Employee assistance programs: an alternative resource for mental health service delivery.

Science.gov (United States)

Santa-Barbara, J

1984-09-01

The purpose of this article is to provide a very brief introduction to employee assistance programs (EAPs) and their role in the mental health delivery system. In addition, some consideration will be given to the opportunity these programs offer for making a significant impact on both the mental health of Canadians and the productivity of Canadian business.

A multistate quality improvement program to decrease elective deliveries before 39 weeks of gestation.

Science.gov (United States)

Oshiro, Bryan T; Kowalewski, Leslie; Sappenfield, William; Alter, Caroline C; Bettegowda, Vani R; Russell, Rebecca; Curran, John; Reeves, Lori; Kacica, Marilyn; Andino, Nelson; Mason-Marti, Peyton; Crouse, Dennis; Knight, Susan; Littlejohn, Karen; Malatok, Sharyn; Dudley, Donald J; Berns, Scott D

2013-05-01

Nonmedically indicated (elective) deliveries before 39 weeks of gestation result in unnecessary neonatal morbidity. We sought to determine whether implementation of a process improvement program will decrease the rate of elective scheduled singleton early-term deliveries (37 0/7-38 6/7 weeks of gestation) in a group of diverse community and academic hospitals. Policies and procedures for scheduling inductions and cesarean deliveries were implemented and patient and health care provider education was provided. Outcomes for scheduled singleton deliveries at 34 weeks of gestation or higher were submitted through a web-based data entry system. The rate of scheduled singleton elective early-term deliveries as well as the rates of early-term medically indicated and unscheduled deliveries, neonatal intensive care unit admissions, and singleton term fetal mortality rate were evaluated. A total of 29,030 scheduled singletons at 34 weeks of gestation or higher were delivered in 26 participating hospitals between January 2011 and December 2011. Elective scheduled early-term deliveries decreased from 27.8% in the first month to 4.8% in the 12th month (Pscheduled singleton early-term inductions (72%, P=.029) and cesarean deliveries (84%; Pscheduled early-term singletons decreased nonsignificantly from 1.5% to 1.2% (P=.24). There was no increase in the term fetal mortality rate. A rapid-cycle process improvement program substantially decreased elective scheduled early-term deliveries to less than 5% in a group of diverse hospitals across multiple states. III.

Volunteer Delivery of a Community-Based Strength Training Program: Comparison of Adopting and Nonadopting Extension Educator Perspectives

Directory of Open Access Journals (Sweden)

Lisa T. Washburn

2016-10-01

Full Text Available Volunteer leaders are increasingly being utilized to deliver community strength training classes, but the factors affecting adoption of volunteer delivery approaches by educators or program managers have not been well explored. This study sought to identify these factors by comparing perspectives of adopting and nonadopting county Extension educators for a group strength training program delivered through county Cooperative Extension offices. Semistructured interviews were conducted with a purposive sample of adopting (n=6 and nonadopting (n=13 educators. Interviews were recorded, transcribed verbatim, and coded using thematic content analysis. Review of codes related to adoption or nonadoption of volunteer delivery approaches produced common themes. Both groups acknowledged role differences between educators and volunteers and expressed concerns about maintaining program quality. Adopters expressed greater comfort with volunteer-led program approaches and understanding of the educator-volunteer role. Nonadopters were hesitant to request program participants serve as leaders but felt participants were capable. Both groups were motivated to offer the program for dual personal and community benefit, but nonadopters expressed reliance on the program to maintain physical activity habits and for social support. Findings can inform others seeking to adapt community programs for volunteer delivery or engage volunteers in existing program delivery.

Technologic advances in aural rehabilitation: applications and innovative methods of service delivery.

Science.gov (United States)

Sweetow, Robert W; Sabes, Jennifer Henderson

2007-06-01

The level of interest in aural rehabilitation has increased recently, both in clinical use and in research presentations and publications. Advances in aural rehabilitation have seen previous techniques such as speech tracking and analytic auditory training reappear in computerized forms. These new delivery methods allow for a consistent, cost-effective, and convenient training program. Several computerized aural rehabilitation programs for hearing aid wearers and cochlear implant recipients have recently been developed and were reported on at the 2006 State of the Science Conference of the Rehabilitation Engineering Research Center on Hearing Enhancement at Gallaudet University. This article reviews these programs and outlines the similarities and differences in their design. Another promising area of aural rehabilitation research is the use of pharmaceuticals in the rehabilitation process. The results from a study of the effect of d-amphetamine in conjunction with intensive aural rehabilitation with cochlear implant patients are also described.

75 FR 75532 - Surface Transportation Project Delivery Pilot Program; Caltrans Audit Report

Science.gov (United States)

2010-12-03

...] Surface Transportation Project Delivery Pilot Program; Caltrans Audit Report AGENCY: Federal Highway... participating in the Pilot Program, 23 U.S.C. 327(g) mandates semiannual audits during each of the first 2 years of State participation. This notice announces and solicits comments on the fifth audit report for the...

76 FR 5237 - Surface Transportation Project Delivery Pilot Program; Caltrans Audit Report

Science.gov (United States)

2011-01-28

...] Surface Transportation Project Delivery Pilot Program; Caltrans Audit Report AGENCY: Federal Highway... participating in the Pilot Program, 23 U.S.C. 327(g) mandates semiannual audits during each of the first 2 years of State participation. This final report presents the findings from the fifth FHWA audit of the...

77 FR 26355 - Surface Transportation Project Delivery Pilot Program; Caltrans Audit Report

Science.gov (United States)

2012-05-03

...] Surface Transportation Project Delivery Pilot Program; Caltrans Audit Report AGENCY: Federal Highway... participating in the Pilot Program, 23 U.S.C. 327(g) mandates semiannual audits during each of the first 2 years of State participation. This final report presents the findings from the sixth FHWA audit of the...

West Virginia peer exchange : streamlining highway safety improvement program project delivery.

Science.gov (United States)

2015-01-01

The West Virginia Division of Highways (WV DOH) hosted a Peer Exchange to share information and experiences : for streamlining Highway Safety Improvement Program (HSIP) project delivery. The event was held September : 22 to 23, 2014 in Charleston, We...

The effect of a structured neonatal resuscitation program on delivery room practices.

LENUS (Irish Health Repository)

Ryan, C A

2012-02-03

PURPOSE: This study evaluated the introduction of the Neonatal Resuscitation Program (NRP) of the American Academy of Pediatrics and the American Heart Association into the delivery room of an Irish maternity hospital. DESIGN: Prospective, controlled observational study of 51 deliveries before and 51 deliveries following the training of delivery room personnel in the NRP. SAMPLE: Participants were 33 nurse-midwives and 11 pediatric resident physicians. MAIN OUTCOME VARIABLE: Evaluation of postdelivery, newborn resuscitation practices. RESULTS: The introduction of the NRP was associated with significant improvements in delivery room preparation, in the evaluation and management of the newborn infant, and in thermal protection at birth. Although there was a trend to use more free-flow oxygen following the introduction of the NRP, this was not statistically significant. Bag and mask ventilation was also used more frequently following NRP training. However, there were no significant differences in the use of endotracheal intubation, chest compressions, and medications. Fifteen of the 51 infants became hypothermic prior to the introduction of the NRP; none of the infants developed hypothermia in the post-NRP part of the study.

A low-cost ultrasound program leads to increased antenatal clinic visits and attended deliveries at a health care clinic in rural Uganda.

Directory of Open Access Journals (Sweden)

Andrew B Ross

Full Text Available BACKGROUND: In June of 2010, an antenatal ultrasound program to perform basic screening for high-risk pregnancies was introduced at a community health care center in rural Uganda. Whether the addition of ultrasound scanning to antenatal visits at the health center would encourage or discourage potential patients was unknown. Our study sought to evaluate trends in the numbers of antenatal visits and deliveries at the clinic, pre- and post-introduction of antenatal ultrasound to determine what effect the presence of ultrasound at the clinic had on these metrics. METHODS AND FINDINGS: Records at Nawanyago clinic were reviewed to obtain the number of antenatal visits and deliveries for the 42 months preceding the introduction of ultrasound and the 23 months following. The monthly mean deliveries and antenatal visits by category (first visit through fourth return visit were compared pre- and post- ultrasound using a Kruskal-Wallis one-way ANOVA. Following the introduction of ultrasound, significant increases were seen in the number of mean monthly deliveries and antenatal visits. The mean number of monthly deliveries at the clinic increased by 17.0 (13.3-20.6, 95% CI from a pre-ultrasound average of 28.4 to a post-ultrasound monthly average of 45.4. The number of deliveries at a comparison clinic remained flat over this same time period. The monthly mean number of antenatal visits increased by 97.4 (83.3-111.5, 95% CI from a baseline monthly average of 133.5 to a post-ultrasound monthly mean of 231.0, with increases seen in all categories of antenatal visits. CONCLUSIONS: The availability of a low-cost antenatal ultrasound program may assist progress towards Millennium Development Goal 5 by encouraging women in a rural environment to come to a health care facility for skilled antenatal care and delivery assistance instead of utilizing more traditional methods.

Adaptations to the coping power program's structure, delivery settings, and clinician training.

Science.gov (United States)

Lochman, John E; Powell, Nicole; Boxmeyer, Caroline; Andrade, Brendan; Stromeyer, Sara L; Jimenez-Camargo, Luis Alberto

2012-06-01

This article describes the conceptual framework for the Coping Power program that has focused on proximal risk factors that can actively alter preadolescent children's aggressive behavior. The results of initial controlled efficacy trials are summarized. However, consistent with the theme of this special section, some clinicians and workshop participants have indicated barriers to the implementation of the Coping Power program in their service settings. In response to these types of concerns, three key areas of programmatic adaptation of the program that serve to address these concerns are then described in the article. First, existing and in-process studies of variations in how the program can be delivered are presented. Existing findings indicate how the child component fares when delivered by itself without the parent component, how simple monthly boosters affect intervention effects, and whether the program can be reduced by a third of its length and still be effective. Research planned or in progress on program variations examines whether group versus individual delivery of the program affects outcomes, whether the program can be adapted for early adolescents, whether the program can be delivered in an adaptive manner with the use of the Family Check Up, and whether a brief, efficient version of the program in conjunction with Internet programming can be developed and be effective. Second, the program has been and is being developed for use in different settings, other than the school-based delivery in the efficacy trials. Research has examined its use with aggressive deaf youth in a residential setting, with Oppositional Defiant Disorder and Conduct Disorder children in outpatient clinics, and in after-school programs. Third, the article reports how variations in training clinicians affect their ability to effectively use the program. PsycINFO Database Record (c) 2012 APA, all rights reserved.

Tools and Methods for Hardening Communication Security of Energy Delivery Systems

Energy Technology Data Exchange (ETDEWEB)

Gadgil, Shrirang [Applied Communication Sciences, Basking Ridge, NJ (United States); Lin, Yow-Jian [Applied Communication Sciences, Basking Ridge, NJ (United States); Ghosh, Abhrajit [Applied Communication Sciences, Basking Ridge, NJ (United States); Samtani, Sunil [Applied Communication Sciences, Basking Ridge, NJ (United States); Kang, Jaewon [Applied Communication Sciences, Basking Ridge, NJ (United States); Siegell, Bruce [Applied Communication Sciences, Basking Ridge, NJ (United States); Kaul, Vikram [Applied Communication Sciences, Basking Ridge, NJ (United States); Unger, John [Applied Communication Sciences, Basking Ridge, NJ (United States); De Bruet, Andre [DTE Energy, Detroit, MI (United States); Martinez, Catherine [DTE Energy, Detroit, MI (United States); Vermeulen, Gerald [DTE Energy, Detroit, MI (United States); Rasche, Galen [Electric Power Research Inst. (EPRI), Palo Alto, CA (United States); Sternfeld, Scott [Electric Power Research Inst. (EPRI), Palo Alto, CA (United States); Berthier, Robin [Univ. of Illinois, Urbana-Champaign, IL (United States); Bobba, Rakesh [Univ. of Illinois, Urbana-Champaign, IL (United States); Campbell, Roy [Univ. of Illinois, Urbana-Champaign, IL (United States); Sanders, Williams [Univ. of Illinois, Urbana-Champaign, IL (United States)

2014-09-28

This document summarizes the research and development work the TT Government Solutions (TTGS), d.b.a. Applied Communication Sciences (ACS), team performed for the Department of Energy Cybersecurity for Energy Delivery Systems (CEDS) program. It addresses the challenges in protecting critical grid control and data communication, including the identification of vulnerabilities and deficiencies of communication protocols commonly used in energy delivery systems (e.g., ICCP, DNP3, C37.118, C12.22), as well as the development of effective means to detect and prevent the exploitation of such vulnerabilities and deficiencies.

Evaluating program effects on institutional delivery in Peru.

Science.gov (United States)

McQuestion, Michael J; Velasquez, Anibal

2006-07-01

We evaluate the joint effects of two targeted Peruvian health programs on a mother's choice of whether to deliver in a public emergency obstetric care (EmOC) facility. The national maternal and child health insurance, or SMI Program, provided delivery care coverage to Peru's poorest households beginning in 1998. During 1996-2002, Proyecto 2000 sought to improve the quality of EmOC and increase utilization of public EmOC facilities in the districts reporting the highest maternal and neonatal mortality levels. Our data come from the Proyecto 2000 endline evaluation, which sampled 5335 mothers living in the catchment areas of 29 treatment and 29 matched control EmOC facilities. Using propensity scoring and two quality of care indices, we find significantly higher quality of care in Proyecto 2000 treatment facilities. Using variance components logistic models, we find a mother enrolled in the SMI Program was more likely to have delivered her last child in a public EmOC, controlling for household constraints. Residence in a Proyecto 2000 treatment area did not significantly affect the choice. A cross-level interaction term was insignificant, indicating the two program effects were independent.

METHOD OF CHOOSING THE TECHNOLOGY OF VEHICLE OPERATION ON DELIVERY ROUTES

Directory of Open Access Journals (Sweden)

Ye. Nagornyi

2014-10-01

Full Text Available A method for determining the technology of vehicles operation on delivery (team routes, which allows to determine the optimal sequence of cargo delivery to customers by vehicles of certain capacity in order to meet the requirements of cargo owners regarding the conditions of service is offered. Recommendations for creation of an automated system of forming the technology of vehicles operation on delivery routes are developed.

Physical non-viral gene delivery methods for tissue engineering.

Science.gov (United States)

Mellott, Adam J; Forrest, M Laird; Detamore, Michael S

2013-03-01

The integration of gene therapy into tissue engineering to control differentiation and direct tissue formation is not a new concept; however, successful delivery of nucleic acids into primary cells, progenitor cells, and stem cells has proven exceptionally challenging. Viral vectors are generally highly effective at delivering nucleic acids to a variety of cell populations, both dividing and non-dividing, yet these viral vectors are marred by significant safety concerns. Non-viral vectors are preferred for gene therapy, despite lower transfection efficiencies, and possess many customizable attributes that are desirable for tissue engineering applications. However, there is no single non-viral gene delivery strategy that "fits-all" cell types and tissues. Thus, there is a compelling opportunity to examine different non-viral vectors, especially physical vectors, and compare their relative degrees of success. This review examines the advantages and disadvantages of physical non-viral methods (i.e., microinjection, ballistic gene delivery, electroporation, sonoporation, laser irradiation, magnetofection, and electric field-induced molecular vibration), with particular attention given to electroporation because of its versatility, with further special emphasis on Nucleofection™. In addition, attributes of cellular character that can be used to improve differentiation strategies are examined for tissue engineering applications. Ultimately, electroporation exhibits a high transfection efficiency in many cell types, which is highly desirable for tissue engineering applications, but electroporation and other physical non-viral gene delivery methods are still limited by poor cell viability. Overcoming the challenge of poor cell viability in highly efficient physical non-viral techniques is the key to using gene delivery to enhance tissue engineering applications.

Physical non-viral gene delivery methods for tissue engineering

Science.gov (United States)

Mellott, Adam J.; Forrest, M. Laird; Detamore, Michael S.

2016-01-01

The integration of gene therapy into tissue engineering to control differentiation and direct tissue formation is not a new concept; however, successful delivery of nucleic acids into primary cells, progenitor cells, and stem cells has proven exceptionally challenging. Viral vectors are generally highly effective at delivering nucleic acids to a variety of cell populations, both dividing and non-dividing, yet these viral vectors are marred by significant safety concerns. Non-viral vectors are preferred for gene therapy, despite lower transfection efficiencies, and possess many customizable attributes that are desirable for tissue engineering applications. However, there is no single non-viral gene delivery strategy that “fits-all” cell types and tissues. Thus, there is a compelling opportunity to examine different non-viral vectors, especially physical vectors, and compare their relative degrees of success. This review examines the advantages and disadvantages of physical non-viral methods (i.e., microinjection, ballistic gene delivery, electroporation, sonoporation, laser irradiation, magnetofection, and electric field-induced molecular vibration), with particular attention given to electroporation because of its versatility, with further special emphasis on Nucleofection™. In addition, attributes of cellular character that can be used to improve differentiation strategies are examined for tissue engineering applications. Ultimately, electroporation exhibits a high transfection efficiency in many cell types, which is highly desirable for tissue engineering applications, but electroporation and other physical non-viral gene delivery methods are still limited by poor cell viability. Overcoming the challenge of poor cell viability in highly efficient physical non-viral techniques is the key to using gene delivery to enhance tissue engineering applications. PMID:23099792

Can the delivery method influence lower urinary tract symptoms triggered by the first pregnancy?

Directory of Open Access Journals (Sweden)

Simone Botelho

2012-04-01

Full Text Available INTRODUCTION AND OBJECTIVES: The increase of the intensity of urinary symptoms in late pregnancy and postpartum has been well documented by several authors, but their causes remain uncertain, partly because of its probable multifactor origin. There are also controversies whether the etiology of lower urinary tract symptoms during pregnancy is the same as postpartum and whether the method of delivery could influence the risk of onset of urinary symptoms. This study aimed to evaluate the urinary symptoms triggered during pregnancy and its evolution in the late puerperium, correlating them with the delivery method. MATERIALS AND METHODS: A longitudinal study was conducted, which included 75 primigravidae women, classified according to method of delivery as: (VD vaginal delivery with right mediolateral episiotomy (n = 28; (CS elective caesarean section (n = 26; and (EC emergency caesarean section (n = 21. Urinary symptoms were assessed in the last trimester of pregnancy and at 45 days (± 10 of puerperium with validated versions for Portuguese language of the following questionnaires: International Consultation on Incontinence Questionnaire - Urinary Incontinence Short Form (ICIQ-UI SF and the International Consultation on Incontinence Questionnaire Overactive Bladder (ICIQ-OAB. RESULTS: It was observed that frequency, urgency, nocturia and urge incontinence, triggered during pregnancy, decreased significantly in the postpartum period, regardless of the delivery method (p = 0.0001. However, symptoms related to urinary loss due to stress persisted after vaginal delivery (p = 0.0001. CONCLUSIONS: Urgency, frequency and nocturia triggered during pregnancy tend to disappear in the late postpartum period, regardless of the delivery method, but the symptoms related to urinary loss due to stress tend to persist in late postpartum period after vaginal delivery.

Frank Gilbreth and health care delivery method study driven learning.

Science.gov (United States)

Towill, Denis R

2009-01-01

The purpose of this article is to look at method study, as devised by the Gilbreths at the beginning of the twentieth century, which found early application in hospital quality assurance and surgical "best practice". It has since become a core activity in all modern methods, as applied to healthcare delivery improvement programmes. The article traces the origin of what is now currently and variously called "business process re-engineering", "business process improvement" and "lean healthcare" etc., by different management gurus back to the century-old pioneering work of Frank Gilbreth. The outcome is a consistent framework involving "width", "length" and "depth" dimensions within which healthcare delivery systems can be analysed, designed and successfully implemented to achieve better and more consistent performance. Healthcare method (saving time plus saving motion) study is best practised as co-joint action learning activity "owned" by all "players" involved in the re-engineering process. However, although process mapping is a key step forward, in itself it is no guarantee of effective re-engineering. It is not even the beginning of the end of the change challenge, although it should be the end of the beginning. What is needed is innovative exploitation of method study within a healthcare organisational learning culture accelerated via the Gilbreth Knowledge Flywheel. It is shown that effective healthcare delivery pipeline improvement is anchored into a team approach involving all "players" in the system especially physicians. A comprehensive process study, constructive dialogue, proper and highly professional re-engineering plus managed implementation are essential components. Experience suggests "learning" is thereby achieved via "natural groups" actively involved in healthcare processes. The article provides a proven method for exploiting Gilbreths' outputs and their many successors in enabling more productive evidence-based healthcare delivery as summarised

Efficient and effective implementation of alternative project delivery methods.

Science.gov (United States)

2017-05-01

Over the past decade, the Maryland Department of Transportation State Highway : Administration (MDOT SHA) has implemented Alternative Project Delivery (APD) methods : in a number of transportation projects. While these innovative practices have produ...

Measurement of integrated healthcare delivery: a systematic review of methods and future research directions

Directory of Open Access Journals (Sweden)

Martin Strandberg-Larsen

2009-02-01

Full Text Available Background: Integrated healthcare delivery is a policy goal of healthcare systems. There is no consensus on how to measure the concept, which makes it difficult to monitor progress. Purpose: To identify the different types of methods used to measure integrated healthcare delivery with emphasis on structural, cultural and process aspects. Methods: Medline/Pubmed, EMBASE, Web of Science, Cochrane Library, WHOLIS, and conventional internet search engines were systematically searched for methods to measure integrated healthcare delivery (published – April 2008. Results: Twenty-four published scientific papers and documents met the inclusion criteria. In the 24 references we identified 24 different measurement methods; however, 5 methods shared theoretical framework. The methods can be categorized according to type of data source: a questionnaire survey data, b automated register data, or c mixed data sources. The variety of concepts measured reflects the significant conceptual diversity within the field, and most methods lack information regarding validity and reliability. Conclusion: Several methods have been developed to measure integrated healthcare delivery; 24 methods are available and some are highly developed. The objective governs the method best used. Criteria for sound measures are suggested and further developments should be based on an explicit conceptual framework and focus on simplifying and validating existing methods.

Examining Delivery Method and Infant Feeding Intentions between Women in Traditional and Non-Traditional Prenatal Care.

Science.gov (United States)

Risisky, Deb; Chan, Ronna L; Zigmont, Victoria A; Asghar, Syed Masood; DeGennaro, Nancy

2018-02-01

Introduction The purpose of the study is to evaluate delivery method and breastfeeding initiation in women enrolled in group prenatal care (CenteringPregnancy) and in traditional prenatal care. Methods Data were obtained from medical records of a hospital-based midwifery practice in south central Connecticut that offered both types of prenatal care programs. Medical information from 307 women enrolled in this practice was included in the analysis. Out of the 307, 80 were enrolled in group prenatal care. Socio-demographic, lifestyle, and previous and current obstetrical information from medical records formed the basis of comparison. Bivariate and logistic regression analyses were carried out. Results Women in Centering had fewer planned cesarean sections (1.3 vs. 12.8%) and had a higher breastfeeding initiation (88.7 vs. 80.0%). However, Centering women were found to have a higher portion of unplanned cesarean sections (27.5 vs. 11.0%). Both the unadjusted and the adjusted odds ratios of having a cesarean planned delivery were lower in the group care. Women in Centering had 2.44 (95% CI 1.05, 5.66) times the odds of breastfeeding initiation compared to the odds for women in traditional prenatal care after adjusting for maternal age, smoking status, gestation and race. Discussion CenteringPregnancy can have positive impact for the woman and baby. This program implementation saw lower rates of elective cesarean sections and increased breastfeeding compared to women in traditional care.

Study of high-pressure cryogenic pumps with different methods of delivery control

International Nuclear Information System (INIS)

Braun, V.M.; Brailovskii, Y.L.; Pavlenko, Y.A.; Tsokalo, I.V.

1986-01-01

This paper describes new reciprocating pumps with smooth control of delivery in a running pump. Control is effected either by changing the length of the piston stroke or by changing the speed of the driving motor. The individual features of the two methods are described. In the first method (mechanical), delivery is controlled in the range 50 to 100%. A separate actuating mechanism is needed to connect the pump to an automatic control system. This method complicates the driving mechanism and increases the bulk and cost of production. In the second method of controlling the speed of the electric motor, an electric drive fitted with a frequency thyristor is used. AC induction motors series 4A working at current frequencies of 60 HZ are used. By this method, delivery control could be enhanced by 1.3 times. Comparative tests were made on pumps using the above methods of control. The tests demonstrated the possibilities of using the frequency thyristor converters. The complexity and high cost of EKT type drives is largely compensated by the convenience and simplicity of control in a wide range. The mechanical control is advantageous only in low-output units

The population-level impacts of a national health insurance program and franchise midwife clinics on achievement of prenatal and delivery care standards in the Philippines

Science.gov (United States)

Kozhimannil, Katy Backes; Valera, Madeleine R.; Adams, Alyce S.; Ross-Degnan, Dennis

2009-01-01

Objectives Adequate prenatal and delivery care are vital components of successful maternal health care provision. Starting in 1998, two programs were widely expanded in the Philippines: a national health insurance program (PhilHealth); and a donor-funded franchise of midwife clinics (Well-Family Midwife Clinics). This paper examines population-level impacts of these interventions on achievement of minimum standards for prenatal and delivery care. Methods Data from two waves of the Demographic and Health Surveys, conducted before (1998) and after (2003) scale up of the interventions, are employed in a pre/post study design, using longitudinal multivariate logistic and linear regression models. Results After controlling for demographic and socioeconomic characteristics, the PhilHealth insurance program scale up was associated with increased odds of receiving at least four prenatal visits (OR 1.04 [95% CI 1.01–1.06]) and receiving a visit during the first trimester of pregnancy (OR 1.03 [95% CI 1.01–1.06]). Exposure to midwife clinics was not associated with significant changes in achievement of prenatal care standards. While both programs were associated with slight increases in the odds of delivery in a health facility, these increases were not statistically significant. Conclusions These results suggest that expansion of an insurance program with accreditation standards was associated with increases in achievement of minimal standards for prenatal care among women in the Philippines. PMID:19327862

Provisional-Ideal-Point-Based Multi-objective Optimization Method for Drone Delivery Problem

Science.gov (United States)

Omagari, Hiroki; Higashino, Shin-Ichiro

2018-04-01

In this paper, we proposed a new evolutionary multi-objective optimization method for solving drone delivery problems (DDP). It can be formulated as a constrained multi-objective optimization problem. In our previous research, we proposed the "aspiration-point-based method" to solve multi-objective optimization problems. However, this method needs to calculate the optimal values of each objective function value in advance. Moreover, it does not consider the constraint conditions except for the objective functions. Therefore, it cannot apply to DDP which has many constraint conditions. To solve these issues, we proposed "provisional-ideal-point-based method." The proposed method defines a "penalty value" to search for feasible solutions. It also defines a new reference solution named "provisional-ideal point" to search for the preferred solution for a decision maker. In this way, we can eliminate the preliminary calculations and its limited application scope. The results of the benchmark test problems show that the proposed method can generate the preferred solution efficiently. The usefulness of the proposed method is also demonstrated by applying it to DDP. As a result, the delivery path when combining one drone and one truck drastically reduces the traveling distance and the delivery time compared with the case of using only one truck.

Factors Associated with Teacher Delivery of a Classroom-Based Tier 2 Prevention Program

Science.gov (United States)

Sutherland, Kevin S; Conroy, Maureen A; McLeod, Bryce D; Algina, James; Kunemund, Rachel L

2018-01-01

Teachers sometimes struggle to deliver evidence based programs designed to prevent and ameliorate chronic problem behaviors of young children with integrity. Identifying factors associated with variations in the quantity and quality of delivery is thus an important goal for the field. This study investigated factors associated with teacher…

An Improved Method for Magnetic Nanocarrier Drug Delivery across the Cell Membrane

Directory of Open Access Journals (Sweden)

Behzad Mehrafrooz

2018-01-01

Full Text Available One of the crucial issues in the pharmacological field is developing new drug delivery systems. The main concern is to develop new methods for improving the drug delivery efficiencies such as low disruptions, precise control of the target of delivery and drug sustainability. Nowadays, there are many various methods for drug delivery systems. Carbon-based nanocarriers are a new efficient tool for translocating drug into the defined area or cells inside the body. These nanocarriers can be functionalized with proteins, peptides and used to transport their freight to cells or defined areas. Since functionalized carbon-based nanocarriers show low toxicity and high biocompatibility, they are used in many nanobiotechnology fields. In this study, different shapes of nanocarrier are investigated, and the suitable magnetic field, which is applied using MRI for the delivery of the nanocarrier, is proposed. In this research, based on the force required to cross the membrane and MD simulations, the optimal magnetic field profile is designed. This optimal magnetic force field is derived from the mathematical model of the system and magnetic particle dynamics inside the nanocarrier. The results of this paper illustrate the effects of the nanocarrier’s shapes on the percentage of success in crossing the membrane and the optimal required magnetic field.

The Post-Secondary Student Support Program: An Examination of Alternative Delivery Mechanisms. A Report to the Indian and Northern Affairs Canada

Science.gov (United States)

Usher, Alex

2009-01-01

The purpose of this document is to examine the Department of Indian and Northern Affairs Canada (INAC)'s Post-Secondary Student Support Program (PSSSP) and analyse the advantages and disadvantages of both the existing system of program delivery and a trio of alternative delivery mechanisms. It does not issue any recommendation with respect to a…

Delivery Device and Method for Forming the Same

Science.gov (United States)

Ma, Peter X. (Inventor); Liu, Xiaohua (Inventor); McCauley, Laurie (Inventor)

2014-01-01

A delivery device includes a hollow container, and a plurality of biodegradable and/or erodible polymeric layers established in the container. A layer including a predetermined substance is established between each of the plurality of polymeric layers, whereby degradation of the polymeric layer and release of the predetermined substance occur intermittently. Methods for forming the device are also disclosed herein.

Using Facebook for Health-related Research Study Recruitment and Program Delivery

OpenAIRE

Pedersen, Eric R.; Kurz, Jeremy

2016-01-01

Facebook has become an important tool for recruiting research participants and for program delivery. Given the wide use of Facebook, there is much potential for the site to help with recruitment efforts in both physical and behavioral health care arenas; reaching groups typically difficult to recruit and providing outreach to individuals that may not have received services elsewhere. Health studies using Facebook have generally reported success, including cost-effectiveness, recruitment of sa...

A feasible method for clinical delivery verification and dose reconstruction in tomotherapy

International Nuclear Information System (INIS)

Kapatoes, J.M.; Olivera, G.H.; Ruchala, K.J.; Smilowitz, J.B.; Reckwerdt, P.J.; Mackie, T.R.

2001-01-01

Delivery verification is the process in which the energy fluence delivered during a treatment is verified. This verified energy fluence can be used in conjunction with an image in the treatment position to reconstruct the full three-dimensional dose deposited. A method for delivery verification that utilizes a measured database of detector signal is described in this work. This database is a function of two parameters, radiological path-length and detector-to-phantom distance, both of which are computed from a CT image taken at the time of delivery. Such a database was generated and used to perform delivery verification and dose reconstruction. Two experiments were conducted: a simulated prostate delivery on an inhomogeneous abdominal phantom, and a nasopharyngeal delivery on a dog cadaver. For both cases, it was found that the verified fluence and dose results using the database approach agreed very well with those using previously developed and proven techniques. Delivery verification with a measured database and CT image at the time of treatment is an accurate procedure for tomotherapy. The database eliminates the need for any patient-specific, pre- or post-treatment measurements. Moreover, such an approach creates an opportunity for accurate, real-time delivery verification and dose reconstruction given fast image reconstruction and dose computation tools

Preclinical evaluation of gene delivery methods for the treatment of loco-regional disease in breast cancer.

LENUS (Irish Health Repository)

Rajendran, Simon

2011-04-01

Preclinical results with various gene therapy strategies indicate significant potential for new cancer treatments. However, many therapeutics fail at clinical trial, often due to differences in tissue physiology between animal models and humans, and tumor phenotype variation. Clinical data relevant to treatment strategies may be generated prior to clinical trial through experimentation using intact patient tissue ex vivo. We developed a novel tumor slice model culture system that is universally applicable to gene delivery methods, using a realtime luminescence detection method to assess gene delivery. Methods investigated include viruses (adenovirus [Ad] and adeno-associated virus), lipofection, ultrasound (US), electroporation and naked DNA. Viability and tumor populations within the slices were well maintained for seven days, and gene delivery was qualitatively and quantitatively examinable for all vectors. Ad was the most efficient gene delivery vector with transduction efficiency >50%. US proved the optimal non-viral gene delivery method in human tumor slices. The nature of the ex vivo culture system permitted examination of specific elements. Parameters shown to diminish Ad gene delivery included blood, regions of low viability and secondary disease. US gene delivery was significantly reduced by blood and skin, while tissue hyperthermia improved gene delivery. US achieved improved efficacy for secondary disease. The ex vivo model was also suitable for examination of tissue-specific effects on vector expression, with Ad expression mediated by the CXCR4 promoter shown to provide a tumor selective advantage over the ubiquitously active cytomegalovirus promoter. In conclusion, this is the first study incorporating patient tissue models in comparing gene delivery from various vectors, providing knowledge on cell-type specificity and examining the crucial biological factors determining successful gene delivery. The results highlight the importance of in

Preclinical evaluation of gene delivery methods for the treatment of loco-regional disease in breast cancer.

LENUS (Irish Health Repository)

Rajendran, Simon

2012-01-31

Preclinical results with various gene therapy strategies indicate significant potential for new cancer treatments. However, many therapeutics fail at clinical trial, often due to differences in tissue physiology between animal models and humans, and tumor phenotype variation. Clinical data relevant to treatment strategies may be generated prior to clinical trial through experimentation using intact patient tissue ex vivo. We developed a novel tumor slice model culture system that is universally applicable to gene delivery methods, using a realtime luminescence detection method to assess gene delivery. Methods investigated include viruses (adenovirus [Ad] and adeno-associated virus), lipofection, ultrasound (US), electroporation and naked DNA. Viability and tumor populations within the slices were well maintained for seven days, and gene delivery was qualitatively and quantitatively examinable for all vectors. Ad was the most efficient gene delivery vector with transduction efficiency >50%. US proved the optimal non-viral gene delivery method in human tumor slices. The nature of the ex vivo culture system permitted examination of specific elements. Parameters shown to diminish Ad gene delivery included blood, regions of low viability and secondary disease. US gene delivery was significantly reduced by blood and skin, while tissue hyperthermia improved gene delivery. US achieved improved efficacy for secondary disease. The ex vivo model was also suitable for examination of tissue-specific effects on vector expression, with Ad expression mediated by the CXCR4 promoter shown to provide a tumor selective advantage over the ubiquitously active cytomegalovirus promoter. In conclusion, this is the first study incorporating patient tissue models in comparing gene delivery from various vectors, providing knowledge on cell-type specificity and examining the crucial biological factors determining successful gene delivery. The results highlight the importance of in

Cyclic delivery scheduling to customers with different priorities

Directory of Open Access Journals (Sweden)

Katarzyna Zofia Gdowska

2013-12-01

Full Text Available Background: In this paper a cyclic delivery scheduling problem for customers with different priorities is presented. Shops, which are provided with deliveries, are occasionally located in places which are crucial for the proper flow of traffic. In such places coordination of deliveries is crucial; therefore it allows to completely eliminate the phenomenon of the simultaneous arrivals of suppliers. Methods: In this paper the cyclic delivery scheduling problem for customers with different priorities was presented. To this theoretical problem a mix integer programming model was developed. Specific approach to the cyclic delivery scheduling problem is inspired by timetabling problem for urban public transport. Results: Mixed integer programming model was employed for solving four cases of cyclic delivery scheduling problem for customers with different priorities. When the value of the synchronization priority assigned to a single customer raised then the total number of synchronizations in the whole network decreased. In order to compare solutions a synchronization rate was utilized. A simple factor was utilized - the proportion of number of synchronizations of deliveries to a given customer to the total number of synchronizations obtained for the whole network. When the value of synchronization priority raised then the value of synchronization rate of this customer improved significantly. Conclusions: The mixed integer programming model for the cyclic delivery scheduling problem for customers with different priorities presented in this paper can be utilized for generating schedules of serving customers located in places where only one delivery can be received and unloaded at one go and where there is no space for other suppliers to wait in a queue. Such a schedule can be very useful for organizing deliveries to small shops united in a franchising network, since they operate in a way that is very similar to the network presented in this paper

An Innovative Program in the Science of Health Care Delivery: Workforce Diversity in the Business of Health.

Science.gov (United States)

Essary, Alison C; Wade, Nathaniel L

2016-01-01

According to the most recent statistics from the National Center for Education Statistics, disparities in enrollment in undergraduate and graduate education are significant and not improving commensurate with the national population. Similarly, only 12% of graduating medical students and 13% of graduating physician assistant students are from underrepresented racial and ethnic groups. Established in 2012 to promote health care transformation at the organization and system levels, the School for the Science of Health Care Delivery is aligned with the university and college missions to create innovative, interdisciplinary curricula that meet the needs of our diverse patient and community populations. Three-year enrollment trends in the program exceed most national benchmarks, particularly among students who identify as Hispanic and American Indian/Alaska Native. The Science of Health Care Delivery program provides students a seamless learning experience that prepares them to be solutions-oriented leaders proficient in the business of health care, change management, innovation, and data-driven decision making. Defined as the study and design of systems, processes, leadership and management used to optimize health care delivery and health for all, the Science of Health Care Delivery will prepare the next generation of creative, diverse, pioneering leaders in health care.

Solving Disparities Through Payment And Delivery System Reform: A Program To Achieve Health Equity.

Science.gov (United States)

DeMeester, Rachel H; Xu, Lucy J; Nocon, Robert S; Cook, Scott C; Ducas, Andrea M; Chin, Marshall H

2017-06-01

Payment systems generally do not directly encourage or support the reduction of health disparities. In 2013 the Finding Answers: Solving Disparities through Payment and Delivery System Reform program of the Robert Wood Johnson Foundation sought to understand how alternative payment models might intentionally incorporate a disparities-reduction component to promote health equity. A qualitative analysis of forty proposals to the program revealed that applicants generally did not link payment reform tightly to disparities reduction. Most proposed general pay-for-performance, global payment, or shared savings plans, combined with multicomponent system interventions. None of the applicants proposed making any financial payments contingent on having successfully reduced disparities. Most applicants did not address how they would optimize providers' intrinsic and extrinsic motivation to reduce disparities. A better understanding of how payment and care delivery models might be designed and implemented to reduce health disparities is essential. Project HOPE—The People-to-People Health Foundation, Inc.

West Virginia Peer Exchange : Streamlining Highway Safety Improvement Program Project Delivery - An RSPCB Peer Exchange

Science.gov (United States)

2014-09-01

The West Virginia Division of Highways (WV DOH) hosted a Peer Exchange to share information and experiences for streamlining Highway Safety Improvement Program (HSIP) project delivery. The event was held September 23 to 24, 2014 in Charleston, West V...

The delivery of distance education--is it time for doctoral programs in gerontology?

Science.gov (United States)

Heinz, Melinda; Martin, Peter; Doll, Gayle; Pearson-Scott, Jean

2015-01-01

The delivery of higher education in gerontology is changing; students are now able to receive an education solely online. Perhaps it is time to consider offering this option at the doctoral level. A needs assessment was conducted to assess whether a doctoral program in gerontology should be created in the Great Plains Interactive Distance Education Alliance (GPIDEA) program. An online survey was sent to 247 students enrolled in the GPIDEA program and to students who had taken a GPIDEA course in gerontology but were not currently enrolled in the program. One hundred and twenty-three students began the survey, although only 120 students completed the survey. Findings indicated students are interested in a doctoral program in gerontology. Approximately 65% of students were interested in obtaining a PhD from a distance education program. However, an applied program focusing on community outreach and leadership was of most interest to students. Students were less interested in research-based programs or in research residency. Therefore, the development of distance education doctoral degree programs in gerontology may need to be created differently than "traditional" formats.

Effective teaching strategies and methods of delivery for patient education: a systematic review and practice guideline recommendations.

Science.gov (United States)

Friedman, Audrey Jusko; Cosby, Roxanne; Boyko, Susan; Hatton-Bauer, Jane; Turnbull, Gale

2011-03-01

The objective of this study was to determine effective teaching strategies and methods of delivery for patient education (PE). A systematic review was conducted and reviews with or without meta-analyses, which examined teaching strategies and methods of delivery for PE, were included. Teaching strategies identified are traditional lectures, discussions, simulated games, computer technology, written material, audiovisual sources, verbal recall, demonstration, and role playing. Methods of delivery focused on how to deliver the teaching strategies. Teaching strategies that increased knowledge, decreased anxiety, and increased satisfaction included computer technology, audio and videotapes, written materials, and demonstrations. Various teaching strategies used in combination were similarly successful. Moreover, structured-, culturally appropriate- and patient-specific teachings were found to be better than ad hoc teaching or generalized teaching. Findings provide guidance for establishing provincial standards for the delivery of PE. Recommendations concerning the efficacy of the teaching strategies and delivery methods are provided.

[Methods of pushing at vaginal delivery and pelvi-perineal consequences. Review].

Science.gov (United States)

Ratier, N; Balenbois, E; Letouzey, V; Marès, P; de Tayrac, R

2015-03-01

The main objective of that review was to evaluate the pelvi-perineal consequences of the different methods of pushing at vaginal delivery. A review on PubMed, the Cochrane Library and EM-Premium was performed from 1984 to 2014. Among 29 manuscripts analysed, only nine randomised controlled trials (including one meta-analysis of three trials) comparing Valsalva and spontaneous pushing were selected. A 10 th study, secondary analysis of a randomized controlled trial comparing different methods of perineal protection (warm compresses, massage and manual protection), was also selected. Two trials have shown that spontaneous pushing reduces the risk of perineal tears, but studies were heterogeneous and discordant results do not allowed definitive conclusions. Results on the duration of the second stage of labour are conflicting. The method of pushing does not seem to affect the rate of episiotomy, instrumental delivery and cesarean section. Maternal satisfaction seems to be better after spontaneous pushing. It seems that there is no negative effect of spontaneous pushing on neonate well-being, and one study has shown a significant improvement of prenatal fetal parameters during the expulsive phase. According to current knowledge, both techniques of pushing during the expulsive phase at delivery seem comparable in terms of duration, risk of perineal tears and neonatal outcome. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

Comparison of different decontaminant delivery methods for sterilizing unoccupied commercial airliner cabins

Energy Technology Data Exchange (ETDEWEB)

Chen, Xi; Chen, Qingyan [National Air Transport Center of Excellence for Research in the Intermodal Transport Environment (RITE), School of Mechanical Engineering, Purdue University, 585 Purdue Mall, West Lafayette, IN 47905 (United States)

2010-09-15

Effective decontamination is crucial if an airliner cabin is contaminated by biological contaminants, such as infectious disease viruses or intentionally released biological agents. This study used computational fluid dynamics (CFD) method as a tool and vaporized hydrogen peroxide (VHP) as an exemplary decontaminant and Geobacillus stearothermophilus spores as a simulant contaminant to investigate three VHP delivery methods for sterilizing two different airliner cabins. The CFD first determined the airflow and the transient distributions of the contaminant and decontaminant in cabins. Auxiliary equations were implemented into the CFD model for evaluating efficacy of the sterilization process. The improved CFD model was validated by the measured airflow and simulated contaminant distributions obtained from a cabin mockup and the measured efficacy data from the literature. The three decontaminant delivery methods were (1) to supply the mixed VHP and air through the environmental control system of a cabin, (2) to send mixed VHP and air through a front door and to extract them from a back door of a cabin, and (3) to send directly VHP to a cabin and enhance the mixing with air in the cabin by fans. The two air cabins studied were a single-aisle and a twin-aisle airliner one. The results show that the second decontaminant delivery method (displacement method) was the best because the VHP distributions in the cabins were most uniform, the sterilization time was moderate, and the corrosion risk was low. The method displaced the existing air by the air/disinfectant solution, rather than dispersive mixing as the other two methods. (author)

SU-C-BRD-01: Multi-Centre Collaborative Quality Assurance Program for IMRT Planning and Delivery: Year 3 Results

Energy Technology Data Exchange (ETDEWEB)

McNiven, A; Jaffray, D; Letourneau, D [Princess Margaret Cancer Centre and Department of Radiation Oncology, University of Toronto, Toronto, ON (Canada)

2015-06-15

Purpose: A multi-centre quality assurance program was developed to enable quality improvement by coupling measurement of intensity modulated radiotherapy (IMRT) planning and delivery performance for site-specific planning exercises with diagnostic testing. The third year of the program specifically assessed the quality of spine stereotactic body radiotherapy (SBRT) planning and delivery amongst the participating centres. Methods: A spine SBRT planning exercise (24 Gy in 2 fractions) was created and completed by participants prior to an on-site visit. The delivery portion of the on-site visit included spine SBRT plan delivery and diagnostic testing, which included portal image acquisition for quantification of phantom positioning error and multi-leaf collimator (MLC) calibration accuracy. The measured dose was compared to that calculated in the treatment planning system (TPS) using 3%/2mm composite analysis and 3%/3mm gamma analysis. Results: Fourteen institutions participated, creating 17 spine SBRT plans (15 VMAT and 2 IMRT). Three different TPS, two beam energies (6 MV and 6 MV FFF), and four MLC designs from two linac vendors were tested. Large variation in total monitor units (MU) per plan (2494–6462 MU) and dose-volume parameters was observed. The maximum point dose in the plans ranged from 116–149% and was dependent upon the TPS used. Pass rates for measured to planned dose comparison ranged from 89.4–100% and 97.3–100% for 3%/2mm and 3%/3mm criteria respectively. The largest measured MLC error did Result in one of the poorer pass rates. No direct correlation between phantom positioning error and pass rates overall. Conclusion: Significant differences were observed in the planning exercise for some plan and dose-volume parameters based on the TPS used. Standard evaluation criteria showed good agreement between planned and measured dose for all participants, however on an individual plan basis, diagnostic tests were able to identify contributing

SU-C-BRD-01: Multi-Centre Collaborative Quality Assurance Program for IMRT Planning and Delivery: Year 3 Results

International Nuclear Information System (INIS)

McNiven, A; Jaffray, D; Letourneau, D

2015-01-01

Purpose: A multi-centre quality assurance program was developed to enable quality improvement by coupling measurement of intensity modulated radiotherapy (IMRT) planning and delivery performance for site-specific planning exercises with diagnostic testing. The third year of the program specifically assessed the quality of spine stereotactic body radiotherapy (SBRT) planning and delivery amongst the participating centres. Methods: A spine SBRT planning exercise (24 Gy in 2 fractions) was created and completed by participants prior to an on-site visit. The delivery portion of the on-site visit included spine SBRT plan delivery and diagnostic testing, which included portal image acquisition for quantification of phantom positioning error and multi-leaf collimator (MLC) calibration accuracy. The measured dose was compared to that calculated in the treatment planning system (TPS) using 3%/2mm composite analysis and 3%/3mm gamma analysis. Results: Fourteen institutions participated, creating 17 spine SBRT plans (15 VMAT and 2 IMRT). Three different TPS, two beam energies (6 MV and 6 MV FFF), and four MLC designs from two linac vendors were tested. Large variation in total monitor units (MU) per plan (2494–6462 MU) and dose-volume parameters was observed. The maximum point dose in the plans ranged from 116–149% and was dependent upon the TPS used. Pass rates for measured to planned dose comparison ranged from 89.4–100% and 97.3–100% for 3%/2mm and 3%/3mm criteria respectively. The largest measured MLC error did Result in one of the poorer pass rates. No direct correlation between phantom positioning error and pass rates overall. Conclusion: Significant differences were observed in the planning exercise for some plan and dose-volume parameters based on the TPS used. Standard evaluation criteria showed good agreement between planned and measured dose for all participants, however on an individual plan basis, diagnostic tests were able to identify contributing

Mental Illness Stigma Intervention in African Americans: Examining Two Delivery Methods.

Science.gov (United States)

Vinson, Ebony S; Abdullah, Tahirah; Brown, Tamara L

2016-05-01

Stigma surrounding mental illness and mental health treatment remains a significant problem, particularly among African Americans. This study sought to examine the effects of 2 intervention delivery methods in reducing reported stigma. African Americans (n = 158) were nonrandomly assigned to an in-person contact or video condition and administered a survey immediately before, after, and 2 weeks following the stigma intervention. The in vivo contact condition consisted of an African American man discussing his experiences with mental illness and psychotherapy. The session was recorded, and the recording was used for the video condition. There were no significant effects based on delivery method; however, there was a significant effect for time on stigma and help-seeking attitude measures. Further research is needed to determine the overall effectiveness of the intervention.

The Usefulness of Appreciative Inquiry As a Method to Identify Mass Sports Program Success

Directory of Open Access Journals (Sweden)

Bernadine VAN GRAMBERG

2010-06-01

Full Text Available The importance of the relationship between good health and physical activity is well known. Despite the growth of public mass sports programs in many countries, few evaluate them to ensure they meet their targets. Measuring organizational effectiveness and program success in public sports organizations is difficult and cannot be done directly as it involves a number of complex dimensions involving both internal (organizational and external (customer factors. Recognizing this, the paper advances the Appreciative Inquiry approach as a culturally sensitive method to focus on the positives of human experience rather than finding faults or gaps and as a means of identifying the success factors of service delivery. The paper outlines the research strategy to investigate success in Malaysian mass sport programs.

Integrated project delivery methods for energy renovation of social housing

Directory of Open Access Journals (Sweden)

Tadeo Baldiri Salcedo Rahola

2015-11-01

Full Text Available Optimised project delivery methods forsocial housing energy renovations European Social Housing Organisations (SHOs are currently facing challenging times. The ageing of their housing stock and the economic crisis, which has affected both their finances and the finances of their tenants, are testing their capacity to stick to their aim of providing decent and affordable housing. Housing renovation projects offer the possibility of upgrading the health and comfort levels of their old housing stock to current standards and improve energy efficiency, and this solution also addresses the fuel poverty problems suffered by some tenants. Unfortunately, the limited financial capacity of SHOs is hampering the scale of housing renovation projects and the energy savings achieved.  At the same time, the renovation of the existing housing stock is seen as one of the most promising alternative routes to achieving the ambitious CO2 emissions reduction targets set by European authorities – namely, to reduce EU CO2 emissions to 20% below their 1990 levels by 2020. The synergy between European targets and the aims of SHOs has been addressed by the energy policies of the member states, which focus on the potential energy savings achievable by renovating social housing. In fact, the European initiatives have prioritised energy savings in social housing renovations to such an extent that these are referred to as ‘energy renovations’. Energy renovation is therefore a renovation project with higher energy savings target than a regular renovation project. In total, European SHOs own 21.5 million dwellings representing around 9.4% of the total housing stock. Each SHO owns a large number of dwellings, which means there are fewer people to convince of the need to make energy savings through building renovations, maximising the potentially high impact of decisions. Moreover, SHOs are responsible for maintaining and upgrading their properties in order to continue

The association between cesarean delivery on maternal request and method of newborn feeding in China.

Directory of Open Access Journals (Sweden)

Xinxue Liu

Full Text Available Cesarean delivery has increased significantly during the last decades. This study aimed to investigate the association between planned mode of delivery and method of feeding.A cohort was created retrospectively using data from a population-based maternal and child health surveillance system, which covers 27 study sites in China from 1993 to 2006. The cohort consisted of 431,704 women for analysis, including 22,462 women with planned cesarean delivery on maternal request (CDMR and 409,242 women with planned vaginal delivery (VD. Logistic regression models were used to examine the association between mode of delivery and method of feeding adjusting for selected covariates. In this cohort, 398,176 (92.2% women exclusively breastfed their baby, 28,798 (6.7% women chose mixed feeding, and 4,730 (1.1% women chose formula feeding before hospital discharge. Women who planned CDMR were less likely to exclusively breastfeed and more likely to formula feed their babies than those who planned VD. After adjusting for covariates, the odds ratios were 0.85 (95% CI: 0.81-0.89 for exclusive breastfeeding and 1.61 (95% CI: 1.45-1.79 for formula feeding. Associations between planned mode of delivery and method of feeding in the south, north, rural and urban areas yielded similar results.This study demonstrated that planned CDMR was associated with a lower rate of exclusive breastfeeding and a higher rate of formula feeding in a low-risk Chinese population.

Roles of Social Movement Organizations for Securing Workers' Safety in Korea: A Case Study of Abolition of the 30-Minute Delivery Guarantee Program in Pizza Delivery Service.

Science.gov (United States)

Park, Ji-Eun; Kim, Myoung-Hee

2016-07-01

Many restaurants in Korea maintain quick-delivery service programs to satisfy customers. This service allows delivery workers limited time to deliver, which frequently put them in danger. Most of the workers are young, work part-time, and are rarely organized into trade unions. In this article, through a case study of the social movement to abolish the 30-minute delivery guarantee program of pizza companies in Korea, we argue that social movements involving social movement organizations (SMOs) and individual citizens could serve as a means to rectify this problem. We show how the SMOs developed and expanded the movement using a framing perspective and how the general public became involved through social media. Data was collected via online searching. Interview scripts from key players of SMOs and unofficial documents they provided were also reviewed. Three SMOs primarily led the movement, successfully forming a frame that emphasized social responsibility. SMOs also utilized social media to link their standing frame with unmobilized citizens and to expand the movement. We identified contributing factors and limitations of the movement and drew lessons that could be applied to other sectors where workers are in vulnerable positions. © The Author(s) 2016.

Comet Assay: A Method to Evaluate Genotoxicity of Nano-Drug Delivery System

Science.gov (United States)

Vandghanooni, Somayeh; Eskandani, Morteza

2011-01-01

Introduction Drug delivery systems could induce cellular toxicity as side effect of nanomaterials. The mechanism of toxicity usually involves DNA damage. The comet assay or single cell gel electrophoresis (SCGE) is a sensitive method for detecting strand damages in the DNA of a cell with applications in genotoxicity testing and molecular epidemiology as well as fundamental research in DNA damage and repair. Methods In the current study, we reviewed recent drug delivery researches related to SCGE. Results We found that one preference for choosing the assay is that comet images may result from apoptosis-mediated nuclear fragmentation. This method has been widely used over the last decade in several different areas. Overall cells, such as cultured cells are embedded in agarose on a microscope slide, lysed with detergent, and treated with high salt. Nucleoids are supercoiled DNA form. When the slide is faced to alkaline electrophoresis any breakages present in the DNA cause the supercoiling to relax locally and loops of DNA extend toward the anode as a ‘‘comet tail’’. Conclusion This article provides a relatively comprehensive review upon potentiality of the comet assay for assessment of DNA damage and accordingly it can be used as an informative platform in genotoxicity studies of drug delivery systems. PMID:23678412

Data delivery method based on neighbor nodes' information in a mobile ad hoc network.

Science.gov (United States)

Kashihara, Shigeru; Hayashi, Takuma; Taenaka, Yuzo; Okuda, Takeshi; Yamaguchi, Suguru

2014-01-01

This paper proposes a data delivery method based on neighbor nodes' information to achieve reliable communication in a mobile ad hoc network (MANET). In a MANET, it is difficult to deliver data reliably due to instabilities in network topology and wireless network condition which result from node movement. To overcome such unstable communication, opportunistic routing and network coding schemes have lately attracted considerable attention. Although an existing method that employs such schemes, MAC-independent opportunistic routing and encoding (MORE), Chachulski et al. (2007), improves the efficiency of data delivery in an unstable wireless mesh network, it does not address node movement. To efficiently deliver data in a MANET, the method proposed in this paper thus first employs the same opportunistic routing and network coding used in MORE and also uses the location information and transmission probabilities of neighbor nodes to adapt to changeable network topology and wireless network condition. The simulation experiments showed that the proposed method can achieve efficient data delivery with low network load when the movement speed is relatively slow.

Data Delivery Method Based on Neighbor Nodes’ Information in a Mobile Ad Hoc Network

Directory of Open Access Journals (Sweden)

Shigeru Kashihara

2014-01-01

Full Text Available This paper proposes a data delivery method based on neighbor nodes’ information to achieve reliable communication in a mobile ad hoc network (MANET. In a MANET, it is difficult to deliver data reliably due to instabilities in network topology and wireless network condition which result from node movement. To overcome such unstable communication, opportunistic routing and network coding schemes have lately attracted considerable attention. Although an existing method that employs such schemes, MAC-independent opportunistic routing and encoding (MORE, Chachulski et al. (2007, improves the efficiency of data delivery in an unstable wireless mesh network, it does not address node movement. To efficiently deliver data in a MANET, the method proposed in this paper thus first employs the same opportunistic routing and network coding used in MORE and also uses the location information and transmission probabilities of neighbor nodes to adapt to changeable network topology and wireless network condition. The simulation experiments showed that the proposed method can achieve efficient data delivery with low network load when the movement speed is relatively slow.

Using a Mixed-Methods RE-AIM Framework to Evaluate Community Health Programs for Older Latinas.

Science.gov (United States)

Schwingel, Andiara; Gálvez, Patricia; Linares, Deborah; Sebastião, Emerson

2017-06-01

This study used the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework to evaluate a promotora-led community health program designed for Latinas ages 50 and older that sought to improve physical activity, nutrition, and stress management. A mixed-methods evaluation approach was administered at participant and organizational levels with a focus on the efficacy, adoption, implementation, and maintenance components of the RE-AIM theoretical model. The program was shown to be effective at improving participants' eating behaviors, increasing their physical activity levels, and lowering their depressive symptoms. Promotoras felt motivated and sufficiently prepared to deliver the program. Some implementation challenges were reported. More child care opportunities and an increased focus on mental well-being were suggested. The promotora delivery model has promise for program sustainability with both promotoras and participants alike expressing interest in leading future programs.

National findings regarding health IT use and participation in health care delivery reform programs among office-based physicians.

Science.gov (United States)

Heisey-Grove, Dawn; Patel, Vaishali

2017-01-01

Our objective was to characterize physicians' participation in delivery and payment reform programs over time and describe how participants in these programs were using health information technology (IT) to coordinate care, engage patients, manage patient populations, and improve quality. A nationally representative cohort of physicians was surveyed in 2012 (unweighted N = 2567) and 2013 (unweighted N = 2399). Regression analyses used those survey responses to identify associations between health IT use and participation in and attrition from patient-centered medical homes (PCMHs), accountable care organizations (ACOs), and pay-for-performance programs (P4Ps). In 2013, 45% of physicians participated in PCMHs, ACOs, or P4Ps. While participation in each program increased (P payment reform programs increased between 2012 and 2013. Participating physicians were more likely to use health IT. There was significant attrition from and switching between PCMHs, ACOs, and P4Ps. This work provides the basis for understanding physician participation in and attrition from delivery and payment reform programs, as well as how health IT was used to support those programs. Understanding health IT use by program participants may help to identify factors enabling a smooth transition to alternative payment models. Published by Oxford University Press on behalf of the American Medical Informatics Association 2016. This work is written by US Government employees and is in the public domain in the United States.

The relationship between quality of life and methods of delivery: A systematic review and meta-analysis.

Science.gov (United States)

Rezaei, Nazanin; Tavalaee, Zahra; Sayehmiri, Kourosh; Sharifi, Nasibeh; Daliri, Salman

2018-04-01

Some physical, emotional and social changes arise in mothers during the postpartum periods which can affect the quality of life (QOL) of the mother and family. Given the importance of the quality of life in the postpartum period and its influencing factors such as method of delivery, the present study aimed at investigating the relationship between the quality of life and methods of delivery in the world, using a systematic review and meta-analysis method. The present study is a systematic review and meta-analysis on the relationship between aspects of quality of life and method of delivery in the world conducted in Persian and English language articles published by the end of 2015. For this purpose, the databases of Medlib, SID, Scopus, ISI Web of Science, PubMed, Google scholar, Irandoc, Magiran and Iranmedex were searched using key words and their compounds. The results of studies were combined using the random effects model in the meta-analysis. Heterogeneity of studies was assessed using I2 index and Cochran test and data were analyzed using STATA Version 11.1 and SPSS Version 16. Based on the results of the meta-analysis of studies, the aspect of physical functioning had the highest quality of life mean score in women with vaginal delivery: 74.37 (95% CI: 67.7-81) and mental health had the highest QOL mean score in women with cesarean delivery: 65.8 (95% CI: 62.7-69). Also, based on the time elapsed since delivery, mental health had the highest mean score in less than 1 month, 2 months and 4 months' postpartum. Physical pain had the highest mean score 6 months after giving birth, and mental functioning in 8 months after giving birth. The results of the present meta-analysis showed that the mean scores for most dimensions of quality of life in women with vaginal delivery were higher than in women with cesarean delivery.

Waste feed delivery test and evaluation plan

Energy Technology Data Exchange (ETDEWEB)

O' TOOLE, S.M.

1999-09-30

This plan documents the Waste Feed Delivery Program test and evaluation planning and implementation approach. The purpose of this document is to define and communicate the Waste Feed Delivery Program Test and Evaluation scope, objectives, planning and implementation approach.

Waste feed delivery test and evaluation plan

International Nuclear Information System (INIS)

O'TOOLE, S.M.

1999-01-01

This plan documents the Waste Feed Delivery Program test and evaluation planning and implementation approach. The purpose of this document is to define and communicate the Waste Feed Delivery Program Test and Evaluation scope, objectives, planning and implementation approach

Use of electronic group method in assessing food safety training needs and delivery methods among international college students in the U.S.

Science.gov (United States)

Garden-Robinson, Julie; Eighmy, Myron A; Lyonga, Agnes Ngale

2010-12-01

The purpose of this study was to determine the types of unfamiliar foods international students in the U.S. encounter and to assess food safety information that international students would like to receive for mitigating risks associated with handling and preparing unfamiliar foods. The study identified preferred instructional delivery methods and media for receiving food safety training or information. An electronic group method was used for this study. The electronic group method was chosen to maximize group efficiency by allowing participants to share ideas simultaneously and anonymously with minimal use of time and resources.Types of different (unfamiliar) foods were grouped into major categories. Fast and ready-to-eat foods, and processed and frozen foods constituted a major change for some international students, who were accustomed to homemade and fresh foods in their countries. Participants were interested in receiving information about how to safely handle and prepare unfamiliar foods in their new environment. Preferred methods for receiving food safety information included written materials, online publications, presentations, and materials provided during student orientation. Food packages, websites, and television programs were other preferred methods of receiving food safety information. Copyright © 2010 Elsevier Ltd. All rights reserved.

76 FR 25345 - Annual Assessment of the Status of Competition in the Market for the Delivery of Video Programming

Science.gov (United States)

2011-05-04

... industry inputs and consumer behavior on the delivery of video programming. We expect to discuss three key... delivered over the Internet to televisions. Consumer Behavior 56. We seek information about how trends in consumer behavior affect the products and services of providers of delivered video programming. We seek...

Non-Viral Transfection Methods Optimized for Gene Delivery to a Lung Cancer Cell Line

Science.gov (United States)

Salimzadeh, Loghman; Jaberipour, Mansooreh; Hosseini, Ahmad; Ghaderi, Abbas

2013-01-01

Background Mehr-80 is a newly established adherent human large cell lung cancer cell line that has not been transfected until now. This study aims to define the optimal transfection conditions and effects of some critical elements for enhancing gene delivery to this cell line by utilizing different non-viral transfection Procedures. Methods In the current study, calcium phosphate (CaP), DEAE-dextran, superfect, electroporation and lipofection transfection methods were used to optimize delivery of a plasmid construct that expressed Green Fluorescent Protein (GFP). Transgene expression was detected by fluorescent microscopy and flowcytometry. Toxicities of the methods were estimated by trypan blue staining. In order to evaluate the density of the transfected gene, we used a plasmid construct that expressed the Stromal cell-Derived Factor-1 (SDF-1) gene and measured its expression by real-time PCR. Results Mean levels of GFP-expressing cells 48 hr after transfection were 8.4% (CaP), 8.2% (DEAE-dextran), 4.9% (superfect), 34.1% (electroporation), and 40.1% (lipofection). Lipofection had the highest intense SDF-1 expression of the analyzed methods. Conclusion This study has shown that the lipofection and electroporation methods were more efficient at gene delivery to Mehr-80 cells. The quantity of DNA per transfection, reagent concentration, and incubation time were identified as essential factors for successful transfection in all of the studied methods. PMID:23799175

The state-led large scale public private partnership 'Chiranjeevi Program' to increase access to institutional delivery among poor women in Gujarat, India: How has it done? What can we learn?

Directory of Open Access Journals (Sweden)

Ayesha De Costa

Full Text Available BACKGROUND: Many low-middle income countries have focused on improving access to and quality of obstetric care, as part of promoting a facility based intra-partum care strategy to reduce maternal mortality. The state of Gujarat in India, implements a facility based intra-partum care program through its large for-profit private obstetric sector, under a state-led public-private-partnership, the Chiranjeevi Yojana (CY, under which the state pays accredited private obstetricians to perform deliveries for poor/tribal women. We examine CY performance, its contribution to overall trends in institutional deliveries in Gujarat over the last decade and its effect on private and public sector deliveries there. METHODS: District level institutional delivery data (public, private, CY, national surveys, poverty estimates, census data were used. Institutional delivery trends in Gujarat 2000-2010 are presented; including contributions of different sectors and CY. Piece-wise regression was used to study the influence of the CY program on public and private sector institutional delivery. RESULTS: Institutional delivery rose from 40.7% (2001 to 89.3% (2010, driven by sharp increases in private sector deliveries. Public sector and CY contributed 25-29% and 13-16% respectively of all deliveries each year. In 2007, 860 of 2000 private obstetricians participated in CY. Since 2007, >600,000 CY deliveries occurred i.e. one-third of births in the target population. Caesareans under CY were 6%, higher than the 2% reported among poor women by the DLHS survey just before CY. CY did not influence the already rising proportion of private sector deliveries in Gujarat. CONCLUSION: This paper reports a state-led, fully state-funded, large-scale public-private partnership to improve poor women's access to institutional delivery - there have been >600,000 beneficiaries. While caesarean proportions are higher under CY than before, it is uncertain if all beneficiaries who require

Is home delivery really preferred? a mixed-methods national study in Pakistan.

Science.gov (United States)

Zafar, Shamsa; Sikander, Siham; Ahmad, Ikhlaq; Ahmad, Mansoor; Parveen, Nazia; Saleem, Shumaila; Nawaz, Tayyba; Suleman, Zainab; Suleman, Nadia; ulAin, Noor; Naeem, Ayesha; Bashir, Asma

2015-11-25

Pakistan has a high maternal mortality ratio and a low rate of skilled birth attendants (SBAs). To address these two important issues, the Pakistan Maternal Newborn and Child Health (MNCH) programme launched the community midwives (CMW) initiative in 2007. CMWs are supposed to conduct deliveries at community level outside health facilities. The purpose of the current study is to document perceptions about CMWs and preferences for birthing place. A mixed-methods study was conducted covering four provinces. For the quantitative survey, households were selected through a multistage sampling technique from rural districts. In 1,450 rural households, preferences of respondents about CMW-conducted deliveries were recorded. Qualitative data were obtained through focus group discussions (FGDs) and in-depth interviews (IDIs) with women, community elders, CMWs, and MNCH programme personnel in the same areas where the quantitative study was carried out. In both studies, preferences and the reasons behind particular respondent preferences were recorded. Frequencies of responses were analysed for the quantitative study. Narration and quotes from various types of participants were used to present findings from FGDs and IDIs. In the quantitative study, 42% of respondents expressed a preference for birthing stations, i.e. a place where CMWs conduct deliveries; 22% preferred home deliveries. Birthing stations were favoured because of the availability of space and equipment and the proximity to women's homes. These findings were largely supported by the qualitative component, although a range of views about where a CMW should conduct deliveries were expressed. Insights into where CMWs might provide delivery services were obtained through this study. Birthing stations may be an option as a preferred location for delivery care and should be considered as part of Pakistan's national CMW programme.

Influence of Course Delivery Method and Proctoring on Performance in Introductory Economics

OpenAIRE

Wachenheim, Cheryl J.

2011-01-01

This work was published in the Review of Agricultural Economics. See Wachenheim, C.J. 2009. Final Exam Scores in Introductory Economics Courses: Effect of Course Delivery Method and Proctoring. Review of Agricultural Economics 31(3), pp. 640-652.

From Entry to Practice to Advanced Nurse Practitioner - The Progression of Competencies and How They Assist in Delivery of eHealth Programs for Healthy Ageing.

Science.gov (United States)

Rodger, Daragh; Hussey, Pamela

2017-01-01

Most of the health issues encountered in persons of older age are the result of one or more chronic diseases. The evidence base reports that chronic diseases can be prevented or delayed by engaging in healthy behaviors. Education provides a cost effective intervention on both economic grounds in addition to delivery of optimal patient outcomes. Information and Communication Technology (ICT) increasingly is viewed as a critical utility in eHealth delivery, providing scope for expanding online education facilities for older persons. Developing nursing competencies in the delivery of eHealth solutions to deliver user education programs therefore makes sense. This chapter discusses nursing competencies on the development of targeted eHealth programs for healthy ageing. The role of Advanced Nurse Practitioner in Ireland and its associated competency set identifies how a strong action learning model can be designed to deliver eHealth educational programs for effective delivery of healthy ageing in place.

Design of Drug Delivery Methods for the Brain and Central Nervous System

Science.gov (United States)

Lueshen, Eric

-enhanced drug delivery (CED) is a technique used to bypass the BBB via direct intracranial injection using a catheter driven by a positive pressure gradient from an infusion pump. Although CED boasts the advantage of achieving larger drug distribution volumes compared to diffusion driven methods, difficulty in predicting drug spread and preventing backflow along the catheter shaft commonly occur. In this dissertation, a method for predicting drug distributions in the brain using diffusion tensor imaging (DTI) data is employed to show how small variations in catheter placement can lead to drastically different volumes of drug distribution in vivo. The impact that microfluid flow has on deformable brain phantom gel is studied in order to elucidate the causes of backflow, and the results are used to develop backflow-free catheters with safe volumetric flow rates up to 10 ?l/min. Through implementation of our backflow-free catheter designs, physicians will be able to target specific regions of the brain with improved accuracy, increased drug concentration, and larger drug distribution geometries. Intrathecal (IT) drug delivery involves direct drug infusion into the spinal canal and has become standard practice for treating many CNS diseases. Although IT drug delivery boasts the advantage of reduced systemic toxicity compared to oral and intravenous techniques, current IT delivery protocols lack a means of sufficient drug targeting at specific locations of interest within the CNS. In this dissertation, the method of intrathecal magnetic drug targeting (IT-MDT) is developed to overcome the limited targeting capabilities of standard IT drug delivery protocols. The basic idea behind IT-MDT is to guide intrathecally-injected, drug-functionalized magnetic nanoparticles (MNPs) using an external magnetic field to diseased regions within the spinal canal. Cerebrospinal fluid (CSF) transport phenomena are studied, and in vitro human spine surrogates are built. Experiments are run on the in

Non-viral transfection methods optimized for gene delivery to a lung cancer cell line.

Science.gov (United States)

Salimzadeh, Loghman; Jaberipour, Mansooreh; Hosseini, Ahmad; Ghaderi, Abbas

2013-04-01

Mehr-80 is a newly established adherent human large cell lung cancer cell line that has not been transfected until now. This study aims to define the optimal transfection conditions and effects of some critical elements for enhancing gene delivery to this cell line by utilizing different non-viral transfection Procedures. In the current study, calcium phosphate (CaP), DEAE-dextran, superfect, electroporation and lipofection transfection methods were used to optimize delivery of a plasmid construct that expressed Green Fluorescent Protein (GFP). Transgene expression was detected by fluorescent microscopy and flowcytometry. Toxicities of the methods were estimated by trypan blue staining. In order to evaluate the density of the transfected gene, we used a plasmid construct that expressed the Stromal cell-Derived Factor-1 (SDF-1) gene and measured its expression by real-time PCR. Mean levels of GFP-expressing cells 48 hr after transfection were 8.4% (CaP), 8.2% (DEAE-dextran), 4.9% (superfect), 34.1% (electroporation), and 40.1% (lipofection). Lipofection had the highest intense SDF-1 expression of the analyzed methods. This study has shown that the lipofection and electroporation methods were more efficient at gene delivery to Mehr-80 cells. The quantity of DNA per transfection, reagent concentration, and incubation time were identified as essential factors for successful transfection in all of the studied methods.

QoE Power-Efficient Multimedia Delivery Method for LTE-A

OpenAIRE

Mushtaq, M. Sajid; Mellouk, Abdelhamid; Augustin, Brice; Fowler, Scott

2016-01-01

The fastest growing of multimedia services overfuture wireless communication system demand more networkresources, efficient delivery of multimedia service with highusers satisfaction, and power optimization of User Equipments(UEs). The resources and power optimization are significant infuture mobile computing systems, because emerging multimediaservices consume more resources and power. The 4G standard ofLTE-A wireless system has adopted the Discontinuous Reception(DRX) method to extend and o...

Evaluating Student Perceptions of Course Delivery Platforms

Science.gov (United States)

Bramorski, Tom; Madan, Manu S.

2016-01-01

In this paper we evaluate effectiveness of course delivery mode on three dimensions: values, networking opportunities and learning. While students and their future employers are two important customers for the business program, we focus on the perception of students regarding the effectiveness of course delivery mode on program performance. The…

Understanding Process in Group-Based Intervention Delivery: Social Network Analysis and Intra-entity Variability Methods as Windows into the "Black Box".

Science.gov (United States)

Molloy Elreda, Lauren; Coatsworth, J Douglas; Gest, Scott D; Ram, Nilam; Bamberger, Katharine

2016-11-01

Although the majority of evidence-based programs are designed for group delivery, group process and its role in participant outcomes have received little empirical attention. Data were collected from 20 groups of participants (94 early adolescents, 120 parents) enrolled in an efficacy trial of a mindfulness-based adaptation of the Strengthening Families Program (MSFP). Following each weekly session, participants reported on their relations to group members. Social network analysis and methods sensitive to intraindividual variability were integrated to examine weekly covariation between group process and participant progress, and to predict post-intervention outcomes from levels and changes in group process. Results demonstrate hypothesized links between network indices of group process and intervention outcomes and highlight the value of this unique analytic approach to studying intervention group process.

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

Science.gov (United States)

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

2009-09-26

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

Special delivery: an analysis of mHealth in maternal and newborn health programs and their outcomes around the world.

Science.gov (United States)

Tamrat, Tigest; Kachnowski, Stan

2012-07-01

Mobile health (mHealth) encompasses the use of mobile telecommunication and multimedia into increasingly mobile and wireless health care delivery systems and has the potential to improve tens of thousands of lives each year. The ubiquity and penetration of mobile phones presents the opportunity to leverage mHealth for maternal and newborn care, particularly in under-resourced health ecosystems. Moreover, the slow progress and funding constraints in attaining the Millennium Development Goals for child and maternal health encourage harnessing innovative measures, such as mHealth, to address these public health priorities. This literature review provides a schematic overview of the outcomes, barriers, and strategies of integrating mHealth to improve prenatal and neonatal health outcomes. Six electronic databases were methodically searched using predetermined search terms. Retrieved articles were then categorized according to themes identified in previous studies. A total of 34 articles and reports contributed to the findings with information about the use and limitations of mHealth for prenatal and neonatal healthcare access and delivery. Health systems have implemented mHealth programs to facilitate emergency medical responses, point-of-care support, health promotion and data collection. However, the policy infrastructure for funding, coordinating and guiding the sustainable adoption of prenatal and neonatal mHealth services remains under-developed. The integration of mobile health for prenatal and newborn health services has demonstrated positive outcomes, but the sustainability and scalability of operations requires further feedback from and evaluation of ongoing programs.

Computational Experiment Study on Selection Mechanism of Project Delivery Method Based on Complex Factors

Directory of Open Access Journals (Sweden)

Xiang Ding

2014-01-01

Full Text Available Project delivery planning is a key stage used by the project owner (or project investor for organizing design, construction, and other operations in a construction project. The main task in this stage is to select an appropriate project delivery method. In order to analyze different factors affecting the PDM selection, this paper establishes a multiagent model mainly to show how project complexity, governance strength, and market environment affect the project owner’s decision on PDM. Experiment results show that project owner usually choose Design-Build method when the project is very complex within a certain range. Besides, this paper points out that Design-Build method will be the prior choice when the potential contractors develop quickly. This paper provides the owners with methods and suggestions in terms of showing how the factors affect PDM selection, and it may improve the project performance.

Bespoke program design for school-aged therapy disability service delivery.

Science.gov (United States)

Weatherill, Pamela; Bahn, Susanne; Cooper, Trudi

2012-01-01

This article uses the evaluation of a school-aged therapy service for children with disabilities in Western Australia to investigate models of service delivery. The current literature on family-centered practice, multidisciplinary and transdisciplinary approaches, and 4 models of service are reviewed. The models include the life needs model, the relational goal-orientated model of optimal service delivery to children and families, the quality of life model, and the collaborative model of service delivery. Analysis of the data is presented together with a bespoke model of service delivery for children with disabilities, arguing that local contexts benefit from custom-made service design.

Programming the finite element method

CERN Document Server

Smith, I M; Margetts, L

2013-01-01

Many students, engineers, scientists and researchers have benefited from the practical, programming-oriented style of the previous editions of Programming the Finite Element Method, learning how to develop computer programs to solve specific engineering problems using the finite element method. This new fifth edition offers timely revisions that include programs and subroutine libraries fully updated to Fortran 2003, which are freely available online, and provides updated material on advances in parallel computing, thermal stress analysis, plasticity return algorithms, convection boundary c

An evaluation of gating window size, delivery method, and composite field dosimetry of respiratory-gated IMRT

International Nuclear Information System (INIS)

Hugo, Geoffrey D.; Agazaryan, Nzhde; Solberg, Timothy D.

2002-01-01

A respiratory gating system has been developed based on a commercial patient positioning system. The purpose of this study is to investigate the ability of the gating system to reproduce normal, nongated IMRT operation and to quantify the errors produced by delivering a nongated IMRT treatment onto a moving target. A moving phantom capable of simultaneous two-dimensional motion was built, and an analytical liver motion function was used to drive the phantom. Studies were performed to assess the effect of gating window size and choice of delivery method (segmented and dynamic multileaf collimation). Additionally, two multiple field IMRT cases were delivered to quantify the error in gated and nongated IMRT with motion. Dosimetric error between nonmoving and moving deliveries is related to gating window size. By reducing the window size, the error can be reduced. Delivery error can be reduced for both dynamic and segmented delivery with gating. For the implementation of dynamic IMRT delivery in this study, dynamic delivery was found to generate larger delivery errors than segmented delivery in most cases studied. For multiple field IMRT delivery, the largest errors were generated in regions where high field modulation was present parallel to the axis of motion. Gating was found to reduce these large errors to clinically acceptable levels

A novel method for sub-arc VMAT dose delivery verification based on portal dosimetry with an EPID.

Science.gov (United States)

Cools, Ruud A M; Dirkx, Maarten L P; Heijmen, Ben J M

2017-11-01

The EPID-based sub-arc verification of VMAT dose delivery requires synchronization of the acquired electronic portal images (EPIs) with the VMAT delivery, that is, establishment of the start- and stop-MU of the acquired images. To realize this, published synchronization methods propose the use of logging features of the linac or dedicated hardware solutions. In this study, we developed a novel, software-based synchronization method that only uses information inherently available in the acquired images. The EPIs are continuously acquired during pretreatment VMAT delivery and converted into Portal Dose Images (PDIs). Sub-arcs of approximately 10 MU are then defined by combining groups of sequentially acquired PDIs. The start- and stop-MUs of measured sub-arcs are established in a synchronization procedure, using only dosimetric information in measured and predicted PDIs. Sub-arc verification of a VMAT dose delivery is based on comparison of measured sub-arc PDIs with synchronized, predicted sub-arc PDIs, using γ-analyses. To assess the accuracy of this new method, measured and predicted PDIs were compared for 20 clinically applied VMAT prostate cancer plans. The sensitivity of the method for detection of delivery errors was investigated using VMAT deliveries with intentionally inserted, small perturbations (25 error scenarios; leaf gap deviations ≤ 1.5 mm, leaf motion stops during ≤ 15 MU, linac output error ≤ 2%). For the 20 plans, the average failed pixel rates (FPR) for full-arc and sub-arc dose QA were 0.36% ± 0.26% (1 SD) and 0.64% ± 0.88%, based on 2%/2 mm and 3%/3 mm γ-analyses, respectively. Small systematic perturbations of up to 1% output error and 1 mm leaf offset were detected using full-arc QA. Sub-arc QA was able to detect positioning errors in three leaves only during approximately 20 MU and small dose delivery errors during approximately 40 MU. In an ROC analysis, the area under the curve (AUC) for the combined full-arc/sub-arc approach was

MRI in ocular drug delivery

OpenAIRE

Li, S. Kevin; Lizak, Martin J.; Jeong, Eun-Kee

2008-01-01

Conventional pharmacokinetic methods for studying ocular drug delivery are invasive and cannot be conveniently applied to humans. The advancement of MRI technology has provided new opportunities in ocular drug-delivery research. MRI provides a means to non-invasively and continuously monitor ocular drug-delivery systems with a contrast agent or compound labeled with a contrast agent. It is a useful technique in pharmacokinetic studies, evaluation of drug-delivery methods, and drug-delivery de...

Acute and Impaired Wound Healing: Pathophysiology and Current Methods for Drug Delivery, Part 2: Role of Growth Factors in Normal and Pathological Wound Healing: Therapeutic Potential and Methods of Delivery

Science.gov (United States)

Demidova-Rice, Tatiana N.; Hamblin, Michael R.; Herman, Ira M.

2012-01-01

This is the second of 2 articles that discuss the biology and pathophysiology of wound healing, reviewing the role that growth factors play in this process and describing the current methods for growth factor delivery into the wound bed. PMID:22820962

A Novel Nonviral Gene Delivery System: Multifunctional Envelope-Type Nano Device

Science.gov (United States)

Hatakeyama, Hiroto; Akita, Hidetaka; Kogure, Kentaro; Harashima, Hideyoshi

In this review we introduce a new concept for developing a nonviral gene delivery system which we call "Programmed Packaging." Based on this concept, we succeeded in developing a multifunctional envelope-type nano device (MEND), which exerts high transfection activities equivalent to those of an adenovirus in a dividing cell. The use of MEND has been extended to in vivo applications. PEG/peptide/DOPE ternary conjugate (PPD)-MEND, a new in vivo gene delivery system for the targeting of tumor cells that dissociates surface-modified PEG in tumor tissue by matrix metalloproteinase (MMP) and exerts significant transfection activities, was developed. In parallel with the development of MEND, a quantitative gene delivery system, Confocal Image-assisted 3-dimensionally integrated quantification (CIDIQ), also was developed. This method identified the rate-limiting step of the nonviral gene delivery system by comparing it with adenoviral-mediated gene delivery. The results of this analysis provide a new direction for the development of rational nonviral gene delivery systems.

FastStats: Births -- Method of Delivery

Science.gov (United States)

... 1990–2013 [PDF – 423 KB] Primary Cesarean Delivery Rates, by State: Results From the Revised Birth Certificate, 2006–2012 [PDF – 274 KB] Related Links Vital Statistics downloadable public use data files American College of ...

Are written information or counseling (WOMAN-PRO II program) able to improve patient satisfaction and the delivery of health care of women with vulvar neoplasms? Secondary outcomes of a multicenter randomized controlled trial

Science.gov (United States)

Gehrig, Larissa; Kobleder, Andrea; Werner, Birgit; Denhaerynck, Kris; Senn, Beate

2017-01-01

Background: Patients with vulvar neoplasms report a lack of information, missing support in self-management and a gap in delivery of health care. Aim: The aim of the study was to investigate if written information or counseling based on the WOMAN-PRO II program are able to improve patient satisfaction and the delivery of health care from the health professional's perspective of women with vulvar neoplasms. Method: Patient satisfaction and the delivery of health care have been investigated as two secondary outcomes in a multicenter randomized controlled parallel-group phase II study (Clinical Trial ID: NCT01986725). In total, 49 women, from four hospitals (CH, AUT), completed the questionnaire PACIC-S11 after written information (n = 13) and counseling (n = 36). The delivery of health care was evaluated by ten Advanced Practice Nurses (APNs) by using the G-ACIC before and after implementing counseling based on the WOMAN-PRO II program. Results: There were no significant differences between the two groups identified (p = 0.25). Only few aspects were rated highly by all women, such as the overall satisfaction (M = 80.3 %) and satisfaction with organization of care (M = 83.0 %). The evaluation of delivery of health care by APNs in women who received counseling improved significantly (p = 0.031). Conclusions: There are indications, that the practice of both interventions might have improved patient satisfaction and counseling the delivery of health care. The aspects that have been rated low in the PACIC-S11 and G-ACIC indicate possibilities to optimize the delivery of health care.

Leadership training design, delivery, and implementation: A meta-analysis.

Science.gov (United States)

Lacerenza, Christina N; Reyes, Denise L; Marlow, Shannon L; Joseph, Dana L; Salas, Eduardo

2017-12-01

Recent estimates suggest that although a majority of funds in organizational training budgets tend to be allocated to leadership training (Ho, 2016; O'Leonard, 2014), only a small minority of organizations believe their leadership training programs are highly effective (Schwartz, Bersin, & Pelster, 2014), calling into question the effectiveness of current leadership development initiatives. To help address this issue, this meta-analysis estimates the extent to which leadership training is effective and identifies the conditions under which these programs are most effective. In doing so, we estimate the effectiveness of leadership training across four criteria (reactions, learning, transfer, and results; Kirkpatrick, 1959) using only employee data and we examine 15 moderators of training design and delivery to determine which elements are associated with the most effective leadership training interventions. Data from 335 independent samples suggest that leadership training is substantially more effective than previously thought, leading to improvements in reactions (δ = .63), learning (δ = .73), transfer (δ = .82), and results (δ = .72), the strength of these effects differs based on various design, delivery, and implementation characteristics. Moderator analyses support the use of needs analysis, feedback, multiple delivery methods (especially practice), spaced training sessions, a location that is on-site, and face-to-face delivery that is not self-administered. Results also suggest that the content of training, attendance policy, and duration influence the effectiveness of the training program. Practical implications for training development and theoretical implications for leadership and training literatures are discussed. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Redefining continuing education delivery.

Science.gov (United States)

Carlton, K H

1997-01-01

Just as technology is transforming the delivery of education, the Internet and advanced telecommunication applications are changing the "face" of CE and the connotation of "lifelong learning." As late as the mid-1980s, a discussion of computer applications in nursing CE focused on the "timely" transition to microcomputers as tools for the enhancement of managerial tasks for increased productivity. Even as recently as 1990, there seemed to be "time" for those providers who were "slower to adopt innovation" to "catch up." Now, the CE provider who does not integrate the microcomputer and advanced telecommunications as an integral component of their delivery modalities may be outsourced rapidly by an educational or commercial competitive unit that is able to utilize the communication medium, mergers and partnerships, enterprise, and individual lifestyle and learning patterns that will epitomize the CE unit of the 21st century. As with the "re-engineering" of nursing education, the "re-engineered" delivery modalities of evolving CE entity might now best be conceptualized on a continuum from the traditional mode that time and place dependent to a mode of synchronous and asynchronous data and advanced telecommunication. Delivery methods will need to be selected according to the target populations, content, and situation. The health-care educational provider may discover, as in other industries, that a combination of distance and residential offerings will be the most successful medium for the delivery of CE to the progressively more "information and technologically savvy" lifelong learner of the 21st century. In addressing the dramatic effects of the information technology era on the refocused multimedia/interactive delivery method for student education, educators amply quoted Bob Dylan's phrase of the 1960s, "The times, they are a-changing." And so, we see that the times are also changing at an astronomical rate for the health-care educational provider as well as the

Sport Psychology Service Provision: Preferences for Consultant Characteristics and Mode of Delivery among Elite Malaysian Athletes.

Science.gov (United States)

Ponnusamy, Vellapandian; Grove, J Robert

2014-09-01

Factors relevant to the working alliance between athletes and sport psychology consultants were investigated in a sample of elite Malaysian athletes (n = 217). The athletes represented a variety of team and individual sports, and they provided information about the perceived importance of seven consultant characteristics/behaviors as well as seven program delivery options. At a full-sample level, general preferences were expressed for consultants to lead a physically active lifestyle, regularly attend training sessions and competitions, and have prior experience as an athlete or coach. General preferences were also expressed for program content to be determined by the coach or consultant, and for regular, small doses of mental skills training to be delivered in a face-to-face context throughout the year. At a sub-group level, team sport athletes had stronger preferences than individual sport athletes for program delivery on a group/team basis, while individual sport athletes had stronger preferences than team sport athletes for having a role in determining program content. Findings are discussed in relation to dominant value themes within Malaysian society and the reinforcement of these themes within specific sport subcultures. Key pointsConsultant characteristics and program delivery methods have an impact on the effectiveness of sport psychology services.Preferred consultant characteristics and preferred methods of delivery may be affected by cultural and subcultural values.Elite Malaysian athletes prefer consultants to lead a physically active lifestyle; to regularly attend training/competition; and to have prior experience as an athlete or coach.Elite Malaysian athletes also prefer that the coach or consultant determine program content, and that mental skills training take place in a face-to-face context throughout the year.

Sport Psychology Service Provision: Preferences for Consultant Characteristics and Mode of Delivery among Elite Malaysian Athletes

Science.gov (United States)

Ponnusamy, Vellapandian; Grove, J. Robert

2014-01-01

Factors relevant to the working alliance between athletes and sport psychology consultants were investigated in a sample of elite Malaysian athletes (n = 217). The athletes represented a variety of team and individual sports, and they provided information about the perceived importance of seven consultant characteristics/behaviors as well as seven program delivery options. At a full-sample level, general preferences were expressed for consultants to lead a physically active lifestyle, regularly attend training sessions and competitions, and have prior experience as an athlete or coach. General preferences were also expressed for program content to be determined by the coach or consultant, and for regular, small doses of mental skills training to be delivered in a face-to-face context throughout the year. At a sub-group level, team sport athletes had stronger preferences than individual sport athletes for program delivery on a group/team basis, while individual sport athletes had stronger preferences than team sport athletes for having a role in determining program content. Findings are discussed in relation to dominant value themes within Malaysian society and the reinforcement of these themes within specific sport subcultures. Key points Consultant characteristics and program delivery methods have an impact on the effectiveness of sport psychology services. Preferred consultant characteristics and preferred methods of delivery may be affected by cultural and subcultural values. Elite Malaysian athletes prefer consultants to lead a physically active lifestyle; to regularly attend training/competition; and to have prior experience as an athlete or coach. Elite Malaysian athletes also prefer that the coach or consultant determine program content, and that mental skills training take place in a face-to-face context throughout the year. PMID:25177193

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

Directory of Open Access Journals (Sweden)

Fennell Mary L

2009-09-01

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

A modified method of planning and delivery for dynamic multileaf collimator intensity-modulated radiation therapy

International Nuclear Information System (INIS)

Dogan, Nesrin; Leybovich, Leonid B.; Sethi, Anil; Krasin, Matthew; Emami, Bahman

2000-01-01

Purpose: To develop a modified planning and delivery technique that reduces dose nonuniformity for tomographic delivery of intensity-modulated radiation therapy (IMRT). Methods and Materials: The NOMOS-CORVUS system delivers IMRT in a tomographic paradigm. This type of delivery is prone to create multiple dose nonuniformity regions at the arc abutment regions. The modified technique was based on the cyclical behavior of arc positions as a function of a target length. With the modified technique, two plans are developed for the same patient, one with the original target and the second with a slightly increased target length and the abutment regions shifted by ∼5 mm compared to the first plan. Each plan is designed to deliver half of the target prescription dose delivered on alternate days, resulting in periodic shifts of abutment regions. This method was experimentally tested in phantoms with and without intentionally introduced errors in couch indexing. Results: With the modified technique, the degree of dose nonuniformity was reduced. For example, with 1 mm error in couch indexing, the degree of dose nonuniformity changed from ∼25% to ∼12%. Conclusion: Use of the modified technique reduces dose nonuniformity due to periodic shifts of abutment regions during treatment delivery

Determining the Effectiveness of Various Delivery Methods in an Information Technology/Information Systems Curriculum

Science.gov (United States)

Davis, Gary Alan; Kovacs, Paul J.; Scarpino, John; Turchek, John C.

2010-01-01

The emergence of increasingly sophisticated communication technologies and the media-rich extensions of the World Wide Web have prompted universities to use alternatives to the traditional classroom teaching and learning methods. This demand for alternative delivery methods has led to the development of a wide range of eLearning techniques.…

Combinatorial programming of human neuronal progenitors using magnetically-guided stoichiometric mRNA delivery.

Science.gov (United States)

Azimi, Sayyed M; Sheridan, Steven D; Ghannad-Rezaie, Mostafa; Eimon, Peter M; Yanik, Mehmet Fatih

2018-05-01

Identification of optimal transcription-factor expression patterns to direct cellular differentiation along a desired pathway presents significant challenges. We demonstrate massively combinatorial screening of temporally-varying mRNA transcription factors to direct differentiation of neural progenitor cells using a dynamically-reconfigurable magnetically-guided spotting technology for localizing mRNA, enabling experiments on millimetre size spots. In addition, we present a time-interleaved delivery method that dramatically reduces fluctuations in the delivered transcription-factor copy-numbers per cell. We screened combinatorial and temporal delivery of a pool of midbrain-specific transcription factors to augment the generation of dopaminergic neurons. We show that the combinatorial delivery of LMX1A, FOXA2 and PITX3 is highly effective in generating dopaminergic neurons from midbrain progenitors. We show that LMX1A significantly increases TH -expression levels when delivered to neural progenitor cells either during proliferation or after induction of neural differentiation, while FOXA2 and PITX3 increase expression only when delivered prior to induction, demonstrating temporal dependence of factor addition. © 2018, Azimi et al.

MO-G-BRE-04: Automatic Verification of Daily Treatment Deliveries and Generation of Daily Treatment Reports for a MR Image-Guided Treatment Machine

International Nuclear Information System (INIS)

Yang, D; Li, X; Li, H; Wooten, H; Green, O; Rodriguez, V; Mutic, S

2014-01-01

Purpose: Two aims of this work were to develop a method to automatically verify treatment delivery accuracy immediately after patient treatment and to develop a comprehensive daily treatment report to provide all required information for daily MR-IGRT review. Methods: After systematically analyzing the requirements for treatment delivery verification and understanding the available information from a novel MR-IGRT treatment machine, we designed a method to use 1) treatment plan files, 2) delivery log files, and 3) dosimetric calibration information to verify the accuracy and completeness of daily treatment deliveries. The method verifies the correctness of delivered treatment plans and beams, beam segments, and for each segment, the beam-on time and MLC leaf positions. Composite primary fluence maps are calculated from the MLC leaf positions and the beam-on time. Error statistics are calculated on the fluence difference maps between the plan and the delivery. We also designed the daily treatment delivery report by including all required information for MR-IGRT and physics weekly review - the plan and treatment fraction information, dose verification information, daily patient setup screen captures, and the treatment delivery verification results. Results: The parameters in the log files (e.g. MLC positions) were independently verified and deemed accurate and trustable. A computer program was developed to implement the automatic delivery verification and daily report generation. The program was tested and clinically commissioned with sufficient IMRT and 3D treatment delivery data. The final version has been integrated into a commercial MR-IGRT treatment delivery system. Conclusion: A method was developed to automatically verify MR-IGRT treatment deliveries and generate daily treatment reports. Already in clinical use since December 2013, the system is able to facilitate delivery error detection, and expedite physician daily IGRT review and physicist weekly chart

Is home delivery really preferred? a mixed-methods national study in Pakistan

OpenAIRE

Zafar, Shamsa; Sikander, Siham; Ahmad, Ikhlaq; Ahmad, Mansoor; Parveen, Nazia; Saleem, Shumaila; Nawaz, Tayyba; Suleman, Zainab; Suleman, Nadia; ulAin, Noor; Naeem, Ayesha; Bashir, Asma

2015-01-01

Background Pakistan has a high maternal mortality ratio and a low rate of skilled birth attendants (SBAs). To address these two important issues, the Pakistan Maternal Newborn and Child Health (MNCH) programme launched the community midwives (CMW) initiative in 2007. CMWs are supposed to conduct deliveries at community level outside health facilities. The purpose of the current study is to document perceptions about CMWs and preferences for birthing place. Methods A mixed-methods study was co...

Synthesis of PLGA-Lipid Hybrid Nanoparticles for siRNA Delivery Using the Emulsion Method PLGA-PEG-Lipid Nanoparticles for siRNA Delivery.

Science.gov (United States)

Wang, Lei; Griffel, Benjamin; Xu, Xiaoyang

2017-01-01

The effective delivery of small interfering RNA (siRNA) to tumor cells remains a challenge for applications in cancer therapy. The development of polymeric nanoparticles with high siRNA loading efficacy has shown great potential for cancer targets. Double emulsion solvent evaporation technique is a useful tool for encapsulation of hydrophilic molecules (e.g., siRNA). Here we describe a versatile platform for siRNA delivery based on PLGA-PEG-cationic lipid nanoparticles by using the double emulsion method. The resulting nanoparticles show high encapsulation efficiency for siRNA (up to 90%) and demonstrate effective downregulation of the target genes in vitro and vivo.

Non-invasive Oil-Based Method to Increase Topical Delivery of Nucleic Acids to Skin.

Science.gov (United States)

Vij, Manika; Alam, Shamshad; Gupta, Nidhi; Gotherwal, Vishvabandhu; Gautam, Hemlata; Ansari, Kausar M; Santhiya, Deenan; Natarajan, Vivek T; Ganguli, Munia

2017-06-07

Topical delivery of nucleic acids to skin has huge prospects in developing therapeutic interventions for cutaneous disorders. In spite of initial success, clinical translation is vastly impeded by the constraints of bioavailability as well as stability in metabolically active environment of skin. Various physical and chemical methods used to overcome these limitations involve invasive procedures or compounds that compromise skin integrity. Hence, there is an increasing demand for developing safe skin penetration enhancers for efficient nucleic acid delivery to skin. Here, we demonstrate that pretreatment of skin with silicone oil can increase the transfection efficiency of non-covalently associated peptide-plasmid DNA nanocomplexes in skin ex vivo and in vivo. The method does not compromise skin integrity, as indicated by microscopic evaluation of cellular differentiation, tissue architecture, enzyme activity assessment, dye penetration tests using Franz assay, and cytotoxicity and immunogenicity analyses. Stability of nanocomplexes is not hampered on pretreatment, thereby avoiding nuclease-mediated degradation. The mechanistic insights through Fourier transform infrared (FTIR) spectroscopy reveal some alterations in the skin hydration status owing to possible occlusion effects of the enhancer. Overall, we describe a topical, non-invasive, efficient, and safe method that can be used to increase the penetration and delivery of plasmid DNA to skin for possible therapeutic applications. Copyright © 2017 The American Society of Gene and Cell Therapy. Published by Elsevier Inc. All rights reserved.

The Feasibility of Embedding Data Collection into the Routine Service Delivery of a Multi-Component Program for High-Risk Young People

OpenAIRE

Knight, Alice; Havard, Alys; Shakeshaft, Anthony; Maple, Myfanwy; Snijder, Mieke; Shakeshaft, Bernie

2017-01-01

Background: There is little evidence about how to improve outcomes for high-risk young people, of whom Indigenous young people are disproportionately represented, due to few evaluation studies of interventions. One way to increase the evidence is to have researchers and service providers collaborate to embed evaluation into the routine delivery of services, so program delivery and evaluation occur simultaneously. This study aims to demonstrate the feasibility of integrating best-evidence meas...

Effect of administration method, animal weight and age on the intranasal delivery of drugs to the brain.

Science.gov (United States)

Krishnan, Jishnu K S; Arun, Peethambaran; Chembukave, Bhadra; Appu, Abhilash P; Vijayakumar, Nivetha; Moffett, John R; Puthillathu, Narayanan; Namboodiri, Aryan M A

2017-07-15

The intranasal route of administration has proven to be an effective method for bypassing the blood brain barrier and avoiding first pass hepatic metabolism when targeting drugs to the brain. Most small molecules gain rapid access to CNS parenchyma when administered intranasally. However, bioavailability is affected by various factors ranging from the molecular weight of the drug to the mode of intranasal delivery. We examined the effects of animal posture, intranasal application method and animal weight and age on the delivery of radiolabeled pralidoxime ( 3 H-2-PAM) to the brain of rats. We found that using upright vs. supine posture did not significantly affect 3 H-2-PAM concentrations in different brain regions. Older animals with higher weights required increased doses to achieve the same drug concentration throughout the brain when compared to young animals with lower body weights. The use of an intranasal aerosol propelled delivery device mainly increased bioavailability in the olfactory bulbs, but did not reliably increase delivery of the drug to various other brain regions, and in some regions of the brain delivered less of the drug than simple pipette administration. In view of the emerging interest in the use of intranasal delivery of drugs to combat cognitive decline in old age, we tested effectiveness in very old rats and found the method to be as effective in the older rats. Copyright © 2017 Elsevier B.V. All rights reserved.

[Preparation of panax notoginseng saponins-tanshinone H(A) composite method for pulmonary delivery with spray-drying method and its characterization].

Science.gov (United States)

Wang, Hua-Mei; Fu, Ting-Ming; Guo, Li-Wei

2013-02-01

To prepare panax notoginseng saponins-tanshinone II(A) composite particles for pulmonary delivery, in order to explore a dry powder particle preparation method ensuring synchronized arrival of multiple components of traditional Chinese medicine compounds at absorption sites. Panax notoginseng saponins-tanshinone II(A) composite particles were prepared with spray-drying method, and characterized by scanning electron microscopy (SEM), confocal laser scanning microscope (CLSM), X-ray diffraction (XRD), infrared analysis (IR), dry laser particle size analysis, high performance liquid chromatography (HPLC) and the aerodynamic behavior was evaluated by a Next Generation Impactor (NGI). The dry powder particles produced had narrow particle size distribution range and good aerodynamic behavior, and could realize synchronized administration of multiple components. The spray-drying method is used to combine traditional Chinese medicine components with different physical and chemical properties in the same particle, and product into traditional Chinese medicine compound particles in line with the requirements for pulmonary delivery.

Noninvasive ocular drug delivery: potential transcorneal and other alternative delivery routes for therapeutic molecules in glaucoma.

Science.gov (United States)

Foldvari, Marianna

2014-01-01

Drug delivery to the eye is made difficult by multiple barriers (such as the tear film, cornea, and vitreous) between the surface of the eye and the treatment site. These barriers are difficult to surmount for the purposes of drug delivery without causing toxicity. Using nanotechnology tools to control, manipulate, and study delivery systems, new approaches to delivering drugs, genes, and antigens that are effective and safe can be developed. Topical administration to the ocular surface would be the safest method for delivery, as it is noninvasive and painless compared with other delivery methods. However, there is only limited success using topical delivery methods, especially for gene therapy. Current thinking on treatments of the future enabled by nanodelivery systems and the identification of target specificity parameters that require deeper understanding to develop successful topical delivery systems for glaucoma is highlighted.

Non-utility generation and demand management reliability of customer delivery systems

International Nuclear Information System (INIS)

Hamoud, G.A.; Wang, L.

1995-01-01

A probabilistic methodology for evaluating the impact of non-utility generation (NUG) and demand management programs (DMP) on supply reliability of customer delivery systems was presented. The proposed method was based on the criteria that the supply reliability to the customers on the delivery system should not be affected by the integration of either NUG or DMPs. The method considered station load profile, load forecast, and uncertainty in size and availability of the nuio. Impacts on system reliability were expressed in terms of possible delays of the in-service date for new facilities or in terms of an increase in the system load carrying capability. Examples to illustrate the proposed methodology were provided. 10 refs., 8 tabs., 2 figs

From home deliveries to health care facilities: establishing a traditional birth attendant referral program in Kenya.

Science.gov (United States)

Tomedi, Angelo; Stroud, Sophia R; Maya, Tania Ruiz; Plaman, Christopher R; Mwanthi, Mutuku A

2015-07-16

To assess the effectiveness of a traditional birth attendant (TBA) referral program on increasing the number of deliveries overseen by skilled birth attendants (SBA) in rural Kenyan health facilities before and after the implementation of a free maternity care policy. In a rural region of Kenya, TBAs were recruited to educate pregnant women about the importance of delivering in healthcare facilities and were offered a stipend for every pregnant woman whom they brought to the healthcare facility. We evaluated the percentage of prenatal care (PNC) patients who delivered at the intervention site compared with the percentage of PNC patients who delivered at rural control facilities, before and after the referral program was implemented, and before and after the Kenya government implemented a policy of free maternity care. The window period of the study was from July of 2011 through September 2013, with a TBA referral intervention conducted from March to September 2013. The absolute increases from the pre-intervention period to the TBA referral intervention period in SBA deliveries were 5.7 and 24.0% in the control and intervention groups, respectively (p facility significantly increased compared to control health facilities when TBAs educated women about the need to deliver with a SBA and when TBAs received a stipend for bringing women to local health facilities to deliver. Furthermore, this TBA referral program proved to be far more effective in the target region of Kenya than a policy change to provide free obstetric care.

Immunization delivery in British Columbia

Science.gov (United States)

Omura, John; Buxton, Jane; Kaczorowski, Janusz; Catterson, Jason; Li, Jane; Derban, Andrea; Hasselback, Paul; Machin, Shelagh; Linekin, Michelle; Morgana, Tamsin; O’Briain, Barra; Scheifele, David; Dawar, Meena

2014-01-01

Abstract Objective To explore the experiences of family physicians and pediatricians delivering immunizations, including perceived barriers and supports. Design Qualitative study using focus groups. Setting Ten cities throughout British Columbia. Participants A total of 46 family physicians or general practitioners, 10 pediatricians, and 2 residents. Methods A semistructured dialogue guide was used by a trained facilitator to explore participants’ experiences and views related to immunization delivery in British Columbia. Verbatim transcriptions were independently coded by 2 researchers. Key themes were analyzed and identified in an iterative manner using interpretive description. Main findings Physicians highly valued vaccine delivery. Factors facilitating physician-delivered immunizations included strong beliefs in the value of vaccines and having adequate information. Identified barriers included the large time commitment and insufficient communication about program changes, new vaccines, and the adult immunization program in general. Some physicians reported good relationships with local public health, while others reported the opposite experience, and this varied by geographic location. Conclusion These findings suggest that physicians are supportive of delivering vaccines. However, there are opportunities to improve the sustainability of physician-delivered immunizations. While compensation schemes remain under the purview of the provincial governments, local public health authorities can address the information needs of physicians. PMID:24627403

77 FR 47383 - Annual Assessment of the Status of Competition in the Market for the Delivery of Video Programming

Science.gov (United States)

2012-08-08

... performance, consumer behavior, urban- rural comparisons, and key industry inputs for video programming. To... upstream and downstream to examine the influence of industry inputs and consumer behavior on the delivery... the implications for the American consumer, and provide a solid foundation for Commission policy...

[Surgical methods for delivery in modern obstetrics and their influence on maternal and infant health].

Science.gov (United States)

Kokhanevych, Ie V; Mitsoda, R M; Konoplianko, T V; Konoplianko, V V

2000-03-01

The article addresses issues of comparative characterization of deliveries involving surgery and impact thereof on the health of the mother and her child. Risk factors are identified that the mother and her child run in sectio cesarea, in application of obstetrical forceps, and in vacuum-extraction of the fetus. Cesarean section was found out to be the most acceptable mode of delivery in origination of organic and functional nervous system involvement in children but the most ill-chosen and unpropitious one in the mother, especially so in those groups at risk for bleeding, septic complications, and genital endometriosis. Among those surgical methods of delivery being the least traumatic to the mother are obstetrical forceps and vacuum-extraction of the fetus.

Routine Immunization Service Delivery Through the Basic Package of Health Services Program in Afghanistan: Gaps, Challenges, and Opportunities.

Science.gov (United States)

Mbaeyi, Chukwuma; Kamawal, Noor Shah; Porter, Kimberly A; Azizi, Adam Khan; Sadaat, Iftekhar; Hadler, Stephen; Ehrhardt, Derek

2017-07-01

The Basic Package of Health Services (BPHS) program has increased access to immunization services for children living in rural Afghanistan. However, multiple surveys have indicated persistent immunization coverage gaps. Hence, to identify gaps in implementation, an assessment of the BPHS program was undertaken, with specific focus on the routine immunization (RI) component. A cross-sectional survey was conducted in 2014 on a representative sample drawn from a sampling frame of 1858 BPHS health facilities. Basic descriptive analysis was performed, capturing general characteristics of survey respondents and assessing specific RI components, and χ2 tests were used to evaluate possible differences in service delivery by type of health facility. Of 447 survey respondents, 27% were health subcenters (HSCs), 30% were basic health centers, 32% were comprehensive health centers, and 12% were district hospitals. Eighty-seven percent of all respondents offered RI services, though only 61% of HSCs did so. Compared with other facility types, HSCs were less likely to have adequate stock of vaccines, essential cold-chain equipment, or proper documentation of vaccination activities. There is an urgent need to address manpower and infrastructural deficits in RI service delivery through the BPHS program, especially at the HSC level. © The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America.

Development of a gastroretentive pulsatile drug delivery platform.

Science.gov (United States)

Thitinan, Sumalee; McConville, Jason T

2012-04-01

To develop a novel gastroretentive pulsatile drug delivery platform by combining the advantages of floating dosage forms for the stomach and pulsatile drug delivery systems. A gastric fluid impermeable capsule body was used as a vessel to contain one or more drug layer(s) as well as one or more lag-time controlling layer(s). A controlled amount of air was sealed in the innermost portion of the capsule body to reduce the overall density of the drug delivery platform, enabling gastric floatation. An optimal mass fill inside the gastric fluid impermeable capsule body enabled buoyancy in a vertical orientation to provide a constant surface area for controlled erosion of the lag-time controlling layer. The lag-time controlling layer consisted of a swellable polymer, which rapidly formed a gel to seal the mouth of capsule body and act as a barrier to gastric fluid ingress. By varying the composition of the lag-time controlling layer, it was possible to selectively program the onset of the pulsatile delivery of a drug. This new delivery platform offers a new method of delivery for a variety of suitable drugs targeted in chronopharmaceutical therapy. This strategy could ultimately improve drug efficacy and patient compliance, and reduce harmful side effects by scaling back doses of drug administered. © 2012 The Authors. JPP © 2012 Royal Pharmaceutical Society.

Initiatives to Enhance Primary Care Delivery

Directory of Open Access Journals (Sweden)

Jan L. Losby

2015-01-01

Full Text Available Objectives: Increasing demands on primary care providers have created a need for systems-level initiatives to improve primary care delivery. The purpose of this article is to describe and present outcomes for 2 such initiatives: the Pennsylvania Academy of Family Physicians’ Residency Program Collaborative (RPC and the St Johnsbury Vermont Community Health Team (CHT. Methods: Researchers conducted case studies of the initiatives using mixed methods, including secondary analysis of program and electronic health record data, systematic document review, and interviews. Results: The RPC is a learning collaborative that teaches quality improvement and patient centeredness to primary care providers, residents, clinical support staff, and administrative staff in residency programs. Results show that participation in a higher number of live learning sessions resulted in a significant increase in patient-centered medical home recognition attainment and significant improvements in performance in diabetic process measures including eye examinations (14.3%, P = .004, eye referrals (13.82%, P = .013, foot examinations (15.73%, P = .003, smoking cessation (15.83%, P = .012, and self-management goals (25.45%, P = .001. As a community-clinical linkages model, CHT involves primary care practices, community health workers (CHWs, and community partners. Results suggest that CHT members successfully work together to coordinate comprehensive care for the individuals they serve. Further, individuals exposed to CHWs experienced increased stability in access to health insurance ( P = .001 and prescription drugs ( P = .000 and the need for health education counseling ( P = .000. Conclusion: Findings from this study indicate that these 2 system-level strategies have the promise to improve primary care delivery. Additional research can determine the extent to which these strategies can improve other health outcomes.

Dual and multi-stimuli responsive polymeric nanoparticles for programmed site-specific drug delivery.

Science.gov (United States)

Cheng, Ru; Meng, Fenghua; Deng, Chao; Klok, Harm-Anton; Zhong, Zhiyuan

2013-05-01

In the past decades, polymeric nanoparticles have emerged as a most promising and viable technology platform for targeted and controlled drug delivery. As vehicles, ideal nanoparticles are obliged to possess high drug loading levels, deliver drug to the specific pathological site and/or target cells without drug leakage on the way, while rapidly unload drug at the site of action. To this end, various "intelligent" polymeric nanoparticles that release drugs in response to an internal or external stimulus such as pH, redox, temperature, magnetic and light have been actively pursued. These stimuli-responsive nanoparticles have demonstrated, though to varying degrees, improved in vitro and/or in vivo drug release profiles. In an effort to further improve drug release performances, novel dual and multi-stimuli responsive polymeric nanoparticles that respond to a combination of two or more signals such as pH/temperature, pH/redox, pH/magnetic field, temperature/reduction, double pH, pH and diols, temperature/magnetic field, temperature/enzyme, temperature/pH/redox, temperature/pH/magnetic, pH/redox/magnetic, temperature/redox/guest molecules, and temperature/pH/guest molecules have recently been developed. Notably, these combined responses take place either simultaneously at the pathological site or in a sequential manner from nanoparticle preparation, nanoparticle transporting pathways, to cellular compartments. These dual and multi-stimuli responsive polymeric nanoparticles have shown unprecedented control over drug delivery and release leading to superior in vitro and/or in vivo anti-cancer efficacy. With programmed site-specific drug delivery feature, dual and multi-stimuli responsive nanoparticulate drug formulations have tremendous potential for targeted cancer therapy. In this review paper, we highlight the recent exciting developments in dual and multi-stimuli responsive polymeric nanoparticles for precision drug delivery applications, with a particular focus

MRI-Guided Focused Ultrasound as a New Method of Drug Delivery

Directory of Open Access Journals (Sweden)

M. Thanou

2013-01-01

Full Text Available Ultrasound-mediated drug delivery under the guidance of an imaging modality can improve drug disposition and achieve site-specific drug delivery. The term focal drug delivery has been introduced to describe the focal targeting of drugs in tissues with the help of imaging and focused ultrasound. Focal drug delivery aims to improve the therapeutic profile of drugs by improving their specificity and their permeation in defined areas. Focused-ultrasound- (FUS- mediated drug delivery has been applied with various molecules to improve their local distribution in tissues. FUS is applied with the aid of microbubbles to enhance the permeability of bioactive molecules across BBB and improve drug distribution in the brain. Recently, FUS has been utilised in combination with MRI-labelled liposomes that respond to temperature increase. This strategy aims to “activate” nanoparticles to release their cargo locally when triggered by hyperthermia induced by FUS. MRI-guided FUS drug delivery provides the opportunity to improve drug bioavailability locally and therefore improve the therapeutic profiles of drugs. This drug delivery strategy can be directly translated to clinic as MRg FUS is a promising clinically therapeutic approach. However, more basic research is required to understand the physiological mechanism of FUS-enhanced drug delivery.

A rapid pathway toward a superb gene delivery system: programming structural and functional diversity into a supramolecular nanoparticle library.

Science.gov (United States)

Wang, Hao; Liu, Kan; Chen, Kuan-Ju; Lu, Yujie; Wang, Shutao; Lin, Wei-Yu; Guo, Feng; Kamei, Ken-ichiro; Chen, Yi-Chun; Ohashi, Minori; Wang, Mingwei; Garcia, Mitch André; Zhao, Xing-Zhong; Shen, Clifton K-F; Tseng, Hsian-Rong

2010-10-26

Nanoparticles are regarded as promising transfection reagents for effective and safe delivery of nucleic acids into a specific type of cells or tissues providing an alternative manipulation/therapy strategy to viral gene delivery. However, the current process of searching novel delivery materials is limited due to conventional low-throughput and time-consuming multistep synthetic approaches. Additionally, conventional approaches are frequently accompanied with unpredictability and continual optimization refinements, impeding flexible generation of material diversity creating a major obstacle to achieving high transfection performance. Here we have demonstrated a rapid developmental pathway toward highly efficient gene delivery systems by leveraging the powers of a supramolecular synthetic approach and a custom-designed digital microreactor. Using the digital microreactor, broad structural/functional diversity can be programmed into a library of DNA-encapsulated supramolecular nanoparticles (DNA⊂SNPs) by systematically altering the mixing ratios of molecular building blocks and a DNA plasmid. In vitro transfection studies with DNA⊂SNPs library identified the DNA⊂SNPs with the highest gene transfection efficiency, which can be attributed to cooperative effects of structures and surface chemistry of DNA⊂SNPs. We envision such a rapid developmental pathway can be adopted for generating nanoparticle-based vectors for delivery of a variety of loads.

Design and Delivery of Technical Module for the Business Intelligence Course

Science.gov (United States)

Wang, Shouhong; Wang, Hai

2013-01-01

IS programs are increasingly being called on to offer courses in business intelligence. This article presents the pedagogical design and the delivery method of a practicable technical module for a non-technically oriented Business Intelligence course. It is a tutorial for the instructors who wish to incorporate a practical technical element in…

A method for assessing fidelity of delivery of telephone behavioral support for smoking cessation

OpenAIRE

Lorencatto, F.; West, R.; Bruguera, C.; Michie, S.

2014-01-01

Objectives: Behavioral support for smoking cessation is delivered through different modalities, often guided by treatment manuals. Recently developed methods for assessing fidelity of delivery have shown that face-to-face behavioral support is often not delivered as specified in the service treatment manual. This study aimed to extend this method to evaluate fidelity of telephone-delivered behavioral support. \\ud \\ud Method: A treatment manual and transcripts of 75 audio-recorded behavioral s...

The Role of Delivery Methods on the Perceived Learning Performance and Satisfaction of IT Students in Software Programming Courses

Science.gov (United States)

He, Wu; Yen, Cherng-Jyh

2014-01-01

More and more information technology (IT) programs are offering distance learning courses to their students. However, to date, there are a very limited number of published articles in the IT education literature that compare how different methods of delivering distance course relate to undergraduate students' learning outcomes in IT software…

Diverse Delivery Methods and Strong Psychological Benefits: A Review of Online Formative Assessment

Science.gov (United States)

McLaughlin, T.; Yan, Z.

2017-01-01

This article is a review of literature on online formative assessment (OFA). It includes a narrative summary that synthesizes the research on the diverse delivery methods of OFA, as well as the empirical literature regarding the strong psychological benefits and limitations. Online formative assessment can be delivered using many traditional…

Caring Wisely: A Program to Support Frontline Clinicians and Staff in Improving Healthcare Delivery and Reducing Costs.

Science.gov (United States)

Gonzales, Ralph; Moriates, Christopher; Lau, Catherine; Valencia, Victoria; Imershein, Sarah; Rajkomar, Alvin; Prasad, Priya; Boscardin, Christy; Grady, Deborah; Johnston, S

2017-08-01

We describe a program called "Caring Wisely"®, developed by the University of California, San Francisco's (UCSF), Center for Healthcare Value, to increase the value of services provided at UCSF Health. The overarching goal of the Caring Wisely® program is to catalyze and advance delivery system redesign and innovations that reduce costs, enhance healthcare quality, and improve health outcomes. The program is designed to engage frontline clinicians and staff-aided by experienced implementation scientists-to develop and implement interventions specifically designed to address overuse, underuse, or misuse of services. Financial savings of the program are intended to cover the program costs. The theoretical underpinnings for the design of the Caring Wisely® program emphasize the importance of stakeholder engagement, behavior change theory, market (target audience) segmentation, and process measurement and feedback. The Caring Wisely® program provides an institutional model for using crowdsourcing to identify "hot spot" areas of low-value care, inefficiency and waste, and for implementing robust interventions to address these areas. © 2017 Society of Hospital Medicine.

SU-E-T-325: The New Evaluation Method of the VMAT Plan Delivery Using Varian DynaLog Files and Modulation Complexity Score (MCS)

Energy Technology Data Exchange (ETDEWEB)

Tateoka, K [Proton Treatment Center, Radiation Therapy Research Institute, Social Medical Corporation Teishinkai, Sapporo (Japan); Graduate School of Medicine, Sapporo Medical University, Sapporo, JP (Japan); Fujimomo, K; Hareyama, M [Proton Treatment Center, Radiation Therapy Research Institute, Social Medical Corporation Teishinkai, Sapporo (Japan); Saitou, Y; Nakazawa, T; Abe, T; Nakata, A; Yano, M [Graduate School of Medicine, Sapporo Medical University, Sapporo, JP (Japan)

2014-06-01

Purpose: The aim of the study is to evaluate the use of Varian DynaLog files to verify VMAT plans delivery and modulation complexity score (MCS) of VMAT. Methods: Delivery accuracy of machine performance was quantified by multileaf collimator (MLC) position errors, gantry angle errors and fluence delivery accuracy for volumetric modulated arc therapy (VMAT). The relationship between machine performance and plan complexity were also investigated using the modulation complexity score (MCS). Plan and Actual MLC positions, gantry angles and delivered fraction of monitor units were extracted from Varian DynaLog files. These factors were taken from the record and verify system of MLC control file. Planned and delivered beam data were compared to determine leaf position errors and gantry angle errors. Analysis was also performed on planned and actual fluence maps reconstructed from those of the DynaLog files. This analysis was performed for all treatment fractions of 5 prostate VMAT plans. The analysis of DynaLog files have been carried out by in-house programming in Visual C++. Results: The root mean square of leaf position and gantry angle errors were about 0.12 and 0.15, respectively. The Gamma of planned and actual fluence maps at 3%/3 mm criterion was about 99.21. The gamma of the leaf position errors were not directly related to plan complexity as determined by the MCS. Therefore, the gamma of the gantry angle errors were directly related to plan complexity as determined by the MCS. Conclusion: This study shows Varian dynalog files for VMAT plan can be diagnosed delivery errors not possible with phantom based quality assurance. Furthermore, the MCS of VMAT plan can evaluate delivery accuracy for patients receiving of VMAT. Machine performance was found to be directly related to plan complexity but this is not the dominant determinant of delivery accuracy.

Dynamics of Indel Profiles Induced by Various CRISPR/Cas9 Delivery Methods

DEFF Research Database (Denmark)

Kosicki, Michael; Rajan, Sandeep S; Lorenzetti, Flaminia C

2017-01-01

The introduction of CRISPR/Cas9 gene editing in mammalian cells is a scientific breakthrough, which has greatly affected basic research and gene therapy. The simplicity and general access to CRISPR/Cas9 reagents has in an unprecedented manner "democratized" gene targeting in biomedical research...... approach. In this study we review the most commonly used indel detection methods and using a robust, sensitive, and cost efficient Indel Detection by Amplicon Analysis method, we have investigated the impact of the most commonly used CRISPR/Cas9 delivery formats, including lentivirus transduction, plasmid...

Neonatal outcomes and operative vaginal delivery versus cesarean delivery.

LENUS (Irish Health Repository)

Contag, Stephen A

2010-06-01

We compared outcomes for neonates with forceps-assisted, vacuum-assisted, or cesarean delivery in the second stage of labor. This is a secondary analysis of a randomized trial in laboring, low-risk, nulliparous women at >or=36 weeks\\' gestation. Neonatal outcomes after use of forceps, vacuum, and cesarean were compared among women in the second stage of labor at station +1 or below (thirds scale) for failure of descent or nonreassuring fetal status. Nine hundred ninety women were included in this analysis: 549 (55%) with an indication for delivery of failure of descent and 441 (45%) for a nonreassuring fetal status. Umbilical cord gases were available for 87% of neonates. We found no differences in the base excess (P = 0.35 and 0.78 for failure of descent and nonreassuring fetal status) or frequencies of pH below 7.0 (P = 0.73 and 0.34 for failure of descent and nonreassuring fetal status) among the three delivery methods. Birth outcomes and umbilical cord blood gas values were similar for those neonates with a forceps-assisted, vacuum-assisted, or cesarean delivery in the second stage of labor. The occurrence of significant fetal acidemia was not different among the three delivery methods regardless of the indication.

Nonlinear programming analysis and methods

CERN Document Server

Avriel, Mordecai

2012-01-01

This text provides an excellent bridge between principal theories and concepts and their practical implementation. Topics include convex programming, duality, generalized convexity, analysis of selected nonlinear programs, techniques for numerical solutions, and unconstrained optimization methods.

Health Care Delivery.

Science.gov (United States)

Starfield, Barbara

1987-01-01

The article reviews emerging health care delivery options for handicapped children. Cost structures, quality of care, and future prospects are considered for Health Maintenance Organizations, Preferred Provider Organizations, Tax Supported Direct Service Programs, Hospital-Based Services, and Ambulatory Care Organizations. (Author/DB)

The population-level impacts of a national health insurance program and franchise midwife clinics on achievement of prenatal and delivery care standards in the Philippines.

Science.gov (United States)

Kozhimannil, Katy Backes; Valera, Madeleine R; Adams, Alyce S; Ross-Degnan, Dennis

2009-09-01

Adequate prenatal and delivery care are vital components of successful maternal health care provision. Starting in 1998, two programs were widely expanded in the Philippines: a national health insurance program (PhilHealth); and a donor-funded franchise of midwife clinics (Well Family Midwife Clinics). This paper examines population-level impacts of these interventions on achievement of minimum standards for prenatal and delivery care. Data from two waves of the Demographic and Health Surveys, conducted before (1998) and after (2003) scale-up of the interventions, are employed in a pre/post-study design, using longitudinal multivariate logistic and linear regression models. After controlling for demographic and socioeconomic characteristics, the PhilHealth insurance program scale-up was associated with increased odds of receiving at least four prenatal visits (OR 1.04 [95% CI 1.01-1.06]) and receiving a visit during the first trimester of pregnancy (OR 1.03 [95% CI 1.01-1.06]). Exposure to midwife clinics was not associated with significant changes in achievement of prenatal care standards. While both programs were associated with slight increases in the odds of delivery in a health facility, these increases were not statistically significant. These results suggest that expansion of an insurance program with accreditation standards was associated with increases in achievement of minimal standards for prenatal care among women in the Philippines.

Telemedicine delivery of patient education in remote Ontario communities: feasibility of an Advanced Clinician Practitioner in Arthritis Care (ACPAC-led inflammatory arthritis education program

Directory of Open Access Journals (Sweden)

Warmington K

2017-02-01

Full Text Available Kelly Warmington,1 Carol Flewelling,2 Carol A Kennedy,3,4 Rachel Shupak,5 Angelo Papachristos,5 Caroline Jones,5 Denise Linton,3 Dorcas E Beaton,3,4,6–8 Sydney Lineker9 1Learning Institute, The Hospital for Sick Children, 2Telemedicine Program, 3Musculoskeletal Health & Outcomes Research, St. Michael’s Hospital, 4Institute for Work & Health, 5Martin Family Centre for Arthritis Care & Research, St. Michael’s Hospital, 6Graduate Department of Health Policy, Management and Evaluation, 7Graduate Department of Rehabilitation Science, 8Department of Occupational Science and Occupational Therapy, University of Toronto, 9The Arthritis Society (Ontario Division, Toronto, ON, Canada Objective: Telemedicine-based approaches to health care service delivery improve access to care. It was recognized that adults with inflammatory arthritis (IA living in remote areas had limited access to patient education and could benefit from the 1-day Prescription for Education (RxEd program. The program was delivered by extended role practitioners with advanced training in arthritis care. Normally offered at one urban center, RxEd was adapted for videoconference delivery through two educator development workshops that addressed telemedicine and adult education best practices. This study explores the feasibility of and participant satisfaction with telemedicine delivery of the RxEd program in remote communities.Materials and methods: Participants included adults with IA attending the RxEd program at one of six rural sites. They completed post-course program evaluations and follow-up interviews. Educators provided post-course feedback to identify program improvements that were later implemented.Results: In total, 123 people (36 in-person and 87 remote, across 6 sites participated, attending one of three RxEd sessions. Remote participants were satisfied with the quality of the videoconference (% agree/strongly agree: could hear the presenter (92.9% and discussion

Job shop scheduling model for non-identic machine with fixed delivery time to minimize tardiness

Science.gov (United States)

Kusuma, K. K.; Maruf, A.

2016-02-01

Scheduling non-identic machines problem with low utilization characteristic and fixed delivery time are frequent in manufacture industry. This paper propose a mathematical model to minimize total tardiness for non-identic machines in job shop environment. This model will be categorized as an integer linier programming model and using branch and bound algorithm as the solver method. We will use fixed delivery time as main constraint and different processing time to process a job. The result of this proposed model shows that the utilization of production machines can be increase with minimal tardiness using fixed delivery time as constraint.

Financial Management and Relationship Skills Education: Gauging Consumer Interest and Delivery Preferences

Science.gov (United States)

Futris, Ted G.; Nielsen, Robert B.; Barton, Allen W.

2011-01-01

The study reported here explored level of interest and preferred delivery method of Extension programming related to financial management and relationship skills education. These two subjects comprise areas of Extension that often receive less recognition but appear as pertinent issues in the lives of many individuals. Using a diverse sample of…

Recommendations for Filler Material Composition and Delivery Method for Bench-Scale Testing

Energy Technology Data Exchange (ETDEWEB)

Hardin, Ernest [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Brady, Patrick Vane [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States)

2018-03-01

This report supplements Joint Workplan on Filler Investigations for DPCs (SNL 2017) providing new and some corrected information for use in planning Phase 1 laboratory testing of slurry cements as possible DPC fillers. The scope description is to "Describe a complete laboratory testing program for filler composition, delivery, emplacement in surrogate canisters, and post-test examination. To the extent possible specify filler material and equipment sources." This report includes results from an independent expert review (Dr. Arun Wagh, retired from Argonne National Laboratory and contracted by Sandia) that helped to narrow the range of cement types for consideration, and to provide further guidance on mix variations to optimize injectability, durability, and other aspects of filler performance.

Novel electric power-driven hydrodynamic injection system for gene delivery: safety and efficacy of human factor IX delivery in rats.

Science.gov (United States)

Yokoo, T; Kamimura, K; Suda, T; Kanefuji, T; Oda, M; Zhang, G; Liu, D; Aoyagi, Y

2013-08-01

The development of a safe and reproducible gene delivery system is an essential step toward the clinical application of the hydrodynamic gene delivery (HGD) method. For this purpose, we have developed a novel electric power-driven injection system called the HydroJector-EM, which can replicate various time-pressure curves preloaded into the computer program before injection. The assessment of the reproducibility and safety of gene delivery system in vitro and in vivo demonstrated the precise replication of intravascular time-pressure curves and the reproducibility of gene delivery efficiency. The highest level of luciferase expression (272 pg luciferase per mg of proteins) was achieved safely using the time-pressure curve, which reaches 30 mm Hg in 10 s among various curves tested. Using this curve, the sustained expression of a therapeutic level of human factor IX protein (>500 ng ml(-1)) was maintained for 2 months after the HGD of the pBS-HCRHP-FIXIA plasmid. Other than a transient increase in liver enzymes that recovered in a few days, no adverse events were seen in rats. These results confirm the effectiveness of the HydroJector-EM for reproducible gene delivery and demonstrate that long-term therapeutic gene expression can be achieved by automatic computer-controlled hydrodynamic injection that can be performed by anyone.

Development of strategies to reduce cesarean delivery rates in iran 2012-2014: A mixed methods study

Directory of Open Access Journals (Sweden)

Razieh Lotfi

2014-01-01

Full Text Available Background: With the change in population policy from birth control toward encouraging birth and population growth in Iran, repeated cesarean deliveries as a main reason of cesarean section are associated with more potential adverse consequences. The aim of this research was to explore effective strategies to reduce cesarean delivery rates in Iran. Methods: A mixed methodological study was designed and implemented. First, using a qualitative approach, concepts and influencing factors of increased cesarean delivery were explored. Based on the findings of this phase of the study, a questionnaire including the proposed strategies to reduce cesarean delivery was developed. Then in a quantitative phase, the questionnaire was assessed by key informants from across the country and evaluated to obtain more effective strategies to reduce cesarean delivery. Ten participants in the qualitative study included policy makers from the Ministry of Health, obstetricians, midwives and anthropologists. In the next step, 141 participants from private and public hospitals, insurance experts, Academic Associations of Midwifery, and policy makers in Maternity Health Affairs of Ministry of Health were invited to assess and provide feedback on the strategies that work to reduce cesarean deliveries. Results: Qualitative data analysis showed four concept related to increased cesarean delivery rates including; "standardization", "education", "amending regulations", and "performance supervision". Effective strategies extracted from qualitative data were rated by participants then, using ACCEPT derived from A as attainability, C as costing, C as complication, E as effectiveness, P as popularity, and T as timing table 19 strategies were detected as priorities. Conclusions: Although developing effective strategies to reduce cesarean delivery rates is complex process because of the multi-factorial nature of increased cesarean deliveries, in this study we have achieved

Obstetric care and method of delivery in Mexico: results from the 2012 National Health and Nutrition Survey.

Directory of Open Access Journals (Sweden)

Ileana Heredia-Pi

Full Text Available OBJECTIVE: To identify the current clinical, socio-demographic and obstetric factors associated with the various types of delivery strategies in Mexico. MATERIALS AND METHODS: This is a cross-sectional study based on the 2012 National Health and Nutrition Survey (ENSANUT of 6,736 women aged 12 to 49 years. Delivery types discussed in this paper include vaginal delivery, emergency cesarean section and planned cesarean section. Using bivariate analyses, sub-population group differences were identified. Logistic regression models were applied, including both binary and multinomial outcome variables from the survey. The logistic regression results identify those covariates associated with the type of delivery. RESULTS: 53.1% of institutional births in the period 2006 through 2012 were vaginal deliveries, 46.9% were either a planned or emergency cesarean sections. The highest rates of this procedure were among women who reported a complication during delivery (OR: 4.21; 95%CI: 3.66-4.84, between the ages of 35 and 49 at the time of their last child birth (OR: 2.54; 95%CI: 2.02-3.20 and women receiving care through private healthcare providers during delivery (OR: 2.36; 95%CI: 1.84-3.03. CONCLUSIONS: The existence of different socio-demographic and obstetric profiles among women who receive care for vaginal or cesarean delivery, are supported by the findings of the present study. The frequency of vaginal delivery is higher in indigenous women, when the care provider is public and, in women with two or more children at time of the most recent child birth. Planned cesarean deliveries are positively associated with years of schooling, a higher socioeconomic level, and higher age. The occurrence of emergency cesarean sections is elevated in women with a diagnosis of a health issue during pregnancy or delivery, and it is reduced in highly marginalized settings.

Separable programming theory and methods

CERN Document Server

Stefanov, Stefan M

2001-01-01

In this book, the author considers separable programming and, in particular, one of its important cases - convex separable programming Some general results are presented, techniques of approximating the separable problem by linear programming and dynamic programming are considered Convex separable programs subject to inequality equality constraint(s) and bounds on variables are also studied and iterative algorithms of polynomial complexity are proposed As an application, these algorithms are used in the implementation of stochastic quasigradient methods to some separable stochastic programs Numerical approximation with respect to I1 and I4 norms, as a convex separable nonsmooth unconstrained minimization problem, is considered as well Audience Advanced undergraduate and graduate students, mathematical programming operations research specialists

Comparing two instructional methods of role playing and lecture on primigravida females, decision about type of delivery.

Science.gov (United States)

Abedian, Zahra; Navaee, Maryam; Sani, Hossein Jafari; Ebrahimzadeh, Saeed

2017-01-01

Each mother has the legal right to decide about her delivery, but this decision should be made based on scientific knowledge. Instructions during pregnancy help to choose the proper type of delivery. This study conducted aimed to compare two instructional methods of role playing and lecture on primigravida decision about type of delivery. In this single-blind clinical trial 67 primigravida, 34-36 week were selected using multi-stage sampling and assigned into two groups randomly. Decision-making (before, 2-week after, and at admission in maternity department) was tested by a questionnaire. In role-playing group, advantages and disadvantages of two type delivery were presented by role-playing in 90-min by three scenarios. In lecture group, it was also presented in a 90-min lecture. Data were analyzed by mean difference test, Fisher test, independent and paired t -test. Two groups showed a significant difference in terms of decision at admission to maternity department ( P = 0.000). 75% of lecture group and 100% of role-playing group selected normal delivery. Postintervention knowledge score in lecture group was 18 ± 5.3 and in role-playing group 17.1 ± 4.0. Percent of change in knowledge scores in two groups was significant ( P = 0.001). Participants' attitude, before and after the intervention, in both groups was significant ( P 0.05). In this research, lecture was more effective in raising knowledge level, and role playing was more effective in raising decision to vaginal delivery and reducing elective caesarean section. It is therefore suggested to use both teaching methods altogether for pregnant women to decrease the rate of unnecessary cesarean.

Soil chemical sensor and precision agricultural chemical delivery system and method

Science.gov (United States)

Colburn, Jr., John W.

1991-01-01

A real time soil chemical sensor and precision agricultural chemical delivery system includes a plurality of ground-engaging tools in association with individual soil sensors which measure soil chemical levels. The system includes the addition of a solvent which rapidly saturates the soil/tool interface to form a conductive solution of chemicals leached from the soil. A multivalent electrode, positioned within a multivalent frame of the ground-engaging tool, applies a voltage or impresses a current between the electrode and the tool frame. A real-time soil chemical sensor and controller senses the electrochemical reaction resulting from the application of the voltage or current to the leachate, measures it by resistivity methods, and compares it against pre-set resistivity levels for substances leached by the solvent. Still greater precision is obtained by calibrating for the secondary current impressed through solvent-less soil. The appropriate concentration is then found and the servo-controlled delivery system applies the appropriate amount of fertilizer or agricultural chemicals substantially in the location from which the soil measurement was taken.

Coupling surfactants with permanganate for DNAPL removal : coinjection or sequential application as delivery methods

Energy Technology Data Exchange (ETDEWEB)

Dugan, P.J. [Carus Corp., Peru, IL (United States); Siegrist, R.L. [Colorado School of Mines, Golden, CO (United States); Crimi, M.L. [Clarkson Univ., Potsdam, NY (United States)

2010-07-01

This PowerPoint presentation described a study conducted to test the effectiveness of surfactant-enhanced permanganate for the remediation of dense nonaqueous phase liquids (DNAPL). When DNAPL enters the environment, it can pollute millions of gallons of ground water and create huge dissolved plumes that act as long-term sources of contamination. Surfactants were used to enhance the solubilization and mobilization of DNAPL during the remediation process. In situ chemical oxidation (ISCO) was then used to deliver oxidants into the sub-surface to destroy organic contaminants in the soil and ground water. Experimental 2-D flow-through cell studies of 72 surfactants were conducted with the permanganate to evaluate delivery methods and determine compatible co-solvents for the surfactant process. Delivery methods included co-injection and sequential application. Four compatible surfactants were found to be compatible with the permanganate. A 90 percent DNAPL remediation rate was achieved using relatively low surfactant and oxidant concentrations. tabs., figs.

Rural and urban women entrepreneurs: A comparison of service needs and delivery methods priorities

Directory of Open Access Journals (Sweden)

Davis, A.

2011-01-01

Full Text Available Women entrepreneurs face a wide variety of barriers and challenges throughout the life and growth of their entrepreneurial venture. This study expands the knowledge base on women entrepreneurs’ needs, specifically their needs in terms of service areas and service delivery method preferences. Twenty three “needed” service areas were identified by 95 Manitoba based women entrepreneurs. The first five included: finding new customers, growth benefits and tools, market expansion, general marketing, and networking skills. This study also examined the differences between urban and rural based entrepreneurs. Two service need areas “how to find mentors and role models” and “legal issues” exhibited statistically significant priority differences. Service delivery methods did not produce any statistically significant differences. Overall, this study concludes that regardless of location, women entrepreneurs’ training and support needs are not significantly that different. The effects of entrepreneurial stage and years in business on entrepreneurial support needs are also examined.

An efficient parallel stochastic simulation method for analysis of nonviral gene delivery systems

KAUST Repository

Kuwahara, Hiroyuki

2011-01-01

Gene therapy has a great potential to become an effective treatment for a wide variety of diseases. One of the main challenges to make gene therapy practical in clinical settings is the development of efficient and safe mechanisms to deliver foreign DNA molecules into the nucleus of target cells. Several computational and experimental studies have shown that the design process of synthetic gene transfer vectors can be greatly enhanced by computational modeling and simulation. This paper proposes a novel, effective parallelization of the stochastic simulation algorithm (SSA) for pharmacokinetic models that characterize the rate-limiting, multi-step processes of intracellular gene delivery. While efficient parallelizations of the SSA are still an open problem in a general setting, the proposed parallel simulation method is able to substantially accelerate the next reaction selection scheme and the reaction update scheme in the SSA by exploiting and decomposing the structures of stochastic gene delivery models. This, thus, makes computationally intensive analysis such as parameter optimizations and gene dosage control for specific cell types, gene vectors, and transgene expression stability substantially more practical than that could otherwise be with the standard SSA. Here, we translated the nonviral gene delivery model based on mass-action kinetics by Varga et al. [Molecular Therapy, 4(5), 2001] into a more realistic model that captures intracellular fluctuations based on stochastic chemical kinetics, and as a case study we applied our parallel simulation to this stochastic model. Our results show that our simulation method is able to increase the efficiency of statistical analysis by at least 50% in various settings. © 2011 ACM.

Lumbar spine intervertebral disc gene delivery: a pilot study in lewis rats.

Science.gov (United States)

Damle, Sheela R; Rawlins, Bernard A; Boachie-Adjei, Oheneba; Crystal, Ronald G; Hidaka, Chisa; Cunningham, Matthew E

2013-02-01

Basic research toward understanding and treating disc pathology in the spine has utilized numerous animal models, with delivery of small molecules, purified factors, and genes of interest. To date, gene delivery to the rat lumbar spine has only been described utilizing genetically programmed cells in a matrix which has required partial disc excision, and expected limitation of treatment diffusion into the disc. This study was designed to develop and describe a surgical technique for lumbar spine exposure and disc space preparation, and use of a matrix-free method for gene delivery. Naïve or genetically programmed isogeneic bone marrow stromal cells were surgically delivered to adolescent male Lewis rat lumbar discs, and utilizing quantitative biochemical and qualitative immunohistological assessments, the implanted cells were detected 3 days post-procedure. Statistically significant differences were noted for recovery of the β-galactosidase marker gene comparing delivery of naïve or labeled cells (10(5) cells per disc) from the site of implantation, and between delivery of 10(5) or 10(6) labeled cells per disc at the site of implantation and the adjacent vertebral body. Immunohistology confirmed that the β-galactosidase marker was detected in the adjacent vertebra bone in the zone of surgical implantation. The model requires further testing in larger cohorts and with biologically active genes of interest, but the observations from the pilot experiments are very encouraging that this will be a useful comparative model for basic spine research involving gene or cell delivery, or other locally delivered therapies to the intervertebral disc or adjacent vertebral bodies in rats.

Normal Range of Head-to-body Delivery Interval by Two-step Delivery

Directory of Open Access Journals (Sweden)

Hong-Yu Zhang

2016-01-01

Conclusions: The average time of head-to-body delivery interval was longer than 60 s by two-step delivery. Majority shoulders were delivered at the first contraction. Majority shoulders emerged from perineum rather from under pubic arch. The routine one-step method of shoulder delivery where the downward force applied is not necessary and is not the right direction. Baby's breath, making faces, sucking, bubble from noses and mouth, and the light blue color of the faces, all those signs during shoulder delivery indicated a normal live birth.

Overview of Faculty Development Programs for Interprofessional Education.

Science.gov (United States)

Ratka, Anna; Zorek, Joseph A; Meyer, Susan M

2017-06-01

Objectives. To describe characteristics of faculty development programs designed to facilitate interprofessional education, and to compile recommendations for development, delivery, and assessment of such faculty development programs. Methods. MEDLINE, CINAHL, ERIC, and Web of Science databases were searched using three keywords: faculty development, interprofessional education, and health professions. Articles meeting inclusion criteria were analyzed for emergent themes, including program design, delivery, participants, resources, and assessment. Results. Seventeen articles were identified for inclusion, yielding five characteristics of a successful program: institutional support; objectives and outcomes based on interprofessional competencies; focus on consensus-building and group facilitation skills; flexibility based on institution- and participant-specific characteristics; and incorporation of an assessment strategy. Conclusion. The themes and characteristics identified in this literature overview may support development of faculty development programs for interprofessional education. An advanced evidence base for interprofessional education faculty development programs is needed.

Non-Viral Transfection Methods Optimized for Gene Delivery to a Lung Cancer Cell Line

OpenAIRE

Salimzadeh, Loghman; Jaberipour, Mansooreh; Hosseini, Ahmad; Ghaderi, Abbas

2013-01-01

Background Mehr-80 is a newly established adherent human large cell lung cancer cell line that has not been transfected until now. This study aims to define the optimal transfection conditions and effects of some critical elements for enhancing gene delivery to this cell line by utilizing different non-viral transfection Procedures. Methods In the current study, calcium phosphate (CaP), DEAE-dextran, superfect, electroporation and lipofection transfection methods were used to optimize deliver...

Training Delivery Methods as Source of Dynamic Capabilities: The Case of Sports' Organisations

Science.gov (United States)

Arraya, Marco António Mexia; Porfírio, Jose António

2017-01-01

Purpose: Training as an important source of dynamic capabilities (DC) is important to the performance of sports' organisations (SO) both to athletes and to non-athletic staff. There are a variety of training delivery methods (TDMs). The purpose of this study is to determine from a set of six TDMs which one is considered to be the most suitable to…

Improved overall delivery documentation following implementation of a standardized shoulder dystocia delivery form

Science.gov (United States)

Moragianni, Vasiliki A.; Hacker, Michele R.; Craparo, Frank J.

2013-01-01

Objective Our objective was to evaluate whether using a standardized shoulder dystocia delivery form improved documentation. A standardized delivery form was added to our institution’s obstetrical record in August 2003. Methods A retrospective cohort study was conducted comparing 100 vaginal deliveries complicated by shoulder dystocia before, and 81 after implementation of the standardized delivery form. The two groups were compared in terms of obstetric characteristics, neonatal outcomes and documentation components. Results Charts that included the standardized delivery form were more likely to contain documentation of estimated fetal weight (82.7% vs. 39.0% without the form, Pdystocia, and second stage duration. Conclusions Inclusion of a standardized form in the delivery record improves the rate of documentation of both shoulder dystocia-specific and general delivery components. PMID:22017330

Cost effectiveness and efficiency in assistive technology service delivery.

Science.gov (United States)

Warren, C G

1993-01-01

In order to develop and maintain a viable service delivery program, the realities of cost effectiveness and cost efficiency in providing assistive technology must be addressed. Cost effectiveness relates to value of the outcome compared to the expenditures. Cost efficiency analyzes how a provider uses available resources to supply goods and services. This paper describes how basic business principles of benefit/cost analysis can be used to determine cost effectiveness. In addition, basic accounting principles are used to illustrate methods of evaluating a program's cost efficiency. Service providers are encouraged to measure their own program's effectiveness and efficiency (and potential viability) in light of current trends. This paper is meant to serve as a catalyst for continued dialogue on this topic.

Model for determining and optimizing delivery performance in industrial systems

Directory of Open Access Journals (Sweden)

Fechete Flavia

2017-01-01

Full Text Available Performance means achieving organizational objectives regardless of their nature and variety, and even overcoming them. Improving performance is one of the major goals of any company. Achieving the global performance means not only obtaining the economic performance, it is a must to take into account other functions like: function of quality, delivery, costs and even the employees satisfaction. This paper aims to improve the delivery performance of an industrial system due to their very low results. The delivery performance took into account all categories of performance indicators, such as on time delivery, backlog efficiency or transport efficiency. The research was focused on optimizing the delivery performance of the industrial system, using linear programming. Modeling the delivery function using linear programming led to obtaining precise quantities to be produced and delivered each month by the industrial system in order to minimize their transport cost, satisfying their customers orders and to control their stock. The optimization led to a substantial improvement in all four performance indicators that concern deliveries.

Promotion of family-centered birth with gentle cesarean delivery.

Science.gov (United States)

Magee, Susanna R; Battle, Cynthia; Morton, John; Nothnagle, Melissa

2014-01-01

In this commentary we describe our experience developing a "gentle cesarean" program at a community hospital housing a family medicine residency program. The gentle cesarean technique has been popularized in recent obstetrics literature as a viable option to enhance the experience and outcomes of women and families undergoing cesarean delivery. Skin-to-skin placement of the infant in the operating room with no separation of mother and infant, reduction of extraneous noise, and initiation of breastfeeding in the operating room distinguish this technique from traditional cesarean delivery. Collaboration among family physicians, obstetricians, midwives, pediatricians, neonatologists, anesthesiologists, nurses, and operating room personnel facilitated the provision of gentle cesarean delivery to families requiring an operative birth. Among 144 gentle cesarean births performed from 2009 to 2012, complication rates were similar to or lower than those for traditional cesarean births. Gentle cesarean delivery is now standard of care at our institution. By sharing our experience, we hope to help other hospitals develop gentle cesarean programs. Family physicians should play an integral role in this process. © Copyright 2014 by the American Board of Family Medicine.

A MODIFICATION OF THE METHOD CALLED “SUM” WITH THE TIME CONSTRAINTS OF DELIVERY OF GOODS

Directory of Open Access Journals (Sweden)

Sergey Nikolayevich Prosov

2017-05-01

Full Text Available The heuristic procedure considered the shift-daily planning of delivery routes method “amounts”. We present the solution of the transportation problem or the routing problem in efficiency optimization of transportation.

Optical methods for creating delivery systems of chemical compounds to plant roots

Science.gov (United States)

Kuznetsov, Pavel E.; Rogacheva, Svetlana M.; Arefeva, Oksana A.; Minin, Dmitryi V.; Tolmachev, Sergey A.; Kupadze, Machammad S.

2004-08-01

Spectrophotometric and fluorescence methods have been used for creation and investigation of various systems of target delivery of chemical compounds to roots of plants. The possibility of using liposomes, incrusted by polysaccharides of the external surface of nitrogen-fixing rizospheric bacteria Azospirillum brasilense SP 245, and nanoparticles incrusted by polysaccharides of wheat roots, as the named systems has been shown. The important role of polysaccharide-polysaccharide interaction in the adsorption processes of bacteria on wheat roots has been demonstrated.

Experiment in Application of Methods of Programmed Instruction.

Science.gov (United States)

Fradkin, S. L.

In a document translated from the Russian, an analysis is made of various forms and methods of programed learning. The primary developments in the introduction of programed learning methods are: creation of programed teaching aids; use of existing textbooks for programed lectures with feedback; and use of both teaching machines and machineless…

An overview of solution methods for multi-objective mixed integer linear programming programs

DEFF Research Database (Denmark)

Andersen, Kim Allan; Stidsen, Thomas Riis

Multiple objective mixed integer linear programming (MOMIP) problems are notoriously hard to solve to optimality, i.e. finding the complete set of non-dominated solutions. We will give an overview of existing methods. Among those are interactive methods, the two phases method and enumeration...... methods. In particular we will discuss the existing branch and bound approaches for solving multiple objective integer programming problems. Despite the fact that branch and bound methods has been applied successfully to integer programming problems with one criterion only a few attempts has been made...

Effects of Recruiting Midwives into a Family Physician Program on Women's Awareness and Preference for Mode of Delivery and Caesarean Section Rates in Rural Areas of Kurdistan.

Science.gov (United States)

Hajizadeh, Shayesteh; Tehrani, Fahimeh Ramezani; Simbar, Masoumeh; Farzadfar, Farshad

2016-01-01

The accepted rate rate of caesarean section is 15%. It is expected that an increase in the density of midwives in the family physician program lead to a decrease in this indicator. This study aimed to compare the rates of caesarean section and women's awareness and preference for mode of delivery before and after the implementation of the family physician program in health centres with and without an increase in midwives density. In this cross-sectional study, using multistage cluster sampling method a total of 668 mothers with two-month-old children were selected from among all mothers with two-month-old children who were living in rural areas of Kurdistan province. Using the difference-in-differences model and Matchit statistical model, the factors associated with caesarean section rates and women's awareness and preference for mode of delivery were compared in centres with and without an increase in midwives density after the implementation of the family physician program. To compare the changes before and after the program, we used the data collected from the same number of women in 2005 as the baseline. After adjusting for baseline data collected in 2005, the resutls showed no significant change in caesarean section rates and women's awareness and preference for mode of delivery in the centres with and without an increase in midwives density after the implementation of the family physician program. The Matchit model showed a significant mean increase 14%(0.03-0.25) in women's awareness of the benefits of natural childbirth between 2005 and 2013 in health centres where the density of midwives increased compared with health centres where it did not. The difference-in-differences model showed that the odds ratio of women's preference for caesarean section decreased by 41% among participants who were aware of the benefits of natural childbirth, (OR = 0.59, 95% CI: (0.22-0.85); P>0.001). The results of this study showed that an increase in the density of midwives

Discount method for programming language evaluation

DEFF Research Database (Denmark)

Kurtev, Svetomir; Christensen, Tommy Aagaard; Thomsen, Bent

2016-01-01

This paper presents work in progress on developing a Discount Method for Programming Language Evaluation inspired by the Discount Usability Evaluation method (Benyon 2010) and the Instant Data Analysis method (Kjeldskov et al. 2004). The method is intended to bridge the gap between small scale...... internal language design evaluation methods and large scale surveys and quantitative evaluation methods. The method is designed to be applicable even before a compiler or IDE is developed for a new language. To test the method, a usability evaluation experiment was carried out on the Quorum programming...... language (Stefik et al. 2016) using programmers with experience in C and C#. When comparing our results with previous studies of Quorum, most of the data was comparable though not strictly in agreement. However, the discrepancies were mainly related to the programmers pre-existing expectations...

32 CFR 199.17 - TRICARE program.

Science.gov (United States)

2010-07-01

... other health care delivery or financing methods is necessary to achieve important Federal interests... under safety programs, members on the Temporary Disability Retired List (for statutorily required... than 50 miles, or approximately one hour driving time, from the nearest military treatment facility...

Rethinking the delivery of public services to citizens

National Research Council Canada - National Science Library

Seidle, F. Leslie

1995-01-01

... Sector Reform and Service Delivery in the Antipodes New Zealand: Transforming the State Australia: a Concerted Program of Management Reform Conclusion Notes 75 Chapter Four The Canadian Federal Government and Service Delivery Issues Perceptions of Service from the Federal Government The Mulroney Government and Public Service 2000 Special Operati...

Costs of a Hospital-Based, Ready-To-Use Syringe Delivery Programme

DEFF Research Database (Denmark)

Risør, Bettina Wulff; Vand, S; Lisby, M

2017-01-01

%) and at €20,905 (an increase of 228%) for the endoscopy department. The ready-to-use delivery program imposed an additional cost of €11.32 per day surgery operation and €2.41 per endoscopy procedure. Conclusion: This ready-to-use programme increased the cost of the medical handling process. This incremental......Objective: The risk of errors in the medication administration process is high. Applications of pre lled syringes may improve patient safety but could be more costly. The objective of this study was to assess the additional costs of a ready-to-use syringe delivery programme in comparison...... with a conventional delivery programme at day surgery and endoscopy departments at a large university hospital. Methods: The cost analysis used the hospital perspective and developed an “activity-based costing” model to assess the costs of medicine- handling activities. The model was calibrated with six-month data...

Intranet Delivery of Simulation-Centered Tutoring

National Research Council Canada - National Science Library

Munro, Allen

2003-01-01

.... Java programs that implement a simulation delivery system work in concern with authored graphics and behavioral specifications to provide interactive graphical simulations with training for distance learners...

Fiber coupled optical spark delivery system

Science.gov (United States)

Yalin, Azer; Willson, Bryan; Defoort, Morgan

2008-08-12

A spark delivery system for generating a spark using a laser beam is provided, the spark delivery system including a laser light source and a laser delivery assembly. The laser delivery assembly includes a hollow fiber and a launch assembly comprising launch focusing optics to input the laser beam in the hollow fiber. In addition, the laser delivery assembly includes exit focusing optics that demagnify an exit beam of laser light from the hollow fiber, thereby increasing the intensity of the laser beam and creating a spark. In accordance with embodiments of the present invention, the assembly may be used to create a spark in a combustion engine. In accordance with other embodiments of the present invention, a method of using the spark delivery system is provided. In addition, a method of choosing an appropriate fiber for creating a spark using a laser beam is also presented.

Method for programming a flash memory

Energy Technology Data Exchange (ETDEWEB)

Brosky, Alexander R.; Locke, William N.; Maher, Conrado M.

2016-08-23

A method of programming a flash memory is described. The method includes partitioning a flash memory into a first group having a first level of write-protection, a second group having a second level of write-protection, and a third group having a third level of write-protection. The write-protection of the second and third groups is disabled using an installation adapter. The third group is programmed using a Software Installation Device.

Coated microneedle arrays for transcutaneous delivery of live virus vaccines.

Science.gov (United States)

Vrdoljak, Anto; McGrath, Marie G; Carey, John B; Draper, Simon J; Hill, Adrian V S; O'Mahony, Conor; Crean, Abina M; Moore, Anne C

2012-04-10

Vaccines are sensitive biologics that require continuous refrigerated storage to maintain their viability. The vast majority of vaccines are also administered using needles and syringes. The need for cold chain storage and the significant logistics surrounding needle-and-syringe vaccination is constraining the success of immunization programs. Recombinant live viral vectors are a promising platform for the development of vaccines against a number of infectious diseases, however these viruses must retain infectivity to be effective. Microneedles offer an effective and painless method for delivery of vaccines directly into skin that in the future could provide solutions to current vaccination issues. Here we investigated methods of coating live recombinant adenovirus and modified vaccinia virus Ankara (MVA) vectors onto solid microneedle arrays. An effective spray-coating method, using conventional pharmaceutical processes, was developed, in tandem with suitable sugar-based formulations, which produces arrays with a unique coating of viable virus in a dry form around the shaft of each microneedle on the array. Administration of live virus-coated microneedle arrays successfully resulted in virus delivery, transcutaneous infection and induced an antibody or CD8(+) T cell response in mice that was comparable to that obtained by needle-and-syringe intradermal immunization. To our knowledge, this is the first report of successful vaccination with recombinant live viral vectored vaccines coated on microneedle delivery devices. Copyright © 2011 Elsevier B.V. All rights reserved.

Coated microneedle arrays for transcutaneous delivery of live virus vaccines

Science.gov (United States)

Vrdoljak, Anto; McGrath, Marie G.; Carey, John B.; Draper, Simon J.; Hill, Adrian V.S.; O’Mahony, Conor; Crean, Abina M.; Moore, Anne C.

2016-01-01

Vaccines are sensitive biologics that require continuous refrigerated storage to maintain their viability. The vast majority of vaccines are also administered using needles and syringes. The need for cold chain storage and the significant logistics surrounding needle-and-syringe vaccination is constraining the success of immunization programs. Recombinant live viral vectors are a promising platform for the development of vaccines against a number of infectious diseases, however these viruses must retain infectivity to be effective. Microneedles offer an effective and painless method for delivery of vaccines directly into skin that in the future could provide solutions to current vaccination issues. Here we investigated methods of coating live recombinant adenovirus and modified vaccinia virus Ankara (MVA) vectors onto solid microneedle arrays. An effective spray-coating method, using conventional pharmaceutical processes, was developed, in tandem with suitable sugar-based formulations, which produces arrays with a unique coating of viable virus in a dry form around the shaft of each microneedle on the array. Administration of live virus-coated microneedle arrays successfully resulted in virus delivery, transcutaneous infection and induced an antibody or CD8+ T cell response in mice that was comparable to that obtained by needle-and-syringe intradermal immunization. To our knowledge, this is the first report of successful vaccination with recombinant live viral vectored vaccines coated on microneedle delivery devices. PMID:22245683

Facile method of building hydroxyapatite 3D scaffolds assembled from porous hollow fibers enabling nutrient delivery

NARCIS (Netherlands)

Salamon, David; Da Silva Teixeira, Sandra; Dutczak, S.M.; Stamatialis, Dimitrios

2014-01-01

Nowadays, diffusion through scaffold and tissue usually limits transport, and forms potentially hypoxic regions. Several methods are used for preparation of 3D hydroxyapatite scaffolds, however, production of a scaffold including porous hollow fibers for nutrition delivery is difficult and

A Rational Method for Ranking Engineering Programs.

Science.gov (United States)

Glower, Donald D.

1980-01-01

Compares two methods for ranking academic programs, the opinion poll v examination of career successes of the program's alumni. For the latter, "Who's Who in Engineering" and levels of research funding provided data. Tables display resulting data and compare rankings by the two methods for chemical engineering and civil engineering. (CS)

A method for estimation of accuracy of dose delivery with dynamic slit windows in medical linear accelerators

International Nuclear Information System (INIS)

Ravichandran, R.; Binukumar, J.P.; Sivakumar, S.S.; Krishnamurthy, K.; Davis, C.A.

2008-01-01

Intensity-modulated radiotherapy (IMRT) clinical dose delivery is based on computer-controlled multileaf movements at different velocities. To test the accuracy of modulation of the beam periodically, quality assurance (QA) methods are necessary. Using a cylindrical phantom, dose delivery was checked at a constant geometry for sweeping fields. Repeated measurements with an in-house designed methodology over a period of 1 year indicate that the method is very sensitive to check the proper functioning of such dose delivery in medical linacs. A cylindrical perspex phantom with facility to accurately position a 0.6- cc (FC 65) ion chamber at constant depth at isocenter, (SA 24 constancy check tool phantom for MU check, Scanditronix Wellhofer) was used. Dosimeter readings were integrated for 4-mm, 10-mm, 20-mm sweeping fields and for 3 angular positions of the gantry periodically. Consistency of standard sweeping field output (10-mm slit width) and the ratios of outputs against other slit widths over a long period were reported. A 10-mm sweeping field output was found reproducible within an accuracy of 0.03% (n = 25) over 1 year. Four-millimeter, 20-mm outputs expressed as ratio with respect to 10- mm sweep output remained within a mean deviation of 0.2% and 0.03% respectively. Outputs at 3 gantry angles remained within 0.5%, showing that the effect of dynamic movements of multileaf collimator (MLC) on the output is minimal for angular positions of gantry. This method of QA is very simple and is recommended in addition to individual patient QA measurements, which reflect the accuracy of dose planning system. In addition to standard output and energy checks of linacs, the above measurements can be complemented so as to check proper functioning of multileaf collimator for dynamic field dose delivery. (author)

India's JSY cash transfer program for maternal health: Who participates and who doesn't - a report from Ujjain district

Directory of Open Access Journals (Sweden)

Sidney Kristi

2012-01-01

Full Text Available Abstract Background India launched a national conditional cash transfer program, Janani Suraksha Yojana (JSY, aimed at reducing maternal mortality by promoting institutional delivery in 2005. It provides a cash incentive to women who give birth in public health facilities. This paper studies the extent of program uptake, reasons for participation/non participation, factors associated with non uptake of the program, and the role played by a program volunteer, accredited social health activist (ASHA, among mothers in Ujjain district in Madhya Pradesh, India. Methods A cross-sectional study was conducted from January to May 2011 among women giving birth in 30 villages in Ujjain district. A semi-structured questionnaire was administered to 418 women who delivered in 2009. Socio-demographic and pregnancy related characteristics, role of the ASHA during delivery, receipt of the incentive, and reasons for place of delivery were collected. Multinomial regression analysis was used to identify predictors for the outcome variables; program delivery, private facility delivery, or a home delivery. Results The majority of deliveries (318/418; 76% took place within the JSY program; 81% of all mothers below poverty line delivered in the program. Ninety percent of the women had prior knowledge of the program. Most program mothers reported receiving the cash incentive within two weeks of delivery. The ASHA's influence on the mother's decision on where to deliver appeared limited. Women who were uneducated, multiparious or lacked prior knowledge of the JSY program were significantly more likely to deliver at home. Conclusion In this study, a large proportion of women delivered under the program. Most mothers reporting timely receipt of the cash transfer. Nevertheless, there is still a subset of mothers delivering at home, who do not or cannot access emergency obstetric care under the program and remain at risk of maternal death.

The Impact of Nutrition Information Delivery Methods on Restaurant Consumers' Attitudes and Behavior

OpenAIRE

Zhu, Jiaqi

2013-01-01

Zhu, Jiaqi. M.S., Purdue University, December 2013. The Impact of Nutrition Information Delivery Methods on Restaurant Consumers' Attitudes and Behavior. Major Professors: Barbara A. Almanza, Carl A. Behnke. Obesity is a major public health threat. It not only creates challenges for those who are obese and overweight, but also brings an economic burden to the whole society. One important contributing factor for obesity is food eaten away from home, which accounts for more than 40% of Ameri...

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

Directory of Open Access Journals (Sweden)

Riswati Riswati

2015-06-01

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

Scoping out the literature on mobile needle and syringe programs-review of service delivery and client characteristics, operation, utilization, referrals, and impact.

Science.gov (United States)

Strike, Carol; Miskovic, Miroslav

2018-02-08

Needle and syringe program (NSP) service delivery models encompass fixed sites, mobile services, vending machines, pharmacies, peer NSPs, street outreach, and inter-organizational agreements to add NSP services to other programs. For programs seeking to implement or improve mobile services, access to a synthesis of the evidence related to mobile services is beneficial, but lacking. We used a scoping study method to search MEDLINE, PSYCHInfo, Embase, Scopus, and Sociological for relevant literature. We identified 39 relevant manuscripts published between 1975 and November 2017 after removing duplicates and non-relevant manuscripts from the 1313 identified by the search. Charting of the data showed that these publications reported findings related to the service delivery model characteristics, client characteristics, service utilization, specialized interventions offered on mobile NSPs, linking clients to other services, and impact on injection risk behaviors. Mobile NSPs are implemented in high-, medium-, and low-income countries; provide equipment distribution and many other harm reduction services; face limitations to service complement, confidentiality, and duration of interactions imposed by physical space; adapt to changes in locations and types of drug use; attract people who engage in high-risk/intensity injection behavior and who are often not reached by other service models; and may lead to reduced injection-related risks. It is not clear from the literature reviewed, what are, or if there are, a "core and essential" complement of services that mobile NSPs should offer. Decisions about service complement for mobile NSPs need to be made in relation to the context and also other available services. Reports of client visits to mobile NSP provide a picture of the volume and frequency of utilization but are difficult to compare given varied measures and reference periods. Mobile NSPs have an important role to play in improving HIV and HCV prevention efforts

Home visitation programs: An untapped opportunity for the delivery of early childhood obesity prevention

Science.gov (United States)

Salvy, Sarah-Jeanne; de la Haye, Kayla; Galama, Titus; Goran, Michael I.

2016-01-01

Background Extant obesity efforts have had limited impact among low-income underserved children, in part because of limitations inherent to existing programs: 1) short duration and low intensity; 2) late timing of implementation, when children are already overweight or obese; 3) intervention delivery limiting their accessibility and sustainability; and 4) failure to address barriers such as a lack of culturally competent services, poverty and housing instability, which interfere with healthy lifestyle changes. Objective This concept paper proposes an innovative model of obesity prevention implemented in infancy and sustained throughout early childhood to address the limitations of current obesity prevention efforts. Specifically, we propose to integrate sustained, weekly, in-home obesity prevention as part of the services already delivered by ongoing Home Visitation Programs, which currently do not target obesity prevention. Conclusion The home visiting structure represents an ideal model for impactful obesity prevention as home visitation programs: (1) already provide comprehensive services to diverse low-income infants and families who are most at risk for obesity and poor health due to socio-economic and structural conditions; (2) services are initiated in infancy and sustained throughout critical developmental periods for the formation of healthy/unhealthy behaviors; and (3) have been in place for more than 40 years, with a widespread presence across the United States and nationwide, which is critical for the scalability and sustainability of obesity prevention. PMID:27911984

Home visitation programs: an untapped opportunity for the delivery of early childhood obesity prevention.

Science.gov (United States)

Salvy, S-J; de la Haye, K; Galama, T; Goran, M I

2017-02-01

Extant obesity efforts have had limited impact among low-income underserved children, in part because of limitations inherent to existing programs: (i) short duration and low intensity; (ii) late timing of implementation, when children are already overweight or obese; (iii) intervention delivery limiting their accessibility and sustainability; and (iv) failure to address barriers such as a lack of culturally competent services, poverty and housing instability, which interfere with healthy lifestyle changes. This concept paper proposes an innovative model of obesity prevention implemented in infancy and sustained throughout early childhood to address the limitations of current obesity prevention efforts. Specifically, we propose to integrate sustained, weekly, in-home obesity prevention as part of the services already delivered by ongoing Home Visitation Programs, which currently do not target obesity prevention. The home visiting structure represents an ideal model for impactful obesity prevention as home visitation programs: (i) already provide comprehensive services to diverse low-income infants and families who are most at risk for obesity and poor health because of socio-economic and structural conditions; (ii) services are initiated in infancy and sustained throughout critical developmental periods for the formation of healthy/unhealthy behaviors; and (iii) have been in place for more than 40 years, with a widespread presence across the United States and nationwide, which is critical for the scalability and sustainability of obesity prevention. © 2016 World Obesity Federation.

Microfabrication for Drug Delivery

Science.gov (United States)

Koch, Brendan; Rubino, Ilaria; Quan, Fu-Shi; Yoo, Bongyoung; Choi, Hyo-Jick

2016-01-01

This review is devoted to discussing the application of microfabrication technologies to target challenges encountered in life processes by the development of drug delivery systems. Recently, microfabrication has been largely applied to solve health and pharmaceutical science issues. In particular, fabrication methods along with compatible materials have been successfully designed to produce multifunctional, highly effective drug delivery systems. Microfabrication offers unique tools that can tackle problems in this field, such as ease of mass production with high quality control and low cost, complexity of architecture design and a broad range of materials. Presented is an overview of silicon- and polymer-based fabrication methods that are key in the production of microfabricated drug delivery systems. Moreover, the efforts focused on studying the biocompatibility of materials used in microfabrication are analyzed. Finally, this review discusses representative ways microfabrication has been employed to develop systems delivering drugs through the transdermal and oral route, and to improve drug eluting implants. Additionally, microfabricated vaccine delivery systems are presented due to the great impact they can have in obtaining a cold chain-free vaccine, with long-term stability. Microfabrication will continue to offer new, alternative solutions for the development of smart, advanced drug delivery systems. PMID:28773770

Drug delivery device including electrolytic pump

KAUST Repository

Foulds, Ian G.; Buttner, Ulrich; Yi, Ying

2016-01-01

Systems and methods are provided for a drug delivery device and use of the device for drug delivery. In various aspects, the drug delivery device combines a “solid drug in reservoir” (SDR) system with an electrolytic pump. In various aspects an improved electrolytic pump is provided including, in particular, an improved electrolytic pump for use with a drug delivery device, for example an implantable drug delivery device. A catalytic reformer can be incorporated in a periodically pulsed electrolytic pump to provide stable pumping performance and reduced actuation cycle.

Drug delivery device including electrolytic pump

KAUST Repository

Foulds, Ian G.

2016-03-31

Systems and methods are provided for a drug delivery device and use of the device for drug delivery. In various aspects, the drug delivery device combines a “solid drug in reservoir” (SDR) system with an electrolytic pump. In various aspects an improved electrolytic pump is provided including, in particular, an improved electrolytic pump for use with a drug delivery device, for example an implantable drug delivery device. A catalytic reformer can be incorporated in a periodically pulsed electrolytic pump to provide stable pumping performance and reduced actuation cycle.

The state-led large scale public private partnership 'Chiranjeevi Program' to increase access to institutional delivery among poor women in Gujarat, India: How has it done? What can we learn?

Science.gov (United States)

De Costa, Ayesha; Vora, Kranti S; Ryan, Kayleigh; Sankara Raman, Parvathy; Santacatterina, Michele; Mavalankar, Dileep

2014-01-01

Many low-middle income countries have focused on improving access to and quality of obstetric care, as part of promoting a facility based intra-partum care strategy to reduce maternal mortality. The state of Gujarat in India, implements a facility based intra-partum care program through its large for-profit private obstetric sector, under a state-led public-private-partnership, the Chiranjeevi Yojana (CY), under which the state pays accredited private obstetricians to perform deliveries for poor/tribal women. We examine CY performance, its contribution to overall trends in institutional deliveries in Gujarat over the last decade and its effect on private and public sector deliveries there. District level institutional delivery data (public, private, CY), national surveys, poverty estimates, census data were used. Institutional delivery trends in Gujarat 2000-2010 are presented; including contributions of different sectors and CY. Piece-wise regression was used to study the influence of the CY program on public and private sector institutional delivery. Institutional delivery rose from 40.7% (2001) to 89.3% (2010), driven by sharp increases in private sector deliveries. Public sector and CY contributed 25-29% and 13-16% respectively of all deliveries each year. In 2007, 860 of 2000 private obstetricians participated in CY. Since 2007, >600,000 CY deliveries occurred i.e. one-third of births in the target population. Caesareans under CY were 6%, higher than the 2% reported among poor women by the DLHS survey just before CY. CY did not influence the already rising proportion of private sector deliveries in Gujarat. This paper reports a state-led, fully state-funded, large-scale public-private partnership to improve poor women's access to institutional delivery - there have been >600,000 beneficiaries. While caesarean proportions are higher under CY than before, it is uncertain if all beneficiaries who require sections receive these. Other issues to explore include

Applications of polymeric nanocapsules in field of drug delivery systems.

Science.gov (United States)

Rong, Xinyu; Xie, Yinghua; Hao, Xiaomei; Chen, Tao; Wang, Yingming; Liu, Yuanyuan

2011-09-01

Drug-loaded polymeric nanocapsules have exhibited potential applications in the field of drug delivery systems in recent years. This article entails the biodegradable polymers generally used for preparing nanocapsules, which include both natural polymers and synthetic polymers. Furthermore, the article presents a general review of the different preparation methods: nanoprecipitation method, emulsion-diffusion method, double emulsification method, emulsion-coacervation method, layer-by-layer assembly method. In addition, the analysis methods of nanocapsule characteristics, such as mean size, morphology, surface characteristics, shell thickness, encapsulation efficiency, active substance release, dispersion stability, are mentioned. Also, the applications of nanocapsules as carriers for use in drug delivery systems are reviewed, which primarily involve targeting drug delivery, controlled/sustained release drug delivery systems, transdermal drug delivery systems and improving stability and bioavailability of drugs. Nanocapsules, prepared with different biodegradable polymers, have received more and more attention and have been regarded as one of the most promising drug delivery systems.

Prevalent Approaches to Professional Development in State 4-H Programs

Science.gov (United States)

Smith, Martin H.; Worker, Steven M.; Schmitt-McQuitty, Lynn; Meehan, Cheryl L.; Lewis, Kendra M.; Schoenfelder, Emily; Brian, Kelley

2017-01-01

High-quality 4-H programming requires effective professional development of educators. Through a mixed methods study, we explored professional development offered through state 4-H programs. Survey results revealed that both in-person and online delivery modes were used commonly for 4-H staff and adult volunteers; for teen volunteers, in-person…

Private sector delivery of health services in developing countries: a mixed-methods study on quality assurance in social franchises

Science.gov (United States)

2013-01-01

Background Across the developing world health care services are most often delivered in the private sector and social franchising has emerged, over the past decade, as an increasingly popular method of private sector health care delivery. Social franchising aims to strengthen business practices through economies of scale: branding clinics and purchasing drugs in bulk at wholesale prices. While quality is one of the established goals of social franchising, there is no published documentation of how quality levels might be set in the context of franchised private providers, nor what quality assurance measures can or should exist within social franchises. The aim of this study was to better understand the quality assurance systems currently utilized in social franchises, and to determine if there are shared standards for practice or quality outcomes that exist across programs. Methods The study included three data sources and levels of investigation: 1) Self-reported program data; 2) Scoping telephone interviews; and 3) In-depth field interviews and clinic visits. Results Social Franchises conceive of quality assurance not as an independent activity, but rather as a goal that is incorporated into all areas of franchise operations, including recruitment, training, monitoring of provider performance, monitoring of client experience and the provision of feedback. Conclusions These findings are the first evidence to support the 2002 conceptual model of social franchising which proposed that the assurance of quality was one of the three core goals of all social franchises. However, while quality is important to franchise programs, quality assurance systems overall are not reflective of the evidence to-date on quality measurement or quality improvement best practices. Future research in this area is needed to better understand the details of quality assurance systems as applied in social franchise programs, the process by which quality assurance becomes a part of the

Private sector delivery of health services in developing countries: a mixed-methods study on quality assurance in social franchises

Directory of Open Access Journals (Sweden)

Schlein Karen

2013-01-01

Full Text Available Abstract Background Across the developing world health care services are most often delivered in the private sector and social franchising has emerged, over the past decade, as an increasingly popular method of private sector health care delivery. Social franchising aims to strengthen business practices through economies of scale: branding clinics and purchasing drugs in bulk at wholesale prices. While quality is one of the established goals of social franchising, there is no published documentation of how quality levels might be set in the context of franchised private providers, nor what quality assurance measures can or should exist within social franchises. The aim of this study was to better understand the quality assurance systems currently utilized in social franchises, and to determine if there are shared standards for practice or quality outcomes that exist across programs. Methods The study included three data sources and levels of investigation: 1 Self-reported program data; 2 Scoping telephone interviews; and 3 In-depth field interviews and clinic visits. Results Social Franchises conceive of quality assurance not as an independent activity, but rather as a goal that is incorporated into all areas of franchise operations, including recruitment, training, monitoring of provider performance, monitoring of client experience and the provision of feedback. Conclusions These findings are the first evidence to support the 2002 conceptual model of social franchising which proposed that the assurance of quality was one of the three core goals of all social franchises. However, while quality is important to franchise programs, quality assurance systems overall are not reflective of the evidence to-date on quality measurement or quality improvement best practices. Future research in this area is needed to better understand the details of quality assurance systems as applied in social franchise programs, the process by which quality assurance

Method of targeted delivery of laser beam to isolated retinal rods by fiber optics.

Science.gov (United States)

Sim, Nigel; Bessarab, Dmitri; Jones, C Michael; Krivitsky, Leonid

2011-11-01

A method of controllable light delivery to retinal rod cells using an optical fiber is described. Photo-induced current of the living rod cells was measured with the suction electrode technique. The approach was tested with measurements relating the spatial distribution of the light intensity to photo-induced current. In addition, the ion current responses of rod cells to polarized light at two different orientation geometries of the cells were studied.

Modular programming method at JAERI

International Nuclear Information System (INIS)

Asai, Kiyoshi; Katsuragi, Satoru

1982-02-01

In this report the histories, concepts and a method for the construction and maintenance of nuclear code systems of Japan Atomic Energy Research Institute (JAERI) are presented. The method is mainly consisted of novel computer features. The development process of the features and experiences with them which required many man-months and efforts of scientists and engineers of JAERI and a computer manufacturer are also described. One of the features is a file handling program named datapool. The program is being used in code systems which are under development at JAERI. The others are computer features such as dynamic linking, reentrant coding of Fortran programs, interactive programming facility, document editor, quick system output viewer and editor, flexible man-machine interactive Fortran executor, and selective use of time-sharing or batch oriented computer in an interactive porgramming environment. In 1980 JAERI has replaced its two old computer systems by three FACOM M-200 computer systems and they have such features as mentioned above. Since 1981 most code systems, or even big single codes can be changed to modular code systems even if the developers or users of the systems will not recognize the fact that they are using modular code systems. The purpose of this report is to describe our methodology of modular programming from aspects of computer features and some of their applications to nuclear codes to get sympathetic understanding of it from persons of organizations who are concerned with the effective use of computers, especially, in nuclear research fields. (author)

Vector-free intracellular delivery by reversible permeabilization.

Directory of Open Access Journals (Sweden)

Shirley O'Dea

Full Text Available Despite advances in intracellular delivery technologies, efficient methods are still required that are vector-free, can address a wide range of cargo types and can be applied to cells that are difficult to transfect whilst maintaining cell viability. We have developed a novel vector-free method that uses reversible permeabilization to achieve rapid intracellular delivery of cargos with varying composition, properties and size. A permeabilizing delivery solution was developed that contains a low level of ethanol as the permeabilizing agent. Reversal of cell permeabilization is achieved by temporally and volumetrically controlling the contact of the target cells with this solution. Cells are seeded in conventional multi-well plates. Following removal of the supernatant, the cargo is mixed with the delivery solution and applied directly to the cells using an atomizer. After a short incubation period, permeabilization is halted by incubating the cells in a phosphate buffer saline solution that dilutes the ethanol and is non-toxic to the permeabilized cells. Normal culture medium is then added. The procedure lasts less than 5 min. With this method, proteins, mRNA, plasmid DNA and other molecules have been delivered to a variety of cell types, including primary cells, with low toxicity and cargo functionality has been confirmed in proof-of-principle studies. Co-delivery of different cargo types has also been demonstrated. Importantly, delivery occurs by diffusion directly into the cytoplasm in an endocytic-independent manner. Unlike some other vector-free methods, adherent cells are addressed in situ without the need for detachment from their substratum. The method has also been adapted to address suspension cells. This delivery method is gentle yet highly reproducible, compatible with high throughput and automated cell-based assays and has the potential to enable a broad range of research, drug discovery and clinical applications.

Fractional laser-assisted drug delivery

DEFF Research Database (Denmark)

Taudorf, Elisabeth Hjardem; Lerche, C.M.; Erlendsson, A M

2016-01-01

BACKGROUND AND OBJECTIVE: Ablative fractional laser (AFXL) facilitates delivery of topical methotrexate (MTX). This study investigates impact of laser-channel depth on topical MTX-delivery. MATERIALS AND METHODS: MTX (1% [w/v]) diffused for 21 hours through AFXL-exposed porcine skin in in vitro F...

An employee assistance program for caregiver support.

Science.gov (United States)

Mains, Douglas A; Fairchild, Thomas J; René, Antonio A

2006-01-01

The Comprehensive Caregiver Choices Program provided support for employee caregivers of elderly people for employees at a hospital in Fort Worth, Texas. Key informant interviews and focus groups provided direction for program development and implementation. A full-time MSW and professionals with expertise in gerontology/geriatrics provided education and care coordination services to caregivers. Approximately 4% of the hospital's workforce participated in the program. Attendees evaluated educational sessions and follow-up interviews were conducted with program participants. Caregiver support programs must continue to seek innovative and creative marketing and service delivery methods to reach out and assist working caregivers in need of support.

Educating the delivery of bad news in medicine: Preceptorship versus simulation.

Science.gov (United States)

Jacques, Andrew P; Adkins, Eric J; Knepel, Sheri; Boulger, Creagh; Miller, Jessica; Bahner, David P

2011-07-01

Simulation experiences have begun to replace traditional education models of teaching the skill of bad news delivery in medical education. The tiered apprenticeship model of medical education emphasizes experiential learning. Studies have described a lack of support in bad news delivery and inadequacy of training in this important clinical skill as well as poor familial comprehension and dissatisfaction on the part of physicians in training regarding the resident delivery of bad news. Many residency training programs lacked a formalized training curriculum in the delivery of bad news. Simulation teaching experiences may address these noted clinical deficits in the delivery of bad news to patients and their families. Unique experiences can be role-played with this educational technique to simulate perceived learner deficits. A variety of scenarios can be constructed within the framework of the simulation training method to address specific cultural and religious responses to bad news in the medical setting. Even potentially explosive and violent scenarios can be role-played in order to prepare physicians for these rare and difficult situations. While simulation experiences cannot supplant the model of positive, real-life clinical teaching in the delivery of bad news, simulation of clinical scenarios with scripting, self-reflection, and peer-to-peer feedback can be powerful educational tools. Simulation training can help to develop the skills needed to effectively and empathetically deliver bad news to patients and families in medical practice.

Peer Programs: An In-Depth Look at Peer Helping: Planning, Implementation, and Administration.

Science.gov (United States)

Tindall, Judith A.

The goal of this book is to provide a program designed to teach peer helping professionals a method and rationale for training peer helpers. Peer helping programs are a major delivery system of affective education or deliberate psychological education. Peer helping programs can provide prevention, intervention, and support systems for people.…

Radon Measurement Proficiency (RMP) Program methods and devices

International Nuclear Information System (INIS)

Harrison, J.; Hoornbeek, J.; Jalbert, P.; Sensintaffar, E.; Hopper, R.

1991-01-01

The US EPA developed the voluntary Radon Measurement Proficiency Program in 1986 in response to a Federal and State need for measurement services firms to demonstrate their proficiency with radon measurement methods and devices. Since that time, the program has set basic standards for the radon measurement industry. The program has grown dramatically since its inception. In 1986, fewer than 50 companies participated in the program. By 1989, more than 5,000 companies were participating. Participants represent firms with an analytical capability as well as firms that rely upon another firm for analysis service. Since the beginning of the RMP Program, the Agency has learned a great deal about radon measurement methods and devices. This paper reviews the measurement devices used in the program and what the EPA has learned about them since the program's inception. Performance data from the RMP Program are used to highlight relevant findings

Preliminary results from direct-to-facility vaccine deliveries in Kano, Nigeria.

Science.gov (United States)

Aina, Muyi; Igbokwe, Uchenna; Jegede, Leke; Fagge, Rabiu; Thompson, Adam; Mahmoud, Nasir

2017-04-19

As part of its vaccine supply chain redesign efforts, Kano state now pushes vaccines directly from 6 state stores to primary health centers equipped with solar refrigerators. Our objective is to describe preliminary results from the first 20months of Kano's direct vaccine delivery operations. This is a retrospective review of Kano's direct vaccine delivery program. We analyzed trends in health facility vaccine stock levels, and examined the relationship between stock-out rates and each of cascade vaccine deliveries and timeliness of deliveries. Analysis of vaccination trends was based on administrative data from 27 sentinel health facilities. Costs for both the in-sourced and out-sourced approaches were estimated using a bottoms-up model-based approach. Overall stock adequacy increased from 54% in the first delivery cycle to 68% by cycle 33. Conversely, stock-out rates decreased from 41% to 10% over the same period. Similar trends were observed in the out-sourced and in-sourced programs. Stock-out rates rose incrementally with increasing number of cascade facilities, and delays in vaccine deliveries correlated strongly with stock-out rates. Recognizing that stock availability is one of many factors contributing to vaccinations, we nonetheless compared pre- and post- direct deliveries vaccinations in sentinel facilities, and found statistically significant upward trends for 4 out of 6 antigens. 1 antigen (measles) showed an upward trend that was not statistically significant. Hepatitis b vaccinations declined during the period. Overall, there appeared to be a one-year lag between commencement of direct deliveries and the increase in number of vaccinations. Weighted average cost per delivery is US$29.8 and cost per child immunized is US$0.7 per year. Direct vaccine delivery to health facilities in Kano, through a streamlined architecture, has resulted in decreased stock-outs and improved stock adequacy. Concurrent operation of insourced and outsourced programs has

Potential Cost-Effectiveness of an Influenza Vaccination Program Offering Microneedle Patch for Vaccine Delivery in Children.

Directory of Open Access Journals (Sweden)

Carlos Wong

Full Text Available The influenza vaccine coverage rate of children is low in Hong Kong. Microneedle patches (MNPs is a technology under development for painless delivery of vaccines. This study aimed to examine the potential clinical outcomes and direct medical costs of an influenza program offering MNP vaccine to children who have declined intramuscular (IM vaccine in Hong Kong.A decision model was designed to compare potential outcomes between IM vaccine program and a program offering MNP vaccine to those declined IM vaccine (IM/MNP program in a hypothetical cohort of children over one-year time horizon. The model outcomes included direct medical cost, influenza infection rate, mortality rate, and quality-adjusted life-years (QALYs loss. Model inputs were retrieved from published literature. Sensitivity analyses were performed to examine the robustness of model results.In base-case analysis, IM/MNP program was more costly per child (USD19.13 versus USD13.69; USD1 = HKD7.8 with lower influenza infection rate (98.9 versus 124.8 per 1,000 children, hospitalization rate (0.83 versus 1.05 per 1,000 children and influenza-related mortality rate (0.00042 versus 0.00052 per 1,000 children when compared to IM program. The incremental cost per QALY saved (ICER of IM/MNP program versus IM program was 27,200 USD/QALY. Using gross domestic product (GDP per capita of Hong Kong (USD40,594 as threshold of willingness-to-pay (WTP per QALY, one-way sensitivity analysis found ICER of IM/MNP to exceed WTP when duration of illness in outpatient setting was 1.39-time of IM vaccine cost. In 10,000 Monte Carlo simulations, IM/MNP program was the preferred option in 57.28% and 91.68% of the time, using 1x and 3x GDP per capita as WTP threshold, respectively.Acceptance of IM/MNP program as the preferred program was subject to the WTP threshold, duration of illness in outpatient settings, and cost of MNP vaccine.

Laser beam uniformity and stability using homogenizer-based fiber optic launch method: square core fiber delivery

Science.gov (United States)

Lizotte, Todd E.

2011-03-01

Over the years, technological achievements within the laser medical diagnostic, treatment, and therapy markets have led to ever increasing requirements for greater control of critical laser beam parameters. Increased laser power/energy stabilization, temporal and spatial beam shaping and flexible laser beam delivery systems with ergonomic focusing or imaging lens systems are sought by leading medical laser system producers. With medical procedures that utilize laser energy, there is a constant emphasis on reducing adverse effects that come about by the laser itself or its optical system, but even when these variables are well controlled the medical professional will still need to deal with the multivariate nature of the human body. Focusing on the variables that can be controlled, such as accurate placement of the laser beam where it will expose a surface being treated as well as laser beam shape and uniformity is critical to minimizing adverse conditions. This paper covers the use of fiber optic beam delivery as a means of defining the beam shape (intensity/power distribution uniformity) at the target plane as well as the use of fiber delivery as a means to allow more flexible articulation of the laser beam over the surface being treated. The paper will present a new concept of using a square core fiber beam delivery design utilizing a unique micro lens array (MLA) launch method that improves the overall stability of the system, by minimizing the impact of the laser instability. The resulting performance of the prototype is presented to demonstrate its stability in comparison to simple lens launch techniques, with an emphasis on homogenization and articulated fiber delivery.

Non-linear programming method in optimization of fast reactors

International Nuclear Information System (INIS)

Pavelesku, M.; Dumitresku, Kh.; Adam, S.

1975-01-01

Application of the non-linear programming methods on optimization of nuclear materials distribution in fast reactor is discussed. The programming task composition is made on the basis of the reactor calculation dependent on the fuel distribution strategy. As an illustration of this method application the solution of simple example is given. Solution of the non-linear program is done on the basis of the numerical method SUMT. (I.T.)

Action research to improve methods of delivery and feedback in an Access Grid Room environment

Science.gov (United States)

McArthur, Lynne C.; Klass, Lara; Eberhard, Andrew; Stacey, Andrew

2011-12-01

This article describes a qualitative study which was undertaken to improve the delivery methods and feedback opportunity in honours mathematics lectures which are delivered through Access Grid Rooms. Access Grid Rooms are facilities that provide two-way video and audio interactivity across multiple sites, with the inclusion of smart boards. The principal aim was to improve the student learning experience, given the new environment. The specific aspects of the course delivery that the study focused on included presentation of materials and provision of opportunities for interaction between the students and between students and lecturers. The practical considerations in the delivery of distance learning are well documented in the literature, and similar problems arise in the Access Grid Room environment; in particular, those of limited access to face-to-face interaction and the reduction in peer support. The nature of the Access Grid Room classes implies that students studying the same course can be physically situated in different cities, and possibly in different countries. When studying, it is important that students have opportunity to discuss new concepts with others; particularly their peers and their lecturer. The Access Grid Room environment also presents new challenges for the lecturer, who must learn new skills in the delivery of materials. The unique nature of Access Grid Room technology offers unprecedented opportunity for effective course delivery and positive outcomes for students, and was developed in response to a need to be able to interact with complex data, other students and the instructor, in real-time, at a distance and from multiple sites. This is a relatively new technology and as yet there has been little or no studies specifically addressing the use and misuse of the technology. The study found that the correct placement of cameras and the use of printed material and smart boards were all crucial to the student experience. In addition, the

Experience of using heat citric acid disinfection method in central dialysis fluid delivery system.

Science.gov (United States)

Sakuma, Koji; Uchiumi, Nobuko; Sato, Sumihiko; Aida, Nobuhiko; Ishimatsu, Taketo; Igoshi, Tadaaki; Kodama, Yoshihiro; Hotta, Hiroyuki

2010-09-01

We applied the heat citric acid disinfection method in the main part of the central dialysis fluid delivery system (MPCDDS), which consists of a multiple-patient dialysis fluid supply unit, dialysis console units, and dialysis fluid piping. This disinfection method has been used for single-patient dialysis machines, but this is the first trial in the MPCDDS. We examined, by points of safety and disinfection effect, whether this disinfection method is comparable to conventional disinfection methods in Japan. The conventional disinfection method is a combination of two disinfectants, sodium hypochlorite and acetic acid, used separately for protein removal and decalcification. Consequently, total microbial counts and endotoxin concentrations fully satisfied the microbiological requirements for standard dialysis fluid of ISO 11663. From our results and discussion, this heat citric acid disinfection method is proved to be safe and reliable for MPCDDS. However, to satisfy the microbiological requirements for ultrapure dialysis fluid, further consideration for this method in MPCDDS including the reverse osmosis device composition and piping is necessary.

Methods to model and predict the ViewRay treatment deliveries to aid patient scheduling and treatment planning.

Science.gov (United States)

Liu, Shi; Wu, Yu; Wooten, H Omar; Green, Olga; Archer, Brent; Li, Harold; Yang, Deshan

2016-03-08

A software tool is developed, given a new treatment plan, to predict treatment delivery time for radiation therapy (RT) treatments of patients on ViewRay magnetic resonance image-guided radiation therapy (MR-IGRT) delivery system. This tool is necessary for managing patient treatment scheduling in our clinic. The predicted treatment delivery time and the assessment of plan complexities could also be useful to aid treatment planning. A patient's total treatment delivery time, not including time required for localization, is modeled as the sum of four components: 1) the treatment initialization time; 2) the total beam-on time; 3) the gantry rotation time; and 4) the multileaf collimator (MLC) motion time. Each of the four components is predicted separately. The total beam-on time can be calculated using both the planned beam-on time and the decay-corrected dose rate. To predict the remain-ing components, we retrospectively analyzed the patient treatment delivery record files. The initialization time is demonstrated to be random since it depends on the final gantry angle of the previous treatment. Based on modeling the relationships between the gantry rotation angles and the corresponding rotation time, linear regression is applied to predict the gantry rotation time. The MLC motion time is calculated using the leaves delay modeling method and the leaf motion speed. A quantitative analysis was performed to understand the correlation between the total treatment time and the plan complexity. The proposed algorithm is able to predict the ViewRay treatment delivery time with the average prediction error 0.22min or 1.82%, and the maximal prediction error 0.89 min or 7.88%. The analysis has shown the correlation between the plan modulation (PM) factor and the total treatment delivery time, as well as the treatment delivery duty cycle. A possibility has been identified to significantly reduce MLC motion time by optimizing the positions of closed MLC pairs. The accuracy of

Dynamic Line Rating Oncor Electric Delivery Smart Grid Program

Energy Technology Data Exchange (ETDEWEB)

Johnson, Justin; Smith, Cale; Young, Mike; Donohoo, Ken; Owen, Ross; Clark, Eddit; Espejo, Raul; Aivaliotis, Sandy; Stelmak, Ron; Mohr, Ron; Barba, Cristian; Gonzalez, Guillermo; Malkin, Stuart; Dimitrova, Vessela; Ragsdale, Gary; Mitchem, Sean; Jeirath, Nakul; Loomis, Joe; Trevino, Gerardo; Syracuse, Steve; Hurst, Neil; Mereness, Matt; Johnson, Chad; Bivens, Carrie

2013-05-04

Electric transmission lines are the lifeline of the electric utility industry, delivering its product from source to consumer. This critical infrastructure is often constrained such that there is inadequate capacity on existing transmission lines to efficiently deliver the power to meet demand in certain areas or to transport energy from high-generation areas to high-consumption regions. When this happens, the cost of the energy rises; more costly sources of power are used to meet the demand or the system operates less reliably. These economic impacts are known as congestion, and they can amount to substantial dollars for any time frame of reference: hour, day or year. There are several solutions to the transmission constraint problem, including: construction of new generation, construction of new transmission facilities, rebuilding and reconductoring of existing transmission assets, and Dynamic Line Rating (DLR). All of these options except DLR are capital intensive, have long lead times and often experience strong public and regulatory opposition. The Smart Grid Demonstration Program (SGDP) project co-funded by the Department of Energy (DOE) and Oncor Electric Delivery Company developed and deployed the most extensive and advanced DLR installation to demonstrate that DLR technology is capable of resolving many transmission capacity constraint problems with a system that is reliable, safe and very cost competitive. The SGDP DLR deployment is the first application of DLR technology to feed transmission line real-time dynamic ratings directly into the system operation’s State Estimator and load dispatch program, which optimizes the matching of generation with load demand on a security, reliability and economic basis. The integrated Dynamic Line Rating (iDLR)1 collects transmission line parameters at remote locations on the lines, calculates the real-time line rating based on the equivalent conductor temperature, ambient temperature and influence of wind and solar

Use of quality measurement across US dental delivery systems: a qualitative analysis.

Science.gov (United States)

Alrqiq, Hosam M; Edelstein, Burton L

2016-03-01

Dentistry is increasingly challenged by payers and the public to demonstrate quality measurement (QM) activities that substantiate value. Unknown is how various components of the US oral health-care financing and delivery systems have adopted QM. The objective of this study is to explore QM activities by US dental delivery, management, financing, and related organizations. Using a structured interview guide based on a novel conceptual framework that incorporates factors influencing QM intention, adoption, and implementation, 19 key informant interviews were conducted. Informants represented safety net delivery programs (health center, nonprofit mobile, hospital-based, Veterans Administration, and tribal dental programs), private delivery organizations (private practice, closed panel HMO, and for-profit mobile dental programs), training programs that deliver care (dental and dental therapy programs), management organizations (private and Medicaid group practice management companies), care financing organizations (Medicaid managed care plan, state Medicaid program, dental benefits companies), and dental quality organizations (institute and dental professional organization). Interviews were transcribed and analyzed qualitatively. Informants report wide variation in the intensity of QM efforts with organizational leadership cited as most influential. Motivation to adopt QM efforts is more often internal than imposed. Data management and information technology both facilitate and limit QM activities. QM activities are associated with operational improvements including use of guidelines and refinements of mission. Organizational type and size appear to influence QM programs. The current status of QM is highly variable across dental organizations because organizational leadership, needs, and requirements vary according to mission and structure. © 2015 American Association of Public Health Dentistry.

Methods for evaluation of industry training programs

International Nuclear Information System (INIS)

Morisseau, D.S.; Roe, M.L.; Persensky, J.J.

1987-01-01

The NRC Policy Statement on Training and Qualification endorses the INPO-managed Training Accreditation Program in that it encompasses the elements of effective performance-based training. Those elements are: analysis of the job, performance-based learning objectives, training design and implementation, trainee evaluation, and program evaluation. As part of the NRC independent evaluation of utilities implementation of training improvement programs, the staff developed training review criteria and procedures that address all five elements of effective performance-based training. The staff uses these criteria to perform reviews of utility training programs that have already received accreditation. Although no performance-based training program can be said to be complete unless all five elements are in place, the last two, trainee and program evaluation, are perhaps the most important because they determine how well the first three elements have been implemented and ensure the dynamic nature of training. This paper discusses the evaluation elements of the NRC training review criteria. The discussion will detail the elements of evaluation methods and techniques that the staff expects to find as integral parts of performance-based training programs at accredited utilities. Further, the review of the effectiveness of implementation of the evaluation methods is discussed. The paper also addresses some of the qualitative differences between what is minimally acceptable and what is most desirable with respect to trainee and program evaluation mechanisms and their implementation

Comparison between Synchronous and Asynchronous Instructional Delivery Method of Training Programme on In-Service Physical Educators' Knowledge

Science.gov (United States)

Emmanouilidou, Kyriaki; Derri, Vassiliki; Antoniou, Panagiotis; Kyrgiridis, Pavlos

2012-01-01

The purpose of the study was to compare the influences of a training programme's instructional delivery method (synchronous and asynchronous) on Greek in-service physical educators' cognitive understanding on student assessment. Forty nine participants were randomly divided into synchronous, asynchronous, and control group. The experimental groups…

Validated spectrofluorometric method for determination of gemfibrozil in self nanoemulsifying drug delivery systems (SNEDDS)

Science.gov (United States)

Sierra Villar, Ana M.; Calpena Campmany, Ana C.; Bellowa, Lyda Halbaut; Trenchs, Monserrat Aróztegui; Naveros, Beatriz Clares

2013-09-01

A spectrofluorometric method has been developed and validated for the determination of gemfibrozil. The method is based on the excitation and emission capacities of gemfibrozil with excitation and emission wavelengths of 276 and 304 nm respectively. This method allows de determination of the drug in a self-nanoemulsifying drug delivery system (SNEDDS) for improve its intestinal absorption. Results obtained showed linear relationships with good correlation coefficients (r2 > 0.999) and low limits of detection and quantification (LOD of 0.075 μg mL-1 and LOQ of 0.226 μg mL-1) in the range of 0.2-5 μg mL-1, equally this method showed a good robustness and stability. Thus the amounts of gemfibrozil released from SNEDDS contained in gastro resistant hard gelatine capsules were analysed, and release studies could be performed satisfactorily.

Emerging Technologies of Polymeric Nanoparticles in Cancer Drug Delivery

International Nuclear Information System (INIS)

Brewer, E.; Coleman, J.; Lowman, A.

2011-01-01

Polymeric nanomaterials have the potential to improve upon present chemotherapy delivery methods. They successfully reduce side effects while increasing dosage, increase residence time in the body, offer a sustained and tunable release, and have the ability to deliver multiple drugs in one carrier. However, traditional nanomaterial formulations have not produced highly therapeutic formulations to date due to their passive delivery methods and lack of rapid drug release at their intended site. In this paper, we have focused on a few smart technologies that further enhance the benefits of typical nanomaterials. Temperature and pH-responsive drug delivery devices were reviewed as methods for triggering release of encapsulating drugs, while aptamer and ligand conjugation were discussed as methods for targeted and intracellular delivery, with emphases on in vitro and in vivo works for each method.

A comprehensive postpartum follow-up health care program for women with history of preeclampsia: protocol for a mixed methods research.

Science.gov (United States)

Kamravamanesh, Mastaneh; Kohan, Shahnaz; Rezavand, Negin; Farajzadegan, Ziba

2018-05-18

Long-term postpartum follow-up is of great importance since women with preeclampsia history are at high risk of upcoming health complications. However, postpartum follow-up rates are poor. According to evidences, preeclampsia is not just a transient health problem; rather it causes short term and long term complications, which affect women's life for years after delivery. Although it seems the problem is solved by the end of pregnancy, the follow-up of subjects should not be stopped after delivery. Postpartum is the best possible time to provide necessary care to these women who are at the risk of future complications. Due to importance of well-designed follow-up plan for women suffering preeclampsia, this study will carry out to provide a postpartum follow-up health care program for subjected women. This study is a qualitative-quantitative mixed sequencing exploratory study that consists of three consecutive phases. In this study, following a qualitative approach, the researcher will explain the needs and strategies related to promoting the health of women with preeclampsia history in the postpartum period. By entering the second phase, the researcher will design a comprehensive follow-up health care program in the postpartum period in which, in addition to using the qualitative study results, related papers and texts will be also used. The proposed program is designed by a panel of experts based on prioritization guidelines. Finally, after passing different stages of program finalizing, its effectiveness on the lifestyle of women with preeclampsia history will be investigated in a semi-experimental study in the third phase of the study. It is expected conducting a mixed method study to design and execute an interventional program to follow up women with preeclampsia history improve their health status and well-being, while reducing their health care costs through prevention in various levels within the current structure of health care services. If this program is

Broadly Applicable Nanowafer Drug Delivery System for Treating Eye Injuries

Science.gov (United States)

2015-09-01

Systems in Systemic , Dermal, Transdermal , and Ocular Drug Delivery . Crit. Rev. Ther. Drug 2008, 25, 545–584. 14. Choy, Y. B.; Park, J.-H.; McCarey, B...AWARD NUMBER: W81XWH-13-1-0146 TITLE: Broadly Applicable Nanowafer Drug Delivery System for Treating Eye Injuries PRINCIPAL INVESTIGATOR: Dr...Broadly Applicable Nanowafer Drug Delivery System for Treating Eye Injuries” 5b. GRANT NUMBER W81XWH-13-1-0146 5c. PROGRAM ELEMENT NUMBER 6

Energy-efficient Public Procurement: Best Practice in Program Delivery

Energy Technology Data Exchange (ETDEWEB)

Payne, Christopher [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States). Environmental Energy Technologies Division; Weber, Andrew [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States). Environmental Energy Technologies Division; Semple, Abby [Public Procurement Analysis, London (United Kingdom)

2013-02-15

This document illustrates the key issues and considerations involved in implementing energy-efficient public procurement. Our primary sources of information have been our partners in the Super Efficient Equipment and Appliance Deployment (SEAD) Initiative Procurement Working Group. Where applicable, we have highlighted specific ways in which working group participants have successfully overcome barriers to delivering effective programs. The following key points emerge from this analysis of programs for energy-efficient public procurement. Lessons for both developed and developing programs are highlighted throughout the guide. 1. Policy: Policy provides the initiative to begin a transition from first cost to life-cycle cost based purchasing methods and culture. Effective policy is well-communicated, establishes accountability from top to bottom of organizations and simplifies the processes necessary to comply. Flexibility and responsiveness are essential in policy development and implementation. Mandatory and voluntary policies may complement one another. 2. Procurement Criteria: Procurement staff must be confident that energy-efficient procurement criteria offer the best long-term value for their organization’s money and represent real environmental gains. Involving multiple stakeholders at the early stages of the criteria creation process can result in greater levels of cooperation from private industry. Criteria should make comparison of products easy for purchasers and require minimal additional calculations. Criteria will need to be regularly updated to reflect market developments. 3. Training: Resources for the creation of training programs are usually very limited, but well-targeted training is necessary in order for a program to be effective. Training must emphasize a process that is efficient for purchasers and simplifies compliance. Purchaser resources and policy must be well designed for training to be effective. Training program development is an

Population Estimation with Mark and Recapture Method Program

International Nuclear Information System (INIS)

Limohpasmanee, W.; Kaewchoung, W.

1998-01-01

Population estimation is the important information which required for the insect control planning especially the controlling with SIT. Moreover, It can be used to evaluate the efficiency of controlling method. Due to the complexity of calculation, the population estimation with mark and recapture methods were not used widely. So that, this program is developed with Qbasic on the purpose to make it accuracy and easier. The program evaluation consists with 6 methods; follow Seber's, Jolly-seber's, Jackson's Ito's, Hamada's and Yamamura's methods. The results are compared with the original methods, found that they are accuracy and more easier to applied

Distance Learning Delivery Systems: Instructional Options.

Science.gov (United States)

Steele, Ray L.

1993-01-01

Discusses the availability of satellite and cable programing to provide distance education opportunities in school districts. Various delivery systems are described, including telephones with speakers, personal computers, and satellite dishes; and a sidebar provides a directory of distance learning opportunities, including telecommunications…

Oral Cholera Vaccination Delivery Cost in Low- and Middle-Income Countries: An Analysis Based on Systematic Review

Science.gov (United States)

Ramani, Enusa; Wee, Hyeseung; Kim, Jerome H.

2016-01-01

Background Use of the oral cholera vaccine (OCV) is a vital short-term strategy to control cholera in endemic areas with poor water and sanitation infrastructure. Identifying, estimating, and categorizing the delivery costs of OCV campaigns are useful in analyzing cost-effectiveness, understanding vaccine affordability, and in planning and decision making by program managers and policy makers. Objectives To review and re-estimate oral cholera vaccination program costs and propose a new standardized categorization that can help in collation, analysis, and comparison of delivery costs across countries. Data sources Peer reviewed publications listed in PubMed database, Google Scholar and World Health Organization (WHO) websites and unpublished data from organizations involved in oral cholera vaccination. Study eligibility criteria The publications and reports containing oral cholera vaccination delivery costs, conducted in low- and middle-income countries based on World Bank Classification. Limits are humans and publication date before December 31st, 2014. Participants No participants are involved, only costs are collected. Intervention Oral cholera vaccination and cost estimation. Study appraisal and synthesis method A systematic review was conducted using pre-defined inclusion and exclusion criteria. Cost items were categorized into four main cost groups: vaccination program preparation, vaccine administration, adverse events following immunization and vaccine procurement; the first three groups constituting the vaccine delivery costs. The costs were re-estimated in 2014 US dollars (US$) and in international dollar (I$). Results Ten studies were identified and included in the analysis. The vaccine delivery costs ranged from US$0.36 to US$ 6.32 (in US$2014) which was equivalent to I$ 0.99 to I$ 16.81 (in I$2014). The vaccine procurement costs ranged from US$ 0.29 to US$ 29.70 (in US$2014), which was equivalent to I$ 0.72 to I$ 78.96 (in I$2014). The delivery costs in

Floating Microparticulate Oral Diltiazem Hydrochloride Delivery ...

African Journals Online (AJOL)

Purpose: To formulate and evaluate floating microparticulate oral diltiazem delivery system for possible delivery to the heart. Method: Floating microspheres were prepared using cellulose acetate and Eudragit RS100 polymers by emulsion solvent evaporation technique. The dried floating microspheres were evaluated for ...

Determinants of institutional delivery in rural Jhang, Pakistan

Directory of Open Access Journals (Sweden)

Carton Thomas W

2011-07-01

Full Text Available Abstract Background There is expert consensus that delivery at a health facility substantially reduces the risk of maternal death. By increasing the use of antenatal (ANC, postnatal care (PNC and family planning, the risk of maternal death can be further reduced. There has been little investigation of factors associated with the use of these services in Pakistan. Methods A representative household survey was conducted in rural areas of Jhang district, Pakistan, to determine the effect of demographic, economic and program factors on the utilization of maternal health services. Married women who had children ages 12 months or younger were interviewed. Data was collected from 2,018 women on socio-demographic characteristics and the utilization of health services. Logistic regression analysis was conducted to identify the correlates of health services use. Marginal effects quantify the impact of various factors on service utilization. Results Parity and education had the largest impact on institutional delivery: women were substantially less likely to deliver at a health facility after their first birth; women with primary or higher education were much more likely to have an institutional delivery. Age, autonomy, household wealth, proximity to a health facility and exposure to mass media were also important drivers of institutional delivery. The use of family planning within a year of delivery was low, with parity, education and husband's approval being the strongest determinants of use. Conclusions The findings suggest that rural women are likely to respond to well-designed interventions that remove financial and physical barriers to accessing maternal health services and motivate women by emphasizing the benefits of these services. Interventions should specifically target women who have two or more living children, little formal education and are from the poorest households.

Simple Calculation Programs for Biology Immunological Methods

Indian Academy of Sciences (India)

First page Back Continue Last page Overview Graphics. Simple Calculation Programs for Biology Immunological Methods. Computation of Ab/Ag Concentration from EISA data. Graphical Method; Raghava et al., 1992, J. Immuno. Methods 153: 263. Determination of affinity of Monoclonal Antibody. Using non-competitive ...

Emerging Technologies of Polymeric Nanoparticles in Cancer Drug Delivery

Directory of Open Access Journals (Sweden)

Erik Brewer

2011-01-01

Full Text Available Polymeric nanomaterials have the potential to improve upon present chemotherapy delivery methods. They successfully reduce side effects while increasing dosage, increase residence time in the body, offer a sustained and tunable release, and have the ability to deliver multiple drugs in one carrier. However, traditional nanomaterial formulations have not produced highly therapeutic formulations to date due to their passive delivery methods and lack of rapid drug release at their intended site. In this paper, we have focused on a few “smart” technologies that further enhance the benefits of typical nanomaterials. Temperature and pH-responsive drug delivery devices were reviewed as methods for triggering release of encapsulating drugs, while aptamer and ligand conjugation were discussed as methods for targeted and intracellular delivery, with emphases on in vitro and in vivo works for each method.

Evaluation of a Soft Skills Training Program

Science.gov (United States)

Charoensap-Kelly, Piyawan; Broussard, Lauren; Lindsly, Mallory; Troy, Megan

2016-01-01

This study was conducted to determine the effectiveness of a soft skills employee training program. We examined willingness to learn and delivery methods (face-to-face vs. online) and their associations with the training outcomes in terms of learning and behavioral change. Results showed that neither participants' willingness to learn nor delivery…

Split delivery vehicle routing problem with time windows: a case study

Science.gov (United States)

Latiffianti, E.; Siswanto, N.; Firmandani, R. A.

2018-04-01

This paper aims to implement an extension of VRP so called split delivery vehicle routing problem (SDVRP) with time windows in a case study involving pickups and deliveries of workers from several points of origin and several destinations. Each origin represents a bus stop and the destination represents either site or office location. An integer linear programming of the SDVRP problem is presented. The solution was generated using three stages of defining the starting points, assigning busses, and solving the SDVRP with time windows using an exact method. Although the overall computational time was relatively lengthy, the results indicated that the produced solution was better than the existing routing and scheduling that the firm used. The produced solution was also capable of reducing fuel cost by 9% that was obtained from shorter total distance travelled by the shuttle buses.

Sparsity Prevention Pivoting Method for Linear Programming

DEFF Research Database (Denmark)

Li, Peiqiang; Li, Qiyuan; Li, Canbing

2018-01-01

When the simplex algorithm is used to calculate a linear programming problem, if the matrix is a sparse matrix, it will be possible to lead to many zero-length calculation steps, and even iterative cycle will appear. To deal with the problem, a new pivoting method is proposed in this paper....... The principle of this method is avoided choosing the row which the value of the element in the b vector is zero as the row of the pivot element to make the matrix in linear programming density and ensure that most subsequent steps will improve the value of the objective function. One step following...... this principle is inserted to reselect the pivot element in the existing linear programming algorithm. Both the conditions for inserting this step and the maximum number of allowed insertion steps are determined. In the case study, taking several numbers of linear programming problems as examples, the results...

Sparsity Prevention Pivoting Method for Linear Programming

DEFF Research Database (Denmark)

Li, Peiqiang; Li, Qiyuan; Li, Canbing

2018-01-01

. The principle of this method is avoided choosing the row which the value of the element in the b vector is zero as the row of the pivot element to make the matrix in linear programming density and ensure that most subsequent steps will improve the value of the objective function. One step following......When the simplex algorithm is used to calculate a linear programming problem, if the matrix is a sparse matrix, it will be possible to lead to many zero-length calculation steps, and even iterative cycle will appear. To deal with the problem, a new pivoting method is proposed in this paper...... this principle is inserted to reselect the pivot element in the existing linear programming algorithm. Both the conditions for inserting this step and the maximum number of allowed insertion steps are determined. In the case study, taking several numbers of linear programming problems as examples, the results...

Effect of milk sample delivery methods and arrival conditions on bacterial contamination rates.

Science.gov (United States)

Dinsmore, R P; English, P B; Matthews, J C; Sears, P M

1990-07-01

A cross sectional study was performed of factors believed to contribute to the contamination of bovine milk sample cultures submitted to the Ithaca Regional Laboratory of the Quality Milk Promotion Services/New York State Mastitis Control. Of 871 samples entered in the study, 137 (15.7%) were contaminated. There were interactions between the sample source (veterinarian vs dairyman), delivery method, and time between sample collection and arrival at the laboratory. If only those samples collected and hand delivered by the dairyman within 1 day of collection were compared to a like subset of samples collected and hand delivered by veterinarians, no statistically significant differences in milk sample contamination rate (MSCR) were found. Samples were delivered to the laboratory by hand, US Postal Service, United Parcel Service, via the New York State College of Veterinary Medicine Diagnostic Laboratory, or Northeast Dairy Herd Improvement Association Courier. The MSCR was only 7.6% for hand delivered samples, while 26% of Postal Service samples were contaminated. These rates differed significantly from other delivery methods (P less than 0.0001). The USPS samples arrived a longer time after sampling than did samples sent by other routes, and time had a significant effect on MSCR (0 to 1 day, 8.9%; greater than 1 day, 25.9%; P less than 0.01). Samples packaged with ice packs sent by routes other than the Postal Service had a lower MSCR than those not packaged with ice packs, but ice packs did not reduce the MSCR for samples sent by the Postal Service.(ABSTRACT TRUNCATED AT 250 WORDS)

Vaginal delivery versus cesarean section for term breech delivery

Directory of Open Access Journals (Sweden)

Babović Ivana

2010-01-01

Full Text Available Background/Aim. The optimal method of delivery for breech presentation at term still remains a matter of controversy. This is probably due to the fact that the skills of vaginal breech delivery are being lost. The aim of this study was to examine risk factors: mother's age, parity, labor's duration, estimated neonatal birth weight for the mode of breech presentation delivery at term as well as the influence of the delivery mode on neonatal outcome. Methods. A retrospective study of 401 terms (more than 37 week's gestation breech deliveries at the Institute of Gynecology and Obstetrics, Belgrade, from 2007 to 2008 was made. The following groups with respect to mode of delivery were included: the group I - vaginal delivery (VD in 139 patients; the group II - urgent cesarean section (UCS in 128 patients; and the group III - elective cesarean section (ECS in 134 patients. Mother's age, parity, duration of VD, neonatal birth weight (BW, the Apgar score at 5th minute, and duration of stay in a neonatal intensive care unit (NICU vere determined. Neonatal mortality and major neonatal morbidity were compared according to the route of delivery. Fetuses and neonates with hemolytic disease and fetal and neonatal anomalies were excluded from the study. For statistical analyses we performed Student's t test, χ2 likelihood ratio, Kruskall-Wallis test, Mann Whitney test, and ANOVA. Results. The mean age of patients in the group I was 28.29 ± 4.97 years, in the group II 29.68 ± 5.92 years and in the group III 30.06 ± 5.41 years. Difference in mother's age between the group I and III was significant (p = 0.022. In the group III there were 73.9% nuliparous similarly to the gropu II (73.4%. We performed ECS in 54.6% of the nuliparous older than 35 years, and 54.4% multiparous younger than 35 years were delivered by VD. The use of oxytocin for stimulation of vaginal labor was not associated with its duration (p = 0.706. Lowset maneuver was performed in 88.5% of

Development of a Program Logic Model and Evaluation Plan for a Participatory Ergonomics Intervention in Construction

Science.gov (United States)

Jaegers, Lisa; Dale, Ann Marie; Weaver, Nancy; Buchholz, Bryan; Welch, Laura; Evanoff, Bradley

2013-01-01

Background Intervention studies in participatory ergonomics (PE) are often difficult to interpret due to limited descriptions of program planning and evaluation. Methods In an ongoing PE program with floor layers, we developed a logic model to describe our program plan, and process and summative evaluations designed to describe the efficacy of the program. Results The logic model was a useful tool for describing the program elements and subsequent modifications. The process evaluation measured how well the program was delivered as intended, and revealed the need for program modifications. The summative evaluation provided early measures of the efficacy of the program as delivered. Conclusions Inadequate information on program delivery may lead to erroneous conclusions about intervention efficacy due to Type III error. A logic model guided the delivery and evaluation of our intervention and provides useful information to aid interpretation of results. PMID:24006097

An in vivo dose verification method for SBRT–VMAT delivery using the EPID

Energy Technology Data Exchange (ETDEWEB)

McCowan, P. M., E-mail: peter.mccowan@cancercare.mb.ca [Department of Physics and Astronomy, University of Manitoba, Winnipeg, Manitoba R3T 2N2 (Canada); Medical Physics Department, CancerCare Manitoba, 675 McDermot Avenue, Winnipeg, Manitoba R3E 0V9 (Canada); Van Uytven, E.; Van Beek, T.; Asuni, G. [Medical Physics Department, CancerCare Manitoba, 675 McDermot Avenue, Winnipeg, Manitoba R3E 0V9 (Canada); McCurdy, B. M. C. [Department of Physics and Astronomy, University of Manitoba, Winnipeg, Manitoba R3T 2N2 (Canada); Medical Physics Department, CancerCare Manitoba, 675 McDermot Avenue, Winnipeg, Manitoba R3E 0V9 (Canada); Department of Radiology, University of Manitoba, 820 Sherbrook Street, Winnipeg, Manitoba R3A 1R9 (Canada)

2015-12-15

Purpose: Radiation treatments have become increasingly more complex with the development of volumetric modulated arc therapy (VMAT) and the use of stereotactic body radiation therapy (SBRT). SBRT involves the delivery of substantially larger doses over fewer fractions than conventional therapy. SBRT–VMAT treatments will strongly benefit from in vivo patient dose verification, as any errors in delivery can be more detrimental to the radiobiology of the patient as compared to conventional therapy. Electronic portal imaging devices (EPIDs) are available on most commercial linear accelerators (Linacs) and their documented use for dosimetry makes them valuable tools for patient dose verification. In this work, the authors customize and validate a physics-based model which utilizes on-treatment EPID images to reconstruct the 3D dose delivered to the patient during SBRT–VMAT delivery. Methods: The SBRT Linac head, including jaws, multileaf collimators, and flattening filter, were modeled using Monte Carlo methods and verified with measured data. The simulation provides energy spectrum data that are used by their “forward” model to then accurately predict fluence generated by a SBRT beam at a plane above the patient. This fluence is then transported through the patient and then the dose to the phosphor layer in the EPID is calculated. Their “inverse” model back-projects the EPID measured focal fluence to a plane upstream of the patient and recombines it with the extra-focal fluence predicted by the forward model. This estimate of total delivered fluence is then forward projected onto the patient’s density matrix and a collapsed cone convolution algorithm calculates the dose delivered to the patient. The model was tested by reconstructing the dose for two prostate, three lung, and two spine SBRT–VMAT treatment fractions delivered to an anthropomorphic phantom. It was further validated against actual patient data for a lung and spine SBRT–VMAT plan. The

A Mexico City-Based Immersion Education Program: Training Mental Health Clinicians for Practice with Latino Communities

Science.gov (United States)

Platt, Jason James

2012-01-01

This article describes the philosophical foundations and educational methods of a Spanish language and cultural immersion program based in Mexico City, Mexico. The program is designed to assist U.S. graduate students in marriage and family therapy and clinical psychology programs to improve clinical service delivery with Latino clients. Utilizing…

Investigation of Factors Affecting Microdialysis Probe Delivery and ...

African Journals Online (AJOL)

Purpose: To investigate in vitro the factors affecting microdialysis probe delivery and recovery of puerarin. Methods: The recovery and delivery of puerarin were tested for extraction efficiency and retro-dialysis methods. Factors such as drug concentration, stirring speed, additives and length of membrane were studied to ...

Investigation of Factors Affecting Microdialysis Probe Delivery and ...

African Journals Online (AJOL)

Purpose: To investigate in vitro the factors affecting microdialysis probe delivery and recovery of puerarin . Methods: The recovery and delivery of puerarin were tested for extraction efficiency and retro-dialysis methods. Factors such as drug concentration, stirring speed, additives and length of membrane were studied to ...

Implementing the LifeSkills Training drug prevention program: factors related to implementation fidelity

Directory of Open Access Journals (Sweden)

Fagan Abigail A

2008-01-01

Full Text Available Abstract Background Widespread replication of effective prevention programs is unlikely to affect the incidence of adolescent delinquency, violent crime, and substance use until the quality of implementation of these programs by community-based organizations can be assured. Methods This paper presents the results of a process evaluation employing qualitative and quantitative methods to assess the extent to which 432 schools in 105 sites implemented the LifeSkills Training (LST drug prevention program with fidelity. Regression analysis was used to examine factors influencing four dimensions of fidelity: adherence, dosage, quality of delivery, and student responsiveness. Results Although most sites faced common barriers, such as finding room in the school schedule for the program, gaining full support from key participants (i.e., site coordinators, principals, and LST teachers, ensuring teacher participation in training workshops, and classroom management difficulties, most schools involved in the project implemented LST with very high levels of fidelity. Across sites, 86% of program objectives and activities required in the three-year curriculum were delivered to students. Moreover, teachers were observed using all four recommended teaching practices, and 71% of instructors taught all the required LST lessons. Multivariate analyses found that highly rated LST program characteristics and better student behavior were significantly related to a greater proportion of material taught by teachers (adherence. Instructors who rated the LST program characteristics as ideal were more likely to teach all lessons (dosage. Student behavior and use of interactive teaching techniques (quality of delivery were positively related. No variables were related to student participation (student responsiveness. Conclusion Although difficult, high implementation fidelity by community-based organizations can be achieved. This study suggests some important factors that

Synthesis of the project leadership staffing needs for successful development of alternative delivery programs.

Science.gov (United States)

2017-08-01

This research provides a synthesis of practices in organizational structuring and professional staffing of the innovative delivery units in several state DOTs across the nation that are actively utilizing alternative project delivery. Several major c...

Accessing Safe Deliveries in Tanzania (IMCHA) | IDRC ...

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

Few healthcare workers are trained to offer emergency obstetrical care, so timely ... With better access to skilled care and emergency services, the project aims to ... training program as it relates to health service delivery and health outcomes.

Using the community-based health planning and services program to promote skilled delivery in rural Ghana: socio-demographic factors that influence women utilization of skilled attendants at birth in northern Ghana.

Science.gov (United States)

Sakeah, Evelyn; Doctor, Henry V; McCloskey, Lois; Bernstein, Judith; Yeboah-Antwi, Kojo; Mills, Samuel

2014-04-10

The burden of maternal mortality in sub-Saharan Africa is enormous. In Ghana the maternal mortality ratio was 350 per 100,000 live births in 2010. Skilled birth attendance has been shown to reduce maternal deaths and disabilities, yet in 2010 only 68% of mothers in Ghana gave birth with skilled birth attendants. In 2005, the Ghana Health Service piloted an enhancement of its Community-Based Health Planning and Services (CHPS) program, training Community Health Officers (CHOs) as midwives, to address the gap in skilled attendance in rural Upper East Region (UER). The study determined the extent to which CHO-midwives skilled delivery program achieved its desired outcomes in UER among birthing women. We conducted a cross-sectional household survey with women who had ever given birth in the three years prior to the survey. We employed a two stage sampling techniques: In the first stage we proportionally selected enumeration areas, and the second stage involved random selection of households. In each household, where there is more than one woman with a child within the age limit, we interviewed the woman with the youngest child. We collected data on awareness of the program, use of the services and factors that are associated with skilled attendants at birth. A total of 407 households/women were interviewed. Eighty three percent of respondents knew that CHO-midwives provided delivery services in CHPS zones. Seventy nine percent of the deliveries were with skilled attendants; and over half of these skilled births (42% of total) were by CHO-midwives. Multivariate analyses showed that women of the Nankana ethnic group and those with uneducated husbands were less likely to access skilled attendants at birth in rural settings. The implementation of the CHO-midwife program in UER appeared to have contributed to expanded skilled delivery care access and utilization for rural women. However, women of the Nankana ethnic group and uneducated men must be targeted with health

AN APPLICATION FOR EFFICIENT TELECOMMUNICATION NETWORKS PROVISIONING USING LINEAR PROGRAMMING

Directory of Open Access Journals (Sweden)

Maria Augusta Soares Machado

2015-03-01

Full Text Available This paper presents a practical proposition for the application of the Linear Programming quantitative method in order to assist planning and control of customer circuit delivery activities in telecommunications companies working with the corporative market. Based upon data provided for by a telecom company operating in Brazil, the Linear Programming method was employed for one of the classical problems of determining the optimum mix of production quantities for a set of five products of that company: Private Telephone Network, Internet Network, Intranet Network, Low Speed Data Network, and High Speed Data Network, in face of several limitations of the productive resources, seeking to maximize the company’s monthly revenue. By fitting the production data available into a primary model, observation was made as to what number of monthly activations for each product would be mostly optimized in order to achieve maximum revenues in the company. The final delivery of a complete network was not observed but the delivery of the circuits that make it up, and this was a limiting factor for the study herein, which, however, brings an innovative proposition for the planning of private telecommunications network provisioning.

Nanocomposite thin films for triggerable drug delivery.

Science.gov (United States)

Vannozzi, Lorenzo; Iacovacci, Veronica; Menciassi, Arianna; Ricotti, Leonardo

2018-05-01

Traditional drug release systems normally rely on a passive delivery of therapeutic compounds, which can be partially programmed, prior to injection or implantation, through variations in the material composition. With this strategy, the drug release kinetics cannot be remotely modified and thus adapted to changing therapeutic needs. To overcome this issue, drug delivery systems able to respond to external stimuli are highly desirable, as they allow a high level of temporal and spatial control over drug release kinetics, in an operator-dependent fashion. Areas covered: On-demand drug delivery systems actually represent a frontier in this field and are attracting an increasing interest at both research and industrial level. Stimuli-responsive thin films, enabled by nanofillers, hold a tremendous potential in the field of triggerable drug delivery systems. The inclusion of responsive elements in homogeneous or heterogeneous thin film-shaped polymeric matrices strengthens and/or adds intriguing properties to conventional (bare) materials in film shape. Expert opinion: This Expert Opinion review aims to discuss the approaches currently pursued to achieve an effective on-demand drug delivery, through nanocomposite thin films. Different triggering mechanisms allowing a fine control on drug delivery are described, together with current challenges and possible future applications in therapy and surgery.

Pair Programming as a Modern Method of Teaching Computer Science

Directory of Open Access Journals (Sweden)

Irena Nančovska Šerbec

2008-10-01

Full Text Available At the Faculty of Education, University of Ljubljana we educate future computer science teachers. Beside didactical, pedagogical, mathematical and other interdisciplinary knowledge, students gain knowledge and skills of programming that are crucial for computer science teachers. For all courses, the main emphasis is the absorption of professional competences, related to the teaching profession and the programming profile. The latter are selected according to the well-known document, the ACM Computing Curricula. The professional knowledge is therefore associated and combined with the teaching knowledge and skills. In the paper we present how to achieve competences related to programming by using different didactical models (semiotic ladder, cognitive objectives taxonomy, problem solving and modern teaching method “pair programming”. Pair programming differs from standard methods (individual work, seminars, projects etc.. It belongs to the extreme programming as a discipline of software development and is known to have positive effects on teaching first programming language. We have experimentally observed pair programming in the introductory programming course. The paper presents and analyzes the results of using this method: the aspects of satisfaction during programming and the level of gained knowledge. The results are in general positive and demonstrate the promising usage of this teaching method.

SU-D-201-03: During-Treatment Delivery Monitoring System for TomoTherapy

Energy Technology Data Exchange (ETDEWEB)

Chen, Q; Read, P [University of Virginia, Charlottesville, VA (United States)

2016-06-15

Purpose: Multiple error pathways can lead to delivery errors during the treatment course that cannot be caught with pre-treatment QA. While in vivo solutions are being developed for linacs, no such solution exists for tomotherapy. The purpose of this study is to develop a near real-time system for tomotherapy that can monitor the delivery and dose accumulation process during the treatment-delivery, which enable the user to assess the impact of delivery variations and/or errors and to interrupt the treatment if necessary. Methods: A program running on a tomotherapy planning station fetches the raw DAS data during treatment. Exit detector data is extracted as well as output, gantry angle, and other machine parameters. For each sample, the MLC open-close state is determined. The delivered plan is compared with the original plan via a Monte Carlo dose engine which transports fluence deviations from a pre-treatment Monte Carlo run. A report containing the difference in fluence, dose and DVH statistics is created in html format. This process is repeated until the treatment is completed. Results: Since we only need to compute the dose for the difference in fluence for a few projections each time, dose with 2% statistical uncertainty can be computed in less than 1 second on a 4-core cpu. However, the current bottleneck in this near real-time system is the repeated fetching and processing the growing DAS data file throughout the delivery. The frame rate drops from 10Hz at the beginning of treatment to 5Hz after 3 minutes and to 2Hz after 10 minutes. Conclusion: A during-treatment delivery monitor system has been built to monitor tomotherapy treatments. The system improves patient safety by allowing operators to assess the delivery variations and errors during treatment delivery and adopt appropriate actions.

SU-D-201-03: During-Treatment Delivery Monitoring System for TomoTherapy

International Nuclear Information System (INIS)

Chen, Q; Read, P

2016-01-01

Purpose: Multiple error pathways can lead to delivery errors during the treatment course that cannot be caught with pre-treatment QA. While in vivo solutions are being developed for linacs, no such solution exists for tomotherapy. The purpose of this study is to develop a near real-time system for tomotherapy that can monitor the delivery and dose accumulation process during the treatment-delivery, which enable the user to assess the impact of delivery variations and/or errors and to interrupt the treatment if necessary. Methods: A program running on a tomotherapy planning station fetches the raw DAS data during treatment. Exit detector data is extracted as well as output, gantry angle, and other machine parameters. For each sample, the MLC open-close state is determined. The delivered plan is compared with the original plan via a Monte Carlo dose engine which transports fluence deviations from a pre-treatment Monte Carlo run. A report containing the difference in fluence, dose and DVH statistics is created in html format. This process is repeated until the treatment is completed. Results: Since we only need to compute the dose for the difference in fluence for a few projections each time, dose with 2% statistical uncertainty can be computed in less than 1 second on a 4-core cpu. However, the current bottleneck in this near real-time system is the repeated fetching and processing the growing DAS data file throughout the delivery. The frame rate drops from 10Hz at the beginning of treatment to 5Hz after 3 minutes and to 2Hz after 10 minutes. Conclusion: A during-treatment delivery monitor system has been built to monitor tomotherapy treatments. The system improves patient safety by allowing operators to assess the delivery variations and errors during treatment delivery and adopt appropriate actions.

Management Communication in Non-U.S. MBA Programs: Current Trends and Practices

Science.gov (United States)

Knight, Melinda

2005-01-01

A study of top-ranked, full-time, global MBA programs suggests that management communication is indeed both an important focus and component in the curriculum. The methods of delivery, however, do not seem to follow any particular model, such as the common U.S. practice of a separate program or department. Required courses are found at 10 of the…

Factors influencing the place of delivery in rural Meghalaya, India: A qualitative study

Directory of Open Access Journals (Sweden)

Amrita Sarkar

2018-01-01

Full Text Available Background: In Meghalaya, only 51.4% expectant mothers go for any institutional delivery with a wide rural-urban gap causing morbidity and mortality in the mothers and the neonates. Objectives: The objective of this study is to find out the factors influencing the choice of the place of delivery in rural women. Methodology: The present qualitative cross-sectional study was conducted from October to December 2016 in Bhoirymbong community health center (CHC and the area catered to by it. This CHC was selected by purposive sampling. Data collection methods included focused group discussions and in-depth interviews. The data were analyzed manually using thematic content analysis. Results: Most of the women in the study area opted for home delivery by traditional birth attendants (TBAs, on whose skills the community had strong faith. Financial constraints, fear of out-of-pocket expenditure, ignorance of available schemes, unavailability of transport, bad roads, and distant hospitals were found to be important causes of this choice. Home delivery apparently offered the women privacy and the opportunity to attend to their household chores and older children. Illiteracy, increasing age, and parity were risk factors for home delivery. Perceived need for institutional delivery was low. Staff attitudes and unnecessary referrals had an impact on the choice of place of delivery. Conclusion: In the rural areas of this study, home deliveries are the preferred norm. The wide range of factors identified in this study for the preference of TBA and home deliveries could help policy makers and program implementers to adopt socially and culturally appropriate community-based interventions that can contribute to the reduction of maternal, fetal, and neonatal mortality and morbidity and increase service utilization.

Utilization of clean and safe delivery service package of health services extension program and associated factors in rural kebeles of Kafa Zone, Southwest Ethiopia.

Science.gov (United States)

Bayou, Negalign Berhanu; Gacho, Yohannes Haile Michael

2013-07-01

In Ethiopia, 94% of births take place at home unattended by trained persons. The government introduced an innovative strategy, Health Services Extension Program in 2003. Clean and safe delivery service is a component of maternal and child healthcare package of the program. However, little is known about the status of uptake of the service. This study thus aimed to assess utilization of clean and safe delivery service and associated factors in rural kebeles of Kafa Zone, Ethiopia. A community based cross sectional survey was conducted in rural kebeles of Kefa Zone from January 21(st) to February 25(th), 2009 using a sample of 229 mothers. Kafa Zone is located 465 kilometres away from Addis Ababa to southwest of Ethiopia. Data were collected using a structured questionnaire and analyzed using SPSS for windows version 16. OR and 95% CI were calculated. Phistory of abortion, knowledge of danger signs and antenatal care attendance. Educating women and improving their knowledge about danger signs of pregnancy and labor is recommended. Health extension workers should consider antenatal care visits as opportunities for this purpose.

Influence of Students’ Feedback on the Quality of Adult Higher Distance Education Service Delivery

Directory of Open Access Journals (Sweden)

Akpovire ODUARAN

2017-10-01

Full Text Available The evaluation of a program’s compliance with service delivery and features necessary for the attainment of the programs educational objectives, student outcomes and continuous improvement is an important element in program accreditation and continuous improvement process. The study reported in this paper investigated the possible effects of students’ feedback on the improvement of adult higher education distance learning service quality in a South African rural-based university. The study interrogated the service provision factors that seemingly helped in improving the delivery of the program. Such information are vital for planning, good governance, policy formulation, monitoring and evaluation, and for decision-making. The study used a quantitative descriptive statistics analysis of data generated ranging from 2013-2014. It comprised of overall student satisfaction as the dependent variable and the explanatory variables were given by program management, facilitation, assessment, learner support, systems, resources, program outcomes and subject matter. Analytical results were obtained from the Mann Whitney Test. The population consisted of students enrolled in the Advanced Certificate in Education (ACE program by distance mode. The 313 respondents sampled were randomly selected from a total population of 916 students. Data were collected using a semi-structured questionnaire. The results revealed that service qualities linked to effective management, facilitation, academic support and subject matter delivery were the main qualities that the students recommended for the improvement of the program. It is therefore recommended that adult higher education programs must have a documented systematically utilized and effective process involving program service delivery constituencies like assessment, academic support and resources provided, for the periodic review of the program educational objectives to ensure that the program remains consistent

Nanoscale drug delivery for targeted chemotherapy.

Science.gov (United States)

Xin, Yong; Huang, Qian; Tang, Jian-Qin; Hou, Xiao-Yang; Zhang, Pei; Zhang, Long Zhen; Jiang, Guan

2016-08-28

Despite significant improvements in diagnostic methods and innovations in therapies for specific cancers, effective treatments for neoplastic diseases still represent major challenges. Nanotechnology as an emerging technology has been widely used in many fields and also provides a new opportunity for the targeted delivery of cancer drugs. Nanoscale delivery of chemotherapy drugs to the tumor site is highly desirable. Recent studies have shown that nanoscale drug delivery systems not only have the ability to destroy cancer cells but may also be carriers for chemotherapy drugs. Some studies have demonstrated that delivery of chemotherapy via nanoscale carriers has greater therapeutic benefit than either treatment modality alone. In this review, novel approaches to nanoscale delivery of chemotherapy are described and recent progress in this field is discussed. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Palliative Care Program Development in a Low- to Middle-Income Country: Delivery of Care by a Nongovernmental Organization in India

Directory of Open Access Journals (Sweden)

Anjali Krishnan

2018-03-01

Full Text Available Purpose: Limited data describe the delivery of palliative care services in low- and middle-income countries. We describe delivery of care by the Trivandrum Institute of Palliative Sciences (TIPS in Trivandrum, India. Methods: Administrative records were used to describe case volumes, setting of care, and organizational expenditures. An estimate of cost per clinical encounter was derived by dividing 2016 monthly clinical expenditures by the number of patient visits. Costs are reported in US dollars and are corrected for Organization for Economic Co-operation and Development purchasing power parity (PPP. Results: A total of 11,620 new patients were seen at TIPS during 2007 to 2016; 59% had cancer. The average annual growth rate in case volumes was 18% (480 new patients in 2007 and 1,882 in 2016. The proportion of patients with cancer increased over time from 56% in 2014 to 66% in 2016 (P < .001. During 2014 to 2016, outpatient visits increased 26% (from 8,524 to 10,732, inpatient days increased 49% (from 1,763 to 2,625, inpatient visits at other hospitals increased 41% (from 248 to 417, and home visits increased 57% (from 3,951 to 6,186. Total clinical expenditures in 2016 were $288,489 (PPP corrected, $5.1 million. Between 2014 and 2016, the cost of delivering care increased by 74%. The mean cost per clinical encounter in 2016 was $15 (PPP corrected, $263. Conclusion: Demand for palliative care services has increased substantially, with an increasing proportion related to cancer. The organization of clinical services by TIPS may serve as a model for the development of other palliative care programs in low- and middle-income countries.

Interior-Point Methods for Linear Programming: A Review

Science.gov (United States)

Singh, J. N.; Singh, D.

2002-01-01

The paper reviews some recent advances in interior-point methods for linear programming and indicates directions in which future progress can be made. Most of the interior-point methods belong to any of three categories: affine-scaling methods, potential reduction methods and central path methods. These methods are discussed together with…

100TH T-38C Delivery Ceremony (Defense Acquisition Review Journal)

National Research Council Canada - National Science Library

Ott, David D; Davis, James B

2002-01-01

In 2000, the United States Air Force T-38 Avionics Upgrade System Program Office began to pursue Lean initiatives to reduce out-year program cost and delivery risk at the Boeing T-38C Upgrade facility...

A real-time virtual delivery system for photon radiotherapy delivery monitoring

Directory of Open Access Journals (Sweden)

Feng Shi

2014-03-01

Full Text Available Purpose: Treatment delivery monitoring is important for radiotherapy, which enables catching dosimetric error at the earliest possible opportunity. This project develops a virtual delivery system to monitor the dose delivery process of photon radiotherapy in real-time using GPU-based Monte Carlo (MC method.Methods: The simulation process consists of 3 parallel CPU threads. A thread T1 is responsible for communication with a linac, which acquires a set of linac status parameters, e.g. gantry angles, MLC configurations, and beam MUs every 20 ms. Since linac vendors currently do not offer interface to acquire data in real time, we mimic this process by fetching information from a linac dynalog file at the set frequency. Instantaneous beam fluence map (FM is calculated based. A FM buffer is also created in T1 and the instantaneous FM is accumulated to it. This process continues, until a ready signal is received from thread T2 on which an in-house developed MC dose engine executes on GPU. At that moment, the accumulated FM is transferred to T2 for dose calculations, and the FM buffer in T1 is cleared. Once the dose calculation finishes, the resulting 3D dose distribution is directed to thread T3, which displays it in three orthogonal planes in color wash overlaid on the CT image. This process continues to monitor the 3D dose distribution in real-time.Results: An IMRT and a VMAT cases used in our patient-specific QA are studied. Maximum dose differences between our system and treatment planning system are 0.98% and 1.58% for the IMRT and VMAT cases, respectively. The update frequency is >10Hz and the relative uncertainty level is 2%.Conclusion: By embedding a GPU-based MC code in a novel data/work flow, it is possible to achieve real-time MC dose calculations to monitor delivery process.------------------------------Cite this article as: Shi F, Gu X, Graves YJ, Jiang S, Jia X. A real-time virtual delivery system for photon radiotherapy delivery

The PrePex device is unlikely to achieve cost-savings compared to the forceps-guided method in male circumcision programs in sub-Saharan Africa.

Directory of Open Access Journals (Sweden)

Walter Obiero

Full Text Available Male circumcision (MC reduces the risk of heterosexual HIV acquisition in men by approximately 60%. MC programs for HIV prevention are currently being scaled-up in fourteen countries in sub-Saharan Africa. The current standard surgical technique for MC in many sub-Saharan African countries is the forceps-guided male circumcision (FGMC method. The PrePex male circumcision (PMC method could replace FGMC and potentially reduce MC programming costs. We compared the potential costs of introducing the PrePex device into MC programming to the cost of the forceps-guided method.Data were obtained from the Nyanza Reproductive Health Society (NRHS, an MC service delivery organization in Kenya, and from the Kenya Ministry of Health. Analyses are based on 48,265 MC procedures performed in four Districts in western Kenya from 2009 through 2011. Data were entered into the WHO/UNAIDS Decision Makers Program Planning Tool. The tool assesses direct and indirect costs of MC programming. Various sensitivity analyses were performed. Costs were discounted at an annual rate of 6% and are presented in United States Dollars.Not including the costs of the PrePex device or referral costs for men with phimosis/tight foreskin, the costs of one MC surgery were $44.54-$49.02 and $54.52-$55.29 for PMC and FGMC, respectively.The PrePex device is unlikely to result in significant cost-savings in comparison to the forceps-guided method. MC programmers should target other aspects of the male circumcision minimum package for improved cost efficiency.

Overview of States' Use of Telehealth for the Delivery of Early Intervention (IDEA Part C Services

Directory of Open Access Journals (Sweden)

Jana Cason

2012-12-01

Full Text Available Background: Early intervention (EI services are designed to promote the development of skills and enhance the quality of life of infants and toddlers who have been identified as having a disability or developmental delay, enhance capacity of families to care for their child with special needs, reduce future educational costs, and promote independent living (NECTAC 2011.  EI services are regulated by Part C of the Individuals with Disabilities Education Improvement Act (IDEA; however, personnel shortages, particularly in rural areas, limit access for children who qualify.  Telehealth is an emerging delivery model demonstrating potential to deliver EI services effectively and efficiently, thereby improving access and ameliorating the impact of provider shortages in underserved areas. The use of a telehealth delivery model facilitates inter-disciplinary collaboration, coordinated care, and consultation with specialists not available within a local community.  Method:  A survey sent by the National Early Childhood Technical Assistance Center (NECTAC to IDEA Part C coordinators assessed their utilization of telehealth within states’ IDEA Part C programs.  Reimbursement for provider type and services and barriers to implement a telehealth service delivery model were identified.  Results:  Representatives from 26 states and one jurisdiction responded to the NECTAC telehealth survey.  Of these, 30% (n=9 indicated that they are either currently using telehealth as an adjunct service delivery model (n=6 or plan to incorporate telehealth within the next 1-2 years (n=3.  Identified telehealth providers included developmental specialists, teachers of the Deaf/Hard of Hearing (DHH, speech-language pathologists, occupational therapists, physical therapists, behavior specialists, audiologists, and interpreters.  Reimbursement was variable and included use of IDEA Part C funding, Medicaid, and private insurance.  Expressed barriers and concerns for

Method to render second order beam optics programs symplectic

International Nuclear Information System (INIS)

Douglas, D.; Servranckx, R.V.

1984-10-01

We present evidence that second order matrix-based beam optics programs violate the symplectic condition. A simple method to avoid this difficulty, based on a generating function approach to evaluating transfer maps, is described. A simple example illustrating the non-symplectricity of second order matrix methods, and the effectiveness of our solution to the problem, is provided. We conclude that it is in fact possible to bring second order matrix optics methods to a canonical form. The procedure for doing so has been implemented in the program DIMAT, and could be implemented in programs such as TRANSPORT and TURTLE, making them useful in multiturn applications. 15 refs

Multicenter Collaborative Quality Assurance Program for the Province of Ontario, Canada: First-Year Results

International Nuclear Information System (INIS)

Létourneau, Daniel; McNiven, Andrea; Jaffray, David A.

2013-01-01

Purpose: The objective of this work was to develop a collaborative quality assurance (CQA) program to assess the performance of intensity modulated radiation therapy (IMRT) planning and delivery across the province of Ontario, Canada. Methods and Materials: The CQA program was designed to be a comprehensive end-to-end test that can be completed on multiple planning and delivery platforms. The first year of the program included a head-and-neck (H and N) planning exercise and on-site visit to acquire dosimetric measurements to assess planning and delivery performance. A single dosimeter was used at each institution, and the planned to measured dose agreement was evaluated for both the H and N plan and a standard plan (linear-accelerator specific) that was created to enable a direct comparison between centers with similar infrastructure. Results: CQA program feasibility was demonstrated through participation of all 13 radiation therapy centers in the province. Planning and delivery was completed on a variety of infrastructure (treatment planning systems and linear accelerators). The planning exercise was completed using both static gantry and rotational IMRT, and planned-to-delivered dose agreement (pass rates) for 3%/3-mm gamma evaluation were greater than 90% (92.6%-99.6%). Conclusions: All centers had acceptable results, but variation in planned to delivered dose agreement for the same planning and delivery platform was noted. The upper end of the range will provide an achievable target for other centers through continued quality improvement, aided by feedback provided by the program through the use of standard plans and simple test fields

Distance Synchronous Information Systems Course Delivery

Science.gov (United States)

Peslak, Alan R.; Lewis, Griffith R.; Aebli, Fred

2014-01-01

Teaching computer information systems via distance education is a challenge for both student and faculty. Much research work has been performed on methods of teaching via distance education. Today we are faced with a variety of options for course delivery. Asynchronous delivery via online or lesson instruction still remains most common. But…

Participation of HIV prevention programs among men who have sex with men in two cities of China—a mixed method study

Directory of Open Access Journals (Sweden)

Ma Wei

2012-10-01

Full Text Available Abstract Background Although various HIV prevention programs targeting men who have sex with men (MSM are operating in China, whether and how these programs are being utilized is unclear. This study explores participation of HIV prevention programs and influencing factors among MSM in two cities in China. Methods This is a mixed-method study conducted in Beijing and Chongqing. A qualitative study consisting of in-depth interviews with 54 MSM, 11 key informants, and 8 focus group discussions, a cross-sectional survey using respondent-driven sampling among 998 MSM were conducted in 2009 and 2010 respectively to elicit information on MSM’s perception and utilization of HIV prevention programs. Qualitative findings were integrated with quantitative multivariate factors to explain the quantitative findings. Results Fifty-six percent of MSM in Chongqing and 75.1% in Beijing ever participated in at least one type of HIV prevention program (P=0.001. Factors related to participation in HIV prevention programs included age, ethnicity, income, HIV risk perception, living with boyfriend, living in urban area, size of MSM social network, having talked about HIV status with partners, and knowing someone who is HIV positive. Reasons why MSM did not participate in HIV prevention programs included logistical concerns like limited time for participation and distance to services; program content and delivery issues such as perceived low quality services and distrust of providers; and, cultural issues like HIV-related stigma and low risk perception. Conclusions The study shows that there is much room for improvement in reaching MSM in China. HIV prevention programs targeting MSM in China may need to be more comprehensive and incorporate the cultural, logistic and HIV-related needs of the population in order to effectively reach and affect this population’s risk for HIV.

Health facility and skilled birth deliveries among poor women with Jamkesmas health insurance in Indonesia: a mixed-methods study.

Science.gov (United States)

Brooks, Mohamad I; Thabrany, Hasbullah; Fox, Matthew P; Wirtz, Veronika J; Feeley, Frank G; Sabin, Lora L

2017-02-02

The growing momentum for quality and affordable health care for all has given rise to the recent global universal health coverage (UHC) movement. As part of Indonesia's strategy to achieve the goal of UHC, large investments have been made to increase health access for the poor, resulting in the implementation of various health insurance schemes targeted towards the poor and near-poor, including the Jamkesmas program. In the backdrop of Indonesia's aspiration to reach UHC is the high rate of maternal mortality that disproportionally affects poor women. The objective of this study was to evaluate the association of health facility and skilled birth deliveries among poor women with and without Jamkesmas and explore perceived barriers to health insurance membership and maternal health service utilization. We used a mixed-methods design. Utilizing data from the 2012 Indonesian Demographic and Health Survey (n = 45,607), secondary analysis using propensity score matching was performed on key outcomes of interest: health facility delivery (HFD) and skilled birth delivery (SBD). In-depth interviews (n = 51) were conducted in the provinces of Jakarta and Banten among poor women, midwives, and government representatives. Thematic framework analysis was performed on qualitative data to explore perceived barriers. In 2012, 63.0% of women did not have health insurance; 19.1% had Jamkesmas. Poor women with Jamkesmas were 19% (OR = 1.19 [1.03-1.37]) more likely to have HFD and 17% (OR = 1.17 [1.01-1.35]) more likely to have SBD compared to poor women without insurance. Qualitative interviews highlighted key issues, including: lack of proper documentation for health insurance registration; the preference of pregnant women to deliver in their parents' village; the use of traditional birth attendants; distance to health facilities; shortage of qualified health providers; overcrowded health facilities; and lack of health facility accreditation. Poor women with

The development of a parenting program for incarcerated mothers in Australia: a review of prison-based parenting programs.

Science.gov (United States)

Newman, Claire; Fowler, Cathrine; Cashin, Andrew

2011-08-01

The increasing population of children with an incarcerated parent is a significant public health issue. A literature search highlighted that children of incarcerated parents experience psychological stressors that may potentially impact on health and behavioural outcomes. Parenting programs for prisoners may be of benefit as early parenting experiences during childhood have a significant impact on a child's future experiences as an adolescent and adult. A review of identified evaluation-based studies of parenting programs for prisoners (N = 11), although varied in program delivery approaches and evaluation methods, suggest that such programs have the potential to improve the parenting skills, knowledge and confidence of incarcerated parents. Finally, this paper provides an outline of the development of an Australian based parenting program for incarcerated mothers and their young children.

Simple Calculation Programs for Biology Other Methods

Indian Academy of Sciences (India)

First page Back Continue Last page Overview Graphics. Simple Calculation Programs for Biology Other Methods. Hemolytic potency of drugs. Raghava et al., (1994) Biotechniques 17: 1148. FPMAP: methods for classification and identification of microorganisms 16SrRNA. graphical display of restriction and fragment map of ...

Matlab and C programming for Trefftz finite element methods

CERN Document Server

Qin, Qing-Hua

2008-01-01

Although the Trefftz finite element method (FEM) has become a powerful computational tool in the analysis of plane elasticity, thin and thick plate bending, Poisson's equation, heat conduction, and piezoelectric materials, there are few books that offer a comprehensive computer programming treatment of the subject. Collecting results scattered in the literature, MATLAB® and C Programming for Trefftz Finite Element Methods provides the detailed MATLAB® and C programming processes in applications of the Trefftz FEM to potential and elastic problems. The book begins with an introduction to th

Challenges and opportunities in dermal/transdermal delivery

OpenAIRE

Paudel, Kalpana S; Milewski, Mikolaj; Swadley, Courtney L; Brogden, Nicole K; Ghosh, Priyanka; Stinchcomb, Audra L

2010-01-01

Transdermal drug delivery is an exciting and challenging area. There are numerous transdermal delivery systems currently available on the market. However, the transdermal market still remains limited to a narrow range of drugs. Further advances in transdermal delivery depend on the ability to overcome the challenges faced regarding the permeation and skin irritation of the drug molecules. Emergence of novel techniques for skin permeation enhancement and development of methods to lessen skin i...

Incidence of Incisional Hernia after Cesarean Delivery

DEFF Research Database (Denmark)

Aabakke, Anna J M; Krebs, Lone; Ladelund, Steen

2014-01-01

OBJECTIVE: To estimate the incidence of incisional hernias requiring surgical repair after cesarean delivery over a 10-year period. METHODS: This population- and register-based cohort study identified all women in Denmark with no history of previous abdominal surgery who had a cesarean delivery...... the inclusion period. The cumulated incidence of a hernia repair within 10 years after a cesarean delivery was 0.197% (95% CI 0.164-0.234%). The risk of a hernia repair was higher during the first 3 years after a cesarean delivery, with an incidence after 3 years of 0.157% (95% CI 0.127-0.187%). CONCLUSIONS...

Delivery of Cargo to Lysosomes Using GNeosomes.

Science.gov (United States)

Hamill, Kristina M; Wexselblatt, Ezequiel; Tong, Wenyong; Esko, Jeffrey D; Tor, Yitzhak

2017-01-01

Liposomes have been used to improve the intracellular delivery of a variety of cargos. Encapsulation of cargos in liposomes leads to improved plasma half-lives and minimized degradation. Here, we present a method for improving the selective delivery of liposomes to the lysosomes using a guanidinylated neomycin (GNeo) transporter. The method for synthesizing GNeo-lipids, incorporating them into liposomes, and the enhanced lysosomal delivery of encapsulated cargo are presented. GNeo-liposomes, termed GNeosomes, are capable of delivering a fluorescent dye to the lysosomes of Chinese hamster ovary cells as shown using confocal microscopy. GNeosomes can also be used to deliver therapeutic quantities of lysosomal enzymes to fibroblasts isolated from patients with a lysosomal storage disorder.

Sociocultural determinants of home delivery in Ethiopia: a qualitative study

Directory of Open Access Journals (Sweden)

Kaba M

2016-04-01

Full Text Available Mirgissa Kaba,1 Tesfaye Bulto,2 Zergu Tafesse,2 Wassie Lingerh,2 Ismael Ali2 1Department of Preventive Medicine, School of Public Health, Addis Ababa University, 2Integrated Family Health Program, John Snow, Inc., Addis Ababa, Ethiopia Background: Maternal health remains a major public health problem in Ethiopia. Despite the government’s measures to ensure institutional delivery assisted by skilled attendants, home delivery remains high, estimated at over 80% of all pregnant women.Objective: The study aims to identify determinants that sustain home delivery in Ethiopia.Methods: A total of 48 women who delivered their most recent child at home, 56 women who delivered their most recent child in a health facility, 55 husbands of women who delivered within 1 year preceding the study, and 23 opinion leaders in selected districts of Amhara, Oromia, Southern Nations, Nationalities, and Peoples’ Region, and Tigray regions were involved in the study. Key informant interview, in-depth interviews, and focus group discussions were conducted to collect data using checklists developed for this purpose. Data reduction and analysis were facilitated by Maxqda qualitative data analysis software version 11.Results: Findings show that pregnancy and delivery is a normal and natural life event. Research participants unanimously argue that such a life event should not be linked with health problems. Home is considered a natural space for delivery and most women aspire to deliver at home where rituals during labor and after delivery are considered enjoyable. Even those who delivered in health facilities appreciate events in connection to home delivery. Efforts are underway to create home-like environments in health facilities, but health facilities are not yet recognized as a natural place of delivery. The positive tendency to deliver at home is further facilitated by poor service delivery at the facility level. Perceived poor competence of providers and limited

A New Drug Release Method in Early Development of Transdermal Drug Delivery Systems

Directory of Open Access Journals (Sweden)

Bing Cai

2012-01-01

Full Text Available In vitro drug release tests are a widely used tool to measure the variance between transdermal product performances and required by many authorities. However, the result cannot provide a good estimation of the in vivo drug release. In the present work, a new method for measuring drug release from patches has been explored and compared with the conventional USP apparatus 2 and 5 methods. Durogesic patches, here used as a model patch, were placed on synthetic skin simulator and three moisture levels (29, 57, 198 μL cm−2 were evaluated. The synthetic skin simulators were collected after 1, 2, 3, 4, 6, and 24 hours and extracted with pH 1.0 hydrochloric acid solution. The drug concentrations in the extractions were measured by isocratic reverse phase high-pressure liquid chromatography. The results showed that, with the increasing moisture level on the synthetic skin simulator, the drug release rate increased. In comparison with the conventional USP method, the drug release results performed by the new method were in more correlation to the release rate claimed in the product label. This new method could help to differentiate the drug release rates among assorted formulations of transdermal drug delivery systems in the early stage of development.

Carbon Nanotube Arrays for Intracellular Delivery and Biological Applications

Science.gov (United States)

Golshadi, Masoud

Introducing nucleic acids into mammalian cells is a crucial step to elucidate biochemical pathways, modify gene expression in immortalized cells, primary cells, and stem cells, and intoduces new approaches for clinical diagnostics and therapeutics. Current gene transfer technologies, including lipofection, electroporation, and viral delivery, have enabled break-through advances in basic and translational science to enable derivation and programming of embryonic stem cells, advanced gene editing using CRISPR (Clustered regularly interspaced short palindromic repeats), and development of targeted anti-tumor therapy using chimeric antigen receptors in T-cells (CAR-T). Despite these successes, current transfection technologies are time consuming and limited by the inefficient introduction of test molecules into large populations of target cells, and the cytotoxicity of the techniques. Moreover, many cell types cannot be consistently transfected by lipofection or electroporation (stem cells, T-cells) and viral delivery has limitations to the size of experimental DNA that can be packaged. In this dissertation, a novel coverslip-like platform consisting of an array of aligned hollow carbon nanotubes (CNTs) embedded in a sacrificial template is developed that enhances gene transfer capabilities, including high efficiency, low toxicity, in an expanded range of target cells, with the potential to transfer mixed combinations of protein and nucleic acids. The CNT array devices are fabricated by a scalable template-based manufacturing method using commercially available membranes, eliminating the need for nano-assembly. High efficient transfection has been demonstrated by delivering various cargos (nanoparticles, dye and plasmid DNA) into populations of cells, achieving 85% efficiency of plasmid DNA delivery into immortalized cells. Moreover, the CNT-mediated transfection of stem cells shows 3 times higher efficiency compared to current lipofection methods. Evaluating the cell

Dynamics of Antenatal Care and Birth Delivery Preferences in Puskesmas Kassi-Kassi, Makassar City, South Sulawesi

Directory of Open Access Journals (Sweden)

Syarifah Nuraini

2015-11-01

Full Text Available Background: Riskesdas 2010 illustrates that birth deliveries by health workers in low-income community reached 69.3%; while deliveries were conducted health workers at health facilities only reached 55.4%. This illustrates that the health facility or program that has given local or central government has not run optimally. Methods:This study aims to determine antenatal care and birth delivery preferences in the community and what factors underlie the preference. The location of research is precisely in the area of Puskesmas Kassi-kassi, Makassar City. Results showed that the mother already has the knowledge, attitudes and behavior quite well in maintaining health. Society does not always take advantage of government facilities. Antinatal care is mostly done in the doctor or midwife in private practice for reasons of convenience and prestige; while health centers for labor is still the main choice for the cheapest. Conclusion: Urban community in Kassi Health Center area have many option other than health center the quality only type of services is factor related to costumer choice because they are able to finance the cost. Recommendation: Government need to involve the private sector and do not ignore the social economic and culture condition for the successful of program.

Training in Emergency Obstetrics: A Needs Assessment of U.S. Emergency Medicine Program Directors

Directory of Open Access Journals (Sweden)

Daniel W. Robinson

2017-12-01

Full Text Available Introduction Obstetrical emergencies are a high-risk yet infrequent occurrence in the emergency department. While U.S. emergency medicine (EM residency graduates are required to perform 10 low-risk normal spontaneous vaginal deliveries, little is known about how residencies prepare residents to manage obstetrical emergencies. We sought to profile the current obstetrical training curricula through a survey of U.S. training programs. Methods We sent a web-based survey covering the four most common obstetrical emergencies (pre-eclampsia/eclampsia, postpartum hemorrhage (PPH, shoulder dystocia, and breech presentation through email invitations to all program directors (PD of U.S. EM residency programs. The survey focused on curricular details as well as the comfort level of the PDs in the preparation of their graduating residents to treat obstetrical emergencies and normal vaginal deliveries. Results Our survey had a 55% return rate (n=105/191. Of the residencies responding, 75% were in the academic setting, 20.2% community, 65% urban, and 29.8% suburban, and the obstetrical curricula were 2–4 weeks long occurring in post-graduate year one. The most common teaching method was didactics (84.1–98.1%, followed by oral cases for pre-eclampsia (48% and PPH (37.2%, and homemade simulation for shoulder dystocia (37.5% and breech delivery (33.3%. The PDs’ comfort about residency graduate skills was highest for normal spontaneous vaginal delivery, pre-eclampsia, and PPH. PDs were not as comfortable about their graduates’ skill in handling shoulder dystocia or breech delivery. Conclusion Our survey found that PDs are less comfortable in their graduates’ ability to perform non-routine emergency obstetrical procedures.

Elective cesarean delivery for term breech

DEFF Research Database (Denmark)

Krebs, Lone; Langhoff-Roos, Jens

2003-01-01

and anemia (RR 0.91; 95% CI 0.84, 0.97), and operations for wound infection (RR 0.69; 95% CI 0.57, 0.83) than emergency cesarean delivery. There was a higher rate of puerperal fever and pelvic infection (RR 1.20; 95% CI 1.11, 1.25) than for vaginal delivery. Thromboembolic disease occurred in 0.1% of women......OBJECTIVE: To compare the maternal complications of elective cesarean delivery for breech at term with those after vaginal or emergency cesarean delivery. METHODS: We conducted a population-based, retrospective cohort study of 15441 primiparas who delivered singleton breech at term. Information...... was obtained from the Danish Medical Birth Register, the Register of Death Causes, and the Denmark Patient Register. RESULTS: Elective cesarean delivery was associated with lower rates of puerperal fever and pelvic infection (relative risk [RR] 0.81; 95% confidence interval [CI] 0.70, 0.92), hemorrhage...

Distribution of a viscous binder during high shear granulation--sensitivity to the method of delivery and its impact on product properties.

Science.gov (United States)

Tan, Bernice Mei Jin; Loh, Zhi Hui; Soh, Josephine Lay Peng; Liew, Celine Valeria; Heng, Paul Wan Sia

2014-01-02

Binder distribution in the powder mass during high shear granulation is especially critical with the use of viscous liquid binders and with short processing times. A viscous liquid binder was delivered into the powder mass at two flow rates using three methods: pouring, pumping and spraying from a pressure pot. Binder content analyses at the scale of individual granules were conducted to investigate the impact of different delivery conditions on the homogeneity of binder distribution. There was clear evidence of non-uniformity of binder content among individual granules across all delivery conditions, particularly for the fast rates of delivery. Poorer reproducibility values of tablet thickness and disintegration time were observed when binder was poured but this may be overcome by pumping or spraying from the pressure pot. Greater homogeneity of binder distribution occurred with the slow rates of delivery and led to the earlier onset of granule growth and a consequent increase in granule size. Larger granule size and lower proportion of fines were in turn associated with increased granule bulk density and improvement of granule flow. In conclusion, delivery of a viscous binder at a slow rate either by pumping or via a pressure pot was most desirable during granulation. Copyright © 2013 Elsevier B.V. All rights reserved.

Simple Calculation Programs for Biology Methods in Molecular ...

Indian Academy of Sciences (India)

First page Back Continue Last page Overview Graphics. Simple Calculation Programs for Biology Methods in Molecular Biology. GMAP: A program for mapping potential restriction sites. RE sites in ambiguous and non-ambiguous DNA sequence; Minimum number of silent mutations required for introducing a RE sites; Set ...

A pulsed mode electrolytic drug delivery device

KAUST Repository

Yi, Ying

2015-09-14

This paper reports the design of a proof-of-concept drug delivery device that is actuated using the bubbles formed during electrolysis. The device uses a platinum (Pt) coated nickel (Ni) metal foam and a solid drug in reservoir (SDR) approach to improve the device\\'s performance. This electrochemically-driven pump has many features that are unlike conventional drug delivery devices: it is capable of pumping periodically and being refilled automatically; it features drug release control; and it enables targeted delivery. Pt-coated metal foam is used as a catalytic reforming element, which reduces the period of each delivery cycle. Two methods were used for fabricating the Pt-coated metal: sputtering and electroplating. Of these two methods, the sputtered Pt-coated metal foam has a higher pumping rate; it also has a comparable recombination rate when compared to the electroplated Pt-coated metal foam. The only drawback of this catalytic reformer is that it consumes nickel scaffold. Considering long-term applications, the electroplated Pt metal foam was selected for drug delivery, where a controlled drug release rate of 2.2 μg ± 0.3 μg per actuation pulse was achieved using 4 mW of power.

An Online Adult-Learner Focused Program: An Assessment of Effectiveness

Science.gov (United States)

Todd, Curtis L.; Ravi, Kokila; Akoh, Harry; Gray, Vance

2015-01-01

The landscape of higher education has significantly changed. Methods of instructional delivery, student profiles and degree offerings have transformed traditional brick and mortar institutions. Distance educational courses and programs, either fully online or hybrid, have been a major contributing factor in this shift. While a high percentage of…

Infectious morbidity, operative blood loss, and length of the operative procedure after cesarean delivery by method of placental removal and site of uterine repair.

Science.gov (United States)

Magann, E F; Washburne, J F; Harris, R L; Bass, J D; Duff, W P; Morrison, J C

1995-12-01

This study was done to determine the impact of the method of placental removal and the site of uterine repair on postcesarean infectious morbidity rates in women receiving prophylactic antibiotics at cesarean delivery. This prospective study included 284 women who underwent cesarean delivery and who were randomly assigned to four groups based on the method of placental removal and the site of uterine repair: group 1, spontaneous placental removal and in situ uterine repair; group 2, spontaneous placental removal and exteriorized uterine repair; group 3, manual placental removal and in situ uterine repair; and group 4, manual placental removal with exteriorized uterine repair. Exclusion criteria were repeat cesarean deliveries without labor, active infection at the time of cesarean delivery, and patient refusal to participate. There was no significant difference among the groups in maternal age, race, parity, weight, the length of time from rupture of membranes (ROM) or the number of vaginal examinations from ROM to cesarean delivery, or preoperative hematocrit. Intraoperatively, the type of uterine incision, anesthesia administered, incidence of meconium-stained amniotic fluid, Apgar scores, and cord gases were similar between groups. The incidence of postcesarean endometritis was greater in group 4 (32 [45 percent] of 71, p = 0.003) compared with group 1 (17 [24 percent] of 71), group 2 (12 [30 percent] of 71); and group 3 (13 [18 percent] of 71). Manual placental removal and exteriorization of the uterus for repair of the surgical incision increases the infectious morbidity rate in women receiving prophylactic antibiotics at the time of cesarean delivery and increases the length of hospitalization.

HEALS Hypertension Control Program: Training Church Members as Program Leaders.

Science.gov (United States)

Dodani, Sunita; Beayler, Irmatine; Lewis, Jennifer; Sowders, Lindsey A

2014-01-01

Health disparities related to cardiovascular diseases (CVDs) including stroke have remained higher in the African-Americans (AAs) than in other populations. HEALS is a faith-based hypertension (HTN) control program modified according to AA community needs, and delivered by the church-lay members called church health advisors (CHAs). This study examined the feasibility and acceptability of training CHAs as HEALS program leaders. Four CHAs completed a 10-hour HEALS program training workshop at the Church, conducted by the nutrition experts. Workshop was evaluated by CHAs on their level of satisfaction, clarity of contents covered and comfort in delivery the program to the church congregation. The overall six main HEALS curriculum components were completed. Workshop was highly evaluated by CHAs on length of training, balance between content and skills development, and level of satisfaction with program delivery. Church-based culturally modified health promotion interventions conducted by the community lay members may be a way to reduce health disparities in ethnic minorities.

Determination and Comparison of Neonatal Complications in Painless Epidural Delivery and without Pain Control Qom Izadi Hospital during the Years 2004-5

Directory of Open Access Journals (Sweden)

N. Tashakorinia

2007-04-01

Full Text Available Background and objectives Provision of standard childbirth facilities has been considered as an important healthcare issue for a long time. The physical and psychological states of mothers are important factors determining the fate of delivery. Therefore, several programs have been established to decrease the mother-child mortality rates and the complications of delivery. One of the most common approaches for controlling the pain of delivery is application of local anesthesia such as epidural, spinal, or a combination of these methods. It has been shown that complications of epidural anesthesia are less than other methods of local anesthesia employed for the painless delivery. In this study, a comparison is made between two groups of 80 neonates delivered by either NVD or EU.Methods A form was designed for collection of data including Apgar score at first minute, need for CPR, NICU admission, FHR variability, breast feeding time, duration of hospital stay, and neonatal reflexes. The data were analyzed by chi-square and fisher tests using SPSS software.Results There was no significant difference between the neonates born by EA or NVD at the 95% confidence level.Conclusion Based on these findings it could be concluded that epidural anesthesia for delivery does not lead to neonatal complications more than that of NVD without pain control. Therefore, this method could be recommended to mothers, who choose elective cesarean section to avoid the pain of childbirth.Keywords: Heart Rate, Fetal ; Cardiopulmonary Resuscitation ; Intensive care, Neonatal; Anesthesia, Epidural

Private sector delivery of health services in developing countries: a mixed-methods study on quality assurance in social franchises.

Science.gov (United States)

Schlein, Karen; De La Cruz, Anna York; Gopalakrishnan, Tisha; Montagu, Dominic

2013-01-03

Across the developing world health care services are most often delivered in the private sector and social franchising has emerged, over the past decade, as an increasingly popular method of private sector health care delivery. Social franchising aims to strengthen business practices through economies of scale: branding clinics and purchasing drugs in bulk at wholesale prices. While quality is one of the established goals of social franchising, there is no published documentation of how quality levels might be set in the context of franchised private providers, nor what quality assurance measures can or should exist within social franchises. The aim of this study was to better understand the quality assurance systems currently utilized in social franchises, and to determine if there are shared standards for practice or quality outcomes that exist across programs. The study included three data sources and levels of investigation: 1) Self-reported program data; 2) Scoping telephone interviews; and 3) In-depth field interviews and clinic visits. Social Franchises conceive of quality assurance not as an independent activity, but rather as a goal that is incorporated into all areas of franchise operations, including recruitment, training, monitoring of provider performance, monitoring of client experience and the provision of feedback. These findings are the first evidence to support the 2002 conceptual model of social franchising which proposed that the assurance of quality was one of the three core goals of all social franchises. However, while quality is important to franchise programs, quality assurance systems overall are not reflective of the evidence to-date on quality measurement or quality improvement best practices. Future research in this area is needed to better understand the details of quality assurance systems as applied in social franchise programs, the process by which quality assurance becomes a part of the organizational culture, and the components of

A Prototype Educational Delivery System Using Water Quality Monitoring as a Model.

Science.gov (United States)

Glazer, Richard B.

This report describes the model educational delivery system used by Ulster County Community College in its water quality monitoring program. The educational delivery system described in the report encompasses the use of behavioral objectives as its foundation and builds upon this foundation to form a complete system whose outcomes can be measured,…

Malaria Prevention by New Technology: Vectored Delivery of Antibody Genes

Science.gov (United States)

2017-10-01

AWARD NUMBER: W81XWH-15-1-0401 TITLE: Malaria Prevention by New Technology : Vectored Delivery of Antibody Genes PRINCIPAL INVESTIGATOR: Gary...CONTRACT NUMBER Malaria Prevention by New Technology : Vectored Delivery of Antibody Genes 5b. GRANT NUMBER W81XWH-15-1-0401 5c. PROGRAM ELEMENT...whole animals. Using a specific technology originally applied to expression of HIV antibodies, we demonstrated that mice can be protected from

Effects of Phytophthora cinnamomi isolate, inoculum delivery method, flood, and drought on vigor, disease severity and mortality of blueberry plants

Science.gov (United States)

Four studies evaluated the effect of Phytophthora cinnamomi isolates, inoculum delivery methods, and flood and drought conditions on vigor, disease severity scores, and survival of blueberry plants grown in pots in the greenhouse. Phytophthora cinnamomi isolates were obtained from blueberry plants ...

R&D program benefits estimation: DOE Office of Electricity Delivery and Energy Reliability

Energy Technology Data Exchange (ETDEWEB)

None, None

2006-12-04

The overall mission of the U.S. Department of Energy’s Office of Electricity Delivery and Energy Reliability (OE) is to lead national efforts to modernize the electric grid, enhance the security and reliability of the energy infrastructure, and facilitate recovery from disruptions to the energy supply. In support of this mission, OE conducts a portfolio of research and development (R&D) activities to advance technologies to enhance electric power delivery. Multiple benefits are anticipated to result from the deployment of these technologies, including higher quality and more reliable power, energy savings, and lower cost electricity. In addition, OE engages State and local government decision-makers and the private sector to address issues related to the reliability and security of the grid, including responding to national emergencies that affect energy delivery. The OE R&D activities are comprised of four R&D lines: High Temperature Superconductivity (HTS), Visualization and Controls (V&C), Energy Storage and Power Electronics (ES&PE), and Distributed Systems Integration (DSI).

Ultrasound mediated nanoparticle drug delivery

Science.gov (United States)

Mullin, Lee B.

Ultrasound is not only a powerful diagnostic tool, but also a promising therapeutic technology that can be used to improve localized drug delivery. Microbubble contrast agents are micron sized encapsulated gas filled bubbles that are administered intravenously. Originally developed to enhance ultrasound images, microbubbles are highly echogenic due to the gas core that provides a detectable impedance difference from the surrounding medium. The core also allows for controlled response of the microbubbles to ultrasound pulses. Microbubbles can be pushed using acoustic radiation force and ruptured using high pressures. Destruction of microbubbles can increase permeability at the cellular and vascular level, which can be advantageous for drug delivery. Advances in drug delivery methods have been seen with the introduction of nanoparticles, nanometer sized objects often carrying a drug payload. In chemotherapy, nanoparticles can deliver drugs to tumors while limiting systemic exposure due to abnormalities in tumor vasculature such large gaps between endothelial cells that allow nanoparticles to enter into the interstitial space; this is referred to as the enhanced permeability and retention (EPR) effect. However, this effect may be overestimated in many tumors. Additionally, only a small percentage of the injected dose accumulates in the tumor, which most the nanoparticles accumulating in the liver and spleen. It is hypothesized that combining the acoustic activity of an ultrasound contrast agent with the high payload and extravasation ability of a nanoparticle, localized delivery to the tumor with reduced systemic toxicity can be achieved. This method can be accomplished by either loading nanoparticles onto the shell of the microbubble or through a coadministration method of both nanoparticles and microbubbles. The work presented in this dissertation utilizes novel and commercial nanoparticle formulations, combined with microbubbles and a variety of ultrasound systems

20 CFR 652.208 - How are core services and intensive services related to the methods of service delivery described...

Science.gov (United States)

2010-04-01

... 20 Employees' Benefits 3 2010-04-01 2010-04-01 false How are core services and intensive services related to the methods of service delivery described in § 652.207(b)(2)? 652.208 Section 652.208 Employees' Benefits EMPLOYMENT AND TRAINING ADMINISTRATION, DEPARTMENT OF LABOR ESTABLISHMENT AND...

Home Delivery Medicament Program: access, inactivity and cardiovascular risk.

Science.gov (United States)

Araújo, Roque da Silva; Arcuri, Edna Apparecida Moura; Lopes, Victor Cauê

2016-10-10

to verify causes of inactivity in the Home Delivery Medicament Program, as referred by users from a Primary Health Care Service in São Paulo, comparing them to the causes registered in the program and analyzing them in the theoretical model Concept of Access to Health. cross-sectional study, interviewing 111 inactive users; and documentary study in the program records. half of the users did not know the condition of inactivity. Discrepancies were found between the user's and the program's information, observing different levels of agreement: Absence of physician and administrative staff member 0%; Transfer to other service 25%; Death 50%; Option to quit 50%; Address change 57% and Change in therapeutic schedule 80%. The users' feeling of accepting the program was observed. In the health access concept, inactivity can be explained in the information dimension, in the degree of asymmetry between the patient's and the health professional's knowledge, identified through the indicators: education, knowledge and information sources. due to the low education level, the user does not assimilate the information on the steps of the program flowchart, does not return for the assessment that guarantees its continuity. Consequently, (s)he stops receiving the medication and spends a long time without treatment, increasing the cardiovascular risk of hypertensive (92% of the sample), diabetic (44%) and dyslipidemic patients (31%). verificar causas de inatividade no Programa Remédio em Casa, referidas por usuários de Unidade Básica de Saúde de São Paulo, comparando-as às registradas pelo programa e analisando-as no modelo teórico Conceito de Acesso à Saúde. estudo transversal entrevistando 111 usuários inativos; e documental, nos registros do programa. metade dos usuários desconhecia a condição de inatividade. Constatadas discrepâncias nas informações usuário versus programa, observando-se diferentes níveis de concordância: Falta de médico e funcion

Dosimetric verification of RapidArc treatment delivery

DEFF Research Database (Denmark)

Korreman, Stine; Medin, Joakim; Kjaer-Kristoffersen, Flemming

2009-01-01

. METHODS AND MATERIALS: Nine treatment plans were generated in the Eclipse version 8.5 including the RapidArc optimizer for H&N and prostate cases. The plans were delivered to the Scandidos Delta4 cylindrical diode array phantom. First, the measured dose distributions were compared with the calculated......: Overall, good agreement was observed between measured and calculated doses in most cases with gamma values above 1 in >95% of measured points. The reproducibility of delivery was also very high. Gamma analysis between two consecutive runs of the same delivery plan generally showed gamma values above 1......: The delivery of RapidArc beam delivery has been verified to correspond well with calculated dose distributions for a number of different cases. The delivery was very reproducible, and was carried out with high stability of the accelerator performance....

Reduction of treatment delivery variances with a computer-controlled treatment delivery system

International Nuclear Information System (INIS)

Fraass, B.A.; Lash, K.L.; Matrone, G.M.; Lichter, A.S.

1997-01-01

Purpose: To analyze treatment delivery variances for 3-D conformal therapy performed at various levels of treatment delivery automation, ranging from manual field setup to virtually complete computer-controlled treatment delivery using a computer-controlled conformal radiotherapy system. Materials and Methods: All external beam treatments performed in our department during six months of 1996 were analyzed to study treatment delivery variances versus treatment complexity. Treatments for 505 patients (40,641 individual treatment ports) on four treatment machines were studied. All treatment variances noted by treatment therapists or quality assurance reviews (39 in all) were analyzed. Machines 'M1' (CLinac (6(100))) and 'M2' (CLinac 1800) were operated in a standard manual setup mode, with no record and verify system (R/V). Machines 'M3' (CLinac 2100CD/MLC) and ''M4'' (MM50 racetrack microtron system with MLC) treated patients under the control of a computer-controlled conformal radiotherapy system (CCRS) which 1) downloads the treatment delivery plan from the planning system, 2) performs some (or all) of the machine set-up and treatment delivery for each field, 3) monitors treatment delivery, 4) records all treatment parameters, and 5) notes exceptions to the electronically-prescribed plan. Complete external computer control is not available on M3, so it uses as many CCRS features as possible, while M4 operates completely under CCRS control and performs semi-automated and automated multi-segment intensity modulated treatments. Analysis of treatment complexity was based on numbers of fields, individual segments (ports), non-axial and non-coplanar plans, multi-segment intensity modulation, and pseudo-isocentric treatments (and other plans with computer-controlled table motions). Treatment delivery time was obtained from the computerized scheduling system (for manual treatments) or from CCRS system logs. Treatment therapists rotate among the machines, so this analysis

Long-term delivery of protein therapeutics.

Science.gov (United States)

Vaishya, Ravi; Khurana, Varun; Patel, Sulabh; Mitra, Ashim K

2015-03-01

Proteins are effective biotherapeutics with applications in diverse ailments. Despite being specific and potent, their full clinical potential has not yet been realized. This can be attributed to short half-lives, complex structures, poor in vivo stability, low permeability, frequent parenteral administrations and poor adherence to treatment in chronic diseases. A sustained release system, providing controlled release of proteins, may overcome many of these limitations. This review focuses on recent development in approaches, especially polymer-based formulations, which can provide therapeutic levels of proteins over extended periods. Advances in particulate, gel-based formulations and novel approaches for extended protein delivery are discussed. Emphasis is placed on dosage form, method of preparation, mechanism of release and stability of biotherapeutics. Substantial advancements have been made in the field of extended protein delivery via various polymer-based formulations over last decade despite the unique delivery-related challenges posed by protein biologics. A number of injectable sustained-release formulations have reached market. However, therapeutic application of proteins is still hampered by delivery-related issues. A large number of protein molecules are under clinical trials, and hence, there is an urgent need to develop new methods to deliver these highly potent biologics.

Micro fabrication of biodegradable polymer drug delivery devices

DEFF Research Database (Denmark)

Nagstrup, Johan

The pharmaceutical industry is presently facing several obstacles in developing oral drug delivery systems. This is primarily due to the nature of the discovered drug candidates. The discovered drugs often have poor solubility and low permeability across the gastro intestinal epithelium. Furtherm......The pharmaceutical industry is presently facing several obstacles in developing oral drug delivery systems. This is primarily due to the nature of the discovered drug candidates. The discovered drugs often have poor solubility and low permeability across the gastro intestinal epithelium...... permeability and degradation. These systems are for the majority based on traditional materials used in micro technology, such as SU-8, silicon, poly(methyl methacrylate). The next step in developing these new drug delivery systems is to replace classical micro fabrication materials with biodegradable polymers....... In order to successfully do this, methods for fabricating micro structures in biodegradable polymers need to be developed. The goal of this project has been to develop methods for micro fabrication in biodegradable polymers and to use these methods to produce micro systems for oral drug delivery. This has...

Evaluation of Retrofit Delivery Packages

Energy Technology Data Exchange (ETDEWEB)

Berman, M.; Smith, P.; Porse, E.

2013-07-01

Residential energy retrofit activities are a critical component of efforts to increase energy efficiency in the U.S. building stock; however, retrofits account for a small percentage of aggregate energy savings at relatively high per unit costs. This report by Building America research team, Alliance for Residential Building Innovation (ARBI), describes barriers to widespread retrofits and evaluates opportunities to improve delivery of home retrofit measures by identifying economies of scale in marketing, energy assessments, and bulk purchasing through pilot programs in portions of Sonoma, Los Angeles, and San Joaquin Counties, CA. These targeted communities show potential and have revealed key strategies for program design, as outlined in the report.

Sustained delivery of biomolecules from gelatin carriers for applications in bone regeneration.

Science.gov (United States)

Song, Jiankang; Leeuwenburgh, Sander Cg

2014-08-01

Local delivery of therapeutic biomolecules to stimulate bone regeneration has matured considerably during the past decades, but control over the release of these biomolecules still remains a major challenge. To this end, suitable carriers that allow for tunable spatial and temporal delivery of biomolecules need to be developed. Gelatin is one of the most widely used natural polymers for the controlled and sustained delivery of biomolecules because of its biodegradability, biocompatibility, biosafety and cost-effectiveness. The current study reviews the applications of gelatin as carriers in form of bulk hydrogels, microspheres, nanospheres, colloidal gels and composites for the programmed delivery of commonly used biomolecules for applications in bone regeneration with a specific focus on the relationship between carrier properties and delivery characteristics.

Methods of pushing during vaginal delivery and pelvic floor and perineal outcomes: a review.

Science.gov (United States)

de Tayrac, Renaud; Letouzey, Vincent

2016-12-01

Over the past 20 years, several randomized studies have compared Valsalva and spontaneous pushing techniques during vaginal delivery. This review summarizes current medical knowledge concerning their maternal and fetal consequences, focusing on pelvic and perineal outcomes. We selected nine randomized controlled trials comparing Valsalva and spontaneous pushing, and a secondary analysis of a randomized controlled trial comparing different methods of perineal protection. Two trials showed that spontaneous pushing reduces the risk of perineal tears, but no firm conclusions can be drawn given the heterogeneity and inconsistent results of these studies. Conflicting results have been reported regarding the duration of the second stage of labor. Pushing technique does not seem to affect episiotomy, instrumental delivery or cesarean rates. Maternal satisfaction seems to be better after spontaneous pushing. Spontaneous pushing appears to have no adverse effects on neonatal well being, and one study showed a significant improvement in prenatal fetal parameters during the expulsive phase. Valsalva and spontaneous pushing techniques currently appear comparable in terms of duration, pelvic floor, perineal, and neonatal outcomes. In the absence of strong evidence in favor of either technique, the decision should be guided by patient preference and the clinical situation. Additional, well-designed randomized controlled trials are required.

Bioresponsive matrices in drug delivery

Directory of Open Access Journals (Sweden)

Ye George JC

2010-11-01

Full Text Available Abstract For years, the field of drug delivery has focused on (1 controlling the release of a therapeutic and (2 targeting the therapeutic to a specific cell type. These research endeavors have concentrated mainly on the development of new degradable polymers and molecule-labeled drug delivery vehicles. Recent interest in biomaterials that respond to their environment have opened new methods to trigger the release of drugs and localize the therapeutic within a particular site. These novel biomaterials, usually termed "smart" or "intelligent", are able to deliver a therapeutic agent based on either environmental cues or a remote stimulus. Stimuli-responsive materials could potentially elicit a therapeutically effective dose without adverse side effects. Polymers responding to different stimuli, such as pH, light, temperature, ultrasound, magnetism, or biomolecules have been investigated as potential drug delivery vehicles. This review describes the most recent advances in "smart" drug delivery systems that respond to one or multiple stimuli.

Using mixed methods to assess fidelity of delivery and its influencing factors in a complex self-management intervention for people with osteoarthritis and low back pain.

LENUS (Irish Health Repository)

Toomey, Elaine

2017-08-04

Despite an increasing awareness of the importance of fidelity of delivery within complex behaviour change interventions, it is often poorly assessed. This mixed methods study aimed to establish the fidelity of delivery of a complex self-management intervention and explore the reasons for these findings using a convergent\\/triangulation design.

Pyrochemical and Dry Processing Methods Program. A selected bibliography

Energy Technology Data Exchange (ETDEWEB)

McDuffie, H.F.; Smith, D.H.; Owen, P.T.

1979-03-01

This selected bibliography with abstracts was compiled to provide information support to the Pyrochemical and Dry Processing Methods (PDPM) Program sponsored by DOE and administered by the Argonne National Laboratory. Objectives of the PDPM Program are to evaluate nonaqueous methods of reprocessing spent fuel as a route to the development of proliferation-resistant and diversion-resistant methods for widespread use in the nuclear industry. Emphasis was placed on the literature indexed in the ERDA--DOE Energy Data Base (EDB). The bibliography includes indexes to authors, subject descriptors, EDB subject categories, and titles.

Pyrochemical and Dry Processing Methods Program. A selected bibliography

International Nuclear Information System (INIS)

McDuffie, H.F.; Smith, D.H.; Owen, P.T.

1979-03-01

This selected bibliography with abstracts was compiled to provide information support to the Pyrochemical and Dry Processing Methods (PDPM) Program sponsored by DOE and administered by the Argonne National Laboratory. Objectives of the PDPM Program are to evaluate nonaqueous methods of reprocessing spent fuel as a route to the development of proliferation-resistant and diversion-resistant methods for widespread use in the nuclear industry. Emphasis was placed on the literature indexed in the ERDA--DOE Energy Data Base (EDB). The bibliography includes indexes to authors, subject descriptors, EDB subject categories, and titles

Program-target methods of management small business

Directory of Open Access Journals (Sweden)

Gurova Ekaterina

2017-01-01

Full Text Available Experience of small businesses in Russia are just beginning their path to development. difficulties arise with the involvement of small businesses in the implementation of government development programmes. Small business in modern conditions to secure a visible prospect of development without the implementation of state support programmes. Ways and methods of regulation of development of the market economy are diverse. The total mass of the huge role is played by the program-target methods of regulation. The article describes the basic principles on the use of program-target approach to the development of a specific sector of the economy, as small businesses, designed to play an important role in getting the national economy out of crisis. The material in this publication is built from the need to maintain the connection between the theory of government regulation, practice of formation of development programs at the regional level and the needs of small businesses. Essential for the formation of entrepreneurship development programmes is to preserve the flexibility of small businesses in making management decisions related to the selection and change of activities.

Comparison of two lecture delivery platforms in a hybrid distance education program.

Science.gov (United States)

Ried, L Douglas; Byers, Katherine

2009-08-28

To compare students' preferences for and academic performance using 2 different distance education course content delivery platforms. A randomized, crossover research design was used to compare traditional video with a 4-panel platform among learners on multiple campuses within 1 college of pharmacy.(1) The outcomes were students' preferences for delivery platform and examination scores. Rasch analysis was used to assess unidimensionality and the difficulty of examination items. Hierarchical logistic and multiple regression models were used to assess students' preferences and academic performance. The logistic model predicting preference for the 4-panel or traditional platform was not significant, but African-Americans and Hispanics were more likely to prefer the 4-panel platform than Caucasian and Asian students. The delivery platform did not impact students' academic performance. Students who did well on the semester's previous 2 examinations scored higher on the questions related to schizophrenia. Students with higher Pharmacy College Admission Test (PCAT) scores performed better on the bipolar questions than students who preferred the traditional video platform. The additional faculty time, effort, and cost invested in presenting the class material in a 4-panel platform, and the students' extra time and effort spent viewing the 4-panel platform did not produce a comparable benefit in student preference and performance.

A method for assessing fidelity of delivery of telephone behavioral support for smoking cessation.

Science.gov (United States)

Lorencatto, Fabiana; West, Robert; Bruguera, Carla; Michie, Susan

2014-06-01

Behavioral support for smoking cessation is delivered through different modalities, often guided by treatment manuals. Recently developed methods for assessing fidelity of delivery have shown that face-to-face behavioral support is often not delivered as specified in the service treatment manual. This study aimed to extend this method to evaluate fidelity of telephone-delivered behavioral support. A treatment manual and transcripts of 75 audio-recorded behavioral support sessions were obtained from the United Kingdom's national Quitline service and coded into component behavior change techniques (BCTs) using a taxonomy of 45 smoking cessation BCTs. Interrater reliability was assessed using percentage agreement. Fidelity was assessed by comparing the number of BCTs identified in the manual with those delivered in telephone sessions by 4 counselors. Fidelity was assessed according to session type, duration, counselor, and BCT. Differences between self-reported and actual BCT use were examined. Average coding reliability was high (81%). On average, 41.8% of manual-specified BCTs were delivered per session (SD = 16.2), with fidelity varying by counselor from 32% to 49%. Fidelity was highest in pre-quit sessions (46%) and for BCT "give options for additional support" (95%). Fidelity was lowest for quit-day sessions (35%) and BCT "set graded tasks" (0%). Session duration was positively correlated with fidelity (r = .585; p reliably coded in terms of BCTs. This can be used to assess fidelity to treatment manuals and to in turn identify training needs. The observed low fidelity underlines the need to establish routine procedures for monitoring delivery of behavioral support. PsycINFO Database Record (c) 2014 APA, all rights reserved.

Peptide and protein delivery using new drug delivery systems.

Science.gov (United States)

Jain, Ashish; Jain, Aviral; Gulbake, Arvind; Shilpi, Satish; Hurkat, Pooja; Jain, Sanjay K

2013-01-01

Pharmaceutical and biotechnological research sorts protein drug delivery systems by importance based on their various therapeutic applications. The effective and potent action of the proteins/peptides makes them the drugs of choice for the treatment of numerous diseases. Major research issues in protein delivery include the stabilization of proteins in delivery devices and the design of appropriate target-specific protein carriers. Many efforts have been made for effective delivery of proteins/peptidal drugs through various routes of administrations for successful therapeutic effects. Nanoparticles made of biodegradable polymers such as poly lactic acid, polycaprolactone, poly(lactic-co-glycolic acid), the poly(fumaric-co-sebacic) anhydride chitosan, and modified chitosan, as well as solid lipids, have shown great potential in the delivery of proteins/peptidal drugs. Moreover, scientists also have used liposomes, PEGylated liposomes, niosomes, and aquasomes, among others, for peptidal drug delivery. They also have developed hydrogels and transdermal drug delivery systems for peptidal drug delivery. A receptor-mediated delivery system is another attractive strategy to overcome the limitation in drug absorption that enables the transcytosis of the protein across the epithelial barrier. Modification such as PEGnology is applied to various proteins and peptides of the desired protein and peptides also increases the circulating life, solubility and stability, pharmacokinetic properties, and antigenicity of protein. This review focuses on various approaches for effective protein/peptidal drug delivery, with special emphasis on insulin delivery.

Microencapsulation: A promising technique for controlled drug delivery.

Science.gov (United States)

Singh, M N; Hemant, K S Y; Ram, M; Shivakumar, H G

2010-07-01

MICROPARTICLES OFFER VARIOUS SIGNIFICANT ADVANTAGES AS DRUG DELIVERY SYSTEMS, INCLUDING: (i) an effective protection of the encapsulated active agent against (e.g. enzymatic) degradation, (ii) the possibility to accurately control the release rate of the incorporated drug over periods of hours to months, (iii) an easy administration (compared to alternative parenteral controlled release dosage forms, such as macro-sized implants), and (iv) Desired, pre-programmed drug release profiles can be provided which match the therapeutic needs of the patient. This article gives an overview on the general aspects and recent advances in drug-loaded microparticles to improve the efficiency of various medical treatments. An appropriately designed controlled release drug delivery system can be a foot ahead towards solving problems concerning to the targeting of drug to a specific organ or tissue, and controlling the rate of drug delivery to the target site. The development of oral controlled release systems has been a challenge to formulation scientist due to their inability to restrain and localize the system at targeted areas of gastrointestinal tract. Microparticulate drug delivery systems are an interesting and promising option when developing an oral controlled release system. The objective of this paper is to take a closer look at microparticles as drug delivery devices for increasing efficiency of drug delivery, improving the release profile and drug targeting. In order to appreciate the application possibilities of microcapsules in drug delivery, some fundamental aspects are briefly reviewed.

Resuscitation of newborn in high risk deliveries

International Nuclear Information System (INIS)

Yousaf, U.F.; Hayat, S.

2015-01-01

High risk deliveries are usually associated with increased neonatal mortality and morbidity. Neonatal resuscitation can appreciably affect the outcome in these types of deliveries. Presence of personnel trained in basic neonatal resuscitation at the time of delivery can play an important role in reducing perinatal complications in neonates at risk. The study was carried out to evaluate the effects of newborn resuscitation on neonatal outcome in high risk deliveries. Methods: This descriptive case series was carried out at the Department of Obstetrics and Gynecology, Jinnah Hospital, Lahore. Ninety consecutive high risk deliveries were included and attended by paediatricians trained in newborn resuscitation. Babies delivered by elective Caesarean section, normal spontaneous vaginal deliveries and still births were excluded. Neonatal resuscitation was performed in babies who failed to initiate breathing in the first minute after birth. Data was analyzed using SPSS-16.0. Results: A total of 90 high risk deliveries were included in the study. Emergency caesarean section was the mode of delivery in 94.4% (n=85) cases and spontaneous vaginal delivery in 5.6% (n=5). Preterm pregnancy was the major high risk factor. Newborn resuscitation was required in 37.8% (n=34) of all high risk deliveries (p=0.013). All the new-borns who required resuscitation survived. Conclusion: New-born resuscitation is required in high risk pregnancies and personnel trained in newborn resuscitation should be available at the time of delivery. (author)

Two-dimensional inverse planning and delivery with a preclinical image guided microirradiator

International Nuclear Information System (INIS)

Stewart, James M. P.; Lindsay, Patricia E.; Jaffray, David A.

2013-01-01

Purpose: Recent advances in preclinical radiotherapy systems have provided the foundation for scaling many of the elements of clinical radiation therapy practice to the dimensions and energy demanded in small animal studies. Such systems support the technical capabilities to accurately deliver highly complex dose distributions, but methods to optimize and deliver such distributions remain in their infancy. This study developed an optimization method based on empirically measured two-dimensional dose kernel measurements to deliver arbitrary planar dose distributions on a recently developed small animal radiotherapy platform.Methods: A two-dimensional dose kernel was measured with repeated radiochromic film measurements for the circular 1 mm diameter fixed collimator of the small animal radiotherapy system at 1 cm depth in a solid water phantom. This kernel was utilized in a sequential quadratic programming optimization framework to determine optimal beam positions and weights to deliver an arbitrary desired dose distribution. The positions and weights were then translated to a set of stage motions to automatically deliver the optimized dose distribution. End-to-end efficacy of the framework was quantified through five repeated deliveries of two dosimetric challenges: (1) a 5 mm radius bullseye distribution, and (2) a “sock” distribution contained within a 9 × 13 mm bounding box incorporating rectangular, semicircular, and exponentially decaying geometric constructs and a rectangular linear dose gradient region. These two challenges were designed to gauge targeting, geometric, and dosimetric fidelity.Results: Optimization of the bullseye and sock distributions required 2.1 and 5.9 min and utilized 50 and 77 individual beams for delivery, respectively. Automated delivery of the resulting optimized distributions, validated using radiochromic film measurements, revealed an average targeting accuracy of 0.32 mm, and a dosimetric delivery error along four line

Polymer nanogels: a versatile nanoscopic drug delivery platform

Science.gov (United States)

Chacko, Reuben T.; Ventura, Judy; Zhuang, Jiaming; Thayumanavan, S.

2012-01-01

In this review we put the spotlight on crosslinked polymer nanogels, a promising platform that has the characteristics of an “ideal” drug delivery vehicle. Some of the key aspects of drug delivery vehicle design like stability, response to biologically relevant stimuli, passive targeting, active targeting, toxicity and ease of synthesis are discussed. We discuss several delivery systems in this light and highlight some examples of systems, which satisfy some or all of these design requirements. In particular, we point to the advantages that crosslinked polymeric systems bring to drug delivery. We review some of the synthetic methods of nanogel synthesis and conclude with the diverse applications in drug delivery where nanogels have been fruitfully employed. PMID:22342438

40 CFR 141.155 - Report delivery and recordkeeping.

Science.gov (United States)

2010-07-01

... 40 Protection of Environment 22 2010-07-01 2010-07-01 false Report delivery and recordkeeping. 141.155 Section 141.155 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) WATER PROGRAMS (CONTINUED) NATIONAL PRIMARY DRINKING WATER REGULATIONS Consumer Confidence Reports § 141.155...

Accuracy of Blood Loss Measurement during Cesarean Delivery

OpenAIRE

Doctorvaladan, Sahar V.; Jelks, Andrea T.; Hsieh, Eric W.; Thurer, Robert L.; Zakowski, Mark I.; Lagrew, David C.

2017-01-01

Objective?This study aims to compare the accuracy of visual, quantitative gravimetric, and colorimetric methods used to determine blood loss during cesarean delivery procedures employing a hemoglobin extraction assay as the reference standard. Study Design?In 50 patients having cesarean deliveries blood loss determined by assays of hemoglobin content on surgical sponges and in suction canisters was compared with obstetricians' visual estimates, a quantitative gravimetric method, and the blood...

Patient Involvement in Safe Delivery: A Qualitative Study

OpenAIRE

Olfati, Forozun; Asefzadeh, Saeid; Changizi, Nasrin; Keramat, Afsaneh; Yunesian, Masud

2015-01-01

Introduction: Patient involvement in safe delivery planning is considered important yet not widely practiced. The present study aimed at identifythe factors that affect patient involvementin safe delivery, as recommended by parturient women. Methods: This study was part of a qualitative research conducted by content analysis method and purposive sampling in 2013. The data were collected through 63 semi-structured interviews in4 hospitalsand analyzed using thematic content analysis. The partic...

A method to determine the kink resistance of stents and stent delivery systems according to international standards

Directory of Open Access Journals (Sweden)

Brandt-Wunderlich Christoph

2016-09-01

Full Text Available The kink behavior of vascular stents is of particular interest for clinicians, stent manufacturers and regulatory as a kinked stent generates a lumen loss in the stented vessel and can lead to in-stent restenosis. In this study methods to determine the kink resistance of stents and stent delivery systems according to the ISO 25539-2 and FDA guidance no. 1545 were presented. The methods are applicable for balloon expandable stents as well as for self-expanding stents and determine the lumen loss and residual diameter change dependent on the specific bending radius.

Cell number and transfection volume dependent peptide nucleic acid antisense activity by cationic delivery methods

DEFF Research Database (Denmark)

Llovera Nadal, Laia; Berthold, Peter; Nielsen, Peter E

2012-01-01

have now quantitatively compared the cellular activity (in the pLuc705 HeLa cell splice correction system) of PNA antisense oligomers using lipoplex delivery of cholesterol- and bisphosphonate-PNA conjugates, polyplex delivery via a PNA-polyethyleneimine conjugate and CPP delivery via a PNA......Efficient intracellular delivery is essential for high activity of nucleic acids based therapeutics, including antisense agents. Several strategies have been developed and practically all rely on auxiliary transfection reagents such as cationic lipids, cationic polymers and cell penetrating...... peptides as complexing agents and carriers of the nucleic acids. However, uptake mechanisms remain rather poorly understood, and protocols always require optimization of transfection parameters. Considering that cationic transfection complexes bind to and thus may up-concentrate on the cell surface, we...

An introduction to fuzzy linear programming problems theory, methods and applications

CERN Document Server

Kaur, Jagdeep

2016-01-01

The book presents a snapshot of the state of the art in the field of fully fuzzy linear programming. The main focus is on showing current methods for finding the fuzzy optimal solution of fully fuzzy linear programming problems in which all the parameters and decision variables are represented by non-negative fuzzy numbers. It presents new methods developed by the authors, as well as existing methods developed by others, and their application to real-world problems, including fuzzy transportation problems. Moreover, it compares the outcomes of the different methods and discusses their advantages/disadvantages. As the first work to collect at one place the most important methods for solving fuzzy linear programming problems, the book represents a useful reference guide for students and researchers, providing them with the necessary theoretical and practical knowledge to deal with linear programming problems under uncertainty.

Recent trends in challenges and opportunities of Transdermal drug delivery system

OpenAIRE

P.M.Patil; P.D.Chaudhari; Jalpa K.Patel; K.A.Kedar; P.P.Katolkar

2012-01-01

Drug delivery system relates to the production of a drug, its delivery medium, and the way of administration. Drug delivery systems are even used for administering nitroglycerin. Transdermal drug delivery system is the system in which the delivery of the active ingredients of the drug occurs by the means of skin. Various types of transdermal patches are used. There are various methods to enhance the transdermal drug delivery system. But using microfabricated microneedles drugs are delivered v...

Buccal Transmucosal Delivery System of Enalapril for Improved ...

African Journals Online (AJOL)

Purpose: To prepare and characterize buccal transmucosal delivery system of enalapril maleate for overcoming its low bioavailability, and hence provide improved therapeutic efficacy and patient compliance. Methods: Transmucosal drug delivery systems of enalapril maleate were formulated as buccal films by solvent ...

Step by step parallel programming method for molecular dynamics code

International Nuclear Information System (INIS)

Orii, Shigeo; Ohta, Toshio

1996-07-01

Parallel programming for a numerical simulation program of molecular dynamics is carried out with a step-by-step programming technique using the two phase method. As a result, within the range of a certain computing parameters, it is found to obtain parallel performance by using the level of parallel programming which decomposes the calculation according to indices of do-loops into each processor on the vector parallel computer VPP500 and the scalar parallel computer Paragon. It is also found that VPP500 shows parallel performance in wider range computing parameters. The reason is that the time cost of the program parts, which can not be reduced by the do-loop level of the parallel programming, can be reduced to the negligible level by the vectorization. After that, the time consuming parts of the program are concentrated on less parts that can be accelerated by the do-loop level of the parallel programming. This report shows the step-by-step parallel programming method and the parallel performance of the molecular dynamics code on VPP500 and Paragon. (author)

Challenges and opportunities in dermal/transdermal delivery

Science.gov (United States)

Paudel, Kalpana S; Milewski, Mikolaj; Swadley, Courtney L; Brogden, Nicole K; Ghosh, Priyanka; Stinchcomb, Audra L

2010-01-01

Transdermal drug delivery is an exciting and challenging area. There are numerous transdermal delivery systems currently available on the market. However, the transdermal market still remains limited to a narrow range of drugs. Further advances in transdermal delivery depend on the ability to overcome the challenges faced regarding the permeation and skin irritation of the drug molecules. Emergence of novel techniques for skin permeation enhancement and development of methods to lessen skin irritation would widen the transdermal market for hydrophilic compounds, macromolecules and conventional drugs for new therapeutic indications. As evident from the ongoing clinical trials of a wide variety of drugs for various clinical conditions, there is a great future for transdermal delivery of drugs. PMID:21132122

A pulsed mode electrolytic drug delivery device

International Nuclear Information System (INIS)

Yi, Ying; Foulds, Ian G; Buttner, Ulrich; Carreno, Armando A A; Conchouso, David

2015-01-01

This paper reports the design of a proof-of-concept drug delivery device that is actuated using the bubbles formed during electrolysis. The device uses a platinum (Pt) coated nickel (Ni) metal foam and a solid drug in reservoir (SDR) approach to improve the device’s performance. This electrochemically-driven pump has many features that are unlike conventional drug delivery devices: it is capable of pumping periodically and being refilled automatically; it features drug release control; and it enables targeted delivery. Pt-coated metal foam is used as a catalytic reforming element, which reduces the period of each delivery cycle. Two methods were used for fabricating the Pt-coated metal: sputtering and electroplating. Of these two methods, the sputtered Pt-coated metal foam has a higher pumping rate; it also has a comparable recombination rate when compared to the electroplated Pt-coated metal foam. The only drawback of this catalytic reformer is that it consumes nickel scaffold. Considering long-term applications, the electroplated Pt metal foam was selected for drug delivery, where a controlled drug release rate of 2.2 μg  ±  0.3 μg per actuation pulse was achieved using 4 mW of power. (paper)

Obstetric care and method of delivery in Mexico: results from the 2012 National Health and Nutrition Survey.

Science.gov (United States)

Heredia-Pi, Ileana; Servan-Mori, Edson E; Wirtz, Veronika J; Avila-Burgos, Leticia; Lozano, Rafael

2014-01-01

To identify the current clinical, socio-demographic and obstetric factors associated with the various types of delivery strategies in Mexico. This is a cross-sectional study based on the 2012 National Health and Nutrition Survey (ENSANUT) of 6,736 women aged 12 to 49 years. Delivery types discussed in this paper include vaginal delivery, emergency cesarean section and planned cesarean section. Using bivariate analyses, sub-population group differences were identified. Logistic regression models were applied, including both binary and multinomial outcome variables from the survey. The logistic regression results identify those covariates associated with the type of delivery. 53.1% of institutional births in the period 2006 through 2012 were vaginal deliveries, 46.9% were either a planned or emergency cesarean sections. The highest rates of this procedure were among women who reported a complication during delivery (OR: 4.21; 95%CI: 3.66-4.84), between the ages of 35 and 49 at the time of their last child birth (OR: 2.54; 95%CI: 2.02-3.20) and women receiving care through private healthcare providers during delivery (OR: 2.36; 95%CI: 1.84-3.03). The existence of different socio-demographic and obstetric profiles among women who receive care for vaginal or cesarean delivery, are supported by the findings of the present study. The frequency of vaginal delivery is higher in indigenous women, when the care provider is public and, in women with two or more children at time of the most recent child birth. Planned cesarean deliveries are positively associated with years of schooling, a higher socioeconomic level, and higher age. The occurrence of emergency cesarean sections is elevated in women with a diagnosis of a health issue during pregnancy or delivery, and it is reduced in highly marginalized settings.

Sci—Thur PM: Planning and Delivery — 03: Automated delivery and quality assurance of a modulated electron radiation therapy plan

International Nuclear Information System (INIS)

Connell, T; Papaconstadopoulos, P; Alexander, A; Serban, M; Devic, S; Seuntjens, J

2014-01-01

Modulated electron radiation therapy (MERT) offers the potential to improve healthy tissue sparing through increased dose conformity. Challenges remain, however, in accurate beamlet dose calculation, plan optimization, collimation method and delivery accuracy. In this work, we investigate the accuracy and efficiency of an end-to-end MERT plan and automated-delivery workflow for the electron boost portion of a previously treated whole breast irradiation case. Dose calculations were performed using Monte Carlo methods and beam weights were determined using a research-based treatment planning system capable of inverse optimization. The plan was delivered to radiochromic film placed in a water equivalent phantom for verification, using an automated motorized tertiary collimator. The automated delivery, which covered 4 electron energies, 196 subfields and 6183 total MU was completed in 25.8 minutes, including 6.2 minutes of beam-on time with the remainder of the delivery time spent on collimator leaf motion and the automated interfacing with the accelerator in service mode. The delivery time could be reduced by 5.3 minutes with minor electron collimator modifications and the beam-on time could be reduced by and estimated factor of 2–3 through redesign of the scattering foils. Comparison of the planned and delivered film dose gave 3%/3 mm gamma pass rates of 62.1, 99.8, 97.8, 98.3, and 98.7 percent for the 9, 12, 16, 20 MeV, and combined energy deliveries respectively. Good results were also seen in the delivery verification performed with a MapCHECK 2 device. The results showed that accurate and efficient MERT delivery is possible with current technologies

Calibrated delivery drape versus indirect gravimetric technique for the measurement of blood loss after delivery: a randomized trial.

Science.gov (United States)

Ambardekar, Shubha; Shochet, Tara; Bracken, Hillary; Coyaji, Kurus; Winikoff, Beverly

2014-08-15

Trials of interventions for PPH prevention and treatment rely on different measurement methods for the quantification of blood loss and identification of PPH. This study's objective was to compare measures of blood loss obtained from two different measurement protocols frequently used in studies. Nine hundred women presenting for vaginal delivery were randomized to a direct method (a calibrated delivery drape) or an indirect method (a shallow bedpan placed below the buttocks and weighing the collected blood and blood-soaked gauze/pads). Blood loss was measured from immediately after delivery for at least one hour or until active bleeding stopped. Significantly greater mean blood loss was recorded by the direct than by the indirect measurement technique (253.9 mL and 195.3 mL, respectively; difference = 58.6 mL (95% CI: 31-86); p 500 mL (8.7% vs. 4.7%, p = 0.02). The study suggests a real and significant difference in blood loss measurement between these methods. Research using blood loss measurement as an endpoint needs to be interpreted taking measurement technique into consideration. This study has been registered at clinicaltrials.gov as NCT01885845.

Patient Involvement in Safe Delivery: A Qualitative Study.

Science.gov (United States)

Olfati, Forozun; Asefzadeh, Saeid; Changizi, Nasrin; Keramat, Afsaneh; Yunesian, Masud

2015-09-28

Patient involvement in safe delivery planning is considered important yet not widely practiced. The present study aimed at identifythe factors that affect patient involvementin safe delivery, as recommended by parturient women. This study was part of a qualitative research conducted by content analysis method and purposive sampling in 2013.The data were collected through 63 semi-structured interviews in4 hospitalsand analyzed using thematic content analysis. The participants in this research were women before discharge and after delivery. Findings were analyzed using Colaizzi's method. Four categories of factors that could affect patient involvement in safe delivery emerged from our analysis: patient-related (true and false beliefs, literacy, privacy, respect for patient), illness-related (pain, type of delivery, patient safety incidents), health care professional-relatedand task-related factors (behavior, monitoring &training), health care setting-related (financial aspects, facilities). More research is needed to explore the factors affecting the participation of mothers. It is therefore, recommended to: 1) take notice of mother education, their husbands, midwives and specialists; 2) provide pregnant women with insurance coverage from the outset of pregnancy, especially during prenatal period; 3) form a labor pain committee consisting of midwives, obstetricians, and anesthesiologists in order to identify the preferred painless labor methods based on the existing facilities and conditions, 4) carry out research on observing patients' privacy and dignity; 5) pay more attention on the factors affecting cesarean.

Cesarean deliveries and maternal weight retention.

Science.gov (United States)

Kapinos, Kandice A; Yakusheva, Olga; Weiss, Marianne

2017-10-04

Cesarean delivery accounts for nearly one-third of all births in the U.S. and contributes to an additional $38 billion in healthcare costs each year. Although Cesarean delivery has a long record of improving maternal and neonatal mortality and morbidity, increased utilization over time has yielded public health concerns and calls for reductions. Observational evidence suggests Cesarean delivery is associated with increased maternal postpartum weight, which may have significant implications for the obesity epidemic. Previous literature, however, typically does not address selection biases stemming from correlations of pre-pregnancy weight and reproductive health with Cesarean delivery. We used fetal malpresentation as a natural experiment as it predicts Cesarean delivery but is uncorrelated with pre-pregnancy weight or maternal health. We used hospital administrative data (including fields used in vital birth record) from the state of Wisconsin from 2006 to 2013 to create a sample of mothers with at least two births. Using propensity score methods, we compared maternal weight prior to the second pregnancy of mothers who delivered via Cesarean due to fetal malpresentation to mothers who deliver vaginally. We found no evidence that Cesarean delivery in the first pregnancy causally leads to greater maternal weight, BMI, or movement to a higher BMI classification prior to the second pregnancy. After accounting for correlations between pre-pregnancy weight, gestational weight gain, and mode of delivery, there is no evidence of a causal link between Cesarean delivery and maternal weight retention.

Exploring educational disparities in risk of preterm delivery

DEFF Research Database (Denmark)

Poulsen, Gry; Strandberg-Larsen, Katrine; Mortensen, Laust

2015-01-01

data. METHODS: The study included data from 12 European cohorts from Denmark, England, France, Lithuania, the Netherlands, Norway, Italy, Portugal, and Spain. The cohorts included between 2434 and 99 655 pregnancies. The association between maternal education and preterm delivery (22-36 completed weeks...... characteristics. Nevertheless, there were similar educational differences in risk of preterm delivery in 8 of the 12 cohorts with slope index of inequality varying between 2.2 [95% CI 1.1, 3.3] and 4.0 [95% CI 1.4, 6.6] excess preterm deliveries per 100 singleton deliveries among the educationally most......BACKGROUND: An association between education and preterm delivery has been observed in populations across Europe, but differences in methodology limit comparability. We performed a direct cross-cohort comparison of educational disparities in preterm delivery based on individual-level birth cohort...

MULTI-CRITERIA PROGRAMMING METHODS AND PRODUCTION PLAN OPTIMIZATION PROBLEM SOLVING IN METAL INDUSTRY

OpenAIRE

Tunjo Perić; Željko Mandić

2017-01-01

This paper presents the production plan optimization in the metal industry considered as a multi-criteria programming problem. We first provided the definition of the multi-criteria programming problem and classification of the multicriteria programming methods. Then we applied two multi-criteria programming methods (the STEM method and the PROMETHEE method) in solving a problem of multi-criteria optimization production plan in a company from the metal industry. The obtained resul...

Delivery presentations

Science.gov (United States)

Pregnancy - delivery presentation; Labor - delivery presentation; Occiput posterior; Occiput anterior; Brow presentation ... The mother can walk, rock, and try different delivery positions during labor to help encourage the baby ...

Photoacoustic microscopy imaging for microneedle drug delivery

Science.gov (United States)

Moothanchery, Mohesh; Seeni, Razina Z.; Xu, Chenjie; Pramanik, Manojit

2018-02-01

The recent development of novel transdermal drug delivery systems (TDDS) using microneedle technology allows micron-sized conduits to be formed within the outermost skin layers attracting keen interest in skin as an interface for localized and systemic delivery of therapeutics. In light of this, researchers are using microneedles as tools to deliver nanoparticle formulations to targeted sites for effective therapy. However, in such studies the use of traditional histological methods are employed for characterization and do not allow for the in vivo visualization of drug delivery mechanism. Hence, this study presents a novel imaging technology to characterize microneedle based nanoparticle delivery systems using optical resolution-photoacoustic microscopy (OR-PAM). In this study in vivo transdermal delivery of gold nanoparticles using microneedles in mice ear and the spatial distribution of the nanoparticles in the tissue was successfully illustrated. Characterization of parameters that are relevant in drug delivery studies such as penetration depth, efficiency of delivered gold nanoparticles were monitored using the system. Photoacoustic microscopy proves an ideal tool for the characterization studies of microneedle properties and the studies shows microneedles as an ideal tool for precise and controlled drug delivery.

Next Generation Nuclear Plant Methods Technical Program Plan

Energy Technology Data Exchange (ETDEWEB)

Richard R. Schultz; Abderrafi M. Ougouag; David W. Nigg; Hans D. Gougar; Richard W. Johnson; William K. Terry; Chang H. Oh; Donald W. McEligot; Gary W. Johnsen; Glenn E. McCreery; Woo Y. Yoon; James W. Sterbentz; J. Steve Herring; Temitope A. Taiwo; Thomas Y. C. Wei; William D. Pointer; Won S. Yang; Michael T. Farmer; Hussein S. Khalil; Madeline A. Feltus

2010-12-01

One of the great challenges of designing and licensing the Very High Temperature Reactor (VHTR) is to confirm that the intended VHTR analysis tools can be used confidently to make decisions and to assure all that the reactor systems are safe and meet the performance objectives of the Generation IV Program. The research and development (R&D) projects defined in the Next Generation Nuclear Plant (NGNP) Design Methods Development and Validation Program will ensure that the tools used to perform the required calculations and analyses can be trusted. The Methods R&D tasks are designed to ensure that the calculational envelope of the tools used to analyze the VHTR reactor systems encompasses, or is larger than, the operational and transient envelope of the VHTR itself. The Methods R&D focuses on the development of tools to assess the neutronic and thermal fluid behavior of the plant. The fuel behavior and fission product transport models are discussed in the Advanced Gas Reactor (AGR) program plan. Various stress analysis and mechanical design tools will also need to be developed and validated and will ultimately also be included in the Methods R&D Program Plan. The calculational envelope of the neutronics and thermal-fluids software tools intended to be used on the NGNP is defined by the scenarios and phenomena that these tools can calculate with confidence. The software tools can only be used confidently when the results they produce have been shown to be in reasonable agreement with first-principle results, thought-problems, and data that describe the “highly ranked” phenomena inherent in all operational conditions and important accident scenarios for the VHTR.

MULTI-CRITERIA PROGRAMMING METHODS AND PRODUCTION PLAN OPTIMIZATION PROBLEM SOLVING IN METAL INDUSTRY

Directory of Open Access Journals (Sweden)

Tunjo Perić

2017-09-01

Full Text Available This paper presents the production plan optimization in the metal industry considered as a multi-criteria programming problem. We first provided the definition of the multi-criteria programming problem and classification of the multicriteria programming methods. Then we applied two multi-criteria programming methods (the STEM method and the PROMETHEE method in solving a problem of multi-criteria optimization production plan in a company from the metal industry. The obtained results indicate a high efficiency of the applied methods in solving the problem.

Methods and computer programs for PWR's fuel management: Programs Sothis and Ciclon

International Nuclear Information System (INIS)

Aragones, J.M.; Corella, M.R.; Martinez-Val, J.M.

1976-01-01

Methos and computer programs developed at JEN for fuel management in PWR are discussed, including scope of model, procedures for sistematic selection of alternatives to be evaluated, basis of model for neutronic calculation, methods for fuel costs calculation, procedures for equilibrium and trans[tion cycles calculation with Soth[s and Ciclon codes and validation of methods by comparison of results with others of reference (author) ' [es

From Data to Improved Decisions: Operations Research in Healthcare Delivery.

Science.gov (United States)

Capan, Muge; Khojandi, Anahita; Denton, Brian T; Williams, Kimberly D; Ayer, Turgay; Chhatwal, Jagpreet; Kurt, Murat; Lobo, Jennifer Mason; Roberts, Mark S; Zaric, Greg; Zhang, Shengfan; Schwartz, J Sanford

2017-11-01

The Operations Research Interest Group (ORIG) within the Society of Medical Decision Making (SMDM) is a multidisciplinary interest group of professionals that specializes in taking an analytical approach to medical decision making and healthcare delivery. ORIG is interested in leveraging mathematical methods associated with the field of Operations Research (OR) to obtain data-driven solutions to complex healthcare problems and encourage collaborations across disciplines. This paper introduces OR for the non-expert and draws attention to opportunities where OR can be utilized to facilitate solutions to healthcare problems. Decision making is the process of choosing between possible solutions to a problem with respect to certain metrics. OR concepts can help systematically improve decision making through efficient modeling techniques while accounting for relevant constraints. Depending on the problem, methods that are part of OR (e.g., linear programming, Markov Decision Processes) or methods that are derived from related fields (e.g., regression from statistics) can be incorporated into the solution approach. This paper highlights the characteristics of different OR methods that have been applied to healthcare decision making and provides examples of emerging research opportunities. We illustrate OR applications in healthcare using previous studies, including diagnosis and treatment of diseases, organ transplants, and patient flow decisions. Further, we provide a selection of emerging areas for utilizing OR. There is a timely need to inform practitioners and policy makers of the benefits of using OR techniques in solving healthcare problems. OR methods can support the development of sustainable long-term solutions across disease management, service delivery, and health policies by optimizing the performance of system elements and analyzing their interaction while considering relevant constraints.

Gamma-index method sensitivity for gauging plan delivery accuracy of volumetric modulated arc therapy.

Science.gov (United States)

Park, Jong In; Park, Jong Min; Kim, Jung-In; Park, So-Yeon; Ye, Sung-Joon

2015-12-01

The aim of this study was to investigate the sensitivity of the gamma-index method according to various gamma criteria for volumetric modulated arc therapy (VMAT). Twenty head and neck (HN) and twenty prostate VMAT plans were retrospectively selected for this study. Both global and local 2D gamma evaluations were performed with criteria of 3%/3 mm, 2%/2 mm, 1%/2 mm and 2%/1 mm. In this study, the global and local gamma-index calculated the differences in doses relative to the maximum dose and the dose at the current measurement point, respectively. Using log files acquired during delivery, the differences in parameters at every control point between the VMAT plans and the log files were acquired. The differences in dose-volumetric parameters between reconstructed VMAT plans using the log files and the original VMAT plans were calculated. The Spearman's rank correlation coefficients (rs) were calculated between the passing rates and those differences. Considerable correlations with statistical significances were observed between global 1%/2 mm, local 1%/2 mm and local 2%/1 mm and the MLC position differences (rs = -0.712, -0.628 and -0.581). The numbers of rs values with statistical significance between the passing rates and the changes in dose-volumetric parameters were largest in global 2%/2 mm (n = 16), global 2%/1 mm (n = 15) and local 2%/1 mm (n = 13) criteria. Local gamma-index method with 2%/1 mm generally showed higher sensitivity to detect deviations between a VMAT plan and the delivery of the VMAT plan. Copyright © 2015 Associazione Italiana di Fisica Medica. Published by Elsevier Ltd. All rights reserved.

Modeling foam delivery mechanisms in deep vadose-zone remediation using method of characteristics

Energy Technology Data Exchange (ETDEWEB)

Roostapour, A. [Craft and Hawkins Department of Petroleum Engineering, Louisiana State University, Baton Rouge, LA 70803 (United States); Kam, S.I., E-mail: kam@lsu.edu [Craft and Hawkins Department of Petroleum Engineering, Louisiana State University, Baton Rouge, LA 70803 (United States)

2012-12-15

Highlights: Black-Right-Pointing-Pointer A new mathematical framework established for vadose-zone foam remediation. Black-Right-Pointing-Pointer Graphical solutions presented by Method of Characteristics quantitatively. Black-Right-Pointing-Pointer Effects of design parameters in the field applications thoroughly investigated. Black-Right-Pointing-Pointer Implication of modeling study for successful field treatment discussed. - Abstract: This study investigates foam delivery mechanisms in vadose-zone remediation by using Method of Characteristics (MoC), a mathematical tool long been used for the analysis of miscible and immiscible flooding in porous media in petroleum industry. MoC converts the governing material-balance partial differential equations into a series of ordinary differential equations, and the resulting solutions are in a form of wave propagation (more specifically, for chemical species and phase saturations) through the system as a function of time and space. Deep vadose-zone remediation has special features compared to other conventional remediation applications. They include, not limited to, a high level of heterogeneity, a very dry initial condition with low water saturation (S{sub w}), pollutants such as metals and radionuclides fully dissolved in groundwater, and a serious concern about downward migration during the remediation treatments. For the vadose-zone remediation processes to be successful, the injected aqueous phase should carry chemicals to react with pollutants and precipitate them for immobilization and stabilization purposes. As a result, foams are believed to be an effective means, and understanding foam flow mechanism in situ is a key to the optimal design of field applications. Results show that foam delivery mechanism is indeed very complicated, making the optimum injection condition field-specific. The five major parameters selected (i.e., initial saturation of the medium, injection foam quality, surfactant adsorption, foam

Modeling foam delivery mechanisms in deep vadose-zone remediation using method of characteristics

International Nuclear Information System (INIS)

Roostapour, A.; Kam, S.I.

2012-01-01

Highlights: ► A new mathematical framework established for vadose-zone foam remediation. ► Graphical solutions presented by Method of Characteristics quantitatively. ► Effects of design parameters in the field applications thoroughly investigated. ► Implication of modeling study for successful field treatment discussed. - Abstract: This study investigates foam delivery mechanisms in vadose-zone remediation by using Method of Characteristics (MoC), a mathematical tool long been used for the analysis of miscible and immiscible flooding in porous media in petroleum industry. MoC converts the governing material-balance partial differential equations into a series of ordinary differential equations, and the resulting solutions are in a form of wave propagation (more specifically, for chemical species and phase saturations) through the system as a function of time and space. Deep vadose-zone remediation has special features compared to other conventional remediation applications. They include, not limited to, a high level of heterogeneity, a very dry initial condition with low water saturation (S w ), pollutants such as metals and radionuclides fully dissolved in groundwater, and a serious concern about downward migration during the remediation treatments. For the vadose-zone remediation processes to be successful, the injected aqueous phase should carry chemicals to react with pollutants and precipitate them for immobilization and stabilization purposes. As a result, foams are believed to be an effective means, and understanding foam flow mechanism in situ is a key to the optimal design of field applications. Results show that foam delivery mechanism is indeed very complicated, making the optimum injection condition field-specific. The five major parameters selected (i.e., initial saturation of the medium, injection foam quality, surfactant adsorption, foam strength, and foam stability) are shown to be all important, interacting with each other. Results also

Oromucosal multilayer films for tailor-made, controlled drug delivery.

Science.gov (United States)

Lindert, Sandra; Breitkreutz, Jörg

2017-11-01

The oral mucosa has recently become increasingly important as an alternative administration route for tailor-made, controlled drug delivery. Oromucosal multilayer films, assigned to the monograph oromucosal preparations in the Ph.Eur. may be a promising dosage form to overcome the requirements related to this drug delivery site. Areas covered: We provide an overview of multilayer films as drug delivery tools, and discuss manufacturing processes and characterization methods. We focus on the suitability of characterization methods for particular requirements of multilayer films. A classification was performed covering indication areas and APIs incorporated in multilayer film systems for oromucosal use in order to provide a summary of data published in this field. Expert opinion: The shift in drug development to high molecular weight drugs will influence the field of pharmaceutical development and delivery technologies. For a high number of indication areas, such as hormonal disorders, cardiovascular diseases or local treatment of infections, the flexible layer design of oromucosal multilayer films provides a promising option for tailor-made, controlled delivery of APIs to or through defined surfaces in the oral cavity. However, there is a lack of discriminating or standardized testing methods to assess the quality of multilayer films in a reliable way.

Infection control in delivery care units, Gujarat state, India: A needs assessment

Directory of Open Access Journals (Sweden)

Ramani KV

2011-05-01

Full Text Available Abstract Background Increasingly, women in India attend health facilities for childbirth, partly due to incentives paid under government programs. Increased use of health facilities can alleviate the risks of infections contracted in unhygienic home deliveries, but poor infection control practices in labour and delivery units also cause puerperal sepsis and other infections of childbirth. A needs assessment was conducted to provide information on procedures and practices related to infection control in labour and delivery units in Gujarat state, India. Methods Twenty health care facilities, including private and public primary health centres and referral hospitals, were sampled from two districts in Gujarat state, India. Three pre-tested tools for interviewing and for observation were used. Data collection was based on existing infection control guidelines for clean practices, clean equipment, clean environment and availability of diagnostics and treatment. The study was carried out from April to May 2009. Results Seventy percent of respondents said that standard infection control procedures were followed, but a written procedure was only available in 5% of facilities. Alcohol rubs were not used for hand cleaning and surgical gloves were reused in over 70% of facilities, especially for vaginal examinations in the labour room. Most types of equipment and supplies were available but a third of facilities did not have wash basins with "hands-free" taps. Only 15% of facilities reported that wiping of surfaces was done immediately after each delivery in labour rooms. Blood culture services were available in 25% of facilities and antibiotics are widely given to women after normal delivery. A few facilities had data on infections and reported rates of 3% to 5%. Conclusions This study of current infection control procedures and practices during labour and delivery in health facilities in Gujarat revealed a need for improved information systems

Human resources for health strategies adopted by providers in resource-limited settings to sustain long-term delivery of ART: a mixed-methods study from Uganda.

Science.gov (United States)

Zakumumpa, Henry; Taiwo, Modupe Oladunni; Muganzi, Alex; Ssengooba, Freddie

2016-10-19

Human resources for health (HRH) constraints are a major barrier to the sustainability of antiretroviral therapy (ART) scale-up programs in Sub-Saharan Africa. Many prior approaches to HRH constraints have taken a top-down trend of generalized global strategies and policy guidelines. The objective of the study was to examine the human resources for health strategies adopted by front-line providers in Uganda to sustain ART delivery beyond the initial ART scale-up phase between 2004 and 2009. A two-phase mixed-methods approach was adopted. In the first phase, a survey of a nationally representative sample of health facilities (n = 195) across Uganda was conducted. The second phase involved in-depth interviews (n = 36) with ART clinic managers and staff of 6 of the 195 health facilities purposively selected from the first study phase. Quantitative data was analysed based on descriptive statistics, and qualitative data was analysed by coding and thematic analysis. The identified strategies were categorized into five themes: (1) providing monetary and non-monetary incentives to health workers on busy ART clinic days; (2) workload reduction through spacing ART clinic appointments; (3) adopting training workshops in ART management as a motivation strategy for health workers; (4) adopting non-physician-centred staffing models; and (5) devising ART program leadership styles that enhanced health worker commitment. Facility-level strategies for responding to HRH constraints are feasible and can contribute to efforts to increase country ownership of HIV programs in resource-limited settings. Consideration of the human resources for health strategies identified in the study by ART program planners and managers could enhance the long-term sustainment of ART programs by providers in resource-limited settings.

SU-F-T-540: Comprehensive Fluence Delivery Optimization with Multileaf Collimation

Energy Technology Data Exchange (ETDEWEB)

Weppler, S; Villarreal-Barajas, J [Department of Physics and Astronomy, University of Calgary, Calgary, Alberta (Canada); Department of Medical Physics, Tom Baker Cancer Center, Calgary, Alberta (Canada); McGeachy, P [Department of Medical Physics, CancerCare Manitoba, Winnipeg, Manitoba (Canada); Khan, R [Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO (United States)

2016-06-15

Purpose: Multileaf collimator (MLC) leaf sequencing is performed via commercial black-box implementations, on which a user has limited to no access. We have developed an explicit, generic MLC sequencing model to serve as a tool for future investigations of fluence map optimization, fluence delivery optimization, and rotational collimator delivery methods. Methods: We have developed a novel, comprehensive model to effectively account for a variety of transmission and penumbra effects previously treated on an ad hoc basis in the literature. As the model is capable of quantifying a variety of effects, we utilize the asymmetric leakage intensity across each leaf to deliver fluence maps with pixel size smaller than the narrowest leaf width. Developed using linear programming and mixed integer programming formulations, the model is implemented using state of the art open-source solvers. To demonstrate the versatility of the algorithm, a graphical user interface (GUI) was developed in MATLAB capable of accepting custom leaf specifications and transmission parameters. As a preliminary proof-ofconcept, we have sequenced the leaves of a Varian 120 Leaf Millennium MLC for five prostate cancer patient fields and one head and neck field. Predetermined fluence maps have been processed by data smoothing methods to obtain pixel sizes of 2.5 cm{sup 2}. The quality of output was analyzed using computer simulations. Results: For the prostate fields, an average root mean squared error (RMSE) of 0.82 and gamma (0.5mm/0.5%) of 91.4% were observed compared to RMSE and gamma (0.5mm/0.5%) values of 7.04 and 34.0% when the leakage considerations were omitted. Similar results were observed for the head and neck case. Conclusion: A model to sequence MLC leaves to optimality has been proposed. Future work will involve extensive testing and evaluation of the method on clinical MLCs and comparison with black-box leaf sequencing algorithms currently used by commercial treatment planning systems.

A Service Delivery Model for Addressing Activity and Social Participation Needs of People Living with HIV

Directory of Open Access Journals (Sweden)

Gayle Restall

2017-05-01

Full Text Available Background: Occupational therapy can contribute to the health and well-being of people with human immunodeficiency virus (HIV who are experiencing health consequences of living long term with this disease. However, there are no comprehensive rehabilitation service delivery models to guide this emerging area of practice. The purpose of this study was to obtain critical feedback about a service delivery model to address the activity and social participation needs of people living with HIV. Method: We developed a service delivery model from a synthesis of the literature. Using a qualitative research design, we conducted individual and focus group interviews with 35 informants from diverse backgrounds and involvement in HIV-related research, service provision, and policymaking to provide critical feedback about the model. The interviews were audio-recorded, transcribed verbatim, and analyzed using inductive qualitative methods. Results: The informants identified the strengths and limitations of the model and supports and barriers to its implementation. They highlighted the importance of principle-based services, increasing resources for service navigation, building capacity of rehabilitation services to address the needs of people with HIV, and increasing research and program evaluation targeted to achieving activity and social participation outcomes. Conclusions: The model provides a framework for occupational therapists to design and evaluate services for this population.

[Morbidity among mothers and infants after ambulatory deliveries].

Science.gov (United States)

Kierkegaard, O

1991-07-29

Postpartum early discharge programs are reviewed. Few programs were mandatory and both primi- and multiparae were included. Discharge varied from two to 72 hours after delivery. Nearly all programs had prenatal preparation and all patients had postpartum follow-up at home. Approximately one per cent of the infants were readmitted mostly on account of hyperbilirubinemia and infections, and half as many mothers were readmitted mostly for hemorrhage and endometritis. Infants discharged very early were readmitted more frequently than others. There were no statistical significant difference in mortality or morbidity between mothers or infants in early discharge groups and control groups.

77 FR 48733 - Transitional Program for Covered Business Method Patents-Definitions of Covered Business Method...

Science.gov (United States)

2012-08-14

... Office 37 CFR Part 42 Transitional Program for Covered Business Method Patents--Definitions of Covered... Business Method Patents-- Definitions of Covered Business Method Patent and Technological Invention AGENCY... forth in detail the definitions of the terms ``covered business method patent'' and ``technological...

Factors Affecting Husband Participation in Antenatal Care Attendance and Delivery

Science.gov (United States)

Rumaseuw, R.; Berliana, S. M.; Nursalam, N.; Efendi, F.; Pradanie, R.; Rachmawati, P. D.; Aurizki, G. E.

2018-02-01

The government has implemented several programs to prevent and reduce a mother’s mortality rate by enhancing active role of the family. The most responsible family member on maintaining the pregnancy and delivery process is the husband. The husband must be active to take care of his wife. Active participation of the husband in accompanying his wife during pregnancy and the delivery process is one of the substantial factors, which helps the husband to take decisions related to the health of his wife. This study aimed to identify variables and its trends, which significantly affect a husband’s participation in accompanying his wife during pregnancy and the delivery process. The data used in this study was from an Indonesian Demographic Health Survey 2012. The study used binary logistic regression as the analysis method. The result showed as many as 8,237 husbands accompanied their wife in antenatal care and the delivery process. The significant variables affecting the husband participation are the age of the wife, the education of wife, the education of the husband, the occupational status of the wife and the husband, the number of children, pregnancy status, and residency region. The possibility for a husband to accompany his wife is larger in several factors, such as the wife being between the ages of 21 - 35 years old, a husband who minimally graduated from junior high school, a working husband, as well as a wife, and the number of children less than and equal to two and the expected pregnancy. The government should consider those factors to create policy related women’s health and integrate the factors into various sectors.

Targeted nanodrug delivery systems for the treatment of Tuberculosis

CSIR Research Space (South Africa)

Lemmer, Yolandy

2010-06-01

Full Text Available patient treatment compliance and drug resistance pose a great challenge to TB treatment programs worldwide. To improve the current inadequate therapeutic management of TB, a polymeric anti-TB nanodrug delivery system for anti-TB drugs was developed...

Systems and methods for interpolation-based dynamic programming

KAUST Repository

Rockwood, Alyn

2013-01-03

Embodiments of systems and methods for interpolation-based dynamic programming. In one embodiment, the method includes receiving an object function and a set of constraints associated with the objective function. The method may also include identifying a solution on the objective function corresponding to intersections of the constraints. Additionally, the method may include generating an interpolated surface that is in constant contact with the solution. The method may also include generating a vector field in response to the interpolated surface.

Systems and methods for interpolation-based dynamic programming

KAUST Repository

Rockwood, Alyn

2013-01-01

Embodiments of systems and methods for interpolation-based dynamic programming. In one embodiment, the method includes receiving an object function and a set of constraints associated with the objective function. The method may also include identifying a solution on the objective function corresponding to intersections of the constraints. Additionally, the method may include generating an interpolated surface that is in constant contact with the solution. The method may also include generating a vector field in response to the interpolated surface.

[Unwanted adolescent pregnancy and post-partum utilization of contraceptive methods].

Science.gov (United States)

Núñez-Urquiza, Rosa María; Hernández-Prado, Bernardo; García-Barrios, Cecilia; González, Dolores; Walker, Dylis

2003-01-01

To describe the proportion of unwanted pregnancies among all pregnant adolescents, its association with sociodemographic characteristics, and the use of post-partum contraceptive methods. A cross-sectional study was conducted among 220 women between 13 and 19 years of age, in two semi-urban municipalities of the State of Morelos, Mexico, interviewed between 1992 and 1994. Women were interviewed at home, six to twelve weeks after their delivery date. Women were asked whether they had wanted their last pregnancy, and about knowledge and use of contraceptive methods after delivery. Adolescent pregnancies accounted for 17% of all births registered in these two municipalities. Among all adolescent mother 22.73% reported that their pregnancy had not been wanted. A positive association was found between the lack of access to health services provided by public medical insurance systems (Instituto Mexicano del Seguro Social IMSS and Instituto de Seguridad y Servicios Sociales para los Trabajadores del Estado ISSSTE) and unwanted pregnancy (adjusted OR = 3.03, 95% CI (1.31, 7.) An association was also found between living in an urban community (adjusted OR = 2.16, 95% CI (1.08, 4.33) and an unwanted pregnancy. Among all adolescent mothers, 91.3% were familiar with "the pill" as a contraceptive method; 84.72% knew about the IUD, and 63.68% knew about the condom. However, only 35% of them were actually using an effective contraceptive method six weeks after delivery. No difference in frequency of contraceptive use was found among the adolescent mothers, according to whether they wanted their last pregnancy. Only 43.39% of mothers who delivered at hospitals or health centers were using an effective contraceptive method. These findings suggest that there is a great potential for family planning programs to target adolescents, and that the use of contraceptive methods after delivery should be promoted among adolescent mothers, especially those lacking access to public medical

Feasibility of a knowledge translation CME program: Courriels Cochrane.

Science.gov (United States)

Pluye, Pierre; Grad, Roland; Granikov, Vera; Theriault, Guyléne; Frémont, Pierre; Burnand, Bernard; Mercer, Jay; Marlow, Bernard; Arroll, Bruce; Luconi, Francesca; Légaré, France; Labrecque, Michel; Ladouceur, Roger; Bouthillier, France; Sridhar, Soumya Bindiganavile; Moscovici, Jonathan

2012-01-01

Systematic literature reviews provide best evidence, but are underused by clinicians. Thus, integrating Cochrane reviews into continuing medical education (CME) is challenging. We designed a pilot CME program where summaries of Cochrane reviews (Courriels Cochrane) were disseminated by e-mail. Program participants automatically received CME credit for each Courriel Cochrane they rated. The feasibility of this program is reported (delivery, participation, and participant evaluation). We recruited French-speaking physicians through the Canadian Medical Association. Program delivery and participation were documented. Participants rated the informational value of Courriels Cochrane using the Information Assessment Method (IAM), which documented their reflective learning (relevance, cognitive impact, use for a patient, expected health benefits). IAM responses were aggregated and analyzed. The program was delivered as planned. Thirty Courriels Cochrane were delivered to 985 physicians, and 127 (12.9%) completed at least one IAM questionnaire. Out of 1109 Courriels Cochrane ratings, 973 (87.7%) conta-ined 1 or more types of positive cognitive impact, while 835 (75.3%) were clinically relevant. Participants reported the use of information for a patient and expected health benefits in 595 (53.7%) and 569 (51.3%) ratings, respectively. Program delivery required partnering with 5 organizations. Participants valued Courriels Cochrane. IAM ratings documented their reflective learning. The aggregation of IAM ratings documented 3 levels of CME outcomes: participation, learning, and performance. This evaluation study demonstrates the feasibility of the Courriels Cochrane as an approach to further disseminate Cochrane systematic literature reviews to clinicians and document self-reported knowledge translation associated with Cochrane reviews. Copyright © 2012 The Alliance for Continuing Education in the Health Professions, the Society for Academic Continuing Medical Education, and

ROTAX: a nonlinear optimization program by axes rotation method

International Nuclear Information System (INIS)

Suzuki, Tadakazu

1977-09-01

A nonlinear optimization program employing the axes rotation method has been developed for solving nonlinear problems subject to nonlinear inequality constraints and its stability and convergence efficiency were examined. The axes rotation method is a direct search of the optimum point by rotating the orthogonal coordinate system in a direction giving the minimum objective. The searching direction is rotated freely in multi-dimensional space, so the method is effective for the problems represented with the contours having deep curved valleys. In application of the axes rotation method to the optimization problems subject to nonlinear inequality constraints, an improved version of R.R. Allran and S.E.J. Johnsen's method is used, which deals with a new objective function composed of the original objective and a penalty term to consider the inequality constraints. The program is incorporated in optimization code system SCOOP. (auth.)

Inhalation method for delivery of nanoparticles to the Drosophila respiratory system for toxicity testing

International Nuclear Information System (INIS)

Posgai, Ryan; Ahamed, Maqusood; Hussain, Saber M.; Rowe, John J.; Nielsen, Mark G.

2009-01-01

The growth of the nanotechnology industry and subsequent proliferation of nanoparticle types present the need to rapidly assess nanoparticle toxicity. We present a novel, simple and cost-effective nebulizer-based method to deliver nanoparticles to the Drosophila melanogaster respiratory system, for the purpose of toxicity testing. FluoSpheres (registered) , silver, and CdSe/ZnS nanoparticles of different sizes were effectively aerosolized, showing the system is capable of functioning with a wide range of nanoparticle types and sizes. Red fluorescent CdSe/ZnS nanoparticles were successfully delivered to the fly respiratory system, as visualized by fluorescent microscopy. Silver coated and uncoated nanoparticles were delivered in a toxicity test, and induced Hsp70 expression in flies, confirming the utility of this model in toxicity testing. This is the first method developed capable of such delivery, provides the advantage of the Drosophila health model, and can serve as a link between tissue culture and more expensive mammalian models in a tiered toxicity testing strategy.

Inhalation method for delivery of nanoparticles to the Drosophila respiratory system for toxicity testing

Energy Technology Data Exchange (ETDEWEB)

Posgai, Ryan; Ahamed, Maqusood [Department of Biology, University of Dayton, Dayton, OH, 45469-2320 (United States); Hussain, Saber M. [Applied Biotechnology Branch, Human Effectiveness Directorate Air Force Research Laboratory/RHBP, Wright-Patterson Air Force Base, OH, 45433 (United States); Rowe, John J. [Department of Biology, University of Dayton, Dayton, OH, 45469-2320 (United States); Nielsen, Mark G., E-mail: Mark.Nielsen@notes.udayton.edu [Department of Biology, University of Dayton, Dayton, OH, 45469-2320 (United States)

2009-12-20

The growth of the nanotechnology industry and subsequent proliferation of nanoparticle types present the need to rapidly assess nanoparticle toxicity. We present a novel, simple and cost-effective nebulizer-based method to deliver nanoparticles to the Drosophila melanogaster respiratory system, for the purpose of toxicity testing. FluoSpheres (registered) , silver, and CdSe/ZnS nanoparticles of different sizes were effectively aerosolized, showing the system is capable of functioning with a wide range of nanoparticle types and sizes. Red fluorescent CdSe/ZnS nanoparticles were successfully delivered to the fly respiratory system, as visualized by fluorescent microscopy. Silver coated and uncoated nanoparticles were delivered in a toxicity test, and induced Hsp70 expression in flies, confirming the utility of this model in toxicity testing. This is the first method developed capable of such delivery, provides the advantage of the Drosophila health model, and can serve as a link between tissue culture and more expensive mammalian models in a tiered toxicity testing strategy.

Microemulsion Drug Delivery Systems for Radiopharmacy Studies

Directory of Open Access Journals (Sweden)

Emre Ozgenc

2016-11-01

Full Text Available Microemulsions have been used increasingly for last year’s because of ideal properties like favorable drug delivery, ease of preparation and physical stability. They have been improved the solubility and efficacy of the drug and reduce the side effects. Use of radiolabeled microemulsions plays an alternative role in drug delivery systems by investigating the formation, stability and application of microemulsions in radiopharmacy. Gama scintigraphic method is well recognized for developing and detecting the biodistribution of newly developed drugs or formulation. This review will focus on how radionuclides are able to play role with characterization studies of microemulsion drug delivery systems.

Predictors of maternal mortality in institutional deliveries in Nigeria

African Journals Online (AJOL)

Administrator

Departmentof Emergency Preparedness and Capacity Building, World Health Organization, ... Four-fifths (80.5%) of all deliveries were normal deliveries. ... disorders, and obstructed labour are preventable3. ... also reflects disparities in socio-economic ... characteristics associated with maternal mortality in. Nigeria. Methods.

Preferred Methods of Learning for Nursing Students in an On-Line Degree Program.

Science.gov (United States)

Hampton, Debra; Pearce, Patricia F; Moser, Debra K

Investigators have demonstrated that on-line courses result in effective learning outcomes, but limited information has been published related to preferred teaching strategies. Delivery of on-line courses requires various teaching methods to facilitate interaction between students, content, and technology. The purposes of this study were to understand student teaching/learning preferences in on-line courses to include (a) differences in preferred teaching/learning methods for on-line nursing students across generations and (b) which teaching strategies students found to be most engaging and effective. Participants were recruited from 2 accredited, private school nursing programs (N=944) that admit students from across the United States and deliver courses on-line. Participants provided implied consent, and 217 (23%) students completed the on-line survey. Thirty-two percent of the students were from the Baby Boomer generation (1946-1964), 48% from Generation X (1965-1980), and 20% from the Millennial Generation (born after 1980). The preferred teaching/learning methods for students were videos or narrated PowerPoint presentations, followed by synchronous Adobe Connect educations sessions, assigned journal article reading, and e-mail dialog with the instructor. The top 2 methods identified by participants as the most energizing/engaging and most effective for learning were videos or narrated PowerPoint presentations and case studies. The teaching/learning method least preferred by participants and that was the least energizing/engaging was group collaborative projects with other students; the method that was the least effective for learning was wikis. Baby Boomers and Generation X participants had a significantly greater preference for discussion board (PBaby Boomer and Generation X students and rated on-line games as significantly more energizing/engaging and more effective for learning (PBaby Boomer and Generation X students. In conclusion, the results of this

The Value of Developing a Mixed-Methods Program of Research.

Science.gov (United States)

Simonovich, Shannon

2017-07-01

This article contributes to the discussion of the value of utilizing mixed methodological approaches to conduct nursing research. To this end, the author of this article proposes creating a mixed-methods program of research over time, where both quantitative and qualitative data are collected and analyzed simultaneously, rather than focusing efforts on designing singular mixed-methods studies. A mixed-methods program of research would allow for the best of both worlds: precision through focus on one method at a time, and the benefits of creating a robust understanding of a phenomenon over the trajectory of one's career through examination from various methodological approaches.

Chitosan-Based Nanoparticles for Mucosal Delivery of RNAi Therapeutics

DEFF Research Database (Denmark)

Martirosyan, Alina; Olesen, Morten Jarlstad; Howard, Kenneth A.

2014-01-01

of the polysaccharide chitosan have been used to facilitate delivery of siRNA across mucosal surfaces following local administration. This chapter describes the mucosal barriers that need to be addressed in order to design an effective mucosal delivery strategy and the utilization of the mucoadhesive properties...... of chitosan. Focus is given to preparation methods and the preclinical application of chitosan nanoparticles for respiratory and oral delivery of siRNA....

SU-E-T-442: Sensitivity of Quality Assurance Tools to Delivery Errors On a Magnetic Resonance-Imaging Guided Radiation Therapy (MR-IGRT) System

International Nuclear Information System (INIS)

Rodriguez, V; Li, H; Yang, D; Kashani, R; Wooten, H; Mutic, S; Green, O; Dempsey, J

2014-01-01

Purpose: To test the sensitivity of the quality assurance (QA) tools actively used on a clinical MR-IGRT system for potential delivery errors. Methods: Patient-specific QA procedures have been implemented for a commercially available Cobalt-60 MR-IGRT system. The QA tools utilized were a MR-compatible cylindrical diode-array detector (ArcCHECK) with a custom insert which positions an ionization chamber (Exradin A18) in the middle of the device, as well as an in-house treatment delivery verification program. These tools were tested to investigate their sensitivity to delivery errors. For the ArcCHECK and ion chamber, a baseline was established with a static field irradiation to a known dose. Variations of the baseline were investigated which included rotated gantry, altered field size, directional shifts, and different delivery time. In addition, similar variations were tested with the automated delivery verification program that compared the treatment parameters in the machine delivery logs to the ones in the plan. To test the software, a 3-field conformal plan was generated as the baseline. Results: ArcCHECK noted at least a 13% decrease in passing rate from baseline in the following scenarios: gantry rotation of 1 degree from plan, 5mm change in field size, 2mm lateral shift, and delivery time decrease. Ion chamber measurements remained consistent for these variations except for the 5 second decrease in delivery time scenario which resulted in an 8% difference from baseline. The delivery verification software was able to detect and report the simulated errors such as when the gantry was rotated by 0.6 degrees, the beam weighting was changed by a percent, a single multileaf collimator was moved by 1cm, and the dose was changed from 2 to 1.8Gy. Conclusion: The results show that the current tools used for patient specific QA are capable of detecting small errors in RT delivery with presence of magnetic field

Implementing the LifeSkills Training drug prevention program: factors related to implementation fidelity.

Science.gov (United States)

Mihalic, Sharon F; Fagan, Abigail A; Argamaso, Susanne

2008-01-18

Widespread replication of effective prevention programs is unlikely to affect the incidence of adolescent delinquency, violent crime, and substance use until the quality of implementation of these programs by community-based organizations can be assured. This paper presents the results of a process evaluation employing qualitative and quantitative methods to assess the extent to which 432 schools in 105 sites implemented the LifeSkills Training (LST) drug prevention program with fidelity. Regression analysis was used to examine factors influencing four dimensions of fidelity: adherence, dosage, quality of delivery, and student responsiveness. Although most sites faced common barriers, such as finding room in the school schedule for the program, gaining full support from key participants (i.e., site coordinators, principals, and LST teachers), ensuring teacher participation in training workshops, and classroom management difficulties, most schools involved in the project implemented LST with very high levels of fidelity. Across sites, 86% of program objectives and activities required in the three-year curriculum were delivered to students. Moreover, teachers were observed using all four recommended teaching practices, and 71% of instructors taught all the required LST lessons. Multivariate analyses found that highly rated LST program characteristics and better student behavior were significantly related to a greater proportion of material taught by teachers (adherence). Instructors who rated the LST program characteristics as ideal were more likely to teach all lessons (dosage). Student behavior and use of interactive teaching techniques (quality of delivery) were positively related. No variables were related to student participation (student responsiveness). Although difficult, high implementation fidelity by community-based organizations can be achieved. This study suggests some important factors that organizations should consider to ensure fidelity, such as

Transdermal drug delivery

Science.gov (United States)

Prausnitz, Mark R.; Langer, Robert

2009-01-01

Transdermal drug delivery has made an important contribution to medical practice, but has yet to fully achieve its potential as an alternative to oral delivery and hypodermic injections. First-generation transdermal delivery systems have continued their steady increase in clinical use for delivery of small, lipophilic, low-dose drugs. Second-generation delivery systems using chemical enhancers, non-cavitational ultrasound and iontophoresis have also resulted in clinical products; the ability of iontophoresis to control delivery rates in real time provides added functionality. Third-generation delivery systems target their effects to skin’s barrier layer of stratum corneum using microneedles, thermal ablation, microdermabrasion, electroporation and cavitational ultrasound. Microneedles and thermal ablation are currently progressing through clinical trials for delivery of macromolecules and vaccines, such as insulin, parathyroid hormone and influenza vaccine. Using these novel second- and third-generation enhancement strategies, transdermal delivery is poised to significantly increase impact on medicine. PMID:18997767

The impact of treatment complexity and computer-control delivery technology on treatment delivery errors

International Nuclear Information System (INIS)

Fraass, Benedick A.; Lash, Kathy L.; Matrone, Gwynne M.; Volkman, Susan K.; McShan, Daniel L.; Kessler, Marc L.; Lichter, Allen S.

1998-01-01

Purpose: To analyze treatment delivery errors for three-dimensional (3D) conformal therapy performed at various levels of treatment delivery automation and complexity, ranging from manual field setup to virtually complete computer-controlled treatment delivery using a computer-controlled conformal radiotherapy system (CCRS). Methods and Materials: All treatment delivery errors which occurred in our department during a 15-month period were analyzed. Approximately 34,000 treatment sessions (114,000 individual treatment segments [ports]) on four treatment machines were studied. All treatment delivery errors logged by treatment therapists or quality assurance reviews (152 in all) were analyzed. Machines 'M1' and 'M2' were operated in a standard manual setup mode, with no record and verify system (R/V). MLC machines 'M3' and 'M4' treated patients under the control of the CCRS system, which (1) downloads the treatment delivery plan from the planning system; (2) performs some (or all) of the machine set up and treatment delivery for each field; (3) monitors treatment delivery; (4) records all treatment parameters; and (5) notes exceptions to the electronically-prescribed plan. Complete external computer control is not available on M3; therefore, it uses as many CCRS features as possible, while M4 operates completely under CCRS control and performs semi-automated and automated multi-segment intensity modulated treatments. Analysis of treatment complexity was based on numbers of fields, individual segments, nonaxial and noncoplanar plans, multisegment intensity modulation, and pseudoisocentric treatments studied for a 6-month period (505 patients) concurrent with the period in which the delivery errors were obtained. Treatment delivery time was obtained from the computerized scheduling system (for manual treatments) or from CCRS system logs. Treatment therapists rotate among the machines; therefore, this analysis does not depend on fixed therapist staff on particular

Preparation of Starch/Gelatin Blend Microparticles by a Water-in-Oil Emulsion Method for Controlled Release Drug Delivery

OpenAIRE

Phromsopha, Theeraphol; Baimark, Yodthong

2014-01-01

Information on the preparation and properties of starch/gelatin blend microparticles with and without crosslinking for drug delivery is presented. The blend microparticles were prepared by the water-in-oil emulsion solvent diffusion method. Glutaraldehyde and methylene blue were used as the crosslinker and the water-soluble drug model, respectively. The blend microparticles were characterized by scanning electron microscopy (SEM), Fourier transform infrared (FTIR) spectroscopy, and UV-Vis spe...

Evaluation of a cross-sector community initiative partnership: delivering a local sport program.

Science.gov (United States)

Kihl, Lisa A; Tainsky, Scott; Babiak, Kathy; Bang, Hyejin

2014-06-01

Corporate community initiatives (CCI) are often established via cross-sector partnerships with nonprofit agencies to address critical social problems. While there is a growing body of literature exploring the effectiveness and social impact of these partnerships, there is a limited evaluative research on the implementation and execution processes of CCIs. In this paper, we examined the implementation and operational processes in the delivery of a professional sport organization's CCI initiative using program theory evaluation. The findings showed discrepancies between the associate organization and the implementers regarding understanding and fulfilling responsibilities with performing certain aspects (maintaining accurate records and program marketing) of the service delivery protocol. Despite program stakeholders being satisfied overall with the program delivery, contradictions between program stakeholders' satisfaction in the quality of program delivery was found in critical components (marketing and communications) of the service delivery. We conclude that ongoing evaluations are necessary to pinpoint the catalyst of the discrepancies along with all partners valuing process evaluation in addition to outcome evaluation. Copyright © 2014 Elsevier Ltd. All rights reserved.

Providing an address for delivery of nanoencapsulated TB drugs

CSIR Research Space (South Africa)

Lemmer, Yolandy

2010-06-01

Full Text Available compliance and drug resistance pose a great challenge to TB treatment programs worldwide. To improve the current inadequate therapeutic management of TB, a polymeric anti-TB nanodrug delivery system, for anti-TB drugs, was developed that could enable entry...

Program for searching for semiempirical parameters by the MNDO method

International Nuclear Information System (INIS)

Bliznyuk, A.A.; Voityuk, A.A.

1987-01-01

The authors describe an program for optimizing atomic models constructed using the MNDO method which varies not only the parameters but also the scope for simple changes in the calculation scheme. The target function determines properties such as formation enthalpies, dipole moments, ionization potentials, and geometrical parameters. Software used to minimize the target function is based on the simplex method on the Nelder-Mead algorithm and on the Fletcher variable-metric method. The program is written in FORTRAN IV and implemented on the ES computer

Mathematical programming methods for large-scale topology optimization problems

DEFF Research Database (Denmark)

Rojas Labanda, Susana

for mechanical problems, but has rapidly extended to many other disciplines, such as fluid dynamics and biomechanical problems. However, the novelty and improvements of optimization methods has been very limited. It is, indeed, necessary to develop of new optimization methods to improve the final designs......, and at the same time, reduce the number of function evaluations. Nonlinear optimization methods, such as sequential quadratic programming and interior point solvers, have almost not been embraced by the topology optimization community. Thus, this work is focused on the introduction of this kind of second...... for the classical minimum compliance problem. Two of the state-of-the-art optimization algorithms are investigated and implemented for this structural topology optimization problem. A Sequential Quadratic Programming (TopSQP) and an interior point method (TopIP) are developed exploiting the specific mathematical...

Application of Fused Deposition Modelling (FDM) Method of 3D Printing in Drug Delivery.

Science.gov (United States)

Long, Jingjunjiao; Gholizadeh, Hamideh; Lu, Jun; Bunt, Craig; Seyfoddin, Ali

2017-01-01

Three-dimensional (3D) printing is an emerging manufacturing technology for biomedical and pharmaceutical applications. Fused deposition modelling (FDM) is a low cost extrusion-based 3D printing technique that can deposit materials layer-by-layer to create solid geometries. This review article aims to provide an overview of FDM based 3D printing application in developing new drug delivery systems. The principle methodology, suitable polymers and important parameters in FDM technology and its applications in fabrication of personalised tablets and drug delivery devices are discussed in this review. FDM based 3D printing is a novel and versatile manufacturing technique for creating customised drug delivery devices that contain accurate dose of medicine( s) and provide controlled drug released profiles. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

Place of Delivery Associated With Postnatal Care Utilization Among Childbearing Women in Zambia

Directory of Open Access Journals (Sweden)

Charles Chungu

2018-04-01

Full Text Available ObjectivePostnatal care (PNC utilization is critical to the prevention of maternal morbidity and mortality. Despite its importance, the proportion of women utilizing this service is still low in Zambia. We investigated if place of delivery was associated with PNC utilization in the first 48 h among childbearing women in Zambia.MethodsData from the 2013/14 Zambia Demographic and Health Survey for women, aged 15–49 years, who reported giving birth in the 2 years preceding the survey was used. The data comprised of sociodemographic and other obstetric data, which were cleaned, recoded, and analyzed using STATA version 13 (Stata Corporation, College Station, TX, USA. Multivariate logistic regression was used to examine the association of place of delivery and other background variables.ResultsWomen who delivered in a health facility were more likely to utilize PNC in the first 48 h compared to those who did not deliver in a health facility: government hospital (AOR 7.24, 95% CI 4.92–11.84, government health center/clinic (AOR 7.15 95% CI 4.79–10.66, other public sector (AOR 23.2 95% CI 3.69–145.91, private hospital/clinic (AOR 10.08 95% CI 3.35–30.35, and Mission hospital/clinic (AOR 8.56 95% CI 4.71–15.53. Additionally, women who were attended to by a skilled personnel during delivery of the baby were more likely to utilize PNC (AOR 2.30, 95% CI 1.57–3.37. Women from rural areas were less likely to utilize PNC in the first 48 h (AOR 0.70, 95% CI 0.53–0.90.ConclusionPlace of delivery was found to be linked with PNC utilization in this population although access to health care is still driven by inequity-related dynamics and imbalances. Given that inequity stresses are heaviest in the rural and poor groups, interventions should aim to reach this group.SignificanceThe study results will help program managers to increase access to health facility delivery and direct interventional efforts toward the affected subpopulations

Dissolving and biodegradable microneedle technologies for transdermal sustained delivery of drug and vaccine

Science.gov (United States)

Hong, Xiaoyun; Wei, Liangming; Wu, Fei; Wu, Zaozhan; Chen, Lizhu; Liu, Zhenguo; Yuan, Weien

2013-01-01

Microneedles were first conceptualized for drug delivery many decades ago, overcoming the shortages and preserving the advantages of hypodermic needle and conventional transdermal drug-delivery systems to some extent. Dissolving and biodegradable microneedle technologies have been used for transdermal sustained deliveries of different drugs and vaccines. This review describes microneedle geometry and the representative dissolving and biodegradable microneedle delivery methods via the skin, followed by the fabricating methods. Finally, this review puts forward some perspectives that require further investigation. PMID:24039404

New Jersey's residential radon remediation program - methods and experience

International Nuclear Information System (INIS)

Pluta, T.A.; Cosolita, F.J.; Rothfuss, E.

1986-01-01

As part of a remedial action program to decontaminate over 200 residential properties, 12 typical properties were selected and a demonstration program was initiated in the spring of 1985. The residences selected represented a range of contamination levels and configurations and differing architectural styles representative of the age of construction. The physical limitations of the sites and the overall nature of a decontamination project in active residential communities imposed a number of severe restrictions on work methods and equipment. Regulations governing transportation and disposal set virtually zero defect standards for the condition of containers. The intrusive nature of the work in residential neighborhoods required continual interaction with local residents, public officials and citizen task forces. Media coverage was very high. Numerous briefings were held to allay fears and promote public understanding. Numerous issues ranging in content from public health and safety to engineering and construction methods arose during the remedial action program. These issues were resolved by a multi-disciplined management team which was knowledgeable in public administration, radiation physics, and engineering design and construction. This paper discusses the nature of the problem, the methods applied to resolve the problem and the experience gained as a result of a remedial action program

Retention of Vaginal Breech Delivery Skills Taught in Simulation.

Science.gov (United States)

Stone, Heather; Crane, Joan; Johnston, Kathy; Craig, Catherine

2018-02-01

The optimal frequency of conducting simulation training for high-acuity, low-frequency events in obstetrics and gynaecology residency programs is unknown. This study evaluated retention over time of vaginal breech delivery skills taught in simulation, by comparing junior and senior residents. In addition, the residents' subjective comfort level to perform this skill clinically was assessed. This prospective cohort study included 22 obstetrics and gynaecology residents in a Canadian residency training program. Digital recordings were completed for pre-training, immediate post-training, and delayed (10-26 weeks later) post-training intervals of a vaginal breech delivery simulation, with skill assessment by a blinded observer using a binary checklist. Residents also completed questionnaires to assess their subjective comfort level at each interval. Junior and senior residents had significant improvements in vaginal breech delivery skills from the pre-training assessment to both the immediate post-training assessment (junior, P simulation 10-26 weeks later, although a decline in skills occurred over this time period. Comfort level was positively affected and retained. These results will aid in determining the frequency of simulation teaching for high-acuity, low-frequency events in a residency simulation curriculum. Copyright © 2018 Society of Obstetricians and Gynaecologists of Canada. Published by Elsevier Inc. All rights reserved.

Assisted Vaginal Delivery

Science.gov (United States)

... Education & Events Advocacy For Patients About ACOG Assisted Vaginal Delivery Home For Patients Search FAQs Assisted Vaginal ... Vaginal Delivery FAQ192, February 2016 PDF Format Assisted Vaginal Delivery Labor, Delivery, and Postpartum Care What is ...

Self–Evaluation of Distance Learning Study Program as a Part of Internal Quality Assurance

Directory of Open Access Journals (Sweden)

Radojka Krneta

2012-02-01

Full Text Available This paper features quality assurance of specific distance learning master study program through self-evaluation. This unique program involving e-learning as the program content, as well as delivery method, is presented in the paper from the aspects of its quality assurance. Student evaluation of this study program as a part of the internal quality assurance is performed at the end of every school year in the aim of its quality assurance. Results and conclusions of self-evaluation conducted in this school year by known SEVAQ+ evaluation tool are presented here.

Graduate Student Services: A Study of the Delivery of Services at the Location Where Students Matriculate

Science.gov (United States)

Burlison, John G.

2010-01-01

This dissertation investigates and explores the best method for the delivery of graduate student services. Essentially, there are two methods for delivery of these services. They can be delivered by virtue of centralization or decentralization. Decentralized delivery, for the purpose of this dissertation is the delivery of graduate student…

Pattern of Institutional delivery in Dadeldhura district of Nepal: A cross-sectional study

Directory of Open Access Journals (Sweden)

Damaru Prasad Paneru

2014-01-01

Full Text Available Background: Maternal mortality ratio of Nepal is one of the highest (380/100000 live births among the South East Asian countries, where majority of the births take place at home without the assistance of skilled attendant. Latest estimates revealed that only 36.0% births were attended by skilled attendants in Nepal. Objective: To examine the pattern of institutional deliveries among the mothers in Dadeldhura District of Nepal. Materials and Methods: A community-based cross-sectional quantitative study was conducted in Dadeldhura district during October 2012 to March 2013 among 516 mothers who delivered within last 1 year. In addition, 3 years records of District Health Office, Dadeldhura were reviewed. Data were collected by trained enumerators through face to face interview using structured interview schedule. Data were analyzed by SPSS (17.0 versions. Percentage, mean, median, standard deviation, and range were calculated. Results: Mean age of the participants was 24.76 ± 3.77 years. The combined proportion of Dalit and Chhetri was 82.8%. About 17.6% participants were illiterates and 81.6% agriculture workers. About 95% had done one time antenatal care (ANC visit, while only 64.8% had four time ANC visits during index pregnancy. Majority (82.2% had received ANC services from primary level health facilities. Almost 77.3% had institutional delivery; among them 59.6% delivered at primary level health facilities. About two-third went to facility on foot, where 45.4% accessed delivery care from a health facility with an approximate distance of >5 km. Almost 55.0% had knowledge of at least one complication occurring during delivery and 74.0% were known about the safe delivery incentive program. Conclusions: Institutional delivery rate was good (77.3% as against national average (37.0%. Majority (59.6% had delivery at primary level health facilities. Three quarters were known about Safe Delivery Incentive Programme. Strengthening the capacity of

Interior Point Methods for Large-Scale Nonlinear Programming

Czech Academy of Sciences Publication Activity Database

Lukšan, Ladislav; Matonoha, Ctirad; Vlček, Jan

2005-01-01

Roč. 20, č. 4-5 (2005), s. 569-582 ISSN 1055-6788 R&D Projects: GA AV ČR IAA1030405 Institutional research plan: CEZ:AV0Z10300504 Keywords : nonlinear programming * interior point methods * KKT systems * indefinite preconditioners * filter methods * algorithms Subject RIV: BA - General Mathematics Impact factor: 0.477, year: 2005

Bioengineered microparticles for controlled drug delivery to the lungs

OpenAIRE

Sivadas, Neeraj

2010-01-01

Traditional formulations for pulmonary drug delivery mainly focused on two approaches: (i) Dissolving or suspending the drug in a solvent or propellant to produce liquid aerosols or (ii) Blending drug particulates with dry carrier particles typically composed of sugars. Although effective for localised delivery of small drug molecules, these methods did not meet the complex formulation and delivery challenges posed by the newer biotechnology-derived medicines. One of the many avenues being ex...

The Ontario Mother and Infant Study (TOMIS III: A multi-site cohort study of the impact of delivery method on health, service use, and costs of care in the first postpartum year

Directory of Open Access Journals (Sweden)

Landy Christine

2009-04-01

Full Text Available Abstract Background The caesarean section rate continues to rise globally. A caesarean section is inarguably the preferred method of delivery when there is good evidence that a vaginal delivery may unduly risk the health of a woman or her infant. Any decisions about delivery method in the absence of clear medical indication should be based on knowledge of outcomes associated with different childbirth methods. However, there is lack of sold evidence of the short-term and long-term risks and benefits of a planned caesarean delivery compared to a planned vaginal delivery. It also is important to consider the economic aspects of caesarean sections, but very little attention has been given to health care system costs that take into account services used by women for themselves and their infants following hospital discharge. Methods and design The Ontario Mother and Infant Study III is a prospective cohort study to examine relationships between method of delivery and maternal and infant health, service utilization, and cost of care at three time points during the year following postpartum hospital discharge. Over 2500 women were recruited from 11 hospitals across the province of Ontario, Canada, with data collection occurring between April 2006 and October 2008. Participants completed a self-report questionnaire in hospital and structured telephone interviews at 6 weeks, 6 months, and 12 months after discharge. Data will be analyzed using generalized estimating equation, a special generalized linear models technique. A qualitative descriptive component supplements the survey approach, with the goal of assisting in interpretation of data and providing explanations for trends in the findings. Discussion The findings can be incorporated into patient counselling and discussions about the advantages and disadvantages of different delivery methods, potentially leading to changes in preferences and practices. In addition, the findings will be useful to

Numerical methods of mathematical optimization with Algol and Fortran programs

CERN Document Server

Künzi, Hans P; Zehnder, C A; Rheinboldt, Werner

1971-01-01

Numerical Methods of Mathematical Optimization: With ALGOL and FORTRAN Programs reviews the theory and the practical application of the numerical methods of mathematical optimization. An ALGOL and a FORTRAN program was developed for each one of the algorithms described in the theoretical section. This should result in easy access to the application of the different optimization methods.Comprised of four chapters, this volume begins with a discussion on the theory of linear and nonlinear optimization, with the main stress on an easily understood, mathematically precise presentation. In addition

Control system and method for a power delivery system having a continuously variable ratio transmission

Science.gov (United States)

Frank, Andrew A.

1984-01-01

A control system and method for a power delivery system, such as in an automotive vehicle, having an engine coupled to a continuously variable ratio transmission (CVT). Totally independent control of engine and transmission enable the engine to precisely follow a desired operating characteristic, such as the ideal operating line for minimum fuel consumption. CVT ratio is controlled as a function of commanded power or torque and measured load, while engine fuel requirements (e.g., throttle position) are strictly a function of measured engine speed. Fuel requirements are therefore precisely adjusted in accordance with the ideal characteristic for any load placed on the engine.

Path Following in the Exact Penalty Method of Convex Programming.

Science.gov (United States)

Zhou, Hua; Lange, Kenneth

2015-07-01

Classical penalty methods solve a sequence of unconstrained problems that put greater and greater stress on meeting the constraints. In the limit as the penalty constant tends to ∞, one recovers the constrained solution. In the exact penalty method, squared penalties are replaced by absolute value penalties, and the solution is recovered for a finite value of the penalty constant. In practice, the kinks in the penalty and the unknown magnitude of the penalty constant prevent wide application of the exact penalty method in nonlinear programming. In this article, we examine a strategy of path following consistent with the exact penalty method. Instead of performing optimization at a single penalty constant, we trace the solution as a continuous function of the penalty constant. Thus, path following starts at the unconstrained solution and follows the solution path as the penalty constant increases. In the process, the solution path hits, slides along, and exits from the various constraints. For quadratic programming, the solution path is piecewise linear and takes large jumps from constraint to constraint. For a general convex program, the solution path is piecewise smooth, and path following operates by numerically solving an ordinary differential equation segment by segment. Our diverse applications to a) projection onto a convex set, b) nonnegative least squares, c) quadratically constrained quadratic programming, d) geometric programming, and e) semidefinite programming illustrate the mechanics and potential of path following. The final detour to image denoising demonstrates the relevance of path following to regularized estimation in inverse problems. In regularized estimation, one follows the solution path as the penalty constant decreases from a large value.

Self-nanoemulsifying drug delivery systems for oral insulin delivery

DEFF Research Database (Denmark)

Li, Ping; Tan, Angel; Prestidge, Clive A

2014-01-01

This study aims at evaluating the combination of self-nanoemulsifying drug delivery systems (SNEDDS) and enteric-coated capsules as a potential delivery strategy for oral delivery of insulin. The SNEDDS preconcentrates, loaded with insulin-phospholipid complex at different levels (0, 2.5 and 10% w...

Preparation of Starch/Gelatin Blend Microparticles by a Water-in-Oil Emulsion Method for Controlled Release Drug Delivery.

Science.gov (United States)

Phromsopha, Theeraphol; Baimark, Yodthong

2014-01-01

Information on the preparation and properties of starch/gelatin blend microparticles with and without crosslinking for drug delivery is presented. The blend microparticles were prepared by the water-in-oil emulsion solvent diffusion method. Glutaraldehyde and methylene blue were used as the crosslinker and the water-soluble drug model, respectively. The blend microparticles were characterized by scanning electron microscopy (SEM), Fourier transform infrared (FTIR) spectroscopy, and UV-Vis spectroscopy. The functional groups of the starch and gelatin blend matrices were determined from the FTIR spectra. Blend microparticles with a nearly spherical shape and internal porous structure were observed from SEM images. The average particle size of the gelatin microparticles depended on the crosslinker ratio but not on the starch/gelatin blend ratio. The in vitro drug release content significantly decreased as the crosslinker ratio increased and the starch blend ratio decreased. The results demonstrated that the starch/gelatin blend microparticles should be a useful controlled release delivery carrier for water-soluble drugs.

Effective and efficient implementation of alternative project delivery : research summary.

Science.gov (United States)

2017-05-01

Alternative project delivery (APD) methods such as Design Build (DB) and Construction Manager at Risk (CMAR), are used by state departments of transportation to improve the efficiency and effectiveness of project delivery. The Maryland Department of ...

A mathematical method for boiling water reactor control rod programming

International Nuclear Information System (INIS)

Tokumasu, S.; Hiranuma, H.; Ozawa, M.; Yokomi, M.

1985-01-01

A new mathematical programming method has been developed and utilized in OPROD, an existing computer code for automatic generation of control rod programs as an alternative inner-loop routine for the method of approximate programming. The new routine is constructed of a dual feasible direction algorithm, and consists essentially of two stages of iterative optimization procedures Optimization Procedures I and II. Both follow almost the same algorithm; Optimization Procedure I searches for feasible solutions and Optimization Procedure II optimizes the objective function. Optimization theory and computer simulations have demonstrated that the new routine could find optimum solutions, even if deteriorated initial control rod patterns were given

Transdermal drug delivery

OpenAIRE

Prausnitz, Mark R.; Langer, Robert

2008-01-01

Transdermal drug delivery has made an important contribution to medical practice, but has yet to fully achieve its potential as an alternative to oral delivery and hypodermic injections. First-generation transdermal delivery systems have continued their steady increase in clinical use for delivery of small, lipophilic, low-dose drugs. Second-generation delivery systems using chemical enhancers, non-cavitational ultrasound and iontophoresis have also resulted in clinical products; the ability ...

Thiolated polymers as mucoadhesive drug delivery systems.

Science.gov (United States)

Duggan, Sarah; Cummins, Wayne; O' Donovan, Orla; Hughes, Helen; Owens, Eleanor

2017-03-30

Mucoadhesion is the process of binding a material to the mucosal layer of the body. Utilising both natural and synthetic polymers, mucoadhesive drug delivery is a method of controlled drug release which allows for intimate contact between the polymer and a target tissue. It has the potential to increase bioavailability, decrease potential side effects and offer protection to more sensitive drugs such as proteins and peptide based drugs. The thiolation of polymers has, in the last number of years, come to the fore of mucoadhesive drug delivery, markedly improving mucoadhesion due to the introduction of free thiol groups onto the polymer backbone while also offering a more cohesive polymeric matrix for the slower and more controlled release of drug. This review explores the concept of mucoadhesion and the recent advances in both the polymers and the methods of thiolation used in the synthesis of mucoadhesive drug delivery devices. Copyright © 2017 Elsevier B.V. All rights reserved.

Comparative Study of Various Delivery Methods for the Supply of Alpha-Ketoglutarate to the Neural Cells for Tissue Engineering

Directory of Open Access Journals (Sweden)

Tanushree Vishnoi

2013-01-01

Full Text Available Delivery of growth factors or bioactive molecules plays an important role in tissue engineering, as the duration to which these are supplied can modulate the cell fate. Thus, the delivery method plays an important role, and the same is presented in this work wherein the exogenous supply of alpha-ketoglutarate (α-KG gave better results for fast proliferating cells as compared to delivery by microspheres or microspheres incorporated scaffolds which can be used while culturing slow growing cells. All these studies were performed in two dimensional (2D and three dimensional (3D setups in which chitosan-gelatin-polypyrrole has been used as 3-D scaffolds. Chitosan and gelatin microspheres alone as well as incorporated in the cryogels were characterized. MTT assay done using neuro-2a cell line showed approximately 42% and 70% increment in cellular proliferation when gelatin and chitosan microspheres were added in a 3-D setup, respectively, as compared to the control. Biochemical analysis of ammonia showed 6-fold reductions in ammonia level in a 3-D setup compared to the control. We also studied the synthesis of a neurotransmitter-like glutamate and found that its concentration increased up to 0.25 mg/ml when the microspheres were added exogenously in a 3-D system.

Dynamic Programming Approaches for the Traveling Salesman Problem with Drone

OpenAIRE

Bouman, Paul; Agatz, Niels; Schmidt, Marie

2017-01-01

markdownabstractA promising new delivery model involves the use of a delivery truck that collaborates with a drone to make deliveries. Effectively combining a drone and a truck gives rise to a new planning problem that is known as the Traveling Salesman Problem with Drone (TSP-D). This paper presents an exact solution approach for the TSP-D based on dynamic programming and present experimental results of different dynamic programming based heuristics. Our numerical experiments show that our a...

Sustained subconjunctival protein delivery using a thermosetting gel delivery system.

Science.gov (United States)

Rieke, Erin R; Amaral, Juan; Becerra, S Patricia; Lutz, Robert J

2010-02-01

An effective treatment modality for posterior eye diseases would provide prolonged delivery of therapeutic agents, including macromolecules, to eye tissues using a safe and minimally invasive method. The goal of this study was to assess the ability of a thermosetting gel to deliver a fluorescently labeled protein, Alexa 647 ovalbumin, to the choroid and retina of rats following a single subconjunctival injection of the gel. Additional experiments were performed to compare in vitro to in vivo ovalbumin release rates from the gel. The ovalbumin content of the eye tissues was monitored by spectrophotometric assays of tissue extracts of Alexa 647 ovalbumin from dissected sclera, choroid, and retina at time points ranging from 2 h to 14 days. At the same time points, fluorescence microscopy images of tissue samples were also obtained. Measurement of intact ovalbumin was verified by LDS-PAGE analysis of the tissue extract solutions. In vitro release of Alexa 488 ovalbumin into 37 degrees C PBS solutions from ovalbumin-loaded gel pellets was also monitored over time by spectrophotometric assay. In vivo ovalbumin release rates were determined by measurement of residual ovalbumin extracted from gel pellets removed from rat eyes at various time intervals. Our results indicate that ovalbumin concentrations can be maintained at measurable levels in the sclera, choroid, and retina of rats for up to 14 days using the thermosetting gel delivery system. The concentration of ovalbumin exhibited a gradient that decreased from sclera to choroid and to retina. The in vitro release rate profiles were similar to the in vivo release profiles. Our findings suggest that the thermosetting gel system may be a feasible method for safe and convenient sustained delivery of proteins to choroidal and retinal tissue in the posterior segments of the eye.

Process evaluation of a national school-based iron supplementation program for adolescent girls in Iran.

Science.gov (United States)

Kheirouri, Sorayya; Alizadeh, Mohammad

2014-09-16

Iron deficiency anemia remains as one of the most common nutritional problems in Iran, especially in women and girls. A process evaluation study of the national iron supplementation program targeting girls attending high schools was conducted to examine degree of exposure and satisfaction of the targets with the intervention components, and to assess the delivery (quantity), fidelity (quality), and environmental mediators of the intervention. Three assessment tools were developed and used for the process evaluation. A total of 8 schools were selected using a simple randomization method. Data were collected from students (n = 658 of 661 participants), teachers (n = 80), and school principals (n = 7 of 8). For the qualitative measures semi-structured interviews were conducted with the three study groups. Mean continuous compliance was 62.3%. Intolerance to pills and no water supply in classrooms accounted for 47.72% and 36.21% of the refusals, respectively. The refusal rate was significantly correlated (p knowledge of iron deficiency issues (p < 0.05). The odds of refusal in the absence of a classroom water supply were 2.02 (95% CI 1 · 044 to 3 · 900) times greater than for those classrooms with a water supply. Student exposure to the program's goal was satisfactory; however, delivery and fidelity of educational materials and training sessions were inadequate. The findings suggest that the methods of delivery and the fidelity of the program components, education materials and training sessions were insufficient and need to be improved. Additionally, specific attention has to be given to contextual factors to ensure the success of the program.

What Health Service Provider Factors Are Associated with Low Delivery of HIV Testing to Children with Acute Malnutrition in Dowa District of Malawi?

Science.gov (United States)

Chitete, Lusungu; Puoane, Thandi

2015-01-01

The Community-based Management of Acute Malnutrition is the national program for treating acute malnutrition in Malawi. Under this program's guidelines all children enrolled should undergo an HIV test, so that those infected can receive appropriate treatment and care. However, the national data of 2012 shows a low delivery of testing. Prior studies have investigated client-related factors affecting uptake of HIV testing in Community-based Management of Acute Malnutrition program. Lacking is the information on the service provider factors that are associated with the delivery of testing. This study investigated service provider factors that affect delivery of HIV testing among children enrolled in the program and explored ways in which this could be improved. A descriptive study that used qualitative methods of data collection. Client registers were reviewed to obtain the number of children enrolled in Community-based Management of Acute Malnutrition and the number of children who were tested for HIV over a 12-month period. In-depth interviews were conducted with Community-based Management of Acute Malnutrition and HIV Testing and Counselling focal persons to investigate factors affecting HIV test delivery. Descriptive statistics were used to analyze data from client registers. Information from interviews was analyzed using a thematic approach. Quantitative data revealed that 1738 (58%) of 2981 children enrolled in Community-based Management of Acute Malnutrition were tested for HIV. From in-depth interviews four themes emerged, that is, lack of resources for HIV tests; shortage of staff skilled in HIV testing and counseling; lack of commitment among staff in referring children for HIV testing; and inadequately trained staff. There is a need for a functioning health system to help reduce child mortality resulting from HIV related conditions.

Outcomes of Operative Vaginal Delivery during Trial of Labor after Cesarean Delivery.

Science.gov (United States)

Brock, Clifton O; Govindappagari, Shravya; Gyamfi-Bannerman, Cynthia

2017-07-01

Objective  The objective of this study is to determine the maternal and neonatal morbidity associated with attempting operative vaginal delivery (OVD) compared with the alternative of a laboring repeat cesarean delivery (LRCD) in women attempting a trial of labor after cesarean delivery (TOLAC). Methods  This is a secondary analysis of a multicenter prospective study designed to assess perinatal outcomes of OVD in women with a prior uterine scar. The study includes women who attempted TOLAC and reached +2 station with a fully dilated cervix. Composites on neonatal and maternal morbidity were compared between women in whom OVD was attempted and those who underwent LRCD by fitting multivariate logistic regression models. Results  In total, 6,489 women attempting TOLAC reached 2+ station with a fully dilated cervix. Of these, 5,640 (86.9%) had a spontaneous vaginal delivery, 762 (11.7%) underwent attempted OVD, and 87 (1.3%) had an LRCD. Compared with attempting OVD, LRCD was associated with greater neonatal morbidity (odds ratio [OR]: 2.41; 95% confidence interval [CI]: 1.13-5.15) and less maternal morbidity (OR: 0.28; 95% CI: 0.14-0.55). Maternal morbidity of OVD is driven by perineal injury. Conclusion  In laboring women with a previous uterine scar, attempting OVD is associated with greater maternal and less neonatal morbidity than LRCD. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Biomimetics in drug delivery systems: A critical review.

Science.gov (United States)

Sheikhpour, Mojgan; Barani, Leila; Kasaeian, Alibakhsh

2017-05-10

Today, the advanced drug delivery systems have been focused on targeted drug delivery fields. The novel drug delivery is involved with the improvement of the capacity of drug loading in drug carriers, cellular uptake of drug carriers, and the sustained release of drugs within target cells. In this review, six groups of therapeutic drug carriers including biomimetic hydrogels, biomimetic micelles, biomimetic liposomes, biomimetic dendrimers, biomimetic polymeric carriers and biomimetic nanostructures, are studied. The subject takes advantage of the biomimetic methods of productions or the biomimetic techniques for the surface modifications, similar to what accrues in natural cells. Moreover, the effects of these biomimetic approaches for promoting the drug efficiency in targeted drug delivery are visible. The study demonstrates that the fabrication of biomimetic nanocomposite drug carriers could noticeably promote the efficiency of drugs in targeted drug delivery systems. Copyright © 2017 Elsevier B.V. All rights reserved.

Soluble polymer conjugates for drug delivery.

Science.gov (United States)

Minko, Tamara

2005-01-01

The use of water-soluble polymeric conjugates as drug carriers offers several possible advantages. These advantages include: (1) improved drug pharmacokinetics; (2) decreased toxicity to healthy organs; (3) possible facilitation of accumulation and preferential uptake by targeted cells; (4) programmed profile of drug release. In this review, we will consider the main types of useful polymeric conjugates and their role and effectiveness as carriers in drug delivery systems.: © 2005 Elsevier Ltd . All rights reserved.

Interplay Wellbeing Framework: Community Perspectives on Working Together for Effective Service Delivery in Remote Aboriginal Communities

Directory of Open Access Journals (Sweden)

Eva McRae-Williams

2018-02-01

Full Text Available Access to effective services and programs is necessary to improve wellbeing for Aboriginal and Torres Strait Islander people living in remote Australia. Without genuine participation of Aboriginal community members in the design, governance, and delivery of services, desired service delivery outcomes are rarely achieved. Using a "shared space" model, Aboriginal communities, governments, and scientists came together to design and develop the Interplay Wellbeing Framework. This Framework brings together stories and numbers (or qualitative and quantitative data to represent community values for the purpose of informing program and policy agendas. This article unpacks what community members saw as making a service work well and why. The domains of empowerment and community functioning are discussed and their relationship to effective service delivery demonstrated.

On the complexity of a combined homotopy interior method for convex programming

Science.gov (United States)

Yu, Bo; Xu, Qing; Feng, Guochen

2007-03-01

In [G.C. Feng, Z.H. Lin, B. Yu, Existence of an interior pathway to a Karush-Kuhn-Tucker point of a nonconvex programming problem, Nonlinear Anal. 32 (1998) 761-768; G.C. Feng, B. Yu, Combined homotopy interior point method for nonlinear programming problems, in: H. Fujita, M. Yamaguti (Eds.), Advances in Numerical Mathematics, Proceedings of the Second Japan-China Seminar on Numerical Mathematics, Lecture Notes in Numerical and Applied Analysis, vol. 14, Kinokuniya, Tokyo, 1995, pp. 9-16; Z.H. Lin, B. Yu, G.C. Feng, A combined homotopy interior point method for convex programming problem, Appl. Math. Comput. 84 (1997) 193-211.], a combined homotopy was constructed for solving non-convex programming and convex programming with weaker conditions, without assuming the logarithmic barrier function to be strictly convex and the solution set to be bounded. It was proven that a smooth interior path from an interior point of the feasible set to a K-K-T point of the problem exists. This shows that combined homotopy interior point methods can solve the problem that commonly used interior point methods cannot solveE However, so far, there is no result on its complexity, even for linear programming. The main difficulty is that the objective function is not monotonically decreasing on the combined homotopy path. In this paper, by taking a piecewise technique, under commonly used conditions, polynomiality of a combined homotopy interior point method is given for convex nonlinear programming.

Methods for evaluating a mature substance abuse prevention/early intervention program.

Science.gov (United States)

Becker, L R; Hall, M; Fisher, D A; Miller, T R

2000-05-01

The authors describe methods for work in progress to evaluate four workplace prevention and/or early intervention programs designed to change occupational norms and reduce substance abuse at a major U.S. transportation company. The four programs are an employee assistance program, random drug testing, managed behavioral health care, and a peer-led intervention program. An elaborate mixed-methods evaluation combines data collection and analysis techniques from several traditions. A process-improvement evaluation focuses on the peer-led component to describe its evolution, document the implementation process for those interested in replicating it, and provide information for program improvement. An outcome-assessment evaluation examines impacts of the four programs on job performance measures (e.g., absenteeism, turnover, injury, and disability rates) and includes a cost-offset and employer cost-savings analysis. Issues related to using archival data, combining qualitative and quantitative designs, and working in a corporate environment are discussed.

Frontiers in economic research on petroleum allocation using mathematical programming methods

International Nuclear Information System (INIS)

Rowse, J.

1991-01-01

This paper presents a state of the art of operations research techniques applied in petroleum allocation, namely mathematical programming methods, with principal attention directed toward linear programming and nonlinear programming (including quadratic programming). Contributions to the economics of petroleum allocation are discussed for international trade, industrial organization, regional/macro economics, public finance and natural resource/environmental economics

Developments in the formulation and delivery of spray dried vaccines.

Science.gov (United States)

Kanojia, Gaurav; Have, Rimko Ten; Soema, Peter C; Frijlink, Henderik; Amorij, Jean-Pierre; Kersten, Gideon

2017-10-03

Spray drying is a promising method for the stabilization of vaccines, which are usually formulated as liquids. Usually, vaccine stability is improved by spray drying in the presence of a range of excipients. Unlike freeze drying, there is no freezing step involved, thus the damage related to this step is avoided. The edge of spray drying resides in its ability for particles to be engineered to desired requirements, which can be used in various vaccine delivery methods and routes. Although several spray dried vaccines have shown encouraging preclinical results, the number of vaccines that have been tested in clinical trials is limited, indicating a relatively new area of vaccine stabilization and delivery. This article reviews the current status of spray dried vaccine formulations and delivery methods. In particular it discusses the impact of process stresses on vaccine integrity, the application of excipients in spray drying of vaccines, process and formulation optimization strategies based on Design of Experiment approaches as well as opportunities for future application of spray dried vaccine powders for vaccine delivery.

Developments in the formulation and delivery of spray dried vaccines

Science.gov (United States)

Kanojia, Gaurav; Have, Rimko ten; Soema, Peter C.; Frijlink, Henderik; Amorij, Jean-Pierre; Kersten, Gideon

2017-01-01

ABSTRACT Spray drying is a promising method for the stabilization of vaccines, which are usually formulated as liquids. Usually, vaccine stability is improved by spray drying in the presence of a range of excipients. Unlike freeze drying, there is no freezing step involved, thus the damage related to this step is avoided. The edge of spray drying resides in its ability for particles to be engineered to desired requirements, which can be used in various vaccine delivery methods and routes. Although several spray dried vaccines have shown encouraging preclinical results, the number of vaccines that have been tested in clinical trials is limited, indicating a relatively new area of vaccine stabilization and delivery. This article reviews the current status of spray dried vaccine formulations and delivery methods. In particular it discusses the impact of process stresses on vaccine integrity, the application of excipients in spray drying of vaccines, process and formulation optimization strategies based on Design of Experiment approaches as well as opportunities for future application of spray dried vaccine powders for vaccine delivery. PMID:28925794

Improved Ant Colony Optimization for Seafood Product Delivery Routing Problem

Directory of Open Access Journals (Sweden)

Baozhen Yao

2014-02-01

Full Text Available This paper deals with a real-life vehicle delivery routing problem, which is a seafood product delivery routing problem. Considering the features of the seafood product delivery routing problem, this paper formulated this problem as a multi-depot open vehicle routing problem. Since the multi-depot open vehicle routing problem is a very complex problem, a method is used to reduce the complexity of the problem by changing the multi-depot open vehicle routing problem into an open vehicle routing problem with a dummy central depot in this paper. Then, ant colony optimization is used to solve the problem. To improve the performance of the algorithm, crossover operation and some adaptive strategies are used. Finally, the computational results for the benchmark problems of the multi-depot vehicle routing problem indicate that the proposed ant colony optimization is an effective method to solve the multi-depot vehicle routing problem. Furthermore, the computation results of the seafood product delivery problem from Dalian, China also suggest that the proposed ant colony optimization is feasible to solve the seafood product delivery routing problem.

Method for delivery of small molecules and proteins across the cell wall of algae using molecular transporters

Science.gov (United States)

Geihe, Erika; Trantow, Brian; Wender, Paul; Hyman, Joel M.; Parvin, Bahram

2017-11-14

The introduction of tools to study, control or expand the inner-workings of algae has been slow to develop. Provided are embodiments of a molecular method based on guanidinium-rich molecular transporters (GR-MoTrs) for bringing molecular cargos into algal cells. The methods of the disclosure have been shown to work in wild-type algae that have an intact cell wall. Developed using Chlamydomonas reinhardtii, this method is also successful with less studied algae, including Neochloris oleoabundans and Scenedesmus dimorphus, thus providing a new and versatile tool for algal research and modification. The method of delivering a cargo compound to an algal cell comprises contacting an algal cell with a guanidinium-rich delivery vehicle comprising a guanidinium-rich molecular transporter (GR-MoTr) linked to a cargo compound desired to be delivered to the algal cell, whereby the guanidinium-rich molecular transporter can traverse the algal cell wall, thereby delivering the cargo compound to the algal cell.

Microneedles for intradermal and transdermal delivery

Science.gov (United States)

Tuan-Mahmood, Tuan-Mazlelaa; McCrudden, Maeliosa T.C.; Torrisi, Barbara M.; McAlister, Emma; Garland, Martin J; Singh, Thakur Raghu Raj; Donnelly, Ryan F

2014-01-01

The formidable barrier properties of the uppermost layer of the skin, the stratum corneum impose significant limitations for successful systemic delivery of a broad range of therapeutic molecules, particularly macromolecules and genetic material. Microneedle delivery has been proposed as a strategy to breach the SC barrier function in order to facilitate effective transport of molecules across the skin. This strategy involves the use of micron sized needles fabricated from different materials and using different geometries to create transient aqueous conduits across the skin. Microneedles in isolation, or in combination with other enhancing strategies, have been shown to dramatically enhance the skin permeability of numerous therapeutic molecules including biopharmaceuticals either in vitro, ex vivo or in vivo. Progress in the areas of microneedle design, development and manufacture have proven promising in terms of the potential use of this emerging delivery method in clinical applications such as insulin delivery, transcutaneous immunisations and cutaneous gene delivery. This review article focuses on recent and potential future developments in microneedle technologies. This will include the detailing of progress made in microneedle design, an exploration of the challenges faced in this field and potential forward strategies to embrace the exploitation of microneedle methodologies, while considering the inherent safety aspects of such therapeutic tools. PMID:23680534

MO-E-BRB-04: Real-Time Exit-Fluence Delivery Validation

Energy Technology Data Exchange (ETDEWEB)

Siebers, J. [University of Virginia Health System (United States)

2015-06-15

could be used. review error detection via log file analysis Learn how exit detector signal recorded in log file could be used to improve patient safety understand real-time EPID-based transmission dosimetry methods understand the goals of real-time delivery monitoring CMS Innovation grant. Rapid response supportive and palliative care program for patients with advanced cancer, starts July, 2012; Accuray Inc. Exit detector based QA software evaluation, Sept, 2012-Sept, 2013; ROI GRant from ASTRO “Safety and Quality: IMRT treatment delivery accuracy”.

MO-E-BRB-04: Real-Time Exit-Fluence Delivery Validation

International Nuclear Information System (INIS)

Siebers, J.

2015-01-01

could be used. review error detection via log file analysis Learn how exit detector signal recorded in log file could be used to improve patient safety understand real-time EPID-based transmission dosimetry methods understand the goals of real-time delivery monitoring CMS Innovation grant. Rapid response supportive and palliative care program for patients with advanced cancer, starts July, 2012; Accuray Inc. Exit detector based QA software evaluation, Sept, 2012-Sept, 2013; ROI GRant from ASTRO “Safety and Quality: IMRT treatment delivery accuracy”

Verification of patient position and delivery of IMRT by electronic portal imaging

International Nuclear Information System (INIS)

Fielding, Andrew L.; Evans, Philip M.; Clark, Catharine H.

2004-01-01

Background and purpose: The purpose of the work presented in this paper was to determine whether patient positioning and delivery errors could be detected using electronic portal images of intensity modulated radiotherapy (IMRT). Patients and methods: We carried out a series of controlled experiments delivering an IMRT beam to a humanoid phantom using both the dynamic and multiple static field method of delivery. The beams were imaged, the images calibrated to remove the IMRT fluence variation and then compared with calibrated images of the reference beams without any delivery or position errors. The first set of experiments involved translating the position of the phantom both laterally and in a superior/inferior direction a distance of 1, 2, 5 and 10 mm. The phantom was also rotated 1 and 2 deg. For the second set of measurements the phantom position was kept fixed and delivery errors were introduced to the beam. The delivery errors took the form of leaf position and segment intensity errors. Results: The method was able to detect shifts in the phantom position of 1 mm, leaf position errors of 2 mm, and dosimetry errors of 10% on a single segment of a 15 segment IMRT step and shoot delivery (significantly less than 1% of the total dose). Conclusions: The results of this work have shown that the method of imaging the IMRT beam and calibrating the images to remove the intensity modulations could be a useful tool in verifying both the patient position and the delivery of the beam

Electrospun polymeric nanofibers for transdermal drug delivery

Directory of Open Access Journals (Sweden)

Mahya Rahmani

2017-04-01

Full Text Available Conventional transdermal drug delivery systems (TDDS have been designed for drug delivery through the skin. These systems use the permeability property of stratum corneum, the outermost surface layer of the skin. Applying polymeric micro and nanofibers in drug delivery has recently attracted great attention and the electrospinning technique is the preferred method for polymeric micro-nanofibers fabrication with a great potential for drug delivery. More studies in the field of nanofibers containing drug are divided two categories: first, preparation and characterization of nanofibers containing drug and second, investigation of their therapeutic applications. Drugs used in electrospun nanofibers can be categorized into three main groups, including antibiotics and antimicrobial agents, anti-inflammatory agents and vitamins with therapeutic applications. In this paper, we review the application of electrospun polymeric scaffolds in TDDS and also introduce several pharmaceutical and therapeutic agents which have been used in polymer nanofibrous patches.

Nurse mentor perceptions in the delivery of a home-based cardiac rehabilitation program to support patients living in rural areas: An interpretive study.

Science.gov (United States)

Frohmader, Terence J; Lin, Frances; Chaboyer, Wendy P

2017-05-01

Home-based cardiac rehabilitation (CR) programs improve health outcomes for people diagnosed with heart disease. Mentoring of patients by nurses trained in CR has been proposed as an innovative model of cardiac care. Little is known however, about the experience of mentors facilitating such programs and adapting to this new role. The aim of this qualitative study was to explore nurse mentor perceptions of their role in the delivery of a home-based CR program for rural patients unable to attend a hospital or outpatient CR program. Seven nurses mentored patients by telephone providing patients with education, psychosocial support and lifestyle advice during their recovery. An open-ended survey was administered to mentors by email and findings revealed mentors perceived their role to be integral to the success of the program. Nurses were satisfied with the development of their new role as patient mentors. They believed their collaborative skills, knowledge and experience in coronary care, timely support and guidance of patients during their recovery and use of innovative audiovisual resources improved the health outcomes of patients not able to attend traditional programs. Cardiac nurses in this study perceived that they were able to successfully transition from their normal work practices in hospital to mentoring patients in their homes. Crown Copyright © 2017. Published by Elsevier Ltd. All rights reserved.

Applying a Total Market Lens: Increased IUD Service Delivery Through Complementary Public- and Private-Sector Interventions in 4 Countries.

Science.gov (United States)

White, Julia N; Corker, Jamaica

2016-08-11

Increasing access to the intrauterine device (IUD), as part of a comprehensive method mix, is a key strategy for reducing unintended pregnancy and maternal mortality in low-income countries. To expand access to IUDs within the framework of informed choice, Population Services International (PSI) has historically supported increased IUD service delivery through private providers. In applying a total market lens to better understand the family planning market and address major market gaps, PSI identified a lack of high-quality public provision of IUDs. In 2013, PSI started a pilot in 4 countries (Guatemala, Laos, Mali, and Uganda) to grow public-provider IUD service delivery through increased public-sector engagement while maintaining its ongoing focus on private providers. In collaboration with country governments, PSI affiliates carried out family planning market analyses in the 4 pilot countries to identify gaps in IUD service delivery and create sustainable strategies for scaling up IUD services in the public sector. Country-specific interventions to increase service delivery were implemented across all levels of the public health system, including targeted advocacy at the national level to promote government ownership and program sustainability. Mechanisms to ensure government ownership were built into the program design, including a proof-of-concept approach to convince governments of the feasibility and value of taking over and scaling up interventions. In the first 2 years of the pilot (2013-2014), 102,055 IUD services were provided to women at 417 targeted public-sector facilities. These preliminary results suggest that there is untapped demand for IUD service delivery in the public sector that can be met in part through greater participation of the public sector in family planning and IUD provision. © White et al.

Applying a Total Market Lens: Increased IUD Service Delivery Through Complementary Public- and Private-Sector Interventions in 4 Countries

Science.gov (United States)

White, Julia N; Corker, Jamaica

2016-01-01

ABSTRACT Increasing access to the intrauterine device (IUD), as part of a comprehensive method mix, is a key strategy for reducing unintended pregnancy and maternal mortality in low-income countries. To expand access to IUDs within the framework of informed choice, Population Services International (PSI) has historically supported increased IUD service delivery through private providers. In applying a total market lens to better understand the family planning market and address major market gaps, PSI identified a lack of high-quality public provision of IUDs. In 2013, PSI started a pilot in 4 countries (Guatemala, Laos, Mali, and Uganda) to grow public-provider IUD service delivery through increased public-sector engagement while maintaining its ongoing focus on private providers. In collaboration with country governments, PSI affiliates carried out family planning market analyses in the 4 pilot countries to identify gaps in IUD service delivery and create sustainable strategies for scaling up IUD services in the public sector. Country-specific interventions to increase service delivery were implemented across all levels of the public health system, including targeted advocacy at the national level to promote government ownership and program sustainability. Mechanisms to ensure government ownership were built into the program design, including a proof-of-concept approach to convince governments of the feasibility and value of taking over and scaling up interventions. In the first 2 years of the pilot (2013–2014), 102,055 IUD services were provided to women at 417 targeted public-sector facilities. These preliminary results suggest that there is untapped demand for IUD service delivery in the public sector that can be met in part through greater participation of the public sector in family planning and IUD provision. PMID:27540122

Impact of alternative reimbursement strategies in the new cooperative medical scheme on caesarean delivery rates: a mixed-method study in rural China

Directory of Open Access Journals (Sweden)

Huang Kun

2012-07-01

Full Text Available Abstract Background The rate of caesarean delivery (CD in rural China has been rapidly increasing in recent decades. Due to the exorbitant costs associated with CD, paying for this expensive procedure is often a great challenge for the majority of rural families. Since 2003, the Chinese government has re-established the New Cooperative Medical Scheme (NCMS, aimed to improve the access of essential healthcare to rural residents and reduce financial burden owing to high out of pocket payments. This paper seeks to test the hypothesis that NCMS may provide service users and providers with financial incentives to select CD. It also assesses the effect of different health insurance reimbursement strategies of NCMS on CD rates in rural China. Methods Mixed quantitative and qualitative methods were adopted for data collection. Two cross-sectional household surveys were conducted with women having babies delivered in 2006 and 2009; 2326 and 1515 women, respectively, from the study sites were interviewed using structured questionnaires, to collect demographic and socio-economic data, maternal and child care characteristics and health-related expenditures. Focus group discussions (FGDs and in-depth key informant interviews (KIIs were undertaken with policy makers, health managers, providers and mothers to understand their perceptions of the influence of NCMS on the choices of delivery mode. Results The CD rates in the two study counties were 46.0 percent and 64.7 percent in 2006, increasing to 63.6 percent and 82.1 percent, respectively, in 2009. The study found that decisions on the selection of CD largely came from the pregnant women. Logistic regression analysis, after adjusting for socio-economic, maternal and fetal characteristics, did not indicate a significant effect of either proportional reimbursement or fixed amount reimbursement on the choice of CD for both study years. Interviews with stakeholders reflected that different reimbursable rates for

Effects of Contract Delivery Method on the LEED(trademark) Score of U.S. Navy Military Construction Projects (Fiscal Years 2004-2006) (CD-ROM)

National Research Council Canada - National Science Library

Carpenter, Deanna S

2005-01-01

...: 1 CD-ROM; 4 3/4 in.; 484 KB. ABSTRACT: This research study focused on determining the effects that the two major contract delivery methods had on the LEED score of projects over the design and construction time horizon...

Spatiotemporal Quantification of Local Drug Delivery Using MRI

Directory of Open Access Journals (Sweden)

Morgan B. Giers

2013-01-01

Full Text Available Controlled release formulations for local, in vivo drug delivery are of growing interest to device manufacturers, research scientists, and clinicians; however, most research characterizing controlled release formulations occurs in vitro because the spatial and temporal distribution of drug delivery is difficult to measure in vivo. In this work, in vivo magnetic resonance imaging (MRI of local drug delivery was performed to visualize and quantify the time resolved distribution of MRI contrast agents. Three-dimensional maps (generated from -weighted images with varied were processed using noise-reducing filtering. A segmented region of contrast, from a thresholded image, was converted to concentration maps using the equation , where and are the precontrast and postcontrast map values, respectively. In this technique, a uniform estimated value for was used. Error estimations were performed for each step. The practical usefulness of this method was assessed using comparisons between devices located in different locations both with and without contrast. The method using a uniform , requiring no registration of pre- and postcontrast image volumes, was compared to a method using either affine or deformation registrations.

Packaged Au-PPy valves for drug delivery systems

Science.gov (United States)

Tsai, Han-Kuan A.; Ma, Kuo-Sheng; Zoval, Jim; Kulinsky, Lawrence; Madou, Marc

2006-03-01

The most common methods for the drug delivery are swallowing pills or receiving injections. However, formulations that control the rate and period of medicine (i.e., time-release medications) are still problematic. The proposed implantable devices which include batteries, sensors, telemetry, valves, and drug storage reservoirs provide an alternative method for the responsive drug delivery system [1]. Using this device, drug concentration can be precisely controlled which enhances drug efficiency and decreases the side effects. In order to achieve responsive drug delivery, a reliable release valve has to be developed. Biocompatibility, low energy consumption, and minimized leakage are the main requirements for such release method. A bilayer structure composed of Au/PPy film is fabricated as a flap to control the release valve. Optimized potentiostatic control to synthesize polypyrrole (PPy) is presented. The release of miniaturize valve is tested and showed in this paper. A novel idea to simultaneously fabricate the device reservoirs as well as protective packaging is proposed in this paper. The solution of PDMS permeability problem is also mentioned in this article.

Microneedle-mediated delivery of viral vectored vaccines.

Science.gov (United States)

Zaric, Marija; Ibarzo Yus, Bárbara; Kalcheva, Petya Petrova; Klavinskis, Linda Sylvia

2017-10-01

Microneedle array platforms are a promising technology for vaccine delivery, due to their ease of administration with no sharp waste generated, small size, possibility of targeted delivery to the specified skin depth and efficacious delivery of different vaccine formulations, including viral vectors. Areas covered: Attributes and challenges of the most promising viral vector candidates that have advanced to the clinic and that have been leveraged for skin delivery by microneedles; The importance of understanding the immunobiology of antigen-presenting cells in the skin, in particular dendritic cells, in order to generate further improved skin vaccination strategies; recent studies where viral vectors expressing various antigens have been coupled with microneedle technology to examine their potential for improved vaccination. Expert opinion: Simple, economic and efficacious vaccine delivery methods are needed to improve health outcomes and manage possible outbreaks of new emerging viruses. Understanding what innate/inflammatory signals are required to induce both immediate and long-term responses remains a major hurdle in the development of the effective vaccines. One approach to meet these needs is microneedle-mediated viral vector vaccination. In order for this technology to fulfil this potential the industry must invest significantly to further develop its design, production, biosafety, delivery and large-scale manufacturing.

Private sector delivery of health services in developing countries: a mixed-methods study on quality assurance in social franchises

OpenAIRE

Schlein, Karen; De La Cruz, Anna York; Gopalakrishnan, Tisha; Montagu, Dominic

2013-01-01

Abstract Background Across the developing world health care services are most often delivered in the private sector and social franchising has emerged, over the past decade, as an increasingly popular method of private sector health care delivery. Social franchising aims to strengthen business practices through economies of scale: branding clinics and purchasing drugs in bulk at wholesale prices. While quality is one of the established goals of social...

Experimental methods and transport models for drug delivery across the blood-brain barrier.

Science.gov (United States)

Fu, Bingmei M

2012-06-01

The blood-brain barrier (BBB) is a dynamic barrier essential for maintaining the micro-environment of the brain. Although the special anatomical features of the BBB determine its protective role for the central nervous system (CNS) from blood-born neurotoxins, however, the BBB extremely limits the therapeutic efficacy of drugs into the CNS, which greatly hinders the treatment of major brain diseases. This review summarized the unique structures of the BBB, described a variety of in vivo and in vitro experimental methods for determining the transport properties of the BBB, e.g., the permeability of the BBB to water, ions, and solutes including nutrients, therapeutic agents and drug carriers, and presented newly developed mathematical models which quantitatively correlate the anatomical structures of the BBB with its barrier functions. Finally, on the basis of the experimental observations and the quantitative models, several strategies for drug delivery through the BBB were proposed.

Triple-component nanocomposite films prepared using a casting method: Its potential in drug delivery

Directory of Open Access Journals (Sweden)

Sadia Gilani

2018-04-01

Full Text Available The purpose of this study was to fabricate a triple-component nanocomposite system consisting of chitosan, polyethylene glycol (PEG, and drug for assessing the application of chitosan–PEG nanocomposites in drug delivery and also to assess the effect of different molecular weights of PEG on nanocomposite characteristics. The casting/solvent evaporation method was used to prepare chitosan–PEG nanocomposite films incorporating piroxicam-β-cyclodextrin. In order to characterize the morphology and structure of nanocomposites, X-ray diffraction technique, scanning electron microscopy, thermogravimetric analysis, and Fourier transmission infrared spectroscopy were used. Drug content uniformity test, swelling studies, water content, erosion studies, dissolution studies, and anti-inflammatory activity were also performed. The permeation studies across rat skin were also performed on nanocomposite films using Franz diffusion cell. The release behavior of films was found to be sensitive to pH and ionic strength of release medium. The maximum swelling ratio and water content was found in HCl buffer pH 1.2 as compared to acetate buffer of pH 4.5 and phosphate buffer pH 7.4. The release rate constants obtained from kinetic modeling and flux values of ex vivo permeation studies showed that release of piroxicam-β-cyclodextrin increased with an increase in concentration of PEG. The formulation F10 containing 75% concentration of PEG showed the highest swelling ratio (3.42±0.02 in HCl buffer pH 1.2, water content (47.89±1.53% in HCl buffer pH 1.2, maximum cumulative drug permeation through rat skin (2405.15±10.97 μg/cm2 in phosphate buffer pH 7.4, and in vitro drug release (35.51±0.26% in sequential pH change mediums, and showed a significantly (p<0.0001 higher anti-inflammatory effect (0.4 cm. It can be concluded from the results that film composition had a particular impact on drug release properties. The different molecular weights of PEG have a

Improving the delivery of preventive care services.

Science.gov (United States)

Hung, Dorothy Y

2007-05-01

Performance of preventive services is an important indicator of high-quality health care, but many recommended services are not regularly offered in primary care practices. Health risk assessments, counseling, and referral to community-based programs help address risk behaviors, many of which are leading causes of preventable death and disability in the United States. This study examined various influences on the delivery of preventive services designed to address smoking, excessive consumption of alcohol, unhealthy diets, and sedentary lifestyles. More than 300 health care providers in 52 practices nationwide have contributed data to this study. Staff participation in quality improvement enhanced work relationships and also diminished the effect of practice size on the performance of preventive care. The use of nurse practitioners, allied health professionals, clinician reminders, and patient registries were positively associated with care delivery.

Drug delivery from the oral cavity: a focus on mucoadhesive buccal drug delivery systems.

Science.gov (United States)

Shinkar, Dattatraya Manohar; Dhake, Avinash Sridhar; Setty, Chitral Mallikarjuna

2012-01-01

Since the early 1980s the concept of mucoadhesion has gained considerable interest in pharmaceutical technology. The various advantages associated with these systems made buccal drug delivery as a novel route of drug administration. It prolongs the residence time of the dosage form at the site of application. These systems remain in close contact with the absorption tissue, the mucous membrane, and thus contribute to improved and/or better therapeutic performance of the drug and of both local and systemic effects. This review highlights the anatomy and structure of oral mucosa, mechanism and theories of mucoadhesion, factors affecting mucoadhesion, characteristics and properties of desired mucoadhesive polymers, various types of dosage forms, and general considerations in design of mucoadhesive buccal dosage forms, permeation enhancers, and evaluation methods. Over the past few decades the mucoadhesive buccal drug delivery system has received a great deal of attention to develop mucoadhesive dosage forms to enable the prolonged retention at the site of action, providing a controlled release of drug for improved therapeutic outcome. Mucoadhesive drug delivery gives facility to include a permeation enhancer/enzyme inhibitor or pHmodifier in the formulation and versatility in designing as multidirectional or unidirectional release systems for local and systemic action. Local delivery to tissues of the oral cavity has a number of applications, including treatment of local conditions such as periodontal disease, bacterial and fungal infections, and aphthous stomatitis and vesiculo bullous diseases. For the treatment of chronic diseases, the mucoadhesive buccal drug delivery system allows easily accessibility and is generally well-accepted for administeringdrugs by systemic action.

Oral Cholera Vaccination Delivery Cost in Low- and Middle-Income Countries: An Analysis Based on Systematic Review.

Science.gov (United States)

Mogasale, Vittal; Ramani, Enusa; Wee, Hyeseung; Kim, Jerome H

2016-12-01

Use of the oral cholera vaccine (OCV) is a vital short-term strategy to control cholera in endemic areas with poor water and sanitation infrastructure. Identifying, estimating, and categorizing the delivery costs of OCV campaigns are useful in analyzing cost-effectiveness, understanding vaccine affordability, and in planning and decision making by program managers and policy makers. To review and re-estimate oral cholera vaccination program costs and propose a new standardized categorization that can help in collation, analysis, and comparison of delivery costs across countries. Peer reviewed publications listed in PubMed database, Google Scholar and World Health Organization (WHO) websites and unpublished data from organizations involved in oral cholera vaccination. The publications and reports containing oral cholera vaccination delivery costs, conducted in low- and middle-income countries based on World Bank Classification. Limits are humans and publication date before December 31st, 2014. No participants are involved, only costs are collected. Oral cholera vaccination and cost estimation. A systematic review was conducted using pre-defined inclusion and exclusion criteria. Cost items were categorized into four main cost groups: vaccination program preparation, vaccine administration, adverse events following immunization and vaccine procurement; the first three groups constituting the vaccine delivery costs. The costs were re-estimated in 2014 US dollars (US$) and in international dollar (I$). Ten studies were identified and included in the analysis. The vaccine delivery costs ranged from US$0.36 to US$ 6.32 (in US$2014) which was equivalent to I$ 0.99 to I$ 16.81 (in I$2014). The vaccine procurement costs ranged from US$ 0.29 to US$ 29.70 (in US$2014), which was equivalent to I$ 0.72 to I$ 78.96 (in I$2014). The delivery costs in routine immunization systems were lowest from US$ 0.36 (in US$2014) equivalent to I$ 0.99 (in I$2014). The reported cost categories

A proton beam delivery system for conformal therapy and intensity modulated therapy

International Nuclear Information System (INIS)

Yu Qingchang

2001-01-01

A scattering proton beam delivery system for conformal therapy and intensity modulated therapy is described. The beam is laterally spread out by a dual-ring double scattering system and collimated by a program-controlled multileaf collimator and patient specific fixed collimators. The proton range is adjusted and modulated by a program controlled binary filter and ridge filters

A Review of Analytical Methods for the Identification and Characterization of Nano Delivery Systems in Food

NARCIS (Netherlands)

Luykx, D.M.A.M.; Peters, R.J.B.; Ruth, van S.M.; Bouwmeester, H.

2008-01-01

Detection and characterization of nano delivery systems is an essential part of understanding the benefits as well as the potential toxicity of these systems in food. This review gives a detailed description of food nano delivery systems based on lipids, proteins, and/or polysaccharides and

Tissue factor-dependent blood coagulation is enhanced following delivery irrespective of the mode of delivery

NARCIS (Netherlands)

Boer, K.; den Hollander, I. A.; Meijers, J. C. M.; Levi, M. [=Marcel M.

2007-01-01

BACKGROUND: The risk of thrombosis is clearly increased in the postpartum period. Mice with a targeted deletion of the transmembrane domain of tissue factor (TF) develop serious activation of blood coagulation and widespread thrombosis after delivery. OBJECTIVE AND METHODS: We hypothesized that TF,

Determination and Comparison of Neonatal Complications in Painless Epidural Delivery and without Pain Control Qom Izadi Hospital during the Years 2004-5

Directory of Open Access Journals (Sweden)

N Tashakorinia

2012-05-01

Full Text Available

Background and objectives

 Provision of standard childbirth facilities has been considered as an important healthcare issue for a long time. The physical and psychological states of mothers are important factors determining the fate of delivery. Therefore, several programs have been established to decrease the mother-child mortality rates and the complications of delivery. One of the most common approaches for controlling the pain of delivery is application of local anesthesia such as epidural, spinal, or a combination of these methods. It has been shown that complications of epidural anesthesia are less than other methods of local anesthesia employed for the painless delivery. In this study, a comparison is made between two groups of 80 neonates delivered by either NVD or EU.

Methods

 A form was designed for collection of data including Apgar score at first minute, need for CPR, NICU admission, FHR variability, breast feeding time, duration of hospital stay, and neonatal reflexes. The data were analyzed by chi-square and fisher tests using SPSS software.

Results

 There was no significant difference between the neonates born by EA or NVD at the 95% confidence level.

Conclusion

 Based on these findings it could be concluded that epidural anesthesia for delivery does not lead to neonatal complications more than that of NVD without pain control. Therefore, this method could be recommended to mothers, who choose elective cesarean section to avoid the pain of childbirth.

Keywords: Heart Rate, Fetal ; Cardiopulmonary Resuscitation ; Intensive care, Neonatal; Anesthesia, Epidural

Molecularly Imprinted Polymers: Novel Discovery for Drug Delivery.

Science.gov (United States)

Dhanashree, Surve; Priyanka, Mohite; Manisha, Karpe; Vilasrao, Kadam

2016-01-01

Molecularly imprinted polymers (MIP) are novel carriers synthesized by imprinting of a template over a polymer. This paper presents the recent application of MIP for diagnostic and therapeutic drug delivery. MIP owing to their 3D polymeric structures and due to bond formation with the template serves as a reservoir of active causing stimuli sensitive, enantioselective, targetted and/or controlled release. The review elaborates about key factors for optimization of MIP, controlled release by MIP for various administration routes various forms like patches, contact lenses, nanowires along with illustrations. To overcome the limitation of organic solvent usage causing increased cost, water compatible MIP and use of supercritical fluid technology for molecular imprinting were developed. Novel methods for developing water compatible MIP like pickering emulsion polymerization, co-precipitation method, cyclodextrin imprinting, surface grafting, controlled/living radical chain polymerization methods are described with illustration in this review. Various protein imprinting methods like bulk, epitope and surface imprinting are described along with illustrations. Further, application of MIP in microdevices as biomimetic sensing element for personalized therapy is elaborated. Although development and application of MIP in drug delivery is still at its infancy, constant efforts of researchers will lead to a novel intelligent drug delivery with commercial value. Efforts should be directed in developing solid oral dosage forms consisting of MIP for therapeutic protein and peptide delivery and targeted release of potent drugs addressing life threatening disease like cancer. Amalgamation of bio-engineering and pharmaceutical techniques can make these future prospects into reality.