WorldWideScience

Sample records for policy improvement center

  1. Nutrition and physical activity randomized control trial in child care centers improves knowledge, policies, and children's body mass index.

    Science.gov (United States)

    Alkon, Abbey; Crowley, Angela A; Neelon, Sara E Benjamin; Hill, Sherika; Pan, Yi; Nguyen, Viet; Rose, Roberta; Savage, Eric; Forestieri, Nina; Shipman, Linda; Kotch, Jonathan B

    2014-03-01

    To address the public health crisis of overweight and obese preschool-age children, the Nutrition And Physical Activity Self Assessment for Child Care (NAP SACC) intervention was delivered by nurse child care health consultants with the objective of improving child care provider and parent nutrition and physical activity knowledge, center-level nutrition and physical activity policies and practices, and children's body mass index (BMI). A seven-month randomized control trial was conducted in 17 licensed child care centers serving predominantly low income families in California, Connecticut, and North Carolina, including 137 child care providers and 552 families with racially and ethnically diverse children three to five years old. The NAP SACC intervention included educational workshops for child care providers and parents on nutrition and physical activity and consultation visits provided by trained nurse child care health consultants. Demographic characteristics and pre - and post-workshop knowledge surveys were completed by providers and parents. Blinded research assistants reviewed each center's written health and safety policies, observed nutrition and physical activity practices, and measured randomly selected children's nutritional intake, physical activity, and height and weight pre- and post-intervention. Hierarchical linear models and multiple regression models assessed individual- and center-level changes in knowledge, policies, practices and age- and sex-specific standardized body mass index (zBMI), controlling for state, parent education, and poverty level. Results showed significant increases in providers' and parents' knowledge of nutrition and physical activity, center-level improvements in policies, and child-level changes in children's zBMI based on 209 children in the intervention and control centers at both pre- and post-intervention time points. The NAP SACC intervention, as delivered by trained child health professionals such as child care

  2. Nutrition and physical activity randomized control trial in child care centers improves knowledge, policies, and children’s body mass index

    Science.gov (United States)

    2014-01-01

    Background To address the public health crisis of overweight and obese preschool-age children, the Nutrition And Physical Activity Self Assessment for Child Care (NAP SACC) intervention was delivered by nurse child care health consultants with the objective of improving child care provider and parent nutrition and physical activity knowledge, center-level nutrition and physical activity policies and practices, and children’s body mass index (BMI). Methods A seven-month randomized control trial was conducted in 17 licensed child care centers serving predominantly low income families in California, Connecticut, and North Carolina, including 137 child care providers and 552 families with racially and ethnically diverse children three to five years old. The NAP SACC intervention included educational workshops for child care providers and parents on nutrition and physical activity and consultation visits provided by trained nurse child care health consultants. Demographic characteristics and pre - and post-workshop knowledge surveys were completed by providers and parents. Blinded research assistants reviewed each center’s written health and safety policies, observed nutrition and physical activity practices, and measured randomly selected children’s nutritional intake, physical activity, and height and weight pre- and post-intervention. Results Hierarchical linear models and multiple regression models assessed individual- and center-level changes in knowledge, policies, practices and age- and sex-specific standardized body mass index (zBMI), controlling for state, parent education, and poverty level. Results showed significant increases in providers’ and parents’ knowledge of nutrition and physical activity, center-level improvements in policies, and child-level changes in children’s zBMI based on 209 children in the intervention and control centers at both pre- and post-intervention time points. Conclusions The NAP SACC intervention, as delivered by

  3. Optimization of Overflow Policies in Call Centers

    DEFF Research Database (Denmark)

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

    2015-01-01

    We examine how overflow policies in a multi-skill call center should be designed to accommodate performance measures that depend on waiting time percentiles such as service level. This is done using a discrete Markovian approximation of the waiting time of the first customers waiting in line...... and customers are treated in a FCFS order....

  4. 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...

  5. Georgia Health Policy Center Child Policy Briefs, 2001.

    Science.gov (United States)

    2001

    This set of briefs discusses state public policy and implications as they pertain to children in Georgia. The five briefs each address a single policy issue: kinship care, dental care, child care, special health care needs, and school health practice in Georgia. Each two-page brief provides background information on the issue, details the types of…

  6. "Not Another Team!" School Improvement Infrastructure Viewed through the Lens of Addressing Barriers to Learning and Teaching. A Center Policy & Practice Brief

    Science.gov (United States)

    Center for Mental Health in Schools at UCLA, 2011

    2011-01-01

    This brief underscores the need to rethink the proliferation of school teams, work groups, and committees. While such mechanisms are essential to enhancing school improvement, they must be designed in a delimited way to carry out fundamental functions and must be fully integrated with each other. From a functional perspective, because of current…

  7. Effects of a New State Policy on Physical Activity Practices in Child Care Centers in South Carolina.

    Science.gov (United States)

    O'Neill, Jennifer R; Dowda, Marsha; Benjamin Neelon, Sara E; Neelon, Brian; Pate, Russell R

    2017-01-01

    We sought to determine the extent to which child care centers in South Carolina improved physical activity practices after a new policy took effect. In 2012, South Carolina adopted new mandatory physical activity standards within its child care quality enhancement program. This quasi-experimental study used North Carolina, a state not making policy changes, as the comparison. Participants were 34 child care centers in South Carolina and 30 centers in North Carolina. Researchers used the Environment and Policy Assessment and Observation (EPAO) tool to conduct center observations before and after policy implementation and then conducted repeated-measures linear regression with interaction between state and time for the Physical Activity Environment Total Score and the 8 subscale scores. Compared with centers in North Carolina, EPAO subscale scores in South Carolina centers increased significantly for the Fixed Play Environment (P child care centers was associated with improvements in practices aimed at increasing children's physical activity.

  8. 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…

  9. Improving Staff Productivity in Mental Health Centers.

    Science.gov (United States)

    Southern Regional Education Board, Atlanta, GA.

    This guide is concerned with productivity measurement and improvement in mental health centers, and focuses on the relationship between service outputs and available clinical staff, i.e., staff productivity. Staff productivity measures are described as useful in identifying existing levels of productivity, making comparisons to determine the…

  10. From Policy to Practice: Implementation of Water Policies in Child Care Centers in Connecticut

    Science.gov (United States)

    Middleton, Ann E.; Henderson, Kathryn E.; Schwartz, Marlene B.

    2013-01-01

    Objective: Child care policies may contribute to healthy beverage consumption patterns. This study documented availability and accessibility of water and correspondence with state and federal policy and accreditation standards in child care centers. Design: One-day observations were conducted in a random sample of 40 Child and Adult Care Food…

  11. 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.

  12. 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.

  13. Improving Accountability in Public Education. Policy Brief

    Science.gov (United States)

    Stecher, Brian; Li, Jennifer

    2009-01-01

    This is one in a series of policy briefs on key education issues prepared by the RAND Corporation for the Obama administration. The accountability systems put in place by No Child Left Behind have not produced enough improvement to meet the goal of all students meeting proficiency standards by 2014. While the current accountability system has…

  14. 77 FR 31615 - Improving Mail Management Policies, Procedures, and Activities

    Science.gov (United States)

    2012-05-29

    ... ADMINISTRATION Improving Mail Management Policies, Procedures, and Activities AGENCY: Office of Governmentwide Policy, General Services Administration (GSA). ACTION: Notice of FMR Bulletin G-03. SUMMARY: The General... guidance to Executive Branch agencies for improving mail management policies, procedures, and activities...

  15. 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...

  16. Disparities and quality improvement: federal policy levers.

    Science.gov (United States)

    Lurie, Nicole; Jung, Minna; Lavizzo-Mourey, Risa

    2005-01-01

    Using a quality improvement framework to address racial and ethnic disparities in health care highlights multiple opportunities for federal and state governments to exert policy leverage, particularly through their roles as purchasers and regulators. Under such a framework, federal and state governments can expand their roles in collecting race/ethnicity data; define universal and meaningful race/ethnicity categories; more broadly disseminate standards for cultural competence; and demand the reduction of disparities through leveraging their status as collectively the largest U.S. health care payer.

  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. State-Mandated Nutrition, Physical Activity, and Screen Time Policies in Child Care Centers.

    Science.gov (United States)

    Chang-Martinez, Catherina; Ahmed, Nasar U; Natale, Ruby A; Messiah, Sarah E

    2017-09-01

    The child care center (CCC) environment presents opportunities for healthy weight promotion in preschoolers. Our study examined the current state of CCC adherence to nutrition, physical activity, and screen time legislative regulations and the differences in their adherence by center socioeconomic position (SEP: low, middle, high) in Miami-Dade County. In 34 CCC, we used the Environment and Policy Assessment and Observation tool to evaluate nutrition, physical activity, and screen time practices during 1-school day. Twenty-five of the centers (73.5%) were participants of the Child and Adult Care Food Program. Almost 80% of the centers adhered to serving low-fat/fat-free milk to children older than 2 years. Only 34.5% served vegetables and 75.9% served whole fruits during meals/snacks. Ninety-four percent of the centers had quiet and active play incorporated into their daily routines. All centers adhered to the 2-hour screen time limit for children older than 2 years. Low- and middle-SEP centers fared better in the serving of fruits, vegetables, and low-fat/fat-free milk. The centers averaged 1 hour in outdoor play regardless of SEP. High-SEP centers had no TV or screen time during day of observation. CCC practices highlight opportunities for improvement in nutrition, physical activity, and screen time practices in the prevention of overweight in early childhood.

  19. Healthcare quality improvement -- policy implications and practicalities.

    Science.gov (United States)

    Esain, Ann Elizabeth; Williams, Sharon J; Gakhal, Sandeep; Caley, Lynne; Cooke, Matthew W

    2012-01-01

    This article aims to explore quality improvement (QI) at individual, group and organisational level. It also aims to identify restraining forces using formative evaluation and discuss implications for current UK policy, particularly quality, innovation, productivity and prevention. Learning events combined with work-based projects, focusing on individual and group responses are evaluated. A total of 11 multi-disciplinary groups drawn from NHS England healthcare Trusts (self-governing operational groups) were sampled. These Trusts have different geographic locations and participants were drawn from primary, secondary and commissioning arms. Mixed methods: questionnaires, observations and reflective accounts were used. The paper finds that solution versus problem identification causes confusion and influences success. Time for problem solving to achieve QI was absent. Feedback and learning structures are often not in place or inflexible. Limited focus on patient-centred services may be related to past assumptions regarding organisational design, hence assumptions and models need to be understood and challenged. The authors revise the Plan, Do, Study; Act (PDSA) model by adding an explicit problem identification step and hence avoiding solution-focused habits; demonstrating the need for more formative evaluations to inform managers and policy makers about healthcare QI processes. - Although UK-centric, the quality agenda is a USA and European theme, findings may help those embarking on this journey or those struggling with QI.

  20. Risk evaluation and mitigation strategies: assessment of a medical center's policies and procedures.

    Science.gov (United States)

    Childs, Lindsey; Alexander, Earnest; Duong, Minh-Tri

    2012-05-15

    The results of a hospital's initiative to evaluate and improve compliance with federally mandated risk evaluation and mitigation strategies (REMS) are presented. Food and Drug Administration approved REMS plans are required for more than 145 drugs, but clear guidance on strategies for achieving REMS compliance is lacking. As a first step toward determining the extent of REMS compliance at a large medical center, a systematic assessment was conducted to ascertain existing policies and procedures for the use of drugs subject to REMS requirements applicable in the inpatient setting. About 123 drugs with such "inpatient-applicable" REMS requirements were identified; of those, 10 had been ordered by hospital providers during a specified 18-month time frame and were included in the assessment of policies and procedures. The assessment revealed that the hospital lacked a formal REMS policy and had no REMS-compliant procedures in place for 7 evaluated drugs (ambrisentan, buprenorphine-naloxone, darbepoetin alfa, epoetin alfa, oxycodone controlled-release tablets, prasugrel, and pregabalin). Pursuant to the compliance assessment, new procedures to help ensure the safe use of those 7 drugs were developed, and REMS-focused educational programs, order-entry system enhancements, and drug storage modifications were implemented. Quality-improvement initiatives including staff education, incorporation of REMS requirements into existing policy, development of an electronic resource, and creation of a separate storage section for drugs subject to REMS were implemented at a large academic medical center to help ensure compliance with inpatient-applicable REMS requirements.

  1. 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.

  2. 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.

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

    Science.gov (United States)

    Srivastava, Aradhana; Singh, Devaki; Montagu, Dominic; Bhattacharyya, Sanghita

    2017-07-14

    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. 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. 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. 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.

  4. 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.

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

    African Journals Online (AJOL)

    Admin

    SERVICOM policy, in which we examine descriptively the nature and implementation process of the policy, against a theoretical background depicting the nature of public services, quality and quality improvement, problems in the. Nigerian public sector, earlier policy prescriptions for an efficiently functioning service, and an.

  6. 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…

  7. 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.

  8. Ways to Improve the Personnel Policy of the Restaurant Business

    Directory of Open Access Journals (Sweden)

    Alexandra Borisova

    2017-06-01

    Full Text Available At the present stage, the effectiveness of the organization activity directly depends on the properly organized personnel policy. The article presents the results of the problem diagnosis in the personnel policy of one of the organizations. The analysis of the use of labor resources, procedures and methods of implementing the personnel policy is performed. Measures to improve the effectiveness of the personnel policy of the organization are developed and recommended The ultimate goal of the personnel policy is to create a cohesive, responsible, high-performance team that is able to solve any tasks that correspond to the mission and strategy of the organization.

  9. State policy affecting pain management: recent improvements and the positive impact of regulatory health policies.

    Science.gov (United States)

    Gilson, Aaron M; Maurer, Martha A; Joranson, David E

    2005-10-01

    Criteria-driven policy analysis resources from the University of Wisconsin Pain and Policy Studies Group (PPSG) evaluated drug control and professional practice policies that can influence use of controlled substances for pain management, and documented changes over a 3-year period. Additional research was needed to determine the extent of change, the types of messages contained in the policies, and what has contributed to changing policy content. Four research aims guided this study: (1) evaluate change between 2000 and 2003 of state policy that can affect pain relief, (2) describe content differences for statutes, regulations, guidelines, and policy statements, (3) evaluate differences between policies specific to pain management and policies governing general healthcare practice, and (4) compare content of policies specific to pain management created by healthcare regulatory boards to those created by state legislatures. Results showed that more current policies, especially policies regulating health professionals, tend to encourage pain management and avoid language that restricts professional decision-making and patient treatment. In addition, pain policies from healthcare regulatory boards were generally less restrictive than statutes or policies that govern general healthcare practice. These findings suggest that the positive policy change results primarily from state medical, pharmacy, and nursing boards adopting policies promoting pain management and the use of opioids, while containing few if any restrictions. Despite this improvement, further progress can be made when states continue to abrogate additional restrictions or clinically obsolete provisions from policies. PPSG policy evaluations provide guidance to lawmakers, healthcare regulators, and clinicians who are striving to achieve balanced policy, an attainable but redoubtable goal, to benefit patient care.

  10. 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...

  11. 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…

  12. Improved input-legitimacy and efficient policies?

    DEFF Research Database (Denmark)

    Agger, Annika

    a proliferation of attempts to create both more efficient as well as flexible public services. Theories of innovation haw inspired efforts to close the gap between high public expecta-tions and limited public resources. The fact that the innovation agenda is to a large extent inspired by theories and models from......-ours. Empirically, the paper draws on a case study of collaborative policy innovation in a Danish municipality. We have studied a local task force set up to develop a municipal policy for “Citizen – and stakeholder participation”. The members of the taskforce were the local mayor, the city manager, 6 citizens, 6...... local politicians and 2 administrators. The taskforce have experimented with new forms of conversations and facilitated dialogues and in new ways of getting inputs from a broad variety of stakeholders. Moreover, a theatre workshop and an innovation camp have been held as part of the project...

  13. 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.

  14. Nutrition and physical activity in child care centers: the impact of a wellness policy initiative on environment and policy assessment and observation outcomes, 2011.

    Science.gov (United States)

    Lyn, Rodney; Maalouf, Joyce; Evers, Sarah; Davis, Justin; Griffin, Monica

    2013-05-23

    The child care environment has emerged as an ideal setting in which to implement policies that promote healthy body weight of children. The purpose of this study was to assess the effect of a wellness policy and training program on the physical activity and nutrition environment in 24 child care centers in Georgia. We used the Environment and Policy Assessment and Observation instrument to identify changes to foods served, staff behaviors, and physical activity opportunities. Observations were performed over 1 day, beginning with breakfast and concluding when the program ended for the day. Observations were conducted from February 2010 through April 2011 for a total of 2 observations in each center. Changes to nutrition and physical activity in centers were assessed on the basis of changes in scores related to the physical activity and nutrition environment documented in the observations. Paired t test analyses were performed to determine significance of changes. Significant improvements to total nutrition (P environments of centers by enhancing active play (P = .02), the sedentary environment (P = .005), the portable environment (P = .002), staff behavior (P = .004), and physical activity training and education (P environment (P policies and training caregivers in best practices for physical activity and nutrition can promote healthy weight for young children in child care settings.

  15. 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…

  16. 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

  17. Endocrine Disruptors: Improving Regulatory Science Policy.

    Science.gov (United States)

    Ricci, Paolo F

    2015-01-01

    Law and science combine in the estimation of risks from endocrine disruptors (EDs) and actions for their regulation. For both, dose-response models are the causal link between exposure and probability (or percentage change) of adverse response. The evidence that leads to either regulations or judicial decrees is affected by uncertainty and limited knowledge, raising difficult policy issues that we enumerate and discuss. In the United States, some courts have dealt with EDs, but causation based on animal studies has been a stumbling block for plaintiffs seeking compensation, principally because those courts opt for epidemiological evidence. The European Union (EU) has several regulatory tools and ongoing research on the risks associated with bisphenol A, under the Registration, Evaluation, Authorisation and Restriction of Chemicals (REACH) Regulation and other regulations or directives. The integration of a vast (in kind and in scope) number of research papers into a statement of causation for either policy or to satisfy legal requirements, in both the United States and the EU, relies on experts. We outline the discursive dilemma and issues that may affect consensus-based results and a Bayesian causal approach that accounts for the evolution of information, yielding both value of information and flexibility associated with public choices.

  18. 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...

  19. India′s draft National Health Policy, 2015: Improving policy to implementation effectiveness

    Directory of Open Access Journals (Sweden)

    Nata Menabde

    2015-01-01

    Full Text Available As the Government of India is working on drafting a new National Health Policy, developing national health accounts, and planning for a "health assurance mission," this opportunity has the potential to transform health status of millions of Indians and achieve universal health coverage. The draft of new National Health Policy of India was put in public domain for comments in early 2015. This editorial reviews the draft National Health Policy 2015 and proposes a few steps to improve implementation effectiveness.

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

    OpenAIRE

    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 throughout their value chain. In the Netherlands, a nationwide policy programme was in place between 2002 and 2007 that is a prominent example of this type of policy initiatives. In this paper we pr...

  1. 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.

  2. Model-Driven Policy Framework for Data Centers

    DEFF Research Database (Denmark)

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

    2016-01-01

    Data Centers (DCs) continue to become increasingly complex, due to comprising multiple functional entities (e.g. routing, orchestration). Managing the multitude of interconnected components in the DC becomes difficult and error prone, leading to slow service provisioning, lack of QoS support, etc...

  3. DoDs Efforts to Consolidate Data Centers Need Improvement

    Science.gov (United States)

    2016-03-29

    H 2 9 , 2 0 1 6 Report No. DODIG-2016-068 DoD’s Efforts to Consolidate Data Centers Need Improvement Mission Our mission is to provide independent...e DODIG-2016-068 (Project No. D2015-D000RC-0137.000) │ i Results in Brief DoD’s Efforts to Consolidate Data Centers Need Improvement Visit us at...www.dodig.mil March 29, 2016 Objective Our audit objective was to determine whether selected DoD Components were effectively consolidating their data

  4. Primary Care for Underserved Populations: Navigating Policy to Incorporate Occupational Therapy Into Federally Qualified Health Centers.

    Science.gov (United States)

    Murphy, Aileen D; Griffith, Vanessa M; Mroz, Tracy M; Jirikowic, Tracy L

    Federally qualified health centers (FQHCs) provide low- or no-cost primary care to medically underserved populations such as homeless or low-income people, migrant workers, and members of marginalized cultural groups. Occupational therapy services have the potential to help improve the health and functioning of FQHC patients. Using a FQHC serving American Indian/Alaska Native populations as a case example, we describe how occupational therapy is well suited to help meet the needs of medically underserved populations. We then examine options for integrating occupational therapy into this unique primary care setting, discuss related administrative and policy considerations, and propose possible solutions to identified barriers. Copyright © 2017 by the American Occupational Therapy Association, Inc.

  5. 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.

  6. 75 FR 75867 - National Sheep Industry Improvement Center

    Science.gov (United States)

    2010-12-07

    ... Service 7 CFR Part 63 National Sheep Industry Improvement Center AGENCY: Agricultural Marketing Service, USDA. ACTION: Affirmation of interim rule as a final rule. SUMMARY: The Agricultural Marketing Service... information, Marketing agreements, Reporting and recordkeeping requirements. PART 63--NATIONAL SHEEP INDUSTRY...

  7. Legal prison tattooing centers: viable health policy initiative?

    Science.gov (United States)

    Awofeso, Niyi

    2010-01-01

    Tattooing exemplifies several important links between criminal justice systems, public health, custodial management, and the social organization and behavior of prisoners. This commentary examines the efficiency of setting up legal, prison-financed tattooing centers as a way of discouraging illicit tattooing and minimizing bloodborne disease transmission risks in prison settings. The author posits that the impact of legal prison tattooing centers is unlikely to be significant since less than 5 percent of bloodborne infectious diseases have been reliably attributable to tattooing, either in prison or in community settings. Behavioral studies indicate that prisoners at the highest risk of contracting bloodborne infections would probably not utilize legal prison tattooing services. Furthermore, such a service is likely to be very expensive relative to potential health benefits. Strategies focussed on reducing injecting drug use among prisoners will yield greater benefits for reducing bloodborne disease transmission per dollar spent compared with setting up legal prison tattooing parlors. Social marketing of temporary tattooing alternatives (eg, henna tattoos) to traditional illicit tattooing techniques in prison settings is potentially valuable, as temporary tattoos pose no infection risk and may also facilitate reduction in occupational and social stigma associated with many illicit prison tattoos.

  8. 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.

  9. Enacting Sustainable School-Based Health Initiatives: A Communication-Centered Approach to Policy and Practice

    Science.gov (United States)

    Canary, Heather E.

    2011-01-01

    Communication plays an important role in all aspects of the development and use of policy. We present a communication-centered perspective on the processes of enacting public health policies. Our proposed conceptual framework comprises 4 communication frames: orientation, amplification, implementation, and integration. Empirical examples from 2 longitudinal studies of school-based health policies show how each frame includes different communication processes that enable sustainable public health policy practices in school-based health initiatives. These 4 frames provide unique insight into the capacity of school-based public health policy to engage youths, parents, and a broader community of stakeholders. Communication is often included as an element of health policy; however, our framework demonstrates the importance of communication as a pivotal resource in sustaining changes in public health practices. PMID:21233442

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

    Science.gov (United States)

    Ritter, Alison; Lancaster, Kari; Diprose, Rosalyn

    2018-02-08

    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.

  11. 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.

  12. 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.

  13. 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.

  14. Comparative Evaluation of a South Carolina Policy to Improve Nutrition in Child Care.

    Science.gov (United States)

    Benjamin Neelon, Sara E; Mayhew, Meghan; O'Neill, Jennifer R; Neelon, Brian; Li, Fan; Pate, Russell R

    2016-06-01

    Policies to promote healthy eating in young children appear promising, but are largely untested. Recently, South Carolina implemented mandatory nutrition standards governing child-care centers serving low-income children. This study evaluated consistency with the standards before and after the policy took effect. This study evaluated consistency with the nutrition standards in South Carolina, using North Carolina-a state not making policy changes-as the comparison. The research team conducted assessments in a longitudinal sample of centers and a cross-sectional sample of children before and approximately 9 months after the standards took effect. Trained observers recorded foods and beverages served to 102 children from 34 centers in South Carolina and 90 children from 30 centers in North Carolina at baseline. At follow-up, the research team observed 99 children from 33 centers in South Carolina and 78 children from 26 centers in North Carolina. The policy was implemented in April 2012 and included 13 standards governing the nutritional quality of foods and beverages served to children, and staff behaviors related to feeding children in care. The outcome was consistency with each standard at follow-up in South Carolina compared with North Carolina, controlling for baseline consistency and other covariates. Logistic regressions were conducted to evaluate consistency with each standard, adjusting for baseline and potential confounders. Compared with North Carolina, centers in South Carolina were more likely to be consistent with the standard prohibiting the use of food as a reward or punishment (odds ratio=1.22; 95% CI 1.11 to 1.61; P=0.03). Two centers in South Carolina met all 13 standards at follow-up compared with none in North Carolina. No other differences were observed. New standards modestly improved nutrition practices in South Carolina child-care centers, but additional support is needed to bring all centers into compliance with the current policies

  15. Spiral analysis-improved clinical utility with center detection.

    Science.gov (United States)

    Wang, Hongzhi; Yu, Qiping; Kurtis, Mónica M; Floyd, Alicia G; Smith, Whitney A; Pullman, Seth L

    2008-06-30

    Spiral analysis is a computerized method that measures human motor performance from handwritten Archimedean spirals. It quantifies normal motor activity, and detects early disease as well as dysfunction in patients with movement disorders. The clinical utility of spiral analysis is based on kinematic and dynamic indices derived from the original spiral trace, which must be detected and transformed into mathematical expressions with great precision. Accurately determining the center of the spiral and reducing spurious low frequency noise caused by center selection error is important to the analysis. Handwritten spirals do not all start at the same point, even when marked on paper, and drawing artifacts are not easily filtered without distortion of the spiral data and corruption of the performance indices. In this report, we describe a method for detecting the optimal spiral center and reducing the unwanted drawing artifacts. To demonstrate overall improvement to spiral analysis, we study the impact of the optimal spiral center detection in different frequency domains separately and find that it notably improves the clinical spiral measurement accuracy in low frequency domains.

  16. Instituting a smoke-free policy for city recreation centers and playgrounds, Philadelphia, Pennsylvania, 2010.

    Science.gov (United States)

    Leung, Raymond; Mallya, Giridhar; Dean, Lorraine T; Rizvi, Amna; Dignam, Leo; Schwarz, Donald F

    2013-07-11

    In the United States, more than 600 municipalities have smoke-free parks, and more than 100 have smoke-free beaches. Nevertheless, adoption of outdoor smoke-free policies has been slow in certain regions. Critical to widespread adoption is the sharing of knowledge about the policy development and implementation process. In this article, we describe our experience in making City of Philadelphia recreation centers and playgrounds smoke-free. Of the 10 largest US cities, Philadelphia has among the highest rates of adult and youth smoking. Our objectives for an outdoor smoke-free policy included protecting against secondhand smoke, supporting a normative message that smoking is harmful, motivating smokers to quit, and mitigating tobacco-related sanitation costs. The Philadelphia Department of Public Health and the Department of Parks and Recreation engaged civic leaders, agency staff, and community stakeholders in the following steps: 1) making the policy case, 2) vetting policy options and engaging stakeholders, and 3) implementing policy. Near-term policy impacts were assessed through available data sources. More than 220 recreation centers, playgrounds, and outdoor pools became smoke-free through a combined mayoral executive order and agency regulation. Support for the policy was high. Estimates suggest a policy reach of 3.6 million annual visitors and almost 850 acres of new smoke-free municipal property. Localities can successfully implement outdoor smoke-free policies with careful planning and execution. Such policies hold great potential for reducing exposure to secondhand smoke, promoting nonsmoking norms, and providing additional motivation for residents to quit smoking.

  17. 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.

  18. Geographic Modeling to Quantify the Impact of Primary and Comprehensive Stroke Center Destination Policies.

    Science.gov (United States)

    Mullen, Michael T; Pajerowski, William; Messé, Steven R; Mechem, C Crawford; Jia, Judy; Abboud, Michael; David, Guy; Carr, Brendan G; Band, Roger

    2018-02-28

    We evaluated the impact of a primary stroke center (PSC) destination policy in a major metropolitan city and used geographic modeling to evaluate expected changes for a comprehensive stroke center policy. We identified suspected stroke emergency medical services encounters from 1/1/2004 to 12/31/2013 in Philadelphia, PA. Transport times were compared before and after initiation of a PSC destination policy on 10/3/2011. Geographic modeling estimated the impact of bypassing the closest hospital for the closest PSC and for the closest comprehensive stroke center. There were 2 326 943 emergency medical services runs during the study period, of which 15 099 had a provider diagnosis of stroke. Bypassing the closest hospital for a PSC was common before the official policy and increased steadily over time. Geographic modeling suggested that bypassing the closest hospital in favor of the closest PSC adds a median of 3.1 minutes to transport time. Bypassing to the closest comprehensive stroke center would add a median of 8.3 minutes. Within a large metropolitan area, the time cost of routing patients preferentially to PSCs and comprehensive stroke centers is low. © 2018 American Heart Association, Inc.

  19. 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

  20. 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

  1. 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.

  2. 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

  3. 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.

  4. 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.

  5. Ambulatory quality improvement in academic medical centers: a changing landscape.

    Science.gov (United States)

    Leas, Brian F; Goldfarb, Neil I; Browne, Robert C; Keroack, Mark; Nash, David B

    2009-01-01

    Efforts to improve the quality of ambulatory care have received tremendous attention as bold new initiatives aimed at influencing the environment of care through financial incentives, public transparency, and information technology rapidly spread. Academic medical centers, which represent a long tradition of excellence and innovation in medical care, might be expected to lead the charge in these new arenas, but motivation for change may be mitigated by the unique complexity and multiple goals of these institutions. A survey conducted in the fall of 2006 examined the early impact of these major new influences on faculty practice plans. Respondents reported that many institutions have begun to develop key components of a quality infrastructure, but much work remains before a robust model emerges at most sites. Some academic medical centers have also embraced pay-for-performance and public reporting efforts, but many are not equipped or eager to engage in these new initiatives.

  6. 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.

  7. 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.

  8. 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.

  9. 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.

  10. 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.

  11. 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.

  12. Determining the Optimal Inventory Management Policy for Naval Medical Center San Diego’s Pharmacy

    Science.gov (United States)

    2016-12-01

    budget. It is a very good tool for those hospitals that have a restrictive formulary. There is also the option to combine these to analyses into the...evaluating the inventory of a pharmacy and should be used in conjunction with a tool that takes non- monetary factors into consideration. The VEN analysis...OPTIMAL INVENTORY MANAGEMENT POLICY FOR NAVAL MEDICAL CENTER SAN DIEGO’S PHARMACY by Jason S. Galka December 2016 Thesis Advisor: Eddine

  13. [Laboral health in Penitentiary Center of Chile: a look from policies of human resources].

    Science.gov (United States)

    Güilgüiruca R, M; Herrera-Bascur, J

    2015-01-01

    This article examines the influence of human resources policies on occupational health variables, such as engagement and job satisfaction, with regard to Chilean prison employees. 80 workers at the Women's Prison of Iquique were evaluated and results show that 77% and 88 % have a moderate to high score in terms of engagement and job satisfaction respectively. The 24% variation in engagement of the workers studied can be explained by policies aimed at promoting personal interests, while 32% of the variation in job satisfaction could be explained by policies of self-efficacy and personal interests. The above data permits the assertion to be made that human resources policies have a role that is relevant and necessary to modify and improve the occupational health conditions of these public sector workers.

  14. 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.

  15. 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.

  16. 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).

  17. Improved Adaptive Routing Algorithm in Distributed Data Centers

    Directory of Open Access Journals (Sweden)

    Dmitry Perepelkin

    2017-01-01

    Full Text Available Currently, telecom operators use virtualization of network infrastructure based on Data Centers (DCs. But when a company grows to a certain size and one DC is not sufficient, there are questions how to further develop the network infrastructure. There is a need to expand existing DC boundaries or to add new elements in the network structure. In this paper, we propose improved adaptive routing algorithm in distributed networks of DCs with united service providers, which increases the efficiency of adaptive routing process during dynamic adding of nodes or communication links. The mathematical model and enlarged form of algorithm are shown in the work. In the paper, a comparison of the proposed algorithm with known analogies, such as modified Dijkstra's algorithm and paired transitions algorithm, is performed. To validate the correctness of proposed algorithm, we developed software for simulation of adaptive routing processes in networks of distributed DCs. Comparative analysis of adaptive routing algorithms in distributed networks of DCs with united service providers confirms the effectiveness of the proposed approach and reduces the complexity of constructing routing tables to the value O(mN.

  18. Improving the explainability of Random Forest classifier - user centered approach.

    Science.gov (United States)

    Petkovic, Dragutin; Altman, Russ; Wong, Mike; Vigil, Arthur

    2018-01-01

    Machine Learning (ML) methods are now influencing major decisions about patient care, new medical methods, drug development and their use and importance are rapidly increasing in all areas. However, these ML methods are inherently complex and often difficult to understand and explain resulting in barriers to their adoption and validation. Our work (RFEX) focuses on enhancing Random Forest (RF) classifier explainability by developing easy to interpret explainability summary reports from trained RF classifiers as a way to improve the explainability for (often non-expert) users. RFEX is implemented and extensively tested on Stanford FEATURE data where RF is tasked with predicting functional sites in 3D molecules based on their electrochemical signatures (features). In developing RFEX method we apply user-centered approach driven by explainability questions and requirements collected by discussions with interested practitioners. We performed formal usability testing with 13 expert and non-expert users to verify RFEX usefulness. Analysis of RFEX explainability report and user feedback indicates its usefulness in significantly increasing explainability and user confidence in RF classification on FEATURE data. Notably, RFEX summary reports easily reveal that one needs very few (from 2-6 depending on a model) top ranked features to achieve 90% or better of the accuracy when all 480 features are used.

  19. Nutrition policies at child-care centers and impact on role modeling of healthy eating behaviors of caregivers.

    Science.gov (United States)

    Erinosho, Temitope O; Hales, Derek P; McWilliams, Christina P; Emunah, Josie; Ward, Dianne Stanton

    2012-01-01

    Studies suggest that caregivers influence children's dietary behaviors through role modeling in child-care environments. However, few studies have examined role modeling by caregivers and child-care center policies. This cross-sectional study evaluated the associations between child-care center policies about staff eating practices and caregivers' eating behaviors during mealtime interactions with children. Data were collected in 2008-2009 at 50 North Carolina child-care centers. Caregivers (n=124) reported about modeling healthy eating behaviors to children, trained research staff observed caregivers' (n=112) eating behaviors in classrooms, and directors reported about the presence/absence of center policies on staff eating practices. About 90% of caregivers reported modeling healthy eating behaviors to children. At 80% of centers, caregivers were observed modeling healthy dietary behaviors (eg, sitting with or eating same foods as children), but at fewer centers they were observed consuming unhealthy foods (eg, fast foods, salty snacks: 25%; and sugar-sweetened beverages: 50%). Although no substantial associations were observed between caregiver behaviors and center policies, effect size estimates suggest differences that may be of clinical significance. For example, caregivers were observed modeling healthy dietary behaviors more frequently at centers that had written policies about staff discouraging unhealthy foods for meals/snacks and having informal nutrition talks with children at meals. However, caregivers were observed consuming unhealthy foods and sugar-sweetened beverages more often at centers with policies that promoted healthier foods for meals/snacks. Future research should build on this study by using larger samples to understand why healthy food policies in child-care centers may not translate to eating practices among caregivers. Copyright © 2012 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.

  20. 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

  1. 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.

  2. 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

    been developed to improve the system as it is known today, since the Community patent is not guaranteed to be introduced in the near future. Should it be introduced, the Working Group considers that many of the policy options put forward would have an even better effect. When making its recommendations...... forward in the report includes an assessment of key patenting activity trends occurring at the moment. The analysis assesses what kind of impact these trends have on the ability of the European patent system to work well, and what are the specific challenges that arise as a result. The report identifies...... that worldwide, the most important patent trends happening now relate to the number of patent applications being made. Specifically, the fact that applications received by patent offices continue to grow steeply, resulting in high numbers of granted patent rights. One potentially undesirable consequence...

  3. Technologies and Policies to Improve Energy Efficiency in Industry

    Energy Technology Data Exchange (ETDEWEB)

    Price, Lynn; Price, Lynn

    2008-03-01

    The industrial sector consumes nearly 40% of annual global primary energy use and is responsible for a similar share of global energy-related carbon dioxide (CO2) emissions. Many studies and actual experience indicate that there is considerable potential to reduce the amount of energy used to manufacture most commodities, concurrently reducing CO2 emissions. With the support of strong policies and programs, energy-efficient technologies and measures can be implemented that will reduce global CO2 emissions. A number of countries, including the Netherlands, the UK, and China, have experience implementing aggressive programs to improve energy efficiency and reduce related CO2 emissions from industry. Even so, there is no silver bullet and all options must be pursued if greenhouse gas emissions are to be constrained to the level required to avoid significant negative impacts from global climate change.

  4. Aortic Center: specialized care improves outcomes and decreases mortality

    Directory of Open Access Journals (Sweden)

    Marcela da Cunha Sales

    2014-12-01

    Full Text Available Objective: To compare in-hospital outcomes in aortic surgery in our cardiac surgery unit, before and after foundation of our Center for Aortic Surgery (CTA. Methods: Prospective cohort with non-concurrent control. Foundation of CTA required specialized training of surgical, anesthetic and intensive care unit teams, routine neurological monitoring, endovascular and hybrid facilities, training of the support personnel, improvement of the registry and adoption of specific protocols. We included 332 patients operated on between: January/2003 to December/2007 (before-CTA, n=157, 47.3%; and January/2008 to December/2010 (CTA, n=175, 52.7%. Baseline clinical and demographic data, operative variables, complications and in-hospital mortality were compared between both groups. Results: Mean age was 58±14 years, with 65% male. Group CTA was older, had higher rate of diabetes, lower rates of COPD and HF, more non-urgent surgeries, endovascular procedures, and aneurysms. In the univariate analysis, CTA had lower mortality (9.7 vs. 23.0%, P=0.008, which occurred consistently across different diseases and procedures. Other outcomes which were reduced in CTA included lower rates of reinterventions (5.7 vs 11%, P=0.046, major complications (20.6 vs. 33.1%, P=0.007, stroke (4.6 vs. 10.9%, P=0.045 and sepsis (1.7 vs. 9.6%, P=0.001, as compared to before-CTA. Multivariable analysis adjusted for potential counfounders revealed that CTA was independently associated with mortality reduction (OR=0.23, IC 95% 0.08 – 0.67, P=0.007. CTA independent mortality reduction was consistent in the multivariable analysis stratified by disease (aneurysm, OR=0.18, CI 95% 0.03 – 0.98, P=0.048; dissection, OR=0.31, CI 95% 0.09 – 0.99, P=0.049 and by procedure (hybrid, OR=0.07, CI 95% 0.007 – 0.72, P=0.026; Bentall, OR=0.18, CI 95% 0.038 – 0.904, P=0.037. Additional multivariable predictors of in-hospital mortality included creatinine (OR=1.7 [1.1-2.6], P=0.008, urgent

  5. Making child care centers SAFER: a non-regulatory approach to improving child care center siting.

    Science.gov (United States)

    Somers, Tarah S; Harvey, Margaret L; Rusnak, Sharee Major

    2011-01-01

    Licensed child care centers are generally considered to be safe because they are required to meet state licensing regulations. As part of their licensing requirements, many states inspect child care centers and include an assessment of the health and safety of the facility to look for hazardous conditions or practices that may harm children. However, most states do not require an environmental assessment of the child care center building or land to prevent a center from being placed on, next to, or inside contaminated buildings. Having worked on several sites where child care centers were affected by environmental contaminants, the Centers for Disease Control and Prevention and the Agency for Toxic Substances and Disease Registry (ATSDR) endeavor to raise awareness of this issue. One of ATSDR's partner states, Connecticut, took a proactive, non-regulatory approach to the issue with the development its Child Day Care Screening Assessment for Environmental Risk Program.

  6. 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 ...

  7. Impact of Policies on Physical Activity and Screen Time Practices in 50 Child-Care Centers in North Carolina.

    Science.gov (United States)

    Erinosho, Temitope; Hales, Derek; Vaughn, Amber; Mazzucca, Stephanie; Ward, Dianne S

    2016-01-01

    This study assessed physical activity and screen time policies in child-care centers and their associations with physical activity and screen time practices and preschool children's (3-5 years old) physical activity. Data were from 50 child-care centers in North Carolina. Center directors reported on the presence/absence of written policies. Trained research assistants observed physical activity and screen time practices in at least 1 preschool classroom across 3 to 4 days. Children (N = 544) wore accelerometers to provide an objective measure of physical activity. Physical activity and screen time policies varied across centers. Observational data showed 82.7 min/d of active play opportunities were provided to children. Screen time provided did not exceed 30 min/d/child at 98% of centers. Accelerometer data showed children spent 38 min/d in moderate-to-vigorous physical activity and 206 min/d in sedentary activity. Policies about staff supervision of media use were negatively associated with screen time (P < .05). Contrary to expectation, policies about physical activity were associated with less time in physical activity. Clear strategies are needed for translating physical activity policies to practice. Further research is needed to evaluate the quality of physical activity policies, their impact on practice, and ease of operationalization.

  8. Analysis of Academic Medical Center Graduate Medical Education Websites for Policies Regarding Restrictive Covenants in Non-ACGME Fellowships.

    Science.gov (United States)

    Juern, Jeremy S; Stahl, David M; Weigelt, John A

    2017-10-25

    The topic of restrictive covenants in fellowships that are not approved by the Accreditation Council for Graduate Medical Education (ACGME) has not been studied. To investigate the presence of institutional polices at academic medical centers regarding restrictive covenants in non-ACGME fellowships. The graduate medical education (GME) office website of 132 academic medical centers was evaluated and searched for the following as of June 1, 2017: presence of any ACGME residency or fellowship, presence of any non-ACGME fellowship, presence of GME policies and procedures, presence of a restrictive covenant policy, and if that policy applies to non-ACGME fellowships. A total of 96 academic medical centers had non-ACGME fellowships. Of these, 56 prohibit restrictive covenants in non-ACGME fellowships because of either their GME policy or state law. Seven academic medical centers have a GME policy that allows restrictive covenants in non-ACGME fellowships. Two academic medical centers clearly state that fellows in a certain subspecialty fellowship will be required to sign a restrictive covenant. GME policies at academic medical centers that allow restrictive covenants in non-ACGME fellowships are very uncommon. The practice of having fellows sign a restrictive covenant in a non-ACGME fellowship is in conflict with an American Medical Association ethics statement, ACGME institutional requirement IV.L, and the rules of the San Francisco Match. Copyright © 2017 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

  9. 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...

  10. Societal values and policies may curtail preschool children's physical activity in child care centers.

    Science.gov (United States)

    Copeland, Kristen A; Sherman, Susan N; Kendeigh, Cassandra A; Kalkwarf, Heidi J; Saelens, Brian E

    2012-02-01

    Three-fourths of US preschool-age children are in child care centers. Children are primarily sedentary in these settings, and are not meeting recommended levels of physical activity. Our objective was to identify potential barriers to children's physical activity in child care centers. Nine focus groups with 49 child care providers (55% African American) were assembled from 34 centers (inner-city, suburban, Head Start, and Montessori) in Cincinnati, Ohio. Three coders independently analyzed verbatim transcripts for themes. Data analysis and interpretation of findings were verified through triangulation of methods. We identified 3 main barriers to children's physical activity in child care: (1) injury concerns, (2) financial, and (3) a focus on "academics." Stricter licensing codes intended to reduce children's injuries on playgrounds rendered playgrounds less physically challenging and interesting. In addition, some parents concerned about potential injury, requested staff to restrict playground participation for their children. Small operating margins of most child care centers limited their ability to install abundant playground equipment. Child care providers felt pressure from state mandates and parents to focus on academics at the expense of gross motor play. Because children spend long hours in care and many lack a safe place to play near their home, these barriers may limit children's only opportunity to engage in physical activity. Societal priorities for young children--safety and school readiness--may be hindering children's physical development. In designing environments that optimally promote children's health and development, child advocates should think holistically about potential unintended consequences of policies.

  11. Influencing Public Policy to Improve the Lives of Older Americans

    Science.gov (United States)

    Hinrichsen, Gregory A.; Kietzman, Kathryn G.; Alkema, Gretchen E.; Bragg, Elizabeth J.; Hensel, Brian K.; Miles, Toni P.; Segev, Dorry L.; Zerzan, Judy

    2010-01-01

    Aging of the U.S. population raises numerous public policy issues about which gerontological researchers, policy experts, and practitioners have much to contribute. However, the means by which aging-related public policy is influenced are not always apparent. Drawing on experience working in the U.S. Senate and other settings as Health and Aging…

  12. 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.

  13. 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.

  14. Danish energy efficiency policy: revisited and future improvements

    Energy Technology Data Exchange (ETDEWEB)

    Togeby, Mikael; Dyhr-Mikkelsen, Kirsten (Ea Energy Analyses (Denmark)); Larsen, Anders; Juel Hansen, Morten (Roskilde Univ., Dept. of Society and Globalisation, Roskilde (Denmark)); Bach, Peter (Danish Energy Authority, Copenhagen (Denmark))

    2009-07-01

    Ten groups of policy instruments for promoting energy efficiency are actively used in Denmark. Among these are the EU instruments such as the CO{sub 2} emissions trading scheme and labelling of appliances, labelling of all buildings, combined with national instruments such as high taxes especially on households and the public sector, obligations for energy companies (electricity, natural gas, district heating, and oil) to deliver documented savings, strict building codes, special instructions for the public sector, and an Electricity Saving Trust. A political agreement from 2005 states that an evaluation of the entire Danish energy efficiency policy portfolio must be carried out before end 2008 and put forward for discussion among governing parties no later than February 2009. A consortium comprising Ea Energy Analyses, Niras, the Dept. of Society and Globalisation (Roskilde Univ.) and 4-Fact was assigned with this task. The evaluation aimed to answer the crucial questions: - Is the overall design of the portfolio of instruments appropriate? - Does the impact of the instruments justify the costs, so that we reach the national goals in a cost efficient way? - Will the current instrument portfolio be able to meet the required reduction in final energy consumption (goal for 2013) and in primary energy consumption (with goals in 2011 and 2020) as planned by parliament? Recommendations were made on how to improve and develop the portfolio using cost effectiveness as well as organisational clarity as criteria in developing the recommendations. The evaluation was completed in December 2008, and this paper presents the main findings and proceeds to discuss the issues from an EU perspective.

  15. 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.

  16. 5 strategies for improving performance of academic medical centers.

    Science.gov (United States)

    Valletta, Robert M; Harkness, Alicia

    2013-06-01

    Academic medical centers should consider five strategies for becoming more cost-efficient and profitable as reforms are implemented: Make faculty responsible for cost and quality. Explore opportunities to collaborate with community hospitals. Extend care and education beyond the walls of the organization, employing technology and innovative teaching practices. Maximize healthcare IT investment by sharing data-rich patient records with other medical centers and research institutes. Align research with business strategy.

  17. Performance Centered Maintenance as a Core Policy in Strategic Maintenance Control

    OpenAIRE

    Apallius de Vos, Jack I.; van Dongen, Leonardus Adriana Maria

    2015-01-01

    Rolling stock maintenance in the Netherlands traditionally is performed on several levels of complexity and therefore on levels of non-availability and cost. The challenge in optimizing performance and cost of rolling stock maintenance is to integrate the policy on maintenance concepts, maintenance locations and maintenance intervals (what, when & where). NedTrain as a subsidiary of the Netherlands Railways is developing and implementing this improved concept of maintenance. On one hand maint...

  18. 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…

  19. 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.

  20. 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.

  1. A Clustering Classification of Spare Parts for Improving Inventory Policies

    Science.gov (United States)

    Meri Lumban Raja, Anton; Ai, The Jin; Diar Astanti, Ririn

    2016-02-01

    Inventory policies in a company may consist of storage, control, and replenishment policy. Since the result of common ABC inventory classification can only affect the replenishment policy, we are proposing a clustering based classification technique as a basis for developing inventory policy especially for storage and control policy. Hierarchical clustering procedure is used after clustering variables are defined. Since hierarchical clustering procedure requires metric variables only, therefore a step to convert non-metric variables to metric variables is performed. The clusters resulted from the clustering techniques are analyzed in order to define each cluster characteristics. Then, the inventory policies are determined for each group according to its characteristics. A real data, which consists of 612 items from a local manufacturer's spare part warehouse, are used in the research of this paper to show the applicability of the proposed methodology.

  2. Improving The Oral Health Care Capacity Of Federally Qualified Health Centers.

    Science.gov (United States)

    Crall, James J; Pourat, Nadereh; Inkelas, Moira; Lampron, Colleen; Scoville, Richard

    2016-12-01

    Despite efforts that increased dental visits at federally qualified health centers (FQHCs) by 65 percent between 2007 and 2014, only 21 percent of FQHC patients received dental services in 2015-not altogether surprising, given that most such facilities do not offer dental services on site. Many of these facilities are part of multisite organizations that offer dental services at other locations; however, sites with co-located dental and medical services often serve only a fraction of their primary care patients. This article describes an initiative, funded by First 5 LA and led by the University of California, Los Angeles (UCLA), designed to improve access to and quality of oral health care for young children at twenty Los Angeles County FQHCs with co-located medical and dental services. The UCLA-First 5 LA Oral Health Program supported infrastructure enhancements, technical assistance, clinical training, quality improvement, health education for parents and caregivers, and related policy analyses. Findings demonstrate a twofold increase in diagnostic and treatment services capacity for young children and a threefold increase in preventive services capacity after two years. Investments in infrastructure, plus support for training and quality improvement focused on medical and dental integration, were crucial to these capacity increases. Project HOPE—The People-to-People Health Foundation, Inc.

  3. 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 ...

  4. Toward Improvement of Credit Policies on Guaranteed Student Loans.

    Science.gov (United States)

    Shay, Robert P.

    Four aspects of the Guaranteed Student Loan (GSL) Program are compared with credit policies on other loans made by consumer installment lenders. The four aspects are: (1) the planning, screening, monitoring, collecting, and write-off policies on GSLs versus uninsured loans; (2) the importance of the Student Loan Marketing Association in providing…

  5. 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…

  6. Societal Values and Policies May Curtail Preschool Children’s Physical Activity in Child Care Centers

    Science.gov (United States)

    Sherman, Susan N.; Kendeigh, Cassandra A.; Kalkwarf, Heidi J.; Saelens, Brian E.

    2012-01-01

    BACKGROUND AND OBJECTIVES: Three-fourths of US preschool-age children are in child care centers. Children are primarily sedentary in these settings, and are not meeting recommended levels of physical activity. Our objective was to identify potential barriers to children’s physical activity in child care centers. METHODS: Nine focus groups with 49 child care providers (55% African American) were assembled from 34 centers (inner-city, suburban, Head Start, and Montessori) in Cincinnati, Ohio. Three coders independently analyzed verbatim transcripts for themes. Data analysis and interpretation of findings were verified through triangulation of methods. RESULTS: We identified 3 main barriers to children’s physical activity in child care: (1) injury concerns, (2) financial, and (3) a focus on “academics.” Stricter licensing codes intended to reduce children's injuries on playgrounds rendered playgrounds less physically challenging and interesting. In addition, some parents concerned about potential injury, requested staff to restrict playground participation for their children. Small operating margins of most child care centers limited their ability to install abundant playground equipment. Child care providers felt pressure from state mandates and parents to focus on academics at the expense of gross motor play. Because children spend long hours in care and many lack a safe place to play near their home, these barriers may limit children's only opportunity to engage in physical activity. CONCLUSIONS: Societal priorities for young children—safety and school readiness—may be hindering children’s physical development. In designing environments that optimally promote children’s health and development, child advocates should think holistically about potential unintended consequences of policies. PMID:22218842

  7. Improving the physical activity and nutrition environment through self-assessment (NAP SACC) in rural area child care centers in North Carolina.

    Science.gov (United States)

    Battista, Rebecca A; Oakley, Hillary; Weddell, Melissa S; Mudd, Lanay M; Greene, J B; West, Stephanie T

    2014-10-01

    To determine if child care centers in rural, Western North Carolina met recommendations for nutrition and physical activity, if focusing on nutrition and physical activity practices and policies was effective in improving the center environment, and if differences existed between centers affiliated or unaffiliated with schools. Of 33 child care centers in three counties, 29 submitted mini-grant requests and participated in a pre-post evaluation using Nutrition and Physical Activity Self-Assessment for Child Care (NAP SACC). NAP SACC assesses compliance for nutrition and physical activity recommendations and standards. Between October 2011 and April 2012, centers participated in workshops and goal setting specific to nutrition and physical activity. At baseline, over 95% of the centers met all recommendations. However, post-intervention, Wilcoxon Signed Ranks Test (pcenter types in five out of 37 nutrition and seven out of 17 physical activity standards following the intervention. Centers unaffiliated with schools made significant changes in ten nutrition standards, while those affiliated with schools improved in only two standards and decreased on one standard. Overall, rural child care centers in Western North Carolina were meeting standards, they were still able to strengthen policies and practices by following NAP SACC. This was especially true for centers unaffiliated with schools. Continued financial support may assist centers in sustaining increased physical activity in children. Copyright © 2014 The Authors. Published by Elsevier Inc. All rights reserved.

  8. Improving Training Cost Information at the Naval Avionics Center

    Science.gov (United States)

    1991-12-01

    Interviews with senior NAC managers were conducted to determine the most valuable courses. Senior managers at NAC (civil service GM 13-15) were interviewed...for the services rendered. The only additional training input to the Comptroller Department is the engineer’s weekly labor distribution card. From this...information exchange. 29 RECOMMENDED TRAINING COST ACCOUNTING SYSTEM DIVISION DTIE REPORTS MANAGERS BY INDMDUAL REPORTS BY COST CENTER SOFWARE SOFTWARE N VAX

  9. 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.

  10. Opportunities for Improving Cancer Prevention at Federally Qualified Health Centers

    OpenAIRE

    Allen, Claire L.; Harris, Jeffrey R.; Hannon, Peggy A.; Parrish, Amanda T.; Hammerback, Kristen; Craft, John; Gray, Bruce

    2013-01-01

    As the Affordable Care Act unfolds, federally qualified health centers (FQHCs) will likely experience an influx of newly insured, low-income patients at disparate risk for cancer. Cancer-focused organizations are seeking to collaborate with FQHCs and the Primary Care Associations (PCAs) that serve them, to prevent cancer and reduce disparities. To guide this collaboration, we conducted 21 interviews with representatives from PCAs and FQHCs across four western states. We asked about: FQHC prio...

  11. 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.

  12. 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.

  13. Improving documentation of oral chemotherapy at a community cancer center.

    Science.gov (United States)

    Enright, Katherine; MacMillan, Meghan; Lymburner, Patricia; Sodoski, Catherine; Gollee, Simerjit; Carvalho, Maritza; Van Dorn, Laurie; Fung, Ron; Almeida, Bernadette

    2015-05-01

    Safe administration of oral chemotherapy is a complex process that represents a potential threat to patient safety. Clear documentation of the plan of care for patients receiving oral chemotherapy can improve patient safety by ensuring complete health information is available to the health care team. We undertook a rapid-cycle improvement project to improve documentation of oral chemotherapy by increasing the number of components of an oral chemotherapy care plan (as outlined by American Society of Clinical Oncology and Oncology Nursing Society) documented in the medical record before starting a new oral chemotherapy drug. Three improvement cycles were implemented, including: introduction of a standardized nursing flow sheet, use of computerized physician order entry for oral chemotherapy prescribing, and a review of computerized physician order entry to ensure all oral chemotherapy regimens were included. Our intervention resulted in a meaningful and sustained improvement in the number of components of oral chemotherapy care plans documented in the medical record, from a mean of 67% (eight of 12 components) to a mean of 92% (11 of 12). We are hopeful that this improvement project will enhance patient safety by improving communication within the health care team regarding the details of the chemotherapy care plan. Copyright © 2015 by American Society of Clinical Oncology.

  14. Asymmetric Cache Coherency: Policy Modifications to Improve Multicore Performance

    OpenAIRE

    Shield, John; Diguet, Jean-Philippe; Gogniat, Guy

    2012-01-01

    International audience; Asymmetric coherency is a new optimisation method for coherency policies to support non-uniform work- loads in multicore processors. Asymmetric coherency assists in load balancing a workload and this is applica- ble to SoC multicores where the applications are not evenly spread among the processors and customization of the coherency is possible. Asymmetric coherency is a policy change, and consequently our designs re- quire little or no additional hardware over an exis...

  15. 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

  16. Using quality improvement methods to improve door-to-balloon time at an academic medical center.

    Science.gov (United States)

    Huang, Robert L; Donelli, Anderson; Byrd, Jeannie; Mickiewicz, Marc A; Slovis, Corey; Roumie, Christianne; Elasy, Tom A; Dittus, Robert S; Speroff, Ted; Disalvo, Tom; Zhao, David

    2008-02-01

    1) Describe a quality improvement (QI) process to decrease door-to-balloon time (D2B); 2) Explain implementation of evidence-based strategies to improve D2B. The ACC/AHA 2006 guideline target for ST-elevation myocardial infarction (STEMI) is a D2B of 90 minutes (min). QI methods can be used to identify areas for improvement, measure current processes, and provide rapid-cycle feedback about which strategies are effective. We studied all STEMI patients presenting to Vanderbilt University Medical Center from July 2005 through November 2006. A process flow chart was created and all D2B process steps were analyzed. In February 2006, evidence-based strategies were implemented to address bottlenecks and decrease D2B. Statistical process control (SPC) was used to monitor D2B time in real-time. Targeted changes led to a 44 min decrease (p < 0.001) in overall median D2B time from 108 min (interquartile range [IQR] = 94-122 min) to 64 min (IQR = 56-94 min). Subinterval time periods for emergency department (ED)-to-electrocardiogram (ECG) time decreased by 7 min (p = 0.008), ECG-to-cardiac catheterization laboratory (CCL) time decreased by 18 min (p = 0.01), and CCL-to-balloon time decreased by 4 min (p = 0.19). After implementation, SPC charts revealed a 50% decrease in the central mean line and narrower control limits indicating more reliable performance. Using QI methods of flow-charting, identifying bottlenecks, targeting strategies to bottleneck areas, and real-time monitoring with SPC and rapid-cycle feedback, D2B processes can be systematically redesigned for improvement. QI methods can be used by individual institutions to customize and implement strategies for their particular context.

  17. 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...

  18. The National Quality Improvement Center on the Privatization of Child Welfare Services: A Program Description

    Science.gov (United States)

    Collins-Camargo, Crystal; Ensign, Karl; Flaherty, Chris

    2008-01-01

    Quality improvement centers were created by the U.S. Department of Health and Human Services' Children's Bureau beginning in 2001 to promote knowledge development through an innovative approach to applied collaborative research in child welfare. The National Quality Improvement Center on the Privatization of Child Welfare Services was funded to…

  19. Technology assessment in Australia : the case for a formal agency to improve advice to policy makers

    NARCIS (Netherlands)

    Russell, A. Wendy; Vanclay, Frank M.; Salisbury, Janet G.; Aslin, Heather J.

    The pace and reach of technological change has led to calls for better technology policy and governance to improve social outcomes. Technology assessment can provide information and processes to improve technology policy. Having conducted a review of international best practice, we established a set

  20. 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.

  1. 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 stability...

  2. 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.

  3. 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...... these and the other challenges identified in the report. Instead, the Working Group believes a package of interrelated options is more suitable. This reflects the intricacy of the policy situation and mirrors the many connected and complex fields involved. For instance, the workings of the European patent system...

  4. 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

  5. The Role of Charter Schools in Improving Education. Policy Brief

    Science.gov (United States)

    Bodilly, Susan; Li, Jennifer

    2009-01-01

    This is one in a series of policy briefs on key education issues prepared by the RAND Corporation for the Obama administration. Despite controversy, charter schools are increasing in numbers as alternatives to traditional public schools. Research finds that charter schools do not produce the predicted negative effects and that they have some…

  6. 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...

  7. 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.

  8. 75 FR 52374 - National Environmental Policy Act; NASA Glenn Research Center Plum Brook Station Wind Farm Project

    Science.gov (United States)

    2010-08-25

    ...; NASA Glenn Research Center Plum Brook Station Wind Farm Project AGENCY: National Aeronautics and Space... Environmental Impact Statement (EIS) for the NASA GRC Plum Brook Station Wind Farm Project located near Sandusky... at Plum Brook Station, which will enable NASA to meet the objectives of the Energy Policy Act of 2005...

  9. 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…

  10. 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

    challenge identified is that new subject matter and science-based inventions are making it harder for examiners to accurately assess patentability requirements. And this may mean that undesirably broad rights are being granted in emerging technologies. No single all-embracing policy strategy is able to meet......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...

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

    Science.gov (United States)

    2014-06-01

    Convention on the Law of the Sea URL uniform resource locator USAID United States Agency for International Development USG United States government UTA ...its foreign policies and messaging toward China based on the wide variety of feedback it receives from social networks and internet traffic, UTA ...67  a.  Step One . Is it in the National Interest? If yes, continue. .....67  b.  Step Two. Communicating Diplomatic Intent: A

  12. 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

  13. 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…

  14. 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.

  15. 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…

  16. 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…

  17. How to improve Open Education and (re-)use of OER by policies and open licenses?

    NARCIS (Netherlands)

    Stracke, Christian M.

    2017-01-01

    Stracke, C. M. (2017, 8 March). How to improve Open Education and (re-)use of OER by policies and open licenses? Panel Presentation at International OE Global Conference, Cape Town, South Africa. More information about the Panel:

  18. 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.

  19. Policies and Practices for Improving Student Bus Behavior: A Delphi Study

    OpenAIRE

    Cornett, Joshua Stephen

    2015-01-01

    Students' behavior on buses continues to be an issue that requires administrators to spend significant time investigating and applying consequences for the behavior (Neatrour, 1994; Pattington, 1945; Putnam, Handler, Ramirez-Plat, and Luiselli, 2003). The purpose of this study was to identify policies and practices that may improve student bus behavior. Two research questions were addressed: (a) What policies could school districts implement to facilitate the improvement of student bus beh...

  20. Course Redesign Improves Learning and Reduces Cost. Policy Alert

    Science.gov (United States)

    Twigg, Carol A.

    2005-01-01

    American Colleges and Universities are continuously challenged to increase access to higher education, improve the quality of student learning, and control or reduce the rising cost of instruction. These challenges are interrelated. As tuition costs continue to rise, access is curtailed. When high failure rates prevent students from successfully…

  1. 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.

  2. 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)

  3. 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…

  4. 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.

  5. Assessment of family-centered care policies and practices for pediatric patients in nine US emergency departments.

    Science.gov (United States)

    Eckle, N; MacLean, S L

    2001-06-01

    Family-centered care recognizes the integral role of the family in the health and well-being of the pediatric patient. However, implementing a family-centered care approach often requires significant philosophical, practice, and environmental changes. A self-assessment inventory of family-centered practices can identify areas for change. ENA conducted a validation study on an instrument used to assess family-centered care in the emergency department. Nine emergency departments of varying demographics used the Family-centered Care Self-assessment Inventory to evaluate their family-centered care practices. The inventory is organized into 7 sections: (1) vision, mission, and philosophy of care; (2) family support; (3) information and decision making; (4) services coordination and continuity; (5) personnel practices; (6) quality improvement; and (7) community partnerships. Individual and group interviews were completed with a variety of staff in each emergency department. All 9 emergency departments demonstrated some integration of family-centered care principles. However, staff knowledge about family-centered care varied. Support of family-centered care was most consistent in the departments with specific competencies, educational programs, and practices that were inclusive of the family. The Family-centered Care Self-assessment Inventory tool was effective in evaluating family-centered care for pediatric patients in emergency departments. The assessment tool helped the departments to identify current family-centered care practices. Based on those assessments, the departments were able to identify areas of strength and opportunities for improvement in the care of children and their families.

  6. 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

  7. SOCIAL POLICY CENTERED APPROACH ON GENDER DISCRIMINATION IN TURKEY: A SITUATIONAL ANALYSIS

    OpenAIRE

    YÜKSEL, HASAN; ÖZTÜRK, MUSTAFA; ESER, H.BAHADIR

    2015-01-01

    As a field of science, social policy is the term that deals with the problems which appeal to all the units of the society including both men and women. In other words, as the concept of umbrella term, social policy within the framework of gender discrimination develops strategies and analyses data on both sexes in regards to employment, education, health, and so forth. In parallel to the objectives of social policy, it tries hard to close the gap between the women and men by laying an emphas...

  8. 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

  9. 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…

  10. Quality improvements in resident mobility care: using person- and relationship-centered frameworks.

    Science.gov (United States)

    Taylor, Janice Anne; Sims, Jane; Haines, Terry P

    2014-06-01

    Research is needed to demonstrate the application of person- and relationship-centered care to nursing home practice. This article aimed to find a suitable person/relationship-centered framework to assist with mobility care practice improvements in nursing homes. The authors discuss the task of mobility care, the nature of person- and relationship-centered care, and the significance of such approaches to mobility care. The Senses Framework (Nolan, Davies, Ryan, & Keady, 2008) is employed to develop mobility care practice improvement objectives. The objectives are used to evaluate outcomes from 2 hypothetical scenarios to illustrate the possible value of the Senses Framework. The Senses Framework facilitated development of objectives for mobility care practice improvement that considers the needs of all stakeholders.

  11. 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.)

  12. Evidence-informed policy formulation and implementation: a comparative case study of two national policies for improving health and social care in Sweden.

    Science.gov (United States)

    Strehlenert, H; Richter-Sundberg, L; Nyström, M E; Hasson, H

    2015-12-08

    Evidence has come to play a central role in health policymaking. However, policymakers tend to use other types of information besides research evidence. Most prior studies on evidence-informed policy have focused on the policy formulation phase without a systematic analysis of its implementation. It has been suggested that in order to fully understand the policy process, the analysis should include both policy formulation and implementation. The purpose of the study was to explore and compare two policies aiming to improve health and social care in Sweden and to empirically test a new conceptual model for evidence-informed policy formulation and implementation. Two concurrent national policies were studied during the entire policy process using a longitudinal, comparative case study approach. Data was collected through interviews, observations, and documents. A Conceptual Model for Evidence-Informed Policy Formulation and Implementation was developed based on prior frameworks for evidence-informed policymaking and policy dissemination and implementation. The conceptual model was used to organize and analyze the data. The policies differed regarding the use of evidence in the policy formulation and the extent to which the policy formulation and implementation phases overlapped. Similarities between the cases were an emphasis on capacity assessment, modified activities based on the assessment, and a highly active implementation approach relying on networks of stakeholders. The Conceptual Model for Evidence-Informed Policy Formulation and Implementation was empirically useful to organize the data. The policy actors' roles and functions were found to have a great influence on the choices of strategies and collaborators in all policy phases. The Conceptual Model for Evidence-Informed Policy Formulation and Implementation was found to be useful. However, it provided insufficient guidance for analyzing actors involved in the policy process, capacity-building strategies

  13. 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 (pinterventions had clinically meaningful associations with reduced stage III and IV HAPU incidence rates in 55 academic medical centers. These QI interventions can be used in support of an evidence-based prevention protocol for pressure ulcers. Hospitals can not only use these findings from this study as part of a QI bundle for preventing HAPUs.

  14. Can all cause readmission policy improve quality or lower expenditures? A historical perspective on current initiatives.

    Science.gov (United States)

    Burgess, James F; Hockenberry, Jason M

    2014-04-01

    All-cause readmission to inpatient care is of wide policy interest in the United States and a number of other countries (Centers for Medicare and Medicaid Services, in the United Kingdom by the National Centre for Health Outcomes Development, and in Australia by the Australian Institute of Health and Welfare). Contemporary policy efforts, including high powered incentives embedded in the current US Hospital Readmission Reduction Program, and the organizationally complex interventions derived in anticipation of this policy, have been touted based on potential cost savings. Strong incentives and resulting interventions may not enjoy the support of a strong theoretical model or the empirical research base that are typical of strong incentive schemes. We examine the historical broad literature on the issue, lay out a 'full' conceptual organizational model of patient transitions as they relate to the hospital, and discuss the strengths and weaknesses of previous and proposed policies. We use this to set out a research and policy agenda on this critical issue rather than attempt to conduct a comprehensive structured literature review. We assert that researchers and policy makers should consider more fundamental societal issues related to health, social support and health literacy if progress is going to be made in reducing readmissions.

  15. 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.

  16. 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.

  17. Comparing the implementation of team approaches for improving diabetes care in community health centers

    NARCIS (Netherlands)

    Wees, P.J. van der; Friedberg, M.W.; Guzman, E.; Ayanian, J.Z.; Rodriguez, H.P.

    2014-01-01

    BackgroundPatient panel management and community-based care management may be viable strategies for community health centers to improve the quality of diabetes care for vulnerable patient populations. The objective of our study was to clarify implementation processes and experiences of integrating

  18. 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…

  19. 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...

  20. 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.

  1. 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

  2. IMPROVING TBO OF FREIGHT CAR BOGIES. GEOMETRY MODEL OF CENTER PAD WEAR

    Directory of Open Access Journals (Sweden)

    L. A. Muradian

    2017-02-01

    Full Text Available Purpose. The scientific work is aimed to: 1 analyze the technical condition of freight cars and technological methods used in the repair; 2 identify possible ways to improve resource of freight car bogies; 3 develop a mathematical model to describe the wear geometry of the original surface of bogie center pad at the corresponding life cycle of a freight car. Methodology. In order to solve the problem complex of increasing TBO of freight car bogies the methods for the synthesis, analysis and systematic approach were used. In addition, the use of mathematical modeling unit, solid state physics, the theory of friction and wear of solids. Findings. The analysis of the technical condition of freight cars has shown that up to 15% of the faults falls on the bogies. A separate element of the repaired bogie is a bolster. At this the center pad is recovered most often. The center pad wear is uneven and the technological methods used for the repair, do not allow providing uniform wear due to which there is a need in premature repairs. One of the ways to improve the center pad resource during repair is the application of welding or sputtering deposition, but with providing discrete strength and durability in the longitudinal and transverse directions of the car axis, respectively. In order to establish the boundaries of the distribution of renewable material along the center pad diameter it was considered the fatigue wear process in cooperation with center plate and described the geometry of the surface of the center pad wear. Originality. Technical condition of freight car bogies according to wear criterion was analyzed in the paper. It is shown that the dynamics of bogie faults has a positive character. In addition, a significant place among the repaired parts takes the bolster, and a special loaded place is the center pad. To describe the geometry of wear for the first time a mathematical model for determining the initial surface of the center pad in the

  3. Performance Centered Maintenance as a Core Policy in Strategic Maintenance Control

    NARCIS (Netherlands)

    Apallius de Vos, Jack I.; van Dongen, Leonardus Adriana Maria

    2015-01-01

    Rolling stock maintenance in the Netherlands traditionally is performed on several levels of complexity and therefore on levels of non-availability and cost. The challenge in optimizing performance and cost of rolling stock maintenance is to integrate the policy on maintenance concepts, maintenance

  4. Screening Mental Health Problems in Schools. A Center Policy Issues Analysis Brief

    Science.gov (United States)

    Center for Mental Health in Schools at UCLA, 2007

    2007-01-01

    Long-standing policy controversies have heated up as a result of increasing proposals for using schools to screen for mental health problems (e.g., depression screening). This brief highlights the following issues: (1) How appropriate is large-scale screening for mental health problems? (2) Will the costs of large-scale mental health screening…

  5. 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.

  6. 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

  7. 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.

  8. 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, missed...... appointments, and general discomfort. In this poster we report on preliminary findings from a project aimed at creating improved IT support for coordination of care for the elderly in a Danish municipality. We propose that in order to successfully support heterogeneous collaboration, our system must address...

  9. Traces of Old and New Center-Periphery Dynamics in Language-in-Education Policy and Practice: Insights from a Linguistic Ethnographic Study in Timor-Leste

    Science.gov (United States)

    Da Costa Cabral, Ildegrada; Martin-Jones, Marilyn

    2017-01-01

    This article reveals how center-periphery relations have unfolded, over time, in language policy processes in one nation--Timor-Leste--on the global periphery. We take a "longue durée" perspective on the language policy processes at work in this historical context, showing how different regimes of language were imposed, in the past, by…

  10. Do Father-Friendly Policies Promote Father-Friendly Child-Rearing Practices? A Review of Swedish Parental Leave and Child Health Centers

    Science.gov (United States)

    Wells, Michael B.; Sarkadi, Anna

    2012-01-01

    By reviewing the literature, we looked at how parental leave policies in Sweden have influenced two well-defined areas of early father involvement: participating in parental leave and at visits/activities at the Child Health Centers. Sweden has one of the most comprehensive and egalitarian parental leave policies in the world, permitting parents…

  11. Foreign and Security Policy of the Newly Independent States: Balancing between Two Power Centers

    Directory of Open Access Journals (Sweden)

    Sergiy G. Fedunyak

    2014-12-01

    Full Text Available The article is focusing on the interplay between foreign policy agenda of the post-Soviet states at the one hand and internal policy developments in these countries at the other hand. One of the main explanations why the post-Soviet elites in non-Russian republics are pursuing the so-called multi-vectorialism in the foreign policy is that it serves as a strategy to maximize the most from having good relations both with East and West, and thus trying to perpetuate the monopoly of the power. Uzbekistan is a country in case, as Ukraine (and Moldova is (or was indeed also. At the same time, the special relations between the elites of post-Soviet countries and Moscow are very important in shaping the foreign policy agenda of these countries as a result of the Soviet legacy, i.e. the ties of the former Communist nomenklatura with Moscow are still playing a very important role in the most of the former Soviet republics. Another relevant variable in explaining the current state of affairs in the foreign and security issues of the post-Soviet states and the still dominant role of Russia is the fact that the West (NATO and EU especially are not very successful in trying to limit Moscow’s ambitions in the “near abroad”. This is making the leaders of most NIS to be obedient to Russia’s pretensions in lack of real support from the West in order to counteract these neo-imperial claims from the part of the former metropolis.

  12. Developing a frenotomy policy at one medical center: a case study approach.

    Science.gov (United States)

    Masaitis, N S; Kaempf, J W

    1996-09-01

    The objective of this study was to change procedures in our medical center regarding frenotomy for ankyloglossia (tongue-tie). The medical and breastfeeding outcomes of 36 fullterm infants who received frenotomies were studied. The information was used to develop frenotomy eligibility standards that would guide other physicians and insure timely treatment to avoid breastfeeding cessation.

  13. Student Centered Policies and Practices Help Students 'At Risk' Earn High School Diploma.

    Science.gov (United States)

    Pollard, Connie J.; Thorne, Tom

    2003-01-01

    A Wyoming alternative high school successfully graduates at-risk students because of its student-centered environment. Flexibility in the timelines to earn credits, a cross-disciplinary curriculum, community partnerships, and meaningful career enterprises offer the "person-environment fit" needed by students at risk. Student counseling…

  14. Understanding Quality in Context: Child Care Centers, Communities, Markets, and Public Policy

    Science.gov (United States)

    Rohacek, Monica; Adams, Gina C.; Kisker, Ellen E.

    2010-01-01

    Early care and education can prepare children for school, but while some preschool and child care programs do an excellent job, others are inadequate and some may even harm healthy development. This study focuses on child care center directors to better understand why there is so much variation, and how public initiatives can better help…

  15. An improvement in the appointment scheduling in primary health care centers using data mining.

    Science.gov (United States)

    Cubillas, Juan José; Ramos, M Isabel; Feito, Francisco R; Ureña, Tomás

    2014-08-01

    An optimal resource management in health care centers implies the use of an appropriate timetabling scheme to schedule appointments. Timetables of health centers are usually divided into time slots whose duration is equal to time required for clinical attendance. However doctors perform a series of tasks that are not always clinical in nature: issuing prescriptions or prescribing sick leave certificates. In this sense the time spent in attending a clinical or an administrative matter is different. This last required less time to attend the patient. This study is focused in the administrative task. A predictive model is generated to provide daily information on how many patients will go to the health center for an administrative issue. The accuracy of the model is less than 4,6 % absolute error and the improvement in scheduling appointments is a time saving of 21,73 %.

  16. 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

  17. 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.

  18. 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)

  19. 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.

  20. 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

  1. 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.

  2. One kidney transplant center's experience: linking process improvements and Medicare/Medicaid conditions of participation.

    Science.gov (United States)

    Escobedo, Wendy; Hosseinpour, Peter; Abe, Marlene; Cecka, J Michael; Ruzics, Ervin P

    2009-12-01

    An institutional priority toward transplantation, dedicated team dynamics, aggressive clinical growth, and optimal care practices are essential for delivering exceptional care to transplant patients. The importance of multidisciplinary integration of these priorities throughout the continuum of patient care is widely recognized in the transplant arena as well as by the Centers for Medicare and Medicaid Services (CMS). In fact, it is the collaboration within these aspects of care that is necessary for certification by CMS. To establish institution-wide practices, systems, and mechanisms to optimize performance of transplant centers through the use of evidence-based protocols, clinical innovation, and data-driven quality improvements. To develop training programs and competency based orientation addressing the topics needed for transplant nurses, multidisciplinary caregivers, and clinical transplant coordinators who provide care to transplant patients. To comply with the CMS conditions of participation for transplant centers. Formation of a renal transplant council and multidisciplinary care team. Flow chart of hospital course from admission to discharge, carefully examining patients' progression through the continuum of care, assessing for barriers to care and knowledge deficits of transplant practitioners. Development of multiple clinical process improvements resulting in the creation of an environment for continuous learning, optimal transplant care, and exceptional outcomes in transplantation as well as compliance with CMS conditions of participation for transplant centers.

  3. 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.

  4. 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.

  5. Strategies for improving attendance at medical grand rounds at an academic medical center.

    Science.gov (United States)

    Mueller, Paul S; Litin, Scott C; Sowden, Monica L; Habermann, Thomas M; LaRusso, Nicholas F

    2003-05-01

    To evaluate, in this before-and-after study, the results of 5 strategies for improving attendance at medical grand rounds at a tertiary care academic medical center. The strategies included (1) using electronic card readers to improve understanding of attendance patterns, (2) conducting yearly needs assessment surveys, (3) developing sessions of topical interest, (4) increasing formal participation by residents and faculty researchers, and (5) enhancing publicity. Attendance at medical grand rounds by Mayo Clinic faculty, fellows, residents, and others was measured by card readers between 1998 and 2001. After implementation of the 5 strategies, the mean +/- SD attendance (as measured by card readers) at medical grand rounds increased 39% from 99.0 +/- 24.6 persons in 1998 to 137.4 +/- 25.2 persons in 2001 (P attendance at medical grand rounds at an academic medical center.

  6. 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.

  7. NASA's Marshall Space Flight Center Improves Cooling System Performance

    Energy Technology Data Exchange (ETDEWEB)

    None

    2011-02-22

    National Aeronautics and Space Administration’s (NASA) Marshall Space Flight Center (MSFC) has a longstanding sustainability program that revolves around energy and water efficiency as well as environmental protection. MSFC identified a problematic cooling loop with six separate compressor heat exchangers and a history of poor efficiency. The facility engineering team at MSFC partnered with Flozone Services, Incorporated to implement a comprehensive water treatment platform to improve the overall efficiency of the system.

  8. 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

  9. 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.

  10. Meaningful Use in Chronic Care: Improved Diabetes Outcomes Using a Primary Care Extension Center Model.

    Science.gov (United States)

    Cykert, Samuel; Lefebvre, Ann; Bacon, Thomas; Newton, Warren

    The effect of practice facilitation that provides onsite quality improvement (QI) and electronic health record (EHR) coaching on chronic care outcomes is unclear. This study evaluates the effectiveness of such a program-similar to an agricultural extension center model-that provides these services. Through the Health Information Technology for Economic and Clinical Health (HITECH) portion of the American Recovery and Reinvestment Act, the North Carolina Area Health Education Centers program became the Regional Extension Center for Health Information Technology (REC) for North Carolina. The REC program provides onsite technical assistance to help small primary care practices achieve meaningful use of certified EHRs. While pursuing meaningful use functionality, practices were also offered complementary onsite advice regarding QI issues. We followed the first 50 primary care practices that utilized both EHR and QI advice targeting diabetes care. The achievement of meaningful use of certified EHRs and performance of QI with onsite practice facilitation showed an absolute improvement of 19% in the proportion of patients who achieved excellent diabetes control (hemoglobin A1c 9%) fell steeply in these practices. No control group was available for comparison. Practice facilitation that provided EHR and QI coaching support showed important improvements in diabetes outcomes in practices that achieved meaningful use of their EHR systems. This approach holds promise as a way to help small primary care practices achieve excellent patient outcomes. ©2016 by the North Carolina Institute of Medicine and The Duke Endowment. All rights reserved.

  11. 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

  12. 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.

  13. 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

    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...... policy, i.e., it allows the controller to learn stabilizing the pole in the largest domain of initial conditions compared to the results obtained when using a single learning mechanism. This model can also find a successful control policy for goal-directed behavior, i.e., the robot can effectively learn...

  14. 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

  15. Emergent mechanical support in the community: improvement with early transplant center referral.

    Science.gov (United States)

    Morris, Rohinton J; Pochettino, Alberto; O'Hara, Marylou; Gardner, Timothy J; Acker, Michael A

    2005-06-01

    Emergent mechanical support for the failing ventricle, with eventual transfer for definitive care, is often required at non-transplant centers. Transfer for definitive care, in terms of bridge to transplant, may require ventricular assist device (VAD) placement at the primary institution or at the transplant center. Review of consecutive single transplant center referrals was conducted to decipher optimal management. From January 1997 to December 2000, 104 patients were transferred to the University of Pennsylvania Heart Failure/Transplant Service. Most were transferred from active cardiac surgical programs, with 56 patients having post-cardiotomy failure at the primary site. A VAD was placed in procedures done at the outside hospital (OSH) in 28 patients, most commonly (60%) an Abiomed device. Of the 76 patients that received a VAD at the transplant center (TxpC), 86% received a TCI or Thoratec device. Biventricular support was required in 34 patients. Overall survival was 57%, with 54 patients bridged to transplantation and 5 patients undergoing recovery. Patients having a VAD placed at the OSH had a 32% (9 of 28) survival, whereas at the TxpC survival was 65% (45 of 76) (p 1-year post-transplant. The most common cause of death was multi-system organ failure (19 of 45), followed by major neurologic event (15 of 45). Infection was the cause of death in only 6 patients. Left ventricular failure can be treated by emergent VAD placement. Overall survival is substantial if these patients are referred to a transplant center with multiple options. In contrast to previous reports, survival rates may be improved by earlier referral, before VAD placement at non-transplant centers and use of a VAD with longer-term capability.

  16. 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.

  17. 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.

  18. 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

  19. 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.

  20. 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.

  1. 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)

  2. 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…

  3. 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.

  4. 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.

  5. "Harnessing genomics to improve health in India" - an executive course to support genomics policy.

    Science.gov (United States)

    Acharya, Tara; Kumar, Nandini K; Muthuswamy, Vasantha; Daar, Abdallah S; Singer, Peter A

    2004-05-19

    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 ensure broad-based input

  6. "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

  7. 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.

  8. 75 FR 22357 - Center for Nutrition Policy and Promotion; Agency Information Collection Activities; Current...

    Science.gov (United States)

    2010-04-28

    ... that seek to improve eating and physical activity behaviors among children. In accordance with the... activity behaviors among children but could also expand the tools available through the MyPyramid Web site....appsforkids.com . With childhood obesity continuing to rise, the goal of the Challenge is to motivate the...

  9. Security Policy and Infrastructure in the Context of a Multi-Centeric Information System Dedicated to Autism Spectrum Disorder.

    Science.gov (United States)

    Ben Said, Mohamed; Robel, Laurence; Golse, Bernard; Jais, Jean Philippe

    2017-01-01

    Autism spectrum disorders (ASD) are complex neuro-developmental disorders affecting children in their early age. The diagnosis of ASD relies on multidisciplinary investigations, in psychiatry, neurology, genetics, electrophysiology, neuro-imagery, audiology and ophthalmology. In order to support clinicians, researchers and public health decision makers, we designed an information system dedicated to ASD, called TEDIS. TEDIS was designed to manage systematic, exhaustive and continuous multi-centric patient data collection via secured Internet connections. In this paper, we present the security policy and security infrastructure we developed to protect ASD' patients' clinical data and patients' privacy. We tested our system on 359 ASD patient records in a local secured intranet environment and showed that the security system is functional, with a consistent, transparent and safe encrypting-decrypting behavior. It is ready for deployment in the nine ASD expert assessment centers in the Ile de France district.

  10. 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.

  11. Wide variability in physical activity environments and weather-related outdoor play policies in child care centers within a single county of Ohio.

    Science.gov (United States)

    Copeland, Kristen A; Sherman, Susan N; Khoury, Jane C; Foster, Karla E; Saelens, Brian E; Kalkwarf, Heidi J

    2011-05-01

    To examine the variability of physical activity environments and outdoor play policies in child care centers and to determine whether this variability is associated with the demographic characteristics of the child care centers surveyed. Early Learning Environments Physical Activity and Nutrition Telephone Survey. Child care centers in Hamilton County (greater Cincinnati area), Ohio, during the period from 2008 to 2009. Directors of all 185 licensed full-time child care centers in Hamilton County. Descriptive measures of playground and indoor physical activity environments and weather-related outdoor play policies. Of 185 eligible child care centers, 162 (88%) responded to our survey. Of the 162 centers that responded, 151 (93%) reported an on-site playground, but slightly more than half reported that their playgrounds were large, that they were at least one-third covered in shade, or that they had a variety of portable play equipment. Only half reported having a dedicated indoor gross motor room where children could be active during inclement weather. Only 32 centers (20%) allowed children to go outside in temperatures below 32°F (0°C), and 70 centers (43%) reported allowing children outdoors during light rain. A higher percentage of children receiving tuition assistance was associated with lower quality physical activity facilities and stricter weather-related practices. National accreditation was associated with more physical activity-promoting practices. We found considerable variability in the indoor and outdoor physical activity environments offered by child care centers within a single county of Ohio. Depending on the outdoor play policy and options for indoor physical activity of a child care center, children's opportunities for physical activity can be curtailed as a result of subfreezing temperatures or light rain. Policy changes and education of parents and teachers may be needed to ensure that children have ample opportunity for daily physical

  12. Twenty years' single-center experience with mechanical heart valves: a critical review of anticoagulation policy.

    Science.gov (United States)

    Van Nooten, Guido J; Caes, Frank; François, Katrien; Van Bellleghem, Yves; Bové, Thierry; Vandenplas, Guy; Taeymans, Yves

    2012-01-01

    Since January 1990, a variety of mechanical valves (St. Jude Medical, CarboMedics, ATS Medical) have been implanted routinely at the authors' institution. The study aim was to analyze, retrospectively, the 20-year clinical results of those mechanical valves, and to challenge the anticoagulation policy employed over the years. Between January 1990 and December 2008, a total of 2,108 mechanical valves was inserted into 1,887 consecutive patients (1,346 aortic, 725 mitral, 27 tricuspid, 10 pulmonary). The mean age of the patients was 63 +/- 13.2 years, and the majority (61%) were males. Preoperatively, 71% the patients were in NYHA class > or = III (average 3.01). The most frequent comorbidities included: atrial fibrillation (n = 594), coronary disease (n = 567) and diabetes (n = 398). The follow up (99% complete) totaled 13,721 patient-years (pt-yr), and ranged from 12 to 241 months (average 84 months). In-hospital mortality was 5.2% (n = 98, 14 valve-related). Of the 629 late deaths, the majority were cardiac (n = 276). Survival (Kaplan-Meier estimation) was significantly better for aortic valve patients compared to mitral or multiple valve replacement (Mantel-Cox, p valve thrombosis 0.31, thromboembolism 1.08, and bleeding 0.91. However, as repeated events occurred in several patients, the hazard function was not constant. Multivariate analysis (Cox regression model) showed age > 70 years (p or = III (p II as significant risk factors for thromboembolism, while long-acting coumadin and NYHA class > II were significant risk factors for bleeding. This 20-year experience demonstrated excellent clinical outcomes for patients with mechanical prostheses, with no valve structural failure and an acceptable incidence of adverse events. INR values between 2-2.5 for aortic valve patients, and 3-3.5 for mitral valve patients, yielded the fewest major adverse events.

  13. 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...... is furthermore shown to be beneficial for improving throughput among weak node positions that will otherwise achieve zero throughput....

  14. 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).

  15. Standardized Physician-Administered Patient-Centered Discharge Protocol Improves Patients' Comprehension.

    Science.gov (United States)

    Caceres, Jennifer W; Alter, Scott M; Shih, Richard D; Fernandez, Jimmy D; Williams, Frederick K; Paley, Richard; Benda, William; Clayton, Lisa M

    2017-05-01

    Patients are 30% less likely to be readmitted or visit the emergency department if they have a clear understanding of their discharge instructions. A standardized approach to a hospital discharge plan has not been universally implemented, however. Our goal was to increase patients' comprehension of discharge instructions by implementing a standardized patient-centered discharge planning protocol that uses a physician team member to explain these plans. This was a prospective study that included all of the patients discharged from an inpatient medical teaching service in a community-based hospital during the study period. We used two 4-week periods separated by 4 months in which training and practice with the study intervention took place. Patients' understanding of discharge instructions was assessed via a follow-up telephone call from a physician co-investigator within 1 week of each patient's discharge. Differences in patients' understanding between groups were analyzed. A total of 181 patients were enrolled, with 9 lost to follow-up. After implementation of the discharge planning protocol, a statistically significant improvement in patients' understanding was found in study subjects' knowledge of their diagnosis, the adverse effects of their medications, whom to call after discharge, and follow-up appointments. Institution of a standardized patient-centered discharge planning protocol can improve patients' understanding of several key components of their discharge process, which may lead to improved compliance with instructions and outcomes.

  16. 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.

  17. Wind tunnel productivity status and improvement activities at NASA Langley Research Center

    Science.gov (United States)

    Putnam, Lawrence E.

    1996-01-01

    Over the last three years, a major effort has been underway to re-engineering the way wind tunnel testing is accomplished at the NASA Langley Research Center. This effort began with the reorganization of the LaRC and the consolidation of the management of the wind tunnels in the Aerodynamics Division under one operations branch. This paper provides an overview of the re-engineering activities and gives the status of the improvements in the wind tunnel productivity and customer satisfaction that have resulted from the new ways of working.

  18. 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.

  19. Improving the quality of data in your database: lessons from a cardiovascular center.

    Science.gov (United States)

    Haan, Constance K; Adams, Mark; Cook, Ray

    2004-12-01

    Creating and having a database should not be an end goal but rather a source of valid data and a means for generating information by which to assess process, performance, and outcome quality. The Cardiovascular Center at Shands Jacksonville (Florida) made measurable improvements in the quality of data in national registries and internally available software tools for collection of patient care data. The process of data flow was mapped from source to report submission to identify input timing and process gaps, data sources, and responsible individuals. Cycles of change in data collection and entry were developed and the improvements were tracked. Data accuracy was improved by involving all caregivers in datasheet completion and assisting them with data-field definitions. Using hospital electronic databases decreased the need for manual retrospective review of medical records for datasheet completion. The number of fields with missing values decreased by 83.6%, and the number of missing values decreased from 31.2% to 1.9%. Data accuracy rose dramatically by realtime data entry at point of care. Key components to ensuring data quality for process and outcome improvement are (1) education of the caregiver team, (2) process supervision by a database manager, (3) commitment and explicit support from leadership,(4) increased and improved use of electronic data sources, and (5) data entry at point of care.

  20. 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.

  1. 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)

  2. 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.

  3. The evaluation of land consolidation policy in improving agricultural productivity in China.

    Science.gov (United States)

    Jin, Xiaobin; Shao, Yang; Zhang, Zhihong; Resler, Lynn M; Campbell, James B; Chen, Guo; Zhou, Yinkang

    2017-06-05

    China is presently undergoing rapid economic development and unprecedented urbanization. Concerns over food security have prompted the Chinese government to implement large-scale land consolidation projects. However, no formal evaluation has been conducted on such projects. Thus, effectiveness of land consolidation policy remains uncertain. We obtained detailed geo-spatial information for 5328 land consolidation projects implemented between 2006 and 2010, and used time-series MODIS NDVI (2006-2016) data to assess effectiveness of China's land consolidation policy in improving agricultural productivity. Our results show that the overall effectiveness of land consolidation in improving agricultural productivity is low, which lies in contrast to optimistic estimates based on regional statistical analysis and theoretical approaches. For projects (n = 560) implemented in 2006, about 29.5% showed significant (p consolidation. For 2007-2010, lower percentages (e.g., 25.9% in 2007 and 13.5% in 2010) of projects showed significant increasing trends. Furthermore, we found effectiveness of land consolidation projects displayed clear regional differences and driving factors are inconsistent with policy design. We anticipate our research to be a starting point for a more comprehensive evaluation involving longer time-series and higher spatial resolution data.

  4. 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.

  5. 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.

  6. Utilizing integrated facility design to improve the quality of a pediatric ambulatory surgery center.

    Science.gov (United States)

    Pelly, Nicole; Zeallear, Brian; Reed, Mark; Martin, Lynn

    2013-07-01

    The aim was to use Integrated Facility Design (IFD) to design a surgery center that enhances the delivery of health care by developing processes that provide highly efficient patient, family, and provider flows while adding value and utilizing costly resources effectively. Integrated Facility Design is an adaptation of the Toyota 3P (Production, Preparation, Process) Program. The goal of IFD is to accelerate development time and lower start-up costs. The use of IFD produced a savings of $30 million in project costs and enabled a completion date 3.5 months ahead of schedule. The designed patient flow processes resulted in dramatic improvements in patient, family, and provider throughput. The use of IFD in the design of a pediatric ambulatory clinic and surgery resulted in significant cost savings and improved clinical efficiency. © 2013 John Wiley & Sons Ltd.

  7. Patient-Centered Care Transition for Patients Admitted through the ED: Improving Patient and Employee Experience

    Directory of Open Access Journals (Sweden)

    Andrea Algauer BSN, RN

    2015-05-01

    Full Text Available With increasing wait times in emergency departments (ED across America, there is a need to streamline the inpatient admission process in order to decrease wait times and more important, to increase patient and employee satisfaction. One inpatient unit at New York-Presbyterian Weill Cornell Medical Center initiated a program to help expedite the inpatient admission process from the ED. The goal of the ED Bridge program is to ease the patient's transition from the ED to an inpatient unit by visiting the patient in the ED and introducing and setting expectations for the inpatient environment (i.e. telemetry alarms, roommates, hourly comfort rounds. Along with improving the patient experience, this program intends to improve the collaboration between ED nurses and inpatient nurses. With the continued support of our nurse management, hospital administrators and most important, our staff, this concept is aimed to increase patient satisfaction scores and subsequently employee satisfaction.

  8. Patient-Centered Care Transition for Patients Admitted through the ED: Improving Patient and Employee Experience.

    Science.gov (United States)

    Algauer, Andrea; Rivera, Stephanie; Faurote, Robert

    2015-05-01

    With increasing wait times in emergency departments (ED) across America, there is a need to streamline the inpatient admission process in order to decrease wait times and more important, to increase patient and employee satisfaction. One inpatient unit at New York-Presbyterian Weill Cornell Medical Center initiated a program to help expedite the inpatient admission process from the ED. The goal of the ED Bridge program is to ease the patient's transition from the ED to an inpatient unit by visiting the patient in the ED and introducing and setting expectations for the inpatient environment (i.e. telemetry alarms, roommates, hourly comfort rounds). Along with improving the patient experience, this program intends to improve the collaboration between ED nurses and inpatient nurses. With the continued support of our nurse management, hospital administrators and most important, our staff, this concept is aimed to increase patient satisfaction scores and subsequently employee satisfaction.

  9. 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

  10. 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

  11. 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.

  12. 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.

  13. 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

  14. 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.

  15. A Quality Improvement Project to Increase Nurse Attendance on Pediatric Family Centered Rounds.

    Science.gov (United States)

    Aragona, Elena; Ponce-Rios, Jose; Garg, Priya; Aquino, Julia; Winer, Jeffrey C; Schainker, Elisabeth

    2016-01-01

    Family centered rounds (FCR) occur at the bedside and include the patient and their family when creating a daily medical care plan. Despite recommendations that family centered rounds (FCR) with nursing staff be standard practice, nurses were frequently absent from FCR at our institution. To increase nurse attendance on hospitalist FCR to 80% in three months. Secondary outcomes were to investigate the relationship between nurse-to-patient ratio and nurse attendance, and to assess for change in perception toward FCR. This resident driven interrupted time series study included a focus group to identify barriers to nurse attendance on FCR, four plan-do-study-act cycles, and surveys to assess for changes in perceptions toward FCR. Control charts, SHEWHART rules, linear regression and chi squared analysis were used for data analysis. Nurse attendance on FCR improved from 30% to 59%. There was no correlation between nurse-to-patient ratio and nurse attendance on FCR. Surveys indicated increase in the perception that it is helpful to have a nurse present at FCR. A resident driven quality improvement project can increase nurse presence on FCR. Copyright © 2016 Elsevier Inc. All rights reserved.

  16. 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%; Phemorrhagic 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.

  17. Improving skills development in residency using a deliberate-practice and learner-centered model.

    Science.gov (United States)

    Bhatti, Nasir I; Ahmed, Aadil

    2015-10-01

    Work-hour restrictions, increased workload, and subjective assessment of competency are major threats to the efficacy of the traditional apprenticeship model of surgical training in modern surgical practice. In response, medical educators are developing time- and resource-efficient competency-based models of surgical training. The purpose of our project was to develop, implement, and measure the outcomes of such objective and structured programs in otolaryngology. We also investigated factors affecting the learning curve, especially deliberate practice, formative feedback, and learners' autonomy. Prospective, longitudinal study. To measure the surgical skills of residents, we first developed and tested objective tools for otolaryngology procedures. Based on these instruments, we identified milestones of the procedures. Training on a virtual-reality simulator was validated to shorten the learning curve. We also studied a learner-centered approach of training, factors affecting the learning curve, and barriers to a competency-based model. The objective tools were found to be a feasible, reliable, and valid opportunity for measuring competency in both the laboratory and operating room. With the formative assessment from these tools, residents had a remediation target to be achieved by deliberate practice. The milestones helped identify the threshold of competency, and deliberate practice on the simulator gave an opportunity for improving skills. The learner-centered approach allowed flexibility and personalized learning by shifting the responsibility of the learning process to the learners. The competency-based model of residency, based on the principles of deliberate practice and a learner-centered approach, is a feasible model of residency training that allows development of competent surgeons and hence improves patient outcomes. Despite these advantages, challenges to this model require a concerted effort to overcome and fully implement these principles of training

  18. 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.

  19. School-Based Health Center Intervention Improves Body Mass Index in Overweight and Obese Adolescents

    Directory of Open Access Journals (Sweden)

    Alberta S. Kong

    2013-01-01

    Full Text Available Adolescents Committed to Improvement of Nutrition and Physical Activity (ACTION was undertaken to determine feasibility of a school-based health center (SBHC weight management program. Two urban New Mexico SBHCs were randomized to deliver ACTION or standard care. ACTION consisted of eight visits using motivational interviewing to improve eating and physical activity behavior. An educational nutrition and physical activity DVD for students and a clinician toolkit were created for use as menu of options. Standard care consisted of one visit with the SBHC provider who prescribed recommendations for healthy weight. Sixty nondiabetic overweight/obese adolescents were enrolled. Measures included BMI percentile, waist circumference, insulin resistance by homeostasis model assessment (HOMA-IR, blood pressure, triglycerides, and HDL-C levels. Pre- to postchanges for participants were compared between groups. Fifty-one students (mean age 15 years, 62% female, 75% Hispanic completed pre- and postmeasures. ACTION students (n=28 had improvements in BMI percentile (P=0.04 and waist circumference (P=0.04 as compared with students receiving standard care (n=23. No differences were found between the two groups in blood pressure, HOMA-IR, triglycerides, and HDL-C. The ACTION SBHC weight management program was feasible and demonstrated improved outcomes in BMI percentile and waist circumference.

  20. 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

    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......), 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...

  1. 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.

  2. 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

  3. Scorecard - An innovative simplified tool to supplement the existing monitoring mechanism to assess and improve performance of antiretroviral treatment centers

    Directory of Open Access Journals (Sweden)

    Sudhir Chawla

    2017-01-01

    Full Text Available Introduction: All 26 antiretroviral treatment (ART centers of Gujarat were monitored by Gujarat State AIDS Control Society under the National AIDS Control Program. A comprehensive tool is needed to identify gap in service delivery and to prioritize monitoring visits. Objectives: To supplement the existing monitoring system, identify strengths/weakness of ART centers, and give recommendations. Methodology: Scorecard was developed in spreadsheet format with 17 scoring indicators on monthly base from March 2014 onward. The centers were classified in three color zones: green (score ≥80%, yellow (score <80% and ≥50%, and red (score <50%. Visits were prioritized at centers with more indicators in yellow/red zone. The performance of centers was compared for March 2014 and March 2015. Results: The statistically significant improvement was observed in indicator “ART initiation within 2 months of eligibility,” while after removing red zone from analysis, four more indicators named “eligible patients transferred out before ART initiation, general clients started on ART, antenatal women started on ART, and pre-ART follow-up CD4 done” reflect statistically significant improvement. Quadrant analysis was done for some indicators, which provide insight that less number of eligible patients may be a reason for low initiation of ART at one center, and at four other centers, the possible reasons for low retention are high death rate and high lost to follow-up rate. Based on these findings, the recommendations were made to regular mentoring centers, improve coordination between ART center and care and support centers (CSCs, and conduct verbal autopsy. Conclusion: Scorecard is a simple and cost-effective tool for monitoring, and by highlighting low-performing indicators, it helps in improving quality of services provided at ART centers.

  4. The development and goals of the AAFP center for policy studies in family practice and primary care. American Academy of Family Physicians.

    Science.gov (United States)

    Green, L A; Fryer, G E

    1999-11-01

    In this article we describe the creation and role of the Center for Policy Studies in Family Practice and Primary Care established by the American Academy of Family Physicians in Washington, DC, this year. We recount the events leading to the decision to implement the Center, list its guiding assumptions, and explain its initial structure and function. We also identify the 3 themes that will guide the early work of the Center: sustaining the functional domain of family practice and primary care; investing in key infrastructures; and securing universal health coverage.

  5. Childcare service centers' preferences and intentions to use a web-based program to implement healthy eating and physical activity policies and practices: a cross-sectional study.

    Science.gov (United States)

    Yoong, Sze Lin; Williams, Christopher Michael; Finch, Meghan; Wyse, Rebecca; Jones, Jannah; Freund, Megan; Wiggers, John Henry; Nathan, Nicole; Dodds, Pennie; Wolfenden, Luke

    2015-04-30

    Overweight and obesity is a significant public health problem that impacts a large number of children globally. Supporting childcare centers to deliver healthy eating and physical activity-promoting policies and practices is a recommended strategy for obesity prevention, given that such services provide access to a substantial proportion of children during a key developmental period. Electronic Web-based interventions represent a novel way to support childcare service providers to implement such policies and practices. This study aimed to assess: (1) childcare centers' current use of technology, (2) factors associated with intention to use electronic Web-based interventions, and (3) Web-based features that managers rated as useful to support staff with implementing healthy eating and physical activity-promoting policies and practices. A computer-assisted telephone interview (CATI) was conducted with service managers from long day care centers and preschools. The CATI assessed the following: (1) childcare center characteristics, (2) childcare centers' use of electronic devices, (3) intention to use a hypothetical electronic Web-based program-assessed using the Technology Acceptance Model (TAM) with ratings between 1 (strongly disagree) and 7 (strongly agree), and (4) features rated as useful to include in a Web-based program. Overall, 214 service centers out of 277 (77.3%) consented to participate. All service centers except 2 reported using computers (212/214, 99.1%), whereas 40.2% (86/214) used portable tablets. A total of 71.9% (151/210) of childcare service managers reported a score of 6 or more for intention to use a hypothetical electronic Web-based program. In a multivariable logistic regression analysis, intention to use the program was significantly associated with perceived ease of use (P=.002, odds ratio [OR] 3.9, 95% CI 1.6-9.2) and perceived usefulness (Pchildcare center performance in relation to other childcare centers (212/212, 100%). Childcare

  6. The quality of teacher educators in the European policy debate: actions and measures to improve the professionalism of teacher educators

    OpenAIRE

    Snoek, Marco; Swennen, Anja; Van der Klink, Marcel

    2012-01-01

    Snoek, M., Swennen, A., & Van der Klink, M. (2011). The quality of teacher educators in the European policy debate: actions and measures to improve the professionalism of teacher educators. Professional Development in Education, 37(5), 651-664.

  7. 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.

  8. 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.

  9. A hospital-centered approach to improve emergency obstetric care in South Sudan.

    Science.gov (United States)

    Groppi, Lavinia; Somigliana, Edgardo; Pisani, Vincenzo; Ika, Michelina; Mabor, Joseph L; Akec, Henry N; Nhial, John A; Mading, Michel S; Scanagatta, Chiara; Manenti, Fabio; Putoto, Giovanni

    2015-01-01

    To assess provision of emergency obstetric care (EmOC) in Greater Yirol, South Sudan, after implementation of a hospital-centered intervention with an ambulance referral system. In a descriptive study, data were prospectively recorded for all women referred to Yirol County Hospital for delivery in 2012. An ambulance referral system had been implemented in October 2011. Access to the hospital and ambulance use were free of charge. The number of deliveries at Yirol County Hospital increased in 2012 to 1089, corresponding to 13.3% of the 8213 deliveries expected to have occurred in the catchment area. Cesareans were performed for 53 (4.9%) deliveries, corresponding to 0.6% of the expected number of deliveries in the catchment area. Among 950 women who delivered a newborn weighing at least 2500 g at the hospital, 6 (0.6%) intrapartum or very early neonatal deaths occurred. Of 1232 women expected to have major obstetric complications in 2012 in the catchment area, 472 (38.3%) received EmOC at the hospital. Of 115 expected absolute obstetric indications, 114 (99.1%) were treated in the hospital. A hospital-centered approach with an ambulance referral system effectively improves the availability of EmOC in underprivileged remote settings. Copyright © 2014 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

  10. Center of Excellence to build nursing scholarship and improve health care in Italy.

    Science.gov (United States)

    Rocco, Gennaro; Affonso, Dyanne; Mayberry, Linda; Sasso, Loredana; Stievano, Alessandro; Alvaro, Rosaria

    2015-03-01

    This article profiles the establishment and initial phase (2010-2014) of a Center of Excellence (CoE) as an instrument to strengthen nursing scholarship and improve health care in Italy. This CoE is unique as a non-university-based center. The National Regulatory Board of Registered Nurses, Health Visitors, and Pediatric Nurses (IPASVI) designated substantial administrative and funding support to the CoE for advancing nursing education, clinical practice, research development, and research training. Boyer's Model of Scholarship underpinned the CoE's conceptual framework, and its operational infrastructure was adapted from the U.S. National Institutes of Health P20 program award mechanism. Diverse methods included sponsoring research studies by nurse-led teams, research training courses, nursing education longitudinal studies, evidence-based practice training, and related pilot studies. Multiple collaborative projects were conducted via the CoE in conjunction with the successful launch of an expansive digital library and communication system accessible to nurses. The introduction of English proficiency courses was also a unique contribution. The CoE concept is a potential instrument to strengthen nursing scholarship in Italy with potential scalability considerations to other global settings. An overlapping focus on research, education, and practice under the umbrella of nursing scholarship within a CoE while engaging all levels of nursing is important to impact healthcare changes. © 2015 Sigma Theta Tau International.

  11. 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.

  12. 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.

  13. A new generation of cysteine derivatives with three active antioxidant centers: improving reactivity and stability.

    Science.gov (United States)

    Haya, Luisa; Mainar, Ana M; Pardo, Juan I; Urieta, Jose S

    2014-01-28

    The development of new antioxidants with enhanced activity constitutes a very active research field as it can contribute to the improvement of human health. Although the antioxidant activity occurs through different mechanisms, usually most of the antioxidant molecules present a unique active center which is able to react following a specific way. To overcome this weakness and in the belief that the coupling of different antioxidant groups is a good strategy to obtain multipotent antioxidants, the effect of introducing different N-protective groups on the cysteine core is evaluated by using DFT. As a result, in this work we present a multicenter antioxidant, N-(9-fluorenylmethyloxycarbonyl)cysteine methyl ester 8, able to fight efficiently through different mechanisms against free radicals independently of their nature. This antioxidant appears to be the first one of a promising new class of multipotent antioxidants with three operative centers: C(α) that is a good hydrogen donor, the Fmoc group that is a good electron donor and the all-around thiol group. Besides, its neutral radical shows a high stability due to the captodative effect in such a way that the subsequent toxic effects would be avoided. Then, its experimental radical-trapping antioxidant activity postulates compound 8 as a prototype of antioxidants more versatile and efficient than N-acetylcysteine, ascorbic acid or Trolox.

  14. 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.

  15. 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.

  16. 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

  17. Improving health through policies that promote active travel: a review of evidence to support integrated health impact assessment.

    Science.gov (United States)

    de Nazelle, Audrey; Nieuwenhuijsen, Mark J; Antó, Josep M; Brauer, Michael; Briggs, David; Braun-Fahrlander, Charlotte; Cavill, Nick; Cooper, Ashley R; Desqueyroux, Hélène; Fruin, Scott; Hoek, Gerard; Panis, Luc Int; Janssen, Nicole; Jerrett, Michael; Joffe, Michael; Andersen, Zorana Jovanovic; van Kempen, Elise; Kingham, Simon; Kubesch, Nadine; Leyden, Kevin M; Marshall, Julian D; Matamala, Jaume; Mellios, Giorgos; Mendez, Michelle; Nassif, Hala; Ogilvie, David; Peiró, Rosana; Pérez, Katherine; Rabl, Ari; Ragettli, Martina; Rodríguez, Daniel; Rojas, David; Ruiz, Pablo; Sallis, James F; Terwoert, Jeroen; Toussaint, Jean-François; Tuomisto, Jouni; Zuurbier, Moniek; Lebret, Erik

    2011-05-01

    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 further co-benefits. Little is known, however, about the interconnections among effects of policies considered, including potential unintended consequences. We review available literature regarding health impacts from policies that encourage active travel in the context of developing health impact assessment (HIA) models to help decision-makers propose better solutions for healthy environments. We identify important components of HIA models of modal shifts in active travel in response to transport policies and interventions. Policies that increase active travel are likely to generate large individual health benefits through increases in physical activity for active travelers. Smaller, but population-wide benefits could accrue through reductions in air and noise pollution. Depending on conditions of policy implementations, risk tradeoffs are possible for some individuals who shift to active travel and consequently increase inhalation of air pollutants and exposure to traffic injuries. Well-designed policies may enhance health benefits through indirect outcomes such as improved social capital and diet, but these synergies are not sufficiently well understood to allow quantification at this time. Evaluating impacts of active travel policies is highly complex; however, many associations can be quantified. Identifying health-maximizing policies and conditions requires integrated HIAs. Copyright © 2011 Elsevier Ltd. All rights reserved.

  18. 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.

  19. 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.

  20. 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).

  1. Transitioning From Volume to Value: One Academic Medical Center's Approach to Improving Population Health.

    Science.gov (United States)

    Halvorson, Stephanie A C; Tanski, Mary E; Yackel, Thomas R

    2017-05-01

    The U.S. health care system is undergoing a major transformation. Clinical delivery systems are now being paid according to the value of the care they provide, in accordance with the Triple Aim, which incorporates improving the quality and cost of care and the patient experience. Increasingly, financial risk is being transferred from insurers to clinical delivery systems that become responsible for both episode-based clinical care and the longitudinal care of patients. Thus, these delivery systems need to develop strategies to manage the health of populations. Academic medical centers (AMCs) serve a unique role in many markets yet may be ill prepared for this transformation. In 2013, Oregon Health & Science University (OHSU) partnered with a large health insurer and six other hospitals across the state to form Propel Health, a collaborative partnership designed to deliver the tools, methods, and support necessary for population health management. OHSU also developed new internal structures and transformed its business model to embrace this value-based care model. Each Propel Health partner included the employees and dependents enrolled in its employee medical plan, for approximately 55,000 covered individuals initially. By 2017, Propel Health is expected to cover 110,000 individuals. Other outcomes to measure in the future include the quality and cost of care provided under this partnership. Anticipated challenges to overcome include insufficient primary care networks, conflicting incentives, local competition, and the magnitude of the transformation. Still, the time is right for AMCs to commit to improving the health of populations.

  2. 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 …

  3. 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.

  4. Impact of the Centers for Medicare and Medicaid Services Hospital-Acquired Conditions Policy on Billing Rates for 2 Targeted Healthcare-Associated Infections.

    Science.gov (United States)

    Kawai, Alison Tse; Calderwood, Michael S; Jin, Robert; Soumerai, Stephen B; Vaz, Louise E; Goldmann, Donald; Lee, Grace M

    2015-08-01

    The 2008 Centers for Medicare & Medicaid Services hospital-acquired conditions policy limited additional payment for conditions deemed reasonably preventable. To examine whether this policy was associated with decreases in billing rates for 2 targeted conditions, vascular catheter-associated infections (VCAI) and catheter-associated urinary tract infections (CAUTI). Adult Medicare patients admitted to 569 acute care hospitals in California, Massachusetts, or New York and subject to the policy. DESIGN We used an interrupted times series design to assess whether the hospital-acquired conditions policy was associated with changes in billing rates for VCAI and CAUTI. Before the policy, billing rates for VCAI and CAUTI were increasing (prepolicy odds ratio per quarter for VCAI, 1.17 [95% CI, 1.11-1.23]; for CAUTI, 1.19 [1.16-1.23]). The policy was associated with an immediate drop in billing rates for VCAI and CAUTI (odds ratio for change at policy implementation for VCAI, 0.75 [95% CI, 0.69-0.81]; for CAUTI, 0.87 [0.79-0.96]). In the postpolicy period, we observed a decreasing trend in the billing rate for VCAI and a leveling-off in the billing rate for CAUTI (postpolicy odds ratio per quarter for VCAI, 0.98 [95% CI, 0.97-0.99]; for CAUTI, 0.99 [0.97-1.00]). The Centers for Medicare & Medicaid Services hospital-acquired conditions policy appears to have been associated with immediate reductions in billing rates for VCAI and CAUTI, followed by a slight decreasing trend or leveling-off in rates. These billing rates, however, may not correlate with changes in clinically meaningful patient outcomes and may reflect changes in coding practices.

  5. 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

  6. Veterans Affairs Information Technology: Management Attention Needed to Improve Critical System Modernizations, Consolidate Data Centers, and Retire Legacy Systems

    Science.gov (United States)

    2017-02-07

    Veterans Affairs, Volume 1: Integrated Report (Washington, D.C.: Sept. 1, 2015). This assessment was conducted in response to a requirement in the Veterans...VETERANS AFFAIRS INFORMATION TECHNOLOGY Management Attention Needed to Improve Critical System Modernizations...Management Attention Needed to Improve Critical System Modernizations, Consolidate Data Centers, and Retire Legacy Systems What GAO Found GAO

  7. 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.

  8. Can a pediatric trauma center improve the response to a mass casualty incident?

    Science.gov (United States)

    Barthel, Erik R; Pierce, James R; Goodhue, Catherine J; Burke, Rita V; Ford, Henri R; Upperman, Jeffrey S

    2012-10-01

    Recent events including the 2001 terrorist attacks on New York; Hurricane Katrina; the 2010 Haitian and Chilean earthquakes; and the 2011 earthquake, tsunami, and nuclear disaster in Japan have reminded disaster planners and responders of the tremendous scale of mass casualty disasters and their resulting human devastation. Although adult disaster medicine is a well-developed field with roots in wartime medicine, we are increasingly recognizing that children may comprise up to 50% of disaster victims, and response mechanisms are often designed without adequate preparation for the number of pediatric victims that can result. In this short educational review, we explore the differences between the pediatric and adult disaster and trauma populations, the requirements for designation of a site as a pediatric trauma center (PTC), and the magnitude of the problem of pediatric disaster patients as described in the literature, specifically as it pertains to the availability and use of designated PTCs as opposed to trauma centers in general. We also review our own experience in planning and simulating pediatric mass casualty events and suggest strategies for preparedness when there is no PTC available. We aim to demonstrate from this brief survey that the availability of a designated PTC in the setting of a mass casualty disaster event is likely to significantly improve the outcome for the pediatric demographic of the affected population. We conclude that the relative scarcity of disaster data specific to children limits epidemiologic study of the pediatric disaster population and offer suggestions for strategies for future study of our hypothesis. Systematic review, level III.

  9. 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.

  10. 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.

  11. 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.

  12. Rhetoric and Reality of School Improvement in Chile. A Multiple Case Study of School Improvement Policy and External Technical Support Programmes for Municipal Primary Schools

    OpenAIRE

    Gonzalez Torres, A. F.

    2017-01-01

    Currently we are witnessing the expansion of performance-based reforms in education around the world, based on a global education reform agenda. In Chile, the policy framework for school improvement has changed because of modifications to the governance structure and the introduction of performance standards in the school system. This policy framework defines a performance-based accountability system according to students’ achievement in Chile’s national examination (SIMCE), and institutes ex...

  13. Improved cosmic-ray injection models and the Galactic Center gamma-ray excess

    Science.gov (United States)

    Carlson, Eric; Linden, Tim; Profumo, Stefano

    2016-09-01

    Fermi-LAT observations of the Milky Way Galactic Center (GC) have revealed a spherically symmetric excess of GeV γ rays extending to at least 10° from the dynamical center of the Galaxy. A critical uncertainty in extracting the intensity, spectrum, and morphology of this excess concerns the accuracy of astrophysical diffuse γ -ray emission models near the GC. Recently, it has been noted that many diffuse emission models utilize a cosmic-ray injection rate far below that predicted based on the observed star-formation rate in the Central Molecular Zone. In this study, we add a cosmic-ray injection component which nonlinearly traces the Galactic H2 density determined in three dimensions, and find that the associated γ -ray emission is degenerate with many properties of the GC γ -ray excess. Specifically, in models that utilize a large sideband (4 0 ° ×4 0 ° surrounding the GC) to normalize the best-fitting diffuse emission models, the intensity of the GC excess decreases by approximately a factor of 2, and the morphology of the excess becomes less peaked and less spherically symmetric. In models which utilize a smaller region of interest (1 5 ° ×1 5 ° ) the addition of an excess template instead suppresses the intensity of the best-fit astrophysical diffuse emission, and the GC excess is rather resilient to changes in the details of the astrophysical diffuse modeling. In both analyses, the addition of a GC excess template still provides a statistically significant improvement to the overall fit to the γ -ray data. We also implement advective winds at the GC, and find that the Fermi-LAT data strongly prefer outflows of order several hundred km/s, whose role is to efficiently advect low-energy cosmic rays from the inner-few kpc of the Galaxy. Finally, we perform numerous tests of our diffuse emission models, and conclude that they provide a significant improvement in the physical modeling of the multiwavelength nonthermal emission from the GC region.

  14. 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; 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)

  15. 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

  16. 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...

  17. 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...

  18. 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.

  19. Improving transportation networks: Effects of population structure and decision making policies.

    Science.gov (United States)

    Pablo-Martí, Federico; Sánchez, Angel

    2017-07-03

    Transportation networks are one of the fundamental tools for human society to work, more so in our globalized world. The importance of a correct, efficient design of a transportation network for a given region or country cannot be overstated. We here study how network design is affected by the geography of the towns or nuclei to be connected, and also by the decision process necessary to choose which connections should be improved (in a generic sense) first. We begin by establishing that Delaunay networks provide an efficient starting point for the network design and at the same time allow us to introduce a computationally amenable model. Subsequent improvements lead to decentralized designs in geographies where towns are more or less homogeneously distributed, whereas radial designs arise when there is a core-periphery distribution of nodes. We also show that optimization of Delaunay networks outperforms that of complete networks at a lower cost, by allowing for a proper selection of the links to improve. In closing, we draw conclusions relevant to policy making applied to designing transportation networks and point our how our study can be useful to identify mechanisms relevant to the historical development of a region.

  20. 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

  1. Improving outcomes at Level I trauma centers: an early evaluation of the Trauma Survivors Network.

    Science.gov (United States)

    Castillo, Renan C; Wegener, Stephen T; Newell, Mary Zadnik; Carlini, Anthony R; Bradford, Anna N; Heins, Sara E; Wysocki, Elizabeth; Pollak, Andrew N; Teter, Harry; Mackenzie, Ellen J

    2013-06-01

    The Trauma Survivors Network (TSN), a program developed to help patients and families manage the psychosocial impact of their injuries, combines information access, self-management training, peer support, and online social networking. The purpose of this study was to evaluate the effectiveness of the TSN in improving patient reported outcomes among orthopedic trauma patients at a Level I trauma center. We prospectively enrolled 251 patients with either severe lower-extremity injuries or polytrauma in two cohorts: one group (n = 125) before implementation of the TSN and one group (n = 126) after implementation. Participants were interviewed during their initial hospital stay and at 6 months. Outcomes evaluated at 6 months included depression, anxiety, self-efficacy, health status, and patient activation. Participation in the individual components of the TSN was low, ranging between 3% for the NextSteps self-management program and 27% for receipt of the Patient and Family Handbook. There were no statistically significant differences between treatment and control groups in self-efficacy, anxiety, health status, or activation. There were statistically significant differences in depression (24% of patients with probable depression in the TSN group vs. 40% in the control group, p = 0.02). However, the groups were not balanced with respect to sex, education, and baseline social support. After controlling for these differences, the TSN group still had 49% lower odds (95% confidence interval, 0% to 74%) of depression (p = 0.05). The TSN represents a potentially important step toward the development of comprehensive psychosocial support programs for trauma survivors. Despite improvements in one important outcome, a key finding of this evaluation is the low rate of use of program components. This finding highlights the need for greater understanding of use barriers and efforts to increase adoption. Therapeutic study, level IV.

  2. 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.

  3. 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.

  4. Clinical mentorship to improve pediatric quality of care at the health centers in rural Rwanda: a qualitative study of perceptions and acceptability of health care workers.

    Science.gov (United States)

    Manzi, Anatole; Magge, Hema; Hedt-Gauthier, Bethany L; Michaelis, Annie P; Cyamatare, Felix R; Nyirazinyoye, Laetitia; Hirschhorn, Lisa R; Ntaganira, Joseph

    2014-06-20

    Despite evidence supporting Integrated Management of Childhood Illness (IMCI) as a strategy to improve pediatric care in countries with high child mortality, its implementation faces challenges related to lack of or poor post-didactic training supervision and gaps in necessary supporting systems. These constraints lead to health care workers' inability to consistently translate IMCI knowledge and skills into practice. A program providing mentoring and enhanced supervision at health centers (MESH), focusing on clinical and systems improvement was implemented in rural Rwanda as a strategy to address these issues, with the ultimate goal of improving the quality of pediatric care at rural health centers. We explored perceptions of MESH from the perspective of IMCI clinical mentors, mentees, and district clinical leadership. We conducted focus group discussions with 40 health care workers from 21 MESH-supported health centers. Two FGDs in each district were carried out, including one for nurses and one for director of health centers. District medical directors and clinical mentors had individual in-depth interviews. We performed a hermeneutic analysis using Atlas.ti v5.2. Study participants highlighted program components in five key areas that contributed to acceptability and impact, including: 1) Interactive, collaborative capacity-building, 2) active listening and relationships, 3) supporting not policing, 4) systems improvement, and 5) real-time feedback. Staff turn-over, stock-outs, and other facility/systems gaps were identified as barriers to MESH and IMCI implementation. Health care workers reported high acceptance and positive perceptions of the MESH model as an effective strategy to build their capacity, bridge the gap between knowledge and practice in pediatric care, and address facility and systems issues. This approach also improved relationships between the district supervisory team and health center-based care providers. Despite some challenges, many

  5. 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

  6. 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...

  7. Comparing the implementation of team approaches for improving diabetes care in community health centers.

    Science.gov (United States)

    Van der Wees, Philip J; Friedberg, Mark W; Guzman, Elena Alcala; Ayanian, John Z; Rodriguez, Hector P

    2014-12-03

    Patient panel management and community-based care management may be viable strategies for community health centers to improve the quality of diabetes care for vulnerable patient populations. The objective of our study was to clarify implementation processes and experiences of integrating office-based medical assistant (MA) panel management and community health worker (CHW) community-based management into routine care for diabetic patients. Mixed methods study with interviews and surveys of clinicians and staff participating in a study comparing the effectiveness of MA and CHW health coaching for improving diabetes care. Participants included 24 key informants in five role categories and 249 clinicians and staff survey respondents from 14 participating practices. We conducted thematic analyses of key informant interview transcripts to clarify implementation processes and describe barriers to integrating the new roles into practice. We surveyed clinicians and staff to assess differences in practice culture among intervention and control groups. We triangulated findings to identify concordant and disparate results across data sources. Implementation processes and experiences varied considerably among the practices implementing CHW and MA team-based approaches, resulting in differences in the organization of health coaching and self-management support activities. Importantly, CHW and MA responsibilities converged over time to focus on health coaching of diabetic patients. MA health coaches experienced difficulty in allocating dedicated time due to other MA responsibilities that often crowded out time for diabetic patient health coaching. Time constraints also limited the personal introduction of patients to health coaches by clinicians. Participants highlighted the importance of a supportive team climate and proactive leadership as important enablers for MAs and CHWs to implement their health coaching responsibilities and also promoted professional growth

  8. Improving the Brooke Army Medical Center Department of Emergency Medicine Admissions Process

    National Research Council Canada - National Science Library

    Fuda, John R

    2006-01-01

    This study determined, evaluated, and proposed ways to mitigate factors contributing to overcrowding and wait times experienced by patients admitted through the Brooke Army Medical Center Emergency Department...

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

    Directory of Open Access Journals (Sweden)

    Jian Weiyan

    2012-12-01

    Full Text Available Abstract 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.

  10. Important steps to improve translation from medical research to health policy.

    Science.gov (United States)

    Jiang, Fan; Zhang, Jun; Wang, Xiangdong; Shen, Xiaoming

    2013-02-08

    Translational medicine entails not only "from-bench-to-bedside" but also preventive medicine. The present article proposes a conceptual framework of translational research from scientific research to health care policy and public health policy. We highlight the importance of translational medicine to bridge between research and policy and share our experience of translating medical research to public health policy in China as well as obstacles and challenges we are facing in the translation process.

  11. Important steps to improve translation from medical research to health policy

    OpenAIRE

    Jiang, Fan; Zhang, Jun; Wang, Xiangdong; Shen, Xiaoming

    2013-01-01

    Abstract Translational medicine entails not only “from-bench-to-bedside” but also preventive medicine. The present article proposes a conceptual framework of translational research from scientific research to health care policy and public health policy. We highlight the importance of translational medicine to bridge between research and policy and share our experience of translating medical research to public health policy in China as well as obstacles and challenges we are facing in the tran...

  12. The need for a Communicative Approach to improve Environmental Policy integration in urban Land Use Planning

    NARCIS (Netherlands)

    Simeonova, V.; Valk, van der A.J.J.

    2009-01-01

    The debate on sustainable development emphasizes the importance of integrating environmental policy into all policy sectors. It is increasingly recognized that this integration is needed at both the national and the local levels of governance. The Environmental Policy Integration (EPI) principle

  13. 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.

  14. 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…

  15. 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…

  16. 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.

  17. 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.

  18. 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.

  19. Improved Regional Disparities in Neonatal Care by Government-led Policies in Korea.

    Science.gov (United States)

    Song, In Gyu; Shin, Seung Han; Kim, Han Suk

    2018-02-05

    Although the number of high-risk neonates has increased in Korea, hospitals were reluctant to open or maintain neonatal intensive care unit (NICU) due to the low medical cost. Consequently, there were regional disparities in facilities, equipment, and neonatal health outcomes. For these reasons, the Korean government began to invest in neonatal care during the last decade. We identified the status of NICUs in Korea and assessed changes after the government-driven policies. We surveyed 87 of 89 hospitals that operated NICUs in 2015. The questionnaire assessed the number of NICU beds, admission and mortality rates of very low birthweight infants (VLBWIs), personnel status, equipment and facilities, and available multidisciplinary approach. Current data was compared with the previous studies and changes in the status and function of the nationwide NICU from 2009 and 2011. During the last 7 years, there was an increase of 462 NICU beds, which met the required number estimated by the number of births and covered about 90% of regional VLBWI births. Status of facilities and equipment improved in all regions in Korea but there were still regional differences in multidisciplinary approach and human resources. The difference in odds ratios for mortality of VLBWI between regions decreased compared to 2009. There was improvement in regional disparities of neonatal care and mortality of premature babies with the government investment in Korea. Further supports are required for human resources and referral system. © 2018 The Korean Academy of Medical Sciences.

  20. 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.

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

    Science.gov (United States)

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

    2014-11-01

    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 (Nr) 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.

  2. 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.

  3. 75 FR 44231 - Notice of Proposed Extension of Project Period and Waiver for the State and Federal Policy Forum...

    Science.gov (United States)

    2010-07-28

    ... Notice of Proposed Extension of Project Period and Waiver for the State and Federal Policy Forum for... extension of project period and waiver for the State and Federal Policy Forum for Program Improvement Center... enable the currently funded State and Federal Policy Forum for Program Improvement Center to receive...

  4. Absolute IGS antenna phase center model igs08.atx: status and potential improvements

    Science.gov (United States)

    Schmid, R.; Dach, R.; Collilieux, X.; Jäggi, A.; Schmitz, M.; Dilssner, F.

    2016-04-01

    On 17 April 2011, all analysis centers (ACs) of the International GNSS Service (IGS) adopted the reference frame realization IGS08 and the corresponding absolute antenna phase center model igs08.atx for their routine analyses. The latter consists of an updated set of receiver and satellite antenna phase center offsets and variations (PCOs and PCVs). An update of the model was necessary due to the difference of about 1 ppb in the terrestrial scale between two consecutive realizations of the International Terrestrial Reference Frame (ITRF2008 vs. ITRF2005), as that parameter is highly correlated with the GNSS satellite antenna PCO components in the radial direction.

  5. 78 FR 24380 - National Sheep Industry Improvement Center: Notice of Request for Extension and Revision of a...

    Science.gov (United States)

    2013-04-25

    ...; ] DEPARTMENT OF AGRICULTURE Agricultural Marketing Service National Sheep Industry Improvement Center: Notice...: Agricultural Marketing Service, USDA. ACTION: Notice and request for comments. SUMMARY: In accordance with the... Promotion Division; Livestock, Poultry, and Seed Program; Agricultural Marketing Service; U.S. Department of...

  6. Feedback to professionals on patient-centered fertility care is insufficient for improvement: a mixed-method study

    NARCIS (Netherlands)

    Huppelschoten, A.G.; Aarts, J.W.M.; Empel, I.W. van; Cohlen, B.J.; Kremer, J.A.M.; Nelen, W.L.D.M.

    2013-01-01

    OBJECTIVE: To determine the effect of audits and feedback on the level of patient-centeredness in fertility care, and to obtain a more in-depth understanding of professionals' views on patient-centered care and achieving improvements. DESIGN: Mixed-method design, using semistructured in-depth

  7. The Use of Infant Confinement Equipment in Community-Based Child Care Centers: An Analysis of Centers Participating in a Statewide Quality Rating and Improvement System.

    Science.gov (United States)

    Hallam, Rena A; Bargreen, Kaitlin; Fouts, Hillary N; Lessard, Laura; Skrobot, Christine

    2018-01-20

    Objectives Although infants increasingly spend time in community-based child care centers, little attention has been paid to their physical activity experiences while in group care. In particular, the use of devices to restrict infant mobility, such as bouncy seats, high chairs, cribs, and stationary activity centers, has received little attention in the physical activity literature. The current study examines the presence and use of these confinement devices in infant classrooms. Methods A secondary analysis of observational data in child care centers participating in Delaware's Quality Rating and Improvement System was conducted. Quality assessment observations were coded for the use of confinement devices and the actual amount of time the confinement device was employed per child. The sample consisted of 38 infant classrooms serving a total of 162 infants in the statewide system. Results Findings suggest a high level of utilization of confinement devices in infant child care classrooms with each classroom averaging three pieces of equipment used during the observations and 22% of observed children being confined 30 min or longer during the observation period. Conclusions for Practice The reliance on confinement devices in group child care is a potential concern in the quest to prevent childhood obesity by ensuring adequate physical activity and mobility for infants in group care settings. More research is needed to understand the implications of the use of confinement devices on physical activity in group care settings.

  8. 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...

  9. 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

  10. 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...

  11. 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...

  12. Correcting Blindness In the Nerve Center: How To Improve Situational Awareness

    Science.gov (United States)

    2015-12-01

    situation reports that, according to New Jersey State Police Colonel Rick Fuentes , “provided up-to-the-minute information about the locations of shelters...86 Rick Fuentes , “Fusion Center Coordinates New Jersey Hurricane Sandy Disaster Response,” Information Sharing Environment, February 5, 2013...https://www.ise.gov/blog/col-rick- fuentes /fusion- center-coordinates-new-jersey-hurricane-sandy-disaster-response. 87 Committee on Homeland Security

  13. 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

  14. 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.

  15. Improving the Assessment and Valuation of Climate Change Impacts for Policy and Regulatory Analysis

    Energy Technology Data Exchange (ETDEWEB)

    Marten, Alex; Kopp, Robert E.; Shouse, Kate C.; Griffiths, Charles; Hodson, Elke L.; Kopits, Elizabeth; Mignone, Bryan K.; Moore, Chris; Newbold, Steve; Waldhoff, Stephanie T.; Wolverton, Ann

    2013-04-01

    to updating the estimates regularly as modeling capabilities and scientific and economic knowledge improves. To help foster further improvements in estimating the SCC, the U.S. Environmental Protection Agency and the U.S. Department of Energy hosted a pair of workshops on “Improving the Assessment and Valuation of Climate Change Impacts for Policy and Regulatory Analysis.” The first focused on conceptual and methodological issues related to integrated assessment modeling and the second brought together natural and social scientists to explore methods for improving damage assessment for multiple sectors. These two workshops provide the basis for the 13 papers in this special issue.

  16. 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.

  17. 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...

  18. 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.

  19. 78 FR 45231 - Medicare and Medicaid Programs; Initial Approval of Center for Improvement in Healthcare Quality...

    Science.gov (United States)

    2013-07-26

    .... Section 1861(e) of the Social Security Act (the Act) establishes distinct criteria for facilities seeking... not limited to, the following: An onsite administrative review of CIHQ's: (1) Corporate policies; (2... revised its standards to address the hospital's responsibility to provide a process for prompt resolution...

  20. 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.

  1. 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)

  2. 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…

  3. Middle School Matters: Improving the Life Course of Black Boys. Policy Notes. Volume 20, Number 4, Winter 2012

    Science.gov (United States)

    Yaffe, Deborah

    2012-01-01

    This issue of ETS Policy Notes (Vol. 20, No. 4) provides highlights from the symposium, "Middle School Matters: Improving the Life Course of Black Boys" held on July 23-24, 2012. The second in a series of four symposia co-sponsored by ETS and the Children's Defense Fund (CDF), the seminar examined the education and status of…

  4. 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.

  5. 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

  6. Improving Basic Education for All Learners: The Role of Arts Education. SERVE Policy Brief.

    Science.gov (United States)

    Mikow-Porto, Victoria A.

    Although the term "arts education" conjures up competing images and definitions for different people, for the purposes of this policy brief, arts education is defined as incorporating four distinct subject areas: (1) music, (2) dance, (3) theater arts, and (4) visual arts, as taught by certified arts educators. The policy brief provides…

  7. Do Farm Advisory Services Improve Adoption of Rural Development Policies? An Empirical Analysis in GI Areas

    Science.gov (United States)

    De Rosa, Marcello; Bartoli, Luca

    2017-01-01

    Purpose: The aim of the paper is to evaluate how advisory services stimulate the adoption of rural development policies (RDP) aiming at value creation. Design/methodology/approach: By linking the use of agricultural extension services (AES) to policies for value creation, we will put forward an empirical analysis in Italy, with the aim of…

  8. 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...

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

    Science.gov (United States)

    Johnson, Donna B; Quinn, Emilee; Sitaker, Marilyn; Ammerman, Alice; Byker, Carmen; Dean, Wesley; Fleischhacker, Sheila; Kolodinsky, Jane; Pinard, Courtney; Pitts, Stephanie B Jilcott; Sharkey, Joseph

    2014-06-12

    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. 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. 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 build economic viability in

  10. 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

  11. 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.

  12. 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

  13. 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.

  14. A Policy Analysis for the Implementation of the Generic Inventory Package in a Medical Center Engineering Supply Warehouse

    National Research Council Canada - National Science Library

    Weichel, Richard L

    2007-01-01

    ...) to assist medical center directors in the fiscal management of their purchasing programs. The Generic Inventory Package was to be implemented in March 2003 by all purchasing activities involving their primary and secondary supply accounts...

  15. 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...

  16. 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

  17. Incorporating air quality improvement at a local level into climate policy in the transport sector : a case study in Bandung City, Indonesia

    NARCIS (Netherlands)

    Gunawan, Helmi; Bressers, Hans; Mohlakoana, Nthabiseng; Hoppe, Thomas

    2017-01-01

    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

  18. Incorporating Air Quality Improvement at a Local Level into Climate Policy in the Transport Sector : A Case Study in Bandung City, Indonesia.

    NARCIS (Netherlands)

    Gunawan, Helmi; Bressers, Hans; Mohlakoana, Nthabi; Hoppe, T.

    2017-01-01

    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

  19. 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.

  20. 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.

  1. 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.

  2. 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.

  3. 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

  4. Improving population health through integration of primary care and public health: providing access to physical activity for community health center patients.

    Science.gov (United States)

    Silva, Matthew; Cashman, Suzanne; Kunte, Parag; Candib, Lucy M

    2012-11-01

    Our community health center attempted to meet public health goals for encouraging exercise in adult patients vulnerable to obesity, diabetes, hypertension, and other chronic diseases by partnering with a local YMCA. During routine office visits, providers referred individual patients to the YMCA at no cost to the patient. After 2 years, the YMCA instituted a $10 per month patient copay for new and previously engaged health center patients. The copay policy change led to discontinuation of participation at the YMCA by 80% of patients. Patients who persisted at the YMCA increased their visits by 50%; however, more men than women became frequent users after institution of the copay. New users after the copay were also more likely to be younger men. Thus the copay skewed the population toward a younger group of men who exercised more frequently. Instituting a fee appeared to discourage more tentative users, specifically women and older patients who may be less physically active. Free access to exercise facilities (rather than self-paid memberships) may be a more appropriate approach for clinicians to begin engaging inexperienced or uncertain patients in regular fitness activities to improve health.

  5. Moving beyond the Three Tier Intervention Pyramid toward a Comprehensive Framework for Student and Learning Supports. A Center Policy Brief

    Science.gov (United States)

    Center for Mental Health in Schools at UCLA, 2011

    2011-01-01

    Introduction into federal policy of response to intervention (RTI) and positive behavior intervention and supports (PBIS) led to widespread adoption and adaptation of the three tier intervention pyramid. As originally presented, the pyramid highlights three different levels of intervention and suggests the percent of students at each level. While…

  6. 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

  7. 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.

  8. 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.

  9. 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.

  10. 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.

  11. 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

  12. 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...

  13. Regional economic development policy of cross-border cooperation: improving trends

    Directory of Open Access Journals (Sweden)

    V. F. Lutchak

    2014-11-01

    Accordingly, it is necessary to work out a proper independent regional policy of economic cross-border cooperation development that will define a strategy for border regions development and cross-border cooperation across the whole state border. In the process of implementation this policy should include programme development that will provide for the use of opportunities of cross-border cooperation for increase of living standards of border regions by forming of integrated cross-border economic space of Ukraine.

  14. 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...

  15. 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...

  16. NASA Marshall Space Flight Center Improves Cooling System Performance: Best Management Practice Case Study #10: Cooling Towers (Fact Sheet)

    Energy Technology Data Exchange (ETDEWEB)

    2011-02-01

    National Aeronautics and Space Administration's (NASA) Marshall Space Flight Center (MSFC) has a longstanding sustainability program that revolves around energy and water efficiency as well as environmental protection. MSFC identified a problematic cooling loop with six separate compressor heat exchangers and a history of poor efficiency. The facility engineering team at MSFC partnered with Flozone Services, Incorporated to implement a comprehensive water treatment platform to improve the overall efficiency of the system.

  17. 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.

  18. Free-standing cancer centers: rationale for improving cancer care delivery.

    Science.gov (United States)

    Lokich, J J; Silvers, S; Brereton, H; Byfield, J; Bick, R

    1989-10-01

    Free-standing cancer centers (FSCC) represent a growing trend in cancer care delivery within community practice. The critical components to FSCC are multidisciplinary cancer care, a complete menu of direct care and support services, a commitment to clinical trials and clinical investigation, and a comprehensive program for quality assurance. The advantages of FSCC to the community, to hospital programs, to the practicing surgical, medical, and radiation oncologists, and to the third-party carriers, including health maintenance organizations, are detailed. The development of an FSCC depends on the resolution of issues of (a) competition (between hospitals, hospitals and physicians, therapeutic disciplines, regional comprehensive cancer centers and FSCCs) and (b) concerns about conflict of interest. The ideal model of FSCC may well be represented by the joint venture of community hospital(s) and the community oncologists.

  19. Improving Heat-Related Health Outcomes in an Urban Environment with Science-Based Policy

    Directory of Open Access Journals (Sweden)

    David Sailor

    2016-10-01

    Full Text Available We use the Northeast US Urban Climate Archipelago as a case study to explore three key limitations of planning and policy initiatives to mitigate extreme urban heat. These limitations are: (1 a lack of understanding of spatial considerations—for example, how nearby urban areas interact, affecting, and being affected by, implementation of such policies; (2 an emphasis on air temperature reduction that neglects assessments of other important meteorological parameters, such as humidity, mixing heights, and urban wind fields; and (3 too narrow of a temporal focus—either time of day, season, or current vs. future climates. Additionally, the absence of a direct policy/planning linkage between heat mitigation goals and actual human health outcomes, in general, leads to solutions that only indirectly address the underlying problems. These issues are explored through several related atmospheric modeling case studies that reveal the complexities of designing effective urban heat mitigation strategies. We conclude with recommendations regarding how policy-makers can optimize the performance of their urban heat mitigation policies and programs. This optimization starts with a thorough understanding of the actual end-point goals of these policies, and concludes with the careful integration of scientific knowledge into the development of location-specific strategies that recognize and address the limitations discussed herein.

  20. Improving Management of Pediatric Patients with Attention- Deficit/Hyperactivity Disorder at Naval Medical Center Portsmouth

    Science.gov (United States)

    2004-04-30

    0.83562)*100 = 0.8356 S.V. = 69.82% Provider Selection for ADHD 24 Approximately 70% of the variance in predicting the provider system...63(9), 1803-1810. Huffman, S. (2000) . Incoming Commanders Brief Naval Medical Center Portsmouth. Principles of Revised Financing, Bid Price ... ecommerce - now/marketingdefined.htm Pharmacy (n.d.) . Retrieved December 22, 2003, from http://www.tricare.osd.mil/pharmacy/bene info.cfm Sander, D

  1. 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…

  2. 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.

  3. 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.

  4. 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.

  5. The impact of accreditation of primary healthcare centers: successes, challenges and policy implications as perceived by healthcare providers and directors in Lebanon.

    Science.gov (United States)

    El-Jardali, Fadi; Hemadeh, Randa; Jaafar, Maha; Sagherian, Lucie; El-Skaff, Ranime; Mdeihly, Reem; Jamal, Diana; Ataya, Nour

    2014-02-25

    In 2009, the Lebanese Ministry of Public Health (MOPH) launched the Primary Healthcare (PHC) accreditation program to improve quality across the continuum of care. The MOPH, with the support of Accreditation Canada, conducted the accreditation survey in 25 PHC centers in 2012. This paper aims to gain a better understanding of the impact of accreditation on quality of care as perceived by PHC staff members and directors; how accreditation affected staff and patient satisfaction; key enablers, challenges and strategies to improve implementation of accreditation in PHC. The study was conducted in 25 PHC centers using a cross-sectional mixed methods approach; all staff members were surveyed using a self-administered questionnaire whereas semi-structured interviews were conducted with directors. The scales measuring Management and Leadership had the highest mean score followed by Accreditation Impact, Human Resource Utilization, and Customer Satisfaction. Regression analysis showed that Strategic Quality Planning, Customer Satisfaction and Staff Involvement were associated with a perception of higher Quality Results. Directors emphasized the benefits of accreditation with regards to documentation, reinforcement of quality standards, strengthened relationships between PHC centers and multiple stakeholders and improved staff and patient satisfaction. Challenges encountered included limited financial resources, poor infrastructure, and staff shortages. To better respond to population health needs, accreditation is an important first step towards improving the quality of PHC delivery arrangement system. While there is a need to expand the implementation of accreditation to cover all PHC centers in Lebanon, considerations should be given to strengthening their financial arrangements as well.

  6. The 2016 Academic Emergency Medicine Consensus Conference, Shared Decision Making in the Emergency Department: Development of a Policy-relevant Patient-centered Research Agenda May 10, 2016, New Orleans, LA.

    Science.gov (United States)

    Grudzen, Corita R; Anderson, Jana R; Carpenter, Christopher R; Hess, Erik P

    2016-12-01

    Shared decision making in emergency medicine has the potential to improve the quality, safety, and outcomes of emergency department (ED) patients. Given that the ED is the gateway to care for patients with a variety of illnesses and injuries and the safety net for patients otherwise unable to access care, shared decision making in the ED is relevant to numerous disciplines and the interests of the United States (U.S.) public. On May 10, 2016 the 16th annual Academic Emergency Medicine (AEM) consensus conference, "Shared Decision Making: Development of a Policy-Relevant Patient-Centered Research Agenda" was held in New Orleans, Louisiana. During this one-day conference clinicians, researchers, policy-makers, patient and caregiver representatives, funding agency representatives, trainees, and content experts across many areas of medicine interacted to define high priority areas for research in 1 of 6 domains: 1) diagnostic testing; 2) policy, 3) dissemination/implementation and education, 4) development and testing of shared decision making approaches and tools in practice, 5) palliative care and geriatrics, and 6) vulnerable populations and limited health literacy. This manuscript describes the current state of shared decision making in the ED context, provides an overview of the conference planning process, the aims of the conference, the focus of each respective breakout session, the roles of patient and caregiver representatives and an overview of the conference agenda. The results of this conference published in this issue of AEM provide an essential summary of the future research priorities for shared decision making to increase quality of care and patient-centered outcomes. © 2016 by the Society for Academic Emergency Medicine.

  7. 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.

  8. 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.

  9. Electronic Patient Registries Improve Diabetes Care and Clinical Outcomes in Rural Community Health Centers

    Science.gov (United States)

    Pollard, Cecil; Bailey, Kelly A.; Petitte, Trisha; Baus, Adam; Swim, Mary; Hendryx, Michael

    2009-01-01

    Context: Diabetes care is challenging in rural areas. Research has shown that the utilization of electronic patient registries improves care; however, improvements generally have been described in combination with other ongoing interventions. The level of basic registry utilization sufficient for positive change is unknown. Purpose: The goal of…

  10. 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

  11. 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.

  12. 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.…

  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. 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

  15. 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.

  16. Patient-Reported Measures for Person-Centered Coordinated Care: A Comparative Domain Map and Web-Based Compendium for Supporting Policy Development and Implementation.

    Science.gov (United States)

    Lloyd, Helen; Wheat, Hannah; Horrell, Jane; Sugavanam, Thavapriya; Fosh, Benjamin; Valderas, Jose M; Close, James

    2018-02-14

    Patient-reported measure (PRM) questionnaires were originally used in research to measure outcomes of intervention studies. They have now evolved into a diverse family of tools measuring a range of constructs including quality of life and experiences of care. Current health and social care policy increasingly advocates their use for embedding the patient voice into service redesign through new models of care such as person-centered coordinated care (P3C). If chosen carefully and used efficiently, these tools can help improve care delivery through a variety of novel ways, including system-level feedback for health care management and commissioning. Support and guidance on how to use these tools would be critical to achieve these goals. The objective of this study was to develop evidence-based guidance and support for the use of P3C-PRMs in health and social care policy through identification of PRMs that can be used to enhance the development of P3C, mapping P3C-PRMs against an existing model of domains of P3C, and integration and organization of the information in a user-friendly Web-based database. A pragmatic approach was used for the systematic identification of candidate P3C-PRMs, which aimed at balancing comprehensiveness and feasibility. This utilized a number of resources, including existing compendiums, peer-reviewed and gray literature (using a flexible search strategy), and stakeholder engagement (which included guidance for relevant clinical areas). A subset of those candidate measures (meeting prespecified eligibility criteria) was then mapped against a theoretical model of P3C, facilitating classification of the construct being measured and the subsequent generation of shortlists for generic P3C measures, specific aspects of P3C (eg, communication or decision making), and condition-specific measures (eg, diabetes, cancer) in priority areas, as highlighted by stakeholders. In total, 328 P3C-PRMs were identified, which were used to populate a freely

  17. 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.

  18. 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.

  19. 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.

  20. 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.

  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. 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...

  3. 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.

  4. Implementation examined in a health center-delivered, educational intervention that improved infant growth in Trujillo, Peru: successes and challenges.

    Science.gov (United States)

    Robert, Rebecca C; Gittelsohn, Joel; Creed-Kanashiro, Hilary M; Penny, Mary E; Caulfield, Laura E; Narro, M Rocio; Steckler, Allan; Black, Robert E

    2007-06-01

    Process evaluation was used to examine the implementation of a randomized, controlled trial of an education intervention that improved infant growth in Trujillo, Peru. Health personnel delivered the multi-component intervention as part of usual care in the government health centers. Quantitative and qualitative methods were used to examine process indicators, which included the extent of delivery (dose), fidelity to intervention protocol, barriers to implementation and context. Results demonstrated that most intervention components were delivered at a level of 50-90% of expectations. Fidelity to intervention protocol, where measured, was lower (28-70% of expectations). However, when compared with existing nutrition education, as represented by the control centers, significant improvements were demonstrated. This included both improved delivery of existing educational activities as well as delivery of new intervention components to strengthen overall nutrition education. Barriers to, and facilitators of, implementation were explored with health personnel and helped to explain results. This study demonstrates the importance of examining actual versus planned implementation in order to improve our understanding of how interventions succeed. The information gained from this study will inform future evaluation designs, and lead to the development and implementation of more effective intervention programs for child health.

  5. 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.

  6. Implementation successes and challenges in participating in a pragmatic study to improve colon cancer screening: perspectives of health center leaders.

    Science.gov (United States)

    Coronado, Gloria D; Schneider, Jennifer L; Petrik, Amanda; Rivelli, Jennifer; Taplin, Stephen; Green, Beverly B

    2017-09-01

    Little is known about the challenges faced by community clinics who must address clinical priorities first when participating in pragmatic studies. We report on implementation challenges faced by the eight community health centers that participated in Strategies and Opportunities to STOP Colon Cancer in Priority Populations (STOP CRC), a large comparative effectiveness cluster-randomized trial to evaluate a direct-mail program to increase the rate of colorectal cancer (CRC) screening. We conducted interviews, at the onset of implementation and 1 year later, with center leaders to identify challenges with implementing and sustaining an electronic medical record (EMR)-driven mailed program to increase CRC screening rates. We used the Consolidated Framework for Implementation Research to thematically analyze the content of meeting discussions and identify anticipated and experienced challenges. Common early concerns were patients' access to colonoscopy, patients' low awareness of CRC screening, time burden on clinic staff to carry out the STOP CRC program, inability to accurately identify eligible patients, and incompatibility of the program's approach with the patient population or organizational culture. Once the program was rolled out, time burden remained a primary concern and new organizational capacity and EMR issues were raised (e.g., EMR staffing resources and turnover in key leadership positions). Cited program successes were improved CRC screening processes and rates, more patients reached, reduced costs, and improved patient awareness, engagement, or satisfaction. These findings may inform any clinic considering mailed fecal testing programs and future pragmatic research efforts in community health centers.

  7. 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.

  8. 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.

  9. 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.

  10. Improving Anti-Rape Policy and Education at the University of Delaware

    Science.gov (United States)

    Schiffman, Jessica

    2010-01-01

    It is incumbent on colleges and universities to evaluate the conditions that lead to sexual assault on their campuses and to address those that may support a climate that encourages or tolerates rape. Though various policies and educational programs attempt to mitigate the problem, still it persists. The University of Delaware has not engaged in a…

  11. Policy Implications of a Proposed Framework to Improve the Accessibility and Effectiveness of Internships in Accounting

    Science.gov (United States)

    Capka, John; Foltin, Craig

    2017-01-01

    Accounting internships provide substantial benefits to employers and students alike. However, opportunities for students are not equitable across all populations due to the existing policies that exist for placing interns. This inequity is particularly true for students from community colleges where there is a larger proportion of underrepresented…

  12. 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...

  13. 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

  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.

    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. 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

  16. 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....

  17. 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...

  18. 77 FR 44515 - Airport Improvement Program (AIP): Policy Regarding Access to Airports From Residential Property

    Science.gov (United States)

    2012-07-30

    ... policies, restrictions, and/or requirements to be imposed on fly-in guests who taxi from the airport... a legal right of access from the property to the airport (e.g., by easement or contract) in.... Because the ability of some sponsors to control access has been compromised as a result of legal rights...

  19. Applying multi-criteria decision-making to improve the waste reduction policy in Taiwan.

    Science.gov (United States)

    Su, Jun-Pin; Hung, Ming-Lung; Chao, Chia-Wei; Ma, Hwong-wen

    2010-01-01

    Over the past two decades, the waste reduction problem has been a major issue in environmental protection. Both recycling and waste reduction policies have become increasingly important. As the complexity of decision-making has increased, it has become evident that more factors must be considered in the development and implementation of policies aimed at resource recycling and waste reduction. There are many studies focused on waste management excluding waste reduction. This study paid more attention to waste reduction. Social, economic, and management aspects of waste treatment policies were considered in this study. Further, a life-cycle assessment model was applied as an evaluation system for the environmental aspect. Results of both quantitative and qualitative analyses on the social, economic, and management aspects were integrated via the Technique for Order Preference by Similarity to Ideal Solution (TOPSIS) method into the comprehensive decision-making support system of multi-criteria decision-making (MCDM). A case study evaluating the waste reduction policy in Taoyuan County is presented to demonstrate the feasibility of this model. In the case study, reinforcement of MSW sorting was shown to be the best practice. The model in this study can be applied to other cities faced with the waste reduction problems.

  20. 76 FR 15028 - Airport Improvement Program (AIP): Interim Policy Regarding Access to Airports From Residential...

    Science.gov (United States)

    2011-03-18

    ... fees. Paying property taxes and airport fees is ``double taxation.'' Response: Grant-assisted airports... the agency to permit an exception to the through-the-fence policy for residents who own aircraft. At... constant observation of the airport by close neighbors. Some commenters argued that residents who own...

  1. An Algorithm for Detecting the Center of the Iris Using a Color Image and Improvements of Its Processing Speed

    Science.gov (United States)

    Yonezawa, Tetsuya; Ogata, Kohichi; Shiratani, Kazuyuki

    We have studied a man-machine interface system by using an eye gaze detection technique. Target users for this system are ordinary people and orthopedically impaired people who have no movement in their hands and heads. Ordinary people can use this system under the condition that they do not move their heads. An algorithm for detecting the center of the iris is proposed in this paper. An image of the eye is captured with a small video camera and the center of the iris is obtained by filtering in color space and pattern matching with a ringshaped template. Improvement of the pattern matching speed is also described and the effectiveness of the reduction of calculation costs is shown in the paper. Furthermore, the accuracy of the eye gaze detection was evaluated.

  2. 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.

  3. An evaluation of family-centered care services and organization of visiting policies in Belgian intensive care units: a multicenter survey.

    Science.gov (United States)

    Vandijck, Dominique M; Labeau, Sonia O; Geerinckx, Cindy E; De Puydt, Ellen; Bolders, Ann C; Claes, Brigitte; Blot, Stijn I

    2010-01-01

    Admission in an intensive care unit (ICU) is a major cause of psychologic stress for the patient and the entire family, and liberalization of visitation has been shown to have a beneficial impact. However, despite the data available, practice has not changed much to incorporate these findings. This study aimed to evaluate the visiting policies of Belgian ICUs. A descriptive multicenter questionnaire survey was prospectively conducted. Fifty-seven ICUs completed the questionnaire (75.0%). All (100%) reported restricted visiting-hour policies, and limited numbers of visitors. Mean total daily visiting time was 69+/-33 minutes. The type of visitors was restricted to only immediate relatives in 11 ICUs (19.3%). Children were not allowed in 5 ICUs (8.8%), and 46 ICUs (80.7%) fixed an age limit for visiting. Thirty ICUs (52.6%) were providing families with information in a special room in addition to the waiting room, whereas 6 (10.5%) reported having no waiting room available, and 9 ICUs (15.8%) provided an information leaflet. A structured first family meeting at time of admission was organized in 42 ICUs (73.7%). A final family meeting at ICU discharge was planned in only 16 centers (28.1%). Participating ICUs homogeneously reported restricted visiting policies regarding visiting hours and type and number of visitors. According to the evidence available, providing a plea for more liberal visitation, these results may be a first step toward reorganization of visiting policies in Belgian ICUs. Copyright 2010 Elsevier Inc. All rights reserved.

  4. 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.

  5. 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.)

  6. 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

  7. 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.

  8. 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.

  9. 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…

  10. Improving Basic Skills in Low Achieving Kindergarten Students through Supervised Learning Centers.

    Science.gov (United States)

    Keller, Carol

    Because low achieving kindergarten children attending a neighborhood school in the South Area of the Dade County Public School System were experiencing difficulty during independent work periods, a practicum study was designed to improve their basic skills by providing closely supervised visual, manipulative, language, and listening activities.…

  11. 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

  12. 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.

  13. Design of a quality and performance improvement project for small primary care practices: reflections on the Center for Practice Innovation.

    Science.gov (United States)

    Marsteller, Jill A; Woodward, Paula; Underwood, William S; Hsiao, Chun-Ju; Barr, Michael S

    2011-01-01

    Small practices often lack the human, financial and technical resources to make necessary practice improvements and infrastructure investments in order to achieve sustainable change that promotes quality and efficiency. To report on an effort to assist small primary care practices in improving quality of care and efficiency of practice management to meet the needs of patients, improve physician satisfaction and enhance the ability of these small practices to survive. We report on an intervention design and the reflections of the implementers on what they learned and what went well or poorly during implementation. Results of the intervention are reported separately (in Quality in Primary Care). Thirty practices underwent the entire intervention. The practices were selected on the basis of practice size, diversity in patient factors, apparent dedication to making practice improvements and geographic location. The main components of the intervention were two site visits to the participating practices by Center for Practice Innovation (CPI); now known as the Centre for Practice Improvement and Innovation, team members. The CPI team provided ongoing advice and support in focus areas selected by practices after initial site visit and assessment. A customised session focusing on the practice report and on helping practices to think about which areas they wished to improve was more effective in engaging practices than didactic presentation. Quality and practice management improvements were observed in information posting, patient education, staff communication and patient safety practices. Having a strong physician champion and a strong office manager determined to make quality improvement changes were important elements for successful change. In addition, practices with greater stability of staff and strong finances were more likely to meet project goals. Small practices today are facing a range of important challenges. The CPI sought to provide successful guidance to

  14. [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.

  15. Core modifications of the Texas A and M Nuclear Science Center reactor for improved commercial utilization

    International Nuclear Information System (INIS)

    Walker, Ken L.; Randall, John D.; Feltz, Donald E.; Taft, Joseph P.

    1980-01-01

    As a result of increasing demand for reactor services by industrial organizations as well as university experimenters, the Texas A and M Nuclear Science Center recently modified its core design with the objective of providing more irradiation positions with a higher neutron flux. This was accomplished by loading a core comprised of 87 FLIP fuel elements with peripheral bundle locations left vacant on three of the four core faces. Minor problems were encountered in predicting and achieving sufficient core excess reactivity as well as in maintaining adequate linearity of monitoring instruments positioned near the notches. The final core design was successful in providing three core slots with effective neutron fluxes of approximately 2.5 x 10 13 , an increase by a factor of 3-4 over previously available irradiation positions on the core face. Other reflector and face irradiation facilities showed slight increases as well. Appropriate sample holders have been designed for the new positions and initial customer reaction has been positive. Higher sample specific activities result in lower cost per curie of activity for commercial users, and the increased capability allows academic researchers to pursue projects previously impractical due to insufficient flux. (author)

  16. Differentiating Subtypes of Apathy to Improve Person-Centered Care in Frontotemporal Degeneration

    Science.gov (United States)

    Massimo, Lauren; Evans, Lois K.; Grossman, Murray

    2014-01-01

    Apathy, a reduction in goal-directed behavior (GDB), affects 90% of individuals with behavioral variant frontotemporal degeneration, which is a common cause of early onset neurodegenerative disease. The cognitive and neural impairments associated with apathy make it difficult to initiate, plan, and self-motivate activities toward a specific goal, such as dressing or bathing. These impairments are associated with significant decline in functional ability, caregiver burden, and increased cost of care due to early institutionalization. The current article reviews the evidence suggesting that apathy arises from the interruption of one or any combination of three GDB processes: initiation, planning, and motivation. From this perspective, three subtypes of apathy related to dysfunction at the level of GDB and the corresponding neuroanatomy are explored. Further research is required to confirm and measure these subtypes of apathy for use in clinical and research settings. A more precise classification of apathy by subtype will allow implementation of the most appropriate person-centered, individualized therapy. PMID:25199154

  17. Improvement of cryogenic 3-dimensional observation system of soft x-ray microscope at the SR center of Ritsumeikan University

    Science.gov (United States)

    Takemoto, K.; Usui, K.; Ohigashi, T.; Fujii, H.; Yoshimura, M.; Namba, H.; Kihara, H.

    2013-10-01

    The improvements of a soft x-ray microscope beamline (BL-12) at the SR center of Ritsumeikan University are reported. A wedge-shaped slit and Si plane mirror were newly introduced. The better energy resolution was expected and the +2nd order diffraction from the CZP (1.2 nm at 2.4 nm observation) was suppressed. A new sample holding fixture allows the sample to be replaced quickly and accurately. A new sample cooling system allowed a stable cryogenic x-ray imaging.

  18. Improving Perinatal Health: Are Indian Health Policies Progressing In The Right Direction?

    Science.gov (United States)

    Singh, Sharad K; Kaur, Ravinder; Prabhakar, P K; Gupta, Madhu; Kumar, Rajesh

    2017-01-01

    Strategic investments and policy directives of the Indian Government has demonstrated highest degree of political commitment for maternal and child health care. To evaluate the impact of the rise in institutional deliveries in India on perinatal mortality. Hospital delivery rate and perinatal mortality rate (PNMR), reported by Sample Registration System, Registrar General of India, on a representative sample was used. The correlation between relative change in hospital deliveries and PNMR was examined. In rural areas of India, hospital deliveries have increased during 2005-2013 from 24.4 to 69.7% and PNMR has declined from 40 to 28 per 1000 births. At the state level, there was significant correlation between the rise in hospital delivery rate and decline in PNMR ( r 0.4, p 0.04). Decline in perinatal rates can be attributed to India's strategic initiatives in health policy and planning for increasing deliveries in hospitals.

  19. Regional economic development policy of cross-border cooperation: improving trends

    OpenAIRE

    O. O. Sokolovska

    2014-01-01

    Development of regional cross-border economic cooperation on the national and regional levels become increasingly important for the european integration of Ukraine. When forming the state regional policy, in the field of cross-border economic cooperation it is necessary to use the approach that is directed at strengthening the role of regions in the integration process of Ukraine and cross-border cooperation development, increasing the region’s competitiveness, that can finally result in econ...

  20. Defense Logistics: Enhanced Policy and Procedures Needed to Improve Management of Sensitive Conventional Ammunition

    Science.gov (United States)

    2016-02-01

    making adjustments to the electronic record if necessary, tracking of SRC I ammunition by serial number, and the shipment of SRC I ammunition in the...remaining depots regarding the physical inventory process and process for adjusting the electronic record, if necessary. For five military service...Air Force to reexamine the current security policy that permits less than full inspection of vehicles, such as trash trucks, that could easily

  1. 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

  2. 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.

  3. Improving of safe operation and new open policy at VR-1 reactor

    International Nuclear Information System (INIS)

    Sklenka, Lubomir; Matejka, Karel; Kropik, Martin

    2003-01-01

    Full text: The VR-1 Reactor is operated for training of university students and nuclear power plant personnel, R and D, and information services for non-military nuclear energy use. During last four years a large number of improvements in operation was achieved. Some of them are the most important from the safety-related point of view. In the beginning of 2003 new web-portal with on-line information from the operation of the reactor was launched. Web-portal brings new feature in the way to opening information about operation of the VR-1 Reactor to public audience. Operation documentation and neutronics calculations reviewing. New Czech Atomic Act issued in 1997 and updated in 2002 requests reviewing all safety and operation documentation within five years from the date of releasing the Atomic Act. Majority of the VR-1 Reactor documentation was reviewed and updated or new documentation was created. According to requirements of the Atomic Act, Czech regulatory body requirements and IAEA recommendations there were reviewed: Operational limits and conditions; Quality assurance programmes and procedures; Inner emergency plan; emergency preparedness and emergency exercises; Operation staff qualification and training procedure, Operating instructions and procedures; Radiation protection and environmental monitoring procedure, waste management procedure. Two of them (quality assurance programmes and procedures and emergency preparedness and emergency exercises) were significantly innovated. New procedure for decommissioning was created. This preliminary version provides aims and methodology for potential decommissioning of reactor only. Next safety analysis report will be elaborated 10 years after the last SAR and after full upgrade of Control and safety system (2005-2006). At the end of 2003 works on Safety analysis by PSA method will be finished. Operation documentation reviewing for the reactor was very useful and brought at the same time new aspects and views on

  4. Can Preoperative Intramuscular Single-Dose Dexamethasone Improve Patient-Centered Outcomes Following Third Molar Surgery?

    Science.gov (United States)

    Al-Dajani, Mahmoud

    2017-08-01

    Because of increased attention focused on administering dexamethasone to treat third molar surgical complications, this study investigated the efficacy of single-dose dexamethasone in managing postoperative complications after impacted third molar surgery. Pain intensity and analgesic intake, patients' discomfort, limitation of oral function, and limitation of daily activities were assessed. This triple-blinded split-mouth randomized controlled clinical trial included patients 18 to 30 years old who underwent randomized bilateral extractions of impacted mandibular third molars during 2 consecutive sessions. Each patient was given a single-dose intramuscular injection of dexamethasone (0.1 mg/kg) preoperatively in 1 session and a placebo in the other session. Data were collected daily for 7 postoperative days, and 14 patient-centered outcomes were interpreted. A 2-tailed P value less than .05 was considered significant. All 32 patients (100%) enrolled completed the study. When administered dexamethasone, patients reported less pain (P ≤ .007), took fewer analgesics (P ≤ .002), reported less swelling (P ≤ .007), had less difficulty in eating (P ≤ .024), had less difficulty in enjoying food (P ≤ .005), had less difficulty in speech (P = .043), had less trismus (P = .005), were absent less from school or work (P ≤ .016), and had less disruption of daily activity (P ≤ .042). The differences between the 2 conditions in bleeding, malaise, and sleep disturbance were not significant (P > .05). Prophylactic dexamethasone administered intramuscularly before third molar surgery should be recommended as a safe and effective strategy for decreasing pain and discomfort and enhancing oral functions and daily activities, unless contraindicated. Copyright © 2017 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

  5. 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.

  6. Making meaningful improvements to direct care worker training through informed policy: Understanding how care setting structure and culture matter.

    Science.gov (United States)

    Kemeny, M Elizabeth; Mabry, J Beth

    2017-01-01

    Well-intentioned policy governing the training of direct care workers (DCWs) who serve older persons, in practice, may become merely a compliance issue for organizations rather than a meaningful way to improve quality of care. This study investigates the relationships between best practices in DCW training and the structure and culture of long term support service (LTSS) organizations. Using a mixed-methods approach to analyzing data from 328 licensed LTSS organizations in Pennsylvania, the findings suggest that public policy should address methods of training, not just content, and consider organizational variations in size, training evaluation practices, DCW integration, and DCW input into care planning. Effective training also incorporates support for organizations and supervisors as key aspects of DCWs' learning and working environment.

  7. Marshall Space Flight Center solid waste characterization and recycling improvement study

    Science.gov (United States)

    Eley, Michael H.; Crews, Lavonne; Johnston, Ben; Lee, David; Colebaugh, James

    1995-01-01

    The MSFC Facilities Office, which is responsible for disposing of all waste generated by MSFC, issued a delivery order to the University of Alabama in Huntsville (UAH) to characterize current MSFC waste streams and to evaluate their existing recycling program. The purpose of the study was to define the nature, quantity, and types of waste produced and to generate ideas for improving the present recycling program. Specifically, the following tasks were to be performed: Identify various surplus and waste materials--as identified by the Contracting Officer's Technical Representative (COTR)--by source, location, and type; Analyze MSFC's current methods for handling, storage, transport, and disposition of waste and surplussed materials; Determine the composition of various surplus and waste materials as to type and quantities from various sources and locations; Analyze different methods for the disposition of various surplus and waste materials, including quality, quantity, preparation, transport cost, and value; Study possible alternatives to current methods of handling, storage, transport, and disposition of surplus and waste materials to improve the quality and quantities recycled or sold and to reduce and minimize the quantities of surplus and waste material currently being disposed of or stored; Provide recommendations for source and centralized segregation and aggregation of materials for recycling and/or disposition; and The analysis could include identification and laboratory level evaluation of methods and/or equipment, including capital costs, operating costs, maintenance requirements, life cycle and return on investment for systems to support the waste reduction program mission.

  8. Improvement of Traffic Movement for Roads Network in Al-Kadhimiya City Center

    Directory of Open Access Journals (Sweden)

    Mohammed Qadir Ismael

    2016-09-01

    Full Text Available Numerous regions in the city of Baghdad experience the congestion and traffic problems. Due to the religious and economic significance, Al-Kadhimiya city (inside the metropolitan range of Baghdad was chosen as study area. The data gathering stage was separated into two branches: the questionnaire method which is utilized to estimate the traffic volumes for the chosen roads and field data collection method which included video recording and manual counting for the volumes entering the selected signal intersections. The stage of analysis and evaluation for the seventeen urban roads, one highway, and three intersections was performed by HCS-2000 software.The presented work plots a system for assessing the level of service for roads network within the study region. Moreover, several improvement alternatives were proposed to overcome the traffic movement operations issues. This work shows that traffic facilities currently undergoing serious degradation causing a traffic jam. Therefore, the implementation of some remedial action is necessary to improve the level of service for these facilities.

  9. Taking the Offensive in the Struggle against Anti-Gay Abuse in Public Schools: Improving School Policies and State Laws. A Landmark Compendium of Model Policies and Laws.

    Science.gov (United States)

    Buckel, David S.

    This document presents some helpful examples of existing school policies and state laws that may spark action to help communities deal with homophobia and harassment of homosexual students. Most school districts have nondiscrimination policies of one sort or another, but these policies may not cover discrimination based on sexual harassment.…

  10. 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

  11. 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

  12. 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

  13. 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

  14. 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.

  15. 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

  16. 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

  17. Locoregional Prostate Cancer Treatment Pattern Variation in Independent Cancer Centers: Policy Effect, Patient Preference, or Physician Incentive?

    Directory of Open Access Journals (Sweden)

    Andrew S. Camarata

    2015-01-01

    Full Text Available Surveillance, Epidemiologic, and End Results (SEER registry data abstracted from a priority 2 or higher reporting source from 2006 to 2008 were used to compare treatment patterns in 45–64-year old men diagnosed with locoregional prostate cancer (LRPC across states with or without radiation therapy-directed certificate of need (CON laws and across independent cancer centers (ICCs compared to large multi-specialty groups (LMSGs. Adjusted treatment percentages for the five most common LRPC treatments (surgery, external beam radiation therapy (EBRT, combination brachytherapy with EBRT, brachytherapy, and observation were compared using cross-sectional logistic regression between CON-unregulated and -regulated states and between LMSGs and ICCs. LRPC EBRT rates were no different across CON regions, but are increased in ICCs compared to LMSGs (37.00% vs. 13.23%, P < 0.001. Variation in LRPC treatment patterns by reporting source merits further scrutiny under the Affordable Care Act of 2010, considering the intent of incentivized accountable care organizations (ACOs established by the Patient Protection and Affordable Care Act of 2010 (PPACA and the implications of early descriptions of these new healthcare provider organizations on prostate cancer treatment patterns.

  18. 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.

  19. Evaluating the Wellness School Assessment Tool for Use in Public Health Practice to Improve School Nutrition and Physical Education Policies in New York

    Science.gov (United States)

    Brissette, Ian; Wales, Kathleen; O'Connell, Meghan

    2013-01-01

    Background: Addressing the limitations of existing Local Wellness Policies (LWPs) and promoting their implementation remain priorities for health and education agencies. One gap has been the absence of a standard assessment to support LWP revision. During planning for an initiative to improve school nutrition and physical education policy, the…

  20. 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.

  1. 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.

  2. Improving Quality for Child Care Centers in Greater Philadelphia: An Evaluation of Success by 6®. Technical Appendix. Publication #2016-07B

    Science.gov (United States)

    Warner-Richter, Mallory; Lowe, Claire; Tout, Kathryn; Epstein, Dale; Li, Weilin

    2016-01-01

    The Success By 6® (SB6) initiative is designed to support early care and education centers in improving and sustaining quality in Pennsylvania's Keystone STARS Quality Rating and Improvement System (QRIS). The SB6 evaluation report examines implementation and outcomes. The findings have implications for SB6 continous quality improvement process…

  3. Improving Quality for Child Care Centers in Greater Philadelphia: An Evaluation of Success by 6®. Executive Summary. Publication #2016-07A

    Science.gov (United States)

    Warner-Richter, Mallory; Lowe, Claire; Tout, Kathryn; Epstein, Dale; Li, Weilin

    2016-01-01

    The Success By 6® (SB6) initiative is designed to support early care and education centers in improving and sustaining quality in Pennsylvania's Keystone STARS Quality Rating and Improvement System (QRIS). The SB6 evaluation report examines implementation and outcomes. The findings have implications for SB6 continous quality improvement process…

  4. Improving Quality for Child Care Centers in Greater Philadelphia: An Evaluation of Success by 6®. Program Design Appendix. Publication #2016-07C

    Science.gov (United States)

    Warner-Richter, Mallory; Lowe, Claire; Tout, Kathryn; Epstein, Dale; Li, Weilin

    2016-01-01

    The Success By 6® (SB6) initiative is designed to support early care and education centers in improving and sustaining quality in Pennsylvania's Keystone STARS Quality Rating and Improvement System (QRIS). The SB6 evaluation report examines implementation and outcomes. The findings have implications for SB6 continous quality improvement process…

  5. Improving Quality for Child Care Centers in Greater Philadelphia: An Evaluation of Success by 6®. Final Report. Publication #2016-07

    Science.gov (United States)

    Warner-Richter, Mallory; Lowe, Claire; Tout, Kathryn; Epstein, Dale; Li, Weilin

    2016-01-01

    The Success By 6® (SB6) initiative is designed to support early care and education centers in improving and sustaining quality in Pennsylvania's Keystone STARS Quality Rating and Improvement System (QRIS). This SB6 evaluation report examines implementation and outcomes. The findings have implications for SB6 continous quality improvement process…

  6. 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

  7. 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.

  8. 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.

  9. 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.

  10. 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…

  11. 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.

  12. 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.

  13. 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.

  14. Integrated soil improvement and agricultural development: why current policy approaches fail

    NARCIS (Netherlands)

    Koning, N.B.J.; Heerink, N.B.M.; Kauffman, S.

    1997-01-01

    Integrated soil management is an essential condition for agricultural development in West Africa. Such an approach combines improved soil hydraulic measures, organic fertility measures, and inorganic fertilizers and soil amendments. The synergetic effects which result from this combination are

  15. 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

  16. 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 ( ...

  17. 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.

  18. 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.

  19. [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.

  20. 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

  1. 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…

  2. Concussion management in United States college sports: compliance with National Collegiate Athletic Association concussion policy and areas for improvement.

    Science.gov (United States)

    Baugh, Christine M; Kroshus, Emily; Daneshvar, Daniel H; Filali, Naji A; Hiscox, Michael J; Glantz, Leonard H

    2015-01-01

    In 2010, the National Collegiate Athletic Association (NCAA) adopted its Concussion Policy and Legislation, which applies to more than 450,000 collegiate athletes annually. To date, there has been no examination of school-level compliance with the NCAA Concussion Policy. To examine whether stakeholders at NCAA schools report that their school has a concussion management plan and whether existing plans are consistent with the NCAA policy. Also examined were stakeholders' perceptions regarding concussion management at their institution and possible areas for improvement. Cross-sectional study; Level of evidence, 3. Surveys were sent by e-mail to coaches, sports medicine clinicians, and compliance administrators at all 1066 NCAA member institutions. Surveys asked population-specific questions about institutional concussion management. Individuals (N=2880) from 907 unique schools participated in this survey. Most respondents (n=2607; 92.7%) indicated their school had a concussion management plan. Most schools had all (82.1%) or some (15.2%) respondents indicate a concussion management plan was present. When asked to indicate all individuals who could have final responsibility for returning athletes to play after a concussion, 83.4% selected team doctor, 72.8% athletic trainer, 31.0% specialist physician, 6.8% coach, and 6.6% athlete. Most respondents (76.1%) indicated that their institution had a process for annual athlete concussion education; 91.2% required athletes to acknowledge their responsibility to report concussion symptoms. Nearly all respondents (98.8%) thought their school's concussion management plan protected athletes "well" or "very well." Top categories suggested for improvement included better coach education (39.7%), increasing sports medicine staffing (37.2%), and better athlete education (35.2%). Although a large majority of respondents indicated that their school has a concussion management plan, improvement is needed. Compliance with specified

  3. Pay Policy Reform : Building a Foundation for Public Sector Performance Through Improved Public Sector Pay Policy by Using a "Single Pay Spine"

    OpenAIRE

    Malcolm Green

    2009-01-01

    Appropriate public sector remuneration policies are key for performance. They can motivate staff to a limited extent by rewarding performance but more generally by eliminating inequities and avoiding frequent and sudden changes in pay. They can also assist in retaining competent staff one of the most critical drivers of public sector performance. Developing pay policy in the public sector is ...

  4. 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.

  5. 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

  6. 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.

  7. 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

  8. Development of an improved commercial sector energy model for national policy analysis

    Energy Technology Data Exchange (ETDEWEB)

    Belzer, D.B.

    1992-12-01

    Pacific Northwest Laboratory provided support to the Office of Conservation and Renewable Energy (CE), under the Office of Planning and Assessment, to develop improved energy and environmental analysis tools. Commercial building sector energy models from the past decade were analyzed in order to provoke comment and stimulate discussion between potential model users and developers as to the appropriate structure and capability of a commercial sector energy model supported by CE. Three specific areas were examined during this review. These areas provide (1) a look at recent suggestions and guidance as to what constitutes a minimal set of requirements and capabilities for a commercial buildings energy model for CE, (2) a review of several existing models in terms of their general structure and how they match up with the requirements listed previously, and (3) an overview of a proposed improved commercial sector energy model.

  9. Practical Recommendations on the Improvement of the Effectiveness of Anti-Corruption Policy in Universities

    OpenAIRE

    Zamaletdinov, Radif R.; Yudina, Nadezhda P.; Lavrentyeva, Elvira I.; Savva, Lubov I.; Pugacheva, Natalya B.

    2016-01-01

    The relevance of the study is conditioned by the expansion of the scale of corruption in higher education. The purpose of the article is to develop practical recommendations for improving of anti-corruption policy’s effectiveness at universities. The study involved 450 teachers, 1200 students from 140 Russian universities. The main results of the study are to identify the causes of bribery and popular tools of counteraction of corruption in universities, organizational and practical measure...

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

    OpenAIRE

    Emma Davies; Ben Mathews; John Read

    2014-01-01

    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, ...

  11. Improving transportation networks: Effects of population structure and decision making policies

    OpenAIRE

    Pablo-Mart?, Federico; S?nchez, Angel

    2017-01-01

    Transportation networks are one of the fundamental tools for human society to work, more so in our globalized world. The importance of a correct, efficient design of a transportation network for a given region or country cannot be overstated. We here study how network design is affected by the geography of the towns or nuclei to be connected, and also by the decision process necessary to choose which connections should be improved (in a generic sense) first. We begin by establishing that Dela...

  12. 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.

  13. 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. PMID:26448807

  14. Improving food environments and tackling obesity: A realist systematic review of the policy success of regulatory interventions targeting population nutrition.

    Science.gov (United States)

    Sisnowski, Jana; Street, Jackie M; Merlin, Tracy

    2017-01-01

    This systematic review (PROSPERO: CRD42015025276) employs a realist approach to investigate the effect of "real-world" policies targeting different aspects of the food environment that shape individual and collective nutrition. We were interested in assessing intermediate outcomes along the assumed causal pathway to "policy success", in addition to the final outcome of changed consumption patterns. We performed a search of 16 databases through October 2015, with no initial restriction by language. We included all publications that reported the effect of statutory provisions aimed at reducing the consumption of energy-dense foods and beverages in the general population. We allowed all methodological approaches that contained some measure of comparison, including studies of implementation progress. We reviewed included studies using the appraisal tools for pre-post and observational studies developed by the National Heart, Lung, and Blood Institute. Given the considerable heterogeneity in interventions assessed, study designs employed, and outcome measures reported, we opted for a narrative synthesis of results. Results drawn from 36 peer-reviewed articles and grey literature reports demonstrated that isolated regulatory interventions can improve intermediate outcomes, but fail to affect consumption at clinically significant levels. The included literature covered six different types of interventions, with 19 studies reporting on calorie posting on chain restaurant menus. The large majority of the identified interventions were conducted in the US. Early results from recent taxation measures were published after the review cut-off date but these suggested more favorable effects on consumption levels. Nevertheless, the evidence assessed in this review suggests that current policies are generally falling short of anticipated health impacts.

  15. How Public Education Benefits from the Federal Income Tax Deduction for State and Local Taxes and Other Special Tax Provisions. A Background Paper from the Center on Education Policy

    Science.gov (United States)

    Riddle, Wayne C.

    2011-01-01

    This background paper is intended to serve as a companion to the Center on Education Policy report, "Get the Federal Government Out of Education? That Wasn't the Founding Fathers' Vision." That report discusses the historical foundations and current purposes of the federal role in education. This paper goes into more detail about an issue…

  16. 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.

  17. 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.

  18. 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 customer satisfaction with the authored works approval process, leading to 100% signature compliance, a comprehensive longitudinal repository of all authored work requests, and a 97% "completely or mostly satisfied

  19. 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

  20. 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.

  1. 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

  2. Perspectives on quality mental health care from Brazilian and Cape Verdean outpatients: Implications for effective patient-centered policies and models of care

    Directory of Open Access Journals (Sweden)

    Maria De Jesus

    2014-01-01

    Full Text Available 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.

  3. 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. PMID:24461570

  4. The Power to drive change: Working together for excellence. Creating a continuously improving consumer engagement framework for excellence in patient-centered care.

    Science.gov (United States)

    Ryan, Catherine

    2016-01-01

    The World Health Organization has acknowledged Patient Safety while receiving hospital care as a serious global public health issue, with patient empowerment and community engagement key to continuously improving safety and quality of care for the best possible clinical and patient outcomes. In Australia, the introduction of ten mandatory National Safety and Quality Health Service Standards in 2011 provided the catalyst for all Australian health facilities to review their systems. Standard 2: Partnering with Consumers required health facilities across Australia to assess commitment to, and capacity for consumer and community engagement and participation. At this time, the Royal Brisbane and Women's Hospital did not have a strategic perspective and understanding, or an organizational structure for engaging with consumers (patients, families, care givers and community members). The concept required a new model to replace the clinician-led model of healthcare historically featured in Australia, with a change in culture and core business. processes to partner with consumers at all levels of the system, from individual patient care through to participating in policy development, health service planning and delivery, and evaluation and measurement processes. The challenge for the hospital was to build a sustainable framework of engagement for a genuine patient-centered model of care informed by best practice, and provide leadership and commitment to developing as an area of excellence in patient engagement and experience. A successful and sustainable framework for consumer and community engagement has been embedded in the hospital, with resultant culture change, achieving accreditation across all core and developmental criteria for the partnering with consumer standards including several Met with Merit ratings.

  5. 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,

  6. Can universal pre-kindergarten programs improve population health and longevity? Mechanisms, evidence, and policy implications.

    Science.gov (United States)

    Muennig, Peter

    2015-02-01

    Recent research has found that children who attended pre-kindergarten programs in childhood were more likely to be healthy as adults. One intuitive way of improving population health and longevity may therefore be to invest in pre-kindergarten programs. However, much of the research linking pre-kindergarten programs to health is very recent and has not been synthesized. In this paper, I review the mechanisms linking pre-kindergarten programs in childhood to adult longevity, and the experimental evidence backing up these linkages. I conclude with a critical exploration of whether investments in pre-kindergarten programs could also serve as investments in public health. Copyright © 2014 Elsevier Ltd. All rights reserved.

  7. Effect of artemether-lumefantrine policy and improved vector control on malaria burden in KwaZulu-Natal, South Africa.

    Directory of Open Access Journals (Sweden)

    Karen I Barnes

    2005-11-01

    Full Text Available Between 1995 and 2000, KwaZulu-Natal province, South Africa, experienced a marked increase in Plasmodium falciparum malaria, fuelled by pyrethroid and sulfadoxine-pyrimethamine resistance. In response, vector control was strengthened and artemether-lumefantrine (AL was deployed in the first Ministry of Health artemisinin-based combination treatment policy in Africa. In South Africa, effective vector and parasite control had historically ensured low-intensity malaria transmission. Malaria is diagnosed definitively and treatment is provided free of charge in reasonably accessible public-sector health-care facilities.We reviewed four years of malaria morbidity and mortality data at four sentinel health-care facilities within KwaZulu-Natal's malaria-endemic area. In the year following improved vector control and implementation of AL treatment, malaria-related admissions and deaths both declined by 89%, and outpatient visits decreased by 85% at the sentinel facilities. By 2003, malaria-related outpatient cases and admissions had fallen by 99%, and malaria-related deaths had decreased by 97%. There was a concomitant marked and sustained decline in notified malaria throughout the province. No serious adverse events were associated causally with AL treatment in an active sentinel pharmacovigilance survey. In a prospective study with 42 d follow up, AL cured 97/98 (99% and prevented gametocyte developing in all patients. Consistent with the findings of focus group discussions, a household survey found self-reported adherence to the six-dose AL regimen was 96%.Together with concurrent strengthening of vector control measures, the antimalarial treatment policy change to AL in KwaZulu-Natal contributed to a marked and sustained decrease in malaria cases, admissions, and deaths, by greatly improving clinical and parasitological cure rates and reducing gametocyte carriage.

  8. 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…

  9. 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)

  10. 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.

  11. 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

  12. 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)

  13. Randomised primary health center based interventions to improve the diagnosis and treatment of undifferentiated fever and dengue in Vietnam

    Directory of Open Access Journals (Sweden)

    Binh Tran Q

    2010-09-01

    Full Text Available Abstract Background Fever is a common reason for attending primary health facilities in Vietnam. Response of health care providers to patients with fever commonly consists of making a presumptive diagnosis and proposing corresponding treatment. In Vietnam, where malaria was brought under control, viral infections, notably dengue, are the main causes of undifferentiated fever but they are often misdiagnosed and inappropriately treated with antibiotics. This study investigate if educating primary health center (PHC staff or introducing rapid diagnostic tests (RDTs improve diagnostic resolution and accuracy for acute undifferentiated fever (AUF and reduce prescription of antibiotics and costs for patients. Methods In a PHC randomized intervention study in southern Vietnam, the presumptive diagnoses for AUF patients were recorded and confirmed by serology on paired (acute and convalescence sera. After one year, PHCs were randomized to four intervention arms: training on infectious diseases (A, the provision of RDTs (B, the combination (AB and control (C. The intervention lasted from 2002 until 2006. Results The frequency of the non-etiologic diagnosis "undifferentiated fever" decreased in group AB, and - with some delay- also in group B. The diagnosis "dengue" increased in group AB, but only temporarily, although dengue was the most common cause of fever. A correct diagnosis for dengue initially increased in groups AB and B but only for AB this was sustained. Antibiotics prescriptions increased in group C. During intervention it initially declined in AB with a tendency to increase afterwards; in B it gradually declined. There was a substantial increase of patients' costs in B. Conclusions The introduction of RDTs for infectious diseases such as dengue, through free market principles, does improve the quality of the diagnosis and decreases the prescription of antibiotics at the PHC level. However, the effect is more sustainable in combination with

  14. Randomised primary health center based interventions to improve the diagnosis and treatment of undifferentiated fever and dengue in Vietnam.

    Science.gov (United States)

    Phuong, Hoang L; Nga, Tran T T; Giao, Phan T; Hung, Le Q; Binh, Tran Q; Nam, Nguyen V; Nagelkerke, Nico; de Vries, Peter J

    2010-09-21

    Fever is a common reason for attending primary health facilities in Vietnam. Response of health care providers to patients with fever commonly consists of making a presumptive diagnosis and proposing corresponding treatment. In Vietnam, where malaria was brought under control, viral infections, notably dengue, are the main causes of undifferentiated fever but they are often misdiagnosed and inappropriately treated with antibiotics.This study investigate if educating primary health center (PHC) staff or introducing rapid diagnostic tests (RDTs) improve diagnostic resolution and accuracy for acute undifferentiated fever (AUF) and reduce prescription of antibiotics and costs for patients. In a PHC randomized intervention study in southern Vietnam, the presumptive diagnoses for AUF patients were recorded and confirmed by serology on paired (acute and convalescence) sera. After one year, PHCs were randomized to four intervention arms: training on infectious diseases (A), the provision of RDTs (B), the combination (AB) and control (C). The intervention lasted from 2002 until 2006. The frequency of the non-etiologic diagnosis "undifferentiated fever" decreased in group AB, and - with some delay- also in group B. The diagnosis "dengue" increased in group AB, but only temporarily, although dengue was the most common cause of fever. A correct diagnosis for dengue initially increased in groups AB and B but only for AB this was sustained. Antibiotics prescriptions increased in group C. During intervention it initially declined in AB with a tendency to increase afterwards; in B it gradually declined. There was a substantial increase of patients' costs in B. The introduction of RDTs for infectious diseases such as dengue, through free market principles, does improve the quality of the diagnosis and decreases the prescription of antibiotics at the PHC level. However, the effect is more sustainable in combination with training; without it RDTs lead to an excess of costs.

  15. 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.

  16. 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.

  17. Improving clinical research and cancer care delivery in community settings: evaluating the NCI community cancer centers program.

    Science.gov (United States)

    Clauser, Steven B; Johnson, Maureen R; O'Brien, Donna M; Beveridge, Joy M; Fennell, Mary L; Kaluzny, Arnold D

    2009-09-26

    In this article, we describe the National Cancer Institute (NCI) Community Cancer Centers Program (NCCCP) pilot and the evaluation designed to assess its role, function, and relevance to the NCI's research mission. In doing so, we describe the evolution of and rationale for the NCCCP concept, participating sites' characteristics, its multi-faceted aims to enhance clinical research and quality of care in community settings, and the role of strategic partnerships, both within and outside of the NCCCP network, in achieving program objectives. The evaluation of the NCCCP is conceptualized as a mixed method multi-layered assessment of organizational innovation and performance which includes mapping the evolution of site development as a means of understanding the inter- and intra-organizational change in the pilot, and the application of specific evaluation metrics for assessing the implementation, operations, and performance of the NCCCP pilot. The assessment of the cost of the pilot as an additional means of informing the longer-term feasibility and sustainability of the program is also discussed. The NCCCP is a major systems-level set of organizational innovations to enhance clinical research and care delivery in diverse communities across the United States. Assessment of the extent to which the program achieves its aims will depend on a full understanding of how individual, organizational, and environmental factors align (or fail to align) to achieve these improvements, and at what cost.

  18. Improving clinical research and cancer care delivery in community settings: evaluating the NCI community cancer centers program

    Directory of Open Access Journals (Sweden)

    Fennell Mary L

    2009-09-01

    Full Text Available Abstract Background In this article, we describe the National Cancer Institute (NCI Community Cancer Centers Program (NCCCP pilot and the evaluation designed to assess its role, function, and relevance to the NCI's research mission. In doing so, we describe the evolution of and rationale for the NCCCP concept, participating sites' characteristics, its multi-faceted aims to enhance clinical research and quality of care in community settings, and the role of strategic partnerships, both within and outside of the NCCCP network, in achieving program objectives. Discussion The evaluation of the NCCCP is conceptualized as a mixed method multi-layered assessment of organizational innovation and performance which includes mapping the evolution of site development as a means of understanding the inter- and intra-organizational change in the pilot, and the application of specific evaluation metrics for assessing the implementation, operations, and performance of the NCCCP pilot. The assessment of the cost of the pilot as an additional means of informing the longer-term feasibility and sustainability of the program is also discussed. Summary The NCCCP is a major systems-level set of organizational innovations to enhance clinical research and care delivery in diverse communities across the United States. Assessment of the extent to which the program achieves its aims will depend on a full understanding of how individual, organizational, and environmental factors align (or fail to align to achieve these improvements, and at what cost.

  19. Diagnosis and improvement proposals for the Ezeiza Atomic Center quality management system by carrying out the third laboratories workshop

    International Nuclear Information System (INIS)

    Eliosoff, Nilda M.

    2003-01-01

    By the end of 2001 the management of the Ezeiza Atomic Center (EAC) under the National Atomic Energy Commission of Argentina, stated the necessity of carrying out a survey of its laboratories. The purpose of this survey was to get information that would allow to assess the quality of the laboratories and the services they perform, including the degree of implementation of the management systems. In order to comply with this purpose fourteen EAC's laboratories were studied. The information obtained was related to the staff, their training, the kind of tasks they perform as services or as research and development, the customers, the amount of invoicing, the premises, the equipment and the adapting and implementation of the quality management system. With the results obtained from the survey a report was issued. Economic, Financial, Commercial and Human Resources workshops as well as Technical Aspects and Quality Management workshops were organized. These workshops were to go deep into the analysis of the information obtained and to generate improvement proposals of the different subjects. (author)

  20. Guidelines for Implementation of an Advanced Outage Control Center to Improve Outage Coordination, Problem Resolution, and Outage Risk Management

    Energy Technology Data Exchange (ETDEWEB)

    St. Germain, Shawn W. [Idaho National Lab. (INL), Idaho Falls, ID (United States); Farris, Ronald K. [Idaho National Lab. (INL), Idaho Falls, ID (United States); Whaley, April M. [Idaho National Lab. (INL), Idaho Falls, ID (United States); Medema, Heather D. [Idaho National Lab. (INL), Idaho Falls, ID (United States); Gertman, David I. [Idaho National Lab. (INL), Idaho Falls, ID (United States)

    2014-09-01

    This research effort is a part of the Light-Water Reactor Sustainability (LWRS) Program, which is a research and development (R&D) program sponsored by Department of Energy (DOE) and performed in close collaboration with industry R&D programs that provide the technical foundations for licensing and managing the long-term, safe, and economical operation of current nuclear power plants. The LWRS program serves to help the U.S. nuclear industry adopt new technologies and engineering solutions that facilitate the continued safe operation of the plants and extension of the current operating licenses. The purpose of this research is to improve management of nuclear power plant (NPP) outages through the development of an advanced outage control center (AOCC) that is specifically designed to maximize the usefulness of communication and collaboration technologies for outage coordination and problem resolution activities. This technical report for industry implementation outlines methods and considerations for the establishment of an AOCC. This report provides a process for implementation of a change management plan, evaluation of current outage processes, the selection of technology, and guidance for the implementation of the selected technology. Methods are presented for both adoption of technologies within an existing OCC and for a complete OCC replacement, including human factors considerations for OCC design and setup.