WorldWideScience

Sample records for providing significant performance

  1. 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.

  2. Provider Customer Service Program - Performance Data

    Data.gov (United States)

    U.S. Department of Health & Human Services — CMS is continuously analyzing performance and quality of the Provider Customer Service Programs (PCSPs) of the contractors and will be identifying trends and making...

  3. 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

  4. 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...

  5. 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....

  6. 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

  7. 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.

  8. 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

  9. 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...

  10. 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].

  11. 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

  12. Behavioral Change and Building Performance: Strategies for Significant, Persistent, and Measurable Institutional Change

    Energy Technology Data Exchange (ETDEWEB)

    Wolfe, Amy K.; Malone, Elizabeth L.; Heerwagen, Judith H.; Dion, Jerome P.

    2014-04-01

    The people who use Federal buildings — Federal employees, operations and maintenance staff, and the general public — can significantly impact a building’s environmental performance and the consumption of energy, water, and materials. Many factors influence building occupants’ use of resources (use behaviors) including work process requirements, ability to fulfill agency missions, new and possibly unfamiliar high-efficiency/high-performance building technologies; a lack of understanding, education, and training; inaccessible information or ineffective feedback mechanisms; and cultural norms and institutional rules and requirements, among others. While many strategies have been used to introduce new occupant use behaviors that promote sustainability and reduced resource consumption, few have been verified in the scientific literature or have properly documented case study results. This paper documents validated strategies that have been shown to encourage new use behaviors that can result in significant, persistent, and measureable reductions in resource consumption. From the peer-reviewed literature, the paper identifies relevant strategies for Federal facilities and commercial buildings that focus on the individual, groups of individuals (e.g., work groups), and institutions — their policies, requirements, and culture. The paper documents methods with evidence of success in changing use behaviors and enabling occupants to effectively interact with new technologies/designs. It also provides a case study of the strategies used at a Federal facility — Fort Carson, Colorado. The paper documents gaps in the current literature and approaches, and provides topics for future research.

  13. Leukoaraiosis significantly worsens driving performance of ordinary older drivers.

    Directory of Open Access Journals (Sweden)

    Kimihiko Nakano

    Full Text Available BACKGROUND: Leukoaraiosis is defined as extracellular space caused mainly by atherosclerotic or demyelinated changes in the brain tissue and is commonly found in the brains of healthy older people. A significant association between leukoaraiosis and traffic crashes was reported in our previous study; however, the reason for this is still unclear. METHOD: This paper presents a comprehensive evaluation of driving performance in ordinary older drivers with leukoaraiosis. First, the degree of leukoaraiosis was examined in 33 participants, who underwent an actual-vehicle driving examination on a standard driving course, and a driver skill rating was also collected while the driver carried out a paced auditory serial addition test, which is a calculating task given verbally. At the same time, a steering entropy method was used to estimate steering operation performance. RESULTS: The experimental results indicated that a normal older driver with leukoaraiosis was readily affected by external disturbances and made more operation errors and steered less smoothly than one without leukoaraiosis during driving; at the same time, their steering skill significantly deteriorated. CONCLUSIONS: Leukoaraiosis worsens the driving performance of older drivers because of their increased vulnerability to distraction.

  14. 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

  15. 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

  16. The influence of system quality characteristics on health care providers' performance: Empirical evidence from Malaysia.

    Science.gov (United States)

    Mohd Salleh, Mohd Idzwan; Zakaria, Nasriah; Abdullah, Rosni

    The Ministry of Health Malaysia initiated the total hospital information system (THIS) as the first national electronic health record system for use in selected public hospitals across the country. Since its implementation 15 years ago, there has been the critical requirement for a systematic evaluation to assess its effectiveness in coping with the current system, task complexity, and rapid technological changes. The study aims to assess system quality factors to predict the performance of electronic health in a single public hospital in Malaysia. Non-probability sampling was employed for data collection among selected providers in a single hospital for two months. Data cleaning and bias checking were performed before final analysis in partial least squares-structural equation modeling. Convergent and discriminant validity assessments were satisfied the required criterions in the reflective measurement model. The structural model output revealed that the proposed adequate infrastructure, system interoperability, security control, and system compatibility were the significant predictors, where system compatibility became the most critical characteristic to influence an individual health care provider's performance. The previous DeLone and McLean information system success models should be extended to incorporate these technological factors in the medical system research domain to examine the effectiveness of modern electronic health record systems. In this study, care providers' performance was expected when the system usage fits with patients' needs that eventually increased their productivity. Copyright © 2016 King Saud Bin Abdulaziz University for Health Sciences. Published by Elsevier Ltd. All rights reserved.

  17. Tumor-Associated Macrophages Provide Significant Prognostic Information in Urothelial Bladder Cancer.

    Directory of Open Access Journals (Sweden)

    Minna M Boström

    Full Text Available Inflammation is an important feature of carcinogenesis. Tumor-associated macrophages (TAMs can be associated with either poor or improved prognosis, depending on their properties and polarization. Current knowledge of the prognostic significance of TAMs in bladder cancer is limited and was investigated in this study. We analyzed 184 urothelial bladder cancer patients undergoing transurethral resection of a bladder tumor or radical cystectomy. CD68 (pan-macrophage marker, MAC387 (polarized towards type 1 macrophages, and CLEVER-1/Stabilin-1 (type 2 macrophages and lymphatic/blood vessels were detected immunohistochemically. The median follow-up time was 6.0 years. High macrophage counts associated with a higher pT category and grade. Among patients undergoing transurethral resection, all studied markers apart from CLEVER-1/Stabilin-1 were associated with increased risk of progression and poorer disease-specific and overall survival in univariate analyses. High levels of two macrophage markers (CD68/MAC387+/+ or CD68/CLEVER-1+/+ groups had an independent prognostic role after transurethral resection in multivariate analyses. In the cystectomy cohort, MAC387, alone and in combination with CD68, was associated with poorer survival in univariate analyses, but none of the markers were independent predictors of outcome in multivariate analyses. In conclusion, this study demonstrates that macrophage phenotypes provide significant independent prognostic information, particularly in bladder cancers undergoing transurethral resection.

  18. 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.

  19. 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.

  20. 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

  1. 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.

  2. Performance monitoring and error significance in patients with obsessive-compulsive disorder.

    Science.gov (United States)

    Endrass, Tanja; Schuermann, Beate; Kaufmann, Christan; Spielberg, Rüdiger; Kniesche, Rainer; Kathmann, Norbert

    2010-05-01

    Performance monitoring has been consistently found to be overactive in obsessive-compulsive disorder (OCD). The present study examines whether performance monitoring in OCD is adjusted with error significance. Therefore, errors in a flanker task were followed by neutral (standard condition) or punishment feedbacks (punishment condition). In the standard condition patients had significantly larger error-related negativity (ERN) and correct-related negativity (CRN) ampliudes than controls. But, in the punishment condition groups did not differ in ERN and CRN amplitudes. While healthy controls showed an amplitude enhancement between standard and punishment condition, OCD patients showed no variation. In contrast, group differences were not found for the error positivity (Pe): both groups had larger Pe amplitudes in the punishment condition. Results confirm earlier findings of overactive error monitoring in OCD. The absence of a variation with error significance might indicate that OCD patients are unable to down-regulate their monitoring activity according to external requirements. Copyright 2010 Elsevier B.V. All rights reserved.

  3. 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.

  4. 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.

  5. 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...

  6. Focused R&D For Electrochromic Smart Windowsa: Significant Performance and Yield Enhancements

    Energy Technology Data Exchange (ETDEWEB)

    Mark Burdis; Neil Sbar

    2003-01-31

    There is a need to improve the energy efficiency of building envelopes as they are the primary factor governing the heating, cooling, lighting and ventilation requirements of buildings--influencing 53% of building energy use. In particular, windows contribute significantly to the overall energy performance of building envelopes, thus there is a need to develop advanced energy efficient window and glazing systems. Electrochromic (EC) windows represent the next generation of advanced glazing technology that will (1) reduce the energy consumed in buildings, (2) improve the overall comfort of the building occupants, and (3) improve the thermal performance of the building envelope. ''Switchable'' EC windows provide, on demand, dynamic control of visible light, solar heat gain, and glare without blocking the view. As exterior light levels change, the window's performance can be electronically adjusted to suit conditions. A schematic illustrating how SageGlass{reg_sign} electrochromic windows work is shown in Figure I.1. SageGlass{reg_sign} EC glazings offer the potential to save cooling and lighting costs, with the added benefit of improving thermal and visual comfort. Control over solar heat gain will also result in the use of smaller HVAC equipment. If a step change in the energy efficiency and performance of buildings is to be achieved, there is a clear need to bring EC technology to the marketplace. This project addresses accelerating the widespread introduction of EC windows in buildings and thus maximizing total energy savings in the U.S. and worldwide. We report on R&D activities to improve the optical performance needed to broadly penetrate the full range of architectural markets. Also, processing enhancements have been implemented to reduce manufacturing costs. Finally, tests are being conducted to demonstrate the durability of the EC device and the dual pane insulating glass unit (IGU) to be at least equal to that of conventional

  7. 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...

  8. 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.

  9. Performance evaluation recommendations of nuclear power plants outdoor significant civil structures earthquake resistance. Performance evaluation examples

    International Nuclear Information System (INIS)

    2005-06-01

    The Japan Society of Civil Engineers has updated performance evaluation recommendations of nuclear power plants outdoor significant civil structures earthquake resistance in June 2005. Based on experimental and analytical considerations, analytical seismic models of soils for underground structures, effects of vertical motions on time-history dynamic analysis and shear fracture of reinforced concretes by cyclic loadings have been incorporated in new recommendations. This document shows outdoor civil structures earthquake resistance and endurance performance evaluation examples based on revised recommendations. (T. Tanaka)

  10. 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...

  11. 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

  12. 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.

  13. 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

  14. 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...

  15. 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.

  16. 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.

  17. 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.

  18. 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.

  19. The Real World Significance of Performance Prediction

    Science.gov (United States)

    Pardos, Zachary A.; Wang, Qing Yang; Trivedi, Shubhendu

    2012-01-01

    In recent years, the educational data mining and user modeling communities have been aggressively introducing models for predicting student performance on external measures such as standardized tests as well as within-tutor performance. While these models have brought statistically reliable improvement to performance prediction, the real world…

  20. Identifying the most significant indicators of the total road safety performance index.

    Science.gov (United States)

    Tešić, Milan; Hermans, Elke; Lipovac, Krsto; Pešić, Dalibor

    2018-04-01

    The review of the national and international literature dealing with the assessment of the road safety level has shown great efforts of the authors who tried to define the methodology for calculating the composite road safety index on a territory (region, state, etc.). The procedure for obtaining a road safety composite index of an area has been largely harmonized. The question that has not been fully resolved yet concerns the selection of indicators. There is a wide range of road safety indicators used to show a road safety situation on a territory. Road safety performance index (RSPI) obtained on the basis of a larger number of safety performance indicators (SPIs) enable decision makers to more precisely define the earlier goal- oriented actions. However, recording a broader comprehensive set of SPIs helps identify the strengths and weaknesses of a country's road safety system. Providing high quality national and international databases that would include comparable SPIs seems to be difficult since a larger number of countries dispose of a small number of identical indicators available for use. Therefore, there is a need for calculating a road safety performance index with a limited number of indicators (RSPI ln n ) which will provide a comparison of a sufficient quality, of as many countries as possible. The application of the Data Envelopment Analysis (DEA) method and correlative analysis has helped to check if the RSPI ln n is likely to be of sufficient quality. A strong correlation between the RSPI ln n and the RSPI has been identified using the proposed methodology. Based on this, the most contributing indicators and methodologies for gradual monitoring of SPIs, have been defined for each country analyzed. The indicator monitoring phases in the analyzed countries have been defined in the following way: Phase 1- the indicators relating to alcohol, speed and protective systems; Phase 2- the indicators relating to roads and Phase 3- the indicators relating to

  1. Optimized distributed systems achieve significant performance improvement on sorted merging of massive VCF files.

    Science.gov (United States)

    Sun, Xiaobo; Gao, Jingjing; Jin, Peng; Eng, Celeste; Burchard, Esteban G; Beaty, Terri H; Ruczinski, Ingo; Mathias, Rasika A; Barnes, Kathleen; Wang, Fusheng; Qin, Zhaohui S

    2018-06-01

    Sorted merging of genomic data is a common data operation necessary in many sequencing-based studies. It involves sorting and merging genomic data from different subjects by their genomic locations. In particular, merging a large number of variant call format (VCF) files is frequently required in large-scale whole-genome sequencing or whole-exome sequencing projects. Traditional single-machine based methods become increasingly inefficient when processing large numbers of files due to the excessive computation time and Input/Output bottleneck. Distributed systems and more recent cloud-based systems offer an attractive solution. However, carefully designed and optimized workflow patterns and execution plans (schemas) are required to take full advantage of the increased computing power while overcoming bottlenecks to achieve high performance. In this study, we custom-design optimized schemas for three Apache big data platforms, Hadoop (MapReduce), HBase, and Spark, to perform sorted merging of a large number of VCF files. These schemas all adopt the divide-and-conquer strategy to split the merging job into sequential phases/stages consisting of subtasks that are conquered in an ordered, parallel, and bottleneck-free way. In two illustrating examples, we test the performance of our schemas on merging multiple VCF files into either a single TPED or a single VCF file, which are benchmarked with the traditional single/parallel multiway-merge methods, message passing interface (MPI)-based high-performance computing (HPC) implementation, and the popular VCFTools. Our experiments suggest all three schemas either deliver a significant improvement in efficiency or render much better strong and weak scalabilities over traditional methods. Our findings provide generalized scalable schemas for performing sorted merging on genetics and genomics data using these Apache distributed systems.

  2. 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

  3. 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.

  4. 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...

  5. 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

  6. 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.

  7. 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...

  8. Prescription Program Provides Significant Savings

    Science.gov (United States)

    Rowan, James M.

    2010-01-01

    Most school districts today are looking for ways to save money without decreasing services to its staff. Retired pharmacist Tim Sylvester, a lifelong resident of Alpena Public Schools in Alpena, Michigan, presented the district with a pharmaceuticals plan that would save the district money without raising employee co-pays for prescriptions. The…

  9. Labour Mobility and Plant Performance in Denmark: The Significance of Related Inflows

    DEFF Research Database (Denmark)

    Timmermans, Bram; Boschma, Ron

    This paper investigates the impact of different types of labour mobility on plant performance, making use of the IDA-database that provides detailed information on all individuals and plants for the whole of Denmark. Our study shows that the effect of labour mobility can only be assessed when one...... performance. Moreover, intra-regional skilled labour mobility had a negative effect on plant performance in general, while the effect of inter-regional labour mobility depends on the type of skills that flow into the plant. We used a sophisticated indicator of revealed relatedness that measures the degree...... accounts for the type of skills that flow into the plant, and the degree to which these match the existing set of skills at the plant level. We found that the inflow of related skills has a positive impact on plant performance, while inflows of similar and unrelated skills have a negative effect on plant...

  10. 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.

  11. 40 CFR 141.723 - Requirements to respond to significant deficiencies identified in sanitary surveys performed by EPA.

    Science.gov (United States)

    2010-07-01

    ... deficiencies identified in sanitary surveys performed by EPA. 141.723 Section 141.723 Protection of Environment... performed by EPA, systems must respond in writing to significant deficiencies identified in sanitary survey... will address significant deficiencies noted in the survey. (d) Systems must correct significant...

  12. The baseline serum value of α-amylase is a significant predictor of distance running performance.

    Science.gov (United States)

    Lippi, Giuseppe; Salvagno, Gian Luca; Danese, Elisa; Tarperi, Cantor; La Torre, Antonio; Guidi, Gian Cesare; Schena, Federico

    2015-02-01

    This study was planned to investigate whether serum α-amylase concentration may be associated with running performance, physiological characteristics and other clinical chemistry analytes in a large sample of recreational athletes undergoing distance running. Forty-three amateur runners successfully concluded a 21.1 km half-marathon at 75%-85% of their maximal oxygen uptake (VO2max). Blood was drawn during warm up and 15 min after conclusion of the run. After correction for body weight change, significant post-run increases were observed for serum values of alkaline phosphatase, alanine aminotransferase, aspartate aminotransferase, bilirubin, creatine kinase (CK), iron, lactate dehydrogenase (LDH), triglycerides, urea and uric acid, whereas the values of body weight, glomerular filtration rate, total and low density lipoprotein-cholesterol were significantly decreased. The concentration of serum α-amylase was unchanged. In univariate analysis, significant associations with running performance were found for gender, VO2max, training regimen and pre-run serum values of α-amylase, CK, glucose, high density lipoprotein-cholesterol, LDH, urea and uric acid. In multivariate analysis, only VO2max (p=0.042) and baseline α-amylase (p=0.021) remained significant predictors of running performance. The combination of these two variables predicted 71% of variance in running performance. The baseline concentration of serum α-amylase was positively correlated with variation of serum glucose during the trial (r=0.345; p=0.025) and negatively with capillary blood lactate at the end of the run (r=-0.352; p=0.021). We showed that the baseline serum α-amylase concentration significantly and independently predicts distance running performance in recreational runners.

  13. Six Significant Questions About Performance and Performance Courses in the Major.

    Science.gov (United States)

    Lawson, Hal A.; Pugh, D. Lionel

    James Bryant Conant's book, "The Education of America" (1963), triggered a major change in physical education curricula. Formerly a (sports) skills and applied techniques oriented discipline, physical education has expanded to areas such as kinesiology and sports sociology. However, performance and performance courses are still an important aspect…

  14. 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.

  15. 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.

  16. 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.

  17. Millisecond photo-thermal process on significant improvement of supercapacitor’s performance

    International Nuclear Information System (INIS)

    Wang, Kui; Wang, Jixiao; Wu, Ying; Zhao, Song; Wang, Zhi; Wang, Shichang

    2016-01-01

    Graphical abstract: A high way for charge transfer is created by a millisecond photo-thermal process which could decrease contact resistance among nanomaterials and improve the electrochemical performances. - Highlights: • Improve conductivity among nanomaterials with a millisecond photo-thermal process. • The specific capacitance can increase about 25% with an photo-thermal process. • The circle stability and rate capability can be improved above 10% with photo-thermal process. • Provide a new way that create electron path to improve electrochemical performance. - Abstract: Supercapacitors fabricated with nanomaterials usually have high specific capacitance and excellent performance. However, the small size of nanomaterials renders a considerable limitation of the contact area among nanomaterials, which is harmful to charge carrier transfer. This fact may hinder the development and application of nanomaterials in electrochemical storage systems. Here, a millisecond photo-thermal process was introduced to create a charge carries transfer path to decrease the contact resistance among nanomaterials, and enhance the electrochemical performance of supercapacitors. Polyaniline (PANI) nanowire, as a model nanomaterial, was used to modify electrodes under different photo-thermal process conditions. The modified electrodes were characterized by scanning electronic microscopy (SEM), cyclic voltammetry (CV), electrochemical impedance spectroscopy (EIS) and the results were analysed by equivalent circuit simulation. These results demonstrate that the photo-thermal process can alter the morphology of PANI nanowires, lower the charge transfer resistances and thus improve the performance of electrodes. The specific capacitance increase of the modified electrodes is about 25%. The improvement of the circle stability and rate capability are above 10%. To the best of our knowledge, this is the first attempt on research the effect of photo-thermal process on the conductivity

  18. 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 ...

  19. 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.

  20. 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.

  1. 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.

  2. Parameter definition using vibration prediction software leads to significant drilling performance improvements

    Energy Technology Data Exchange (ETDEWEB)

    Amorim, Dalmo; Hanley, Chris Hanley; Fonseca, Isaac; Santos, Juliana [National Oilwell Varco, Houston TX (United States); Leite, Daltro J.; Borella, Augusto; Gozzi, Danilo [Petroleo Brasileiro S.A. (PETROBRAS), Rio de Janeiro, RJ (Brazil)

    2012-07-01

    The understanding and mitigation of downhole vibration has been a heavily researched subject in the oil industry as it results in more expensive drilling operations, as vibrations significantly diminish the amount of effective drilling energy available to the bit and generate forces that can push the bit or the Bottom Hole Assembly (BHA) off its concentric axis of rotation, producing high magnitude impacts with the borehole wall. In order to drill ahead, a sufficient amount of energy must be supplied by the rig to overcome the resistance of the drilling system, including the reactive torque of the system, drag forces, fluid pressure losses and energy dissipated by downhole vibrations, then providing the bit with the energy required to fail the rock. If the drill string enters resonant modes of vibration, not only does it decreases the amount of available energy to drill, but increases the potential for catastrophic downhole equipment and drilling bit failures. In this sense, the mitigation of downhole vibrations will result in faster, smoother, and cheaper drilling operations. A software tool using Finite Element Analysis (FEA) has been developed to provide better understanding of downhole vibration phenomena in drilling environments. The software tool calculates the response of the drilling system at various input conditions, based on the design of the wellbore along with the geometry of the Bottom Hole Assembly (BHA) and the drill string. It identifies where undesired levels of resonant vibration will be driven by certain combinations of specific drilling parameters, and also which combinations of drilling parameters will result in lower levels of vibration, so the least shocks, the highest penetration rate and the lowest cost per foot can be achieved. With the growing performance of personal computers, complex software systems modeling the drilling vibrations using FEA has been accessible to a wider audience of field users, further complimenting with real time

  3. 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

  4. 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...

  5. PROVIDING ENGLISH LANGUAGE INPUT: DECREASING STUDENTS’ ANXIETY IN READING COMPREHENSION PERFORMANCE

    Directory of Open Access Journals (Sweden)

    Elva Yohana

    2016-11-01

    Full Text Available The primary condition for successful in second or foreign language learning is providing an adequate environment. It is as a medium of increasing the students’ language exposure in order to be able to success in acquiring second or foreign language profciency. This study was designed to propose the adequate English language input that can decrease the students’ anxiety in reading comprehension performance. Of the four skills, somehow reading can be regarded as especially important because reading is assumed to be the central means for learning new information. Some students, however, still encounter many problems in reading. It is because of their anxiety when they are reading. Providing and creating an interesting-contextual reading material and gratifed teachers can make out this problem which occurs mostly in Indonesian’s classrooms. It revealed that the younger learners of English there do not received adequate amount of the target language input in their learning of English. Hence, it suggested the adoption of extensive reading programs as the most effective means in the creation of an input-rich environment in EFL learning contexts. Besides they also give suggestion to book writers and publisher to provide myriad books that appropriate and readable for their students.

  6. 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.

  7. Significant performance enhancement of InGaN/GaN nanorod LEDs with multi-layer graphene transparent electrodes by alumina surface passivation.

    Science.gov (United States)

    Latzel, M; Büttner, P; Sarau, G; Höflich, K; Heilmann, M; Chen, W; Wen, X; Conibeer, G; Christiansen, S H

    2017-02-03

    Nanotextured surfaces provide an ideal platform for efficiently capturing and emitting light. However, the increased surface area in combination with surface defects induced by nanostructuring e.g. using reactive ion etching (RIE) negatively affects the device's active region and, thus, drastically decreases device performance. In this work, the influence of structural defects and surface states on the optical and electrical performance of InGaN/GaN nanorod (NR) light emitting diodes (LEDs) fabricated by top-down RIE of c-plane GaN with InGaN quantum wells was investigated. After proper surface treatment a significantly improved device performance could be shown. Therefore, wet chemical removal of damaged material in KOH solution followed by atomic layer deposition of only 10 [Formula: see text] alumina as wide bandgap oxide for passivation were successfully applied. Raman spectroscopy revealed that the initially compressively strained InGaN/GaN LED layer stack turned into a virtually completely relaxed GaN and partially relaxed InGaN combination after RIE etching of NRs. Time-correlated single photon counting provides evidence that both treatments-chemical etching and alumina deposition-reduce the number of pathways for non-radiative recombination. Steady-state photoluminescence revealed that the luminescent performance of the NR LEDs is increased by about 50% after KOH and 80% after additional alumina passivation. Finally, complete NR LED devices with a suspended graphene contact were fabricated, for which the effectiveness of the alumina passivation was successfully demonstrated by electroluminescence measurements.

  8. 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...

  9. 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.

  10. Significant improvements of electrical discharge machining performance by step-by-step updated adaptive control laws

    Science.gov (United States)

    Zhou, Ming; Wu, Jianyang; Xu, Xiaoyi; Mu, Xin; Dou, Yunping

    2018-02-01

    In order to obtain improved electrical discharge machining (EDM) performance, we have dedicated more than a decade to correcting one essential EDM defect, the weak stability of the machining, by developing adaptive control systems. The instabilities of machining are mainly caused by complicated disturbances in discharging. To counteract the effects from the disturbances on machining, we theoretically developed three control laws from minimum variance (MV) control law to minimum variance and pole placements coupled (MVPPC) control law and then to a two-step-ahead prediction (TP) control law. Based on real-time estimation of EDM process model parameters and measured ratio of arcing pulses which is also called gap state, electrode discharging cycle was directly and adaptively tuned so that a stable machining could be achieved. To this end, we not only theoretically provide three proved control laws for a developed EDM adaptive control system, but also practically proved the TP control law to be the best in dealing with machining instability and machining efficiency though the MVPPC control law provided much better EDM performance than the MV control law. It was also shown that the TP control law also provided a burn free machining.

  11. 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.

  12. Provider volume and outcomes for oncological procedures.

    LENUS (Irish Health Repository)

    Killeen, S D

    2012-02-03

    BACKGROUND: Oncological procedures may have better outcomes if performed by high-volume providers. METHODS: A review of the English language literature incorporating searches of the Medline, Embase and Cochrane collaboration databases was performed. Studies were included if they involved a patient cohort from 1984 onwards, were community or population based, and assessed health outcome as a dependent variable and volume as an independent variable. The studies were also scored quantifiably to assess generalizability with respect to any observed volume-outcome relationship and analysed according to organ system; numbers needed to treat were estimated where possible. RESULTS: Sixty-eight relevant studies were identified and a total of 41 were included, of which 13 were based on clinical data. All showed either an inverse relationship, of variable magnitude, between provider volume and mortality, or no volume-outcome effect. All but two clinical reports revealed a statistically significant positive relationship between volume and outcome; none demonstrated the opposite. CONCLUSION: High-volume providers have a significantly better outcome for complex cancer surgery, specifically for pancreatectomy, oesphagectomy, gastrectomy and rectal resection.

  13. Experimental shielding evaluation of the radiation protection provided by the structurally significant components of residential structures.

    Science.gov (United States)

    Dickson, E D; Hamby, D M

    2014-03-01

    The human health and environmental effects following a postulated accidental release of radioactive material to the environment have been a public and regulatory concern since the early development of nuclear technology. These postulated releases have been researched extensively to better understand the potential risks for accident mitigation and emergency planning purposes. The objective of this investigation is to provide an updated technical basis for contemporary building shielding factors for the US housing stock. Building shielding factors quantify the protection from ionising radiation provided by a certain building type. Much of the current data used to determine the quality of shielding around nuclear facilities and urban environments is based on simplistic point-kernel calculations for 1950s era suburbia and is no longer applicable to the densely populated urban environments realised today. To analyse a building's radiation shielding properties, the ideal approach would be to subject a variety of building types to various radioactive sources and measure the radiation levels in and around the building. While this is not entirely practicable, this research analyses the shielding effectiveness of ten structurally significant US housing-stock models (walls and roofs) important for shielding against ionising radiation. The experimental data are used to benchmark computational models to calculate the shielding effectiveness of various building configurations under investigation from two types of realistic environmental source terms. Various combinations of these ten shielding models can be used to develop full-scale computational housing-unit models for building shielding factor calculations representing 69.6 million housing units (61.3%) in the United States. Results produced in this investigation provide a comparison between theory and experiment behind building shielding factor methodology.

  14. Experimental shielding evaluation of the radiation protection provided by the structurally significant components of residential structures

    International Nuclear Information System (INIS)

    Dickson, E D; Hamby, D M

    2014-01-01

    The human health and environmental effects following a postulated accidental release of radioactive material to the environment have been a public and regulatory concern since the early development of nuclear technology. These postulated releases have been researched extensively to better understand the potential risks for accident mitigation and emergency planning purposes. The objective of this investigation is to provide an updated technical basis for contemporary building shielding factors for the US housing stock. Building shielding factors quantify the protection from ionising radiation provided by a certain building type. Much of the current data used to determine the quality of shielding around nuclear facilities and urban environments is based on simplistic point-kernel calculations for 1950s era suburbia and is no longer applicable to the densely populated urban environments realised today. To analyse a building’s radiation shielding properties, the ideal approach would be to subject a variety of building types to various radioactive sources and measure the radiation levels in and around the building. While this is not entirely practicable, this research analyses the shielding effectiveness of ten structurally significant US housing-stock models (walls and roofs) important for shielding against ionising radiation. The experimental data are used to benchmark computational models to calculate the shielding effectiveness of various building configurations under investigation from two types of realistic environmental source terms. Various combinations of these ten shielding models can be used to develop full-scale computational housing-unit models for building shielding factor calculations representing 69.6 million housing units (61.3%) in the United States. Results produced in this investigation provide a comparison between theory and experiment behind building shielding factor methodology. (paper)

  15. Does the new conceptual framework provide adequate concepts for reporting relevant information about performance?

    NARCIS (Netherlands)

    Brouwer, A.; Faramarzi, A; Hoogendoorn, M.

    2014-01-01

    The basic question we raise in this paper is whether the 2013 Discussion Paper (DP 2013) on the Conceptual Framework provides adequate principles for reporting an entity’s performance and what improvements could be made in light of both user needs and evidence from academic literature. DP 2013

  16. Hypoxia: Exposure Time Until Significant Performance Effects

    Science.gov (United States)

    2016-03-07

    three alcoholic beverages per day (on average), or were taking any prescription medication (besides oral contraceptives). Likewise, those who were...or tested positively for pregnancy were disqualified from the study, as the risks of hypoxia to a human fetus are currently unknown. Also, those...that could impact inclusion in the study. After the questionnaire, all female participants provided a urine sample for pregnancy testing. Participants

  17. Brake response time is significantly impaired after total knee arthroplasty: investigation of performing an emergency stop while driving a car.

    Science.gov (United States)

    Jordan, Maurice; Hofmann, Ulf-Krister; Rondak, Ina; Götze, Marco; Kluba, Torsten; Ipach, Ingmar

    2015-09-01

    The objective of this study was to investigate whether total knee arthroplasty (TKA) impairs the ability to perform an emergency stop. An automatic transmission brake simulator was developed to evaluate total brake response time. A prospective repeated-measures design was used. Forty patients (20 left/20 right) were measured 8 days and 6, 12, and 52 wks after surgery. Eight days postoperative total brake response time increased significantly by 30% in right TKA and insignificantly by 2% in left TKA. Brake force significantly decreased by 35% in right TKA and by 25% in left TKA during this period. Baseline values were reached at week 12 in right TKA; the impairment of outcome measures, however, was no longer significant at week 6 compared with preoperative values. Total brake response time and brake force in left TKA fell below baseline values at weeks 6 and 12. Brake force in left TKA was the only outcome measure significantly impaired 8 days postoperatively. This study highlights that categorical statements cannot be provided. This study's findings on automatic transmission driving suggest that right TKA patients may resume driving 6 wks postoperatively. Fitness to drive in left TKA is not fully recovered 8 days postoperatively. If testing is not available, patients should refrain from driving until they return from rehabilitation.

  18. NREL Research Yields Significant Thermoelectric Performance | News | NREL

    Science.gov (United States)

    Chemical and Materials Science and Technology center, said the introduction of SWCNT into fabrics could from an exemplary SWNCT thin film improved thermoelectric properties. The newest paper revealed that that the same SWCNT thin film achieved identical performance when doped with either positive or

  19. 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

  20. Omega-3 polyunsaturated fatty acids provided during embryonic development improve the growth performance and welfare of Muscovy ducks (Cairina moschata).

    Science.gov (United States)

    Baéza, E; Chartrin, P; Bordeau, T; Lessire, M; Thoby, J M; Gigaud, V; Blanchet, M; Alinier, A; Leterrier, C

    2017-09-01

    The welfare of ducks can be affected by unwanted behaviors such as excessive reactivity and feather pecking. Providing long-chain n-3 polyunsaturated fatty acids (LC n-3 PUFA) during gestation and early life has been shown to improve the brain development and function of human and rodent offspring. The aim of this study was to test whether the pecking behavior of Muscovy ducks during rearing could be reduced by providing LC n-3 PUFA during embryonic and/or post-hatching development of ducklings. Enrichment of eggs, and consequently embryos, with LC n-3 PUFA was achieved by feeding female ducks (n-3F) a diet containing docosahexaenoic (DHA) and linolenic acids (microalgae and linseed oil). A control group of female ducks (CF) was fed a diet containing linoleic acid (soybean oil). Offspring from both groups were fed starter and grower diets enriched with DHA and linolenic acid or only linoleic acid, resulting in four treatment groups with 48 ducklings in each. Several behavioral tests were performed between 1 and 3 weeks of age to analyze the adaptation ability of ducklings. The growth performance, time budget, social interactions, feather growth, and pecking behavior of ducklings were recorded regularly during the rearing period. No significant interaction between maternal and duckling feeding was found. Ducklings from n-3F ducks had a higher body weight at day 0, 28, and 56, a lower feed conversion ratio during the growth period, and lower reactivity to stress than ducklings from CF ducks. Ducklings from n-3F ducks also exhibited a significantly reduced feather pecking frequency at 49 and 56 days of age and for the whole rearing period. Moreover, consumption of diets enriched with n-3 PUFA during the starter and grower post-hatching periods significantly improved the tibia mineralization of ducklings and the fatty acid composition of thigh muscles at 84 days of age by increasing the n-3 FA content. © 2017 Poultry Science Association Inc.

  1. Effect of a Neonatal Resuscitation Course on Healthcare Providers' Performances Assessed by Video Recording in a Low-Resource Setting.

    Science.gov (United States)

    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.

  2. Magnetic resonance imaging-detected extramural venous invasion in rectal cancer before and after preoperative chemoradiotherapy. Diagnostic performance and prognostic significance

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Eun Sun [Chung-Ang University Hospital, Department of Radiology, Seoul (Korea, Republic of); Chung-Ang University, College of Medicine and Graduate School of Medicine, Seoul (Korea, Republic of); National Cancer Centre, Department of Radiology, Goyang-si, Gyeonggi-do (Korea, Republic of); Kim, Min Ju; Hur, Bo Yun [National Cancer Centre, Department of Radiology, Goyang-si, Gyeonggi-do (Korea, Republic of); Park, Sung Chan; Hyun, Jong Hee; Chang, Hee Jin; Baek, Ji Yeon; Kim, Dae Yong; Oh, Jae Hwan [National Cancer Centre, Centre for Colorectal Cancer, Goyang, Gyeonggi-do (Korea, Republic of); Kim, Sun Young [National Cancer Centre, Centre for Colorectal Cancer, Goyang, Gyeonggi-do (Korea, Republic of); University of Ulsan College of Medicine, Department of Oncology, Asan Medical Centre, Seoul (Korea, Republic of)

    2018-02-15

    We evaluated the diagnostic performance of magnetic resonance imaging (MRI) in terms of identifying extramural venous invasion (EMVI) in rectal cancer patients with preoperative chemoradiotherapy (CRT) and its prognostic significance. During 2008-2010, 200 patients underwent surgery following preoperative CRT for rectal cancer. Two radiologists independently reviewed all pre- and post-CRT MRI retrospectively. We investigated diagnostic performance of pre-CRT MR-EMVI (MR-EMVI) and post-CRT MR-EMVI (yMR-EMVI), based on pathological EMVI as the standard of reference. We assessed correlation between MRI findings and patients' prognosis, such as disease-free survival (DFS) and overall survival (OS). Additionally, subgroup analysis in MR- or yMR-EMVI-positive patients was performed to confirm the significance of the severity of EMVI in MRI on patient's prognosis. The sensitivity and specificity of yMR-EMVI were 76.19% and 79.75% (area under the curve: 0.830), respectively. In univariate analysis, yMR-EMVI was the only significant MRI factor in DFS (P = 0.027). The mean DFS for yMR-EMVI (+) patients was significantly less than for yMR-EMVI (-) patients: 57.56 months versus 72.46 months. yMR-EMVI demonstrated good diagnostic performance. yMR-EMVI was the only significant EMVI-related MRI factor that correlated with patients' DFS in univariate analysis; however, it was not significant in multivariate analysis. (orig.)

  3. Vegetation composition and structure significantly influence green roof performance

    Energy Technology Data Exchange (ETDEWEB)

    Dunnett, N.; Nagase, A.; Booth, R.; Grime, P. [Sheffield Univ., Sheffield (United Kingdom). Dept. of Landscape Architecture

    2005-07-01

    The majority of published literature on green roofs contains little specific information on the contribution of plants to the various functions and properties of green roofs. This paper reviewed previously published material in an attempt to shed light on the role of vegetation composition in green roof systems, with specific reference to hydrology and biodiversity support. Two ongoing experiments at the University of Sheffield were then considered: (1) a comparison of quality and quantity of runoff from different types of vegetation; and (2) a comparison of flowering seasons and biodiversity support of different vegetation. Results of the studies showed that there was no general pattern of variation in runoff that could be related to vegetation complexity or taxonomic composition of the communities. During the winter months, high precipitation quickly saturated the soil and percolate losses were similar for all treatments. In the summer, throughflow losses differed between treatments in relation to the structure of the plant canopy. Differing mechanisms resulted in variations in the volume of percolate that was collected. Lower volumes of percolate were observed in herb-only monocultures of Leontdon hispidus, a species with a high water content. Tap-rooted species were seen to more effectively absorb soil moisture. The biodiversity support study focused on the study of Sedum species and Labiatae species, which suggested that mixed vegetation containing these species had a far greater likelihood of attracting wild bees to support pollination. Results of the studies indicated that green roof vegetation with greater structural and species diversity may provide different benefits than sedum-dominated roots. Further studies are needed to investigate the trade-offs between vegetation types, and green roof functions and performance in order to justify calls for a wider diversity of green roof types. 8 refs., 2 tabs., 1 fig.

  4. Bayesian approaches for detecting significant deterioration

    International Nuclear Information System (INIS)

    Roed, Willy; Aven, Terje

    2009-01-01

    Risk indicators can provide useful input to risk management processes and are given increased attention in the Norwegian petroleum industry. Examples include indicators expressing the proportion of test failures of safety and barrier systems. Such indicators give valuable information about the performance of the systems and provide a basis for trend evaluations. Early warning of a possible deterioration is essential due to the importance of the systems in focus, but what should be the basis for the warning criterion? This paper presents and discusses several Bayesian approaches for the establishment of a warning criterion to disclose significant deterioration. The Norwegian petroleum industry is the starting point for this paper, but the study is relevant for other application areas as well

  5. 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.

  6. There are lots of big fish in this pond: The role of peer overqualification on task significance, perceived fit, and performance for overqualified employees.

    Science.gov (United States)

    Hu, Jia; Erdogan, Berrin; Bauer, Talya N; Jiang, Kaifeng; Liu, Songbo; Li, Yuhui

    2015-07-01

    Research has uncovered mixed results regarding the influence of overqualification on employee performance outcomes, suggesting the existence of boundary conditions for such an influence. Using relative deprivation theory (Crosby, 1976) as the primary theoretical basis, in the current research, we examine the moderating role of peer overqualification and provide insights to the questions regarding whether, when, and how overqualification relates to employee performance. We tested the theoretical model with data gathered across three phases over 6 months from 351 individuals and their supervisors in 72 groups. Results showed that when working with peers whose average overqualification level was high, as opposed to low, employees who felt overqualified for their jobs perceived greater task significance and person-group fit, and demonstrated higher levels of in-role and extra-role performance. We discuss theoretical and managerial implications for overqualification at the individual level and within the larger group context. (c) 2015 APA, all rights reserved).

  7. A Meta-analysis for the Diagnostic Performance of Transient Elastography for Clinically Significant Portal Hypertension.

    Science.gov (United States)

    You, Myung-Won; Kim, Kyung Won; Pyo, Junhee; Huh, Jimi; Kim, Hyoung Jung; Lee, So Jung; Park, Seong Ho

    2017-01-01

    We aimed to evaluate the correlation between liver stiffness measurement using transient elastography (TE-LSM) and hepatic venous pressure gradient and the diagnostic performance of TE-LSM in assessing clinically significant portal hypertension through meta-analysis. Eleven studies were included from thorough literature research and selection processes. The summary correlation coefficient was 0.783 (95% confidence interval [CI], 0.737-0.823). Summary sensitivity, specificity and area under the hierarchical summary receiver operating characteristic curve (AUC) were 87.5% (95% CI, 75.8-93.9%), 85.3 % (95% CI, 76.9-90.9%) and 0.9, respectively. The subgroup with low cut-off values of 13.6-18 kPa had better summary estimates (sensitivity 91.2%, specificity 81.3% and partial AUC 0.921) than the subgroup with high cut-off values of 21-25 kPa (sensitivity 71.2%, specificity 90.9% and partial AUC 0.769). In summary, TE-LSM correlated well with hepatic venous pressure gradient and represented good diagnostic performance in diagnosing clinically significant portal hypertension. For use as a sensitive screening tool, we propose using low cut-off values of 13.6-18 kPa in TE-LSM. Copyright © 2016 World Federation for Ultrasound in Medicine & Biology. Published by Elsevier Inc. All rights reserved.

  8. 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.

  9. 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.

  10. Performance evaluation recommendations of nuclear power plants outdoor significant civil structures earthquake resistance. Technical documentation

    International Nuclear Information System (INIS)

    2005-06-01

    The Japan Society of Civil Engineers has updated performance evaluation recommendations of nuclear power plants outdoor significant civil structures earthquake resistance in June 2005. Experimental and analytical considerations on the seismic effects evaluation criteria, such as analytical seismic models of soils for underground structures, effects of vertical motions on time-history dynamic analysis and shear fracture of reinforced concretes by cyclic loadings, were shown in this document and incorporated in new recommendations. (T. Tanaka)

  11. Performance evaluation recommendations and manuals of nuclear power plants outdoor significant civil structures earthquake resistance

    International Nuclear Information System (INIS)

    2005-06-01

    Performance evaluation recommendations and manuals of nuclear power plants outdoor significant civil structures earthquake resistance have been updated in June 2005 by the Japan Society of Civil Engineers. Based on experimental and analytical considerations on the recommendations of May 2002, analytical seismic models of soils for underground structures, effects of vertical motions on time-history dynamic analysis and shear fracture of reinforced concretes by cyclic loadings have been evaluated and incorporated in new recommendations. (T. Tanaka)

  12. EVALUATION OF THE METERED-DOSE INHALER TECHNIQUE AMONG HEALTHCARE PROVIDERS

    Directory of Open Access Journals (Sweden)

    E. Nadi F. Zeraati

    2005-07-01

    Full Text Available Poor inhaler technique is a common problem both in asthmatic patients and healthcare providers, which contributes to poor asthma control. This study was performed to evaluate the adequacy of metered-dose inhaler (MDI technique in a sample of physicians and nurses practicing in hospitals of Hamadan University of Medical Sciences. A total of 173 healthcare providers voluntary participated in this study. After the participants answered a questionnaire aimed at identifying their involvement in MDI prescribing and counseling, a trained observer assessed their MDI technique using a checklist of nine steps. Of the 173 participants, 35 (20.2% were physicians and 138 (79.8% were nurses. Only 12 participants (6.93% performed all steps correctly. Physicians performed essential steps significantly better than nurses (85.7% vs. 63.8%, P < 0.05. The majority of healthcare providers responsible for instructing patients on the correct MDI technique were unable to perform this technique correctly, indicating the need for regular formal training programs on inhaler techniques.

  13. The Effect of an Electronic Checklist on Critical Care Provider Workload, Errors, and Performance.

    Science.gov (United States)

    Thongprayoon, Charat; Harrison, Andrew M; O'Horo, John C; Berrios, Ronaldo A Sevilla; Pickering, Brian W; Herasevich, Vitaly

    2016-03-01

    The strategy used to improve effective checklist use in intensive care unit (ICU) setting is essential for checklist success. This study aimed to test the hypothesis that an electronic checklist could reduce ICU provider workload, errors, and time to checklist completion, as compared to a paper checklist. This was a simulation-based study conducted at an academic tertiary hospital. All participants completed checklists for 6 ICU patients: 3 using an electronic checklist and 3 using an identical paper checklist. In both scenarios, participants had full access to the existing electronic medical record system. The outcomes measured were workload (defined using the National Aeronautics and Space Association task load index [NASA-TLX]), the number of checklist errors, and time to checklist completion. Two independent clinician reviewers, blinded to participant results, served as the reference standard for checklist error calculation. Twenty-one ICU providers participated in this study. This resulted in the generation of 63 simulated electronic checklists and 63 simulated paper checklists. The median NASA-TLX score was 39 for the electronic checklist and 50 for the paper checklist (P = .005). The median number of checklist errors for the electronic checklist was 5, while the median number of checklist errors for the paper checklist was 8 (P = .003). The time to checklist completion was not significantly different between the 2 checklist formats (P = .76). The electronic checklist significantly reduced provider workload and errors without any measurable difference in the amount of time required for checklist completion. This demonstrates that electronic checklists are feasible and desirable in the ICU setting. © The Author(s) 2014.

  14. Significantly enhanced robustness and electrochemical performance of flexible carbon nanotube-based supercapacitors by electrodepositing polypyrrole

    Science.gov (United States)

    Chen, Yanli; Du, Lianhuan; Yang, Peihua; Sun, Peng; Yu, Xiang; Mai, Wenjie

    2015-08-01

    Here, we report robust, flexible CNT-based supercapacitor (SC) electrodes fabricated by electrodepositing polypyrrole (PPy) on freestanding vacuum-filtered CNT film. These electrodes demonstrate significantly improved mechanical properties (with the ultimate tensile strength of 16 MPa), and greatly enhanced electrochemical performance (5.6 times larger areal capacitance). The major drawback of conductive polymer electrodes is the fast capacitance decay caused by structural breakdown, which decreases cycling stability but this is not observed in our case. All-solid-state SCs assembled with the robust CNT/PPy electrodes exhibit excellent flexibility, long lifetime (95% capacitance retention after 10,000 cycles) and high electrochemical performance (a total device volumetric capacitance of 4.9 F/cm3). Moreover, a flexible SC pack is demonstrated to light up 53 LEDs or drive a digital watch, indicating the broad potential application of our SCs for portable/wearable electronics.

  15. The European Academy laparoscopic “Suturing Training and Testing’’ (SUTT) significantly improves surgeons’ performance

    Science.gov (United States)

    Sleiman, Z.; Tanos, V.; Van Belle, Y.; Carvalho, J.L.; Campo, R.

    2015-01-01

    The efficiency of suturing training and testing (SUTT) model by laparoscopy was evaluated, measuring the suturingskill acquisition of trainee gynecologists at the beginning and at the end of a teaching course. During a workshop organized by the European Academy of Gynecological Surgery (EAGS), 25 participants with three different experience levels in laparoscopy (minor, intermediate and major) performed the 4 exercises of the SUTT model (Ex 1: both hands stitching and continuous suturing, Ex 2: right hand stitching and intracorporeal knotting, Ex 3: left hand stitching and intracorporeal knotting, Ex 4: dominant hand stitching, tissue approximation and intracorporeal knotting). The time needed to perform the exercises is recorded for each trainee and group and statistical analysis used to note the differences. Overall, all trainees achieved significant improvement in suturing time (p psychomotor skills, surgery, teaching, training suturing model. PMID:26977264

  16. 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

  17. The Proposal of Key Performance Indicators in Facility Management and Determination the Weights of Significance

    Science.gov (United States)

    Rimbalová, Jarmila; Vilčeková, Silvia

    2013-11-01

    The practice of facilities management is rapidly evolving with the increasing interest in the discourse of sustainable development. The industry and its market are forecasted to develop to include non-core functions, activities traditionally not associated with this profession, but which are increasingly being addressed by facilities managers. The scale of growth in the built environment and the consequential growth of the facility management sector is anticipated to be enormous. Key Performance Indicators (KPI) are measure that provides essential information about performance of facility services delivery. In selecting KPI, it is critical to limit them to those factors that are essential to the organization reaching its goals. It is also important to keep the number of KPI small just to keep everyone's attention focused on achieving the same KPIs. This paper deals with the determination of weights of KPI of FM in terms of the design and use of sustainable buildings.

  18. Field significance of performance measures in the context of regional climate model evaluation. Part 2: precipitation

    Science.gov (United States)

    Ivanov, Martin; Warrach-Sagi, Kirsten; Wulfmeyer, Volker

    2018-04-01

    A new approach for rigorous spatial analysis of the downscaling performance of regional climate model (RCM) simulations is introduced. It is based on a multiple comparison of the local tests at the grid cells and is also known as `field' or `global' significance. The block length for the local resampling tests is precisely determined to adequately account for the time series structure. New performance measures for estimating the added value of downscaled data relative to the large-scale forcing fields are developed. The methodology is exemplarily applied to a standard EURO-CORDEX hindcast simulation with the Weather Research and Forecasting (WRF) model coupled with the land surface model NOAH at 0.11 ∘ grid resolution. Daily precipitation climatology for the 1990-2009 period is analysed for Germany for winter and summer in comparison with high-resolution gridded observations from the German Weather Service. The field significance test controls the proportion of falsely rejected local tests in a meaningful way and is robust to spatial dependence. Hence, the spatial patterns of the statistically significant local tests are also meaningful. We interpret them from a process-oriented perspective. While the downscaled precipitation distributions are statistically indistinguishable from the observed ones in most regions in summer, the biases of some distribution characteristics are significant over large areas in winter. WRF-NOAH generates appropriate stationary fine-scale climate features in the daily precipitation field over regions of complex topography in both seasons and appropriate transient fine-scale features almost everywhere in summer. As the added value of global climate model (GCM)-driven simulations cannot be smaller than this perfect-boundary estimate, this work demonstrates in a rigorous manner the clear additional value of dynamical downscaling over global climate simulations. The evaluation methodology has a broad spectrum of applicability as it is

  19. 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

  20. Subjective Significance Shapes Arousal Effects on Modified Stroop Task Performance: A Duality of Activation Mechanisms Account.

    Science.gov (United States)

    Imbir, Kamil K

    2016-01-01

    Activation mechanisms such as arousal are known to be responsible for slowdown observed in the Emotional Stroop and modified Stroop tasks. Using the duality of mind perspective, we may conclude that both ways of processing information (automatic or controlled) should have their own mechanisms of activation, namely, arousal for an experiential mind, and subjective significance for a rational mind. To investigate the consequences of both, factorial manipulation was prepared. Other factors that influence Stroop task processing such as valence, concreteness, frequency, and word length were controlled. Subjective significance was expected to influence arousal effects. In the first study, the task was to name the color of font for activation charged words. In the second study, activation charged words were, at the same time, combined with an incongruent condition of the classical Stroop task around a fixation point. The task was to indicate the font color for color-meaning words. In both studies, subjective significance was found to shape the arousal impact on performance in terms of the slowdown reduction for words charged with subjective significance.

  1. Subjective Significance Shapes Arousal Effects on Modified Stroop Task Performance: a Duality of Activation Mechanisms Account

    Directory of Open Access Journals (Sweden)

    Kamil Konrad Imbir

    2016-02-01

    Full Text Available Activation mechanisms such as arousal are known to be responsible for slowdown observed in the Emotional Stroop (EST and modified Stroop tasks. Using the duality of mind perspective, we may conclude that both ways of processing information (automatic or controlled should have their own mechanisms of activation, namely, arousal for an experiential mind, and subjective significance for a rational mind. To investigate the consequences of both, factorial manipulation was prepared. Other factors that influence Stroop task processing such as valence, concreteness, frequency and word length were controlled. Subjective significance was expected to influence arousal effects. In the first study, the task was to name the color of font for activation charged words. In the second study, activation charged words were, at the same time, combined with an incongruent condition of the classical Stroop task around a fixation point. The task was to indicate the font color for color-meaning words. In both studies, subjective significance was found to shape the arousal impact on performance in terms of the slowdown reduction for words charged with subjective significance.

  2. Performance of the Sellick maneuver significantly improves when residents and trained nurses use a visually interactive guidance device in simulation

    International Nuclear Information System (INIS)

    Connor, Christopher W; Saffary, Roya; Feliz, Eddy

    2013-01-01

    We examined the proper performance of the Sellick maneuver, a maneuver used to reduce the risk of aspiration of stomach contents during induction of general anesthesia, using a novel device that measures and visualizes the force applied to the cricoid cartilage using thin-film force sensitive resistors in a form suitable for in vivo use. Performance was tested in three stages with twenty anaesthesiology residents and twenty trained operating room nurses. Firstly, subjects applied force to the cricoid cartilage as was customary to them. Secondly, subjects used the device to guide the application of that force. Thirdly, subjects were again asked to perform the manoeuvre without visual guidance. Each test lasted 1 min and the amount of force applied was measured throughout. Overall, the Sellick maneuver was often not applied properly, with large variance between individual subjects. Performance and inter-subject consistency improved to a very highly significant degree when subjects were able to use the device as a visual guide (p < 0.001). Subsequent significant improvements in performances during the last, unguided test demonstrated that the device initiated learning. (paper)

  3. Performance of the Sellick maneuver significantly improves when residents and trained nurses use a visually interactive guidance device in simulation

    Energy Technology Data Exchange (ETDEWEB)

    Connor, Christopher W; Saffary, Roya; Feliz, Eddy [Department of Anesthesiology Boston Medical Center, Boston, MA (United States)

    2013-12-15

    We examined the proper performance of the Sellick maneuver, a maneuver used to reduce the risk of aspiration of stomach contents during induction of general anesthesia, using a novel device that measures and visualizes the force applied to the cricoid cartilage using thin-film force sensitive resistors in a form suitable for in vivo use. Performance was tested in three stages with twenty anaesthesiology residents and twenty trained operating room nurses. Firstly, subjects applied force to the cricoid cartilage as was customary to them. Secondly, subjects used the device to guide the application of that force. Thirdly, subjects were again asked to perform the manoeuvre without visual guidance. Each test lasted 1 min and the amount of force applied was measured throughout. Overall, the Sellick maneuver was often not applied properly, with large variance between individual subjects. Performance and inter-subject consistency improved to a very highly significant degree when subjects were able to use the device as a visual guide (p < 0.001). Subsequent significant improvements in performances during the last, unguided test demonstrated that the device initiated learning. (paper)

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

    DEFF Research Database (Denmark)

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

    2018-01-01

    ' choice of antibiotics. During 2006-2013, eight Swedish health care authorities adopted P4P to make physicians select narrow-spectrum antibiotics more often in the treatment of children with RTI. Exploiting register data on all purchases of RTI antibiotics in a difference-in-differences analysis, wefind......, which act on fewer bacteria types, when possible. Inappropriate use of antibiotics is nonetheless widespread, not least for respiratory tract infections (RTI), a common reason for antibiotics prescriptions. We examine if pay-for-performance (P4P) presents a way to influence primary care physicians...... that P4P significantly increased the share of narrow-spectrum antibiotics. There are no signs that physicians gamed the system by issuing more prescriptions overall....

  5. 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)

  6. 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…

  7. 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 ...

  8. 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

  9. Field significance of performance measures in the context of regional climate model evaluation. Part 1: temperature

    Science.gov (United States)

    Ivanov, Martin; Warrach-Sagi, Kirsten; Wulfmeyer, Volker

    2018-04-01

    A new approach for rigorous spatial analysis of the downscaling performance of regional climate model (RCM) simulations is introduced. It is based on a multiple comparison of the local tests at the grid cells and is also known as "field" or "global" significance. New performance measures for estimating the added value of downscaled data relative to the large-scale forcing fields are developed. The methodology is exemplarily applied to a standard EURO-CORDEX hindcast simulation with the Weather Research and Forecasting (WRF) model coupled with the land surface model NOAH at 0.11 ∘ grid resolution. Monthly temperature climatology for the 1990-2009 period is analysed for Germany for winter and summer in comparison with high-resolution gridded observations from the German Weather Service. The field significance test controls the proportion of falsely rejected local tests in a meaningful way and is robust to spatial dependence. Hence, the spatial patterns of the statistically significant local tests are also meaningful. We interpret them from a process-oriented perspective. In winter and in most regions in summer, the downscaled distributions are statistically indistinguishable from the observed ones. A systematic cold summer bias occurs in deep river valleys due to overestimated elevations, in coastal areas due probably to enhanced sea breeze circulation, and over large lakes due to the interpolation of water temperatures. Urban areas in concave topography forms have a warm summer bias due to the strong heat islands, not reflected in the observations. WRF-NOAH generates appropriate fine-scale features in the monthly temperature field over regions of complex topography, but over spatially homogeneous areas even small biases can lead to significant deteriorations relative to the driving reanalysis. As the added value of global climate model (GCM)-driven simulations cannot be smaller than this perfect-boundary estimate, this work demonstrates in a rigorous manner the

  10. 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.

  11. On the significance of the noise model for the performance of a linear MPC in closed-loop operation

    DEFF Research Database (Denmark)

    Hagdrup, Morten; Boiroux, Dimitri; Mahmoudi, Zeinab

    2016-01-01

    This paper discusses the significance of the noise model for the performance of a Model Predictive Controller when operating in closed-loop. The process model is parametrized as a continuous-time (CT) model and the relevant sampled-data filtering and control algorithms are developed. Using CT...... models typically means less parameters to identify. Systematic tuning of such controllers is discussed. Simulation studies are conducted for linear time-invariant systems showing that choosing a noise model of low order is beneficial for closed-loop performance. (C) 2016, IFAC (International Federation...

  12. Quantifying the Lateral Bracing Provided by Standing Steam Roof Systems

    OpenAIRE

    Sorensen, Taylor J.

    2016-01-01

    One of the major challenges of engineering is finding the proper balance between economical and safe. Currently engineers at Nucor Corporation have ignored the additional lateral bracing provided by standing seam roofing systems to joists because of the lack of methods available to quantify the amount of bracing provided. Based on the results of testing performed herein, this bracing is significant, potentially resulting in excessively conservative designs and unnecessary costs. This proje...

  13. The effect of interprofessional education on interprofessional performance and diabetes care knowledge of health care teams at the level one of health service providing.

    Science.gov (United States)

    Yamani, Nikoo; Asgarimoqadam, Marzieh; Haghani, Fariba; Alavijeh, Abbas Qari

    2014-01-01

    The increase in life expectancy and changes in lifestyle have led to prevalence of non-communicable diseases including diabetes whose treatment and care requires effective teamwork. This study was conducted to examine the effect of inter-professional education on performance and diabetes care knowledge of health care teams. This quasi-experimental study was performed as an inter-professional education on 6 healthcare teams (34 people) based on Kolb's Learning Cycle and consisted of a set of training activities to improve individual, group, and inter-professional capabilities of members of the health care team. The pre- and post-tests included Team Climate Inventory (TCI) and a knowledge assessment tool performed before the workshop and 3 months later. Mean scores for knowledge of health care team before intervention and 3 months later were 7.06 ± 1.04 and 7.97 ± 0.97 out of 10, respectively, that showed a significant difference (P teams. It also can make the health-related messages provided to the covered population more consistent in addition to enhancing self-confidence of the personnel.

  14. Nutritional Supplement of Hatchery Eggshell Membrane Improves Poultry Performance and Provides Resistance against Endotoxin Stress.

    Science.gov (United States)

    Makkar, S K; Rath, N C; Packialakshmi, B; Zhou, Z Y; Huff, G R; Donoghue, A M

    2016-01-01

    Eggshells are significant part of hatchery waste which consist of calcium carbonate crust, membranes, and proteins and peptides of embryonic origins along with other entrapped contaminants including microbes. We hypothesized that using this product as a nutritional additive in poultry diet may confer better immunity to the chickens in the paradigm of mammalian milk that enhances immunity. Therefore, we investigated the effect of hatchery eggshell membranes (HESM) as a short term feed supplement on growth performance and immunity of chickens under bacterial lipopolysaccharide (LPS) challenged condition. Three studies were conducted to find the effect of HESM supplement on post hatch chickens. In the first study, the chickens were fed either a control diet or diets containing 0.5% whey protein or HESM as supplement and evaluated at 5 weeks of age using growth, hematology, clinical chemistry, plasma immunoglobulins, and corticosterone as variables. The second and third studies were done to compare the effects of LPS on control and HESM fed birds at 5 weeks of age following at 4 and 24 h of treatment where the HESM was also sterilized with ethanol to deplete bacterial factors. HESM supplement caused weight gain in 2 experiments and decreased blood corticosterone concentrations. While LPS caused a significant loss in body weight at 24 h following its administration, the HESM supplemented birds showed significantly less body weight loss compared with the control fed birds. The WBC, heterophil/lymphocyte ratio, and the levels of IgG were low in chickens fed diets with HESM supplement compared with control diet group. LPS challenge increased the expression of pro-inflammatory cytokine gene IL-6 but the HESM fed birds showed its effect curtailed, also, which also, favored the up-regulation of anti-inflammatory genes compared with control diet fed chickens. Post hatch supplementation of HESM appears to improve performance, modulate immunity, and increase resistance of

  15. The corporate culture's significance toorganization management

    Institute of Scientific and Technical Information of China (English)

    2015-01-01

    In modern organization management, the organization culture is gradually drawn attention by the entrepreneurs and the CEO or managers of the enterprises. Theclose relationship between culture management and organization successis constantly beingproved to be true that culture is indeed one of the vital elements of organization management.Although it is not simple to research the culture impact on management in all respects, this essay attempts to illustrate that culture management is very significant to a successful organization,and the recommendation of how organizational culture management improving the enterprise performance as well as making the companies successful are provided.

  16. Influence of Organizational Culture on Service Provider Selection

    OpenAIRE

    Yılmaz, Mehmet; Yılmaz Börekçi, Dilek; Örnek, Ali

    2017-01-01

    Although Third Party Logistics Service Provider (3PL) selection literature mentions organizational culture’s role in the development as well as in the maintenance of 3PL arrangements, there is a paucity of attempts to underline the significance of organizational culture’s influence on the formation and management of 3PL relationships. In this study, the influence of different organizational cultural orientations in uncertainty avoidance, future orientation, performance orientation and paterna...

  17. 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$

  18. Darpana for development: performance and change. The Darpana outreach programme: performance, education and change.

    Science.gov (United States)

    Yarrow, R

    1997-03-01

    This paper reports on the advancement and assessment results of three project strategies--Awakening Awareness, Jagruti, and Parivartan--based on project documentations, interviews and direct observation conducted among 6th grade school children in Ahmedabad, Gujarat. Awakening Awareness aimed to motivate children in facing problems through story telling. Results of this pilot project indicate a significant impact on the children. Jagruti discusses the environmental and health issues through performing arts. Results reveal that the communication approach is an effective method in providing knowledge-awareness-skill among students. Parivartan, which included music and dance performance in initiating social, cultural, gender and health change revealed significant shifts in their behavior. These three projects exhibit success in the promotion of knowledge and awareness, instigation of attitude change, and stimulation of subsequent responsible action through performative and interactive methods. Furthermore, these initiatives provided more significance in the local and national contexts, which provides not only a way to develop responsibility, but also a practical, testable and direct addition to the aesthetic and educational repertoire.

  19. Significant Effect of a Pre-Exercise High-Fat Meal after a 3-Day High-Carbohydrate Diet on Endurance Performance

    Directory of Open Access Journals (Sweden)

    Ikuma Murakami

    2012-06-01

    Full Text Available We investigated the effect of macronutrient composition of pre-exercise meals on endurance performance. Subjects consumed a high-carbohydrate diet at each meal for 3 days, followed by a high-fat meal (HFM; 1007 ± 21 kcal, 30% CHO, 55% F and 15% P or high-carbohydrate meal (HCM; 1007 ± 21 kcal, 71% CHO, 20% F and 9% P 4 h before exercise. Furthermore, just prior to the test, subjects in the HFM group ingested either maltodextrin jelly (M or a placebo jelly (P, while subjects in the HCM ingested a placebo jelly. Endurance performance was measured as running time until exhaustion at a speed between lactate threshold and the onset of blood lactate accumulation. All subjects participated in each trial, randomly assigned at weekly intervals. We observed that the time until exhaustion was significantly longer in the HFM + M (p < 0.05 than in HFM + P and HCM + P conditions. Furthermore, the total amount of fat oxidation during exercise was significantly higher in HFM + M and HFM + P than in HCM + P (p < 0.05. These results suggest that ingestion of a HFM prior to exercise is more favorable for endurance performance than HCM. In addition, HFM and maltodextrin ingestion following 3 days of carbohydrate loading enhances endurance running performance.

  20. Significantly enhanced electrochemical performance of lithium titanate anode for lithium ion battery by the hybrid of nitrogen and sulfur co-doped graphene quantum dots

    International Nuclear Information System (INIS)

    Ruiyi, Li; Yuanyuan, Jiang; Xiaoyan, Zhou; Zaijun, Li; Zhiguo, Gu; Guangli, Wang; Junkang, Liu

    2015-01-01

    Graphical abstract: The study reported a facile synthesis of Li4Ti5O12/nitrogen and sulfur co-doped graphene quantum dots (LTO/N,S-GQDs). The unique architecture and the introduction of N,S-GQDs create both ultrafast electron transfer and electrolyte transport. The as-prepared LTO/N,S-GQDs anode provides prominent advantage of specific capacity, high-rate performance and cycle stability. - Highlights: • We reported a new lithium titanate/nitrogen and sulfur co-doped graphene quantum dots hybrid • The synthesis creates a crystalline interconnected porous framework composed of nanoscale LTO • The unique architecture achieves to maximize the rate performance and enhance the power density • Introduction of N,S-GQDs greatly enhances the electron transfer and the storage lithium capacity • The hybrid anode provides an excellent electrochemical performance for lithium-ion batteries - ABSTRACT: The paper reported a facile synthesis of lithium titanate/nitrogen and sulfur co-doped graphene quantum dots(LTO/N,S-GQDs). Tetrabutyl titanate was dissolved in tertbutanol and heated to refluxing state by microwave irradiation. Then, lithium acetate was added into the mixed solution to produce LTO precursor. The precursor was hybridized with N,S-GQDs in ethanol. Followed by drying and thermal annealing at 500 °C in Ar/H_2 to obtain LTO/N,S-GQDs. The synthesis creates fully crystalline interconnected porous framework composed of nanoscale LTO crystals. The unique architecture achieves to maximize the high-rate performance and enhance the power density. More importantly, the introduction of N,S-GQDs don't almost influence on the electrolyte transport, but greatly improve the electron transfer and the storage lithium capacity. The LTO/N,S-GQDs anode exhibits remarkably enhanced electrochemical performance for lithium ion battery. The specific discharge capacity is 254.2 mAh g"−"1 at 0.1C and 126.5 mAh g"−"1 at 10C. The capacity remains 96.9% at least after 2000 cycles

  1. Roles and significance of water conducting features for transport models in performance assessment

    International Nuclear Information System (INIS)

    Carrera, J.; Sanchez-Vila, X.; Medina, A.

    1999-01-01

    The term water conducting features (WCF) refers to zones of high hydraulic conductivity. In the context of waste disposal, it is further implied that they are narrow so that chances of sampling them are low. Yet, they may carry significant amounts of water. Moreover, their relatively small volumetric water content causes solutes to travel fast through them. Water-conducting features are a rather common feature of natural media. The fact that they have become a source of concern in recent years, reflects more the increased level of testing and monitoring than any intrinsic property of low permeability media. Accurate simulations of solute transport require a realistic accounting for water conducting features. Methods are presented to do so and examples are shown to illustrate these methods. Since detailed accounting of WCF's will not be possible in actual performance assessments, efforts should be directed towards typification, so as to identify the essential effects of WCF's on solute transport through different types of rocks. Field evidence suggests that, although individual WCF's may be difficult to characterize, their effects are quite predictable. (author)

  2. 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.

  3. Nutritional Supplement of Hatchery Eggshell Membrane Improves Poultry Performance and Provides Resistance against Endotoxin Stress.

    Directory of Open Access Journals (Sweden)

    S K Makkar

    Full Text Available Eggshells are significant part of hatchery waste which consist of calcium carbonate crust, membranes, and proteins and peptides of embryonic origins along with other entrapped contaminants including microbes. We hypothesized that using this product as a nutritional additive in poultry diet may confer better immunity to the chickens in the paradigm of mammalian milk that enhances immunity. Therefore, we investigated the effect of hatchery eggshell membranes (HESM as a short term feed supplement on growth performance and immunity of chickens under bacterial lipopolysaccharide (LPS challenged condition. Three studies were conducted to find the effect of HESM supplement on post hatch chickens. In the first study, the chickens were fed either a control diet or diets containing 0.5% whey protein or HESM as supplement and evaluated at 5 weeks of age using growth, hematology, clinical chemistry, plasma immunoglobulins, and corticosterone as variables. The second and third studies were done to compare the effects of LPS on control and HESM fed birds at 5 weeks of age following at 4 and 24 h of treatment where the HESM was also sterilized with ethanol to deplete bacterial factors. HESM supplement caused weight gain in 2 experiments and decreased blood corticosterone concentrations. While LPS caused a significant loss in body weight at 24 h following its administration, the HESM supplemented birds showed significantly less body weight loss compared with the control fed birds. The WBC, heterophil/lymphocyte ratio, and the levels of IgG were low in chickens fed diets with HESM supplement compared with control diet group. LPS challenge increased the expression of pro-inflammatory cytokine gene IL-6 but the HESM fed birds showed its effect curtailed, also, which also, favored the up-regulation of anti-inflammatory genes compared with control diet fed chickens. Post hatch supplementation of HESM appears to improve performance, modulate immunity, and increase

  4. 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.

  5. Performance characteristics of SCC radioimmunoassay and clinical significance serum SCC Ag assay in patients with malignancy

    International Nuclear Information System (INIS)

    Kim, Dong Youn

    1986-01-01

    To evaluate the performance characteristics of SCC RIV and the clinical significance of serum SCC Ag assay in patients with malignancy, serum SCC Ag levels were measured by SCC RIV kit in 40 normal controls and 35 percents with various untreated malignancy, who visited Chonju Presbyterian Medical Center. The results were as follows; 1. The SCC RIA was simple to perform and can be completed in two workday. And the standard curve and reproducibility were both good. 2. The mean serum SCC Ag level in normal controls was 1.64 ± 0.93 ng/mL and normal upper limit of serum SCC Ag was defined as 2.6 ng/mL. 3 out of 40 (7.5%) normal controls showed elevated SCC Ag levels above the normal upper limit. 3. In 35 patients with various untreated malignancy, 18 patients (51.4%) showed elevated serum SCC Ag levels, 59.1% of 22 patients with cervical cancer, 80% of 5 patients with lung cancer, 33% of 3 patients with esophageal cancer, 0% of 2 patients with rectal cancer and 0% of 3 patients with breast cancer showed elevated serum SCC Ag levels. Above results represent that SCC RIV is simple method to perform followed by good standard curve and reproducibility, and may be a useful indicator reflecting diagnostic data of patients with cervical cancer and lung cancer

  6. A puzzle form of a non-verbal intelligence test gives significantly higher performance measures in children with severe intellectual disability.

    Science.gov (United States)

    Bello, Katrina D; Goharpey, Nahal; Crewther, Sheila G; Crewther, David P

    2008-08-01

    Assessment of 'potential intellectual ability' of children with severe intellectual disability (ID) is limited, as current tests designed for normal children do not maintain their interest. Thus a manual puzzle version of the Raven's Coloured Progressive Matrices (RCPM) was devised to appeal to the attentional and sensory preferences and language limitations of children with ID. It was hypothesized that performance on the book and manual puzzle forms would not differ for typically developing children but that children with ID would perform better on the puzzle form. The first study assessed the validity of this puzzle form of the RCPM for 76 typically developing children in a test-retest crossover design, with a 3 week interval between tests. A second study tested performance and completion rate for the puzzle form compared to the book form in a sample of 164 children with ID. In the first study, no significant difference was found between performance on the puzzle and book forms in typically developing children, irrespective of the order of completion. The second study demonstrated a significantly higher performance and completion rate for the puzzle form compared to the book form in the ID population. Similar performance on book and puzzle forms of the RCPM by typically developing children suggests that both forms measure the same construct. These findings suggest that the puzzle form does not require greater cognitive ability but demands sensory-motor attention and limits distraction in children with severe ID. Thus, we suggest the puzzle form of the RCPM is a more reliable measure of the non-verbal mentation of children with severe ID than the book form.

  7. No significant effect of prefrontal tDCS on working memory performance in older adults

    Directory of Open Access Journals (Sweden)

    Jonna eNilsson

    2015-12-01

    Full Text Available Transcranial direct current stimulation (tDCS has been put forward as a non-pharmacological alternative for alleviating cognitive decline in old age. Although results have shown some promise, little is known about the optimal stimulation parameters for modulation in the cognitive domain. In this study, the effects of tDCS over the dorsolateral prefrontal cortex (dlPFC on working memory performance were investigated in thirty older adults. An N-back task assessed working memory before, during and after anodal tDCS at a current strength of 1mA and 2mA, in addition to sham stimulation. The study used a single-blind, cross-over design. The results revealed no significant effect of tDCS on accuracy or response times during or after stimulation, for any of the current strengths. These results suggest that a single session of tDCS over the dlPFC is unlikely to improve working memory, as assessed by an N-back task, in old age.

  8. Lack of significant associations with early career performance suggest no link between the DMRT3 "Gait Keeper" mutation and precocity in Coldblooded trotters.

    Directory of Open Access Journals (Sweden)

    Kim Jäderkvist Fegraeus

    Full Text Available The Swedish-Norwegian Coldblooded trotter (CBT is a local breed in Sweden and Norway mainly used for harness racing. Previous studies have shown that a mutation from cytosine (C to adenine (A in the doublesex and mab-3 related transcription factor 3 (DMRT3 gene has a major impact on harness racing performance of different breeds. An association of the DMRT3 mutation with early career performance has also been suggested. The aim of the current study was to investigate this proposed association in a randomly selected group of CBTs. 769 CBTs (485 raced, 284 unraced were genotyped for the DMRT3 mutation. The association with racing performance was investigated for 13 performance traits and three different age intervals: 3 years, 3 to 6 years, and 7 to 10 years of age, using the statistical software R. Each performance trait was analyzed for association with DMRT3 using linear models. The results suggest no association of the DMRT3 mutation with precocity (i.e. performance at 3 years of age. Only two traits (race time and number of disqualifications were significantly different between the genotypes, with AA horses having the fastest times and CC horses having the highest number of disqualifications at 3 years of age. The frequency of the AA genotype was significantly lower in the raced CBT sample compared with the unraced sample and less than 50% of the AA horses participated in a race. For the age intervals 3 to 6 and 7 to 10 years the AA horses also failed to demonstrate significantly better performance than the other genotypes. Although suggested as the most favorable genotype for racing performance in Standardbreds and Finnhorses across all ages, the AA genotype does not appear to be associated with superior performance, early or late, in the racing career of CBTs.

  9. Significant enhancement in thermoelectric performance of nanostructured higher manganese silicides synthesized employing a melt spinning technique.

    Science.gov (United States)

    Muthiah, Saravanan; Singh, R C; Pathak, B D; Avasthi, Piyush Kumar; Kumar, Rishikesh; Kumar, Anil; Srivastava, A K; Dhar, Ajay

    2018-01-25

    The limited thermoelectric performance of p-type Higher Manganese Silicides (HMS) in terms of their low figure-of-merit (ZT), which is far below unity, is the main bottle-neck for realising an efficient HMS based thermoelectric generator, which has been recognized as the most promising material for harnessing waste-heat in the mid-temperature range, owing to its thermal stability, earth-abundant and environmentally friendly nature of its constituent elements. We report a significant enhancement in the thermoelectric performance of nanostructured HMS synthesized using rapid solidification by optimizing the cooling rates during melt-spinning followed by spark plasma sintering of the resulting melt-spun ribbons. By employing this experimental strategy, an unprecedented ZT ∼ 0.82 at 800 K was realized in spark plasma sintered 5 at% Al-doped MnSi 1.73 HMS, melt spun at an optimized high cooling rate of ∼2 × 10 7 K s -1 . This enhancement in ZT represents a ∼25% increase over the best reported values thus far for HMS and primarily originates from a nano-crystalline microstructure consisting of a HMS matrix (20-40 nm) with excess Si (3-9 nm) uniformly distributed in it. This nanostructure, resulting from the high cooling rates employed during the melt-spinning of HMS, introduces a high density of nano-crystallite boundaries in a wide spectrum of nano-scale dimensions, which scatter the low-to-mid-wavelength heat-carrying phonons. This abundant phonon scattering results in a significantly reduced thermal conductivity of ∼1.5 W m -1 K -1 at 800 K, which primarily contributes to the enhancement in ZT.

  10. Evaluation of Techniques to Detect Significant Network Performance Problems using End-to-End Active Network Measurements

    Energy Technology Data Exchange (ETDEWEB)

    Cottrell, R.Les; Logg, Connie; Chhaparia, Mahesh; /SLAC; Grigoriev, Maxim; /Fermilab; Haro, Felipe; /Chile U., Catolica; Nazir, Fawad; /NUST, Rawalpindi; Sandford, Mark

    2006-01-25

    End-to-End fault and performance problems detection in wide area production networks is becoming increasingly hard as the complexity of the paths, the diversity of the performance, and dependency on the network increase. Several monitoring infrastructures are built to monitor different network metrics and collect monitoring information from thousands of hosts around the globe. Typically there are hundreds to thousands of time-series plots of network metrics which need to be looked at to identify network performance problems or anomalous variations in the traffic. Furthermore, most commercial products rely on a comparison with user configured static thresholds and often require access to SNMP-MIB information, to which a typical end-user does not usually have access. In our paper we propose new techniques to detect network performance problems proactively in close to realtime and we do not rely on static thresholds and SNMP-MIB information. We describe and compare the use of several different algorithms that we have implemented to detect persistent network problems using anomalous variations analysis in real end-to-end Internet performance measurements. We also provide methods and/or guidance for how to set the user settable parameters. The measurements are based on active probes running on 40 production network paths with bottlenecks varying from 0.5Mbits/s to 1000Mbit/s. For well behaved data (no missed measurements and no very large outliers) with small seasonal changes most algorithms identify similar events. We compare the algorithms' robustness with respect to false positives and missed events especially when there are large seasonal effects in the data. Our proposed techniques cover a wide variety of network paths and traffic patterns. We also discuss the applicability of the algorithms in terms of their intuitiveness, their speed of execution as implemented, and areas of applicability. Our encouraging results compare and evaluate the accuracy of our

  11. More than a cool illusion? Functional significance of self-motion illusion (circular vection) for perspective switches.

    Science.gov (United States)

    Riecke, Bernhard E; Feuereissen, Daniel; Rieser, John J; McNamara, Timothy P

    2015-01-01

    Self-motion can facilitate perspective switches and "automatic spatial updating" and help reduce disorientation in applications like virtual reality (VR). However, providing physical motion through moving-base motion simulators or free-space walking areas comes with high cost and technical complexity. This study provides first evidence that merely experiencing an embodied illusion of self-motion ("circular vection") can provide similar behavioral benefits as actual self-motion: Blindfolded participants were asked to imagine facing new perspectives in a well-learned room, and point to previously learned objects. Merely imagining perspective switches while stationary yielded worst performance. When perceiving illusory self-rotation to the novel perspective, however, performance improved significantly and yielded performance similar to actual rotation. Circular vection was induced by combining rotating sound fields ("auditory vection") and biomechanical vection from stepping along a carrousel-like rotating floor platter. In sum, illusory self-motion indeed facilitated perspective switches and thus spatial orientation, similar to actual self-motion, thus providing first compelling evidence of the functional significance and behavioral relevance of vection. This could ultimately enable us to complement the prevailing introspective vection measures with behavioral indicators, and guide the design for more affordable yet effective VR simulators that intelligently employ multi-modal self-motion illusions to reduce the need for costly physical observer motion.

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

    Science.gov (United States)

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

    2018-01-01

    Antibiotic resistance is a major threat to public health worldwide. As the healthcare sector's use of antibiotics is an important contributor to the development of resistance, it is crucial that physicians only prescribe antibiotics when needed and that they choose narrow-spectrum antibiotics, which act on fewer bacteria types, when possible. Inappropriate use of antibiotics is nonetheless widespread, not least for respiratory tract infections (RTI), a common reason for antibiotics prescriptions. We examine if pay-for-performance (P4P) presents a way to influence primary care physicians' choice of antibiotics. During 2006-2013, 8 Swedish healthcare authorities adopted P4P to make physicians select narrow-spectrum antibiotics more often in the treatment of children with RTI. Exploiting register data on all purchases of RTI antibiotics in a difference-in-differences analysis, we find that P4P significantly increased the share of narrow-spectrum antibiotics. There are no signs that physicians gamed the system by issuing more prescriptions overall. © 2017 The Authors Health Economics Published by John Wiley & Sons Ltd.

  13. Significant NRC Enforcement Actions

    Data.gov (United States)

    Nuclear Regulatory Commission — This dataset provides a list of Nuclear Regulartory Commission (NRC) issued significant enforcement actions. These actions, referred to as "escalated", are issued by...

  14. The energetic significance of cooking.

    Science.gov (United States)

    Carmody, Rachel N; Wrangham, Richard W

    2009-10-01

    While cooking has long been argued to improve the diet, the nature of the improvement has not been well defined. As a result, the evolutionary significance of cooking has variously been proposed as being substantial or relatively trivial. In this paper, we evaluate the hypothesis that an important and consistent effect of cooking food is a rise in its net energy value. The pathways by which cooking influences net energy value differ for starch, protein, and lipid, and we therefore consider plant and animal foods separately. Evidence of compromised physiological performance among individuals on raw diets supports the hypothesis that cooked diets tend to provide energy. Mechanisms contributing to energy being gained from cooking include increased digestibility of starch and protein, reduced costs of digestion for cooked versus raw meat, and reduced energetic costs of detoxification and defence against pathogens. If cooking consistently improves the energetic value of foods through such mechanisms, its evolutionary impact depends partly on the relative energetic benefits of non-thermal processing methods used prior to cooking. We suggest that if non-thermal processing methods such as pounding were used by Lower Palaeolithic Homo, they likely provided an important increase in energy gain over unprocessed raw diets. However, cooking has critical effects not easily achievable by non-thermal processing, including the relatively complete gelatinisation of starch, efficient denaturing of proteins, and killing of food borne pathogens. This means that however sophisticated the non-thermal processing methods were, cooking would have conferred incremental energetic benefits. While much remains to be discovered, we conclude that the adoption of cooking would have led to an important rise in energy availability. For this reason, we predict that cooking had substantial evolutionary significance.

  15. 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.

  16. 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.

  17. Significant improvement of olfactory performance in sleep apnea patients after three months of nasal CPAP therapy - Observational study and randomized trial.

    Directory of Open Access Journals (Sweden)

    Bettina Boerner

    Full Text Available The olfactory function highly impacts quality of life (QoL. Continuous positive airway pressure is an effective treatment for obstructive sleep apnea (OSA and is often applied by nasal masks (nCPAP. The influence of nCPAP on the olfactory performance of OSA patients is unknown. The aim of this study was to assess the sense of smell before initiation of nCPAP and after three months treatment, in moderate and severe OSA patients.The sense of smell was assessed in 35 patients suffering from daytime sleepiness and moderate to severe OSA (apnea/hypopnea index ≥ 15/h, with the aid of a validated test battery (Sniffin' Sticks before initiation of nCPAP therapy and after three months of treatment. Additionally, adherent subjects were included in a double-blind randomized three weeks CPAP-withdrawal trial (sub-therapeutic CPAP pressure.Twenty five of the 35 patients used the nCPAP therapy for more than four hours per night, and for more than 70% of nights (adherent group. The olfactory performance of these patients improved significantly (p = 0.007 after three months of nCPAP therapy. When considering the entire group of patients, olfaction also improved significantly (p = 0.001. In the randomized phase the sense of smell of six patients deteriorated under sub-therapeutic CPAP pressure (p = 0.046 whereas five patients in the maintenance CPAP group showed no significant difference (p = 0.501.Olfactory performance improved significantly after three months of nCPAP therapy in patients suffering from moderate and severe OSA. It seems that this effect of nCPAP is reversible under sub-therapeutic CPAP pressure.ISRCTN11128866.

  18. Management and non-supervisory perceptions surrounding the implementation and significance of high-performance work practices in a nuclear power plant

    Science.gov (United States)

    Ashbridge, Gayle Ann

    Change management has become an imperative for organizations as they move into the 21st century; up to 75 percent of change initiatives fail. Nuclear power plants face the same challenges as industrial firms with the added challenge of deregulation. Faced with this challenge, restructuring the electric utility has raised a number of complex issues. Under traditional cost-of-service regulation, electric utilities were able to pass on their costs to consumers who absorbed them. In the new competitive environment, customers will now choose their suppliers based on the most competitive price. The purpose of this study is to determine the degree of congruence between non-supervisory and supervisory personnel regarding the perceived implementation of high performance workplace practices at a nuclear power plant. This study used as its foundation the practices identified in the Road to High Performance Workplaces: A Guide to Better Jobs and Better Business Results by the U.S. Department of Labor's Office of the American Workplace (1994). The population for this study consisted of organizational members at one nuclear power plant. Over 300 individuals completed surveys on high performance workplace practices. Two surveys were administered, one to non-supervisory personnel and one to first line supervisors and above. The determination of implementation levels was accomplished through descriptive statistical analysis. Results of the study revealed 32 areas of noncongruence between non-supervisory and supervisory personnel in regard to the perceived implementation level of the high performance workplace practices. Factor analysis further revealed that the order in which the respondents place emphasis on the variables varies between the two groups. This study provides recommendations that may improve the nuclear power plants alignment of activities. Recommendations are also provided for additional research on high-performance work practices.

  19. Danish mutual fund performance

    DEFF Research Database (Denmark)

    Christensen, Michael

    2013-01-01

    This article provides the first independent performance analysis of Danish mutual funds. We analyse selectivity and market timing abilities for 71 mutual funds that have been in operation from 2001 to 2010. The results show great fund performance diversity. Half the funds have performed neutrally......, whereas 42% of the funds have shown significantly negative performance and only 7% of the funds have over-performed their benchmark. Furthermore, 14% of the funds analysed possess market timing abilities, but for 8 out of 10 funds, their market timing ability has been unsuccessful....

  20. Hyper-Realistic, Team-Centered Fleet Surgical Team Training Provides Sustained Improvements in Performance.

    Science.gov (United States)

    Hoang, Tuan N; Kang, Jeff; Siriratsivawong, Kris; LaPorta, Anthony; Heck, Amber; Ferraro, Jessica; Robinson, Douglas; Walsh, Jonathan

    2016-01-01

    The high-stress, fast-paced environment of combat casualty care relies on effective teamwork and communication which translates into quality patient care. A training course was developed for U.S. Navy Fleet Surgical Teams to address these aspects of patient care by emphasizing efficiency and appropriate patient care. An effective training course provides knowledge and skills to pass the course evaluation and sustain the knowledge and skills acquired over time. The course included classroom didactic hours, and hands-on simulation sessions. A pretest was administered before the course, a posttest upon completion, and a sustainment test 5 months following course completion. The evaluation process measured changes in patient time to disposition and critical errors made during patient care. Naval Base San Diego, with resuscitation and surgical simulations carried out within the shipboard medical spaces. United States Navy medical personnel including physicians of various specialties, corpsmen, nurses, and nurse anesthetists deploying aboard ships. Time to disposition improved significantly, 11 ± 3 minutes, from pretest to posttest, and critical errors improved by 4 ± 1 errors per encounter. From posttest to sustainment test, time to disposition increased by 3 ± 1, and critical errors decreased by 1 ± 1. This course showed value in improving teamwork and communication skills of participants, immediately upon completion of the course, and after 5 months had passed. Therefore, with ongoing sustainment activities within 6 months, this course can substantially improve trauma care provided by shipboard deployed Navy medical personnel to wounded service members. Published by Elsevier Inc.

  1. 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…

  2. Examining significant factors in micro and small enterprises performance: case study in Amhara region, Ethiopia

    Science.gov (United States)

    Cherkos, Tomas; Zegeye, Muluken; Tilahun, Shimelis; Avvari, Muralidhar

    2017-07-01

    Furniture manufacturing micro and small enterprises are confronted with several factors that affect their performance. Some enterprises fail to sustain, some others remain for long period of time without transforming, and most are producing similar and non-standard products. The main aim of this manuscript is on improving the performance and contribution of MSEs by analyzing impact of significant internal and external factors. Data was collected via a questionnaire, group discussion with experts and interviewing process. Randomly selected eight representative main cities of Amhara region with 120 furniture manufacturing enterprises are considered. Data analysis and presentation was made using SPSS tools (correlation, proximity, and T test) and impact-effort analysis matrix tool. The correlation analysis shows that politico-legal with infrastructure, leadership with entrepreneurship skills and finance and credit with marketing factors are those factors, which result in high correlation with Pearson correlation values of r = 0.988, 0.983, and 0.939, respectively. The study investigates that the most critical factors faced by MSEs are work premises, access to finance, infrastructure, entrepreneurship and business managerial problems. The impact of these factors is found to be high and is confirmed by the 50% drop-out rate in 2014/2015. Furthermore, more than 25% work time losses due to power interruption daily and around 65% work premises problems challenged MSEs. Further, an impact-effort matrix was developed to help the MSEs to prioritize the affecting factors.

  3. 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.

  4. Significant manipulation of output performance of a bridge-structured spin valve magnetoresistance sensor via an electric field

    Science.gov (United States)

    Zhang, Yue; Yan, Baiqian; Ou-Yang, Jun; Wang, Xianghao; Zhu, Benpeng; Chen, Shi; Yang, Xiaofei

    2016-01-01

    Through principles of spin-valve giant magnetoresistance (SV-GMR) effect and its application in magnetic sensors, we have investigated electric-field control of the output performance of a bridge-structured Co/Cu/NiFe/IrMn SV-GMR sensor on a PZN-PT piezoelectric substrate using the micro-magnetic simulation. We centered on the influence of the variation of uniaxial magnetic anisotropy constant (K) of Co on the output of the bridge, and K was manipulated via the stress of Co, which is generated from the strain of a piezoelectric substrate under an electric field. The results indicate that when K varies between 2 × 104 J/m3 and 10 × 104 J/m3, the output performance can be significantly manipulated: The linear range alters from between -330 Oe and 330 Oe to between -650 Oe and 650 Oe, and the sensitivity is tuned by almost 7 times, making it possible to measure magnetic fields with very different ranges. According to the converse piezoelectric effect, we have found that this variation of K can be realized by applying an electric field with the magnitude of about 2-20 kV/cm on a PZN-PT piezoelectric substrate, which is realistic in application. This result means that electric-control of SV-GMR effect has potential application in developing SV-GMR sensors with improved performance.

  5. Maternity Care Services Provided by Family Physicians in Rural Hospitals.

    Science.gov (United States)

    Young, Richard A

    The purpose of this study was to describe how many rural family physicians (FPs) and other types of providers currently provide maternity care services, and the requirements to obtain privileges. Chief executive officers of rural hospitals were purposively sampled in 15 geographically diverse states with significant rural areas in 2013 to 2014. Questions were asked about the provision of maternity care services, the physicians who perform them, and qualifications required to obtain maternity care privileges. Analysis used descriptive statistics, with comparisons between the states, community rurality, and hospital size. The overall response rate was 51.2% (437/854). Among all identified hospitals, 44.9% provided maternity care services, which varied considerably by state (range, 17-83%; P maternity care, a mean of 271 babies were delivered per year, 27% by cesarean delivery. A mean of 7.0 FPs had privileges in these hospitals, of which 2.8 provided maternity care and 1.8 performed cesarean deliveries. The percentage of FPs who provide maternity care (mean, 48%; range, 10-69%; P maternity care who are FPs (mean, 63%; range, 10-88%; P maternity care services in US rural hospitals, including cesarean deliveries. Some family medicine residencies should continue to train their residents to provide these services to keep replenishing this valuable workforce. © Copyright 2017 by the American Board of Family Medicine.

  6. 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

  7. More than a Cool Illusion? Functional Significance of Self-Motion Illusion (Circular Vection for Perspective Switches

    Directory of Open Access Journals (Sweden)

    Bernhard E. Riecke

    2015-08-01

    Full Text Available Self-motion can facilitate perspective switches and automatic spatial updating and help reduce disorientation in applications like Virtual Reality. However, providing physical motion through moving-base motion simulators or free-space walking areas comes with high cost and technical complexity. This study provides first evidence that merely experiencing an embodied illusion of self-motion (circular vection can provide similar behavioral benefits as actual self-motion: Blindfolded participants were asked to imagine facing new perspectives in a well-learned room, and point to previously-learned objects. Merely imagining perspective switches while stationary yielded worst performance. When perceiving illusory self-rotation to the novel perspective, however, performance improved significantly and yielded performance similar to actual rotation. Circular vection was induced by combining rotating sound fields (auditory vection and biomechanical vection from stepping along a carrousel-like rotating floor platter. In sum, illusory self-motion indeed facilitated perspective switches and thus spatial orientation, similar to actual self-motion, thus providing first compelling evidence of the functional significance and behavioral relevance of vection. This could ultimately enable us to complement the prevailing introspective vection measures with behavioral indicators, and guide the design for more affordable yet effective Virtual Reality simulators that intelligently employ multi-modal self-motion illusions to reduce the need for costly physical observer motion.

  8. Evacuation of performance and significant chemical constituents and by products in drinking water treatment

    International Nuclear Information System (INIS)

    Jamrah, I. A.

    1999-01-01

    Drinking water treatment is a task that comprises of several processes that eventually lead to the addition of chemicals to achieve the objectives of treatment. This study was conducted to assess treatment performance, explain the presence of significant chemical species in water, and investigate the interactions and chemical by-products that are formed during the course of treatment. Grab water samples were collected on a regular basis from the influent and effluent of Zai water treatment plant. Chemical analysis were conducted to determine the concentrations of various chemical species of interest. Turbidity, temperature, and pH of the samples were also measured. The study concluded that Zai Water Treatment Plant produces potable drinking water in accordance with Jordanian Standards. The use of treatment chemical resulted in an increase in the concentrations of certain materials, such as manganese, aluminum, and sulfate. The turbidity of the raw water and the TOC of the samples were positively correlated, and the treatment results in approximately 20% TOC reduction, which demonstrates that the measures used for the control of TOC (carbon adsorption and permanganate pre-oxidation), are not very effective. The study also showed that the TOC content of our raw water samples and the concentration of tribalomethanes resulting after disinfection were positively correlated, and that bromoform was the dominant component. Also chloroform was the minor component of tribalomethanes formed during treatment. Positive correlation between the total concentration of tribalomethanes in water and the chlorine dose used for disinfection was also observed, and the total concentration of tribalomethanes increased with temperature. The formation of tribalomethanes was enhanced as the pH of water increased and as the concentration of bromide ion in raw water became significant. (author). 25 refs., 14 figs.1 table

  9. Significance of uncertainties derived from settling tank model structure and parameters on predicting WWTP performance - A global sensitivity analysis study

    DEFF Research Database (Denmark)

    Ramin, Elham; Sin, Gürkan; Mikkelsen, Peter Steen

    2011-01-01

    Uncertainty derived from one of the process models – such as one-dimensional secondary settling tank (SST) models – can impact the output of the other process models, e.g., biokinetic (ASM1), as well as the integrated wastewater treatment plant (WWTP) models. The model structure and parameter...... and from the last aerobic bioreactor upstream to the SST (Garrett/hydraulic method). For model structure uncertainty, two one-dimensional secondary settling tank (1-D SST) models are assessed, including a first-order model (the widely used Takács-model), in which the feasibility of using measured...... uncertainty of settler models can therefore propagate, and add to the uncertainties in prediction of any plant performance criteria. Here we present an assessment of the relative significance of secondary settling model performance in WWTP simulations. We perform a global sensitivity analysis (GSA) based...

  10. 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.

  11. 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...

  12. Significant manipulation of output performance of a bridge-structured spin valve magnetoresistance sensor via an electric field

    Energy Technology Data Exchange (ETDEWEB)

    Zhang, Yue; Yan, Baiqian; Ou-Yang, Jun; Zhu, Benpeng; Chen, Shi; Yang, Xiaofei, E-mail: hust-yangxiaofei@163.com [School of Optical and Electronic Information, Huazhong University of Science and Technology, Wuhan 430074 (China); Wang, Xianghao [School of Information Engineering, Wuhan University of Technology, Wuhan 430070 (China)

    2016-01-28

    Through principles of spin-valve giant magnetoresistance (SV-GMR) effect and its application in magnetic sensors, we have investigated electric-field control of the output performance of a bridge-structured Co/Cu/NiFe/IrMn SV-GMR sensor on a PZN-PT piezoelectric substrate using the micro-magnetic simulation. We centered on the influence of the variation of uniaxial magnetic anisotropy constant (K) of Co on the output of the bridge, and K was manipulated via the stress of Co, which is generated from the strain of a piezoelectric substrate under an electric field. The results indicate that when K varies between 2 × 10{sup 4 }J/m{sup 3} and 10 × 10{sup 4 }J/m{sup 3}, the output performance can be significantly manipulated: The linear range alters from between −330 Oe and 330 Oe to between −650 Oe and 650 Oe, and the sensitivity is tuned by almost 7 times, making it possible to measure magnetic fields with very different ranges. According to the converse piezoelectric effect, we have found that this variation of K can be realized by applying an electric field with the magnitude of about 2–20 kV/cm on a PZN-PT piezoelectric substrate, which is realistic in application. This result means that electric-control of SV-GMR effect has potential application in developing SV-GMR sensors with improved performance.

  13. Significant manipulation of output performance of a bridge-structured spin valve magnetoresistance sensor via an electric field

    International Nuclear Information System (INIS)

    Zhang, Yue; Yan, Baiqian; Ou-Yang, Jun; Zhu, Benpeng; Chen, Shi; Yang, Xiaofei; Wang, Xianghao

    2016-01-01

    Through principles of spin-valve giant magnetoresistance (SV-GMR) effect and its application in magnetic sensors, we have investigated electric-field control of the output performance of a bridge-structured Co/Cu/NiFe/IrMn SV-GMR sensor on a PZN-PT piezoelectric substrate using the micro-magnetic simulation. We centered on the influence of the variation of uniaxial magnetic anisotropy constant (K) of Co on the output of the bridge, and K was manipulated via the stress of Co, which is generated from the strain of a piezoelectric substrate under an electric field. The results indicate that when K varies between 2 × 10 4  J/m 3 and 10 × 10 4  J/m 3 , the output performance can be significantly manipulated: The linear range alters from between −330 Oe and 330 Oe to between −650 Oe and 650 Oe, and the sensitivity is tuned by almost 7 times, making it possible to measure magnetic fields with very different ranges. According to the converse piezoelectric effect, we have found that this variation of K can be realized by applying an electric field with the magnitude of about 2–20 kV/cm on a PZN-PT piezoelectric substrate, which is realistic in application. This result means that electric-control of SV-GMR effect has potential application in developing SV-GMR sensors with improved performance

  14. 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…

  15. Cost Calculation Model for Logistics Service Providers

    Directory of Open Access Journals (Sweden)

    Zoltán Bokor

    2012-11-01

    Full Text Available The exact calculation of logistics costs has become a real challenge in logistics and supply chain management. It is essential to gain reliable and accurate costing information to attain efficient resource allocation within the logistics service provider companies. Traditional costing approaches, however, may not be sufficient to reach this aim in case of complex and heterogeneous logistics service structures. So this paper intends to explore the ways of improving the cost calculation regimes of logistics service providers and show how to adopt the multi-level full cost allocation technique in logistics practice. After determining the methodological framework, a sample cost calculation scheme is developed and tested by using estimated input data. Based on the theoretical findings and the experiences of the pilot project it can be concluded that the improved costing model contributes to making logistics costing more accurate and transparent. Moreover, the relations between costs and performances also become more visible, which enhances the effectiveness of logistics planning and controlling significantly

  16. Functional relationships between plasmids and their significance for metabolism and symbiotic performance of Rhizobium leguminosarum bv. trifolii.

    Science.gov (United States)

    Stasiak, Grażyna; Mazur, Andrzej; Wielbo, Jerzy; Marczak, Małgorzata; Zebracki, Kamil; Koper, Piotr; Skorupska, Anna

    2014-11-01

    Rhizobium leguminosarum bv. trifolii TA1 (RtTA1) is a soil bacterium establishing a highly specific symbiotic relationship with clover, which is based on the exchange of molecular signals between the host plant and the microsymbiont. The RtTA1 genome is large and multipartite, composed of a chromosome and four plasmids, which comprise approximately 65 % and 35 % of the total genome, respectively. Extrachromosomal replicons were previously shown to confer significant metabolic versatility to bacteria, which is important for their adaptation in the soil and nodulation competitiveness. To investigate the contribution of individual RtTA1 plasmids to the overall cell phenotype, metabolic properties and symbiotic performance, a transposon-based elimination strategy was employed. RtTA1 derivatives cured of pRleTA1b or pRleTA1d and deleted in pRleTA1a were obtained. In contrast to the in silico predictions of pRleTA1b and pRleTA1d, which were described as chromid-like replicons, both appeared to be completely curable. On the other hand, for pRleTA1a (symbiotic plasmid) and pRleTA1c, which were proposed to be unessential for RtTA1 viability, it was not possible to eliminate them at all (pRleTA1c) or entirely (pRleTA1a). Analyses of the phenotypic traits of the RtTA1 derivatives obtained revealed the functional significance of individual plasmids and their indispensability for growth, certain metabolic pathways, production of surface polysaccharides, autoaggregation, biofilm formation, motility and symbiotic performance. Moreover, the results allow us to suggest broad functional cooperation among the plasmids in shaping the phenotypic properties and symbiotic capabilities of rhizobia.

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

    Science.gov (United States)

    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.

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

    Science.gov (United States)

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

    2015-12-01

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

  19. Selection of a cardiac surgery provider in the managed care era.

    Science.gov (United States)

    Shahian, D M; Yip, W; Westcott, G; Jacobson, J

    2000-11-01

    Many health planners promote the use of competition to contain cost and improve quality of care. Using a standard econometric model, we examined the evidence for "value-based" cardiac surgery provider selection in eastern Massachusetts, where there is significant competition and managed care penetration. McFadden's conditional logit model was used to study cardiac surgery provider selection among 6952 patients and eight metropolitan Boston hospitals in 1997. Hospital predictor variables included beds, cardiac surgery case volume, objective clinical and financial performance, reputation (percent out-of-state referrals, cardiac residency program), distance from patient's home to hospital, and historical referral patterns. Subgroup analyses were performed for each major payer category. Distance from patient's home to hospital (odds ratio 0.90; P =.000) and the historical referral pattern from each patient's hometown (z = 45.305; P =.000) were important predictors in all models. A cardiac surgery residency enhanced the probability of selection (odds ratio 5.25; P =.000), as did percent out-of-state referrals (odds ratio 1.10; P =.001). Higher mortality rates were associated with decreased probability of selection (odds ratio 0.51; P =.027), but higher length of stay was paradoxically associated with greater probability (odds ratio 1.72; P =.000). Total hospital costs were irrelevant (odds ratio 1.00; P =.179). When analyzed by payer subgroup, Medicare patients appeared to select hospitals with both low mortality (odds ratio 0.43; P =.176) and short length of stay (odds ratio 0.76; P =.213), although the results did not achieve statistical significance. The commercial managed care subgroup exhibited the least "value-based" behavior. The odds ratio for length of stay was the highest of any group (odds ratio = 2.589; P =.000) and there was a subset of hospitals for which higher mortality was actually associated with greater likelihood of selection. The observable

  20. Outcomes after intrauterine insemination are independent of provider type

    Science.gov (United States)

    Goldman, Randi H.; Batsis, Maria; Hacker, Michele R.; Souter, Irene; Petrozza, John C.

    2015-01-01

    OBJECTIVE We sought to determine whether the success of intrauterine insemination (IUI) varies based on the type of health care provider performing the procedure. STUDY DESIGN This was a retrospective cohort study set at an infertility clinic at an academic institution. The patients who comprised this study were 1575 women who underwent 3475 IUI cycles from late 2003 through early 2012. Cycles were stratified into 3 groups according to the type of provider who performed the procedure: attending physician, fellow physician, or registered nurse (RN). The primary outcome was live birth. Additional outcomes of interest included positive pregnancy test and clinical pregnancy. Repeated measures log binomial regression was used to estimate the risk ratios (RR) and 95% confidence intervals (CI) for the outcomes and to evaluate the effect of potential confounders. All tests were 2-sided, and P values < .05 were considered statistically significant. RESULTS Of the 3475 IUI cycles, 2030 (58.4%) were gonadotropin stimulated, 929 (26.7%) were clomiphene citrate stimulated, and 516 (14.9%) were natural. The incidences of clinical pregnancy and live birth among all cycles were 11.8% and 8.8%, respectively. After adjusting for female age, male partner age, and cycle type, the incidence of live birth was similar for RNs compared with attending physicians (RR, 0.80; 95% CI, 0.58–1.1) and fellow physicians compared with attending physicians (RR, 0.84; 95% CI, 0.58–1.2). Similar results were seen for positive pregnancy test and clinical pregnancy. CONCLUSION There was no significant difference in live birth following IUI cycles in which the procedure was performed by a fellow physician or RN compared with an attending physician. PMID:24881820

  1. Imparting improvements in electrochemical sensors: evaluation of different carbon blacks that give rise to significant improvement in the performance of electroanalytical sensing platforms

    International Nuclear Information System (INIS)

    Vicentini, Fernando Campanhã; Ravanini, Amanda E.; Figueiredo-Filho, Luiz C.S.; Iniesta, Jesús; Banks, Craig E.; Fatibello-Filho, Orlando

    2015-01-01

    Three different carbon black materials have been evaluated as a potential modifier, however, only one demonstrated an improvement in the electrochemical properties. The carbon black structures were characterised with SEM, XPS and Raman spectroscopy and found to be very similar to that of amorphous graphitic materials. The modifications utilised were constructed by three different strategies (using ultrapure water, chitosan and dihexadecylphosphate). The fabricated sensors are electrochemically characterised using N,N,N',N'-tetramethyl-para-phenylenediamine and both inner-sphere and outer-sphere redox probes, namely potassium ferrocyanide(II) and hexaammineruthenium(III) chloride, in addition to the biologically relevant and electroactive analytes, dopamine (DA) and acetaminophen (AP). Comparisons are made with an edge-plane pyrolytic graphite and glassy-carbon electrode and the benefits of carbon black implemented as a modifier for sensors within electrochemistry are explored, as well as the characterisation of their electroanalytical performances. We reveal significant improvements in the electrochemical performance (excellent sensitivity, faster heterogeneous electron transfer rate (HET)) over that of a bare glassy-carbon and edge-plane pyrolytic graphite electrode and thus suggest that there are substantial advantages of using carbon black as modifier in the fabrication of electrochemical based sensors. Such work is highly important and informative for those working in the field of electroanalysis where electrochemistry can provide portable, rapid, reliable and accurate sensing protocols (bringing the laboratory into the field), with particular relevance to those searching for new electrode materials

  2. Identifying significant uncertainties in thermally dependent processes for repository performance analysis

    International Nuclear Information System (INIS)

    Gansemer, J.D.; Lamont, A.

    1994-01-01

    In order to study the performance of the potential Yucca Mountain Nuclear Waste Repository, scientific investigations are being conducted to reduce the uncertainty about process models and system parameters. This paper is intended to demonstrate a method for determining a strategy for the cost effective management of these investigations. It is not meant to be a complete study of all processes and interactions, but does outline a method which can be applied to more in-depth investigations

  3. 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

  4. The cingulo-opercular network provides word-recognition benefit.

    Science.gov (United States)

    Vaden, Kenneth I; Kuchinsky, Stefanie E; Cute, Stephanie L; Ahlstrom, Jayne B; Dubno, Judy R; Eckert, Mark A

    2013-11-27

    Recognizing speech in difficult listening conditions requires considerable focus of attention that is often demonstrated by elevated activity in putative attention systems, including the cingulo-opercular network. We tested the prediction that elevated cingulo-opercular activity provides word-recognition benefit on a subsequent trial. Eighteen healthy, normal-hearing adults (10 females; aged 20-38 years) performed word recognition (120 trials) in multi-talker babble at +3 and +10 dB signal-to-noise ratios during a sparse sampling functional magnetic resonance imaging (fMRI) experiment. Blood oxygen level-dependent (BOLD) contrast was elevated in the anterior cingulate cortex, anterior insula, and frontal operculum in response to poorer speech intelligibility and response errors. These brain regions exhibited significantly greater correlated activity during word recognition compared with rest, supporting the premise that word-recognition demands increased the coherence of cingulo-opercular network activity. Consistent with an adaptive control network explanation, general linear mixed model analyses demonstrated that increased magnitude and extent of cingulo-opercular network activity was significantly associated with correct word recognition on subsequent trials. These results indicate that elevated cingulo-opercular network activity is not simply a reflection of poor performance or error but also supports word recognition in difficult listening conditions.

  5. Significant Returns in Engagement and Performance with a Free Teaching App

    Science.gov (United States)

    Green, Alan

    2016-01-01

    Pedagogical research shows that teaching methods other than traditional lectures may result in better outcomes. However, lecture remains the dominant method in economics, likely due to high implementation costs of methods shown to be effective in the literature. In this article, the author shows significant benefits of using a teaching app for…

  6. Does the amount of tagged stool and fluid significantly affect the radiation exposure in low-dose CT colonography performed with an automatic exposure control?

    Energy Technology Data Exchange (ETDEWEB)

    Lim, Hyun Kyong; Lee, Kyoung Ho; Kim, So Yeon; Kim, Young Hoon [Seoul National University Bundang Hospital, Department of Radiology, Seongnam-si, Gyeonggi-do (Korea, Republic of); Seoul National University College of Medicine, Seoul National University Medical Research Center, Institute of Radiation Medicine, Bundang (Korea, Republic of); Kim, Kil Joong [Seoul National University College of Medicine, Department of Radiation Applied Life Science, Seoul (Korea, Republic of); Kim, Bohyoung; Lee, Hyunna [Seoul National University, School of Computer Science and Engineering, Seoul (Korea, Republic of); Park, Seong Ho [University of Ulsan College of Medicine, Department of Radiology and Research Institute of Radiology, Asan Medical Center, Seoul (Korea, Republic of); Yanof, Jeffrey H. [Philips Healthcare, CT Clinical Science, Cleveland, OH (United States); Hwang, Seung-sik [Inha University School of Medicine, Department of Social and Preventive Medicine, Incheon (Korea, Republic of)

    2011-02-15

    To determine whether the amount of tagged stool and fluid significantly affects the radiation exposure in low-dose screening CT colonography performed with an automatic tube-current modulation technique. The study included 311 patients. The tagging agent was barium (n = 271) or iodine (n = 40). Correlation was measured between mean volume CT dose index (CTDI{sub vol}) and the estimated x-ray attenuation of the tagged stool and fluid (ATT). Multiple linear regression analyses were performed to determine the effect of ATT on CTDI{sub vol} and the effect of ATT on image noise while adjusting for other variables including abdominal circumference. CTDI{sub vol} varied from 0.88 to 2.54 mGy. There was no significant correlation between CTDI{sub vol} and ATT (p = 0.61). ATT did not significantly affect CTDI{sub vol} (p = 0.93), while abdominal circumference was the only factor significantly affecting CTDI{sub vol} (p < 0.001). Image noise ranged from 59.5 to 64.1 HU. The p value for the regression model explaining the noise was 0.38. The amount of stool and fluid tagging does not significantly affect radiation exposure. (orig.)

  7. Does the amount of tagged stool and fluid significantly affect the radiation exposure in low-dose CT colonography performed with an automatic exposure control?

    International Nuclear Information System (INIS)

    Lim, Hyun Kyong; Lee, Kyoung Ho; Kim, So Yeon; Kim, Young Hoon; Kim, Kil Joong; Kim, Bohyoung; Lee, Hyunna; Park, Seong Ho; Yanof, Jeffrey H.; Hwang, Seung-sik

    2011-01-01

    To determine whether the amount of tagged stool and fluid significantly affects the radiation exposure in low-dose screening CT colonography performed with an automatic tube-current modulation technique. The study included 311 patients. The tagging agent was barium (n = 271) or iodine (n = 40). Correlation was measured between mean volume CT dose index (CTDI vol ) and the estimated x-ray attenuation of the tagged stool and fluid (ATT). Multiple linear regression analyses were performed to determine the effect of ATT on CTDI vol and the effect of ATT on image noise while adjusting for other variables including abdominal circumference. CTDI vol varied from 0.88 to 2.54 mGy. There was no significant correlation between CTDI vol and ATT (p = 0.61). ATT did not significantly affect CTDI vol (p = 0.93), while abdominal circumference was the only factor significantly affecting CTDI vol (p < 0.001). Image noise ranged from 59.5 to 64.1 HU. The p value for the regression model explaining the noise was 0.38. The amount of stool and fluid tagging does not significantly affect radiation exposure. (orig.)

  8. Cloud benchmarking for performance

    OpenAIRE

    Varghese, Blesson; Akgun, Ozgur; Miguel, Ian; Thai, Long; Barker, Adam

    2014-01-01

    Date of Acceptance: 20/09/2014 How can applications be deployed on the cloud to achieve maximum performance? This question has become significant and challenging with the availability of a wide variety of Virtual Machines (VMs) with different performance capabilities in the cloud. The above question is addressed by proposing a six step benchmarking methodology in which a user provides a set of four weights that indicate how important each of the following groups: memory, processor, computa...

  9. The attitudes of primary care providers towards screening for colorectal cancer

    Directory of Open Access Journals (Sweden)

    Jesús López-Torres Hidalgo

    2013-06-01

    Full Text Available Background and objective: the scientific community supports the appropriateness of colorectal cancer screening, and there is consensus on the need to raise awareness about the significance of prevention among both health care professionals and the population. The goal was to record the attitude of primary care providers towards colorectal cancer screening, as well as the main barriers to both patient and provider participation. Methods: a cross-sectional, observational study was performed of 511 professionals in Albacete Health District. Variables included views on screening effectiveness and cost-effectiveness, acceptance by providers and patients, barriers to participation, frequency of prevention recommendations, and education needs. Results: most (76 % considered screening was effective; 85 % said acceptance of fecal occult blood testing was intermediate or high, and 68.2 % this is also the case for colonoscopy when needed; 71.9 % would recommend screening should a population-based program be implemented (currently only 9.7 % recommends this. Correspondence analysis revealed that recommendation is more common when assigned populations are smaller. Conclusions: most providers consider screening is both effective and acceptable for patients. In today's situation, where screening is only performed in an opportunistic manner, the proportion of professionals who commonly recommend screening for the mid-risk population is low, especially when assigned populations are huge.

  10. 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.

  11. Performance characteristics of CA 19-9 radioimmunoassay and clinical significance of serum CA 19-9 assay in patients with malignancy

    International Nuclear Information System (INIS)

    Kim, S.E.; Shong, Y.K.; Cho, B.Y.; Kim, N.K.; Koh, C.S.; Lee, M.H.; Hong, K.S.

    1985-01-01

    To evaluate the performance characteristics of CA 19-9 radioimmunoassay and the clinical significance of serum CA 19-9 assay in patients with malignancy, serum CA 19-9 levels were measured by radioimmunoassay using monoclonal antibody in 135 normal controls, 81 patients with various untreated malignancy, 9 patients of postoperative colon cancer without recurrence and 20 patients with benign gastrointestinal diseases, who visited Seoul National University Hospital from June, 1984 to March, 1985. (Author)

  12. 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

  13. Pharmacy student absenteeism and academic performance.

    Science.gov (United States)

    Hidayat, Levita; Vansal, Sandeep; Kim, Esther; Sullivan, Maureen; Salbu, Rebecca

    2012-02-10

    To assess the association of pharmacy students' personal characteristics with absenteeism and academic performance. A survey instrument was distributed to first- (P1) and second-year (P2) pharmacy students to gather characteristics including employment status, travel time to school, and primary source of educational funding. In addition, absences from specific courses and reasons for not attending classes were assessed. Participants were divided into "high" and "low" performers based on grade point average. One hundred sixty survey instruments were completed and 135 (84.3%) were included in the study analysis. Low performers were significantly more likely than high performers to have missed more than 8 hours in therapeutics courses. Low performers were significantly more likely than high performers to miss class when the class was held before or after an examination and low performers were significantly more likely to believe that participating in class did not benefit them. There was a negative association between the number of hours students' missed and their performance in specific courses. These findings provide further insight into the reasons for students' absenteeism in a college or school of pharmacy setting.

  14. Provider-Independent Use of the Cloud

    Science.gov (United States)

    Harmer, Terence; Wright, Peter; Cunningham, Christina; Perrott, Ron

    Utility computing offers researchers and businesses the potential of significant cost-savings, making it possible for them to match the cost of their computing and storage to their demand for such resources. A utility compute provider enables the purchase of compute infrastructures on-demand; when a user requires computing resources a provider will provision a resource for them and charge them only for their period of use of that resource. There has been a significant growth in the number of cloud computing resource providers and each has a different resource usage model, application process and application programming interface (API)-developing generic multi-resource provider applications is thus difficult and time consuming. We have developed an abstraction layer that provides a single resource usage model, user authentication model and API for compute providers that enables cloud-provider neutral applications to be developed. In this paper we outline the issues in using external resource providers, give examples of using a number of the most popular cloud providers and provide examples of developing provider neutral applications. In addition, we discuss the development of the API to create a generic provisioning model based on a common architecture for cloud computing providers.

  15. 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.

  16. Hand Washing Practices Among Emergency Medical Services Providers

    Directory of Open Access Journals (Sweden)

    Joshua Bucher

    2015-10-01

    Full Text Available Introduction: Hand hygiene is an important component of infection control efforts. Our primary and secondary goals were to determine the reported rates of hand washing and stethoscope cleaning in emergency medical services (EMS workers, respectively. Methods: We designed a survey about hand hygiene practices. The survey was distributed to various national EMS organizations through e-mail. Descriptive statistics were calculated for survey items (responses on a Likert scale and subpopulations of survey respondents to identify relationships between variables. We used analysis of variance to test differences in means between the subgroups. Results: There were 1,494 responses. Overall, reported hand hygiene practices were poor among pre-hospital providers in all clinical situations. Women reported that they washed their hands more frequently than men overall, although the differences were unlikely to be clinically significant. Hygiene after invasive procedures was reported to be poor. The presence of available hand sanitizer in the ambulance did not improve reported hygiene rates but improved reported rates of cleaning the stethoscope (absolute difference 0.4, p=0.0003. Providers who brought their own sanitizer were more likely to clean their hands. Conclusion: Reported hand hygiene is poor amongst pre-hospital providers. There is a need for future intervention to improve reported performance in pre-hospital provider hand washing.

  17. Hand Washing Practices Among Emergency Medical Services Providers.

    Science.gov (United States)

    Bucher, Joshua; Donovan, Colleen; Ohman-Strickland, Pamela; McCoy, Jonathan

    2015-09-01

    Hand hygiene is an important component of infection control efforts. Our primary and secondary goals were to determine the reported rates of hand washing and stethoscope cleaning in emergency medical services (EMS) workers, respectively. We designed a survey about hand hygiene practices. The survey was distributed to various national EMS organizations through e-mail. Descriptive statistics were calculated for survey items (responses on a Likert scale) and subpopulations of survey respondents to identify relationships between variables. We used analysis of variance to test differences in means between the subgroups. There were 1,494 responses. Overall, reported hand hygiene practices were poor among pre-hospital providers in all clinical situations. Women reported that they washed their hands more frequently than men overall, although the differences were unlikely to be clinically significant. Hygiene after invasive procedures was reported to be poor. The presence of available hand sanitizer in the ambulance did not improve reported hygiene rates but improved reported rates of cleaning the stethoscope (absolute difference 0.4, p=0.0003). Providers who brought their own sanitizer were more likely to clean their hands. Reported hand hygiene is poor amongst pre-hospital providers. There is a need for future intervention to improve reported performance in pre-hospital provider hand washing.

  18. Using Audience Response Technology to provide formative feedback on pharmacology performance for non-medical prescribing students--a preliminary evaluation.

    Science.gov (United States)

    Mostyn, Alison; Meade, Oonagh; Lymn, Joanne S

    2012-11-13

    The use of anonymous audience response technology (ART) to actively engage students in classroom learning has been evaluated positively across multiple settings. To date, however, there has been no empirical evaluation of the use of individualised ART handsets and formative feedback of ART scores. The present study investigates student perceptions of such a system and the relationship between formative feedback results and exam performance. Four successive cohorts of Non-Medical Prescribing students (n=107) had access to the individualised ART system and three of these groups (n=72) completed a questionnaire about their perceptions of using ART. Semi-structured interviews were carried out with a purposive sample of seven students who achieved a range of scores on the formative feedback. Using data from all four cohorts of students, the relationship between mean ART scores and summative pharmacology exam score was examined using a non-parametric correlation. Questionnaire and interview data suggested that the use of ART enhanced the classroom environment, motivated students and promoted learning. Questionnaire data demonstrated that students found the formative feedback helpful for identifying their learning needs (95.6%), guiding their independent study (86.8%), and as a revision tool (88.3%). Interviewees particularly valued the objectivity of the individualised feedback which helped them to self-manage their learning. Interviewees' initial anxiety about revealing their level of pharmacology knowledge to the lecturer and to themselves reduced over time as students focused on the learning benefits associated with the feedback.A significant positive correlation was found between students' formative feedback scores and their summative pharmacology exam scores (Spearman's rho = 0.71, N=107, p<.01). Despite initial anxiety about the use of individualised ART units, students rated the helpfulness of the individualised handsets and personalised formative feedback highly

  19. Using Audience Response Technology to provide formative feedback on pharmacology performance for non-medical prescribing students - a preliminary evaluation

    Directory of Open Access Journals (Sweden)

    Mostyn Alison

    2012-11-01

    Full Text Available Abstract Background The use of anonymous audience response technology (ART to actively engage students in classroom learning has been evaluated positively across multiple settings. To date, however, there has been no empirical evaluation of the use of individualised ART handsets and formative feedback of ART scores. The present study investigates student perceptions of such a system and the relationship between formative feedback results and exam performance. Methods Four successive cohorts of Non-Medical Prescribing students (n=107 had access to the individualised ART system and three of these groups (n=72 completed a questionnaire about their perceptions of using ART. Semi-structured interviews were carried out with a purposive sample of seven students who achieved a range of scores on the formative feedback. Using data from all four cohorts of students, the relationship between mean ART scores and summative pharmacology exam score was examined using a non-parametric correlation. Results Questionnaire and interview data suggested that the use of ART enhanced the classroom environment, motivated students and promoted learning. Questionnaire data demonstrated that students found the formative feedback helpful for identifying their learning needs (95.6%, guiding their independent study (86.8%, and as a revision tool (88.3%. Interviewees particularly valued the objectivity of the individualised feedback which helped them to self-manage their learning. Interviewees’ initial anxiety about revealing their level of pharmacology knowledge to the lecturer and to themselves reduced over time as students focused on the learning benefits associated with the feedback. A significant positive correlation was found between students’ formative feedback scores and their summative pharmacology exam scores (Spearman’s rho = 0.71, N=107, p Conclusions Despite initial anxiety about the use of individualised ART units, students rated the helpfulness of the

  20. Using Audience Response Technology to provide formative feedback on pharmacology performance for non-medical prescribing students - a preliminary evaluation

    Science.gov (United States)

    2012-01-01

    Background The use of anonymous audience response technology (ART) to actively engage students in classroom learning has been evaluated positively across multiple settings. To date, however, there has been no empirical evaluation of the use of individualised ART handsets and formative feedback of ART scores. The present study investigates student perceptions of such a system and the relationship between formative feedback results and exam performance. Methods Four successive cohorts of Non-Medical Prescribing students (n=107) had access to the individualised ART system and three of these groups (n=72) completed a questionnaire about their perceptions of using ART. Semi-structured interviews were carried out with a purposive sample of seven students who achieved a range of scores on the formative feedback. Using data from all four cohorts of students, the relationship between mean ART scores and summative pharmacology exam score was examined using a non-parametric correlation. Results Questionnaire and interview data suggested that the use of ART enhanced the classroom environment, motivated students and promoted learning. Questionnaire data demonstrated that students found the formative feedback helpful for identifying their learning needs (95.6%), guiding their independent study (86.8%), and as a revision tool (88.3%). Interviewees particularly valued the objectivity of the individualised feedback which helped them to self-manage their learning. Interviewees’ initial anxiety about revealing their level of pharmacology knowledge to the lecturer and to themselves reduced over time as students focused on the learning benefits associated with the feedback. A significant positive correlation was found between students’ formative feedback scores and their summative pharmacology exam scores (Spearman’s rho = 0.71, N=107, pstudents rated the helpfulness of the individualised handsets and personalised formative feedback highly. The significant correlation between ART

  1. Significance of ISO 9000 Quality Management System for ...

    African Journals Online (AJOL)

    Significance of ISO 9000 Quality Management System for Performance ... of ISO 9000 Quality Management System implementation for performance improvement. ... to find out the relationship between certification and process variability.

  2. Implementing a Nurse Manager Profile to Improve Unit Performance.

    Science.gov (United States)

    Krugman, Mary E; Sanders, Carolyn L

    2016-06-01

    Nurse managers face significant pressures in the rapidly changing healthcare environment. Staying current with multiple sources of data, including reports that detail institutional and unit performance outcomes, is particularly challenging. A Nurse Manager Customized Profile was developed at a western academic hospital to provide a 1-page visual of pertinent data to help managers and director supervisors focus coaching to improve unit performance. Use of the Decisional Involvement Scale provided new insights into measuring manager performance.

  3. Performance studies of GooFit on GPUs vs RooFit on CPUs while estimating the statistical significance of a new physical signal

    Science.gov (United States)

    Di Florio, Adriano

    2017-10-01

    In order to test the computing capabilities of GPUs with respect to traditional CPU cores a high-statistics toy Monte Carlo technique has been implemented both in ROOT/RooFit and GooFit frameworks with the purpose to estimate the statistical significance of the structure observed by CMS close to the kinematical boundary of the J/ψϕ invariant mass in the three-body decay B + → J/ψϕK +. GooFit is a data analysis open tool under development that interfaces ROOT/RooFit to CUDA platform on nVidia GPU. The optimized GooFit application running on GPUs hosted by servers in the Bari Tier2 provides striking speed-up performances with respect to the RooFit application parallelised on multiple CPUs by means of PROOF-Lite tool. The considerable resulting speed-up, evident when comparing concurrent GooFit processes allowed by CUDA Multi Process Service and a RooFit/PROOF-Lite process with multiple CPU workers, is presented and discussed in detail. By means of GooFit it has also been possible to explore the behaviour of a likelihood ratio test statistic in different situations in which the Wilks Theorem may or may not apply because its regularity conditions are not satisfied.

  4. Personality, political skill, and job performance

    DEFF Research Database (Denmark)

    Blickle, G.; Meurs, J.A.; Zettler, Ingo

    2008-01-01

    constructs of agreeableness and conscientiousness with political skill predict job performance. Our results supported our hypothesis for the agreeableness-political skill interaction. Additionally, after correcting for the unreliability and restricted range of conscientiousness, we found that its interaction...... with political skill also significantly predicted job performance, although not precisely as hypothesized. Implications of the results and directions for future research are provided....

  5. Genome-wide identification of significant aberrations in cancer genome.

    Science.gov (United States)

    Yuan, Xiguo; Yu, Guoqiang; Hou, Xuchu; Shih, Ie-Ming; Clarke, Robert; Zhang, Junying; Hoffman, Eric P; Wang, Roger R; Zhang, Zhen; Wang, Yue

    2012-07-27

    Somatic Copy Number Alterations (CNAs) in human genomes are present in almost all human cancers. Systematic efforts to characterize such structural variants must effectively distinguish significant consensus events from random background aberrations. Here we introduce Significant Aberration in Cancer (SAIC), a new method for characterizing and assessing the statistical significance of recurrent CNA units. Three main features of SAIC include: (1) exploiting the intrinsic correlation among consecutive probes to assign a score to each CNA unit instead of single probes; (2) performing permutations on CNA units that preserve correlations inherent in the copy number data; and (3) iteratively detecting Significant Copy Number Aberrations (SCAs) and estimating an unbiased null distribution by applying an SCA-exclusive permutation scheme. We test and compare the performance of SAIC against four peer methods (GISTIC, STAC, KC-SMART, CMDS) on a large number of simulation datasets. Experimental results show that SAIC outperforms peer methods in terms of larger area under the Receiver Operating Characteristics curve and increased detection power. We then apply SAIC to analyze structural genomic aberrations acquired in four real cancer genome-wide copy number data sets (ovarian cancer, metastatic prostate cancer, lung adenocarcinoma, glioblastoma). When compared with previously reported results, SAIC successfully identifies most SCAs known to be of biological significance and associated with oncogenes (e.g., KRAS, CCNE1, and MYC) or tumor suppressor genes (e.g., CDKN2A/B). Furthermore, SAIC identifies a number of novel SCAs in these copy number data that encompass tumor related genes and may warrant further studies. Supported by a well-grounded theoretical framework, SAIC has been developed and used to identify SCAs in various cancer copy number data sets, providing useful information to study the landscape of cancer genomes. Open-source and platform-independent SAIC software is

  6. 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

  7. Impact significance determination-Back to basics

    International Nuclear Information System (INIS)

    Lawrence, David P.

    2007-01-01

    Impact significance determination is widely recognized as a vital and critical EIA activity. But impact significance related concepts are poorly understood. And the quality of approaches for impact significance determination in EIA practice remains highly variable. This article seeks to help establish a sound and practical conceptual foundation for formulating and evaluating impact significance determination approaches. It addresses the nature (what is impact significance?), the core characteristics (what are the major properties of significance determination?), the rationale (why are impact significance determinations necessary?), the procedural and substantive objectives (what do impact significance determinations seek to achieve?), and the process for making impact significance judgments (how is impact significance determination conducted?). By identifying fundamental attributes and key distinctions associated with impact significance determinations, a basis is provided for designing and evaluating impact significance determination procedures at both the regulatory and applied levels

  8. Effect of provider experience on clinician-performed ultrasonography for hydronephrosis in patients with suspected renal colic.

    Science.gov (United States)

    Herbst, Meghan K; Rosenberg, Graeme; Daniels, Brock; Gross, Cary P; Singh, Dinesh; Molinaro, Annette M; Luty, Seth; Moore, Christopher L

    2014-09-01

    .9%), specificity of 73.3% (95% CI 66.1% to 79.4%), positive likelihood ratio of 2.72 (95% CI 2.25 to 3.27), and negative likelihood ratio of 0.37 (95% CI 0.31 to 0.44) for hydronephrosis, using hydronephrosis on CT as the criterion standard. Among attending physicians with fellowship training, ultrasonography had sensitivity of 92.7% (95% CI 83.8% to 96.9%), positive likelihood ratio of 4.97 (95% CI 2.90 to 8.51), and negative likelihood ratio of 0.08 (95% CI 0.03 to 0.23). Overall, ultrasonography performed by emergency clinicians was moderately sensitive and specific for detection of hydronephrosis as seen on CT in patients with suspected renal colic. However, presence or absence of hydronephrosis as determined by emergency physicians with fellowship training in ultrasonography yielded more definitive test results. For clinicians without fellowship training, there was no significant difference between groups in the predictive accuracy of the application according to experience level. Copyright © 2014 American College of Emergency Physicians. Published by Mosby, Inc. All rights reserved.

  9. SRS Process Facility Significance Fire Frequency

    Energy Technology Data Exchange (ETDEWEB)

    Sarrack, A.G. [Westinghouse Savannah River Company, AIKEN, SC (United States)

    1995-10-01

    This report documents the method and assumptions of a study performed to determine a site generic process facility significant fire initiator frequency and explains the proper way this value should be used.

  10. SRS Process Facility Significance Fire Frequency

    International Nuclear Information System (INIS)

    Sarrack, A.G.

    1995-10-01

    This report documents the method and assumptions of a study performed to determine a site generic process facility significant fire initiator frequency and explains the proper way this value should be used

  11. Moderate running and plyometric training during off-season did not show a significant difference on soccer-related high-intensity performances compared with no-training controls.

    Science.gov (United States)

    Nakamura, Daisuke; Suzuki, Tomohiro; Yasumatsu, Mikinobu; Akimoto, Takayuki

    2012-12-01

    Several investigators have reported the effects of reduced training and interrupted training on athletic performance, but few reports are available for soccer players. The purpose of this study was to examine, using the Yo-Yo intermittent recovery level 2 (YoYoIR2) test and sprint performance, the effects on soccer players of a reduced training program consisting of either moderate running training, plyometric training. After the completion of a competitive season, 29 male soccer players were divided into 3 groups: the running group (n = 13), the plyometric group (n = 11), and the control group (n = 5). Both training groups completed either running or plyometric training sessions 2 d·wk(-1) for 3 weeks, whereas the control group was not allowed to perform any training. The subjects performed YoYoIR2 and 20-m sprint tests before (pre) and after (post) the experimental period. Neither training group showed any significant training effects on the YoYoIR2 performance or 20-m sprint times compared with the control group. This study suggests that neither endurance running nor plyometric training 2 d·wk(-1) for 3 weeks has a significant effect on high-intensity performance compared with a nontraining regimen. However, our results do not support complete inactivity. These results may have important implications for the management of training cessation for a few weeks.

  12. Significance of MPEG-7 textural features for improved mass detection in mammography.

    Science.gov (United States)

    Eltonsy, Nevine H; Tourassi, Georgia D; Fadeev, Aleksey; Elmaghraby, Adel S

    2006-01-01

    The purpose of the study is to investigate the significance of MPEG-7 textural features for improving the detection of masses in screening mammograms. The detection scheme was originally based on morphological directional neighborhood features extracted from mammographic regions of interest (ROIs). Receiver Operating Characteristics (ROC) was performed to evaluate the performance of each set of features independently and merged into a back-propagation artificial neural network (BPANN) using the leave-one-out sampling scheme (LOOSS). The study was based on a database of 668 mammographic ROIs (340 depicting cancer regions and 328 depicting normal parenchyma). Overall, the ROC area index of the BPANN using the directional morphological features was Az=0.85+/-0.01. The MPEG-7 edge histogram descriptor-based BPNN showed an ROC area index of Az=0.71+/-0.01 while homogeneous textural descriptors using 30 and 120 channels helped the BPNN achieve similar ROC area indexes of Az=0.882+/-0.02 and Az=0.877+/-0.01 respectively. After merging the MPEG-7 homogeneous textural features with the directional neighborhood features the performance of the BPANN increased providing an ROC area index of Az=0.91+/-0.01. MPEG-7 homogeneous textural descriptor significantly improved the morphology-based detection scheme.

  13. 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

  14. 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.

  15. Fuel performance annual report for 1990

    International Nuclear Information System (INIS)

    Preble, E.A.; Painter, C.L.; Alvis, J.A.; Berting, F.M.; Beyer, C.E.; Payne, G.A.; Wu, S.L.

    1993-11-01

    This annual report, the thirteenth in a series, provides a brief description of fuel performance during 1990 in commercial nuclear power plants. Brief summaries of fuel design changes, fuel surveillance programs, fuel operating experience and trends, fuel problems high-burnup fuel experience, and items of general significance are provided . References to additional, more detailed information, and related NRC evaluations are included where appropriate

  16. Provider performance in treating poor patients--factors influencing prescribing practices in lao PDR: a cross-sectional study.

    Science.gov (United States)

    Syhakhang, Lamphone; Soukaloun, Douangdao; Tomson, Göran; Petzold, Max; Rehnberg, Clas; Wahlström, Rolf

    2011-01-06

    Out-of-pocket payments make up about 80% of medical care spending at hospitals in Laos, thereby putting poor households at risk of catastrophic health expenditure. Social security schemes in the form of community-based health insurance and health equity funds have been introduced in some parts of the country. Drug and Therapeutics Committees (DTCs) have been established to ensure rational use of drugs and improve quality of care. The objective was to assess the appropriateness and expenditure for treatment for poor patients by health care providers at hospitals in three selected provinces of Laos and to explore associated factors. Cross-sectional study using four tracer conditions. Structured interviews with 828 in-patients at twelve provincial and district hospitals on the subject of insurance protection, income and expenditures for treatment, including informal payment. Evaluation of each patient's medical record for appropriateness of drug use using a checklist of treatment guidelines (maximum score=10). No significant difference in appropriateness of care for patients at different income levels, but higher expenditures for patients with the highest income level. The score for appropriate drug use in insured patients was significantly higher than uninsured patients (5.9 vs. 4.9), and the length of stay in days significantly shorter (2.7 vs. 3.7). Insured patients paid significantly less than uninsured patients, both for medicines (USD 14.8 vs. 43.9) and diagnostic tests (USD 5.9 vs. 9.2). On the contrary the score for appropriateness of drug use in patients making informal payments was significantly lower than patients not making informal payments (3.5 vs. 5.1), and the length of stay significantly longer (6.8 vs. 3.2), while expenditures were significantly higher both for medicines (USD 124.5 vs. 28.8) and diagnostic tests (USD 14.1 vs. 7.7). The lower expenditure for insured patients can help reduce the number of households experiencing catastrophic health

  17. Provider performance in treating poor patients - factors influencing prescribing practices in lao PDR: a cross-sectional study

    Directory of Open Access Journals (Sweden)

    Petzold Max

    2011-01-01

    Full Text Available Abstract Background Out-of-pocket payments make up about 80% of medical care spending at hospitals in Laos, thereby putting poor households at risk of catastrophic health expenditure. Social security schemes in the form of community-based health insurance and health equity funds have been introduced in some parts of the country. Drug and Therapeutics Committees (DTCs have been established to ensure rational use of drugs and improve quality of care. The objective was to assess the appropriateness and expenditure for treatment for poor patients by health care providers at hospitals in three selected provinces of Laos and to explore associated factors. Methods Cross-sectional study using four tracer conditions. Structured interviews with 828 in-patients at twelve provincial and district hospitals on the subject of insurance protection, income and expenditures for treatment, including informal payment. Evaluation of each patient's medical record for appropriateness of drug use using a checklist of treatment guidelines (maximum score = 10. Results No significant difference in appropriateness of care for patients at different income levels, but higher expenditures for patients with the highest income level. The score for appropriate drug use in insured patients was significantly higher than uninsured patients (5.9 vs. 4.9, and the length of stay in days significantly shorter (2.7 vs. 3.7. Insured patients paid significantly less than uninsured patients, both for medicines (USD 14.8 vs. 43.9 and diagnostic tests (USD 5.9 vs. 9.2. On the contrary the score for appropriateness of drug use in patients making informal payments was significantly lower than patients not making informal payments (3.5 vs. 5.1, and the length of stay significantly longer (6.8 vs. 3.2, while expenditures were significantly higher both for medicines (USD 124.5 vs. 28.8 and diagnostic tests (USD 14.1 vs. 7.7. Conclusions The lower expenditure for insured patients can help reduce

  18. 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.

  19. Institutional capacity to provide psychosocial oncology support services: A report from the Association of Oncology Social Work.

    Science.gov (United States)

    Zebrack, Brad; Kayser, Karen; Padgett, Lynne; Sundstrom, Laura; Jobin, Chad; Nelson, Krista; Fineberg, Iris C

    2016-06-15

    This study reports cancer-treating institutions' capacity to deliver comprehensive psychosocial support services. Oncology care providers at 60 cancer-treating institutions completed surveys assessing the capacity of their institutions to provide psychosocial care. Capacity was assessed with the Cancer Psychosocial Care Matrix (CPCM) from the National Cancer Institute (NCI). Scores represented individuals' perceptions of their cancer program's performance with respect to 10 fundamental elements of psychosocial care. Among 2134 respondents, 62% reported a mid-level capacity for ≥5 of 10 CPCM items. In comparison with other types of cancer programs (eg, NCI-designated, academic, or comprehensive centers), providers at community cancer programs reported a significantly greater capacity with respect to patient-provider communication, psychosocial needs assessment, and continuity in the delivery of psychosocial care over time. Nurses and primary medical providers reported a significantly lower capacity for linking patients and families with needed psychosocial services within their respective cancer programs. They also reported a significantly higher capacity for conducting follow-up, re-evaluations, and adjustments of psychosocial treatment plans. Cancer programs are performing moderately well in terms of communicating to patients the importance of psychosocial care, identifying patient psychosocial needs, and referring patients and families to psychosocial services. They are doing less well with respect to the provision of that care over time. Findings suggest that gaps in psychosocial service capacity are a function of patient, provider, and system characteristics. These results may be useful in formulating strategies to enhance psychosocial care delivery. Cancer 2016;122:1937-45. © 2016 American Cancer Society. © 2016 American Cancer Society.

  20. Stunting, poor iron status and parasite infection are significant risk factors for lower cognitive performance in Cambodian school-aged children.

    Directory of Open Access Journals (Sweden)

    Marlene Perignon

    Full Text Available BACKGROUND: Nutrition is one of many factors affecting the cognitive development of children. In Cambodia, 55% of children <5 y were anemic and 40% stunted in 2010. Currently, no data exists on the nutritional status of Cambodian school-aged children, or on how malnutrition potentially affects their cognitive development. OBJECTIVE: To assess the anthropometric and micronutrient status (iron, vitamin A, zinc, iodine of Cambodian schoolchildren and their associations with cognitive performance. METHODS: School children aged 6-16 y (n = 2443 from 20 primary schools in Cambodia were recruited. Anthropometry, hemoglobin, serum ferritin, transferrin receptors, retinol-binding protein and zinc concentrations, inflammation status, urinary iodine concentration and parasite infection were measured. Socio-economic data were collected in a sub-group of children (n = 616. Cognitive performance was assessed using Raven's Colored Progressive Matrices (RCPM and block design and picture completion, two standardized tests from the Wechsler Intelligence Scale for Children (WISC-III. RESULTS: The prevalence of anemia, iron, zinc, iodine and vitamin A deficiency were 15.7%; 51.2%, 92.8%, 17.3% and 0.7% respectively. The prevalence of stunting was 40.0%, including 10.9% of severe stunting. Stunted children scored significantly lower than non-stunted children on all tests. In RCPM test, boys with iron-deficiency anemia had lower scores than boys with normal iron status (-1.46, p<0.05. In picture completion test, children with normal iron status tended to score higher than iron-deficient children with anemia (-0.81; p = 0.067 or without anemia (-0.49; p = 0.064. Parasite infection was associated with an increase in risk of scoring below the median value in block design test (OR = 1.62; p<0.05, and with lower scores in other tests, for girls only (both p<0.05. CONCLUSION: Poor cognitive performance of Cambodian school-children was multifactorial and

  1. Next step in antibiotic stewardship: Pharmacist-provided penicillin allergy testing.

    Science.gov (United States)

    Gugkaeva, Z; Crago, J S; Yasnogorodsky, M

    2017-08-01

    Penicillin allergy limits therapeutic options for patients but often disappears over time, leaving patients erroneously labelled allergic and leading to the utilization of broad-spectrum and more expensive antibiotics. Penicillin allergy can be effectively assessed via skin testing. To improve patient access to penicillin allergy testing by implementing a pharmacist-provided service in a hospital setting. Beta-lactams remain a mainstream therapy for many infections due to their effectiveness, low side effects and affordability. Typically, patient access to penicillin allergy testing is limited by the availability of allergy specialists, who traditionally perform such testing. A pharmacist-provided penicillin allergy testing service was implemented at our hospital in 2015 and became a powerful antibiotic stewardship tool. Removing penicillin allergy from patient profiles significantly expanded therapeutic options, expedited discharges and reduced costs of care. Pharmacists can expand patient access to penicillin allergy testing. Pharmacist-provided penicillin allergy testing permitted optimized antibiotic treatment and expedited discharges. © 2017 John Wiley & Sons Ltd.

  2. The role of private health providers in HIV testing: analysis of data from 18 countries.

    Science.gov (United States)

    Johnson, Doug; Cheng, Xi

    2014-05-12

    HIV testing and counseling is a critical component of the overall response to the HIV epidemic in low and middle income countries. To date, little attention has been paid to the role of private for-profit providers in HIV testing. We use data from Demographic and Health Surveys and AIDS Indicators Surveys to explore the extent to which this sector provides HIV testing in 18 developing countries. We find that use of the private sector for HIV testing varies significantly by country, with private for-profit providers playing a significant role in some countries and a relatively minor one in others. At the country level, use of private providers for HIV testing is correlated with use of private providers for other health services yet, in many countries, significant differences between use of the private sector for HIV testing and other services exist. Within countries, we find that wealth is strongly associated with use of the private sector for HIV testing in most countries, but the relative socio-economic profile of clients who receive an HIV test from a private provider varies considerably across countries. On the one measure of quality to which we have access, reported adherence to antenatal care testing guidelines, there are no statistically significant differences in performance between public and private for-profit providers in most countries after controlling for wealth. These results suggest that strategies for supervising and engaging private health providers with regard to HIV testing should be country specific and take into account local context.

  3. Postexercise Glycogen Recovery and Exercise Performance is Not Significantly Different Between Fast Food and Sport Supplements.

    Science.gov (United States)

    Cramer, Michael J; Dumke, Charles L; Hailes, Walter S; Cuddy, John S; Ruby, Brent C

    2015-10-01

    A variety of dietary choices are marketed to enhance glycogen recovery after physical activity. Past research informs recommendations regarding the timing, dose, and nutrient compositions to facilitate glycogen recovery. This study examined the effects of isoenergetic sport supplements (SS) vs. fast food (FF) on glycogen recovery and exercise performance. Eleven males completed two experimental trials in a randomized, counterbalanced order. Each trial included a 90-min glycogen depletion ride followed by a 4-hr recovery period. Absolute amounts of macronutrients (1.54 ± 0.27 g·kg-1 carbohydrate, 0.24 ± 0.04 g·kg fat-1, and 0.18 ±0.03g·kg protein-1) as either SS or FF were provided at 0 and 2 hr. Muscle biopsies were collected from the vastus lateralis at 0 and 4 hr post exercise. Blood samples were analyzed at 0, 30, 60, 120, 150, 180, and 240 min post exercise for insulin and glucose, with blood lipids analyzed at 0 and 240 min. A 20k time-trial (TT) was completed following the final muscle biopsy. There were no differences in the blood glucose and insulin responses. Similarly, rates of glycogen recovery were not different across the diets (6.9 ± 1.7 and 7.9 ± 2.4 mmol·kg wet weight- 1·hr-1 for SS and FF, respectively). There was also no difference across the diets for TT performance (34.1 ± 1.8 and 34.3 ± 1.7 min for SS and FF, respectively. These data indicate that short-term food options to initiate glycogen resynthesis can include dietary options not typically marketed as sports nutrition products such as fast food menu items.

  4. 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

  5. Comparing the quality of preconception care provided in healthcare centers in Mashhad in 2012.

    Science.gov (United States)

    Sardasht, Fatemeh Ghaffari; Shourab, Nahid Jahani; Jafarnejad, Farzaneh; Esmaily, Habibollah

    2015-01-01

    Improving the quality of healthcare services is considered as the main strategy to improve maternal and neonatal health outcomes. Providing appropriate healthcare for mothers and their newborn children is facilitated significantly by considering the mothers' health and welfare before pregnancy occurs. Therefore, the aim of this study was to compare the quality of preconception care provided to women of reproductive age provided by five health centers in Mashhad in 2012 and 2013. Multi-stage sampling was used to select the participants in this descriptive study. As a result, 360 women of reproductive age and 39 healthcare providers from 24 healthcare centers in Mashhad were selected to participate. The data gathering tool was a checklist based on the Donabedian model that includes the three dimensions of structure, process, and outcome. The data were analyzed by SPSS software (version 11.5), Kruskal-Wallis tests, ANOVA, and Spearman rank correlation. The results showed that preconception care at the 24 healthcare centers had essentially the same conditions. But in the process and outcome components, the quality of the preconception care at five of the health centers was significantly different (p=0.008). The highest quality of care processes was identified at health center number 3. The difference in the component of outcomes being followed up by the healthcare providers at five of the health centers was statistically significant (p=0.000); however, there were no significant differences found among the satisfaction and awareness of the women who participated at the five health centers. The results showed that the performance of health personnel in providing preconception care and providing follow-up care was not satisfactory.

  6. Adaptive Tests of Significance Using Permutations of Residuals with R and SAS

    CERN Document Server

    O'Gorman, Thomas W

    2012-01-01

    Provides the tools needed to successfully perform adaptive tests across a broad range of datasets Adaptive Tests of Significance Using Permutations of Residuals with R and SAS illustrates the power of adaptive tests and showcases their ability to adjust the testing method to suit a particular set of data. The book utilizes state-of-the-art software to demonstrate the practicality and benefits for data analysis in various fields of study. Beginning with an introduction, the book moves on to explore the underlying concepts of adaptive tests, including:Smoothing methods and normalizing transforma

  7. How Good Is Good: Improved Tracking and Managing of Safety Goals, Performance Indicators, Production Targets and Significant Events Using Learning Curves

    International Nuclear Information System (INIS)

    Duffey, Rommey B.; Saull, John W.

    2002-01-01

    We show a new way to track and measure safety and performance using learning curves derived on a mathematical basis. When unusual or abnormal events occur in plants and equipment, the regulator and good management practice requires they be reported, investigated, understood and rectified. In addition to reporting so-called 'significant events', both management and the regulator often set targets for individual and collective performance, which are used for both reward and criticism. For almost completely safe systems, like nuclear power plants, commercial aircraft and chemical facilities, many parameters are tracked and measured. Continuous improvement has to be demonstrated, as well as meeting reduced occurrence rates, which are set as management goals or targets. This process usually takes the form of statistics for availability of plant and equipment, forced or unplanned maintenance outage, loss of safety function, safety or procedural violations, etc. These are often rolled up into a set of so-called 'Performance Indicators' as measures of how well safety and operation is being managed at a given facility. The overall operating standards of an industry are also measured. A whole discipline is formed of tracking, measuring, reporting, managing and understanding the plethora of indicators and data. Decreasing occurrence rates and meeting or exceeding goals are seen and rewarded as virtues. Managers and operators need to know how good is their safety management system that has been adopted and used (and paid for), and whether it can itself be improved. We show the importance of accumulated experience in correctly measuring and tracking the decreasing event and error rates speculating a finite minimum rate. We show that the rate of improvement constitutes a measurable 'learning curve', and the attainment of the goals and targets can be affected by the adopted measures. We examine some of the available data on significant events, reportable occurrences, and loss of

  8. Fuel performance annual report for 1989

    International Nuclear Information System (INIS)

    Bailey, W.J.; Berting, F.M.; Wu, S.

    1992-06-01

    This annual report, the twelfth in a series, provides a brief description of fuel performance during 1989 in commercial nuclear power plants and an indication of trends. Brief summaries of fuel design changes, fuel surveillance programs, fuel operating experience, fuel problems, high-burnup fuel experience, and items of general significance are provided. References to more detailed information and related US Nuclear Regulatory Commission evaluations are included

  9. Artificial horizon effects on motion sickness and performance.

    Science.gov (United States)

    Tal, Dror; Gonen, Adi; Wiener, Guy; Bar, Ronen; Gil, Amnon; Nachum, Zohar; Shupak, Avi

    2012-07-01

    To investigate whether the projection of Earth-referenced scenes during provocative motion can alleviate motion sickness severity and prevent motion sickness-induced degradation of performance. Exposure to unfamiliar motion patterns commonly results in motion sickness and decreased performance. Thirty subjects with moderate-to-severe motion sickness susceptibility were exposed to the recorded motion profile of a missile boat under moderate sea conditions in a 3-degrees-of-freedom ship motion simulator. During a 120-minute simulated voyage, the study participants were repeatedly put through a performance test battery and completed a motion sickness susceptibility questionnaire, while self-referenced and Earth-referenced visual scenes were projected inside the closed simulator cabin. A significant decrease was found in the maximal motion sickness severity score, from 9.83 ± 9.77 (mean ± standard deviation) to 7.23 ± 7.14 (p pitch, and heave movements of the simulator. Although there was a significant decrease in sickness severity, substantial symptoms still persisted. Decision making, vision, concentration, memory, simple reasoning, and psychomotor skills all deteriorated under the motion conditions. However, no significant differences between the projection conditions could be found in the scores of any of the performance tests. Visual information regarding the vessel's movement provided by an artificial horizon device might decrease motion sickness symptoms. However, although this device might be suitable for passive transportation, the continued deterioration in performance measures indicates that it provides no significant advantage for personnel engaged in the active operation of modern vessels.

  10. 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

  11. Current Knowledge and Practice of Pediatric Providers in Umbilical Cord Blood Banking.

    Science.gov (United States)

    Armstrong, Amy E; Fonstad, Rachel; Spellman, Stephen; Tullius, Zoe; Chaudhury, Sonali

    2018-02-01

    More than 35 000 umbilical cord blood (UCB) transplants have been performed worldwide, prompting the development of private and public banks to collect and store UCB cells. We hypothesized that pediatricians, who are uniquely poised to discuss UCB banking (UCBB) during prenatal or sibling visits, rarely do so. Through distribution of a 26-question electronic survey to general and subspecialty pediatric providers, we assessed baseline knowledge and conversations about UCBB. A total of 473 providers completed the survey; only 22% of physicians ever discussed UCBB with expectant parents. The majority responded that autologous UCB transplants were indicated in malignant (73%) and nonmalignant (61%) conditions; however, these are rare indications. Providers practicing >10 years were more likely to address UCBB ( P ≤ .001), whereas younger and female general pediatric providers were significantly less likely ( P < .001). Overall, pediatric providers rarely speak to families about UCBB, and we believe that they can be better informed to its current clinical utility.

  12. 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.

  13. How do we make sense of significance?

    DEFF Research Database (Denmark)

    Lyhne, Ivar; Kørnøv, Lone

    2013-01-01

    Determination of significance is widely recognised as an important step in environmental assessment (EA) processes. The prescriptive literature and guidance on significance determination is comprehensive within the field of EA, whereas descriptive and explorative studies of how we go about making......' sense-making, including important differences in the way individuals screen and scope. These patterns concern what we notice, how fast we frame the choice, and when we are critical about the provided information. The indications provide a basis for reflections on practice and on how to organise EA...

  14. SC-HTGR Performance Impact for Arid Sites

    International Nuclear Information System (INIS)

    Lommers, L.; Geschwindt, J.; Southworth, F.; Shahrokhi, F.

    2014-01-01

    The SC-HTGR provides high temperature steam which can support industrial process heat applications as well as high efficiency electricity generation. The increased generating efficiency resulting from using high steam temperature provides greater plant output than lower temperature concepts, and it also reduces the fraction of waste heat which must be rejected. This capability is particularly attractive for sites with little or no water for heat rejection. This high temperature capability provides greater flexibility for these sites, and it results in a smaller performance penalty than for lower temperature systems when dry cooling must be used. The performance of the SC-HTGR for a conventional site with wet cooling is discussed first. Then the performance for arid sites is evaluated. Dry cooling performance is evaluated for both moderately arid sites and very hot sites. Offdesign performance of the dry cooling system under extreme conditions is also considered. Finally, operating strategies are explored for sites where some cooling water may be available but only in very limited quantities. Results of these assessments confirm that the higher operating temperatures of the SC-HTGR are very beneficial for arid sites, providing significant advantages for both gross and net power generation. (author)

  15. Significant performance enhancement in AlGaN/GaN high electron mobility transistor by high-κ organic dielectric

    International Nuclear Information System (INIS)

    Ze-Gao, Wang; Yuan-Fu, Chen; Cao, Chen; Ben-Lang, Tian; Fu-Tong, Chu; Xing-Zhao, Liu; Yan-Rong, Li

    2010-01-01

    The electrical properties of AlGaN/GaN high electron mobility transistor (HEMT) with and without high-κ organic dielectrics are investigated. The maximum drain current I D max and the maximum transconductance g m max of the organic dielectric/AlGaN/GaN structure can be enhanced by 74.5%, and 73.7% compared with those of the bare AlGaN/GaN HEMT, respectively. Both the threshold voltage V T and g m max of the dielectric/AlGaN/GaN HEMT are strongly dielectric-constant-dependent. Our results suggest that it is promising to significantly improve the performance of the AlGaN/GaN HEMT by introducing the high-κ organic dielectric. (condensed matter: electronic structure, electrical, magnetic, and optical properties)

  16. Effectiveness of Resident Physicians as Triage Liaison Providers in an Academic Emergency Department.

    Science.gov (United States)

    Weston, Victoria; Jain, Sushil K; Gottlieb, Michael; Aldeen, Amer; Gravenor, Stephanie; Schmidt, Michael J; Malik, Sanjeev

    2017-06-01

    Emergency department (ED) crowding is associated with detrimental effects on ED quality of care. Triage liaison providers (TLP) have been used to mitigate the effects of crowding. Prior studies have evaluated attending physicians and advanced practice providers as TLPs, with limited data evaluating resident physicians as TLPs. This study compares operational performance outcomes between resident and attending physicians as TLPs. This retrospective cohort study compared aggregate operational performance at an urban, academic ED during pre- and post-TLP periods. The primary outcome was defined as cost-effectiveness based upon return on investment (ROI). Secondary outcomes were defined as differences in median ED length of stay (LOS), median door-to-provider (DTP) time, proportion of left without being seen (LWBS), and proportion of "very good" overall patient satisfaction scores. Annual profit generated for physician-based collections through LWBS capture (after deducting respective salary costs) equated to a gain (ROI: 54%) for resident TLPs and a loss (ROI: -31%) for attending TLPs. Accounting for hospital-based collections made both profitable, with gains for resident TLPs (ROI: 317%) and for attending TLPs (ROI: 86%). Median DTP time for resident TLPs was significantly lower (phistorical control. Proportion of "very good" patient satisfaction scores and LWBS was improved for both resident and attending TLPs over historical control. Overall median LOS was not significantly different. Resident and attending TLPs improved DTP time, patient satisfaction, and LWBS rates. Both resident and attending TLPs are cost effective, with residents having a more favorable financial profile.

  17. Simulations of VLBI observations of a geodetic satellite providing co-location in space

    Science.gov (United States)

    Anderson, James M.; Beyerle, Georg; Glaser, Susanne; Liu, Li; Männel, Benjamin; Nilsson, Tobias; Heinkelmann, Robert; Schuh, Harald

    2018-02-01

    We performed Monte Carlo simulations of very-long-baseline interferometry (VLBI) observations of Earth-orbiting satellites incorporating co-located space-geodetic instruments in order to study how well the VLBI frame and the spacecraft frame can be tied using such measurements. We simulated observations of spacecraft by VLBI observations, time-of-flight (TOF) measurements using a time-encoded signal in the spacecraft transmission, similar in concept to precise point positioning, and differential VLBI (D-VLBI) observations using angularly nearby quasar calibrators to compare their relative performance. We used the proposed European Geodetic Reference Antenna in Space (E-GRASP) mission as an initial test case for our software. We found that the standard VLBI technique is limited, in part, by the present lack of knowledge of the absolute offset of VLBI time to Coordinated Universal Time at the level of microseconds. TOF measurements are better able to overcome this problem and provide frame ties with uncertainties in translation and scale nearly a factor of three smaller than those yielded from VLBI measurements. If the absolute time offset issue can be resolved by external means, the VLBI results can be significantly improved and can come close to providing 1 mm accuracy in the frame tie parameters. D-VLBI observations with optimum performance assumptions provide roughly a factor of two higher uncertainties for the E-GRASP orbit. We additionally simulated how station and spacecraft position offsets affect the frame tie performance.

  18. Technical Basis for Assessing Uranium Bioremediation Performance

    International Nuclear Information System (INIS)

    PE Long; SB Yabusaki; PD Meyer; CJ Murray; AL N'Guessan

    2008-01-01

    In situ bioremediation of uranium holds significant promise for effective stabilization of U(VI) from groundwater at reduced cost compared to conventional pump and treat. This promise is unlikely to be realized unless researchers and practitioners successfully predict and demonstrate the long-term effectiveness of uranium bioremediation protocols. Field research to date has focused on both proof of principle and a mechanistic level of understanding. Current practice typically involves an engineering approach using proprietary amendments that focuses mainly on monitoring U(VI) concentration for a limited time period. Given the complexity of uranium biogeochemistry and uranium secondary minerals, and the lack of documented case studies, a systematic monitoring approach using multiple performance indicators is needed. This document provides an overview of uranium bioremediation, summarizes design considerations, and identifies and prioritizes field performance indicators for the application of uranium bioremediation. The performance indicators provided as part of this document are based on current biogeochemical understanding of uranium and will enable practitioners to monitor the performance of their system and make a strong case to clients, regulators, and the public that the future performance of the system can be assured and changes in performance addressed as needed. The performance indicators established by this document and the information gained by using these indicators do add to the cost of uranium bioremediation. However, they are vital to the long-term success of the application of uranium bioremediation and provide a significant assurance that regulatory goals will be met. The document also emphasizes the need for systematic development of key information from bench scale tests and pilot scales tests prior to full-scale implementation

  19. Technical Basis for Assessing Uranium Bioremediation Performance

    Energy Technology Data Exchange (ETDEWEB)

    PE Long; SB Yabusaki; PD Meyer; CJ Murray; AL N’Guessan

    2008-04-01

    In situ bioremediation of uranium holds significant promise for effective stabilization of U(VI) from groundwater at reduced cost compared to conventional pump and treat. This promise is unlikely to be realized unless researchers and practitioners successfully predict and demonstrate the long-term effectiveness of uranium bioremediation protocols. Field research to date has focused on both proof of principle and a mechanistic level of understanding. Current practice typically involves an engineering approach using proprietary amendments that focuses mainly on monitoring U(VI) concentration for a limited time period. Given the complexity of uranium biogeochemistry and uranium secondary minerals, and the lack of documented case studies, a systematic monitoring approach using multiple performance indicators is needed. This document provides an overview of uranium bioremediation, summarizes design considerations, and identifies and prioritizes field performance indicators for the application of uranium bioremediation. The performance indicators provided as part of this document are based on current biogeochemical understanding of uranium and will enable practitioners to monitor the performance of their system and make a strong case to clients, regulators, and the public that the future performance of the system can be assured and changes in performance addressed as needed. The performance indicators established by this document and the information gained by using these indicators do add to the cost of uranium bioremediation. However, they are vital to the long-term success of the application of uranium bioremediation and provide a significant assurance that regulatory goals will be met. The document also emphasizes the need for systematic development of key information from bench scale tests and pilot scales tests prior to full-scale implementation.

  20. Diagnostic significance of haematological testing in patients presenting at the Emergency Department

    Directory of Open Access Journals (Sweden)

    Giuseppe Lippi

    2012-03-01

    Full Text Available The use of simple and economic tests to rule out diseases of sufficient clinical severity is appealing in emergency department (ED, since it would be effective for contrasting ED overcrowding and decreasing healthcare costs. The aim of this study was to assess the diagnostic performance of simple and economic haematological testing in a large sample of adult patients presenting at the ED of the Academic Hospital of Parma during the year 2010 with the five most frequent acute pathologies (i.e., acute myocardial infarction, renal colic, pneumonia, trauma and pancreatitis. Both leukocyte count and hemoglobin showed a good diagnostic performance (Area Under the Curve [AUC] of 0.85 for leukocyte count and 0.76 for hemoglobin; both p < 0.01. Although the platelet count was significantly increased in all patients groups except pancreatitis, the diagnostic performance did not achieve statistical significance (AUC 0.53; p = 0.07. We also observed an increased RDW in all groups, except in those with trauma and the diagnostic performance was acceptable (AUC 0.705; p < 0.01. The mean platelet volume (MPV was consistently lower in all patients groups and also characterized by an efficient diagnostic performance (AUC 0.76; p < 0.01. This evidence led us to design an arbitrary formula, whereby MPV and hemoglobin were multiplied, and further divided by the leukocyte count, obtaining a remarkable AUC (0.91; p < 0.01. We conclude that simple, rapid and cheap hematological tests might provide relevant clinical information for decision making to busy emergency physicians, and the their combination into an arbitrary formula might further increase the specific diagnostic potential of each of them.

  1. SIGWX Charts - High Level Significant Weather

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — High level significant weather (SIGWX) forecasts are provided for the en-route portion of international flights. NOAA's National Weather Service Aviation Center...

  2. Genome-wide identification of significant aberrations in cancer genome

    Directory of Open Access Journals (Sweden)

    Yuan Xiguo

    2012-07-01

    Full Text Available Abstract Background Somatic Copy Number Alterations (CNAs in human genomes are present in almost all human cancers. Systematic efforts to characterize such structural variants must effectively distinguish significant consensus events from random background aberrations. Here we introduce Significant Aberration in Cancer (SAIC, a new method for characterizing and assessing the statistical significance of recurrent CNA units. Three main features of SAIC include: (1 exploiting the intrinsic correlation among consecutive probes to assign a score to each CNA unit instead of single probes; (2 performing permutations on CNA units that preserve correlations inherent in the copy number data; and (3 iteratively detecting Significant Copy Number Aberrations (SCAs and estimating an unbiased null distribution by applying an SCA-exclusive permutation scheme. Results We test and compare the performance of SAIC against four peer methods (GISTIC, STAC, KC-SMART, CMDS on a large number of simulation datasets. Experimental results show that SAIC outperforms peer methods in terms of larger area under the Receiver Operating Characteristics curve and increased detection power. We then apply SAIC to analyze structural genomic aberrations acquired in four real cancer genome-wide copy number data sets (ovarian cancer, metastatic prostate cancer, lung adenocarcinoma, glioblastoma. When compared with previously reported results, SAIC successfully identifies most SCAs known to be of biological significance and associated with oncogenes (e.g., KRAS, CCNE1, and MYC or tumor suppressor genes (e.g., CDKN2A/B. Furthermore, SAIC identifies a number of novel SCAs in these copy number data that encompass tumor related genes and may warrant further studies. Conclusions Supported by a well-grounded theoretical framework, SAIC has been developed and used to identify SCAs in various cancer copy number data sets, providing useful information to study the landscape of cancer genomes

  3. Hanford Site performance report - December 1998

    International Nuclear Information System (INIS)

    EDER, D.M.

    2001-01-01

    The purpose of the Hanford Site Performance Report is to provide the Department of Energy Richland Operations Office's (DOE-RL's) report of Hanford's performance by: U. S. Department of Energy, Richland Operations Office, Project Hanford Management Contract (PHMC) through Fluor Daniel Hanford, Inc. (FDH) and its subcontractors, Environmental Restoration Contract through Bechtel Hanford, Inc. (BHI), and its subcontractors, and Pacific Northwest National Laboratories (PNNL) for Science and Technology support to the Environmental Management (EM) mission. This report is published monthly with the intent of relating work performance and progress in the context of the Success Indicators and Critical Success Factors as outlined in the Hanford Strategic Plan. Currently, the report focuses on the EM mission, and will be expanded in the future to include non-EM activities. Section A of this report is the Executive Summary, encapsulating high-level data in this report into an overall brief. Summary information provided includes Notable Accomplishments, a tabular performance profile with associated analyses, Critical Issues, Key Integration Activities, a look at Significant Trends, and a ''quick list'' of Upcoming Key Events. Section B of this report, the Site Summary section, provides Environmental Management performance data specifically organized to the pertinent Critical Success Factors and Success Indicators. The Site Summary is a compilation of performance data from all of the Mission Areas and the Projects that comprise these Mission Areas; the information is presented in both narrative and graphical formats. The remaining sections provide performance data relative to each individual mission area (e.g., Waste Management, Spent Nuclear Fuels, etc.). The information provided in the Mission Area sections is at a level of greater detail than is presented in either the Executive Summary or the Site Summary sections. At the end of this report, a glossary of terms is provided

  4. Clinical significance of the fabella

    International Nuclear Information System (INIS)

    Dodevski, A.; Lazarova-Tosovska, D.; Zhivadinovik, J.; Lazareska, M.

    2012-01-01

    Full text: Introduction: There is variable number of sesamoid bones in the human body; one of them is fabella, located in the tendon of the gastrocnemius muscle. Aim of this study was to investigate the frequency of occurrence of fabella in the Macedonian population and to discuss about clinical importance of this bone. Materials and methods: We retrospectively examined radiographs of 53 patients who had knee exams undertaken for a variety of clinical reasons, performed as a part of their medical treatment. Over a time span of six months, 53 patients (38 males and 15 females, age range 19-60 years, mean age of 36.7±12.3 years) were examined. Results: In seven (13.2%) patients of 53 analyzed reports, fabella was found in the lateral tendon of gastrocnemius muscle. We did not find a significant gender or side difference in the appearance of fabella. Conclusion: Although anatomic studies emphasized a lack of significance of the fabella, this bone has been associated with a spectrum of pathology affecting the knee as fabellar syndrome, perineal nerve injury and fracture. We should think of this sesamoid bone while performing diagnostic and surgical procedures

  5. Registered nurses' perceptions of rewarding and its significance.

    Science.gov (United States)

    Seitovirta, Jaana; Lehtimäki, Aku-Ville; Vehviläinen-Julkunen, Katri; Mitronen, Lasse; Kvist, Tarja

    2017-11-07

    To examine reward type preferences and their relationships with the significance of rewarding perceived by registered nurses in Finland. Previous studies have found relationships between nurses' rewarding and their motivation at work, job satisfaction and organisational commitment. Data were collected in a cross-sectional, descriptive, questionnaire survey from 402 registered nurses using the Registered Nurses' Perceptions of Rewarding Scale in 2015, and analysed with descriptive and multivariate statistical methods. Registered nurses assigned slightly higher values to several non-financial than to financial rewards. The non-financial reward types appreciation and feedback from work community, worktime arrangements, work content, and opportunity to develop, influence and participate were highly related to the significance of rewarding. We identified various rewards that registered nurses value, and indications that providing an appropriate array of rewards, particularly non-financial rewards, is a highly beneficial element of nursing management. It is important to understand the value of rewards for nursing management. Nurse managers should offer diverse rewards to their registered nurses to promote excellent performance and to help efforts to secure and maintain high-quality, safe patient care. The use of appropriate rewards is especially crucial to improving registered nurses' reward satisfaction and job satisfaction globally in the nursing profession. © 2017 John Wiley & Sons Ltd.

  6. Empirical Study on Annual Energy-Saving Performance of Energy Performance Contracting in China

    Directory of Open Access Journals (Sweden)

    Hongquan Ruan

    2018-05-01

    Full Text Available A lack of trust in Energy Service Company (ESCo is the most critical factor affecting the development of Energy Performance Contracting (EPC in China, compared with other constraints. One cannot easily estimate the energy-saving performance of an EPC project. Under that condition, lack of trust may cause the Energy-Consuming Unit (ECU to suspect the energy-saving performance promised by the ESCo, thus leaving potentially profitable projects without necessary funding. Currently, specific studies taking an across-projects viewpoint on annual energy-saving performance of EPC projects in multiple subsectors, objectively and quantitatively, are lacking. This paper studies the regression relationships of annual energy-saving quantity in terms of revamping cost and the regression relationships of annual cost saving in terms of revamping cost. The regression results show that there are statistically significant correlations in the above relationships in the nine subsectors investigated. This is significant for ESCos and ECUs, because knowledge on energy-saving performance could contribute to EPC investment decisions and trust relationships between ESCos and ECUs. Then, a multiple linear regression model of revamping cost is set up to analyze its influencing factors. The model indicates that the subsector the sample belongs to, financing, registered capital of the ESCo, and contract period have significant effects on revamping cost. Thus, policy implications regarding innovation of EE promotion technology, clarifying ESCos’ exit mechanism, innovation of financing mechanism, and improving the market credit environment for promoting investment in EPC projects, are provided.

  7. A case of gastric endocrine cell carcinoma which was significantly reduced in size by radiotherapy

    International Nuclear Information System (INIS)

    Azakami, Kiyoshi; Nishida, Kouji; Tanikawa, Ken

    2016-01-01

    In 2010, the World Health Organization classified gastric neuroendocrine tumors (NETs) into three types: NET grade (G) 1, NET G2 and neuroendocrine carcinoma (NEC). NECs are associated with a very poor prognosis. The patient was an 84-year-old female who was initially diagnosed by gastrointestinal endoscope with type 3 advanced gastric cancer with stenosis of the gastric cardia. Her overall status and performance status did not allow for operations or intensive chemotherapy. Palliative radiotherapy was performed and resulted in a significant reduction in the size of the tumor as well as the improvement of the obstructive symptoms. She died 9 months after radiotherapy. An autopsy provided a definitive diagnosis of gastric endocrine cell carcinoma, and the effectiveness of radiotherapy was pathologically-confirmed. Palliative radiotherapy may be a useful treatment option for providing symptom relief, especially for old patients with unresectable advanced gastric neuroendocrine carcinoma. (author)

  8. Subsonic Performance of Ejector Systems

    Science.gov (United States)

    Weil, Samuel

    Combined cycle engines combining scramjets with turbo jets or rockets can provide efficient hypersonic flight. Ejectors have the potential to increase the thrust and efficiency of combined cycle engines near static conditions. A computer code was developed to support the design of a small-scale, turbine-based combined cycle demonstrator with an ejector, built around a commercially available turbojet engine. This code was used to analyze the performance of an ejector system built around a micro-turbojet. With the use of a simple ejector, net thrust increases as large as 20% over the base engine were predicted. Additionally the specific fuel consumption was lowered by 10%. Increasing the secondary to primary area ratio of the ejector lead to significant improvements in static thrust, specific fuel consumption (SFC), and propulsive efficiency. Further ejector performance improvements can be achieved by using a diffuser. Ejector performance drops off rapidly with increasing Mach number. The ejector has lower thrust and higher SFC than the turbojet core at Mach numbers above 0.2. When the nozzle chokes a significant drop in ejector performance is seen. When a diffuser is used, higher Mach numbers lead to choking in the mixer and a shock in the nozzle causing a significant decrease in ejector performance. Evaluation of different turbo jets shows that ejector performance depends significantly on the properties of the turbojet. Static thrust and SFC improvements can be achieved with increasing ejector area for all engines, but size of increase and change in performance at higher Mach numbers depend heavily on the turbojet. The use of an ejector in a turbine based combined cycle configuration also increases performance at static conditions with a thrust increase of 5% and SFC decrease of 5% for the tested configuration.

  9. Customer assessment of long-term care pharmacy provider services.

    Science.gov (United States)

    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.

  10. Compression stockings significantly improve hemodynamic performance in post-thrombotic syndrome irrespective of class or length.

    Science.gov (United States)

    Lattimer, Christopher R; Azzam, Mustapha; Kalodiki, Evi; Makris, Gregory C; Geroulakos, George

    2013-07-01

    Graduated elastic compression (GEC) stockings have been demonstrated to reduce the morbidity associated with post-thrombotic syndrome. The ideal length or compression strength required to achieve this is speculative and related to physician preference and patient compliance. The aim of this study was to evaluate the hemodynamic performance of four different stockings and determine the patient's preference. Thirty-four consecutive patients (40 legs, 34 male) with post-thrombotic syndrome were tested with four different stockings (Mediven plus open toe, Bayreuth, Germany) of their size in random order: class 1 (18-21 mm Hg) and class II (23-32 mm Hg), below-knee (BK) and above-knee thigh-length (AK). The median age, Venous Clinical Severity Score, Venous Segmental Disease Score, and Villalta scale were 62 years (range, 31-81 years), 8 (range, 1-21), 5 (range, 2-10), and 10 (range, 2-22), respectively. The C of C0-6EsAs,d,pPr,o was C0 = 2, C2 = 1, C3 = 3, C4a = 12, C4b = 7, C5 = 12, C6 = 3. Obstruction and reflux was observed on duplex in 47.5% legs, with deep venous reflux alone in 45%. Air plethysmography was used to measure the venous filling index (VFI), venous volume, and time to fill 90% of the venous volume. Direct pressure measurements were obtained while lying and standing using the PicoPress device (Microlab Elettronica, Nicolò, Italy). The pressure sensor was placed underneath the test stocking 5 cm above and 2 cm posterior to the medial malleolus. At the end of the study session, patients stated their preferred stocking based on comfort. The VFI, venous volume, and time to fill 90% of the venous volume improved significantly with all types of stocking versus no compression. In class I, the VFI (mL/s) improved from a median of 4.9 (range, 1.7-16.3) without compression to 3.7 (range, 0-14) BK (24.5%) and 3.6 (range, 0.6-14.5) AK (26.5%). With class II, the corresponding improvement was to 4.0 (range, 0.3-16.2) BK (18.8%) and 3.7 (range, 0.5-14.2) AK (24

  11. Financial health and customer satisfaction in private health care providers in Brazil.

    Science.gov (United States)

    Schiozer, Rafael Felipe; Saito, Cristiana Checchia; Saito, Richard

    2011-11-01

    This paper analyzes the relationship between the financial health and organizational form of private health care providers in Brazil. It also examines the major determinants of customer satisfaction associated with the provider's organizational form. An adjusted Altman's z-score is used as an indicator of financial health. A proxy variable based on customer complaints filed at the Brazilian National Agency for Supplementary Health is used as an indicator for customer satisfaction. The study uses a sample of 270 private health care providers and their operations over the period 2003-2005. Panel data analysis includes control variables related to market, operations, and management. Principal results indicate that: (1) private health care providers benefit from economies of scale; (2) self-funded health plans have better financial health; (3) spending on marketing does not have a significant impact on customer satisfaction in Brazil; (4) weak empirical evidence exists showing that good financial performance enhances customer's satisfaction.

  12. Fuel performance annual report for 1986

    International Nuclear Information System (INIS)

    Bailey, W.J.; Wu, S.

    1988-03-01

    This annual report, the ninth in a series, provides a brief description of fuel performance during 1986 in commercial nuclear power plants and an indication of trends. Brief summaries of fuel design changes, fuel surveillance programs, fuel operating experience, fuel problems, high-burnup fuel experience, and items of general significance are provided. References to more detailed information and related U.S. Nuclear Regulatory Commission evaluations are included. 550 refs., 12 figs., 31 tabs

  13. Fuel performance: Annual report for 1987

    International Nuclear Information System (INIS)

    Bailey, W.J.; Wu, S.

    1989-03-01

    This annual report, the tenth in a series, provides a brief description of fuel performance during 1987 in commercial nuclear power plants and an indication of trends. Brief summaries of fuel design changes, fuel surveillance programs, fuel operating experience, fuel problems, high-burnup fuel experience, and items of general significance are provided. References to more detailed information and related US Nuclear Regulator Commission evaluations are included. 384 refs., 13 figs., 33 tabs

  14. Improving performance by anchoring movement and "nerves".

    Science.gov (United States)

    Iso-Ahola, Seppo E; Dotson, Charles O; Jagodinsky, Adam E; Clark, Lily C; Smallwood, Lorraine L; Wilburn, Christopher; Weimar, Wendi H; Miller, Matthew W

    2016-10-01

    Golf's governing bodies' recent decision to ban all putting styles "anchoring one end of the club against the body" bridges an important practical problem with psychological theory. We report the first experiment testing whether anchoring provides technical and/or psychological advantage in competitive performance. Many "greats" of professional golf from Arnold Palmer and Jack Nicklaus to Tiger Woods have argued against anchoring, believing that it takes "nerves" out of competitive performance and therefore artificially levels the playing field. To shed more light on the issue, we tested participants' performance with anchored and unanchored putters under low and high pressure when controlling for the putter length. We found no statistically significant evidence for a technical advantage due to anchoring but a clear psychological advantage: participants who anchored their putters significantly outperformed unanchored counterparts under high, but not low, pressure. Results provide tentative evidence for the ban's justification from a competitive standpoint. However, before any definite conclusions can be made, more research is needed when using high-level golfers. Copyright © 2016 Elsevier B.V. All rights reserved.

  15. 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.

  16. PROVIDING R-TREE SUPPORT FOR MONGODB

    Directory of Open Access Journals (Sweden)

    L. Xiang

    2016-06-01

    Full Text Available Supporting large amounts of spatial data is a significant characteristic of modern databases. However, unlike some mature relational databases, such as Oracle and PostgreSQL, most of current burgeoning NoSQL databases are not well designed for storing geospatial data, which is becoming increasingly important in various fields. In this paper, we propose a novel method to provide R-tree index, as well as corresponding spatial range query and nearest neighbour query functions, for MongoDB, one of the most prevalent NoSQL databases. First, after in-depth analysis of MongoDB’s features, we devise an efficient tabular document structure which flattens R-tree index into MongoDB collections. Further, relevant mechanisms of R-tree operations are issued, and then we discuss in detail how to integrate R-tree into MongoDB. Finally, we present the experimental results which show that our proposed method out-performs the built-in spatial index of MongoDB. Our research will greatly facilitate big data management issues with MongoDB in a variety of geospatial information applications.

  17. Providing R-Tree Support for Mongodb

    Science.gov (United States)

    Xiang, Longgang; Shao, Xiaotian; Wang, Dehao

    2016-06-01

    Supporting large amounts of spatial data is a significant characteristic of modern databases. However, unlike some mature relational databases, such as Oracle and PostgreSQL, most of current burgeoning NoSQL databases are not well designed for storing geospatial data, which is becoming increasingly important in various fields. In this paper, we propose a novel method to provide R-tree index, as well as corresponding spatial range query and nearest neighbour query functions, for MongoDB, one of the most prevalent NoSQL databases. First, after in-depth analysis of MongoDB's features, we devise an efficient tabular document structure which flattens R-tree index into MongoDB collections. Further, relevant mechanisms of R-tree operations are issued, and then we discuss in detail how to integrate R-tree into MongoDB. Finally, we present the experimental results which show that our proposed method out-performs the built-in spatial index of MongoDB. Our research will greatly facilitate big data management issues with MongoDB in a variety of geospatial information applications.

  18. Providing Consistent (A)ATSR Solar Channel Radiometry for Climate Studies

    Science.gov (United States)

    Smith, D.; Latter, B. G.; Poulsen, C.

    2012-04-01

    Data from the solar reflectance channels of the Along Track Scanning Radiometer (ATSR) series of instruments are being used in applications for monitoring trends in clouds and aerosols. In order to provide quantitative information, the radiometric calibrations of the sensors must be consistent, stable and ideally traced to international standards. This paper describes the methods used to monitor the calibrations of the ATSR instruments to provide consistent Level 1b radiometric data sets. Comparisons of the in-orbit calibrations are made by reference to data from quasi stable sites such as DOME-C in Antarctica or Saharan Desert sites. Comparisons are performed either by time coincident match-ups of the radiometric data for sensors having similar spectral bands and view/solar geometry and overpass times as for AATSR and MERIS; or via a reference BRDF model derived from averages of measurements over the site from a reference sensor where there is limited or no temporal overlap (e.g. MODIS-Aqua, ATSR-1 and ATSR-2). The results of the intercomparisons provide values of the long term calibration drift and systematic biases between the sensors. Look-up tables based on smoothed averages of the drift measurements are used to provide the corrections to Level 1b data. The uncertainty budgets for the comparisons are provided. It is also possible to perform comparisons of measurements against high spectral resolution instruments that are co-located on the same platform, i.e. AATSR/SCIA on ENVISAT and ATSR-2/GOME on ERS-2. The comparisons are performed by averaging the spectrometer data to the spectral response of the filter radiometer, and averaging the radiometer data to the spatial resolution of the spectrometer. In this paper, the authors present the results of the inter-comparisons to achieve a consistent calibration for the solar channels of the complete ATSR dataset. An assessment of the uncertainties associated with the techniques will be discussed. The impacts of the

  19. Development of the National Transplant Program Has Significantly Decreased but Not Ended Transplant Tourism in Montenegro.

    Science.gov (United States)

    Ratkovic, M; Basic Jukic, N; Kastelan, Z; Radunovic, D; Kavaric, P; Brezak, J; Topalovic Grkovic, M; Hudolin, T; Prelevic, V

    2018-06-01

    Organ transplantation has prolonged and improved the lives of many patients around the world. However, a widespread shortage of donors remains the main factor that has led to organ trafficking and transplant tourism. To stop transplant tourism and to provide optimal treatment for its citizens with end-stage renal disease, Montenegro started performing renal transplantations in September 2012. Thirty-five transplantations have been performed since that time, 34 from living donors and only 1 from a deceased donor. This practice has significantly decreased but not ended transplant tourism in Montenegro. Copyright © 2018 Elsevier Inc. All rights reserved.

  20. Multiple genetic interaction experiments provide complementary information useful for gene function prediction.

    Directory of Open Access Journals (Sweden)

    Magali Michaut

    Full Text Available Genetic interactions help map biological processes and their functional relationships. A genetic interaction is defined as a deviation from the expected phenotype when combining multiple genetic mutations. In Saccharomyces cerevisiae, most genetic interactions are measured under a single phenotype - growth rate in standard laboratory conditions. Recently genetic interactions have been collected under different phenotypic readouts and experimental conditions. How different are these networks and what can we learn from their differences? We conducted a systematic analysis of quantitative genetic interaction networks in yeast performed under different experimental conditions. We find that networks obtained using different phenotypic readouts, in different conditions and from different laboratories overlap less than expected and provide significant unique information. To exploit this information, we develop a novel method to combine individual genetic interaction data sets and show that the resulting network improves gene function prediction performance, demonstrating that individual networks provide complementary information. Our results support the notion that using diverse phenotypic readouts and experimental conditions will substantially increase the amount of gene function information produced by genetic interaction screens.

  1. Performance Indicators in Spine Surgery.

    Science.gov (United States)

    St-Pierre, Godefroy Hardy; Yang, Michael H; Bourget-Murray, Jonathan; Thomas, Ken C; Hurlbert, Robin John; Matthes, Nikolas

    2018-02-15

    Systematic review. To elucidate how performance indicators are currently used in spine surgery. The Patient Protection and Affordable Care Act has given significant traction to the idea that healthcare must provide value to the patient through the introduction of hospital value-based purchasing. The key to implementing this new paradigm is to measure this value notably through performance indicators. MEDLINE, CINAHL Plus, EMBASE, and Google Scholar were searched for studies reporting the use of performance indicators specific to spine surgery. We followed the Prisma-P methodology for a systematic review for entries from January 1980 to July 2016. All full text articles were then reviewed to identify any measure of performance published within the article. This measure was then examined as per the three criteria of established standard, exclusion/risk adjustment, and benchmarking to determine if it constituted a performance indicator. The initial search yielded 85 results among which two relevant studies were identified. The extended search gave a total of 865 citations across databases among which 15 new articles were identified. The grey literature search provided five additional reports which in turn led to six additional articles. A total of 27 full text articles and reports were retrieved and reviewed. We were unable to identify performance indicators. The articles presenting a measure of performance were organized based on how many criteria they lacked. We further examined the next steps to be taken to craft the first performance indicator in spine surgery. The science of performance measurement applied to spine surgery is still in its infancy. Current outcome metrics used in clinical settings require refinement to become performance indicators. Current registry work is providing the necessary foundation, but requires benchmarking to truly measure performance. 1.

  2. Efficacy of a Word- and Text-Based Intervention for Students With Significant Reading Difficulties.

    Science.gov (United States)

    Vaughn, Sharon; Roberts, Garrett J; Miciak, Jeremy; Taylor, Pat; Fletcher, Jack M

    2018-05-01

    We examine the efficacy of an intervention to improve word reading and reading comprehension in fourth- and fifth-grade students with significant reading problems. Using a randomized control trial design, we compare the fourth- and fifth-grade reading outcomes of students with severe reading difficulties who were provided a researcher-developed treatment with reading outcomes of students in a business-as-usual (BAU) comparison condition. A total of 280 fourth- and fifth-grade students were randomly assigned within school in a 1:1 ratio to either the BAU comparison condition ( n = 139) or the treatment condition ( n = 141). Treatment students were provided small-group tutoring for 30 to 45 minutes for an average of 68 lessons (mean hours of instruction = 44.4, SD = 11.2). Treatment students performed statistically significantly higher than BAU students on a word reading measure (effect size [ES] = 0. 58) and a measure of reading fluency (ES = 0.46). Though not statistically significant, effect sizes for students in the treatment condition were consistently higher than BAU students for decoding measures (ES = 0.06, 0.08), and mixed for comprehension (ES = -0.02, 0.14).

  3. Standardizing communication from acute care providers to primary care providers on critically ill adults.

    Science.gov (United States)

    Ellis, Kerri A; Connolly, Ann; Hosseinnezhad, Alireza; Lilly, Craig M

    2015-11-01

    To increase the frequency of communication of patient information between acute and primary care providers. A secondary objective was to determine whether higher rates of communication were associated with lower rates of hospital readmission 30 days after discharge. A validated instrument was used for telephone surveys before and after an intervention designed to increase the frequency of communication among acute care and primary care providers. The communication intervention was implemented in 3 adult intensive care units from 2 campuses of an academic medical center. The frequency of communication among acute care and primary care providers, the perceived usefulness of the intervention, and its association with 30-day readmission rates were assessed for 202 adult intensive care episodes before and 100 episodes after a communication intervention. The frequency of documented communication increased significantly (5/202 or 2% before to 72/100 or 72% after the intervention; P communication was considered useful by every participating primary care provider. Rates of rehospitalization at 30 days were lower for the intervention group than the preintervention group, but the difference was not statistically significant (41/202 or 23% vs 16/88 or 18% of discharged patients; P = .45; power 0.112 at P = .05). The frequency of communication episodes that provide value can be increased through standardized processes. The key aspects of this effective intervention were setting the expectation that communication should occur, documenting when communication has occurred, and reviewing that documentation during multiprofessional rounds. ©2015 American Association of Critical-Care Nurses.

  4. Fuel performance annual report for 1983. Volume 1

    Energy Technology Data Exchange (ETDEWEB)

    Bailey, W.J.; Dunenfeld, M.S.

    1985-03-01

    This annual report, the sixth in a series, provides a brief description of fuel performance during 1983 in commercial nuclear power plants. Brief summaries of fuel design changes, fuel surveillance programs, fuel operating experience, fuel problems, high-burnup fuel experience, and items of general significance are provided. References to additional, more detailed information and related NRC evaluations are included.

  5. Effectiveness of Resident Physicians as Triage Liaison Providers in an Academic Emergency Department

    Directory of Open Access Journals (Sweden)

    Victoria Weston

    2017-04-01

    Full Text Available Introduction: Emergency department (ED crowding is associated with detrimental effects on ED quality of care. Triage liaison providers (TLP have been used to mitigate the effects of crowding. Prior studies have evaluated attending physicians and advanced practice providers as TLPs, with limited data evaluating resident physicians as TLPs. This study compares operational performance outcomes between resident and attending physicians as TLPs. Methods: This retrospective cohort study compared aggregate operational performance at an urban, academic ED during pre- and post-TLP periods. The primary outcome was defined as cost-effectiveness based upon return on investment (ROI. Secondary outcomes were defined as differences in median ED length of stay (LOS, median door-to-provider (DTP time, proportion of left without being seen (LWBS, and proportion of “very good” overall patient satisfaction scores. Results: Annual profit generated for physician-based collections through LWBS capture (after deducting respective salary costs equated to a gain (ROI: 54% for resident TLPs and a loss (ROI: −31% for attending TLPs. Accounting for hospital-based collections made both profitable, with gains for resident TLPs (ROI: 317% and for attending TLPs (ROI: 86%. Median DTP time for resident TLPs was significantly lower (p<0.0001 than attending or historical control. Proportion of “very good” patient satisfaction scores and LWBS was improved for both resident and attending TLPs over historical control. Overall median LOS was not significantly different. Conclusion: Resident and attending TLPs improved DTP time, patient satisfaction, and LWBS rates. Both resident and attending TLPs are cost effective, with residents having a more favorable financial profile.

  6. Reduced memory skills and increased hair cortisol levels in recent Ecstasy/MDMA users: significant but independent neurocognitive and neurohormonal deficits.

    Science.gov (United States)

    Downey, Luke A; Sands, Helen; Jones, Lewis; Clow, Angela; Evans, Phil; Stalder, Tobias; Parrott, Andrew C

    2015-05-01

    The goals of this study were to measure the neurocognitive performance of recent users of recreational Ecstasy and investigate whether it was associated with the stress hormone cortisol. The 101 participants included 27 recent light users of Ecstasy (one to four times in the last 3 months), 23 recent heavier Ecstasy users (five or more times) and 51 non-users. Rivermead paragraph recall provided an objective measure for immediate and delayed recall. The prospective and retrospective memory questionnaire provided a subjective index of memory deficits. Cortisol levels were taken from near-scalp 3-month hair samples. Cortisol was significantly raised in recent heavy Ecstasy users compared with controls, whereas hair cortisol in light Ecstasy users was not raised. Both Ecstasy groups were significantly impaired on the Rivermead delayed word recall, and both groups reported significantly more retrospective and prospective memory problems. Stepwise regression confirmed that lifetime Ecstasy predicted the extent of these memory deficits. Recreational Ecstasy is associated with increased levels of the bio-energetic stress hormone cortisol and significant memory impairments. No significant relationship between cortisol and the cognitive deficits was observed. Ecstasy users did display evidence of a metacognitive deficit, with the strength of the correlations between objective and subjective memory performances being significantly lower in the Ecstasy users. Copyright © 2015 John Wiley & Sons, Ltd.

  7. 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…

  8. 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...

  9. A clip-based protocol for breast boost radiotherapy provides clear target visualisation and demonstrates significant volume reduction over time

    Energy Technology Data Exchange (ETDEWEB)

    Lewis, Lorraine [Department of Radiation Oncology, Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, New South Wales (Australia); Cox, Jennifer [Department of Radiation Oncology, Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, New South Wales (Australia); Faculty of Health Sciences, University of Sydney, Sydney, New South Wales (Australia); Morgia, Marita [Department of Radiation Oncology, Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, New South Wales (Australia); Atyeo, John [Faculty of Health Sciences, University of Sydney, Sydney, New South Wales (Australia); Lamoury, Gillian [Department of Radiation Oncology, Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, New South Wales (Australia)

    2015-09-15

    The clinical target volume (CTV) for early stage breast cancer is difficult to clearly identify on planning computed tomography (CT) scans. Surgical clips inserted around the tumour bed should help to identify the CTV, particularly if the seroma has been reabsorbed, and enable tracking of CTV changes over time. A surgical clip-based CTV delineation protocol was introduced. CTV visibility and its post-operative shrinkage pattern were assessed. The subjects were 27 early stage breast cancer patients receiving post-operative radiotherapy alone and 15 receiving post-operative chemotherapy followed by radiotherapy. The radiotherapy alone (RT/alone) group received a CT scan at median 25 days post-operatively (CT1rt) and another at 40 Gy, median 68 days (CT2rt). The chemotherapy/RT group (chemo/RT) received a CT scan at median 18 days post-operatively (CT1ch), a planning CT scan at median 126 days (CT2ch), and another at 40 Gy (CT3ch). There was no significant difference (P = 0.08) between the initial mean CTV for each cohort. The RT/alone cohort showed significant CTV volume reduction of 38.4% (P = 0.01) at 40 Gy. The Chemo/RT cohort had significantly reduced volumes between CT1ch: median 54 cm{sup 3} (4–118) and CT2ch: median 16 cm{sup 3}, (2–99), (P = 0.01), but no significant volume reduction thereafter. Surgical clips enable localisation of the post-surgical seroma for radiotherapy targeting. Most seroma shrinkage occurs early, enabling CT treatment planning to take place at 7 weeks, which is within the 9 weeks recommended to limit disease recurrence.

  10. A clip-based protocol for breast boost radiotherapy provides clear target visualisation and demonstrates significant volume reduction over time

    International Nuclear Information System (INIS)

    Lewis, Lorraine; Cox, Jennifer; Morgia, Marita; Atyeo, John; Lamoury, Gillian

    2015-01-01

    The clinical target volume (CTV) for early stage breast cancer is difficult to clearly identify on planning computed tomography (CT) scans. Surgical clips inserted around the tumour bed should help to identify the CTV, particularly if the seroma has been reabsorbed, and enable tracking of CTV changes over time. A surgical clip-based CTV delineation protocol was introduced. CTV visibility and its post-operative shrinkage pattern were assessed. The subjects were 27 early stage breast cancer patients receiving post-operative radiotherapy alone and 15 receiving post-operative chemotherapy followed by radiotherapy. The radiotherapy alone (RT/alone) group received a CT scan at median 25 days post-operatively (CT1rt) and another at 40 Gy, median 68 days (CT2rt). The chemotherapy/RT group (chemo/RT) received a CT scan at median 18 days post-operatively (CT1ch), a planning CT scan at median 126 days (CT2ch), and another at 40 Gy (CT3ch). There was no significant difference (P = 0.08) between the initial mean CTV for each cohort. The RT/alone cohort showed significant CTV volume reduction of 38.4% (P = 0.01) at 40 Gy. The Chemo/RT cohort had significantly reduced volumes between CT1ch: median 54 cm 3 (4–118) and CT2ch: median 16 cm 3 , (2–99), (P = 0.01), but no significant volume reduction thereafter. Surgical clips enable localisation of the post-surgical seroma for radiotherapy targeting. Most seroma shrinkage occurs early, enabling CT treatment planning to take place at 7 weeks, which is within the 9 weeks recommended to limit disease recurrence

  11. Understanding protocol performance: impact of test performance.

    Science.gov (United States)

    Turner, Robert G

    2013-01-01

    This is the second of two articles that examine the factors that determine protocol performance. The objective of these articles is to provide a general understanding of protocol performance that can be used to estimate performance, establish limits on performance, decide if a protocol is justified, and ultimately select a protocol. The first article was concerned with protocol criterion and test correlation. It demonstrated the advantages and disadvantages of different criterion when all tests had the same performance. It also examined the impact of increasing test correlation on protocol performance and the characteristics of the different criteria. To examine the impact on protocol performance when individual tests in a protocol have different performance. This is evaluated for different criteria and test correlations. The results of the two articles are combined and summarized. A mathematical model is used to calculate protocol performance for different protocol criteria and test correlations when there are small to large variations in the performance of individual tests in the protocol. The performance of the individual tests that make up a protocol has a significant impact on the performance of the protocol. As expected, the better the performance of the individual tests, the better the performance of the protocol. Many of the characteristics of the different criteria are relatively independent of the variation in the performance of the individual tests. However, increasing test variation degrades some criteria advantages and causes a new disadvantage to appear. This negative impact increases as test variation increases and as more tests are added to the protocol. Best protocol performance is obtained when individual tests are uncorrelated and have the same performance. In general, the greater the variation in the performance of tests in the protocol, the more detrimental this variation is to protocol performance. Since this negative impact is increased as

  12. Composite Indexes Economic and Social Performance: Do they Provide Valuable Information?

    Directory of Open Access Journals (Sweden)

    Nasierowski Wojciech

    2016-01-01

    Full Text Available This paper examines the information content of the selected composite indexes, namely the Global Competitiveness Report Index, the Human Development Index, the Knowledge Economy Index, the Innovation Union Scoreboard, and the like. These indexes are examined from the viewpoint of country rankings. It is argued that these indexes provide highly similar information, which brings to question the usefulness of such a variety of approaches. This paper also explores the drawbacks of composite indexes, and questions whether these indexes can adequately serve as policy-setting mechanisms.

  13. Does Pay-For-Performance Program Increase Providers Adherence to Guidelines for Managing Hepatitis B and Hepatitis C Virus Infection in Taiwan?

    Science.gov (United States)

    Chen, Huei-Ju; Huang, Nicole; Chen, Long-Sheng; Chou, Yiing-Jenq; Li, Chung-Pin; Wu, Chen-Yi; Chang, Yu-Chia

    2016-01-01

    Many people are concerned about that the quality of preventive care for patients with hepatitis B virus (HBV) and hepatitis C virus (HCV) infection is suboptimal. Taiwan, a hyperendemic area of chronic HBV and HCV infection, implemented a nationwide pay-for-performance (P4P) program in 2010, which aimed to improve the preventive care provided to HBV and HCV patients by increasing physicians' adherence to guidelines through financial incentives. The objective of this study was to evaluate the early effects of the P4P program on utilization of preventive services by HBV and HCV patients. Using a quasi-experimental design with propensity score matching method, we matched the HBV and HCV patients enrolled in the P4P program with non-enrollees in 2010, resulting in 21,643 patients in each group. Generalized estimating equations was applied to examine the difference-in-difference effects of P4P program enrollment on the utilization of three guideline-recommended preventive services (regular outpatient follow-up visits, abdominal ultrasonography (US) examinations, and aspartate aminotransferase and alanine aminotransferase (AST/ALT) tests by HBV and HCV patients. The P4P program enrollees were significantly more likely to attend twice-annual follow-up visits, to receive recommended US examinations and AST/ALT tests, than non-enrollees. The results of our preliminary assessment indicate that financial incentives offered by the P4P program was associated with a modest improvement in adherence to guidelines for better chronic HBV and HBC management.

  14. School Breakfast Program and School Performance.

    Science.gov (United States)

    Meyers, Alan; And Others

    Children who participate in the School Breakfast Program show significant improvement in academic performance and tardiness rates, and a trend toward improvement in absenteeism. The School Breakfast Program was created by Congress in 1966 to provide a breakfast on school days for low income children who would otherwise have none. Children…

  15. The Significance of the Nursery School

    Science.gov (United States)

    Gesell, Arnold

    2017-01-01

    From the standpoint of mental health and perhaps even from the standpoint of human culture, the complete realization of the educational possibilities of the preschool child is of foundational significance. Normative and comparative studies performed at a psychological clinic at Yale examining norms of development in children from one month to five…

  16. Variation in performance measure criteria significantly affects cardiology practice rankings: Insights from the National Cardiovascular Data Registry's Practice Innovation and Clinical Excellence Registry.

    Science.gov (United States)

    Eapen, Zubin J; Tang, Fengming; Jones, Phil G; Maddox, Thomas M; Oetgen, William J; Spertus, John A; Rumsfeld, John S; Heidenreich, Paul A; Peterson, Eric D; Drozda, Joseph P

    2015-06-01

    Million Hearts is a national initiative to prevent 1 million heart attacks and strokes over 5 years by improving cardiovascular prevention. An important tool in the success of programs like Million Hearts is public ranking on the quality of practices, yet different measures may provide different rankings, so the true quality of practices is difficult to discern. We evaluated the quality of ambulatory cardiology care using performance measure metrics. We compared rankings of practices participating in the National Cardiovascular Data Registry's Practice Innovation and Clinical Excellence Registry using measures from (1) the physician quality reporting system and (2) the American College of Cardiology/American Heart Association/Physician Consortium for Performance Improvement. We compared achievement rates for measures between the 2 frameworks and determined correlations in rankings using Spearman correlation coefficients. From January 1, 2008 to December 31, 2012, there were 1,711,326 patients enrolled from 111 US practices. Among eligible patients, the physician quality reporting system and American College of Cardiology/American Heart Association/Physician Consortium for Performance Improvement measures were achieved in 76.1% versus 77.4% for antiplatelet prescription (P performance and failing to achieve public health goals. Copyright © 2015 Elsevier Inc. All rights reserved.

  17. Algorithm of Golgi protein 73 and liver stiffness accurately diagnoses significant fibrosis in chronic HBV infection.

    Science.gov (United States)

    Cao, Zhujun; Li, Ziqiang; Wang, Hui; Liu, Yuhan; Xu, Yumin; Mo, Ruidong; Ren, Peipei; Chen, Lichang; Lu, Jie; Li, Hong; Zhuang, Yan; Liu, Yunye; Wang, Xiaolin; Zhao, Gangde; Tang, Weiliang; Xiang, Xiaogang; Cai, Wei; Liu, Longgen; Bao, Shisan; Xie, Qing

    2017-11-01

    Serum Golgi protein 73 (GP73) is a potential biomarker for fibrosis assessment. We aimed to develop an algorithm based on GP73 and liver stiffness (LS) for further improvement of accuracy for significant fibrosis in patients with antiviral-naïve chronic hepatitis B virus (HBV) infection. Diagnostic accuracy evaluation of GP73 and development of GP73-LS algorithm was performed in training cohort (n = 267) with an independent cohort (n = 133) for validation. A stepwise increasing pattern of serum GP73 was observed across fibrosis stages in patients with antiviral-naïve chronic HBV infection. Serum GP73 significantly correlated (rho = 0.48, P 73, accuracy: 63.6%). Using GP73-LS algorithm, GP73 < 63 in agreement with LS < 8.5 provided accuracy of 81.7% to excluded significant fibrosis. GP73 ≥ 63 in agreement with LS ≥ 8.5 provided accuracy of 93.3% to confirm significant fibrosis. Almost 64% or 68% of patients in the training or validation cohort could be accurately classified. Serum GP73 is a robust biomarker for significant fibrosis diagnosis. GP73-LS algorithm provided better diagnostic accuracy than currently available approaches. More than 60% antiviral naïve CHB patients could use this algorithm without resorting to liver biopsy. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  18. Evaluation of a social franchising and telemedicine programme and the care provided for childhood diarrhoea and pneumonia, Bihar, India.

    Science.gov (United States)

    Mohanan, Manoj; Giardili, Soledad; Das, Veena; Rabin, Tracy L; Raj, Sunil S; Schwartz, Jeremy I; Seth, Aparna; Goldhaber-Fiebert, Jeremy D; Miller, Grant; Vera-Hernández, Marcos

    2017-05-01

    To evaluate the impact on the quality of the care provided for childhood diarrhoea and pneumonia in Bihar, India, of a large-scale, social franchising and telemedicine programme - the World Health Partners' Sky Program. We investigated changes associated with the programme in the knowledge and performance of health-care providers by carrying out 810 assessments in a representative sample of providers in areas where the programme was and was not implemented. Providers were assessed using hypothetical patient vignettes and the standardized patient method both before and after programme implementation, in 2011 and 2014, respectively. Differences in providers' performance between implementation and nonimplementation areas were assessed using multivariate difference-in-difference linear regression models. The programme did not significantly improve health-care providers' knowledge or performance with regard to childhood diarrhoea or pneumonia in Bihar. There was a persistent large gap between knowledge of appropriate care and the care actually delivered. Social franchising has received attention globally as a model for delivering high-quality care in rural areas in the developing world but supporting data are scarce. Our findings emphasize the need for sound empirical evidence before social franchising programmes are scaled up.

  19. Impact significance determination-Pushing the boundaries

    International Nuclear Information System (INIS)

    Lawrence, David P.

    2007-01-01

    Impact significance determination practice tends to be highly variable. Too often insufficient consideration is given to good practice insights. Also, impact significance determinations are frequently narrowly defined addressing, for example, only individual, negative impacts, focusing on bio-physical impacts, and not seeking to integrate either the Precautionary Principle or sustainability. This article seeks to extend the boundaries of impact significance determination practice by providing an overview of good general impact significance practices, together with stakeholder roles and potential methods for addressing significance determination challenges. Relevant thresholds, criteria, contextual considerations and support methods are also highlighted. The analysis is then extended to address how impact significance determination practices change for positive as compared with negative impacts, for cumulative as compared with individual impacts, for socio-economic as compared with bio-physical impacts, when the Precautionary Principle is integrated into the process, and when sustainability contributions drive the EIA process and related impact significance determinations. These refinements can assist EIA practitioners in ensuring that the scope and nature of impact significance determinations reflect the broadened scope of emerging EIA requirements and practices. Suggestions are included for further refining and testing of the proposed changes to impact significance determination practice

  20. Trifocal intraocular lenses: a comparison of the visual performance and quality of vision provided by two different lens designs

    Directory of Open Access Journals (Sweden)

    Gundersen KG

    2017-06-01

    Full Text Available Kjell G Gundersen,1 Rick Potvin2 1IFocus Øyeklinikk AS, Haugesund, Norway; 2Science in Vision, Akron, NY, USA Purpose: To compare two different diffractive trifocal intraocular lens (IOL designs, evaluating longer-term refractive outcomes, visual acuity (VA at various distances, low contrast VA and quality of vision.Patients and methods: Patients with binocularly implanted trifocal IOLs of two different designs (FineVision [FV] and Panoptix [PX] were evaluated 6 months to 2 years after surgery. Best distance-corrected and uncorrected VA were tested at distance (4 m, intermediate (80 and 60 cm and near (40 cm. A binocular defocus curve was collected with the subject’s best distance correction in place. The preferred reading distance was determined along with the VA at that distance. Low contrast VA at distance was also measured. Quality of vision was measured with the National Eye Institute Visual Function Questionnaire near subset and the Quality of Vision questionnaire.Results: Thirty subjects in each group were successfully recruited. The binocular defocus curves differed only at vergences of −1.0 D (FV better, P=0.02, −1.5 and −2.00 D (PX better, P<0.01 for both. Best distance-corrected and uncorrected binocular vision were significantly better for the PX lens at 60 cm (P<0.01 with no significant differences at other distances. The preferred reading distance was between 42 and 43 cm for both lenses, with the VA at the preferred reading distance slightly better with the PX lens (P=0.04. There were no statistically significant differences by lens for low contrast VA (P=0.1 or for quality of vision measures (P>0.3.Conclusion: Both trifocal lenses provided excellent distance, intermediate and near vision, but several measures indicated that the PX lens provided better intermediate vision at 60 cm. This may be important to users of tablets and other handheld devices. Quality of vision appeared similar between the two lens designs

  1. Significance of size dependent and material structure coupling on the characteristics and performance of nanocrystalline micro/nano gyroscopes

    Science.gov (United States)

    Larkin, K.; Ghommem, M.; Abdelkefi, A.

    2018-05-01

    Capacitive-based sensing microelectromechanical (MEMS) and nanoelectromechanical (NEMS) gyroscopes have significant advantages over conventional gyroscopes, such as low power consumption, batch fabrication, and possible integration with electronic circuits. However, inadequacies in the modeling of these inertial sensors have presented issues of reliability and functionality of micro-/nano-scale gyroscopes. In this work, a micromechanical model is developed to represent the unique microstructure of nanocrystalline materials and simulate the response of micro-/nano-gyroscope comprising an electrostatically-actuated cantilever beam with a tip mass at the free end. Couple stress and surface elasticity theories are integrated into the classical Euler-Bernoulli beam model in order to derive a size-dependent model. This model is then used to investigate the influence of size-dependent effects on the static pull-in instability, the natural frequencies and the performance output of gyroscopes as the scale decreases from micro-to nano-scale. The simulation results show significant changes in the static pull-in voltage and the natural frequency as the scale of the system is decreased. However, the differential frequency between the two vibration modes of the gyroscope is observed to drastically decrease as the size of the gyroscope is reduced. As such, the frequency-based operation mode may not be an efficient strategy for nano-gyroscopes. The results show that a strong coupling between the surface elasticity and material structure takes place when smaller grain sizes and higher void percentages are considered.

  2. Significant clinical impact and prognostic stratification provided by FDG-PET in the staging of oesophageal cancer

    International Nuclear Information System (INIS)

    Duong, Cuong P.; Demitriou, Helen; Thompson, Anne; Williams, David; Thomas, Robert J.S.; Weih, LeAnn; Hicks, Rodney J.

    2006-01-01

    To evaluate the clinical impact of FDG-PET in staging oesophageal cancer and whether this information improves prognostic stratification. Impact was based on comparison of a prospectively recorded pre-PET plan with post-PET treatment in 68 consecutive patients undergoing primary staging. Survival was analysed using the Kaplan-Meier product limit method and the Cox proportional hazards regression model. FDG-PET findings impacted on the management of 27/68 patients (40%): in 12 therapy was changed from curative to palliative and in three from palliative to curative, while in 12 other patients there was a change in the treatment modality or delivery but not in the treatment intent. The median survival was 21 months, with post-PET stage and treatment intent both strongly associated with survival (p<0.001). Conventional stage was not able to clearly stratify this population. The use of FDG-PET for primary staging of oesophageal cancer changed the clinical management of more than one-third of patients and provided superior prognostic stratification compared with conventional investigations. (orig.)

  3. Ventricular kinetic energy may provide a novel noninvasive way to assess ventricular performance in patients with repaired tetralogy of Fallot.

    Science.gov (United States)

    Jeong, Daniel; Anagnostopoulos, Petros V; Roldan-Alzate, Alejandro; Srinivasan, Shardha; Schiebler, Mark L; Wieben, Oliver; François, Christopher J

    2015-05-01

    Ventricular kinetic energy measurements may provide a novel imaging biomarker of declining ventricular efficiency in patients with repaired tetralogy of Fallot. Our purpose was to assess differences in ventricular kinetic energy with 4-dimensional flow magnetic resonance imaging between patients with repaired tetralogy of Fallot and healthy volunteers. Cardiac magnetic resonance, including 4-dimensional flow magnetic resonance imaging, was performed at rest in 10 subjects with repaired tetralogy of Fallot and 9 healthy volunteers using clinical 1.5T and 3T magnetic resonance imaging scanners. Right and left ventricular kinetic energy (KERV and KELV), main pulmonary artery flow (QMPA), and aortic flow (QAO) were quantified using 4-dimensional flow magnetic resonance imaging data. Right and left ventricular size and function were measured using standard cardiac magnetic resonance techniques. Differences in peak systolic KERV and KELV in addition to the QMPA/KERV and QAO/KELV ratios between groups were assessed. Kinetic energy indices were compared with conventional cardiac magnetic resonance parameters. Peak systolic KERV and KELV were higher in patients with repaired tetralogy of Fallot (6.06 ± 2.27 mJ and 3.55 ± 2.12 mJ, respectively) than in healthy volunteers (5.47 ± 2.52 mJ and 2.48 ± 0.75 mJ, respectively), but were not statistically significant (P = .65 and P = .47, respectively). The QMPA/KERV and QAO/KELV ratios were lower in patients with repaired tetralogy of Fallot (7.53 ± 5.37 mL/[cycle mJ] and 9.65 ± 6.61 mL/[cycle mJ], respectively) than in healthy volunteers (19.33 ± 18.52 mL/[cycle mJ] and 35.98 ± 7.66 mL/[cycle mJ], respectively; P tetralogy of Fallot. Quantification of ventricular kinetic energy in patients with repaired tetralogy of Fallot is a new observation. Future studies are needed to determine whether changes in ventricular kinetic energy can provide earlier evidence of ventricular dysfunction and guide future medical and

  4. ROLE AND SIGNIFICANCE OF STATEMENT OF OTHER COMPREHENSIVE INCOME– IN RESPECT OF REPORTING COMPANIES’ PERFORMANCE

    Directory of Open Access Journals (Sweden)

    Ildiko Orban

    2014-07-01

    Full Text Available A commonly accepted rule-system, which name was International Financial Reporting Standards (IFRS created the framework for represent the financial performace, and other facts related to the company’s health. In the system of IFRS profit is not equal to income less expenses, this deviation led to the other comprehensive income, OCI term. IFRS have created the term of other comprehensive income, but knowledge and using of it is not widespread. In this paper I tend to present the meaning and essence of this income category, and to reveal how it is work in corporate practice. As basis of the research, definitions and formats related to the statement of comprehensive income will be presented in the paper first. In order to get a clear picture about the differences between the income statements, I make a comparison of the IFRS and the Hungarian Accounting Act in the field of performance’s representation. As a result of my comparison I’ve stated that the EU accepted the international financial reporting standards to present the financial performance of publicly traded companies, and as EU member state it is obligatory for the Hungarian companies as well. This is the reason why Hungary’s present task is taking over the IFRS mentality. After the comparative analysis I’ve examined the Statement of other comprehensive income in the practice of 11 listed companies in the Budapest Stock Exchange. The Premium category includes those companies’ series of liquid shares, which has got broader investor base. The aim of this examination was to reveal if the most significant listed companies calculate other comprehensive income and what kind of items do they present in the statement of OCI. As a result of the research we can state that statement of other comprehensive income is part of the statement of total comprehensive income in general, and not an individual statement. Main items of the other comprehensive income of the examined companies are the

  5. 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

  6. 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

  7. 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 ...

  8. Creatine co-ingestion with carbohydrate or cinnamon extract provides no added benefit to anaerobic performance.

    Science.gov (United States)

    Islam, Hashim; Yorgason, Nick J; Hazell, Tom J

    2016-09-01

    The insulin response following carbohydrate ingestion enhances creatine transport into muscle. Cinnamon extract is promoted to have insulin-like effects, therefore this study examined if creatine co-ingestion with carbohydrates or cinnamon extract improved anaerobic capacity, muscular strength, and muscular endurance. Active young males (n = 25; 23.7 ± 2.5 y) were stratified into 3 groups: (1) creatine only (CRE); (2) creatine+ 70 g carbohydrate (CHO); or (3) creatine+ 500 mg cinnamon extract (CIN), based on anaerobic capacity (peak power·kg(-1)) and muscular strength at baseline. Three weeks of supplementation consisted of a 5 d loading phase (20 g/d) and a 16 d maintenance phase (5 g/d). Pre- and post-supplementation measures included a 30-s Wingate and a 30-s maximal running test (on a self-propelled treadmill) for anaerobic capacity. Muscular strength was measured as the one-repetition maximum 1-RM for chest, back, quadriceps, hamstrings, and leg press. Additional sets of the number of repetitions performed at 60% 1-RM until fatigue measured muscular endurance. All three groups significantly improved Wingate relative peak power (CRE: 15.4% P = .004; CHO: 14.6% P = .004; CIN: 15.7%, P = .003), and muscular strength for chest (CRE: 6.6% P creatine ingestion lead to similar changes in anaerobic power, strength, and endurance.

  9. An applicable approach for performance auditing in ERP

    Directory of Open Access Journals (Sweden)

    Wan Jian Guo

    2016-01-01

    Full Text Available This paper aims at the realistic problem of performance auditing in ERP environment. Traditional performance auditing methods and existing approaches for performance evaluation of ERP implementation could not work well, because they are either difficult to work or contains certain subjective elements. This paper proposed an applicable performance auditing approach for SAP ERP based on quantitative analysis. This approach consists of 3 parts which are system utilization, data quality and the effectiveness of system control. In each part, we provide the main process to conduct the operation, especially how to calculate the online settlement rate of SAP system. This approach has played an important role in the practical auditing work. A practical case is provided at the end of this paper to describe the effectiveness of this approach. Implementation of this approach also has some significance to the performance auditing of other ERP products.

  10. An international scorecard for measuring bank performance: The case of Dutch banks

    OpenAIRE

    J.W.B. Bos; J.A.J. Draulans; D. van den Kommer; B.A. Verhoef

    2006-01-01

    Measuring bank performance solely on the basis of profitability conveys significant information about past performance, but may provide little information about expectations for future performance. Therefore, this paper relies on a much broader definition of performance and introduces a scorecard where performance is measured on the basis of four performance criteria: (i) profitability; (ii) risk; (iii) market power, and (iv) efficiency. We use this scorecard to compare the performance of maj...

  11. Prevention of Surgical Fires: A Certification Course for Healthcare Providers.

    Science.gov (United States)

    Fisher, Marquessa

    2015-08-01

    An estimated 550 to 650 surgical fires occur annually in the United States. Surgical fires may have severe consequences, including burns, disfigurement, long-term medical care, or death. This article introduces a potential certification program for the prevention of surgical fires. A pilot study was conducted with a convenience sample of 10 anesthesia providers who participated in the education module. The overall objective was to educate surgical team members and to prepare them to become certified in surgical fire prevention. On completion of the education module, participants completed the 50-question certification examination. The mean pretest score was 66%; none of the participants had enough correct responses (85%) to be considered competent in surgical fire prevention. The mean post- test score was 92.80%, with all participants answering at least 85% of questions correct. A paired-samples t test showed a statistically significant increase in knowledge: t (df = 9) = 11.40; P = .001. Results of the pilot study indicate that this course can remediate gaps in knowledge of surgical fire prevention for providers. Their poor performance on the pretest suggests that many providers may not receive sufficient instruction in surgical fire prevention.

  12. How does information congruence influence diagnosis performance?

    Science.gov (United States)

    Chen, Kejin; Li, Zhizhong

    2015-01-01

    Diagnosis performance is critical for the safety of high-consequence industrial systems. It depends highly on the information provided, perceived, interpreted and integrated by operators. This article examines the influence of information congruence (congruent information vs. conflicting information vs. missing information) and its interaction with time pressure (high vs. low) on diagnosis performance on a simulated platform. The experimental results reveal that the participants confronted with conflicting information spent significantly more time generating correct hypotheses and rated the results with lower probability values than when confronted with the other two levels of information congruence and were more prone to arrive at a wrong diagnosis result than when they were provided with congruent information. This finding stresses the importance of the proper processing of non-congruent information in safety-critical systems. Time pressure significantly influenced display switching frequency and completion time. This result indicates the decisive role of time pressure. Practitioner Summary: This article examines the influence of information congruence and its interaction with time pressure on human diagnosis performance on a simulated platform. For complex systems in the process control industry, the results stress the importance of the proper processing of non-congruent information in safety-critical systems.

  13. THE EFFECT OF MOTIVATION ON PURCHASING INTENTION OF ONLINE GAMES AND VIRTUAL ITEMS PROVIDED BY ONLINE GAME PROVIDER

    Directory of Open Access Journals (Sweden)

    Sisca Stefany

    2014-05-01

    Full Text Available The development of online games is so high that leads many companies to compose games. To increase competitiveness, extra service is needed for the customers. Before giving service, online games provider has to know what factor that motivates player to buy online games and virtual items that are presented in order to increase competitiveness. The research is done by using case of online games perfect world, where the area of respondents is Jakarta and the age ranges between 15 to 24. This research involves survey for 186 respondents in which 30 respondents are for pilot test while 156 are for actual test. The data processing is used SEM which the measurement variables consist of effort expectancy, performance expectancy, perceived value, enjoyment story, enjoyment length, enjoyment graphic, enjoyment control, customization, purchase intention and actual purchase behavior. The result of research shows that motivation factor that has high effect to purchase intention is perceived value, enjoyment story, enjoyment length, enjoyment control and customization. While, purchase intention affects actual purchase behavior significantly

  14. Health Providers' Counselling of Caregivers in the Integrated ...

    African Journals Online (AJOL)

    Results: Health providers performed well in assessing the child's problem (85%); listening (100%); use of simple language (95%); use of kind tone of voice (99%); showing interest in caregivers (99%); giving feeding ... Keywords: Child, preschool; infant; health-provider; caregiver; counselling; IMCI-counselling; Uganda

  15. Performance Characteristics of CA 19-9 Radioimmunoassay and Clinical Significance of Serum CA 19-9 Assay in Patients with Malignancy

    International Nuclear Information System (INIS)

    Kim, Sang Eun; Shong, Young Kee; Cho, Bo Youn; Kim, Noe Kyeong; Koh, Chang Soon; Lee, Mun Ho; Hong, Seong Woon; Hong, Kee Suk

    1985-01-01

    To evaluate the performance characteristics of CA 19-9 radioimmunoassay and the clinical significance of serum CA 19-9 assay in patients with malignancy, serum. CA 19-9 levels were measured by radioimmunoassay using monoclonal antibody in 135 normal controls, 81 patients with various untreated malignancy, 9 patients of postoperative colon cancer without recurrence and 20 patients with benign gastrointestinal diseases, who visited Seoul National University Hospital from June, 1984 to March, 1985. The results were as follows; 1) The CA 19-9 radioimmunoassay was simple to perform and can be completed in one work day. And the between-assay reproducibility and the assay recovery were both excellent. 2) The mean serum CA 19-9 level in 135 normal controls was 8.4±4.2 U/mL. Normal upper limit of serum CA 19-9 was defined as 21.0 U/mL. 4 out of 135 (3.0%) normal controls showed elevated CA 19-9 levels above the normal upper limit. 3) One out of 20 (5.0%) patients with benign gastrointestinal diseases showed elevated serum CA 19-9 level above the normal upper limit. 4) In 81 patients with various untreated malignancy, 41 patients (50.6%) showed elevated serum CA 19-9 levels. 66.7% of 18 patients with colorectal cancer, 100% of 2 patients with pancreatic cancer, 100% of 3 patients with common bile duct cancer, 47.1% of 17 patients with stomach cancer, 28.6% of 28 patients with hepatoma and 60.0% of 5 gastrointestinal tract cancers showed elevated serum CA 19-9 levels. 5) The sensitivities of serum CA 19-9 related to respectability in colorectal and stomach cancer were 33.3% in resectable colorectal cancer, 83.3% in unresectable colorectal cancer, 41.7% in resectable stomach cancer, 60.0% in unresectable stomach cancer respectively. 6) The sensitivity of serum CA 19-9 in 9 patients of postoperative colorectal cancer without recurrence were 33.3% and significantly decreased compared with that of untreated colorectal cancer, 66.7% (p<0.05). 7) In Patients with colorectal cancer

  16. Accuracy of Referring Provider and Endoscopist Impressions of Colonoscopy Indication.

    Science.gov (United States)

    Naveed, Mariam; Clary, Meredith; Ahn, Chul; Kubiliun, Nisa; Agrawal, Deepak; Cryer, Byron; Murphy, Caitlin; Singal, Amit G

    2017-07-01

    Background: Referring provider and endoscopist impressions of colonoscopy indication are used for clinical care, reimbursement, and quality reporting decisions; however, the accuracy of these impressions is unknown. This study assessed the sensitivity, specificity, positive and negative predictive value, and overall accuracy of methods to classify colonoscopy indication, including referring provider impression, endoscopist impression, and administrative algorithm compared with gold standard chart review. Methods: We randomly sampled 400 patients undergoing a colonoscopy at a Veterans Affairs health system between January 2010 and December 2010. Referring provider and endoscopist impressions of colonoscopy indication were compared with gold-standard chart review. Indications were classified into 4 mutually exclusive categories: diagnostic, surveillance, high-risk screening, or average-risk screening. Results: Of 400 colonoscopies, 26% were performed for average-risk screening, 7% for high-risk screening, 26% for surveillance, and 41% for diagnostic indications. Accuracy of referring provider and endoscopist impressions of colonoscopy indication were 87% and 84%, respectively, which were significantly higher than that of the administrative algorithm (45%; P 90%) for determining screening (vs nonscreening) indication, but specificity of the administrative algorithm was lower (40.3%) compared with referring provider (93.7%) and endoscopist (84.0%) impressions. Accuracy of endoscopist, but not referring provider, impression was lower in patients with a family history of colon cancer than in those without (65% vs 84%; P =.001). Conclusions: Referring provider and endoscopist impressions of colonoscopy indication are both accurate and may be useful data to incorporate into algorithms classifying colonoscopy indication. Copyright © 2017 by the National Comprehensive Cancer Network.

  17. The effect of interprofessional education on interprofessional performance and diabetes care knowledge of health care teams at the level one of health service providing

    Directory of Open Access Journals (Sweden)

    Nikoo Yamani

    2014-01-01

    Conclusion: It seems that inter-professional education can improve the quality of health care to some extent through influencing knowledge and collaborative performance of health care teams. It also can make the health-related messages provided to the covered population more consistent in addition to enhancing self-confidence of the personnel.

  18. Accounting for Marketing: Marketing Performance Through Financial Results

    OpenAIRE

    Levent KOSAN

    2014-01-01

    Accounting, especially strategic management accounting, provides significant contributions to companies for decisions in environments of intense competition. Accounting, which has positive effects of company strategy development and management, has become a required facet of marketing, another area that has gained significance. The aim of this study is to assess the contributions of accounting to marketing performance management and other areas related to marketing development and to evaluate...

  19. [Significance of the doctorate in scientific medical education].

    Science.gov (United States)

    Frosch, Matthias

    2018-02-01

    According to European and German law, the medical education of physicians must take place in a scientific degree program at a university or under the supervision of a university. To keep up the ideal of a scientific degree program, various organizations and associations, such as the German Research Foundation, the German Council of Science and Humanities and the German Medical Faculty Association, see the need for an even stronger anchoring of academic learning content in the course of study. Traditionally, a scientific project, which is carried out during the studies, provides the basis for the Doctor of Medicine (Dr. med.) after graduation, although the research projects as a basis for medical degrees are currently not obligatory parts of the curricula. The number of medical students performing such research projects is significantly decreasing, thus they are missing major skills for working in science. To counteract these developments, faculties of medicine are currently developing model curricula including deepened scientific education. Despite these efforts, the German Association of Faculties of Medicine argues that the performance of research projects leading to the doctoral degree is most suitable for obtaining expertise in scientific work. According to recommendations by the German Council of Science on the requirements for quality assurance of graduation doctoral degree programs have been introduced. This and further measures, like MD/PhD programs or research-based additional study programs serving the scientific qualification of medical students, are the subject of this article.

  20. Factors associated with contingency management adoption among opioid treatment providers receiving a comprehensive implementation strategy.

    Science.gov (United States)

    Becker, Sara J; Kelly, Lourah M; Kang, Augustine W; Escobar, Katherine I; Squires, Daniel D

    2018-03-29

    Contingency management (CM) is an evidence-based behavioral intervention for opioid use disorders (OUDs); however, CM adoption in OUD treatment centers remains low due to barriers at patient, provider, and organizational levels. In a recent trial, OUD treatment providers who received the Science to Service Laboratory (SSL), a multilevel implementation strategy developed by a federally funded addiction training center, had significantly greater odds of CM adoption than providers who received training as usual. This study examined whether CM adoption frequency varied as a function of provider sociodemographic characteristics (i.e., age, race/ethnicity, licensure) and perceived barriers to adoption (i.e., patient-, provider-, organization-level) among providers receiving the SSL in an opioid treatment program. Thirty-nine providers (67% female, 77% non-Hispanic white, 72% with specialty licensure, M age = 42 [SD = 11.46]) received the SSL, which consisted of didactic training, performance feedback, specialized training of internal change champions, and external coaching. Providers completed a comprehensive baseline assessment and reported on their adoption of CM biweekly for 52 weeks. Providers reported using CM an average of nine 2-week intervals (SD = 6.35). Hierarchical multiple regression found that providers identifying as younger, non-Hispanic white, and without addiction-related licensure all had higher levels of CM adoption frequency. Higher perceived patient-level barriers predicted lower levels of CM adoption frequency, whereas provider- and organization-level barriers were not significant predictors. The significant effect of age on CM adoption frequency was consistent with prior research on predictors of evidence-based practice adoption, whereas the effect of licensure was counter to prior research. The finding that CM adoption frequency was lower among racially/ethnically diverse providers was not expected and suggests that the SSL may require adaptation

  1. The Significance of Privacy and Trust in Providing Health-Related Services to Behaviorally Bisexual Men in the United States

    Science.gov (United States)

    Dodge, Brian; Schnarrs, Phillip W.; Goncalves, Gabriel; Malebranche, David; Martinez, Omar; Reece, Michael; Rhodes, Scott D.; Van Der Pol, Barbara; Nix, Ryan; Fortenberry, J. Dennis

    2012-01-01

    Previous research suggests that bisexual men face unique health concerns in comparison to their exclusively homosexual and heterosexual counterparts. However, little is known about behaviorally bisexual men's experiences with health services, including ways of providing services that would be most appropriate to meet the health needs of this…

  2. HYPERBARIC OXYGENATION AND AEROBIC PERFORMANCE

    Directory of Open Access Journals (Sweden)

    Irvine D. Prather

    2004-03-01

    Full Text Available The continuing desire to improve performance, particularly at the national and international levels, has led to the use of ergogenic aids. Ergogenic aids are defined as 'a procedure or agent that provides the athlete with a competitive edge beyond that obtained via normal training methods'. Random drug testing has been implemented in an effort to minimize an athlete's ability to gain an unfair advantage. However, other means of improving performance have been tried. Blood doping has been used to enhance endurance performance by improving oxygen delivery to working muscles. As oxygen is carried in combination with the hemoglobin, it seems logical that increasing the number of red blood cells (RBC's in the body would increase the oxygen carrying capacity to the tissues and result in improved performance. The first experiments of removing and then reinfusing blood showed a significant improvement in performance time

  3. Student-Led Project Teams: Significance of Regulation Strategies in High- and Low-Performing Teams

    Science.gov (United States)

    Ainsworth, Judith

    2016-01-01

    We studied group and individual co-regulatory and self-regulatory strategies of self-managed student project teams using data from intragroup peer evaluations and a postproject survey. We found that high team performers shared their research and knowledge with others, collaborated to advise and give constructive criticism, and demonstrated moral…

  4. Evaluation of the Metered-Dose Inhaler Technique among Health Care Providers Practicing in Hamadan University of Medical Sciences

    Directory of Open Access Journals (Sweden)

    E. Nadi

    2004-07-01

    Full Text Available Poor inhaler technique is a common problem both in asthma patients and health care providers , which contributes to poor asthma control. The aim of this study was to evaluate the correctness of metered-dose inhaler (MDI technique in a sample of physicians , pharmacists and nurses practicing in Hamadan University hospitals. A total of 176 healthcare providers (35 internists and general physicians , 138 nurses and 3 pharmacists were participated voluntary in this study. After the participants answered a questionnaire aimed at identifying their involvement in MDI prescribing and counseling , a trained observer assessed their MDI technique using a checklist of ten steps.Of the 176 participants , 35(20% were physician , and 3 subjects (2% were pharmacists , and 138 (78% were nurses. However only 6 participants (3.4% performed all steps correctly. Physicians performed significantly better than non-physicians (8.6% vs. 2.13%.The majority of healthcare providers responsible for instructing patients on the correct MDI technique were unable to perform this technique correctly ‘indicating the need for regular formal training programmes on inhaler techniques.

  5. Primary HPV testing recommendations of US providers, 2015.

    Science.gov (United States)

    Cooper, Crystale Purvis; Saraiya, Mona

    2017-12-01

    To investigate the HPV testing recommendations of US physicians who perform cervical cancer screening. Data from the 2015 DocStyles survey of U.S. health care providers were analyzed using multivariate logistic regression to identify provider characteristics associated with routine recommendation of primary HPV testing for average-risk, asymptomatic women ≥30years old. The analysis was limited to primary care physicians and obstetrician-gynecologists who performed cervical cancer screening (N=843). Primary HPV testing for average-risk, asymptomatic women ≥30years old was recommended by 40.8% of physicians who performed cervical cancer screening, and 90.1% of these providers recommended primary HPV testing for women of all ages. The screening intervals most commonly recommended for primary HPV testing with average-risk, asymptomatic women ≥30years old were every 3years (35.5%) and annually (30.2%). Physicians who reported that patient HPV vaccination status influenced their cervical cancer screening practices were almost four times more likely to recommend primary HPV testing for average-risk, asymptomatic women ≥30years old than other providers (Adj OR=3.96, 95% CI=2.82-5.57). Many US physicians recommended primary HPV testing for women of all ages, contrary to guidelines which limit this screening approach to women ≥25years old. The association between provider recommendation of primary HPV testing and patient HPV vaccination status may be due to anticipated reductions in the most oncogenic HPV types among vaccinated women. Published by Elsevier Inc.

  6. Applying the balanced scorecard in healthcare provider organizations.

    Science.gov (United States)

    Inamdar, Noorein; Kaplan, Robert S; Bower, Marvin

    2002-01-01

    Several innovative healthcare executives have recently introduced a new business strategy implementation tool: the Balanced Scorecard. The scorecard's measurement and management system provides the following potential benefits to healthcare organizations: It aligns the organization around a more market-oriented, customer-focused strategy It facilitates, monitors, and assesses the implementation of the strategy It provides a communication and collaboration mechanism It assigns accountability for performance at all levels of the organization It provides continual feedback on the strategy and promotes adjustments to marketplace and regulatory changes. We surveyed executives in nine provider organizations that were implementing the Balanced Scorecard. We asked about the following issues relating to its implementation and effect: 1. The role of the Balanced Scorecard in relation to a well-defined vision, mission, and strategy 2. The motivation for adopting the Balanced Scorecard 3. The difference between the Balanced Scorecard and other measurement systems 4. The process followed to develop and implement the Balanced Scorecard 5. The challenges and barriers during the development and implementation process 6. The benefits gained by the organization from adoption and use. The executives reported that the Balanced Scorecard strategy implementation and performance management tool could be successfully applied in the healthcare sector, enabling organizations to improve their competitive market positioning, financial results, and customer satisfaction. This article concludes with guidelines for other healthcare provider organizations to capture the benefits of the Balanced Scorecard performance management system.

  7. Constraints on muscle performance provide a novel explanation for the scaling of posture in terrestrial animals.

    Science.gov (United States)

    Usherwood, James R

    2013-08-23

    Larger terrestrial animals tend to support their weight with more upright limbs. This makes structural sense, reducing the loading on muscles and bones, which is disproportionately challenging in larger animals. However, it does not account for why smaller animals are more crouched; instead, they could enjoy relatively more slender supporting structures or higher safety factors. Here, an alternative account for the scaling of posture is proposed, with close parallels to the scaling of jump performance. If the costs of locomotion are related to the volume of active muscle, and the active muscle volume required depends on both the work and the power demanded during the push-off phase of each step (not just the net positive work), then the disproportional scaling of requirements for work and push-off power are revealing. Larger animals require relatively greater active muscle volumes for dynamically similar gaits (e.g. top walking speed)-which may present an ultimate constraint to the size of running animals. Further, just as for jumping, animals with shorter legs and briefer push-off periods are challenged to provide the power (not the work) required for push-off. This can be ameliorated by having relatively long push-off periods, potentially accounting for the crouched stance of small animals.

  8. Predictors of early stable symptomatic remission after an exacerbation of schizophrenia: the significance of symptoms, neuropsychological performance and cognitive biases.

    Science.gov (United States)

    Andreou, Christina; Roesch-Ely, Daniela; Veckenstedt, Ruth; Bohn, Francesca; Aghotor, Julia; Köther, Ulf; Pfueller, Ute; Moritz, Steffen

    2013-12-30

    Neuropsychological deficits and severity of initial psychopathology have been repeatedly associated with poor symptomatic outcomes in schizophrenia. The role of higher-order cognitive biases on symptomatic outcomes of the disorder has not yet been investigated. The present study aimed to assess the contribution of cognitive biases, psychopathology and neuropsychological deficits on the probability of achieving early symptomatic remission after a psychotic episode in patients with schizophrenia. Participants were 79 patients with a DSM-IV diagnosis of schizophrenia or schizoaffective disorder undergoing an acute psychotic episode, and 25 healthy controls. According to psychopathology assessments, patients were split into those who had achieved remission after an average follow-up interval of 7 months, and those who had not (NR). Patients who achieved remission exhibited higher premorbid IQ and better performance on the TMT-B, as well as lower baseline positive, disorganized and distress symptoms than NR patients. TMT-B performance and positive symptoms at baseline were the best predictors of remission. Cognitive biases and negative symptoms were not associated with later remission. The findings highlight the significance of initial symptom severity for at least short-term symptomatic outcomes and, thus, the importance of adequate symptomatic treatment and prevention of psychotic outbreaks in patients. © 2013 Elsevier Ireland Ltd. All rights reserved.

  9. A significant-loophole-free test of Bell's theorem with entangled photons

    Science.gov (United States)

    Giustina, Marissa; Versteegh, Marijn A. M.; Wengerowsky, Sören; Handsteiner, Johannes; Hochrainer, Armin; Phelan, Kevin; Steinlechner, Fabian; Kofler, Johannes; Larsson, Jan-Åke; Abellán, Carlos; Amaya, Waldimar; Mitchell, Morgan W.; Beyer, Jörn; Gerrits, Thomas; Lita, Adriana E.; Shalm, Lynden K.; Nam, Sae Woo; Scheidl, Thomas; Ursin, Rupert; Wittmann, Bernhard; Zeilinger, Anton

    2017-10-01

    John Bell's theorem of 1964 states that local elements of physical reality, existing independent of measurement, are inconsistent with the predictions of quantum mechanics (Bell, J. S. (1964), Physics (College. Park. Md). Specifically, correlations between measurement results from distant entangled systems would be smaller than predicted by quantum physics. This is expressed in Bell's inequalities. Employing modifications of Bell's inequalities, many experiments have been performed that convincingly support the quantum predictions. Yet, all experiments rely on assumptions, which provide loopholes for a local realist explanation of the measurement. Here we report an experiment with polarization-entangled photons that simultaneously closes the most significant of these loopholes. We use a highly efficient source of entangled photons, distributed these over a distance of 58.5 meters, and implemented rapid random setting generation and high-efficiency detection to observe a violation of a Bell inequality with high statistical significance. The merely statistical probability of our results to occur under local realism is less than 3.74×10-31, corresponding to an 11.5 standard deviation effect.

  10. Assessing the Financial Condition of Provider-Sponsored Health Plans.

    Science.gov (United States)

    McCue, Michael J

    2015-06-01

    The aim of this study was to assess the performance of health plans sponsored by provider organizations, with respect to plans generating strong positive cash flow relative to plans generating weaker cash flow. A secondary aim was to assess their capital adequacy. The study identified 24 provider-sponsored health plans (PSHPs) with an average positive cash flow margin from 2011 through 2013 at or above the top 75th percentile, defined as "strong cash flow PSHPs:" This group was compared with 72 PSHPs below the 75th percentile, defined as "weak cash flow PSHPs:" Atlantic Information Services Directory of Health Plans was used to identify the PSHPs. Financial ratios were computed from 2013 National Association of Insurance Commissioners Financial Filings. The study conducted a t test mean comparison between strong and weak cash flow PSHPs across an array of financial performance and capital adequacy measures. In 2013, the strong cash flow PSHPs averaged a cash-flow margin ratio of 6.6%. Weak cash flow PSHPs averaged a cash-flow margin of -0.4%. The net worth capital position of both groups was more than 4.5 times authorized capital. The operational analysis shows that strong cash-flow margin PSHPs are managing their medical costs to achieve this position. Although their medical loss ratio increased by almost 300 basis points from 2011 to 2013, it was still statistically significantly lower than the weaker cash flow PSHP group (P<.001). In terms of capital adequacy, both strong and weak cash-flow margin PSHP groups possessed sufficient capital to ensure the viability of these plans.

  11. Olympic weightlifting and plyometric training with children provides similar or greater performance improvements than traditional resistance training.

    Science.gov (United States)

    Chaouachi, Anis; Hammami, Raouf; Kaabi, Sofiene; Chamari, Karim; Drinkwater, Eric J; Behm, David G

    2014-06-01

    A number of organizations recommend that advanced resistance training (RT) techniques can be implemented with children. The objective of this study was to evaluate the effectiveness of Olympic-style weightlifting (OWL), plyometrics, and traditional RT programs with children. Sixty-three children (10-12 years) were randomly allocated to a 12-week control OWL, plyometric, or traditional RT program. Pre- and post-training tests included body mass index (BMI), sum of skinfolds, countermovement jump (CMJ), horizontal jump, balance, 5- and 20-m sprint times, isokinetic force and power at 60 and 300° · s(-1). Magnitude-based inferences were used to analyze the likelihood of an effect having a standardized (Cohen's) effect size exceeding 0.20. All interventions were generally superior to the control group. Olympic weightlifting was >80% likely to provide substantially better improvements than plyometric training for CMJ, horizontal jump, and 5- and 20-m sprint times, whereas >75% likely to substantially exceed traditional RT for balance and isokinetic power at 300° · s(-1). Plyometric training was >78% likely to elicit substantially better training adaptations than traditional RT for balance, isokinetic force at 60 and 300° · s(-1), isokinetic power at 300° · s(-1), and 5- and 20-m sprints. Traditional RT only exceeded plyometric training for BMI and isokinetic power at 60° · s(-1). Hence, OWL and plyometrics can provide similar or greater performance adaptations for children. It is recommended that any of the 3 training modalities can be implemented under professional supervision with proper training progressions to enhance training adaptations in children.

  12. Liver stiffness measurement-based scoring system for significant inflammation related to chronic hepatitis B.

    Directory of Open Access Journals (Sweden)

    Mei-Zhu Hong

    Full Text Available Liver biopsy is indispensable because liver stiffness measurement alone cannot provide information on intrahepatic inflammation. However, the presence of fibrosis highly correlates with inflammation. We constructed a noninvasive model to determine significant inflammation in chronic hepatitis B patients by using liver stiffness measurement and serum markers.The training set included chronic hepatitis B patients (n = 327, and the validation set included 106 patients; liver biopsies were performed, liver histology was scored, and serum markers were investigated. All patients underwent liver stiffness measurement.An inflammation activity scoring system for significant inflammation was constructed. In the training set, the area under the curve, sensitivity, and specificity of the fibrosis-based activity score were 0.964, 91.9%, and 90.8% in the HBeAg(+ patients and 0.978, 85.0%, and 94.0% in the HBeAg(- patients, respectively. In the validation set, the area under the curve, sensitivity, and specificity of the fibrosis-based activity score were 0.971, 90.5%, and 92.5% in the HBeAg(+ patients and 0.977, 95.2%, and 95.8% in the HBeAg(- patients. The liver stiffness measurement-based activity score was comparable to that of the fibrosis-based activity score in both HBeAg(+ and HBeAg(- patients for recognizing significant inflammation (G ≥3.Significant inflammation can be accurately predicted by this novel method. The liver stiffness measurement-based scoring system can be used without the aid of computers and provides a noninvasive alternative for the prediction of chronic hepatitis B-related significant inflammation.

  13. Alternate-Fueled Combustor-Sector Performance: Part A: Combustor Performance Part B: Combustor Emissions

    Science.gov (United States)

    Shouse, D. T.; Neuroth, C.; Henricks, R. C.; Lynch, A.; Frayne, C.; Stutrud, J. S.; Corporan, E.; Hankins, T.

    2010-01-01

    Alternate aviation fuels for military or commercial use are required to satisfy MIL-DTL-83133F(2008) or ASTM D 7566 (2010) standards, respectively, and are classified as drop-in fuel replacements. To satisfy legacy issues, blends to 50% alternate fuel with petroleum fuels are certified individually on the basis of feedstock. Adherence to alternate fuels and fuel blends requires smart fueling systems or advanced fuel-flexible systems, including combustors and engines without significant sacrifice in performance or emissions requirements. This paper provides preliminary performance (Part A) and emissions and particulates (Part B) combustor sector data for synthetic-parafinic-kerosene- (SPK-) type fuel and blends with JP-8+100 relative to JP-8+100 as baseline fueling.

  14. Individual Performance Management: A Review of Current Practices

    Directory of Open Access Journals (Sweden)

    Ian O’ Boyle

    2013-05-01

    Full Text Available This paper provides a review of current practice in relation to individual performance management systems and process within the traditional business environment. There is a consensus that the role of the individual is central to the overall performance of any organization and how individual performances are managed and evaluated can have significant impacts on overall organizational success. Many organizations employ the traditional performance appraisal in order to monitor and assess individual employee performances. However, new approaches, such as 360-degree feedback have also become commonplace within the business environment. An analysis of each approach including benefits and challenges associated with each process is presented within this paper.

  15. Evidence That Bimanual Motor Timing Performance Is Not a Significant Factor in Developmental Stuttering

    Science.gov (United States)

    Hilger, Allison I.; Zelaznik, Howard; Smith, Anne

    2016-01-01

    Purpose: Stuttering involves a breakdown in the speech motor system. We address whether stuttering in its early stage is specific to the speech motor system or whether its impact is observable across motor systems. Method: As an extension of Olander, Smith, and Zelaznik (2010), we measured bimanual motor timing performance in 115 children: 70…

  16. Improving Physical Task Performance with Counterfactual and Prefactual Thinking.

    Science.gov (United States)

    Hammell, Cecilia; Chan, Amy Y C

    2016-01-01

    Counterfactual thinking (reflecting on "what might have been") has been shown to enhance future performance by translating information about past mistakes into plans for future action. Prefactual thinking (imagining "what might be if…") may serve a greater preparative function than counterfactual thinking as it is future-orientated and focuses on more controllable features, thus providing a practical script to prime future behaviour. However, whether or not this difference in hypothetical thought content may translate into a difference in actual task performance has been largely unexamined. In Experiment 1 (n = 42), participants performed trials of a computer-simulated physical task, in between which they engaged in either task-related hypothetical thinking (counterfactual or prefactual) or an unrelated filler task (control). As hypothesised, prefactuals contained more controllable features than counterfactuals. Moreover, participants who engaged in either form of hypothetical thinking improved significantly in task performance over trials compared to participants in the control group. The difference in thought content between counterfactuals and prefactuals, however, did not yield a significant difference in performance improvement. Experiment 2 (n = 42) replicated these findings in a dynamic balance task environment. Together, these findings provide further evidence for the preparatory function of counterfactuals, and demonstrate that prefactuals share this same functional characteristic.

  17. Causes of Low-Skilled Workers’ Performance in Construction Projects

    Directory of Open Access Journals (Sweden)

    Alhaji Ali Zannah

    2017-06-01

    Full Text Available Skilled workers’ performance is one of the crucial aspects of labour productivity that requires proper attention for effective projects delivery in the construction industry. The level of skilled workers’ low performance has been seen to be a major factor which contributes toward inefficient construction projects productivity. Therefore, the objective of this research is to identify the causes of low-skilled workers’ performance in construction projects in the Nigeria. The objective was achieved through a structured quantitative method of questionnaire distributed to 150 respondents that comprise of active stakeholders in the Nigerian construction industry. 111 responses representing 74 % were retrieved. The data were analysed using descriptive statistics and analysis of variance (ANOVA. The finding shows that; low wages of skilled, lack of sufficient skill acquisition centres and lack of incentive schemes for skilled workers were the most significant causes of low-skilled workers’ performance in the Nigerian construction industry. The homogenous analysis indicates that there are significant differences in perception of respondents on few variables whereas majority of respondents have similarities in most of the variables. The research findings indicate the need for stakeholders in the Nigerian construction industry to provide incentives and motivate skilled workers, provide training and retraining, conducive working condition, supply of quality materials and equipment, and proper site management in order improve low-skilled workers’ performance in Nigerian construction industry towards optimal performance.

  18. High performance separation of lanthanides and actinides

    International Nuclear Information System (INIS)

    Sivaraman, N.; Vasudeva Rao, P.R.

    2011-01-01

    The major advantage of High Performance Liquid Chromatography (HPLC) is its ability to provide rapid and high performance separations. It is evident from Van Deemter curve for particle size versus resolution that packing materials with particle sizes less than 2 μm provide better resolution for high speed separations and resolving complex mixtures compared to 5 μm based supports. In the recent past, chromatographic support material using monolith has been studied extensively at our laboratory. Monolith column consists of single piece of porous, rigid material containing mesopores and micropores, which provide fast analyte mass transfer. Monolith support provides significantly higher separation efficiency than particle-packed columns. A clear advantage of monolith is that it could be operated at higher flow rates but with lower back pressure. Higher operating flow rate results in higher column permeability, which drastically reduces analysis time and provides high separation efficiency. The above developed fast separation methods were applied to assay the lanthanides and actinides from the dissolver solutions of nuclear reactor fuels

  19. Statistical and Machine Learning Models to Predict Programming Performance

    OpenAIRE

    Bergin, Susan

    2006-01-01

    This thesis details a longitudinal study on factors that influence introductory programming success and on the development of machine learning models to predict incoming student performance. Although numerous studies have developed models to predict programming success, the models struggled to achieve high accuracy in predicting the likely performance of incoming students. Our approach overcomes this by providing a machine learning technique, using a set of three significant...

  20. INDONESIA PUBLIC BANKS PERFORMANCE EVALUATION USING FUZZY LOGIC

    Directory of Open Access Journals (Sweden)

    Sugiarto Sugiarto

    2016-10-01

    Full Text Available Return on Asset (ROA is a variable that has the greatest ability in predicting public banks stock prices in Indonesia. The coefficient of determination of ROA on public banks stock prices in Indonesia reached 54.8%. ROA has a significant positive influence on public bank stock prices in Indonesia. Fuzzy logic process on the performance of the 15 public banks in Indonesia have been carried out using the data of ROA for the period 2010 up to 2013. Bank reference performance according to ROA is based on Bank Indonesia Letter No. 6 / 23DPNP / 2011. The performance of each bank was analyzed by conventional methods and as a comparison used fuzzy logic. The evaluation with fuzzy logic method able to provide added value to the currently enforced performance evaluation method. There is significant difference in conclusion between the determination of fuzzy logic models and conventional method

  1. Board of directors’ composition and performance in French CAC 40 listed firms

    Directory of Open Access Journals (Sweden)

    Ali Ahmadi

    2017-11-01

    Full Text Available Reflecting investor expectations, most prior corporate governance research attempt to find a relationship between boards of directors’ composition and firm financial performance. Specifically, we try to examine the relationship between the boards’ size, board independence, CEO duality and gender diversity and two measurements of performance in listed companies in CAC 40, namely return on assets (ROA and return of equities (ROE. We found evidence provide that board characteristics were positively correlated to the firm’ performance. However, our results show a significant association between ROE, ROA and the board of directors’ composition. We find significant negative association between financial information and equity-based management compensation. On the other hand, the presence of independent directors on the board seems to affect, positively, the level of financial performance of CAC 40 firms. Likewise, the stewardship theory assumption, the CEO duality is very high and is significantly associated with a higher level of firm performance. The results show that there was a significant relationship between board gender diversity and firm performance from our samples CAC 40 companies. In addition, we find significant negative impact of leverage on the financial performance for CAC 40 firms.

  2. Testing Significance Testing

    Directory of Open Access Journals (Sweden)

    Joachim I. Krueger

    2018-04-01

    Full Text Available The practice of Significance Testing (ST remains widespread in psychological science despite continual criticism of its flaws and abuses. Using simulation experiments, we address four concerns about ST and for two of these we compare ST’s performance with prominent alternatives. We find the following: First, the 'p' values delivered by ST predict the posterior probability of the tested hypothesis well under many research conditions. Second, low 'p' values support inductive inferences because they are most likely to occur when the tested hypothesis is false. Third, 'p' values track likelihood ratios without raising the uncertainties of relative inference. Fourth, 'p' values predict the replicability of research findings better than confidence intervals do. Given these results, we conclude that 'p' values may be used judiciously as a heuristic tool for inductive inference. Yet, 'p' values cannot bear the full burden of inference. We encourage researchers to be flexible in their selection and use of statistical methods.

  3. Analysis of business process maturity and organisational performance relations

    Directory of Open Access Journals (Sweden)

    Kalinowski T. Bartosz

    2016-12-01

    Full Text Available The paper aims to present results of the study on business process maturity in relation to organisational performance. A two-phase methodology, based on literature review and survey was used. The literature is a source of knowledge about business process maturity and organisational performance, whereas the research on process maturity vs organisational performance in Polish Enterprises provides findings based on 84 surveyed companies. The main areas of the research covered: identification and analysis of maturity related variables and identification of organisational performance perspectives and its relation to process maturity. The study shows that there is a significant positive relation between process maturity and organisational performance. Although there are research on such relation available, they are scarce and have some significant limitations in terms of research sample or the scope of maturity or organisational performance covered. This publication is part of a project funded by the National Science Centre awarded by decision number DEC-2011/01/D/HS4/04070.

  4. The Significance of a Body in Contemporary Arts

    Directory of Open Access Journals (Sweden)

    Emmanouela Vogiatzaki

    2016-04-01

    Full Text Available This paper discusses the role and significance of a body in Performance Art. Considering that Art reflects social, cultural and sometimes political realities, we identify types of messages that an artwork using advanced technological might transmit to us, spectators or artists. This paper focusses on the Cyborg Theatre, whereby the technology is its inherent element without which the performance could not happen. Such a technological performance cannot occur without a body. We refer here to a cyborg body as a human organism extended with mechanical parts, which integrate non organic components in order to gain meaning within the artwork. By focusing on such a theatrical performance, we observe a relationship developing between the performer and the spectator. This is an unusual interaction, which deserves our attention. We claim that both the performer and the spectator take part in a social event that does not only represent societal realities, but also indicates future ones.

  5. Roles and methods of performance evaluation of hospital academic leadership.

    Science.gov (United States)

    Zhou, Ying; Yuan, Huikang; Li, Yang; Zhao, Xia; Yi, Lihua

    2016-01-01

    The rapidly advancing implementation of public hospital reform urgently requires the identification and classification of a pool of exceptional medical specialists, corresponding with incentives to attract and retain them, providing a nucleus of distinguished expertise to ensure public hospital preeminence. This paper examines the significance of academic leadership, from a strategic management perspective, including various tools, methods and mechanisms used in the theory and practice of performance evaluation, and employed in the selection, training and appointment of academic leaders. Objective methods of assessing leadership performance are also provided for reference.

  6. The influence of in-game emotions on basketball performance.

    Science.gov (United States)

    Uphill, Mark; Groom, Ryan; Jones, Marc

    2014-01-01

    This study examined the influence of emotions on performance in basketball. Six female basketball players were videotaped in six games. Frequency of performance behaviours was recorded minute-by-minute and indices of successful (SGI) and unsuccessful (UGI) game involvement derived for each player. Post-game, players reported the intensity of experienced emotions (anger, anxiety, embarrassment, excitement and happiness), and the time of the eliciting incident. The only emotion revealed as a significant predictor of SGI was happiness; both anger and embarrassment were significant predictors of increased UGI. Consideration of individual player analyses suggests that there is variation in the magnitude of the influence of emotions on performance and the extent to which this influence was helpful or harmful to performance. The study provides evidence that emotions are associated with changes in game behaviours in competition. Implications for further research examining the emotion-performance relationship are discussed.

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

    NARCIS (Netherlands)

    Portrait, F.R.M.; van den Berg, B.

    2015-01-01

    Background and objectives: 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

  8. Perceived organizational support and extra-role performance: which leads to which?

    Science.gov (United States)

    Chen, Zhixia; Eisenberger, Robert; Johnson, Kelly M; Sucharski, Ivan L; Aselage, Justin

    2009-02-01

    L. Rhoades and R. Eisenberger (2002) reported the meta-analytic finding of a highly statistically significant relation between perceived organizational support (POS) and performance but concluded that the reviewed studies' methodology allowed no conclusion concerning the direction of the association. To investigate this issue, the authors assessed POS and extra-role performance 2 times, separated by a 3-year interval, among 199 employees of an electronic and appliance sales organization. Using a cross-lagged panel design, the authors found that POS was positively associated with a temporal change in extra-role performance. In contrast, the relation between extra-role performance and temporal change in POS was not statistically significant. These findings provide evidence that POS leads to extra-role performance.

  9. Factoring local sequence composition in motif significance analysis.

    Science.gov (United States)

    Ng, Patrick; Keich, Uri

    2008-01-01

    We recently introduced a biologically realistic and reliable significance analysis of the output of a popular class of motif finders. In this paper we further improve our significance analysis by incorporating local base composition information. Relying on realistic biological data simulation, as well as on FDR analysis applied to real data, we show that our method is significantly better than the increasingly popular practice of using the normal approximation to estimate the significance of a finder's output. Finally we turn to leveraging our reliable significance analysis to improve the actual motif finding task. Specifically, endowing a variant of the Gibbs Sampler with our improved significance analysis we demonstrate that de novo finders can perform better than has been perceived. Significantly, our new variant outperforms all the finders reviewed in a recently published comprehensive analysis of the Harbison genome-wide binding location data. Interestingly, many of these finders incorporate additional information such as nucleosome positioning and the significance of binding data.

  10. Nanotechnology-Based Performance Improvements For Portland Cement Concrete - Phase I

    Science.gov (United States)

    2012-08-16

    A fundamental understanding of the nano-structure of Portland cement concrete (PCC) is the key to realizing significant breakthroughs regarding high performance and susta : (MBTC 2095/3004) using molecular dynamics (MD) provided new understanding of ...

  11. Total error components - isolation of laboratory variation from method performance

    International Nuclear Information System (INIS)

    Bottrell, D.; Bleyler, R.; Fisk, J.; Hiatt, M.

    1992-01-01

    The consideration of total error across sampling and analytical components of environmental measurements is relatively recent. The U.S. Environmental Protection Agency (EPA), through the Contract Laboratory Program (CLP), provides complete analyses and documented reports on approximately 70,000 samples per year. The quality assurance (QA) functions of the CLP procedures provide an ideal data base-CLP Automated Results Data Base (CARD)-to evaluate program performance relative to quality control (QC) criteria and to evaluate the analysis of blind samples. Repetitive analyses of blind samples within each participating laboratory provide a mechanism to separate laboratory and method performance. Isolation of error sources is necessary to identify effective options to establish performance expectations, and to improve procedures. In addition, optimized method performance is necessary to identify significant effects that result from the selection among alternative procedures in the data collection process (e.g., sampling device, storage container, mode of sample transit, etc.). This information is necessary to evaluate data quality; to understand overall quality; and to provide appropriate, cost-effective information required to support a specific decision

  12. Significant Factors Determining E-government Adoption in Selangor, Malaysia

    Directory of Open Access Journals (Sweden)

    Siti Hajar Mohd Idris

    2016-06-01

    Full Text Available Studies have shown that low adoption rate among citizens has been hindering the optimization of e-Government services especially in developing countries. Hence, one of the critical measures that has to be undertaken is to identify and overcome possible barriers to further facilitate a higher rate of adoption. A multistage stratified sampling was used in this study to collect data from 1000 respondents, both user and non-user residing in the state of Selangor, Malaysia. This state was chosen as to provide a better understanding of low adoption when issues of basic facilities have been successfully overcome. An exploratory factor analysis was performed to identify latent constructs and seven key factors were identified. A multiple regression model was subsequently used to analyze significant factors in determining the willingness to use e-Government services. The determinants are language barrier, educational level, secure, format, easy to use, enjoyable, reliable, visual appeal and infrastructure. The result shows significant variables that act as barriers to adoption are reliable, enjoyable, easy to use, secure, and language used. The constraints pointed out in the open ended questions mainly focus on the issue of accessibility, ease of use and awareness. Overcoming these obstacles is therefore crucial in order to enhance the usage of e-Government services which consequently will improve the quality of public administration in Malaysia.

  13. 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.

  14. Measuring and managing the work environment of the mid-level provider – the neglected human resource

    Directory of Open Access Journals (Sweden)

    McAuliffe Eilish

    2009-02-01

    Full Text Available Abstract Background Much has been written in the past decade about the health workforce crisis that is crippling health service delivery in many middle-income and low-income countries. Countries having lost most of their highly qualified health care professionals to migration increasingly rely on mid-level providers as the mainstay for health services delivery. Mid-level providers are health workers who perform tasks conventionally associated with more highly trained and internationally mobile workers. Their training usually has lower entry requirements and is for shorter periods (usually two to four years. Our study aimed to explore a neglected but crucial aspect of human resources for health in Africa: the provision of a work environment that will promote motivation and performance of mid-level providers. This paper explores the work environment of mid-level providers in Malawi, and contributes to the validation of an instrument to measure the work environment of mid-level providers in low-income countries. Methods Three districts were purposively sampled from each of the three geographical regions in Malawi. A total of 34 health facilities from the three districts were included in the study. All staff in each of the facilities were included in the sampling frame. A total of 153 staff members consented to be interviewed. Participants completed measures of perceptions of work environment, burnout and job satisfaction. Findings The Healthcare Provider Work Index, derived through Principal Components Analysis and Rasch Analysis of our modification of an existing questionnaire, constituted four subscales, measuring: (1 levels of staffing and resources; (2 management support; (3 workplace relationships; and (4 control over practice. Multivariate analysis indicated that scores on the Work Index significantly predicted key variables concerning motivation and attrition such as emotional exhaustion, job satisfaction, satisfaction with the profession

  15. New software for improving performance in wind farm operations

    Energy Technology Data Exchange (ETDEWEB)

    Collins, Mark [Ekho for Wind (Canada)

    2011-07-01

    The performance of wind farms depends on multiple field and business systems. This makes operational planning difficult because of so many data being in separate systems, duplication of data and the impossibility of gathering all relevant data together in one place. The aim of this paper is to present a new software, Ekho for Wind, which helps improve performance in wind farm operations by providing features such as high level views, performance analysis, downtime tracking, quality data management and forecast generation. This new software provides operational intelligence which offers incentives for continuous improvement. Ekho for Wind can bring such benefits as maximization of generation, increased lifetime of assets, minimization of costs and increased profitability. This presentation introduced a new software for improving the performance of wind farms and the lifetime of assets, resulting in significant payback.

  16. Structural mode significance using INCA. [Interactive Controls Analysis computer program

    Science.gov (United States)

    Bauer, Frank H.; Downing, John P.; Thorpe, Christopher J.

    1990-01-01

    Structural finite element models are often too large to be used in the design and analysis of control systems. Model reduction techniques must be applied to reduce the structural model to manageable size. In the past, engineers either performed the model order reduction by hand or used distinct computer programs to retrieve the data, to perform the significance analysis and to reduce the order of the model. To expedite this process, the latest version of INCA has been expanded to include an interactive graphical structural mode significance and model order reduction capability.

  17. Significant improvement of electrochemical performance of Cu ...

    Indian Academy of Sciences (India)

    LiVPO4F cathode material for lithium-ion batteries. YU ZHANGa,∗, XIAOLAN BAIb ... and energy dispersive spectroscopy (EDS). ... Analysis of electrochemical impedance spectra (EIS) ... studied with a SEM (JSM-7500F, Japan) equipped with.

  18. Employee motivation in Product-Service-System providers

    DEFF Research Database (Denmark)

    Kreye, Melanie

    2016-01-01

    This research investigates how intrinsic and extrinsic motivation factors contribute to employee motivation in providers of Product-Service Systems (PSS). Employee motivation determines the quality of the delivered service and is thus an area of great importance for PSS providers. We present rich...... case-based data collected through semi-structured interviews, a survey and secondary sources. The analysis showed the particularly high importance of intrinsic and individual motivation factors such as the fulfilling nature of the work and skill development showing the ownership and pride service...... employees took in their work. Further, the organisation needs to set the context of high employee motivation by enabling flexibility and performance feedback. Our research contributes to the literature by providing a first empirical study of employee motivation in PSS providers and thus providing important...

  19. Planning for high performance project teams

    International Nuclear Information System (INIS)

    Reed, W.; Keeney, J.; Westney, R.

    1997-01-01

    Both industry-wide research and corporate benchmarking studies confirm the significant savings in cost and time that result from early planning of a project. Amoco's Team Planning Workshop combines long-term strategic project planning and short-term tactical planning with team building to provide the basis for high performing project teams, better project planning, and effective implementation of the Amoco Common Process for managing projects

  20. Effective communication with primary care providers.

    Science.gov (United States)

    Smith, Karen

    2014-08-01

    Effective communication requires direct interaction between the hospitalist and the primary care provider using a standardized method of information exchange with the opportunity to ask questions and assign accountability for follow-up roles. The discharge summary is part of the process but does not provide the important aspects of handoff, such as closed loop communication and role assignments. Hospital discharge is a significant safety risk for patients, with more than half of discharged patients experiencing at least one error. Hospitalist and primary care providers need to collaborate to develop a standardized system to communicate about shared patients that meets handoff requirements. Copyright © 2014 Elsevier Inc. All rights reserved.

  1. Emergency surgeon-performed hepatobiliary ultrasonography.

    LENUS (Irish Health Repository)

    Kell, M R

    2012-02-03

    BACKGROUND: Acute hepatobiliary pathology is a common general surgical emergency referral. Diagnosis requires imaging of the biliary tree by ultrasonography. The accuracy and impact of surgeon-performed ultrasonography (SUS) on the diagnosis of emergent hepatobiliary pathology was examined. METHODS: A prospective study, over a 6-month period, enrolled all patients with symptoms or signs of acute hepatobiliary pathology. Patients provided informed consent and underwent both SUS and standard radiology-performed ultrasonography (RUS). SUS was performed using a 2-5-MHz broadband portable ultrasound probe by two surgeons trained in ultrasonography, and RUS using a 2-5-MHz fixed unit. SUS results were correlated with those of RUS and pathological diagnoses. RESULTS: Fifty-three consecutive patients underwent 106 ultrasonographic investigations. SUS agreed with RUS in 50 (94.3 per cent) of 53 patients. SUS accurately detected cholelithiasis in all but two cases and no patient was inaccurately diagnosed as having cholelithiasis at SUS (95.2 per cent sensitivity and 100 per cent specificity). As an overall complementary diagnostic tool SUS provided the correct diagnosis in 96.2 per cent of patients. Time to scan was significantly shorter following SUS (3.1 versus 12.0 h, P < 0.05). CONCLUSION: SUS provides a rapid and accurate diagnosis of emergency hepatobiliary pathology and may contribute to the emergency management of hepatobiliary disease.

  2. Prognostic significance of MR angiography in patients with cerebral infarction

    International Nuclear Information System (INIS)

    Moon, Woong Jae; Kim, Jun Ho; Seo, Jeong Jin; Cho, Ki Hyun; Kim, Yun Hyeon; Kim, Jae Kyu; Kang, Heoung Keun

    1994-01-01

    This study was designed to evaluate the prognostic significance of Magnetic resonance angiography(MRA) in patients with cerebral infarction. Magnetic Resonance Imaging(MRI) and 2 dimensional or 3 dimensional Time-of-Flight MRA were performed subsequently in 83 patients with cerebral infarction proven by brain CT and clinical manifestations, using GE Signa Advantage 1.5 T. We classified the size of infarction on MRI as Extent I( 6 cm) and classified the intracranial vascular occlusion according to visualizations of intracranial vascular branches on MRA as Grade 0, Grade I, Grade II, Grade III. And we evaluated clinical outcomes of these patients according to Rankin's disability scale, compared with MRI and MRA. In 72 cases(86.8%), the larger the size of infarction on MRI, the more severe vascular occlusion on MRA, the worse the clinical outcomes were noted(p < 0.01). However, in 7 cases(8.4%) who showed huge cerebral infarction on MRI with low grade intracranial vascular occlusion on MRA, the clinical outcomes were improved. In 4 cases(4.8%) who noted small sized cerebral infarction on MRI with high grade vascular occlusion on MRA, the clinical outcomes were worsened. MRA provides additional useful information to that provided by MRI in predicting the prognosis of patients with cerebral infarction

  3. A simple bedside blood test (Fibrofast; FIB-5) is superior to FIB-4 index for the differentiation between non-significant and significant fibrosis in patients with chronic hepatitis C.

    Science.gov (United States)

    Shiha, G; Seif, S; Eldesoky, A; Elbasiony, M; Soliman, R; Metwally, A; Zalata, K; Mikhail, N

    2017-05-01

    A simple non-invasive score (Fibrofast, FIB-5) was developed using five routine laboratory tests (ALT, AST, alkaline phosphatase, albumin and platelets count) for the detection of significant hepatic fibrosis in patients with chronic hepatitis C. The FIB-4 index is a non-invasive test for the assessment of liver fibrosis, and a score of ≤1.45 enables the correct identification of patients who have non-significant (F0-1) from significant fibrosis (F2-4), and could avoid liver biopsy. The aim of this study was to compare the performance characteristics of FIB-5 and FIB-4 to differentiate between non-significant and significant fibrosis. A cross-sectional study included 604 chronic HCV patients. All liver biopsies were scored using the METAVIR system. Both FIB-5 and FIB-4 scores were measured and the performance characteristics were calculated using the ROC curve. The performance characteristics of FIB-5 at ≥7.5 and FIB-4 at ≤1.45 for the differentiation between non-significant fibrosis and significant fibrosis were: specificity 94.4%, PPV 85.7%, and specificity 54.9%, PPV 55.7% respectively. FIB-5 score at the new cutoff is superior to FIB-4 index for the differentiation between non-significant and significant fibrosis.

  4. Candiduria: A review of clinical significance and management

    International Nuclear Information System (INIS)

    Bukhary, Z.A.

    2008-01-01

    Candiduria is a common nosocomial infection afflicting the urinary tract. This review is aimed at providing an updated summary of the problem in hospitalized adult patients. A review of English Medline literature published between January 1970 until June 2007 was performed. Reviews, clinical trials and case-controlled studies in adult patients were included. Risk factors for candiduria included urinary indwelling catheters, use of antibiotics, elderly age, underlying genitourinary tract abnormality, previous surgery and presence of diabetes mellitus. Presence of candiduria may represent only colonization and there are no consistent diagnostic criteria to define significant infection. Candiduria may not be associated with candidemia and most cases are asymptomatic. Asymptomatic canididuria is usually benign, and does not require local or systemic antifungal therapy. Physicians need to confirm the infection by a second sterile urine sample, adopt non-pharmacologic interventions and modify risk factors. Mortality rate can be high particularly in debilitated patients and awareness to validate candiduria is necessary to stratify treatment according to patient status. Appropriate use of antifungal drugs, when indicated, should not replace correction of the underlying risk factors. Treatment of symptomatic candiduria is less controversial and easier. (author)

  5. Safety significance of steam generator tube degradation mechanisms

    Energy Technology Data Exchange (ETDEWEB)

    Roussel, G; Mignot, P [AIB-Vincotte Nuclear - AVN, Brussels (Belgium)

    1991-07-01

    Steam generator (SG) tube bundle is a part of the Reactor Coolant Pressure Boundary (RCPB): this means that its integrity must be maintained. However, operating experience shows various types of tube degradation to occur in the SG tubing, which may lead to SG tube leaks or SG tube ruptures and create a loss of primary system coolant through the SG, therefore providing a direct path to the environment outside the primary containment structure. In this paper, the major types of known SG tube degradations are described and analyzed in order to assess their safety significance with regard to SG tube integrity. In conclusion: The operational reliability and the safety of the PWR steam generator s requires a sufficient knowledge of the degradation mechanisms to determine the amount of degradation that a tube can withstand and the time that it may remain in operation. They also require the availability of inspection techniques to accurately detect and characterize the various degradations. The status of understanding of the major types of degradation summarized in this paper shows and justifies why efforts are being performed to improve the management of the steam generator tube defects.

  6. PROVIDING WOMEN, KEPT MEN

    Science.gov (United States)

    Mojola, Sanyu A

    2014-01-01

    This paper draws on ethnographic and interview based fieldwork to explore accounts of intimate relationships between widowed women and poor young men that emerged in the wake of economic crisis and a devastating HIV epidemic among the Luo ethnic group in Western Kenya. I show how the cooptation of widow inheritance practices in the wake of an overwhelming number of widows as well as economic crisis resulted in widows becoming providing women and poor young men becoming kept men. I illustrate how widows in this setting, by performing a set of practices central to what it meant to be a man in this society – pursuing and providing for their partners - were effectively doing masculinity. I will also show how young men, rather than being feminized by being kept, deployed other sets of practices to prove their masculinity and live in a manner congruent with cultural ideals. I argue that ultimately, women’s practice of masculinity in large part seemed to serve patriarchal ends. It not only facilitated the fulfillment of patriarchal expectations of femininity – to being inherited – but also served, in the end, to provide a material base for young men’s deployment of legitimizing and culturally valued sets of masculine practice. PMID:25489121

  7. Non-opioid anesthetic drug abuse among anesthesia care providers: a narrative review.

    Science.gov (United States)

    Zuleta-Alarcón, Alix; Coffman, John C; Soghomonyan, Suren; Papadimos, Thomas J; Bergese, Sergio D; Moran, Kenneth R

    2017-02-01

    The objective of this narrative review is to provide an overview of the problem of non-opioid anesthetic drug abuse among anesthesia care providers (ACPs) and to describe current approaches to screening, therapy, and rehabilitation of ACPs suffering from non-opioid anesthetic drug abuse. We first performed a search of all literature available on PubMed prior to April 11, 2016. The search was limited to articles published in Spanish and English, and the following key words were used: anesthesiology, anesthesia personnel, AND substance-related disorders. We also searched Ovid MEDLINE ® databases from 1946-April 11, 2016 using the following search terms: anesthesiology OR anesthesia, OR nurse anesthetist OR anesthesia care provider OR perioperative nursing AND substance-related disorders. Despite an increased awareness of drug abuse among ACPs and improvements in preventive measures, the problem of non-opioid anesthetic drug abuse remains significant. While opioids are the most commonly abused anesthesia medications among ACPs, the abuse of non-opioid anesthetics is a significant cause of morbidity, mortality, and professional demise. Early detection, effective therapy, and long-term follow-up help ACPs cope more effectively with the problem and, when possible, resume their professional activities. There is insufficient evidence to determine the ability of ACPs to return safely to anesthesia practice after rehabilitation, though awareness of the issue and ongoing treatment are necessary to minimize patient risk from potentially related clinical errors.

  8. Effect of decision making on ultrasonic examination performance

    International Nuclear Information System (INIS)

    Harris, D.H.

    1992-05-01

    A decision aid was developed to overcome examiner limitations in information processing and decision making during ultrasonic examinations. The aid provided a means of noting signal characteristics as they were observed during the examination, and of presenting them simultaneously for decision making. The aid also served as a way of providing detailed feedback on examination performance during training. The aid was incorporated into worksheets used for the conduct of practice examinations during ultrasonic examination training. To support the introduction and use of the decision aid, one hour of supplementary training was inserted in an existing 64-hour training course on ultrasonic detection of defects. This study represented a modest step in improving the performance of ultrasonic examinations in nuclear power plants. Findings indicated that aided decision making supported by limited training can significantly improve ultrasonic detection performance

  9. The Jak2 Inhibitor, G6, Alleviates Jak2-V617F–Mediated Myeloproliferative Neoplasia by Providing Significant Therapeutic Efficacy to the Bone Marrow

    Directory of Open Access Journals (Sweden)

    Annet Kirabo

    2011-11-01

    Full Text Available We recently developed a Janus kinase 2 (Jak2 small-molecule inhibitor called G6 and found that it inhibits Jak2-V617F– mediated pathologic cell growth in vitro, ex vivo, and in vivo. However, its ability to inhibit Jak2-V617F–mediated myeloproliferative neoplasia, with particular emphasis in the bone marrow, has not previously been examined. Here, we investigated the efficacy of G6 in a transgenic mouse model of Jak2-V617F–mediated myeloproliferative neoplasia. We found that G6 provided therapeutic benefit to the peripheral blood as determined by elimination of leukocytosis, thrombocytosis, and erythrocytosis. G6 normalized the pathologically high plasma concentrations of interleukin 6 (IL-6. In the liver, G6 eliminated Jak2-V617F–driven extramedullary hematopoiesis. With respect to the spleen, G6 significantly reduced both the spleno-megaly and megakaryocytic hyperplasia. In the critically important bone marrow, G6 normalized the pathologically high levels of phospho-Jak2 and phospho–signal transducer and activator of transcription 5 (STAT5. It significantly reduced the megakaryocytic hyperplasia in the marrow and completely normalized the M/E ratio. Most importantly, G6 selectively reduced the mutant Jak2 burden by 67% on average, with virtual elimination of mutant Jak2 cells in one third of all treated mice. Lastly, clonogenic assays using marrow stem cells from the myeloproliferative neoplasm mice revealed a time-dependent elimination of the clonogenic growth potential of these cells by G6. Collectively, these data indicate that G6 exhibits exceptional efficacy in the peripheral blood, liver, spleen, and, most importantly, in the bone marrow, thereby raising the possibility that this compound may alter the natural history of Jak2-V617F–mediated myeloproliferative neoplasia.

  10. Relationship between meaningful work and job performance in nurses.

    Science.gov (United States)

    Tong, Ling

    2018-04-01

    The present study was designed to determine the relationship between meaningful work and job performance, and the impact of meaningful work on nursing care quality. Meaningful work has been suggested as a significant factor affecting job performance, but the relationship has never been studied in nurses in China. A descriptive correlational study was designed to assess the level of meaningful work, tasks, and contextual performance as well as their relationships. We used a stratified random-sampling approach to enrol nurses from hospitals. Multivariate regression analysis was applied to determine the relationship between meaningful work and their demographic data. There were significant, positive relationships between meaningful work and task performance and contextual performance. Education level, work unit, and employment type influenced meaningful work. The work motivation score of the nurses was lower than that of the other 2 dimensions, and a negative work motivation score negatively influenced job performance. Improving meaningful work and providing more support and assistance could improve nurse performance, thereby improving the quality of nursing care. © 2018 John Wiley & Sons Australia, Ltd.

  11. Quantitative performance monitoring

    International Nuclear Information System (INIS)

    Heller, A.S.

    1987-01-01

    In the recently published update of NUREG/CR 3883, it was shown that Japanese plants of size and design similar to those in the US have significantly fewer trips in a given year of operation. One way to reduce such imbalance is the efficient use of available plant data. Since plant data are recorded and monitored continuously for management feedback and timely resolution of problems, this data should be actively used to increase the efficiency of operations and, ultimately, for a reduction of plant trips in power plants. A great deal of information is lost, however, if the analytical tools available for the data evaluation are misapplied or not adopted at all. This paper deals with a program developed to use quantitative techniques to monitor personnel performance in an operating power plant. Visual comparisons of ongoing performance with predetermined quantitative performance goals are made. A continuous feedback is provided to management for early detection of adverse trends and timely resolution of problems. Ultimately, costs are reduced through effective resource management and timely decision making

  12. Increasing Performance of Professional Soccer Players and Elite Track and Field Athletes with Peak Performance Training and Biofeedback: A Pilot Study.

    Science.gov (United States)

    Rijken, Noortje H; Soer, Remko; de Maar, Ewold; Prins, Hilco; Teeuw, Wouter B; Peuscher, Jan; Oosterveld, Frits G J

    2016-12-01

    The aim of this pilot study was to investigate the effects of an intervention consisting of mental coaching combined with either electro encephalogram (EEG) alpha power feedback or heart rate variability (HRV) feedback on HRV, EEG outcomes and self-reported factors related to stress, performance, recovery and sleep quality in elite athletes. A prospective pilot study was performed with two distinct cohorts. Soccer players were provided with four sessions of mental coaching combined with daily HRV biofeedback (Group A); track and field athletes were provided with four sessions of mental coaching in combination with daily neurofeedback (Group B). Measurements were performed at baseline, post intervention and at 5 weeks follow-up. Objective measures: EEG and ECG. Subjective measures: Numeric Rating Scale for performance, Pittsburgh Sleep Quality Index, Rest and Stress Questionnaire and Sports Improvement-60. Group characteristics were too distinct to compare the interventions. Linear mixed models were used to analyze differences within groups over time. In Group A, significant changes over time were present in alpha power at 5 of 7 EEG locations (p HRV low frequency power and recovery scale of the REST-Q significantly increased (p = 0.02 and HRV or EEG alpha power feedback may increase HRV and alpha power and may lead to better performance-related outcomes and stress reduction. Further research is needed to elucidate the effects of either type of feedback and to compare effects with a control group.

  13. Impact of High-Fidelity Simulation and Pharmacist-Specific Didactic Lectures in Addition to ACLS Provider Certification on Pharmacy Resident ACLS Performance.

    Science.gov (United States)

    Bartel, Billie J

    2014-08-01

    This pilot study explored the use of multidisciplinary high-fidelity simulation and additional pharmacist-focused training methods in training postgraduate year 1 (PGY1) pharmacy residents to provide Advanced Cardiovascular Life Support (ACLS) care. Pharmacy resident confidence and comfort level were assessed after completing these training requirements. The ACLS training requirements for pharmacy residents were revised to include didactic instruction on ACLS pharmacology and rhythm recognition and participation in multidisciplinary high-fidelity simulation ACLS experiences in addition to ACLS provider certification. Surveys were administered to participating residents to assess the impact of this additional education on resident confidence and comfort level in cardiopulmonary arrest situations. The new ACLS didactic and simulation training requirements resulted in increased resident confidence and comfort level in all assessed functions. Residents felt more confident in all areas except providing recommendations for dosing and administration of medications and rhythm recognition after completing the simulation scenarios than with ACLS certification training and the didactic components alone. All residents felt the addition of lectures and simulation experiences better prepared them to function as a pharmacist in the ACLS team. Additional ACLS training requirements for pharmacy residents increased overall awareness of pharmacist roles and responsibilities and greatly improved resident confidence and comfort level in performing most essential pharmacist functions during ACLS situations. © The Author(s) 2013.

  14. Influence of ABO blood group on sports performance.

    Science.gov (United States)

    Lippi, Giuseppe; Gandini, Giorgio; Salvagno, Gian Luca; Skafidas, Spyros; Festa, Luca; Danese, Elisa; Montagnana, Martina; Sanchis-Gomar, Fabian; Tarperi, Cantor; Schena, Federico

    2017-06-01

    Despite being a recessive trait, the O blood group is the most frequent worldwide among the ABO blood types. Since running performance has been recognized as a major driver of evolutionary advantage in humans, we planned a study to investigate whether the ABO blood group may have an influence on endurance running performance in middle-aged recreational athletes. The study population consisted of 52 recreational, middle-aged, Caucasian athletes (mean age: 49±13 years, body mass index, 23.4±2.3 kg/m 2 ), regularly engaged in endurance activity. The athletes participated to a scientific event called "Run for Science" (R4S), entailing the completion of a 21.1 km (half-marathon) run under competing conditions. The ABO blood type status of the participants was provided by the local Service of Transfusion Medicine. In univariate analysis, running performance was significantly associated with age and weekly training, but not with body mass index. In multiple linear regression analysis, age and weekly training remained significantly associated with running performance. The ABO blood group status was also found to be independently associated with running time, with O blood type athletes performing better than those with non-O blood groups. Overall, age, weekly training and O blood group type explained 62.2% of the total variance of running performance (age, 41.6%; training regimen, 10.5%; ABO blood group, 10.1%). The results of our study show that recreational athletes with O blood group have better endurance performance compared to those with non-O blood group types. This finding may provide additional support to the putative evolutionary advantages of carrying the O blood group.

  15. Adaptive significance of root grafting in trees

    Energy Technology Data Exchange (ETDEWEB)

    Loehle, C.; Jones, R.

    1988-12-31

    Root grafting has long been observed in forest trees but the adaptive significance of this trait has not been fully explained. Various authors have proposed that root grafting between trees contributes to mechanical support by linking adjacent root systems. Keeley proposes that this trait would be of greatest advantage in swamps where soils provide poor mechanical support. He provides as evidence a greenhouse study of Nyssa sylvatica Marsh in which seedlings of swamp provenance formed between-individual root grafts more frequently than upland provenance seedlings. In agreement with this within-species study, Keeley observed that arid zone species rarely exhibit grafts. Keeley also demonstrated that vines graft less commonly than trees, and herbs never do. Since the need for mechanical support coincides with this trend, these data seem to support his model. In this paper, the authors explore the mechanisms and ecological significance of root grafting, leading to predictions of root grafting incidence. Some observations support and some contradict the mechanical support hypothesis.

  16. Dynamic Reconfiguration in Real-Time Systems Energy, Performance, and Thermal Perspectives

    CERN Document Server

    Wang, Weixun; Ranka, Sanjay

    2013-01-01

    Given the widespread use of real-time multitasking systems, there are tremendous optimization opportunities if reconfigurable computing can be effectively incorporated while maintaining performance and other design constraints of typical applications. The focus of this book is to describe the dynamic reconfiguration techniques that can be safely used in real-time systems. This book provides comprehensive approaches by considering synergistic effects of computation, communication as well as storage together to significantly improve overall performance, power, energy and temperature.  Provides a comprehensive introduction to optimization and dynamic reconfiguration techniques in real-time embedded systems; Covers state-of-the-art techniques and ongoing research in reconfigurable architectures; Focuses on algorithms tuned for dynamic reconfiguration techniques in real-time systems;  Provides reference for anyone designing low-power systems, energy-/temperature-constrained devices, and power-performance efficie...

  17. Rising labor costs, earnings management, and financial performance of health care providers around the world.

    Science.gov (United States)

    Dong, Gang Nathan

    2015-01-01

    Amid increasing interest in how government regulation and market competition affect the cost and financial sustainability in health care sector, it remains unclear whether health care providers behave similarly to their counterparts in other industries. The goal of this chapter is to study the degree to which health care providers manipulate accruals in periods of financial difficulties caused, in part, by the rising costs of labor. We collected the financial information of health care provider in 43 countries from 1984 to 2013 and conducted a pooled cross-sectional study with country and year fixed-effects. The empirical evidence shows that health care providers with higher wage costs are more likely to smooth their earnings in order to maintain financial sustainability. The finding of this study not only informs regulators that earnings management is pervasive in health care organizations around the world, but also contributes to the studies of financial booktax reporting alignment, given the existing empirical evidence linking earnings management to corporate tax avoidance in this very sector.

  18. Research Performance of Higher Education Institutions: A Review on the Measurements and Affecting Factors of Research Performance

    Directory of Open Access Journals (Sweden)

    Oya TAMTEKİN AYDIN

    2017-08-01

    Full Text Available Recently, the increasing competition in higher education has attracted attention by many researchers. They have emphasized that the aim of the growing competition between universities is to increase the number of students, the research performance and get research support, find qualified faculty members, and receive financial contributions. This paper aims to draw attention to “research performance” which is a significant part of the competition among the universities. In connection with this goal, the study tries to outline the results of an extensive literature review in the field of higher education research performance. Firstly, literature regarding research performance, its definition as a concept, and its indicators are discussed. Then, the factors influencing research performance are presented in a comprehensive manner. At the end of the study, a conceptual framework that will be useful for all university staff is provided. Understanding the concept of research performance and the factors affecting research performance can help relevant authorities improve their current positions.

  19. Impact of High - Performance Work Systems on Export - Oriented SMEs Performance: The Mediating Role of Human Capital Development

    Directory of Open Access Journals (Sweden)

    Zeeshan Hamid

    2017-10-01

    Full Text Available Small and medium enterprises (SMEs contribute substantially to the economic development, income generation, poverty reduction, and particularly job creation for both developed and developing economies. However, compared with large firms, SMEs face several challenges related to their performance and competitiveness. The role of human capital (HC and human resource practices (HR Practices in enhancing SMEs competitiveness and performance is vital but understudied areas. Therefore, the purpose of this study was to investigate the role of HC development between the relationship of high-performance work systems (HPWS and export-oriented SMEs performance. Quantitative strategy and cross-sectional survey method was used to collect data from 205 managerial staff through a self-administered structured questionnaire. HPWS had a significant positive impact on export-oriented SMEs performance. The findings of the study provide evidence that HC development plays a mediating role between HPWS and enterprises performance.

  20. THE IMPACT OF THE LEVERAGE PROVIDED BY THE FUTURES ONTHE PERFORMANCE OF TECHNICAL INDICATORS:EVIDENCEFROMTURKEY

    Directory of Open Access Journals (Sweden)

    Hakan ER

    2012-07-01

    Full Text Available Although in developed countries the futures markets have been in existence sincemid-nineteenth century, they are relatively new in the developing countries. In thelate twentieth and early twenty first century, many new futures exchanges wereestablishedin developing countries and in the majority of these newly establishedexchanges substantial growth in futures trading have been observed within a smallperiod of time. This fast growth in the futures trading volume was mainly due tothe tremendous leverage the futures provides to speculators. Thanks to futuresmargining system, by committing only a small fraction of the money needed tomaintain a position on the underlying security in the spot market, a speculator canattain a much higher return potentialby buying or selling a futures contract. Thispaper studies this effect by employing daily return data on 19 selected stockslisted continuously in IMKB-30 (Istanbul Stock Exchange 30,Turkey fromJanuary 2005 to December 2010. Populartechnical indicators are used to generatebuy and sell signals in both the spot market (Istanbul Stock Exchange and thefutures market (VOB, a fast growing derivatives exchange located in İzmir,Turkey. The profit/loss resulting from trading strategies are then calculated andcompared. The results of the study show that, although the amount invested inboth markets is the same, the profit generated from the strategies applied onfutures is significantly higher than that on spot market.A CAPM (Capital AssetPricing Model based hedge ratio is used to apply the trading strategies generated from spot market data on futures. The results show that this strategy generatessuperior returns in the futures market.

  1. The business end of health information technology. Can a fully integrated electronic health record increase provider productivity in a large community practice?

    Science.gov (United States)

    De Leon, Samantha; Connelly-Flores, Alison; Mostashari, Farzad; Shih, Sarah C

    2010-01-01

    Electronic health records (EHRs) are expected to transform and improve the way medicine is practiced. However, providers perceive many barriers toward implementing new health information technology. Specifically, they are most concerned about the potentially negative impact on their practice finances and productivity. This study compares the productivity of 75 providers at a large urban primary care practice from January 2005 to February 2009, before and after implementing an EHR system, using longitudinal mixed model analyses. While decreases in productivity were observed at the time the EHR system was implemented, most providers quickly recovered, showing increases in productivity per month shortly after EHR implementation. Overall, providers had significant productivity increases of 1.7% per month per provider from pre- to post-EHR adoption. The majority of the productivity gains occurred after the practice instituted a pay-for-performance program, enabled by the data capture of the EHRs. Coupled with pay-for-performance, EHRs can spur rapid gains in provider productivity.

  2. Cameroon mid-level providers offer a promising public health dentistry model

    Directory of Open Access Journals (Sweden)

    Achembong Leo

    2012-11-01

    Full Text Available Background Oral health services are inadequate and unevenly distributed in many developing countries, particularly those in sub-Saharan Africa. Rural areas in these countries and poorer sections of the population in urban areas often do not have access to oral health services mainly because of a significant shortage of dentists and the high costs of care. We reviewed Cameroon’s experience with deploying a mid-level cadre of oral health professionals and the feasibility of establishing a more formal and predictable role for these health workers. We anticipate that a task-shifting approach in the provision of dental care will significantly improve the uneven distribution of oral health services particularly in the rural areas of Cameroon, which is currently served by only 3% of the total number of dentists. Methods The setting of this study was the Cameroon Baptist Convention Health Board (BCHB, which has four dentists and 42 mid-level providers. De-identified data were collected manually from the registries of 10 Baptist Convention clinics located in six of Cameroon’s 10 regions and then entered into an Excel format before importing into STATA. A retrospective abstraction of all entries for patient visits starting October 2010, and going back in time until 1500 visits were extracted from each clinic. Results This study showed that mid-level providers in BCHB clinics are offering a full scope of dental work across the 10 clinics, with the exception of treatment for major facial injuries. Mid-level providers alone performed 93.5% of all extractions, 87.5% of all fillings, 96.5% of all root canals, 97.5% of all cleanings, and 98.1% of all dentures. The dentists also typically played a teaching role in training the mid-level providers. Conclusions The Ministry of Health in Cameroon has an opportunity to learn from the BCHB model to expand access to oral health care across the country. This study shows the benefits of using a simple, workable, low

  3. Changing relationships with significant others: Reflections of ...

    African Journals Online (AJOL)

    Symbolic interactionism provides the framework for analysing the building of relationships between elite athletes and their significant others. In-depth interviews were conducted with elite throwers and decathlon athletes. The sample included current (n=15) and retired (n=5) student-athletes, parents (n=5), coaches (n=2) ...

  4. Network Expansion and Pathway Enrichment Analysis towards Biologically Significant Findings from Microarrays

    Directory of Open Access Journals (Sweden)

    Wu Xiaogang

    2012-06-01

    Full Text Available In many cases, crucial genes show relatively slight changes between groups of samples (e.g. normal vs. disease, and many genes selected from microarray differential analysis by measuring the expression level statistically are also poorly annotated and lack of biological significance. In this paper, we present an innovative approach - network expansion and pathway enrichment analysis (NEPEA for integrative microarray analysis. We assume that organized knowledge will help microarray data analysis in significant ways, and the organized knowledge could be represented as molecular interaction networks or biological pathways. Based on this hypothesis, we develop the NEPEA framework based on network expansion from the human annotated and predicted protein interaction (HAPPI database, and pathway enrichment from the human pathway database (HPD. We use a recently-published microarray dataset (GSE24215 related to insulin resistance and type 2 diabetes (T2D as case study, since this study provided a thorough experimental validation for both genes and pathways identified computationally from classical microarray analysis and pathway analysis. We perform our NEPEA analysis for this dataset based on the results from the classical microarray analysis to identify biologically significant genes and pathways. Our findings are not only consistent with the original findings mostly, but also obtained more supports from other literatures.

  5. Cognitive human reliability analysis for an assessment of the safety significance of complex transients

    International Nuclear Information System (INIS)

    Amico, P.J.; Hsu, C.J.; Youngblood, R.W.; Fitzpatrick, R.G.

    1989-01-01

    This paper reports that as part of a probabilistic assessment of the safety significance of complex transients at certain PWR power plants, it was necessary to perform a cognitive human reliability analysis. To increase the confidence in the results, it was desirable to make use of actual observations of operator response which were available for the assessment. An approach was developed which incorporated these observations into the human cognitive reliability (HCR) modeling approach. The results obtained provided additional insights over what would have been found using other approaches. These insights were supported by the observations, and it is suggested that this approach be considered for use in future probabilistic safety assessments

  6. Kinematic characteristics of a sprinting technique and morphofunctional structures of its providing

    Directory of Open Access Journals (Sweden)

    V. A. Druz

    2017-02-01

    2Kazimierz Wielki University in Bydgoszcz     Abstract Introduction The overall performance of a coach and the efficiency of performances of sportsmen are defined completely by the depth of understanding of regularities which are the cornerstone of the mechanisms, which provide the performance of competitive exercises. The most comprehensive investigations of these questions in track and field athletics are devoted to studying of sprint that significantly promoted the improvement of the process of a coach (Yefremenko, 2013 -2015; Shesterova, Yanhao, 2014-2016. However, the uniform generalization in the received scientific results isn't reached. It considerably reduces the overall performance of a coach. The optimization of the training process and the efficiency of performance of a sportsman are defined by the depth of knowledge of the interdependent relations of kinematic and dynamic characteristics of the performed physical actions and their connections with the morphofunctional educations, which provide their implementation. At the same time the final result depends on the motive endowments of a sportsman, the level of preparedness and the current functional state. The purpose of the research. To present the uniform system of the interdependent relations of the biomechanical and physiological regularities which provide the fastest movement of the general center of body weight GCBW of a sportsman when passing by him the established distance of run and to establish the structure of creation of an optimum algorithm of the training process taking into account individual physical development of a sportsman on the basis of provisions of the theory of training. The achievement of the purpose defined the need of the solution of the following tasks: 1. To carry out the analysis of literature and to systematize scientific achievements on the considered problem. 2. To select the fundamental laws of mechanics which define kinematic and dynamic characteristics of movement

  7. Intraoperative Sensorcaine significantly improves postoperative pain management in outpatient reduction mammaplasty.

    Science.gov (United States)

    Culliford, Alfred T; Spector, Jason A; Flores, Roberto L; Louie, Otway; Choi, Mihye; Karp, Nolan S

    2007-09-15

    Breast reduction is one of the most frequently performed plastic surgical procedures in the United States; more than 160,500 patients underwent the procedure in 2005. Many outpatient reduction mammaplasty patients report the greatest postoperative discomfort in the first 48 hours. The authors' investigated the effect of intraoperative topical application of the long-acting local anesthetic agent bupivacaine (Sensorcaine or Marcaine) on postoperative pain, time to postanesthesia care unit discharge, and postoperative use of narcotic medication. In a prospective, randomized, single-blind trial, intraoperative use of Sensorcaine versus placebo (normal saline) was compared. Postoperative pain was quantified using the visual analogue scale, and time to discharge from the postanesthesia care unit was recorded. Patients documented their outpatient pain medication usage. Of the 37 patients enrolled in the study, 20 were treated with intraoperative topical Sensorcaine and 17 received placebo. Patients treated with Sensorcaine were discharged home significantly faster (2.9 hours versus 3.8 hours, p = 0.002). The control arm consistently had higher pain scores in the postanesthesia care unit (although not statistically significant) than the Sensorcaine group using the visual analogue scale system. Furthermore, patients receiving Sensorcaine required significantly less narcotic medication while recovering at home (mean, 3.5 tablets of Vicodin) than the control group (mean, 6.4 tablets; p = 0.001). There were no complications resulting from Sensorcaine usage. This prospective, randomized, single-blind study demonstrates that a single dose of intraoperative Sensorcaine provides a safe, inexpensive, and efficacious way to significantly shorten the length of postanesthesia care unit stay and significantly decrease postoperative opioid analgesic use in patients undergoing ambulatory reduction mammaplasty.

  8. Providing better indoor environmental quality brings economicbenefits

    Energy Technology Data Exchange (ETDEWEB)

    Fisk, William; Seppanen, Olli

    2007-06-01

    This paper summarizes the current scientific evidence that improved indoor environmental quality can improve work performance and health. The review indicates that work and school work performance is affected by indoor temperature and ventilation rate. Pollutant source removal can sometimes improve work performance. Based on formal statistical analyses of existing research results, quantitative relationships are provided for the linkages of work performance with indoor temperature and outdoor air ventilation rate. The review also indicates that improved health and related financial savings are obtainable from reduced indoor tobacco smoking, prevention and remediation of building dampness, and increased ventilation. Example cost-benefit analyses indicate that many measures to improve indoor temperature control and increase ventilation rates will be highly cost effective, with benefit-cost ratios as high as 80 and annual economic benefits as high as $700 per person.

  9. Human Factors Research in Aircrew Performance and Training: 1986-1991

    Science.gov (United States)

    1992-07-01

    significant loss of realism . Seventeen functions could not be performed at all, primarily because of three missing system features: an automated target...traditionally trained aviators. In 1979, Anacapa developed 13 cinematic exercises to provide supplemental training in map interpretation and terrain

  10. Funnel plot control limits to identify poorly performing healthcare providers when there is uncertainty in the value of the benchmark.

    Science.gov (United States)

    Manktelow, Bradley N; Seaton, Sarah E; Evans, T Alun

    2016-12-01

    There is an increasing use of statistical methods, such as funnel plots, to identify poorly performing healthcare providers. Funnel plots comprise the construction of control limits around a benchmark and providers with outcomes falling outside the limits are investigated as potential outliers. The benchmark is usually estimated from observed data but uncertainty in this estimate is usually ignored when constructing control limits. In this paper, the use of funnel plots in the presence of uncertainty in the value of the benchmark is reviewed for outcomes from a Binomial distribution. Two methods to derive the control limits are shown: (i) prediction intervals; (ii) tolerance intervals Tolerance intervals formally include the uncertainty in the value of the benchmark while prediction intervals do not. The probability properties of 95% control limits derived using each method were investigated through hypothesised scenarios. Neither prediction intervals nor tolerance intervals produce funnel plot control limits that satisfy the nominal probability characteristics when there is uncertainty in the value of the benchmark. This is not necessarily to say that funnel plots have no role to play in healthcare, but that without the development of intervals satisfying the nominal probability characteristics they must be interpreted with care. © The Author(s) 2014.

  11. Evaluation of a social franchising and telemedicine programme and the care provided for childhood diarrhoea and pneumonia, Bihar, India

    Science.gov (United States)

    Giardili, Soledad; Das, Veena; Rabin, Tracy L; Raj, Sunil S; Schwartz, Jeremy I; Seth, Aparna; Goldhaber-Fiebert, Jeremy D; Miller, Grant; Vera-Hernández, Marcos

    2017-01-01

    Abstract Objective To evaluate the impact on the quality of the care provided for childhood diarrhoea and pneumonia in Bihar, India, of a large-scale, social franchising and telemedicine programme – the World Health Partners’ Sky Program. Methods We investigated changes associated with the programme in the knowledge and performance of health-care providers by carrying out 810 assessments in a representative sample of providers in areas where the programme was and was not implemented. Providers were assessed using hypothetical patient vignettes and the standardized patient method both before and after programme implementation, in 2011 and 2014, respectively. Differences in providers’ performance between implementation and nonimplementation areas were assessed using multivariate difference-in-difference linear regression models. Findings The programme did not significantly improve health-care providers’ knowledge or performance with regard to childhood diarrhoea or pneumonia in Bihar. There was a persistent large gap between knowledge of appropriate care and the care actually delivered. Conclusion Social franchising has received attention globally as a model for delivering high-quality care in rural areas in the developing world but supporting data are scarce. Our findings emphasize the need for sound empirical evidence before social franchising programmes are scaled up. PMID:28479635

  12. Significant determinants of academic performance by new students enrolled in the higher distance education system of Ecuador. The case of the Universidad Técnica Particular de Loja

    Directory of Open Access Journals (Sweden)

    Luis F. Moncada Mora

    2011-12-01

    Full Text Available In this article we present the significant determiners of academic performance of new students enrolled in the higher distance education system of Ecuador. A description and correlation of the variables were undertaken to formalize the probabilistic model that confirms the positive, negative, individual and global effects.

  13. Providers' perceptions of the implementation of a performance measurement system for substance abuse treatment: A process evaluation of the Service Quality Measures initiative.

    Science.gov (United States)

    Myers, Bronwyn; Williams, Petal Petersen; Johnson, Kim; Govender, Rajen; Manderscheid, Ron; Koch, J Randy

    2016-02-22

    In South Africa, concerns exist about the quality of substance abuse treatment. We developed a performance measurement system, known as the Service Quality Measures (SQM) initiative, to monitor the quality of treatment and assess efforts to improve quality of care. In 2014, the SQM system was implemented at six treatment sites to evaluate how implementation protocols could be improved in preparation for wider roll-out. To describe providers' perceptions of the feasibility and acceptability of implementing the SQM system, including barriers to and facilitators of implementation. We conducted 15 in-depth interviews (IDIs) with treatment providers from six treatment sites (two sites in KwaZulu-Natal and four in the Western Cape). Providers were asked about their experiences in implementing the system, the perceived feasibility of the system, and barriers to implementation. All IDIs were audio-recorded and transcribed verbatim. A framework approach was used to analyse the data. Providers reported that the SQM system was feasible to implement and acceptable to patients and providers. Issues identified through the IDIs included a perceived lack of clarity about sequencing of key elements in the implementation of the SQM system, questions on integration of the system into clinical care pathways, difficulties in tracking patients through the system, and concerns about maximising patient participation in the process. Findings suggest that the SQM system is feasible to implement and acceptable to providers, but that some refinements to the implementation protocols are needed to maximise patient participation and the likelihood of sustained implementation.

  14. Nutrition strategies before and during ultra-endurance event: A significant gap between science and practice.

    Science.gov (United States)

    Papadopoulou, S K; Xyla, E E; Methenitis, S; Feidantsis, K G; Kotsis, Y; Pagkalos, I G; Hassapidou, M N

    2018-03-01

    The purpose of this study was to investigate and assess the nutritional practices of open-water swimmers, during the preparation period and the competition, as well as their implications on performance and anthropometric parameters according to their age. Twenty-four (n = 24) men open-water swimmers, twelve young (26.3 ± 4.9 years) and twelve older athletes (45.8 ± 9.7 years), participated in this study. Nutritional behavior-energy intake consumption, and anthropometric characteristics were evaluated prior to the Toroneos Gulf crossing (26 km). In addition, nutritional intakes during the race and anthropometrics after the race were also evaluated. Significant differences between the two groups were found for Toroneos Gulf crossing performance, BMI, and all variables of body composition at the preparation period (P nutritional intakes during the preparation period and the competition, and athletes' performance. In summary, this study provides strong evidence about the malnutrition of ultra-endurance swimmers prior and during their competition, with potential dangers for their health and performance as certain deficiencies in both macro- and micronutrient contents are present. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  15. The Effect Of Intangible Asset Financial Performance And Financial Policies On The Firm Value

    Directory of Open Access Journals (Sweden)

    Rindu Rika Gamayuni

    2015-01-01

    Full Text Available Abstract The purpose of this study is to test empirically the relationship between intangible assets financial policies and financial performance to the firm value at going-public company in Indonesia. Path analysis was used to ascertain the relationship between intangible assets financial policies financial performance and firm value at going-public company in Indonesia in the year 2007 to 2009. This study also provides empirical evidence that Intangible assets financial policies financial performance have significant influence to the firm value simultaneously. Intangible assets has no significant influence to financial policies but has positive and significant influenced to financial performance ROA and firm value. Debt policies and financial performance ROA influenced firm value positive and significant. Financial statements limitation in measuring and disclosing intangible assets is the cause of significant difference between book value equity and market value equity. Measurement and disclosure of intangible assets intellectual capital precisely and aqurately is very important because intangible assets have a positive and significant effect to the firm value. Accounting standards should be concerned about this.

  16. ACCOUNTING FOR MARKETING: MARKETING PERFORMANCE THROUGH FINANCIAL RESULTS

    Directory of Open Access Journals (Sweden)

    Levent KOSAN

    2014-10-01

    Full Text Available Accounting, especially strategic management accounting, provides significant contributions to companies for decisions in environments of intense competition. Accounting, which has positive effects of company strategy development and management, has become a required facet of marketing, another area that has gained significance. The aim of this study is to assess the contributions of accounting to marketing performance management and other areas related to marketing development and to evaluate the relationship and synergies between marketing and accounting with comparative examples.

  17. Providing global WLCG transfer monitoring

    International Nuclear Information System (INIS)

    Andreeva, J; Dieguez Arias, D; Campana, S; Keeble, O; Magini, N; Molnar, Z; Ro, G; Saiz, P; Salichos, M; Tuckett, D; Flix, J; Oleynik, D; Petrosyan, A; Uzhinsky, A; Wildish, T

    2012-01-01

    The WLCG[1] Transfers Dashboard is a monitoring system which aims to provide a global view of WLCG data transfers and to reduce redundancy in monitoring tasks performed by the LHC experiments. The system is designed to work transparently across LHC experiments and across the various technologies used for data transfer. Currently each LHC experiment monitors data transfers via experiment-specific systems but the overall cross-experiment picture is missing. Even for data transfers handled by FTS, which is used by 3 LHC experiments, monitoring tasks such as aggregation of FTS transfer statistics or estimation of transfer latencies are performed by every experiment separately. These tasks could be performed once, centrally, and then served to all experiments via a well-defined set of APIs. In the design and development of the new system, experience accumulated by the LHC experiments in the data management monitoring area is taken into account and a considerable part of the code of the ATLAS DDM Dashboard is being re-used. The paper describes the architecture of the Global Transfer monitoring system, the implementation of its components and the first prototype.

  18. Interest in Providing Multiple Sclerosis Care and Subspecializing in Multiple Sclerosis Among Neurology Residents

    Science.gov (United States)

    Teixeira-Poit, Stephanie; Kane, Heather L.; Frost, A. Corey; Keating, Michael; Olmsted, Murrey

    2014-01-01

    Background: Although detailed knowledge regarding treatment options for multiple sclerosis (MS) patients is largely limited to neurologists, shortages in the neurologist workforce, including MS subspecialists, are predicted. Thus, MS patients may have difficulties in gaining access to appropriate care. No systematic evaluation has yet been performed of the number of neurology residents planning to pursue MS subspecialization. This study identifies factors affecting interest in providing MS patient care or MS subspecialization among current neurology residents. Methods: We randomly selected half of all Accreditation Council of Graduate Medical Education–certified neurology residency programs in the continental United States to receive the neurology resident survey. Completed surveys were received from 218 residents. Results: Residents were significantly more likely to have increased interest in MS care when they participated in MS research, were interested in teaching, and indicated that the “ability to improve patient outcomes and quality of life” was a positive factor influencing their desire to provide MS patient care. Residents who were interested in providing MS care, interested in teaching, and indicated that “research opportunities” was a positive factor for providing MS patient care were significantly more likely to express interest in MS subspecialization. Conclusions: Increasing opportunities to interact with MS patients, learn about MS care, and participate in MS research may increase interest in MS care and subspecialization among neurology residents. Opportunities to educate residents regarding MS patient care may affect residents’ attitudes. PMID:24688352

  19. Contracting with private providers for primary care services: evidence from urban China.

    Science.gov (United States)

    Wang, Yan; Eggleston, Karen; Yu, Zhenjie; Zhang, Qiong

    2013-01-17

    Controversy surrounds the role of the private sector in health service delivery, including primary care and population health services. China's recent health reforms call for non-discrimination against private providers and emphasize strengthening primary care, but formal contracting-out initiatives remain few, and the associated empirical evidence is very limited. This paper presents a case study of contracting with private providers for urban primary and preventive health services in Shandong Province, China. The case study draws on three primary sources of data: administrative records; a household survey of over 1600 community residents in Weifang and City Y; and a provider survey of over 1000 staff at community health stations (CHS) in both Weifang and City Y. We supplement the quantitative data with one-on-one, in-depth interviews with key informants, including local officials in charge of public health and government finance.We find significant differences in patient mix: Residents in the communities served by private community health stations are of lower socioeconomic status (more likely to be uninsured and to report poor health), compared to residents in communities served by a government-owned CHS. Analysis of a household survey of 1013 residents shows that they are more willing to do a routine health exam at their neighborhood CHS if they are of low socioeconomic status (as measured either by education or income). Government and private community health stations in Weifang did not statistically differ in their performance on contracted dimensions, after controlling for size and other CHS characteristics. In contrast, the comparison City Y had lower performance and a large gap between public and private providers. We discuss why these patterns arose and what policymakers and residents considered to be the main issues and concerns regarding primary care services.

  20. Contracting with private providers for primary care services: evidence from urban China

    Science.gov (United States)

    2013-01-01

    Controversy surrounds the role of the private sector in health service delivery, including primary care and population health services. China’s recent health reforms call for non-discrimination against private providers and emphasize strengthening primary care, but formal contracting-out initiatives remain few, and the associated empirical evidence is very limited. This paper presents a case study of contracting with private providers for urban primary and preventive health services in Shandong Province, China. The case study draws on three primary sources of data: administrative records; a household survey of over 1600 community residents in Weifang and City Y; and a provider survey of over 1000 staff at community health stations (CHS) in both Weifang and City Y. We supplement the quantitative data with one-on-one, in-depth interviews with key informants, including local officials in charge of public health and government finance. We find significant differences in patient mix: Residents in the communities served by private community health stations are of lower socioeconomic status (more likely to be uninsured and to report poor health), compared to residents in communities served by a government-owned CHS. Analysis of a household survey of 1013 residents shows that they are more willing to do a routine health exam at their neighborhood CHS if they are of low socioeconomic status (as measured either by education or income). Government and private community health stations in Weifang did not statistically differ in their performance on contracted dimensions, after controlling for size and other CHS characteristics. In contrast, the comparison City Y had lower performance and a large gap between public and private providers. We discuss why these patterns arose and what policymakers and residents considered to be the main issues and concerns regarding primary care services. PMID:23327666

  1. Electronic monitoring in combination with direct observation as a means to significantly improve hand hygiene compliance.

    Science.gov (United States)

    Boyce, John M

    2017-05-01

    Monitoring hand hygiene compliance among health care personnel (HCP) is an essential element of hand hygiene promotion programs. Observation by trained auditors is considered the gold standard method for establishing hand hygiene compliance rates. Advantages of observational surveys include the unique ability to establish compliance with all of the World Health Organization "My 5 Moments for Hand Hygiene" initiative Moments and to provide just-in-time coaching. Disadvantages include the resources required for observational surveys, insufficient sample sizes, and nonstandardized methods of conducting observations. Electronic and camera-based systems can monitor hand hygiene performance on all work shifts without a Hawthorne effect and provide significantly more data regarding hand hygiene performance. Disadvantages include the cost of installation, variable accuracy in estimating compliance rates, issues related to acceptance by HCP, insufficient data regarding their cost-effectiveness and influence on health care-related infection rates, and the ability of most systems to monitor only surrogates for Moments 1, 4, and 5. Increasing evidence suggests that monitoring only Moments 1, 4, and 5 provides reasonable estimates of compliance with all 5 Moments. With continued improvement of electronic monitoring systems, combining electronic monitoring with observational methods may provide the best information as part of a multimodal strategy to improve and sustain hand hygiene compliance rates among HCP. Copyright © 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

  2. Does Judge Turnover Affect Judicial Performance?

    DEFF Research Database (Denmark)

    Guerra, Alice; Tagliapietra, Claudio

    2017-01-01

    office to another after three years of mandate, and the law prescribes their transfer after ten years to guarantee their independence. Flaws in the process managing the backlog of outbound judges and the existence of asynchrony between outbound and inbound transfers produce a chain of delays...... to the disposition of court cases. Using a novel dataset on Court of Appeal Districts in Italy (2008–2012), we provide evidence of a strong negative relation between high turnover rates and judicial performance. We find that marginal increases in judge turnover rates lead to a statistically significant decrease...... in judicial performance over two years of time...

  3. Cloud Provider Capacity Augmentation Through Automated Resource Bartering

    OpenAIRE

    Gohera, Syeda ZarAfshan; Bloodsworth, Peter; Rasool, Raihan Ur; McClatchey, Richard

    2018-01-01

    Growing interest in Cloud Computing places a heavy workload on cloud providers which is becoming increasingly difficult for them to manage with their primary datacenter infrastructures. Resource limitations can make providers vulnerable to significant reputational damage and it often forces customers to select services from the larger, more established companies, sometimes at a higher price. Funding limitations, however, commonly prevent emerging and even established providers from making con...

  4. Health service providers in Somalia: their readiness to provide malaria case-management.

    Science.gov (United States)

    Noor, Abdisalan M; Rage, Ismail A; Moonen, Bruno; Snow, Robert W

    2009-05-13

    Studies have highlighted the inadequacies of the public health sector in sub-Saharan African countries in providing appropriate malaria case management. The readiness of the public health sector to provide malaria case-management in Somalia, a country where there has been no functioning central government for almost two decades, was investigated. Three districts were purposively sampled in each of the two self-declared states of Puntland and Somaliland and the south-central region of Somalia, in April-November 2007. A survey and mapping of all public and private health service providers was undertaken. Information was recorded on services provided, types of anti-malarial drugs used and stock, numbers and qualifications of staff, sources of financial support and presence of malaria diagnostic services, new treatment guidelines and job aides for malaria case-management. All settlements were mapped and a semi-quantitative approach was used to estimate their population size. Distances from settlements to public health services were computed. There were 45 public health facilities, 227 public health professionals, and 194 private pharmacies for approximately 0.6 million people in the three districts. The median distance to public health facilities was 6 km. 62.3% of public health facilities prescribed the nationally recommended anti-malarial drug and 37.7% prescribed chloroquine as first-line therapy. 66.7% of public facilities did not have in stock the recommended first-line malaria therapy. Diagnosis of malaria using rapid diagnostic tests (RDT) or microscopy was performed routinely in over 90% of the recommended public facilities but only 50% of these had RDT in stock at the time of survey. National treatment guidelines were available in 31.3% of public health facilities recommended by the national strategy. Only 8.8% of the private pharmacies prescribed artesunate plus sulphadoxine/pyrimethamine, while 53.1% prescribed chloroquine as first-line therapy. 31.4% of

  5. Health service providers in Somalia: their readiness to provide malaria case-management

    Directory of Open Access Journals (Sweden)

    Moonen Bruno

    2009-05-01

    Full Text Available Abstract Background Studies have highlighted the inadequacies of the public health sector in sub-Saharan African countries in providing appropriate malaria case management. The readiness of the public health sector to provide malaria case-management in Somalia, a country where there has been no functioning central government for almost two decades, was investigated. Methods Three districts were purposively sampled in each of the two self-declared states of Puntland and Somaliland and the south-central region of Somalia, in April-November 2007. A survey and mapping of all public and private health service providers was undertaken. Information was recorded on services provided, types of anti-malarial drugs used and stock, numbers and qualifications of staff, sources of financial support and presence of malaria diagnostic services, new treatment guidelines and job aides for malaria case-management. All settlements were mapped and a semi-quantitative approach was used to estimate their population size. Distances from settlements to public health services were computed. Results There were 45 public health facilities, 227 public health professionals, and 194 private pharmacies for approximately 0.6 million people in the three districts. The median distance to public health facilities was 6 km. 62.3% of public health facilities prescribed the nationally recommended anti-malarial drug and 37.7% prescribed chloroquine as first-line therapy. 66.7% of public facilities did not have in stock the recommended first-line malaria therapy. Diagnosis of malaria using rapid diagnostic tests (RDT or microscopy was performed routinely in over 90% of the recommended public facilities but only 50% of these had RDT in stock at the time of survey. National treatment guidelines were available in 31.3% of public health facilities recommended by the national strategy. Only 8.8% of the private pharmacies prescribed artesunate plus sulphadoxine/pyrimethamine, while 53

  6. Impact of audit and feedback and pay-for-performance interventions on pediatric hospitalist discharge communication with primary care providers.

    Science.gov (United States)

    Tejedor-Sojo, Javier; Creek, Tracy; Leong, Traci

    2015-01-01

    The study team sought to improve hospitalist communication with primary care providers (PCPs) at discharge through interventions consisting of (a) audit and feedback and (b) inclusion of a discharge communication measure in the incentive compensation for pediatric hospitalists. The setting was a 16-physician pediatric hospitalist group within a tertiary pediatric hospital. Discharge summaries were selected randomly for documentation of communication with PCPs. At baseline, 57% of charts had documented communication with PCPs, increasing to 84% during the audit and feedback period. Following the addition of a financial incentive, documentation of communication with PCPs increased to 93% and was sustained during the combined intervention period. The number of physicians meeting the study's performance goal increased from 1 to 14 by the end of the study period. A financial incentive coupled with an audit and feedback tool was effective at modifying physician behavior, achieving focused, measurable quality improvement gains. © 2014 by the American College of Medical Quality.

  7. Work domain constraints for modelling surgical performance.

    Science.gov (United States)

    Morineau, Thierry; Riffaud, Laurent; Morandi, Xavier; Villain, Jonathan; Jannin, Pierre

    2015-10-01

    Three main approaches can be identified for modelling surgical performance: a competency-based approach, a task-based approach, both largely explored in the literature, and a less known work domain-based approach. The work domain-based approach first describes the work domain properties that constrain the agent's actions and shape the performance. This paper presents a work domain-based approach for modelling performance during cervical spine surgery, based on the idea that anatomical structures delineate the surgical performance. This model was evaluated through an analysis of junior and senior surgeons' actions. Twenty-four cervical spine surgeries performed by two junior and two senior surgeons were recorded in real time by an expert surgeon. According to a work domain-based model describing an optimal progression through anatomical structures, the degree of adjustment of each surgical procedure to a statistical polynomial function was assessed. Each surgical procedure showed a significant suitability with the model and regression coefficient values around 0.9. However, the surgeries performed by senior surgeons fitted this model significantly better than those performed by junior surgeons. Analysis of the relative frequencies of actions on anatomical structures showed that some specific anatomical structures discriminate senior from junior performances. The work domain-based modelling approach can provide an overall statistical indicator of surgical performance, but in particular, it can highlight specific points of interest among anatomical structures that the surgeons dwelled on according to their level of expertise.

  8. Test for the statistical significance of differences between ROC curves

    International Nuclear Information System (INIS)

    Metz, C.E.; Kronman, H.B.

    1979-01-01

    A test for the statistical significance of observed differences between two measured Receiver Operating Characteristic (ROC) curves has been designed and evaluated. The set of observer response data for each ROC curve is assumed to be independent and to arise from a ROC curve having a form which, in the absence of statistical fluctuations in the response data, graphs as a straight line on double normal-deviate axes. To test the significance of an apparent difference between two measured ROC curves, maximum likelihood estimates of the two parameters of each curve and the associated parameter variances and covariance are calculated from the corresponding set of observer response data. An approximate Chi-square statistic with two degrees of freedom is then constructed from the differences between the parameters estimated for each ROC curve and from the variances and covariances of these estimates. This statistic is known to be truly Chi-square distributed only in the limit of large numbers of trials in the observer performance experiments. Performance of the statistic for data arising from a limited number of experimental trials was evaluated. Independent sets of rating scale data arising from the same underlying ROC curve were paired, and the fraction of differences found (falsely) significant was compared to the significance level, α, used with the test. Although test performance was found to be somewhat dependent on both the number of trials in the data and the position of the underlying ROC curve in the ROC space, the results for various significance levels showed the test to be reliable under practical experimental conditions

  9. Human performance modeling for system of systems analytics: combat performance-shaping factors.

    Energy Technology Data Exchange (ETDEWEB)

    Lawton, Craig R.; Miller, Dwight Peter

    2006-01-01

    The US military has identified Human Performance Modeling (HPM) as a significant requirement and challenge of future systems modeling and analysis initiatives. To support this goal, Sandia National Laboratories (SNL) has undertaken a program of HPM as an integral augmentation to its system-of-system (SoS) analytics capabilities. The previous effort, reported in SAND2005-6569, evaluated the effects of soldier cognitive fatigue on SoS performance. The current effort began with a very broad survey of any performance-shaping factors (PSFs) that also might affect soldiers performance in combat situations. The work included consideration of three different approaches to cognition modeling and how appropriate they would be for application to SoS analytics. This bulk of this report categorizes 47 PSFs into three groups (internal, external, and task-related) and provides brief descriptions of how each affects combat performance, according to the literature. The PSFs were then assembled into a matrix with 22 representative military tasks and assigned one of four levels of estimated negative impact on task performance, based on the literature. Blank versions of the matrix were then sent to two ex-military subject-matter experts to be filled out based on their personal experiences. Data analysis was performed to identify the consensus most influential PSFs. Results indicate that combat-related injury, cognitive fatigue, inadequate training, physical fatigue, thirst, stress, poor perceptual processing, and presence of chemical agents are among the PSFs with the most negative impact on combat performance.

  10. High Performing Greenways Design: A Case Study of Gainesville, GA

    OpenAIRE

    AKPINAR, Abdullah

    2015-01-01

    Greenways play a significant role in structuring and developing our living environment in urban as well as suburban areas. They provide many recreational, environmental, ecological, social, educational, and economical benefits to cities. This article questions what makes high performing greenways by exploring the concept, history, and development of greenways in the United States. The paper illustrates the concept of linked open spaces and high performing urban greenways in residential commun...

  11. High Performing Greenways Design: A Case Study of Gainesville, GA

    OpenAIRE

    AKPINAR, Abdullah

    2014-01-01

    Greenways play a significant role in structuring and developing our living environment in urban as well as suburban areas. They provide many recreational, environmental, ecological, social, educational, and economical benefits to cities. This article questions what makes high performing greenways by exploring the concept, history, and development of greenways in the United States. The paper illustrates the concept of linked open spaces and high performing urban greenways in residential commun...

  12. Mixing students and performance artists to provide innovative ways of communicating scientific research

    Science.gov (United States)

    van Manen, S. M.

    2007-12-01

    In May 2007 the Open University (U.K.) in conjunction with the MK (Milton Keynes) Gallery invited performance artists Noble and Silver to work with a group of students to design innovative methods of disseminating their research to a general audience. The students created a multitude of well-received live and multimedia performances based on their research. Students found they greatly benefited from the artists' and each others' different viewpoints and backgrounds, resulting in improved communication skills and varying interpretations of their own topic of interest. This work focuses on research aimed at identifying precursory activity at volcanoes using temperature, earthquake and ground movement data, to aid improvement of early warning systems. For this project an aspect of the research relevant to the public was chosen: the importance of appropriately timed warnings regarding the possibility of an eruption. If a warning is issued too early it may cause complacency and apathy towards the situation, whereas issuing a warning too late may endanger lives and property. An interactive DVD was produced which leads the user through the events preceding a volcanic eruption. The goal is to warn the public about the impending eruption at the most appropriate time. Data is presented in short film clips, after which questions are posed. Based on the player's answers the consequences or follow-up events of the choices are explored. We aim to improve and expand upon this concept in the near future, as well as making the DVD available to schools for educational purposes.

  13. TIME-BASED COMPETITION IN THE SUPPLY-CHAIN: THE ROLE OF THE LOGISTICS SERVICE PROVIDERS

    Directory of Open Access Journals (Sweden)

    Judit OLÁH

    2018-05-01

    Full Text Available Among the service industries, the analysis logistics as an academic field which has a great influence on firms’ creation of value and competitiveness, and within this the analysis of firms providing logistics services (3PLP, has become more relevant than in previous years. Among the expectations of logistics service providers, and among the sources of competitive advantage, are timeliness and flexibility, which can only be handled and measured together, because of the integration of services. At the same time, when supply chains (not corporations compete with each other, we must create the opportunity to manage chains beyond company boundaries. Our aim is to investigate the time-related problems of supply chains (and sections and logistics service providers, and their consequences and solutions. We have found that the development of time factors which appear and can be measured in the realization of logistics services contributes to the competitiveness of a logistics service company. The performance provided by companies that are integrated into the supply chain’s member companies and operate as flexible logistics service providers can have a significant impact on the (full operation and efficiency of the supply chain.

  14. Performance of the measures of processes of care for adults and service providers in rehabilitation settings.

    Science.gov (United States)

    Bamm, Elena L; Rosenbaum, Peter; Wilkins, Seanne; Stratford, Paul

    2015-01-01

    In recent years, client-centered care has been embraced as a new philosophy of care by many organizations around the world. Clinicians and researchers have identified the need for valid and reliable outcome measures that are easy to use to evaluate success of implementation of new concepts. The current study was developed to complete adaptation and field testing of the companion patient-reported measures of processes of care for adults (MPOC-A) and the service provider self-reflection measure of processes of care for service providers working with adult clients (MPOC-SP(A)). A validation study. In-patient rehabilitation facilities. MPOC-A and measure of processes of care for service providers working with adult clients (MPOC-SP(A)). Three hundred and eighty-four health care providers, 61 patients, and 16 family members completed the questionnaires. Good to excellent internal consistency (0.71-0.88 for health care professionals, 0.82-0.90 for patients, and 0.87-0.94 for family members), as well as moderate to good correlations between domains (0.40-0.78 for health care professionals and 0.52-0.84 for clients) supported internal reliability of the tools. Exploratory factor analysis of the MPOC-SP(A) responses supported the multidimensionality of the questionnaire. MPOC-A and MPOC-SP(A) are valid and reliable tools to assess patient and service-provider accounts, respectively, of the extent to which they experience, or are able to provide, client-centered service. Research should now be undertaken to explore in more detail the relationships between client experience and provider reports of their own behavior.

  15. Evaluating health service quality: using importance performance analysis.

    Science.gov (United States)

    Izadi, Azar; Jahani, Younes; Rafiei, Sima; Masoud, Ali; Vali, Leila

    2017-08-14

    Purpose Measuring healthcare service quality provides an objective guide for managers and policy makers to improve their services and patient satisfaction. Consequently, the purpose of this paper is to measure service quality provided to surgical and medical inpatients at Kerman Medical Sciences University (KUMS) in 2015. Design/methodology/approach A descriptive-analytic study, using a cross-sectional method in the KUMS training hospitals, was implemented between October 2 and March 15, 2015. Using stratified random sampling, 268 patients were selected. Data were collected using an importance-performance analysis (IPA) questionnaire, which measures current performance and determines each item's importance from the patients' perspectives. These data indicate overall satisfaction and appropriate practical strategies for managers to plan accordingly. Findings Findings revealed a significant gap between service importance and performance. From the patients' viewpoint, tangibility was the highest priority (mean=3.54), while reliability was given the highest performance (mean=3.02). The least important and lowest performance level was social accountability (mean=1.91 and 1.98, respectively). Practical implications Healthcare managers should focus on patient viewpoints and apply patient comments to solve problems, improve service quality and patient satisfaction. Originality/value The authors applied an IPA questionnaire to measure service quality provided to surgical and medical ward patients. This method identifies and corrects service quality shortcomings and improving service recipient perceptions.

  16. Systemic racism moderates effects of provider racial biases on adherence to hypertension treatment for African Americans.

    Science.gov (United States)

    Greer, Tawanda M; Brondolo, Elizabeth; Brown, Porschia

    2014-01-01

    The purpose of the current study was to examine perceived exposure to systemic racism as a moderator of the effects of perceived exposure to provider racial biases on treatment adherence and mistrust of health care for a sample of African American hypertensive patients. We hypothesized that patients who endorsed high levels of systemic racism would exhibit poor adherence to hypertension treatment and increased mistrust in health care in relation to perceptions of exposure to provider racial biases. The sample consisted of 100 African American patients who ranged in age from 24 to 82 years. All were diagnosed with hypertension and were recruited from an outpatient clinic located in the Southeastern region of the United States. Moderated regression analyses were performed to test the study hypotheses. Findings revealed a positive, significant main effect for perceived provider racial biases in predicting mistrust of care. This finding suggested that an increase in mistrust of health care was associated with increased perceptions of provider biases. In predicting treatment adherence, a significant interaction revealed that patients who endorsed low and moderate degrees of exposure to systemic racism displayed poor adherence to treatment in relation to greater perceptions of provider racial biases. The overall findings suggest that patients who perceive themselves as infrequently exposed to systemic racism possess the greatest risk for nonadherence to hypertension treatment in relation to increased perceptions of provider racial biases. Implications of the findings are discussed. 2014 APA, all rights reserved

  17. Documentation of daily sit-to-stands performed by community-dwelling adults.

    Science.gov (United States)

    Bohannon, Richard W; Barreca, Susan R; Shove, Megan E; Lambert, Cynthia; Masters, Lisa M; Sigouin, Christopher S

    2008-01-01

    No information exists about how many sit-to-stands (STSs) are performed daily by community-dwelling adults. We, therefore, examined the feasibility of using a tally counter to document daily STSs, documented the number of daily STSs performed, and determined if the number of STSs was influenced by demographic or health variables. Ninety-eight community-dwelling adults (19-84 years) agreed to participate. After providing demographic and health information, subjects used a tally counter to document the number of STSs performed daily for 7 consecutive days. All but two subjects judged their counter-documented STS number to be accurate. Excluding data from these and two other subjects, the mean number of STSs for subjects was 42.8 to 49.3, depending on the day. The number was significantly higher on weekdays than weekends. No demographic or health variable was significantly related to the number of STSs in univariate or multivariate analysis. In conclusion, this study suggests that a tally counter may be a practical aid to documenting STS activity. The STS repetitions recorded by the counter in this study provide an estimate of the number of STSs that community-dwelling adults perform daily.

  18. Efficiency and hospital effectiveness in improving Hospital Consumer Assessment of Healthcare Providers and Systems ratings.

    Science.gov (United States)

    Al-Amin, Mona; Makarem, Suzanne C; Rosko, Michael

    2016-01-01

    Efficiency has emerged as a central goal to the operations of health care organizations. There are two competing perspectives on the relationship between efficiency and organizational performance. Some argue that organizational slack is a waste and that efficiency contributes to organizational performance, whereas others maintain that slack acts as a buffer, allowing organizations to adapt to environmental demands and contributing to organizational performance. As value-based purchasing becomes more prevalent, health care organizations are incented to become more efficient and, at the same time, improve their patients' experiences and outcomes. Unused slack resources might facilitate the timely implementation of these improvements. Building on previous research on organizational slack and inertia, we test whether efficiency and other organizational factors predict organizational effectiveness in improving Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) ratings. We rely on data from the American Hospital Association and HCAHPS. We estimate hospital cost-efficiency by Stochastic Frontier Analysis and use regression analysis to determine whether efficiency, competition, hospital size, and other organizational factors are significant predictors of hospital effectiveness. Our findings indicate that efficiency and hospital size have a significant negative association with organizational ability to improve HCAHPS ratings. Although achieving organizational efficiency is necessary for health care organizations, given the changes that are currently occurring in the U.S. health care system, it is important for health care managers to maintain a certain level of slack to respond to environmental demands and have the resources needed to improve their performance.

  19. Work experience, job-fulfillment and burnout among VMMC providers in Kenya, South Africa, Tanzania and Zimbabwe.

    Directory of Open Access Journals (Sweden)

    Linnea Perry

    Full Text Available BACKGROUND: Human resource capacity is vital to the scale-up of voluntary medical male circumcision (VMMC services. VMMC providers are at risk of "burnout" from performing a single task repeatedly in a high volume work environment that produces long work hours and intense work effort. METHODS AND FINDINGS: The Systematic Monitoring of the Voluntary Medical Male Circumcision Scale-up (SYMMACS surveyed VMMC providers in Kenya, South Africa, Tanzania, and Zimbabwe in 2011 (n = 357 and 2012 (n = 591. Providers self-reported on their training, work experience, levels of job-fulfillment and work fatigue/burnout. Data analysis included a descriptive analysis of VMMC provider characteristics, and both bivariate and multivariate analyses of factors associated with provider work fatigue/burnout. In 2012, Kenyan providers had worked in VMMC for a median of 31 months compared to South Africa (10 months, Tanzania (15 months, and Zimbabwe (11 months. More than three-quarters (78 - 99% of providers in all countries in 2012 reported that VMMC is a personally fulfilling job. However, 67% of Kenyan providers reported starting to experience work fatigue/burnout compared to South Africa (33%, Zimbabwe (17%, and Tanzania (15%. Despite the high level of work fatigue/burnout in Kenya, none of the measured factors (i.e., gender, age, full-time versus part-time status, length of service, number of operations performed, or cadre were significantly associated with work fatigue/burnout in 2011. In 2012, logistic regression found increases in age (p<.05 and number of months working in VMMC (p<.01 were associated with an increased likelihood of experiencing work fatigue/burnout, while higher career total VMMCs decreased the likelihood of experiencing burnout. CONCLUSION: Given cross-country differences, further elucidation of cultural and other contextual factors that may influence provider burnout is required. Continuing to emphasize the contribution that providers make in

  20. The Augmented Performer and the Performative Augmentation

    DEFF Research Database (Denmark)

    Kallionpaa, Maria; Gasselseder, Hans-Peter

    2016-01-01

    Composers, performers, and listeners usually regard musical compositions as unchangeable entities, which limits the composition techniques and decreases the originality of performers ́ interpretations, thus leading to a stagnation of classical music culture. The significance and possibilities of ...

  1. CSR organisational taxonomy and job characteristics on performance: SME case studies

    Directory of Open Access Journals (Sweden)

    Thanalechumy Seeramulu

    2017-05-01

    Full Text Available This study examines the relationship between the CSR of organizational structure and job characteristics that influence employee job performance in the Malaysian context. Hence, it is important to study and analyze these two factors within the CSR taxonomy describing how these factors significantly influence employee job performance and to make recommendations how performance can be promoted among employees. This paper is based on a quantitative research approach where responses were gathered from the working population within Malaysia SMEs. The results from this study will help to point out the influence of these factors on the employee job performance and provide guidance to an organization for which these aspects should be emphasized in order to increase employees’ job performance to align performance with organizational goals. The analysis includes two dimensions of CSR taxonomy of organizational structure namely, centralization and formalization, as well as a set of five dimensions of job characteristics, such as task identity, task significance, skill variety, autonomy and feedback. The results of these findings show that job characteristics such as task significance, autonomy, feedback, and skill variety, positively influence job performance with autonomy having highest predictive power on job performance. The results of these findings reveal that the organizational structure does not contribute to the prediction of job performance even though a significant positive correlation exists between the structure and job performance in the Pearson correlation coefficient test. Therefore, this study will enrich the existing knowledge in the area of human resource management by focusing on job performance management.

  2. Improving Compressed Air System Performance: A Sourcebook for Industry v3

    Energy Technology Data Exchange (ETDEWEB)

    Ron Marshall, William Scales, Gary Shafer, Paul Shaw, Paul Sheaffer, Rick Stasyshan, H.P.

    2016-03-01

    This sourcebook is designed to provide compressed air system users with a reference that outlines opportunities for system performance improvements. It is not intended to be a comprehensive technical text on improving compressed air systems, but rather a document that makes compressed air system users aware of the performance improvement potential, details some of the significant opportunities, and directs users to additional sources of assistance.

  3. Progress on high-performance rapid prototype aluminum mirrors

    Science.gov (United States)

    Woodard, Kenneth S.; Myrick, Bruce H.

    2017-05-01

    Near net shape parts can be produced using some very old processes (investment casting) and the relatively new direct metal laser sintering (DMLS) process. These processes have significant advantages for complex blank lightweighting and costs but are not inherently suited for producing high performance mirrors. The DMLS process can provide extremely complex lightweight structures but the high residual stresses left in the material results in unstable mirror figure retention. Although not to the extreme intricacy of DMLS, investment casting can also provide complex lightweight structures at considerably lower costs than DMLS and even conventional wrought mirror blanks but the less than 100% density for casting (and also DMLS) limits finishing quality. This paper will cover the progress that has been made to make both the DMLS and investment casting processes into viable near net shape blank options for high performance aluminum mirrors. Finish and figure results will be presented to show performance commensurate with existing conventional processes.

  4. Is valve choice a significant determinant of paravalular leak post-transcatheter aortic valve implantation? A systematic review and meta-analysis.

    LENUS (Irish Health Repository)

    O'Sullivan, Katie E

    2013-11-01

    Paravalvular regurgitation (PVR) following transcatheter aortic valve implantation (TAVI) is associated with poor survival. The two main valve delivery systems used to date differ significantly in both structure and deployment technique. The primary objective of this study was to perform a systematic review and meta-analysis of studies identifying PVR in patients post-TAVI using Medtronic CoreValve (MCV) and Edward Sapien (ES) valves in order to identify whether a significant difference exists between valve types. The secondary objective was to identify additional factors predisposing to PVR to provide an overview of the other associated considerations.

  5. Age and inconsistency in driving performance.

    Science.gov (United States)

    Bunce, David; Young, Mark S; Blane, Alison; Khugputh, Priya

    2012-11-01

    Research in cognitive neuropsychology suggests that investigation of the within-person variability, or inconsistency, of cognitive performance may provide valuable insights into ageing mental processes. It is rare though, for this interest in intraindividual variability to extend to everyday activities. As this may provide important information about driving behaviour, we therefore assessed age differences in driving inconsistency in younger (n=24, M age=21.29 years) and older (n=21, M age=71.24 years) persons who drove in residential, urban and motorway conditions in a fully immersive driving simulator. In measures of headway (maintaining a safe distance to a preceding vehicle) and lateral lane position, older drivers exhibited significantly greater performance inconsistency, and this was particularly marked in the faster motorway condition. Older drivers also recorded greater perceived mental demands associated with driving, and greater within-person variability across a range of cognitive measures. The findings suggest that age-related deficits in attentional and executive control may affect the consistency of driving performance in older persons. Discussion considers interventions to introduce in-vehicle systems to help maintain attention in older drivers, and to intervene when safety-critical boundaries are exceeded. Copyright © 2012 Elsevier Ltd. All rights reserved.

  6. CEO performance appraisal: review and recommendations.

    Science.gov (United States)

    Newman, J F; Tyler, L; Dunbar, D M

    2001-01-01

    CEO performance appraisal (PA) is very valuable to an organization, but the chances of obtaining a PA of high quality decrease as executive responsibility increases. The realities of CEO PA are that it: (1) is inevitable; (2) is creative and complex; (3) involves politics; and (4) has a significant effect on the organization and the executive. PA is conducted for legal and social requirements, to enhance communication, to provide opportunities for improvement, and to relate performance to compensation. This article discusses several problems with chief executive officer (CEO) PA and the contemporary approaches that seek to improve it. Three fundamental areas for evaluation are identified: (1) organizational success; (2) areawide health status; and (3) professional role fulfillment. These provide an outline for successful healthcare PA. In addition to a discussion of the strategic considerations behind a successful CEO PA system, several recommendations are offered for the implementation of the annual evaluation process. The final goal of CEO PA is to link its results to CEO incentive compensation. It is strongly recommended that some portion of the CEO's salary directly hinge on his performance in two critical areas: organizational effectiveness and community health status.

  7. Application of selected advanced technologies to high performance, single-engine, business airplanes

    Science.gov (United States)

    Domack, C. S.; Martin, G. L.

    1984-01-01

    Improvements in performance and fuel efficiency are evaluated for five new configurations of a six place, single turboprop, business airplane derived from a conventional, aluminum construction baseline aircraft. Results show the greatest performance gains for enhancements in natural laminar flow. A conceptual diesel engine provides greater fuel efficiency but reduced performance. Less significant effects are produced by the utilization of composite materials construction or by reconfiguration from tractor to pusher propeller installation.

  8. Production Systems and their Business Performance in Iran

    Directory of Open Access Journals (Sweden)

    alireza pooya

    2012-06-01

    Full Text Available Taxonomic studies in manufacturing not only give appropriate description of dominated organizational groups, but also provide necessary context for more special studies and theory building in subjects such as performance evaluation and manufacturing decision making. Available taxonomic investigations on manufacturing systems are limited. In this paper, taxonomic study of manufacturing systems has been performed based on nine decision categories in Iran. K-mean cluster analysis has been used and four clusters have been identified as industry average, world class, less developed and developed. Their business performance has been also studied. Findings imply that only the less developed cluster has significant difference in business performance from other clusters. Justification of the four clusters has been discussed and finally, limitations and suggestions have been addressed.

  9. Improving Mobility Performance in Wheelchair Basketball.

    Science.gov (United States)

    Veeger, Thom T J; De Witte, Annemarie M H; Berger, Monique A M; Van Der Slikke, Rienk M A; Veeger, Dirkjan H E J; Hoozemans, Marco J M

    2017-10-16

    This study aimed to investigate which characteristics of athlete, wheelchair and athlete-wheelchair interface are the best predictors of wheelchair basketball mobility performance. Sixty experienced wheelchair basketball players performed a wheelchair mobility performance test to assess their mobility performance. To determine which variables were the best predictors of mobility performance, forward stepwise linear regression analyses were performed on a set of 33 characteristics, including ten athlete, nineteen wheelchair and four athlete-wheelchair interface characteristics. Eight of the characteristics turned out to be significant predictors of wheelchair basketball mobility performance. Classification, experience, maximal isometric force, wheel axis height and hand rim diameter - which both interchangeable with each other and wheel diameter - camber angle, and the vertical distance between shoulder and rear wheel axis - which was interchangeable with seat height - were positively associated with mobility performance. The vertical distance between the front seat and the footrest was negatively associated with mobility performance. With this insight, coaches and biomechanical specialists are provided with statistical findings to determine which characteristics they could focus on best to improve mobility performance. Six out of eight predictors are modifiable and can be optimized to improve mobility performance. These adjustments could be carried out both in training (maximal isometric force) and in wheelchair configurations (e.g. camber angle).

  10. High performance MEAs. Final report

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2012-07-15

    The aim of the present project is through modeling, material and process development to obtain significantly better MEA performance and to attain the technology necessary to fabricate stable catalyst materials thereby providing a viable alternative to current industry standard. This project primarily focused on the development and characterization of novel catalyst materials for the use in high temperature (HT) and low temperature (LT) proton-exchange membrane fuel cells (PEMFC). New catalysts are needed in order to improve fuel cell performance and reduce the cost of fuel cell systems. Additional tasks were the development of new, durable sealing materials to be used in PEMFC as well as the computational modeling of heat and mass transfer processes, predominantly in LT PEMFC, in order to improve fundamental understanding of the multi-phase flow issues and liquid water management in fuel cells. An improved fundamental understanding of these processes will lead to improved fuel cell performance and hence will also result in a reduced catalyst loading to achieve the same performance. The consortium have obtained significant research results and progress for new catalyst materials and substrates with promising enhanced performance and fabrication of the materials using novel methods. However, the new materials and synthesis methods explored are still in the early research and development phase. The project has contributed to improved MEA performance using less precious metal and has been demonstrated for both LT-PEM, DMFC and HT-PEM applications. New novel approach and progress of the modelling activities has been extremely satisfactory with numerous conference and journal publications along with two potential inventions concerning the catalyst layer. (LN)

  11. High performance work practices, innovation and performance

    DEFF Research Database (Denmark)

    Jørgensen, Frances; Newton, Cameron; Johnston, Kim

    2013-01-01

    Research spanning nearly 20 years has provided considerable empirical evidence for relationships between High Performance Work Practices (HPWPs) and various measures of performance including increased productivity, improved customer service, and reduced turnover. What stands out from......, and Africa to examine these various questions relating to the HPWP-innovation-performance relationship. Each paper discusses a practice that has been identified in HPWP literature and potential variables that can facilitate or hinder the effects of these practices of innovation- and performance...

  12. A systematic literature review on first aid provided by laypeople to trauma victims.

    Science.gov (United States)

    Tannvik, T D; Bakke, H K; Wisborg, T

    2012-11-01

    Death from trauma is a significant and international problem. Outcome for patients suffering out-of-hospital cardiac arrests is significantly improved by early cardiopulmonary resuscitation. The usefulness of first aid given by laypeople in trauma is less well established. The aim of this study was to review the existing literature on first aid provided by laypeople to trauma victims and to establish how often first aid is provided, if it is performed correctly, and its impact on outcome. A systematic review was carried out, according to preferred reporting items for systematic reviews and meta-analysis (PRISMA) guidelines, of all studies involving first aid provided by laypeople to trauma victims. Cochrane, Embase, Medline, Pubmed, and Google Scholar databases were systematically searched. Ten eligible articles were identified involving a total of 5836 victims. Eight studies were related to patient outcome, while two studies were simulation based. The proportion of patients who received first aid ranged from 10.7% to 65%. Incorrect first aid was given in up to 83.7% of cases. Airway handling and haemorrhage control were particular areas of concern. One study from Iraq investigated survival and reported a 5.8% reduction in mortality. Two retrospective autopsy-based studies estimated that correct first aid could have reduced mortality by 1.8-4.5%. There is limited evidence regarding first aid provided by laypeople to trauma victims. Due to great heterogeneity in the studies, firm conclusions can not be drawn. However, the results show a potential mortality reduction if first aid is administered to trauma victims. Further research is necessary to establish this. © 2012 The Authors. Acta Anaesthesiologica Scandinavica © 2012 The Acta Anaesthesiologica Scandinavica Foundation.

  13. Fuel performance annual report for 1991. Volume 9

    International Nuclear Information System (INIS)

    Painter, C.L.; Alvis, J.M.; Beyer, C.E.; Marion, A.L.; Kendrick, E.D.

    1994-08-01

    This report is the fourteenth in a series that provides a compilation of information regarding commercial nuclear fuel performance. The series of annual reports were developed as a result of interest expressed by the public, advising bodies, and the US Nuclear Regulatory Commission (NRC) for public availability of information pertaining to commercial nuclear fuel performance. During 1991, the nuclear industry's focus regarding fuel continued to be on extending burnup while maintaining fuel rod reliability. Utilities realize that high-burnup fuel reduces the amount of generated spent fuel, reduces fuel costs, reduces operational and maintenance costs, and improves plant capacity factors by extending operating cycles. Brief summaries of fuel operating experience, fuel design changes, fuel surveillance programs, high-burnup experience, problem areas, and items of general significance are provided

  14. Early Observations on the Performance of Windows Azure

    Directory of Open Access Journals (Sweden)

    Zach Hill

    2011-01-01

    Full Text Available A significant open issue in cloud computing is the real performance of the infrastructure. Few, if any, cloud providers or technologies offer quantitative performance guarantees. Regardless of the potential advantages of the cloud in comparison to enterprise-deployed applications, cloud infrastructures may ultimately fail if deployed applications cannot predictably meet behavioral requirements. In this paper, we present the results of comprehensive performance experiments we conducted on Windows Azure from October 2009 to February 2010. In general, we have observed good performance of the Windows Azure mechanisms, although the average 10 min VM startup time must be accounted for in application design. We also present performance and reliability observations and analysis from our deployment of a large-scale scientific application hosted on Azure, called ModisAzure, that show unusual and sporadic VM execution slowdown of over 4× in some cases and affected up to 16% of task executions at times. In addition to a detailed performance evaluation of Windows Azure, we provide recommendations for potential users of Windows Azure based on these early observations. Although the discussion and analysis is tailored to scientific applications, the results are broadly applicable to the range of existing and future applications running in Windows Azure.

  15. Analisa Kinerja Jaringan Provider untuk Aplikasi Video Chatting (Studi Kasus di Daerah Marpoyan)

    OpenAIRE

    Danur, Jeri Dwi; ', Febrizal '

    2016-01-01

    Video chat is a communication that allows users to chat and can see the other person's face directly. Video chatting requires a good network to transmit audio and video data in a short time. This paper examines the performance of three mobile network provider (Provider A and Provider B Provider C) in a video chat in the area Marpoyan and the effect of time when doing video chat on the performance of each provider. The method used is the method using packet sniffing software wireshark to see Q...

  16. Relationship of Ethical Leadership, Corporate Social Responsibility and Organizational Performance

    Directory of Open Access Journals (Sweden)

    Min-Seong Kim

    2018-02-01

    Full Text Available Corporate social responsibility (CSR has become a major part of the foodservice industry due to external forces which encourage enterprises’ responsiveness. In reality, consumers’ social concern influences their attitudes towards foodservice firms’ socially responsible practices and purchase decisions, thereby influencing senior management to react. Considering this issue, this study examines the impact of senior management’s ethical leadership in evaluating operational, commercial, and economic performances along with the mediating role of CSR in the foodservice industry. A conceptual model was formulated and empirically tested based on responses from 196 foodservice franchise firms in South Korea. The results indicated ethical leadership significantly influenced CSR and operational performance, while CSR also had a positive effect on operational and commercial performances. Additionally, operational performance had a significantly positive influence on commercial performance, which subsequently enhanced economic performance. Overall, the findings highlight the role that ethical leadership exhibited by senior management of foodservice franchises influenced initiation of CSR activities, which provide implications for research and industry practice and is outlined.

  17. Provider-to-Provider Communication during Transitions of Care from Outpatient to Acute Care: A Systematic Review.

    Science.gov (United States)

    Luu, Ngoc-Phuong; Pitts, Samantha; Petty, Brent; Sawyer, Melinda D; Dennison-Himmelfarb, Cheryl; Boonyasai, Romsai Tony; Maruthur, Nisa M

    2016-04-01

    Most research on transitions of care has focused on the transition from acute to outpatient care. Little is known about the transition from outpatient to acute care. We conducted a systematic review of the literature on the transition from outpatient to acute care, focusing on provider-to-provider communication and its impact on quality of care. We searched the MEDLINE, CINAHL, Scopus, EMBASE, and Cochrane databases for English-language articles describing direct communication between outpatient providers and acute care providers around patients presenting to the emergency department or admitted to the hospital. We conducted double, independent review of titles, abstracts, and full text articles. Conflicts were resolved by consensus. Included articles were abstracted using standardized forms. We maintained search results via Refworks (ProQuest, Bethesda, MD). Risk of bias was assessed using a modified version of the Downs' and Black's tool. Of 4009 citations, twenty articles evaluated direct provider-to-provider communication around the outpatient to acute care transition. Most studies were cross-sectional (65%), conducted in the US (55%), and studied communication between primary care and inpatient providers (62%). Of three studies reporting on the association between communication and 30-day readmissions, none found a significant association; of these studies, only one reported a measure of association (adjusted OR for communication vs. no communication, 1.08; 95% CI 0.92-1.26). The literature on provider-to-provider communication at the transition from outpatient to acute care is sparse and heterogeneous. Given the known importance of communication for other transitions of care, future studies are needed on provider-to-provider communication during this transition. Studies evaluating ideal methods for communication to reduce medical errors, utilization, and optimize patient satisfaction at this transition are especially needed.

  18. Haemoglobin variants may cause significant differences in haemoglobin A1c as measured by high-performance liquid chromatography and enzymatic methods in diabetic patients: a cross-sectional study.

    Science.gov (United States)

    Otabe, Shuichi; Nakayama, Hitomi; Ohki, Tsuyoshi; Soejima, Eri; Tajiri, Yuji; Yamada, Kentaro

    2017-07-01

    Background We aimed to determine whether the discrepancy between haemoglobin A1c values determined by high-performance liquid chromatography and enzymatic haemoglobin A1c measurements in diabetic patients was clinically relevant. Methods We randomly recruited 1421 outpatients undergoing diabetic treatment and follow-up who underwent at least three haemoglobin A1c measurements between April 2014 and March 2015 at our clinic. In 6369 samples, haemoglobin A1c was simultaneously measured by HA-8160 and MetaboLead (enzymatic assay), and the values were compared. Results haemoglobin A1c measurements by high-performance liquid chromatography and enzymatic assay were strongly correlated (correlation coefficient: 0.9828, linear approximation curve y = 0.9986x - 0.2507). Mean haemoglobin A1c (6.8 ± 1.0%) measured by high-performance liquid chromatography was significantly higher than that measured by enzymatic assay (6.5 ± 1.0%, P liquid chromatography than those from enzymatic assay. Of these, three had Hb Toranomon [β112 (G14) Cys→Trp]. The fourth had Hb Ube-2 [α68 (E17) Asn→Asp]. One other subject presented consistently higher haemoglobin A1c values (>1%) by high-performance liquid chromatography than those from enzymatic assay and was diagnosed with a -77 (T > C) mutation in the δ-globin gene. These unrelated asymptomatic subjects had normal erythrocyte profiles, without anaemia. Conclusions We showed that haemoglobin A1c values measured by high-performance liquid chromatography were significantly higher than those measured by enzymatic assay in diabetic subjects. However, when an oversized deviation (>0.7%) between glycaemic control status and haemoglobin A1c is apparent, clinicians should check the methods used to measure haemoglobin A1c and consider the possible presence of a haemoglobin variant.

  19. Does Tax Haven FDI Influence Firm Performance?

    OpenAIRE

    Dewit, Gerda; Jones, Chris; Leahy, Dermot

    2017-01-01

    This paper provides theoretical and empirical evidence of the link between the use of tax haven subsidiaries by multinational enterprises (MNEs) and firm performance, as measured by total factor productivity. We find that the use of tax havens has no impact on economic dynamism for a sample of MNEs from across the OECD. Our results have significant policy implications in terms of the role of tax havens in the world economy.

  20. [Nutritional risk screening and its clinical significance in 706 children hospitalized in the surgical department].

    Science.gov (United States)

    Peng, Lu-Ting; Li, Rong; Zhao, Wei-Hua; Chen, Yin-Hua; Li, Xiao-Mei; Chen, Meng-Ying; Cao, Jia; Li, Xiao-Nan

    2013-10-01

    To investigate nutritional risk and its relationship with clinical outcome in children hospitalized in the surgical department, and to provide a scientific basis for clinical nutrition management. Nutritional risk screening was performed on 706 children hospitalized in the surgical department using the Screening Tool for Risk on Nutritional Status and Growth. The data on nutritional support during hospitalization, incidence of infectious complications, length of hospital stay, post operative length of hospital stay and total hospital expenses were recorded. Of the 706 cases, 11.5% had high nutritional risk, 46.0% had moderate nutritional risk, and 42.5% had low nutritional risk. Congenital hypertrophic pyloric stenosis, intestinal obstruction and congenital heart disease were the three most common types of high nutritional risk. The incidence of high nutritional risk was significantly higher in infants than in other age groups (Pnutritional risk received parenteral nutrition. Children with high nutritional risk were significantly more likely to have weight loss than children with low nutritional risk (Pnutritional risk had significantly increased incidence of infectious complications, length of hospital stay, post operative length of hospital stay and total hospital expenses compared with those with moderate or low nutritional risk (Pnutritional risk is seen in children hospitalized in the surgical department. Nutritional risk score is correlated with clinical outcome. Nutritional support for these children is not yet properly provided. Nutritional risk screening and standard nutritional support should be widely applied among hospitalized children.

  1. Performance of Syariah and Composite Indices: Evidence from Bursa Malaysia

    OpenAIRE

    Mohamed Albaity; Rubi Ahmad

    2008-01-01

    This study provides new evidence on the risk and return performance of the Kuala Lumpur Syariah Index (KLSI) and the Kuala Lumpur Composite Index (KLCI). An Islamic stock market index such as KLSI selects stocks according to Islamic laws, and thus has a more stringent screening process than its conventional counterpart, KLCI. Our results, however, provide no evidence of significant statistical differences in risk-adjusted returns between Islamic and conventional stock market indices during 19...

  2. Performance and Costs of Ductless Heat Pumps in Marine-Climate High-Performance Homes -- Habitat for Humanity The Woods

    Energy Technology Data Exchange (ETDEWEB)

    Lubliner, Michael [Building America Partnership for Improved Residential Construction, Olympia, WA (United States). Washington States Univ. Energy Program; Howard, Luke [Building America Partnership for Improved Residential Construction, Olympia, WA (United States). Washington States Univ. Energy Program; Hales, David [Building America Partnership for Improved Residential Construction, Olympia, WA (United States). Washington States Univ. Energy Program; Kunkle, Rick [Building America Partnership for Improved Residential Construction, Olympia, WA (United States). Washington States Univ. Energy Program; Gordon, Andy [Building America Partnership for Improved Residential Construction, Olympia, WA (United States). Washington States Univ. Energy Program; Spencer, Melinda [Building America Partnership for Improved Residential Construction, Olympia, WA (United States). Washington States Univ. Energy Program

    2016-02-18

    The Woods is a Habitat for Humanity (HFH) community of ENERGY STAR Homes Northwest (ESHNW)-certified homes located in the marine climate of Tacoma/Pierce County, Washington. This research report builds on an earlier preliminary draft 2014 BA report, and includes significant billing analysis and cost effectiveness research from a collaborative, ongoing Ductless Heat Pump (DHP)research effort for Tacoma Public Utilities (TPU) and Bonneville Power Administration (BPA). This report focuses on the results of field testing, modeling, and monitoring of ductless mini-split heat pump hybrid heating systems in seven homes built and first occupied at various times between September 2013 and October 2014. The report also provides WSU documentation of high-performance home observations, lessons learned, and stakeholder recommendations for builders of affordable high-performance housing such as HFH. Tacoma Public Utilities (TPU) and Bonneville Power Administration (BPA). This report focuses on the results of field testing, modeling, and monitoring of ductless mini-split heat pump hybrid heating systems in seven homes built and first occupied at various times between September 2013 and October 2014. The report also provides WSU documentation of high-performance home observations, lessons learned, and stakeholder recommendations for builders of affordable high-performance housing such as HFH.

  3. Tailored model abstraction in performance assessments

    International Nuclear Information System (INIS)

    Kessler, J.H.

    1995-01-01

    Total System Performance Assessments (TSPAs) are likely to be one of the most significant parts of making safety cases for the continued development and licensing of geologic repositories for the disposal of spent fuel and HLW. Thus, it is critical that the TSPA model capture the 'essence' of the physical processes relevant to demonstrating the appropriate regulation is met. But how much detail about the physical processes must be modeled and understood before there is enough confidence that the appropriate essence has been captured? In this summary the level of model abstraction that is required is discussed. Approaches for subsystem and total system performance analyses are outlined, and the role of best estimate models is examined. It is concluded that a conservative approach for repository performance, based on limited amount of field and laboratory data, can provide sufficient confidence for a regulatory decision

  4. Significance of heel pad confinement for the shock absorption at heel strike.

    Science.gov (United States)

    Jørgensen, U; Ekstrand, J

    1988-12-01

    Shock absorption (SA) is a simple way to reduce the body load and can be used in the prevention and treatment of injuries. The heel pad is the most important shock absorber in the shoe heel complex. The purpose of this study was to investigate whether the SA at heel strike can be increased by heel support in people and shoes with high or low SA. The impact forces at heel strike were measured on an AMTI (R) force platform. Fourteen legs were tested in seven persons (nine with normal and five with low heel pad SA) in gait analysis and in human drop tests. The tests were performed barefooted, and in a soccer and a running shoe (selected by shoe drop test), with and without the distal 2 cm of the heel counter. The heel pad confinement produced by the heel counter (the heel counter effect) increased the SA in both shoe types significantly in both impact situations. The mean increase in SA was 8.8% (range 5.8%-15.5%). The heel counter effect was in all situations significantly higher in persons with low heel pad shock absorbency (LHPSA) than in those with normal heel pads. The barefoot impact peak force per kg body weight was significantly higher (6% mean) on the side with LHPSA. The running shoe provided the significantly greatest SA compared with the soccer shoe. It is concluded that the shock absorbency at heel strike can be increased significantly by heel support, with highest effect in persons with LHPSA, both in shoes with high and low SA.(ABSTRACT TRUNCATED AT 250 WORDS)

  5. Improving Seismic Data Accessibility and Performance Using HDF Containers

    Science.gov (United States)

    Evans, B. J. K.; Wang, J.; Yang, R.

    2017-12-01

    The performance of computational geophysical data processing and forward modelling relies on both computational and data. Significant efforts on developing new data formats and libraries have been made the community, such as IRIS/PASSCAL and ASDF in data, and programs and utilities such as ObsPy and SPECFEM. The National Computational Infrastructure hosts a national significant geophysical data collection that is co-located with a high performance computing facility and provides an opportunity to investigate how to improve the data formats from both a data management and a performance point of view. This paper investigates how to enhance the data usability in several perspectives: 1) propose a convention for the seismic (both active and passive) community to improve the data accessibility and interoperability; 2) recommend the convention used in the HDF container when data is made available in PH5 or ASDF formats; 3) provide tools to convert between various seismic data formats; 4) provide performance benchmark cases using ObsPy library and SPECFEM3D to demonstrate how different data organization in terms of chunking size and compression impact on the performance by comparing new data formats, such as PH5 and ASDF to traditional formats such as SEGY, SEED, SAC, etc. In this work we apply our knowledge and experience on data standards and conventions, such as CF and ACDD from the climate community to the seismology community. The generic global attributes widely used in climate community are combined with the existing convention in the seismology community, such as CMT and QuakeML, StationXML, SEGY header convention. We also extend such convention by including the provenance and benchmarking records so that the r user can learn the footprint of the data together with its baseline performance. In practise we convert the example wide angle reflection seismic data from SEGY to PH5 or ASDF by using ObsPy and pyasdf libraries. It quantitatively demonstrates how the

  6. Performance of the FFTF heat transport system during cycles 1 and 2

    International Nuclear Information System (INIS)

    Burke, T.M.; Yunker, W.H.; Cramer, E.R.

    1983-01-01

    From April 1982 through May 1983, the Fast Flux Test Facility (FFTF) completed its first two full cycles of operation. This experience has provided significant information relative to the performance of the Main Heat Transport System (MHTS). While in general, the MHTS performance has been extremely good, there have been a few unanticipated events and trends which could very well influence the design and/or operation of further LMFBR plants. The performance of the major MHTS components is discussed

  7. Stress-first protocol for myocardial perfusion SPECT imaging with semiconductor cameras: high diagnostic performances with significant reduction in patient radiation doses

    International Nuclear Information System (INIS)

    Perrin, Mathieu; Claudin, Marine; Veran, Nicolas; Morel, Olivier; Besseau, Cyril; Boutley, Henri; Djaballah, Wassila; Poussier, Sylvain; Verger, Antoine; Moulin, Frederic; Imbert, Laetitia; Karcher, Gilles; Marie, Pierre-Yves

    2015-01-01

    Effective doses of 14 mSv or higher are currently being attained in patients having stress and rest myocardial perfusion imaging (MPI) single photon emission computed tomography (SPECT) performed on the same day with conventional protocols. This study aimed to assess the actual reduction in effective doses as well as diagnostic performances for MPI routinely planned with: (1) high-sensitivity cadmium zinc telluride (CZT) cameras, (2) very low injected activities and (3) a stress-first protocol where the normality of stress images may lead to avoiding rest imaging. During a 1-year period, 2,845 patients had MPI on a CZT camera, a single-day stress-first protocol and low injected activities (120 MBq of 99m Tc-sestamibi at stress for 75 kg body weight and threefold higher at rest). The ability to detect > 50 % coronary stenosis was assessed in a subgroup of 149 patients who also had coronary angiography, while the normalcy rate was assessed in a subgroup of 128 patients with a low pretest likelihood of coronary artery disease (<10 %). Overall, 33 % of patients had abnormal MPI of which 34 % were women and 34 % were obese. The mean effective doses and the percentage of exams involving only stress images were: (1) 3.53 ± 2.10 mSv and 37 % in the overall population, (2) 4.83 ± 1.56 mSv and 5 % in the subgroup with angiography and (3) 1.96 ± 1.52 mSv and 71 % in the low-probability subgroup. Sensitivity and global accuracy for identifying the 106 patients with coronary stenosis were 88 and 80 %, respectively, while the normalcy rate was 97 %. When planned with a low-dose stress-first protocol on a CZT camera, MPI provides high diagnostic performances and a dramatic reduction in patient radiation doses. This reduction is even greater in low-risk subgroups with high rates of normal stress images, thus allowing the mean radiation dose to be balanced against cardiac risk in targeted populations. (orig.)

  8. Port performance evaluation tool based on microsimulation model

    Directory of Open Access Journals (Sweden)

    Tsavalista Burhani Jzolanda

    2017-01-01

    Full Text Available As port performance is becoming correlative to national competitiveness, the issue of port performance evaluation has significantly raised. Port performances can simply be indicated by port service levels to the ship (e.g., throughput, waiting for berthing etc., as well as the utilization level of equipment and facilities within a certain period. The performances evaluation then can be used as a tool to develop related policies for improving the port’s performance to be more effective and efficient. However, the evaluation is frequently conducted based on deterministic approach, which hardly captures the nature variations of port parameters. Therefore, this paper presents a stochastic microsimulation model for investigating the impacts of port parameter variations to the port performances. The variations are derived from actual data in order to provide more realistic results. The model is further developed using MATLAB and Simulink based on the queuing theory.

  9. Energy Design Guidelines for High Performance Schools: Tropical Island Climates

    Energy Technology Data Exchange (ETDEWEB)

    2004-11-01

    The Energy Design Guidelines for High Performance Schools--Tropical Island Climates provides school boards, administrators, and design staff with guidance to help them make informed decisions about energy and environmental issues important to school systems and communities. These design guidelines outline high performance principles for the new or retrofit design of your K-12 school in tropical island climates. By incorporating energy improvements into their construction or renovation plans, schools can significantly reduce energy consumption and costs.

  10. Provider Education about Glaucoma and Glaucoma Medications during Videotaped Medical Visits

    Directory of Open Access Journals (Sweden)

    Betsy Sleath

    2014-01-01

    Full Text Available Objective. The purpose of this study was to examine how patient, physician, and situational factors are associated with the extent to which providers educate patients about glaucoma and glaucoma medications, and which patient and provider characteristics are associated with whether providers educate patients about glaucoma and glaucoma medications. Methods. Patients with glaucoma who were newly prescribed or on glaucoma medications were recruited and a cross-sectional study was conducted at six ophthalmology clinics. Patients’ visits were videotape recorded and patients were interviewed after visits. Generalized estimating equations were used to analyze the data. Results. Two hundred and seventy-nine patients participated. Providers were significantly more likely to educate patients about glaucoma and glaucoma medications if they were newly prescribed glaucoma medications. Providers were significantly less likely to educate African American patients about glaucoma. Providers were significantly less likely to educate patients of lower health literacy about glaucoma medications. Conclusion. Eye care providers did not always educate patients about glaucoma or glaucoma medications. Practice Implications. Providers should consider educating more patients about what glaucoma is and how it is treated so that glaucoma patients can better understand their disease. Even if a patient has already been educated once, it is important to reinforce what has been taught before.

  11. Remember the Drive Home? An Assessment of Emergency Providers' Sleep Deficit.

    Science.gov (United States)

    Ferguson, Brian A; Shoff, Hugh W; McGowan, Jennifer E; Huecker, Martin R

    2018-01-01

    Sleep deprivation decreases work performance and predisposes workers to deleterious health outcomes. We sought to evaluate sleep hygiene and fatigue among emergency physicians. In March-June 2016, physicians and residents at an academic emergency medicine program were invited to complete a survey evaluating sleep and alertness. Six attending physicians and 26 residents completed the survey. Among six personal priorities, sleep ranked fourth behind family, work, and leisure. 75% stated poor sleep impedes effectiveness as a physician while 53% noted difficulty falling asleep before a night shift. In the last three months, 39% of subjects forgot driving home from a shift, and 34% had fallen asleep while driving. 34% used medications to assist with sleep (including melatonin (36%), alcohol (27%), and prescription drugs (9%)). Most providers attested to phone (88%) and television exposure (69%) immediately prior to goal sleep onset. Despite sleep being identified as a priority among EM physicians, deleterious habits remain. Poor sleep affects perceived effectiveness and personal safety, as evidenced by a significant portion of providers falling asleep on the commute home. Night shift is the chief obstacle to optimal sleep hygiene.

  12. Air and fuel supercharge in the performance of a diesel cycle engine

    Directory of Open Access Journals (Sweden)

    Marcelo Silveira de Farias

    Full Text Available ABSTRACT: This paper aimed to evaluate the performance of a Diesel cycle engine, changing the configurations for the air and fuel supply system. Variables analyzed were torque, power, specific fuel consumption and thermal efficiency in four different engine configurations (aspirated, aspirated + service, turbocharged + service and turbocharged. For that, there were dynamometer experiments by power take-off of an agricultural tractor. The experimental outline used was entirely randomized, in a bifatorial design with three repetitions. Results indicated that the engine supercharge, compared to its original configuration, provided a significant increase of torque and power. Only the addition of turbo does not caused a significant effect in the engine performance. Application of turbocharger provides an improvement in the burning of the air/fuel mixture, which favors the increase of engine power and; consequently, reduced the specific fuel consumption.

  13. Effect on maternal and child health services in Rwanda of payment to primary health-care providers for performance: an impact evaluation.

    Science.gov (United States)

    Basinga, Paulin; Gertler, Paul J; Binagwaho, Agnes; Soucat, Agnes L B; Sturdy, Jennifer; Vermeersch, Christel M J

    2011-04-23

    Evidence about the best methods with which to accelerate progress towards achieving the Millennium Development Goals is urgently needed. We assessed the effect of performance-based payment of health-care providers (payment for performance; P4P) on use and quality of child and maternal care services in health-care facilities in Rwanda. 166 facilities were randomly assigned at the district level either to begin P4P funding between June, 2006, and October, 2006 (intervention group; n=80), or to continue with the traditional input-based funding until 23 months after study baseline (control group; n=86). Randomisation was done by coin toss. We surveyed facilities and 2158 households at baseline and after 23 months. The main outcome measures were prenatal care visits and institutional deliveries, quality of prenatal care, and child preventive care visits and immunisation. We isolated the incentive effect from the resource effect by increasing comparison facilities' input-based budgets by the average P4P payments made to the treatment facilities. We estimated a multivariate regression specification of the difference-in-difference model in which an individual's outcome is regressed against a dummy variable, indicating whether the facility received P4P that year, a facility-fixed effect, a year indicator, and a series of individual and household characteristics. Our model estimated that facilities in the intervention group had a 23% increase in the number of institutional deliveries and increases in the number of preventive care visits by children aged 23 months or younger (56%) and aged between 24 months and 59 months (132%). No improvements were seen in the number of women completing four prenatal care visits or of children receiving full immunisation schedules. We also estimate an increase of 0·157 standard deviations (95% CI 0·026-0·289) in prenatal quality as measured by compliance with Rwandan prenatal care clinical practice guidelines. The P4P scheme in Rwanda had

  14. Impact significance determination-Designing an approach

    International Nuclear Information System (INIS)

    Lawrence, David P.

    2007-01-01

    The question of how best to go about determining the significance of impacts has, to date, only been addressed in a partial and preliminary way. The assumption tends to be made that it is either only necessary to provide explicit, justified reasons for a judgment about significance and/or to explicitly apply a prescribed procedure-a procedure usually involving the staged application of thresholds and/or criteria. The detailed attributes, strengths and limitations of such approaches and possible alternative approaches have yet to be explored systematically. This article addresses these deficiencies by analyzing the characteristics, specific methods and positive and negative tendencies of three general impact significance determination approaches-the technical approach, the collaborative approach and the reasoned argumentation approach. A range of potential composite approaches are also described. With an enhanced understanding of these approaches, together with potential combinations, EIA practitioners and other EIA participants can be in a better position to select an approach appropriate to their needs, to reinforce the positive tendencies and offset the negative tendencies of the selected approach and to combine the best qualities of more than one approach

  15. Toward High-Performance Communications Interfaces for Science Problem Solving

    Science.gov (United States)

    Oviatt, Sharon L.; Cohen, Adrienne O.

    2010-12-01

    From a theoretical viewpoint, educational interfaces that facilitate communicative actions involving representations central to a domain can maximize students' effort associated with constructing new schemas. In addition, interfaces that minimize working memory demands due to the interface per se, for example by mimicking existing non-digital work practice, can preserve students' attentional focus on their learning task. In this research, we asked the question: What type of interface input capabilities provide best support for science problem solving in both low- and high- performing students? High school students' ability to solve a diverse range of biology problems was compared over longitudinal sessions while they used: (1) hardcopy paper and pencil (2) a digital paper and pen interface (3) pen tablet interface, and (4) graphical tablet interface. Post-test evaluations revealed that time to solve problems, meta-cognitive control, solution correctness, and memory all were significantly enhanced when using the digital pen and paper interface, compared with tablet interfaces. The tangible pen and paper interface also was the only alternative that significantly facilitated skill acquisition in low-performing students. Paradoxically, all students nonetheless believed that the tablet interfaces provided best support for their performance, revealing a lack of self-awareness about how to use computational tools to best advantage. Implications are discussed for how pen interfaces can be optimized for future educational purposes, and for establishing technology fluency curricula to improve students' awareness of the impact of digital tools on their performance.

  16. Prediction of Human Performance Using Electroencephalography under Different Indoor Room Temperatures

    Science.gov (United States)

    Zhang, Tinghe; Mao, Zijing; Xu, Xiaojing; Zhang, Lin; Pack, Daniel J.; Dong, Bing; Huang, Yufei

    2018-01-01

    Varying indoor environmental conditions is known to affect office worker’s performance; wherein past research studies have reported the effects of unfavorable indoor temperature and air quality causing sick building syndrome (SBS) among office workers. Thus, investigating factors that can predict performance in changing indoor environments have become a highly important research topic bearing significant impact in our society. While past research studies have attempted to determine predictors for performance, they do not provide satisfactory prediction ability. Therefore, in this preliminary study, we attempt to predict performance during office-work tasks triggered by different indoor room temperatures (22.2 °C and 30 °C) from human brain signals recorded using electroencephalography (EEG). Seven participants were recruited, from whom EEG, skin temperature, heart rate and thermal survey questionnaires were collected. Regression analyses were carried out to investigate the effectiveness of using EEG power spectral densities (PSD) as predictors of performance. Our results indicate EEG PSDs as predictors provide the highest R2 (> 0.70), that is 17 times higher than using other physiological signals as predictors and is more robust. Finally, the paper provides insight on the selected predictors based on brain activity patterns for low- and high-performance levels under different indoor-temperatures. PMID:29690601

  17. [Assessment of financial performance improves the quality of healthcare provided by medical organizations].

    Science.gov (United States)

    Afek, Arnon; Meilik, Ahuva; Rotstein, Zeev

    2009-01-01

    Today, medical organizations have to contend with a highly competitive environment, an atmosphere saturated with a multitude of innovative new technologies and ever-increasing costs. The ability of these organizations to survive and to develop and expand their services mandates adoption of management guidelines based on the world of finance/commerce, adapted to make them relevant to the world of medical service. In this article the authors chose to present a management administration assessment which is a process that ensures that the management will effectively administer the organization's resources, and meet the goals set by the organization. The system demands that hospital "centers of responsibility" be defined, a management information system be set up, activities be priced, budget be defined and the expenses assessed. These processes make it possible to formulate a budget and assess any possible deviation between the budget and the actual running costs. An assessment of deviations will reveal any possible deviation of the most significant factor--efficiency. Medical organization managers, with the cooperation of the directors of the "centers of responsibility", can assess subunit activities and gain an understanding of the significance of management decisions and thus improve the quality of management, and the medical organization. The goal of this management system is not only to Lower costs and to meet the financial goals that were set; it is a tool that ensures quality. Decreasing expenditure is important in this case, but is only secondary in importance and will be a result of reducing the costs incurred by services lacking in quality.

  18. Improvement of AEP Predictions Using Diurnal CFD Modelling with Site-Specific Stability Weightings Provided from Mesoscale Simulation

    International Nuclear Information System (INIS)

    Hristov, Y; Oxley, G; Žagar, M

    2014-01-01

    The Bolund measurement campaign, performed by Danish Technical University (DTU) Wind Energy Department (also known as RISØ), provided significant insight into wind flow modeling over complex terrain. In the blind comparison study several modelling solutions were submitted with the vast majority being steady-state Computational Fluid Dynamics (CFD) approaches with two equation k-ε turbulence closure. This approach yielded the most accurate results, and was identified as the state-of-the-art tool for wind turbine generator (WTG) micro-siting. Based on the findings from Bolund, further comparison between CFD and field measurement data has been deemed essential in order to improve simulation accuracy for turbine load and long-term Annual Energy Production (AEP) estimations. Vestas Wind Systems A/S is a major WTG original equipment manufacturer (OEM) with an installed base of over 60GW in over 70 countries accounting for 19% of the global installed base. The Vestas Performance and Diagnostic Centre (VPDC) provides online live data to more than 47GW of these turbines allowing a comprehensive comparison between modelled and real-world energy production data. In previous studies, multiple sites have been simulated with a steady neutral CFD formulation for the atmospheric surface layer (ASL), and wind resource (RSF) files have been generated as a base for long-term AEP predictions showing significant improvement over predictions performed with the industry standard linear WAsP tool. In this study, further improvements to the wind resource file generation with CFD are examined using an unsteady diurnal cycle approach with a full atmospheric boundary layer (ABL) formulation, with the unique stratifications throughout the cycle weighted according to mesoscale simulated sectorwise stability frequencies

  19. Significance of mineralogy in soil mechanics

    Directory of Open Access Journals (Sweden)

    Bojana Dolinar

    2002-12-01

    Full Text Available The research of consistency limits according to Atterberg is of key importance in soil mechanics because it determines, in a simple way, results of interactions between solid and liquid phases in soils, and thus provides possibility to classify them in groups withsimilar mechanic properties. In most cases, the results of these investigations provide a good basis for predicting other properties such as deformability, expansion, hydraulic conductivity and strength of soils. This proves that basis factors influencing the valuesof consistency limits and other mechanic properties are the same. It is known that the values of consistency limits primarily depend on the type and quantity of clay minerals in soils. The article focuses on experimental evidence of dependence between the quantityof water at the liquid limit for soils and type, portion and specific surface of clay grains.Experiments were performed with monomineral soils, their mixtures and composed samples of clay- and non-clay components. It was established that in parallel orientation of clay particles the quantity of water between grains at liquid limit is dependent on their external specific surface.

  20. Identifying significant temporal variation in time course microarray data without replicates

    Directory of Open Access Journals (Sweden)

    Porter Weston

    2009-03-01

    Full Text Available Abstract Background An important component of time course microarray studies is the identification of genes that demonstrate significant time-dependent variation in their expression levels. Until recently, available methods for performing such significance tests required replicates of individual time points. This paper describes a replicate-free method that was developed as part of a study of the estrous cycle in the rat mammary gland in which no replicate data was collected. Results A temporal test statistic is proposed that is based on the degree to which data are smoothed when fit by a spline function. An algorithm is presented that uses this test statistic together with a false discovery rate method to identify genes whose expression profiles exhibit significant temporal variation. The algorithm is tested on simulated data, and is compared with another recently published replicate-free method. The simulated data consists both of genes with known temporal dependencies, and genes from a null distribution. The proposed algorithm identifies a larger percentage of the time-dependent genes for a given false discovery rate. Use of the algorithm in a study of the estrous cycle in the rat mammary gland resulted in the identification of genes exhibiting distinct circadian variation. These results were confirmed in follow-up laboratory experiments. Conclusion The proposed algorithm provides a new approach for identifying expression profiles with significant temporal variation without relying on replicates. When compared with a recently published algorithm on simulated data, the proposed algorithm appears to identify a larger percentage of time-dependent genes for a given false discovery rate. The development of the algorithm was instrumental in revealing the presence of circadian variation in the virgin rat mammary gland during the estrous cycle.

  1. Statistical significance of cis-regulatory modules

    Directory of Open Access Journals (Sweden)

    Smith Andrew D

    2007-01-01

    Full Text Available Abstract Background It is becoming increasingly important for researchers to be able to scan through large genomic regions for transcription factor binding sites or clusters of binding sites forming cis-regulatory modules. Correspondingly, there has been a push to develop algorithms for the rapid detection and assessment of cis-regulatory modules. While various algorithms for this purpose have been introduced, most are not well suited for rapid, genome scale scanning. Results We introduce methods designed for the detection and statistical evaluation of cis-regulatory modules, modeled as either clusters of individual binding sites or as combinations of sites with constrained organization. In order to determine the statistical significance of module sites, we first need a method to determine the statistical significance of single transcription factor binding site matches. We introduce a straightforward method of estimating the statistical significance of single site matches using a database of known promoters to produce data structures that can be used to estimate p-values for binding site matches. We next introduce a technique to calculate the statistical significance of the arrangement of binding sites within a module using a max-gap model. If the module scanned for has defined organizational parameters, the probability of the module is corrected to account for organizational constraints. The statistical significance of single site matches and the architecture of sites within the module can be combined to provide an overall estimation of statistical significance of cis-regulatory module sites. Conclusion The methods introduced in this paper allow for the detection and statistical evaluation of single transcription factor binding sites and cis-regulatory modules. The features described are implemented in the Search Tool for Occurrences of Regulatory Motifs (STORM and MODSTORM software.

  2. E-Commerce Performance. Shopping Cart Key Performance Indicators

    Directory of Open Access Journals (Sweden)

    Mihaela I. MUNTEAN

    2016-01-01

    Full Text Available In an e-commerce performance framework is important to identify the key performance indicators that measure success and together provide the greatest context into the business perfor-mance. Shopping carts are an essential part of ecommerce, a minimal set of key performance indicators being the subject of our debate. The theoretical approach is sustained by a case study, an e-shop implemented using PHP and MySQL, for simulating main business processes within the considered performance framework. Our approach opens a perspective for future research using additional indicators in order to properly evaluate the global performance of any e-shop.

  3. Organizational culture associated with provider satisfaction.

    Science.gov (United States)

    Scammon, Debra L; Tabler, Jennifer; Brunisholz, Kimberly; Gren, Lisa H; Kim, Jaewhan; Tomoaia-Cotisel, Andrada; Day, Julie; Farrell, Timothy W; Waitzman, Norman J; Magill, Michael K

    2014-01-01

    Organizational culture is key to the successful implementation of major improvement strategies. Transformation to a patient-centered medical home (PCHM) is such an improvement strategy, requiring a shift from provider-centric care to team-based care. Because this shift may impact provider satisfaction, it is important to understand the relationship between provider satisfaction and organizational culture, specifically in the context of practices that have transformed to a PCMH model. This was a cross-sectional study of surveys conducted in 2011 among providers and staff in 10 primary care clinics implementing their version of a PCMH: Care by Design. Measures included the Organizational Culture Assessment Instrument and the American Medical Group Association provider satisfaction survey. Providers were most satisfied with quality of care (mean, 4.14; scale of 1-5) and interactions with patients (mean, 4.12) and were least satisfied with time spent working (mean, 3.47), paperwork (mean, 3.45), and compensation (mean, 3.35). Culture profiles differed across clinics, with family/clan and hierarchical cultures the most common. Significant correlations (P ≤ .05) between provider satisfaction and clinic culture archetypes included family/clan culture negatively correlated with administrative work; entrepreneurial culture positively correlated with the Time Spent Working dimension; market/rational culture positively correlated with how practices were facing economic and strategic challenges; and hierarchical culture negatively correlated with the Relationships with Staff and Resource dimensions. Provider satisfaction is an important metric for assessing experiences with features of a PCMH model. Identification of clinic-specific culture archetypes and archetype associations with provider satisfaction can help inform practice redesign. Attention to effective methods for changing organizational culture is recommended.

  4. Materials balance area Custodian Performance Evaluation Program at PNL

    International Nuclear Information System (INIS)

    Dickman, D.A.

    1991-07-01

    The material balance area (MBA) custodian has primary responsibility for control and accountability of nuclear material within an MBA. In this role, the custodian operates as an extension of the facility material control and accountability (MC ampersand A) organization. To effectively meet administrative requirements and protection needs, the custodian must be fully trained in all aspects of MC ampersand A related to the MBA, and custodian performance must be periodically evaluated. DOE Policy requires that each facility provide for a program which assures that each facility provide for a program which assures that personnel performing MC ampersand A functions are (1) trained and/or qualified to perform their duties and responsibilities and (2) knowledgeable of requirements and procedures related to their functions. The MBA Custodian Performance Evaluation Program at PNL uses a variety of assessment techniques to meet this goal, including internal and independent MBA audits, periodic custodian testing, conduct of limited scope performance tests, daily monitoring of MC ampersand A documentation, and reviewing custodian performance during physical inventories. The data collected from these sources is analyzed and incorporated into an annual custodian performance evaluation document, given to each custodian and line management. Development of this program has resulted in significantly improved custodian performance and a marked decrease in finding and observations identified during MBA audits

  5. Social networking strategies that aim to reduce obesity have achieved significant although modest results.

    Science.gov (United States)

    Ashrafian, Hutan; Toma, Tania; Harling, Leanne; Kerr, Karen; Athanasiou, Thanos; Darzi, Ara

    2014-09-01

    The global epidemic of obesity continues to escalate. Obesity accounts for an increasing proportion of the international socioeconomic burden of noncommunicable disease. Online social networking services provide an effective medium through which information may be exchanged between obese and overweight patients and their health care providers, potentially contributing to superior weight-loss outcomes. We performed a systematic review and meta-analysis to assess the role of these services in modifying body mass index (BMI). Our analysis of twelve studies found that interventions using social networking services produced a modest but significant 0.64 percent reduction in BMI from baseline for the 941 people who participated in the studies' interventions. We recommend that social networking services that target obesity should be the subject of further clinical trials. Additionally, we recommend that policy makers adopt reforms that promote the use of anti-obesity social networking services, facilitate multistakeholder partnerships in such services, and create a supportive environment to confront obesity and its associated noncommunicable diseases. Project HOPE—The People-to-People Health Foundation, Inc.

  6. Biological variability in biomechanical engineering research: Significance and meta-analysis of current modeling practices.

    Science.gov (United States)

    Cook, Douglas; Julias, Margaret; Nauman, Eric

    2014-04-11

    Biological systems are characterized by high levels of variability, which can affect the results of biomechanical analyses. As a review of this topic, we first surveyed levels of variation in materials relevant to biomechanics, and compared these values to standard engineered materials. As expected, we found significantly higher levels of variation in biological materials. A meta-analysis was then performed based on thorough reviews of 60 research studies from the field of biomechanics to assess the methods and manner in which biological variation is currently handled in our field. The results of our meta-analysis revealed interesting trends in modeling practices, and suggest a need for more biomechanical studies that fully incorporate biological variation in biomechanical models and analyses. Finally, we provide some case study example of how biological variability may provide valuable insights or lead to surprising results. The purpose of this study is to promote the advancement of biomechanics research by encouraging broader treatment of biological variability in biomechanical modeling. Copyright © 2014 Elsevier Ltd. All rights reserved.

  7. Self-assessment of human performance errors in nuclear operations

    International Nuclear Information System (INIS)

    Chambliss, K.V.

    1996-01-01

    One of the most important approaches to improving nuclear safety is to have an effective self-assessment process in place, whose cornerstone is the identification and improvement of human performance errors. Experience has shown that significant events usually have had precursors of human performance errors. If these precursors are left uncorrected or not understood, the symptoms recur and result in unanticipated events of greater safety significance. The Institute of Nuclear Power Operations (INPO) has been championing the cause of promoting excellence in human performance in the nuclear industry. INPO's report, open-quotes Excellence in Human Performance,close quotes emphasizes the importance of several factors that play a role in human performance. They include individual, supervisory, and organizational behaviors; real-time feedback that results in specific behavior to produce safe and reliable performance; and proactive measures that remove obstacles from excellent human performance. Zack Pate, chief executive officer and president of INPO, in his report, open-quotes The Control Room,close quotes provides an excellent discussion of serious events in the nuclear industry since 1994 and compares them with the results from a recent study by the National Transportation Safety Board of airline accidents in the 12-yr period from 1978 to 1990 to draw some common themes that relate to human performance issues in the control room

  8. Significance testing in ridge regression for genetic data

    Directory of Open Access Journals (Sweden)

    De Iorio Maria

    2011-09-01

    Full Text Available Abstract Background Technological developments have increased the feasibility of large scale genetic association studies. Densely typed genetic markers are obtained using SNP arrays, next-generation sequencing technologies and imputation. However, SNPs typed using these methods can be highly correlated due to linkage disequilibrium among them, and standard multiple regression techniques fail with these data sets due to their high dimensionality and correlation structure. There has been increasing interest in using penalised regression in the analysis of high dimensional data. Ridge regression is one such penalised regression technique which does not perform variable selection, instead estimating a regression coefficient for each predictor variable. It is therefore desirable to obtain an estimate of the significance of each ridge regression coefficient. Results We develop and evaluate a test of significance for ridge regression coefficients. Using simulation studies, we demonstrate that the performance of the test is comparable to that of a permutation test, with the advantage of a much-reduced computational cost. We introduce the p-value trace, a plot of the negative logarithm of the p-values of ridge regression coefficients with increasing shrinkage parameter, which enables the visualisation of the change in p-value of the regression coefficients with increasing penalisation. We apply the proposed method to a lung cancer case-control data set from EPIC, the European Prospective Investigation into Cancer and Nutrition. Conclusions The proposed test is a useful alternative to a permutation test for the estimation of the significance of ridge regression coefficients, at a much-reduced computational cost. The p-value trace is an informative graphical tool for evaluating the results of a test of significance of ridge regression coefficients as the shrinkage parameter increases, and the proposed test makes its production computationally feasible.

  9. In surgeons performing cardiothoracic surgery is sleep deprivation significant in its impact on morbidity or mortality?

    Science.gov (United States)

    Asfour, Leila; Asfour, Victoria; McCormack, David; Attia, Rizwan

    2014-09-01

    A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was: is there a difference in cardiothoracic surgery outcomes in terms of morbidity or mortality of patients operated on by a sleep-deprived surgeon compared with those operated by a non-sleep-deprived surgeon? Reported search criteria yielded 77 papers, of which 15 were deemed to represent the best evidence on the topic. Three studies directly related to cardiothoracic surgery and 12 studies related to non-cardiothoracic surgery. Recommendations are based on 18 121 cardiothoracic patients and 214 666 non-cardiothoracic surgical patients. Different definitions of sleep deprivation were used in the studies, either reviewing surgeon's sleeping hours or out-of-hours operating. Surgical outcomes reviewed included: mortality rate, neurological, renal, pulmonary, infectious complications, length of stay, length of intensive care stay, cardiopulmonary bypass times and aortic-cross-clamp times. There were no significant differences in mortality or intraoperative complications in the groups of patients operated on by sleep-deprived versus non-sleep-deprived surgeons in cardiothoracic studies. One study showed a significant increase in the rate of septicaemia in patients operated on by severely sleep-deprived surgeons (3.6%) compared with the moderately sleep-deprived (0.9%) and non-sleep-deprived groups (0.8%) (P = 0.03). In the non-cardiothoracic studies, 7 of the 12 studies demonstrated statistically significant higher reoperation rate in trauma cases (P sleep deprivation in cardiothoracic surgeons on morbidity or mortality. However, overall the non-cardiothoracic studies have demonstrated that operative time and sleep deprivation can have a significant impact on overall morbidity and mortality. It is likely that other confounding factors concomitantly affect outcomes in out-of-hours surgery. © The Author 2014. Published by Oxford University Press on behalf of

  10. A Framework for Fully Automated Performance Testing for Smart Buildings

    DEFF Research Database (Denmark)

    Markoska, Elena; Johansen, Aslak; Lazarova-Molnar, Sanja

    2018-01-01

    , setup of performance tests has been manual and labor-intensive and has required intimate knowledge of buildings’ complexity and systems. The emergence of the concept of smart buildings has provided an opportunity to overcome this restriction. In this paper, we propose a framework for automated......A significant proportion of energy consumption by buildings worldwide, estimated to ca. 40%, has yielded a high importance to studying buildings’ performance. Performance testing is a mean by which buildings can be continuously commissioned to ensure that they operate as designed. Historically...... performance testing of smart buildings that utilizes metadata models. The approach features automatic detection of applicable performance tests using metadata queries and their corresponding instantiation, as well as continuous commissioning based on metadata. The presented approach has been implemented...

  11. The emotional and professional wellbeing of Australian midwives: A comparison between those providing continuity of midwifery care and those not providing continuity.

    Science.gov (United States)

    Fenwick, Jennifer; Sidebotham, Mary; Gamble, Jenny; Creedy, Debra K

    2018-02-01

    Continuity of midwifery care contributes to significant positive outcomes for women and babies. There is a perception that providing continuity of care may negatively impact on the wellbeing and professional lives of midwives. To compare the emotional and professional wellbeing as well as satisfaction with time off and work-life balance of midwives providing continuity of care with midwives not providing continuity. Online survey. Measures included; Copenhagen Burnout Inventory (CBI); Depression, Anxiety and Stress Scale-21; and Perceptions of Empowerment in Midwifery Scale (PEMS-Revised). The sample (n=862) was divided into two groups; midwives working in continuity (n=214) and those not working in continuity (n=648). Mann Whitney U tests were used to compare the groups. The continuity group had significantly lower scores on each of the burnout subscales (CBI Personal p=.002; CBI Work pwork-life balance. Our results indicate that providing continuity of midwifery care is also beneficial for midwives. Conversely, midwives working in shift-based models providing fragmented care are at greater risk of psychological distress. Maternity service managers should feel confident that re-orientating care to align with the evidence is likely to improve workforce wellbeing and is a sustainable way forward. Copyright © 2017 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

  12. Role of Leadership and Employee Engagement towards Individual Performance of Pharmacy Employees

    Directory of Open Access Journals (Sweden)

    Susi A. Rahayu

    2012-09-01

    Full Text Available Employees dissatisfaction to the head of the hospital pharmacy will decrease employees performance and unsatisfied customers. To solve the problems, employees should be based on performance as customer expectations in providing services. One of the ways to improve the performance of the employees, they must feel engage to the work. One of the factors to improve employee engagement is the leadership factor. Therefore, it is necessary to study the impact of leadership on individual performance employee in hospital pharmacy and also the influence of employee engagement as a mediator. A total of 79 employees from the pharmacy in two private hospitals in Bandung became the participants. This study used the technique of partial least squares to test the hypothesized relationships. The results showed that there were significant between leadership to employee engagement (t value (12,84 > t-table (1.64, the significance of employee engagement on individual performance (t value (3.83 > t-table (1.64. In contrast, there was no influence and significance in leadership on individual performance (t value (0.45 < t-table (1.64. Employee engagement fully mediated the relationship between leadership and individual performance. Therefore, improving pharmacy services is a set of actions and involvement of pharmacy employees who are consistent, sustainable and clear.

  13. Self-Study Guide for Florida VPK Provider Improvement Plan Development

    Science.gov (United States)

    Phillips, Beth M.; Mazzeo, Debbie; Smith, Kevin

    2016-01-01

    This Self-Study Guide has been developed to support Florida Voluntary Prekindergarten Providers (VPK) who are required to complete an improvement plan process (i.e., low-performing providers). The guide has sections that can be used during both the process of selecting target areas for an improvement plan and the process of implementing new or…

  14. Corporate governance structure and firm’ financial performance: Evidences from Egypt

    Directory of Open Access Journals (Sweden)

    Mohammed M. Soliman

    2014-01-01

    Full Text Available Recent financial international scandals have generated hyped interest in the area of corporate governance as a mean to mitigate financial problems faced in developing nations. The purpose of this study is to examine the link between corporate governance structure and firm’ financial performance in Egypt. The data for analysis are gathered from manual review of the financial statements and websites of the thirty enterprises that make up the (EGX 30 covering the four years period 2007-2010. Results from the study indicate that board size; the presence of audit committee; and audit quality significantly have relationship with firm’ financial performance measured by ROA and ROE. The results also, indicate that board independence; and institutional ownership have no significant correlation with firm’ financial performance. For CEO duality, the results indicate that CEO duality has a positive impact upon companies’ financial performance measured by ROE, at the same time, is not correlated with the ROA measure of financial performance. This study is important because it offers evidence on the impact of corporate governance structure on firm financial performance. In addition, it provides useful information that is of great value to policy makers, academics and other stakeholders.

  15. Neutronic performance issues for the Spallation Neutron Source moderators

    International Nuclear Information System (INIS)

    Iverson, E.B.; Murphy, B.D.

    2001-01-01

    We continue to develop the neutronic models of the Spallation Neutron Source target station and moderators in order to better predict the neutronic performance of the system as a whole and in order to better optimize that performance. While we are not able to say that every model change leads to more intense neutron beams being predicted, we do feel that such changes are advantageous in either performance or in the accuracy of the prediction of performance. We have computationally and experimentally studied the neutronics of hydrogen-water composite moderators such as are proposed for the SNS Project. In performing these studies, we find that the composite moderator, at least in the configuration we have examined, does not provide performance characteristics desirable for the instruments proposed and being designed for this neutron scattering facility. The pulse width as a function of energy is significantly broader than for other moderators, limiting attainable resolution-bandwidth combinations. Furthermore, there is reason to expect that higher-energy (0.1-1 eV) applications will be significantly impacted by bimodal pulse shapes requiring enormous effort to parameterize. As a result of these studies, we have changed the SNS design, and will not use a composite moderator at this time. We have analyzed the depletion of a gadolinium poison plate in a hydrogen moderator at the Spallation Neutron Source, and found that conventional poison thicknesses will be completely unable to last the desired component lifetime of three operational years. A poison plate 300-600 μm thick will survive for the required length of time, but will somewhat degrade the intensity (by as much as 15% depending on neutron energy) and the consistency of the neutron source performance. Our results should scale fairly easily to other moderators on this or any other spallation source. While depletion will be important for all highly-absorbing materials in high-flux regions, we feel it likely that

  16. Magnetic Gimbal Proof-of-Concept Hardware performance results

    Science.gov (United States)

    Stuart, Keith O.

    1993-01-01

    The Magnetic Gimbal Proof-of-Concept Hardware activities, accomplishments, and test results are discussed. The Magnetic Gimbal Fabrication and Test (MGFT) program addressed the feasibility of using a magnetic gimbal to isolate an Electro-Optical (EO) sensor from the severe angular vibrations induced during the firing of divert and attitude control system (ACS) thrusters during space flight. The MGFT effort was performed in parallel with the fabrication and testing of a mechanically gimballed, flex pivot based isolation system by the Hughes Aircraft Missile Systems Group. Both servo systems supported identical EO sensor assembly mockups to facilitate direct comparison of performance. The results obtained from the MGFT effort indicate that the magnetic gimbal exhibits the ability to provide significant performance advantages over alternative mechanically gimballed techniques.

  17. Caveats for using statistical significance tests in research assessments

    DEFF Research Database (Denmark)

    Schneider, Jesper Wiborg

    2013-01-01

    controversial and numerous criticisms have been leveled against their use. Based on examples from articles by proponents of the use statistical significance tests in research assessments, we address some of the numerous problems with such tests. The issues specifically discussed are the ritual practice......This article raises concerns about the advantages of using statistical significance tests in research assessments as has recently been suggested in the debate about proper normalization procedures for citation indicators by Opthof and Leydesdorff (2010). Statistical significance tests are highly...... argue that applying statistical significance tests and mechanically adhering to their results are highly problematic and detrimental to critical thinking. We claim that the use of such tests do not provide any advantages in relation to deciding whether differences between citation indicators...

  18. The Business Value of Superior Energy Performance

    Energy Technology Data Exchange (ETDEWEB)

    McKane, Aimee; Scheihing, Paul; Evans, Tracy; Glatt, Sandy; Meffert, William

    2015-08-04

    Industrial facilities participating in the U.S. Department of Energy’s (US DOE) Superior Energy Performance (SEP) program are finding that it provides them with significant business value. This value starts with the implementation of ISO 50001-Energy management system standard, which provides an internationally-relevant framework for integration of energy management into an organization’s business processes. The resulting structure emphasizes effective use of available data and supports continual improvement of energy performance. International relevance is particularly important for companies with a global presence or trading interests, providing them with access to supporting ISO standards and a growing body of certified companies representing the collective knowledge of communities of practice. This paper examines the business value of SEP, a voluntary program that builds on ISO 50001, inviting industry to demonstrate an even greater commitment through third-party verification of energy performance improvement to a specified level of achievement. Information from 28 facilities that have already achieved SEP certification will illustrate key findings concerning both the value and the challenges from SEP/ISO 50001 implementation. These include the facilities’ experience with implementation, internal and external value of third-party verification of energy performance improvement; attractive payback periods and the importance of SEP tools and guidance. US DOE is working to bring the program to scale, including the Enterprise-Wide Accelerator (SEP for multiple facilities in a company), the Ratepayer-Funded Program Accelerator (supporting tools for utilities and program administrators to include SEP in their program offerings), and expansion of the program to other sectors and industry supply chains.

  19. Seed metabolomic study reveals significant metabolite variations and correlations among different soybean cultivars.

    Science.gov (United States)

    Lin, Hong; Rao, Jun; Shi, Jianxin; Hu, Chaoyang; Cheng, Fang; Wilson, Zoe A; Zhang, Dabing; Quan, Sheng

    2014-09-01

    Soybean [Glycine max (L.) Merr.] is one of the world's major crops, and soybean seeds are a rich and important resource for proteins and oils. While "omics" studies, such as genomics, transcriptomics, and proteomics, have been widely applied in soybean molecular research, fewer metabolomic studies have been conducted for large-scale detection of low molecular weight metabolites, especially in soybean seeds. In this study, we investigated the seed metabolomes of 29 common soybean cultivars through combined gas chromatography-mass spectrometry and ultra-performance liquid chromatography-tandem mass spectrometry. One hundred sixty-nine named metabolites were identified and subsequently used to construct a metabolic network of mature soybean seed. Among the 169 detected metabolites, 104 were found to be significantly variable in their levels across tested cultivars. Metabolite markers that could be used to distinguish genetically related soybean cultivars were also identified, and metabolite-metabolite correlation analysis revealed some significant associations within the same or among different metabolite groups. Findings from this work may potentially provide the basis for further studies on both soybean seed metabolism and metabolic engineering to improve soybean seed quality and yield. © 2014 Institute of Botany, Chinese Academy of Sciences.

  20. Seed metabolomic study reveals significant metabolite variations and correlations among different soybean cultivars

    Institute of Scientific and Technical Information of China (English)

    Hong Lin; Jun Rao; Jianxin Shi; Chaoyang Hu; Fang Cheng; Zoe AWilson; Dabing Zhang; Sheng Quan

    2014-01-01

    Soybean [Glycine max (L.) Merr.] is one of the world’s major crops, and soybean seeds are a rich and important resource for proteins and oils. While “omics”studies, such as genomics, transcriptomics, and proteomics, have been widely applied in soybean molecular research, fewer metabolomic studies have been conducted for large-scale detection of low molecular weight metabolites, especial y in soybean seeds. In this study, we investigated the seed metabolomes of 29 common soybean cultivars through combined gas chromatography-mass spectrometry and ultra-performance liquid chromatography-tandem mass spectrometry. One hundred sixty-nine named metabolites were identified and subsequently used to construct a metabolic network of mature soybean seed. Among the 169 detected metabolites, 104 were found to be significantly variable in their levels across tested cultivars. Metabolite markers that could be used to distinguish genetical y related soybean cultivars were also identified, and metabolite-metabolite correlation analysis revealed some significant associations within the same or among different metabolite groups. Findings from this work may potentially provide the basis for further studies on both soybean seed metabolism and metabolic engineering to improve soybean seed quality and yield.

  1. Building stones can be of geoheritage significance

    Science.gov (United States)

    Brocx, Margaret; Semeniuk, Vic

    2017-04-01

    Building stones have generally been assigned values according to their cultural, aesthetic, and rarity significance, amongst other criteria, but they also may have geoheritage significance. This is akin to the geoheritage significance ascribed to minerals and fossils housed as ex situ specimens in museums. We proffer the notion that building stones can be of geoheritage value particularly where they comprise permanent buildings, they illustrate significant windows into the history of the Earth, and they can be visited as an ex situ museum locality (e.g., the "Blue Granite" of Iceland) for education as part of building-stone tours. For some rocks the quarries that supplied the building stone are no longer in existence and hence the building stones provide the only record of that type of material; for other rocks, the building stone may illustrate features in the lithology no longer present in the quarry itself (e.g., rare and large xenoliths). Building stones are particularly significant as they are often polished and manifest structures, fabrics, and textures not evident in outcrop. We illustrate here examples of building stone of geoheritage significance using Australian and International examples. Australian designated stones could include the "Sydney Sandstone" or "Victorian Bluestone". For international examples, there is the famous "Carrara Marble" in Italy and the widely known "Portland Limestone" from southern England, the latter having been utilized for St Pauls Cathedral in London and the UN building in New York City.

  2. Arbitrary Deprivation of an Unregistered Credit Provider's Right to ...

    African Journals Online (AJOL)

    Arbitrary Deprivation of an Unregistered Credit Provider's Right to Claim Restitution of Performance Rendered Opperman v Boonzaaier (24887/2010) 2012 ZAWCHC 27 (17 April 2012) and National Credit Regulator v Opperman 2013 2 SA 1 (CC)

  3. Significance levels for studies with correlated test statistics.

    Science.gov (United States)

    Shi, Jianxin; Levinson, Douglas F; Whittemore, Alice S

    2008-07-01

    When testing large numbers of null hypotheses, one needs to assess the evidence against the global null hypothesis that none of the hypotheses is false. Such evidence typically is based on the test statistic of the largest magnitude, whose statistical significance is evaluated by permuting the sample units to simulate its null distribution. Efron (2007) has noted that correlation among the test statistics can induce substantial interstudy variation in the shapes of their histograms, which may cause misleading tail counts. Here, we show that permutation-based estimates of the overall significance level also can be misleading when the test statistics are correlated. We propose that such estimates be conditioned on a simple measure of the spread of the observed histogram, and we provide a method for obtaining conditional significance levels. We justify this conditioning using the conditionality principle described by Cox and Hinkley (1974). Application of the method to gene expression data illustrates the circumstances when conditional significance levels are needed.

  4. Optimizing Tobacco Cessation Resource Awareness Among Patients and Providers.

    Science.gov (United States)

    Ma, Laura; Donohue, Caitlin; DeNofrio, Tina; Vitale Pedulla, Lillian; Haddad, Robert I; Rabinowits, Guilherme

    2016-01-01

    Despite receiving a cancer diagnosis, many patients continue to use tobacco during treatment, negatively affecting their outcomes. We hypothesized that limited tobacco cessation (TC) discussion among patients and providers was partially the result of providers' lack of awareness of current TC resources available. We surveyed the head and neck oncology providers (HNOPs) at Dana-Farber Cancer Institute to evaluate their awareness of existing TC resources within the community and performed a 6-month medical record review of active tobacco users (ATUs) to evaluate the frequency of documented TC discussions in clinic. We educated the HNOPs about available TC resources, developed a TC resource teaching sheet, placed a provider alert page in examination rooms as a reminder of TC discussions, and built a TC discussion template to ease documentation. Four weeks postintervention, we resurveyed providers and again performed medical record reviews of ATUs. Preintervention, 13% of HNOPs were aware of TC resources available, and TC discussion documentation was 28%. Postintervention, 100% of HNOPs became aware of the TC resources available, and documentations increased to 56% at 5 months. Identification of ATUs increased from six to 13 per month to 17 to 33 per month post intervention. Eighty-eight percent of HNOPs felt the intervention prompted TC discussions in clinic with their ATUs. The limited number of TC discussions among patients and providers was at least partially the result of unawareness of TC resources available within the community. Educating HNOPs and alerting them to ATUs at their clinic visits successfully prompted TC discussions in clinic. Copyright © 2015 by American Society of Clinical Oncology.

  5. Electrical performance characteristics of the SSC Accelerator System String Test

    International Nuclear Information System (INIS)

    Robinson, W.; Burgett, W.; Dombeck, T.; Gannon, J.; Kraushaar, P.; McInturff, A.; Savord, T.; Tool, G.

    1993-01-01

    The string test facility was constructed to provide a development test bed for the arc regions of the Superconducting Super Collider (SSC). Significant effort has been devoted to the development and testing of superconducting magnets, spools, and accelerator control systems required for the SSC. The string test facility provides the necessary environment required to evaluate the operational performance of these components as they are configured as an accelerator lens in the collider. This discussion will review the results of high current testing of the string conducted to evaluate magnet element uniformity and compatibility, the splice resistance used to connect the magnets, and system response to various quench conditions. Performance results of the spools, energy bypass systems, energy dump, and the power supply system are also discussed

  6. Electrical performance characteristics of the SSC Accelerator System String Test

    International Nuclear Information System (INIS)

    Robinson, W.; Burgett, W.; Dombeck, T.; Gannon, J.; Kraushaar, P.; McInturff, A.; Savord, T.; Tool, G.

    1993-05-01

    The string test facility was constructed to provide a development test bed for the arc regions of the Superconducting Super Collider (SSC). Significant effort has been devoted to the development and testing of superconducting magnets, spools, and accelerator control systems required for the SSC. The string test facility provides the necessary environment required to evaluate the operational performance of these components as they are configured as an accelerator lens in the collider. This discussion will review the results of high current testing of the string conducted to evaluate magnet element uniformity and compatibility, the splice resistance used to connect the magnets, and system response to various quench conditions. Performance results of the spools, energy bypass systems, energy dump, and the power supply system are also discussed

  7. Significant Change Spotting for Periodic Human Motion Segmentation of Cleaning Tasks Using Wearable Sensors

    Directory of Open Access Journals (Sweden)

    Kai-Chun Liu

    2017-01-01

    Full Text Available The proportion of the aging population is rapidly increasing around the world, which will cause stress on society and healthcare systems. In recent years, advances in technology have created new opportunities for automatic activities of daily living (ADL monitoring to improve the quality of life and provide adequate medical service for the elderly. Such automatic ADL monitoring requires reliable ADL information on a fine-grained level, especially for the status of interaction between body gestures and the environment in the real-world. In this work, we propose a significant change spotting mechanism for periodic human motion segmentation during cleaning task performance. A novel approach is proposed based on the search for a significant change of gestures, which can manage critical technical issues in activity recognition, such as continuous data segmentation, individual variance, and category ambiguity. Three typical machine learning classification algorithms are utilized for the identification of the significant change candidate, including a Support Vector Machine (SVM, k-Nearest Neighbors (kNN, and Naive Bayesian (NB algorithm. Overall, the proposed approach achieves 96.41% in the F1-score by using the SVM classifier. The results show that the proposed approach can fulfill the requirement of fine-grained human motion segmentation for automatic ADL monitoring.

  8. Current status of system development to provide databases of nuclides migration

    International Nuclear Information System (INIS)

    Sasamoto, Hiroshi; Yoshida, Yasushi; Isogai, Takeshi; Suyama, Tadahiro; Shibata, Masahiro; Yui, Mikazu; Jintoku, Takashi

    2005-01-01

    JNC has developed databases of nuclides migration for safety assessment of high-level radioactive waste (HLW) repository, and they have been used in the second progress report to present the technical reliability of HLW geological disposal system in Japan. The technical level and applicability of databases have been highly evaluated even overseas. To provide the databases broadly over the world and to promote the use of the databases, we have performed the followings: 1) development of tools to convert the database format from geochemical code PHREEQE to PHREEQC, GWB and EQ3/6 and 2) set up a web site (http://migrationdb.jnc.go.jp) which enables the public to access to the databases. As a result, the number of database users has significantly increased. Additionally, a number of useful comments from the users can be applied to modification and/or update of databases. (author)

  9. 48 CFR 815.304 - Evaluation factors and significant subfactors.

    Science.gov (United States)

    2010-10-01

    ... AFFAIRS CONTRACTING METHODS AND CONTRACT TYPES CONTRACTING BY NEGOTIATION Source Selection 815.304 Evaluation factors and significant subfactors. (a) In an effort to assist SDVOSBs and VOSBs, contracting officers shall include evaluation factors providing additional consideration to such offerors in...

  10. Energy Design Guidelines for High Performance Schools: Arctic and Subarctic Climates

    Energy Technology Data Exchange (ETDEWEB)

    2004-11-01

    The Energy Design Guidelines for High Performance Schools--Arctic and Subarctic Climates provides school boards, administrators, and design staff with guidance to help them make informed decisions about energy and environmental issues important to school systems and communities. These design guidelines outline high performance principles for the new or retrofit design of your K-12 school in arctic and subarctic climates. By incorporating energy improvements into their construction or renovation plans, schools can significantly reduce energy consumption and costs.

  11. Alpha neurofeedback training improves SSVEP-based BCI performance

    Science.gov (United States)

    Wan, Feng; Nuno da Cruz, Janir; Nan, Wenya; Wong, Chi Man; Vai, Mang I.; Rosa, Agostinho

    2016-06-01

    Objective. Steady-state visual evoked potential (SSVEP)-based brain-computer interfaces (BCIs) can provide relatively easy, reliable and high speed communication. However, the performance is still not satisfactory, especially in some users who are not able to generate strong enough SSVEP signals. This work aims to strengthen a user’s SSVEP by alpha down-regulating neurofeedback training (NFT) and consequently improve the performance of the user in using SSVEP-based BCIs. Approach. An experiment with two steps was designed and conducted. The first step was to investigate the relationship between the resting alpha activity and the SSVEP-based BCI performance, in order to determine the training parameter for the NFT. Then in the second step, half of the subjects with ‘low’ performance (i.e. BCI classification accuracy <80%) were randomly assigned to a NFT group to perform a real-time NFT, and the rest half to a non-NFT control group for comparison. Main results. The first step revealed a significant negative correlation between the BCI performance and the individual alpha band (IAB) amplitudes in the eyes-open resting condition in a total of 33 subjects. In the second step, it was found that during the IAB down-regulating NFT, on average the subjects were able to successfully decrease their IAB amplitude over training sessions. More importantly, the NFT group showed an average increase of 16.5% in the SSVEP signal SNR (signal-to-noise ratio) and an average increase of 20.3% in the BCI classification accuracy, which was significant compared to the non-NFT control group. Significance. These findings indicate that the alpha down-regulating NFT can be used to improve the SSVEP signal quality and the subjects’ performance in using SSVEP-based BCIs. It could be helpful to the SSVEP related studies and would contribute to more effective SSVEP-based BCI applications.

  12. Significantly Enhanced Dielectric Performances and High Thermal Conductivity in Poly(vinylidene fluoride)-Based Composites Enabled by SiC@SiO2 Core-Shell Whiskers Alignment.

    Science.gov (United States)

    He, Dalong; Wang, Yao; Song, Silong; Liu, Song; Deng, Yuan

    2017-12-27

    Design of composites with ordered fillers arrangement results in anisotropic performances with greatly enhanced properties along a specific direction, which is a powerful tool to optimize physical properties of composites. Well-aligned core-shell SiC@SiO 2 whiskers in poly(vinylidene fluoride) (PVDF) matrix has been achieved via a modified spinning approach. Because of the high aspect ratio of SiC whiskers, strong anisotropy and significant enhancement in dielectric constant were observed with permittivity 854 along the parallel direction versus 71 along the perpendicular direction at 20 vol % SiC@SiO 2 loading, while little increase in dielectric loss was found due to the highly insulating SiO 2 shell. The anisotropic dielectric behavior of the composite is perfectly understood macroscopically to have originated from anisotropic intensity of interfacial polarization based on an equivalent circuit model of two parallel RC circuits connected in series. Furthermore, finite element simulations on the three-dimensional distribution of local electric field, polarization, and leakage current density in oriented SiC@SiO 2 /PVDF composites under different applied electrical field directions unambiguously revealed that aligned core-shell SiC@SiO 2 whiskers with a high aspect ratio significantly improved dielectric performances. Importantly, the thermal conductivity of the composite was synchronously enhanced over 7 times as compared to that of PVDF matrix along the parallel direction at 20 vol % SiC@SiO 2 whiskers loading. This study highlights an effective strategy to achieve excellent comprehensive properties for high-k dielectrics.

  13. Arkansas community pharmacists' opinions on providing immunizations.

    Science.gov (United States)

    Pace, Anne C; Flowers, Schwanda K; Hastings, Jan K

    2010-10-01

    To determine community pharmacists' attitudes and knowledge on providing immunizations including perceived barriers to immunizing. The study also examined the percentage of Arkansas pharmacists providing immunizations and the utilization of student pharmacists. Survey. Arkansas community pharmacies from February to March 2009. Community pharmacists. Mailed survey. Perceived barriers to providing immunizations, pharmacists' attitudes regarding immunizations, number of immunization-certified pharmacists, immunization administration rates within the last year, and senior student pharmacists utilization. A total of 350 surveys were mailed, and 129 were returned. In all, 79% of the respondents believed administering immunizations has advanced or significantly advanced the profession. Being certified and attitude toward providing immunizations were correlated; 37% of the respondents held certification to immunize, of which 77% reported immunizing within the last year. Commonly reported barriers included time (76%) followed by reimbursement and legal liability. Only half the respondents realized fourth year student pharmacists could immunize and only 33% of certified pharmacists utilized student pharmacists to immunize. Pharmacists perceive many barriers to providing immunizations. Training student pharmacists to give immunizations may not result in them providing immunizations upon graduation. Additional education on overcoming potential barriers and using senior student pharmacists to administer immunizations is needed.

  14. Management of Patients With Hepatitis C Virus, Monoclonal Gammopathy of Undetermined Significance, and Multiple Myeloma

    Directory of Open Access Journals (Sweden)

    Alisse Hannaford BS

    2017-04-01

    Full Text Available Background and Aim: The vast majority of the 2.7 million individuals in the United States who are currently infected with hepatitis C virus (HCV were born between 1945 and 1965. The median age of these patients in this particular generation at the time of this writing was 55 years. In the general population, older age is a risk factor for multiple myeloma (MM and other monogammopathies. As the baby boomer population ages, HCV providers are increasingly likely to encounter HCV-infected patients with a monoclonal gammopathy. Guidelines for managing these patients are needed. Methods: We conducted a detailed case series investigation of 4 HCV-positive patients with MM or a monoclonal gammopathy disorder. Patients were followed at the Mount Sinai Faculty Practice liver clinic. We also performed a detailed review of the literature exploring if there is any known association between HCV, MM, and monoclonal gammopathy. Results and Conclusions: There is no convincing evidence of a causal association between HCV and MM. HCV is linked to type II and type III cryoglobulinemia, specific kinds of monoclonal gammopathies of determinable significance. Whether a link exists between HCV and MM or monoclonal gammopathy of undetermined significance is unclear. Our case series provides the first evidence that modern HCV treatments with direct-acting antivirals can be safely and effectively co-administered with MM chemotherapy.

  15. Home Care Providers to the Rescue: A Novel First-Responder Programme.

    Directory of Open Access Journals (Sweden)

    Steen M Hansen

    Full Text Available 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.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.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 and shock was delivered in one case. For 26 of the 28 cases, the cardiac arrest occurred in a private home. Ninety-five per cent of the providers who had been dispatched to a cardiac arrest reported feeling prepared for managing the initial resuscitation, including use of AED.Home care providers are suited to act as first-responders in predominantly rural and residential districts. Future follow-up will allow further evaluation of home care provider arrivals and patient survival.

  16. Home Care Providers to the Rescue: A Novel First-Responder Programme

    Science.gov (United States)

    Hansen, Steen M.; Brøndum, Stig; Thomas, Grethe; Rasmussen, Susanne R.; Kvist, Birgitte; Christensen, Anette; Lyng, Charlotte; Lindberg, Jan; Lauritsen, Torsten L. B.; Lippert, Freddy K.; Torp-Pedersen, Christian; Hansen, Poul A.

    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 and shock was delivered in one case. For 26 of the 28 cases, the cardiac arrest occurred in a private home. Ninety-five per cent of the providers who had been dispatched to a cardiac arrest reported feeling prepared for managing the initial resuscitation, including use of AED. Conclusion Home care providers are suited to act as first-responders in predominantly rural and residential districts. Future follow-up will allow further evaluation of home care provider arrivals and patient survival. PMID:26509532

  17. Provider Payment Trends and Methods in the Massachusetts Health Care System

    OpenAIRE

    Allison Barrett; Timothy Lake

    2010-01-01

    This report investigates provider payment methods in Massachusetts. Payments include fee-for-service, the predominant model; global payments, which pay providers a single fee for all or most required services during a contract period; and pay-for-performance models, which layer quality incentives onto payments.

  18. Performance and first results of fission product release and transport provided by the VERDON facility

    Energy Technology Data Exchange (ETDEWEB)

    Gallais-During, A., E-mail: annelise.gallais-during@cea.fr [CEA, DEN, DEC, F-13108 Saint-Paul-lez-Durance (France); Bonnin, J.; Malgouyres, P.-P. [CEA, DEN, DEC, F-13108 Saint-Paul-lez-Durance (France); Morin, S. [IRSN, F-13108 Saint-Paul-lez-Durance (France); Bernard, S.; Gleizes, B.; Pontillon, Y.; Hanus, E.; Ducros, G. [CEA, DEN, DEC, F-13108 Saint-Paul-lez-Durance (France)

    2014-10-01

    Highlights: • A new facility to perform experimental LWR severe accidents sequences is evaluated. • In the furnace a fuel sample is heated up to 2600 °C under a controlled gas atmosphere. • Innovative thermal gradient tubes are used to study fission product transport. • The new VERDON facility shows an excellent consistency with results from VERCORS. • Fission product re-vapourization results confirm the correct functioning of the gradient tubes. - Abstract: One of the most important areas of research concerning a hypothetical severe accident in a light water reactor (LWR) is determining the source term, i.e. quantifying the nature, release kinetics and global released fraction of the fission products (FPs) and other radioactive materials. In line with the former VERCORS programme to improve source term estimates, the new VERDON laboratory has recently been implemented at the CEA Cadarache Centre in the LECA-STAR facility. The present paper deals with the evaluation of the experimental equipment of this new VERDON laboratory (furnace, release and transport loops) and demonstrates its capability to perform experimental sequences representative of LWR severe accidents and to supply the databases necessary for source term assessments and FP behaviour modelling.

  19. The Effect of Information Analysis Automation Display Content on Human Judgment Performance in Noisy Environments

    Science.gov (United States)

    Bass, Ellen J.; Baumgart, Leigh A.; Shepley, Kathryn Klein

    2014-01-01

    Displaying both the strategy that information analysis automation employs to makes its judgments and variability in the task environment may improve human judgment performance, especially in cases where this variability impacts the judgment performance of the information analysis automation. This work investigated the contribution of providing either information analysis automation strategy information, task environment information, or both, on human judgment performance in a domain where noisy sensor data are used by both the human and the information analysis automation to make judgments. In a simplified air traffic conflict prediction experiment, 32 participants made probability of horizontal conflict judgments under different display content conditions. After being exposed to the information analysis automation, judgment achievement significantly improved for all participants as compared to judgments without any of the automation's information. Participants provided with additional display content pertaining to cue variability in the task environment had significantly higher aided judgment achievement compared to those provided with only the automation's judgment of a probability of conflict. When designing information analysis automation for environments where the automation's judgment achievement is impacted by noisy environmental data, it may be beneficial to show additional task environment information to the human judge in order to improve judgment performance. PMID:24847184

  20. The Effect of Information Analysis Automation Display Content on Human Judgment Performance in Noisy Environments.

    Science.gov (United States)

    Bass, Ellen J; Baumgart, Leigh A; Shepley, Kathryn Klein

    2013-03-01

    Displaying both the strategy that information analysis automation employs to makes its judgments and variability in the task environment may improve human judgment performance, especially in cases where this variability impacts the judgment performance of the information analysis automation. This work investigated the contribution of providing either information analysis automation strategy information, task environment information, or both, on human judgment performance in a domain where noisy sensor data are used by both the human and the information analysis automation to make judgments. In a simplified air traffic conflict prediction experiment, 32 participants made probability of horizontal conflict judgments under different display content conditions. After being exposed to the information analysis automation, judgment achievement significantly improved for all participants as compared to judgments without any of the automation's information. Participants provided with additional display content pertaining to cue variability in the task environment had significantly higher aided judgment achievement compared to those provided with only the automation's judgment of a probability of conflict. When designing information analysis automation for environments where the automation's judgment achievement is impacted by noisy environmental data, it may be beneficial to show additional task environment information to the human judge in order to improve judgment performance.

  1. A statistical model for predicting muscle performance

    Science.gov (United States)

    Byerly, Diane Leslie De Caix

    The objective of these studies was to develop a capability for predicting muscle performance and fatigue to be utilized for both space- and ground-based applications. To develop this predictive model, healthy test subjects performed a defined, repetitive dynamic exercise to failure using a Lordex spinal machine. Throughout the exercise, surface electromyography (SEMG) data were collected from the erector spinae using a Mega Electronics ME3000 muscle tester and surface electrodes placed on both sides of the back muscle. These data were analyzed using a 5th order Autoregressive (AR) model and statistical regression analysis. It was determined that an AR derived parameter, the mean average magnitude of AR poles, significantly correlated with the maximum number of repetitions (designated Rmax) that a test subject was able to perform. Using the mean average magnitude of AR poles, a test subject's performance to failure could be predicted as early as the sixth repetition of the exercise. This predictive model has the potential to provide a basis for improving post-space flight recovery, monitoring muscle atrophy in astronauts and assessing the effectiveness of countermeasures, monitoring astronaut performance and fatigue during Extravehicular Activity (EVA) operations, providing pre-flight assessment of the ability of an EVA crewmember to perform a given task, improving the design of training protocols and simulations for strenuous International Space Station assembly EVA, and enabling EVA work task sequences to be planned enhancing astronaut performance and safety. Potential ground-based, medical applications of the predictive model include monitoring muscle deterioration and performance resulting from illness, establishing safety guidelines in the industry for repetitive tasks, monitoring the stages of rehabilitation for muscle-related injuries sustained in sports and accidents, and enhancing athletic performance through improved training protocols while reducing

  2. U.S. healthcare providers' knowledge, attitudes, beliefs, and perceptions concerning Chronic Fatigue Syndrome

    Directory of Open Access Journals (Sweden)

    Lin Jin-Mann S

    2010-04-01

    Full Text Available Abstract Background Chronic fatigue syndrome (CFS is a debilitating illness with particular difficulties for healthcare providers because there are no diagnostic signs or laboratory tests and because management aims to merely improve symptoms. Further complicating management, healthcare providers' awareness concerning CFS has not been rigorously assessed. The present study aimed to ascertain United States (U.S. healthcare providers' awareness of CFS and to assess their knowledge, attitudes, and beliefs (KAB related to diagnosis and management of the illness. This information forms the foundation for developing CFS educational strategies. Methods We combined convenience and probability samples to measure CFS KAB among healthcare providers. In the convenience sample, 1,255 healthcare providers (81% response rate from 13 professional conferences completed a 12-item form. Descriptive statistics were reported for 9 KAB item responses and chi-square tests were performed for examining their association with giving a diagnosis of CFS. We used principal component analysis to construct multidimensional subscales and perform a general linear model to examine factors associated with subscales. The probability sample involved data on 15 CFS-specific questions from 2006 and 2007 DocStyles web-based panel surveys collected from 2,750 physicians (average response rate 55%. We calculated descriptive and chi-square statistics. The significance was set at two-tailed with the alpha level of 0.05. Results Healthcare providers in both samples were aware of CFS and exhibited a high level of knowledge. Overall, 96% of respondents in the DocStyles (probability sample had heard about CFS. Healthcare providers in the conference (convenience sample demonstrated good KAB scores; physicians' scores were highest on KAB scales and lowest in perception. Nurses' scores were lowest in knowledge. More than 40% of physicians reported ever giving a CFS diagnosis and in the Doc

  3. Self-reported healthcare provider utilization across United States Midwestern households

    Directory of Open Access Journals (Sweden)

    S.R. Dominick

    2018-06-01

    Full Text Available Understanding the relationships between health care provider usage and demographics of patients is necessary for the development of educational materials, outreach information, and programs targeting individuals who may benefit from services. This analysis identified relationships between health care provider usage and individual's demographics. A sample of Midwestern U.S. respondents (n = 1265 was obtained through the use of an online survey distributed February 12–26, 2016 and was targeted to be representative of the population of the Midwestern states sampled in terms of sex, age, income, and state of residence. Specific factors identified as significant in contributing to provider usage (in the past five years differed across the eleven provider types studied. In the most commonly used practitioners (the general or primary physician, relationships between provider usage and age, income, health insurance coverage status, and having children in the household were identified. Furthermore, significant (and positive correlations were identified between the usage of various practitioners; reporting the use of one type of practitioner studied was correlated positively with reporting the use of another type of health care provider studied in this analysis. This analysis provides insight into the relationships between health care provider usage and demographics of individuals, which can aid in the development of educational materials, outreach programs, and policy development. Keywords: Healthcare, Provider use, Clinician use, Primary physician

  4. Provider volume and outcomes for abdominal aortic aneurysm repair, carotid endarterectomy, and lower extremity revascularization procedures.

    LENUS (Irish Health Repository)

    Killeen, Shane D

    2012-02-03

    BACKGROUND: Intuitively, vascular procedures performed by high-volume vascular subspecialists working at high-volume institutions should be associated with improved patient outcome. Although a large number of studies assess the relationship between volume and outcome, a single contemporary compilation of such studies is lacking. METHODS: A review of the English language literature was performed incorporating searches of the Medline, EMBASE, and Cochrane collaboration databases for abdominal aortic aneurysm repair (elective and emergent), carotid endarterectomy, and arterial lower limb procedures for any volume outcome relationship. Studies were included if they involved a patient cohort from 1980 onwards, were community or population based, and assessed health outcomes (mortality and morbidity) as a dependent variable and volume as an independent variable. RESULTS: We identified 74 relevant studies, and 54 were included. All showed either an inverse relationship of variable magnitude between provider volume and mortality, or no volume-outcome effect. The reduction in the risk-adjusted mortality rate (RAMR) for high-volume providers was 3% to 11% for elective abdominal aortic aneurysm (AAA) repair, 2.5 to 5% for emergent AAA repair, 0.7% to 4.7% carotid endarterectomy, and 0.3% to 0.9% for lower limb arterial bypass procedures. Subspeciality training also conferred a considerable morbidity and mortality benefit for emergent AAA repair, carotid endarterectomy, and lower limb arterial procedures. CONCLUSION: High-volume providers have significantly better outcomes for vascular procedures both in the elective and emergent setting. Subspeciality training also has a considerable impact. These data provide further evidence for the specialization of vascular services, whereby vascular procedures should generally be preformed by high-volume, speciality trained providers.

  5. Time-driven activity-based costing: a driver for provider engagement in costing activities and redesign initiatives.

    Science.gov (United States)

    McLaughlin, Nancy; Burke, Michael A; Setlur, Nisheeta P; Niedzwiecki, Douglas R; Kaplan, Alan L; Saigal, Christopher; Mahajan, Aman; Martin, Neil A; Kaplan, Robert S

    2014-11-01

    To date, health care providers have devoted significant efforts to improve performance regarding patient safety and quality of care. To address the lagging involvement of health care providers in the cost component of the value equation, UCLA Health piloted the implementation of time-driven activity-based costing (TDABC). Here, the authors describe the implementation experiment, share lessons learned across the care continuum, and report how TDABC has actively engaged health care providers in costing activities and care redesign. After the selection of pilots in neurosurgery and urology and the creation of the TDABC team, multidisciplinary process mapping sessions, capacity-cost calculations, and model integration were coordinated and offered to engage care providers at each phase. Reviewing the maps for the entire episode of care, varying types of personnel involved in the delivery of care were noted: 63 for the neurosurgery pilot and 61 for the urology pilot. The average cost capacities for care coordinators, nurses, residents, and faculty were $0.70 (range $0.63-$0.75), $1.55 (range $1.28-$2.04), $0.58 (range $0.56-$0.62), and $3.54 (range $2.29-$4.52), across both pilots. After calculating the costs for material, equipment, and space, the TDABC model enabled the linking of a specific step of the care cycle (who performed the step and its duration) and its associated costs. Both pilots identified important opportunities to redesign care delivery in a costconscious fashion. The experimentation and implementation phases of the TDABC model have succeeded in engaging health care providers in process assessment and costing activities. The TDABC model proved to be a catalyzing agent for cost-conscious care redesign.

  6. Internationalization and firm performance in Chindia countries: a meta-analytic review

    Directory of Open Access Journals (Sweden)

    LINDA SCHULZE

    Full Text Available For more than four decades, researchers have examined theoretically and empirically the relationship between internationalization and firm performance. While existing studies have provided important contributions, the stream of research still lacks consistency due to ambiguous findings on the internationalization-firm performance relationship. Moreover, previous research has often been limited to developed countries. The present study focuses on the emerging Chindia countries and determines the direction and the strength of the internationalization-firm performance relationship. Additionally, we have identified moderators of the relationship. Drawing on 21 studies, based on 9026 firms, we utilize a meta-analytic review to assess our hypotheses. Our results show that there is a significant and positive internationalization-firm performance relationship in Chindia countries. The effect of internationalization in India and China does not significantly differ. Moreover, we find that the effect of internationalization is significantly stronger in the United States as compared to the Chindia countries. The time period of data collection did not play an important role as a moderator. The present study contributes to the International Business literature by examining how and to which extent internationalization influences firm performance and offers implications for theory and practice as well as recommendations for future research.

  7. Effects of memory rehearsal on driver performance: experiment and theoretical account.

    Science.gov (United States)

    Salvucci, Dario D; Beltowska, Joanna

    2008-10-01

    We report an experiment and a theoretical analysis concerning the effects of an exclusively cognitive task, specifically a memory rehearsal task, on driver performance. Although recent work on driver distraction has elucidated the sometimes significant effects of cognitive processing on driver performance, these studies have typically mixed cognitive with perceptual and motor processing, making it difficult to isolate the effects of cognitive processing alone. We asked participants to drive in a driving simulator during only the rehearsal stage of a serial-recall memory task while we measured their ability to maintain a central lane position and respond to the illumination of a lead vehicle's brake lights. Memory rehearsal significantly affected drivers' steering performance as measured by lateral deviation from lane center, and it also significantly affected drivers' response time to the braking stimulus for the higher load memory task. These results lend support to a theoretical account of cognitive distraction provided by threaded cognition theory in terms of a cognitive bottleneck in procedural processing, and they also suggest that consideration of task urgency may be important in accounting for performance trade-offs among concurrent tasks. The experiment augments the current understanding of cognitive driver distraction and suggests that even exclusively cognitive secondary tasks may sometimes affect driver performance.

  8. Content of Orthopedic Patient Education Provided by Nurses in Seven European Countries.

    Science.gov (United States)

    Charalambous, Andreas; Papastavrou, E; Valkeapää, K; Zabalegui, A; Ingadóttir, B; Lemonidou, C; Fatkulina, N; Jouko, K; Leino-Kilpi, H

    2017-07-01

    Patients' and their significant others' education during the perioperative phase is an important and challenging aspect of care. This study explored the content of education provided by nurses to arthroplasty patients and their significant others. Data were collected with the Education of Patients-NURSE content (EPNURSE-Content), Received Knowledge of Hospital Patient (RKhp), and Received Knowledge of Significant Other (RKso) scales. The results showed that the content of education emphasized biophysiological and functional needs, differed between countries, and was related to how physically demanding nurses found their job to be and the amount of education provided. There is congruence between the received knowledge of patients and their significant others in relation to the content of education provided by nurses. The findings can support nurses in developing aid material for patients and significant others explaining the nature of education and advising them what to expect and how to optimize their participation in the process.

  9. Brain Structure Linking Delay Discounting and Academic Performance.

    Science.gov (United States)

    Wang, Song; Kong, Feng; Zhou, Ming; Chen, Taolin; Yang, Xun; Chen, Guangxiang; Gong, Qiyong

    2017-08-01

    As a component of self-discipline, delay discounting refers to the ability to wait longer for preferred rewards and plays a pivotal role in shaping students' academic performance. However, the neural basis of the association between delay discounting and academic performance remains largely unknown. Here, we examined the neuroanatomical substrates underlying delay discounting and academic performance in 214 adolescents via voxel-based morphometry (VBM) by performing structural magnetic resonance imaging (S-MRI). Behaviorally, we confirmed the significant correlation between delay discounting and academic performance. Neurally, whole-brain regression analyses indicated that regional gray matter volume (rGMV) of the left dorsolateral prefrontal cortex (DLPFC) was associated with both delay discounting and academic performance. Furthermore, delay discounting partly accounted for the association between academic performance and brain structure. Differences in the rGMV of the left DLPFC related to academic performance explained over one-third of the impact of delay discounting on academic performance. Overall, these results provide the first evidence for the common neural basis linking delay discounting and academic performance. Hum Brain Mapp 38:3917-3926, 2017. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

  10. Evaluating Tourist Destination Performance: Expanding the Sustainability Concept

    Directory of Open Access Journals (Sweden)

    Wenbin Luo

    2018-02-01

    Full Text Available Performance evaluations are a critical tool in promoting the sustainability of tourist destinations. The literature shows a lack of consensus on basic terminology and definitions of destination performance. While research focuses on business efficiency, areas such as development effectiveness, social equality, and environmental integrity are still not well understood, even though these are salient elements of sustainable development. This paper provides a framework for evaluating destination performance under the 4E rubric of economy, efficiency, effectiveness, and environmental quality, which reflects a more holistic and effective destination performance. The information entropy weight method and a multi-factor comprehensive evaluation model are developed and applied to an international destination, Zhangjiajie, China, which was selected as a case study to test the framework developed. Results show that the economy, efficiency, effectiveness, and environmental quality aspects should be considered when evaluating tourism development performance. The empirical analysis shows that based on these criteria, Zhangjiajie’s destination performance improved measurably during the test period from 2005 to 2009. The results indicate that significant events, natural disasters, and financial crises influence performance most.

  11. Burnout syndrome and coping strategies in Portuguese oncology health care providers

    Directory of Open Access Journals (Sweden)

    VASCO F. J. CUMBE

    Full Text Available Abstract Background Burnout is a multidimensional syndrome and includes symptoms of emotional exhaustion, depersonalization, and reduced personal accomplishment at work. Oncology health care providers are at high risk to develop symptoms of burnout because of work-related stressors. Adaptive coping strategies adopted to deal with stressors may prevent the development of burnout. Objective The present study aims to assess the association between burnout, functional coping strategies, and occupational factors in a sample of oncology providers, mostly nurses. Methods Sociodemographic Questionnaire, the Maslach Burnout Inventory, and the Problem Solving Inventory “Inventário de Resolução de Problemas” were administered. Descriptive, correlational, and linear regression analyses were performed. Results The study showed that emotional exhaustion correlated with lower levels of adaptive coping, less years of experience in Oncology, and a greater amount of hours worked per week. Personal accomplishment was associated with the adaptive coping strategies. No further statistically significant associations were identified. Discussion Our findings support the importance of adaptive coping strategies in order to prevent symptoms of burnout when health professionals face potentially stressful occupational factors. Training aimed at improving adaptive coping skills may prevent burnout syndrome for health care professionals working in Oncology.

  12. Strategic information systems planning for health service providers.

    Science.gov (United States)

    Moriarty, D D

    1992-01-01

    There is significant opportunity for health service providers to gain competitive advantage through the innovative use of strategic information systems. This analysis presents some key strategic information systems issues that will enable managers to identify opportunities within their organizations.

  13. Using attribution theory to examine community rehabilitation provider stigma.

    Science.gov (United States)

    Strauser, David R; Ciftci, Ayse; O'Sullivan, Deirdre

    2009-03-01

    This study builds on existing research investigating the stigma-reducing strategies specific to rehabilitation service providers by comparing differences in education levels and degree of contact among rehabilitation service providers. Rehabilitation service providers with master's level and bachelor level education showed significant differences in their stigmatizing tendencies on subscales of controllability and stability for different categories of disabilities. Specifically, service providers with a master's degree had more stigmatizing beliefs for psychosis and cocaine addiction, compared with service providers with a bachelor's degree. Service providers with either a bachelor's degree or master's degree reported lower levels of stigma overall for five of the six categories of disability compared with their community college student counterparts. No differences were found for length of time working with persons with psychiatric disabilities.

  14. The Vehicle Integrated Performance Analysis Experience: Reconnecting With Technical Integration

    Science.gov (United States)

    McGhee, D. S.

    2006-01-01

    Very early in the Space Launch Initiative program, a small team of engineers at MSFC proposed a process for performing system-level assessments of a launch vehicle. Aimed primarily at providing insight and making NASA a smart buyer, the Vehicle Integrated Performance Analysis (VIPA) team was created. The difference between the VIPA effort and previous integration attempts is that VIPA a process using experienced people from various disciplines, which focuses them on a technically integrated assessment. The foundations of VIPA s process are described. The VIPA team also recognized the need to target early detailed analysis toward identifying significant systems issues. This process is driven by the T-model for technical integration. VIPA s approach to performing system-level technical integration is discussed in detail. The VIPA process significantly enhances the development and monitoring of realizable project requirements. VIPA s assessment validates the concept s stated performance, identifies significant issues either with the concept or the requirements, and then reintegrates these issues to determine impacts. This process is discussed along with a description of how it may be integrated into a program s insight and review process. The VIPA process has gained favor with both engineering and project organizations for being responsive and insightful

  15. Environmental Management Performance Report

    International Nuclear Information System (INIS)

    EDER, D.M.

    2002-01-01

    The purpose of this report is to provide the Department of Energy Richland Operations Office (RL) a monthly summary of the Central Plateau Contractor's Environmental Management (EM) performance by Fluor Hanford (FH) and its subcontractors. Only current FH workscope responsibilities are described and other contractor/RL managed work is excluded. Please refer to other sections (BHI, PNNL) for other contractor information. Section A, Executive Summary, provides an executive level summary of the cost, schedule, and technical performance described in this report. It summarizes performance for the period covered, highlights areas worthy of management attention, and provides a forward look to some of the upcoming key performance activities as extracted from the contractor baseline. The remaining sections provide detailed performance data relative to each individual subproject (e.g., Plutonium Finishing Plant, Spent Nuclear Fuels, etc.), in support of Section A of the report. All information is updated as of January 31, 2002 unless otherwise noted. ''Stoplight'' boxes are used to indicate at a glance the condition of a particular safety area. Green boxes denote either (1) the data are stable at a level representing ''acceptable'' performance, or (2) an improving trend exists. Yellows denote the data are stable at a level from which improvement is needed. Red denotes a trend exists in a non-improving direction

  16. 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.

  17. Knowledge, attitude, willingness and readiness of primary health care providers to provide oral health services to children in Niagara, Ontario: a cross-sectional survey.

    Science.gov (United States)

    Singhal, Sonica; Figueiredo, Rafael; Dupuis, Sandy; Skellet, Rachel; Wincott, Tara; Dyer, Carolyn; Feller, Andrea; Quiñonez, Carlos

    2017-01-01

    Most children are exposed to medical, but not dental, care at an early age, making primary health care providers an important player in the reduction of tooth decay. The goal of this research was to understand the feasibility of using primary health care providers in promoting oral health by assessing their knowledge, attitude, willingness and readiness in this regard. Using the Dillman method, a mail-in cross-sectional survey was conducted among all family physicians and pediatricians in the Niagara region of Ontario who have primary contact with children. A descriptive analysis was performed. Close to 70% (181/265) of providers responded. More than 90% know that untreated tooth decay could affect the general health of a child. More than 80% examine the oral cavity for more than 50% of their child patients. However, more than 50% are not aware that white spots or lines on the tooth surface are the first signs of tooth decay. Lack of clinical time was the top reason for not performing oral disease prevention measures. Overall, survey responses show a positive attitude and willingness to engage in the oral health of children. To capitalize on this, there is a need to identify mechanisms of providing preventive oral health care services by primary health care providers; including improving their knowledge of oral health and addressing other potential barriers.

  18. Managing human performance

    International Nuclear Information System (INIS)

    Strucic, M.; Kavsek, D.

    2004-01-01

    Human performance remains a significant factor for management attention not only from a reactor safety perspective, but also from a financial one. Recent significant events analysis shows that human errors are still dominant causes and contributors to them. An analysis of significant events in nuclear industry occurred through 15-years period revealed that three of four significant events were triggered by human error, although the number of events have dropped by more than a factor of four. A number of human performance breakdowns occurred in the application of errorprevention techniques. These included a lack of pre-job briefs, inadequate turnover of tasks, ineffective use of peer checking, inadequate procedure adherence, and failure to apply a questioning attitude when unexpected changes were encountered in the task. Attempts by the industry to improve human performance have traditionally focused at the worker level. However, human error occurs within the context of the organization, which can either foster or resist human error. The greatest room for improvement lies not only in the continued improvement of front-line worker performance but more so in the identification and elimination of weaknesses in the organizational and managerial domains that contributes to worker performance at the job site. Based on mentioned analysis, other industrial sources and own operating experience, NPP Krsko is paying more attention to improve human performance among own as well as contractor workers. Through series of programs and activities, such as Reactivity Management Program, Safety Culture Program, Self-assessment Program, Corrective Action Program, Plant Performance Monitoring Program, developed in last few years, and through new procedures, written guides and publications, training and management efforts, number of human errors is going to be reduced. Involvement of higher levels of NPP Krsko organization in promotion and use of Human Performance techniques is

  19. Adolescent sleep disturbance and school performance: the confounding variable of socioeconomics.

    Science.gov (United States)

    Pagel, James F; Forister, Natalie; Kwiatkowki, Carol

    2007-02-15

    To assess how selected socioeconomic variables known to affect school performance alter the association between reported sleep disturbance and poor school performance in a contiguous middle school/high school population. A school district/college IRB approved questionnaire was distributed in science and health classes in middle school and high school. This questionnaire included a frequency scaled pediatric sleep disturbance questionnaire for completion by students and a permission and demographic questionnaire for completion by parents (completed questionnaires n = 238 with 69.3% including GPA). Sleep complaints occur at high frequency in this sample (sleep onset insomnia 60% > 1 x /wk.; 21.2% every night; sleepiness during the day (45.7% > 1 x /wk.; 15.2 % every night), and difficulty concentrating (54.6% > 1 x /wk.; 12.9% always). Students with lower grade point averages (GPAs) were more likely to have restless/aching legs when trying to fall asleep, difficulty concentrating during the day, snoring every night, difficulty waking in the morning, sleepiness during the day, and falling asleep in class. Lower reported GPAs were significantly associated with lower household incomes. After statistically controlling for income, restless legs, sleepiness during the day, and difficulty with concentration continued to significantly affect school performance. This study provides additional evidence indicating that sleep disturbances occur at high frequencies in adolescents and significantly affect daytime performance, as measured by GPA. The socioeconomic variable of household income also significantly affects GPA. After statistically controlling for age and household income, the number and type of sleep variables noted to significantly affect GPA are altered but persistent in demonstrating significant effects on school performance.

  20. An investigation of noise performance in optical lock-in thermography

    Science.gov (United States)

    Rajic, Nik; Antolis, Cedric

    2017-12-01

    An investigation into the noise performance of optical lock-in thermography (OLT) is described. The study aims to clarify the influence of infrared detector type and key inspection parameters such as illumination strength and lock-in duration on the quality of OLT amplitude and phase imagery. The study compares the performance of a state-of-the-art cooled photon detector with several lower-cost microbolometers. The results reveal a significant noise performance advantage to the photon detector. Under certain inspection regimes the advantage with respect to phase image quality is disproportionately high relative to detector sensitivities. This is shown to result from an explicit dependence in the phase signal variance on the ratio between the signal amplitude and the detector sensitivity. While this finding supports the preferred use of photon detectors for OLT inspections, it does not exclude microbolometers from a useful role. In cases where the significantly lower capital cost and improved practicality of microbolometers provide an advantage it is shown that performance shortfalls can be overcome with a relatively small factorial increase in optical illumination intensity.

  1. Rating the digital help: electronic medical records, software providers, and physicians.

    Science.gov (United States)

    Butler, Richard J; Johnson, William G

    2016-09-01

    To separate the effects of physicians' characteristics on the perceived productivity of EMRs from the effects of limitations on usability inherent in EMR design, a multivariate regression model is used to estimate the factors influencing physicians' rankings of five attributes of their EMRs, namely; ease of use and reliability; the EMRs effect on physician and staff productivity and the EMRs performance vs. vendor's promises. We divide the factors influencing the rankings into three groups: physician characteristics, EMR characteristics and practice characteristics (type of practice, size, and location). The data are from approximately 1800 practicing physicians in Arizona. Physician's characteristics influence perceived ease of use and physicians' productivity, but not staff productivity, reliability or vendors' promised performance. Practice type and EMR characteristics affect perceived productivity, reliability and performance versus vendors' promises. Vendor-specific effects are highly correlated across all five attributes and are always jointly significant. EMR characteristics are the most significant influence on physicians' perceptions of the EMRs effect on their productivity and that of their staff. Physicians' characteristics (particularly age) have a small but significant influence on perceived productivity.

  2. Analyzing traffic source impact on returning visitors ratio in information provider website

    Science.gov (United States)

    Prasetio, A.; Sari, P. K.; Sharif, O. O.; Sofyan, E.

    2016-04-01

    Web site performance, especially returning visitor is an important metric for an information provider web site. Since high returning visitor is a good indication of a web site’s visitor loyalty, it is important to find a way to improve this metric. This research investigated if there is any difference on returning visitor metric among three web traffic sources namely direct, referral and search. Monthly returning visitor and total visitor from each source is retrieved from Google Analytics tools and then calculated to measure returning visitor ratio. The period of data observation is from July 2012 to June 2015 resulting in a total of 108 samples. These data then analysed using One-Way Analysis of Variance (ANOVA) to address our research question. The results showed that different traffic source has significantly different returning visitor ratio especially between referral traffic source and the other two traffic sources. On the other hand, this research did not find any significant difference between returning visitor ratio from direct and search traffic sources. The owner of the web site can focus to multiply referral links from other relevant sites.

  3. Total sleep deprivation does not significantly degrade semantic encoding.

    Science.gov (United States)

    Honn, K A; Grant, D A; Hinson, J M; Whitney, P; Van Dongen, Hpa

    2018-01-17

    Sleep deprivation impairs performance on cognitive tasks, but it is unclear which cognitive processes it degrades. We administered a semantic matching task with variable stimulus onset asynchrony (SOA) and both speeded and self-paced trial blocks. The task was administered at the baseline and 24 hours later after 30.8 hours of total sleep deprivation (TSD) or matching well-rested control. After sleep deprivation, the 20% slowest response times (RTs) were significantly increased. However, the semantic encoding time component of the RTs remained at baseline level. Thus, the performance impairment induced by sleep deprivation on this task occurred in cognitive processes downstream of semantic encoding.

  4. The significance of small streams

    Science.gov (United States)

    Wohl, Ellen

    2017-09-01

    Headwaters, defined here as first- and secondorder streams, make up 70%‒80% of the total channel length of river networks. These small streams exert a critical influence on downstream portions of the river network by: retaining or transmitting sediment and nutrients; providing habitat and refuge for diverse aquatic and riparian organisms; creating migration corridors; and governing connectivity at the watershed-scale. The upstream-most extent of the channel network and the longitudinal continuity and lateral extent of headwaters can be difficult to delineate, however, and people are less likely to recognize the importance of headwaters relative to other portions of a river network. Consequently, headwaters commonly lack the legal protections accorded to other portions of a river network and are more likely to be significantly altered or completely obliterated by land use.

  5. Managed care, vertical integration strategies and hospital performance.

    Science.gov (United States)

    Wang, B B; Wan, T T; Clement, J; Begun, J

    2001-09-01

    The purpose of this study is to examine the association of managed care with hospital vertical integration strategies, as well as to observe the relationships of different types of vertical integration with hospital efficiency and financial performance. The sample consists of 363 California short-term acute care hospitals in 1994. Linear structure equation modeling is used to test six hypotheses derived from the strategic adaptation model. Several organizational and market factors are controlled statistically. Results suggest that managed care is a driving force for hospital vertical integration. In terms of performance, hospitals that are integrated with physician groups and provide outpatient services (backward integration) have better operating margins, returns on assets, and net cash flows (p < 0.01). These hospitals are not, however, likely to show greater productivity. Forward integration with a long-term-care facility, on the other hand, is positively and significantly related to hospital productivity (p < 0.001). Forward integration is negatively related to financial performance (p < 0.05), however, opposite to the direction hypothesized. Health executives should be responsive to the growth of managed care in their local market and should probably consider providing more backward integrated services rather than forward integrated services in order to improve the hospital's financial performance in today's competitive health care market.

  6. The BaBar instrumented flux return performance: lessons learned

    CERN Document Server

    Anulli, F; Baldini, R; Band, H R; Bionta, R; Brau, J E; Brigljevic, V; Buzzo, A; Calcaterra, A; Carpinelli, M; Cartaro, C; Cavallo, N; Crosetti, G; De Nardo, Gallieno; De Sangro, R; Eichenbaum, A; Fabozzi, F; Falciai, D; Ferrarotto, F; Ferroni, F; Finocchiaro, G; Forti, F; Frey, R; Gatto, C; Graug; Iakovlev, N I; Iwasaki, M; Johnson, J R; Lange, D J; Lista, L; Lo Vetere, M; Lü, C; Macri, M; Messner, R; Moore, T B; Morganti, S; Neal, H; Neri, N; Palano, A; Paoloni, E; Paolucci, P; Passaggio, S; Pastore, F C; Patteri, P; Peruzzi, I; Piccolo, D; Piccolo, M; Piredda, G; Robutti, E; Roodman, A; Santroni, A; Sciacca, C; Sinev, N B; Soha, A; Strom, D; Tosi, S; Vavra, J; Wisniewski, W J; Wright, D M; Xie, Y; Zallo, A

    2002-01-01

    The BaBar Collaboration has operated an instrumented flux return (IFR) system covering over 2000 m sup 2 with resistive plate chambers (RPCs) for nearly 3 years. The chambers are constructed of bakelite sheets separated by 2 mm. The inner surfaces are coated with linseed oil. This system provides muon and neutral hadron detection for BaBar. Installation and commissioning were completed in 1998, and operation began mid-year 1999. While initial performance of the system reached design, over time, a significant fraction of the RPCs demonstrated significant degradation, marked by increased currents and reduced efficiency. A coordinated effort of investigations have identified many of the elements responsible for the degradation. This article presents our current understanding of the aging process of the BaBar RPCs along with the action plan to combat performance degradation of the IFR system.

  7. Hedge Fund Performance Attribution Under Various Market Conditions

    OpenAIRE

    Stafylas, Dimitrios; Anderson, Keith Philip; Uddin, Muhammad Moshfique

    2018-01-01

    We investigate US hedge funds’ performance. Our proposed model contains exogenous and endogenous break points, based on business cycles and on a regime switching process conditional on different states of the market. During difficult market conditions most hedge fund strategies do not provide significant alphas. At such times hedge funds reduce both the number of their exposures to different asset classes and their portfolio allocations, while some strategies even reverse their exposures. Dir...

  8. REVERSIBLE IMPAIRMENT OF ASSETS AND THE IMPACT ON ECONOMIC PERFORMANCE

    Directory of Open Access Journals (Sweden)

    MIRON VASILE-CRISTIAN-IOACHIM

    2015-03-01

    Full Text Available Economic performance is an essential objective of economic entities activating in the energy sector. The profit and loss account provides relevant information for performance analyzes, but evaluating the factors which determined the modification of the financial result demands detailed analyzes based on specific techniques. This paper develops and implements an econometric model that analyses the relation between gross profit and the reversible impairment of assets. The results of the analysis have shown that, in the energy sector, there is a significant connection between those two variables.

  9. CT provides precise size assessment of implanted titanium alloy pedicle screws.

    Science.gov (United States)

    Elliott, Michael J; Slakey, Joseph B

    2014-05-01

    After performing instrumented spinal fusion with pedicle screws, postoperative imaging using CT to assess screw position may be necessary. Stainless steel implants produce significant metal artifact on CT, and the degree of distortion is at least partially dependent on the cross-sectional area of the implanted device. If the same effect occurs with titanium alloy implants, ability to precisely measure proximity of screws to adjacent structures may be adversely affected as screw size increases. We therefore asked whether (1) CT provides precise measurements of true screw widths; and (2) precision degrades based on the size of the titanium implant imaged. CT scans performed on 20 patients after instrumented spinal fusion for scoliosis were reviewed. The sizes of 151 titanium alloy pedicle screws were measured and compared with known screw size. The amount of metal bloom artifact was determined for each of the four screw sizes. ANOVA with Tukey's post hoc test were performed to evaluate differences in scatter, and Spearman's rho coefficient was used to measure relationship between screw size and scatter. All screws measured larger than their known size, but even with larger 7-mm screws the size differential was less than 1 mm. The four different screw sizes produced scatter amounts that were different from each other (p titanium alloy pedicle screws produces minimal artifact, thus making this the preferred imaging modality to assess screw position after surgery. Although the amount of artifact increases with the volume of titanium present, the degree of distortion is minimal and is usually less than 1 mm.

  10. Performance of Radiant Heating Systems of Low-Energy Buildings

    Science.gov (United States)

    Sarbu, Ioan; Mirza, Matei; Crasmareanu, Emanuel

    2017-10-01

    After the introduction of plastic piping, the application of water-based radiant heating with pipes embedded in room surfaces (i.e., floors, walls, and ceilings), has significantly increased worldwide. Additionally, interest and growth in radiant heating and cooling systems have increased in recent years because they have been demonstrated to be energy efficient in comparison to all-air distribution systems. This paper briefly describes the heat distribution systems in buildings, focusing on the radiant panels (floor, wall, ceiling, and floor-ceiling). Main objective of this study is the performance investigation of different types of low-temperature heating systems with different methods. Additionally, a comparative analysis of the energy, environmental, and economic performances of floor, wall, ceiling, and floor-ceiling heating using numerical simulation with Transient Systems Simulation (TRNSYS) software is performed. This study showed that the floor-ceiling heating system has the best performance in terms of the lowest energy consumption, operation cost, CO2 emission, and the nominal boiler power. The comparison of the room operative air temperatures and the set-point operative air temperature indicates also that all radiant panel systems provide satisfactory results without significant deviations.

  11. Research and Practice Communications Between Oral Health Providers and Prenatal Health Providers: A Bibliometric Analysis.

    Science.gov (United States)

    Skvoretz, John; Dyer, Karen; Daley, Ellen; Debate, Rita; Vamos, Cheryl; Kline, Nolan; Thompson, Erika

    2016-08-01

    Objectives We aimed to examine scholarly collaboration between oral health and prenatal providers. Oral disease is a silent epidemic with significant public health implications for pregnant women. Evidence linking poor oral health during pregnancy to adverse pregnancy and birth outcomes requires oral health and prenatal providers to communicate on the prevention, treatment and co-management matters pertaining to oral health issues among their pregnant patients. The need for inter-professional collaboration is highlighted by guidelines co-endorsed by the American College of Obstetricians and Gynecologists and the American Dental Association, stressing the importance of oral health care during pregnancy. Methods To assess if interdisciplinary communication occurs between oral health and prenatal disciplines, we conducted a network analysis of research on pregnancy-related periodontal disease. Results Social Network analysis allowed us to identify communication patterns between communities of oral health and prenatal professionals via scientific journals. Analysis of networks of citations linking journals in different fields reveals a core-periphery pattern dominated by oral health journals with some participation from medicine journals. However, an analysis of dyadic ties of citation reveals statistically significant "inbreeding" tendencies in the citation patterns: both medical and oral health journals tend to cite their own kind at greater-than-chance levels. Conclusions Despite evidence suggesting that professional collaboration benefits patients' overall health, findings from this research imply that little collaboration occurs between these two professional groups. More collaboration may be useful in addressing women's oral-systemic health concerns that result in adverse pregnancy outcomes.

  12. 78 FR 69438 - AGOA: Trade and Investment Performance Overview; AGOA: Economic Effects of Providing Duty-Free...

    Science.gov (United States)

    2013-11-19

    ... INTERNATIONAL TRADE COMMISSION [Investigation No. 332-542, Investigation No. 332-544, Investigation No. 332-545, Investigation No. 332-546] AGOA: Trade and Investment Performance Overview; AGOA... To Promote Regional Integration and Increase Exports to the United States; EU-South Africa FTA...

  13. Evaluating Common Privacy Vulnerabilities in Internet Service Providers

    Science.gov (United States)

    Kotzanikolaou, Panayiotis; Maniatis, Sotirios; Nikolouzou, Eugenia; Stathopoulos, Vassilios

    Privacy in electronic communications receives increased attention in both research and industry forums, stemming from both the users' needs and from legal and regulatory requirements in national or international context. Privacy in internet-based communications heavily relies on the level of security of the Internet Service Providers (ISPs), as well as on the security awareness of the end users. This paper discusses the role of the ISP in the privacy of the communications. Based on real security audits performed in national-wide ISPs, we illustrate privacy-specific threats and vulnerabilities that many providers fail to address when implementing their security policies. We subsequently provide and discuss specific security measures that the ISPs can implement, in order to fine-tune their security policies in the context of privacy protection.

  14. Fatigue, Work Schedules, and Perceived Performance in Bedside Care Nurses.

    Science.gov (United States)

    Sagherian, Knar; Clinton, Michael E; Abu-Saad Huijer, Huda; Geiger-Brown, Jeanne

    2017-07-01

    Hospital nurses are expected to maintain optimal work performance; yet, fatigue can threaten safe practice and result in unfavorable patient outcomes. This descriptive cross-sectional study explored the association between fatigue, work schedules, and perceived work performance among nurses. The study sample included 77 bedside nurses who were mostly female, single, and between 20 and 29 years of age. The majority worked 8-hour shifts and overtime. Nurses who worked during off days reported significantly higher chronic fatigue compared with those nurses who took time off. Nurses who reported feeling refreshed after sleep had significantly less chronic and acute fatigue and more intershift recovery. Nurses with acute and chronic fatigue perceived poorer physical performance. Also, nurses who reported chronic fatigue perceived they were less alert and less able to concentrate when providing patient care. Less effective communication was also associated with acute and chronic fatigue. In conclusion, fatigue has safety implications for nurses' practice that should be monitored by nursing management.

  15. The IPE Database: providing information on plant design, core damage frequency and containment performance

    International Nuclear Information System (INIS)

    Lehner, J.R.; Lin, C.C.; Pratt, W.T.; Su, T.; Danziger, L.

    1996-01-01

    A database, called the IPE Database has been developed that stores data obtained from the Individual Plant Examinations (IPEs) which licensees of nuclear power plants have conducted in response to the Nuclear Regulatory Commission's (NRC) Generic Letter GL88-20. The IPE Database is a collection of linked files which store information about plant design, core damage frequency (CDF), and containment performance in a uniform, structured way. The information contained in the various files is based on data contained in the IPE submittals. The information extracted from the submittals and entered into the IPE Database can be manipulated so that queries regarding individual or groups of plants can be answered using the IPE Database

  16. Bike Desks in the Classroom: Energy Expenditure, Physical Health, Cognitive Performance, Brain Functioning, and Academic Performance.

    Science.gov (United States)

    Torbeyns, Tine; de Geus, Bas; Bailey, Stephen; Decroix, Lieselot; Van Cutsem, Jeroen; De Pauw, Kevin; Meeusen, Romain

    2017-06-01

    Physical activity is positively associated with physical health, cognitive performance, brain functioning and academic performance. The aim of this study is to investigate the influence of bike desks in the classroom on adolescents' energy expenditure, physical health, cognitive performance, brain functioning and academic performance. Forty-four adolescents were randomly assigned to control group (CG) or intervention group (IG). During 5 months, the IG used a bike desk for 4 class hours/week. Energy expenditure was measured during 6 consecutive days. Anthropometric parameters, aerobic fitness, academic performance, cognitive performance and brain functioning were assessed before (T0) and after (T1) the intervention. Energy expenditure of the IG was significantly higher during the class hours in which they used the bike desks relative to normal class hours. The CG had a significantly higher BMI at T1 relative to T0 while this was not significantly different for the IG. Aerobic fitness was significantly better in the IG at T1 relative to T0. No significant effects on academic performance cognitive performance and brain functioning were observed. As the implementation of bike desks in the classroom did not interfere with adolescents' academic performance, this can be seen as an effective means of reducing in-class sedentary time and improving adolescents' physical health.

  17. Heterostructured TiO2/NiTiO3 Nanorod Arrays for Inorganic Sensitized Solar Cells with Significantly Enhanced Photovoltaic Performance and Stability.

    Science.gov (United States)

    Li, Yue-Ying; Wang, Jian-Gan; Sun, Huan-Huan; Wei, Bingqing

    2018-04-11

    Organic dyes used in the conventional dye-sensitized solar cells (DSSCs) suffer from poor light stability and high cost. In this work, we demonstrate a new inorganic sensitized solar cell based on ordered one-dimensional semiconductor nanorod arrays of TiO 2 /NiTiO 3 (NTO) heterostructures prepared via a facile two-step hydrothermal approach. The semiconductor heterostructure arrays are highly desirable and promising for DSSCs because of their direct charge transport capability and slow charge recombination rate. The low-cost NTO inorganic semiconductor possesses an appropriate band gap that matches well with TiO 2 , which behaves like a "dye" to enable efficient light harvesting and fast electron-hole separation. The solar cells constructed by the ordered TiO 2 /NTO heterostructure photoanodes show a significantly improved power conversion efficiency, high fill factor, and more promising, outstanding life stability. The present work will open up an avenue to design heterostructured inorganics for high-performance solar cells.

  18. Implementation of Provider Perspectives Resulted in Proper Health Care Resource Utilization

    National Research Council Canada - National Science Library

    Mclean, Hugh

    2001-01-01

    .... One such system is Provider Perspectives. This study shows that Provider Perspectives significantly decreased Emergency Room utilization and subsequently increased the usage of primary care clinics at Martin Army Community Hospital and Winn...

  19. Enhancement of human performance with developing ergonomic workplace environment and providing work-life balance

    OpenAIRE

    Tamas Forgacs,; Henrietta Finna

    2010-01-01

    Ergonomy aims at creating a work place that suits the employee’s needs. A well-developed office does not only increase work efficiency but it can also significantly reduce costs. This study researches and reveals the specific personal attributes and the factors of workplace environment, which have an effect on the efficiency of the workforce. We were searching for studies, where the core work wasn’t changed -the increase in work efficiency was reached only by changing the work environment.

  20. Development of Model for Providing Feasible Scholarship

    Directory of Open Access Journals (Sweden)

    Harry Dhika

    2016-05-01

    Full Text Available The current work focuses on the development of a model to determine a feasible scholarship recipient on the basis of the naiv¨e Bayes’ method using very simple and limited attributes. Those attributes are the applicants academic year, represented by their semester, academic performance, represented by their GPa, socioeconomic ability, which represented the economic capability to attend a higher education institution, and their level of social involvement. To establish and evaluate the model performance, empirical data are collected, and the data of 100 students are divided into 80 student data for the model training and the remaining of 20 student data are for the model testing. The results suggest that the model is capable to provide recommendations for the potential scholarship recipient at the level of accuracy of 95%.