the first 3 years, as well as an updated dyslipidemia protocol. Assessment Period 1 (2006-2008): 267 patients with dyslipidemia. Assessment Period 2 (2009-2011): 222 patients, excluding exitus and address changes. age, sex, personal history of CVD, vascular risk factors, lipids, drug treatment, risk levels, and percentages of CV control objectives. Mean age was 66.2 years (SD 13.4), 66.3% women. Period 1-Period 2: Total cholesterol: 221.9-196.6 mg/dl (P=.000); LDL-cholesterol: 147.9-115.8 mg/dl (P=.000). In high risk patients, therapeutic targets: 14-50.5% (P=.024); medium risk: 35-68.1% (P=.038); low risk: 44-68.2% (P=NS). Pharmacotherapy 68-77% (P=.000). Changing treatment: 30-43% (P=.001). Adherence: 75-86% (P=.003). Untreated high risk: 15.4-16.3% (P=NS). There was a significant improvement in Period 2, especially in high-risk patients, after presenting the results of the evaluation for Period 1 and with the updated dyslipidemia protocol. There are high risk patients without lipid-lowering treatment to be detected and reviewed. Copyright © 2013 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España. All rights reserved.

  17. Stakeholders' Recommendations to Improve Patient-centered "LGBTQ" Primary Care in Rural and Multicultural Practices.

    Science.gov (United States)

    Kano, Miria; Silva-Bañuelos, Alma Rosa; Sturm, Robert; Willging, Cathleen E

    2016-01-01

    Individuals among gender/sexual minorities share experiences of stigma and discrimination, yet have distinctive health care needs influenced by ethnic/racial minority and rural realities. We collected qualitative data from lesbian/gay/bisexual/transgender (LGBT) and queer persons across the largely rural, multicultural state of New Mexico, particularly those from understudied ethnic groups, regarding factors facilitating or impeding patient-centered primary care. The themes identified formed the basis for a statewide summit on LGBT health care guidelines and strategies for decreasing treatment gaps. Three to 15 individuals, ages 18 to 75 years, volunteered for 1 of 4 town hall dialogues (n = 32), and 175 people took part in the summit. Participants acknowledged health care gaps pertinent to LGBT youth, elders, American Indians, and Latinos/Latinas, expressing specific concern for rural residents. This preliminary research emphasizes the need to improve primary care practices that treat rural and ethnic-minority LGBT people and offers patient-driven recommendations to enhance care delivery while clinic-level transformations are implemented. © Copyright 2016 by the American Board of Family Medicine.

  18. The role of community health centers in assessing the social determinants of health for planning and policy: the example of frontier New Mexico.

    Science.gov (United States)

    Bruna, Sean; Stone, Lisa Cacari; Wilger, Susan; Cantor, Jeremy; Guzman, Carolina

    2014-01-01

    This article examines the experience of a frontier-based community health center when it utilized the Tool for Health and Resilience in Vulnerable Environments (THRIVE) for assessing social determinants of health with a local health consortium. Community members (N = 357) rated safety, jobs, housing, and education among the top health issues. Community leaders integrated these health priorities in a countywide strategic planning process. This example of a frontier county in New Mexico demonstrates the critical role that community health centers play when engaging with local residents to assess community health needs for strategic planning and policy development.

  19. Community Health Policy Assessment of a Rural Northeast Missouri County using the Centers for Disease Control and Prevention’s CHANGE Tool

    Directory of Open Access Journals (Sweden)

    Mitch Stewart

    2013-06-01

    Full Text Available Background: In order to build a framework to address policy gaps and needs, community’s risk factors were identified and the extent to which current policies were in place to address the risk factors were compared. Methods: Face-to-face interviews, using the US Centers for Disease Con¬trol and Prevention’s CHANGE tool were conducted in a rural Northeast Missouri county possessing exceptionally high chronic disease rates to as¬sess the factor(s had the greatest influence on the rates in each sector of the community. Results: The Health Care Agency sector possessed the most factors cate¬gorized as environmental and policy assets, and the Community-at-Large and Business/Worksite sectors seemed to possess the least environmental and policy factors categorized as assets.Conclusions: Because organizational policies can strongly influence community health practices and behaviors, collaborative leadership from the Health Care Agency sector, comprehensive worksite health promotion programs in the Business/Worksite and Community In¬stitu¬tions/Organizations sectors, and tobacco-free school policies are recom¬mended. Multiple community sectors must work together to change not only behaviors but also environments in this county.

  20. Perspective: Improving nutritional guidelines for sustainable health policies: Current status and perspectives

    DEFF Research Database (Denmark)

    Magni, Paolo; Bier, Dennis M; Pecorelli, Sergio

    2017-01-01

    a constructive coalition among scientists, policy makers, and communication professionals for sustainable health and nutritional policies. Currently, a strong rationale and available data support a personalized dietary approach according to personal variables, including sex and age, circulating metabolic...

  1. A Measurement Management Technology for Improving Energy Efficiency in Data Centers and Telecommunication Facilities

    Energy Technology Data Exchange (ETDEWEB)

    Hendrik Hamann, Levente Klein

    2012-06-28

    Data center (DC) electricity use is increasing at an annual rate of over 20% and presents a concern for the Information Technology (IT) industry, governments, and the society. A large fraction of the energy use is consumed by the compressor cooling to maintain the recommended operating conditions for IT equipment. The most common way to improve the DC efficiency is achieved by optimally provisioning the cooling power to match the global heat dissipation in the DC. However, at a more granular level, the large range of heat densities of today's IT equipment makes the task of provisioning cooling power optimized to the level of individual computer room air conditioning (CRAC) units much more challenging. Distributed sensing within a DC enables the development of new strategies to improve energy efficiency, such as hot spot elimination through targeted cooling, matching power consumption at rack level with workload schedule, and minimizing power losses. The scope of Measurement and Management Technologies (MMT) is to develop a software tool and the underlying sensing technology to provide critical decision support and control for DC and telecommunication facilities (TF) operations. A key aspect of MMT technology is integration of modeling tools to understand how changes in one operational parameter affect the overall DC response. It is demonstrated that reduced ordered models for DC can generate, in less than 2 seconds computational time, a three dimensional thermal model in a 50 kft{sup 2} DC. This rapid modeling enables real time visualization of the DC conditions and enables 'what if' scenarios simulations to characterize response to 'disturbances'. One such example is thermal zone modeling that matches the cooling power to the heat generated at a local level by identifying DC zones cooled by a specific CRAC. Turning off a CRAC unit can be simulated to understand how the other CRAC utilization changes and how server temperature responds

  2. A case study of the counterpart technical support policy to improve rural health services in Beijing

    Science.gov (United States)

    2012-01-01

    Background There is, globally, an often observed inequality in the health services available in urban and rural areas. One strategy to overcome the inequality is to require urban doctors to spend time in rural hospitals. This approach was adopted by the Beijing Municipality (population of 20.19 million) to improve rural health services, but the approach has never been systematically evaluated. Methods Drawing upon 1.6 million cases from 24 participating hospitals in Beijing (13 urban and 11 rural hospitals) from before and after the implementation of the policy, changes in the rural–urban hospital performance gap were examined. Hospital performance was assessed using changes in six indices over-time: Diagnosis Related Groups quantity, case-mix index (CMI), cost expenditure index (CEI), time expenditure index (TEI), and mortality rates of low- and high-risk diseases. Results Significant reductions in rural–urban gaps were observed in DRGs quantity and mortality rates for both high- and low-risk diseases. These results signify improvements of rural hospitals in terms of medical safety, and capacity to treat emergency cases and more diverse illnesses. No changes in the rural–urban gap in CMI were observed. Post-implementation, cost and time efficiencies worsened for the rural hospitals but improved for urban hospitals, leading to a widening rural–urban gap in hospital efficiency. Conclusions The strategy for reducing urban–rural gaps in health services adopted, by the Beijing Municipality shows some promise. Gains were not consistent, however, across all performance indicators, and further improvements will need to be tried and evaluated. PMID:23272703

  3. Proposals for Standardizing and Improving the Policy of Adding Points on the Entrance Exam

    Science.gov (United States)

    Yuhong, Deng

    2013-01-01

    This article reviews policies for adding points on the College Entrance Examination. It analyzes the rationales and specific implementation strategies of various policies for adding points on the entrance exam, as well as their advantages and pitfalls. Based on these observations and analysis, the author also offers policy recommendations on the…

  4. Using Knowledge of the Past to Improve Education Today: US Education History and Policy-Making

    Science.gov (United States)

    Vinovskis, Maris A.

    2015-01-01

    Early American historians provided the public and policy-makers with information about US history that provided both entertainment and policy suggestions. As American historians became more professionalised in the early twentieth century, they concentrated more on their own scholarly concerns and less on policy-relevant writings. In recent…

  5. Innovation Policy of the European Union: Concept Strategic Update and Instruments Improvement

    Directory of Open Access Journals (Sweden)

    Belal Hassouna

    2013-01-01

    Full Text Available The article characterizes formation of EU innovation policy and its conceptual update, which has strategic character and is concerned with the social and economic model change, determines differences between EU innovation policy and national politics and the forms of its implementation, detects major changes of EU innovation policy instruments, which were the result of support concept and innovation regulations change.

  6. Systematic framework and measures of economic policy in function of Serbian agriculture improvement requirements

    Directory of Open Access Journals (Sweden)

    Branko KATIC

    2010-12-01

    Full Text Available One of the most significant economic activities in Serbia is agriculture, which also represents the base for food industry and some other branches of processing industry. In this field Serbia finds its developmental opportunity in future period. Inclusion of the country in EU, as well as in the World Tourist Organization, implies appropriate preparation and qualification in this field, so there could be more successful deal with rising competitiveness of foreign goods, in conditions of increasing liberalization level of foreign trade. Therefore, domestic regulatory rules must be adjusted to EU regulatory rules, like as concrete measures regarding agriculture and rural development improvement must be adjusted to the measures in the Joint EU Agrarian Policy. Serbian agriculture is in quite bad condition, and financial possibilities of the state, to expedite its development by abundant assets, are still insufficient. In terms of recession, caused by world economic crisis, too, incentive assets reduce, while making business in this field become more and more aggravated. This paper points out, in short, to significance and condition of agriculture in Serbia, on regulatory rules and future plan documents important for this field, as well as on concrete measures, which have to be undertaken in order to improve this activity.

  7. Interactive Web-Based Learning: Translating Health Policy Into Improved Diabetes Care.

    Science.gov (United States)

    Rider, Briana B; Lier, Silje C; Johnson, Tisha K; Hu, Dale J

    2016-01-01

    In August 2014, the U.S. DHHS's Office of Disease Prevention and Health Promotion released the National Action Plan for Adverse Drug Event Prevention, highlighting prevention of diabetes agent-related hypoglycemia as a key area for improvement. In support of the Action Plan, the Office of Disease Prevention and Health Promotion then developed a web-based interactive module, or eLearning lesson, based on formative research and stakeholder feedback to educate healthcare professionals on strategies to prevent adverse drug events from diabetes agents. The training incorporates health literacy principles by demonstrating, through video scenarios, how to apply shared decision making when setting individualized glycemic targets, and how to use the teach-back method to confirm patients' understanding. Prior to release in September 2014, the training went through intensive usability testing and was pilot tested using a 36-item evaluation. Six months after its release (September 2014 to March 2015), the training landing page on health.gov had 24,334 unique page views. More than 90% of the 234 participants who earned continuing education credit agreed that they will be able to apply the knowledge gained from the lesson to their practice. Online trainings that model key prevention strategies are well received by health professional users and may play an important role in translating policy into improved outcomes. Published by Elsevier Inc.

  8. Inflation Expectations and Monetary Policy Design : Evidence from the Laboratory (Replaces CentER DP 2009-007)

    NARCIS (Netherlands)

    Pfajfar, D.; Zakelj, B.

    2011-01-01

    Using laboratory experiments within a New Keynesian macro framework, we explore the formation of inflation expectations and its interaction with monetary policy design. The central question in this paper is how to design monetary policy in the environment characterized by heterogeneous expectations.

  9. Aligning the goals of community-engaged research: why and how academic health centers can successfully engage with communities to improve health.

    Science.gov (United States)

    Michener, Lloyd; Cook, Jennifer; Ahmed, Syed M; Yonas, Michael A; Coyne-Beasley, Tamera; Aguilar-Gaxiola, Sergio

    2012-03-01

    Community engagement (CE) and community-engaged research (CEnR) are increasingly viewed as the keystone to translational medicine and improving the health of the nation. In this article, the authors seek to assist academic health centers (AHCs) in learning how to better engage with their communities and build a CEnR agenda by suggesting five steps: defining community and identifying partners, learning the etiquette of CE, building a sustainable network of CEnR researchers, recognizing that CEnR will require the development of new methodologies, and improving translation and dissemination plans. Health disparities that lead to uneven access to and quality of care as well as high costs will persist without a CEnR agenda that finds answers to both medical and public health questions. One of the biggest barriers toward a national CEnR agenda, however, are the historical structures and processes of an AHC-including the complexities of how institutional review boards operate, accounting practices and indirect funding policies, and tenure and promotion paths. Changing institutional culture starts with the leadership and commitment of top decision makers in an institution. By aligning the motivations and goals of their researchers, clinicians, and community members into a vision of a healthier population, AHC leadership will not just improve their own institutions but also improve the health of the nation-starting with improving the health of their local communities, one community at a time.

  10. Borders as membranes :metaphors and models for improved policy in border regions.

    Energy Technology Data Exchange (ETDEWEB)

    Malczynski, Leonard A.; Passell, Howard David; Forster, Craig B. (University of Utah, Salt Lake City, UT); Cockerill, Kristan (Cockerill Consulting, Boone, NC)

    2005-10-01

    Political borders are controversial and contested spaces. In an attempt to better understand movement along and through political borders, this project applied the metaphor of a membrane to look at how people, ideas, and things ''move'' through a border. More specifically, the research team employed this metaphor in a system dynamics framework to construct a computer model to assess legal and illegal migration on the US-Mexico border. Employing a metaphor can be helpful, as it was in this project, to gain different perspectives on a complex system. In addition to the metaphor, the multidisciplinary team utilized an array of methods to gather data including traditional literature searches, an experts workshop, a focus group, interviews, and culling expertise from the individuals on the research team. Results from the qualitative efforts revealed strong social as well as economic drivers that motivate individuals to cross the border legally. Based on the information gathered, the team concluded that legal migration dynamics were of a scope we did not want to consider hence, available demographic models sufficiently capture migration at the local level. Results from both the quantitative and qualitative data searches were used to modify a 1977 border model to demonstrate the dynamic nature of illegal migration. Model runs reveal that current US-policies based on neo-classic economic theory have proven ineffective in curbing illegal migration, and that proposed enforcement policies are also likely to be ineffective. We suggest, based on model results, that improvement in economic conditions within Mexico may have the biggest impact on illegal migration to the U.S. The modeling also supports the views expressed in the current literature suggesting that demographic and economic changes within Mexico are likely to slow illegal migration by 2060 with no special interventions made by either government.

  11. Policies for agricultural nitrogen management—trends, challenges and prospects for improved efficiency in Denmark

    International Nuclear Information System (INIS)

    Dalgaard, Tommy; Hutchings, Nicholas J; Olesen, Jørgen E; Sillebak Kristensen, Ib; Graversgaard, Morten; Hansen, Birgitte; Hasler, Berit; Hertel, Ole; Termansen, Mette; Jacobsen, Brian H; Stoumann Jensen, Lars; Schjørring, Jan K; Kronvang, Brian; Vejre, Henrik

    2014-01-01

    With more than 60% of the land farmed, with vulnerable freshwater and marine environments, and with one of the most intensive, export-oriented livestock sectors in the world, the nitrogen (N) pollution pressure from Danish agriculture is severe. Consequently, a series of policy action plans have been implemented since the mid 1980s with significant effects on the surplus, efficiency and environmental loadings of N. This paper reviews the policies and actions taken and their ability to mitigate effects of reactive N (N r ) while maintaining agricultural production. In summary, the average N-surplus has been reduced from approximately 170 kg N ha −1 yr −1 to below 100 kg N ha −1 yr −1 during the past 30 yrs, while the overall N-efficiency for the agricultural sector (crop + livestock farming) has increased from around 20–30% to 40–45%, the N-leaching from the field root zone has been halved, and N losses to the aquatic and atmospheric environment have been significantly reduced. This has been achieved through a combination of approaches and measures (ranging from command and control legislation, over market-based regulation and governmental expenditure to information and voluntary action), with specific measures addressing the whole N cascade, in order to improve the quality of ground- and surface waters, and to reduce the deposition to terrestrial natural ecosystems. However, there is still a major challenge in complying with the EU Water Framework and Habitats Directives, calling for new approaches, measures and technologies to mitigate agricultural N losses and control N flows. (paper)

  12. Improving coordination of care centers for the elderly through IT support

    DEFF Research Database (Denmark)

    Johansen, Andreas Kaas; Lauridsen, Frederik Vahr Bjarnø; Manea, Vlad

    2015-01-01

    In Denmark, care of elderly people involves numerous and relatively autonomous care providers, including care centers, activity centers, physiotherapists, doctors, and other specialists. However, due to a poor coordination of activities, many elderly experience a lack of continuity of care, misse...... the disruptions in the existing routines, minimize the inherent articulation work, and coherently unify their coordination mechanisms....

  13. Adaptation to Climatic Hazards in the Savannah Ecosystem: Improving Adaptation Policy and Action

    Science.gov (United States)

    Yiran, Gerald A. B.; Stringer, Lindsay C.

    2017-10-01

    People in Ghana's savannah ecosystem have historically experienced a range of climatic hazards that have affected their livelihoods. In view of current climate variability and change, and projected increases in extreme events, adaptation to climate risks is vital. Policies have been put in place to enhance adaptation across sub-Saharan Africa in accordance with international agreements. At the same time, local people, through experience, have learned to adapt. This paper examines current policy actions and their implementation alongside an assessment of barriers to local adaptation. In doing so it links adaptation policy and practice. Policy documents were analysed that covered key livelihood sectors, which were identified as climate sensitive. These included agriculture, water, housing and health policies, as well as the National Climate Change Policy. In-depth interviews and focus group discussions were also held with key stakeholders in the Upper East Region of Ghana. Analyses were carried using thematic content analysis. Although policies and actions complement each other, their integration is weak. Financial, institutional, social, and technological barriers hinder successful local implementation of some policy actions, while lack of local involvement in policy formulation also hinders adaptation practice. Integration of local perspectives into policy needs to be strengthened in order to enhance adaptation. Coupled with this is a need to consider adaptation to climate change in development policies and to pursue efforts to reduce or remove the key barriers to implementation at the local level.

  14. Employee Perceptions of Progress with Implementing a Student-Centered Model of Institutional Improvement: An Achieving the Dream Case Study

    Science.gov (United States)

    Cheek, Annesa LeShawn

    2011-01-01

    Achieving the Dream is a national initiative focused on helping more community college students succeed, particularly students of color and low-income students. Achieving the Dream's student-centered model of institutional improvement focuses on eliminating gaps and raising student achievement by helping institutions build a culture of evidence…

  15. Policy Instruments to Improve Energy Performance of Existing Owner Occupied Dwellings

    Directory of Open Access Journals (Sweden)

    Lorraine Colette Murphy

    2016-11-01

    Full Text Available The aim of this thesis is to add knowledge to the role and impact of policy instruments in meeting energy performance ambition in the existing owner occupied housing stock. The focus was instruments available in the Netherlands in 2011 and 2012. These instruments represented the ‘on the ground’ efforts to meet climate change targets and many continue to do so today in the same or slightly altered forms. At international level there is a recognized need to keep global temperatures within the range of 1.5 - 2°C above pre-industrial levels (Carrington, 2016. At European level, the 2020 package contains a series of binding legislation to help the EU meet its more immediate climate and energy targets. 2020 targets include 20% reduction in greenhouse gas emission, 20% of EU energy obtained from renewable sources and 20% improvement in energy efficiency. 2020 targets for the Netherlands are a 20% reduction in greenhouse gas emissions and a 14% increase in energy generation from renewable sources (Vringer et al., 2014. A raft of policies has been produced over the last number of decades from international to local level to orientate action towards targets. At European level the Energy Performance of Buildings Directive (EPBD drives efforts at reducing energy among one of the biggest players, the building sector. By requiring a mandatory certificate at the point of sale and rent of buildings and making regulatory demands on existing buildings the EPBD upped the ante of what could be expected from the building sector, but especially the existing dwelling stock. National governments have already been tackling existing dwellings for decades propelled by the energy crisis and later by climate change policy. Information campaigns, subsidies, energy taxes, energy loans and tailored advice are among the instruments that have been available to homeowners to carry out works on their dwellings to reduce energy consumption. In recent years, the pace of efforts

  16. The Virtual Environmental Microbiology Center - A Social Network for Enhanced Communication between Water Researchers and Policy Makers

    Science.gov (United States)

    Effective communication within and between organizations involved in research and policy making activities is essential. Sharing information across organizational and geographic boundaries can also facilitate coordination and collaboration, promote a better understanding of tech...

  17. Metropolitan transportation management center concepts of operation : a cross-cutting study : improving transportation network efficiency

    Science.gov (United States)

    1999-10-01

    The implementor and operator of a regional transportation management center (TMC) face a challenging task. Operators of TMCsthe primary point of coordination for managing transportation resourcestypically control millions of dollars of intellig...

  18. Evaluating and improving incident management using historical incident data : case studies at Texas transportation management centers.

    Science.gov (United States)

    2009-08-01

    The companion guidebook (0-5485-P2) developed as part of this study provides the procedures and : methodologies for effective use of historical incident data at Texas Transportation Management Centers : (TMCs). This research report documents the resu...

  19. Nursing schools and academic health centers: toward improved alignment and a synergistic partnership

    Directory of Open Access Journals (Sweden)

    Emami A

    2017-08-01

    Full Text Available Azita Emami,1 Darcy Jaffe,2 Paula Minton-Foltz,3 Grace Parker,4 Susan Manfredi,5 Theresa Braungardt,6 Kelly W Marley,1 Laura Cooley,1 Staishy Bostick Siem7 1University of Washington School of Nursing, Seattle, WA, USA; 2Harborview Medical Center, University of Washington Medicine, Seattle, WA, USA; 3Patient Care Services, Harborview Medical Center, University of Washington Medicine, Seattle, WA, USA; 4University of Washington Medical Center, Seattle, WA, USA; 5Patient Care Services, Northwest Hospital and Medical Center, Seattle, WA, USA; 6Valley Medical Center, Seattle, WA, USA; 7Marketing and Communications, University of Washington School of Nursing, Seattle, WA, USA Abstract: This paper presents the findings from a national survey which the University of Washington conducted among leaders of 32 US academic nursing institutions that are part of academic health centers (AHCs and complements these findings with results from a separate report by the American Association of Colleges of Nursing. While expressing overall satisfaction with their AHC relationships, these leaders find that nursing is often given greater parity in matters of education and research than in mission setting, financial, and governance matters. AHCs are being asked to meet new health care challenges in new ways, starting with the education of health care professionals. AHCs need to be restructured to give nursing full parity if the nation’s and world’s needs for preventive and clinical care are to be best met.Keywords: nursing parity, academic nursing institutions, nurse leaders, institutional alignment

  20. Policy Recommendation from Stakeholders to Improve Forest Products Transportation: A Qualitative Study

    Directory of Open Access Journals (Sweden)

    Anil Koirala

    2017-11-01

    Full Text Available With recently announced federal funding and subsidies to redevelop vacant mills and the communities they were in, the forest products industry in Maine is poised to gain its momentum once again. One of the important components influencing the cost of delivered forest products is transportation. A recent study in the region has shown that the location and availability of markets along with lack of skilled labor force are the major challenges faced by the forest products transportation sector in Maine. This study was focused on developing a management guideline which included various field level options for improving trucking enterprises in Maine. For this, a qualitative research approach utilizing a case study research tradition was employed, with in-depth semi-structured interviews with professionals directly related to the forest products transportation sector used for data generation. Thirteen semi-structured interviews were conducted, with each being audio recorded and later transcribed verbatim. Interview transcriptions were analyzed using NVivo 11. Suggestions, like increasing benefits to drivers and providing training, were proposed for challenges related to manpower shortage, while the marketing of new forest products and adjustment in some state-level policies were proposed for challenges related to the forest products market condition of the state.

  1. Product reformulation in the food system to improve food safety. Evaluation of policy interventions.

    Science.gov (United States)

    Marotta, Giuseppe; Simeone, Mariarosaria; Nazzaro, Concetta

    2014-03-01

    The objective of this study is to understand the level of attention that the consumer awards to a balanced diet and to product ingredients, with a twofold purpose: to understand whether food product reformulation can generate a competitive advantage for companies that practice it and to evaluate the most appropriate policy interventions to promote a healthy diet. Reformulation strategy, in the absence of binding rules, could be generated by consumers. Results from qualitative research and from empirical analysis have shown that the question of health is a latent demand influenced by two main factors: a general lack of information, and the marketing strategies adopted by companies which bring about an increase in the information asymmetry between producers and consumers. In the absence of binding rules, it is therefore necessary that the government implement information campaigns (food education) aimed at increasing knowledge regarding the effects of unhealthy ingredients, in order to inform and improve consumer choice. It is only by means of widespread information campaigns that food product reformulation can become a strategic variable and allow companies to gain a competitive advantage. This may lead to virtuous results in terms of reducing the social costs related to an unhealthy diet. Copyright © 2013 Elsevier Ltd. All rights reserved.

  2. A Policy Analysis of the Coast Guard's Existing Patient Satisfaction System and Recommendations for Improvement

    National Research Council Canada - National Science Library

    Coughlin, Kelly A

    2007-01-01

    .... This paper evaluates CG organizational demands, describes CG practice landscape, presents standards, reviews initial clinic process analysis, and evaluates the cost and criteria of proposed policy alternatives...

  3. Community Coalitions' Gender-Aware Policy and Systems Changes to Improve the Health of Women and Girls.

    Science.gov (United States)

    Kowalczyk, Shelly; Randolph, Suzanne M; Oravecz, Linda

    2017-10-17

    Addressing environmental barriers and community conditions through policy and systems change provides the foundation for creating sustainable public health change at the population level. In an effort to influence population-level change that is gender aware, the United States Department of Health and Human Services Office on Women's Health funded the Coalition for a Healthier Community initiative supporting 10 grantees in the implementation of gender-based, public health systems approaches to improve women and girls' health. A national evaluation assessed the extent to which these gender-aware public health systems approaches result in programs and policies that are sustainable and cost effective in addressing health disparities in women and girls. For this paper, a review of policies reported on in grantees' quarterly progress reports was conducted, and policies were categorized based on each policy's status, level, sector affected, and whether it was gender aware. The review revealed 77 policies at varying stages of development or implementation intended to facilitate systems-level change at the coalition, school, organizational, local, or state level. Fifty-one percent of these policies were identified as being gender aware, because they were intended to reduce barriers to or increase facilitators of gender equity. Community coalitions, like the Coalition for a Healthier Community coalitions, can be valuable channels for promoting policy change, as demonstrated by the many policies developed and/or supported by the Coalition for a Healthier Community grantees in their attempt to meet the needs of women and girls. Copyright © 2017. Published by Elsevier Inc.

  4. Genomics for public health improvement: relevant international ethical and policy issues around genome-wide association studies and biobanks.

    Science.gov (United States)

    Pang, T

    2013-01-01

    Genome-wide association studies and biobanks are at the forefront of genomics research and possess unprecedented potential to improve public health. However, for public health genomics to ultimately fulfill its potential, technological and scientific advances alone are insufficient. Scientists, ethicists, policy makers, and regulators must work closely together with research participants and communities in order to craft an equitable and just ethical framework, and a sustainable environment for effective policies. Such a framework should be a 'hybrid' form which balances equity and solidarity with entrepreneurship and scientific advances. A good balance between research and policy on one hand, and privacy, protection and trust on the other is the key for public health improvement based on advances in genomics science. Copyright © 2013 S. Karger AG, Basel.

  5. A successful strategy for increasing the influenza vaccination rate of healthcare workers without a mandatory policy outside of the United States: a multifaceted intervention in a Japanese tertiary care center.

    Science.gov (United States)

    Honda, Hitoshi; Sato, Yumiko; Yamazaki, Akinori; Padival, Simi; Kumagai, Akira; Babcock, Hilary

    2013-11-01

    Although mandatory vaccination programs have been effective in improving the vaccination rate among healthcare workers, implementing this type of program can be challenging because of varied reasons for vaccine refusal. The purpose of our study is to measure improvement in the influenza vaccination rate from a multifaceted intervention at a Japanese tertiary care center where implementing a mandatory vaccination program is difficult. Before-and-after trial. Healthcare workers at a 550-bed, tertiary care, academic medical center in Sapporo, Japan. We performed a multifaceted intervention including (1) use of a declination form, (2) free vaccination, (3) hospital-wide announcements during the vaccination period, (4) prospective audit and real-time telephone interview for healthcare workers who did not receive the vaccine, (5) medical interview with the hospital executive for noncompliant (no vaccine, no declination form) healthcare workers during the vaccination period, and (6) mandatory submission of a vaccination document if vaccinated outside of the study institution. With the new multifaceted intervention, the vaccination rate in the 2012-2013 season increased substantially, up to 97%. This rate is similar to that reported in studies with a mandatory vaccination program. Improved vaccination acceptance, particularly among physicians, likely contributed to the overall increase in the vaccination rate reported in the study. Implementation of comprehensive strategies with strong leadership can lead to substantial improvements in vaccine uptake among healthcare workers even without a mandatory vaccination policy. The concept is especially important for institutions where implementing mandatory vaccination programs is challenging.

  6. Improved Outcomes for Hispanic Women with Gestational Diabetes Using the Centering Pregnancy© Group Prenatal Care Model.

    Science.gov (United States)

    Schellinger, Megan M; Abernathy, Mary Pell; Amerman, Barbara; May, Carissa; Foxlow, Leslie A; Carter, Amy L; Barbour, Kelli; Luebbehusen, Erin; Ayo, Katherine; Bastawros, Dina; Rose, Rebecca S; Haas, David M

    2017-02-01

    Objective To determine the impact of Centering Pregnancy © -based group prenatal care for Hispanic gravid diabetics on pregnancy outcomes and postpartum follow-up care compared to those receiving traditional prenatal care. Methods A cohort study was performed including 460 women diagnosed with gestational diabetes mellitus (GDM) who received traditional or Centering Pregnancy © prenatal care. The primary outcome measured was completion of postpartum glucose tolerance testing. Secondary outcomes included postpartum visit attendance, birth outcomes, breastfeeding, and initiation of a family planning method. Results 203 women received Centering Pregnancy © group prenatal care and 257 received traditional individual prenatal care. Women receiving Centering Pregnancy © prenatal care were more likely to complete postpartum glucose tolerance testing than those receiving traditional prenatal care, (83.6 vs. 60.7 %, respectively; p prenatal care (30.2 vs. 42.1 %; p = 0.009), and were less likely to undergo inductions of labor (34.5 vs. 46.2 %; p = 0.014). When only Hispanic women were compared, women in the Centering group continued to have higher rates of breastfeeding and completion of postpartum diabetes screening. Conclusion for Practice Hispanic women with GDM who participate in Centering Pregnancy © group prenatal care may have improved outcomes.

  7. A proposal for improving data center management through strategic implementation of Server virtualization technology to support Malaysian Nuclear Agency's activities

    International Nuclear Information System (INIS)

    Mohamad Safuan Sulaiman; Abdul Muin Abdul Rahman; Raja Murzaferi Raja Moktar; Saaidi Ismail

    2010-01-01

    Management of servers in Nuclear Malaysia's data center poses a big challenge to IT Center as well as to the general management. Traditional server management techniques have been used to provide reliable and continuous support for the ever increasing services and applications demanded by researchers and the other staffs of Nuclear Malaysia. Data centers are cost centers which need logistical support such as electricity, air conditioning, room space, manpower and other resources. To save cost and comply with Green Technology while maintaining or improving the level of services, a new concept called server virtualization is proposed and a feasibility study of this technology has been initiated to explore its potential to accommodate IT centers ever demanding services while reducing the need for such logistical supports, hence adhering to the Green IT concept. Server virtualization is a new technology where a single high performance physical server can host multiple high processing services, and different types operating systems with different hardware and software requirements which are traditionally performed by multiple server machines. This paper briefly explains server virtualization concepts, tools and techniques and proposes an implementation strategy of the technology for Nuclear Malaysia's data center. (author)

  8. Improving Educational Outcomes for Latinos: A Study of the Interactive Policy Effects of Representative Bureaucracy and Personnel Stability

    Science.gov (United States)

    Morton, Tabitha S. M.

    2015-01-01

    This article seeks to determine whether 2 common management strategies, representative bureaucracy and personnel stability, can be used in combination with each other in order to improve educational policy outcomes for Latinos. Using data from Texas school districts from 1994 to 2010 and a cross-sectional longitudinal research design, I find that…

  9. Forty years of improvements in European air quality: regional policy-industry interactions with global impacts

    Directory of Open Access Journals (Sweden)

    M. Crippa

    2016-03-01

    Full Text Available The EDGARv4.3.1 (Emissions Database for Global Atmospheric Research global anthropogenic emissions inventory of gaseous (SO2, NOx, CO, non-methane volatile organic compounds and NH3 and particulate (PM10, PM2.5, black and organic carbon air pollutants for the period 1970–2010 is used to develop retrospective air pollution emissions scenarios to quantify the roles and contributions of changes in energy consumption and efficiency, technology progress and end-of-pipe emission reduction measures and their resulting impact on health and crop yields at European and global scale. The reference EDGARv4.3.1 emissions include observed and reported changes in activity data, fuel consumption and air pollution abatement technologies over the past 4 decades, combined with Tier 1 and region-specific Tier 2 emission factors. Two further retrospective scenarios assess the interplay of policy and industry. The highest emission STAG_TECH scenario assesses the impact of the technology and end-of-pipe reduction measures in the European Union, by considering historical fuel consumption, along with a stagnation of technology with constant emission factors since 1970, and assuming no further abatement measures and improvement imposed by European emission standards. The lowest emission STAG_ENERGY scenario evaluates the impact of increased fuel consumption by considering unchanged energy consumption since the year 1970, but assuming the technological development, end-of-pipe reductions, fuel mix and energy efficiency of 2010. Our scenario analysis focuses on the three most important and most regulated sectors (power generation, manufacturing industry and road transport, which are subject to multi-pollutant European Union Air Quality regulations. Stagnation of technology and air pollution reduction measures at 1970 levels would have led to 129 % (or factor 2.3 higher SO2, 71 % higher NOx and 69 % higher PM2.5 emissions in Europe (EU27, demonstrating the large

  10. Integrated Pest Management Intervention in Child Care Centers Improves Knowledge, Pest Control, and Practices.

    Science.gov (United States)

    Alkon, Abbey; Nouredini, Sahar; Swartz, Alicia; Sutherland, Andrew Mason; Stephens, Michelle; Davidson, Nita A; Rose, Roberta

    To reduce young children's exposure to pests and pesticides, an integrated pest management (IPM) intervention was provided for child care center staff. The 7-month IPM education and consultation intervention was conducted by trained nurse child care health consultants in 44 child care centers in California. IPM knowledge surveys were completed by child care staff, objective IPM assessments were completed by research assistants pre- and postintervention, and activity logs were completed by the nurses. There were significant increases in IPM knowledge for the child care staff who attended workshops. There were reductions in the prevalence of pests and increases in IPM practices at the postintervention compared with the preintervention time point. The nurses consulted an average of 5.4 hours per center. A nurse-led IPM intervention in child care centers can reduce exposure to harmful substances for young children attending child care centers. Copyright © 2016 National Association of Pediatric Nurse Practitioners. Published by Elsevier Inc. All rights reserved.

  11. Medicaid Expansion And Grant Funding Increases Helped Improve Community Health Center Capacity.

    Science.gov (United States)

    Han, Xinxin; Luo, Qian; Ku, Leighton

    2017-01-01

    Through the expansion of Medicaid eligibility and increases in core federal grant funding, the Affordable Care Act (ACA) sought to increase the capacity of community health centers to provide primary care to low-income populations. We examined the effects of the ACA Medicaid expansion and changes in federal grant levels on the centers' numbers of patients, percentages of patients by type of insurance, and numbers of visits from 2012 to 2015. In the period after expansion (2014-15), health centers in expansion states had a 5 percent higher total patient volume, larger shares of Medicaid patients, smaller shares of uninsured patients, and increases in overall visits and mental health visits, compared to centers in nonexpansion states. Increases in federal grant funding levels were associated with increases in numbers of patients and of overall, medical, and preventive service visits. If federal grant levels are not sustained after 2017, there could be marked reductions in health center capacity in both expansion and nonexpansion states. Project HOPE—The People-to-People Health Foundation, Inc.

  12. 77 FR 51948 - Airport Improvement Program (AIP): Policy Regarding Access to Airports From Residential Property...

    Science.gov (United States)

    2012-08-28

    ... Administration published a Notice of Proposed Policy in the Federal Register at 77 FR 44515 proposing an FAA... DEPARTMENT OF TRANSPORTATION Federal Aviation Administration 14 CFR Chapter 1 [Docket No. FAA-2012...; Correction AGENCY: Federal Aviation Administration (FAA), DOT. ACTION: Proposed policy; implementation of...

  13. Good Policy, Good Practice II. Improving Outcomes and Productivity in Higher Education: A Guide for Policymakers

    Science.gov (United States)

    Brenneman, Meghan Wilson; Callan, Patrick M.; Ewell, Peter T.; Finney, Joni E.; Jones, Dennis P.; Zis, Stacey

    2010-01-01

    This new edition of "Good Policy, Good Practice II" revises and updates the authors' 2007 publication. Like the earlier edition, it responds to one of the questions that is raised most frequently in the authors' work with public policy and education leaders as they begin to address the national and state imperatives to increase the proportion of…

  14. Healthier Schools: A Review of State Policies for Improving Indoor Air Quality. Research Report.

    Science.gov (United States)

    Bernstein, Tobie

    Existing indoor air quality (IAQ) policies for schools reflect the variety of institutional, political, social, and economic contexts that exist within individual states. The purpose of this report is to provide a better understanding of the types of policy strategies used by states in addressing general indoor air quality problems. The policies…

  15. Improving health in prisons - from evidence to policy to implementation - experiences from the UK.

    Science.gov (United States)

    Leaman, Jane; Richards, Anna Amelia; Emslie, Lynn; O'Moore, Eamonn Joseph

    2017-09-11

    good understanding of current practice. Practical implications The review findings support the World Health Organisation position on the value of integrated prison and public health systems in improving quality of healthcare. It also recommends future policy needs to take account of the "whole prison approach" recognising that healthcare in prisons cannot operate in isolation from the prison regime or the community. Originality/value This is unique research which has great value in supporting prison reform in England. It will also be of interest internationally due to the paucity of data in the published peer-reviewed literature on the impact of commissioning models on healthcare or health outcomes.

  16. Developing an agenda for research about policies to improve access to healthy foods in rural communities: a concept mapping study

    Science.gov (United States)

    2014-01-01

    Background Policies that improve access to healthy, affordable foods may improve population health and reduce health disparities. In the United States most food access policy research focuses on urban communities even though residents of rural communities face disproportionately higher risk for nutrition-related chronic diseases compared to residents of urban communities. The purpose of this study was to (1) identify the factors associated with access to healthy, affordable food in rural communities in the United States; and (2) prioritize a meaningful and feasible rural food policy research agenda. Methods This study was conducted by the Rural Food Access Workgroup (RFAWG), a workgroup facilitated by the Nutrition and Obesity Policy Research and Evaluation Network. A national sample of academic and non-academic researchers, public health and cooperative extension practitioners, and other experts who focus on rural food access and economic development was invited to complete a concept mapping process that included brainstorming the factors that are associated with rural food access, sorting and organizing the factors into similar domains, and rating the importance of policies and research to address these factors. As a last step, RFAWG members convened to interpret the data and establish research recommendations. Results Seventy-five participants in the brainstorming exercise represented the following sectors: non-extension research (n = 27), non-extension program administration (n = 18), “other” (n = 14), policy advocacy (n = 10), and cooperative extension service (n = 6). The brainstorming exercise generated 90 distinct statements about factors associated with rural food access in the United States; these were sorted into 5 clusters. Go Zones were established for the factors that were rated highly as both a priority policy target and a priority for research. The highest ranked policy and research priorities include strategies designed to

  17. Improving access to skilled attendance at delivery: a policy brief for Uganda.

    Science.gov (United States)

    Nabudere, Harriet; Asiimwe, Delius; Amandua, Jacinto

    2013-04-01

    This study describes the process of production, findings for a policy brief on Increasing Access to Skilled Birth Attendance, and subsequent use of the report by policy makers and others from the health sector in Uganda. The methods used to prepare the policy brief use the SUPPORT Tools for evidence-informed health policy making. The problem that this evidence brief addresses was identified through an explicit priority setting process involving policy makers and other stakeholders, further clarification with key informant interviews of relevant policy makers, and review of relevant documents. A working group of national stakeholder representatives and external reviewers commented on and contributed to successive drafts of the report. Research describing the problem, policy options, and implementation considerations was identified by reviewing government documents, routinely collected data, electronic literature searches, contact with key informants, and reviewing the reference lists of relevant documents that were retrieved. The proportion of pregnant women delivering from public and private non-profit facilities was low at 34 percent in 2008/09. The three policy options discussed in the report could be adopted independently or complementary to the other to increase access to skilled care. The Ministry of Health in deliberating to provide intrapartum care at first level health facilities from the second level of care, requested for research evidence to support these decisions. Maternal waiting shelters and working with the private-for-profit sector to facilitate deliveries in health facilities are promising complementary interventions that have been piloted in both the public and private health sector. A combination of strategies is needed to effectively implement the proposed options as discussed further in this article. The policy brief report was used as a background document for two stakeholder dialogue meetings involving members of parliament, policy makers

  18. Policy approaches to improve availability and affordability of medicines in Mexico - an example of a middle income country.

    Science.gov (United States)

    Moye-Holz, Daniela; van Dijk, Jitse P; Reijneveld, Sijmen A; Hogerzeil, Hans V

    2017-08-01

    The World Health Organization recommends establishing and implementing a national pharmaceutical policy (NPP) to guarantee effective and equitable access to medicines. Mexico has implemented several policy approaches to regulate the pharmaceutical sector, but it has no formal NPP. This article describes the approach that the Mexican government has taken to improve availability and affordability of essential medicines. Descriptive policy analysis of public pharmaceutical policy proposals and health action plans on the basis of publicly available data and health progress reports, with a focus on availability and affordability of medicines. The government has implemented pooled procurement, price negotiations, and an information platform in the public sector to improve affordability and availability. The government mainly reports on the savings that these strategies have generated in the public expenditure but their full impact on availability and affordability has not been assessed. To increase availability and affordability of medicines in the public sector, the Mexican government has resorted on isolated strategies. In addition to efficient procurement, price negotiations and price information, other policy components and pricing interventions are needed. All these strategies should be included in a comprehensive NPP.

  19. July 2011 Memorandum: Improving EPA Review of Appalachian Surface Coal Mining Operations Under the Clean Water Act, National Environmental Policy Act, and the Environmental Justice Executive Order

    Science.gov (United States)

    Memorandum: Improving EPA Review of Appalachian Surface Coal Mining Operations Under the Clean Water Act, National Environmental Policy Act, and the Environmental Justice Executive Order, July 21, 2011

  20. Photosynthetic antennas and reaction centers: Current understanding and prospects for improvement

    Energy Technology Data Exchange (ETDEWEB)

    Blankenship, R.E. [Arizona State Univ., Tempe, AZ (United States)

    1996-09-01

    A brief introduction to the principles, structures and kinetic processes that take place in natural photosynthetic reaction center complexes is presented. Energy is first collected by an antenna system, and is transferred to a reaction center complex where primary electron transfer takes place. Secondary reactions lead to oxidation of water and reduction of CO{sub 2} in some classes of organisms. Antenna systems are highly regulated to maximize energy collection efficiency while avoiding photodamage. Some areas that are presently not well understood are listed.

  1. Local food policies can help promote local foods and improve health: a case study from the Federated States of Micronesia.

    Science.gov (United States)

    Englberger, Lois; Lorens, Adelino; Pretrick, Moses; Tara, Mona J; Johnson, Emihner

    2011-11-01

    The Federated States of Micronesia (FSM) and other countries throughout the Pacific are facing an epidemic of non-communicable disease health problems. These are directly related to the increased consumption of unhealthy imported processed foods, the neglect of traditional food systems, and lifestyle changes, including decreased physical activity. The FSM faces the double burden of malnutrition with both non-communicable diseases and micronutrient deficiencies, including vitamin A deficiency and anemia. To help increase the use of traditional island foods and improve health, the Island Food Community of Pohnpei has initiated a program in the FSM to support and promote local food policies, along with its Go Local awareness campaign. Such local food policies are defined broadly and include individual and family commitments, community group local food policies and policies established by government, including presidential proclamations and increased taxation on soft drinks. The aim of this paper is to describe this work. An inter-agency, community- and research-based, participatory and media approach was used. Partners are both non-governmental and governmental. The use of continuing awareness work along with local food policy establishment and the acknowledgement of the individuals and groups involved are essential. The work is still in the preliminary stage but ad hoc examples show that this approach has had success in increased awareness on health issues and improving dietary intake on both an individual and group basis. This indicates that further use of local food policies could have an instrumental impact in FSM as well as other Pacific Island countries in promoting local foods and improving dietary intake and health, including the control of non-communicable diseases and other dietary-related health problems.

  2. The National Air Intelligence Center Software Process Improvement Effort (NAIC SPI)

    National Research Council Canada - National Science Library

    Blankenship, Donald

    2001-01-01

    ...) Software Process Improvements effort. The objective of this effort was for the contractor to provide engineering and software process improvement for NAIC/SCD to reach SEI's CMM Level 2 in process maturity...

  3. Trends in patient satisfaction in Dutch university medical centers: room for improvement for all

    NARCIS (Netherlands)

    Kleefstra, Sophia M.; Zandbelt, Linda C.; de Haes, Hanneke J. C. J. M.; Kool, Rudolf B.

    2015-01-01

    Results of patient satisfaction research provide hospitals areas for quality improvement. Although it may take several years to achieve such improvement, not all hospitals analyze changes in patient satisfaction over time structurally. Consequently, they lack information from patients' perspective

  4. Primary care program improves reimbursement. The Federally Qualified Health Center program helps hospitals improve services to the medically indigent.

    Science.gov (United States)

    Fahey, T M; Gallitano, D G

    1993-03-01

    Under a program created by Congress in 1989, certain primary care treatment centers serving the medically and economically indigent can become Federally Qualified Health Centers (FQHCs). Recently enacted rules and regulations allow participants in the FQHC program to receive 100 percent reasonable cost reimbursement for Medicaid services and 80 percent for Medicare services. An all-inclusive annual cost report is the basis for determining reimbursement rates. The report factors in such expenses as physician and other healthcare and professional salaries and benefits, medical supplies, certain equipment depreciation, and overhead for facility and administrative costs. Both Medicaid and Medicare reimbursement is based on an encounter rate, and states employ various methodologies to determine the reimbursement level. In Illinois, for example, typical reimbursement for a qualified encounter ranges from $70 to $88. To obtain FQHC status, an organization must demonstrate community need, deliver the appropriate range of healthcare services, satisfy management and finance requirements, and function under a community-based governing board. In addition, an FQHC must provide primary healthcare by physicians and (where appropriate) midlevel practitioners; it must also offer its community diagnostic laboratory and x-ray services, preventive healthcare and dental care, case management, pharmacy services, and arrangements for emergency services. Because FQHCs must be freestanding facilities, establishing them can trigger a number of ancillary legal issues, such as those involved in forming a new corporation, complying with not-for-profit corporation regulations, applying for tax-exempt status, and applying for various property and sales tax exemptions. Hospitals that establish FQHCs must also be prepared to relinquish direct control over the delivery of primary care services.

  5. Preferences for policy attributes and willingness to pay for water quality improvements under uncertainty

    Science.gov (United States)

    Mullen, Jeffrey D.; Calhoun, Kayla C.; Colson, Gregory J.

    2017-04-01

    When exploring environmental policy options, sometimes neither the current state of the environmental good being analyzed nor the effectiveness of the proposed policy is known with certainty. This is the case with privately owned, residential, onsite wastewater treatment systems (septic systems)—there is ample evidence that they can contribute to water quality impairment, but their contribution is generally stochastic in nature and the efficacy of technological solutions is uncertain. Furthermore, the benefits of ameliorating water quality impairments are public in nature. Septic system owners are legally responsible for maintaining their systems, but requiring them to upgrade otherwise properly functioning tanks is outside the scope of water quality regulations. An incentive structure is necessary to induce private homeowners to invest in septic upgrades that deliver both private benefits in addition to the positive externality for the wider public and environment. The question for policy makers is how these private incentives should be financed, and whether public support can be garnered. Results of a choice experiment in Gwinnett County, Georgia, accounting for both sources of uncertainty—the current state of water quality and the efficacy of the intervention—in the design of water quality policy are presented. We find baseline water quality conditions and policy efficacy significantly affect public support for a policy transferring public funds to private homeowners, in terms of both sentiment and willingness to pay. The manner in which costs are shared across stakeholders also affects the selection of a policy option, but not willingness to pay for it.

  6. Finding electronic information for health policy advocacy: a guide to improving search results.

    Science.gov (United States)

    Olsan, Tobie H; Bianchi, Carolanne; White, Pamela; Glessner, Theresa; Mapstone, Pamela L

    2011-12-01

    The success of advanced practice registered nurses' (APRNs') health policy advocacy depends on staying well informed about key issues. Searching for high-quality health policy information, however, can be frustrating and time consuming. Busy clinicians need strategies and tips to reduce information overload and to access synthesized research for evidence-based health policy. This article therefore offers APRNs practical guidelines and resources for searching electronic health policy information. Scholarly databases and Internet sites. Electronic health policy information is generated by a wide variety of public and private organizations and disseminated in hundreds of journals and Web pages. Specialty search tools are needed to retrieve the unindexed gray literature, which includes government documents, agency reports, fact sheets, standards, and statistics not produced by commercial publishers. Further, Internet users need to examine search results with a critical eye for information quality. Expertise in searching electronic health policy information is a prerequisite for developing APRNs' leadership in political arenas to influence health policy and the delivery of healthcare services. ©2011 The Author(s) Journal compilation ©2011 American Academy of Nurse Practitioners.

  7. Mandatory Reporting? Issues to consider when developing legislation and policy to improve discovery of child abuse

    Directory of Open Access Journals (Sweden)

    Emma Davies

    2014-10-01

    Full Text Available Article by Dr Emma Davies (School of Law, Liverpool John Moores University, Associate Professor Ben Mathews (School of Law, Queensland University of Technology and Professor John Read (Institute of Psychology, Health and Society, University of Liverpool. In the United Kingdom, recent investigations into child sexual abuse occurring within schools, the Catholic Church and the British Broadcasting Corporation, have intensified debate on ways to improve the discovery of child sexual abuse, and child maltreatment generally. One approach adopted in other jurisdictions to better identify cases of severe child maltreatment is the introduction of some form of legislative mandatory reporting to require designated persons to report known and suspected cases. The debate in England has raised the prospect of whether adopting a strategy of some kind of mandatory reporting law is advisable. The purpose of this article is to add to this debate by identifying fundamental principles, issues and complexities underpinning policy and even legislative developments in the interests of children and society. The article will first highlight the data on the hidden nature of child maltreatment and the background to the debate. Secondly, it will identify some significant gaps in knowledge that need to be filled. Thirdly, the article will summarise the barriers to reporting abuse and neglect. Fourthly, we will identify a range of options for, and clarify the dilemmas in developing, legislative mandatory reporting, addressing two key issues: who should be mandated to report, and what types of child maltreatment should they be required to report? Finally, we draw attention to some inherently different goals and competing interests, both between and within the various institutions involved in the safeguarding of children and the criminal prosecution of some offenders. Based on this analysis we offer some concluding observations that we hope contribute to informed and careful

  8. Harnessing Scientific and Technological Advances to Improve Equity in Kidney Allocation Policies.

    Science.gov (United States)

    Tambur, A R; Audry, B; Antoine, C; Suberbielle, C; Glotz, D; Jacquelinet, C

    2017-12-01

    We reported that current assignment of HLA-DQ is a barrier to organ allocation. Here we simulated the impact of incorporating HLA-DQ antigens and antibodies as A/B and αβ allelic variants, respectively, on calculated panel reactive antibody (cPRA) and probability of finding potential compatible donors (PCD). A cohort of 1224 donors and 2075 sensitized candidates was analyzed using HLA-DQαβ allelic (study) versus serologic (current practice) nomenclature. A significant (p < 10 -4 ) decrease in cPRA was observed with higher impact for male versus female, and first transplant versus retransplant (p < 10 -4 ), affecting mostly patients with moderate cPRA (30-80%). Consequently, the number of patients qualifying for 100% cPRA points according to the United Network for Organ Sharing-Kidney Allocation System decreased by 37%. More critically, by using allelic versus serologic nomenclature for HLA-DQ, the number of PCDs for all patients was increased, with male and first-transplant patients showing a higher expansion compared with female and retransplants. Patients of blood group O showed the highest benefit. The goal of reporting unacceptable antigens is to improve accuracy of virtual crossmatching and increase the likelihood of finding immunologically compatible donors. Our simulation provides strong support for the need to re-evaluate the use of allele typing and how HLA-DQ antigens and antibodies are incorporated into allocation policies to ensure equity. © 2017 The American Society of Transplantation and the American Society of Transplant Surgeons.

  9. Improved Early Cleft Lip and Palate Complications at a Surgery Specialty Center in the Developing World.

    Science.gov (United States)

    Park, Eugene; Deshpande, Gaurav; Schonmeyr, Bjorn; Restrepo, Carolina; Campbell, Alex

    2018-01-01

    To evaluate complication rates following cleft lip and cleft palate repairs during the transition from mission-based care to center-based care in a developing region. We performed a retrospective review of 3419 patients who underwent cleft lip repair and 1728 patients who underwent cleft palate repair in Guwahati, India between December 2010 and February 2014. Of those who underwent cleft lip repair, 654 were treated during a surgical mission and 2765 were treated at a permanent center. Of those who underwent cleft palate repair, 236 were treated during a surgical mission and 1491 were treated at a permanent center. Two large surgical missions to Guwahati, India, and the Guwahati Comprehensive Cleft Care Center (GCCCC) in Assam, India. Overall complication rates following cleft lip and cleft palate repair. Overall complication rates following cleft lip repair were 13.2% for the first mission, 6.7% for the second mission, and 4.0% at GCCCC. Overall complication rates following cleft palate repair were 28.0% for the first mission, 30.0% for the second mission, and 15.8% at GCCCC. Complication rates following cleft palate repair by the subset of surgeons permanently based at GCCCC (7.2%) were lower than visiting surgeons ( P cleft care delivery in the developing world can lead to decreased complication rates.

  10. Social Insurance for Delivery (Jampersal Policy in Indonesia: Culture-Based Approach for Improving Delivery by Health Workers in Rural Areas

    Directory of Open Access Journals (Sweden)

    Riswati Riswati

    2015-06-01

    Full Text Available Background: Jampersal program was launched in Indonesia in January of 2011 by Permenkes No.631/Menkes/PER/III/2011. The aim was to improve the coverage of antenatal care, delivery, postpartum care, postnatal, and family planning by health professionals free of charge. After over a year Jampersal program runs, The ANC figures of Jampersal utilization were still very low. Methods:Quantitative and qualitative research on socio- cultural factors in relation to the selection of health personnel by utilizing Jampersal conducted in 2012 which was then followed by a round table discussion to review the policy options related to the Jampersal utilization of the 6 rural districts. Results: Policy options suggested in Jampersal socialization activities need Intersectoral Commitment:The Ministry of Home Affairs, Ministry of Religious Affairs, and BKKBN, followed by a clear and decisive political commitment. They need active partnerships of the midwives, TBAs and cadres in Jampersal socialization. Midwives in the health center level should be prohibited from private practice, but the total amount of compensation of midwife in helping delivery should be adjusted. Regulations are required and procedures should be set for Jamkesnas, Jamkesda, and Jampersal; They need regulation on cooperation between the health centers staffs and village chiefs to further reinforce ID requirement;The transportation cost to refferal unit; TBAs services (division of task and cost; Financial restrictions to cover by Jampersal on second or third delivery. Additionally need a regulation of reward and punishment for midwives,TBAs and cadres involvement in serving pregnancy and delivery. In village level, they need to establish regulation, that TbaS AND Cadres should write the pregnat women data at the board office of village chiefts. Lastly, MoU between head of district health center and midwife assosiation related to midwife understanding of cultural approaches and on

  11. Molar extinction coefficients and other properties of an improved reaction center preparation from Rhodopseudomonas viridis

    Energy Technology Data Exchange (ETDEWEB)

    Clayton, R.K.; Clayton, B.J.

    1978-01-01

    Reaction centers have been purified from chromatophores of Rhodopseudomonas viridis by treatment with lauryl dimethyl amine oxide followed by hydroxyapatite chromatography and precipitation with ammonium sulfate. The absorption spectrum at low temperature shows bands at 531 and 543 nm, assigned to two molecules of bacteriopheophytin b. The 600 nm band of bacteriochlorophyll b is resolved at low temperature into components at 601 and 606.5 nm. At room temperature the light-induced difference spectrum shows a negative band centered at 615 nm, where the absorption spectrum shows only a week shoulder adjacent to the 600 nm band. The fluorescence spectrum shows a band at 1000 nm and no fluorescence corresponding to the 830 nm absorption band. Two molecules of cytochrome 558 and three of cytochrome 552 accompany each reaction center. The differential extinction coefficient (reduced minus oxidized) of cytochrome 558 nm was estimated as 20 +- 2 mM/sup -1/.cm/sup -1/ through a coupled reaction with equine cytochrome c. The extinction coefficient of reaction centers at 960 nm was determined to be 123 +- 25 mM/sup -1/.cm/sup -1/ by measuring the light-induced bleaching of P-960 and the coupled oxidation of cytochrome 558. The corresponding extinction coefficient at 830 nm is 300 +- 65 mM/sup -1/.cm/sup -1/. The absorbance ratio ..cap alpha../sub 280nm/..cap alpha../sub 830nm/ in our preparations was 2.1, and there was 190 kg protein per mol of reaction centers. Sodium dodecyl sulfate-polyacrylamide gel electrophoresis showed three major components of apparent molecular weights 31,000, 37,000, and 41,000.

  12. A systematic strategic planning process focused on improved community engagement by an academic health center: the University of Kansas Medical Center's story.

    Science.gov (United States)

    Cook, David C; Nelson, Eve-Lynn; Ast, Cori; Lillis, Teresa

    2013-05-01

    A growing number of academic health centers (AHCs) are considering approaches to expand collaboration with their communities in order to address complex and multisystem health concerns. In 2010, internal leaders at the University of Kansas Medical Center undertook a strategic planning process to enhance both community engagement activities and the scholarship resulting from these engagement activities. The authors describe the strategic planning process, recommendations, and actions associated with elevating community engagement within the AHC's mission and priorities. The strategic planning process included conducting an inventory of community engagement activities within the AHC; analyzing strengths, weaknesses, opportunities, and threats for community engagement work; and identifying goals and strategies to improve future community engagement activities and scholarship. The resulting road map for enhancing community engagement at their institution through 2015 consists of four main strategies: emphasize scholarship in community engagement, revise organizational structures to better facilitate community engagement, prioritize current engagement activities to ensure appropriate use of resources, and enhance communication of engagement initiatives to further develop stakeholder relationships.The authors also discuss implementation of the plan to date and highlight lessons learned that may inform other AHCs as they enhance and expand similar endeavors.

  13. Policies, activities, and structures supporting research mentoring: a national survey of academic health centers with clinical and translational science awards.

    Science.gov (United States)

    Tillman, Robert E; Jang, Susan; Abedin, Zainab; Richards, Boyd F; Spaeth-Rublee, Brigitta; Pincus, Harold Alan

    2013-01-01

    To document the frequency of policies and activities in support of mentoring practices at institutions receiving a U.S. National Institutes of Health's Clinical and Translational Science Award (CTSA). The study consisted of a 69-item survey with questions about the inclusion (formal or informal) of policies, activities, and structures supporting mentoring within CTSA-sponsored research (i.e., KL2 programs) and, more broadly, in the CTSA's home institution. The survey, conducted from November 2010 through January 2011, was sent to the 55 institutions awarded CTSAs at the time of the survey. Follow-up phone interviews were conducted to clarify responses as needed. Fifty-one of 55 (92%) institutions completed the survey for institutional programs and 53 of 55 (96%) for KL2 programs. Responses regarding policies and activities involving mentor criteria, mentor-mentee relationship, incentives, and evaluative mechanisms revealed considerable variability between KL2 and institutional programs in some areas, such as having mentor qualification criteria and processes to evaluate mentors. The survey also identified areas, such as training and women and minority mentoring programs, where there was frequent sharing of activities between the institutional and KL2 programs. KL2 programs and institutional programs tend to have different preferences for policies versus activities to optimize qualification of mentors, the mentor-mentee relationship, incentives, and evaluation mechanisms. Frequently, these elements are informal. Individuals in charge of implementing and maintaining mentoring initiatives can use the results of the study to consider their current mentoring policies, structures, and activities by comparing them with national patterns within CTSA institutions.

  14. Care Management Medical Home Center Model: Preliminary Results of a Patient-Centered Approach to Improving Care Quality for Diabetic Patients.

    Science.gov (United States)

    Page, Timothy F; Amofah, St Anthony; McCann, Shelia; Rivo, Julie; Varghese, Asha; James, Terisa; Rivo, Marc; Williams, Mark L

    2015-07-01

    This article presents preliminary findings of the impact of an innovative care management model for diabetic patients. The model was implemented by seven Federally Qualified Health Centers serving 10,000 diabetic patients in Miami-Dade County. A primary intervention of this model is a centralized care management team that makes previsit phone calls to diabetic patients who have scheduled appointments. These previsit phone calls optimize patient knowledge and self-management goals, and provide patient care coordinators with relevant clinical information to optimize the office visit and help to ensure completion of recommended diabetic preventive and chronic care services. Data suggest that following the implementation of this care management model, more diabetic patients are receiving regular care, and compliance with recommended tests and screenings has improved. © 2015 Society for Public Health Education.

  15. Improvements of the Penalty Avoiding Rational Policy Making Algorithm and an Application to the Othello Game

    Science.gov (United States)

    Miyazaki, Kazuteru; Tsuboi, Sougo; Kobayashi, Shigenobu

    The purpose of reinforcement learning is to learn an optimal policy in general. However, in 2-players games such as the othello game, it is important to acquire a penalty avoiding policy. In this paper, we focus on formation of a penalty avoiding policy based on the Penalty Avoiding Rational Policy Making algorithm [Miyazaki 01]. In applying it to large-scale problems, we are confronted with the curse of dimensionality. We introduce several ideas and heuristics to overcome the combinational explosion in large-scale problems. First, we propose an algorithm to save the memory by calculation of state transition. Second, we describe how to restrict exploration by two type knowledge; KIFU database and evaluation funcion. We show that our learning player can always defeat against the well-known othello game program KITTY.

  16. Paradigmatic obstacles to improving the health of populations: implications for health policy

    Directory of Open Access Journals (Sweden)

    McKinlay John B.

    1998-01-01

    Full Text Available While there are promising developments in public health, most interventions (both at the individual and community levels remain focused on "downstream" tertiary treatments or one-on-one interventions. These efforts have their origins in the biomedical paradigm and risk factor epidemiology and the behavioral science research methods that serve as their handmaidens. This paper argues for a more appropriate balance of "downstream" efforts with a more appropriate whole population public health approach to health policy -what may be termed a social policy approach to healthy lifestyles rather than the current lifestyle approach to health policy. New, more appropriate research methods must be developed and applied to match these emerging levels of whole population intervention. We must avoid any disjunction between new upstream policy level interventions and the methods used to measure their effect -appropriate unto the intervention level must be the evaluation method thereof.

  17. Defense Management: Proposed Lodging Policy May Lead to Improvements, but More Actions Are Required

    National Research Council Canada - National Science Library

    Bartlett, Roscoe

    2002-01-01

    Mthough we do not believe that travel regulations require DOD to revise its PCS lodging policy, the department does have the discretion to make the proposed change to bring consistency to the program...

  18. Report: EPA Needs to Improve Recording Information Technology Investments and Issue a Policy Covering All Investments

    Science.gov (United States)

    Report #15-P-0292, September 22, 2015. The EPA management of its $334 million in IT investments is noncompliant with its current policy. Thus, the EPA is at risk of not managing taxpayer dollars properly.

  19. Uruguay - Policy Options for Improving the Efficiency of Uruguay’s Railway Sector : Consolidated Report

    OpenAIRE

    World Bank

    2010-01-01

    The aim of this paper is to review the state of the productive infrastructure of Uruguay and the development policies that govern it and to propose policy options for the long term contribution to achieving a higher level of economic and sustainable development, based on the premise that there is a link between the development of a country's infrastructure and its economic growth. The stud...

  20. Can early intervention policies improve wellbeing? Evidence from a randomized controlled trial

    OpenAIRE

    Michael Daly; Liam Delaney; Orla Doyle; Nick Fitzpatrick; Christine O'Farrelly

    2014-01-01

    Many authors have proposed incorporating measures of well-being into evaluations of public policy. Yet few evaluations use experimental design or examine multiple aspects of well-being, thus the causal impact of public policies on well-being is largely unknown. In this paper we examine the effect of an intensive early intervention program on maternal well-being in a targeted disadvantaged community. Using a randomized controlled trial design we estimate and compare treatment effects on global...

  1. Can Early Intervention Policies Improve Well-being? Evidence from a randomized controlled trial

    OpenAIRE

    Daly, Michael; Delaney, Liam; Doyle, Orla; Fitzpatrick, Nick; O'Farrelly, Christine

    2014-01-01

    Many authors have proposed incorporating measures of well-being into evaluations of public policy. Yet few evaluations use experimental design or examine multiple aspects of wellbeing, thus the causal impact of public policies on well-being is largely unknown. In this paper we examine the effect of an intensive early intervention program on maternal wellbeing in a targeted disadvantaged community. Using a randomized controlled trial design we estimate and compare treatment effects on global w...

  2. The implications of alcohol intoxication and the Uniform Policy Provision Law on trauma centers; a national trauma data bank analysis of minimally injured patients.

    Science.gov (United States)

    O'Keeffe, Terence; Shafi, Shahid; Sperry, Jason L; Gentilello, Larry M

    2009-02-01

    Alcohol intoxication may confound the initial assessment of trauma patients, resulting in increased use of diagnostic and therapeutic procedures, thereby increasing hospital costs. The Uniform Policy Provision Law (UPPL) exists in many states and allows insurance companies to deny payment for medical treatment for alcohol-related injuries. If intoxication increases resource utilization, these denials compound the financial burden of alcohol use on trauma centers. We hypothesized that patients injured while under the influence of alcohol require more diagnostic tests, procedures, and hospital admissions, leading to higher hospital charges. The National Trauma Databank (2000-2004) was analyzed to identify adult trauma patients (age > or = 16 years) who were discharged alive, had a length of stay laws that penalize trauma centers for identifying intoxicated patients should be repealed in states where they exist.

  3. How to improve collaboration between the public health sector and other policy sectors to reduce health inequalities? - A study in sixteen municipalities in the Netherlands.

    Science.gov (United States)

    Storm, Ilse; den Hertog, Frank; van Oers, Hans; Schuit, Albertine J

    2016-06-22

    The causes of health inequalities are complex. For the reduction of health inequalities, intersectoral collaboration between the public health sector and both social policy sectors (e.g. youth affairs, education) and physical policy sectors (e.g. housing, spatial planning) is essential, but in local practice difficult to realize. The aim of this study was to examine the collaboration between the sectors in question more closely and to identify opportunities for improvement. A qualitative descriptive analysis of five aspects of collaboration within sixteen Dutch municipalities was performed to examine the collaboration between the public health sector and other policy sectors: 1) involvement of the sectors in the public health policy network, 2) harmonisation of objectives, 3) use of policies by the relevant sectors, 4) formalised collaboration, and 5) previous experience. Empirical data on these collaboration aspects were collected based on document analysis, questionnaires and interviews. The study found that the policy workers of social sectors were more involved in the public health network and more frequently supported the objectives in the field of health inequality reduction. Both social policy sectors and physical policy sectors used policies and activities to reduce health inequalities. More is done to influence the determinants of health inequality through policies aimed at lifestyle and social setting than through policies aimed at socioeconomic factors and the physical environment. Where the physical policy sectors are involved in the public health network, the collaboration follows a very similar pattern as with the social policy sectors. All sectors recognise the importance of good relationships, positive experiences, a common interest in working together and coordinated mechanisms. This study shows that there is scope for improving collaboration in the field of health inequality reduction between the public health sector and both social policy sectors

  4. Fostering evidence-based quality improvement for patient-centered medical homes: Initiating local quality councils to transform primary care.

    Science.gov (United States)

    Stockdale, Susan E; Zuchowski, Jessica; Rubenstein, Lisa V; Sapir, Negar; Yano, Elizabeth M; Altman, Lisa; Fickel, Jacqueline J; McDougall, Skye; Dresselhaus, Timothy; Hamilton, Alison B

    Although the patient-centered medical home endorses quality improvement principles, methods for supporting ongoing, systematic primary care quality improvement have not been evaluated. We introduced primary care quality councils at six Veterans Health Administration sites as an organizational intervention with three key design elements: (a) fostering interdisciplinary quality improvement leadership, (b) establishing a structured quality improvement process, and (c) facilitating organizationally aligned frontline quality improvement innovation. Our evaluation objectives were to (a) assess design element implementation, (b) describe implementation barriers and facilitators, and (c) assess successful quality improvement project completion and spread. We analyzed administrative records and conducted interviews with 85 organizational leaders. We developed and applied criteria for assessing design element implementation using hybrid deductive/inductive analytic techniques. All quality councils implemented interdisciplinary leadership and a structured quality improvement process, and all but one completed at least one quality improvement project and a toolkit for spreading improvements. Quality councils were perceived as most effective when service line leaders had well-functioning interdisciplinary communication. Matching positions within leadership hierarchies with appropriate supportive roles facilitated frontline quality improvement efforts. Two key resources were (a) a dedicated internal facilitator with project management, data collection, and presentation skills and (b) support for preparing customized data reports for identifying and addressing practice level quality issues. Overall, quality councils successfully cultivated interdisciplinary, multilevel primary care quality improvement leadership with accountability mechanisms and generated frontline innovations suitable for spread. Practice level performance data and quality improvement project management support

  5. An improved initialization center k-means clustering algorithm based on distance and density

    Science.gov (United States)

    Duan, Yanling; Liu, Qun; Xia, Shuyin

    2018-04-01

    Aiming at the problem of the random initial clustering center of k means algorithm that the clustering results are influenced by outlier data sample and are unstable in multiple clustering, a method of central point initialization method based on larger distance and higher density is proposed. The reciprocal of the weighted average of distance is used to represent the sample density, and the data sample with the larger distance and the higher density are selected as the initial clustering centers to optimize the clustering results. Then, a clustering evaluation method based on distance and density is designed to verify the feasibility of the algorithm and the practicality, the experimental results on UCI data sets show that the algorithm has a certain stability and practicality.

  6. Implementing the Customer Contact Center: An Opportunity to Create a Valid Measurement System for Assessing and Improving a Library's Telephone Services

    Science.gov (United States)

    Murphy, Sarah Anne; Cerqua, Judith

    2012-01-01

    A customer contact center offers academic libraries the ability to consistently improve their telephone, e-mail, and IM services. This paper discusses the establishment of a contact center and the benefits of implementing the contact center model at this institution. It then introduces a practical methodology for developing a valid measurement…

  7. Biomedical optics centers: forty years of multidisciplinary clinical translation for improving human health

    Science.gov (United States)

    Tromberg, Bruce J.; Anderson, R. Rox; Birngruber, Reginald; Brinkmann, Ralf; Berns, Michael W.; Parrish, John A.; Apiou-Sbirlea, Gabriela

    2016-12-01

    Despite widespread government and public interest, there are significant barriers to translating basic science discoveries into clinical practice. Biophotonics and biomedical optics technologies can be used to overcome many of these hurdles, due, in part, to offering new portable, bedside, and accessible devices. The current JBO special issue highlights promising activities and examples of translational biophotonics from leading laboratories around the world. We identify common essential features of successful clinical translation by examining the origins and activities of three major international academic affiliated centers with beginnings traceable to the mid-late 1970s: The Wellman Center for Photomedicine (Mass General Hospital, USA), the Beckman Laser Institute and Medical Clinic (University of California, Irvine, USA), and the Medical Laser Center Lübeck at the University of Lübeck, Germany. Major factors driving the success of these programs include visionary founders and leadership, multidisciplinary research and training activities in light-based therapies and diagnostics, diverse funding portfolios, and a thriving entrepreneurial culture that tolerates risk. We provide a brief review of how these three programs emerged and highlight critical phases and lessons learned. Based on these observations, we identify pathways for encouraging the growth and formation of similar programs in order to more rapidly and effectively expand the impact of biophotonics and biomedical optics on human health.

  8. Improving surface and defect center chemistry of fluorescent nanodiamonds for imaging purposes--a review.

    Science.gov (United States)

    Nagl, Andreas; Hemelaar, Simon Robert; Schirhagl, Romana

    2015-10-01

    Diamonds are widely used for jewelry owing to their superior optical properties accounting for their fascinating beauty. Beyond the sparkle, diamond is highly investigated in materials science for its remarkable properties. Recently, fluorescent defects in diamond, particularly the negatively charged nitrogen-vacancy (NV(-)) center, have gained much attention: The NV(-) center emits stable, nonbleaching fluorescence, and thus could be utilized in biolabeling, as a light source, or as a Förster resonance energy transfer donor. Even more remarkable are its spin properties: with the fluorescence intensity of the NV(-) center reacting to the presence of small magnetic fields, it can be utilized as a sensor for magnetic fields as small as the field of a single electron spin. However, a reproducible defect and surface and defect chemistry are crucial to all applications. In this article we review methods for using nanodiamonds for different imaging purposes. The article covers (1) dispersion of particles, (2) surface cleaning, (3) particle size selection and reduction, (4) defect properties, and (5) functionalization and attachment to nanostructures, e.g., scanning probe microscopy tips.

  9. Improving anti-bullying laws and policies to protect youth from weight-based victimization: parental support for action.

    Science.gov (United States)

    Puhl, R M; Suh, Y; Li, X

    2017-04-01

    Weight-based bullying is a prevalent problem among youth with overweight and obesity, but remains neglected in existing policy-level strategies to address youth bullying. Parental support is an influential catalyst motivating political will for policy decisions affecting youth, but has received limited research attention. To assess levels of, and predictors of, parental support for school-based policies and state/federal legal measures to address weight-based bullying in 2014 and 2015. Identical online questionnaires were completed by two independent national samples of parents in 2014 and 2015 (N = 1804). Parental support for all policy actions was high (at least 81%) and significantly increased from 2014 to 2015 for legal measures that would a) require state anti-bullying laws to add protections against weight-based bullying, and b) enact a federal anti-bullying law that includes weight-based bullying. These findings can inform policy discourse about remedies for youth bullying, and suggest that parental support for improved legal protections against weight-based bullying is present, consistent, and strong. © 2016 World Obesity Federation.

  10. Well-being, health, and productivity improvement after an employee well-being intervention in large retail distribution centers.

    Science.gov (United States)

    Rajaratnam, Augustine S; Sears, Lindsay E; Shi, Yuyan; Coberley, Carter R; Pope, James E

    2014-12-01

    To evaluate changes in well-being, biometric, and productivity indicators after a well-being intervention. Biometric and self-reported outcomes were assessed among 677 retail distribution center employees before and after a 6-month well-being intervention. Despite lower well-being at baseline compared to an independent random sample of workers, program participants' well-being, productivity, body mass index, systolic blood pressure, and total cholesterol improved significantly after the intervention, whereas the decline in diastolic blood pressure was not significant. Moreover, participants' specific transition across well-being segments over the intervention period demonstrated more improvement than decline. There is evidence that programs designed to improve well-being within a workforce can be used to significantly and positively impact employee health and productivity, which should result in reduced health care costs, improved employee productivity, and increased overall profitability.

  11. Improving Archives-Library Relations: User-Centered Solutions to a Sibling Rivalry.

    Science.gov (United States)

    Maher, William J.

    1990-01-01

    Examines the sources of tension between academic archives and academic libraries, prospects for improved relations based on common ground, and factors that might limit improved relations. Areas where cooperation might occur are discussed, including mutual fund raising efforts, documentation strategies, administrative information services, and…

  12. A Case Study on the Influence of Organizational Structures and Policies on Faculty Implementation of Learner-Centered Teaching

    Science.gov (United States)

    Piskadlo, Kevin Scott

    2016-01-01

    In their seminal 1995 article, Barr and Tagg encouraged higher education to think differently about undergraduate education and suggested that a new paradigm be adopted that focused less on what is taught and more on what is learned. Dubbed the learner-centered paradigm, this reframing of education challenges long standing practices and removes…

  13. Developing recommendations to improve the quality of diabetes care in Ireland: a policy analysis.

    Science.gov (United States)

    Mc Hugh, Sheena M; Perry, Ivan J; Bradley, Colin; Brugha, Ruairí

    2014-09-18

    In 2006, the Health Service Executive (HSE) in Ireland established an Expert Advisory Group (EAG) for Diabetes, to act as its main source of operational policy and strategic advice for this chronic condition. The process was heralded as the starting point for the development of formal chronic disease management programmes. Although recommendations were published in 2008, implementation did not proceed as expected. Our aim was to examine the development of recommendations by the EAG as an instrumental case study of the policy formulation process, in the context of a health system undergoing organisational and financial upheaval. This study uses Kingdon's Multiple Streams Theory to examine the evolution of the EAG recommendations. Semi-structured interviews were conducted with a purposive sample of 15 stakeholders from the advisory group. Interview data were supplemented with documentary analysis of published and unpublished documents. Thematic analysis was guided by the propositions of the Kingdon model. In the problem stream, the prioritisation of diabetes within the policy arena was a gradual process resulting from an accumulation of evidence, international comparison, and experience. The policy stream was bolstered by group consensus rather than complete agreement on the best way to manage the condition. The EAG assumed the politics stream was also on course to converge with the other streams, as the group was established by the HSE, which had the remit for policy implementation. However, the politics stream did not converge due to waning support from health service management and changes to the organisational structure and financial capacity of the health system. These changes trumped the EAG process and the policy window remained closed, stalling implementation. Our results reflect the dynamic nature of the policy process and the importance of timing. The results highlight the limits of rational policy making in the face of organisational and fiscal upheaval

  14. The Effect of Centering Pregnancy versus Traditional Prenatal Care Models on Improved Adolescent Health Behaviors in the Perinatal Period.

    Science.gov (United States)

    Trotman, Gylynthia; Chhatre, Gayatri; Darolia, Renuka; Tefera, Eshetu; Damle, Lauren; Gomez-Lobo, Veronica

    2015-10-01

    To determine if the CenteringPregnancy model of prenatal care improves maternal health behaviors in adolescent pregnancy. We conducted a retrospective chart review comparing 150 pregnant adolescents who received prenatal care between 2008 to 2012 with CenteringPregnancy to those receiving care in traditional prenatal care models with either multiprovider or single-provider visits. Outcome measures included weight gain during pregnancy, compliance to prenatal care appointments, infant feeding method, postpartum follow up and contraceptive use postpartum. A χ(2) analysis was used to compare outcomes between the 3 groups at a 2-tailed α of .05. Fifty individuals were evaluated in each group. Adolescents in the CenteringPregnancy group were more likely to comply with prenatal and postpartum visits and to meet the 2009 Institute of Medicine gestational weight guidelines for weight gain in pregnancy than were adolescents in either multiprovider (62.0% vs 38.0%, P = .02) or single-provider (62.0% vs 38.0%, P = .02) groups. The CenteringPregnancy group was also more likely to solely breastfeed compared with adolescents in the multiprovider group (40.0% vs 20.0%, P = .03) and include breastfeeding in addition to bottle-feeding compared with both multiprovider (32.0% vs 14.0%, P = .03) and single-provider (32.0% vs 12.0%, P = .03) patient groups. Additionally, the CenteringPregnancy group had increased uptake of long-acting reversible contraception and were less likely to suffer from postpartum depression. CenteringPregnancy Prenatal Care program aids in compliance to prenatal visits, appropriate weight gain, increased uptake of highly effective contraception, and breastfeeding among adolescent mothers. Copyright © 2015 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

  15. Priorities for improving the scientific foundation of conservation policy in North America.

    Science.gov (United States)

    Noss, Reed F; Fleishman, Erica; Dellasala, Dominick A; Fitzgerald, John M; Gross, Mart R; Main, Martin B; Nagle, Fiona; O'Malley, Stacey L; Rosales, Jon

    2009-08-01

    The Society for Conservation Biology (SCB) can enhance conservation of biodiversity in North America by increasing its engagement in public policy. Toward this end, the North America Section of SCB is establishing partnerships with other professional organizations in order to speak more powerfully to decision makers and taking other actions--such as increasing interaction with chapters--geared to engage members more substantively in science-policy issues. Additionally, the section is developing a North American Biodiversity Blueprint, which spans the continental United States and Canada and is informed by natural and social science. This blueprint is intended to clarify the policy challenges for protecting continental biodiversity, to foster bilateral collaboration to resolve common problems, and to suggest rational alternative policies and practices that are more likely than current practices to sustain North America's natural heritage. Conservation scientists and practitioners can play a key role by drawing policy makers' attention to ultimate, as well as proximate, causes of biodiversity decline and to the ecological and economic consequences of not addressing these threats.

  16. Gerald L. Epstein, PhD: director, center for science, technology, and security policy, American Association for the Advancement of Science (AAAS). Interview by Madeline Drexler.

    Science.gov (United States)

    Epstein, Gerald L

    2009-12-01

    Over his entire career, Gerald Epstein has toiled at the nexus of science, technology, and security. From 2003 to 2009, he was Senior Fellow for Science and Security at the Center for Strategic and International Studies Homeland Security Program, where he worked on reducing biological weapons threats, improving national preparedness, and easing potential tensions between the scientific research and national security communities. Epstein came to CSIS from the Institute for Defense Analyses. From 1996 to 2001, he served in the White House Office of Science and Technology Policy. And from 1983 to 1989, and again from 1991 until its demise in 1995, Epstein worked at the Congressional Office of Technology Assessment, where he directed a study on the proliferation of weapons of mass destruction, alongside research on other global security topics. A recognized expert in biological risk reduction, Epstein was actually trained as a physicist, having received SB degrees in physics and electrical engineering from MIT, and a PhD in physics from the University of California at Berkeley. How, then, did he come to study the evolving threat from bioterrorism? "What compelled me about bioterrorism was that it was a stellar example of a topic that would lead to a train wreck between the scientific community and the security community unless they figured out how to work together," he said. "The distance between a laboratory and a very large consequence event is a lot shorter in biology than in any other field. I got into bioterrorism to help make sure that the security community doesn't get so scared of the science that it shuts it down, and that the science community isn't so oblivious of security concerns that it pays no attention to them." Epstein spoke on November 6, 2009, with contributing writer Madeline Drexler, author of Emerging Epidemics: The Menace of New Infections (Penguin, 2009), an updated version of an earlier volume. Drexler holds a visiting appointment at the

  17. Using Surveys of Students' Social-Emotional Learning and School Climate for Accountability and Continuous Improvement. Policy Brief 17-1

    Science.gov (United States)

    Hough, Heather; Kalogrides, Demetra; Loeb, Susanna

    2017-01-01

    The research featured in this paper is part of the CORE-PACE Research Partnership, through which Policy Analysis for California Education (PACE) has partnered with the CORE districts to conduct research designed to support them in continuous improvement while simultaneously helping to improve policy and practice in California and nationwide.…

  18. Marine renewable energy policy in China and recommendations for improving implementation

    Science.gov (United States)

    Wang, Haifeng; Wang, Ji; Liu, Yuxin; Chen, Libo

    2018-02-01

    Renewable energy is the effective solution for the harmonious coexistence of human and environment as well as for the sustainable development. Marine renewable energy as one of the renewable energies, potentially offer fewer environmental risks and thus community acceptance than other renewable energy developments. Government support is the key and initial power for developing marine renewable energy. To promote the development and utilization of marine renewable energy, the Chinese government has established the special funding plan for marine renewable energy, and released “the 13th Five-years Plan (2016-2020) for marine renewable energy”. This paper describes the mechanisms established by the marine renewable Energy policy in China, and provides a comparative analysis of the Chinese marine renewable energy policy framework. We provides some policy recommendations for future development of marine renewable energy in China.

  19. Evaluating the Coding and Workload Accounting Improvement Initiative of Madigan Army Medical Center

    National Research Council Canada - National Science Library

    Bewley, Lee W; Bender, Brian J

    2007-01-01

    ... documentation, provider coding accuracy and education, and clinic electronic medical record (AHLTA) usage. The desired end state of the CWAI is improved medical documentation and coding accuracy at MAMC...

  20. Government/contractor partnerships for continuous improvement. A Goddard Space Flight Center example

    Science.gov (United States)

    Tagler, Richard C.

    1992-01-01

    The efforts of a government organization and its major contractors to foster a continuous improvement environment which transcends the traditional government/contractor relationship is discussed. This relationship is aimed at communication, partnership, and trust - creating benefits for all involved.

  1. Analysis of federal policy options for improving US lighting energy efficiency: Commercial and residential buildings

    Energy Technology Data Exchange (ETDEWEB)

    Atkinson, B.A.; McMahon, J.E.; Mills, E.; Chan, P.; Chan, T.W.; Eto, J.H.; Jennings, J.D.; Koomey, J.G.; Lo, K.W.; Lecar, M.; Price, L.; Rubinstein, F.; Sezgen, O.; Wenzel, T.

    1992-12-01

    The US Department of Energy (DOE) has recognized the opportunity to achieve energy, economic, and environmental benefits by promoting energy-efficient lighting through federal policies, including lighting standards, financial incentives, and information programs. To assist in this process, the Office of Conservation and Renewable Energy's Office of Codes and Standards invited Lawrence Berkeley Laboratory to assess prospective national impacts for a variety of policy options. Some progress has already been made in developing lighting policies at both the federal and state levels. The US DOE's Office of Building Technologies has evaluated lighting efficiency incentives as part of its analysis for the National Energy Strategy. Fluorescent and incandescent lamp standards are included in the national Energy Policy Act of 1992 (P.L. 102-486, October 24, 1992). A few states have analyzed or implemented lamp and luminaire standards. Many policy-related issues merit further investigation. For example, there is considerable debate over issues such as mandatory or voluntary standards versus component labeling and other education-oriented strategies. Several different technologies are involved that interact with each other-lamps (incandescent, compact fluorescent, and HID), ballasts (for fluorescent and HID lamps), and fixtures with reflectors and lenses. Control systems and operation patterns must also be considered (timers, automated dimming, or occupancy sensors). Lighting applications are diverse, ranging from offices, restaurants, hallways, hospital operating rooms, to exterior lights. Lighting energy use influences heating and cooling requirements in buildings. Successful lighting system design must also address interactions between architectural design elements and daylighting availability. Proper system installation and ongoing operation and maintenance are crucial. The economic aspects of the preceding points must also be considered for policy making.

  2. Analysis of federal policy options for improving US lighting energy efficiency: Commercial and residential buildings

    Energy Technology Data Exchange (ETDEWEB)

    Atkinson, B.A.; McMahon, J.E.; Mills, E.; Chan, P.; Chan, T.W.; Eto, J.H.; Jennings, J.D.; Koomey, J.G.; Lo, K.W.; Lecar, M.; Price, L.; Rubinstein, F.; Sezgen, O.; Wenzel, T.

    1992-12-01

    The US Department of Energy (DOE) has recognized the opportunity to achieve energy, economic, and environmental benefits by promoting energy-efficient lighting through federal policies, including lighting standards, financial incentives, and information programs. To assist in this process, the Office of Conservation and Renewable Energy`s Office of Codes and Standards invited Lawrence Berkeley Laboratory to assess prospective national impacts for a variety of policy options. Some progress has already been made in developing lighting policies at both the federal and state levels. The US DOE`s Office of Building Technologies has evaluated lighting efficiency incentives as part of its analysis for the National Energy Strategy. Fluorescent and incandescent lamp standards are included in the national Energy Policy Act of 1992 (P.L. 102-486, October 24, 1992). A few states have analyzed or implemented lamp and luminaire standards. Many policy-related issues merit further investigation. For example, there is considerable debate over issues such as mandatory or voluntary standards versus component labeling and other education-oriented strategies. Several different technologies are involved that interact with each other-lamps (incandescent, compact fluorescent, and HID), ballasts (for fluorescent and HID lamps), and fixtures with reflectors and lenses. Control systems and operation patterns must also be considered (timers, automated dimming, or occupancy sensors). Lighting applications are diverse, ranging from offices, restaurants, hallways, hospital operating rooms, to exterior lights. Lighting energy use influences heating and cooling requirements in buildings. Successful lighting system design must also address interactions between architectural design elements and daylighting availability. Proper system installation and ongoing operation and maintenance are crucial. The economic aspects of the preceding points must also be considered for policy making.

  3. An implementation evaluation of a policy aiming to improve financial access to maternal health care in Djibo district, Burkina Faso

    Directory of Open Access Journals (Sweden)

    Belaid Loubna

    2012-12-01

    Full Text Available Abstract Background To bring down its high maternal mortality ratio, Burkina Faso adopted a national health policy in 2007 that designed to boost the assisted delivery rate and improving quality of emergency obstetrical and neonatal care. The cost of transportation from health centres to district hospitals is paid by the policy. The worst-off are exempted from all fees. Methods The objectives of this paper are to analyze perceptions of this policy by health workers, assess how this health policy was implemented at the district level, identify difficulties faced during implementation, and highlight interactional factors that have an influence on the implementation process. A multiple site case study was conducted at 6 health centres in the district of Djibo in Burkina Faso. The following sources of data were used: 1 district documents (n = 23; 2 key interviews with district health managers (n = 10, health workers (n = 16, traditional birth attendants (n = 7, and community management committees (n = 11; 3 non-participant observations in health centres; 4 focus groups in communities (n = 62; 5 a feedback session on the findings with 20 health staff members. Results All the activities were implemented as planned except for completely subsidizing the worst-off, and some activities such as surveys for patients and the quality assurance service team aiming to improve quality of care. District health managers and health workers perceived difficulties in implementing this policy because of the lack of clarity on some topics in the guidelines. Entering the data into an electronic database and the long delay in reimbursing transportation costs were the principal challenges perceived by implementers. Interactional factors such as relations between providers and patients and between health workers and communities were raised. These factors have an influence on the implementation process. Strained relations between the groups involved

  4. An implementation evaluation of a policy aiming to improve financial access to maternal health care in Djibo district, Burkina Faso.

    Science.gov (United States)

    Belaid, Loubna; Ridde, Valéry

    2012-12-08

    To bring down its high maternal mortality ratio, Burkina Faso adopted a national health policy in 2007 that designed to boost the assisted delivery rate and improving quality of emergency obstetrical and neonatal care. The cost of transportation from health centres to district hospitals is paid by the policy. The worst-off are exempted from all fees. The objectives of this paper are to analyze perceptions of this policy by health workers, assess how this health policy was implemented at the district level, identify difficulties faced during implementation, and highlight interactional factors that have an influence on the implementation process. A multiple site case study was conducted at 6 health centres in the district of Djibo in Burkina Faso. The following sources of data were used: 1) district documents (n = 23); 2) key interviews with district health managers (n = 10), health workers (n = 16), traditional birth attendants (n = 7), and community management committees (n = 11); 3) non-participant observations in health centres; 4) focus groups in communities (n = 62); 5) a feedback session on the findings with 20 health staff members. All the activities were implemented as planned except for completely subsidizing the worst-off, and some activities such as surveys for patients and the quality assurance service team aiming to improve quality of care. District health managers and health workers perceived difficulties in implementing this policy because of the lack of clarity on some topics in the guidelines. Entering the data into an electronic database and the long delay in reimbursing transportation costs were the principal challenges perceived by implementers. Interactional factors such as relations between providers and patients and between health workers and communities were raised. These factors have an influence on the implementation process. Strained relations between the groups involved may reduce the effectiveness of the policy

  5. Japan's energy conservation policy

    International Nuclear Information System (INIS)

    Yoda, Kenichi

    1990-01-01

    This article reviews developments in Japanese energy conservation since the 1970s. The industrial sector has achieved the greatest success, due to industrial restructuring as well as improvements in energy efficiency. In the residential/commercial sector, the efficiency of appliances has been much improved. Although improvements have been made in the fuel efficiency of passenger cars, energy consumption in the transportation sector has risen slightly owing to increased transport of passengers and freight. The overall responsibility for energy conservation policy rests with the Ministry of International Trade and Industry. MITI is also responsible for implementing specific conservation policies in regard to the industrial and commercial sectors. In the residential sector, MITI works with the Ministry of Construction and in the transportation sector with the Ministry of Transport. To realize the goals of energy conservation policy through general research, dissemination of public information and other activities, MITI works with the Energy Conservation Center (ECC). (author). 2 figs, 3 tabs

  6. Extending the scope of interprofessional education: Integrating insights from policy, management and economics for improved health outcomes

    OpenAIRE

    Shafqat Shehzad, PhD Health Economics

    2016-01-01

    This study explores the potential of bringing innovations in public health education by drawing insights from the specialised disciplines of Economics, Policy and Management for their applications in the health sector. Working with subject experts from these disciplines can enhance the understanding of a working health care system and the necessary improvements for better health outcomes. Sole reliance on one field or skewed allocation of resources in certain areas may not result in achieving...

  7. Achieving Health Equity Through Community Engagement in Translating Evidence to Policy: The San Francisco Health Improvement Partnership, 2010?2016

    OpenAIRE

    Grumbach, Kevin; Vargas, Roberto A.; Fleisher, Paula; Arag?n, Tom?s J.; Chung, Lisa; Chawla, Colleen; Yant, Abbie; Garcia, Estela R.; Santiago, Amor; Lang, Perry L.; Jones, Paula; Liu, Wylie; Schmidt, Laura A.

    2017-01-01

    Background The San Francisco Health Improvement Partnership (SFHIP) promotes health equity by using a novel collective impact model that blends community engagement with evidence-to-policy translational science. The model involves diverse stakeholders, including ethnic-based community health equity coalitions, the local public health department, hospitals and health systems, a health sciences university, a school district, the faith community, and others sectors. Community Context We report o...

  8. Generalization of some ways of improvement of depreciation policy and restoration of depreciation of fixed assets of the enterprises

    Directory of Open Access Journals (Sweden)

    Sergeev Leonid Ivanovich

    2016-07-01

    Full Text Available Discusses approaches to consider different factors in constructing the amortization policy and recording of different forms of wear of fixed assets of enterprises. Analyzed proposals of domestic and foreign researchers on the improvement of recovery processes and the acquisition of fixed assets under different conditions of their exploitation. It is proposed on the basis of management accounting and financial performance to build rational depreciation system recovery value of fixed assets of enterprises.

  9. Developing recommendations to improve the quality of diabetes care in Ireland: a policy analysis.

    LENUS (Irish Health Repository)

    Mc Hugh, Sheena M

    2014-09-01

    In 2006, the Health Service Executive (HSE) in Ireland established an Expert Advisory Group (EAG) for Diabetes, to act as its main source of operational policy and strategic advice for this chronic condition. The process was heralded as the starting point for the development of formal chronic disease management programmes. Although recommendations were published in 2008, implementation did not proceed as expected. Our aim was to examine the development of recommendations by the EAG as an instrumental case study of the policy formulation process, in the context of a health system undergoing organisational and financial upheaval.

  10. Therapy with horse benefits to improve the austistic children socializacion in Sancti Spiritus equintherapy center

    Directory of Open Access Journals (Sweden)

    Raisa Yacel Jiménez García

    2014-12-01

    Full Text Available This research arises due to the necessity of facilitating the Physical Culture professionals a tool with the necessary elements for the educational attention to autistic scholars of "Efraín Alfonso Liriano" special school in Sancti Spíritus. The work was carried out by means of several methods of the theoretical, empiric and mathematical statistic levels; it was developed during the academic course 2011-2012; when it was preceded to the study of the work horses’ potentialities in order to develop social abilities in the autistic scholars of the mentioned school center, in the sessions of therapy with horses. The carried out diagnosis evidences the existence of countless potentialities that could favour the development of affective bonds, like empathy and communication among the scholars, as well as with the personnel of the equestrian center, all that in a enriching, stimulant, creative and playful environment in contact with the natural nature, what will stimulate the children capacities. It’s recommended continue the study of this therapy potentialities for this type of handicap, and the elaboration of alternatives or programs, like proposals of solution that facilitate the work in the several areas of these scholars development.

  11. Collaborating to improve the global competitiveness of US academic medical centers.

    Science.gov (United States)

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

    2012-01-01

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

  12. How Can Urban Policies Improve Air Quality and Help Mitigate Global Climate Change: a Systematic Mapping Review.

    Science.gov (United States)

    Slovic, Anne Dorothée; de Oliveira, Maria Aparecida; Biehl, João; Ribeiro, Helena

    2016-02-01

    Tackling climate change at the global level is central to a growing field of scientific research on topics such as environmental health, disease burden, and its resulting economic impacts. At the local level, cities constitute an important hub of atmospheric pollution due to the large amount of pollutants that they emit. As the world population shifts to urban centers, cities will increasingly concentrate more exposed populations. Yet, there is still significant progress to be made in understanding the contribution of urban pollutants other than CO2, such as vehicle emissions, to global climate change. It is therefore particularly important to study how local governments are managing urban air pollution. This paper presents an overview of local air pollution control policies and programs that aim to reduce air pollution levels in megacities. It also presents evidence measuring their efficacy. The paper argues that local air pollution policies are not only beneficial for cities but are also important for mitigating and adapting to global climate change. The results systematize several policy approaches used around the world and suggest the need for more in-depth cross-city studies with the potential to highlight best practices both locally and globally. Finally, it calls for the inclusion of a more human rights-based approach as a mean of guaranteeing of clean air for all and reducing factors that exacerbate climate change.

  13. 75 FR 57829 - Airport Improvement Program (AIP): Policy Regarding Access to Airports From Residential Property

    Science.gov (United States)

    2010-09-22

    ... for Correction On September 9, 2010, the Federal Aviation Administration published a Notice of... DEPARTMENT OF TRANSPORTATION Federal Aviation Administration [Docket No. FAA-2010-0831] Airport... Aviation Administration (FAA). ACTION: Notice of proposed policy; notice of proposed amendment to sponsor...

  14. Voluntary agreements with white certificates for energy efficiency improvement as a hybrid policy instrument

    NARCIS (Netherlands)

    Oikonomou, V.; Patel, M.K.; van der Gaast, W.; Rietbergen, M.G.

    2009-01-01

    In this paper we examine the implementation of a combined policy scheme that consists of a traditional instrument, the voluntary agreements (VAs), and an innovative one, the white certificates (WhC). The basic structure of this scheme is that energy suppliers who undertake an energy efficiency

  15. Voluntary agreements with white certificates for energy efficiency improvement as a hybrid policy instrument

    NARCIS (Netherlands)

    Oikonomou, V.; Patel, M. K.; van der Gaast, W.; Rietbergen, M.

    In this paper we examine the implementation of a combined policy scheme that consists of a traditional instrument, the voluntary agreements (VAs), and an innovative one, the white certificates (WhC). The basic structure of this scheme is that energy suppliers who undertake an energy efficiency

  16. Policy options to improve the U.S. standard of living

    OpenAIRE

    C. Alan Garner

    1988-01-01

    The U.S. standard of living has been slipping relative to living standards in other industrial nations. While there is no easy road to national wealth, reducing the federal budget deficit appears to be the most dependable policy to enhance the future U.S. living standard.

  17. Analyzing the cost effectiveness of Santiago, Chile's policy of using urban forests to improve air quality

    Science.gov (United States)

    Francisco J. Escobedo; John E. Wagner; David J. Nowak; Carmen Luz De la Maza; Manuel Rodriguez; Daniel E. Crane

    2008-01-01

    Santiago, Chile has the distinction of having among the worst urban air pollution problems in Latin America. As part of an atmospheric pollution reduction plan, the Santiago Regional Metropolitan government defined an environmental policy goal of using urban forests to remove particulate matter less than 10 µm (PM10) in the Gran...

  18. Improving the implementation of health workforce policies through governance : a review of case studies

    NARCIS (Netherlands)

    Dieleman, Marjolein; Shaw, Daniel Mp; Zwanikken, Prisca A C

    2011-01-01

    INTRODUCTION: Responsible governance is crucial to national development and a catalyst for achieving the Millennium Development Goals. To date, governance seems to have been a neglected issue in the field of human resources for health (HRH), which could be an important reason why HRH policy

  19. Improving the implementation of health workforce policies through governance: a review of case studies

    NARCIS (Netherlands)

    Dieleman, M.; Shaw, D.M.P.; Zwanikken, P.

    2011-01-01

    Introduction: Responsible governance is crucial to national development and a catalyst for achieving the Millennium Development Goals. To date, governance seems to have been a neglected issue in the field of human resources for health (HRH), which could be an important reason why HRH policy

  20. Beyond product innovation; improving innovation policy support for SMEs in traditional industries

    NARCIS (Netherlands)

    Wintjes, R.J.M.; Douglas, D.; Fairburn, J.; Hollanders, H.J.G.M.; Pugh, G.

    2014-01-01

    Innovation support measures in the EU are mostly designed to support product innovation in R&D intensive sectors. To increase the still considerable contribution to regional employment and competitiveness from SMEs in traditional manufacturing industries a broader innovation (policy) mix is more

  1. Review of policies adopted in 34 Countries to improve diet and physical activity

    Directory of Open Access Journals (Sweden)

    Anna Ceccarelli

    2011-06-01

    Full Text Available

    Background: Today, obesity can be considered in most OECD and EU countries as an unprecedented public health challenge which has been underestimated, poorly assessed and not fully accepted as a strategic governmental problem with substantial economic implications.
    The aim of this paper is to provide a review of the major policy statements on diet and physical activity adopted in 34 OECD and other EU countries until 2008, and to point out similarities and differences between country approaches and factors that may explain them.


    Methods: Information about policies and interventions was mainly retrieved from official sources such as the WHO Regional Office for Europe nutrition policy database, and websites of Health Ministries and national public health institutions.


    Results: The review pointed out that almost all WHO and OECD Member States have government-approved policies on nutrition and food safety. Although countries have large data and documents on overweight and obesity, they do not seem to rely on them to define clear strategies and plans for action which, as a result, are often vague and unspecific.

    Conclusions: In order to reverse the obesity trend down to decent levels and to reach the lower socio-economic groups, concerted, multisectorial, long-term actions are needed in combination with a much larger political determination.

  2. Combining apps targeting professionals and senior citizens to improve housing accessibility and influence housing provision policies

    DEFF Research Database (Denmark)

    Helle, Tina; Iwarsson, Susanne; Lunn, Tine Bieber

    2015-01-01

    Two separate apps that address the increasingly important issue of accessible housing for senior citizens have been developed in different project settings. One of the apps was developed to facilitate the process for professional raters to assess housing accessibility in the context of individual...... and influence housing provision policies....

  3. Linking Teacher Evaluation to Professional Development: Focusing on Improving Teaching and Learning. Research & Policy Brief

    Science.gov (United States)

    Goe, Laura; Biggers, Kietha; Croft, Andrew

    2012-01-01

    Recently, teacher evaluation has become a major focus in educational policy debates and research efforts. This increased attention to teacher evaluation has raised questions about the relationship between evaluation and student outcomes. Rivkin, Hanushek, and Kain (2005) and others have demonstrated with value-added research that there are…

  4. Improving Land Administration and Management for Sustainable Urban Development : Philippines Urbanization Review Policy Notes

    OpenAIRE

    World Bank

    2017-01-01

    This policy note assesses the performance of existing land administration and management (LAM) system in the Philippines in creating an environment for competitive cities. It looks at the influence of LAM (including property rights) in the proper functioning of land markets in urban areas; the effectiveness of land use planning and regulations in shaping urban growth, reducing informality,...

  5. European type NPP electric power and vent systems. For safety improvement and proposal of international center

    International Nuclear Information System (INIS)

    Sugiyama, Kenichiro

    2011-01-01

    For prevention of reactor accidents of nuclear power plants, multiplicity and redundancy of emergency power would be most important. At station blackout accident, European type manually operated vent operation could minimize release amount of radioactive materials and keep safety of neighboring residents. After Fukushima Daiichi accident, nuclear power plants could not restart operation even after completion of periodical inspection. This article introduced European type emergency power and vent systems in Swiss, Sweden and Germany with state of nuclear power phaseout for reference at considering to upgrade safety and accident mitigation measures for better understanding of the public. In addition, it would be important to recover trust of nuclear technology to continue to disseminate latest information on new knowledge of accident site and decontamination technologies to domestic and overseas people. As its implementation, establishment of Fukushima international center was proposed. (T. Tanaka)

  6. Adolescents with Cancer in Italy: Improving Access to National Cooperative Pediatric Oncology Group (AIEOP) Centers.

    Science.gov (United States)

    Ferrari, Andrea; Rondelli, Roberto; Pession, Andrea; Mascarin, Maurizio; Buzzoni, Carlotta; Mosso, Maria Luisa; Maule, Milena; Barisone, Elena; Bertolotti, Marina; Clerici, Carlo Alfredo; Jankovic, Momcilo; Fagioli, Franca; Biondi, Andrea

    2016-06-01

    This analysis compared the numbers of patients treated at Italian pediatric oncology group (Associazione Italiana Ematologia Oncologia Pediatrica [AIEOP]) centers with the numbers of cases predicted according to the population-based registry. It considered 32,431 patients registered in the AIEOP database (1989-2012). The ratio of observed (O) to expected (E) cases was 0.79 for children (0-14 years old) and 0.15 for adolescents (15-19 years old). The proportion of adolescents increased significantly over the years, however, from 0.05 in the earliest period to 0.10, 0.18, and then 0.28 in the latest period of observation, suggesting a greater efficacy of local/national programs dedicated to adolescents. © 2016 Wiley Periodicals, Inc.

  7. Nursing schools and academic health centers: toward improved alignment and a synergistic partnership.

    Science.gov (United States)

    Emami, Azita; Jaffe, Darcy; Minton-Foltz, Paula; Parker, Grace; Manfredi, Susan; Braungardt, Theresa; Marley, Kelly W; Cooley, Laura; Siem, Staishy Bostick

    2017-01-01

    This paper presents the findings from a national survey which the University of Washington conducted among leaders of 32 US academic nursing institutions that are part of academic health centers (AHCs) and complements these findings with results from a separate report by the American Association of Colleges of Nursing. While expressing overall satisfaction with their AHC relationships, these leaders find that nursing is often given greater parity in matters of education and research than in mission setting, financial, and governance matters. AHCs are being asked to meet new health care challenges in new ways, starting with the education of health care professionals. AHCs need to be restructured to give nursing full parity if the nation's and world's needs for preventive and clinical care are to be best met.

  8. Measuring and improving quality of care in an academic medical center.

    Science.gov (United States)

    Blayney, Douglas W

    2013-05-01

    The Donabedian definition of quality—structure, process, and outcome—provides a useful framework. A relentless focus on measuring process adherence and outcome is critical. Systemic improvements usually require teams to plan and to implement them. The lean or Toyota production system for process improvement is one useful method of organizing work, although different approaches are often necessary at the physician, practice unit, and statewide level. Challenges include scalability of the change (ie, rolling them out across the institution or system), tailoring the information technology tools, and building systems for sustainability.

  9. Creating 21st-Century Laboratories and Classrooms for Improving Population Health: A Call to Action for Academic Medical Centers.

    Science.gov (United States)

    DeVoe, Jennifer E; Likumahuwa-Ackman, Sonja; Shannon, Jackilen; Steiner Hayward, Elizabeth

    2017-04-01

    Academic medical centers (AMCs) in the United States built world-class infrastructure to successfully combat disease in the 20th century, which is inadequate for the complexity of sustaining and improving population health. AMCs must now build first-rate 21st-century infrastructure to connect combating disease and promoting health. This infrastructure must acknowledge the bio-psycho-social-environmental factors impacting health and will need to reach far beyond the AMC walls to foster community "laboratories" that support the "science of health," complementary to those supporting the "science of medicine"; cultivate community "classrooms" to stimulate learning and discovery in the places where people live, work, and play; and strengthen bridges between academic centers and these community laboratories and classrooms to facilitate bidirectional teaching, learning, innovation, and discovery.Private and public entities made deep financial investments that contributed to the AMC disease-centered approach to clinical care, education, and research in the 20th century. Many of these same funders now recognize the need to transform U.S. health care into a system that is accountable for population health and the need for a medical workforce equipped with the skills to measure and improve health. Innovative ideas about communities as centers of learning, the importance of social factors as major determinants of health, and the need for multidisciplinary perspectives to solve complex problems are not new; many are 20th-century ideas still waiting to be fully implemented. The window of opportunity is now. The authors articulate how AMCs must take bigger and bolder steps to become leaders in population health.

  10. Effectiveness of social work intervention with a systematic approach to improve general health in opioid addicts in addiction treatment centers

    Directory of Open Access Journals (Sweden)

    Raheb G

    2016-11-01

    Full Text Available Ghoncheh Raheb,1,2 Esmat Khaleghi,1 Amir Moghanibashi-Mansourieh,1 Ali Farhoudian,2 Robab Teymouri3 1Department of Social Work, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran; 2Substance Abuse and Dependence Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran; 3Pediatric Neurorehabilitation Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran Purpose: This study takes a systematic approach to investigate the effect of social work intervention aimed at increasing general health among opioid addicts in addiction treatment centers. Patients and methods: This is an experimental plan (pretest to posttest with a control group; the study sample included 60 patients with drug dependencies undergoing treatment in addiction treatment centers. These patients were randomly assigned as case (30 and control (30 groups. The case group was subjected to intervention over ten sessions, whereas the control group received no intervention. Both groups then passed through a posttest, while a follow-up was conducted after 4 months. Data were obtained via a General Health Questionnaire. Results: A covariance analysis test and independent and dependent t-test results indicated that a social work intervention adopting systematic approach was effective in increasing the general health of drug-addicted patients under treatment. Conclusion: Thus, the nature of the presence of social workers in addiction treatment centers has been effective and can have a significant influence by reducing anxiety and insomnia and somatic symptoms, improving patients’ self-understanding and self-recognition, and enhancing social functioning. Keywords: social work, intervention, systematic approach, general health, opioid addicts

  11. Customer care policy for utilities - demonstrated with the example of a call center; Customer Care fuer EVU - Wirkungszusammenhaenge am Beispiel des Telefon-Service

    Energy Technology Data Exchange (ETDEWEB)

    Weisse, D. [Consulting und Services, pdv Unternehmensberatung GmbH, Roesrath (Germany)

    2000-01-10

    Customer care policy, for preventing change to another provider and consolidating customer loyalty, is becoming a strategic (powerful) instrument for a utility in the competitive market. But what does this really imply for the day-to-day process of dealing with client-specific operations and workflows? The article describes the interactions between strategic marketing for ensuring client satisfaction and the resulting requirements to be met by a utility's call center, and also describes the key 'parameters' and requirements for successful day-to-day management of call centers. (orig./CB) [German] Customer Care zur Reduzierung der Wechselbereitschaft bzw. zur Erhoehung der Kundenbindung wird fuer EVU zu einem strategischen Instrument im Kampf um die Kunden. Aber was bedeutet dies fuer die operative Abwicklung der kundenbezogenen Geschaeftsprozesse? Der Verfasser erlaeutert die Zusammenhaenge zwischen dem strategischen Ziel der Kundenzufriedenheit und der operativen Umsetzung des Telefon-Service und beschreibt die 'Stellschrauben', die fuer diesen Zweck bei der Planung aber auch im taeglichen Management eines Call Centers zur Verfuegung stehen. (orig.)

  12. Is the Distance Worth It? Patients With Rectal Cancer Traveling to High-Volume Centers Experience Improved Outcomes.

    Science.gov (United States)

    Xu, Zhaomin; Becerra, Adan Z; Justiniano, Carla F; Boodry, Courtney I; Aquina, Christopher T; Swanger, Alex A; Temple, Larissa K; Fleming, Fergal J

    2017-12-01

    It is unclear whether traveling long distances to high-volume centers would compensate for travel burden among patients undergoing rectal cancer resection. The purpose of this study was to determine whether operative volume outweighs the advantages of being treated locally by comparing the outcomes of patients with rectal cancer treated at local, low-volume centers versus far, high-volume centers. This was a population-based study. The National Cancer Database was queried for patients with rectal cancer. Patients with stage II or III rectal cancer who underwent surgical resection between 2006 and 2012 were included. The outcomes of interest were margins, lymph node yield, receipt of neoadjuvant chemoradiation, adjuvant chemotherapy, readmission within 30 days, 30-day and 90-day mortality, and 5-year overall survival. A total of 18,605 patients met inclusion criteria; 2067 patients were in the long-distance/high-volume group and 1362 in the short-distance/low-volume group. The median travel distance was 62.6 miles for the long-distance/high-volume group and 2.3 miles for the short-distance/low-volume group. Patients who were younger, white, privately insured, and stage III were more likely to have traveled to a high-volume center. When controlled for patient factors, stage, and hospital factors, patients in the short-distance/low-volume group had lower odds of a lymph node yield ≥12 (OR = 0.51) and neoadjuvant chemoradiation (OR = 0.67) and higher 30-day (OR = 3.38) and 90-day mortality (OR = 2.07) compared with those in the long-distance/high-volume group. The short-distance/low-volume group had a 34% high risk of overall mortality at 5 years compared with the long-distance/high-volume group. We lacked data regarding patient and physician decision making and surgeon-specific factors. Our results indicate that when controlled for patient, tumor, and hospital factors, patients who traveled a long distance to a high-volume center had improved lymph node yield

  13. Hyper-Realistic, Team-Centered Fleet Surgical Team Training Provides Sustained Improvements in Performance.

    Science.gov (United States)

    Hoang, Tuan N; Kang, Jeff; Siriratsivawong, Kris; LaPorta, Anthony; Heck, Amber; Ferraro, Jessica; Robinson, Douglas; Walsh, Jonathan

    2016-01-01

    The high-stress, fast-paced environment of combat casualty care relies on effective teamwork and communication which translates into quality patient care. A training course was developed for U.S. Navy Fleet Surgical Teams to address these aspects of patient care by emphasizing efficiency and appropriate patient care. An effective training course provides knowledge and skills to pass the course evaluation and sustain the knowledge and skills acquired over time. The course included classroom didactic hours, and hands-on simulation sessions. A pretest was administered before the course, a posttest upon completion, and a sustainment test 5 months following course completion. The evaluation process measured changes in patient time to disposition and critical errors made during patient care. Naval Base San Diego, with resuscitation and surgical simulations carried out within the shipboard medical spaces. United States Navy medical personnel including physicians of various specialties, corpsmen, nurses, and nurse anesthetists deploying aboard ships. Time to disposition improved significantly, 11 ± 3 minutes, from pretest to posttest, and critical errors improved by 4 ± 1 errors per encounter. From posttest to sustainment test, time to disposition increased by 3 ± 1, and critical errors decreased by 1 ± 1. This course showed value in improving teamwork and communication skills of participants, immediately upon completion of the course, and after 5 months had passed. Therefore, with ongoing sustainment activities within 6 months, this course can substantially improve trauma care provided by shipboard deployed Navy medical personnel to wounded service members. Published by Elsevier Inc.

  14. A User-Centered Educational Modeling Language Improving the Controllability of Learning Design Quality

    Science.gov (United States)

    Zendi, Asma; Bouhadada, Tahar; Bousbia, Nabila

    2016-01-01

    Semiformal EMLs are developed to facilitate the adoption of educational modeling languages (EMLs) and to address practitioners' learning design concerns, such as reusability and readability. In this article, SDLD (Structure Dialogue Learning Design) is presented, which is a semiformal EML that aims to improve controllability of learning design…

  15. Wound Care Center of Excellence: A Process for Continuous Monitoring and Improvement of Wound Care Quality.

    Science.gov (United States)

    Howell, Raelina S; Kohan, Lauren S; Woods, Jon S; Criscitelli, Theresa; Gillette, Brian M; Donovan, Virginia; Gorenstein, Scott

    2018-05-01

    To provide information about a study using a new process for continuous monitoring to improve chronic wound care quality.This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care.After completing this continuing education activity, you should be better able to:1. Recognize problems associated with chronic wound care.2. Identify methods used in this project to improve care.3. Illustrate the findings from this and similar projects and implications for providing improved wound care.Patients with chronic wounds require complex care because of comorbidities that can affect healing. Therefore, the goal of this project was to develop a system of reviewing all hospitalized patients seen by the study authors' wound care service on a weekly basis to decrease readmissions, morbidity, and mortality. Weekly multidisciplinary conferences were conducted to evaluate patient data and systematically assess for adherence to wound care protocols, as well as to create and modify patient care plans. This review of pathology and the performance of root-cause analyses often led to improved patient care.

  16. Policy options to improve the effectiveness of the EU emissions trading system: A multi-criteria analysis

    International Nuclear Information System (INIS)

    Clò, Stefano; Battles, Susan; Zoppoli, Pietro

    2013-01-01

    This paper considers several policy options which have been proposed to improve the functioning of the ETS. These options require an intervention either on the ETS cap (−30% target, set-aside, carbon central bank, long-term target) or on the carbon price (European and national price floor). We analyse the impact of each policy on the ETS carbon price and emissions. A multi-criteria evaluation method is applied to compare the policy options against a plurality of environmental, economic and procedural criteria. We find that the final ranking depends on the goals to be achieved, i.e., the relative weights attributed to the criteria. When policymakers want mainly to support the carbon price both in the short and long-run, while improving ETS flexibility and harmonization, the CCB and the EU price floor are, respectively ranked as first and second-best options. As the preference for environmental and implementation goals gradually increases, the position of the EU price floor and CCB options tend to invert. The −30% target should be adopted when reducing emissions is the priority goal, while a national price floor is the worst option, in this case. Nevertheless, self-interested States looking for a relatively quick, feasible solution, may find it optimal. - Highlights: ► A multi-criteria analysis is adopted to compare policy options to improve the ETS effectiveness. ► An ETS cap reversible adjustment by a carbon central bank is the first-best option. ► The establishment of a EU-wide price floor would represent a second-best solution. ► A national price floor is the worst option but self-interest states may find it optimal. ► A post-2020 target is not a mutually exclusive option and should be set

  17. Impact of a Reference Center on Leprosy Control under a Decentralized Public Health Care Policy in Brazil.

    Science.gov (United States)

    Barbieri, Raquel Rodrigues; Sales, Anna Maria; Hacker, Mariana Andrea; Nery, José Augusto da Costa; Duppre, Nádia Cristina; Machado, Alice de Miranda; Moraes, Milton Ozório; Sarno, Euzenir Nunes

    2016-10-01

    We evaluated the profile of patients referred to the Fiocruz Outpatient Clinic, a reference center for the diagnosis and treatment of leprosy in Rio de Janeiro, RJ, and analyzed the origins and outcomes of these referrals. This is an observational retrospective study based on information collected from the Leprosy Laboratory database at Fiocruz, Rio de Janeiro, RJ, Brazil. A total of 1,845 suspected leprosy cases examined at the reference center between 2010 and 2014 were included. The originating health service referrals and diagnostic outcomes were analyzed as well as the clinical and epidemiological data of patients diagnosed with leprosy. Our data show that the profile of the patients treated at the Clinic has changed in recent years. There was an increase in both the proportion of patients with other skin diseases and those who had visited only one health service prior to our Clinic. Among the total 1,845 cases analyzed, the outcomes of 1,380 were linked to other diseases and, in 74% of these cases, a biopsy was not necessary to reach a diagnostic conclusion. A decrease in new leprosy case detection among our patients was also observed. Yet, among the leprosy patients, 40% had some degree of disability at diagnosis. The results of the present study demonstrated the importance of referral centers in support of basic health services within the decentralization strategy. But, the success of the program depends on the advent of new developmental tools to augment diagnostic accuracy for leprosy. However, it should be emphasized that for new diagnostic methods to be developed, a greater commitment on the part of the health care system regarding research is urgently needed.

  18. Quality of care indicators in inflammatory bowel disease in a tertiary referral center with open access and objective assessment policies.

    Science.gov (United States)

    Gonczi, Lorant; Kurti, Zsuzsanna; Golovics, Petra Anna; Lovasz, Barbara Dorottya; Menyhart, Orsolya; Seres, Anna; Sumegi, Liza Dalma; Gal, Alexander; Ilias, Akos; Janos, Papp; Gecse, Krisztina Barbara; Bessisow, Talat; Afif, Waqqas; Bitton, Alain; Vegh, Zsuzsanna; Lakatos, Peter Laszlo

    2018-01-01

    In the management of inflammatory bowel diseases, there is considerable variation in quality of care. The aim of this study was to evaluate structural, access/process components and outcome quality indicators in our tertiary referral IBD center. In the first phase, structural/process components were assessed, followed by the second phase of formal evaluation of access and management on a set of consecutive IBD patients with and without active disease (248CD/125UC patients, median age 35/39 years). Structural/process components of our IBD center met the international recommendations. At or around the time of diagnosis usual procedures were full colonoscopy in all patients, with ileocolonoscopy/gastroscopy/CT/MRI in 81.8/45.5/66.1/49.6% of CD patients. A total of 86.7% of CD patients had any follow-up imaging evaluation or endoscopy. The median waiting time for non-emergency endoscopy/CT/MRI was 16/14/22 days. During the observational period patients with flares (CD/UC:50.6/54.6%) were seen by specialist at the IBD clinic within a median of 1day with same day laboratory assessment, abdominal US, CT scan/surgical consult and change in therapy if needed. Surgery and hospitalization rates were 20.1/1.4% and 17.3/3.2% of CD/UC patients. Our results highlight that structural components and processes applied in our center are in line with international recommendations, including an open clinic concept and fast track access to specialist consultation, endoscopy and imaging. Copyright © 2017 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

  19. The National Hartford Center of Gerontological Nursing Excellence: An Evolution of a Nursing Initiative to Improve Care of Older Adults.

    Science.gov (United States)

    Harden, J Taylor; Watman, Rachael A

    2015-06-01

    The mission of the John A. Hartford Foundation is to improve the health of older Americans. This mission has been realized throughout the evolution of the National Hartford Center of Gerontological Nursing Excellence-an international collaboration between Schools of Nursing and Sigma Theta Tau International Honor Society of Nursing-whose goal is to support research, education, and practice to provide better nursing care for our aging society. The National Hartford Center is the focus of this supplement and an example of the Foundation's grant-making to prepare the nursing workforce to be competent to care for our aging society. This article traces the innovative origin and inception of the National Hartford Center, first as the Building Academic Geriatric Nursing Capacity (BAGNC) Initiative in 2000 under the leadership of two groundbreaking scholars in nursing and aging sciences: Claire M. Fagin, PhD, RN, and Patricia G. Archbold, DNSc. We continue through to today's leadership and culminate by describing the Center's influence on the gerontological nursing workforce and clinical practice; the paper also includes a brief introduction to the articles, highlighting advances in gerontological nursing science. With funding from the John A. Hartford Foundation, The Atlantic Philanthropies, The Mayday Fund, and a number of creative public and nonprofit partnerships, the National Hartford Center celebrates two decades and its greatest asset-the nearly 300 gerontological nursing leaders, including Archbold nursing pre-docs, Fagin nursing post-docs, and expert faculty, along with its Hartford Centers of Gerontological Nursing Excellence across the country. We trace the transition of BAGNC to the membership-based National Hartford Center and its move to The Gerontological Society of America to become a self-sustaining, autonomous unit. Current needs, challenges, lessons learned, and strategies of the National Hartford Center are examined within the context of sustainability

  20. A framework for improving access and customer service times in health care: application and analysis at the UCLA Medical Center.

    Science.gov (United States)

    Duda, Catherine; Rajaram, Kumar; Barz, Christiane; Rosenthal, J Thomas

    2013-01-01

    There has been an increasing emphasis on health care efficiency and costs and on improving quality in health care settings such as hospitals or clinics. However, there has not been sufficient work on methods of improving access and customer service times in health care settings. The study develops a framework for improving access and customer service time for health care settings. In the framework, the operational concept of the bottleneck is synthesized with queuing theory to improve access and reduce customer service times without reduction in clinical quality. The framework is applied at the Ronald Reagan UCLA Medical Center to determine the drivers for access and customer service times and then provides guidelines on how to improve these drivers. Validation using simulation techniques shows significant potential for reducing customer service times and increasing access at this institution. Finally, the study provides several practice implications that could be used to improve access and customer service times without reduction in clinical quality across a range of health care settings from large hospitals to small community clinics.

  1. SU-C-BRD-07: The Radiological Physics Center (RPC): 45 Years of Improving Radiotherapy Dosimetry

    Energy Technology Data Exchange (ETDEWEB)

    Followill, D; Lowenstein, J; Molineu, A; Alvarez, P; Summers, P; Kry, S [UT MD Anderson Cancer Center, Houston, TX (United States)

    2014-06-15

    Purpose: The RPC, established in 1968 has contributed to the development, conduct, and QA of NCI funded multi-institutional cooperative group clinical trials and institutions, primarily in the USA/Canada and 242 other countries, participating in trials. Methods: The RPC QA program components were designed to audit the radiation dose calculation chain from the NIST traceable reference beam calibration, to inclusion of dosimetry parameters used to calculate tumor doses, to the delivery of the radiation dose. The QA program included: 1) remote TLD/OSLD audit of machine output, 2) on-site dosimetry review visits, 3) credentialing for advanced technologies, and 4) review of patient treatment records. The RPC presented and published their findings to the radiation oncology community. Results: The number of institutions monitored by the RPC increased from around 1200 in the late 90s, to ∼2000 in 2013. There were over 4000 megavoltage therapy machines and ∼28,000 therapy beams in the 1991 institutions monitored by the RPC by the end of 2013. Within the 14,000 photon, electron and proton beam outputs remotely monitored with TLD/OSLD annually, between 10-20% of the institutions have one or more beams outside the RPC 5% criterion. Dosimetry site visits to photon and proton centers continue to result in 2-4 recommendations affecting key dosimetry parameters that impact patient treatment times. One in four patient treatment records reviewed by the RPC have their dose data corrected by >5% before trial groups use them for outcomes analysis. Twelve of fourteen clinically active proton centers are approved to participate in NCI funded clinical trials. The RPC published 222 peer reviewed articles since 1972. Conclusion: Findings from the RPC suggest that human errors continue to play a role in radiotherapy discrepancies and without the RPC independent QA program, the number of undetected errors and time elapsed before their discovery would have been greater. Work supported by

  2. Improved Short-Term Outcomes following Orthognathic Surgery Are Associated with High-Volume Centers.

    Science.gov (United States)

    Berlin, Nicholas L; Tuggle, Charles T; Steinbacher, Derek M

    2016-08-01

    Previous studies assessing outcomes following orthognathic surgery rely primarily on single-center/surgeon experience. In addition to issues of generalizability, these studies are limited in evaluating the effect of operative volume on patient outcomes. Orthognathic procedures were identified in the 1999 to 2011 Healthcare Cost and Utilization Project Nationwide Inpatient Sample. Outcomes included occurrence of any in-hospital complication, extended length of stay (>2 days), and increased costs (>$10,784). High-volume hospitals were defined as the 90th percentile of case volume or higher (>31 cases/year). Univariate and multivariate analyses were conducted to identify independent predictors of outcomes. Trend analyses were performed to assess changes in the annual rate of patients treated at high-volume hospitals over the study period. Among 101,692 orthognathic surgery patients, 19.6 percent underwent concurrent ancillary procedures (i.e., genioplasty, rhinoplasty, or septoplasty), and 37.6 percent underwent double-jaw surgery. Fifty-three percent were treated at high-volume hospitals. High-volume hospitals more often performed ancillary procedures (21.4 percent versus 17.4 percent; p surgery (41.3 percent versus 33.4 percent; p orthognathic cases nationwide are performed at a small number of high-volume hospitals. These hospitals discharge patients earlier, perform more complex procedures, and have fewer complications. Risk, III.

  3. Cumulative complexity: a functional, patient-centered model of patient complexity can improve research and practice.

    Science.gov (United States)

    Shippee, Nathan D; Shah, Nilay D; May, Carl R; Mair, Frances S; Montori, Victor M

    2012-10-01

    To design a functional, patient-centered model of patient complexity with practical applicability to analytic design and clinical practice. Existing literature on patient complexity has mainly identified its components descriptively and in isolation, lacking clarity as to their combined functions in disrupting care or to how complexity changes over time. The authors developed a cumulative complexity model, which integrates existing literature and emphasizes how clinical and social factors accumulate and interact to complicate patient care. A narrative literature review is used to explicate the model. The model emphasizes a core, patient-level mechanism whereby complicating factors impact care and outcomes: the balance between patient workload of demands and patient capacity to address demands. Workload encompasses the demands on the patient's time and energy, including demands of treatment, self-care, and life in general. Capacity concerns ability to handle work (e.g., functional morbidity, financial/social resources, literacy). Workload-capacity imbalances comprise the mechanism driving patient complexity. Treatment and illness burdens serve as feedback loops, linking negative outcomes to further imbalances, such that complexity may accumulate over time. With its components largely supported by existing literature, the model has implications for analytic design, clinical epidemiology, and clinical practice. Copyright © 2012 Elsevier Inc. All rights reserved.

  4. [Italian health centers and Web Marketing strategy: necessary improvements, even in nephrology].

    Science.gov (United States)

    Rinaldi Miliani, Maria; Barracca, Antonio; Quintaliani, Giuseppe

    2017-09-28

    The complete digitalization of the health system is an objective that Italy, from 2014, is pursuing with great difficulty, spurred by the many European initiatives dedicated to it. Despite the social and cultural background seems to be clearly ready for an application of the renewal strategies, e-Health and m-Health are struggling to get off the ground throughout the territory. The main difficulties are find at local level and don't spare any medical discipline, nephrology included. The characteristics of the official websites belonging to the local health centers demonstrate it. Today, these institutions are still sparsely present on Social Media or in the Italian Smart Mobile Technology landscape. The article illustrates the main features of the phenomenon and calls for reflection on the necessity to accelerate the digital innovation of the communication with patients. This is a possible strategy for reducing chronicity through prevention, and, potentially, for decreasing health costs. Copyright by Società Italiana di Nefrologia SIN, Rome, Italy.

  5. Is improved lane keeping during cognitive load caused by increased physical arousal or gaze concentration toward the road center?

    Science.gov (United States)

    Li, Penghui; Markkula, Gustav; Li, Yibing; Merat, Natasha

    2018-08-01

    Driver distraction is one of the main causes of motor-vehicle accidents. However, the impact on traffic safety of tasks that impose cognitive (non-visual) distraction remains debated. One particularly intriguing finding is that cognitive load seems to improve lane keeping performance, most often quantified as reduced standard deviation of lateral position (SDLP). The main competing hypotheses, supported by current empirical evidence, suggest that cognitive load improves lane keeping via either increased physical arousal, or higher gaze concentration toward the road center, but views are mixed regarding if, and how, these possible mediators influence lane keeping performance. Hence, a simulator study was conducted, with participants driving on a straight city road section whilst completing a cognitive task at different levels of difficulty. In line with previous studies, cognitive load led to increased physical arousal, higher gaze concentration toward the road center, and higher levels of micro-steering activity, accompanied by improved lane keeping performance. More importantly, during the high cognitive task, both physical arousal and gaze concentration changed earlier in time than micro-steering activity, which in turn changed earlier than lane keeping performance. In addition, our results did not show a significant correlation between gaze concentration and physical arousal on the level of individual task recordings. Based on these findings, various multilevel models for micro-steering activity and lane keeping performance were conducted and compared, and the results suggest that all of the mechanisms proposed by existing hypotheses could be simultaneously involved. In other words, it is suggested that cognitive load leads to: (i) an increase in arousal, causing increased micro-steering activity, which in turn improves lane keeping performance, and (ii) an increase in gaze concentration, causing lane keeping improvement through both (a) further increased micro

  6. Improvement of Inventory Control Using Continuous Review Policy in A Local Hospital at Bandung City, Indonesia

    Directory of Open Access Journals (Sweden)

    Fina Hafnika

    2016-12-01

    Full Text Available Abstract. This research was aimed to analyze the excess inventories issue in pharmacy and medical equipment unit at a local hospital in Bandung which affected the service level of the hospital. As one of the busy hospital in Java, proven by the higher amount of the patient/year than in other average Java typical hospital, the hospital needs to concern about the pharmaceutical and medical equipment inventories in order to fulfill patients’ needs and in the same time keeping the inventory level under control. Therefore, an inventory control evaluation was conducted to determine the appropriate number of inventories and time of order to avoid the excessive goods in central warehouse of the hospital. By using probabilistic inventory model and continuous review policy, the pharmaceutical inventory in the hospital was calculated to compare the ideal and actual amount of the average inventory level (AIL. ABC (Always, Better, Control classification also classified in this research to identify the proper item which potentially can be reduced from the inventory. From the analysis, we have discovered that the hospital potentially able to reduce almost Rp 830 million or 57% from the overstock inventory level by using continuous review policy as the basis of inventory control calculation system. Keywords: Continuous review policy, inventory control, EOQ, ROP, AIL

  7. Industrial policy, production efficiency improvement and the Chinese county economic growth

    Directory of Open Access Journals (Sweden)

    Wang Zhenhua

    2016-12-01

    Full Text Available This study aims at analyzing the difference in the level of economic development between China’s counties from the two perspectives of industrial policy and production efficiency. Based on panel data of 1830 Chinese counties, this study employs the new classical economic growth theory framework to analyze the counties’ economic growth by the perpetual inventory method, Malmquist index, among others. The results show that the economy of the counties exhibits δ convergence since 2004, and the absolute differences in the different counties are expanding. Industrial policy ensures the additional deepening of the level of capital in the county. Additionally, a substantial difference was observed between the agricultural sector and the non-agricultural sector, whereby the total factor productivity and the technical efficiency are on the rise, resulting in the phenomenon of dual paths of technological progress. In summary, the capital deepening difference between the sectors, production efficiency, and dual paths of technological progress owing to the counties’ industrial policy are the basic reasons for the regional differences in the level of economic development in China.

  8. Effectiveness of social work intervention with a systematic approach to improve general health in opioid addicts in addiction treatment centers.

    Science.gov (United States)

    Raheb, Ghoncheh; Khaleghi, Esmat; Moghanibashi-Mansourieh, Amir; Farhoudian, Ali; Teymouri, Robab

    2016-01-01

    This study takes a systematic approach to investigate the effect of social work intervention aimed at increasing general health among opioid addicts in addiction treatment centers. This is an experimental plan (pretest to posttest with a control group); the study sample included 60 patients with drug dependencies undergoing treatment in addiction treatment centers. These patients were randomly assigned as case (30) and control (30) groups. The case group was subjected to intervention over ten sessions, whereas the control group received no intervention. Both groups then passed through a posttest, while a follow-up was conducted after 4 months. Data were obtained via a General Health Questionnaire. A covariance analysis test and independent and dependent t -test results indicated that a social work intervention adopting systematic approach was effective in increasing the general health of drug-addicted patients under treatment. Thus, the nature of the presence of social workers in addiction treatment centers has been effective and can have a significant influence by reducing anxiety and insomnia and somatic symptoms, improving patients' self-understanding and self-recognition, and enhancing social functioning.

  9. Nitrous oxide emissions from agricultural landscapes: quantification tools, policy development, and opportunities for improved management

    Science.gov (United States)

    Tonitto, C.; Gurwick, N. P.

    2012-12-01

    Policy initiatives to reduce greenhouse gas emissions (GHG) have promoted the development of agricultural management protocols to increase SOC storage and reduce GHG emissions. We review approaches for quantifying N2O flux from agricultural landscapes. We summarize the temporal and spatial extent of observations across representative soil classes, climate zones, cropping systems, and management scenarios. We review applications of simulation and empirical modeling approaches and compare validation outcomes across modeling tools. Subsequently, we review current model application in agricultural management protocols. In particular, we compare approaches adapted for compliance with the California Global Warming Solutions Act, the Alberta Climate Change and Emissions Management Act, and by the American Carbon Registry. In the absence of regional data to drive model development, policies that require GHG quantification often use simple empirical models based on highly aggregated data of N2O flux as a function of applied N - Tier 1 models according to IPCC categorization. As participants in development of protocols that could be used in carbon offset markets, we observed that stakeholders outside of the biogeochemistry community favored outcomes from simulation modeling (Tier 3) rather than empirical modeling (Tier 2). In contrast, scientific advisors were more accepting of outcomes based on statistical approaches that rely on local observations, and their views sometimes swayed policy practitioners over the course of policy development. Both Tier 2 and Tier 3 approaches have been implemented in current policy development, and it is important that the strengths and limitations of both approaches, in the face of available data, be well-understood by those drafting and adopting policies and protocols. The reliability of all models is contingent on sufficient observations for model development and validation. Simulation models applied without site-calibration generally

  10. Improving patient safety in cardiothoracic surgery: an audit of surgical handover in a tertiary center.

    Science.gov (United States)

    Bauer, Natasha Johan

    2016-01-01

    Novel research has revealed that the relative risk of death increased by 10% and 15% for admissions on a Saturday and Sunday, respectively. With an imminent threat of 7-day services in the National Health Service, including weekend operating lists, handover plays a pivotal role in ensuring patient safety is paramount. This audit evaluated the quality, efficiency, and safety of surgical handover of pre- and postoperative cardiothoracic patients in a tertiary center against guidance on Safe Handover published by the Royal College of Surgeons of England and the British Medical Association. A 16-item questionnaire prospectively audited the nature, time and duration of handover, patient details, operative history and current clinical status, interruptions during handover, and difficulties cross-covering specialties over a month. Just over half (52%) of the time, no handover took place. The majority of handovers (64%) occurred over the phone; two-thirds of these were uninterrupted. All handovers were less than 10 minutes in duration. About half of the time, the senior house officer had previously met the registrar involved in the handover, but the overwhelming majority felt it would facilitate the handover process if they had prior contact. Patient details handed over 100% of the time included name, ward, and current clinical diagnosis. A third of the time, the patient's age, responsible consultant, and recent operations or procedures were not handed over, potentially compromising future management due to delays and lack of relevant information. Perhaps the most revealing result was that the overall safety of handover was perceived to be five out of ten, with ten being very safe with no aspects felt to impact negatively on optimal patient care. These findings were presented to the department, and a handover proforma was implemented. Recommendations included the need for a new face-to-face handover. A reaudit will evaluate the effects of these changes.

  11. Does Person-Centered Care Improve Residents' Satisfaction With Nursing Home Quality?

    Science.gov (United States)

    Poey, Judith L; Hermer, Linda; Cornelison, Laci; Kaup, Migette L; Drake, Patrick; Stone, Robyn I; Doll, Gayle

    2017-11-01

    Person-centered care (PCC) is meant to enhance nursing home residents' quality of life (QOL). Including residents' perspectives is critical to determining whether PCC is meeting residents' needs and desires. This study examines whether PCC practices promote satisfaction with QOL and quality of care and services (QOC and QOS) among nursing home residents. A longitudinal, retrospective cohort study using an in-person survey. Three hundred twenty nursing homes in Kansas enrolled or not enrolled in a pay-for-performance program, Promoting Excellent Alternatives in Kansas (PEAK 2.0), to promote PCC in nursing homes. A total of 6214 nursing home residents in 2013-2014 and 5538 residents in 2014-2015, with a Brief Interview for Mental Status score ≥8, participated in face-to-face interviews. Results were aggregated to the nursing home level. My InnerView developed a Resident Satisfaction Survey for Kansas composed of 32 questions divided into QOL, QOC, QOS, and global satisfaction subdomains. After controlling for facility characteristics, satisfaction with overall QOL and QOC was higher in homes that had fully implemented PCC. Although some individual measures in the QOS domain (eg, food) showed greater satisfaction at earlier levels of implementation, high satisfaction was observed primarily in homes that had fully implemented PCC. These findings provide evidence for the effectiveness of PCC implementation on nursing home resident satisfaction. The PEAK 2.0 program may provide replicable methods for nursing homes and states to implement PCC systematically. Copyright © 2017 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

  12. Bridging evidence, policy, and practice to strengthen health systems for improved maternal and newborn health in Pakistan.

    Science.gov (United States)

    Hirose, Atsumi; Hall, Sarah; Memon, Zahid; Hussein, Julia

    2015-11-25

    Policy and decision making should be based on evidence, but translating evidence into policy and practice is often sporadic and slow. It is recognised that the relationship between research and policy uptake is complex and that dissemination of research findings is necessary, but insufficient, for policy uptake. Political, social, and economic context, use of (credible) data and dialogues between and across networks of researchers and policymakers play important roles in evidence uptake. Advocacy is the process of mobilising political and public opinions to achieve specific aims and its role is crucial in mobilising key actors to push for policy uptake. Advocacy and research groups (i.e. those who would like to see research evidence used by policymakers) may use different approaches and tools to stimulate the diffusion of research findings. The use of mass- and social media, communication with study participants, and the involvement of stakeholders at the early stages of research development are examples of the approaches that can be employed to stimulate diffusion of evidence and increase evidence uptake. The Research and Advocacy Fund (RAF) for Maternal and Newborn Health (MNH) worked within the health system context in Pakistan with the aim of espousing the principles of evidence, advocacy, and dissemination to improve MNH outcomes. The articles included in this special issue are outputs of RAF and highlight where RAF's approaches contributed to MNH policy reforms. The papers discuss critical health system issues facing Pakistan, including service delivery components, demand creation, equitable access, transportation interventions for improved referrals, availability of medicines and equipment, and health workforce needs. In addition to these tangible elements, the health system 'software', i.e. the power and the political and social contexts, is also represented in the collection. These articles highlight three considerations for the future: the growing

  13. Strategies to improve the implementation of healthy eating, physical activity and obesity prevention policies, practices or programmes within childcare services.

    Science.gov (United States)

    Wolfenden, Luke; Jones, Jannah; Williams, Christopher M; Finch, Meghan; Wyse, Rebecca J; Kingsland, Melanie; Tzelepis, Flora; Wiggers, John; Williams, Amanda J; Seward, Kirsty; Small, Tameka; Welch, Vivian; Booth, Debbie; Yoong, Sze Lin

    2016-10-04

    Despite the existence of effective interventions and best-practice guideline recommendations for childcare services to implement policies, practices and programmes to promote child healthy eating, physical activity and prevent unhealthy weight gain, many services fail to do so. The primary aim of the review was to examine the effectiveness of strategies aimed at improving the implementation of policies, practices or programmes by childcare services that promote child healthy eating, physical activity and/or obesity prevention. The secondary aims of the review were to:1. describe the impact of such strategies on childcare service staff knowledge, skills or attitudes;2. describe the cost or cost-effectiveness of such strategies;3. describe any adverse effects of such strategies on childcare services, service staff or children;4. examine the effect of such strategies on child diet, physical activity or weight status. We searched the following electronic databases on 3 August 2015: the Cochrane Central Register of Controlled trials (CENTRAL), MEDLINE, MEDLINE In Process, EMBASE, PsycINFO, ERIC, CINAHL and SCOPUS. We also searched reference lists of included trials, handsearched two international implementation science journals and searched the World Health Organization International Clinical Trials Registry Platform (www.who.int/ictrp/) and ClinicalTrials.gov (www.clinicaltrials.gov). We included any study (randomised or non-randomised) with a parallel control group that compared any strategy to improve the implementation of a healthy eating, physical activity or obesity prevention policy, practice or programme by staff of centre-based childcare services to no intervention, 'usual' practice or an alternative strategy. The review authors independently screened abstracts and titles, extracted trial data and assessed risk of bias in pairs; we resolved discrepancies via consensus. Heterogeneity across studies precluded pooling of data and undertaking quantitative

  14. The second phase in creating the cardiac center for the next generation: beyond structure to process improvement.

    Science.gov (United States)

    Woods, J

    2001-01-01

    The third generation cardiac institute will build on the successes of the past in structuring the service line, re-organizing to assimilate specialist interests, and re-positioning to expand cardiac services into cardiovascular services. To meet the challenges of an increasingly competitive marketplace and complex delivery system, the focus for this new model will shift away from improved structures, and toward improved processes. This shift will require a sound methodology for statistically measuring and sustaining process changes related to the optimization of cardiovascular care. In recent years, GE Medical Systems has successfully applied Six Sigma methodologies to enable cardiac centers to control key clinical and market development processes through its DMADV, DMAIC and Change Acceleration processes. Data indicates Six Sigma is having a positive impact within organizations across the United States, and when appropriately implemented, this approach can serve as a solid foundation for building the next generation cardiac institute.

  15. Global policy and programme guidance on maternal nutrition: what exists, the mechanisms for providing it, and how to improve them?

    Science.gov (United States)

    Shrimpton, Roger

    2012-07-01

    Undernutrition in one form or another affects the majority of women of reproductive age in most developing countries. However, there are few or no effective programmes trying to solve maternal undernutrition problems. The purpose of the paper is to examine global policy and programme guidance mechanisms for nutrition, what their content is with regard to maternal nutrition in particular, as well as how these might be improved. Almost all countries have committed themselves politically to ensuring the right of pregnant and lactating women to good nutrition through the Convention on the Elimination of all Forms of Discrimination Against Women. Despite this, the World Health Organization (WHO) has not endorsed any policy commitments with regard to maternal nutrition. The only policy guidance coming from the various technical departments of WHO relates to the control of maternal anaemia. There is no policy or programme guidance concerning issues of maternal thinness, weight gain during pregnancy and/or low birthweight prevention. Few if any countries have maternal nutrition programmes beyond those for maternal anaemia, and most of those are not effective. The lack of importance given to maternal nutrition is related in part to a weakness of evidence, related to the difficulty of getting ethical clearance, as well as a generalised tendency to downplay the importance of those interventions found to be efficacious. No priority has been given to implementing existing policy and programme guidance for the control of maternal anaemia largely because of a lack of any dedicated funding, linked to a lack of Millennium Development Goals indicator status. This is partly due to the poor evidence base, as well as to the common belief that maternal anaemia programmes were not effective, even if efficacious. The process of providing evidence-based policy and programme guidance to member states is currently being revamped and strengthened by the Department of Nutrition for Health and

  16. Improving Immunization Rates Using Lean Six Sigma Processes: Alliance of Independent Academic Medical Centers National Initiative III Project.

    Science.gov (United States)

    Hina-Syeda, Hussaini; Kimbrough, Christina; Murdoch, William; Markova, Tsveti

    2013-01-01

    Quality improvement education and work in interdisciplinary teams is a healthcare priority. Healthcare systems are trying to meet core measures and provide excellent patient care, thus improving their Hospital Consumer Assessment of Healthcare Providers & Systems scores. Crittenton Hospital Medical Center in Rochester Hills, MI, aligned educational and clinical objectives, focusing on improving immunization rates against pneumonia and influenza prior to the rates being implemented as core measures. Improving immunization rates prevents infections, minimizes hospitalizations, and results in overall improved patient care. Teaching hospitals offer an effective way to work on clinical projects by bringing together the skill sets of residents, faculty, and hospital staff to achieve superior results. WE DESIGNED AND IMPLEMENTED A STRUCTURED CURRICULUM IN WHICH INTERDISCIPLINARY TEAMS ACQUIRED KNOWLEDGE ON QUALITY IMPROVEMENT AND TEAMWORK, WHILE FOCUSING ON A SPECIFIC CLINICAL PROJECT: improving global immunization rates. We used the Lean Six Sigma process tools to quantify the initial process capability to immunize against pneumococcus and influenza. The hospital's process to vaccinate against pneumonia overall was operating at a Z score of 3.13, and the influenza vaccination Z score was 2.53. However, the process to vaccinate high-risk patients against pneumonia operated at a Z score of 1.96. Improvement in immunization rates of high-risk patients became the focus of the project. After the implementation of solutions, the process to vaccinate high-risk patients against pneumonia operated at a Z score of 3.9 with a defects/million opportunities rate of 9,346 and a yield of 93.5%. Revisions to the adult assessment form fixed 80% of the problems identified. This process improvement project was not only beneficial in terms of improved quality of patient care but was also a positive learning experience for the interdisciplinary team, particularly for the residents. The

  17. Use of a data warehouse at an academic medical center for clinical pathology quality improvement, education, and research.

    Science.gov (United States)

    Krasowski, Matthew D; Schriever, Andy; Mathur, Gagan; Blau, John L; Stauffer, Stephanie L; Ford, Bradley A

    2015-01-01

    Pathology data contained within the electronic health record (EHR), and laboratory information system (LIS) of hospitals represents a potentially powerful resource to improve clinical care. However, existing reporting tools within commercial EHR and LIS software may not be able to efficiently and rapidly mine data for quality improvement and research applications. We present experience using a data warehouse produced collaboratively between an academic medical center and a private company. The data warehouse contains data from the EHR, LIS, admission/discharge/transfer system, and billing records and can be accessed using a self-service data access tool known as Starmaker. The Starmaker software allows users to use complex Boolean logic, include and exclude rules, unit conversion and reference scaling, and value aggregation using a straightforward visual interface. More complex queries can be achieved by users with experience with Structured Query Language. Queries can use biomedical ontologies such as Logical Observation Identifiers Names and Codes and Systematized Nomenclature of Medicine. We present examples of successful searches using Starmaker, falling mostly in the realm of microbiology and clinical chemistry/toxicology. The searches were ones that were either very difficult or basically infeasible using reporting tools within the EHR and LIS used in the medical center. One of the main strengths of Starmaker searches is rapid results, with typical searches covering 5 years taking only 1-2 min. A "Run Count" feature quickly outputs the number of cases meeting criteria, allowing for refinement of searches before downloading patient-identifiable data. The Starmaker tool is available to pathology residents and fellows, with some using this tool for quality improvement and scholarly projects. A data warehouse has significant potential for improving utilization of clinical pathology testing. Software that can access data warehouse using a straightforward visual

  18. Use of a data warehouse at an academic medical center for clinical pathology quality improvement, education, and research

    Directory of Open Access Journals (Sweden)

    Matthew D Krasowski

    2015-01-01

    Full Text Available Background: Pathology data contained within the electronic health record (EHR, and laboratory information system (LIS of hospitals represents a potentially powerful resource to improve clinical care. However, existing reporting tools within commercial EHR and LIS software may not be able to efficiently and rapidly mine data for quality improvement and research applications. Materials and Methods: We present experience using a data warehouse produced collaboratively between an academic medical center and a private company. The data warehouse contains data from the EHR, LIS, admission/discharge/transfer system, and billing records and can be accessed using a self-service data access tool known as Starmaker. The Starmaker software allows users to use complex Boolean logic, include and exclude rules, unit conversion and reference scaling, and value aggregation using a straightforward visual interface. More complex queries can be achieved by users with experience with Structured Query Language. Queries can use biomedical ontologies such as Logical Observation Identifiers Names and Codes and Systematized Nomenclature of Medicine. Result: We present examples of successful searches using Starmaker, falling mostly in the realm of microbiology and clinical chemistry/toxicology. The searches were ones that were either very difficult or basically infeasible using reporting tools within the EHR and LIS used in the medical center. One of the main strengths of Starmaker searches is rapid results, with typical searches covering 5 years taking only 1-2 min. A "Run Count" feature quickly outputs the number of cases meeting criteria, allowing for refinement of searches before downloading patient-identifiable data. The Starmaker tool is available to pathology residents and fellows, with some using this tool for quality improvement and scholarly projects. Conclusion: A data warehouse has significant potential for improving utilization of clinical pathology testing

  19. Centers for medicare and medicaid services: using an episode-based payment model to improve oncology care.

    Science.gov (United States)

    Kline, Ronald M; Bazell, Carol; Smith, Erin; Schumacher, Heidi; Rajkumar, Rahul; Conway, Patrick H

    2015-03-01

    Cancer is a medically complex and expensive disease with costs projected to rise further as new treatment options increase and the United States population ages. Studies showing significant regional variation in oncology quality and costs and model tests demonstrating cost savings without adverse outcomes suggest there are opportunities to create a system of oncology care in the US that delivers higher quality care at lower cost. The Centers for Medicare and Medicaid Services (CMS) have designed an episode-based payment model centered around 6 month periods of chemotherapy treatment. Monthly per-patient care management payments will be made to practices to support practice transformation, including additional patient services and specific infrastructure enhancements. Quarterly reporting of quality metrics will drive continuous quality improvement and the adoption of best practices among participants. Practices achieving cost savings will also be eligible for performance-based payments. Savings are expected through improved care coordination and appropriately aligned payment incentives, resulting in decreased avoidable emergency department visits and hospitalizations and more efficient and evidence-based use of imaging, laboratory tests, and therapeutic agents, as well as improved end of life care. New therapies and better supportive care have significantly improved cancer survival in recent decades. This has come at a high cost, with cancer therapy consuming $124 billion in 2010. CMS has designed an episode-based model of oncology care that incorporates elements from several successful model tests. By providing care management and performance based payments in conjunction with quality metrics and a rapid learning environment, it is hoped that this model will demonstrate how oncology care in the US can transform into a high value, high quality system. Copyright © 2015 by American Society of Clinical Oncology.

  20. Satisfaction with Dental Appearance and Attitude toward improving Dental Esthetics among Patients attending a Dental Teaching Center.

    Science.gov (United States)

    Maghaireh, Ghada A; Alzraikat, Hanan; Taha, Nessrin A

    2016-01-01

    The aim of this study was to evaluate the factors influencing the satisfaction of dental appearance and attitude toward treatments to improve dental esthetics among patients attending a dental teaching center. A questionnaire was used to collect data of four background variables among 450 patients attended a dental teaching center in the city of Irbid in Jordan. The questionnaire enclosed self-reported questions about the appearance of anterior teeth, received esthetic treatment and desired treatment for improving esthetics. Descriptive, multiple logistic regression and Chi-square tests were used for data analysis (p ≤ 0.05). The 450 participants consisted of (66.2%) male and (33.8%) female. Of these, 69.3% were satisfied with their dental appearance and 58.0% with the color of their teeth. Esthetic restorations were the most received treatment (39.8%) and whitening of teeth was the most desired treatment (55.3%). The patients' satisfaction with dental appearance was influenced by teeth color, crowding and receiving whitening (p < 0.05. r = 0.561, r(2) = 0.315). The most desired esthetic treatments influenced by the satisfaction with dental appearance were esthetic restorations and orthodontics (p < 0.05. r = 0.223, r(2) = 0.05). Significantly more female reported having esthetic restorations and orthodontics (p = 0.008, 0.000) and desired to have orthodontic, crowns or veneers and esthetic restorations (p = 0.000, 0.015, 0.028). Satisfaction with dental appearance was affected by teeth color, feeling teeth are crowded, desire for esthetic restorations and orthodontic treatment. A high percentage of patients were not satisfied with the color of their teeth. Recognizing the factors that affect patients' satisfaction with their present dental appearance and attitude toward treatments to improve dental esthetic can guide clinicians to strategies to improve esthetics.

  1. Improving Communication Skills: A Course for Academic Medical Center Surgery Residents and Faculty.

    Science.gov (United States)

    Raper, Steven E; Gupta, Meera; Okusanya, Olugbenga; Morris, Jon B

    2015-01-01

    To improve physician/patient communication and familiarize surgeons with contemporary skills for and metrics assessing communication, courses were developed to provide academic general surgery residents and faculty with a toolkit of information, behaviors, and specific techniques. If academic faculty are expected to mentor residents in communication and residents are expected to learn good communication skills, then both should have the necessary education to accomplish such a goal. Didactic lectures introduced current concepts of physician-patient communication including information on better patient care, fewer malpractice suits, and the move toward transparency of communication metrics. Next, course participants viewed and critiqued "Surgi-Drama" videos, with actors simulating "before" and "after" physician-patient communication scenarios. Finally, participants were provided with a "toolkit" of techniques for improving physician-patient communication including "2-3-4"-a semiscripted short communication tool residents and other physicians can use in patient encounters-and a number of other acronymic approaches. Each participant was asked to complete an anonymous evaluation to assess course content satisfaction. Overall, 86% of residents participated (68/79), with a 52% response rate (35/68) for the evaluation tool. Overall, 88% of faculty participated (84/96), with an 84% response rate (71/84). Residents voiced satisfaction with all domains. For faculty, satisfaction was quantitatively confirmed (Likert score 4 or 5) in 4 of 7 domains, with the highest satisfaction in "communication of goals" and "understanding of the HCAHPS metric." The percentage of "top box" Doctor Communication Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores and national percentile ranking showed a sustained increase more than 1 and 2 years from the dates of the courses. The assessment of communication skills is increasing in importance in the practice of

  2. Improving patient safety in cardiothoracic surgery: an audit of surgical handover in a tertiary center

    Directory of Open Access Journals (Sweden)

    Bauer NJ

    2016-05-01

    Full Text Available Natasha Johan Bauer Department of Cardiothoracic Surgery, Royal Brompton Hospital, London, UK Background: Novel research has revealed that the relative risk of death increased by 10% and 15% for admissions on a Saturday and Sunday, respectively. With an imminent threat of 7-day services in the National Health Service, including weekend operating lists, handover plays a pivotal role in ensuring patient safety is paramount. This audit evaluated the quality, efficiency, and safety of surgical handover of pre- and postoperative cardiothoracic patients in a tertiary center against guidance on Safe Handover published by the Royal College of Surgeons of ­England and the British Medical Association. Methods: A 16-item questionnaire prospectively audited the nature, time and duration of handover, patient details, operative history and current clinical status, interruptions during handover, and difficulties cross-covering specialties over a month. Results: Just over half (52% of the time, no handover took place. The majority of handovers (64% occurred over the phone; two-thirds of these were uninterrupted. All handovers were less than 10 minutes in duration. About half of the time, the senior house officer had previously met the registrar involved in the handover, but the overwhelming majority felt it would facilitate the handover process if they had prior contact. Patient details handed over 100% of the time included name, ward, and current clinical diagnosis. A third of the time, the patient’s age, responsible consultant, and recent operations or procedures were not handed over, potentially compromising future management due to delays and lack of relevant information. Perhaps the most revealing result was that the overall safety of handover was perceived to be five out of ten, with ten being very safe with no aspects felt to impact negatively on optimal patient care. Conclusion: These findings were presented to the department, and a handover proforma

  3. Management Matters. Selection Policies

    Science.gov (United States)

    Pappas, Marjorie L.

    2003-01-01

    One of the most important policy documents for a school library media center is the selection policy or the collection development policy. A well-developed selection policy provides a rationale for the selection decisions made by the school library media specialist. A selection policy represents the criteria against which a challenged book is…

  4. Improved method for eliminating center-of-mass coordinates from matrix elements in oscillator basis

    International Nuclear Information System (INIS)

    Richardson, R.H.; Shapiro, J.Y.

    1986-01-01

    This paper presents a concise, efficient method of reducing potential energy matrix elements to relative coordinates, when one is using an oscillator basis. It is especially suited to computer calculations. One nice feature of the method is its modular form, which allows a wide range of calculations. Separate FORTRAN subroutines have been written which calculate and store tables of the one-dimensional brackets of an equation that is presented and the single particle brackets from the isotropic to the axially symmetric oscillator equations. The tables are used by other subroutines which calculate the modified brackets and the brackets with spin. The methods developed here are a substantial improvement over what has been done heretofore, and open up new possibilities for performing nuclear structure calculations

  5. Support for Policies to Improve the Nutritional Impact of the Supplemental Nutrition Assistance Program in California

    Science.gov (United States)

    Ryan-Ibarra, Suzanne; Linares, Amanda; Induni, Marta; Sugerman, Sharon; Long, Michael W.; Rimm, Eric B.; Willett, Walter C.

    2015-01-01

    The Supplemental Nutrition Assistance Program (SNAP) provides a vital buffer against hunger and poverty for 47.6 million Americans. Using 2013 California Dietary Practices Survey data, we assessed support for policies to strengthen the nutritional influence of SNAP. Among SNAP participants, support ranged from 74% to 93% for providing monetary incentives for fruits and vegetables, restricting purchases of sugary beverages, and providing more total benefits. Nonparticipants expressed similar levels of support. These approaches may alleviate the burden of diet-related disease in low-income populations. PMID:26066922

  6. Policies for agricultural nitrogen management-trends, challenges and prospects for improved efficiency in Denmark

    DEFF Research Database (Denmark)

    Dalgaard, Tommy; Hansen, Birgitte; Hasler, Berit

    2014-01-01

    losses to the aquatic and atmospheric environment have been significantly reduced. This has been achieved through a combination of approaches and measures (ranging from command and control legislation, over market-based regulation and governmental expenditure to information and voluntary action......With more than 60% of the land farmed, with vulnerable freshwater and marine environments, and with one of the most intensive, export-oriented livestock sectors in the world, the nitrogen (N) pollution pressure from Danish agriculture is severe. Consequently, a series of policy action plans have...... approaches, measures and technologies to mitigate agricultural N losses and control N flows....

  7. Support for Policies to Improve the Nutritional Impact of the Supplemental Nutrition Assistance Program in California.

    Science.gov (United States)

    Leung, Cindy W; Ryan-Ibarra, Suzanne; Linares, Amanda; Induni, Marta; Sugerman, Sharon; Long, Michael W; Rimm, Eric B; Willett, Walter C

    2015-08-01

    The Supplemental Nutrition Assistance Program (SNAP) provides a vital buffer against hunger and poverty for 47.6 million Americans. Using 2013 California Dietary Practices Survey data, we assessed support for policies to strengthen the nutritional influence of SNAP. Among SNAP participants, support ranged from 74% to 93% for providing monetary incentives for fruits and vegetables, restricting purchases of sugary beverages, and providing more total benefits. Nonparticipants expressed similar levels of support. These approaches may alleviate the burden of diet-related disease in low-income populations.

  8. Why Do Electricity Policy and Competitive Markets Fail to Use Advanced PV Systems to Improve Distribution Power Quality?

    Directory of Open Access Journals (Sweden)

    Mark P. McHenry

    2016-01-01

    Full Text Available The increasing pressure for network operators to meet distribution network power quality standards with increasing peak loads, renewable energy targets, and advances in automated distributed power electronics and communications is forcing policy-makers to understand new means to distribute costs and benefits within electricity markets. Discussions surrounding how distributed generation (DG exhibits active voltage regulation and power factor/reactive power control and other power quality capabilities are complicated by uncertainties of baseline local distribution network power quality and to whom and how costs and benefits of improved electricity infrastructure will be allocated. DG providing ancillary services that dynamically respond to the network characteristics could lead to major network improvements. With proper market structures renewable energy systems could greatly improve power quality on distribution systems with nearly no additional cost to the grid operators. Renewable DG does have variability challenges, though this issue can be overcome with energy storage, forecasting, and advanced inverter functionality. This paper presents real data from a large-scale grid-connected PV array with large-scale storage and explores effective mitigation measures for PV system variability. We discuss useful inverter technical knowledge for policy-makers to mitigate ongoing inflation of electricity network tariff components by new DG interconnection requirements or electricity markets which value power quality and control.

  9. Planning for Integral Development. Public Policies, Economic Growth and Social Improvements in Santa Rosa (Ecuador

    Directory of Open Access Journals (Sweden)

    José Prada-Trigo

    2014-12-01

    Full Text Available Ecuador is immersed, since the adoption of the 2008 Constitution, in a process of economic, social and political changes, following the steps on their path to a more equal, post-extractive and democratic society. The main tool for this purpose, the National Strategy for the «Buen Vivir» (Good living and the Change in the Production Model emphasizes new ways for producing, consumption and self-organization. Although Ecuadorian Constitution comprises these ideas and the Ecuadorian Government has promoted different programs and strategies, there is a limited analysis about the local manifestations of these policies. In this way, this paper proposes a study of the local strategies developed in a medium-size city in the south of Ecuador through the analysis of the local networks and the initiatives of local actors for developing strategies oriented to this end. Interviews and statistical data (demographic, economic and social data mainly are used to confirm the level of accomplishment of these objectives. Thus, the existing local networks and the path of the city of Santa Rosa may explain the different level of recent socioeconomic changes taken place at local level instead of Central government policies.

  10. Becoming allies: Combining social science and technological perspectives to improve energy research and policy making

    Energy Technology Data Exchange (ETDEWEB)

    Diamond, Rick; Moezzi, Mithra

    2002-07-01

    Within the energy research community, social sciences tends to be viewed fairly narrowly, often as simply a marketing tool to change the behavior of consumers and decision makers, and to ''attack market barriers''. As we see it, social sciences, which draws on sociology, psychology, political science, business administration, and other academic disciplines, is capable of far more. A social science perspective can re-align questions in ways that can lead to the development of technologies and technology policy that are much stronger and potentially more successful than they would be otherwise. In most energy policies governing commercial buildings, the prevailing R and D directives are firmly rooted in a technology framework, one that is generally more quantitative and evaluative than that fostered by the social sciences. To illustrate how social science thinking would approach the goal of achieving high energy performance in the commercial building sector, they focus on the US Department of Energy's Roadmap for commercial buildings (DOE 2000) as a starting point. By ''deconstructing'' the four strategies provided by the Roadmap, they set the stage for proposing a closer partnership between advocates of technology-based and social science-based approaches.

  11. Recent Improvements to the Acoustical Testing Laboratory at the NASA Glenn Research Center

    Science.gov (United States)

    Podboy, Devin M.; Mirecki, Julius H.; Walker, Bruce E.; Sutliff, Daniel L.

    2014-01-01

    The Acoustical Testing Laboratory (ATL) consists of a 27 by 23 by 20 ft (height) convertible hemi/anechoic chamber and separate sound-attenuating test support enclosure. Absorptive fiberglass wedges in the test chamber provide an anechoic environment down to 100 Hz. A spring-isolated floor system affords vibration isolation above 3 Hz. These specifications, along with very low design background levels, enable the acquisition of accurate and repeatable acoustical measurements on test articles that produce very low sound pressures. Removable floor wedges allow the test chamber to operate in either a hemi-anechoic or anechoic configuration, depending on the size of the test article and the specific test being conducted. The test support enclosure functions as a control room during normal operations. Recently improvements were accomplished in support of continued usage of the ATL by NASA programs including an analysis of the ultra-sonic characteristics. A 3 dimensional traverse system inside the chamber was utilized for acquiring acoustic data for these tests. The traverse system drives a linear array of 13, 1/4"-microphones spaced 3" apart (36" span). An updated data acquisition system was also incorporated into the facility.

  12. IMPROVEMENT OF BODY SHOP MANAGING AS A PART OF VEHICLE IMPORTERS CENTER

    Directory of Open Access Journals (Sweden)

    Vasil Stamboliski

    2014-12-01

    Full Text Available The dynamic rhythm of living in today’s contemporary surroundings can not be considered without the use of personal and commercial vehicles, for transport of passengers and cargo. This means that every manufacturer in this segment, in their departments for development, find a way to increase their participation in the market. Since the race with time, for promoting new models on the market, not always is in positive relation with the profit which the manufacturer plans to achieve, issues the manufacturer’s focus in the after-sale activities. The body shop with its service, as part of the after-sale activities, brings the client satisfaction to a higher level and of course contributes to realization of higher profit of the company. The setting of the equipment and the staff management, the analysis of the number of entries and realized working hours in the body shop of an importer centre are the central topic/main subject for the author in this paper work. Finding the key factors, as well as the possibility for implementation of the key factors, would reflect increased number of entries, increased number of realized working hours and possibility for improving of the existing system of managing.

  13. The Carter Center Mental Health Program: addressing the public health crisis in the field of mental health through policy change and stigma reduction.

    Science.gov (United States)

    Palpant, Rebecca G; Steimnitz, Rachael; Bornemann, Thomas H; Hawkins, Katie

    2006-04-01

    Some of the most pervasive and debilitating illnesses are mental illnesses, according to World Health Organization's The World Health Report 2001--Mental Health: New Understanding, New Hope. Neuropsychiatric conditions account for four of the top five leading causes of years of life lived with disability in people aged 15 to 44 in the Western world. Many barriers prevent people with mental illnesses from seeking care, such as prohibitive costs, lack of insurance, and the stigma and discrimination associated with mental illnesses. The Carter Center Mental Health Program, established in 1991, focuses on mental health policy issues within the United States and internationally. This article examines the public health crisis in the field of mental health and focuses on The Carter Center Mental Health Program's initiatives, which work to increase public knowledge of and decrease the stigma associated with mental illnesses through their four strategic goals: reducing stigma and discrimination against people with mental illnesses; achieving equity of mental health care comparable with other health services; advancing early promotion, prevention, and early intervention services for children and their families; and increasing public awareness about mental illnesses and mental health issues.

  14. Current use of impact models for agri-environment schemes and potential for improvements of policy design and assessment.

    Science.gov (United States)

    Primdahl, Jørgen; Vesterager, Jens Peter; Finn, John A; Vlahos, George; Kristensen, Lone; Vejre, Henrik

    2010-06-01

    Agri-Environment Schemes (AES) to maintain or promote environmentally-friendly farming practices were implemented on about 25% of all agricultural land in the EU by 2002. This article analyses and discusses the actual and potential use of impact models in supporting the design, implementation and evaluation of AES. Impact models identify and establish the causal relationships between policy objectives and policy outcomes. We review and discuss the role of impact models at different stages in the AES policy process, and present results from a survey of impact models underlying 60 agri-environmental schemes in seven EU member states. We distinguished among three categories of impact models (quantitative, qualitative or common sense), depending on the degree of evidence in the formal scheme description, additional documents, or key person interviews. The categories of impact models used mainly depended on whether scheme objectives were related to natural resources, biodiversity or landscape. A higher proportion of schemes dealing with natural resources (primarily water) were based on quantitative impact models, compared to those concerned with biodiversity or landscape. Schemes explicitly targeted either on particular parts of individual farms or specific areas tended to be based more on quantitative impact models compared to whole-farm schemes and broad, horizontal schemes. We conclude that increased and better use of impact models has significant potential to improve efficiency and effectiveness of AES. (c) 2009 Elsevier Ltd. All rights reserved.

  15. [OCCUPATIONAL HEALTH RISK ASSESSMENT AND MANAGEMENT IN WORKERS IN IMPROVEMENT OF NATIONAL POLICY IN OCCUPATIONAL HYGIENE AND SAFETY].

    Science.gov (United States)

    Shur, P Z; Zaĭtseva, N V; Alekseev, V B; Shliapnikov, D M

    2015-01-01

    In accordance with the international documents in the field of occupational safety and hygiene, the assessment and minimization of occupational risks is a key instrument for the health maintenance of workers. One of the main ways to achieve it is the minimization of occupational risks. Correspondingly, the instrument for the implementation of this method is the methodology of analysis of occupational risks. In Russian Federation there were the preconditions for the formation of the system for the assessment and management of occupational risks. As the target of the national (state) policy in the field of occupational safety in accordance with ILO Conventions it can be offered the prevention of accidents and injuries to health arising from work or related with it, minimizing the causes of hazards inherent in the working environment, as far as it is reasonably and practically feasible. Global trend ofusing the methodology of the assessment and management of occupational risks to life and health of citizens requires the improvement of national policies in the field of occupational hygiene and safety. Achieving an acceptable level of occupational risk in the formation of national policy in the field of occupational hygiene and safety can be considered as one of the main tasks.

  16. Towards an effective partnership policy for improving urban low-income housing provision in Nigeria: New institutional economics perspective.

    Directory of Open Access Journals (Sweden)

    Job Taiwo Gbadegesin

    2017-07-01

    Full Text Available Recent critique against the past urban housing provision strategies in Nigeria was that the low-income groups are marginalised. It then led to the adoption of public private partnership (PPP initiative with a view to pursuing the broad goal of housing-for-all in Nigeria. Most recent studies have however criticised the effectiveness of the existing PPP practice in the housing provision structure without providing a pragmatic suggestion towards an effective framework for improvement. It thus raised the question; what are the main causes of ineffectiveness of existing PPP in housing provision and how can an effective PPP policy framework for urban low-income housing be achieved in Nigeria? This study utilised the concepts of new institutional economics (NIE - a theoretical and methodological underpinning for multi-actors’ policy matters. Using qualitative data from structured interview and credible literature sources, findings indicate that uncertainties in land accessibility, high transaction costs and the developers’ high profit agenda, are the major causes of PPP ineffectiveness for housing provision, which are also attributed to lack of a specific PPP policy that recognises all income groups and their roles on housing provision. End-users suggested that government could have a negotiation with land owners and building materials dealers to address the housing problem. In conclusion, it is established in this study that adoption of all-inclusive conceptual approach described within the context of NIE thought can facilitate an effective planning for urban low-income housing in Nigeria.

  17. Improving results of surgery for fecal peritonitis due to perforated colorectal disease: A single center experience.

    Science.gov (United States)

    Mineccia, Michela; Zimmitti, Giuseppe; Ribero, Dario; Giraldi, Francesco; Bertolino, Franco; Brambilla, Romeo; Ferrero, Alessandro

    2016-01-01

    fecal peritonitis due to colorectal perforation is a dramatic event characterized by high mortality. Our study aims at determining how results of sigmoid resection (eventually extended to upper rectum) for colorectal perforation with fecal peritonitis changed in recent years and which factors affected eventual changes. Seventy-four patients were operated on at our institution (2005-2014) for colorectal perforation with fecal peritonitis and were divided into two numerically equal groups (operated on before (ERA1-group) and after (ERA2-group) May 2010). Mannheim Peritonitis Index (MPI) was calculated for each patient. Characteristics of two groups were compared. Predictors of postoperative outcomes were identified. Postoperative overall complications, major complications, and mortality occurred in 59%, 28%, and 18% of cases, respectively, and were less frequent in ERA2-group (51%, 16%, and 8%, respectively), compared to ERA1-group (68%, 41%, and 27%, respectively; p = .155, .02, and .032, respectively). Such results paralleled lower MPI values in ERA2-group, compared to ERA1-group (23(16-39) vs. 28(21-43), p = .006). Using receiver operating characteristic analysis, the best cut-off value for MPI for predicting postoperative complications and mortality was 28.5. MPI>28 was the only independent predictor of postoperative overall (p = .009, OR = 4.491) and major complications (p peritonitis longer than 24 h (p = .045, OR = 17.099). results of surgery for colorectal perforation with fecal peritonitis have improved over time, matching a concurrent decrease of MPI values and a better preoperative patient management. MPI value may help in selecting patients benefitting from surgical treatment. Copyright © 2015 IJS Publishing Group Limited. Published by Elsevier Ltd. All rights reserved.

  18. Endovascular Stroke Therapy Results Improve over Time: The ‘Learning Curve' at a New Comprehensive Stoke Center

    Directory of Open Access Journals (Sweden)

    Ethan A. Benardete

    2015-01-01

    Full Text Available Background: The requirements for a comprehensive stroke center (CSC include the capability to perform endovascular stroke therapy (EST. EST is a complex process requiring early identification of appropriate patients and effective delivery of intervention. In order to provide prompt intervention for stroke, CSCs have been established away from large academic centers in community-based hospitals. We hypothesized that quantifiable improvements would occur during the first 2 years of a community-based CSC as the processes and personnel evolved. We report the results over time of EST at a new community-based CSC. Methods: We have retrospectively analyzed demographic data and outcome metrics of EST from the initiation phase of a new community-based CSC. Data was divided into year 1 and year 2. Statistical analysis (Student's t test and Fisher's exact test was performed to compare the patient population and outcomes across the two time periods. Outcome variables included the thrombolysis in cerebral infarction (TICI score, a change in the NIH stroke scale score and the modified Rankin Scale (mRS score. Analysis of variance (ANOVA was used to statistically analyze the relationship between population variables and outcome. Computed tomography (CT angiography and CT perfusion analysis were used to select patients for EST. Approximately half of the patients undergoing EST were excluded from receiving intravenous recombinant tissue plasminogen activator (IV rt-PA by standard criteria, while the other half showed no sign of improvement following 1 h of IV rt-PA treatment. Mechanical thrombolysis with a stentriever was performed in the majority of cases with or without intra-arterial medication. The majority of treated occlusions were in the middle cerebral artery. Results: A total of 18 patients underwent EST during year 1 and year 2. A statistically significant increase in good outcomes (mRS score ≤2 at discharge was seen from year 1 to year 2 (p = 0

  19. Federal Research: Opportunities Exist to Improve the Management and Oversight of Federally Funded Research and Development Centers

    National Research Council Canada - National Science Library

    Woods, William; Mittal, Anu; Neumann, John; Williams, Cheryl; Candon, Sharron; Sterling, Suzanne; Wade, Jacqueline; Zwanzig, Peter

    2008-01-01

    .... FFRDCs -- including laboratories, studies and analyses centers, and systems engineering centers -- conduct research in military space programs, nanotechnology, microelectronics, nuclear warfare...

  20. Novel, Family-Centered Intervention to Improve Nutrition in Patients Recovering From Critical Illness: A Feasibility Study.

    Science.gov (United States)

    Marshall, Andrea P; Lemieux, Margot; Dhaliwal, Rupinder; Seyler, Hilda; MacEachern, Kristen N; Heyland, Daren K

    2017-06-01

    Critically ill patients are at increased risk of developing malnutrition-related complications because of physiological changes, suboptimal delivery, and reduced intake. Strategies to improve nutrition during critical illness recovery are required to prevent iatrogenic underfeeding and risk of malnutrition. The purpose of this study was to assess the feasibility and acceptability of a novel family-centered intervention to improve nutrition in critically ill patients. A 3-phase, prospective cohort feasibility study was conducted in 4 intensive care units (ICUs) across 2 countries. Intervention feasibility was determined by patient eligibility, recruitment, and retention rates. The acceptability of the intervention was assessed by participant perspectives collected through surveys. Participants included family members of the critically ill patients and ICU and ward healthcare professionals (HCPs). A total of 75 patients and family members, as well as 56 HCPs, were enrolled. The consent rate was 66.4%, and 63 of 75 (84%) of family participants completed the study. Most family members (53/55; 98.1%) would recommend the nutrition education program to others and reported improved ability to ask questions about nutrition (16/20; 80.0%). Family members viewed nutrition care more positively in the ICU. HCPs agreed that families should partner with HCPs to achieve optimal nutrition in the ICU and the wards. Health literacy was identified as a potential barrier to family participation. The intervention was feasible and acceptable to families of critically ill patients and HCPs. Further research to evaluate intervention impact on nutrition intake and patient-centered outcomes is required.

  1. A Qualitative Study of the Treatment Improvement Protocols (TIPs): An Assessment of the Use of TIPs by Individuals Affiliated with the Addiction Technology Transfer Centers (ATTCs).

    Science.gov (United States)

    Hayashi, Susan W.; Suzuki, Marcia; Hubbard, Susan M.; Huang, Judy Y.; Cobb, Anita M.

    2003-01-01

    Evaluated the Addiction Technology Transfer Centers (ATTCs) of the Center for Substance Abuse Treatment (CSAT) as a means of diffusion of innovations, focusing on use of the Treatment Improvement Protocols (TIPs). Qualitative studies at 6 ATTCs that included 57 interviews show that the CSAT is at the forefront of providing resources to the…

  2. The improvement of CO2 emission reduction policies based on system dynamics method in traditional industrial region with large CO2 emission

    International Nuclear Information System (INIS)

    Li, Fujia; Dong, Suocheng; Li, Zehong; Li, Yu; Li, Shantong; Wan, Yongkun

    2012-01-01

    Some traditional industrial regions are characterized by high industrial proportion and large CO 2 emission. They are facing dual pressures of maintaining economic growth and largely reducing CO 2 emission. From the perspective of study of typological region, taking the typical traditional industrial region—Liaoning Province of China as a case, this study establishes a system dynamics model named EECP and dynamically simulates CO 2 emission trends under different conditions. Simulation results indicate, compared to the condition without CO 2 emission reduction policies, CO 2 emission intensity under the condition of implementing CO 2 emission reduction policies of “Twelfth Five-Year Plan” is decreased by 11% from 2009 to 2030, but the economic cost is high, making the policies implementation faces resistance. Then some improved policies are offered and proved by EECP model that they can reduce CO 2 emission intensity after 2021 and decrease the negative influence to GDP, realizing the improvement objects of reducing CO 2 emission and simultaneously keeping a higher economy growth speed. The improved policies can provide reference for making and improving CO 2 emission reduction policies in other traditional industrial regions with large CO 2 emission. Simultaneously, EECP model can provide decision-makers with reference and help for similar study of energy policy. - Highlights: ► We build EECP model for CO 2 emission reduction study in traditional industry region. ► By the model, we simulate CO 2 emission trend and improve emission reduction policy. ► By improvement, both CO 2 emission intensity and economic cost can be largely reduced. ► Besides CO 2 emission is reduced effectively, higher GDP increment speed is kept. ► EECP model can be widely used for making and improving regional energy policies.

  3. Improved tools and strategies for the prevention and control of arboviral diseases: A research-to-policy forum.

    Directory of Open Access Journals (Sweden)

    Piero Olliaro

    2018-02-01

    Full Text Available Research has been conducted on interventions to control dengue transmission and respond to outbreaks. A summary of the available evidence will help inform disease control policy decisions and research directions, both for dengue and, more broadly, for all Aedes-borne arboviral diseases.A research-to-policy forum was convened by TDR, the Special Programme for Research and Training in Tropical Diseases, with researchers and representatives from ministries of health, in order to review research findings and discuss their implications for policy and research.The participants reviewed findings of research supported by TDR and others. Surveillance and early outbreak warning. Systematic reviews and country studies identify the critical characteristics that an alert system should have to document trends reliably and trigger timely responses (i.e., early enough to prevent the epidemic spread of the virus to dengue outbreaks. A range of variables that, according to the literature, either indicate risk of forthcoming dengue transmission or predict dengue outbreaks were tested and some of them could be successfully applied in an Early Warning and Response System (EWARS. Entomological surveillance and vector management. A summary of the published literature shows that controlling Aedes vectors requires complex interventions and points to the need for more rigorous, standardised study designs, with disease reduction as the primary outcome to be measured. House screening and targeted vector interventions are promising vector management approaches. Sampling vector populations, both for surveillance purposes and evaluation of control activities, is usually conducted in an unsystematic way, limiting the potentials of entomological surveillance for outbreak prediction. Combining outbreak alert and improved approaches of vector management will help to overcome the present uncertainties about major risk groups or areas where outbreak response should be initiated and

  4. Achieving Health Equity Through Community Engagement in Translating Evidence to Policy: The San Francisco Health Improvement Partnership, 2010–2016

    Science.gov (United States)

    Vargas, Roberto A.; Fleisher, Paula; Aragón, Tomás J.; Chung, Lisa; Chawla, Colleen; Yant, Abbie; Garcia, Estela R.; Santiago, Amor; Lang, Perry L.; Jones, Paula; Liu, Wylie; Schmidt, Laura A.

    2017-01-01

    Background The San Francisco Health Improvement Partnership (SFHIP) promotes health equity by using a novel collective impact model that blends community engagement with evidence-to-policy translational science. The model involves diverse stakeholders, including ethnic-based community health equity coalitions, the local public health department, hospitals and health systems, a health sciences university, a school district, the faith community, and others sectors. Community Context We report on 3 SFHIP prevention initiatives: reducing consumption of sugar sweetened beverages (SSBs), regulating retail alcohol sales, and eliminating disparities in children’s oral health. Methods SFHIP is governed by a steering committee. Partnership working groups for each initiative collaborate to 1) develop and implement action plans emphasizing feasible, scalable, translational-science–informed interventions and 2) consider sustainability early in the planning process by including policy and structural interventions. Outcome Through SFHIP’s efforts, San Francisco enacted ordinances regulating sale and advertising of SSBs and a ballot measure establishing a soda tax. Most San Francisco hospitals implemented or committed to implementing healthy-beverage policies that prohibited serving or selling SSBs. SFHIP helped prevent Starbucks and Taco Bell from receiving alcohol licenses in San Francisco and helped prevent state authorization of sale of powdered alcohol. SFHIP increased the number of primary care clinics providing fluoride varnish at routine well-child visits from 3 to 14 and acquired a state waiver to allow dental clinics to be paid for dental services delivered in schools. Interpretation The SFHIP model of collective impact emphasizing community engagement and policy change accomplished many of its intermediate goals to create an environment promoting health and health equity. PMID:28333598

  5. Achieving Health Equity Through Community Engagement in Translating Evidence to Policy: The San Francisco Health Improvement Partnership, 2010-2016.

    Science.gov (United States)

    Grumbach, Kevin; Vargas, Roberto A; Fleisher, Paula; Aragón, Tomás J; Chung, Lisa; Chawla, Colleen; Yant, Abbie; Garcia, Estela R; Santiago, Amor; Lang, Perry L; Jones, Paula; Liu, Wylie; Schmidt, Laura A

    2017-03-23

    The San Francisco Health Improvement Partnership (SFHIP) promotes health equity by using a novel collective impact model that blends community engagement with evidence-to-policy translational science. The model involves diverse stakeholders, including ethnic-based community health equity coalitions, the local public health department, hospitals and health systems, a health sciences university, a school district, the faith community, and others sectors. We report on 3 SFHIP prevention initiatives: reducing consumption of sugar sweetened beverages (SSBs), regulating retail alcohol sales, and eliminating disparities in children's oral health. SFHIP is governed by a steering committee. Partnership working groups for each initiative collaborate to 1) develop and implement action plans emphasizing feasible, scalable, translational-science-informed interventions and 2) consider sustainability early in the planning process by including policy and structural interventions. Through SFHIP's efforts, San Francisco enacted ordinances regulating sale and advertising of SSBs and a ballot measure establishing a soda tax. Most San Francisco hospitals implemented or committed to implementing healthy-beverage policies that prohibited serving or selling SSBs. SFHIP helped prevent Starbucks and Taco Bell from receiving alcohol licenses in San Francisco and helped prevent state authorization of sale of powdered alcohol. SFHIP increased the number of primary care clinics providing fluoride varnish at routine well-child visits from 3 to 14 and acquired a state waiver to allow dental clinics to be paid for dental services delivered in schools. The SFHIP model of collective impact emphasizing community engagement and policy change accomplished many of its intermediate goals to create an environment promoting health and health equity.

  6. Workshop: Improving the Assessment and Valuation of Climate Change Impacts for Policy and Regulatory Analysis: Modeling Climate Change Impacts and Associated Economic Damages (2010 - part 1)

    Science.gov (United States)

    The purpose of this workshop Improving the Assessment and Valuation of Climate Change Impacts for Policy and Regulatory Analysis. focused on conceptual and methodological issues - integrated assessment modeling and valuation.

  7. Workshop: Improving the Assessment and Valuation of Climate Change Impacts for Policy and Regulatory Analysis: Modeling Climate Change Impacts and Associated Economic Damages (2011 - part 2)

    Science.gov (United States)

    The purpose of this workshop Improving the Assessment and Valuation of Climate Change Impacts for Policy and Regulatory Analysis. focused on conceptual and methodological issues - estimating impacts and valuing damages on a sectoral basis.

  8. Safety of a DVT chemoprophylaxis protocol following traumatic brain injury: a single center quality improvement initiative.

    Science.gov (United States)

    Nickele, Christopher M; Kamps, Timothy K; Medow, Joshua E

    2013-04-01

    Venous thromboembolism (VTE) is a complication that affects approximately 30 % of moderate and severe traumatic brain injury (TBI) patients when pharmacologic prophylaxis is not used. Following TBI, specifically in the case of contusions, the safety and efficacy of pharmacologic thromboembolism prophylaxis (PTP) has been studied only in small sample sizes. In this study, we attempt to assess the safety and efficacy of a PTP protocol for TBI patients, as a quality improvement (QI) initiative, in the neuroscience intensive care unit (NSICU). Between January 1st and December 31st, 2009, consecutive patients discharged from the University of Wisconsin NSICU after >a 48 h minimum stay were evaluated as part of a QI project. A protocol for the initiation of PTP was designed and implemented for NSICU patients. The protocol did not vary based on type of intracranial injury. The rate of VTE was reported as was heparin-induced thrombocytopenia and PTP-related expansion of intracranial hemorrhage (IH) requiring reoperation. The number of patients receiving PTP and the timing of therapy were tracked. Patients were excluded for persistent coagulopathy, other organ system bleeding (such as the gastrointestinal tract), or pregnancy. Faculty could opt out of the protocol without reason. Using the same criteria, patients discharged during the preceding 6 months, from July 1st to December 31st, 2008, were evaluated as controls as the PTP protocol was not in effect during this time. During the control period, there were 48 head trauma admissions who met the inclusion criteria. In 22 patients (45.8 %), PTP was initiated at an average of 4.9 ± 5.4 days after admission. During the protocol period, there were 87 head trauma admissions taken from 1,143 total NSICU stays who met criteria. In 63 patients (72.4 %), the care team in the NSICU successfully initiated PTP, at an average of 3.4 ± 2.8 days after admission. All 87 trauma patients were analyzed, and the rate of clinically

  9. Carbon Monoxide Information Center

    Medline Plus

    Full Text Available ... OnSafety Blog Safety Education Centers Neighborhood Safety Network Community Outreach Resource Center Toy Recall Statistics CO Poster ... Sitemap RSS E-mail Inside CPSC Accessibility Privacy Policy Budget, Performances & Finance Open Government Freedom of Information ( ...

  10. Incorporating Air Quality Improvement at a Local Level into Climate Policy in the Transport Sector: A Case Study in Bandung City, Indonesia

    Directory of Open Access Journals (Sweden)

    Helmi Gunawan

    2017-06-01

    Full Text Available Climate policy has a strong influence on policy processes at national levels in Indonesia, while other policies with a focus on air quality improvement are being implemented at local levels. Indonesia as a developing country has committed to reducing greenhouse gas (GHG emissions by 29 percent by the year 2030. This calls into question the extent to which cities and local governments can cope with the challenges of climate change mitigation. The purpose of the research is to find out the extent to which local air pollution reduction policies can contribute to the climate change mitigation program. The research design involved an empirical case study on governance and policy relevant to climate change efforts to lower GHG in Bandung City, Indonesia. The study evaluated the air quality improvement and the climate change mitigation programs using the actor-based framework of the Contextual Interaction Theory (CIT. The governance and stakeholder characteristic of climate change mitigation were also analysed using the structural context part of the CIT framework. The result shows that air quality improvement policy is implemented separately from climate policy; the latter operates at the national level and the former at the local level. By looking at the actor interaction analysis, the study concludes that a more holistic environmental policy approach would be more efficient at reducing local air pollution and contributing to the mitigation of climate change.

  11. Beyond coverage: improving the quality of antenatal care delivery through integrated mentorship and quality improvement at health centers in rural Rwanda.

    Science.gov (United States)

    Manzi, Anatole; Nyirazinyoye, Laetitia; Ntaganira, Joseph; Magge, Hema; Bigirimana, Evariste; Mukanzabikeshimana, Leoncie; Hirschhorn, Lisa R; Hedt-Gauthier, Bethany

    2018-02-23

    Inadequate antenatal care (ANC) can lead to missed diagnosis of danger signs or delayed referral to emergency obstetrical care, contributing to maternal mortality. In developing countries, ANC quality is often limited by skill and knowledge gaps of the health workforce. In 2011, the Mentorship, Enhanced Supervision for Healthcare and Quality Improvement (MESH-QI) program was implemented to strengthen providers' ANC performance at 21 rural health centers in Rwanda. We evaluated the effect of MESH-QI on the completeness of danger sign assessments. Completeness of danger sign assessments was measured by expert nurse mentors using standardized observation checklists. Checklists completed from October 2010 to May 2011 (n = 330) were used as baseline measurement and checklists completed between February and November 2012 (12-15 months after the start of MESH-QI implementation) were used for follow-up. We used a mixed-effects linear regression model to assess the effect of the MESH-QI intervention on the danger sign assessment score, controlling for potential confounders and the clustering of effect at the health center level. Complete assessment of all danger signs improved from 2.1% at baseline to 84.2% after MESH-QI (p ANC screening items. After controlling for potential confounders, the improvement in danger sign assessment score was significant. However, the effect of the MESH-QI was different by intervention district and type of observed ANC visit. In Southern Kayonza District, the increase in the danger sign assessment score was 6.28 (95% CI: 5.59, 6.98) for non-first ANC visits and 5.39 (95% CI: 4.62, 6.15) for first ANC visits. In Kirehe District, the increase in danger sign assessment score was 4.20 (95% CI: 3.59, 4.80) for non-first ANC visits and 3.30 (95% CI: 2.80, 3.81) for first ANC visits. Assessment of critical danger signs improved under MESH-QI, even when controlling for nurse-mentees' education level and previous training in focused ANC. MESH

  12. [A proposal to improve nursing fee differentiation policy for general hospitals using profitability-analysis in the national health insurance].

    Science.gov (United States)

    Kim, Sungjae; Kim, Jinhyun

    2012-06-01

    The purpose of this study was to propose optimal hospitalization fees for nurse staffing levels and to improve the current nursing fee policy. A break-even analysis was used to evaluate the impact of a nursing fee policy on hospital's financial performance. Variables considered included the number of beds, bed occupancy rate, annual total patient days, hospitalization fees for nurse staffing levels, the initial annual nurses' salary, and the ratio of overhead costs to nursing labor costs. Data were collected as secondary data from annual reports of the Hospital Nursing Association and national health insurance. The hospitalization fees according to nurse staffing levels in general hospitals are required to sustain or decrease in grades 1, 2, 3, 4, and 7, and increase in grades 5 and 6. It is suggested that the range between grade 2 and 3 be sustained at the current level, the range between grade 4 and 5 be widen or merged into one, and the range between grade 6 and 7 be divided into several grades. Readjusting hospitalization fees for nurse staffing level will improve nurse-patient ratio and enhance the quality of nursing care in hospitals. Follow-up studies including tertiary hospitals and small hospitals are recommended.

  13. Quality assured health care in certified breast centers and improvement of the prognosis of breast cancer patients.

    Science.gov (United States)

    Beckmann, Matthias W; Brucker, Cosima; Hanf, Volker; Rauh, Claudia; Bani, Mayada R; Knob, Stefanie; Petsch, Sabrina; Schick, Stefan; Fasching, Peter A; Hartmann, Arndt; Lux, Michael P; Häberle, Lothar

    2011-01-01

    Increasing effort has been put in the implementation and certification of breast centers in order to establish standardized, quality assured health care for breast cancer patients. The aim of this analysis was to investigate whether patients treated in certified breast centers (CBC) have a favorable prognosis as compared to patients treated outside of certified breast treatment units. The data of 3,940 patients with invasive nonmetastatic breast cancer were analyzed with regard to differences in patient and tumor characteristics and crude overall survival according to diagnosis in or outside CBC in Middle Franconia, Germany. Patient, tumor, and follow-up data were obtained from the clinical cancer registry. Patients in CBC were younger, and had lower disease stages and lower grading. Independent of the effects of these variables on overall survival, being treated at a CBC added to the prediction of overall survival. Patients treated at a CBC had a hazard ratio of 0.70 (95% confidence interval 0.52-0.93) in the adjusted Cox model. Independent from common prognostic factors, diagnosis and treatment of breast cancer at a CBC improves the prognosis of patients. It can be hypothesized that this effect is mediated through quality assured health care provided by the certification process. Copyright © 2011 S. Karger AG, Basel.

  14. Electronic health records and technical assistance to improve quality of primary care: Lessons for regional extension centers.

    Science.gov (United States)

    Boas, Samuel J; Bishop, Tara F; Ryan, Andrew M; Shih, Sarah C; Casalino, Lawrence P

    2014-07-01

    In 2009, the American Recovery and Reinvestment Act apportioned $643 million for a Health Information Technology Extension Program, which established Regional Extension Centers (RECs) to support the implementation and use of electronic health records (EHRs). Little is known, however, about how RECs should assist in EHR implementation and how they should structure ongoing support. The purpose of this paper is to describe physicians' experiences with the Primary Care Information Project (PCIP), an REC run by the New York City Department of Health and Mental Hygiene. We interviewed 17 physicians enrolled in PCIP to understand the role of the EHRon quality of care and their experience with technical assistance from PCIP. All physicians stated that they felt that the EHR improved the quality of care they delivered to their patients particularly because it helped them track patients. All the physicians found technical assistance helpful but most wanted ongoing assistance months or years after they adopted the EHR. © 2013 Published by Elsevier Inc.

  15. 78 FR 73144 - Acceleration of Broadband Deployment by Improving Wireless Facilities Siting Policies

    Science.gov (United States)

    2013-12-05

    ... license is required, which in turn extends to any apparatus for the transmission of energy, or... No. 11-59; FCC 13-122] Acceleration of Broadband Deployment by Improving Wireless Facilities Siting... of new wireless facilities and on rules to implement statutory provisions governing State and local...

  16. Quality Improvement in Home-Based Child Care Settings: Research Resources to Inform Policy

    Science.gov (United States)

    Lawrence, Sharmila; Stephens, Samuel A.

    2016-01-01

    This "Topic of Interest" provides a comprehensive list of research in the Research Connections collection that was published in 2005 or later addressing issues related to quality improvement specifically in home-based child care. The resources are grouped under the following headings: Overviews, Summaries, and Reviews of Quality…

  17. Improving antimicrobial prescribing: implementation of an antimicrobial i.v.-to-oral switch policy.

    Science.gov (United States)

    McCallum, A D; Sutherland, R K; Mackintosh, C L

    2013-01-01

    Antimicrobial stewardship programmes reduce the risk of hospital associated infections (HAI) and antimicrobial resistance, and include early intravenous-to-oral switch (IVOS) as a key stewardship measure. We audited the number of patients on intravenous antimicrobials suitable for oral switch, assessed whether prescribing guidelines were followed and reviewed prescribing documentation in three clinical areas in the Western General Hospital, Edinburgh, in late 2012. Following this, the first cycle results and local guidelines were presented at a local level and at the hospital grand rounds, posters with recommendations were distributed, joint infection consult and antimicrobial rounds commenced and an alert antimicrobial policy was introduced before re-auditing in early 2013. We demonstrate suboptimal prescribing of intravenous antimicrobials, with 43.9% (43/98) of patients eligible for IVOS at the time of auditing. Only 56.1% (55/98) followed empiric prescribing recommendations. Documentation of antimicrobial prescribing was poor with stop dates recorded in 14.3%, indication on prescription charts in 18.4% and in the notes in 90.8%. The commonest reason for deferring IVOS was deteriorating clinical condition or severe sepsis. Further work to encourage prudent antimicrobial prescribing and earlier consideration of IVOS is required.

  18. Use of CAHPS® patient experience survey data as part of a patient-centered medical home quality improvement initiative

    Directory of Open Access Journals (Sweden)

    Quigley DD

    2015-07-01

    Full Text Available Denise D Quigley,1 Peter J Mendel,1 Zachary S Predmore,2 Alex Y Chen,3 Ron D Hays41RAND Corporation, Santa Monica, CA, 2RAND Corporation, Boston, MA, 3AltaMed Health Services Corporation, 4Division of General Internal Medicine and Health Services Research, UCLA, Los Angeles, CA, USAObjective: To describe how practice leaders used Consumer Assessment of Healthcare Providers and Systems (CAHPS® Clinician and Group (CG-CAHPS data in transitioning toward a patient-centered medical home (PCMH.Study design: Interviews conducted at 14 primary care practices within a large urban Federally Qualified Health Center in California.Participants: Thirty-eight interviews were conducted with lead physicians (n=13, site clinic administrators (n=13, nurse supervisors (n=10, and executive leadership (n=2.Results: Seven themes were identified on how practice leaders used CG-CAHPS data for PCMH transformation. CAHPS® was used: 1 for quality improvement (QI and focusing changes for PCMH transformation; 2 to maintain focus on patient experience; 3 alongside other data; 4 for monitoring site-level trends and changes; 5 to identify, analyze, and monitor areas for improvement; 6 for provider-level performance monitoring and individual coaching within a transparent environment of accountability; and 7 for PCMH transformation, but changes to instrument length, reading level, and the wording of specific items were suggested.Conclusion: Practice leaders used CG-CAHPS data to implement QI, develop a shared vision, and coach providers and staff on performance. They described how CAHPS® helped to improve the patient experience in the PCMH model, including access to routine and urgent care, wait times, provider spending enough time and listening carefully, and courteousness of staff. Regular reporting, reviewing, and discussing of patient-experience data alongside other clinical quality and productivity measures at multilevels of the organization was critical in maximizing the

  19. Harnessing genomics to improve health in the Eastern Mediterranean Region – an executive course in genomics policy

    Directory of Open Access Journals (Sweden)

    Singer Peter A

    2005-01-01

    Full Text Available Abstract Background While innovations in medicine, science and technology have resulted in improved health and quality of life for many people, the benefits of modern medicine continue to elude millions of people in many parts of the world. To assess the potential of genomics to address health needs in EMR, the World Health Organization's Eastern Mediterranean Regional Office and the University of Toronto Joint Centre for Bioethics jointly organized a Genomics and Public Health Policy Executive Course, held September 20th–23rd, 2003, in Muscat, Oman. The 4-day course was sponsored by WHO-EMRO with additional support from the Canadian Program in Genomics and Global Health. The overall objective of the course was to collectively explore how to best harness genomics to improve health in the region. This article presents the course findings and recommendations for genomics policy in EMR. Methods The course brought together senior representatives from academia, biotechnology companies, regulatory bodies, media, voluntary, and legal organizations to engage in discussion. Topics covered included scientific advances in genomics, followed by innovations in business models, public sector perspectives, ethics, legal issues and national innovation systems. Results A set of recommendations, summarized below, was formulated for the Regional Office, the Member States and for individuals. • Advocacy for genomics and biotechnology for political leadership; • Networking between member states to share information, expertise, training, and regional cooperation in biotechnology; coordination of national surveys for assessment of health biotechnology innovation systems, science capacity, government policies, legislation and regulations, intellectual property policies, private sector activity; • Creation in each member country of an effective National Body on genomics, biotechnology and health to: - formulate national biotechnology strategies - raise

  20. Multidisciplinary Prerounding Meeting as a Continuous Quality Improvement Tool: Leveraging to Reduce Continuous Benzodiazepine Use at an Academic Medical Center.

    Science.gov (United States)

    Flannery, Alexander H; Thompson Bastin, Melissa L; Montgomery-Yates, Ashley; Hook, Corrine; Cassity, Evan; Eaton, Phillip M; Morris, Peter E

    2018-01-01

    Evidence-based medicine often has many barriers to overcome prior to implementation in practice, hence the importance of continuous quality improvement. We report on a brief (≤10 minutes) multidisciplinary meeting prior to rounds to establish a dashboard for continuous quality improvement and studied the success of this meeting on a particular area of focus: continuous infusion benzodiazepine minimization. This was a prospective observational study of patients admitted to the medical intensive care unit (MICU) of a large academic medical center over a 4-month period. A morning multidisciplinary prerounding meeting was implemented to report on metrics required to establish a dashboard for MICU care for the previous 24 hours. Fellows and nurse practitioners on respective teams reported on key quality metrics and other important data related to patient census. Continuous benzodiazepines were tracked daily as the number of patients per team who had orders for a continuous benzodiazepine infusion. The aim of this report is to describe the development of the morning multidisciplinary prerounding meeting and its impact on continuous benzodiazepine use, along with associated clinical outcomes. The median number of patients prescribed a continuous benzodiazepine daily decreased over this time period and demonstrated a sustained reduction at 1 year. Furthermore, sedation scores improved, corresponding to a reduction in median duration of mechanical ventilation. The effectiveness of this intervention was mapped post hoc to conceptual models used in implementation science. A brief multidisciplinary meeting to review select data points prior to morning rounds establishes mechanisms for continuous quality improvement and may serve as a mediating factor for successful implementation when initiating and monitoring practice change in the ICU.

  1. Utilizing Lean Six Sigma Methodology to Improve the Authored Works Command Approval Process at Naval Medical Center San Diego.

    Science.gov (United States)

    Valdez, Michelle M; Liwanag, Maureen; Mount, Charles; Rodriguez, Rechell; Avalos-Reyes, Elisea; Smith, Andrew; Collette, David; Starsiak, Michael; Green, Richard

    2018-03-14

    Inefficiencies in the command approval process for publications and/or presentations negatively impact DoD Graduate Medical Education (GME) residency programs' ability to meet ACGME scholarly activity requirements. A preliminary review of the authored works approval process at Naval Medical Center San Diego (NMCSD) disclosed significant inefficiency, variation in process, and a low level of customer satisfaction. In order to facilitate and encourage scholarly activity at NMCSD, and meet ACGME requirements, the Executive Steering Council (ESC) chartered an interprofessional team to lead a Lean Six Sigma (LSS) Rapid Improvement Event (RIE) project. Two major outcome metrics were identified: (1) the number of authored works submissions containing all required signatures and (2) customer satisfaction with the authored works process. Primary metric baseline data were gathered utilizing a Clinical Investigations database tracking publications and presentations. Secondary metric baseline data were collected via a customer satisfaction survey to GME faculty and residents. The project team analyzed pre-survey data and utilized LSS tools and methodology including a "gemba" (environment) walk, cause and effect diagram, critical to quality tree, voice of the customer, "muda" (waste) chart, and a pre- and post-event value stream map. The team selected an electronic submission system as the intervention most likely to positively impact the RIE project outcome measures. The number of authored works compliant with all required signatures improved from 52% to 100%. Customer satisfaction rated as "completely or mostly satisfied" improved from 24% to 97%. For both outcomes, signature compliance and customer satisfaction, statistical significance was achieved with a p methodology and tools to improve signature compliance and increase customer satisfaction with the authored works approval process, leading to 100% signature compliance, a comprehensive longitudinal repository of all

  2. What China can learn from international policy experiences to improve industrial energy efficiency and reduce CO2 emissions?

    Energy Technology Data Exchange (ETDEWEB)

    Liu, Xu [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Shen, Bo [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Price, Lynn [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Lu, Hongyou [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Hasanbeigi, Ali [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States)

    2016-11-01

    China’s industrial sector dominates the country’s total energy consumption and energy efficiency in the industry sector is crucial to help China reach its energy and CO2 emissions reduction goals. There are many energy efficiency policies in China, but the motivation and willingness of enterprises to improve energy efficiency has weakened. This report first identifies barriers that enterprises face to be self-motivated to implement energy efficiency measures. Then, this report reviews international policies and programs to improve energy efficiency and evaluates how these policies helped to address the identified barriers. Lastly, this report draws conclusions and provides recommendations to China in developing policies and programs to motivate enterprises to improve energy efficiency.

  3. Development of Improved Graphical Displays for an Advanced Outage Control Center, Employing Human Factors Principles for Outage Schedule Management

    Energy Technology Data Exchange (ETDEWEB)

    St Germain, Shawn Walter [Idaho National Lab. (INL), Idaho Falls, ID (United States); Farris, Ronald Keith [Idaho National Lab. (INL), Idaho Falls, ID (United States); Thomas, Kenneth David [Idaho National Lab. (INL), Idaho Falls, ID (United States)

    2015-09-01

    The long-term viability of existing nuclear power plants in the United States (U.S.) is dependent upon a number of factors, including maintaining high capacity factors, maintaining nuclear safety, and reducing operating costs, particularly those associated with refueling outages. Refueling outages typically take 20-30 days, and for existing light water NPPs in the U.S., the reactor cannot be in operation during the outage. Furthermore, given that many NPPs generate between $1-1.5 million/day in revenue when in operation, there is considerable interest in shortening the length of refueling outages. Yet refueling outages are highly complex operations, involving multiple concurrent and dependent activities that are somewhat challenging to coordinate; therefore, finding ways to improve refueling outage performance, while maintaining nuclear safety has proven to be difficult. The Advanced Outage Control Center (AOCC) project is a research and development (R&D) demonstration activity under the LWRS Program. LWRS is an R&D program that works closely with industry R&D programs to establish technical foundations for the licensing and managing of long-term, safe, and economical operation of current fleet of NPPs. As such, the LWRS Advanced Outage Control Center project has the goal of improving the management of commercial NPP refueling outages. To accomplish this goal, INL is developing an advanced outage control center (OCC) that is specifically designed to maximize the usefulness of communication and collaboration technologies for outage coordination and problem resolution activities. The overall focus is on developing an AOCC with the following capabilities that enables plant and OCC staff to; Collaborate in real-time to address emergent issues; Effectively communicate outage status to all workers involved in the outage; Effectively communicate discovered conditions in the field to the OCC; Provide real-time work status; Provide automatic pending support notifications

  4. Development of Improved Graphical Displays for an Advanced Outage Control Center, Employing Human Factors Principles for Outage Schedule Management

    International Nuclear Information System (INIS)

    St Germain, Shawn Walter; Farris, Ronald Keith; Thomas, Kenneth David

    2015-01-01

    The long-term viability of existing nuclear power plants in the United States (U.S.) is dependent upon a number of factors, including maintaining high capacity factors, maintaining nuclear safety, and reducing operating costs, particularly those associated with refueling outages. Refueling outages typically take 20-30 days, and for existing light water NPPs in the U.S., the reactor cannot be in operation during the outage. Furthermore, given that many NPPs generate between $1-1.5 million/day in revenue when in operation, there is considerable interest in shortening the length of refueling outages. Yet refueling outages are highly complex operations, involving multiple concurrent and dependent activities that are somewhat challenging to coordinate; therefore, finding ways to improve refueling outage performance, while maintaining nuclear safety has proven to be difficult. The Advanced Outage Control Center (AOCC) project is a research and development (R&D) demonstration activity under the LWRS Program. LWRS is an R&D program that works closely with industry R&D programs to establish technical foundations for the licensing and managing of long-term, safe, and economical operation of current fleet of NPPs. As such, the LWRS Advanced Outage Control Center project has the goal of improving the management of commercial NPP refueling outages. To accomplish this goal, INL is developing an advanced outage control center (OCC) that is specifically designed to maximize the usefulness of communication and collaboration technologies for outage coordination and problem resolution activities. The overall focus is on developing an AOCC with the following capabilities that enables plant and OCC staff to; Collaborate in real-time to address emergent issues; Effectively communicate outage status to all workers involved in the outage; Effectively communicate discovered conditions in the field to the OCC; Provide real-time work status; Provide automatic pending support notifications

  5. Geophysical Research Letters: New policies improve top-cited geosciences journal

    Science.gov (United States)

    Calais, Eric; Diffenbaugh, Noah; D'Odorico, Paolo; Harris, Ruth; Knorr, Wolfgang; Lavraud, Benoit; Mueller, Anne; Peterson, William; Rignot, Eric; Srokosz, Meric; Strutton, Peter; Tyndall, Geoff; Wysession, Michael; Williams, Paul

    2010-01-01

    Geophysical Research Letters (GRL) is the American Geophysical Union's premier journal of fast, groundbreaking communication. It rapidly publishes high- impact,letter-length articles, and it is the top-cited multidisciplinary geosciences journal over the past 10 years, with an impact factor that increased again in 2009, to 3.204. For manuscripts submitted to GRL, the median time to first and final decision is 23 and 27 days, respectively—a 35% improvement since 2007—and the median time from submission to publication is 13 weeks for 90% of GRL papers—a 25% improvement since 2007. Among high-impact publications in the geosciences, GRL has the fastest turnaround.

  6. Improving Skilled Birth Attendance in Ghana: An Evidence-Based Policy Brief.

    Science.gov (United States)

    Apanga, Paschal Awingura; Awoonor-Williams, John Koku

    2017-01-01

    This commentary has the objective of improving skilled birth attendance in Ghana to reduce maternal and neonatal mortality and morbidity. We have provided evidence of causes of low-skilled birth attendance in Ghana. Physical accessibility of health care, sociocultural factors, economic factors and health care system delivery problems were found as the main underlying causes of low levels of skilled birth attendance in Ghana. The paper provides potential strategies in addressing maternal and child health issues in Ghana.

  7. Evaluating games console electricity use : technologies and policy options to improve energy efficiency.

    OpenAIRE

    Webb, Amanda E.

    2016-01-01

    Energy efficiency regulations and standards are increasingly being used as an approach to reduce the impact of appliances on climate change. Each new generation of games consoles is significantly different to the last and their cumulative electricity use has risen due to improved performance and functionality and increasing sales. As a result, consoles have been identified in the EU, US and Australia as a product group with the potential for significant electricity savings. However, there is ...

  8. Improving Nigerian health policymakers' capacity to access and utilize policy relevant evidence: outcome of information and communication technology training workshop.

    Science.gov (United States)

    Uneke, Chigozie Jesse; Ezeoha, Abel Ebeh; Uro-Chukwu, Henry; Ezeonu, Chinonyelum Thecla; Ogbu, Ogbonnaya; Onwe, Friday; Edoga, Chima

    2015-01-01

    Information and communication technology (ICT) tools are known to facilitate communication and processing of information and sharing of knowledge by electronic means. In Nigeria, the lack of adequate capacity on the use of ICT by health sector policymakers constitutes a major impediment to the uptake of research evidence into the policymaking process. The objective of this study was to improve the knowledge and capacity of policymakers to access and utilize policy relevant evidence. A modified "before and after" intervention study design was used in which outcomes were measured on the target participants both before the intervention is implemented and after. A 4-point likert scale according to the degree of adequacy; 1 = grossly inadequate, 4 = very adequate was employed. This study was conducted in Ebonyi State, south-eastern Nigeria and the participants were career health policy makers. A two-day intensive ICT training workshop was organized for policymakers who had 52 participants in attendance. Topics covered included: (i). intersectoral partnership/collaboration; (ii). Engaging ICT in evidence-informed policy making; use of ICT for evidence synthesis; (iv) capacity development on the use of computer, internet and other ICT. The pre-workshop mean of knowledge and capacity for use of ICT ranged from 2.19-3.05, while the post-workshop mean ranged from 2.67-3.67 on 4-point scale. The percentage increase in mean of knowledge and capacity at the end of the workshop ranged from 8.3%-39.1%. Findings of this study suggest that policymakers' ICT competence relevant to evidence-informed policymaking can be enhanced through training workshop.

  9. Household biomass energy choice and its policy implications on improving rural livelihoods in Sichuan, China

    International Nuclear Information System (INIS)

    Chen, Qiu; Yang, Haoran; Liu, Tianbiao; Zhang, Lin

    2016-01-01

    It is widely known that a switch from traditional biomass energy to modern clean, safe and efficient energy could improve local rural livelihoods by enhancing the access to ‘high quality’ energy and reducing the negative impacts of traditional biomass energy on health, environment and living standards. Hence, in this paper, we used alternative-specific conditional logit model (ASCLM) to examine the rural household energy choice behaviors in Sichuan Province of China from the perspective of revealed and stated preferences. The results show that the fuel switching in our study region is not a simple unidirectional process from traditional biomass energy to modern fuels as incomes improve. Household energy choice behaviors could be not only affected by energy-specific characteristics such as fuel price, smoky level and safety risk, but also influenced by household-specific factors such as income level, age and educational level of the decision maker, household demographic structure, number of people frequently eating at home, distance to the nearest biomass collecting spot and household location, suggesting that government should attach more importance to simultaneously improve energy quality, control energy price and enhance household socio-economic status. - Highlights: •McFadden's choice model was applied to analyze household energy choice in Sichuan. •We examined household revealed and stated preferences for different fuels. •Household fuel switching is not a simple or unidirectional process. •Households prefer to use fuel with lower cost, higher safety and lower indoor pollution. •Household fuel choice is affected by interactions among multiple factors.

  10. The law, policy, and ethics of employers' use of financial incentives to improve health.

    Science.gov (United States)

    Madison, Kristin M; Volpp, Kevin G; Halpern, Scott D

    2011-01-01

    The Patient Protection and Affordable Care Act (ACA) turns to a nontraditional mechanism to improve public health: employer-provided financial incentives for healthy behaviors. Critics raise questions about incentive programs' effectiveness, employer involvement, and potential discrimination. We support incentive program development despite these concerns. The ACA sets the stage for a broad-based research and implementation agenda through which we can learn to structure incentive programs to not only promote public health but also address prevalent concerns. © 2011 American Society of Law, Medicine & Ethics, Inc.

  11. Policies and means to assess and improve service quality in electricity supply systems

    International Nuclear Information System (INIS)

    Lagostena, L.; Mirra, C.; Noferi, P.L.; Sani, G.

    1992-03-01

    Quality of electricity supply to users consists of a series of characteristics of the voltage at the points of delivery. This report shows how service quality, in the past basically related to the tolerance of voltage and frequency with respect to the nominal value, as well as, to the continuity of supply, is nowadays assessed also in relation to other aspects, generally referred to as disturbances. Short interruptions, voltage dips, transient overvoltages, harmonics and flicker are mainly taken into consideration. A description is given of the approach adopted by ENEL (the Italian Electricity Board) in order to evaluate and, if required, improve the quality of service, based upon the acquisition of data related to faults, interruptions and disturbances. These data are processed in order to obtain significant indices on the state of the network and on the effectiveness of the actions which can be implemented. Finally, the measures which may lead to an improvement in the quality of service are identified, and potential advantages, in terms of the reduction of non-supplied energy and number of faults, of adopting appropriate automatic devices and optimizing maintenance work on some distribution networks are illustrated

  12. Do specialist self-referral insurance policies improve access to HIV-experienced physicians as a regular source of care?

    Science.gov (United States)

    Heslin, Kevin C; Andersen, Ronald M; Ettner, Susan L; Kominski, Gerald F; Belin, Thomas R; Morgenstern, Hal; Cunningham, William E

    2005-10-01

    Health insurance policies that require prior authorization for specialty care may be detrimental to persons with HIV, according to evidence that having a regular physician with HIV expertise leads to improved patient outcomes. The objective of this study is to determine whether HIV patients who can self-refer to specialists are more likely to have physicians who mainly treat HIV. The authors analyze cross-sectional survey data from the HIV Costs and Services Utilization Study. At baseline, 67 percent of patients had insurance that permitted self-referral. In multivariate analyses, being able to self-refer was associated with an 8-12 percent increased likelihood of having a physician at a regular source of care that mainly treats patients with HIV. Patients who can self-refer are more likely to have HIV-experienced physicians than are patients who need prior authorization. Insurance policies allowing self-referral to specialists may result in HIV patients seeing physicians with clinical expertise relevant to HIV care.

  13. Theory-Informed Interventions to Improve the Quality of Tuberculosis Evaluation at Ugandan Health Centers: A Quasi-Experimental Study.

    Directory of Open Access Journals (Sweden)

    Lelia H Chaisson

    Full Text Available Tuberculosis (TB remains under-diagnosed in many countries, in part due to poor evaluation practices at health facilities. Theory-informed strategies are needed to improve implementation of TB evaluation guidelines. We aimed to evaluate the impact of performance feedback and same-day smear microscopy on the quality of TB evaluation at 6 health centers in rural Uganda.We tested components of a multi-faceted intervention to improve adherence to the International Standards for Tuberculosis Care (ISTC: performance feedback and same-day smear microscopy. The strategies were selected based on a qualitative assessment guided by the Theory of Planned Behavior and the PRECEDE model. We collected patient data 6 months before and after the introduction of each intervention component, and compared ISTC adherence in the pre- and post-intervention periods for adults with cough ≥ 2 weeks' duration.The performance feedback evaluation included 1,446 adults; 838 (58% were evaluated during the pre-intervention period and 608 (42% during the post-intervention period. Performance feedback resulted in a 15% (95%CI +10% to +20%, p<0.001 increase in the proportion of patients receiving ISTC-adherent care. The same-day microscopy evaluation included 1,950 adults; 907 (47% were evaluated during the pre-intervention period and 1,043 (53% during the post-intervention period. Same-day microscopy was associated with a 14% (95%CI +10% to +18%, p<0.001 increase in the proportion of patients receiving ISTC-adherent care.Performance feedback and same-day microscopy should be considered along with ISTC training as part of a multi-faceted intervention to improve the quality of TB evaluation in other high TB burden countries.

  14. Theory-Informed Interventions to Improve the Quality of Tuberculosis Evaluation at Ugandan Health Centers: A Quasi-Experimental Study.

    Science.gov (United States)

    Chaisson, Lelia H; Katamba, Achilles; Haguma, Priscilla; Ochom, Emmanuel; Ayakaka, Irene; Mugabe, Frank; Miller, Cecily; Vittinghoff, Eric; Davis, J Lucian; Handley, Margaret A; Cattamanchi, Adithya

    2015-01-01

    Tuberculosis (TB) remains under-diagnosed in many countries, in part due to poor evaluation practices at health facilities. Theory-informed strategies are needed to improve implementation of TB evaluation guidelines. We aimed to evaluate the impact of performance feedback and same-day smear microscopy on the quality of TB evaluation at 6 health centers in rural Uganda. We tested components of a multi-faceted intervention to improve adherence to the International Standards for Tuberculosis Care (ISTC): performance feedback and same-day smear microscopy. The strategies were selected based on a qualitative assessment guided by the Theory of Planned Behavior and the PRECEDE model. We collected patient data 6 months before and after the introduction of each intervention component, and compared ISTC adherence in the pre- and post-intervention periods for adults with cough ≥ 2 weeks' duration. The performance feedback evaluation included 1,446 adults; 838 (58%) were evaluated during the pre-intervention period and 608 (42%) during the post-intervention period. Performance feedback resulted in a 15% (95%CI +10% to +20%, pISTC-adherent care. The same-day microscopy evaluation included 1,950 adults; 907 (47%) were evaluated during the pre-intervention period and 1,043 (53%) during the post-intervention period. Same-day microscopy was associated with a 14% (95%CI +10% to +18%, pISTC-adherent care. Performance feedback and same-day microscopy should be considered along with ISTC training as part of a multi-faceted intervention to improve the quality of TB evaluation in other high TB burden countries.

  15. Explaining the non-implementation of health-improving policies related to solid fuels use in South Africa

    International Nuclear Information System (INIS)

    Matinga, Margaret Njirambo; Clancy, Joy S.; Annegarn, Harold J.

    2014-01-01

    In 1998, the South African government developed an energy policy that focused on a pro-poor agenda. Its objectives included addressing the health impacts of solid fuel use in households. Fourteen years later, and with household electrification at over 80%, millions still use solid fuels and yet ambitious policy objectives to address this situation are not being met. Using three theoretical frameworks; institutional capacity, policy inheritance and the symbolic use of policy, this paper analyses the reasons why household energy policy objectives related to solid fuels and health, as stated in the 1998 South African energy policy, have not been implemented. The results of the analysis show that the symbolic use of policy, including meanings of objects used for meeting policy objectives is the most critical explanation. The paper illustrates that political and historical contexts are critical to understanding policy outcomes in developing and transition countries which often experience tensions between implementing what may seem as objective policies, and that matches their political and historical experiences and aspirations. We recommend that policy analysts in the energy sector complement currently common methods to include political contexts of policy development and implementation in order to better understand why policy makers chose to implement certain policies over others. - Highlights: • Policy non-implementation in developing countries focuses on lack of resources. • We add policy inheritance and policy symbolism to assess non-implementation. • South Africa's racial politics affect how policies are perceived and implemented. • Politically, firewood and electricity symbolise repression and emancipation. • Electricity and firewood's symbolic meanings affect policy makers' focus on these

  16. Limiting Size of Fish Fillets at the Center of the Plate Improves the Sustainability of Aquaculture Production

    Directory of Open Access Journals (Sweden)

    Stephen F. Cross

    2011-07-01

    Full Text Available North American dining customers like to have a singular large piece of protein in the center of the plate. When fish is the protein of choice, the portion size from many species is limited by the overall size of the fish. Therefore, for these species, the means to achieve a singular larger portion of “center of the plate” protein is to grow a larger animal. However, fish become less efficient in converting feed to protein as they age. A second option would be to provide two smaller fillets originating from younger, more efficient fish. Here, the sustainability ramifications of these two protein provisioning strategies (single large or two small fillets are considered for three species of fish produced in aquaculture. Growth data for channel catfish (Ictalurus punctatus produced in ponds, rainbow trout (Oncorhynchus mykiss in raceways, and sablefish (Anoplopoma fimbria in marine net pens, were modeled to assess the total biomass and overall food conversion ratio for the production of small, medium or large fish. The production of small fish added an additional 50% or more biomass per year for trout, catfish, and sablefish compared to the production of large fish. Feed conversion ratios were also improved by nearly 10% for the smaller compared to larger fish of each species. Thus, even though all of these species tend to be considered aquaculture species of low environmental impact (and hence “green” or sustainable options, the product form requested by retailers and served by chefs can further increase the sustainability of these species.

  17. Prevention By Seismic Risk In The Ordinary Praxis Of Governance. The Case Of Historic Centers And Respective Policies And/Or Dedicated Tools

    International Nuclear Information System (INIS)

    Ugolini, Pietro; Pirlone, Francesca; Conelli, Francesco; Spadaro, Ilenia; Cumbo, Francesco

    2008-01-01

    Bussana Vecchia has been declared of important historical-cultural interest according to the laws D.Lgs.490/1999 and DDG made by the Ministry of Cultural Goods in date 11/12/2000, that has registered the historic core on the State property. The design proposals individuated in the research summarized in this paper, constitute a set of interventions aimed at favouring the liveability improvement and revitalizing of the fabric of the city, in order to return enjoyable spaces and structures for social and cultural activities to the context. In this paper a significant experience is related, through which it has been possible to test the methodology concerning the seismic damage scenarios assessment, aimed at the prevention in the usual procedures of governance (dedicated policies and instruments)

  18. Chain-computerisation for interorganisational public policy implementation : A new approach to developing non-intrusive information infrastructures that improve public policy implementation

    NARCIS (Netherlands)

    Grijpink, J.H.A.M.

    1999-01-01

    In two articles the author presents some key elements from his recently completed thesis about functional, non-intrusive information infrastructures for interorganisational public policy implementation. The development of these information infrastructures requires a new approach,

  19. Perspectives on quality mental health care from Brazilian and Cape Verdean outpatients: implications for effective patient-centered policies and models of care.

    Science.gov (United States)

    De Jesus, Maria; Earl, Tara R

    2014-01-01

    Mental health providers are increasingly coming into contact with large and growing multi-racial/ethnic and immigrant patient populations in the United States. Knowledge of patient perspectives on what constitutes quality mental health care is necessary for these providers. The aim of this study was to identify indicators of quality of mental health care that matter most to two underrepresented immigrant patient groups of Portuguese background: Brazilians and Cape Verdeans. A qualitative design was adopted using focus group discussions. Six focus groups of patients (n=24 Brazilians; n=24 Cape Verdeans) who received outpatient mental health treatment through public safety net clinics in the northeast region of the United States were conducted. The Consensual Qualitative Research analytic method allowed us to identify three quality of care domains: provider performance, aspects of mental health care environment, and effectiveness of mental health care treatment. Provider performance was associated with five categories: relational, communication, linguistic, cultural, and technical competencies. Aspects of mental health care environment were linked to two categories: psychosocial and physical environment. Effectiveness of mental health care treatment was related to two categories: therapeutic relationship and treatment outcomes. Study findings provide useful data for the development of more culturally appropriate and effective patient-centered models and policies in mental health care.

  20. Specialty pharmaceuticals: policy initiatives to improve assessment, pricing, prescription, and use.

    Science.gov (United States)

    Robinson, James C; Howell, Scott

    2014-10-01

    The value of "specialty pharmaceuticals" for cancer and other complex conditions depends not merely on their molecular structures but also on the manner in which the drugs are assessed, insured, priced, prescribed, and used. This article analyzes the five principal stages through which a specialty drug must pass on its journey from the laboratory to the bedside. These include regulatory approval by the Food and Drug Administration for market access, insurance coverage, pricing and payment, physician prescription, and patient engagement. If structured appropriately, each stage improves performance and supports continued research and development. If structured inappropriately, however, each stage adds to administrative burdens, distorts clinical decision making, and weakens incentives for innovation. Cautious optimism is in order, but neither the continued development of breakthrough products nor their use according to evidence-based guidelines can be taken for granted. Project HOPE—The People-to-People Health Foundation, Inc.

  1. Improving Nutrition and Physical Activity Policies and Practices in Early Care and Education in Three States, 2014-2016.

    Science.gov (United States)

    Smith, Teresa M; Blaser, Casey; Geno-Rasmussen, Cristy; Shuell, Julie; Plumlee, Catherine; Gargano, Tony; Yaroch, Amy L

    2017-08-31

    The National Early Care and Education Learning Collaboratives (ECELC) project aims to facilitate best practices in nutrition, physical activity, screen time, and breastfeeding support and infant feeding among early care and education (ECE) programs across multiple states. The project uses a train-the-trainer approach with 5, in-person learning-collaborative sessions, technical assistance, and action planning. We describe the longitudinal practice-based evaluation of the project and assess whether ECE programs evaluated (n = 104) sustained changes in policies and practices 1 year after completing the project. The number of best practices increased from pre-assessment to post-assessment (P professional development and training focused on improving best practices for environment-level child nutrition and physical activity, which is one strategy among many that are warranted for obesity prevention in young children.

  2. Water quality improvement policies: lessons learned from the implementation of Proposition O in Los Angeles, California.

    Science.gov (United States)

    Park, Mi-Hyun; Stenstrom, Michael; Pincetl, Stephanie

    2009-03-01

    This article evaluates the implementation of Proposition O, a stormwater cleanup measure, in Los Angeles, California. The measure was intended to create new funding to help the city comply with the Total Maximum Daily Load requirements under the federal Clean Water Act. Funding water quality objectives through a bond measure was necessary because the city had insufficient revenues to deploy new projects in its budget. The bond initiative required a supermajority vote (two-thirds of the voters), hence the public had to be convinced that such funding both was necessary and would be effective. The bond act language included project solicitation from the public, as well as multiple benefit objectives. Accordingly, nonprofit organizations mobilized to present projects that included creating new parks, using schoolyards for flood control and groundwater recharge, and replacing parking lots with permeable surfaces, among others. Yet few, if any, of these projects were retained for funding, as the city itself also had a list of priorities and higher technical expertise in justifying them as delivering water quality improvements. Our case study of the implementation of Proposition O points to the potentially different priorities for the renovation of urban infrastructure that are held by nonprofit organizations and city agencies and the importance of structuring public processes clearly so that there are no misimpressions about funding and implementation responsibilities that can lead to disillusionment with government, especially under conditions of fiscal constraints.

  3. A systems approach to improving fleet policy compliance within the US Federal Government

    Energy Technology Data Exchange (ETDEWEB)

    Deason, Kristin S. [The George Washington University, 1776 G St. NW, Washington, DC 20052 (United States); Jefferson, Theresa [Virginia Polytechnic Institute and State University, 1101 King St, Suite 610 Alexandria, VA 22314 (United States)

    2010-06-15

    To reduce dependence on foreign sources of energy, address climate change, and improve environmental quality, the US government has established a goal of reducing petroleum fuel use in its federal agencies. To this end, the government requires its agencies to purchase alternative fuel vehicles, use alternative fuel, and adopt other strategies to reduce petroleum consumption. Compliance with these requirements, while important, creates challenges for federal fleet managers who oversee large, geographically dispersed fleets. In this study, a group of 25 experienced federal fleet managers participated in a pilot study using a structured methodology for developing strategies to comply with fleet requirements while using agency resources as efficiently as possible. Multi-criteria decision making (MCDM) methods were used to identify and quantify agency priorities in combination with a linear programming model to optimize the purchase of fleet vehicles. The method was successful in quantifying tradeoffs and decreasing the amount of time required to develop fleet management strategies. As such, it is recommended to federal agencies as a standard tool for the development of these strategies in the future. (author)

  4. A systems approach to improving fleet policy compliance within the US Federal Government

    International Nuclear Information System (INIS)

    Deason, Kristin S.; Jefferson, Theresa

    2010-01-01

    To reduce dependence on foreign sources of energy, address climate change, and improve environmental quality, the US government has established a goal of reducing petroleum fuel use in its federal agencies. To this end, the government requires its agencies to purchase alternative fuel vehicles, use alternative fuel, and adopt other strategies to reduce petroleum consumption. Compliance with these requirements, while important, creates challenges for federal fleet managers who oversee large, geographically dispersed fleets. In this study, a group of 25 experienced federal fleet managers participated in a pilot study using a structured methodology for developing strategies to comply with fleet requirements while using agency resources as efficiently as possible. Multi-criteria decision making (MCDM) methods were used to identify and quantify agency priorities in combination with a linear programming model to optimize the purchase of fleet vehicles. The method was successful in quantifying tradeoffs and decreasing the amount of time required to develop fleet management strategies. As such, it is recommended to federal agencies as a standard tool for the development of these strategies in the future. (author)

  5. College and University Environmental Programs as a Policy Problem (Part 2): Strategies for Improvement

    Science.gov (United States)

    Clark, Susan G.; Rutherford, Murray B.; Auer, Matthew R.; Cherney, David N.; Wallace, Richard L.; Mattson, David J.; Clark, Douglas A.; Foote, Lee; Krogman, Naomi; Wilshusen, Peter; Steelman, Toddi

    2011-05-01

    Environmental studies and environmental sciences programs in American and Canadian colleges and universities seek to ameliorate environmental problems through empirical enquiry and analytic judgment. In a companion article (Part 1) we describe the environmental program movement (EPM) and discuss factors that have hindered its performance. Here, we complete our analysis by proposing strategies for improvement. We recommend that environmental programs re-organize around three principles. First, adopt as an overriding goal the concept of human dignity—defined as freedom and social justice in healthy, sustainable environments. This clear higher-order goal captures the human and environmental aspirations of the EPM and would provide a more coherent direction for the efforts of diverse participants. Second, employ an explicit, genuinely interdisciplinary analytical framework that facilitates the use of multiple methods to investigate and address environmental and social problems in context. Third, develop educational programs and applied experiences that provide students with the technical knowledge, powers of observation, critical thinking skills and management acumen required for them to become effective professionals and leaders. Organizing around these three principles would build unity in the EPM while at the same time capitalizing on the strengths of the many disciplines and diverse local conditions involved.

  6. Improving maternity services for Indigenous women in Australia: moving from policy to practice.

    Science.gov (United States)

    Kildea, Sue; Tracy, Sally; Sherwood, Juanita; Magick-Dennis, Fleur; Barclay, Lesley

    2016-10-17

    The well established disparities in health outcomes between Indigenous and non-Indigenous Australians include a significant and concerning higher incidence of preterm birth, low birth weight and newborn mortality. Chronic diseases (eg, diabetes, hypertension, cardiovascular and renal disease) that are prevalent in Indigenous Australian adults have their genesis in utero and in early life. Applying interventions during pregnancy and early life that aim to improve maternal and infant health is likely to have long lasting consequences, as recognised by Australia's National Maternity Services Plan (NMSP), which set out a 5-year vision for 2010-2015 that was endorsed by all governments (federal and state and territory). We report on the actions targeting Indigenous women, and the progress that has been achieved in three priority areas: The Indigenous maternity workforce; Culturally competent maternity care; and; Developing dedicated programs for "Birthing on Country". The timeframe for the NMSP has expired without notable results in these priority areas. More urgent leadership is required from the Australian government. Funding needs to be allocated to the priority areas, including for scholarships and support to train and retain Indigenous midwives, greater commitment to culturally competent maternity care and the development and evaluation of Birthing on Country sites in urban, rural and particularly in remote and very remote communities. Tools such as the Australian Rural Birth Index and the National Maternity Services Capability Framework can help guide this work.

  7. Water Quality Improvement Policies: Lessons Learned from the Implementation of Proposition O in Los Angeles, California

    Science.gov (United States)

    Park, Mi-Hyun; Stenstrom, Michael; Pincetl, Stephanie

    2009-03-01

    This article evaluates the implementation of Proposition O, a stormwater cleanup measure, in Los Angeles, California. The measure was intended to create new funding to help the city comply with the Total Maximum Daily Load requirements under the federal Clean Water Act. Funding water quality objectives through a bond measure was necessary because the city had insufficient revenues to deploy new projects in its budget. The bond initiative required a supermajority vote (two-thirds of the voters), hence the public had to be convinced that such funding both was necessary and would be effective. The bond act language included project solicitation from the public, as well as multiple benefit objectives. Accordingly, nonprofit organizations mobilized to present projects that included creating new parks, using schoolyards for flood control and groundwater recharge, and replacing parking lots with permeable surfaces, among others. Yet few, if any, of these projects were retained for funding, as the city itself also had a list of priorities and higher technical expertise in justifying them as delivering water quality improvements. Our case study of the implementation of Proposition O points to the potentially different priorities for the renovation of urban infrastructure that are held by nonprofit organizations and city agencies and the importance of structuring public processes clearly so that there are no misimpressions about funding and implementation responsibilities that can lead to disillusionment with government, especially under conditions of fiscal constraints.

  8. Strategies and policies for improving energy efficiency programs: Closing the loop between evaluation and implementation

    International Nuclear Information System (INIS)

    Vine, Edward

    2008-01-01

    Program implementers often use evaluation results to improve the performance of their programs, but, as described in this paper, this is not always the case. Based on a review of the literature, participation in workshops, and interviews with over 50 program implementers, evaluators, and regulators in the United States and Canada, the utilization of evaluation results is investigated by asking the following questions: (1) How are program evaluation results used by program implementers and other stakeholders? (2) How are program evaluation results communicated to program implementers and other stakeholders? (3) Are the needs of program implementers being met by program evaluation? (4) What is the role of the utility regulator in facilitating the use of program evaluation results? (5) What other mechanisms can facilitate the use of program evaluation results? While there is some consensus on the answers to these questions, the type of interest in and use of evaluation varies by functional role (e.g., evaluator versus implementer), maturity of the energy efficiency market, institutional context (e.g., evaluation and implementation conducted inside the same organization, or evaluation and implementation conducted by separate entities), and by regulatory demands and evaluation interests

  9. College and university environmental programs as a policy problem (Part 2): Strategies for improvement

    Science.gov (United States)

    Clark, S.G.; Rutherford, M.B.; Auer, M.R.; Cherney, D.N.; Wallace, R.L.; Mattson, D.J.; Clark, D.A.; Foote, L.; Krogman, N.; Wilshusen, P.; Steelman, T.

    2011-01-01

    Environmental studies and environmental sciences programs in American and Canadian colleges and universities seek to ameliorate environmental problems through empirical enquiry and analytic judgment. In a companion article (Part 1) we describe the environmental program movement (EPM) and discuss factors that have hindered its performance. Here, we complete our analysis by proposing strategies for improvement. We recommend that environmental programs re-organize around three principles. First, adopt as an overriding goal the concept of human dignity-defined as freedom and social justice in healthy, sustainable environments. This clear higher-order goal captures the human and environmental aspirations of the EPM and would provide a more coherent direction for the efforts of diverse participants. Second, employ an explicit, genuinely interdisciplinary analytical framework that facilitates the use of multiple methods to investigate and address environmental and social problems in context. Third, develop educational programs and applied experiences that provide students with the technical knowledge, powers of observation, critical thinking skills and management acumen required for them to become effective professionals and leaders. Organizing around these three principles would build unity in the EPM while at the same time capitalizing on the strengths of the many disciplines and diverse local conditions involved. ?? 2011 Springer Science+Business Media, LLC.

  10. Charting the Research on the Policies and Politics of Coaching

    Science.gov (United States)

    Woulfin, Sarah L.

    2014-01-01

    Facing relentless pressure to improve student achievement, many states and districts are using coaching as a policy lever to promote changes in practice. This special issue centers on the policies and politics of coaching, and this editorial commentary highlights what we know about the role of coaches and coaching in the field of education. Then I…

  11. Monitoring the Carbon Cycle: Improving Our Ability to Proved Policy Relevant Information

    Science.gov (United States)

    Bruhwiler, L.

    2017-12-01

    improved modeling and assimilation techniques for estimating fluxes from observations.

  12. Improving the use of economics in animal health - Challenges in research, policy and education.

    Science.gov (United States)

    Rushton, Jonathan

    2017-02-01

    The way that an economist and an animal health professional use economics differs and creates frustrations. The economist is in search of optimizing resource allocation in the management of animal health and disease problems with metrics associated with the productivity of key societal resources of labour and capital. The animal health professional have a strong belief that productivity can be improved with the removal of pathogens. These differences restrict how well economics is used in animal health, and the question posed is whether this matters. The paper explores the question by looking at the changing role of animals in society and the associated change of the animal health professional's activities. It then questions if the current allocation of scarce resources for animal health are adequately allocated for societies and whether currently available data are sufficient for good allocation. A rapid review of the data on disease impacts - production losses and costs of human reaction - indicate that the data are sparse collected in different times and geographical regions. This limits what can be understood on the productivity of the economic resources used for animal health and this needs to be addressed with more systematic collection of data on disease losses and costs of animal health systems. Ideally such a process should learn lessons from the way that human health has made estimates of the burden of diseases and their capture of data on the costs of human health systems. Once available data on the global burden of animal diseases and the costs of animal health systems would allow assessments of individual disease management processes and the productivity of wider productivity change. This utopia should be aimed at if animal health is to continue to attract and maintain adequate resources. Copyright © 2016 Elsevier B.V. All rights reserved.

  13. CVD Prevention Through Policy: a Review of Mass Media, Food/Menu Labeling, Taxation/Subsidies, Built Environment, School Procurement, Worksite Wellness, and Marketing Standards to Improve Diet

    OpenAIRE

    Afshin, Ashkan; Penalvo, Jose; Del Gobbo, Liana; Kashaf, Michael; Micha, Renata; Morrish, Kurtis; Pearson-Stuttard, Jonathan; Rehm, Colin; Shangguan, Siyi; Smith, Jessica D.; Mozaffarian, Dariush

    2015-01-01

    Poor diet is the leading cause of cardiovascular disease in the USA and globally. Evidence-based policies are crucial to improve diet and population health. We reviewed the effectiveness for a range of policy levers to alter diet and diet-related risk factors. We identified evidence to support benefits of focused mass media campaigns (especially for fruits, vegetables, salt), food pricing strategies (both subsidies and taxation, with stronger effects at lower income levels), school procuremen...

  14. Note on ‘Combining an Improved Multi-delivery Policy into a Single-producer Multi-retailer Integrated Inventory System with Scrap in Production’

    OpenAIRE

    Chung-li Chou; Wen Kuei Wu; Singa W. Chiu

    2014-01-01

    In a recent study, Chiu et al. (2014) employed a mathematical modeling and conventional optimization technique to determine the optimal production-shipment policy for a single-producer multi-retailer integrated inventory system with scrap and an improved product distribution policy. This study replaces their optimization process of using differential calculus with an algebraic derivation. Such a simplified approach enables practitioners, who may have insufficient knowledge of calculus, to man...

  15. Improving Education and Employment for Disadvantaged Young Men: Proven and Promising Strategies. National Poverty Center Working Paper Series #10-04

    Science.gov (United States)

    Heinrich, Carolyn J.; Holzer, Harry J.

    2010-01-01

    Low high school graduation rates and sharply declining employment rates among disadvantaged youth have led to increasing numbers of youth who are disconnected from both school and work. What programs and policies might prevent these disconnections and improve educational and employment outcomes, particularly among young men? We review the evidence…

  16. Improving health through policies that promote active travel: A review of evidence to support integrated health impact assessment

    NARCIS (Netherlands)

    Nazelle, A. de; Nieuwenhuijsen, M.J.; Antó, J.M.; Brauer, M.; Briggs, D.; Braun-Fahrlander, C.; Cavill, N.; Cooper, A.R.; Desqueyroux, H.; Fruin, S.; Hoek, G.; Panis, L.I.; Janssen, N.; Jerrett, M.; Joffe, M.; Andersen, Z.J.; Kempen, E. van; Kingham, S.; Kubesch, N.; Leyden, K.M.; Marshall, J.D.; Matamala, J.; Mellios, G.; Mendez, M.; Nassif, H.; Ogilvie, D.; Peiró, R.; Pérez, K.; Rabl, A.; Ragettli, M.; Rodríguez, D.; Rojas, D.; Ruiz, P.; Sallis, J.F.; Terwoert, J.; Toussaint, J.-F.; Tuomisto, J.; Zuurbier, M.; Lebret, E.

    2011-01-01

    Substantial policy changes to control obesity, limit chronic disease, and reduce air pollution emissions, including greenhouse gasses, have been recommended. Transportation and planning policies that promote active travel by walking and cycling can contribute to these goals, potentially yielding

  17. Geothermal power, policy, and design: Using levelized cost of energy and sensitivity analysis to target improved policy incentives for the U.S. geothermal market

    Science.gov (United States)

    Richard, Christopher L.

    At the core of the geothermal industry is a need to identify how policy incentives can better be applied for optimal return. Literature from Bloomquist (1999), Doris et al. (2009), and McIlveen (2011) suggest that a