WorldWideScience

Sample records for providing significant performance

  1. Significant improvement of electrochemical performance of Cu ...

    Indian Academy of Sciences (India)

    Significant improvement of electrochemical performance of Cu-coated LiVPO4F cathode material for lithium-ion batteries ... School of Mechanical Engineering and Automation, Northeastern University, Shenyang 110819, China; School of Mechanical Engineering, Shenyang University of Chemical Technology, Shenyang ...

  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. Wound classification in pediatric general surgery: significant variation exists among providers.

    Science.gov (United States)

    Snyder, Rebecca A; Johnson, Lisa; Tice, Jamie; Wingo, Tammy; Williams, Dana; Wang, Li; Blakely, Martin L

    2013-11-01

    Risk-adjusted rates of surgical site infections (SSI) are used as a quality metric to facilitate improvement within a hospital system and allow comparison across institutions. The NSQIP-Pediatric, among others, uses surgical wound classification as a variable in models designed to predict risk-adjusted postoperative morbidity, including SSI rates. The purpose of this study was to measure the level of agreement in wound classification assignment among 3 providers: surgeons, operating room (OR) nurses, and NSQIP surgical clinical reviewers (SCR). An analysis was performed of pediatric general surgery operations from 2010 to 2011. Wound classification was assigned at the time of operation by the OR nurse and surgeon, and by the NSQIP SCR postoperatively, according to NSQIP methodology. Disagreement was defined as any discrepancy in classification among the 3 providers, and the level of agreement was determined using the kappa statistic. For the 374 procedures reviewed, there was an overall disagreement of 48% among all providers, kappa 0.48 (95% CI 0.43 to 0.53). When comparing wound classification by surgeon and NSQIP SCR, 23% of cases were in disagreement, kappa 0.74 (95% CI 0.68 to 0.78). Disagreement between OR nurse and either surgeon or NSQIP SCR was higher: 38%, kappa 0.45 (95% CI 0.38 to 0.53) and 40%, kappa 0.44 (95% CI 0.37 to 0.51). Fundoplication, appendectomy, and cholecystectomy demonstrated the highest overall disagreement (73%, 71%, and 60%, respectively). There is significant variation in assigning surgical wound classification among health care providers. For future SSI comparative analyses, it will be critical to improve uniformity and understanding of wound class assignment among providers and institutions. Copyright © 2013 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

  4. 5 CFR 9701.407 - Monitoring performance and providing feedback.

    Science.gov (United States)

    2010-01-01

    ... implementing directives and policies, supervisors must— (a) Monitor the performance of their employees and the organization; and (b) Provide timely periodic feedback to employees on their actual performance with respect to their performance expectations, including one or more interim performance reviews during each appraisal...

  5. Which significance test performs the best in climate simulations?

    Science.gov (United States)

    Decremer, D.; Chung, C. E.; Ekman, A. M.

    2013-12-01

    Externally-forced climate change simulated by general circulation models (GCMs) needs to be compared with model noise (model internal variability) in order to assess the robustness of climate change signals. Significance tests are performed to establish the robustness of the signal. Student's t-test has been the most popular significance testing technique, despite more sophisticated techniques developed over the years. These sophisticated techniques were designed to address unrealistic assumptions in Student's t-test, such as assuming no temporal correlation in the time series. Some of these advanced techniques were tested before, but only on artificial data generated by time series models that cannot fully capture all the features of GCM output. We evaluate five different significance testing techniques (including Student's t-test) on 10 to 100 continuous-year simulations, and validate the performance using much longer (375 to 1000 years) model simulations. We find that Student's t-test is at least as good as the 4 advanced techniques in estimating model noise for GCM simulations of up to 60 years. Furthermore, in establishing the robustness of signals against noise, Student's t-test is at least as good as the other 4 techniques for the simulations of at least up to 100 years. 10~100 year simulation covers the range of typical model integrations, and over this range we suggest that Student's t-test suffice.

  6. 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.

  7. Can Composite Measures Provide a Different Perspective on Provider Performance Than Individual Measures?

    Science.gov (United States)

    Shwartz, Michael; Rosen, Amy K; Burgess, James F

    2017-12-01

    Composite measures, which aggregate performance on individual measures into a summary score, are increasingly being used to evaluate facility performance. There is little understanding of the unique perspective that composite measures provide. To examine whether high/low (ie, high or low) performers on a composite measures are also high/low performers on most of the individual measures that comprise the composite. We used data from 2 previous studies, one involving 5 measures from 632 hospitals and one involving 28 measures from 112 Veterans Health Administration (VA) nursing homes; and new data on hospital readmissions for 3 conditions from 131 VA hospitals. To compare high/low performers on a composite to high/low performers on the component measures, we used 2-dimensional tables to categorize facilities into high/low performance on the composite and on the individual component measures. In the first study, over a third of the 162 hospitals in the top quintile based on the composite were in the top quintile on at most 1 of the 5 individual measures. In the second study, over 40% of the 27 high-performing nursing homes on the composite were high performers on 8 or fewer of the 28 individual measures. In the third study, 20% of the 61 low performers on the composite were low performers on only 1 of the 3 individual measures. Composite measures can identify as high/low performers facilities that perform "pretty well" (or "pretty poorly") across many individual measures but may not be high/low performers on most of them.

  8. Nanospray FAIMS Fractionation Provides Significant Increases in Proteome Coverage of Unfractionated Complex Protein Digests*

    Science.gov (United States)

    Swearingen, Kristian E.; Hoopmann, Michael R.; Johnson, Richard S.; Saleem, Ramsey A.; Aitchison, John D.; Moritz, Robert L.

    2012-01-01

    High-field asymmetric waveform ion mobility spectrometry (FAIMS) is an atmospheric pressure ion mobility technique that can be used to reduce sample complexity and increase dynamic range in tandem mass spectrometry experiments. FAIMS fractionates ions in the gas-phase according to characteristic differences in mobilities in electric fields of different strengths. Undesired ion species such as solvated clusters and singly charged chemical background ions can be prevented from reaching the mass analyzer, thus decreasing chemical noise. To date, there has been limited success using the commercially available Thermo Fisher FAIMS device with both standard ESI and nanoLC-MS. We have modified a Thermo Fisher electrospray source to accommodate a fused silica pulled tip capillary column for nanospray ionization, which will enable standard laboratories access to FAIMS technology. Our modified source allows easily obtainable stable spray at flow rates of 300 nL/min when coupled with FAIMS. The modified electrospray source allows the use of sheath gas, which provides a fivefold increase in signal obtained when nanoLC is coupled to FAIMS. In this work, nanoLC-FAIMS-MS and nanoLC-MS were compared by analyzing a tryptic digest of a 1:1 mixture of SILAC-labeled haploid and diploid yeast to demonstrate the performance of nanoLC-FAIMS-MS, at different compensation voltages, for post-column fractionation of complex protein digests. The effective dynamic range more than doubled when FAIMS was used. In total, 10,377 unique stripped peptides and 1649 unique proteins with SILAC ratios were identified from the combined nanoLC-FAIMS-MS experiments, compared with 6908 unique stripped peptides and 1003 unique proteins with SILAC ratios identified from the combined nanoLC-MS experiments. This work demonstrates how a commercially available FAIMS device can be combined with nanoLC to improve proteome coverage in shotgun and targeted type proteomics experiments. PMID:22186714

  9. S-index: Measuring significant, not average, citation performance

    Science.gov (United States)

    Antonoyiannakis, Manolis

    2009-03-01

    We recently [1] introduced the ``citation density curve'' (or cumulative impact factor curve) that captures the full citation performance of a journal: its size, impact factor, the maximum number of citations per paper, the relative size of the different-cited portions of the journal, etc. The citation density curve displays a universal behavior across journals. We exploit this universality to extract a simple metric (the ``S-index'') to characterize the citation impact of ``significant'' papers in each journal. In doing so, we go beyond the journal impact factor, which only measures the impact of the average paper. The conventional wisdom of ranking journals according to their impact factors is thus challenged. Having shown the utility and robustness of the S-index in comparing and ranking journals of different sizes but within the same field, we explore the concept further, going beyond a single field, and beyond journals. Can we compare different scientific fields, departments, or universities? And how should one generalize the citation density curve and the S-index to address these questions? [1] M. Antonoyiannakis and S. Mitra, ``Is PRL too large to have an `impact'?'', Editorial, Physical Review Letters, December 2008.

  10. Performance of the provider satisfaction inventory to measure provider satisfaction with diabetes care.

    Science.gov (United States)

    Montori, Victor M; Tweedy, Deborah A; Vogelsang, Debra A; Schryver, Patricia G; Naessens, James M; Smith, Steven A

    2002-01-01

    To develop and validate an inventory to measure provider satisfaction with diabetes management. Using the Mayo Clinic Model of Care, a review of the literature, and expert input, we developed a 4-category (chronic disease management, collaborative team practice, outcomes, and supportive environment), 29-item, 7-point-per-item Provider Satisfaction Inventory (PSI). For evaluation of the PSI, we mailed the survey to 192 primary-care and specialized providers from 8 practice sites (of whom 60 primary-care providers were participating in either usual or planned diabetes care). The Cronbach a score was used to assess the instrument's internal reliability. Participating providers indicated satisfaction or dissatisfaction with management of chronic disease by responding to 29 statements. The response rate was 58%. In each category, the Cronbach a score ranged from 0.71 to 0.90. Providers expressed satisfaction with patient-physician relationships, with the contributions of the nurse educator to the team, and with physician leadership. Providers were dissatisfied with their ability to spend adequate time with the patient (3.6 +/- 1.4), their ability to give patients with diabetes necessary personal attention (4.1 +/- 1.2), the efficient passing of communication (4.3 +/- 1.2), and the opportunities for input to change practice (4.3 +/- 1.6). No statistically significant difference (P = 0.12) was found in mean total scores between planned care (5.0 +/- 0.5) and usual care (4.7 +/- 0.6) providers. Moreover, no significant differences were noted across practice sites. The PSI is a reliable and preliminarily valid instrument for measuring provider satisfaction with diabetes care. Use in research and quality improvement activities awaits further validation.

  11. Children's Support Services: Providing a System of Care for Urban Preschoolers with Significant Behavioral Challenges

    Science.gov (United States)

    Tewhey, Karen

    2006-01-01

    In this article, the author features the Children's Support Services (CSS) project in Lowell, Massachusetts, which is an interagency, multidisciplinary program that provides young children and their families a range of child development, mental health, and family support services. The CSS project, which was begun in September 2000, addresses the…

  12. 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...

  13. Bayesian species identification under the multispecies coalescent provides significant improvements to DNA barcoding analyses.

    Science.gov (United States)

    Yang, Ziheng; Rannala, Bruce

    2017-06-01

    DNA barcoding methods use a single locus (usually the mitochondrial COI gene) to assign unidentified specimens to known species in a library based on a genetic distance threshold that distinguishes between-species divergence from within-species diversity. Recently developed species delimitation methods based on the multispecies coalescent (MSC) model offer an alternative approach to individual assignment using either single-locus or multiloci sequence data. Here, we use simulations to demonstrate three features of an MSC method implemented in the program bpp. First, we show that with one locus, MSC can accurately assign individuals to species without the need for arbitrarily determined distance thresholds (as required for barcoding methods). We provide an example in which no single threshold or barcoding gap exists that can be used to assign all specimens without incurring high error rates. Second, we show that bpp can identify cryptic species that may be misidentified as a single species within the library, potentially improving the accuracy of barcoding libraries. Third, we show that taxon rarity does not present any particular problems for species assignments using bpp and that accurate assignments can be achieved even when only one or a few loci are available. Thus, concerns that have been raised that MSC methods may have problems analysing rare taxa (singletons) are unfounded. Currently, barcoding methods enjoy a huge computational advantage over MSC methods and may be the only approach feasible for massively large data sets, but MSC methods may offer a more stringent test for species that are tentatively assigned by barcoding. © 2017 John Wiley & Sons Ltd.

  14. The role of health care providers and significant others in evaluating the quality of life of patients with chronic disease

    NARCIS (Netherlands)

    Sneeuw, Kommer C. A.; Sprangers, Mirjam A. G.; Aaronson, Neil K.

    2002-01-01

    Health-related quality of life (HRQL) studies sometimes rely, in part, on proxy information obtained from patients' significant others (spouse or close companion) or health care providers. This review: (1) provides a quantitative analysis of the results that have been reported in recent studies

  15. 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…

  16. Physical Profiling Performance of Air Force Primary Care Providers

    Science.gov (United States)

    2017-08-09

    MTF medical treatment facility OR odds ratio PCP primary care provider PHA Periodic Health Assessment SE standard error SME subject matter expert ...ascertain if predictors existed to augment PCP screening. This study was a cross-sectional, retrospective medical records review of active duty U.S. Air...Force (AF) members receiving care in an AF medical treatment facility (MTF) between October 31, 2013, and September 30, 2014, who had at least one

  17. Performance feedback, paraeducators, and literacy instruction for students with significant disabilities.

    Science.gov (United States)

    Westover, Jennifer M; Martin, Emma J

    2014-12-01

    Literacy skills are fundamental for all learners. For students with significant disabilities, strong literacy skills provide a gateway to generative communication, genuine friendships, improved access to academic opportunities, access to information technology, and future employment opportunities. Unfortunately, many educators lack the knowledge to design or implement appropriate evidence-based literacy instruction for students with significant disabilities. Furthermore, students with significant disabilities often receive the majority of their instruction from paraeducators. This single-subject design study examined the effects of performance feedback on the delivery skills of paraeducators during systematic and explicit literacy instruction for students with significant disabilities. The specific skills targeted for feedback were planned opportunities for student responses and correct academic responses. Findings suggested that delivery of feedback on performance resulted in increased pacing, accuracy in student responses, and subsequent attainment of literacy skills for students with significant disabilities. Implications for the use of performance feedback as an evaluation and training tool for increasing effective instructional practices are provided. © The Author(s) 2014.

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

    Science.gov (United States)

    Burkhardt, Joshua N.; Glick, Joshua E.; Terndrup, Thomas E.

    2014-01-01

    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. PMID:25035744

  19. 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.

  20. A computerised sampling strategy for therapeutic drug monitoring of lithium provides precise estimates and significantly reduces dose-finding time

    DEFF Research Database (Denmark)

    Høgberg, Lotte Christine Groth; Jürgens, Gesche; Zederkof, Vivian Wederking

    2012-01-01

    citrate. Bayesian approach was performed in the intervention groups, and estimation of lithium steady-state trough concentration was obtained from non-steady-state blood sample, collected about 12 hr after the first lithium study dose. The estimate was compared with the actually measured steady......-state concentration. In the control group, lithium monitoring was traditionally performed as steady-state blood sampling. Predicted and measured lithium concentrations were comparable. The desired lithium dose was reached significantly faster in the intervention group compared to control; 2.47 ± 2.22 days versus 9.......96 ± 11.24 days (mean ± S.D.) (p = 0.0003). Bayesian approach was an advantage for the clinicians as a fast and safe aid to obtain the optimal lithium treatment dose....

  1. 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…

  2. 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.

  3. PeerWise provides significant academic benefits to biological science students across diverse learning tasks, but with minimal instructor intervention.

    Science.gov (United States)

    McQueen, H A; Shields, C; Finnegan, D J; Higham, J; Simmen, M W

    2014-01-01

    We demonstrate that student engagement with PeerWise, an online tool that allows students to author and answer multiple-choice questions (MCQs), is associated with enhanced academic performance across diverse assessment types on a second year Genetics course. Benefits were consistent over three course deliveries, with differential benefits bestowed on groups of different prior ability. A rating scheme, to assess the educational quality of students' questions, is presented and demonstrates that our students are able intuitively to make such quality assessments, and that the process of authoring high quality questions alone does not explain the academic benefits. We further test the benefits of providing additional PeerWise support and conclude that PeerWise works efficiently with minimal intervention, and can be reliably assessed using automatically generated PeerWise scores. Copyright © 2014 The International Union of Biochemistry and Molecular Biology.

  4. 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.

  5. Provider performance measures in private and public programs: achieving meaningful alignment with flexibility to innovate.

    Science.gov (United States)

    Higgins, Aparna; Veselovskiy, German; McKown, Lauren

    2013-08-01

    In recent years there has been a significant expansion in the use of provider performance measures for quality improvement, payment, and public reporting. Using data from a survey of health plans, we characterize the use of such performance measures by private payers. We also compare the use of these measures among selected private and public programs. We studied twenty-three health plans with 121 million commercial enrollees--66 percent of the national commercial enrollment. The health plans reported using 546 distinct performance measures. There was much variation in the use of performance measures in both private and public payment and care delivery programs, despite common areas of focus that included cardiovascular conditions, diabetes, and preventive services. We conclude that policy makers and stakeholders who seek less variability in the use of performance measures to increase consistency should balance this goal with the need for flexibility to meet the needs of specific populations and promote innovation.

  6. Significant differences in pediatric psychotropic side effects: Implications for school performance.

    Science.gov (United States)

    Kubiszyn, Thomas; Mire, Sarah; Dutt, Sonia; Papathopoulos, Katina; Burridge, Andrea Backsheider

    2012-03-01

    Some side effects (SEs) of increasingly prescribed psychotropic medications can impact student performance in school. SE risk varies, even among drugs from the same class (e.g., antidepressants). Knowing which SEs occur significantly more often than others may enable school psychologists to enhance collaborative risk-benefit analysis, medication monitoring, data-based decision-making, and inform mitigation efforts. SE data from Full Prescribing Information (PI) on the FDA website for ADHD drugs, atypical antipsychotics, and antidepressants with pediatric indications were analyzed. Risk ratios (RR) are reported for each drug within a category compared with placebo. RR tables and graphs inform the reader about SE incidence differences for each drug and provide clear evidence of the wide variability in SE incidence in the FDA data. Breslow-Day and Cochran Mantel-Haenszel methods were used to test for drug-placebo SE differences and to test for significance across drugs within each category based on odds ratios (ORs). Significant drug-placebo differences were found for each drug compared with placebo, when odds were pooled across all drugs in a category compared with placebo, and between some drugs within categories. Unexpectedly, many large RR differences did not reach significance. Potential explanations are offered, including limitations of the FDA data sets and statistical and methodological issues. Future research directions are offered. The potential impact of certain SEs on school performance, mitigation strategies, and the potential role of the school psychologist is discussed, with consideration for ethical and legal limitations. (c) 2012 APA, all rights reserved.

  7. 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

  8. Real-time video communication improves provider performance in a simulated neonatal resuscitation.

    Science.gov (United States)

    Fang, Jennifer L; Carey, William A; Lang, Tara R; Lohse, Christine M; Colby, Christopher E

    2014-11-01

    To determine if a real-time audiovisual link with a neonatologist, termed video-assisted resuscitation or VAR, improves provider performance during a simulated neonatal resuscitation scenario. Using high-fidelity simulation, 46 study participants were presented with a neonatal resuscitation scenario. The control group performed independently, while the intervention group utilized VAR. Time to effective ventilation was compared using Wilcoxon rank sum tests. Providers' use of the corrective steps for ineffective ventilation per the NRP algorithm was compared using Cochran-Armitage trend tests. The time needed to establish effective ventilation was significantly reduced in the intervention group when compared to the control group (mean time 2 min 42 s versus 4 min 11 s, presuscitation scenario significantly reduces the time to establish effective ventilation and improves provider adherence to NRP guidelines. This technology may be a means for regional centers to support local providers during a neonatal emergency to improve patient safety and improve neonatal outcomes. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  9. 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.

  10. Real-World Verbal Communication Performance of Children Provided With Cochlear Implants or Hearing Aids.

    Science.gov (United States)

    Meister, Hartmut; Keilmann, Annerose; Leonhard, Katharina; Streicher, Barbara; Müller, Linda; Lang-Roth, Ruth

    2015-07-01

    To compare the real-world verbal communication performance of children provided with cochlear implants (CIs) with their peers with hearing aids (HAs). Cross-sectional study in university tertiary referral centers and at hearing aid dispensers. Verbal communication performance was assessed by the Functioning after Pediatric Cochlear Implantation (FAPCI) instrument. The FAPCI was administered to 38 parents of children using CIs and 62 parents of children with HAs. According to the WHO classification, children with HAs were categorized into three groups (mild-moderate-severe hearing loss). Analysis of variance (ANOVA) was performed on the FAPCI scores, with study group, hearing age (i.e., device experience), and age at hearing intervention as sources of variation. ANOVA showed that hearing age and study group significantly contribute to the FAPCI outcome. In all study groups except the children with mild hearing loss, FAPCI scores increased alongside growing experience with the devices. Children with mild hearing loss using HAs showed higher scores than those with severe hearing loss or implanted children. There were no significant differences between the children with CIs and the children with moderate or severe hearing loss using HAs. Real-world verbal communication abilities of children with CIs are similar to those of children with moderate-to-severe hearing loss using amplification. Because hearing age significantly influences performance, children with moderate-to-severe hearing loss using HAs and implanted children catch up with children with mild hearing loss at a hearing age of approximately 3 years.

  11. Significant performance enhancement in photoconductive terahertz optoelectronics by incorporating plasmonic contact electrodes

    National Research Council Canada - National Science Library

    Berry, C W; Wang, N; Hashemi, M R; Unlu, M; Jarrahi, M

    2013-01-01

    ... has been hindered by attributes of existing terahertz optoelectronics. Here we demonstrate that the use of plasmonic contact electrodes can significantly mitigate the low-quantum efficiency performance of photoconductive terahertz optoelectronic...

  12. A peptide-retrieval strategy enables significant improvement of quantitative performance without compromising confidence of identification.

    Science.gov (United States)

    Tu, Chengjian; Shen, Shichen; Sheng, Quanhu; Shyr, Yu; Qu, Jun

    2017-01-30

    confidence matched to confident proteins were retrieved. However, the total peptide-spectrum-match false discovery rate (PSM FDR) after retrieval analysis was still controlled at a confident level of FDR≤1%. As expected, the penalty for occasionally incorporating incorrect peptide identifications is negligible by comparison with the improvements in quantitative performance. More quantifiable peptides, lower missing value rate, better quantitative accuracy and precision were significantly achieved for the same protein identifications by this simple strategy. This strategy is theoretically applicable for any quantitative approaches in proteomics and thereby provides more quantitative information, especially on low-abundance proteins. Published by Elsevier B.V.

  13. Peerwise Provides Significant Academic Benefits to Biological Science Students across Diverse Learning Tasks, but with Minimal Instructor Intervention

    Science.gov (United States)

    McQueen, H. A.; Shields, C.; Finnegan, D. J.; Higham, J.; Simmen, M. W.

    2014-01-01

    We demonstrate that student engagement with PeerWise, an online tool that allows students to author and answer multiple-choice questions (MCQs), is associated with enhanced academic performance across diverse assessment types on a second year Genetics course. Benefits were consistent over three course deliveries, with differential benefits…

  14. Mineral apposition rates provide significant information on long-term effects in BMP-induced bone regeneration.

    Science.gov (United States)

    Schopper, Christian; Moser, Doris; Spassova-Tzekova, Else; Russmueller, Guenter; Goriwoda, Walter; Lagogiannis, Georgios; Ewers, Rolf; Redl, Heinz

    2009-06-01

    In this study, a CaP biomaterial was used as a carrier for rhBMP-2. Biomaterials were investigated in calvarial and femoral defects using a rabbit animal model, with unloaded biomaterials serving as control. Fluorochrome labels were administered at days 14 and 70. Specimens were retrieved after 12 weeks for histological analysis. When area fractions were assessed by conventional histomorphometry, no significant effect of rhBMP-2 on the amounts of regenerated bone and residual biomaterial were seen by 12 weeks. After mineral appositional rate (MAR) measurement using double labels, calculation yielded significantly higher MARs for defects at both implantation sites, when compared with surrounding bone, whether or not biomaterials were loaded with rhBMP-2. Analyzing the effect of rhBMP-2, both defect sites showed significantly higher MARs in the rhBMP-2 group. MARs of bone surrounding the defects had also been elevated significantly by rhBMP-2 at calvarial and femoral implantation sites. It is concluded that MAR measurement is suitable to identify long-term effects of rhBMP-2 on bone formation at a time when conventional histomorphometry using fractional area determination is inadequate. Also, by MAR assessment, effects of rhBMP-2 on surrounding bone can be documented. 2008 Wiley Periodicals, Inc.

  15. Experiential value co-creation: what’s the significance of the co-created value to providers?

    Directory of Open Access Journals (Sweden)

    Frankline Otiende Awuor

    2015-10-01

    Full Text Available This study aimed at exploring the value providers derive from experiential value co-creation according to the sixth fundamental principle of the Service Dominant Logic. We use kayaking tour guides as cases and use data collected by means of questionnaires and in-depth interviews via content analysis approach. The result indicate that that tour guides co-consume the fun co-created with tourists and derive job satisfaction from experiential value co-creation.

  16. 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.

  17. 42 CFR 493.19 - Provider-performed microscopy (PPM) procedures.

    Science.gov (United States)

    2010-10-01

    ...-field or phase-contrast microscopy. (4) The specimen is labile or delay in performing the test could... 42 Public Health 5 2010-10-01 2010-10-01 false Provider-performed microscopy (PPM) procedures. 493....19 Provider-performed microscopy (PPM) procedures. (a) Requirement. To be categorized as a PPM...

  18. Pay-for-performance for healthcare providers: Design, performance measurement, and (unintended) effects

    NARCIS (Netherlands)

    F. Eijkenaar (Frank)

    2013-01-01

    textabstractHealthcare systems around the world are characterized by a suboptimal delivery of healthcare services. There has been a growing belief among policymakers that many deficiencies (e.g., in the quality of care) stem from flawed provider payment systems creating perverse incentives for

  19. Significant alterations in reported clinical practice associated with increased oversight of organ transplant center performance.

    Science.gov (United States)

    Schold, Jesse D; Arrington, Charlotte J; Levine, Greg

    2010-09-01

    In the past several years, emphasis on quality metrics in the field of organ transplantation has increased significantly, largely because of the new conditions of participation issued by the Centers for Medicare and Medicaid Services. These regulations directly associate patients' outcomes and measured performance of centers with the distribution of public funding to institutions. Moreover, insurers and marketing ventures have used publicly available outcomes data from transplant centers for business decision making and advertisement purposes. We gave a 10-question survey to attendees of the Transplant Management Forum at the 2009 meeting of the United Network for Organ Sharing to ascertain how centers have responded to the increased oversight of performance. Of 63 responses, 55% indicated a low or near low performance rating at their center in the past 3 years. Respondents from low-performing centers were significantly more likely to indicate increased selection criteria for candidates (81% vs 38%, P = .001) and donors (77% vs 31%, P vs 52%, P = .007). Among respondents indicating lost insurance contracts (31%), these differences were also highly significant. Based on respondents' perceptions, outcomes of performance evaluations are associated with significant changes in clinical practice at transplant centers. The transplant community and policy makers should practice vigilance that performance evaluations and regulatory oversight do not inadvertently lead to diminished access to care among viable candidates or decreased transplant volume.

  20. 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

  1. Meteorites at Meridiani Planum provide evidence for significant amounts of surface and near-surface water on early Mars

    Science.gov (United States)

    Fairen, Alberto G.; Dohm, James M.; Baker, Victor R.; Thompson, Shane D.; Mahaney, William C.; Herkenhoff, Kenneth E.; Rodriguez, J. Alexis P.; Davila, Alfonso F.; Schulze-Makuch, Dirk; El Maarry, M. Ramy; Uceda, Esther R.; Amils, Ricardo; Miyamoto, Hirdy; Kim, Kyeong J.; Anderson, Robert C.; McKay, Christopher P.

    2011-01-01

    Six large iron meteorites have been discovered in the Meridiani Planum region of Mars by the Mars Exploration Rover Opportunity in a nearly 25 km-long traverse. Herein, we review and synthesize the available data to propose that the discovery and characteristics of the six meteorites could be explained as the result of their impact into a soft and wet surface, sometime during the Noachian or the Hesperian, subsequently to be exposed at the Martian surface through differential erosion. As recorded by its sediments and chemical deposits, Meridiani has been interpreted to have undergone a watery past, including a shallow sea, a playa, an environment of fluctuating ground water, and/or an icy landscape. Meteorites could have been encased upon impact and/or subsequently buried, and kept underground for a long time, shielded from the atmosphere. The meteorites apparently underwent significant chemical weathering due to aqueous alteration, as indicated by cavernous features that suggest differential acidic corrosion removing less resistant material and softer inclusions. During the Amazonian, the almost complete disappearance of surface water and desiccation of the landscape, followed by induration of the sediments and subsequent differential erosion and degradation of Meridiani sediments, including at least 10–80 m of deflation in the last 3–3.5 Gy, would have exposed the buried meteorites. We conclude that the iron meteorites support the hypothesis that Mars once had a denser atmosphere and considerable amounts of water and/or water ice at and/or near the surface.

  2. 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.

  3. Performance Measurement for a Logistics Services Provider to the Polymer Industry

    OpenAIRE

    Tok, King Lai

    2007-01-01

    This management project discusses the form of performance measurement system suitable for a logistics services provider who focuses on providing its services to large multinational petrochemical companies in the polymer industry

  4. 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...

  5. Accuracy of eyewitness identification is significantly associated with performance on a standardized test of face recognition.

    Science.gov (United States)

    Morgan, Charles A; Hazlett, Gary; Baranoski, Madelon; Doran, Anthony; Southwick, Steven; Loftus, Elizabeth

    2007-01-01

    This study assessed the relationship between Eyewitness Accuracy regarding a person met under conditions of high stress and performance on a standardized, neutral test of memory for human faces. Fifty-three U.S. Army personnel were exposed to interrogation stress. Forty-eight hours later, participants were administered the Weschler Face Test and then asked to identify the one interrogator who they had encountered 48 h earlier. A significant positive relationship was observed between performance on the Weschler Face Test and performance on the Eyewitness task. Inaccurate eyewitnesses exhibited more False Negative errors when performing the Weschler Face Test. Trait ability to remember human faces may be related to how accurately people recall faces that are associated with highly emotional circumstances. Detection probability methods, such as ROC curve analyses, may be of assistance to forensic examiners, the police, and the courts, when assessing the probability that eyewitness evidence is accurate.

  6. 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.

  7. Development of a Child Abuse Checklist to Evaluate Prehospital Provider Performance.

    Science.gov (United States)

    Alphonso, Aimee; Auerbach, Marc; Bechtel, Kirsten; Bilodeau, Kyle; Gawel, Marcie; Koziel, Jeannette; Whitfill, Travis; Tiyyagura, Gunjan Kamdar

    2017-01-01

    To develop and provide validity evidence for a performance checklist to evaluate the child abuse screening behaviors of prehospital providers. Checklist Development: We developed the first iteration of the checklist after review of the relevant literature and on the basis of the authors' clinical experience. Next, a panel of six content experts participated in three rounds of Delphi review to reach consensus on the final checklist items. Checklist Validation: Twenty-eight emergency medical services (EMS) providers (16 EMT-Basics, 12 EMT-Paramedics) participated in a standardized simulated case of physical child abuse to an infant followed by one-on-one semi-structured qualitative interviews. Three reviewers scored the videotaped performance using the final checklist. Light's kappa and Cronbach's alpha were calculated to assess inter-rater reliability (IRR) and internal consistency, respectively. The correlation of successful child abuse screening with checklist task completion and with participant characteristics were compared using Pearson's chi squared test to gather evidence for construct validity. The Delphi review process resulted in a final checklist that included 24 items classified with trichotomous scoring (done, not done, or not applicable). The overall IRR of the three raters was 0.70 using Light's kappa, indicating substantial agreement. Internal consistency of the checklist was low, with an overall Cronbach's alpha of 0.61. Of 28 participants, only 14 (50%) successfully screened for child abuse in simulation. Participants who successfully screened for child abuse did not differ significantly from those who failed to screen in terms of training level, past experience with child abuse reporting, or self-reported confidence in detecting child abuse (all p > 0.30). Of all 24 tasks, only the task of exposing the infant significantly correlated with successful detection of child abuse (p child abuse checklist that demonstrated strong content validity and

  8. Drilling into the functional significance of stereopsis: the impact of stereoscopic information on surgical performance.

    Science.gov (United States)

    Al-Saud, Loulwa M; Mushtaq, Faisal; Mirghani, Isra'a; Balkhoyor, Ahmed; Keeling, Andrew; Manogue, Michael; Mon-Williams, Mark A

    2017-07-01

    One suggested advantage of human binocular vision is the facilitation of sophisticated motor control behaviours via stereopsis - but little empirical evidence exists to support this suggestion. We examined the functional significance of stereopsis by exploring whether stereopsis is used to perform a highly skilled real-world motor task essential for the occupational practice of dentistry. We used a high fidelity virtual reality simulator to study how dentists' performance is affected by the removal of horizontal retinal image disparities under direct and indirect (mirror) observation. Thirteen qualified dentists performed a total of four different dental tasks under non-stereoscopic and stereoscopic vision conditions, with two levels of task complexity (direct and indirect observation) using a virtual reality dental simulator. Depth related errors were significantly higher under non-stereoscopic viewing but lateral errors did not differ between conditions. Indirect observation led to participants drilling less of the target area compared to direct viewing, but this did not interact with the stereopsis manipulation. The data confirm that dental practitioners use stereopsis and its presence results in improved dental performance. It remains to be determined whether individuals with stereo-deficits can compensate adequately. Nevertheless, these findings suggest an important role for stereopsis within at least one occupation and justify the design of simulators with 3D displays. © 2017 The Authors. Ophthalmic and Physiological Optics published by John Wiley & Sons Ltd on behalf of College of Optometrists.

  9. 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

  10. 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.

  11. 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...

  12. 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.

  13. Large performance incentives had the greatest impact on providers whose quality metrics were lowest at baseline.

    Science.gov (United States)

    Greene, Jessica; Hibbard, Judith H; Overton, Valerie

    2015-04-01

    This study examined the impact of Fairview Health Services' primary care provider compensation model, in which 40 percent of compensation was based on clinic-level quality outcomes. Fairview Health Services is a Pioneer accountable care organization in Minnesota. Using publicly reported performance data from 2010 and 2012, we found that Fairview's improvement in quality metrics was not greater than the improvement in other comparable Minnesota medical groups. An analysis of Fairview's administrative data found that the largest predictor of improvement over the first two years of the compensation model was primary care providers' baseline quality performance. Providers whose baseline performance was in the lowest tertile improved three times more, on average, across the three quality metrics studied than those in the middle tertile, and almost six times more than those in the top tertile. As a result, there was a narrowing of variation in performance across all primary care providers at Fairview and a narrowing of the gap in quality between providers who treated the highest-income patient panels and those who treated the lowest-income panels. The large quality incentive fell short of its overall quality improvement aim. However, the results suggest that payment reform may help narrow variation in primary care provider performance, which can translate into narrowing socioeconomic disparities. Project HOPE—The People-to-People Health Foundation, Inc.

  14. 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

    ...) and select attributes and experience/training variables. For BAMC's provider incentive program, analysis reveals statistical significance for record compliance rates with data dated measures, F(underscored)(1,103)= 4.74, p(underscored) = .03...

  15. Genetic variants in the peripheral auditory system significantly affect adult cochlear implant performance.

    Science.gov (United States)

    Shearer, A Eliot; Eppsteiner, Robert W; Frees, Kathy; Tejani, Viral; Sloan-Heggen, Christina M; Brown, Carolyn; Abbas, Paul; Dunn, Camille; Hansen, Marlan R; Gantz, Bruce J; Smith, Richard J H

    2017-05-01

    Cochlear implantation is an effective habilitation modality for adults with significant hearing loss. However, post-implant performance is variable. A portion of this variance in outcome can be attributed to clinical factors. Recent physiological studies suggest that the health of the spiral ganglion also impacts post-operative cochlear implant outcomes. The goal of this study was to determine whether genetic factors affecting spiral ganglion neurons may be associated with cochlear implant performance. Adults with post-lingual deafness who underwent cochlear implantation at the University of Iowa were studied. Pre-implantation evaluation included comprehensive genetic testing for genetic diagnosis. A novel score of genetic variants affecting genes with functional effects in the spiral ganglion was calculated. A Z-scored average of up to three post-operative speech perception tests (CNC, HINT, and AzBio) was used to assess outcome. Genetically determined spiral ganglion health affects cochlear implant outcomes, and when considered in conjunction with clinically determined etiology of deafness, accounts for 18.3% of the variance in postoperative speech recognition outcomes. Cochlear implant recipients with deleterious genetic variants that affect the cochlear sensory organ perform significantly better on tests of speech perception than recipients with deleterious genetic variants that affect the spiral ganglion. Etiological diagnosis of deafness including genetic testing is the single largest predictor of postoperative speech outcomes in adult cochlear implant recipients. A detailed understanding of the genetic underpinning of hearing loss will better inform pre-implant counseling. The method presented here should serve as a guide for further research into the molecular physiology of the peripheral auditory system and cochlear implants. Copyright © 2017. Published by Elsevier B.V.

  16. Classification accuracy of claims-based methods for identifying providers failing to meet performance targets

    Science.gov (United States)

    Hubbard, Rebecca A.; Benjamin-Johnson, Rhondee; Onega, Tracy; Smith-Bindman, Rebecca; Zhu, Weiwei; Fenton, Joshua J.

    2014-01-01

    Summary Quality assessment is critical for healthcare reform but data sources are lacking for measurement of many important healthcare outcomes. With over 49 million people covered by Medicare as of 2010, Medicare claims data offer a potentially valuable source that could be used in targeted health care quality improvement efforts. However, little is known about the operating characteristics of provider profiling methods using claims-based outcome measures that may estimate provider performance with error. Motivated by the example of screening mammography performance, we compared approaches to identifying providers failing to meet guideline targets using Medicare claims data. We used data from the Breast Cancer Surveillance Consortium and linked Medicare claims to compare claims-based and clinical estimates of cancer detection rate. We then demonstrated the performance of claim-based estimates across a broad range of operating characteristics using simulation studies. We found that identification of poor performing providers was extremely sensitive to algorithm specificity, with no approach identifying more than 65% of poorly performing providers when claims-based measures had specificity of 0.995 or less. We conclude that claims have the potential to contribute important information on healthcare outcomes to quality improvement efforts. However, to achieve this potential, development of highly accurate claims-based outcome measures should remain a priority. PMID:25302935

  17. Monitoring the hydraulic performance of a containment system with significant barometric pressure effects.

    Science.gov (United States)

    Hare, P W; Morse, R E

    1999-01-01

    Under certain circumstances, wells in unconfined aquifers can display significant water level fluctuations in response to changes in barometric pressure. This is illustrated by Hare and Morse (1997) at a site where a portion of the unconfined aquifer is isolated by a soil-bentonite cutoff wall and clay cap. A relief well located within the containment system displays water level fluctuations that mirror barometric pressure changes. Water levels fluctuated 0.37 m in response to barometric pressure changes of 2.87 centimeters mercury (cm-Hg), representing a barometric efficiency of 93.6%. As described in this paper, the short-term variability in water level elevations inside the containment system had to be considered to develop a reliable post-enhancement performance monitoring program. The approach that was ultimately selected involves correcting the water level elevations obtained in the relief well within the containment system for the effects of barometric pressure changes prior to comparison with the water level elevations in an observation well in the aquifer outside the system. The reliability of the post-enhancement performance monitoring program is improved further by simply requiring that any decision to enhance the containment system be based on the water level measurements obtained during two consecutive months. Using this approach, the probability that the containment system's performance will erroneously be deemed unacceptable is low. The post-enhancement performance monitoring program also requires no extra field work and does not involve any specialized equipment, which helps to keep operation and maintenance costs to a minimum.

  18. 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

  19. 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

  20. Impact of Interatrial Communication on Left Ventricle Performance in Patients with Significant Post-tricuspid Shunt.

    Science.gov (United States)

    Elhoury, Motea E; Galal, Mohammed Omar; Almoukirish, Abdulrahman; Saeed, Abdalla; El-Segaier, Milad

    2016-03-01

    Infants with post-tricuspid valve shunts (PTS) may benefit from interatrial communication (IAC). The effect of IAC on left ventricular (LV) performance in these patients was studied. IAC was documented prospectively in 55 patients with PTS. Clinical status, echocardiographic dimensions of LV, mitral inflow Doppler, tissue Doppler velocities and time intervals were measured. Creatinine kinase (CK), CKMB, troponin-I and NT pro-brain natriuretic peptide (NT pro-BNP) were measured. Patients were divided into four groups: (A) PTS but no IAC (n = 32); (B) PTS and IAC (n = 23); (C) VSD but no IAC (n = 16); and (D) VSD and IAC (n = 19). Group A had more frequent mitral regurgitation (p = 0.041), larger mitral annulus (1.80 vs. 1.30 cm, p < 0.0001) and larger LV systolic and diastolic dimensions (2.01 vs. 1.40 and 3.28 vs. 2.35 cm, p < 0.001) than group B. The E-wave deceleration time tended to be longer in group A (121.0 vs. 106.8 ms, p = 0.06). By tissue Doppler, group A had E'- and S-waves significantly taller (15.51 vs. 13.14 and 7.69 vs. 6.72 cm, p = 0.04 and p = 0.005, respectively) than group B. Also, NT pro-BNP was significantly higher in group A (1116.15 vs. 458.73 pg/ml, p = 0.028). Group C had significant larger mitral z-score values (1.2 vs. 0.01, p < 0.001), larger LV diameter z-score (p = 0.001) and higher NT pro-BNP level (1477.37 vs. 451.66 pg/ml, p = 0.001) than group D. There was no significant difference in the clinical status between the groups. In children with PTS, the presence of IAC could be beneficial. Their echocardiographic parameters and biomarker show better systolic and diastolic LV performance.

  1. Views of mental health care consumers on public reporting of information on provider performance.

    Science.gov (United States)

    Stein, Bradley D; Kogan, Jane N; Essock, Susan; Fudurich, Stephanie

    2009-05-01

    This qualitative study examined consumer preferences regarding the content and use of provider performance data and other provider information to aid in consumers' decision making. Focus groups were conducted with 41 adults who were consumers of mental health care, and discussions were transcribed and analyzed with standard qualitative research methods. Consumers supported trends toward enhancing information about providers and its availability. Several key themes emerged, including the need for easily accessible information and the most and least useful types of information. Current efforts to share provider performance information do not meet consumer preferences. Modest changes in the types of information being shared and the manner in which it is shared may substantially enhance use of such information. Such changes may help consumers to be more informed and empowered in making decisions about care, improve the quality of the care delivered, and support the movement toward a more recovery-focused system of care.

  2. Significant performance enhancement in photoconductive terahertz optoelectronics by incorporating plasmonic contact electrodes.

    Science.gov (United States)

    Berry, C W; Wang, N; Hashemi, M R; Unlu, M; Jarrahi, M

    2013-01-01

    Even though the terahertz spectrum is well suited for chemical identification, material characterization, biological sensing and medical imaging, practical development of these applications has been hindered by attributes of existing terahertz optoelectronics. Here we demonstrate that the use of plasmonic contact electrodes can significantly mitigate the low-quantum efficiency performance of photoconductive terahertz optoelectronics. The use of plasmonic contact electrodes offers nanoscale carrier transport path lengths for the majority of photocarriers, increasing the number of collected photocarriers in a subpicosecond timescale and, thus, enhancing the optical-to-terahertz conversion efficiency of photoconductive terahertz emitters and the detection sensitivity of photoconductive terahertz detectors. We experimentally demonstrate 50 times higher terahertz radiation powers from a plasmonic photoconductive emitter in comparison with a similar photoconductive emitter with non-plasmonic contact electrodes, as well as 30 times higher terahertz detection sensitivities from a plasmonic photoconductive detector in comparison with a similar photoconductive detector with non-plasmonic contact electrodes.

  3. Access to high-volume surgeons and the opportunity cost of performing radical prostatectomy by low-volume providers.

    Science.gov (United States)

    Barzi, Afsaneh; Klein, Eric A; Daneshmand, Siamak; Gill, Inderbir; Quinn, David I; Sadeghi, Sarmad

    2017-07-01

    Evidence suggests that redirecting surgeries to high-volume providers may be associated with better outcomes and significant societal savings. Whether such referrals are feasible remains unanswered. Medicare Provider Utilization and Payment Data, SEER 18, and US Incidence data were used to determine the geographic distribution and radical prostatectomy volume for providers. Access was defined as availability of a high-volume provider within driving distance of 100 miles. The opportunity cost was defined as the value of benefits achievable by performing the surgery by a high-volume provider that was forgone by not making a referral. The savings per referral were derived from a published Markov model for radical prostatectomy. A total of 14% of providers performed>27% of the radical prostatectomies with>30 cases per year and were designated high-volume providers. Providers with below-median volume (≤16 prostatectomies per year) performed>32% of radical prostatectomies. At least 47% of these were within a 100-mile driving distance (median = 22 miles), and therefore had access to a high-volume provider (>30 prostatectomies per year). This translated into a discounted savings of more than $24 million per year, representing the opportunity cost of not making a referral. The average volume for high- and low-volume providers was 55 and 13, respectively, resulting in an annual experience gap of 43 and a cumulative gap of 125 surgeries over 3 years. In 2014, the number of surgeons performing radical prostatectomy decreased by 5% while the number of high- and low-volume providers decreased by 25% and 11% showing a faster decline in the number of high-volume providers compared with low-volume surgeons. About half of prostatectomies performed by surgeons with below-median annual volume were within a 100-mile driving distance (median of 22 miles) of a high-volume surgeon. Such a referral may result in minimal additional costs and substantially improved outcomes. Copyright

  4. Comparing the performance of English mental health providers in achieving patient outcomes.

    Science.gov (United States)

    Moran, Valerie; Jacobs, Rowena

    2015-09-01

    Evidence on provider payment systems that incorporate patient outcomes is limited for mental health care. In England, funding for mental health care services is changing to a prospective payment system with a future objective of linking some part of provider payment to outcomes. This research examines performance of mental health providers offering hospital and community services, in order to investigate if some are delivering better outcomes. Outcomes are measured using the Health of the Nation Outcome Scales (HoNOS) - a clinician-rated routine outcome measure (CROM) mandated for national use. We use data from the Mental Health Minimum Data Set (MHMDS) - a dataset on specialist mental health care with national coverage - for the years 2011/12 and 2012/13 with a final estimation sample of 305,960 observations with follow-up HoNOS scores. A hierarchical ordered probit model is used and outcomes are risk adjusted with independent variables reflecting demographic, need, severity and social indicators. A hierarchical linear model is also estimated with the follow-up total HoNOS score as the dependent variable and the baseline total HoNOS score included as a risk-adjuster. Provider performance is captured by a random effect that is quantified using Empirical Bayes methods. We find that worse outcomes are associated with severity and better outcomes with older age and social support. After adjusting outcomes for various risk factors, variations in performance are still evident across providers. This suggests that if the intention to link some element of provider payment to outcomes becomes a reality, some providers may gain financially whilst others may lose. The paper contributes to the limited literature on risk adjustment of outcomes and performance assessment of providers in mental health in the context of prospective activity-based payment systems. Copyright © 2015 Elsevier Ltd. All rights reserved.

  5. 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.

  6. Graphene Oxide Quantum Dots Covalently Functionalized PVDF Membrane with Significantly-Enhanced Bactericidal and Antibiofouling Performances

    Science.gov (United States)

    Zeng, Zhiping; Yu, Dingshan; He, Ziming; Liu, Jing; Xiao, Fang-Xing; Zhang, Yan; Wang, Rong; Bhattacharyya, Dibakar; Tan, Timothy Thatt Yang

    2016-02-01

    Covalent bonding of graphene oxide quantum dots (GOQDs) onto amino modified polyvinylidene fluoride (PVDF) membrane has generated a new type of nano-carbon functionalized membrane with significantly enhanced antibacterial and antibiofouling properties. A continuous filtration test using E. coli containing feedwater shows that the relative flux drop over GOQDs modified PVDF is 23%, which is significantly lower than those over pristine PVDF (86%) and GO-sheet modified PVDF (62%) after 10 h of filtration. The presence of GOQD coating layer effectively inactivates E. coli and S. aureus cells, and prevents the biofilm formation on the membrane surface, producing excellent antimicrobial activity and potentially antibiofouling capability, more superior than those of previously reported two-dimensional GO sheets and one-dimensional CNTs modified membranes. The distinctive antimicrobial and antibiofouling performances could be attributed to the unique structure and uniform dispersion of GOQDs, enabling the exposure of a larger fraction of active edges and facilitating the formation of oxidation stress. Furthermore, GOQDs modified membrane possesses satisfying long-term stability and durability due to the strong covalent interaction between PVDF and GOQDs. This study opens up a new synthetic avenue in the fabrication of efficient surface-functionalized polymer membranes for potential waste water treatment and biomolecules separation.

  7. 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

  8. 16 CFR 1401.5 - Providing performance and technical data to purchasers by labeling.

    Science.gov (United States)

    2010-01-01

    ... 16 Commercial Practices 2 2010-01-01 2010-01-01 false Providing performance and technical data to purchasers by labeling. 1401.5 Section 1401.5 Commercial Practices CONSUMER PRODUCT SAFETY COMMISSION... identification and warning statement may appear on a firmly affixed tag, tape, card, or sticker or similar...

  9. 16 CFR 1407.3 - Providing performance and technical data to purchasers by labeling.

    Science.gov (United States)

    2010-01-01

    ... 16 Commercial Practices 2 2010-01-01 2010-01-01 false Providing performance and technical data to purchasers by labeling. 1407.3 Section 1407.3 Commercial Practices CONSUMER PRODUCT SAFETY COMMISSION... the portable generator that cannot be removed without the use of tools, and (B) On a location that is...

  10. The Effect of Performance Feedback Provided to Student-Teachers Working with Multiple Disabilities

    Science.gov (United States)

    Safak, Pinar; Yilmaz, Hatice Cansu; Demiryurek, Pinar; Dogus, Mustafa

    2016-01-01

    The aim of the study was to investigate the effect of performance feedback (PF) provided to student teachers working with students with multiple disabilities and visual impairment (MDVI) on their teaching skills. The study group of the research was composed of 11 student teachers attending to the final year of the Teaching Students with Visual…

  11. 48 CFR 1553.216-70 - EPA Form 1900-41A, CPAF Contract Summary of Significant Performance Observation.

    Science.gov (United States)

    2010-10-01

    ... Contract Summary of Significant Performance Observation. 1553.216-70 Section 1553.216-70 Federal... 1553.216-70 EPA Form 1900-41A, CPAF Contract Summary of Significant Performance Observation. As prescribed in 1516.404-278, EPA Form 1900-41A shall be used to document significant performance observations...

  12. 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 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.

  13. The Medicare Electronic Health Record Incentive Program: provider performance on core and menu measures.

    Science.gov (United States)

    Wright, Adam; Feblowitz, Joshua; Samal, Lipika; McCoy, Allison B; Sittig, Dean F

    2014-02-01

    To measure performance by eligible health care providers on CMS's meaningful use measures. Medicare Electronic Health Record Incentive Program Eligible Professionals Public Use File (PUF), which contains data on meaningful use attestations by 237,267 eligible providers through May 31, 2013. Cross-sectional analysis of the 15 core and 10 menu measures pertaining to use of EHR functions reported in the PUF. Providers in the dataset performed strongly on all core measures, with the most frequent response for each of the 15 measures being 90-100 percent compliance, even when the threshold for a particular measure was lower (e.g., 30 percent). PCPs had higher scores than specialists for computerized order entry, maintaining an active medication list, and documenting vital signs, while specialists had higher scores for maintaining a problem list, recording patient demographics and smoking status, and for providing patients with an after-visit summary. In fact, 90.2 percent of eligible providers claimed at least one exclusion, and half claimed two or more. Providers are successfully attesting to CMS's requirements, and often exceeding the thresholds required by CMS; however, some troubling patterns in exclusions are present. CMS should raise program requirements in future years. © Health Research and Educational Trust.

  14. The MOF+Technique: A Significant Synergic Effect Enables High Performance Chromate Removal.

    Science.gov (United States)

    Luo, Ming Biao; Xiong, Yang Yang; Wu, Hui Qiong; Feng, Xue Feng; Li, Jian Qiang; Luo, Feng

    2017-12-18

    A significant synergic effect between a metal-organic framework (MOF) and Fe 2 SO 4 , the so-called MOF + technique, is exploited for the first time to remove toxic chromate from aqueous solutions. The results show that relative to the pristine MOF samples (no detectable chromate removal), the MOF + method enables super performance, giving a 796 Cr mg g -1 adsorption capacity. The value is almost eight-fold higher than the best value of established MOF adsorbents, and the highest value of all reported porous adsorbents for such use. The adsorption mechanism, unlike the anion-exchange process that dominates chromate removal in all other MOF adsorbents, as unveiled by X-ray photoelectron spectroscopy (XPS), scanning electron microscopy (SEM), and transmission electron microscopy (TEM), is due to the surface formation of Fe 0.75 Cr 0.25 (OH) 3 nanospheres on the MOF samples. © 2017 Wiley-VCH Verlag GmbH & Co. KGaA, Weinheim.

  15. 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.

  16. Performance of spleen stiffness measurement in prediction of clinical significant portal hypertension: A meta-analysis.

    Science.gov (United States)

    Song, Jinzhen; Huang, Jianbo; Huang, He; Liu, Shiyu; Luo, Yan

    2017-12-06

    Our purpose was to evaluate the correlation between spleen stiffness (SS) measured by ultrasound-based elastography and hepatic venous pressure gradient (HVPG) and assess the accuracy of SS in detecting clinical significant portal hypertension (CSPH) and severe portal hypertension. Nine studies were included from thorough literature research and selection processes. A random model was used to analyze the correlation between HVPG and SS. We adopted the bivariate mixed effects model to assess the diagnostic performance. Regarding to correlation between SS and HVPG, the summary correlation coefficient was 0.72 (95% confidence interval [CI], 0.63-0.80). In detection of CSPH, the sensitivity, specificity, AUC and DOR were: 0.88 (0.70-0.96), 0.84 (0.72-0.92), 0.92 (0.89-0.94) and 38 (17-84) for CSPH, respectively; and 0.92 (0.82-0.96), 0.79 (0.72-0.85), 0.87 (0.84-0.90) and 41 (17-100) for severe portal hypertension, respectively. Correlation between SS and HVPG was good. Although SS showed good sensitivity and specificity, the different cut-off values and techniques among studies might limit the impact of our results on clinical practice. Therefore, more high-quality prospective studies are required to evaluate the role of SS in predicting portal hypertension. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  17. 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.

  18. The placebo effect in alternative medicine: can the performance of a healing ritual have clinical significance?

    Science.gov (United States)

    Kaptchuk, Ted J

    2002-06-04

    In alternative medicine, the main question regarding placebo has been whether a given therapy has more than a placebo effect. Just as mainstream medicine ignores the clinical significance of its own placebo effect, the placebo effect of unconventional medicine is disregarded except for polemics. This essay looks at the placebo effect of alternative medicine as a distinct entity. This is done by reviewing current knowledge about the placebo effect and how it may pertain to alternative medicine. The term placebo effect is taken to mean not only the narrow effect of a dummy intervention but also the broad array of nonspecific effects in the patient-physician relationship, including attention; compassionate care; and the modulation of expectations, anxiety, and self-awareness. Five components of the placebo effect--patient, practitioner, patient-practitioner interaction, nature of the illness, and treatment and setting--are examined. Therapeutic patterns that heighten placebo effects are especially prominent in unconventional healing, and it seems possible that the unique drama of this realm may have "enhanced" placebo effects in particular conditions. Ultimately, only prospective trials directly comparing the placebo effects of unconventional and mainstream medicine can provide reliable evidence to support such claims. Nonetheless, the possibility of enhanced placebo effects raises complex conundrums. Can an alternative ritual with only nonspecific psychosocial effects have more positive health outcomes than a proven, specific conventional treatment? What makes therapy legitimate, positive clinical outcomes or culturally acceptable methods of attainment? Who decides?

  19. Context-dependent codon partition models provide significant increases in model fit in atpB and rbcL protein-coding genes.

    Science.gov (United States)

    Baele, Guy; Van de Peer, Yves; Vansteelandt, Stijn

    2011-05-27

    Accurate modelling of substitution processes in protein-coding sequences is often hampered by the computational burdens associated with full codon models. Lately, codon partition models have been proposed as a viable alternative, mimicking the substitution behaviour of codon models at a low computational cost. Such codon partition models however impose independent evolution of the different codon positions, which is overly restrictive from a biological point of view. Given that empirical research has provided indications of context-dependent substitution patterns at four-fold degenerate sites, we take those indications into account in this paper. We present so-called context-dependent codon partition models to assess previous empirical claims that the evolution of four-fold degenerate sites is strongly dependent on the composition of its two flanking bases. To this end, we have estimated and compared various existing independent models, codon models, codon partition models and context-dependent codon partition models for the atpB and rbcL genes of the chloroplast genome, which are frequently used in plant systematics. Such context-dependent codon partition models employ a full dependency scheme for four-fold degenerate sites, whilst maintaining the independence assumption for the first and second codon positions. We show that, both in the atpB and rbcL alignments of a collection of land plants, these context-dependent codon partition models significantly improve model fit over existing codon partition models. Using Bayes factors based on thermodynamic integration, we show that in both datasets the same context-dependent codon partition model yields the largest increase in model fit compared to an independent evolutionary model. Context-dependent codon partition models hence perform closer to codon models, which remain the best performing models at a drastically increased computational cost, compared to codon partition models, but remain computationally interesting

  20. 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

  1. 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

  2. Performance on a computerized shopping task significantly predicts real world functioning in persons diagnosed with bipolar disorder.

    Science.gov (United States)

    Laloyaux, Julien; Pellegrini, Nadia; Mourad, Haitham; Bertrand, Hervé; Domken, Marc-André; Van der Linden, Martial; Larøi, Frank

    2013-12-15

    Persons diagnosed with bipolar disorder often suffer from cognitive impairments. However, little is known concerning how these cognitive deficits impact their real world functioning. We developed a computerized real-life activity task, where participants are required to shop for a list of grocery store items. Twenty one individuals diagnosed with bipolar disorder and 21 matched healthy controls were administered the computerized shopping task. Moreover, the patient group was assessed with a battery of cognitive tests and clinical scales. Performance on the shopping task significantly differentiated patients and healthy controls for two variables: Total time to complete the shopping task and Mean time spent to consult the shopping list. Moreover, in the patient group, performance on these variables from the shopping task correlated significantly with cognitive functioning (i.e. processing speed, verbal episodic memory, planning, cognitive flexibility, and inhibition) and with clinical variables including duration of illness and real world functioning. Finally, variables from the shopping task were found to significantly explain 41% of real world functioning of patients diagnosed with bipolar disorder. These findings suggest that the shopping task provides a good indication of real world functioning and cognitive functioning of persons diagnosed with bipolar disorder. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  3. Significant performance improvement obtained in a wireless mesh network using a beamswitching antenna

    CSIR Research Space (South Africa)

    Lysko, AA

    2012-09-01

    Full Text Available The paper describes the performance enhancement obtained by adding an electronically controlled beamswitching antenna to a laboratory set up of a wireless mesh network. The antenna permits several modes offering several beam shapes and directions...

  4. 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.

  5. Performances of sexuality counselling: a framework for provider-client encounters.

    Science.gov (United States)

    van der Kwaak, Anke; Ferris, Kristina; van Kats, Jetty; Dieleman, Marjolein

    2010-12-01

    Adequately assessing quality of care poses enormous challenges. While conducting fieldwork, we were struck by the need for a framework that encapsulates provider-client encounters. Little evidence exists concerning the most effective training, and management of health staff engaged in sexuality, reproductive health and HIV related health services. This paper proposes a framework for analysing these encounters. This paper is based on five studies. Mixed method studies were carried out in Uganda and Kenya. Two additional studies looked into the effect of HIV on health worker performance in Uganda and Zambia. As a result of the findings, a desk review looked into factors affecting provider-client encounters in order to improve the responsiveness of programs. Positive encounters between provider and client are built on trust and respect, consist of communication, practice and process, and are influenced by space, place and context. Combining these facets allows for a better understanding of their interactions. A holistic perspective in which the breadth of dynamics and processes are described should be used when assessing the quality of provider-client encounters. Within training, management and human resource planning, these dynamics need to be utilized to realize the best possible care. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

  6. 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.

  7. AHP SUPPORT TO ESTIMATION OF THE INFORMATION SYSTEM (IS) SIGNIFICANCE TO THE BUSINESS PERFORMANCE, PARTICULARLY THE HOSPITALITY PERFORMANCE

    National Research Council Canada - National Science Library

    Daniela Garbin Praničević; Velimir Srića

    2013-01-01

    .... It is supposed that the possibility of the assessment despite the complexity of IS elements and related decisions can be supported by using the AHP method. Additionally, the obtained results are compared with the results of one of the author’s previous studies based on the hospitality manager experience regarding the relationship between IS elements and hospitality performance.

  8. 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…

  9. 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…

  10. The significance of citation impact indicators of research performance in the developing countries of sub-Saharan Africa

    Directory of Open Access Journals (Sweden)

    Japhet Bakuwa

    2014-07-01

    Full Text Available This paper argues that Sub-Saharan Africa needs to produce more journals indexed by ISI Web of Science (WoS. Researchers from the region should also publish in other ISI indexed, reputable and high impact journals such as Nature and Science. Inevitably, this will make Sub-Saharan African researchers visible and globally competitive. The Sub- Saharan African region has only about 40 journals out of over 12 000 journals that have been indexed by the ISI Web of Science (WoS. Arguably, ranking of universities across the globe and qualification for Nobel Prizes are determined by metrics-based evaluation of research performance. Sub-Saharan Africa is poorly represented on the world university rankings. The region has also produced only six Nobel Prize award winners from 1901 to 2010. In the same period, USA, UK and Germany produced 326, 116 and 102 recipients respectively. While there are some limitations on the use of citation indicators to evaluate research output, this researcher argues that citation impact indicators of research performance provide policymakers, researchers and funding agencies with an objective measure for assessing research performance and therefore are of great significance in the developing countries of Sub-Saharan Africa.

  11. The atypia of undetermined significance/follicular lesion of undetermined significance:malignant ratio: a proposed performance measure for reporting in The Bethesda System for thyroid cytopathology.

    Science.gov (United States)

    Krane, Jeffrey F; Vanderlaan, Paul A; Faquin, William C; Renshaw, Andrew A

    2012-04-25

    The Bethesda System (TBS) for reporting thyroid cytopathology introduced the atypia of undetermined significance/follicular lesion of undetermined significance (AUS) category, but did not provide adequate guidance for the appropriate use of this diagnosis. In the current study, the authors sought to identify an appropriate measure for AUS use based on experience to date with TBS. The authors reviewed 8 series, including their own laboratory experiences, with a total of 30,466 thyroid aspirates classified within TBS. The median AUS rate was 9.9% with a range of 3.0% to 18.0%. Use of the individual diagnostic categories within TBS varied up to 12.7-fold. The ratio of "suspicious for follicular neoplasm" plus "suspicious for malignancy" to "malignant" (M) diagnoses varied the least (1.8-fold). The AUS:M ratio provided a suitable measure of assessing AUS use, with a median ratio of 2.0 and a range of 0.5 to 4.9. Based on available studies, an AUS:M ratio of 1.0 to 3.0 is recommended. AUS:M ratios > 3.0 are likely because of overdiagnosis of AUS or underdiagnosis of M. AUS:M ratios expense of sensitivity. Copyright © 2011 American Cancer Society.

  12. 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…

  13. 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

  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. A review of atomic layer deposition providing high performance lithium sulfur batteries

    Science.gov (United States)

    Yan, Bo; Li, Xifei; Bai, Zhimin; Song, Xiaosheng; Xiong, Dongbin; Zhao, Mengli; Li, Dejun; Lu, Shigang

    2017-01-01

    With the significant obstacles that have been conquered in lithium-sulfur (Li-S) batteries, it is urgent to impel accelerating development of room-temperature Li-S batteries with high energy density and long-term stability. In view of the unique solid-liquid-solid conversion processes of Li-S batteries, however, designing effective strategies to address the insulativity and volume effect of cathode, shuttle of soluble polysulfides, and/or safety hazard of Li metal anode has been challenging. An atomic layer deposition (ALD) is a representative thin film technology with exceptional capabilities in developing atomic-precisely conformal films. It has been demonstrated to be a promise strategy of solving emerging issues in advanced electrical energy storage (EES) devices via the surface modification and/or the fabrication of complex nanostructured materials. In this review, the recent developments and significances on how ALD improves the performance of Li-S batteries were discussed in detail. Significant attention mainly focused on the various strategies with the use of ALD to refine the electrochemical interfaces and cell configurations. Furthermore, the novel opportunities and perspective associated with ALD for future research directions were summarized. This review may boost the development and application of advanced Li-S batteries using ALD.

  16. Human Resources Audit. Is It Significant in Evaluation of Management Performance?

    OpenAIRE

    Susmanschi Georgiana

    2012-01-01

    Human Resource Management can be defined as a set of measures designed interdisciplinary regarding recruitment, selection, employment, ergonomic use of the organization of labor, material and moral stimulation of employees. HR audit should be considered a diagnostic tool for identifying strengths and weaknesses of an organization. An effective audit can be useful in stimulating constructive thinking, identifying positive aspects and organizational deficiencies and providing recommendations fo...

  17. FOCUSED R&D FOR ELECTROCHROMIC SMART WINDOWS: SIGNIFICANT PERFORMANCE AND YIELD ENHANCEMENTS

    Energy Technology Data Exchange (ETDEWEB)

    Marcus Milling

    2004-09-23

    Developments made under this program will play a key role in underpinning the technology for producing EC devices. It is anticipated that the work begun during this period will continue to improve materials properties, and drive yields up and costs down, increase durability and make manufacture simpler and more cost effective. It is hoped that this will contribute to a successful and profitable industry, which will help reduce energy consumption and improve comfort for building occupants worldwide. The first major task involved improvements to the materials used in the process. The improvements made as a result of the work done during this project have contributed to the enhanced performance, including dynamic range, uniformity and electrical characteristics. Another major objective of the project was to develop technology to improve yield, reduce cost, and facilitate manufacturing of EC products. Improvements directly attributable to the work carried out as part of this project and seen in the overall EC device performance, have been accompanied by an improvement in the repeatability and consistency of the production process. Innovative test facilities for characterizing devices in a timely and well-defined manner have been developed. The equipment has been designed in such a way as to make scaling-up to accommodate higher throughput necessary for manufacturing relatively straightforward. Finally, the third major goal was to assure the durability of the EC product, both by developments aimed at improving the product performance, as well as development of novel procedures to test the durability of this new product. Both aspects have been demonstrated, both by carrying out a number of different durability tests, both in-house and by independent third-party testers, and also developing several novel durability tests.

  18. 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...

  19. 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

  20. Administrative data provide vital research evidence for maximizing health-system performance and outcomes.

    Science.gov (United States)

    Roder, David; Buckley, Elizabeth

    2017-06-01

    Although the quality of administrative data is frequently questioned, these data are vital for health-services evaluation and complement data from trials, other research studies and registries for research. Trials generally provide the strongest evidence of outcomes in research settings but results may not apply in many service environments. High-quality observational research has a complementary role where trials are not applicable and for assessing whether trial results apply to groups excluded from trials. Administrative data have a broader system-wide reach, enabling system-wide health-services research and monitoring of performance markers. Where administrative data raise questions about service outcomes, follow-up enquiry may be required to investigate validity and service implications. Greater use should be made of administrative data for system-wide monitoring and for research on service effectiveness and equity. © 2017 John Wiley & Sons Australia, Ltd.

  1. The significance of orbital anatomy and periocular wrinkling when performing laser skin resurfacing.

    Science.gov (United States)

    Trelles, M A; Pardo, L; Benedetto, A V; García-Solana, L; Torrens, J

    2000-03-01

    Knowledge of orbital anatomy and the interaction of muscle contractions, gravitational forces and photoagingis fundamental in understanding the limitations of carbon dioxide (CO2) laser skin resurfacing when rejuvenating the skin of the periocular area. Laser resurfacing does not change the mimetic behavior of the facial muscles nor does it influence gravitational forces. When resurfacing periocular tissue, the creation of scleral show and ectropion are a potential consequence when there is an over zealous attempt at improving the sagging malar fat pad and eyelid laxity by performing an excess amount of laser passes at the lateral portion of the lower eyelid. This results in an inadvertent widening of the palpebral fissure due to the lateral pull of the Orbicularis oculi. Retrospectively, 85 patients were studied, who had undergone periorbital resurfacing with a CO2 laser using anew treatment approach. The Sharplan 40C CO2 Feather Touchlaser was programmed with a circular scanning pattern and used just for the shoulders of the wrinkles. A final laser pass was performed with the same program over the entire lower eyelid skin surface, excluding the outer lateral portion (e.g. a truncated triangle-like area),corresponding to the lateral canthus. Only a single laser pass was delivered to the lateral canthal triangle to avoid widening the lateral opening of the eyelid, which might lead to the potential complications of scleral show and ectropion. When the area of the crows' feet is to be treated, three passes on the skin of this entire lateral orbital surface are completed by moving laterally and upward toward the hairline. Patients examined on days 1, 7, 15, 30, 60, and one year after laser resurfacing showed good results. At two months after treatment, the clinical improvement was rated by the patient and physician as being "very good" in 81 of the 85 patients reviewed. These patients underwent laser resurfacing without complications. The proposed technique of

  2. Hyaluronic Acid Filler Injections Under the Metatarsal Heads Provide a Significant and Long-Lasting Improvement in Metatarsalgia From Wearing High-Heeled Shoes.

    Science.gov (United States)

    Foumenteze, Jean Paul; Simpson, Helen; Kerrouche, Nabil

    2018-01-22

    Metatarsalgia is a common overuse injury that may be caused by wearing high-heeled shoes. To evaluate the decrease in metatarsalgia using a hyaluronic acid dermal filler. A 6-month, open study was conducted in 15 subjects with metatarsalgia because of regularly wearing high-heeled shoes. Hyaluronic acid (20 mg/mL) with lidocaine hydrochloride (3 mg/mL) was injected under the metatarsal heads at baseline. Pain (on a 0-10 scale) under the metatarsal heads when walking in high heels was recorded in a weekly subject diary. At 6 months after injections, 5 subjects (33.3%) reported no metatarsalgia pain. For subjects with pain, they were able to wear high heels for significantly longer than before the injections (7.2 hours at 6 months vs 3.4 hours at baseline). Significant improvements from baseline were observed at Month 6 for time to onset of pain (3.5 hours longer), time between onset of pain and intolerable pain (1.9 hours longer), and pain sensation (-2.2 grades at onset and -3.8 grades at shoe removal). No adverse events were reported. Injection of hyaluronic acid filler to the forefeet provided a significant effective, long-lasting, and well-tolerated improvement in metatarsalgia because of wearing high-heeled shoes.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

  3. Authoring experience: the significance and performance of storytelling in Socratic dialogue with rehabilitating cancer patients.

    Science.gov (United States)

    Knox, Jeanette Bresson Ladegaard; Svendsen, Mette Nordahl

    2015-08-01

    This article examines the storytelling aspect in philosophizing with rehabilitating cancer patients in small Socratic dialogue groups (SDG). Recounting an experience to illustrate a philosophical question chosen by the participants is the traditional point of departure for the dialogical exchange. However, narrating is much more than a beginning point or the skeletal framework of events and it deserves more scholarly attention than hitherto given. Storytelling pervades the whole Socratic process and impacts the conceptual analysis in a SDG. In this article we show how the narrative aspect became a rich resource for the compassionate bond between participants and how their stories cultivated the abstract reflection in the group. In addition, the aim of the article is to reveal the different layers in the performance of storytelling, or of authoring experience. By picking, poking and dissecting an experience through a collaborative effort, most participants had their initial experience existentially refined and the chosen concept of which the experience served as an illustration transformed into a moral compass to be used in self-orientation post cancer.

  4. Clinical Significance of Myocardial Uptake on F-18 FDG PET/CT Performed in Oncologic Patients

    Energy Technology Data Exchange (ETDEWEB)

    Cho, Ho Jin; Cho, Eung Hyuck; Lee, Jong Doo; Kang, Won Jun [Yonsei University College of Medicine, Seoul (Korea, Republic of)

    2009-12-15

    F-18 fluorodeoxyglucose (FDG) uptake of myocardium is influenced by various factors. Increased glycolysis, and subsequent increased F-18 FDG uptake has been reported in ischemic cardiomyopathy. However, clinical significance of incidentally found myocardial F-18 FDG uptake has not been clarified. We retrospectively reviewed the degree and pattern of myocardial uptake in patients without history of ischemic heart disease who underwent torso F-18 FDG PET/CT for evaluation of neoplastic disease. From January 2005 to June 2009, 77 patients who underwent F-18 FDG PET/CT and Tc-99m sestamibi stress/rest SPECT within 3 months were enrolled. Of 77 patients, 55 (71.4%) showed increased F-18 FDG uptake in the myocardium. In this population, 40 showed uniform uptake pattern, while 15 showed focal uptake. In patients with uniform uptake, 17 showed decreased uptake in the septum without perfusion defect on myocardial SPECT. Remaining 23 patients showed uniform uptake, with 1 reversible perfusion defect and 1 fixed perfusion defect. In 15 patients with focal uptake, 9 showed increased F-18 FDG uptake in the base, and only 1 of them showed reversible perfusion defect on myocardial SPECT. In the remaining 6 focal uptake group, 4 had reversible perfusion defect in the corresponding wall, and 1 had apical hypertrophy. We demonstrated that septal defect pattern and basal uptake pattern in the myocardium may represent normal variants. Focal myocardial uptake other than normal variants on oncologic torso F-18 FDG PET/CT with routine fasting protocol may suggest ischemic heart disease, thus further evaluation is warranted.

  5. 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 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...... parameters for calibration is limited. The other SST model is a state-of-the-art, second-order, convection-dispersion tool (Plósz et al., 2007). The sensitivity results obtained from the four scenarios consistently indicate that the settler models and their parameters are among the most significant sources...

  6. The Jak2 inhibitor, G6, alleviates Jak2-V617F-mediated myeloproliferative neoplasia by providing significant therapeutic efficacy to the bone marrow.

    Science.gov (United States)

    Kirabo, Annet; Park, Sung O; Majumder, Anurima; Gali, Meghanath; Reinhard, Mary K; Wamsley, Heather L; Zhao, Zhizhuang Joe; Cogle, Christopher R; Bisht, Kirpal S; Keserü, György M; Sayeski, Peter P

    2011-11-01

    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 splenomegaly 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.

  7. The Jak2 Inhibitor, G6, Alleviates Jak2-V617F-Mediated Myeloproliferative Neoplasia by Providing Significant Therapeutic Efficacy to the Bone Marrow1

    Science.gov (United States)

    Kirabo, Annet; Park, Sung O; Majumder, Anurima; Gali, Meghanath; Reinhard, Mary K; Wamsley, Heather L; Zhao, Zhizhuang Joe; Cogle, Christopher R; Bisht, Kirpal S; Keserü, György M; Sayeski, Peter P

    2011-01-01

    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 splenomegaly 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. PMID:22131881

  8. 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.

  9. A peptide prime-DNA boost immunization protocol provides significant benefits as a new generation Aβ42 DNA vaccine for Alzheimer disease.

    Science.gov (United States)

    Lambracht-Washington, Doris; Qu, Bao-xi; Fu, Min; Anderson, Larry D; Eagar, Todd N; Stüve, Olaf; Rosenberg, Roger N

    2013-01-15

    Immunotherapy has the potential to provide a possible treatment therapy to prevent or delay Alzheimer disease. In a clinical trial (AN1792) in which patients received this immunotherapy and received active Aβ1-42 peptide immunizations, treatment was stopped when 6% of patients showed signs of meningoencephalitis. Follow up on these patients led to the conclusion that the antibody response was beneficial in removing Aβ1-42 from brain but an accompanying inflammatory Th1 T cell response was harmful. As a safe alternative treatment targeting the same self protein, Aβ1-42, in brain, we and others are working on a DNA Aβ1-42 immunization protocol as the immune response to DNA immunizations differs in many aspects from immunizations with peptide antigens. Because the immune response to DNA vaccination has different kinetics and has a significantly lower antibody production, we evaluated two different prime boost regimens, Aβ1-42 DNA prime/Aβ1-42 peptide boost and Aβ1-42 peptide prime/Aβ1-42 DNA boost for their effectiveness in antibody production and possible side effects due to inflammatory T cell responses. While both boost regimes significantly enhanced the specific antibody production with comparable antibody concentrations, the absence of the Aβ1-42 T cell response (no proliferation and no cytokine production) is consistent with our previous findings using this DNA Aβ1-42 trimer immunization and greatly enhances the safety aspect for possible clinical use. Copyright © 2012 Elsevier B.V. All rights reserved.

  10. 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

  11. Performance assessment in health care providers: a critical review of evidence and current practice.

    Science.gov (United States)

    Hamilton, Karen E Stc; Coates, Vivien; Kelly, Billy; Boore, Jennifer R P; Cundell, Jill H; Gracey, Jacquie; McFetridge, Brian; McGonigle, Mary; Sinclair, Marlene

    2007-11-01

    To evaluate methods of performance assessment through an international literature review and a survey of current practice. Over the past two decades health care organizations have focussed on promoting high quality care in conjunction with retaining motivated staff. Cognisant of such initiatives, we sought to evaluate assessment methods for qualified staff according to their utility in the working environment. A systematic literature search was completed and each paper independently reviewed. All health care organizations in Northern Ireland submitted details of their performance assessments. Each was critically appraised using a utility index. Performance was not universally defined. A broad range of assessments were identified, each method had advantages and disadvantages. Although many lacked rigorous testing, areas of good practice were also noted. No single method is appropriate for assessing clinical performance. Rather, this study endorses proposals for a multi-method strategy to ensure that performance assessment demonstrates all attributes required for effective nursing and midwifery practice.

  12. 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 < .001; CHO: 6.7% P < .001; CIN: 6.4% P < .001), back (CRE: 5.8% P < .001; CHO: 6.4% P < .001; CIN: 8.1% P < .001), and leg press (CRE: 11.7% P = .013; CHO: 10.0% P = .007; CIN: 17.3% P < .001). Only the CRE (10.4%, P = .021) and CIN (15.5%, P < .001) group improved total muscular endurance. No differences existed between groups post-supplementation. These findings demonstrate that three different methods of creatine ingestion lead to similar changes in anaerobic power, strength, and endurance.

  13. VISION: a regional performance improvement initiative for HIV health care providers.

    Science.gov (United States)

    Bruno, Theodore O; Hicks, Charles B; Naggie, Susanna; Wohl, David A; Albrecht, Helmut; Thielman, Nathan M; Rabin, Daniel U; Layton, Sherry; Subramaniam, Chitra; Grichnik, Katherine P; Shlien, Amanda; Weyer, Dianne

    2014-01-01

    VISION (HIV Integrated Learning ModuleS: Achieving Performance Improvement through CollaboratiON) was a regional performance improvement (PI) continuing medical education (CME) initiative designed to increase guideline-conforming practice of clinicians who manage patients with HIV infection. The 3-part activity consisted of (1) clinical practice assessment and development of an action plan for practice change, (2) completion of relevant education, and (3) reassessment. The activity did not change practitioners' performance in clinical status monitoring and in patient treatment, in large part because guidelines were being appropriately implemented at baseline as well as after the educational intervention. There was a trend toward improvement, however, in practitioner performance in the area of patient medication adherence (increased from 66% to 74%). Results observed in the VISION initiative were consistent with HIVQUAL metrics. Ongoing education in HIV is important, and VISION demonstrated performance improvement in medication adherence, a critical aspect of health care. © 2014 The Alliance for Continuing Education in the Health Professions, the Society for Academic Continuing Medical Education, and the Council on Continuing Medical Education, Association for Hospital Medical Education.

  14. A Validation Study of the Performance Indicators and Learner Outcomes of Kentucky's Alternate Assessment for Students with Significant Disabilities.

    Science.gov (United States)

    Kleinert, Harold L.; Kearns, Jacqui Farmer

    1999-01-01

    A survey of 44 national authorities in best practices for students with severe cognitive disabilities found a high degree of professional congruence on the core of best practices embodied in the performance criteria for Kentucky's alternate assessment for students with significant disabilities. Concerns about more limited learner outcomes are…

  15. Providing the Answers Does Not Improve Performance on a College Final Exam

    Science.gov (United States)

    Glass, Arnold Lewis; Sinha, Neha

    2013-01-01

    In the context of an upper-level psychology course, even when students were given an opportunity to refer to text containing the answers and change their exam responses in order to improve their exam scores, their performance on these questions improved slightly or not at all. Four experiments evaluated competing explanations for the students'…

  16. Correlation between provider computer experience and accuracy of electronic anesthesia charting A pilot study and performance improvement project

    Science.gov (United States)

    2017-03-20

    Anesthesia recordkeeping: Accuracy of recall with computerized and manual entry recordkeeping. CORRELATION BETWEEN PROVIDER COMPUTER EXPERIENCE 39...Unexpected increased mortality after implementation of a CORRELATION BETWEEN PROVIDER COMPUTER EXPERIENCE 40 commercially sold computerized physician...Correlation between provider computer experience and accuracy of electronic anesthesia charting – A pilot study and performance improvement

  17. Performances of sexuality counselling : a framework for provider-client encounters

    NARCIS (Netherlands)

    van der Kwaak, Anke; Ferris, Kristina; van Kats, Jetty; Dieleman, Marjolein

    2010-01-01

    OBJECTIVE: Adequately assessing quality of care poses enormous challenges. While conducting fieldwork, we were struck by the need for a framework that encapsulates provider-client encounters. Little evidence exists concerning the most effective training, and management of health staff engaged in

  18. Effort provides its own reward: endeavors reinforce subjective expectation and evaluation of task performance.

    Science.gov (United States)

    Wang, Lei; Zheng, Jiehui; Meng, Liang

    2017-04-01

    Although many studies have investigated the relationship between the amount of effort invested in a certain task and one's attitude towards the subsequent reward, whether exerted effort would impact one's expectation and evaluation of performance feedback itself still remains to be examined. In the present study, two types of calculation tasks that varied in the required effort were adopted, and we resorted to electroencephalography to probe the temporal dynamics of how exerted effort would affect one's anticipation and evaluation of performance feedback. In the high-effort condition, a more salient stimulus-preceding negativity was detected during the anticipation stage, which was accompanied with a more salient FRN/P300 complex (a more positive P300 and a less negative feedback-related negativity) in response to positive outcomes in the evaluation stage. These results suggested that when more effort was invested, an enhanced anticipatory attention would be paid toward one's task performance feedback and that positive outcomes would be subjectively valued to a greater extent.

  19. Interdepartmental Occupational Standards for Social Service Providers and Their Role in Improving Job Performance

    Directory of Open Access Journals (Sweden)

    Zabrodin Yu.M.,

    2016-04-01

    Full Text Available The paper presents an analysis of the occupational standards development abroad and in Russia. It focuses on interdepartmental occupational standards for social service providers. While creating occupational standards for social services as an integrated industry it is advisable to consider the design of whole system and its macro-level effects in a document called “sectoral qualification framework”. It is pointed out that 1 real professional activity in social sphere has a clear humanitarian focus, and its objects are radically different population groups; 2 the complexity of the social work is often associated with the interaction between various professionals and their activity have to be interdepartmentally organized. The author identifies the factors influencing development and implementation of professional standards in different countries and consider the main strategy directions of development and application of occupational standards of education and social service providers in Russia.

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

    OpenAIRE

    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 suppleme...

  1. 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.

  2. 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…

  3. Assessment of the Nurses Performance in Providing Care to Patients Undergoing Nasogastric Tube in Suez Canal University Hospital

    National Research Council Canada - National Science Library

    Magda Abdelaziz Mohammed; Mahmoud el Prince Mahmoud; Hamdy A Sleem; Mariam Sabry Shehab

    2017-01-01

    .... In general, tube feeding is a technique used for those who are unable to eat on their own. The aim of the present study is to assess nurses' performance in providing care to patients undergoing nasogastric tube...

  4. 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

  5. A feasibility study of a web-based performance improvement system for substance abuse treatment providers.

    Science.gov (United States)

    Forman, Robert; Crits-Christoph, Paul; Kaynak, Ovgü; Worley, Matt; Hantula, Donald A; Kulaga, Agatha; Rotrosen, John; Chu, Melissa; Gallop, Robert; Potter, Jennifer; Muchowski, Patrice; Brower, Kirk; Strobbe, Stephen; Magruder, Kathy; Chellis, A'Delle H; Clodfelter, Tad; Cawley, Margaret

    2007-12-01

    We report here on the feasibility of implementing a semiautomated performance improvement system-Patient Feedback (PF)-that enables real-time monitoring of patient ratings of therapeutic alliance, treatment satisfaction, and drug/alcohol use in outpatient substance abuse treatment clinics. The study was conducted in six clinics within the National Institute on Drug Abuse Clinical Trials Network. It involved a total of 39 clinicians and 6 clinic supervisors. Throughout the course of the study (consisting of five phases: training period [4 weeks], baseline [4 weeks], intervention [12 weeks], postintervention assessment [4 weeks], sustainability [1 year]), there was an overall collection rate of 75.5% of the clinic patient census. In general, the clinicians in these clinics had very positive treatment satisfaction and alliance ratings throughout the study. However, one clinic had worse drug use scores at baseline than other participating clinics and showed a decrease in self-reported drug use at postintervention. Although the implementation of the PF system proved to be feasible in actual clinical settings, further modifications of the PF system are needed to enhance any potential clinical usefulness.

  6. Minimally invasive esophagectomy provides significant survival advantage compared with open or hybrid esophagectomy for patients with cancers of the esophagus and gastroesophageal junction.

    Science.gov (United States)

    Palazzo, Francesco; Rosato, Ernest L; Chaudhary, Asadulla; Evans, Nathaniel R; Sendecki, Jocelyn A; Keith, Scott; Chojnacki, Karen A; Yeo, Charles J; Berger, Adam C

    2015-04-01

    Minimally invasive esophagectomy (MIE) is increasingly being used to treat patients with cancer of the esophagus and gastroesophageal junction. We previously reported that oncologic efficacy may be improved with MIE compared with open or hybrid esophagectomy (OHE). We compared survival of patients undergoing MIE and OHE. Our contemporary series of patients who underwent MIE (2008 to 2013) was compared with a cohort undergoing OHE (3-hole [n = 39], Ivor Lewis [n = 16], hybrid [n = 13], 2000 to 2013). Summary statistics were calculated by operation type; Kaplan-Meier methods were used to compare survival. Cox regression was used to assess the impact of operation type (MIE vs OHE) on mortality, adjusting for age, sex, total lymph nodes, lymph node ratio (LNR), neoadjuvant chemoradiotherapy (CRT), and stage. The MIE (n = 104) and OHE (n = 68) groups were similar with respect to age and sex. The MIE group tended to have higher BMI, earlier stage disease, and was less likely to receive CRT. The MIE group experienced lower operative mortality (3.9% vs 8.8%, p = 0.35) and significantly fewer major complications. Five-year survival between groups was significantly different (MIE, 64%, OHE, 35%, p analysis demonstrated that patients undergoing OHE had a significantly worse survival compared with MIE independent of age, LNR, CRT, and pathologic stage (hazard ratio 2.00, p = 0.019). This study supports MIE for EC as a superior procedure with respect to overall survival, perioperative mortality, and severity of postoperative complications. Several biases may have affected these results: earlier stage in the MIE group and disparity in timing of the procedures. These results will need to be confirmed in future prospective studies with longer follow-up. Copyright © 2015 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

  7. Food restriction alters salivary cortisol and α-amylase responses to a simulated weightlifting competition without significant performance modification.

    Science.gov (United States)

    Durguerian, Alexandre; Filaire, Edith; Drogou, Catherine; Bougard, Clément; Chennaoui, Mounir

    2018-03-01

    The aim of this investigation was to evaluate the effect of a 6-day food restriction period on the physiological responses and performance of 11 high-level weightlifters. After a period of weight maintenance (T 2 ), they were assigned into two groups depending on whether they lost (Diet group, n = 6) or maintained their body weight (Control group, n = 5) during the course of those 6 days. An evaluation of performance and the measurement of salivary cortisol concentrations and salivary α-amylase (sAA) activity were performed during a simulated weightlifting competition which took place at T 2 , after a 6-day period of food restriction (T 3 ). Dietary data were collected using a 6-day diet record. We noted a 41.8% decrease in mean energy intake during the dietary restriction period, leading to a 4.34% weight loss for the Diet group. Dietary restriction did not modify absolute performance levels, whilst a significant improvement was noted for the Control group. Furthermore, we noted a response of decreased salivary cortisol and increased sAA activity to the simulated competition stress at T 3 for the Diet group. These results may indicate that dietary reduction led to a dissociation of the hypothalamo-pituitary-adrenal axis and the sympatho-adreno-medullary system, which could impair training adaptations and absolute performance development.

  8. 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

  9. Camelid Ig V genes reveal significant human homology not seen in therapeutic target genes, providing for a powerful therapeutic antibody platform

    Science.gov (United States)

    Klarenbeek, Alex; Mazouari, Khalil El; Desmyter, Aline; Blanchetot, Christophe; Hultberg, Anna; de Jonge, Natalie; Roovers, Rob C; Cambillau, Christian; Spinelli, Sylvia; Del-Favero, Jurgen; Verrips, Theo; de Haard, Hans J; Achour, Ikbel

    2015-01-01

    Camelid immunoglobulin variable (IGV) regions were found homologous to their human counterparts; however, the germline V repertoires of camelid heavy and light chains are still incomplete and their therapeutic potential is only beginning to be appreciated. We therefore leveraged the publicly available HTG and WGS databases of Lama pacos and Camelus ferus to retrieve the germline repertoire of V genes using human IGV genes as reference. In addition, we amplified IGKV and IGLV genes to uncover the V germline repertoire of Lama glama and sequenced BAC clones covering part of the Lama pacos IGK and IGL loci. Our in silico analysis showed that camelid counterparts of all human IGKV and IGLV families and most IGHV families could be identified, based on canonical structure and sequence homology. Interestingly, this sequence homology seemed largely restricted to the Ig V genes and was far less apparent in other genes: 6 therapeutically relevant target genes differed significantly from their human orthologs. This contributed to efficient immunization of llamas with the human proteins CD70, MET, interleukin (IL)-1β and IL-6, resulting in large panels of functional antibodies. The in silico predicted human-homologous canonical folds of camelid-derived antibodies were confirmed by X-ray crystallography solving the structure of 2 selected camelid anti-CD70 and anti-MET antibodies. These antibodies showed identical fold combinations as found in the corresponding human germline V families, yielding binding site structures closely similar to those occurring in human antibodies. In conclusion, our results indicate that active immunization of camelids can be a powerful therapeutic antibody platform. PMID:26018625

  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. 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.

  12. 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.

  13. 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…

  14. 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.

  15. 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.

  16. 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

  17. ["Onlay" mesh provides significantly better results than "sublay" reconstruction. Prospective randomized multicenter study of abdominal wall reconstruction with sutures only, or with surgical mesh--results of a five-years follow-up].

    Science.gov (United States)

    Wéber, György; Baracs, József; Horváth, Ors Péter

    2010-10-01

    There are several well-known procedures to treat abdominal wall hernias, but the results are quite controversial. The aim of study was to compare the results of different surgical modalities - mesh (onlay vs. sublay position) and suture repair - in the treatment of abdominal wall hernias. A five-year randomized, multicentric, internet-based, clinical trial was started in 2002. 953 patients were included in the study and divided into two groups according to the size of hernia orifice. In group 'A' ( n = 494) the surface of hernia orifice was between 5-25 cm 2 (small hernia), and in group 'B' ( n = 459) it was above 25 cm 2 (large hernia). Patients of these two groups were randomized according to surgery: group 'A' (suture vs. mesh) and in group 'B' (mesh in onlay vs. sublay position). In group 'A' suture repair was performed in 247, and sublay mesh implantation in 247 cases. In group 'B' sublay ( n = 235) and onlay ( n = 224) mesh reconstruction was performed. The patients were followed-up for five years. 734 patients - 77% of all randomized cases - have completed the study. In the small hernia group significantly ( p suture repair ( n = 50-27%) than in mesh repair ( n = 15-8%). In the large hernia group onlay mesh reconstruction provided significantly better ( p suture repair. In case of large hernias the recurrence rate is higher after sublay reconstruction. The randomized trial was registered on www.ClinicalTrials.gov - ID number: NCT01018524.

  18. 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).

  19. The clinical significance of incidental intra-abdominal findings on positron emission tomography performed to investigate pulmonary nodules

    Directory of Open Access Journals (Sweden)

    Gill Richdeep S

    2012-01-01

    Full Text Available Abstract Background Lung cancer is a common cause of cancer-related death. Staging typically includes positron emission tomography (PET scanning, in which18F-fluoro-2-dexoy-D-glucose (FDG is taken up by cells proportional to metabolic activity, thus aiding in differentiating benign and malignant pulmonary nodules. Uptake of FDG can also occur in the abdomen. The clinical significance of incidental intraabdominal FDG uptake in the setting of pulmonary nodules is not well established. Our objective was to report on the clinical significance of incidental intra-abdominal FDG activity in the setting of lung cancer. Methods Fifteen hundred FDG-PET reports for studies performed for lung cancer were retrospectively reviewed for the presence of incidental FDG-positive intraabdominal findings. Patient charts with positive findings were then reviewed and information extracted. Results Twenty-five patients (25/1500 demonstrated incidental intraabdominal FDG uptake thought to be significant (1.7% with a mean patient age of 71 years. Colonic uptake was most common (n = 17 with 9 (52% being investigated further. Of these 9 cases, a diagnosis of malignancy was made in 3 patients, pre-malignant adenomas in 2 patients, a benign lipoma in 1 patient and no abnormal findings in the remaining patients. 8 patients were not investigated further (3 diagnosed with metastatic lung cancer and 2 were of advanced age secondary to poor prognosis. Conclusion Incidental abdominal findings in the colon on FDG-PET scan for work-up of pulmonary nodules need to be further investigated by colonoscopy.

  20. Competency in Chaos: Lifesaving Performance of Care Providers Utilizing a Competency-Based, Multi-Actor Emergency Preparedness Training Curriculum

    Science.gov (United States)

    Scott, Lancer A.; Swartzentruber, Derrick A.; Davis, Christopher Ashby; Maddux, P. Tim; Schnellman, Jennifer; Wahlquist, Amy E.

    2015-01-01

    Objective Providing comprehensive emergency preparedness training (EPT) to care providers is important to the future success of disaster operations in the US. Few EPT programs possess both competency-driven goals and metrics to measure performance during a multi-patient simulated disaster. Methods A 1-day (8-hour) EPT course for care providers was developed to enhance provider knowledge, skill, and comfort necessary to save lives during a simulated disaster. Nine learning objectives, 18 competencies, and 34 performance objectives were developed. During the 2-year demonstration of the curriculum, 24 fourth-year medical students and 17 Veterans Hospital Administration (VHA) providers were recruited and volunteered to take the course (two did not fully complete the research materials). An online pre-test, two post-tests, course assessment, didactic and small group content, and a 6-minute clinical casualty scenario were developed. During the scenario, trainees working in teams were confronted with three human simulators and 10 actor patients simultaneously. Unless appropriate performance objectives were met, the simulators “died” and the team was exposed to “anthrax.” After the scenario, team members participated in a facilitator-led debriefing using digital video and then repeated the scenario. Results Trainees (N = 39) included 24 (62%) medical students; seven (18%) physicians; seven (18%) nurses; and one (3%) emergency manager. Forty-seven percent of the VHA providers reported greater than 16 annual hours of disaster training, while 15 (63%) of the medical students reported no annual disaster training. The mean (SD) score for the pre-test was 12.3 (3.8), or 51% correct, and after the training, the mean (SD) score was 18.5 (2.2), or 77% (P <.01). The overall rating for the course was 96 out of 100. Trainee self-assessment of “Overall Skill” increased from 63.3 out of 100 to 83.4 out of 100 and “Overall Knowledge” increased from 49.3 out of 100 to 78

  1. 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

  2. A linear and non-linear polynomial neural network modeling of dissolved oxygen content in surface water: Inter- and extrapolation performance with inputs' significance analysis.

    Science.gov (United States)

    Šiljić Tomić, Aleksandra; Antanasijević, Davor; Ristić, Mirjana; Perić-Grujić, Aleksandra; Pocajt, Viktor

    2018-01-01

    Accurate prediction of water quality parameters (WQPs) is an important task in the management of water resources. Artificial neural networks (ANNs) are frequently applied for dissolved oxygen (DO) prediction, but often only their interpolation performance is checked. The aims of this research, beside interpolation, were the determination of extrapolation performance of ANN model, which was developed for the prediction of DO content in the Danube River, and the assessment of relationship between the significance of inputs and prediction error in the presence of values which were of out of the range of training. The applied ANN is a polynomial neural network (PNN) which performs embedded selection of most important inputs during learning, and provides a model in the form of linear and non-linear polynomial functions, which can then be used for a detailed analysis of the significance of inputs. Available dataset that contained 1912 monitoring records for 17 water quality parameters was split into a "regular" subset that contains normally distributed and low variability data, and an "extreme" subset that contains monitoring records with outlier values. The results revealed that the non-linear PNN model has good interpolation performance (R 2 =0.82), but it was not robust in extrapolation (R 2 =0.63). The analysis of extrapolation results has shown that the prediction errors are correlated with the significance of inputs. Namely, the out-of-training range values of the inputs with low importance do not affect significantly the PNN model performance, but their influence can be biased by the presence of multi-outlier monitoring records. Subsequently, linear PNN models were successfully applied to study the effect of water quality parameters on DO content. It was observed that DO level is mostly affected by temperature, pH, biological oxygen demand (BOD) and phosphorus concentration, while in extreme conditions the importance of alkalinity and bicarbonates rises over p

  3. TS-Chemscore, a Target-Specific Scoring Function, Significantly Improves the Performance of Scoring in Virtual Screening.

    Science.gov (United States)

    Wang, Wen-Jing; Huang, Qi; Zou, Jun; Li, Lin-Li; Yang, Sheng-Yong

    2015-07-01

    Most of the scoring functions currently used in structure-based drug design belong to 'universal' scoring functions, which often give a poor correlation between the calculated scores and experimental binding affinities. In this investigation, we proposed a simple strategy to construct target-specific scoring functions based on known 'universal' scoring functions. This strategy was applied to Chemscore, a widely used empirical scoring function, which led to a new scoring function, termed TS-Chemscore. TS-Chemscore was validated on 14 protein targets, which cover a wide range of biological target categories. The results showed that TS-Chemscore significantly improved the correlation between the calculated scores and experimental binding affinities compared with the original Chemscore. TS-Chemscore was then applied in virtual screening to retrieve novel JAK3 and YopH inhibitors. Top 30 compounds for each target were selected for experimental validation. Six active compounds for JAK3 and four for YopH were obtained. These compounds were out of the lists of top 30 compounds sorted by Chemscore. Collectively, TS-Chemscore established in this study showed a better performance in virtual screening than its counterpart Chemscore. © 2014 John Wiley & Sons A/S.

  4. Improving health worker performance of abortion services: an assessment of post-training support to providers in India, Nepal and Nigeria.

    Science.gov (United States)

    Benson, Janie; Healy, Joan; Dijkerman, Sally; Andersen, Kathryn

    2017-11-21

    Health worker performance has been the focus of numerous interventions and evaluation studies in low- and middle-income countries. Few have examined changes in individual provider performance with an intervention encompassing post-training support contacts to improve their clinical practice and resolve programmatic problems. This paper reports the results of an intervention with 3471 abortion providers in India, Nepal and Nigeria. Following abortion care training, providers received in-person visits and virtual contacts by a clinical and programmatic support team for a 12-month period, designed to address their individual practice issues. The intervention also included technical assistance to and upgrades in facilities where the providers worked. Quantitative measures to assess provider performance were established, including: 1) Increase in service provision; 2) Consistent service provision; 3) Provision of high quality of care through use of World Health Organization-recommended uterine evacuation technologies, management of pain and provision of post-abortion contraception; and 4) Post-abortion contraception method mix. Descriptive univariate analysis was conducted, followed by examination of the bivariate relationships between all independent variables and the four dependent performance outcome variables by calculating unadjusted odds ratios, by country and overall. Finally, multivariate logistic regression was performed for each outcome. Providers received an average of 5.7 contacts. Sixty-two percent and 46% of providers met measures for consistent service provision and quality of care, respectively. Fewer providers achieved an increased number of services (24%). Forty-six percent provided an appropriate postabortion contraceptive mix to clients. Most providers met the quality components for use of WHO-recommended abortion methods and provision of pain management. Factors significantly associated with achievement of all measures were providers working in

  5. Significance of ground-water chemistry in performance of North Sahara Tube wells in Algeria and Tunisia

    Science.gov (United States)

    Clarke, Frank Eldridge; Jones, Blair F.

    1972-01-01

    Nine ground-water samples from the principal shallow and deep North Sahara aquifers of Algeria and Tunisia were examined to determine the relation of their chemical composition to corrosion and mineral encrustation thought to be contributing to observed decline in well capacities within a UNESCO/UNDP Special Fund Project area. Although the shallow and deep waters differ significantly in certain quality factors, all are sulfochloride types with corrosion potentials ranging from moderate to extreme. None appear to be sufficiently supersaturated with troublesome mineral species to cause rapid or severe encrustation of filter pipes or other well parts. However, calcium carbonate encrustation of deep-well cooling towers and related irrigation pipes can be expected because of loss of carbon dioxide and water during evaporative cooling. Corrosion products, particularly iron sulfide, can be expected to deposit in wells producing waters from the deep aquifers. This could reduce filterpipe openings and increase casing roughness sufficiently to cause significant reduction in well capacity. It seems likely, however, that normal pressure reduction due to exploitation of the artesian systems is a more important control of well performance. If troublesome corrosion and related encrustation are confirmed by downhole inspection, use of corrosion-resisting materials, such as fiber-glass casing and saw-slotted filter pipe (shallow wells only), or stainless-steel screen, will minimize the effects of the waters represented by these samples. A combination of corrosion-resisting stainless steel filter pipe electrically insulated from the casing with a nonconductive spacer and cathodic protection will minimize external corrosion of steel casing, if this is found to be a problem. However, such installations are difficult to make in very deep wells and difficult to control in remote areas. Both the shallow waters and the deep waters examined in this study will tend to cause soil

  6. 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.

  7. 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.

  8. 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

  9. 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.

  10. OPTIMIZATION OF DEEP DRILLING PERFORMANCE--DEVELOPMENT AND BENCHMARK TESTING OF ADVANCED DIAMOND PRODUCT DRILL BITS & HP/HT FLUIDS TO SIGNIFICANTLY IMPROVE RATES OF PENETRATION

    Energy Technology Data Exchange (ETDEWEB)

    Alan Black; Arnis Judzis

    2004-10-01

    The industry cost shared program aims to benchmark drilling rates of penetration in selected simulated deep formations and to significantly improve ROP through a team development of aggressive diamond product drill bit--fluid system technologies. Overall the objectives are as follows: Phase 1--Benchmark ''best in class'' diamond and other product drilling bits and fluids and develop concepts for a next level of deep drilling performance; Phase 2--Develop advanced smart bit-fluid prototypes and test at large scale; and Phase 3--Field trial smart bit-fluid concepts, modify as necessary and commercialize products. As of report date, TerraTek has concluded all major preparations for the high pressure drilling campaign. Baker Hughes encountered difficulties in providing additional pumping capacity before TerraTek's scheduled relocation to another facility, thus the program was delayed further to accommodate the full testing program.

  11. Measuring the significance of workload on performance of cytotechnologists in gynecologic cytology: a study using rapid prescreening.

    Science.gov (United States)

    Deschenes, Majorie; Renshaw, Andrew A; Auger, Manon

    2008-06-25

    Workload is extensively regulated and often used as a measure of quality in gynecologic cytology. Whether workload correlates with the sensitivity of screening in gynecologic cytology is not known. The sensitivity of gynecologic cytology screening was measured over an 8-month period using the result of full screening coupled with the results of rapid prescreening. Sensitivity results were then correlated with daily workload volumes and the experience level of individual cytotechnologists. Rapid prescreening had an average sensitivity of 41.9% for atypical squamous cells of undetermined significance (ASCUS) and above. Full screening had a corrected sensitivity of 82.2% for ASCUS and above. Rapid prescreening increased the sensitivity of the laboratory to 89.9%. The sensitivity of full screening was significantly different between cytotechnologists (79.2% vs 99%, P .05). When sensitivity and workload were examined on a monthly basis, there was no significant difference between sensitivity either as a group or individually at the highest and lowest workloads (P > .40 for all). Screeners sensitivity in gynecologic cytology appears to be unrelated to the experience level of individual cytotechnologists or to their workload at the levels examined. (c) 2008 American Cancer Society.

  12. Does ownership matter? An overview of systematic reviews of the performance of private for-profit, private not-for-profit and public healthcare providers.

    Science.gov (United States)

    Herrera, Cristian A; Rada, Gabriel; Kuhn-Barrientos, Lucy; Barrios, Ximena

    2014-01-01

    Ownership of healthcare providers has been considered as one factor that might influence their health and healthcare related performance. The aim of this article was to provide an overview of what is known about the effects on economic, administrative and health related outcomes of different types of ownership of healthcare providers--namely public, private non-for-profit (PNFP) and private for-profit (PFP)--based on the findings of systematic reviews (SR). An overview of systematic reviews was performed. Different databases were searched in order to select SRs according to an explicit comprehensive criterion. Included SRs were assessed to determine their methodological quality. Of the 5918 references reviewed, fifteen SR were included, but six of them were rated as having major limitations, so they weren't incorporated in the analyses. According to the nine analyzed SR, ownership does seem to have an effect on health and healthcare related outcomes. In the comparison of PFP and PNFP providers, significant differences in terms of mortality of patients and payments to facilities have been found, both being higher in PFP facilities. In terms of quality and economic indicators such as efficiency, there are no concluding results. When comparing PNFP and public providers, as well as for PFP and public providers, no clear differences were found. PFP providers seem to have worst results than their PNFP counterparts, but there are still important evidence gaps in the literature that needs to be covered, including the comparison between public and both PFP and PNFP providers. More research is needed in low and middle income countries to understand the impact on and development of healthcare delivery systems.

  13. 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

  14. 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 < .001), 68.3% versus 90.8% for blood pressure control (P < .001), 26.9% versus 43.4% for cholesterol control (P < .001), and 37.4% versus 40.6% for smoking cessation (P = .383). Practice rankings were strongly correlated for antiplatelet prescription (correlation coefficient 0.98) and cholesterol control (0.92) but poorly correlated for blood pressure control (0.39) and smoking cessation (0.22). Evaluation of preventive care and individual practice rankings vary significantly depending on how measures are defined. Publicly reported measures need to be validly associated with outcomes to avoid incorrectly evaluating practice performance and failing to achieve public health goals. Copyright © 2015

  15. Formative evaluation of a telemedicine model for delivering clinical neurophysiology services part I: Utility, technical performance and service provider perspective

    Directory of Open Access Journals (Sweden)

    Breen Patricia

    2010-09-01

    Full Text Available Abstract Background Formative evaluation is conducted in the early stages of system implementation to assess how it works in practice and to identify opportunities for improving technical and process performance. A formative evaluation of a teleneurophysiology service was conducted to examine its technical and sociological dimensions. Methods A teleneurophysiology service providing routine EEG investigation was established. Service use, technical performance and satisfaction of clinical neurophysiology personnel were assessed qualitatively and quantitatively. These were contrasted with a previously reported analysis of the need for teleneurophysiology, and examination of expectation and satisfaction with clinical neurophysiology services in Ireland. A preliminary cost-benefit analysis was also conducted. Results Over the course of 40 clinical sessions during 20 weeks, 142 EEG investigations were recorded and stored on a file server at a satellite centre which was 130 miles away from the host clinical neurophysiology department. Using a virtual private network, the EEGs were accessed by a consultant neurophysiologist at the host centre for interpretation. The model resulted in a 5-fold increase in access to EEG services as well as reducing average waiting times for investigation by a half. Technically the model worked well, although a temporary loss of virtual private network connectivity highlighted the need for clarity in terms of responsibility for troubleshooting and repair of equipment problems. Referral quality, communication between host and satellite centres, quality of EEG recordings, and ease of EEG review and reporting indicated that appropriate organisational processes were adopted by the service. Compared to traditional CN service delivery, the teleneurophysiology model resulted in a comparable unit cost per EEG. Conclusion Observations suggest that when traditional organisational boundaries are crossed challenges associated with the

  16. Community pediatric hospitalists providing care in the emergency department: an analysis of physician productivity and financial performance.

    Science.gov (United States)

    Dudas, Robert A; Monroe, David; McColligan Borger, Melissa

    2011-11-01

    Community hospital pediatric inpatient programs are being threatened by current financial and demographic trends. We describe a model of care and report on the financial implications associated with combining emergency department (ED) and inpatient care of pediatric patients. We determine whether this type of model could generate sufficient revenue to support physician salaries for continuous in-house coverage in community hospitals. Financial productivity and selected performance indicators were obtained from a retrospective review of registration and billing records. Data were obtained from 2 community-based pediatric hospitalist programs, which are part of a single health system and included care delivered in the ED and inpatient settings during a 1-year period from July 1, 2008, to July 1, 2009. Together, the combined programs were able to generate 6079 total relative value units and collections of $244,828 annually per full-time equivalent (FTE). Salary, benefits, and practice expenses totaled $235,674 per FTE. Thus, combined daily revenues exceeded expenses and provided 104% of physician salary, benefits, and practice expenses. However, 1 program generated a net profit of $329,715 ($40,706 per FTE), whereas the other recorded a loss of $207,969 ($39,994 per FTE). Emergency department throughput times and left-without-being-seen rates at both programs were comparable to national benchmarks. Incorporating ED care into a pediatric hospitalist program can be an effective strategy to maintain the financial viability of pediatric services at community hospitals with low inpatient volumes that seek to provide 24-hour pediatric staffing.

  17. Concave Pit-Containing Scaffold Surfaces Improve Stem Cell-Derived Osteoblast Performance and Lead to Significant Bone Tissue Formation

    Science.gov (United States)

    Cusella-De Angelis, Maria Gabriella; Laino, Gregorio; Piattelli, Adriano; Pacifici, Maurizio; De Rosa, Alfredo; Papaccio, Gianpaolo

    2007-01-01

    Background Scaffold surface features are thought to be important regulators of stem cell performance and endurance in tissue engineering applications, but details about these fundamental aspects of stem cell biology remain largely unclear. Methodology and Findings In the present study, smooth clinical-grade lactide-coglyolic acid 85:15 (PLGA) scaffolds were carved as membranes and treated with NMP (N-metil-pyrrolidone) to create controlled subtractive pits or microcavities. Scanning electron and confocal microscopy revealed that the NMP-treated membranes contained: (i) large microcavities of 80–120 µm in diameter and 40–100 µm in depth, which we termed primary; and (ii) smaller microcavities of 10–20 µm in diameter and 3–10 µm in depth located within the primary cavities, which we termed secondary. We asked whether a microcavity-rich scaffold had distinct bone-forming capabilities compared to a smooth one. To do so, mesenchymal stem cells derived from human dental pulp were seeded onto the two types of scaffold and monitored over time for cytoarchitectural characteristics, differentiation status and production of important factors, including bone morphogenetic protein-2 (BMP-2) and vascular endothelial growth factor (VEGF). We found that the microcavity-rich scaffold enhanced cell adhesion: the cells created intimate contact with secondary microcavities and were polarized. These cytological responses were not seen with the smooth-surface scaffold. Moreover, cells on the microcavity-rich scaffold released larger amounts of BMP-2 and VEGF into the culture medium and expressed higher alkaline phosphatase activity. When this type of scaffold was transplanted into rats, superior bone formation was elicited compared to cells seeded on the smooth scaffold. Conclusion In conclusion, surface microcavities appear to support a more vigorous osteogenic response of stem cells and should be used in the design of therapeutic substrates to improve bone repair and

  18. A Novel Polyaniline-Coated Bagasse Fiber Composite with Core-Shell Heterostructure Provides Effective Electromagnetic Shielding Performance.

    Science.gov (United States)

    Zhang, Yang; Qiu, Munan; Yu, Ying; Wen, Bianying; Cheng, Lele

    2017-01-11

    A facile route was proposed to synthesize polyaniline (PANI) uniformly deposited on bagasse fiber (BF) via a one-step in situ polymerization of aniline in the dispersed system of BF. Correlations between the structural, electrical, and electromagnetic properties were extensively investigated. Scanning electron microscopy images confirm that the PANI was coated dominantly on the BF surface, indicating that the as-prepared BF/PANI composite adopted the natural and inexpensive BF as its core and the PANI as the shell. Fourier transform infrared spectra suggest significant interactions between the BF and PANI shell, and a high degree of doping in the PANI shell was achieved. X-ray diffraction results reveal that the crystallization of the PANI shell was improved. The dielectric behaviors are analyzed with respect to dielectric constant, loss tangent, and Cole-Cole plots. The BF/PANI composite exhibits superior electrical conductivity (2.01 ± 0.29 S·cm-1), which is higher than that of the pristine PANI with 1.35 ± 0.15 S·cm-1. The complex permittivity, electromagnetic interference (EMI), shielding effectiveness (SE) values, and attenuation constants of the BF/PANI composite were larger than those of the pristine PANI. The EMI shielding mechanisms of the composite were experimentally and theoretically analyzed. The absorption-dominated total EMI SE of 28.8 dB at a thickness of 0.4 mm indicates the usefulness of the composite for electromagnetic shielding. Moreover, detailed comparison of electrical and EMI shielding properties with respect to the BF/PANI, dedoped BF/PANI composite, and the pristine PANI indicate that the enhancement of electromagnetic properties for the BF/PANI composite was due to the improved conductivity and the core-shell architecture. Thus, the composite has potential commercial applications for high-performance electromagnetic shielding materials and also could be used as a conductive filler to endow polymers with electromagnetic shielding

  19. Does training on performance based financing make a difference in performance and quality of health care delivery? Health care provider's perspective in Rungwe Tanzania.

    Science.gov (United States)

    Manongi, Rachel; Mushi, Declare; Kessy, Joachim; Salome, Saria; Njau, Bernard

    2014-04-04

    In recent years, Performance Based Financing (PBF); a form of result based financing, has attracted a global attention in health systems in developing countries. PBF promotes autonomous health facilities, motivates and introduces financial incentives to motivate health facilities and health workers to attain pre-determined targets. To achieve this, the Tanzanian government through the Christian Social Services Commission initiated a PBF pilot project in Rungwe district, Mbeya region. Kilimanjaro Christian Medical Center was given the role of training health workers on PBF principles in Rungwe. The aim of this study was to explore health care providers' perception on a three years training on PBF principles in a PBF pilot project at Rungwe District in Mbeya, Tanzania. This was an explorative qualitative study, which took place at Rungwe PBF pilot area in October 2012. Twenty six (26) participants were purposively selected. Six took part in- depth interviews (IDIs) and twenty (20) in the group discussions. Both the IDIs and the GDs explored the perceived benefit and challenges of implementing PBF in their workplace. Data were manually analyzed using content analysis approach. Overall informants had positive perspectives on PBF training. Most of the health facilities were able to implement some of the PBF concepts in their work places after the training, such as developing job descriptions for their staff, creating quarterly business plans for their facilities, costing for their services and entering service agreement with the government, improved record keeping, customer care and involving community as partners in running their facilities. The most common principle of paying individual performance bonuses was mentioned as a major challenge due to inadequate funding and poor design of Rungwe PBF pilot project. Despite poor design and inadequate funding, our findings have shown some promising results after PBF training in the study area. The findings have highlighted

  20. How can information systems provide support to nurses’ hand hygiene performance? Using gamification and indoor location to improve hand hygiene awareness and reduce hospital infections

    National Research Council Canada - National Science Library

    Marques, Rita; Gregório, João; Pinheiro, Fernando; Póvoa, Pedro; da Silva, Miguel Mira; Lapão, Luís Velez

    2017-01-01

    .... To raise awareness regarding hand hygiene compliance, individual behaviour change and performance optimization, we aimed to develop a gamification solution that collects data and provides real-time...

  1. Wounding patterns and human performance in knife attacks: optimising the protection provided by knife-resistant body armour.

    Science.gov (United States)

    Bleetman, A; Watson, C H; Horsfall, I; Champion, S M

    2003-12-01

    Stab attacks generate high loads, and to defeat them, armour needs to be of a certain thickness and stiffness. Slash attacks produce much lower loads and armour designed to defeat them can be far lighter and more flexible. Phase 1: Human performance in slash attacks: 87 randomly selected students at the Royal Military College of Science were asked to make one slash attack with an instrumented blade on a vertically mounted target. No instructions on how to slash the target were given. The direction, contact forces and velocity of each attack were recorded. Phase 2: Clinical experience with edged weapon attacks: The location and severity of all penetrating injuries in patients attending the Glasgow Royal Infirmary between 1993 and 1996 were charted on anatomical figures. Phase 1: Two types of human slash behaviour were evident: a 'chop and drag' blow and a 'sweep motion' type of attack. 'Chop and drag' attacks had higher peak forces and velocities than sweep attacks. Shoulder to waist blows (diagonal) accounted for 82% of attacks, 71% of attackers used a long diagonal slash with an average cut length of 34 cm and 11% used short diagonal attacks with an average cut length of 25 cm. Only 18% of attackers slashed across the body (short horizontal); the average measured cut length of this type was 28 cm. The maximum peak force for the total sample population was 212 N; the maximum velocity was 14.88 m s(-1). The 95 percentile force for the total sample population was 181 N and the velocity was 9.89 m s(-1). Phase 2: 431 of the 500 patients had been wounded with edged weapons. The average number of wounds sustained by victims in knife assaults was 2.4. The distribution of wounds by frequency and severity are presented. Anti-slash protection is required for the arms, neck, shoulders, and thighs. The clinical experience of knife-attack victims provides information on the relative vulnerabilities of different regions of the body. It is anticipated that designing a tunic

  2. 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.

  3. 16 CFR 1406.4 - Requirements to provide performance and technical notice to prospective purchasers and purchasers.

    Science.gov (United States)

    2010-01-01

    ... recommends the use of this 2 label format in order to provide more consumer awareness of the operation and... any identification of the manufacturer, brand, model, and similar designations. At the manufacturer's...

  4. Analyzing effects of providing performance feedback at ward rounds on guideline adherence - the importance of feedback usage analysis and statistical control charts.

    Science.gov (United States)

    Abu-Hanna, Ameen; Eslami, Saeid; Schultz, Marcus J; de Jonge, Evert; de Keizer, Nicolette F

    2010-01-01

    Feedback to clinicians on their past performance is often aimed at increasing adherence to guidelines. We investigate how various analytical approaches influence the interpretation of adherence data. The analytical approaches vary in considering the actual or the intended use of the feedback, and whether outcomes are inspected over time. At base line, a computerized decision support system was employed at the ICU bedside to increase adherence to a mechanical ventilation strategy. We intervened by providing feedback about adherence to the guideline at the daily ward rounds. The outcome measure was the percentage of ventilation time (VT) in excess of the guideline's recommendation. Actual usage of the feedback was logged and data analysis was carried out using two approaches: classical statistics, and statistical process control (SPC) that inspect progress of an outcome over time. Prospective, before/after study. The classical analysis stated that the percentage of ventilation time in excess of the guideline's recommendation decreased significantly due to the feedback (5% reduction, p analysis of the outcome was applied, the effect was deemed not significant. When the actual delivery of feedback over time was also included it showed that the experiment does not allow for conclusive results. The concluded effect of providing feedback on adherence to a guideline depends on whether the actual usage pattern of the feedback and the inspection of the outcome over time are considered. Future evaluative studies should report on usage patterns and progression of outcomes over time.

  5. Formative evaluation of a telemedicine model for delivering clinical neurophysiology services part I: utility, technical performance and service provider perspective.

    LENUS (Irish Health Repository)

    Breen, Patricia

    2010-01-01

    Formative evaluation is conducted in the early stages of system implementation to assess how it works in practice and to identify opportunities for improving technical and process performance. A formative evaluation of a teleneurophysiology service was conducted to examine its technical and sociological dimensions.

  6. 78 FR 69438 - AGOA: Trade and Investment Performance Overview; AGOA: Economic Effects of Providing Duty-Free...

    Science.gov (United States)

    2013-11-19

    ...: Economic Effects of Providing Duty-Free Treatment for Imports; investigation No. 332-545, U.S. AGOA Rules... COMMISSION [Investigation No. 332-542, Investigation No. 332-544, Investigation No. 332-545, Investigation No...-Free Treatment for Imports, U.S. AGOA Rules of Origin: Possible Changes To Promote Regional Integration...

  7. VA residential substance use disorder treatment program providers' perceptions of facilitators and barriers to performance on pre-admission processes.

    Science.gov (United States)

    Ellerbe, Laura S; Manfredi, Luisa; Gupta, Shalini; Phelps, Tyler E; Bowe, Thomas R; Rubinsky, Anna D; Burden, Jennifer L; Harris, Alex H S

    2017-04-04

    In the U.S. Department of Veterans Affairs (VA), residential treatment programs are an important part of the continuum of care for patients with a substance use disorder (SUD). However, a limited number of program-specific measures to identify quality gaps in SUD residential programs exist. This study aimed to: (1) Develop metrics for two pre-admission processes: Wait Time and Engagement While Waiting, and (2) Interview program management and staff about program structures and processes that may contribute to performance on these metrics. The first aim sought to supplement the VA's existing facility-level performance metrics with SUD program-level metrics in order to identify high-value targets for quality improvement. The second aim recognized that not all key processes are reflected in the administrative data, and even when they are, new insight may be gained from viewing these data in the context of day-to-day clinical practice. VA administrative data from fiscal year 2012 were used to calculate pre-admission metrics for 97 programs (63 SUD Residential Rehabilitation Treatment Programs (SUD RRTPs); 34 Mental Health Residential Rehabilitation Treatment Programs (MH RRTPs) with a SUD track). Interviews were then conducted with management and front-line staff to learn what factors may have contributed to high or low performance, relative to the national average for their program type. We hypothesized that speaking directly to residential program staff may reveal innovative practices, areas for improvement, and factors that may explain system-wide variability in performance. Average wait time for admission was 16 days (SUD RRTPs: 17 days; MH RRTPs with a SUD track: 11 days), with 60% of Veterans waiting longer than 7 days. For these Veterans, engagement while waiting occurred in an average of 54% of the waiting weeks (range 3-100% across programs). Fifty-nine interviews representing 44 programs revealed factors perceived to potentially impact performance in

  8. Interpolating and Estimating Horizontal Diffuse Solar Irradiation to Provide UK-Wide Coverage: Selection of the Best Performing Models

    Directory of Open Access Journals (Sweden)

    Diane Palmer

    2017-02-01

    Full Text Available Plane-of-array (PoA irradiation data is a requirement to simulate the energetic performance of photovoltaic devices (PVs. Normally, solar data is only available as global horizontal irradiation, for a limited number of locations, and typically in hourly time resolution. One approach to handling this restricted data is to enhance it initially by interpolation to the location of interest; next, it must be translated to PoA data by separately considering the diffuse and the beam components. There are many methods of interpolation. This research selects ordinary kriging as the best performing technique by studying mathematical properties, experimentation and leave-one-out-cross validation. Likewise, a number of different translation models has been developed, most of them parameterised for specific measurement setups and locations. The work presented identifies the optimum approach for the UK on a national scale. The global horizontal irradiation will be split into its constituent parts. Divers separation models were tried. The results of each separation algorithm were checked against measured data distributed across the UK. It became apparent that while there is little difference between procedures (14 Wh/m2 mean bias error (MBE, 12 Wh/m2 root mean square error (RMSE, the Ridley, Boland, Lauret equation (a universal split algorithm consistently performed well. The combined interpolation/separation RMSE is 86 Wh/m2.

  9. Mid-level providers in emergency obstetric and newborn health care: factors affecting their performance and retention within the Malawian health system

    Directory of Open Access Journals (Sweden)

    McAuliffe Eilish

    2009-02-01

    Full Text Available Abstract Background Malawi has a chronic shortage of human resources for health. This has a significant impact on maternal health, with mortality rates amongst the highest in the world. Mid-level cadres of health workers provide the bulk of emergency obstetric and neonatal care. In this context these cadres are defined as those who undertake roles and tasks that are more usually the province of internationally recognised cadres, such as doctors and nurses. While there have been several studies addressing retention factors for doctors and registered nurses, data and studies addressing the perceptions of these mid-level cadres on the factors that influence their performance and retention within health care systems are scarce. Methods This exploratory qualitative study took place in four rural mission hospitals in Malawi. The study population was mid-level providers of emergency obstetric and neonatal care. Focus group discussions took place with nursing and medical cadres. Semi-structured interviews with key human resources, training and administrative personnel were used to provide context and background. Data were analysed using a framework analysis. Results Participants confirmed the difficulties of their working conditions and the clear commitment they have to serving the rural Malawian population. Although insufficient financial remuneration had a negative impact on retention and performance, the main factors identified were limited opportunities for career development and further education (particularly for clinical officers and inadequate or non-existent human resources management systems. The lack of performance-related rewards and recognition were perceived to be particularly demotivating. Conclusion Mid-level cadres are being used to stem Africa's brain drain. It is in the interests of both the government and mission organizations to protect their investment in these workers. For optimal performance and quality of care they need to be

  10. Mid-level providers in emergency obstetric and newborn health care: factors affecting their performance and retention within the Malawian health system.

    Science.gov (United States)

    Bradley, Susan; McAuliffe, Eilish

    2009-02-19

    Malawi has a chronic shortage of human resources for health. This has a significant impact on maternal health, with mortality rates amongst the highest in the world. Mid-level cadres of health workers provide the bulk of emergency obstetric and neonatal care. In this context these cadres are defined as those who undertake roles and tasks that are more usually the province of internationally recognised cadres, such as doctors and nurses. While there have been several studies addressing retention factors for doctors and registered nurses, data and studies addressing the perceptions of these mid-level cadres on the factors that influence their performance and retention within health care systems are scarce. This exploratory qualitative study took place in four rural mission hospitals in Malawi. The study population was mid-level providers of emergency obstetric and neonatal care. Focus group discussions took place with nursing and medical cadres. Semi-structured interviews with key human resources, training and administrative personnel were used to provide context and background. Data were analysed using a framework analysis. Participants confirmed the difficulties of their working conditions and the clear commitment they have to serving the rural Malawian population. Although insufficient financial remuneration had a negative impact on retention and performance, the main factors identified were limited opportunities for career development and further education (particularly for clinical officers) and inadequate or non-existent human resources management systems. The lack of performance-related rewards and recognition were perceived to be particularly demotivating. Mid-level cadres are being used to stem Africa's brain drain. It is in the interests of both the government and mission organizations to protect their investment in these workers. For optimal performance and quality of care they need to be supported and properly motivated. A structured system of continuing

  11. 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

  12. Effect of a peer-educational intervention on provider knowledge and reported performance in family planning services: a cluster randomized trial.

    Science.gov (United States)

    Charandabi, Sakineh Mohammad-Alizadeh; Vahidi, Rezagoli; Marions, Lena; Wahlström, Rolf

    2010-02-02

    Peer education is an interactive method of teaching or learning which is widely used for educating school and college students, in a variety of different forms. However, there are few studies on its effectiveness for in-service education. The aim of this study was to evaluate the effect of an educational programme including peer discussions, based on a needs assessment, on the providers' knowledge and reported performance in family planning services. An educational programme was designed and applied in a random selection of half of in-charges of the 74 family health units (intervention group) in Tabriz at a regular monthly meeting. The other half constituted the control group. The programme included eight pages of written material and a two-hour, face-to-face discussion session with emphasis on the weak areas identified through a needs assessment questionnaire. The educated in-charges were requested to carry out a similar kind of programme with all peers at their health facilities within one month. All in-charges received one self-administered questionnaire containing knowledge questions one month after the in-charge education (follow-up I: 61 responses), and another one containing knowledge and self-reported performance questions 26 months later (follow-up II: 61 responses). Also, such tests were done for the peers facilitated by the in-charges one (105 responses) and 27 months (114 responses) after the peer discussions. Multiple linear regression was used for comparing mean total scores, and Chi square for comparing proportions between control and intervention groups, after defining facility as the unit of randomization. The mean total percentage scores of knowledge (percent of maximal possible score) in the intervention group were significantly higher than in the control group, both at follow-up I (63%) and at follow-up II (57%); with a difference of 16 (95% CI: 11, 22) and 5 (95% CI: 0.4, 11) percentage units, respectively. Only two of the nine reported

  13. Performance of the cobas HPV Test for the Triage of Atypical Squamous Cells of Undetermined Significance Cytology in Cervical Specimens Collected in SurePath.

    Science.gov (United States)

    Tewari, Devansu; Novak-Weekley, Susan; Hong, Christina; Aslam, Shagufta; Behrens, Catherine M

    2017-11-02

    Determine performance of the cobas human papillomavirus (HPV) test for triage of atypical squamous cells of undetermined significance (ASC-US) in SurePath. Women presenting for routine screening had cervical specimens collected in SurePath and specimen transport medium (STM); those with ASC-US cytology underwent colposcopy. Performance of cobas HPV in SurePath specimens that had undergone a preanalytic procedure to reverse possible cross-linking of HPV DNA was compared with Hybrid Capture 2 (hc2) specimens in STM. Among 856 women, HPV prevalence was 45.8%; HPV 16 and HPV 18 prevalences were lower than expected in the 21- to 29-year-old group in this highly vaccinated population. cobas HPV performance in SurePath was comparable to hc2 in STM. Sensitivity and specificity for detection of cervical intraepithelial neoplasia grade 3 or worse were 87.5% (95% confidence interval [CI], 71.9%-95.2%) and 55.5% (95% CI, 52.1%-58.9%) for cobas and 85.3% (95% CI, 69.9%-93.6%) and 54.7% (95% CI, 51.4%-57.9%) for hc2. Sensitivity was negatively affected by random biopsies performed at colposcopy; comparable sensitivities were achieved in the nonvaccinated and vaccinated populations with disease determined by directed biopsy only. Performance of cobas HPV for ASC-US triage in pretreated SurePath specimens meets criteria for validation. Preliminary data indicate reliable performance of HPV testing in a highly vaccinated population.

  14. 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.

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

    Directory of Open Access Journals (Sweden)

    Crewther Sheila G

    2008-08-01

    Full Text Available Abstract Background 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. Methods 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. Results 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. Conclusion 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.

  16. astrophysical significance

    Directory of Open Access Journals (Sweden)

    Dartois E.

    2014-02-01

    Full Text Available Clathrate hydrates, ice inclusion compounds, are of major importance for the Earth’s permafrost regions and may control the stability of gases in many astrophysical bodies such as the planets, comets and possibly interstellar grains. Their physical behavior may provide a trapping mechanism to modify the absolute and relative composition of icy bodies that could be the source of late-time injection of gaseous species in planetary atmospheres or hot cores. In this study, we provide and discuss laboratory-recorded infrared signatures of clathrate hydrates in the near to mid-infrared and the implications for space-based astrophysical tele-detection in order to constrain their possible presence.

  17. 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.

    Science.gov (United States)

    Fortier, Sylvie; Basset, Fabien A; Mbourou, Ginette A; Favérial, Jérôme; Teasdale, Normand

    2005-06-01

    (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. Key PointsThe linear discriminative analysis allows the identification of starting block parameters differentiating elite from sub-elite athletes.6-week of feedback does not alter starting block performance in training context.The present results failed to confirm previous studies since feedback did not improve targeted kinetic parameters of the complex motor task in real-world context.

  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. 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.

  20. Influence of pay-for-performance programs on information technology use among child health providers: the devil is in the details.

    Science.gov (United States)

    Menachemi, Nir; Struchen-Shellhorn, Wendy; Brooks, Robert G; Simpson, Lisa

    2009-01-01

    Pay-for-performance programs are used to promote improved health care quality, often through increased use of health information technology. However, little is known about whether pay-for-performance programs influence the adoption of health information technology, especially among child health providers. This study explored how various pay-for-performance compensation methods are related to health information technology use. Survey data from 1014 child health providers practicing in Florida were analyzed by using univariate and multivariate techniques. Questions asked about the adoption of electronic health records and personal digital assistants, as well as types of activities that affected child health provider compensation or income. The most common reported method to affect respondents' compensation was traditional productivity or billing (78%). Of the pay-for-performance-related methods of compensation, child health providers indicated that measures of clinical care (41%), patient surveys and experience (34%), the use of health information technology (29%), and quality bonuses or incentives (27%) were a major or minor factor in their compensation. In multivariate logistic regression analyses, only pay-for-performance programs that compensated directly for health information technology use were associated with an increased likelihood of electronic health record system adoption. Pay-for-performance programs linking measures of clinical quality to compensation were positively associated with personal digital assistant use among child health providers. Pay-for-performance programs that do not directly emphasize health information technology use do not influence the adoption of electronic health records among Florida physicians treating children. Understanding how different pay-for-performance compensation methods incentivize health information technology adoption is important for improving quality.

  1. Reduced dosage of β-catenin provides significant rescue of cardiac outflow tract anomalies in a Tbx1 conditional null mouse model of 22q11.2 deletion syndrome.

    Directory of Open Access Journals (Sweden)

    Silvia E Racedo

    2017-03-01

    Full Text Available The 22q11.2 deletion syndrome (22q11.2DS; velo-cardio-facial syndrome; DiGeorge syndrome is a congenital anomaly disorder in which haploinsufficiency of TBX1, encoding a T-box transcription factor, is the major candidate for cardiac outflow tract (OFT malformations. Inactivation of Tbx1 in the anterior heart field (AHF mesoderm in the mouse results in premature expression of pro-differentiation genes and a persistent truncus arteriosus (PTA in which septation does not form between the aorta and pulmonary trunk. Canonical Wnt/β-catenin has major roles in cardiac OFT development that may act upstream of Tbx1. Consistent with an antagonistic relationship, we found the opposite gene expression changes occurred in the AHF in β-catenin loss of function embryos compared to Tbx1 loss of function embryos, providing an opportunity to test for genetic rescue. When both alleles of Tbx1 and one allele of β-catenin were inactivated in the Mef2c-AHF-Cre domain, 61% of them (n = 34 showed partial or complete rescue of the PTA defect. Upregulated genes that were oppositely changed in expression in individual mutant embryos were normalized in significantly rescued embryos. Further, β-catenin was increased in expression when Tbx1 was inactivated, suggesting that there may be a negative feedback loop between canonical Wnt and Tbx1 in the AHF to allow the formation of the OFT. We suggest that alteration of this balance may contribute to variable expressivity in 22q11.2DS.

  2. 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

  3. Who do you prefer? A study of public preferences for health care provider type in performing cutaneous surgery and cosmetic procedures in the United States.

    Science.gov (United States)

    Bangash, Haider K; Ibrahimi, Omar A; Green, Lawrence J; Alam, Murad; Eisen, Daniel B; Armstrong, April W

    2014-06-01

    The public preference for provider type in performing cutaneous surgery and cosmetic procedures is unknown in the United States. An internet-based survey was administered to the lay public. Respondents were asked to select the health care provider (dermatologist, plastic surgeon, primary care physician, general surgeon, and nurse practitioner/physician's assistant) they mostly prefer to perform different cutaneous cosmetic and surgical procedures. Three hundred fifty-four respondents undertook the survey. Dermatologists were identified as the most preferable health care provider to evaluate and biopsy worrisome lesions on the face (69.8%), perform skin cancer surgery on the back (73.4%), perform skin cancer surgery on the face (62.7%), and perform laser procedures (56.3%) by most of the respondents. For filler injections, the responders similarly identified plastic surgeons and dermatologists (47.3% vs 44.6%, respectively) as the most preferred health care provider. For botulinum toxin injections, there was a slight preference for plastic surgeons followed by dermatologists (50.6% vs 38.4%). Plastic surgeons were the preferred health care provider for procedures such as liposuction (74.4%) and face-lift surgery (96.1%) by most of the respondents. Dermatologists are recognized as the preferred health care providers over plastic surgeons, primary care physicians, general surgeons, and nurse practitioners/physician's assistants to perform a variety of cutaneous cosmetic and surgical procedures including skin cancer surgery, on the face and body, and laser procedures. The general public expressed similar preferences for dermatologists and plastic surgeons regarding filler injections.

  4. Development of an instrument for a primary airway provider's performance with an ICU multidisciplinary team in pediatric respiratory failure using simulation.

    Science.gov (United States)

    Nishisaki, Akira; Donoghue, Aaron J; Colborn, Shawn; Watson, Christine; Meyer, Andrew; Niles, Dana; Bishnoi, Ram; Hales, Roberta; Hutchins, Larissa; Helfaer, Mark A; Brown, Calvin A; Walls, Ron M; Nadkarni, Vinay M; Boulet, John R

    2012-07-01

    To develop a scoring system that can assess the multidisciplinary management of respiratory failure in a pediatric ICU. In a single tertiary pediatric ICU we conducted a simulation-based evaluation in a patient care area auxiliary to the ICU. The subjects were pediatric and emergency medicine residents, nurses, and respiratory therapists who work in the pediatric ICU. A multidisciplinary focus group with experienced providers in pediatric ICU airway management and patient safety specialists was formed. A task-based scoring instrument was developed to evaluate a primary airway provider's performance through Healthcare Failure Mode and Effect Analysis. Reliability and validity of the instrument were evaluated using multidisciplinary simulation-based airway management training sessions. Each session was evaluated by 3 independent expert raters. A global assessment of the team performance and the previous experience in training were used to evaluate the validity of the instrument. The Just-in-Time Pediatric Airway Provider Performance Scale (JIT-PAPPS) version 3, with 34 task-based items (14 technical, 20 behavioral), was developed. Eighty-five teams led by resident airway providers were evaluated by 3 raters. The intraclass correlation coefficient for raters was 0.64. The JIT-PAPPS score correlated well with the global rating scale (r = 0.71, P primary airway provider's performance with a multidisciplinary pediatric ICU team on simulated pediatric respiratory failure was developed. Reliability and validity evaluation supports the developed scale.

  5. Diagnostic performance of algorithm for computer-assisted detection of significant coronary artery disease in patients with acute chest pain: comparison with invasive coronary angiography.

    Science.gov (United States)

    Min, Ji Hye; Kim, Sung Mok; Lee, Sunyoung; Choi, Jin-Ho; Chang, Sung-A; Choe, Yeon Hyeon

    2014-04-01

    The purpose of this study was to evaluate the performance of an automated computer-assisted detection (CAD) algorithm to detect coronary artery stenosis on coronary CT angiography (CTA). We investigated 128 consecutive patients (76 men, 52 women; mean [SD] age, 64 ± 11 years) who had acute chest pain and underwent 128-slice dual-source coronary CTA and invasive coronary angiography at an emergency department. All coronary CTA data were analyzed using customized software for the detection of coronary artery stenosis without human interaction. The diagnostic performance of a CAD algorithm for evaluation of stenosis of at least 50% of vessel diameter was compared with that of human interpretation of coronary CTA, with invasive coronary angiography as a reference standard. Of the 128 patients, 25 patients were excluded because of failure of data processing (n = 9) or history of stent insertion or coronary artery bypass graft (n = 16). Invasive coronary angiography revealed significant stenosis in 62% (64/103) of the remaining patients. In detecting significant stenosis, the CAD algorithm yielded 100% sensitivity, 23.1% specificity, 68.1% positive predictive value (PPV), and 100% negative predictive value (NPV) in per-patient analysis. On per-vessel analysis, the CAD algorithm yielded 90.0% sensitivity, 62.4% specificity, 40.1% PPV, and 95.7% NPV. Human interpretation of coronary CTA yielded 98.4% and 96.7% sensitivities, 79.5% and 95.0% specificities, 88.7% and 84.5% PPVs, and 96.9% and 99.0% NPVs for diagnosing significant stenosis on per-patient and per-vessel analyses, respectively. The CAD algorithm yields a high NPV in detecting stenosis of at least 50% on coronary CTA. As a second "reader," the CAD algorithm may help to exclude significant coronary stenosis in patients with acute chest pain at an emergency department.

  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. 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

  8. 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.

  9. Attitudes, subjective norms, and intention to perform routine oral examination for oropharyngeal candidiasis as perceived by primary health-care providers in Nairobi Province.

    Science.gov (United States)

    Koyio, Lucina N; Kikwilu, Emil; Mulder, Jan; Frencken, Jo E

    2013-01-01

    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. A 47-item Theory of Planned Behaviour-based questionnaire was developed and administered, in a cross-sectional survey, to 216 PHC providers (clinical officers and nurses) working in 54 clinics, dispensaries, and health centers in Nairobi Province in January 2010. The constructs - attitudes, subjective norms, and perceived behavioral control (dependent variables) - and their individual indirect (direct) items were analyzed for scores, internal validity, independent variables (district, gender, years of service, profession, and age), and contribution to intentions. Perceived behavioral control had low construct validity and was therefore removed from subsequent analyses. The questionnaire was completed by 195 participants (90 percent response rate). PHC provider's attitudes, subjective norms, and intentions to perform an oral examination during outpatient consultations were highly positive, with mean scores of 6.30 (0.82), 6.06 (1.07), and 5.6 (1.33), respectively, regardless of sociodemographic characteristics. Indirect attitude and subjective norms were strongly correlated to their individual items (r=0.63-0.79, Psubjective norms (P<0.0001) were both predictive of intentions. PHC providers were willing to integrate patients' oral health care into their routine medical consultations. Emphasizing the importance of detecting other oral problems and of the fact that routine oral examination for OPC is likely to give patients' fulfillment will enhance PHC providers' morale in performing routine oral examinations. Winning support from policy makers, their supervisors, specialists, and colleagues is important for motivating PHC providers to perform routine oral examinations for OPC at their workplaces. © 2012 American Association of Public Health Dentistry.

  10. 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

  11. Relationship of Provider and Practice Volume to Performance Measure Adherence for Coronary Artery Disease, Heart Failure, and Atrial Fibrillation: Results From the National Cardiovascular Data Registry.

    Science.gov (United States)

    Fleming, Lisa M; Jones, Philip; Chan, Paul S; Andrei, Adin-Christian; Maddox, Thomas M; Farmer, Steven A

    2016-01-01

    There is a reported association between high clinical volume and improved outcomes. Whether this relationship is true for outpatients with coronary artery disease (CAD), heart failure (HF), and atrial fibrillation (AF) remains unknown. Using the PINNACLE Registry (2009-2012), average monthly provider and practice volumes were calculated for CAD, HF, and AF. Adherence with 4 American Heart Association CAD, 2 HF, and 1 AF performance measure were assessed at the most recent encounter for each patient. Hierarchical logistic regression models were used to assess the relationship between provider and practice volume and performance on eligible quality measures. Data incorporated patients from 1094 providers at 71 practices (practice level analyses n=654 535; provider level analyses n=529 938). Median monthly provider volumes were 79 (interquartile range [IQR], 51-117) for CAD, 27 (16-45) for HF, and 37 (24-54) for AF. Median monthly practice volumes were 923 (IQR, 476-1455) for CAD, 311 (145-657) for HF, and 459 (185-720) for AF. Overall, 55% of patients met all CAD measures, 72% met all HF measures, and 58% met the AF measure. There was no definite relationship between practice volume and concordance for CAD, AF, or HF (P=0.56, 0.52, and 0.79, respectively). In contrast, higher provider volume was associated with increased concordance for CAD and AF performance measures (Pperformance was modest and variable. Higher provider volume was positively associated with quality, whereas practice volume was not. © 2015 American Heart Association, Inc.

  12. Performance of a Cartridge-Based Assay for Detection of Clinically Significant Human Papillomavirus (HPV) Infection: Lessons from VALGENT (Validation of HPV Genotyping Tests)

    Science.gov (United States)

    Geraets, Daan; Cuzick, Jack; Cadman, Louise; Moore, Catherine; Vanden Broeck, Davy; Padalko, Elisaveta; Quint, Wim; Arbyn, Marc

    2016-01-01

    The Validation of Human Papillomavirus (HPV) Genotyping Tests (VALGENT) studies offer an opportunity to clinically validate HPV assays for use in primary screening for cervical cancer and also provide a framework for the comparison of analytical and type-specific performance. Through VALGENT, we assessed the performance of the cartridge-based Xpert HPV assay (Xpert HPV), which detects 14 high-risk (HR) types and resolves HPV16 and HPV18/45. Samples from women attending the United Kingdom cervical screening program enriched with cytologically abnormal samples were collated. All had been previously tested by a clinically validated standard comparator test (SCT), the GP5+/6+ enzyme immunoassay (EIA). The clinical sensitivity and specificity of the Xpert HPV for the detection of cervical intraepithelial neoplasia grade 2 or higher (CIN2+) and CIN3+ relative to those of the SCT were assessed as were the inter- and intralaboratory reproducibilities according to international criteria for test validation. Type concordance for HPV16 and HPV18/45 between the Xpert HPV and the SCT was also analyzed. The Xpert HPV detected 94% of CIN2+ and 98% of CIN3+ lesions among all screened women and 90% of CIN2+ and 96% of CIN3+ lesions in women 30 years and older. The specificity for CIN1 or less (≤CIN1) was 83% (95% confidence interval [CI], 80 to 85%) in all women and 88% (95% CI, 86 to 91%) in women 30 years and older. Inter- and intralaboratory agreements for the Xpert HPV were 98% and 97%, respectively. The kappa agreements for HPV16 and HPV18/45 between the clinically validated reference test (GP5+/6+ LMNX) and the Xpert HPV were 0.92 and 0.91, respectively. The clinical performance and reproducibility of the Xpert HPV are comparable to those of well-established HPV assays and fulfill the criteria for use in primary cervical cancer screening. PMID:27385707

  13. Ga doping to significantly improve the performance of all-electrochemically fabricated Cu2O-ZnO nanowire solar cells.

    Science.gov (United States)

    Xie, Jiale; Guo, Chunxian; Li, Chang Ming

    2013-10-14

    Cu2O-ZnO nanowire solar cells have the advantages of light weight and high stability while possessing a large active material interface for potentially high power conversion efficiencies. In particular, electrochemically fabricated devices have attracted increasing attention due to their low-cost and simple fabrication process. However, most of them are "partially" electrochemically fabricated by vacuum deposition onto a preexisting ZnO layer. There are a few examples made via all-electrochemical deposition, but the power conversion efficiency (PCE) is too low (0.13%) for practical applications. Herein we use an all-electrochemical approach to directly deposit ZnO NWs onto FTO followed by electrochemical doping with Ga to produce a heterojunction solar cell. The Ga doping greatly improves light utilization while significantly suppressing charge recombination. A 2.5% molar ratio of Ga to ZnO delivers the best performance with a short circuit current density (Jsc) of 3.24 mA cm(-2) and a PCE of 0.25%, which is significantly higher than in the absence of Ga doping. Moreover, the use of electrochemically deposited ZnO powder-buffered Cu2O from a mixed Cu(2+)-ZnO powder solution and oxygen plasma treatment could reduce the density of defect sites in the heterojunction interface to further increase Jsc and PCE to 4.86 mA cm(-2) and 0.34%, respectively, resulting in the highest power conversion efficiency among all-electrochemically fabricated Cu2O-ZnO NW solar cells. This approach offers great potential for a low-cost solution-based process to mass-manufacture high-performance Cu2O-ZnO NW solar cells.

  14. Optimization of Deep Drilling Performance--Development and Benchmark Testing of Advanced Diamond Product Drill Bits & HP/HT Fluids to Significantly Improve Rates of Penetration

    Energy Technology Data Exchange (ETDEWEB)

    Alan Black; Arnis Judzis

    2003-10-01

    This document details the progress to date on the OPTIMIZATION OF DEEP DRILLING PERFORMANCE--DEVELOPMENT AND BENCHMARK TESTING OF ADVANCED DIAMOND PRODUCT DRILL BITS AND HP/HT FLUIDS TO SIGNIFICANTLY IMPROVE RATES OF PENETRATION contract for the year starting October 2002 through September 2002. The industry cost shared program aims to benchmark drilling rates of penetration in selected simulated deep formations and to significantly improve ROP through a team development of aggressive diamond product drill bit--fluid system technologies. Overall the objectives are as follows: Phase 1--Benchmark ''best in class'' diamond and other product drilling bits and fluids and develop concepts for a next level of deep drilling performance; Phase 2--Develop advanced smart bit--fluid prototypes and test at large scale; and Phase 3--Field trial smart bit--fluid concepts, modify as necessary and commercialize products. Accomplishments to date include the following: 4Q 2002--Project started; Industry Team was assembled; Kick-off meeting was held at DOE Morgantown; 1Q 2003--Engineering meeting was held at Hughes Christensen, The Woodlands Texas to prepare preliminary plans for development and testing and review equipment needs; Operators started sending information regarding their needs for deep drilling challenges and priorities for large-scale testing experimental matrix; Aramco joined the Industry Team as DEA 148 objectives paralleled the DOE project; 2Q 2003--Engineering and planning for high pressure drilling at TerraTek commenced; 3Q 2003--Continuation of engineering and design work for high pressure drilling at TerraTek; Baker Hughes INTEQ drilling Fluids and Hughes Christensen commence planning for Phase 1 testing--recommendations for bits and fluids.

  15. 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.

  16. On the computational assessment of white matter hyperintensity progression: difficulties in method selection and bias field correction performance on images with significant white matter pathology

    Energy Technology Data Exchange (ETDEWEB)

    Valdes Hernandez, Maria del C.; Gonzalez-Castro, Victor; Wang, Xin; Doubal, Fergus; Munoz Maniega, Susana; Wardlaw, Joanna M. [Centre for Clinical Brian Sciences, Department of Neuroimaging Sciences, Edinburgh (United Kingdom); Ghandour, Dina T. [University of Edinburgh, College of Medicine and Veterinary Medicine, Edinburgh (United Kingdom); Armitage, Paul A. [University of Sheffield, Department of Cardiovascular Sciences, Sheffield (United Kingdom)

    2016-05-15

    Subtle inhomogeneities in the scanner's magnetic fields (B{sub 0} and B{sub 1}) alter the intensity levels of the structural magnetic resonance imaging (MRI) affecting the volumetric assessment of WMH changes. Here, we investigate the influence that (1) correcting the images for the B{sub 1} inhomogeneities (i.e. bias field correction (BFC)) and (2) selection of the WMH change assessment method can have on longitudinal analyses of WMH progression and discuss possible solutions. We used brain structural MRI from 46 mild stroke patients scanned at stroke onset and 3 years later. We tested three BFC approaches: FSL-FAST, N4 and exponentially entropy-driven homomorphic unsharp masking (E{sup 2}D-HUM) and analysed their effect on the measured WMH change. Separately, we tested two methods to assess WMH changes: measuring WMH volumes independently at both time points semi-automatically (MCMxxxVI) and subtracting intensity-normalised FLAIR images at both time points following image gamma correction. We then combined the BFC with the computational method that performed best across the whole sample to assess WMH changes. Analysis of the difference in the variance-to-mean intensity ratio in normal tissue between BFC and uncorrected images and visual inspection showed that all BFC methods altered the WMH appearance and distribution, but FSL-FAST in general performed more consistently across the sample and MRI modalities. The WMH volume change over 3 years obtained with MCMxxxVI with vs. without FSL-FAST BFC did not significantly differ (medians(IQR)(with BFC) = 3.2(6.3) vs. 2.9(7.4)ml (without BFC), p = 0.5), but both differed significantly from the WMH volume change obtained from subtracting post-processed FLAIR images (without BFC)(7.6(8.2)ml, p < 0.001). This latter method considerably inflated the WMH volume change as subtle WMH at baseline that became more intense at follow-up were counted as increase in the volumetric change. Measurement of WMH volume change remains

  17. 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

    2017-09-15

    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

  18. Systematic analysis of adaptations in aerobic capacity and submaximal energy metabolism provides a unique insight into determinants of human aerobic performance

    DEFF Research Database (Denmark)

    Vollaard, Niels B J; Constantin-Teodosiu, Dimitru; Fredriksson, Katarina

    2009-01-01

    It has not been established which physiological processes contribute to endurance training-related changes (Delta) in aerobic performance. For example, the relationship between intramuscular metabolic responses at the intensity used during training and improved human functional capacity has...... Deltalactate (r(2) = 0.32; P humans are not related to altered maximal oxygen transport capacity. Altered muscle metabolism may provide the link between training...

  19. 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.

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

    Energy Technology Data Exchange (ETDEWEB)

    Perrin, Mathieu; Claudin, Marine; Veran, Nicolas; Morel, Olivier; Besseau, Cyril; Boutley, Henri [CHU-Nancy, Department of Nuclear Medicine, Nancy (France); Nancyclotep Experimental Imaging Platform, Nancy (France); Djaballah, Wassila; Poussier, Sylvain; Verger, Antoine [CHU-Nancy, Department of Nuclear Medicine, Nancy (France); Nancyclotep Experimental Imaging Platform, Nancy (France); INSERM U947 et Universite de Lorraine, Nancy (France); Moulin, Frederic [CHU-Nancy, Department of Cardiology, Nancy (France); Imbert, Laetitia; Karcher, Gilles [CHU-Nancy, Department of Nuclear Medicine, Nancy (France); Nancyclotep Experimental Imaging Platform, Nancy (France); UMR 7039 CRAN et Universite de Lorraine, Nancy (France); Marie, Pierre-Yves [CHU-Nancy, Department of Nuclear Medicine, Nancy (France); Nancyclotep Experimental Imaging Platform, Nancy (France); INSERM U1116 et Universite de Lorraine, Nancy (France)

    2015-02-25

    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 {sup 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.)

  1. Performance of a Cartridge-Based Assay for Detection of Clinically Significant Human Papillomavirus (HPV) Infection: Lessons from VALGENT (Validation of HPV Genotyping Tests).

    Science.gov (United States)

    Cuschieri, Kate; Geraets, Daan; Cuzick, Jack; Cadman, Louise; Moore, Catherine; Vanden Broeck, Davy; Padalko, Elisaveta; Quint, Wim; Arbyn, Marc

    2016-09-01

    The Validation of Human Papillomavirus (HPV) Genotyping Tests (VALGENT) studies offer an opportunity to clinically validate HPV assays for use in primary screening for cervical cancer and also provide a framework for the comparison of analytical and type-specific performance. Through VALGENT, we assessed the performance of the cartridge-based Xpert HPV assay (Xpert HPV), which detects 14 high-risk (HR) types and resolves HPV16 and HPV18/45. Samples from women attending the United Kingdom cervical screening program enriched with cytologically abnormal samples were collated. All had been previously tested by a clinically validated standard comparator test (SCT), the GP5+/6+ enzyme immunoassay (EIA). The clinical sensitivity and specificity of the Xpert HPV for the detection of cervical intraepithelial neoplasia grade 2 or higher (CIN2+) and CIN3+ relative to those of the SCT were assessed as were the inter- and intralaboratory reproducibilities according to international criteria for test validation. Type concordance for HPV16 and HPV18/45 between the Xpert HPV and the SCT was also analyzed. The Xpert HPV detected 94% of CIN2+ and 98% of CIN3+ lesions among all screened women and 90% of CIN2+ and 96% of CIN3+ lesions in women 30 years and older. The specificity for CIN1 or less (≤CIN1) was 83% (95% confidence interval [CI], 80 to 85%) in all women and 88% (95% CI, 86 to 91%) in women 30 years and older. Inter- and intralaboratory agreements for the Xpert HPV were 98% and 97%, respectively. The kappa agreements for HPV16 and HPV18/45 between the clinically validated reference test (GP5+/6+ LMNX) and the Xpert HPV were 0.92 and 0.91, respectively. The clinical performance and reproducibility of the Xpert HPV are comparable to those of well-established HPV assays and fulfill the criteria for use in primary cervical cancer screening. Copyright © 2016, American Society for Microbiology. All Rights Reserved.

  2. 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...

  3. 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...

  4. Aggressive Treatment of Performance Status 1 and 2 HCC Patients Significantly Improves Survival - an Egyptian Retrospective Cohort Study of 524 Cases.

    Science.gov (United States)

    Aziz, Ashraf Omar Abdel; Omran, Dalia; Nabeel, Mohamed Mahmoud; Elbaz, Tamer Mahmoud; Abdelmaksoud, Ahmed Hosni; Attar, Inas El; Shousha, Hend Ibrahim

    2016-01-01

    In the Barcelona Clinic Liver Cancer (BCLC) system, only sorafenib is suggested for HCC patients having performance status (PS) 1 or 2 even if they have treatable lesions. In the current study, we aimed to explore the outcome of using aggressive treatment for HCC patients with PS 1 and 2. Five hundred and twenty four patients with HCC were enrolled in this study and divided into 2 groups: 404 PS 1 and 120 PS 2. Of the included 524 patients, 136 recceived non-aggressive supportive treatment and sorafenib, while 388 patients were offered aggressive treatment in the form of surgical resection, transplantation, percutaneous ablation, trans-arterial chemoembolization and/or chemoperfusion. All the patients were followed up for a period of 2 years to determine their survival. Most HCC patients were CHILD A and B grades (89.4% versus 85.0%, for PS1 and PS2, respectively). Patients with PS1 were significantly younger. Out of the enrolled 524 patients, 388 were offered aggressive treatment, 253 (65.2%) having their lesions fully ablated, 94 (24.2%) undergoing partial ablation and 41 patients with no ablation (10.6%). The median survival of the patients with PS 1 who were offered aggressive treatment was 20 months versus 9 months only for those who were offered supportive treatment and sorafenib (<0.001). Regarding HCC patients with PS 2, the median survivals were similarly 19.7 months versus 8.7 months only (<0.001). Aggressive treatment of HCC patients with PS 1 and 2 significantly improves their survival. Revising the BCLC guidelines regarding such patients is recommended.

  5. The significant effect of the thickness of Ni film on the performance of the Ni/Au Ohmic contact to p-GaN

    Energy Technology Data Exchange (ETDEWEB)

    Li, X. J.; Zhao, D. G., E-mail: dgzhao@red.semi.ac.cn; Jiang, D. S.; Liu, Z. S.; Chen, P.; Zhu, J. J.; Le, L. C.; Yang, J.; He, X. G. [State Key Laboratory on Integrated Optoelectronics, Institute of Semiconductors, Chinese Academy of Science, P.O. Box 912, Beijing 100083 (China); Zhang, S. M.; Zhang, B. S.; Liu, J. P. [Suzhou Institute of Nano-tech and Nano-bionics, Chinese Academy of Sciences, Suzhou 215123 (China); Yang, H. [State Key Laboratory on Integrated Optoelectronics, Institute of Semiconductors, Chinese Academy of Science, P.O. Box 912, Beijing 100083 (China); Suzhou Institute of Nano-tech and Nano-bionics, Chinese Academy of Sciences, Suzhou 215123 (China)

    2014-10-28

    The significant effect of the thickness of Ni film on the performance of the Ohmic contact of Ni/Au to p-GaN is studied. The Ni/Au metal films with thickness of 15/50 nm on p-GaN led to better electrical characteristics, showing a lower specific contact resistivity after annealing in the presence of oxygen. Both the formation of a NiO layer and the evolution of metal structure on the sample surface and at the interface with p-GaN were checked by transmission electron microscopy and energy-dispersive x-ray spectroscopy. The experimental results indicate that a too thin Ni film cannot form enough NiO to decrease the barrier height and get Ohmic contact to p-GaN, while a too thick Ni film will transform into too thick NiO cover on the sample surface and thus will also deteriorate the electrical conductivity of sample.

  6. Highly Efficient Deep Blue Organic Light-Emitting Diodes Based on Imidazole: Significantly Enhanced Performance by Effective Energy Transfer with Negligible Efficiency Roll-off.

    Science.gov (United States)

    Shan, Tong; Liu, Yulong; Tang, Xiangyang; Bai, Qing; Gao, Yu; Gao, Zhao; Li, Jinyu; Deng, Jian; Yang, Bing; Lu, Ping; Ma, Yuguang

    2016-10-26

    Great efforts have been devoted to develop efficient deep blue organic light-emitting diodes (OLEDs) materials meeting the standards of European Broadcasting Union (EBU) standard with Commission International de L'Eclairage (CIE) coordinates of (0.15, 0.06) for flat-panel displays and solid-state lightings. However, high-performance deep blue OLEDs are still rare for applications. Herein, two efficient deep blue emitters, PIMNA and PyINA, are designed and synthesized by coupling naphthalene with phenanthreneimidazole and pyreneimidazole, respectively. The balanced ambipolar transporting natures of them are demonstrated by single-carrier devices. Their nondoped OLEDs show deep blue emissions with extremely small CIEy of 0.034 for PIMNA and 0.084 for PyINA, with negligible efficiency roll-off. To take advantage of high photoluminescence quantum efficiency of PIMNA and large fraction of singlet exciton formation of PyINA, doped devices are fabricated by dispersing PyINA into PIMNA. A significantly improved maximum external quantum efficiency (EQE) of 5.05% is obtained through very effective energy transfer with CIE coordinates of (0.156, 0.060), and the EQE remains 4.67% at 1000 cd m(-2), which is among the best of deep blue OLEDs reported matching stringent EBU standard well.

  7. 8-C N-ethyl-2-pyrrolidinone substituted flavan-3-ols as the marker compounds of Chinese dark teas formed in the post-fermentation process provide significant antioxidative activity.

    Science.gov (United States)

    Wang, Weinan; Zhang, Liang; Wang, Shu; Shi, Shepo; Jiang, Yong; Li, Ning; Tu, Pengfei

    2014-01-01

    Phytochemical investigation of the aqueous extract of pu-erh tea afforded eight novel 8-C N-ethyl-2-pyrrolidinone substituted flavan-3-ols (puerins I-VIII) by (1)H, (13)C, two-dimensional nuclear magnetic resonance (NMR) and high-performance liquid chromatography with diode array detection and electrospray ionization mass spectrometry (HPLC-DAD-ESI/MS) analysis. Comparative chemical analysis of green tea, black tea and Chinese dark teas confirmed that these compounds were the marker compounds of Chinese dark teas. Furthermore, fungal fermentation was indispensable for the biosynthesis of these novel compounds. Through single fungal fermentation, it was proved that catechins and theanine were the precursors of puerins I-VIII. HPLC-DAD-ESI/MS analysis elucidated the biosynthetic pathway for puerins I-VIII. Puerins I-IV have potential protective effects for the human micro-vascular endothelial cells (HMEC) injury induced by hydrogen dioxide compared to other tea polyphenols. 8-C N-ethyl-2-pyrrolidinone substituted flavan-3-ols could be used in the quality control and authentication of Chinese dark teas. Copyright © 2013 Elsevier Ltd. All rights reserved.

  8. Meta-analysis provides evidence-based interpretation guidelines for the clinical significance of mean differences for the FACT-G, a cancer-specific quality of life questionnaire

    Directory of Open Access Journals (Sweden)

    Madeleine T King

    2010-09-01

    Full Text Available Madeleine T King1, David Cella2, David Osoba3, Martin Stockler4, David Eton5, Joanna Thompson6, Amy Eisenstein71Psycho-oncology Co-operative Research Group School of Psychology, University of Sydney, New South Wales, Australia; 2Department of Medical Social Sciences, Northwestern University, Illinois, USA; 3QOL Consulting, Vancouver, British Columbia, Canada; 4NHMRC Clinical Trials Centre, University of Sydney, New South Wales, Australia; 5Mayo Clinic, Rochester, Minnesota, USA; 6Centre for Health Economics Research and Evaluation, University of Technology, Sydney, New South Wales, Australia; 7Center on Outcomes Research and Education (CORE, Evanston Northwestern Healthcare (ENH, Evanston, Illinois, USAAbstract: Our aim was to develop evidence-based interpretation guidelines for the Functional Assessment of Cancer Therapy-General (FACT-G, a cancer-specific health-related quality of life (HRQOL instrument, from a range of clinically relevant anchors, incorporating expert judgment about clinical significance. Three clinicians with many years’ experience managing cancer patients and using HRQOL outcomes in clinical research reviewed 71 papers. Blinded to the FACT-G results, they considered the clinical anchors associated with each FACT-G mean difference, predicted which dimensions of HRQOL would be affected, and whether the effects would be trivial, small, moderate, or large. These size classes were defined in terms of clinical relevance. The experts’ judgments were then linked with FACT-G mean differences, and inverse-variance weighted mean differences were calculated for each size class. Small, medium, and large differences (95% confidence interval from 1,118 cross-sectional comparisons were as follows: physical well-being 1.9 (0.6–3.2, 4.1 (2.7–5.5, 8.7 (5.2–12; functional well-being 2.0 (0.5–3.5, 3.8 (2.0–5.5, 8.8 (4.3–13; emotional well-being 1.0 (0.1–2.6, 1.9 (0.3–3.5, no large differences; social well-being 0.7 (-0.7 to 2

  9. A comparison of the aided performance and benefit provided by a linear and a two-channel wide dynamic range compression hearing aid.

    Science.gov (United States)

    Humes, L E; Christensen, L; Thomas, T; Bess, F H; Hedley-Williams, A; Bentler, R

    1999-02-01

    The aided performance and benefit achieved with linear and two-channel wide dynamic range compression (WDRC) in-the-canal (ITC) hearing aids were established in 55 individuals. Study participants had been wearing either linear or adaptive-frequency-response (Bass Increase at Low Levels, BILL) ITC hearing aids for approximately one year before participation in this study. Outcome measures included aided performance and objective benefit in quiet and noise at a variety of speech levels (50, 60, and 75 dB SPL), at various levels of babble background (quiet, signal-to-babble ratios of +5 and +10 dB), and for various types of test materials (monosyllabic words and sentences in connected speech). Several subjective measures of aided performance (sound-quality judgments and magnitude estimates of listening effort) and relative benefit (improvement in listening effort and the Hearing Aid Performance Inventory, HAPI) were also obtained. Finally, self-report measures of hearing-aid use were also obtained using daily logs. Participants completed all outcome measures for the linear ITC hearing aids first, following 2 months of usage, and then repeated all outcome measures for the WDRC instruments after a subsequent 2-month period of use. In general, although both types of hearing aids demonstrated significant benefit, the results indicated that the WDRC instruments were superior to the linear devices for many of the outcome measures. This tended to be the case most frequently when low speech levels were used. Many of the performance differences between devices most likely can be ascribed to differences in gain, and prescriptive approaches (DSL[i/o] vs. NAL-R), for the fixed volume control testing performed in this study.

  10. External muscle heating during warm-up does not provide added performance benefit above external heating in the recovery period alone.

    Science.gov (United States)

    Faulkner, Steve H; Ferguson, Richard A; Hodder, Simon G; Havenith, George

    2013-11-01

    Having previously shown the use of passive external heating between warm-up completion and sprint cycling to have had a positive effect on muscle temperature (T m) and maximal sprint performance, we sought to determine whether adding passive heating during active warm up was of further benefit. Ten trained male cyclists completed a standardised 15 min sprint based warm-up on a cycle ergometer, followed by 30 min passive recovery before completing a 30 s maximal sprint test. Warm up was completed either with or without additional external passive heating. During recovery, external passive leg heating was used in both standard warm-up (CONHOT) and heated warm-up (HOTHOT) conditions, for control, a standard tracksuit was worn (CON). T m declined exponentially during CON, CONHOT and HOTHOT reduced the exponential decline during recovery. Peak (11.1 %, 1561 ± 258 W and 1542 ± 223 W), relative (10.6 % 21.0 ± 2.2 W kg(-1) and 20.9 ± 1.8 W kg(-1)) and mean (4.1 %, 734 ± 126 W and 729 ± 125 W) power were all improved with CONHOT and HOTHOT, respectively compared to CON (1,397 ± 239 W; 18.9 ± 3.0 W kg(-1) and 701 ± 109 W). There was no additional benefit of HOTHOT on T m or sprint performance compared to CONHOT. External heating during an active warm up does not provide additional physiological or performance benefit. As noted previously, external heating is capable of reducing the rate of decline in T m after an active warm-up, improving subsequent sprint cycling performance.

  11. How can information systems provide support to nurses' hand hygiene performance? Using gamification and indoor location to improve hand hygiene awareness and reduce hospital infections.

    Science.gov (United States)

    Marques, Rita; Gregório, João; Pinheiro, Fernando; Póvoa, Pedro; da Silva, Miguel Mira; Lapão, Luís Velez

    2017-01-31

    Hospital-acquired infections are still amongst the major problems health systems are facing. Their occurrence can lead to higher morbidity and mortality rates, increased length of hospital stay, and higher costs for both hospital and patients. Performing hand hygiene is a simple and inexpensive prevention measure, but healthcare workers' compliance with it is often far from ideal. To raise awareness regarding hand hygiene compliance, individual behaviour change and performance optimization, we aimed to develop a gamification solution that collects data and provides real-time feedback accurately in a fun and engaging way. A Design Science Research Methodology (DSRM) was used to conduct this work. DSRM is useful to study the link between research and professional practices by designing, implementing and evaluating artifacts that address a specific need. It follows a development cycle (or iteration) composed by six activities. Two work iterations were performed applying gamification components, each using a different indoor location technology. Preliminary experiments, simulations and field studies were performed in an Intensive Care Unit (ICU) of a Portuguese tertiary hospital. Nurses working on this ICU were in a focus group during the research, participating in several sessions across the implementation process. Nurses enjoyed the concept and considered that it allows for a unique opportunity to receive feedback regarding their performance. Tests performed on the indoor location technology applied in the first iteration regarding distances estimation presented an unacceptable lack of accuracy. Using a proximity-based technique, it was possible to identify the sequence of positions, but beacons presented an unstable behaviour. In the second work iteration, a different indoor location technology was explored but it did not work properly, so there was no chance of testing the solution as a whole (gamification application included). Combining automated monitoring

  12. A nationwide postal survey on the perception of Malaysian public healthcare providers on family medicine specialists' (PERMFAMS) clinical performance, professional attitudes and research visibility.

    Science.gov (United States)

    Chew, Boon-How; Yasin, Mazapuspavina Md; Cheong, Ai-Theng; Rashid, Mohd-Radzniwan A; Hamzah, Zuhra; Ismail, Mastura; Ali, Norsiah; Bashah, Baizury; Mohd-Salleh, Noridah

    2015-01-01

    Perception of healthcare providers who worked with family medicine specialists (FMSs) could translate into the effectiveness of primary healthcare delivery in daily practices. This study examined perceptions of public healthcare providers/professionals (PHCPs) on FMSs at public health clinics throughout Malaysia. This was a cross-sectional study in 2012-2013 using postal method targeting PHCPs from three categories of health facilities, namely health clinics, health offices and hospitals. A structured questionnaire was developed to assess PHCP's perception of FMS's clinical competency, safety practice, ethical and professional values, and research involvement. It consists of 37 items with Likert scale of strongly disagree (a score of 1) to strongly agree (a score of 5). Interaction and independent effect of the independent variables were tested and adjusted means score were reported. The participants' response rate was 58.0% (780/1345) with almost equal proportion from each of the three public healthcare facilities. There were more positive perceptions than negative among the PHCPs. FMSs were perceived to provide effective and safe treatment to their patients equally disregards of patient's social background. However, there were some concerns of FMSs not doing home visits, not seeing walk-in patients, had long appointment time, not active in scientific research, writing and publication. There were significant differences in perception based on a respondent's health care facility (p publication.

  13. Aspects of Cultural Landscape Application on Classical Stage Art. Ballet Performance in the Open Space as a Significant Element of the Cultural Landscape

    Directory of Open Access Journals (Sweden)

    Jelena Lebedeva

    2016-04-01

    Full Text Available The article examines the applications aspects of cultural landscape for the preparation of the classical performing arts staging. Research findings highlighted that the cultural landscape (parks, estates, castles, bastions, etc. objects occupies an increasingly important role in public recreation and classical art development programs. At the same time it is noted that event’s aesthetic and emotional quality suffers due to the fact that no specific attention was given for the preparation of the event space. More methodological materials are necessary for preparation of this type of design spaces. In Lithuania classical performing arts events in cultural landscape open spaces are based on XVI–XVII century tradition and has good prospects for modern development. A review of some of the classical art events installations, based on the importance of quality of open spaces influence on the emotional impact, that should be an integral part of the cultural event. The author summarizes his experience of ballet events in open spaces in the cultural landscape – Klaipėda, Trakai. Presented is Tchaikovsky's ballet “Swan Lake” construction in Klaipėda John Hill project that includes infrastructure and environmental design concept: audience space, stage design, stage design performance solutions. Analogous key decisions are later adapted to the ballet performance in the natural environment of the lake Trakai. Experience of this project dictated the necessity of deeper understanding and methodological basis for the classical performing arts analysis and design.

  14. The effect of intra- and inter-regional labour mobility on plant performance in Denmark : The significance of related labour inflows

    NARCIS (Netherlands)

    Timmermans, Bram; Boschma, Ron

    2014-01-01

    This article investigates the impact of labour mobility on plant performance in Denmark. Our study shows that the effect of labour mobility can only be assessed when one accounts for the type of skills that flow into the plant and the degree to which these match the existing skills at the plant

  15. Significantly improved photovoltaic performance in polymer bulk heterojunction solar cells with graphene oxide /PEDOT:PSS double decked hole transport layer

    Science.gov (United States)

    Rafique, Saqib; Abdullah, Shahino Mah; Shahid, Muhammad Mehmood; Ansari, Mohammad Omaish; Sulaiman, Khaulah

    2017-01-01

    This work demonstrates the high performance graphene oxide (GO)/PEDOT:PSS doubled decked hole transport layer (HTL) in the PCDTBT:PC71BM based bulk heterojunction organic photovoltaic device. The devices were tested on merits of their power conversion efficiency (PCE), reproducibility, stability and further compared with the devices with individual GO or PEDOT:PSS HTLs. Solar cells employing GO/PEDOT:PSS HTL yielded a PCE of 4.28% as compared to either of individual GO or PEDOT:PSS HTLs where they demonstrated PCEs of 2.77 and 3.57%, respectively. In case of single GO HTL, an inhomogeneous coating of ITO caused the poor performance whereas PEDOT:PSS is known to be hygroscopic and acidic which upon direct contact with ITO reduced the device performance. The improvement in the photovoltaic performance is mainly ascribed to the increased charge carriers mobility, short circuit current, open circuit voltage, fill factor, and decreased series resistance. The well matched work function of GO and PEDOT:PSS is likely to facilitate the charge transportation and an overall reduction in the series resistance. Moreover, GO could effectively block the electrons due to its large band-gap of ~3.6 eV, leading to an increased shunt resistance. In addition, we also observed the improvement in the reproducibility and stability.

  16. Significantly improved photovoltaic performance in polymer bulk heterojunction solar cells with graphene oxide /PEDOT:PSS double decked hole transport layer.

    Science.gov (United States)

    Rafique, Saqib; Abdullah, Shahino Mah; Shahid, Muhammad Mehmood; Ansari, Mohammad Omaish; Sulaiman, Khaulah

    2017-01-13

    This work demonstrates the high performance graphene oxide (GO)/PEDOT:PSS doubled decked hole transport layer (HTL) in the PCDTBT:PC71BM based bulk heterojunction organic photovoltaic device. The devices were tested on merits of their power conversion efficiency (PCE), reproducibility, stability and further compared with the devices with individual GO or PEDOT:PSS HTLs. Solar cells employing GO/PEDOT:PSS HTL yielded a PCE of 4.28% as compared to either of individual GO or PEDOT:PSS HTLs where they demonstrated PCEs of 2.77 and 3.57%, respectively. In case of single GO HTL, an inhomogeneous coating of ITO caused the poor performance whereas PEDOT:PSS is known to be hygroscopic and acidic which upon direct contact with ITO reduced the device performance. The improvement in the photovoltaic performance is mainly ascribed to the increased charge carriers mobility, short circuit current, open circuit voltage, fill factor, and decreased series resistance. The well matched work function of GO and PEDOT:PSS is likely to facilitate the charge transportation and an overall reduction in the series resistance. Moreover, GO could effectively block the electrons due to its large band-gap of ~3.6 eV, leading to an increased shunt resistance. In addition, we also observed the improvement in the reproducibility and stability.

  17. 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

  18. Providers with Limited Experience Perform Better in Advanced Life Support with Assistance Using an Interactive Device with an Automated External Defibrillator Linked to a Ventilator.

    Science.gov (United States)

    Busch, Christian Werner; Qalanawi, Mohammed; Kersten, Jan Felix; Kalwa, Tobias Johannes; Scotti, Norman Alexander; Reip, Wikhart; Doehn, Christoph; Maisch, Stefan; Nitzschke, Rainer

    2015-10-01

    Medical teams with limited experience in performing advanced life support (ALS) or with a low frequency of cardiopulmonary resuscitation (CPR) while on duty, often have difficulty complying with CPR guidelines. This study evaluated whether the quality of CPR of trained medical students, who served as an example of teams with limited experience in ALS, could be improved with device assistance. The primary outcome was the hands-off time (i.e., the percentage of the entire CPR time without chest compressions). The secondary outcome was seven time intervals, which should be as short as possible, and the quality of ventilations and chest compressions on the mannequin. We compared standard CPR equipment to an interactive device with visual and acoustic instructions for ALS workflow measures to guide briefly trained medical students through the ALS algorithm in a full-scale mannequin simulation study with a randomized crossover study design. The study equipment consisted of an automatic external defibrillator and ventilator that were electronically linked and communicating as a single system. Included were regular medical students in the third to sixth years of medical school of one class who provided written informed consent for voluntary participation and for the analysis of their CPR performance data. No exclusion criteria were applied. For statistical measures of evaluation we used an analysis of variance for crossover trials accounting for treatment effect, sequence effect, and carry-over effect, with adjustment for prior practical experience of the participants. Forty-two medical students participated in 21 CPR sessions, each using the standard and study equipment. Regarding the primary end point, the study equipment reduced the hands-off time from 40.1% (95% confidence interval [CI] 36.9-43.4%) to 35.6% (95% CI 32.4-38.9%, p = 0.031) compared with the standard equipment. Within the prespecified secondary end points, study equipment reduced the time interval until

  19. Diagnostic performance of combined noninvasive anatomic and functional assessment with dual-source CT and adenosine-induced stress dual-energy CT for detection of significant coronary stenosis.

    Science.gov (United States)

    Ko, Sung Min; Choi, Jin Woo; Hwang, Hweung Kon; Song, Meong Gun; Shin, Je Kyoun; Chee, Hyun Keun

    2012-03-01

    The purpose of our study was to prospectively evaluate the incremental diagnostic value of combined dual-source coronary CT angiography (CTA) and CT myocardial perfusion imaging (MPI) for the detection of significant coronary stenoses. Forty-five patients with known coronary artery disease detected by dual-source coronary CTA were investigated by adenosine-induced stress dual-source CTA and conventional coronary angiography. Analysis was performed in three steps: classification of coronary stenosis severity using dual-source coronary CTA, identification of myocardial perfusion defects using rest and stress CT MPI, and reclassification of coronary stenosis severity according to combined dual-source coronary CTA and CT MPI. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of dual-source coronary CTA before and after CT MPI were calculated on a per-vessel basis compared with conventional coronary angiography as the standard of reference. Dual-source coronary CTA revealed 87 significantly stenotic vessels in 45 patients. Conventional coronary angiography revealed significant stenoses in 73 vessels in 42 patients. CT MPI showed myocardial perfusion defects in 81 vessel territories in 43 patients. After the CT MPI analysis, dual-source coronary CTA identified significant stenoses in 77 coronary vessels in 42 patients. Sensitivity, specificity, PPV, and NPV of the dual-source coronary CTA on a per-vessel basis before CT MPI were 91.8%, 67.7%, 73.6%, and 87.5%, respectively, and after CT MPI were 93.2%, 85.5%, 88.3%, and 91.4%, respectively. The area under the receiver operating characteristic curve increased significantly from 0.798 to 0.893 (p = 0.004). Combined dual-source coronary CTA and CT MPI provides incremental diagnostic value compared with dual-source coronary CTA alone for the detection of significant coronary stenoses.

  20. Lower rate of invasive revascularisation in acute coronary syndrome patients with significant stenosis on coronary angiography when angiography is performed on a diagnostics only hospital

    DEFF Research Database (Denmark)

    Hvelplund, Anders; Galatius, Søren; Madsen, Mette

    Purpose We studied the population of all acute coronary syndrome (ACS) patients examined with coronary angiography (CAG) in order to evaluate differences in invasive revascularisation rate. Denmark (population 5.5 million) has a universal health insurance coverage system and uniform national...... guidelines for the treatment of ACS. There are 5 tertiary invasive centres performing CAG, percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG), 8 hospitals with diagnostic units performing CAG only, and a further 36 hospitals without these facilities receiving patients...... with ACS. We investigated if there was a difference in revascularisation after CAG following admission with ACS, depending on distance between place of residence and invasive centre. Methods All patients hospitalised with a first ACS from January 2005 to December 2007 were identified in the National...

  1. Determination of Route Delivery in the Logistic Service Provider (LSP) by Reviewing the Performance of Street in The City of Malang

    Science.gov (United States)

    Agustin, I. W.; Sumantri, Y.

    2017-03-01

    Malang as the National Activity Centre (PKN) led to increased economic growth and increased the demand for goods both primary and tertiary goods. Demand of goods which is increasing and also diversing will certainly have an impact on the process of transportation of goods involving a freight forwarder. Shipping of goods is part of the supply chain, which handles the flow of goods, distribution and delivery service or commonly called the courier. Fulfilling the request of goods would require Logistics Service Provider (LSP) that distribute goods from point of origin to destination. Delays in the distribution of goods will slow(DOWN) economic growth in Malang, therefore focused studies on the movement of goods which includes the election of the delivery route is needed. The purpose of this study is to get the delivery route for LSP by identifying its patterns of freight transport movement and to analyze the network performance of the road that is passed by freight transportation. Data collection techniques in this research are interviews, questionnaires and observations of moving-car and traffic counting to get the volume of traffic. The study used road’s performance analysis to get the level of service (LOS) of roads which are used by the freight transportation of LSP and Dijkstra’s algorithm analysis to determine the delivery routes. The results showed that the Level of Service of the roads (LOS) is at the level of D to F which indicates that the chosen roads experience instability of traffic flow even reach a critical condition. Therefore by considering delivery routes selection both of existing condition and analysis result as well as the condition of the road network in Malang, then given alternative is by deliverying goods on the chosen routes but not at peak hour.

  2. "I should be doing more for my parent:" Chinese adult children's worry about performance in providing care for their oldest-old parents.

    Science.gov (United States)

    Liu, Jinyu; Bern-Klug, Mercedes

    2016-02-01

    In China, as is the case in most of the world, family is the largest source of support for frail older adults. Confucian filial piety expectations hold children-in particular sons-responsible for the care of aging parents in China. During the course of caregiving, in addition to positive feelings, the caregiver may feel overwhelmed, entrapped, and worried about their performance, which can have negative health consequences. The purpose of this exploratory study is to examine one dimension of caregiver burden "worry about performance" (WaP) and investigate whether variables inspired by Pearlin's Stress Process Model help to explain the variation of WaP, so that at-risk caregivers can be identified and supported. Multiple regression was used to analyze CLHLS data from 895 Chinese adult children providing care for their oldest old parent in eight coastal provinces in China. WaP was measured by two items from the Zarit Burden Inventory. Independent variables representing concepts from Pearlin's Stress Process Model and control variables were included in the models. Compared to a model of control variables only, using independent variables inspired by Pearlin's Stress Process Model increased the ability to explain the variation in WaP by three fold to 14%. The following variables increased WaP: parent's IADL level, the amount of time spent caregiving, being a daughter, reporting an emotionally close relationship with the parent, sharing a residence with the parent. Despite not being able to fully operationalize Pearlin's Model with this dataset, analyzing variables that represent concepts from the model was useful in increasing the ability to explain the variation in WaP. Results suggest that caregiver support directed at daughters may be particularly beneficial.

  3. Computational Assessment of a 3-Stage Axial Compressor Which Provides Airflow to the NASA 11- by 11-Foot Transonic Wind Tunnel, Including Design Changes for Increased Performance

    Science.gov (United States)

    Kulkarni, Sameer; Beach, Timothy A.; Jorgenson, Philip C.; Veres, Joseph P.

    2017-01-01

    A 24 foot diameter 3-stage axial compressor powered by variable-speed induction motors provides the airflow in the closed-return 11- by 11-Foot Transonic Wind Tunnel (11-Foot TWT) Facility at NASA Ames Research Center at Moffett Field, California. The facility is part of the Unitary Plan Wind Tunnel, which was completed in 1955. Since then, upgrades made to the 11-Foot TWT such as flow conditioning devices and instrumentation have increased blockage and pressure loss in the tunnel, somewhat reducing the peak Mach number capability of the test section. Due to erosion effects on the existing aluminum alloy rotor blades, fabrication of new steel rotor blades is planned. This presents an opportunity to increase the Mach number capability of the tunnel by redesigning the compressor for increased pressure ratio. Challenging design constraints exist for any proposed design, demanding the use of the existing driveline, rotor disks, stator vanes, and hub and casing flow paths, so as to minimize cost and installation time. The current effort was undertaken to characterize the performance of the existing compressor design using available design tools and computational fluid dynamics (CFD) codes and subsequently recommend a new compressor design to achieve higher pressure ratio, which directly correlates with increased test section Mach number. The constant cross-sectional area of the compressor leads to highly diffusion factors, which presents a challenge in simulating the existing design. The CFD code APNASA was used to simulate the aerodynamic performance of the existing compressor. The simulations were compared to performance predictions from the HT0300 turbomachinery design and analysis code, and to compressor performance data taken during a 1997 facility test. It was found that the CFD simulations were sensitive to endwall leakages associated with stator buttons, and to a lesser degree, under-stator-platform flow recirculation at the hub. When stator button leakages were

  4. Providing critical laboratory results on time, every time to help reduce emergency department length of stay: how our laboratory achieved a Six Sigma level of performance.

    Science.gov (United States)

    Blick, Kenneth E

    2013-08-01

    To develop a fully automated core laboratory, handling samples on a "first in, first out" real-time basis with Lean/Six Sigma management tools. Our primary goal was to provide services to critical care areas, eliminating turnaround time outlier percentage (TAT-OP) as a factor in patient length of stay (LOS). A secondary goal was to achieve a better laboratory return on investment. In 2011, we reached our primary goal when we calculated the TAT-OP distribution and found we had achieved a Six Sigma level of performance, ensuring that our laboratory service can be essentially eliminated as a factor in emergency department patient LOS. We also measured return on investment, showing a productivity improvement of 35%, keeping pace with our increased testing volume. As a result of our Lean process improvements and Six Sigma initiatives, in part through (1) strategic deployment of point-of-care testing and (2) core laboratory total automation with robotics, middleware, and expert system technology, physicians and nurses at the Oklahoma University Medical Center can more effectively deliver lifesaving health care using evidence-based protocols that depend heavily on "on time, every time" laboratory services.

  5. The use of the standard exercise test to establish the clinical significance of mild echocardiographic changes in a Thoroughbred poor performer : clinical communication

    Directory of Open Access Journals (Sweden)

    C. Meyer

    2004-06-01

    Full Text Available A 4-year-old Thoroughbred gelding racehorse was referred to the Onderstepoort Veterinary Academic Hospital (OVAH with a history of post-race distress and collapse. In the absence of any obvious abnormalities in the preceding diagnostic work-up, a standard exercise test was performed to determine an underlying cause for the post-race distress reported. In this particular case oxygen desaturation became evident at speeds as slow as 6 m/s, where PO2 was measured at 82.3 mm Hg. Similarly at a blood pH of 7.28, PCO2 had dropped to 30.0mm Hg indicating a combined metabolic acidosis and respiratory alkalosis. The cause of the distress was attributed to a severe hypoxia, with an associated hypocapnoea, confirmed on blood gas analyses, where PO2 levels obtained were as low as 56.6 mm Hg with a mean PCO2 level of 25.4 mm Hg during strenuous exercise. Arterial oxygenation returned to normal immediately after cessation of exercise to 106.44 mm Hg, while the hypocapnoeic alkalosis, PCO2 25.67 mm Hg, persisted until the animal's breathing normalized. The results obtained were indicative of a dynamic cardiac insufficiency present during exercise. The combination of an aortic stenosis and a mitral valve insufficiency may have resulted in a condition similar to that described as high-altitude pulmonary oedema, with respiratory changes and compensation as for acute altitude disease. The results obtained were indicative of a dynamic cardiac insufficiency present during exercise and substantiate the fact that an extensive diagnostic regime may be required to establish a cause for poor performance and that the standard exercise test remains an integral part of this work-up.

  6. Significant performance variation among PCR systems in diagnosing congenital toxoplasmosis in São Paulo, Brazil: analysis of 467 amniotic fluid samples.

    Science.gov (United States)

    Okay, Thelma Suely; Yamamoto, Lidia; Oliveira, Léa Campos; Manuli, Erika Regina; Andrade Junior, Heitor Franco de; Del Negro, Gilda Maria Barbaro

    2009-01-01

    Performance variation among PCR systems in detecting Toxoplasma gondii has been extensively reported and associated with target genes, primer composition, amplification parameters, treatment during pregnancy, host genetic susceptibility and genotypes of different parasites according to geographical characteristics. A total of 467 amniotic fluid samples from T. gondii IgM- and IgG-positive Brazilian pregnant women being treated for 1 to 6 weeks at the time of amniocentesis (gestational ages of 14 to 25 weeks). One nested-B1-PCR and three one-round amplification systems targeted to rDNA, AF146527 and the B1 gene were employed. Of the 467 samples, 189 (40.47%) were positive for one-round amplifications: 120 (63.49%) for the B1 gene, 24 (12.69%) for AF146527, 45 (23.80%) for both AF146527 and the B1 gene, and none for rDNA. Fifty previously negative one-round PCR samples were chosen by computer-assisted randomization analysis and re-tested (nested-B1-PCR), during which nine additional cases were detected (9/50 or 18%). The B1 gene PCR was far more sensitive than the AF146527 PCR, and the rDNA PCR was the least effective even though the rDNA had the most repetitive sequence. Considering that the four amplification systems were equally affected by treatment, that the amplification conditions were optimized for the target genes and that most of the primers have already been reported, it is plausible that the striking differences found among PCR performances could be associated with genetic diversity in patients and/or with different Toxoplasma gondii genotypes occurring in Brazil. The use of PCR for the diagnosis of fetal Toxoplasma infections in Brazil should be targeted to the B1 gene when only one gene can be amplified, preferably by nested amplification with primers B22/B23.

  7. Significant performance variation among PCR systems in diagnosing congenital toxoplasmosis in São Paulo, Brazil: analysis of 467 amniotic fluid samples

    Directory of Open Access Journals (Sweden)

    Thelma Suely Okay

    2009-03-01

    Full Text Available INTRODUCTION: Performance variation among PCR systems in detecting Toxoplasma gondii has been extensively reported and associated with target genes, primer composition, amplification parameters, treatment during pregnancy, host genetic susceptibility and genotypes of different parasites according to geographical characteristics. PATIENTS: A total of 467 amniotic fluid samples from T. gondii IgM- and IgG-positive Brazilian pregnant women being treated for 1 to 6 weeks at the time of amniocentesis (gestational ages of 14 to 25 weeks. METHODS: One nested-B1-PCR and three one-round amplification systems targeted to rDNA, AF146527 and the B1 gene were employed. RESULTS: Of the 467 samples, 189 (40.47% were positive for one-round amplifications: 120 (63.49% for the B1 gene, 24 (12.69% for AF146527, 45 (23.80% for both AF146527 and the B1 gene, and none for rDNA. Fifty previously negative one-round PCR samples were chosen by computer-assisted randomization analysis and re-tested (nested-B1-PCR, during which nine additional cases were detected (9/50 or 18%. DISCUSSION: The B1 gene PCR was far more sensitive than the AF146527 PCR, and the rDNA PCR was the least effective even though the rDNA had the most repetitive sequence. Considering that the four amplification systems were equally affected by treatment, that the amplification conditions were optimized for the target genes and that most of the primers have already been reported, it is plausible that the striking differences found among PCR performances could be associated with genetic diversity in patients and/or with different Toxoplasma gondii genotypes occurring in Brazil. CONCLUSION: The use of PCR for the diagnosis of fetal Toxoplasma infections in Brazil should be targeted to the B1 gene when only one gene can be amplified, preferably by nested amplification with primers B22/B23.

  8. Ultrasound Detection of Soft Tissue Abscesses Performed by Non-Physician U.S. Army Medical Providers Naïve to Diagnostic Sonography.

    Science.gov (United States)

    LaDuke, Mike; Monti, Jon; Cronin, Aaron; Gillum, Bart

    2017-03-01

    Patients commonly present to emergency rooms and primary care clinics with cellulitic skin infections with or without abscess formation. In military operational units, non-physician medical personnel provide most primary and initial emergency medical care. The objective of this study was to determine if, after minimal training, Army physician assistants and medics could use portable ultrasound (US) machines to detect superficial soft tissue abscesses. This was a single-blinded, randomized, prospective observational study conducted over the course of 2 days at a military installation. Active duty military physician assistants and medics with little or no US experience were recruited as participants. They received a short block of training on abscess detection using both clinical examination skills (inspection/palpation) and US examination. The participants were then asked to provide a yes/no answer regarding abscess presence in a chicken tissue model. Results were analyzed to assess the participants' abilities to detect abscesses, compare the diagnostic accuracy of their clinical examinations with their US examinations, and assess how often US results changed treatment plans initially on the basis of clinical examination findings alone. 22 participants performed a total of 220 clinical examinations and 220 US scans on 10 chicken tissue abscess models. Clinical examination for abscess detection yielded a sensitivity of 73.5% (95% confidence interval [CI], 65.3-80.3%) and a specificity of 77.2% (95% CI, 67.4-84.9%), although US examination for abscess detection yielded a sensitivity of 99.2% (95% CI, 95.4-99.9%) and a specificity of 95.5% (95% CI, 88.5-98.6%). Clinical examination yielded a diagnostic accuracy of 75.0% (95% CI, 68.9-80.3) although US examination yielded a diagnostic accuracy of 97.7% (95% CI, 94.6-99.2%), a difference in accuracy of 22.7% favoring US (p soft tissue abscesses with excellent accuracy. Reprint & Copyright © 2017 Association of Military

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

    DEFF Research Database (Denmark)

    Perignon, Marlene; Fiorentino, Marion; Khov, Kuong

    2014-01-01

    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... 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

  10. Propagation of Significant Figures.

    Science.gov (United States)

    Schwartz, Lowell M.

    1985-01-01

    Shows that the rules of thumb for propagating significant figures through arithmetic calculations frequently yield misleading results. Also describes two procedures for performing this propagation more reliably than the rules of thumb. However, both require considerably more calculational effort than do the rules. (JN)

  11. Knowledge of Patients' Human Papillomavirus Status at the Time of Cytologic Review Significantly Affects the Performance of Cervical Cytology in the ATHENA Study.

    Science.gov (United States)

    Wright, Thomas C; Stoler, Mark H; Aslam, Shagufta; Behrens, Catherine M

    2016-09-01

    With human papillomavirus (HPV) testing, patients' HPV status may be known when reviewing cytology specimens. 41,955 women 25 years or older had cytology and HPV screening. Originally, cytology was reviewed blinded to HPV status. We re-reviewed unblinded to HPV status a subset of 428 cytology slides from women with cervical intraepithelial neoplasia grade 2 + (CIN2+) and 1,287 from women without CIN2+. Of the original interpretations of atypical squamous cells of undetermined significance (ASC-US), 33.7% were downgraded to negative after unblinded review, and 8.7% were upgraded to atypical squamous cells, cannot rule out a high-grade squamous intraepithelial lesion or high-grade squamous intraepithelial lesion. Of the original interpretations of ASC-US, 66.7% were downgraded on unblinded review in HPV-negative women and 30.2% were upgraded in HPV 16+/HPV 18+ women. Unblinding increases the sensitivity for cervical intraepithelial neoplasia grade 3+ of cotesting from 54.1% to 62.4% (P = .0015) and the sensitivity of HPV primary screening from 72.2% to 77.1% (P = .0029). With cotesting, specificity with unblinding is improved, whereas with HPV primary screening, there would be a small decrease in specificity. Unblinded cytology increases overall sensitivity with either cotesting or HPV primary screening; specificity is either slightly improved or is not affected by unblinding. © American Society for Clinical Pathology, 2016. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  12. Putting the pieces together: high-performance LC-MS/MS provides network-, pathway-, and protein-level perspectives in Populus.

    Science.gov (United States)

    Abraham, Paul; Giannone, Richard J; Adams, Rachel M; Kalluri, Udaya; Tuskan, Gerald A; Hettich, Robert L

    2013-01-01

    High-performance mass spectrometry (MS)-based proteomics enabled the construction of a detailed proteome atlas for Populus, a woody perennial plant model organism. Optimization of experimental procedures and implementation of current state-of-the-art instrumentation afforded the most detailed look into the predicted proteome space of Populus, offering varying proteome perspectives: (1) network-wide, (2) pathway-specific, and (3) protein-level viewpoints. Together, enhanced protein retrieval through a detergent-based lysis approach and maximized peptide sampling via the dual-pressure linear ion trap mass spectrometer (LTQ Velos), have resulted in the identification of 63,056 tryptic peptides. The technological advancements, specifically spectral-acquisition and sequencing speed, afforded the deepest look into the Populus proteome, with peptide abundances spanning 6 orders of magnitude and mapping to ∼25% of the predicted proteome space. In total, tryptic peptides mapped to 11,689 protein assignments across four organ-types: mature (fully expanded, leaf plastichronic index (LPI) 10-12) leaf, young (juvenile, LPI 4-6) leaf, root, and stem. To resolve protein ambiguity, identified proteins were grouped by sequence similarity (≥ 90%), thereby reducing the protein assignments into 7538 protein groups. In addition, this large-scale data set features the first systems-wide survey of protein expression across different Populus organs. As a demonstration of the precision and comprehensiveness of the semiquantitative analysis, we were able to contrast two stages of leaf development, mature versus young leaf. Statistical comparison through ANOVA analysis revealed 1432 protein groups that exhibited statistically significant (p ≤ 0.01) differences in protein abundance. Experimental validation of the metabolic circuitry expected in mature leaf (characterized by photosynthesis and carbon fixation) compared with young leaf (characterized by rapid growth and moderate

  13. Putting the Pieces Together: High-performance LC-MS/MS Provides Network-, Pathway-, and Protein-level Perspectives in Populus*

    Science.gov (United States)

    Abraham, Paul; Giannone, Richard J.; Adams, Rachel M.; Kalluri, Udaya; Tuskan, Gerald A.; Hettich, Robert L.

    2013-01-01

    High-performance mass spectrometry (MS)-based proteomics enabled the construction of a detailed proteome atlas for Populus, a woody perennial plant model organism. Optimization of experimental procedures and implementation of current state-of-the-art instrumentation afforded the most detailed look into the predicted proteome space of Populus, offering varying proteome perspectives: (1) network-wide, (2) pathway-specific, and (3) protein-level viewpoints. Together, enhanced protein retrieval through a detergent-based lysis approach and maximized peptide sampling via the dual-pressure linear ion trap mass spectrometer (LTQ Velos), have resulted in the identification of 63,056 tryptic peptides. The technological advancements, specifically spectral-acquisition and sequencing speed, afforded the deepest look into the Populus proteome, with peptide abundances spanning 6 orders of magnitude and mapping to ∼25% of the predicted proteome space. In total, tryptic peptides mapped to 11,689 protein assignments across four organ-types: mature (fully expanded, leaf plastichronic index (LPI) 10–12) leaf, young (juvenile, LPI 4–6) leaf, root, and stem. To resolve protein ambiguity, identified proteins were grouped by sequence similarity (≥ 90%), thereby reducing the protein assignments into 7538 protein groups. In addition, this large-scale data set features the first systems-wide survey of protein expression across different Populus organs. As a demonstration of the precision and comprehensiveness of the semiquantitative analysis, we were able to contrast two stages of leaf development, mature versus young leaf. Statistical comparison through ANOVA analysis revealed 1432 protein groups that exhibited statistically significant (p ≤ 0.01) differences in protein abundance. Experimental validation of the metabolic circuitry expected in mature leaf (characterized by photosynthesis and carbon fixation) compared with young leaf (characterized by rapid growth and moderate

  14. Significant Improvement of Semiconducting Performance of the Diketopyrrolopyrrole-Quaterthiophene Conjugated Polymer through Side-Chain Engineering via Hydrogen-Bonding.

    Science.gov (United States)

    Yao, Jingjing; Yu, Chenmin; Liu, Zitong; Luo, Hewei; Yang, Yang; Zhang, Guanxin; Zhang, Deqing

    2016-01-13

    Three diketopyrrolopyrrole (DPP)-quaterthiophene conjugated polymers, pDPP4T-1, pDPP4T-2, and pDPP4T-3, in which the molar ratios of the urea-containing alkyl chains vs branching alkyl chains are 1:30, 1:20, and 1:10, respectively, were prepared and investigated. In comparison with pDPP4T without urea groups in the alkyl side chains and pDPP4T-A, pDPP4T-B, and pDPP4T-C containing both linear and branched alkyl chains, thin films of pDPP4T-1, pDPP4T-2, and pDPP4T-3 exhibit higher hole mobilities; thin-film mobility increases in the order pDPP4T-1 thin film of pDPP4T-3 can reach 13.1 cm(2) V(-1) s(-1) after thermal annealing at just 100 °C. The incorporation of urea groups in the alkyl side chains also has an interesting effect on the photovoltaic performances of DPP-quaterthiophene conjugated polymers after blending with PC71BM. Blended thin films of pDPP4T-1:PC71BM, pDPP4T-2:PC71BM, and pDPP4T-3:PC71BM exhibit higher power conversion efficiencies (PCEs) than pDPP4T:PC71BM, pDPP4T-A:PC71BM, pDPP4T-B:PC71BM, and pDPP4T-C:PC71BM. The PCE of pDPP4T-1:PC71BM reaches 6.8%. Thin films of pDPP4T-1, pDPP4T-2, and pDPP4T-3 and corresponding thin films with PC71BM were characterized with AFM, GIXRD, and STEM. The results reveal that the lamellar packing order of the alkyl chains is obviously enhanced for thin films of pDPP4T-1, pDPP4T-2, and pDPP4T-3; after thermal annealing, slight inter-chain π-π stacking emerges for pDPP4T-2 and pDPP4T-3. Blends of pDPP4T-1, pDPP4T-2, and pDPP4T-3 with PC71BM show a more pronounced micro-phase separation. These observations suggest that the presence of urea groups may further facilitate the assemblies of these conjugated polymers into nanofibers and ordered aggregation of PC71BM.

  15. Growth performance, behaviour, forestomach development and meat quality of veal calves provided with barley grain or ground wheat straw for welfare purpose

    Directory of Open Access Journals (Sweden)

    Igino Andrighetto

    2010-01-01

    Full Text Available Two different feeding plans for veal calves were compared in the study: a traditional liquid diet supplemented with 250  g/calf/d of barley grain or with 250 g/calf/d of ground wheat straw. The two solid feeds had different chemical composi-  tion but a similar particle size obtained by grinding the straw in a mill with an 8-mm mesh screen. Twenty-four Polish  Friesian male calves were used in the study and they were housed in individual wooden stalls (0.83 x 1.80 m. The health  status of all the calves was satisfactory for the entire fattening period and no specific medical treatment was required  during the trial. Calves fed wheat straw showed a greater intake of solid feed (196 vs. 139 g/d; P  average daily gain (1288 vs. 1203 g/d; P  not affected by the type of solid feed and no milk refusal episodes were detected. The haemoglobin concentration was  similar in calves receiving the two feeding treatments despite the higher iron intake provided by the wheat straw through-  out the fattening period (2.12 vs. 1.15 g; P  calves’ metabolism. Feeding behaviour was affected by the provision of solid feeds. Eating and chewing were prolonged  in calves receiving ground wheat straw and the same solid feed reduced the frequency of oral stereotypies at the end of  the fattening period. At the slaughterhouse, no differences were observed between the feeding treatments as regards  carcass weight and dressing percentage. The calves fed ground wheat straw had a heavier weight of the empty omasum  (518 vs. 341 g; P  fed barley grain. The incidence of abomasal erosions, ulcers and scars was similar in both treatments; however the index  of abomasal damage, which considers the number and the seriousness of different type of lesions, was higher in calves  receiving barley grain. Therefore, the grinding of straw particles, as opposed to barley grain, can reduce the abrasive-  ness of roughage at the abomasum level. Visual evaluation of the

  16. Hypoxia: Exposure Time Until Significant Performance Effects

    Science.gov (United States)

    2016-03-07

    as a failing of sensory function, working memory , and motor skills leading up to the time at which corrective action is no longer able to be taken...questionnaire which confirmed compliance with pre-established alcohol, caffeine , supplement, and medication usage standards given during consent and...1994). Acute hypoxia fails to influence two aspects of short-term memory : implications for the source of cognitive deficits. Aviation, Space

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

    Indian Academy of Sciences (India)

    rial due to its environmental safety, long life cycle and high energy density. It is isostructural with the naturally-occurring mineral tavorite, LiFePO4·OH or ambylgonite, LiAlPO4F and crystallizes with a triclinic structure (space group P).5 Besides, it has a relatively high potential of 4.2V (vs. Li+/Li) and a theoretical capacity of ...

  18. A nationwide postal survey on the perception of Malaysian public healthcare providers on family medicine specialists? (PERMFAMS) clinical performance, professional attitudes and research visibility

    OpenAIRE

    Chew, Boon-How; Yasin, Mazapuspavina Md; Cheong, Ai-Theng; Rashid, Mohd-Radzniwan A; Hamzah, Zuhra; Ismail, Mastura; Ali, Norsiah; Bashah, Baizury; Mohd-Salleh, Noridah

    2015-01-01

    Perception of healthcare providers who worked with family medicine specialists (FMSs) could translate into the effectiveness of primary healthcare delivery in daily practices. This study examined perceptions of public healthcare providers/professionals (PHCPs) on FMSs at public health clinics throughout Malaysia. This was a cross-sectional study in 2012-2013 using postal method targeting PHCPs from three categories of health facilities, namely health clinics, health offices and hospitals. A s...

  19. PERFORMANCE

    Directory of Open Access Journals (Sweden)

    M Cilli

    2014-10-01

    Full Text Available This study aimed to investigate the kinematic and kinetic changes when resistance is applied in horizontal and vertical directions, produced by using different percentages of body weight, caused by jumping movements during a dynamic warm-up. The group of subjects consisted of 35 voluntary male athletes (19 basketball and 16 volleyball players; age: 23.4 ± 1.4 years, training experience: 9.6 ± 2.7 years; height: 177.2 ± 5.7 cm, body weight: 69.9 ± 6.9 kg studying Physical Education, who had a jump training background and who were training for 2 hours, on 4 days in a week. A dynamic warm-up protocol containing seven specific resistance movements with specific resistance corresponding to different percentages of body weight (2%, 4%, 6%, 8%, 10% was applied randomly on non consecutive days. Effects of different warm-up protocols were assessed by pre-/post- exercise changes in jump height in the countermovement jump (CMJ and the squat jump (SJ measured using a force platform and changes in hip and knee joint angles at the end of the eccentric phase measured using a video camera. A significant increase in jump height was observed in the dynamic resistance warm-up conducted with different percentages of body weight (p 0.05. In jump movements before and after the warm-up, while no significant difference between the vertical ground reaction forces applied by athletes was observed (p>0.05, in some cases of resistance, a significant reduction was observed in hip and knee joint angles (p<0.05. The dynamic resistance warm-up method was found to cause changes in the kinematics of jumping movements, as well as an increase in jump height values. As a result, dynamic warm-up exercises could be applicable in cases of resistance corresponding to 6-10% of body weight applied in horizontal and vertical directions in order to increase the jump performance acutely.

  20. Analyzing effects of providing performance feedback at ward rounds on guideline adherence - The importance of feedback usage analysis and statistical control charts

    NARCIS (Netherlands)

    Abu-Hanna, Ameen; Eslami, Saeid; Schultz, Marcus J.; de Jonge, Evert; de Keizer, Nicolette F.

    2010-01-01

    Objective: Feedback to clinicians on their past performance is often aimed at increasing adherence to guidelines. We investigate how various analytical approaches influence the interpretation of adherence data. The analytical approaches vary in considering the actual or the intended use of the

  1. The Effect of Providing Breakfast on Student Performance: Evidence from an In-Class Breakfast Program. NBER Working Paper No. 17720

    Science.gov (United States)

    Imberman, Scott A.; Kugler, Adriana D.

    2012-01-01

    In response to low take-up, many public schools have experimented with moving breakfast from the cafeteria to the classroom. We examine whether such a program increases performance as measured by standardized test scores, grades and attendance rates. We exploit quasi-random timing of program implementation that allows for a…

  2. Investigating the Practice of Providing Written Corrective Feedback Types by ESL Teachers at the Upper Secondary Level in High Performance Schools

    Science.gov (United States)

    Mahmud, Norasyikin

    2016-01-01

    The past few decades has seen the rapid development of WCF (written corrective feedback) study. The present study examined the practice of providing WCF by teachers. The aim of this study was to determine the types of WCF used by English teachers. The study is an explanatory sequential mixed-methods design using open-ended and close-ended survey…

  3. Calculations of Financial Incentives for Providers in a Pay-for-Performance Program: Manual Review Versus Data From Structured Fields in Electronic Health Records.

    Science.gov (United States)

    Urech, Tracy H; Woodard, LeChauncy D; Virani, Salim S; Dudley, R Adams; Lutschg, Meghan Z; Petersen, Laura A

    2015-10-01

    Hospital report cards and financial incentives linked to performance require clinical data that are reliable, appropriate, timely, and cost-effective to process. Pay-for-performance plans are transitioning to automated electronic health record (EHR) data as an efficient method to generate data needed for these programs. To determine how well data from automated processing of structured fields in the electronic health record (AP-EHR) reflect data from manual chart review and the impact of these data on performance rewards. Cross-sectional analysis of performance measures used in a cluster randomized trial assessing the impact of financial incentives on guideline-recommended care for hypertension. A total of 2840 patients with hypertension assigned to participating physicians at 12 Veterans Affairs hospital-based outpatient clinics. Fifty-two physicians and 33 primary care personnel received incentive payments. Overall, positive and negative agreement indices and Cohen's kappa were calculated for assessments of guideline-recommended antihypertensive medication use, blood pressure (BP) control, and appropriate response to uncontrolled BP. Pearson's correlation coefficient was used to assess how similar participants' calculated earnings were between the data sources. By manual chart review data, 72.3% of patients were considered to have received guideline-recommended antihypertensive medications compared with 65.0% by AP-EHR review (κ=0.51). Manual review indicated 69.5% of patients had controlled BP compared with 66.8% by AP-EHR review (κ=0.87). Compared with 52.2% of patients per the manual review, 39.8% received an appropriate response by AP-EHR review (κ=0.28). Participants' incentive payments calculated using the 2 methods were highly correlated (r≥0.98). Using the AP-EHR data to calculate earnings, participants' payment changes ranged from a decrease of $91.00 (-30.3%) to an increase of $18.20 (+7.4%) for medication use (interquartile range, -14.4% to 0

  4. Potential for the Use of Energy Savings Performance Contracts to Reduce Energy Consumption and Provide Energy and Cost Savings in Non-Building Applications

    Energy Technology Data Exchange (ETDEWEB)

    Williams, Charles; Green, Andrew S.; Dahle, Douglas; Barnett, John; Butler, Pat; Kerner, David

    2013-08-01

    The findings of this study indicate that potential exists in non-building applications to save energy and costs. This potential could save billions of federal dollars, reduce reliance on fossil fuels, increase energy independence and security, and reduce greenhouse gas emissions. The Federal Government has nearly twenty years of experience with achieving similar energy cost reductions, and letting the energy costs savings pay for themselves, by applying energy savings performance contracts (ESPC) inits buildings. Currently, the application of ESPCs is limited by statute to federal buildings. This study indicates that ESPCs can be a compatible and effective contracting tool for achieving savings in non-building applications.

  5. The "Performance of Rotavirus and Oral Polio Vaccines in Developing Countries" (PROVIDE) study: description of methods of an interventional study designed to explore complex biologic problems.

    Science.gov (United States)

    Kirkpatrick, Beth D; Colgate, E Ross; Mychaleckyj, Josyf C; Haque, Rashidul; Dickson, Dorothy M; Carmolli, Marya P; Nayak, Uma; Taniuchi, Mami; Naylor, Caitlin; Qadri, Firdausi; Ma, Jennie Z; Alam, Masud; Walsh, Mary Claire; Diehl, Sean A; Petri, William A

    2015-04-01

    Oral vaccines appear less effective in children in the developing world. Proposed biologic reasons include concurrent enteric infections, malnutrition, breast milk interference, and environmental enteropathy (EE). Rigorous study design and careful data management are essential to begin to understand this complex problem while assuring research subject safety. Herein, we describe the methodology and lessons learned in the PROVIDE study (Dhaka, Bangladesh). A randomized clinical trial platform evaluated the efficacy of delayed-dose oral rotavirus vaccine as well as the benefit of an injectable polio vaccine replacing one dose of oral polio vaccine. This rigorous infrastructure supported the additional examination of hypotheses of vaccine underperformance. Primary and secondary efficacy and immunogenicity measures for rotavirus and polio vaccines were measured, as well as the impact of EE and additional exploratory variables. Methods for the enrollment and 2-year follow-up of a 700 child birth cohort are described, including core laboratory, safety, regulatory, and data management practices. Intense efforts to standardize clinical, laboratory, and data management procedures in a developing world setting provide clinical trials rigor to all outcomes. Although this study infrastructure requires extensive time and effort, it allows optimized safety and confidence in the validity of data gathered in complex, developing country settings. © The American Society of Tropical Medicine and Hygiene.

  6. The “Performance of Rotavirus and Oral Polio Vaccines in Developing Countries” (PROVIDE) Study: Description of Methods of an Interventional Study Designed to Explore Complex Biologic Problems

    Science.gov (United States)

    Kirkpatrick, Beth D.; Colgate, E. Ross; Mychaleckyj, Josyf C.; Haque, Rashidul; Dickson, Dorothy M.; Carmolli, Marya P.; Nayak, Uma; Taniuchi, Mami; Naylor, Caitlin; Qadri, Firdausi; Ma, Jennie Z.; Alam, Masud; Walsh, Mary Claire; Diehl, Sean A.; Petri, William A.

    2015-01-01

    Oral vaccines appear less effective in children in the developing world. Proposed biologic reasons include concurrent enteric infections, malnutrition, breast milk interference, and environmental enteropathy (EE). Rigorous study design and careful data management are essential to begin to understand this complex problem while assuring research subject safety. Herein, we describe the methodology and lessons learned in the PROVIDE study (Dhaka, Bangladesh). A randomized clinical trial platform evaluated the efficacy of delayed-dose oral rotavirus vaccine as well as the benefit of an injectable polio vaccine replacing one dose of oral polio vaccine. This rigorous infrastructure supported the additional examination of hypotheses of vaccine underperformance. Primary and secondary efficacy and immunogenicity measures for rotavirus and polio vaccines were measured, as well as the impact of EE and additional exploratory variables. Methods for the enrollment and 2-year follow-up of a 700 child birth cohort are described, including core laboratory, safety, regulatory, and data management practices. Intense efforts to standardize clinical, laboratory, and data management procedures in a developing world setting provide clinical trials rigor to all outcomes. Although this study infrastructure requires extensive time and effort, it allows optimized safety and confidence in the validity of data gathered in complex, developing country settings. PMID:25711607

  7. Providing supplementary, artificial milk for large litters during lactation: effects on performance and health of sows and piglets: a case study.

    Science.gov (United States)

    Pustal, J; Traulsen, I; Preißler, R; Müller, K; Beilage, T Große; Börries, U; Kemper, N

    2015-01-01

    One possible way to support raising large litter sizes in pigs is to offer supplementary, artificial milk ad libitum in the farrowing pen in addition to the sow's milk. In order to evaluate the potential use of this method and its effects on performance and health, supplemented (n = 60) and control sows (n = 60) with their litters were tested over 15 batches in one herd during one year. In the supplemented group (SG), piglets had access to supplementary milk in addition to sow's milk from their 2nd day of life until weaning (day 27). The litters of SG sows were adjusted to contain as many piglets as the sow had functional teats, whereas in the control group (CG), piglets were set to the number of functional teats minus one, due to animal welfare reasons. With supplementary milk provision, the weaning of large litters was achieved without any negative impacts on performance and health. On average, 13.5 and 12.4 piglets were weaned in SG and CG, respectively (P  0.05) and average daily weight gain of the piglets (SG: 0.25 kg v. CG: 0.25 kg; P > 0.05) did not differ, total litter weight was consequently higher in SG than in CG (104.9 kg v. 96.7 kg; P  0.05). With regard to documented medical treatments, facial lesions were treated less frequently in piglets of SG (46 v. 32 treatments; P  0.05). To summarise, in the presented case offering ad libitum supplementary, artificial milk supported the sow in raising large litters by compensating possible negative impacts of high piglet numbers on the weight gain of piglets and the body condition of the sows.

  8. Performative

    DEFF Research Database (Denmark)

    Sack-Nielsen, Torsten

    2015-01-01

    The article describes the potential of building skins being climate-adaptive. The principle of folding, and the relation between form and performance of facades are discussed here.......The article describes the potential of building skins being climate-adaptive. The principle of folding, and the relation between form and performance of facades are discussed here....

  9. Improving iSC performance through outsourcing - Considerations for using third-party service providers to increase innovation, capacity and efficiency.

    Science.gov (United States)

    Wright, Martin; Forster, Gary; Beale, John

    2017-04-19

    Development partners and donors have encouraged and incentivized governments in developing countries to explore ways of working with third-party service suppliers to reduce costs and increase service delivery capacity. The distribution of vaccines and medicines has for a long time shown demand for outsourcing but public health systems have struggled to develop the expertise and capital assets necessary to manage such ventures. Existing transport and logistics capacity within public health systems, in particular, is well documented as being insufficient to support existing, let alone future immunization needs. Today, a number of countries are contracting party logistics providers (3PLs) to supplement the in-house distribution operations of public health systems. This commentary reflects on recent, leading examples of outsourcing initiatives to address critical gaps in transport and logistics. Copyright © 2017. Published by Elsevier Ltd.

  10. Examining the effects of enhanced provider-patient communication on postoperative tonsillectomy pain: protocol of a randomised controlled trial performed by nurses in daily clinical care.

    Science.gov (United States)

    van Vliet, Liesbeth M; van Dulmen, Sandra; Thiel, Bram; van Deelen, Gerard W; Immerzeel, Stephanie; Godfried, Marc B; Bensing, Jozien M

    2017-11-03

    Placebo effects (true biopsychological effects not attributable to the active ingredients of medical technical interventions) can be attributed to several mechanisms, such as expectancy manipulation and empathy manipulation elicited by a provider's communication. So far, effects have primarily been shown in laboratory settings. The aim of this study is to determine the separate and combined effects of expectancy manipulation and empathy manipulation during preoperative and postoperative tonsillectomy analgesia care on clinical adult patients' outcomes. Using a two-by-two randomised controlled trial, 128 adult tonsillectomy patients will be randomly assigned to one out of four conditions differing in the level of expectancy manipulation (standard vs enhanced) and empathy manipulation (standard vs enhanced). Day care ward nurses are trained to deliver the intervention, while patients are treated via the standard analgesia protocol and hospital routines. The primary outcome, perceived pain, is measured via hospital routine by a Numeric Rating Scale, and additional prehospitalisation, perihospitalisation and posthospitalisation questionnaires are completed (until day 3, ie, 2 days after the operation). The manipulation is checked using audio recordings of nurse-patient interactions. Although communication is manipulated, the manipulations do not cross norms or values of acceptable behaviour. Standard medical care is provided. The ethical committee of the UMC Utrecht and the local OLVG hospital committee approved the study. Results will be published via (inter)national peer-reviewed journals and a lay publication. NTR5994; Pre-results. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  11. Statistical significance of quantitative PCR

    Directory of Open Access Journals (Sweden)

    Mazza Christian

    2007-04-01

    Full Text Available Abstract Background PCR has the potential to detect and precisely quantify specific DNA sequences, but it is not yet often used as a fully quantitative method. A number of data collection and processing strategies have been described for the implementation of quantitative PCR. However, they can be experimentally cumbersome, their relative performances have not been evaluated systematically, and they often remain poorly validated statistically and/or experimentally. In this study, we evaluated the performance of known methods, and compared them with newly developed data processing strategies in terms of resolution, precision and robustness. Results Our results indicate that simple methods that do not rely on the estimation of the efficiency of the PCR amplification may provide reproducible and sensitive data, but that they do not quantify DNA with precision. Other evaluated methods based on sigmoidal or exponential curve fitting were generally of both poor resolution and precision. A statistical analysis of the parameters that influence efficiency indicated that it depends mostly on the selected amplicon and to a lesser extent on the particular biological sample analyzed. Thus, we devised various strategies based on individual or averaged efficiency values, which were used to assess the regulated expression of several genes in response to a growth factor. Conclusion Overall, qPCR data analysis methods differ significantly in their performance, and this analysis identifies methods that provide DNA quantification estimates of high precision, robustness and reliability. These methods allow reliable estimations of relative expression ratio of two-fold or higher, and our analysis provides an estimation of the number of biological samples that have to be analyzed to achieve a given precision.

  12. Independent from muscle power and balance performance, a creatinine clearance below 65 ml/min is a significant and independent risk factor for falls and fall-related fractures in elderly men and women diagnosed with osteoporosis.

    Science.gov (United States)

    Dukas, L; Schacht, E; Runge, M

    2010-07-01

    We assessed in a cross-sectional study in elderly men and women with osteoporosis, the association between the creatinine clearance (CrCl) and the performance in different balance and muscle power and function tests and found that a decreasing creatinine clearance was significantly associated with lower balance and muscle power. To determine if a creatinine clearance of power and balance and an increased risk for falls and fractures. We assessed in a cross-sectional-study in 1781 German osteoporotic patients, the association between the CrCl, the physical performance, and the number of falls and fractures. Controlling for age, gender, BMI, and osteoporosis treatment (fracture analysis only), a decreasing CrCl was associated with lower physical performance in the timed-up-and-go test (corr -0.2337, P or=65 ml/min. In this study, we found a significant gender-independent correlation between decreasing CrCl and lower performance in balance and muscle power tests. Reduced muscle power and balance may therefore be involved in the low creatinine clearance associated increased risk for falls and fall-related fractures. Furthermore, we found that a CrCl power, muscle function, and balance tests, is a significant risk factor for falls and fractures.

  13. DECOVALEX III III/BENCHPAR PROJECTS. Approaches to Upscaling Thermal-Hydro-Mechanical Processes in a Fractured Rock. Mass and its Significance for Large-Scale Repository Performance Assessment. Summary of Findings. Report of BMT2/WP3

    Energy Technology Data Exchange (ETDEWEB)

    Andersson, Johan (comp.) [JA Streamflow AB, Aelvsjoe (Sweden); Staub, Isabelle (comp.) [Golder Associates AB, Stockholm (Sweden); Knight, Les (comp.) [Nirex UK Ltd, Oxon (United Kingdom)

    2005-02-15

    The Benchmark Test 2 of DECOVALEX III and Work Package 3 of BENCHPAR concerns the upscaling Thermal (T), Hydrological (H) and Mechanical (M) processes in a fractured rock mass and its significance for large-scale repository performance assessment. The work is primarily concerned with the extent to which various thermo-hydro-mechanical couplings in a fractured rock mass adjacent to a repository are significant in terms of solute transport typically calculated in large-scale repository performance assessments. Since the presence of even quite small fractures may control the hydraulic, mechanical and coupled hydromechanical behaviour of the rock mass, a key of the work has been to explore the extent to which these can be upscaled and represented by 'equivalent' continuum properties appropriate PA calculations. From these general aims the BMT was set-up as a numerical study of a large scale reference problem. Analysing this reference problem should: help explore how different means of simplifying the geometrical detail of a site, with its implications on model parameters, ('upscaling') impacts model predictions of relevance to repository performance, explore to what extent the THM-coupling needs to be considered in relation to PA-measures, compare the uncertainties in upscaling (both to uncertainty on how to upscale or uncertainty that arises due to the upscaling processes) and consideration of THM couplings with the inherent uncertainty and spatial variability of the site specific data. Furthermore, it has been an essential component of the work that individual teams not only produce numerical results but are forced to make their own judgements and to provide the proper justification for their conclusions based on their analysis. It should also be understood that conclusions drawn will partly be specific to the problem analysed, in particular as it mainly concerns a 2D application. This means that specific conclusions may have limited applicability

  14. 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 high-performance 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.

  15. 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.

  16. Significant vertical phase separation in solvent-vapor-annealed poly(3,4-ethylenedioxythiophene):poly(styrene sulfonate) composite films leading to better conductivity and work function for high-performance indium tin oxide-free optoelectronics.

    Science.gov (United States)

    Yeo, Jun-Seok; Yun, Jin-Mun; Kim, Dong-Yu; Park, Sungjun; Kim, Seok-Soon; Yoon, Myung-Han; Kim, Tae-Wook; Na, Seok-In

    2012-05-01

    In the present study, a novel polar-solvent vapor annealing (PSVA) was used to induce a significant structural rearrangement in poly(3,4-ethylenedioxythiophene):poly(styrene sulfonate) (PEDOT:PSS) films in order to improve their electrical conductivity and work function. The effects of polar-solvent vapor annealing on PEDOT:PSS were systematically compared with those of a conventional solvent additive method (SAM) and investigated in detail by analyzing the changes in conductivity, morphology, top and bottom surface composition, conformational PEDOT chains, and work function. The results confirmed that PSVA induces significant phase separation between excess PSS and PEDOT chains and a spontaneous formation of a highly enriched PSS layer on the top surface of the PEDOT:PSS polymer blend, which in turn leads to better 3-dimensional connections between the conducting PEDOT chains and higher work function. The resultant PSVA-treated PEDOT:PSS anode films exhibited a significantly enhanced conductivity of up to 1057 S cm(-1) and a tunable high work function of up to 5.35 eV. The PSVA-treated PEDOT:PSS films were employed as transparent anodes in polymer light-emitting diodes (PLEDs) and polymer solar cells (PSCs). The cell performances of organic optoelectronic devices with the PSVA-treated PEDOT:PSS anodes were further improved due to the significant vertical phase separation and the self-organized PSS top surface in PSVA-treated PEDOT:PSS films, which can increase the anode conductivity and work function and allow the direct formation of a functional buffer layer between the active layer and the polymeric electrode. The results of the present study will allow better use and understanding of polymeric-blend materials and will further advance the realization of high-performance indium tin oxide (ITO)-free organic electronics.

  17. Statistical Significance vs. Practical Significance: An Exploration through Health Education

    Science.gov (United States)

    Rosen, Brittany L.; DeMaria, Andrea L.

    2012-01-01

    The purpose of this paper is to examine the differences between statistical and practical significance, including strengths and criticisms of both methods, as well as provide information surrounding the application of various effect sizes and confidence intervals within health education research. Provided are recommendations, explanations and…

  18. Significant New Alternatives Policy (SNAP)

    Science.gov (United States)

    These webpages provide information on EPA’s Significant New Alternatives Policy (SNAP) program which evaluates substitutes for ozone-depleting substances in major industrial use sectors. The SNAP program promotes a smooth transition to safer alternatives.

  19. Performance Hero

    Directory of Open Access Journals (Sweden)

    Craig Derksen

    2009-01-01

    Full Text Available The Guitar Hero series of video games and their spin-offs have provided millions with a new way to interact with music. These games are not only culturally significant but also philosophically significant. Based on the way that these games allow people to interact with music we must decide that either playing a song in one of these games can be a legitimate performance of that song or that our current accounts of performance are inadequate.

  20. Modeling of Horizontal Well Performance to Provide Insight in Coning Control Modélisation des performances de forages horizontaux pour comprendre les phénomènes de formation de cônes

    Directory of Open Access Journals (Sweden)

    Folefac A. N.

    2006-11-01

    Full Text Available This paper addresses the relatively new topic of performance and characterization of horizontal wells in numerical simulation models. The productivity index of a well grid block is obtained by the use of conformal mapping techniques to transform complex flow geometries to simple ones for which analytical expressions can be derived. The techniques have already been reported in the literature with regard to the whole reservoir. Therefore we report in this paper only those aspects that relate to simulation grid blocks, namely, the conditions under which such an expression can be used to represent flow in a horizontal well block. It is shown that the grid block width to length ratio should not exceed 10 if the existing analytical expressions are to be used. A single horizontal well model has been proposed. Here a horizontal well continuum is represented by a discretised model consisting of a horizontal cylindrical grid system. The conversion of an existing single well simulator to this model is outlined. In order to demonstrate the potential advantages of horizontal wells in thin oil zone recovery, a number of case studies are presented to show the sensitivity of well length to aquifer control. Results obtained show that the recovery of oil from thin oil zones can be efficiently carried out if the well length is of the order of 70% or more of the reservoir length. An attempt to recover the oil by a conventional vertical well will lead to early water break-through and poor sweep efficiency. Cet article traite d'un sujet relativement nouveau, les performances et les caractéristiques des forages horizontaux dans les modèles de simulation numérique. On obtient l'indice de productivité d'un bloc de maillage de puits en utilisant des techniques de projection conforme pour transformer les géométries d'écoulement complexes en systèmes simples pour lesquels on peut calculer une expression analytique. Ces techniques ont déjà été exposées dans la

  1. 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@SiO2 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@SiO2 loading, while little increase in dielectric loss was found due to the highly insulating SiO2 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@SiO2/PVDF composites under different applied electrical field directions unambiguously revealed that aligned core-shell SiC@SiO2 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@SiO2 whiskers loading. This study highlights an effective strategy to achieve excellent comprehensive properties for high-k dielectrics.

  2. Improving the performance of reflex Human Papilloma Virus (HPV) testing in triaging women with atypical squamous cells of undetermined significance (ASCUS): A restrospective study in a tertiary hospital in United Arab Emirates (UAE).

    Science.gov (United States)

    Fakhreldin, Marwa; Elmasry, Karim

    2016-02-03

    Cervical cancer is the second commonest cancer in women worldwide. Infection with oncogenic types of human Papillomavirus (HPV) is the most important risk factor for developing cervical cancer. Reflex High risk HPV (HR-HPV) testing is of significant value in the assessment of Papanicolaou (Pap) smear results where ASCUS are identified. To improve the performance of reflex HR-HPV testing in triage of ASCUS and analyze the factors impacting it. In this study, we generated a database of 9641 women who had cervical smears collected during the study period from the cytopathology record in a large tertiary hospital in UAE. These included 297 smears with ASCUS diagnosis. All cases were retrospectively followed up with a mean duration of 2.44 years. We analyzed data according to the outcome based on several follow-up Pap smear analysis as the reference assessment. We detected HR-HPV infection in 17.9% of cases. 9.1% ASCUS cases can be more accurate in premenopausal women upon adding age group and presenting complaint as a triage item. This improves the performance of reflex HPV testing and the subsequent selection of high risk patients for colposcopy. Copyright © 2015 Elsevier Ltd. All rights reserved.

  3. Capital humano e sua relação com o desempenho organizacional em empresas prestadoras de serviços contábeis = Human capital and its relationship with the organizational performance in accounting services providers

    Directory of Open Access Journals (Sweden)

    Suzete Antonieta Lizote

    2017-08-01

    Full Text Available Na atualidade o valor das empresas não pode ser estimado apenas pelos seus ativos tangíveis. A geração e aquisição de conhecimento são fundamentais para a obtenção de vantagens competitivas, pelo que cresce a importância do capital intelectual da organização. Nesse contexto a pesquisa objetiva analisar se o capital humano (CH que as empresas prestadoras de serviços contábeis dispõem se relaciona positivamente com seu desempenho organizacional (DO. Metodologicamente, a pesquisa se caracteriza como quantitativa e de natureza aplicada, com os dados empíricos obtidos com questionário numa amostra intencional. Levantaram-se dados de ambos os constructos e dos respondentes e suas empresas. Os métodos estatísticos foram o teste t e a análise de variância para as comparações de médias. Empregou-se também a análise fatorial exploratória e confirmatória e a modelagem em equações estruturais para avaliar a relação conjecturada. Os resultados obtidos mostraram que os respondentes têm percepções estatisticamente iguais para ambos os constructos ao considerar o gênero e o tipo de gestão que a firma possui, mas houve diferenças para a percepção do desempenho segundo seu tamanho. Empresas maiores declaram ter maior desempenho. A hipótese que o CH se relaciona positiva e significativamente com o DO foi confirmada. Currently the value of companies cannot only be estimated by their tangible assets. The generation and acquisition of knowledge are key for obtaining competitive advantages, reason for which the importance of the intellectual capital of the organization grows. In this context the research aims to analyze whether the human capital (CH held by companies providing accounting services are positively related to their organizational performance (DO. Methodologically, the research is characterized as quantitative and of an applied nature, with the empirical data obtained from a questionnaire in intentional sample. Data

  4. High Performance Computing and Communications Act of 1991. Hearing Before the Subcommittee on Science, Technology, and Space of the Committee on Commerce, Science, and Transportation. One Hundred Second Congress, First Session on S. 272 To Provide for a Coordinated Federal Research Program To Ensure Continued United States Leadership in High-Performance Computing.

    Science.gov (United States)

    Congress of the U.S., Washington, DC. Senate Committee on Commerce, Science, and Transportation.

    This hearing before the Senate Subcommittee on Science, Technology, and Space focuses on S. 272, the High-Performance Computing and Communications Act of 1991, a bill that provides for a coordinated federal research and development program to ensure continued U.S. leadership in this area. Performance computing is defined as representing the…

  5. Significant scales in community structure.

    Science.gov (United States)

    Traag, V A; Krings, G; Van Dooren, P

    2013-10-14

    Many complex networks show signs of modular structure, uncovered by community detection. Although many methods succeed in revealing various partitions, it remains difficult to detect at what scale some partition is significant. This problem shows foremost in multi-resolution methods. We here introduce an efficient method for scanning for resolutions in one such method. Additionally, we introduce the notion of "significance" of a partition, based on subgraph probabilities. Significance is independent of the exact method used, so could also be applied in other methods, and can be interpreted as the gain in encoding a graph by making use of a partition. Using significance, we can determine "good" resolution parameters, which we demonstrate on benchmark networks. Moreover, optimizing significance itself also shows excellent performance. We demonstrate our method on voting data from the European Parliament. Our analysis suggests the European Parliament has become increasingly ideologically divided and that nationality plays no role.

  6. Biological significance of selenium

    Energy Technology Data Exchange (ETDEWEB)

    Duerre, P.; Andreesen, J.R.

    1986-02-01

    Until a few years ago, selenium was exclusively thought of as a toxic substance which was applied mainly in the optical and electrical industries. By now, many biological reactions have been detected which cannot take place without the catalytic effect of selenium. The majority of these processes was found and clarified in microorganisms; however, the anticarcinogenic properties of this trace element may well have some significance for man in future.

  7. Internet Medline providers.

    Science.gov (United States)

    Vine, D L; Coady, T R

    1998-01-01

    Each database in this review has features that will appeal to some users. Each provides a credible interface to information available within the Medline database. The major differences are pricing and interface design. In this context, features that cost more and might seem trivial to the occasional searcher may actually save time and money when used by the professional. Internet Grateful Med is free, but Ms. Coady and I agree the availability of only three ANDable search fields is a major functional limitation. PubMed is also free but much more powerful. The command line interface that permits very sophisticated searches requires a commitment that casual users will find intimidating. Ms. Coady did not believe the feedback currently provided during a search was sufficient for sustained professional use. Paper Chase and Knowledge Finder are mature, modestly priced Medline search services. Paper Chase provides a menu-driven interface that is very easy to use, yet permits the user to search virtually all of Medline's data fields. Knowledge Finder emphasizes the use of natural language queries but fully supports more traditional search strategies. The impact of the tradeoff between fuzzy and Boolean strategies offered by Knowledge Finder is unclear and beyond the scope of this review. Additional software must be downloaded to use all of Knowledge Finders' features. Other providers required no software beyond the basic Internet browser, and this requirement prevented Ms. Coady from evaluating Knowledge Finder. Ovid and Silver Platter offer well-designed interfaces that simplify the construction of complex queries. These are clearly services designed for professional users. While pricing eliminates these for casual use, it should be emphasized that Medline citation access is only a portion of the service provided by these high-end vendors. Finally, we should comment that each of the vendors and government-sponsored services provided prompt and useful feedback to e

  8. Normative significance of transnationalism?

    DEFF Research Database (Denmark)

    Lægaard, Sune

    2010-01-01

    The paper concerns the specific transnational aspects of the ‘cartoons controversy' over the publication of 12 drawings of the Prophet Muhammad in the Danish newspaper Jyllands-Posten. Transnationalism denotes the relationships that are not international (between states) or domestic (between states...... and citizens, or between groups or individuals within a state). The paper considers whether the specifically transnational aspects of the controversy are normatively significant, that is, whether transnationalism makes a difference for the applicability or strength of normative considerations concerning...... publications such as the Danish cartoons. It is argued that, although some of the usual arguments about free speech only or mainly apply domestically, many also apply transnationally; that standard arguments for multicultural recognition are difficult to apply transnationally; and that requirements of respect...

  9. A randomised control trial to determine if use of the iResus© application on a smart phone improves the performance of an advanced life support provider in a simulated medical emergency.

    Science.gov (United States)

    Low, D; Clark, N; Soar, J; Padkin, A; Stoneham, A; Perkins, G D; Nolan, J

    2011-04-01

    This study sought to determine whether using the Resuscitation Council UK's iResus© application on a smart phone improves the performance of doctors trained in advanced life support in a simulated emergency. Thirty-one doctors (advanced life support-trained within the previous 48 months) were recruited. All received identical training using the smart phone and the iResus application. The participants were randomly assigned to a control group (no smart phone) and a test group (access to iResus on smart phone). Both groups were tested using a validated extended cardiac arrest simulation test (CASTest) scoring system. The primary outcome measure was the overall cardiac arrest simulation test score; these were significantly higher in the smart phone group (median (IQR [range]) 84.5 (75.5-92.5 [64-96])) compared with the control group (72 (62-87 [52-95]); p=0.02). Use of the iResus application significantly improves the performance of an advanced life support-certified doctor during a simulated medical emergency. Further studies are needed to determine if iResus can improve care in the clinical setting. © 2011 The Authors. Anaesthesia © 2011 The Association of Anaesthetists of Great Britain and Ireland.

  10. Diagnostic relevance and clinical significance of the new enhanced performance M2 (MIT3) ELISA for the detection of IgA and IgG antimitochondrial antibodies in primary biliary cirrhosis.

    Science.gov (United States)

    Gabeta, Stella; Norman, Gary L; Liaskos, Christos; Papamichalis, Panagiotis A; Zografos, Theodoros; Garagounis, Athanasios; Rigopoulou, Eirini I; Dalekos, George N

    2007-07-01

    Antimitochondrial antibodies (AMAs) are the serological hallmark of primary biliary cirrhosis (PBC). We evaluated the sensitivity and specificity of a new M2 enhanced performance enzyme-linked immunosorbent assay (ELISA) (MIT3) for the detection of IgG- and IgA-specific isotypes of AMA in PBC patients including a number of PBC patients negative for AMA by indirect immunofluorescence (IIF) as well as in patients with diverse, non-PBC disorders. We also investigated the clinical significance of IgG and IgA AMA in PBC. One hundred and three Greek PBC patients including 27 with AMA IIF-negative at the time of the investigation, 29 with autoimmune hepatitis-1 (AIH-1), 12 with primary sclerosing cholangitis (PSC), 26 with hepatitis C virus (HCV), 15 with hepatitis B virus (HBV), and 29 healthy were investigated for AMA (IgG and IgA) using the MIT3-based ELISAs (INOVA Diagnostics, San Diego, CA). The samples were also tested by conventional anti-M2 ELISA (INOVA Diagnostics, Inc.). The IgG MIT3-based ELISA significantly increased AMA detection in the cohort of PBC patients, over 26% of whom were AMA IIF-negative, from 63.1% by the conventional anti-M2, and 73.7% by IIF to 79.6% by MIT3-based ELISA (p<0.001). IgA AMAs were detected in 47.6% patients. Overall, IgG/IgA AMAs were detected in 84/103 (81.6%). IgG MIT3-based ELISA detected 12/27 IIF AMA-negative samples (44.4%), while IgG/IgA MIT3-based ELISAs detected 13/27 IIF AMA-negative patients (48.1%). The specificities of MIT3-based ELISAs (IgG and IgA) were 82.8% and 89.7%, respectively, in AIH-1, 100% and 93.3%, respectively, in HBV, 100% in PSC, and 96% and 93.3%, respectively, in HCV. Patients positive for IgG AMA had significantly more severe disease as shown by worse histology and elevated biochemical markers; IgG and IgA AMA titers were associated positively with the Mayo risk score but none of the isotypes were able to predict disease outcome. The new IgG and IgA MIT3-based ELISAs seem to have higher specificity

  11. Clinical Significance of Pyometra.

    Science.gov (United States)

    Lui, Man-Wa; Cheung, Vincent Y T; Pun, Ting Chung

    2015-01-01

    To review the clinical profiles and management outcomes of patients with pyometra. A retrospective review of all women admitted with a confirmed diagnosis of pyometra over an 8-year period (January 2003 to December 2010). The medical records, including operation notes, histological and microbiological results, were reviewed. A total of 57 patients accounting for 76 admissions were identified. The mean patient age was 82.0 ± 11.3 years. The most common presenting symptom was postmenopausal bleeding (59.2%), followed by vaginal discharge (40.8%), fever (6.6%), and abdominal pain (5.3%). Drainage of pyometra was either by uterine Foley catheter insertion (48 patients [84.2%]) or repeated endometrial aspiration (2 patients [3.5%]). Antibiotics were prescribed to 49 patients (86.0%). Diagnostic hysteroscopy with mechanical cervical dilation was performed in 6 patients (10.5%). Gynecological malignancy was identified in only 1 patient, while colorectal cancer was identified in 2 patients. No patient had spontaneous uterine perforation or sepsis. Sixteen patients had recurrent pyometra within a mean follow-up period of 5.1 ± 5.8 months (range, 0.5-23 months). Pyometra usually presents with postmenopausal bleeding and can be treated with drainage and antibiotics treatment. In contrast to previous reports, our study indicates that spontaneous uterine perforation and gynecological malignancies are not commonly associated with pyometra.

  12. The Types and Nature of Questions vis-à-vis Students' Test-Taking Skills as Significant Indicators of Second Language Examinees? Performance on the TOEFL-ITP Reading Comprehension Sub-Test

    Science.gov (United States)

    Perez-Amurao, Analiza

    2011-01-01

    This study examines the reading performance of selected students at the Pre-College program of the Mahidol University International College (PC-MUIC) as they are required to attain a score of 520 in the TOEFL-ITP (or equivalent performance in IELTS) to enter MUIC. Specifically, this research aims to evaluate whether the reading skills that…

  13. Significance analysis of prognostic signatures.

    Directory of Open Access Journals (Sweden)

    Andrew H Beck

    Full Text Available A major goal in translational cancer research is to identify biological signatures driving cancer progression and metastasis. A common technique applied in genomics research is to cluster patients using gene expression data from a candidate prognostic gene set, and if the resulting clusters show statistically significant outcome stratification, to associate the gene set with prognosis, suggesting its biological and clinical importance. Recent work has questioned the validity of this approach by showing in several breast cancer data sets that "random" gene sets tend to cluster patients into prognostically variable subgroups. This work suggests that new rigorous statistical methods are needed to identify biologically informative prognostic gene sets. To address this problem, we developed Significance Analysis of Prognostic Signatures (SAPS which integrates standard prognostic tests with a new prognostic significance test based on stratifying patients into prognostic subtypes with random gene sets. SAPS ensures that a significant gene set is not only able to stratify patients into prognostically variable groups, but is also enriched for genes showing strong univariate associations with patient prognosis, and performs significantly better than random gene sets. We use SAPS to perform a large meta-analysis (the largest completed to date of prognostic pathways in breast and ovarian cancer and their molecular subtypes. Our analyses show that only a small subset of the gene sets found statistically significant using standard measures achieve significance by SAPS. We identify new prognostic signatures in breast and ovarian cancer and their corresponding molecular subtypes, and we show that prognostic signatures in ER negative breast cancer are more similar to prognostic signatures in ovarian cancer than to prognostic signatures in ER positive breast cancer. SAPS is a powerful new method for deriving robust prognostic biological signatures from clinically

  14. Therapy Provider Phase Information

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Therapy Provider Phase Information dataset is a tool for providers to search by their National Provider Identifier (NPI) number to determine their phase for...

  15. Significance evaluation in factor graphs

    DEFF Research Database (Denmark)

    Madsen, Tobias; Hobolth, Asger; Jensen, Jens Ledet

    2017-01-01

    in genomics and the multiple-testing issues accompanying them, accurate significance evaluation is of great importance. We here address the problem of evaluating statistical significance of observations from factor graph models. Results Two novel numerical approximations for evaluation of statistical......Background Factor graphs provide a flexible and general framework for specifying probability distributions. They can capture a range of popular and recent models for analysis of both genomics data as well as data from other scientific fields. Owing to the ever larger data sets encountered...... a theoretical viewpoint and with simulations. A guideline for choosing between the normal approximation, saddle-point approximation and importance sampling is also provided. Finally, the applicability of the methods is demonstrated with examples from cancer genomics, motif-analysis and phylogenetics...

  16. Modelo para avaliar o desempenho de operadores logísticos: um estudo de caso na indústria têxtil Model for assessing logistics providers performance: a case study in the textile industry

    Directory of Open Access Journals (Sweden)

    Fábio Cristiano Zamcopé

    2010-12-01

    adequate decisions. In this context, this study proposes a model to evaluate the performance of Logistic Providers considering the continuing improvement of the logistic chain focusing on customer needs. Hence, a case study was carried out in a Brazilian textile industry using MCDA-C as an intervention tool since it enables: i the identification of the issues considered the most important in their logistics chain; ii the construction of scales to measure the contribution of the Logistic Provider to each indicator mentioned in the previous item iii a process for the operators to improve their performance. The evaluation model proposed allowed the development of strategies to improve the Logistic Providers of the company analyzed.

  17. Significance evaluation in factor graphs

    DEFF Research Database (Denmark)

    Madsen, Tobias; Hobolth, Asger; Jensen, Jens Ledet

    2017-01-01

    Background Factor graphs provide a flexible and general framework for specifying probability distributions. They can capture a range of popular and recent models for analysis of both genomics data as well as data from other scientific fields. Owing to the ever larger data sets encountered...... in genomics and the multiple-testing issues accompanying them, accurate significance evaluation is of great importance. We here address the problem of evaluating statistical significance of observations from factor graph models. Results Two novel numerical approximations for evaluation of statistical...... significance are presented. First a method using importance sampling. Second a saddlepoint approximation based method. We develop algorithms to efficiently compute the approximations and compare them to naive sampling and the normal approximation. The individual merits of the methods are analysed both from...

  18. What HERA May Provide?

    Energy Technology Data Exchange (ETDEWEB)

    Jung, Hannes; /DESY; De Roeck, Albert; /CERN; Bartels, Jochen; /Hamburg U., Inst. Theor. Phys. II; Behnke, Olaf; Blumlein, Johannes; /DESY; Brodsky, Stanley; /SLAC /Durham U., IPPP; Cooper-Sarkar, Amanda; /Oxford U.; Deak, Michal; /DESY; Devenish, Robin; /Oxford U.; Diehl, Markus; /DESY; Gehrmann, Thomas; /Zurich U.; Grindhammer, Guenter; /Munich, Max Planck Inst.; Gustafson, Gosta; /CERN /Lund U., Dept. Theor. Phys.; Khoze, Valery; /Durham U., IPPP; Knutsson, Albert; /DESY; Klein, Max; /Liverpool U.; Krauss, Frank; /Durham U., IPPP; Kutak, Krzysztof; /DESY; Laenen, Eric; /NIKHEF, Amsterdam; Lonnblad, Leif; /Lund U., Dept. Theor. Phys.; Motyka, Leszek; /Hamburg U., Inst. Theor. Phys. II /Birmingham U. /Southern Methodist U. /DESY /Piemonte Orientale U., Novara /CERN /Paris, LPTHE /Hamburg U. /Penn State U.

    2011-11-10

    More than 100 people participated in a discussion session at the DIS08 workshop on the topic What HERA may provide. A summary of the discussion with a structured outlook and list of desirable measurements and theory calculations is given. The HERA accelerator and the HERA experiments H1, HERMES and ZEUS stopped running in the end of June 2007. This was after 15 years of very successful operation since the first collisions in 1992. A total luminosity of {approx} 500 pb{sup -1} has been accumulated by each of the collider experiments H1 and ZEUS. During the years the increasingly better understood and upgraded detectors and HERA accelerator have contributed significantly to this success. The physics program remains in full swing and plenty of new results were presented at DIS08 which are approaching the anticipated final precision, fulfilling and exceeding the physics plans and the previsions of the upgrade program. Most of the analyses presented at DIS08 were still based on the so called HERA I data sample, i.e. data taken until 2000, before the shutdown for the luminosity upgrade. This sample has an integrated luminosity of {approx} 100 pb{sup -1}, and the four times larger statistics sample from HERA II is still in the process of being analyzed.

  19. Department of Energy High-Performance Computing Act of 1991. Hearing before the Committee on Energy and Natural Resources, United States Senate, One Hundred Second Congress, First Session, on S. 343, To Provide for Continued United States Leadership in High-Performance Computing.

    Science.gov (United States)

    Congress of the U.S., Washington, DC. Senate Committee on Energy and Natural Resources.

    This report of a hearing begins with an opening statement by Senator J. Bennett Johnston, Chairman of the Committee, and prepared statements from Committee members Larry E. Craig and Pete V. Domenici. The text of the bill, which provides for continued U.S. leadership in high-performance computing, is then presented, followed by additional…

  20. Significance evaluation in factor graphs.

    Science.gov (United States)

    Madsen, Tobias; Hobolth, Asger; Jensen, Jens Ledet; Pedersen, Jakob Skou

    2017-03-31

    Factor graphs provide a flexible and general framework for specifying probability distributions. They can capture a range of popular and recent models for analysis of both genomics data as well as data from other scientific fields. Owing to the ever larger data sets encountered in genomics and the multiple-testing issues accompanying them, accurate significance evaluation is of great importance. We here address the problem of evaluating statistical significance of observations from factor graph models. Two novel numerical approximations for evaluation of statistical significance are presented. First a method using importance sampling. Second a saddlepoint approximation based method. We develop algorithms to efficiently compute the approximations and compare them to naive sampling and the normal approximation. The individual merits of the methods are analysed both from a theoretical viewpoint and with simulations. A guideline for choosing between the normal approximation, saddle-point approximation and importance sampling is also provided. Finally, the applicability of the methods is demonstrated with examples from cancer genomics, motif-analysis and phylogenetics. The applicability of saddlepoint approximation and importance sampling is demonstrated on known models in the factor graph framework. Using the two methods we can substantially improve computational cost without compromising accuracy. This contribution allows analyses of large datasets in the general factor graph framework.

  1. Comparison of the clinical performance of an HPV mRNA test and an HPV DNA test in triage of atypical squamous cells of undetermined significance (ASC-US)

    DEFF Research Database (Denmark)

    Waldstrom, M; Ornskov, D

    2012-01-01

    The effect of triaging women with atypical squamous cells of undetermined significance (ASC-US) with human papillomavirus (HPV) DNA testing has been well documented. New tests detecting HPV E6/E7 mRNA are emerging, claiming to be more specific for detecting high-grade disease. We evaluated...

  2. Preferred provider organizations.

    Science.gov (United States)

    Davy, J D

    1984-05-01

    The 1980s has marked the beginning of a new alternative health care delivery system: the preferred provider organization ( PPO ). This system has developed from the health maintenance organization model and is predominant in California and Colorado. A PPO is a group of providers, usually hospitals and doctors, who agree to provide health care to subscribers for a negotiated fee that is usually discounted. Preferred provider organizations are subject to peer review and strict use controls in exchange for a consistent volume of patients and speedy turnaround on claims payments. This article describes the factors leading to the development of PPOs and the implications for occupational therapy.

  3. Significances of Multimedia Technologies Training

    Science.gov (United States)

    Zhang, Fulei

    The use of multimedia technologies in education has enabled teachers to simulate final outcomes and assist s-tudents in applying knowledge learned from textbooks, thereby compensating for the deficiency of traditional teach- ing methods. It is important to examine how effective these technologies are in practical use. This study developed online learning-teaching resource platforms using Flash multimedia, providing interactive and integrated features in an easy-to-use user interface, in order to discuss Computer-Aided Drawing (CAD). The study utilized a teaching experiment with a non-equivalent pretest-posttest control group design to test and discuss students' professional cognition, operating skill cognition, and level of learning satisfaction during the learning process. No significant differences emerged between the groups in regards to professional cognition or operation skills cognition. However, a significant difference in learning satisfaction was noted, indicating that the coursework with multimedia Flash produced greater satisfaction than with traditional learning methods. Results are explained in detail and recommendations for further research provided.

  4. Building Service Provider Capabilities

    DEFF Research Database (Denmark)

    Brandl, Kristin; Jaura, Manya; Ørberg Jensen, Peter D.

    In this paper we study whether and how the interaction between clients and the service providers contributes to the development of capabilities in service provider firms. In situations where such a contribution occurs, we analyze how different types of activities in the production process...

  5. Providing free autopoweroff plugs

    DEFF Research Database (Denmark)

    Jensen, Carsten Lynge; Hansen, Lars Gårn; Fjordbak, Troels

    2012-01-01

    Experimental evidence of the effect of providing households with cheap energy saving technology is sparse. We present results from a field experiment in which autopoweroff plugs were provided free of charge to randomly selected households. We use propensity score matching to find treatment effects...

  6. Providing sexual information to ostomy patients.

    Science.gov (United States)

    Gloeckner, M R; Starling, J R

    1982-09-01

    Forty patients with a permanent colostomy, ileostomy, or ileal conduit were interviewed. Besides changes in sexual performance postoperatively, the authors specifically attempted to determine answers to other sexual variables such as attractiveness, appliance problems, and partner reactions. The extent of information provided to patients on sexuality prior to the permanent ostomy was also examined. There was a significant but predictable incidence of male impotence and female dyspareunia after surgery. Despite innumerable sexual variables, other than performance, which these patients faced postoperatively, 42 per cent received no information regarding sexuality at the time of ostomy surgery. most patients (97.5 per cent) stated that sexuality, including variables other than performance, should be discussed primarily by the surgeon prior to permanent ostomy surgery. The enterostomal therapist has an important role in the total patient adjustment in the long-term postoperative period.

  7. Enstore with Chimera namespace provider

    Energy Technology Data Exchange (ETDEWEB)

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

    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.

  8. 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.

  9. Performance of p16INK4a/Ki-67 immunocytochemistry for identifying CIN2+ in atypical squamous cells of undetermined significance and low-grade squamous intraepithelial lesion specimens: a Japanese Gynecologic Oncology Group study.

    Science.gov (United States)

    Fujii, Takuma; Saito, Miyuki; Hasegawa, Toshihiko; Iwata, Takashi; Kuramoto, Hiroyuki; Kubushiro, Kaneyuki; Ohmura, Mineo; Ochiai, Kazunori; Arai, Hiroharu; Sakamoto, Masaru; Motoyama, Teiichi; Aoki, Daisuke

    2015-02-01

    p16(INK4a) immunohistochemistry has revealed a high rate of positivity in cervical intraepithelial neoplasia grade 2 (CIN2) and more severe conditions (CIN2+). The Lower Anogenital Squamous Terminology Standardization project proposed p16(INK4a) immunohistochemistry as an ancillary test for CIN. Immunocytochemistry involving dual staining for p16(INK4a) and Ki-67 in the triage of atypical squamous cells of undetermined significance (ASCUS) and low-grade squamous intraepithelial lesions (LSIL) is reported to be useful in the identification of CIN2+. However, it is unclear whether p16(INK4a)/Ki-67 immunocytochemistry is of practical relevance for the triage of ASCUS and LSIL in the Japanese screening system. From 427 women fulfilling the eligibility criteria, 188 ASCUS and 239 LSIL specimens were analyzed. The accuracy of p16(INK4a)/Ki-67 immunocytochemistry and genotyping of high-risk human papillomaviruses (HPVs) in detecting CIN2+ were compared. p16(INK4a)/Ki-67 immunocytochemistry was positive in 33.5 % (63/188) of ASCUS, and 36.8 % (88/239) of LSIL specimens. The sensitivity and specificity of p16(INK4a)/Ki-67 immunocytochemistry was 87.3 % (95 % confidence interval 78.0-93.8 %) and 76.4 % (71.6-80.8 %), respectively. The positive and negative predictive values were 45.7 % (37.6-54.0 %) and 96.4 % (93.4-98.3 %), respectively; positive and negative likelihood ratios were 3.71 and 0.17, respectively. Using the McNemar test, p16(INK4a)/Ki-67 immunocytochemistry showed equivalent sensitivity but higher specificity than the HPV genotyping test Compared with high-risk HPV genotyping, p16(INK4a)/Ki-67 immunocytochemistry was a more accurate triage test for identifying CIN2+ in ASCUS and LSIL specimens.

  10. 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.

  11. Relative performance of three formulas to assess renal function at predicting in-hospital hemorrhagic complications in an acute coronary syndrome population. What does the new CKD-EPI formula provide?

    Science.gov (United States)

    Cabanas-Grandío, Pilar; Abu-Assi, Emad; Raposeiras-Roubin, Sergio; Alvarez-Alvarez, Belén; González-Cambeiro, Cristina; Romaní, Santiago Gestal; Pereira-López, Eva; Bouzas-Cruz, Noelia; López-López, Andrea; Rodríguez-Girondo, Mar; Pedreira, Milagros; García-Acuña, José María; González-Juanatey, José Ramón

    2014-09-01

    Assessment of renal function is important for bleeding risk stratification in acute coronary syndrome (ACS). There are three formulas routinely used to assess renal function: the Cockroft-Gault (C-G) formula, the MDRD-4 formula and the new Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. Our aim was to compare the ability of these formulas to predict the risk of in-hospital bleeding in patients with ACS. The study included 3270 patients with ACS. The performance of each formula with respect to in-hospital TIMI (Thrombolysis In Myocardial Infarction) major or TIMI minor bleeding were assessed using continuous data and by dividing patients into four subgroups according to the estimated glomerular filtration rate (eGFR): ≥90, 89-60, 30-59 and formula than for MDRD-4 and CKD-EPI formulas, as evaluated by the area under the curve (AUC); continuous eGFR AUCs: 0.73, 0.69 and 0.71, respectively; categorical eGFR AUCs: 0.71, 0.66 and 0.68, respectively. Net reclassification improvement based on the eGFR categories was significantly positively favored C-G: 9.5% (95% confidence interval (CI) 1.8-17.2%) and 19.1% (95% CI 11.3-26.9%) compared with CKD-EPI and MDRD-4, respectively. After multivariable adjustment, the C-G formula predicted in-hospital bleeding better than MDRD-4 formula (severe renal dysfunction vs. normal renal function: odds ratio 7.98, 95% CI 2.61-24.38 with C-G; odds ratio 3.76, 95% CI 1.63-8.69 with MDRD-4; and odds ratio 5.77, 95% CI 2.18-15.24 with CKD-EPI. Our findings suggest that the C-G eGFR may improve risk prediction of in-hospital bleeding more than the MDRD-4 equation and the new CKD-EPI equation in patients with ACS. © The European Society of Cardiology 2014.

  12. Provider of Services File

    Data.gov (United States)

    U.S. Department of Health & Human Services — The POS file consists of two data files, one for CLIA labs and one for 18 other provider types. The file names are CLIA and OTHER. If downloading the file, note it...

  13. The Provident Principal.

    Science.gov (United States)

    McCall, John R.

    This monograph offers leadership approaches for school principals. Discussion applies the business leadership theory of Warren Bennis and Burt Nanus to the role of the principal. Each of the booklet's three parts concludes with discussion questions. Part 1, "Visions and Values for the Provident Principal," demonstrates the importance of…

  14. What HERA may provide?

    Energy Technology Data Exchange (ETDEWEB)

    Jung, Hannes [DESY, Hamburg (Germany); De Roeck, Albert [CERN, Genf (Switzerland); Bartles, Jochen [Univ. Hamburg (DE). Institut fuer Theoretische Physik II] (and others)

    2008-09-15

    More than 100 people participated in a discussion session at the DIS08 workshop on the topic What HERA may provide. A summary of the discussion with a structured outlook and list of desirable measurements and theory calculations is given. (orig.)

  15. care Providers in Ibadan

    African Journals Online (AJOL)

    Three hundred and eighty six respondents (77.7%) were aware of intermittent preventive treatment (IPT). Awareness ... Key Words: malaria in pregnancy, intermittent preventive treatment, malaria control, health care providers. Department of Obstetrics .... Auxiliary nurses do not have formal training prior to employment.

  16. A randomised control trial to determine if use of the iResus©application on a smart phone improves the performance of an advanced life support provider in a simulated medical emergency

    National Research Council Canada - National Science Library

    Low, D; Clark, N; Soar, J; Padkin, A; Stoneham, A; Perkins, G. D; Nolan, J

    2011-01-01

    This study sought to determine whether using the Resuscitation Council UK’s iResus © application on a smart phone improves the performance of doctors trained in advanced life support in a simulated emergency...

  17. Ultra Performance Liquid Chromatography-Based Metabonomic Study of Therapeutic Effect of the Surface Layer of Poria cocos on Adenine-Induced Chronic Kidney Disease Provides New Insight into Anti-Fibrosis Mechanism: e59617

    National Research Council Canada - National Science Library

    Ying-Yong Zhao; Ya-Long Feng; Xu Bai; Xiao-Jie Tan; Rui-Chao Lin; Qibing Mei

    2013-01-01

    .... Ultra performance liquid chromatography/quadrupole time-of-flight high-sensitivity mass spectrometry and a novel mass spectrometryElevated Energy data collection technique was employed to investigate...

  18. Intratumoral genetic heterogeneity and number of cytogenetic aberrations provide additional prognostic significance in chronic lymphocytic leukemia.

    Science.gov (United States)

    Yi, Shuhua; Li, Zengjun; Zou, Dehui; An, Gang; Cui, Rui; Zhong, Shizhen; Li, Heng; Xiong, Wenjie; Li, Chenwen; Chen, Weiwei; Liu, Wei; Lv, Rui; Yu, Zhen; Wang, Huijun; Xu, Yan; Zhou, Keshu; Ru, Kun; Wang, Jianxiang; Cheng, Tao; Qiu, Lugui

    2017-02-01

    Chronic lymphocytic leukemia (CLL) is a heterogeneous disease with cytogenetic aberrations that are still considered the gold standard of prognostic factors. However, heterogeneity remains within each cytogenetic group, especially in patients with concomitant cytogenetic aberrations. A panel of DNA probes was used to detect cytogenetic aberrations, including RB1/D13S25 at 13q14, ATM at 11q22, TP53 at 17p13, CEP12 and IGH translocation at 14q32, by fluorescence in situ hybridization. A comprehensive method integrating the number of cytogenetic aberrations and intratumoral genetic heterogeneity was used to analyze the prognosis for patients with concomitant aberrations. Within the conventional favorable or neutral prognostic groups (i.e., with del 13q, trisomy 12, and/or t(14q32)), the coincidence of these three aberrations worsened survival in terms of time to first therapy, progression-free survival, and overall survival. However, within the conventional unfavorable prognostic group (i.e., del 11q or del 17p), patients with a minor unfavorable clone had an unexpected survival advantage compared with patients with a major unfavorable clone. A new cytogenetic prognostic system that integrates the number of cytogenetic aberrations and intratumoral genetic subclones was more precise than the conventional system. The number of cytogenetic aberrations and the size of intratumoral genetic subclones should be comprehensively considered to determine the prognosis for CLL.Genet Med 19 2, 182-191.

  19. A haemovigilance team provides both significant financial and quality benefits in a University Hospital.

    Science.gov (United States)

    Decadt, Ine; Costermans, Els; Van de Poel, Maai; Kesteloot, Katrien; Devos, Timothy

    2017-04-01

    Haemovigilance is the process of surveillance of blood transfusion procedures including unexpected hazards and reactions during the transfusion pathway in both donors and recipients. The haemovigilance team aims to increase blood transfusion safety and to decrease both morbidity and mortality in donors and recipients. The team collects data about transfusion reactions and incidents, instructs the involved health workers and assures the tracing of blood components. The haemovigilance team at the University Hospitals Leuven has played a pioneering role in the development of haemovigilance in Belgium Although the literature about safety and quality improvements by haemovigilance systems is abundant, there are no published data available measuring their financial impact in a hospital. Therefore, we studied the costs and returns of the haemovigilance team at the University Hospitals Leuven. This study has a descriptive explorative design. Research of the current costs and returns of the haemovigilance team were based upon data from the Medical Administration of the hospital. Data were analyzed descriptively. The haemovigilance team of the University Hospitals Leuven is financially viable: the direct costs are covered by the annual financial support of the National Public Health Service. The indirect returns come from two important tasks of the haemovigilance team itself: correction of the electronic registration of administered blood component and improvement of the return of conform preserved blood components to the blood bank. Besides safety and quality improvement, which are obviously their main goals, the haemovigilance team also implies a financial benefit for the hospital. Copyright © 2016 Elsevier Ltd. All rights reserved.

  20. Providing plastic zone extrusion

    Science.gov (United States)

    Manchiraju, Venkata Kiran; Feng, Zhili; David, Stan A.; Yu, Zhenzhen

    2017-04-11

    Plastic zone extrusion may be provided. First, a compressor may generate frictional heat in stock to place the stock in a plastic zone of the stock. Then, a conveyer may receive the stock in its plastic zone from the compressor and transport the stock in its plastic zone from the compressor. Next, a die may receive the stock in its plastic zone from the conveyer and extrude the stock to form a wire.

  1. Statistically significant relational data mining :

    Energy Technology Data Exchange (ETDEWEB)

    Berry, Jonathan W.; Leung, Vitus Joseph; Phillips, Cynthia Ann; Pinar, Ali; Robinson, David Gerald; Berger-Wolf, Tanya; Bhowmick, Sanjukta; Casleton, Emily; Kaiser, Mark; Nordman, Daniel J.; Wilson, Alyson G.

    2014-02-01

    This report summarizes the work performed under the project (3z(BStatitically significant relational data mining.(3y (BThe goal of the project was to add more statistical rigor to the fairly ad hoc area of data mining on graphs. Our goal was to develop better algorithms and better ways to evaluate algorithm quality. We concetrated on algorithms for community detection, approximate pattern matching, and graph similarity measures. Approximate pattern matching involves finding an instance of a relatively small pattern, expressed with tolerance, in a large graph of data observed with uncertainty. This report gathers the abstracts and references for the eight refereed publications that have appeared as part of this work. We then archive three pieces of research that have not yet been published. The first is theoretical and experimental evidence that a popular statistical measure for comparison of community assignments favors over-resolved communities over approximations to a ground truth. The second are statistically motivated methods for measuring the quality of an approximate match of a small pattern in a large graph. The third is a new probabilistic random graph model. Statisticians favor these models for graph analysis. The new local structure graph model overcomes some of the issues with popular models such as exponential random graph models and latent variable models.

  2. Providing Compassion through Flow

    Directory of Open Access Journals (Sweden)

    Lydia Royeen

    2015-07-01

    Full Text Available Meg Kral, MS, OTR/L, CLT, is the cover artist for the Summer 2015 issue of The Open Journal of Occupational Therapy. Her untitled piece of art is an oil painting and is a re-creation of a photograph taken while on vacation. Meg is currently supervisor of outpatient services at Rush University Medical Center. She is lymphedema certified and has a specific interest in breast cancer lymphedema. Art and occupational therapy serve similar purposes for Meg: both provide a sense of flow. She values the outcomes, whether it is a piece of art or improved functional status

  3. Providing Contraception to Adolescents.

    Science.gov (United States)

    Raidoo, Shandhini; Kaneshiro, Bliss

    2015-12-01

    Adolescents have high rates of unintended pregnancy and face unique reproductive health challenges. Providing confidential contraceptive services to adolescents is important in reducing the rate of unintended pregnancy. Long-acting contraception such as the intrauterine device and contraceptive implant are recommended as first-line contraceptives for adolescents because they are highly effective with few side effects. The use of barrier methods to prevent sexually transmitted infections should be encouraged. Adolescents have limited knowledge of reproductive health and contraceptive options, and their sources of information are often unreliable. Access to contraception is available through a variety of resources that continue to expand. Copyright © 2015 Elsevier Inc. All rights reserved.

  4. Ysla S. Catalina & Providence

    OpenAIRE

    Diazgranados, Carlos Nicolás; Torres Carreño, Guillermo Andrés; Castell, Edmon; Moreno, Santiago; Ramirez, Natalia

    2010-01-01

    Esta Hoja de Mano pertenece a la exposición temporal "Ysla S. Catalina & Providence". Contiene un resumen histórico de las Islas de Santa Catalina y Providencia en los idiomas inglés y español y un mapa del siglo VI que lo hace más didáctico apoyado por figuras recortables. Esta muestra hace parte del proyecto IDA y VUELTA del Sistema de Patrimonio Cultural y Museos SPM que gestiona la descentralización del patrimonio cultural de la Universidad Nacional de Colombia a otras ciudades del pa...

  5. 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

  6. 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.

  7. Significant improvements in children's health.

    Science.gov (United States)

    Tam, L

    1994-01-01

    The field report from PLAN field offices in Sucre and Altiplano in Bolivia, Santo Domingo in the Dominican Republic, and Amatitlan in Guatemala provides a summary of survey results pertaining to diarrheal disease control, immunizations, and nutrition. The PLAN sites are rural with the exception of the periurban slum surrounding Santo Domingo, which has better access to health services. Interviews were conducted among mothers with children aged 0-23 months in project areas, with the exception of Altiplano and Santo Domingo which included nonproject areas for comparative purposes. The results for diarrhea disease control are that an estimated 90% of episodes can be successfully treated at home. Evaluation is made of the timeliness and coverage of immunizations, the degree of management of diarrhea at home and at the health facility, and the extent of exclusive breast feeding in the first 4 months, and total breast feeding with food supplementation in the first year of life. The conclusion is that the four field offices make a significant and positive impact on children aged 0-23 months.

  8. Statistical significance for hierarchical clustering.

    Science.gov (United States)

    Kimes, Patrick K; Liu, Yufeng; Neil Hayes, David; Marron, James Stephen

    2017-09-01

    Cluster analysis has proved to be an invaluable tool for the exploratory and unsupervised analysis of high-dimensional datasets. Among methods for clustering, hierarchical approaches have enjoyed substantial popularity in genomics and other fields for their ability to simultaneously uncover multiple layers of clustering structure. A critical and challenging question in cluster analysis is whether the identified clusters represent important underlying structure or are artifacts of natural sampling variation. Few approaches have been proposed for addressing this problem in the context of hierarchical clustering, for which the problem is further complicated by the natural tree structure of the partition, and the multiplicity of tests required to parse the layers of nested clusters. In this article, we propose a Monte Carlo based approach for testing statistical significance in hierarchical clustering which addresses these issues. The approach is implemented as a sequential testing procedure guaranteeing control of the family-wise error rate. Theoretical justification is provided for our approach, and its power to detect true clustering structure is illustrated through several simulation studies and applications to two cancer gene expression datasets. © 2017, The International Biometric Society.

  9. 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...

  10. Reputational concerns with altruistic providers.

    Science.gov (United States)

    Olivella, Pau; Siciliani, Luigi

    2017-09-01

    We study a model of reputational concerns when doctors differ in their degree of altruism and they can signal their altruism by their (observable) quality. When reputational concerns are high, following the introduction or enhancement of public reporting, the less altruistic (bad) doctor mimics the more altruistic (good) doctor. Otherwise, either a separating or a semi-separating equilibrium arises: the bad doctor mimics the good doctor with probability less than one. Pay-for-performance incentive schemes are unlikely to induce crowding out, unless some dimensions of quality are unobservable. Under the pooling equilibrium a purchaser can implement the first-best quality by appropriately choosing a simple payment scheme with a fixed price per unit of quality provided. This is not the case under the separating equilibrium. Therefore, policies that enhance public reporting complement pay-for-performance schemes. Copyright © 2017 Elsevier B.V. All rights reserved.

  11. Preparing to provide MTM services.

    Science.gov (United States)

    Glenn, Zandra M; Mahdavian, Soheyla L; Woodard, Todd J

    2015-02-01

    Medication Therapy Management (MTM) has been a way for pharmacist to enhance their position as an integral member of the health care team as the need for improved clinical and economic outcomes in relation to the US health care system became apparent. MTM Certificate training programs are provided by numerous organizations. Collaboration Practice Agreements (CPA) are gaining significance as the role of the pharmacist is expanding in the care of patients as part of a multidisciplinary health care team. One major hurdle that many pharmacists are faced with is receiving reimbursement for the services provided. The Medicare Modernization Act of 2003 recognized that pharmacists play an important role in the management of patient care and that pharmacists bring an expertise and knowledge that will help to identify and resolve patient medication therapy problems. © The Author(s) 2014.

  12. Providing global WLCG transfer monitoring

    CERN Document Server

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

  13. Structural significance of mechanical damage.

    Science.gov (United States)

    2012-05-01

    The letter transmits the Final Report for work completed under US DOT PHMSA Other Transaction Agreement (OTA) DTPH56-08-T-000011, Structural Significance of Mechanical Damage. The project was implemented to develop a detailed experimental database on...

  14. Historical Significant Volcanic Eruption Locations

    Data.gov (United States)

    Department of Homeland Security — A significant eruption is classified as one that meets at least one of the following criteriacaused fatalities, caused moderate damage (approximately $1 million or...

  15. Astronomical Significance of Ancient Monuments

    Science.gov (United States)

    Simonia, I.

    2011-06-01

    Astronomical significance of Gokhnari megalithic monument (eastern Georgia) is considered. Possible connection of Amirani ancient legend with Gokhnari monument is discussed. Concepts of starry practicality and solar stations are proposed.

  16. Fostering significant learning in graduate nursing education.

    Science.gov (United States)

    Marrocco, Geraldine F

    2014-03-01

    Faculty who want to energize graduate students with creative classes that lead to long-lasting learning will benefit by designing course objectives, learning activities, and assessment tools using Fink's taxonomy of significant learning and Wiggins's insights on performance-based or educative assessments. Research shows that course designs relying on content-driven lectures and written examinations do not promote significant learning among adult learners. This article reviews six types of significant learning using Fink's taxonomy and examines Wiggins's "backward" approach to designing courses using performance-based assessments that gauge true learning and learning that promotes a lasting change. When designing courses, educators should ask: "What do I really want students to get out of this course?" The answers will direct the design of objectives, learning activities, and assessment tools. Designing graduate courses using Fink's taxonomy and Wiggins's backward approach can lead to significant learning to better prepare nurse practitioners for the future of health care. Copyright 2014, SLACK Incorporated.

  17. How do we make sense of significance?

    DEFF Research Database (Denmark)

    Lyhne, Ivar; Kørnøv, Lone

    2013-01-01

    ' 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......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...

  18. 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…

  19. Urban building recognition during significant temporal variations

    DEFF Research Database (Denmark)

    Nguyen, Phuong Giang; Andersen, Hans Jørgen

    2008-01-01

    features (Multi-scale Oriented Patches) in [2], which extract features of patches around interest points. To speed up the searching process, we employ the vocabulary tree based search technique in [12]. Our final system shows high performance in recognizing buildings under significant temporal variations...

  20. Chemical and Biological Significance of Naturally Occurring ...

    African Journals Online (AJOL)

    PROF HORSFALL

    and www.bioline.org.br/j a. Chemical and Biological Significance of Naturally Occurring Additives on. African Black Soap and its Performance. IKOTUN, A. ADEBOMI; OGUNDELE, O. FISAYO; KAYODE, O. MOBOLAJI;. *AJAELU, C. JOHN. Department of Chemistry and Industrial Chemistry, Bowen Univeristy, Iwo, Nigeria.

  1. The historical significance of oak

    Science.gov (United States)

    J. V. Thirgood

    1971-01-01

    A brief history of the importance of oak in Europe, contrasting the methods used in France and Britain to propagate the species and manage the forests for continued productivity. The significance of oak as a strategic resource during the sailing-ship era is stressed, and mention is made of the early development of oak management in North America. The international...

  2. Ecological Significance of Marine Microzooplankton

    Digital Repository Service at National Institute of Oceanography (India)

    Godhantaraman, N.

    ). Studies concerning microzooplankton in marine coastal, estuarine and brackish-water systems along tropical Indian waters are limited. Hence, in the following sections, I provide the results obtained by the research conducted in the tropical Vellar... estuarine systems, southeast coast of India. This was one of the first comprehensive studies on microzooplankton in India. There are also comparative accounts of microzooplankton researches from my studies in Japanese coastal marine waters. Microzooplankton...

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

    African Journals Online (AJOL)

    reported data on perceived outcomes and quality of services, and a discharge form that gathers data on the type of ... 6 Department of Psychology, Virginia Commonwealth University, Richmond, Virginia, USA. Corresponding author: B Myers .... processes: 'We had a big question mark as to where exactly and in which week.

  4. Electrolysis Propulsion Provides High-Performance, Inexpensive, Clean Spacecraft Propulsion

    Science.gov (United States)

    deGroot, Wim A.

    1999-01-01

    An electrolysis propulsion system consumes electrical energy to decompose water into hydrogen and oxygen. These gases are stored in separate tanks and used when needed in gaseous bipropellant thrusters for spacecraft propulsion. The propellant and combustion products are clean and nontoxic. As a result, costs associated with testing, handling, and launching can be an order of magnitude lower than for conventional propulsion systems, making electrolysis a cost-effective alternative to state-of-the-art systems. The electrical conversion efficiency is high (>85 percent), and maximum thrust-to-power ratios of 0.2 newtons per kilowatt (N/kW), a 370-sec specific impulse, can be obtained. A further advantage of the water rocket is its dual-mode potential. For relatively high thrust applications, the system can be used as a bipropellant engine. For low thrust levels and/or small impulse bit requirements, cold gas oxygen can be used alone. An added innovation is that the same hardware, with modest modifications, can be converted into an energy-storage and power-generation fuel cell, reducing the spacecraft power and propulsion system weight by an order of magnitude.

  5. Clinical significance of neonatal menstruation.

    Science.gov (United States)

    Brosens, Ivo; Benagiano, Giuseppe

    2016-01-01

    Past studies have clearly shown the existence of a spectrum of endometrial progesterone responses in neonatal endometrium, varying from proliferation to full decidualization with menstrual-like shedding. The bleedings represent, similar to what occurs in adult menstruation, a progesterone withdrawal bleeding. Today, the bleeding is completely neglected and considered an uneventful episode of no clinical significance. Yet clinical studies have linked the risk of bleeding to a series of events indicating fetal distress. The potential link between the progesterone response and major adolescent disorders requires to be investigated by prospective studies. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  6. Moral significance of phenomenal consciousness.

    Science.gov (United States)

    Levy, Neil; Savulescu, Julian

    2009-01-01

    Recent work in neuroimaging suggests that some patients diagnosed as being in the persistent vegetative state are actually conscious. In this paper, we critically examine this new evidence. We argue that though it remains open to alternative interpretations, it strongly suggests the presence of consciousness in some patients. However, we argue that its ethical significance is less than many people seem to think. There are several different kinds of consciousness, and though all kinds of consciousness have some ethical significance, different kinds underwrite different kinds of moral value. Demonstrating that patients have phenomenal consciousness--conscious states with some kind of qualitative feel to them--shows that they are moral patients, whose welfare must be taken into consideration. But only if they are subjects of a sophisticated kind of access consciousness--where access consciousness entails global availability of information to cognitive systems--are they persons, in the technical sense of the word employed by philosophers. In this sense, being a person is having the full moral status of ordinary human beings. We call for further research which might settle whether patients who manifest signs of consciousness possess the sophisticated kind of access consciousness required for personhood.

  7. Monoclonal gammopathies of renal significance.

    Science.gov (United States)

    Caravaca-Fontán, Fernando; Gutiérrez, Eduardo; Delgado Lillo, Ramón; Praga, Manuel

    The term monoclonal gammopathy of renal significance (MGRS) comprises a group of diseases pathogenetically characterised by proliferation of a B-cell or plasma cell clone that synthesises and secretes a monoclonal immunoglobulin or its components (light and/or heavy chains), that may deposit and cause glomerular, tubular, interstitial and/or vascular damage. The importance of differentiating the term MGRS from other monoclonal gammopathies lies in the fact that diagnostic and therapeutic procedures aimed at controlling monoclonal protein synthesis and secretion can be indicated, irrespective of the classic criteria based on malignant tumour expansion. Renal pathology associated with MGRS is highly heterogeneous, and therefore renal biopsy should be considered a key diagnostic tool. A precise diagnostic approach, however, must also identify the monoclonal protein in plasma and/or in urine, together with a complete haematological study in order to determine the nature and extension of cell clones. Recent advances in the understanding of these entities have resulted in significant improvements in clinical course and survival in several forms of MGRS, although more studies and clinical experience are needed in order to delineate more effective therapeutic strategies. In this review, we summarise the main clinical and pathological features of MGRS, highlighting the most appropriate diagnostic approach and current therapeutic options. Copyright © 2017 Sociedad Española de Nefrología. Published by Elsevier España, S.L.U. All rights reserved.

  8. 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

  9. Clinical significance of precipitous labor.

    Science.gov (United States)

    Suzuki, Shunji

    2015-03-01

    Precipitous labor is defined as expulsion of the fetus within less than 3 hours of commencement of regular contractions. We retrospectively examined our cases of precipitous labor to identify the clinical significance and perinatal outcomes following precipitous labor in singleton vertex deliveries. A retrospective population-based study was conducted comparing women with singleton precipitous labor and those with labor of normal duration. We examined the clinical characteristics and outcomes by comparing patients with precipitous labor and those with labor of normal duration in 0 and two-parous singleton pregnant women. Using a multivariate analysis, precipitous labor in nulliparous women was independently associated with teenagers (adjusted OR: 1.71, 95% CI: 0.99 - 2.95, P = 0.049), preterm delivery (adjusted OR: 1.77, 95% CI: 1.16 - 2.70, P precipitous labor was associated with hypertensive disorders in singleton vertex deliveries, it was not associated with maternal or neonatal outcomes.

  10. The significance of constitutional values

    Directory of Open Access Journals (Sweden)

    HN Nisihara

    2001-12-01

    Full Text Available This article addresses the question of the meaning and legal significance of constitutional values in contemporary times. The article attends also to related questions namely, what constitute “constitutional values” and what are the limitations of the meaning afforded to this notion. Attention is paid in the particular, to freedom, equality and democracy as value-neutral criteria of fairness and government neutrality with reference to the South African and German contexts as well as to value-neutrality as a culturally conditioned value. The author concludes with a cosmopolitan view of freedom and the right to peace with reference to the constitutional texts of Japan and the United States.

  11. Determining Semantically Related Significant Genes.

    Science.gov (United States)

    Taha, Kamal

    2014-01-01

    GO relation embodies some aspects of existence dependency. If GO term xis existence-dependent on GO term y, the presence of y implies the presence of x. Therefore, the genes annotated with the function of the GO term y are usually functionally and semantically related to the genes annotated with the function of the GO term x. A large number of gene set enrichment analysis methods have been developed in recent years for analyzing gene sets enrichment. However, most of these methods overlook the structural dependencies between GO terms in GO graph by not considering the concept of existence dependency. We propose in this paper a biological search engine called RSGSearch that identifies enriched sets of genes annotated with different functions using the concept of existence dependency. We observe that GO term xcannot be existence-dependent on GO term y, if x- and y- have the same specificity (biological characteristics). After encoding into a numeric format the contributions of GO terms annotating target genes to the semantics of their lowest common ancestors (LCAs), RSGSearch uses microarray experiment to identify the most significant LCA that annotates the result genes. We evaluated RSGSearch experimentally and compared it with five gene set enrichment systems. Results showed marked improvement.

  12. Home Care Providers to the Rescue

    DEFF Research Database (Denmark)

    Hansen, Steen M; 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...

  13. Null hypothesis significance testing: a short tutorial

    Science.gov (United States)

    Pernet, Cyril

    2016-01-01

    Although thoroughly criticized, null hypothesis significance testing (NHST) remains the statistical method of choice used to provide evidence for an effect, in biological, biomedical and social sciences. In this short tutorial, I first summarize the concepts behind the method, distinguishing test of significance (Fisher) and test of acceptance (Newman-Pearson) and point to common interpretation errors regarding the p-value. I then present the related concepts of confidence intervals and again point to common interpretation errors. Finally, I discuss what should be reported in which context. The goal is to clarify concepts to avoid interpretation errors and propose reporting practices. PMID:29067159

  14. Querying Data Providing Web Services

    OpenAIRE

    Sabesan, Manivasakan

    2010-01-01

    Web services are often used for search computing where data is retrieved from servers providing information of different kinds. Such data providing web services return a set of objects for a given set of parameters without any side effects. There is need to enable general and scalable search capabilities of data from data providing web services, which is the topic of this Thesis. The Web Service MEDiator (WSMED) system automatically provides relational views of any data providing web service ...

  15. Systematic identification of statistically significant network measures

    Science.gov (United States)

    Ziv, Etay; Koytcheff, Robin; Middendorf, Manuel; Wiggins, Chris

    2005-01-01

    We present a graph embedding space (i.e., a set of measures on graphs) for performing statistical analyses of networks. Key improvements over existing approaches include discovery of “motif hubs” (multiple overlapping significant subgraphs), computational efficiency relative to subgraph census, and flexibility (the method is easily generalizable to weighted and signed graphs). The embedding space is based on scalars, functionals of the adjacency matrix representing the network. Scalars are global, involving all nodes; although they can be related to subgraph enumeration, there is not a one-to-one mapping between scalars and subgraphs. Improvements in network randomization and significance testing—we learn the distribution rather than assuming Gaussianity—are also presented. The resulting algorithm establishes a systematic approach to the identification of the most significant scalars and suggests machine-learning techniques for network classification.

  16. 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.

  17. Choosing a primary care provider

    Science.gov (United States)

    ... Supplements Videos & Tools Español You Are Here: Home → Medical Encyclopedia → Choosing a primary care provider URL of this page: //medlineplus.gov/ency/article/001939.htm Choosing a primary care provider To ...

  18. Types of health care providers

    Science.gov (United States)

    ... Supplements Videos & Tools Español You Are Here: Home → Medical Encyclopedia → Types of health care providers URL of this page: //medlineplus.gov/ency/article/001933.htm Types of health care providers To ...

  19. 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.

  20. 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.

  1. Systematic errors in estimation of gravitational-wave candidate significance

    Science.gov (United States)

    Capano, C.; Dent, T.; Hanna, C.; Hendry, M.; Messenger, C.; Hu, Y.-M.; Veitch, J.

    2017-10-01

    The statistical significance of a candidate gravitational-wave (GW) event is crucial to the prospects for a confirmed detection, or for its selection as a candidate for follow-up electromagnetic observation. To determine the significance of a GW candidate, a ranking statistic is evaluated and compared to an empirically-estimated background distribution, yielding a false alarm probability or p -value. The reliability of this background estimate is limited by the number of background samples and by the fact that GW detectors cannot be shielded from signals, making it impossible to identify a pure background data set. Different strategies have been proposed: in one method, all samples, including potential signals, are included in the background estimation, whereas in another method, coincidence removal is performed in order to exclude possible signals from the estimated background. Here we report on a mock data challenge, performed prior to the first detections of GW signals by Advanced LIGO, to compare these two methods. The all-samples method is found to be self-consistent in terms of the rate of false positive detection claims, but its p -value estimates are systematically conservative and subject to higher variance. Conversely, the coincidence-removal method yields a mean-unbiased estimate of the p -value but sacrifices self-consistency. We provide a simple formula for the uncertainty in estimate significance and compare it to mock data results. Finally, we discuss the use of different methods in claiming the detection of GW signals.

  2. Providing for the Future: Providers' Views on Apprenticeship Reform

    Science.gov (United States)

    McCrone, Tami; Sims, David; Gladding, Cath

    2016-01-01

    Apprenticeships are currently undergoing reform in England. Funding mechanisms and the content of Apprenticeship programmes are being restructured. NFER and the Association of Employment and Learning Providers (AELP) have carried out a joint research project to inform future policy and practice with evidence on how providers of Apprenticeships are…

  3. Significant Attenuation of Lightly Damped Resonances Using Particle Dampers

    Science.gov (United States)

    Smith, Andrew; LaVerde, Bruce; Hunt, Ron; Knight, Joseph Brent

    2015-01-01

    When equipment designs must perform in a broad band vibration environment it can be difficult to avoid resonances that affect life and performance. This is especially true when an organization seeks to employ an asset from a heritage design in a new, more demanding vibration environment. Particle dampers may be used to provide significant attenuation of lightly damped resonances to assist with such a deployment of assets by including only a very minor set of modifications. This solution may be easier to implement than more traditional attenuation schemes. Furthermore, the cost in additional weight to the equipment can be very small. Complexity may also be kept to a minimum, because the particle dampers do not require tuning. Attenuating the vibratory response with particle dampers may therefore be simpler (in a set it and forget it kind of way) than tuned mass dampers. The paper will illustrate the use of an "equivalent resonance test jig" that can assist designers in verifying the potential resonance attenuation that may be available to them during the early trade stages of the design. An approach is suggested for transforming observed attenuation in the jig to estimated performance in the actual service design. KEY WORDS: Particle Damper, Performance in Vibration Environment, Damping, Resonance, Attenuation, Mitigation of Vibration Response, Response Estimate, Response Verification.

  4. Social significance of community structure: statistical view.

    Science.gov (United States)

    Li, Hui-Jia; Daniels, Jasmine J

    2015-01-01

    Community structure analysis is a powerful tool for social networks that can simplify their topological and functional analysis considerably. However, since community detection methods have random factors and real social networks obtained from complex systems always contain error edges, evaluating the significance of a partitioned community structure is an urgent and important question. In this paper, integrating the specific characteristics of real society, we present a framework to analyze the significance of a social community. The dynamics of social interactions are modeled by identifying social leaders and corresponding hierarchical structures. Instead of a direct comparison with the average outcome of a random model, we compute the similarity of a given node with the leader by the number of common neighbors. To determine the membership vector, an efficient community detection algorithm is proposed based on the position of the nodes and their corresponding leaders. Then, using a log-likelihood score, the tightness of the community can be derived. Based on the distribution of community tightness, we establish a connection between p-value theory and network analysis, and then we obtain a significance measure of statistical form . Finally, the framework is applied to both benchmark networks and real social networks. Experimental results show that our work can be used in many fields, such as determining the optimal number of communities, analyzing the social significance of a given community, comparing the performance among various algorithms, etc.

  5. Analysis of inter-provider conflicts among healthcare providers

    OpenAIRE

    Stecker, Mona; Epstein, Nancy; Mark M Stecker; Ausman, James I.; Harrigan, Noyes

    2013-01-01

    Background: Patient safety is a top priority of healthcare organizations. The Joint Commission (TJC) is now requiring that healthcare organizations promulgate polices to investigate and resolve disruptive behavior among employees. Methods: Our aims in this investigation utilizing the Provider Conflict Questionnaire (PCQ: Appendix A) included; determining what conflicts exist among a large sample of healthcare providers, how to assess the extent and frequency of disruptive behaviors, and what ...

  6. Babesiosis for Health Care Providers

    Centers for Disease Control (CDC) Podcasts

    2012-04-25

    This podcast will educate health care providers on diagnosing babesiosis and providing patients at risk with tick bite prevention messages.  Created: 4/25/2012 by Center for Global Health, Division of Parasitic Diseases and Malaria.   Date Released: 4/25/2012.

  7. Significance of surgical management for cystic prolactinoma.

    Science.gov (United States)

    Ogiwara, Toshihiro; Horiuchi, Tetsuyoshi; Nagm, Alhusain; Goto, Tetsuya; Hongo, Kazuhiro

    2017-04-01

    It is generally accepted that dopamine agonists (DA) represent the first-line treatment for most patients with prolactinoma, and patients become candidates for surgical intervention when DA is contraindicated. Surgical indication for cystic prolactinoma remains controversial. This study was performed to investigate the significance of surgery for cystic prolactinoma. A total of 28 patients that underwent transsphenoidal resection of prolactinoma between February 2004 and May 2016 were reviewed. Five consecutive patients with cystic prolactinoma were included in this study. Our surgical strategy for cystic prolactinoma was categorized as follows: first, when the purpose of surgical resection was normalization of the prolactin level, aggressive resection was performed; second, when volume reduction was essential to relieve the visual symptoms and headache, internal decompression was performed followed by DA therapy. The clinical outcomes were analyzed accordingly. All cystic prolactinoma were resected via the transsphenoidal approach without any complications, and all symptoms including visual impairment and hypogonadal activity were finally relieved combined with medication. Surgery for cystic prolactinoma could be a better option. Transsphenoidal surgery is relatively safe to remove the cystic prolactinoma, additionally it can normalize the prolactine level and achieve adequate and rapid decompression of optic chiasm. The risk of transsphenoidal surgery is highly dependent on the skill of the surgeon and treatment decision for cystic prolactinoma needs to be individualized for each patient.

  8. Coordination of primary care providers.

    Science.gov (United States)

    Hettler, D L; McAlister, W H

    1988-02-01

    Surveys were sent to family physicians in Illinois to determine knowledge and attitude concerning optometry. The respondents were knowledgeable in certain aspects of optometry. However, many need to become more aware of the optometrist as a health care provider.

  9. Medicare Referring Provider DMEPOS PUF

    Data.gov (United States)

    U.S. Department of Health & Human Services — This dataset, which is part of CMSs Medicare Provider Utilization and Payment Data, details information on Durable Medical Equipment, Prosthetics, Orthotics and...

  10. Seeing Your Health Care Provider

    Science.gov (United States)

    ... Reduce Font Size 100% Increase Font Size Positive Spin Basics Federal Response Digital Tools Events Blog Home ... that may assist you. Be on time. Most healthcare providers have full appointment schedules—if you are ...

  11. EAMJ Provider April 10.indd

    African Journals Online (AJOL)

    2010-04-04

    Apr 4, 2010 ... with breast cancer is known to result in more adverse outcomes (1). ... Objective: To determine the extent and nature of provider delay in breast cancer management at .... and calls for a review of booking procedures. Also.

  12. TERRAIN, PROVIDENCE COUNTY, RHODE ISLAND

    Data.gov (United States)

    Federal Emergency Management Agency, Department of Homeland Security — The Providence AOI consists of the costal portion of the county, and meshes up seamlessly with the Kent county AOI directly south. Ground Control is collected...

  13. Lodging Update: Providence, Rhode Island

    Directory of Open Access Journals (Sweden)

    Ragel Roginsky

    2013-04-01

    Full Text Available Each quarter, Pinnacle Advisory Group prepares an analysis of the New England lodging industry, which provides a regional summary and then focuses in depth on a particular market. These reviews look at recent and proposed supply changes, factors affecting demand and growth rates, and the effects of interactions between such supply and demand trends. In this issue, the authors spotlight the lodging market in Providence, Rhode Island.

  14. 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.

  15. The early social significance of shared ritual actions.

    Science.gov (United States)

    Liberman, Zoe; Kinzler, Katherine D; Woodward, Amanda L

    2018-02-01

    Many rituals are socially stipulated such that engaging in a group's rituals can fundamentally signal membership in that group. Here, we asked whether infants infer information about people's social affiliation based on whether those people perform the same ritualistic action versus different actions. We presented 16-month-old infants with two people who used the same object to achieve the same goal: turning on a light. In a first study, the actions that the actors used to turn on the light had key properties of ritual: they were not causally necessary to reach the overall goal, and there were no features of the situation that required doing the particular actions. We varied whether the two actors performed the same action or performed different actions to turn on the light. Infants expected people who used the same ritualistic action to be more likely to affiliate than people who used different actions. A second study indicated that these results were not due to perceptual similarity: when the differences in the actors' actions were not marked by properties of ritual, but were instead due to situational constraints, infants expected the actors to affiliate. Thus, infants understand the social significance of people engaging in common, potentially ritualistic actions, and expect these actions to provide information about third-party social relationships. Copyright © 2017 Elsevier B.V. All rights reserved.

  16. A nonparametric significance test for sampled networks.

    Science.gov (United States)

    Elliott, Andrew; Leicht, Elizabeth; Whitmore, Alan; Reinert, Gesine; Reed-Tsochas, Felix

    2018-01-01

    Our work is motivated by an interest in constructing a protein-protein interaction network that captures key features associated with Parkinson's disease. While there is an abundance of subnetwork construction methods available, it is often far from obvious which subnetwork is the most suitable starting point for further investigation. We provide a method to assess whether a subnetwork constructed from a seed list (a list of nodes known to be important in the area of interest) differs significantly from a randomly generated subnetwork. The proposed method uses a Monte Carlo approach. As different seed lists can give rise to the same subnetwork, we control for redundancy by constructing a minimal seed list as the starting point for the significance test. The null model is based on random seed lists of the same length as a minimum seed list that generates the subnetwork; in this random seed list the nodes have (approximately) the same degree distribution as the nodes in the minimum seed list. We use this null model to select subnetworks which deviate significantly from random on an appropriate set of statistics and might capture useful information for a real world protein-protein interaction network. The software used in this paper are available for download at https://sites.google.com/site/elliottande/. The software is written in Python and uses the NetworkX library. ande.elliott@gmail.com or felix.reed-tsochas@sbs.ox.ac.uk. Supplementary data are available at Bioinformatics online.

  17. Ecosystem services provided by waterbirds.

    Science.gov (United States)

    Green, Andy J; Elmberg, Johan

    2014-02-01

    Ecosystem services are ecosystem processes that directly or indirectly benefit human well-being. There has been much recent literature identifying different services and the communities and species that provide them. This is a vital first step towards management and maintenance of these services. In this review, we specifically address the waterbirds, which play key functional roles in many aquatic ecosystems, including as predators, herbivores and vectors of seeds, invertebrates and nutrients, although these roles have often been overlooked. Waterbirds can maintain the diversity of other organisms, control pests, be effective bioindicators of ecological conditions, and act as sentinels of potential disease outbreaks. They also provide important provisioning (meat, feathers, eggs, etc.) and cultural services to both indigenous and westernized societies. We identify key gaps in the understanding of ecosystem services provided by waterbirds and areas for future research required to clarify their functional role in ecosystems and the services they provide. We consider how the economic value of these services could be calculated, giving some examples. Such valuation will provide powerful arguments for waterbird conservation. © 2013 The Authors. Biological Reviews © 2013 Cambridge Philosophical Society.

  18. Ancillary Services Provided from DER

    Energy Technology Data Exchange (ETDEWEB)

    Campbell, J.B.

    2005-12-21

    Distributed energy resources (DER) are quickly making their way to industry primarily as backup generation. They are effective at starting and then producing full-load power within a few seconds. The distribution system is aging and transmission system development has not kept up with the growth in load and generation. The nation's transmission system is stressed with heavy power flows over long distances, and many areas are experiencing problems in providing the power quality needed to satisfy customers. Thus, a new market for DER is beginning to emerge. DER can alleviate the burden on the distribution system by providing ancillary services while providing a cost adjustment for the DER owner. This report describes 10 types of ancillary services that distributed generation (DG) can provide to the distribution system. Of these 10 services the feasibility, control strategy, effectiveness, and cost benefits are all analyzed as in the context of a future utility-power market. In this market, services will be provided at a local level that will benefit the customer, the distribution utility, and the transmission company.

  19. 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.

  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. Provider practice characteristics that promote interpersonal continuity.

    Science.gov (United States)

    Mittelstaedt, Tyler S; Mori, Motomi; Lambert, William E; Saultz, John W

    2013-01-01

    Becoming certified as a patient-centered medical home now requires practices to measure how effectively they provide continuity of care. To understand how continuity can be improved, we studied the association between provider practice characteristics and interpersonal continuity using the Usual Provider Continuity Index (UPC). We conducted a mixed-methods study of the relationship between provider practice characteristics and UPC in 4 university-based family medicine clinics. For the quantitative part of the study, we analyzed data extracted from monthly provider performance reports for 63 primary care providers (PCPs) between July 2009 and June 2010. We tested the association of 5 practice parameters on UPC: (1) clinic frequency; (2) panel size; (3) patient load (ratio of panel size to clinic frequency); (4) attendance ratio; and (5) duration in practice (number of years working in the current practice). Clinic, care team, provider sex, and provider type (physicians versus nonphysician providers) were analyzed as covariates. Simple and multiple linear regressions were used for statistical modeling. Findings from the quantitative part of the study were validated using qualitative data from provider focus groups that were analyzed using sequential thematic coding. There were strong linear associations between UPC and both clinic frequency (β = 0.94; 95% CI, 0.62-1.27) and patient load (β = -0.37; 95% CI, -0.48 to -0.26). A multiple linear regression including clinic frequency, patient load, duration in practice, and provider type explained more than 60% of the variation in UPC (adjusted R(2) = 0.629). UPC for nurse practitioners and physician assistants was more strongly dependent on clinic frequency and was at least as high as it was for physicians. Focus groups identified 6 themes as other potential sources of variability in UPC. Variability in UPC between providers is strongly correlated with variables that can be modified by practice managers. Our study

  2. Splitting the BLOSUM Score into Numbers of Biological Significance

    Directory of Open Access Journals (Sweden)

    Tossi Alessandro

    2007-01-01

    Full Text Available Mathematical tools developed in the context of Shannon information theory were used to analyze the meaning of the BLOSUM score, which was split into three components termed as the BLOSUM spectrum (or BLOSpectrum. These relate respectively to the sequence convergence (the stochastic similarity of the two protein sequences, to the background frequency divergence (typicality of the amino acid probability distribution in each sequence, and to the target frequency divergence (compliance of the amino acid variations between the two sequences to the protein model implicit in the BLOCKS database. This treatment sharpens the protein sequence comparison, providing a rationale for the biological significance of the obtained score, and helps to identify weakly related sequences. Moreover, the BLOSpectrum can guide the choice of the most appropriate scoring matrix, tailoring it to the evolutionary divergence associated with the two sequences, or indicate if a compositionally adjusted matrix could perform better.

  3. 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.

  4. Providing Southern Perspectives on CSR

    DEFF Research Database (Denmark)

    Jeppesen, Søren; Kothuis, Bas

    The article seeks to contribute to the SMEs and CSR literature in developing countries by providing; a) a ‘Southern’ SME perspective, which includes the voices of managers and workers, b) a perspective of CSR, which opens up to informal CSR practices that SMEs undertake, and c) an analysis...

  5. Wind Turbine Providing Grid Support

    DEFF Research Database (Denmark)

    2011-01-01

    A variable speed wind turbine is arranged to provide additional electrical power to counteract non-periodic disturbances in an electrical grid. A controller monitors events indicating a need to increase the electrical output power from the wind turbine to the electrical grid. The controller...

  6. Narratives of Ghanaian abortion providers

    African Journals Online (AJOL)

    AJRH Managing Editor

    Michigan, Department of Women's Studies, Ann Arbor, MI, USA; 7University of Michigan, Department of Obstetrics and. Gynaecology, Ann Arbor, MI USA ..... personal spending habits of physicians who were known to provide abortion – a new ..... characterized by safe space for speaking can improve physician's resilience to ...

  7. Twitter for travel medicine providers.

    Science.gov (United States)

    Mills, Deborah J; Kohl, Sarah E

    2016-03-01

    Travel medicine practitioners, perhaps more so than medical practitioners working in other areas of medicine, require a constant flow of information to stay up-to-date, and provide best practice information and care to their patients. Many travel medicine providers are unaware of the popularity and potential of the Twitter platform. Twitter use among our travellers, as well as by physicians and health providers, is growing exponentially. There is a rapidly expanding body of published literature on this information tool. This review provides a brief overview of the ways Twitter is being used by health practitioners, the advantages that are peculiar to Twitter as a platform of social media, and how the interested practitioner can get started. Some key points about the dark side of Twitter are highlighted, as well as the potential benefits of using Twitter as a way to disseminate accurate medical information to the public. This article will help readers develop an increased understanding of Twitter as a tool for extracting useful facts and insights from the ever increasing volume of health information. © International Society of Travel Medicine, 2016. All rights reserved. Published by Oxford University Press. For permissions, please e-mail: journals.permissions@oup.com.

  8. Extensive IT outsourcing: advice from providers.

    Science.gov (United States)

    Smith, Mike; Whiting, Stacilee

    2007-01-01

    In summary, providers are reporting some benefits related to resources and knowledge, improved service levels/performance and stronger IT staff/leadership. Also, on average, providers are reporting satisfactory experiences with application support and CIO outsourcing. However, not all of their expectations are being met, and some providers have discontinued outsourcing due to unmet expectations. Clearly, outsourcing is an option one must research in depth--it is not for everyone. When one evaluates the results of extensive IT outsourcing, it becomes easier to see what outsourcing mix and firm may be a good match for your organization's needs and expected outcomes. As you decide upon the outsourcing mix and firm that is right for you, providers advise you to pay special attention to contractual arrangements. With adequate research and contractual provisions, organizations can find the outsourcing mix that is right for them.

  9. Providing traceability for neuroimaging analyses.

    Science.gov (United States)

    McClatchey, Richard; Branson, Andrew; Anjum, Ashiq; Bloodsworth, Peter; Habib, Irfan; Munir, Kamran; Shamdasani, Jetendr; Soomro, Kamran

    2013-09-01

    With the increasingly digital nature of biomedical data and as the complexity of analyses in medical research increases, the need for accurate information capture, traceability and accessibility has become crucial to medical researchers in the pursuance of their research goals. Grid- or Cloud-based technologies, often based on so-called Service Oriented Architectures (SOA), are increasingly being seen as viable solutions for managing distributed data and algorithms in the bio-medical domain. For neuroscientific analyses, especially those centred on complex image analysis, traceability of processes and datasets is essential but up to now this has not been captured in a manner that facilitates collaborative study. Few examples exist, of deployed medical systems based on Grids that provide the traceability of research data needed to facilitate complex analyses and none have been evaluated in practice. Over the past decade, we have been working with mammographers, paediatricians and neuroscientists in three generations of projects to provide the data management and provenance services now required for 21st century medical research. This paper outlines the finding of a requirements study and a resulting system architecture for the production of services to support neuroscientific studies of biomarkers for Alzheimer's disease. The paper proposes a software infrastructure and services that provide the foundation for such support. It introduces the use of the CRISTAL software to provide provenance management as one of a number of services delivered on a SOA, deployed to manage neuroimaging projects that have been studying biomarkers for Alzheimer's disease. In the neuGRID and N4U projects a Provenance Service has been delivered that captures and reconstructs the workflow information needed to facilitate researchers in conducting neuroimaging analyses. The software enables neuroscientists to track the evolution of workflows and datasets. It also tracks the outcomes of

  10. Support Net for Frontline Providers

    Science.gov (United States)

    2016-03-01

    With a multidisciplinary team that included an external evaluator (Dr. Robert Durham), and an extended research team (Drs. Alan Peterson and Bret...21.7%) indicated being single. The sample of providers included 13 clinical psychologists (21.7%), 17 counselors or psychotherapists (28.3%), three...a sample of service members from Iraq and Afghanistan. Military Medicine, 172, 359–363. Figley, C. R. (2002). Compassion fatigue: Psychotherapists

  11. Transcutaneous bilirubin nomogram for prediction of significant neonatal hyperbilirubinemia.

    Science.gov (United States)

    Varvarigou, Anastasia; Fouzas, Sotirios; Skylogianni, Eleni; Mantagou, Lito; Bougioukou, Dorothea; Mantagos, Stefanos

    2009-10-01

    The goal was to develop a predictive nomogram, based on transcutaneous bilirubin (TcB) measurements, for assessment of the risk of significant hyperbilirubinemia in healthy term and near-term neonates. A total of 10382 TcB measurements were performed with 2039 healthy neonates (gestational age of > or =35 weeks and birth weight of > or =2000 g), with a BiliCheck bilirubinometer (SpectRx, Norcross, GA), at designated time points between 12 and 120 hours of life. According to their severity, these TcB measurements were selectively cross-checked with a direct spectrophotometric device, and significant hyperbilirubinemia was defined on the basis of the hour-specific threshold values for phototherapy proposed by the American Academy of Pediatrics. With the use of likelihood ratios (LRs), the high- and low-risk demarcators for each designated time were calculated and presented on an hour-specific nomogram. Significant hyperbilirubinemia was documented for 122 neonates (6%). At 24 hours of life, the high-risk zone of the nomogram had 73.9% sensitivity and a positive LR of 12.1 in predicting significant hyperbilirubinemia, whereas the low-risk zone had 97.7% sensitivity and a negative LR of 0.04. At 48 hours, the high-risk zone had 90% sensitivity and a positive LR of 12.1, whereas the low-risk zone had 98.8% sensitivity and a negative LR of 0.02. In our study population, the probability of significant hyperbilirubinemia would be >35% for values in the high-risk zone and <0.5% for values in the low-risk zone of the nomogram. We provide a predictive TcB tool that could allow for a noninvasive, risk-based approach to neonatal hyperbilirubinemia.

  12. Significance and popularity in music production.

    Science.gov (United States)

    Monechi, Bernardo; Gravino, Pietro; Servedio, Vito D P; Tria, Francesca; Loreto, Vittorio

    2017-07-01

    Creative industries constantly strive for fame and popularity. Though highly desirable, popularity is not the only achievement artistic creations might ever acquire. Leaving a longstanding mark in the global production and influencing future works is an even more important achievement, usually acknowledged by experts and scholars. 'Significant' or 'influential' works are not always well known to the public or have sometimes been long forgotten by the vast majority. In this paper, we focus on the duality between what is successful and what is significant in the musical context. To this end, we consider a user-generated set of tags collected through an online music platform, whose evolving co-occurrence network mirrors the growing conceptual space underlying music production. We define a set of general metrics aiming at characterizing music albums throughout history, and their relationships with the overall musical production. We show how these metrics allow to classify albums according to their current popularity or their belonging to expert-made lists of important albums. In this way, we provide the scientific community and the public at large with quantitative tools to tell apart popular albums from culturally or aesthetically relevant artworks. The generality of the methodology presented here lends itself to be used in all those fields where innovation and creativity are in play.

  13. Significance and popularity in music production

    Science.gov (United States)

    Monechi, Bernardo; Gravino, Pietro; Servedio, Vito D. P.; Tria, Francesca; Loreto, Vittorio

    2017-07-01

    Creative industries constantly strive for fame and popularity. Though highly desirable, popularity is not the only achievement artistic creations might ever acquire. Leaving a longstanding mark in the global production and influencing future works is an even more important achievement, usually acknowledged by experts and scholars. `Significant' or `influential' works are not always well known to the public or have sometimes been long forgotten by the vast majority. In this paper, we focus on the duality between what is successful and what is significant in the musical context. To this end, we consider a user-generated set of tags collected through an online music platform, whose evolving co-occurrence network mirrors the growing conceptual space underlying music production. We define a set of general metrics aiming at characterizing music albums throughout history, and their relationships with the overall musical production. We show how these metrics allow to classify albums according to their current popularity or their belonging to expert-made lists of important albums. In this way, we provide the scientific community and the public at large with quantitative tools to tell apart popular albums from culturally or aesthetically relevant artworks. The generality of the methodology presented here lends itself to be used in all those fields where innovation and creativity are in play.

  14. Advances in Significance Testing for Cluster Detection

    Science.gov (United States)

    Coleman, Deidra Andrea

    Over the past two decades, much attention has been given to data driven project goals such as the Human Genome Project and the development of syndromic surveillance systems. A major component of these types of projects is analyzing the abundance of data. Detecting clusters within the data can be beneficial as it can lead to the identification of specified sequences of DNA nucleotides that are related to important biological functions or the locations of epidemics such as disease outbreaks or bioterrorism attacks. Cluster detection techniques require efficient and accurate hypothesis testing procedures. In this dissertation, we improve upon the hypothesis testing procedures for cluster detection by enhancing distributional theory and providing an alternative method for spatial cluster detection using syndromic surveillance data. In Chapter 2, we provide an efficient method to compute the exact distribution of the number and coverage of h-clumps of a collection of words. This method involves defining a Markov chain using a minimal deterministic automaton to reduce the number of states needed for computation. We allow words of the collection to contain other words of the collection making the method more general. We use our method to compute the distributions of the number and coverage of h-clumps in the Chi motif of H. influenza.. In Chapter 3, we provide an efficient algorithm to compute the exact distribution of multiple window discrete scan statistics for higher-order, multi-state Markovian sequences. This algorithm involves defining a Markov chain to efficiently keep track of probabilities needed to compute p-values of the statistic. We use our algorithm to identify cases where the available approximation does not perform well. We also use our algorithm to detect unusual clusters of made free throw shots by National Basketball Association players during the 2009-2010 regular season. In Chapter 4, we give a procedure to detect outbreaks using syndromic

  15. Providing Southern Perspectives on CSR

    OpenAIRE

    Jeppesen, Søren; Kothuis, Bas

    2014-01-01

    The article seeks to contribute to the SMEs and CSR literature in developing countries by providing; a) a ‘Southern’ SME perspective, which includes the voices of managers and workers, b) a perspective of CSR, which opens up to informal CSR practices that SMEs undertake, and c) an analysis of the key institutional issues affecting the CSR practices of SMEs. It presents perceptions of CSR practices among 21 SMEs in the garment industry in South Africa, based on 40 interviews with managers and ...

  16. Poor school performance.

    Science.gov (United States)

    Karande, Sunil; Kulkarni, Madhuri

    2005-11-01

    Education is one of the most important aspects of human resource development. Poor school performance not only results in the child having a low self-esteem, but also causes significant stress to the parents. There are many reasons for children to under perform at school, such as, medical problems, below average intelligence, specific learning disability, attention deficit hyperactivity disorder, emotional problems, poor socio-cultural home environment, psychiatric disorders and even environmental causes. The information provided by the parents, classroom teacher and school counselor about the child's academic difficulties guides the pediatrician to form an initial diagnosis. However, a multidisciplinary evaluation by an ophthalmologist, otolaryngologist, counselor, clinical psychologist, special educator, and child psychiatrist is usually necessary before making the final diagnosis. It is important to find the reason(s) for a child's poor school performance and come up with a treatment plan early so that the child can perform up to full potential.

  17. Performing the Super Instrument

    DEFF Research Database (Denmark)

    Kallionpaa, Maria

    2016-01-01

    The genre of contemporary classical music has seen significant innovation and research related to new super, hyper, and hybrid instruments, which opens up a vast palette of expressive potential. An increasing number of composers, performers, instrument designers, engineers, and computer programmers...... have become interested in different ways of “supersizing” acoustic instruments in order to open up previously-unheard instrumental sounds. Super instruments vary a great deal but each has a transformative effect on the identity and performance practice of the performing musician. Furthermore, composers...... provides the performer extensive virtuoso capabilities in terms of instrumental range, harmony, timbre, or spatial, textural, acoustic, technical, or technological qualities. The discussion will be illustrated by a composition case study involving augmented musical instrument electromagnetic resonator...

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

    Science.gov (United States)

    Frosch, Matthias

    2017-12-07

    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.

  19. Significance-aware filtering for nonlinear acoustic echo cancellation

    Science.gov (United States)

    Hofmann, Christian; Huemmer, Christian; Guenther, Michael; Kellermann, Walter

    2016-12-01

    This article summarizes and extends the recently proposed concept of Significance-Aware (SA) filtering for nonlinear acoustic echo cancellation. The core idea of SA filtering is to decompose the estimation of the nonlinear echo path into beneficially interacting subsystems, each of which can be adapted with high computational efficiency. The previously proposed SA Hammerstein Group Models (SA-HGMs) decompose the nonlinear acoustic echo path into a direct-path part, modeled by a Hammerstein Group Model (HGM) and a complementary part, modeled by a very efficient Hammerstein model. In this article, we furthermore propose a novel Equalization-based SA (ESA) structure, where the echo path is equalized by a linear filter to allow for an estimation of the loudspeaker nonlinearities by very small and efficient models. Additionally, we provide a novel in-depth analysis of the computational complexity of the previously proposed SA and the novel ESA filters and compare both SA filtering approaches to each other, to adaptive HGMs, and to linear filters, where fast partitioned-block frequency-domain realizations of the competing filter structures are considered. Finally, the echo reduction performance of the proposed SA filtering approaches is verified using real recordings from a commercially available smartphone. Beyond the scope of previous publications on SA-HGMs, the ability of the SA filters to generalize for double-talk situations is explicitly considered as well. The low complexity as well as the good echo reduction performance of both SA filters illustrate the potential of SA filtering in practice.

  20. 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

  1. Clinical significance of three-dimensional sonohysterography

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Eun Hye; Lee, Mi Hwa; Lee, Chan; Kim, Jong Wook; Shin, Myung Choel [Pochon Cha University College of Medicine, Pochon (Korea, Republic of)

    1999-12-15

    To evaluate the usefulness of three dimensional sonohysterography (3D SHG) in the evaluation of uterine endometrial and submucosal lesions in comparison with conventional two-dimensional sonohysterography (2D SHG). Our series consisted of 26 patients (mean aged 41 years) who complained of uterine bleeding, menorrhagia, or dysmenorrhea. 2D SHG was performed, and then 3D SHG was done after the volume mode was switched on. Simultaneous display of three perpendicular two-dimensional planes and surface rendering of findings on particular section were obtained. We analyzed whether the endometrium was thickened or not, and the location, size, shape, echogenicity, posterior shadowing, and echogenic rim of the focal lesion. The results were compared with the pathologic findings or MRI. There were submucosal myomas (n=12), intramural myomas (n=2), endometrial polyps (n=7), placental polyp (n=1), and normal endometrial cavities (n=4) on SHG. Nineteen cases were confirmed by pathologic findings or MRI. The results were correlated in 89% (17/19) of the cases. We misdiagnosed 2 cases: focal endometrial hyperplasia and choriocarcinoma were misdiagnosed as endometrial polyp and placental polyp, respectively. Imaging diagnoses were same in the techniques. Comparing with 2D SHG, 3D SHG provided a subjective display of pathologic findings and an additional information about spatial relationship between focal lesion and surroundings.

  2. Quantifying the Clinical Significance of Cannabis Withdrawal

    Science.gov (United States)

    Allsop, David J.; Copeland, Jan; Norberg, Melissa M.; Fu, Shanlin; Molnar, Anna; Lewis, John; Budney, Alan J.

    2012-01-01

    Background and Aims Questions over the clinical significance of cannabis withdrawal have hindered its inclusion as a discrete cannabis induced psychiatric condition in the Diagnostic and Statistical Manual of Mental Disorders (DSM IV). This study aims to quantify functional impairment to normal daily activities from cannabis withdrawal, and looks at the factors predicting functional impairment. In addition the study tests the influence of functional impairment from cannabis withdrawal on cannabis use during and after an abstinence attempt. Methods and Results A volunteer sample of 49 non-treatment seeking cannabis users who met DSM-IV criteria for dependence provided daily withdrawal-related functional impairment scores during a one-week baseline phase and two weeks of monitored abstinence from cannabis with a one month follow up. Functional impairment from withdrawal symptoms was strongly associated with symptom severity (p = 0.0001). Participants with more severe cannabis dependence before the abstinence attempt reported greater functional impairment from cannabis withdrawal (p = 0.03). Relapse to cannabis use during the abstinence period was associated with greater functional impairment from a subset of withdrawal symptoms in high dependence users. Higher levels of functional impairment during the abstinence attempt predicted higher levels of cannabis use at one month follow up (p = 0.001). Conclusions Cannabis withdrawal is clinically significant because it is associated with functional impairment to normal daily activities, as well as relapse to cannabis use. Sample size in the relapse group was small and the use of a non-treatment seeking population requires findings to be replicated in clinical samples. Tailoring treatments to target withdrawal symptoms contributing to functional impairment during a quit attempt may improve treatment outcomes. PMID:23049760

  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. 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.

  5. 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.

  6. Can a virtual reality surgical simulation training provide a self-driven and mentor-free skills learning? Investigation of the practical influence of the performance metrics from the virtual reality robotic surgery simulator on the skill learning and associated cognitive workloads.

    Science.gov (United States)

    Lee, Gyusung I; Lee, Mija R

    2018-01-01

    While it is often claimed that virtual reality (VR) training system can offer self-directed and mentor-free skill learning using the system's performance metrics (PM), no studies have yet provided evidence-based confirmation. This experimental study investigated what extent to which trainees achieved their self-learning with a current VR simulator and whether additional mentoring improved skill learning, skill transfer and cognitive workloads in robotic surgery simulation training. Thirty-two surgical trainees were randomly assigned to either the Control-Group (CG) or Experiment-Group (EG). While the CG participants reviewed the PM at their discretion, the EG participants had explanations about PM and instructions on how to improve scores. Each subject completed a 5-week training using four simulation tasks. Pre- and post-training data were collected using both a simulator and robot. Peri-training data were collected after each session. Skill learning, time spent on PM (TPM), and cognitive workloads were compared between groups. After the simulation training, CG showed substantially lower simulation task scores (82.9 ± 6.0) compared with EG (93.2 ± 4.8). Both groups demonstrated improved physical model tasks performance with the actual robot, but the EG had a greater improvement in two tasks. The EG exhibited lower global mental workload/distress, higher engagement, and a better understanding regarding using PM to improve performance. The EG's TPM was initially long but substantially shortened as the group became familiar with PM. Our study demonstrated that the current VR simulator offered limited self-skill learning and additional mentoring still played an important role in improving the robotic surgery simulation training.

  7. Vaccine hesitancy and healthcare providers.

    Science.gov (United States)

    Paterson, Pauline; Meurice, François; Stanberry, Lawrence R; Glismann, Steffen; Rosenthal, Susan L; Larson, Heidi J

    2016-12-20

    While most people vaccinate according to the recommended schedule, this success is challenged by individuals and groups who delay or refuse vaccines. The aim of this article is to review studies on vaccine hesitancy among healthcare providers (HCPs), and the influences of their own vaccine confidence and vaccination behaviour on their vaccination recommendations to others. The search strategy was developed in Medline and then adapted across several multidisciplinary mainstream databases including Embase Classic & Embase, and PschInfo. All foreign language articles were included if the abstract was available in English. A total of 185 articles were included in the literature review. 66% studied the vaccine hesitancy among HCPs, 17% analysed concerns, attitudes and/or behaviour of HCPs towards vaccinating others, and 9% were about evaluating intervention(s). Overall, knowledge about particular vaccines, their efficacy and safety, helped to build HCPs own confidence in vaccines and their willingness to recommend vaccines to others. The importance of societal endorsement and support from colleagues was also reported. In the face of emerging vaccine hesitancy, HCPs still remain the most trusted advisor and influencer of vaccination decisions. The capacity and confidence of HCPs, though, are stretched as they are faced with time constraints, increased workload and limited resources, and often have inadequate information or training support to address parents' questions. Overall, HCPs need more support to manage the quickly evolving vaccine environment as well as changing public, especially those who are reluctant or refuse vaccination. Some recommended strategies included strengthening trust between HCPs, health authorities and policymakers, through more shared involvement in the establishment of vaccine recommendations. Copyright © 2016. Published by Elsevier Ltd.

  8. Traditional Indian spices and their health significance.

    Science.gov (United States)

    Krishnaswamy, Kamala

    2008-01-01

    India has been recognized all over the world for spices and medicinal plants. Both exhibit a wide range of physiological and pharmacological properties. Current biomedical efforts are focused on their scientific merits, to provide science-based evidence for the traditional uses and to develop either functional foods or nutraceuticals. The Indian traditional medical systems use turmeric for wound healing, rheumatic disorders, gastrointestinal symptoms, deworming, rhinitis and as a cosmetic. Studies in India have explored its anti-inflammatory, cholekinetic and anti-oxidant potentials with the recent investigations focusing on its preventive effect on precarcinogenic, anti-inflammatory and anti atherosclerotic effects in biological systems both under in vitro and in vivo conditions in animals and humans. Both turmeric and curcumin were found to increase detoxifying enzymes, prevent DNA damage, improve DNA repair, decrease mutations and tumour formation and exhibit antioxidative potential in animals. Limited clinical studies suggest that turmeric can significantly impact excretion of mutagens in urine in smokers and regress precancerous palatal lesions. It reduces DNA adducts and micronuclei in oral epithelial cells. It prevents formation of nitroso compounds both in vivo and in vitro. It delays induced cataract in diabetes and reduces hyperlipidemia in obese rats. Recently several molecular targets have been identified for therapeutic / preventive effects of turmeric. Fenugreek seeds, a rich source of soluble fiber used in Indian cuisine reduces blood glucose and lipids and can be used as a food adjuvant in diabetes. Similarly garlic, onions, and ginger have been found to modulate favourably the process of carcinogenesis.

  9. Standardising Responsibility? The Significance of Interstitial Spaces.

    Science.gov (United States)

    Wickson, Fern; Forsberg, Ellen-Marie

    2015-10-01

    Modern society is characterised by rapid technological development that is often socially controversial and plagued by extensive scientific uncertainty concerning its socio-ecological impacts. Within this context, the concept of 'responsible research and innovation' (RRI) is currently rising to prominence in international discourse concerning science and technology governance. As this emerging concept of RRI begins to be enacted through instruments, approaches, and initiatives, it is valuable to explore what it is coming to mean for and in practice. In this paper we draw attention to a realm that is often backgrounded in the current discussions of RRI but which has a highly significant impact on scientific research, innovation and policy-namely, the interstitial space of international standardization. Drawing on the case of nanoscale sciences and technologies to make our argument, we present examples of how international standards are already entangled in the development of RRI and yet, how the process of international standardization itself largely fails to embody the norms proposed as characterizing RRI. We suggest that although current models for RRI provide a promising attempt to make research and innovation more responsive to societal needs, ethical values and environmental challenges, such approaches will need to encompass and address a greater diversity of innovation system agents and spaces if they are to prove successful in their aims.

  10. Significance and popularity in music production

    Science.gov (United States)

    Gravino, Pietro; Servedio, Vito D. P.; Tria, Francesca; Loreto, Vittorio

    2017-01-01

    Creative industries constantly strive for fame and popularity. Though highly desirable, popularity is not the only achievement artistic creations might ever acquire. Leaving a longstanding mark in the global production and influencing future works is an even more important achievement, usually acknowledged by experts and scholars. ‘Significant’ or ‘influential’ works are not always well known to the public or have sometimes been long forgotten by the vast majority. In this paper, we focus on the duality between what is successful and what is significant in the musical context. To this end, we consider a user-generated set of tags collected through an online music platform, whose evolving co-occurrence network mirrors the growing conceptual space underlying music production. We define a set of general metrics aiming at characterizing music albums throughout history, and their relationships with the overall musical production. We show how these metrics allow to classify albums according to their current popularity or their belonging to expert-made lists of important albums. In this way, we provide the scientific community and the public at large with quantitative tools to tell apart popular albums from culturally or aesthetically relevant artworks. The generality of the methodology presented here lends itself to be used in all those fields where innovation and creativity are in play. PMID:28791169

  11. The measure and significance of Bateman's principles.

    Science.gov (United States)

    Collet, Julie M; Dean, Rebecca F; Worley, Kirsty; Richardson, David S; Pizzari, Tommaso

    2014-05-07

    Bateman's principles explain sex roles and sexual dimorphism through sex-specific variance in mating success, reproductive success and their relationships within sexes (Bateman gradients). Empirical tests of these principles, however, have come under intense scrutiny. Here, we experimentally show that in replicate groups of red junglefowl, Gallus gallus, mating and reproductive successes were more variable in males than in females, resulting in a steeper male Bateman gradient, consistent with Bateman's principles. However, we use novel quantitative techniques to reveal that current methods typically overestimate Bateman's principles because they (i) infer mating success indirectly from offspring parentage, and thus miss matings that fail to result in fertilization, and (ii) measure Bateman gradients through the univariate regression of reproductive over mating success, without considering the substantial influence of other components of male reproductive success, namely female fecundity and paternity share. We also find a significant female Bateman gradient but show that this likely emerges as spurious consequences of male preference for fecund females, emphasizing the need for experimental approaches to establish the causal relationship between reproductive and mating success. While providing qualitative support for Bateman's principles, our study demonstrates how current approaches can generate a misleading view of sex differences and roles.

  12. Doctors or mid-level providers for abortion.

    Science.gov (United States)

    Barnard, Sharmani; Kim, Caron; Park, Min Hae; Ngo, Thoai D

    2015-07-27

    out in India, Sweden and Nepal. The studies included women with gestational ages up to 14 weeks for surgical abortion and nine weeks for medical abortion.Risk of selection bias was considered to be low in the three RCTs, unclear in four observational studies and high in one observational study. Concealment bias was considered to be low in the three RCTs and high in all five observational studies. Although none of the eight studies performed blinding of the participants to the provider type, we considered the performance bias to be low as this is part of the intervention. Detection bias was considered to be high in all eight studies as none of the eight studies preformed blinding of the outcome assessment. Attrition bias was low in seven studies and high in one, with over 20% attrition. We considered six studies to have unclear risk of selective reporting bias as their protocols had not been published. The remaining two studies had published their protocols. Few other sources of bias were found.Based on an analysis of three cohort studies, the risk of surgical abortion failure was significantly higher when provided by mid-level providers than when procedures were administered by doctors (RR 2.25, 95% CI 1.38 to 3.68), however the quality of evidence for this outcome was deemed to be very low. For surgical abortion procedures, we found no significant differences in the risk of complications between mid-level providers and doctors (RR 0.99, 95% CI 0.17 to 5.70 from RCTs; RR 1.38, 95% CI 0.70 to 2.72 from observational studies). When we combined the data for failure and complications for surgical abortion we found no significant differences between mid-level providers and doctors in both the observational study analysis (RR 1.36, 95% CI 0.86 to 2.14) and the RCT analysis (RR 3.07, 95% CI 0.16 to 59.08). The quality of evidence of the outcome for RCT studies was considered to be low and for observational studies very low. For medical abortion procedures the risk of failure

  13. Performing Performance Design Anglonationally

    DEFF Research Database (Denmark)

    2016-01-01

    Video recording of pecha kucha style bricolage aural enactment of an international version of performance design......Video recording of pecha kucha style bricolage aural enactment of an international version of performance design...

  14. Recovery-promoting professional competencies: perspectives of mental health consumers, consumer-providers and providers.

    Science.gov (United States)

    Russinova, Zlatka; Rogers, E Sally; Ellison, Marsha Langer; Lyass, Asya

    2011-01-01

    The purpose of this study was to empirically validate a set of conceptually derived recovery-promoting competencies from the perspectives of mental health consumers, consumer-providers and providers. A national sample of 603 consumers, 153 consumer-providers and 239 providers completed an anonymous survey via the Internet. The survey evaluated respondents' perceptions about a set of 37 competencies hypothesized to enhance clients' hope and empowerment and inquired about interactions with providers that enhanced clients' recovery process. We used descriptive statistics and ranking to establish the relevance of each competency and generalized linear models and post-hoc tests to examine differences in the consumers', consumer-providers' and providers' assessments of these competencies. Analyses confirmed the recovery relevance of several competencies and their relative importance within each group of study participants. They also revealed that while most competencies tended to have universal significance, others depended more strongly on the client's preferences. Finally, differences in the perceptions of consumers, consumer-providers and providers about the recovery relevance of these competencies were established. The study highlighted the crucial role practitioners play in enhancing recovery from serious mental illnesses through specific strategies and attitudes that acknowledge clients' personhood and foster their hopefulness, empowerment and illness management. It informed the development of a new instrument measuring providers' recovery-promoting competence and provides guidelines for sharpening the recovery focus of a wide range of mental health and rehabilitation services.

  15. 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%.

  16. 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

  17. Practical significance of weld strength matching

    Energy Technology Data Exchange (ETDEWEB)

    Sloterdijk, W. [N.V. Nederlandse Gasunie, Groningen (Netherlands); Schipaanboord, W.N. [N.V. Nederlandse Gasunie, Groningen (Netherlands)

    1996-10-01

    Defect tolerance in welds in pipelines constructed in modern high strength material depends on the balance in strength between weld material and pipe material. The Guidelines on the assessment of girth weld defects published by the European Pipeline Research Group (EPRG) define in Tier 2 defect limits assuming that the (actual) weld metal yield strength is equal or greater than the yield strength of the parent material. The defect limits according to Tier 2 exceed the defect limits in `workmanship standards` (l>25 mm). Nevertheless, the draft European welding standard EN 288 does not yet require a test to measure and verify the weld metal yield strength. Gasunie has performed a test program with the aim to look at the practical significance of weld strength matching in a strain controlled situation and to verify the relevance of limits given in the European welding and line pipe codes, in combination with the EPRG Guidelines. It is concluded that the results of the tests confirm the defect acceptance limits according to Tier 2 of the EPRG Guidelines. (orig.) [Deutsch] Die Zulaessigkeit von Fehlern in Rundschweissnaehten in Rohrleitungen aus modernen hochfesten Baustaehlen haengt von dem Verhaeltnis der Werkstofffestigkeit des Schweissgutes zu der des Grundwerkstoffs ab. Die von der European Pipeline Research Group (EPRG) veroeffentlichte Richtlinie zur Bewertung von Schweissnahtfehlern gibt in der zweiten Bewertungsstufe (Tier 2) Werte fuer zulaessige Schweissnahtfehlergroessen unter der Bedingung an, dass die Dehngrenze des Schweissgutes groesser oder gleich der Dehngrenze des Grundwerkstoffs ist. Die nach Tier 2 zulaessigen Fehler sind groesser als die in `Good-workmanship`-Regelwerken angegebenen Fehlerlaenge (l>25 mm). Demgegenueber fehlt im Entwurf der europaeischen Schweissnorm EN 288 bislang ein solcher Dehngrenzennachweis. Gasunie hat ein Versuchsprogramm durchgefuehrt, um die Bedeutung der Schweissgutfestigkeit bei dehnungskontrollierter Belastung sowie

  18. Bariatric Surgery Significantly Improves Body Proportion

    Science.gov (United States)

    Kang, Thomas; Wooldridge, James; Periou, Laura; Richardson, William S.

    2012-01-01

    Background It is well known that bariatric surgery provides excellent weight loss and resolution of comorbid conditions. We propose an additional benefit: Because body proportion is an independent predictor of diabetes and cardiovascular risk, we hypothesize that bariatric surgery results in improved body proportion and may thus improve health risk independent of overall weight loss and resolution of comorbid conditions. Methods A total of 168 patients underwent laparoscopic bariatric surgery at our institution from December 2006 to September 2009. Prospective data gathered preoperatively and at 3, 6, and 12 months postoperatively included body mass index (BMI); excess weight loss (EWL); waist-hip ratio (WHR); and discontinuation of hypertensive, hyperlipidemic, and diabetic medications. Results Of the 168 patients, 122 underwent Roux-en-Y gastric bypass, 40 gastric band, and 6 gastric sleeve procedures. Mean preoperative BMI was 48.6 kg/m2 (SD  =  7.8 kg/m2). Mean EWL was 33.7 lbs (SD  =  11.9 lbs) at 3 months, 46.35 lbs (SD  =  15.58 lbs) at 6 months, and 52.48 lbs (SD  =  24.19 lbs) at 1 year. Mean WHR was 0.91 (SD  =  0.1) preoperatively, 0.87 (SD  =  0.1) at 3 months (P < .0001), 0.87 (SD  =  0.09) at 6 months (P < .0001), and 0.86 (SD  =  0.1) at 1 year (P  =  .0006). At 1-year follow-up, 52% of patients had discontinued hypertensive medications, 64% had discontinued diabetic medications, and 56% had discontinued hyperlipidemic medications. Conclusions Along with well-known improvements in overall weight and comorbid conditions, bariatric surgery significantly improves body proportion, which may decrease health risk. Continued follow-up will determine if this change is long term or if patients will revert to preoperative WHRs. Future studies with sufficient power to study individual bariatric procedures will determine which procedures, if any, provide patients with the greatest

  19. 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.

  20. 48 CFR 2110.7003 - Significant events.

    Science.gov (United States)

    2010-10-01

    ... 48 Federal Acquisition Regulations System 6 2010-10-01 2010-10-01 true Significant events. 2110..., AND OTHER PURCHASE DESCRIPTIONS Contract Specifications 2110.7003 Significant events. The contractor is required to inform the contracting officer of all significant events. ...

  1. Creating Significant Learning Experiences across Disciplines

    Science.gov (United States)

    Levine, Laura E.; Fallahi, Carolyn R.; Nicoll-Senft, Joan M.; Tessier, Jack T.; Watson, Cheryl L.; Wood, Rebecca M.

    2008-01-01

    The purpose of this study was to use Fink's (2003) taxonomy of significant learning to redesign courses and assess student learning. Significant improvements were found across the semester for students in the six courses, but there were differences in which taxa showed improvement in each course. The meta-analysis showed significant, positive…

  2. 23 CFR 630.1010 - Significant projects.

    Science.gov (United States)

    2010-04-01

    ... 23 Highways 1 2010-04-01 2010-04-01 false Significant projects. 630.1010 Section 630.1010 Highways... PRECONSTRUCTION PROCEDURES Work Zone Safety and Mobility § 630.1010 Significant projects. (a) A significant project is one that, alone or in combination with other concurrent projects nearby is anticipated to cause...

  3. 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.

  4. Provider Patient-Sharing Networks and Multiple-Provider Prescribing of Benzodiazepines.

    Science.gov (United States)

    Ong, Mei-Sing; Olson, Karen L; Cami, Aurel; Liu, Chunfu; Tian, Fang; Selvam, Nandini; Mandl, Kenneth D

    2016-02-01

    Prescription benzodiazepine overdose continues to cause significant morbidity and mortality in the US. Multiple-provider prescribing, due to either fragmented care or "doctor-shopping," contributes to the problem. To elucidate the effect of provider professional relationships on multiple-provider prescribing of benzodiazepines, using social network analytics. A retrospective analysis of commercial healthcare claims spanning the years 2008 through 2011. Provider patient-sharing networks were modelled using social network analytics. Care team cohesion was measured using care density, defined as the ratio between the total number of patients shared by provider pairs within a patient's care team and the total number of provider pairs in the care team. Relationships within provider pairs were further quantified using a range of network metrics, including the number and proportion of patients or collaborators shared. The relationship between patient-sharing network metrics and the likelihood of multiple prescribing of benzodiazepines. Patients between the ages of 18 and 64 years who received two or more benzodiazepine prescriptions from multiple providers, with overlapping coverage of more than 14 days. A total of 5659 patients and 1448 provider pairs were included in our study. Among these, 1028 patients (18.2 %) received multiple prescriptions of benzodiazepines, involving 445 provider pairs (30.7 %). Patients whose providers rarely shared patients had a higher risk of being prescribed overlapping benzodiazepines; the median care density was 8.1 for patients who were prescribed overlapping benzodiazepines and 10.1 for those who were not (p benzodiazepines. Our findings demonstrate the importance of care team cohesion in addressing multiple-provider prescribing of controlled substances. Furthermore, we illustrate the potential of the provider network as a surveillance tool to detect and prevent adverse events that could arise due to fragmentation of care.

  5. THE SIGNIFICANCE OF BUILDING PURSUITS IN ISLAM

    Directory of Open Access Journals (Sweden)

    Spahic Omer

    2014-02-01

    Full Text Available Abstract This paper explains the significance of erecting buildings in Islam. Four themes are discussed in the paper: 1 building as a basis of civilization, 2 building as an indispensable and creditable activity, 3 the Prophet Muhammad (pbuh and building, and 4 avoiding vices in building. The paper concludes that in Islam erecting buildings is a very important enterprise, in that such signifies the creation of a physical locus of the daily individual, family and social activities of Muslims. Thus, the existence of Islamic built environment is essential for the realization of the divine purpose on earth. The chief duty that Islamic built environment performs is the facilitation of such a realization. While writing the paper, I have tried as much as possible to draw on the original sources that deal with the theme at hand, the most important of which, certainly, are the Holy Qur’an and the authentic compilations of Prophet Muhammad’s words and actions. Finally, the paper aims to enhance the awareness, both of the professionals and general readership, as to the importance of correctly conceptualizing, creating and using Islamic built environment. The approach in the paper is conceptual, rather than empirical.   Keywords: Erecting Buildings, Built Environment, Islam, Muslims, Prophet Muhammad (pbuh     Abstrak Makalah ini menjelaskan pentingnya pendirian bangunan dalam Islam. Empat tema yang dibahas dalam makalah ini : 1 bangunan sebagai dasar peradaban, 2 bangunan sebagai suatu kegiatan yang sangat diperlukan, 3 Nabi Muhammad (saw dan bangunan, dan 4 menghindari kejahatan dalam bangunan. Makalah ini menyimpulkan bahwa dalam Islam mendirikan bangunan adalah sebuah usaha yang sangat penting, seperti menandakan penciptaan lokus fisik kegiatan individu sehari-hari, keluarga dan sosial umat Islam. Dengan demikian, keberadaan lingkungan yang dibangun Islam sangat penting untuk mewujudkan tujuan Ilahi di bumi. Pemimpin bertugas memfasilitasi

  6. SPACEWAY: Providing affordable and versatile communication solutions

    Science.gov (United States)

    Fitzpatrick, E. J.

    1995-08-01

    By the end of this decade, Hughes' SPACEWAY network will provide the first interactive 'bandwidth on demand' communication services for a variety of applications. High quality digital voice, interactive video, global access to multimedia databases, and transborder workgroup computing will make SPACEWAY an essential component of the computer-based workplace of the 21st century. With relatively few satellites to construct, insure, and launch -- plus extensive use of cost-effective, tightly focused spot beams on the world's most populated areas -- the high capacity SPACEWAY system can pass its significant cost savings onto its customers. The SPACEWAY network is different from other proposed global networks in that its geostationary orbit location makes it a truly market driven system: each satellite will make available extensive telecom services to hundreds of millions of people within the continuous view of that satellite, providing immediate capacity within a specific region of the world.

  7. ICU nurses' experiences in providing terminal care.

    Science.gov (United States)

    Espinosa, Laura; Young, Anne; Symes, Lene; Haile, Brenda; Walsh, Teresa

    2010-01-01

    At least 1 in 5 Americans die while using intensive care service-a number that is expected to increase as society ages. Many of these deaths involve withholding or withdrawing life-sustaining therapies. In these situations, the role of intensive care nurses shifts from providing aggressive care to end-of-life care. While hospice and palliative care nurses typically receive specialized support to cope with death and dying, intensive care nurses usually do not receive this support. Understanding the experiences of intensive care nurses in providing care at the end of life is an important first step to improving terminal care in the intensive care unit (ICU). This phenomenological research study explores the experiences of intensive care nurses who provide terminal care in the ICU. The sample consisted of 18 registered nurses delivering terminal care in an ICU that participated in individual interviews and focus groups. Colaizzi's steps for data analysis were used to identify themes within the context of nursing. Three major themes consisted of (1) barriers to optimal care, (2) internal conflict, and (3) coping. Providing terminal care creates significant personal and professional struggles among ICU nurses.

  8. The Lay Public's Misinterpretation of the Meaning of 'Significant': A Call for Simple yet Significant Changes in Scientific Reporting

    Directory of Open Access Journals (Sweden)

    Philip Tromovitch

    2015-02-01

    Full Text Available A large national sample of U.S. adults (n > 1,000 was queried regarding their interpretation of the term significant when used in regard to scientific findings. The vast majority provided incorrect interpretations of the meaning with only 5.8% providing a reasonably correct interpretation. Most respondents who reported they hold doctoral degrees provided incorrect interpretations. Given the widespread misinterpretation of this term, scientific journals should require—not merely recommend—that all usages of the term significant be prefaced with an adjective (e.g., statistically, practically, clinically and that the meaning of statistical significance be reviewed prior to its first usage. Additionally, all claims regarding the size of a finding should be required to be supported with appropriate effect size statistics to ensure that statistical significance is not misrepresented as indicating practical significance.

  9. 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.

  10. Regionally Significant Ecological Areas - MLCCS derived 2008

    Data.gov (United States)

    Minnesota Department of Natural Resources — This is an analysis of regionally significant Terrestrial and Wetland Ecological Areas in the seven county metropolitan area. Individual forest, grassland and...

  11. Central Region Regionally Ecological Significant Areas

    Data.gov (United States)

    Minnesota Department of Natural Resources — This is an analysis of regionally significant Terrestrial and Wetland Ecological Areas in the seven county metropolitan area. Individual forest, grassland and...

  12. How significant is nocturnal sap flow?

    Science.gov (United States)

    Forster, Michael A

    2014-07-01

    Nocturnal sap flow (Qn) has been found to occur across many taxa, seasons and biomes. There is no general understanding as to how much Qn occurs and whether it is a significant contribution to total daily sap flow (Q). A synthesis of the literature and unpublished data was made to determine how significant is Qn, as a proportion of Q (%Qn), across seasons, biomes, phylogenetic groups and different thermometric sap flow methods. A total of 98 species were analysed to find that %Qn, on average, was 12.03% with the highest average dataset of 69.00%. There was significantly less %Qn in winter than in other temperate seasons, and significantly less %Qn in the wet season than in the dry season. The equatorial and tropical biomes had significantly higher %Qn than the warm temperate and nemoral biomes. The heat ratio method (HRM) and the thermal dissipation (TDP) method had significantly higher %Qn than the heat balance method. Additional analysis between HRM and TDP found HRM to have significantly higher %Qn in winter, wet season and various biomes. In all but one out of 246 cases Qn occurred, demonstrating that Qn is significant and needs to be carefully considered in sap flow and related studies. © The Author 2014. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

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

    African Journals Online (AJOL)

    The paper explores the nuanced articulation of social dynamics in relationships between elite athletes and their significant others. It captures that these relationships changes over time. A case study was undertaken at the University of Johannesburg to determine the roles of significant others at various phases of elite ...

  14. A Differentiated Program: Significant Curriculum Adaptations.

    Science.gov (United States)

    Alonso, Juan A.

    1999-01-01

    This article describes a model for curricular adaptations for gifted students. A distinction is made between non-significant curriculum adaptations that can be easily made by the regular teacher and significant curriculum adaptations that involve deep changes in aims, content, and evaluation criteria. (Contains references.) (DB)

  15. The Vernier Caliper and Significant Figures.

    Science.gov (United States)

    Oberhofer, E. S.

    1985-01-01

    Misconceptions occur because the caliper is often read with the same significant figures as a meter stick; however, the precision of the vernier caliper is greater than the precision of a meter stick. Clarification of scale reading, precision of both tools, and significant figures are discussed. (JN)

  16. Discovering the Significance of Scientific Design Practice

    DEFF Research Database (Denmark)

    Pries-Heje, Jan; Baskerville, Richard

    that new science is burdened and limited in realizing its potential when cloaking itself in old science wrappers. This point is then demonstrated by two cases. The paper discusses how new science constitutes its significance. This discussion translates an old science framework of theory significance uses...

  17. The thresholds for statistical and clinical significance

    DEFF Research Database (Denmark)

    Jakobsen, Janus Christian; Gluud, Christian; Winkel, Per

    2014-01-01

    BACKGROUND: Thresholds for statistical significance are insufficiently demonstrated by 95% confidence intervals or P-values when assessing results from randomised clinical trials. First, a P-value only shows the probability of getting a result assuming that the null hypothesis is true and does...... not reflect the probability of getting a result assuming an alternative hypothesis to the null hypothesis is true. Second, a confidence interval or a P-value showing significance may be caused by multiplicity. Third, statistical significance does not necessarily result in clinical significance. Therefore......, assessment of intervention effects in randomised clinical trials deserves more rigour in order to become more valid. METHODS: Several methodologies for assessing the statistical and clinical significance of intervention effects in randomised clinical trials were considered. Balancing simplicity...

  18. Dynamics of ecosystem services provided by subtropical ...

    Science.gov (United States)

    The trends in the provision of ecosystem services during restoration and succession of subtropical forests and plantations were quantified, in terms of both receiver and donor values, based on a case study of a 3-step secondary succession series that included a 400-year-old subtropical forest and a 23-year history of growth on 3 subtropical forest plantations in Southeastern China. The ‘People's Republic of China Forestry Standard: Forest Ecosystem Service Valuation Norms’ was revised and applied to quantify the receiver values of ecosystem services, which were then compared with the emergy-based, donor values of the services. The results revealed that the efficiencies of subtropical forests and plantations in providing ecosystem services were 2 orders of magnitude higher than similar services provided by the current China economic system, and these efficiencieskept increasing over the course of succession. As a result, we conclude that afforestation is an efficient way to accelerate both the ability and efficiency of subtropical forests to provide ecosystem services. This paper is significant because it examines the dynamics of the provision of ecosystem services by forests over a succession series that spans 400 years. The paper also examines the rate of increase of services during forest restoration over a period of 23 years. The emergy used in ecosystem services provision is compared to the provision of similar services by economic means in the Chinese e

  19. Desempenho de serviços de saúde no tratamento diretamente observado no domicílio para controle da tuberculose Desempeño de los servicios de salud para el control de la tuberculosis a través del tratamiento domiciliar directamente observado The performance of health services in providing dots in households to control tuberculosis

    Directory of Open Access Journals (Sweden)

    Roxana Isabel Cardozo Gonzales

    2008-12-01

    écnico-asistencial de los profesionales para el control de la TBC.Exploratory study of qualitative and quantitative nature that evaluates the performance of the health services in providing DOT in households of a big city in Brazil. For the quantitative analysis, indexes were created to evaluate the optimization of material/human resources and the observation of the medicine ingestion. It was observed that performance of services is influenced by the availability of human/material resources, the internal organization of services and the absence of the ill person in the household. For the qualitative analysis it was used the content analysis, thematic modality. The main factors influencing the performance of the health service were found to be its insufficiency ofmaterial and human resources and the ill person's social-cultural and economic context. Concluding, it is necessary permanent managerial, organizational and techno-assistance qualification of the health professionals in the TB control.

  20. Mining significant semantic locations from GPS data

    DEFF Research Database (Denmark)

    Cao, Xin; Cong, Gao; Jensen, Christian S.

    2010-01-01

    With the increasing deployment and use of GPS-enabled devices, massive amounts of GPS data are becoming available. We propose a general framework for the mining of semantically meaningful, significant locations, e.g., shopping malls and restaurants, from such data. We present techniques capable...... of extracting semantic locations from GPS data. We capture the relationships between locations and between locations and users with a graph. Significance is then assigned to locations using random walks over the graph that propagates significance among the locations. In doing so, mutual reinforcement between...

  1. Discovering the Significance of Scientific Design Practice

    DEFF Research Database (Denmark)

    Pries-Heje, Jan; Baskerville, Richard

    2016-01-01

    This paper discusses and defines the achievement of significance in design science research. We review the values and processes of old-science and how this mode of science attacks the complexity of scientific knowledge production through analysis. We then explain how new-science attacks...... the complexity of scientific knowledge production through synthesis. The work argues that significance of the new-science contribution in design science can be obfuscated when wrapped in old-science. This understanding helps reveal how new-science, such as design science research, constitutes its significance...

  2. 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.

  3. 45 CFR 1351.1 - Significant terms.

    Science.gov (United States)

    2010-10-01

    ...-term (maximum of 15 days) room and board and core crisis intervention services, on a 24-hour basis, by... SERVICES BUREAU RUNAWAY AND HOMELESS YOUTH PROGRAM Definition of Terms § 1351.1 Significant terms. For the...

  4. Economically Significant Sites - OSPR [ds356

    Data.gov (United States)

    California Department of Resources — This point data set shows locations of Economically Significant Sites along the California coast from Del Norte to San Diego counties. Data for locating these points...

  5. IMPORTANCE AND CLINICAL SIGNIFICANCE OF SERUM SIALIC ...

    African Journals Online (AJOL)

    Open Access DOWNLOAD FULL TEXT Subscription or Fee Access. IMPORTANCE AND CLINICAL SIGNIFICANCE OF SERUM SIALIC ACID AND LACTATE DEHYDROGENASE DETERMINATION IN CERVICAL CANCER PATIENTS. Farouk H. Saber, Essam F. Hammouda, Mohamed Khaled M, Essam A. Afifi. Abstract.

  6. Brown Adipose Tissue: Function and Physiological Significance

    National Research Council Canada - National Science Library

    CANNON, BARBARA; NEDERGAARD, JAN

    2004-01-01

    .... Brown Adipose Tissue: Function and Physiological Significance. Physiol Rev 84: 277–359, 2004; 10.1152/physrev.00015.2003.—The function of brown adipose tissue is to transfer energy from food into heat...

  7. Discovering the Significance of Scientific Design Practice

    DEFF Research Database (Denmark)

    Pries-Heje, Jan; Baskerville, Richard

    2016-01-01

    This paper discusses and defines the achievement of significance in design science research. We review the values and processes of old-science and how this mode of science attacks the complexity of scientific knowledge production through analysis. We then explain how new-science attacks...... the complexity of scientific knowledge production through synthesis. The work argues that significance of the new-science contribution in design science can be obfuscated when wrapped in old-science. This understanding helps reveal how new-science, such as design science research, constitutes its significance....... This discussion translates an old-science framework of theory significance into a new-science framework and uses two published cases to illustrate the framework. The results offer a grounding on which design science research can realize its potential as both new-science and old-science....

  8. Measuring stigma among abortion providers: assessing the Abortion Provider Stigma Survey instrument.

    Science.gov (United States)

    Martin, Lisa A; Debbink, Michelle; Hassinger, Jane; Youatt, Emily; Eagen-Torkko, Meghan; Harris, Lisa H

    2014-01-01

    We explored the psychometric properties of 15 survey questions that assessed abortion providers' perceptions of stigma and its impact on providers' professional and personal lives referred to as the Abortion Provider Stigma Survey (APSS). We administered the survey to a sample of abortion providers recruited for the Providers' Share Workshop (N = 55). We then completed analyses using Stata SE/12.0. Exploratory factor analysis, which resulted in 13 retained items and identified three subscales: disclosure management, resistance and resilience, and discrimination. Stigma was salient in abortion provider's lives: they identified difficulties surrounding disclosure (66%) and felt unappreciated by society (89%). Simultaneously, workers felt they made a positive contribution to society (92%) and took pride in their work (98%). Paired t-test analyses of the pre- and post-Workshop APSS scores showed no changes in the total score. However, the Disclosure Management subscale scores were significantly lower (indicating decreased stigma) for two subgroups of participants: those over the age of 30 and those with children. This analysis is a promising first step in the development of a quantitative tool for capturing abortion providers' experiences of and responses to pervasive abortion stigma.

  9. Formal conditions for the significance-effect

    DEFF Research Database (Denmark)

    Thellefsen, Torkild Leo; Sørensen, Bent; Thellefsen, Martin

    2006-01-01

    The significance-effect is the right effect of meaning caused upon an interpreting mind. The right effect is understood as the right interpretation of an intended meaning caused by a sign communicated by an utterer. In the article, which is inspired by Charles S. Peirce's doctrine of signs, his s...... semeiotics and his theory of communication, we account for the formal conditions that have to be present for the release of the significance-effect....

  10. Understanding cultural significance, the edible mushrooms case

    OpenAIRE

    Garibay-Orijel, Roberto; Caballero, Javier; Estrada-Torres, Arturo; Cifuentes, Joaqu?n

    2007-01-01

    Abstract Background Cultural significance is a keystone in quantitative ethnobiology, which offers the possibility to make inferences about traditional nomenclature systems, use, appropriation and valuing of natural resources. In the present work, using as model the traditional mycological knowledge of Zapotecs from Oaxaca, Mexico, we analyze the cultural significance of wild edible resources. Methods In 2003 we applied 95 questionnaires to a random sample of informants. With this data we int...

  11. Pharmacist provider status legislation: Projections and prospects.

    Science.gov (United States)

    Harper, Patrick C

    2015-01-01

    To compare legislation at the federal level that would recognize pharmacists as health care providers under Medicare Part B with similar state-level efforts in an attempt to identify the strengths and weaknesses of these options and forecast outcomes. The current primary care provider shortage poses a significant threat to public health in the United States. The effort to achieve federal provider status for pharmacists, currently in the form of identical bills introduced in January 2015 into the U.S. House of Representatives and the U.S. Senate as the Pharmacy and Medically Underserved Areas Enhancement Act (H.R. 592 and S. 314), would amend the Social Security Act to recognize pharmacists as health care providers in sections of Medicare Part B that specify coverage and reimbursement. This action has budgetary implications owing to the compensation that would accrue to pharmacists caring for Medicare beneficiaries. Passage of these bills into law could improve public health by sustainably increasing access to pharmacists' patient care services in medically underserved areas. In this article, the legislation's strengths and weaknesses are analyzed. The resulting information may be used to forecast the bills' fate as well as plan strategies to help support their success. Comparison of the bills with existing, state-level efforts is used as a framework for such policy analysis. While the current political climate benefits the bills in the U.S. Congress, established legislative precedents suggest that parts of H.R. 592/S. 314, specifically those regarding compensation mechanisms, may require negotiated amendment to improve their chances of success.

  12. Algorithm for Detecting Significant Locations from Raw GPS Data

    Science.gov (United States)

    Kami, Nobuharu; Enomoto, Nobuyuki; Baba, Teruyuki; Yoshikawa, Takashi

    We present a fast algorithm for probabilistically extracting significant locations from raw GPS data based on data point density. Extracting significant locations from raw GPS data is the first essential step of algorithms designed for location-aware applications. Assuming that a location is significant if users spend a certain time around that area, most current algorithms compare spatial/temporal variables, such as stay duration and a roaming diameter, with given fixed thresholds to extract significant locations. However, the appropriate threshold values are not clearly known in priori and algorithms with fixed thresholds are inherently error-prone, especially under high noise levels. Moreover, for N data points, they are generally O(N 2) algorithms since distance computation is required. We developed a fast algorithm for selective data point sampling around significant locations based on density information by constructing random histograms using locality sensitive hashing. Evaluations show competitive performance in detecting significant locations even under high noise levels.

  13. Clinical Significance of Atypical Squamous Cells of Undetermined Significance among Patients Undergoing Cervical Conization.

    Science.gov (United States)

    Nishimura, Mai; Miyatake, Takashi; Nakashima, Ayaka; Miyoshi, Ai; Mimura, Mayuko; Nagamatsu, Masaaki; Ogita, Kazuhide; Yokoi, Takeshi

    2015-01-01

    Atypical squamous cells of undetermined significance (ASCUS) feature a wide variety of cervical cells, including benign and malignant examples. The management of ASCUS is complicated. Guidelines for office gynecology in Japan recommend performing a high-risk human papillomavirus (HPV) test as a rule. The guidelines also recommend repeat cervical cytology after 6 and 12 months, or immediate colposcopy. The purpose of this study was to determine the clinical significance of ASCUS. Between January 2012 and December 2014, a total of 162 patients underwent cervical conization for cervical intraepithelial neoplasia grade 3 (CIN3), carcinoma in situ, squamous cell carcinoma, microinvasive squamous cell carcinoma, and adenocarcinoma in situ at our hospital. The results of cervical cytology prior to conization, the pathology after conization, and high-risk HPV testing were obtained from clinical records and analyzed retrospectively. Based on cervical cytology, 31 (19.1%) of 162 patients were primarily diagnosed with ASCUS. Among these, 25 (80.6%) were positive for high-risk HPV, and the test results of the remaining 6 patients (19.4%) were uncertain. In the final pathological diagnosis after conization, 27 (87.1%) and 4 patients (12.9%) were diagnosed with CIN3 and carcinoma in situ, respectively. Although ASCUS is known as a low-risk abnormal cervical cytology, approximately 20% of patients who underwent cervical conization had ASCUS. The relationship between the cervical cytology of ASCUS and the final pathological results for CIN3 or invasive carcinoma should be investigated statistically. In cases of ASCUS, we recommend HPV tests or colposcopic examination rather than cytological follow-up, because of the risk of missing CIN3 or more advanced disease.

  14. Multiagency Initiative to Provide Greenhouse Gas Information

    Science.gov (United States)

    Boland, Stacey W.; Duren, Riley M.

    2009-11-01

    Global Greenhouse Gas Information System Workshop; Albuquerque, New Mexico, 20-22 May 2009; The second Greenhouse Gas Information System (GHGIS) workshop brought together 74 representatives from 28 organizations including U.S. government agencies, national laboratories, and members of the academic community to address issues related to the understanding, operational monitoring, and tracking of greenhouse gas emissions and carbon offsets. The workshop was held at Sandia National Laboratories and organized by an interagency collaboration among NASA centers, Department of Energy laboratories, and the U.S. National Oceanic and Atmospheric Administration. It was motivated by the perceived need for an integrated interagency, community-wide initiative to provide information about greenhouse gas sources and sinks at policy-relevant temporal and spatial scales. Such an initiative could significantly enhance the ability of national and regional governments, industry, and private citizens to implement and evaluate effective climate change mitigation policies.

  15. 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

  16. Performing Nation, Performing Difference

    DEFF Research Database (Denmark)

    Jensen, Lars

    Baz Luhrmann's Australia is simultaneously a film made for an Australian and an international audience. One of the interesting question this raises is how Luhrmann performs the nation for the national and the international audience. The film's juxtaposition of the national epic of pioneering...

  17. Structure and functional significance of branched anastomosing ...

    African Journals Online (AJOL)

    Animal Research International ... Abstract. Histology has provided morphologist a powerful tool that enhances the nature, form and detailed structure of organs. ... The predominating acid mucin suggest air-breathing function since the acid will always make the epithelium moist for gaseous exchange between dissolved air in ...

  18. Null Hypothesis Significance Testing and "p" Values

    Science.gov (United States)

    Travers, Jason C.; Cook, Bryan G.; Cook, Lysandra

    2017-01-01

    "p" values are commonly reported in quantitative research, but are often misunderstood and misinterpreted by research consumers. Our aim in this article is to provide special educators with guidance for appropriately interpreting "p" values, with the broader goal of improving research consumers' understanding and interpretation…

  19. The Sport Film--Its Cultural Significance.

    Science.gov (United States)

    Crawford, Scott A. G. M.

    1988-01-01

    This article presents athletic activity in films as not being representative of a real world but as stereotypes and symbols. Selected films are reviewed to provide a cultural shorthand for determining American attitudes toward sport and athletic activity. Basic thematic issues are identified for discussion and analysis. (JD)

  20. Augustine's baptism: Its significance once and today

    African Journals Online (AJOL)

    2013-04-10

    Apr 10, 2013 ... sceptic; and by now he had become a Catholic Christian. The change was not from paganism to. Christianity, but from one form of Christianity to another. 1.The following lines provide a very brief overview. The best recent book on early Christian baptism is the extensive study by Ferguson. (2009).

  1. [Significance of laparoscopic assistance in vaginal hysterectomy].

    Science.gov (United States)

    Malinowski, Andrzej; Bobin, Leszek; Maciołek-Blewniewska, Grazyna

    2005-01-01

    The objective of this publication was the analysis of laparoscopically assisted vaginal hysterectomies (LAVH) performed in Department of Surgical and Endoscopic Gynecology of Polish Mother Health Centre Research Institute. There was the analysis of 57 LAVHs performed from June 2002 to December 2003. Following parameters were evaluated: indications to LAVH, operating time, weight of the removed uterus, complications, blood loss, duration of postoperative hospitalisation, the day of introducing general diet, anesthetic and antibiotic demand in postoperative period. There were indications to LAVH: fibroid uterus, endometrial hyperplasia, endometrial cancer, adnexal mass, cervix dysplasia. Previous laparotomy and caesarean section, endometriosis, narrow vagina of non-parous women were additional indications to use of laparoscopy during the operation. Complications were found in two (3,5%) cases: bleeding to abdominal cavity from infundibulo-pelvic ligament demanding reoperation and superficial epigastric artery injury no demanding reoperation. There were no infection, conversion to laparotomy, abdominal cavity organs injury and other complications. It was observed short time of introducing general diet, low anesthetic consumption and short post-operation stay in hospital (mean 3,6 days). Laparoscopically assisted vaginal hysterectomy is an operation with a small risk of intra- and postoperative complications, quick return to general diet and full life activity, short post-operation stay in hospital, low anesthetic consumption and good cosmetic effect. Use of laparoscopic stage in vaginal hysterectomy make possible evasion of laparotomy in the situation of impossible performance of ordinary vaginal hysterectomy.

  2. Green tea polyphenol induces significant cell death in human lung ...

    African Journals Online (AJOL)

    Green tea polyphenol induces significant cell death in human lung cancer cells. Jie Huang, Fa-jiu Li, Shi Chen, Yi Shi, Xiao-jiang Wang, Chuan-hai Wang, Qing- ..... method for the determination of green and black tea polyphenols in biomatrices by high-performance liquid chromatography with coulometric array detection.

  3. 40 CFR 35.6655 - Notification of significant developments.

    Science.gov (United States)

    2010-07-01

    ... OTHER FEDERAL ASSISTANCE STATE AND LOCAL ASSISTANCE Cooperative Agreements and Superfund State Contracts... of significant developments. Events may occur between the scheduled performance reporting dates which... must inform the EPA project officer as soon as the following types of conditions become known: (a...

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

    African Journals Online (AJOL)

    The objective of this paper is to analyze the significances of ISO 9000 Quality Management System implementation for performance improvement. Two consecutive cases are studied cascaded one over the other. Harar Brewery Share Company (HBSC), one of the Ethiopian Quality Award winners in 2009 is taken as the first ...

  5. Encounter Probability of Significant Wave Height

    DEFF Research Database (Denmark)

    Liu, Z.; Burcharth, H. F.

    The determination of the design wave height (often given as the significant wave height) is usually based on statistical analysis of long-term extreme wave height measurement or hindcast. The result of such extreme wave height analysis is often given as the design wave height corresponding to a c...

  6. Significance and technology of coal mine packing

    Science.gov (United States)

    Wang, Yunliang

    2017-08-01

    Packing is a kind of mining method which is used to fill the goaf with filling material to control the movement of overlying strata and reduce the deformation of the surface. This paper mainly discusses the significance of coal mine packing, and introduces the current method of filling and mining. Finally, the future of coal mine packing is forecasted.

  7. Quilting after mastectomy significantly reduces seroma formation ...

    African Journals Online (AJOL)

    Introduction: Seroma formation is one of the most frequently encountered complications following mastectomy. It may cause significant morbidity, including delayed wound healing, infection and frequent clinic attendance for seroma aspiration. Objective: To evaluate the effect of surgical quilting after mastectomy in the ...

  8. Bullying in Academe: Prevalent, Significant, and Incessant

    Science.gov (United States)

    Cassell, Macgorine A.

    2011-01-01

    This paper examines the top-down perspective of bullying and mobbing of professors by analyzing why it is prevalent, significant, and incessant and then proposes a framework to produce a caring, respectful, and safe environment for professors to engage in their teaching, scholarship, and service. The author suggests that the failure of…

  9. Cystic echinococcosis: prevalence and economic significance in ...

    African Journals Online (AJOL)

    ... study showed that cystic echinococcosis of small ruminants causes significant economic loss. Further study to determine prevalence of cystic echinococcosis in small ruminants in different agro ecology of the country is recommended. Keywords: Cystic echinococcosis; Cyst viability test; Economic loss; Goat; Origin; Sheep ...

  10. The geometrical significance of the Laplacian

    Science.gov (United States)

    Styer, Daniel F.

    2015-12-01

    The Laplacian operator can be defined, not only as a differential operator, but also through its averaging properties. Such a definition lends geometric significance to the operator: a large Laplacian at a point reflects a "nonconformist" (i.e., different from average) character for the function there. This point of view is used to motivate the wave equation for a drumhead.

  11. The Historical Significance of the Universal Declaration.

    Science.gov (United States)

    Eide, Asbjorn

    1998-01-01

    Explains the historical significance of the Universal Declaration of Human Rights. Focuses on the initiative for the Declaration and its elaboration, the precursors to modern human rights, the foundation of the Declaration, the rights contained in the Universal Declaration, three modes of human rights analysis, and global governance and human…

  12. Significance of Literature in Foreign Language Teaching

    Science.gov (United States)

    Babaee, Ruzbeh; Yahya, Wan Roselezam Bt Wan

    2014-01-01

    This research aims to consider literature as a significant tool for teaching fundamental language skills including speaking, listening, reading and writing. Reasons for the use of literature in language classrooms and major factors for choosing appropriate kinds of literary texts in such classes should be highlighted in order to make readers aware…

  13. Hemodynamic significance of internal carotid artery disease

    DEFF Research Database (Denmark)

    Schroeder, T

    1988-01-01

    a significant improvement in baseline flow occur. Flow reserve determined by cerebral vasodilation, however, will improve in most patients with hemodynamic failure. In addition, some patients in the low-pressure group develop marked, but temporary, hyperperfusion after reconstruction of very high grade carotid...

  14. Can Educationally Significant Learning Be Assessed?

    Science.gov (United States)

    Stolz, Steven A.

    2017-01-01

    This article argues that assessment is a central feature of teaching, particularly as a means to determine whether what has been taught has been learnt. However, I take issue with the current trend in education which places a significant amount of emphasis upon large-scale public testing, which in turn has exacerbated the…

  15. Anthropological significance of dermatoglyphic trait variation: an ...

    African Journals Online (AJOL)

    The cluster analysis was applied on D2 Mahalanobis distance matrix. Results: The chi-square test revealed high significant differences between the sexes for the frequencies of arches in the case of the fifth finger and for the frequencies of loops in the case of the fourth left finger and the first left finger. The difference of the ...

  16. Significant Bacteriuria in Pregnancy in Enugu, Nigeria ...

    African Journals Online (AJOL)

    Objective: To determine the prevalence, demographic characteristics and microbiological assessment of the causative agents of significant bacteriuria in healthy pregnant women and its effect on pregnancy in women in Enugu, Eastern Nigeria. Materials and Methods: A prospective study based on data obtained from ...

  17. Mycotoxins: significance to global economics and health

    Science.gov (United States)

    Mycotoxins are fungal metabolites produced my micro-fungi (molds and mildews) that have significant impacts on global economics and health. Some of these metabolites are beneficial, but most are harmful and have been associated with well-known epidemics dating back to medieval times. The terms ‘myco...

  18. Petrography, geochemistry and regional significance of crystalline ...

    Indian Academy of Sciences (India)

    77–78. Paul D K, Chandy K C, Bhalla J N and Sengupta N R. 1982 Geochronology and geochemistry of Lingtse Gneiss,. Darjeeling–Sikkim Himalayas; Indian J. Earth Sci. 9. 11–17. Pecher A and Le-Fort P 1977 Origin and significance of the. Lesser Himalayan augen gneiss; In: Himalaya Sciences de la Terra. Coll. Internat.

  19. Microsatellite variability reveals significant genetic differentiation of ...

    African Journals Online (AJOL)

    Jane

    2011-10-05

    Oct 5, 2011 ... (Lande,1988; Packer et al., 1991; Pimm and Raven,. 2000). It is very difficult for small isolated populations to maintain long-term survival even though excellent habitat or few human disturbances occur (Pimm and Raven,. 2000; Loucks et .... The Wilcoxon signed-rank test was used to determine significance.

  20. Methodology, theoretical framework and scholarly significance: An ...

    African Journals Online (AJOL)

    Methodology, theoretical framework and scholarly significance: An overview of International best practices in legal research. ... unpacks contemporary issues in an analytical manner; a clear and concise presentation of ideas with focus on effectiveness; adoption of tested theoretical frameworks to underpin new ideas; and a ...

  1. Shared services centers can drive significant savings.

    Science.gov (United States)

    McDowell, Jim

    2011-06-01

    A study of more than 30 U.S. integrated delivery systems (IDSs) found that implementing effective shared services centers can drive significant cost savings in human resources, accounts payable, and procurement. Many IDSs have not adopted effective shared services strategies. Implementing administrative shared services involves low risk and a relatively low start-up investment.

  2. Significance of primary irradiation creep in graphite

    CSIR Research Space (South Africa)

    Erasmus, C

    2013-05-01

    Full Text Available of Nuclear Materials, vol. 436(1-3), pp 167-174 Significance of primary irradiation creep in graphite Christiaan Erasmus a,⇑, Schalk Kok b, Michael P. Hindley a a Pebble Bed Modular Reactor (Proprietary) Limited, PO Box 9396, Centurion 0046, South...

  3. 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)

  4. Threatened corals provide underexplored microbial habitats.

    Directory of Open Access Journals (Sweden)

    Shinichi Sunagawa

    Full Text Available Contemporary in-depth sequencing of environmental samples has provided novel insights into microbial community structures, revealing that their diversity had been previously underestimated. Communities in marine environments are commonly composed of a few dominant taxa and a high number of taxonomically diverse, low-abundance organisms. However, studying the roles and genomic information of these "rare" organisms remains challenging, because little is known about their ecological niches and the environmental conditions to which they respond. Given the current threat to coral reef ecosystems, we investigated the potential of corals to provide highly specialized habitats for bacterial taxa including those that are rarely detected or absent in surrounding reef waters. The analysis of more than 350,000 small subunit ribosomal RNA (16S rRNA sequence tags and almost 2,000 nearly full-length 16S rRNA gene sequences revealed that rare seawater biosphere members are highly abundant or even dominant in diverse Caribbean corals. Closely related corals (in the same genus/family harbored similar bacterial communities. At higher taxonomic levels, however, the similarities of these communities did not correlate with the phylogenetic relationships among corals, opening novel questions about the evolutionary stability of coral-microbial associations. Large proportions of OTUs (28.7-49.1% were unique to the coral species of origin. Analysis of the most dominant ribotypes suggests that many uncovered bacterial taxa exist in coral habitats and await future exploration. Our results indicate that coral species, and by extension other animal hosts, act as specialized habitats of otherwise rare microbes in marine ecosystems. Here, deep sequencing provided insights into coral microbiota at an unparalleled resolution and revealed that corals harbor many bacterial taxa previously not known. Given that two of the coral species investigated are listed as threatened under

  5. Warm eyes provide superior vision in swordfishes.

    Science.gov (United States)

    Fritsches, Kerstin A; Brill, Richard W; Warrant, Eric J

    2005-01-11

    Large and powerful ocean predators such as swordfishes, some tunas, and several shark species are unique among fishes in that they are capable of maintaining elevated body temperatures (endothermy) when hunting for prey in deep and cold water . In these animals, warming the central nervous system and the eyes is the one common feature of this energetically costly adaptation . In the swordfish (Xiphias gladius), a highly specialized heating system located in an extraocular muscle specifically warms the eyes and brain up to 10 degrees C-15 degrees C above ambient water temperatures . Although the function of neural warming in fishes has been the subject of considerable speculation , the biological significance of this unusual ability has until now remained unknown. We show here that warming the retina significantly improves temporal resolution, and hence the detection of rapid motion, in fast-swimming predatory fishes such as the swordfish. Depending on diving depth, temporal resolution can be more than ten times greater in these fishes than in fishes with eyes at the same temperature as the surrounding water. The enhanced temporal resolution allowed by heated eyes provides warm-blooded and highly visual oceanic predators, such as swordfishes, tunas, and sharks, with a crucial advantage over their agile, cold-blooded prey.

  6. Internet developments and their significance for healthcare

    OpenAIRE

    Briggs, Jim; Early, G

    1999-01-01

    This paper reviews some recent developments in the technology of the Internet, and shows how they may affect the way in which healthcare is provided. Starting with a brief technical history of the Internet, the paper discusses some of the technical developments that have taken place or been proposed in recent years, and speculates on the realities of their adoption within the next five years. The paper also discusses trends in public accessibility to the Internet and the development of Intern...

  7. Significance of Iqbal’s Wisdom Poetry

    OpenAIRE

    Muhammad Suheyl Umar

    2002-01-01

    The distinguishing feature of Iqbal's poetry is his "conscious concerns" about issues vital to the Ummah. These concerns also provide the key to understand the psycho-dynamics of Iqbal's mind and help us to appreciate the reasons for which his poetry has become meaningful for the Ummah. Iqbal's poetry has to be considered as "contemplative or higher poetry" in that the response is born of his intellect. Iqbal is a poet of "intellectual conception" and "intuition expression" wherein the inner ...

  8. Understanding cultural significance, the edible mushrooms case.

    Science.gov (United States)

    Garibay-Orijel, Roberto; Caballero, Javier; Estrada-Torres, Arturo; Cifuentes, Joaquín

    2007-01-11

    Cultural significance is a keystone in quantitative ethnobiology, which offers the possibility to make inferences about traditional nomenclature systems, use, appropriation and valuing of natural resources. In the present work, using as model the traditional mycological knowledge of Zapotecs from Oaxaca, Mexico, we analyze the cultural significance of wild edible resources. In 2003 we applied 95 questionnaires to a random sample of informants. With this data we integrated the Edible Mushroom Cultural Significance Index. This index included eight variables: frequency of mention, perceived abundance, use frequency, taste, multifunctional food use, knowledge transmission, health and economy. Data were analyzed in an inductive perspective using ordination and grouping techniques to reveal the behavior of species in a cultural multivariate dimension. In each variable the species had different conducts. Cantharellus cibarius s.l. was the species with most frequency of mention. Pleurotus sp. had the highest perceived abundance. C. cibarius s.l. was the most frequently consumed species. Gomphus clavatus was the most palatable species and also ranked highest in the multifunctional food index. Cortinarius secc. Malacii sp. had the highest traditional importance. Only Tricholoma magnivelare was identified as a health enhancer. It also had the most economic importance. According to the compound index, C. cibarius s.l., the Amanita caesarea complex, Ramaria spp. and Neolentinus lepideus were the mushrooms with highest cultural significance. Multivariate analysis showed that interviewees identify three main groups of mushrooms: species with high traditional values, frequent consumption and known by the majority; species that are less known, infrequently consumed and without salient characteristics; and species with low traditional values, with high economic value and health enhancers. The compound index divided the cultural significance into several cultural domains and showed

  9. Understanding cultural significance, the edible mushrooms case

    Directory of Open Access Journals (Sweden)

    Cifuentes Joaquín

    2007-01-01

    Full Text Available Abstract Background Cultural significance is a keystone in quantitative ethnobiology, which offers the possibility to make inferences about traditional nomenclature systems, use, appropriation and valuing of natural resources. In the present work, using as model the traditional mycological knowledge of Zapotecs from Oaxaca, Mexico, we analyze the cultural significance of wild edible resources. Methods In 2003 we applied 95 questionnaires to a random sample of informants. With this data we integrated the Edible Mushroom Cultural Significance Index. This index included eight variables: frequency of mention, perceived abundance, use frequency, taste, multifunctional food use, knowledge transmission, health and economy. Data were analyzed in an inductive perspective using ordination and grouping techniques to reveal the behavior of species in a cultural multivariate dimension. Results In each variable the species had different conducts. Cantharellus cibarius s.l. was the species with most frequency of mention. Pleurotus sp. had the highest perceived abundance. C. cibarius s.l. was the most frequently consumed species. Gomphus clavatus was the most palatable species and also ranked highest in the multifunctional food index. Cortinarius secc.Malacii sp. had the highest traditional importance. Only Tricholoma magnivelare was identified as a health enhancer. It also had the most economic importance. According to the compound index, C. cibarius s.l., the Amanita caesarea complex, Ramaria spp. and Neolentinus lepideus were the mushrooms with highest cultural significance. Multivariate analysis showed that interviewees identify three main groups of mushrooms: species with high traditional values, frequent consumption and known by the majority; species that are less known, infrequently consumed and without salient characteristics; and species with low traditional values, with high economic value and health enhancers. Conclusion The compound index divided

  10. Factors Shaping Women's Pre-abortion Communication with Their Regular Gynecologic Care Providers.

    Science.gov (United States)

    Chor, Julie; Tusken, Megan; Lyman, Phoebe; Gilliam, Melissa

    2016-01-01

    To understand women's experiences communicating with their regular gynecologic care provider about abortion decision making before obtaining an abortion at a dedicated abortion clinic. Semistructured interviews were conducted with women presenting for first-trimester surgical abortion at a high-volume, hospital-based abortion clinic. Women were asked whether and why they did or did not discuss their abortion decision with their gynecologic care provider. Interviews were transcribed and computer-assisted content analysis was performed; salient themes are presented. Thirty women who obtained an abortion were interviewed. A majority of the 24 women who had a regular gynecologic care provider did not discuss their decision with that provider. Themes associated with not discussing their decision included: 1) perceiving that the discussion would not be beneficial, 2) expecting that gynecologic care providers do not perform abortions, 3) anticipating or experiencing logistical barriers, and 4) worrying about disrupting the patient-provider relationship. Women who did discuss their decision primarily did so because the pregnancy was diagnosed at the time of a previously scheduled appointment and generally did not believe that their provider performed abortions. For many women, seeking counsel from a regular gynecologic provider before seeking an abortion may not afford a significant benefit. However, some women express concerns with regard to seeking abortion counselling from their regular provider. These concerns underscore the need for gynecologic providers to foster patient-provider relationships that allow women to feel comfortable discussing all aspects of their reproductive health. Copyright © 2016 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.

  11. Performance, Performance System, and High Performance System

    Science.gov (United States)

    Jang, Hwan Young

    2009-01-01

    This article proposes needed transitions in the field of human performance technology. The following three transitions are discussed: transitioning from training to performance, transitioning from performance to performance system, and transitioning from learning organization to high performance system. A proposed framework that comprises…

  12. Cross wavelet analysis: significance testing and pitfalls

    Directory of Open Access Journals (Sweden)

    D. Maraun

    2004-01-01

    Full Text Available In this paper, we present a detailed evaluation of cross wavelet analysis of bivariate time series. We develop a statistical test for zero wavelet coherency based on Monte Carlo simulations. If at least one of the two processes considered is Gaussian white noise, an approximative formula for the critical value can be utilized. In a second part, typical pitfalls of wavelet cross spectra and wavelet coherency are discussed. The wavelet cross spectrum appears to be not suitable for significance testing the interrelation between two processes. Instead, one should rather apply wavelet coherency. Furthermore we investigate problems due to multiple testing. Based on these results, we show that coherency between ENSO and NAO is an artefact for most of the time from 1900 to 1995. However, during a distinct period from around 1920 to 1940, significant coherency between the two phenomena occurs.

  13. Comparing Criteria: Assessing the Significance of Memorials

    Directory of Open Access Journals (Sweden)

    Lisa Murray

    2008-09-01

    Full Text Available This article focuses on the practicalities of assessing the cultural significance of memorials. It outlines the main criteria that are currently in use in New South Wales – The Burra Charter, the NSW Heritage Branch assessment criteria and the National Trust’s Heritage Values for Cemeteries – and considers which are the most appropriate to apply to memorials. In doing this it highlights the inadequacies of significance criteria in capturing the memorial process and contested memories that are often attached to memorials. The philosophical question of when a memorial becomes heritage is also considered; and whether the act of heritage listing is a form of memorialisation in itself. This article draws upon the work of the Cemeteries Committee, a conservation technical committee of the National Trust of Australia (NSW.

  14. Significant structure theory applied to phase separation.

    Science.gov (United States)

    Lee, S H; Jhon, M S; Eyring, H

    1977-01-01

    The significant structure theory of liquids has been applied to the partially miscible system of the O(3)-O(2) mixture, which exhibits partial miscibility in the temperature range from -195.5 degrees C to -179.9 degrees C. The thermodynamic condition for phase separation is given by the following inequality: [Formula: see text] A partition function for the binary liquid mixture is developed using significant liquid structure theory. Here X(i) is the mole fraction of either of the two components. We obtain the coexistence curve of the O(3)-O(2) system by varying the mole fractions of the components to find the temperature at which the two liquids separate. The agreement between theory and experiment is satisfactory.

  15. [Left-handedness and its clinical significance].

    Science.gov (United States)

    Cernácek, J

    1991-09-01

    The occurrence rate of lefthanded persons is estimated to range between 4-8% in the human population, according to the criteria used. On assessing pathological lefthandedness, the role of all factors affecting the development of a lefthanded subject has to be considered. There are morphological differences between left- and righthanded subjects. The differences in neuropsychologie performance of the right and left hemisphere are less pronounced in lefthanded than in righthanded persons. A relationship between lefthandedness and the occurrence of some pathological conditions has been established. On sociobiological evaluation it appears more appropriate to consider lefthandedness as a continuous quantitative manifestation of handedness rather than a separate biological variant of man.

  16. Meniscal root tears: significance, diagnosis, and treatment.

    Science.gov (United States)

    Bhatia, Sanjeev; LaPrade, Christopher M; Ellman, Michael B; LaPrade, Robert F

    2014-12-01

    Meniscal root tears, less common than meniscal body tears and frequently unrecognized, are a subset of meniscal injuries that often result in significant knee joint disorders. The meniscus root attachment aids meniscal function by securing the meniscus in place and allowing for optimal shock-absorbing function in the knee. With root tears, meniscal extrusion often occurs, and the transmission of circumferential hoop stresses is impaired. This alters knee biomechanics and kinematics and significantly increases tibiofemoral contact pressure. In recent years, meniscal root tears, which by definition include direct avulsions off the tibial plateau or radial tears adjacent to the root itself, have attracted attention because of concerns that significant meniscal extrusion dramatically inhibits normal meniscal function, leading to a condition biomechanically similar to a total meniscectomy. Recent literature has highlighted the importance of early diagnosis and treatment; fortunately, these processes have been vastly improved by advances in magnetic resonance imaging and arthroscopy. This article presents a review of the clinically relevant anatomic, biomechanical, and functional descriptions of the meniscus root attachments, as well as current strategies for accurate diagnosis and treatment of common injuries to these meniscus root attachments. © 2014 The Author(s).

  17. Nonpowder firearms cause significant pediatric injuries.

    Science.gov (United States)

    Veenstra, Michelle; Prasad, Jai; Schaewe, Heather; Donoghue, Lydia; Langenburg, Scott

    2015-06-01

    We hypothesize that nonpowder firearms cause significant injuries in children, often requiring intervention. We have noted a difference in demographics of children presenting with injuries from nonpowder firearms compared with patients injured by powder firearms. We reviewed our institution's experience with patients with nonpowder firearm injuries to evaluate these aspects. A retrospective chart review was completed for all patients with a firearm injury from 2003 through February 2013 to a pediatric urban Level I trauma center. Patients were excluded if they were 18 years of age or older or readmitted. Demographics, injury circumstances, interventions, and outcomes were reviewed for 303 patients. The χ test and analysis of variance were completed with a statistical significance of p paintball guns. Treatment included computed tomography scan in 39 patients, three bedside procedures, one angiography, and operative intervention in 25 patients. The most common injury locations were the eye (n = 37), head (n = 7), and neck (n = 6). Children injured by nonpowder firearms were less likely to be female (p = 0.04), more likely to be white (p < 0.01), and less likely to be injured in a violence-related event (p < 0.01). Nonpowder firearms can cause severe pediatric injuries requiring operative intervention and significant radiographic exposure from computed tomography scans. Prevention and education are important in decreasing this risk in the pediatric population and should be targeted to a different population than powder firearm prevention. Epidemiologic study, level V.

  18. 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...

  19. INTEGRATED INFORMATION SYSTEM ARCHITECTURE PROVIDING BEHAVIORAL FEATURE

    Directory of Open Access Journals (Sweden)

    Vladimir N. Shvedenko

    2016-11-01

    Full Text Available The paper deals with creation of integrated information system architecture capable of supporting management decisions using behavioral features. The paper considers the architecture of information decision support system for production system management. The behavioral feature is given to an information system, and it ensures extraction, processing of information, management decision-making with both automated and automatic modes of decision-making subsystem being permitted. Practical implementation of information system with behavior is based on service-oriented architecture: there is a set of independent services in the information system that provides data of its subsystems or data processing by separate application under the chosen variant of the problematic situation settlement. For creation of integrated information system with behavior we propose architecture including the following subsystems: data bus, subsystem for interaction with the integrated applications based on metadata, business process management subsystem, subsystem for the current state analysis of the enterprise and management decision-making, behavior training subsystem. For each problematic situation a separate logical layer service is created in Unified Service Bus handling problematic situations. This architecture reduces system information complexity due to the fact that with a constant amount of system elements the number of links decreases, since each layer provides communication center of responsibility for the resource with the services of corresponding applications. If a similar problematic situation occurs, its resolution is automatically removed from problem situation metamodel repository and business process metamodel of its settlement. In the business process performance commands are generated to the corresponding centers of responsibility to settle a problematic situation.

  20. Significant gastrointestinal morbidity after sacrocolpopexy: The incidence and risk factors.

    Science.gov (United States)

    Jo, Yu Ri; Kim, Ji Young; Jeon, Myung Jae

    2014-07-01

    This study aimed to quantify the risk of significant gastrointestinal (GI) morbidity after sacrocolpopexy (SCP), and to identify related risk factors. A retrospective study was performed of 258 patients who underwent laparotomic SCP for symptomatic pelvic organ prolapse (POP) from November 2008 to August 2013. By the review of medical records, the frequency of significant GI morbidity that resulted in a prolonged initial hospitalization, readmission, or reoperation was assessed. Thereafter, risk factors for significant GI morbidity were assessed using univariate and multivariate analyses. Ten patients (3.9%) were identified as having significant GI morbidity; nine (3.5%) had a prolonged initial hospital stay or were readmitted for the medical treatment of postoperative ileus and 1 (0.4%) underwent reoperation for small bowel obstruction. The occurrence of significant GI morbidity was significantly associated with patient's age and prior laparotomy. By multivariable logistic regression analysis, age (odds ratio [OR], 1.14; 95% confidence interval [CI], 1.01-1.27; P=0.03) and prior laparotomy (OR, 6.82; 95% CI, 1.37-34.07; P=0.02) were found as independent risk factors for significant GI morbidity. One in 25 (3.9%) women after SCP experiences significant GI morbidity. Particularly, women with older age and prior laparotomy have a higher risk for significant GI morbidity. This data will aid preoperative counseling for Korean POP patients undergoing SCP.

  1. 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.

  2. The Relationship Between Social Performance and Corporate Financial Performance

    Directory of Open Access Journals (Sweden)

    Hamidreza Salmani Mojaveri

    2016-09-01

    Full Text Available This study investigates the relationship between social performance and corporate financial performance based on the information of companies listed in Tehran Stock Exchange - Iran. Today, economic entity has to identify the needs of their surrounding environment and community and in general interested parties to continue their survival and link with executive operation of the manufacturing of their products and by explaining the necessities of community provide the best services and achieve their organizational goals by selling more products. Overall, the process to identify community needs and interested parties and surrounding environment and provide services to them placed in social performance framework which is considered as the important issues to achieve success for organizations in today's competitive world. Therefore, we can say that the companies which do better their social functions financially might be in a desirable place than other competitor. In this study have been selected 90 companies of Tehran stock exchange based on elimination sampling and in order to investigate whether good social performance also leads to better financial performance. Financial variables are ROA and ROE and social variables contain five dimensions of Mark vinola model which obtain from tracking in financial statements and notes and based on score between -2 and +2. Finally, we conclude that there is no significant relationship between the social performance and corporate financial performance.

  3. Insure Kids Now (IKN) (Dental Care Providers)

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Insure Kids Now (IKN) Dental Care Providers in Your State locator provides profile information for oral health providers participating in Medicaid and Children's...

  4. Mechanisms and significance of fungicide resistance†

    Science.gov (United States)

    Deising, Holger B.; Reimann, Sven; Pascholati, Sérgio F.

    2008-01-01

    In this review article, we show that occurrence of fungicide resistance is one of the most important issues in modern agriculture. Fungicide resistance may be due to mutations of genes encoding fungicide targets (qualitative fungicide resistance) or to different mechanisms that are induced by sub-lethal fungicide stress. These mechanisms result in different and varying levels of resistance (quantitative fungicide resistance). We discuss whether or not extensive use of fungicides in agricultural environments is related to the occurrence of fungicide resistance in clinical environments. Furthermore, we provide recommendations of how development of fungicide resistant pathogen populations may be prevented or delayed. PMID:24031218

  5. Mechanisms and significance of fungicide resistance.

    Science.gov (United States)

    Deising, Holger B; Reimann, Sven; Pascholati, Sérgio F

    2008-04-01

    In this review article, we show that occurrence of fungicide resistance is one of the most important issues in modern agriculture. Fungicide resistance may be due to mutations of genes encoding fungicide targets (qualitative fungicide resistance) or to different mechanisms that are induced by sub-lethal fungicide stress. These mechanisms result in different and varying levels of resistance (quantitative fungicide resistance). We discuss whether or not extensive use of fungicides in agricultural environments is related to the occurrence of fungicide resistance in clinical environments. Furthermore, we provide recommendations of how development of fungicide resistant pathogen populations may be prevented or delayed.

  6. Significance of Iqbal’s Wisdom Poetry

    Directory of Open Access Journals (Sweden)

    Muhammad Suheyl Umar

    2002-12-01

    Full Text Available The distinguishing feature of Iqbal's poetry is his "conscious concerns" about issues vital to the Ummah. These concerns also provide the key to understand the psycho-dynamics of Iqbal's mind and help us to appreciate the reasons for which his poetry has become meaningful for the Ummah. Iqbal's poetry has to be considered as "contemplative or higher poetry" in that the response is born of his intellect. Iqbal is a poet of "intellectual conception" and "intuition expression" wherein the inner meaning dominates totally over the form. The "vital operation" of which Iqbal's poetry is a manifestation is an intellectual conception born of the poet's wisdom.

  7. Significance of terrestrial inflows to carbon and nitrogen distribution ...

    African Journals Online (AJOL)

    Significance of terrestrial inflows to carbon and nitrogen distribution in the Lake Victoria surface water. ... Samples away from the river mouth provided C:N ratios within the Redfield ratio range (C:N:P; 106:16:1) indicating materials of phytoplanktonic origin. The POM isotopes composition indicated a maximum ä13C value of ...

  8. The Significance of Blood Sacrifice in the Old Testament

    African Journals Online (AJOL)

    DrNneka

    communion, making propitiation, cleansing, averting evils or failures to providing nourishment for Yahweh, on the one hand, and as it affects man. On the other hand, and as it affects God, in obeying the Sovereign God who cares about our welfare. Old. Testament blood sacrifice is, therefore, of utmost significance because ...

  9. Inspiration and Intellect: Significant Learning in Musical Forms and Analysis

    Science.gov (United States)

    Kelley, Bruce C.

    2009-01-01

    In his book "Creating Significant Learning Experiences" (2003), Dee Fink challenges professors to create a deep vision for the courses they teach. Educators often have a vision for what their courses could be, but often lack a model for instituting change. Fink's book provides that model. In this article, the author describes how this model helped…

  10. Spectroscopic probes of vibrationally excited molecules at chemically significant energies

    Energy Technology Data Exchange (ETDEWEB)

    Rizzo, T.R. [Univ. of Rochester, NY (United States)

    1993-12-01

    This project involves the application of multiple-resonance spectroscopic techniques for investigating energy transfer and dissociation dynamics of highly vibrationally excited molecules. Two major goals of this work are: (1) to provide information on potential energy surfaces of combustion related molecules at chemically significant energies, and (2) to test theoretical modes of unimolecular dissociation rates critically via quantum-state resolved measurements.

  11. Hemodynamic significance of internal carotid artery disease

    DEFF Research Database (Denmark)

    Schroeder, T

    1988-01-01

    . Examination of periorbital flow direction or oculoplethysmography could be used as a screening procedure. Negative tests most certainly rule out any severe pressure gradient across the stenosis, irrespective of the luminal reduction. A positive result, on the other hand, should be further quantified since...... a significant improvement in baseline flow occur. Flow reserve determined by cerebral vasodilation, however, will improve in most patients with hemodynamic failure. In addition, some patients in the low-pressure group develop marked, but temporary, hyperperfusion after reconstruction of very high grade carotid...

  12. Significant exposures to isoeugenol derivatives in perfumes

    DEFF Research Database (Denmark)

    Rastogi, S.C.; Johansen, Jeanne Duus

    2008-01-01

    in perfumes/aftershaves. Materials and Methods: 29 international brand perfumes/aftershaves were analysed for the target fragrance ingredient by gas chromatography-mass spectrometery. All samples were analysed in duplicate at detection levels of 1-5 p.p.m. Results: 16 products (55%) contained isoeugenol...... was not detected in any of the investigated products. Conclusions: Isoeugenyl acetate is present in perfumes/aftershaves, in some products in significant amounts. This may lead to elicitation of contact allergy in isoeugenol-sensitized individuals and may contribute to unchanged levels of isoeugenol sensitization...

  13. Significant exposures to isoeugenol derivaties in perfumes

    DEFF Research Database (Denmark)

    Rastogi, Suresh Chandra; Johansen, Jeanne Duus

    2008-01-01

    in perfumes/aftershaves. MATERIALS AND METHODS: 29 international brand perfumes/aftershaves were analysed for the target fragrance ingredient by gas chromatography-mass spectrometry. All samples were analysed in duplicate at detection levels of 1-5 p.p.m. RESULTS: 16 products (55%) contained isoeugenol...... was not detected in any of the investigated products. CONCLUSIONS: Isoeugenyl acetate is present in perfumes/aftershaves, in some products in significant amounts. This may lead to elicitation of contact allergy in isoeugenol-sensitized individuals and may contribute to unchanged levels of isoeugenol sensitization....

  14. Os odontoideum: a significant radiographic finding

    Energy Technology Data Exchange (ETDEWEB)

    Choit, Rachel L.; Reilly, Christopher W. [BC Children' s Hospital, Department of Orthopaedics, Vancouver, BC (Canada); Jamieson, Douglas H. [BC Children' s Hospital, Department of Radiology, Vancouver (Canada)

    2005-08-01

    Os odontoideum can lead to instability of the atlantoaxial joint and places the spinal cord at significant risk for acute catastrophic events after minor trauma or chronic neurological change. We present two cases of os odontoideum in pediatric patients that were not appreciated at earlier remote imaging but were, in retrospect, detectable. One patient presented with an acute spinal cord injury. Incorporating assessment of dens integrity into the evaluation algorithm for all pediatric cervical spine studies should lead to early detection of os odontoideum lesions and allow referral to appropriate clinical spinal services for evaluation, surveillance and possible surgery to prevent future complications. (orig.)

  15. Thermodynamic significance of human basal metabolism

    Science.gov (United States)

    Wang, Cuncheng

    1993-06-01

    The human basal state, a non-equilibrium steady state, is analysed in this paper in the light of the First and Second Laws of Thermodynamics whereby the thermodynamic significance of the basal metabolic rate and its distinction to the dissipation function and exergy loss are identified. The analysis demonstrates the correct expression of the effects of the blood flow on the heat balance in a human-body bio-heat model and the relationship between the basal metabolic rate and the blood perfusion.

  16. 20 CFR 404.1662 - What support we will provide.

    Science.gov (United States)

    2010-04-01

    ... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false What support we will provide. 404.1662 Section 404.1662 Employees' Benefits SOCIAL SECURITY ADMINISTRATION FEDERAL OLD-AGE, SURVIVORS AND... support we will provide. Performance support may include, but is not limited to, any or all of the...

  17. 20 CFR 416.1062 - What support we will provide.

    Science.gov (United States)

    2010-04-01

    ... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false What support we will provide. 416.1062 Section 416.1062 Employees' Benefits SOCIAL SECURITY ADMINISTRATION SUPPLEMENTAL SECURITY INCOME FOR THE... What support we will provide. Performance support may include, but is not limited to, any or all of the...

  18. Advanced Communications Architecture Demonstration Made Significant Progress

    Science.gov (United States)

    Carek, David Andrew

    2004-01-01

    Simulation for a ground station located at 44.5 deg latitude. The Advanced Communications Architecture Demonstration (ACAD) is a concept architecture to provide high-rate Ka-band (27-GHz) direct-to-ground delivery of payload data from the International Space Station. This new concept in delivering data from the space station targets scientific experiments that buffer data onboard. The concept design provides a method to augment the current downlink capability through the Tracking Data Relay Satellite System (TDRSS) Ku-band (15-GHz) communications system. The ACAD concept pushes the limits of technology in high-rate data communications for space-qualified systems. Research activities are ongoing in examining the various aspects of high-rate communications systems including: (1) link budget parametric analyses, (2) antenna configuration trade studies, (3) orbital simulations (see the preceding figure), (4) optimization of ground station contact time (see the following graph), (5) processor and storage architecture definition, and (6) protocol evaluations and dependencies.

  19. A world-wide databridge supported by a commercial cloud provider

    Science.gov (United States)

    Tat Cheung, Kwong; Field, Laurence; Furano, Fabrizio

    2017-10-01

    Volunteer computing has the potential to provide significant additional computing capacity for the LHC experiments. One of the challenges with exploiting volunteer computing is to support a global community of volunteers that provides heterogeneous resources. However, high energy physics applications require more data input and output than the CPU intensive applications that are typically used by other volunteer computing projects. While the so-called databridge has already been successfully proposed as a method to span the untrusted and trusted domains of volunteer computing and Grid computing respective, globally transferring data between potentially poor-performing residential networks and CERN could be unreliable, leading to wasted resources usage. The expectation is that by placing a storage endpoint that is part of a wider, flexible geographical databridge deployment closer to the volunteers, the transfer success rate and the overall performance can be improved. This contribution investigates the provision of a globally distributed databridge implemented upon a commercial cloud provider.

  20. Significance of leukocyte scanning in infected endoprostheses

    Energy Technology Data Exchange (ETDEWEB)

    Becker, W.; Pasurka, B.; Boerner, W.

    1989-03-01

    31 patients with suspected septic loosening of an endoprosthesis (hip endoprosthesis n=30; knee endoprosthesis n=1) were examined with leukocyte scans (10 MBq /sup 111/In-oxine: n=22; 300 MBq /sup 99m/Tc-HMPAO: n=9). The results were compared with results of the bacterial growth (n=22), the histology (n=12) and of the bone scans (/sup 99m/Tc-MDP: n=20) which were performed within 4 days. The sensitivity of the bone scan was 100%, the specificity 30% and the diagnostic accuracy regarding a septic loosening of the arthroplasty was 55%. For the leukocyte scans a comparable sensitivity of 100%, but a higher specificity (86%) and accuracy (91%) could be calculated. A false positive leukocyte scan could be observed in a periprosthetic granuloma, an ossifying periarthritis and in a patient with negative bacterial growth with the histological proof of an inflammation.