Implementation of selective prevention for cardiometabolic diseases; are Dutch general practices adequately prepared?

Science.gov (United States)

Stol, Daphne M; Hollander, Monika; Nielen, Markus M J; Badenbroek, Ilse F; Schellevis, François G; de Wit, Niek J

2018-03-01

Current guidelines acknowledge the need for cardiometabolic disease (CMD) prevention and recommend five-yearly screening of a targeted population. In recent years programs for selective CMD-prevention have been developed, but implementation is challenging. The question arises if general practices are adequately prepared. Therefore, the aim of this study is to assess the organizational preparedness of Dutch general practices and the facilitators and barriers for performing CMD-prevention in practices currently implementing selective CMD-prevention. Observational study. Dutch primary care. General practices. Organizational characteristics. General practices implementing selective CMD-prevention are more often organized as a group practice (49% vs. 19%, p = .000) and are better organized regarding chronic disease management compared to reference practices. They are motivated for performing CMD-prevention and can be considered as 'frontrunners' of Dutch general practices with respect to their practice organization. The most important reported barriers are a limited availability of staff (59%) and inadequate funding (41%). The organizational infrastructure of Dutch general practices is considered adequate for performing most steps of selective CMD-prevention. Implementation of prevention programs including easily accessible lifestyle interventions needs attention. All stakeholders involved share the responsibility to realize structural funding for programmed CMD-prevention. Aforementioned conditions should be taken into account with respect to future implementation of selective CMD-prevention. Key Points   There is need for adequate CMD prevention. Little is known about the organization of selective CMD prevention in general practices.   • The organizational infrastructure of Dutch general practices is adequate for performing most steps of selective CMD prevention.   • Implementation of selective CMD prevention programs including easily accessible

5 CFR 9701.407 - Monitoring performance and providing feedback.

Science.gov (United States)

2010-01-01

... feedback. 9701.407 Section 9701.407 Administrative Personnel DEPARTMENT OF HOMELAND SECURITY HUMAN... performance and providing feedback. In applying the requirements of the performance management system and its... organization; and (b) Provide timely periodic feedback to employees on their actual performance with respect to...

Quasi-adequate semigroups

International Nuclear Information System (INIS)

El-Qallali, A.

1987-11-01

The least fundamental adequate good congruence on an arbitrary type W semigroup S is described as well as the largest superabundant full subsemigroup of S and the largest full subsemigroup of S which is a band of cancellative monoids. Weak type W semigroups are defined by replacing the idempotent-connected property in type W by one of its consequences and a structure theorem is obtained for such semigroups. (author). 12 refs

ENSURING ADEQUATE SAFETY WHEN USING HYDROGEN AS A FUEL

Energy Technology Data Exchange (ETDEWEB)

Coutts, D

2007-01-22

Demonstration projects using hydrogen as a fuel are becoming very common. Often these projects rely on project-specific risk evaluations to support project safety decisions. This is necessary because regulations, codes, and standards (hereafter referred to as standards) are just being developed. This paper will review some of the approaches being used in these evolving standards, and techniques which demonstration projects can implement to bridge the gap between current requirements and stakeholder desires. Many of the evolving standards for hydrogen-fuel use performance-based language, which establishes minimum performance and safety objectives, as compared with prescriptive-based language that prescribes specific design solutions. This is being done for several reasons including: (1) concern that establishing specific design solutions too early will stifle invention, (2) sparse performance data necessary to support selection of design approaches, and (3) a risk-adverse public which is unwilling to accept losses that were incurred in developing previous prescriptive design standards. The evolving standards often contain words such as: ''The manufacturer shall implement the measures and provide the information necessary to minimize the risk of endangering a person's safety or health''. This typically implies that the manufacturer or project manager must produce and document an acceptable level of risk. If accomplished using comprehensive and systematic process the demonstration project risk assessment can ease the transition to widespread commercialization. An approach to adequately evaluate and document the safety risk will be presented.

Providers perspective and geographic and institutional factors associated with family planning counseling.

Science.gov (United States)

de la Vara-Salazar, Elvia; Suárez-López, Leticia; Rivera, Leonor; Lazcano-Ponce, Eduardo

2018-06-01

Family planning (FP) counseling is an essential activity to prevent unplanned pregnancies and allow a fulfilling sex life. We defined adequate counseling in FP as the counseling given to women and men of reproductive age that provided complete information about use, application, effectiveness, side effects, and contraindications. Two objectives are proposed in this study. First, we seek to analyze geographic and institutional factors associated with FP counseling in primary and secondary healthcare facilities in Mexico. Second, we seek to identify the cultural barriers that providers perceive as a limitation of the clients so that they can come to request information related to FP and that are associated with FP counseling. This cross-sectional study uses a complex, probabilistic, stratified sampling design representative at national level by institution, region and rural-urban areas. We collected 16,829 provider questionnaires at healthcare facilities. Bivariate and logistic regression analyses were performed. Providers in rural areas had a greater possibility of offering adequate counseling (OR = 2.98; 95%CI 1.18-7.53). Providers in the northern region of the country were more likely to provide adequate counseling (OR = 5.37; 95% CI 1.91-15.12). Providers whom perceive religion as a limitation for clients to come to request information about FP are less likely to provide adequate counseling (OR = 0.37; 95% CI 0.15-0.88). Physical space exclusively for the provision of FP counseling and the availability of manuals were not associated with adequate counseling. There is a need to address the social and cultural influences on the quality of counseling in these healthcare facilities. Copyright © 2018 Elsevier B.V. All rights reserved.

Funding an 'Adequate' Education.

Science.gov (United States)

Guthrie, James W.

1983-01-01

The U.S. political process has been used to define an "adequate" education, in terms of resources, procedures, content, or outcomes. The marketplace also allows individuals to define adequacy through various voucher arrangements. Both mechanisms should be used, based on whether public or private interests are paramount in a particular…

Maintaining Adequate Carbon Dioxide Washout for an Advanced Extravehicular Mobility Unit

Science.gov (United States)

Chullen, Cinda; Navarro, Moses; Conger, Bruce; Korona, Adam; McMillin, Summer; Norcross, Jason; Swickrath, Mike

2013-01-01

Over the past several years, NASA has realized tremendous progress in technology development that is aimed at the production of an Advanced Extravehicular Mobility Unit (AEMU). Of the many functions provided by the spacesuit and portable life support subsystem within the AEMU, delivering breathing gas to the astronaut along with removing the carbon dioxide (CO2) remains one of the most important environmental functions that the AEMU can control. Carbon dioxide washout is the capability of the ventilation flow in the spacesuit helmet to provide low concentrations of CO2 to the crew member to meet breathing requirements. CO2 washout performance is a critical parameter needed to ensure proper and sufficient designs in a spacesuit and in vehicle applications such as sleep stations and hygiene compartments. Human testing to fully evaluate and validate CO2 washout performance is necessary but also expensive due to the levied safety requirements. Moreover, correlation of math models becomes challenging because of human variability and movement. To supplement human CO2 washout testing, a breathing capability will be integrated into a suited manikin test apparatus to provide a safe, lower cost, stable, easily modeled alternative to human testing. Additionally, this configuration provides NASA Johnson Space Center (JSC) the capability to evaluate CO2 washout under off-nominal conditions that would otherwise be unsafe for human testing or difficult due to fatigue of a test subject. Testing has been under way in-house at JSC and analysis has been initiated to evaluate whether the technology provides sufficient performance in ensuring that the CO2 is removed sufficiently and the ventilation flow is adequate for maintaining CO2 washout in the AEMU spacesuit helmet of the crew member during an extravehicular activity. This paper will review recent CO2 washout testing and analysis activities, testing planned in-house with a spacesuit simulator, and the associated analytical work

40 CFR 716.25 - Adequate file search.

Science.gov (United States)

2010-07-01

... 40 Protection of Environment 30 2010-07-01 2010-07-01 false Adequate file search. 716.25 Section... ACT HEALTH AND SAFETY DATA REPORTING General Provisions § 716.25 Adequate file search. The scope of a person's responsibility to search records is limited to records in the location(s) where the required...

Minimal Adequate Model of Unemployment Duration in the Post-Crisis Czech Republic

Directory of Open Access Journals (Sweden)

Adam Čabla

2016-03-01

Full Text Available Unemployment is one of the leading economic problems in a developed world. The aim of this paper is to identify the differences in unemployment duration in different strata in the post-crisis Czech Republic via building a minimal adequate model, and to quantify the differences. Data from Labour Force Surveys are used and since they are interval censored in nature, proper metodology must be used. The minimal adequate model is built through the accelerated failure time modelling, maximum likelihood estimates and likelihood ratio tests. Variables at the beginning are sex, marital status, age, education, municipality size and number of persons in a household, containing altogether 29 model parameters. The minimal adequate model contains 5 parameters and differences are found between men and women, the youngest category and the rest and the university educated and the rest. The estimated expected values, variances, medians, modes and 90th percentiles are provided for all subgroups.

Pregnant x-ray technologist: providing adequate radiation safety for the fetus

International Nuclear Information System (INIS)

Caprio, M.L. Jr.

1980-01-01

The human embryo-fetus is highly radiosensitive and must be protected from excessive exposure to ionizing radiation. The maximum permissible dose equivalent for the developing embryo-fetus is set at 0.5 rem per year - the MPD level for members of the general public. Methods by which supervisory personnel can limit the fetal dose incurred by the occupational exposure of the mother are presented. It is recommended that supervisory personnel attempt to limit occupational exposure to the current non-occupational MPD levels for all x-ray technologists, thereby, insuring that the fetal dose limits are not surpassed and providing an added safety factor for personnel by keeping exposures as low as reasonably achievable

Do Online Bicycle Routing Portals Adequately Address Prevalent Safety Concerns?

Directory of Open Access Journals (Sweden)

Martin Loidl

2018-03-01

Full Text Available Safety concerns are among the most prevalent deterrents for bicycling. The provision of adequate bicycling infrastructure is considered as one of the most efficient means to increase cycling safety. However, limited public funding does not always allow agencies to implement cycling infrastructure improvements at the desirable level. Thus, bicycle trip planners can at least partly alleviate the lack of adequate infrastructure by recommending optimal routes in terms of safety. The presented study provides a systematic review of 35 bicycle routing applications and analyses to which degree they promote safe bicycling. The results show that most trip planners lack corresponding routing options and therefore do not sufficiently address safety concerns of bicyclists. Based on these findings, we developed recommendations on how to better address bicycling safety in routing portals. We suggest employing current communication technology and analysis to consider safety concerns more explicitly.

Physical Profiling Performance of Air Force Primary Care Providers

Science.gov (United States)

2017-08-09

AFRL-SA-WP-TR-2017-0014 Physical Profiling Performance of Air Force Primary Care Providers Anthony P. Tvaryanas1; William P...COVERED (From – To) September 2016 – January 2017 4. TITLE AND SUBTITLE Physical Profiling Performance of Air Force Primary Care Providers...encounter with their primary care team. An independent medical standards subject matter expert (SME) reviewed encounters in the electronic health record

9 CFR 305.3 - Sanitation and adequate facilities.

Science.gov (United States)

2010-01-01

... 9 Animals and Animal Products 2 2010-01-01 2010-01-01 false Sanitation and adequate facilities. 305.3 Section 305.3 Animals and Animal Products FOOD SAFETY AND INSPECTION SERVICE, DEPARTMENT OF... OF VIOLATION § 305.3 Sanitation and adequate facilities. Inspection shall not be inaugurated if an...

Calculation of the Cost of an Adequate Education in Kentucky: A Professional Judgment Approach

Directory of Open Access Journals (Sweden)

Deborah A. Verstegen

2004-02-01

Full Text Available What is an adequate education and how much does it cost? In 1989, Kentucky’s State Supreme Court found the entire system of education unconstitutional-“all of its parts and parcels”. The Court called for all children to have access to an adequate education, one that is uniform and has as its goal the development of seven capacities, including: (i “sufficient oral and written communication skills to enable students to function in a complex and rapidly changing civilization . . . .and (vii sufficient levels of academic or vocational skills to enable public school students to compete favorably with their counterparts in surrounding states, in academics or in the job market”. Now, over a decade later, key questions remain regarding whether these objectives have been fulfilled. This research is designed to calculate the cost of an adequate education by aligning resources to State standards, laws and objectives, using a professional judgment approach. Seven focus groups were convened for this purpose and the scholarly literature was reviewed to provide multiple inputs into study findings. The study produced a per pupil base cost for each of three prototype school districts and an total statewide cost, with the funding gap between existing revenue and the revenue needed for current operations of $1.097 billion per year (2001-02. Additional key resource requirements needed to achieve an adequate education, identified by professional judgment panels, include: (1 extending the school year for students and teachers, (2 adding voluntary half-day preschool for three and four year olds, and (3 raising teacher salaries. This increases the funding gap to $1.23 billion and suggests that significant new funding is required over time if the Commonwealth of Kentucky is to provide an adequate and equitable education of high quality for all children and youth as directed by the State Supreme Court.

Engaging service providers in improving industry performance

International Nuclear Information System (INIS)

Oberth, R.

2012-01-01

Effective task leadership is the key to achieving results in the nuclear industry and in most other industries. One of the themes of this conference is to discuss how the nuclear industry can undertake Issue-Identification and Definition as a means of 'identifying what needs attention' and then 'defining what needs to be done to make that happen'. I will explore this theme from the perspective of the 'Service Provider' - which by the definition of this conference includes everyone not within an operating utility - meaning 'those involved in everything from inspection and repair to research and plant architecture' - basically the member companies of my association, OCI. Our members take the definition of the roles and responsibilities of the 'Service Provider' community very seriously. In the context of this discussion a key utility function is the early definition of requirements and expectations of Service Providers in supplying to these requirements. Let's explore for a moment the Service Provider role and perspective. Service Providers are by nature pro-active - they seek ways to engage with utilities (and tier one vendors) to solve problems and achieve good outcomes. They come to industry conferences like this one to learn about upcoming utility programs and supply opportunities and how they can improve performance. Service Providers particularly want to hear senior utility people comment on emerging issues even those at the very early identification stage. Some Clarification of Roles is in Order - as that is the focus of this conference: 'Issue-Identification and Definition'. 'Issue-Identification' is the utility's job - it is the utility's role to identify as early as possible 'what needs attention and what their needs and expectations are'. This takes place before service provider engagement. 'Issue-Definition' is more challenging. It means 'determining and prioritizing what needs to be done to deal with the situation at hand'. This typically involves

Real Time Investments with Adequate Portfolio Theory

Directory of Open Access Journals (Sweden)

Alina Kvietkauskienė

2015-02-01

Full Text Available The objective of this paper is to identify investment decision makingschemes using the adequate portfolio model. This approach can be employed to project investment in stocks, using the opportunities offered by the markets and investor intelligence. It was decided to use adequate portfolio theory for investment decision making, simulation of financial markets, and optimisation of utility function. The main conclusion of article suggests investigating return on individual portfolio level. Real investment is a way to make sure of the soundness of applicable strategies.

Security measures effect over performance in service provider network

African Journals Online (AJOL)

pc

2018-03-05

Mar 5, 2018 ... Abstract—network security is defined as a set of policies and actions taken by a ... These threats are linked with the following factors that are ... typically smaller than those in the service provider space. ... Service providers cannot manage to provide ... e the DB performance effect ... r the business needs [10].

33 CFR 155.4050 - Ensuring that the salvors and marine firefighters are adequate.

Science.gov (United States)

2010-07-01

... 33 Navigation and Navigable Waters 2 2010-07-01 2010-07-01 false Ensuring that the salvors and marine firefighters are adequate. 155.4050 Section 155.4050 Navigation and Navigable Waters COAST GUARD..., water turbidity, water depth, sea state and temperature extremes). (13) Resource provider has the...

Perception of Mothers on Adequate Nutrition

Directory of Open Access Journals (Sweden)

Darshini Valoo

2017-03-01

Full Text Available Background: Malnutrition in children less than 5 years old persists around the world. In West Java and one of the districts of West Java (Sumedang, the prevalence of malnutrition is about 18.5% and 15.8% respectively. Numerous factors can lead to child malnutrition. Difficulties in availability, accessibility, acceptability and quality of food can be contributing factors. A good perception of mother on adequate nutrition can improve children’s nutritional status. This study was conducted to study the perception of mothers with children 2 to 5 years old on adequate nutrition. Methods: Most of the respondents had good perception on the aspect of adequate nutrition. Results showed perception on availability was 83.8%, physical accessibility was 97.1%, economical accessibility was 98.6%, information accessibility was 84.8% and acceptability was 81.0%. However, perception of respondents on good quality nutrition for the main meal and additional food was still poor. Moreover, there are taboos for eating shrimp and watermelon. Additionally, children were given snacks in large amount. Results: There was a strong correlation between mid-upper arm muscle area/size and muscular strength (correlation cooefficient 0.746. Moreover, the higher the Body Mass Index, the stronger the muscle strength was to some point. If the BMI was more than 25 kg/m2, this findings did not occurred. Conclusions: This study reveals that the perception of mothers on good quality food is poor regardless the good results on availibility, accesibility and acceptability.

Diagnosing Anomalous Network Performance with Confidence

Energy Technology Data Exchange (ETDEWEB)

Settlemyer, Bradley W [ORNL; Hodson, Stephen W [ORNL; Kuehn, Jeffery A [ORNL; Poole, Stephen W [ORNL

2011-04-01

Variability in network performance is a major obstacle in effectively analyzing the throughput of modern high performance computer systems. High performance interconnec- tion networks offer excellent best-case network latencies; how- ever, highly parallel applications running on parallel machines typically require consistently high levels of performance to adequately leverage the massive amounts of available computing power. Performance analysts have usually quantified network performance using traditional summary statistics that assume the observational data is sampled from a normal distribution. In our examinations of network performance, we have found this method of analysis often provides too little data to under- stand anomalous network performance. Our tool, Confidence, instead uses an empirically derived probability distribution to characterize network performance. In this paper we describe several instances where the Confidence toolkit allowed us to understand and diagnose network performance anomalies that we could not adequately explore with the simple summary statis- tics provided by traditional measurement tools. In particular, we examine a multi-modal performance scenario encountered with an Infiniband interconnection network and we explore the performance repeatability on the custom Cray SeaStar2 interconnection network after a set of software and driver updates.

DoD Actions Were Not Adequate to Reduce Improper Travel Payments

Science.gov (United States)

2016-03-10

vouchers in near real time and identifies duplicate or incorrect payments. DoD Components developed corrective actions that did not include steps to...causes of improper payments. In addition, many of the payment errors were not preventable through real - time or post-payment automated validation checks...H 1 0 , 2 0 1 6 Report No. DODIG-2016-060 DoD Actions Were Not Adequate to Reduce Improper Travel Payments Mission Our mission is to provide

Nuclear waste disposal: achieving adequate financing - special study

International Nuclear Information System (INIS)

Quasebarth, M.V.

1984-01-01

An analysis by the Congressional Budget Office (CBO) evaluates whether the current one mill fee now charged to nuclear-electricity consumers will adequately finance the waste disposal program. The CBO found that, if the fee is adjusted annually for inflation, it should provide enough revenues to cover all program costs under all nuclear growth forecasts. If the fee is unchanged, however, the fees will be inadequate if inflation exceeds 3% annually. The report suggests two alternatives for fee revision, but makes no recommendations. The alternatives are to increase the fee only at specific intervals or to automatically adjust the fee through indexation. The report examines the effect of delaying the program, cost overruns, and alternative inflation rate and interest rate assumptions. 3 figures, 12 tables

13 CFR 108.200 - Adequate capital for NMVC Companies.

Science.gov (United States)

2010-01-01

... VENTURE CAPITAL (âNMVCâ) PROGRAM Qualifications for the NMVC Program Capitalizing A Nmvc Company § 108.200 Adequate capital for NMVC Companies. You must meet the requirements of §§ 108.200-108.230 in order to... 13 Business Credit and Assistance 1 2010-01-01 2010-01-01 false Adequate capital for NMVC...

Assuring Adequate Health Insurance for Children With Special Health Care Needs: Progress From 2001 to 2009-2010.

Science.gov (United States)

Ghandour, Reem M; Comeau, Meg; Tobias, Carol; Dworetzky, Beth; Hamershock, Rose; Honberg, Lynda; Mann, Marie Y; Bachman, Sara S

2015-01-01

To report on coverage and adequacy of health insurance for children with special health care needs (CSHCN) in 2009-2010 and assess changes since 2001. Data were from the National Survey of Children with Special Health Care Needs (NS-CSHCN), a random-digit telephone survey with 40,243 (2009-2010) and 38,866 (2001) completed interviews. Consistency and adequacy of insurance was measured by: 1) coverage status, 2) gaps in coverage, 3) coverage of needed services, 4) reasonableness of uncovered costs, and 5) ability to see needed providers, as reported by parents. Bivariate and multivariable analyses were conducted to assess factors associated with adequate insurance coverage in 2009-2010. Unadjusted and adjusted prevalence estimates were examined to identify changes in the type of insurance coverage and the proportion of CSHCN with adequate coverage by insurance type. The proportion of CSHCN with private coverage decreased from 64.7% to 50.7% between 2001 and 2009-2010, while public coverage increased from 21.7% to 34.7%; the proportion of CSHCN without any insurance declined from 5.2% to 3.5%. The proportion of CSHCN with adequate coverage varied over time and by insurance type: among privately covered CSHCN, the proportion with adequate coverage declined (62.6% to 59.6%), while among publicly covered CSHCN, the proportion with adequate insurance increased (63.0% to 70.7%). Publicly insured CSHCN experienced improvements in each of the 3 adequacy components. There has been a continued shift from private to public coverage, which is more affordable, offers benefits that are more likely to meet CSHCN needs, and allowed CSHCN to see necessary providers. Published by Elsevier Inc.

Iron absorption from adequate Filipinos meals

International Nuclear Information System (INIS)

Trinidad, T.P.; Madriaga, J.R.; Valdez, D.H.; Cruz, E.M.; Mallillin, A.C.; Sison, C.C.; Kuizon, M.D.

1989-01-01

Iron absorption from adequate Filipino meals representing the three major island groups of the Philippines (Luzon, Visayas, and Mindanao) was studied using double isotope extrinsic tag method. Mean iron absorption of the one-day meal for Metro Manila was 6.6 +- 1.26%. Central Visayas, 6.3 +- 1.15% and Southern Mindanao, 6.4 +- 1.19%. Comparison between meals (breakfast, lunch, dinner) for each region as well as one-day meal for the three regions showed no significant differences (P>0.01). Correlation tests done between iron absorption and the following iron enhancers: ascorbic acid, amount of fish, meat or poultry; and inhibitors: phytic acid and tannic acid, did not give significant results. The overall average of 6.4 +- 1.20% may be used as the iron absorption level from an adequate Filipino meal. This value can be considered as one of the bases for arriving at recommended dietary allowances for iron among Filipinos instead of the 10% iron absorption assumed in 1976. (Auth.). 21 refs.; 3 tabs.; 3 annexes

Iron absorption from adequate Filipino meals

International Nuclear Information System (INIS)

Trinidad, T.P.; Madriaga, J.R.; Valdez, D.H.; Cruz, E.M.; Mallillin, A.C.; Sison, C.C.; Kuizon, M.D.

1991-01-01

Iron absorption from adequate Filipino meals representing the three major island groups of the Philippines (Luzon, Visayas and Mindanao) was studied using double isotope extrinsic tag method. Mean iron absorption of the one-day meal for Metro Manila was 6.6 ± 1.26%, Central Visayas, 6.3 ± 1.15% and Southern Mindanao, 6.4 ± 1.19%. Comparison between meals (breakfast, lunch, dinner) for each region as well as one-day meal for the three regions showed no significant differences (P > .01). Correlation tests done between iron absorption and the following iron enhancers: ascorbic acid, amount of fish, meat or poultry and inhibitors: phytic acid and tannic acid did not give significant results. The overall bar x of 6.4 ± 1.20% may be used as the non-heme iron absorption level from an adequate Filipino meal. This value can be considered as one of the bases for arriving at recommended dietary allowances for iron among Filipinos instead of the 10% iron absorption assumed in 1976

Composite Measures of Health Care Provider Performance: A Description of Approaches

Science.gov (United States)

Shwartz, Michael; Restuccia, Joseph D; Rosen, Amy K

2015-01-01

Context Since the Institute of Medicine’s 2001 report Crossing the Quality Chasm, there has been a rapid proliferation of quality measures used in quality-monitoring, provider-profiling, and pay-for-performance (P4P) programs. Although individual performance measures are useful for identifying specific processes and outcomes for improvement and tracking progress, they do not easily provide an accessible overview of performance. Composite measures aggregate individual performance measures into a summary score. By reducing the amount of data that must be processed, they facilitate (1) benchmarking of an organization’s performance, encouraging quality improvement initiatives to match performance against high-performing organizations, and (2) profiling and P4P programs based on an organization’s overall performance. Methods We describe different approaches to creating composite measures, discuss their advantages and disadvantages, and provide examples of their use. Findings The major issues in creating composite measures are (1) whether to aggregate measures at the patient level through all-or-none approaches or the facility level, using one of the several possible weighting schemes; (2) when combining measures on different scales, how to rescale measures (using z scores, range percentages, ranks, or 5-star categorizations); and (3) whether to use shrinkage estimators, which increase precision by smoothing rates from smaller facilities but also decrease transparency. Conclusions Because provider rankings and rewards under P4P programs may be sensitive to both context and the data, careful analysis is warranted before deciding to implement a particular method. A better understanding of both when and where to use composite measures and the incentives created by composite measures are likely to be important areas of research as the use of composite measures grows. PMID:26626986

Arabidopsis: an adequate model for dicot root systems?

Directory of Open Access Journals (Sweden)

Richard W Zobel

2016-02-01

Full Text Available The Arabidopsis root system is frequently considered to have only three classes of root: primary, lateral, and adventitious. Research with other plant species has suggested up to 8 different developmental/functional classes of root for a given plant root system. If Arabidopsis has only three classes of root, it may not be an adequate model for eudicot plant root systems. Recent research, however, can be interpreted to suggest that pre-flowering Arabidopsis does have at least five (5 of these classes of root. This then suggests that Arabidopsis root research can be considered an adequate model for eudicot plant root systems.

The yield of adequate and conclusive fine-needle aspiration results in thyroid nodules is uniform across functional and goiter types.

Science.gov (United States)

Liel, Y

1999-01-01

Relatively little is known about the cytological characteristics of hyperfunctioning (hot) thyroid nodules. Concern has been expressed that fine-needle aspiration (FNA) identifies hot nodules as follicular tumors or indeterminate, and as a consequence patients could be unnecessarily referred for surgery. Between 1979 and 1996, thyroid FNA was performed on 829 patients. Result of thyroid scan was available in 326; 69 (21%) patients had hot, and 257 (79%) had warm or cold thyroid nodules. Nodules in each of these major groups were divided into 2 subgroups: clinically solitary nodules and dominant nodules in multinodular goiters (MNG). The frequencies of adequate versus inadequate FNA samples, and of conclusive versus indeterminate FNA results were determined separately for each of the groups and subgroups. In addition, patients with hot nodules and overt hyperthyroidism were identified and evaluated separately. Bivariate analyses were performed for the frequency of adequate versus inadequate smears and conclusive versus indeterminate results between hot, toxic, and cold-warm nodules, and between solitary nodules and MNG. The frequency of adequate aspirations and conclusive results in the various groups and subgroups was found to be statistically indistinguishable. In conclusion, the yield of adequate samples and the rate of conclusive results of FNA in thyroid nodules is similar, irrespective of the functional state or of goiter presentation. Hot thyroid nodules do not seem to produce an increase in the rate of inadequate or indeterminate FNA results, and therefore, do not affect the overall performance of thyroid FNA.

Factors affecting the performance of maternal health care providers in Armenia

Directory of Open Access Journals (Sweden)

Voltero Lauren

2004-06-01

Full Text Available Abstract Background Over the last five years, international development organizations began to modify and adapt the conventional Performance Improvement Model for use in low-resource settings. This model outlines the five key factors believed to influence performance outcomes: job expectations, performance feedback, environment and tools, motivation and incentives, and knowledge and skills. Each of these factors should be supplied by the organization in which the provider works, and thus, organizational support is considered as an overarching element for analysis. Little research, domestically or internationally, has been conducted on the actual effects of each of the factors on performance outcomes and most PI practitioners assume that all the factors are needed in order for performance to improve. This study presents a unique exploration of how the factors, individually as well as in combination, affect the performance of primary reproductive health providers (nurse-midwives in two regions of Armenia. Methods Two hundred and eighty-five nurses and midwives were observed conducting real or simulated antenatal and postpartum/neonatal care services and interviewed about the presence or absence of the performance factors within their work environment. Results were analyzed to compare average performance with the existence or absence of the factors; then, multiple regression analysis was conducted with the merged datasets to obtain the best models of "predictors" of performance within each clinical service. Results Baseline results revealed that performance was sub-standard in several areas and several performance factors were deficient or nonexistent. The multivariate analysis showed that (a training in the use of the clinic tools; and (b receiving recognition from the employer or the client/community, are factors strongly associated with performance, followed by (c receiving performance feedback in postpartum care. Other – extraneous �

Providing safe surgery for neonates in sub-Saharan Africa.

Science.gov (United States)

Ameh, Emmanuel A; Ameh, Nkeiruka

2003-07-01

Advances in neonatal intensive care, total parenteral nutrition and improvements in technology have led to a greatly improved outcome of neonatal surgery in developed countries. In many parts of sub-Saharan Africa, however, neonatal surgery continues to pose wide-ranging challenges. Delivery outside hospital, delayed referral, poor transportation, and lack of appropriate personnel and facilities continue to contribute to increased morbidity and mortality in neonates, particularly under emergency situations. Antenatal supervision and hospital delivery needs to be encouraged in our communities. Adequate attention needs to be paid to providing appropriate facilities for neonatal transport and support and training of appropriate staff for neonatal surgery. Neonates with surgical problems should be adequately resuscitated before referral where necessary but surgery should not be unduly delayed. Major neonatal surgery should as much as possible be performed by those trained to operate on neonates. Appropriate research and international collaboration is necessary to improve neonatal surgical care in the environment.

Measuring Provider Performance for Physicians Participating in the Merit-Based Incentive Payment System.

Science.gov (United States)

Squitieri, Lee; Chung, Kevin C

2017-07-01

In 2017, the Centers for Medicare and Medicaid Services began requiring all eligible providers to participate in the Quality Payment Program or face financial reimbursement penalty. The Quality Payment Program outlines two paths for provider participation: the Merit-Based Incentive Payment System and Advanced Alternative Payment Models. For the first performance period beginning in January of 2017, the Centers for Medicare and Medicaid Services estimates that approximately 83 to 90 percent of eligible providers will not qualify for participation in an Advanced Alternative Payment Model and therefore must participate in the Merit-Based Incentive Payment System program. The Merit-Based Incentive Payment System path replaces existing quality-reporting programs and adds several new measures to evaluate providers using four categories of data: (1) quality, (2) cost/resource use, (3) improvement activities, and (4) advancing care information. These categories will be combined to calculate a weighted composite score for each provider or provider group. Composite Merit-Based Incentive Payment System scores based on 2017 performance data will be used to adjust reimbursed payment in 2019. In this article, the authors provide relevant background for understanding value-based provider performance measurement. The authors also discuss Merit-Based Incentive Payment System reporting requirements and scoring methodology to provide plastic surgeons with the necessary information to critically evaluate their own practice capabilities in the context of current performance metrics under the Quality Payment Program.

Presentations provided

International Nuclear Information System (INIS)

Hashemian, H.; Beverly, D.

1998-01-01

The following topics covered in detail at the workshop included: temperature instrumentation; pressure instrumentation; in-situ calibration and response time testing of RTDs and pressure transmitters; on-line performance monitoring and preventive maintenance of critical equipment; automated measurement of critical parameters; nuclear power plant infrastructure, management and Quality Assurance issues and recent developments for WWER and RBMK reactors. Conclusions drawn were: aging can adversely affect the performance of nuclear plant pressure transmitters; current testing interval of once in every fuel cycle is adequate for aging management; in-situ response time measurements and on-line calibration testing methods have been developed and validated for nuclear plant pressure transmitters; NUREG/CR-5851 should be taken into account for details of aging research on pressure transmitters

Presentations provided

Energy Technology Data Exchange (ETDEWEB)

Hashemian, H; Beverly, D [Analysis and Measurement Services Corp., Knoxville, TN (United States)

1999-12-31

The following topics covered in detail at the workshop included: temperature instrumentation; pressure instrumentation; in-situ calibration and response time testing of RTDs and pressure transmitters; on-line performance monitoring and preventive maintenance of critical equipment; automated measurement of critical parameters; nuclear power plant infrastructure, management and Quality Assurance issues and recent developments for WWER and RBMK reactors. Conclusions drawn were: aging can adversely affect the performance of nuclear plant pressure transmitters; current testing interval of once in every fuel cycle is adequate for aging management; in-situ response time measurements and on-line calibration testing methods have been developed and validated for nuclear plant pressure transmitters; NUREG/CR-5851 should be taken into account for details of aging research on pressure transmitters

Dashboard report on performance on select quality indicators to cancer care providers.

Science.gov (United States)

Stattin, Pär; Sandin, Fredrik; Sandbäck, Torsten; Damber, Jan-Erik; Franck Lissbrant, Ingela; Robinson, David; Bratt, Ola; Lambe, Mats

2016-01-01

Cancer quality registers are attracting increasing attention as important, but still underutilized sources of clinical data. To optimize the use of registers in quality assurance and improvement, data have to be rapidly collected, collated and presented as actionable, at-a-glance information to the reporting departments. This article presents a dashboard performance report on select quality indicators to cancer care providers. Ten quality indicators registered on an individual patient level in the National Prostate Cancer Register of Sweden and recommended by the National Prostate Cancer Guidelines were selected. Data reported to the National Prostate Cancer Register are uploaded within 24 h to the Information Network for Cancer Care platform. Launched in 2014, "What''s Going On, Prostate Cancer" provides rapid, at-a-glance performance feedback to care providers. The indicators include time to report to the National Prostate Cancer Register, waiting times, designated clinical nurse specialist, multidisciplinary conference, adherence to guidelines for diagnostic work-up and treatment, and documentation and outcome of treatment. For each indicator, three performance levels were defined. What's Going On, a dashboard performance report on 10 selected quality indicators to cancer care providers, provides an example of how data in cancer quality registers can be transformed into condensed, at-a-glance information to be used as actionable metrics for quality assurance and improvement.

Costs and Performance of English Mental Health Providers.

Science.gov (United States)

Moran, Valerie; Jacobs, Rowena

2017-06-01

Despite limited resources in mental health care, there is little research exploring variations in cost performance across mental health care providers. In England, a prospective payment system for mental health care based on patient needs has been introduced with the potential to incentivise providers to control costs. The units of payment under the new system are 21 care clusters. Patients are allocated to a cluster by clinicians, and each cluster has a maximum review period. The aim of this research is to explain variations in cluster costs between mental health providers using observable patient demographic, need, social and treatment variables. We also investigate if provider-level variables explain differences in costs. The residual variation in cluster costs is compared across providers to provide insights into which providers may gain or lose under the new financial regime. The main data source is the Mental Health Minimum Data Set (MHMDS) for England for the years 2011/12 and 2012/13. Our unit of observation is the period of time spent in a care cluster and costs associated with the cluster review period are calculated from NHS Reference Cost data. Costs are modelled using multi-level log-linear and generalised linear models. The residual variation in costs at the provider level is quantified using Empirical Bayes estimates and comparative standard errors used to rank and compare providers. There are wide variations in costs across providers. We find that variables associated with higher costs include older age, black ethnicity, admission under the Mental Health Act, and higher need as reflected in the care clusters. Provider type, size, occupancy and the proportion of formal admissions at the provider-level are also found to be significantly associated with costs. After controlling for patient- and provider-level variables, significant residual variation in costs remains at the provider level. The results suggest that some providers may have to increase

HSQC-1,n-ADEQUATE: a new approach to long-range 13C-13C correlation by covariance processing.

Science.gov (United States)

Martin, Gary E; Hilton, Bruce D; Willcott, M Robert; Blinov, Kirill A

2011-10-01

Long-range, two-dimensional heteronuclear shift correlation NMR methods play a pivotal role in the assembly of novel molecular structures. The well-established GHMBC method is a high-sensitivity mainstay technique, affording connectivity information via (n)J(CH) coupling pathways. Unfortunately, there is no simple way of determining the value of n and hence no way of differentiating two-bond from three- and occasionally four-bond correlations. Three-bond correlations, however, generally predominate. Recent work has shown that the unsymmetrical indirect covariance or generalized indirect covariance processing of multiplicity edited GHSQC and 1,1-ADEQUATE spectra provides high-sensitivity access to a (13)C-(13) C connectivity map in the form of an HSQC-1,1-ADEQUATE spectrum. Covariance processing of these data allows the 1,1-ADEQUATE connectivity information to be exploited with the inherent sensitivity of the GHSQC spectrum rather than the intrinsically lower sensitivity of the 1,1-ADEQUATE spectrum itself. Data acquisition times and/or sample size can be substantially reduced when covariance processing is to be employed. In an extension of that work, 1,n-ADEQUATE spectra can likewise be subjected to covariance processing to afford high-sensitivity access to the equivalent of (4)J(CH) GHMBC connectivity information. The method is illustrated using strychnine as a model compound. Copyright © 2011 John Wiley & Sons, Ltd.

Incentives for an adequate, economic and reliable Swiss transmission grid. Final version

International Nuclear Information System (INIS)

Twomey, P.; Neuhoff, K.; Newbery, D.

2006-11-01

This comprehensive final report for the Swiss Federal Office of Energy (SFOE) discusses incentives necessary for the implementation of an adequate, economic and reliable Swiss electricity transmission grid. As Switzerland moves towards a more liberalised and competitive electricity market, an essential task of policy makers will be to ensure that incentives are in place for the construction, maintenance and operation of adequate, economic and reliable transmission infrastructure. As well as continuing to serve the domestic market, the location of Switzerland at the centre of Europe also means that policy should embrace opportunities in servicing the developing European Internal Market by providing transit and other services. Topics discussed include the economic evaluation of transmission investment proposals, regulated transmission investment, investments in transmission lines by power merchants, power auctions and congestion management as well as inter-TSO compensation mechanisms. European regulations and practice are discussed as are access questions and transmission charges. Developments in interconnection management and harmonisation are examined. The particular characteristics of the Swiss energy system, its prices and its legal frameworks are discussed. Cross-border trading and security of supply are also discussed

Incentives for an adequate, economic and reliable Swiss transmission grid. Final version

Energy Technology Data Exchange (ETDEWEB)

Twomey, P.; Neuhoff, K.; Newbery, D.

2006-11-15

This comprehensive final report for the Swiss Federal Office of Energy (SFOE) discusses incentives necessary for the implementation of an adequate, economic and reliable Swiss electricity transmission grid. As Switzerland moves towards a more liberalised and competitive electricity market, an essential task of policy makers will be to ensure that incentives are in place for the construction, maintenance and operation of adequate, economic and reliable transmission infrastructure. As well as continuing to serve the domestic market, the location of Switzerland at the centre of Europe also means that policy should embrace opportunities in servicing the developing European Internal Market by providing transit and other services. Topics discussed include the economic evaluation of transmission investment proposals, regulated transmission investment, investments in transmission lines by power merchants, power auctions and congestion management as well as inter-TSO compensation mechanisms. European regulations and practice are discussed as are access questions and transmission charges. Developments in interconnection management and harmonisation are examined. The particular characteristics of the Swiss energy system, its prices and its legal frameworks are discussed. Cross-border trading and security of supply are also discussed

The Nigerian health care system: Need for integrating adequate medical intelligence and surveillance systems

Directory of Open Access Journals (Sweden)

Menizibeya Osain Welcome

2011-01-01

Full Text Available Objectives : As an important element of national security, public health not only functions to provide adequate and timely medical care but also track, monitor, and control disease outbreak. The Nigerian health care had suffered several infectious disease outbreaks year after year. Hence, there is need to tackle the problem. This study aims to review the state of the Nigerian health care system and to provide possible recommendations to the worsening state of health care in the country. To give up-to-date recommendations for the Nigerian health care system, this study also aims at reviewing the dynamics of health care in the United States, Britain, and Europe with regards to methods of medical intelligence/surveillance. Materials and Methods : Databases were searched for relevant literatures using the following keywords: Nigerian health care, Nigerian health care system, and Nigerian primary health care system. Additional keywords used in the search were as follows: United States (OR Europe health care dynamics, Medical Intelligence, Medical Intelligence systems, Public health surveillance systems, Nigerian medical intelligence, Nigerian surveillance systems, and Nigerian health information system. Literatures were searched in scientific databases Pubmed and African Journals OnLine. Internet searches were based on Google and Search Nigeria. Results : Medical intelligence and surveillance represent a very useful component in the health care system and control diseases outbreak, bioattack, etc. There is increasing role of automated-based medical intelligence and surveillance systems, in addition to the traditional manual pattern of document retrieval in advanced medical setting such as those in western and European countries. Conclusion : The Nigerian health care system is poorly developed. No adequate and functional surveillance systems are developed. To achieve success in health care in this modern era, a system well grounded in routine

42 CFR 493.53 - Notification requirements for laboratories issued a certificate for provider-performed microscopy...

Science.gov (United States)

2010-10-01

... certificate for provider-performed microscopy (PPM) procedures. 493.53 Section 493.53 Public Health CENTERS... CERTIFICATION LABORATORY REQUIREMENTS Registration Certificate, Certificate for Provider-performed Microscopy... certificate for provider-performed microscopy (PPM) procedures. Laboratories issued a certificate for PPM...

Adequate formal language performance in unilateral cochlear implanted children: is it indicative of complete recovery in all linguistic domains? Insights from referential communication.

Science.gov (United States)

Mancini, Patrizia; Dincer D'Alessandro, Hilal; Guerzoni, Letizia; Cuda, Domenico; Ruoppolo, Giovanni; Musacchio, Angela; Di Mario, Alessia; De Seta, Elio; Bosco, Ersilia; Nicastri, Maria

2015-04-01

Referential communication (RC) is a key element in achieving a successful communication. This case series aimed to evaluate RC in children with unilateral cochlear implants (CIs) with formal language skills within the normal range. A total of 31 children with CIs, with language development within the normal range, were assessed using the Pragmatic Language Skills test (MEDEA). Of the children with CIs, 83.9% reached performance levels appropriate for their chronological ages. The results confirmed a positive effect of cochlear implantation on RC development, although difficulties remained in some CI users. The outcomes emphasize the need to pay greater attention to the pragmatic aspects of language, assessing them with adequate testing in the early phase after cochlear implantation. Clear knowledge of children's communicative competence is the key in optimizing their communicative environments in order to create the basis for future successful interpersonal exchanges and social integration. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

How Much and What Kind? Identifying an Adequate Technology Infrastructure for Early Childhood Education. Policy Brief

Science.gov (United States)

Daugherty, Lindsay; Dossani, Rafiq; Johnson, Erin-Elizabeth; Wright, Cameron

2014-01-01

To realize the potential benefits of technology use in early childhood education (ECE), and to ensure that technology can help to address the digital divide, providers, families of young children, and young children themselves must have access to an adequate technology infrastructure. The goals for technology use in ECE that a technology…

Child malnutrition and mortality among families not utilizing adequately iodized salt in Indonesia.

Science.gov (United States)

Semba, Richard D; de Pee, Saskia; Hess, Sonja Y; Sun, Kai; Sari, Mayang; Bloem, Martin W

2008-02-01

Salt iodization is the main strategy for reducing iodine deficiency disorders worldwide. Characteristics of families not using iodized salt need to be known to expand coverage. The objective was to determine whether families who do not use iodized salt have a higher prevalence of child malnutrition and mortality and to identify factors associated with not using iodized salt. Use of adequately iodized salt (>or =30 ppm), measured by rapid test kits, was assessed between January 1999 and September 2003 in 145 522 and 445 546 families in urban slums and rural areas, respectively, in Indonesia. Adequately iodized salt was used by 66.6% and 67.2% of families from urban slums and rural areas, respectively. Among families who used adequately iodized salt, mortality in neonates, infants, and children aged urban slums; among families who did not use adequately iodized salt, the respective values were 4.2% compared with 6.3%, 7.1% compared with 11.2%, and 8.5% compared with 13.3% (P rural areas. Families not using adequately iodized salt were more likely to have children who were stunted, underweight, and wasted. In multivariate analyses that controlled for potential confounders, low maternal education was the strongest factor associated with not using adequately iodized salt. In Indonesia, nonuse of adequately iodized salt is associated with a higher prevalence of child malnutrition and mortality in neonates, infants, and children aged <5 y. Stronger efforts are needed to expand salt iodization in Indonesia.

Healthcare workers' behaviors and personal determinants associated with providing adequate sexual and reproductive healthcare services in sub-Saharan Africa: a systematic review.

Science.gov (United States)

Jonas, Kim; Crutzen, Rik; van den Borne, Bart; Reddy, Priscilla

2017-03-13

Healthcare workers may affect the utilization of sexual and reproductive healthcare (SRH) services, and quality of care thereof, for example by their behaviours or attitudes they hold. This can become a hindrance to accessing and utilizing SRH services, particularly by young people, and thus a better understanding of these behaviours and associated factors is needed to improve access to and utilization of SRH services. A systematic review of literature was conducted to identify studies focusing on healthcare workers' behaviors and personal determinants associated with providing adequate SRH services in sub-Saharan Africa (January 1990 - October 2015). Five databases were searched until 30th October 2015, using a search strategy that was adapted based on the technical requirements of each specific database. Articles were independently screened for eligibility by two researchers. Of the 125-screened full-text articles, 35 studies met all the inclusion criteria. Negative behaviours and attitudes of healthcare workers, as well as other personal determinants, such as poor knowledge and skills of SRH services, and related factors, like availability of essential drugs and equipment are associated with provision of inadequate SRH services. Some healthcare workers still have negative attitudes towards young people using contraceptives and are more likely to limit access to and utilization of SRH by adolescents especially. Knowledge of and implementation of specific SRH components are below optimum levels according to the WHO recommended guidelines. Healthcare workers' negative behaviours and attitudes are unlikely to encourage women in general to access and utilize SRH services, but more specifically young women. Knowledge of SRH services, including basic emergency obstetric care (EmOC) is insufficient among healthcare workers in SSA. A protocol for this systematic review was registered with PROSPERO and the registration number is: CRD42015017509 .

25 CFR 115.803 - What information will be provided in a statement of performance?

Science.gov (United States)

2010-04-01

... 25 Indians 1 2010-04-01 2010-04-01 false What information will be provided in a statement of performance? 115.803 Section 115.803 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR FINANCIAL... provided in a statement of performance? The statement of performance will identify the source, type, and...

Using provider performance incentives to increase HIV testing and counseling services in Rwanda.

Science.gov (United States)

de Walque, Damien; Gertler, Paul J; Bautista-Arredondo, Sergio; Kwan, Ada; Vermeersch, Christel; de Dieu Bizimana, Jean; Binagwaho, Agnès; Condo, Jeanine

2015-03-01

Paying for performance provides financial rewards to medical care providers for improvements in performance measured by utilization and quality of care indicators. In 2006, Rwanda began a pay for performance scheme to improve health services delivery, including HIV/AIDS services. Using a prospective quasi-experimental design, this study examines the scheme's impact on individual and couples HIV testing. We find a positive impact of pay for performance on HIV testing among married individuals (10.2 percentage points increase). Paying for performance also increased testing by both partners by 14.7 percentage point among discordant couples in which only one of the partners is an AIDS patient. Copyright © 2014. Published by Elsevier B.V.

Compliance Performance: Effects of a Provider Incentive Program and Coding Compliance Plan

National Research Council Canada - National Science Library

Tudela, Joseph A

2004-01-01

The purpose of this project is to study provider and coder related performance, i.e., provider compliance rate and coder productivity/accuracy rates and average dollar difference between coder and auditor, at Brooke Army Medical Center...

Effects of performance measure implementation on clinical manager and provider motivation.

Science.gov (United States)

Damschroder, Laura J; Robinson, Claire H; Francis, Joseph; Bentley, Douglas R; Krein, Sarah L; Rosland, Ann-Marie; Hofer, Timothy P; Kerr, Eve A

2014-12-01

Clinical performance measurement has been a key element of efforts to transform the Veterans Health Administration (VHA). However, there are a number of signs that current performance measurement systems used within and outside the VHA may be reaching the point of maximum benefit to care and in some settings, may be resulting in negative consequences to care, including overtreatment and diminished attention to patient needs and preferences. Our research group has been involved in a long-standing partnership with the office responsible for clinical performance measurement in the VHA to understand and develop potential strategies to mitigate the unintended consequences of measurement. Our aim was to understand how the implementation of diabetes performance measures (PMs) influences management actions and day-to-day clinical practice. This is a mixed methods study design based on quantitative administrative data to select study facilities and quantitative data from semi-structured interviews. Sixty-two network-level and facility-level executives, managers, front-line providers and staff participated in the study. Qualitative content analyses were guided by a team-based consensus approach using verbatim interview transcripts. A published interpretive motivation theory framework is used to describe potential contributions of local implementation strategies to unintended consequences of PMs. Implementation strategies used by management affect providers' response to PMs, which in turn potentially undermines provision of high-quality patient-centered care. These include: 1) feedback reports to providers that are dissociated from a realistic capability to address performance gaps; 2) evaluative criteria set by managers that are at odds with patient-centered care; and 3) pressure created by managers' narrow focus on gaps in PMs that is viewed as more punitive than motivating. Next steps include working with VHA leaders to develop and test implementation approaches to help

Horizontal cooperations between logistics service providers:motives, structure, performance

OpenAIRE

Schmoltzi, Christina; Wallenburg, Carl Marcus

2011-01-01

Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG geförderten) Allianz- bzw. Nationallizenz frei zugänglich. This publication is with permission of the rights owner freely accessible due to an Alliance licence and a national licence (funded by the DFG, German Research Foundation) respectively. Purpose – This paper aims to provide a comprehensive overview of the motives, structure and performance attributes of horizontal cooperations between logistics service provi...

The enforceability of the human right to adequate food : a comparative study

NARCIS (Netherlands)

mr.dr. Bart F.W. Wernaart

2013-01-01

While the right to adequate food is often discussed in the context of developing countries, especially in situations where access to adequate food is a problem on a larger scale, this book focusses on the right to food in two Western countries in which theoretically the circumstances allow this

Is the Marketing Concept Adequate for Continuing Education?

Science.gov (United States)

Rittenburg, Terri L.

1984-01-01

Because educators have a social responsibility to those they teach, the marketing concept may not be adequate as a philosophy for continuing education. In attempting to broaden the audience for continuing education, educators should consider a societal marketing concept to meet the needs of the educationally disadvantaged. (SK)

How adequate policies can push renewables

International Nuclear Information System (INIS)

Goldemberg, J.; Coelho, S.T.; Lucon, Oswaldo

2004-01-01

The growing interest in the establishment of a minimum share of renewable sources in the world energy matrix, after the Johannesburg's World Summit for Sustainable Development (WSSD), has raised the question about the means for such new technologies to compete with the traditional ones. The Brazilian experience in the last 25 years with ethanol as a replacement for gasoline can illustrate this possibility. Moreover, recent policies introduced by the Federal government for a minimum share of new renewable sources - wind, modern biomass and small hydro - in the Brazilian electricity matrix reinforces the country's commitment to utilize adequate policies for achieving sustainable development

Personality traits affect teaching performance of attending physicians: results of a multi-center observational study

NARCIS (Netherlands)

Scheepers, Renée A.; Lombarts, Kiki M. J. M. H.; van Aken, Marcel A. G.; Heineman, Maas Jan; Arah, Onyebuchi A.

2014-01-01

Worldwide, attending physicians train residents to become competent providers of patient care. To assess adequate training, attending physicians are increasingly evaluated on their teaching performance. Research suggests that personality traits affect teaching performance, consistent with studied

Measuring Healthcare Providers' Performances Within Managed Competition Using Multidimensional Quality and Cost Indicators.

Science.gov (United States)

Portrait, France R M; van der Galiën, Onno; Van den Berg, Bernard

2016-04-01

The Dutch healthcare system is in transition towards managed competition. In theory, a system of managed competition involves incentives for quality and efficiency of provided care. This is mainly because health insurers contract on behalf of their clients with healthcare providers on, potentially, quality and costs. The paper develops a strategy to comprehensively analyse available multidimensional data on quality and costs to assess and report on the relative performance of healthcare providers within managed competition. We had access to individual information on 2409 clients of 19 Dutch diabetes care groups on a broad range of (outcome and process related) quality and cost indicators. We carried out a cost-consequences analysis and corrected for differences in case mix to reduce incentives for risk selection by healthcare providers. There is substantial heterogeneity between diabetes care groups' performances as measured using multidimensional indicators on quality and costs. Better quality diabetes care can be achieved with lower or higher costs. Routine monitoring using multidimensional data on quality and costs merged at the individual level would allow a systematic and comprehensive analysis of healthcare providers' performances within managed competition. Copyright © 2015 John Wiley & Sons, Ltd.

Procedures for Determining the Performance of Stand-Alone Photovoltaic Systems; TOPICAL

International Nuclear Information System (INIS)

DeBlasio, R.; Durand, S.; Hansen, R.; Hutchinson, P.; Kroposki, B.; McNutt, P.; Rosenthal, A.; Thomas, M.

1999-01-01

This document provides the procedures for determining the performance of stand-alone PV systems. The procedures in this document provide a common approach for evaluating whether a given PV system is suitable to perform the function for which it was designed and manufactured to accomplish, and whether it will provide adequate power to run the load. These procedures cover small stand-alone PV systems. They cover complete outdoor system testing. Test results are valid only for the system that is tested

Are general surgery residents adequately prepared for hepatopancreatobiliary fellowships? A questionnaire-based study

Science.gov (United States)

Osman, Houssam; Parikh, Janak; Patel, Shirali; Jeyarajah, D Rohan

2015-01-01

Background The present study was conducted to assess the preparedness of hepatopancreatobiliary (HPB) fellows upon entering fellowship, identify challenges encountered by HPB fellows during the initial part of their HPB training, and identify potential solutions to these challenges that can be applied during residency training. Methods A questionnaire was distributed to all HPB fellows in accredited HPB fellowship programmes in two consecutive academic years (n = 42). Reponses were then analysed. Results A total of 19 (45%) fellows responded. Prior to their fellowship, 10 (53%) were in surgical residency and the rest were in other surgical fellowships or surgical practice. Thirteen (68%) were graduates of university-based residency programmes. All fellows felt comfortable in performing basic laparoscopic procedures independently at the completion of residency and less comfortable in performing advanced laparoscopy. Eight (42%) fellows cited a combination of inadequate case volume and lack of autonomy during residency as the reasons for this lack of comfort. Thirteen (68%) identified inadequate preoperative workup and management as their biggest fear upon entering practice after general surgery training. A total of 17 (89%) fellows felt they were adequately prepared to enter HPB fellowship. Extra rotations in transplant, vascular or minimally invasive surgery were believed to be most helpful in preparing general surgery residents pursing HPB fellowships. Conclusions Overall, HPB fellows felt themselves to be adequately prepared for fellowship. Advanced laparoscopic procedures and the perioperative management of complex patients are two of the challenges facing HPB fellows. General surgery residents who plan to pursue an HPB fellowship may benefit from spending extra rotations on certain subspecialties. Focus on perioperative workup and management should be an integral part of residency and fellowship training. PMID:25387852

Pain Management in CKD: A Guide for Nephrology Providers.

Science.gov (United States)

Koncicki, Holly M; Unruh, Mark; Schell, Jane O

2017-03-01

Although pain is one of the most commonly experienced symptoms by patients with chronic kidney disease, it is under-recognized, the severity is underestimated, and the treatment is inadequate. Pain management is one of the general primary palliative care competencies for medical providers. This review provides nephrology providers with basic skills for pain management. These skills include recognition of types of pain (nociceptive and neuropathic) syndromes and appropriate history-taking skills. Through this history, providers can identify clinical circumstances in which specialist referral is beneficial, including those who are at high risk for addiction, at risk for adverse effects to medications, and those with complicated care needs such as patients with a limited prognosis. Management of pain begins with the development of a shared treatment plan, identification of appropriate medications, and continual follow-up and assessment of efficacy and adverse effects. Through adequate pain management, providers can positively affect the health of individual patients and the performance of health care systems. Copyright © 2016 National Kidney Foundation, Inc. All rights reserved.

Region 6: Texas Austin Adequate Letter (11/23/2016)

Science.gov (United States)

EPA letter approves the Motor Vehicle Emissions Budgets contained in the latest revision to Dallas/Fort Worth 2008 8-hour Ozone State Implementation Plan, finding them adequate for transportation conformity purposes to be announced in the Federal Register.

Study Concerning Exercising an Adequate Professional Reasoning in Developing the Evaluation and Audit

Directory of Open Access Journals (Sweden)

Vârteiu Daniel Petru

2017-01-01

Even though there are regulations which clearly specify the way in which an evaluation process, respectively an adequate audit process must take place, for a good management of encountered situations and difficulties, the evaluator, respectively the auditor must exercise an adequate professional reasoning.

Providing adequate economic incentives for bioenergies with CO2 capture and geological storage

International Nuclear Information System (INIS)

Ricci, Olivia

2012-01-01

Knowing that carbon capture and storage (CCS) could play an important role in reducing emissions, it is important to have a good understanding of this role and the importance of environmental policies to support carbon capture and geological storage from bioenergies (BECCS). To date CCS technologies are not deployed on a commercial level, and policy instruments should be used to provide incentives to firms to use these technologies to reduce pollution. The aim of this paper is to compare the cost-efficiency of several incentive-based instruments (a fossil fuel tax, an emissions tax, a cap and trade system, and a subsidy on captured emissions) needed to spur the adoption of CCS and BECCS, using a dynamic general equilibrium model. This type of model has become the standard for assessing economy-wide impacts of environmental and technological policies. The study shows that BECCS will be deployed only if a specific subsidy per unit of biomass emissions captured with a CCS technology is available. We show also that the two most cost-efficient instruments for achieving a given emissions reduction target are a specific subsidy that rewards captured emissions and a carbon tax whose revenues are recycled to subsidize BECCS. - Highlights: ► We investigate the suitability of economic instruments to support CCS and BECCS. ► We model CCS and BECCS in a dynamic general equilibrium model. ► We compare the cost-efficiency of economic instruments to reduce emissions. ► A subsidy that rewards biomass captured emissions is appropriate to encourage BECCS. ► A carbon tax whose revenues are recycled to subsidize BECCS is cost-efficient.

Are doctor of pharmacy curricula in developing countries adequate to train graduates to provide pharmaceutical care?

Directory of Open Access Journals (Sweden)

Ramalingam Peraman

2017-01-01

Full Text Available Doctor of Pharmacy (PharmD program is a new dimension of pharmacy education in developing countries. The PharmD graduates are expected to participate in patient health care by providing pharmaceutical care. The graduates should have enough necessary clinical knowledge, competitiveness and skills in community, hospital and clinical pharmacy related services. There is a need of curriculum that fit into the program outcome that helps to attain graduate competency. Programs in India, Pakistan, Iran and Nepal were reviewed based on the available literature. Even though it is evident that the PharmD curriculum in developing countries has made an attempt to provide patient-oriented approach for pharmacists, the existing curriculum, training and orientation have several pitfalls. It needs assessment, evaluation and improvement.

The Audit Opinion of the DISA FY 2011 Working Capital Fund Financial Statements Was Not Adequately Supported

Science.gov (United States)

2013-04-26

President’s Council on Integrity and Efficiency MD&A Management Discussion and Analysis MFR Memorandum for Record NoF Notification of...memorandums for record ( MFRs ) would have a material impact on the financial statements and ultimately Acuity’s opinion, • perform adequate completeness...the deficiencies identified by DISA in its FBWT MFRs would impact the reliability of the financial statements and ultimately Acuity’s opinion

Enhancing entrepreneurship development in Bosnia and Herzegovina through adequate governmental financial support

Directory of Open Access Journals (Sweden)

Bahrija Umihanić

2016-06-01

Full Text Available Entrepreneurship and SME sector is extremely important for general economic development in Bosnia and Herzegovina. In order to enhance further development of the SME sector adequate sources of financing for businesses need to be available and accessible. Entrepreneurs and owners of small and medium businesses in Bosnia and Herzegovina are facing certain challenges in obtaining finances. The issue of accessing sources of finance for SMEs in this country has remained problematic for years. Many relevant studies worldwide emphasise the importance of adequate sources of financing entrepreneurship and SME development. However, a variety of factors influence financing of SMEs depending on the region, economic development, development of financial markets etc. In this paper the authors are addressing the problem of financing SMEs focusing on the governmental support, with emphasis on Bosnia and Herzegovina. The main aim of the paper is to provide an answer to the question whether the government support in Bosnia and Herzegovina enables SMEs to access initial financing, needed for their entrepreneurial activity. The paper presents results of an empirical research conducted among managers of SMEs in Bosnia and Herzegovina in regards to availability and adequacy of financial products for these businesses. The results indicate that entrepreneurs in B&H rarely use government funds as a source of financing business activities, which is mostly caused by insufficient funds and inefficient government procedures.

Do British travel agents provide adequate health advice for travellers?

Science.gov (United States)

Lawlor, D A; Burke, J; Bouskill, E; Conn, G; Edwards, P; Gillespie, D

2000-01-01

Travel-related illness is a burden for primary care, with more than two million travellers consulting a general practitioner each year. The annual cost of travel-related illness in the United Kingdom is 11 million Pounds. Travel agents are in a unique position to influence this burden as the most common and most serious problems are preventable with simple advice and/or immunisation. This study, using covert researchers, suggests this potential is not being fully utilised. PMID:10954940

Federated or cached searches: providing expected performance from multiple invasive species databases

Science.gov (United States)

Graham, Jim; Jarnevich, Catherine S.; Simpson, Annie; Newman, Gregory J.; Stohlgren, Thomas J.

2011-01-01

Invasive species are a universal global problem, but the information to identify them, manage them, and prevent invasions is stored around the globe in a variety of formats. The Global Invasive Species Information Network is a consortium of organizations working toward providing seamless access to these disparate databases via the Internet. A distributed network of databases can be created using the Internet and a standard web service protocol. There are two options to provide this integration. First, federated searches are being proposed to allow users to search “deep” web documents such as databases for invasive species. A second method is to create a cache of data from the databases for searching. We compare these two methods, and show that federated searches will not provide the performance and flexibility required from users and a central cache of the datum are required to improve performance.

Network performance and fault analytics for LTE wireless service providers

CERN Document Server

Kakadia, Deepak; Gilgur, Alexander

2017-01-01

 This book is intended to describe how to leverage emerging technologies big data analytics and SDN, to address challenges specific to LTE and IP network performance and fault management data in order to more efficiently manage and operate an LTE wireless networks. The proposed integrated solutions permit the LTE network service provider to operate entire integrated network, from RAN to Core , from UE to application service, as one unified system and correspondingly collect and align disparate key metrics and data, using an integrated and holistic approach to network analysis. The LTE wireless network performance and fault involves the network performance and management of network elements in EUTRAN, EPC and IP transport components, not only as individual components, but also as nuances of inter-working of these components. The key metrics for EUTRAN include radio access network accessibility, retainability, integrity, availability and mobility. The key metrics for EPC include MME accessibility, mobility and...

Does the mean adequately represent reading performance? Evidence from a cross-linguistic study

Directory of Open Access Journals (Sweden)

Chiara Valeria eMarinellli

2014-08-01

Full Text Available Reading models are largely based on the interpretation of average data from normal or impaired readers, mainly drawn from English-speaking individuals. In the present study we evaluated the possible contribution of orthographic consistency in generating individual differences in reading behaviour. We compared the reading performance of young adults speaking English (one of the most irregular orthographies and Italian (a very regular orthography. In the 1st experiment we presented 22 English and 30 Italian readers with 5-letter words using the Rapid Serial Visual Presentation (RSVP paradigm. In a 2nd experiment, we evaluated a new group of 26 English and 32 Italian proficient readers through the RSVP procedure and lists matched in the two languages for both number of phonemes and letters. The results of the two experiments indicate that English participants read at a similar rate but with much greater individual differences than the Italian participants. In a 3rd experiment, we extended these results to a vocal reaction time (vRT task, examining the effect of word frequency. An ex-Gaussian distribution analysis revealed differences between languages in the size of the exponential parameter (tau and in the variance (sigma, but not the mean, of the Gaussian component. Notably, English readers were more variable for both tau and sigma than Italian readers. The pattern of performance in English individuals runs counter to models of performance in timed tasks (Faust et al., 1999; Myerson et al., 2003 which envisage a general relationship between mean performance and variability; indeed, this relationship does not hold in the case of the English participants. The present data highlight the importance of developing reading models that not only capture mean level performance, but also variability across individuals, especially in order to account for cross-linguistic differences in reading behaviour.

Human Performance Evaluation System

International Nuclear Information System (INIS)

Hardwick, R.J. Jr.

1985-01-01

Operating nuclear power plants requires high standards of performance, extensive training and responsive management. Despite our best efforts inappropriate human actions do occur, but they can be managed. An extensive review of License Event Reports (LERs) was conducted which indicated continual inadequacy in human performance and in evaluation of root causes. Of some 31,000 LERs, about 5,000 or 16% were directly attributable to inappropriate actions. A recent analysis of 87 Significant Event Reports (issued by INPO in 1983) identified inappropriate actions as being the most frequent root cause (44% of the total). A more recent analysis of SERs issued in 1983 and 1984 indicate that 52% of the root causes were attributed to human performance. The Human Performance Evaluation System (HPES) is a comprehensive, coordinated utility/industry system for evaluating and reporting human performance situtations. HPES is a result of the realization that current reporting system provide limited treatment of human performance and rarely provide adequate information about root causes of inappropriate actions by individuals. The HPES was implemented to identify and eliminate root causes of inappropriate actions

9 CFR 2.40 - Attending veterinarian and adequate veterinary care (dealers and exhibitors).

Science.gov (United States)

2010-01-01

... veterinary care (dealers and exhibitors). 2.40 Section 2.40 Animals and Animal Products ANIMAL AND PLANT... and Adequate Veterinary Care § 2.40 Attending veterinarian and adequate veterinary care (dealers and... veterinary care to its animals in compliance with this section. (1) Each dealer and exhibitor shall employ an...

Current strategies for the restoration of adequate lordosis during lumbar fusion

Science.gov (United States)

Barrey, Cédric; Darnis, Alice

2015-01-01

Not restoring the adequate lumbar lordosis during lumbar fusion surgery may result in mechanical low back pain, sagittal unbalance and adjacent segment degeneration. The objective of this work is to describe the current strategies and concepts for restoration of adequate lordosis during fusion surgery. Theoretical lordosis can be evaluated from the measurement of the pelvic incidence and from the analysis of spatial organization of the lumbar spine with 2/3 of the lordosis given by the L4-S1 segment and 85% by the L3-S1 segment. Technical aspects involve patient positioning on the operating table, release maneuvers, type of instrumentation used (rod, screw-rod connection, interbody cages), surgical sequence and the overall surgical strategy. Spinal osteotomies may be required in case of fixed kyphotic spine. AP combined surgery is particularly efficient in restoring lordosis at L5-S1 level and should be recommended. Finally, not one but several strategies may be used to achieve the need for restoration of adequate lordosis during fusion surgery. PMID:25621216

4 CFR 200.14 - Responsibility for maintaining adequate safeguards.

Science.gov (United States)

2010-01-01

... identifiable personal data and automated systems shall be adequately trained in the security and privacy of... the security and privacy of such records. (5) The disposal and destruction of identifiable personal....14 Section 200.14 Accounts RECOVERY ACCOUNTABILITY AND TRANSPARENCY BOARD PRIVACY ACT OF 1974 § 200...

Is prophetic discourse adequate to address global economic justice?

Directory of Open Access Journals (Sweden)

Piet J. Naudé

2011-04-01

Full Text Available This article outlined key features of prophetic discourse and investigated whether this form of moral discourse adequately addresses issues of economic injustice. It is shown that the strength of prophetic discourse is its ability to denounce instances of injustice whilst at the same time announcing a God-willed alternative future. The ‘preferential option for the poor’ in Latin American liberation theologies is treated as a case study of the influence of prophetic discourse in contexts of perceived economic injustice. Also the core weaknesses of prophetic discourse are investigated, specifically its incomplete moral argument, weak moral analyses, silence on transition measures, and its inability to take a positive stance on reforms in the system from which itself benefits. In the final section it is concluded that prophetic discourse plays an indispensable role in addressing issues of global economic justice, but – taken by itself – it is not an adequate form of moral discourse to address concrete matters of justice.

Electrocautery device does not provide adequate pulmonary vessel sealing in transumbilical anatomic pulmonary lobectomy.

Science.gov (United States)

Liu, Hung-Ping; Chu, Yen; Wu, Yi-Cheng; Hsieh, Ming-Ju; Liu, Chieng-Ying; Chen, Tzu-Ping; Chao, Yin-Kai; Wu, Ching-Yang; Yeh, Chi-Ju; Ko, Po-Jen; Liu, Yun-Hen

2016-05-01

Safe pulmonary vessel sealing device plays a crucial role in anatomic lung resection. In 2014, we reported high rates of massive bleeding complications during transumbilical lobectomy in a canine model due to difficulty in managing the pulmonary vessel with an endostapler. In this animal survival series, we aimed to evaluate the outcome of pulmonary vessel sealing with an electrocautery device to simplify the transumbilical thoracic surgery. Under general anesthesia, a 3-cm longitudinal incision was made over the umbilicus. Under video guidance, a bronchoscope was inserted through the incision for exploration. The diaphragmatic wound was created with an electrocautery knife and used as the entrance into the thoracic cavity. Using the transumbilical technique, anatomic lobectomy was performed with electrosurgical devices and endoscopic vascular staplers in 15 canines. Transumbilical endoscopic anatomic lobectomy was successfully completed in 12 of the 15 animals. Intraoperative bleeding developed in three animals during pulmonary hilum dissection, where one animal was killed due to hemodynamic instability and the other two animals required thoracotomy to complete the operation. There were five delayed bleeding and surgical mortality cases caused by inadequate vessel sealing by electrosurgical devices. Postmortem examination confirmed correct transumbilical lobectomy in the twelve animals that survived the operations. Transumbilical anatomic lobectomy is technically feasible in a canine model; however, the electrosurgical devices were not effective in sealing the pulmonary vessel in the current canine model.

Child Care Providers' Knowledge About Dental Injury First Aid in Preschool-age Children.

Science.gov (United States)

Sienkiewicz, Kristine L; Rainchuso, Lori; Boyd, Linda D; Giblin, Lori

2017-06-01

Purpose: The aim of this study was to assess child care providers' level of knowledge of first aid management and attitudes towards dental injuries among preschool-age children within Fairfield County, Connecticut and Boston, Massachusetts. Methods: This descriptive cross-sectional study used a web-based, validated questionnaire adapted from several studies with permission from authors. A panel of 5 dental experts determined the relevance of the questions and overall content (I-CVI range 0.8-1; S-CVI = 0.95). The 28 question survey included demographics, level of knowledge, attitudes about traumatic dental injuries, emergency management, and 2 case study questions on management of luxation and tooth fracture. Survey data was coded and analyzed for associations and trends using STATA® statistics/data analysis software v. 11.2. Results: A total of 100 child care providers completed the online questionnaire. Eighty-four percent self-reported little to no knowledge about dental injury management. Sixty percent of child care providers agreed that they are responsible for managing dental injuries. Approximately two-thirds of child care providers reported not feeling adequately informed about dental injuries, with 77% expressing interest in receiving more information. Conclusions: The majority of child care providers' do not have the knowledge to perform adequate first aid following a dental injury. Professional development on first aid for dental injuries is recommended among this workforce population. Copyright © 2017 The American Dental Hygienists’ Association.

Cognitive Attributes of Adequate and Inadequate Responders to Reading Intervention in Middle School

Science.gov (United States)

Miciak, Jeremy; Stuebing, Karla K.; Vaughn, Sharon; Roberts, Greg; Barth, Amy E.; Fletcher, Jack M.

2014-01-01

No studies have investigated the cognitive attributes of middle school students who are adequate and inadequate responders to Tier 2 reading intervention. We compared students in Grades 6 and 7 representing groups of adequate responders (n = 77) and inadequate responders who fell below criteria in (a) comprehension (n = 54); (b) fluency (n = 45);…

Performance of Healthcare Providers Regarding Iranian Women Experiencing Physical Domestic Violence in Isfahan.

Science.gov (United States)

Yousefnia, Nasim; Nekuei, Nafisehsadat; Farajzadegan, Ziba; Yadegarfar, Ghasem

2018-01-01

Domestic violence (DV) can threaten women's health. Healthcare providers (HCPs) may be the first to come into contact with a victim of DV. Their appropriate performance regarding a DV victim can decrease its complications. The aim of the present study was to investigate HCPs' performance regarding women experiencing DV in emergency and maternity wards of hospitals in Isfahan, Iran. The present descriptive, cross-sectional study was conducted among 300 HCPs working in emergency and maternity wards in hospitals in Isfahan. The participants were selected using quota random sampling from February to May 2016. A researcher-made questionnaire containing the five items of HCPs performance regarding DV (assessment, intervention, documentation, reference, and follow-up) was used to collect data. The reliability and validity of the questionnaire were confirmed, and the collected data were analyzed using SPSS software. Cronbach's alpha was used to assess the reliability of the questionnaires. To present a general description of the data (variables, mean, and standard deviation), the table of frequencies was designed. The performance of the participants regarding DV in the assessment (mean = 64.22), intervention (mean = 68.55), and reference stages (mean = 68.32) were average. However, in the documentation (mean = 72.55) and follow-up stages (mean = 23.10), their performance was good and weak respectively (criterion from 100). Based on the results, because of defects in providing services for women experiencing DV, a practical indigenous guideline should be provided to treat and support these women.

16 CFR 1401.5 - Providing performance and technical data to purchasers by labeling.

Science.gov (United States)

2010-01-01

... POINT OF PURCHASE OF PERFORMANCE AND TECHNICAL DATA § 1401.5 Providing performance and technical data to... the time of original purchase and to the first purchaser for purposes other than resale. The data... to be read and understood by ordinary individuals under normal conditions of purchase. This...

Evidenced-based, practical food portion sizes for preschool children and how they fit into a well balanced, nutritionally adequate diet.

Science.gov (United States)

More, J A; Emmett, P M

2015-04-01

Healthy eating guidelines for 1-4-year-old children are available but evidence-based portion sizes have not been specified. Parents and early-years providers are concerned about under- or over-feeding young children. The present study aimed to report detailed information about appropriate average portion size ranges and suggest a practical food plan for feeding preschool children, providing adequate nutrient intakes within energy requirements. Two sources of information were used to obtain an appropriate portion size range for the types of foods normally eaten by this age group. Median portions of a variety of foods were combined into a food plan fulfilling healthy eating guidelines regarding the number of servings from each food group. The nutrient and energy content of the plan was assessed and compared with recommended adequate nutrient intakes and percentage energy contributions from macronutrients. UK children, aged 1-4 years, taking part in Avon Longitudinal Study of Parents and Children and National Diet and Nutrition Survey, were used in the present study. Portion size ranges were developed for 164 foods. The theoretical food plan using foods with high to medium nutrient density was shown to provide an adequate intake of all nutrients, except vitamin D, for which there are very few food sources. These practical food portion size ranges could be used both in early years settings and in advice to parents. The food plan emphasises the need to include a variety of nutrient-dense foods if a balanced diet is to be achieved for preschool children. © 2014 The British Dietetic Association Ltd.

10 CFR 1304.114 - Responsibility for maintaining adequate safeguards.

Science.gov (United States)

2010-01-01

... the security and privacy of personal data. (4) The disposal and disposition of identifiable personal... contained in a system of records are adequately trained to protect the security and privacy of such records....114 Section 1304.114 Energy NUCLEAR WASTE TECHNICAL REVIEW BOARD PRIVACY ACT OF 1974 § 1304.114...

Providing surgery in a war-torn context: the Médecins Sans Frontières experience in Syria.

Science.gov (United States)

Trelles, Miguel; Dominguez, Lynette; Tayler-Smith, Katie; Kisswani, Katrin; Zerboni, Alberto; Vandenborre, Thierry; Dallatomasina, Silvia; Rahmoun, Alaa; Ferir, Marie-Christine

2015-01-01

Since 2011, civil war has crippled Syria leaving much of the population without access to healthcare. Various field hospitals have been clandestinely set up to provide basic healthcare but few have been able to provide quality surgical care. In 2012, Medecins Sans Frontieres (MSF) began providing surgical care in the Jabal al-Akrad region of north-western Syria. Based on the MSF experience, we describe, for the period 5th September 2012 to 1st January 2014: a) the volume and profile of surgical cases, b) the volume and type of anaesthetic and surgical procedures performed, and c) the intraoperative mortality rate. A descriptive study using routinely collected MSF programme data. Quality surgical care was assured through strict adherence to the following minimum standards: adequate infrastructure, adequate water and sanitation provisions, availability of all essential disposables, drugs and equipment, strict adherence to hygiene requirements and universal precautions, mandatory use of sterile equipment for surgical and anaesthesia procedures, capability for blood transfusion and adequate human resources. During the study period, MSF operated on 578 new patients, of whom 57 % were male and median age was 25 years (Interquartile range: 21-32 years). Violent trauma was the most common surgical indication (n-254, 44 %), followed by obstetric emergencies (n-191, 33 %) and accidental trauma (n-59, 10 %). In total, 712 anaesthetic procedures were performed. General anaesthesia without intubation was the most common type of anaesthesia (47 % of all anaesthetics) followed by spinal anaesthesia (25 %). A total of 831 surgical procedures were performed, just over half being minor/wound care procedures and nearly one fifth, caesarean sections. There were four intra-operative deaths, giving an intra-operative mortality rate of 0.7 %. Surgical needs in a conflict-afflicted setting like Syria are high and include both combat and non-combat indications, particularly

Need for Adequate Funding in the Administration of Secondary ...

African Journals Online (AJOL)

Funding is considered all over the world as the life wire that propels the educational sector towards achieving her objectives. The paper focuses on the need for adequate funding of secondary education in Nigeria. Emphases were laid on the alternative sources of funding for secondary schools as well as the consequences ...

Performance of healthcare providers regarding iranian women experiencing physical domestic violence in Isfahan

Directory of Open Access Journals (Sweden)

Nasim Yousefnia

2018-01-01

Full Text Available Background: Domestic violence (DV can threaten women's health. Healthcare providers (HCPs may be the first to come into contact with a victim of DV. Their appropriate performance regarding a DV victim can decrease its complications. The aim of the present study was to investigate HCPs' performance regarding women experiencing DV in emergency and maternity wards of hospitals in Isfahan, Iran. Materials and Methods: The present descriptive, cross-sectional study was conducted among 300 HCPs working in emergency and maternity wards in hospitals in Isfahan. The participants were selected using quota random sampling from February to May 2016. A researcher-made questionnaire containing the five items of HCPs performance regarding DV (assessment, intervention, documentation, reference, and follow-up was used to collect data. The reliability and validity of the questionnaire were confirmed, and the collected data were analyzed using SPSS software. Cronbach's alpha was used to assess the reliability of the questionnaires. To present a general description of the data (variables, mean, and standard deviation, the table of frequencies was designed. Results: The performance of the participants regarding DV in the assessment (mean = 64.22, intervention (mean = 68.55, and reference stages (mean = 68.32 were average. However, in the documentation (mean = 72.55 and follow-up stages (mean = 23.10, their performance was good and weak respectively (criterion from 100. Conclusions: Based on the results, because of defects in providing services for women experiencing DV, a practical indigenous guideline should be provided to treat and support these women.

Managing poorly performing clinicians: health care providers' willingness to pay for independent help.

Science.gov (United States)

Watson, Verity; Sussex, Jon; Ryan, Mandy; Tetteh, Ebenezer

2012-03-01

To determine the willingness to pay (WTP) of senior managers in the UK National Health Service (NHS) for services to help manage performance concerns with doctors, dentists and pharmacists. A discrete choice experiment (DCE) was used to elicit senior managers' preferences for a support service to help manage clinical performance concerns. The DCE was based on: a literature review; interviews with support service providers and clinical professional bodies; and discussion groups with managers. From the DCE responses, we estimate marginal WTP for aspects of support services. 451 NHS managers completed the DCE questionnaire. NHS managers are willing to pay for: advice, 'facilitation', and behavioural, health, clinical and organisational assessments. Telephone advice with written confirmation was valued most highly. NHS managers were willing to pay £161.56 (CI: £160.81-£162.32) per year per whole time equivalent doctor, dentist or pharmacist, for support to help manage clinical performance concerns. Marginal WTP varied across respondent subgroups but was always positive. Health care managers valued help in managing the clinicians' performance, and were willing to pay for it from their organisations' limited funds. Their WTP exceeds the current cost of a UK body providing similar support. Establishing a central body to provide such services across a health care system, with the associated economies of scale including cumulative experience, is an option that policy makers should consider seriously. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

PERFORMANCE AUDITING OF A HUMAN AIR POLLUTION EXPOSURE CHAMBER FOR PM2.5

Science.gov (United States)

Databases derived from human health effects research play a vital role in setting environmental standards. An underlying assumption in using these databases for standard setting purposes is that they are of adequate quality. The performance auditing program described provides n...

Market competition, ownership, payment systems and the performance of health care providers - a panel study among Finnish occupational health services providers.

Science.gov (United States)

Kankaanpää, Eila; Linnosmaa, Ismo; Valtonen, Hannu

2013-10-01

Many health care reforms rely on competition although health care differs in many respects from the assumptions of perfect competition. Finnish occupational health services provide an opportunity to study empirically competition, ownership and payment systems and the performance of providers. In these markets employers (purchasers) choose the provider and prices are market determined. The price regulation of public providers was abolished in 1995. We had data on providers from 1992, 1995, 1997, 2000 and 2004. The unbalanced panel consisted of 1145 providers and 4059 observations. Our results show that in more competitive markets providers in general offered a higher share of medical care compared to preventive services. The association between unit prices and revenues and market environment varied according to the provider type. For-profit providers had lower prices and revenues in markets with numerous providers. The public providers in more competitive regions were more sensitive to react to the abolishment of their price regulation by raising their prices. Employer governed providers had weaker association between unit prices or revenues and competition. The market share of for-profit providers was negatively associated with productivity, which was the only sign of market spillovers we found in our study.

Developing a model for the adequate description of electronic communication in hospitals.

Science.gov (United States)

Saboor, Samrend; Ammenwerth, Elske

2011-01-01

Adequate information and communication systems (ICT) can help to improve the communication in hospitals. Changes to the ICT-infrastructure of hospitals must be planed carefully. In order to support a comprehensive planning, we presented a classification of 81 common errors of the electronic communication on the MIE 2008 congress. Our objective now was to develop a data model that defines specific requirements for an adequate description of electronic communication processes We first applied the method of explicating qualitative content analysis on the error categorization in order to determine the essential process details. After this, we applied the method of subsuming qualitative content analysis on the results of the first step. A data model for the adequate description of electronic communication. This model comprises 61 entities and 91 relationships. The data model comprises and organizes all details that are necessary for the detection of the respective errors. It can be for either used to extend the capabilities of existing modeling methods or as a basis for the development of a new approach.

Cognitive Attributes of Adequate and Inadequate Responders to Reading Intervention in Middle School

OpenAIRE

Miciak, Jeremy; Stuebing, Karla K.; Vaughn, Sharon; Roberts, Greg; Barth, Amy Elizabeth; Fletcher, Jack M.

2014-01-01

No studies have investigated the cognitive attributes of middle school students who are adequate and inadequate responders to Tier 2 reading intervention. We compared students in Grades 6 and 7 representing groups of adequate responders (n = 77) and inadequate responders who fell below criteria in (a) comprehension (n = 54); (b) fluency (n = 45); and (c) decoding, fluency, and comprehension (DFC; n = 45). These students received measures of phonological awareness, listening comprehension, rap...

Performance modeling of network data services

Energy Technology Data Exchange (ETDEWEB)

Haynes, R.A.; Pierson, L.G.

1997-01-01

Networks at major computational organizations are becoming increasingly complex. The introduction of large massively parallel computers and supercomputers with gigabyte memories are requiring greater and greater bandwidth for network data transfers to widely dispersed clients. For networks to provide adequate data transfer services to high performance computers and remote users connected to them, the networking components must be optimized from a combination of internal and external performance criteria. This paper describes research done at Sandia National Laboratories to model network data services and to visualize the flow of data from source to sink when using the data services.

Are the current Australian sun exposure guidelines effective in maintaining adequate levels of 25-hydroxyvitamin D?

Science.gov (United States)

Kimlin, Michael; Sun, Jiandong; Sinclair, Craig; Heward, Sue; Hill, Jane; Dunstone, Kimberley; Brodie, Alison

2016-01-01

An adequate vitamin D status, as measured by serum 25-hydroxyvitamin D (25(OH)D) concentration, is important in humans for maintenance of healthy bones and muscle function. Serum 25(OH)D concentration was assessed in participants from Melbourne, Australia (37.81S, 144.96E), who were provided with the current Australian guidelines on sun exposure for 25(OH)D adequacy (25(OH)D ≥50 nmol/L). Participants were interviewed in February (summer, n=104) and August (winter, n=99) of 2013. Serum 25(OH)D concentration was examined as a function of measures of sun exposure and sun protection habits with control of key characteristics such as dietary intake of vitamin D, body mass index (BMI) and skin colour, that may modify this relationship. The mean 25(OH)D concentration in participants who complied with the current sun exposure guidelines was 67.3 nmol/L in summer and 41.9 nmol/L in winter. At the end of the study, 69.3% of participants who complied with the summer sun exposure guidelines were 25(OH)D adequate, while only 27.6% of participants who complied with the winter sun exposure guidelines were 25(OH)D adequate at the end of the study. The results suggest that the current Australian guidelines for sun exposure for 25(OH)D adequacy are effective for most in summer and ineffective for most in winter. This article is part of a Special Issue entitled '17th Vitamin D Workshop'. Copyright © 2015 Elsevier Ltd. All rights reserved.

12 CFR 1229.5 - Capital distributions for adequately capitalized Banks.

Science.gov (United States)

2010-01-01

... capitalized Banks. 1229.5 Section 1229.5 Banks and Banking FEDERAL HOUSING FINANCE AGENCY ENTITY REGULATIONS CAPITAL CLASSIFICATIONS AND PROMPT CORRECTIVE ACTION Federal Home Loan Banks § 1229.5 Capital... classification of adequately capitalized. A Bank may not make a capital distribution if such distribution would...

Adequate proverb interpretation is associated with performance on the independent living scales.

Science.gov (United States)

Ahmed, Fayeza S; Miller, L Stephen

2015-01-01

The purpose of this study was to examine proverb interpretation performance and functional independence in older adults. From the limited literature on proverb interpretation in aging and its conceptualization as an executive function, it was hypothesized that proverb interpretation would be related to functional independence similar to other executive functions. Tests of proverb interpretation, additional executive functions, and functional ability were administered to nondemented older adults. Results showed that proverb interpretation accounted for a significant amount of unique variance of functional ability scores. This supports including a measure of proverb interpretation to the assessment of older adults.

Procurement risk management practices and supply chain performance among mobile phone service providers in Kenya

OpenAIRE

Emily Adhiambo Okonjo; Peterson Obara Magutu; Richard Bitange Nyaoga

2016-01-01

The aim of this study was to establish the relationship between procurement risk management practices and supply chain performance among mobile phone service providers in Kenya. The study specifically set out to establish the extent to which mobile phone service providers have implemented procurement risk management practices and to determine the relationship between procurement risk management practices and supply chain performance. The study adopted a descriptive study design by collecting ...

A traumatic central cord syndrome occurring after adequate decompression for cervical spondylosis: biomechanics of injury: case report.

Science.gov (United States)

Dickerman, Rob D; Lefkowitz, Michael; Epstein, Joseph A

2005-10-15

Case report with review of the literature. To present the first case of a central cord syndrome occurring after adequate decompression, and review the mechanics of the cervical spinal cord injury and postoperative biomechanical and anatomic changes occurring after cervical decompressive laminectomy. Cervical spondylosis is a common pathoanatomic occurrence in the elderly population and is thought to be one of the primary causes for a central cord syndrome. Decompressive laminectomy with or without fusion has been a primary treatment for spondylotic disease and is thought to be protective against further injury. To our knowledge, there are no cases of a central cord syndrome occurring after adequate decompression reported in the literature. Case study with extensive review of the literature. The patient underwent C3-C7 cervical laminectomy without complications. After surgery, the patient's spasticity and gait difficulties improved. She was discharged to inpatient rehabilitation for further treatment of upper extremity weakness. The patient fell in the rehabilitation center, with a central cord syndrome despite adequate decompression of her spinal canal. The patient was treated conservatively for the central cord and had minimal improvement. Decompressive laminectomy provides an immediate decompressive effect on the spinal cord as seen by the dorsal migration of the cord, however, the biomechanics of the cervical spine after decompressive laminectomy remain uncertain. This case supports the ongoing research and need for more intensive research on postoperative cervical spine biomechanics, including decompressive laminectomies, decompressive laminectomy and fusion, and laminoplasty.

Procurement risk management practices and supply chain performance among mobile phone service providers in Kenya

Directory of Open Access Journals (Sweden)

Emily Adhiambo Okonjo

2016-02-01

Full Text Available The aim of this study was to establish the relationship between procurement risk management practices and supply chain performance among mobile phone service providers in Kenya. The study specifically set out to establish the extent to which mobile phone service providers have implemented procurement risk management practices and to determine the relationship between procurement risk management practices and supply chain performance. The study adopted a descriptive study design by collecting data from the four (4 mobile telecommunication companies in Kenya using a self-administered questionnaire. Means, standard deviation, and regression analysis were used to analyze the data collected. The study established that most of the mobile phone service providers in Kenya had implemented procurement risk management practices. It was also clear that there was a very significant relationship between procurement risk management practices and supply chain performance.

Region 10: Idaho Northern Ada County Adequate Letter (6/21/2013)

Science.gov (United States)

EPA approves motor vehicle emissions budget in the Northern Ada County PM10 State Implementation Plan, Maintenance Plan: Ten-Year Update for PM10 national ambient air quality standard, adequate for transportation conformity purposes.

Can pay-for-performance to primary care providers stimulate appropriate use of antibiotics?

DEFF Research Database (Denmark)

Dietrichson, Jens; Maria Ellegård, Lina; Anell, Anders

-for-performance in a difference-in-differences analysis. Despite that the monetary incentives were small, we find that P4P significantly increased narrow-spectrum antibiotics' share of RTI antibiotics consumption. We further find larger effects in areas where there were many private providers, where the incentive was formulated...... as a penalty rather than a reward, and where all providers were close to a P4P target....

Effect of Prior Cardiopulmonary Resuscitation Knowledge on Compression Performance by Hospital Providers

Directory of Open Access Journals (Sweden)

Joshua N. Burkhardt

2014-07-01

Full Text Available Introduction: The purpose of this study was to determine cardiopulmonary resuscitation (CPR knowledge of hospital providers and whether knowledge affects performance of effective compressions during a simulated cardiac arrest. Methods: This cross-sectional study evaluated the CPR knowledge and performance of medical students and ED personnel with current CPR certification. We collected data regarding compression rate, hand placement, depth, and recoil via a questionnaire to determine knowledge, and then we assessed performance using 60 seconds of compressions on a simulation mannequin. Results: Data from 200 enrollments were analyzed by evaluators blinded to subject knowledge. Regarding knowledge, 94% of participants correctly identified parameters for rate, 58% for hand placement, 74% for depth, and 94% for recoil. Participants identifying an effective rate of ≥100 performed compressions at a significantly higher rate than participants identifying <100 (µ=117 vs. 94, p<0.001. Participants identifying correct hand placement performed significantly more compressions adherent to guidelines than those identifying incorrect placement (µ=86% vs. 72%, p<0.01. No significant differences were found in depth or recoil performance based on knowledge of guidelines. Conclusion: Knowledge of guidelines was variable; however, CPR knowledge significantly impacted certain aspects of performance, namely rate and hand placement, whereas depth and recoil were not affected. Depth of compressions was poor regardless of prior knowledge, and knowledge did not correlate with recoil performance. Overall performance was suboptimal and additional training may be needed to ensure consistent, effective performance and therefore better outcomes after cardiopulmonary arrest.

48 CFR 52.216-29 - Time-and-Materials/Labor-Hour Proposal Requirements-Non-Commercial Item Acquisition With Adequate...

Science.gov (United States)

2010-10-01

...-Hour Proposal Requirements-Non-Commercial Item Acquisition With Adequate Price Competition. 52.216-29... Proposal Requirements—Non-Commercial Item Acquisition With Adequate Price Competition (FEB 2007) (a) The... Time-and-Materials/Labor-Hour Proposal Requirements—Non-Commercial Item Acquisition With Adequate Price...

[Neonatal ABO incompatibility underlies a potentially severe hemolytic disease of the newborn and requires adequate care].

Science.gov (United States)

Senterre, T; Minon, J-M; Rigo, J

2011-03-01

ABO allo-immunization is the most frequent hemolytic disease of the newborn and ABO incompatibility is present in 15-25 % of pregnancies. True ABO alloimmunization occurs in approximately one out of 150 births. Intensity is generally lower than in RhD allo-immunization. We report on three cases showing that ABO allo-immunization can lead to severe hemolytic disease of the newborn with potentially threatening hyperbilirubinemia and complications. Early diagnosis and adequate care are necessary to prevent complications in ABO incompatibility. A direct antiglobulin test is the cornerstone of diagnosis and should be performed at birth on cord blood sampling in all group infants born to O mothers, especially if of African origin. Risk factor analysis and attentive clinical monitoring during the first days of life are essential. Vigilance is even more important for infants discharged before the age of 72 h. Every newborn should be assessed for the risk of developing severe hyperbilirubinemia and should be examined by a qualified healthcare professional in the first days of life. Treatment depends on the total serum bilirubin level, which may increase very rapidly in the first 48 h of life in cases of hemolytic disease of the newborn. Phototherapy and, in severe cases, exchange transfusion are used to prevent hyperbilirubinemia encephalopathy. Intravenous immunoglobulins are used to reduce exchange transfusion. Treatments of severe hemolytic disease of the newborn should be provided and performed by trained personnel in neonatal intensive care units. Copyright © 2010 Elsevier Masson SAS. All rights reserved.

[The human right to adequate food: an urban vision].

Science.gov (United States)

Casemiro, Juliana Pereira; Valla, Victor Vincent; Guimarães, Maria Beatriz Lisboa

2010-07-01

The human right to adequate food is comprehended in two dimensions: being free of hunger and denutrition and having access to an adequate food. The urban context, in which the possession of food is done primarily through merchandising because of its strong consuming appealing, became a big challenge to debate this topic in poor districts today. Here we combine considerations of a qualitative study carried out in São João de Meriti, Rio de Janeiro State, joining leaders from Pastoral da Criança in focal group sessions. The unemployment, the sub-employment and the difficulty in reaching the public health system, the social assistance and basic sanitation were presented as the major obstacles to bring into effect the human right to food. It was possible to determine that, among the strategies to fight the poverty and hunger, a big highlight is the establishment of mutual help mechanisms. The social support, generosity and religiousness were presented as the most important categories among the thoughts of the leaders. Facing a reality in which poverty and hunger appear as something inherent or become a mechanism of change during elections, the issue of the clienteles appears as a huge concern and challenge for those leaders.

Which Food Security Determinants Predict Adequate Vegetable Consumption among Rural Western Australian Children?

Science.gov (United States)

Godrich, Stephanie L; Lo, Johnny; Davies, Christina R; Darby, Jill; Devine, Amanda

2017-01-03

Improving the suboptimal vegetable consumption among the majority of Australian children is imperative in reducing chronic disease risk. The objective of this research was to determine whether there was a relationship between food security determinants (FSD) (i.e., food availability, access, and utilisation dimensions) and adequate vegetable consumption among children living in regional and remote Western Australia (WA). Caregiver-child dyads ( n = 256) living in non-metropolitan/rural WA completed cross-sectional surveys that included questions on FSD, demographics and usual vegetable intake. A total of 187 dyads were included in analyses, which included descriptive and logistic regression analyses via IBM SPSS (version 23). A total of 13.4% of children in this sample had adequate vegetable intake. FSD that met inclusion criteria ( p ≤ 0.20) for multivariable regression analyses included price; promotion; quality; location of food outlets; variety of vegetable types; financial resources; and transport to outlets. After adjustment for potential demographic confounders, the FSD that predicted adequate vegetable consumption were, variety of vegetable types consumed ( p = 0.007), promotion ( p = 0.017), location of food outlets ( p = 0.027), and price ( p = 0.043). Food retail outlets should ensure that adequate varieties of vegetable types (i.e., fresh, frozen, tinned) are available, vegetable messages should be promoted through food retail outlets and in community settings, towns should include a range of vegetable purchasing options, increase their reliance on a local food supply and increase transport options to enable affordable vegetable purchasing.

Which Food Security Determinants Predict Adequate Vegetable Consumption among Rural Western Australian Children?

Directory of Open Access Journals (Sweden)

Stephanie L. Godrich

2017-01-01

Full Text Available Improving the suboptimal vegetable consumption among the majority of Australian children is imperative in reducing chronic disease risk. The objective of this research was to determine whether there was a relationship between food security determinants (FSD (i.e., food availability, access, and utilisation dimensions and adequate vegetable consumption among children living in regional and remote Western Australia (WA. Caregiver-child dyads (n = 256 living in non-metropolitan/rural WA completed cross-sectional surveys that included questions on FSD, demographics and usual vegetable intake. A total of 187 dyads were included in analyses, which included descriptive and logistic regression analyses via IBM SPSS (version 23. A total of 13.4% of children in this sample had adequate vegetable intake. FSD that met inclusion criteria (p ≤ 0.20 for multivariable regression analyses included price; promotion; quality; location of food outlets; variety of vegetable types; financial resources; and transport to outlets. After adjustment for potential demographic confounders, the FSD that predicted adequate vegetable consumption were, variety of vegetable types consumed (p = 0.007, promotion (p = 0.017, location of food outlets (p = 0.027, and price (p = 0.043. Food retail outlets should ensure that adequate varieties of vegetable types (i.e., fresh, frozen, tinned are available, vegetable messages should be promoted through food retail outlets and in community settings, towns should include a range of vegetable purchasing options, increase their reliance on a local food supply and increase transport options to enable affordable vegetable purchasing.

COMMUNICATION OPENNESS IN PERFORMANCE APPRAISAL SYSTEMS ENHANCING JOB SATISFACTION

Directory of Open Access Journals (Sweden)

ISMAIL Azman

2014-06-01

Full Text Available The aim of this paper is to investigate the relationship between communication openness in performance appraisal systems and job satisfaction. A survey method was employed to gather data from employees who have worked in a privatized postal company in Sarawak, Malaysia. SmartPLS version 2.0 was used to determine the validity and reliability of instrument and test the research hypotheses. The outcomes of SmartPLS path model showed that explanation and feedback were positively and significantly related to job satisfaction. This result confirms that the ability of appraisers to clearly explain the performance appraisal practices and adequately provide feedback in determining performance scores have been important predictors of appraises’ job satisfaction in the studied organization. Further, this study provides discussion, implications and conclusion.

Apneic oxygenation combined with extracorporeal arteriovenous carbon dioxide removal provides sufficient gas exchange in experimental lung injury

DEFF Research Database (Denmark)

Nielsen, Niels Dalsgaard; Kjærgaard, Benedict; Koefoed-Nielsen, Jacob

2008-01-01

We hypothesized that apneic oxygenation, using an open lung approach, combined with extracorporeal CO2 removal, would provide adequate gas exchange in acute lung injury. We tested this hypothesis in nine anesthetized and mechanically ventilated pigs (85-95 kg), in which surfactant was depleted fr....../min. Thus, the method provided adequate gas exchange in this experimental model, suggesting that it might have potential as an alternative treatment modality in acute lung injury.......We hypothesized that apneic oxygenation, using an open lung approach, combined with extracorporeal CO2 removal, would provide adequate gas exchange in acute lung injury. We tested this hypothesis in nine anesthetized and mechanically ventilated pigs (85-95 kg), in which surfactant was depleted from...

Impact of Providing Compassion on Job Performance and Mental Health: The Moderating Effect of Interpersonal Relationship Quality.

Science.gov (United States)

Chu, Li-Chuan

2017-07-01

To examine the relationships of providing compassion at work with job performance and mental health, as well as to identify the role of interpersonal relationship quality in moderating these relationships. This study adopted a two-stage survey completed by 235 registered nurses employed by hospitals in Taiwan. All hypotheses were tested using hierarchical regression analyses. The results show that providing compassion is an effective predictor of job performance and mental health, whereas interpersonal relationship quality can moderate the relationships of providing compassion with job performance and mental health. When nurses are frequently willing to listen, understand, and help their suffering colleagues, the enhancement engendered by providing compassion can improve the provider's job performance and mental health. Creating high-quality relationships in the workplace can strengthen the positive benefits of providing compassion. Motivating employees to spontaneously exhibit compassion is crucial to an organization. Hospitals can establish value systems, belief systems, and cultural systems that support a compassionate response to suffering. In addition, nurses can internalize altruistic belief systems into their own personal value systems through a long process of socialization in the workplace. © 2017 Sigma Theta Tau International.

Providing hierarchical approach for measuring supply chain performance using AHP and DEMATEL methodologies

Directory of Open Access Journals (Sweden)

Ali Najmi

2010-06-01

Full Text Available Measuring the performance of a supply chain is normally of a function of various parameters. Such a problem often involves in a multiple criteria decision making (MCMD problem where different criteria need to be defined and calculated, properly. During the past two decades, Analytical hierarchy procedure (AHP and DEMATEL have been some of the most popular MCDM approaches for prioritizing various attributes. The study of this paper uses a new methodology which is a combination of AHP and DEMATEL to rank various parameters affecting the performance of the supply chain. The DEMATEL is used for understanding the relationship between comparison metrics and AHP is used for the integration to provide a value for the overall performance.

BUSINESS PERFORMANCE OF HEALTH TOURISM SERVICE PROVIDERS IN THE REPUBLIC OF CROATIA.

Science.gov (United States)

Vrkljan, Sanela; Hendija, Zvjezdana

2016-03-01

Health tourism can be generally divided into medical, health spa and wellness tourism. Health spa tourism services are provided in special hospitals for medical rehabilitation and health resorts, and include under medical supervision controlled use of natural healing factors and physical therapy in order to improve and preserve health. There are 13 special hospitals for medical rehabilitation and health resorts in Croatia. Most of them are financed through the state budget and lesser by sale on the market. More than half of their accommodation capacity is offered for sale on the market while the rest is under contract with the Croatian Health Insurance Fund. Domestic overnights are several times higher than foreign overnights. The aim of this study was to analyze business performance of special hospitals for medical rehabilitation and health resorts in Croatia in relation to the sources of financing and the structure of service users. The assumption was that those who are more market-oriented achieve better business performance. In proving these assumptions, an empirical research was conducted and the assumptions were tested. A positive correlation was proven in tested indicators of business performance of the analyzed service providers of health-spa tourism with a higher amount of overnight stays realized through sales on the market in relation to total overnight stays, with a greater share of foreign overnights in total of overnights and with a higher share of realized revenue on the market out of total revenue. The results of the research show that special hospitals for medical rehabilitation and health resorts that are more market-oriented are more successful in their business performance. These findings are important for planning the health and tourism policies in countries like Croatia.

Establishing adequate conditions for mercury determination in environmental samples by INAA

International Nuclear Information System (INIS)

Perez, Caroline; Santos, Eliane C.; Saiki, Mitiko

2017-01-01

Mercury (Hg) is a toxic element released into the environment mainly by anthropic activities. Consequently, the improvement for Hg determination in environmental samples is of great interest. Instrumental Neutron Activation Analysis (INAA) is considered an adequate method to determine several elements. However, Hg determination by INAA is often hampered by its volatility, which causes losses. The aim of this study was to establish adequate irradiation conditions for Hg determination in environmental samples by INAA. The following parameters were evaluated: irradiation time, container for irradiation and spectral gamma ray interferences. For the study, aliquots of certified reference materials (CRMs) and tree bark samples were irradiated together with Hg synthetic standard at the IEA-R1 nuclear research reactor. Gamma ray activities of 1 97 Hg and 203 Hg were measured in a spectrometer coupled to a HGe detector. Results obtained indicated that polyethylene capsules or envelopes can be used as container for sample irradiation and the Hg impurities in these containers were negligible. Irradiation time of one hour was adequate for Hg determination and in long irradiations of 8 h problems of spectral interference of 198 Au and 75 Se were observed. In addition, Hg loss during the irradiation of 1 h and after irradiation was not observed. Quality control of Hg results, obtained in the CRMs analyses using one hour of irradiation, indicated good precision and accuracy with |Z score| < 2. The experimental conditions established in this study were applied to tree bark samples. Detection limits for Hg of these analyses were between 0.14 and 1.9 μg g -1 . (author)

Barriers to adequate prenatal care utilization in American Samoa

Science.gov (United States)

Hawley, Nicola L; Brown, Carolyn; Nu’usolia, Ofeira; Ah-Ching, John; Muasau-Howard, Bethel; McGarvey, Stephen T

2013-01-01

Objective To describe the utilization of prenatal care in American Samoan women and to identify socio-demographic predictors of inadequate prenatal care utilization. Methods Using data from prenatal clinic records, women (n=692) were categorized according to the Adequacy of Prenatal Care Utilization Index as having received adequate plus, adequate, intermediate or inadequate prenatal care during their pregnancy. Categorical socio-demographic predictors of the timing of initiation of prenatal care (week of gestation) and the adequacy of received services were identified using one way Analysis of Variance (ANOVA) and independent samples t-tests. Results Between 2001 and 2008 85.4% of women received inadequate prenatal care. Parity (P=0.02), maternal unemployment (P=0.03), and both parents being unemployed (P=0.03) were negatively associated with the timing of prenatal care initation. Giving birth in 2007–2008, after a prenatal care incentive scheme had been introduced in the major hospital, was associated with earlier initiation of prenatal care (20.75 versus 25.12 weeks; Pprenatal care utilization in American Samoa is a major concern. Improving healthcare accessibility will be key in encouraging women to attend prenatal care. The significant improvements in the adequacy of prenatal care seen in 2007–2008 suggest that the prenatal care incentive program implemented in 2006 may be a very positive step toward addressing issues of prenatal care utilization in this population. PMID:24045912

American College of Sports Medicine position stand. Nutrition and athletic performance.

Science.gov (United States)

Rodriguez, Nancy R; Di Marco, Nancy M; Langley, Susie

2009-03-01

It is the position of the American Dietetic Association, Dietitians of Canada, and the American College of Sports Medicine that physical activity, athletic performance, and recovery from exercise are enhanced by optimal nutrition. These organizations recommend appropriate selection of foods and fluids, timing of intake, and supplement choices for optimal health and exercise performance. This updated position paper couples a rigorous, systematic, evidence-based analysis of nutrition and performance-specific literature with current scientific data related to energy needs, assessment of body composition, strategies for weight change, nutrient and fluid needs, special nutrient needs during training and competition, the use of supplements and ergogenic aids, nutrition recommendations for vegetarian athletes, and the roles and responsibilities of the sports dietitian. Energy and macronutrient needs, especially carbohydrate and protein, must be met during times of high physical activity to maintain body weight, replenish glycogen stores, and provide adequate protein to build and repair tissue. Fat intake should be sufficient to provide the essential fatty acids and fat-soluble vitamins and to contribute energy for weight maintenance. Although exercise performance can be affected by body weight and composition, these physical measures should not be a criterion for sports performance and daily weigh-ins are discouraged. Adequate food and fluid should be consumed before, during, and after exercise to help maintain blood glucose concentration during exercise, maximize exercise performance, and improve recovery time. Athletes should be well hydrated before exercise and drink enough fluid during and after exercise to balance fluid losses. Sports beverages containing carbohydrates and electrolytes may be consumed before, during, and after exercise to help maintain blood glucose concentration, provide fuel for muscles, and decrease risk of dehydration and hyponatremia. Vitamin

Scope of work for evaluating the mechanical performance of EPR first wall coatings

International Nuclear Information System (INIS)

Jones, W.B.; Van Den Avyle, J.A.

1978-01-01

An outline is presented for a proposed scope of work to evaluate the mechanical performance of candidate first wall coatings for a Tokamak-type fusion reactor. The goal of the overall program is to provide an adequate coating material and recoating process which can be manufactured by currently available vendors

Providing Hospitalized Patients With an Educational Booklet Increases the Quality of Colonoscopy Bowel Preparation.

Science.gov (United States)

Ergen, William F; Pasricha, Trisha; Hubbard, Francie J; Higginbotham, Tina; Givens, Tonya; Slaughter, James C; Obstein, Keith L

2016-06-01

Inadequate bowel preparation is a problem frequently encountered by gastroenterologists who perform colonoscopies on hospitalized patients. A method is needed to increase the quality of bowel preparation in inpatients. An educational booklet has been shown to increase the overall quality of bowel preparation for outpatients. We performed a prospective study to evaluate the effects of an educational booklet on the quality of bowel preparation in a group of hospitalized patients. We performed a randomized, single-blind, controlled trial of all inpatients at a tertiary care medical center scheduled for inpatient colonoscopy from October 2013 through March 2014. They were randomly assigned to groups that were (n = 45) or were not (controls, n = 40) given the booklet before bowel preparation the evening before their colonoscopy. All patients received a standard bowel preparation (clear liquid diet the day before the procedure, followed by split-dose GoLYTELY). At the colonoscopy, the Boston Bowel preparation scale (BBPS) was used to assess bowel preparation. The primary outcome measure was adequate bowel preparation (a total BBPS score ≥6 with all segment scores ≥2). Secondary outcomes assessed included total BBPS score, BBPS segment score, and a total BBPS score of 0. There were no differences between the groups in age, race, sex, body mass index, history of colonoscopy, history of polyps, or time of colonoscopy. Twenty-eight patients who received the booklet (62%) and 14 who did not (35%) had an adequate bowel preparation (P = .012). The number needed to treat to attain adequate bowel preparation was 4. After adjusting for age and history of prior colonoscopies, the odds of achieving an adequate bowel preparation and a higher total BBPS score after receipt of the booklet were 3.14 (95% confidence interval, 1.29-7.83) and 2.27 (95% confidence interval, 1.05-4.88), respectively. Three patients in the booklet group and 9 in the no-booklet group had a BBPS score

Radiographic appearances following adequate transfusion in. beta. -thalassaemia

Energy Technology Data Exchange (ETDEWEB)

Scutellari, P.N.; Orzincolo, C.; Bagni, B.; Franceschini, F.

1989-01-01

The main lesions of the skull and hand, observed in a group of hypertransfused ..beta..-thalassaemic patients, are compared with a control group of low-transfused patients. Bony abnormalities reflect the relationship between proliferating bone marrow and bone cortex, and hypertransfusion therapy will prevent development of lesions only if established early in life. If this is done, the diploe in the skull may become normal, overgrowth of facial bones is moderate, pneumatisation of the paranasal sinuses is not completely prevented, and the 'hair-brush' pattern may disappear completely. A normal appearance of the hand in adequately treated patients differentiates between prepubertal patients and adults.

Importance of adequate exercise in the detection of coronary heart disease by radionuclide ventriculography

International Nuclear Information System (INIS)

Brady, T.J.; Thrall, J.H.; Lo, K.; Pitt, B.

1980-01-01

Rest and exercise radionuclide ventriculograms were obtained on 77 symptomatic patients without prior documented coronary artery disease (CAD). Coronary artery disease was present by angiograms in 48. Radionuclide ventriculography (RNV) was abnormal in 41 patients (overall sensitivity 85%). In 29 patients with normal coronary arteries, RNV was normal in 24 (specificity 83%). To determine if the exercise level affects sensitivity, the studies were graded for adequacy of exercise. It was considered adequate if patients developed (a) chest pain, or (b) ST segment depression of at least 1 mm, or (c) if they achieved a pressure rate product greater than 250. Among the 48 patients with coronary artery disease, 35 achieved adequate exercise. Thirty-three had an abnormal RNV (sensitivity 94%). In 13 patients who failed to achieve adequate exercise, RNV was abnormal in eight (sensitivity of only 62%). Some patients with coronary artery disease may have a normal ventricular response at inadequate levels of stress

Wind farms providing secondary frequency regulation: evaluating the performance of model-based receding horizon control

Directory of Open Access Journals (Sweden)

C. R. Shapiro

2018-01-01

Full Text Available This paper is an extended version of our paper presented at the 2016 TORQUE conference (Shapiro et al., 2016. We investigate the use of wind farms to provide secondary frequency regulation for a power grid using a model-based receding horizon control framework. In order to enable real-time implementation, the control actions are computed based on a time-varying one-dimensional wake model. This model describes wake advection and wake interactions, both of which play an important role in wind farm power production. In order to test the control strategy, it is implemented in a large-eddy simulation (LES model of an 84-turbine wind farm using the actuator disk turbine representation. Rotor-averaged velocity measurements at each turbine are used to provide feedback for error correction. The importance of including the dynamics of wake advection in the underlying wake model is tested by comparing the performance of this dynamic-model control approach to a comparable static-model control approach that relies on a modified Jensen model. We compare the performance of both control approaches using two types of regulation signals, RegA and RegD, which are used by PJM, an independent system operator in the eastern United States. The poor performance of the static-model control relative to the dynamic-model control demonstrates that modeling the dynamics of wake advection is key to providing the proposed type of model-based coordinated control of large wind farms. We further explore the performance of the dynamic-model control via composite performance scores used by PJM to qualify plants for regulation services or markets. Our results demonstrate that the dynamic-model-controlled wind farm consistently performs well, passing the qualification threshold for all fast-acting RegD signals. For the RegA signal, which changes over slower timescales, the dynamic-model control leads to average performance that surpasses the qualification threshold, but further

Establishing adequate conditions for mercury determination in environmental samples by INAA

Energy Technology Data Exchange (ETDEWEB)

Perez, Caroline; Santos, Eliane C.; Saiki, Mitiko, E-mail: caroline.perez@usp.br [Instituto de Pesquisas Energéticas e Nucleares (IPEN/CNEN-SP), São Paulo, SP (Brazil)

2017-07-01

Mercury (Hg) is a toxic element released into the environment mainly by anthropic activities. Consequently, the improvement for Hg determination in environmental samples is of great interest. Instrumental Neutron Activation Analysis (INAA) is considered an adequate method to determine several elements. However, Hg determination by INAA is often hampered by its volatility, which causes losses. The aim of this study was to establish adequate irradiation conditions for Hg determination in environmental samples by INAA. The following parameters were evaluated: irradiation time, container for irradiation and spectral gamma ray interferences. For the study, aliquots of certified reference materials (CRMs) and tree bark samples were irradiated together with Hg synthetic standard at the IEA-R1 nuclear research reactor. Gamma ray activities of 1{sup 97}Hg and {sup 203}Hg were measured in a spectrometer coupled to a HGe detector. Results obtained indicated that polyethylene capsules or envelopes can be used as container for sample irradiation and the Hg impurities in these containers were negligible. Irradiation time of one hour was adequate for Hg determination and in long irradiations of 8 h problems of spectral interference of {sup 198}Au and {sup 75}Se were observed. In addition, Hg loss during the irradiation of 1 h and after irradiation was not observed. Quality control of Hg results, obtained in the CRMs analyses using one hour of irradiation, indicated good precision and accuracy with |Z score| < 2. The experimental conditions established in this study were applied to tree bark samples. Detection limits for Hg of these analyses were between 0.14 and 1.9 μg g{sup -1}. (author)

Provide a model to improve the performance of intrusion detection systems in the cloud

OpenAIRE

Foroogh Sedighi

2016-01-01

High availability of tools and service providers in cloud computing and the fact that cloud computing services are provided by internet and deal with public, have caused important challenges for new computing model. Cloud computing faces problems and challenges such as user privacy, data security, data ownership, availability of services, and recovery after breaking down, performance, scalability, programmability. So far, many different methods are presented for detection of intrusion in clou...

Subjects with molecularly defined familial hypercholesterolemia or familial defective apoB-100 are not being adequately treated.

Directory of Open Access Journals (Sweden)

Trond P Leren

2011-02-01

Full Text Available To study whether subjects with a molecular genetic diagnosis of familial hypercholesterolemia (FH or familial defective apoB-100 (FDB are being adequately treated.A questionnaire regarding medical history was sent to 2611 subjects who had been provided with a molecular genetic diagnosis of FH or FDB, and a blood sample was obtained for lipid measurements.956 (36.6% of the 2611 subjects participated. The mean age for starting lipid-lowering therapy was 33.4 (±12.1 years. Among those below 18 years of age, only 20.4% were on lipid-lowering drugs, whereas 89.1% of those aged 18 and above were on lipid-lowering drugs. The mean levels of total serum cholesterol and LDL-cholesterol were 5.7 (±1.5 mmol/l and 3.9 (±1.3 mmol/l, respectively. Among those who were on lipid-lowering drugs, 29.0% and 12.2% had levels of LDL cholesterol below 3.0 mmol/l and 2.6 mmol/l, respectively. Only 47.3% of the 956 subjects were considered as being adequately treated largely due to a failure to titrate their drug regimens. From the use of cholesterol-years score, lipid-lowering therapy must start before the age of 20 in order to prevent the subjects from contracting premature coronary heart disease.The majority of FH/FDB subjects are being diagnosed late in life and are not being adequately treated. In order to prevent them from contracting premature coronary heart disease, it is key that levels of LDL cholesterol are normalized from a young age and that sufficient doses of lipid-lowering drugs are being used.

Predictors of Timely Prenatal Care Initiation and Adequate Utilization in a Sample of Late Adolescent Texas Latinas.

Science.gov (United States)

Torres, Rosamar; Kehoe, Priscilla; Heilemann, MarySue V

2018-03-01

Little is known of late adolescent Texas Latinas' prenatal care perceptions or how these perceptions predict timely prenatal care initiation or adequate utilization. Hence, the purpose of this study is to describe and compare these perceptions between participants with timely versus late prenatal care initiation and adequate, intermediate, and inadequate prenatal care utilization; and to determine predictors of timely prenatal care initiation and adequate utilization. Fifty-four postpartum Latinas were recruited through social media. Eligibility criteria were 18 to 21 years old, Texas-born, primiparous, uncomplicated pregnancy/delivery, and English literate. Prenatal care perceptions were measured with the Revised Better Babies Survey and Access Barriers to Care Index. Participants had favorable views of prenatal care benefits; however, not living with the baby's father predicted inadequate prenatal care, Wald χ 2 (1) = 4.93, p = .026. Perceived benefits of timely and adequate prenatal care predicted timely prenatal care initiation, χ 2 (1) = 7.47, p = .006. Self-reported depression during pregnancy predicted timely entry into prenatal care, χ 2 (1) = 4.73, p = .03. Participants' positive prenatal care perceptions did not predict adequate prenatal care utilization, indicating that barriers serve as powerful obstacles in late adolescent Texas Latinas.

The classification of explosion-proof protected induction motor into adequate temperature and efficiency class

Science.gov (United States)

Brinovar, Iztok; Srpčič, Gregor; Seme, Sebastijan; Štumberger, Bojan; Hadžiselimović, Miralem

2017-07-01

This article deals with the classification of explosion-proof protected induction motors, which are used in hazardous areas, into adequate temperature and efficiency class. Hazardous areas are defined as locations with a potentially explosive atmosphere where explosion may occur due to present of flammable gasses, liquids or combustible dusts (industrial plants, mines, etc.). Electric motors and electrical equipment used in such locations must be specially designed and tested to prevent electrical initiation of explosion due to high surface temperature and arcing contacts. This article presents the basic tests of three-phase explosion-proof protected induction motor with special emphasis on the measuring system and temperature rise test. All the measurements were performed with high-accuracy instrumentation and accessory equipment and carried out at the Institute of energy technology in the Electric machines and drives laboratory and Applied electrical engineering laboratory.

The Efficacy of Private Sector Providers in Improving Public Educational Outcomes

Science.gov (United States)

Heinrich, Carolyn J.; Nisar, Hiren

2013-01-01

School districts required under No Child Left Behind (NCLB) to provide supplemental educational services (SES) to students in schools that are not making adequate yearly progress rely heavily on the private sector to offer choice in services. If the market does not drive out ineffective providers, students may not gain through SES participation.…

Response of cotton genotypes to boron under-b-adequate conditions

International Nuclear Information System (INIS)

Shah, J. A.; Sial, M. A.; Hassan, Z. U.; Rajpar, I.

2015-01-01

Balanced boron (B) application is well-known to enhance the cotton production; however, the narrow range between B-deficiency and toxicity levels makes it difficult to manage. Cotton genotypes extensively differ in their response to B requirements. The adequate dose of B for one genotype may be insufficient or even toxic to other genotype. The effects of boron (B) on seed cotton yield and its various yield associated traits were studied on 10 cotton genotypes of Pakistan. The pot studies were undertaken to categorize cotton genotypes using B-deficient (control) and B-adequate (2.0 kg B ha-1) levels arranged in CRD with four repeats. The results indicated that the seed cotton yield, yield attributes and B-uptake of genotypes were comparatively decreased in B-deficient stressed treatment. Genotype NIA-Ufaq exhibited wide range of adaptation and ranked as efficient-responsive, as it produced higher seed cotton yield under both B-regimes. SAU-2 and CIM-506 were highly-efficient and remaining all genotypes were medium-efficient. Genotype Sindh-1 produced low seed cotton yield under B deficient condition and ranked as low-efficient. B-efficient cotton genotypes can be grown in B deficient soils without B application. (author)

Relationship Between Green Logistics Tendency and Logistics Performance: A Comparative Case Study on Logistics Service Providers

OpenAIRE

Ayşenur DOĞRU; Cemile SOLAK FIŞKIN

2016-01-01

Increasing concerns related to environmental side effects of the logistics services and competition between the logistics service providers are two pressuring factors on logistics service providers. This study seeks to explore the relation between green logistics tendency and logistic performance from the perspective of logistics service providers. In order to reach this aim, two logistics service providers are investigated by comparative case study method. Findings showed the effects of g...

Not-for-profit versus for-profit health care providers--Part II: Comparing and contrasting their records.

Science.gov (United States)

Rotarius, Timothy; Trujillo, Antonio J; Liberman, Aaron; Ramirez, Bernardo

2006-01-01

The debate over which health care providers are most capably meeting their responsibilities in serving the public's interest continues unabated, and the comparisons of not-for-profit (NFP) versus for-profit (FP) hospitals remain at the epicenter of the discussion. From the perspective of available factual information, which of the two sides to this debate is correct? This article is part II of a 2-part series on comparing and contrasting the performance records of NFP health care providers with their FP counterparts. Although it is demonstrated that both NFP and FP providers perform virtuous and selfless feats on behalf of America's public, it is also shown that both camps have been accused of being involved in potentially willful clinical and administrative missteps. Part I provided the background information (eg, legal differences, perspectives on social responsibility, and types of questionable and fraudulent behavior) required to adequately understand the scope of the comparison issue. Part II offers actual comparisons of the 2 organizational structures using several disparate factors such as specific organizational behaviors, approach to the health care priorities of cost and quality, and business-focused goals of profits, efficiency, and community benefit.

Enhanced jump performance when providing augmented feedback compared to an external or internal focus of attention.

Science.gov (United States)

Keller, Martin; Lauber, Benedikt; Gottschalk, Marius; Taube, Wolfgang

2015-01-01

Factors such as an external focus of attention (EF) and augmented feedback (AF) have been shown to improve performance. However, the efficacy of providing AF to enhance motor performance has never been compared with the effects of an EF or an internal focus of attention (IF). Therefore, the aim of the present study was to identify which of the three conditions (AF, EF or IF) leads to the highest performance in a countermovement jump (CMJ). Nineteen volunteers performed 12 series of 8 maximum CMJs. Changes in jump height between conditions and within the series were analysed. Jump heights differed between conditions (P jump heights at the end of the series in AF (+1.60%) and lower jump heights at the end of the series in EF (-1.79%) and IF (-1.68%) were observed. Muscle activity did not differ between conditions. The differences between conditions and within the series provide evidence that AF leads to higher performance and better progression within one series than EF and IF. Consequently, AF seems to outperform EF and IF when maximising jump height.

Rectal cancer delivery of radiotherapy in adequate time and with adequate dose is influenced by treatment center, treatment schedule, and gender and is prognostic parameter for local control: Results of study CAO/ARO/AIO-94

International Nuclear Information System (INIS)

Fietkau, Rainer; Roedel, Claus; Hohenberger, Werner; Raab, Rudolf; Hess, Clemens; Liersch, Torsten; Becker, Heinz; Wittekind, Christian; Hutter, Matthias; Hager, Eva; Karstens, Johann; Ewald, Hermann; Christen, Norbert; Jagoditsch, Michael; Martus, Peter; Sauer, Rolf

2007-01-01

Purpose: The impact of the delivery of radiotherapy (RT) on treatment results in rectal cancer patients is unknown. Methods and Materials: The data from 788 patients with rectal cancer treated within the German CAO/AIO/ARO-94 phase III trial were analyzed concerning the impact of the delivery of RT (adequate RT: minimal radiation RT dose delivered, 4300 cGy for neoadjuvant RT or 4700 cGy for adjuvant RT; completion of RT in <44 days for neoadjuvant RT or <49 days for adjuvant RT) in different centers on the locoregional recurrence rate (LRR) and disease-free survival (DFS) at 5 years. The LRR, DFS, and delivery of RT were analyzed as endpoints in multivariate analysis. Results: A significant difference was found between the centers and the delivery of RT. The overall delivery of RT was a prognostic factor for the LRR (no RT, 29.6% ± 7.8%; inadequate RT, 21.2% ± 5.6%; adequate RT, 6.8% ± 1.4%; p = 0.0001) and DFS (no RT, 55.1% ± 9.1%; inadequate RT, 57.4% ± 6.3%; adequate RT, 69.1% ± 2.3%; p = 0.02). Postoperatively, delivery of RT was a prognostic factor for LRR on multivariate analysis (together with pathologic stage) but not for DFS (independent parameters, pathologic stage and age). Preoperatively, on multivariate analysis, pathologic stage, but not delivery of RT, was an independent prognostic parameter for LRR and DFS (together with adequate chemotherapy). On multivariate analysis, the treatment center, treatment schedule (neoadjuvant vs. adjuvant RT), and gender were prognostic parameters for adequate RT. Conclusion: Delivery of RT should be regarded as a prognostic factor for LRR in rectal cancer and is influenced by the treatment center, treatment schedule, and patient gender

Motor unit recruitment by size does not provide functional advantages for motor performance.

Science.gov (United States)

Dideriksen, Jakob L; Farina, Dario

2013-12-15

It is commonly assumed that the orderly recruitment of motor units by size provides a functional advantage for the performance of movements compared with a random recruitment order. On the other hand, the excitability of a motor neuron depends on its size and this is intrinsically linked to its innervation number. A range of innervation numbers among motor neurons corresponds to a range of sizes and thus to a range of excitabilities ordered by size. Therefore, if the excitation drive is similar among motor neurons, the recruitment by size is inevitably due to the intrinsic properties of motor neurons and may not have arisen to meet functional demands. In this view, we tested the assumption that orderly recruitment is necessarily beneficial by determining if this type of recruitment produces optimal motor output. Using evolutionary algorithms and without any a priori assumptions, the parameters of neuromuscular models were optimized with respect to several criteria for motor performance. Interestingly, the optimized model parameters matched well known neuromuscular properties, but none of the optimization criteria determined a consistent recruitment order by size unless this was imposed by an association between motor neuron size and excitability. Further, when the association between size and excitability was imposed, the resultant model of recruitment did not improve the motor performance with respect to the absence of orderly recruitment. A consistent observation was that optimal solutions for a variety of criteria of motor performance always required a broad range of innervation numbers in the population of motor neurons, skewed towards the small values. These results indicate that orderly recruitment of motor units in itself does not provide substantial functional advantages for motor control. Rather, the reason for its near-universal presence in human movements is that motor functions are optimized by a broad range of innervation numbers.

Use of Provider-Level Dashboards and Pay-for-Performance in Venous Thromboembolism Prophylaxis*

Science.gov (United States)

Michtalik, Henry J.; Carolan, Howard T.; Haut, Elliott R.; Lau, Brandyn D.; Streiff, Michael B.; Finkelstein, Joseph; Pronovost, Peter J.; Durkin, Nowella; Brotman, Daniel J.

2014-01-01

Background Despite safe and cost-effective venous thromboembolism (VTE) prevention measures, VTE prophylaxis rates are often suboptimal. Healthcare reform efforts emphasize transparency through programs to report performance, and payment incentives through programs to pay-for-performance. Objective To sequentially examine an individualized physician dashboard and pay-for-performance program to improve VTE prophylaxis rates amongst hospitalists. Design Retrospective analysis of 3144 inpatient admissions. After a baseline observation period, VTE prophylaxis compliance was compared during both interventions. Setting 1060-bed tertiary care medical center. Participants 38 part- and full-time academic hospitalists. Interventions A Web-based hospitalist dashboard provided VTE prophylaxis feedback. After 6 months of feedback only, a pay-for-performance program was incorporated, with graduated payouts for compliance rates of 80-100%. Measurements Prescription of American College of Chest Physicians guideline-compliant VTE prophylaxis and subsequent pay-for-performance payments. Results Monthly VTE prophylaxis compliance rates were 86% (95% CI: 85, 88), 90% (95% CI: 88, 93), and 94% (95% CI: 93, 96) during the baseline, dashboard, and combined dashboard/pay-for-performance periods, respectively. Compliance significantly improved with the use of the dashboard (p=0.01) and addition of the pay-for-performance program (p=0.01). The highest rate of improvement occurred with the dashboard (1.58%/month; p=0.01). Annual individual physician performance payments ranged from $53 to $1244 (mean $633; SD ±350). Conclusions Direct feedback using dashboards was associated with significantly improved compliance, with further improvement after incorporating an individual physician pay-for-performance program. Real-time dashboards and physician-level incentives may assist hospitals in achieving higher safety and quality benchmarks. PMID:25545690

Factors Affecting the Presence of Adequately Iodized Salt at Home in Wolaita, Southern Ethiopia: Community Based Study.

Science.gov (United States)

Kumma, Wondimagegn Paulos; Haji, Yusuf; Abdurahmen, Junayde; Mehretie Adinew, Yohannes

2018-01-01

Universal use of iodized salt is a simple and inexpensive method to prevent and eliminate iodine deficiency disorders like mental retardation. However, little is known about the level of adequately iodized salt consumption in the study area. Therefore, the study was aimed at assessing the proportion of households having adequately iodized salt and associated factors in Wolaita Sodo town and its peripheries, Southern Ethiopia. A cross-sectional study was conducted from May 10 to 20, 2016, in 441 households in Sodo town and its peripheries. Samples were selected using the systematic sampling technique. An iodometric titration method (AOAC, 2000) was used to analyze the iodine content of the salt samples. Data entry and analysis were done using Epi Info version 3.5.1 and SPSS version 16, respectively. The female to male ratio of the respondents was 219. The mean age of the respondents was 30.2 (±7.3 SD). The proportion of households having adequately iodized salt was 37.7%, with 95% CI of 33.2% to 42.2%. Not exposing salt to sunlight with [OR: 3.75; 95% CI: 2.14, 6.57], higher monthly income [OR: 3.71; 95% CI: 1.97-7.01], and formal education of respondents with [OR: 1.75; 95% CI: 1.14, 2.70] were found associated with the presence of adequately iodized salt at home. This study revealed low levels of households having adequately iodized salt in Wolaita Sodo town and its peripheries. The evidence here shows that there is a need to increase the supply of adequately iodized salt to meet the goal for monitoring progress towards sustainable elimination of IDD.

Physiological aspect walking and Nordic walking as adequate kinetic activities.

OpenAIRE

BENEŠ, Václav

2010-01-01

This bachelor thesis on the topic of The Physiological Aspect of Walking and Nordic Walking as an adequate physical activity focuses on chosen physiological changes of an organism during a five-month training cycle. In the theoretical part I describe the physiological changes of organism during a regularly repeated strain, and also the technique of walking, Nordic walking and health benefits of these activities are defined here. The research part of the thesis describes the measurement method...

A balanced strategy in managing steam generator thermal performance

International Nuclear Information System (INIS)

Hu, M. H.; Nelson, P. R.

2009-01-01

This paper presents a balanced strategy in managing thermal performance of steam generator designed to deliver rated megawatt thermal (MWt) and megawatt electric (MWe) power without loss with some amount of thermal margin. A steam generator (SG) is a boiling heat exchanger whose thermal performance may degrade because of steam pressure loss. In other words, steam pressure loss is an indicator of thermal performance degradation. Steam pressure loss is mainly a result of either 1) tube scale induced poor boiling or 2) tube plugging historically resulting from tubing corrosion, wear due to flow induced tube vibration or loose parts impact. Thermal performance degradation was historically due to tube plugging but more recently it is due to poor boiling caused by more bad than good constituents of feedwater impurities. The whole SG industry still concentrates solely on maintenance programs towards preventing causes for tube plugging and yet almost no programs on maintaining adequate boiling of fouled tubes. There can be an acceptable amount of tube scale that provides excellent boiling capacity without tubing corrosion, as operational experience has repeatedly demonstrated. Therefore, future maintenance has to come up balanced programs for allocating limited resources in both maintaining good boiling capacity and preventing tube plugging. This paper discusses also thermal performance degradation due to feedwater impurity induced blockage of tube support plate and thus subsequent water level oscillations, and how to mitigate them. This paper provides a predictive management of tube scale for maintaining adequate steam pressure and stable water level without loss in MWt/MWe or recovering from steam pressure loss or water level oscillations. This paper offers a balanced strategy in managing SG thermal performance to fulfill its mission. Such a strategy is even more important in view of the industry trend in pursuing extended power uprate as high as 20 percent

Self-esteem, social support, and satisfaction differences in women with adequate and inadequate prenatal care.

Science.gov (United States)

Higgins, P; Murray, M L; Williams, E M

1994-03-01

This descriptive, retrospective study examined levels of self-esteem, social support, and satisfaction with prenatal care in 193 low-risk postpartal women who obtained adequate and inadequate care. The participants were drawn from a regional medical center and university teaching hospital in New Mexico. A demographic questionnaire, the Coopersmith self-esteem inventory, the personal resource questionnaire part 2, and the prenatal care satisfaction inventory were used for data collection. Significant differences were found in the level of education, income, insurance, and ethnicity between women who received adequate prenatal care and those who received inadequate care. Women who were likely to seek either adequate or inadequate prenatal care were those whose total family income was $10,000 to $19,999 per year and high school graduates. Statistically significant differences were found in self-esteem, social support, and satisfaction between the two groups of women. Strategies to enhance self-esteem and social support have to be developed to reach women at risk for receiving inadequate prenatal care.

The impact of urban gardens on adequate and healthy food: a systematic review.

Science.gov (United States)

Garcia, Mariana T; Ribeiro, Silvana M; Germani, Ana Claudia Camargo Gonçalves; Bógus, Cláudia M

2018-02-01

To examine the impacts on food and nutrition-related outcomes resulting from participation in urban gardens, especially on healthy food practices, healthy food access, and healthy food beliefs, knowledge and attitudes. The systematic review identified studies by searching the PubMed, ERIC, LILACS, Web of Science and Embase databases. An assessment of quality and bias risk of the studies was carried out and a narrative summary was produced. Studies published as original articles in peer-reviewed scientific journals in English, Spanish or Portuguese between 2005 and 2015 were included. The studies included were based on data from adult participants in urban gardens. Twenty-four studies were initially selected based on the eligibility criteria, twelve of which were included. There was important heterogeneity of settings, population and assessment methods. Assessment of quality and bias risk of the studies revealed the need for greater methodological rigour. Most studies investigated community gardens and employed a qualitative approach. The following were reported: greater fruit and vegetable consumption, better access to healthy foods, greater valuing of cooking, harvest sharing with family and friends, enhanced importance of organic production, and valuing of adequate and healthy food. Thematic patterns related to adequate and healthy food associated with participation in urban gardens were identified, revealing a positive impact on practices of adequate and healthy food and mainly on food perceptions.

Quantifying dose to the reconstructed breast: Can we adequately treat?

Energy Technology Data Exchange (ETDEWEB)

Chung, Eugene; Marsh, Robin B.; Griffith, Kent A.; Moran, Jean M. [Department of Radiation Oncology, University of Michigan, Ann Arbor, MI (United States); Pierce, Lori J., E-mail: ljpierce@umich.edu [Department of Radiation Oncology, University of Michigan, Ann Arbor, MI (United States)

2013-04-01

To evaluate how immediate reconstruction (IR) impacts postmastectomy radiotherapy (PMRT) dose distributions to the reconstructed breast (RB), internal mammary nodes (IMN), heart, and lungs using quantifiable dosimetric end points. 3D conformal plans were developed for 20 IR patients, 10 autologous reconstruction (AR), and 10 expander-implant (EI) reconstruction. For each reconstruction type, 5 right- and 5 left-sided reconstructions were selected. Two plans were created for each patient, 1 with RB coverage alone and 1 with RB + IMN coverage. Left-sided EI plans without IMN coverage had higher heart Dmean than left-sided AR plans (2.97 and 0.84 Gy, p = 0.03). Otherwise, results did not vary by reconstruction type and all remaining metrics were evaluated using a combined AR and EI dataset. RB coverage was adequate regardless of laterality or IMN coverage (Dmean 50.61 Gy, D95 45.76 Gy). When included, IMN Dmean and D95 were 49.57 and 40.96 Gy, respectively. Mean heart doses increased with left-sided treatment plans and IMN inclusion. Right-sided treatment plans and IMN inclusion increased mean lung V{sub 20}. Using standard field arrangements and 3D planning, we observed excellent coverage of the RB and IMN, regardless of laterality or reconstruction type. Our results demonstrate that adequate doses can be delivered to the RB with or without IMN coverage.

Sleep and Final Exam Performance in Introductory Physics

Science.gov (United States)

Coletta, Vincent; Wikholm, Colin; Pascoe, Daniel

2018-03-01

Most physics instructors believe that adequate sleep is important in order for students to perform well on problem solving, and many instructors advise students to get plenty of sleep the night before an exam. After years of giving such advice to students at Loyola Marymount University (LMU), one of us decided to find out how many hours students actually do sleep the night before an exam, and how that would relate to their performance. The effect of inadequate sleep on exam performance was explored in a second-semester introductory physics course. At the end of the final exam, students reported the number of hours they slept the night before. Sleep deprivation corresponded to lower final exam scores. The main purpose of this study is to provide evidence that instructors can provide to their students to convince them that their time is better spent sleeping rather than studying all night before an exam.

Factors Affecting the Presence of Adequately Iodized Salt at Home in Wolaita, Southern Ethiopia: Community Based Study

Directory of Open Access Journals (Sweden)

Wondimagegn Paulos Kumma

2018-01-01

Full Text Available Background. Universal use of iodized salt is a simple and inexpensive method to prevent and eliminate iodine deficiency disorders like mental retardation. However, little is known about the level of adequately iodized salt consumption in the study area. Therefore, the study was aimed at assessing the proportion of households having adequately iodized salt and associated factors in Wolaita Sodo town and its peripheries, Southern Ethiopia. Methods. A cross-sectional study was conducted from May 10 to 20, 2016, in 441 households in Sodo town and its peripheries. Samples were selected using the systematic sampling technique. An iodometric titration method (AOAC, 2000 was used to analyze the iodine content of the salt samples. Data entry and analysis were done using Epi Info version 3.5.1 and SPSS version 16, respectively. Result. The female to male ratio of the respondents was 219. The mean age of the respondents was 30.2 (±7.3 SD. The proportion of households having adequately iodized salt was 37.7%, with 95% CI of 33.2% to 42.2%. Not exposing salt to sunlight with [OR: 3.75; 95% CI: 2.14, 6.57], higher monthly income [OR: 3.71; 95% CI: 1.97–7.01], and formal education of respondents with [OR: 1.75; 95% CI: 1.14, 2.70] were found associated with the presence of adequately iodized salt at home. Conclusion. This study revealed low levels of households having adequately iodized salt in Wolaita Sodo town and its peripheries. The evidence here shows that there is a need to increase the supply of adequately iodized salt to meet the goal for monitoring progress towards sustainable elimination of IDD.

The Impact of Order Source Misattribution on Computerized Provider Order Entry (CPOE) Performance Metrics.

Science.gov (United States)

Gellert, George A; Catzoela, Linda; Patel, Lajja; Bruner, Kylynn; Friedman, Felix; Ramirez, Ricardo; Saucedo, Lilliana; Webster, S Luke; Gillean, John A

2017-01-01

One strategy to foster adoption of computerized provider order entry (CPOE) by physicians is the monthly distribution of a list identifying the number and use rate percentage of orders entered electronically versus on paper by each physician in the facility. Physicians care about CPOE use rate reports because they support the patient safety and quality improvement objectives of CPOE implementation. Certain physician groups are also motivated because they participate in contracted financial and performance arrangements that include incentive payments or financial penalties for meeting (or failing to meet) a specified CPOE use rate target. Misattribution of order sources can hinder accurate measurement of individual physician CPOE use and can thereby undermine providers' confidence in their reported performance, as well as their motivation to utilize CPOE. Misattribution of order sources also has significant patient safety, quality, and medicolegal implications. This analysis sought to evaluate the magnitude and sources of misattribution among hospitalists with high CPOE use and, if misattribution was found, to formulate strategies to prevent and reduce its recurrence, thereby ensuring the integrity and credibility of individual and facility CPOE use rate reporting. A detailed manual order source review and validation of all orders issued by one hospitalist group at a midsize community hospital was conducted for a one-month study period. We found that a small but not dismissible percentage of orders issued by hospitalists-up to 4.18 percent (95 percent confidence interval, 3.84-4.56 percent) per month-were attributed inaccurately. Sources of misattribution by department or function were as follows: nursing, 42 percent; pharmacy, 38 percent; laboratory, 15 percent; unit clerk, 3 percent; and radiology, 2 percent. Order management and protocol were the most common correct order sources that were incorrectly attributed. Order source misattribution can negatively affect

Vaccines provided by family physicians.

Science.gov (United States)

Campos-Outcalt, Doug; Jeffcott-Pera, Michelle; Carter-Smith, Pamela; Schoof, Bellinda K; Young, Herbert F

2010-01-01

This study was conducted to document current immunization practices by family physicians. In 2008 the American Academy of Family Physicians (AAFP) conducted a survey among a random sample of 2,000 of its members who reported spending 80% or more of their time in direct patient care. The survey consisted of questions regarding the demographics of the practice, vaccines that are provided at the physicians' clinical site, whether the practice refers patients elsewhere for vaccines, and participation in the Vaccines for Children (VFC) program. The response rate was 38.5%, 31.8% after non-office-based respondents were deleted. A high proportion of respondents (80% or more) reported providing most routinely recommended child, adolescent, and adult vaccines at their practice sites. The exceptions were rotavirus vaccine for children and herpes zoster vaccine for adults., A significant proportion, however, reported referring elsewhere for some vaccines (44.1% for children and adolescent vaccines and 53.5% for adult vaccines), with the most frequent referral location being a public health department. A higher proportion of solo and 2-physician practices than larger practices reported referring patients. A lack of adequate payment was listed as the reason for referring patients elsewhere for vaccines by one-half of those who refer patients. One-half of responders do not participate in the VFC program. Provision of recommended vaccines by most family physicians remains an important service. Smaller practices have more difficulty offering a full array of vaccine products, and lack of adequate payment contributes to referring patients outside the medical home. The reasons behind the lack of participation in the VFC program deserve further study.

Good, better, best? A comprehensive comparison of healthcare providers' performance: An application to physiotherapy practices in primary care.

Science.gov (United States)

Steenhuis, Sander; Groeneweg, Niels; Koolman, Xander; Portrait, France

2017-12-01

Most payment methods in healthcare stimulate volume-driven care, rather than value-driven care. Value-based payment methods such as Pay-For-Performance have the potential to reduce costs and improve quality of care. Ideally, outcome indicators are used in the assessment of providers' performance. The aim of this paper is to describe the feasibility of assessing and comparing the performances of providers using a comprehensive set of quality and cost data. We had access to unique and extensive datasets containing individual data on PROMs, PREMs and costs of physiotherapy practices in Dutch primary care. We merged these datasets at the patient-level and compared the performances of these practices using case-mix corrected linear regression models. Several significant differences in performance were detected between practices. These results can be used by both physiotherapists, to improve treatment given, and insurers to support their purchasing decisions. The study demonstrates that it is feasible to compare the performance of providers using PROMs and PREMs. However, it would take an extra effort to increase usefulness and it remains unclear under which conditions this effort is cost-effective. Healthcare providers need to be aware of the added value of registering outcomes to improve their quality. Insurers need to facilitate this by designing value-based contracts with the right incentives. Only then can payment methods contribute to value-based healthcare and increase value for patients. Copyright © 2017 Elsevier B.V. All rights reserved.

Adequate Prenatal Care Reduces the Risk of Adverse Pregnancy Outcomes in Women with History of Infertility: A Nationwide Population-Based Study

Science.gov (United States)

Alibekova, Raushan; Huang, Jian-Pei; Chen, Yi-Hua

2013-01-01

Objectives To investigate the effects of various measures of prenatal care on adverse pregnancy outcomes in women with a history of infertility. Study Design A retrospective cohort study. Methods Data were derived by linking 2 large nationwide population-based datasets, the National Health Insurance Research Database and Taiwan Birth Certificate Registry. The study sample included 15,056 women with an infertility diagnosis and 60,224 randomly selected women without infertility matched to the study sample by maternal age. A conditional logistic regression analysis was performed for the analysis. Results Women diagnosed with infertility respectively had 1.39 (95% CI, 1.06~1.83), 1.15 (95% CI, 1.08~1.24), 1.13 (95% CI, 1.08~1.18), and 1.08 (95% CI, 1.05~1.12) higher odds of having very low birth weight (VLBW) babies, preterm births, labor complications, and cesarean sections (CSs) compared to women without infertility. Inadequate numbers of total and major prenatal visits and late initiation of prenatal care increased the risks of adverse pregnancy outcomes in women with infertility, especially the risk of a VLBW baby. However, no significant associations were found for the risks of adverse birth outcomes in infertile women with adequate prenatal care compared to fertile women with adequate care. Conclusions Study findings suggest that adequate prenatal care can reduce the risk of adverse pregnancy outcomes in women with infertility. PMID:24358347

The influence of nutritional supplement drinks on providing adequate calorie and protein intake in older adults with dementia.

Science.gov (United States)

Allen, V; Methven, L; Gosney, M

2013-09-01

Investigate the impact of the provision of ONS on protein and energy intake from food and ability to meet protein and calorie requirements in people with dementia. After consent by proxy was obtained, participants took part in a cross over study comparing oral intake on an intervention day to an adjacent control day. The study occurred in Nursing homes and hospitalised settings. Older adults with dementia over the age of 65 were recruited. 26 participants (aged 83.9+/-8.4years, MMSE 13.08+/-8.13) took part. Intervention (if any): On the intervention day nutritional supplement drinks were provided three times. Each drink provided 283.3+/-41.8 Kcal of energy and 13.8+/-4.7g of protein. Supplements were removed approximately 1 hour before meals were served and weighed waste (g) was obtained. Intake of food consumed was determined on intervention and control days using the quartile method (none, quarter, half, three quarters, all) for each meal component. More people achieved their energy and protein requirements with the supplement drink intervention with no sufficient impact on habitual food consumption. Findings from these 26 participants with dementia indicate that supplement drinks may be beneficial in reducing the prevalence of malnutrition within the group as more people meet their nutritional requirements. As the provision of supplement drinks is also demonstrated to have an additive effect to consumption of habitual foods these can be used alongside other measures to also improve oral intake.

Performance Assessment as a Diagnostic Tool for Science Teachers

Science.gov (United States)

Kruit, Patricia; Oostdam, Ron; van den Berg, Ed; Schuitema, Jaap

2018-04-01

Information on students' development of science skills is essential for teachers to evaluate and improve their own education, as well as to provide adequate support and feedback to the learning process of individual students. The present study explores and discusses the use of performance assessments as a diagnostic tool for formative assessment to inform teachers and guide instruction of science skills in primary education. Three performance assessments were administered to more than 400 students in grades 5 and 6 of primary education. Students performed small experiments using real materials while following the different steps of the empirical cycle. The mutual relationship between the three performance assessments is examined to provide evidence for the value of performance assessments as useful tools for formative evaluation. Differences in response patterns are discussed, and the diagnostic value of performance assessments is illustrated with examples of individual student performances. Findings show that the performance assessments were difficult for grades 5 and 6 students but that much individual variation exists regarding the different steps of the empirical cycle. Evaluation of scores as well as a more substantive analysis of students' responses provided insight into typical errors that students make. It is concluded that performance assessments can be used as a diagnostic tool for monitoring students' skill performance as well as to support teachers in evaluating and improving their science lessons.

Do clinicians receive adequate training to identify trafficked persons? A scoping review of NHS Foundation Trusts.

Science.gov (United States)

Thompson, Charles Dr; Mahay, Arun; Stuckler, David; Steele, Sarah

2017-09-01

We investigate whether physicians in secondary care in the English NHS receive adequate training to recognise and appropriately refer for services those persons suspected to be victims of human trafficking. Freedom of Information requests were sent to the 105 England's NHS Trusts delivering acute care in England. NHS Trusts providing secondary care in England. English NHS Trusts. We requested data about the training provided on human trafficking to clinicians, including the nature, delivery, and format of any education, and any planned training. A total of 89.5% of the 105 Trusts responded. Of these Trusts, 69% provide education to physicians on human trafficking, and a further 6% provide training but did not specify who received it. The majority of Trusts providing training did so within wider safeguarding provision (91%). Only one trust reported that it provides stand-alone training on trafficking to all its staff, including physicians. Within training offered by Trusts, 54% observed best practice providing training on the clinical indicators of trafficking, while 16% referenced the National Referral Mechanism. Amongst those not providing training, 39% of Trusts report provision is in development. Our results find that 25% of NHS Foundation Trusts appear to lack training for physicians around human trafficking. It is also of concern that of the Trusts who currently do not provide training, only 39% are developing training or planning to do so. There is an urgent need to review and update the scope of available training and bring it into alignment with current legislation.

Do clinicians receive adequate training to identify trafficked persons? A scoping review of NHS Foundation Trusts

Science.gov (United States)

Mahay, Arun; Stuckler, David; Steele, Sarah

2017-01-01

Objective We investigate whether physicians in secondary care in the English NHS receive adequate training to recognise and appropriately refer for services those persons suspected to be victims of human trafficking. Design Freedom of Information requests were sent to the 105 England’s NHS Trusts delivering acute care in England. Setting NHS Trusts providing secondary care in England. Participants English NHS Trusts. Main outcome measures We requested data about the training provided on human trafficking to clinicians, including the nature, delivery, and format of any education, and any planned training. Results A total of 89.5% of the 105 Trusts responded. Of these Trusts, 69% provide education to physicians on human trafficking, and a further 6% provide training but did not specify who received it. The majority of Trusts providing training did so within wider safeguarding provision (91%). Only one trust reported that it provides stand-alone training on trafficking to all its staff, including physicians. Within training offered by Trusts, 54% observed best practice providing training on the clinical indicators of trafficking, while 16% referenced the National Referral Mechanism. Amongst those not providing training, 39% of Trusts report provision is in development. Conclusions Our results find that 25% of NHS Foundation Trusts appear to lack training for physicians around human trafficking. It is also of concern that of the Trusts who currently do not provide training, only 39% are developing training or planning to do so. There is an urgent need to review and update the scope of available training and bring it into alignment with current legislation. PMID:28904806

Spent Fuel Transportation Package Performance Study - Experimental Design Challenges

International Nuclear Information System (INIS)

Snyder, A. M.; Murphy, A. J.; Sprung, J. L.; Ammerman, D. J.; Lopez, C.

2003-01-01

Numerous studies of spent nuclear fuel transportation accident risks have been performed since the late seventies that considered shipping container design and performance. Based in part on these studies, NRC has concluded that the level of protection provided by spent nuclear fuel transportation package designs under accident conditions is adequate. [1] Furthermore, actual spent nuclear fuel transport experience showcase a safety record that is exceptional and unparalleled when compared to other hazardous materials transportation shipments. There has never been a known or suspected release of the radioactive contents from an NRC-certified spent nuclear fuel cask as a result of a transportation accident. In 1999 the United States Nuclear Regulatory Commission (NRC) initiated a study, the Package Performance Study, to demonstrate the performance of spent fuel and spent fuel packages during severe transportation accidents. NRC is not studying or testing its current regulations, a s the rigorous regulatory accident conditions specified in 10 CFR Part 71 are adequate to ensure safe packaging and use. As part of this study, NRC currently plans on using detailed modeling followed by experimental testing to increase public confidence in the safety of spent nuclear fuel shipments. One of the aspects of this confirmatory research study is the commitment to solicit and consider public comment during the scoping phase and experimental design planning phase of this research

Not-for-profit versus for-profit health care providers-Part I: comparing and contrasting their records.

Science.gov (United States)

Rotarius, Timothy; Trujillo, Antonio J; Liberman, Aaron; Ramirez, Bernardo

2005-01-01

The debate over which health care providers are most capably meeting their responsibilities in serving the public's interest continues unabated, and the comparisons of not-for-profit (NFP) versus for-profit (FP) hospitals remain at the epicenter of the discussion. From the perspective of available factual information, which of the two sides to this debate is correct? This article is part I of a 2-part series on comparing and contrasting the performance records of NFP health care providers with their FP counterparts. Although it is demonstrated that both NFP and FP providers perform virtuous and selfless feats on behalf of America's public, it is also shown that both camps are involved in potentially willful clinical and administrative missteps. Part I contains the background information (eg, legal differences, perspectives on social responsibility, and types of questionable and fraudulent behavior) that is necessary to adequately understand the scope of the comparison issue. Part II offers actual comparisons of the 2 organizational structures using several disparate factors such as specific organizational behaviors, approach to the health care priorities of cost and quality, and business-focused goals of profits, efficiency, and community benefit.

Evaluation of lymph node numbers for adequate staging of Stage II and III colon cancer

Directory of Open Access Journals (Sweden)

Bumpers Harvey L

2011-05-01

Full Text Available Abstract Background Although evaluation of at least 12 lymph nodes (LNs is recommended as the minimum number of nodes required for accurate staging of colon cancer patients, there is disagreement on what constitutes an adequate identification of such LNs. Methods To evaluate the minimum number of LNs for adequate staging of Stage II and III colon cancer, 490 patients were categorized into groups based on 1-6, 7-11, 12-19, and ≥ 20 LNs collected. Results For patients with Stage II or III disease, examination of 12 LNs was not significantly associated with recurrence or mortality. For Stage II (HR = 0.33; 95% CI, 0.12-0.91, but not for Stage III patients (HR = 1.59; 95% CI, 0.54-4.64, examination of ≥20 LNs was associated with a reduced risk of recurrence within 2 years. However, examination of ≥20 LNs had a 55% (Stage II, HR = 0.45; 95% CI, 0.23-0.87 and a 31% (Stage III, HR = 0.69; 95% CI, 0.38-1.26 decreased risk of mortality, respectively. For each six additional LNs examined from Stage III patients, there was a 19% increased probability of finding a positive LN (parameter estimate = 0.18510, p Conclusions Thus, the 12 LN cut-off point cannot be supported as requisite in determining adequate staging of colon cancer based on current data. However, a minimum of 6 LNs should be examined for adequate staging of Stage II and III colon cancer patients.

Guidelines for radiological performance assessment of DOE low-level radioactive waste disposal sites

International Nuclear Information System (INIS)

Case, M.J.; Otis, M.D.

1988-07-01

This document provides guidance for conducting radiological performance assessments of Department of Energy (DOE) low-level radioactive waste (LLW) disposal facilities. The guidance is specifically intended to provide the fundamental approach necessary to meet the performance assessment requirements. The document is written for LLW facility operators or other personnel who will manage the performance assessment task. The document is meant to provide guidance for conducting performance assessments in a generally consistent manner at all DOE LLW disposal facilities. The guidance includes a summary of performance objectives to be met by LLW disposal facilities (these objectives are derived from current DOE and other applicable federal regulatory guidelines); specific criteria for an adequate performance assessment and from which a minimum set of required calculations may be determined; recommendations of methods for screening critical components of the analysis system so that these components can be addressed in detail; recommendations for the selection of existing models and the development of site-specific models; recommendations of techniques for comparison of assessment results with performance objectives; and a summary of reporting requirements

21 CFR 740.10 - Labeling of cosmetic products for which adequate substantiation of safety has not been obtained.

Science.gov (United States)

2010-04-01

... 21 Food and Drugs 7 2010-04-01 2010-04-01 false Labeling of cosmetic products for which adequate..., DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) COSMETICS COSMETIC PRODUCT WARNING STATEMENTS Warning Statements § 740.10 Labeling of cosmetic products for which adequate substantiation of safety has not been...

How many CT detector rows are necessary to perform adequate three dimensional visualization?

International Nuclear Information System (INIS)

Fischer, Lars; Tetzlaff, Ralf; Schoebinger, Max; Radeleff, Boris; Bruckner, Thomas; Meinzer, H.P.; Buechler, M.W.; Schemmer, Peter

2010-01-01

Introduction: The technical development of computer tomography (CT) imaging has experienced great progress. As consequence, CT data to be used for 3D visualization is not only based on 4 row CTs and 16 row CTs but also on 64 row CTs, respectively. The main goal of this study was to examine whether the increased amount of CT detector rows is correlated with improved quality of the 3D images. Material and Methods: All CTs were acquired during routinely performed preoperative evaluation. Overall, there were 12 data sets based on 4 detector row CT, 12 data sets based on 16 detector row CT, and 10 data sets based on 64 detector row CT. Imaging data sets were transferred to the DKFZ Heidelberg using the CHILI teleradiology system. For the analysis all CT scans were examined in a blinded fashion, i.e. both the name of the patient as well as the name of the CT brand were erased. For analysis, the time for segmentation of liver, both portal and hepatic veins as well as the branching depth of portal veins and hepatic veins was recorded automatically. In addition, all results were validated in a blinded fashion based on given quality index. Results: Segmentation of the liver was performed in significantly shorter time (p < 0.01, Kruskal-Wallis test) in the 16 row CT (median 479 s) compared to 4 row CT (median 611 s), and 64 row CT (median 670 s), respectively. The branching depth of the portal vein did not differ significantly among the 3 different data sets (p = 0.37, Kruskal-Wallis test). However, the branching depth of the hepatic veins was significantly better (p = 0.028, Kruskal-Wallis test) in the 4 row CT and 16 row CT compared to 64 row CT. The grading of the quality index was not statistically different for portal veins and hepatic veins (p = 0.80, Kruskal-Wallis test). Even though the total quality index was better for the vessel tree based on 64 row CT data sets (mean scale 2.6) compared to 4 CT row data (mean scale 3.25) and 16 row CT data (mean scale 3.0), these

Proposal for a advanced PWR core with adequate characteristics for passive safety concept

International Nuclear Information System (INIS)

Perrotta, Jose Augusto

1999-01-01

This work presents a discussion upon the suitable from an advanced PWR core, classified by the EPRI as 'Passive PWR' (advanced reactor with passive safety concept to power plants with less than 600 MW electrical power). The discussion upon the type of core is based on nuclear fuel engineering concepts. Discussion is made on type of fuel materials, structural materials, geometric shapes and manufacturing process that are suitable to produce fuel assemblies which give good performance for this type of reactors. The analysis is guided by the EPRI requirements for Advanced Light Water Reactor (ALWR). By means of comparison, the analysis were done to Angra 1 (old type of 600 MWe PWR class), and the design of the Westinghouse Advanced PWR-AP600. It was verified as a conclusion of this work that the modern PWR fuels are suitable for advanced PWR's Nevertheless, this work presents a technical alternative to this kind of fuel, still using UO 2 as fuel, but changing its cylindrical form of pellets and pin type fuel element to plane shape pallets and plate type fuel element. This is not a novelty fuel, since it was used in the 50's at Shippingport Reactor and as an advanced version by CEA of France in the 70's. In this work it is proposed a new mechanical assembly design for this fuel, which can give adequate safety and operational performance to the core of a 'Passive PWR'. (author)

Adequate Consultation And Dialogue With Local Community Unlocking The Untapped Potential For Peace And Development Evidences From South Omo Zone

Directory of Open Access Journals (Sweden)

Mohammed Yimer

2017-10-01

Full Text Available The paper argues that adequate consultation and public wide dialogues at the grass root level are the two potential entry points in times of development interventions. This will foster peace among the nearby people and led a foundation for the subsequent development. The study was undertaken to examine whether the agro-pastoral communities of South Omo zone were jeopardized as a result of the Omo Kuraz Sugar development project or not. It also targeted whether there was adequate consultation with the local people at the earliest days of the project. Adopting Ethnographic design the study accompanied by primary data collected through participant observation focus group discussion and key informant interview indicated that there were attempts to consult the indigenous people though not adequate. It also indicated that despite the absence of compensation for the local displaced people due to their mobile life the people were not endangered as a result of the project. This project as a development project that is established at the communal land of the agro-pastoralists is providing training for the nearby people to hire them in its various offices. Far from the claims of the various oversees institutions propounded as if the agro-pastoral communities were miserably suffered from such a project the people consider it as if it is their own project. The study implied that South Omo zone is a counter example of how local level consultation and a wide range of dialogue are indispensable preconditions to foster peace and development in many pastoral and agro-pastoral areas of the country.

An exploratory study of factors influencing resuscitation skills retention and performance among health providers.

Science.gov (United States)

Curran, Vernon; Fleet, Lisa; Greene, Melanie

2012-01-01

Resuscitation and life support skills training comprises a significant proportion of continuing education programming for health professionals. The purpose of this study was to explore the perceptions and attitudes of certified resuscitation providers toward the retention of resuscitation skills, regular skills updating, and methods for enhancing retention. A mixed-methods, explanatory study design was undertaken utilizing focus groups and an online survey-questionnaire of rural and urban health care providers. Rural providers reported less experience with real codes and lower abilities across a variety of resuscitation areas. Mock codes, practice with an instructor and a team, self-practice with a mannequin, and e-learning were popular methods for skills updating. Aspects of team performance that were felt to influence resuscitation performance included: discrepancies in skill levels, lack of communication, and team leaders not up to date on their skills. Confidence in resuscitation abilities was greatest after one had recently practiced or participated in an update or an effective debriefing session. Lowest confidence was reported when team members did not work well together, there was no clear leader of the resuscitation code, or if team members did not communicate. The study findings highlight the importance of access to update methods for improving providers' confidence and abilities, and the need for emphasis on teamwork training in resuscitation. An eclectic approach combining methods may be the best strategy for addressing the needs of health professionals across various clinical departments and geographic locales. Copyright © 2012 The Alliance for Continuing Education in the Health Professions, the Society for Academic Continuing Medical Education, and the Council on CME, Association for Hospital Medical Education.

Nurse education and willingness to provide spiritual care.

Science.gov (United States)

Wu, Li-Fen; Tseng, Hui-Chen; Liao, Yu-Chen

2016-03-01

Spiritual care is a critical part of holistic care, and nurses require adequate preparation to address the spiritual needs of patients. However, nurses' willingness to provide such care has rarely been reported. Hence, nurses' education, and knowledge of spiritual care, as well as their willingness to provide it require further study. A convenience sample of 200 nurses participated in the study. Quantitative data were collected using a 21-item Spiritual Care Needs Inventory (content validity index=.87; Cronbach's alpha=.96). The majority of participants were female (96.5%, n=193) between 21 and 59years old (mean=35.1years). Moreover, the majority of participants had a Bachelor's degree (74.0%, n=148) and 1-36years of clinical experience (mean=12.13years). Regarding religious beliefs, 63 (31.5%) had no religious belief, and 93 (46.5%) did not engage in any religious activity. Overall, the nurses were willing to provide spiritual care, although only 25 (12.5%) felt that they had received adequate education. The findings of this study indicate the need for further educational preparation in spiritual care for nurses. Specifically, additional teaching materials are required that are more directly related to spiritual care. Greater emphasis should be placed on different subject areas in school-based education, continuing education, and self-learning education according to the needs of nurses. Since spiritual care education needs policy support, in-depth discussions should take place regarding the approach and cultural environment for providing spiritual care in future nursing courses. Moreover, further studies should investigate barriers in providing spiritual nursing care to patients and whether they are the results of a lack of relevant knowledge or other factors. Copyright © 2016 Elsevier Ltd. All rights reserved.

Case of two electrostatics problems: Can providing a diagram adversely impact introductory physics students’ problem solving performance?

Directory of Open Access Journals (Sweden)

Alexandru Maries

2018-03-01

Full Text Available Drawing appropriate diagrams is a useful problem solving heuristic that can transform a problem into a representation that is easier to exploit for solving it. One major focus while helping introductory physics students learn effective problem solving is to help them understand that drawing diagrams can facilitate problem solution. We conducted an investigation in which two different interventions were implemented during recitation quizzes in a large enrollment algebra-based introductory physics course. Students were either (i asked to solve problems in which the diagrams were drawn for them or (ii explicitly told to draw a diagram. A comparison group was not given any instruction regarding diagrams. We developed rubrics to score the problem solving performance of students in different intervention groups and investigated ten problems. We found that students who were provided diagrams never performed better and actually performed worse than the other students on three problems, one involving standing sound waves in a tube (discussed elsewhere and two problems in electricity which we focus on here. These two problems were the only problems in electricity that involved considerations of initial and final conditions, which may partly account for why students provided with diagrams performed significantly worse than students who were not provided with diagrams. In order to explore potential reasons for this finding, we conducted interviews with students and found that some students provided with diagrams may have spent less time on the conceptual analysis and planning stage of the problem solving process. In particular, those provided with the diagram were more likely to jump into the implementation stage of problem solving early without fully analyzing and understanding the problem, which can increase the likelihood of mistakes in solutions.

Case of two electrostatics problems: Can providing a diagram adversely impact introductory physics students' problem solving performance?

Science.gov (United States)

Maries, Alexandru; Singh, Chandralekha

2018-06-01

Drawing appropriate diagrams is a useful problem solving heuristic that can transform a problem into a representation that is easier to exploit for solving it. One major focus while helping introductory physics students learn effective problem solving is to help them understand that drawing diagrams can facilitate problem solution. We conducted an investigation in which two different interventions were implemented during recitation quizzes in a large enrollment algebra-based introductory physics course. Students were either (i) asked to solve problems in which the diagrams were drawn for them or (ii) explicitly told to draw a diagram. A comparison group was not given any instruction regarding diagrams. We developed rubrics to score the problem solving performance of students in different intervention groups and investigated ten problems. We found that students who were provided diagrams never performed better and actually performed worse than the other students on three problems, one involving standing sound waves in a tube (discussed elsewhere) and two problems in electricity which we focus on here. These two problems were the only problems in electricity that involved considerations of initial and final conditions, which may partly account for why students provided with diagrams performed significantly worse than students who were not provided with diagrams. In order to explore potential reasons for this finding, we conducted interviews with students and found that some students provided with diagrams may have spent less time on the conceptual analysis and planning stage of the problem solving process. In particular, those provided with the diagram were more likely to jump into the implementation stage of problem solving early without fully analyzing and understanding the problem, which can increase the likelihood of mistakes in solutions.

Gulf War Illnesses: DOD's Conclusions about U.S. Troops' Exposure Cannot Be Adequately Supported

National Research Council Canada - National Science Library

Rhodes, Keith

2004-01-01

... (MOD) conclusions about troops' exposure. The GAO found that DoD's and MOD's conclusions about troops' exposure to CW agents, based on DoD and CIA plume modeling, cannot be adequately supported...

The adequate rocuronium dose required for complete block of the adductor muscles of the thigh.

Science.gov (United States)

Fujimoto, M; Kawano, K; Yamamoto, T

2018-03-01

Rocuronium can prevent the obturator jerk during transurethral resection of bladder tumors. We investigated the adequate rocuronium dose required for complete block of the thigh adductor muscles, and its correlation with individual responses of the adductor pollicis muscle to rocuronium. Eleven patients scheduled for transurethral resection of bladder tumors under general anesthesia were investigated. After general anesthesia induction, neuromuscular monitoring of the adductor pollicis muscle and ultrasonography-guided stimulation of the obturator nerve was commenced. Rocuronium, 0.15 mg/kg, was repeatedly administered intravenously. The adequate rocuronium dose required for complete block of the thigh muscles, defined as the cumulative dose of rocuronium administered until that time, and its correlation with the first twitch response of the adductor pollicis muscle on train-of-four stimulation after initial rocuronium administration was analyzed. The rocuronium dose found adequate for complete block of the thigh muscles was 0.30 mg/kg in seven patients and 0.45 mg/kg in the remaining four patients, which did not correlate with the first twitch response. At the time of complete block of the thigh muscles, the neuromuscular blockade level of the adductor pollicis muscle varied greatly, although the level was never more profound than a post-tetanic count of 1. Although the response of the adductor pollicis muscle to rocuronium cannot be used to determine the adequate rocuronium dose required for complete block of the thigh muscles, intense blockade, with maintenance of post-tetanic count at ≤ 1 in the adductor pollicis muscle is essential to prevent the obturator jerk. © 2017 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

46 CFR 92.15-15 - Ventilation for crew quarters and, where provided, passenger spaces.

Science.gov (United States)

2010-10-01

..., unless it can be shown that a natural system will provide adequate ventilation. However, vessels which... 46 Shipping 4 2010-10-01 2010-10-01 false Ventilation for crew quarters and, where provided...) CARGO AND MISCELLANEOUS VESSELS CONSTRUCTION AND ARRANGEMENT Ventilation § 92.15-15 Ventilation for crew...

Air Force Health Care Providers Incidence of Performing Testicular Exams and Instruction of Testicular Self-Exam

National Research Council Canada - National Science Library

Adams, Nicola

1999-01-01

...) within an Air Force healthcare setting. The study is also designed to determine any significant differences among providers, Family Practice Physicians, Nurse Practitioners, and Physicians Assistants, regarding the incidence of performing...

Herpes labialis and Nigerian dental health care providers: knowledge, attitudes, behaviors, and refusal to treat.

Science.gov (United States)

Azodo, Clement Chinedu; Umoh, Agnes O

2015-09-15

The few existing studies on herpes labialis among health care workers have been predominantly among non-dental health care workers. The purpose of this study was to determine Nigerian dental health care providers' knowledge of, attitudes toward, preventive behaviors for, and refusal to treat patients with herpes labialis. This cross-sectional study was conducted among final-year dental students at the University of Benin, dental house officers, and residents at the University of Benin Teaching Hospital, Benin City, Nigeria. Data collection was via a self-administered questionnaire. Bivariate statistics and logistic regression were used to relate the dependent and independent variables. Of the 120 questionnaires distributed, 110 were completed and returned, giving a 91.7% retrieval rate. However, 15 of the returned questionnaires were discarded because they were improperly completed, leaving a total of 95 questionnaires for final analysis in this study. The majority of participants were over 28 years old (54.7%), male (67.4%), unmarried (66.3%), and postgraduate dental health care providers (51.6%). Less than half (43.2%) of participants demonstrated adequate overall knowledge of herpes labialis. About one-tenth (10.5%) and more than three-quarters (87.4%) of participants reported a positive attitude and performance of adequate preventive behaviors, respectively. A total of 16.8% of participants reported a high tendency to refuse treatment to patients with herpes labialis. Although not statistically significant, young, unmarried, male undergraduate participants reported a greater likelihood to refuse treatment to herpes labialis patients. We found a statistically significant positive correlation between attitude and refusal to treat patients with herpes labialis. However, marital status and the attitude of participants toward these patients emerged as the determinants for refusal to treat patients with herpes labialis. Data from this study revealed a high level of

Does Current Army Physical Fitness Training Doctrine Adequately Prepare Soldiers for War?

Science.gov (United States)

2010-06-11

longer 7 adequate to sustain the activity. Anaerobic activities include sprinting, soccer , and basketball. Balance: The ability to maintain...deep muscles, and joint articulations. The common push-up requires the interaction of 21 different muscles to execute one repetition. The overhead press...aerobically break down glycogen, carbohydrates , and fats to produce energy. The more regularly the individual conducts cardio-respiratory training

A student's perspective: are medical students adequately trained in BLS?

Directory of Open Access Journals (Sweden)

Oyewole T

2016-11-01

Full Text Available Tobi Oyewole,1 Folashade Oyewole2 1University of Liverpool – The School of Medicine, Liverpool, 2Imperial College London, London, UK We read with great interest the article by Lami et al regarding improving basic life support (BLS training for medical students.1 We agree that BLS skills are vital for junior doctors. The days of trial by fire have long gone away, and junior doctors and medical students need to feel that they are adequately trained to handle emergency situations they may face in hospital.  Read the original article

[The pregnant employee in anaesthesia and intensive care - An evidence-based approach to designing adequate workplaces].

Science.gov (United States)

Röher, Katharina; Göpfert, Matthias S

2015-07-01

In the light of a rising percentage of women among employees in anaesthesia and intensive care designing adequate workplaces for pregnant employees plays an increasingly important role. Here it is necessary to align the varied interests of the pregnant employee, fellow employees and the employer, where the legal requirements of the Maternity Protection Act ("Mutterschutzgesetz") form the statutory framework. This review describes how adequate workplaces for pregnant employees in anaesthesia and intensive care can be established considering the scientific evidence on the subject. © Georg Thieme Verlag Stuttgart · New York.

"Diverse Providers" in Action: School Restructuring in Hawaii. Education Outlook. No. 8

Science.gov (United States)

Hess, Frederick M.; Squire, Juliet P.

2009-01-01

What to do about persistently low-performing schools is a pressing challenge for policymakers and educators across the nation. Schools that fail to make "adequate yearly progress" (AYP) for five consecutive years under No Child Left Behind (NCLB) must be "restructured." The 3,500 schools in the United States currently in…

"Diverse Providers" in Action: School Restructuring in Hawaii. Working Paper 2009-03

Science.gov (United States)

Hess, Frederick M.; Squire, Juliet P.

2009-01-01

What to do about persistently low-performing schools is a pressing challenge for policymakers and educators across the nation. Schools that fail to make "adequate yearly progress" (AYP) for five consecutive years under No Child Left Behind (NCLB) must be "restructured". The 3,500 schools in the United States currently in…

The Impact of Order Source Misattribution on Computerized Provider Order Entry (CPOE) Performance Metrics

Science.gov (United States)

Gellert, George A.; Catzoela, Linda; Patel, Lajja; Bruner, Kylynn; Friedman, Felix; Ramirez, Ricardo; Saucedo, Lilliana; Webster, S. Luke; Gillean, John A.

2017-01-01

Background One strategy to foster adoption of computerized provider order entry (CPOE) by physicians is the monthly distribution of a list identifying the number and use rate percentage of orders entered electronically versus on paper by each physician in the facility. Physicians care about CPOE use rate reports because they support the patient safety and quality improvement objectives of CPOE implementation. Certain physician groups are also motivated because they participate in contracted financial and performance arrangements that include incentive payments or financial penalties for meeting (or failing to meet) a specified CPOE use rate target. Misattribution of order sources can hinder accurate measurement of individual physician CPOE use and can thereby undermine providers’ confidence in their reported performance, as well as their motivation to utilize CPOE. Misattribution of order sources also has significant patient safety, quality, and medicolegal implications. Objective This analysis sought to evaluate the magnitude and sources of misattribution among hospitalists with high CPOE use and, if misattribution was found, to formulate strategies to prevent and reduce its recurrence, thereby ensuring the integrity and credibility of individual and facility CPOE use rate reporting. Methods A detailed manual order source review and validation of all orders issued by one hospitalist group at a midsize community hospital was conducted for a one-month study period. Results We found that a small but not dismissible percentage of orders issued by hospitalists—up to 4.18 percent (95 percent confidence interval, 3.84–4.56 percent) per month—were attributed inaccurately. Sources of misattribution by department or function were as follows: nursing, 42 percent; pharmacy, 38 percent; laboratory, 15 percent; unit clerk, 3 percent; and radiology, 2 percent. Order management and protocol were the most common correct order sources that were incorrectly attributed

Study of the bismuth oxide concentration required to provide Portland cement with adequate radiopacity for endodontic use.

Science.gov (United States)

Bueno, Carlos Eduardo da Silveira; Zeferino, Eduardo Gregatto; Manhães, Luiz Roberto Coutinho; Rocha, Daniel Guimarães Pedro; Cunha, Rodrigo Sanches; De Martin, Alexandre Sigrist

2009-01-01

The purpose of this study was to determine the ideal concentration of bismuth oxide in white Portland cement to provide it with sufficient radiopacity for use as an endodontic material (ADA specification #57). 2-mm thick standardized test specimens of white MTA and of white Portland cement, as controls, and of white Portland cement with the experimental addition of 5%, 10%, 15%, 20%, 25% or 30% of bismuth oxide were radiographed and compared with various thicknesses of pure aluminum, using optic density to determine the observed grayscale levels of radiopacity in a scale ranging from 0 to 255. The data was submitted to ANOVA (pcement with 0%, 5%, 10%, 15%, 20%, 25% and 30% of bismuth oxide presented mean readings of 63.3, 95.7, 110.7, 142.7, 151.3, 161.0 and 180.0 respectively. MTA presented a mean reading of 157.3. The readings of MTA and white Portland cement with 15% bismuth oxide did not differ significantly from the reading observed for a thickness of 4 mm of aluminum (145.3), which is considered ideal for a test specimen by ADA specification #57 (2 mm above the thickness of the test specimen). White MTA and white Portland cement with 15% bismuth oxide presented the radiopacity required for an endodontic cement.

Towards 31Mg-β-NMR resonance linewidths adequate for applications in magnesium chemistry

DEFF Research Database (Denmark)

Stachura, M.; McFadden, R. M. L.; Chatzichristos, A.

2017-01-01

The span of most chemical shifts recorded in conventional 25Mg-NMR spectroscopy is ~ 100 ppm. Accordingly, linewidths of ~ 10 ppm or better are desirable to achieve adequate resolution for applications in chemistry. Here we present first high-field 31Mg- β-NMR measurements of 31Mg+ ions implanted...

A Performance Analysis of Public Expenditure on Maternal Health in Mexico.

Science.gov (United States)

Servan-Mori, Edson; Avila-Burgos, Leticia; Nigenda, Gustavo; Lozano, Rafael

2016-01-01

We explore the relationship between public expenditure, coverage of adequate ANC (including timing, frequent and content), and the maternal mortality ratio--adjusted by coverage of adequate ANC--observed in Mexico in 2012 at the State level. Additionally, we examine the inequalities and concentration of public expenditure between populations with and without Social Security. Results suggest that in the 2003-2011 period, the public expenditure gap between women with and without Social Security decreased 74%, however, the distribution is less equitable among women without Social Security, across the States. Despite high levels of coverage on each dimension of ANC explored, coverage of adequate ANC was lower among Social Security than non-Social Security women. This variability results in differences up to 1.5 times in State-adjusted maternal mortality rate at the same level of expense and maternal mortality rate, respectively. The increase in the economic resources is only a necessary condition for achieving improved health outcomes. Providing adequate health services and achieving efficient, effective and transparent use of resources in health, are critical elements for health systems performance. The attainment of universal effective coverage of maternal health and reducing maternal mortality in Mexico, requires the adjustment of policy innovations including the rules of allocation and execution of health resources. Health policies should be designed on a more holistic view promoting a balance between accessibility, effective implementation and rigorous stewardship.

Adequate Education: Issues in Its Definition and Implementation. School Finance Project, Working Papers.

Science.gov (United States)

Tron, Esther, Ed.

Section 1203 of the Education Amendments of 1978 mandated the undertaking of studies concerning the adequate financing of elementary and secondary education in the 1980s. Created to carry out this mandate, the School Finance Project established as one of its goals reporting to Congress on issues implicit in funding educational adequacy. Several…

Child sexual abuse as an etiological factor of overweight and eating disorders - considerations for primary health care providers.

Science.gov (United States)

Opydo-Szymaczek, Justyna; Jarząbek-Bielecka, Grażyna; Kędzia, Witold; Borysewicz-Lewicka, Maria

2018-01-01

Despite the recognition of the clinical importance of child sexual abuse, primary health care providers are often not ad-equately prepared to perform medical evaluations and diagnose child sexual maltreatment. Paper presents basic symptoms and signs of CSA, which may suggest the need for further patient's diagnosis and referral. Since the great majority of sexually abused children do not have any abnormal physical findings, special attention is paid to the silent warning signs of CSA, such as changes in attitude towards own body and eating habits. Numerous studies suggest that victims of CSA may develop obesity or eating disorders of various forms and intensities.

Performance evaluation of hospitals that provide care in the public health system, Brazil.

Science.gov (United States)

Ramos, Marcelo Cristiano de Azevedo; da Cruz, Lucila Pedroso; Kishima, Vanessa Chaer; Pollara, Wilson Modesto; de Lira, Antônio Carlos Onofre; Couttolenc, Bernard François

2015-01-01

OBJECTIVE To analyze if size, administrative level, legal status, type of unit and educational activity influence the hospital network performance in providing services to the Brazilian Unified Health System. METHODS This cross-sectional study evaluated data from the Hospital Information System and the Cadastro Nacional de Estabelecimentos de Saúde (National Registry of Health Facilities), 2012, in Sao Paulo, Southeastern Brazil. We calculated performance indicators, such as: the ratio of hospital employees per bed; mean amount paid for admission; bed occupancy rate; average length of stay; bed turnover index and hospital mortality rate. Data were expressed as mean and standard deviation. The groups were compared using analysis of variance (ANOVA) and Bonferroni correction. RESULTS The hospital occupancy rate in small hospitals was lower than in medium, big and special-sized hospitals. Higher hospital occupancy rate and bed turnover index were observed in hospitals that include education in their activities. The hospital mortality rate was lower in specialized hospitals compared to general ones, despite their higher proportion of highly complex admissions. We found no differences between hospitals in the direct and indirect administration for most of the indicators analyzed. CONCLUSIONS The study indicated the importance of the scale effect on efficiency, and larger hospitals had a higher performance. Hospitals that include education in their activities had a higher operating performance, albeit with associated importance of using human resources and highly complex structures. Specialized hospitals had a significantly lower rate of mortality than general hospitals, indicating the positive effect of the volume of procedures and technology used on clinical outcomes. The analysis related to the administrative level and legal status did not show any significant performance differences between the categories of public hospitals.

Performance evaluation of hospitals that provide care in the public health system, Brazil

Directory of Open Access Journals (Sweden)

Marcelo Cristiano de Azevedo Ramos

2015-01-01

Full Text Available OBJECTIVE To analyze if size, administrative level, legal status, type of unit and educational activity influence the hospital network performance in providing services to the Brazilian Unified Health System.METHODS This cross-sectional study evaluated data from the Hospital Information System and the Cadastro Nacional de Estabelecimentos de Saúde (National Registry of Health Facilities, 2012, in Sao Paulo, Southeastern Brazil. We calculated performance indicators, such as: the ratio of hospital employees per bed; mean amount paid for admission; bed occupancy rate; average length of stay; bed turnover index and hospital mortality rate. Data were expressed as mean and standard deviation. The groups were compared using analysis of variance (ANOVA and Bonferroni correction.RESULTS The hospital occupancy rate in small hospitals was lower than in medium, big and special-sized hospitals. Higher hospital occupancy rate and bed turnover index were observed in hospitals that include education in their activities. The hospital mortality rate was lower in specialized hospitals compared to general ones, despite their higher proportion of highly complex admissions. We found no differences between hospitals in the direct and indirect administration for most of the indicators analyzed.CONCLUSIONS The study indicated the importance of the scale effect on efficiency, and larger hospitals had a higher performance. Hospitals that include education in their activities had a higher operating performance, albeit with associated importance of using human resources and highly complex structures. Specialized hospitals had a significantly lower rate of mortality than general hospitals, indicating the positive effect of the volume of procedures and technology used on clinical outcomes. The analysis related to the administrative level and legal status did not show any significant performance differences between the categories of public hospitals.

Fault Management Architectures and the Challenges of Providing Software Assurance

Science.gov (United States)

Savarino, Shirley; Fitz, Rhonda; Fesq, Lorraine; Whitman, Gerek

2015-01-01

The satellite systems Fault Management (FM) is focused on safety, the preservation of assets, and maintaining the desired functionality of the system. How FM is implemented varies among missions. Common to most is system complexity due to a need to establish a multi-dimensional structure across hardware, software and operations. This structure is necessary to identify and respond to system faults, mitigate technical risks and ensure operational continuity. These architecture, implementation and software assurance efforts increase with mission complexity. Because FM is a systems engineering discipline with a distributed implementation, providing efficient and effective verification and validation (VV) is challenging. A breakout session at the 2012 NASA Independent Verification Validation (IVV) Annual Workshop titled VV of Fault Management: Challenges and Successes exposed these issues in terms of VV for a representative set of architectures. NASA's IVV is funded by NASA's Software Assurance Research Program (SARP) in partnership with NASA's Jet Propulsion Laboratory (JPL) to extend the work performed at the Workshop session. NASA IVV will extract FM architectures across the IVV portfolio and evaluate the data set for robustness, assess visibility for validation and test, and define software assurance methods that could be applied to the various architectures and designs. This work focuses efforts on FM architectures from critical and complex projects within NASA. The identification of particular FM architectures, visibility, and associated VVIVV techniques provides a data set that can enable higher assurance that a satellite system will adequately detect and respond to adverse conditions. Ultimately, results from this activity will be incorporated into the NASA Fault Management Handbook providing dissemination across NASA, other agencies and the satellite community. This paper discusses the approach taken to perform the evaluations and preliminary findings from the

Can trained lay providers perform HIV testing services? A review of national HIV testing policies.

Science.gov (United States)

Flynn, David E; Johnson, Cheryl; Sands, Anita; Wong, Vincent; Figueroa, Carmen; Baggaley, Rachel

2017-01-04

Only an estimated 54% of people living with HIV are aware of their status. Despite progress scaling up HIV testing services (HTS), a testing gap remains. Delivery of HTS by lay providers may help close this testing gap, while also increasing uptake and acceptability of HIV testing among key populations and other priority groups. 50 National HIV testing policies were collated from WHO country intelligence databases, contacts and testing program websites. Data regarding lay provider use for HTS was extracted and collated. Our search had no geographical or language restrictions. This data was then compared with reported data from the Global AIDS Response Progress Reporting (GARPR) from July 2015. Forty-two percent of countries permit lay providers to perform HIV testing and 56% permit lay providers to administer pre-and post-test counseling. Comparative analysis with GARPR found that less than half (46%) of reported data from countries were consistent with their corresponding national HIV testing policy. Given the low uptake of lay provider use globally and their proven use in increasing HIV testing, countries should consider revising policies to support lay provider testing using rapid diagnostic tests.

Long-Term Recurrent Subarachnoid Hemorrhage After Adequate Coiling Versus Clipping of Ruptured Intracranial Aneurysms

NARCIS (Netherlands)

Schaafsma, Joanna D.; Sprengers, Marieke E.; van Rooij, Willem Jan; Sluzewski, Menno; Majoie, Charles B. L. M.; Wermer, Marieke J. H.; Rinkel, Gabriel J. E.

Background and Purpose-Coiling is increasingly used as treatment for intracranial aneurysms. Despite its favorable short-term outcome, concerns exist about long-term reopening and inherent risk of recurrent subarachnoid hemorrhage (SAH). We hypothesized a higher risk for recurrent SAH after adequate

The Impact of the Dimensions of Transformational Leadership on the Post-acquisition Performance of the Acquired Company

Directory of Open Access Journals (Sweden)

Sladjana Savovic

2017-08-01

Full Text Available Mergers and acquisitions (M&A are the important mechanisms through which companies can achieve growth, gain access to new markets and diversify their activities. Although companies engage themselves in M&As with optimism, empirical evidence shows that many M&A transactions are not successful. Therefore, research is often focused on the identification of the ways to improve post-acquisition performance. One of the key success factors of M&A is to provide adequate transformational leadership during the process of change, especially in the critical phase of the post-acquisition integration. A transformational leader should provide incentives and support to the employees in order for them to accept changes and focus on achieving challenging goals. This paper explores the impact of the different dimensions of transformational leadership on the post-acquisition performance based on the example of a company operating in the Republic of Serbia’s retail sector, which was the subject of a cross-border acquisition. In order to ensure the adequate representativeness of the sample, a questionnaire was distributed in all parts of the company throughout the Republic of Serbia. The results of this study show that all the dimensions of transformational leadership positively impact post-acquisition performance. The “individual consideration” dimension of transformational leadership has the strongest impact on post-acquisition performance, whereas the “intellectual simulation” dimension has the weakest.

Providing Extrinsic Reward for Test Performance Undermines Long-Term Memory Acquisition

Directory of Open Access Journals (Sweden)

Christof eKuhbandner

2016-02-01

Full Text Available Based on numerous studies showing that testing studied material can improve long-term retention more than restudying the same material, it is often suggested that the number of tests in education should be increased to enhance knowledge acquisition. However, testing in real-life educational settings often entails a high degree of extrinsic motivation of learners due to the common practice of placing important consequences on the outcome of a test. Such an effect on the motivation of learners may undermine the beneficial effects of testing on long-term memory because it has been shown that extrinsic motivation can reduce the quality of learning. To examine this issue, participants learned foreign language vocabulary words, followed by an immediate test in which one third of the words were tested and one third restudied. To manipulate extrinsic motivation during immediate testing, participants received either monetary reward contingent on test performance or no reward. After one week, memory for all words was tested. In the immediate test, reward reduced correct recall and increased commission errors, indicating that reward reduced the number of items that can benefit from successful retrieval. The results in the delayed test revealed that reward additionally reduced the gain received from successful retrieval because memory for initially successfully retrieved words was lower in the reward condition. However, testing was still more effective than restudying under reward conditions because reward undermined long-term memory for concurrently restudied material as well. These findings indicate that providing performance-contingent reward in a test can undermine long-term knowledge acquisition.

Providing Extrinsic Reward for Test Performance Undermines Long-Term Memory Acquisition.

Science.gov (United States)

Kuhbandner, Christof; Aslan, Alp; Emmerdinger, Kathrin; Murayama, Kou

2016-01-01

Based on numerous studies showing that testing studied material can improve long-term retention more than restudying the same material, it is often suggested that the number of tests in education should be increased to enhance knowledge acquisition. However, testing in real-life educational settings often entails a high degree of extrinsic motivation of learners due to the common practice of placing important consequences on the outcome of a test. Such an effect on the motivation of learners may undermine the beneficial effects of testing on long-term memory because it has been shown that extrinsic motivation can reduce the quality of learning. To examine this issue, participants learned foreign language vocabulary words, followed by an immediate test in which one-third of the words were tested and one-third restudied. To manipulate extrinsic motivation during immediate testing, participants received either monetary reward contingent on test performance or no reward. After 1 week, memory for all words was tested. In the immediate test, reward reduced correct recall and increased commission errors, indicating that reward reduced the number of items that can benefit from successful retrieval. The results in the delayed test revealed that reward additionally reduced the gain received from successful retrieval because memory for initially successfully retrieved words was lower in the reward condition. However, testing was still more effective than restudying under reward conditions because reward undermined long-term memory for concurrently restudied material as well. These findings indicate that providing performance-contingent reward in a test can undermine long-term knowledge acquisition.

Communication at an online infertility expert forum: provider responses to patients' emotional and informational cues.

Science.gov (United States)

Aarts, J W M; van Oers, A M; Faber, M J; Cohlen, B J; Nelen, W L D M; Kremer, J A M; van Dulmen, A M

2015-01-01

Online patient-provider communication has become increasingly popular in fertility care. However, it is not known to what extent patients express cues or concerns and how providers respond. In this study, we investigated cues and responses that occur in online patient-provider communication at an infertility-specific expert forum. We extracted 106 threads from the multidisciplinary expert forum of two Dutch IVF clinics. We performed the following analyses: (1) thematic analysis of patients' questions; and (2) rating patients' emotional and informational cues and subsequent professionals' responses using an adaptation of the validated Medical Interview Aural Rating Scale. Frequencies of themes, frequencies of cues and responses, and sequences (what cue is followed by what response) were extracted. Sixty-five infertile patients and 19 providers participated. The most common themes included medication and lifestyle. Patients gave more informational than emotional cues (106 versus 64). Responses to informational cues were mostly adequate (61%). The most common response to emotional cues was empathic acknowledgment (72%). Results indicate that an online expert forum could have a positive effect on patient outcomes, which should guide future research. Offering infertile patients an expert forum to communicate with providers can be a promising supplement to usual care in both providing information and addressing patients' concerns.

Degree of patient satisfaction with health care performance assesed by marketing surveys.

Science.gov (United States)

Druguş, Daniela; Azoicăi, Doina

2015-01-01

Marketing surveys of the health system collect useful information to develop effective management strategies. The research aim consisted in measuring patient satisfaction with health care quality. The qualitative research was based on an online SurveyMonkey open-ended questionnaire. The analysis of patient satisfaction/dissatisfaction with healthcare professionals was performed in 1838 patients. Correlation analysis allowed the identification of some determinants associated with patient satisfaction. The variable most commonly associated with satisfaction was "I got adequate information about procedures/treatment" according to 32.2% of respondents. The patients who were dissatisfied most commonly complained that they were "Not adequately informed about maneuvers and treatment", reported by 40.0% of respondents. This study provides a basis for building an original model for determining the variables of an efficient healthcare system which to ensure a high degree of patient satisfaction.

When one is not enough: prevalence and characteristics of homes not adequately protected by smoke alarms.

Science.gov (United States)

Peek-Asa, C; Allareddy, V; Yang, J; Taylor, C; Lundell, J; Zwerling, C

2005-12-01

The National Fire Protection Association (NFPA) has specific recommendations about the number, location, and type of smoke alarms that are needed to provide maximum protection for a household. No previous studies have examined whether or not homes are completely protected according to these guidelines. The authors describe the prevalence and home characteristics associated with compliance to recommendations for smoke alarm installation by the NFPA. Data are from the baseline on-site survey of a randomized trial to measure smoke alarm effectiveness. The trial was housed in a longitudinal cohort study in a rural Iowa county. Of 1005 homes invited, 691 (68.8%) participated. Information about smoke alarm type, placement, and function, as well as home and occupant characteristics, was collected through an on-site household survey. Although 86.0% of homes had at least one smoke alarm, only 22.3% of homes (approximately one in five) were adequately protected according to NFPA guidelines. Fourteen percent of homes had no functioning smoke alarms. More than half of the homes with smoke alarms did not have enough of them or had installed them incorrectly, and 42.4% of homes with alarms had at least one alarm that did not operate. Homes with at least one high school graduate were nearly four times more likely to be fully protected. Homes that had multiple levels, a basement, or were cluttered or poorly cleaned were significantly less likely to be fully protected. These findings indicate that consumers may not be knowledgeable about the number of alarms they need or how to properly install them. Occupants are also not adequately maintaining the alarms that are installed.

A qualitative study of the challenges of providing pre-prosthetic rehabilitation in rural South Africa.

Science.gov (United States)

Ennion, Liezel; Johannesson, Anton

2018-04-01

There is a known shortage of rehabilitation staff in rural settings and a sharp increase in the number of lower limb amputations being performed. A lack of adequate pre-prosthetic rehabilitation will result in worse physical and psychological outcomes for a person with a lower limb amputation, and they will not be eligible to be fitted with a prosthesis. To explore therapists' experiences with providing pre-prosthetic rehabilitation in a rural setting. A qualitative descriptive approach was used to collect and analyse data. Data were collected from 17 purposively sampled therapists in five district hospitals in a rural community in South Africa. Data were collected in two rounds of focus groups to explore the challenges of providing pre-prosthetic rehabilitation in rural South Africa. The main themes identified in the study were (1) a lack of government health system support, (2) poor socioeconomic circumstances of patients and (3) cultural factors that influence rehabilitation. These themes all negatively influence the therapists' ability to follow up patients for pre-prosthetic rehabilitation after discharge from hospital. A lack of adequate pre-prosthetic rehabilitation is a substantial barrier to prosthetic fitting in rural South Africa. Patients who do not receive pre-prosthetic rehabilitation have a poorly shaped residuum or other complications such as knee or hip joint contractures which disqualifies them from being referred to prosthetic services. Therapists involved in this study identified the most important barriers to patients having access to prosthetic services. Clinical relevance Pre-prosthetic rehabilitation provides care of the residuum; maintenance or improvement of physical strength, joint range of motion and referral to a prosthetist. By exploring the challenges known to exist in this service, we can identify potential ways to reduce these barriers and improve the lives of those who use it.

Examination of the roles and capacities of duty bearers responsible for protecting the human rights to adequate food, nutritional health and wellbeing in Ugandan children's homes.

Science.gov (United States)

Olafsen, Monica; Rukooko, Archangel Byaruhanga; Iversen, Per Ole; Andreassen, Bård A

2018-04-17

The majority of Ugandan children face vulnerability and malnutrition. As a State Party to international human rights treaties, Uganda has legal obligations of guaranteeing the fundamental rights and the best interest of the nation's children. Despite being protected under international and national law, Uganda is not providing adequate child protection, including safeguarding children's food security. Numerous privately owned and unregulated children's homes face this problem. The overall aim of the study was to examine to what extent children's homes' operations are consistent with the right to adequate food, nutritional health and wellbeing of children. We performed a qualitative role- and capacity analysis of duty bearers with human rights duties towards children living in children's homes. We studied three groups of duty bearers: caretakers working in private children's homes, State actors working in government and its institutions, and non-State actors working in civil society organizations. A human rights based approach guided all aspects of the study. An analysis of the roles, performance and capacities of duty bearers was employed, with individual face-to-face structured qualitative in-depth interviews, self-administered structured questionnaires, and a structured observational study, as well as a desk review of relevant literature. The State of Uganda's efforts to respect and realize its obligations towards children living in children's homes is inadequate. There are numerous capacity gaps among the duty bearers, and the concepts of human rights and the best interest of the child are not well understood among the duty bearers. The efforts of the State of Uganda to realize its human rights obligations towards children in children's homes are lacking in important areas. Hence the State does not fulfill its minimum obligations under the International Covenant on Economic, Social and Cultural Rights to ensure all children freedom from hunger. There is a need

Use of Linear Programming to Develop Cost-Minimized Nutritionally Adequate Health Promoting Food Baskets

DEFF Research Database (Denmark)

Parlesak, A.; Tetens, Inge; Dejgård Jensen, Jørgen

2016-01-01

Food-Based Dietary Guidelines (FBDGs) are developed to promote healthier eating patterns, but increasing food prices may make healthy eating less affordable. The aim of this study was to design a range of cost-minimized nutritionally adequate health-promoting food baskets (FBs) that help prevent ...

Relationships among providing maternal, child, and adolescent health services; implementing various financial strategy responses; and performance of local health departments.

Science.gov (United States)

Issel, L Michele; Olorunsaiye, Comfort; Snebold, Laura; Handler, Arden

2015-04-01

We explored the relationships between local health department (LHD) structure, capacity, and macro-context variables and performance of essential public health services (EPHS). In 2012, we assessed a stratified, random sample of 195 LHDs that provided data via an online survey regarding performance of EPHS, the services provided or contracted out, the financial strategies used in response to budgetary pressures, and the extent of collaborations. We performed weighted analyses that included analysis of variance, pairwise correlations by jurisdiction population size, and linear regressions. On average, LHDs provided approximately 13 (36%) of 35 possible services either directly or by contract. Rather than cut services or externally consolidating, LHDs took steps to generate more revenue and maximize capacity. Higher LHD performance of EPHS was significantly associated with delivering more services, initiating more financial strategies, and engaging in collaboration, after adjusting for the effects of the Affordable Care Act and jurisdiction size. During changing economic and health care environments, we found that strong structural capacity enhanced local health department EPHS performance for maternal, child, and adolescent health.

Impact of a cost constraint on nutritionally adequate food choices for French women: an analysis by linear programming.

Science.gov (United States)

Darmon, Nicole; Ferguson, Elaine L; Briend, André

2006-01-01

To predict, for French women, the impact of a cost constraint on the food choices required to provide a nutritionally adequate diet. Isocaloric daily diets fulfilling both palatability and nutritional constraints were modeled in linear programming, using different cost constraint levels. For each modeled diet, total departure from an observed French population's average food group pattern ("mean observed diet") was minimized. To achieve the nutritional recommendations without a cost constraint, the modeled diet provided more energy from fish, fresh fruits and green vegetables and less energy from animal fats and cheese than the "mean observed diet." Introducing and strengthening a cost constraint decreased the energy provided by meat, fresh vegetables, fresh fruits, vegetable fat, and yogurts and increased the energy from processed meat, eggs, offal, and milk. For the lowest cost diet (ie, 3.18 euros/d), marked changes from the "mean observed diet" were required, including a marked reduction in the amount of energy from fresh fruits (-85%) and green vegetables (-70%), and an increase in the amount of energy from nuts, dried fruits, roots, legumes, and fruit juices. Nutrition education for low-income French women must emphasize these affordable food choices.

Median Urinary Iodine Concentrations Are Indicative of Adequate Iodine Status among Women of Reproductive Age in Prey Veng, Cambodia.

Science.gov (United States)

Karakochuk, Crystal D; Michaux, Kristina D; Chai, Tze L; Chan, Benny B; Whitfield, Kyly C; Barr, Susan I; McLean, Judy; Talukder, Aminuzzaman; Hou, Kroeun; Ly, Sokhoing; Green, Tim J

2016-03-03

Iodine deficiency disorders are estimated to affect over 1.9 million people worldwide. Iodine deficiency is especially serious for women during pregnancy and lactation because of the negative consequences for both mother and infant. The aim of this cross-sectional study was to determine the median urinary iodine concentration (UIC) as a population-level indicator of iodine status among rural women farmers of reproductive age (18-45 years) in the province of Prey Veng, Cambodia. A total of 450 women provided a spot morning urine sample in 2012. Of those women, 93% (n = 420) were non-pregnant and 7% (n = 30) were pregnant at the time of collection. UIC was quantified using the Sandell-Kolthoff reaction with modifications. The median UIC of non-pregnant (139 μg/L) and pregnant women (157 μg/L) were indicative of adequate iodine status using the WHO/UNICEF/ICCIDD epidemiological criteria for both groups (median UIC between 100-199 and 150-249 μg/L, respectively). We conclude that non-pregnant and pregnant women in rural Prey Veng, Cambodia had adequate iodine status based on single spot morning urine samples collected in 2012. More research is warranted to investigate iodine status among larger and more representative populations of women in Cambodia, especially in light of recent policy changes to the national program for universal salt iodization.

Adequate performance of cardiopulmonary resuscitation techniques during simulated cardiac arrest over and under protective equipment in football.

Science.gov (United States)

Waninger, Kevin N; Goodbred, Andrew; Vanic, Keith; Hauth, John; Onia, Joshua; Stoltzfus, Jill; Melanson, Scott

2014-07-01

To investigate (1) cardiopulmonary resuscitation (CPR) adequacy during simulated cardiac arrest of equipped football players and (2) whether protective football equipment impedes CPR performance measures. Exploratory crossover study performed on Laerdal SimMan 3 G interactive manikin simulator. Temple University/St Luke's University Health Network Regional Medical School Simulation Laboratory. Thirty BCLS-certified ATCs and 6 ACLS-certified emergency department technicians. Subjects were given standardized rescuer scenarios to perform three 2-minute sequences of compression-only CPR. Baseline CPR sequences were captured on each subject. Experimental conditions included 2-minute sequences of CPR either over protective football shoulder pads or under unlaced pads. Subjects were instructed to adhere to 2010 American Heart Association guidelines (initiation of compressions alone at 100/min to 51 mm). Dependent variables included average compression depth, average compression rate, percentage of time chest wall recoiled, and percentage of hands-on contact during compressions. Differences between subject groups were not found to be statistically significant, so groups were combined (n = 36) for analysis of CPR compression adequacy. Compression depth was deeper under shoulder pads than over (P = 0.02), with mean depths of 36.50 and 31.50 mm, respectively. No significant difference was found with compression rate or chest wall recoil. Chest compression depth is significantly decreased when performed over shoulder pads, while there is no apparent effect on rate or chest wall recoil. Although the clinical outcomes from our observed 15% difference in compression depth are uncertain, chest compression under the pads significantly increases the depth of compressions and more closely approaches American Heart Association guidelines for chest compression depth in cardiac arrest.

Search for adequate quality standards for neutron radiography of nuclear fuel

International Nuclear Information System (INIS)

Domanus, J.C.

1983-01-01

Unlike in other fields of industrial radiography, where standard methods and procedures are used to control the quality of the radiographic image, no such standard exists for neutron radiography of nuclear fuel. To fill that gap it was felt that standardization work ought to be started in that field, too. Accordingly in 1979 an Euratom Neutron Radiography Working Group was constituted, which initiated standardization work in the field of neutron radiography of nuclear fuel. Finding adequate standards for image quality of neutron radiographs and checking the accuracy of dimension measurements from them were given first priority. (Auth.)

Understanding the motivations of health-care providers in performing female genital mutilation: an integrative review of the literature.

Science.gov (United States)

Doucet, Marie-Hélène; Pallitto, Christina; Groleau, Danielle

2017-03-23

Female genital mutilation (FGM) is a traditional harmful practice that can cause severe physical and psychological damages to girls and women. Increasingly, trained health-care providers carry out the practice at the request of families. It is important to understand the motivations of providers in order to reduce the medicalization of FGM. This integrative review identifies, appraises and summarizes qualitative and quantitative literature exploring the factors that are associated with the medicalization of FGM and/or re-infibulation. Literature searches were conducted in PubMed, CINAHL and grey literature databases. Hand searches of identified studies were also examined. The "CASP Qualitative Research Checklist" and the "STROBE Statement" were used to assess the methodological quality of the qualitative and quantitative studies respectively. A total of 354 articles were reviewed for inclusion. Fourteen (14) studies, conducted in countries where FGM is largely practiced as well as in countries hosting migrants from these regions, were included. The main findings about the motivations of health-care providers to practice FGM were: (1) the belief that performing FGM would be less harmful for girls or women than the procedure being performed by a traditional practitioner (the so-called "harm reduction" perspective); (2) the belief that the practice was justified for cultural reasons; (3) the financial gains of performing the procedure; (4) responding to requests of the community or feeling pressured by the community to perform FGM. The main reasons given by health-care providers for not performing FGM were that they (1) are concerned about the risks that FGM can cause for girls' and women's health; (2) are preoccupied by the legal sanctions that might result from performing FGM; and (3) consider FGM to be a "bad practice". The findings of this review can inform public health program planners, policy makers and researchers to adapt or create strategies to end

Can Earth Materials BE Adequately Covered in a - or Two-Semester Course?

Science.gov (United States)

Hefferan, K. P.; O'Brien, J.

2007-12-01

Traditional geology programs offer courses in mineralogy, optical mineralogy, igneous petrology, metamorphic petrology, sedimentology and economic geology. At many universities this suite of mineralogy/petrology courses has been supplanted by a one-semester or two-semester Earth Materials course. This interactive poster poses five questions to faculty and students related to the means by which Earth Materials can be delivered: 1) Available online syllabi demonstrate a wide variation in the topics addressed in Earth Materials courses; is there a standard core of key topics that must be covered and in what level of detail? 2) Can a one-semester or two- semester Earth Materials course adequately cover these topics? 3) Excellent textbooks exist in both mineralogy and in petrology; what textbooks, if any, adequately encompass Earth Materials? 4) How has the online environment changed the way in which we use textbooks in the classroom? 5) Given the evolution of geology programs, higher education and the global economy in the past twenty years, what additional changes can be anticipated with respect to delivery and demand of Earth Materials topics? Answers-- or at least related discussions-- to these questions are encouraged via verbal dialogue among participants and/or by comments written on the poster. Our goal is to solicit faculty, student and industry feedback to create a textbook, curricula and online materials that support an Earth Materials course.

Developmental origins of metabolic disorders: The need for biomarker candidates and therapeutic targets from adequate preclinical models

Directory of Open Access Journals (Sweden)

Antonio Gonzalez-Bulnes

2016-03-01

Full Text Available The investigation on obesity and associated disorders have changed from an scenario in which genome drove the phenotype to a dynamic setup in which prenatal and early-postnatal conditions are determinant. However, research in human beings is difficult due to confounding factors (lifestyle and socioeconomic heterogeneity plus ethical issues. Hence, there is currently an intensive effort for developing adequate preclinical models, aiming for an adequate combination of basic studies in rodent models and specific preclinical studies in large animals. The results of these research strategies may increase the identification and development of contrasted biomarkers and therapeutic targets.

Multi-criteria group decision making for evaluating the performance of e-waste recycling programs under uncertainty.

Science.gov (United States)

Wibowo, Santoso; Deng, Hepu

2015-06-01

This paper presents a multi-criteria group decision making approach for effectively evaluating the performance of e-waste recycling programs under uncertainty in an organization. Intuitionistic fuzzy numbers are used for adequately representing the subjective and imprecise assessments of the decision makers in evaluating the relative importance of evaluation criteria and the performance of individual e-waste recycling programs with respect to individual criteria in a given situation. An interactive fuzzy multi-criteria decision making algorithm is developed for facilitating consensus building in a group decision making environment to ensure that all the interest of individual decision makers have been appropriately considered in evaluating alternative e-waste recycling programs with respect to their corporate sustainability performance. The developed algorithm is then incorporated into a multi-criteria decision support system for making the overall performance evaluation process effectively and simple to use. Such a multi-criteria decision making system adequately provides organizations with a proactive mechanism for incorporating the concept of corporate sustainability into their regular planning decisions and business practices. An example is presented for demonstrating the applicability of the proposed approach in evaluating the performance of e-waste recycling programs in organizations. Copyright © 2015 Elsevier Ltd. All rights reserved.

Fair Balance and Adequate Provision in Direct-to-Consumer Prescription Drug Online Banner Advertisements: A Content Analysis

Science.gov (United States)

2016-01-01

Background The current direct-to-consumer advertising (DTCA) guidelines were developed with print, television, and radio media in mind, and there are no specific guidelines for online banner advertisements. Objective This study evaluates how well Internet banner ads comply with existing Food and Drug Administration (FDA) guidelines for DTCA in other media. Methods A content analysis was performed of 68 banner advertisements. A coding sheet was developed based on (1) FDA guidance documents for consumer-directed prescription drug advertisements and (2) previous DTCA content analyses. Specifically, the presence of a brief summary detailing the drug’s risks and side effects or of a “major statement” identifying the drug’s major risks, and the number and type of provisions made available to consumers for comprehensive information about the drug were coded. In addition, the criterion of “fair balance,” the FDA’s requirement that prescription drug ads balance information relating to the drug’s risks with information relating to its benefits, was measured by numbering the benefit and risk facts identified in the ads and by examining the presentation of risk and benefit information. Results Every ad in the sample included a brief summary of risk information and at least one form of adequate provision as required by the FDA for broadcast ads that do not give audiences a brief summary of a drug’s risks. No ads included a major statement. There were approximately 7.18 risk facts for every benefit fact. Most of the risks (98.85%, 1292/1307) were presented in the scroll portion of the ad, whereas most of the benefits (66.5%, 121/182) were presented in the main part of the ad. Out of 1307 risk facts, 1292 were qualitative and 15 were quantitative. Out of 182 benefit facts, 181 were qualitative and 1 was quantitative. The majority of ads showed neutral images during the disclosure of benefit and risk facts. Only 9% (6/68) of the ads displayed positive images and

Fair Balance and Adequate Provision in Direct-to-Consumer Prescription Drug Online Banner Advertisements: A Content Analysis.

Science.gov (United States)

Adams, Crystal

2016-02-18

The current direct-to-consumer advertising (DTCA) guidelines were developed with print, television, and radio media in mind, and there are no specific guidelines for online banner advertisements. This study evaluates how well Internet banner ads comply with existing Food and Drug Administration (FDA) guidelines for DTCA in other media. A content analysis was performed of 68 banner advertisements. A coding sheet was developed based on (1) FDA guidance documents for consumer-directed prescription drug advertisements and (2) previous DTCA content analyses. Specifically, the presence of a brief summary detailing the drug's risks and side effects or of a "major statement" identifying the drug's major risks, and the number and type of provisions made available to consumers for comprehensive information about the drug were coded. In addition, the criterion of "fair balance," the FDA's requirement that prescription drug ads balance information relating to the drug's risks with information relating to its benefits, was measured by numbering the benefit and risk facts identified in the ads and by examining the presentation of risk and benefit information. Every ad in the sample included a brief summary of risk information and at least one form of adequate provision as required by the FDA for broadcast ads that do not give audiences a brief summary of a drug's risks. No ads included a major statement. There were approximately 7.18 risk facts for every benefit fact. Most of the risks (98.85%, 1292/1307) were presented in the scroll portion of the ad, whereas most of the benefits (66.5%, 121/182) were presented in the main part of the ad. Out of 1307 risk facts, 1292 were qualitative and 15 were quantitative. Out of 182 benefit facts, 181 were qualitative and 1 was quantitative. The majority of ads showed neutral images during the disclosure of benefit and risk facts. Only 9% (6/68) of the ads displayed positive images and none displayed negative images when presenting risks

Feedback providing improvement strategies and reflection on feedback use: Effects on students' writing motivation, process, and performance

NARCIS (Netherlands)

Duijnhouwer, H.; Prins, F.J.; Stokking, K.M.

2012-01-01

This study investigated the effects of feedback providing improvement strategies and a reflection assignment on students’ writing motivation, process, and performance. Students in the experimental feedback condition (n = 41) received feedback including improvement strategies, whereas students in the

Maintaining adequate nutrient supply - Principles, decision-support tools, and best management practices [Chapter 6

Science.gov (United States)

Robert B. Harrison; Douglas A. Maguire; Deborah Page-Dumroese

2011-01-01

Maintaining adequate nutrient supply to maintain or enhance tree vigor and forest growth requires conservation of topsoil and soil organic matter. Sometimes nutrient amendments are also required to supplement inherent nutrient-pool limitations or replenish nutrients removed in harvested material. The goal is to maintain the productive potential of the soil and, when...

[Association between speed and endurance performance with sleep duration in children and adolescents].

Science.gov (United States)

Chen, T Q; Dong, B; Zhang, W J; Gao, D S; Dong, Y H; Ma, J; Ma, Y H

2018-06-18

To analyze the association between sleep duration and athletic performance, and provide scientific basis to improve the 50 m and endurance performance in children and adolescents. All the 119 462 subjects aged 9-15 years in both genders were sampled from 2014 National Physical Fitness and Health Surveillance by using stratified random cluster sampling method, to measure the height, weight, 50 meters and endurance performance and investigate sleep duration with questionnaire. Their body mass indexes (BMI) were calculated and the students' 50 m, endurance run scores and sleep durations were assessed. Binary Logistic regression was used to analyze the difference between the different sleep groups, and multifactor Logistic regression was used to analyze the relationship between the sleep condition and athletic performance. The prevalence of insufficient sleep was 94.67% in the total subjects, the prevalence was higher among the girls (95.26%)than the boys (94.09%, χ 2 =80.99, Pchildren with sufficient sleep had better performance in 50 m and endurance run scores( χ 2 50 m =10.10, P 50 m ＜0.01; χ 2 endurance run =21.76, Pchildren with adequate sleep showed better results(OR 50 m =1.14, 95%CI 50 m =1.05-1.23, P 50 m endurance run =1.21, 95%CI endurance run =1.11-1.31, P endurance run endurance run scores in the boys with adequate sleep were higher (Pendurance run excellent rates in the girls of different sleep conditions. The excellent rates of 50 m and endurance run in the urban children and the endurance rate in the rural children and adolescents with adequate sleep were higher than those with insufficient sleep (Psleep groups in rural areas. The 50 m and endurance run excellent rates of the children and adolescents with adequate sleep in each grade were higher than those of the children in the same grade with insufficient sleep (P primary students' endurance performance Children and adolescents with normal BMI and overweight who slept well had better

Performance and self-perceived competencies of enrolled nurse/midwives: a mixed methods study from rural Tanzania.

Science.gov (United States)

Tarimo, Edith A M; Moyo, Gustav; Masenga, Happy; Magesa, Paul; Mzava, Dafroza

2018-04-11

Tanzania is experiencing a severe shortage of human resources for health, which poses a serious threat to the quality of health care services particularly in rural areas. Task shifting has been considered a way to address this problem. However, since a large percentage of health care providers in rural setting is comprised of Enrolled Nurse/Midwives (ENMs), most of the health care tasks are shifted to them. This article analyzes the performance and self-perceived competencies of ENMs at the dispensary level; the lowest health facility in Tanzania. Performance refers to routine duties performed by ENMs, and self-perceived competence means self-perceived proficiency in performing nursing/midwifery and medical duties. This was a mixed methods study conducted in rural Tanzania. A purposeful sample of twelve (12) informants (six ENMs; two Community Leaders [CLs] and four Dispensary In-charges [DIs]) was recruited for semi-structured interviews. The interviews were supplemented with quantitative data from 59 ENMs. Both thematic and descriptive analysis approaches were used. Three themes emerged: (1) 'Approval of the performances of ENMs in meeting community health needs' underscores important services the community members got from ENMs at dispensaries. (2) 'Experienced difficulties of meeting community health needs' indicate the problems ENMs encountered while providing services to the community. In striving to serve a large number of demanding clients without adequate medical equipment and supplies, sometimes the ENMs ended up with prescription errors (3) 'Appreciating the performances and competencies of ENMs' shows the acknowledgement of community members towards ENMs' performance and competencies within and beyond their scope of practice. The community members as well as ENMs and their supervisors knew that ENMs must sometimes provide care that is outside their scope of training and competency. Overall, the performance among ENMs above 38 years of age (P�

A preliminary study on the association between ventilation rates in classrooms and student performance.

Science.gov (United States)

Shaughnessy, R J; Haverinen-Shaughnessy, U; Nevalainen, A; Moschandreas, D

2006-12-01

Poor conditions leading to substandard indoor air quality (IAQ) in classrooms have been frequently cited in the literature over the past two decades. However, there is limited data linking poor IAQ in the classrooms to student performance. Whereas, it is assumed that poor IAQ results in reduced attendance and learning potential, and subsequent poor student performance, validating this hypothesis presents a challenge in today's school environment. This study explores the association between student performance on standardized aptitude tests that are administered to students on a yearly basis, to classroom carbon dioxide (CO2) concentrations, which provide a surrogate of ventilation being provided to each room. Data on classroom CO2 concentrations (over a 4-5 h time span within a typical school day) were recorded in fifth grade classrooms in 54 elementary schools within a school district in the USA. Results from this preliminary study yield a significant (P classroom-level ventilation rate and test results in math. They also indicate that non-linear effects may need to be considered for better representation of the association. A larger sample size is required in order to draw more definitive conclusions. Practical Implications Future studies could focus on (1) gathering more evidence on the possible association between classroom ventilation rates and students' academic performance; (2) the linear/non-linear nature of the association; and (3) whether it is possible to detect 'no observed adverse effect level' for adequate ventilation with respect to academic performance in schools. All of this information could be used to improve guidance and take regulatory actions to ensure adequate ventilation in schools. The high prevalence of low ventilation rates, combined with the growing evidence of the positive impact that sufficient ventilation has on human performance, suggests an opportunity for improving design and management of school facilities.

The iodized salt programme in Bangalore, India provides adequate iodine intakes in pregnant women and more-than-adequate iodine intakes in their children

NARCIS (Netherlands)

Jaiswal, N.; Boonstra, A.; Sharma, S.K.; Srinivasan, K.; Zimmerman, M.B.

2015-01-01

Objective To compare the iodine status of pregnant women and their children who were sharing all meals in Bangalore, India. Design A cross-sectional study evaluating demographic characteristics, household salt iodine concentration and salt usage patterns, urinary iodine concentrations (UIC) in women

Provider Monitoring and Pay-for-Performance When Multiple Providers Affect Outcomes: An Application to Renal Dialysis

Science.gov (United States)

Hirth, Richard A; Turenne, Marc N; Wheeler, John RC; Pan, Qing; Ma, Yu; Messana, Joseph M

2009-01-01

Objective To characterize the influence of dialysis facilities and nephrologists on resource use and patient outcomes in the dialysis population and to illustrate how such information can be used to inform payment system design. Data Sources Medicare claims for all hemodialysis patients for whom Medicare was the primary payer in 2004, combined with the Medicare Enrollment Database and the CMS Medical Evidence Form (CMS Form 2728), which is completed at onset of renal replacement therapy. Study Design Resource use (mainly drugs and laboratory tests) per dialysis session and two clinical outcomes (achieving targets for anemia management and dose of dialysis) were modeled at the patient level with random effects for nephrologist and dialysis facility, controlling for patient characteristics. Results For each measure, both the physician and the facility had significant effects. However, facilities were more influential than physicians, as measured by the standard deviation of the random effects. Conclusions The success of tools such as P4P and provider profiling relies upon the identification of providers most able to enhance efficiency and quality. This paper demonstrates a method for determining the extent to which variation in health care costs and quality of care can be attributed to physicians and institutional providers. Because variation in quality and cost attributable to facilities is consistently larger than that attributable to physicians, if provider profiling or financial incentives are targeted to only one type of provider, the facility appears to be the appropriate locus. PMID:19555398

國民中學適足教育經費：臺灣偏遠與非偏遠地區學校的比較 Estimating Adequate Funding to Meet Performance Standards for Junior High School Students: Adequate Funding Comparisons Between Rural and Non-Rural Schools in Taiwan

Directory of Open Access Journals (Sweden)

張良丞 Liang-Cheng Zhang

2016-09-01

Full Text Available 臺灣學生近年來在國際大型測驗表現亮眼，但如進一步檢視學校所處地區，即可明顯看出臺灣存在巨大的城鄉差距問題：偏遠地區與大城市相比，不僅數學表現較差，且出現各校數學差距相對較大的情況。不足的教育經費可能是導致此差距的原因之一，本研究因此以成本函數法來估算偏遠與非偏遠地區學校達成預期學生學業成就所需的適足經費，並以國中基測數學基礎級、平均數、精熟級來作為適足分數，以估算不同程度所需的適足經費，結果發現，無論何種適足分數，偏遠地區所需的每生適足經費皆比非偏遠地區為高，且超過半數以上的偏遠學校未達適足經費水準。本研究亦根據研究結果，提出改進建議。 Although the mathematical ability of Taiwanese students is ranked high according to the Programme for International Student Assessment (PISA, Taiwan faces the problem of a gap in test scores between rural students and their non-rural counterparts, with the latter group scoring higher on average. Inadequate funding is a possible reason for this discrepancy. Therefore, this paper uses the cost function approach to compare adequate funding requirements between rural and non-rural schools. The adequate funding estimates are calculated based on the different levels of mathematics scores in the Basic Competence Test (basic, average, and proficient. The results showed that rural schools require more per student funding than do non-rural schools, irrespective of the use of score levels as references. A greater portion of rural schools were shown to operate under inadequate per student funding compared with non-rural schools. This paper provides further evidence of the urgency of increased investment in rural schools.

Position of the American Dietetic Association, Dietitians of Canada, and the American College of Sports Medicine: Nutrition and athletic performance.

Science.gov (United States)

Rodriguez, Nancy R; DiMarco, Nancy M; Langley, Susie

2009-03-01

It is the position of the American Dietetic Association, Dietitians of Canada, and the American College of Sports Medicine that physical activity, athletic performance, and recovery from exercise are enhanced by optimal nutrition. These organizations recommend appropriate selection of foods and fluids, timing of intake, and supplement choices for optimal health and exercise performance. This updated position paper couples a rigorous, systematic, evidence-based analysis of nutrition and performance-specific literature with current scientific data related to energy needs, assessment of body composition, strategies for weight change, nutrient and fluid needs, special nutrient needs during training and competition, the use of supplements and ergogenic aids, nutrition recommendations for vegetarian athletes, and the roles and responsibilities of sports dietitians. Energy and macronutrient needs, especially carbohydrate and protein, must be met during times of high physical activity to maintain body weight, replenish glycogen stores, and provide adequate protein to build and repair tissue. Fat intake should be sufficient to provide the essential fatty acids and fat-soluble vitamins, as well as contribute energy for weight maintenance. Although exercise performance can be affected by body weight and composition, these physical measures should not be a criterion for sports performance and daily weigh-ins are discouraged. Adequate food and fluid should be consumed before, during, and after exercise to help maintain blood glucose concentration during exercise, maximize exercise performance, and improve recovery time. Athletes should be well hydrated before exercise and drink enough fluid during and after exercise to balance fluid losses. Sports beverages containing carbohydrates and electrolytes may be consumed before, during, and after exercise to help maintain blood glucose concentration, provide fuel for muscles, and decrease risk of dehydration and hyponatremia. Vitamin

Using a quality improvement model to enhance providers' performance in maternal and newborn health care: a post-only intervention and comparison design.

Science.gov (United States)

Ayalew, Firew; Eyassu, Gizachew; Seyoum, Negash; van Roosmalen, Jos; Bazant, Eva; Kim, Young Mi; Tekleberhan, Alemnesh; Gibson, Hannah; Daniel, Ephrem; Stekelenburg, Jelle

2017-04-12

The Standards Based Management and Recognition (SBM-R © ) approach to quality improvement has been implemented in Ethiopia to strengthen routine maternal and newborn health (MNH) services. This evaluation assessed the effect of the intervention on MNH providers' performance of routine antenatal care (ANC), uncomplicated labor and delivery and immediate postnatal care (PNC) services. A post-only evaluation design was conducted at three hospitals and eight health centers implementing SBM-R and the same number of comparison health facilities. Structured checklists were used to observe MNH providers' performance on ANC (236 provider-client interactions), uncomplicated labor and delivery (226 provider-client interactions), and immediate PNC services in the six hours after delivery (232 provider-client interactions); observations were divided equally between intervention and comparison groups. Main outcomes were provider performance scores, calculated as the percentage of essential tasks in each service area completed by providers. Multilevel analysis was used to calculate adjusted mean percentage performance scores and standard errors to compare intervention and comparison groups. There was no statistically significant difference between intervention and comparison facilities in overall mean performance scores for ANC services (63.4% at intervention facilities versus 61.0% at comparison facilities, p = 0.650) or in any specific ANC skill area. MNH providers' overall mean performance score for uncomplicated labor and delivery care was 11.9 percentage points higher in the intervention than in the comparison group (77.5% versus 65.6%; p = 0.002). Overall mean performance scores for immediate PNC were 22.2 percentage points higher at intervention than at comparison facilities (72.8% versus 50.6%; p = 0.001); and there was a significant difference of 22 percentage points between intervention and comparison facilities for each PNC skill area: care for the newborn

Knowledge, Attitudes, Practices and Beliefs about Medical Male Circumcision (MMC among a Sample of Health Care Providers in Haiti.

Directory of Open Access Journals (Sweden)

Jessy G Dévieux

Full Text Available Haiti has the highest number of people living with HIV infection in the Caribbean/Latin America region. Medical male circumcision (MMC has been recommended to help prevent the spread of HIV. We sought to assess knowledge, attitudes, practices and beliefs about MMC among a sample of health care providers in Haiti.A convenience sample of 153 health care providers at the GHESKIO Centers in Haiti responded to an exploratory survey that collected information on several topics relevant to health providers about MMC. Descriptive statistics were calculated for the responses and multivariable logistic regression was conducted to determine opinions of health care providers about the best age to perform MMC on males. Bayesian network analysis and sensitivity analysis were done to identify the minimum level of change required to increase the acceptability of performing MMC at age less than 1 year.The sample consisted of medical doctors (31.0%, nurses (49.0%, and other health care professionals (20.0%. Approximately 76% showed willingness to offer MMC services if they received training. Seventy-six percent believed that their male patients would accept circumcision, and 59% believed infancy was the best age for MMC. More than 90% of participants said that MMC would reduce STIs. Physicians and nurses who were willing to offer MMC if provided with adequate training were 2.5 (1.15-5.71 times as likely to choose the best age to perform MMC as less than one year. Finally, if the joint probability of choosing "the best age to perform MMC" as one year or older and having the mistaken belief that "MMC prevents HIV entirely" is reduced by 63% then the probability of finding that performing MMC at less than one year acceptable to health care providers is increased by 35%.Participants demonstrated high levels of knowledge and positive attitudes towards MMC. Although this study suggests that circumcision is acceptable among certain health providers in Haiti, studies

Wind farms providing secondary frequency regulation: Evaluating the performance of model-based receding horizon control

International Nuclear Information System (INIS)

Shapiro, Carl R.; Meneveau, Charles; Gayme, Dennice F.; Meyers, Johan

2016-01-01

We investigate the use of wind farms to provide secondary frequency regulation for a power grid. Our approach uses model-based receding horizon control of a wind farm that is tested using a large eddy simulation (LES) framework. In order to enable real-time implementation, the control actions are computed based on a time-varying one-dimensional wake model. This model describes wake advection and interactions, both of which play an important role in wind farm power production. This controller is implemented in an LES model of an 84-turbine wind farm represented by actuator disk turbine models. Differences between the velocities at each turbine predicted by the wake model and measured in LES are used for closed-loop feedback. The controller is tested on two types of regulation signals, “RegA” and “RegD”, obtained from PJM, an independent system operator in the eastern United States. Composite performance scores, which are used by PJM to qualify plants for regulation, are used to evaluate the performance of the controlled wind farm. Our results demonstrate that the controlled wind farm consistently performs well, passing the qualification threshold for all fastacting RegD signals. For the RegA signal, which changes over slower time scales, the controlled wind farm's average performance surpasses the threshold, but further work is needed to enable the controlled system to achieve qualifying performance all of the time. (paper)

Feedback Providing Improvement Strategies and Reflection on Feedback Use: Effects on Students' Writing Motivation, Process, and Performance

Science.gov (United States)

Duijnhouwer, Hendrien; Prins, Frans J.; Stokking, Karel M.

2012-01-01

This study investigated the effects of feedback providing improvement strategies and a reflection assignment on students' writing motivation, process, and performance. Students in the experimental feedback condition (n = 41) received feedback including improvement strategies, whereas students in the control feedback condition (n = 41) received…

Relationships between Contextual and Task Performance and Interrater Agreement: Are There Any?

Science.gov (United States)

Díaz-Vilela, Luis F; Delgado Rodríguez, Naira; Isla-Díaz, Rosa; Díaz-Cabrera, Dolores; Hernández-Fernaud, Estefanía; Rosales-Sánchez, Christian

2015-01-01

Work performance is one of the most important dependent variables in Work and Organizational Psychology. The main objective of this paper was to explore the relationships between citizenship performance and task performance measures obtained from different appraisers and their consistency through a seldom-used methodology, intraclass correlation coefficients. Participants were 135 public employees, the total staff in a local government department. Jobs were clustered into job families through a work analysis based on standard questionnaires. A task description technique was used to develop a performance appraisal questionnaire for each job family, with three versions: self-, supervisor-, and peer-evaluation, in addition to a measure of citizenship performance. Only when the self-appraisal bias is controlled, significant correlations appeared between task performance rates. However, intraclass correlations analyses show that only self- (contextual and task) performance measures are consistent, while interrater agreement disappears. These results provide some interesting clues about the procedure of appraisal instrument development, the role of appraisers, and the importance of choosing adequate consistency analysis methods.

Providers' perceptions of the implementation of a performance ...

African Journals Online (AJOL)

partly due to the lack of a system for reminding providers that patients were due to complete the ... system was feasible to implement as part of standard practice in ... Although the SAATSA is completed by the patients, in cases where they have ... platform is an important goal for this initiative; in the short term we are trying to ...

Observations of oral hygiene care interventions provided by nurses to hospitalized older people.

Science.gov (United States)

Coker, Esther; Ploeg, Jenny; Kaasalainen, Sharon; Carter, Nancy

Dependent older hospitalized patients rely on nurses to assist them with the removal of plaque from their teeth, dentures, and oral cavities. Oral care interventions by 25 nurses on post-acute units, where patients have longer hospital stays, were observed during evening care. In addition to efforts to engage patients in oral care, nurses provided the following interventions: (a) supporting the care of persons with dentures; (b) supporting the care of natural teeth; (c) cleansing the tongue and oral cavity; and (d) moisturizing lips and oral tissues. Patients' oral hygiene care was supported in just over one-third of encounters. Denture care was inconsistently performed, and was infrequently followed by care of the oral cavity. Nurses did not encourage adequate self-care of natural teeth by patients, and infrequently moisturized tissues. Evidence-based oral hygiene care standards are required to assist nurses to support patients in achieving optimal oral hygiene outcomes. Copyright © 2016 Elsevier Inc. All rights reserved.

76 FR 51041 - Hemoglobin Standards and Maintaining Adequate Iron Stores in Blood Donors; Public Workshop

Science.gov (United States)

2011-08-17

...] Hemoglobin Standards and Maintaining Adequate Iron Stores in Blood Donors; Public Workshop AGENCY: Food and... Donors.'' The purpose of this public workshop is to discuss blood donor hemoglobin and hematocrit qualification standards in the United States, its impact on donor safety and blood availability, and potential...

Changes in performance: a 5-year longitudinal study of participants in a multi-source feedback programme.

Science.gov (United States)

Violato, Claudio; Lockyer, Jocelyn M; Fidler, Herta

2008-10-01

Multi-source feedback (MSF) enables performance data to be provided to doctors from patients, co-workers and medical colleagues. This study examined the evidence for the validity of MSF instruments for general practice, investigated changes in performance for doctors who participated twice, 5 years apart, and determined the association between change in performance and initial assessment and socio-demographic characteristics. Data for 250 doctors included three datasets per doctor from, respectively, 25 patients, eight co-workers and eight medical colleagues, collected on two occasions. There was high internal consistency (alpha > 0.90) and adequate generalisability (Ep(2) > 0.70). D study results indicate adequate generalisability coefficients for groups of eight assessors (medical colleagues, co-workers) and 25 patient surveys. Confirmatory factor analyses provided evidence for the validity of factors that were theoretically expected, meaningful and cohesive. Comparative fit indices were 0.91 for medical colleague data, 0.87 for co-worker data and 0.81 for patient data. Paired t-test analysis showed significant change between the two assessments from medical colleagues and co-workers, but not between the two patient surveys. Multiple linear regressions explained 2.1% of the variance at time 2 for medical colleagues, 21.4% of the variance for co-workers and 16.35% of the variance for patient assessments, with professionalism a key variable in all regressions. There is evidence for the construct validity of the instruments and for their stability over time. Upward changes in performance will occur, although their effect size is likely to be small to moderate.

Role of natural analogs in performance assessment of nuclear waste repositories

International Nuclear Information System (INIS)

Sagar, B.; Wittmeyer, G.W.

1995-01-01

Mathematical models of the flow of water and transport of radionuclides in porous media will be used to assess the ability of deep geologic repositories to safely contain nuclear waste. These models must, in some sense, be validated to ensure that they adequately describe the physical processes occurring within the repository and its geologic setting. Inasmuch as the spatial and temporal scales over which these models must be applied in performance assessment are very large, validation of these models against laboratory and small-scale field experiments may be considered inadequate. Natural analogs may provide validation data that are representative of physico-chemical processes that occur over spatial and temporal scales as large or larger than those relevant to repository design. The authors discuss the manner in which natural analog data may be used to increase confidence in performance assessment models and conclude that, while these data may be suitable for testing the basic laws governing flow and transport, there is insufficient control of boundary and initial conditions and forcing functions to permit quantitative validation of complex, spatially distributed flow and transport models. The authors also express their opinion that, for collecting adequate data from natural analogs, resources will have to be devoted to them that are much larger than are devoted to them at present

Modelling of adequate and safe vitamin D intake in Danish women using different fortification and supplementation scenarios to inform fortification policies

DEFF Research Database (Denmark)

Grønborg, Ida Marie; Tetens, Inge; Ege, Majken

2018-01-01

Fortification of foods with vitamin D may be a population-based solution to low vitamin D intake. We performed modelling of vitamin D from diet, fortified foods and supplements in a population of Danish women 18-50 years, a risk group of vitamin D deficiency, to inform fortification policies...... on safe and adequate levels. Based on individual habitual dietary vitamin D intake of female participants from the Danish National Survey of Dietary Habits and Physical Activity (DANSDA) (n = 855), we performed graded intake modelling to predict the intake in six scenarios increasing the vitamin D intake...... from a habitual diet without fish to habitual diet including fish, fortified foods and supplements (40/80 µg). Four different foods were used as potential foods to fortify with vitamin D. The vitamin D intake was below the Average Requirement (AR) of 7.5 µg/day for 88% of the assessed women. Safe...

Should trained lay providers perform HIV testing? A systematic review to inform World Health Organization guidelines.

Science.gov (United States)

Kennedy, C E; Yeh, P T; Johnson, C; Baggaley, R

2017-12-01

New strategies for HIV testing services (HTS) are needed to achieve UN 90-90-90 targets, including diagnosis of 90% of people living with HIV. Task-sharing HTS to trained lay providers may alleviate health worker shortages and better reach target groups. We conducted a systematic review of studies evaluating HTS by lay providers using rapid diagnostic tests (RDTs). Peer-reviewed articles were included if they compared HTS using RDTs performed by trained lay providers to HTS by health professionals, or to no intervention. We also reviewed data on end-users' values and preferences around lay providers preforming HTS. Searching was conducted through 10 online databases, reviewing reference lists, and contacting experts. Screening and data abstraction were conducted in duplicate using systematic methods. Of 6113 unique citations identified, 5 studies were included in the effectiveness review and 6 in the values and preferences review. One US-based randomized trial found patients' uptake of HTS doubled with lay providers (57% vs. 27%, percent difference: 30, 95% confidence interval: 27-32, p lay providers. Studies from Cambodia, Malawi, and South Africa comparing testing quality between lay providers and laboratory staff found little discordance and high sensitivity and specificity (≥98%). Values and preferences studies generally found support for lay providers conducting HTS, particularly in non-hypothetical scenarios. Based on evidence supporting using trained lay providers, a WHO expert panel recommended lay providers be allowed to conduct HTS using HIV RDTs. Uptake of this recommendation could expand HIV testing to more people globally.

Zinc content of selected tissues and taste perception in rats fed zinc deficient and zinc adequate rations

International Nuclear Information System (INIS)

Boeckner, L.S.; Kies, C.

1986-01-01

The objective of the study was to determine the effects of feeding zinc sufficient and zinc deficient rations on taste sensitivity and zinc contents of selected organs in rats. The 36 Sprague-Dawley male weanling rats were divided into 2 groups and fed zinc deficient or zinc adequate rations. The animals were subjected to 4 trial periods in which a choice of deionized distilled water or a solution of quinine sulfate at 1.28 x 10 -6 was given. A randomized schedule for rat sacrifice was used. No differences were found between zinc deficient and zinc adequate rats in taste preference aversion scores for quinine sulfate in the first three trial periods; however, in the last trial period rats in the zinc sufficient group drank somewhat less water containing quinine sulfate as a percentage of total water consumption than did rats fed the zinc deficient ration. Significantly higher zinc contents of kidney, brain and parotid salivary glands were seen in zinc adequate rats compared to zinc deficient rats at the end of the study. However, liver and tongue zinc levels were lower for both groups at the close of the study than were those of rats sacrificed at the beginning of the study

Suggestions for an adequate risk communication - experiences based on German epidemiological studies on childhood cancer and neighbourhood to nuclear power plants

International Nuclear Information System (INIS)

Kaatsch, P.

2006-01-01

From the example of the German studies on childhood cancer in the vicinity of nuclear power plants general principles for adequate risk communication could be derived. It is particularly important to explain the complexity of the issue to the public in an adequate way, when dealing with topics of such an emotionally loaded nature. Some rules are required, when explaining the nature of risk to the layman, the press, politicians, or scientists from other fields. The main principle is to create a basis of trustfulness, whereupon results can be presented. In this contribution we derive general and proven specific recommendations for adequate risk communication on the basis of experiences made at the German Childhood Cancer Registry. (orig.)

Providing housing and care to elderly homeless men and women in Australia.

Science.gov (United States)

Lipmann, Bryan

2003-01-01

People who are unemployed and who lack the resources to buy adequate food, shelter, or basic health care services face an endless struggle to survive. It is frequently a degrading and humiliating experience. The elderly homeless, who are often frail and sick, are particularly disadvantaged in this struggle. Yet resources are often available to welfare providers to care for the aged homeless. All that is needed is a willingness for providers and government agencies to acknowledge the existence of homelessness among the elderly and be prepared to alleviate the problem.

Audit Report on 'The Department's Management of Nuclear Materials Provided to Domestic Licensees'

International Nuclear Information System (INIS)

2009-01-01

The objective if to determine whether the Department of Energy (Department) was adequately managing its nuclear materials provided to domestic licensees. The audit was performed from February 2007 to September 2008 at Department Headquarters in Washington, DC, and Germantown, MD; the Oak Ridge Office and the Oak Ridge National Laboratory in Oak Ridge, TN. In addition, we visited or obtained data from 40 different non-Departmental facilities in various states. To accomplish the audit objective, we: (1) Reviewed Departmental and Nuclear Regulatory Commission (NRC) requirements for the control and accountability of nuclear materials; (2) Analyzed a Nuclear Materials Management and Safeguards System (NMMSS) report with ending inventory balances for Department-owned nuclear materials dated September 30, 2007, to determine the amount and types of nuclear materials located at non-Department domestic facilities; (3) Held discussions with Department and NRC personnel that used NMMSS information to determine their roles and responsibilities related to the control and accountability over nuclear materials; (4) Selected a judgmental sample of 40 non-Department domestic facilities; (5) Met with licensee officials and sent confirmations to determine whether their actual inventories of Department-owned nuclear materials were consistent with inventories reported in the NMMSS; and, (6) Analyzed historical information related to the 2004 NMMSS inventory rebaselining initiative to determine the quantity of Department-owned nuclear materials that were written off from the domestic licensees inventory balances. This performance audit was conducted in accordance with generally accepted Government auditing standards. Those standards require that we plan and perform the audit to obtain sufficient, appropriate evidence to provide a reasonable basis for our findings and conclusions based on our audit objective. We believe that the evidence obtained provides a reasonable basis for our

Strongly anisotropic thermal conductivity and adequate breathability of bilayered films for heat management of on-skin electronics

Science.gov (United States)

Zhou, Tianle; Wei, Hao; Tan, Huaping; Wang, Xin; Zeng, Haibo; Liu, Xiaoheng; Nagao, Shijo; Koga, Hirotaka; Nogi, Masaya; Sugahara, Tohru; Suganuma, Katsuaki

2018-07-01

Thin-film wearable electronics are required to be directly laminated on to human skin for reliable, sensitive bio-sensing but with minimal irritation to the user after long-time use. Excellent heat management films with strongly anisotropic thermal conductivity (K) and adequate breathability are increasingly desirable for shielding the skin from heating while allowing the skin to breathe properly. Here, interfacial self-assembly of a graphene oxide (GO) film covering an ambient-dried bacterial cellulose aerogel (AD-BCA) film followed by laser reduction was proposed to prepare laser-reduced GO (L-rGO)/AD-BCA bilayered films. The AD-BCA substrate provides low cross-plane K (K ⊥  ≈  0.052 W mK‑1), high breathability, and high compressive and tensile resistance by ‘partially’ inheriting the pore structure from bacterial cellulose (BC) gel. The introduction of an upper L-rGO film, which is only 0.31 wt% content, dramatically increases the in-plane K (K // ) from 0.3 W mK‑1 in AD-BCA to 10.72 W mK‑1 owing to the highly in-plane oriented, continuous, uniform assembling geometry of the GO film; while K ⊥ decreases to a lower value of 0.033 W mK‑1, mainly owing to the air pockets between L-rGO multilayers caused by the laser reduction. The bilayered films achieve a K // /K ⊥ of 325, which is substantially larger even than that of graphite and similar polymer composites. They permit high transmission rates for water vapor (416.78 g/m2/day, >204 g/m2/day of normal skin) and O2 (449.35 cm3/m2/day). The combination of strongly anisotropic thermal conductivity and adequate breathability facilitates applications in heat management in on-skin electronics.

Performance of the lot quality assurance sampling method compared to surveillance for identifying inadequately-performing areas in Matlab, Bangladesh.

Science.gov (United States)

Bhuiya, Abbas; Hanifi, S M A; Roy, Nikhil; Streatfield, P Kim

2007-03-01

This paper compared the performance of the lot quality assurance sampling (LQAS) method in identifying inadequately-performing health work-areas with that of using health and demographic surveillance system (HDSS) data and examined the feasibility of applying the method by field-level programme supervisors. The study was carried out in Matlab, the field site of ICDDR,B, where a HDSS has been in place for over 30 years. The LQAS method was applied in 57 work-areas of community health workers in ICDDR,B-served areas in Matlab during July-September 2002. The performance of the LQAS method in identifying work-areas with adequate and inadequate coverage of various health services was compared with those of the HDSS. The health service-coverage indicators included coverage of DPT, measles, BCG vaccination, and contraceptive use. It was observed that the difference in the proportion of work-areas identified to be inadequately performing using the LQAS method with less than 30 respondents, and the HDSS was not statistically significant. The consistency between the LQAS method and the HDSS in identifying work-areas was greater for adequately-performing areas than inadequately-performing areas. It was also observed that the field managers could be trained to apply the LQAS method in monitoring their performance in reaching the target population.

What factors are associated with state performance on provision of transition services to CSHCN?

Science.gov (United States)

Kane, Debra J; Kasehagen, Laurin; Punyko, Judy; Carle, Adam C; Penziner, Andy; Thorson, Sarah

2009-12-01

To examine whether individual, condition-related, and system-related characteristics are associated with state performance (high, medium, low) on the provision of transition services to children with special health care needs (CSHCN). We conducted descriptive, bivariate, and multivariable analyses of 16876 children aged 12 to 17 years by using data from the 2005-2006 National Survey of Children With Special Health Care Needs. Polytomous logistic regression was used to compare the characteristics of CSHCN residing within high-, medium-, and low-performance states, with low-performance states serving as the reference group. Compared with non-Hispanic white CSHCN, Hispanic (adjusted odds ratio [aOR]: 0.25 [95% confidence interval (CI): 0.17-0.37]) and non-Hispanic black (aOR: 0.44 [95% CI: 0.30-0.62]) CSHCN were less likely to reside in a high-performance than in a low-performance state. Compared with CSHCN who had a medical home or adequate insurance coverage, CSHCN who did not have a medical home or adequate insurance coverage were less likely to reside in a high-performance than in a low-performance state (aOR: 0.73 [95% CI: 0.57-0.95]; aOR: 0.73 [95% CI: 0.58-0.93], respectively). Key factors found to be important in a state's performance on provision of transition services to CSHCN were race/ethnicity and having a medical home and adequate insurance coverage. Efforts to support the Maternal and Child Health Bureau's integration of system-level factors in quality-improvement activities, particularly establishing a medical home and attaining and maintaining adequate insurance, are likely to help states improve their performance on provision of transition services.

78 FR 48543 - Veterans Health Administration Fund Availability Under the VA's Homeless Providers Grant and Per...

Science.gov (United States)

2013-08-08

... and engage with the community; (2) Facilitate reintegration with the community and provide services that may optimize reintegration such as life-skills education, recreational activities, and follow-up... relationships with family; (4) Ensure adequate supervision, including supervision of medication and monitoring...

Improving the performance of solar still by using nanofluids and providing vacuum

International Nuclear Information System (INIS)

Kabeel, A.E.; Omara, Z.M.; Essa, F.A.

2014-01-01

Highlights: • Modified solar still integrated with an external condenser and used nanofluids were studied. • The results obtained that using cuprous oxide increased the distilled productivity by 133.64%. • Using the aluminum oxide–water nanofluid increased the distillate productivity of the modified still by 125.0%. - Abstract: The experimental modifications were carried out into the conventional solar still, considerably increasing the distillate water productivity. The effects of using different types of nanomaterials on the performance of solar still were studied. The investigated solid nanoparticles are the cuprous and aluminum oxides. The performance was investigated at different weight fraction concentrations of nanoparticles in the basin water with and without providing vacuum. These additions and modifications greatly improve the evaporation and condensation rates and hence the distillate yield was augmented. The research was conducted for range of concentrations starting from 0.02% to 0.2% with a step of 0.02%. The maxima productivity was obtained for using the cuprous oxide nanoparticles with a concentration of 0.2% with operating the vacuum fan. The results obtained that using cuprous oxide nanoparticles increased the distilled productivity by 133.64% and 93.87% with and without the fan respectively. On the other hand, using aluminum oxide nanoparticles enhanced the distillate by 125.0% and 88.97% with and without the fan respectively as compared to the conventional still. The estimated cost of 1.0 l of distillate are approximately 0.035$, 0.045$ when using the cuprous oxide nanomaterial with and without the fan and, as well as the aluminum oxide nanoparticles, 0.038$ and 0.051$ respectively, and for the conventional still is 0.048$

The role of kaizen in creating radical performance results in a logistics service provider

Directory of Open Access Journals (Sweden)

Erez Agmoni

2016-09-01

Full Text Available Background: This study investigates the role of an incremental change in organizational process in creating radical performance results in a service provider company. The role of Kaizen is established prominently in manufacturing, but is nascent in service applications. This study examines the impact of introducing Kaizen as an ODI tool-how it is applied, how it works, and whether participants believe it helps service groups form more effective working relationships that result in significant performance improvements. Methods: Exploring the evolving role of Kaizen in service contexts, this study explores a variety of facets of human communication in the context of continuous improvement and teamwork inter-organizationally. The paper consists of an archival study and an action research case study. A pre-intervention study consisting of observations, interviews, and submission of questionnaires to employees of a manufacturing and air-sea freight firm was conducted. A Kaizen intervention occurred subsequently, and a post-intervention study was then conducted. Results: Radical improvements in both companies such as 30% financial growth, 81% productivity improvement and more are demonstrated in this paper. Conclusions: Findings offer unique insights into the effects of Kaizen in creating radical performance improvements in a service company and its customer. Both qualitative and quantitative results of business, satisfaction, and productivity suggest time invested in introducing Kaizen into a service organization helps the companies improve relationships and improve the bottom line dramatically.

Improved ASTM G72 Test Method for Ensuring Adequate Fuel-to-Oxidizer Ratios

Science.gov (United States)

Juarez, Alfredo; Harper, Susana Tapia

2016-01-01

The ASTM G72/G72M-15 Standard Test Method for Autogenous Ignition Temperature of Liquids and Solids in a High-Pressure Oxygen-Enriched Environment is currently used to evaluate materials for the ignition susceptibility driven by exposure to external heat in an enriched oxygen environment. Testing performed on highly volatile liquids such as cleaning solvents has proven problematic due to inconsistent test results (non-ignitions). Non-ignition results can be misinterpreted as favorable oxygen compatibility, although they are more likely associated with inadequate fuel-to-oxidizer ratios. Forced evaporation during purging and inadequate sample size were identified as two potential causes for inadequate available sample material during testing. In an effort to maintain adequate fuel-to-oxidizer ratios within the reaction vessel during test, several parameters were considered, including sample size, pretest sample chilling, pretest purging, and test pressure. Tests on a variety of solvents exhibiting a range of volatilities are presented in this paper. A proposed improvement to the standard test protocol as a result of this evaluation is also presented. Execution of the final proposed improved test protocol outlines an incremental step method of determining optimal conditions using increased sample sizes while considering test system safety limits. The proposed improved test method increases confidence in results obtained by utilizing the ASTM G72 autogenous ignition temperature test method and can aid in the oxygen compatibility assessment of highly volatile liquids and other conditions that may lead to false non-ignition results.

Knowledge, attitudes, and practices regarding dengue infection among public sector healthcare providers in Machala, Ecuador

OpenAIRE

Handel, Andrew S.; Ayala, Efra?n Beltr?n; Borbor-Cordova, Mercy J.; Fessler, Abigail G.; Finkelstein, Julia L.; Espinoza, Roberto Xavier Robalino; Ryan, Sadie J.; Stewart-Ibarra, Anna M.

2016-01-01

Background Dengue fever is a rapidly emerging infection throughout the tropics and subtropics with extensive public health burden. Adequate training of healthcare providers is crucial to reducing infection incidence through patient education and collaboration with public health authorities. We examined how public sector healthcare providers in a dengue-endemic region of Ecuador view and manage dengue infections, with a focus on the 2009 World Health Organization (WHO) Dengue Guidelines. Metho...

Injectable loop recorder implantation in an ambulatory setting by advanced practice providers: Analysis of outcomes.

Science.gov (United States)

Kipp, Ryan; Young, Natasha; Barnett, Anne; Kopp, Douglas; Leal, Miguel A; Eckhardt, Lee L; Teelin, Thomas; Hoffmayer, Kurt S; Wright, Jennifer; Field, Michael

2017-09-01

Implantable loop recorder (ILR) insertion has historically been performed in a surgical environment such as the electrophysiology (EP) lab. The newest generation loop recorder (Medtronic Reveal LINQ™, Minneapolis, MN, USA) is injectable with potential for implantation in a non-EP lab setting by advanced practice providers (APPs) facilitating improved workflow and resource utilization. We report the safety and efficacy of injectable ILR placement in the ambulatory care setting by APPs. A retrospective review was performed including all patients referred for injectable ILR placement from March 2014 to November 2015. All device placement procedures were performed in an ambulatory care setting using the standard manufacturer deployment kit with sterile technique and local anesthetic following a single dose of intravenous antibiotics. Acute procedural success and complication rates following injectable ILR placement in the ambulatory setting were reviewed. During the study period, 125 injectable ILRs were implanted. Acute procedural success with adequate sensing (R-waves ≥ 0.2 mV) occurred in 100% of patients. There were no acute procedural complications. Subacute complications occurred in two patients (1.6% of implantations), including one possible infection treated with oral antibiotics and one device removal due to pain at the implant site. In this retrospective single-center study, implantation of injectable ILR in an ambulatory care setting by APPs following a single dose of intravenous antibiotics and standard manufacturer technique yielded a low complication rate with high acute procedural success. Use of this implantation strategy may improve EP lab workflow while providing a safe and effective technique for device placement. © 2017 Wiley Periodicals, Inc.

Exploring barriers to and enablers of adequate healthcare for Indigenous Australian prisoners with cancer: a scoping review drawing on evidence from Australia, Canada and the United States.

Science.gov (United States)

Olds, Jessica; Reilly, Rachel; Yerrell, Paul; Stajic, Janet; Micklem, Jasmine; Morey, Kim; Brown, Alex

International frameworks supported by national principles in Australia stipulate that prisoners should be provided with health services equivalent to those provided in the general community. However, a number of barriers unique to the prison system may hinder the provision of equitable healthcare for this population. In Australia, Indigenous people carry a greater burden of cancer mortality, which the Cancer Data and Aboriginal Disparities (CanDAD) project is seeking to address. During the course of recruiting participants to the CanDAD study, Indigenous Australian prisoners with cancer emerged as an important, under-researched but difficult to access sub-group. This scoping review sought to identify barriers and facilitators of access to adequate and equitable healthcare for Indigenous Australian prisoners with cancer in Australia. This review demonstrated a lack of research and, as such, the scoping review was extended to prisoners with cancer in Australia, New Zealand, the United States and Canada. This approach was taken in order to summarise the existing body of evidence regarding the barriers and facilitators of access to adequate and equitable healthcare for those who are incarcerated and suffering from cancer, and highlight areas that may require further investigation. Eight studies or commentaries were found to meet the inclusion criteria. This limited set of findings pointed to a range of possible barriers faced by prisoners with cancer, including a tension between the prisons' concern with security versus the need for timely access to medical care. Findings identified here offer potential starting points for research and policy development. Further research is needed to better elucidate how barriers to adequate cancer care for prisoners may be identified and overcome, in Australia and internationally. Furthermore, given Indigenous Australians' over-burden of cancer mortality and over-representation in the prison system, further research is needed to

Dental health care providers' views on child physical abuse in Malaysia.

Science.gov (United States)

Hussein, A S; Ahmad, R; Ibrahim, N; Yusoff, A; Ahmad, D

2016-10-01

To assess the knowledge, attitudes and experience of a group of Malaysian dental health care providers regarding child physical abuse (CPA) cases in terms of frequency of occurrence, diagnosis, risk factors and reporting. A questionnaire was distributed to all dental health care providers attending a national paediatric dentistry conference in Kuantan, Malaysia, and demographical variables, knowledge, attitudes and experience about CPA, risk factors and the reasons for not reporting abuse cases were collected. Descriptive statistics and bivariance analysis were performed. A 5 % level of statistical significance was applied for the analyses (p ≤ 0.05). The response rate was 74.7 %. Half of the respondents (52.8 %) stated that the frequency of occurrence of CPA is common in Malaysia. Full agreement between dental health care providers was not determined concerning the identification of signs of CPA and its risk factors. Although 83.3 % were aware that reporting CPA is a legal requirement in Malaysia, only 14.8 % have reported such cases. Lack of adequate history was the main reason for not reporting. Virtually two-thirds of the respondents (62 %) indicated that they had not received sufficient information about CPA and were willing to be educated on how to diagnose and report child abuse cases (81.5, 78.7 %, respectively). There were considerable disparities in respondents' knowledge and attitudes regarding the occurrence, signs of suspected cases, risk factors and reporting of CPA. Despite being aware of such cases, only a handful was reported. Enhancement in the education of Malaysian dental health care providers on recognising and reporting CPA is recommended.

Performance assessment review guide for DOE low-level radioactive waste disposal facilities

International Nuclear Information System (INIS)

Dodge, R.L.; Hansen, W.R.; Kennedy, W.E. Jr.; Layton, D.W.; Lee, D.W.; Maheras, S.T.; Neuder, S.M.; Wilhite, E.L.; Curl, R.U.; Grahn, K.F.; Heath, B.A.; Turner, K.H.

1991-10-01

This report was prepared under the direction of the Performance Assessment Peer Review Panel. The intent is to help Department of Energy sites prepare performance assessments that meet the Panel's expectations in terms of detail, quality, content, and consistency. Information on the Panel review process and philosophy are provided, as well as important technical issues that will be focused on during a review. This guidance is not intended to provide a detailed review plan as in NUREG-1200, Standard Review Plan for Review of a License Application for a Low-Level Radioactive Waste Disposal Facility (January 1988). The focus and intent of the Panel's reviews differ significantly from a regulatory review. The review of a performance assessment by the Panel uses the collective professional judgment of the members to ascertain that the approach taken the methodology used, the assumptions made, etc., are technically sound and adequately justified. The results of the Panel's review will be used by Department of Energy Headquarters in determining compliance with the requirements of DOE Order 5820.2A, ''Radioactive Waste Management.''

The management of water providing strategic ecosystems. The case of the basins that supply Medellin and Bogota in Colombia

International Nuclear Information System (INIS)

Cardenas Agudelo, Maria Fernanda

2013-01-01

The population growth and the urban concentration involve a sustained increment in water demand, which requires an adequate effort and management of the ecosystems that provide the liquid to guarantee a plenty future offer. The performance of the entities in charge of the management of such ecosystems and the results obtained in the basins that supply drinkable water to two cities in Colombia are analyzed; financial topics and their relation with the local community are considered. Management is delegated to governmental entities, whose work is insufficient and unsatisfactory. Thus, application of economical, legal and social tools is proposed in order to improve ecosystem's conservation and life quality of farmers that inhabit in their influence areas, partially transferring management to the local community's orbit.

Protecting the Home and Adequate Housing - Living in a Caravan or Trailer as a Human Right

NARCIS (Netherlands)

Donders, Y.

2016-01-01

Many Roma, gypsies and travellers live in caravans or trailers, sometimes in together trailer parks or camps. This article analyses how this specific lifestyle connected to their housing is protected under the various regimes and provisions of international human rights law. Home and adequate

Diet quality of Italian yogurt consumers: an application of the probability of adequate nutrient intake score (PANDiet).

Science.gov (United States)

Mistura, Lorenza; D'Addezio, Laura; Sette, Stefania; Piccinelli, Raffaela; Turrini, Aida

2016-01-01

The diet quality in yogurt consumers and non-consumers was evaluated by applying the probability of adequate nutrient intake (PANDiet) index to a sample of adults and elderly from the Italian food consumption survey INRAN SCAI 2005-06. Overall, yogurt consumers had a significantly higher mean intake of energy, calcium and percentage of energy from total sugars whereas the mean percentage of energy from total fat, saturated fatty acid and total carbohydrate were significantly (p yogurt consumers than in non-consumers, (60.58 ± 0.33 vs. 58.58 ± 0.19, p yogurt consumers. The items of calcium, potassium and riboflavin showed the major percentage variation between consumers and non-consumers. Yogurt consumers were more likely to have adequate intakes of vitamins and minerals, and a higher quality score of the diet.

The APT program plan: Providing an assured tritium production capability

International Nuclear Information System (INIS)

Lisowski, P.W.; Anderson, J.L.; Bishop, W.P.; Boggs, B.; Hall, K.

1996-01-01

Tritium is a radioactive hydrogen isotope used in all U.S. nuclear weapons. Because the half-life of tritium is short, 12.3 yr, it must be periodically replenished. To provide a new source, the U.S. Department of Energy (DOE) is sponsoring conceptual design and engineering development and demonstration activities for a plant that will use a high-power proton linear accelerator to produce tritium and will go on-line no later than 2007. The APT project is in the process of completing the conceptual design for a tritium production plant. In addition, there are several important areas under engineering development and demonstration that will ensure an efficient, cost-effective plant design and provide an adequate margin of tritium production. Information provided from this work will be used by the DOE in its 1998 choice of production technology implementation

Employee Retention Strategies And Organizational Performance ...

African Journals Online (AJOL)

Implication of the results for practice is that any organization that fails to put in place adequate employee retention strategies is not likely to retain competent and motivated workforce in its employment and hence experience frequent labour turnover and poor organizational performance. Keywords: Employees, Retention ...

Quality of assistance provided to children with sickle cell disease by primary healthcare services

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Ludmila Mourão Xavier Gomes

2011-01-01

Full Text Available OBJECTIVE: To evaluate the quality of healthcare provided to sickle cell disease children by primary healthcare services in a region of high prevalence. METHODS: A cross-sectional, descriptive study was performed by interviewing members of families with sickle cell disease children. The children had been identified from the Neonatal Screening Program in Minas Gerais state over the last 12 years in towns of the Montes Claros-Bocaiuva microregion. A structured questionnaire specially developed for this study and based on three axes was used: indicators of the child's health (immunization, growth and development, prophylaxis antibiotic therapy, perception of care by the family (health education and accessibility and knowledge of the family about the disease. RESULTS: Sixty-three of 71 families with children identified as having sickle cell disease were interviewed. The predominant genotypes were Hb SS (44.4% and Hb SC (41.2%. Adequate monitoring of growth and development was recorded for the first year of life in 23 children (36.6% and for the second year of life in 18 children (28.6%. The basic vaccination schedule was completed by 44 children (69.8% but 62 vaccination record cards (98.4% identified delays of special vaccines. Regular use of prophylactic penicillin was reported by 55 caregivers (87.3%. The family's perception of the care provided suggests poor accessibility to health services and lack of opportunities to answer doubts. The average performance of families in knowledge testing was 59.8%. CONCLUSION: The quality of healthcare is unsatisfactory. The care provided to children with sickle cell disease in primary healthcare services needs improvements.

The Leap of a Provincial SME into the Global Market Using E-commerce: The Success of Adequate Planning

Science.gov (United States)

Sainz de Abajo, Beatriz; García Salcines, Enrique; Burón Fernández, F. Javier; López Coronado, Miguel; de Castro Lozano, Carlos

The leap into the global market is not easy when it involves a provincial family business. This article demonstrates how adequate planning is fundamental in a small and medium-sized enterprise (SME) with the tight budget they have available to them, in order to be able to differentiate themselves in a highly competitive market, taking into accounts the benefits and risks involved. The Information Technology (IT) tools put in place will give the necessary support and allow for the possibility of increasing and improving the infrastructure as the company requires. An adequate strategy for the future to increases sales would be e-marketing techniques as well as the current promotions which contribute to diffusing the brand.

Aurally-adequate time-frequency analysis for scattered sound in auditoria

Science.gov (United States)

Norris, Molly K.; Xiang, Ning; Kleiner, Mendel

2005-04-01

The goal of this work was to apply an aurally-adequate time-frequency analysis technique to the analysis of sound scattering effects in auditoria. Time-frequency representations were developed as a motivated effort that takes into account binaural hearing, with a specific implementation of interaural cross-correlation process. A model of the human auditory system was implemented in the MATLAB platform based on two previous models [A. Härmä and K. Palomäki, HUTear, Espoo, Finland; and M. A. Akeroyd, A. Binaural Cross-correlogram Toolbox for MATLAB (2001), University of Sussex, Brighton]. These stages include proper frequency selectivity, the conversion of the mechanical motion of the basilar membrane to neural impulses, and binaural hearing effects. The model was then used in the analysis of room impulse responses with varying scattering characteristics. This paper discusses the analysis results using simulated and measured room impulse responses. [Work supported by the Frank H. and Eva B. Buck Foundation.

48 CFR 36.501 - Performance of work by the contractor.

Science.gov (United States)

2010-10-01

... 48 Federal Acquisition Regulations System 1 2010-10-01 2010-10-01 false Performance of work by the... Performance of work by the contractor. (a) To assure adequate interest in and supervision of all work involved... contracting officer shall insert the clause at 52.236-1, Performance of Work by the Contractor, in...

Do people know adequately about leptospirosis? A knowledge assessment survey in post-outbreak situation in Sri Lanka

Directory of Open Access Journals (Sweden)

Suneth B Agampodi

2010-01-01

Conclusions: Although there is not adequate information on MDD prevalence in some areas of Iran, the overall current preva-lence of MDD in the country is high and females are at the greater risk of disease.

Primary care performance in Dominica

Directory of Open Access Journals (Sweden)

James Macinko

2015-02-01

Full Text Available Objective. To document the structure and functions of primary care (PC in the country of Dominica using the Primary Care Assessment Tools (PCAT, a set of questionnaires that evaluate PC functions. Methods. This cross-sectional study combined data from two surveys. The systems PCAT (S-PCAT survey gathered national-level data from key informants about health system characteristics and PC performance. The provider version (P-PCAT survey collected data on PC performance from health providers (nurses and physicians at all PC facilities in the country. Provider-level data were aggregated to obtain national and district-level results for PC domains scored from 0.00 (worst to 1.00 (best. Results. From the systems perspective, results showed several knowledge gaps in PC policy, financing, and structure. Key informants gave “Good” (adequate ratings for “first-contact” care (0.74, continuity of care (0.77, comprehensive care (0.70, and coordinated care (0.78; middling scores for family-centered care and community-oriented care (0.65; and low scores for access to care (0.57. PC providers assessed access to care (which included “first-contact” care, in the P-PCAT surveys (0.84, continuity of care (0.86, information systems (0.84, family-centered care (0.92, and community-oriented care (0.85 as “Very Good”; comprehensive care as “Good” (0.79; and coordinated care as “Reasonable” (0.68. Overall, the scores for the country's health districts were good, although the ratings varied by specific PC domain. Conclusions. The assessments described here were carried out with relatively little expense and have provided important inputs into strategic planning, strategies for improving PC, and identification of priority areas for further investigation. This two-staged approach could be adapted and used in other countries.

A test of the cerebellar hypothesis of dyslexia in adequate and inadequate responders to reading intervention.

Science.gov (United States)

Barth, Amy E; Denton, Carolyn A; Stuebing, Karla K; Fletcher, Jack M; Cirino, Paul T; Francis, David J; Vaughn, Sharon

2010-05-01

The cerebellar hypothesis of dyslexia posits that cerebellar deficits are associated with reading disabilities and may explain why some individuals with reading disabilities fail to respond to reading interventions. We tested these hypotheses in a sample of children who participated in a grade 1 reading intervention study (n = 174) and a group of typically achieving children (n = 62). At posttest, children were classified as adequately responding to the intervention (n = 82), inadequately responding with decoding and fluency deficits (n = 36), or inadequately responding with only fluency deficits (n = 56). Based on the Bead Threading and Postural Stability subtests from the Dyslexia Screening Test-Junior, we found little evidence that assessments of cerebellar functions were associated with academic performance or responder status. In addition, we did not find evidence supporting the hypothesis that cerebellar deficits are more prominent for poor readers with "specific" reading disabilities (i.e., with discrepancies relative to IQ) than for poor readers with reading scores consistent with IQ. In contrast, measures of phonological awareness, rapid naming, and vocabulary were strongly associated with responder status and academic outcomes. These results add to accumulating evidence that fails to associate cerebellar functions with reading difficulties.

Optimal energy management of urban rail systems: Key performance indicators

International Nuclear Information System (INIS)

González-Gil, A.; Palacin, R.; Batty, P.

2015-01-01

Highlights: • An overall picture of urban rail energy use is provided. • Performance indicators are developed for urban rail system energy optimisation. • A multi-level methodology for assessing energy efficiency measures is presented. - Abstract: Urban rail systems are facing increasing pressure to minimise their energy consumption and thusly reduce their operational costs and environmental impact. However, given the complexity of such systems, this can only be effectively achieved through a holistic approach which considers the numerous interdependences between subsystems (i.e. vehicles, operations and infrastructure). Such an approach requires a comprehensive set of energy consumption-related Key Performance Indicators (KEPIs) that enable: a multilevel analysis of the actual energy performance of the system; an assessment of potential energy saving strategies; and the monitoring of the results of implemented measures. This paper proposes an original, complete list of KEPIs developed through a scientific approach validated by different stakeholders. It consists of a hierarchical list of 22 indicators divided into two levels: 10 key performance indicators, to ascertain the performance of the whole system and complete subsystems; and 12 performance indicators, to evaluate the performance of single units within subsystems, for example, a single rail vehicle or station. Additionally, the paper gives a brief insight into urban rail energy usage by providing an adequate context in which to understand the proposed KEPIs, together with a methodology describing their application when optimising the energy consumption of urban rail systems

Home Care Pharmacy Practice in Canada: A Cross-Sectional Survey of Services Provided, Remuneration, Barriers, and Facilitators.

Science.gov (United States)

Houle, Sherilyn; MacKeigan, Linda

2017-01-01

As the population ages, and individuals desire to remain in their homes as long as possible, the need for in-home care is expected to increase. However, pharmacists have rarely been included in studies of in-home care, and little is known about the prevalence or effectiveness of pharmacists' home-based services in Canada. To identify pharmacy practices in Canada that regularly provide in-home patient care and to identify specific services provided, remuneration obtained, and barriers and facilitators influencing the provision of home-based care. A link to a web-based survey was posted in e-newsletters of provincial, territorial, and national pharmacy associations in Canada. In addition, pharmacists known to the researchers as providing in-home clinical services were contacted directly. The survey was open from October to December 2015. Practices or organizations that performed at least one home visit per week for clinical purposes, with documentation of the services provided, were eligible to participate. One response per practice or organization was allowed. Seventeen practices meeting the inclusion criteria were identified, representing community, hospital, and clinic settings. Home visits were most commonly performed for individuals with complex medication regimens or nonadherence to medication therapy. The most common services were conducting medication reconciliation and reviews and counselling patients about medication adherence. No practices or organizations billed patients for these services, yet lack of remuneration was an important barrier identified by many respondents. Although 12 (71%) of the respondents collected data for evaluative purposes, collection of clinical or health system outcome data was rare. Few Canadian pharmacy practices that provide in-home patient care at least once a week could be identified. Data collection suitable to establish an evidence base for this service was infrequently performed by practices and organizations providing

On the assessment of performance and emissions characteristics of a SI engine provided with a laser ignition system

Science.gov (United States)

Birtas, A.; Boicea, N.; Draghici, F.; Chiriac, R.; Croitoru, G.; Dinca, M.; Dascalu, T.; Pavel, N.

2017-10-01

Performance and exhaust emissions of spark ignition engines are strongly dependent on the development of the combustion process. Controlling this process in order to improve the performance and to reduce emissions by ensuring rapid and robust combustion depends on how ignition stage is achieved. An ignition system that seems to be able for providing such an enhanced combustion process is that based on plasma generation using a Q-switched solid state laser that delivers pulses with high peak power (of MW-order level). The laser-spark devices used in the present investigations were realized using compact diffusion-bonded Nd:YAG/Cr4+:YAG ceramic media. The laser igniter was designed, integrated and built to resemble a classical spark plug and therefore it could be mounted directly on the cylinder head of a passenger car engine. In this study are reported the results obtained using such ignition system provided for a K7M 710 engine currently produced by Renault-Dacia, where the standard calibrations were changed towards the lean mixtures combustion zone. Results regarding the performance, the exhaust emissions and the combustion characteristics in optimized spark timing conditions, which demonstrate the potential of such an innovative ignition system, are presented.

Relationships between Contextual and Task Performance and Interrater Agreement: Are There Any?

Directory of Open Access Journals (Sweden)

Luis F Díaz-Vilela

Full Text Available Work performance is one of the most important dependent variables in Work and Organizational Psychology. The main objective of this paper was to explore the relationships between citizenship performance and task performance measures obtained from different appraisers and their consistency through a seldom-used methodology, intraclass correlation coefficients. Participants were 135 public employees, the total staff in a local government department. Jobs were clustered into job families through a work analysis based on standard questionnaires. A task description technique was used to develop a performance appraisal questionnaire for each job family, with three versions: self-, supervisor-, and peer-evaluation, in addition to a measure of citizenship performance. Only when the self-appraisal bias is controlled, significant correlations appeared between task performance rates. However, intraclass correlations analyses show that only self- (contextual and task performance measures are consistent, while interrater agreement disappears. These results provide some interesting clues about the procedure of appraisal instrument development, the role of appraisers, and the importance of choosing adequate consistency analysis methods.

Clear Purpose...Complete Commitment. A Long-Range Program To Provide Louisianians with Library and Information Services Adequate to Their Needs 1996-2000.

Science.gov (United States)

Jaques, Thomas F.

This document provides the 5-year (1996-2000) library plan for public libraries in Louisiana. It identifies specific inadequacies in public library services, resources, facilities, and personnel. It identifies the people who are to be served, and reveals the geographical, sociological, economic, and educational barriers to the expanded use of…

Assessment of Work Performance (AWP)--development of an instrument.

Science.gov (United States)

Sandqvist, Jan L; Törnquist, Kristina B; Henriksson, Chris M

2006-01-01

Adequate work assessments are a matter of importance both for individuals and society [5,29,31,38,40,46,52]. However, there is a lack of adequate and reliable instruments for use in work rehabilitation [14,15,20,21,31,44]. The purpose of this study was to develop and evaluate an observation instrument for assessing work performance, the AWP (Assessment of Work Performance). The purpose of the 14-item instrument is to assess the individual's observable working skills in three different areas: motor skills, process skills, and communication and interaction skills. This article describes the development and results of preliminary testing of the AWP. The testing indicates a satisfactory face validity and utility for the AWP and supports further research and testing of the instrument.

DJFS: Providing Highly Reliable and High‐Performance File System with Small‐Sized

Directory of Open Access Journals (Sweden)

Junghoon Kim

2017-11-01

Full Text Available File systems and applications try to implement their own update protocols to guarantee data consistency, which is one of the most crucial aspects of computing systems. However, we found that the storage devices are substantially under‐utilized when preserving data consistency because they generate massive storage write traffic with many disk cache flush operations and force‐unit‐access (FUA commands. In this paper, we present DJFS (Delta‐Journaling File System that provides both a high level of performance and data consistency for different applications. We made three technical contributions to achieve our goal. First, to remove all storage accesses with disk cache flush operations and FUA commands, DJFS uses small‐sized NVRAM for a file system journal. Second, to reduce the access latency and space requirements of NVRAM, DJFS attempts to journal compress the differences in the modified blocks. Finally, to relieve explicit checkpointing overhead, DJFS aggressively reflects the checkpoint transactions to file system area in the unit of the specified region. Our evaluation on TPC‐C SQLite benchmark shows that, using our novel optimization schemes, DJFS outperforms Ext4 by up to 64.2 times with only 128 MB of NVRAM.

Does Initial Learning about the Meaning of Fractions Present Similar Challenges for Students with and without Adequate Whole-Number Skill?

Science.gov (United States)

Namkung, Jessica M; Fuchs, Lynn S; Koziol, Natalie

2018-01-01

The purposes of this study were to (a) explore whether early fractions understanding at 4 th grade is differentially challenging for students with versus without adequate whole-number competence and (b) identify specific whole-number skill associated with difficulty in fractions understanding. Based on initial whole-number competence, 1,108 4 th graders were classified as having (a) adequate whole-number competence ( n = 775), (b) less severe whole-number difficulty ( n = 201), and (c) severe whole-number difficulty ( n = 132). At the end of 4 th grade, they were assessed on fractions understanding and further classified as with versus without difficulty in fractions understanding. Multi-level logistic regression indicated that compared to students with adequate whole-number competence, those with less severe whole-number difficulty were almost 5 times as likely to experience difficulty with fractions understanding whereas those with severe whole-number difficulty were about 32 times as likely to experience difficulty with fractions understanding. Students with severe whole-number difficulty were about 7 times as likely to experience difficulty with fractions understanding compared to those with less severe whole-number difficulty. Among students with adequate whole-number competence, the pretest whole-number skill distinguishing those with versus without difficulty in fractions understanding was basic division facts (i.e., 2-digit dividend ÷ 1-digit divisor) and simple multiplication (i.e., 3-digit × 1-digit without regrouping). The role of whole-number competence in developing initial fractions understanding and implications for instruction are discussed.

Spirulina does not decrease muscle damage nor oxdidative stress in cycling athletes with adequate nutritional status

Directory of Open Access Journals (Sweden)

G.A.M. Franca

2010-12-01

Full Text Available The objective of this study was to assess the effect of Spirulina maxima on oxidative stress and muscle damage in cycling athletes subjected to high volume and intensity of training. Eighteen male athletes were randomly divided into an experimental group (n=11 with age 27.8±3.5 and placebo (n=7 with age 34.3±2.3 in a double-blind fashion. They carried out a protocol of Spirulina dietary supplementation (7.5 g/day of placebo for four weeks and maintained their trainings during this period. A nutritional anamnesis was performed and blood tests were done to determine pre and post levels of creatine kinase (CK, lactic dehydrogenase (LHD, superoxide dismutase (SOD and malondialdehyde (MDA. The supplemented and placebo groups performed the same volume training, has adequate macronutrients and antioxidant vitamins ingestion before study, as well as initial CK, LDH, SOD and MDA levels. Supplementation did not promote a significant alteration in CK levels on supplemented group (158.4±16.3 for 140.0±16.6 U/l, p>0.05, LDH (420±13.2 for 394.9±27.9 UI/l, p>0.05, MDA (2.8±0.2 for 2.9±0.4 nmol/ml, p>0.05, nor an increase in the SOD (7.3±0.6 for 7.0±0.6 U/mg Hb, p>0.05. We conclude that administration of Spirulina does not interfere in the magnitude of muscle damage nor in antioxidant status of cycling athletes that practice intense training.

The link between performance assessment and quality of data

International Nuclear Information System (INIS)

Csullog, G.W.

1990-11-01

Performance assessments, using both individual and cumulative inventories, produce estimates of the risk or dose consequences for repository concepts. Unacceptable risk or dose for a given contaminant identify it as a problem contaminant. While risk or dose consequences are common outputs of safety assessments, results can also be reported as estimates of the safe inventory limit for each contaminant in a repository scenario. Once problem contaminants are identified, it may be useful to: validate the data used in the performance assessment; restrict contaminant inventories in the repository; or, improve the containment capability of the repository (including improved packaging). A key point is that performance assessments define the quality of data to be collected. If a contaminant's inventory will be far below its estimated safe inventory limit for a repository, then it is reasonable to accept inventory estimates that have high variances and low confidence. For contaminants that have a significant impact upon performance assessments, efforts must be made to provide the best inventory (source term) estimates practicable. One important goal of characterization programs should be to establish the adequacy of data used in performance assessments. There is little value in striving to improve confidence in data for some waste streams if they are assessed to have a minor impact upon repository performance. Streams that have a major impact upon performance deserve the time, attention and money to be characterized adequately. Waste acceptance must be linked to the quality of characterization data provided by generators. This link sets compliance monitoring requirements

Development of adequate meteorological monitoring standards for safety analysis of nuclear facilities

International Nuclear Information System (INIS)

Alp, E.; Lewis, P.J.

1985-09-01

The aim of this report is to identify what constitutes adequate meteorological information for airborne dispersion calculations in case of releases from nuclear facilities during 'normal operation', 'design postulated accidents', and 'emergency situations'. The models used for estimating downwind dispersion are reviewed, including short-range simple terrain, short-range complex terrain and medium to long range models with emphasis on Lagrangian models. The meteorogolical input parameters required for running these models are identified. The methods by which these parameters may be obtained from raw meteorological data are then considered. Emphasis is placed on well-tried and recommended methods rather than those which are currently being developed and lack long-term field tests. The meteorological data required to calculate the parameters that are in turn input to dispersion calculation methods can be obtained mainly from tower measurements. Recommended tower height is 50 m, with two levels of instruments (10 and 50 m) for wind speed, wind direction and temperature. Data for precipitation and solar radiation, that may be required under certain conditions and for special calculations, may be estimated from nearby representative weather stations (if available). For simple terrain, a single tower is sufficient. For complex terrain, such as coastal regions, two towers are desirable for accurate characterization of the turbulence regime in the vicinity of a release site. The report provides the necessary accuracy specifications for instruments required for the meteorological measurements. Data monitoring and recording, maintenance, quality control and assurance are also discussed. Error propagation analyses are recommended to determine the full implications of instrument accuracies on the accuracy of dispersion model predictions. 82 refs

Ensuring Adequate Health and Safety Information for Decision Makers during Large-Scale Chemical Releases

Science.gov (United States)

Petropoulos, Z.; Clavin, C.; Zuckerman, B.

2015-12-01

The 2014 4-Methylcyclohexanemethanol (MCHM) spill in the Elk River of West Virginia highlighted existing gaps in emergency planning for, and response to, large-scale chemical releases in the United States. The Emergency Planning and Community Right-to-Know Act requires that facilities with hazardous substances provide Material Safety Data Sheets (MSDSs), which contain health and safety information on the hazardous substances. The MSDS produced by Eastman Chemical Company, the manufacturer of MCHM, listed "no data available" for various human toxicity subcategories, such as reproductive toxicity and carcinogenicity. As a result of incomplete toxicity data, the public and media received conflicting messages on the safety of the contaminated water from government officials, industry, and the public health community. Two days after the governor lifted the ban on water use, the health department partially retracted the ban by warning pregnant women to continue avoiding the contaminated water, which the Centers for Disease Control and Prevention deemed safe three weeks later. The response in West Virginia represents a failure in risk communication and calls to question if government officials have sufficient information to support evidence-based decisions during future incidents. Research capabilities, like the National Science Foundation RAPID funding, can provide a solution to some of the data gaps, such as information on environmental fate in the case of the MCHM spill. In order to inform policy discussions on this issue, a methodology for assessing the outcomes of RAPID and similar National Institutes of Health grants in the context of emergency response is employed to examine the efficacy of research-based capabilities in enhancing public health decision making capacity. The results of this assessment highlight potential roles rapid scientific research can fill in ensuring adequate health and safety data is readily available for decision makers during large

Europe's gas consumption and imports to increase with adequate low cost supplies

International Nuclear Information System (INIS)

Odell, P.R.

1997-01-01

Gas in Europe has always been sold above its long-run supply price. Lower prices, however, still permit profitable indigeneous supply expansion. As further reductions in production and transport costs from technological advances are expected, this will continue based on the exploitation of large proven and probable reserves. By 2025, indigeneous output will be 60% up on 1995. Nevertheless, an average 2.2%/annum growth in gas demand will increase import dependence from 130 to 320 BCM over this period. Future international oil prices indicate gas-equivalent border values adequate to secure profitable supply from a range of external sources, leading to continuing competition for markets and the diversification of imports. (9 tables; 31 references). (author)

Pre-conceptual-schema-based patterns for deriving key performance indicators from strategic objectives

Directory of Open Access Journals (Sweden)

Carlos Mario Zapata Jaramillo

2017-05-01

Full Text Available Performance measurement is crucial for achieving business success. Moreover, such success is also related to the fulfillment of the organizational strategic objectives. Hence, an adequate determination of relevant performance indicators—or key performance indicators (KPIs—and their relationships to organizational objectives is needed. Even though several approaches for treating KPIs and objective-KPI relationships have been proposed, they exhibit some drawbacks associated with the lack of reusability and traceability. We attempt to fill this gap by proposing a set of patterns based on pre-conceptual schemas for supporting the systematic derivation of KPIs and their relationships to organizational objectives. In this way, the proposed patterns guarantee a reusable and traceable derivation process of a set of candidate KPIs from organizational strategic objectives. Lastly, we provide a lab study in order to illustrate the usefulness of this proposal.

Recovery and Performance in Sport: Consensus Statement.

Science.gov (United States)

Kellmann, Michael; Bertollo, Maurizio; Bosquet, Laurent; Brink, Michel; Coutts, Aaron J; Duffield, Rob; Erlacher, Daniel; Halson, Shona L; Hecksteden, Anne; Heidari, Jahan; Kallus, K Wolfgang; Meeusen, Romain; Mujika, Iñigo; Robazza, Claudio; Skorski, Sabrina; Venter, Ranel; Beckmann, Jürgen

2018-02-01

The relationship between recovery and fatigue and its impact on performance has attracted the interest of sport science for many years. An adequate balance between stress (training and competition load, other life demands) and recovery is essential for athletes to achieve continuous high-level performance. Research has focused on the examination of physiological and psychological recovery strategies to compensate external and internal training and competition loads. A systematic monitoring of recovery and the subsequent implementation of recovery routines aims at maximizing performance and preventing negative developments such as underrecovery, nonfunctional overreaching, the overtraining syndrome, injuries, or illnesses. Due to the inter- and intraindividual variability of responses to training, competition, and recovery strategies, a diverse set of expertise is required to address the multifaceted phenomena of recovery, performance, and their interactions to transfer knowledge from sport science to sport practice. For this purpose, a symposium on Recovery and Performance was organized at the Technical University Munich Science and Study Center Raitenhaslach (Germany) in September 2016. Various international experts from many disciplines and research areas gathered to discuss and share their knowledge of recovery for performance enhancement in a variety of settings. The results of this meeting are outlined in this consensus statement that provides central definitions, theoretical frameworks, and practical implications as a synopsis of the current knowledge of recovery and performance. While our understanding of the complex relationship between recovery and performance has significantly increased through research, some important issues for future investigations are also elaborated.

Measuring performance at trade shows

DEFF Research Database (Denmark)

Hansen, Kåre

2004-01-01

Trade shows is an increasingly important marketing activity to many companies, but current measures of trade show performance do not adequately capture dimensions important to exhibitors. Based on the marketing literature's outcome and behavior-based control system taxonomy, a model is built...... that captures a outcome-based sales dimension and four behavior-based dimensions (i.e. information-gathering, relationship building, image building, and motivation activities). A 16-item instrument is developed for assessing exhibitors perceptions of their trade show performance. The paper presents evidence...

Selection of adequate site location during early stages of construction project management: A multi-criteria decision analysis approach

Science.gov (United States)

Marović, Ivan; Hanak, Tomaš

2017-10-01

In the management of construction projects special attention should be given to the planning as the most important phase of decision-making process. Quality decision-making based on adequate and comprehensive collaboration of all involved stakeholders is crucial in project’s early stages. Fundamental reasons for existence of this problem arise from: specific conditions of construction industry (final products are inseparable from the location i.e. location has a strong influence of building design and its structural characteristics as well as technology which will be used during construction), investors’ desires and attitudes, and influence of socioeconomic and environment aspects. Considering all mentioned reasons one can conclude that selection of adequate construction site location for future investment is complex, low structured and multi-criteria problem. To take into account all the dimensions, the proposed model for selection of adequate site location is devised. The model is based on AHP (for designing the decision-making hierarchy) and PROMETHEE (for pairwise comparison of investment locations) methods. As a result of mixing basis feature of both methods, operational synergies can be achieved in multi-criteria decision analysis. Such gives the decision-maker a sense of assurance, knowing that if the procedure proposed by the presented model has been followed, it will lead to a rational decision, carefully and systematically thought out.

ENVIRONMENTAL PERFORMANCE AS A REFLECTION OF MARKET DEMANDS

Directory of Open Access Journals (Sweden)

Wahyu Yun Santoso

2008-02-01

Full Text Available This paper focuses on the concept of corporate social responsibilities (CSR, particularly its implementation on environmental issues. The main question aimed to be answered is on how can environmental performance be adequately signaled to the market? It assumes by performing proper environmental performance, companies could benefit from financial incentive for future improvement and reputation benefit for the companies’ image, which eventually influence the bargaining position of companies in the market.

Intraoperative adverse events can be compensated by technical performance in neonates and infants after cardiac surgery: a prospective study.

Science.gov (United States)

Nathan, Meena; Karamichalis, John M; Liu, Hua; del Nido, Pedro; Pigula, Frank; Thiagarajan, Ravi; Bacha, Emile A

2011-11-01

Our objective was to define the relationship between surgical technical performance score, intraoperative adverse events, and major postoperative adverse events in complex pediatric cardiac repairs. Infants younger than 6 months were prospectively followed up until discharge from the hospital. Technical performance scores were graded as optimal, adequate, or inadequate based on discharge echocardiograms and need for reintervention after initial surgery. Case complexity was determined by Risk Adjustment in Congenital Heart Surgery (RACHS-1) category, and preoperative illness severity was assessed by Pediatric Risk of Mortality (PRISM) III score. Intraoperative adverse events were prospectively monitored. Outcomes were analyzed using nonparametric methods and a logistic regression model. A total of 166 patients (RACHS 4-6 [49%]), neonates [50%]) were observed. Sixty-one (37%) had at least 1 intraoperative adverse event, and 47 (28.3%) had at least 1 major postoperative adverse event. There was no correlation between intraoperative adverse events and RACHS, preoperative PRISM III, technical performance score, or postoperative adverse events on multivariate analysis. For the entire cohort, better technical performance score resulted in lower postoperative adverse events, lower postoperative PRISM, and lower length of stay and ventilation time (P events, including surgical revisions, provided technical performance score is at least adequate. Copyright © 2011 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

Transgenic tobacco plants with improved cyanobacterial Rubisco expression but no extra assembly factors grow at near wild-type rates if provided with elevated CO2.

Science.gov (United States)

Occhialini, Alessandro; Lin, Myat T; Andralojc, P John; Hanson, Maureen R; Parry, Martin A J

2016-01-01

Introducing a carbon-concentrating mechanism and a faster Rubisco enzyme from cyanobacteria into higher plant chloroplasts may improve photosynthetic performance by increasing the rate of CO2 fixation while decreasing losses caused by photorespiration. We previously demonstrated that tobacco plants grow photoautotrophically using Rubisco from Synechococcus elongatus, although the plants exhibited considerably slower growth than wild-type and required supplementary CO2 . Because of concerns that vascular plant assembly factors may not be adequate for assembly of a cyanobacterial Rubisco, prior transgenic plants included the cyanobacterial chaperone RbcX or the carboxysomal protein CcmM35. Here we show that neither RbcX nor CcmM35 is needed for assembly of active cyanobacterial Rubisco. Furthermore, by altering the gene regulatory sequences on the Rubisco transgenes, cyanobacterial Rubisco expression was enhanced and the transgenic plants grew at near wild-type growth rates, although still requiring elevated CO2 . We performed detailed kinetic characterization of the enzymes produced with and without the RbcX and CcmM35 cyanobacterial proteins. These transgenic plants exhibit photosynthetic characteristics that confirm the predicted benefits of introduction of non-native forms of Rubisco with higher carboxylation rate constants in vascular plants and the potential nitrogen-use efficiency that may be achieved provided that adequate CO2 is available near the enzyme. © 2015 The Authors The Plant Journal © 2015 John Wiley & Sons Ltd.

Embedded Sensors and Controls to Improve Component Performance and Reliability Conceptual Design Report

Energy Technology Data Exchange (ETDEWEB)

Kisner, R.; Melin, A.; Burress, T.; Fugate, D.; Holcomb, D.; Wilgen, J.; Miller, J.; Wilson, D.; Silva, P.; Whitlow, L.; Peretz, F.

2012-09-15

The objective of this project is to demonstrate improved reliability and increased performance made possible by deeply embedding instrumentation and controls (I&C) in nuclear power plant (NPP) components and systems. The project is employing a highly instrumented canned rotor, magnetic bearing, fluoride salt pump as its I&C technology demonstration platform. I&C is intimately part of the basic millisecond-by-millisecond functioning of the system; treating I&C as an integral part of the system design is innovative and will allow significant improvement in capabilities and performance. As systems become more complex and greater performance is required, traditional I&C design techniques become inadequate and more advanced I&C needs to be applied. New I&C techniques enable optimal and reliable performance and tolerance of noise and uncertainties in the system rather than merely monitoring quasistable performance. Traditionally, I&C has been incorporated in NPP components after the design is nearly complete; adequate performance was obtained through over-design. By incorporating I&C at the beginning of the design phase, the control system can provide superior performance and reliability and enable designs that are otherwise impossible. This report describes the progress and status of the project and provides a conceptual design overview for the platform to demonstrate the performance and reliability improvements enabled by advanced embedded I&C.

Detailed NMR, Including 1,1-ADEQUATE, and Anticancer Studies of Compounds from the Echinoderm Colobometra perspinosa

Directory of Open Access Journals (Sweden)

Catherine H. Liptrot

2009-11-01

Full Text Available From the dichloromethane/methanol extract of the crinoid Colobometra perspinosa, collected south east of Richards Island (Bedara, Family Islands, Central Great Barrier Reef, Australia, 3-(1'-hydroxypropyl-1,6,8-trihydroxy-9,10-anthraquinone [one of the two stereoisomers of rhodoptilometrin, (1], 3-propyl-1,6,8-trihydroxy-9,10-anthraquinone (3, 2-[(phenylacetylamino]ethanesulfonic acid (4, and 4-hydroxybutanoic acid (5 were isolated. Comparison of 1H- and 13C-NMR data for rhodoptilometrin (1 with those reported in the literature showed significant differences for some resonances associated with rings A and C. In an attempt to provide accurately assigned 1H- and 13C-NMR data, as well as to confirm the structure of 1, a thorough NMR investigation of this compound was undertaken. Measurements included: concentration dependent 13C, 1D selective NOE, HSQC, HMBC and 1,1-ADEQUATE. The NMR data for 4 and 5 are reported here for the first time, as is their occurrence from the marine environment. The in vitro anticancer activity of the original extract was found to be associated with 1, 3 and 5.

Humidification performance of 48 passive airway humidifiers: comparison with manufacturer data.

Science.gov (United States)

Lellouche, François; Taillé, Solenne; Lefrançois, Frédéric; Deye, Nicolas; Maggiore, Salvatore Maurizio; Jouvet, Philippe; Ricard, Jean-Damien; Fumagalli, Bruno; Brochard, Laurent

2009-02-01

Heat and moisture exchangers (HMEs) are increasingly used in the ICU for gas conditioning during mechanical ventilation. Independent assessments of the humidification performance of HMEs are scarce. The aim of the present study was thus to assess the humidification performance of a large number of adult HMEs. We assessed 48 devices using a bench test apparatus that simulated real-life physiologic ventilation conditions. Thirty-two devices were described by the manufacturers as HMEs, and 16 were described as antibacterial filters. The test apparatus provided expiratory gases with an absolute humidity (AH) of 35 mg H(2)O/L. The AH of inspired gases was measured after steady state using the psychrometric method. We performed three hygrometric measurements for each device, measured their resistance, and compared our results with the manufacturer data. Of the 32 HMEs tested, only 37.5% performed well (>or= 30 mg H(2)O/L), while 25% performed poorly ( 4 mg H(2)O/L. The mean difference for the antibacterial filters was 0.2 +/- 1.4 mg H(2)O/L. The mean resistance of all the tested devices was 2.17 +/- 0.70 cm H(2)O/L/s. Several HMEs performed poorly and should not be used as HMEs. The values determined by independent assessments may be lower than the manufacturer data. Describing a device as an HME does not guarantee that it provides adequate humidification. The performance of HMEs must be verified by independent assessment.

Are forestation, bio-char and landfilled biomass adequate offsets for the climate effects of burning fossil fuels?

NARCIS (Netherlands)

Reijnders, L.

2009-01-01

Forestation and landfilling purpose-grown biomass are not adequate offsets for the CO2 emission from burning fossil fuels. Their permanence is insufficiently guaranteed and landfilling purpose-grown biomass may even be counterproductive. As to permanence, bio-char may do better than forests or

Maintenance of exercise training benefits is associated with adequate milk and dairy products intake in elderly hypertensive subjects following detraining.

Science.gov (United States)

Moraes, Wilson Max Almeida Monteiro de; Santos, Neucilane Silveira Dos; Aguiar, Larissa Pereira; Sousa, Luís Gustavo Oliveira de

2017-01-01

To investigate whether maintenance of exercise training benefits is associated with adequate milk and dairy products intake in hypertensive elderly subjects after detraining. Twenty-eight elderly hypertensive patients with optimal clinical treatment underwent 16 weeks of multicomponent exercise training program followed by 6 weeks of detraining, and were classified according to milk and dairy products intake as low milk (exercise training, there was a significant reduction (pexercise training benefits related to pressure levels, lower extremity strength and aerobic capacity, is associated with adequate milk and dairy products intake in hypertensive elderly subjects following 6 weeks of detraining.

NRC performance assessment program

International Nuclear Information System (INIS)

Coplan, S.M.

1986-01-01

The U.S. Nuclear Regulatory Commission's (NRC) performance assessment program includes the development of guidance to the U.S. Department of Energy (DOE) on preparation of a license application and on conducting the studies to support a license application. The nature of the licensing requirements of 10 CFR Part 60 create a need for performance assessments by the DOE. The NRC and DOE staffs each have specific roles in assuring the adequacy of those assessments. Performance allocation is an approach for determining what testing and analysis will be needed during site characterization to assure that an adequate data base is available to support the necessary performance assessments. From the standpoint of establishing is implementable methodology, the most challenging performance assessment needed for licensing is the one that will be used to determine compliance with the U.S. Environmental Protection Agency's (EPA) containment requirement

The Goal of Adequate Nutrition: Can It Be Made Affordable, Sustainable, and Universal?

Directory of Open Access Journals (Sweden)

Ian McFarlane

2016-11-01

Full Text Available Until about 1900, large proportions of the world population endured hunger and poverty. The 20th century saw world population increase from 1.6 to 6.1 billion, accompanied and to some extent made possible by rapid improvements in health standards and food supply, with associated advances in agricultural and nutrition sciences. In this paper, I use the application of linear programming (LP in preparation of rations for farm animals to illustrate a method of calculating the lowest cost of a human diet selected from locally available food items, constrained to provide recommended levels of food energy and nutrients; then, to find a realistic minimum cost, I apply the further constraint that the main sources of food energy in the costed diet are weighted in proportion to the actual reported consumption of food items in that area. Worldwide variations in dietary preferences raise the issue as to the sustainability of popular dietary regimes, and the paper reviews the factors associated with satisfying requirements for adequate nutrition within those regimes. The ultimate physical constraints on food supply are described, together with the ways in which climate change may affect those constraints. During the 20th century, food supply increased sufficiently in most areas to keep pace with the rapid increase in world population. Many challenges will need to be overcome if food supply is to continue to meet demand, and those challenges are made more severe by rising expectations of quality of life in the developing world, as well as by the impacts of climate change on agriculture and aquaculture.

Prediction of Adequate Prenatal Care Utilization Based on the Extended Parallel Process Model.

Science.gov (United States)

Hajian, Sepideh; Imani, Fatemeh; Riazi, Hedyeh; Salmani, Fatemeh

2017-10-01

Pregnancy complications are one of the major public health concerns. One of the main causes of preventable complications is the absence of or inadequate provision of prenatal care. The present study was conducted to investigate whether Extended Parallel Process Model's constructs can predict the utilization of prenatal care services. The present longitudinal prospective study was conducted on 192 pregnant women selected through the multi-stage sampling of health facilities in Qeshm, Hormozgan province, from April to June 2015. Participants were followed up from the first half of pregnancy until their childbirth to assess adequate or inadequate/non-utilization of prenatal care services. Data were collected using the structured Risk Behavior Diagnosis Scale. The analysis of the data was carried out in SPSS-22 using one-way ANOVA, linear regression and logistic regression analysis. The level of significance was set at 0.05. Totally, 178 pregnant women with a mean age of 25.31±5.42 completed the study. Perceived self-efficacy (OR=25.23; Pprenatal care. Husband's occupation in the labor market (OR=0.43; P=0.02), unwanted pregnancy (OR=0.352; Pcare for the minors or elderly at home (OR=0.35; P=0.045) were associated with lower odds of receiving prenatal care. The model showed that when perceived efficacy of the prenatal care services overcame the perceived threat, the likelihood of prenatal care usage will increase. This study identified some modifiable factors associated with prenatal care usage by women, providing key targets for appropriate clinical interventions.

[Practical chemistry education provided by team-based learning (TBL) and peer evaluation].

Science.gov (United States)

Yasuhara, Tomohisa; Konishi, Motomi; Nishida, Takahiro; Kushihata, Taro; Sone, Tomomichi; Kurio, Wasako; Yamamoto, Yumi; Nishikawa, Tomoe; Yanada, Kazuo; Nakamura, Mitsutaka

2014-01-01

Learning chemistry is cumulative: basic knowledge and chemical calculation skills are required to gain understanding of higher content. However, we often suffer from students' lack of learning skills to acquire these concepts. One of the reasons is the lack of adequate training in the knowledge and skills of chemistry, and one of the reasons for this lack is the lack of adequate evaluation of training procedures and content. Team-based learning (TBL) is a strong method for providing training in the knowledge and skills of chemistry and reaffirms the knowledge and skills of students of various levels. In our faculty, TBL exercises are provided for first-year students concurrently with lectures in physical chemistry and analytical chemistry. In this study, we researched the adoption of a peer evaluation process for this participatory learning model. Questionnaires taken after TBL exercises in the previous year showed a positive response to TBL. Further, a questionnaire taken after TBL exercises in the spring semester of the current year also yielded a positive response not only to TBL but also to peer evaluation. In addition, a significant correlation was observed between the improvement of students' grades in chemistry classes and the feeling the percentage (20%) of peer evaluation in overall evaluation low (logistic regression analysis, p=0.022). On the basis of the findings, we argue that TBL provides a generic, practical learning environment including an effective focus on learning strategy and evaluation of knowledge, skills, and attitudes, and studies on the educational effects of TBL and peer evaluation.

Optimization of the gas turbine-modular helium reactor using statistical methods to maximize performance without compromising system design margins

International Nuclear Information System (INIS)

Lommers, L.J.; Parme, L.L.; Shenoy, A.S.

1995-07-01

This paper describes a statistical approach for determining the impact of system performance and design uncertainties on power plant performance. The objectives of this design approach are to ensure that adequate margin is provided, that excess margin is minimized, and that full advantage can be taken of unconsumed margin. It is applicable to any thermal system in which these factors are important. The method is demonstrated using the Gas Turbine Modular Helium Reactor as an example. The quantitative approach described allows the characterization of plant performance and the specification of the system design requirements necessary to achieve the desired performance with high confidence. Performance variations due to design evolution, inservice degradation, and basic performance uncertainties are considered. The impact of all performance variabilities is combined using Monte Carlo analysis to predict the range of expected operation

Performance-based, cost- and time-effective PCB analytical methodology

International Nuclear Information System (INIS)

Alvarado, J. S.

1998-01-01

Laboratory applications for the analysis of PCBs (polychlorinated biphenyls) in environmental matrices such as soil/sediment/sludge and oil/waste oil were evaluated for potential reduction in waste, source reduction, and alternative techniques for final determination. As a consequence, new procedures were studied for solvent substitution, miniaturization of extraction and cleanups, minimization of reagent consumption, reduction of cost per analysis, and reduction of time. These new procedures provide adequate data that meet all the performance requirements for the determination of PCBs. Use of the new procedures reduced costs for all sample preparation techniques. Time and cost were also reduced by combining the new sample preparation procedures with the power of fast gas chromatography. Separation of Aroclor 1254 was achieved in less than 6 min by using DB-1 and SPB-608 columns. With the greatly shortened run times, reproducibility can be tested quickly and consequently with low cost. With performance-based methodology, the applications presented here can be applied now, without waiting for regulatory approval

Development of a large-area Multigap RPC with adequate spatial resolution for muon tomography

Science.gov (United States)

Wang, J.; Wang, Y.; Wang, X.; Zeng, M.; Xie, B.; Han, D.; Lyu, P.; Wang, F.; Li, Y.

2016-11-01

We study the performance of a large-area 2-D Multigap Resistive Plate Chamber (MRPC) designed for muon tomography with high spatial resolution. An efficiency up to 98% and a spatial resolution of around 270 μ m are obtained in cosmic ray and X-ray tests. The performance of the MRPC is also investigated for two working gases: standard gas and pure Freon. The result shows that the MRPC working in pure Freon can provide higher efficiency and better spatial resolution.

Emerging practices of faith-based organisations addressing human resources for health

NARCIS (Netherlands)

Dieleman, M.A.; Hilhorst, Thea; Utrera, Jose; Olivier, J; Wodon, Q

2012-01-01

Adequate health system performance and achieving the Millennium Development Goals for health, requires that qualified health care providers are available and can perform adequately. However, there is a critical shortage of health care providers in sub-Saharan Africa, and this crisis is hitting

The Nursing Performance Instrument: Exploratory and Confirmatory Factor Analyses in Registered Nurses.

Science.gov (United States)

Sagherian, Knar; Steege, Linsey M; Geiger-Brown, Jeanne; Harrington, Donna

2018-04-01

The optimal performance of nurses in healthcare settings plays a critical role in care quality and patient safety. Despite this importance, few measures are provided in the literature that evaluate nursing performance as an independent construct from competencies. The nine-item Nursing Performance Instrument (NPI) was developed to fill this gap. The aim of this study was to examine and confirm the underlying factor structure of the NPI in registered nurses. The design was cross-sectional, using secondary data collected between February 2008 and April 2009 for the "Fatigue in Nursing Survey" (N = 797). The sample was predominantly dayshift female nurses working in acute care settings. Using Mplus software, exploratory and confirmatory factor analyses were applied to the NPI data, which were divided into two equal subsamples. Multiple fit indices were used to evaluate the fit of the alternative models. The three-factor model was determined to fit the data adequately. The factors that were labeled as "physical/mental decrements," "consistent practice," and "behavioral change" were moderately to strongly intercorrelated, indicating good convergent validity. The reliability coefficients for the subscales were acceptable. The NPI consists of three latent constructs. This instrument has the potentialto be used as a self-monitoring instrument that addressesnurses' perceptions of performance while providing patient care.

The development of an effective performance indicator program aids management effectiveness

International Nuclear Information System (INIS)

Kelm, R.R.

1989-01-01

One problem that has plagued nuclear security departments has been the failure to adequately develop accurate and effective means of tracking and trending computer-based security system performance data at nuclear power facilities. The purpose of this paper is twofold: to provide information on the development and uses of one system employed by the Detroit Edison Company that has proven to be an effective performance indicator system to track security system data and to explain how management makes use of the system data. The performance indicator system has had a remarkable effect on the department's performance. The system's users have become more effective in isolating problems with security system components. The data have been utilized as part of the cost/benefit analysis for justifying improvements or equipment upgrades, clearly documenting cost savings. Finally, security management at all levels is able to promptly identify individual problems or trends. The time, money, and hours devoted to system development have greatly contributed to Detroit Edison's nuclear security department achieving a SALP 1 rating

The Role of Mentoring Program in Enhancing Mentees’ Academic Performance

Directory of Open Access Journals (Sweden)

Azman Ismail

2014-02-01

Full Text Available According to institutions of higher learning literature, mentoring program has two important features: communication and support. The ability of mentors to appropriately implement comfortable communication and provide adequate support may ehance positive mentee outcomes, especially academic performance. Although the nature of this relationship is crucial, little is known about the role of mentoring program as an important predictor of mentees’ academic performance in the higher education mentoring research literature. Therefore, this study was conducted to measure the relationship between mentoring program and mentees’ academic performance using self-administered questionnaires gathered from undergraduate students in Malaysian institutions of higher learning in Sarawak. The results of SmartPLS path model showed two important outcomes: firstly, communication positively and significantly correlated with academic performance. Secondly, support positively and significantly correlated with academic performance. The result demonstrates that mentoring program does act as an important predictor of mentees’ academic performance in the organizational sample. Thus, discussion, implications and conclusion are elaborated.

Key Sustainability Performance Indicator Analysis for Czech Breweries

Directory of Open Access Journals (Sweden)

Edward Kasem

2015-01-01

Full Text Available Sustainability performance can be said to be an ability of an organization to remain productive over time and hold on to its potential for maintaining long-term profitability. Since the brewery sector is one of the most important and leading markets in the foodstuff industry of the Czech Republic, this study depicts the Czech breweries’ formal entry into sustainability reporting and performance. The purpose of this paper is to provide an efficiency level evaluation which would represent the level of corporate performance of Czech breweries. For this reason, Data Envelopment Analysis (DEA is introduced. In order to apply it, we utilize a set of key performance indicators (KPIs based on two international standard frameworks: the Global Reporting Initiative (GRI and its GRI 4 guidelines, and the guideline KPIs for ESG 3.0, which was published by the DVFA Society. Four sustainability dimensions (economic, environmental, social and governance are covered, making it thus possible to adequately evaluate sustainability performance in Czech breweries. The main output is not only the efficiency score of the company but also the input weights. These weights are used to determine the contribution of particular criteria to the breweries’ achieved score. According to the achieved efficiency results for Czech breweries, the percentage of women supervising the company does not affect the sustainability performance.

Performances of domiciliary ventilators compared by using a parametric procedure

Directory of Open Access Journals (Sweden)

Fresnel Emeline

2016-12-01

Performances of domiciliary ventilators strongly depend not only on the breathing dynamics but also on the ventilator strategy. One given ventilator may be more adequate than another one for a given patient.

Does Military Culture Adequately Prepare Senior Leaders to Provide Clear Objective, and Useful Strategic Advice?

Science.gov (United States)

2012-05-17

relegate South Vietnamese forces to the fight against the Viet Cong in lieu of training and employing them in the fight against the existential threat...counter insurgencies in foreign countries that are ostensibly of minimal threat to the existential being of the United States. Since insurgent threats to...profound difference between the will to understand for purposes of coexistence and humanistic enlargement of horizons, and the will to dominate for

Three Canted Radiator Panels to Provide Adequate Cooling for Instruments on Slewing Spacecraft in LEO

Science.gov (United States)

Choi, Michael K.

2012-01-01

Certain free-flying spacecraft in low Earth orbit (LEO) or payloads on the International Space Station (ISS) are required to slew to point the telescopes at targets. Instrument detectors and electronics require cooling. Traditionally a planar thermal radiator is used. The temperature of such a radiator varies significantly when the spacecraft slews because its view factors to space vary significantly. Also for payloads on the ISS, solar impingement on the radiator is possible. These thermal adversities could lead to inadequate cooling for the instrument. This paper presents a novel thermal design concept that utilizes three canted radiator panels to mitigate this problem. It increases the overall radiator view factor to cold space and reduces the overall solar or albedo flux absorbed per unit area of the radiator.

Laboratory and gas-fired furnace performance tests of epoxy primers for intumescent coatings

DEFF Research Database (Denmark)

Nørgaard, Kristian Petersen; Dam-Johansen, Kim; Catala, Pere

2014-01-01

, either to ensure adhesion of the intumescent coating to the steel or to provide corrosion resistance. It is essential to document the performance of the intumescent coating together with the primer to ensure the overall quality of coating system. In the present work, two epoxy primers were used...... to a gas-fired furnace following the ISO834 fire curve (a so-called cellulosic fire), one of the primers selected performed well and the other poorly. From tests in the electrically heated oven, it was found that both primers were sensitive to the film thickness employed and the presence of oxygen....... At oxygen-rich conditions, higher primer thicknesses gave weaker performance. In addition, a color change from red to black was observed in nitrogen, while the color remained red in the oxygen-nitrogen mixture. In summary, the results suggest that an adequate choice of primer, primer thickness...

Making ecological models adequate

Science.gov (United States)

Getz, Wayne M.; Marshall, Charles R.; Carlson, Colin J.; Giuggioli, Luca; Ryan, Sadie J.; Romañach, Stephanie; Boettiger, Carl; Chamberlain, Samuel D.; Larsen, Laurel; D'Odorico, Paolo; O'Sullivan, David

2018-01-01

Critical evaluation of the adequacy of ecological models is urgently needed to enhance their utility in developing theory and enabling environmental managers and policymakers to make informed decisions. Poorly supported management can have detrimental, costly or irreversible impacts on the environment and society. Here, we examine common issues in ecological modelling and suggest criteria for improving modelling frameworks. An appropriate level of process description is crucial to constructing the best possible model, given the available data and understanding of ecological structures. Model details unsupported by data typically lead to over parameterisation and poor model performance. Conversely, a lack of mechanistic details may limit a model's ability to predict ecological systems’ responses to management. Ecological studies that employ models should follow a set of model adequacy assessment protocols that include: asking a series of critical questions regarding state and control variable selection, the determinacy of data, and the sensitivity and validity of analyses. We also need to improve model elaboration, refinement and coarse graining procedures to better understand the relevancy and adequacy of our models and the role they play in advancing theory, improving hind and forecasting, and enabling problem solving and management.

What information is provided in transcripts and Medical Student Performance Records from Canadian Medical Schools? A retrospective cohort study.

Science.gov (United States)

Robins, Jason A; McInnes, Matthew D F; Esmail, Kaisra

2014-01-01

Resident selection committees must rely on information provided by medical schools in order to evaluate candidates. However, this information varies between institutions, limiting its value in comparing individuals and fairly assessing their quality. This study investigates what is included in candidates' documentation, the heterogeneity therein, as well as its objective data. Samples of recent transcripts and Medical Student Performance Records were anonymised prior to evaluation. Data were then extracted by two independent reviewers blinded to the submitting university, assessing for the presence of pre-selected criteria; disagreement was resolved through consensus. The data were subsequently analysed in multiple subgroups. Inter-rater agreement equalled 92%. Inclusion of important criteria varied by school, ranging from 22.2% inclusion to 70.4%; the mean equalled 47.4%. The frequency of specific criteria was highly variable as well. Only 17.7% of schools provided any basis for comparison of academic performance; the majority detailed only status regarding pass or fail, without any further qualification. Considerable heterogeneity exists in the information provided in official medical school documentation, as well as markedly little objective data. Standardization may be necessary in order to facilitate fair comparison of graduates from different institutions. Implementation of objective data may allow more effective intra- and inter-scholastic comparison.

What information is provided in transcripts and Medical Student Performance Records from Canadian Medical Schools? A retrospective cohort study

Directory of Open Access Journals (Sweden)

Jason A. Robins

2014-09-01

Full Text Available Background: Resident selection committees must rely on information provided by medical schools in order to evaluate candidates. However, this information varies between institutions, limiting its value in comparing individuals and fairly assessing their quality. This study investigates what is included in candidates’ documentation, the heterogeneity therein, as well as its objective data. Methods: Samples of recent transcripts and Medical Student Performance Records were anonymised prior to evaluation. Data were then extracted by two independent reviewers blinded to the submitting university, assessing for the presence of pre-selected criteria; disagreement was resolved through consensus. The data were subsequently analysed in multiple subgroups. Results: Inter-rater agreement equalled 92%. Inclusion of important criteria varied by school, ranging from 22.2% inclusion to 70.4%; the mean equalled 47.4%. The frequency of specific criteria was highly variable as well. Only 17.7% of schools provided any basis for comparison of academic performance; the majority detailed only status regarding pass or fail, without any further qualification. Conclusions: Considerable heterogeneity exists in the information provided in official medical school documentation, as well as markedly little objective data. Standardization may be necessary in order to facilitate fair comparison of graduates from different institutions. Implementation of objective data may allow more effective intra- and inter-scholastic comparison.

Evaluation of a transit first-aid station providing emergency care to former Yugoslavian war victims evacuated in Ancona, Italy.

Science.gov (United States)

Prospero, E; Raffo, M; Appignanesi, R; Faccenda, G; Ronveaux, O; Annino; D'Errico, M M

2000-03-01

A first-aid station was implemented in Falconara Marittima airport (Ancona, Italy). It provided medical emergency care to war victims evacuated from former Yugoslavia in transit for further treatment. A descriptive analysis of the displaced population arriving at the first-aid station was performed using three independent datasets for administrative information, of which one included medical information. The implemented resources were also evaluated. From August 1993 to March 1995, 2272 displaced persons were registered at the first-aid station, out of which 54.2% were accompanying family members. Among those needing medical intervention (45.8% of total), most frequent diagnoses were traumatisms and burns (59.8%), neoplasms (15.6%), and congenital malformations (13.2%). The medical care provided at the first-aid station was most often basic: a medical examination alone was performed on 77.0% of the patients, and a minor dressing on 17.3%. Median length of stay was 1 day. Patients were sent to 30 different countries and 8% were forwarded to the local regional hospital. Deployed logistical resources exceeded by far actual needs but a lack of psychological assistance was observed, mainly for children. The agencies involved did not coordinate data sharing and follow-up information. The medical assistance to the war victims was efficient regarding provided care and timeliness. Effectiveness of such a programme could be improved by a better coordination between partners, allowing more adequate logistics according to appropriate epidemiological information.

Clinical evaluation of postoperative analgesia provided by ketoprofen associated with intravenous or epidural morphine in bitches undergoing ovariosalpingohysterectomy

Directory of Open Access Journals (Sweden)

Gabriela Carvalho Aquilino Santos

2015-04-01

Full Text Available Multimodal analgesia refers to the practice of combining multiple analgesic drug classes or techniques to target different points along the pain pathway. The objective of this work was to evaluate clinically if ketoprofen associated or not with intravenous or epidural morphine provided adequate postoperative analgesia in bitches undergoing ovariosalpingohysterectomy (OSH. Forty healthy female dogs, weighing 10.7±6.0 kg, sedated with acepromazine (0.05mg kg –1.iv, induced with propofol (5 mg.kg-1. iv and maintained with isoflurane anesthesia, were distributed into four groups of 10 animals each. After stabilization of inhalation anesthesia, the bitches in Miv and CMiv groups received 0.2 mg.kg-1 of morphine intravenously diluted in 10ml of saline; whereas Mep and CMep groups received 0.1mg.kg-1 of epidural morphine. Thirty minutes after premedication, 2.0mg.kg-1.im of ketoprofen was administered in groups CMiv and CMep. Heart and respiratory rate, systolic blood pressure, and rectal temperature were measured. The degree of analgesia was assessed by a blind study in the following 6 hours after surgery, using a descriptive scale and a scale composed by physiologic and behavioral parameters. An statistical analysis was performed using the Tukey-Kramer test and nonparametric Kruskal-Wallis test, with statistical significance of 5%. There was no important difference between the four groups regarding postoperative analgesia, heart and respiratory rate, systolic blood pressure and rectal temperature. According to the results it can be concluded that the use of ketoprofen associated with intravenous or epidural morphine provided adequate and safe analgesia in the first six hours of postoperative in bitches undergoing ovariohysterectomy, suggesting that there was no analgesic potentiation when both agents were combined.

Migration and access to maternal healthcare: determinants of adequate antenatal care and institutional delivery among socio-economically disadvantaged migrants in Delhi, India.

Science.gov (United States)

Kusuma, Yadlapalli S; Kumari, Rita; Kaushal, Sonia

2013-10-01

To identify the determinants of adequate antenatal care (ANC) utilisation and institutional deliveries among socio-economically disadvantaged migrants living in Delhi, India. In a cross-sectional survey, 809 rural-urban migrant mothers with a child aged below 2 years were interviewed with a pretested questionnaire. Data on receiving antenatal, delivery and post-natal services, migration history and other social, demographic and income were collected. Recent migrants used the services significantly less than settled migrants. ANC was adequate only among 37% (35% of recent migrant women and 39% of settled migrants). Multinomial regression revealed that being a recent migrant, multiparous, illiterate and married to an unskilled worker were significant risk factors for receiving inadequate ANC. Around 53% of deliveries took place at home. ANC seeking has a strong influence on place of delivery: 70% of births to women who received inadequate ANC were at home. Women who are educated, had their first delivery after the age of 20 years and received adequate ANC were more likely to deliver their child in hospital. Post-natal care is grossly neglected among these groups. Migrant women, particularly recent migrants, are at the risk of not receiving adequate maternal healthcare. Because migration is a continuing phenomenon, measures to mitigate disadvantage due to migration need to be taken in the healthcare system. © 2013 John Wiley & Sons Ltd.

Performance assessment

International Nuclear Information System (INIS)

Doe, T.

1985-01-01

The purpose of performance assessment is to show that the repository is expected to serve its stated function - disposing of radioactive waste safely both during operation and for the postclosure period. Performance assessment is a straightforward concept, but its application may be very complicated. The concept of performance assessment has been clarified by the Nuclear Regulatory Commission (NRC) in their Draft Generic Technical Position on Licensing Assessment Methodology for High-Level Waste Geologic Repositories (NRC, 1984). This document has gone a long way toward defining the criteria that the NRC will use to determine whether or not information from site characterization is adequate to meet the regulations of the Nuclear Regulatory Commission and the Environmental Protection Agency (EPA). A favorable determination is required for issuance of a construction authorization, which is the first major regulatory requirement for developing a working repository. It is, therefore, essential that a research program be developed that not only resolves the outstanding technical issues, but also does it in such a way that the results are clearly applicable to the formal performance assessment and licensing procedures. The definitions of performance assessment are reviewed and the current NRC thinking is summarized

Performing a nuclear facility EMI audit

International Nuclear Information System (INIS)

White, D.R.J.

1993-01-01

This paper addresses several questions which may arise when performing a nuclear facility EMI audit. Among the issues addressed are how a nuclear electrical power plant can ensure that it has taken adequate EMC measures to protect it from hostile electromagnetic ambient environments, means by which these measures can be implemented with sufficient integrity and reliability, and how often an inspection or audit should be performed to assess the EMC measures. Means of assessing EMI hardening and effective control of aging effects are also discussed. 2 figs

The Relationship between Environmental Turbulence, Management Support, Organizational Collaboration, Information Technology Solution Realization, and Process Performance, in Healthcare Provider Organizations

Science.gov (United States)

Muglia, Victor O.

2010-01-01

The Problem: The purpose of this study was to investigate relationships between environmental turbulence, management support, organizational collaboration, information technology solution realization, and process performance in healthcare provider organizations. Method: A descriptive/correlational study of Hospital medical services process…

Improving health worker performance : in search of promising practices

NARCIS (Netherlands)

Dieleman, M.A.; Harnmeijer, JW

2006-01-01

Qualified and motivated human resources (HR) are essential for adequate health service provision, but HR shortages have now reached critical levels in many resource-poor settings, especially in rural areas. Strategies improving performance are essential to address shortages of the existing

Apneic oxygenation combined with extracorporeal arteriovenous carbon dioxide removal provides sufficient gas exchange in experimental lung injury

DEFF Research Database (Denmark)

Nielsen, Niels Dalsgaard; Kjærgaard, Benedict; Nielsen, Jakob Koefoed

In this porcine lung injury model, apneic oxygenation with arteriovenous CO2 removal provided sufficient gas exchange and stable hemodynamics, indicating that the method might have a potential in the treatment of severe ARDS.   Acknowledgements The membrane lungs were kindly provided by Novalung GmbH, Germany.......Background and aim of study We hypothesized that continuous high airway pressure without ventilatory movements (apneic oxygenation), using an open lung approach, combined with extracorporeal, pumpless, arterio-venous, carbon dioxide (CO2) removal would provide adequate gas exchange in acute lung...

Nutritional Status and Cognitive Performance among Children Aged ...

African Journals Online (AJOL)

Without adequate nutrition, children cannot develop to their full physical and mental potentials. The nutritional status and the cognitive performance of 500 school children aged 5-12 years from urban and rural areas of Enugu State, Nigeria were evaluated. Anthropometric measurements of heights and weights were ...

A Customer’s Possibilities to Increase the Performance of a Service Provider by Adding Value and Deepening the Partnership in Facility Management Service

Directory of Open Access Journals (Sweden)

Sillanpää Elina

2016-06-01

Full Text Available Reliable and good suppliers are an important competitive advantage for a customer and that is why the development of suppliers, improvement of performance and enhancement of customership are also in the interest of the customer. The purpose of this study is to clarify a customer’s possibilities to increase the performance of a service provider and to develop the service process in FM services and thus help to improve partnership development. This research is a qualitative research. The research complements the existing generic model of supplier development towards partnership development by customer and clarifies the special features that facility management services bring to this model. The data has been gathered from interviews of customers and service providers in the facility management service sector. The result is a model of customers’ possibilities to develop the performance of service providers from the viewpoint of value addition and relationship development and in that way ensure added value to the customer and the development of a long-term relationship. The results can be beneficial to customers when they develop the cooperation between the customer and the service provider toward being more strategic and more partnership focused.

The Comprehension Problems for Second-Language Learners with Poor Reading Comprehension Despite Adequate Decoding: A Meta-Analysis

Science.gov (United States)

Spencer, Mercedes; Wagner, Richard K.

2017-01-01

We conducted a meta-analysis of 16 existing studies to examine the nature of the comprehension problems for children who were second-language learners with poor reading comprehension despite adequate decoding. Results indicated that these children had deficits in oral language (d = -0.80), but these deficits were not as severe as their reading…

Is the world supply of omega-3 fatty acids adequate for optimal human nutrition?

Science.gov (United States)

Salem, Norman; Eggersdorfer, Manfred

2015-03-01

To delineate the available sources of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) for human consumption and to determine if the available supply is capable of supplying the nutrient levels recommended by expert bodies. There are converging opinions among experts, professional organizations and health professionals that a recommendation for a daily individual consumption of 500 mg of EPA/DHA would provide health benefits, and this translates to an annual human consumption of 1.3 million metric tons. Current human consumption of EPA/DHA is estimated to be only a small fraction of this amount and many people may suffer from suboptimal health as a result of low intake. EPA and DHA originate in the phytoplankton and are made available in the human food chain mainly through fish and other seafood. The fish catch is not elastic and in fact has long since reached a plateau. Aquaculture has grown rapidly, but most of the fish oil produced is currently being used to support aquaculture feed and so this would appear to limit aquaculture growth - or at least the growth in availability of fish sources of EPA/DHA. Vegetable oil-derived alpha-linolenic acid, though relatively plentiful, is converted only at a trace level in humans to DHA and not very efficiently to EPA, and so cannot fill this gap. Microbial EPA/DHA production can in the future be increased, although this oil is likely to remain more expensive than fish oil. Plant sources of EPA and DHA have now been produced in the laboratory via transgenic means and will eventually clear regulatory hurdles for commercialization, but societal acceptance remains in question. The purpose of this review is to discuss the various sources of omega-3 fatty acids within the context of the potential world demand for these nutrients. In summary, it is concluded that fish and vegetable oil sources will not be adequate to meet future needs, but that algal oil and terrestrial plants modified genetically to produce EPA and DHA

Use of Linear Programming to Develop Cost-Minimized Nutritionally Adequate Health Promoting Food Baskets.

Science.gov (United States)

Parlesak, Alexandr; Tetens, Inge; Dejgård Jensen, Jørgen; Smed, Sinne; Gabrijelčič Blenkuš, Mojca; Rayner, Mike; Darmon, Nicole; Robertson, Aileen

2016-01-01

Food-Based Dietary Guidelines (FBDGs) are developed to promote healthier eating patterns, but increasing food prices may make healthy eating less affordable. The aim of this study was to design a range of cost-minimized nutritionally adequate health-promoting food baskets (FBs) that help prevent both micronutrient inadequacy and diet-related non-communicable diseases at lowest cost. Average prices for 312 foods were collected within the Greater Copenhagen area. The cost and nutrient content of five different cost-minimized FBs for a family of four were calculated per day using linear programming. The FBs were defined using five different constraints: cultural acceptability (CA), or dietary guidelines (DG), or nutrient recommendations (N), or cultural acceptability and nutrient recommendations (CAN), or dietary guidelines and nutrient recommendations (DGN). The variety and number of foods in each of the resulting five baskets was increased through limiting the relative share of individual foods. The one-day version of N contained only 12 foods at the minimum cost of DKK 27 (€ 3.6). The CA, DG, and DGN were about twice of this and the CAN cost ~DKK 81 (€ 10.8). The baskets with the greater variety of foods contained from 70 (CAN) to 134 (DGN) foods and cost between DKK 60 (€ 8.1, N) and DKK 125 (€ 16.8, DGN). Ensuring that the food baskets cover both dietary guidelines and nutrient recommendations doubled the cost while cultural acceptability (CAN) tripled it. Use of linear programming facilitates the generation of low-cost food baskets that are nutritionally adequate, health promoting, and culturally acceptable.

Effect of flocculating agent dosages on the performance of red mud flocculation under shear conditions

International Nuclear Information System (INIS)

Gagnon, M.J.; Simard, G.; Leclerc, A.; Peloquin, G.

2002-01-01

The performance of different polymers used to flocculate red mud particulate materials in the Bayer process can be evaluated on the basis of their efficiency to achieve adequate settling velocities and turbidity levels. In this study, three commercially available flocculants are evaluated under typical conditions found in the last washer of a Bayer plant. The different shear levels are produced by using a modified Couette flow system. Great differences are noticed in the performance of the polymers when they are compared at different dosages and at different shear rate levels. The data collected also suggests that conventional cylinder settling tests may not be adequate to measure the performance of certain types of polymers. (author)

Maternal and newborn healthcare providers in rural Tanzania: in-depth interviews exploring influences on motivation, performance and job satisfaction.

Science.gov (United States)

Prytherch, H; Kakoko, D C V; Leshabari, M T; Sauerborn, R; Marx, M

2012-01-01

Major improvements in maternal and neonatal health (MNH) remain elusive in Tanzania. The causes are closely related to the health system and overall human resource policy. Just 35% of the required workforce is actually in place and 43% of available staff consists of lower-level cadres such as auxiliaries. Staff motivation is also a challenge. In rural areas the problems of recruiting and retaining health staff are most pronounced. Yet, it is here that the majority of the population continues to reside. A detailed understanding of the influences on the motivation, performance and job satisfaction of providers at rural, primary level facilities was sought to inform a research project in its early stages. The providers approached were those found to be delivering MNH care on the ground, and thus include auxiliary staff. Much of the previous work on motivation has focused on defined professional groups such as physicians and nurses. While attention has recently broadened to also include mid-level providers, the views of auxiliary health workers have seldom been explored. In-depth interviews were the methodology of choice. An interview guideline was prepared with the involvement of Tanzanian psychologists, sociologists and health professionals to ensure the instrument was rooted in the socio-cultural setting of its application. Interviews were conducted with 25 MNH providers, 8 facility and district managers, and 2 policy-makers. Key sources of encouragement for all the types of respondents included community appreciation, perceived government and development partner support for MNH, and on-the-job learning. Discouragements were overwhelmingly financial in nature, but also included facility understaffing and the resulting workload, malfunction of the promotion system as well as health and safety, and security issues. Low-level cadres were found to be particularly discouraged. Difficulties and weaknesses in the management of rural facilities were revealed. Basic steps

Improving access to adequate pain management in Taiwan.

Science.gov (United States)

Scholten, Willem

2015-06-01

There is a global crisis in access to pain management in the world. WHO estimates that 4.65 billion people live in countries where medical opioid consumption is near to zero. For 2010, WHO considered a per capita consumption of 216.7 mg morphine equivalents adequate, while Taiwan had a per capita consumption of 0.05 mg morphine equivalents in 2007. In Asia, the use of opioids is sensitive because of the Opium Wars in the 19th century and for this reason, the focus of controlled substances policies has been on the prevention of diversion and dependence. However, an optimal public health outcome requires that also the beneficial aspects of these substances are acknowledged. Therefore, WHO recommends a policy based on the Principle of Balance: ensuring access for medical and scientific purposes while preventing diversion, harmful use and dependence. Furthermore, international law requires that countries ensure access to opioid analgesics for medical and scientific purposes. There is evidence that opioid analgesics for chronic pain are not associated with a major risk for developing dependence. Barriers for access can be classified in the categories of overly restrictive laws and regulations; insufficient medical training on pain management and problems related to assessment of medical needs; attitudes like an excessive fear for dependence or diversion; and economic and logistical problems. The GOPI project found many examples of such barriers in Asia. Access to opioid medicines in Taiwan can be improved by analysing the national situation and drafting a plan. The WHO policy guidelines Ensuring Balance in National Policies on Controlled Substances can be helpful for achieving this purpose, as well as international guidelines for pain treatment. Copyright © 2015. Published by Elsevier B.V.

Adequate Rhetorical Delivery when Staging Premodernity

DEFF Research Database (Denmark)

Hansen, Jette Barnholdt

2015-01-01

Artiklen handler om iscenesættelse af performative kunstværker fra det 18. årh., der ofte også rummer stillingtagen til retorisk fremførelse. Jeg advokerer for, at man sammentænker synkrone indfaldsvinker med diakrone, så man fx ikke udelukkende fokuserer på at genskabe gestus fra det 18.århundre...

Risk of Performance Decrement and Crew Illness Due to an Inadequate Food System

Science.gov (United States)

Douglas, Grace L.; Cooper, Maya; Bermudez-Aguirre, Daniela; Sirmons, Takiyah

2016-01-01

NASA is preparing for long duration manned missions beyond low-Earth orbit that will be challenged in several ways, including long-term exposure to the space environment, impacts to crew physiological and psychological health, limited resources, and no resupply. The food system is one of the most significant daily factors that can be altered to improve human health, and performance during space exploration. Therefore, the paramount importance of determining the methods, technologies, and requirements to provide a safe, nutritious, and acceptable food system that promotes crew health and performance cannot be underestimated. The processed and prepackaged food system is the main source of nutrition to the crew, therefore significant losses in nutrition, either through degradation of nutrients during processing and storage or inadequate food intake due to low acceptability, variety, or usability, may significantly compromise the crew's health and performance. Shelf life studies indicate that key nutrients and quality factors in many space foods degrade to concerning levels within three years, suggesting that food system will not meet the nutrition and acceptability requirements of a long duration mission beyond low-Earth orbit. Likewise, mass and volume evaluations indicate that the current food system is a significant resource burden. Alternative provisioning strategies, such as inclusion of bioregenerative foods, are challenged with resource requirements, and food safety and scarcity concerns. Ensuring provisioning of an adequate food system relies not only upon determining technologies, and requirements for nutrition, quality, and safety, but upon establishing a food system that will support nutritional adequacy, even with individual crew preference and self-selection. In short, the space food system is challenged to maintain safety, nutrition, and acceptability for all phases of an exploration mission within resource constraints. This document presents the

Hydroxyapatite clay for gap filling and adequate bone ingrowth.

Science.gov (United States)

Maruyama, M; Terayama, K; Ito, M; Takei, T; Kitagawa, E

1995-03-01

In uncemented total hip arthroplasty, a complete filling of the gap between femoral prosthesis and the host bone is difficult and defects would remain, because the anatomy of the reamed intramedullary canal cannot fit the prosthesis. Therefore, it seems practical to fill the gap with a clay containing hydroxyapatite (HA), which has an osteoconductive character. The clay (HA clay) is made by mixing HA granules (size 0.1 mm or more) having a homogeneous pore distribution and a porosity of 35-48 vol%, and a viscous substance such as a saline solution of sodium alginate (SSSA). In the first experiment, the ratio of HA granules and sodium alginate in SSSA is set for the same handling properties of HA clay and polymethylmethacrylate bone cement (standard viscosity) before hardening. As a result, the ratio is set for 55 wt% of HA in the clay and 12.5 wt% of sodium alginate in SSSA (i.e., HA:sodium alginate:saline solution = 9.8:1:7). In the second study, the gap between the femoral stem and bone model is completely filled with HA clay. However, the gap is not filled only with HA granules or HA granules mixed with saline solution. In the third animal experiment, using an unloaded model, histology shows that HA clay has an osteoconductive property bridging the gap between the implant and the cortical bone without any adverse reaction. HA clay is considered a useful biomaterial to fill the gap with adequate bone ingrowth.

Reinvigorating the indigenous flute in African dance performance ...

African Journals Online (AJOL)

In doing this, it attempts to explore the usefulness of flute in encouraging vocational and entrepreneurial skills among the youth, with a view to creating job opportunities. Over the decades, scholars and performing arts practitioners have failed to adequately develop the indigenous musical aerophone instruments such as the ...

Practices in adequate structural design

Science.gov (United States)

Ryan, Robert S.

1989-01-01

Structural design and verification of space vehicles and space systems is a very tricky and awe inspiring business, particularly for manned missions. Failures in the missions with loss of life is devastating personally and nationally. The scope of the problem is driven by high performance requirements which push state-of-the-art technologies, creating high sensitivites to small variations and uncertainties. Insurance of safe, reliable flight dictates the use of sound principles, procedures, analysis, and testing. Many of those principles which were refocused by the Space Shuttle Challenger (51-L) accident on January 26, 1986, and the activities conducted to insure safe shuttle reflights are discussed. The emphasis will be focused on engineering, while recognizing that project and project management are also key to success.

Biodiversity of the Great Barrier Reef—how adequately is it protected?

Directory of Open Access Journals (Sweden)

Zoe T. Richards

2018-05-01

Full Text Available Background The Great Barrier Reef (GBR is the world’s most iconic coral reef ecosystem, recognised internationally as a World Heritage Area of outstanding significance. Safeguarding the biodiversity of this universally important reef is a core legislative objective; however, ongoing cumulative impacts including widespread coral bleaching and other detrimental impacts have heightened conservation concerns for the future of the GBR. Methods Here we review the literature to report on processes threatening species on the GBR, the status of marine biodiversity, and evaluate the extent of species-level monitoring and reporting. We assess how many species are listed as threatened at a global scale and explore whether these same species are protected under national threatened species legislation. We conclude this review by providing future directions for protecting potentially endangered elements of biodiversity within the GBR. Results Most of the threats identified to be harming the diversity of marine life on the GBR over the last two–three decades remain to be effectively addressed and many are worsening. The inherent resilience of this globally significant coral reef ecosystem has been seriously compromised and various elements of the biological diversity for which it is renowned may be at risk of silent extinction. We show at least 136 of the 12,000+ animal species known to occur on the GBR (approximately 20% of the 700 species assessed by the IUCN occur in elevated categories of threat (Critically Endangered, Endangered or Vulnerable at a global scale. Despite the wider background level of threat for these 136 species, only 23 of them are listed as threatened under regional or national legislation. Discussion To adequately protect the biodiversity values of the GBR, it may be necessary to conduct further targeted species-level monitoring and reporting to complement ecosystem management approaches. Conducting a vigorous value of information

Enstore with Chimera namespace provider

International Nuclear Information System (INIS)

Litvintsev, Dmitry; Moibenko, Alexander; Oleynik, Gene; Zalokar, Michael

2012-01-01

Enstore is a mass storage system developed by Fermilab that provides distributed access and management of data stored on tapes. It uses a namespace service, PNFS, developed by DESY to provide a filesystem-like view of the stored data. PNFS is a legacy product and is being replaced by a new implementation, called Chimera, which is also developed by DESY. Chimera offers multiple advantages over PNFS in terms of performance and functionality. The Enstore client component, encp, has been modified to work with Chimera, as well as with any other namespace provider. We performed high load end-to-end acceptance test of Enstore with the Chimera namespace. This paper describes the modifications to Enstore, the test procedure and the results of the acceptance testing.

Home care providers to the rescue

DEFF Research Database (Denmark)

Hansen, Steen Møller; Brøndum, Stig; Thomas, Grethe

2015-01-01

AIM: To describe the implementation of a novel first-responder programme in which home care providers equipped with automated external defibrillators (AEDs) were dispatched in parallel with existing emergency medical services in the event of a suspected out-of-hospital cardiac arrest (OHCA......). METHODS: We evaluated a one-year prospective study that trained home care providers in performing cardiopulmonary resuscitation (CPR) and using an AED in cases of suspected OHCA. Data were collected from cardiac arrest case files, case files from each provider dispatch and a survey among dispatched...... providers. The study was conducted in a rural district in Denmark. RESULTS: Home care providers were dispatched to 28 of the 60 OHCAs that occurred in the study period. In ten cases the providers arrived before the ambulance service and subsequently performed CPR. AED analysis was executed in three cases...

Choosing an adequate design and analysis in cross-cultural personality research

Directory of Open Access Journals (Sweden)

Jia He

2017-02-01

Full Text Available The flourishing of cross-cultural personality research requires a keen eye for rigorous methodology in such research. With decades of experience in cross-cultural research methods, we have come to appreciate that methodological aspects of such studies are critical for obtaining valid findings. Ill-designed or -conducted studies may produce results that are difficult to interpret. A careful design and analysis can help to deal with various methodological problems in cross-cultural personality studies. Drawing on the extensive knowledge that has been accumulated in cross-cultural and personality research in the past decades, we describe a framework of bias and equivalence that enables the choice of adequate research methods and the avoidance of pitfalls that endanger valid conclusions in cross-cultural personality research. Specifically, we focus on sampling issues, test adaptations, and the combination of emic and etic approaches in this short review article. We encourage researchers to use the tools and experience that are available to considerably enlarge our insights in cross-cultural differences and similarities in personality research.

The Effect of Providing Breakfast in Class on Student Performance

Science.gov (United States)

Imberman, Scott A.; Kugler, Adriana D.

2014-01-01

Many schools have recently experimented with moving breakfast from the cafeteria to the classroom. We examine whether such a program increases achievement, grades, and attendance rates. We exploit quasi-random timing of program implementation that allows for a difference-in-differences identification strategy. We find that providing breakfast in…

Bilevel vs ICU ventilators providing noninvasive ventilation: effect of system leaks: a COPD lung model comparison.

Science.gov (United States)

Ferreira, Juliana C; Chipman, Daniel W; Hill, Nicholas S; Kacmarek, Robert M

2009-08-01

Noninvasive positive-pressure ventilation (NPPV) modes are currently available on bilevel and ICU ventilators. However, little data comparing the performance of the NPPV modes on these ventilators are available. In an experimental bench study, the ability of nine ICU ventilators to function in the presence of leaks was compared with a bilevel ventilator using the IngMar ASL5000 lung simulator (IngMar Medical; Pittsburgh, PA) set at a compliance of 60 mL/cm H(2)O, an inspiratory resistance of 10 cm H(2)O/L/s, an expiratory resistance of 20 cm H(2)O/ L/s, and a respiratory rate of 15 breaths/min. All of the ventilators were set at 12 cm H(2)O pressure support and 5 cm H(2)O positive end-expiratory pressure. The data were collected at baseline and at three customized leaks. At baseline, all of the ventilators were able to deliver adequate tidal volumes, to maintain airway pressure, and to synchronize with the simulator, without missed efforts or auto-triggering. As the leak was increased, all of the ventilators (except the Vision [Respironics; Murrysville, PA] and Servo I [Maquet; Solna, Sweden]) needed adjustment of sensitivity or cycling criteria to maintain adequate ventilation, and some transitioned to backup ventilation. Significant differences in triggering and cycling were observed between the Servo I and the Vision ventilators. The Vision and Servo I were the only ventilators that required no adjustments as they adapted to increasing leaks. There were differences in performance between these two ventilators, although the clinical significance of these differences is unclear. Clinicians should be aware that in the presence of leaks, most ICU ventilators require adjustments to maintain an adequate tidal volume.

Funding an Adequate Education for America's Youth: A Plan for Melding Political and Market Definitions of Educational Adequacy.

Science.gov (United States)

Guthrie, James W.

Noting that American society has conventionally relied on both the political process and the marketplace to arrive at a "definition" of adequate education, but that the political process fails to account for individual preferences while the marketplace can cater to many individual preferences, this paper attempts to combine the two…

Towards {sup 31}Mg-β-NMR resonance linewidths adequate for applications in magnesium chemistry

Energy Technology Data Exchange (ETDEWEB)

Stachura, M., E-mail: mstachura@triumf.ca [TRIUMF (Canada); McFadden, R. M. L. [University of British Columbia, Chemistry Department (Canada); Chatzichristos, A.; Dehn, M. H. [University of British Columbia, Department of Physics and Astronomy (Canada); Gottberg, A. [TRIUMF (Canada); Hemmingsen, L. [Københavns Universitet Universitetsparken 5, Kemisk Institut (Denmark); Jancso, A. [University of Szeged, Department of Inorganic and Analytical Chemistry (Hungary); Karner, V. L. [University of British Columbia, Chemistry Department (Canada); Kiefl, R. F. [University of British Columbia, Department of Physics and Astronomy (Canada); Larsen, F. H. [Københavns Universitet Rolighedsvej 26, Institut for Fødevarevidenskab (Denmark); Lassen, J.; Levy, C. D. P.; Li, R. [TRIUMF (Canada); MacFarlane, W. A. [University of British Columbia, Chemistry Department (Canada); Morris, G. D. [TRIUMF (Canada); Pallada, S. [CERN (Switzerland); Pearson, M. R. [TRIUMF (Canada); Szunyogh, D.; Thulstrup, P. W. [Københavns Universitet Universitetsparken 5, Kemisk Institut (Denmark); Voss, A. [University of Jyväskylä, Department of Physics (Finland)

2017-11-15

The span of most chemical shifts recorded in conventional {sup 25}Mg-NMR spectroscopy is ~ 100 ppm. Accordingly, linewidths of ~ 10 ppm or better are desirable to achieve adequate resolution for applications in chemistry. Here we present first high-field {sup 31}Mg- β-NMR measurements of {sup 31}Mg{sup +} ions implanted into a MgO single crystal carried out at the ISAC facility at TRIUMF. The resonances recorded at 2.5 T and 3.5 T show strong linewidth dependency on the applied RF power, ranging from ~ 419 ppm for the highest RF power down to ~ 48 ppm for the lowest one.

Are individual transferable quotas an adequate solution to overfishing and overcapacity? Evidence from Danish fisheries

DEFF Research Database (Denmark)

Merayo Garcia, Eugenia; Nielsen, Rasmus; Hoff, Ayoe

2018-01-01

Individual Transferable Quotas stand in large parts of the fisheries economic literature as the panacea that solves all problems of overfishing and overcapacity of world´s fisheries. However, they are also criticized by a number of authors based on their negative social effects. Individual...... in local fishing communities compared to the national average was found. The Danish experience proves that Individual Transferable Quotas can be an adequate solution with regards to overfishing and overcapacity with also positive effects on the environment due to reduced fuel consumption and fishing...

The burden of neck pain: its meaning for persons with neck pain and healthcare providers, explored by concept mapping

NARCIS (Netherlands)

Carlijn H. van Randeraad-van der Zee; Anna Beurskens; Raymond Swinkels; Jan Pool; Roy Batterham; Richard Osborne; Henrica de Vet

2015-01-01

Purpose To empirically define the concept of burden of neck pain. The lack of a clear understanding of this construct from the perspective of persons with neck pain and care providers hampers adequate measurement of this burden. An additional aim was to compare the conceptual model obtained with the

The burden of neck pain : its meaning for persons with neck pain and healthcare providers, explored by concept mapping

NARCIS (Netherlands)

Carlijn H. van Randeraad-van der Zee; Anna J.H.M. Beurskens; Reymond A.H.M. Swinkels; Jan J.M. Pool; Richard H. Osborne; Roy W. Batterham; Henrica C.W. de Vet

2015-01-01

Purpose To empirically define the concept of burden of neck pain. The lack of a clear understanding of this construct from the perspective of persons with neck pain and care providers hampers adequate measurement of this burden. An additional aim was to compare the conceptual model obtained with the

IEEE 802.15.4 Frame Aggregation Enhancement to Provide High Performance in Life-Critical Patient Monitoring Systems.

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Akbar, Muhammad Sajjad; Yu, Hongnian; Cang, Shuang

2017-01-28

In wireless body area sensor networks (WBASNs), Quality of Service (QoS) provision for patient monitoring systems in terms of time-critical deadlines, high throughput and energy efficiency is a challenging task. The periodic data from these systems generates a large number of small packets in a short time period which needs an efficient channel access mechanism. The IEEE 802.15.4 standard is recommended for low power devices and widely used for many wireless sensor networks applications. It provides a hybrid channel access mechanism at the Media Access Control (MAC) layer which plays a key role in overall successful transmission in WBASNs. There are many WBASN's MAC protocols that use this hybrid channel access mechanism in variety of sensor applications. However, these protocols are less efficient for patient monitoring systems where life critical data requires limited delay, high throughput and energy efficient communication simultaneously. To address these issues, this paper proposes a frame aggregation scheme by using the aggregated-MAC protocol data unit (A-MPDU) which works with the IEEE 802.15.4 MAC layer. To implement the scheme accurately, we develop a traffic patterns analysis mechanism to understand the requirements of the sensor nodes in patient monitoring systems, then model the channel access to find the performance gap on the basis of obtained requirements, finally propose the design based on the needs of patient monitoring systems. The mechanism is initially verified using numerical modelling and then simulation is conducted using NS2.29, Castalia 3.2 and OMNeT++. The proposed scheme provides the optimal performance considering the required QoS.

Canada's Compassionate Care Benefit: is it an adequate public health response to addressing the issue of caregiver burden in end-of-life care?

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Williams, Allison M; Eby, Jeanette A; Crooks, Valorie A; Stajduhar, Kelli; Giesbrecht, Melissa; Vuksan, Mirjana; Cohen, S Robin; Brazil, Kevin; Allan, Diane

2011-05-18

An increasingly significant public health issue in Canada, and elsewhere throughout the developed world, pertains to the provision of adequate palliative/end-of-life (P/EOL) care. Informal caregivers who take on the responsibility of providing P/EOL care often experience negative physical, mental, emotional, social and economic consequences. In this article, we specifically examine how Canada's Compassionate Care Benefit (CCB)--a contributory benefits social program aimed at informal P/EOL caregivers--operates as a public health response in sustaining informal caregivers providing P/EOL care, and whether or not it adequately addresses known aspects of caregiver burden that are addressed within the population health promotion (PHP) model. As part of a national evaluation of Canada's Compassionate Care Benefit, 57 telephone interviews were conducted with Canadian informal P/EOL caregivers in 5 different provinces, pertaining to the strengths and weaknesses of the CCB and the general caregiving experience. Interview data was coded with Nvivo software and emerging themes were identified by the research team, with such findings published elsewhere. The purpose of the present analysis was identified after comparing the findings to the literature specific to caregiver burden and public health, after which data was analyzed using the PHP model as a guiding framework. Informal caregivers spoke to several of the determinants of health outlined in the PHP model that are implicated in their burden experience: gender, income and social status, working conditions, health and social services, social support network, and personal health practises and coping strategies. They recognized the need for improving the CCB to better address these determinants. This study, from the perspective of family caregivers, demonstrates that the CCB is not living up to its full potential in sustaining informal P/EOL caregivers. Effort is required to transform the CCB so that it may fulfill the

A preliminary investigation on the effects of characteristics and contractual behaviour on civil engineering project performance

Science.gov (United States)

Ismail, W. N. W.; Adnan, H.; Yusuwan, N.; Maisham, M.; Hassan, A. A.

2018-02-01

The significant role of civil engineering project is not only to make the lives of people easier and secure but also to trigger the economic growth by providing infrastructure facilities as well as job opportunities. As it is dominantly initiated by government sectors, performance of the civil engineering projects is always observed. This study aims to investigate the characteristics of civil engineering project and the contractual behavior of the key participants and how do these two factors affect civil engineering projects performance. Literature reviews, content analysis and questionnaires survey were conducted to undertake the research. A total of 50 questionnaires were distributed and 10 questionnaires were returned, resulting in a 20% response rate. The research unveiled that performance of civil engineering projects are influenced greatly by the ability to handle the unpredictable character of the civil engineering projects and adequate behavioral management. Apart from that, balancing the factors with high quality of workmanship, avoidance or well managed conflicts and high satisfaction level will ensure performance in projects.

Report: EPA Has Adequate Controls to Manage Advice From Science and Research Federal Advisory Committees, but Transparency Could Be Improved

Science.gov (United States)

Report #17-P-0124, March 13, 2017. Science plays an integral role in the EPA's mission. The EPA has an adequate system of controls to manage recommendations from its science and research federal advisory committees.

Thioacetamide-induced cirrhosis in selenium-adequate mice displays rapid and persistent abnormity of hepatic selenoenzymes which are mute to selenium supplementation

International Nuclear Information System (INIS)

Zhang Jinsong; Wang Huali; Yu Hanqing

2007-01-01

Selenium reduction in cirrhosis is frequently reported. The known beneficial effect of selenium supplementation on cirrhosis is probably obtained from nutritionally selenium-deficient subjects. Whether selenium supplementation truly improves cirrhosis in general needs additional experimental investigation. Thioacetamide was used to induce cirrhosis in selenium-adequate and -deficient mice. Selenoenzyme activity and selenium content were measured and the influence of selenium supplementation was evaluated. In Se-adequate mice, thioacetamide-mediated rapid onset of hepatic oxidative stress resulted in an increase in thioredoxin reductase activity and a decrease in both glutathione peroxidase activity and selenium content. The inverse activity of selenoenzymes (i.e. TrxR activity goes up and GPx activity goes down) was persistent and mute to selenium supplementation during the progress of cirrhosis; accordingly, cirrhosis was not improved by selenium supplementation in any period. On the other hand, selenium supplementation to selenium-deficient mice always more efficiently increased hepatic glutathione peroxidase activity and selenium content compared with those treated with thioacetamide, indicating that thioacetamide impairs the liver bioavailability of selenium. Although thioacetamide profoundly affects hepatic selenium status in selenium-adequate mice, selenium supplementation does not modify the changes. Selenium supplementation to cirrhotic subjects with a background of nutritional selenium deficiency can improve selenium status but cannot restore hepatic glutathione peroxidase and selenium to normal levels

The role of medical staff in providing patients rights.

Science.gov (United States)

Masic, Izet; Izetbegovic, Sebija

2014-01-01

Among the priority basic human rights, without a doubt, are the right to life and health-social protection. The process of implementation of human rights in the everyday life of an ordinary citizen in the post-war recovery of Bosnia and Herzegovina faces huge objective and subjective difficulties. Citizens need to be affordable adequate healthcare facilities that will be open to all on equal terms. The term hospital activity implies a set of measures, activities and procedures that are undertaken for the purpose of treatment, diagnosis and medical rehabilitation of patients in the respective health institutions. Principles of hospital care should include: Comprehensiveness (Hospital care is available to all citizens equally); Continuity (Provided is continuous medical care to all users); Availability (Provided approximately equal protection of rights for all citizens). Education of health professionals: The usual threats to patient safety include medical errors, infections occurred in the hospital, unnecessary exposure to high doses of radiation and the use of the wrong drug. Everyday continuing education in the profession of a doctor is lifelong.

Guidelines for evaluating performance of oyster habitat restoration

Science.gov (United States)

Baggett, Lesley P.; Powers, Sean P.; Brumbaugh, Robert D.; Coen, Loren D.; DeAngelis, Bryan M.; Greene, Jennifer K.; Hancock, Boze T.; Morlock, Summer M.; Allen, Brian L.; Breitburg, Denise L.; Bushek, David; Grabowski, Jonathan H.; Grizzle, Raymond E.; Grosholz, Edwin D.; LaPeyre, Megan K.; Luckenbach, Mark W.; McGraw, Kay A.; Piehler, Michael F.; Westby, Stephanie R.; zu Ermgassen, Philine S. E.

2015-01-01

Restoration of degraded ecosystems is an important societal goal, yet inadequate monitoring and the absence of clear performance metrics are common criticisms of many habitat restoration projects. Funding limitations can prevent adequate monitoring, but we suggest that the lack of accepted metrics to address the diversity of restoration objectives also presents a serious challenge to the monitoring of restoration projects. A working group with experience in designing and monitoring oyster reef projects was used to develop standardized monitoring metrics, units, and performance criteria that would allow for comparison among restoration sites and projects of various construction types. A set of four universal metrics (reef areal dimensions, reef height, oyster density, and oyster size–frequency distribution) and a set of three universal environmental variables (water temperature, salinity, and dissolved oxygen) are recommended to be monitored for all oyster habitat restoration projects regardless of their goal(s). In addition, restoration goal-based metrics specific to four commonly cited ecosystem service-based restoration goals are recommended, along with an optional set of seven supplemental ancillary metrics that could provide information useful to the interpretation of prerestoration and postrestoration monitoring data. Widespread adoption of a common set of metrics with standardized techniques and units to assess well-defined goals not only allows practitioners to gauge the performance of their own projects but also allows for comparison among projects, which is both essential to the advancement of the field of oyster restoration and can provide new knowledge about the structure and ecological function of oyster reef ecosystems.

Technical Quality of Root Fillings Performed by Undergraduate Students: A Radiographic Study

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Tatjana Vukadinov

2014-01-01

Full Text Available Aim. The aim of this study was to evaluate the radiographic technical quality of endodontic treatment performed by undergraduate students at the School of Dentistry, Faculty of Medicine, University of Novi Sad, Serbia. Materials and Methods. Electronic records of 220 patients treated by final-year undergraduate students during the school year 2011/2012 were examined, and the final sample consisted of 212 patients, 322 teeth, and 565 root canals. The criteria for overall radiographic adequacy of root canal fillings were defined as the presence of adequate length and density and absence of iatrogenic errors (ledge, fractured instrument, untreated canal, and apical transportation. Chi-square test was used to determine statistical significance between different parameters. Results. Adequate root canal fillings were found in 74.22% of the teeth. The percentage of root fillings with adequate length and density was 89.73% and 92.6%, respectively. Fractured instruments and ledges were present in 16 root canals (2.8%, while the presence of missed canal and apical transportation was observed in 2 cases, each (0.3%. Conclusions. Overall, the technical quality of root canal fillings performed by undergraduate students was satisfactory.

The effectiveness of performance measuring in Slovenian public libraries

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Silva Novljan

1997-01-01

Full Text Available The article describes methods of performance measuring in Slovenian public libraries, and calls attention to the problems attached to it. The argued presumption is that the performance measuring carried out on the state level, is not always a sufficient and adequate foundation for plarming of the developmenl and functioning of an individual library which has to cater for the needs and wishes of the population in a certain area.

The Adoption of Roles by Primary Care Providers during Implementation of the New Chronic Disease Guidelines in Urban Mongolia: A Qualitative Study

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Oyun Chimeddamba

2016-04-01

Full Text Available (1 Background: In 2011, new chronic disease guidelines were introduced across Mongolia. No formal advice was provided regarding role delineation. This study aimed to analyse the roles that different primary care providers adopted, and the variations in these, in the implementation of the guidelines in urban Mongolia; (2 Methods: Ten group interviews with nurses and ten individual interviews each with practice doctors and practice directors were conducted. Data was analysed using a thematic approach based on the identified themes relevant to role delineation; (3 Results: There was some variability and flexibility in role delineation. Factors involving teamwork, task rotation and practice flexibility facilitated well the guideline implementation. However, factors including expectations and decision making, nursing shortage, and training gaps adversely influenced in the roles and responsibilities. Some role confusion and dissatisfaction was identified, often associated with a lack of training or staff turnover; (4 Conclusions: Findings suggest that adequate ongoing training is required to maximize the range of roles particular provider types, especially primary care nurses, are competent to perform. Ensuring that role delineation is specified in guidelines could remove confusion and enhance implementation of such guidelines.

Healthcare providers balancing norms and practice: challenges and opportunities in providing contraceptive counselling to young people in Uganda - a qualitative study.

Science.gov (United States)

Paul, Mandira; Näsström, Sara B; Klingberg-Allvin, Marie; Kiggundu, Charles; Larsson, Elin C

2016-01-01

Pregnancies among young women force girls to compromise education, resulting in low educational attainment with subsequent poverty and vulnerability. A pronounced focus is needed on contraceptive use, pregnancy, and unsafe abortion among young women. This study aims to explore healthcare providers' (HCPs) perceptions and practices regarding contraceptive counselling to young people. We conducted 27 in-depth interviews with doctors and midwives working in seven health facilities in central Uganda. Interviews were open-ended and allowed the participant to speak freely on certain topics. We used a topic guide to cover areas topics of interest focusing on post-abortion care (PAC) but also covering contraceptive counselling. Transcripts were transcribed verbatim and data were analysed using thematic analysis. The main theme, HCPs' ambivalence to providing contraceptive counselling to sexually active young people is based on two sub-themes describing the challenges of contraceptive counselling: A) HCPs echo the societal norms regarding sexual practice among young people, while at the same time our findings B) highlights the opportunities resulting from providers pragmatic approach to contraceptive counselling to young women. Providers expressed a self-identified lack of skill, limited resources, and inadequate support from the health system to successfully provide appropriate services to young people. They felt frustrated with the consultations, especially when meeting young women seeking PAC. Despite existing policies for young people's sexual and reproductive health in Uganda, HCPs are not sufficiently equipped to provide adequate contraceptive counselling to young people. Instead, HCPs are left in between the negative influence of social norms and their pragmatic approach to address the needs of young people, especially those seeking PAC. We argue that a clear policy supported by a clear strategy with practical guidelines should be implemented alongside in

Benchmarking Global Food Safety Performances: The Era of Risk Intelligence.

Science.gov (United States)

Valleé, Jean-Charles Le; Charlebois, Sylvain

2015-10-01

Food safety data segmentation and limitations hamper the world's ability to select, build up, monitor, and evaluate food safety performance. Currently, there is no metric that captures the entire food safety system, and performance data are not collected strategically on a global scale. Therefore, food safety benchmarking is essential not only to help monitor ongoing performance but also to inform continued food safety system design, adoption, and implementation toward more efficient and effective food safety preparedness, responsiveness, and accountability. This comparative study identifies and evaluates common elements among global food safety systems. It provides an overall world ranking of food safety performance for 17 Organisation for Economic Co-Operation and Development (OECD) countries, illustrated by 10 indicators organized across three food safety risk governance domains: risk assessment (chemical risks, microbial risks, and national reporting on food consumption), risk management (national food safety capacities, food recalls, food traceability, and radionuclides standards), and risk communication (allergenic risks, labeling, and public trust). Results show all countries have very high food safety standards, but Canada and Ireland, followed by France, earned excellent grades relative to their peers. However, any subsequent global ranking study should consider the development of survey instruments to gather adequate and comparable national evidence on food safety.

Sleep and Final Exam Performance in Introductory Physics

Science.gov (United States)

Coletta, Vincent; Wikholm, Colin; Pascoe, Daniel

2018-01-01

Most physics instructors believe that adequate sleep is important in order for students to perform well on problem solving, and many instructors advise students to get plenty of sleep the night before an exam. After years of giving such advice to students at Loyola Marymount University (LMU), one of us decided to find out how many hours students…

Performance limitations of polymer electrolytes based on ethylene oxide polymers

International Nuclear Information System (INIS)

Buriez, Olivier; Han, Yong Bong; Hou, Jun; Kerr, John B.; Qiao, Jun; Sloop, Steven E.; Tian, Minmin; Wang, Shanger

1999-01-01

Studies of polymer electrolyte solutions for lithium-polymer batteries are described. Two different salts, lithium bis(trifluoromethanesulfonyl)imide (LiTFSI) and lithium trifluoromethanesulfonate (LiTf), were dissolved in a variety of polymers. The structures were all based upon the ethylene oxide unit for lithium ion solvation and both linear and comb-branch polymer architectures have been examined. Conductivity, salt diffusion coefficient and transference number measurements demonstrate the superior transport properties of the LiTFSI salt over LiTf. Data obtained on all of these polymers combined with LiTFSI salts suggest that there is a limit to the conductivity achievable at room temperature, at least for hosts containing ethylene oxide units. The apparent conductivity limit is 5 x 10-5 S/cm at 25 C. Providing that the polymer chain segment containing the ethylene oxide units is at least 5-6 units long there appears to be little influence of the polymer framework to which the solvating groups are attached. To provide adequate separator function, the mechanical properties may be disconnected from the transport properties by selection of an appropriate architecture combined with an adequately long ethylene oxide chain. For both bulk and interfacial transport of the lithium ions, conductivity data alone is insufficient to understand the processes that occur. Lithium ion transference numbers and salt diffusion coefficients also play a major role in the observed behavior and the transport properties of these polymer electrolyte solutions appear to be quite inadequate for ambient temperature performance. At present, this restricts the use of such systems to high temperature applications. Several suggestions are given to overcome these obstacles

Does social marketing provide a framework for changing healthcare practice?

Science.gov (United States)

Morris, Zoë Slote; Clarkson, Peter John

2009-07-01

We argue that social marketing can be used as a generic framework for analysing barriers to the take-up of clinical guidelines, and planning interventions which seek to enable this change. We reviewed the literature on take-up of clinical guidelines, in particular barriers and enablers to change; social marketing principles and social marketing applied to healthcare. We then applied the social marketing framework to analyse the literature and to consider implications for future guideline policy to assess its feasibility and accessibility. There is sizeable extant literature on healthcare practitioners' non-compliance with clinical guidelines. This is an international problem common to a number of settings. The reasons for poor levels of take up appear to be well understood, but not addressed adequately in practice. Applying a social marketing framework brings new insights to the problem." We show that a social marketing framework provides a useful solution-focused framework for systematically understanding barriers to individual behaviour change and designing interventions accordingly. Whether the social marketing framework provides an effective means of bringing about behaviour change remains an empirical question which has still to be tested in practice. The analysis presented here provides strong motivation to begin such testing.

Kinesthetic Imagery Provides Additive Benefits to Internal Visual Imagery on Slalom Task Performance.

Science.gov (United States)

Callow, Nichola; Jiang, Dan; Roberts, Ross; Edwards, Martin G

2017-02-01

Recent brain imaging research demonstrates that the use of internal visual imagery (IVI) or kinesthetic imagery (KIN) activates common and distinct brain areas. In this paper, we argue that combining the imagery modalities (IVI and KIN) will lead to a greater cognitive representation (with more brain areas activated), and this will cause a greater slalom-based motor performance compared with using IVI alone. To examine this assertion, we randomly allocated 56 participants to one of the three groups: IVI, IVI and KIN, or a math control group. Participants performed a slalom-based driving task in a driving simulator, with average lap time used as a measure of performance. Results revealed that the IVI and KIN group achieved significantly quicker lap times than the IVI and the control groups. The discussion includes a theoretical advancement on why the combination of imagery modalities might facilitate performance, with links made to the cognitive neuroscience literature and applied practice.

Personality traits affect teaching performance of attending physicians: results of a multi-center observational study.

Directory of Open Access Journals (Sweden)

Renée A Scheepers

Full Text Available BACKGROUND: Worldwide, attending physicians train residents to become competent providers of patient care. To assess adequate training, attending physicians are increasingly evaluated on their teaching performance. Research suggests that personality traits affect teaching performance, consistent with studied effects of personality traits on job performance and academic performance in medicine. However, up till date, research in clinical teaching practice did not use quantitative methods and did not account for specialty differences. We empirically studied the relationship of attending physicians' personality traits with their teaching performance across surgical and non-surgical specialties. METHOD: We conducted a survey across surgical and non-surgical specialties in eighteen medical centers in the Netherlands. Residents evaluated attending physicians' overall teaching performance, as well as the specific domains learning climate, professional attitude, communication, evaluation, and feedback, using the validated 21-item System for Evaluation of Teaching Qualities (SETQ. Attending physicians self-evaluated their personality traits on a 5-point scale using the validated 10-item Big Five Inventory (BFI, yielding the Five Factor model: extraversion, conscientiousness, neuroticism, agreeableness and openness. RESULTS: Overall, 622 (77% attending physicians and 549 (68% residents participated. Extraversion positively related to overall teaching performance (regression coefficient, B: 0.05, 95% CI: 0.01 to 0.10, P = 0.02. Openness was negatively associated with scores on feedback for surgical specialties only (B: -0.10, 95% CI: -0.15 to -0.05, P<0.001 and conscientiousness was positively related to evaluation of residents for non-surgical specialties only (B: 0.13, 95% CI: 0.03 to 0.22, p = 0.01. CONCLUSIONS: Extraverted attending physicians were consistently evaluated as better supervisors. Surgical attending physicians who display high levels of

Enhancing Data Transfer Performance Utilizing a DTN between Cloud Service Providers

Directory of Open Access Journals (Sweden)

Wontaek Hong

2018-04-01

Full Text Available The rapid transfer of massive data in the cloud environment is required to prepare for unexpected situations like disaster recovery. With regard to this requirement, we propose a new approach to transferring cloud virtual machine images rapidly in the cloud environment utilizing dedicated Data Transfer Nodes (DTNs. The overall procedure is composed of local/remote copy processes and a DTN-to-DTN transfer process. These processes are coordinated and executed based on a fork system call in the proposed algorithm. In addition, we especially focus on the local copy process between a cloud controller and DTNs and improve data transfer performance through the well-tuned mount techniques in Network File System (NFS-based connections. Several experiments have been performed considering the combination of synchronous/asynchronous modes and the network buffer size. We show the results of throughput in all the experiment cases and compare them. Consequently, the best throughput in write operations has been obtained in the case of an NFS server in a DTN and an NFS client in a cloud controller running entirely in the asynchronous mode.

Provider Adherence to National Guidelines for Managing Hypertension in African Americans

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Jeanette Sessoms

2015-01-01

Full Text Available Purpose. To evaluate provider adherence to national guidelines for the treatment of hypertension in African Americans. Design. A descriptive, preexperimental, quantitative method. Methods. Electronic medical records were reviewed and data were obtained from 62 charts. Clinical data collected included blood pressure readings, medications prescribed, laboratory studies, lifestyle modification, referral to hypertension specialist, and follow-up care. Findings. Overall provider adherence was 75%. Weight loss, sodium restriction, and physical activity recommendations were documented on 82.3% of patients. DASH diet and alcohol consumption were documented in 6.5% of participants. Follow-up was documented in 96.6% of the patients with controlled blood pressure and 9.1% in patients with uncontrolled blood pressure. Adherence in prescribing ACEIs in patients with a comorbidity of DM was documented in 70% of participants. Microalbumin levels were ordered in 15.2% of participants. Laboratory adherence prior to prescribing medications was documented in 0% of the patients and biannual routine labs were documented in 65% of participants. Conclusion. Provider adherence overall was moderate. Despite moderate provider adherence, BP outcomes and provider adherence were not related. Contributing factors that may explain this lack of correlation include patient barriers such as nonadherence to medication and lifestyle modification recommendations and lack of adequate follow-up. Further research is warranted.

Team performance in the Italian NHS: the role of reflexivity.

Science.gov (United States)

Urbini, Flavio; Callea, Antonino; Chirumbolo, Antonio; Talamo, Alessandra; Ingusci, Emanuela; Ciavolino, Enrico

2018-04-09

Purpose The purpose of this paper is twofold: first, to investigate the goodness of the input-process-output (IPO) model in order to evaluate work team performance within the Italian National Health Care System (NHS); and second, to test the mediating role of reflexivity as an overarching process factor between input and output. Design/methodology/approach The Italian version of the Aston Team Performance Inventory was administered to 351 employees working in teams in the Italian NHS. Mediation analyses with latent variables were performed via structural equation modeling (SEM); the significance of total, direct, and indirect effect was tested via bootstrapping. Findings Underpinned by the IPO framework, the results of SEM supported mediational hypotheses. First, the application of the IPO model in the Italian NHS showed adequate fit indices, showing that the process mediates the relationship between input and output factors. Second, reflexivity mediated the relationship between input and output, influencing some aspects of team performance. Practical implications The results provide useful information for HRM policies improving process dimensions of the IPO model via the mediating role of reflexivity as a key role in team performance. Originality/value This study is one of a limited number of studies that applied the IPO model in the Italian NHS. Moreover, no study has yet examined the role of reflexivity as a mediator between input and output factors in the IPO model.

The cost for meeting SLA dependability requirements; implications for customers and providers

International Nuclear Information System (INIS)

Følstad, Eirik L.; Helvik, Bjarne E.

2016-01-01

A Service Level Agreement (SLA) describes the service, the service-level objectives (SLOs), the price the customer should pay and the compensation if the SLOs are not met. There is a trade-off for the provider between the costs for improving the deployed service quality vs. probability of paying compensation. We propose how to estimate the provider's optimal service deployment. We show that the optimal deployed service quality is dependent on the SLOs, deployment cost, compensation and observation interval. A service deployment based on cost optimization results in targeted dependability objective values that are significantly better than stated in the SLOs. The proposed approach provides valuable insight for an aggregator, who buys services from other providers, to negotiate adequate SLOs, price and compensation from the providers to make a valuable offer for its own customers. - Highlights: • SLA with availability, number of failures, down time criteria and observation period. • Analysis of compound service delivery in the SLA context by a semi-Markov model. • SLA non-conformance risk dependent on the inherent/steady state system parameters. • Cost optimal service operation under non-conformance penalties (the safety margin).

Prehospital Providers' Perceptions on Providing Patient and Family Centered Care.

Science.gov (United States)

Ayub, Emily M; Sampayo, Esther M; Shah, Manish I; Doughty, Cara B

2017-01-01

A gap exists in understanding a provider's approach to delivering care that is mutually beneficial to patients, families, and other providers in the prehospital setting. The purpose of this study was to identify attitudes, beliefs, and perceived barriers to providing patient and family centered care (PFCC) in the prehospital setting and to describe potential solutions for improving PFCC during critical pediatric events. We conducted a qualitative, cross-sectional study of a purposive sample of Emergency Medical Technicians (EMTs) and paramedics from an urban, municipal, fire-based EMS system, who participated in the Pediatric Simulation Training for Emergency Prehospital Providers (PediSTEPPS) course. Two coders reviewed transcriptions of audio recordings from participants' first simulation scenario debriefings and performed constant comparison analysis to identify unifying themes. Themes were verified through member checking with two focus groups of prehospital providers. A total of 122 EMTs and paramedics participated in 16 audiotaped debriefing sessions and two focus groups. Four overarching themes emerged regarding the experience of PFCC by prehospital providers: (1) Perceived barriers included the prehospital environment, limited manpower, multi-tasking medical care, and concern for interference with patient care; (2) Providing emotional support comprised of empathetically comforting caregivers, maintaining a calm demeanor, and empowering families to feel involved; (3) Effective communication strategies consisted of designating a family point person, narration of actions, preempting the next steps, speaking in lay terms, summarizing during downtime, and conveying a positive first impression; (4) Tactics to overcome PFCC barriers were maintaining a line of sight, removing and returning a caregiver to and from the scene, and providing situational awareness. Based on debriefings from simulated scenarios, some prehospital providers identified the provision of

Performance of a CW double electric discharge for supersonic CO lasers

Science.gov (United States)

Stanton, A. C.; Hanson, R. K.; Mitchner, M.

1980-01-01

The results of an experimental investigation of a CW double discharge in supersonic CO mixtures are reported. Stable discharges in CO/N2 and CO/Ar mixtures, with a maximum energy loading of 0.5 eV/CO molecule, were achieved in a small-scale continuous-flow supersonic channel. Detailed measurements of the discharge characteristics were performed, including electrostatic probe measurements of floating potential and electron number density and spectroscopic measurements of the CO vibrational population distributions. The results of these measurements indicate that the vibrational excitation efficiency of the discharge is approximately 60%, for moderate levels of main discharge current. These experiments, on a small scale, demonstrate that the double-discharge scheme provides adequate vibrational energy loading for efficient CO laser operation under CW supersonic flow conditions.

An Assessment of Technologies to Provide Extended Sludge Retrieval from Underground Storage Tanks at the Hanford Site

Energy Technology Data Exchange (ETDEWEB)

JA Bamberger

2000-08-02

The purpose of this study was to identify sludge mobilization technologies that can be readily installed in double-shell tanks along with mixer pumps to augment mixer pump operation when mixer pumps do not adequately mobilize waste. The supplementary technologies will mobilize sludge that may accumulate in tank locations out-of-reach of the mixer-pump jet and move the sludge into the mixer-pump range of operation. The identified technologies will be evaluated to determine if their performances and configurations are adequate to meet requirements developed for enhanced sludge removal systems. The study proceeded in three parallel paths to identify technologies that: (1) have been previously deployed or demonstrated in radioactive waste tanks, (2) have been specifically evaluated for their ability to mobilize or dislodge waste simulants with physical and theological properties similar to those anticipated during waste retrieval, and (3) have been used in similar industrial conditions, bu t not specifically evaluated for radioactive waste retrieval.

An Assessment of Technologies to Provide Extended Sludge Retrieval from Underground Storage Tanks at the Hanford Site

International Nuclear Information System (INIS)

JA Bamberger

2000-01-01

The purpose of this study was to identify sludge mobilization technologies that can be readily installed in double-shell tanks along with mixer pumps to augment mixer pump operation when mixer pumps do not adequately mobilize waste. The supplementary technologies will mobilize sludge that may accumulate in tank locations out-of-reach of the mixer-pump jet and move the sludge into the mixer-pump range of operation. The identified technologies will be evaluated to determine if their performances and configurations are adequate to meet requirements developed for enhanced sludge removal systems. The study proceeded in three parallel paths to identify technologies that: (1) have been previously deployed or demonstrated in radioactive waste tanks, (2) have been specifically evaluated for their ability to mobilize or dislodge waste simulants with physical and theological properties similar to those anticipated during waste retrieval, and (3) have been used in similar industrial conditions, but not specifically evaluated for radioactive waste retrieval

Performance and main characteristic parameters of the Cairo fourier diffractometer facility at the ET-RR-1 reactor

International Nuclear Information System (INIS)

Maayouf, R.M.A.; Abdel-Latif, I.; El-Kady, A.; El-Shafey, A.; Khalil, M.; El-Shaer, Y.

1997-05-01

This report represents the results of measurements performed recently with the Cairo Fourier diffractometer facility (CFDF). The main components of the CFDF were supplied by the IAEA according to the technical assistance project EGY/1/022. The CFDF performance is assessed and the main parameters are given. The neutron guide system attached to the CFDF provides a thermal neutron flux ∼ 10 6 n/cm 2 .sec at the sample position; free from fast neutrons and gamma rays background. It has been found, from measurements with different powder samples, that such value of the thermal neutron flux is adequate for neutron diffraction measurements, at scattering angle 2θ 90 deg. and D values between 0.7A and 2.5A; with 52% resolution. (author). 26 refs, 10 figs, 2 tabs

Defining an adequate sample of earlywood vessels for retrospective injury detection in diffuse-porous species.

Directory of Open Access Journals (Sweden)

Estelle Arbellay

Full Text Available Vessels of broad-leaved trees have been analyzed to study how trees deal with various environmental factors. Cambial injury, in particular, has been reported to induce the formation of narrower conduits. Yet, little or no effort has been devoted to the elaboration of vessel sampling strategies for retrospective injury detection based on vessel lumen size reduction. To fill this methodological gap, four wounded individuals each of grey alder (Alnus incana (L. Moench and downy birch (Betula pubescens Ehrh. were harvested in an avalanche path. Earlywood vessel lumina were measured and compared for each tree between the injury ring built during the growing season following wounding and the control ring laid down the previous year. Measurements were performed along a 10 mm wide radial strip, located directly next to the injury. Specifically, this study aimed at (i investigating the intra-annual duration and local extension of vessel narrowing close to the wound margin and (ii identifying an adequate sample of earlywood vessels (number and intra-ring location of cells attesting to cambial injury. Based on the results of this study, we recommend analyzing at least 30 vessels in each ring. Within the 10 mm wide segment of the injury ring, wound-induced reduction in vessel lumen size did not fade with increasing radial and tangential distances, but we nevertheless advise favoring early earlywood vessels located closest to the injury. These findings, derived from two species widespread across subarctic, mountainous, and temperate regions, will assist retrospective injury detection in Alnus, Betula, and other diffuse-porous species as well as future related research on hydraulic implications after wounding.

When to Stop CPR and When to Perform Rhythm Analysis: Potential Confusion Among ACLS Providers.

Science.gov (United States)

Giberson, Brandon; Uber, Amy; F Gaieski, David; Miller, Joseph B; Wira, Charles; Berg, Katherine; Giberson, Tyler; Cocchi, Michael N; S Abella, Benjamin; Donnino, Michael W

2016-09-01

Health care providers nationwide are routinely trained in Advanced Cardiac Life Support (ACLS), an American Heart Association program that teaches cardiac arrest management. Recent changes in the ACLS approach have de-emphasized routine pulse checks in an effort to promote uninterrupted chest compressions. We hypothesized that this new ACLS algorithm may lead to uncertainty regarding the appropriate action following detection of a pulse during a cardiac arrest. We conducted an observational study in which a Web-based survey was sent to ACLS-trained medical providers at 4 major urban tertiary care centers in the United States. The survey consisted of 5 multiple-choice, scenario-based ACLS questions, including our question of interest. Adult staff members with a valid ACLS certification were included. A total of 347 surveys were analyzed. The response rate was 28.1%. The majority (53.6%) of responders were between 18 and 32 years old, and 59.9% were female. The majority (54.2%) of responders incorrectly stated that they would continue CPR and possibly administer additional therapies when a team member detects a pulse immediately following defibrillation. Secondarily, only 51.9% of respondents correctly chose to perform a rhythm check following 2 minutes of CPR. The other 3 survey questions were correctly answered an average of 89.1% of the time. Confusion exists regarding whether or not CPR and cardiac medications should be continued in the presence of a pulse. Education may be warranted to emphasize avoiding compressions and medications when a palpable pulse is detected. © The Author(s) 2014.

Precise femtosecond laser ablation of dental hard tissue: preliminary investigation on adequate laser parameters

International Nuclear Information System (INIS)

Hikov, Todor; Pecheva, Emilia; Petrov, Todor; Montgomery, Paul; Antoni, Frederic; Leong-Hoi, Audrey

2017-01-01

This work aims at evaluating the possibility of introducing state-of-the-art commercial femtosecond laser system in restorative dentistry by maintaining well-known benefits of lasers for caries removal, but also in overcoming disadvantages such as thermal damage of irradiated substrate. Femtosecond ablation of dental hard tissue is investigated by changing the irradiation parameters (pulsed laser energy, scanning speed and pulse repetition rate), assessed for enamel and dentin. The femtosecond laser system used in this work may be suitable for cavity preparation in dentin and enamel, due to the expected effective ablation and low temperature increase when using ultra short laser pulses. If adequate laser parameters are selected, this system seems to be promising for promoting a laser-assisted, minimally invasive approach in restorative dentistry. (paper)

STARTING BLOCK PERFORMANCE IN SPRINTERS: A STATISTICAL METHOD FOR IDENTIFYING DISCRIMINATIVE PARAMETERS OF THE PERFORMANCE AND AN ANALYSIS OF THE EFFECT OF PROVIDING FEEDBACK OVER A 6-WEEK PERIOD

Directory of Open Access Journals (Sweden)

Sylvie Fortier

2005-06-01

Full Text Available The purpose of this study was twofold: (a to examine if kinetic and kinematic parameters of the sprint start could differentiate elite from sub-elite sprinters and, (b to investigate whether providing feedback (FB about selected parameters could improve starting block performance of intermediate sprinters over a 6-week training period. Twelve male sprinters, assigned to an elite or a sub-elite group, participated in Experiment 1. Eight intermediate sprinters participated in Experiment 2. All athletes were required to perform three sprint starts at maximum intensity followed by a 10-m run. To detect differences between elite and sub-elite groups, comparisons were made using t-tests for independent samples. Parameters reaching a significant group difference were retained for the linear discriminant analysis (LDA. The LDA yielded four discriminative kinetic parameters. Feedback about these selected parameters was given to sprinters in Experiment 2. For this experiment, data acquisition was divided into three periods. The first six sessions were without specific FB, whereas the following six sessions were enriched by kinetic FB. Finally, athletes underwent a retention session (without FB 4 weeks after the twelfth session. Even though differences were found in the time to front peak force, the time to rear peak force, and the front peak force in the retention session, the results of the present study showed that providing FB about selected kinetic parameters differentiating elite from sub-elite sprinters did not improve the starting block performance of intermediate sprinters

Influence of reward system on job performance of librarians in ...

African Journals Online (AJOL)

The surest way to ensure and maintain high job performance in academic libraries is adequate use of reward system. Salaries, awards, allowances and recognitions are agents of satisfaction and motivation which helps in sustaining and transforming the entire workforce in the library. This study therefore analyzed the ...

Towards a Generic Framework for the Performance Evaluation of Manufacturing Strategy: An Innovative Approach

Directory of Open Access Journals (Sweden)

Tigist Fetene Adane

2018-03-01

Full Text Available To be competitive in a manufacturing environment by providing optimal performance in terms of cost-effectiveness and swiftness of system changes, there is a need for flexible production systems based on a well-defined strategy. Companies are steadily looking for methodology to evaluate, improve and update the performance of manufacturing systems for processing operations. Implementation of an adequate strategy for these systems’ flexibility requires a deep understanding of the intricate interactions between the machining process parameters and the manufacturing system’s operational parameters. This paper proposes a framework/generic model for one of the most common metal cutting operations—the boring process of an engine block machining system. A system dynamics modelling approach is presented for modelling the structure of machining system parameters of the boring process, key performance parameters and their intrinsic relationships. The model is based on a case study performed in a company manufacturing engine blocks for heavy vehicles. The approach could allow for performance evaluation of an engine block manufacturing system condition. The presented model enables a basis for other similar processes and industries producing discrete parts.

Monitoring the eye lens: which dose quantity is adequate?

International Nuclear Information System (INIS)

Behrens, R; Dietze, G

2010-01-01

Recent epidemiological studies suggest a rather low dose threshold (below 0.5 Gy) for the induction of a cataract of the eye lens. Some other studies even assume that there is no threshold at all. Therefore, protection measures have to be optimized and current dose limits for the eye lens may be reduced in the future. The question of which personal dose equivalent quantity is appropriate for monitoring the dose to the eye lens arises from this situation. While in many countries dosemeters calibrated in terms of the dose equivalent quantity H p (0.07) have been seen as being adequate for monitoring the dose to the eye lens, this might be questionable in the case of reduced dose limits and, thus, it may become necessary to use the dose equivalent quantity H p (3) for this purpose. To discuss this question, the dose conversion coefficients for the equivalent dose of the eye lens (in the following eye lens dose) were determined for realistic photon and beta radiation fields and compared with the values of the corresponding conversion coefficients for the different operational quantities. The values obtained lead to the following conclusions: in radiation fields where most of the dose comes from photons, especially x-rays, it is appropriate to use dosemeters calibrated in terms of H p (0.07) on a slab phantom, while in other radiation fields (dominated by beta radiation or unknown contributions of photon and beta radiation) dosemeters calibrated in terms of H p (3) on a slab phantom should be used. As an alternative, dosemeters calibrated in terms of H p (0.07) on a slab phantom could also be used; however, in radiation fields containing beta radiation with the end point energy near 1 MeV, an overestimation of the eye lens dose by up to a factor of 550 is possible.

Bioremediation performance as related to chemical availability

International Nuclear Information System (INIS)

Loehr, R.; Olivera, F.; Webster, M.

1995-01-01

Two side-by-side field prepared bed land treatment units (PBLTU) were evaluated. One PBLTU (H unit) treated soils containing chemicals from a diesel spill that had occurred about 12 months earlier. The other PBLTU (G unit) treated soils containing crude oil that had been in the soil for many decades. Laboratory slurry treatability studies and indicated that the hydrocarbons in both soils could be bioremediated if adequate nutrients were provided. The PBLTU had nutrients applied periodically, and were operated in a manner consistent with good operational guidelines. PBLTU performance was based on reductions in mobility, toxicity, and chemical concentration. Spatially random soil samples were taken from the two field PBLTU monthly and analyzed for the above parameters as well as nutrients and pH. Periodically, microbial numbers and type in the soil samples also were evaluated. Performance was monitored over an 18 month period. In the H unit, no detectable TPH reductions occurred although petroleum hydrocarbon degrading microorganisms existed in the soil and other conditions were appropriate for bioremediation. GC/MS analyses indicated reduction in some specific hydrocarbons. The H unit soils had low chemical mobility as determined by leachability tests (TCLP, SPLP) and had low relative toxicity as determined by Microtox trademark

Performance based durability design of a bored tunnel with concrete lining

NARCIS (Netherlands)

Vries, H. de; Siemes, A.J.M.

2002-01-01

Design for durability is gradually changing from a deem-to-satisfy approach to a performance based approach. The conventional building codes give in principle only construction rules. If these rules are fulfilled, it is assumed that the structure will have an adequate durability. But specifications

Product and process effectiveness using performance-based auditing techniques

International Nuclear Information System (INIS)

Horseman, M.L.

1995-01-01

Focus is the backbone of genius. Focus is the lifeblood of adequate products and effective processes. Focus is the theme of Performance-Based Audits (PBA). The Civilian Radioactive Waste Management (CRWM) Program is using the PBA tool extensively to focus on the evaluation of product adequacy and process effectiveness. The term Performance-Based Audit has been around for several years. however, the approach presented here for the systematic end-product selection, planning, and measurement of adequacy and effectiveness is new and innovative

Cone Beam Micro-CT System for Small Animal Imaging and Performance Evaluation

Directory of Open Access Journals (Sweden)

Shouping Zhu

2009-01-01

in this paper. Experimental results show that the system is suitable for small animal imaging and is adequate to provide high-resolution anatomic information for bioluminescence tomography to build a dual modality system.

Dried duckweed and commercial feed promote adequate growth performance of tilapia fingerlings

Directory of Open Access Journals (Sweden)

Flávia de A. Tavares

2008-01-01

Full Text Available http://dx.doi.org/10.5007/2175-7925.2008v21n3p91 Desempenho de alevinos de tilapia nilótica alimentados com uma  combinação de lemnas secas e ração comercial. O presente estudo  avaliou a utilização de ração comercial e lemna seca no cultivo de  alevinos de tilápias nilóticas com o objetivo de reduzir os custos de produção. Três dietas representadas por lemna seca, ração comercial  (40% proteína bruta e uma combinação de lemna seca e ração  comercial foram fornecidas a um grupo de 20 alevinos de tilápia  (Oreochromis niloticus em triplicata. Peixes com peso médio 3,2 ±  0,94g foram estocados em nove tanques-rede com volume de 1-m3 e  alimentados duas vezes ao dia durante um período de 50 dias. O peso  médio final dos alevinos alimentados com ração comercial (21,67 g e  50% ração +50% lemna seca (19,53 g não diferiram estatisticamente  (p<0,05. Paralelamente, os peixes pertencentes aos mesmos tratamentos não apresentaram diferença significativa no crescimento específico. O ganho em peso foi menor em temperaturas mais baixas ao longo do período experimental, causando um aumento significativo na conversão alimentar principalmente dos alevinos alimentados apenas com lemna seca. Além disso, a dieta composta apenas de lemna seca proporcionou o menor ganho em peso e taxa de crescimento específico. Através dos resultados obtidos, conclui-se que a lemna seca pode substituir até 50% (matéria seca 1:1 da ração  comercial (40% proteína bruta utilizada na produção de alevinos de tilápia por um período de 50 dias, sem apresentar redução no crescimento.

Adequate irradiation of the internal jugular lymph node chain: technical considerations

International Nuclear Information System (INIS)

Aref, Amr; Gross, Martin; Fontanesi, James; Devi, Syamala; Kopel, Christine; Thornton, Dale

1997-01-01

Purpose: This research aimed to study the anatomic relationship between the internal jugular vein with the surrounding internal jugular lymph node chain and the underlying bony anatomical structures which are commonly used as landmarks for radiation therapy planning. Methods and Materials: Twelve patients with carcinoma of the head and neck region were studied prospectively. Using our three-dimensional planning system, a beam's-eye view of the internal jugular vein was projected onto a lateral and anterior simulation film. Quantitative measurements were made in every case of the anatomic relationship between the internal jugular vein and the posterior border of the cervical vertebrae and sagittal midline. Results: The distance between the posterior border of the internal jugular vein and the posterior border of the cervical vertebrae ranged between 0 and 2.5 cm. The distances between the sagittal midline and the medial border of the internal jugular veins ranged between 2 and 4 cm. Conclusion: To ensure adequate irradiation of the internal jugular lymph nodes, the posterior border of the lateral radiation therapy upper-neck fields should be placed at least 1 cm posterior to the posterior aspect of the cervical vertebrae. The midline block used in the lower neck anterior field should not exceed 2 cm in width

Are breast biopsies adequately funded? A process cost and revenue analysis

International Nuclear Information System (INIS)

Hahn, M.; Fischbach, E.; Fehm, T.

2011-01-01

Purpose: The objective of the study was to determine whether the various breast biopsy procedures specified in the S 3 guidelines are sensibly represented within the current German health system as considered from a cost evaluation perspective. Materials and Methods: This prospectively designed multicenter study analyzed 221 breast biopsies at 7 institutions from 04/2006 to 01/2007. Core needle biopsies, vacuum-assisted biopsies and surgical open biopsies under sonographic or mammographic guidance were evaluated. During an analysis of process costs, the individual process steps were recorded in diagrammatic form and assigned to the true consumption of resources. The actual resource consumption costs were entered. A process-related breakeven analysis was conducted to check whether the reimbursement of individual biopsy types covers the costs. Results: Only sonographically guided core needle biopsy and surgical open biopsy are adequately reimbursed in the current German health system. All other breast biopsies indicate a negative profit margin. The principal reasons for underfunding are found in the area of reimbursement of investment and non-personnel costs. Conclusion: The reimbursement of breast biopsies must be improved in order to guarantee nationwide care of the population using the breast biopsy methods recommended in the S 3 guidelines and to avoid disincentives with respect to breast biopsy indications. (orig.)

Using a quality improvement model to enhance providers' performance in maternal and newborn health care : a post-only intervention and comparison design

NARCIS (Netherlands)

Ayalew, Firew; Eyassu, Gizachew; Seyoum, Negash; van Roosmalen, Jos; Bazant, Eva; Kim, Young Mi; Tekleberhan, Alemnesh; Gibson, Hannah; Daniel, Ephrem; Stekelenburg, Jelle

2017-01-01

Background: The Standards Based Management and Recognition (SBM-R (R)) approach to quality improvement has been implemented in Ethiopia to strengthen routine maternal and newborn health (MNH) services. This evaluation assessed the effect of the intervention on MNH providers' performance of routine

Embedded Sensors and Controls to Improve Component Performance and Reliability: Conceptual Design Report

Energy Technology Data Exchange (ETDEWEB)

Kisner, Roger A [ORNL; Melin, Alexander M [ORNL; Burress, Timothy A [ORNL; Fugate, David L [ORNL; Holcomb, David Eugene [ORNL; Wilgen, John B [ORNL; Miller, John M [ORNL; Wilson, Dane F [ORNL; Silva, Pamela C [ORNL; Whitlow, Lynsie J [ORNL; Peretz, Fred J [ORNL

2012-10-01

The overall project objective is to demonstrate improved reliability and increased performance made possible by deeply embedding instrumentation and controls (I&C) in nuclear power plant components. The project is employing a highly instrumented canned rotor, magnetic bearing, fluoride salt pump as its I&C technology demonstration vehicle. The project s focus is not primarily on pump design, but instead is on methods to deeply embed I&C within a pump system. However, because the I&C is intimately part of the basic millisecond-by-millisecond functioning of the pump, the I&C design cannot proceed in isolation from the other aspects of the pump. The pump will not function if the characteristics of the I&C are not embedded within the design because the I&C enables performance of the basic function rather than merely monitoring quasi-stable performance. Traditionally, I&C has been incorporated in nuclear power plant (NPP) components after their design is nearly complete; adequate performance was obtained through over-design. This report describes the progress and status of the project and provides a conceptual design overview for the embedded I&C pump.

A blueprint-based case study analysis of nutrition services provided in a midterm care facility for the elderly.

Science.gov (United States)

Paquet, Catherine; St-Arnaud-Mckenzie, Danielle; Ferland, Guylaine; Dubé, Laurette

2003-03-01

Ensuring nutritionally adequate food intake in institutions is a complex and important challenge for dietitians. To tackle this problem, we argue that dietitians need to adopt a systematic, integrative, and patient-centered approach to identify and manage more effectively organizational determinants of the quality of food intake under their control. In this study, we introduce such an approach, the blueprint-based case study, that we applied in the context of a midterm care facility for elderly patients. Data gathered through interviews and field observations were used to develop, from the perspective of key patient encounters, detailed representations of the food, nutrition, and nursing activities necessary to ensure adequate food intake. These service "blueprints" were developed to illustrate all activities that might potentially impact on the nutritional, sensory, functional, and social quality of patients' meals. They were also used as roadmaps to develop a case study analysis in which critical areas were identified and opportunities for improvement put forth, while considering services' resources and priorities. By providing a precise, objective, yet comprehensive mapping of the service operations and management, the blueprint-based case study approach represents a valuable tool to determine the optimal allocation of resources to insure nutritionally adequate food intake to patients.

AUTOMATION BASED LIBRARY MANAGEMENT IN DEPOK PUBLIC LIBRARY IN THE CONTEXT OF RITUAL PERFORMANCE

Directory of Open Access Journals (Sweden)

Rafiqa Maulidia

2017-06-01

Full Text Available Library management using manual system is no longer adequate to handle the workload in the library routines, librarians must use application of library automation. To provide a good working performance, librarians use strategy, competences and certain habits, which are referred to as a ritual performance. The performance of the ritual is the demonstration of competence spontaneously by individuals in dealing with individuals, groups and organizations, which contains elements of personal ritual, the work ritual, social ritual, and organization ritual. The research focuses in the automation based library management in the context of the performance of the ritual. This study used a qualitative approach with case study method. The findings suggest that the personal ritual shows the personal habits of librarians to do their tasks, ritual librarian's work show responsibility towards their duties, social rituals strengthen the emotional connection between librarians and leaders, as well as ritual organizations suggest the involvement of librarians in giving their contribution in decision making. Conclusions of this study shows that the performance of rituals librarian at Depok Public Library gives librarians the skills to implement automation systems in the library management, and reflect the values of responsibility, mutual trust, and mutual respect.   Key words : Library Management, Library Automation, Ritual Performance, Ritual Performance Value

The Effect of a High-Fidelity Home Health Simulations on Nursing Students' Clinical Performance

Science.gov (United States)

Crytzer, Michele Leigh

2011-01-01

With an increasing number of patients receiving nursing care in outpatient settings, it is the responsibility of nursing education programs to provide students with adequate training to enable them to develop the skills necessary to provide safe, effective care in diverse environments, including the home. Providing care to patients in their own…

21 CFR 1.283 - What happens to food that is imported or offered for import without adequate prior notice?

Science.gov (United States)

2010-04-01

... 21 Food and Drugs 1 2010-04-01 2010-04-01 false What happens to food that is imported or offered for import without adequate prior notice? 1.283 Section 1.283 Food and Drugs FOOD AND DRUG... Imported Food Consequences § 1.283 What happens to food that is imported or offered for import without...

Fed up with the right to food? : The Netherlands' policies and practices regarding the human right to adequate food

NARCIS (Netherlands)

Hospes, O.; Meulen, van der B.M.J.

2009-01-01

There is no one in this world who would deny the importance of access to adequate food for every human being. In fact, access to food has been declared a human right in 1948 with the Universal Declaration of Human Rights. In spite of the right to food to be more than half a century old, many are not

Engineering Self-Efficacy Contributing to the Academic Performance of AMAIUB Engineering Students: A Qualitative Investigation

Science.gov (United States)

Aleta, Beda T.

2016-01-01

This research study aims to determine the factors of engineering skills self- efficacy sources contributing on the academic performance of AMAIUB engineering students. Thus, a better measure of engineering self-efficacy is needed to adequately assess engineering students' beliefs in their capabilities to perform tasks in their engineering…

Process measures or patient reported experience measures (PREMs) for comparing performance across providers? A study of measures related to access and continuity in Swedish primary care.

Science.gov (United States)

Glenngård, Anna H; Anell, Anders

2018-01-01

Aim To study (a) the covariation between patient reported experience measures (PREMs) and registered process measures of access and continuity when ranking providers in a primary care setting, and (b) whether registered process measures or PREMs provided more or less information about potential linkages between levels of access and continuity and explaining variables. Access and continuity are important objectives in primary care. They can be measured through registered process measures or PREMs. These measures do not necessarily converge in terms of outcomes. Patient views are affected by factors not necessarily reflecting quality of services. Results from surveys are often uncertain due to low response rates, particularly in vulnerable groups. The quality of process measures, on the other hand, may be influenced by registration practices and are often more easy to manipulate. With increased transparency and use of quality measures for management and governance purposes, knowledge about the pros and cons of using different measures to assess the performance across providers are important. Four regression models were developed with registered process measures and PREMs of access and continuity as dependent variables. Independent variables were characteristics of providers as well as geographical location and degree of competition facing providers. Data were taken from two large Swedish county councils. Findings Although ranking of providers is sensitive to the measure used, the results suggest that providers performing well with respect to one measure also tended to perform well with respect to the other. As process measures are easier and quicker to collect they may be looked upon as the preferred option. PREMs were better than process measures when exploring factors that contributed to variation in performance across providers in our study; however, if the purpose of comparison is continuous learning and development of services, a combination of PREMs and

Exploring Performance Determinants of China’s Cable Operators and OTT Service Providers in the Era of Digital Convergence—From the Perspective of an Industry Platform

Directory of Open Access Journals (Sweden)

Xing Wan

2017-12-01

Full Text Available This paper investigates key determinants of business performance in China’s video industry in the era of digital convergence. Specifically, we analyze China’s OTT (over-the-top service providers and cable operators based on the perspective of an industry platform, which acts as the core module of a business ecosystem and is capable of facilitating and coordinating interdependence among different agents. Panel data models are established to empirically explore what factors impact the performance of these two types of players. The findings demonstrate that both platform use and the size of an installed base are crucial for the determinants of the performance of OTT service providers and cable operators. An online video platform can also benefit from an increasing proportion of mobile viewers by implementing a multi-screen strategy. Further, an OTT service provider can profit from the interaction between its installed base and UGC (user-generated content, while cable operators can take advantage of positive feedback between their demand side and supply side.

Adequate sleep among adolescents is positively associated with health status and health-related behaviors

Directory of Open Access Journals (Sweden)

Jeng Yi-Jong

2006-03-01

Full Text Available Abstract Background Amount of sleep is an important indicator of health and well-being in children and adolescents. Adequate sleep (AS: adequate sleep is defined as 6–8 hours per night regularly is a critical factor in adolescent health and health-related behaviors. The present study was based on a health promotion project previously conducted on adolescents in Tao-Yuan County, Taiwan. The aim was to examine the relationship between AS during schooldays and excessive body weight, frequency of visiting doctors and health-related behaviors among Taiwanese adolescents. Methods A cross-sectional study design, categorical and multivariate data analyses were used. The hypotheses investigated were: high frequency of AS is positively associated with lack of obesity and less frequent visits to doctors; and high frequency AS is positively associated with health-related behavior. Results A total of 656 boys (53.2% and girls (46.8%, ranging in age from 13–18 years were studied between January and June 2004. Three hundred and fifty seven subjects (54% reported that they slept less than the suggested 6–8 hours on schooldays. A significant negative association was found between low sleep and of the following health-related behaviors: (1 life appreciation; (2 taking responsibility for health; (3 adopting healthy diet; (4 effective stress management; (5 regular exercise; and (6 total AHP score. High frequency AS was associated with low frequencies of obesity after potential confounding factors were controlled. Junior high school adolescents reported significantly higher frequencies of AS than high school participants. Gender, family structure, home location and frequency of television watching or computer use were not significantly associated with AS. Conclusion These findings support the proposition that AS is associated with good health status and high-frequency adoption of health-related behavior. Furthermore, these findings suggest that inadequate

Incentives and provider payment methods.

Science.gov (United States)

Barnum, H; Kutzin, J; Saxenian, H

1995-01-01

The mode of payment creates powerful incentives affecting provider behavior and the efficiency, equity and quality outcomes of health finance reforms. This article examines provider incentives as well as administrative costs, and institutional conditions for successful implementation associated with provider payment alternatives. The alternatives considered are budget reforms, capitation, fee-for-service, and case-based reimbursement. We conclude that competition, whether through a regulated private sector or within a public system, has the potential to improve the performance of any payment method. All methods generate both adverse and beneficial incentives. Systems with mixed forms of provider payment can provide tradeoffs to offset the disadvantages of individual modes. Low-income countries should avoid complex payment systems requiring higher levels of institutional development.

How Feasible is Adequate Yearly Progress (AYP? Simulations of School AYP "Uniform Averaging" and "Safe Harbor" under the No Child Left Behind Act

Directory of Open Access Journals (Sweden)

Jaekyung Lee

2004-04-01

Full Text Available The No Child Left Behind Act of 2001 (NCLB requires that schools make “adequate yearly progress” (AYP towards the goal of having 100 percent of their students become proficient by year 2013-14. Through simulation analyses of Maine and Kentucky school performance data collected during the 1990s, this study investigates how feasible schools would have met the AYP targets if the mandate had been applied in the past with “uniform averaging (rolling averages” and “safe harbor” options that have potential to help reduce the number of schools needing improvement or corrective action. Contrary to some expectations, the applications of both options would do little to reduce the risk of massive school failure due to unreasonably high AYP targets for all student groups. Implications of the results for the NCLB school accountability system and possible ways to make the current AYP more feasible and fair are discussed.

Motor performance of children with mild intellectual disability and borderline intellectual functioning

NARCIS (Netherlands)

Vuijk, P. J.; Hartman, E.; Scherder, E.; Visscher, C.

2010-01-01

Background There is a relatively small body of research on the motor performance of children with mild intellectual disabilities (MID) and borderline intellectual functioning (BIF). Adequate levels of motor skills may contribute to lifelong enjoyment of physical activity, participation in sports and

Rhinitis and asthma as a cause of absenteeism and poor work/school performance in a population from Latin-American tropic

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Jorge Sánchez

2016-03-01

Conclusion: Both rhinitis and asthma are associated with lower performance in children and adults and absenteeism in the school; however, adequate treatment may improve clinical control and reduce backlash against job performance.

Development of performance measures based on visibility for effective placement of aids to navigation

Science.gov (United States)

Fang, Tae Hyun; Kim, Yeon-Gyu; Gong, In-Young; Park, Sekil; Kim, Ah-Young

2015-09-01

In order to develop the challenging process of placing Aids to Navigation (AtoN), we propose performance measures which quantifies the effect of such placement. The best placement of AtoNs is that from which the navigator can best recognize the information provided by an AtoN. The visibility of AtoNs depends mostly on light sources, the weather condition and the position of the navigator. Visual recognition is enabled by achieving adequate contrast between the AtoN light source and background light. Therefore, the performance measures can be formulated through the amount of differences between these two lights. For simplification, this approach is based on the values of the human factor suggested by International Association of Marine Aids to Navigation and Lighthouse Authorities (IALA). Performance measures for AtoN placement can be evaluated through AtoN Simulator, which has been being developed by KIOST/KRISO in Korea and has been launched by Korea National Research Program. Simulations for evaluation are carried out at waterway in Busan port in Korea.

Development of performance measures based on visibility for effective placement of aids to navigation

Directory of Open Access Journals (Sweden)

Tae Hyun Fang

2015-05-01

Full Text Available In order to develop the challenging process of placing Aids to Navigation (AtoN, we propose performance measures which quantifies the effect of such placement. The best placement of AtoNs is that from which the navigator can best recognize the information provided by an AtoN. The visibility of AtoNs depends mostly on light sources, the weather condition and the position of the navigator. Visual recognition is enabled by achieving adequate contrast between the AtoN light source and background light. Therefore, the performance measures can be formulated through the amount of differences between these two lights. For simplification, this approach is based on the values of the human factor suggested by International Association of Marine Aids to Navigation and Lighthouse Authorities (IALA. Performance measures for AtoN placement can be evaluated through AtoN Simulator, which has been being developed by KIOST/KRISO in Korea and has been launched by Korea National Research Program. Simulations for evaluation are carried out at waterway in Busan port in Korea.

Factors that affect parent perceptions of provider-family partnership for children with special health care needs.

Science.gov (United States)

Knapp, Caprice A; Madden, Vanessa L; Marcu, Mircea I

2010-09-01

Partnering between families and their children's providers is a cornerstone of family-centered care. This study aimed to identify factors associated with family-provider partnership and determine the association between partnership and other outcome measures for children with special health care needs (CSHCN). Descriptive, bivariate, and multivariate analyses were conducted using data from the 2005-2006 National Survey of Children with Special Health Care Needs. Multivariate models showed that CSHCN who are White non-Hispanic, younger than 12, reside in households with incomes above 400% of the federal poverty level, and have a usual source of care were associated with family-provider partnership. Multivariate models showed that family-provider partnership was significantly associated with adequate insurance, early and continual screening, organized health care services, and transition preparedness. Family-provider partnership was associated with 20% fewer emergency department visits and 9% fewer school days missed. This study suggests that policies aimed at promoting family-provider partnership could increase health outcomes for CSHCN.

Improved voltage performance of the Oak Ridge 25URC tandem accelerator

International Nuclear Information System (INIS)

Meigs, M.J.; Jones, C.M.; Haynes, D.L.; Juras, R.C.; Ziegler, N.F.; Raatz, J.E.; Rathmell, R.D.

1988-01-01

While voltage performance of the accelerator has been adequate for the experimental program to date, it seemed clear that improvement in voltage performance could be of direct benefit to the experimental program in the future. Therefore, we began, in June 1986, a program of modifications and tests which was designed to improve voltage performance of the accelerator. In this paper, we discuss the final phase of this program and initial tests of the accelerator following completion of this final phase. 11 refs., 4 figs

Assessment of Barriers to Providing Introductory Pharmacy Practice Experiences (IPPEs in the Hospital Setting

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Matthew J Gibson

2016-07-01

Full Text Available Objectives: The primary objective of the study is to identify the barriers to providing Introductory Pharmacy Practice Experiences (IPPEs in the hospital setting. Methods: Potential barriers to IPPEs were identified via literature review and interviews with current IPPE preceptors from various institutions. Based on this information, an electronic survey was developed and distributed to IPPE preceptors in order to assess student, preceptor, logistical and college or school of pharmacy related barriers that potentially exist for providing IPPE in the hospital setting. Results: Sixty-eight of the 287 eligible survey respondents (24% completed the electronic survey. Seventy-six percent of respondents agreed or strongly agreed that available time was a barrier to precepting IPPE students even though a majority of respondents reported spending a third or more of their day with an IPPE student when on rotation. Seventy-three percent of respondents disagreed or strongly disagreed that all preceptors have consistent performance expectations for students, while just 46% agreed or strongly agreed that they had adequate training to precept IPPEs. Sixty-five percent of respondents agreed that IPPE students have the ability to be a participant in patient care and 70% of preceptors believe that IPPE students should be involved in patient care. Conclusions: Conducting IPPEs in the institutional setting comes with challenges. Based on the results of this study, experiential directors and colleges/schools of pharmacy could make a positive impact on the quality and consistency of IPPEs by setting student expectations and training preceptors on appropriate and consistent expectations for students.   Type: Original Research

Test performance and acceptability of self- versus provider-collected swabs for high-risk HPV DNA testing in female-to-male trans masculine patients.

Science.gov (United States)

Reisner, Sari L; Deutsch, Madeline B; Peitzmeier, Sarah M; White Hughto, Jaclyn M; Cavanaugh, Timothy P; Pardee, Dana J; McLean, Sarah A; Panther, Lori A; Gelman, Marcy; Mimiaga, Matthew J; Potter, Jennifer E

2018-01-01

High-risk human papillomavirus (hrHPV) causes virtually all cervical cancers. Trans masculine (TM) people (those assigned female at birth who identify with a gender other than female) have low uptake of conventional cervical cancer screening. Self-collected hrHPV DNA testing has high levels of acceptability among cisgender (non-transgender) females and may support increased cervical cancer screening uptake in TM individuals. To assess the test performance and acceptability of self-collected vaginal specimens in comparison to provider-collected cervical swabs for hrHPV DNA detection in TM individuals ages 21-64 years. Between March 2015-September 2016, 150 TM participants with a cervix (mean age = 27.5 years; SD = 5.7) completed a one-time study visit comprised of a self-report survey, self-collected vaginal HPV DNA swab, clinician-administered cervical HPV swab, and brief interview on acceptability of clinical procedures. Participants were randomized to complete either self- or provider-collection first to minimize ordering effects. Self- and provider-collected samples were tested for 13 hrHPV DNA types using a DNA Hybridization Assay. The primary outcome variable was the concordance (kappa statistic) and performance (sensitivity, specificity) of self-collected vaginal HPV DNA specimens versus provider-collected cervical HPV swabs as the gold standard. Of the 131 participants completing both the self- and provider-collected HPV tests, 21 cases of hrHPV were detected by the provider cervical swab (gold standard; 16.0% hrHPV prevalence); 15 of these cases were accurately detected by the self-collected vaginal swab (71.4% concordance) (Kappa = 0.75, 95% Confidence Interval [CI]: 0.59, 0.92; p<0.001). Compared to the provider-collected cervical hrHPV DNA sample (gold standard), the self-collected vaginal hrHPV DNA test demonstrated a sensitivity of 71.4% (95% CI: 0.52, 0.91; p = 0.0495) and specificity of 98.2% (95% CI: 0.96, 1.00; p<0.0001). Over 90% of participants

Contracting private sector providers for public sector health services in Jalisco, Mexico: perspectives of system actors

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González Luz

2009-10-01

Full Text Available Abstract Introduction Contracting out health services is a strategy that many health systems in the developing world are following, despite the lack of decisive evidence that this is the best way to improve quality, increase efficiency and expand coverage. A large body of literature has appeared in recent years focusing on the results of several contracting strategies, but very few papers have addressed aspects of the managerial process and how this can affect results. Case description This paper describes and analyses the perceptions and opinions of managers and workers about the benefits and challenges of the contracting model that has been in place for almost 10 years in the State of Jalisco, Mexico. Both qualitative and quantitative information was collected. An open-ended questionnaire was used to obtain information from a group of managers, while information provided by a self-selected group of workers was collected via a closed-ended questionnaire. The analysis contrasted the information obtained from each source. Discussion and Evaluation Findings show that perceptions of managers and workers vary for most of the items studied. For managers the model has been a success, as it has allowed for expansion of coverage based on a cost-effective strategy, while for workers the model also possesses positive elements but fails to provide fair labour relationships, which negatively affects their performance. Conclusion Perspectives of the two main groups of actors in Jalisco's contracting model are important in the design and adjustment of an adequate contracting model that includes managerial elements to give incentives to worker performance, a key element necessary to achieve the model's ultimate objectives. Lessons learnt from this study could be relevant for the experience of contracting models in other developing countries.

Attitudes, subjective norms, and intention to perform routine oral examination for oropharyngeal candidiasis as perceived by primary health-care providers in Nairobi Province

NARCIS (Netherlands)

Koyio, L.N.; Kikwilu, E.N.; Mulder, J.; Frencken, J.E.F.M.

2013-01-01

Objectives: To assess attitudes, subjective norms, and intentions of primary health-care (PHC) providers in performing routine oral examination for oropharyngeal candidiasis (OPC) during outpatient consultations. Methods: A 47-item Theory of Planned Behaviour-based questionnaire was developed and

PERFORMANCE AUDITING OF A HUMAN AIR POLLUTION EXPOSURE SYSTEM FOR PM2.5

Science.gov (United States)

Databases derived from human health effects research play a vital role in setting environmental standards. An underlying assumption in using these databases for standard setting purposes is that they are of adequate quality. The performance auditing program described in this ma...

Dietary vitamin A intakes of Filipino elders with adequate or low liver vitamin A concentrations as assessed by the deuterated-retinol-dilution method: implications for dietary requirements.

Science.gov (United States)

Ribaya-Mercado, Judy D; Solon, Florentino S; Fermin, Liza S; Perfecto, Christine S; Solon, Juan Antonio A; Dolnikowski, Gregory G; Russell, Robert M

2004-04-01

The vitamin A requirements of elderly humans have not been studied. In a cross-sectional study of 60-88-y-old men (n = 31) and women (n = 31) in rural Philippines, we assessed the dietary intakes of elders with adequate (> or = 0.07 micromol/g) or low (value for elders. The mean (+/- SD) vitamin A intakes of the men and women with adequate vitamin A in liver were 135 +/- 86 and 134 +/- 104 microg retinol activity equivalents (RAE)/d, respectively; intakes of the men and women with low vitamin A in liver were 75 +/- 53 and 60 +/- 27 microg RAE/d, respectively. Total-body vitamin A or liver vitamin A but not serum retinol correlated with dietary RAE, preformed vitamin A, beta-carotene, fat, and protein. An estimated acceptable or sufficient dietary vitamin A intake associated with adequate liver vitamin A concentrations in elders is 6.45 microg RAE/kg body wt; for a reference 76-kg man and a 61-kg woman, these values are approximately 500 and 400 microg RAE/d, respectively. The dietary vitamin A intakes of elders with adequate or low liver vitamin A concentrations as estimated by use of the deuterated-retinol-dilution technique are useful for assessing vitamin A requirements.

Impact of Gatorade Beverage on Elite Female Badminton Players’ Performance

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Sepideh Mehraein

2017-08-01

Full Text Available Sports beverages assumed as one the principle factor on players' performance, and impact on their indicators, noticeably. Gatorade beverage is one of this primary beverages that in present study focused on its impact on elite female badminton players' performance in Iran. In the present survey has been considered in 2 groups of Gatorade and control that included 79 participants. The data has been got based on 24 hours’ recall questionnaire on three different days in every week. As well, skin folds’ brachial triceps index was applied for body fat percent assessment. To quantity VO2max, Shuttle runs sub-maximal test was used. Also, for controlling fluid intake in every two groups based on players’ body weight,150 ml per every 70 kg weight for every 15 minutes was recommended. Besides, for control of blood volume changes related to plasma blood glucose, hematocrit, hemoglobin, sodium, and potassium was measured during three time periods of zero, 30 minutes after the start and 90 minutes after the start. To end, to measure performance, standardized tests measure the indicators: aerobic power, speed, flexibilityy, agility, muscular strength, and endurance were used. The results showed that supply adequate water and fluids in during of sport, play a critical role in gaining the high level of female badminton players’ performance. In truth, the players who supply enough water shown better performance as compared with those who provide Gatorade beverage.

Vis-A-Plan /visualize a plan/ management technique provides performance-time scale

Science.gov (United States)

Ranck, N. H.

1967-01-01

Vis-A-Plan is a bar-charting technique for representing and evaluating project activities on a performance-time basis. This rectilinear method presents the logic diagram of a project as a series of horizontal time bars. It may be used supplementary to PERT or independently.

Report on achievements in fiscal 1998. Development of a waste disposal and recycle related technology. (Development of a technology to dispose of air bags adequately); 1998 nendo haikibutsu shori recycle kanren gijutsu kaihatsu air bag tekisei shori gijutsu no kaihatsu nado seika hokokusho

Energy Technology Data Exchange (ETDEWEB)

NONE

1999-12-01

This technological development is intended to develop a process technology to dispose adequately of air bags convergently when they are removed from waste cars, with consideration paid on environmental and safety aspects. This technology that can dispose of air bags remaining as air bag modules (ABM) in large quantity and adequately can solve the problems of maloperation in opening them in cars and noise in conventional disposal methods. The recovery and disposal system using an inflator can be expected of reducing work load on dismantling contractors and enhancing the work safety. Furthermore, the energy saving process utilizing combustion of plastics can save resources. However, this technology has not elucidated how dioxins, dust, smoke, sulfides, and nitrogen oxides are generated and how the generation can be prevented. Therefore, an exhaust gas dioxin testing facility and an exhaust gas treating facility were installed additionally to the existing heating treatment facility to develop a disposal technology to treat adequately the exhaust gases generated when ABMs are disposed conveergently in large quantity, and treat the waste water discharged from the facilities. Fiscal 1998 has performed preliminary tests to accumulate fundamental data, and design and installation of the above two facilities. (NEDO)

Serum albumin-adjusted glycated albumin is an adequate indicator of glycemic control in patients with Cushing's syndrome.

Science.gov (United States)

Kitamura, Tetsuhiro; Otsuki, Michio; Tamada, Daisuke; Tabuchi, Yukiko; Mukai, Kosuke; Morita, Shinya; Kasayama, Soji; Bando, Yukihiro; Shimomura, Iichiro; Koga, Masafumi

2014-12-01

We recently reported that glycated albumin (GA) in patients with Cushing's syndrome is low. In the present study, we examined whether serum albumin (SA)-adjusted GA (SAaGA) is an adequate indicator of glycemic control in patients with Cushing's syndrome. We studied 26 patients with Cushing's syndrome (13 patients without diabetes and 13 patients with diabetes). Twenty six non-diabetic subjects and 26 patients with type 2 diabetes mellitus matched for age, sex and BMI were used as the controls. SAaGA was calculated using the regression formula between SA and GA in non-diabetic patients with Cushing's syndrome and non-diabetic subjects. SA showed a significant correlation with GA in non-diabetic patients with Cushing's syndrome and non-diabetic subjects. GA, but not SAaGA, in non-diabetic patients with Cushing's syndrome was significantly lower than that in the non-diabetic controls. Furthermore, the GA/HbA1c ratio, but not the SAaGA/HbA1c ratio, in diabetic patients with Cushing's syndrome was significantly lower than that in the diabetic controls. The measured GA in the patients with Cushing's syndrome was significantly lower than the estimated GA, but there was no difference between SAaGA and the estimated GA. The present findings suggest that SAaGA is an adequate indicator of the glycemic control in patients with Cushing's syndrome. Copyright © 2014 The Canadian Society of Clinical Chemists. Published by Elsevier Inc. All rights reserved.

Atmospheric effects on the photovoltaic performance of hybrid perovskite solar cells

KAUST Repository

Sheikh, Arif D.; Bera, Ashok; Haque, Mohammed; Baby, Rakhi Raghavan; Del Gobbo, Silvano; Alshareef, Husam N.; Wu, Tao

2015-01-01

nitrogen, and dry air, on the photovoltaic performance of TiO2-CH3NH3PbI3-xClx-spiro-MeOTAD solar cells. We found that spin coating of spiro-MeOTAD in an oxygen atmosphere alone was not adequate to functionalize its hole-transport property completely

Are forestation, bio-char and landfilled biomass adequate offsets for the climate effects of burning fossil fuels?

International Nuclear Information System (INIS)

Reijnders, L.

2009-01-01

Forestation and landfilling purpose-grown biomass are not adequate offsets for the CO 2 emission from burning fossil fuels. Their permanence is insufficiently guaranteed and landfilling purpose-grown biomass may even be counterproductive. As to permanence, bio-char may do better than forests or landfilled biomass, but there are major uncertainties about net greenhouse gas emissions linked to the bio-char life cycle, which necessitate suspension of judgement about the adequacy of bio-char addition to soils as an offset for CO 2 emissions from burning fossil fuels.

Visual Analysis of Cloud Computing Performance Using Behavioral Lines.

Science.gov (United States)

Muelder, Chris; Zhu, Biao; Chen, Wei; Zhang, Hongxin; Ma, Kwan-Liu

2016-02-29

Cloud computing is an essential technology to Big Data analytics and services. A cloud computing system is often comprised of a large number of parallel computing and storage devices. Monitoring the usage and performance of such a system is important for efficient operations, maintenance, and security. Tracing every application on a large cloud system is untenable due to scale and privacy issues. But profile data can be collected relatively efficiently by regularly sampling the state of the system, including properties such as CPU load, memory usage, network usage, and others, creating a set of multivariate time series for each system. Adequate tools for studying such large-scale, multidimensional data are lacking. In this paper, we present a visual based analysis approach to understanding and analyzing the performance and behavior of cloud computing systems. Our design is based on similarity measures and a layout method to portray the behavior of each compute node over time. When visualizing a large number of behavioral lines together, distinct patterns often appear suggesting particular types of performance bottleneck. The resulting system provides multiple linked views, which allow the user to interactively explore the data by examining the data or a selected subset at different levels of detail. Our case studies, which use datasets collected from two different cloud systems, show that this visual based approach is effective in identifying trends and anomalies of the systems.

Performance Assessment for e-Government Services: An Experience Report

Energy Technology Data Exchange (ETDEWEB)

Liu, Yan; Zhu, Liming; Gorton, Ian

2007-08-14

The transformation and integration of government services, enabled by the use of new technologies such as application servers and Web services, is fundamental to reduce the cost of government and improving service outcomes to citizens. Many core Government information systems comprise applications running on legacy mainframes, databases and transaction processing monitors. As Governments worldwide provide direct access over the Internet to these legacy applications from the general public, they may be exposed to workloads well above the origin design parameters of these back-end systems. This creates a significant risk of high profile failures for Government agencies whose newly integrated systems become overloaded. In this paper we describe how we conducted a performance assessment of a business-critical, Internet-facing Web services that integrated new and legacy systems from two Australian Government agencies. We leveraged prototype tools from our own research along with known techniques in performance modeling. We were able to clearly demonstrate that the existing hardware and software would be adequate to handle the predicted workload for the next financial year. We were also able to do ‘what-if’ analysis and predict how the system can perform with alternative strategies to scale the system. We conclude by summarizing the lessons learnt, including the importance of architecture visibility, benchmarking data quality, and measurement feasibility due to issues of outsourcing, privacy legislation and cross-agency involvement.

Systematic reviews of diagnostic tests in endocrinology: an audit of methods, reporting, and performance.

Science.gov (United States)

Spencer-Bonilla, Gabriela; Singh Ospina, Naykky; Rodriguez-Gutierrez, Rene; Brito, Juan P; Iñiguez-Ariza, Nicole; Tamhane, Shrikant; Erwin, Patricia J; Murad, M Hassan; Montori, Victor M

2017-07-01

Systematic reviews provide clinicians and policymakers estimates of diagnostic test accuracy and their usefulness in clinical practice. We identified all available systematic reviews of diagnosis in endocrinology, summarized the diagnostic accuracy of the tests included, and assessed the credibility and clinical usefulness of the methods and reporting. We searched Ovid MEDLINE, EMBASE, and Cochrane CENTRAL from inception to December 2015 for systematic reviews and meta-analyses reporting accuracy measures of diagnostic tests in endocrinology. Experienced reviewers independently screened for eligible studies and collected data. We summarized the results, methods, and reporting of the reviews. We performed subgroup analyses to categorize diagnostic tests as most useful based on their accuracy. We identified 84 systematic reviews; half of the tests included were classified as helpful when positive, one-fourth as helpful when negative. Most authors adequately reported how studies were identified and selected and how their trustworthiness (risk of bias) was judged. Only one in three reviews, however, reported an overall judgment about trustworthiness and one in five reported using adequate meta-analytic methods. One in four reported contacting authors for further information and about half included only patients with diagnostic uncertainty. Up to half of the diagnostic endocrine tests in which the likelihood ratio was calculated or provided are likely to be helpful in practice when positive as are one-quarter when negative. Most diagnostic systematic reviews in endocrine lack methodological rigor, protection against bias, and offer limited credibility. Substantial efforts, therefore, seem necessary to improve the quality of diagnostic systematic reviews in endocrinology.

Performance of an automatic dose control system for CT. Specifications and basic phantom tests

Energy Technology Data Exchange (ETDEWEB)

Nagel, H.D. [Wissenschaft und Technik fuer die Radiolgoe, Dr. HD Nagel, Buchholz (Germany); Stumpp, P.; Kahn, T.; Gosch, D. [Universitaetsklinikum Leipzig (Germany). Klinik und Poliklinik fuer Diagnostische und Interventionelle Radiologie

2011-01-15

Purpose: To assess the performance and to provide more detailed insight into the characteristics and limitations of devices for automatic dose control (ADC) in CT. Materials and Methods: A comprehensive study on DoseRight 2.0, the ADC system provided by Philips for its Brilliance CT scanners, was conducted. Phantom tests were carried out on a 64-slice scanner (Brilliance 64) using assorted quality control (QC) phantoms that allowed verification of the basic specifications. If feasible, the findings were verified by model calculations based on known specifications. Results: For all tests, the dose reductions and modulation characteristics fully met the values expected from the specifications. Adverse effects due to increased image noise were only moderate as a result of the 'adequate noise system' design that employs comparatively gentle modulation, and the additional use of adaptive filtration. Conclusion: Simple tests with QC phantoms allow evaluation of the most relevant characteristics of devices for ADC in CT. (orig.)

Statistical learning methods: Basics, control and performance

Energy Technology Data Exchange (ETDEWEB)

Zimmermann, J. [Max-Planck-Institut fuer Physik, Foehringer Ring 6, 80805 Munich (Germany)]. E-mail: zimmerm@mppmu.mpg.de

2006-04-01

The basics of statistical learning are reviewed with a special emphasis on general principles and problems for all different types of learning methods. Different aspects of controlling these methods in a physically adequate way will be discussed. All principles and guidelines will be exercised on examples for statistical learning methods in high energy and astrophysics. These examples prove in addition that statistical learning methods very often lead to a remarkable performance gain compared to the competing classical algorithms.

Statistical learning methods: Basics, control and performance

International Nuclear Information System (INIS)

Zimmermann, J.

2006-01-01

The basics of statistical learning are reviewed with a special emphasis on general principles and problems for all different types of learning methods. Different aspects of controlling these methods in a physically adequate way will be discussed. All principles and guidelines will be exercised on examples for statistical learning methods in high energy and astrophysics. These examples prove in addition that statistical learning methods very often lead to a remarkable performance gain compared to the competing classical algorithms

Automation Based Library Management in Depok Public Library In The Context of Ritual Performance

Directory of Open Access Journals (Sweden)

Rafiqa Maulidia

2018-01-01

Full Text Available Library management using manual system is no longer adequate to handle the workload in the library routines, librarians must use application of library automation. To provide a good working performance, librarians use strategy, competences and certain habits, which are referred to as a ritual performance. The performance of the ritual is the demonstration of competence spontaneously by individuals in dealing with individuals, groups and organizations, which contains elements of personal ritual, the work ritual, social ritual, and organization ritual. The research focuses in the automation based library management in the context of the performance of the ritual. This study used a qualitative approach with case study method. The findings suggest that the personal ritual shows the personal habits of librarians to do their tasks, ritual librarian's work show responsibility towards their duties, social rituals strengthen the emotional connection between librarians and leaders, as well as ritual organizations suggest the involvement of librarians in giving their contribution in decision making. Conclusions of this study shows that the performance of rituals librarian at Depok Public Library gives librarians the skills to implement automation systems in the library management, and reflect the values of responsibility, mutual trust, and mutual respect.

Development of a working set of waste package performance criteria for deepsea disposal of low-level radioactive waste. Final report

International Nuclear Information System (INIS)

Columbo, P.; Fuhrmann, M.; Neilson, R.M. Jr; Sailor, V.L.

1982-11-01

The United States ocean dumping regulations developed pursuant to PL92-532, the Marine Protection, Research, and Sanctuaries Act of 1972, as amended, provide for a general policy of isolation and containment of low-level radioactive waste after disposal into the ocean. In order to determine whether any particular waste packaging system is adequate to meet this general requirement, it is necessary to establish a set of performance criteria against which to evaluate a particular packaging system. These performance criteria must present requirements for the behavior of the waste in combination with its immobilization agent and outer container in a deepsea environment. This report presents a working set of waste package performance criteria, and includes a glossary of terms, characteristics of low-level radioactive waste, radioisotopes of importance in low-level radioactive waste, and a summary of domestic and international regulations which control the ocean disposal of these wastes

Lesbian, Gay, Bisexual, Transgender, and Questioning (LGBTQ)-Themed Literature for Teens: Are School Libraries Providing Adequate Collections?

Science.gov (United States)

Hughes-Hassell, Sandra; Overberg, Elizabeth; Harris, Shannon

2013-01-01

The purpose of this study was to determine if young adults have access through school libraries to LGBTQ-themed literature. The library collections in 125 high schools in one Southern U.S. state were examined for the inclusion of LGBTQ-themed fiction, nonfiction, and biographies, including a core collection of 21 recommended titles. Results showed…

Use of Flumazenil to Provide Adequate Recovery Time Post-Midazolom Infusion in a General Intensive Care Unit

Directory of Open Access Journals (Sweden)

MOJTABA MOJTAHEDZADEH

1999-08-01

Full Text Available Sedation permits patients to tolerate the various treatment modalities to which they are subjected. However it may sometimes cause prolonged sedation in critically ill patients. Flumazenil, a benzo¬diazepine antagonist, reverses midazolam-induced sedation and amnesia. We prospectively designed a double-blind randomized study to evaluate the effects of flumazenil on thirty (30 Iranian General Intensive Care Unit (ICU patients. They were requiring mechanical ventilation for more than 12 hours and they were sedated by midazolam infusions. Sedation levels were measured hourly during the infusion, at the end of the infusion, and at 5, 15, 30, 60, and 120 min after cessation of the mida¬zolam infusion. Reversal of sedation was observed in all patients who received flumazenil, and re-sedation occurred in seven of these patients. Reversal was not seen in any of the patients who receiv-ed placebo.

The Association between Provider Practice and Knowledge of ORS and Zinc Supplementation for the Treatment of Childhood Diarrhea in Bihar, Gujarat and Uttar Pradesh, India: A Multi-Site Cross-Sectional Study.

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Lamberti, Laura M; Fischer Walker, Christa L; Taneja, Sunita; Mazumder, Sarmila; Black, Robert E

2015-01-01

Programs aimed at reducing the burden of diarrhea among children under-five in low-resource settings typically allocate resources to training community-level health workers, but studies have suggested that provider knowledge does not necessarily translate into adequate practice. A diarrhea management program implemented in Bihar, Gujarat and Uttar Pradesh, India trained private sector rural medical practitioners (RMPs) and public sector Accredited Social Health Activists (ASHAs) and Anganwadi workers (AWWs) in adequate treatment of childhood diarrhea with oral rehydration salts (ORS) and zinc. We used cross-sectional program evaluation data to determine the association between observed diarrhea treatment practices and reported knowledge of ORS and zinc among each provider cadre. We conducted principal components analysis on providers' responses to diarrhea treatment questions in order to generate a novel scale assessing ORS/zinc knowledge. We subsequently regressed a binary indicator of whether ORS/zinc was prescribed during direct observation onto the resulting knowledge scores, controlling for other relevant knowledge predictors. There was a positive association between ORS/zinc knowledge score and prescribing ORS and zinc to young children with diarrhea among private sector RMPs (aOR: 2.32; 95% CI: 1.29-4.17) and public sector ASHAs and AWWs (aOR 2.48; 95% CI: 1.90-3.24). Controlling for knowledge score, receipt of training in the preceding 6 months was a good predictor of adequate prescribing in the public but not the private sector. In the public sector, direct access to ORS and zinc supplies was also highly associated with prescribing. To enhance the management of childhood diarrhea in India, programmatic activities should center on increasing knowledge of ORS and zinc among public and private sector providers through biannual trainings but should also focus on ensuring sustained access to an adequate supply chain.

The Association between Provider Practice and Knowledge of ORS and Zinc Supplementation for the Treatment of Childhood Diarrhea in Bihar, Gujarat and Uttar Pradesh, India: A Multi-Site Cross-Sectional Study.

Directory of Open Access Journals (Sweden)

Laura M Lamberti

Full Text Available Programs aimed at reducing the burden of diarrhea among children under-five in low-resource settings typically allocate resources to training community-level health workers, but studies have suggested that provider knowledge does not necessarily translate into adequate practice. A diarrhea management program implemented in Bihar, Gujarat and Uttar Pradesh, India trained private sector rural medical practitioners (RMPs and public sector Accredited Social Health Activists (ASHAs and Anganwadi workers (AWWs in adequate treatment of childhood diarrhea with oral rehydration salts (ORS and zinc. We used cross-sectional program evaluation data to determine the association between observed diarrhea treatment practices and reported knowledge of ORS and zinc among each provider cadre.We conducted principal components analysis on providers' responses to diarrhea treatment questions in order to generate a novel scale assessing ORS/zinc knowledge. We subsequently regressed a binary indicator of whether ORS/zinc was prescribed during direct observation onto the resulting knowledge scores, controlling for other relevant knowledge predictors.There was a positive association between ORS/zinc knowledge score and prescribing ORS and zinc to young children with diarrhea among private sector RMPs (aOR: 2.32; 95% CI: 1.29-4.17 and public sector ASHAs and AWWs (aOR 2.48; 95% CI: 1.90-3.24. Controlling for knowledge score, receipt of training in the preceding 6 months was a good predictor of adequate prescribing in the public but not the private sector. In the public sector, direct access to ORS and zinc supplies was also highly associated with prescribing.To enhance the management of childhood diarrhea in India, programmatic activities should center on increasing knowledge of ORS and zinc among public and private sector providers through biannual trainings but should also focus on ensuring sustained access to an adequate supply chain.

The performance of mHealth in cancer supportive care: a research agenda.

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Nasi, Greta; Cucciniello, Maria; Guerrazzi, Claudia

2015-02-13

Since the advent of smartphones, mHealth has risen to the attention of the health care system as something that could radically change the way health care has been viewed, managed, and delivered to date. This is particularly relevant for cancer, as one of the leading causes of death worldwide, and for cancer supportive care, since patients and caregivers have key roles in managing side effects. Given adequate knowledge, they are able to expect appropriate assessments and interventions. In this scenario, mHealth has great potential for linking patients, caregivers, and health care professionals; for enabling early detection and intervention; for lowering costs; and achieving better quality of life. Given its great potential, it is important to evaluate the performance of mHealth. This can be considered from several perspectives, of which organizational performance is particularly relevant, since mHealth may increase the productivity of health care providers and as a result even the productivity of health care systems. This paper aims to review studies on the evaluation of the performance of mHealth, with particular focus on cancer care and cancer supportive care processes, concentrating on its contribution to organizational performance, as well as identifying some indications for a further research agenda. We carried out a review of literature, aimed at identifying studies related to the performance of mHealth in general or focusing on cancer care and cancer supportive care. Our analysis revealed that studies are almost always based on a single dimension of performance. Any evaluations of the performance of mHealth are based on very different methods and measures, with a prevailing focus on issues linked to efficiency. This fails to consider the real contribution that mHealth can offer for improving the performance of health care providers, health care systems, and the quality of life in general. Further research should start by stating and explaining what is meant

Motor Performance of Children with Mild Intellectual Disability and Borderline Intellectual Functioning

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Vuijk, P. J.; Hartman, E.; Scherder, E.; Visscher, C.

2010-01-01

Background: There is a relatively small body of research on the motor performance of children with mild intellectual disabilities (MID) and borderline intellectual functioning (BIF). Adequate levels of motor skills may contribute to lifelong enjoyment of physical activity, participation in sports and healthy lifestyles. The present study compares…

Nature's Notebook Provides Phenology Observations for NASA Juniper Phenology and Pollen Transport Project

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Luval, J. C.; Crimmins, T. M.; Sprigg, W. A.; Levetin, E.; Huete, A.; Nickovic, S.; Prasad, A.; Vukovic, A.; VandeWater, P. K.; Budge, A. M.;

Improving human performance: Industry factors influencing the ability to perform

Directory of Open Access Journals (Sweden)

Güera Massyn Romo

2013-03-01

Full Text Available Learning interventions and new technologies that aim to improve human performance must take cognisance of industry factors inhibiting human performance. The dynamic and fast pace nature of the Information and Communication Technologies (ICT and the engineering industries do not lend themselves to proper skills planning and management. These industries experience real skills gaps, to some of which they contribute by themselves. This study reports on these performance-inhibiting factors such as the underutilisation of available skills, tolerance for individual preferences, and dynamically, and informally refining a role objective while an employee is occupying a certain role. The important professional skills required by individuals to cope with these real life factors are also explored in the skills gaps management context. Moreover, these industries need a profile they refer to as Special Forces, which denotes a high calibre of worker that possesses well-developed professional skills whilst having advanced technical expertise and sufficient experience. This resource profile is required largely due to the poor management of human resource processes in practice and the current reported lack of adequate skills. Furthermore, this study refers to the recent lack of a working definition for these Special Forces leading to the omitted active development of these profiles in industry today, which appears to become a key human performance inhibiting factor.

Customer assessment of long-term care pharmacy provider services.

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Clark, Thomas R

2008-09-01

Assess performance of long-term care pharmacy providers on key services offered to nursing facilities. Cross-sectional; nursing facility team. Random phone survey of nursing facility team members. 485 nursing facility team members (practicing in nursing facilities, interacting with > or = 1 consultant pharmacist); 46 members excluded, unable to identify facility's pharmacy provider. Directors of nursing, medical directors, and administrators were asked to rate long-term care pharmacy provider performance of eight commonly offered pharmacy services. All groups evaluated pharmacy provider performance of these services using a five-point scale. Results are broken down by employer type. Average rating for eight pharmacy services was 3.64. Top two services: "Labeling medications accurately" ranked in top 1-2 services for all groups (combined rating of 3.97) and "Provides medication administration system" ranked in top 1-3 services for all groups (combined rating of 3.95). One service, "Provides educational inservices," ranked lowest for all groups (combined rating of 3.54). In general, when looking at the eight services in combination for all providers, all services were ranked between Good and Very Good (average score of 3.64). Therefore, while the pharmacy provider is performing above average for these services, there is room for improvement in all of these services. These results can be used as a benchmark. Detailed data results and sample surveys are available online at www.ascp.com/supplements. These surveys can be used by the pharmacy provider to solicit assessments from their own facilities on these services.

HIV prevention among street-based sex workers (SSWs) in Chongqing, China: interviews with SSWs, clients and healthcare providers.

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Zeng, Huan; Zhang, Lei; Zhao, Yong; Liu, Hui; Guo, Hang; Wang, Yang; Zhang, Zhen; Mao, Limin

2016-11-01

Street-based female sex workers (SSWs) are subjected to a relatively high risk of HIV transmission, even higher than establishment-based female sex workers in China. However, very few HIV intervention programmes have targeted this particular group to date. Based in Southwest China, this study aims to identify perceived barriers, demands and suggestions on HIV prevention from the perspectives of SSWs, clients and healthcare providers in Chongqing. Face-to-face, in-depth interviews were conducted in July 2008 with 23 participants. They were recruited by purposive, convenience sampling and included 12 SSWs, 5 male clients, 4 government healthcare providers and 2 outreach workers from a community-based non-governmental organisation. Thematic analysis was used. SSWs were largely rural-to-urban migrants with a low socioeconomic status. Most of their clients shared a similar background. Both SSWs and their clients demonstrated a low awareness of HIV infection and a lack of understanding of effective preventive strategies. Financial hardships, lack of family support, fear of police arrest and stigma in relation to sex work were identified as SSWs' major barriers for accessing healthcare services. Both SSWs and their clients indicated an urgent demand for accessing adequate HIV prevention and care programmes. On the other hand, government organisations trying to provide services to this group have also encountered obstacles, specifically their limited ability to establish mutual trust. Programmes provided by community-based non-governmental organisation, however, were perceived to be more attractive. In conclusion, there remains a substantial gap between the need of adequate HIV prevention services for SSWs and their clients and what is currently available. Strengthening inter-sectoral collaboration, providing specifically tailored health services, actively involving SSW peers and their clients, and reducing stigma in the society are keys to meet this urgent demand by SSWs

Relationship between macroeconomic aggregates and bank performance

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Mitrović Ranka

2016-01-01

Full Text Available The aim of the paper is relations between some macroeconomic aggregates and performance of banks. This paper show analysis of trends in gross domestic product, exchange rates, interest rates, inflation load, developments in the balance of payments. On the business side, performance is achieved insight into the liquidity, capital adequacy, and the amount of non-performable loans. The aim of the research is to refute or confirm the interconnectedness of movement values of macroeconomic aggregates and bank performance. The analysis confirmed the association of two set variables. The negative value movements of macroeconomic aggregates directly or indirectly have an impact on the quality of performance of the banking sector. Therefore, it is necessary to define an adequate strategy of the economy, would not it safer to carry out the process of adapting to new developments in the market, such as the global financial crisis, the rise in unproductive enterprises, distrust customers etc.

Kaiser Permanente's performance improvement system, part 2: developing a value framework.

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Schilling, Lisa; Deas, Dennis; Jedlinsky, Maile; Aronoff, Deborah; Fershtman, Juliette; Wali, Abdul

2010-12-01

In 2008, Kaiser Permanente began phased implementation of a nationwide performance improvement (PI) system. The aim was to improve performance by providing consistent, highly meaningful performance measurement, increase PI skills in staff at all levels, develop organizational capabilities, and provide support for making improvements in medical centers and across regions. Evaluating the PI System: The intermediate results of the PI system were assessed in the 22 medical centers in four of the eight Kaiser Permanente regions. Implementation for 3 of these medical centers occurred in January 2008 through November 2008, with implementation for the remaining 19 medical centers occurring from September 2008 through September 2009. The 22 medical centers that were evaluated achieved a 61% improvement in selected capabilities, and improvement advisors (IAs) successfully completed 84% of initial PI projects. For each dollar invested, estimates suggested an average return on investment of $2.36. Critical factors include adequate dedicated time for PI activities by staff with necessary expertise, expert support to operations, alignment of projects with regional and national strategic priorities, and close working relationships between PI staff and operational management. Involving finance leaders in improvement planning, prioritization, and oversight is important. These elements can be adapted to smaller systems and single hospitals. The initial evaluation of the Kaiser Permanente PI system indicated that (1) IAs successfully led projects in conjunction with frontline teams, (2) organizational capabilities increased, and (3) the investment in PI infrastructure and staff was sound. Expansion throughout the entire Kaiser Permanente system is under way.

Short-term Periodization Models: Effects on Strength and Speed-strength Performance.

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Hartmann, Hagen; Wirth, Klaus; Keiner, Michael; Mickel, Christoph; Sander, Andre; Szilvas, Elena

2015-10-01

avoided because it does not provide an adequate training stimulus for gains in muscle cross-sectional area and strength performance. High-volume circuit strength training performed over 2 years negatively affected the development of the power output and maximal strength of the upper extremities in professional rugby players. Indeed, meta-analyses and results with weightlifters, American Football players, and throwers confirm the necessity of the habitual use of ≥80% 1 RM: (1) to improve maximal strength during the off-season and in-season in American Football, (2) to reach peak performance in maximal strength and vertical jump power during tapering in track-and-field, and (3) to produce hypertrophy and strength improvements in advanced athletes. The integration and extent of hypertrophy strength training in in-season conditioning depend on the duration of the contest period, the frequency of the contests, and the proportion of the conditioning program. Based on the literature, 72 h between hypertrophy strength training and strength-power training should be provided to allow for adequate regeneration times and therefore maximal stimulus intensities in training. This conclusion is only valid if the muscle is not trained otherwise during this regeneration phase. Thus, rotating hypertrophy and strength-power sessions in a microcycle during the season is a viable option. Comparative studies in competitive athletes who integrated strength training during pre-season conditioning confirm a tendency for gains in explosive strength and statistically significant improvements in medicine ball throw through SPP but not through daily undulating periodization. These findings indicate that to maximize the speed-strength in the short term (peaking), elite athletes should perform strength-power training twice per week. It is possible to perform a single strength-power session with the method of maximum explosive strength actions moving high-weight loads (90% 1 repetition maximum [RM]) at

Effect of a Neonatal Resuscitation Course on Healthcare Providers' Performances Assessed by Video Recording in a Low-Resource Setting.

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Trevisanuto, Daniele; Bertuola, Federica; Lanzoni, Paolo; Cavallin, Francesco; Matediana, Eduardo; Manzungu, Olivier Wingi; Gomez, Ermelinda; Da Dalt, Liviana; Putoto, Giovanni

2015-01-01

We assessed the effect of an adapted neonatal resuscitation program (NRP) course on healthcare providers' performances in a low-resource setting through the use of video recording. A video recorder, mounted to the radiant warmers in the delivery rooms at Beira Central Hospital, Mozambique, was used to record all resuscitations. One-hundred resuscitations (50 before and 50 after participation in an adapted NRP course) were collected and assessed based on a previously published score. All 100 neonates received initial steps; from these, 77 and 32 needed bag-mask ventilation (BMV) and chest compressions (CC), respectively. There was a significant improvement in resuscitation scores in all levels of resuscitation from before to after the course: for "initial steps", the score increased from 33% (IQR 28-39) to 44% (IQR 39-56), pproviders improved after participation in an adapted NRP course. Video recording was well-accepted by the staff, useful for objective assessment of performance during resuscitation, and can be used as an educational tool in a low-resource setting.

'That would have been beneficial': LGBTQ education for home-care service providers.

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Daley, Andrea; MacDonnell, Judith A

2015-05-01

This paper reports qualitative findings from a pilot study that explored the lesbian, gay, bisexual, transgender and queer (LGBTQ) education needs of home-care service providers working in one large, urban Canadian city. The pilot study builds upon research that has documented barriers to health services for diversely situated LGBTQ people, which function to limit access to good-quality healthcare. LGBTQ activists, organisations and allies have underscored the need for health provider education related to the unique health and service experiences of sexual and gender minority communities. However, the home-care sector is generally overlooked in this important body of research literature. We used purposeful convenience sampling to conduct four focus groups and two individual interviews with a total of 15 professionally diverse home-care service providers. Data collection was carried out from January 2011 to July 2012 and data were analysed using grounded theory methods towards the identification of the overarching theme, 'provider education' and it had two sub-themes: (i) experiences of LGBTQ education; and (ii) recommendations for LGBTQ education. The study findings raise important questions about limited and uneven access to adequate LGBTQ education for home-care service providers, suggest important policy implications for the education and health sectors, and point to the need for anti-oppression principles in the development of education initiatives. © 2014 John Wiley & Sons Ltd.

The anti-human trafficking collaboration model and serving victims: Providers' perspectives on the impact and experience.

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Kim, Hea-Won; Park, Taekyung; Quiring, Stephanie; Barrett, Diana

2018-01-01

A coalition model is often used to serve victims of human trafficking but little is known about whether the model is adequately meeting the needs of the victims. The purpose of this study was to examine anti-human trafficking collaboration model in terms of its impact and the collaborative experience, including challenges and lessons learned from the service providers' perspective. Mixed methods study was conducted to evaluate the impact of a citywide anti-trafficking coalition model from the providers' perspectives. Web-based survey was administered with service providers (n = 32) and focus groups were conducted with Core Group members (n = 10). Providers reported the coalition model has made important impacts in the community by increasing coordination among the key agencies, law enforcement, and service providers and improving quality of service provision. Providers identified the improved and expanded partnerships among coalition members as the key contributing factor to the success of the coalition model. Several key strategies were suggested to improve the coalition model: improved referral tracking, key partner and protocol development, and information sharing.

Irradiation performance of uranium-molybdenum alloy dispersion fuels

International Nuclear Information System (INIS)

Almeida, Cirila Tacconi de

2005-01-01

The U-Mo-Al dispersion fuels of Material Test Reactors (MTR) are analyzed in terms of their irradiation performance. The irradiation performance aspects are associated to the neutronic and thermal hydraulics aspects to propose a new core configuration to the IEA-R1 reactor of IPEN-CNEN/SP using U-Mo-Al fuels. Core configurations using U-10Mo-Al fuels with uranium densities variable from 3 to 8 gU/cm 3 were analyzed with the computational programs Citation and MTRCR-IEA R1. Core configurations for fuels with uranium densities variable from 3 to 5 gU/cm 3 showed to be adequate to use in IEA-R1 reactor e should present a stable in reactor performance even at high burn-up. (author)

Performance Evaluation of Community Health Workers: Case Study in the Amazon of Peru.

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Westgard, Christopher; Naraine, Renuka; Paucar Villacorta, Diego Mauricio

2018-03-26

A shortage in human resources for health is a growing crisis that has led to an inability to provide adequate health services to impoverished populations. By "task-shifting", health systems can delegate certain activities, such as health promotion and referral, to trained community members to help fill the human resource gap. An effective community health agent program can improve maternal and child health and overall effectiveness of rural health systems. Such a program is most effective when the community health agents receive supervision and evaluation of their performance. There is a shortage of literature that provides instruction and example on how to conduct a performance evaluation in the developing world to improve maternal and child health outcomes. The current study provides a case study of a performance evaluation in the Amazon region of Peru and how the findings can be used to make program adjustments. A set of instruments to measure the performance of CHWs was adapted from the literature and then implemented in the field. The instruments were used to measure the quality of home visits by the CHWs, their knowledge of the health topics, and structural activities. Three communities with an active CHW program in Loreto, Peru were chosen to receive the evaluation. All CHWs in the communities were evaluated. The scores from the evaluation were compared internally to identify strengths and weaknesses of the program and within the population of CHWs. The evaluation was completed on 52 home visits and 27 CHWs in three communities. The CHWs were found to be most effective at creating good relationships with caregivers and delivering health messages, and least effective at interacting with the child during the home visit and using material to deliver health messages. The evaluation instruments were well suited for the CHW program that utilizes home visits to teach about child health and development.

Comparison of computational performance of GA and PSO optimization techniques when designing similar systems - Typical PWR core case

Energy Technology Data Exchange (ETDEWEB)

Souza Lima, Carlos A. [Instituto de Engenharia Nuclear - Divisao de Reatores/PPGIEN, Rua Helio de Almeida 75, Cidade Universitaria - Ilha do Fundao, P.O. Box: 68550 - Zip Code: 21941-972, Rio de Janeiro (Brazil); Instituto Politecnico, Universidade do Estado do Rio de Janeiro, Pos-Graduacao em Modelagem Computacional, Rua Alberto Rangel - s/n, Vila Nova, Nova Friburgo, Zip Code: 28630-050, Nova Friburgo (Brazil); Lapa, Celso Marcelo F.; Pereira, Claudio Marcio do N.A. [Instituto de Engenharia Nuclear - Divisao de Reatores/PPGIEN, Rua Helio de Almeida 75, Cidade Universitaria - Ilha do Fundao, P.O. Box: 68550 - Zip Code: 21941-972, Rio de Janeiro (Brazil); Instituto Nacional de Ciencia e Tecnologia de Reatores Nucleares Inovadores (INCT) (Brazil); Cunha, Joao J. da [Eletronuclear Eletrobras Termonuclear - Gerencia de Analise de Seguranca Nuclear, Rua da Candelaria, 65, 7 andar. Centro, Zip Code: 20091-906, Rio de Janeiro (Brazil); Alvim, Antonio Carlos M. [Universidade Federal do Rio de Janeiro, COPPE/Nuclear, Cidade Universitaria - Ilha do Fundao s/n, P.O.Box 68509 - Zip Code: 21945-970, Rio de Janeiro (Brazil); Instituto Nacional de Ciencia e Tecnologia de Reatores Nucleares Inovadores (INCT) (Brazil)

2011-06-15

Research highlights: > Performance of PSO and GA techniques applied to similar system design. > This work uses ANGRA1 (two loop PWR) core as a prototype. > Results indicate that PSO technique is more adequate than GA to solve this kind of problem. - Abstract: This paper compares the performance of two optimization techniques, particle swarm optimization (PSO) and genetic algorithm (GA) applied to the design a typical reduced scale two loop Pressurized Water Reactor (PWR) core, at full power in single phase forced circulation flow. This comparison aims at analyzing the performance in reaching the global optimum, considering that both heuristics are based on population search methods, that is, methods whose population (candidate solution set) evolve from one generation to the next using a combination of deterministic and probabilistic rules. The simulated PWR, similar to ANGRA 1 power plant, was used as a case example to compare the performance of PSO and GA. Results from simulations indicated that PSO is more adequate to solve this kind of problem.

Performance of an SOI Boot-Strapped Full-Bridge MOSFET Driver, Type CHT-FBDR, under Extreme Temperatures

Science.gov (United States)

Patterson, Richard; Hammoud, Ahmad

2009-01-01

Electronic systems designed for use in deep space and planetary exploration missions are expected to encounter extreme temperatures and wide thermal swings. Silicon-based devices are limited in their wide-temperature capability and usually require extra measures, such as cooling or heating mechanisms, to provide adequate ambient temperature for proper operation. Silicon-On-Insulator (SOI) technology, on the other hand, lately has been gaining wide spread use in applications where high temperatures are encountered. Due to their inherent design, SOI-based integrated circuit chips are able to operate at temperatures higher than those of the silicon devices by virtue of reducing leakage currents, eliminating parasitic junctions, and limiting internal heating. In addition, SOI devices provide faster switching, consume less power, and offer improved radiation-tolerance. Very little data, however, exist on the performance of such devices and circuits under cryogenic temperatures. In this work, the performance of an SOI bootstrapped, full-bridge driver integrated circuit was evaluated under extreme temperatures and thermal cycling. The investigations were carried out to establish a baseline on the functionality and to determine suitability of this device for use in space exploration missions under extreme temperature conditions.

Experience measuring performance improvement in multiphase picture archiving and communications systems implementations.

Science.gov (United States)

Reed, G; Reed, D H

1999-05-01

When planning a picture archiving and communications system (PACS) implementation and determining which equipment will be implemented in earlier and later phases, collection and analysis of selected data will aid in setting implementation priorities. If baseline data are acquired relative to performance objectives, the same information used for implementation planning can be used to measure performance improvement and outcomes. The main categories of data to choose from are: (1) financial data; (2) productivity data; (3) operational parameters; (4) clinical data; and (5) information about customer satisfaction. In the authors' experience, detailed workflow data have not proved valuable in measuring PACS performance and outcomes. Reviewing only one category of data in planning will not provide adequate basis for targeting operational improvements that will lead to the most significant gains. Quality improvement takes into account all factors in production: human capacity, materials, operating capital and assets. Once we have identified key areas of focus for quality improvement in each phase, we can translate objectives into implementation requirements and finally into detailed functional and performance requirements. Here, Integration Resources reports its experience measuring PACS performance relative to phased implementation strategies for three large medical centers. Each medical center had its own objectives for overcoming image management, physical/geographical, and functional/technical barriers. The report outlines (1) principal financial and nonfinancial measures used as performance indicators; (2) implementation strategies chosen by each of the three medical centers; and (3) the results of those strategies as compared with baseline data.

Business Performance of Health Spa Tourism Providers in Relation to the Structure of Employees in the Republic of Croatia.

Science.gov (United States)

Vrkljan, Sanela; Grazio, Simeon

2017-12-01

Health spa tourism services are provided in special hospitals for medical rehabilitation and health resorts, and include controlled use of natural healing factors and physical therapy under medical supervision in order to improve and preserve health. Health tourism is a service industry and therefore labor-intensive industry in which human resources are one of the key factors of business success. The aim of this study was to analyze business performance of special hospitals for medical rehabilitation and health resorts in Croatia in relation to the structure of employees, specifically the number of physicians and total medical personnel, as well as the share of physicians and medical personnel in the total number of employees. The assumption was that those who employ more physicians and medical employees are more successful. The empirical research was conducted and the assumption was tested firstly by correlation analysis and afterwards by regression analysis. The total number of employees in the researched health resorts and special hospitals amounted to 2,863, of which the share of physicians specialists accounted for almost 7%, while the share of total medical staff was almost 53%. From the results of our research, it can be concluded that special hospitals for medical rehabilitation and health resorts, which employ more physicians and medical personnel, are achieving better financial business performance. Based on the results obtained, it is possible to provide guidance for further growth and development in the direction of basing the primary offer on medical-health offer, rather than on wellness offer, which is a strong trend in the world. These findings are important for planning the health and tourism policies in Croatia and similar countries.

40 CFR Table 4 to Subpart Kkkkk of... - Requirements for Performance Tests

Science.gov (United States)

2010-07-01

... block average pressure drop values for the three test runs, and determine and record the 3-hour block... limit for the limestone feeder setting Data from the limestone feeder during the performance test You must ensure that you maintain an adequate amount of limestone in the limestone hopper, storage bin...

Performance Evaluation of Extension Education Centers in Universities Based on the Balanced Scorecard

Science.gov (United States)

Wu, Hung-Yi; Lin, Yi-Kuei; Chang, Chi-Hsiang

2011-01-01

This study aims at developing a set of appropriate performance evaluation indices mainly based on balanced scorecard (BSC) for extension education centers in universities by utilizing multiple criteria decision making (MCDM). Through literature reviews and experts who have real practical experiences in extension education, adequate performance…

Healthcare providers balancing norms and practice: challenges and opportunities in providing contraceptive counselling to young people in Uganda – a qualitative study

Directory of Open Access Journals (Sweden)

Mandira Paul

2016-05-01

Full Text Available Background: Pregnancies among young women force girls to compromise education, resulting in low educational attainment with subsequent poverty and vulnerability. A pronounced focus is needed on contraceptive use, pregnancy, and unsafe abortion among young women. Objective: This study aims to explore healthcare providers’ (HCPs perceptions and practices regarding contraceptive counselling to young people. Design: We conducted 27 in-depth interviews with doctors and midwives working in seven health facilities in central Uganda. Interviews were open-ended and allowed the participant to speak freely on certain topics. We used a topic guide to cover areas topics of interest focusing on post-abortion care (PAC but also covering contraceptive counselling. Transcripts were transcribed verbatim and data were analysed using thematic analysis. Results: The main theme, HCPs' ambivalence to providing contraceptive counselling to sexually active young people is based on two sub-themes describing the challenges of contraceptive counselling: A HCPs echo the societal norms regarding sexual practice among young people, while at the same time our findings B highlights the opportunities resulting from providers pragmatic approach to contraceptive counselling to young women. Providers expressed a self-identified lack of skill, limited resources, and inadequate support from the health system to successfully provide appropriate services to young people. They felt frustrated with the consultations, especially when meeting young women seeking PAC. Conclusions: Despite existing policies for young people's sexual and reproductive health in Uganda, HCPs are not sufficiently equipped to provide adequate contraceptive counselling to young people. Instead, HCPs are left in between the negative influence of social norms and their pragmatic approach to address the needs of young people, especially those seeking PAC. We argue that a clear policy supported by a clear strategy

Browsing for the Best Internet Access Provider?

Science.gov (United States)

Weil, Marty

1996-01-01

Highlights points to consider when choosing an Internet Service Provider. Serial Line Internet Protocol (SLIP) and Point to Point Protocol (PPP) are compared regarding price, performance, bandwidth, speed, and technical support. Obtaining access via local, national, consumer online, and telephone-company providers is discussed. A pricing chart and…

How does care coordination provided by registered nurses "fit" within the organisational processes and professional relationships in the general practice context?

Science.gov (United States)

Ehrlich, Carolyn; Kendall, Elizabeth; St John, Winsome

2013-01-01

The aim of this study was to develop understanding about how a registered nurse-provided care coordination model can "fit" within organisational processes and professional relationships in general practice. In this project, registered nurses were involved in implementation of registered nurse-provided care coordination, which aimed to improve quality of care and support patients with chronic conditions to maintain their care and manage their lifestyle. Focus group interviews were conducted with nurses using a semi-structured interview protocol. Interpretive analysis of interview data was conducted using Normalization Process Theory to structure data analysis and interpretation. Three core themes emerged: (1) pre-requisites for care coordination, (2) the intervention in context, and (3) achieving outcomes. Pre-requisites were adequate funding mechanisms, engaging organisational power-brokers, leadership roles, and utilising and valuing registered nurses' broad skill base. To ensure registered nurse-provided care coordination processes were sustainable and embedded, mentoring and support as well as allocated time were required. Finally, when registered nurse-provided care coordination was supported, positive client outcomes were achievable, and transformation of professional practice and development of advanced nursing roles was possible. Registered nurse-provided care coordination could "fit" within the context of general practice if it was adequately resourced. However, the heterogeneity of general practice can create an impasse that could be addressed through close attention to shared and agreed understandings. Successful development and implementation of registered nurse roles in care coordination requires attention to educational preparation, support of the individual nurse, and attention to organisational structures, financial implications and team member relationships.

Medicare Provider Data - Hospice Providers

Data.gov (United States)

U.S. Department of Health & Human Services — The Hospice Utilization and Payment Public Use File provides information on services provided to Medicare beneficiaries by hospice providers. The Hospice PUF...

Use of Linear Programming to Develop Cost-Minimized Nutritionally Adequate Health Promoting Food Baskets

DEFF Research Database (Denmark)

Parlesak, A.; Tetens, Inge; Dejgård Jensen, Jørgen

2016-01-01

Food-Based Dietary Guidelines (FBDGs) are developed to promote healthier eating patterns, but increasing food prices may make healthy eating less affordable. The aim of this study was to design a range of cost-minimized nutritionally adequate health-promoting food baskets (FBs) that help prevent...... both micronutrient inadequacy and diet-related non-communicable diseases at lowest cost. Average prices for 312 foods were collected within the Greater Copenhagen area. The cost and nutrient content of five different cost-minimized FBs for a family of four were calculated per day using linear...... in each of the resulting five baskets was increased through limiting the relative share of individual foods. The one-day version of N contained only 12 foods at the minimum cost of DKK 27 (€ 3.6). The CA, DG, and DGN were about twice of this and the CAN cost ~DKK 81 (€ 10.8). The baskets with the greater...

Open of chat rooms for discussing geological disposal issues and review of adequate approaches for offering the information using the internet

International Nuclear Information System (INIS)

Takizawa, Masayuki; Ito, Toshikazu; Yabuta, Naohiro; Yoshizawa, Nobuaki; Tsunoda, Hirokazu

2001-03-01

JNC is doing publicity work to let the technical reliability for geological disposal of high-level radioactive waste (HLW) comprehended widely. But the information about geological disposal of HLW itself and its technology has not been spread and recognized. It has been required to offer the opportunity to discuss the geological disposal and its technology as our own issue. Recently the internet, which has such characteristics as two-way, instant and open communication means, has become used on business and for pleasure commonly. So the opportunity for discussing the topics related to geological disposal of HLW has been offered on the internet web site so-called 'Internet Forum' by JNC since fiscal year 1999. 'Internet Forum' or an assembly of chat rooms is being run on the web server which is not operated by JNC in order to provide the place where discussion on the issue can be done as fairly and objectively as possible. In this report, the results of Internet Forum in fiscal year 2000 comparing with that in fiscal year 1999 were shown and the adequate approaches of operating 'Internet Forum' and offering the information about geological disposal of HLW were reviewed. (author)

A novel spatial performance metric for robust pattern optimization of distributed hydrological models

Science.gov (United States)

Stisen, S.; Demirel, C.; Koch, J.

2017-12-01

Evaluation of performance is an integral part of model development and calibration as well as it is of paramount importance when communicating modelling results to stakeholders and the scientific community. There exists a comprehensive and well tested toolbox of metrics to assess temporal model performance in the hydrological modelling community. On the contrary, the experience to evaluate spatial performance is not corresponding to the grand availability of spatial observations readily available and to the sophisticate model codes simulating the spatial variability of complex hydrological processes. This study aims at making a contribution towards advancing spatial pattern oriented model evaluation for distributed hydrological models. This is achieved by introducing a novel spatial performance metric which provides robust pattern performance during model calibration. The promoted SPAtial EFficiency (spaef) metric reflects three equally weighted components: correlation, coefficient of variation and histogram overlap. This multi-component approach is necessary in order to adequately compare spatial patterns. spaef, its three components individually and two alternative spatial performance metrics, i.e. connectivity analysis and fractions skill score, are tested in a spatial pattern oriented model calibration of a catchment model in Denmark. The calibration is constrained by a remote sensing based spatial pattern of evapotranspiration and discharge timeseries at two stations. Our results stress that stand-alone metrics tend to fail to provide holistic pattern information to the optimizer which underlines the importance of multi-component metrics. The three spaef components are independent which allows them to complement each other in a meaningful way. This study promotes the use of bias insensitive metrics which allow comparing variables which are related but may differ in unit in order to optimally exploit spatial observations made available by remote sensing

The ambiguous role of healthcare providers: a new perspective in Human Resources Management.

Science.gov (United States)

Panari, Chiara; Levati, W; Bonini, A; Tonelli, M; Alfieri, E; Artioli, Giovanna

2016-05-26

A strategic Human Resources Management approach, that overcomes anadministrative Personnel Management, is becoming crucial for hospital organizations. In this sense, the aimof this work was to examine the figure of healthcare provider using the concept of role, as expected behaviourin term of integration in the organizational culture. The instrument used to analyse the healthcareprovider figure was "role mapping". Particularly, semistructured interviews were conducted and involved to36 health professionals of four units in order to examine the behaviour expectations system towards thehealthcare providers. The analysis revealed that the expectations of different professionals relatedto the healthcare provider were dissimilar. Physicians' expectations referred to technical preparation and efficiency,while nurses and nurse coordinators required collaboration in equip work and emotional support forpatients. In all Operating Units, directors were perceived as missing persons with vague expectations of efficiency.Differences concerned also the four Units. For example, in intensive care Unit, the role of healthcareprovider was clearer and this figure was perceived as essential for patients' care and for the equip teamwork.On the contrary, in Recovery Unit the healthcare provider was underestimated, the role was ambiguous andnot integrated in the equip even if there was a clear division of tasks between nurses and healthcare providers. The "role mapping" instrument allows to identify healthcare provider profile and find possible roleambiguity and conflicts in order to plan adequate human resources management interventions.

Stool consistency and stool frequency are excellent clinical markers for adequate colon preparation after polyethylene glycol 3350 cleansing protocol: a prospective clinical study in children.

Science.gov (United States)

Safder, Shaista; Demintieva, Yulia; Rewalt, Mary; Elitsur, Yoram

2008-12-01

Colon preparation for a colonoscopy in children is a difficult task because of the unpalatable taste and large volume of cleansing solution that needs to be consumed to ensure a clean colon. Consequently, an unprepared colon frequently occurs in routine practices, which causes early termination and a repeated procedure. (1) To assess the effectiveness of polyethylene glycol solution (PEG 3350) in preparing the colon of children scheduled for a colonoscopy and (2) to investigate clinical markers associated with an adequate colon preparation before a colonoscopy. A total of 167 children scheduled for a colonoscopy. In a prospective study, children scheduled for a colonoscopy were given PEG 3350 solution (1.5 g/kg per day, up to 100 g/d) over a 4-day preparation period. Each day, a simple questionnaire that documents the amount of liquid consumed, adverse effects, and the number and consistency of stool was completed by the parents. After a colonoscopy procedure, the colon preparation was assigned a number grade. The data were later assessed and were compared to determine the association between the grade of cleansing and the frequency and/or consistency of stool during preparation. Colon preparation was completed in 149 children, 133 of whom were adequately prepared. Inadequate preparation was found in 16 children; the procedure was terminated prematurely in 2 of these patients because of unacceptable conditions. No significant adverse effects were noted. A number of >or=5 stools/d, and liquid stool consistency in the last 2 days of preparation were associated with adequate colon preparation. PEG 3350 solution is safe, efficacious, and tolerable for children. Stool frequency and consistency in the last 2 days of preparation were excellent markers (positive predictive value 91%-95%), which predict an adequately clean colon before a colonoscopy in children.

District health manager and mid-level provider perceptions of practice environments in acute obstetric settings in Tanzania: a mixed-method study.

Science.gov (United States)

Ng'ang'a, Njoki; Byrne, Mary Woods; Kruk, Margaret E; Shemdoe, Aloisia; de Pinho, Helen

2016-08-08

In sub-Saharan Africa, the capacity of human resources for health (HRH) managers to create positive practice environments that enable motivated, productive, and high-performing HRH is weak. We implemented a unique approach to examining HRH management practices by comparing perspectives offered by mid-level providers (MLPs) of emergency obstetric care (EmOC) in Tanzania to those presented by local health authorities, known as council health management teams (CHMTs). This study was guided by the basic strategic human resources management (SHRM) component model. A convergent mixed-method design was utilized to assess qualitative and quantitative data from the Health Systems Strengthening for Equity: The Power and Potential of Mid-Level Providers project. Survey data was obtained from 837 mid-level providers, 83 of whom participated in a critical incident interview whose aim was to elicit negative events in the practice environment that induced intention to leave their job. HRH management practices were assessed quantitatively in 48 districts with 37 members of CHMTs participating in semi-structured interviews. The eight human resources management practices enumerated in the basic SHRM component model were implemented unevenly. On the one hand, members of CHMTs and mid-level providers agreed that there were severe shortages of health workers, deficient salaries, and an overwhelming workload. On the other hand, members of CHMTs and mid-level providers differed in their perspectives on rewards and allocation of opportunities for in-service training. Although written standards of performance and supervision requirements were available in most districts, they did not reflect actual duties. Members of CHMTs reported high levels of autonomy in key HRH management practices, but mid-level providers disputed the degree to which the real situation on the ground was factored into job-related decision-making by CHMTs. The incongruence in perspectives offered by members of CHMTs

Forecasting the Performance of Agroforestry Systems

Science.gov (United States)

Luedeling, E.; Shepherd, K.

2014-12-01

Agroforestry has received considerable attention from scientists and development practitioners in recent years. It is recognized as a cornerstone of many traditional agricultural systems, as well as a new option for sustainable land management in currently treeless agricultural landscapes. Agroforestry systems are diverse, but most manifestations supply substantial ecosystem services, including marketable tree products, soil fertility, water cycle regulation, wildlife habitat and carbon sequestration. While these benefits have been well documented for many existing systems, projecting the outcomes of introducing new agroforestry systems, or forecasting system performance under changing environmental or climatic conditions, remains a substantial challenge. Due to the various interactions between system components, the multiple benefits produced by trees and crops, and the host of environmental, socioeconomic and cultural factors that shape agroforestry systems, mechanistic models of such systems quickly become very complex. They then require a lot of data for site-specific calibration, which presents a challenge for their use in new environmental and climatic domains, especially in data-scarce environments. For supporting decisions on the scaling up of agroforestry technologies, new projection methods are needed that can capture system complexity to an adequate degree, while taking full account of the fact that data on many system variables will virtually always be highly uncertain. This paper explores what projection methods are needed for supplying decision-makers with useful information on the performance of agroforestry in new places or new climates. Existing methods are discussed in light of these methodological needs. Finally, a participatory approach to performance projection is proposed that captures system dynamics in a holistic manner and makes probabilistic projections about expected system performance. This approach avoids the temptation to take

Dried duckweed and commercial feed promote adequate growth performance of tilapia fi ngerlings

OpenAIRE

Tavares, Flávia de A.; Rodrigues, João Bosco R.; Fracalossi, Débora Machado; Esquivel, Juan; Roubach, Rodrigo

2008-01-01

http://dx.doi.org/10.5007/2175-7925.2008v21n3p91Desempenho de alevinos de tilapia nilótica alimentados com uma  combinação de lemnas secas e ração comercial. O presente estudo  avaliou a utilização de ração comercial e lemna seca no cultivo de  alevinos de tilápias nilóticas com o objetivo de reduzir os custos de produção. Três dietas representadas por lemna seca, ração comercial  (40% proteína bruta) e uma combinação de lemna seca e ração  comercial foram fornecidas a um grupo de 20 alevinos...

Development of a multi-functional platform to perform the I and C system test, diagnosis and training

International Nuclear Information System (INIS)

Ren Chunxiang; Guan Yunquan; Wang Xingye

2014-01-01

The Safety I and C system of Tianwan Nuclear Power Station (TNPS) is implemented with the Class lE digital I and C platform TELEPERM XS (TXS). To satisfy the requirements of TXS system fault diagnosis, spare parts performance test as well as the staff maintenance skill training, through the study of operating environment and configuration characteristics of the online TXS system, and adequately absorb the experiences of the digital control device test systems which are applied in both domestic and abroad, developed and established a set of TXS system multifunctional platform which performs the TXS software/hardware testing, fault diagnosis and staff maintenance skill training. Practice has proved that the platform running well to perform the test of the TXS system hardware and software, fault diagnosis and the training tasks to ensure the reliable operation of the online safety I and C system, and shorten the maintenance cycle of online TXS system, improved the technical level of the Operation and maintenance personnel, it provides a reference for similar I and C systems of other nuclear power plants. (authors)

The performance of the DELPHI hadron calorimeter at LEP

International Nuclear Information System (INIS)

Ajinenko, I.; Beloous, K.; Chudoba, J.

1996-01-01

The DELPHI Hadron Calorimeter was conceived more than ten years ago, as an instrument to measure the energy of hadrons and hadronic jets from e + e - collisions at the CERN collider LEP. In addition it was expected to provide a certain degree of discrimination between pions and muons. The detector is a rather simple and relatively inexpensive device consisting of around 20,000 limited streamer plastic tubes, with inductive pad read-out, embedded in the iron yoke of the 1.2 T DELPHI magnet. Its depth is at minimum 6.6 nuclear interaction lengths. The electronics necessary for the pad readout was designed to have an adequate performance for a reasonable cost. This detector has proved over six years of operation to have an entirely satisfactory performance and great reliability; for example less than 1% of the streamer tubes have failed and electronic problems remain at the per mil level. During the past two years an improvement program has been under way. It has been found possible to use the streamer tubes as strips, hence giving better granularity and particle tracking, by reading out the cathode of individual tubes. The constraints on this were considerable because of the inaccessibility of the detectors in the magnet yoke. However, a cheap and feasible solution has been found. The cathode readout leads to an improved energy resolution, better μ identification, a better π/μ separation and to possibilities of neutral particle separation. The simultaneous anode read-out of several planes of the endcaps of the detector will provide a fast trigger in the forward/backward direction which is an important improvement for LEP200. On the barrel the system will provide a cosmic trigger which is very useful for calibration as counting rates at LEP200 will be very low

Non-financial reports, anti-corruption performance and corporate reputation

Directory of Open Access Journals (Sweden)

Maider Aldaz

2015-12-01

Full Text Available Objective – This paper analyzes whether the anti-corruption reporting practices of the companies are a reflection of adequate anti-corruption systems put in place by companies, or whether the disclosure is merely a tool for companies to improve their reputation and thus maintain their legitimacy. Design/methodology/approach – We apply the PLS method to the collected data in a content analysis of the sustainability reports of 31 companies within the Ibex 35 in December 2008. Theoretical foundation – In the analysis, we use both the legitimacy theory and the stakeholder theory, because we consider them as complementary theories and consistent with our approach. Findings – The results show that regarding the corruption issue there is a negative relationship between disclosure and performance, that is, companies with poor performance disclose more. On the other hand, the results reflect the existence of a positive relationship between disclosure and reputation, i.e. report information to interested parties enhances the perception of stakeholders about the company. This finding could be justified by the above two theories. However, we can’t conclude that companies with good performance disclose information to key stakeholders in order to strengthen relations, as stated by the stakeholder theory. Practical implications – this study provides evidence of how companies use non-financial reporting-specifically anti-corruption data- to improve corporate reputation. It is also noted that reporting practices not necessarily have to be in accordance with the actual anti-corruption practices of firms.

Performance assessment of sealing systems. Conceptual and integrated modelling of plugs and seals

Energy Technology Data Exchange (ETDEWEB)

Ruebel, Andre; Buhmann, Dieter; Kindlein, Jonathan; Lauke, Thomas

2016-08-15

The long-time isolation of radionuclides from the biosphere is the goal of the storage of radioactive waste in deep geological repositories. For repositories in rock salt, this goal is achieved on the one hand by the impermeable undisturbed part of the salt host rock formation and on the other hand by crushed salt, which is used to backfill the mine openings in the emplacement areas and galleries created during the construction of the repository. The crushed salt backfill is compacted over time and achieves a sufficiently high hydraulic resistance to avoid inflow of brines into the emplacement areas of the repository in the long-term. Plugs and seals must additionally provide their sealing function during the early post closure phase, until the compaction of the backfill is adequate and the permeability of the backfill is sufficiently low. To assess the future development of the waste repository, an adequate knowledge of the material behaviour is necessary and related mathematical models must be developed to be able to perform predictions on the long-term safety of the repository. An integrated performance assessment model was formulated that describes the long-term behaviour of a sealing built from salt concrete. The average permeability of the sealing changes with time after its emplacement from various processes of which two were regarded in a constitutive model: first, the healing of the EDZ in the host rock around the sealing, and second, the corrosion of the salt concrete material resulting from brine attack. Empirical parameter model functions were defined for both processes to reflect the actual behaviour. The mathematical model was implemented in the integrated performance assessment model LOPOS which is used by GRS as near-field model for repositories in salt. Deterministic and probabilistic calculations were performed with realistic parameters showing how the permeability of the sealing decreases during the first 2 000 years due to the healing of the EDZ

Performance assessment of sealing systems. Conceptual and integrated modelling of plugs and seals

International Nuclear Information System (INIS)

Ruebel, Andre; Buhmann, Dieter; Kindlein, Jonathan; Lauke, Thomas

2016-08-01

The long-time isolation of radionuclides from the biosphere is the goal of the storage of radioactive waste in deep geological repositories. For repositories in rock salt, this goal is achieved on the one hand by the impermeable undisturbed part of the salt host rock formation and on the other hand by crushed salt, which is used to backfill the mine openings in the emplacement areas and galleries created during the construction of the repository. The crushed salt backfill is compacted over time and achieves a sufficiently high hydraulic resistance to avoid inflow of brines into the emplacement areas of the repository in the long-term. Plugs and seals must additionally provide their sealing function during the early post closure phase, until the compaction of the backfill is adequate and the permeability of the backfill is sufficiently low. To assess the future development of the waste repository, an adequate knowledge of the material behaviour is necessary and related mathematical models must be developed to be able to perform predictions on the long-term safety of the repository. An integrated performance assessment model was formulated that describes the long-term behaviour of a sealing built from salt concrete. The average permeability of the sealing changes with time after its emplacement from various processes of which two were regarded in a constitutive model: first, the healing of the EDZ in the host rock around the sealing, and second, the corrosion of the salt concrete material resulting from brine attack. Empirical parameter model functions were defined for both processes to reflect the actual behaviour. The mathematical model was implemented in the integrated performance assessment model LOPOS which is used by GRS as near-field model for repositories in salt. Deterministic and probabilistic calculations were performed with realistic parameters showing how the permeability of the sealing decreases during the first 2 000 years due to the healing of the EDZ

Performance evaluation of an integrated automotive air conditioning and heat pump system

International Nuclear Information System (INIS)

Hosoz, M.; Direk, M.

2006-01-01

This study deals with the performance characteristics of an R134a automotive air conditioning system capable of operating as an air-to-air heat pump using ambient air as a heat source. For this aim, an experimental analysis has been performed on a plant made up of original components from an automobile air conditioning system and some extra equipment employed to operate the system in the reverse direction. The system has been tested in the air conditioning and heat pump modes by varying the compressor speed and air temperatures at the inlets of the indoor and outdoor coils. Evaluation of the data gathered in steady state test runs has shown the effects of the operating conditions on the capacity, coefficient of performance, compressor discharge temperature and the rate of exergy destroyed by each component of the system for both operation modes. It has been observed that the heat pump operation provides adequate heating only in mild weather conditions, and the heating capacity drops sharply with decreasing outdoor temperature. However, compared with the air conditioning operation, the heat pump operation usually yields a higher coefficient of performance and a lower rate of exergy destruction per unit capacity. It is also possible to improve the heating mode performance of the system by redesigning the indoor coil, using another refrigerant with a higher heat rejection rate in the condenser and employing a better heat source such as the engine coolant or exhaust gases

Vitamin D concentration effect in health care and sport performance

Directory of Open Access Journals (Sweden)

Lora Georgieva

2018-02-01

Full Text Available The molecular structure of Vitamin D is closely allied to that of classical steroids such as cholesterol. Technically Vitamin D is a seco-steroid hormone. Vitamin D3 (cholecalciferol is normally produced by exposure to sunlight of the precursor (7-dehydrocholesterol, present in the skin. Vitamin D supplementation vary between 200 IU to 1000 IU. Serum levels of 25(OHD are generally consider as a indicator of Vitamin D status. Vitamin D plays an essential role in healthcare, related not only with developing and maintaining a healthy skeleton. Its adequate supplementation reduce even the risk of caries and oral infections. Furthermore Vitamin D as a steroid hormone, modulates many gene transcription and has anti-inflammatory and cardiovascular protective effect. Uncertainly low serum levels of 25(OHD are associated with misbalance in lipid profile and dyslipidemia, sacropenia and muscle weakness. Its insufficiency is also a risk factor for enhanced reception of pain, risk of type 2 diabetes, and often falls occurrences. Adequate Vitamin D status is protective against musculoskeletal disorders, infection disease, depression, diabetes mellitus, autoimmune diseases and neurocognitive dysfunctions. In sport activities and athletic population adequate serum levels of 25(OHD increase muscle strength, and physical performance, and should be monitored.

The performance implications of outsourcing customer support to service providers in emerging versus established economies

NARCIS (Netherlands)

Raassens, N.; Wuyts, S.H.K.; Geyskens, I.

Recent discussions in the business press query the contribution of customer-support outsourcing to firm performance. Despite the controversy surrounding its performance implications, customer-support outsourcing is still on the rise, especially to emerging markets. Against this backdrop, we study

The performance implications of outsourcing customer support to service providers in emerging versus established economies

NARCIS (Netherlands)

Raassens, N.; Wuyts, S.; Geyskens, I.

2014-01-01

Recent discussions in the business press query the contribution of customer-support outsourcing to firm performance. Despite the controversy surrounding its performance implications, customer-support outsourcing is still on the rise, especially to emerging markets. Against this backdrop, we study

Evaluation of the performances of wastewater treatment services provided by the metropolitan municipalities in Turkey using Entropy integrated SAW, MOORA and TOPSIS

OpenAIRE

Ayyıldız, Ertuğrul; Özçelik, Gökhan

2018-01-01

Reusingof the wastewater has a vital importance because of limited natural waterresources all around the world. Recycled wastewater can be used in many areassuch as agriculture, industry, cleaning etc. Treatment of wastewater is one ofthe important tasks of metropolitan municipalities. The aim of this study is toevaluate the performances of wastewater treatment services provided by themetropolitan municipalities in Turkey using Entropy integrated SAW, MOORA andTOPSIS methods. In the scope of ...

Compressed multiwall carbon nanotube composite electrodes provide enhanced electroanalytical performance for determination of serotonin

International Nuclear Information System (INIS)

Fagan-Murphy, Aidan; Patel, Bhavik Anil

2014-01-01

Serotonin (5-HT) is an important neurochemical that is present in high concentrations within the intestinal tract. Carbon fibre and boron-doped diamond based electrodes have been widely used to date for monitoring 5-HT, however these electrodes are prone to fouling and are difficult to fabricate in certain sizes and geometries. Carbon nanotubes have shown potential as a suitable material for electroanalytical monitoring of 5-HT but can be difficult to manipulate into a suitable form. The fabrication of composite electrodes is an approach that can shape conductive materials into practical electrode geometries suitable for biological environments. This work investigated how compression of multiwall carbon nanotubes (MWCNTs) epoxy composite electrodes can influence their electroanalytical performance. Highly compressed composite electrodes displayed significant improvements in their electrochemical properties along with decreased internal and charge transfer resistance, reproducible behaviour and improved batch to batch variability when compared to non-compressed composite electrodes. Compression of MWCNT epoxy composite electrodes resulted in an increased current response for potassium ferricyanide, ruthenium hexaammine and dopamine, by preferentially removing the epoxy during compression and increasing the electrochemical active surface of the final electrode. For the detection of serotonin, compressed electrodes have a lower limit of detection and improved sensitivity compared to non-compressed electrodes. Fouling studies were carried out in 10 μM serotonin where the MWCNT compressed electrodes were shown to be less prone to fouling than non-compressed electrodes. This work indicates that the compression of MWCNT carbon-epoxy can result in a highly conductive material that can be moulded to various geometries, thus providing scope for electroanalytical measurements and the production of a wide range of analytical devices for a variety of systems

NRC iterative performance assessment Phase 2. Development of capabilities for review of a performance assessment for a high-level waste repository

International Nuclear Information System (INIS)

Wescott, R.G.; Lee, M.P.; Eisenberg, N.A.; Baca, R.G.

1995-10-01

In order to better review a potential license application to construct and operate a geologic repository for spent nuclear fuel and high-level radioactive waste (HLW), the Nuclear Regulatory Commission staff (and its contractor) has expanded and improved its capability to conduct performance assessments. This report documents the demonstration of the second phase of this capability. The demonstration made use of the scenario selection procedure developed by Sandia National Laboratories to provide a set of scenarios, with corresponding probabilities, for use in the consequence analysis of a potential HLW disposal site in unsaturated tuff. Models of release of radionuclides from the waste form and transport in ground water, air and by direct pathways provided preliminary estimates of releases to the accessible environment for a 10,000 year period. The input values of parameters necessary for the consequence models were sampled numerous times using Latin Hypercube Sampling from assumed probability distributions. The results from the consequence models were then used to generate Complementary Cumulative Distribution Functions (CCDFs) for either release to the accessible environment or effective dose equivalents to a target population. CCDFs were calculated for probabilistically significant combinations (scenarios) of four disruptive events; drilling, pluvial climate, seismicity and magmatism. Sensitivity and uncertainty analyses of the calculated releases and effective dose equivalents were also used to determine the importance of the parameters. Because of the preliminary nature of the analysis and the lack of an adequate data base, the results and conclusions presented in this report should be carefully interpreted. They should not be misconstrued to represent the actual performance of the proposed Yucca Mountain repository nor serve as an endorsement of the methods used

Performance indicators for quality in surgical and laboratory services at Muhimbili National Hospital (MNH) in Tanzania.

Science.gov (United States)

Mbembati, Naboth A; Mwangu, Mugwira; Muhondwa, Eustace P Y; Leshabari, Melkizedek M

2008-04-01

Muhimbili National Hospital (MNH), a teaching and national referral hospital, is undergoing major reforms to improve the quality of health care. We performed a retrospective descriptive study using a set of performance indicators for the surgical and laboratory services of MNH in years 2001 and 2002, to help monitor and evaluate the impact of reforms on the quality of health care during and after the reform process. Hospital records were reviewed and information recorded for planned and postponed operations, laboratory equipment, reagents, laboratory tests and quality assurance programmes. In the year 2001 a total of 4332 non-emergency operations were planned, 3313 operations were performed and 1019 (23.5%) operations were postponed. In the year 2002, 4301 non-emergency operations were planned, 3046 were performed and 1255 (29%) were postponed. The most common reasons for operation postponement were "time-barred", interference by emergency operations, no show of patients and inoperable anaesthetic machines. Equipment problems and supply and staff shortages together accounted for one quarter of postponements. In the laboratory, a lack of equipment prevented some tests, but quality assurance was performed for most tests. Current surgical services at MNH are inadequate; operating theatres require modern, functioning equipment and adequate supplies of consumables to provide satisfactory care.

Postactivation potentiation of sprint acceleration performance using plyometric exercise.

Science.gov (United States)

Turner, Anthony P; Bellhouse, Sam; Kilduff, Liam P; Russell, Mark

2015-02-01

Postactivation potentiation (PAP), an acute and temporary enhancement of muscular performance resulting from previous muscular contraction, commonly occurs after heavy resistance exercise. However, this method of inducing PAP has limited application to the precompetition practices (e.g., warm-up) of many athletes. Very few studies have examined the influence of plyometric activity on subsequent performance; therefore, we aimed to examine the influence of alternate-leg bounding on sprint acceleration performance. In a randomized crossover manner, plyometric-trained men (n = 23) performed seven 20-m sprints (with 10-m splits) at baseline, ∼15 seconds, 2, 4, 8, 12, and 16 minutes after a walking control (C) or 3 sets of 10 repetitions of alternate-leg bounding using body mass (plyometric, P) and body mass plus 10% (weighted plyometric, WP). Mean sprint velocities over 10 and 20 m were similar between trials at baseline. At ∼15 seconds, WP impaired 20-m sprint velocity by 1.4 ± 2.5% when compared with C (p = 0.039). Thereafter, 10- and 20-m sprint velocities improved in WP at 4 minutes (10 m: 2.2 ± 3.1%, p = 0.009; 20 m: 2.3 ± 2.6%, p = 0.001) and 8 minutes (10 m: 2.9 ± 3.6%, p = 0.002; 20 m: 2.6 ± 2.8%, p = 0.001) compared with C. Improved 10-m sprint acceleration performance occurred in P at 4 minutes (1.8 ± 3.3%, p = 0.047) relative to C. Therefore, sprint acceleration performance is enhanced after plyometric exercise providing adequate recovery is given between these activities; however, the effects may differ according to whether additional load is applied. This finding presents a practical method to enhance the precompetition practices of athletes.

National audit of the quality of pain relief provided in emergency departments in Aotearoa, New Zealand: The PRiZED 1 Study.

Science.gov (United States)

2017-04-01

Pain is a common feature of ED presentations and the timely provision of adequate analgesia is important for patient care. However, there is currently no New Zealand data with respect to this indicator of care quality. The present study aimed to provide a baseline for the quality of care with respect to the provision of timely and adequate analgesia in New Zealand EDs. The present study is a secondary analysis of data initially collected for the Shorter Stays in Emergency Department Study, using a retrospective chart review of 1685 randomly selected ED presentations (2006-2012) from 26 New Zealand public hospital EDs. Of the 1685 charts randomly selected, 1547 (91%) were reviewed from 21 EDs. There were 866 ED presentations with painful conditions, of whom 132 (15%) did not have pain recorded, 205 (24%) did not receive pain relief and 19 (2%) did not have time of analgesia documented leaving 510 (59%) for the analysis of time to analgesia. Four hundred and fifty-seven (53%) did not have pain well documented sufficiently to assess adequacy, leaving 277 (32%) for the analysis of adequacy of analgesia. The median (interquartile range) time to analgesia was 62 (30-134) min and the provision of adequate analgesia was 141/277 (51%, 95% CI: 45-57%); however, there was some variation between hospitals for both outcomes. Although these outcomes are on a par with other countries, this baseline audit has shown both poor documentation and variation in the provision of timely and adequate pain relief in New Zealand EDs, with room for improvement with respect to this quality indicator. © 2017 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

Effects of pressure, cold and gloves on hand skin temperature and manual performance of divers.

Science.gov (United States)

Zander, Joanna; Morrison, James

2008-09-01

Cold water immersion and protective gloves are associated with decreased manual performance. Although neoprene gloves slow hand cooling, there is little information on whether they provide sufficient protection when diving in cold water. Nine divers wearing three-fingered neoprene gloves and dry suits were immersed in water at 25 and 4 degrees C, at depths of 0.4 msw (101 kPa altitude adjusted) and 40 msw (497 kPa) in a hyperbaric chamber. Skin temperatures were measured at the fingers, hand, forearm, chest and head. Grip strength, tactile sensitivity and manual dexterity were measured at three time intervals. There was an exponential decay in finger and back of hand skin temperatures with exposure time in 4 degrees C water. Finger and back of hand skin temperatures were lower at 40 msw than at 0.4 msw (P effect of pressure or temperature on grip strength. Tactile sensitivity decreased linearly with finger skin temperature at both pressures. Manual dexterity was not affected by finger skin temperature at 0.4 msw, but decreased with fall in finger skin temperature at 40 msw. Results show that neoprene gloves do not provide adequate thermal protection in 4 degrees C water and that impairment of manual performance is dependent on the type of task, depth and exposure time.

Protocol for VOC-Arid ID remediation performance characterization

International Nuclear Information System (INIS)

Tegner, B.J.; Hassig, N.L.; Last, G.V.

1994-09-01

The Volatile Organic Compound-Arid Integrated Demonstration (VOC-Arid ID) is a technology development program sponsored by the US Department of Energy's Office of Technology Development that is targeted to acquire, develop, demonstrate, and deploy new technologies for the remediation of VOC contaminants in the soils and groundwaters of arid DOE sites. Technologies cannot be adequately evaluated unless sufficient site characterization and technology performance data have been collection and analyzed. The responsibility for identifying these data needs has been placed largely on the Principal Investigators (PIs) developing the remediation technology, who usually are not experts in site characterization or in identification of appropriate sampling, analysis, and monitoring techniques to support the field testing. This document provides a protocol for planning the collection of data before, during, and after a test of a new technology. This generic protocol provides the PIs and project managers with a set of steps to follow. The protocol is based on a data collection planning process called the Data Quality Objectives (DQO) process, which was originally developed by the US Environmental Protection Agency and has been expanded by DOE to support site cleanup decisions. The DQO process focuses on the quality and quantity of data required to make decision. Stakeholders to the decisions must negotiate such key inputs to the process as the decision rules that will be used and the acceptable probabilities of making decision errors

[Lack of correlation between performances in a simulator and in reality].

Science.gov (United States)

Konge, Lars; Bitsch, Mikael

2010-12-13

Simulation-based training provides obvious benefits for patients and doctors in education. Frequently, virtual reality simulators are expensive and evidence for their efficacy is poor, particularly as a result of studies with poor methodology and few test participants. In medical simulated training- and evaluation programmes it is always a question of transfer to the real clinical world. To illustrate this problem a study comparing the test performance of persons on a bowling simulator with their performance in a real bowling alley was conducted. Twenty-five test subjects played two rounds of bowling on a Nintendo Wii and 25 days later on a real bowling alley. Correlations of the scores in the first and second round (test-retest-reliability) and of the scores on the simulator and in reality (criterion validation) were studied and there was tested for any difference between female and male performance. The intraclass correlation coefficient equalled 0.76, i.e. the simulator fairly accurately measured participant performance. In contrast to this there was absolutely no correlation between participants' real bowling abilities and their scores on the simulator (Pearson's r = 0.06). There was no significant difference between female and male abilities. Simulation-based testing and training must be based on evidence. More studies are needed to include an adequate number of subjects. Bowling competence should not be based on Nintendo Wii measurements. Simulated training- and evaluation programmes should be validated before introduction, to ensure consistency with the real world.

GSM Marketing Service Providers Operations and Customers Satisfaction in Nigeria: An Empirical Investigation

Directory of Open Access Journals (Sweden)

Adebisi Sunday Abayomi

2011-06-01

Full Text Available This study has been carried out on the GSM arm of the Nigerian Telecomunication sectorto primarily investigate the level of satisfaction that the subscribers of GSM service providers haveenjoyed in the seven years of operations in Nigeria. In testing this empirically, MTN, GLOBACOMand ZAIN were selected as case studies. 600 questionnaires were administered on the subscribers ofthese GSM service providers in the Six States of the South-Western Nigeria using the purposivesampling technique. In analyzing the collated data, three hypotheses were tested with the use ofPercentages, T-test, F-test, [at 95% confidence limit], Cross-tabulation [using the ‘Eta’ Directionalmeasure] and statistical charts. The results from the SPSS 16 output rejected the Null hypotheses.This further indicated that, the various factors that determined the level of subscribers’ satisfactionwere statistically significant. The study therefore concluded that, subscribers in Nigeria aredissatisfied with the services of their service providers hence, the need for the regulatory body; NCCto ensure that subscribers interests are protected. The study then suggested that,, the GSM serviceproviders should reposition themselves to give adequate value to subscribers money incommensuration with their own gains from the Nigeria Telecommunications market.

Punica granatum (Pomegranate juice provides an HIV-1 entry inhibitor and candidate topical microbicide

Directory of Open Access Journals (Sweden)

Li Yun-Yao

2004-10-01

Full Text Available Abstract Background For ≈ 24 years the AIDS pandemic has claimed ≈ 30 million lives, causing ≈ 14,000 new HIV-1 infections daily worldwide in 2003. About 80% of infections occur by heterosexual transmission. In the absence of vaccines, topical microbicides, expected to block virus transmission, offer hope for controlling the pandemic. Antiretroviral chemotherapeutics have decreased AIDS mortality in industrialized countries, but only minimally in developing countries. To prevent an analogous dichotomy, microbicides should be: acceptable; accessible; affordable; and accelerative in transition from development to marketing. Already marketed pharmaceutical excipients or foods, with established safety records and adequate anti-HIV-1 activity, may provide this option. Methods Fruit juices were screened for inhibitory activity against HIV-1 IIIB using CD4 and CXCR4 as cell receptors. The best juice was tested for inhibition of: (1 infection by HIV-1 BaL, utilizing CCR5 as the cellular coreceptor; and (2 binding of gp120 IIIB and gp120 BaL, respectively, to CXCR4 and CCR5. To remove most colored juice components, the adsorption of the effective ingredient(s to dispersible excipients and other foods was investigated. A selected complex was assayed for inhibition of infection by primary HIV-1 isolates. Results HIV-1 entry inhibitors from pomegranate juice adsorb onto corn starch. The resulting complex blocks virus binding to CD4 and CXCR4/CCR5 and inhibits infection by primary virus clades A to G and group O. Conclusion These results suggest the possibility of producing an anti-HIV-1 microbicide from inexpensive, widely available sources, whose safety has been established throughout centuries, provided that its quality is adequately standardized and monitored.

Intelligence, Academic Self-Concept, and Information Literacy: The Role of Adequate Perceptions of Academic Ability in the Acquisition of Knowledge about Information Searching

Science.gov (United States)