Promising Practices in Citywide Afterschool Initiatives. CityWorks: Focus on Infrastructure.

Science.gov (United States)

Hall, Georgia

This brief is the first in a series featuring promising practices in city-wide after-school initiatives, with a focus at the infrastructure level, focusing on the infrastructure representing the underlying elements or framework that hold a system or initiative together. The brief identifies practices to support the public relations function and…

Return to Experience and Initial Wage Level

DEFF Research Database (Denmark)

Sørensen, Kenneth Lykke; Vejlin, Rune Majlund

This paper estimates the relationship between initial wage and return to experience. We use a Mincer-like wage model to nonparametrically estimate this relationship allowing for an unobservable individual permanent effect in wages and unobservable individual return to experience. The relationship...

Transcendental experiences during meditation practice.

Science.gov (United States)

Travis, Frederick

2014-01-01

This article explores transcendental experiences during meditation practice and the integration of transcendental experiences and the unfolding of higher states of consciousness with waking, dreaming, and sleeping. The subject/object relationship during transcendental experiences is characterized by the absence of time, space, and body sense--the framework that gives meaning to waking experiences. Physiologically, transcendental experiences during Transcendental Meditation practice are marked by slow inhalation, along with autonomic orientation at the onset of breath changes and heightened α1 (8-10 Hz) frontal coherence. The integration of transcendental experiences with waking, dreaming, and sleeping is also marked by distinct subjective and objective markers. This integrated state, called Cosmic Consciousness in the Vedic tradition, is subjectively marked by inner self-awareness coexisting with waking, sleeping, and dreaming. Physiologically, Cosmic Consciousness is marked by the coexistence of α1 electroencephalography (EEG) with delta EEG during deep sleep, and higher brain integration, greater emotional stability, and decreased anxiety during challenging tasks. Transcendental experiences may be the engine that fosters higher human development. © 2013 New York Academy of Sciences.

Return to experience and initial wage level

DEFF Research Database (Denmark)

Sørensen, K.L.; Vejlin, R.

2014-01-01

This paper estimates the relationship between initial wage and return to experience. We use a Mincer-like wage model to non-parametrically estimate this relationship allowing for an unobservable individual permanent effect in wages and unobservable individual return to experience. The relationshi...

Perfect Match? The Practice Ecology of a Labor Market Initiative for Refugees

DEFF Research Database (Denmark)

Buch, Anders; Berthou, Sara Kristine Gløjmar

2018-01-01

the practices exist and are interconnected in ecological arrangements where practice architectures hold one another in place. The theoretical conceptualization in terms of practice, practices, practice architectures, and practice ecologies helps to explain how a seemingly ideal initiative turned out to have...

Initial state radiation experiment at MAMI

Energy Technology Data Exchange (ETDEWEB)

Mihovilovič, M.; Merkel, H. [Institut für Kernphysik, Johannes Gutenberg-Universität Mainz, Johann-Joachim-Becher-Weg 45, 55128 Mainz (Germany); Collaboration: A1-Collaboration

2013-11-07

In an attempt to contribute further insight into the discrepancy between the Lamb shift and elastic scattering determinations of the proton charge radius, a new experiment at MAMI is underway, aimed at measuring proton form-factors at very low momentum transfers by using a new technique based on initial state radiation. This paper reports on first findings of the pilot measurement performed in 2010, whose main goal was to check the feasibility of the proposed experiment and to recognize and overcome potential obstacles before running the full experiment in 2013.

Lean and leadership practices: development of an initial realist program theory.

Science.gov (United States)

Goodridge, Donna; Westhorp, Gill; Rotter, Thomas; Dobson, Roy; Bath, Brenna

2015-09-07

Lean as a management system has been increasingly adopted in health care settings in an effort to enhance quality, capacity and safety, while simultaneously containing or reducing costs. The Ministry of Health in the province of Saskatchewan, Canada has made a multi-million dollar investment in Lean initiatives to create "better health, better value, better care, and better teams", affording a unique opportunity to advance our understanding of the way in which Lean philosophy, principles and tools work in health care. In order to address the questions, "What changes in leadership practices are associated with the implementation of Lean?" and "When leadership practices change, how do the changed practices contribute to subsequent outcomes?", we used a qualitative, multi-stage approach to work towards developing an initial realist program theory. We describe the implications of realist assumptions for evaluation of this Lean initiative. Formal theories including Normalization Process Theory, Theories of Double Loop and Organization Leaning and the Theory of Cognitive Dissonance help understand this initial rough program theory. Data collection included: key informant consultation; a stakeholder workshop; documentary review; 26 audiotaped and transcribed interviews with health region personnel; and team discussions. A set of seven initial hypotheses regarding the manner in which Lean changes leadership practices were developed from our data. We hypothesized that Lean, as implemented in this particular setting, changes leadership practices in the following ways. Lean: a) aligns the aims and objectives of health regions; b) authorizes attention and resources to quality improvement and change management c) provides an integrated set of tools for particular tasks; d) changes leaders' attitudes or beliefs about appropriate leadership and management styles and behaviors; e) demands increased levels of expertise, accountability and commitment from leaders; f) measures and

Understanding foreign language teachers’ practical knowledge: What’s the role of prior language learning experience?

Directory of Open Access Journals (Sweden)

Sibel Arıoğul

2007-04-01

Full Text Available Teachers’ practical knowledge is considered as teachers’ general knowledge, beliefsand thinking (Borg, 2003 which can be traced in teachers’ practices (Connelly & Clandinin,1988 and shaped by various background sources (Borg, 2003; Grossman, 1990; Meijer,Verloop, and Beijard, 1999. This paper initially discusses how language teachers areinfluenced by three background sources: teachers’ prior language learning experiences, priorteaching experience, and professional coursework in pre- and in-service education. Bydrawing its data from the author’s longitidunal study, it also presents the findings of a crosscasetheme emerged from the investigation of three English as a foreign language (EFLteachers’ prior language learning experiences. The paper also discusses how the participationin studies on teachers’ knowledge raises teachers’ own awareness while it informs theresearch.

40 CFR 63.11584 - What are my initial and continuous compliance management practice requirements?

Science.gov (United States)

2010-07-01

... compliance management practice requirements? 63.11584 Section 63.11584 Protection of Environment... What are my initial and continuous compliance management practice requirements? (a) For each new and... gr/dscf, the management practice requirements are as follows: (1) You must conduct an initial visual...

Thermophysical Property Estimation by Transient Experiments: The Effect of a Biased Initial Temperature Distribution

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Federico Scarpa

2015-01-01

Full Text Available The identification of thermophysical properties of materials in dynamic experiments can be conveniently performed by the inverse solution of the associated heat conduction problem (IHCP. The inverse technique demands the knowledge of the initial temperature distribution within the material. As only a limited number of temperature sensors (or no sensor at all are arranged inside the test specimen, the knowledge of the initial temperature distribution is affected by some uncertainty. This uncertainty, together with other possible sources of bias in the experimental procedure, will propagate in the estimation process and the accuracy of the reconstructed thermophysical property values could deteriorate. In this work the effect on the estimated thermophysical properties due to errors in the initial temperature distribution is investigated along with a practical method to quantify this effect. Furthermore, a technique for compensating this kind of bias is proposed. The method consists in including the initial temperature distribution among the unknown functions to be estimated. In this way the effect of the initial bias is removed and the accuracy of the identified thermophysical property values is highly improved.

Initial experience of using an active beam delivery technique at PSI

International Nuclear Information System (INIS)

Pedroni, E.; Boehringer, T.; Coray, A.; Egger, E.; Grossmann, M.; Lin Shixiong; Lomax, A.; Goitein, G.; Roser, W.; Schaffner, B.

1999-01-01

At PSI a new proton therapy facility has been assembled and commissioned. The major features of the facility are the spot scanning technique and the very compact gantry. The operation of the facility was started in 1997 and the feasibility of the spot scanning technique has been demonstrated in practice with patient treatments. In this report we discuss the usual initial difficulties encountered in the commissioning of a new technology, the very positive preliminary experience with the system and the optimistic expectations for the future. The long range goal of this project is to parallel the recent developments regarding inverse planning for photons with a similar advanced technology optimized for a proton beam. (orig.)

The theory-practice relationship: reflective skills and theoretical knowledge as key factors in bridging the gap between theory and practice in initial nursing education.

Science.gov (United States)

Hatlevik, Ida Katrine Riksaasen

2012-04-01

This paper is a report of a correlational study of the relations of nursing students' acquired reflective skills, practical skills and theoretical knowledge on their perception of coherence between theory and practice. Reflection is considered a key factor in bridging the gap between theory and practice. However, it is not evident whether reflective skills are primarily generic in nature or whether they develop from a theoretical knowledge base or the acquisition of practical skills. This study is a secondary analysis of existing data. The data are part of a student survey that was conducted among third-year nursing students in Norway during the spring of 2007. A total of 446 nursing students participated in this study and the response rate was 71%. Structural equation modelling analyses were performed. The results indicate that students' perception of coherence between theory and practice during initial nursing education is directly influenced by reflective skills and theoretical knowledge. The results also reveal that reflective skills have mediating effects and that practical skills have a fully mediated and theoretical knowledge a partially mediated influence on students' perception of coherence. The findings imply that helping students perceive coherence between theory and practice in nursing education, developing students' reflective skills and strengthening the theoretical components of the initial nursing education programme might be beneficial. The results suggest that reflective thinking is not merely a generic skill but rather a skill that depends on the acquisition of relevant professional knowledge and experience. © 2011 Blackwell Publishing Ltd.

Suburban Families' Experience With Food Insecurity Screening in Primary Care Practices.

Science.gov (United States)

Palakshappa, Deepak; Doupnik, Stephanie; Vasan, Aditi; Khan, Saba; Seifu, Leah; Feudtner, Chris; Fiks, Alexander G

2017-07-01

Food insecurity (FI) remains a major public health problem. With the rise in suburban poverty, a greater understanding of parents' experiences of FI in suburban settings is needed to effectively screen and address FI in suburban practices. We conducted 23 semistructured interviews with parents of children practices and screened positive for FI. In the interviews, we elicited parents' perceptions of screening for FI, how FI impacted the family, and recommendations for how practices could more effectively address FI. All interviews were audio recorded and transcribed. We used a modified grounded theory approach to code the interviews inductively and identified emerging themes through an iterative process. Interviews continued until thematic saturation was achieved. Of the 23 parents interviewed, all were women, with 39% white and 39% African American. Three primary themes emerged: Parents expressed initial surprise at screening followed by comfort discussing their unmet food needs; parents experience shame, frustration, and helplessness regarding FI, but discussing FI with their clinician helped alleviate these feelings; parents suggested practices could help them more directly access food resources, which, depending on income, may not be available to them through government programs. Although most parents were comfortable discussing FI, they felt it was important for clinicians to acknowledge their frustrations with FI and facilitate access to a range of food resources. Copyright © 2017 by the American Academy of Pediatrics.

Preservice teachers’ objectives and their experience of practical work

Directory of Open Access Journals (Sweden)

V. Nivalainen

2013-01-01

Full Text Available This study explores third-year preservice physics teachers’ (n=32 views concerning the objectives of practical work at school and university. Content analysis of their essays about practical work revealed not only the objectives of the practical work undertaken but also how they had experienced teaching as school and university students. The objectives most commonly referred to were related to the connections between theory and practice, motivation, understanding phenomena, learning how to observe, and learning how to report. In contrast, some objectives were recognized only rarely, which is an important issue for discussion as a future challenge. Preservice teachers’ positive experiences of practical work resulted from the successful implementation of practical work. According to our findings, practical work can in many cases be regarded as successful, especially when the participants understand the objectives of the teaching. In contrast, negative experiences reflected failures or difficulties in implementation. We conclude by suggesting that preservice teachers should be offered opportunities to reflect on their previous experiences and to see and experience in practice the advantages of practical work.

Initial Educational Experiences of Tertiary Students. LSAY Briefing Number 14

Science.gov (United States)

Hillman, Kylie

2008-01-01

This "Briefing" presents information about the initial tertiary education experiences, such as satisfaction with aspects of student life and changes to initial enrolments, of two groups of young people, based on two recent Longitudinal Surveys of Australian Youth (LSAY) research reports. One study focused on the first year experiences of…

Practical recommendations for the evaluation of improvement initiatives

Science.gov (United States)

Parry, Gareth; Coly, Astou; Goldmann, Don; Rowe, Alexander K; Chattu, Vijay; Logiudice, Deneil; Rabrenovic, Mihajlo; Nambiar, Bejoy

2018-01-01

Abstract A lack of clear guidance for funders, evaluators and improvers on what to include in evaluation proposals can lead to evaluation designs that do not answer the questions stakeholders want to know. These evaluation designs may not match the iterative nature of improvement and may be imposed onto an initiative in a way that is impractical from the perspective of improvers and the communities with whom they work. Consequently, the results of evaluations are often controversial, and attribution remains poorly understood. Improvement initiatives are iterative, adaptive and context-specific. Evaluation approaches and designs must align with these features, specifically in their ability to consider complexity, to evolve as the initiative adapts over time and to understand the interaction with local context. Improvement initiatives often identify broadly defined change concepts and provide tools for care teams to tailor these in more detail to local conditions. Correspondingly, recommendations for evaluation are best provided as broad guidance, to be tailored to the specifics of the initiative. In this paper, we provide practical guidance and recommendations that funders and evaluators can use when developing an evaluation plan for improvement initiatives that seeks to: identify the questions stakeholders want to address; develop the initial program theory of the initiative; identify high-priority areas to measure progress over time; describe the context the initiative will be applied within; and identify experimental or observational designs that will address attribution. PMID:29447410

Initial deuterium pellet experiments on FTU

International Nuclear Information System (INIS)

Snipes, J.A.

1993-01-01

Initial experiments have been performed with the Single Pellet INjector (SPIN) on FTU. SPIN is a two-stage cryogenic deuterium pellet injector capable of injection,a pellets with velocities up to 2.5 km/s. The nominal pellet mass for these experiments was approximately 1 x 10 20 atoms. These initial pellet experiments concentrated on studying pellet penetration under a variety of plasma conditions to compare with code predictions and to examine toroidal particle transport. The principal diagnostics used were two fast (∼1 μsec) photomultiplier tubes at nearly opposite toroidal locations with H α (D α ) interference filters (λ = 656 nm), a microwave cavity for pellet mass and velocity, a vertical array of soft x ray diodes without filters looking down onto the pellet, a DCN interferometer for electron density profiles, and a Michelson ECE system for electron temperature profiles. The time integral of the absolutely calibrated fast H α signal appears to give reasonable agreement with the expected pellet mass. Toroidal transport of deuterium ions from the pellet to nearly the opposite side of the tokamak agrees with calculated thermal deuterium velocities near the plasma edge. Comparison of the experimental results with code calculations using the Neutral Gas Shielding model show good agreement for the post-pellet electron temperature and density profiles and the H α profiles in some cases. Calculated penetration distances agree within 20%

Pharmacists' experience of conflict in community practice.

Science.gov (United States)

Austin, Zubin; Gregory, Paul A M; Martin, J Craig

2010-03-01

Interpersonal conflict may be characterized as intellectual disagreement with emotional entanglement. While interpersonal conflict has been studied and described in different health care settings, there is little research that focuses on community pharmacists and the ways in which they experience conflict in professional practice. To describe and characterize the experience of interpersonal conflict within community pharmacy practice. A self-reporting narrative log was developed in which actively recruited pharmacists reported and reflected upon their day-to-day experiences of interpersonal conflict in professional practice. Focus groups of pharmacists were convened following data analysis to provide context and confirmation of identified themes. Based on this analysis, an explanatory model for interpersonal conflict in community pharmacy practice was generated. Participants were actively recruited from community pharmacy settings in the Toronto (Canada) area. A total of 41 community pharmacists participated. Interpersonal conflict in pharmacy practice is ubiquitous and results from diverse triggers. A conflict stance model was developed, based on the worldview and the communication style of the individual pharmacist. Specific conflict stances identified were: imposing, thwarting, settling, and avoiding. Further testing and refinement of this model is required. Crown Copyright 2010. Published by Elsevier Inc. All rights reserved.

Mapping patients' experiences from initial symptoms to gout diagnosis: a qualitative exploration.

Science.gov (United States)

Liddle, Jennifer; Roddy, Edward; Mallen, Christian D; Hider, Samantha L; Prinjha, Suman; Ziebland, Sue; Richardson, Jane C

2015-09-14

To explore patients' experiences from initial symptoms to receiving a diagnosis of gout. Data from in-depth semistructured interviews were used to construct themes to describe key features of patients' experiences of gout diagnosis. A maximum variation sample of 43 UK patients with gout (29 men; 14 women; age range 32-87 years) were recruited from general practices, rheumatology clinics, gout support groups and through online advertising. Severe joint pain, combined with no obvious signs of physical trauma or knowledge of injury, caused confusion for patients attempting to interpret their symptoms. Reasons for delayed consultation included self-diagnosis and/or self-medication, reluctance to seek medical attention, and financial/work pressures. Factors potentially contributing to delayed diagnosis after consultation included reported misdiagnosis, attacks in joints other than the first metatarsophalangeal joint, and female gender. The limitations in using serum uric acid (SUA) levels for diagnostic purposes were not always communicated effectively to patients, and led to uncertainty and lack of confidence in the accuracy of the diagnosis. Resistance to the diagnosis occurred in response to patients' beliefs about the causes of gout and characteristics of the people likely to be affected. Diagnosis prompted actions, such as changes in diet, and evidence was found of self-monitoring of SUA levels. This study is the first to report data specifically about patients' pathways to initial consultation and subsequent experiences of gout diagnosis. A more targeted approach to information provision at diagnosis would improve patients' experiences. 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.

Initial experience with a novel pre-sign-out quality assurance tool for review of random surgical pathology diagnoses in a subspecialty-based university practice.

Science.gov (United States)

Owens, Scott R; Wiehagen, Luke T; Kelly, Susan M; Piccoli, Anthony L; Lassige, Karen; Yousem, Samuel A; Dhir, Rajiv; Parwani, Anil V

2010-09-01

We recently implemented a novel pre-sign-out quality assurance tool in our subspecialty-based surgical pathology practice at the University of Pittsburgh Medical Center. It randomly selects an adjustable percentage of cases for review by a second pathologist at the time the originating pathologist's electronic signature is entered and requires that the review be completed within 24 hours, before release of the final report. The tool replaced a retrospective audit system and it has been in successful use since January 2009. We report our initial experience for the first 14 months of its service. During this time, the disagreement numbers and levels were similar to those identified using the retrospective system, case turnaround time was not significantly affected, and the number of case amendments generated decreased. The tool is a useful quality assurance instrument and its prospective nature allows for the potential prevention of some serious errors.

Energy efficiency initiatives: Indian experience

Energy Technology Data Exchange (ETDEWEB)

Dey, Dipankar [ICFAI Business School, Kolkata, (IBS-K) (India)

2007-07-01

India, with a population of over 1.10 billion is one of the fastest growing economies of the world. As domestic sources of different conventional commercial energy are drying up, dependence on foreign energy sources is increasing. There exists a huge potential for saving energy in India. After the first 'oil shock' (1973), the government of India realized the need for conservation of energy and a 'Petroleum Conservation Action Group' was formed in 1976. Since then many initiatives aiming at energy conservation and improving energy efficiency, have been undertaken (the establishment of Petroleum Conservation Research Association in 1978; the notification of Eco labelling scheme in 1991; the formation of Bureau of Energy Efficiency in 2002). But no such initiative was successful. In this paper an attempt has been made to analyze the changing importance of energy conservation/efficiency measures which have been initiated in India between 1970 and 2005.The present study tries to analyze the limitations and the reasons of failure of those initiatives. The probable reasons are: fuel pricing mechanism (including subsidies), political factors, corruption and unethical practices, influence of oil and related industry lobbies - both internal and external, the economic situation and the prolonged protection of domestic industries. Further, as India is opening its economy, the study explores the opportunities that the globally competitive market would offer to improve the overall energy efficiency of the economy. The study suggests that the Bureau of Energy Efficiency (BEE) - the newly formed nodal agency for improving energy efficiency of the economy may be made an autonomous institution where intervention from the politicians would be very low. For proper implementation of different initiatives to improve energy efficiency, BEE should involve more the civil societies (NGO) from the inception to the implementation stage of the programs. The paper also

Impact of the Pharmacy Practice Model Initiative on Clinical Pharmacy Specialist Practice.

Science.gov (United States)

Jacobi, Judith; Ray, Shaunta'; Danelich, Ilya; Dodds Ashley, Elizabeth; Eckel, Stephen; Guharoy, Roy; Militello, Michael; O'Donnell, Paul; Sam, Teena; Crist, Stephanie M; Smidt, Danielle

2016-05-01

This paper describes the goals of the American Society of Health-System Pharmacists' Pharmacy Practice Model Initiative (PPMI) and its recommendations for health-system pharmacy practice transformation to meet future patient care needs and elevate the role of pharmacists as patient care providers. PPMI envisions a future in which pharmacists have greater responsibility for medication-related outcomes and technicians assume greater responsibility for product-related activities. Although the PPMI recommendations have elevated the level of practice in many settings, they also potentially affect existing clinical pharmacists, in general, and clinical pharmacy specialists, in particular. Moreover, although more consistent patient care can be achieved with an expanded team of pharmacist providers, the role of clinical pharmacy specialists must not be diminished, especially in the care of complex patients and populations. Specialist practitioners with advanced training and credentials must be available to model and train pharmacists in generalist positions, residents, and students. Indeed, specialist practitioners are often the innovators and practice leaders. Negotiation between hospitals and pharmacy schools is needed to ensure a continuing role for academic clinical pharmacists and their contributions as educators and researchers. Lessons can be applied from disciplines such as nursing and medicine, which have developed new models of care involving effective collaboration between generalists and specialists. Several different pharmacy practice models have been described to meet the PPMI goals, based on available personnel and local goals. Studies measuring the impact of these new practice models are needed. © 2016 Pharmacotherapy Publications, Inc.

Linux thin-client conversion in a large cardiology practice: initial experience.

Science.gov (United States)

Echt, Martin P; Rosen, Jordan

2004-01-01

Capital Cardiology Associates (CCA) is a single-specialty cardiology practice with offices in New York and Massachusetts. In 2003, CCA converted its IT system from a Microsoft-based network to a Linux network employing Linux thin-client technology with overall positive outcomes.

Testing theory in practice: a simple experiment

NARCIS (Netherlands)

Terpstra, R.; Brezocnik, Z.; Kapus, T.; Ferreira Pires, Luis; Heerink, A.W.; Tretmans, G.J.

1996-01-01

In this paper we discuss the experiences gained in conducting a simple testing experiment. The goal of this experiment is to apply the abstract, formal testing framework [8] in a practical setting, and to indicate the critical aspects in its application to realistic testing situations. For that

Nursing Student Teachers' experiences during teaching practice:

African Journals Online (AJOL)

Mary

Teaching practice experiences of nursing student provide greater insight to develop effective classroom and clinical teaching ... expectations and benefits are significantly derived from teaching practice although contingent on the mode of entry into the ...... Participation in and Leadership of. Continual Improvement.

EFL Teachers' Self-Initiated Professional Development: Perceptions and Practices

Science.gov (United States)

Simegn, Birhanu

2014-01-01

This study assessed perceptions and practices of secondary schools (Grade 9-12) EFL teachers' self-initiated professional development. A questionnaire of likert scale items and open-ended questions was used to gather data from thirty-two teachers. The teachers were asked to fill out the questionnaire at Bahir Dar University during their…

Impact of advanced pharmacy practice experience placement changes in colleges and schools of pharmacy.

Science.gov (United States)

Duke, Lori J; Staton, April G; McCullough, Elizabeth S; Jain, Rahul; Miller, Mindi S; Lynn Stevenson, T; Fetterman, James W; Lynn Parham, R; Sheffield, Melody C; Unterwagner, Whitney L; McDuffie, Charles H

2012-04-10

To document the annual number of advanced pharmacy practice experience (APPE) placement changes for students across 5 colleges and schools of pharmacy, identify and compare initiating reasons, and estimate the associated administrative workload. Data collection occurred from finalization of the 2008-2009 APPE assignments throughout the last date of the APPE schedule. Internet-based customized tracking forms were used to categorize the initiating reason for the placement change and the administrative time required per change (0 to 120 minutes). APPE placement changes per institution varied from 14% to 53% of total assignments. Reasons for changes were: administrator initiated (20%), student initiated (23%), and site/preceptor initiated (57%) Total administrative time required per change varied across institutions from 3,130 to 22,750 minutes, while the average time per reassignment was 42.5 minutes. APPE placements are subject to high instability. Significant differences exist between public and private colleges and schools of pharmacy as to the number and type of APPE reassignments made and associated workload estimates.

[A framework for evaluating ethical issues of public health initiatives: practical aspects and theoretical implications].

Science.gov (United States)

Petrini, Carlo

2015-01-01

The "Framework for the Ethical Conduct of Public Health Initiatives", developed by Public Health Ontario, is a practical guide for assessing the ethical implications of evidence-generating public health initiatives, whether research or non-research activities, involving people, their biological materials or their personal information. The Framework is useful not only to those responsible for determining the ethical acceptability of an initiative, but also to investigators planning new public health initiatives. It is informed by a theoretical approach that draws on widely shared bioethical principles. Two considerations emerge from both the theoretical framework and its practical application: the line between practice and research is often blurred; public health ethics and biomedical research ethics are based on the same common heritage of values.

Initial Results from Coaxial Helicity Injection Experiments in NSTX

International Nuclear Information System (INIS)

Raman, R.; Jarboe, T.R.; Mueller, D.; Schaffer, M.J.; Maqueda, R.; Nelson, B.A.; Sabbagh, S.; Bell, M.; Ewig, R.; Fredrickson, E.; Gates, D.; Hosea, J.; Ji, H.; Kaita, R.; Kaye, S.M.; Kugel, H.; Maingi, R.; Menard, J.; Ono, M.; Orvis, D.; Paolette, F.; Paul, S.; Peng, M.; Skinner, C.H.; Wilgen, W.; Zweben, S.

2001-01-01

Coaxial Helicity Injection (CHI) has been investigated on the National Spherical Torus Experiment (NSTX). Initial experiments produced 130 kA of toroidal current without the use of the central solenoid. The corresponding injector current was 20 kA. Discharges with pulse lengths up to 130 ms have been produced

Rural general practice training: experience of a rural general practice team and a postgraduate year two registrar.

Science.gov (United States)

Scott-Jones, Joseph; Lucas, Sarah

2013-09-01

Undertaking training in rural areas is a recognised way of helping recruit staff to work in rural communities. Postgraduate year two medical doctors in New Zealand have been able to undertake a three-month placement in rural practice as part of their pre-vocational training experience since November 2010. To describe the experience of a rural general practice team providing training to a postgraduate year two medical trainee, and to describe the teaching experience and range of conditions seen by the trainee. A pre- and post-placement interview with staff, and analysis of a logbook of cases and teaching undertaken in the practice. The practice team's experience of having the trainee was positive, and the trainee was exposed to a wide range of conditions over 418 clinical encounters. The trainee received 22.5 hours of formal training over the three-month placement. Rural general practice can provide a wide range of clinical experience to a postgraduate year two medical trainee. Rural practices in New Zealand should be encouraged to offer teaching placements at this training level. Exposure to rural practice at every level of training is important to encourage doctors to consider rural practice as a career.

Doctors' experience with handheld computers in clinical practice: qualitative study.

Science.gov (United States)

McAlearney, Ann Scheck; Schweikhart, Sharon B; Medow, Mitchell A

2004-05-15

To examine doctors' perspectives about their experiences with handheld computers in clinical practice. Qualitative study of eight focus groups consisting of doctors with diverse training and practice patterns. Six practice settings across the United States and two additional focus group sessions held at a national meeting of general internists. 54 doctors who did or did not use handheld computers. Doctors who used handheld computers in clinical practice seemed generally satisfied with them and reported diverse patterns of use. Users perceived that the devices helped them increase productivity and improve patient care. Barriers to use concerned the device itself and personal and perceptual constraints, with perceptual factors such as comfort with technology, preference for paper, and the impression that the devices are not easy to use somewhat difficult to overcome. Participants suggested that organisations can help promote handheld computers by providing advice on purchase, usage, training, and user support. Participants expressed concern about reliability and security of the device but were particularly concerned about dependency on the device and over-reliance as a substitute for clinical thinking. Doctors expect handheld computers to become more useful, and most seem interested in leveraging (getting the most value from) their use. Key opportunities with handheld computers included their use as a stepping stone to build doctors' comfort with other information technology and ehealth initiatives and providing point of care support that helps improve patient care.

Previous Experience a Model of Practice UNAE

Directory of Open Access Journals (Sweden)

Ormary Barberi Ruiz

2017-02-01

Full Text Available The statements presented in this article represents a preliminary version of the proposed model of pre-professional practices (PPP of the National University of Education (UNAE of Ecuador, an urgent institutional necessity is revealed in the descriptive analyzes conducted from technical support - administrative (reports, interviews, testimonials, pedagogical foundations of UNAE (curricular directionality, transverse axes in practice, career plan, approach and diagnostic examination as subject nature of the pre professional practice and the demand of socio educational contexts where the practices have been emerging to resize them. By relating these elements allowed conceiving the modeling of the processes of the pre-professional practices for the development of professional skills of future teachers through four components: contextual projective, implementation (tutoring, accompaniment (teaching couple and monitoring (meetings at the beginning, during and end of practice. The initial training of teachers is inherent to teaching (academic and professional training, research and links with the community, these are fundamental pillars of Ecuadorian higher education.

Magnetohydrodynamic simulation of solid-deuterium-initiated Z-pinch experiments

International Nuclear Information System (INIS)

Sheehey, P.T.

1994-02-01

Solid-deuterium-initiated Z-pinch experiments are numerically simulated using a two-dimensional resistive magnetohydrodynamic model, which includes many important experimental details, such as ''cold-start'' initial conditions, thermal conduction, radiative energy loss, actual discharge current vs. time, and grids of sufficient size and resolution to allow realistic development of the plasma. The alternating-direction-implicit numerical technique used meets the substantial demands presented by such a computational task. Simulations of fiber-initiated experiments show that when the fiber becomes fully ionized rapidly developing m=0 instabilities, which originated in the coronal plasma generated from the ablating fiber, drive intense non-uniform heating and rapid expansion of the plasma column. The possibility that inclusion of additional physical effects would improve stability is explored. Finite-Larmor-radius-ordered Hall and diamagnetic pressure terms in the magnetic field evolution equation, corresponding energy equation terms, and separate ion and electron energy equations are included; these do not change the basic results. Model diagnostics, such as shadowgrams and interferograms, generated from simulation results, are in good agreement with experiment. Two alternative experimental approaches are explored: high-current magnetic implosion of hollow cylindrical deuterium shells, and ''plasma-on-wire'' (POW) implosion of low-density plasma onto a central deuterium fiber. By minimizing instability problems, these techniques may allow attainment of higher temperatures and densities than possible with bare fiber-initiated Z-pinches. Conditions for significant D-D or D-T fusion neutron production may be realizable with these implosion-based approaches

Rural general practice training: experience of a rural general practice team and a postgraduate year two registrar

Directory of Open Access Journals (Sweden)

Scott-Jones J

2013-09-01

Full Text Available INTRODUCTION: Undertaking training in rural areas is a recognised way of helping recruit staff to work in rural communities. Postgraduate year two medical doctors in New Zealand have been able to undertake a three-month placement in rural practice as part of their pre-vocational training experience since November 2010. AIM: To describe the experience of a rural general practice team providing training to a postgraduate year two medical trainee, and to describe the teaching experience and range of conditions seen by the trainee. METHODS: A pre- and post-placement interview with staff, and analysis of a logbook of cases and teaching undertaken in the practice. RESULTS: The practice team's experience of having the trainee was positive, and the trainee was exposed to a wide range of conditions over 418 clinical encounters. The trainee received 22.5 hours of formal training over the three-month placement. DISCUSSION: Rural general practice can provide a wide range of clinical experience to a postgraduate year two medical trainee. Rural practices in New Zealand should be encouraged to offer teaching placements at this training level. Exposure to rural practice at every level of training is important to encourage doctors to consider rural practice as a career.

Differences in the emotional and practical experiences of exclusively breastfeeding and combination feeding mothers.

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Komninou, Sophia; Fallon, Victoria; Halford, Jason Christian Grovenor; Harrold, Joanne Alison

2017-07-01

The majority of research examining the barriers to breastfeeding focuses on the physical challenges faced by mothers rather than the risks of encountering negative emotional and practical feeding experiences. We aimed to quantify the emotional and practical experiences of the overall sample of breastfeeding mothers and identify the differences in the emotional and practical experiences of exclusively breastfeeding mothers and combination feeding mothers, by feeding type and intention. Eight hundred forty-five mothers with infants up to 26 weeks of age and who had initiated breastfeeding were recruited through relevant social media via advertisements providing a link to an online survey. Predictors of emotional experiences included guilt, stigma, satisfaction with feeding method, and the need to defend themselves due to infant feeding choices. Practical predictors included perceived support from health professionals, main sources of infant feeding information, and respect from their everyday environment, workplace, and when breastfeeding in public. Current feeding type and prenatal feeding intention. In the overall sample, 15% of the mothers reported feeling guilty, 38% stigmatized, and 55% felt the need to defend their feeding choice. Binary logit models revealed that guilt and dissatisfaction were directly associated with feeding type, being higher when supplementing with formula. No associations with feeding intention were identified. This study demonstrates a link between current breastfeeding promotion strategies and the emotional state of breastfeeding mothers who supplement with formula to any extent. To minimize the negative impact on maternal well-being, it is important that future recommendations recognize the challenges that exclusive breastfeeding brings and provide a more balanced and realistic target for mothers. © 2016 John Wiley & Sons Ltd.

International practice experiences in pharmacy education.

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Cisneros, Robert M; Jawaid, Sarah Parnapy; Kendall, Debra A; McPherson, Charles E; Mu, Keli; Weston, Grady Scott; Roberts, Kenneth B

2013-11-12

To identify reasons for inclusion of international practice experiences in pharmacy curricula and to understand the related structure, benefits, and challenges related to the programs. A convenience sample of 20 colleges and schools of pharmacy in the United States with international pharmacy education programs was used. Telephone interviews were conducted by 2 study investigators. University values and strategic planning were among key driving forces in the development of programs. Global awareness and cultural competency requirements added impetus to program development. Participants' advice for creating an international practice experience program included an emphasis on the value of working with university health professions programs and established travel programs. Despite challenges, colleges and schools of pharmacy value the importance of international pharmacy education for pharmacy students as it increases global awareness of health needs and cultural competencies.

The experiences of employees participating in organisational corporate social responsibility initiatives

Directory of Open Access Journals (Sweden)

Gretha Cook

2018-04-01

Full Text Available Orientation: This article is about the experiences of employees who actively participate in organisational corporate social responsibility (CSR initiatives.   Research purpose: The general aim of this study was to explore the experiences of employees who participate in CSR initiatives within an organisation where a well-developed framework exists.   Motivation for the study: Whilst an emergent number of studies have considered the various dimensions of CSR initiatives, the focus appears to be on stakeholders such as the recipients of CSR, organisations, consumers and shareholders but not the perspective of the employees who actively participate in CSR initiatives.   Research design, approach and method: A qualitative research approach was employed with the intent of exploring the experiences of employees participating in organisational CSR initiatives. Data were collected and analysed from a purposive sample of 12 employees, by means of interactive qualitative analysis.   Main findings: The study revealed that the primary driver that motivates employees to participate in CSR is love. Love sparks a sense of compassion. Compassion, coupled with an enabling environment, stimulates generosity. By being generous, a feeling of hope and inspiration is induced in both the givers and receivers of generosity. A secondary outcome of generosity and hope and inspiration is bringing about change to others, and whilst going through this journey and making a difference in the lives of others, participants experience a progressive change within themselves. This change evokes a feeling of fulfilment, and ultimately a feeling of complete joy.   Contributions or value-add: This research complements existing CSR literature by focussing and reporting on the experiences of the employee as an important stakeholder.

The AGING Initiative experience: a call for sustained support for team science networks.

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Garg, Tullika; Anzuoni, Kathryn; Landyn, Valentina; Hajduk, Alexandra; Waring, Stephen; Hanson, Leah R; Whitson, Heather E

2018-05-18

Team science, defined as collaborative research efforts that leverage the expertise of diverse disciplines, is recognised as a critical means to address complex healthcare challenges, but the practical implementation of team science can be difficult. Our objective is to describe the barriers, solutions and lessons learned from our team science experience as applied to the complex and growing challenge of multiple chronic conditions (MCC). MCC is the presence of two or more chronic conditions that have a collective adverse effect on health status, function or quality of life, and that require complex healthcare management, decision-making or coordination. Due to the increasing impact on the United States society, MCC research has been identified as a high priority research area by multiple federal agencies. In response to this need, two national research entities, the Healthcare Systems Research Network (HCSRN) and the Claude D. Pepper Older Americans Independence Centers (OAIC), formed the Advancing Geriatrics Infrastructure and Network Growth (AGING) Initiative to build nationwide capacity for MCC team science. This article describes the structure, lessons learned and initial outcomes of the AGING Initiative. We call for funding mechanisms to sustain infrastructures that have demonstrated success in fostering team science and innovation in translating findings to policy change necessary to solve complex problems in healthcare.

Workplace discrimination: experiences of practicing physicians.

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Coombs, Alice A Tolbert; King, Roderick K

2005-04-01

In response to a growing concern regarding physician discrimination in the workplace, this study was developed to: (1) describe the types of discrimination that exist for the practicing physician and (2) determine which groups of physicians are more likely to experience the various forms of discrimination. Surveys were mailed to 1930 practicing physicians in Massachusetts. Participants were asked if they had encountered discrimination, how significant the discrimination was against a specific group, the frequency of personal discrimination, and the type of discrimination. Factor analysis identified four types of discrimination: career advancement, punitive behaviors, practice barriers and hiring barriers. A total of 445 responses were received (a 24% response rate). Sixty-three percent of responding physicians had experienced some form of discrimination. Respondents were women (46%), racial/ethnic minorities (42%) and international medical graduates (IMGs) (40%). In addition, 26% of those classified as white were also IMGs. Over 60% of respondents believed discrimination against IMGs was very or somewhat significant. Almost 27% of males acknowledged that gender bias against females was very or somewhat significant. IMGs were more likely to indicate that discrimination against IMGs was significant in their current organization. Of U.S. medical graduates (USMGs) 44% reported that discrimination against IMGs in their current organization was significant. Nonwhites were more likely to report that discrimination based on race/ethnicity was significant. Nearly 29% of white respondents also believed that such discrimination was very or somewhat significant. Physicians practicing in academic, research, and private practice sectors experience discrimination based on gender, ethnic/racial, and IMG status.

Embodied Experience in Educational Practice and Research

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Bengtsson, Jan

2013-01-01

The intention of this article is to make an educational analysis of Merleau-Ponty's theory of experience in order to see what it implicates for educational practice as well as educational research. In this way, we can attain an understanding what embodied experience might mean both in schools and other educational settings and in researching…

Workplace culture and the practice experience of midwifery students: A meta-synthesis.

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Arundell, Fiona; Mannix, Judy; Sheehan, Athena; Peters, Kath

2018-04-01

To describe midwifery students' practice experience and to explore facilitators and barriers to positive clinical learning experiences. Practice experience is a vital component of every midwifery course. Course dissatisfaction and attrition of midwifery students has been attributed to sub-optimal practice experiences. Events or actions experienced by midwifery students that trigger dissatisfaction and attrition need to be identified. A meta-synthesis was based on that developed by Noblit and Hare. Students perceive workplaces as poorly prepared for their arrival and subsequent support. Students' experience in the practice setting is influenced by the existing workplace culture. Workplace culture influences institutional functioning and individuals within the culture. Enculturation of students into the midwifery culture and subsequent learning is affected by the support received. The practice experience of midwifery students was profoundly influenced by workplace culture. Students tended to have polarized accounts of their experience that were predominantly negative. To provide an optimal environment for midwifery students; midwifery managers and individual midwives need to be aware of the facilitators and barriers to midwifery student development in the practice setting. © 2017 John Wiley & Sons Ltd.

Long-term agricultural experiments inform the development of climate-smart agricultural practices

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Kristina Wolf

2017-09-01

Full Text Available California's Mediterranean agro-ecosystems are a major source of U.S. fruits and vegetables, and vulnerable to future extremes of precipitation and temperature brought on by climate change, including increased drought and flooding, and more intense and longer heat waves. To develop resilience to these threats, strategies are necessary for climate-smart management of soil and water. Long-term, large-scale, replicated ecological experiments provide unique testbeds for studying such questions. At the UC Davis Russell Ranch Sustainable Agriculture Facility (RRSAF, the 100-year Century Experiment, initiated in 1992, is investigating the effects of multiple farming practices in a farm-scale replicated study of 10 row crop cropping systems. It includes different fertility management systems: organic, conventional and hybrid (conventional plus winter cover crop systems; different crops: wheat, tomatoes, corn, alfalfa, cover crops and grasslands; and different irrigation systems: rainfed, flood irrigated and drip irrigated. We briefly describe and report on a selection of long-term experiments conducted at RRSAF investigating soil management and irrigation practices, which are an important focus for developing climate-smart strategies in Mediterranean systems. For example, long-term monitoring of soil carbon content revealed that most crop systems have experienced a small increase in soil carbon since 1993, and increases in organically managed plots were substantially higher. As RRSAF continues to build upon this rich dataset from one of a very few long-term row crop experiments in Mediterranean ecosystems, it provides a testbed for identifying climate-smart solutions for these agronomically important ecosystems.

Effects of baby-friendly hospital initiative on breast-feeding practices in Sindh

International Nuclear Information System (INIS)

Khan, M.; Akram, D.S.

2013-01-01

To determine changes in the breastfeeding practices of mothers after receiving counseling on Ten Steps to Successful Breastfeeding as defined by the Baby Friendly Hospital Initiative comparing baby friendly hospitals (BFHs) and non-baby-friendly hospitals in Sindh, Pakistan. Methods: The observational study was conducted from June 2007 to June 2009 in randomly selected baby-friendly and non-baby-friendly hospitals of Sindh, Pakistan. Non-probability purposive sampling was employed. The maternity staff was trained on Ten Steps to Successful Breastfeeding. The changes in breastfeeding practices were analysed by SPSS version 15. Results: A total of 236 women were included in the study. Of them, 196 (83.05%) were from baby-friendly hospitals and 40 (16.94%) from non-baby-friendly hospitals. Besides, 174 (88.7%) mothers in baby-friendly hospitals and 5 (12.5%) in non-baby-friendly hospitals during antenatal care received counseling by healthcare providers. There was an increase in breastfeeding practice up to 194 (98.97%) in the first category compared to 12 (30%) in the other category. Conclusion: Counseling under the Baby Friendly Hospital Initiative improved breastfeeding practices up to 98.97% in baby-friendly compared to non-baby-friendly hospitals. (author)

Experiences of Practice-Based Learning in Phenomenographic Perspective

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Rovio-Johansson, Airi

2018-01-01

Purpose: The paper aims to examine, within the context of professional practice and learning, how designers collaboratively working in international teams experience practice-based learning and how such occasions contribute to professional development. Design/methodology/approach: The paper introduces the cooperation project between Tibro Training…

Practical strategies and perceptions from community pharmacists following their experiences with conducting pharmacy practice research: a qualitative content analysis.

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De Vera, Mary A; Campbell, Natasha K J; Chhina, Harpreet; Galo, Jessica S; Marra, Carlo

2017-10-26

While prior research identified barriers to conducting research in community pharmacies, there remains a need to better understand facilitators to ensure successful collaborations between academic researchers and pharmacists. Our objective was to determine the experiences and perspectives of community pharmacists who have recently conducted a pharmacy practice-based research study to gain in-depth understanding of challenges as well as facilitators and identify strategies and solutions. We conducted a qualitative study involving one-on-one semi-structured telephone interviews with community pharmacists following the completion of a practice-based research study in their pharmacies. Interview transcripts were analysed using inductive content analysis involving open coding, creating categories and abstraction into final themes. Eleven pharmacists participated in the qualitative interviews. We identified six major themes including: (1) barriers (e.g. time constraints); (2) facilitators (e.g. ideal pharmacy layout); (3) support and resources from academic researchers (e.g. helpfulness of training, easy-to-use study materials); (4) pharmacist-initiated strategies for conducting research (beyond prior suggestions from researchers); (5) suggestions for future pharmacy practice research; and (6) motivation for conducting pharmacy practice research. These findings informed practical strategies targeted at academic researchers and pharmacists, respectively, to facilitate the conduct of research in community pharmacists across various stages of the research process. Our study adds to better understanding of community pharmacists' perspectives on conducting research and identifies practical solutions that can be readily implemented by academic researchers and pharmacists participating in research. © 2017 Royal Pharmaceutical Society.

A healthful experience? A patient practice development journey

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Erna Snelgrove Clarke

2016-05-01

Full Text Available While facilitating the first practice development school for our local healthcare authorities in Nova Scotia, Canada, recently, I was simultaneously preparing for my second hip replacement. Focusing workshop participants on the principles of practice development, collaboration, inclusion and participation, I wondered if, in my upcoming journey through the healthcare system, I would experience the processes and outcomes we were promoting in the school. I would like to share this commentary as a reflection of my practice development experience as a patient. Overall, I received care that was inclusive and collaborative – as well as care that was provider focused and system driven. It goes without saying that as a patient, I felt valued when I was included and felt part of the team when my wishes and expectations were taken into consideration. For me, inclusion in care correlates with valuing that patient as a participant in their care journey, as set out by practice development principle 6 (Manley, McCormack and Wilson, 2008 (Table 1. My recent healthcare experience has led me to reflect further on the principles of practice development and its implications and challenges for local healthcare authorities. For example, my anaesthetist comes to mind as embodying practice development principles 2, 4, 6 and 8. The anaesthetist supported my wishes surrounding narcotics, and provided research- and practice-based evidence for each of his actions. Although the offering of additional narcotics is routine practice in hip surgery, I did not want this, so we discussed my expectations and developed a plan together that reflected my wishes. He actually chatted throughout the entire two-hour procedure. I was pleasantly surprised when he told me he provides care that focuses on the patient (practice development principle 1. Nevertheless, inconsistencies in the attention to person-centred practices across the microsystem reminded me that the system is not yet set

Orthopaedic Resident Practice Management and Health Policy Education: Evaluation of Experience and Expectations.

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Stautberg Iii, Eugene F; Romero, Jose; Bender, Sean; DeHart, Marc

2018-04-11

Introduction Practice management and health policy have generally not been considered integral to orthopaedic resident education. Our objective was to evaluate residents' current experience and knowledge, formal training, and desire for further education in practice management and health policy. Methods We developed a 29-question survey that was divided into three sections: practice management, initial employment opportunity, and health policy. Within each section, questions were directed at a resident's current experience and knowledge, formal training, and interest in further education. The survey was distributed at the end of the academic year through an Internet-based survey tool (www.surveymonkey.com) to orthopaedic residents representing multiple programs and all postgraduate years. Results The survey was distributed to 121 residents representing eight residency programs. Of those, 87 residents responded, resulting in a 72% response rate. All postgraduate years were represented. Regarding practice management, 66% had "no confidence" or "some confidence" in coding clinical encounters. When asked if practice models, finance management, and coding should be taught in residency, 95%, 93%, and 97% responded "yes," respectively. When evaluating first employment opportunities, the three most important factors were location, operating room block time, and call. Regarding health policy, 28% were "moderately familiar" or "very familiar" with the Physician Payments Sunshine Act, and 72% were "not familiar" or "somewhat familiar" with bundled payments for arthroplasty. Finally, when asked if yearly lectures in political activities would enhance resident education, 90% responded "yes." Discussion and conclusion Regarding practice management, the survey suggests that current orthopaedic residents are not familiar with basic topics, do not receive formal training, and want further education. The survey suggests that residents also receive minimal training in health policy

Evaluation of the "Foundations in Knowledge Translation" training initiative: preparing end users to practice KT.

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Park, Jamie S; Moore, Julia E; Sayal, Radha; Holmes, Bev J; Scarrow, Gayle; Graham, Ian D; Jeffs, Lianne; Timmings, Caitlyn; Rashid, Shusmita; Johnson, Alekhya Mascarenhas; Straus, Sharon E

2018-04-25

Current knowledge translation (KT) training initiatives are primarily focused on preparing researchers to conduct KT research rather than on teaching KT practice to end users. Furthermore, training initiatives that focus on KT practice have not been rigorously evaluated and have focused on assessing short-term outcomes and participant satisfaction only. Thus, there is a need for longitudinal training evaluations that assess the sustainability of training outcomes and contextual factors that may influence outcomes. We evaluated the KT training initiative "Foundations in KT" using a mixed-methods longitudinal design. "Foundations in KT" provided training in KT practice and included three tailored in-person workshops, coaching, and an online platform for training materials and knowledge exchange. Two cohorts were included in the study (62 participants, including 46 "Foundations in KT" participants from 16 project teams and 16 decision-maker partners). Participants completed self-report questionnaires, focus groups, and interviews at baseline and at 6, 12, 18, and 24 months after the first workshop. Participant-level outcomes include survey results which indicated that participants' self-efficacy in evidence-based practice (F(1,8.9) = 23.7, p = 0.001, n = 45), KT activities (F(1,23.9) = 43.2, p training initiative helped participants achieve their KT project objectives, plan their projects, and solve problems over time. Contextual factors include teams with high self-reported organizational capacity and commitment to implement at the start of their project had buy-in from upper management that resulted in secured funding and resources for their project. Training initiative outcomes include participants who applied the KT knowledge and skills they learned to other projects by sharing their knowledge informally with coworkers. Sustained spread of KT practice was observed with five teams at 24 months. We completed a longitudinal evaluation of a KT

Initially curved microplates under electrostatic actuation: theory and experiment

KAUST Repository

Saghir, Shahid; Bellaredj, Mohammed Lamine Faycal; Ramini, Abdallah; Younis, Mohammad I.

2016-01-01

Microplates are the building blocks of many micro-electro-mechanical systems. It is common for them to experience initial curvature imperfection due to residual stresses caused by the micro fabrication process. Such plates are essentially different

Opting for rural practice: the influence of medical student origin, intention and immersion experience.

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Playford, Denese; Ngo, Hanh; Gupta, Surabhi; Puddey, Ian B

2017-08-21

To compare the influence of rural background, rural intent at medical school entry, and Rural Clinical School (RCS) participation on the likelihood of later participation in rural practice. Analysis of linked data from the Medical School Outcomes Database Commencing Medical Students Questionnaire (CMSQ), routinely collected demographic information, and the Australian Health Practitioner Regulation Agency database on practice location. University of Western Australia medical students who completed the CMSQ during 2006-2010 and were practising medicine in 2016. Medical practice in rural areas (ASGC-RAs 2-5) during postgraduate years 2-5. Full data were available for 508 eligible medical graduates. Rural background (OR, 3.91; 95% CI, 2.12-7.21; P practice in the multivariate analysis of all potential factors. When interactions between intention, origin, and RCS experience were included, RCS participation significantly increased the likelihood of graduates with an initial rural intention practising in a rural location (OR, 3.57; 95% CI, 1.25-10.2; P = 0.017). The effect of RCS participation was not significant if there was no pre-existing intention to practise rurally (OR, 1.38; 95% CI, 0.61-3.16; P = 0.44). For students who entered medical school with the intention to later work in a rural location, RCS experience was the deciding factor for realising this intention. Background, intent and RCS participation should all be considered if medical schools are to increase the proportion of graduates working rurally.

A Bottom up Initiative: Meditation & Mindfulness 'Eastern' Practices in the "Western" Academia

DEFF Research Database (Denmark)

Singla, Rashmi

a case of bottom up initiative, where the students themselves have demanded inclusion of non- conventional psychosocial interventions illustrated by meditation and mindfulness as Eastern psychological practices, thus filling the gap related to the existential, spiritual approaches. The western...

Initiatives on early detection and intervention to proactively identify health and social problems in older people: experiences from the Netherlands.

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Lette, Manon; Baan, Caroline A; van den Berg, Matthijs; de Bruin, Simone R

2015-10-30

Over the last years, several initiatives on early detection and intervention have been put in place to proactively identify health and social problems in (frail) older people. An overview of the initiatives currently available in the Netherlands is lacking, and it is unknown whether they meet the preferences and needs of older people. Therefore, the objectives of this study were threefold: 1. To identify initiatives on early detection and intervention for older people in the Netherlands and compare their characteristics; 2. To explore the experiences of professionals with these initiatives; and 3. To explore to what extent existing initiatives meet the preferences and needs of older people. We performed a qualitative descriptive study in which we conducted semi-structured interviews with seventeen experts in preventive elderly care and three group interviews with volunteer elderly advisors. Data were analysed using the framework analysis method. We identified eight categories of initiatives based on the setting (e.g. general practitioner practice, hospital, municipality) in which they were offered. Initiatives differed in their aims and target groups. The utilization of peers to identify problems and risks, as was done by some initiatives, was seen as a strength. Difficulties were experienced with identifying the target group that would benefit from proactive delivery of care and support most, and with addressing prevalent issues among older people (e.g. psychosocial issues, self-reliance issues). Although there is a broad array of initiatives available, there is a discrepancy between supply and demand. Current initiatives insufficiently address needs of (frail) older people. More insight is needed in "what should be done by whom, for which target group and at what moment", in order to improve current practice in preventive elderly care.

Two-Year Costs and Quality in the Comprehensive Primary Care Initiative.

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Dale, Stacy B; Ghosh, Arkadipta; Peikes, Deborah N; Day, Timothy J; Yoon, Frank B; Taylor, Erin Fries; Swankoski, Kaylyn; O'Malley, Ann S; Conway, Patrick H; Rajkumar, Rahul; Press, Matthew J; Sessums, Laura; Brown, Randall

2016-06-16

The 4-year, multipayer Comprehensive Primary Care Initiative was started in October 2012 to determine whether several forms of support would produce changes in care delivery that would improve the quality and reduce the costs of care at 497 primary care practices in seven regions across the United States. Support included the provision of care-management fees, the opportunity to earn shared savings, and the provision of data feedback and learning support. We tracked changes in the delivery of care by practices participating in the initiative and used difference-in-differences regressions to compare changes over the first 2 years of the initiative in Medicare expenditures, health care utilization, claims-based measures of quality, and patient experience for Medicare fee-for-service beneficiaries attributed to initiative practices and a group of matched comparison practices. During the first 2 years, initiative practices received a median of $115,000 per clinician in care-management fees. The practices reported improvements in approaches to the delivery of primary care in areas such as management of the care of high-risk patients and enhanced access to care. Changes in average monthly Medicare expenditures per beneficiary did not differ significantly between initiative and comparison practices when care-management fees were not taken into account (-$11; 95% confidence interval [CI], -$23 to $1; P=0.07; negative values indicate less growth in spending at initiative practices) or when these fees were taken into account ($7; 95% CI, -$5 to $19; P=0.27). The only significant differences in other measures were a 3% reduction in primary care visits for initiative practices relative to comparison practices (Pinitiative practices relative to comparison practices (P=0.006 and Pinitiative have reported progress in transforming the delivery of primary care. However, at this point these practices have not yet shown savings in expenditures for Medicare Parts A and B after

Interpreting future physics teachers reflections on their professional practice during initial formation: the search for teaching autonomy construction

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Rodolfo Langhi

2012-01-01

Full Text Available This research intends to answer the following main question: which traces of teacher autonomy construction are possible to achieve during reflective formative processes in disciplines like Methodology and Physics Teaching Practice carried out during three semesters, in an undergraduate program designed to physics teachers´ initial education? Using an analytical device based on teachers education research assumptions, which we called convergent formative triangulation for progressive teaching autonomy, we had as a main objective the search for the chance to achieve progressive levels of teachers autonomy, according to its three teacher professionalization models, present in a critical and transformative perspective, relating them to the current formative paradigms: the contents based one, the humanist, the activist, the reflective and the technical (approaches we called CHART. Taking into consideration future physics teachers´ collective reflections about their own teaching practice, this research was supported by the following methodological instruments: focus group, coaching, self-confrontation and formative assessment, taking the discourse analysis as background. The outcomes of this research, which followed a sample of 40 future High School physics teachers during three semesters, through the use of five formative steps (planning, implementation, reflection, socialization, involvement and continuity, revealed the evidences of teachers autonomy construction, probably provided by their own teaching practice collective reflections, according to the analytical device used. This research showed that the reflections brakes provided during the process can allow the future teachers to position themselves critically in relation to their future pedagogical activities, even after their initial training. This experience leads us to rethink how subjects like Methodology and Teaching Practice have been teaching in the teachers’ education programs at

The role of practical wisdom in nurse manager practice: why experience matters.

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Cathcart, Eloise Balasco; Greenspan, Miriam

2013-10-01

To illustrate through the interpretation of one representative nurse manager's narrative how the methodology of practice articulation gives language to the ways practical wisdom develops in leadership practice and facilitates learning. Patricia Benner's corpus of research has demonstrated that reflection on clinical narratives comes closer than other pedagogical methods to replicating and enhancing the experiential learning required for the development of practical wisdom. Using Benner's methodology of practice articulation, 91 nurse managers wrote and read to a peer group a narrative of their lived experience in the role. The groups interpreted the narratives to extract the skilled knowledge and ethics embedded in the practice of the nurse manager authors. One narrative was chosen for this paper because it is a particularly clear exemplar of how practical wisdom develops in nurse manager practice. Articulating and reflecting on experiential learning led to an understanding of how practical wisdom developed in one nurse manager's practice. Interpretation of the narrative of one nurse manager illustrated how reflection on a complex ethical dilemma was a source of character development for the individual and the peer group. Describing and interpreting how practical wisdom develops for individual nurse managers can be a source of learning for the narrative author and other role incumbents who need to make sound decisions and take prudent action in ethically challenging situations. © 2013 John Wiley & Sons Ltd.

Refugee experiences of general practice in countries of resettlement: a literature review.

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Cheng, I-Hao; Drillich, Ann; Schattner, Peter

2015-03-01

Refugees and asylum seekers often struggle to use general practice services in resettlement countries. To describe and analyse the literature on the experiences of refugees and asylum seekers using general practice services in countries of resettlement. Literature review using systematic search and narrative data extraction and synthesis methodologies. International, peer-reviewed literature published in English language between 1990 and 2013. Embase, Ovid MEDLINE, PsycINFO, CSA Sociological Abstracts, and CINAHL databases were searched using the terms: refugee, asylum seeker, experience, perception, doctor, physician, and general practitioner. Titles, abstracts and full texts were reviewed and were critically appraised. Narrative themes describing the refugee or asylum seeker's personal experiences of general practice services were identified, coded, and analysed. From 8722 papers, 85 were fully reviewed and 23 included. These represented the experiences of approximately 864 individuals using general practice services across 11 countries. Common narrative themes that emerged were: difficulties accessing general practice services, language barriers, poor doctor-patient relationships, and problems with the cultural acceptability of medical care. The difficulties refugees and asylum seekers experience accessing and using general practice services could be addressed by providing practical support for patients to register, make appointments, and attend services, and through using interpreters. Clinicians should look beyond refugee stereotypes to focus on the needs and expectations of the individual. They should provide clear explanations about unfamiliar clinical processes and treatments while offering timely management. © British Journal of General Practice 2015.

Medical student attachments in private practice – The experience ...

African Journals Online (AJOL)

Background: Medical student attachments with family/general practitioners (GPs) in non-academic or private practice are a valued resource in the undergraduate teaching of Family Medicine. This study describes the experience and views of GPs in private practice with final-year medical student attachments from the ...

Bile Duct Anastomosis Supplied With Biodegradable Stent in Liver Transplantation: The Initial Experience.

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Janousek, L; Maly, S; Oliverius, M; Kocik, M; Kucera, M; Fronek, J

2016-12-01

The most common biliary complications after orthotopic liver transplantation are bile leaks, anastomotic and intrahepatic strictures, stones, and ampullary dysfunction. These complications can occur in up to 10% to 30% of liver transplant recipients. Leaks occur early in the posttransplant period; the stricture formation typically graduates over time. Ten patients underwent transplantation in our preliminary study: 5 were randomized to the group with stent placement and 5 to the control group. We investigated the role of an absorbable biliary stent with the goal of proving patency of duct-to-duct biliary anastomosis. The stents are made of machine-knitted polydioxanone monofilaments. Our initial results show that duct-to-duct biliary reconstruction using an absorbable internal stent had good patency in all 5 patients. There were no signs of biliary leakage accompanying the anastomoses in any of the cases, and there was no stone formation observed after liver transplantation. The biliary stent was completely absorbed, with no adverse effects. Based on our initial experience and data, we concluded that biodegradable stents can be successfully and safely used in clinical practice. Further large prospective randomized studies are needed to estimate the efficacy of the bioabsorbable stents. Copyright © 2016 Elsevier Inc. All rights reserved.

British Isles Field Experience: An Initiative in International Education.

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Martin, William J.

The British Isles Field Experience (BIFE) program was initiated at Williamsport Area Community College (WACC) to provide a group of WACC faculty and staff members with individual and group activities of a personal, professional, and cultural nature in order to promote an international perspective that can be infused into student, collegiate, and…

Subjective Experiences of Older Adults Practicing Taiji and Qigong

Directory of Open Access Journals (Sweden)

Yang Yang

2011-01-01

Full Text Available This article presents a qualitative study following a 6-month Taiji (T'ai Chi/Qigong (Ch'i Kung intervention for older adults. The researchers conducted in-depth interviews of eight selected participants who elected to continue practicing Taiji after the intervention ended, in order to explore their subjective experiences of Taiji's effects and their motivations for continuing to practice. We created a Layers Model to capture the significance and meaning of the multidimensionality of their reported experiences. Participants not only reported simple benefits along five dimensions of experience (physical, mental, emotional, social and spiritual but also described complex multidimensional experiences. Overall findings indicate that participants derived a very wide variety of perceived benefits, the most meaningful being a felt sense of body-mind-spirit integration. Our results support the important role of qualitative studies in researching the effects of Taiji and Qigong.

The initial experience of trans-rectal ultrasound and biopsy in ...

African Journals Online (AJOL)

The initial experience of trans-rectal ultrasound and biopsy in diagnosis of carcinoma prostate in Gezira Hospital for Renal Disease and Surgery (GHRDS). Walaa Eldin Ibraheem, Sami Mahjoub Taha, Mustafa Omran Mansour, Mohammed El Imam Mohamed Ahmed ...

Stakeholder experiences with general practice pharmacist services: a qualitative study.

Science.gov (United States)

Tan, Edwin C K; Stewart, Kay; Elliott, Rohan A; George, Johnson

2013-09-11

To explore general practice staff, pharmacist and patient experiences with pharmacist services in Australian general practice clinics within the Pharmacists in Practice Study. Qualitative study. Two general practice clinics in Melbourne, Australia, in which pharmacists provided medication reviews, patient and staff education, medicines information and quality assurance services over a 6-month period. Patients, practice staff and pharmacists. Semi-structured telephone interviews with patients, focus groups with practice staff and semi-structured interviews and periodic narrative reports with practice pharmacists. Data were analysed thematically and theoretical frameworks used to explain the findings. 34 participants were recruited: 18 patients, 14 practice staff (9 general practitioners, 4 practice nurses, 1 practice manager) and 2 practice pharmacists. Five main themes emerged: environment; professional relationships and integration; pharmacist attributes; staff and patient benefits and logistical challenges. Participants reported that colocation and the interdisciplinary environment of general practice enabled better communication and collaboration compared to traditional community and consultant pharmacy services. Participants felt that pharmacists needed to possess certain attributes to ensure successful integration, including being personable and proactive. Attitudinal, professional and logistical barriers were identified but were able to be overcome. The findings were explained using D'Amour's structuration model of collaboration and Roger's diffusion of innovation theory. This is the first qualitative study to explore the experiences of general practice staff, pharmacists and patients on their interactions within the Australian general practice environment. Participants were receptive of colocated pharmacist services, and various barriers and facilitators to integration were identified. Future research should investigate the feasibility and sustainability of

Connecting to Experience: High-Impact Practices for Leadership Development.

Science.gov (United States)

Priest, Kerry L; Clegorne, Nicholas A

2015-01-01

Leadership educators can leverage high-impact experiences to enhance student leadership development. This chapter describes three key practices--sociocultural conversations with peers, mentoring, and membership in off-campus organizations--as levers of leadership learning. Illustrations of the practice in context and reflections from practitioners and students are also included. The chapter concludes with considerations of context, developmental readiness, and best practices of experiential education. © 2015 Wiley Periodicals, Inc., A Wiley Company.

Moving science into state child and adolescent mental health systems: Illinois' evidence-informed practice initiative.

Science.gov (United States)

Starin, Amy C; Atkins, Marc S; Wehrmann, Kathryn C; Mehta, Tara; Hesson-McInnis, Matthew S; Marinez-Lora, A; Mehlinger, Renee

2014-01-01

In 2005, the Illinois State Mental Health Authority embarked on an initiative to close the gap between research and practice in the children's mental health system. A stakeholder advisory council developed a plan to advance evidence informed practice through policy and program initiatives. A multilevel approach was developed to achieve this objective, which included policy change, stakeholder education, and clinician training. This article focuses on the evidence-informed training process designed following review of implementation research. The training involved in-person didactic sessions and twice-monthly telephone supervision across 6 cohorts of community based clinicians, each receiving 12 months of training. Training content initially included cognitive behavioral therapy and behavioral parent training and was adapted over the years to a practice model based on common element concepts. Evaluation based on provider and parent report indicated children treated by training clinicians generally showed superior outcomes versus both a treatment-as-usual comparison group for Cohorts 1 to 4 and the statewide child population as a whole after 90 days of care for Cohorts 5 to 6. The results indicated primarily moderate to strong effects for the evidence-based training groups. Moving a large public statewide child mental health system toward more effective services is a complex and lengthy process. These results indicate training of community mental health providers in Illinois in evidence-informed practice was moderately successful in positively impacting child-level functional outcomes. These findings also influenced state policy in committing resources to continuing the initiative, even in difficult economic times.

Initial experience with golimumab in clinical practice for ulcerative colitis

Directory of Open Access Journals (Sweden)

Luisa Castro-Laria

Full Text Available Background: Golimumab is a TNF-blocking agent indicated as a second-line therapy in ulcerative colitis. Purpose: To research the effectiveness and safety of golimumab in patients with ulcerative colitis in clinical practice. Methods: Retrospective study of the effectiveness and safety of golimumab in patients with ulcerative colitis. All patients received golimumab 200 mg subcutaneously at week 0, and golimumab 100 mg subcutaneously at week 2. After the induction treatment, each patient received 50 mg sc. every 4 weeks in patients with body weight less than 80 kg, and 100 mg every 4 weeks in patients with body weight greater than or equal to 80 kg. Results: Study of a group of 23 ulcerative colitis patients, 7 of whom were naive to any anti-TNF therapy, and 16 patients who had previously been treated with an anti-TNF agent other than golimumab (non-naive patients. The average treatment time with golimumab was 14.3 weeks. Globally, withdrawal of corticosteroids was observed in 74% of cases. Clinical response was observed in 85.5% of patients who had not received biological treatment previously, and in patients who had previously received biological treatment the response rate was 75%. Conclusions: In this short study, golimumab seems to be an alternative treatment in naive and non-naive anti-TNF ulcerative colitis patients. It is also a safe therapy, given that there were no adverse effects in the patients studied.

Innovative Approach to the Organization of Future Social Workers' Practical Training: Foreign Experience

Science.gov (United States)

Polishchuk, Vira; Slozanska, Hanna

2014-01-01

Innovative approaches to practical training of future social workers in higher educational establishments have been defined. Peculiarities of foreign experience of social workers' practical training in higher educational establishments have been analyzed. Experience of organizing practice for bachelor students studying at "Social Work"…

Initial experience with the NRC significance determination process

International Nuclear Information System (INIS)

Madison, A.L.

2001-01-01

The U.S. Nuclear Regulatory Commission (NRC) has revamped its inspection, assessment, and enforcement programs for commercial nuclear power plants. The new oversight process uses more objective, timely, and safety-significant criteria in assessing performance, while seeking to more effectively and efficiently regulate the industry. The NRC tested the new process at thirteen reactors at nine sites across the country on a pilot basis in 1999 to identify what things worked well and what improvements were called for before beginning Initial Implementation at all US nuclear power plants on April 2, 2000. After a year of experience has been gained with the new oversight process at all US plants, the NRC anticipates making further improvements based on this wider experience. (author)

Initial experience with the NRC significance determination process

Energy Technology Data Exchange (ETDEWEB)

Madison, A.L. [Office of Nuclear Reactor Regulation, US Nuclear Regulatory Commission (United States)

2001-07-01

The U.S. Nuclear Regulatory Commission (NRC) has revamped its inspection, assessment, and enforcement programs for commercial nuclear power plants. The new oversight process uses more objective, timely, and safety-significant criteria in assessing performance, while seeking to more effectively and efficiently regulate the industry. The NRC tested the new process at thirteen reactors at nine sites across the country on a pilot basis in 1999 to identify what things worked well and what improvements were called for before beginning Initial Implementation at all US nuclear power plants on April 2, 2000. After a year of experience has been gained with the new oversight process at all US plants, the NRC anticipates making further improvements based on this wider experience. (author)

Where theory and practice of global health intersect: the developmental history of a Canadian global health initiative.

Science.gov (United States)

Daibes, Ibrahim; Sridharan, Sanjeev

2014-01-01

This paper examines the scope of practice of global health, drawing on the practical experience of a global health initiative of the Government of Canada--the Teasdale-Corti Global Health Research Partnership Program. A number of challenges in the practical application of theoretical definitions and understandings of global health are addressed. These challenges are grouped under five areas that form essential characteristics of global health: equity and egalitarian North-South partnerships, interdisciplinary scope, focus on upstream determinants of health, global conceptualization, and global health as an area of both research and practice. Information in this paper is based on the results of an external evaluation of the program, which involved analysis of project proposals and technical reports, surveys with grantees and interviews with grantees and program designers, as well as case studies of three projects and a review of relevant literature. The philosophy and recent definitions of global health represent a significant and important departure from the international health paradigm. However, the practical applicability of this maturing area of research and practice still faces significant systemic and structural impediments that, if not acknowledged and addressed, will continue to undermine the development of global health as an effective means to addressing health inequities globally and to better understanding, and acting upon, upstream determinants of health toward health for all. While it strives to redress global inequities, global health continues to be a construct that is promoted, studied, and dictated mostly by Northern institutions and scholars. Until practical mechanisms are put in place for truly egalitarian partnerships between North and South for both the study and practice of global health, the emerging philosophy of global health cannot be effectively put into practice.

Effects of RN Age and Experience on Transformational Leadership Practices.

Science.gov (United States)

Herman, Susan; Gish, Mary; Rosenblum, Ruth; Herman, Michael

2017-06-01

This study reported the evolution of transformational leadership (TL) practices and behaviors across years of age, management experience, and professional nursing practice within a professional nursing leadership organization. Recent studies of CNO TL found valuations peak near age 60 years. This study reported on a wider range of management positions, correlating years of RN practice and management experience and age to TL metrics. This study used Kouzes and Posner's Leadership Practices Inventory-Self-Assessment (LPI-S) to survey a nursing leadership organization, the Association of California Nurse Leaders (ACNL). Anonymous responses were analyzed to identify leadership trends in age and years of professional service. On average, LPI-S metrics of leadership skills advance through years of management, RN experience, and age. The TL scores are statistically higher in most LPI-S categories for those with more than 30 years of RN or management experience. Decade-averaged LPI-S TL metrics in the ACNL survey evolve linearly throughout age before peaking in the decade from age 60 to 69 years. A similar evolution of TL metrics is seen in decades of either years of management experience or years of RN experience. Transformational leadership increased with nursing maturity particularly for LPI-S categories of "inspire a shared vision," "challenge the process," and "enable others to act." In the ACNL population studied, decade-averaged leadership metrics advanced. Leadership evolution with age in the broader RN population peaked in age bracket 60 to 69 years. The LPI-S averages declined when older than 70 years, coinciding with a shift from full-time work toward retirement and part-time employment.

Medical students, early general practice placements and positive supervisor experiences.

Science.gov (United States)

Henderson, Margaret; Upham, Susan; King, David; Dick, Marie-Louise; van Driel, Mieke

2018-03-01

Introduction Community-based longitudinal clinical placements for medical students are becoming more common globally. The perspective of supervising clinicians about their experiences and processes involved in maximising these training experiences has received less attention than that of students. Aims This paper explores the general practitioner (GP) supervisor perspective of positive training experiences with medical students undertaking urban community-based, longitudinal clinical placements in the early years of medical training. Methods Year 2 medical students spent a half-day per week in general practice for either 13 or 26 weeks. Transcribed semi-structured interviews from a convenience sample of participating GPs were thematically analysed by two researchers, using a general inductive approach. Results Identified themes related to the attributes of participating persons and organisations: GPs, students, patients, practices and their supporting institution; GPs' perceptions of student development; and triggers enhancing the experience. A model was developed to reflect these themes. Conclusions Training experiences were enhanced for GPs supervising medical students in early longitudinal clinical placements by the synergy of motivated students and keen teachers with support from patients, practice staff and academic institutions. We developed an explanatory model to better understand the mechanism of positive experiences. Understanding the interaction of factors enhancing teaching satisfaction is important for clinical disciplines wishing to maintain sustainable, high quality teaching.

F-18 FDG PET with coincidence detection, dual-head gamma camera, initial experience in oncology

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Chu, J.M.G.; Pocock, N.; Quach, T.; Camden, B.M.C. [Liverpool Health Services, Liverpool, NSW (Australia). Department of Nuclear Medicine and Clinical Ultrasound

1998-06-01

Full text: The development of Co-incidence Detection (CD) in gamma camera technology has allowed the use of positron radiopharmaceuticals in clinical practice without dedicated PET facilities. We report our initial experience of this technology in Oncological applications. All patients were administered 200 MBq of F- 18 FDG intravenously in a fasting state, with serum glucose below 8.9 mmol/L., and hydration well maintained. Tomography was performed using an ADAC Solus Molecular Co-incidence Detection (MCD) dual-head gamma camera, 60 minutes after administration and immediately after voiding. Tomography of the torso required up to three collections depending on the length of the patient, with each collection requiring 32 steps of 40 second duration, and a 50% overlap. Tomography of the brain required a single collection with 32 steps of 80 seconds. Patients were scanned in the supine position. An iterative reconstruction algorithm was employed without attenuation correction. All patients had histologically confirmed malignancy. Scan findings were correlated with results of all conventional diagnostic imaging procedures that were pertinent to the evaluation and management of each individual patient`s disease. Correlation with tumour type and treatment status was also undertaken. F-18 FDG uptake as demonstrated by CD-PET was increased in tumour bearing sites. The degree of increased uptake varied with tumour type and with treatment status. Our initial experience with CD-PET has been very encouraging, and has led us to undertake prospective short and long term studies to define its role in oncology

Initial Smoking Experiences and Current Smoking Behaviors and Perceptions among Current Smokers

Directory of Open Access Journals (Sweden)

Hugh Klein

2013-01-01

Full Text Available Purpose. We examine early-onset cigarette smoking and how, if at all, it is related to subsequent smoking practices. Methods. From 2004 to 2007, face-to-face interviews were conducted with 485 adult cigarette smokers residing in the Atlanta metropolitan area. Data analysis involved a multivariate analysis to determine whether age of smoking onset was related to current smoking practices when the effects of gender, age, race, marital/relationship status, income, and educational attainment were taken into account. Results. The mean age for smoking onset was 14.8, and more than one-half of all smokers had their first cigarette between the ages of 12 and 16. Most people reported an interval of less than one month between their first and second time using tobacco. Earlier onset cigarette smoking was related to more cigarette use and worse tobacco-related health outcomes in adulthood. Conclusions. Early prevention and intervention are needed to avoid early-onset smoking behaviors. Intervening after initial experimentation but before patterned smoking practices are established will be challenging, as the interval between initial and subsequent use tends to be short.

Managing the clinical setting for best nursing practice: a brief overview of contemporary initiatives.

Science.gov (United States)

Henderson, Amanda; Winch, Sarah

2008-01-01

Leadership strategies are important in facilitating the nursing profession to reach their optimum standards in the practice environment. To compare and contrast the central tenets of contemporary quality initiatives that are commensurate with enabling the environment so that best practice can occur. Democratic leadership, accessible and relevant education and professional development, the incorporation of evidence into practice and the ability of facilities to be responsive to change are core considerations for the successful maintenance of practice standards that are consistent with best nursing practice. While different concerns of management drive the adoption of contemporary approaches, there are many similarities in the how these approaches are translated into action in the clinical setting. Managers should focus on core principles of professional nursing that add value to practice rather than business processes.

Experience Practices on Decontamination Activity in NPP Decommissioning

Energy Technology Data Exchange (ETDEWEB)

Yoon, Suk Bon; Kim, Jeongju; Sohn, Wook [Korea Hydro and Nuclear Power Co., Daejeon (Korea, Republic of)

2016-10-15

Decommissioning of a nuclear power plant (NPP) involves various technical and administrative activities for a utility to terminate its license, which allows the plant site to be released from the regulatory control (site release). Decontamination activity in NPP decommissioning is one of the main technical activities to be performed during the decommissioning. The decontamination at decommissioning sites is usually performed due to several reasons such as reducing personnel dose and disposal costs, and cleanup to meet license termination requirements by using physical or chemical removal techniques proven through the previous experience practices. This paper introduces the best and worst practices for the decontamination activities collected from the decommissioning operational experiences through the implementation of nuclear decommissioning projects around the world. Review of the experiences of decontamination shows that it is important to conduct an advanced planning for optimized implementation of decontamination taking into considering site specific conditions such as operating time, reactor type, system, and so on. Also, a review of newer decontamination methods is necessary to safely and economically decommission the nuclear facility.

“We Need more Practice!” How Future Teachers Evaluate Their Experiences with Micro-Teaching?

Directory of Open Access Journals (Sweden)

Andreja Retelj

2016-12-01

Full Text Available This paper deals with micro-teaching as a possibility for combining theory and practice during the studies of future teachers of German. One of the key elements for combining theory and practice is pedagogical practicums in primary and secondary schools. From students’ reflections on their practicums, we have seen that it is very difficult for students to put their theoretical knowledge into practice. In order to alleviate initial difficulties and the anxiety future teachers face, we have implemented a specific micro-teaching model at the Department of German, Dutch and Swedish; students in the second year of the MA-level pedagogical stream participated in the model. The students’ self-evaluation on the effects of micro-learning showed it to be a useful model for obtaining their first pedagogical experience because it allows students, through reflection and feedback from their didactics teachers and from their fellow students, to become aware of the didactic and methodological principles of modern foreign language teaching and thus to be better prepared for their teaching practicums.

Medical students' experience in practical skills is far from stakeholders' expectations

DEFF Research Database (Denmark)

Ringsted, Charlotte; Schroeder, Torben V.; Henriksen, Jørgen

2001-01-01

This study compares medical graduates' experience in practical skills with a range of stakeholders' expectations. A questionnaire listing 58 practical skills was sent out to a group of graduating medical students. The medical students were asked to indicate their experience in each skill during...... medical school. A similar questionnaire was sent out to five groups of stakeholders asking for their expectations regarding graduates' experience. The stakeholders were: faculty members; consultants at clinical departments with interns in training; general practitioners; nurses; recently graduated junior...... doctors. A total of 472 questionnaires were sent out and 315 (67%) were returned. Medical graduates showed substantial variation in level of experience, and their experience was substantially lower than the expectations of the stakeholders. Nurses and junior doctors tended to have higher expectations...

Preliminary results from initial in-pile debris bed experiments

International Nuclear Information System (INIS)

Rivard, J.B.

1977-01-01

An accident in a liquid metal fast breeder reactor (LMFBR) in which molten core material is suddenly quenched with subcooled liquid sodium could result in extensive fragmentation and dispersal of fuel as subcritical beds of frozen particulate debris within the reactor vessel. Since this debris will continue to generate power due to decay of retained fission products, containment of the debris is threatened if the generated heat is not removed. Therefore, the initial safety question is the capacity which debris beds may have for transfer of the decay heat to overlying liquid sodium by natural processes--i.e., without the aid of forced circulation of the coolant. Up to the present time, all experiments on debris bed behavior either have used substitute materials (e.g., sand and water) or have employed actual materials, but atypical heating methods. Increased confidence in the applicability of debris bed simulations is afforded if the heat is generated within the fuel component of the appropriate fast reactor materials. The initial series of in-pile tests reported on herein constitutes the first experiments in which the internal heating mode has been produced in particulate oxide fuel immersed in liquid sodium. Fission heating of the fully-enriched UO 2 in the experiment while it is contained within Sandia Laboratories Annular Core Pulse Reactor (ACPR), operating in its steady-state mode, approximates the decay heating of debris. Preliminary results are discussed

Analysis of molten fuel-coolant interaction during a reactivity-initiated accident experiment

International Nuclear Information System (INIS)

El-Genk, M.S.; Hobbins, R.R.

1981-01-01

The results of a reactivity-initiated accident experiment, designated RIA-ST-4, are discussed and analyzed with regard to molten fuel-coolant interaction (MFCI). In this experiment, extensive amounts of molten UO 2 fuel and zircaloy cladding were produced and fragmented upon mixing with the coolant. Coolant pressurization up to 35 MPa and coolant overheating in excess of 940 K occurred after fuel rod failure. The initial coolant conditions were similar to those in boiling water reactors during a hot startup (that is, coolant pressure of 6.45 MPa, coolant temperature of 538 K, and coolant flow rate of 85 cm 3 /s). It is concluded that the high coolant pressure recorded in the RIA-ST-4 experiment was caused by an energetic MFCI and was not due to gas release from the test rod at failure, Zr/water reaction, or to UO 2 fuel vapor pressure. The high coolant temperature indicated the presence of superheated steam, which may have formed during the expansion of the working fluid back to the initial coolant pressure; yet, the thermal-to-mechanical energy conversion ratio is estimated to be only 0.3%

Experience, theory, and practical wisdom in teaching and teacher education

NARCIS (Netherlands)

Lunenberg, Mieke; Korthagen, Fred

In this contribution, we discuss what it means to be a professional teacher with practical wisdom, and how practical wisdom is related to theory and experience. These questions are especially relevant as nowadays, in many countries, teacher education becomes more school?based. Building on theories

Experience, theory, and practical wisdom in teaching and teacher education

NARCIS (Netherlands)

Lunenberg, Mieke; Korthagen, Fred

2009-01-01

In this contribution, we discuss what it means to be a professional teacher with practical wisdom, and how practical wisdom is related to theory and experience. These questions are especially relevant as nowadays, in many countries, teacher education becomes more school-based. Building on theories

The Design, Experience and Practice of Networked Learning

DEFF Research Database (Denmark)

. The Design, Experience and Practice of Networked Learning will prove indispensable reading for researchers, teachers, consultants, and instructional designers in higher and continuing education; for those involved in staff and educational development, and for those studying post graduate qualifications...

Initial development of a practical safety audit tool to assess fleet safety management practices.

Science.gov (United States)

Mitchell, Rebecca; Friswell, Rena; Mooren, Lori

2012-07-01

Work-related vehicle crashes are a common cause of occupational injury. Yet, there are few studies that investigate management practices used for light vehicle fleets (i.e. vehicles less than 4.5 tonnes). One of the impediments to obtaining and sharing information on effective fleet safety management is the lack of an evidence-based, standardised measurement tool. This article describes the initial development of an audit tool to assess fleet safety management practices in light vehicle fleets. The audit tool was developed by triangulating information from a review of the literature on fleet safety management practices and from semi-structured interviews with 15 fleet managers and 21 fleet drivers. A preliminary useability assessment was conducted with 5 organisations. The audit tool assesses the management of fleet safety against five core categories: (1) management, systems and processes; (2) monitoring and assessment; (3) employee recruitment, training and education; (4) vehicle technology, selection and maintenance; and (5) vehicle journeys. Each of these core categories has between 1 and 3 sub-categories. Organisations are rated at one of 4 levels on each sub-category. The fleet safety management audit tool is designed to identify the extent to which fleet safety is managed in an organisation against best practice. It is intended that the audit tool be used to conduct audits within an organisation to provide an indicator of progress in managing fleet safety and to consistently benchmark performance against other organisations. Application of the tool by fleet safety researchers is now needed to inform its further development and refinement and to permit psychometric evaluation. Copyright © 2012 Elsevier Ltd. All rights reserved.

Exploring nursing students’ experience of peer learning in clinical practice

Science.gov (United States)

Ravanipour, Maryam; Bahreini, Masoud; Ravanipour, Masoumeh

2015-01-01

Background: Peer learning is an educational process wherein someone of the same age or level of experience level interacts with other students interested in the same topic. There is limited evidence specifically focusing on the practical use of peer learning in Iran. The aim of this study was to explore nursing students’ experiences of peer learning in clinical practice. Materials and Methods: A qualitative content analysis was conducted. Focus groups were used to find the students’ experiences about peerlearning. Twenty-eight baccalaureate nursing students at Bushehr University of Medical Sciences were selected purposively, and were arranged in four groups of seven students each. The focus group interviews were conducted using a semi-structured interview schedule. All interviews were tape-recorded, transcribed verbatim, and analyzed using conventional content analysis method. Results: The analysis identified four themes: Paradoxical dualism, peer exploitation, first learning efficacy, and socialization practice. Gained advantages and perceived disadvantages created paradoxical dualism, and peer exploitation resulted from peer selection and peer training. Conclusion: Nursing students reported general satisfaction concerning peer learning due to much more in-depth learning with little stress than conventional learning methods. Peer learning is a useful method for nursing students for practicing educational leadership and learning the clinical skills before they get a job. PMID:26097860

Initial acceptance test experience with FFTF plant equipment

International Nuclear Information System (INIS)

Brown, R.K.; Coleman, K.A.; Mahaffey, M.K.; McCargar, C.G.; Young, M.W.

1978-09-01

The purpose of this paper is to examine the initial acceptance test experience of certain pieces of auxiliary equipment of the Fast Flux Test Facility (FFTF). The scope focuses on the DHX blowers and drive train, inert gas blowers, H and V containment isolation valves, and the Surveillance and In-service Inspection (SISI) transporter and trolley. For each type of equipment, the discussion includes a summary of the design and system function, installation history, preoperational acceptance testing procedures and results, and unusual events and resolutions

The Community Reclaims Control? Learning Experiences from Rural Broadband Initiatives in the Netherlands

NARCIS (Netherlands)

Salemink, Koen; Strijker, Dirk; Bosworth, Gary

2017-01-01

Based on four illustrative case studies from the Netherlands, this article discusses learning experiences gained from rural broadband initiatives. As an example of the big society' (or participatiesamenleving' in Dutch), initiatives try to step in where the market and the government fail. The main

"Elite" Career-Changers and Their Experience of Initial Teacher Education

Science.gov (United States)

Wilkins, Chris

2017-01-01

This study explores the motivation of "high-status" professionals to change career and enter teaching, and their experience of undertaking initial teacher education (ITE) programmes in England. The study builds on previous research which found that career-changers are disproportionately more likely to fail to complete their ITE studies,…

Professional Learning Experiences and Administrator Practice: Is There a Connection?

Science.gov (United States)

Bickmore, Dana L.

2012-01-01

This study identified the formal and informal professional learning experiences in which school administrators engaged and the relationship between these professional learning experiences and administrator practice. The researcher developed an instrument that solicited school administrators' engagement and perceived value of formal and informal…

Integrating virtual reality video games into practice: clinicians' experiences.

Science.gov (United States)

Levac, Danielle E; Miller, Patricia A

2013-10-01

The Nintendo Wii is a popular virtual reality (VR) video gaming system in rehabilitation practice and research. As evidence emerges related to its effectiveness as a physical therapy training method, clinicians require information about the pragmatics of its use in practice. The purpose of this descriptive qualitative study is to explore observations and insights from a sample of physical therapists (PTs) working with children with acquired brain injury regarding practical implications of using the Wii as a physical therapy intervention. Six PTs employed at a children's rehabilitation center participated in semi-structured interviews, which were transcribed and analyzed using content analysis. Two themes summarize the practical implications of Wii use: 1) technology meets clinical practice; and 2) onus is on the therapist. Therapists described both beneficial and challenging implications arising from the intersection of technology and practice, and reported the personal commitment required to orient oneself to the gaming system and capably implement this intervention. Findings include issues that may be relevant to professional development in a broader rehabilitation context, including suggestions for the content of educational initiatives and the need for institutional support from managers in the form of physical resources for VR implementation.

From pipelines to pathways: the Memorial experience in educating doctors for rural generalist practice.

Science.gov (United States)

Rourke, James; Asghari, Shabnam; Hurley, Oliver; Ravalia, Mohamed; Jong, Michael; Parsons, Wanda; Duggan, Norah; Stringer, Katherine; O'Keefe, Danielle; Moffatt, Scott; Graham, Wendy; Sturge Sparkes, Carolyn; Hippe, Janelle; Harris Walsh, Kristin; McKay, Donald; Samarasena, Asoka

2018-03-01

This report describes the community context, concept and mission of The Faculty of Medicine at Memorial University of Newfoundland (Memorial), Canada, and its 'pathways to rural practice' approach, which includes influences at the pre-medical school, medical school experience, postgraduate residency training, and physician practice levels. Memorial's pathways to practice helped Memorial to fulfill its social accountability mandate to populate the province with highly skilled rural generalist practitioners. Programs/interventions/initiatives: The 'pathways to rural practice' include initiatives in four stages: (1) before admission to medical school; (2) during undergraduate medical training (medical degree (MD) program); (3) during postgraduate vocational residency training; and (4) after postgraduate vocational residency training. Memorial's Learners & Locations (L&L) database tracks students through these stages. The Aboriginal initiative - the MedQuest program and the admissions process that considers geographic or minority representation in terms of those selecting candidates and the candidates themselves - occurs before the student is admitted. Once a student starts Memorial's MD program, the student has ample opportunities to have rural-based experiences through pre-clerkship and clerkship, of which some take place exclusively outside of St. John's tertiary hospitals. Memorial's postgraduate (PG) Family Medicine (FM) residency (vocational) training program allows for deeper community integration and longer periods of training within the same community, which increases the likelihood of a physician choosing rural family medicine. After postgraduate training, rural physicians were given many opportunities for professional development as well as faculty development opportunities. Each of the programs and initiatives were assessed through geospatial rurality analysis of administrative data collected upon entry into and during the MD program and PG training (L

How eight primary care practices initiated and maintained quality monitoring and reporting.

Science.gov (United States)

Sloane, Philip D; Wroth, Thomas; Halladay, Jacquie; Bray, Paul; Spragens, Lynn; Stearns, Sally; Zimmerman, Sheryl

2011-01-01

Primary care medical practices increasingly are asked by payers, employers, and government agencies to report quality data, but the process of doing so is not well delineated. Providers and office staff in a diverse sample of eight primary care practices in North Carolina comprised this study population. Interviews were conducted and self-administered questionnaires were disseminated in practices that were successfully reporting data to one or more of 4 reporting programs. Our measures included responses to open-ended and Likert scale questions about experiences and potential facilitators and barriers, as well as subscales of the Practice Assessment tool and the Culture of Group Practices instrument. Study practices had stronger change histories, higher information and quality emphases, and lower business emphases than historical comparison practices. Motivation to participate, a leader who catalyzes the process, and establishment of new systems characterized successful practices. Staff time, information technology challenges, and resistance from some providers were common barriers. Practices achieve a sustainability state when numerous barriers have been successfully overcome and tangible results achieved from the process. Implementing and sustaining quality reporting requires a complex set of motivators, facilitators, and strategies to overcome inherent barriers that can present themselves in practices that seek to implement changes in this direction.

Dynamic crack initiation toughness : experiments and peridynamic modeling.

Energy Technology Data Exchange (ETDEWEB)

Foster, John T.

2009-10-01

This is a dissertation on research conducted studying the dynamic crack initiation toughness of a 4340 steel. Researchers have been conducting experimental testing of dynamic crack initiation toughness, K{sub Ic}, for many years, using many experimental techniques with vastly different trends in the results when reporting K{sub Ic} as a function of loading rate. The dissertation describes a novel experimental technique for measuring K{sub Ic} in metals using the Kolsky bar. The method borrows from improvements made in recent years in traditional Kolsky bar testing by using pulse shaping techniques to ensure a constant loading rate applied to the sample before crack initiation. Dynamic crack initiation measurements were reported on a 4340 steel at two different loading rates. The steel was shown to exhibit a rate dependence, with the recorded values of K{sub Ic} being much higher at the higher loading rate. Using the knowledge of this rate dependence as a motivation in attempting to model the fracture events, a viscoplastic constitutive model was implemented into a peridynamic computational mechanics code. Peridynamics is a newly developed theory in solid mechanics that replaces the classical partial differential equations of motion with integral-differential equations which do not require the existence of spatial derivatives in the displacement field. This allows for the straightforward modeling of unguided crack initiation and growth. To date, peridynamic implementations have used severely restricted constitutive models. This research represents the first implementation of a complex material model and its validation. After showing results comparing deformations to experimental Taylor anvil impact for the viscoplastic material model, a novel failure criterion is introduced to model the dynamic crack initiation toughness experiments. The failure model is based on an energy criterion and uses the K{sub Ic} values recorded experimentally as an input. The failure model

Blast experiments for the derivation of initial cloud dimensions after a ''Dirty Bomb'' event

International Nuclear Information System (INIS)

Thielen, H.; Schroedl, E.

2004-01-01

Basis for the assessment of potential consequences of a ''dirty bomb'' event is the calculation of the atmospheric dispersion of airborne particles. The empirical derivation of parameters for the estimation of the initial pollutant cloud dimensions was the principal purpose for blast experiments performed in the training area Munster in summer 2003 with the participation of several highly engaged German organisations and institutions. The experiments were performed under variation of parameters like mass and kind of explosive, subsurface characteristics or meteorological conditions and were documented by digital video recording. The blasting experiments supplied significant results under reproducible conditions. The initial cloud dimension was primarily influenced by the explosive mass. The influence of other parameters was relatively small and within the range of the experimental uncertainties. Based on these experimental results a new correlation was determined for the empirical estimation of the initial cloud dimensions as a function of explosive mass. The observed initial cloud volumes were more than an order of magnitude smaller than those calculated with other widely-used formulas (e.g. HOTSPOT). As a smaller volume of the initial cloud leads to higher near-ground concentration maxima, our results support an appropriate adjustment of currently employed calculation methods. (orig.)

Comparison of the initial ETA gas propagation experiments with theoretical models

Energy Technology Data Exchange (ETDEWEB)

Chambers, F.W.; Clark, J.C.; Fessenden, T.J.

1982-04-20

This report contains a description of the initial ETA propagation experiments in air at a beam current of 4.5 kA. The beam was observed to propagate at the pressures anticipated on the basis of previous theory and experiment. A comparison of measured net current waveforms with predictions of the PHOENIX code showed good agreement over the pressure range 0.1 to 200 torr. However, the beam was observed to expand with Z at a faster rate than theory predicts. Excessive transverse beam modulation at injection complicated the experiments and limited their comparison with theory.

Comparison of the initial ETA gas propagation experiments with theoretical models

International Nuclear Information System (INIS)

Chambers, F.W.; Clark, J.C.; Fessenden, T.J.

1982-01-01

This report contains a description of the initial ETA propagation experiments in air at a beam current of 4.5 kA. The beam was observed to propagate at the pressures anticipated on the basis of previous theory and experiment. A comparison of measured net current waveforms with predictions of the PHOENIX code showed good agreement over the pressure range 0.1 to 200 torr. However, the beam was observed to expand with Z at a faster rate than theory predicts. Excessive transverse beam modulation at injection complicated the experiments and limited their comparison with theory

Shock initiation experiments on ratchet grown PBX 9502

Energy Technology Data Exchange (ETDEWEB)

Gustavsen, Richard L [Los Alamos National Laboratory; Thompson, Darla G [Los Alamos National Laboratory; Olinger, Barton W [Los Alamos National Laboratory; Deluca, Racci [Los Alamos National Laboratory; Bartram, Brian D [Los Alamos National Laboratory; Pierce, Timothy H [Los Alamos National Laboratory; Sanchez, Nathaniel J [Los Alamos National Laboratory

2010-01-01

This study compares the shock initiation behavior of PBX 9502 pressed to less than nominal density (nominal density is 1.890 {+-} 0.005 g/cm{sup 3}) with PBX 9502 pressed to nominal density and then ''ratchet grown'' to low density. PBX 9502 is an insensitive plastic bonded explosive consisting of 95 weight % dry-aminated tri-amino-tri-nitro-benzene (TATB) and 5 weight % Kel-F 800 plastic binder. ''Ratchet growth'' - an irreversible increase in specific volume - occurs when an explosive based on TATB is temperature cycled. The design of our study is as follows: PBX 9502, all from the same lot, received the following four treatments. Samples in the first group were pressed to less than nominal density. These were not ratchet grown and used as a baseline. Samples in the second group were pressed to nominal density and then ratchet grown by temperature cycling 30 times between -54 C and +80 C. Samples in the final group were pressed to nominal density and cut into 100 mm by 25.4 mm diameter cylinders. During thermal cycling the cylinders were axially constrained by a 100 psi load. Samples for shock initiation experiments were cut perpendicular (disks) and parallel (slabs) to the axial load. The four sample groups can be summarized with the terms pressed low, ratchet grown/no load, axial load/disks, and axial load/slabs. All samples were shock initiated with nearly identical inputs in plate impact experiments carried out on a gas gun. Wave profiles were measured after propagation through 3, 4, 5, and 6 mm of explosive. Side by side comparison of wave profiles from different samples is used as a measure of relative sensitivity. All reduced density samples were more shock sensitive than nominal density PBX 9502. Differences in shock sensitivity between ratchet grown and pressed to low density PBX 9502 were small, but the low density pressings are slightly more sensitive than the ratchet grown samples.

Physiotherapy in hip and knee osteoarthritis: development of a practice guideline concerning initial assessment, treatment and evaluation.

NARCIS (Netherlands)

Peter, W.F.H.; Jansen, M.J.; Hurkmans, E.J.; Bloo, H.; Dekker-Bakker, L.M.M.C.J.; Dilling, R.G.; Hilberdink, W.K.H.A.; Kersten-Smit, C.; Rooij, M. de; Veenhof, C.; Vermeulen, H.M.; Vos, R.J. de; Schoones, J.W.; Vliet Vlieland, T.P.M.

2011-01-01

BACKGROUND: An update of a Dutch physiotherapy practice guideline in Hip and Knee Osteoarthritis (HKOA) was made, based on current evidence and best practice. METHODS: A guideline steering committee, comprising 10 expert physiotherapists, selected topics concerning the guideline chapters: initial

Decomposing the interaction between retention interval and study/test practice: the role of retrievability.

Science.gov (United States)

Jang, Yoonhee; Wixted, John T; Pecher, Diane; Zeelenberg, René; Huber, David E

2012-01-01

Even without feedback, test practice enhances delayed performance compared to study practice, but the size of the effect is variable across studies. We investigated the benefit of testing, separating initially retrievable items from initially nonretrievable items. In two experiments, an initial test determined item retrievability. Retrievable or nonretrievable items were subsequently presented for repeated study or test practice. Collapsing across items, in Experiment 1, we obtained the typical cross-over interaction between retention interval and practice type. For retrievable items, however, the cross-over interaction was quantitatively different, with a small study benefit for an immediate test and a larger testing benefit after a delay. For nonretrievable items, there was a large study benefit for an immediate test, but one week later there was no difference between the study and test practice conditions. In Experiment 2, initially nonretrievable items were given additional study followed by either an immediate test or even more additional study, and one week later performance did not differ between the two conditions. These results indicate that the effect size of study/test practice is due to the relative contribution of retrievable and nonretrievable items.

Researching local sports initiatives for young migrants from a political perspective: methodological and practical challenges

Directory of Open Access Journals (Sweden)

Noemi García-Arjona

2017-11-01

Full Text Available The processes of incorporation of young migrants have been studied using a range of new approaches. Among them, sports and physical activity have been claimed as a space for social and cultural integration. To date, most research has been based mainly on ethnographic and grassroots perspectives to better understand the experiences of sports practices of migrants and their families. However, fewer contributions have focused on the political discourse on sports as a field of integration. This article explores methodological challenges arosen when choosing sports policies as a field of study. The main methodological challenges considered include the contested conceptualizations of the target population in sports initiatives and the development of comparative selection criteria for different levels of institutional participants. An indepth analysis of these methodological issues can help to reflect on the ideological constructs of sports as a field of integration and highlight the contribution of the political sociological perspective to existing migration studies.

Improving immediate newborn care practices in Philippine hospitals: impact of a national quality of care initiative 2008-2015.

Science.gov (United States)

Silvestre, Maria Asuncion A; Mannava, Priya; Corsino, Marie Ann; Capili, Donna S; Calibo, Anthony P; Tan, Cynthia Fernandez; Murray, John C S; Kitong, Jacqueline; Sobel, Howard L

2018-03-31

To determine whether intrapartum and newborn care practices improved in 11 large hospitals between 2008 and 2015. Secondary data analysis of observational assessments conducted in 11 hospitals in 2008 and 2015. Eleven large government hospitals from five regions in the Philippines. One hundred and seven randomly sampled postpartum mother-baby pairs in 2008 and 106 randomly sampled postpartum mothers prior to discharge from hospitals after delivery. A national initiative to improve quality of newborn care starting in 2009 through development of a standard package of intrapartum and newborn care services, practice-based training, formation of multidisciplinary hospital working groups, and regular assessments and meetings in hospitals to identify actions to improve practices, policies and environments. Quality improvement was supported by policy development, health financing packages, health facility standards, capacity building and health communication. Sixteen intrapartum and newborn care practices. Between 2008 and 2015, initiation of drying within 5 s of birth, delayed cord clamping, dry cord care, uninterrupted skin-to-skin contact, timing and duration of the initial breastfeed, and bathing deferred until 6 h after birth all vastly improved (P<0.001). The proportion of newborns receiving hygienic cord handling and the hepatitis B birth dose decreased by 11-12%. Except for reduced induction of labor, inappropriate maternal care practices persisted. Newborn care practices have vastly improved through an approach focused on improving hospital policies, environments and health worker practices. Maternal care practices remain outdated largely due to the ineffective didactic training approaches adopted for maternal care.

HDR brachytherapy in carcinoma of cervix: initial experience at AWARE hospitals

International Nuclear Information System (INIS)

Rajendran, M.; Reddy, K.D.; Reddy, R.M.; Reddy, J.M.; Reddy, B.V.N.; Kiran Kumar; Gopi, S.; Dharaniraj; Janardhanan

2002-01-01

High dose rate (HDR) brachytherapy is well established in the management of gynaecological malignancies. A report on the initial results of one and half year experience with a consistent dose/fractionation schedule and procedure of planning with delivery of treatment schedule is presented

Autopsy practice in forensic pathology - Evidence-based or experience-based?

DEFF Research Database (Denmark)

Colville-Ebeling, Bonnie; Freeman, Michael; Banner, Jytte

2014-01-01

Current autopsy practice in forensic pathology is to a large extent based on experience and individual customary practices as opposed to evidence and consensus based practices. As a result there is the potential for substantial variation in how knowledge is applied in each case. In the present case......-gathering and the use of check lists specific to certain injury causes are likely to result in less deviation from evidence-based practices in forensic pathology. Pre-autopsy data-gathering and check lists will help ensure a higher degree of standardization in autopsy reports thus enhancing the quality and accuracy...

Initiating events of accidents in the practice of oil well logging in Cuba

International Nuclear Information System (INIS)

Alles Leal, A.; Perez Reyes, Y.; Dumenigo Gonzalez, C.

2013-01-01

The oil well logging is an extremely important activity within the oil industry, but in turn, brings risks that occasionally result in damage to health, the environment and economic losses. In this context, risk analysis has become an important tool to control them through their prediction and the study of the factors that determine them, enabling substantiated decisions to, first, foresee accidents and, secondly, to minimize their consequences. This paper proposes the elaboration of a list of initiating events of accidents in the practice of oil well logging which is one of the most important aspects for further evaluation of radiation safety of this practice. For its determination the technique employed to identify risks was 'Failure Modes and Effects Analysis (FMEA)' by applying it to the different stages and processes of practice. (Author)

Methicillin-resistant Staphylococcus aureus screening as a patient safety initiative: using patients' experiences to improve the quality of screening practices.

Science.gov (United States)

Currie, Kay; Knussen, Christina; Price, Lesley; Reilly, Jacqui

2014-01-01

while methicillin-resistant Staphylococcus aureus screening is generally acceptable to patients as a regular patient safety initiative, to enhance the quality of the patient experience, clinicians should consider the timing, content and effectiveness of information provision. © 2013 John Wiley & Sons Ltd.

Selecting and training opinion leaders and best practice collaborators:Experience from the Canadian Chiropractic Guideline Initiative

OpenAIRE

Bussières, André E.; Maiers, Michele; Grondin, Diane; Brockhusen, Simon

2017-01-01

Objectives: To describe the process for selecting and training chiropractic opinion leaders (OLs) and best practice collaborators (BPCs) to increase the uptake of best practice. Methods: In Phase 1, OLs were identified using a cross-sectional survey among Canadian chiropractic stakeholders. A 10-member committee ranked nominees. Top-ranked nominees were invited to a training workshop. In Phase 2, a national e-survey was administered to 7200 Canadian chiropractors to identify additional OLs an...

The experiences of student nurses on placements with practice nurses: A pilot study.

Science.gov (United States)

Gale, Julia; Ooms, Ann; Sharples, Kath; Marks-Maran, Di

2016-01-01

To prepare the registered nurse of tomorrow in the United Kingdom (UK) to care for patients in general practice (GP)-led services, today's student nurses need to have the opportunity to experience placements with practice nurses to enable them to make positive career choices to become practice nurses in the future. The role of the practice nurse is described in the article. As a pilot project, seventeen students undertook placements with practice nurses in one of seven GP practices selected by the London GP Deanery and the university as having fulfilled the criteria to support student nurses in placements. A mentorship preparation programme was provided to prepare practice nurses for mentoring these students. An evaluation study was undertaken of this pilot project. Findings showed that students were highly positive about the experience; the majority rated this placement as being as good as or better than previous placement experiences. The evaluation also explored the impact on student learning and the value that the placement had. There was a positive impact on students' knowledge and skills in certain clinical areas especially related to health promotion. Students also indicated that they would like to have additional placements with practice nurses and would consider a career as a practice nurse in the future. Copyright © 2015 Elsevier Ltd. All rights reserved.

Practical Insights from Initial Studies Related to Human Error Analysis Project (HEAP)

International Nuclear Information System (INIS)

Follesoe, Knut; Kaarstad, Magnhild; Droeivoldsmo, Asgeir; Hollnagel, Erik; Kirwan; Barry

1996-01-01

This report presents practical insights made from an analysis of the three initial studies in the Human Error Analysis Project (HEAP), and the first study in the US NRC Staffing Project. These practical insights relate to our understanding of diagnosis in Nuclear Power Plant (NPP) emergency scenarios and, in particular, the factors that influence whether a diagnosis will succeed or fail. The insights reported here focus on three inter-related areas: (1) the diagnostic strategies and styles that have been observed in single operator and team-based studies; (2) the qualitative aspects of the key operator support systems, namely VDU interfaces, alarms, training and procedures, that have affected the outcome of diagnosis; and (3) the overall success rates of diagnosis and the error types that have been observed in the various studies. With respect to diagnosis, certain patterns have emerged from the various studies, depending on whether operators were alone or in teams, and on their familiarity with the process. Some aspects of the interface and alarm systems were found to contribute to diagnostic failures while others supported performance and recovery. Similar results were found for training and experience. Furthermore, the availability of procedures did not preclude the need for some diagnosis. With respect to HRA and PSA, it was possible to record the failure types seen in the studies, and in some cases to give crude estimates of the failure likelihood for certain scenarios. Although these insights are interim in nature, they do show the type of information that can be derived from these studies. More importantly, they clarify aspects of our understanding of diagnosis in NPP emergencies, including implications for risk assessment, operator support systems development, and for research into diagnosis in a broader range of fields than the nuclear power industry. (author)

Pedagogical Practices and Students' Experiences in Eritrean Higher Education Institutions

Science.gov (United States)

Tsegay, Samson Maekele; Zegergish, Mulgeta Zemuy; Ashraf, Muhammad Azeem

2018-01-01

Using semi-structured interview and review of documents, this study analyzes the pedagogical practices and students' experiences in Eritrean Higher Education Institutions (HEIs). The study indicated that pedagogical practices are affected by instructors' pedagogical skills and perceptions, and the teaching-learning environment. Moreover, the…

Addressing Opioid-Associated Constipation Using Quality Oncology Practice Initiative Scores and Plan-Do-Study-Act Cycles.

Science.gov (United States)

Kaur, Varinder; Haider, Sajjad; Sasapu, Appalanaidu; Mehta, Paulette; Arnaoutakis, Konstantinos; Makhoul, Issam

2017-01-01

Using the Quality Oncology Practice Initiative, an affiliate program of ASCO, we outlined opioid-associated constipation (OAC) as a subject in need of quality improvement (QI) in our fellowship program at the University of Arkansas for Medical Sciences and Central Arkansas Veterans Healthcare System. We initiated a fellow-led QI project to advance the quality of patient care and provide a valuable avenue for QI training of young physicians. Fellows organized meetings with all stakeholders, addressed the scope of the problem, and devised strategies for OAC management. Monthly meetings were organized using Plan-Do-Study-Act principles. Mandatory check boxes were inserted into our electronic medical record templates to remind all physicians to identify patients on opioid medications and assess and address OAC. Final chart audit and patient satisfaction surveys were performed 6 months after project initiation. Assessment of OAC improved from 52% at baseline to 92% ( P < .003). This improvement corresponded with high patient satisfaction scores, with 90% of surveyed patients reporting adequate management of their constipation. In this QI initiative, we showed that participation in ASCO's Quality Oncology Practice Initiative helps identify areas in need of QI, and such fellow-led QI projects can serve as models for QI training of young physicians.

GOOD PRACTICES REGARDING PRESCHOOL AND PRIMARY SCHOOL TEACHERS` INITIAL TRAINING

Directory of Open Access Journals (Sweden)

Gabriela V. KELEMEN

2013-11-01

Full Text Available The training of future preschool and primary school teachers at a high quality level is a main goal of our institution and all our efforts are channelled towards fulfilling it. Being a teacher is a science, a science based on competences acquired while attending well-structured lectures that mingle theoretical knowledge with practical assignments. Students acquire knowledge, abilities and develop field related competences during initial training but three years of study are not enough. The Law of Education regulates the following amendment: in order for a teacher to be well trained to meet the requirements of the third millennium it is necessary for him/her to continue the training in level II i.e. master degree, which provides additional competences. In this article we discuss a master programme developed within an European project that offers educational training according to the requirements of a high quality training both practical and theoretical. The components of the Master programme entitled Psychopedagogy of early education and young schooling containa curriculum adjusted to the requirements of a competitive higher education, the courses and seminars are the result of a thorough analysis of different educational models that have been implemented in other European countries. Currently, we are at the end of the first year and we want to share the good practices obtained so far.

Shifting Perspectives and Practices: Teacher Candidates’ Experiences of a First Nation, Métis, and Inuit Infusion in Mainstream Teacher Education

Directory of Open Access Journals (Sweden)

Melissa Marilyn Fern Blimkie

2014-10-01

Full Text Available This exploratory case study shares teacher candidates’ perspectives and experiences of the First Nation, Métis, and Inuit Infusion at ABC University’s Faculty of Education field site in XYZ, Ontario. For this initiative, Aboriginal content and pedagogies were infused throughout placements and courses of the mainstream teacher education program. Teacher candidates shared that the Infusion prepared them to teach Aboriginal content in culturally respectful and meaningful ways by providing them with a foundation to build on and helping them to develop teaching practices inclusive of diverse ways of knowing and being in the world. These findings may be useful to other educators developing and implementing their own infusion initiatives.

Experiences of Supervision at Practice Placement Sites

Directory of Open Access Journals (Sweden)

Lesley Diack

2014-01-01

Full Text Available Background. Whilst placement supervision and clinical education programmes are of significant value in shaping the behaviours of undergraduate healthcare students, appropriate provisions which are efficacious to the learner are somewhat lacking, particularly for students studying on UK MPharm programmes. Objectives. To explore and explain the value of placement supervision to the personal development and employability of undergraduate pharmacy students. Methods. Students participated in a week long community pharmacy pilot programme, a result of a collaborative effort between the School of Pharmacy and Life Sciences and a small consortium of community pharmacies. Students and stakeholders were asked to evaluate their experiences via separate questionnaires which had been developed to elicit views and attitudes. Key Findings. Feedback from students and stakeholders towards the experience was overwhelmingly positive with multiple benefits being reported. Of particular prominence was the emphasis in student feedback on the value of placement supervision to their professional and personal development. Findings were indicative of a development in clinical practice proficiencies, core skills, and improvement in decision-making practice. Conclusions. The benefits of clinical supervision to the professional and personal development of MPharm students are well documented, although attracting professional pharmacy supervisors is proving a problematic task for educational providers in the UK.

Investigating the experiences of New Zealand MRI technologists: Exploring intra-orbital metallic foreign body safety practices

Energy Technology Data Exchange (ETDEWEB)

Jacobs, Philippa K [River Radiology, Victoria Clinic, 750 Victoria Street, Hamilton, Waikato (New Zealand); Henwood, Suzanne [Unitec - Medical Imaging, Unitec Ratanui Street Henderson, Auckland (New Zealand); River Radiology, Victoria Clinic, 750 Victoria Street, Hamilton, Waikato (New Zealand)

2013-12-15

Qualitative research is lacking regarding the experiences of magnetic resonance imaging (MRI) technologists and their involvement in workplace safety practices. This article provides a gateway to explore, describe and document experiences of MRI technologists in New Zealand (NZ) pertaining to intra-orbital metallic foreign body (IMFB) safety practices. This phenomenological study describes the experiences of seven MRI technologists all with a minimum of 5 years' NZ work experience in MRI. The MRI technologists were interviewed face-to-face regarding their professional IMFB workplace experiences in order to explore historical, current and potential issues. Findings demonstrated that aspects of organization and administration are fundamentally important to MRI technologists. Varying levels of education and knowledge, as well as experience and skills gained, have significantly impacted on MRI technologists’ level of confidence and control in IMFB practices. Participants’ descriptions of their experiences in practice regarding decision-making capabilities further highlight the complexity of these themes. A model was developed to demonstrate the interrelated nature of the themes and the complexity of the situation in totality. Findings of this study have provided insight into the experiences of MRI technologists pertaining to IMFB safety practices and highlighted inconsistencies. It is hoped that these findings will contribute to and improve the level of understanding of MRI technologists and the practices and protocols involved in IMFB safety screening. The scarcity of available literature regarding IMFB safety practices highlights that more research is required to investigate additional aspects that could improve MRI technologists’ experiences.

Investigating the experiences of New Zealand MRI technologists: Exploring intra-orbital metallic foreign body safety practices

International Nuclear Information System (INIS)

Jacobs, Philippa K; Henwood, Suzanne

2013-01-01

Qualitative research is lacking regarding the experiences of magnetic resonance imaging (MRI) technologists and their involvement in workplace safety practices. This article provides a gateway to explore, describe and document experiences of MRI technologists in New Zealand (NZ) pertaining to intra-orbital metallic foreign body (IMFB) safety practices. This phenomenological study describes the experiences of seven MRI technologists all with a minimum of 5 years' NZ work experience in MRI. The MRI technologists were interviewed face-to-face regarding their professional IMFB workplace experiences in order to explore historical, current and potential issues. Findings demonstrated that aspects of organization and administration are fundamentally important to MRI technologists. Varying levels of education and knowledge, as well as experience and skills gained, have significantly impacted on MRI technologists’ level of confidence and control in IMFB practices. Participants’ descriptions of their experiences in practice regarding decision-making capabilities further highlight the complexity of these themes. A model was developed to demonstrate the interrelated nature of the themes and the complexity of the situation in totality. Findings of this study have provided insight into the experiences of MRI technologists pertaining to IMFB safety practices and highlighted inconsistencies. It is hoped that these findings will contribute to and improve the level of understanding of MRI technologists and the practices and protocols involved in IMFB safety screening. The scarcity of available literature regarding IMFB safety practices highlights that more research is required to investigate additional aspects that could improve MRI technologists’ experiences

Commissioning and initial experimental program of the BGO-OD experiment at ELSA

Science.gov (United States)

Alef, S.; Bauer, P.; Bayadilov, D.; Beck, R.; Becker, M.; Bella, A.; Bielefeldt, P.; Böse, S.; Braghieri, A.; Brinkmann, K.; Cole, P.; Di Salvo, R.; Dutz, H.; Elsner, D.; Fantini, A.; Freyermuth, O.; Friedrich, S.; Frommberger, F.; Ganenko, V.; Geffers, D.; Gervino, G.; Ghio, F.; Görtz, S.; Gridnev, A.; Gutz, E.; Hammann, D.; Hannappel, J.; Hillert, W.; Ignatov, A.; Jahn, R.; Joosten, R.; Jude, T. C.; Klein, F.; Knaust, J.; Kohl, K.; Koop, K.; Krusche, B.; Lapik, A.; Levi Sandri, P.; Lopatin, I. V.; Mandaglio, G.; Messi, F.; Messi, R.; Metag, V.; Moricciani, D.; Mushkarenkov, A.; Nanova, M.; Nedorezov, V.; Novinskiy, D.; Pedroni, P.; Reitz, B.; Romaniuk, M.; Rostomyan, T.; Rudnev, N.; Schaerf, C.; Scheluchin, G.; Schmieden, H.; Stugelev, A.; Sumachev, V.; Tarakanov, V.; Vegna, V.; Walther, D.; Watts, D.; Zaunick, H.; Zimmermann, T.

2016-11-01

BGO-OD is a new meson photoproduction experiment at the ELSA facility of Bonn University. It aims at the investigation of non strange and strange baryon excitations, and is especially designed to be able to detect weekly bound meson-baryon type structures. The setup for the BGO-OD experiment is presented, the characteristics of the photon beam and the detector performances are shown and the initial experimental program is discussed.

Practical knowledge engineering

CERN Document Server

Kelly, Richard

1991-01-01

This book provides knowledge engineers with practical methods for initiating, designing, building, managing, and demonstrating successful commercial expert systems. It is a record of what actually works (and does not work) in the construction of expert systems, drawn from the author's decade of experience in building expert systems in all major areas of application for American, European, and Japanese organizations.The book features:* knowledge engineering programming techniques* useful skills for demonstrating expert systems * practical costing and metrics* guidelines for using knowledge repr

Sick leave and disability pension before and after initiation of antirheumatic therapies in clinical practice.

Science.gov (United States)

Neovius, M; Simard, J F; Klareskog, L; Askling, J

2011-08-01

To investigate sick leave and disability pension in rheumatoid arthritis (RA) in relation to the initiation of biological and non-biological antirheumatic therapies in clinical practice. Patients aged 19-60 years initiating non-biological mono (n=2796) or combination disease-modifying antirheumatic drug (DMARD) therapy (n=973), or biological agents (n=4787) were identified in the Swedish Rheumatology Quality Register between 1999 and 2007. Sick leave and disability pension data (1995-2010) were retrieved from national registers. During the year before the start of mono DMARD, combination DMARD and biological treatment, 10%, 12% and 43% of patients received disability pension benefits, respectively. The corresponding combined annual sick leave and disability pension days were 78 (54+25), 132 (105+27) and 190 (79+111). Irrespective of treatment type, initiators were characterised by a history of increasing sick leave and disability pension. Treatment start was associated with a break in this trajectory: sick leave decreased while disability pension increased, resulting in a net stabilisation of total days. Higher levels of days on sick leave and disability pension at treatment start were observed in patients initiating biologics in 1999 (236 days/year) compared with 2007 (150 days/year; ppension increased rapidly before the initiation of antirheumatic therapy, which was associated with a halt but not a reversal of this development. Work ability is a metric of importance for clinical practice, signalling large remaining needs in the RA population, and the need for intervention earlier in the disease process.

The promise and challenge of practice-research collaborations: Guiding principles and strategies for initiating, designing, and implementing program evaluation research.

Science.gov (United States)

Secret, Mary; Abell, Melissa L; Berlin, Trey

2011-01-01

The authors present a set of guiding principles and strategies to facilitate the collaborative efforts of social work researchers and practitioners as they initiate, design, and implement outcome evaluations of human service interventions and programs. Beginning with an exploration of the interpersonal barriers to practice-research collaborations, and building on their experiences in successfully completing a community-based research evaluation, the authors identify specific relationship-focused principles and strategies and illustrate how these approaches can guide practice-research teams through the various sequential activities of the evaluation research process. In particular, it is suggested that practice-research collaborations can be formed, strengthened, and sustained by emphasis on a spirit of discovery and shared leadership at the start of the relationship, use of a comprehensive evaluation model to clarify and frame the evaluation and program goals, beginning where the client is when selecting research methodology and measurement tools, commitment to keeping the program first and recording everything during the implementation and data-collection stages, discussion of emerging findings and presentation of findings in graphic format at the data-analysis stage, and a total team approach at the dissemination stage.

Keeping it real--building an ROI model for an ambulatory EMR initiative that the physician practices espouse.

Science.gov (United States)

Mullen, Rńee; Donnelly, John T

2006-01-01

The ambulatory electronic medical record initiative at Magic Valley Regional Medical Center (MVRMC) in South Central Idaho underwent a rigorous product evaluation process that resulted in one of the market-leading EMR products being selected for implementation. MVRMC includes four business entities, including a 213-bed regional hospital and a 19-practice management services organization. Early in the process, the organization viewed buy-in from its physicians as a critical success factor. The physicians had been integral to product selection, and it was equally important for them to trust the economic model for its acquisition-especially because it was likely that they would be asked to put "some skin in the game." To make this initiative economically feasible, MVRMC received a grant from Agency for Healthcare Research and Quality based on the potential impact of the endeavor on healthcare delivery in the region. However, because the functional analysis did not result in the selection of the least expensive product, the AHRQ grant would only help defray the startup expenses, but not ongoing support and maintenance expenses after implementation; these costs would be borne by anticipated increases in the practice's revenue or reduction in its operating expenses. The ROI model would need to explain how each practice, from the single physician specialist to an almost 20-physician family practice, could pay for the desirable outcomes discussed during the selection phase of the project. The physicians, who had participated in technology initiatives in the past, were skeptical that cost-justifying an IT system was realistic, even though they recognized the potential benefits it could have on the quality and consistency of the care. Because some process standardization within and between practices would be needed to use electronic charting effectively, it was important that the ROI model did not outweigh the benefits of an as-yet untested operational workflow that

Initial experience of tritium exposure control at JET

International Nuclear Information System (INIS)

Patel, B.; Campling, D.C.; Schofield, P.A.; Macheta, P.; Sandland, K.

1998-01-01

Some of the safety procedures and controls in place for work with tritium are described, and initial operational experience of handling tritium is discussed. A description is given of work to rectify a water leak in a JET neutral beam heating component, which involved man-access to a confined volume to perform repairs, at tritium levels about 100 DAC (80 MBq/m 3 . HTO). Control measures involving use of purge and extract ventilation, and of personal protection using air-fed pressurized suits are described. Results are given of the internal doses to project staff and of atmospheric discharges of tritium during the repair outage. (P.A.)

Initial experience with robotic pancreatic surgery in Singapore: single institution experience with 30 consecutive cases.

Science.gov (United States)

Goh, Brian K P; Low, Tze-Yi; Lee, Ser-Yee; Chan, Chung-Yip; Chung, Alexander Y F; Ooi, London L P J

2018-05-24

Presently, the worldwide experience with robotic pancreatic surgery (RPS) is increasing although widespread adoption remains limited. In this study, we report our initial experience with RPS. This is a retrospective review of a single institution prospective database of 72 consecutive robotic hepatopancreatobiliary surgeries performed between 2013 and 2017. Of these, 30 patients who underwent RPS were included in this study of which 25 were performed by a single surgeon. The most common procedure was robotic distal pancreatectomy (RDP) which was performed in 20 patients. This included eight subtotal pancreatectomies, two extended pancreatecto-splenectomies (en bloc gastric resection) and 10 spleen-saving-RDP. Splenic preservation was successful in 10/11 attempted spleen-saving-RDP. Eight patients underwent pancreaticoduodenectomies (five hybrid with open reconstruction), one patient underwent a modified Puestow procedure and one enucleation of uncinate tumour. Four patients had extended resections including two RDP with gastric resection and two pancreaticoduodenectomies with vascular resection. There was one (3.3%) open conversion and seven (23.3%) major (>Grade II) morbidities. Overall, there were four (13.3%) clinically significant (Grade B) pancreatic fistulas of which three required percutaneous drainage. These occurred after three RDP and one robotic enucleation. There was one reoperation for port-site hernia and no 30-day/in-hospital mortalities. The median post-operative stay was 6.5 (range: 3-36) days and there were six (20%) 30-day readmissions. Our initial experience showed that RPS can be adopted safely with a low open conversion rate for a wide variety of procedures including pancreaticoduodenectomy. © 2018 Royal Australasian College of Surgeons.

Core competencies in the science and practice of knowledge translation: description of a Canadian strategic training initiative.

Science.gov (United States)

Straus, Sharon E; Brouwers, Melissa; Johnson, David; Lavis, John N; Légaré, France; Majumdar, Sumit R; McKibbon, K Ann; Sales, Anne E; Stacey, Dawn; Klein, Gail; Grimshaw, Jeremy

2011-12-09

Globally, healthcare systems are attempting to optimize quality of care. This challenge has resulted in the development of implementation science or knowledge translation (KT) and the resulting need to build capacity in both the science and practice of KT. We are attempting to meet these challenges through the creation of a national training initiative in KT. We have identified core competencies in this field and have developed a series of educational courses and materials for three training streams. We report the outline for this approach and the progress to date. We have prepared a strategy to develop, implement, and evaluate a national training initiative to build capacity in the science and practice of KT. Ultimately through this initiative, we hope to meet the capacity demand for KT researchers and practitioners in Canada that will lead to improved care and a strengthened healthcare system.

Stakeholder Engagement for Inclusive Water Governance: “Practicing What We Preach” with the OECD Water Governance Initiative

Directory of Open Access Journals (Sweden)

Aziza Akhmouch

2016-05-01

Full Text Available A cursory glance at the literature on water governance reveals that stakeholder engagement has long been considered an integral part of sound governance processes. However, a closer look at the literature reveals that, beyond this general assertion, there is a lack of evidence-based assessment on how engagement processes contribute to water governance objectives. This article addresses this research gap by presenting key findings and policy guidance from a study by the Organisation for Economic Co-operation and Development (OECD on “Stakeholder Engagement for Inclusive Water Governance”. This study employed comprehensive methods, including a survey administered to 215 stakeholder groups worldwide and separately, 69 case studies of specific stakeholder engagement initiatives on water management. This article also shares the experiences and lessons that have emerged from engaging stakeholders in the OECD Water Governance Initiative—an international multi-stakeholder policy forum created in 2013 to share policy and practical experiences on water governance at different levels. We hope this research will be used to stimulate and enrich discussions about the necessary conditions for results-oriented stakeholder engagement, and to guide decision makers accordingly.

The Relationship of a Pilot's Educational Background, Aeronautical Experience and Recency of Experience to Performance In Initial Training at a Regional Airline

Science.gov (United States)

Shane, Nancy R.

The purpose of this study was to determine how a pilot's educational background, aeronautical experience and recency of experience relate to their performance during initial training at a regional airline. Results show that variables in pilots' educational background, aeronautical experience and recency of experience do predict performance in training. The most significant predictors include years since graduation from college, multi-engine time, total time and whether or not a pilot had military flying experience. Due to the pilot shortage, the pilots entering regional airline training classes since August 2013 have varied backgrounds, aeronautical experience and recency of experience. As explained by Edward Thorndike's law of exercise and the law of recency, pilots who are actively using their aeronautical knowledge and exercising their flying skills should exhibit strong performance in those areas and pilots who have not been actively using their aeronautical knowledge and exercising their flying skills should exhibit degraded performance in those areas. Through correlation, chi-square and multiple regression analysis, this study tests this theory as it relates to performance in initial training at a regional airline.

Nursing home practices following resident death: the experience of Certified Nursing Assistants.

Science.gov (United States)

Barooah, Adrita; Boerner, Kathrin; van Riesenbeck, Isabelle; Burack, Orah R

2015-01-01

This study examined certified nursing assistants' (CNAs) experiences of nursing home practices following resident death. Participants were 140 CNAs who had experienced recent resident death. In semi-structured, in-person interviews, CNAs were asked about their experiences with the removal of the resident's body, filling the bed with a new resident, and how they were notified about the death. The facilities' practice of filling the bed quickly was most often experienced as negative. Responses to body removal and staff notification varied, but negative experiences were reported by a substantial minority. Being notified prior to returning to work was associated with a more positive experience. Learning about the death by walking into a room to find the bed empty or already filled was the most negative experience. Study findings suggest that more mindful approaches to the transitions related to resident deaths would be valued by CNAs and could improve their work experience. Copyright © 2015 Elsevier Inc. All rights reserved.

Learning Practice-Based Research Methods: Capturing the Experiences of MSW Students

Science.gov (United States)

Natland, Sidsel; Weissinger, Erika; Graaf, Genevieve; Carnochan, Sarah

2016-01-01

The literature on teaching research methods to social work students identifies many challenges, such as dealing with the tensions related to producing research relevant to practice, access to data to teach practice-based research, and limited student interest in learning research methods. This is an exploratory study of the learning experiences of…

Fourth Workshop on Sustainable Software for Science: Practice and Experiences (WSSSPE4)

NARCIS (Netherlands)

Katz, Daniel S; Niemeyer, Kyle E; Gesing, Sandra; Hwang, Lorraine; Bangerth, Wolfgang; Hettrick, Simon; Idaszak, Ray; Salac, Jean; Chue Hong, Neil; Núñez-Corrales, Santiago; Allen, Alice; Geiger, R Stuart; Miller, Jonah; Chen, Emily; Dubey, Anshu; Lago, Patricia

2018-01-01

This article summarizes motivations, organization, and activities of the Fourth Workshop on Sustainable Software for Science: Practice and Experiences (WSSSPE4). The WSSSPE series promotes sustainable research software by positively impacting principles and best practices, careers, learning, and

The Initial Training of Geography Teachers at the University of Porto: Model and Training, Practices and Representations

Science.gov (United States)

Martins, Felisbela

2015-01-01

Since 2008, the initial training of Geography teachers in Portugal was combined with the initial training of History teachers. This forced union has led to implications in the practices and teaching of geography. This paper intends to explore the thoughts and actions of the student teachers at the Faculty of Arts and Humanities, University of…

The gamification and the enrichment of innovation practices in the firm: an analysis of experiences

Directory of Open Access Journals (Sweden)

Cristina Gallego Gomez

2013-09-01

Full Text Available Purpose: Description of gamification practices in the company and the analysis of its influence on firm’s results by comparing experiences. Design/methodology: Analysis of experiences from different firm’s experiences. Findings: To show through real examples that the gamification leads to the achievement of better results in the organizations. Research limitations/implications: Access to the information of the few cases that we can find in our context. It is a quite new a yet unusual practice for most organizations. Practical implications: Reformulation of business communication strategies from best practices, where the gaming industry is an interesting precedent, which proofs that these practices improve business results. Social implications: Socialization of the innovation process at firms Originality/value: Provide an overview of the gamification as a practice that helps to pursue the strategy of collaboration with the client to improve results.

Initial clinical experience with frameless radiosurgery for patients with intracranial metastases

International Nuclear Information System (INIS)

Kamath, Reena; Ryken, Timothy C.; Meeks, Sanford L.; Pennington, Edward C.; Ritchie, Justine; Buatti, John M.

2005-01-01

Purpose: To review the initial clinical experience with frameless stereotactic radiosurgery (SRS) for treating intracranial metastatic disease. Methods and Materials: Sixty-four patients received frameless SRS for intracranial metastatic disease. Minimum follow-up was 6 months with none lost to follow-up. Patients had a median of 2 metastases and a maximum of 4. The median number of isocenters was 2 with median arcs of 10 and median dose of 17.5 Gy. Thirteen patients were treated for progressive/recurrent disease after surgical resection or whole brain radiotherapy (WBRT). Fifty-one patients were treated with frameless SRS as an an adjunct to initial treatment. Of the total treated, 17 were treated with SRS alone, 20 were treated with WBRT plus SRS, 16 were treated with surgical resection plus SRS, and the remaining 11 were treated with surgical resection plus WBRT plus SRS. Results: With a median actuarial follow-up period of 8.2 months, ultimate local control was 88%. The median time to progression was 8.1 months. The median overall survival was 8.7 months. Of the 17 patients treated with SRS alone, 86% had ultimate local control with mean overall survival of 7.1 months. Of the 13 patients who received surgical resection plus SRS without WBRT as primary treatment, there was 85% ultimate local control with an overall survival of 10.3 months. Three patients treated with initial surgery alone had recurrence treated with SRS 2-3 months after resection. All these patients obtained local control and median survival was >10 months. Of the 13 patients who received WBRT followed by SRS as boost treatment, 92% had local control and mean overall survival was 7.3 months. Of 7 patients who received SRS after recurrence after WBRT, 100% had local control with median survival of 8.2 months. For 8 patients who received surgery followed by WBRT and SRS, local control was 50%; however, ultimate intracranial control was achieved in 7 of 8 patients with repeat SRS and surgical

Initially curved microplates under electrostatic actuation: theory and experiment

KAUST Repository

Saghir, Shahid

2016-07-01

Microplates are the building blocks of many micro-electro-mechanical systems. It is common for them to experience initial curvature imperfection due to residual stresses caused by the micro fabrication process. Such plates are essentially different from perfectly flat ones and cannot be modeled using flat plate models. In this paper, we adopt a dynamic analog of the von Karman governing equations of imperfect plates. These equations are then used to develop a reduced order model based on the Galerkin procedure, to simulate the static and dynamic behavior of the microplate under electrostatic actuation. To validate the simulation results, an initially curved imperfect microplate made of silicon nitride is fabricated and tested. The static behaviour of the microplate is investigated when applying a DC voltage Vdc. Then, the dynamic behaviour of the microplate is examined under the application of a harmonic AC voltage, Vac, superimposed to Vdc. The simulation results show good agreement with the experimentally measured responses. © 2016 IOP Publishing Ltd.

A mixed-methods study of system-level sustainability of evidence-based practices in 12 large-scale implementation initiatives.

Science.gov (United States)

Scudder, Ashley T; Taber-Thomas, Sarah M; Schaffner, Kristen; Pemberton, Joy R; Hunter, Leah; Herschell, Amy D

2017-12-07

In recent decades, evidence-based practices (EBPs) have been broadly promoted in community behavioural health systems in the United States of America, yet reported EBP penetration rates remain low. Determining how to systematically sustain EBPs in complex, multi-level service systems has important implications for public health. This study examined factors impacting the sustainability of parent-child interaction therapy (PCIT) in large-scale initiatives in order to identify potential predictors of sustainment. A mixed-methods approach to data collection was used. Qualitative interviews and quantitative surveys examining sustainability processes and outcomes were completed by participants from 12 large-scale initiatives. Sustainment strategies fell into nine categories, including infrastructure, training, marketing, integration and building partnerships. Strategies involving integration of PCIT into existing practices and quality monitoring predicted sustainment, while financing also emerged as a key factor. The reported factors and strategies impacting sustainability varied across initiatives; however, integration into existing practices, monitoring quality and financing appear central to high levels of sustainability of PCIT in community-based systems. More detailed examination of the progression of specific activities related to these strategies may aide in identifying priorities to include in strategic planning of future large-scale initiatives. ClinicalTrials.gov ID NCT02543359 ; Protocol number PRO12060529.

Simulation Experiments in Practice : Statistical Design and Regression Analysis

NARCIS (Netherlands)

Kleijnen, J.P.C.

2007-01-01

In practice, simulation analysts often change only one factor at a time, and use graphical analysis of the resulting Input/Output (I/O) data. Statistical theory proves that more information is obtained when applying Design Of Experiments (DOE) and linear regression analysis. Unfortunately, classic

[Evaluation of the influence of humidity and temperature on the drug stability by initial average rate experiment].

Science.gov (United States)

He, Ning; Sun, Hechun; Dai, Miaomiao

2014-05-01

To evaluate the influence of temperature and humidity on the drug stability by initial average rate experiment, and to obtained the kinetic parameters. The effect of concentration error, drug degradation extent, humidity and temperature numbers, humidity and temperature range, and average humidity and temperature on the accuracy and precision of kinetic parameters in the initial average rate experiment was explored. The stability of vitamin C, as a solid state model, was investigated by an initial average rate experiment. Under the same experimental conditions, the kinetic parameters obtained from this proposed method were comparable to those from classical isothermal experiment at constant humidity. The estimates were more accurate and precise by controlling the extent of drug degradation, changing humidity and temperature range, or by setting the average temperature closer to room temperature. Compared with isothermal experiments at constant humidity, our proposed method saves time, labor, and materials.

African American women's experiences with the initial discovery, diagnosis, and treatment of breast cancer.

Science.gov (United States)

Lackey, N R; Gates, M F; Brown, G

2001-04-01

To describe the experiences of African American women living with breast cancer following the primary diagnosis and while undergoing initial treatment. Phenomenologic. 13 African American women (ages 30-66) purposefully selected from two oncology clinics in the mid-South. Phenomenologic interviews (transcribed verbatim) and field notes were analyzed using Colaizzi's method of phenomenologic description and analysis. Experience Trajectory, Femininity, and Spirituality were the three major themes. The Experience Trajectory subthemes were finding the lump, getting the diagnosis, undergoing surgery and adjuvant treatment. The Femininity subthemes were loss of all or part of the breast, loss of hair, and sexual attractiveness to a man. Spirituality was reflected as a reliance on God. Telling the story of their experience trajectory during their breast cancer experience is valuable in assessing African American women's feelings, emotions, and fears of body changes that occur during surgery and treatment. Their spirituality helps them through this experience. Research involving both African American women and their partners would provide greater insight into specific relationship patterns and communication related to sexuality during this experience. Nurses need to listen to the stories of African American women about the initial experience of discovery, diagnosis, and treatment of breast cancer so they can be more informed advocates for these women. African American women need more information from healthcare providers regarding the whole experience trajectory.

Nurses' experiences and perspectives on medication safety practices: an explorative qualitative study.

Science.gov (United States)

Smeulers, Marian; Onderwater, Astrid T; van Zwieten, Myra C B; Vermeulen, Hester

2014-04-01

To explore nurses' experiences with and perspectives on preventing medication administration errors. Insight into nurses' experiences with and perspectives on preventing medication administration errors is important and can be utilised to tailor and implement safety practices. A qualitative interview study of 20 nurses in an academic medical centre was conducted between March and December of 2011. Three themes emerged from this study: (1) nurses' roles and responsibilities in medication safety: aside from safe preparation and administration, the clinical reasoning of nurses is essential for medication safety; (2) nurses' ability to work safely: knowledge of risks and nurses' work circumstances influence their ability to work safely; and (3) nurses' acceptance of safety practices: advantages, feasibility and appropriateness are important incentives for acceptance of a safety practice. Nurses' experiences coincide with the assumption that they are in a pre-eminent position to enable safe medication management; however, their ability to adequately perform this role depends on sufficient knowledge to assess the risks of medication administration and on the circumstances in which they work. Safe medication management requires a learning climate and professional practice environment that enables further development of professional nursing skills and knowledge. © 2014 John Wiley & Sons Ltd.

First year undergraduate nursing students and nursing mentors: An evaluation of their experience of specialist areas as their hub practice learning environment.

Science.gov (United States)

McCallum, Jacqueline; Lamont, David; Kerr, Emma-Louise

2016-01-01

Specialist environments have traditionally not been considered as practice learning environments for year one nursing students. Through implementation of the hub and spoke model of practice learning this was implemented across one health board and Higher Education Institution in Scotland. Sixty nine students from specialist and 147 from general areas out of a total population of 467 students (46.2%) and thirteen mentors from specialist and 26 from general areas out of a total 577 mentors (6.7%) completed a questionnaire. The findings support this initiative and suggest in some cases student experiences are more positive in specialist environments. Copyright © 2015 Elsevier Ltd. All rights reserved.

Primary healthcare nurses' experiences with motivational interviewing in health promotion practice.

Science.gov (United States)

Brobeck, Elisabeth; Bergh, Håkan; Odencrants, Sigrid; Hildingh, Cathrine

2011-12-01

The aim of the study was to describe primary healthcare nurses' experiences with motivational interviewing as a method for health promotion practice. A person's lifestyle has a major effect on his or her health. Motivational interviewing is one way of working with lifestyle changes in health promotion practice. The basic plan of motivational interviewing is to help people understand their lifestyle problems and make positive lifestyle changes. Motivational interviewing has been proven to be more effective than conventional methods in increasing patient motivation. This study has a descriptive design and uses a qualitative method. Twenty nurses who worked in primary health care and actively used motivational interviewing in their work were interviewed. Qualitative content analysis was used to process the data. The primary healthcare nurses' experiences with motivational interviewing as a method of health promotion practice demonstrate that motivational interviewing is a demanding, enriching and useful method that promotes awareness and guidance in the care relationship. The results also show that motivational interviewing is a valuable tool for primary healthcare nurses' health promotion practice. This study shows that motivational interviewing places several different demands on nurses who use this method. Those who work with motivational interviewing must make an effort to incorporate this new method to avoid falling back into the former practice of simply giving advice. Maintaining an open mind while implementing motivational interviewing in real healthcare settings is crucial for nurses to increase this method's effectiveness. The nurses in the study had a positive experience with motivational interviewing, which can contribute to the increased use, adaption and development of motivational interviewing among primary healthcare professionals. Increased motivational interviewing knowledge and skills would also contribute to promotion of health lifestyle practices

Seamless learning: Technology-enhanced learning from practical experiences across contexts

NARCIS (Netherlands)

Rusman, Ellen

2018-01-01

Rusman, E. (2018, 8th of June). Seamless learning: Technology-enhanced learning from practical experiences across contexts. Keynote presentation at the Seamless learning conference, Maastricht, The Netherlands. http://www.ou.nl/slc

The utah beacon experience: integrating quality improvement, health information technology, and practice facilitation to improve diabetes outcomes in small health care facilities.

Science.gov (United States)

Tennison, Janet; Rajeev, Deepthi; Woolsey, Sarah; Black, Jeff; Oostema, Steven J; North, Christie

2014-01-01

The Utah Improving Care through Connectivity and Collaboration (IC3) Beacon community (2010-2013) was spearheaded by HealthInsight, a nonprofit, community-based organization. One of the main objectives of IC(3) was to improve health care provided to patients with diabetes in three Utah counties, collaborating with 21 independent smaller clinics and two large health care enterprises. This paper will focus on the use of health information technology (HIT) and practice facilitation to develop and implement new care processes to improve clinic workflow and ultimately improve patients' diabetes outcomes at 21 participating smaller, independent clinics. Early in the project, we learned that most of the 21 clinics did not have the resources needed to successfully implement quality improvement (QI) initiatives. IC(3) helped clinics effectively use data generated from their electronic health records (EHRs) to design and implement interventions to improve patients' diabetes outcomes. This close coupling of HIT, expert practice facilitation, and Learning Collaboratives was found to be especially valuable in clinics with limited resources. Through this process we learned that (1) an extensive readiness assessment improved clinic retention, (2) clinic champions were important for a successful collaboration, and (3) current EHR systems have limited functionality to assist in QI initiatives. In general, smaller, independent clinics lack knowledge and experience with QI and have limited HIT experience to improve patient care using electronic clinical data. Additionally, future projects like IC(3) Beacon will be instrumental in changing clinic culture so that QI is integrated into routine workflow. Our efforts led to significant changes in how practice staff optimized their EHRs to manage and improve diabetes care, while establishing the framework for sustainability. Some of the IC(3) Beacon practices are currently smoothly transitioning to new models of care such as Patient

Core competencies in the science and practice of knowledge translation: description of a Canadian strategic training initiative

Directory of Open Access Journals (Sweden)

Straus Sharon E

2011-12-01

Full Text Available Abstract Background Globally, healthcare systems are attempting to optimize quality of care. This challenge has resulted in the development of implementation science or knowledge translation (KT and the resulting need to build capacity in both the science and practice of KT. Findings We are attempting to meet these challenges through the creation of a national training initiative in KT. We have identified core competencies in this field and have developed a series of educational courses and materials for three training streams. We report the outline for this approach and the progress to date. Conclusions We have prepared a strategy to develop, implement, and evaluate a national training initiative to build capacity in the science and practice of KT. Ultimately through this initiative, we hope to meet the capacity demand for KT researchers and practitioners in Canada that will lead to improved care and a strengthened healthcare system.

Initial experiences of simultaneous laparoscopic resection of colorectal cancer and liver metastases

NARCIS (Netherlands)

Hoekstra, L. T.; Busch, O. R. C.; Bemelman, W. A.; van Gulik, T. M.; Tanis, P. J.

2012-01-01

Introduction. Simultaneous resection of primary colorectal carcinoma (CRC) and synchronous liver metastases (SLMs) is subject of debate with respect to morbidity in comparison to staged resection. The aim of this study was to evaluate our initial experience with this approach. Methods. Five patients

Assessing experience in the deliberate practice of running using a fuzzy decision-support system

Science.gov (United States)

Roveri, Maria Isabel; Manoel, Edison de Jesus; Onodera, Andrea Naomi; Ortega, Neli R. S.; Tessutti, Vitor Daniel; Vilela, Emerson; Evêncio, Nelson

2017-01-01

The judgement of skill experience and its levels is ambiguous though it is crucial for decision-making in sport sciences studies. We developed a fuzzy decision support system to classify experience of non-elite distance runners. Two Mamdani subsystems were developed based on expert running coaches’ knowledge. In the first subsystem, the linguistic variables of training frequency and volume were combined and the output defined the quality of running practice. The second subsystem yielded the level of running experience from the combination of the first subsystem output with the number of competitions and practice time. The model results were highly consistent with the judgment of three expert running coaches (r>0.88, p0.86, p<0.001). From the expert’s knowledge and the fuzzy model, running experience is beyond the so-called "10-year rule" and depends not only on practice time, but on the quality of practice (training volume and frequency) and participation in competitions. The fuzzy rule-based model was very reliable, valid, deals with the marked ambiguities inherent in the judgment of experience and has potential applications in research, sports training, and clinical settings. PMID:28817655

Assessing experience in the deliberate practice of running using a fuzzy decision-support system.

Directory of Open Access Journals (Sweden)

Maria Isabel Roveri

Full Text Available The judgement of skill experience and its levels is ambiguous though it is crucial for decision-making in sport sciences studies. We developed a fuzzy decision support system to classify experience of non-elite distance runners. Two Mamdani subsystems were developed based on expert running coaches' knowledge. In the first subsystem, the linguistic variables of training frequency and volume were combined and the output defined the quality of running practice. The second subsystem yielded the level of running experience from the combination of the first subsystem output with the number of competitions and practice time. The model results were highly consistent with the judgment of three expert running coaches (r>0.88, p0.86, p<0.001. From the expert's knowledge and the fuzzy model, running experience is beyond the so-called "10-year rule" and depends not only on practice time, but on the quality of practice (training volume and frequency and participation in competitions. The fuzzy rule-based model was very reliable, valid, deals with the marked ambiguities inherent in the judgment of experience and has potential applications in research, sports training, and clinical settings.

Physiotherapy in hip and knee osteoarthritis: development of a practice guideline concerning initial assessment, treatment and evaluation.

Science.gov (United States)

Peter, W F; Jansen, M J; Hurkmans, E J; Bloo, H; Dekker, J; Dilling, R G; Hilberdink, W; Kersten-Smit, C; de Rooij, M; Veenhof, C; Vermeulen, H M; de Vos, R J; Schoones, J W; Vliet Vlieland, T P

2011-01-01

An update of a Dutch physiotherapy practice guideline in Hip and Knee Osteoarthritis (HKOA) was made, based on current evidence and best practice. A guideline steering committee, comprising 10 expert physiotherapists, selected topics concerning the guideline chapters: initial assessment, treatment and evaluation. With respect to treatment a systematic literature search was performed using various databases, and the evidence was graded (1-4). For the initial assessment and evaluation mainly review papers and textbooks were used. Based on evidence and expert opinion, recommendations were formulated. A first draft of the guideline was reviewed by 17 experts from different professional backgrounds. A second draft was field-tested by 45 physiotherapists. In total 11 topics were selected. For the initial assessment, three recommendations were formulated, pertaining to history taking, red flags, and formulating treatment goals. Concerning treatment, 7 recommendations were formulated; (supervised) exercise therapy, education and self management interventions, a combination of exercise and manual therapy, postoperative exercise therapy and taping of the patella were recommended. Balneotherapy and hydrotherapy in HKOA, and thermotherapy, TENS, and Continuous Passive Motion in knee OA were neither recommended nor discouraged. Massage therapy, ultrasound, electrotherapy, electromagnetic field, Low Level Laser Therapy, preoperative physiotherapy and education could not be recommended. For the evaluation of treatment goals the following measurement instruments were recommended: Lequesne index, Western Ontario and McMaster Universities osteoarthritis index, Hip disability and Osteoarthritis Outcome Score and Knee injury and Osteoarthritis Outcome Score, 6-minute walktest, Timed Up and Go test, Patient Specific Complaint list, Visual Analoge Scale for pain, Intermittent and Constant OsteoArthritis Pain Questionnaire, goniometry, Medical Research Council for strength, handheld

First-Year Students’ Initial Motivational Beliefs at University: Predicted by Motivational Beliefs Derived from Within and Out-of-School Experience and Malleable Regardless of the Extent of Students’ Out-of-School Experience

Science.gov (United States)

Gorges, Julia

2017-01-01

revisions to them via experience. Multiple-group structural equation modeling showed no moderating effect of the extent of students’ out-of-school experience. The discussion focuses on interpretations of the expectancy-value theory that explicitly include motivational beliefs derived from out-of-school settings as antecedents of expectancy and value. With respect to practical implications, results are discussed in the light of student counseling and support to help students develop an adequate picture of a study program’s learning contents and overcome initial motivational setbacks. PMID:28790951

First-Year Students' Initial Motivational Beliefs at University: Predicted by Motivational Beliefs Derived from Within and Out-of-School Experience and Malleable Regardless of the Extent of Students' Out-of-School Experience.

Science.gov (United States)

Gorges, Julia

2017-01-01

via experience. Multiple-group structural equation modeling showed no moderating effect of the extent of students' out-of-school experience. The discussion focuses on interpretations of the expectancy-value theory that explicitly include motivational beliefs derived from out-of-school settings as antecedents of expectancy and value. With respect to practical implications, results are discussed in the light of student counseling and support to help students develop an adequate picture of a study program's learning contents and overcome initial motivational setbacks.

Teacher's experiences in PBL: implications for practice

Science.gov (United States)

Alves, Anabela C.; Sousa, Rui M.; Fernandes, Sandra; Cardoso, Elisabete; Carvalho, Maria Alice; Figueiredo, Jorge; Pereira, Rui M. S.

2016-03-01

Project-Based Learning (PBL) has been implemented in the first year of the Industrial Engineering and Management programme at the University of Minho, Portugal, since 2004/2005. The purpose of this paper is to analyse and discuss teachers' experiences in PBL in this programme and to explore its implications for student learning and for teaching practices in higher education. For data collection, the research method used was written narratives to these teachers, at the end of the PBL semester. Findings suggest that teachers express a positive view of PBL as a learning approach. They identify student motivation and engagement, along with a better understanding of the application of concepts in real-life situations, as important outcomes of the project for students. Besides this, teachers also highlight the importance of the development of transversal skills by students throughout the project. Recommendations for future work and implications for practice will also be discussed.

Goethe's Conception of "Experiment as Mediator" and Implications for Practical Work in School Science

Science.gov (United States)

Park, Wonyong; Song, Jinwoong

2018-03-01

There has been growing criticism over the aims, methods, and contents of practical work in school science, particularly concerning their tendency to oversimplify the scientific practice with focus on the hypothesis-testing function of experiments. In this article, we offer a reading of Johann Wolfgang von Goethe's scientific writings—particularly his works on color as an exquisite articulation of his ideas about experimentation—through the lens of practical school science. While avoiding the hasty conclusions made from isolated experiments and observations, Goethe sought in his experiments the interconnection among diverse natural phenomena and rejected the dualistic epistemology about the relation of humans and nature. Based on a close examination of his color theory and its underlying epistemology, we suggest three potential contributions that Goethe's conception of scientific experimentation can make to practical work in school science.

Initiating Service Encounter-based Innovation by Word-of-Business

DEFF Research Database (Denmark)

Mattsson, Jan

2015-01-01

Purpose – This paper aims to set up a natural experiment as action research and to develop a framework of cognitive distance of informants to improve the initiation of service encounter-based innovation. Design/methodology/approach – Natural experiment as action research in one Scandinavian case...... transcriptions of interviews and transcriptions. Research limitations/implications – Only one Scandinavian company and a limited number of informants were activated. Also, the time period only included the initiation phase of service encounter-based innovation. Practical implications – Three different strategies...... in an emerging innovation field, open/user-driven innovation. Theory from business marketing, service encounter and innovation is also used....

Nurses' experiences and perspectives on medication safety practices: an explorative qualitative study

NARCIS (Netherlands)

Smeulers, Marian; Onderwater, Astrid T.; van Zwieten, Myra C. B.; Vermeulen, Hester

2014-01-01

To explore nurses' experiences with and perspectives on preventing medication administration errors. Insight into nurses' experiences with and perspectives on preventing medication administration errors is important and can be utilised to tailor and implement safety practices. A qualitative

The Relationship Between Personality Traits, Flow-Experience, and Different Aspects of Practice Behavior of Amateur Vocal Students.

Science.gov (United States)

Heller, Katharina; Bullerjahn, Claudia; von Georgi, Richard

2015-01-01

Most of the existing studies on musical practice are concerned with instrumentalists only. Since singers are seldom considered in research, the present study is based on an online-sample of amateur vocal students (N = 120; 92 female, 28 male). The study investigated the correlations between personality traits, flow-experience and several aspects of practice characteristics. Personality was represented by the three personality dimensions extraversion, neuroticism and psychoticism, assessed by Eysenck's Personality Profiler as well as the trait form of the Positive and Negative Affect Schedule. 'Flow-experience,' 'self-congruence' and 'fear of losing control over concentration,' assessed by the Practice Flow Inventory, served as variables for flow-experience. The practice motivation was measured by the Practice Motivation Questionnaire in four categories ('self,' 'group,' 'audience,' 'teacher'). In addition, the Practice Behavior Questionnaire was used to provide an insight into the practice situation and behavior of singing students. The results show significant correlations: participants with high extraversion-scores experience significantly more flow than less extraverted persons, whereas lesser flow-experience seems to be related to high neuroticism-scores. Nevertheless, there is no influence in flow-experience concerning singing style ('classical' or 'popular'). The longer the practicing time, the more likely students are to achieve flow-experience. However, older singers tend to have less flow-experience. Consequently, singers seem to differ in their personality and practice behavior compared to other musicians. Most of the findings show that having control over one's instrument is decisive for achieving a performance of high quality, especially for singers. On the other hand, certainty in handling an instrument is essential to arouse a flow-feeling. However, flow-experience seems to be common mainly with amateur singers. In conclusion, this offers a starting

Soundwalk as a multifaceted practice

Directory of Open Access Journals (Sweden)

Kamila STAŚKO-MAZUR

2015-12-01

Full Text Available The soundwalk was invented as part of the initiatives undertaken by the World Soundscape Project group with an acoustic ecology profile, which emphasised the noise pollution that exists in people’s sonic environment and the need to reacquire our ‘lost skill’ of conscious listening. Initially, the practice of soundwalking was used as a method allowing us to ‘hone our hearing’ (to boost our sonological competence, to show the human condition with respect to modern reality. Soon, the soundwalk became an inspiration for many artistic undertakings that made use of the sonic properties of the environment and employed various listening strategies. This article is designed to present the idea of soundwalking since its theory and practices began to form. By presenting selected works by Hildegard Westerkamp, I intend to show the motivations behind the practice of soundwalking, which encompass the complex issues of perceiving and assessing city sounds. I refer these to Tim Ingold’s proposition to understand sound as a medium of experience. Soundwalking, as a practice of conscious listening by focusing attention on aural sensations, paradoxically seems to reveal the multi‑sensory structure of our relationship with the world, and the mediatory function of sound in our experience of being‑in‑the‑world.

Rethinking priorities: experience of an educational initiative to change attitudes, behaviours and clinical practice in end-of-life care.

Science.gov (United States)

Edwards, Annette; Barros D'Sa, Viv; Hicks, Fiona

2017-05-08

To implement the National End of Life Care strategy and enable more people to express and achieve their preferences about care at the end of life, senior clinicians outside palliative medicine need to make it a routine part of their practice. However, it is acknowledged that recognising that people are entering the last phase of their illness is not always straightforward, and having conversations about aims of treatment and planning for future care may not be easy. In order to begin to address these challenges, funding was sought from the Yorkshire and the Humber Strategic Health Authority (SHA), and subsequently Health Education England, Yorkshire and the Humber (HEEYH), to pilot a development programme in 2 acute trusts. 2 palliative medicine consultants shared the trainer role at each site, supporting hospital consultants from a range of specialties, with a GP to give a community perspective. The programme involved individual clinicians identifying their own learning needs and specific issues for end-of-life care in their patients. The group met together monthly in action learning sets to discuss issues in a safe yet challenging environment. Following evaluation using a combination of training needs analyses, feedback questionnaires, audits and service evaluations, it was modified slightly and repiloted in 2 further trusts as 'Rethinking Priorities'. This paper describes the programme and its outcomes, especially in relation to participants' learning, service development and leadership. It also highlights the challenges, including different learning styles, the concept of action learning, obtaining funding and dedicated time, and how to evaluate the effectiveness of a programme. Overall, it suggests that an educational initiative based on clinicians identifying their own learning needs, and using an action learning approach to explore issues with other colleagues, with the addition of some targeted sessions, can result in positive change in knowledge, behaviour

Barrier experiment: Shock initiation under complex loading

Energy Technology Data Exchange (ETDEWEB)

Menikoff, Ralph [Los Alamos National Lab. (LANL), Los Alamos, NM (United States)

2016-01-12

The barrier experiments are a variant of the gap test; a detonation wave in a donor HE impacts a barrier and drives a shock wave into an acceptor HE. The question we ask is: What is the trade-off between the barrier material and threshold barrier thickness to prevent the acceptor from detonating. This can be viewed from the perspective of shock initiation of the acceptor subject to a complex pressure drive condition. Here we consider key factors which affect whether or not the acceptor undergoes a shock-to-detonation transition. These include the following: shock impedance matches for the donor detonation wave into the barrier and then the barrier shock into the acceptor, the pressure gradient behind the donor detonation wave, and the curvature of detonation front in the donor. Numerical simulations are used to illustrate how these factors affect the reaction in the acceptor.

The experiences of student nurses on placements with practice nurses : a pilot study

OpenAIRE

Gale, Julia; Ooms, Ann; Sharples, Kath; Marks-Maran, Di

2016-01-01

To prepare the registered nurse of tomorrow in the United Kingdom (UK) to care for patients in general practice (GP)-led services, today's student nurses need to have the opportunity to experience placements with practice nurses to enable them to make positive career choices to become practice nurses in the future. The role of the practice nurse is described in the article. As a pilot project, seventeen students undertook placements with practice nurses in one of seven GP practices selected b...

Exploring body-anchored and experience-based learning in a community of practice

DEFF Research Database (Denmark)

Stelter, Reinhard

2008-01-01

which, in a second step, is presented as part of the social realm and as one of the prerequisites of learning in a community of practice. This integration is established and becomes visible through the following two concepts: 1. Reification as the outflow of co-ordinated action, and 2. narratives......The article aims to integrate body-anchored and experience-based learning in the theoretical concept of learning in a community of practice. Present moment, epoché, intentional orientation and meaning making are introduced as the four basic premises for body-anchored and experience-based learning...

A Survey of Optometry Graduates to Determine Practice Patterns: Part II: Licensure and Practice Establishment Experiences.

Science.gov (United States)

Bleimann, Robert L.; Smith, Lee W.

1985-01-01

A summary of Part II of a two-volume study of optometry graduates conducted by the Association of Schools and Colleges of Optometry is presented. Part II includes the analysis of the graduates' licensure and practice establishment experiences. (MLW)

Thinking strategically: academic-practice relationships: one health system's experience.

Science.gov (United States)

Wurmser, Teri; Bliss-Holtz, Jane

2011-01-01

Strategic planning and joint leverage of the strengths inherent in the academic and practice arenas of nursing are imperative to confront the challenges facing the profession of nursing and its place within the healthcare team of the future. This article presents a description and discussion of the implementation of several academic-practice partnership initiatives by Meridian Health, a health system located in central New Jersey. Included in the strategies discussed are creation of a support program for nonprofessional employees to become registered nurses; active partnership in the development of an accelerated BSN program; construction of support systems and academic partnerships for staff participation in RN-to-BSN programs; construction of on-site clinical simulation laboratories to foster interprofessional learning; and the implementation of a new BSN program, the first and only generic BSN program in two counties of the state. Outcomes of these academic-practice partnerships also are presented, including number of participants; graduation and NCLEX-RN pass rates; MH nurse vacancy rates; and nurse retention rates after first employment. Copyright © 2011 Elsevier Inc. All rights reserved.

Impact of Advanced Practice Registered Nurses on Quality Measures: The Missouri Quality Initiative Experience.

Science.gov (United States)

Rantz, Marilyn J; Popejoy, Lori; Vogelsmeier, Amy; Galambos, Colleen; Alexander, Greg; Flesner, Marcia; Murray, Cathy; Crecelius, Charles; Ge, Bin; Petroski, Gregory

2018-06-01

The purpose of this article is to review the impact of advanced practice registered nurses (APRNs) on the quality measure (QM) scores of the 16 participating nursing homes of the Missouri Quality Initiative (MOQI) intervention. The MOQI was one of 7 program sites in the US, with specific interventions unique to each site tested for the Centers for Medicaid and Medicare Services Innovations Center. While the goals of the MOQI for long-stay nursing home residents did not specifically include improvement of the QM scores, it was anticipated that improvement most likely would occur. Primary goals of the MOQI were to reduce the frequency of avoidable hospital admissions and readmissions; improve resident health outcomes; improve the process of transitioning between inpatient hospitals and nursing facilities; and reduce overall healthcare spending without restricting access to care or choice of providers. A 2-group comparison analysis was conducted using statewide QMs; a matched comparison group was selected from facilities in the same counties as the intervention homes, similar baseline QM scores, similar size and ownership. MOQI nursing homes each had an APRN embedded full-time to improve care and help the facility achieve MOQI goals. Part of their clinical work with residents and staff was to focus on quality improvement strategies with potential to influence healthcare outcomes. Trajectories of QM scores for the MOQI intervention nursing homes and matched comparison group homes were tested with nonparametric tests to examine for change in the desired direction between the 2 groups from baseline to 36 months. A composite QM score for each facility was constructed, and baseline to 36-month average change scores were examined using nonparametric tests. Then, adjusting for baseline, a repeated measures analysis using analysis of covariance as conducted. Composite QM scores of the APRN intervention group were significantly better (P = .025) than the comparison group

Kidney organ donation: developing family practice initiatives to reverse inertia

Science.gov (United States)

2010-01-01

Background Kidney transplantation is associated with greater long term survival rates and improved quality of life compared with dialysis. Continuous growth in the number of patients with kidney failure has not been matched by an increase in the availability of kidneys for transplantation. This leads to long waiting lists, higher treatment costs and negative health outcomes. Discussion Misunderstandings, public uncertainty and issues of trust in the medical system, that limit willingness to be registered as a potential donor, could be addressed by community dissemination of information and new family practice initiatives that respond to individuals' personal beliefs and concerns regarding organ donation and transplantation. Summary Tackling both personal and public inertia on organ donation is important for any community oriented kidney donation campaign. PMID:20478042

Experimental test accelerator: description and results of initial experiments

International Nuclear Information System (INIS)

Fessenden, T.; Birx, D.; Briggs, R.

1980-01-01

The ETA is a high current (10,000 Amp) linear induction accelerator that produces short (30 ns) pulses of electrons at 5 MeV twice per second or in bursts of 5 pulses separated by as little as one millisecond. At this time the machine has operated at 65% of its design current and 90% of the design voltage. This report contains a description of the accelerator and its diagnostics; the results of the initial year of operation; a comparison of design codes with experiments on beam transport; and a discussion of some of the special problems and their status

Reform and practice for photoelectric specialty experimental teaching based on virtual simulation experiment platform

Science.gov (United States)

Ye, Yan; Lv, Qingsong; Wu, Maocheng; Xu, Yishen; Gu, Jihua

2017-08-01

In view of some problems about the traditional photoelectric specialty experimental teaching process, such as separation of theoretical teaching and practical teaching, immobilization of experimental teaching contents, low quality of experiments and no obvious effect, we explored and practiced a new experimental teaching model of "theoretical teaching, virtual simulation and physical experiment", which combined the characteristics of photoelectric information science and engineering major and the essential requirements of engineering innovation talents cultivation. The virtual simulation experiment platform has many advantages, such as high performance-to-price ratio, easy operation and open experimental process, which makes virtual simulation combine physical experiment, complete each other with virtual for practical. After the users log into the virtual simulation experimental platform, they will first study the contents of the experiment, clarify the purpose and requirements of the experiment, master the method of using the instrument and the relevant notes, and then use the experimental instruments provided by the platform to build the corresponding experimental system. Once the experimenter's optical path is set incorrectly or the instrument parameters are set incorrectly, the error or warning message will be automatically triggered, and the reference information will be given instructing the student to complete the correct experimental operation. The results of our practice in recent years show that the teaching reform of the photoelectric specialty experiments has not only brought great convenience to the experimental teaching management, broadened the students' thinking and vision, enhanced the students' experimental skills and comprehensive qualities, but also made the students participate in the experiment with their enthusiasm. During the construction of experiment programs, the students' engineering practical ability and independent innovation awareness

Discharge initiation experiments in the Tokapole II tokamak

International Nuclear Information System (INIS)

Shepard, D.A.

1984-01-01

Experiments in the Tokapole II tokamak demonstrate the benefits of high density (n/sub e//n/sub o/ greater than or equal to 0.01) preionization by reducing four quantities at startup: necessary toroidal loop voltage (V 1 ) (50%), volt-second consumption (40-50%), impurity radiation (25-50%), and runaway electron production (approx. 80-100%). A zero-dimensional code models the loop voltage reduction dependence on preionization density and predicts a similar result for reactor scale devices. The code shows low initial resistivity and a high resistivity time derivative contribute to loop voltage reduction. Microwaves at the electron cyclotron resonance (ECR) frequency and plasma gun injection produce high density preionization, which reduces the initial V 1 , volt-second consumption, and runaways. The ECR preionization also reduces impurity radiation by shortening the time from voltage application to current channel formation. This, evidently, reduces the total plasma-wall interaction at startup. The power balance of the ECR plasma in a toroidal-field-only case was studied using Langmuir probes and impurity doping. The vertical electric field and current, which result from curvature drift, were measured as approx. 10 V/cm and 50 amps, respectively, and exceeded expected values for the bulk electron temperature (approx. 10 eV)

Large-Scale Laboratory Experiments of Initiation of Motion and Burial of Objects under Currents and Waves

Science.gov (United States)

Landry, B. J.; Wu, H.; Wenzel, S. P.; Gates, S. J.; Fytanidis, D. K.; Garcia, M. H.

2017-12-01

Unexploded ordnances (UXOs) can be found at the bottom of coastal areas as the residue of military wartime activities, training or accidents. These underwater objects are hazards for humans and the coastal environment increasing the need for addressing the knowledge gaps regarding the initiation of motion, fate and transport of UXOs under currents and wave conditions. Extensive experimental analysis was conducted for the initiation of motion of UXOs under various rigid bed roughness conditions (smooth PVC, pitted steel, marbles, gravels and bed of spherical particles) for both unidirectional and oscillatory flows. Particle image velocimetry measurements were conducted under both flow conditions to resolve the flow structure estimate the critical flow conditions for initiation of motion of UXOs. Analysis of the experimental observations shows that the geometrical characteristics of the UXOs, their properties (i.e. volume, mass) and their orientation with respect to the mean flow play an important role on the reorientation and mobility of the examined objects. A novel unified initiation of motion diagram is proposed using an effective/unified hydrodynamic roughness and a new length scale which includes the effect of the projected area and the bed-UXO contact area. Both unidirectional and oscillatory critical flow conditions collapsed into a single dimensionless diagram highlighting the importance and practical applicability of the proposed work. In addition to the rigid bed experiments, the burial dynamics of proud UXOs on a mobile sand bed were also examined. The complex flow-bedform-UXOs interactions were evaluated which highlighted the effect of munition density on burial rate and final burial depth. Burial dynamics and mechanisms for motion were examined for various UXOs types, and results show that, for the case of the low density UXOs under energetic conditions, lateral transport coexists with burial. Prior to burial, UXO re-orientation was also observed

Initial resident refractive surgical experience: outcomes of PRK and LASIK for myopia.

Science.gov (United States)

Wagoner, Michael D; Wickard, Joseph C; Wandling, George R; Milder, Lisa C; Rauen, Matthew P; Kitzmann, Anna S; Sutphin, John E; Goins, Kenneth M

2011-03-01

To evaluate and compare the outcome of initial resident surgical experience with photorefractive keratectomy (PRK) and LASIK. Retrospective review of all cases performed with the VISX Star S4 platform (Abbott Medical Optics) between July 1, 2003 and June 30, 2007. Inclusion criteria were spherical equivalent of -0.50 to -10.00 diopters (D), refractive astigmatic error of ≤3.00 D, intention to provide full distance correction, and minimum 3-month postoperative follow-up after initial ablation or retreatment (if performed). A total of 153 cases performed by 20 different residents met the inclusion criteria; 38 eyes underwent PRK and 115 eyes had LASIK. After initial treatment, mean Snellen uncorrected distance visual acuity (UDVA) after PRK was 20/17.3 and after LASIK was 20/19.5. Photorefractive keratectomy was associated with a significantly better approximation between preoperative corrected distance visual acuity (CDVA) and postoperative UDVA (ΔlogMAR 0.009 vs 0.091; P=.004) and a greater percentage of eyes that achieved UDVA of 20/20 or better (94.7% vs 78.3%; P=.02) or 20/30 or better (100% vs 87.8%; P=.02). There was a higher prevalence of retreatment in eyes that underwent LASIK (7.0% vs 0%; P=.20). One (0.9%) eye lost 2 lines of CDVA after LASIK. Supervised refractive surgery residents can achieve excellent visual outcomes in patients operated during their initial refractive experience. Photorefractive keratectomy was associated with better visual outcome than LASIK. Copyright 2011, SLACK Incorporated.

How is brand experience designed in practice? : Results of a multiple-case study

NARCIS (Netherlands)

Bakker-Wu, S.; Calabretta, G.; Hultink, H.J.; Bohemia, E.; de Bont, C.; Svengren Holm, L.

2017-01-01

Brand experience is an important concept in marketing because it can affect brand loyalty, brand recall, and brand attitude. Brand experience design is therefore an important practice for companies to create favourable and meaningful experiences, through the design of various touchpoints that are in

Simulated learning environment experience in nursing students for paediatric practice.

Science.gov (United States)

Mendoza-Maldonado, Yessy; Barría-Pailaquilén, René Mauricio

The training of health professionals requires the acquisition of clinical skills in a safe and efficient manner, which is facilitated by a simulated learning environment (SLE). It is also an efficient alternative when there are limitations for clinical practice in certain areas. This paper shows the work undertaken in a Chilean university in implementing paediatric practice using SLE. Over eight days, the care experience of a hospitalized infant was studied applying the nursing process. The participation of a paediatrician, resident physician, nursing technician, and simulated user was included in addition to the use of a simulation mannequin and equipment. Simulation of care was integral and covered interaction with the child and family and was developed in groups of six students by a teacher. The different phases of the simulation methodology were developed from a pedagogical point of view. The possibility of implementing paediatric clinical practice in an efficient and safe way was confirmed. The experience in SLE was highly valued by the students, allowing them to develop different skills and abilities required for paediatric nursing through simulation. Copyright © 2018 Elsevier España, S.L.U. All rights reserved.

Creativity and connections: the future of nursing education and practice: the Massachusetts Initiative.

Science.gov (United States)

Sroczynski, Maureen; Gravlin, Gayle; Route, Paulette Seymour; Hoffart, Nancy; Creelman, Patricia

2011-01-01

Education and practice partnerships are key to effective academic program design and implementation in a time of decreasing supply and increasing demands on the nursing profession. An integrated education/practice competency model can positively impact patient safety, improve patient care, increase retention, and ensure a sufficient and competent nursing workforce, which is paramount to survival of the health care system. Through the contributions of nursing leaders from the broad spectrum of nursing and industry organizations within the state, the Massachusetts Nurse of the Future project developed a competency-based framework for the future design of nursing educational programs to meet current and future practice needs. The Massachusetts Nurse of the Future Nursing Core Competencies(©) expand on the Institute of Medicine's core competencies for all health care professionals and the Quality and Safety Education for Nurses competencies for quality and safety to define the expectations for all professional nurses of the future. The Massachusetts Nurse of the Future Nursing Core Competencies define the knowledge, attitude, and skills required as the minimal expectations for initial nursing practice following completion of a prelicensure professional nursing education program. These competencies are now being integrated into new models for seamless, coordinated nursing curriculum and transition into practice within the state and beyond. Copyright © 2011 Elsevier Inc. All rights reserved.

Enhancing Research and Practice in Early Childhood through Formative and Design Experiments

Science.gov (United States)

Bradley, Barbara A.; Reinking, David

2011-01-01

This article describes formative and design experiments and how they can advance research and instructional practices in early childhood education. We argue that this relatively new approach to education research closes the gap between research and practice, and it addresses limitations that have been identified in early childhood research. We…

The Relationship Between Personality Traits, Flow-Experience, and Different Aspects of Practice Behavior of Amateur Vocal Students

Science.gov (United States)

Heller, Katharina; Bullerjahn, Claudia; von Georgi, Richard

2015-01-01

Most of the existing studies on musical practice are concerned with instrumentalists only. Since singers are seldom considered in research, the present study is based on an online-sample of amateur vocal students (N = 120; 92 female, 28 male). The study investigated the correlations between personality traits, flow-experience and several aspects of practice characteristics. Personality was represented by the three personality dimensions extraversion, neuroticism and psychoticism, assessed by Eysenck’s Personality Profiler as well as the trait form of the Positive and Negative Affect Schedule. ‘Flow-experience,’ ‘self-congruence’ and ‘fear of losing control over concentration,’ assessed by the Practice Flow Inventory, served as variables for flow-experience. The practice motivation was measured by the Practice Motivation Questionnaire in four categories (‘self,’ ‘group,’ ‘audience,’ ‘teacher’). In addition, the Practice Behavior Questionnaire was used to provide an insight into the practice situation and behavior of singing students. The results show significant correlations: participants with high extraversion-scores experience significantly more flow than less extraverted persons, whereas lesser flow-experience seems to be related to high neuroticism-scores. Nevertheless, there is no influence in flow-experience concerning singing style (‘classical’ or ‘popular’). The longer the practicing time, the more likely students are to achieve flow-experience. However, older singers tend to have less flow-experience. Consequently, singers seem to differ in their personality and practice behavior compared to other musicians. Most of the findings show that having control over one’s instrument is decisive for achieving a performance of high quality, especially for singers. On the other hand, certainty in handling an instrument is essential to arouse a flow-feeling. However, flow-experience seems to be common mainly with amateur singers

Organisational support for evidence-based practice: occupational therapists perceptions.

Science.gov (United States)

Bennett, Sally; Allen, Shelley; Caldwell, Elizabeth; Whitehead, Mary; Turpin, Merrill; Fleming, Jennifer; Cox, Ruth

2016-02-01

Barriers to the use of evidence-based practice extend beyond the individual clinician and often include organisational barriers. Adoption of systematic organisational support for evidence-based practice in health care is integral to its use. This study aimed to explore the perceptions of occupational therapy staff regarding the influence of organisational initiatives to support evidence-based practice on workplace culture and clinical practice. This study used semi-structured interviews with 30 occupational therapists working in a major metropolitan hospital in Brisbane, Australia regarding their perceptions of organisational initiatives designed to support evidence-based practice. Four themes emerged from the data: (i) firmly embedding a culture valuing research and EBP, (ii) aligning professional identity with the Research and Evidence in Practice model, (iii) experiences of change: pride, confidence and pressure and (iv) making evidence-based changes to clinical practices. Organisational initiatives for evidence-based practice were perceived as influencing the culture of the workplace, therapists' sense of identity as clinicians, and as contributing to changes in clinical practice. It is therefore important to consider organisational factors when attempting to increase the use of evidence in practice. © 2016 Occupational Therapy Australia.

School Counselors' Professional Experience and Practices Working with Students Who Self-Harm: A Qualitative Study

Science.gov (United States)

Roberts, Ellen Adams

2013-01-01

The professional experiences and practices of school counselors and the interventions they employ while working with adolescent students who self-harm is an underrepresented area within current research. This generic qualitative study provides a rich description and a deeper understanding of the professional experiences and practices of school…

Undergraduates' perceptions of the value of practical inhalation sedation experience in a UK dental school.

Science.gov (United States)

Walley, S; Albadri, S

2015-10-01

This was to establish the level and reported value of paediatric IHS experience from the perspective of final year undergraduates and to evaluate whether those students with more experience expressed feeling better-prepared for future practice and more likely to undertake further postgraduate education in IHS. All final year students were invited to complete an anonymous questionnaire designed to elicit undergraduate perceptions of IHS using visual analogue scales and free-text questions. A response rate of 77 % was achieved. Results revealed that only 21 % of participants reported acting as operator sedationist in ten or more IHS cases. Thus, the majority of undergraduates' did not meet the recommended quantity of practical IHS experiences, as outlined by the British Dental Sedation Teachers Group. In general, students felt on the value of IHS in the management of anxious children and expressed a desire to undertake further postgraduate education in conscious sedation. However, those students with more experience of practical IHS expressed feeling better able to describe the IHS experience with patients and parents, and were more satisfied with the quality of teaching. Furthermore free-text comments revealed that, regardless of experience, students wished to gain more experience of the practical administration of IHS. There is a need to increase the provision of IHS training within an undergraduate curriculum, in addition to improving the accessibility of postgraduate sedation courses.

Experience as a doctor in the developing world: does it benefit the clinical and organisational performance in general practice?

Directory of Open Access Journals (Sweden)

de Wit Niek J

2009-12-01

Full Text Available Abstract Background Many physicians have medical experience in developing countries early in their career, but its association with their medical performance later is not known. To explore possible associations we compared primary care physicians (GPs with and without professional experience in a developing country in performance both clinical and organisational. Methods A retrospective survey using two databases to analyse clinical and organisational performance respectively. Analysis was done at the GP level and practice level. 517 GPs received a questionnaire regarding relevant working experience in a developing country. Indicators for clinical performance were: prescription, referral, external diagnostic procedures and minor procedures. We used the district health insurance data base covering 570.000 patients. Explorative secondary analysis of practice visits of 1004 GPs in 566 practices in the Netherlands from 1999 till 2001. We used a validated practice visit method (VIP; 385 indicators in 51 dimensions of practice management to compare having experience in a developing country or not. Results Almost 8% of the GPs had experience in a developing country of at least two years. These GPs referred 9,5% less than their colleagues and did more surgical procedures. However, in the multivariate analysis 'experience in a developing country' was not significantly associated with clinical performance or with other GP- and practice characteristics. 16% of the practices a GP or GPs with at least two years experience in a developing country. They worked more often in group and rural practices with less patients per fte GP and more often part-time. These practices are more hygienic, collaborate more with the hospital and score better on organisation of the practice. These practices score less on service and availability, spend less time on patients in the consultation and the quality of recording in the EMD is lower. Conclusions We found interesting

Educational experiment for students using natural radioactivity. 2. Practical example of radiochemical experiment conducted at Tottori University

International Nuclear Information System (INIS)

Nakamura, Mariko; Esaka, Takao; Kamata, Masahiro

1999-01-01

This paper presents a practical example of educational experiment conducted at Tottori University, whose theme is to separate 214 Bi(+ 214 Pb) from superphosphate of lime or the soil sampled at Ningyo-Touge mountain pass. The results of this experiment are quantitative enough for educational purpose, although the amount of radioactivity is so small that it is free from any regulation in Japan. (author)

Practice and documentation of palliative sedation: a quality improvement initiative

Science.gov (United States)

McKinnon, M.; Azevedo, C.; Bush, S.H.; Lawlor, P.; Pereira, J.

2014-01-01

Background Palliative sedation (ps), the continuous use of sedating doses of medication to intentionally reduce consciousness and relieve refractory symptoms at end of life, is ethically acceptable if administered according to standards of best practice. Procedural guidelines outlining the appropriate use of ps and the need for rigorous documentation have been developed. As a quality improvement strategy, we audited the practice and documentation of ps on our palliative care unit (pcu). Methods A pharmacy database search of admissions in 2008 identified, for a subsequent chart review, patients who had received either a continuous infusion of midazolam (≥10 mg/24 h), regular parenteral dosing of methotrimeprazine (≥75 mg daily), or regular phenobarbital. Documentation of the decision-making process, consent, and medication use was collected using a data extraction form based on current international ps standards. Results Interpretation and comparison of data were difficult because of an apparent lack of a consistent operational definition of ps. Patient records had no specific documentation in relation to ps initiation, to clearly identified refractory symptoms, and to informed consent in 60 (64.5%), 43 (46.2%), and 38 (40.9%) charts respectively. Variation in the medications used was marked: 54 patients (58%) were started on a single agent and 39 (42%), on multiple agents. The 40 patients (43%) started on midazolam alone received a mean daily dose of 21.4 mg (standard deviation: 24.6 mg). Conclusions The lack of documentation and standardized practice of ps on our pcu has resulted in a quality improvement program to address those gaps. They also highlight the importance of conducting research and developing clinical guidelines in this area. PMID:24764700

Paediatric magnetic resonance enteroclysis under general anaesthesia - initial experience

International Nuclear Information System (INIS)

Sadigh, Sophie; Chopra, Mark; Olsen, Oeystein E.; Watson, Tom A.; Sury, Michael R.; Shah, Neil

2017-01-01

MR enterography is the accepted imaging reference standard for small bowel assessment in inflammatory bowel disease. There is an increasing cohort of children with inflammatory bowel disease presenting at an early age (<5 years) with severe disease. Younger children present a technical challenge for enterography because of the need for sedation/general anaesthesia to allow image optimisation and the need for oral contrast to allow adequate luminal assessment. Through our experiences, MR enteroclysis under general anaesthesia has proven to be a successful imaging technique for the work-up of these patients. In this paper, we present our institutional practice for performing MR enteroclysis under general anaesthesia. (orig.)

Paediatric magnetic resonance enteroclysis under general anaesthesia - initial experience

Energy Technology Data Exchange (ETDEWEB)

Sadigh, Sophie; Chopra, Mark; Olsen, Oeystein E.; Watson, Tom A. [Great Ormond Street Hospital NHS Foundation Trust, Department of Paediatric Radiology, London (United Kingdom); Sury, Michael R. [Great Ormond Street Hospital NHS Foundation Trust, Department of Paediatric Anaesthetics, London (United Kingdom); Shah, Neil [Great Ormond Street Hospital NHS Foundation Trust, Department of Paediatric Gastroenterology, London (United Kingdom)

2017-06-15

MR enterography is the accepted imaging reference standard for small bowel assessment in inflammatory bowel disease. There is an increasing cohort of children with inflammatory bowel disease presenting at an early age (<5 years) with severe disease. Younger children present a technical challenge for enterography because of the need for sedation/general anaesthesia to allow image optimisation and the need for oral contrast to allow adequate luminal assessment. Through our experiences, MR enteroclysis under general anaesthesia has proven to be a successful imaging technique for the work-up of these patients. In this paper, we present our institutional practice for performing MR enteroclysis under general anaesthesia. (orig.)

Embodied practice: claiming the body's experience, agency, and knowledge for social work.

Science.gov (United States)

Tangenberg, Kathleen M; Kemp, Susan

2002-01-01

Although social work practice typically is concerned with physical conditions and experiences such as poverty, addiction, and violence, relatively little attention has been given to the body in professional literature. Emphasizing both physical and sociocultural dimensions of the body, this article argues for an invigorated, more complex understanding of the body in social work theory, practice, and research. Drawing from scholarship in the humanities, social sciences, and social work, a framework involving three dimensions of the body is proposed for integration with accepted ecological practice models. The nature and implications of three primary dimensions of the body for multiple domains of social work practice are explored, citing examples from narratives of mothers living with HIV disease: (1) the experiencing body, focused on the physicality of daily life; (2) the body of power, focused on the physicality of oppression and marginality, typically based on race or ethnicity, socioeconomic status, gender, sexual orientation, age, disability, physical appearance, and illness; and (3) the client body, reflecting the bodily experiences of those identified as clients who participate in relationships with social workers.

Initial cathode processing experiences and results for the treatment of spent fuel

International Nuclear Information System (INIS)

Westphal, B.R.; Laug, D.V.; Brunsvold, A.R.; Roach, P.D.

1996-01-01

As part of the spent fuel treatment demonstration at Argonne National Laboratory, a vacuum distillation process is being employed for the recovery of uranium following an electrorefining process. Distillation of a salt electrolyte, primarily consisting of a eutectic mixture of lithium and potassium chlorides, from uranium is achieved by a batch operation termed ''cathode processing.'' Cathode processing is performed in a retort furnace which enables the production of a stable uranium product that can be isotopically diluted and stored. To date, experiments have been performed with two distillation units; one for prototypical testing and the other for actual spent fuel treatment operations. The results and experiences from these initial experiments with both units will be discussed as well as problems encountered and their resolution

Discharge initiation experiments in the Tokapole II tokamak

International Nuclear Information System (INIS)

Shepard, D.A.

1984-06-01

Experiments in the Tokapole II tokamak demonstrate the benefits of high density (n/sub e//n 0 greater than or equal to 0.01) preionization by reducing four quantities at startup: necessary toroidal loop voltage (V 1 ) (50%), volt-second consumption (40 to 50%), impurity radiation (25 to 50%), and runaway electron production (approx. 80 to 100%). A zero-dimensional code models the loop voltage reduction dependence on preionization density and predicts a similar result for reactor scale devices. The code shows low initial resistivity and a high resistivity time derivative contribute to loop voltage reduction. The power balance of the ECR plasma in a toroidal-field-only case was studied. Langmuir probes and impurity doping were used. The vertical electric field (E/sub v/) and current (I/sub v/), which result from curvature drift, were measured (E/sub v/ approx. 10 V/cm and I/sub v/ approx. 50 Amps) and exceeded expected values for the bulk electron temperature (approx. 10 eV). A series of experiments with external windings to simulate field errors perpendicular to the toroidal field was done. The results imply that an error field of 0.1% of the toroidal field is deleterious to ECR plasma density

High/Scope Preschool Key Experiences: Initiative and Social Relations. [with] Curriculum Videotape.

Science.gov (United States)

Graves, Michelle

As preschoolers develop the ability to carry out their ideas and play alone and with others, they are developing the foundation for social competence. This booklet and a companion videotape help teachers and parents recognize and support nine High/Scope key experiences in initiative and social relations: (1) making and expressing choices, plans,…

A pilot study of the experience of participating in a Therapeutic Touch practice group.

Science.gov (United States)

Moore, Theresa; Ting, Brigid; Rossiter-Thornton, Maria

2008-09-01

This pilot study explored the experience of participating in a Therapeutic Touch practice group. A qualitative descriptive-exploratory method was used, involving 12 members of practice groups in Ontario and British Columbia, Canada. Analysis of the data using an extraction-synthesis process yielded four themes: (a) learning with others through sharing and hands-on experience is valued; (b) connecting with a network of supportive relationships that sustain self and Therapeutic Touch practice; (c) comfort-discomfort arising with self, others, or ideas; and (d) meaningful changes emerge while experiencing group energy and Therapeutic Touch. The findings expand current knowledge about the positive aspects of participating in practice groups and provide a beginning understanding of member discomfort, which had not been previously reported. This knowledge will be useful to Therapeutic Touch organizations, practice group leaders, and group members. It will also guide health care agencies and practitioners of other healing modalities who may be considering establishing practice groups.

SU-E-E-05: Initial Experience On Physics Rotation of Radiological Residents

International Nuclear Information System (INIS)

Zhang, J; Williams, D; DiSantis, D; Hardy, P; Oates, M

2014-01-01

Purpose: The new ABR core exam integrates physics into clinical teaching, with an emphasis on understanding image quality, image artifacts, radiation dose and patient safety for each modality and/or sub-specialty. Accordingly, physics training of radiological residents faces a challenge. A traditional teaching of physics through didactic lectures may not fully fulfill this goal. It is also difficult to incorporate physics teaching in clinical practice due to time constraints. A dedicated physics rotation may be a solution. This study is to evaluate a full week physics workshop developed for the first year radiological residents. Methods: The physics rotation took a full week. It included three major parts, introduction lectures, hand-on experiences and observation of technologist operation. An introduction of basic concepts was given to each modality at the beginning. Hand-on experiments were emphasized and took most of time. During hand-on experiments, residents performed radiation measurements, studied the relationship between patient dose and practice (i.e., fluoroscopy), investigated influence of acquisition parameters (i.g., kV, mAs) on image quality, and evaluated image quality using phantoms A physics test before and after the workshop was also given but not for comparison purpose. Results: The evaluation shows that the physics rotation during the first week of residency in radiology is preferred by all residents. The length of a full week of physics workshop is appropriate. All residents think that the intensive workshop can significantly benefit their coming clinical rotations. Residents become more comfortable regarding the use of radiation and counseling relevant questions such as a pregnant patient risk from a CE PE examination. Conclusion: A dedicated physics rotation, assisting with didactic lectures, may fulfill the requirements of physics of the new ABR core exam. It helps radiologists deeply understand the physics concepts and more efficiently use

SU-E-E-05: Initial Experience On Physics Rotation of Radiological Residents

Energy Technology Data Exchange (ETDEWEB)

Zhang, J; Williams, D; DiSantis, D; Hardy, P; Oates, M [University of Kentucky, Lexington, KY (United States)

2014-06-01

Purpose: The new ABR core exam integrates physics into clinical teaching, with an emphasis on understanding image quality, image artifacts, radiation dose and patient safety for each modality and/or sub-specialty. Accordingly, physics training of radiological residents faces a challenge. A traditional teaching of physics through didactic lectures may not fully fulfill this goal. It is also difficult to incorporate physics teaching in clinical practice due to time constraints. A dedicated physics rotation may be a solution. This study is to evaluate a full week physics workshop developed for the first year radiological residents. Methods: The physics rotation took a full week. It included three major parts, introduction lectures, hand-on experiences and observation of technologist operation. An introduction of basic concepts was given to each modality at the beginning. Hand-on experiments were emphasized and took most of time. During hand-on experiments, residents performed radiation measurements, studied the relationship between patient dose and practice (i.e., fluoroscopy), investigated influence of acquisition parameters (i.g., kV, mAs) on image quality, and evaluated image quality using phantoms A physics test before and after the workshop was also given but not for comparison purpose. Results: The evaluation shows that the physics rotation during the first week of residency in radiology is preferred by all residents. The length of a full week of physics workshop is appropriate. All residents think that the intensive workshop can significantly benefit their coming clinical rotations. Residents become more comfortable regarding the use of radiation and counseling relevant questions such as a pregnant patient risk from a CE PE examination. Conclusion: A dedicated physics rotation, assisting with didactic lectures, may fulfill the requirements of physics of the new ABR core exam. It helps radiologists deeply understand the physics concepts and more efficiently use

Leadership and management skills of general practice nurses: experience or education?

Science.gov (United States)

Lau, Rosalind; Cross, Wendy; Moss, Cheryle; Campbell, Annie; De Castro, Magali; Oxley, Victoria

2014-12-01

A key finding of this qualitative exploratory descriptive study into advanced nursing for general practice nurses (Australian setting) revealed that participants viewed leadership and management as best learnt 'apprenticeship' style on the job by years of experience. Participants (48) comprised of general practice nurses, practice managers and general practitioners from metropolitan Melbourne were interviewed. Other findings demonstrated that the participants generally had limited awareness that postgraduate education can assist in the development of leadership and management in advanced nursing practice. The participants lacked clarity about professional competencies and generally did not connect these to leadership and management. Professional bodies need to take the opportunity to promote awareness of the national competency standards. All three groups of participants expressed hopes about the future provision of professional development opportunities and support by the Medicare Local for leadership and management aspirations within advanced practice nursing.

First-Year Students’ Initial Motivational Beliefs at University: Predicted by Motivational Beliefs Derived from Within and Out-of-School Experience and Malleable Regardless of the Extent of Students’ Out-of-School Experience

Directory of Open Access Journals (Sweden)

Julia Gorges

2017-07-01

school indicating revisions to them via experience. Multiple-group structural equation modeling showed no moderating effect of the extent of students’ out-of-school experience. The discussion focuses on interpretations of the expectancy-value theory that explicitly include motivational beliefs derived from out-of-school settings as antecedents of expectancy and value. With respect to practical implications, results are discussed in the light of student counseling and support to help students develop an adequate picture of a study program’s learning contents and overcome initial motivational setbacks.

Student agreement regarding adequacy of didactic content and practical experiences of vaccination clinic business operations.

Science.gov (United States)

George, David L; Johnson, Eric J; O'Neal, Katherine S; Smith, Michael J

2018-04-01

To report student perceived adequacy regarding didactic content and practical experiences of vaccination clinic business operations. Didactic content, a case study, and practical experiences regarding vaccination clinic business operations were implemented in related lectures of a Pharmacy Business and Entrepreneurship (PBE) elective and the college of pharmacy sponsored vaccination clinics. An online survey was used to evaluate student perceived adequacy of didactic content and practical experiences of vaccination clinic business operations. Mean scaled agreement was compared between students in the PBE elective versus those not in the elective. Student confidence in performing business operations was also assessed. Students in the PBE had higher mean confidence than non-elective students regarding staff management (3.23 vs. 2.73, p = 0.04). Success of the interventions may be attributed to students in the PBE elective that reported a higher mean perceived adequacy of content and practical experiences and confidence in performing nearly all business operations. Still, further evaluation of interventions is being considered to assess effectiveness of learning. Published by Elsevier Inc.

Practical experiences with granular activated carbon (GAC) at the ...

African Journals Online (AJOL)

Practical experiences with granular activated carbon (GAC) at the Rietvlei Water Treatment Plant. ... The porosity was found to be 0.69 for the 12 x 40 size carbon and 0.66 for the 8 x 30 size carbon. By using a ... The third part of the study measured the physical changes of the GAC found at different points in the GAC cycle.

Pacemaker diagnostics in atrial fibrillation: limited usefulness for therapy initiation in a pacemaker practice.

Science.gov (United States)

Yedlapati, Neeraja; Fisher, John D

2014-09-01

We aimed to determine the practical value of pacemaker diagnostics for atrial fibrillation (AF) in an unselected general pacemaker practice, specifically workflow and initiation of anticoagulation or antiarrhythmic drug (AAD) therapy. We prospectively followed consecutive pacemaker interrogations over a period of 1 year to identify patients with AF (burden from 1% to 99%). We contacted referring physicians with AF details, and then determined whether the information resulted in therapeutic changes. Of the 1,100 pacemakers interrogated, 728 were dual chamber (DDDs) with AF diagnostic capability. AF was recorded in 73 (10%) but seven had limited information, leaving 66 patients; of these, 42 (63%) patients were already anticoagulated and in five (7%) patients, anticoagulation had been stopped because of complications. Initial diagnosis of AF was made by the pacemaker in 17 patients (26% of 66; 2% of 728); four (6% of 66) patients were newly initiated on anticoagulation. Of the 66 patients, 17 patients were already on AADs; 49 (74%) had satisfactory rate control or had other issues; only two (3% of 66; 0.3% of 728) received new AADs. Of 728 patients with DDD pacemakers, only 17 were newly discovered to have AF, and six (0.8%) had changes in medications based on the pacemaker data. Adding pacemaker-derived data to existing clinical information had little therapeutic impact, due to a combination of cumbersome workflow, and because AF was usually known to practitioners. Developments in automated monitoring systems may provide more accessible and therapeutically useful information. ©2014 Wiley Periodicals, Inc.

Parental feeding practices in Mexican American families: initial test of an expanded measure

Science.gov (United States)

2013-01-01

Background Although obesity rates are high among Latino children, relatively few studies of parental feeding practices have examined Latino families as a separate group. Culturally-based approaches to measurement development can begin to identify parental feeding practices in specific cultural groups. This study used qualitative and quantitative methods to develop and test the Parental Feeding Practices (PFP) Questionnaire for use with Mexican American parents. Items reflected both parent’s use of control over child eating and child-centered feeding practices. Methods In the qualitative phase of the research, 35 Latino parents participated in focus groups. Items for the PFP were developed from focus group discussions, as well as adapted from existing parent feeding practice measures. Cognitive interviews were conducted with 37 adults to evaluate items. In the quantitative phase, mothers and fathers of 174 Mexican American children ages 8–10 completed the PFP and provided demographic information. Anthropometric measures were obtained on family members. Results Confirmatory factor analyses identified four parental feeding practice dimensions: positive involvement in child eating, pressure to eat, use of food to control behavior, and restriction of amount of food. Factorial invariance modeling suggested equivalent factor meaning and item response scaling across mothers and fathers. Mothers and fathers differed somewhat in their use of feeding practices. All four feeding practices were related to child body mass index (BMI) percentiles, for one or both parents. Mothers reporting more positive involvement had children with lower BMI percentiles. Parents using more pressure to eat had children with lower BMI percentiles, while parents using more restriction had children with higher BMI percentiles. Fathers using food to control behavior had children with lower BMI percentiles. Conclusions Results indicate good initial validity and reliability for the PFP. It can be

Parental feeding practices in Mexican American families: initial test of an expanded measure

Directory of Open Access Journals (Sweden)

Tschann Jeanne M

2013-01-01

Full Text Available Abstract Background Although obesity rates are high among Latino children, relatively few studies of parental feeding practices have examined Latino families as a separate group. Culturally-based approaches to measurement development can begin to identify parental feeding practices in specific cultural groups. This study used qualitative and quantitative methods to develop and test the Parental Feeding Practices (PFP Questionnaire for use with Mexican American parents. Items reflected both parent’s use of control over child eating and child-centered feeding practices. Methods In the qualitative phase of the research, 35 Latino parents participated in focus groups. Items for the PFP were developed from focus group discussions, as well as adapted from existing parent feeding practice measures. Cognitive interviews were conducted with 37 adults to evaluate items. In the quantitative phase, mothers and fathers of 174 Mexican American children ages 8–10 completed the PFP and provided demographic information. Anthropometric measures were obtained on family members. Results Confirmatory factor analyses identified four parental feeding practice dimensions: positive involvement in child eating, pressure to eat, use of food to control behavior, and restriction of amount of food. Factorial invariance modeling suggested equivalent factor meaning and item response scaling across mothers and fathers. Mothers and fathers differed somewhat in their use of feeding practices. All four feeding practices were related to child body mass index (BMI percentiles, for one or both parents. Mothers reporting more positive involvement had children with lower BMI percentiles. Parents using more pressure to eat had children with lower BMI percentiles, while parents using more restriction had children with higher BMI percentiles. Fathers using food to control behavior had children with lower BMI percentiles. Conclusions Results indicate good initial validity and

Family practice residents' maternity leave experiences and benefits.

Science.gov (United States)

Gjerdingen, D K; Chaloner, K M; Vanderscoff, J A

1995-09-01

A growing number of residents are having babies during residency training. While many businesses are working to improve maternity conditions and benefits for their employees, residency programs are often not prepared to accommodate pregnant residents. This study was conducted to examine the maternity leave experiences of women who delivered infants during their family practice residency training. Program directors from each of the 394 family practice residency programs listed in the 1993 Directory of Family Practice Residency Programs were asked to distribute surveys to female residents who gave birth during their residency training and had returned to work by the time of the study. Of 199 known eligible residents, 171 (86%) completed surveys; these women represented 127 programs located in 36 states and Puerto Rico. Only 56.8% of women were aware of their program having a written maternity leave policy. The average length of maternity leave was 8 weeks; 76% had leaves of 10 weeks or less. For many, the maternity leave was derived from more than one source, including vacation, sick time, or a mother-child elective. Nearly all (88.3%) the women breast-fed, and the mean duration of breast-feeding was more than 19 weeks. In general, participants believed that having a baby during residency was somewhat difficult. Problems frequently encountered by women after their return to work included sleep deprivation and tiredness, difficulty arranging for child care, guilt about child care, and breast-feeding. Factors that detracted most from the childbirth experience were too little sleep, problems arranging for child care, and lack of support from the partner, residency faculty, and other residents. Having a baby during residency is somewhat difficult for the average female resident. Factors that may ease this difficulty include getting adequate sleep and receiving support from one's partner, faculty, and other residents.

Prioritising integrated care initiatives on a national level. Experiences from Austria

Directory of Open Access Journals (Sweden)

Karin Eger

2009-09-01

Full Text Available Introduction and background: Based on a policy initiative and the foundation of the Competence Centre for Integrated Care by the Austrian Social Security Institutions in 2006, the aim of the project was to identify and prioritise potential diseases and target groups for which integrated care models should be developed and implemented within the Austrian health system. The project was conducted as a cooperation between the Competence Centre for Integrated Care of the Viennese Health Insurance Fund and the Institute of Social Medicine of the Medical University Vienna to ensure the involvement of both, theory and practice. Project report: The focus of the project was to develop an evidence-based process for the identification and prioritisation of diseases and target groups for integrated care measures. As there was no evidence of similar projects elsewhere, the team set out to design the prioritisation process and formulate the selection criteria based on the work in a focus group, literature reviews and a scientific council of national and international experts. The method and criteria were evaluated by an expert workshop. Discussion: The active involvement of all stakeholders from the beginning was crucial for the success. The time constraint proved also beneficial since it allowed the project team to demand focus and cooperation from all experts and stakeholders included. Conclusion: Our experience demonstrates that, with a clear concept and model, an evidence-based prioritisation including all stakeholders can be achieved. Ultimately however, the prioritisation is a political discussion and decision. Our model can only help base these decisions on sound and reasonable assumptions.

[Characterization of photochemical smog chamber and initial experiments].

Science.gov (United States)

Jia, Long; Xu, Yong-Fu; Shi, Yu-Zhen

2011-02-01

A self-made new indoor environmental chamber facility for the study of atmospheric processes leading to the formation of ozone and secondary organic aerosols has been introduced and characterized. The characterization experiments include the measurements of wall effects for reactive species and the determination of chamber dependent * OH radical sources by CO-NO(x) irradiation experiments. Preliminary ethene-NO(x) and benzene-NO(x) experiments were conducted as well. The results of characterization experiments show that the wall effects for O3 and NO2 in a new reactor are not obvious. Relative humidity has a great effect on the wall losses in the old reactor, especially for O3. In the old reactor, the rate constant for O3 wall losses is obtained to be 1.0 x 10(-5) s(-1) (RH = 5%) and 4.0 x10(-5) s(-1) (RH = 91%), whereas for NO2, it is 1.0 x 10(-6) s(-1) (RH = 5%) and 0.6 x 10(-6) s(-1) (RH = 75%). The value for k(NO2 --> HONO) determined by CO-NO(x) irradiation experiments is (4.2-5.2) x 10(-5) s(-1) and (2.3-2.5) x 10(-5) s(-1) at RH = 5% and RH 75% -77%, respectively. The average *OH concentration is estimated to be (2.1 +/- 0.4) x 10(6) molecules/cm3 by using a reaction rate coefficient of CO and * OH. The sensitivity of chamber dependent auxiliary reactions to the O3 formation is discussed. Results show that NO2 --> HONO has the greatest impact on the O3 formation during the initial stage, N2O5 + H2O --> 2HNO3 has a minus effect to maximum O3 concentration, and that the wall losses of both O3 and NO2 have little impact on the O3 formation. The results from the ethene-NO(x) and benzene-NO(x) experiments are in good agreement with those from the MCM simulation, which reflects that the facility for the study of the formation of secondary pollution of ozone and secondary organic aerosols is reliable. This demonstrates that our facility can be further used in the deep-going study of chemical processes in the atmosphere.

The Offering, Scheduling and Maintenance of Elective Advanced Pharmacy Practice Experiences

Directory of Open Access Journals (Sweden)

Rex O. Brown

2015-12-01

Full Text Available The Accreditation Council for Pharmacy Education (ACPE provides standards for colleges of pharmacy to assist in the provision of pharmacy education to student pharmacists. An integral part of all college educational programs includes the provision of experiential learning. Experiential learning allows students to gain real-world experience in direct patient care during completion of the curriculum. All college of pharmacy programs provide several Advanced Pharmacy Practice Experiences (APPEs, which include a balance between the four required experiences and a number of other required or elective APPEs. Required APPEs include advanced community, advanced institutional, ambulatory care, and general medicine. The elective APPEs include a myriad of opportunities to help provide a balanced education in experiential learning for student pharmacists. These unique opportunities help to expose student pharmacists to different career tracks that they may not have been able to experience otherwise. Not all colleges offer enough elective APPEs to enable the student pharmacist to obtain experiences in a defined area. Such an approach is required to produce skilled pharmacy graduates that are capable to enter practice in various settings. Elective APPEs are scheduled logically and are based upon student career interest and site availability. This article describes the offering, scheduling and maintenance of different elective APPEs offered by The University of Tennessee College of Pharmacy.

On the placement of practice questions during study.

Science.gov (United States)

Weinstein, Yana; Nunes, Ludmila D; Karpicke, Jeffrey D

2016-03-01

Retrieval practice improves retention of information on later tests. A question remains: When should retrieval occur during learning-interspersed throughout study or at the end of each study period? In a lab experiment, an online experiment, and a classroom study, we aimed to determine the ideal placement (interspersed vs. at-the-end) of retrieval practice questions. In the lab experiment, 64 subjects viewed slides about APA style and answered short-answer practice questions about the content or restudied the slides (restudy condition). The practice questions either appeared 1 every 1-2 slides (interspersed condition), or all at the end of the presentation (at-the-end condition). One week later, subjects returned and answered the same questions on a final test. In the online experiment, 175 subjects completed the same procedure. In the classroom study, 62 undergraduate students took quizzes as part of class lectures. Short-answer practice questions appeared either throughout the lectures (interspersed condition) or at the end of the lectures (at-the-end condition). Nineteen days after the last quiz, students were given a surprise final test. Results from the 3 experiments converge in demonstrating an advantage for interspersing practice questions on the initial tests, but an absence of this advantage on the final test. (c) 2016 APA, all rights reserved).

Student nurses' experiences of community-based practice placement learning: a qualitative exploration.

Science.gov (United States)

Baglin, M R; Rugg, Sue

2010-05-01

United Kingdom (UK) health policy has adopted an increasing community and primary care focus over recent years (Department of Health, 1997; Department of Health, 1999. Making a Difference: Strengthening the Nursing, Midwifery and Health Visitor Contribution to Health and Health Care. Department of Health, London; Department of Health, 2004. The NHS Knowledge and Skills Framework (NHS KSF). Department of Health, London). Nursing practice, education and workforce planning are called upon to adapt accordingly (Department of Health, 2004. The NHS Knowledge and Skills Framework (NHS KSF). Department of Health, London; Kenyon, V., Smith, E., Hefty, L., Bell, M., Martaus, T., 1990. Clinical competencies for community health nursing. Public Health Nursing 7(1), 33-39; United Kingdom Central Council for Nursing, Midwifery and Health Visiting, 1986. Project 2000: A New Preparation for Practice. UKCC, London). Such changes have major implications for pre-registration nursing education, including its practice placement element. From an educational perspective, the need for increased community nursing capacity must be balanced with adequate support for student nurses' learning needs during community-based placements. This qualitative study explored six second year student nurses' experiences of 12 week community-based practice placements and the extent to which these placements were seen to meet their perceived learning needs. The data came from contemporaneous reflective diaries, completed by participants to reflect their 'lived experience' during their practice placements (Landeen, J., Byrne, Brown, B., 1995. Exploring the lived experiences of psychiatric nursing students through self-reflective journals. Journal of Advanced Nursing 21(5), 878-885; Kok, J., Chabeli, M.M., 2002. Reflective journal writing: how it promotes reflective thinking in clinical nursing education: a students' perspective. Curationis 25(3), 35-42; Löfmark, A., Wikblad, K., 2001. Facilitating and

Open access and knowledge sharing: reflections on the Pathfinder projects and Open Access Good Practice initiative

Directory of Open Access Journals (Sweden)

Hannah DeGroff

2016-07-01

Full Text Available The following article provides a selection of reflections from a number of higher education institutions and their staff about participation in the UK-wide Pathfinder project scheme. These nine projects (comprising 30 institutions form the core of the Jisc-funded Open Access Good Practice initiative. They have produced a wide range of outputs which endorse and encourage best practice when implementing open access across institutions. Each project has a blog where progress and outputs can be tracked. Details are listed at the end of this article.

HIV testing and counseling: test providers' experiences of best practices.

Science.gov (United States)

Myers, Ted; Worthington, Catherine; Haubrich, Dennis J; Ryder, Karen; Calzavara, Liviana

2003-08-01

Although education is central to HIV testing and counseling, little is known about the educational processes within the testing experience. This study investigated test providers' understandings of testing and counseling best practices. Interviews with a purposive sample of 24 test providers were thematically analyzed. Analysis revealed five best practices specific to HIV education and public health--ensuring information and education for HIV risk reduction, individualization of risk assessment, ensuring test results are given in person, providing information and referrals, and facilitating partner notification--and six practices not specific to HIV counseling relationship building. The latter were building trust and rapport; maintaining professional boundaries; ensuring a comfortable, safe environment; ensuring confidentiality; imparting nonjudgmntal attitude; and self-determination. The identified best practices demonstrated remarkable consistency across respondent subgroups. Although counseling was seen as largely educational and with a preventive focus, it included individualized messages based on assessments of risk, knowledge, and social and cultural characteristics.

Initiation of traditional birth attendants and their traditional and spiritual practices during pregnancy and childbirth in Ghana.

Science.gov (United States)

Aziato, Lydia; Omenyo, Cephas N

2018-03-07

Prior to the advent of modern obstetric services, traditional birth attendants (TBAs) have rendered services to pregnant women and women in labour for a long time. Although it is anticipated that women in contemporary societies will give birth in hospitals and clinics, some women still patronize the services of TBAs. The study therefore sought to gain an in-depth understanding of the initiation of TBAs and their traditional and spiritual practices employed during pregnancy and childbirth in Ghana. The design was an exploratory qualitative one using in-depth individual interviews. Data saturation was reached with 16 participants who were all of Christian faith. Interviews were conducted with a semi-structured interview guide, audiotaped and transcribed verbatim. Content analysis was employed to generate findings. The findings showed that TBAs were initiated through apprenticeship from family members who were TBAs and other non-family TBAs as well as through dreams and revelations. They practice using both spiritual and physical methods and their work was founded on spiritual directions, use of spiritual artefacts, herbs and physical examination. TBAs delay cutting of the cord and disposal of the placenta was associated with beliefs which indicated that when not properly disposed, it will have negative consequences on the child during adulthood. Although, TBAs like maternal health professionals operate to improve maternal health care, some of their spiritual practices and beliefs may pose threats to their clients. Nonetheless, with appropriate initiation and training, they can become useful.

Experience of Initial Symptoms of Breast Cancer and Triggers for Action in Ethiopia

International Nuclear Information System (INIS)

Dye, T.D.; Hobden, C.; Reeler, A.; Dye, T.D.; Bogale, S.; Tilahun, Y.; Deressa, T.

2012-01-01

Objective. This study assessed the initial experiences, symptoms, and actions of patients in Ethiopia ultimately determined to have breast cancer. Methods. 69 participants in a comprehensive breast cancer treatment program at the main national cancer hospital in Ethiopia were interviewed using mixed qualitative and quantitative approaches. Participants narratives of their initial cancer experience were coded and analyzed for themes around their symptoms, time to seeking advice, triggers for action, and contextual factors. The assessment was approved by the Addis Ababa University Faculty of Medicine Institutional Review Board. Results. Nearly all women first noticed lumps, though few sought medical advice within the first year (average time to action: 1.5 years). Eventually, changes in their symptoms motivated most participants to seek advice. Most participants did not think the initial lump would be cancer, nor was a lump of any particular concern until symptoms changed. Conclusion. Given the frequency with which lumps are the first symptom noticed, raising awareness among participants that lumps should trigger medical consultation could contribute significantly to more rapid medical advice-seeking among women in Ethiopia. Primary care sites should be trained and equipped to offer evaluation of lumps so that women can be referred appropriately for assessment if needed

Practical Applications and Experiences in K-20 Blended Learning Environments

Science.gov (United States)

Kyei-Blankson, Lydia, Ed.; Ntuli, Esther, Ed.

2014-01-01

Learning environments continue to change considerably and is no longer confined to the face-to-face classroom setting. As learning options have evolved, educators must adopt a variety of pedagogical strategies and innovative technologies to enable learning. "Practical Applications and Experiences in K-20 Blended Learning Environments"…

Wind and Solar Energy Curtailment: Experience and Practices in the United States

Energy Technology Data Exchange (ETDEWEB)

Bird, Lori [National Renewable Energy Lab. (NREL), Golden, CO (United States); Cochran, Jaquelin [National Renewable Energy Lab. (NREL), Golden, CO (United States); Wang, Xi [National Renewable Energy Lab. (NREL), Golden, CO (United States)

2014-03-01

This report examines U.S. curtailment practices, with a particular emphasis on utilities in the Western states. The information presented here is based on a series of interviews conducted with utilities, system operators, wind energy developers, and non-governmental organizations. The report provides case studies of curtailment experience and examines the reasons for curtailment, curtailment procedures, compensation, and practices that can minimize curtailment.

Initiation of non-invasive ventilation in amyotrophic lateral sclerosis and clinical practice guidelines: Single-centre, retrospective, descriptive study in a national reference centre.

Science.gov (United States)

Georges, Marjolaine; Golmard, Jean-Louis; Llontop, Claudia; Shoukri, Amr; Salachas, François; Similowski, Thomas; Morelot-Panzini, Capucine; Gonzalez-Bermejo, Jésus

2017-02-01

In amyotrophic lateral sclerosis (ALS), respiratory muscle weakness leads to respiratory failure. Non-invasive ventilation (NIV) maintains adequate ventilation in ALS patients. NIV alleviates symptoms and improves survival. In 2006, French guidelines established criteria for NIV initiation based on limited evidence. Their impact on clinical practice remains unknown. Our objective was to describe NIV initiation practices of the main French ALS tertiary referral centre with respect to guidelines. In this retrospective descriptive study, 624 patients followed in a single national reference centre began NIV between 2005 and 2013. We analysed criteria used to initiate NIV, including symptoms, PaCO 2 , forced vital capacity, maximal inspiratory pressures and time spent with SpO 2 NIV initiation, 90% of patients were symptomatic. Median PaCO 2 was 48 mmHg. The main criterion to initiate NIV was 'symptoms' followed by 'hypercapnia' in 42% and 34% of cases, respectively. NIV was initiated on functional parameters in only 5% of cases. Guidelines were followed in 81% of cases. In conclusion, despite compliance with French guidelines, the majority of patients are treated at the stage of symptomatic daytime hypoventilation, which suggests that NIV is initiated late in the course of ALS. Whether this practice could be improved by changing guidelines or increasing respiratory-dedicated resources remains to be determined.

[Initiation, promotion, initiation experiments with radon and cigarette smoke: Lung tumors in rats]. Progress report

International Nuclear Information System (INIS)

Moolgavkar, S.H.

1994-01-01

During the past several years, the authors have made considerable progress in modeling carcinogenesis in general, and in modeling radiation carcinogenesis, in particular. They present an overview of their progress in developing stochastic carcinogenesis models and applying them to experimental and epidemiologic data sets. Traditionally, cancer models have been used for the analysis of incidence (or prevalence) data in epidemiology and time to tumor data in experimental studies. The relevant quantities for the analysis of these data are the hazard function and the probability of tumor. The derivation of these quantities is briefly described here. More recently, the authors began to use these models for the analysis of data on intermediate lesions on the pathway to cancer. Such data are available in experimental carcinogenesis studies, in particular in initiation and promotion studies on the mouse skin and the rat liver. If however, quantitative information on intermediate lesions on the pathway to lung cancer were to be come available at some future date, the methods that they have developed for the analysis of initiation-promotion experiments could easily be applied to the analysis of these lesions. The mathematical derivations here are couched in terms of a particular two-mutation model of carcinogenesis. Extension to models postulating more than two mutations is not always straightforward

Documenting Student Engagement Using an Intention/Reflection Exercise during an Advanced Pharmacy Practice Experience

Science.gov (United States)

Fierke, Kerry K.; Lepp, Gardner A.

2015-01-01

The article shares the outcomes of a practice called Intention/Reflection (I/R) when applied to a group of ten students in a five-week course involving an international advanced pharmacy practice experience. Developed by the authors and founded on a combination of theoretical principles, this practice is unique because of the blend of formative…

Experience of Military Nurse Practitioners During their First Year of Practice

Science.gov (United States)

2000-05-01

Manen , 1990). Lived body refers to the phenomenological fact that we are always bodily in the world. Van Manen writes, in our physical or bodily...experience as it is lived. Phenomenology focuses on gaining a deeper understanding of the meaning of our everyday experiences ( Van Manen , 1990). The...preceptor stories, patients and practice, and looking toward the future. The data was related to Van Manen s four existential themes. This study is

Management support to e-business initiatives: The Croatian experience

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Mario Spremić

2003-01-01

Full Text Available After defining e-business and explaining why an evolutionary aspect of moving to e-business is required, the dimensions of e-business is defined with respect to differences between traditional business, partial, or pure e-business. Also, a model for moving to e-business is illustrated. The e-business evolving model is divided into six stages and represents an evolutionary aspect of migrating to e-business. Finally, the results of the research study on current practices in evolving e-business in the most successful Croatian companies are given. In this research, some aspects of business process innovation and e-business usage have been investigated (general e-business issues with levels of e-business usage, key objectives of participating in e-business, alignment of business strategy with e-business initiatives, initiation of e-business projects and e-business planning issues, especially e-business funding. The questionnaire was sent to 400 CEOs or CIOs in Croatian companies selected from the Register of the ‘400 Biggest’ Croatian companies which were ranked according to their 2001 annual revenue and which were most likely to represent the structure of the Croatian economy. Although they represent less than 1% of the total number of registered companies in Croatia, the sampled companies hold 73% of the equity capital of the whole Croatian economy, they contribute with 65% in the total Croatian economy’s export balance and they employ 37% of the total number of people employed in Croatia.

The lesser evil? Initiating a benzodiazepine prescription in general practice

Science.gov (United States)

Anthierens, Sibyl; Habraken, Hilde; Petrovic, Mirko; Christiaens, Thierry

2007-01-01

Objective Chronic benzodiazepine (BZD) use is widespread and linked with adverse effects. There is consensus concerning the importance of initiating BZD as a crucial moment. Nevertheless specific research in this field is lacking. This paper addresses the views of GPs on why they start prescribing BZDs to first-time users. Design Qualitative study with five focus groups analysed using a systematic content analysis. Setting Regions of Ghent and Brussels in Belgium. Subjects A total of 35 general practitioners. Main outcome measure The GPs’ perspective on their initiating of BZD prescribing. Results GPs reported that they are cautious in initiating BZD usage. At the same time, GPs feel overwhelmed by the psychosocial problems of their patients. They show empathy by prescribing. They feel in certain situations there are no other solutions and they experience BZDs as the lesser evil. They admit to resorting to BZDs because of time restraint and lack of alternatives. GPs do not perceive the addictive nature of BZD consumption as a problem with first-time users. GPs do not specifically mention patients’ demand as an element for starting. Conclusion The main concern of GPs is to help the patient. GPs should be aware of the addictive nature of BZD even in low doses and a non-pharmacological approach should be seen as the best first approach. If GPs decide to prescribe a BZD they should make plain to the patient that the medication is only a “temporary” solution with clear agreements with regard to medication withdrawal. PMID:18041658

Beliefs, practices, and experiences of Korean women in relation to childbirth.

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Park, K J; Peterson, L M

1991-01-01

Korean women's health beliefs and childbirth experiences in the United States were examined. A convenience sampling procedure was used, and face-to-face interviews were conducted in Korean. Interviews were audiotaped, typed, and translated from Korean to English. These women had a holistic concept of health. Some practices were influence by ancient Chinese medicine. Childbirth experiences indicated that language is a barrier requiring specific interventions. Recommendations include (a) development of an assessment tool with which health-care professionals can identify individual health beliefs early in pregnancy; (b) development of a bilingual pamphlet about medical terms and the U.S. health-care system; (c) development of a short bilingual dictionary of common foods for use in menu selection during hospitalization; and (d) provision of English practice periods based on anticipatory guidance principles to prepare women to ask for specific assistance.

Initiation process of a thrust fault revealed by analog experiments

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Yamada, Yasuhiro; Dotare, Tatsuya; Adam, Juergen; Hori, Takane; Sakaguchi, Hide

2016-04-01

We conducted 2D (cross-sectional) analog experiments with dry sand using a high resolution digital image correlation (DIC) technique to reveal initiation process of a thrust fault in detail, and identified a number of "weak shear bands" and minor uplift prior to the thrust initiation. The observations suggest that the process can be divided into three stages. Stage 1: characterized by a series of abrupt and short-lived weak shear bands at the location where the thrust will be generated later. Before initiation of the fault, the area to be the hanging wall starts to uplift. Stage 2: defined by the generation of the new thrust and its active displacement. The location of the new thrust seems to be constrained by its associated back-thrust, produced at the foot of the surface slope (by the previous thrust). The activity of the previous thrust turns to zero once the new thrust is generated, but the timing of these two events is not the same. Stage 3: characterized by a constant displacement along the (new) thrust. Similar minor shear bands can be seen in the toe area of the Nankai accretionary prism, SW Japan and we can correlate the along-strike variations in seismic profiles to the model results that show the characteristic features in each thrust development stage.

An investigation of nurse educator's perceptions and experiences of undertaking clinical practice.

Science.gov (United States)

Williams, Angela; Taylor, Cathy

2008-11-01

Educational policy (DOH, 1999. Making a difference: strengthening the nursing, midwifery and health visiting contribution to health and healthcare. Department of Health, London; UKCC, 1999. Fitness for Practice. United Kingdom Central Council for Nursing, Midwifery and Health Visiting, London; Nursing and Midwifery Council, 2006. Standards to support learning and assessment in practice. Nursing and Midwifery Council, London) and current nursing literature (Griscti, O., Jacono, B., Jacono, J., 2005. The nurse educator's clinical role. Journal of Advanced Nursing 50 (1), 84-92; Owen, S., Ferguson, K., Baguley, I., 2005. The clinical activity of mental health nurse lecturers. Journal of Psychiatric and Mental Health Nursing 12, 310-316), place increasing emphasis on nurse educators undertaking clinical practice to facilitate their clinical confidence and competence. This study investigated nurse educators' perceptions and experiences of undertaking clinical practice. A qualitative design and descriptive, exploratory approach were used. A purposive sample of 11 nurse educators in one nursing department, took part in two focus group interviews, one with 5 and the other with 6 respondents, to identify and discuss their perceptions and experiences of undertaking clinical practice. A process of thematic content analysis revealed three broad themes relating to the meaning and importance of clinical practice, perceived benefits and barriers which are examined and discussed. The paper concludes that despite policy recommendations, barriers highlighted in this study such as insufficient time, heavy workload and a lack of valuing of the clinical role have been raised over the past few decades. The effect of undertaking clinical practice, particularly on the quality of teaching is argued to be valuable armoury in the battle to secure sufficient resources to support engagement in clinical practice. Financial and organisational commitment; valuing of clinical practice and research

Practical experience in spent fuel management for German nuclear power plants

International Nuclear Information System (INIS)

Althaus, D.; Luehrmann, A.; Seepolt, R.; Springer, K.

1999-01-01

The paper describes the practical experience in spent fuel management gained in the past by using the traditional route of reprocessing and, since the amendment to the Atomic Law in 1994, by using also direct disposal via interim storage. (author)

Initial experience in hybrid PET-MRI for evaluation of refractory focal onset epilepsy.

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Shin, Hae W; Jewells, Valerie; Sheikh, Arif; Zhang, Jingwen; Zhu, Hongtu; An, Hongyu; Gao, Wei; Shen, Dinggang; Hadar, Eldad; Lin, Weili

2015-09-01

We aim to evaluate the utility/improved accuracy of hybrid PET/MR compared to current practice separate 3T MRI and PET-CT imaging for localization of seizure foci. In a pilot study, twenty-nine patients undergoing epilepsy surgery evaluation were imaged using PET/MR. This subject group had 29 previous clinical 3T MRI as well as 12 PET-CT studies. Prior clinical PET and MR images were read sequentially while the hybrid PET/MR was concurrently read. The median interval between hybrid PET/MR and prior imaging studies was 5 months (range 1-77 months). In 24 patients, there was no change in the read between the clinical exams and hybrid PET/MR while new anatomical or functional lesions were identified by hybrid PET/MR in 5 patients without significant clinical change. Four new anatomical MR lesions were seen with concordant PET findings. The remaining patient revealed a new abnormal PET lesion without an MR abnormality. All new PET/MR lesions were clinically significant with concordant EEG and/or SPECT results as potential epileptic foci. Our initial hybrid PET-MRI experience increased diagnostic yields for detection of potential epileptic lesions. This may be due to the unique advantage of improved co-registration and simultaneous review of both structural and functional data. Copyright © 2015 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.

Building clinicians-researchers partnerships: lessons from diverse natural settings and practice-oriented initiatives.

Science.gov (United States)

Castonguay, Louis G; Youn, Soo Jeong; Xiao, Henry; Muran, J Christopher; Barber, Jacques P

2015-01-01

In this concluding paper, we identify the type of studies conducted by 11 teams of contributors to a special issue on building clinicians-researchers partnerships. Those studies were conducted across a variety of clinical settings. We also integrate the lessons that have emerged from their collaborative initiatives in terms of obstacles faced, strategies adopted to address these challenges, benefits gained, and general recommendations offered to facilitate studies conducted with or by clinicians. The paper ends with the authors' thoughts about the future success of practice-oriented research in general.

The Experience of Evidence-Based Practice in an Australian Public Library: An Ethnography

Science.gov (United States)

Gillespie, Ann; Partridge, Helen; Bruce, Christine; Howlett, Alisa

2016-01-01

Introduction: This paper presents the findings from a project that investigated the lived experiences of library and information professionals in relation to evidence-based practice within an Australian public library. Method: The project employed ethnography, which allows holistic description of people's experiences within a particular community…

SPINAL CORD STIMULATION IN TREATMENT OF THE NEUROPATHIC PAIN SYNDROMES: INITIAL EXPERIENCE

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D. A. Rzaev

2010-01-01

Full Text Available In the article initial experience of spinal cord stimulation for chronic pain syndromes is described. The trial was done for 62 patients, in 52 cases trial was successful and subcutaneous pulse generator were implanated. Maximal follow-up is 26 months. The level of pain evaluates at VAS. Permanent pain-relieve results were achieved in 46 patients (74,2%. These results correspond to literature data.

40 CFR Table 38 to Subpart Uuu of... - Initial Compliance With Work Practice Standards for HAP Emissions From Bypass Lines

Science.gov (United States)

2010-07-01

... 40 Protection of Environment 12 2010-07-01 2010-07-01 true Initial Compliance With Work Practice... Pollutants for Petroleum Refineries: Catalytic Cracking Units, Catalytic Reforming Units, and Sulfur Recovery Units Pt. 63, Subpt. UUU, Table 38 Table 38 to Subpart UUU of Part 63—Initial Compliance With Work...

The experience of initiating injection drug use and its social context: a qualitative systematic review and thematic synthesis.

Science.gov (United States)

Guise, Andy; Horyniak, Danielle; Melo, Jason; McNeil, Ryan; Werb, Dan

2017-12-01

Understanding the experience of initiating injection drug use and its social contexts is crucial to inform efforts to prevent transitions into this mode of drug consumption and support harm reduction. We reviewed and synthesized existing qualitative scientific literature systematically to identify the socio-structural contexts for, and experiences of, the initiation of injection drug use. We searched six databases (Medline, Embase, PsychINFO, CINAHL, IBSS and SSCI) systematically, along with a manual search, including key journals and subject experts. Peer-reviewed studies were included if they qualitatively explored experiences of or socio-structural contexts for injection drug use initiation. A thematic synthesis approach was used to identify descriptive and analytical themes throughout studies. From 1731 initial results, 41 studies reporting data from 1996 participants were included. We developed eight descriptive themes and two analytical (higher-order) themes. The first analytical theme focused on injecting initiation resulting from a social process enabled and constrained by socio-structural factors: social networks and individual interactions, socialization into drug-using identities and choices enabled and constrained by social context all combine to produce processes of injection initiation. The second analytical theme addressed pathways that explore varying meanings attached to injection initiation and how they link to social context: seeking pleasure, responses to increasing tolerance to drugs, securing belonging and identity and coping with pain and trauma. Qualitative research shows that injection drug use initiation has varying and distinct meanings for individuals involved and is a dynamic process shaped by social and structural factors. Interventions should therefore respond to the socio-structural influences on injecting drug use initiation by seeking to modify the contexts for initiation, rather than solely prioritizing the reduction of individual

Initial experiment of focusing wiggler of MM wave Free Electron Laser on LAX-1

International Nuclear Information System (INIS)

Sakamoto, Keishi; Maebara, Sunao; Watanabe, Akihiko; Kishimoto, Yasuaki; Nagashima, Takashi; Maeda, Hikosuke; Shiho, Makoto; Oda, Hisako; Kawasaki, Sunao.

1991-03-01

Initial results of Free Electron laser (FEL) Experiment in the mm wave region are presented. The experiment is carried out using a induction linac system (LAX-1: Large current Accelerator Experiment) of E b = 1 MeV, Ib = 1 ∼ 3 kA. The wiggler of FEL is composed of the curved surface magnets arrays (focusing wiggler), which is found to be effective for a transport of low energy and high current beam through the wiggler. The superradiance of the mm wave region (30 GHz ∼ 40 GHz) is observed. The growth rate of this radiation is 0.42 dB/cm. (author)

Does Experience Rating Improve Obstetric Practices?

DEFF Research Database (Denmark)

Amaral-Garcia, Sofia; Bertoli, Paola; Grembi, Veronica

2015-01-01

is associated with a decrease in the probability of performing a C-section from 2.3 to 3.7 percentage points (7–11.6%) with no consequences for medical complications or neonatal outcomes. The impact can be explained by a reduction in the discretion of obstetric decision-making rather than by patient cream......Using inpatient discharge records from the Italian region of Piedmont, we estimate the impact of an increase in malpractice pressure brought about by experience-rated liability insurance on obstetric practices. Our identification strategy exploits the exogenous location of public hospitals in court...... districts with and without schedules for noneconomic damages. We perform difference-in-differences analysis on the entire sample and on a subsample which only considers the nearest hospitals in the neighborhood of court district boundaries. We find that the increase in medical malpractice pressure...

Medical Home Implementation Gaps for Seniors: Perceptions and Experiences of Primary Care Medical Practices.

Science.gov (United States)

Hoff, Timothy; DePuccio, Matthew

2018-07-01

The study objective was to better understand specific implementation gaps for various aspects of patient-centered medical home (PCMH) care delivered to seniors. The study illuminates the physician and staff experience by focusing on how individuals make sense of and respond behaviorally to aspects of PCMH implementation. Qualitative data from 51 in-depth, semi-structured interviews across six different National Committee for Quality Assurance (NCQA)-accredited primary care practices were collected and analyzed. Physicians and staff identified PCMH implementation gaps for their seniors: (a) performing in-depth clinical assessments, (b) identifying seniors' life needs and linking them with community resources, and (c) care management and coordination, in particular self-management support for seniors. Prior experiences trying to perform these aspects of PCMH care for older adults produced collective understandings that led to inaction and avoidance by medical practices around the first two gaps, and proactive behavior that took strategic advantage of external incentives for addressing the third gap. Greater understanding of physician and staff's PCMH implementation experiences, and the learning that accumulates from these experiences, allows for a deeper understanding of how primary care practices choose to enact the medical home model for seniors on an everyday basis.

[Differences in practice among physicians staffing an emergency department in relation to years of experience].

Science.gov (United States)

Busca, Pablo; Inchaurza, Estibaliz; Illarramendi, Aiora; Urbina, Ohiana; González, Laura; Miró, Òscar

2015-06-01

To determine differences in certain variables reflecting clinical practice in a group of emergency physicians with varying levels of experience and to explore whether differences are associated with experience. Retrospective observational study of differences in variables reflecting emergency physicians' practice between 2005 and 2012. We studied work variables (months worked, patients treated, caseload distribution according to triage levels), patient management variables (consultation with other specialists, admissions, ambulance requests), diagnostic procedures ordered (simple radiographs, laboratory tests, ultrasound or computed tomography imaging), and time patients discharged home spent in the department (arrival to discharge). We explored relationships between these variables and the emergency physician's experience using linear regression analysis, followed by the construction of multivariable models to adjust for physician characteristics. Data for 50 emergency medicine physicians, in 291 years of work, were analyzed. The specialists' experience ranged from 1 to 22 years (mean [SD], 9.5 [5.8] years). They attended between 47 and 158 patients monthly (mean, 86 [19] patients). The physicians' experience was inversely and independently related to the mean number of patients attended monthly and the percentage of patients assigned a triage level of 1 or 2. Experience was directly and independently related to discharged patients' time spent in the emergency department and number of simple radiographs ordered. All associations were small (R2<0.010), however. Those variables continued to show statistically significant associations after increasingly complex modeling to adjust for the following physician variables: physician, age, sex, specialty, residency training in the same hospital). The practice of emergency physicians with more accumulated experience shows slight but significant differences from the practice of less experienced physicians.

The experience of being a member of the Student International Community of Practice: a collaborative reflection

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Brighide M. Lynch

2015-05-01

Full Text Available Background: In 2010 a community of practice was set up for and by doctoral students engaged in person-centred and practitioner research. After three years, this community became part of a larger international community of practice. Aims and objectives: Captured under the stanzas of a poem and supported by the literature, this paper uses member narratives and creative expressions in a critical reflection on the experience of being a member of the Student International Community of Practice. Conclusions: Membership in the community of practice was experienced as beneficial, providing both support and challenge to enrich the doctoral students’ development as person-centred researchers. Retaining connectivity across an international landscape and finding effective ways to integrate new members into the community presented the greatest challenges. Implications for practice development: • The theoretical foundation and experiential knowledge could assist others considering support structures for the development of person-centred practices • Shared learning and co-creation of knowledge add value to the experience of being a doctoral researcher • Membership fluctuations present challenges to continuity of learning and the maintenance of a safe space with communities of practice. Such fluctuations, however, create chances for community members to experience diverse roles within the group and encourage explicit attention to person-centredness

Technologies for adaptation. Perspectives and practical experiences; Climate change

Energy Technology Data Exchange (ETDEWEB)

Christiansen, Lars; Olhoff, A; Traerup, S

2011-11-15

The present report is the second volume of the UNEP Risoe Centre Technology Transfer Perspectives Series. The report is related to the global Technology Needs Assessment (TNA) project, financed by the Global Environment Facility (GEF) and implemented by UNEP Risoe Centre. The nine articles in this volume discuss issues like: a) the concepts and context of technologies for adaptation; b) assessments of adaptation technology needs; c) practical experiences from working with technologies for adaptation. (LN)

Applying thematic analysis theory to practice: a researcher's experience.

Science.gov (United States)

Tuckett, Anthony G

2005-01-01

This article describes an experience of thematic analysis. In order to answer the question 'What does analysis look like in practice?' it describes in brief how the methodology of grounded theory, the epistemology of social constructionism, and the theoretical stance of symbolic interactionism inform analysis. Additionally, analysis is examined by evidencing the systematic processes--here termed organising, coding, writing, theorising, and reading--that led the researcher to develop a final thematic schema.

Paramedics' experiences of financial medicine practices in the pre-hospital environment. A pilot study

Directory of Open Access Journals (Sweden)

Craig Vincent-Lambert

2016-10-01

Objectives: This qualitative pilot study explored and described the experiences of South African Paramedics with regard to the practicing of financial medicine in the local pre-hospital emergency care environment. Method: A sample of South African Paramedics were interviewed either face-to-face or telephonically. The interviews were audio recorded and transcripts produced. Content analysis was conducted to explore, document and describe the participants' experiences with regard to financial medicine practices in the local pre-hospital environment. Results: It emerged that all of the participants had experienced a number of financial medicine practices and associated unethical conduct. Examples included Over-servicing, Selective Patient Treatment, Fraudulent Billing Practices, Eliciting of kickbacks, incentives or benefits and Deliberate Time Wasting. Conclusion: The results of this study are concerning as the actions of service providers described by the participants constitute gross violations of the ethical and professional guidelines for health care professionals. The authors recommend additional studies be conducted to further explore these findings and to establish the reasons for, and ways of, limiting financial medicine practices in the South African emergency care environment.

Patients' Experiences of Performing Self-care of Stomas in the Initial Postoperative Period.

Science.gov (United States)

Lim, Siew Hoon; Chan, Sally Wai Chi; He, Hong-Gu

2015-01-01

With the loss of an important bodily function and the distortion in body image, a stoma patient experiences physical, psychological, and social changes. With limited current studies exploring experiences of patients in the management of their stoma, there is a need to explore their experiences, their needs, and factors that influence their self-management. The aim of this study was to investigate patients' experiences of performing self-care of stomas in the initial postoperative period. This study adopted a descriptive qualitative approach from the interpretive paradigm. Semistructured interviews were conducted with 12 patients 1 month postoperatively in a colorectal ward in a hospital in Singapore. Thematic analysis was applied to the interview data. Five themes were identified: process of acceptance and self-management of stoma, physical limitations, psychological reactions, social support, and need for timely and sufficient stoma preparation and education. This study highlights the importance of health professionals' role in helping patients adjust preoperatively and postoperatively and accept the presence of a stoma. Health professionals need to be aware of the physical, psychological, and social impact of stoma on patients in the initial 30-day postoperative period. Research findings informed the type and level of assistance and support to be offered to patients by nurses and the importance of encouraging patients to be involved in stoma care at an early stage, which will ultimately contribute to effective and independent self-management. Patients can be prepared preoperatively to reduce the psychological and social impact of stoma after creation of their stoma.

Prostate brachytherapy in Ghana: our initial experience

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James Edward Mensah

2016-10-01

Full Text Available Purpose: This study presents the experience of a brachytherapy team in Ghana with a focus on technology transfer and outcome. The team was initially proctored by experienced physicians from Europe and South Africa. Material and methods : A total of 90 consecutive patients underwent either brachytherapy alone or brachytherapy in combination with external beam radiotherapy for prostate carcinoma between July 2008 and February 2014 at Korle Bu Teaching Hospital, Accra, Ghana. Patients were classified as low-risk, intermediate, and high-risk according to the National Comprehensive Cancer Network (NCCN criteria. All low-risk and some intermediate risk group patients were treated with seed implantation alone. Some intermediate and all high-risk group patients received brachytherapy combined with external beam radiotherapy. Results: The median patient age was 64.0 years (range 46-78 years. The median follow-up was 58 months (range 18-74 months. Twelve patients experienced biochemical failure including one patient who had evidence of metastatic disease and died of prostate cancer. Freedom from biochemical failure rates for low, intermediate, and high-risk cases were 95.4%, 90.9%, and 70.8%, respectively. Clinical parameters predictive of biochemical outcome included: clinical stage, Gleason score, and risk group. Pre-treatment prostate specific antigen (PSA was not a statistically significant predictor of biochemical failure. Sixty-nine patients (76.6% experienced grade 1 urinary symptoms in the form of frequency, urgency, and poor stream. These symptoms were mostly self-limiting. Four patients needed catheterization for urinary retention (grade 2. One patient developed a recto urethral fistula (grade 3 following banding for hemorrhoids. Conclusions : Our results compare favorably with those reported by other institutions with more extensive experience. We believe therefore that, interstitial permanent brachytherapy can be safely and effectively

Assertiveness levels of nursing students who experience verbal violence during practical training.

Science.gov (United States)

Unal, Sati; Hisar, Filiz; Görgülü, Ulkü

2012-08-01

The aim of the study was to investigate students' verbal violence experiences, the effect of assertiveness on being subjected to violence, the behaviour of students after the violence and the experience of psychological distress during practical training. The study sample consisted of 274 students attending a school of nursing. A questionnaire form and the Rathus Assertiveness Schedule (RAS) were used for data collection. Percentages, means and the independent samples t-test were used for the evaluation of data. During practical training, the students suffered verbal violence from teachers, department nurses and doctors. The students had higher mean scores of RAS for most types of violence committed by the teachers and being reprimanded by the nurses and 69.3% had not responded to the violence. Students with a high level of assertiveness are subjected to violence more frequently. Being subjected to verbal violence and feeling psychological distress during practical training are a major problem among nursing students. Students should be supported in terms of assertiveness and dealing with violence effectively.

Comparison of Quality Oncology Practice Initiative (QOPI) Measure Adherence Between Oncology Fellows, Advanced Practice Providers, and Attending Physicians.

Science.gov (United States)

Zhu, Jason; Zhang, Tian; Shah, Radhika; Kamal, Arif H; Kelley, Michael J

2015-12-01

Quality improvement measures are uniformly applied to all oncology providers, regardless of their roles. Little is known about differences in adherence to these measures between oncology fellows, advance practice providers (APP), and attending physicians. We investigated conformance across Quality Oncology Practice Initiative (QOPI) measures for oncology fellows, advance practice providers, and attending physicians at the Durham Veterans Affairs Medical Center (DVAMC). Using data collected from the Spring 2012 and 2013 QOPI cycles, we abstracted charts of patients and separated them based on their primary provider. Descriptive statistics and the chi-square test were calculated for each QOPI measure between fellows, advanced practice providers (APPs), and attending physicians. A total of 169 patients were reviewed. Of these, 31 patients had a fellow, 39 had an APP, and 99 had an attending as their primary oncology provider. Fellows and attending physicians performed similarly on 90 of 94 QOPI metrics. High-performing metrics included several core QOPI measures including documenting consent for chemotherapy, recommending adjuvant chemotherapy when appropriate, and prescribing serotonin antagonists when prescribing emetogenic chemotherapies. Low-performing metrics included documentation of treatment summary and taking action to address problems with emotional well-being by the second office visit. Attendings documented the plan for oral chemotherapy more often (92 vs. 63%, P=0.049). However, after the chart audit, we found that fellows actually documented the plan for oral chemotherapy 88% of the time (p=0.73). APPs and attendings performed similarly on 88 of 90 QOPI measures. The quality of oncology care tends to be similar between attendings and fellows overall; some of the significant differences do not remain significant after a second manual chart review, highlighting that the use of manual data collection for QOPI analysis is an imperfect system, and there may

Initial Scaling Studies and Conceptual Thermal Fluids Experiments for the Prismatic NGNP Point Design

Energy Technology Data Exchange (ETDEWEB)

D. M. McEligot; G. E. McCreery

2004-09-01

The objective of this report is to document the initial high temperature gas reactor scaling studies and conceptual experiment design for gas flow and heat transfer. The general approach of the project is to develop new benchmark experiments for assessment in parallel with CFD and coupled CFD/ATHENA/RELAP5-3D calculations for the same geometry. Two aspects of the complex flow in an NGNP are being addressed: (1) flow and thermal mixing in the lower plenum ("hot streaking" issue) and (2) turbulence and resulting temperature distributions in reactor cooling channels ("hot channel" issue). Current prismatic NGNP concepts are being examined to identify their proposed flow conditions and geometries over the range from normal operation to decay heat removal in a pressurized cooldown. Approximate analyses are being applied to determine key non-dimensional parameters and their magnitudes over this operating range. For normal operation, the flow in the coolant channels can be considered to be dominant forced convection with slight transverse property variation. The flow in the lower plenum can locally be considered to be a situation of multiple buoyant jets into a confined density-stratified crossflow -- with obstructions. Experiments are needed for the combined features of the lower plenum flows. Missing from the typical jet experiments are interactions with nearby circular posts and with vertical posts in the vicinity of vertical walls - with near stagnant surroundings at one extreme and significant crossflow at the other. Two heat transfer experiments are being considered. One addresses the "hot channel" problem, if necessary. The second experiment will treat heated jets entering a model plenum. Unheated MIR (Matched-Index-of-Refraction) experiments are first steps when the geometry is complicated. One does not want to use a computational technique which will not even handle constant properties properly. The MIR experiment will simulate flow features of the paths of jets

How to manage organisational change and create practice teams: experiences of a South African primary care health centre.

Science.gov (United States)

Mash, B J; Mayers, P; Conradie, H; Orayn, A; Kuiper, M; Marais, J

2008-07-01

In South Africa, first-contact primary care is delivered by nurses in small clinics and larger community health centres (CHC). CHCs also employ doctors, who often work in isolation from the nurses, with poor differentiation of roles and little effective teamwork or communication. Worcester CHC, a typical public sector CHC in rural South Africa, decided to explore how to create more successful practice teams of doctors and nurses. This paper is based on their experience of both unsuccessful and successful attempts to introduce practice teams and reports on their learning regarding organisational change. An emergent action research study design utilised a co-operative inquiry group. The first nine months of inquiry focused on understanding the initial unsuccessful attempt to create practice teams. This paper reports primarily on the subsequent nine months (four cycles of planning, action, observation and reflection) during which practice teams were re-introduced. The central question was how more effective practice teams of doctors and nurses could be created. The group utilised outcome mapping to assist with planning, monitoring and evaluation. Outcome mapping defined a vision, mission, boundary partners, outcome challenges, progress markers and strategies for the desired changes and supported quantitative monitoring of the process. Qualitative data were derived from the co-operative inquiry group (CIG) meetings and interviews with doctors, nurses, practice teams and patients. The CIG engaged effectively with 68% of the planned strategies, and more than 60% of the progress markers were achieved for clinical nurse practitioners, doctors, support staff and managers, but not for patients. Key themes that emerged from the inquiry group's reflection on their experience of the change process dealt with the amount of interaction, type of communication, team resilience, staff satisfaction, leadership style, reflective capacity, experimentation and evolution of new

Servant leadership: a phenomenological study of practices, Experiences, organizational effectiveness and barriers

Directory of Open Access Journals (Sweden)

Amy R. Savage-Austin, PhD

2013-07-01

Full Text Available The subject of leadership is complex, and one of the main issues facing organizational leaders today is how to motivate employees to actively participate in the efforts that lead to accomplishing organizational goals. This study gathered lived experiences of 15 organizational leaders who practice the servant leadership philosophy, and explored how business leaders link their servant leadership practices to their organization’s effectiveness. The qualitative responses obtained during this study indicated that the perceived organizational barriers that prevent the servant leadership practices are the organization’s culture, the fear of change, and the lack of knowledge regarding the servant leadership philosophy. This study also gained insight into the impact that these organizational barriers have on one’s ability to practice servant leadership

Reflective practice in sport coaching: an autoethnographic exploration into the lived experiences of one coach

OpenAIRE

Ang, Denis

2017-01-01

This study seeks to contribute to the growing pool of knowledge on the use of alternative representation of lived experiences to advance practical understandings in sport coaching. Documenting a self-inquiry into my coaching practice, this study demonstrates the value of autoethnography as a methodology to deepen knowledge from experiences. By illuminating my coach-researcher voice through a self-narrative, this study shows how autoethnography is able to immerse the sport researcher in his or...

Liver transplantations in Bulgaria--initial experience.

Science.gov (United States)

Vladov, N; Mihaylov, V; Takorov, I; Vasilevski, I; Lukanova, T; Odisseeva, E; Katzarov, K; Simonova, M; Tomova, D; Konakchieva, M; Petrov, N; Mladenov, N; Sergeev, S; Mutafchiiski, V

2014-01-01

The filed of liver transplantation (LT) continues to evolve and is highly effective therapy for many patients with acute and chronic liver failure resulting from a variety of causes. Improvement of perioperative care, surgical technique and immunosuppression in recent years has led to its transformation into a safe and routine procedure with steadily improving results. The aim of this paper is to present the initial experience of the transplant team at Military Medical Academy - Sofia, Bulgaria. For the period of April 2007 - August 2014 the team performed 38 liver transplants in 37 patients (one retransplantation). Patients were followed up prospectively and retrospectively. In 36 (95%) patients a graft from a cadaveric donor was used and in two cases--a right liver grafts from live donor. The mean MELD score of the transplanted patients was 17 (9-40). The preferred surgical technique was "piggyback" with preservation of inferior vena cava in 33 (86%) of the cases and classical technique in 3 (8%) patients. The overall complication rate was 48%. Early mortality rate was 13% (5 patients). The overall 1- and 5-year survival is 81% and 77% respectivelly. The setting of a new LT program is a complex process which requires the effort and effective colaboration of a wide range of speciacialists (hepatologists, surgeons, anesthesiologists, psychologists, therapists, coordinators, etc.) and institutions. The good results are function of a proper selection of the donors and the recipients. Living donation is an alternative in the shortage of cadaveric donors.

Psilocybin-occasioned mystical-type experience in combination with meditation and other spiritual practices produces enduring positive changes in psychological functioning and in trait measures of prosocial attitudes and behaviors.

Science.gov (United States)

Griffiths, Roland R; Johnson, Matthew W; Richards, William A; Richards, Brian D; Jesse, Robert; MacLean, Katherine A; Barrett, Frederick S; Cosimano, Mary P; Klinedinst, Maggie A

2018-01-01

Psilocybin can occasion mystical-type experiences with participant-attributed increases in well-being. However, little research has examined enduring changes in traits. This study administered psilocybin to participants who undertook a program of meditation/spiritual practices. Healthy participants were randomized to three groups (25 each): (1) very low-dose (1 mg/70 kg on sessions 1 and 2) with moderate-level ("standard") support for spiritual-practice (LD-SS); (2) high-dose (20 and 30 mg/70 kg on sessions 1 and 2, respectively) with standard support (HD-SS); and (3) high-dose (20 and 30 mg/70kg on sessions 1 and 2, respectively) with high support for spiritual practice (HD-HS). Psilocybin was administered double-blind and instructions to participants/staff minimized expectancy confounds. Psilocybin was administered 1 and 2 months after spiritual-practice initiation. Outcomes at 6 months included rates of spiritual practice and persisting effects of psilocybin. Compared with low-dose, high-dose psilocybin produced greater acute and persisting effects. At 6 months, compared with LD-SS, both high-dose groups showed large significant positive changes on longitudinal measures of interpersonal closeness, gratitude, life meaning/purpose, forgiveness, death transcendence, daily spiritual experiences, religious faith and coping, and community observer ratings. Determinants of enduring effects were psilocybin-occasioned mystical-type experience and rates of meditation/spiritual practices. Psilocybin can occasion enduring trait-level increases in prosocial attitudes/behaviors and in healthy psychological functioning. Trial Registration ClinicalTrials.gov Identifier NCT00802282.

Practice Location Characteristics of Non-Traditional Dental Practices.

Science.gov (United States)

Solomon, Eric S; Jones, Daniel L

2016-04-01

Current and future dental school graduates are increasingly likely to choose a non-traditional dental practice-a group practice managed by a dental service organization or a corporate practice with employed dentists-for their initial practice experience. In addition, the growth of non-traditional practices, which are located primarily in major urban areas, could accelerate the movement of dentists to those areas and contribute to geographic disparities in the distribution of dental services. To help the profession understand the implications of these developments, the aim of this study was to compare the location characteristics of non-traditional practices and traditional dental practices. After identifying non-traditional practices across the United States, the authors located those practices and traditional dental practices geographically by zip code. Non-traditional dental practices were found to represent about 3.1% of all dental practices, but they had a greater impact on the marketplace with almost twice the average number of staff and annual revenue. Virtually all non-traditional dental practices were located in zip codes that also had a traditional dental practice. Zip codes with non-traditional practices had significant differences from zip codes with only a traditional dental practice: the populations in areas with non-traditional practices had higher income levels and higher education and were slightly younger and proportionally more Hispanic; those practices also had a much higher likelihood of being located in a major metropolitan area. Dental educators and leaders need to understand the impact of these trends in the practice environment in order to both prepare graduates for practice and make decisions about planning for the workforce of the future.

The (Co-Construction of Knowledge within Initial Teacher Training: Experiences from Croatia

Directory of Open Access Journals (Sweden)

Lidija Vujičić

2015-06-01

Full Text Available “Learning by doing” within and together with a “community that learns” ought to become the fundamental method of learning – not only for children, but also for their teachers and other participants in the educational process. To what extent are students of early and preschool education involved in such work methods, and what have their experiences been like? An example of a research-based, reflective approach to practice grounded in action research and the co-construction of knowledge with students shall be presented as an example of quality practice at the Faculty of Teacher Education in Rijeka. Such a form of practice creates knowledge through the action itself and through contemplation of one’s actions and the actions of others, all with the purpose of strengthening the practical competencies of future teachers. Our conclusion is that mutual learning, as propounded by the social constructivist approach to education, within the context of the mutual discussions between students and teachers that we organized directly contributed to the development of (self-reflection competencies among future teachers, while also immersing all participants in an environment conducive to deliberation and the (redefinition of oneself and one’s own pedagogical work.

Patient experience of source isolation: lessons for clinical practice.

Science.gov (United States)

Barratt, Ruth Linda; Shaban, Ramon; Moyle, Wendy

2011-10-01

Methicillin-resistant Staphylococcus aureus (MRSA) is now the leading antimicrobial-resistant organism of concern to clinicians worldwide. Preventing and controlling the increase and spread of MRSA within the health-care environment is therefore an important function of the infection control team. The prevention and control of MRSA requires strict use of both Standard and Additional Precautions, which include good hand hygiene practices, judicious antimicrobial prescribing, and source isolation. While few would dispute the need for these precautions for preventing the spread of MRSA and other infections, their use may result in adverse physical and psychological effects for the patient. In an age of quality and safety of health care, ensuring infection control practice such as source isolation and contact precautions adhere to fundamental human rights is paramount. This paper presents a review of the literature on the patient experience of source isolation for MRSA or other infectious diseases. The review yielded five major interconnected themes: (1) psychological effects of isolation; (2) coping with isolation; (3) social isolation; (4) communication and information provision; and (5) physical environment and quality of care. It found that the experience of isolation by patients has both negative and positive elements. Isolation may result in detrimental psychological effects including anxiety, stress and depression, but may also result in the patient receiving less or substandard care. However, patients may also benefit from the quietness and privacy of single rooms. Nurses and other healthcare workers must look for ways to improve the experience of isolation and contact precautions of patients in source isolation. Opportunities exist in particular in improving the environment and the patient's self-control of the situation and in providing adequate information.

Initial Results on Neutralized Drift Compression Experiments (NDCX-IA) for High Intensity Ion Beam

CERN Document Server

Roy, Prabir K; Baca, David; Bieniosek, Frank; Coleman, Joshua E; Davidson, Ronald C; Efthimion, Philip; Eylon, Shmuel; Gilson, Erik P; Grant Logan, B; Greenway, Wayne; Henestroza, Enrique; Kaganovich, Igor D; Leitner, Matthaeus; Rose, David; Sefkow, Adam; Sharp, William M; Shuman, Derek; Thoma, Carsten H; Vanecek, David; Waldron, William; Welch, Dale; Yu, Simon

2005-01-01

Ion beam neutralization and compression experiments are designed to determine the feasibility of using compressed high intensity ion beams for high energy density physics (HEDP) experiments and for inertial fusion power. To quantitatively ascertain the various mechanisms and methods for beam compression, the Neutralized Drift Compression Experiment (NDCX) facility is being constructed at Lawrence Berkeley National Laboratory (LBNL). In the first compression experiment, a 260 KeV, 25 mA, K+ ion beam of centimeters size is radially compressed to a mm size spot by neutralization in a meter-long plasma column and beam peak current is longitudinally compressed by an induction velocity tilt core. Instrumentation, preliminary results of the experiments, and practical limits of compression are presented. These include parameters such as emittance, degree of neutralization, velocity tilt time profile, and accuracy of measurements (fast and spatially high resolution diagnostic) are discussed.

Student Teachers' Experiences of Relation Building in Teaching Practice

DEFF Research Database (Denmark)

Nielsen, Anne Maj; Laursen, Per Fibæk

The study explores how 22 student teachers in a Danish college of education experience and interpret their own becoming a teacher and the implied attitudes to pupils. The student teachers attending mainstream teacher education and a course in mindful awareness and relational competencies have...... – to a larger extend than the mainstream educated student teachers - learned a reflexive attitude to their state of being in teaching practice and to their relational interaction with children in class....

Simulation Experiments in Practice: Statistical Design and Regression Analysis

OpenAIRE

Kleijnen, J.P.C.

2007-01-01

In practice, simulation analysts often change only one factor at a time, and use graphical analysis of the resulting Input/Output (I/O) data. The goal of this article is to change these traditional, naïve methods of design and analysis, because statistical theory proves that more information is obtained when applying Design Of Experiments (DOE) and linear regression analysis. Unfortunately, classic DOE and regression analysis assume a single simulation response that is normally and independen...

Demographics of cleft care providers in Africa and reported experience in training and practice: direct analysis of continent-based practitioners.

Science.gov (United States)

Adetayo, Oluwaseun A; Martin, Mark C

2012-05-01

To elucidate the impact of several geographic, cultural, and socioeconomic variables on cleft care delivery in Africa, and to investigate the current status of cleft care delivery in Africa. Survey of practitioners attending the second Pan-African Congress on Cleft Lip and Palate (PACCLIP). The annual PACCLIP conference in Ibadan, Nigeria, West Africa, February 2007. To provide an analysis of the demographics and training experience of cleft care providers in Africa by collating information directly from the continent-based practitioners. Plastic surgeons and oral and maxillofacial surgeons provide the majority of cleft care. Most of the participants reported availability of formal training programs in their respective countries. The predominant practice settings were university and government-based. During training, half of the providers had encountered up to 30 cleft cases, and a quarter had managed more than 100 cases. Representation of visiting surgeons were equally distributed between African and non-African countries. This study provides initial and detailed analysis crucial to understanding the underlying framework of cleft care composition teams, demographics of providers, and training and practice experience. This awareness will further enable North American and other non-African plastic surgeons to effectively partner with African cleft care providers to have a further reaching impact in the region.

Prototype radiographic system for emergency and intensive care units: Initial experience

International Nuclear Information System (INIS)

Mirvis, S.

1986-01-01

A prototype radiographic system has been developed for use in bedside examinations in multibed trauma or intensive care units and emergency rooms. The system features a single-phase, high-frequency 30-kW ceiling-mounted generator with an x-ray tube extending from a long counterbalanced arm. All movements are servo-assisted for ease of operation. Based on initial experience, the unit allows easier access to the patient around resuscitation and monitoring equipment, occupies less floor space, and yields better quality images than do standard mobile radiographic units

Longitudinal qualitative study describing family physicians' experiences with attempting to integrate physical activity prescriptions in their practice: 'It's not easy to change habits'.

Science.gov (United States)

Bélanger, Mathieu; Phillips, Emily Wolfe; O'Rielly, Connor; Mallet, Bertin; Aubé, Shane; Doucet, Marylène; Couturier, Jonathan; Mallet, Maxime; Martin, Jessica; Gaudet, Christine; Murphy, Nathalie; Brunet, Jennifer

2017-07-13

Physical activity (PA) prescriptions provided by family physicians can promote PA participation among patients, but few physicians regularly write PA prescriptions. The objective of this study was to describe family physicians' experiences of trying to implement written PA prescriptions into their practice. Longitudinal qualitative study where participants were interviewed four times during a 12-month period. After the first interview, they were provided with PA prescription pads. Data were analysed using thematic analysis. Family medicine clinics in New Brunswick, Canada. Family physicians (n=11) with no prior experience writing PA prescriptions, but who expressed interest in changing their practice to implement written PA prescriptions. Initially, participants exhibited confidence in their ability to write PA prescriptions in the future and intended to write prescriptions. However, data from the follow-up interviews indicated that the rate of implementation was lower than anticipated by participants and prescriptions were not part of their regular practice. Two themes emerged as factors explaining the gap between their intentions and behaviours: (1) uncertainty about the effectiveness of written PA prescription, and (2) practical concerns (eg, changing well-established habits, time constraints, systemic institutional barriers). It may be effective to increase awareness among family physicians about the effectiveness of writing PA prescriptions and address barriers related to how their practice is organised in order to promote written PA prescription rates. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Surviving and Thriving Your First Year in Private Practice

Science.gov (United States)

Schwab, Elizabeth Falk

2016-01-01

Taking the leap toward a career as a private practice owner is daunting. When in the initial stages of starting a private practice, I searched for current advice from an audiologist who had recently confronted the same challenges I was about to face. Because of the limited information available, I documented my process in hopes of providing an overview of my startup experience to help others. Included is a timeline of startup tasks and a sample budget to use as a reference. In this chapter, I share my experiences, both the positives and the negatives, and tips with the goal of helping you survive and thrive in your first year in private practice. PMID:28028322

Proceedings of the International Workshop on Occupational Radiation Protection in Severe Accident Management 'sharing practices and experiences'

International Nuclear Information System (INIS)

2014-06-01

The objective of the Workshop on Occupational Radiation Protection in Severe Accident Management was to share practices and experiences in approaches to severe accident management. The workshop: provided an international forum for information and experience exchange amongst nuclear electricity utilities and national regulatory authorities on approaches to, and issues in severe accident management, including national and international implications. Focus was placed on sharing practices and experiences in many countries on approaches to severe accident management; identified best occupational radiation protection approaches in strategies, practices, as well as limitations for developing effective management. This included experiences in various countries; identified national experiences to be incorporated into the final version of ISOE EG-SAM report. The workshop included a series of plenary presentations that provided participants with an overview of practices and experiences in severe accident management from various countries. Furthermore, by taking into account the structure of the interim report, common themes and issues were discussed in follow-up breakout sessions. Sessions included invited speakers, moderated by designated experts, allowing participants to discuss their national experiences and possible inputs into the report. The outcomes of the breakout sessions were presented in plenary by the respective moderators followed by an open discussion, with a view towards elaborating ways forward to achieve more effective severe accident management. This document brings together the abstracts and the slides of the available presentations

Between initial familiarity and future use – a case of Collocated Collaborative Writing

DEFF Research Database (Denmark)

Bødker, Susanne; Polli, Anna Maria

2014-01-01

these with the three above forms of practice. The initial familiarity leads to two different early practices that get in the way of each other, and the collaborative writing idea. They point instead towards a discursive sharing of individual feelings, a different kind of past experiences than anticipated in design.......This paper reports on a design experiment in an art gallery, where we explored visitor practices of commenting on art, and how they were shaped in interaction with a newly designed collocated, collaborative writing technology. In particular we investigate what potentials previous practices carry...... with them that may affect early use and further development of use. We base our analyses on interviews in the art gallery and on socio-cultural theories of artefactmediated learning and collaboration. The analyses help identify three forms of collaborative writing, which are placed in the space between...

Using Reflective Practice to Facilitate Conversations and Transform Instructional Practice for Middle School Science Teachers

Science.gov (United States)

Higdon, Robbie L.

The process of teaching, especially inquiry, is complex and requires extended time for developing one's instructional practice (Loucks-Horsley, Stiles, Mundry, Love, & Hewson, 2010). The implementation of a continued cycle of self-reflection can engage teachers in analyzing their prior experiences and understandings about their instructional practice to promote the accommodation of new concepts and transform their practice. However, many teachers have difficulty engaging in the cognitive dissonance needed to identify those problems and promote their own growth without support. As one's professional practice becomes more repetitive and routine, it is difficult for the practitioner to recognize opportunities in which to contemplate one's habitual actions (Schon, 1983). In this multi-case study, two middle school science teachers who were engaged within a sustained professional development initiative participated in a series of one-on-one reflective dialogues regarding the decisions they made about the utilization of inquiry-based instruction. In addition, these teachers were asked to reflect upon the criteria used to determine how and when to implement these inquiry-based practices. These reflective dialogue sessions provided the opportunity to observe teacher conceptions and stimulate teacher cognitive dissonance about instructional practice. Qualitative analysis of data collected from these reflective dialogues along with informal and formal classroom observations of instructional practice uncovered diverse perceptions regarding the implementation of inquiry-based methods into present teaching practice. The use of reflective dialogue within the existing structure of the professional development initiative allowed for the facilitators of the professional development initiative to tailor ongoing support and their effective implementation of inquiry-based instruction. Additional research is needed to investigate the impact of reflective dialogue in achieving

Continuous quality improvement programs provide new opportunities to drive value innovation initiatives in hospital-based radiology practices.

Science.gov (United States)

Steele, Joseph R; Schomer, Don F

2009-07-01

Imaging services constitute a huge portion of the of the total dollar investment within the health care enterprise. Accordingly, this generates competition among medical specialties organized along service lines for their pieces of the pie and increased scrutiny from third-party payers and government regulators. These market and political forces create challenge and opportunity for a hospital-based radiology practice. Clearly, change that creates or builds greater value for patients also creates sustainable competitive advantage for a radiology practice. The somewhat amorphous concept of quality constitutes a significant value driver for innovation in this scenario. Quality initiatives and programs seek to define and manage this amorphous concept and provide tools for a radiology practice to create or build more value. Leadership and the early adoption of these inevitable programs by a radiology practice strengthens relationships with hospital partners and slows the attrition of imaging service lines to competitors.

Is faculty practice valuable? The experience of Western Australian nursing and midwifery academics undertaking faculty clinical practice - A discussion paper.

Science.gov (United States)

Fowler, Amanda C; Baker, Melanie; Geraghty, Sadie

2017-09-01

The faculty clinical practice model provides dedicated time for nursing lecturers and educators in a university school of nursing to work with supervision in the clinical environments for an agreed amount of time each year. Allowing academics to partake in faculty clinical practice this way has been shown to update skills and retain clinical competency. Some nursing and midwifery academics believe it is essential to remain clinically current and up-to-date with professional issues in the clinical environments, whereas other academics believe reading current research maintains clinical competency. This discussion paper will explore the authors' own experiences of faculty clinical practice as an opportunity to enhance their learning. Narrative accounts of time spent in the clinical areas being expressed as invaluable as it allowed the authors to become part of the health professional team, refine clinical skills, gain clinical confidence, and share knowledge. This, in turn, impacted upon the academic's teaching style as well as redefined it by introducing incidents and stories from their experience. It has been concluded by the authors that faculty clinical practice allows academics to increase confidence, encourage leadership skills, and improve their teaching abilities in their clinical area of expertise. Copyright © 2017 Elsevier Ltd. All rights reserved.

Translating Neurodevelopmental Care Policies Into Practice: The Experience of Neonatal ICUs in France-The EPIPAGE-2 Cohort Study.

Science.gov (United States)

Pierrat, Veronique; Coquelin, Anaëlle; Cuttini, Marina; Khoshnood, Babak; Glorieux, Isabelle; Claris, Olivier; Durox, Mélanie; Kaminski, Monique; Ancel, Pierre-Yves; Arnaud, Catherine

2016-10-01

To describe the implementation of neurodevelopmental care for newborn preterm infants in neonatal ICUs in France in 2011, analyze changes since 2004, and investigate factors associated with practice. Prospective national cohort study of all births before 32 weeks of gestation. Twenty-five French regions. All neonatal ICUs (n = 66); neonates surviving at discharge (n = 3,005). None. Neurodevelopmental care policies and practices were assessed by structured questionnaires. Proportions of neonates initiating kangaroo care during the first week of life and those whose mothers expressed breast milk were measured as neurodevelopmental care practices. Multilevel logistic regression analyses were used to investigate relationships between kangaroo care or breast-feeding practices and unit policies, taking into account potential confounders. Free visiting policies, bed availability for parents, and kangaroo care encouragement significantly improved between 2004 and 2011 but with large variabilities between units. Kangaroo care initiation varied from 39% for neonates in the most restrictive units to 68% in less restrictive ones (p neurodevelopmental care significantly influenced kangaroo care initiation (odds ratio, 3.5; 95% CI, 1.8-7.0 for Newborn Individualized Developmental Care and Assessment Program implementation compared with no training). Breast milk expression by mothers was greater in units with full-time availability professionals trained for breast-feeding support (60% vs 73%; p neurodevelopmental practices occurred between 2004 and 2011, but large variabilities between units persist. Practices increased in units with supportive policies. Specific neurodevelopmental care training with multifaceted interventions strengthened the implementation of policies.

Experiences of self-practice/self-reflection in cognitive behavioural therapy: a meta-synthesis of qualitative studies.

Science.gov (United States)

Gale, Corinne; Schröder, Thomas

2014-12-01

Self-practice/self-reflection is a valuable training strategy which involves therapists applying therapeutic techniques to themselves, and reflecting on the process. To undertake a meta-synthesis of qualitative studies exploring therapists' experiences of self-practice/self-reflection in cognitive behavioural therapy (CBT). This would integrate, and interpret, the current literature in order to develop a new understanding, and contribute to the development of CBT training programmes. The meta-synthesis encompassed three distinct phases: undertaking a comprehensive and systematic literature search; critically appraising the papers; and synthesising the data using the meta-ethnographic method. The literature search identified 378 papers, ten met the criteria for inclusion. After critical appraisal, all were included in the synthesis. The synthesis identified 14 constructs, which fell into three broad categories: 'experience of self-practice/self-reflection'; 'outcomes of self-practice/self-reflection'; and 'implications for training'. This synthesis found that self-practice allows therapists to put themselves into their clients' shoes, experiencing the benefits that therapy can bring but also the problems that clients can run in to. This experience increases therapists' empathy for their clients, allowing them to draw on their own experiences in therapy. As a result, therapists tend to feel both more confident in themselves and more competent as a therapist. The self-practice/self-reflection process was facilitated by reflective writing and working with others, particularly peers. Self-practice/self-reflection is a valuable training strategy in CBT, which has a range of beneficial outcomes. It can also be used as a means of continuing personal and professional development. Self-practice of CBT techniques, and reflecting on the process, can be a useful training strategy and helpful for ongoing development Therapists could consider developing a 'self-case' study

Integrated initial training program for a CEGB operations engineer

International Nuclear Information System (INIS)

Tompsett, P.A.

1987-01-01

This paper considers the overall training programs undertaken by a newly appointed Operations Engineer at one of the Central Electricity Generating Board's (CEGB) Advanced Gas Cooled Reactor (AGR) nuclear power stations. The training program is designed to equip him with the skills and knowledge necessary for him to discharge his duties safely and effectively. In order to assist the learning process and achieve and integrated program, aspects of reactor technology and operation, initially the subject of theoretical presentations at the CEGB's Nuclear Power Training Center (NPTC) are reinforced by either simulation and/or practical experience on site. In the later stages plant-specific simulators, operated by trained tutors, are incorporated into the training program to provide the trainee with practical experience of plant operation. The trainee's performance is assessed throughout the program to provide feedback to the trainee, the trainers and station management

A survey of critical care nurses' practices and perceptions surrounding early intravenous antibiotic initiation during septic shock.

Science.gov (United States)

Roberts, Russel J; Alhammad, Abdullah M; Crossley, Lindsay; Anketell, Eric; Wood, LeeAnn; Schumaker, Greg; Garpestad, Erik; Devlin, John W

2017-08-01

Delays in antibiotic administration after severe sepsis recognition increases mortality. While physician and pharmacy-related barriers to early antibiotic initiation have been well evaluated, those factors that affect the speed by which critical care nurses working in either the emergency department or the intensive care unit setting initiate antibiotic therapy remains poorly characterized. To evaluate the knowledge, practices and perceptions of critical care nurses regarding antibiotic initiation in patients with newly recognised septic shock. A validated survey was distributed to 122 critical care nurses at one 320-bed academic institution with a sepsis protocol advocating intravenous(IV) antibiotic initiation within 1hour of shock recognition. Among 100 (82%) critical care nurses responding, nearly all (98%) knew of the existence of the sepsis protocol. However, many critical care nurses stated they would optimise blood pressure [with either fluid (38%) or both fluid and a vasopressor (23%)] before antibiotic initiation. Communicated barriers to rapid antibiotic initiation included: excessive patient workload (74%), lack of awareness IV antibiotic(s) ordered (57%) or delivered (69%), need for administration of multiple non-antibiotic IV medications (54%) and no IV access (51%). Multiple nurse-related factors influence IV antibiotic(s) initiation speed and should be incorporated into sepsis quality improvement efforts. Copyright © 2017 Elsevier Ltd. All rights reserved.

Exploration and practice in-class practice teaching mode

Science.gov (United States)

Zang, Xue-Ping; Wu, Wei-Feng

2017-08-01

According to the opto-electronic information science and engineering professional course characteristics and cultivate students' learning initiative, raised the teaching of photoelectric professional course introduce In-class practice teaching mode. By designing different In-class practice teaching content, the students' learning interest and learning initiative are improved, deepen students' understanding of course content and enhanced students' team cooperation ability. In-class practice teaching mode in the course of the opto-electronic professional teaching practice, the teaching effect is remarkable.

Instructional Experiment of Practical Competencies-Oriented Teaching Materials in Technical Universities

Science.gov (United States)

Chen, Su-Chang

2010-01-01

This study aims to conduct experimental instruction on the human resource management unit of business management in practical competencies-oriented business program developed by Chen (2005). This study is based on the quasi-experiment method and the subjects are two classes of students in a four-year technical university who have completed the…

16 CFR 5.65 - Review of initial decision.

Science.gov (United States)

2010-01-01

... 16 Commercial Practices 1 2010-01-01 2010-01-01 false Review of initial decision. 5.65 Section 5.65 Commercial Practices FEDERAL TRADE COMMISSION ORGANIZATION, PROCEDURES AND RULES OF PRACTICE... initial decision. Appeals from the initial decision of the Administrative Law Judge or review by the...

Initial Experiences of Simultaneous Laparoscopic Resection of Colorectal Cancer and Liver Metastases

Directory of Open Access Journals (Sweden)

L. T. Hoekstra

2012-01-01

Full Text Available Introduction. Simultaneous resection of primary colorectal carcinoma (CRC and synchronous liver metastases (SLMs is subject of debate with respect to morbidity in comparison to staged resection. The aim of this study was to evaluate our initial experience with this approach. Methods. Five patients with primary CRC and a clinical diagnosis of SLM underwent combined laparoscopic colorectal and liver surgery. Patient and tumor characteristics, operative variables, and postoperative outcomes were evaluated retrospectively. Results. The primary tumor was located in the colon in two patients and in the rectum in three patients. The SLM was solitary in four patients and multiple in the remaining patient. Surgical approach was total laparoscopic (2 patients or hand-assisted laparoscopic (3 patients. The midline umbilical or transverse suprapubic incision created for the hand port and/or extraction of the specimen varied between 5 and 10 cm. Median operation time was 303 (range 151–384 minutes with a total blood loss of 700 (range 200–850 mL. Postoperative hospital stay was 5, 5, 9, 14, and 30 days. An R0 resection was achieved in all patients. Conclusions. From this initial single-center experience, simultaneous laparoscopic colorectal and liver resection appears to be feasible in selected patients with CRC and SLM, with satisfying short-term results.

Preparing beginning reading teachers: An experimental comparison of initial early literacy field experiences

OpenAIRE

Al Otaiba, Stephanie; Lake, Vickie E.; Greulich, Luana; Folsom, Jessica S.; Guidry, Lisa

2012-01-01

This randomized-control trial examined the learning of preservice teachers taking an initial Early Literacy course in an early childhood education program and of the kindergarten or first grade students they tutored in their field experience. Preservice teachers were randomly assigned to one of two tutoring programs: Book Buddies and Tutor Assisted Intensive Learning Strategies (TAILS), which provided identical meaning-focused instruction (shared book reading), but differed ...

Past Examination Questions in Senior Secondary Chemistry: From Written Practice to Hands-On Experiments

Science.gov (United States)

Chow, Cheuk-Fai; So, Wing-Mui Winnie; Cheung, Tsz-Yan

2016-01-01

This study applied an unconventional use of past examination papers by converting questions into hands-on experiments for students. Students in an experimental group were engaged in use of those experiments while the remainder attended conventional lectures with written practice. The results reflect that the experimental group positively improved…

Medical practice branding using cable television.

Science.gov (United States)

Miaoulis, George; Kissinger, Mark; Sirko-Fiorilli, Mary Ann

2005-01-01

Genesis Medical Associates is an independent primary care practice in the suburbs of Pittsburgh. Given competitive pressures, a member of the physician leadership began thinking about the need for the practice to develop an "identity and awareness" program to set the practice apart from the competition. The idea for branding the campaign began when Dr. Rob Potter, Jr., was attending a Pittsburgh Pirates baseball game and a fan said to him, "You're that doctor I see on television" in the nursing home commercial. Triggered by this experience, Potter saw the opportunity to develop an awareness and identity campaign for Genesis. In this article we share the reasons for, the steps taken, and initial results in developing a medical practice branding strategy.

The CRINE initiative -- Producing the engineering tools (functional specifications and common working practices)

International Nuclear Information System (INIS)

Tuft, V.

1995-01-01

Alongside culture change, CRINE's other challenge is producing the right tools for the North Sea industry to change its traditional method of operation. CRINE, an acronym for Cost Reduction Initiative for the New Era, is an industry-wide program now underway in the UK Continental Shelf whose main objective is to achieve thirty percent or more savings in capital costs and to half operating costs over the next few years. These tools cover functional specifications, common working practices and quality. Turning these tools into deliverables, and on time, was a mixture of painstaking work and willingness by people to adapt to the needs of the task

Application of quality-improvement methods in a community practice: the Sandhills Pediatrics Asthma Initiative.

Science.gov (United States)

Wroth, Thomas H; Boals, Joseph C

2005-01-01

leadership and support. The leaders of the practice saw beyond the usual metrics of patient visit counts and relative value units (RVUs) to embrace the concept of population health: the notion that practices are not only responsible for providing acute, episodic care in the office, but also for improving health outcomes in the community in which they serve. Other important factors included ensuring a basic agreement among providers on the need for improvement and frequent communication about the goals of the project. Although the champions of the project tried to minimize formal meeting time, there was frequent informal communication between team members. In the future, there is a need to develop other approaches to stimulate these endeavors in community practices, such as "pay for performance" programs, continuing education credit, and tying maintenance of board certification to quality improvement initiatives.

People's initiative to counteract misinformation and marketing practices: the Pembo, Philippines, breastfeeding experience, 2006.

Science.gov (United States)

Salud, M A Lourdes B; Gallardo, Josephine I; Dineros, Juliana A; Gammad, Alma F; Basilio, Juanita; Borja, Vicenta; Iellamo, Alessandro; Worobec, Lana; Sobel, Howard; Olivé, Jean-Marc

2009-08-01

The Philippines is among 42 countries accounting for 90% of under 5-year-old deaths. Only 16% of 4 to 5 month old Filipinos exclusively breastfeed. In 2006, almost $100 million was spent advertising formula in the Philippines. To counter widespread misinformation and improve breastfeeding a peer counseling intervention was developed to target mothers with infants less than 2 months of age who were not exclusively breastfeeding or had difficulty breastfeeding. Participants received 3 peer counseling visits. At baseline and 3 weeks later, 24-hour food recalls for infants were collected. The number of exclusively formula-fed infants decreased seven-fold (P < .001). Mixed-fed infants decreased 37% (P < .001). Overall, of the 148 nonexclusively breastfeeding infants, 69.5% had changed feeding methods after 3 home visits, 76% of whom to exclusive breastfeeding. Community-based peer counseling was associated with a drastic improvement of exclusive breastfeeding practices. This intervention evolved and became sustainable by engaging political figures, cities, and communities throughout the process. In 2 years, the Department of Health, World Health Organization (WHO) program has scaled up to improve health service delivery for 161,612 persons in depressed urban communities in the Philippines.

Positioning Learning Design: Learner Experience and the challenges of transforming teaching practice

NARCIS (Netherlands)

Johnson, Mark; Griffiths, Dai; Hanslot, Zubair

2010-01-01

Johnson, M., Griffiths, D., & Hanslot, Z. (2010). Positioning Learning Design: Learner Experience and the challenges of transforming teaching practice. In D. Griffiths, & R. Koper (Eds.), Rethinking Learning and Employment at a Time of Economic Uncertainty. Proceedings of the 6th TENCompetence Open

The comparison of birth outcomes and birth experiences of low-risk women in different sized midwifery practices in the Netherlands.

Science.gov (United States)

Fontein, Yvonne

2010-09-01

To examine maternal birth outcomes and birth experiences of low-risk women in the Netherlands in different sized midwifery practices. Descriptive study using postal questionnaires six weeks after the estimated due date. Women were recruited from urban, semi-rural and rural areas from small-sized practices (1-2 midwives), medium-sized practices (3-4 midwives) or large-sized practices (5 or more). 718 Dutch speaking women with uncomplicated pregnancies, a representative sample of women in 143 midwifery practices in the Netherlands who had given birth in the period between 20 April and 20 May 2007. Distribution of place of birth categories and intervention categories, birth experience, woman-midwife relationship and presence of own midwife after referral. Data were analyzed with Statistical Package for Social Sciences (SPSS). Women in practices with a maximum of two midwives were significantly more likely to experience lower rates of referral, interventions in general and specifically pain relief by means of pethidine, CTG registration and unplanned caesarean sections. Women with a maximum of two midwives were significantly more likely to know their midwife or midwives and were more frequently supported by their own midwife after referral in comparison to women in practices with more than two midwives. The presence of the woman's own midwife added value to the birth experience. Women with a maximum of two midwives had higher levels of a positive birth experience than women in practices with more than two midwives. Midwifery practices with a maximum of two midwives contribute to non-interventionist birth and a positive birth experience. Awareness of the study results and further study is recommended to discuss reorganization of care in order to achieve significant reductions on referral and interventions during childbirth and positive maternal birth experiences. Copyright (c) 2010 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

Design of a Flexible Hardware Interface for Multiple Remote Electronic practical Experiments of Virtual Laboratory

Directory of Open Access Journals (Sweden)

Farah Said

2012-03-01

Full Text Available The objective of this work is to present a new design of a Flexible Hardware Interface (FHI based on PID control techniques to use in a virtual laboratory. This flexible hardware interface allows the easy implementation of different and multiple remote electronic practical experiments for undergraduate engineering classes. This interface can be viewed as opened hardware architecture to easily develop simple or complex remote experiments in the electronic domain. The philosophy of the use of this interface can also be expanded to many other domains as optic experiments for instance. It is also demonstrated that software can be developed to enable remote measurements of electronic circuits or systems using only Web site Interface. Using standard browsers (such as Internet explorer, Firefox, Chrome or Safari, different students can have a remote access to different practical experiments at a time.

Experience with an end-of-life practice at a university hospital.

Science.gov (United States)

Campbell, M L; Frank, R R

1997-01-01

To describe a 10-yr experience with an end-of-life practice in a hospital. A nonexperimental, prospective, descriptive design was used to record variables from a convenience sample of patients transferred to the Comprehensive Supportive Care Team. Detroit Receiving Hospital is an urban, university-affiliated, Level I trauma/emergency hospital. Patients who are not expected to survive hospitalization, and for whom a decision has been made to focus care on palliative interventions, are candidates for care by this practice. None. Patient demographics, including the following information: age, gender; diagnoses; illness severity; mortality rate; and disposition. Measures of resource utilization included: referral sources; Therapeutic intervention Scoring System values; bed costs; and length of hospital stay. Satisfactory patient/family care with a measurable reeducation in the use of resources can be achieved in the hospital setting. A hands-on approach to the care of dying patients by this specialty, palliative care service has provided patients, families, and clinicians with the type of support needed for satisfactory end-of-life care. A summary of our experience may be useful to others.

The Attitudes and Practices that Shape Children's Drawing Experience at Home and at School

Science.gov (United States)

Burkitt, Esther; Jolley, Richard; Rose, Sarah

2010-01-01

Concept: Few empirical studies have investigated the influence of teachers, parents and children on children's drawing experience. The current study aims to examine the attitudes and practices of these three key players that shape children's drawing experience. Method: A survey methodology was used, as typically found in previous research in this…

Cardiac 82rubidium PET/CT: initial European experience

International Nuclear Information System (INIS)

Groves, Ashley M.; Dickson, John C.; Kayani, Irfan; Endozo, Raymondo; Blanchard, Patty; Shastry, Manu; Prvulovich, Elizabeth; Waddington, Wendy A.; Ben-Haim, Simona; Bomanji, Jamshed B.; Ell, Peter J.; Speechly-Dick, Marie-Elsya; McEwan, Jean R.

2007-01-01

Myocardial perfusion with PET/CT has advantages over conventional SPECT. We describe our initial European experience using 82 Rubidium-PET/CT, as part of a clinical myocardial perfusion service. We studied the first 100 patients (64 male; 36 female, mean age = 60: SD +/-12.5y, mean body mass index = 30: SD +/-6.9kg/m 2 ) who underwent 82 Rubidium cardiac PET/CT in our institution. Thirty patients had recently undergone coronary angiography. Patients underwent imaging during adenosine infusion and at rest. Images were acquired over 5 minutes using a GE-PET/CT instrument. Image quality was described as good, adequate or inadequate. Images were reported patient-by-patient by a minimum of five nuclear medicine physicians. A segment-by-segment analysis (17-segment model) was also performed. Image quality was good in 77%, adequate 23% and inadequate 0%. There was no statistical difference in image quality between obese and non-obese patients (Fisher's exact test, p = 0.2864). 59% had normal perfusion studies, 29% had inducible ischaemia, 12% had myocardial infarction (11% with super added ischaemia). There was reduced 82 Rubidium uptake in 132/1700 segments during stress. There was reduced 82 Rubidium uptake at rest in 42/1700 segments. The 82 Rubidium PET/CT findings were consistent with the angiographic findings in 28/30 cases. We show that, even from initial use of 82 Rubidium, it is possible to perform myocardial perfusion studies quickly with good image quality, even in the obese. The PET findings correlated well in the third of the cases where angiography was available. As such, 82 Rubidium cardiac PET/CT is likely to be an exciting addition to the European nuclear physician/ cardiologist's radionuclide imaging arsenal. (orig.)

Translating Neurodevelopmental Care Policies Into Practice: The Experience of Neonatal ICUs in France—The EPIPAGE-2 Cohort Study

Science.gov (United States)

Coquelin, Anaëlle; Cuttini, Marina; Khoshnood, Babak; Glorieux, Isabelle; Claris, Olivier; Durox, Mélanie; Kaminski, Monique; Ancel, Pierre-Yves; Arnaud, Catherine

2016-01-01

Objectives: To describe the implementation of neurodevelopmental care for newborn preterm infants in neonatal ICUs in France in 2011, analyze changes since 2004, and investigate factors associated with practice. Design: Prospective national cohort study of all births before 32 weeks of gestation. Setting: Twenty-five French regions. Participants: All neonatal ICUs (n = 66); neonates surviving at discharge (n = 3,005). Interventions: None. Measurements and Main Results: Neurodevelopmental care policies and practices were assessed by structured questionnaires. Proportions of neonates initiating kangaroo care during the first week of life and those whose mothers expressed breast milk were measured as neurodevelopmental care practices. Multilevel logistic regression analyses were used to investigate relationships between kangaroo care or breast-feeding practices and unit policies, taking into account potential confounders. Free visiting policies, bed availability for parents, and kangaroo care encouragement significantly improved between 2004 and 2011 but with large variabilities between units. Kangaroo care initiation varied from 39% for neonates in the most restrictive units to 68% in less restrictive ones (p neurodevelopmental care significantly influenced kangaroo care initiation (odds ratio, 3.5; 95% CI, 1.8–7.0 for Newborn Individualized Developmental Care and Assessment Program implementation compared with no training). Breast milk expression by mothers was greater in units with full-time availability professionals trained for breast-feeding support (60% vs 73%; p neurodevelopmental practices occurred between 2004 and 2011, but large variabilities between units persist. Practices increased in units with supportive policies. Specific neurodevelopmental care training with multifaceted interventions strengthened the implementation of policies. PMID:27518584

Living large: the experiences of large-bodied women when accessing general practice services

Directory of Open Access Journals (Sweden)

Russell N

2013-09-01

Full Text Available INTRODUCTION: Numerous studies report high levels of stigma and discrimination experienced by obese/overweight women within the health care system and society at large. Despite general practice being the most utilised point of access for health care services, there is very little international or national exploration of the experiences of large-bodied women (LBW accessing these services. The aim of this study was to explore LBW's experiences of accessing general practice services in New Zealand. METHODS: This is a qualitative, descriptive, feminist study. Local advertising for participants resulted in eight self-identified, large-bodied women being interviewed. A post-structural feminist lens was applied to the data during thematic analysis. FINDINGS: The women in this study provided examples of verbal insults, inappropriate humour, negative body language, unmet health care needs and breaches of dignity from health care providers in general practice. Seven themes were identified: early experiences of body perception, confronting social stereotypes, contending with feminine beauty ideals, perceptions of health, pursuing health, respecting the whole person, and feeling safe to access care. CONCLUSION: Pressure for body size vigilance has, in effect, excluded the women in this study from the very locations of health that they are 'encouraged' to attend-including socialising and exercising in public, screening opportunities that require bodily exposure, and accessing first point of care health services.

Simulation of rod drop experiments in the initial cores of Loviisa and Mochovce

International Nuclear Information System (INIS)

Kaloinen, E.; Kyrki-Rajamaeki, R.; Wasastjerna, F.

1999-01-01

Interpretation of rod drop measurements during startup tests of the Loviisa reactors has earlier been studied with two-dimensional core calculations using a spatial prompt jump approximation. In these calculations the prediction for the reactivity meter reading was lower than the measured values by 25%. Another approach to solve the problem is simulation of the rod drop experiment with dynamic core calculations coupled with out of core calculations to estimate the response of ex-core ionization chambers for the reactivity meter. This report described the calculations performed with the three-dimensional dynamic code HEXTRAN for prediction of the reactivity meter readings in rod drop experiments in initial cores of the WWER-440 reactors. (Authors)

Local Governments Supporting Local Energy Initiatives: Lessons from the Best Practices of Saerbeck (Germany) and Lochem (The Netherlands)

NARCIS (Netherlands)

Hoppe, Thomas; Graf, Antonia; Warbroek, Wynzen Douwe Beau; Lammers, Imke; Lepping, Isabella

2015-01-01

The social dimension of the transition to a low carbon economy is a key challenge to cities. The establishment of local energy initiatives (LEIs) has recently been attracting attention. It is of great importance to draw lessons from best practices when LEIs have been facilitated by local governments

Improving access to important recovery information for heart patients with low health literacy: reflections on practice-based initiatives.

Science.gov (United States)

Naccarella, Lucio; Biuso, Catuscia; Jennings, Amanda; Patsamanis, Harry

2018-05-29

Evidence exists for the association between health literacy and heart health outcomes. Cardiac rehabilitation is critical for recovery from heart attack and reducing hospital readmissions. Despite this, literacy. This brief case study reflects and documents practice-based initiatives by Heart Foundation Victoria to improve access to recovery information for patients with low literacy levels. Three key initiatives, namely the Six Steps To Cardiac Recovery resource, the Love Your Heart book and the nurse ambassador program, were implemented informed by mixed methods that assessed need and capacity at the individual, organisational and systems levels. Key outcomes included increased access to recovery information for patients with low health literacy, nurse knowledge and confidence to engage with patients on recovery information, improved education of patients and improved availability and accessibility of information for patients in diverse formats. Given the challenges involved in addressing heart health literacy, multifaceted practice-based approaches are essential to improve access to recovery information for patients with low literacy levels. What is known about the topic? Significant challenges exist for patients with lower health literacy receiving recovery information after a heart attack in hospitals. What does this paper add? This case study provides insights into a practice-based initiative by Heart Foundation Victoria to improve access to recovery information for patients with low literacy levels. What are the implications for practitioners? Strategies to improve recovery through increased heart health literacy must address the needs of patients, nursing staff and the health system within hospitals. Such strategies need to be multifaceted and designed to build the capacity of nurses, heart patients and their carers, as well as support from hospital management.

A REFLECTION OF THE MAIN BEING BY MEANS OF THE ONLY EXPERIENCE OF THE TEACHING PRACTICE.

Directory of Open Access Journals (Sweden)

Breydy Dayanna Álvarez Mahecha

2016-09-01

Full Text Available The current dynamics that involve biology teachers in a particular context, try to recreate a subject with an externalized profile setting aside each one of the teacher’s particularities and experiences that can built outside and inside the classroom. Given the above and the reflected on during the academic formation process in the biology department, it is consider important develop a research work inside the pedagogical practices about the biology teacher’s being and to-do in a scholar context. Such task developed in construction with the research line: “pathways and happenings. Studies of teacher’s being and to-do from the pedagogy” initiating a personal relation with the author formative interest. Finally, it is established as final considerations that biology teachers even in a scholar context with stablished dynamics by the institution, can recreate their diary tasks as subjects of change taking pedagogy as way a thought that question the intent of giving the teacher a profile.

Patient engagement in clinical trials: The Clinical Trials Transformation Initiative's leadership from theory to practical implementation.

Science.gov (United States)

Patrick-Lake, Bray

2018-02-01

Patient engagement is an increasingly important aspect of successful clinical trials. Over the past decade, as patient group involvement in clinical trials has continued to increase and diversify, the Clinical Trials Transformation Initiative has not only recognized the crucial role patients play in improving the clinical trial enterprise but also made a deep commitment to help grow and shape the emerging field of patient engagement. This article describes the evolution of patient engagement including the origins of the patient engagement movement; barriers to successful engagement and remaining challenges to full and valuable collaboration between patient groups and trial sponsors; and Clinical Trials Transformation Initiative's role in influencing the field through organizational practices, formal project work and resulting recommendations, and external advocacy efforts.

An initial framework for the language of higher-order thinking mathematics practices

Science.gov (United States)

Staples, Megan E.; Truxaw, Mary P.

2012-09-01

This article presents an examination of the language demands of cognitively demanding tasks and proposes an initial framework for the language demands of higher-order mathematics thinking practices. We articulate four categories for this framework: language of generalisation, language of comparison, language of proportional reasoning, and language of analysing impact. These categories were developed out of our collaborative work to design and implement higher-order thinking tasks with a group of Grade 9 (14- and 15-year-olds) teachers teaching in a linguistically diverse setting; analyses of student work samples on these tasks; and our knowledge of the literature. We describe each type of language demand and then analyse student work in each category to reveal linguistic challenges facing students as they engage these mathematical tasks. Implications for teaching and professional development are discussed.

Overcoming the Barriers of Distance: Using Mobile Technology to Facilitate Moderation and Best Practice in Initial Teacher Training

Science.gov (United States)

Leggatt, Simon

2016-01-01

This case study describes the development process of a model using readily-available technology to facilitate collaboration, moderation and the dissemination of best practice in initial teacher training in the UK. Students, mentors, tutors and external examiners from a number of educational institutions in a UK, higher education-led Lifelong…

Does the cerebellum initiate movement?

Science.gov (United States)

Thach, W T

2014-02-01

Opinion is divided on what the exact function of the cerebellum is. Experiments are summarized that support the following views: (1) the cerebellum is a combiner of multiple movement factors; (2) it contains anatomically fixed permanent focal representation of individual body parts (muscles and segments) and movement modes (e.g., vestibular driven vs. cognitive driven); (3) it contains flexible changing representations/memory of physical properties of the body parts including muscle strength, segment inertia, joint viscosity, and segmental interaction torques (dynamics); (4) it contains mechanisms for learning and storage of the properties in item no. 3 through trial-and-error practice; (5) it provides for linkage of body parts, motor modes, and motordynamics via the parallel fiber system; (6) it combines and integrates the many factors so as to initiate coordinated movements of the many body parts; (7) it is thus enabled to play the unique role of initiating coordinated movements; and (8) this unique causative role is evidenced by the fact that: (a) electrical stimulation of the cerebellum can initiate compound coordinated movements; (b) in naturally initiated compound movements, cerebellar discharge precedes that in downstream target structures such as motor cerebral cortex; and (c) cerebellar ablation abolishes the natural production of compound movements in the awake alert individuals.

Intraoperative 3-tesla MRI in the management of paediatric cranial tumours - initial experience

International Nuclear Information System (INIS)

Avula, Shivaram; Garlick, Deborah; Abernethy, Laurence J.; Mallucci, Connor L.; Pizer, Barry; Crooks, Daniel

2012-01-01

Intraoperative MRI (ioMRI) has been gaining recognition because of its value in the neurosurgical management of cranial tumours. There is limited documentation of its value in children. To review the initial experience of a paediatric 3-Tesla ioMRI unit in the management of cranial tumours. Thirty-eight children underwent ioMRI during 40 cranial tumour resections using a 3-Tesla MR scanner co-located with the neurosurgical operating theatre. IoMRI was performed to assess the extent of tumour resection and/or to update neuronavigation. The intraoperative and follow-up scans, and the clinical records were reviewed. In 27/40 operations, complete resection was intended. IoMRI confirmed complete resection in 15/27 (56%). As a consequence, surgical resection was extended in 5/27 (19%). In 6/27 (22%), ioMRI was equivocal for residual tumour. In 13/40 (33%) operations, the surgical aim was to partially resect the tumour. In 7 of the 13 (54%), surgical resection was extended following ioMRI. In our initial experience, ioMRI has increased the rate of complete resection, with intraoperative surgical strategy being modified in 30% of procedures. Collaborative analysis of ioMRI by the radiologist and neurosurgeon is vital to avoid errors in interpretation. (orig.)

Intraoperative 3-tesla MRI in the management of paediatric cranial tumours - initial experience

Energy Technology Data Exchange (ETDEWEB)

Avula, Shivaram; Garlick, Deborah; Abernethy, Laurence J. [Alder Hey Children' s NHS Foundation Trust, Department of Radiology, Liverpool (United Kingdom); Mallucci, Connor L. [Alder Hey Children' s Hospital, Department of Neurosurgery, Liverpool (United Kingdom); Pizer, Barry [Alder Hey Children' s Hospital, Department of Oncology, Liverpool (United Kingdom); Crooks, Daniel [Walton Centre for Neurology and Neurosurgery, Department of Pathology, Liverpool (United Kingdom)

2012-02-15

Intraoperative MRI (ioMRI) has been gaining recognition because of its value in the neurosurgical management of cranial tumours. There is limited documentation of its value in children. To review the initial experience of a paediatric 3-Tesla ioMRI unit in the management of cranial tumours. Thirty-eight children underwent ioMRI during 40 cranial tumour resections using a 3-Tesla MR scanner co-located with the neurosurgical operating theatre. IoMRI was performed to assess the extent of tumour resection and/or to update neuronavigation. The intraoperative and follow-up scans, and the clinical records were reviewed. In 27/40 operations, complete resection was intended. IoMRI confirmed complete resection in 15/27 (56%). As a consequence, surgical resection was extended in 5/27 (19%). In 6/27 (22%), ioMRI was equivocal for residual tumour. In 13/40 (33%) operations, the surgical aim was to partially resect the tumour. In 7 of the 13 (54%), surgical resection was extended following ioMRI. In our initial experience, ioMRI has increased the rate of complete resection, with intraoperative surgical strategy being modified in 30% of procedures. Collaborative analysis of ioMRI by the radiologist and neurosurgeon is vital to avoid errors in interpretation. (orig.)

Initial clinical experience with a sac-anchoring endoprosthesis for aortic aneurysm repair.

Science.gov (United States)

Donayre, Carlos E; Zarins, Christopher K; Krievins, Dainis K; Holden, Andrew; Hill, Andrew; Calderas, Carlos; Velez, Jaime; White, Rodney A

2011-03-01

All current aortic endografts depend on proximal and distal fixation to prevent migration. However, migration and rupture can occur, particularly in patients with aortic necks that are short or angulated, or both. We present our initial clinical experience with a new sac-anchoring endoprosthesis designed to anchor and seal the device within the aneurysm sac. The initial worldwide experience using a new endoprosthesis for the treatment of aortic aneurysms (Nellix Endovascular, Palo Alto, Calif) was reviewed. The endoprosthesis consists of dual balloon-expandable endoframes surrounded by polymer-filled endobags designed to obliterate the aneurysm sac and maintain endograft position. Clinical results and follow-up contrast computed tomography (CT) scans at 30 days and 6 and 12 months were reviewed. The endograft was successfully deployed in 21 patients with infrarenal aortic aneurysms measuring 5.7 ± 0.7 cm (range, 4.3-7.4 cm). Two patients with common iliac aneurysms were treated with sac-anchoring extenders that maintained patency of the internal iliac artery. Infusion of 71 ± 37 mL of polymer (range, 19-158 mL) into the aortic endobags resulted in complete aneurysm exclusion in all patients. Mean implant time was 76 ± 35 minutes, with 33 ± 17 minutes of fluoroscopy time and 180 ± 81 mL of contrast; estimated blood loss was 174 ± 116 mL. One patient died during the postoperative period (30-day mortality, 4.8%), and one died at 10 months from non-device-related causes. During a mean follow-up of 8.7 ± 3.1 months and a median of 6.3 months, there were no late aneurysm- or device-related adverse events and no secondary procedures. CT imaging studies at 6 months and 1 year revealed no increase in aneurysm size, no device migration, and no new endoleaks. One patient had a limited proximal type I endoleak at 30 days that resolved at 60 days and remained sealed. One patient has an ongoing distal type I endoleak near the iliac bifurcation, with no change in aneurysm

Experience in initial training required for the recognition of the qualified RP expert in Spain

International Nuclear Information System (INIS)

Rodriguez Suarez, M.; Marco Arboli, M.; Menarguez, J.

2003-01-01

An important point of the actions inside the European framework to achieve the harmonisation of the training programmes and recognition was included in the European directive 96/29/Euratom which includes definition and specific tasks of the European Qualified Expert on Radiation Protection (RP). Basic syllabus for training of those experts was developed in the communication 98/C 133/03 concerning BSS applications. Although, in the Spanish education system, the training and recognition requirements of the high level qualified experts on RP was defined since 1977, until 2001, the figure of the Technical Qualified Expert on RP does not appear in the legal framework. In December 2002, a new regulation of the Spanish Regulatory Body, CSN, about qualifications to obtain the recognition of RP Expert in Spain (both high qualified and technical RP experts) was published. Concerning the qualified expert on RP, (RP Officer), responsible of the RP Service, which takes charge of the effective protection and advise radioactive and nuclear facilities in Rp aspects,has to be authorised by the regulatory body. to obtain the RP officer diploma, conceded by the CSN, an initial training of 300 hours and a three-year minimum experience are required (for X-ray installation a 6-month experience is enough). The technical qualified expert on RP is the worker who carried out the tasks in the a RP Service under the supervision of the RP officer. A Technician Qualified Expert on RP does not need an specific accreditation of the Regulatory Body, but an initial RP training and a three-month minimum experience are required and has hold a certificate by the RP officer. Continuous training is also required and as well has to receive a certificate from the RP officer. Since 1977, The Institute for energy Studies has been implementing specific training courses for those professionals who want to obtain the diploma of RP officer (high degree qualified RP expert), conceded by the CSN. Since then

Using Appreciative Inquiry to Explore the Professional Practice of a Lecturer in Higher Education: Moving towards Life-Centric Practice

Science.gov (United States)

Giles, David; Kung, Susie

2010-01-01

This paper reports on a strategy for exploring the life-centric practice of a lecturer in Higher Education. The initiative for this inquiry arose out of the realisation that there did not appear to be positive, heart-lifting stories in a lecturer's current teaching experiences. Using an appreciative eye and supported by a critical friend,…

Modifying mixing and instability growth through the adjustment of initial conditions in a high-energy-density counter-propagating shear experiment on OMEGA

International Nuclear Information System (INIS)

Merritt, E. C.; Doss, F. W.; Loomis, E. N.; Flippo, K. A.; Kline, J. L.

2015-01-01

Counter-propagating shear experiments conducted at the OMEGA Laser Facility have been evaluating the effect of target initial conditions, specifically the characteristics of a tracer foil located at the shear boundary, on Kelvin-Helmholtz instability evolution and experiment transition toward nonlinearity and turbulence in the high-energy-density (HED) regime. Experiments are focused on both identifying and uncoupling the dependence of the model initial turbulent length scale in variable-density turbulence models of k-ϵ type on competing physical instability seed lengths as well as developing a path toward fully developed turbulent HED experiments. We present results from a series of experiments controllably and independently varying two initial types of scale lengths in the experiment: the thickness and surface roughness (surface perturbation scale spectrum) of a tracer layer at the shear interface. We show that decreasing the layer thickness and increasing the surface roughness both have the ability to increase the relative mixing in the system, and thus theoretically decrease the time required to begin transitioning to turbulence in the system. We also show that we can connect a change in observed mix width growth due to increased foil surface roughness to an analytically predicted change in model initial turbulent scale lengths

Initial Experience with the Machine Protection System for LHC

CERN Document Server

Schmidt, Ruediger; Dehning, Bernd; Ferro-Luzzi, Massimiliano; Goddard, Brennan; Lamont, Mike; Siemko, Andrzej; Uythoven, Jan; Wenninger, Jorg; Zerlauth, Markus

2010-01-01

For nominal beam parameters at 7 TeV/c each proton beam with a stored energy of 362 MJ threatens to damage accelerator equipment in case of uncontrolled beam loss. These parameters will only be reached after some years of operation, however, a small fraction of this energy is already sufficient to damage accelerator equipment or experiments. The correct functioning of the machine protection systems is vital during the different operational phases already for initial operation. When operating the complex magnet system, with and without beam, safe operation relies on the protection and interlock systems for the superconducting circuits. For safe injection and transfer of the beams from SPS to LHC, transfer line parameters are monitored, beam absorbers must be in the correct position and the LHC must be ready to accept beam. At the end of a fill and in case of failures beams must be properly extracted onto the dump blocks, for some types of failure within less than few hundred microseconds. Safe operation requir...

Factors influencing the intention of perinatal nurses to adopt the baby-friendly hospital initiative in southeastern quebec, Canada: implications for practice.

Science.gov (United States)

Chabot, Guylaine; Lacombe, Marie

2014-01-01

Nurses play a major role in promoting the baby-friendly hospital initiative (BFHI), yet the adoption of this initiative by nurses remains a challenge in many countries, despite evidences of its positive impacts on breastfeeding outcomes. The aim of this study was to identify the factors influencing perinatal nurses to adopt the BFHI in their practice. Methods. A sample of 159 perinatal nurses from six hospital-based maternity centers completed a survey based on the theory of planned behavior. Hierarchical multiple linear regression analyses were performed to assess the relationship between key independent variables and nurses' intention to adopt the BFHI in their practice. A discriminant analysis of nurses' beliefs helped identify the targets of actions to foster the adoption the BFHI among nurses. Results. The participants are mainly influenced by factors pertaining to their perceived capacity to overcome the strict criteria of the BFHI, the mothers' approval of a nursing practice based on the BFHI, and the antenatal preparation of the mothers. Conclusions. This study provides theory-based evidence for the development of effective interventions aimed at promoting the adoption of the BFHI in nurses' practice.

Navigating Theory and Practice through Evaluation Fieldwork: Experiences of Novice Evaluation Practitioners

Science.gov (United States)

Chouinard, Jill Anne; Boyce, Ayesha S.; Hicks, Juanita; Jones, Jennie; Long, Justin; Pitts, Robyn; Stockdale, Myrah

2017-01-01

To explore the relationship between theory and practice in evaluation, we focus on the perspectives and experiences of student evaluators, as they move from the classroom to an engagement with the social, political, and cultural dynamics of evaluation in the field. Through reflective journals, postcourse interviews, and facilitated group…

Operation of the tokamak fusion test reactor tritium systems during initial tritium experiments

International Nuclear Information System (INIS)

Anderson, J.L.; Gentile, C.; Kalish, M.; Kamperschroer, J.; Kozub, T.; LaMarche, P.; Murray, H.; Nagy, A.; Raftopoulos, S.; Rossmassler, R.; Sissingh, R.; Swanson, J.; Tulipano, F.; Viola, M.; Voorhees, D.; Walters, R.T.

1995-01-01

The high power D-T experiments on the tokamak fusion test reactor (TFTR) at the Princeton Plasma Physics Laboratory commenced in November 1993. During initial operation of the tritium systems a number of start-up problems surfaced and had to be corrected. These were corrected through a series of system modifications and upgrades and by repair of failed or inadequate components. Even as these operational concerns were being addressed, the tritium systems continued to support D-T operations on the tokamak. During the first six months of D-T operations more than 107kCi of tritium were processed successfully by the tritium systems. D-T experiments conducted at TFTR during this period provided significant new data. Fusion power in excess of 9MW was achieved in May 1994. This paper describes some of the early start-up issues, and reports on the operation of the tritium system and the tritium tracking and accounting system during the early phase of TFTR D-T experiments. (orig.)

LWR aerosol containment experiments (LACE) program and initial test results

International Nuclear Information System (INIS)

Muhlestein, L.D.; Hilliard, R.K.; Bloom, G.R.; McCormack, J.D.; Rahn, F.J.

1985-01-01

The LWR aerosol containment experiments (LACE) program is described. The LACE program is being performed at the Hanford Engineer Development Laboratory (operated by Westinghouse Hanford Company) and the initial tests are sponsored by EPRI. The objectives of the LACE program are: to demonstrate, at large-scale, inherent radioactive aerosol retention behavior for postulated high consequence LWR accident situations; and to provide a data base to be used for aerosol behavior . Test results from the first phase of the LACE program are presented and discussed. Three large-scale scoping tests, simulating a containment bypass accident sequence, demonstrated the extent of agglomeration and deposition of aerosols occurring in the pipe pathway and vented auxiliary building under realistic accident conditions. Parameters varied during the scoping tests were aerosol type and steam condensation

Practical Ways Psychotherapy Can Support Physical Healthcare Experiences for Male Survivors of Childhood Sexual Abuse

Science.gov (United States)

Hovey, Angela; Stalker, Carol A.; Schachter, Candice L.; Teram, Eli; Lasiuk, Gerri

2011-01-01

Many survivors of child sexual abuse who engage in psychotherapy also experience physical health problems. This article summarizes the findings of a multiphased qualitative study about survivors' experiences in healthcare settings. The study informed the development of the "Handbook on Sensitive Practice for Health Care Practitioners: Lessons…

Formal Methods: Practice and Experience

DEFF Research Database (Denmark)

Woodcock, Jim; Larsen, Peter Gorm; Bicarregui, Juan

2009-01-01

. Based on this, we discuss the issues surrounding the industrial adoption of formal methods. Finally, we look to the future and describe the development of a Verified Software Repository, part of the worldwide Verified Software Initiative. We introduce the initial projects being used to populate...... the repository, and describe the challenges they address. © 2009 ACM. (146 refs.)...

Evaluating the implementation of a quality improvement process in General Practice using a realist evaluation framework.

Science.gov (United States)

Moule, Pam; Clompus, Susan; Fieldhouse, Jon; Ellis-Jones, Julie; Barker, Jacqueline

2018-05-25

Underuse of anticoagulants in atrial fibrillation is known to increase the risk of stroke and is an international problem. The National Institute for Health Care and Excellence guidance CG180 seeks to reduce atrial fibrillation related strokes through prescriptions of Non-vitamin K antagonist Oral Anticoagulants. A quality improvement programme was established by the West of England Academic Health Science Network (West of England AHSN) to implement this guidance into General Practice. A realist evaluation identified whether the quality improvement programme worked, determining how and in what circumstances. Six General Practices in 1 region, became the case study sites. Quality improvement team, doctor, and pharmacist meetings within each of the General Practices were recorded at 3 stages: initial planning, review, and final. Additionally, 15 interviews conducted with the practice leads explored experiences of the quality improvement process. Observation and interview data were analysed and compared against the initial programme theory. The quality improvement resources available were used variably, with the training being valued by all. The initial programme theories were refined. In particular, local workload pressures and individual General Practitioner experiences and pre-conceived ideas were acknowledged. Where key motivators were in place, such as prior experience, the programme achieved optimal outcomes and secured a lasting quality improvement legacy. The employment of a quality improvement programme can deliver practice change and improvement legacy outcomes when particular mechanisms are employed and in contexts where there is a commitment to improve service. © 2018 John Wiley & Sons, Ltd.

Initial TMX central-cell ICRH experiments

International Nuclear Information System (INIS)

Molvik, A.W.; Coffield, F.E.; Falabella, S.; Griffin, D.; McVey, B.; Pickles, W.; P.

1980-01-01

Four topics are discussed in this report: the feasibility of applying ion cyclotron resonance heating (ICRH) in the TMX central cell, some applications of heating, the results of preliminary experiments, and plans for further ICRH experiments

Initial Egyptian ECMO experience

Directory of Open Access Journals (Sweden)

Akram Abdelbary

2016-04-01

Results: A total of twelve patients received ECMO between January 2014 and June 2015. The mean age was 35.9 years. (range 13–65 years, 8 males, with VV ECMO in 10 patients, and VA ECMO in 2 patients. Out of ten patients of VV ECMO, one had H1N1 pneumonia, one had advanced vasculitic lung, four had bacterial pneumonia, two traumatic lung contusions and one with organophosphorus poisoning, and one undiagnosed etiology leading to severe ARDS. Lung injury score range was 3–3.8, PaO2/FiO2 (20–76 mechanical ventilation duration before ECMO 1–14 days, Femoro-jugular cannulation in 7 patients and femoro-femoral in 2 patients and femoro-subclavian in 1 patient; all patients were initially sedated and paralyzed for (2–4 days and ventilated on pressure controlled ventilation with Pmax of 25 cm H2O and PEEP of 10 cm H2O. In VA ECMO patients were cannulated percutaneously using femoro-femoral approach. One patient showed no neurologic recovery and died after 24 h, the other had CABG on ECMO however the heart didn’t recover and died after 9 days. Heparin intravenous infusion was used initially in all patients and changed to Bivalirudin in 2 patients due to possible HIT. Pump flow ranged from 2.6 to 6.5 L/min. Average support time was 12 days (range 2–24 days. Seven patients (63.3% were successfully separated from ECMO and survived to hospital discharge. Hospital length of stay ranged from 3 to 42 days, tracheostomy was done percutaneously in 5 patients and surgically in 3. Gastrointestinal bleeding occurred in 6 patients, VAP in 7 patients, neurologic complications in 1 patient with complete recovery, cardiac arrhythmias in 3 patients, pneumothorax in 9 patients, and deep venous thrombosis in 2 patients.

Midwives' perceptions and experiences of health promotion practice in Ghana.

Science.gov (United States)

Owusu-Addo, Ebenezer

2015-09-01

This research explores midwives' perceptions and experiences of health promotion practice in Ghana. A qualitative descriptive exploratory design was used in order to gain better insight into midwives' perceptions and experiences of health promotion practice. A total of 21 midwives took part in the study. Data were collected by individual in-depth semi-structured interviews. Thematic analysis was used to analyse the transcript. Five dominant themes emerged from the interview transcripts, namely: health promotion as education, health promotion activities, the value of health promotion, client participation, and midwives' barriers to promoting health. Although midwives underscored the importance of health promotion to their work, their reports indicated that, in practice, midwives mostly delivered health education and behaviour change communication rather than health promotion. The midwives expressed the view that by way of their close association with women, they were in a better position to influence women's health. Health promotion activities engaged by the midwives included weight management, healthy eating, infection prevention, personal hygiene, counselling on family planning, and screening for hazardous and harmful substance use such as alcohol and smoking. All the midwives mentioned that clients participated in their health promotion activities. Factors that were identified by the midwives to enhance client participation were trust, attitude of the midwife, building rapport, creating enabling environment, listening and paying attention to clients and using simple language. The barriers to health promotion identified by the midwives included time, stress, culture, lack of training and inadequate health educational materials. Midwives in this study had limited knowledge about health promotion, yet could play a significant role in influencing health; thus there is a need for on-going in-service training for midwives to focus on health promotion. © The Author

Immediate newborn care practices delay thermoregulation and breastfeeding initiation

Science.gov (United States)

Sobel, Howard L; Silvestre, Maria Asuncion A; Mantaring, Jacinto Blas V; Oliveros, Yolanda E; Nyunt-U, Soe

2011-01-01

Aim A deadly nosocomial outbreak in a Philippine hospital drew nationwide attention to neonatal sepsis. Together with specific infection control measures, interventions that protect newborns against infection-related mortality include drying, skin-to-skin contact, delayed cord clamping, breastfeeding initiation and delayed bathing. This evaluation characterized hospital care in the first hours of life with the intent to drive policy change, strategic planning and hospital reform. Methods Trained physicians observed 481 consecutive deliveries in 51 hospitals using a standardized tool to record practices and timing of immediate newborn care procedures. Results Drying, weighing, eye care and vitamin K injections were performed in more than 90% of newborns. Only 9.6% were allowed skin-to-skin contact. Interventions were inappropriately sequenced, e.g. immediate cord clamping (median 12 sec), delayed drying (96.5%) and early bathing (90.0%). While 68.2% were put to the breast, they were separated two minutes later. Unnecessary suctioning was performed in 94.9%. Doctors trained in neonatal resuscitation were 2.5 (1.1–5.7) times more likely to unnecessarily suction vigorous newborns. Two per cent died and 5.7% developed sepsis/pneumonia. Conclusions This minute-by-minute observational assessment revealed that performance and timing of immediate newborn care interventions are below WHO standards and deprive newborns of basic protections against infection and death. PMID:21375583

Nurse leaders' experiences of implementing regulatory changes in sexual health nursing practice in British Columbia, Canada.

Science.gov (United States)

Bungay, Vicky; Stevenson, Janine

2013-05-01

Most research about regulatory policy change concerning expanded nursing activities has emphasized advanced practice roles and acute care settings. This study is a contribution to the small pool of research concerned with regulatory policy implementation for nurses undertaking expanded nursing practice activities in a public health context. Using the regulatory changes in certified nursing practice in one Canadian province as our starting point, we investigated the experiences of nurse leaders in implementing this change. Using a qualitative interpretive descriptive approach informed by tenets of complexity theory, we examined the experiences of 16 nurse leaders as situated within the larger public health care system in which nurses practice. Two interrelated themes, (a) preparing for certification and (b) the certification process, were identified to illustrate how competing and contrasting demands between health care and regulatory organizations created substantial barriers to policy change. Implications for health service delivery and future research are discussed.

Hawaii Utility Integration Initiatives to Enable Wind (Wind HUI) Final Technical Report

Energy Technology Data Exchange (ETDEWEB)

Dora Nakafuji; Lisa Dangelmaier; Chris Reynolds

2012-07-15

To advance the state and nation toward clean energy, Hawaii is pursuing an aggressive Renewable Portfolio Standard (RPS), 40% renewable generation and 30% energy efficiency and transportation initiatives by 2030. Additionally, with support from federal, state and industry leadership, the Hawaii Clean Energy Initiative (HCEI) is focused on reducing Hawaii's carbon footprint and global warming impacts. To keep pace with the policy momentum and changing industry technologies, the Hawaiian Electric Companies are proactively pursuing a number of potential system upgrade initiatives to better manage variable resources like wind, solar and demand-side and distributed generation alternatives (i.e. DSM, DG). As variable technologies will continue to play a significant role in powering the future grid, practical strategies for utility integration are needed. Hawaiian utilities are already contending with some of the highest penetrations of renewables in the nation in both large-scale and distributed technologies. With island grids supporting a diverse renewable generation portfolio at penetration levels surpassing 40%, the Hawaiian utilities experiences can offer unique perspective on practical integration strategies. Efforts pursued in this industry and federal collaborative project tackled challenging issues facing the electric power industry around the world. Based on interactions with a number of western utilities and building on decades of national and international renewable integration experiences, three priority initiatives were targeted by Hawaiian utilities to accelerate integration and management of variable renewables for the islands. The three initiatives included: Initiative 1: Enabling reliable, real-time wind forecasting for operations by improving short-term wind forecasting and ramp event modeling capabilities with local site, field monitoring; Initiative 2: Improving operators situational awareness to variable resources via real-time grid condition

Learning to walk the community of practice tightrope

Directory of Open Access Journals (Sweden)

Denise Edgar

2016-11-01

Full Text Available Background: The Community of Practice Research was established as a new local health district service initiative. The community comprises novice and experienced multidisciplinary health researchers. Aims: This paper reflects our experience of being Community of Practice Research members and aims to explore the practice development principles aligned to the purpose, progress and outcomes of this community. Conclusions: The journey is compared to walking a tightrope from the beginning to the end. Success in moving forward is attributed to positive leadership and group dynamics enabling a supportive environment. This environment allowed for different types of learning: new research skills and new understandings about oneself. Competing demands such as fluctuating membership and leadership, and the selection of a large initial project were identified as barriers to the Community of Practice Research. Implications for practice: As well as contributing to communities’ shared goals members should identify and make explicit their own learning goals to themselves, the community and their managers Community of practice meetings should include regular facilitated reflection about the learning that is occurring, the challenges and assumptions being made by the group, and the way forward A community of practice uses social processes to aid learning and collaboration across disciplines and organisations and therefore has potential to promote local culture change

THE USES OF HUMOR IN SOCIAL WORK PRACTICE: ANALYSIS OF SOCIAL WORKERS’ EXPERIENCE

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Gabrielė Vaitulionytė

2016-12-01

Full Text Available The article discusses how humor could enrich social work practice and guideline social workers. Social work field is not that traditionally relates with humor. While social work scholars argue that social work field is full of contradictions and humor is relevant tool to express those contradictions and paradoxes. In micro level practice Gitterman (2003 suggests humor could be a creative tool that “must be used differently based on client background, level of functioning, and specific situation”. Article presents results of qualitative study. The analysis of social workers’ professional experiences is based on social constructionism perspective with the aim to explain how humor is used in everyday practice and how use of purposive humor could be helpful in social work intervention. Episodic interviews with six social workers working in intercultural social work field were conducted. Transcripts of interviews were analyzed through conceptualization, developing story and maximizing aims of the study. Anonymity and confidentiality was considered. The results of analysis demonstrate that humor is unique experience in the sociocultural context. Discursive categories explain the purpose of humor for practice, circumstances and conditions for using that determine how the use of humor could contribute to the success of a social worker-client interaction. Using humor is considered as professional competence, which suggests that “having a good sense of humor” and appropriate use of humor with ability to demonstrate empathy and honesty in social worker-client interaction is an important part of social worker competence. Humor as a professional competence contained understanding of the humorous taboo. During analysis were explored how using humor and cultural stories of clients create mezzo level strategies for professional social work practice. Keywords: humor in social work practice, social work process, humor taboo.

Sustaining Participatory Design Initiatives

DEFF Research Database (Denmark)

Iversen, Ole Sejer; Dindler, Christian

2014-01-01

While many participatory design (PD) projects succeed in establishing new organisational initiatives or creating technology that is attuned to the people affected, the issue of how such results are sustained after the project ends remains an important challenge. We explore the challenge...... these various forms of sustainability may be pursued in PD practice and how they can become a resource in reflecting on PD activities. Finally, we discuss implications for PD practice, suggesting that a nuanced conception of sustainability and how it may relate to PD practice are useful resources for designers...... of sustaining PD initiatives beyond the individual project and discuss implications for PD practice. First, based on current PD literature, we distinguish between four ideal typical forms of sustainability: maintaining, scaling, replicating and evolving. Second, we demonstrate from a case study how...

Effect of peer counselling by mother support groups on infant and young child feeding practices: the Lalitpur experience.

Science.gov (United States)

Kushwaha, Komal P; Sankar, Jhuma; Sankar, M Jeeva; Gupta, Arun; Dadhich, J P; Gupta, Y P; Bhatt, Girish C; Ansari, Dilshad A; Sharma, B

2014-01-01

Our primary objective was to evaluate the effect of peer counselling by mother support groups (MSG's) in improving the infant and young child feeding (IYCF) practices in the community. We conducted this repeated-measure before and after study in the Lalitpur district of Uttar Pradesh, India between 2006 and 2011. We assessed the IYCF practices before and after creating MSG's within the community. The feeding practices were reassessed at two time points-2 (T1) and 5 years (T2) after the intervention and compared with that of the pre-intervention phase (T0). The total population covered by the project from the time of its initiation was 105000. A total of 425 (T0), 480 (T1) and 521 (T2) mother infant pairs were selected from this population. There was significant improvement in the following IYCF practices in the community (represented as %; adjOR (95% CI, p) such as initiation of breast feeding within 1 hour at both T1 (71% vs. 11%); 19.6 (13.6, 28.2, p =  counseling by MSG's improved the IYCF practices in the district and could be sustained.

Nursing Practice in Primary Care and Patients' Experience of Care.

Science.gov (United States)

Borgès Da Silva, Roxane; Brault, Isabelle; Pineault, Raynald; Chouinard, Maud-Christine; Prud'homme, Alexandre; D'Amour, Danielle

2018-01-01

Nurses are identified as a key provider in the management of patients in primary care. The objective of this study was to evaluate patients' experience of care in primary care as it pertained to the nursing role. The aim was to test the hypothesis that, in primary health care organizations (PHCOs) where patients are systematically followed by a nurse, and where nursing competencies are therefore optimally used, patients' experience of care is better. Based on a cross-sectional analysis combining organizational and experience of care surveys, we built 2 groups of PHCOs. The first group of PHCOs reported having a nurse who systematically followed patients. The second group had a nurse who performed a variety of activities but did not systematically follow patients. Five indicators of care were constructed based on patient questionnaires. Bivariate and multivariate linear mixed models with random intercepts and with patients nested within were used to analyze the experience of care indicators in both groups. Bivariate analyses revealed a better patient experience of care in PHCOs where a nurse systematically followed patients than in those where a nurse performed other activities. In multivariate analyses that included adjustment variables related to PHCOs and patients, the accessibility indicator was found to be higher. Results indicated that systematic follow-up of patients by nurses improved patients' experience of care in terms of accessibility. Using nurses' scope of practice to its full potential is a promising avenue for enhancing both patients' experience of care and health services efficiency.

A Thematic Inquiry into the Burnout Experience of Australian Solo-Practicing Clinical Psychologists

Science.gov (United States)

Hammond, Trent E.; Crowther, Andrew; Drummond, Sally

2018-01-01

Objective: Burnout is conceptualized as a syndrome that consists of emotional exhaustion, depersonalization, and decreased personal accomplishment. Despite the increased frequency and severity of burnout in the Western world, there is limited published research regarding the experiences of clinical psychologists who have had burnout. The present study examines clinical psychologists’ different experiences of burnout in Australia. Design and Methods: In the year 2015, six privately practicing and solo-employed clinical psychologists provided rich qualitative data by participating in semi-structured interviews. Thematic analysis was the method used to analyze clinical psychologists’ natural accounts of their burnout experiences. Using NVivo, emerging themes were identified through coding ‘first order constructs’ and then axial code ‘second order constructs.’ Findings: Clinical psychologists indicated that their roles are demanding and a diverse range of symptoms, including the enduring effects of burnout, mental stress, fatigue, decreased personal accomplishment, negative affect, depersonalization, reduced productivity and motivation, and insomnia. They identified precursors of burnout, including excessive workload and hours of work, life stresses, mismanaged workload, and transference. Clinical psychologists suggested that protective factors of burnout include knowledge and years worked in direct care, and trusting and long-term relationships. They indicated that the barriers to overcoming burnout include the fallacy that their clients’ expectations and needs are more important than their own, the financial cost of working in private practice, contemporary knowledge and inadequate education regarding self-care, and time constraints. Discussion and Conclusion: The findings presented in this study provide psychologists and other health professionals with an insight about the burnout experience and inform professionals of the mental shortcomings of

A Thematic Inquiry into the Burnout Experience of Australian Solo-Practicing Clinical Psychologists

Directory of Open Access Journals (Sweden)

Trent E. Hammond

2018-01-01

Full Text Available Objective: Burnout is conceptualized as a syndrome that consists of emotional exhaustion, depersonalization, and decreased personal accomplishment. Despite the increased frequency and severity of burnout in the Western world, there is limited published research regarding the experiences of clinical psychologists who have had burnout. The present study examines clinical psychologists’ different experiences of burnout in Australia.Design and Methods: In the year 2015, six privately practicing and solo-employed clinical psychologists provided rich qualitative data by participating in semi-structured interviews. Thematic analysis was the method used to analyze clinical psychologists’ natural accounts of their burnout experiences. Using NVivo, emerging themes were identified through coding ‘first order constructs’ and then axial code ‘second order constructs.’Findings: Clinical psychologists indicated that their roles are demanding and a diverse range of symptoms, including the enduring effects of burnout, mental stress, fatigue, decreased personal accomplishment, negative affect, depersonalization, reduced productivity and motivation, and insomnia. They identified precursors of burnout, including excessive workload and hours of work, life stresses, mismanaged workload, and transference. Clinical psychologists suggested that protective factors of burnout include knowledge and years worked in direct care, and trusting and long-term relationships. They indicated that the barriers to overcoming burnout include the fallacy that their clients’ expectations and needs are more important than their own, the financial cost of working in private practice, contemporary knowledge and inadequate education regarding self-care, and time constraints.Discussion and Conclusion: The findings presented in this study provide psychologists and other health professionals with an insight about the burnout experience and inform professionals of the mental

A Thematic Inquiry into the Burnout Experience of Australian Solo-Practicing Clinical Psychologists.

Science.gov (United States)

Hammond, Trent E; Crowther, Andrew; Drummond, Sally

2017-01-01

Objective: Burnout is conceptualized as a syndrome that consists of emotional exhaustion, depersonalization, and decreased personal accomplishment. Despite the increased frequency and severity of burnout in the Western world, there is limited published research regarding the experiences of clinical psychologists who have had burnout. The present study examines clinical psychologists' different experiences of burnout in Australia. Design and Methods: In the year 2015, six privately practicing and solo-employed clinical psychologists provided rich qualitative data by participating in semi-structured interviews. Thematic analysis was the method used to analyze clinical psychologists' natural accounts of their burnout experiences. Using NVivo, emerging themes were identified through coding 'first order constructs' and then axial code 'second order constructs.' Findings: Clinical psychologists indicated that their roles are demanding and a diverse range of symptoms, including the enduring effects of burnout, mental stress, fatigue, decreased personal accomplishment, negative affect, depersonalization, reduced productivity and motivation, and insomnia. They identified precursors of burnout, including excessive workload and hours of work, life stresses, mismanaged workload, and transference. Clinical psychologists suggested that protective factors of burnout include knowledge and years worked in direct care, and trusting and long-term relationships. They indicated that the barriers to overcoming burnout include the fallacy that their clients' expectations and needs are more important than their own, the financial cost of working in private practice, contemporary knowledge and inadequate education regarding self-care, and time constraints. Discussion and Conclusion: The findings presented in this study provide psychologists and other health professionals with an insight about the burnout experience and inform professionals of the mental shortcomings of working as a solo-practicing

Student Experiences: the 2013 Cascadia Initiative Expedition Team's Apply to Sail Program

Science.gov (United States)

Mejia, H.; Hooft, E. E.; Fattaruso, L.

2013-12-01

During the summer of 2013, the Cascadia Initiative Expedition Team led six oceanographic expeditions to recover and redeploy ocean bottom seismometers (OBSs) across the Cascadia subduction zone and Juan de Fuca plate. The Cascadia Initiative (CI) is an onshore/offshore seismic and geodetic experiment to study questions ranging from megathrust earthquakes to volcanic arc structure to the formation, deformation and hydration of the Juan de Fuca and Gorda plates with the overarching goal of understanding the entire subduction zone system. The Cascadia Initiative Expedition Team is a team of scientists charged with leading the oceanographic expeditions to deploy and recover CI OBSs and developing the associated Education and Outreach effort. Students and early career scientists were encouraged to apply to join the cruises via the Cascadia Initiative Expedition Team's Apply to Sail Program. The goal of this call for open participation was to help expand the user base of OBS data by providing opportunities for students and scientists to directly experience at-sea acquisition of OBS data. Participants were required to have a strong interest in learning field techniques, be willing to work long hours at sea assisting in OBS deployment, recovery and preliminary data processing and have an interest in working with the data collected. In total, there were 51 applicants to the Apply to Sail Program from the US and 4 other countries; 21 graduate students as well as a few undergraduate students, postdocs and young scientists from the US and Canada were chosen to join the crew. The cruises lasted from 6 to 14 days in length. OBS retrievals comprised the three first legs, of which the first two were aboard the Research Vessel Oceanus. During each of the retrievals, multiple acoustic signals were sent while the vessel completed a semi-circle around the OBS to accurately determine its position, a final signal was sent to drop the seismometer's anchor, and finally the ship and crew

Instructional and Career Guidance in STEM: An Improvement Initiative to Create Opportunities for Female High School Students

Science.gov (United States)

Belcher, Aaron Heath

The purpose of this disquisition is to disseminate an improvement initiative in a public high school that addressed female Science, Technology, Engineering and Math (STEM) disparity in STEM classes. In this high school current instructional and career guidance practices were inadequate in providing female STEM students opportunities to experience relevant instruction in STEM through the application of real world practices. The improvement initiative identified four interventions using qualitative research that addressed the question, how do instructional and career guidance practices that emphasize the real world application of STEM impact the academic choices and career aspirations of female STEM students? The interventions include (1) instructional feedback (2) instructional resources, (3) career coaching, and (4) community college partnership. These interventions were chosen as a result of insider research methods that followed a scan, focus, summarize framework for understanding the problem. The aim of the improvement initiative was to develop structured protocols that impact STEM classroom and career guidance practices. An intervention team intended to identify opportunities for female STEM students to experience the real world application of STEM. First, the research context is explained. Then, a review of the literature explains foundation knowledge that led to the conceptual and leadership framework. Next, the research methodology is outlined including design and participants, survey instruments, procedures, timeline, and measures. The research methodology is followed by an analysis of data for instructional and career guidance practice efficacy. Finally, a discussion of the initiative and its outcome are illustrated through the stories of three female STEM students. As a result of these stories, the intervention team developed STEM classroom observation protocols. These protocols can be used by school leaders as a structure for STEM instruction and career

Plasma Discharge Initiation of Explosives in Rock Blasting Application: A Case Study

International Nuclear Information System (INIS)

Chae, Jae-Ou; Jeong, Young-Jun; Shmelev, V M; Denicaev, A A; Poutchkov, V M; Ravi, V

2006-01-01

A plasma discharge initiation system for the explosive volumetric combustion charge was designed, investigated and developed for practical application. Laboratory scale experiments were carried out before conducting the large scale field tests. The resultant explosions gave rise to less noise, insignificant seismic vibrations and good specific explosive consumption for rock blasting. Importantly, the technique was found to be safe and environmentally friendly

[Sexual initiation, masculinity and health: narratives of young men].

Science.gov (United States)

Rebello, Lúcia Emilia Figueiredo de Sousa; Gomes, Romeu

2009-01-01

The main objective of this study was to analyze the narratives of young university students about the experience of sexual initiation. The theoretical and conceptual references used were the sexual scripts of our society that inform people about when, how, where and with whom they should have their sexual experiences, indicating how to act sexually and the reasons why they have to practice some kind of sexual activity. The method used was a qualitative study of narratives from the perspective of dialectic hermeneutics. The methodological design involves the comprehension of sceneries, contexts, environments and characters of the narratives about sexual initiation. The analysis refers to narratives of university students in the city of Rio de Janeiro. Among the meanings of sexual initiation, we emphasize sexual intercourse, the demarcation of a stage of life, the awakening to the opposite sex and the discovery of the body. We observed that the young men's narratives were coherent with what is considered masculine, present in the discourse of different generations. It is concluded that the young men should be encouraged to participate in actions combining health and education aimed at promotion of sexual and reproductive health.

Strengthening Multipayer Collaboration: Lessons From the Comprehensive Primary Care Initiative.

Science.gov (United States)

Anglin, Grace; Tu, H A; Liao, Kristie; Sessums, Laura; Taylor, Erin Fries

2017-09-01

Policy Points: Collaboration across payers to align financial incentives, quality measurement, and data feedback to support practice transformation is critical, but challenging due to competitive market dynamics and competing institutional priorities. The Centers for Medicare & Medicaid Services or other entities convening multipayer initiatives can build trust with other participants by clearly outlining each participant's role and the parameters of collaboration at the outset of the initiative. Multipayer collaboration can be improved if participating payers employ neutral, proactive meeting facilitators; develop formal decision-making processes; seek input on decisions from practice representatives; and champion the initiative within their organizations. With increasing frequency, public and private payers are joining forces to align goals and resources for primary care transformation. However, sustaining engagement and achieving coordination among payers can be challenging. The Comprehensive Primary Care (CPC) initiative is one of the largest multipayer initiatives ever tested. Drawing on the experience of the CPC initiative, this paper examines the factors that influence the effectiveness of multipayer collaboration. This paper draws largely on semistructured interviews with CPC-participating payers and payer conveners that facilitated CPC discussions and on observation of payer meetings. We coded and analyzed these qualitative data to describe collaborative dynamics and outcomes and assess the factors influencing them. We found that several factors appeared to increase the likelihood of successful payer collaboration: contracting with effective, neutral payer conveners; leveraging the support of payer champions, and seeking input on decisions from practice representatives. The presence of these factors helped some CPC regions overcome significant initial barriers to achieve common goals. We also found that leadership from the Centers for Medicare & Medicaid

Characteristics of Patient-Centered Medical Home Initiatives that Generated Savings for Medicare: a Qualitative Multi-Case Analysis.

Science.gov (United States)

Burton, Rachel A; Lallemand, Nicole M; Peters, Rebecca A; Zuckerman, Stephen

2018-02-05

Through the Multi-Payer Advanced Primary Care Practice (MAPCP) Demonstration, Medicare, Medicaid, and private payers offered supplemental payments to 849 primary care practices that became patient-centered medical homes (PCMHs) in eight states; practices also received technical assistance and data reports. Average Medicare payments were capped at $10 per beneficiary per month in each state. Since there was variation in the eight participating states' demonstration designs, experiences, and outcomes, we conducted a qualitative multi-case analysis to identify the key factors that differentiated states that were estimated to have generated net savings for Medicare from states that did not. States' MAPCP Demonstration initiatives were comprehensively profiled in case studies based on secondary document review, three rounds of annual interviews with state staff, payers, practices, and other stakeholders, and other data sources. Case study findings were summarized in a case-ordered predictor-outcome matrix, which identified the presence or absence of key demonstration design features and experiences and arrayed states based on the amount of net savings or losses they generated for Medicare. We then used this matrix to identify initiative features that were present in at least three of the four states that generated net savings and absent from at least three of the four states that did not generate savings. A majority of the states that generated net savings: required practices to be recognized PCMHs to enter the demonstration, did not allow late entrants into the demonstration, used a consistent demonstration payment model across participating payers, and offered practices opportunities to earn performance bonuses. Practices in states that generated net savings also tended to report receiving the demonstration payments and bonuses they expected to receive, without any issues. Designers of future PCMH initiatives may increase their likelihood of generating net savings by

The effects of initial education and training of future foreign language teachers

Directory of Open Access Journals (Sweden)

Đorđević Ana B.

2016-01-01

Full Text Available The effects that initial education and training of future foreign language teachers have on their pedagogic convictions and practice have been of prime interest of numerous authors in the last three decades. In difference to previous pessimistic conclusions in which this type of intervention was assessed as weak and stressed the persistence of preconceived notions of the candidates based on personal experiences from earlier schooling, more recent studies, in the constructivistic spirit of the change of cognition of the students - future teachers is considered more widely, not only as a complete change of the contents of their convictions, i.e. a sudden turn in their attitudes on the group level, but also as a smaller or bigger level of idiosyncratic reconstruction of the existing pedagogic convictions which happens because of acquiring new information and experiences that can reflect significantly on their future work in classroom. The aim of our research was to explore, by reviewing scientific and professional literature, the effects of the initial education and training of foreign language teachers, and focusing on different aspects of the preparation for the teacher's profession (theoretical lecturing and practical training, to find out in which ways various programs can influence the cognition of foreign language teachers and to consider pedagogic implications that these information might have for the organization of initial education and training of students.

The Experience of Learning Meditation and Mind/Body Practices in the COPD Population.

Science.gov (United States)

Chan, Roxane Raffin; Lehto, Rebecca H

2016-01-01

Persons with Chronic Obstructive Pulmonary Disease (COPD) exhibit high levels of comorbid anxiety that severely worsens their sensation of dyspnea and is associated with high levels of avoidance of essential activities resulting in an increase morbidity and mortality. Increasing meditation and mind/body practices have been shown to decrease anxiety, and improve intrapersonal and interpersonal relationships in general populations, however, results of studies in the COPD population have been mixed. Understanding how persons with COPD experience learning meditation and mind/body skills would aid future meditation-focused mind/body intervention design. A mixed-method study of a community based meditation-focused mind/body intervention for persons with COPD. Reflective journaling, phone exit interviews and survey measures: chronic disease respiratory questionnaire, and Anxiety Sensitivity 3 questionnaire. Eight weekly one hour meditation-focused mind/body classes that taught concentration and insight meditation skills along with mind/body exercises that facilitated increased body and emotional awareness. Out of 41 participants, 32 (73%) contributed detailed experience about learning and practicing meditation and mind/body practices that distilled into four themes, barriers to practice, learning style, emotional processing, and benefits of practice. Of those 32 participants 21 (73%) identified improvement in physical or emotional symptoms. Overall, 13 (40%) participants provided details regarding how they adapted specific meditation skills into daily life to improve emotional function and lessen dyspnea. Anxiety sensitivity to social situations was associated with a lack of participation. Lessons learned for larger scale application to future meditation and mind/body intervention design for chronic illness populations such as COPD are identified. Copyright © 2016 Elsevier Inc. All rights reserved.

Experiences of using email for general practice consultations: a qualitative study.

Science.gov (United States)

Atherton, Helen; Pappas, Yannis; Heneghan, Carl; Murray, Elizabeth

2013-11-01

Reports suggest approximately 21-23% of GPs in the UK have consulted with patients using email, but little is known about the nature of this use and what it means for clinicians and patients in general practice. To understand the use of email consultation in general practice by investigating the experiences of existing users and views of experts. A qualitative study conducted in 2010 using purposive sampling and semi-structured interviews in general practice and community settings in some London boroughs. A maximum variation sample of GPs and patients who had used email for consultation in general practice were recruited, as were policy and/or implementation experts. Interviews continued until saturation was achieved. In total 10 GPs, 14 patients, and six experts were interviewed. Consultation by email was often triggered by logistic or practical issues; motivators for ongoing use were the benefits, such as convenience, for GPs and patients. Both GPs and patients reported concerns about safety and lack of guidance about the 'rules of engagement' in email consultations, with GPs also concerned about workload. In response, both groups attempted to introduce their own rules, although this only went some way to addressing uncertainty. Long term, participants felt there was a need for regulation and guidance. Consultations by email in general practice occur in an unregulated and unstructured way. Current UK policy is to promote consultations by email, making it crucial to consider the responsibility and workload faced by clinicians, and the changes required to ensure safe use; not doing so may risk safety breaches and result in suboptimal care for patients.

Experience and Perception of Sexual Harassment During the Clinical Practice of Korean Nursing Students

OpenAIRE

Lee, Sun-Kyoung; Song, Ju-Eun; Kim, Sue

2011-01-01

Purpose: The purpose of this study was to identify the experience and perception of sexual harassment during the clinical practice of Korean nursing students. Methods: The descriptive study was conducted using a self-report questionnaire from December 2009 to January 2010. Participants were 542 nursing students recruited from 12 nursing colleges in Korea, who had finished 1,000 hours of clinical practice which is the minimum requirement for graduation. Data were analyzed by descriptive sta...

Applying new science leadership theory in planning an international nursing student practice experience in Nepal.

Science.gov (United States)

Doyle, Rose Marie

2004-09-01

Planning an international practice experience for nursing students is a challenging, but rewarding, opportunity. Kwantlen University College faculty members' experience of planning for 8 Bachelor of Science in Nursing students to study abroad was no exception. Faculty members' and students' interest prompted a request for a placement in Nepal. The faculty members involved in the planning were dedicated to using a process that would enable them to remain true to the program philosophy and theoretical underpinnings throughout the entire experience, from the planning phase to the follow-up presentation. Using Wheatley's theory, the students and faculty members reexamined their personal leadership styles to ensure they remained relationship focused, rather than task focused. Wheatley maintained that because the potentiality lies in building strong relationships, it is important to support the creative power that lies in those involved in a project. This article describes new science leadership and relates it to the planning phase for the practice experience in Nepal. Then, reflections on how the philosophy of the program may have influenced the experience are shared. Finally, critical reflection on using this theory in nursing education is presented.

Measuring health systems strength and its impact: experiences from the African Health Initiative.

Science.gov (United States)

Sherr, Kenneth; Fernandes, Quinhas; Kanté, Almamy M; Bawah, Ayaga; Condo, Jeanine; Mutale, Wilbroad

2017-12-21

Health systems are essential platforms for accessible, quality health services, and population health improvements. Global health initiatives have dramatically increased health resources; however, funding to strengthen health systems has not increased commensurately, partially due to concerns about health system complexity and evidence gaps demonstrating health outcome improvements. In 2009, the African Health Initiative of the Doris Duke Charitable Foundation began supporting Population Health Implementation and Training Partnership projects in five sub-Saharan African countries (Ghana, Mozambique, Rwanda, Tanzania, and Zambia) to catalyze significant advances in strengthening health systems. This manuscript reflects on the experience of establishing an evaluation framework to measure health systems strength, and associate measures with health outcomes, as part of this Initiative. Using the World Health Organization's health systems building block framework, the Partnerships present novel approaches to measure health systems building blocks and summarize data across and within building blocks to facilitate analytic procedures. Three Partnerships developed summary measures spanning the building blocks using principal component analysis (Ghana and Tanzania) or the balanced scorecard (Zambia). Other Partnerships developed summary measures to simplify multiple indicators within individual building blocks, including health information systems (Mozambique), and service delivery (Rwanda). At the end of the project intervention period, one to two key informants from each Partnership's leadership team were asked to list - in rank order - the importance of the six building blocks in relation to their intervention. Though there were differences across Partnerships, service delivery and information systems were reported to be the most common focus of interventions, followed by health workforce and leadership and governance. Medical products, vaccines and technologies, and

Pollutants in soil. An introduction to their analysis and evaluation, with practical experiments

International Nuclear Information System (INIS)

Lewandowski, J.; Leitschuh, S.; Koss, V.

1997-01-01

The book goes into soil pollutant mobility and analysis and into the interpretation of measured data. The authors took pains to present their subject in an easy-to-read manner. Practical exercises at the end of each chapter help the student to check up on his knowledge. In view of the Universities' current trend towards a more practice-oriented education, the detailed theoretical section is supplemented by a variety of experiments. The book addresses students of chemistry, geosciences, biology, engineering sciences etc. who are interested in environmental science. (orig.). 120 figs [de

The Effects of Active Videogame Feedback and Practicing Experience on Children's Physical Activity Intensity and Enjoyment.

Science.gov (United States)

Chen, Han; Sun, Haichun

2017-08-01

The study aims to explore the effects of receiving active videogame (AVG) feedback and playing experience on individuals' moderate-to-vigorous physical activity (MVPA) and perceived enjoyment. This was a within-subject design study. The participants included 36 (n = 15 and 21 for boys and girls, respectively) fourth graders enrolled in a rural elementary school in southern Georgia area. The experiment lasted for 6 weeks with each week including three sessions. The participants were assigned in either front row (sensor feedback) or back row (no sensor feedback) during practice, which was alternated in different sessions. Two different dance games were played during the study with each game implemented for 3 weeks. The MVPA was measured with GT3X+ accelerometers. Physical activity (PA) enjoyment was assessed after the completion of the first two and last two sessions of each game. A repeated one-way ANOVA (analysis of variance) was used to examine the effects of AVG feedback and game on MVPA. A repeated one-way MANOVA (multivariate analysis of variance) was conducted for each game to examine the effects of experience and AVG feedback on enjoyment and MVPA. No effects of AVG feedback were found for MVPA or enjoyment (P > 0.05). The effects of experience on MVPA were found for Just Dance Kids 2014 with experience decreased MVPA (P < 0.05). Students who practiced dance AVG without receiving feedback still demonstrated positive affection and accumulated similar MVPA than when practicing while receiving feedback. Experience for certain dance games tends to decrease PA intensity.

"Mind the trap": mindfulness practice reduces cognitive rigidity.

Directory of Open Access Journals (Sweden)

Jonathan Greenberg

Full Text Available Two experiments examined the relation between mindfulness practice and cognitive rigidity by using a variation of the Einstellung water jar task. Participants were required to use three hypothetical jars to obtain a specific amount of water. Initial problems were solvable by the same complex formula, but in later problems ("critical" or "trap" problems solving was possible by an additional much simpler formula. A rigidity score was compiled through perseverance of the complex formula. In Experiment 1, experienced mindfulness meditators received significantly lower rigidity scores than non-meditators who had registered for their first meditation retreat. Similar results were obtained in randomized controlled Experiment 2 comparing non-meditators who underwent an eight meeting mindfulness program with a waiting list group. The authors conclude that mindfulness meditation reduces cognitive rigidity via the tendency to be "blinded" by experience. Results are discussed in light of the benefits of mindfulness practice regarding a reduced tendency to overlook novel and adaptive ways of responding due to past experience, both in and out of the clinical setting.

Tamper Indicating Device: Initial Training, Course 50112

Energy Technology Data Exchange (ETDEWEB)

Bonner, Stephen Ray [Los Alamos National Lab. (LANL), Los Alamos, NM (United States); Sandoval, Dana M. [Los Alamos National Lab. (LANL), Los Alamos, NM (United States)

2018-01-29

Tamper Indicating Device (TID): Initial Training, course #50112, covers Los Alamos National Laboratory (LANL) Material Control & Accountability (MC&A) TID Program procedures for the application and removal of TIDs. LANL’s policy is to comply with Department of Energy (DOE) requirements for the use of TIDs consistent with the graded safeguards described in DOE Manual DOE O 474.2, Nuclear Material Control and Accountability. When you have completed this course, you will: recognize standard practices and procedures of the LANL TID Program; have hands-on experience in the application and removal of LANL TIDs, and; verify the application and removal of LANL TIDs.

Finding a path through the health unit: practical experience of Ugandan patients.

Science.gov (United States)

Mogensen, Hanne O

2005-01-01

Finding one's way through a health facility is not necessarily an easy task for Ugandan patients. Our understanding of how people succeed in doing so, and of the obstacles they encounter on their way, is incomplete if we focus only on the cognitive level of the clinical encounter. Much research in public health and medical anthropology implicitly works with the notion that agency is located in the mind and that cognitive understanding is a precondition for practice. Based on material from eastern Uganda, this article explores the practical experience of Ugandan patients and their relatives and reflects upon the ways in which this notion of agency has often caused us to confuse the spectator's point of view with the actor's point of view. Thus, as Pierre Bourdieu has argued, we are made to look for answers to "questions that practice never asks because it has no need to ask them."

The views and experiences of nurses and midwives in the provision and management of provider-initiated HIV testing and counseling: a systematic review of qualitative evidence.

Science.gov (United States)

Evans, Catrin; Nalubega, Sylivia; McLuskey, John; Darlington, Nicola; Croston, Michelle; Bath-Hextall, Fiona

2016-01-15

Global progress towards HIV prevention and care is contingent upon increasing the number of those aware of their status through HIV testing. Provider-initiated HIV testing and counseling is recommended globally as a strategy to enhance uptake of HIV testing and is primarily conducted by nurses and midwives. Research shows that provider-initiated HIV testing and counseling implementation is sub-optimal. The reasons for this are unclear. The review aimed to explore nurses' and midwives' views and experiences of the provision and management of provider-initiated HIV testing and counseling. All cadres of nurses and midwives were considered, including those who undertake routine HIV testing as part of a diverse role and those who are specifically trained as HIV counselors. Types of phenomenon of interest: The review sought to understand the views and experiences of the provision and management of provider-initiated HIV testing and counseling (including perceptions, opinions, beliefs, practices and strategies related to HIV testing and its implementation in practice). The review included only provider-initiated HIV testing and counseling. It excluded all other models of HIV testing. The review included all countries and all healthcare settings. Types of studies: This review considered all forms of qualitative study design and methodology. Qualitative elements of a mixed method study were included if they were presented separately within the publication. A three-step search strategy was utilized. Eight databases were searched for papers published from 1996 to October 2014, followed by hand searching of reference lists. Only studies published in the English language were considered. Methodological quality was assessed using the Qualitative Assessment and Review Instrument developed by the Joanna Briggs Institute. Qualitative findings were extracted using the Joanna Briggs Institute Qualitative Assessment and Review Instrument. Qualitative research findings were pooled

Effects of the learning assistant experience on in-service teachers' practices

Science.gov (United States)

Gray, Kara E.; Webb, David C.; Otero, Valerie K.

2012-02-01

The Colorado Learning Assistant (LA) Program serves as a content-specific supplement to standard teacher preparation programs. In addition to transforming undergraduate STEM courses, it recruits and prepares math and science majors for teaching careers by involving university STEM faculty. The research reported here compares the teaching practices of in-service teachers who participated in the LA experience as undergraduates to a comparison group of teachers who did not participate in the LA program as undergraduates but were certified to teach through the same program. We report on teachers' views of assessments and differences in their teaching practices. This analysis is based on interviews with approximately 30 teachers and observations of their classrooms throughout their induction years of teaching. This work considers how the LA program may help improve current teacher preparation models.

Using Technology, Bioinformatics and Health Informatics Approaches to Improve Learning Experiences in Optometry Education, Research and Practice

Directory of Open Access Journals (Sweden)

Vivek K. Gupta

2016-11-01

Full Text Available Rapid advances in ocular diagnostic approaches and emerging links of pathological changes in the eye with systemic disorders have widened the scope of optometry as the front line of eye health care. Expanding professional requirements stipulate that optometry students get a meticulous training in relevant information and communication technologies (ICT and various bioinformatics and health informatics software to meet current and future challenges. Greater incorporation of ICT approaches in optometry education can facilitate increased student engagement in shared learning experiences and improve collaborative learning. This, in turn, will enable students to participate in and prepare for the complex real-world situations. A judicious use of ICTs by teachers in learning endeavors can help students develop innovative patterns of thinking to be a successful optometry professional. ICT-facilitated learning enables students and professionals to carry out their own research and take initiatives and thus shifts the equilibrium towards self-education. It is important that optometry and allied vision science schools adapt to the changing professional requirements with pedagogical evolution and react appropriately to provide the best educational experience for the students and teachers. This review aims to highlight the scope of ICT applications in optometry education and professional development drawing from similar experiences in other disciplines. Further, while enhanced use of ICT in optometry has the potential to create opportunities for transformative learning experiences, many schools use it merely to reinforce conventional teaching practices. Tremendous developments in ICT should allow educators to consider using ICT tools to enhance communication as well as providing a novel, richer, and more meaningful medium for the comprehensive knowledge construction in optometry and allied health disciplines.

Using Technology, Bioinformatics and Health Informatics Approaches to Improve Learning Experiences in Optometry Education, Research and Practice.

Science.gov (United States)

Gupta, Vivek K; Gupta, Veer B

2016-11-15

Rapid advances in ocular diagnostic approaches and emerging links of pathological changes in the eye with systemic disorders have widened the scope of optometry as the front line of eye health care. Expanding professional requirements stipulate that optometry students get a meticulous training in relevant information and communication technologies (ICT) and various bioinformatics and health informatics software to meet current and future challenges. Greater incorporation of ICT approaches in optometry education can facilitate increased student engagement in shared learning experiences and improve collaborative learning. This, in turn, will enable students to participate in and prepare for the complex real-world situations. A judicious use of ICTs by teachers in learning endeavors can help students develop innovative patterns of thinking to be a successful optometry professional. ICT-facilitated learning enables students and professionals to carry out their own research and take initiatives and thus shifts the equilibrium towards self-education. It is important that optometry and allied vision science schools adapt to the changing professional requirements with pedagogical evolution and react appropriately to provide the best educational experience for the students and teachers. This review aims to highlight the scope of ICT applications in optometry education and professional development drawing from similar experiences in other disciplines. Further, while enhanced use of ICT in optometry has the potential to create opportunities for transformative learning experiences, many schools use it merely to reinforce conventional teaching practices. Tremendous developments in ICT should allow educators to consider using ICT tools to enhance communication as well as providing a novel, richer, and more meaningful medium for the comprehensive knowledge construction in optometry and allied health disciplines.

Did our current initial treatment practice change after EAU/ESPU vesicoureteral reflux risk grouping?

Science.gov (United States)

Tokat, Eda; Gurocak, Serhat; Ure, Iyimser; Acar, Cenk; Sınık, Zafer; Tan, Mustafa Ozgur

2018-06-02

The "European Association of Urology (EAU) Guidelines on Vesicoureteral Reflux (VUR) in Children (September 2012)" established risk classification by analyzing and defining risk factors for each patient. In this study we aimed to investigate how our initial treatment procedures were affected by EAU/ESPU guideline vesicoureteral reflux risk grouping and to compare the early clinical results of treatments performed before and after the risk classification in our patients with VUR. 334 renal units with regular clinical follow-up who were treated owing to VUR (vesicoureteral reflux) between years 2009 and 2017 were retrospectively reviewed. Preoperative clinical parameters such as grade and laterality of reflux, presence of renal scar, initial and follow-up treatments, findings of medical treatment and surgical procedures were analyzed. The initial medical and surgical methods were compared by categorizing patients according to risk groups before and after 2013. Mean age and follow-up duration were 71.4(6-216) months and 47(4-141) months, respectively. Among the preoperative parameters, only high EAU risk group (p = 0.01) and treating lower urinary tract symptoms (p age, sex, and presence of renal scar at DMSA were not affecting the success of treatment significantly. While no significant difference in medical and surgical treatment rates is observed after risk grouping system in low risk group, the percentages of patients who are treated with surgical methods initially were significantly decreased in moderate and high risk groups (p = 0.002 and p = 0.012, respectively). We determined that VUR risk grouping did not change clinical success significantly in all risk groups. Despite the fact that EAU/ESPU VUR risk classification changed our current practice in terms of initial treatment method, this different approach did not seem to affect early clinical success positively. There is still an absolute need for studies with larger sample size and long

Advising the Command: Best Practices from the Special Operations Advisory Experience in Afghanistan

Science.gov (United States)

2015-01-01

in their spare time. They looked for opportunities to have lunch with Afghans and reportedly extended offers for dinner .18 The SMW ETT cultivated...extremely close relationships with their counterparts, in part by routinely eating with colleagues in the Afghan dining facility. They initiated the...October 21 and November 21, 2013. The practice is very much akin to that of Task Force (TF) 51, where Norwegian SOF operators eat daily meals with

Sustainable Agricultural Marketing Initiatives

Directory of Open Access Journals (Sweden)

Hakan Adanacıoğlu

2015-07-01

Full Text Available Sustainable marketing is a holistic approach that puts equal emphasis on environmental, social equity, and economic concerns in the development of marketing strategies. The purpose of the study is to examine and discuss the sustainable agricultural marketing initiatives practiced throughout the World and Turkey, and to put forth suggestions to further improve the performance of agricultural marketing initiatives in Turkey. Some of the sustainable agricultural marketing initiatives practiced around the world are carried out through civil organizations. Furthermore; some of these initiatives have also launched by farmers, consumers, food processors and retailers. The long-term strategies to increase these initiatives should be determined due to the fact that examples of successful sustainable agricultural marketing initiatives are inadequate and cannot be spread in Turkey. In this context, first of all, the supports provided by the government to improve agricultural marketing systems, such as EU funds for rural development should be compatible with the goals of sustainable marketing. For this purpose, it should be examined whether all proposed projects related to agricultural marketing meet the social, economic, and environmental principles of sustainable marketing. It is important that supporting organizations, especially civil society organisations, should take an active role for faster dissemination and adoption of sustainable agricultural marketing practices in Turkey. These organizations may provide technical assistance in preparing successful project proposals and training to farm groups. In addition, the other organizations, such as local administrations, producers' associations, cooperatives, can contribute to the success of sustainable agricultural marketing initiatives. The use of direct marketing strategies and vertical integration attempts in sustainable agricultural marketing initiatives that will likely be implemented in Turkey is

Incorrect results in software engineering experiments: How to improve research practices

OpenAIRE

Jørgensen, Magne; Dybå, Tore; Liestøl, Knut; Sjøberg, Dag

2016-01-01

Context The trustworthiness of research results is a growing concern in many empirical disciplines. Aim The goals of this paper are to assess how much the trustworthiness of results reported in software engineering experiments is affected by researcher and publication bias, given typical statistical power and significance levels, and to suggest improved research practices. Method First, we conducted a small-scale survey to document the presence of researcher and publication biases in software...

Developing Structured-Learning Exercises for a Community Advanced Pharmacy Practice Experience

OpenAIRE

Thomas, Renee Ahrens

2006-01-01

The recent growth in the number of pharmacy schools across the nation has resulted in the need for high-quality community advanced pharmacy practice experience (APPE) sites. A vital part of a student's education, these APPEs should be structured and formalized to provide an environment conducive to student learning. This paper discusses how to use a calendar, structured-learning activities, and scheduled evaluations to develop students' knowledge, skills, and abilities in a community pharmacy...

Developing structured-learning exercises for a community advanced pharmacy practice experience.

Science.gov (United States)

Thomas, Renee Ahrens

2006-02-15

The recent growth in the number of pharmacy schools across the nation has resulted in the need for high-quality community advanced pharmacy practice experience (APPE) sites. A vital part of a student's education, these APPEs should be structured and formalized to provide an environment conducive to student learning. This paper discusses how to use a calendar, structured-learning activities, and scheduled evaluations to develop students' knowledge, skills, and abilities in a community pharmacy setting.

Practical experience with the leaky-fuel monitoring at Bohunice NPP

International Nuclear Information System (INIS)

Kacmar, M.; Cizek, J.

2001-01-01

The first part of this paper describes practical experience with the fuel monitoring in operating reactors from point of view possible leakages. Summarized in the paper are numbers leaky fuel assemblies both for NPP and for particular units. Some failure causes are discussed for operational conditions of Bohunice NPP. In the second part of paper critical power ramps on hot fuel rod of leaky fuel assemblies are analysed to eliminate failures from PCI. The main aim of the paper is the need to understand the mechanism and causes of failures (Authors)

Perceptions of the role of general practice and practical support measures for carers of stroke survivors: a qualitative study

Directory of Open Access Journals (Sweden)

Harris Ruth

2011-06-01

Full Text Available Abstract Background Informal carers frequently suffer adverse consequences from caring. General practice teams are well positioned to support them. However, what carers of stroke survivors want and expect from general practice, and the practical support measures they might like, remain largely unexplored. The aims of this study are twofold. Firstly it explores both the support stroke carers would like from general practice and their reactions to the community based support proposed in the New Deal. Secondly, perceptions of a general practice team are investigated covering similar topics to carer interviews but from their perspective. Methods Semi-structured interviews were conducted with 13 stroke carers and 10 members of a general practice team. Carers' experiences and expectations of general practice and opinions of support measures from recent government policy were explored. General practice professionals were asked about their perceived role and their perceptions of carers' support needs. Interviews were content analysed. Results Carers' expectations of support from general practice were low and they neither received nor expected much support for themselves. General practice was seen as reactive primarily because of time constraints. Some carers would appreciate emotional support but others did not want additional services. Responses to recent policy initiatives were mixed with carers saying these might benefit other carers but not themselves. General practice professionals' opinions were broadly similar. They recognise carers' support needs but see their role as reactive, focussed on stroke survivors, rather than carers. Caring was recognised as challenging. Providing emotional support and referral were seen as important but identification of carers was considered difficult. Time constraints limit their support. Responses to recent policy initiatives were positive. Conclusions Carers' expectations of support from general practice for

[Initial experience in robot-assisted colorectal surgery in Mexico].

Science.gov (United States)

Villanueva-Sáenz, Eduardo; Ramírez-Ramírez, Moisés Marino; Zubieta-O'Farrill, Gregorio; García-Hernández, Luis

Colorectal surgery has advanced notably since the introduction of the mechanical suture and the minimally invasive approach. Robotic surgery began in order to satisfy the needs of the patient-doctor relationship, and migrated to the area of colorectal surgery. An initial report is presented on the experience of managing colorectal disease using robot-assisted surgery, as well as an analysis of the current role of this platform. A retrospective study was conducted in order to review five patients with colorectal disease operated using a robot-assisted technique over one year in the initial phase of the learning curve. Gender, age, diagnosis and surgical indication, surgery performed, surgical time, conversion, bleeding, post-operative complications, and hospital stay, were analysed and described. A literature review was performed on the role of robotic assisted surgery in colorectal disease and cancer. The study included 5 patients, 3 men and 2 women, with a mean age of 62.2 years. Two of them were low anterior resections with colorectal primary anastomoses, one of them extended with a loop protection ileostomy, a Frykman-Goldberg procedure, and two left hemicolectomies with primary anastomoses. The mean operating time was 6hours and robot-assisted 4hours 20minutes. There were no conversions and the mean hospital stay was 5 days. This technology is currently being used worldwide in different surgical centres because of its advantages that have been clinically demonstrated by various studies. We report the first colorectal surgical cases in Mexico, with promising results. There is enough evidence to support and recommend the use of this technology as a viable and safe option. Copyright © 2016 Academia Mexicana de Cirugía A.C. Publicado por Masson Doyma México S.A. All rights reserved.

Using Controlled Landslide Initiation Experiments to Test Limit-Equilibrium Analyses of Slope Stability

Science.gov (United States)

Reid, M. E.; Iverson, R. M.; Brien, D. L.; Iverson, N. R.; Lahusen, R. G.; Logan, M.

2004-12-01

Most studies of landslide initiation employ limit equilibrium analyses of slope stability. Owing to a lack of detailed data, however, few studies have tested limit-equilibrium predictions against physical measurements of slope failure. We have conducted a series of field-scale, highly controlled landslide initiation experiments at the USGS debris-flow flume in Oregon; these experiments provide exceptional data to test limit equilibrium methods. In each of seven experiments, we attempted to induce failure in a 0.65m thick, 2m wide, 6m3 prism of loamy sand placed behind a retaining wall in the 31° sloping flume. We systematically investigated triggering of sliding by groundwater injection, by prolonged moderate-intensity sprinkling, and by bursts of high intensity sprinkling. We also used vibratory compaction to control soil porosity and thereby investigate differences in failure behavior of dense and loose soils. About 50 sensors were monitored at 20 Hz during the experiments, including nests of tiltmeters buried at 7 cm spacing to define subsurface failure geometry, and nests of tensiometers and pore-pressure sensors to define evolving pore-pressure fields. In addition, we performed ancillary laboratory tests to measure soil porosity, shear strength, hydraulic conductivity, and compressibility. In loose soils (porosity of 0.52 to 0.55), abrupt failure typically occurred along the flume bed after substantial soil deformation. In denser soils (porosity of 0.41 to 0.44), gradual failure occurred within the soil prism. All failure surfaces had a maximum length to depth ratio of about 7. In even denser soil (porosity of 0.39), we could not induce failure by sprinkling. The internal friction angle of the soils varied from 28° to 40° with decreasing porosity. We analyzed stability at failure, given the observed pore-pressure conditions just prior to large movement, using a 1-D infinite-slope method and a more complete 2-D Janbu method. Each method provides a static

Construction and Initial Validation of the Multiracial Experiences Measure (MEM)

Science.gov (United States)

Yoo, Hyung Chol; Jackson, Kelly; Guevarra, Rudy P.; Miller, Matthew J.; Harrington, Blair

2015-01-01

This article describes the development and validation of the Multiracial Experiences Measure (MEM): a new measure that assesses uniquely racialized risks and resiliencies experienced by individuals of mixed racial heritage. Across two studies, there was evidence for the validation of the 25-item MEM with 5 subscales including Shifting Expressions, Perceived Racial Ambiguity, Creating Third Space, Multicultural Engagement, and Multiracial Discrimination. The 5-subscale structure of the MEM was supported by a combination of exploratory and confirmatory factor analyses. Evidence of criterion-related validity was partially supported with MEM subscales correlating with measures of racial diversity in one’s social network, color-blind racial attitude, psychological distress, and identity conflict. Evidence of discriminant validity was supported with MEM subscales not correlating with impression management. Implications for future research and suggestions for utilization of the MEM in clinical practice with multiracial adults are discussed. PMID:26460977

Highly Adoptable Improvement: A Practical Model and Toolkit to Address Adoptability and Sustainability of Quality Improvement Initiatives.

Science.gov (United States)

Hayes, Christopher William; Goldmann, Don

2018-03-01

Failure to consider the impact of change on health care providers is a barrier to success. Initiatives that increase workload and have low perceived value are less likely to be adopted. A practical model and supporting tools were developed on the basis of existing theories to help quality improvement (QI) programs design more adoptable approaches. Models and theories from the diffusion of innovation and work stress literature were reviewed, and key-informant interviews and site visits were conducted to develop a draft Highly Adoptable Improvement (HAI) Model. A list of candidate factors considered for inclusion in the draft model was presented to an expert panel. A modified Delphi process was used to narrow the list of factors into main themes and refine the model. The resulting model and supporting tools were pilot tested by 16 improvement advisors for face validity and usability. The HAI Model depicts how workload and perceived value influence adoptability of QI initiatives. The supporting tools include an assessment guide and suggested actions that QI programs can use to help design interventions that are likely to be adopted. Improvement advisors reported good face validity and usability and found that the model and the supporting tools helped address key issues related to adoption and reported that they would continue to use them. The HAI Model addresses important issues regarding workload and perceived value of improvement initiatives. Pilot testing suggests that the model and supporting tools are helpful and practical in guiding design and implementation of adoptable and sustainable QI interventions. Copyright © 2017 The Joint Commission. Published by Elsevier Inc. All rights reserved.

“There should be a room for self-initiated activity” A narrative inquiry on my teaching practices

Directory of Open Access Journals (Sweden)

Hanung Triyoko

2016-07-01

Full Text Available This paper is my endeavour to shorten the gap between the realities in my own teaching practices and those practices presented in books and research reports as effective English teaching. In this paper, through narrative inquiry method of writing, I will refer to my experiences to show my way of knowing as well as my way of writing the specific contexts of my teaching of English. Here and then, I may show my subjectivity upon certain issues in the English teaching-learning process but I do this to enable myself go deeper to my personal values. Nonetheless, for the betterment of my classroom practices specifically and the teaching of English for Islamic studies in Indonesia, in general, my inquiry on my own professional practices and the insights on how I should see and make some changes in my teaching as specified by the AAA perspective discussed in details will become a very good start.

Collaborative leadership and the implementation of community-based fall prevention initiatives: a multiple case study of public health practice within community groups.

Science.gov (United States)

Markle-Reid, Maureen; Dykeman, Cathy; Ploeg, Jenny; Kelly Stradiotto, Caralyn; Andrews, Angela; Bonomo, Susan; Orr-Shaw, Sarah; Salker, Niyati

2017-02-16

Falls among community-dwelling older adults are a serious public health concern. While evidence-based fall prevention strategies are available, their effective implementation requires broad cross-sector coordination that is beyond the capacity of any single institution or organization. Community groups comprised of diverse stakeholders that include public health, care providers from the public and private sectors and citizen volunteers are working to deliver locally-based fall prevention. These groups are examples of collective impact and are important venues for public health professionals (PHPs) to deliver their mandate to work collaboratively towards achieving improved health outcomes. This study explores the process of community-based group work directed towards fall prevention, and it focuses particular attention on the collaborative leadership practices of PHPs, in order to advance understanding of the competencies required for collective impact. Four community groups, located in Ontario, Canada, were studied using an exploratory, retrospective, multiple case study design. The criteria for inclusion were presence of a PHP, a diverse membership and the completion of an initiative that fit within the scope of the World Health Organization Fall Prevention Model. Data were collected using interviews (n = 26), focus groups (n = 4), and documents. Cross-case synthesis was conducted by a collaborative team of researchers. The community groups differed by membership, the role of the PHP and the type of fall prevention initiatives. Seven practice themes emerged: (1) tailoring to address context; (2) making connections; (3) enabling communication; (4) shaping a vision; (5) skill-building to mobilize and take action; (6) orchestrating people and projects; and (7) contributing information and experience. The value of recognized leadership competencies was underscored and the vital role of institutional supports was highlighted. To align stakeholders working

Home food preparation practices, experiences and perceptions: A qualitative interview study with photo-elicitation.

Directory of Open Access Journals (Sweden)

Susanna Mills

Full Text Available Food-related choices have an important impact on health. Food preparation methods may be linked to diet and health benefits. However, the factors influencing people's food choices, and how they are shaped by food preparation experiences, are still not fully understood. We aimed to study home food preparation practices, experiences and perceptions amongst adults in North East England. A matrix was used to purposively sample participants with diverse socio-demographic characteristics. Participants developed photographic food diaries that were used as prompts during semi-structured interviews. Data were analysed using the Framework Method. Interviews were conducted with 18 adults (five men and 13 women, aged approximately 20 to 80 years, to reach data saturation. Participants' practices varied widely, from reliance on pre-prepared foods, to preparing complex meals entirely from basic ingredients. Key themes emerged regarding the cook (identity, the task (process of cooking, and the context (situational drivers. Resources, in terms of time, money and facilities, were also underpinning influences on food preparation. Participants' practices were determined by both personal motivations to cook, and the influence of others, and generally reflected compromises between varied competing demands and challenges in life. Most people appeared to be overall content with their food preparation behaviour, though ideally aspired to cook more frequently, using basic ingredients. This often seemed to be driven by social desirability. Home food preparation is complex, with heterogeneous practices, experiences and perceptions both between individuals and within the same individual over time, according to shifting priorities and circumstances. Generalisability of these findings may be limited by the regional participant sample; however the results support and build upon previous research. Focussing interventions on life transition points at which priorities and

Home food preparation practices, experiences and perceptions: A qualitative interview study with photo-elicitation

Science.gov (United States)

White, Martin; Wrieden, Wendy; Brown, Heather; Stead, Martine; Adams, Jean

2017-01-01

Food-related choices have an important impact on health. Food preparation methods may be linked to diet and health benefits. However, the factors influencing people’s food choices, and how they are shaped by food preparation experiences, are still not fully understood. We aimed to study home food preparation practices, experiences and perceptions amongst adults in North East England. A matrix was used to purposively sample participants with diverse socio-demographic characteristics. Participants developed photographic food diaries that were used as prompts during semi-structured interviews. Data were analysed using the Framework Method. Interviews were conducted with 18 adults (five men and 13 women), aged approximately 20 to 80 years, to reach data saturation. Participants’ practices varied widely, from reliance on pre-prepared foods, to preparing complex meals entirely from basic ingredients. Key themes emerged regarding the cook (identity), the task (process of cooking), and the context (situational drivers). Resources, in terms of time, money and facilities, were also underpinning influences on food preparation. Participants’ practices were determined by both personal motivations to cook, and the influence of others, and generally reflected compromises between varied competing demands and challenges in life. Most people appeared to be overall content with their food preparation behaviour, though ideally aspired to cook more frequently, using basic ingredients. This often seemed to be driven by social desirability. Home food preparation is complex, with heterogeneous practices, experiences and perceptions both between individuals and within the same individual over time, according to shifting priorities and circumstances. Generalisability of these findings may be limited by the regional participant sample; however the results support and build upon previous research. Focussing interventions on life transition points at which priorities and circumstances

Home food preparation practices, experiences and perceptions: A qualitative interview study with photo-elicitation.

Science.gov (United States)

Mills, Susanna; White, Martin; Wrieden, Wendy; Brown, Heather; Stead, Martine; Adams, Jean

2017-01-01

Food-related choices have an important impact on health. Food preparation methods may be linked to diet and health benefits. However, the factors influencing people's food choices, and how they are shaped by food preparation experiences, are still not fully understood. We aimed to study home food preparation practices, experiences and perceptions amongst adults in North East England. A matrix was used to purposively sample participants with diverse socio-demographic characteristics. Participants developed photographic food diaries that were used as prompts during semi-structured interviews. Data were analysed using the Framework Method. Interviews were conducted with 18 adults (five men and 13 women), aged approximately 20 to 80 years, to reach data saturation. Participants' practices varied widely, from reliance on pre-prepared foods, to preparing complex meals entirely from basic ingredients. Key themes emerged regarding the cook (identity), the task (process of cooking), and the context (situational drivers). Resources, in terms of time, money and facilities, were also underpinning influences on food preparation. Participants' practices were determined by both personal motivations to cook, and the influence of others, and generally reflected compromises between varied competing demands and challenges in life. Most people appeared to be overall content with their food preparation behaviour, though ideally aspired to cook more frequently, using basic ingredients. This often seemed to be driven by social desirability. Home food preparation is complex, with heterogeneous practices, experiences and perceptions both between individuals and within the same individual over time, according to shifting priorities and circumstances. Generalisability of these findings may be limited by the regional participant sample; however the results support and build upon previous research. Focussing interventions on life transition points at which priorities and circumstances change

'Chasing the numbers': Australian Bachelor of Midwifery students' experiences of achieving midwifery practice requirements for registration.

Science.gov (United States)

Licqurish, Sharon; Seibold, Camel

2013-06-01

to explore one aspect of the findings from a qualitative study exploring Australian Bachelor of Midwifery students' experiences of achieving competency for beginning practice. a qualitative study using grounded theory, incorporating situational analysis. Data were collected by interviews, field observation and students' documents. one university in Victoria, Australia, which was a member of a consortium of universities that first implemented Bachelor of Midwifery curricula. 19 women, aged 20-40 years, completing the Bachelor of Midwifery course between the years 2005 and 2008. data analysis revealed an overarching social process of assimilation, and three related subprocesses namely realisation, adaptation and consolidation. This paper focuses on consolidation in terms of competency achievement in relation to set requirements. while generally found competent for beginning practice, the Bachelor of Midwifery students in this study felt that their ability to achieve competency according to professional midwifery standards, was constrained by the restricted nature of midwifery practice and medical dominance in the hospitals where they were placed. Furthermore, they found it challenging to achieve the minimum midwifery experience requirements, as well as their own personal learning objectives, within the clinical practicum hours provided in the curriculum. a review of the clinical hours provided by Bachelor of Midwifery curricula is required, with a view to ensure that clinical hours are consistent with recommended hours suggested by Australian Bachelor of Midwifery course accreditation standards. Universities implementing midwifery curricula in Australia need to be cognisant of the theory-practice gap and therefore the applicability of professional competency standards to the education of midwives. The concerns about the reliability of competency standards need to be addressed. Finally, further research is required to validate the current number of, minimum practice

Interpreting future physics teachers reflections on their professional practice during initial formation: the search for teaching autonomy construction

OpenAIRE

Rodolfo Langhi; Roberto Nardi

2012-01-01

This research intends to answer the following main question: which traces of teacher autonomy construction are possible to achieve during reflective formative processes in disciplines like Methodology and Physics Teaching Practice carried out during three semesters, in an undergraduate program designed to physics teachers´ initial education? Using an analytical device based on teachers education research assumptions, which we called convergent formative triangulation for progressive teaching ...

Computerisation of general practice in the Republic of Croatia: experience gained in general practice use

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Biserka Bergman-Markovi_

2007-09-01

Full Text Available Well-organised medical records are the prerequisite for achieving a high level of performance in primary healthcare settings. Recording balanced structured and coded data as well as free text can improve both quality and organisation of work in the office. It provides a more substantiated support of financial transactions and accountancy, allows better communication with other facilities and institutions, and is a source of valuable scientific research material. This article is the result of an individual experience gained in general practice use of various programs/ systems employed within the family medicine frame, and the frame of evaluation of available and commonly- exploited program solutions. The use of various programs allows for systematic adjustments as to the increasingly complex requirements imposed on electronic medical records (EMRs. The experience of a general practitioner, presented in this paper, confirms the assumption that an adequate program to be employed with EMRs should be developed, provided that family medicine practitioners, that is, the final users, have been involved in each and every stage of its development, adjustment, implementation and evaluation.

Home food preparation practices, experiences and perceptions: A qualitative interview study with photo-elicitation

OpenAIRE

Mills, Susanna; White, Martin; Wrieden, Wendy; Brown, Heather; Stead, Martine; Adams, Jean

2017-01-01

Food-related choices have an important impact on health. Food preparation methods may be linked to diet and health benefits. However, the factors influencing people's food choices, and how they are shaped by food preparation experiences, are still not fully understood. We aimed to study home food preparation practices, experiences and perceptions amongst adults in North East England. A matrix was used to purposively sample participants with diverse socio-demographic characteristics. Participa...

Prevalence of Sexual Experience and Initiation of Sexual Intercourse Among Adolescents, Rakai District, Uganda, 1994-2011

DEFF Research Database (Denmark)

Santelli, John S; Song, Xiaoyu; Larsen Holden, Inge Kristine

2015-01-01

: Sexual experience was more common among adolescent women than men. The prevalence of sexual experience rose for most age-gender groups after 1994 and then declined after 2002. Factors associated with higher prevalence of sexual experience (without adjustment for other factors) included age, not enrolled......PURPOSE: The purpose of the study was to identify risk factors and time trends for sexual experience and sexual debut in rural Uganda. METHODS: Using population-based, longitudinal data from 15- to 19-year olds in Rakai, Uganda, we examined temporal trends in the prevalence of sexual experience...... and potential risk factors for sexual experience (n = 31,517 person-round observations) using logistic regression. We then identified factors associated with initiation of sex between survey rounds, using Poisson regression to estimate incidence rate ratios (IRR; n = 5,126 person-year observations). RESULTS...

Web-based multimedia vignettes in advanced community pharmacy practice experiences.

Science.gov (United States)

Flowers, Schwanda K; Vanderbush, Ross E; Hastings, Jan K; West, Donna

2010-04-12

To evaluate the effectiveness of Web-based multimedia vignettes on complex drug administration techniques to augment the training of pharmacy students in advanced community pharmacy practice experiences. During the orientation for a community APPE, students were randomly assigned to either a study group or control group After they began their APPE, students in the study group were given an Internet address to access multimedia vignettes which they were required to watch to augment their training and standardize their counseling of patients in the use of inhalers and ear and eye drops. A 12-item questionnaire was administered to students in both groups at the orientation and again on the last day of the APPE to evaluate their knowledge of counseling patients in the use of inhalers and ear and eye drops. The control group did not experience any improvement in their counseling knowledge of the research topics during their month-long experience. Students in the intervention group scored higher on their postintervention test than students in the control group (p < 0.001). Student learning outcomes from experiential training can be improved through the use of Web-based multimedia instructional vignettes.

Associations between Forced Sexual Initiation, HIV Status, Sexual Risk Behavior, Life Stressors, and Coping Strategies among Adolescents in Nigeria.

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Morenike Oluwatoyin Folayan

Full Text Available Some individuals experience their first sexual intercourse through physically forced sex, which affects the way they experience and cope with stress. We examined differences in sexual risk behavior, experience of stressors, and use of stress-coping strategies among adolescents in Nigeria based on their history of forced sexual initiation and HIV status.We analyzed data from 436 sexually active 10-19-year-old adolescents recruited through a population-based survey from 12 Nigerian states. Using Lazarus and Folkman's conceptual framework of stress and coping, we assessed if adolescents who reported forced sexual initiation were more likely to report HIV sexual risk practices, to report as stressors events related to social expectations, medical care and body images, and loss and grief, and to use more avoidance than adaptive coping strategies to manage stress. We also assessed if HIV status affected experience of stressors and use of coping strategies.Eighty-one adolescents (18.6% reported a history of forced sexual initiation; these participants were significantly more likely to report anal sex practices (OR: 5.04; 95% CI: 2.14-11.87, and transactional sex (OR: 2.80; 95% CI: 1.56-4.95. Adolescents with no history of forced sexual initiation were more likely to identify as stressors, life events related to social expectations (OR: 1.03; 95% CI: 0.96-1.11 and loss and grief (OR: 1.34; 95% CI: 0.73-2.65, but not those related to medical care and body images (OR: 0.63; 95% CI: 0.34-1.18. They were also more likely to use adaptive responses (OR: 1.48; 95% CI: 0.62-3.50 than avoidance responses (OR: 0.90; 95% CI: 0.49-1.64 to cope with stress, though these differences were not significant. More adolescents with a history of forced sexual initiation who were HIV positive identified as stressors, life events related to medical care and body images (p = 0.03 and loss and grief (p = 0.009. Adolescents reporting forced sexual initiation and HIV

Multi-detector CT knee arthrography - initial experience

International Nuclear Information System (INIS)

Thomson, J.M.Z.; Fallon, M.; Breidahl, W.H.

2002-01-01

Full text: Traditional plain film arthrography can achieve reasonable accuracy and is an accepted method of investigation of patients with knee pain and possible meniscal tear. Multi-detector CT can potentially provide a more detailed and accurate examination due to its high-resolution crosssectional and multi-planar capabilities. The aim of this study was to assess the accuracy of our technique. All patients who underwent a multi-detector CT knee arthrogram in an initial 8 month period were identified. Initially the referring clinician was contacted. If the patient was referred to an orthopaedic surgeon the outcome of orthopaedic review was recorded using clinical, arthroscopic and / or MRI follow-up of the patient population. One hundred and twelve patients had a Multi-detector CT knee arthrogram performed within and 8 month period. Follow-up information was received in 69.7% of patients. Of these 68.9% had orthopaedic assessment - of which 69.2% underwent a knee arthroscopy.There was total agreement of findings in 67%, agreement of meniscal findings in 67% and chondral findings in 100%. Overall, orthopaedic opinion agreed with CT findings in 76.9%. At this stage, all meniscal tears not described in the initial CT arthrogram report have in retrospect been visible. Multi-detector CT knee arthrography is an accurate and elegant technique for investigation of knee pain, providing information in a format familiar to those reporting knee MRI. There is an initial learning curve. The technique is particularly useful in chondral assessment. It is accurate for meniscal pathology, although caution and recognition of potential pitfalls is required. Copyright (2002) Blackwell Science Pty Ltd

The Influence of Professional Identity on Teaching Practice: Experiences of Four Music Educators

Science.gov (United States)

Carrillo, Carmen; Baguley, Margaret; Vilar, Mercè

2015-01-01

This study explores the influence of professional identity on the teaching practice of four school music educators, two from Spain and two from Australia. Narrative inquiry methodology was utilized in order to investigate the full spectrum of their musical experiences, ranging from their earliest childhood memories to their current positions in…

Predictors of Survival in Contemporary Practice After Initial Radiosurgery for Brain Metastases

Energy Technology Data Exchange (ETDEWEB)

Likhacheva, Anna; Pinnix, Chelsea C. [Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Parikh, Neil R. [Baylor College of Medicine, Houston, Texas (United States); Allen, Pamela K.; McAleer, Mary F. [Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Chiu, Max S. [University of Nebraska-Lincoln, Lincoln, Nebraska (United States); Sulman, Erik P.; Mahajan, Anita [Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Guha-Thakurta, Nandita [Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Prabhu, Sujit S. [Department of Neurosurgery, University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Cahill, Daniel P. [Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts (United States); Luo, Dershan; Shiu, Almon S. [Department of Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Brown, Paul D. [Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Chang, Eric L., E-mail: eric.chang@med.usc.edu [Department of Radiation Oncology, University of Southern California, Los Angeles, Los Angeles, California (United States)

2013-03-01

Purpose: The number of brain metastases (BM) is a major consideration in determining patient eligibility for stereotactic radiosurgery (SRS), but the evidence for this popular practice is equivocal. The purpose of this study was to determine whether, following multivariate adjustment, the number and volume of BM held prognostic significance in a cohort of patients initially treated with SRS alone. Methods and Materials: A total of 251 patients with primary malignancies, including non-small cell lung cancer (34%), melanoma (30%), and breast carcinoma (16%), underwent SRS for initial treatment of BM. SRS was used as the sole management (62% of patients) or was combined with salvage treatment with SRS (22%), whole-brain radiation therapy (WBRT; 13%), or resection (3%). Median follow-up time was 9.4 months. Survival was determined using the Kaplan-Meier method. Cox regression was used to assess the effects of patient factors on distant brain failure (DBF), local control (LC), and overall survival (OS). Results: LC at 1 year was 94.6%, and median time to DBF was 10 months. Median OS was 11.1 months. On multivariate analysis, statistically significant predictors of OS were presence of extracranial disease (hazard ratio [HR], 4.2, P<.001), total tumor volume greater than 2 cm{sup 3} (HR, 1.98; P<.001), age ≥60 years (HR, 1.67; P=.002), and diagnosis-specific graded prognostic assessment (HR, 0.71; P<.001). The presence of extracranial disease was a statistically significant predictor of DBF (HR, 2.15), and tumor volume was predictive of LC (HR, 4.56 for total volume >2 cm{sup 3}). The number of BM was not predictive of DBF, LC, or OS. Conclusions: The number of BM is not a strong predictor for clinical outcomes following initial SRS for newly diagnosed BM. Other factors including total treatment volume and systemic disease status are better determinants of outcome and may facilitate appropriate use of SRS or WBRT.

Diminishing-cues retrieval practice: A memory-enhancing technique that works when regular testing doesn't.

Science.gov (United States)

Fiechter, Joshua L; Benjamin, Aaron S

2017-08-28

Retrieval practice has been shown to be a highly effective tool for enhancing memory, a fact that has led to major changes to educational practice and technology. However, when initial learning is poor, initial retrieval practice is unlikely to be successful and long-term benefits of retrieval practice are compromised or nonexistent. Here, we investigate the benefit of a scaffolded retrieval technique called diminishing-cues retrieval practice (Finley, Benjamin, Hays, Bjork, & Kornell, Journal of Memory and Language, 64, 289-298, 2011). Under learning conditions that favored a strong testing effect, diminishing cues and standard retrieval practice both enhanced memory performance relative to restudy. Critically, under learning conditions where standard retrieval practice was not helpful, diminishing cues enhanced memory performance substantially. These experiments demonstrate that diminishing-cues retrieval practice can widen the range of conditions under which testing can benefit memory, and so can serve as a model for the broader application of testing-based techniques for enhancing learning.

Curriculum renewal: Alignment of introductory pharmacy practice experiences with didactic course content.

Science.gov (United States)

Nuffer, Wesley; Botts, Sheila; Franson, Kari; Gilliam, Eric; Knutsen, Randy; Nuffer, Monika; O'Brien, Elizabeth; Saseen, Joseph; Thompson, Megan; Vande Griend, Joseph; Willis, Robert

2017-11-01

The University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences (SSPPS) used the opportunity of curriculum renewal to integrate knowledge and skills learned from didactic courses into the introductory pharmacy practice experiences (IPPEs) occurring simultaneously. This paper describes and evaluates the meaningful application of course content into IPPEs, and evaluates the success using qualitative feedback. Students entering the renewed curriculum starting in fall 2012 were provided a list of pharmacy skills and activities from didactic course directors that reinforced course content for that semester. The skills and activities were to be completed during the students' IPPE visits in the community or health systems settings, depending on the program year and semester. Students successfully completed course assignments during their IPPE course program. Not all activities could be completed as designed, and many required modification, including simulated experiences. Feedback from faculty and preceptor members of the school's experiential education committee demonstrated that these activities were valuable and improved learning of course material, but were challenging to implement. A renewed curriculum that mapped course assignments for completion in experiential settings was successfully established, after some modifications. The program was modified at regular intervals to improve the ability of preceptors to complete these activities in their individual practice environment. A balance between the school providing guidance on what activities students should perform and allowing unstructured independent learning with the preceptor is needed for an optimal experience. Copyright © 2017 Elsevier Inc. All rights reserved.

Promoting Media Literacy’ as Practicing “Media Reform”: Reflecting on Personal Experiences

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Hui-Ju Tsai

2016-04-01

Full Text Available This paper assesses conceptions and practices in critical media literacy. In particular, it focuses on teaching experience and the processes which combine the educator’s reflection of theories of the ‘public sphere’, ‘media literacy’, and ‘communication civil rights’. The paper is divided into three main parts. The first of four sections will briefly cover the history of media reform and the relationship between the media reform movement and critical media literacy lessons in community colleges. It will connect this to the idea of ‘turn to the public’. The meaning and position of ‘media literacy’ in the broad media reform movement will also be analyzed. Following this, in the second section, conceptualizations of the ‘public sphere’, ‘public pedagogy’, and ‘critical media literacy pedagogy’ will be developed. Finally, three stages of the lesson design and practical interactions will be examined dialectically. In particular, the community college field research on my teaching experience will be described in the third section, and the suggestions, reflections and conclusions from the research will be examined in the last section.

Past Experiences, Present Beliefs, Future Practices: Using Narratives to Re(present) Leadership Educator Identity

Science.gov (United States)

Priest, Kerry L.; Seemiller, Corey

2018-01-01

In an effort to better understand leadership educator preparation, this qualitative study explores leadership educators' identity constructions, or (re)presentations of experiences, beliefs, and practices that contribute to one's professional identity. We used three narrative approaches (storytelling, symbolic interactionism, and anticipatory…

Initial experience with AcQsim CT simulator

International Nuclear Information System (INIS)

Michalski, Jeff M.; Gerber, Russell; Bosch, Walter R.; Harms, William; Matthews, John W.; Purdy, James A.; Perez, Carlos A.

1995-01-01

Purpose: We recently replaced our university developed CT simulator prototype with a commercial grade spiral CT simulator (Picker AcQsim) that is networked with three independent virtual simulation workstations and our 3D radiation therapy planning (3D-RTP) system multiple workstations. This presentation will report our initial experience with this CT simulation device and define criteria for optimum clinical use as well as describe some potential drawbacks of the current system. Methods and Materials: Over a 10 month period, 210 patients underwent CT simulation using the AcQsim. An additional 127 patients had a volumetric CT scan done on the device with their CT data and target and normal tissue contours ultimately transferred to our 3D-RTP system. We currently perform the initial patient localization and immobilization in the CT simulation suite by using CT topograms and a fiducial laser marking system. Immobilization devices, required for all patients undergoing CT simulation, are constructed and registered to a device that defines the treatment table coordinates. Orthogonal anterior and lateral CT topograms document patient alignment and the position of a reference coordinate center. The volumetric CT scan with appropriate CT contrast materials administered is obtained while the patient is in the immobilization device. On average, more than 100 CT slices are obtained per study. Contours defining tumor, target, and normal tissues are drawn on a slice by slice basis. Isocenter definition can be automatically defined within the target volume and marked on the patient and immobilization device before leaving the initial CT simulation session. Virtual simulation is then performed on the patient data set with the assistance of predefined target volumes and normal tissue contours displayed on rapidly computed digital reconstructed radiographs (DRRs) in a manner similar to a conventional fluoroscopic radiotherapy simulator. Lastly, a verification simulation is

The impact of work experience of small and medium-sized enterprises owners or managers on their competitive intelligence awareness and practices

Directory of Open Access Journals (Sweden)

Rene Pellissier

2013-06-01

Objectives: The objective of this research was to establish the influence of owners’ and managers' working experience of CI practice and awareness in the small and medium-sized enterprises (SMEs environment. Method: This research was quantitative in nature and a questionnaire was used to collect data from SMEs owners and managers in The City of Tshwane Metropolitan Municipality. Results: This research indicates that SMEs in the study are aware of CI through education and training. Moreover, the study reveals that the working experience of owners and managers has a great influence on awareness and practice of CI and one should implement training programmes in this domain to assist with building competitive advantage. Conclusion: Small and medium-sized enterprises owners or managers’ years of working experience has a greater influence on awareness and practice of CI. Put differently, years of working experience is a great predictor of CI awareness and practice.

Initial experience with the new da Vinci single-port robot-assisted platform.

Science.gov (United States)

Ballestero Diego, R; Zubillaga Guerrero, S; Truan Cacho, D; Carrion Ballardo, C; Velilla Diez, G; Calleja Hermosa, P; Gutiérrez Baños, J L

2017-06-01

To describe our experience in the first cases of urological surgeries performed with the da Vinci single-port robot-assisted platform. We performed 5 single-port robot-assisted surgeries (R-LESS) between May and October 2014. We performed 3 ureteral reimplant surgeries, one ureteropyeloplasty in an inverted kidney and 1 partial nephrectomy. The perioperative and postoperative results were collected, as well as a report of the complications according to the Clavien classification system. Of the 5 procedures, 4 were performed completely by LESS, while 1 procedure was reconverted to multiport robot-assisted surgery. There were no intraoperative complications. We observed perioperative complications in 4 patients, all of which were grade 1 or 2. The mean surgical time was 262minutes (range, 230-300). In our initial experience with the da Vinci device, R-LESS surgery was feasible and safe. There are still a number of limitations in its use, which require new and improved R-LESS platforms. Copyright © 2016 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.

[Aortic valve preservation in Marfan syndrome. Initial experience].

Science.gov (United States)

Forteza, Alberto; Cortina, Jose M; Sánchez, Violeta; Centeno, Jorge; López, M Jesús; Pérez de la Sota, Enrique; Rufilanchas, Juan J

2007-05-01

Preservation of the aortic valve using the technique described by David has been shown to be as effective as the Bentall-De Bono procedure. It avoids both the need for long-term anticoagulation and the complications associated with mechanical prostheses. We report our initial experience using this technique in patients with Marfan syndrome. Between April 2004 and April 2006, we used the David reimplantation technique in 40 patients with an aortic root aneurysm. Eighteen patients had Marfan syndrome. Their median age was 29 years (13-55 years). Echocardiography showed that the median diameter of the aortic sinus was 53 mm (46-59 mm). In 17 patients, aortic valve preservation was possible. No patient died during hospitalization and there were no significant complications. On echocardiography at discharge, no patient had greater than grade-II aortic regurgitation. During a median follow-up period of 8 months (1-24 months), one patient died due to rupture of an abdominal aneurysm. The others are all in New York Heart Association class I. Preservation of the aortic valve by means of valve reimplantation produced excellent results. It avoided both the thromboembolic and hemorrhagic complications associated with prostheses and the need for long-term anticoagulation. If reimplanted valves continue to function adequately over the long term, this technique should become the treatment of choice for aneurysms of the ascending aorta in patients with Marfan syndrome.

Deep Brain Stimulation Salvages a Flourishing Dental Practice: A Dentist with Essential Tremor Recounts his Experience.

Science.gov (United States)

Giacopuzzi, Guy; Lising, Melanie; Halpern, Casey H

2016-10-22

In recounting his experience with deep brain stimulation (DBS), a practicing dentist challenged with long-standing bilateral essential tremor of the hands shares insights into his diagnosis, treatments, and ultimately successful DBS surgery at Stanford University Medical Center, CA, USA. Now nearly one year after his surgery, his practice continues to flourish and he encourages others in his profession to consider the possibility of DBS as a definitive treatment for tremors of the hand, which may salvage their practice.

Recent and Continuing Initiatives and Practices in Special Education

Science.gov (United States)

Darrow, Alice-Ann; Adamek, Mary S.

2017-01-01

A number of initiatives in special education have occurred in the United States over the years, some mandated by amendments to the Individuals with Disabilities Education Act. Having a working knowledge of these initiatives allows music educators to have informed discussions with colleagues and parents and participate more fully in Individualized…

Contraception Initiation in the Emergency Department: A Pilot Study on Providers' Knowledge, Attitudes, and Practices.

Science.gov (United States)

Liles, Iyanna; Haddad, Lisa B; Lathrop, Eva; Hankin, Abigail

2016-05-01

Almost half of all pregnancies in the United States are unintended; these pregnancies are associated with adverse outcomes. Many reproductive-age females seek care in the emergency department (ED), are at risk of pregnancy, and are amenable to contraceptive services in this setting. Through a pilot study, we sought to assess ED providers' current practices; attitudes; and knowledge of emergency contraception (EC) and nonemergency contraception (non-EC), as well as barriers with respect to contraception initiation. ED physicians and associate providers in Georgia were e-mailed a link to an anonymous Internet questionnaire using state professional databases and contacts. The questionnaire included Likert scales with multiple-choice questions to assess study objectives. Descriptive statistics were generated as well as univariate analyses using χ(2) and Fisher exact tests. A total of 1232 providers were e-mailed, with 119 questionnaires completed. Participants were predominantly physicians (80%), men (59%), and individuals younger than 45 years (59%). Common practices were referrals (96%), EC prescriptions (77%), and non-EC prescriptions (40%). Common barriers were perceived as low likelihood for follow-up (63%), risk of complications (58%), and adverse effects (51%). More than 70% of participants correctly identified the highly effective contraceptive methods, 3% identified the correct maximum EC initiation time, and 42% correctly recognized pregnancy as a higher risk than hormonal contraception use for pulmonary embolism. Most ED providers in this pilot study referred patients for contraception; however, there was no universal contraceptive counseling and management. Many ED providers in this study had an incorrect understanding of the efficacy, risks, and eligibility associated with contraceptive methods. This lack of understanding may affect patient access and be a barrier to patient care.

Engaging Primary Care Practices in Studies of Improvement: Did You Budget Enough for Practice Recruitment?

Science.gov (United States)

Fagnan, Lyle J; Walunas, Theresa L; Parchman, Michael L; Dickinson, Caitlin L; Murphy, Katrina M; Howell, Ross; Jackson, Kathryn L; Madden, Margaret B; Ciesla, James R; Mazurek, Kathryn D; Kho, Abel N; Solberg, Leif I

2018-04-01

The methods and costs to enroll small primary care practices in large, regional quality improvement initiatives are unknown. We describe the recruitment approach, cost, and resources required to recruit and enroll 500 practices in the Northwest and Midwest regional cooperatives participating in the Agency for Healthcare Research and Quality (AHRQ)-funded initiative, EvidenceNOW: Advancing Heart Health in Primary Care. The project management team of each cooperative tracked data on recruitment methods used for identifying and connecting with practices. We developed a cost-of-recruitment template and used it to record personnel time and associated costs of travel and communication materials. A total of 3,669 practices were contacted during the 14- to 18-month recruitment period, resulting in 484 enrolled practices across the 6 states served by the 2 cooperatives. The average number of interactions per enrolled practice was 7, with a total of 29,100 hours and a total cost of $2.675 million, or $5,529 per enrolled practice. Prior partnerships predicted recruiting almost 1 in 3 of these practices as contrasted to 1 in 20 practices without a previous relationship or warm hand-off. Recruitment of practices for large-scale practice quality improvement transformation initiatives is difficult and costly. The cost of recruiting practices without existing partnerships is expensive, costing 7 times more than reaching out to familiar practices. Investigators initiating and studying practice quality improvement initiatives should budget adequate funds to support high-touch recruitment strategies, including building trusted relationships over a long time frame, for a year or more. © 2018 Annals of Family Medicine, Inc.

The experience of mental health professionals using neuro emotional technique in psychotherapeutic practice

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Marriage, Amanda Lynn

This study reviewed how Neuro Emotional Technique (NET) is used in psychotherapeutic practice, and how it is understood and experienced by the practitioners who use it. Participants included 18 mental health professionals who have obtained the certification-level of training in NET and have incorporated NET into their professional practice. A qualitative method was used to explore NET providers' experiences through an online survey. Data from these surveys was analyzed using the constant comparative method. Six categories containing 18 themes emerged as a result of this analysis. These categories included: (1) practitioners currently employing NET; (2) technique utilization; (3) participant estimation of the efficacy of NET; (4) talking about NET; (5) clients most likely to benefit from NET; and (6) clients least likely to benefit from NET. The 18 themes that emerged within these categories represent important components of the integration of NET into psychological treatment. These themes were compared with existing literature to serve as valuable information for psychologists and other mental health professionals seeking to incorporate NET into their professional practices. This study helps to fill the current void in the area of research on NET as a psychological intervention, or more specifically, as a holistic mind-body approach to self-betterment and the amelioration of symptoms for humans who are healing from a broad spectrum of traumatic and stressful experiences.

Building to Make a Difference: Advanced Practice Nurses' Experience of Power.

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Schoales, Catherine A; Bourbonnais, Frances Fothergill; Rashotte, Judy

2018-02-01

Power is necessary for nurses to affect change in patient care and to move the nursing profession forward. Despite the evolving body of nursing research on power, there have been no studies that have investigated the nature of advanced practice nurses' (APNs') power. The purpose of this study was to explore the APNs' lived experience of power. Interpretive phenomenology guided the method and analysis. Eight APNs employed in a single Canadian tertiary care teaching health-care organization engaged in in-depth interviews. The overarching theme, building to make a difference, reflected the APNs' perception of power in their practice, which involved a passion to facilitate change in practice to improve patient care. Building to make a difference involved three themes: building on, building with, and building for. The APNs experienced more power-a process they described as power creep-when they used soft power that was shared with others to affect positive change in health care. These findings contribute to our understanding of how power is perceived and manifested in the APN role, thus further enabling organizations to create working conditions to support the APNs' endeavors to empower others.

Nurses' experiences, expectations, and preferences for mind-body practices to reduce stress.

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Kemper, Kathi; Bulla, Sally; Krueger, Deborah; Ott, Mary Jane; McCool, Jane A; Gardiner, Paula

2011-04-11

Most research on the impact of mind-body training does not ask about participants' baseline experience, expectations, or preferences for training. To better plan participant-centered mind-body intervention trials for nurses to reduce occupational stress, such descriptive information would be valuable. We conducted an anonymous email survey between April and June, 2010 of North American nurses interested in mind-body training to reduce stress. The e-survey included: demographic characteristics, health conditions and stress levels; experiences with mind-body practices; expected health benefits; training preferences; and willingness to participate in future randomized controlled trials. Of the 342 respondents, 96% were women and 92% were Caucasian. Most (73%) reported one or more health conditions, notably anxiety (49%); back pain (41%); GI problems such as irritable bowel syndrome (34%); or depression (33%). Their median occupational stress level was 4 (0 = none; 5 = extreme stress). Nearly all (99%) reported already using one or more mind-body practices to reduce stress: intercessory prayer (86%), breath-focused meditation (49%), healing or therapeutic touch (39%), yoga/tai chi/qi gong (34%), or mindfulness-based meditation (18%). The greatest expected benefits were for greater spiritual well-being (56%); serenity, calm, or inner peace (54%); better mood (51%); more compassion (50%); or better sleep (42%). Most (65%) wanted additional training; convenience (74% essential or very important), was more important than the program's reputation (49%) or scientific evidence about effectiveness (32%) in program selection. Most (65%) were willing to participate in a randomized trial of mind-body training; among these, most were willing to collect salivary cortisol (60%), or serum biomarkers (53%) to assess the impact of training. Most nurses interested in mind-body training already engage in such practices. They have greater expectations about spiritual and emotional than

Initial results from the Wisconsin Spherically Convergent Ion Focus experiment

International Nuclear Information System (INIS)

Thorson, T.A.; Durst, R.D.; Fonck, R.J.; Foucher, B.S.; Wainwright, L.P.

1995-01-01

The Spherically Convergent Ion Focus (SCIF) is an alternative plasma confinement scheme in which ions are electrostatically confined, accelerated, and concentrated at fusion-relevant energies. This concept has been recently promoted for various near-term applications including waste disposal, particle production, neutron radiography and tomography, plastic explosive detection, materials research, and medical isotope production. The Wisconsin SCIF experiments are designed to evaluate the practicality of the SCIF concept for given applications. In the experiment, a wire globe serves as a simple means of producing the trapping potential well and the ion source consists of a cold, uniform plasma at the edge. Hydrogen ions formed from the background neutral gas are typically accelerated to energies of 5--20 kV, and measured cathode grid currents approach the space-charge limit for concentric spheres. Core size measurements utilize spectrally-filtered CCD camera images of the visible emission from the core region, and the minimal observed core radius of 0.6 cm (HWHM) is within a factor of 2--3 of the theoretical convergence ratio for the device. Neutral particle interactions and potential asymmetries imposed by the grid lead to non-ideal convergence, as evidenced by measured potential asymmetries and core size dependence on cathode grid spacing. Floating probes with 30 kV isolation have allowed unique measurements of the density, electric potential and temperature in the converged core. The ratio of core to edge density is 10--20, which is in good agreement with scaling from radial flux conservation

Knowledge, behavioral practices, and experiences of outdoor fallers: Implications for prevention programs.

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Chippendale, Tracy; Raveis, Victoria

2017-09-01

Although the epidemiology and prevention of falls has been well studied, the focus has been on indoor rather than outdoor falls. Older adults' knowledge of outdoor risk factors and their outdoor fall prevention practices have not been examined. To fill this gap, and to inform the development of a prevention program, we sought to explore the experiences and fall prevention knowledge and practices of older adults who had sustained an outdoor fall. A cross-sectional study using random digit telephone dialing was used to survey community dwelling seniors (N=120) across the five boroughs of New York City. We used the Outdoor Falls Questionnaire (OFQ), a valid and reliable tool as the survey instrument. Perceived outdoor fall risks, strategies used for prevention, and outdoor fall experiences were examined. SPSS version 21 was used for descriptive analysis of participant characteristics and to determine frequencies of perceived outdoor fall risks and strategies used for prevention. Phenomenological analysis was used with the qualitative data. Qualitative and quantitative data were analyzed separately and a mixed methods matrix was used to interpret and integrate the findings. Analysis revealed diverse unmet education and training needs including the importance of using single vision glasses, understanding the fall risks associated with recreational areas and parking lots, safe outdoor walking strategies, safe carrying of items on level and uneven surfaces, as well as when walking up and down stairs, and safety in opening/closing doors. Study findings are informative for outdoor fall prevention programs as well as practice. Copyright © 2017 Elsevier B.V. All rights reserved.

A Qualitative Assessment of the Practice Experiences of Certified Diabetes Educator Pharmacists.

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Alzahrani, Fahad; Taylor, Jeff; Perepelkin, Jason; Mansell, Kerry

2015-08-01

To describe the practice experiences of Certified Diabetes Educator (CDE) pharmacists in Saskatchewan and determine what impact the CDE designation has had on their personal practices. A qualitative research approach was used. All pharmacists in Saskatchewan were e-mailed about the study, and eventually, a purposive sampling method was used to select a range of CDE pharmacists. Semistructured, in-person interviews were performed. An interview guide was developed to assess the work activities performed, the benefits of becoming a CDE and the challenges and resultant solutions that optimize their CDE designations. All interviews were transcribed verbatim and coded using deductive thematic analysis to identify the main themes that described the experiences of respondents, with the aid of QSR NVivo. A total of 14 CDE pharmacists from various communities and work settings chose to participate. All of the participants indicated they were engaging in increased diabetes-related activities since becoming CDEs. All participants indicated they were happy with their decisions to become CDEs and described numerous benefits as a direct result of achieving this designation. Although some solutions were offered, participants still face challenges in optimizing their role as CDEs, such as devoting enough time to diabetes management and remuneration for providing diabetes services. CDE pharmacists in Saskatchewan report performing enhanced diabetes-related activities subsequent to becoming CDEs and that obtaining this designation has had a positive impact on their personal practices. A larger, cross-country study is necessary to determine whether these results are consistent amongst all pharmacists in Canada. Copyright © 2015 Canadian Diabetes Association. Published by Elsevier Inc. All rights reserved.

Seclusion and restraint in psychiatry: patients' experiences and practical suggestions on how to improve practices and use alternatives.

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Kontio, Raija; Joffe, Grigori; Putkonen, Hanna; Kuosmanen, Lauri; Hane, Kimmo; Holi, Matti; Välimäki, Maritta

2012-01-01

This study explored psychiatric inpatients' experiences of, and their suggestions for, improvement of seclusion/restraint, and alternatives to their use in Finland. The data were collected by focused interviews (n= 30) and were analyzed with inductive content analysis. Patients' perspectives received insufficient attention during seclusion/restraint processes. Improvements (e.g., humane treatment) and alternatives (e.g., empathetic patient-staff interaction) to seclusion/restraint, as suggested by the patients, focused on essential parts of nursing practice but have not been largely adopted. Patients' basic needs have to be met, and patient-staff interaction has to also continue during seclusion/restraint. Providing patients with meaningful activities, planning beforehand, documenting the patients' wishes, and making patient-staff agreements reduce the need for restrictions and offer alternatives for seclusion/restraint. Service users must be involved in all practical development. © 2011 Wiley Periodicals, Inc.

Teachers’ perceptions of their own initiative: Collective initiative vs. personal initiative

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Džinović Vladimir

2013-01-01

Full Text Available Current trends in education demand from teachers to exhibit proactive behaviour and assume responsibility for the implementation of changes in school practice. In that sense, it is important to study how teachers perceive their own initiative and to gain insight into the activities where such initiative is demonstrated. This study has been conceived as a mixed-methods research. The qualitative study implied forming four focus groups with subject teachers and class teachers (N=38, while the quantitative study entailed surveying 1441 teachers in forty primary schools in Serbia using the questionnaire constructed based on qualitative data. Data from focus groups were processed by qualitative thematic analysis, while the questionnaire data were processed by principal component analysis and univariate analysis of variance. The findings of the study have shown that teachers mostly demonstrate initiative through co­operative activities that include planning of joint teaching as well as conducting joint projects within school and with the local community actors. Teachers are least ready to demonstrate personal initiative and the initiative aimed at accomplishing considerable changes in school work. The concluding part includes the recommendations for encouraging teachers’ personal initiative and building organizational culture that would support such initiative. [Projekat Ministarstva nauke Republike Srbije, br. br. 47008: Unapređivanje kvaliteta i dostupnosti obrazovanja u procesima modernizacije Srbije i br. 179034: Od podsticanja inicijative, saradnje i stvaralaštva u obrazovanju do novih uloga i identiteta u društvu

Survey highlights the need to expand offerings of introductory pharmacy practice experiences in psychiatry and neurology: Benefits and example experiences.

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Bostwick, Jolene R; Leung, Gillian P; Smith, Tawny L; Ahmed, Uzma; Bainbridge, Jacquelyn L; Peyronnet, Jean-Xavier

2018-01-01

Introductory pharmacy practice experiences (IPPEs) are 1 requirement schools and colleges of pharmacy must fulfill to meet accreditation standards. The purpose of this manuscript is to report existing IPPEs in psychiatry and neurology across the United States. Two separate electronic surveys were administered to individual College of Psychiatric and Neurologic Pharmacists members with board certification in psychiatric pharmacy with an academic affiliation and academic institutions in the 2014-15 academic year to assess the neuropsychiatric curriculum in pharmacy programs. Results focusing on IPPEs were summarized using descriptive statistics. Academic institutional data reveal only 37.3% offered IPPEs in psychiatry, and 6.7% offered neurology. The number of available IPPEs is low even if a program offered an available rotation. The majority of College of Psychiatric and Neurologic Pharmacists member respondents (69.9%) did not offer IPPEs in psychiatry in the 2014-15 academic year, and none offered an IPPE in neurology. More than half of individual respondents feel their institution should increase IPPEs in psychiatry and neurology in order to enhance their curriculum. To expand IPPE availability, pharmacy programs should increase early exposure of pharmacy students to patients with psychiatric and neurologic conditions. Longitudinal experiences may allow students to engage in hands-on experiences, which may impact future career aspirations and reduce stigma. Current example IPPEs at the authors' institutions are included to stimulate discussion and action among readers on how IPPEs in these practice areas may be developed. Implementation of IPPEs in psychiatry and neurology is needed for students to gain experience working with these patients.

Ergonomics in dentistry: experiences of the practice by dental students.

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Garcia, P P N S; Gottardello, A C A; Wajngarten, D; Presoto, C D; Campos, J A D B

2017-08-01

The aim of this study was to qualitatively evaluate the experiences of students enrolled in the last year of dentistry school with ergonomic practice. This is a qualitative, observational and cross-sectional study, with a non-probabilistic sample design. The sample comprised students enrolled in the last year of dentistry in Araraquara-UNESP (n = 29). The data were collected by means of open semi-structured and individual interviews, captured by a digital voice recorder. The students were interviewed in their own university at a time that was previously scheduled, and care was taken to provide a private and welcoming environment to carry out the interviews. A script containing questions related to practices in ergonomics was prepared at the university. Data analysis was carried out using the qualitative-quantitative Collective Subject Discourse technique with the aid of Qualiquantisoft ® software program. It was found that more than half of the students (58.6%) believe that adopting an ergonomic posture is important to prevent future problems, pain and occupational diseases, and 62.1% of the students confirm having difficulties in adopting ergonomic postures due to the types of treatment required and the regions of the mouth being treated. The main reasons stated for the fact that their colleagues do not adopt ergonomic postures are lack of attention, practice and forgetfulness (44.8%) and difficulty in visualising the operatory field or the procedure performed (27.6%). It is possible to conclude that the students interviewed know ergonomic principles and their importance in occupational health. However, they found it difficult to put these principles into practice. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Participation in Risk Management Decisions: Theoretical, Practical, and Strategic Difficulties in the Evaluation of Public Participation Initiatives

International Nuclear Information System (INIS)

Rowe, Gene; Frewer, Lynn

2003-01-01

A current trend in risk management, and policy setting more generally, is the involvement of members of the public, or other significant stakeholders, in the decision-making process. Such involvement has been argued to have the advantage of increasing the democratic legitimacy of decisions, and allowing the incorporation of lay insight into problems that have a degree of scientific uncertainty (and hence that are based to some extent on value judgments). One significant issue is the quality or validity of such processes, namely, the issue of evaluation. Evaluation is important, not only from a quality control perspective, but because it may indicate potential improvements for the conduct of further exercises, and importantly, may help to assure participants (and the public more widely) that the exercise is more than just a public relations exercise. However, evaluation of public involvement initiatives is relatively rare, and little discussed in the academic literature. It is also beset with a large number of potential problems and uncertainties. In this paper, we will discuss a variety of problems with conducting evaluations of participation initiatives. These problems range from the theoretical (how one defines effectiveness, how one measures this, how one confirms the validity, reliability and utility of one's measures), to the practical (how one conducts evaluations given limitations in time, space, resources, and possible sources of data), to the strategic/political (how one deals with sponsor/organiser resistance to evaluation). These problems will be discussed from a theoretical point of view, and with reference to practical evaluations that we have conducted with a large variety of governmental and non-governmental organisations, predominantly in the UK. The paper will conclude with a number of recommendations regarding best practice in conducting evaluations

Interprofessional, practice-driven research: reflections of one "community of inquiry" based in acute stroke.

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Hubbard, I J; Vyslysel, G; Parsons, M W

2009-01-01

Research is often scholarship driven and the findings are then channelled into the practice community on the assumption that it is utilising an evidence-based approach in its service delivery. Because of persisting difficulties in bridging the practice-evidence gap in health care, there has been a call for more active links between researchers and practitioners. The authors were part of an interprofessional research initiative which originated from within an acute stroke clinical community. This research initiative aimed to encourage active participation of health professionals employed in the clinical setting and active collaboration across departments and institutions. On reflection, it appeared that in setting up an interprofessional, practice-driven research collaborative, achievements included the instigation of a community of inquiry and the affording of opportunities for allied health professionals to be actively involved in research projects directly related to their clinical setting. Strategies were put in place to overcome the challenges faced which included managing a demanding and frequently changing workplace, and overcoming differences in professional knowledge, skills and expertise. From our experience, we found that interprofessional, practice-driven research can encourage allied health professionals to bridge the practice-evidence gap, and is a worthwhile experience which we would encourage others to consider.

Nurses' beliefs, experiences and practice regarding complementary and alternative medicine in Taiwan.

Science.gov (United States)

Smith, Graeme D; Wu, Shu-Chen

2012-09-01

To gain an insight into this issue, this study used a qualitative approach and aims to explore and describe nurses' beliefs, experiences and practice regarding complementary and alternative medicine in Taiwan. The integration of complementary and alternative medicine with conventional medicine has become more common worldwide in recent years. An increase in patient use and an expansion of nurses using complementary and alternative medicine has spawned further investigation. Most published studies have concentrated on the usage of complementary and alternative medicine in western societies and have focused principally on physicians' attitudes and practice patterns in this regard. Despite the large amount of time and the unique relationship that nurses share with their patients, little research has investigated the nurse's attitudes and practice regarding complementary and alternative medicine. Moreover, there has been no previous research into understanding this issue from the Taiwanese nursing perspective. A qualitative research design. By using an exploratory, descriptive, qualitative approach, data were collected from 11 registered nurses. The methods of the data collection were in-depth, semi-structured interviews, field notes and memos and the data were analysed using the constant comparative method. Three major categories emerged from the data; namely, a 'lack of clear definition', 'limited experience' and 'high interest' towards complementary and alternative medicine. These results suggest that the definition of complementary and alternative medicine is often unclear for nurses in Taiwan. Due to the organisational policies and personal knowledge base, very few nurses integrate complementary and alternative medicine into their daily practice. However, the nurses in Taiwan show a great desire to participate in complementary and alternative medicine continuing education programmes. This study is not only significant in filling the gap in the existing literature

Oncology nurses and the experience of participation in an evidence-based practice project.

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Fridman, Mary; Frederickson, Keville

2014-07-01

To illuminate the experiences of oncology nurses who participated in an evidence-based practice (EBP) project in an institution with an EBP organizational structure. A descriptive phenomenologic approach and in-depth interviews with each participant. An oncology-focused academic medical center with an established organizational infrastructure for EBP. 12 RNs working in an oncology setting who participated in an EBP project. Descriptive, qualitative phenomenologic approach through use of interviews and analysis of interview text. Four essential themes (i.e., support, challenges, evolution, and empowerment) and 11 subthemes emerged that reflected nurses' professional and personal growth, as well as the creation of a culture of EBP in the workplace. The participants described the EBP project as a positive, empowering personal and professional evolutionary experience with supports and challenges that resulted in improvements in patient care. To the authors' knowledge, the current study is the first qualitative study to demonstrate improved nursing outcomes (e.g., professional growth, improved nursing performance) and nurses' perception of improved patient outcomes (e.g., ongoing healthcare collaboration, evidence-based changes in practice).

Experience of developing Twitter-based communities of practice in higher education

Directory of Open Access Journals (Sweden)

Bex Lewis

2013-06-01

Full Text Available This article presents the results of a case study of the use of a microblogging tool by a university academic to increase their knowledge and experience of social media for educational purposes. The academic had the role of digital steward in a university and attempted to use microblogging (Twitter to increase professional contacts within the framework of a community of practice. Several types of data were collected and analysed. These included the structure of the network arising from the links formed with others by microblogging, the similarity of stated interests between the academic and others in the network, and the contents of postings such as their external references. It was found that a personal network had been established, with some of the characteristics of a community of practice. The activity demonstrated the utility of social media in supporting the professional development of academic staff using technology.

Advantages of the Dental Practice-Based Research Network Initiative and Its Role in Dental Education

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Curro, Frederick A.; Grill, Ashley C.; Thompson, Van P.; Craig, Ronald G.; Vena, Don; Keenan, Analia V.; Naftolin, Frederick

2012-01-01

Practice-based research networks (PBRNs) provide a novel venue in which providers can increase their knowledge base and improve delivery of care through participation in clinical studies. This article describes some aspects of our experience with a National Institute of Dental and Craniofacial Research-supported PBRN and discusses the role it can play in dental education. PBRNs create a structured pathway for providers to advance their professional development by participating in the process of collecting data through clinical research. This process allows practitioners to contribute to the goals of evidence-based dentistry by helping to provide a foundation of evidence on which to base clinical decisions as opposed to relying on anecdotal evidence. PBRNs strengthen the professional knowledge base by applying the principles of good clinical practice, creating a resource for future dental faculty, training practitioners on best practices, and increasing the responsibility, accountability, and scope of care. PBRNs can be the future pivotal instruments of change in dental education, the use of electronic health record systems, diagnostic codes, and the role of comparative effectiveness research, which can create an unprecedented opportunity for the dental profession to advance and be integrated into the health care system. PMID:21828299

Change in University Teachers' Elearning Beliefs and Practices: A Longitudinal Study

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Scott, Karen M.

2016-01-01

Little longitudinal research has examined change in university teachers' elearning beliefs and practices after their initial experience with elearning. This study addresses this gap by focusing on six teachers who developed and implemented an elearning resource, and the changes they made to the resource and its implementation over two years. A…

An Examination of the Outcomes of the Undergraduate Leadership Teaching Assistant (ULTA) Experience as a High-Impact Practice in Leadership Education

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Odom, Summer F.; Ho, Sarah P.; Moore, Lori L.

2015-01-01

The Undergraduate Leadership Teaching Assistant (ULTA) experience offers students a high-impact opportunity to develop, practice, and evaluate their leadership knowledge, skills, and abilities. The purpose of this qualitative study was to examine outcomes of the ULTA experience as a high-impact practice for students studying leadership. Weekly…

Practice education in the chronicles conditions prevention

Directory of Open Access Journals (Sweden)

Bárbara Ferreira dos Santos

2016-12-01

Full Text Available http://dx.doi.org/10.5007/1807-0221.2016v13n24p138 This article reports experiences of undergraduates and university teatchers with the community in an extension project developed from March to December of 2015. In this article, the practices of Diabetes Mellitus, Hypertension, Cardiovascular Diseases and Obesity were discussed, with guidelines and demonstrations for the population at school, restaurant and university. The interventions were initiated by talking with the participants about means of prevention, reduction of diseases, healthy recipes and modifications in the habits of life. Practices to combat hypertension and diabetes have addressed ways to minimize diseases through eating and the ones to combat obesity and cardiovascular diseases were performed through dynamics. The practices revealed public interest in changing lifestyles and brought to extensionists practical knowledge, because they were able to put into practice content learned in class, which is one of the objectives of university extension.

Roles and relationships between health professionals involved in insulin initiation for people with type 2 diabetes in the general practice setting: a qualitative study drawing on relational coordination theory.

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Manski-Nankervis, Jo-Anne; Furler, John; Blackberry, Irene; Young, Doris; O'Neal, David; Patterson, Elizabeth

2014-01-31

The majority of care for people with type 2 diabetes occurs in general practice, however when insulin initiation is required it often does not occur in this setting or in a timely manner and this may have implications for the development of complications. Increased insulin initiation in general practice is an important goal given the increasing prevalence of type 2 diabetes and a relative shortage of specialists. Coordination between primary and secondary care, and between medical and nursing personnel, may be important in achieving this. Relational coordination theory identifies key concepts that underpin effective interprofessional work: communication which is problem solving, timely, accurate and frequent and relationships between professional roles which are characterized by shared goals, shared knowledge and mutual respect. This study explores roles and relationships between health professionals involved in insulin initiation in order to gain an understanding of factors which may impact on this task being carried out in the general practice setting. 21 general practitioners, practice nurses, diabetes nurse educators and physicians were purposively sampled to participate in a semi-structured interview. Transcripts of the interviews were analysed using framework analysis. There were four closely interlinked themes identified which impacted on how health professionals worked together to initiate people with type 2 diabetes on insulin: 1. Ambiguous roles; 2. Uncertain competency and capacity; 3. Varying relationships and communication; and 4. Developing trust and respect. This study has shown that insulin initiation is generally recognised as acceptable in general practice. The role of the DNE and practice nurse in this space and improved communication and relationships between health professionals across organisations and levels of care are factors which need to be addressed to support this clinical work. Relational coordination provides a useful framework for

Independence: proposing an initial framework for occupational therapy.

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Collins, Bethan

2017-11-01

The concept of independence is common in occupational therapy theory and practice but has rarely been clearly defined or conceptualized within in occupational therapy literature and there seems to be no standard definition. This can result in ambiguity, which potentially jeopardizes client-centred practice. This paper proposes an occupational therapy independence framework (OTIF) that synthesizes the range of characterizations of independence in a practically useful and occupation-centred manner. A review of literature, clinical experience, doctoral research and conversations with occupational therapists and disabled people, in particular those involved in a disability activism group and people with physical disabilities, has led to the development of the OTIF. Independence and interdependence, as characterized in the OTIF, occur when an individual exerts choice over occupational performance and can engage in occupations in a manner acceptable to the individual. Interdependence results when occupations are performed with another person whereas independence involves solitary occupational performance. Dependence typically results from inability to choose occupations or a mismatch between performance capacity and environmental factors. The OTIF has the potential to clarify the conceptualization of independence within occupational therapy theory and practice. This initial proposal is presented to stimulate debate and discussion.

Initiation of Addiction Treatment and Access to Services: Young Adults' Accounts of Their Help-Seeking Experiences.

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Wagner, Vincent; Bertrand, Karine; Flores-Aranda, Jorge; Acier, Didier; Brunelle, Natacha; Landry, Michel; Brochu, Serge

2017-09-01

Substance addiction in young adults is particularly problematic. Yet, much remain at stake in understanding the specifics of this population's access to services. The objective of this study is to explore young adults' initiation of substance misuse treatment. Our study sample was composed of 35 individuals aged 18 to 30 with problematic psychoactive substance use who have been identified in criminal courts, hospital emergency departments, and Health and Social Services Centers in Québec (Canada). A thematic analysis was performed on the 62 semi-structured interviews conducted with participants. Three components emerged. First, personal elements-expectations, individual motivations, perceptions of use, and capacity to control it-influence initiation of substance misuse treatment. Second, family and peers have noticeable influences. Finally, system characteristics and prior care experiences also shape the process. Consideration should be given to tailor interventions that can reach young adults and encourage them to initiate appropriate care.

PESP Landscaping Initiative

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Landscaping practices can positively or negatively affect local environments and human health. The Landscaping Initiative seeks to enhance benefits of landscaping while reducing need for pesticides, fertilizers, etc., by working with partners.

Self-reported breast feeding practices and the Baby Friendly Hospital Initiative in Riyadh, Saudi Arabia: prospective cohort study.

Science.gov (United States)

Mosher, Cynthia; Sarkar, Abdullah; Hashem, Alaa AbouBakr; Hamadah, Reem E; Alhoulan, Asma; AlMakadma, Yosra A; Khan, Tehreem A; Al-Hamdani, Abdurahman K; Senok, Abiola

2016-12-16

The Baby Friendly Hospital Initiative (BFHI) is a practice guideline for healthcare providers to promote breastfeeding and increase breastfeeding rates. This study aimed to examine reported experiences and views on breastfeeding of women using prenatal and postnatal services, and opinions of staff, in the context of the BFHI programme in Riyadh, Saudi Arabia. Prospective cohort study. This prospective, longitudinal study was conducted from December 2013 to September 2015 at two healthcare facilities (BFHI and non-BFHI) in Riyadh Saudi Arabia. Women 36-40 weeks gestation receiving antenatal care at the hospitals were enrolled. Questionnaires were administered prenatally, at 1, 3 and 6 months postnatal and to the administrator and maternity staff. We recruited 277 women with an estimated 80% response rate. 156 (BFHI=78/139, non-BFHI=78/138, 56%) participants completed all questionnaires. Most BFHI-hospital participants (77.9%, n=8 for this question) acknowledged seeing the breast feeding policy compared to 23.5% (n=23) at the non-BFHI-hospital (p<0.01). Breast feeding education and encouragement was higher at the BFHI-hospital (93.3%) compared to the non-BFHI-hospital (48.2%; p<0.01). At postpartum discharge, 51% (n=53) of mothers in the BFHI-hospital were breast feeding exclusively versus 29.6% (n=29) at the non-BFHI-hospital. Where formula feed was introduced, women in the BFHI-hospital more often practiced mixed feeding rather than exclusive formula feeding with some switching from mixed feeding to exclusive breast feeding between 3 and 6 months postpartum. Exclusive breast feeding rates declined in both hospitals at 3 and 6 months postpartum with lack of community services for lactation being a major reason. Although BFHI-hospital staff (n=9) were more conversant with BFHI principles, defects in adherence to the BFHI 10 Steps were identified. This is the first study assessing the effectiveness of BFHI implementation in Saudi Arabia. Although women

Holistic health care: Patients' experiences of health care provided by an Advanced Practice Nurse.

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Eriksson, Irene; Lindblad, Monica; Möller, Ulrika; Gillsjö, Catharina

2018-02-01

Advanced Practice Nurse (APN) is a fairly new role in the Swedish health care system. To describe patients' experiences of health care provided by an APN in primary health care. An inductive, descriptive qualitative approach with qualitative open-ended interviews was chosen to obtain descriptions from 10 participants regarding their experiences of health care provided by an APN. The data were collected during the spring 2012, and a qualitative approach was used for analyze. The APNs had knowledge and skills to provide safe and secure individual and holistic health care with high quality, and a respectful and flexible approach. The APNs conveyed trust and safety and provided health care that satisfied the patients' needs of accessibility and appropriateness in level of care. The APNs way of providing health care and promoting health seems beneficial in many ways for the patients. The individual and holistic approach that characterizes the health care provided by the APNs is a key aspect in the prevailing change of health care practice. The transfer of care and the increasing number of older adults, often with a variety of complex health problems, call for development of the new role in this context. © 2017 The Authors. International Journal of Nursing Practice Published by John Wiley & Sons Australia, Ltd.

Pediatric Critical Care Nursing Research Priorities-Initiating International Dialogue.

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Tume, Lyvonne N; Coetzee, Minette; Dryden-Palmer, Karen; Hickey, Patricia A; Kinney, Sharon; Latour, Jos M; Pedreira, Mavilde L G; Sefton, Gerri R; Sorce, Lauren; Curley, Martha A Q

2015-07-01

To identify and prioritize research questions of concern to the practice of pediatric critical care nursing practice. One-day consensus conference. By using a conceptual framework by Benner et al describing domains of practice in critical care nursing, nine international nurse researchers presented state-of-the-art lectures. Each identified knowledge gaps in their assigned practice domain and then poised three research questions to fill that gap. Then, meeting participants prioritized the proposed research questions using an interactive multivoting process. Seventh World Congress on Pediatric Intensive and Critical Care in Istanbul, Turkey. Pediatric critical care nurses and nurse scientists attending the open consensus meeting. Systematic review, gap analysis, and interactive multivoting. The participants prioritized 27 nursing research questions in nine content domains. The top four research questions were 1) identifying nursing interventions that directly impact the child and family's experience during the withdrawal of life support, 2) evaluating the long-term psychosocial impact of a child's critical illness on family outcomes, 3) articulating core nursing competencies that prevent unstable situations from deteriorating into crises, and 4) describing the level of nursing education and experience in pediatric critical care that has a protective effect on the mortality and morbidity of critically ill children. The consensus meeting was effective in organizing pediatric critical care nursing knowledge, identifying knowledge gaps and in prioritizing nursing research initiatives that could be used to advance nursing science across world regions.

Ultrasound-guided Breast Biopsy in the Resource-limited Setting: An Initial Experience in Rural Uganda

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Christopher R. Stark

2017-06-01

Full Text Available Purpose: To describe the methodology and initial experience behind creation of an ultrasoundguided percutaneous breast core biopsy program in rural Uganda. Methods and Materials: Imaging the World Africa (ITWA is the registered non-governmental organization division of Imaging the World (ITW, a not-for-profit organization whose primary aim is the integration of affordable high-quality ultrasound into rural health centers. In 2013, ITWA began the pilot phase of an IRB-approved breast care protocol at a rural health center in Uganda. As part of the protocol’s diagnostic arm, an ultrasound-guided percutaneous breast core biopsy training curriculum was implemented in tandem with creation of regionally supplied biopsy kits. Results: A surgeon at a rural regional referral hospital was successfully trained and certified to perform ultrasound-guided percutaneous breast core biopsies. Affordable and safe biopsy kits were created using locally available medical supplies with the cost of each kit totaling $10.62 USD. Conclusion: Successful implementation of an ultrasound-guided percutaneous breast core biopsy program in the resource-limited setting is possible and can be made sustainable through incorporation of local health care personnel and regionally supplied biopsy materials. Our hope is that ITWA’s initial experience in rural Uganda can serve as a model for similar programs in the future.

"The refer less resolve more" initiative: A five-year experience from CMC Vellore, India

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Jachin Velavan

2012-01-01

Full Text Available India′s one billion plus strong population presents huge health care needs. Presently, approximately 250,000 general practitioners and 30,000 Government doctors are a part of the Indian healthcare workforce, but 80% of them are based in urban India. Problems which plague healthcare delivery and attributed to physician practice may be enumerated as - physicians (1 lack competencies, (2 lack updating, (3 prescribe irrationally (pressures from pharmaceutical companies and patients, (4 practice unethically, (5 refer excessively to specialists and other clinical professionals, and (6 investigate for diseases without justification. A multi-competent Family Physician who could provide a single-window, ethical, and holistic healthcare to patients and families is the need of the hour. Therefore, training, equipping, and empowering these 250,000 doctors to become such physicians will reduce health costs considerably. Distance medical education using all the andragogic methods can be used to train large number of individuals without displacing them from their work-places. Distance learning provides a useful interface for rapidly developing a specialized pool of doctors practicing and advocating family medicine as most-needed discipline. This motivated CMC Vellore, a premier institution for medical education in India, to start a the "refer less resolve more initiative" by offering "two year family medicine diploma course" by distance mode. This is an innovatively-written program consisting of problem-based self-learning modules, video-lectures, video-conferencing, and face-to-face contact programs. Ten secondary level hospitals, across the country, under the supervision of national and international family medicine faculty form the pillars of this program. This distance learning program offered by CMC Vellore has become the platform for change as there is special focus is on ethics, rational prescribing, consultation skills, application of family medicine

"The Refer Less Resolve More" Initiative: A Five-year Experience from CMC Vellore, India.

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Velavan, Jachin

2012-01-01

India's one billion plus strong population presents huge health care needs. Presently, approximately 250,000 general practitioners and 30,000 Government doctors are a part of the Indian healthcare workforce, but 80% of them are based in urban India. Problems which plague healthcare delivery and attributed to physician practice may be enumerated as - physicians (1) lack competencies, (2) lack updating, (3) prescribe irrationally (pressures from pharmaceutical companies and patients), (4) practice unethically, (5) refer excessively to specialists and other clinical professionals, and (6) investigate for diseases without justification. A multi-competent Family Physician who could provide a single-window, ethical, and holistic healthcare to patients and families is the need of the hour. Therefore, training, equipping, and empowering these 250,000 doctors to become such physicians will reduce health costs considerably. Distance medical education using all the andragogic methods can be used to train large number of individuals without displacing them from their work-places. Distance learning provides a useful interface for rapidly developing a specialized pool of doctors practicing and advocating family medicine as most-needed discipline. This motivated CMC Vellore, a premier institution for medical education in India, to start a the "refer less resolve more initiative" by offering "two year family medicine diploma course" by distance mode. This is an innovatively-written program consisting of problem-based self-learning modules, video-lectures, video-conferencing, and face-to-face contact programs. Ten secondary level hospitals, across the country, under the supervision of national and international family medicine faculty form the pillars of this program. This distance learning program offered by CMC Vellore has become the platform for change as there is special focus is on ethics, rational prescribing, consultation skills, application of family medicine principles

Navigating the Complex Practices of Specialized Literacy Professionals in Formalized Teacher Leadership Positions

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Yurkewecz, Thea A.

2017-01-01

This dissertation reports on how one school community engaged in a professional development grant initiative that incorporated teacher leadership. Teacher leaders may have numerous roles and responsibilities that support the professional learning and instructional practices of school communities. This study examined the experiences of three…

Is it all in the game? Flow experience and scientific practices during an INPLACE mobile game

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Bressler, Denise M.

Mobile science learning games show promise for promoting scientific practices and high engagement. Researchers have quantified this engagement according to flow theory. Using an embedded mixed methods design, this study investigated whether an INPLACE mobile game promotes flow experience, scientific practices, and effective team collaboration. Students playing the game (n=59) were compared with students in a business-as-usual control activity (n=120). Using an open-ended instrument designed to measure scientific practices and a self-report flow survey, this study empirically assessed flow and learner's scientific practices. The game players had significantly higher levels of flow and scientific practices. Using a multiple case study approach, collaboration among game teams (n=3 teams) were qualitatively compared with control teams (n=3 teams). Game teams revealed not only higher levels of scientific practices but also higher levels of engaged responses and communal language. Control teams revealed lower levels of scientific practice along with higher levels of rejecting responses and command language. Implications for these findings are discussed.

16 CFR 5.64 - Initial decision.

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2010-01-01

... 16 Commercial Practices 1 2010-01-01 2010-01-01 false Initial decision. 5.64 Section 5.64 Commercial Practices FEDERAL TRADE COMMISSION ORGANIZATION, PROCEDURES AND RULES OF PRACTICE STANDARDS OF... this subpart, except that the determination of the Administrative Law Judge must be supported by a...

Practical methods of target preparation for use in nuclear experiments

International Nuclear Information System (INIS)

Sugai, Isao.

1976-01-01

This is the fifth report on the practical methods of target preparation for use in nuclear experiments following the previous one (INS-J-152, 1975). Electro-deposition is a very powerful technique well suited to the preparation of self-supporting targets of Ni, Cr, Zn, Rh, Cd, Sb and Pb metals over a wide range of thickness from 1 to 20 mg/cm 2 . The uniformities of the thicknesses of Cr, Zn, Rh, Cd and Pb targets were measured with α- and β-ray thickness gauges. The impurities in Cr target were checked by the measurement of elastically scattered protons, and by a optical spectrometer. (auth.)

Practicing more retrieval routes leads to greater memory retention.

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Zheng, Jun; Zhang, Wei; Li, Tongtong; Liu, Zhaomin; Luo, Liang

2016-09-01

A wealth of research has shown that retrieval practice plays a significant role in improving memory retention. The current study focused on one simple yet rarely examined question: would repeated retrieval using two different retrieval routes or using the same retrieval route twice lead to greater long-term memory retention? Participants elaborately learned 22 Japanese-Chinese translation word pairs using two different mediators. Half an hour after the initial study phase, the participants completed two retrieval sessions using either one mediator (Tm1Tm1) or two different mediators (Tm1Tm2). On the final test, which was performed 1week after the retrieval practice phase, the participants received only the cue with a request to report the mediator (M1 or M2) followed by the target (Experiment 1) or only the mediator (M1 or M2) with a request to report the target (Experiment 2). The results of Experiment 1 indicated that the participants who practiced under the Tm1Tm2 condition exhibited greater target retention than those who practiced under the Tm1Tm1 condition. This difference in performance was due to the significant disadvantage in mediator retrieval and decoding of the unpracticed mediator under the Tm1Tm1 condition. Although mediators were provided to participants on the final test in Experiment 2, decoding of the unpracticed mediators remained less effective than decoding of the practiced mediators. We conclude that practicing multiple retrieval routes leads to greater memory retention than focusing on a single retrieval route. Thus, increasing retrieval variability during repeated retrieval practice indeed significantly improves long-term retention in a delay test. Copyright © 2016 Elsevier B.V. All rights reserved.